Pharm Top 200 Drug List Flashcards
Hydrocodone/Acetaminophen (Vicodin, Lortab, Norco)
MOA Hydrocodone-binds, activates mu-opioid receptor, Acetaminophen–suspected to inhibit prostaglandin synthesis which reduces pain
Testable Pearls: Addiction/dependence risk, respiratory depression, constipation
Lisinopril (Prinivil)
MOA: Inhibits angiotensin converting enzyme which ultimately leads to reduction in angiotensin 2 (a potent vasoconstrictor)
Testable Pearls: Cough, Hyperkalemia, used to help protect the kidneys in diabetes
Simvastatin (Zocor)
MOA: Inhibits HMG-CoA reductase – this enzyme is the rate limiting step in cholesterol formation
Testable Pearls: Myopathy, Reduces risk of heart attack/stroke, Dosed at night
Levothyroxine (Synthroid)
MOA: synthetic form of thyroid hormone (T4)
Testable Pearls: Binding interactions w/calcium and iron can lower concentrations, TSH is monitored to adjust dose, signs of hypothyroid–fatigue, dry skin, constipation
Amoxicillin (Amoxil)
MOA: Inhibits penicillin binding protein which prevents cell wall synthesis
Testable Pearls: Diarrhea, nausea/vomiting, rash
Azithromycin (zithromaz)
MOA: Binds 50s ribosomal subunit and prevents protein synthesis.
Testable Pearls: Longer half-life than many antibiotics, GI adverse effects, rare risk for QTc prolongation
QTc prolongation
QT prolongation is a measure of delayed ventricular repolarization. Excessive QT prolongation can predispose the myocardium to the development of early after-depolarizations, which in turn can trigger re-entrant tachycardias such as TdP
Hydrochlorothiazide (HCTZ); (Microzide)
MOA: blocks sodium reabsorption in the distal convoluted tubule of kidney.
Testable Pearls: Frequent urination, elevated uric acid level (exacerbate gout), can help with edema and hypertension
Amlodipine (Norvasc)
MOA: Blocks the entry of calcium into smooth muscle, causing vasodilation.
Testable Pearls: Edema, No action on the heart (compared to diltiazem, verapamil)
Alprazolam (Xanax)
MOA: Enhances GABA activity which has a sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Testable Pearls: Used for acute management of anxiety, dizziness/sedation, generally avoid in elderly
Metformin (Glucophage)
MOA: primarily decreases hepatic glucose production
Testable Pearls: Avoid in moderate to severe kidney disease, rare risk of lactic acidosis, GI side effects like diarrhea is most prominent, first line agent in type 2 diabetes
Atorvastatin (Lipitor)
MOA: inhibits HMG-CoA reductase - this enzyme is the rate limiting step in cholesterol formation.
Testable Pearls: Myopathy, reduces risk of heart attack/stroke, higher intensity statin
Omeprazole (Prilosec)
MOA: Inhibits H+/K+ ATPase pump in gastric parietal cells (reduces hydrogen ion - stomach acid concentration in stomach)
Testable Pearls: Short term only recommended for GERD, associated with low magnesium and B12, most potent acid blocking medication class
Amoxicillin/Clavulanate (Augmentin)
MOA: Amoxicillin - Inhibits penicillin binding protein which prevents cell wall synthesis; Clavulanate - inhibits beta-lactamase which is produced by bacteria to break down beta lactam antibiotics
Testable Pearls: Diarrhea, nausea/vomiting, rash
Atenolol (Tenormin)
MOA: Blocks beta-1 receptor (found primarily in the heart); prevents activity of sympathetic nervous system leading to reduction in heart rate and BP.
Testable Pearls: Pulse monitoring, can blunt beta-agonist activity (potentially exacerbate asthma, COPD); can block signs of hypoglycemia (exception sweating)
Furosemide (Lasix)
MOA: Blocks reabsorption of sodium, chloride nd water from the ascending limb of the loop of Henle - increases urine output
Testing Pearls: Hypokalemia; frequent urination; can lead to dehydration (rising creatinine)
Metoprolol (Lopressor)
MOA: Blocks beta-1-receptors (found primarily in the heart); prevents activity of sympathetic nervous system leading to reduction in heart rate and BP.
Testing Pearls: Pulse monitoring; can blunt beta-agonist activity (potentially exacerbate asthma, COPD); block signs of hypoglycemia (exception sweating)
Sertraline (Zoloft)
MOA: Inhibits reuptake of serotonin which leads to higher concentrations in the synapse.
Testing Pearls: takes a significant amount of time to work (usually weeks); GI side effects; serotonin syndrome risk (elevated temperature, BP, heart rate)
Zolpidem (Ambien)
MOA: Enhances GABA activity which has sedative, hypnotic effects.
Testing pearls: used for insomnia only; dizziness/sedation; generally avoid in elderly
Oxycodone/APAP (Percocet)
MOA: Oxycodone - binds, activates mu-opioid receptor, acetaminophen - suspected to inhibit prostaglandin synthesis which reduces pain.
Testing Pearls: Addiction/dependence risk; respiratory depression; constipation
Esomeprazole (Nexium)
MOA: Inhibits H+/K+ ATPase pump in gastric parietal cells (reduces hydrogen ion - stomach acid concentration in stomach)
Testing Pearls: short term only recommended for GERD; associated with low magnesium and B12; most potent acid blocking medication
Clopidogrel (Plavix)
MOA: Blocks binding of ADP to the P2Y12 receptor; by doing this, it prevents platelet aggregation
Testing Pearls: prodrug - converted to its active metabolite by CYP2C19; bleed risk; often used in combination with aspirin following stenting.
Montelukast (Singulair)
MOA: blocks leukotriene receptors in the lungs which reduces bronchoconstriction and inflammation.
Testing Pearls: used in asthma and allergies; not a rescue medication; rare reports of psychiatric adverse events.
Prednisone (Sterapred)
MOA: Multiple possible pathways of reducing inflammation and suppressing the immune system (inhibition of cytokines, chemokines, arachidonic acid, etc.)
Testing Pearls: Suppression of HPA axis; increases blood sugars, causes insomnia and GI upset; increases risk of osteoporosis.
Escitalopram (Lexapro)
MOA: Inhibits reuptake of serotonin which leads to higher concentrations in the synapse
Testing Pearls: takes a significant amount of time to work (usually weeks); GI side effects; serotonin syndrome risk (elevated temperature, BP, heart rate.
