NPLEX 2 Pharmacology Full (Elective and Core) 2019

**Cetirizine-OTC

*OTC

**Fexofenadine (Allegra)- OTC

*OTC

**Omeprazole (Prilosec)- OTC

*OTC

**oral osmotics- OTC

*OTC

Guaifenesin- OTC

*OTC [Mucinex], expectorant/mucolytic Propanediol derivative MOA: increase volume and reduce viscosity of tenacious sputum, expectorant for productive cough Use: productive cough SE: GI upset, N/V, dizziness, drowsiness, HA, rash, decreased uric acid levels, dry mouth, chapped lips Interactions: none CI: chronic or persistent coughs, hypersensitivity

*Diphenhydramine

*OTC [benadryl], antihistamine, sedative, antiemetic MOA: blocks H1 and muscarinic Ach receptors, prevents histamine induced allergic reactions, prevents vestibular stimulation of vomiting center, causes sedation Use: allergic symptoms **not effective for asthma motion sickness prophylaxis parkinsonism [antimuscarinic] cough insomnia SE: sedation blurred vision dry mouth urinary retention anorexia Interactions CNS depressants, cholinergic agonists or other anti-cholinergics Valerian, St Johns Wort, Kava, Gotu Kola may inc CNS depression CI: neonates, lactation BPH acute glaucoma <6 YO for sedation

*Loperamide-OTC (Imodium)

*OTC: Antidiarrheal opioid analogue, piperidine derivative MOA: activates opioid receptors in GI smooth muscle inhibits ACH release-> dec peristalsis Uses: mild-> moderate acute diarrhea chronic diarrhea from IBD, dec ileostomy drainage SE: constipation drowsiness Interactions: CNS depressants [kava, chamomile, valerian] CI: bloody diarrhea high fever infectious diarrhea acute UC abd pain without diarrhea <2 YO

Loratadine

2nd generation antihistamine, H1 receptor blocker MOA: blocks H1 receptors in nasal mucosa and other tissues, prevents allergic reactions *does not block muscarinic receptors which would cause sedation Use: seasonal allergies chronic idiopathic urticaria SE: HA** fatigue in high amounts giddiness dizziness dry mouth nausea somnolence Interactions: additive effects w/ CNS depressants CI: hypersensitivity, liver disease, acute asthma attack, pneumonia, lower lung infx

*Finasteride

Alopecia agent, BPH MOA: 5 alpha reductase inhibitor decreases DHT levels Uses: BPH male pattern baldness SE: gynecomastia dec. libido/impotence reduced ejaculate testicular pain hypersensitivity- swelling of lips, face, urticaria rashes Interactions: none C/I: children, pregnant women [oral or sexual transmission] pregnancy/lactation category X

*Naproxen Sodium (Aleve)-OTC

Analgesic, NSAID MOA: COX inhibitor- anti inflammatory, analgesic, antipyretic, via reducing prostaglandin synthesis, inhibits platelet aggregation Use: pain, RA, OA, ankylosing spondylitis, migraines, dysmenorrhea SE: abd pn, GI ulcers, bleeding, HA, heartburn, nausea, constipation, dizziness Interactions: antihypertensive effects of hypotensive agents may be reduced, may inc cyclosporine, inc seizure risk with fluoroquinolones [cipro], reduce diuretic efficacy, alcohol increases GI ulcer risk CI: aspirin or NSAID allergy, perioperative pain in setting of coronary artery bypass graft surgery

*Methadone

Analgesic, opioid detox adjunct, opioid agonist MOA: opioid agonist in CNS- decreases response to pain, analgesic and tx of opioid addiction SE: nausea, vomiting, constipation, respiratory depression, hypotension, bradycardia, HA, urinary retention, impotence, QT prolongation Use: opioid treats pain and maintenance therapy. Opioid dependency. Interactions: CNs depression with alcohol CI: acute respiratory depression, bronchial asthma, alcoholism, paralytic ileus, increased intracranial pressure or head injury

*Cocaine

Anesthetic MOA: local anesthetic by blocking generation and conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold Use: local, topical anesthesia of accessible mucous membranes of the oral, laryngeal and nasal cavities SE: anxiety, palpitations, tachycardia, HTN, seizures CI: heart death, hypersensitivity to esters, PABA or parabens

*Isoniazid

Anti TB agent, Isonicotinic acid MOA: inhibits mycolic acid synthesis, blocks building up of bacterial cell wall by inhibiting synthesis of mycolic acid from fatty acid Use: latent and active TB SE: inc in liver function tests peripheral neuropathy Interactions: P450 inhibition- dec metabolism of phenytoin CI: severe hypersensitivity rxn [drug induced hepatisis]

