Medication Class Flashcards
1
Q
3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors
A
- lipid-lowering agents
- indications: dyslipidemia (high LDL, low HDL), hypertriglyceridemia, prevention of coronary heart disease
- contraindicated in active liver disease, persistent elevated AST/ALT, pregnancy, lactation
- inhibits enzyme responsible for catalyzing early step of cholesterol synthesis
- LFTs, cholesterol and TGAs q. 3-6 months
- administer in evening (more cholesterol synthesized at night)
- avoid grapefruit juice
- SE/ADRs: myopathy, hepatotoxicity
- atorvastatin (Lipitor), rosuvastatin (Crestor), lovastatin (Mevacor), simvastatin (Zocor)
2
Q
aldosterone receptor blocker
A
- potassium-sparing diuretic
- indications: hypertension, edema associated with cirrhosis or nephrotic syndrome, primary aldosteronism, acne, transgender hormone therapy (male to female)
- contraindications: anuria, hyperkalemia, acute renal insufficiency, renal impairment, Addison’s disease, eplerenone
- causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions; inhibits testosterone secretion and androgen binding on androgen receptor
- weak diuresis; used to counteract potassium wasting effect of other diuretics
- SE/ADRs: hyperkalemia
- spironolactone (Aldactone, Carospir)
3
Q
angiotensin converting enzyme (ACE) inhibitors
A
- RAAS inhibitor, antihypertensive
- blocks conversion of angiotensin I to angiotensin II; prevents degradation of bradykinin and other vasodilatory prostaglandins; increase plasma renin; decrease plasma aldosterone; causes diuresis and natriuresis → vasodilation, decreased blood volume/CO, decreased arterial pressure
- indications: hypertension, heart failure, myocardial infarction, diabetic nephropathy (unlabeled)
- contraindications: pregnancy, lactation
- SE/ADRs: first dose effect, hypotension, angioedema, hypokalemia, hyperkalemia, cough
- captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil)
4
Q
angiotensin II receptor antagonist (ARBs)
A
- RAAS inhibitor, antihypertensive
- blocks vasoconstriction and aldosterone-secreting effects of angiotensin II at various receptor sites (vascular smooth muscle and adrenal glands) → vasodilation, diuresis, decreased blood volume/CO, decreased arterial pressure
- indications: hypertension, heart failure, MI, diabetic nephropathy, stroke prevention in pts c/ HTN and left ventricular hypertrophy
- contraindications: bilateral renal artery stenosis, pregnancy, lactation
- SE/ADRs: first dose effect, hypotension, angioedema, hypokalemia, hyperkalemia
- losartan (Cozaar), candesartan (Atacand), valsartan (Diovan)
5
Q
anti-emetics
A
- indication: nausea and vomiting
- SE/ADRs: excessive sedation, respiratory depression
- promethazine (Phenergan), metoclopramide (Reglan), prochlorperazine (Compazine), ondansetron (Zofran)
6
Q
anti-platelets
A
- treats and prevents thromboembolic events (MI, stroke, PAD)
- inhibits platelet aggregation; irreversibly changes platelets
- ADRs: bleeding, gastric ulceration, renal impairment, ototoxicity, salicylism (N/V, tinnitius)
- aspirin, clopidogrel (Plavix), ticagrelor (Brintilla), 1st generation NSAIDs
7
Q
Anticoagulants
A
- Interrupt coagulation cascade and thereby reduce fibrin formation
- Indications: venous disease processes; treatment and prevention of VTEs; atrial fibrillation
- prevent clot formation and extension; do not dissolve clots
- contraindicated in coagulation disorders, malignancies, ulcers, recent surgery, active bleeds
- heparin, enoxaparin, warfarin, fondaparinux, rivaroxaban, apixaban, dabigatran
8
Q
beta-1 adrenergic receptor antagonists
A
- antihypertensive; cardioselective beta blocker
- compete with norepinephrine and epinephrine at beta-1 adrenergic receptor sites in heart resulting in decreased sympathetic activity → decreased heart rate, decreased cardiac contractility
- indications: angina, hypertension, MI/CAD (core measure), heart failure
- contraindications: pulmonary edema, uncompensated HF, cardiogenic shock, bradycardia, heart block
- SE/ADRs: bradycardia, hypotension, fatigue, erectile dysfunction, hypoglycemic unawareness
- do not abruptly discontinue
- metoprolol (Lopressor), atenolol (Tenormin)
9
Q
beta-1 and beta-2 adrenergic receptor antagonists
A
- antihypertensive; non-cardioselective beta blocker