Ibuprofen (Advil)
MOA: non-selective inhibitor of cyclooxygenase (COX) - which ultimately reduces the production of prostaglandins which are involved in pain/inflammation
Testing Pearls: increase GI bleed risk; take with food; exacerbates CHF/edema; inhibits platelet activity
Citalopram (Celexa)
MOA: Inhibits reuptake of serotonin which leads to higher concentrations in the synapse.
Testing Pearls: takes a significant amount of time to work (usually weeks); QTc prolongation risk (higher doses, elderly more susceptible); serotonin syndrome risk (elevated temperature, BP heart rate)
Albuterol (ProAir)
MOA: Beta-2 adrenergic receptor agonist - relaxes bronchial smooth muscle and opens airways.
Testing Pearls: Tremor; tachycardia; usual drug of choice for acute relief of respiratory symptoms.
Fluoxetine (Prozac)
MOA: Inhibits reuptake of serotonin which leads to higher concentrations in the synapse.
Testing Pearls: takes a significant amount of time to work (usually weeks); GI side effects; serotonin syndrome risk (elevated temperature, BP, heart rate)
Gabapentin (Neurontin)
MOA: Not well understood - possible action on voltage sensitive calcium channels.
Testing Pearls: dizziness; sedation; can accumulate in renal disease.
Warfarin (Coumadin)
MOA: Inhibits vitamin K dependent production of clotting factors 2, 7, 9, and 10.
Testing Pearls: bleeding risk; routine INR monitoring require (most often goal is 2-3 with a few exceptions); tons of drug interactions (metronidazole, amiodarone, Bactrim, etc.)
Tramadol (Ultram)
MOA: binds, activates mu-opioid receptors leading to analgesic effects.
Testing Pearls: increases seizure risk; sedation; risk of dependence and addiction.
Clonazepam (Klonopin)
MOA: Enhances GABA activity which has sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Testing Pearls: used for acute management of anxiety; dizziness/sedation; generally avoid in elderly.
Lorazepam (Ativan)
MOA: Enhances GABA activity which has sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Testing Pearls: used for acute management of anxiety; dizziness/sedation; generally avoid in elderly
Cephalexin (Keflex)
MOA: Inhibits penicillin binding protein which prevents bacterial cell wall synthesis.
Testing Pearls: Diarrhea; nausea/vomiting; primarily gram + bacteria coverage.
Cyclobenzaprine (Flexeril)
MOA: Not well understood - skeletal muscle relaxant possibly gamma and alpha motor system effects.
Testing Pearls: sedating; anticholinergic potential (i.e. dry mouth, confusion, etc.); not well tolerated in the elderly.
Sulfamethoxazole/trimethoprim (Bactrim, Sepra)
MOA: Sulfamethoxazole - interferes with bacterial folate synthesis; trimethoprim blocks production of tetrahydrofolic acid in bacteria by binding dihydrofolate reductase.
Testing Pearls: significant interaction with warfarin; beware of patients with sulfa allergy - should not take this medication; take with full glass of water.
Ciprofloxacin (Cipro)
MOA: Inhibits DNA gyrase in bacteria which prevents DNA separation and cell division.
Testing Pearls: risk of spontaneous tendonitis or tendon rupture; dose adjustments with poor kidney function; binding interaction with iron and calcium can reduce absorption.
Fluticasone (Flonase)
MOA: Stimulates glucocorticoid receptors which leads to reduced inflammation.
Testing Pearls: may work a little better if taken routinely; nose bleeding, irritation; used in allergic rhinitis.
Triamterene/HCTZ (Dyazide)
MOA: Triamterene - blocks epithelial sodium channels, causing a diuretic type effect in the kidney
Testing Pearls: Elevated K+ possible with triamterene; lowers blood pressure; in combination with HCTZ can help even out potassium levels as HCTZ lowers levels.
Pravastatin (Pravachol)
MOA: Inhibits HMG-CoA reductase - this enzyme is the rate limiting step in cholesterol formation.
Testing Pearls: myopathy; reduces risk of heart attack/stroke; if patients can’t tolerate simvastatin or atorvastatin, this one is often tried.
Rosuvastatin (Crestor)
MOA: Inhibits HMG-CoA reductase - this enzyme is the rate limiting step in cholesterol formation.
Testing Pearls: myopathy; reduces risk of heart attack/stroke; higher intensity statin
Fluticasone + salmeterol (Advair)
MOA: Corticosteroid combined with long acting beta agonist - steroid works on inflammation and salmeterol opens up the airway
Testing Pearls: Rinse mouth following use of steroid (reduces thrush risk); controller medication, not for rescue; beta agonist effects - increased heart rate, tremor
Trazodone (Desyrel)
MOA: Possible serotonin type activity, not well understood; histamine blockade may be responsible for sedative effect.
Testing Pearls: dry mouth; most often used for sleep, rarely used for straight depression; possibly a little safer in elderly than Z-drugs like Zolpidem.
Aledronate (Fosamax)
MOA: Inhibits resorption of bone by osteoclasts.
Testing Pearls: extremely long half life; administration w/out other drugs, food - with a plain glass of water, patient to remain upright after usually reassessed after 5 years of use.
Fexofenadine (Allegra)
MOA: Selective H1 receptor antagonist which leads to relief of allergy symptoms
Testing Pearls: sedation; dry mouth; one daily dosing
Lovastatin (Mevacor)
MOA: Inhibits HMG-CoA reductase - this enzyme is the rate limiting step in cholesterol formation.
Testing Pearls: myopathy; reduces risk of heart attack/stroke; risk of rhabdomyolysis (associated with all statins)
Rhabdomyolysis
Breakdown of muscle tissue that releases the protein (myoglobin) into the blood. Myoglobin can damage the kidneys
Carvedilol (Coreg)
MOA: Blocks beta-1 receptors (found primarily in the heart); prevents activity of sympathetic nervous system leading to reduction in heart rate and BP; has some alpha blockade as well.
Testing Pearls: pulse monitoring; can blunt beta-agonist activity (potentially exacerbate asthma, COPD); can block signs of hypoglycemia (exception sweating)
Paroxetine (Paxil)
MOA: Inhibits reuptake of serotonin which leads to higher concentrations in the synapse.