*levodopa/carbidopa

Anti parkinson agent MOA: converted to DA in DNA, carbidopa inhibits peripheral degradation SE: involuntary movements [dyskinesias], nausea, vomiting, hallucinations and psychiatric problems [depression] Use: Manage parkinson's symptoms. [monotherapy] Interaction: pyridoxine reverses effects CI: lactation, narrow glaucoma, acute phase of MI

*Pramipexole

Anti parkinson disease agent MOA: DA agonist used as adjunct to levodopa in advanced disease patients can also be used as monotherapy for initial symptoms management SE: sudden onset of sleep, nausea, constipation, confusion, insomnia, hallucinations, dyskinesia Use: parkinson's Interaction: antagonism will occur with antipsychotics, enhanced sedation with other sedatives CI: avoid withdrawal, cns depressant, alcohol, renal impairment, psych disorder. *lactation- shuts down lactation by inhibiting prolactin

Sucralfate (Carafate)

Anti-Ulcer Mucosal Protectant MOA: pepsin inhibitor/GI protectant unknown MOA- protects lining perhaps through prostaglandin stimulation enhance mucosal barrier Uses: duodenal ulcer stress ulcer SE: constipation* most common minor se overall Interactions: not with antacids, H2 blocker, PPI- needs acidic env. to work

*Montelukast sodium

Anti-asthmatic leukotriene receptor antagonist MOA: blocks effects of cysteinyl leukotrienes in airways Use: prophylaxis and maintenance tx for persistent asthma, exercise induced asthma, allergic rhinitis SE: HA** dizziness, rash, dyspepsia, cough flu like dx hepatic eosinophilic infiltrate [rare] insomnia, angioedema, anaphylaxis Interactions: prednisone- may cause peripheral edema phenobarbital, phenytoin may inc metabolism CI: hypersensitivity

*Allopurinol

Anti-gout MOA: Purine analogue, xanthine oxidase inhibitor, inhibits conversion of hypoxanthine to xanthine to uric acid **dec uric acid production without blocking synthesis of vital purines Use: gout, hyperuricemia accoc with CA and renal dz recurrent calcium oxalate kidney stones *start low dose and gradually inc. SE: *GI upset SJS- skin rash hepatotoxicity- inc LFTs acute renal failure fatigue- do not drive or operate heavy machinery inc incidence of gout when starting therapy encouraged to drink more water so kidneys can filter out- need alkaline urine CI: severe renal, hepatic dz, ampicillin and amoxicillin inc risk of skin rash

**colesevelam

Anti-hyperlipidemic MOA: bile acid sequestrant SE: triglyceride increase, headache, flatulence, constipation, myalgia. Use: reduce LDL and improve contril glycemic with diabetes. Interaction: oral drugs 4 hours before. deferasirox. CI: GI obstruction. high triglicerides, fat soluble deficiency.

*Sulfasalazine (Azulfidine)

Anti-inflammatory, anti-rheumatic Salicylate sulfonamide MOA: unknown: anti-inflammatory, immunomodulating Use: IBD [Crohn's, UC] RA SE: anorexia HA N/V/gastric distress *reversible oligospermia Interactions: dec. absorption of folic acid and digoxin C/I: hypersensitivity to drug or metabolite [sulfonamide] or salicylates intestinal or urinary obstruction porphyria <2 YO P/L: *pregnancy category C, D caution in breastfeeding

**Methimazole

Anti-thyroid medication MOA: inhibits TPO, blocks thyroid hormone Use: hyperthyroid/Graves SE: agranulocytosis, fever, drop in wbc, joint and muscle pain, drowsiness, dizziness, rash, hair loss. Interaction: antidote: granulocyte colony stimulating factor. Anticoagulants, diabetic meds. CI: pregnancy **teratogenic blood disease, liver disease.

*Ranitidine -OTC

Anti-ulcer agent MOA: H2 antagonist. Blocks gastric acid and secretion at H+/K+ pump. Promotes healing of gastric and duodenal ulcers. Relieves GI discomfort Use: PUD dyspepsia Stress induced gastritis GERD SE: HA *most common NVD Abd discomfort, constipation Interactions antacids- may dec absorption Warfarin- may dec warfarin clearance P/L: avoid during breastfeeding, safe in pregnancy

