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Med Type
CARDIAC MEDS
ACE INHIBITORS
Amioderone (Coradarone)
Amyl Nitrate
Anti-dysrythmics
MOA
SE/NOTES
1st choice for inhibitors
-“prils”
prevent Na retention and
vasodilation
Category x
Dry cough-> bradykinin
ANGIOEDEMA
Antidote for Nipride
toxicity (CN)
Class I: acts at Na+ channels, prevents influx of
sodium, decreased excitability
 Ia: quinidine: prophylaxis of SVT
Nurs priorities: dig, QRS
SE: decreased cardiac fx (HB), mental
status
 1b: lidocaine: Vtach
CNS/CV SE
Propanolol and cimetidine incr toxicity
 1c: fleccanide (ATOMIC BOMB)
PVCs
Class II: beta blockers (-olol)
Make HF worse, MI, diabetics
Decreases HR by neg chonotropes, neg
dromotropes
ClassIII: Amioderone: K+ channel blockers
IND: cardiac conversion of afib; life threatening
Vtach
ELONGATES refractory period
Blue skin, pulmonary fibrosis, thyrotoxicosis
MILK/GRAPEFRUIT
JUICE?
RENAL
dosing?
Cannot be
used w/ RF,
but can
prevent
worsening rf
in diabetic
pts
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digoxin/anticoag toxicity
Class IV: CCB’s (Verapamil)
neg inotrope, neg dromotrope
Kindey failure-> caution, pitting edema of LE
1st line: CCB, dirutetic (loop/thiazide) or RAAS
(ACE, RB, DRI’s);
ACE 1st choice
nd
2 line: add another or change classes;
BBlockers
Anti-hypertensives
ASA
Atorvastatin (Lipitor)
Atropine
Beta blockers
Calcium Channel Blockers
Digoxin
Direct Acting Vasodialator
Statin (HMGOA inhibitor)
Anticholinergic
Indication: Bradycardia
Used for HF
Incr refractoy period
Negative chornotrope
(decr HR)
Negative dromotrope
Increased Fcontraction
(positive inotrope)
RASH
81 mg for stroke/clot prevention
DECREASES TOTAL, triglycerides, LDL
And increases HDL (35-40%)
COQ10 enhances absorption
RHABDO, Hepatitis
Enhanced with
SE: decreased U/O, constipation, drymouth,
HR, mental status
BAD W/
GRAPEFRUIT JUICE
Narrow therapeutic range .125-.25 mg/day;
serum levels btwn 0.5 to 0.8 ng/mL
T1/2: 36 hr
Toxicity: decreased effect, halo, GI
CONSIDERATION: hypokalemia
Osmotic diuretics
Loop diuretics
 Furosemide (Lasix)
 SULFA ALLERGY
 Orthostatics, increased UO,
otoxicity/photosensitivity, hypokalemia
Cant use
Thiazides in
low GFR
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Thiazide diuretics
 HCTZ (hydrochlorothiazide)
 SULFA allergy
 More distal loop: decreased UO than
loop
 Decreased K+ Na+
 Increased Ca2+, uric acid, glucose
K+ sparing
 Spironolactone
 Supplement considerations
Diuretics
Furosemide (Lasix)
Hydrochlorothyazide
(HCTZ)
Loop diuretics
Niacin
Omega 3 fatty acids
Potassium supplements
(KCl)
Propranolol (Inderal)
Thiazide diuretics
RESP MEDS
ASTHMA SCHEDULE
Albuterol (Proventil)
B vitamins
Not effective
RISK OF STROKE
Hot flushASA
No evidence of effectiveness
Increased LDL
Not advised for ACE inhibitors or potassium
sparing diuretics
Non selective betablocker


Mild: SABA for resuce, if >2x week consider next step
Mild, persistent: low dose steroidal inhaler (Beclomethasone, fluticasone [flovent]) + a leukotriene inhibitor
or methylxanthine. SABA
 Moderate: intermediate dose, LABA, tablets or theophylene
 Severe: High doses steroid inhaler, LABA, tablets, or theophylline, and oral steroid (Prednisone) SABA
Short acting beta 2 (non
SNS stimulation causes relaxation of airways
selective) adrenergic.
and bronchodilation.