Testing Pearls: takes a significant amount of time to work (usually weeks); GI side effects; serotonin syndrome risk (elevated temperature, BP, heart rate).
Meloxicam (Mobic)
MOA: Non-selective inhibitor of cyclooxygenase (COX) - which ultimately reduces the production of prostaglandins which are involved in pain/inflammation.
Testing Pearls: increase GI bleed risk; take w/food; exacerbates CHF/edema; inhibits platelet activity.
Diazepam (Valium)
MOA: Enhances GABA activity which has sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Testing Pearls: used for acute management of anxiety/seizure; dizziness/sedation; generally avoid in elderly.
Valsartan (Diovan)
MOA: Angiotensin receptor blocker - prevents the activity of angiotensin which is vasoconstrictor.
Testing Pearls: hyperkalemia; alternate to ACE inhibitor; less incidence of cough compared to ACE inhibitors.
Duloxetine (Cymbalta)
MOA: Serotonin and Norepinephrine reuptake inhibitor which increases concentrations of both in the brain synapses.
Testing Pearls: more beneficial for pain than SSRI’s (neuropathy); possible increase in hypertension at high doses; GI side effects, serotonin syndrome risk.
Venlafaxine (Effexor)
MOA: Serotonin and Norepinephrine reuptake inhibitor which increases concentrations of both in the brain synapses.
Testing Pearls: more beneficial for pain than SSRI’s (neuropathy); possible increase in hypertension at high doses; GI side effects, serotonin syndrome risk.
Ranitidine (Zantac)
MOA: Histamine 2 receptor antagonist which reduces gastric acid secretion leading to relief of heartburn and GI symptoms.
Testing Pearls: slightly less potent than the PPI’s; can accumulate in kidney disease; tend to work a little quicker than the PPI’s.
Fluconazole (Diflucan)
MOA: Inhibits fungal cytochrome P450 enzyme 14alpha-demthylase.
Testing Pearls: 3A4 drug interactions (amiodarone, phenytoin, warfarin, etc.); GI upset; liver concerns.
Naproxen (Aleve)
MOA: Non-selective inhibitor of cyclooxygenase (COX) - which ultimately reduces the production of prostaglandins which are involved in pain/inflammation.
Testing Pearls: increase GI bleed risk; take with food; exacerbates CHF/edema; inhibits platelet actitivty.
Doxycycline (Vibramycin)
MOA: Inhibits bacterial protein synthesis by binding to the 30s ribosomal subunit.
Testing Pearls: increases sensitivity to sunburn; binding interactions with calcium and iron; avoid in pregnancy.
Potassium (Klor-Con)
MOA: Potassium replacement.
Testing Pearls: often used for patient on diuretics that deplete potassium; GI upset; often patients do have trouble swallowing larger doses (big pills) - some forms can be dissolved in water.
Amitriptyline (Elavil)
MOA: Inhibits norepinephrine and serotonin reuptake, leading to increased concentrations in the synapse.
Testing Pearls: highly anticholinergic (sedation, confusion, dry eye, etc.); can be used for pain syndromes (migraines, fibromyalgia, etc.); higher risk of cardiac concerns in overdose compared to SSRI’s so less often used for depression.
Lansoprazole (Prevacid)
MOA: Inhibits H+/K+ ATPase pump in gastric parietal cells (reduces hydrogen ion - stomach acid concentration in stomach).
Testing Pearls: short term only recommended for GERD; associated with low magnesium and B12; most potent acid blocking medication class.
Pioglitazone (Actos)
MOA: Decreases insulin resistance in the periphery; leading to greater uptake of glucose into muscle tissue and lower blood sugar.
Testing Pearls: weight gain; edema; generally avoid in CHF patients.
Methylprednisolone (Medrol)
MOA: Multiple possible pathways of reducing inflammation and suppressing the immune system (inhibition of cytokines, chemokines, arachidonic acid etc.).
Testing Pearls: suppression of HPA axis; increases blood sugars, causes insomnia and GI upset; increases risk of osteoporosis.
Allopurinol (Zyloprim)
MOA: Inhibition of xanthine oxidase which results in less production of uric acid and lower levels.
Testing Pearls: not meant for acute gout flares; rash; can accumulate in kidney disease.
Codeine + APAP (Tylenol #3)
MOA: codeine -binds, activates mu-opioid receptor, Acetaminophen - suspected to inhibit prostaglandin synthesis which reduces pain.
Testing Pearls: addiction/dependence risk; respiratory depression; constipation.
Enalapril (Vasotec)
MOA: Inhibits angiotensin converting enzyme which ultimately leads to reduction in angiotensin 2 (a potent vasoconstrictor).
Testing Pearls: Cough; hyperkalemia; used to protect the kidneys in diabetes
Carisoprodol (Soma)
MOA: Not well understood, potential effects at GABA receptors.
Testing Pearls: sedation; controlled substance; dizziness.
Tamsulosin (Flomax)
MOA: Blocks alpha-1a receptors which causes smooth muscle relaxation of the bladder neck and prostate.
Testing Pearls: dizziness, low blood pressure; work fairly quickly compared o 5 alpha reductase inhibitors; rare risk of floppy iris syndrome in patients having eye surgery.
Ezetimibe (Zetia)
MOA: Inhibits intestinal absorption of cholesterol leading to lower levels.
Testing Pearls: GI upset; not great evidence that indicates reduces eh risk of heart attack and stroke; 2nd or third line agent for lowering cholesterol (statins are drug of choice).
Quetiapine (Seroquel)
MOA: Blockade of dopamine 2 receptors is primary mechanism.
Testing Pearls: sedation and orthostasis risk; extrapyramidal symptoms metabolic syndrome and QTc prolongation risk.
Extrapyramidal Symptoms
drug-induced movement disorders that include acute and tardive symptoms
Levofloxacin (Levaquin)
MOA: Inhibits DNA gyrase in bacteria which prevents DNA separation and cell division.
Testing Pearls: risk of spontaneous tendonitis or tendon rupture; dose adjustments with poor kidney function; binding interaction with iron and calcium can reduce absorption.
Fenofibrate (Tricor)
MOA: Activates lipoprotein lipase and reduces synthesis of apoprotein C-3; both of these mechanisms work to lower cholesterol.
Testing Pearls: target for elevated triglycerides, SE = myopathy; statins reserved for cardiovascular risk reduction and LDL lowering; elevated triglycerides increase risk of pancreatitis.
