Pharmacology Final Review
Diuretics
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Accelerate rate of urine formation
Result in removal of sodium and water
Mainstay of therapy for hypertension and heart failure, and for prevention of kidney damage during acute
kidney injury
Most commonly prescribed drug in the world
Instruct pt to take med in the morning to avoid interference with sleep pattern
Monitor for hypokalemia except for K-sparing: weakness, heart problems
Teach pts to eat high potassium foods
Types:
o Carbonic anhydrase inhibitors (CAI’s)
 Used for glaucoma, edema, epilepsy
 Can cause acidosis, hypokalemia, hypoglycemia
 Acetazolamide
o Loop diuretics
 Used for heart failure
 Most potent diuretic
 Can cause dizziness, tinnitus, dehydration
 Caution in sulfa allergies
 Furosemide (Lasix)
o Osmotic diuretics
 Fast acting
 Used for acute kidney injury, must have good blood flow to kidney
 Contraindicated with intracranial bleeding
 Can cause convulsions, thrombophlebitis
 Mannitol
o Potassium-sparing diuretics
 Weak diuretic
 Block aldosterone
 Monitor for hyperkalemia
 Used to treat hyperaldosteronism and hypertension, heart failure (Amiloride)
 Spironolactone
o Thiazide and thiazide-like diuretics
 Most common one used for hypertension, edema, also used as adjunct for heart failure
 Causes photosensitivity
 Hydrochlorothiazide, metolazone (thiazide-like)
 Excessive licorice consumption can cause hypokalemia
Fluids and Electrolytes
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Crystalloids
o NS, dextrose, ringer’s lactate
o Fluid replacement, good for treating dehydration
Colloids
o Albumin
o Increase colloid oncotic pressure, fluid moves from extravascular space into blood vessels
Blood products
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Only class of fluids that are able to carry oxygen
Increase tissue oxygenation
Increase plasma volume
Most expensive and least available because they require human donor
Cryoprecipitate and plasma protein fraction: to manage acute bleeding (greater than 50% blood
loss slowly, or less than 20% acutely)
o Fresh frozen plasma: increase clotting factors
o Packed red blood cells: increase O2 carrying capacity in pts with anemia or who have lost greater
than 25% total blood volume
o Whole blood: same as packed RBC except more beneficial in cases of extreme blood loss,
contains plasma and blood proteins
o Always run with NS
o Vitals every 15 minutes
Potassium
o Important for muscle contraction, maintenance of acid-base balance, isotonicity, and
electrodynamic characteristics of cell
o Signs of hyperkalemia: muscle weakness, paresthesia, paralysis, cardiac dysrhythmias
o Pts not on heart monitor should receive IV K at no more than 10 mmol/h, on heart monitor can
give at 20 mmol/h
o Should never be given as a bolus or undiluted
Sodium
o Principally involved in control of water distribution, fluid and electrolyte balance and osmotic
pressure of body fluids, helps regulate acid-base balance
Anti-Infective and Anti-Inflammatory Drugs
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S/S of infection:
o Fever, chills, sweats, redness, pain, swelling, fatigue, weight loss, increased WBC, formation of
pus
Treat infection empirically (guessing, broad spectrum antibiotic), prophylactically (prevention, malaria
pills), targeted (swab, identify organism)
Antibiotics:
o Sulfonamides
 Common allergy
 Cause photosensitivity
 Don’t give to infants less than 2 months, avoid in pregnancy
 Used to treat UTI’s and diabetes
o Penicillins
 B-lactame ring, resistant antibiotic
 Combine with clavulin to reduce resistance - amoxiclav
 Common allergy, cross with cephalosporins
 Good for strep and staph
 Safe for kids
o Cephalosporins
 Structurally related to penicillins – cross allergy
 Good skin antibiotic
 Keflex (cefazolin)
 4 generations, can destroy a broad spectrum of bacteria
 Safe for kids
o Carbapenems
 Mostly used in hospital only
Macrolides
 Used for pts with allergies to penicillin
 Good for gonnorrhea, chlamydia, strep
 Photosensitivity, can cause tinnitus
 “-thromycin”, erythromycin
o Quinolones
 Can cause tendonitis or tendon rupture
 Don’t give to kids
 Interact with dairy and antacids
 Can cause ECG changes
 “-floxacin”, ciprofloxacin
o Aminoglycosides