RESCUE MED, not
SE: paradoxical bronchospasm w/ excessive
effective used regularly
use, arrhythmias, hypertension, hypokalemia,
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hyperglycemia
Propper MDI technique: breathe in slowly, hold
breath for 10 s, wash mouth between uses,
SPACER,
Anti-histamine spray
(Astelin)
Beta 2 agonists
Beclamethasone (QVAR)
Decreases mucus, runny
nose, itching, sneezing
Given intranasally
Glucocorticoid
LOW DOSE STEROID
INHALER USED FOR MILD,
PERSISTENT MED
Taper off; candiasis
increase dose w/ stress
Fluticasone
FLONASE: REBOUND CONGESTION
corticosteroid inhaled for congestion/sneezing
H1 blockers
Rhitis/allergy
Montelukast (Singulair)
Leukotrine inhibitor:
decreases eosinophil
response
USED in mild,persistent for
long term asthma control
PO: glucocorticoid for
SEVERE asthma
Sympathomimetic
Used for decongestion
Prednisone
Pseudoephedrine
Rifampin
Inhibits RNA synthesis of
TB
FLOVENT; used as low dose steroid inhaler
Anticholinergic effects
Paradoxical excitation in 50% of children
Suicidal thoughts
REBOUND DECONGESTION
Often combined w/ guaifenesin
DO NOT USE W/ HBP (coricedin hbp)
ORANGE/RED discoloration of bodily fluids
Stains contact lenses
Decreases effectiveness of hormonal b/c, hiv
meds
HEPATOTOXICITY
Empty stomach
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Salmeterol
Long acting beta agonist
for mgmt. of MODERATE
asthma symptoms
MDI
WASH MOUTH
ADHERENCE NOT RESUCE
Steroid inhalers
Wash mouth between uses to prevent
candiasis
Medications for HA, Insomnia, Parkinson’s Disease, Alzheimer’s, Antieleptics, and Anxiolytics (NEURO)
Anti-depressant principles
Benzodiazepines
Diazepam (valium)
Flumazenil
Why did we give it?
Headache Meds
 Preventative or abortive
 Start w/ OTC
 Then w/ ergotamine and triptans
MAOI’s
Thiamine: HTN crisis
Phenytoin (Dilantin)
Partial tonic/clonic szs
T1/2: 8-60 hrs
TI: 10-20 mcg/mL
SE: gingival hyperplasia , SJS
Pregnancy: folic acid/defects, SJS
Decreses effects of hormonal bc/warfarin/gluco
Increases [serum]: benzos, ETOH, cimetatdine
NO ANTIDOTE
Triptans
Serotonin agonist
Heavy arm and chest
vasodilation
Zolpidem (Ambien)
Benzo like drugs
Better to stay asleep
GI MEDS
Antacids
Rebound insomnia
sleep behaviors
Reduces absorption of many other drugs
through chelation: timing is critical
-Aluminum SE: constipation, bone demineral
-Calcium: gastric acid hypersecretion,
constipation, renal failure, hypercalcemia
-magnesium: diarrhea, hyperkalemia, and
hypomagnamesia
Long term
use can
result in CKI
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Anti-emetics
Block receptors of
chemorecptor trigger zone
-Hypernatremia (cardiac overload)
SE: drowsiness, tardive dyskinesia
-anticholinergic: scopolamine
-antihistamines
-phenothiazine
-dopamine receptor blocker :metoclopramide
(Reglan)
-cannaboid
-bismuth salts (pepto bismol)
Bulk forming laxatives
Calcium Carbonate
(TUMS)
Cimetidine (Tagamet)
H2 Blockers (like Zantac)
Acts at Histamine-2
receptors of gastric
parietal cells to prevent
secretion of gastric acid
INDICATED IN PUD, reflux
diseases
Magnesium salts in meds
Psyllium (Metamucil )
Metoclopramide (Reglan)
Bulk forming laxative
Absorbs water and forms
mass to stimulate
peristalsis
Dopamine (inhibitory)
receptor blocker . Used for
anti-emetic. Accelerates
Advise pts that amount of calcium in Tums is
not sufficient to achieve DRA (would have to
take 10-15). Discourage “popping”
Reduces heaptic metabolism of MANY drugs
(resulting in toxicity)
Reduced effect w/ antacids
Toxicity: tachycardia, changes in mental status
CNS confusion, dizziness/drowsiness
ANTICHOLINERGIC SE
Cheaper than PPI and just as effective w/ ulcer
prophylaxis
NEED TO MONITOR FOR IN PT CONDITION, esp
cardiac as can result in hypomagnamemesia
(HTN, tachycardia) and in hyperkalemia
(arrhythmias, muscle weakness)
W/OUT WATER: can lead to obstruction
GI SE (cramps, intestinal/esophageal)
SE: Extrapyramidal side effects. Can cause
arrhythmias, hypo/hypertension, drowsiness
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Osmotic laxatives
Pancreatic enzymes
Scopolamine
Serotonin Receptor
Agonists (Zofran)
Sodium Bicarb
Stimulant laxatives
Surfactant laxatives
Antimicrobials
Amoxicillin/clavulantic
acid (Augmentin)
gastric emptying
Draw water from
capillaries of gut and
stimulate gut
LYTE!
Pancrelipase (Pancrease):
promotes process of
digestion
Anticholinergic
Used for motion sickness
Commonly used in
hosptials for chemo.
