Rx Flashcards
(117 cards)
1
Q
epinephrine
A
Class: Adrenergics
catecholamines
A1&A2&B1&B2&B3 agonist
sympathetic stimulation = inc heart rate, contractility, BP and CO
low doses: B preferred
uses: cardiac arrest, cardiogenic shock, severe hypotension, anaphylaxis, respiratory distress, urticaria, keep anesthetic “local”
side effect: hyperglycemic effect, tachycardia, arrhythmia, MI
~adrenaline
2
Q
norepinephrine
A
Class: Adrenergics
catecholamines
A1&A2>B1 agonist
stimulates peripheral vasoconstriction and inc BP
use: shock, severe hyoptension
side effect: MI due to increased cardiac work
3
Q
isoproterenol
A
Class: Adrenergics catecholamines B1 & B2 agonist inc HR, contractility and cardiac output use: bradycardia, asthma, bronchitis, and emphysema. side effects: tachycardia, MI
4
Q
dopamine
A
Class: Adrenergics catecholamines low dose: D1&D2&B1 agonist high dose: A1&A2 agonist (act as vasopressor) increase contractility and HR use: cardiogenic shock, CHF *causes renal vasodialtion side effect: arrhythmias
5
Q
dobutamine
A
Class: Adrenergics
catecholamines
B1 agonist
uses: cardiogenic shock, congestive heart failure
(increases contractility w/o increase HR) increases cardiac output
side effect: arrhythmias, hypotension
6
Q
phenylephrine
A
adrenergic Agonists/ sympathomimetics
direct agents
A1>A2
vasopressor
uses: rhinitis, decongestion, SVT, hypotension, shock
*big vasoconstriction= increase systemic resistance= inc BP=vagal stimulation= slows heart rate
side effect: rebound mucous swelling
7
Q
midodrine
A
Agonists/ sympathomimetics
direct agents
A1
uses: hypotension, retinal exams (dilates pupils)
8
Q
brimonidine
A
presynaptic anti-adrenergic
direct, Agonist A2
causes dec NE and suppresses sympathetic
uses: glaucoma (decreases aqueous humor formation)
9
Q
clonidine
A
presynaptic anti-adrenergic direct, Agonist A2 causes dec NE and suppresses sympathetic uses: HTN, (inhibits sympathetic outflow) side effect: sedation (CNS active)
10
Q
oxymetazoline (Afrin)
A
Agonists/ sympathomimetics
direct agents
A1 & A2
use: decongestion
11
Q
albuterol/salmeterol/terbutaline (proventil/ventolin)
A
adrenergic Agonists/ sympathomimetics direct agents B2 causes bronchiodilation use: asthma, COPD side effects: tachycardia, tremor
12
Q
fenoldopam
A
adrenergic Agonists/ sympathomimetics direct agents D1 use: severe HTN rapid renal and splanchnic vasodilating effects
13
Q
amphetamine
A
adrenergic Agonists/ sympathomimetics
Indirect acting agents
mechanism: inhibits MAO, releases endogenous NE from storage vesicles= inc NE binding to adrenergic receptors
CNS excitation (can cross BBB)
stimulant: increases heart rate and blood pressure and decreases appetite
14
Q
ephedrine
A
adrenergic Agonists/ sympathomimetics
Mixed agent
Indirect acting: inc NE release from neuron and binding to adrenergic receptor
DIRECTLY stimulates A1&B2
use: asthma, nasal decongestion, hypotension
side effect: HTN
15
Q
phenoxybenzamine
A
adrenergic Antagonists/ adrenergic receptor blockers
A1 & A2,
noncompetitive, binds irreversibly
use: HTN
side effect: reflex tachycardia, increased insulin
16
Q
phentolamine
A
Antagonists/ adrenergic receptor blockers
A1 & A2, competitive
causes: dilation of smooth muscle and dec BP
Uses: HTN
side effects: reflex tachycardia and arrhythmias
17
Q
prazosin
A
Antagonists/ adrenergic receptor blockers
A1 selective
competitive
causes blood vessel vasodilation and dec BP
use: HTN (does not cause tachycardia)
side effect: hypotension and dizziness
“minipress”
18
Q
tamsulosin
A
Antagonists/ adrenergic receptor blockers
A1a selective (GU tract)
use: benign prostatic hypertrophy and bladder obstruction