Clonidine (Catapres)
MOA: Stimulates centrally acting alpha-2 receptors causing reduced sympathetic outflow which lowers BP and pulse.
Testing Pearls: Dry mouth; dizziness, CNS changes; generally avoided in the elderly.
Promethazine (Phenergan)
MOA: Possible anticholinergic (blocks acetylcholine) and antihistamine effects, also may mildly block dopamine receptors.
Testing Pearls: used for motion sickness, nausea and vomiting; sedating; anticholinergic side effects.
Ethinyl estradiol + Drosperinone (Yaz)
MOA: Oral contraceptive - estrogen prevents ovulation and reduces risk of pregnancy.
Testing Pearls: DVT/PE; hypertension; headache/GI symptoms.
Sildenafil (Viagra)
MOA: Inhibition of phosphodiesterace-5 (PDE-5) causes smooth muscle relaxation and increased blood flow to the penis.
Testing Pearls: low blood pressure; rare vision adverse effect; avoid using with nitrates.
Celecoxib (Celebrex)
MOA: Selective inhibition of COX-2 leads to reduced formation of arachidonic acid and prostaglandins.
Testing Pearls: GI side effects generally less than traditional NSAIDs; edema risk; kidney risk still the same as traditional NSAIDs.
Loratadine (Claritin)
MOA: Selective H1 receptor antagonist which leads to relief of allergy symptoms.
Testing Pearls: Sedation; dry mouth; once daily dosing.
Oxycodone (OxyContin)
MOA: Oxycodone - binds, activates mu-opioid receptor.
Testing Pearls: addiction/dependence risk; respiratory depression; constipation.
Glargine (Lantus, Basaglar)
MOA: Long acting insulin analog.
Testing Pearls: weight gain; hypoglycemia risk; dose once daily and targets fasting blood sugar.
Mometasone (Nasonex)
MOA: Stimulates glucocorticoid receptors which leads to reduced inflammation.
Testing Pearls: may work a little better if taken routinely; nose bleeding, irritation; used in allergic rhinitis.
Pregabalin (Lyrica)
MOA: Not well known; suspected that it might bind the alpha2-delta subunits leading to a reduction in neuronal excitability.
Testing Pearls: sedation; dizziness; weight gain.
Amaryl (Glimepiride)
MOA: Stimulates pancreatic beta cells to release insulin.
Testing Pearls: weight gain; hypoglycemia; inexpensive.
Temazepam (Restoril)
MOA: Enhances GABA activity which has sedative, hypnotic, anticonvulsant, and muscle relaxant properties.
Testing Pearls: shorter half-life than others, so may see this one used for sleep; dizziness/sedation; generally avoid in elderly.
Conjugated Estrogen (Premarin)
MOA: Replacement estrogen in postmenopausal women who experience symptoms like hot flashes, vaginal dryness, etc.
Testing Pearls: DVT/PE; hypertension; increased risk of breast cancer.
Folic Acid (Folvite)
MOA: Supplement of folic acid.
Testing Pearls: tolerability is usually fine; given with methotrexate for RA/psoriasis etc.; deficiency can lead to anemia.
Spironolactone (Aldactone)
MOA: Aldosterone antagonist that blocks the effects of aldosterone, leading to lower blood pressure and a diuretic effect.
Testing Pearls: Hyperkalemia; gynecomastia (man-boobs); monitor kidney function.
Digoxin (Lanoxin)
MOA: Inhibits sodium, potassium ATPase leading to an increase in the force of contraction of the heart.
Testing Pearls: Used in atrial fibrillation or CHF; toxicity signs include GI, CNS changes, visual changes, and weight loss; can accumulate in kidney disease and cause more toxicity with low potassium levels.
Isosorbide Mononitrate (Imdur)
MOA: Increase in nitric oxide leads to venous and arterial dilation.
Testing Pearls: headache; dizziness; can become tolerant to effects, usually recommended to have a nitrate free period during the day.
Cefdinir (Omnicef)
MOA: Inhibits penicillin binding protein which prevents bacterial cell wall synthesis.
Testing Pearls: diarrhea; nausea/vomiting; broader spectrum coverage than cephalexin.
Ramipril (Altace)
MOA: Inhibits angiotensin converting enzyme which ultimately leads to reduction in angiotensin 2 (a potent vasoconstrictor).
Testing Pearls: Cough; hyperkalemia, used to help protect the kidneys in diabetes.
Triamcinolone (Nasacort)
MOA: stimulates glucocorticoid receptors which leads to reduced inflammation.
Testing Pearls: May work a little better if taken routinely; nose bleeding, irritation; used in allergic rhinitis.
Losartan (Cozaar)
MOA: Angiotensin receptor blocker - prevents the activity of angiotensin which is a vasoconstrictor.
Testing Pearls: Hyperkalemia; alternate to ACE inhibitor; less incidence of cough compared to ACE inhibitors.
Methylphenidate (Concerta)
MOA: prevents catecholamine reuptake in CNS synapses leading to increased dopamine and norepinephrine.
Testing Pearls: Weight loss; insomnia; anxiety, tachycardia, and increased BP
Glyburide (Diabeta)
MOA: Stimulates pancreatic beta cells to release insulin.
Testing Pearls: weight gain; hypoglycemia; inexpensive.
Valacyclovir (Valtrex)
MOA: Inhibits DNA Polymerase which prevent viral replication.
Testing Pearls: treatment of herpes and varicella viruses; GI upset; prodrug; converted to acyclovir.
Oseltamivir (Tamiflu)
MOA: Inhibits influenza virus neuraminidase, which likely alters replication or release of budding viruses.
Testing Pearls: GI side effects; dose adjusted based on kidney function; used in treatment and prophylaxis of influenza.
Tiotropium (Spiriva)
MOA: Long acting antimuscarinic (anticholinergic) that bins to M3 receptors which relaxes smooth muscle leading to bronchodilation.
Testing Pearls: One of the drugs of choice in COPD maintenance therapy; not intended for acute relief (rescue) of symptoms; dry mouth.
Benazepril (Lotensin)
MOA: Inhibits angiotensin converting enzyme which ultimately leads to reduction in angiotensin 2 (a potent vasoconstrictor).
Testing Pearls: cough; hyperkalemia; used to help protect the kidneys in diabetes.
