Opioid (narcotics)-Morphine

• Narcotic analgesic used in moderate to severe pain, Chest pain related to MI

• Standard against which all other narcotic analgesics are measure for effectiveness

Opioid antagonists

Competes for the opioid receptors. 

It is used to reverse the effects of opiates (respiratory depression) and to treat opioid overdose.

Opioid antagonists Onset:  immediate when given IV.

Duration: short: closely monitor for additional doses needed.

Salicylates-Aspirin

• Used for its analgesic, antipyretic, anti-inflammatory, and antiplatelet effects
• Irreversibly inhibits cycooxygenase (COX)

Nonsteroidal anti-inflammatory medications-Ibuprofen

• Used for its analgesic, antipyretic, and anti-inflammatory effects

• Reversibly inhibits cycooxygenase (COX)

Acetaminophen

Used for mild to moderate pain and fever; usually well tolerated; has no anti-inflammatory effect.

Beta Blockers-“olol” medications-atenolol

• Treats: HTN, & angina

• Decreases heart rate and contractility, slows conduction, suppresses automaticity

• Works on the Beta 1 and Beta 2 receptors, increasing heart rate, increased force of contraction and increased Av conduction

ACE Inhibitors-“pril” medications

• Treats: Hypertension, Myocardial Infarction, heart failure and diabetic nephropathy
• Inhibits the angiotensin-converting enzyme (ACE) needed to change angiotensin I (inactive) to angiotensin II (active).  Angiotensin II is a potent vasoconstrictor, so that less angiotensin II means less vasoconstriction.
• Decreased angiotensin II also decreases secretion of aldosterone, which thus prevents retention of sodium and water
• Lowers blood pressure by decreasing peripheral vascular resistance:  smaller antihypertensive response (monotherapy) in African Americans that whites

Cardiac Glycosides (Digoxin)

• Treats: Heart Failure, a-fib and a-flutter
• Direct effect is to strengthen force of cardiac contraction (+ inotropic effect)
• Indirect effect is to depress the SA node and slow conduction to the AV node (negative dromotropic effect) thus slowing the heart rate (negative chronotropic effect
• Can cause the same arrhythmias it is used to treat
• Antidote for digoxin overdose is digoxin immune Fab

Nitrates

• Treats: angina

• Usually given sublingually or topically, sometimes IV in acute care settings

• Relaxes smooth muscles and dilates vascular beds-it is a vasodilator

Anticoagulant-Heparin

• Treats: anticoagulant that prevents formation or extensions of blood clots.  Has no effect on existing blood clots

• Parenteral administration (IV or SQ)

low-molecular-weight heparin (Lovenox)

• Main use is for prophylactic prevent of DVT after surgery
• Indication: is considered safer than and equally effective as heparin, has an effect on activated factor X and has limited effect on thrombin.  It also affects clotting factor C and antithrombin.  It is absorbed after SC administration and is widely distributed.   
• Administered subcutaneously
• It is used to prevent the extension of a blood clot, in patients with DVT or PE
• Used prophylactically in patients with short-term increased risk of thrombus formation

Coumadin (Warfarin)

• Treats: anticoagulant used to complete treatment with heparin after clot formation; is used prophylactically in patients at high risk of thrombus formation

• Administered orally

• May be give with heparin until therapeutic level of Warfarin is obtained

Lipid-Lowering medications-(Statin Drugs)

Treats: Used to treat hyperlipidemia.  It lowers LDL, triglycerides, and total cholesterol and raises HDL.

Mucolytics

Used to liquefy thick, tenacious secretions

Bronchodilators-Albuterol

Used for: acute and chronic management asthma and COPD

Anti-Inflammatory Agents-Inhaled Glucocorticoids (AeroBid)

Hydrochlorothiazide HTCZ- Thiazide Diuretics

• Widely used alone or with other agents to reduce blood pressure and is considered first line therapy in the treatment of HTN; also used to treat edema from CHF, from hepatic or renal disease, or secondary to drug use. 

