gentamycin

• MOA: disrupts bacterial protein synthesis, bacteriacidal, narrow spectrum.
• TX: gram neg. bacilli- E. coli, K. pneumonia, P. aeruginosa. Parenteral.
• SE: Ototoxic. Irreversable. settles on cochlea, causes nerve damage. Level doesn't trough enough to leave cochlea. Stop. Nephrotoxic. Neuromuscular blockade (flaccid paralysis). Do not mix with PCN. Take peak and trough.
• Gentamycin, amikacin, tobramycin

tetracyclines

• MOA: Suppresses growth by inhibiting protein synthesis, inhibits binding of tRNA to 30s subunit. Bacteriostatic. Broad spectrum. Cannot cross mammalian cell membranes.
• TX: Chlamydia, Mycoplasma, H. pylori, anthrax, rocky mountain spotted fever, cholera, lyme disease, acne tx, peridontal disease, PO, IM, IV
• SE: Stains deciduous teeth. GI upset, C. Diff, candida, hepatotoxic, nephrotoxic, stunts growth
• Do not mix with milk products, MOM, antacids.

penicillins

• MOA: Disrupt synthesis of cell wall and promotes active destruction. Acts of PBP's on cytoplasmic membrane.
• TX: Mostly on gram positive (exc. resistant staph). Gram Neg Cocci, anaerobic bacteria, spirochetes. All forms may be used IM
• SE: Allergic rxn, severe 2-30 min. cross rxn w/ cepholosporins 1%. Interfere with BC, fungal infection, GI upset.
• Penicillin G, Nafcillin, Oxacillin, Ampicillin, Amoxicillin, Ticacillin, Pipericillin.

sulfonamides

• MOA: suppress growth by inhibing synthesis of folic acid. high resistance. Bacteriostatic
• TX: UTI, gram pos. cocci, MRSA, chlamydia, pneumocystitis jiroveci (severe immune compromise/HIV)
• SE: crystalluria (drink lots of water), hypersensitivity, blood dyscrasia (decrease in blood cells), Kernicturus (bilirubin in brain, not for newborns), stevens-johnson syndrome (lesions mostly around the mouth, 25% fatal).
• Bactrim, used first to treat MRSA

succinylcholine

• Neuromuscular blocking agent- flaccid paralysis
• AE:
• Apnea
• Hypotension
• Malignant Hyperthermia
• Hyperkalemia w/ Cardiac arrest
• Muscle Pain
• Never for pt with Myasthenia Gravis
• Does not block pt’s conscious
• Still feel pain/ Hear things

epinephrine

• receptor: alpha1, alpha2, Beta1, beta2
• catelcholamine
• route: topical, injection, inhaled
• agonist
• side effects:hypertensive crisi, dysrhythmias, angina pectoris, necrosis(extravasation), hyperglycemia
• therapeutic uses: delay absorption of local anesthetics, control superficial bleeding, elevate BP, mydriasis, overcome AV heart block, restore cardiac fxn, bronch-dilation, anaphylactic shock
• not safe with:MAO inhibitors, trycyclic antidepressants, general anesthesia(tachydysrhythmias), alpha blockers, beta blockers,

propranolol

• receptor:beta1 and beta2
• antagonist
• side effects: bradycardia, AV heart block, heart failure, rebound cardiac excitation, bronchoconstriction, inhibition of glycogenolysis, CNS effects
• therapeutic uses: reduces heart rate, decreases force of ventricular contraction, suppresses impulse conduction through AV node, HTN, angina, dysrhythmias, MI
• not safe with:calcium channel blockers, insulin

captopril

• ACE inhibitor
• MOA: Causes dilation of arterioles and veins, blocks aldosterones fluid retention.
• TU: treat HTN, HF, diabetic nephropathy, MI
• Prevents CV events in at risk patients
• SE: 1st dose hypotension, cough, hyperkalemia, renal failure, fetal injury, angioedema
• interacts with diuretics, other HTN drugs, lithium, NSAIDS
• PO

vasodilators

Sodium Nitroprusside (Nitropres)