Atropine

Antiarrhythmic vagolytic- anticholinergic MOA: muscarinic receptor antagonist M1 block-sedation, psychosis M2 block-tachycardia, mild vasodilation M3 block-dec peristalsis, urinary retention, cycloplegia Uses: cholinesterase inhibitor poisoning [nerve gas, insecticide-organophosphates] bradycardia during emergencies urinary incontinence ophthalmic solution for mydriasis [dilation] during retinal exams **Diarrhea->see diphenoxylate/atropine [elective only] SE: dry mouth, dry mouth constipation palpitations, tachycardia, arrhythmias mydriasis, photophobia, cycloplegia inc. IOP Interactions: other anticholinergics C/I glaucoma Chronic respiratory dz thyroid storm cardiac failure pyloric stenosis BPH Pregnancy/lactation category C

*Amiodarone

Antiarrhythmic agent MOA: blocks K, Na, Ca channels blocks adrenergic B receptors prolongs cardiac repolarization negative chronotropic inc PR and QT intervals Uses: supraventricular and ventricular arrhythmias V-tach A-fib SE: Pulmonary fibrosis cornea/skin deposits-> blue-gray skin liver toxicity heart block hypotension hypo/hyperthyroidism Interactions: **digoxin, cyclosporine, phenytoin, other antiarrhythmics antihypertensives [b blockers, CCBs] **Hypericum- may inc metabolism and decrease drug effectiveness **photosensitivity- caution with sun exposure C/I: severe sinus node dysfunction 2nd, 3rd degree AV heart block cardio shock neonates <1 mo Pregnancy/lactation category D

*Doxorubicin (Adriamycin)

Antibiotic, antineoplastic MOA: inhibits nucleic acid synthesis Uses: AIDS-related Kaposi's sarcoma ovarian carcinoma metastatic breast cancer SE: leukopenia, thrombocytopenia NVD facial flushing, rash Alopecia* blurred vision, HA, seizures, paresthesias confusion malaise, lethargy skin pigmentation Interaction: *many antibiotics [aminoglycosides] steroids propranolol CI: cardiac dz** severe myelosuppression from previous tx chemo/radiation pregnancy and lactation

*heparin

Anticoagulant MOA: binds to antithrombin 3 which prevent fibrinogen to fibrin formation Use: acute DVT, PE, acute MI SE: hemorrhage, skin irritation Interactions: anticoagulants, salicylates and other antiplatelet drugs CI: bleeding disorders, hepatic, renal dz

*Warfarin

Anticoagulant MOA: coumarin derivative, inhibits synthesis of vitamin K factors 2, 7, 9, 10 and anticoagulant protein C and protein S cofactor. USE: prevention and treatment of venous thromboembolism. MI, AF, DVT, PE SE: abortion, birth defects, pregnancy X, increased PT [extrinsic] cutaneous necrosis [anticoagulant] Interactions: dietary vitamin K changes, steroids, anti seizure, NSAIDS, beta blockers can all increase bleeding CI: bleeding, pregnancy, severe HTN, alcoholism, renal and hepatic impairment

*phenytoin

Anticonvulsant MOA: decreases influx of sodium and increases efflux of sodium in motor cortex during nerve impulses- stabilizes neuronal cell membranes to decrease seizure activity, antiarrhythmic activity by extending refractory period- shortens action potential of the heart Use: generalized tonic clonic seizures, partial seizures, status epilepticus SE: peripheral neuropathy, hyperplasia gingiva, hirsutism, hypersensitivity, lymphadenopathy, nystagmus, teratogenicity, osteomalacia, inhibits insulin secretion, nausea vomiting Interaction: enhances toxic effects of lithium, pregnancy D, **pretty much everything- just don't use this with anything else CI: absence seizures. pregnancy.

*gabapentin

Anticonvulsant MOA: unclear action but structurally similar to GABA Use: epilepsy, neuropathic pain SE: dizziness, drowsiness, ataxia and tremor, somnolence, HA Interaction: reduced absorption with antacids, cimetidine may reduce clearance CI: Withdrawal, renal impairment, depression, cns depressant, alcohol use, drug abuse. *lactation- enters breast milk

*Trazodone

Antidepressant, anxiolytic MOA: 5-HT2 antagonist and ST reuptake inhibitor Use: depression, panic, anxiety SE: drowsiness, dry mouth, HA, blurred vision, nausea, vomiting Interaction: MOIs CI: MI, pregnancy D, suicidal patients

*Glyburide

Antidiabetic sulfonylurea hypoglycemic agent MOA: closes ATP-sensitive K+ channels preventing K efflux and causing Ca influx to depolarize B cells, **increases insulin secretion Use: T2DM- administered once or twice daily with meals SE: hypoglycemia, photosensitivity rxn can cause wt gain Interactions: alcohol, salicylates, NSAIDS, steroids, diuretics, other hypoglycemics CI: DM1, hypoglycemia, DKA **allergy to sulfonamide drugs