Serotonin antagonist at
chemoreceptor trigger
zone
Usually loose/watery stools
Used for rapid, complete evacuation of stools
Nausea, abd cramps, loose stools, obstruction
Hold if NPO, take immediately prior to meals
Can produce statoreas
ATROPINE LIKE EFFECTS
Blurred vision
SE: CNS depression and potentiation of other
narcotics, can cause QT INTERVAL ELONGATION
Biacodyl (Dulcolax)
Stimulates peristalsis and
impacts fluid/electrolyte
balance in gut
Abd cramps, nausea, diarrhea, rectal burning,
hypokalemia, muscle weakness
Broad spectrum
Indicated: penicillin
resistant bact.
Lyses cell wall
Bactericidal
MACULAR RASH: not allergy
diarrhea
Probenecid decreases excretion
<6 mo OM: amoxicillin
>2 yo, wait to see
non-resolve: amoxicillin
DR OM: augmentin
Nephrotoxic:
 Fluroquinolones
 Cephalosporins
Chelation agents:
 Cipro (floroquinolone)
 Tetracycline/doxycylcine
Avoid high fat meals
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 Gentamycin
 Flagyl
Anti-fungals
Anti-virals (-vir)
Cephalosporins
Ciprofloxacin
Doxycycline
Fluroquinolones
Gentamycin
Examples: Amphotericin B, Systemic (opportunisitic/nonopportunistic)
nystatin
mycotic=fungal
Nephrotoxicity
Disrupts cell wall
permeability
Bind ergosterol
(cholesterol component of
fungal membrane)
 Inhibition of nucleic acid synthesis
 Stops viruses from reproducing
Bind to penicillin binding
Seizures
proteins
Given preoperative prophylaxis
1st/2nd gen: narrow
spectrum
3rd/4th: broad
4th: can cross BBB
Superficial
Tetracyline
Bacterostatic inhibitor of
prn synthesis
Used for “weird diseases”
lyme, anthrax, h pylori,
acne, etc
Broad spectrum; inhibits
DNA gyrase
Pseudomonas/anthrax
Chelation
Avoid meals
Drink w/ water
Aerobic gram negative
Inhibits 30s ribosmome
PO
chelating agent: binds to milk, minerals, AND
OTHER DRUGS
SE: photosensitivity, brown teeth, suppresses
long bone (<8 yo)
Use back up B/C, potentiates warfarin
SE: Tendon rupture (NOT GIVE TO CHILDREN
<18yo)
Risk of torsades du pointes
Pharynx and Vagina candiasis
[bile/urine/stool/prostate]
Nephro/ototoxicity
Peak: 30 min-1 hr after IV
Take a long time to work
WKS Not DAYS
Hepatotoxic
Good for use w/
kidneys, however in
kidney failure
(decreased excretion)
incr risk of seziures
-use w/ loop diuretics
and aminoglycosides:
nephrotoxicity
CHELATION AGENT:
avoid antacids, iron,
mag, milk
Renal
adjustment
dosing
Hard on
kidneys and
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Metronidazole (Flagyl)
Penicillin
Analgesics
Acetaminophen (Tylenol)
ASA
Ibuprofen
N-acetycystine
MUCOMYST
Narcan (Naloxone)
Narcotics
NSAIDs
P. aergenosa, ecoli,
klibsiella, serratia, proteus
mirabellus
Protozoal
infections/parasiets/ and
obligate anaerobes
Trichomonoiasis and
Giardia
Narrow spectrum
Mainly gram +, some
gram-
Antipyretic, analgesic
Inhibits synthesis of
prostaglandins in central
NS
1st generation NSAID (cox1 inhibitor and cox 2inhibitor)
1st generation NSAID (cox1 inhibitor and cox 2inhibitor)
antidote
Trough: 1 hr before give you next dose
Inactivd by penecillins/cephalopsorins
ear
SE: nephrotroxicity
DISULFIRAM RXN
Durg interaction w/ ETOH and anti-coags
Nephorotoxi
cty
Least toxic, glossitis/stomatitis;
Most incidences of anaphylaxis: could be
immediate/accelerated (1-72)/late (days-wks)
IM or IV recommended
lasts 24-4 wks
Probenecid
Potentiates warfarin
Back up form of BC
3 mg/day MAX
REYE’s SYNDROME
CATEGORY X
ANTAGONIZE DIURETIC EFFECTS
Kidneys and Liver
PO/IV
charcoal may decrease effectivenss
must give w/in 10-12 hrs
-may be beneficial to promote mobility in
Can cause
renal failure
Renal failure
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Synthetic Opioids
Tramadol (Ultram)
acts on the mu receptor
Drugs Affecting Blood, Coagulation, and Clotting
Agatroban
Direct thrombin inhibitor,
Utilized when a person w/
Heparin Induced
thrombocytopenia (HIT)
needs anticoagulation
Protamine sulfate
Antidote for heparin
overdose
Base that forms w/ acidic
heparin to prevent
absorption and promote
excretion
TpA
Vitamin K
Clot buster
Antidote for warfarin
Warfarin
Modifies intrinsic pathway
ligament pain, not effective for muscle pain,
result in malformation/malhealing delayed
healing
COX-1: GI bleeding, renal failure, clotting issues
COX-2: decreasd inflammation, sensitivity to
pain, risk for colon CA
Analgesic w/ less resp depression
Decreased chance of dependence
CONTRAINDICATED in opioid dependence
no reversal agent known
Monitored via aPTT (12-24 s normal; measures
extrinsic pathway)
Initial loading dose given IV and then adjusted
via lab monitoring.