• MOA: dilates arterioles, decrease cardiac work, increase cardiac output and tissue perfusion. Reduces cardiac afterload
• TU: HTN, hypertensie crisis, HF
• SE: reflex tachycardia, increased blood volume, SLE-like syndrome, orthostatic hypotension
• PO/IV

spironalactone

• Aldosterone receptor blockers
• MOA: Antagonist to aldosterone, stops Na and water retention and K excretion
• TU: HTN, HF, edema
• SE: Hyperkalemia, some endocrine effects
• interacts with ACE inhibitors and other drugs that raise K levels

digoxin

• Anti-dysrhythmics
• MOA: increases force of ventricular contraction 
• TU: HF, dysrhythmias
• reduces symptoms, increases exercise tolerance and decreases hospitalizations but does not prolong life
• SE: cardiac dysrhythmias (can be caused by hypokalemia, HD), anorexia, N/V, fatigue, visual disturbances
• interacts with lots of things
• 0.5 to 0.8 ng/mL

benzodiazepines

• TU:

  Anxiety, insomnia, seizure disorders, alcohol withdrawal, (Diazepam – muscle, spasm/spasticity. Alprazolam/clonazepam/lorazepam – panic disorder. Diazepam, lorazepam, midazolam – preoperative sedation).

• AE:

  CNS depression, anterograde amnesia, sleep driving (and other complex sleep behaviors), paradoxical effects (insomnia, euphoria, excitation, heightened anxiety, and rage – if these occur D/C treatment), physical dependence, respiratory depression, abuse, use during pregnancy (during 1^st trimester – increased risk of congenital malformations, near term – CNS depression in neonate.

warfarin

• anticoagulant, veins
• MOA: decreases production of vitamin K dependent clotting factors
• TU: prophylaxis of thrombis, prevention of VT and related pulmonary embolism, thromboembolism in pts with prosthetic heart valve,prevention of thrombis during atrial fibriliation
• SE:hemorrhage, pregnancy issues (consider termination)
• Do not use in pts with:liver disease, alcoholism, thrombocytopenia, uncontrolled bleeding, pregnancy/lactation, pts undergoing lumbar pncture, anesthesia or surgery of the eye, brain, spinal cord, or vitamin K deficiency
• lab: baseline PT, increase dose if INR is below 2-3, PT INR ratio- 1.5-2avoid prolonged immobility, elevate legs when sitting, avoid restrictive clothing, wear support hose
• antidote: vitamin K oral/IV

heparin

• anticoagulant, reduces formation of fibrin (veins)
• IV/SubQ
• MOA: enhances activities of antithrombin
• TU: preferred anticoagulant in pregnancy, pulmonary embolism, evolving stroke and dvt, and used to prevent coag in extracorporeal devices, low doses post-op to prevent VT, and post MI
• Do not use in pts with: high bleeding risk, pts undergoing spinal puncture, or spinal/epidural anesthesia
• SE: hemorrhage, neurlogic injury, thrombocytopenia, hypersensitivity
• antidote: protamine sulfate
• Labs: CBC, HCT, aPPT (1.5-2x baseline, 60-80 sec), PLT (stop if less than 100,000/mm^3, VS (bleeding)

enoxaparin sodium

• LMW heparin, anticoagulant, reduces formation of fibrin (veins)
• SubQ
• MOA: enhances activity of antithrombin, less able to inactivate thrombin
• TU: Prevent DVT after abdominal surgery, hip/knee replacement, general surgery, trauma, acute spinal injury. Prevent ischemia in pts with unstable angina, non-Q-wave MI and ST-elevation MI. Treat DVT.
• Do not use in pts with: high bleeding risk, pts undergoing spinal puncture, or spinal/epidural anesthesia
• SE: hemorrhage, neurlogic injury, thrombocytopenia, hypersensitivity
• antidote: protamine sulfate
• Labs: CBC, HCT,PLT (stop if less than 100,000/mm^3, VS (bleeding), do not need to monitor aPTT-can be used at home

MAOIs

• TU:

  MAOIs are used for people who have atypical depression; can be helpful for those who have bulimia, OCD, and can reduce panic attacks.

