Top 25 Drugs Flashcards
Doxazosin
1, 2, 4, 8mg TAB
4, 8mg ER TAB
BPH: IR - 1mg po qd / ER - 4mg po qd
HT: IR - 1mg qd, max 16mg qd
~Expulsion of distal ureteral stone: IR 2-4mg qd pm f4wk
~Pheochromocytoma: 1-8mg po qd
- Initial dose w/ breakfast (esp. XR)
- Avoid activities w/ coordination until drug effects are realized.
- Rise slowly, may cause orthostatic hypotension.
- Syncope or loss of consciousness is possible w/ 1st dose or increased dose, esp. in upright position.
- Report priapism to PCP immediately
Decreased BP, improvement in urinary symptoms
Cardura (XL)
a1 - adrenergic blocker
Selectively blocks postsynaptic a1 receptors, reducing peripheral resistance through arterial & venous dilations.
Reflex tachycardia that occurs w/ other vasodilators is infrequent because there is no presynaptic a2 blockade.
Increase urine flow by relaxing smooth muscle tone in the bladder neck & prostate.
(<1%) Hepatotoxicity, priapism
Beta-blockers, NIFEDIPINE, PDE inhibitors
CYP3A4/5 inducers
CYP3A4/5 inhibitors
Tamsulosin
0.4 mg CAP
BPH: 0.4mg qd, tit - 0.8mg qd
~Neurogenic Bladder, Bladder outlet obstruction symptoms, Ureteral stones (DC after successful expulsion)
- Administer 30min after same meal qd as fasting increases bioavailability by 30%.
- Pt should avoid activities that require coordination.
- Rise slowly –>rthostatic hypotension
- Syncope or loss of conciousness possible w/ first dose or ^dose, esp. in upright positions
AUA Symptom score, decrease in residual urine volume
increased urine flow
Flomax
a1 - adrenergic blocker
Closely related to QUINAZOLINE derivatives that selectively block postsynamptic a1 receptors.
Total Peripheral resistance is reduced through arterial & venous dilations.
Relex Tachycardia that occurs w/ other vasodilators is infrequent bc there is no presynaptic a2 blockade.
The drugs also < total cholesterol, ^HDL cholesterol, and may improve glucose tolerance, and reduce left ventricular mass during long-term therapy.
Increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate.
(>10%) Dizziness, headache, abnormal ejeculation, rhinitis
(<1%) Retinal detachment, priapism
a1 blockers > ^hypotension risk
CYP3A4/5 inducers
CYP3A4/5 inhibitors
beta-blockers, calcium channel blockers, MAOIs
Lisinopril
2.5, 5, 10, 20, 30, 40mg TAB
Acute MI: 5-10mg qd f6wk
Heart Failure: 2.5-5mg qd, tit ->40mg/d
HT: Adults - 10mg qd, tit ->80mg/d
Children - 6-16yrs 0.07mg/kg, tit->0.61mg/kg/d
- Avoid Pregnancy
- Use K+ supplements or salt substitute only under medical supervision
- May cause dizziness that may worsen if dehydrated
Decreased BP
Prinivil, Zestril
ACE-Inhibitor, AntiHT
Competetive ACE-I. Reduces serum aldosterone, leading to decreased NA+ retention, potentiates the vasodilator kallikrein-kinin system.
Can alter prostanoid metabolism
Inhibit SNS
Inhibit tissue renin-angiotensin system
(<1%) Angioedema, birth defects, liver failure
Angiotensin-receptor blockers K+ sparing diuretics AZTHIOPRINE CYCLOSPORINE Diuretics NSAIDS K+ Supplements / Salt Substitutes SACUBITRIL
Spironolactone
25, 50, 100mg TAB
Heart Failure (NYHA class 3-4): 12.5-25mg qd, tit->50mg
Edema aw/ Heart Failure: 100mg qd in single or divided doses tit->400mg/d
Nephrotic syndrome: 100mg qd, “
HT: 50-100mg qd, “
Hypokalemia: 25-100mg qd
- May cause dizziness
- Avoid driving/mechinery
- Report s/s of hyperkalemia (muscle weakness, fatigue, bradycardia) and hyponatremia (confusion,dry mouth, thirst, weakness, decreased urination, hypotension)
- Avoid K+ supplements, food/salt
- Avoid alcohol & NSAIDs
Aldactone
Potassium Sparing Diuretic
Selective Aldosterone Blocker
Steroidal competitive aldosterone antagonist that acts from the interstitial side of the distal/collecting tubular epithelium to block na/k exchange, producing a delayed/mild diuresis. Diuretic effect is maximal in states of hyperaldosteronism. Excreation of NA and CL is increased; excretion of K and MG is decreased. Spiranolactone has mild anti-HT activity and has demonstrated a beneficial effect in NYHA class 3/4 heart failure.
