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68 Cards in this Set
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fluticasone, flunisolide, mometason, beclomethasone, budesonide
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nasal corticosteroids
most effective for ongoing nasal stuffiness not acute, safe for long term use used chronically |
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cetrizine, loratidine
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2nd generation anti-histamines
decreased sedation, well tolerated Must start anti-histamine use before exposure to allergen |
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diphenhydramine, chlorphenirimine
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1st generation anti-histamines
prevent/ decrease allergic reaction, block H2, must take before exposure to allergen S.E.- drowsiness, anticholinergic effects (dry mouth, constipation) |
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decongestants
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decrease nasal constriction via vasoconstriction
decrease fluid leaving from blood vessels, decrease inflammation and decrease mucus S.E.- tachycardia, tremor, anxiety, insomnia, increase BP and BG nasal- rebound congestion N.I.- avoid @ bedtime, relative contraindications, know S.E. and duration of nasal use |
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Ipratropium, tiotropium
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anti-cholinergic bronchodilator
increase bronchodilation, decrease mucus and increase bronchodilation S.E.- dry mouth, bitter taste, scratchy throat N.I.- appropriate inhalation |
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formoterol, salmeterol
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LABA- b2 agonist
prophylactic, long term control. Must use with ICS S.E.- tachycardia, angina, tremor N.I- Monitor PRN use, and know difference between SABA and LABA |
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Salbutamol, fenoterol, terbutaline
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SABA- b2 agonist causing bronchodilation
rescue inhaler- fast onset PRN S.E.- tachycardia, tremor, angina |
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theophylline
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produces bronchodilation
diuretic effect has a very defined therapeutic range and has many drug interactions S.E.- caffeine like, nausea, heachache, anxiety GI- vomiting, diarrhea Cardiac- tachycardia, dysrythmmias, anxiety, seizures |
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cromolyn, nedocromil
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non-steroidal agent for bronchodilation
prophylaxis, well tolerated used in children to avoid using corticosteroids |
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advair, symbicort
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combination of LABA and ICS to promote compliance
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methylprednisolone, hydrocortisone
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corticosteroids- anti-inflammatory, not a bronchodilator. Considered cornerstone of asthma care
IV- for acute attack PO- tapering doses and on occasion for chronic prophylaxis S.E.- inhaled, few side effects, just oral trush. prophylaxis only systemic- hyperglycemia, insomnia N.I- importance of use and gargle and spit |
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guaifenesin
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expectorant- loosening and coughing of mucus, unproven efficacy
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dextromethrophan
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anti-tussive for exhausting, non-productive cough
DM is well tolerated, poor evidence for efficacy |
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zafirlukast, montelukast
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leukotriene modifiers
block action of leuktriene which causes inflammation and bronchospasm. Well tolerated, prophylaxis only |
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aluminum hydroxide
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Antacid
S.E.- causes constipation ↑ gastric pH by neutralizing acid = H2O + CO2 (Gas) prevent activation of pepsinogen to pepsin used in indigestion, active and chronic ulcers, reflux esophagitis (GERD) and prevention of stress ulcers |
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magnesium hydroxide
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Antacid
S.E.- causes diarrhea ↑ gastric pH by neutralizing acid = H2O + CO2 (Gas) prevent activation of pepsinogen to pepsin used in indigestion, active and chronic ulcers, reflux esophagitis (GERD) and prevention of stress ulcers |
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Calcium Carbonate
Sodium bicarbonate: Sodium citrate: |
Antacids
Calcium Carbonate: cause slight constipation, long acting Sodium bicarbonate: short acting, gas-forming, systemic effect Sodium citrate: solution, short acting |
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cimetidine, ranitidine, famotidine, nizatidine
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anti-histamines