HYPERSENSITIVITY RXNS, PE,
hyper/hypotension
If initated in pt w/ hypovolemia can result in
cardiovascular complex
Pt may need FFP
Less allergic rxns than streptokinase
IMPORTANT to teach pt to keep level of vitamin
k intake (leafy vegetables) constant when on
Coumadin
Oral anticoagulant
Measured via PT and INR (normal 2-3)
*VALVES need higher INR than arrhythmia care
(4-5)
Once pt is on warfarin, anticipate switching for
Coumadin for home use
stress importance of follow up visits
PREGNANCY CATEGORY X!!!!!!!!!!!!
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Chemotherapy Drugs
Cisplatin (Platinol)
Cytotoxic chemo
Herceptin
Megace
Methotrexate
Alkylator like agent
Nonspecific disruptor of
DNA synthesis in bladder,
ovarian, and testicular
cancer
HIGH ALERT
Does not cross BBB in significant amount:
excreted 5 days
Nephrotoxicity/ototoxicity, sterility,
hypocalcemia, hypoklameia, hypomagnemesia,
hyperuricemia,
leukopenia/thrombocytopenia/anemia
 Act on similar metabolic pathways in both normal and CA cells
 Lack tumor specificity
 Toxicity divided into common SE, adverse rxns, dose limited
 Common SE: n/v, alopecia, bone marrow suppression
 Types
o Antimetabolite: interfere w/ normal DNA production
o Alkylating: Prevent cell division
o Antibiotic: block transcription
o Mitotic inhibitors
o Others: hormones, antihormones, steroids
HIGH ALERT
SE: LOTS OF PULOMNARY SE (Pneumonitis,
monoclonal antibodies
edema, fibrosis), bone marrow suppression,
Tx of metastatic br ca
hypersensitivity rxns
displaying human
epidermal growth factor
receptor 2 (HER2)
Progestin
Thrombocytopenia, edema,
-Used in prostate CA to
suppress androgens
Use w/ caution in thrombophlebitis, vaginal
-Used in oncology to
bleeding
promote weight gain
Believed to derive benefit
from suppression of
pituitary
Antimetabolite: inhibits
Cell phase specific
Nephrotoxic
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synthesis of DNA/RNA
Indications: head, neck,
lung, renal, ovary, bladder,
testicle, leukemia,
lymphoma
Tamoxifen
MSK
Bisphoshonates
Also used as a DMARD
Anti-estrogens
Estrogen receptor + breast
cancers; breast cancer
prevention
Osteoperosis
Inhibits osteoclasts
BIG SE: pulmonary fibrosis
Bone marrow suppression, blurred vision,
SJS/TENS, n/v, acute renal failure
GIVEN W/ LEUCOVORIN TO REDUCE TOXICITY
FULL ANTINEOPLASTIC EFFECT MAY TAKE
MONTHS TO OBSERVE
KNOWN TO CAUSE BIRTH DEFECTS
MAY CAUSE S/SX such as hotflashes
Colchicine HIGH ALERT
Gout
Cyclobenzaprine (Flexeril)
Methocarbamol (robaxin)
Central acting muscle
relaxant (spasm) ; local
Central acting muscle
relaxant (Spasm) ;local
CNS depression
SERMs
Osteoperosis
Succinylcholine
Endocrine/Diabetes
Biguanides (metformin)
Spasticity (systemic)
90 degrees for 30min-1hr
Osteonecrosis of the jaw (ONJ)
Renal failure
Agranulocytosis
Rhabdo w/ statins
GI bleed w/ NSAIDS
Not indicated w/ hyperthyroidism, MI, HF
Anticholinergic
Best in acute injury
black/brown/green urine
Both: intensified w/ ETOH
SHORT TERM ONLY: mood alterin, tolerance,
potential for abuse
SE: increased muscle tone, loss of dexterity
Contraindications “men”
MUST Take w/ calcium
Postmenopausal
Malignant hypertension
GOLD STANDARD OF ORAL
TII DM meds
Promotes peripheral
WILL NOT cause hypoglycemia
BIGGEST SE: LIFE THREATENING lactic acidosis
w/ IV contrast dye
Use w/
caution in
renal pts
Administered w/
meals
LIFE
THREATENI
NG LACTIC
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Liothyronine (Cytomel)
DDAVP[desmopressn
acetate]
DPP-4 inhibitors (Januvia)
Glucocorticoids
Incretin mimetics
(exentide: Byetta)
uptake of glucose and
decreased
gluconeogenesis by liver
T3 preperation indicated
for hypothyroidism; T3 has
shorter half-life, more
rapid onset than prohormone T4
Vasopressin analog given
to treat Diabetes
Inseppidus (retains water)
-Intranasal/PO also