*Metformin

Antidiabetic, Biguanide Hypoglycemic agent MOA: Increases the number and affinity of insulin receptors in peripheral tissues, decreases hepatic glucose output, decreases glucose absorption from the gut, increases glucose uptake and utilization in skeletal muscle and adipose tissue, does not usually cause hypoglycemia Use: DM2- can be used in combo SE: lactic acidosis- cimetidine and furosemide can increase effects Irritated GI tract B12 deficiency

*Ondansetron (Zofran)

Antiemetic agent MOA: Selective STr antagonist 5HT3 receptor blockage stops vomiting reflex pathway GI ST release also inhibitors-> can't send ST signal to brain vomit center Use: prevent nausea and vomiting caused by cancer chemotherapy and radiation therapy and surgery. SE: HA Dizziness Constipation Interaction: *CYP450 inducers and inhibitors CI: liver dz

*Metoclopramide (Reglan)

Antiemetic, GI stimulant [prokinetic] MOA: Dopamine [D2] receptor antagonist in medulla blocks vomit reflex enhances motility w/o affecting secretions inc. LES tone**-> reason its used for GERD Use: N/V associated with cancer- chemo and radiation GERD- second line choice SE: insomnia, agitation/anxiety, drowsiness Dystonia/tardive dyskinesia [stiff jerking- **PERMANENT] Hyperprolactinemia=amenorrhea-galactorrhea Interaction: CNS depressants other DA antagonists [promethazine, antipsychotics] antimuscarinics and opioids *reduce absorption of digoxin CI: GI hemorrhage Parkinson's Perforation Epilepsy Pheochromocytoma

Prochlorperazine

Antiemetic, anxiolytic, antipsychotic Piperazine phenothiazine MOA: antidopaminergic effects- [not fully determined] D2 antagonist with inc DA turnover-> antiemetic blocks anticholinergic and alpha-adrenergic receptors-> muscle relaxation Uses: severe nausea and vomiting psychosis, short term management of nonpsychotic anxiety with GAD SE: restlessness- uncontrolled motor movements [tardive dyskinesia] sedation pseudoparkinsonism reactions photosensitive rxn to sun Interactions: anticholinergics, antihistamines Tricyclic antidepressants drugs used in parkinson's **potentiate all sedatives and analgesics Angelica sinensis, Hypericum-> inc photosensitivity Kava-> inc dystonia C/I: coma, severe CNS depression use of CNS depressants seizure d/o poorly controlled brain damage *Severe HTN, CVD Lactation Children <2 YO P/L: Pregnancy category C

*Cannabis

Antiemetic, cannabinoid MOA: THC binds cannabinoid receptors centrally and peripherally ST release, inc catecholamines inhibits parasympathetic activity inhibits prostaglandin synthesis Uses: analgesia antiematic appetite stimulant glaucoma SE: altered senses dizziness somnolence fatigue impaired balance euphoria paranoia, hallucinations anxiety HTN nausea Interactions: sedatives CNS depressants CI: hypersensitivity

*Colchicine

Antigout Drug MOA: alkaloid from autumn crocus [colchicum autumnale] inhibits beta microtubule polymerization by binding tubulin. prevents neutrophil degranulation & migration to area of uric acid crystals Use: acute grout, low dose for prevention, high dose for acute attack, familial mediterranean fever SE: **NVD [similar to antimetabolite] fatality in as little as 7 grams rhabdomyolysis, elevated LFTs, oligospermia, bone marrow effects [neutropenia, anemia, etc] Interaction: reversible malabsorption of B12 response to CNS depressants and sympathomimetics may increase *CYP3A4 [clarithromycin] *HMG coA reductase inhibitors *inhibitors of p glycoprotein [hepatic] CI: blood dyscrasias severe renal impairment debilitated patients Pregnancy category D

Mebendazole

Antihelminthic MOA: destroys cytoplasmic tubules in worms intestinal cells- blocks uptake of glucose and nutrients resulting in death USE: roundworms, whipworm, pinworm, hookworm SE: angioedema, alopecia, LFTs elevation, bone marrow suppression, NVD, neurologic, **teratogenic Interactions: phenytoin, carbamazepine are enzyme inducers- reduce plasma levels CI: infants <2 YO, pregnancy C