side effect: floppy iris syndrome
19
Q
terazosin
A
Antagonists/ adrenergic receptor blockers A1a selective (GU tract) use: benign prostatic hypertrophy, HTN
20
Q
pindolol
A
Antagonists/ adrenergic receptor blockers
B1 & B2, weak
intrinsic sympathomimetic activity (less effect on resting HR)
use: HTN
side effect: bronchoconstriction
21
Q
propranolol
A
Antagonists/ adrenergic receptor blockers,
Antiarrhythmic: class 2
B1 & B2, strong
effect: prolongs AV conduct and refract; decreases HR and contractility
use: angina pectoris, HTN, MI, SVT, ventricular arrhythmia, tachycardia, Afib, Aflutter
side effect: bronchoconstriction, heart failure
22
Q
metoprolol
A
Antagonists/ adrenergic receptor blockers
Antiarrhythmic: class 2
B1 selective
(-) inotropy, (-) chronotropy
use: HTN, MI, SVT, CP, tachycardias, IHD, CHF
less likely to cause bronchoconstriction
side effect: bradycardia, enters brain (CNS sedation)
23
Q
labetalol
A
Antagonists/ adrenergic receptor blockers
causes vasodilation
Mixed: A1 & B
use: HTN, angina pectoris, CHF
side effects: hypotension, fatigue, bradycardia
24
Q
carvedilol
A
Antagonists/ adrenergic receptor blockers
Mixed: A1 & B
use: HTN, angina pectoris, tachycardia, CHF
(inc ejection fraction)
25
guanethidine
Antagonists/ block adrenergic neuronal function (peripheral pre-synaptic)
decreases NE in synaptic cleft
use: severe HTN, renal HTN
side effects: hypotension, fluid retention, impaired ejaculate, diarrhea, nerve toxicity
**not used anymore
26
hexamethonium (C6)
nonspecific Antagonist
adrenergic and nicotinic cholinergic receptors (nAChnR)
blocks all stimulation of pre-ganglionic neurons
stops release of NE and ACh
use: HTN
side effects: severe
not used clinically
27
atropine
anticholinergic
nonselective muscarinic Antagonist
use: bradycardia, vagal hyperactivity, bronchospasms, over-secretions
(treats DUMBBLSS)
side effect: "hot as a hare, dry as a bone, red as a beet, blind as a bat, and mad as a hatter"
flush, blurred vision, dec secretions, hyperthermia, delirium, hallucinations
big CNS effects
28
cocaine
adrenergic agonist; indirect sympathomimetic
block catecholamine reuptake by membrane transporter (NET)
increases NE in synapse
use: causes vasoconstriction, local anesthesia
side effect: MI
29
(+) inotropic drug
increase heart contractility
30
(+) chronotropic drug
increase heart rate
31
nicotine
nicotinic agonist
nicotinic acetylcholine receptors
stimulate both para- and sympathetic postganglionic neurons
causes skeletal muscle contraction
side effect: medullary depression, inc HR/BP/RR, spasms, toxic
32
succinylcholine (anectine)
nicotinic agonist
binds nicotinic acetylcholine receptors (Nm subtype)
causes prolonged neuromuscular depolarization
use: paralysis for surgery
side effect: malignant hyperthermia, hypotension, arrhythmias
depolarizing blockade- cannot be overcome by cholinesterase inhibitor
33
pancuronium, rocuronium
antinicotinic
competetive antagonist of nicotinic acetylcholine receptors (Nm)
use: paralysis for surgery
side effect: histamine release, hypotension, increase HR, edema
nondepolarizing blockade- can be overcome by cholinesterase inhibitor
34
ipratropium (atrovent)
antimuscarinic
nonselective antagonist acts on parasympathetic sites
inhaled to M3 acetylcholine receptors in bronchi
cause: dec bronchoconstrictions and secretions
use: COPD
35
Procainamide
```
Antiarrhythmic: class 1A: moderate Na channel blocker
binds Na in active state
slows conduction/prolong refractory period
reduces ectopic foci automaticity
use: reentry and ectopic; SVT, VT, VF, WPW
side effect: SLE, long QT