indicated for nocturnal
enuresis
PO given to prevent
breakdown of insulin by
inhibiting DPP-4 enzyme ;
incretin enhancer
Given topically, PO
(prednisone), for systemic
anti-inflammatory effects
Stimulates release of
insulin to:
Decreased vitamin B12 levels
Unpleasent metallic taste
ACIDOSIS
W/ DYE
SE: excessive dosing results in hyperthyroidism
Single dose before breakfast, can be crushed
and suspended in water
Bile acid sequestrants impact absorption, alters
effectiveness of warfarin, diabetes agents, and
estrogen therapy
Given PO, Sub Q, IV, and Intranasal
HTN, flushing, water retention (water
intoxication; drowsy/listless, HA, convulsions),
vasoconstriction, rhinitis, nausea
Assess constantly for fluid retention
Intranasal administration: tolerance can
develop, 10x less potent than IV, blow nose
before use
DOES NOT cause hypoglycemia
Can cause acute renal failure, other few se: HA,
pancreatitis, n/d, URI, allergic rxn
Alters glucose metabolism
Toxicities are duration/dose dependent
BIGGEST SE: adrenal suppression
(immunosuppression (except neutrophilia),
altered glucose metabolism)
Withdrawal can be life threatening, MUST
TAPER OFF and must increase doses in times of
stress
Long term dosing  Cushingoid appearance
Sub Q injection
CAN cause hypoglycemia
Renal
adjustment
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Insulin IV drips
Levothyroxine (Synthroid)
NPH insulin
(HUMALIN N)
Radioactive Iodine I133
thyroid labs
Regular insulin
Sulfonylureas (Glipizide)
-decr glucagon production N/v, pancreatitis, diarrhea, thyroid t cell
-incr satiety
tumors, acute renal failrues
-decrease gastric emptying
MAY promote wt loss
 Varies based on hyperglycemia protocol
 Only lispro (short acting) indicated for IV use according to Davis
T4 preperation
Given PO before breakfast
Takes about 4 half lives (1 mo) to achieve
therapeutic effect
Dif []’s in dif colors
SE: hyperthyroidism
Intermediate acting insulin
Administer 30-60 min before meal
Protamine retards absorption onset takes 1-2 hrs
and prolongs effects
Peak is 6-14 hr and duration is 6-24 hr
Given w/ short acting @ breakfast to cover
breakfast, peak is 4-8 hrs later, so main
concern is late afternoon (3-4 pm)
May be mixed w/ regular, short acting
Can be kept at room temp for 28 days
Emits γ and β rays to kill
Monitor/assess for development of
thyroid cells, block thyroid
hypothyroidism and complications
hormone synthesis
(myxedema)
Must sleep alone, can’t share
Indicated for hyperthyroidism utensils/drinking glasses for few days
following treatment; half life of 8 days
30-60 min
Peak: 2-4 hr
Duration: 5-7 hr
PO, stimulates release of
insulin from pancereas
(requires pancreatic function)
-increases sensitivity of
Give w/in 15-30 min before a meal
Can be kept @ room temp for 28 days after
opened
CAN BE drawn w/ NPH; NOT MIXED w/ lispro
HIGH ALERT
CAN cause hypoglycemia
ASSESS FOR SULFA ALLERGY
Aplastic anemia
Do not administer
micronized
sulfonylureas w/
high fat meals
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receptors
-may decr hepatic glu produc
Herbals/Toxins
Anaphylaxis intervention
Calcium
Charcoal
Herbal supplement
oversight
Poisoning approaches
Vitamins
1. D/c suspected drug
2. Maintain airway (bronchodialators may be required)
3. Adminsiter epi
a. Adults: IM, Sub Q: 0.3-0.5 mg q 5-15 min
i. IV: 0.1 mg over 5 min OR 1-4 mcg/min infusion
b. Children IM, Sub Q: 0.01 mg/kg or 0.1 mg q 5-15 min
i. IV: 0.1 -0.2 mg over 5 min, repeat q 30 min OR 0.1-1.5 mcg/kg/min infusion
4. Diphenhydramine
a. Adult: IM, IV: 500-100 mg single dose, may follow w/ 50 mg q 6 hr for 1-2 days
b. Children: 5mg/kg/day in divided doses q 6-8 hrs; may follow w/ oral therapy for 1-2 days
5. Support BP
6. Administer corticosteroids
7. Documentation
 Stored in liver and fatty tissues (linked to coronary artery plaques?)
