Pharmacology 2 Flashcards
Diuretics: Types (4)
Thiazide
K-sparing
Loop
Mannitol
Thiazide diuretics: Names, usage, contraindication
Hydrochlorothiazide (HCTZ), Chlorthalidone, Indapamide (Lozol)
Usage: HF, HTN, edema
Contraindication: sulfa allergy
Thiazide diuretics: Adverse effects
Increases plasma glucose/hyperglycemia
Increases cholesterol and LDL
Increases uric acid –> may precipitate a gout attack
Hypokalemia (severe muscle weakness, arrhythmias)
Loop diuretics: Name, usage, contraindication
Name: Furosemide (Lasix), Bumetanide (Bumex)
Usage: Edema from HR, cirrhosis, renal Dz, and HTN
* More potent than thiazides but shorter duration of action
Contraindication: sulfa allergy
Loop diuretics: Adverse effects
- Elytes disturbance
- Hypovolemia and HoTN
- Pancreatitis, jaundice, rash
- Ototoxicity
HTN drugs (other than diuretics): Types (5)
ACE inhibitors Angiotensin receptor blockers Ca channel blockers Alpha-blockers Beta-blockers
Beta-blockers: Usage
HTN, post-MI, angina, arrhythmias, migraine prophylaxis
Preferred for angina pectoris, postacute MI
Nonselective beta-blockers: Names (3)
- it blocks both Beta-1 and -2
Propranolol
Carvedilol (Coreg)
Timolol (Blocarden)
Cardioselective beta-blockers: Names (2)
*It blocks beta-1 which are found mainly in the heart. Thus more potent
Atenolol (Tenormin)
Metoprolol
Beta-blockers: Contraindications
Pts w/ chronic lung Dz (asthma, COPD, chronic bronchitis, emphysema), bradycardia and atrioventricular block
Beta-blockers: Adverse effects
Bronchospasm (blocks beta-2 receptors in the lungs)
Bradycardia (blocks beta-1 receptors in the heart)
Depression, fatigue, erectile dysfunction, HF, blunts hypoglycemic response
ACE inhibitors and ARBs: Usage
HTN, diabetes, CKD, post-MI, HF
Preferred agents for Pts w/ HFrEF
ACEI: Names (5)
Name ends w/ -pril Ramipril (Altace) Lisinopril (Zestril) Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec)
ARBs: Names
Name ends with -sartan Losartan (Cozaar) Irbesartan (Avapro) Candesartan (Atacand) Valsartan (Diovan)
ACEIs and ARBs: Adverse effects
Hyperkalemia Dry cough (ACEI only) ACEI is Category C (1st trimester) and category D (2nd - 3rd trimester) --> discontinue ACEI immediately if Pt is pregnant
Ca channel blockers (CCBs): Usage
HTN, angina, arrhythmias, Raynaud’s phenomenon (1st line)
CCBs: Names
Amlodipine (Norvasc)
Diltiazem (Cardizem)
Nifedipine (Procardia)
Verapamil (Calan)
CCBs: Contraindications
AV block (2nd - 3rd degree block)
Bradycardia
CHF
CCBs: Adverse effects
Headache (vasodilation) Peripheral edema Bradycardia HF and heart block HoTN, QT prolongation Constipation (most common)
Alpha-blockers: Adverse effects
Orthostatic HoTN
Dizziness, syncope
Do not use during cataract/glaucoma surgery (floppy iris syndrome)
Oxymetazoline Nasal Spray (Afrin) and Phenylephrine (Neo-Synephrine): Key points
- Topical nasal decongenstants
- Short-term use of topical nasal decongestants (BID PRN x 3 days) is considered safe treatment for nasal congestion (common cold, allergic rhinitis)
- Rhinitis medicamentosa is due to chronic use (>3 days) of nasal decongestants
Antihistamines: Names
Diphenhydramine (Benadryl),
Loratadine (Claritin)
Cetirizine (Zyrtec)
Antihistamines: Considerations for elderly pts
- Avoid using diphenhydramine (Benadryl) in the elderly, if possible
- For elderly patients, use loratadine (Claritin) because it has a lower incidence of sedation
Cetirizine (Zyrtec): Key points
- Zyrtec is more potent and long acting than other antihistamines.
- It is very effective for acute and chronic urticaria
Decongestants: Names
Pseudoephedrine (Sudafed) and phenylephrine
Antitussives: Names
- Dextromethorphan (Robitussin, Delsym)
- Benzonatate (Tessalon)
Dextromethorphan: Contraindication
- Contraindicated within 14 days of a monoamine oxidase inhibitor (MAOI) and selegiline (Eldepryl)
Mucolytics: Names
- Guaifenesin
- H2O
Decongestants: Contraindication
HTN, CAD (angina, MI)
Decongestants: Pts advise
Mixing decongestants with other stimulants (caffeine, Ritalin, albuterol inhaler) will cause heart palpitations, tremors, and anxiety
OTC NSAIDs: Names
Ibuprofen (Advil, Motrin)
Naproxen (Aleve)
RX NSAIDs: Names
- Naproxen (Naprosyn, Anaprox), diclofenac (Voltaren) oral and topical gel
- Indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol)
- Cyclo-oxygenase-2 (COX-2) inhibitors: Celecoxib (Celebrex)
NSAIDs: Warnings
- NSAIDs should be avoided in HF, severe heart disease, GI bleeding, severe renal disease and during the past 3 months of pregnancy
- Patients with nasal polyps and asthma can be sensitive to aspirin/NSAIDs
- Ketorolac (Toradol) IM, IV, or tablets are for short-term use only (up to 5 days)
NSAIDs: Contraindications
- Ketorolac should not be used before surgery, with concurrent acetylsalicylic acid (ASA), pediatric patients, active or recent GI bleed, stroke, labor/delivery, and others.
Salicylates: Names
Aspirin (Bayers)
Drugs that require eye examination: 8 drugs
- Digoxin (yellow to green vision, blurred vision, halos if blood level too high)
- Ethambutol and linezolid (optic neuropathy)
- Corticosteroids (cataracts, glaucoma, optic neuritis)
- Fluoroquinolones (retinal detachment)
- Viagra, Cialis, Levitra (cataracts, blurred vision, ischemic optic neuropathy, others)
- Accutane (cataracts, decreased night vision, others)
- Topamax (acute angle-closure glaucoma, increased intracranial pressure, mydriasis)
- Plaquenil (neuropathy and permanent loss of vision)
Drugs that require tapering: 8 drugs
- Beta-blockers (rebound hypertension or hypertensive crisis)
- Benzodiazepines (severe anxiety, insomnia, seizures, tremors)
- Oral steroids
- Anticonvulsants (seizures)
- Paroxetine or Paxil
- Antiarrhythmics (refer to cardiologists)
- Antipsychotics and many others
- Digoxin
Theophylline level in adult
5-15 mcg/mL
Theophylline: Drug Interactions
- Drug interactions (cimetidine, alprazolam, macrolides, fluvoxamine, others)
- Avoid combining with other stimulants (theophylline, pseudoephedrine, caffeine, Ritalin)