```
36
Quinidine
```
Antiarrhythmic: class 1A: moderate Na channel blocker
binds Na in active state
slows conduction/prolong refractory period
reduces ectopic foci automaticity
use: reentry and ectopic; SVT, VT, VF
side effect: long QT, thrombocytopenia, strong anti-cholinergic effect
```
37
Lidocaine
```
Antiarrhythmic: class 1B: WEAK Na channel blocker
binds Na in both active/inactive state
increase velocity at AV; decrease AP
reduces ectopic foci automaticity
may shorten QT
use: VT, VF, WPW, use after MI
side effects: CNS toxicity and cardiac depression
IV only
```
38
Flecainide
Antiarrhythmic: class 1C: STRONG Na channel blocker
reduces SA node and ectopic foci automaticity
reduces all conduction velocity
prolongs refractory period, long (QT, QRS, and PR)
use: Afib
side effects: heart block, arrhythmias
39
atenolol
```
Antiarrhythmic: class 2, B-blockers
B1 selective
use: HTN, CP/MI, does not cross BBB
decreases HR, output, renin release
little resp. effects (no B2)
```
40
labetalol
Antiarrhythmic: mixed alpha and beta blocker
A1, B1, B2 antagonist
lowers BP (A1), no reflex tachycardia (B1)
use: HTN, CHF, CP
side effect: orthostatic hypotension, heart failure
41
carvedilol
Antiarrhythmic: mixed alpha and beta blocker
A1, B1, B2 antagonist
lowers BP (A1), no reflex tachycardia (B1)
use: CHF, HTN, CP
side effect: orthostatic hypotension
42
amiodarone
Antiarrhythmic: class 3, prolong K repolarization
decrease K efflux
reduce conduction velocity
prolongs refractory and AP
use: VT, Vfib, Afib, Aflutter
side effects: long half life, long (QT, QRS, PR), eye dysfunctions
CYP3A4: affects renal/hepatic elimination (must change warfarin and digoxin levels)
43
sotalol
```
Antiarrhythmic: class 3, prolong K repolarization
AND nonselective B-blocker
prolong AP and refract period
use: VT
*less side effects than amiodarone
```
44
ibutilide
```
Antiarrhythmic: class 3, prolong K repolarization
prolong AP
slow inward Na current
use: Afib, Aflutter
side effect: long QT
IV only
```
45
bretylium
Antiarrhythmic: class 3, prolong K repolarization
blocks the release of norepi from nerve terminals
prolongs AP
use: HTN, only affects ventricle (VT, Vfib)
46
verapamil
Antiarrhythmic: class 4, slow inward Ca
Non-dihydropyridine calcium channel blocker
act on heart
reduce SA/AV conduction, prolong refractory (long PR)
use: SVT, atrial tachy, atrial flutter, Afib
side effects: bradycardia, hypotension, AV block, GI effects
do not use on WPW
CYP3A4: affects renal/hepatic elimination (must change warfarin and digoxin levels)
47
diltiazem
Antiarrhythmic: class 4, slow inward Ca
Non-dihydropyridine calcium channel blocker
act on heart
reduce SA/AV conduction, prolong refractory (long PR)
use: SVT, CP, Afib, HTN
side effects: bradycardia, hypotension, AV block
48
action of B-blockers as a class
decrease HR, contractility,
decrease SA/AV automaticity, conduction velocity
decreases renin
blocks vasoconstriction and decreases peripheral vascular resistance
bronchoconstriction
hyperglycemia sx
49
digoxin
antiarrhythmic: cardiac glycoside
slows conduction through AV node
block Na/K-ATPase pump
decrease conduction, prolong refract (long PR)
EKG: short QT, Twave inversion
enhance vagal activity at AV node, stimulates carotid baroreceptor
decrease HR
(+) ionotroph, increased intracellular Ca
use: ventricular response of Afib, Aflutter, cardiogenic shock, CHF
side effects: digitalis toxicity, bradycardia, fatigue, hypokalemia, arrhythmias, heart block, GI: n/v/d (vagal)
do not mix with quinidine
50
adenosine
antiarrhythmic
prolongs refract: increase K efflux=hyperpolarization