- compete with epinephrine and norepinephrine at receptor sites in heart, bronchioles, and vascular smooth muscle resulting in decreased sympathetic activity → decreased HR, decreased contractility, some vasoconstriction, and bronchoconstriction
- indications: angina, hypertension, MI/CAD (core measure), heart failure
- contraindications: asthma, acute bronchospasm, lung issues, uncompensated HF, pulmonary edema, cardiogenic shock, bradycardia, bradyarrhythmias, heart block
- SE/ADRs: bradycardia, hypotension, bronchospasm, fatigue, erectile dysfunction, hypoglycemic unawareness
- carvedilol (Coreg), labetolol (Trandate), propranolol (Inderal)
10
Q
calcium channel blockers
A
- antihypertensive
- blocks entry of calcium into cells of vascular smooth muscle and myocardium → dilation of coronary arteries and inhibition of vasospasm; diltiazem and verapamil also slow conduction through AV node → slowed HR
- indications: angina, hypertension, coronary artery vasospasm, dysrhythmias (verapamil and diltiazem), cerebral vasospasm (nimodipine; has relatively selective effect on cerebral blood vessels)
- contraindications: bradycardia, heart block (2nd or 3rd degree), decompensated HF
- SE/ADRs: bradycardia, heart block, hypotension, constipation
- verapamil (Calan), diltiazem (Cardizem), amlodipine (Norvasc), nifedipine (Procardia), nicardipine (Cardene)
11
Q
cephalosporins
A
- broad-spectrum antibiotics
- action: binds to bacterial cell wall membrane, causing cell death
- cross-sensitivity to penicillins
- SE/ADRs: anaphylaxis, rash, diarrhea, CDAD
- cefazolin (Ancef, Kefzol), cephalexin (Keflex), cephtriaxone (Rocephin), cefepime (Maxipime)
12
Q
centrally-acting anti-adrenergics
(alpha II adrenergic agonists)
A
- antihypertensive
- stimulates alpha receptors in CNS producing decreased sympathetic outflow to heart, blood vessels, and kidneys → inhibits cardioacceleration and vasoconstriction causing decreased blood pressure, peripheral resistance, and heart rate; stimulates alpha receptors in spinal cord to prevent pain transmission to CNS
- indications: hypertension, adjunctive treatment of neuropathic pain, management of opioid withdrawal
- SE/ADRs: rebound hypertension, hypotension, sedation, dry mouth
- methyldopa (Aldomet), clonidine (Catapres)
13
Q
Direct thrombin inhibitor
A
- anticoagulant
- Treatment and prevention of DVT,PE, and A-fib
- increased RF for GI upset or bleeding
- Antidote is dialysis
- ADR: bleeding, GI disturbanct
- dabigatran (Pradaxa)
14
Q
factor Xa inhibitors
A
- anticoagulant to treat and prevent PE/DVT and atrial fibrullation
- fondaparinux (Arixtra)
- rivaroxaban (Xarelto)
- apixaban (Eliquis)
15
Q
glucocorticoids
A
- steroidal anti-inflammatory, immune modulator (immunosuppressant)
- SE/ADRs: osteoporosis, hyperglycemia, fluid retention, impaired wound healing, increased risk for infection
- DO NOT abruptly d/c med; must be tapered off to prevent adrenal insufficiency
- prednisone (Rayos, Sterapred), methylprednisolone (Solu-Medrol, Depo-Medrol), betamethasone, budesonide (Pulmicort), cortisone, dexamethasone, hydrocortisone (Cortef, Solu-cortef), prednisolone (Orapred)
16
Q
loop diuretics
A
- indications: hypertension, edema due to HF, hepatic impairment, or renal disease
- contraindications: cross-sensitivities with thiazides and sulfonamides possible, hepatic coma, anuria
- inhibits reabsorption of sodium and chloride from loop of Henle and distal renal tubule; increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium
- effective with impaired renal function/decreased GFR
- produces large amounts of diuresis
- monitor I&O, daily weight
- SE/ADRs: dehydration, hypokalemia, electrolyte imbalances
- furosemide (Lasix), bumetanide (Bumex)
17
Q
moderate to strong opioid agonists with acetaminophen
A
- indication: moderate pain (4-6)
- max 4g/day for acetaminophen
- SE/ADRs: respiratory depression, constipation, urinary retention, cough suppression, change in LOC, sedation
- PO meds
- oxycodone/acetaminophen (Percocet), hydrocodone/acetaminophen (Lortab, Norco, Vicodin)
18
Q
non-steroidal anti-inflammatory drugs (NSAIDs)
A
- indications: mild to moderate pain, fever, inflammatory conditions
- contraindications: hypersensitivity to aspirin
- action: analgesic and anti-inflammatory effects due to inhibition of prostaglandin synthesis; antipyretic effects due to vasodilation and inhibition of prostaglandin synthesis in CNS
- SE/ADRs: gastric ulcers, bleeding/increased clotting time, renal impairment
- give with food and full glass of water to decrease gastric upset