• AE:

  MAOIs cause direct CNS stimulation. Excessive stimulation can produce anxiety, insomnia, agitation, hypomania, and mania.

• Diet:

  Foods that are low in tyramine that are safe to eat: most vegetables (no avocados), most fruits (no figs or bananas), fresh meat, milk, cottage cheese, cream cheese (all other cheeses contain high tyramine), and baked goods that contain yeast.

amitriptyline

•  TU: depression and bipolar disorder
• AE:orthostatic hypotension, anticholinergic effect (dry mouth, constipation, dry eyes), diaphoresis, sedation, cardiac toxicity, seizure, hypomania, suicide risk
• do not take with: MAOIs, sympathomimetics, anticholinergics, CNS depressants
• takes 1-2 months to work
  

SSRIs

• lexapro, zoloft, prozaac
• TU: depression, bipolar disorder, Obsessive compulsive disorder, Panic disorder, bulimia, and premenstrual dysphoric disorder
  
  
• AE: sexual dysfunction, nausea, Headache, nervousness, insomnia, anxiety, weight gain, serotonin syndrome, withdrawal, neonatal effects

1st generation anti psychotics

• TU: schizophrenia
• AE: extrapyramidal symptoms, acute dystonia (muscle spasm in the face), Parkinsonism (mask-like faces, drooling, tremor, shuffling gaits), Akathisia (pacing and squirming; continuous movement), tardive dyskinesia (twisting, wormlike movements), neuroleptic malignant syndrome (muscle contraction, stiffness), anticholinergic effects (dry mouth, constipation), orthostatic hypotension, sedation, neuroendocrine effects, seizures, sexual dysfunction, dermatologic effects, agranulocytosis (no WBC), severe dysrhythmias.
• dystonia: benadryl, parkinsonism: symmetrel, NMS: dantrolene
• 
  

2nd generation antipsychotics

• geodon and zyprexa TU: schizophrenia and bipolar disorder
• AE zyprexa: weight gain, dyslipidemia, diabetes
• AE geodon: somnolence, Ortho hypo, rash, prolonged QT interval

• Proton pump inhibitor, prodrug
• TU: G and D ulcers (short term), erosive esophagitis, GERD, ZES (long term)
• PO
• AE: Headache, N/V/D, gastric cancer with long term due to gastrin, osteoporosis/fracture with long term use, pneumonia
• Reduces absorption of Atazanavir, Ketoconazole, Itraconazole
• Take just before eating

sodium phosphate

• Osmotic laxative that retains water
• TU: Bowel evacuation
• Do not use in patients with hyperphosphatemia, hypocalcemia, renal failure, CHF and HTN
• AE: GI effects, drink full glass of liquid, arhythmias, cardiac arrest, electrolyte imbalance

docusate sodium

• Surfactant Laxative
• PO/RC
• MOA: facilitates penetration of water, inhibits fluid absorption, works in 1-3 days
• Do not use within 2 hours of other laxatives
• TU: softening and passage of stool
• SE: Diarrhea

loperamide (immodium)

• antidiarrheal
• TU: diarrhea, volume of discharge in ileostomies
• MOA: suppresses motility and fluid secretion into intestine
• poorly absorbed and does not cross BBB
• no abuse

diphenoxylate (lomotil)

• antidiarrheal
• MOA: decrease motility, decrease fluid into small intestine
• morphine-like in high doses
• PO
• atropine added (increase HR) to deter abuse
• schedule V

psyllium (metamucil)