Block acid secretion by blocking histamine (H2) receptors in GI tract Used for: Peptic ulcer, Prevention of stress ulcers, hypersecretion Reflux esophagitis S.E.- Headaches, malaise, constipation, diarrhea, light‑headedness Cimetidine only: Gynecomastia, confusion more drug interactions |
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Sucralfate
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cytoprotective agent
MOA: Coats ulcer to protect against further damage Used for:Peptic ulcer, prevention of stress ulcers association with NSAIDs |
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Misoprostol
Diclofenac/misoprostol (prostaglandin E-1) |
cytoprotective agent
Inhibits gastric acid secretion increase mucous, bicarbonate and mucosal perfusion (protective effect) Uses: Peptic ulcer association with NSAIDs S.E.-constipation, nausea, gastric discomfort and metallic taste Drug interactions: antacids and H2 blockers |
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Omeprazole (Losec),
Pantoprazole,(Pantoloc) Lansoprazole,(Prevacid) Rabeprazole, (Pariet) Esomeprazole (Nexium) |
PPI
Inhibit acid transport across the cell membrane Most effective inhibitors of gastric acid Uses: Peptic ulcer Agent of choice in severe GERD UGIB upper gastro intestinal bleed S.E.- nausea, abdominal colic, diarrhea, constipation Drug Interactions: inhibits oxidative metabolism - caution with diazepam, phenytoin, clopidogrel & others |
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Metoclopramide
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Motility agent
dopamine antagonist, crosses blood‑brain barrier Used in: Gastric stasis GERD motility agent (ICU/DM) antiemetic S.E.- restlessness, drowsiness, fatigue, lassitude extrapyramidal effects |
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Domperidone
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motility agent, similar to metoclopramide, but does not cross BBB
Uses: Gastric stasis, antiemetic, GERD |
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Bulk Forming agent
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anti-constipation
Increases stool water, bulk Decreases GI transit time >10 g per day (dietitians!) Continue >1 month Fluid intake important Watch for worsening! |
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Docusate
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"anti-constipation"
Does NOT work for constipation Might work for prevention Should not be relied on for efficacy Bulk forming agents +/- dietary fiber should be mainstay of prevention Should Never be ordered PRN |
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Lactulose
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anti-constipation
Metabolized to LMW acids Osmotic effect to ↑ fluids Lowers pH, increases perstalsis Alternative agent Potential electrolyte imbalance |
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Bisacodyl
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anti-constipation, works in 6-12 hours
Stimulant of mucosal nerve plexus Variable response Every few weeks use Severe abd cramping Fluid/electrolyte imbalance Not for pregnancy Pink urine? |
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Senna/ cascara
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Anti-constipation
Stimulant Intermittent use Bowel dependence Melanosis coli after daily use |
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Magnesium Sulfate
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anti-constipation
Osmotic action which retain fluids in colon Stimulates cholecystokinin which increases bowel motility “milk of magnesia” Fluid/electrolyte imbalance |
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Polyethylene glycol electrolyte lavage
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anti-diarrheal
Osmotic fluid shifting Small doses (250 mL or less) can be used to prevent/treat occasional constipation 4 L over ~3 hours “gulp” not “sip” May need NG IN = OUT |
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mineral oil
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anti-constipation
Lubricant 2-3 days Side effect potential Lymphoid tissue reaction Lipoid pneumonia ADEK deficiency Oily leakage |
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kaolin‑pectin
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locally acting anti-diarrheal
adsorbents; bacteria or toxin non‑toxic but effectiveness has not been established |
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dimenhydrinate, diphenhydramine, promethazine, cyclizine
scopolamine |
Activity mostly due to anticholinergic properties, therefore most useful in motion sickness
Side Effects: drowsiness, confusion, blurred vision, dry mouth, urinary retention, tachycardia Monitoring: signs of efficacy and toxicity if dry mouth occurs may wish to use ice chips |
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Prochlorperazine
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Blocks dopamine
Often used in combination therapy for chemotherapy induced emesis Side Effects: hypotension (esp. by injection), drowsiness, extrapyramidal reactions, hypersensitivity |
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Ondansetron
Granisetron Dolasetron |
anti-emetic