decreases AV conduction velocity, blocks Ca entry
EKG: long PR
induces transient heart block, break re-enty
use: re-entry SVT, vasodilation
works very quickly and lasts only a short period of time
side effects: flushing, CP, arrhythmia, dyspnea, hypotension
51
magnesium
use: torsades de pointes, dig toxicity
52
potassium
use: hypokalemia and electrolyte-associated cardiac arrhythmias
side effect: VT
53
bethanechol
```
direct cholinergic agonist
muscarinic: M1, M2, M3
AND nicotinic agonist
increase parasym and secretions
use: post-op GI and bladder motility
resistant to AChE
side effect: bradycardia, bronchoconstriction, parkinsonism
```
54
muscarine
cholinergic agonist
muscarinic: M1, M2, M3
not used clinically
mushroom product used to discover M receptor
55
pilocarpine
direct cholinergic agonist
muscarinic: M1, M2, M3
use: glaucoma (causes miosis), increase secretions (sweat/saliva)
56
carbachol
direct cholinergic agonist
muscarinic: M1, M2, M3
AND nicotinic agonist
increase parasym
use: glaucoma (causes miosis)
side effect: constriction
57
scopolamine
```
anticholinergic
muscarinic antagonist: alkaloid
receptors at eyes and glands
use: motion sickness, n/v/d
can enter BBB; less CNS than atropine
```
58
homatropine
```
anticholinergic
muscarinic antagonist: alkaloid
receptors at eye
causes mydiasis and cycloplegia
side effects: blurred vision, sensitivity, drowsiness
can enter BBB
```
59
oxybutynin/darifenacin/solifenacin
anticholinergic
muscarinic antagonist: tertiary
use: bladder spasms, leakage/incontinence
can enter BBB
side effects: dec secretions, mydiasis and cycloplegia
60
tolterodine
```
anticholinergic
muscarinic antagonist: tertiary
decreases bladder tone
use: overactive bladder
side effects: constipation, dry mouth, headache
can enter BBB
```
61
benztropine
anticholinergic
muscarinic antagonist: tertiary
central action
use: parkinsonism, tremors, rigidity, drooling, akinesia
side effects: tachycardia, hypotension, dry mouth
can enter BBB
62
ipratropium/tiotropium
```
anticholinergic
muscarinic antagonist: quaternary
local: respiratory
inhalation tx
use: bronchoconstriction, COPD, asthma
```
63
propantheline
```
anticholinergic
muscarinic antagonist: quaternary
local: GI, urinary
reduces motility and delays emptying stomach
use: peptic ulcers, spasms
```
64
glycopyrrolate
```
anticholinergic
muscarinic antagonist: quaternary
local: GI, urinary
use: peptic ulcers
also decreases secretions and cardiac relfexes in intubation
```
65
pirenzepine
muscarinic antagonist:
M1 selective
use: peptic ulcers (dec gastric acid)
66
trimethaphan
neural nicotinic (Nn) receptor antagonist
non-depolarizing ganglion blocker
use: HTN
causes vasodilation
triggers histamine release (inc HR, decrease contractility)
side effects: severe
not used clinically
67
varenicline
```
neural nicotinic (Nn) receptor partial agonist
selective A4B2 subtype in CNS
reduces nicotine stimulation
use: smoking cessation
side effects: psych, AMS
```
68
methyldopa
```
presynaptic anti-adrenergic
strong Agonist A2
causes dec NE and suppresses sympathetic
Use: HTN
side effect: sedation
```
69
esmolol
Antagonists/ adrenergic receptor blockers
B1 selective
Use: aortic dissection, tachycardia, SVT
rapid onset, short duration
70
propafenone
Antiarrhythmic: class 1C: STRONG Na channel blocker
slows AV conduction, prolongs refract
use: SVT, Afib
side effects: heart failure, bradycardia, arrhythmia
do not give post MI
71
dofetilide
```
Antiarrhythmic: class 3, prolong K repolarization
prolong AP
increase ERP
use: Afib, Aflutter
side effect: long QT, dizziness
```
72
Niacin
antihyperlipidemic agent: B vitamin.