Lamotrigine (Lamictal)
MOA: Inhibits voltage sensitive sodium channels which stabilizes neuronal membranes.
Testing Pearls: can be used for seizures or mood disorders like bipolar; drug interaction with valproic acid; rash (possibly severe Stephen Johnson’s Syndrome).
Olmesartan (Benicar)
MOA: Angiotensin receptor blocker - prevents the activity of angiotensin which is a vasoconstrictor.
Testing Pearls: hyperkalemia; alternate to ACE inhibitor; less incidence of cough compared to ACE inhibitors.
Donepezil (Aricept)
MOA: Acetylcholinesterase inhibitor which helps increase acetylcholine in the brain (remember the anticholinergics can cause confusion).
Testing Pearls: weight loss; diarrhea; does not reverse dementia.
Risperidone (Risperdal)
MOA: Blockade of dopamine 2 receptors is primary mechanism.
Testing Pearls: sedation and orthostasis risk; extrapyramidal symptoms; metabolic syndrome and QTc prolongation risk.
Glipizide (Glucotrol)
MOA: stimulates pancreatic beta cells to release insulin.
Testing Pearls: weight gain; hypoglycemia; inexpensive.
Amphetamine salts (Adderall)
MOA: Prevents catecholamine reuptake in CNS synapses leading to increased dopamine and norepinephrine.
Testing Pearls: Weight loss; insomnia; anxiety, tachycardia, and increased BP.
Aripiprazole (Abilify)
MOA: Blockade of dopamine 2 receptors is primary mechanism.
Testing Pearls: indicated for augmentation of depression as well as schizophrenia; extrapyramidal symptoms; metabolic syndrome and QTc prolongation risk.
Verapamil (Verelan)
MOA: Non-dihydropyridine; blocks the entry of calcium into smooth muscle and heart, causing vasodilation and slowing of heart rate.
Testing Pearls: used in Afib, HTN, or chronic headaches; monitor pulse; edema.
Clindamycin (Cleocin)
MOA: Bind 50s subunit of bacterial ribosome which prevents protein synthesis.
Testing Pearls: GI side effects; higher risk of colitis and C. diff; good for anaerobic bacteria.
Metronidazole (Flagyl)
MOA: Disrupts bacterial DNA synthesis.
Testing Pearls: Interaction with warfarin; avoid alcohol when taking medication; used for anaerobic bacteria.
Ethinyl Estradiol + Norgestimate (Ortho Tri-Cyclen)
MOA: Oral contraceptive - estrogen prevents ovulation and reduces risk of pregnancy.
Testing Pearls: DVT/PE; hypertension; GI/headache
Tadalafil (Cialis)
MOA: Inhibition of phosphodiesterace-5 (PDE-5) causes smooth muscle relaxation and increased blood flow to the penis.
Testing Pearls: low blood pressure; rare vision adverse effect; avoid using with nitrates.
Phentermine (Adipex)
MOA: Sympathetic amine- increases adrenaline, dopamine, and possibly serotonin.
Testing Pearls: used for weight loss; monitor for cardiac concerns; increase in BP and pulse; can cause insomnia or anxiety.
Hydroxyzine (Vistaril)
MOA: H1 receptor antagonist which leads to relief of allergy symptoms and causes sedation.
Testing Pearls: anticholinergic effects; used for anxiety; considered 1st generation antihistamine (sedating)
Diclofenac (Cataflam)
MOA: Non-selective inhibitor of cyclooxygenases (COX) - which ultimately reduces the production of prostaglandins which are involved in pain/inflammation.
Testing Pearls: increase GI bleed risk; take with food; exacerbates CHF/edema; inhibits platelet activity.
Metoclopramide (Reglan)
MOA: Inhibition of D2 receptors in chemoreceptor trigger zone.
Testing Pearl: risk of movement disorders like EPS; often used in gastroparesis; can exacerbate Parkinson’s disorder
Gemfibrozil (Lopid)
MOA: Not well known - targets triglycerides and can possibly help raise HDL.
Testing Pearls: risk of myopathy; interaction with statins (increases risk of myopathy and rhabdomyolysis); indicated for significantly high triglycerides.
Diltiazem (Cardizem)
MOA: Non-dihydropyridine; blocks the entry of calcium into smooth muscle and heart, causing vasodilation and slowing of heart rate.
Testing Pearls: used in Afib, HTN, or chronic headaches; monitor pulse; edema.
Divalproex (Depakote)
MOA: not well known, possibly increasing GABA in the brain.
Testing Pearls: sedation; weight gain; ataxia, CNS changes.
Nitrofurantoin (Macrobid)
MOA: Altered by bacterial flavoproteins to reactive intermediates which breakdown bacterial ribosomal proteins.
Testing Pearls: GI upset; nitrofurantoin lung (rare); avoid use if suspected kidney/systemic infection, good for UTI only.
Mirtazapine (Remeron)
MOA: Multiple potential mechanisms include blocking alpha-2 receptors, as well as serotonin subtypes and histamine blockade.
Testing Pearls: weight gain; sedating; classified as antidepressant but often used for sleep/sedative properties.
Latanoprost (Xalatan)
MOA: Prostaglandin agonist which increases aqueous humor outflow and reduces intraocular pressure.
Testing Pearls: used for glaucoma; will help eye lashes grow; can alter color of the eye.
Sitagliptin (Januvia)
MOA: DPP-4-inhibitor - DPP-4 breaks down incretins like GLP-1 which are hormones that can reduce blood sugars by promoting fullness.
Testing Pearls: rare pancreatitis risk; GI side effects; low risk of hypoglycemia when used alone.
Acyclovir (Zovirax)
MOA: Inhibits DNA polymerase which prevents viral replication.
Testing Pearls: treatment of herpes and varicella viruses; GI upset; can accumulate in kidney disease.
Doxazosin (Cardura)
MOA: Blocks alpha receptors which causes smooth muscle relaxation of the bladder neck and prostate and vasodilation.
Testing Pearls: Orthostasis risk; not selective for bladder so can be used for HTN and BPH; usually dosed at night.
Eszopiclone (Lunesta)
MOA: Enhances GABA activity which has sedative, hypnotic effects.
Testing Pearls: Used for insomnia only; dizziness/sedation; generally avoid in elderly.