*Gemfibrozil

Antihyperlipidemic Fibric acid derivative [fibrate] MOA: stimulate lipoprotein lipase-> breaks down TGs into VLDL and chylomicrons dec. hepatic cholesterol biosynthesis Uses: hypercholesterolemia dec. TG levels & LDL Mild inc. HDL SE: gallstones- inc cholesterol in bile elevated liver enzymes enhanced oral anticoagulants [bind plasma proteins] myositis, rhabdomyolysis C/I: severe liver/renal dz biliary cirrhosis GB dz other statins Pregnancy category C

Valsartan

Antihypertensive MAO: ARB- angiotensin [AT1] receptor antagonist decrease peripheral vascular resistance dec. aldosterone->dec. circulating volume Use: **all if ACE are not tolerated HTN- with other Rx or if intolerant to ACE heart failure reduce CV death post MI SE: dizziness** hyperkalemia hypotension Interaction K sparing diuretics/ supplements C/I: Pregnancy category D not in breastfeeding

*Clonidine

Antihypertensive MOA: A2 adrenoceptor agonist reduced sympathetic outflow [dec neurotransmitter release] promotes vasodilation neg. chronotropic, inotropic effects [dec. CO, HR] Uses: HTN [essential, malignant and renal] severe pain in CA ADHD [extended release] SE: rebound HTN if d/c abrupt bradycardia sedation* vivid dreams constipation, dry mouth, HA N/V pruritus and dermatitis with patch Interactions: diuretics hypotensives, vasodilators TC antidepressants dec efficacy enhance toxicity of digitalis, lithium C/I arrhythmias- pacemaker d/o P/L: pregnancy category C

*Lisinopril

Antihypertensive MOA: ACE inhibitor decreases angiotensin 2 [vasoconstrictor] promotes vasodilation inc. plasma renin dec. aldosterone Use: HTN CHF prevent diabetic nephropathy decrease mortality in MI pts SE: dizziness** HA fatigue cough- dry persistent, non productive** URI hypotension hyperkalemia** impotence Interactions: antacids dec serum level NSAIDS reduce efficacy potassium sparing diuretics & Trimethoprim [inc risk of hyperkalemia] hypoglycemia with insulin/oral agents P/L: **not in pregnancy- class D in 2nd and 3rd trimester caution in breastfeeding *can lead to angioedema and renal stenosis in fetus

*Amlodipine

Antihypertensive, Antianginal MOA: CCB- blocks voltage-gated Ca+ channels in cardiac smooth muscle inhibit influx of calcium into cells dec. muscle contraction, dec. myocardial contractility [neg inotropic] peripheral vasodilation Use: HTN Prinzmetal's Angina Stable Angina Interactions inc effect of thiazide diuretic and ACE inhibitors avoid with b-blockers Sildenafil [viagra]-> hypotension effects inc with grapefruit juice** CI: hypotension, shock obstruction in LV outflow tract [aortic stenosis]

*spironolactone

Antihypertensive, Weaker diuretic [K sparing] MOA: aldosterone antagonist of Na/K exchanger in DCT inc. Na+ and H20 excretion dec. K excretion androgen receptor antagonist dec testosterone, inc estrogen conversion Uses: HTN CHF Edema hypokalemia hyperaldosteronism off label: PCOS SE: gynecomastia impotence oligomenorrhea hyperkalemia* metabolic acidosis GI distress, PUD Interactions: not with ACE, ARBs-> hyperkaliemia K supplements C/I anuria renal dz Addison's dz [hyperkalemia]

*Atenolol

Antihypertensive, antiangina MOA: B1 adrenoceptor antagonist [selective] reduces resting and exercise induced HR [negative chronotropic] reduces myocardial contractility [negative inotropic] Uses: angina HTN reduce CV mortality in pt with MI SE: fatigue** hypotension, bradycardia cold extremities bronchospasm [if in high dose] HA Nausea nightmares **avoid abrupt d/c> reflex tachycardia Interactions: other hypotensive, nitrates digoxin- excess bradycardia [negative chronotropic] decrease effects of dopamine** CI: abrupt d/c sinus bradycardia, sinus node dysfx 1st degree heart block cardiac failure, shock bronchospastic dz PVD *caution in diabetics P/L: pregnancy and lactation category D [only in life threatening situations] *human fetal risk!