(<1%) Cardiac arrhythmia, gastric hemorrhage
K+ sparing diuretics ACE-Is, angiotensin receptor antagonist EPLERENONE, K+ supplements, salt substitutes NSAIDs DIGOXIN, SOTALOL
Losartan
25, 50, 100mg TAB
HT: Adults, initial 50mg qd, tit-> 25-100mg qd/bid
Child >6yr, 0.7mg/kg qd max 50mg qd
Reduce risk of cerebrovascular accident, in HT patients w/ left ventricular hypertrophy, PROPHYLAXIS, diabetic nepropathy: 50mg qd, tit-> 100mg qd
Diabetic nephropathy: Initial 50mg qd, tit->based on BP up to 100mg qd
~Heart Failure: Initial 12.5mg qd –> 50mg qd
~Cardiovascular event risk, reduction: Adults 50-100mg qd
~Isolated systolic HT, left ventricular HT, nondiabetic kidney disease: 50mg qd
Cozaar
Angiotensin 2 Receptor Antagonist
Antihypertensive
Losartan is a selective, reversible, competitive antagonist of the angiotensin 2 receptor, responsible for the physiologic effects of AT2 including VASOCONSTRICTION, aldosterone secretion, sympathetic outflow, and stimulation of renal NA reabsorption.
(>10%) Headache
(<1%) Angioedema, birth defects, hepatotoxicity, rhabdomyolysis
ACE-Is, K+ sparing diuretics ALISKIREN CYP2C9 & CYP3A4/5 inducers+inhibitors Diuretics K+ supplements/Salt substitutes NSAIDs
Valsartan
40, 80, 160, 320mg TAB
Heart Failure: 40mg bid, tit–>320mg/d
HT: 80-160mg qd, tit->320mg qd
MI: 20mg bid, tit-> 320mg qd
- Do not DC abruptly
- Use K+ supplements /salt ONLY under medical supervision.
- Dizziness
- Avoid driving/machinery
- Avoid Alcohol & NSAIDs
Decreased BP, signs/symptoms of Heart Failure
Diovan
AT2 Receptor Antagonist
Valsartan is a selective, reversible, competitive antagonist of the AT2 receptor, which is responsible for the physiologic effects of AT2, including: vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal NA reabsorption.
(>10%) Dizziness
(<1%) Angioedema, rhabdomyolysis
K+ sparing diuretics ACE-I's K+ supplements / salt NSAIDs DIURETICS ALISKIREN
Nifedipine
30, 60, 90mg XR TAB
10, 20mg CAP
HT: Adults XR30mg qd Children 0.25mg/kg qd Stable Chronic Angina: XR30-60mg qd Variant angina: XR30-60mg qd ~Raynaud phenomenon: XR30-60mg qd
- Take Adalat CC on empty stomach
- avoid GRAPEFRUIT
- Report s/s of hypotension, excerbation of angina, peripheral edema, fatigue,
- Avoid sudden discontinuation of drug, can cause rebound HT
- Dizziness, avoid driving/machinery
Adalat CC, Procardia XL
Calcium Channel Blocker
Nifedipine is a calcium ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle.
Does not alter serum calcium concentrations.
(>10%) Flushing, Headache, Perepheral Edema, Dizziness
(<1%) Aplastic anemia, thrombocytopenia, angina, tachycardia
NSAIDs Beta-Blockers CLOPIDOGREL CYP3A4/5 inducers+inhibitors TACROLIMUS QUINIDINE
Nitroglycerin 2.5, 6.5, 9mg XR CAP 0.3, 0.4, 0.6mg SL TAB 0.1-0.8mg/h Transdermal Patch 24hr 0.4mg/actuation Sublingual Solution 2% Transdermal Ointment 400mcg/spray Translingual Aerosol Solution 0.4% Rectal Ointment
Angina, prophylaxis: XR2.5-6.5mg tid-qid
SL 1tab or 1-2sprays 5-10min before activity (which may induce angina
Transdermal, 0.2-0.4mg/h worn topically 12-14h per day,
Acute Angina: SL 1tab or 1-2 sprays @ first signs of angina, repeat q5min if needed for a total of 3 tabs or doses in 15min
- Sit prior to using SL tablets, SL aerosol, or spray
- Tab should be dissolved under tongue or buccal pouch at FIRST sign of angina. DONT SWALLOW OR CHEW
- Do not drink or eat after placement of tabs.