• Works in the distal tubule to promote excretion of sodium, chloride, potassium and water

Loop Diuretics - High Ceiling Diuretics- Furosemide (Lasix)

• A potent diuretic used to treat edema from CHF, pulmonary edema, and in hepatic and renal disease; may be used as an antihypertensive

• First-choice diuretic for treating hypertension with preexisting renal disease

• Works in the loop of Henle to promote excretion of large amounts of sodium, chloride, potassium and water

Potassium-Sparing Diurectics-Aldactone

Saline Laxatives: Magnesium Hydroxide (Milk of Magnesia)

Laxative for short-term use.  Works by pulling water into the bowel by distending it and promoting peristalsis

Peptic Ulcer medications-Proton Pump Inhibitors

• Treats: peptic ulcers resulting from H. Pylori, GERD, erosive esophagitis, and chronic hypersecretory conditions (Zollinger-Ellison syndrome)

• May interact with other drugs metabolized by CYP 450

Thyroid medications

Synthetic thyroid hormone replacement

Diabetic medications-Regular Insulin

Treats: Used primarily to treat type 1 diabetes mellitus; only type of insulin used for intravenous administration, in external insulin pumps, and for “sliding scale” coverage for hypoglycemia

Oral hypoglycemic-sulfonylureas-Glyburide

Oral hypoglycemic that stimulates insulin release and increases peripheral tissue sensitivity to insulin effects; used as adjunct with dietary restrictions to treat type 2 diabetes mellitus; is available commercially, combined with metformin, to manage type 2 diabetes

Oral hypoglycemic-non-sulfonylureas-Metformin

Oral anti-hyperglycemic that increases peripheral tissue sensitivity to the effects of insulin and decreases hepatic glucose production.  Used to manage type 2 diabetes

Glucose-Elevating Agents

Glucose-elevating agent that accelerates hepatic glyconeogenesis, increasing blood glucose levels

Glucocorticoids

• Used: anti-inflammatory or immunosuppressive therapy

• Hepatic dysfunction may impair prednisone conversion into active prednisolone

• Prednisone may cause adrenal suppression if given for more than 2 weeks and then withdrawn too abruptly, placing the patient at risk for acute adrenal insufficiency.

Benzodiazepines

• Many benzodiazepines available for a multitude of CNS functions and are used for a variety of reasons.  The different benzodiazepines  vary significantly regarding pharmacokinetics and need to be checked for specifics.

• Treats: anxiety disorders anxiety, insomnia, seizures, muscle spasms, alcohol withdrawal, anesthesia induction

• Works by increasing the inhibitory effects of GABA

Selective Serotonin Reuptake Inhibitors-(SSRI’s) sertraline (Zoloft)

• Treats: depression, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder

• Inhibits CNS reuptake of serotonin, weak effect on dopamine or norepinephrine. Achieving antidepressant effects can take anywhere from 10 days to 4 weeks. 

Phenytoin (Dilantin)

• Treat: grand mal and other psychomotor seizures, status epilepticus

• Works: binds to receptors on sodium channels, keeping the channels in a closed position longer, preventing influx of sodium ions and excessive firing of the cell.

Penicillin

Broad spectrum antibiotic

Cephalosporin- Cefazolin

Used for infections caused by gram-positive bacteria, anaerobes, and spirochetes.  Also used as prophylaxis in surgery.

Vancomycin

Used for serious gram-positive infections especially Clostridium difficile and methicillin-resistant staphylococcus aureus.

Aminoglycosides-Gentamicin

Used for serious gram-negative infections

Tetracyclines

Used for Rickettsia, mycoplasma pneumoniae, Chlamydia, and acne

Ciprofloxacin (Cipro)

Used for infections caused by aerobic gram-negative organisms.

Anthrax

Acyclovir

Used for the management of herpes simplex virus, herpes zoster virus, Epstein-Barr virus, and cytomegalovirus

Histamine-2 Receptor Antagonists

• Blocks histamine competitively at histamin-2 receptors in the gastric parietal cells; these receptors are not affected by H-1 antagonists.
  

• Inhibits all phases of gastric acid secretion

•   Used for gastroesophageal reflux disease, duodenal ulcer, gastric ulcer, pathologic hypersecretory conditions; to prevent upper GI bleeding; and for heartburn and acid indigestion (OTC strength only)
•    Interacts with numerous drugs, by decreasing their hepatic metabolism.