*Propranolol

Antihypertensive, antianginal, antiarrhythmic MOA: nonselective B blocker [B1 and B2] negative inotropic [dec contraction and CO] negative chronotropic [dec HR] small reflex peripheral vasoconstriction-> balance leads to hypotension Uses: angina hypertension post-MI cardiomyopathy prevent migraine SE: bronchospasm [B2] depression [dec DA] vasoconstriction [PVD worsen] blunted hypoglycemia effect impotence -> dec blood Interactions: nitrates and other antihypertensives digoxin- bradycardia dec effects of DA C/I: sinus bradycardia cardiac shock heart failure severe hemorrhage asthma, COPD** severe PVD 2nd or 3rd degree heart block caution in diabetics* abrupt d/c** -> reflex tachycardia

*Hydrochlorothiazide[HCTZ]

Antihypertensive, diuretic Thiazide diuretic- **K wasting MOA: inhibits NaCl transporter in DCL inc incretion of NA, K and Cl dec excretion of Ca in pts w/ Ca type kidney stones Uses: HTN, CHF Edema Nephrolithiasis [calcium] Nephrogenic D.I [dec. polyuria] SE: low Na, K, Mg High Ca2+ hypotension, volume depletion hyperuricemia and gout hyperglycemia [dec glucose tolerance] hypersensitivity [sulfonamide based] Photosensitivity in sun Interactions: hypotensive: a-blockers, ACE inhibitors low Na w/ carbamazepine alcohol, barbiturates, opioids [hypotension] effects reduced w/ steroids nephrotoxic w/ NSAIDS **Licorice- more K+ depletion C/I: severe hepatic and renal dz [anuria] Addison's hypercalcemia sulfonamide sensitivity**

*Sildenafil

Antihypertensive, peripheral vasodilator MOA: phosphodiesterase type 5 inhibitor stops cGMP degradation in corpus cavernosum, which results in smooth muscle relaxation increased blood flow to corpus cavernosum to increase erection Uses: Erectile dysfunction SE: *headache most common tachycardia abnormal vision epistaxis insomnia Interactions: symptomatic hypotension with alpha blockers nitrates CI: organic nitrates- can cause fatal hypotension

**Lugol solution

Antihyperthyroid agent MOA: high dose iodine in hyperthyroid pts causes rapid remissions by inhibiting release of thyroid hormone. Reduces vascularity in thyroid gland, firms glandular tissue, shrinks size of cells, increases bound iodine [negative feedback]. Uses: hyperthyroidism, thyroid storm protect gland after radioactive iodine tx or in a radiation exposure emergency- blocks thyroid uptake of radioactive iodine isotopes SE: NVD, metallic taste in mouth, fever, HA Interactions: ACE inhibitors, ARBS, lithium, potassium sparing diuretics [spironolactone] CI: hypothyroidism, caution in pts with renal impairment

Bismuth subsalicylate (Pepto-Bismol)

Antimicrobial, anti-inflammatory [bismuth], antisecretory [salicylate] MOA: anti-diarrheal via electrolyte absorption across intestinal wall [anti-secretory] inhibits prostaglandin synthesis- decrease inflammation and motility binds toxins from E.Coli weak antacid properties Uses: Nause, upset stomach, indigestion heartburn diarrhea H.pylori SE: Nausea- may cause BLACK TONGUE & BLACK TARRY STOOLS Interactions inc. risk of bleeding with warfarin decrease absorption of tetracycline C/I: other salicylates [aspirin] *Pregnancy category C, D

*Paclitaxel

Antineoplastic Agent, Mitotic Inhibitor MOA: binds tubulin and arrests cells in M phase [metaphase] Uses: advance ovarian cancer, non small cell lung cancer, metastatic ovarian or breast cancer unresponsive to first line drugs SE: NVD alopecia anemia, leukopenia, thrombocytopenia peripheral neuropathy arthralgias myalgias Interaction: cyclosporine, doxorubicin, diazepam inc toxicity increased myelosuppression with antineoplastic drugs CI: pregnancy/lactation alcoholism, immunodeficiency syndromes blood dyscrasias [bone marrow hypoplasia, leukopenia, thrombocytopenia or severe anemia]

*Anastrozole

Antineoplastic agent, aromatase inhibitor MOA: inhibits aromatase-> prevents conversion of androstenedione to estrone and testosterone to estradiol leads to reduced serum estradiol concentrations Use: advanced or locally advanced breast cancer SE: Hot flashes, vasodilation altered mood, fatigue, N/V, bone weakness, arthritis pain, depression, pharyngitis Interactions: estrogens, tamoxifen CI: Pregnancy X, premenopausal. hypersensitivity

*Methotrexate

Antineoplastic, Antimetabolite MOA: folic acid antagonist-> inhibits DNA synthesis Uses: choriocarcinoma/trophoblastic tumors, leukemias, breast, head, neck, lung CA severe psoriasis, RA, mycosis fungoides SE: N/V stomatitis hepatotoxicity anemia leukopenia thrombocytopenia nephropathy Interaction: folic acid and derivatives CI: renal/hepatic dz, bone marrow suppression, AIDS pregnancy X, lactation