- Do not inhale, spit out or rinse mouth after use.
- Rise slowly
- Allow 10-12hr drug-free interval
- Avoid concurrent use of ALCOHOL, CNS depressants, antiHT’s, or other drugs that cause hyptension
- Ointment may stain clothing.
MInitran, NItro-Dur, Nitrostat
Nitrate, Antianginal
Nitroglycerin is believed to be converted to Nitric Oxide by Vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.
In myocardial ischemia, nitrates dilate large epicardial vessels, enhance collateral size & flow, and reduce coronary vasoconstriction.
(>10%) Headache
(<1%) ^ intracranial pressure, severe hypotension, syncope, methemoglobinemia
Phosphodiesterase inhibitors
RIOCIGUAT
Digoxin
- 5, 125, 187.5, 250MCG TAB
- 05mg/ml SOLUTION
AFIB: LD of 0.25mg po q2h to a total dose of 1.5mg, then 0.125-0.375mg qd
Heart Failure: Premature infant/children varies greatly
Adults: LD of 0.5-0.75mg once, then 0.125-0.375mg q68 for response, followed by 0.125-0.5mg qd
Supraventricular tachyarrythmia: LD of 0.75-1.5mg (divided into 3 doses, 1/2 total dose initially, followed by 1/4 total dose at q68 intervals later), then 0.125-0.5mg qd
~Fetal Tachycardia, supraventricular tachycardia: 0.125-0.375mg qd (administered to mother)
Lanoxin
Digitalis Glycoside
Digitalis Glycosides exert positive inotropic effects through improved availability of calcium to myocardial contractile elements, thereby increasing cardiac output in heart failure.
Antiarrthmic actions are caused by an increase in AV nodal refractory period via increased VAGAL tone, sympathetic withdrawal and direct mechanisms
(<1%) Cardiac dysrhythmias, psychosis, seizures
Beta Blockers Diuretics P-glycoprotein Inducers+inhibitors Antacids, bile acid sequestrants SUCRALFATE
Latanoprost
0.005% Ophthalmic Solution
Ocular Hypertension, Open-Angle Glaucoma: 1d into affected eye qd pm
- Wash Hands & remove contact lenses before use
- Pull lower lid of your eye to form pocket. Hold dropper close to your eye w/ other hand. Gently close eye.
- Place index finger over the inner corner of eye for 1 min.
- Do not rinse or wipe dropper or allow it to touch anything including eye.
- Put cap on bottle immediately
REDUCTION IN IOP
Xalatan
Prostaglandin
Antiglaucoma Agent
Prostaglandin F2-alpha analog.
Believed to reduce IOP by increasing the outflow of aqueous humor.
Studies suggest that the main MOA is increased uveoscleral outflow, exact MOA UNKNOWN.
(>10%) Blurred vision, itching, sensation of foreign body in eye, hyperpigmentation of eyelid, iris pigmentation
(<1%) Macular retinal edema, diplopia, keratitis.
PILOCARPINE
Azelastine
0.1%, 0.15% Nasal Spray
137 mcg/actuation
Perennial allergic rhinitis / Vasomotor Rhinitis: 2sprays pn bid
Seasonal allergic rhinitis: 1-2sprays pn bid
Avoid spraying in eyes.
Possible Somnolence; avoid alcohol use and hazardous activities.
Proper instillation; PRIME spray w/ initial use or if not used for 3+ days
Blow nose prior to use
Do NOT spray into wall seperating nostrils
Taste disturbances
DECREASE IN RHINITIS SYMPTOMS
Astelin
Antihistamine
Azelastin is a selective H1-receptor antagonist that blocks release of histamine cells.
Inhibits other mediators of allergic rxns and reduces chemotaxis/eosinophil activation.
Common - Bitter taste in mouth, headache, somnolence
CIMETIDINE
Gemfibrozil
600mg Tablet
Coronary Arteriosclerosis
Prophylaxis-familal combined hyperlipidemia
Familial type V hyperlipoproteinemia-Fredrickson type IV hyperlipoproteinemia
600mg po BID
Take 30min before BF and DIN.