 Can’t give orally, IV or eye drops
 Can cause nephrotoxicity and ototoxicity – always check levels in blood
 “-mycin”, gentamycin, tobermycin
o Tetracyclines
 Not for pregnant or kids under 8
 Causes yellow teeth, inhibits bone growth
 Take without dairy, no antacids
 “-cycline” – doxycycline
All antibiotics cause oral birth control not to work
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Antiviral Drugs
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Inhibit progression, do not cure
Few viruses can be controlled by the current drug therapy
o Cytomegalovirus, hepatitis, herpes, HIV, influenza, RSV
Anti-virals are used for non-HIV infections
Acyclovir, amantadine hydrochloride
Contraindicated for lactating women, less than 12 months old, eczema rash
Immunoglobulins
o Concentrated antibodies that attack and destroy viruses
o Pooled from human and animal blood
o Commonly used for needlestick injuries and for pregnant mother’s who have no immunity to
chicken pox (vaccine is dangerous to fetus)
o More commonly thought of as immunizing drugs
Antiretroviral Drugs
o Used for active HIV infection, prophylactically for known potential exposure
o Indinavir sulfate, nevirapine, raltegravir, zidovudine
Anti-Tuberculosis Drugs
o Infection caused by bacterial species mycobacterium
o Granulomas in lungs, disease isn’t only in lungs
o TB difficult to treat in pts who are immunocompromised
o Not all who are exposed to TB will become ill, some people have bacteria walled off and are
dormant, will still test positive for TB
o Inhibit either protein synthesis or cell wall synthesis
o In pregnant women Isoniazid and ethambutol are safe, rifampin is often safe
o Isoniazid, ethambutol, rifampin
o Vitamin B6 may be required to prevent neuropathies and numbness with isoniazid
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Antifungal Drugs
o Fungi are difficult to kill
o Systemic infections: amphotericin B
o Oropharyngeal candidiasis: nystatin (swish and spit)
o Vaginal yeast infection: fluconazole
o Onchymycosis: terbinafine
o Contraindicated with liver failure, kidney failure and griseofulvin (med for porphyria)
o Can cause hepatoxicity
Antimalarial Drugs
o Common to use combo of drugs, management is currently changing due to drug resistance
o Different drugs for different types of malaria
o Contraindicated in pregnancy, tinnitus, and severe renal, hepatic or hematological dysfunction
o Causes photosensitivity, bad dreams
o Atovaquone/proguanil hydrochloride (prophylaxis/treatment), chloroquine diphosphate
(prophylaxis)
Nonmalarial Antiprotozoal Drugs
o Amoebiasis giardiasis, pneumocyctosis, toxoplasmosis, trichomoniasis – protozoal infections
o Don’t take with alcohol
o Atovaquone, metronidazole, paromomycin sulfate, pentamidine lestionate
Antihelmintic Drugs
o Used for round worm, tapeworm, and fluke injections
o Pyrantel not recommended in children under 1, liver disease
o Mebendazole is main one
Anti-Inflammatory and Antigout Drugs
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Anti-inflammatory Drugs
o NSAID’s most commonly prescribed
o Have analgesic, anti-inflammatory, antipyretic effects, antigout, aspirin also has antiplatelet
effects
o Avoid using after 32 weeks gestation, not recommended during lactation, never for kidney
disease
o Monitor kidney function
o GI distress biggest adverse effect
o Aspirin, celebrex, ibuprofen, indomethacin, Toradol
o Aspirin: increases bleeding with warfarin, never given if pt has bleeding disorder, usually enteric
coated
Antihypertensive Drugs
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Lifestyle modifications first line of treatment for hypertension – healthy diet, reduced sodium, regular
physical activity, moderation in alcohol, stress reduction
Treat to target – less than 140/90, 130/80 for diabetes and kidney disease
Combination therapies – meds and lifestyle
On these meds for life – if they stop taking these can have hypertensive emergency
Teach to move slow and get up slow
Risk factors for HTN, what HTN leads to
Check BP before giving med, withhold if low
Beta Blockers
o “-olol”
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o Lowers HR, lowers BP
o Assess HR before administering, monitor HR and BP
o Caution with asthma