• Bulk forming laxative
• MOA: Absorbs water, softening an enlarging mass, works in 1-3 days
• TU: Constipation
• Do not give to patients with ABD pain, N/V, dysphagia
• AE: GI effects, must drink with water, increased blood glucose, decreased absorption of warfarin, salicylates and digoxin

methycellulose (citracel)

• Bulk forming laxative
• MOA: Absorbs water, softening an enlarging mass, works in 1-3 days
• TU: Constipation, relief of diarrhea, patients with diverticulosis and IVS
• Do not give to patients with ABD pain, N/V, dysphagia, pregnancy/lactation
• AE: GI effects, must drink with water

promethazine (phenergan)

• antiemetic, dopamine antagonist
• TU: emesis w/ surgery, CINV
• AE: extrapyramidal effects, anticholinergic effects ( drying), hypotension, sedation

dronabinol (marinol)

• antiemetic, cannabanoid (THC)
• TU: CINV, appetite stimulant in HIV
• SE: temporal disintegration, dissociation, dysphoria (not for psych pts)
• AE: tachycardia and hypotension
• Schedule 3

fluticasone (flonase)

• TU:Decrease congestion, rhinorrhea, sneezing, nasal itching, erythema. Reduces swelling of nasal passages for increased visualization (surgery/procedures).
• preferred for seasonal and perennial allergic rhinitis
• AE: Nasal irritation, decrease nasal passage healing, burning itching sensation. May also have: sore throat, nose bleeds and headache
• do not use in , narrow angle glaucoma, uncontrolled cardiovascular disease, diabetes, thyroid dysfunction, prostatitis. Monitor growth rate in children.

pseudophedrine

• TU: Good for nasal congestion caused from excess secretions and swollen passages caused by: allergies, upper respiratory infections (URIs) like the common cold, rhinitis, sinusitis, for diagnostic and surgical procedures
• AE: tp- nasal mucosal irritation and dryness, CNS stimulation (headache, irritability, agitation, nervousness, uneasiness), cardiac palpitations, HTN, vasoconstriction, rebound congestio. Oral, no rebound congestion

antitussives (codeine)

• TU: chronic nonproductive cough often associated with the common cold and other URIs
• AE: CNS effects – dizziness, lightheadedness, drowsiness, respiratory depression), GI distress (N/V, constipation), potential for abuse. Pregnancy Category Risk C. Contraindicated in patients with acute asthma, head trauma, liver and renal dysfunction, acute alcoholism

guafenesin (mucinex)

• TU: Relief of nonproductive cough (bronchitis, laryngitis, sinusitis). Can be combined with antitussives or a decongestant for treating symptoms of cold, allergic rhinitis or cough caused by lower respiratory disorders.
• AE:

  N/V, gastric irritation, drowsiness, dizziness, allergic reaction (rash). Additive or synergistic hypothyroid effect when used concurrently with lithium or anti-thyroid meds

theophylline (theodur)

• TU: Oral Theophylline is used for maintenance of chronic stable asthma. (IV in emergency cases only).  Theophylline can decrease the frequency and severity of asthma attacks, but it is best used for nocturnal asthma attacks.
• AE:  nausea, vomiting, diarrhea, insomnia, restlessness. Dysrhythmias and convulsions at levels greater than 30, give charcoal
  

corticosteroid inhalers

• TU:   most effective antiasthma drugs available- by suppressing inflammation.Prophylaxis for chronic asthma on fixed schedule NOT prn.
• AE: oropharyngeal candidiasis, Dysphonia
• Ex) QVAR, Pulmicort, Aerobid, Flovent, Azmacort

albuterol

• TU: bronchodilator to control and prevent reversible airway obstruction caused by COPD and asthma. INH- PRN for quick relief, PO- long term control
• AE:

  tachycardia, angina, tremor, nervousness, restlessness, paradoxical bronchospasm, chest pain, palpitations

rifampin (rifadin)

• mechanism of action: broad spectrum against most gram (+) and some (-). suppresses protein synthesis by inhibiting DNA-dependent RNA. Bactericidal to M. tuberculosis and M. leprae.
• drug effects: inducer of P450 enzymes, can decrease the levels of many drugs, especially oral contraceptives, warfarin, and protease inhibitors and NNRTIs (for HIV)
• PO/IV
• therapeutic uses: one of the most effective against TB, both intra- and extracellular. drug of choice for pulmonary and disseminated TB. never used alone.
  