Report signs of rhabdomyolysis, JAUNDICE, or renal failure
- Reduction in TG levels
- Reduction in total cholesterol
Increase in HDL cholesterol
Lopid
Antihyperlipidemic
Fibric acid derivatives activate PPARalpha -> increases lipolysis and elimination of TG-rich particles by activating lipoprotien lipase & Reducing production of opoprotein C3.
Activation of PPARalpha also induces an increase in the synthesis of apoproteins A1 and A2 and HDL-cholesterol.
Common - Indigestion
RBS - Rhabdomyolysis, cholithiasis, hepatotoxicity, mood disorder, impotence, agranulocytosis
STATINS (HMG-CoA reductase inhibitors)
Colchicine, Fibrates, Cholestyramine, colestipol
CYP1A2, CY2C19, CYP2C8, CYP2C9 substances
GLYBURIDE
CYP3A4/5 inducers/inhibitors
Niacin 250mg, 500mg ER Capsule 50, 100, 250, 500mg Tablet 250, 500, 750, 100mg ER Tablet 100, 1000g Oral Powder
Coronary Arteriosclerosis / Hypercholesterolemia: 500mg po qd
Dyslipidemia: IR 100-100mg po TID
ER 500-2000mg qd hs
MI, secondary prophylaxis: ER 500-2000mg qd hs
Start w/ low dose and titrate based on flushing tolerability.
Avoid alcohol & warm beverages to reduce flushing.
DC for several days, need to restart on lower dose.
Aspirin or NSAID 30min prior to niacin can reduce flushing.
Take HS w/ low-fat snack to help w/ flushing
Niaspan / SLO-Niacin
Antihyperlipidemic
Not well Defined.
Partial inhibition of release of free fatty acids from adipose tissue. Increased lipoprotein lipase activity.
Decrease rate of hepatic synthesis of VLDL & LDL
Common - Flushing
RBS - Hypophosphatemia, hepatotoxicity, rhabdomyolysis
Statins
Colchicine
Cholestyramine
Colestipol
Metoprolol
25, 50, 100mg Tablets
25, 50, 100, 200mg XR Tablets
Angina: 50mg bid or XR 100mg qd HF: 12.5-25mg XR po qd f2w HT: 50mg bid XR 25-100mg po qd Acute MI (AMI): 25-50mg q6-12h, convert to bid dosing over 2-3days or XR dosing w/ max dose of 200mg qd
Take on an empty stomach & avoid alcohol.
Avoid abrupt discontinuations, exacerbations of angina may occur.
Report signs of hypotension, HF, or agina w/ initial dose/dose changes.
Advise DIABETIC patients to carefully follow sugar levels.
Decreased BP, reduction in chest pain.
Decreased angina attacks, reduction in use of nitroglycerin for chest pain.
Improvement in s/s of HF.
Toprol XL
Beta Blocker, Cardioselective
Metoprolol is a cardioselective B-Blocker used in arrhythmias, HT, angina, & HF.
Effective in decreasing post-MI mortality.
Common - Dizziness, fatigue, hypotension.
RBS - Heart Failure
Alpha-Blockers, Fentanyl Amiodarone, dronedarone. Anti-DIABETIC drugs CCB's, quinidine, Clonidine, CYP2D6 inhibitors NSAIDS Venlafaxine
Carvedilol
3.125, 6.25, 12.5, 25mg Tablet
10, 20, 40, 80mg XR Capsule
Heart Failure: 3.125mg bid HT: 6.25mg bid, max 25mg bid XR 20mg bid, MAX 80mg qd Impaired LVentricular fxn post MI: 3.125-6.25mg bid, XR 10-20mg qd AM, max 80mg qd
Take w/ food or milk.
Report s/s of HF, bradyarrhthmias, bronchospasm, hypoT, syncope, or angina w/ initial dose or changes.
Avoid abrupt DC.
Avoid driving/machinary/danger
Diabetic patients should carefully follow blood sugar
Decreased BP and HR
Reduction in chest pain, angina attacks, nitroglycerin use
Improvement in s/s of HF
Coreg / Coreg CR
Alpha/Beta Blocker
Carvedilol is a selective Alpha and nonselective Beta blocker that decreases AV NODAL CONDUCTION in supraventricular tachycardias and blockade of catecholamine-induced dysrhythmias.
Common - Cold extremities, dizziness, ED, fatigue, hypoT, weight gain
RBS - HF, hepatotoxicity, Steven-Johnson syndrome
CCB, clonidine, quinidine, amiodarone, dronedarone
P-glycoprotein inducers / inhibitors / Substrates
CYP2D6 inhibitors
Insulin, oral hypoglycemic agents, NSAIDS