Vinblastine

Antineoplastic, Mitotic Inhibitor MOA: Arrests microtubule proteins in M phase of mitosis [metaphase] by stopping spindle formation blocks glutamic acid utilization-> inhibits purine synthesis Uses: Hodgkin's disease Testicular CA Lymphocytic lymphoma Kaposi's sarcoma SE: anemia, leukopenia, myelosuppression, alopecia. Interaction: *CYP3A4 inhibitors may inc S/E phenytoin dec immune response with vaccines CI: severe bone marrow suppression bacterial infections malignant cell infiltration of bone marrow porphyria granulocytopenia elderly w cachexia or extreme skin ulcerations Pregnancy category D, lactation

*5-fluorouracil

Antineoplastic, antimetabolite MOA: interferes with DNA synthesis [S phase] blocks deoxyuridylic acid to thymidylic acid also interferes with RNA synthesis Uses: palliative tx of carcinoma of colon, rectum, breast, stomach or pancreas topically: BCC SE: leukopenia, thrombocytopenia, GI ulceration, bleeding, hemorrhage NVD stomatitis local inflammatory sensitivity rxn Interaction: may inc warfarin effects reduce response to vaccines CI: topical application to mucous membranes, exposure to sunlight depressed bone marrow fnx poor nutritional status pregnancy and lactation category D

*Nitroglycerin

Antinginal, vasodilator [organic nitrate] MOA: release NO in smooth muscle vasodilation inc. coronary blood flow dec. myocardial O2 demand Uses: angina pectoris d/t CAD acute angina- sublingual form** refractory CHF Hypertensive emergencies SE: HA- may be severe** hypotension reflex tachycardia transient LOC Interactions: sildenafil [viagra]-> hypotensive other antihypertensives- caution alcohol, sedatives C/I: acute MI severe anemia Sildenafil [b, a blockers, CCBs]

*Haloperidol

Antipsychotic MOA: blocks postsynaptic D2 receptors in limbic system of brain- decrease response to DA excitation- alo some inhibition at H1, cholinergic receptors and alpha adrenergic receptors Use: positive symptoms of schizophrenia [delusions/hallucinations], tourette syndrome, delirium, agitation SE: tardive dyskinesia, sedation, anticholinergic side effects, [sympathetic], muscle spasms, galactorrhea, amenorrhea [elevated prolactin] Interaction: central depressants, methyldopa, levodopa, TCAs, lithium, guanethidine, epinephrine. Amphetamine. CI: pregnancy, dementia, parkinson's

Dicyclomine [Bentyl]

Antispasmodic MOA: Muscarinic receptor antagonist [anticholinergic] blocks parasympathetics-reduce GI tone and motility relaxes GI smooth muscle Use: IBS SE: constipation, dyspepsia dry mouth urinary retention blurred vision decreased sweating Interactions: other anticholinergics, anti-histamines CI: obstructive GI dz severe UC Myasthenia gravis, glaucoma reflux esophagitis infants <6 mo P/L: C/I in breastfeeding

*Propylthiouracil [PTU]

Antithyroid agent, thioamide derivative MOA: binds TPO, inhibits conversion of iodide to iodine, inhibits production of new thyroid hormone Use: Hyperthyroidism/Graves SE: "ASH" Agranulocytosis, Alopecia, Arthralgia Skin Rash Hepatitis Interactions: may inc oral blood thinners CI: pregnancy D [crosses placenta], hypothyroidism. If needed during pregnancy use the lowest dose possible

*Amantadine

Antiviral, antiparkinson MOA: Antagonist of NMDA glutamate receptor, weak DA agonist, prevents release of infectious viral nucleic acid Use: Anti viral, but mostly anti-parkinson- not recommended for influenza A, herpes zoster in immunocompromised SE: CNS such as anxiety and difficulty swallowing. , seizures. Interactions: CNS stimulants, antimuscarinics, anticholinergics [enhances effects of all] CI: hypersensitivity, seizure d/o, pregnancy C and lactation- enters breast milk untreated narrow angle glaucoma severe renal impairment, gastric ulceration

**Alprazolam

Anxiolytic, Benzodiazepine MOA: anxiolytic, muscle relaxant, anticonvulsant, antidepressant and sleep modifying effects- binds GABA sites in CNS- increases neuronal permeability to chloride ions resulting in hyperpolarization and stabilization Use: short term management of anxiety SE: drowsiness most common, depression, Ha, dry mouth, constipation, diarrhea, muscle weakness, confusion, slurred speech, anterograde amnesia Interactions: potentiates alcohol and CNS depressant effects CI: acute narrow angle glaucoma, CNS depression or coma, respiratory depression, sleep apnea or pulmonary insufficiency, severe hepatic impairment, *pregnancy D, lactation