Niacin (Niaspan)
MOA: Inhibition of triglyceride synthesis by stimulating intracellular Apo-B degradation and reduces release of VLDL and LDL.
Testing Pearls: Can cause flushing; increases uric acid; option in reducing triglycerides.
Propranolol (Inderal)
MOA: Non-selective beta blocker; reduced heart rate, blood pressure; may have higher risk for adverse effects due to non-selectivity (also lot of unique uses - tremor, esophageal varices, migraines).
Testing Pearls: pulse monitoring; can blunt beta-agonist activity (potentially exacerbate asthma, COPD); can block signs of hypoglycemia (exception sweating).
Buprenorphine/naloxone (Suboxone)
MOA: Partial opioid agonist that has a peak effect on stimulating the mu receptors combine with a full opioid antagonist (naloxone), used to treat opioid use disorder.
Testing Pearls: possible opioid like effects to a certain extent; prevents full opioid agonist from binding in management of addiction; needs a special prescribing certificate to prescribe for opioid use disorder.
Bupropion (Wellbutrin)
MOA: Inhibits reuptake of norepinephrine, dopamine and possibly serotonin to help treat depression.
Testing Pearls: used in smoking cessation; avoid in patients with seizures; can contribute to insomnia.
Guaifensesin (Robitussin)
MOA: Increases volume and reduces thickness of mucous (expectorant).
Testing Pearls: well tolerated; questionable effectiveness; take with lots of water.
Topiramate (Topamax)
MOA: Blocks voltage dependent sodium and calcium channels, may have some activity on GABA as well.
Testing Pearls: Cognitive slowing, confusion; sedation; antiseizure medication, but often used for migraines.
Buspirone (Buspar)
MOA: Serotonin partial agonist and 5HT1A receptors; possible activity at dopamine receptors as well.
Testing Pearls: Takes a while to work; used in anxiety; pretty well tolerated compared to benzodiazepines especially in elderly.
Meclizine (Antivert)
MOA: Antihistamine effects at H1 receptors
Testing Pearls: sedation; anticholinergic side effects; primarily used for nausea and motion sickness.
Tolterodine (Detrol)
MOA: Antagonist at muscarinic (M2 and M3) receptors which helps in the management of overactive bladder.
Testing Pearls: dry mouth; confusion; can exacerbate urinary retention.
Lisdexamfetamine (Vyvanse)
MOA: prevents catecholamine reuptake in CNS synapses leading to increased dopamine and norepinephrine.
Testing Pearls: weight loss; insomnia; anxiety, tachycardia, and increased BP.
Quinapril (Accupril)
MOA: Inhibits angiotensin converting enzyme which ultimately leads to reduction in angiotensin 2 (a potent vasoconstrictor)
Testing Pearls: cough; hyperkalemia; used to help protect the kidneys in diabetes
Mupirocin (Bactroban)
MOA: Inhibits bacterial protein and RNA synthesis.
Testing Pearls: topical antibiotic ; skin irritation; MRSA coverage (but only as a topical agent)
Methotrexate (Rheumatrex)
MOA: Inhibition of dihydrofolate reductase (anticancer) also is classified as a disease modifying antirheumatic drug (DMARD).
Testing Pearls: low doses used for RA; need to supplement with folic acid; dose once weekly and monitor liver function.
Polyethylene Glycol (Miralax)
MOA: Osmotic laxative that draws moisture into the bowel to help relieve constipation.
Testing Pearls: Diarrhea; mix with 8oz. of fluid; rare possibility for electrolyte abnormalities.
Fentanyl (Duragesic)
MOA: Binds, activates mu-opioid receptor.
Testing Pearls: Patch formulation; not for acute pain; very slow onset/offset.
Benzonatate (Tessalon Pearls)
MOA: anesthetic types effects which can numb the throat and suppress cough.
Testing Pearls: sedation; GI upset; make sure you aren’t masking ACE inhibitor cough
Irbesartan (Avapro)
MOA: Angiotensin receptor blocker - prevents the activity of angiotensin which is a vasoconstrictor.
Testing Pearls: hyperkalemia; alternate to ACE inhibitor; less incidence of cough compared to ACE inhibitors.
Albuterol + Ipratropium (Duonebs, Combivent)
MOA: Combination beta-agonist and short acting anticholinergic.
Testing Pearls: dry mouth; tachycardia; tremor.
Ibandronate (Boniva)
MOA: Inhibits resorption of bone by osteoclasts.
Testing Pearls: extremely long half life; administration without other drugs, food - with a plain glass of water, patient to remain upright after; usually reassessed after 5 years of use.
Methadone (Methadose)
MOA: Binds, activates mu-opioid receptor.
Testing Pearls: Addiction/dependence risk; respiratory depression; constipation.
Clotrimazole + Betamethasone (Lotrisone)
MOA: Combination antifungal and topical corticosteroid.
Testing Pearls: Fungal infections can take a while to treat; skin thinning with prolonged use; skin irritation.
Sumatriptan (Imitrex)
MOA: Serotonin agonist at 5HT1D receptors - thought to cause vasoconstriction, but maybe a little more unknown now?
Testing Pearls: Caution in patients at high risk of cardiovascular concerns; treatment of acute migraine; CNS adverse effects like confusion.
Nifedipine (Procardia)
MOA: Blocks the entry of calcium into smooth muscle, causing vasodilation.
Testing Pearls: Edema, no action on the heart (compared to diltiazem, verapamil); used to help prevent angina and manage blood pressure.
Famotidine (Pepcid)
MOA: Histamine 2 receptor antagonist which reduces gastric acid secretion leading to relief of heartburn and GI symptoms.
Testing Pearls: Slightly less potent than the PPI’s; can accumulate in kidney disease; tends to work a little quicker than the PPI’s.
Finasteride (Proscar)
MOA: Inhibits 5 alpha reductase which prevent dihydrotesterone formation which contributes to enlargement of the prostate.
Testing Pearls: sexual dysfunction side effect; can be used for hair growth in baldness; takes months to shrink prostate.
Ferrous Sulfate (Feosol)
MOA: Iron replacement.
Testing Pearls: deficiency can cause anemia and RLS; GI upset; constipation.
Terazosin (Hytrin)
MOA: Blocks alpha receptors which causes smooth muscle relaxation of the bladder neck and prostate and vasodilation.
Testing Pearls: Orthostasis risk; not selective for bladder so can be used for HTN and BPH; usually dosed at night.