o “-osin” used for BPH
ACE Inhibitors
o “-pril”
o Often first line for heart failure
o Monitor BP – lowers it
o Causes dry cough
o Has cardiac and renal protection, drug of choice for diabetes and heart failure
ARB’s
o “-sartan”
o Monitor BP
o Will get this if they get cough from ACE
Calcium Channel Blockers
o Amplodipine (Norvasc)
o Work well in African pts
o Used for angina
Diuretics first line pharmacological treatment for hypertension – thiazides most common
Vasodilators
o Not usually given outpatient, for hypertensive emergencies only
o Sodium nitroprusside (Nipride)
Antianginal Drugs
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Chronic stable angina (classic, effort)
Unstable angina (pre-infarction)
Vasospastic (Prinzmental, variant)
Nitroglycerin
o Available sublingual, spray, patch, IV, oral – all but oral bypass first pass effect
o Contraindicated with hypotension, severe head injury, erectile dysfunction drugs
o Should burn under tongue when taken, if not it is not effective
o Keep in original container, can’t be exposed to sunlight, always carry it with you
o If first spray doesn’t relieve chest pain, call 911 and take second spray after 5 minutes, max. 3
sprays over 15 minutes
o Patch should be removed at night and reapplied in morning to avoid tolerance of drug
o Can cause headache and lightheadedness when taken, take while sitting
Heart Failure Drugs
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Not a specific disease, complex clinical syndrome resulting from any functional or structural impairment to
the heart, specifically ejection of blood or ventricular filling
Heart is unable to pump blood in sufficient amounts from the ventricles to meet body’s metabolic needs
o Glycosides
 Increase force of myocardial contraction
 Can cause yellow coloured vision
 Narrow therapeutic index
 Digoxin toxicity – hyperkalemia, cardiac dysrhythmias, overdose
 Many meds interact with digoxin, important to check
 Apical HR for 1 minute prior to admin
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 Monitor drug levels in blood: 0.8-2 ng/mL
Phosphodiesterase Inhibitors
 Short term management of heart failure, given when pt doesn’t respond to digoxin,
diuretics or vasodilators
 Given as weekly 6 hour infusion
 Milrinone only one in Canada
Antidysrhythmic Drugs
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Correct rhythm of the heart
Can use beta blocker if tachy
Adenosine slows conduction through AV node, used in emergencies
All antidysrhythmics can cause dysrhythmias
Anticoagulants
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Do direct effect on blood clot that is already formed
Used prophylactically to prevent thrombus and embolus
o Heparin
 Turn off coagulation pathway and prevent clot formation
 Used more in hospitals
 Monitor PTT
 Short half-life
 Antidote is protamine sulfate
 Available in injections
 Low-weight don’t require frequent lab monitoring, given SUBCUT
o Warfarin
 Discharged home on this
 Monitor INR
 Antidote is Vitamin K
Antiplatelets
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Prevent platelet adhesion
Contraindicated with thrombocytopenia, active bleeds, GI ulcer, stroke
Aspirin
Antifibrinolytic Drugs
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Prevents lysis of fibrin, promotes clot formation
Used for prevention and treatment of excessive bleeding
Used more during emergencies when pt has a clot
Tranexamic acid, desmopressin, aprotinin
Thrombolytic Drugs
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Breakdown or lyse preformed clots
Used for acute MI, DVT, PE, stroke
Given in emergencies, not long term
Increases bleeding
Streptokinase, anistreplase, alteplase, reteplase, tPA
Antilipemic Drugs (Cholesterol)
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LDL is bad cholesterol
HLD is good cholesterol
Monitor liver function
Risk factors for high cholesterol
“-statins” most potent LDL reducers
o Can cause myalgia or increase in liver enzymes
o Don’t use with grapefruit juice
o Take at night because body synthesizes cholesterol while sleeping
Analgesics
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Meds that relieve pain without causing loss of consciousness
Opioids and non opioids
Treat mild pain with Tylenol