Serotonin (5-HT3 ) receptor antagonist Used especially in chemotherapy induced emesis / PONV!! Side Effects: headache, sedation, constipation, diarrhea |
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Droperidol and haloperidol
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anti-emetic
Butyrophenones Blocks dopamine receptors in CTZ Side Effects: drowsiness, hypotension and dystonic reactions |
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Aprepitant
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anti-emetic
NK1 antagonist (substance P/neurokinin-1 antagonist) added to SRA's + Dexamethasone Decreases emesis even more |
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Ipecac Syrup
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emetic
hardly ever used Stimulates CTZ and irritates mucosa causing emesis Used to induce vomiting in early management of acute overdoses of certain agents May cause protracted vomiting, diarrhea and lethargy |
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Activated Charcoal
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adsorbent
Used to prevent absorption of drugs or toxin in GI tract Inert substance, often given by NG tube Do not give at same time as ipecac or other oral therapy *** within 1 hour of ingestion*** |
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orlistat
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weight-loss agent
inhibits lipase action in gut so triglycerides are not broken down to be absorbed modest effect (3-5 Kg weight loss) over 2 year SE: oil spotting, flatulence, fecal urgency & frequency |
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penicillin G
cloxacillin ampicillin and amoxicillin amoxicillin/clavulanic acid (Clavulin®) piperacillin piperacillin/tazobactam ticarcillin +/- clavulanic acid |
well tolerated
bactericidal good tissue penetration relatively inexpensive lots of clinical experience few drug interactions S.E.-Allergy Rash GI: nausea, vomiting, diarrhea* Seizures (rare, high doses, renal dysfunction) Hematological: neutropenia |
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Types of Allergic Reactions (to antimicrobials)
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Type I: Immediate (Anaphylactic) Reaction
Type II: Cytotoxic Reaction Type III: Immune-complex Reaction Type IV: Delayed Hypersensitivity Reaction |
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cefazolin (Ancef); cephalexin (Keflex)
cefuroxime (Zinacef, Ceftin) cefoxitin cefotaxime, ceftriaxone, cefixime ceftazidime cefepime |
cephalosporins
beta-lactams S.E.- Allergy (anaphylaxis rare) Rash GI: nausea, vomiting, diarrhea (2-5%) Seizures (rare, high doses, renal dysfunction) Hematological: neutropenia |
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meropenem
imipenem ertapenem |
carbopenems
beta-lactams broadest coverage of all abx: gram positive, gram negative and anaerobes S.E.- Allergy Rash GI: nausea, vomiting, diarrhea Seizures (rare, high doses, renal dysfunction) Hematological: neutropenia |
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Erythromycin (PO, IV), Clarithromycin (PO), Azithromycin (IV/PO)
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The Macrolides
Gram positive coverage & H. flu, M. catarrhalis “Atypical” coverage (e.g. chlamydia, legionella) Often used for respiratory tract infections Usually part of H. pylori regimen An alternative agent for “penicillin allergic” patients for mild infections S.E.- Gastrointestinal: nausea/vomiting, abdominal pain, diarrhea, metallic taste monitor tolerance! Phlebitis (IV erythro) Liver (cholestatic) QT Prolongation; irregular heart rhythm |
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gentamicin
tobramycin amikacin |
aminoglycosides
gram-negative bacteria including Pseudomonas aeruginosa synergy with other antibiotics for some gram positive bacteria no activity against anaerobes Serum levels monitored for efficacy and toxicity S.E.- Nephrotoxicity (kidney dysfunction) Ototoxicity Neuromuscular Blockade Various dosing regimens; selected based on renal function & pt weight Elderly at highest risk of toxicity: nephrotoxicity and ototoxicity Need to monitor drug levels and SCr |
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norfloxacin (Noroxin®)
ofloxacin (Floxin®) ciprofloxacin (Cipro®) levofloxacin (Levaquin®) moxifloxacin (Avelox®) |
fluorquinolones
Ciprofloxacin Mainly covers gram negative bacteria Levofloxacin, moxifloxacin gram negative coverage good gram positive coverage esp Strept pneumoniae, atypical organisms Used for a variety of infections, incl UTIs, pneumonia S.E.- GI: nausea/vomiting, abdominal pain, diarrhea CNS: headache, dizziness, confusion, seizures Rash; photosensitivity Cipro>Levo>Moxi QT Prolongation on ECG High or low blood sugar levels Arthropathy, tendinitis |
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Cotrimoxazole
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Sulfonamides
Septra Strength of IV, PO tabs and PO liquid varies Oral form well absorbed Gram positive and gram negative bacteria, including MRSA Common uses include tx of UTIs, traveller’s diarrhea, PCP pneumonia S.E.- Skin rash (Esp. HIV+) / allergy 2nd most common cause of allergic rxns Crystalluria keep patients well hydrated Photosensitivity Liver Blood (decreased white or red blood cells ) Some drug interactions |