Fish Oil (Lovaza)
MOA: Not well understood, but can help reduce triglycerides and increase HDL.
Testing Pearls: burping/fish taste; GI upset; rare potential to interfere with platelet aggregation (usually help around surgery)
Tizanidine (Zanaflex)
MOA: Central alpha-2 receptor agonist which inhibits motor neurons and reduces spasticity.
Testing Pearls: sedation; dizziness; maybe a little better tolerated in the elderly than cyclobenzaprine.
Risedronate (Actonel)
MOA: Inhibits resorption of bone by osteoclasts.
Testing Pearls: Extremely long half life; administration without other drugs, food - with a plain glass of water, patient to remain upright after; usually reassessed after 5 years of use.
Memantine (Namenda)
MOA: Inhibition of N-methyl-d-aspartate (NMDA) receptors.
Testing Pearls: CNS side effects like sedation, confusion; dose adjusted in kidney impairment; used in delaying progression of dementia.
Insulin Aspart (Novolog)
MOA: Rapid acting insulin analog.
Testing Pearls: hypoglycemia; weight gain; targets post-prandial elevations in blood sugars.
Aspirin
MOA: Non-selective inhibitor of cyclooxygenase (COX) - Which ultimately reduces the production of prostaglandins which are involved in pain/inflammation.
Testing Pearls: Risk of Reye’s syndrome in pediactrics; typically used for cardiovascular protection as low dose 81-325 mg once daily; GI bleed risk.
Clobetasol (Temovate)
Topical corticosteroid that can reduce inflammation, redness and itching.
Testing Pearls: Skin thinning; possible systemic effects with large quantities over longer periods of times; used for psoriasis and dermatitis.
Bisoprolol (Zebeta)
MOA: Blocks beta-1-receptors (found primarily in the heart); prevents activity of sympathetic nervous system leading to reduction in heart rate and BP.
Testing Pearls: Pulse monitoring; can blunt beta-agonist activity (potentially exacerbate asthma, COPD); can block signs of hypoglycemia (exception sweating)
Nitroglycerin (Nitrostat)
MOA: Relaxes vascular smooth muscle and dilates arteries and veins.
Testing Pearls: dizziness; headache; use for acute chest pain (angina); administer 3 tablets over 15 minutes.
Varenicline (Chantix)
MOA: Partial nicotine agonist which prevents nicotine from binding and reduces reward sensation from smoking.
Testing Pearls: Vivid dreams and nightmares; GI upset; insomnia.
Raloxifene (Evista)
MOA: Selective estrogen receptor modifies; blocks activity at some estrogen receptors and helps at others in management of reducing breast cancer risk and can help in osteoporosis.
Testing Pearls: DVT/PE risk; hot flashes; vaginal dryness.
Olanzapine (Zyprexa)
MOA: Blockade of dopamine 2 receptors is primary mechanism.
Testing Pearls: Sedation and orthostasis risk; extrapyramidal symptoms; metabolic syndrome and QTc prolongation risk.
Ondansetron (Zofran)
MOA: Inhibits 5-HT3 (serotonin) receptors in the chemoreceptor trigger zone to reduce nausea.
Testing Pearls: Rare QTc prolongation risk; often used in patient receiving emetogenic chemotherapy; CNS side effects.
Ropinirole (Requip)
MOA: Dopamine agonist that can be used for Parkinson’s where there is a shortage of dopamine; more commonly used in RLS.
Testing Pearls: Edema; obsessive behaviors like excessive gambling, eating; GI side effects.
Dicyclomine (Bentyl)
MOA: Anticholinergic that can be helpful in managing diarrhea and relaxing smooth muscle in patients with GI spasms and pain.
Testing Pearls: Constipation; dry eyes/dry mouth; confusion.
Insulin Lispro (Humalog)
MOA: rapid acting insulin analog.
Testing Pearls: Hypoglycemia; weight gain; targets post-prandial blood sugars.
Nabumetone (Relafen)
MOA: Non-selective inhibitor of cyclooxygenase (COX) - which ultimately reduces the production of prostaglandins which are involved in pain/inflammation.
Testing Pearls: Increase GI bleed risk, take with food; exacerbates CHF/edema; inhibits platelet activity.
Clarithromycin (Biaxin)
MOA: Binds 50s ribosomal subunit and prevents protein synthesis.
Testing Pearls: Numerous CYP3A4 drug interactions (inhibitor); GI adverse effects; rare risk for QTc prolongation.
Lidocaine patch (Lidoderm)
MOA: Binds to neuronal membrane receptors and inhibits sodium ion influxes and prevents cell action potential
Testing Pearls: Local pain relieving effects; 12 hours on/12 off; systemic side effects usually minimal.
Dutasteride (Avodart)
MOA: Inhibits 5 alpha reductase which prevent dihydrotestosterone formation which contributes to enlargement of the prostate.
Testing Pearls: Sexual dysfunction side effect; fatigue; takes months to shrink prostate.
Phenytoin (Dilantin)
MOA: not well understood, possibly blocking voltage gated sodium channels.
Testing Pearls: Ataxia, CNS changes with toxicity; highly protein bound drug, low albumin can increase toxicity risk; enzyme inducing type effect on CYP3A4 and others.
Colchicine (Colcrys)
MOA: Binds to tubulin and prevents microtubule polymerization - reduces a gout flare and prevents it as well.
Testing Pearls: Diarrhea; rare indication for prophylaxis and treatment; dose adjusted with poor kidney function.
Moxifloxacin (Avelox)
MOA: Inhibits DNA gyrase in bacteria which prevents DNA separation and cell division.
Testing Pearls: Risk of spontaneous tendonitis or tendon rupture; considered a respiratory fluoroquinolone only; binding interaction with iron and calcium can reduce absorption.
Baclofen (Lioresal)
MOA: Not well understood; skeletal muscle relaxant.
Testing Pearls: Used in management of spasms; sedation, confusion; can be used on an as needed basis.
Hydroxychloroquine (Plaquenil)
MOA: Not well understood, originally was used as antimalarial drug, in US, primarily used as DMARD in RA and Lupus.
Testing Pearls: eye exams required; LFT/CBC monitoring; takes a while to begin working (not a quick acting medication in RA or Lupus).