effect: - decreases the synthesis VLDL by the liver
- decrease LDL.
- decreases the synthesis of cholesterol.
- increases the level of HDL (decrease the catabolism)
- decreases Lp(a)
- lowering serum triglycerides.
use: hypertriglyceridemia; combined with an HMG CoA reductase inhibitor to treat most forms of hypercholesterolemia
side effects: flushing, hepatotoxicity
con: need large dose
73
Fenofibrate
antihyperlipidemic agent: fibric acid derivatives
effect: -decrease triglycerides (VLDL) (by activating protein lipase activity)
- increases HDL
use: Familial hypertriglyceridemia, Dysbetalipoproteinemia
side effects: -myopathy and rhabdo
interacts with anti-coag tx
do not use in renal failure
74
Colestipol
antihyperlipidemic agent: Bile acid sequestants
Action: binds and inhibits bile acids resorption, causes liver to reclaim cholesterol and serum LDL (increased clearance)
Effect:
- Increase (Apo B receptors) = decrease LDL, IDL, & VLDL
- Increase HLD
Use: high LDL; combine with statin therapy
Side effect: constipation, inc cholesterol production in liver
Interferes with many any drugs
are not absorbed by the body and therefore are passed in the stool.
75
Cholestyramine
antihyperlipidemic agent: Bile acid sequestants
Action: binds and inhibits bile acids resorption, causes liver to reclaim cholesterol and serum LDL (increased clearance)
Effect:
- Increase (Apo B receptors) = decrease LDL, IDL, & VLDL
- Increase HLD
Use: high LDL; combine with statin therapy
Side effect: constipation, inc cholesterol production in liver
Interferes with many any drugs
are not absorbed by the body and therefore are passed in the stool.
76
Colesevelam
antihyperlipidemic agent: Bile acid sequestants
**best of the group
Action: binds and inhibits bile acids resorption, causes liver to reclaim cholesterol and serum LDL (increased clearance)
Effect:
- Increase (Apo B receptors) = decrease LDL, IDL, & VLDL
- Increase HLD
Use: high LDL; combine with statin therapy
Side effect: constipation, inc cholesterol production in liver
Interferes with many any drugs
are not absorbed by the body and therefore are passed in the stool.