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Tetracycline, minocycline, doxycycline
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Limited spectrum
Used for acne, pneumonia, STIs S.E.- Nausea, abdominal pain, esophagitis give with full glass of water ! Photosensitivity Teeth staining / bone formation (children <9, pregnancy) CNS: headache, lightheadedness, dizziness |
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Clindamycin
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Active against gram positives & anaerobes
NOT related to aminoglycoside or macrolide antibiotics IV and oral Adverse Effects: Mainly GI: nausea, vomiting, abd pain, and diarrhea (incl C. difficile) |
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Metronidazole
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Active vs anaerobes / misc. organisms
IV and oral (oral well absorbed) Also used to treat C. difficile oral preferred Adverse Effects: Mainly GI: nausea, abd pain, anorexia, metallic taste CNS: dizziness, paresthesias Some drug interactions (e.g. ethanol, warfarin) |
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Vancomycin
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A glycopeptide
Covers only gram positive organisms (including MRSA) Used as alternative in penicillin allergic (IgE) patients Not absorbed orally; must be given IV for systemic infection Oral form only to treat C. difficile S.E.- Red Man Syndrome [rate related histamine release—not due to allergy (e.g. IgE)] Flushing, rash over trunk, hypotension Skin reactions--true hypersensitivity rare Nephrotoxicity phlebitis |
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Nystatin, Amphotericin prepns
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polyenes
anti-fungal Main advantage – broad spectrum of activity Ampotheracin B S.E.- Ampho-terrible” Nephrotoxicity Decreased renal function: increase in serum creatinine (up to 50%) (dose limiting) K+, Mg++, bicarb wasting 50-100% Saline loading before dose may reduce nephrotoxicity Anemia with long term use |
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Ketoconazole, fluconazole, itraconazole, voriconazole, posaconazole
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Azole antifungal agents
Fluconazole most commonly used (Candida) Advantages: oral forms available, well tolerated Disadvantages: spectrum of coverage, drug interactions S.E.- Gastrointestinal Rash Skin photosensitivity with voriconazole Liver toxicity Visual disturbances (transient) with voriconazole |
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Caspofungin, micafungin, anidulafungin
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Echinocandins Antifungal Agents
Newest class, inhibit fungal cell wall Intravenous administration only Well tolerated Few drug interactions Adverse Effects: Rash, phlebitis Mild histamine release with infusion possible Liver |
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Bethanecol
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Parasympathomimetics (Cholinergics)
mimics effects of acetylcholines direct acting cholinergic drug – produces the effects of stimulation of the parasympathetic nervous system – works predominantly on muscarinic receptors used for urinary tract disorders to enhance urination S.E.- salivation, lacrimation, urination, defecation |
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donepezil
galantamine |
parasympathetomimetics
Donepezil – indirect acting anticholinesterase agent -used in treatment of Alzheimer’s disease Galantamine – indirect acting cholinergic agent Used in treatment of mild to moderate dementia associated with Alzheimer’s disease S.E.- salivation, lacrimation, urination, defecation |
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Atropine
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Anticholinergics (Parasympatholytics)
Actions - increases heart rate and used in symptomatic bradycardia -first line drug for heart block Indications - bradyarrhythmias |
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Norepinephrine (Levophed®)
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sympathomimetic
- activates alpha and beta1 receptors - main use as - IV infusion to increase blood pressure in shock - increases blood pressure by increasing cardiac output and causing vasoconstriction S.E. Tachycardia or tachyarrhythmias Decreased tissue perfusion – maintain adequate blood volume (fluids) to prevent ischemia Extravasation – inspect infusion site to avoid extravasation Localized vasoconstriction and tissue necrosis if IV goes interstitial. Antidote - phentolamine (alpha blocker) Headache, nausea and vomiting, taste changes |
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Epinephrine (adrenaline®)
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one of the first adrenergic agonists used
_activates all four subtypes of adrenergic receptors: alpha1, alpha2, beta1, beta2 - three main uses:cardiac arrest for asystole (usually 1 mg IV every 3-5 minutes) anaphylactic reactions (epipen® 0.3 mg, if anaphylaxis dose can be repeated every 5-15 minutes – half the dose if children <30 kg) can be used in asthma (not first line) decrease absorption of local anesthetics S.E.- Tachycardia or tachyarrhythmias Decreased tissue perfusion – maintain adequate blood volume (fluids) to prevent ischemia Extravasation – inspect infusion site to avoid extravasation Localized vasoconstriction and tissue necrosis if IV goes interstitial. Antidote - phentolamine (alpha blocker) Headache, nausea and vomiting, taste changes |