 Constipation, bone pain, kidney stones
 Best taken w/ food
 Can cause Mg toxicity if taken simultaneously
 Binds to chelating drugs
Slurried solution to bind w/ drug and prevent absorption when drugs/poisons can’t be vomitied (esophageal
irritants resulting in Mallory Weiss tear)
DO NOT UNDERGO FDA review and approval
Sales surged in 1990s; in 2009: $33.9 billion dollar industry
Federal Trade Commission (FTC): has oversight/responsibility of
 Monitor advertising, reports of SE, can stop sale of product
MEDWATCH program tracks reports of SE
 Principles revolve around stopping absorption, removing or reversing toxin, and providing supportive care
 Ipecac IS NOT go to; should call poison control w/ specific insturctons
 If can’t vomit med, use activated charcoal
 Some meds/toxins have specific reversal agents (when in doubt use Narcan)
 Two categories
o Fat soluble : risk of toxicity
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
o
Topical medications
Atropine eye drops
Cycloplegic eye drops
Ear drop meds
Floxin Otic Drugs
Isoretinoin (Accutane)
Vitamin D (calcium deposition in bones), Vit K, A (adaptation to light, role in
growth/immunity)
Water soluble: need more frequent replacement
 Vitamin B 12 (pernicious anemia or IF deficiency from gastrectomy)
Anticholinergic drug used for
mydriasis (pupil dilation) and
cycloplegia (paralysis of
cilliary muscle of eye) for
ophthalmic surgery or tx of
uveitis (infection)
SE: biggest is systemic anticholinergic effects
(parasympatholytic): tachycardia, decreased
salivation, constipation, increased RR, addative CNS
depression. Also, blurred vision, photophobia (may
last ~6 days)
Drugs that paralyze ciliary muscles
 Administered by creating lower lid pocket, administering , applying pressure for 1-2 min, leaving in for 5
min
 AVOID touching tip to cap that has touched pt, or pt’s eye
 Should be WARMED prior to administration to prevent dizziness/confusion
 For children <3 yr, pull outer ear downward; children >3 pull outer ear out and up
 Keep child on side and instill cotton ball for 2 min
 Avoid touching dropper to ear
 Antibiotics given to children <6 mo, after 2 yr observation therapy applied
Floroquinolone otic drop
Floroquinolone, but very few systemic SE have
administered in treatment been reported from otic concentration
of Necrotizing Otitis
(drugs.com); can cause local irritation/rxns, or
Externa; DAVIS says for
overgrowth of resistant bacteria
OM as well
Similarly, few drug-drug interactions
Retinoid: reduces
PREGNANCY CATEGORY X: Pt must read drug
Admin
sebaceous gland size and
information sheet for each refill, must register istere
differentiation
w/ IPLEDGE, have at minimum 2 pregnancy
d w/
tests, and agree to use of 2 bc methods
meals
-Regimen is 15-20 wk, may be resumed if acne to
relapses
reduc
SE: suicidal thoughts/behavioral changes,
e GI
blurred vision, chelitis, dry mouth, n/v, abd
upset
pain, anorexia, SJS, TENS, photosensitivity, skin
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Latanprost (Xalatan) eye
drops
Phyenylephrine
Pilocarpine
Ranibizumab (Lucentis)
Prostaglandin analog
Used for open angle
glaucoma (characterized
by increased intraocular
pressure) and ocular
hypertension
Relaxes ciliary muscle to
promote outflow of
aqueous humor
Alpha adrenergic agonist
(sympathomimetic)
Mydriatic agent;
Stimulates adrenergic
receptor of pupil
-b/c shorter acting
preferential for exams
whereas atropine used for
surgery
Direct acting cholinergic
2nd line drug of open angle
glaucoma (facilitates
outflow of aqueous
humor)
Also given to counteract
mydriatics following
surgery
Angiogenesis inhibitor
used w/ wet
(neurovascular) ARMD
infections, hypertriglyceridemia, hyperuicemia
-Addative toxicity easily possible (fat soluble
vitamin A derivative)
-addative anticholinergic effects, drying effects
-ETOH: hypertriglyceridemia
-1st Line Therapy for Open Angle Glaucoma: AS
effective as beta blockers w/ less systemic SE
Characterized by progressive pigmentation
(harmless but generally irreversible)
Again, SE are systemic sympathetic related:
tachycardia, hypertension, hyperhidrosis,
trembling, paleness
Addative cardio effects w/ MAOIs
Parasympathomimetic: stimulates constriction
of pupils and contraction of ciliary muscle
CONTRAINDICATIONS: conditions where pupil
constriction should be avoided
Can improve visual acuity, and prevent futher
damage from progression of wet ARMD.