Enoxaparin (Lovenox)
MOA: Increases activity of antithrombin that ultimately inactivates factor 10a; some activity against clotting factor 2a (thrombin), but less than heparin.
Testing Pearls: injection; bleed risk; risk a heparin induced thrombocytopenia.
Atomoxetine (Strattera)
MOA: Possible inhibition of norepinephrine transporter - used in ADHD.
Testing Pearls: Insomnia, anxiety, weight loss; not a controlled substance (compared to methylphenidate and amphetamine derivatives); can worsen agitation, irritability and possibly cause suicidal thoughts.
Diphenhydramine (Benadryl)
MOA: H1 receptor antagonist which leads to relief of allergy symptoms and causes sedation.
Testing Pearls: Anticholinergic effects; used for itching, mild to moderate allergic reactions; over the counter availability.
Ketoconazole (Nizoral)
MOA: Inhibits fungal cytochrome P450 enzyme 14alpha-demthylase.
Testing Pearls: 3A4 drug interactions (amiodarone, phenytoin, warfarin, etc.);primarily used as topical agent (if so, side effects are pretty minimal); liver concerns.
Nortriptyline (Pamelor)
MOA: Inhibits norepinephrine and serotonin reuptake, leading to increased concentrations in the synapse.
Testing Pearls: Highly anticholinergic (sedation, confusion, dry eye, etc.); can be used for pain syndromes (migraines, fibromyalgia, etc.); higher risk of cardiac concerns in overdose compared to SSRI’s so less often used for depression.
Benztropine (Cogentin)
MOA: Anticholinergic that is centrally acting and can inhibit dopamine uptake in the synapse - used to prevent EPS from antipsychotics and possible benefit in Parkinson’s.
Testing Pearls: Anticholinergic side effects like dry eyes, dry mouth, confusion, sedation; if patients are benefitting from antipsychotics but experiencing EPS, this drug may be used; not well tolerated in elderly.
Minocycline (Minocin)
MOA: Inhibits bacterial protein synthesis by binding to the 30s ribosomal subunit.
Testing Pearls: Increase sensitivity to sunburn; binding interactions with calcium and iron; most often used for skin disorders (i.e. acne).
Pantoprazole (Protonix)
MOA: Inhibits H+/K+ ATPase pump in gastric parietal cells (reduces hydrogen ion - stomach acid concentration in stomach).
Testing Pearls: Short term only recommended for GERD; associated with low magnesium and B12; most potent acid blocking medication class.
Cefuroxime (Ceftin)
MOA: Inhibits penicillin binding protein which prevents bacterial cell wall synthesis.
Testing Pearls: Diarrhea; nausea/vomiting; broader spectrum coverage than cephalexin.
Oxybutynin (Ditropan)
MOA: Antagonist at muscarinic receptors which helps in the management of overactive bladder.
Testing Pearls: Dry mouth; confusion; can exacerbate urinary retention.
Levetiracetam (Keppra)
MOA: Not well known; possible anti-seizure activity due to inhibition of presynaptic calcium channels.
Testing Pearls: Sedation; confusion; can accumulate in kidney disease.
Hydralazine (Apresoline)
MOA: Not well understood, directly vasodilator, reduces blood pressure.
Testing Pearls: Dosed multiple times per day; can exacerbate, cause Lupus; low blood pressure, dizziness risk.
Liraglutide (Victoza)
MOA: Acts like human incretin (GLP-1-agonist) which can aid in promoting fullness, decrease appetite and possibly stimulate insulin release.
Testing Pearls: Weight loss effect as well as lowering blood sugars; injection, GI side effects; avoid in patients who’ve had thyroid cancer
Prasugrel (Effient)
MOA: Blocks binding of ADP to the P2Y12 receptor; by doing this, it prevents platelet aggregation.
Testing Pearls: bleed risk; often used in combination with aspirin following stenting; costlier than clopidogrel.
Mirabegron (Myrbetriq)
MOA: Acts as an agonist at Beta-3 type receptors which causes detrusor smooth muscle relaxation and can help with overactive bladder.
Testing Pearls: Increase in blood pressure; increase heart rate; unique mechanism from anticholinergic medication used for OAB.
Canagliflozin (Invokana)
MOA: Inhibits SGLT-2 which helps keep glucose in the urine - so ultimately reduces blood sugar.
Testing Pearls: Risk of urinary tract infections; mild diuretic effect; monitor kidney function.
Apixaban (Eliquis)
MOA: Inhibits clotting factor 10a to prevent blood clots and stroke.
Testing Pearls: Dose adjustments base don age, weight, and kidney function; alternative to warfarin without routine INR requirement; bleed risk.
Tradjenta (Linagliptin)
MOA: DPP-4 inhibitor - DPP-4 breaks down incretins like GLP-1 which are hormones that can reduce blood sugars by promoting fullness.
Testing Pearls: rare pancreatitis risk; GI side effects; low risk of hypoglycemia when used alone.
Dulaglutide (Trulicity)
MOA: Acts like human incretin (GLP-1 agonist) which can aid in promoting fullness, decrease appetite and possibly stimulate insulin release.
Testing Pearls: weight loss effect as well as lowering blood sugars; injection (once weekly), GI side effects; avoid in patients who’ve had thyroid cancer.
Morphine (MS Contin)
MOA: binds, activates mu-opioid receptor.
Testing Pearls: Addiction/dependence risk; respiratory depression; constipation.
Empagliflozin (Jardiance)
MOA: Inhibits SGLT-2 which helps keep glucose in the urine - so ultimately reduces blood sugar.
Testing Pearls: Risk of urinary tract infections; mild diuretic effect; monitor kidney function.
Rivaroxaban (Xarelto)
MOA: Inhibits clotting factor 10a to prevent blood clots and stroke.
Testing Pearls: Dose adjustments based on age, weight, and kidney function; alternative to warfarin without routine INR requirement, bleed risk.
Amiodarone (Cordarone)
MOA: Class 3 antiarrhythmic; likely inhibits potassium and sodium channels which increase the duration of ventricular and atrial muscle contraction.
Testing Pearls: LFT monitoring; TSH monitoring; can cause pulmonary fibrosis.
Carbamazepine (Tegretol)
MOA: Sodium channel antagonist used in the management of seizure, bipolar, and trigeminal neuralgia.
Testing Pearls: Potent enzyme inducer, lots of drug interactions; LFT monitoring; hyponatremia risk.