77
Lovastatin
antihyperlipidemic agent: HMG-CoA reductase Inhibitors
*weak
Effect: STOP cholesterol biosynthesis= liver inc ApoB receptors to reclaim LDL, IDL, and VLDL (inc clearance)
- Increase HDL
- Dec triglycerides
Use: hyperlipidemias, Familial Hypercholesterolemia, Combined Familial Hyperlipidemia, reduce MI risk
Side effect: rhabdo, hepatotoxicity, hyperglycemia
Teratogenic- NOT used in pregnancy
Drug interaction: CYP3A4
78
Simvastatin
antihyperlipidemic agent: HMG-CoA reductase Inhibitors
Effect: STOP cholesterol biosynthesis= liver inc ApoB receptors to reclaim LDL, IDL, and VLDL (inc clearance)
- Increase HDL
- Dec triglycerides
Use: hyperlipidemias, Familial Hypercholesterolemia, Combined Familial Hyperlipidemia, reduce MI risk
Side effect: rhabdo, hepatotoxicity, hyperglycemia
Teratogenic- NOT used in pregnancy
Drug interaction: CYP3A4
79
Pravastatin
antihyperlipidemic agent: HMG-CoA reductase Inhibitors
Effect: STOP cholesterol biosynthesis= liver inc ApoB receptors to reclaim LDL, IDL, and VLDL (inc clearance)
- Increase HDL
- Dec triglycerides
Use: hyperlipidemias, Familial Hypercholesterolemia, Combined Familial Hyperlipidemia, reduce MI risk
Side effect: rhabdo, hepatotoxicity, hyperglycemia
Teratogenic- NOT used in pregnancy
80
Atorvastatin
antihyperlipidemic agent: HMG-CoA reductase Inhibitors
Effect: STOP cholesterol biosynthesis= liver inc ApoB receptors to reclaim LDL, IDL, and VLDL (inc clearance)
- Increase HDL
- Dec triglycerides
Use: hyperlipidemias, Familial Hypercholesterolemia, Combined Familial Hyperlipidemia, reduce MI risk
Side effect: rhabdo, hepatotoxicity, hyperglycemia
Teratogenic- NOT used in pregnancy
Drug interaction: CYP3A4
81
Rosuvastatin
antihyperlipidemic agent: HMG-CoA reductase Inhibitors
*newest
Effect: STOP cholesterol biosynthesis= liver inc ApoB receptors to reclaim LDL, IDL, and VLDL (inc clearance)
- Increase HDL
- Dec triglycerides
Use: hyperlipidemias, Familial Hypercholesterolemia, Combined Familial Hyperlipidemia, reduce MI risk
Side effect: rhabdo, hepatotoxicity, hyperglycemia
Teratogenic- NOT used in pregnancy
Asians show high levels
82
Ezetimibe
antihyperlipidemic agent: Cholesterol absorption inhibitor
Effects: inhibits dietary cholesterol GI absorption
- Lowers LDL
Use: lower serum cholesterol; can be combined with a statin
Side effects: minor GI
83
Laropiprant
Prostaglandin D2 antagonist
| Use in Niacin therapy to reduce flushing
84
Neomycin
antihyperlipidemic agent: aminoglycoside antibiotic.
effect: inhibiting the reabsorption of cholesterol and bile salts.
effect: reduction of total body cholesterol.
- does not affect triglyceride levels.