Treat moderate to severe pain with opioids
Acute pain: sudden and usually subside when treated, less than 3 months
Chronic pain: more than 3 months
Nociceptive pain: classified as either somatic or visceral
Superficial pain: originated from skin and mucous membranes
Vascular pain: originates from some pathology in the vascular or perivascular tissue (headache)
Neuropathic pain: 2-3% of people, results from injury or damage to peripheral nerve fibres or central
neurological damage to CNS, tends to be resistant to OTC analgesics
Phantom pain: type of neuropathic pain after amputation
Psychogenic pain: originated from psychological factors, not physical conditions or disorders, however
physical causes can’t be definitely ruled out
Cancer pain: can be acute or chronic
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Opioids
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3 classes:
 Meperidine-like drugs
 Methadone-like drugs
 Morphine-like drugs
o Monitor respirations
o Can cause respiratory depression
o Reversal of overdose: Narcan
o Constipation most common adverse effect, along with hypotension, palpitations, flushing, rash
o Can cause addiction (psychological dependence), physical dependence, and tolerance
o Don’t take with alcohol or any other CNS depressants
o Doses based on equianalgesic dose (amount of med given IM will equal same amount given PO)
o Contraindicated in severe asthma, any resp insufficiency use caution
o Store high up, in locked cupboard, away from children
Nonopiods
o Tylenol (acetaminophen) most common one, also has antipyretic effects
o NSAID’s are also in this class
o Can be lethal when taken in overdose – max daily dosage of Tylenol is 4000mg, make sure you’re
not taking meds with Tylenol in them
o Don’t use with alcohol
Non-pharm pain management
o TENs, massage, imagery, acupuncture, art therapy, distraction, heat/cold, hypnosis, yoga
Anesthetics
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General or local
Can do moderate sedation – twilight zone, awake, able to answer to stimuli, control own respirations, have
amnesia of procedure after (conscious, procedural), often combo of benzos and narcotics, safer and better
recovery time
o General
 Inhaled: volatile liquids or gases that are vaporized in O2 and inhaled to induce
anaesthesia
 Injectable: IV
 Cause complete loss of consciousness
 Many given in combination to give minimal doses of each (alleviate adverse effects)
 Can cause malignant hyperthermia
 Interacts with antihypertensives, beta blockers, tetracycline
 Used for surgery
o Local
 Used for childbirth, dental procedures, sutures, spinal, diagnostic procedures such as
lumbar puncture or thoracentesis
 Topical or parenteral
 Use epi and lidocaine together to promote vasoconstriction to area of injury
 Risk for spinal headache with spinal anaesthesia
Neuromuscular Blocking Drugs
o Muscle contractions are inhibited and flaccid muscle paralysis results
o Used to maintain controlled ventilation during surgical procedures
o Has no anesthetic effect, can still feel things
Integumentary Drugs
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Ointments – gels – creams - lotions
Topical antimicrobial drugs
o Antibacterial
 Used for the same reasons as oral and parenteral, without systemic effects
 Used to treat impetigo – Keflex and amoycillin
 Most common: bacitracin, neomycin, polymyxin (polysporin, increased allergy in kids,
OTC), neomycin & polymyxin B (Neosporin, OTC), mupirocin (Bactroban, good staph
aureus coverage, becoming resistant because or MRSA, used for impetigo and MRSA,
available by prescription
o Antifungal
 Clotrimazole: for vaginal yeast infections
 Miconazole nitrate: used with athlete’s foot, jock itch, Monistat for yeast infections
o Antiviral
 “-ovir”
 Used for HSV 1, 2
 Use gloves to prevent spread of infection
 Use oral antivirals more often
Antiacne Drugs
o Can use antibiotics – minocycline, doxycycline, tetracycline (not for kids or pregnant)
o Females can use oral contraceptives as acne med
o Common OTC acne med: benzoyl peroxide
o Benzoyl peroxide
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 Keratolytic action: softens scales and loosens outer layer of skin
 Leads to peeling skin, redness, sensation of warmth
 Use thin layer so skin can breathe
