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68 Cards in this Set

  • Front
  • Back
fluticasone, flunisolide, mometason, beclomethasone, budesonide
nasal corticosteroids
most effective for ongoing nasal stuffiness
not acute, safe for long term use
used chronically
cetrizine, loratidine
2nd generation anti-histamines
decreased sedation, well tolerated

Must start anti-histamine use before exposure to allergen
diphenhydramine, chlorphenirimine
1st generation anti-histamines

prevent/ decrease allergic reaction, block H2, must take before exposure to allergen

S.E.- drowsiness, anticholinergic effects (dry mouth, constipation)
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
Ipratropium, tiotropium
anti-cholinergic bronchodilator
increase bronchodilation, decrease mucus and increase bronchodilation
S.E.- dry mouth, bitter taste, scratchy throat
N.I.- appropriate inhalation
formoterol, salmeterol
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
Salbutamol, fenoterol, terbutaline
SABA- b2 agonist causing bronchodilation
rescue inhaler- fast onset PRN

S.E.- tachycardia, tremor, angina
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
cromolyn, nedocromil
non-steroidal agent for bronchodilation

prophylaxis, well tolerated
used in children to avoid using corticosteroids
advair, symbicort
combination of LABA and ICS to promote compliance
methylprednisolone, hydrocortisone
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
expectorant- loosening and coughing of mucus, unproven efficacy
anti-tussive for exhausting, non-productive cough

DM is well tolerated, poor evidence for efficacy
zafirlukast, montelukast
leukotriene modifiers
block action of leuktriene which causes inflammation and bronchospasm.
Well tolerated, prophylaxis only
aluminum hydroxide
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
magnesium hydroxide
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
Calcium Carbonate

Sodium bicarbonate:

Sodium citrate:
Calcium Carbonate:
cause slight constipation, long acting
Sodium bicarbonate:
short acting, gas-forming,
systemic effect
Sodium citrate:
solution, short acting
cimetidine, ranitidine, famotidine, nizatidine

Block acid secretion by blocking histamine (H2) receptors in GI tract
Used for: Peptic ulcer,
Prevention of stress ulcers,
Reflux esophagitis
S.E.- Headaches, malaise, constipation, diarrhea, light‑headedness
Cimetidine only:
more drug interactions
cytoprotective agent

MOA: Coats ulcer to protect against further damage

Used for:Peptic ulcer,
prevention of stress ulcers
association with NSAIDs
(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
Omeprazole (Losec),
Rabeprazole, (Pariet)
Esomeprazole (Nexium)

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
Motility agent
dopamine antagonist, crosses blood‑brain barrier
Used in: Gastric stasis
motility agent (ICU/DM)
S.E.- restlessness, drowsiness, fatigue, lassitude
extrapyramidal effects
motility agent, similar to metoclopramide, but does not cross BBB
Uses: Gastric stasis, antiemetic, GERD
Bulk Forming agent

Increases stool water, bulk
Decreases GI transit time
>10 g per day (dietitians!)
Continue >1 month
Fluid intake important
Watch for worsening!

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
Metabolized to LMW acids
Osmotic effect to ↑ fluids
Lowers pH, increases perstalsis
Alternative agent
Potential electrolyte imbalance
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?
Senna/ cascara
Intermittent use
Bowel dependence
Melanosis coli after daily use
Magnesium Sulfate

Osmotic action which retain fluids in colon
Stimulates cholecystokinin which increases bowel motility
“milk of magnesia”
Fluid/electrolyte imbalance
Polyethylene glycol electrolyte lavage

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
mineral oil

2-3 days
Side effect potential
Lymphoid tissue reaction
Lipoid pneumonia
ADEK deficiency
Oily leakage
locally acting anti-diarrheal

adsorbents; bacteria or toxin
non‑toxic but effectiveness has not been established
dimenhydrinate, diphenhydramine, promethazine, cyclizine
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
Blocks dopamine
Often used in combination therapy for chemotherapy induced emesis
Side Effects: hypotension (esp. by injection),
drowsiness, extrapyramidal reactions, hypersensitivity
Serotonin (5-HT3 ) receptor antagonist

Used especially in chemotherapy induced emesis / PONV!!
Side Effects: headache, sedation, constipation, diarrhea
Droperidol and haloperidol

Blocks dopamine receptors in CTZ
Side Effects: drowsiness, hypotension and dystonic reactions
NK1 antagonist
(substance P/neurokinin-1 antagonist)
added to SRA's + Dexamethasone
Decreases emesis even more
Ipecac Syrup
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
Activated Charcoal
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***
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
penicillin G
ampicillin and amoxicillin
amoxicillin/clavulanic acid (Clavulin®)
ticarcillin +/- clavulanic acid
well tolerated
good tissue penetration
relatively inexpensive
lots of clinical experience
few drug interactions

GI: nausea, vomiting, diarrhea*
Seizures (rare, high doses, renal dysfunction)
Hematological: neutropenia
Types of Allergic Reactions (to antimicrobials)
Type I: Immediate (Anaphylactic) Reaction
Type II: Cytotoxic Reaction
Type III: Immune-complex Reaction
Type IV: Delayed Hypersensitivity Reaction
cefazolin (Ancef); cephalexin (Keflex)
cefuroxime (Zinacef, Ceftin)
cefotaxime, ceftriaxone, cefixime
S.E.- Allergy (anaphylaxis rare)
GI: nausea, vomiting, diarrhea (2-5%)
Seizures (rare, high doses, renal dysfunction)
Hematological: neutropenia

broadest coverage of all abx: gram positive, gram negative and anaerobes

S.E.- Allergy
GI: nausea, vomiting, diarrhea
Seizures (rare, high doses, renal dysfunction)
Hematological: neutropenia
Erythromycin (PO, IV), Clarithromycin (PO), Azithromycin (IV/PO)
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

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)
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
norfloxacin (Noroxin®)
ofloxacin (Floxin®)
ciprofloxacin (Cipro®)
levofloxacin (Levaquin®)
moxifloxacin (Avelox®)

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

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
keep patients well hydrated
Blood (decreased white or red blood cells )
Some drug interactions
Tetracycline, minocycline, doxycycline
Limited spectrum

Used for acne, pneumonia, STIs

S.E.- Nausea, abdominal pain, esophagitis
give with full glass of water !
Teeth staining / bone formation (children <9, pregnancy)
CNS: headache, lightheadedness, dizziness
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)
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)
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
Nystatin, Amphotericin prepns

Main advantage – broad spectrum of activity
Ampotheracin B S.E.- Ampho-terrible”

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
Ketoconazole, fluconazole, itraconazole, voriconazole, posaconazole
Azole antifungal agents

Fluconazole most commonly used (Candida)
Advantages: oral forms available, well tolerated
Disadvantages: spectrum of coverage, drug interactions

S.E.- Gastrointestinal
Skin photosensitivity with voriconazole
Liver toxicity
Visual disturbances (transient) with voriconazole
Caspofungin, micafungin, anidulafungin
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
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
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
Anticholinergics (Parasympatholytics)

Actions - increases heart rate and used in symptomatic bradycardia
-first line drug for heart block
Indications - bradyarrhythmias
Norepinephrine (Levophed®)

- 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
Epinephrine (adrenaline®)
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

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

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

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)

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
- 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)

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.
ACE inhibitors
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
losartan, valsartan, candesartan, irbesartan, telmisartan.
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)
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