Use: combination with niacin to lower Lp(a) levels
85
aliskiren
renin inhibitor
effect: blocks angiotensinogen conversion
use: HTN
side effects: hypotension, hyperkalemia, rash, GI, renal failure
CYP3A4
teratogenic
86
captopril, lisinopril, enalapril
| "pril"
ACE inhibitor
prevents formation of angiotensin2
inc bradykinin and prostaglandins= vasodilation
use: high-renin HTN, arteriolar/venous vasodilation
post MI- enhance reperfusion
side effects: natriuresis, cough, airway irritation, angioedema, renal failure, hyperkalemia
teratogenic
87
losartan
| "sartan"
```
angiotensin 2 antagonist- (ARB)
blocks receptor at vascular muscle
use: HTN, CHF
side effects: hypotension, dizziness, renal failure, hyperkalemia
teratogenic
```
88
spironolactone
aldosterone receptor antagonist
K sparing diuretic
use: edema, CHF, HTN
side effects: endocrine imbalances, hyperkalemia, gynecomastia
89
eplerenone
```
aldosterone receptor antagonist
K sparing diuretic
use: edema, CHF, HTN
side effects: hyperkalemia
**lower affinity for other steroid hormone receptors than spironolactone= less side effects
```
90
hydralazine
```
direct vasodilator
relaxes arterioles
dec BP and afterload
reflex inc HR and CO
directly inc renal blood flow
use: HTN, pregnancy
side effects: many side effects, SLE, fluid retention
```
91
minoxidil
direct vasodilator
prodrug
opens K channels=hyperpolarizes smooth muscle=relaxes arterioles
use: HTN, topical tx male pattern baldness
side effect: hirsuitism, reflex tachycardia, pulmonary damage, fluid retention
92
sodium nitroprusside
direct vasodilator
effect: dilates arteries and veins (dec preload and after load)
nitric oxide-->cGMP--> inactivate myosin= relax smooth muscle= vasodilation
use: IV HTN crisis
side effect: severe hypotension, cyanide toxicity, hepatotoxicity, renal toxicity
93
nitroglycerin
anti-anginal agent
nitric oxide-->cGMP--> inactivate myosin= relax smooth muscle= vasodilation
effect: dilates large coronary arteries= inc blood to heart
dec venous tone= dec cardiac preload
use: CP, MI
side effects: hypotension, reflex tachycardia, cerebral ischemia
do not use with: alcohol, vasodilatiors, PDE5 inhibitors ("afils")
94
nifedipine
```
anti-HTN/anti-anginal
calcium entry blocker
potent peripheral vasodilator
side effect= TOXIC, reflex tachy and inc CO, MI
not used
```
95
nicardipine, clevidipine
```
anti-HTN/anti-anginal
calcium entry blocker
potent peripheral vasodilator
use: CP, HTN emergency
side effect= reflex tachy and inc CO, palpitations
```
96
isosorbide dinitrate
anti-anginal nitrate
nitric oxide-->cGMP--> inactivate myosin= relax smooth muscle= vasodilation
use: CP, CHF
do not combine with vasodilation meds
97
isosorbide-5-mononitrate
anti-anginal nitrate
nitric oxide-->cGMP--> inactivate myosin= relax smooth muscle= vasodilation
use: CP, CHF
do not combine with vasodilation meds
98
nimodipine
```
anti-HTN/anti-anginal
calcium entry blocker
effects cerebral artery vasodilation
use: subarachnoid hemorrhage/CNS damage
side effect: carcinogenic and teratogenic
```
99
uses for mannitol, furosemide (lasix), and hydrochlorothiazide (HCTZ)
diuretic
use: edema, CHF, HTN
works on kidney to increase Na/water excretion
100
aspirin
| acetylsalicylic acid
anti-platelet
irreversible cyclooxygenase inhibitor
dec thromboxane A2 and prostaglandins= dec platelet aggregation
use: MI, stroke, inflammation, fever, pain
side effects: GI ulcers, bleeding, hemorrhage, asthma
recommend: low dose, not for children
PO
101
clopidogrel (Plavix®), prasurgel (Effient®), Ticlopidine (Ticlid)
anti-platelet: thienopyridines
irreversibly blocks ADP receptor (P2Y1 and P2Y12)
use: acute coronary syndrome, atheroclerosis, peripheral arterial disease
side effects: GI ulcers, bleeding, thrombotic purpura
CYP450