 Causes anaerobic death of bacteria causing acne
 Improvement in 4-6 weeks
o Clindamycin Phosphate (Clindets, Dalacin)
 Causes burning, itching, dryness, oiliness, peeling
 Available in creams, gels, lotions, suspension and pledgets
 Benzacline – has benzoyl with it
o Isotretinoin (Clarus, Epuris)
 Used to be Accutane
 Category X in pregnancy
 Women must use contraception during treatment and for at least 1 month after its
discontinuation
 Written consent form
 Observe for S/S of depression and suicidal ideation
 Good for scaring acne, when other topical and oral antibiotics aren’t working
o Tretinoin (Retinoic Acid, Vit A Acid, Retin-A)
 Used for acne and dermatological changes associated with sun damage
 Can cause local inflammatory reactions, alterations in skin pigmentation
 Extremes of weather is biggest thing to worry about
Topical Antipruritics
o Contain antihistamines and corticosteroids
o Don’t use with widespread chicken pox or poison ivy because of systemic absorption and risk for
toxicity
o Prednisone most commonly used
Treatment of burns
o Silver sulfadiazine (Flamazene)
o Use sterile gloves, apply thin layer
o Topical anti-infective
o Feels better putting on out of fridge
Ectoparasiticidal Drugs
o For scabies or lice
o Biggest treatment is non-pharm
o Lindane
Hair Growth Drugs
o Minoxidil (Rogaine)
 Topical, vasodilating, originally used for hypertension
 Not for use in pregnancy or breast feeding
o Finasteride (Propecia)
 Used for alopecia, systemic
 Not to be taken during pregnancy, women not to handle without gloves, do not crush it
Antineoplastics
o Flurorouracil (Efudex)
 For premalignant skin lesions and basal cell carcinomas, actinic keratosis
 Rapidly sheds and gets new skin
 Causes irritation, redness, pain, sores develop, hyperpigmentation, looks worse before it
gets better
 Take pictures for progress
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Immunomodulators
o Target immune system
 Pimecrolimus (Elidel)
 Common, for atopic dermatitis
 Give to kids instead of corticosteroid
 Tolerated well, expensive
 Imiquimod (Aldara P, Vyloma)
 HPV – genital warts
Sunscreen
Respiratory Drugs
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Drugs for Common Cold
o No kids can have cough and cold meds – treat symptoms – Tylenol, humidify, Vicks, fluids
o Antihistamines
 Take with food
 Hangover effect
 Can cause sedation
 Caution with diabetes
 Have anticholinergic effects: urinary retention, dry eyes
 Diphenhydramine – Benadryl
o Decongestants
 Adrenergic
 Topical/nasal spray
o Cause rebound congestion
o Use short-term
o Ephedrine, oxymetazoline, phenylephrine
 Oral
o “-ephedrine”
o No rebound congestion
o Can cause anxiety, nervousness
o Pseudophedrine
 Anticholinergic
 Intranasal: ipratropium (Atrovent)
 Corticosteroids
 AE: local mucosal dryness, irritation
 “-ide”, “-one”
 Intranasal
o Antitussive
 For anyone who had abdominal surgery
 Stops cough
 Opioid
 Codeine
 Not for elderly, risk for respiratory depression
 No driving or operating heavy machinery
 Nonopioid
 Dextromethorphan (Benylin)
 Usually paired with Tylenol and Advil in cold meds
o Expectorants
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 Guafensin (Robatussin)
 Drink lots of fluids to help make mucous thinner
 Caution with elderly and pt with asthma or resp insufficiency
Bronchodilators
o Used for asthma or COPD
o Beta-Agonist Bronchodilators
 Short acting: salbutamol
 Acute asthma attack
 Long acting: salmeterol
 Adjunct therapy
 Side effect: light headed, increase HR, increase anxiety
 Don’t use with beta blockers
 Vasoconstrictive (don’t give if increased risk of stroke)
 Some puffers contain lactose – milk allergy
 Hard to sleep if taken at night
 Don’t take more than 8 x/day
o Anticholinergic Bronchodilators
 Bind to Ach receptors blocking Ach – bronchoconstriction prevented, airways dilate
 Used as preventer – COPD bronchospasms, decrease secretions
 Cause drying effects, use nebulizer for mist
 Contraindicated in atropine allergy
 Ipratropium (Atrovent), tiotropium bromide monohydrate (Spiriva) – usually dosed
2x/day
o Xanthine Derivative Bronchodilators
 Plant alkaloids: caffeine (usually used in NICU), theophylline (most common, narrow
therapeutic range, PO and injectable)