• side effects: toxicity rarely causes discontinuation of tx, hepatotoxicity. Gives a red-orange color to urine, sweat, saliva and tears.
  

isoniazid (INH)

• primary drug for prophylaxis and tx of TB
  
• mechanism of action: highly selective for M. tuberculosis. Bactericidal to bacilli that are actively dividing. Bacteriostatic to dormant. Likely suppresses growth by inhibiting synthesis of mycolic acid for cell wall, which is not produced by the host or other bacteria.
  
• PO/IM
• therapeutic uses: used to treat active TB along with another drug, or alone to treat LTB
• adverse effects: peripheral neuropathy (give pyridoxine-Vitamin B6) and hepatotoxicity, (stop tx)
  
• do not take with phenytoin

amphotericin B (amphotec)

• polyene antibiotics
• increases cell permeability
• broad spectrum of pathogenic fungi, drug of choice for systemic mycoses
• preferably used in the hospital, to monitor for effects
• tx is usually 6-8 weeks
• adverse effects:
• fever, chills, rigors, nausea and headache
• high incidence of phlebitis
• nephrotoxicity
• minimized by administering 1L of saline daily during tx
• hypokalemia
• bone marrow suppression
• do not take with NSAIDs, cyclosporins or aminoglycosides
• monitor, BUN, creatinine, I&O, potassium, hematocrit
• infuse slowly over 2-4 hours, rotate sites of infusion
• pre-treat with tylenol and benadryl

influenza vaccines

• Takes 1-2 weeks to work
• Everyone except those with egg allergy or severe infection should receive

zidovudine (retrovir)

• mechanism of action: (NRTI) Suppress synthesis of viral DNA by reverse transcriptase. must undergo conversion to active form, ZTP, which is incorporated into forming viral DNA, stopping further growth. also causes competitive inhibition of reverse transcriptase.
• drug effects: decrease viral load, increase CD4 T cell counts, delay onset of disease symptoms and reduce symptom severity
• therapeutic uses: used in combination of other drugs for HIV. able to penetrate into CNS
• PO/IV
• key side effects:
• anemia and neutropenia
•  Lactic acidosis with severe hepatomegaly (liver enlargement) and hepatic steatosis(fatty degeneration of liver).
  
• lab values: monitor hemoglobin, neutrophil counts before tx and every 2-4 weeks after. lactic acid levels in arterial blood. AST/ALT
• do not eat with fatty food
  

mannitol (osmitrol)

• TU: prophylaxis of renal failure, reduction of intracranial pressure/intraocular pressure
• IV only
• AE: edema, HA, N/V, F&E imbalance
• contrindicated for heart disease
  

hydrochlorothiazide (HCTZ)

• TU: HTN, edema, diabetes insipidus
• AE: hyponatremia, hypochloremia, hypokalemia, dehydration, hyperglycemia, Mg deficiency
• do not take with lithium, digoxin, antihtn drugs, NSAIDs

furosemide (lasix)

• TU: pulmonary edema (CHF)/ edema of hepatic, cardiac, renal origin/HTN that can't be controlled and severe renal impairment.
• AE:

  hyponatremia/ Hypochloremia/ Dehydration/ hypotension/ hypokalemia/ ototoxicity

central acting anticholinergics

levothyroxine (synthroid)

• TU: Cretinism, myxedema coma, simple goiter & primary hypothyroidism
• acute OD, thyrotoxicosis may result. S&S: tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance & sweating
• chronic OD . accelerated bone loss & increased risk of A.Fib.
  