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Dopamine
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sympathomimetic
activates: dopamine, beta1, and : alpha1 (high doses) - used in septic and cardiogenic shock Has dose dependent receptor activity -in low doses has unique effect on kidneys - increases blood flow and urine output -effects are dose dependent in that the higher the dose the more vasoconstriction (alpha effect) S.E.- Tachycardia or tachyarrhythmias Decreased tissue perfusion – maintain adequate blood volume (fluids) to prevent ischemia Extravasation – inspect infusion site to avoid extravasation Localized vasoconstriction and tissue necrosis if IV goes interstitial. Antidote - phentolamine (alpha blocker) Headache, nausea and vomiting, taste changes |
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Dobutamine
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sympathomimetic
primarily used for cardiogenic shock e.g. Severe heart failure associated with MI - most cardiac specific of the vasopressors (beta1 activity in the heart) - should not significantly increase BP – if it does, reduce dose S.E.- Tachycardia or tachyarrhythmias Decreased tissue perfusion – maintain adequate blood volume (fluids) to prevent ischemia Extravasation – inspect infusion site to avoid extravasation Localized vasoconstriction and tissue necrosis if IV goes interstitial. Antidote - phentolamine (alpha blocker) Headache, nausea and vomiting, taste changes |
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Phentolamine
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sympatholytics
Alpha Blockers Block stimulation of the sympathetic nervous system at level of alpha receptor Phentolamine is prototype – blocks alpha1 and alpha2 receptors: occurs at both renal and arterial vessels Predominant effect is to cause vasodilation and reduce blood pressure Little therapeutic usefulness -side effects, short duration of action and availability of other antihypertensives Still used for extravasation of norepinephrine or dopamine (SC phentolamine will prevent tissue necrosis if used quickly) |
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Propranolol
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sympatholytics
beta-blocker blocks beta-1 and beta-2 receptors and therefore effects are: Heart - decrease HR - decrease conduction - decrease contractility - decrease BP Lungs - can exacerbate bronchospasm in asthma and COPD Used for: Angina Hypertension - arrhythmias - post myocardial infarction - heart failure - others: migraine, glaucoma, essential tremor S.E.- Most are predictable: bradycardia, heart block, heart failure, alterations in blood sugar (masking of hypoglycemia symptoms in diabetic patients) |
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hydrochlorothiazide
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diuretic
Cornerstone of antihypertensive therapy Reduce BP when used alone and also enhance effects of other antihypertensive drugs Thiazide diuretics reduce blood pressure by: reduction of blood volume (initial effect) and reduction of arterial resistance (sustained over longer term) Side Effects: Hypokalemia, Increased serum lipids , Increased uric acid. |
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ACE inhibitors
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Lower BP by preventing angiotensin II mediated vasoconstriction and aldosterone mediated volume expansion
Prototype agent - captopril (Others: Enalapril, Lisinopril, Fosinopril). Mechanism of action - prevent formation of Angiotensin II (potent vasoconstrictor) and aldosterone (Na/H2O retention) Recommended as monotherapy in patients who fail to respond/cannot tolerate diuretics or beta blockers. Can also be used in combination therapy. Side Effects: Renal dysfunction, Hyperkalemia, Teratogenic - avoid in pregnancy as fetal damage can occur Drug Interactions: NSAIDS, Diuretics (additive hypotension), additive effects with other antihypertensives, lithium |
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losartan, valsartan, candesartan, irbesartan, telmisartan.
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angiotensin II antagonists
Angiotensin II antagonists block the ACTIONS of angiotensin II . Both have similar therapeutic effects in terms of blood pressure reduction. Differences are: - ACE inhibitors have greater proven efficacy in improving morbidity and mortality in the treatment of hypertension and heart failure ACE inhibitors cause cough whereas Angiotensin II antagonists do not (theory based on bradykinin levels in lungs – Angiotensin II antagonists do not increase bradykinin levels in the lung) |
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aliskerin
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Direct renin inhibitor
Acts directly on renin to inhibit conversion to angiotensin I – can influence entire RAAS Relatively new agent – long term efficacy and safety unknown |