 Synthetic: aminophylline
 Used for long-term resistant asthma, adjunct for COPD
 Contraindicated with cardiac dysrhythmias, seizures, peptic ulcers
Nonbronchodilating Respiratory Drugs
o Corticosteroids
 “-one”, “-ide”
 Most common
 Reduces inflammation
 Oral or inhaled
 Takes several weeks for full effect
 Fluticasone propionate (Flovent Diskus) – orange, most common one
 Don’t use with anyone with fungal infection
 Rinse mouth after use to avoid thrush
 Risk with diabetes
 Need to use daily to work
o Leukotriene receptor antagonists
 “-kast”
 Newer class, help for asthma triggered by allergies
 Takes 1 week to work
 Prevention, not meant for acute asthma attack
 Contraindicated in pts with allergies to povidone, lactose, titanium dioxide, cellulose
derivatives
 Assess liver function continuously
 Montelukast, zafirlukast
Mast cell stabilizers
 Rare
 Help reduce release of histamines
Monoclonal Antibodies
o New treatment for asthma, fancy expensive drug
o Can help with severe asthma as an antibody drug
Use bronchodilator before nonbronchodilator
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Immunity
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Immunosuppressants
o Transplant pts on them for life
o Used to treat or prevent rejection of transplanted organs
o Also used to treat rheumatoid arthritis, lupus, erythramotosus, Chrohn’s, MS, myasthenia gravis,
psoriasis
o All work to suppress T cells
o Contraindicated in pregnancy (unless emergency), kidney or liver failure
o Don’t take with grapefruit
o Anyone on these is at higher risk for opportunistic infections
o Oral ones should be taken with food
o Monitor WBC count – too low discontinue med, liver and kidney function
o Oral over IV if possible – reduces risk for infection from injection
o Oral antifungals often given with these to treat oral candidiasis (Nystatin)
o Vaccinations to protect themselves, avoid crowds and other sick people
o Azathioprine (Imuran)
 Used as adjunct medication to prevent rejection of kidney transplants, also used to treat
rheumatoid arthritis
o Glatiramer acetate (Copaxone)
 Only one used to treat MS
o Cyclosporine (Neoral, Sandimmune)
 Used in prevention of kidney, liver, heart, and bone marrow transplant rejection
 May be used for other autoimmune disorders
 Don’t mix in Styrofoam
o Tacrolimus (Prograf)
 Used for organ rejection prevention in liver and kidney transplants
 Used in treatment of active rheumatoid arthritis
Vaccines: suspensions of live, attenuated or killed microorganisms that can stimulate the production of
antibodies against the particular organism, 20 available
Babies start getting immunized at 2 months old
Pneumococcal vaccine
o Prevnar 13 in babies – 3 dose schedule and 2, 4, 6 months
o Pneumovax 23 – 65+, every 10 years, SUBCUT
Flu shot
o Can’t get it until 6 months old (2 doses, 1 month apart)
o Most important influenza control measure
o All people over 6 months should get it
o Fluad is specifically indicated for 65+
Contraindications to flu shot
o Egg allergy
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o Previous allergy to shot
Passive immunity
o Artificial: administration of serum or concentrated immunoglobulins, needlestick injury
o Natural: from mother to fetus through placenta, or to infant through breast milk, at 28 weeks
every mother gets vaccinated for pertussis
Active immunity
o Artificial: body clinically exposed to relatively harmless form of antigen that does not cause an
actual infection, vaccine
o Natural: person acquires immunity by surviving the disease itself and produces antibodies to the
disease-causing organism
Immunoglobulins
o Antibodies that have antigen-specific amino acid sequences
o Used for needlestick injuries, rabies, for mothers who are pregnant and have never been exposed
to chicken pox
o Passive artificial immunity
Live vaccines contraindicated in pregnant women or immunocompromised
Expected vaccine reaction
o Fever, minor rash, soreness at injection site, urticaria, arthritis, adenopathy
o Apply warm compress to site if sore, take acetaminophen
Allergic vaccine reaction
o Anaphylactic reaction, hives, facial edema, bronchoconstriction, cyanosis, dyspnea
Shingles (Zoster) vaccine given after 60, live vaccine
HPV given between 9-13 years old