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(age related macular
degeneration)
Timolol eye drops
NON selective beta
blocker (-olol); 1 of five
approved for reduction of
aqueous humor in open
angle glaucoma and
ophthalmic hypertension
-decreases production of
aqueous humor
Vaccinations/Immunomodulators
Cyclosporine (Neoral)
Immunosuppressant/DMA
RD: inhibits IL 2
Indicated for
renal/heaptic/cardiac
transplant
SE: Inflamation/enopthamlitis (infection)
Hep B vaccine
Give IM
Unkown duration , 90% efficacy
Adult high risk populations incl:
immunocompromised and health care workers
Tacrolimus (Progaf)
Tetanus vaccines/dose
INACTIVATED vaccine,
Given in 3 doses at
childhood (birth, 1-2 mo,
6-18 mo) , catch up in
childhood or at risk adult
population
Prevention of organ
rejection (used w/
corticosteroids) in liver,
kidney, or heart transplant
Inhibits T lymphocytes

Minimal local effects, but riskof systemic
absorption resulting in bradycardia,
bronchospasm, AV heart block
ABSOLUTE CONTRAINDICATION: hx of AV
heartblock, not recommended for asthma pts
Applying pressure reduces systemic absorption
Dose is adjusted based on serum level
LIFELONG Therapy
SE are typically dose dependent: post.
reversible encephalopathy syndrome, renal
toxicity, HEPATOTOXICITY, severe HTN
Mild SE related to injection (sl fever, irriation)
Alternative to Cyclosporine, MORE TOXIC
-SZ, changes in sight/hearing, hypertension, QT
elongation, GI bleeding, gi irritation,
nephrotoxicity, hyper/hypokalemia,
hyperlipidemia, hypophosphatemia,
hypocalcemia, hyponatremia, lymphoma,
metabolic acidosis/alkalosis AND A WHOLE LOT
MORE
DTaP given IM in 5 doses to children <7 yo
Mix w/ juice
or milk to
administer
May need to adjust
based on monitoring
of renal lab tests
GRAPEFRUIT
JUICE INCR
ABSORPTIO
N
GRAPEFRUIT
JUINCE
INCREASES
ABSORPTIO
N
(TOXICITY)
REPEATED LABS TO
DETERMINE IF
DOSES MUST BE
ADJUSTED
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Transplant therapies


Vaccine considerations
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Repro/renal meds
>7 yo and adults: doses of Tdap; should be fully immunized by 16 yo (using catch up schedule)
Tdap preferred <65 yo
o Td booster should be given q 10 years
Results in immunocompromised state
o Monitor for s/sx of opportunistic infections
o Medical asepsis priority
o Almost all are toxic
Typically, solu-mederol (glucocorticoid) administered w/ first dose of cyclosporine to prevent adverse rxn
Type of vaccine
o Live vaccine: contraindicated for most immunocompromised states
o Inactivated : short acting, need multiple doses
o Toxoid
o Killed Virus
o Gamma globulin (not true vaccine)
Spacing issues
o Killed and live: can be administered simultaneously or at any interval between doses
o 2 or more killed antigens: “ “
o 2 or more live antigens: 4 wk interval if not given simultaneously
Adverse rxns
o Must be prepared w/ epi and diphenhydramine
TRUE contraindications
o Hx of anaphylactic rxn to specific vaccine OR to a vaccine component (ie. Latex, soy,e gss)
o Moderate or severe illness w/ or w/out fever
Contraindicated in pregnancy
o PPV, MMR, Varicella, Meningococcal, Shingles
Contraindicated in immunocompromised
o Varicella, shingles
SPECIFIC VACCINES
o HIB contraindicated in children w/ active infection or febrile illness
o PPV contraindicated w/in 10 days of chemotherapy
o IPV: ALLERGY ALLERT: streptomycin, neomycin, bacitracin
o Influenza: contraindication w/ allergy to eggs
o MMR: neomycin
o Hep A: bleeding disorder or febrile
o Small pox (Variola): can’t have direct pt contact until lesions healed
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Finasteride (Proscar)
5 alpha reductase
inhibitors; prevents
conversion of T DHT
Indications: BPH
Amyl nitrate
Contraceptives



Admin
istere
d PO
w/ or
w/out
consid
eratio
n to
meals
“Poppers”
Aphrodisiac that has been tried, but not proven to enhance libido/sexual gratification
Systemic vasodilator in brain results in altered sensation
EFFECTIVENESS MAY BE DECREASED BY: CARBAMEZAPINE, PHENOBARBITOL, PHENYTOIN, RIFAMPIN,
o
o
Estrogen (Premarin)
Decreased libido, impotency, decreased
amount of ejaculate
 Women w/ male fetus shouldn’t
handle
 Who can get preg shouldn’t handle
w/out gloves
Typically combination of estrogen w/ synthetic progestin (10,000’s of combinations)
Inhibits secretion of FSH and LH from ant. Pituitary; changes endometrium and thickens cervical
mucus
o OC TYPICALLY 21 days w/ 1 week for period