19
Q
penicillins
A
- anti-infective/anti-antibiotic
- action: binds to bacterial cell wall resulting in cell death
- narrow-spectrum; active against most Gm+, some Gm-, some anaerobic, some spirochetes
- only treatment for enterococcal endocarditis
- SE/ADRs: anaphylaxis/hypersensitivity reactions, rash, diarrhea, seizures
- most common cause of drug allergy
- PenicillinV (PO), PenicillinG (IM, IV), benzathine (IM), procaine (IM)
20
Q
Sedative hypnotic anxiolytics
A
- Benzodiazepines
- enhance GABA effects in CNS
- rapid-acting
- short-term use r/t RF dependence and withdrawal Sx
- SE/ADRs: CNS depression (dizziness, ataxia, sedation, lightheadedness, decreased cognitive function), anterograde amnesia, oral toxicity (lethargy, confusion), IV toxicity (respiratory depression, sever HoTN, cardiac/respiratory arrest), paradoxical effects
- diazepam and lorazepam for IV use
- flumazenil is antidote; oral gastric lavage, activated charcoal, saline cathartics for PO toxicity
- Contraindications: pregnancy, breastfeeding, sleep apnea, respiratory depression, glaucoma
- Interactions: CNS depressants (alcohol, barbiturates, opioids), grapefruit juice, high fat foods
- alprazolam (Xanax), diazepam (Diastat), lorazepam (Ativan), chlordiazepoxide (Librium), oxazepam (Serax), clorazepate (Tranxene), clonazepam (Klonopin)
21
Q
strong opioid agonists
A
- indication: severe (7-10) pain
- SE/ADRs: respiratory depression, respiratory arrest, change in LOC, sedation, cough suppression, constipation, urinary retention, hypotension, euphoria/addiction potential
- do not crush/chew pills
- morphine, hydromorphone (Dilaudid)
22
Q
thiazide diuretics
A
- indications: hypertension (1st line Tx), edema associated with HF, renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy
- contraindications: cross-sensitivities with sulfonamides, lactation, anuria
- inhibits sodium reabsorption in distal convoluted tubule; promotes excretion of water, sodium, chloride, potassium, hydrogen, magnesium, phosphate, and bicarbonate
- takes time to work; not effective with reduced GFR; mild diuresis
- SE/ADRs: electrolyte imbalance, hypokalemia, dehydration
- hydrochlorothiazide/HCTZ (Hydrodiuril, Microzide)
23
Q
vasodilators
A
- antianginal, nitrates
- indications: hypertension, angina, heart failure
- contraindications: ED meds
- SE/ADRs: hypotension, reflex tachycardia, headache
- isosorbide (Isordil), hydralazine (Apresoline), nitroglycerine (Nitro)
24
Q
tetracyclines
A
*broad-spectrum antibiotic
*tetracycline, doxycycline, minocycline, tigecycline
*indications: treats unusual organisms (Mycoplasma, Chlamydia, Rickettsia, Borellia burgdorferi); periodontal disease, chlamydia, gonorrhea and syphilis in PCN-allergic pt, H. pylori, acne
*contraindications: children < 8 years (tooth staining), lactation, pregnancy
*SE/ADRs: tooth discoloration, hepatotoxicity, renal toxicity, photosensitivity, GI upset
*notes: binds with calcium; take 2 hours before or 6 hours after antacids, calcium supplements, zinc products, laxatives containing magnesium, iron; do not take with Ca/Fe/milk
25
Q
aminoglycosides
A
*Treats serious Gram negative organisms when less-toxic ABX contraindicated; only used when causative organism is known
*gentamicin (Garamycin), amikacin (Amikin), streptomycin, tobramycin (Nebcin)
*contraindication: pregnancy
*SE/ADRs: ototoxicity, nephrotoxicity
*usually only given parenterally
26
Q
Short-Acting Beta Agonist
A
*Bronchodilator; relieves bronchospasm associated with asthma or COPD
*Emergency inhaler
*affects mostly beta-2 receptors, also beta-1
* SE/ADRs: tachycardia, palpitations, tremors, headache, nausea, BP changes, restlessness, nervousness, dizziness, dry/irritated throat, unusual taste, paradoxical bronchospasm
*albuterol (Proventil, Ventolin, ProAir); levalbuterol (Xopenex)
27
Q
Long-Acting Beta Agonist
A
– Bronchodilator; relieves bronchospasm associated with asthma or COPD
– affects beta-2 receptors
– not for emergency use; maintenance therapy
– taken before steroid inhaler; wait 5 minutes between meds
– SE/ADRs: palpations, tachycardia, tremors, nervousness, headache, nausea, bad taste, dry mouth, BP changes
– formoterol (Foradil, Perforomist), salmeterol (Severent)
28
Q
Tuberculosis meds
A
– isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), ethambutol (Myambutol)
– pt on 2-4 meds for 6-12 months; compliance is crucial