PO, prodrug
102
ticagrelor (Brilinta®)
```
anti-platelet: thienopyridines
reversible ADP receptor blocker
use: reduce MI, stroke
combine tx with aspirin
side effect: bleeding
PO
```
103
dipyridamole
anti-platelet
PDE inhibitor= inc cAMP
vasodilator (inc levels of adenosine)
use: post heart valve replacement surgery, history stroke
combine tx with warfarin or aspirin
side effect: hypotension, syncope, headache, GI
104
cilostazol
```
anti-platelet
PDE 3 inhibitor= inc cAMP and PKA
effect: dilates lower ext blood vessels
use: intermittent claudication
side effects: headache, palpitations
CYP3A4, CYP2C19
```
105
abciximab
anti-platelet: glycoprotein 2b/3a inhibitor
monoclonal antibody
use: before coronary angioplasty (PCI), MI
side effect: bleeding
combine tx with heparin or aspirin
106
eptifibatide
anti-platelet: glycoprotein 2b/3a inhibitor
synthetic peptide, fibrinogen analog= blocks platelet crosslinking
use: acute coronary syndrome, before coronary angioplasty (PCI), MI
side effect: bleeding, renal failure
107
tirofiban
anti-platelet: glycoprotein 2b/3a inhibitor
reversible
use: unstable angina, before coronary angioplasty (PCI)
side effects: bleeding
108
heparin
Unfractionated heparin
(UFH)
anticoagulant
binds to antithrombin 3 (AT3)= more active= inactivates thrombin (factor 2) and active factor 10, 9, 11.= no fibrin
immediate action
use: DVT, PE, surgery, acute coronary syndrome
side effect: bleeding, hemorrhage, necrosis at injection site, thrombocytopenia
**highly variable anticoagulant response/effects/duration= LMWH used more
IV/injection
antidote: protamine sulfate
monitor aPTT
intrinsic pathway
109
Low-molecular-weight heparins, (LMWH)
| enoxaparin "parin"'s
anticoagulant
smaller fragment of heparin
binds to antithrombin 3 (AT3)= more active= inactivates active factor 10
use: DVT, PE, surgery, acute coronary syndrome
side effect: bleeding, renal failure
****more controlled anticoagulant response/effects/duration= used more common
IV/injection
antidote: protamine sulfate
does not effect PT
intrinsic pathway
110
fondaparinux
```
anticoagulant
inhibits factor 10a
use: DVT, PE
side effect: bleeding, rash
does not effect PT
```
111
warfarin (coumadin)
```
anticoagulant
inhibits enzyme epoxide reductase (VKOR)= inactive vitamin K= loss of gamma-carboxylation rxn for dependent clotting factors (2,7,9,10)
uses:DVT, PE, Afib, dilated cardiomyopathy, prosthetic heart valves
side effects: bleeding, necrosis, GI
CYP2C9
many drug interactions
NOT in pregnancy
orally
monitor PT/INR/vit K
extrinsic pathway
```
112
lepirudin, bivalirudin
```
anticoagulant
direct thrombin inhibitor (from hirudin)
alternative to heparin (no HIT, does not use AT3)
side effect: bleeding, renal failure
IV
```
113
dabigatran (pradaxa),
```
anticoagulant
prodrug, direct thrombin (factor 2a) inhibitor
use: stroke, Afib, DVT, PE, post surgery
*no need to monitor PT
side effects: bleeding
NOT in pregnancy
orally
```
114
rivaroxaban, apixiban
```
anticoagulant
prodrug, direct factor 10a inhibitor
use: stroke, Afib, DVT, PE, post surgery
*no need to monitor PT
side effects: bleeding
CYP3A4
NOT in pregnancy
orally
```
115
argatroban
```
anticoagulant
direct thrombin inhibitor (from hirudin)
alternative to heparin (no HIT, does not use AT3)
side effect: bleeding
cleared through LIVER
CYP450
IV
*similar to lepirudin, bivalirudin, but better for bad renal pts
```
116
streptokinase, urokinase
thrombolytic agent
activates plasminogen= plasmin= degrades fibrin/fibrinogen
use: DVT, MI, stroke, dialysis pts with occlusion
side effect: bleeding, immune rxn
IV
117
tissue plasminogen activator (tPA)
```
thrombolytic agent
activates plasminogen= plasmin= degrades fibrin and ACTIVE clot
use: coronary occlusion
side effects: hematoma
IV
```