  

propylthiouracil (PTU)

• MOA: blocks the synthesis of thyroid hormone
• TU: Graves disease, adjunct to thyroid radiation. prep for thyroid surgery and thyrotoxic crisis (thyroid storm- hyperthermia, tachycardia, restlessness, agitation and tremor). Must dose several times a day since short duration
• SE: rash and rarely: agranulocytosis, hypothyroidism, neonatal hypothyroidism and goiter

vincristine

• BONE MARROW SPARING; IDEAL FOR COMBO CHEMOTHERAPY
• HODGKIN’S and NON-HODGKIN’S LYMPHOMA
• ACUTE LYMPHOCYTIC LEUKEMIA
• WILMS’ TUMOR
• RHABDOMYOSARCOMA
• KAPOSI’S SARCOMA
• BREAST CANCER
• BLADDER CANCER
• AE: neuropathy, necrosis
  

sildenafil (viagra)

• TU: ED
• AE: hypotension, flushing, nasal congestion, diarrhea, rash, dizziness, mild transient visual distrubances, intensifies sleep apnea
• Do not take with nitrates, alpha blockers, grapfruit juice

estrogen

• TU: female hypogonadism, acne, post-menopausal hormone levels
• AE: endometrial hyperplasia and carcinoma, breast cancer, ovarian cancer, nausea, CV effects- pulmonary embolism, VTE, stroke

morphine

• TU: analgesia, sedation, euphoria, cough suppression, and suppression of bowel motility
• AE: respiratory depression, bradycardia, constipation, urinary retention, orthostatic hypotension, emesis, miosis, cough suppression, and biliary colic. also dependence and toelrance with prolonged use
• Antidote is narcan, (naloxone)

• H2 recepter antagonist
• TU: Gastric and duodenal ulcers, ZES, GERD symptoms, aspiration, pneumonitis, heartburn, indigestion, sour stomach
• PO/IM/IV
• AE: antiandronergic (blocks testosterone causing decreased libido, gynecomastia and impotence), rare CNS effects with renal imparement, pneumonia, when given IV may cause hypotension and dysrhythmias
• pH must be 5 or above, do not take within 1 hour of antacids
• increases levels of warfarin, phenytoin, theophylline and lidocaine

• Adrenergic
• Eye - contraction of radial muscle, causes mydriasis
• Arterioles - constriction in skin viscera and mucous membranes
• Veins - constriction
• Ejaculation
• Contraction of prostate capsule
• Bladder - contraction of trigone and sphincter
• therapeutic uses: adjunct to local anesthesia, vasoconstriction, mydriasis, hemostasis, nasal decongestion
• AE: HTN, necrosis, bradycardia

• Adrenergic
• Located in presynaptic nerve terminals
• Inhibition of transmitter release

• Adrenergic
• Heart - increased rate, increased force of contraction, increased AV conduction velocity
• Kidney - renin release
• therapeutic: cardiac arrest, heart failure, shock, AV heart block
• AE: altered heart rate or rhythm, angina pectoris

• Adrenergic
• Arterioles - dilation in heart, lung and skeletal MM
• Bronchi - dilation
• Uteran relaxation
• Liver - Glycogenolysis
• Skeletal MM - enhanced contraction and Glycogenolysis
• uses: asthma, delay of pre-term labor
• AE: hyperglycemia, tremor

• Cholinergic
• All parasympathetic target organs.
• Eye - focus lense for near vision(contracts cilliary MM), causes miosis(contracts iris sphincter MM)
• Heart - decreased rate
• Lung - constriction of bronchi, promotion of secretions
• Bladder - contracts smooth MM, increasing bladder pressure, relaxed trigone and sphincter, coordination of this causes voiding
• GI tract - salivation, increased secretions, increased intestine tone and motility, defecation
• Generalized sweating
• Erection  
• Vasodilation