 Lo dose: for skinny teens, Lower risk for adverse SE and ectopic pregnancy THAN
TRADITIONAL ORAL CONTRACPETIVES
 Monophasic: estrogen/progestin taken for 21 days
 Biphasic: 2 different amounts of progestin, taken during ovulatory and menstrual phases
 Triphasic: Porgestin progressively increased for 21 days
o YAZ: spironolactone cousin (monitor for hyperkalemia)
o OCP: water retention
o Extended cycle (Seasonale): theoretically only 4 periods a month, but breakthrough bleeding
o Rings (Nuva Ring) and Patch: 3 weeks than removed; HIGHER RISK OF CLOTS
o Mini-pill: progestin only, less effective BUT can be given during breastfeeding
o Long acting progestin: Implanon, Depo, IUD (Merena),
o Education regarding contraceptives
 1 dose missed: take asap
 2 doses missed: take 2 pills/day for 2 days then resume
 3 missed: stop taking, use another BC method until pregnancy R/O
Incr. activity of estrogen
Stomach cramps or gas, HA, n/v, decreased
sensitive tissues, NA and
libido, edema, GALLSTONES, WT GAIN
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water retention,
cholesterol lowering
-RISK OF ENDOMETRIAL CA: should be
combined w/ progestin to reduce risk
-SHOULD NOT BE GIVEN TO BREASTFEEDING
WOMEN
-#1 KILLER OF WOMEN <35; STROKES
Contraindications: abnormal bleeding, br ca, hx
of VTE, hypercalcemia, endometreois, uterine
fibroids
Notable SE: wt gain (manufacturer says 5 lbs),
edema, mood, gall stones, INCR clotting, breast
pain, incr risk of STI w/out barrier method of
contraception, hyperglycemia
Estrogen-progestin combo
Notable benefits: pregnancy prevention (70%
protection typical use ), ovarian cyst suppression
(less ovulation/formation of corpus
luteum/scarring), resolution of iron anemia (control
for bleeding), reduced RA and increased bone
density (HOWEVER, Lehne (2013): Benefits of HT for
bone <risks
HRT
IUD
Medroxyprogesterone


Indication: estrogen deficiency esp. in post menopausal women
Use w/ extreme caution and careful monitoring; can provide relief of hot flashes, but benefits in
ostesoperosis < risks w/ HRT
 2 main types:
o Merena: 5 yr, progestin (hormonal)
 Tricks body into thinking it is pregnant to prevent implantation of fertilized ovum
o Paragaurd: Copper: ~10 yr, copper only
 Creates inflammation in endometrium to prevent implantation
o Previous: Dykon Shiled (YIKES), copper cross, Skyla (available outside of US/UK for ~3 yr)
Porgestin analog used for
SE: mood changes, retinal thrombosis, PE, drug
-prevention of pregnancy
induced hepatitis, cervical erosisons,
-decreased endometrial
amenorrhea, breakthrough bleeding, breast
hyperplasia (in estrogen
tenderness, edema, allergic rxns
use)
-restoration of hormonal
-part of combined oral contraceptives
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Sildenafil (Viagra)
Testosterone
balance
Phosphodiesterase 5
inhibitors:
Enhances NO 
producing more
cGMPpromotes smooth
muscle
relaxationpromotes
filling and erection
Indication: androgen
deficiency, hypogonadism,
delayed male puberty,
treatment of anemia,
illegal use for muscle gain
-SE: HA, nausea, flushin, back pain, allergic rxn,
visual changes, HEARING LOSS, at higher doses
(color: pilots)
ABSOLUTE CONTRAINDICATION: USE W/
NITRATES FOR CHEST PAIN
-Levitra: lasts longer
-Cialis: provides coverage for 36 hrs but most
men use it w/in 4 hrs ($$)
-1 shot wonder
PO, IM, SQ
-SE: abd pain, insomnia, dizziness, red skin, HA,
depression, jaundice, change in libido
In females: secondary sex characeteristics (incl
acne)
In males: gyencomastia, urgency, impotence
Use w/ caution in cardiac patients:
hypercholesterolemia and fluid retention
May worsen BPH
Hypercalcemia secondary to metastic cancer
worse
Pharmacokinetics and Pharmacodynamics
ADME issues with age
First pass effect
Half life
Ionized v non-ionized drugs
Loading doses
Medication safety
Fatty
meal
delays
absorptio
n, slows
effect
-Incr fluid to 2000 mL
to prevent UTI
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Meds and the placenta
Plasma drug levels
Prn binding
Theraputic index
Medications w/ renal considerations
 Immunosuppressents
 Biguanides (Metformin)
 Incretin enhancers (Januvia)
 Antacids
 CCBs
 Thiazide diuretics
 ACE inhibitors
 ASA
 Ibuprofen
 Cisplatin
 Cephalosporins
 Floroquinolones
 Gentamycin (aminogylcosides)
 Flagyl
 Colchicine
Meds and Milk
 Cipro
 Tetracycline
Meds and Grapefruit Juice
 Immunosuppressents
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Digoxin
CCBs
Statins