*Hydroxyzine

Anxiolytic, antihistamine, sedative-hypnotic MOA: piperazine derivative blocks H1 receptors in GI tract, blood vessels and respiratory tract causes sedation with antimuscarinic effect skeletal muscle relaxation bronchodilator antiemetic analgesic Use: short-term anxiety pruritis chronic urticaria preoperative sedation allergies SE: CNS depression, paradoxical stimulation dry mouth, blurred vision, tachycardia GI disturbances- constipation HA hypotension thickened respiratory secretions tinnitus Interactions: CNS depressants, stimulants antidepressants antihistamines opioids hypnotics

*Tamsulosin

BPH MOA: selective alpha 1 adrenoceptor blocker abundant A1 receptors in prostate cause smooth muscle tone so blockers help relax it Use: improvement in urine blow in BPH hepatic impairment renal impairment ureter stone expulsion SE: *abnormal ejaculation arthralgia orthostatic hypotension dizziness HA rhinitis infx Interaction: CYP2D6 inhibitors [fluoxetine] or CYP3A4 [ketoconazole, cimetidine] will inc serum concentration CI: hypersensitivity 2D6 polymorphisms hepatic impairment lactation

**penicillin VK

Beta lactam ABX, bacterial cell wall synthesis inhibitor Use: Gram positive bacteria [mild to moderate severe infx] streptococcal infections- URI/scarlet fever pneumococcal infections- OM staphylococcal infections- skin/soft tissue *may also be used for gram positive aerobic bacilli [bacillus anthracis, corynebacterium diphtheria] Gram negative bacteria- limited activity Neisseria meningitidis SE: diarrhea, nausea, oral candidiasis, **black hairy tongue Interaction: doxycycline decreases efficacy, methotrexate more toxic, decrease effect of beta blockers CI: allergy to penicillin/cephalosporins, anaphylactic to beta lactams, asthma, recent abx, seizure disorder, renal impairment.

**Amoxicillin/Clavulanate

Beta lactam ABX, cell wall synthesis inhibitor MOA: inhibits third and last stage of bacterial cell wall synthesis by binding to penicillin binding protein inside bacterial cell wall, opening lactam ring and inactivated enzyme Uses: Meningitis [gram positive listeria] Acute OM, sinusitis, bronchitis **first line choice [gram negative rod H influenza, gram positive cocci pneumococci and s pyogenes. also used in pneumonia] peptic ulcers- eradicate H pylori [use with clarithromycin and PPI] UTI [proteus, e.coli, enterococci] Salmonella *use with clavulanic acid [beta lactamase inhibitor] extends spectrum since amoxicillin is susceptible to resistance by b lactamase bacteria SE: urticaria, dermatitis, NVD Interactions: tetracyclines [doxycycline] CI: hypersensitivity to penicillins, cephalosporins **SAFE IN PREGNANCY

*Tiotropium bromide

Bronchodilator, antimuscarinic, anticholinergic MOA: long acting antimuscarinic non selective for M1-M5 receptors causes bronchodilation by inhibiting Ach in smooth muscle of respiratory tract Use: maintenance therapy in COPD SE: dry mouth, sinusitis constipation cough tachycardia local irritation urinary retention URI, URTI pupil dilation, blurred vision myalgia dyspepsia rash epistaxis with use of inhalation power pharyngitis, rhinitis CI: severe hypersensitivity to milk proteins, lactose allergy *ipratropium is the same drug but shorter acting

*Salmeterol

Bronchodilator, beta 2 adrenergic agonist MOA: inc. cAMP, relaxes bronchial smooth muscle, inhibits late phase of allergen induced bronchoconstriction Use: Asthma- in combo with glucocorticoids for moderate to severe dx- prevents nocturnal attacks and exercise induced *not used for acute bronchospasm slower and longer acting than albuterol- given twice daily via inhalation SE: tachycardia, HA, agitation, **may inc risk of asthma related death [black box warning]

*Modafinil

CNS stimulant MOA: reducing GABA mediated transmission but mechanism unknown fully Use: wakefulness in pts with excessive daytime sleepiness associated with narcolepsy SE: HA, rhinitis, insomnia, personality d/o, tremor anxiety, palpitations, abnormal LFTs Interactions: avoid alcohol, warfarin, TCAs **basically many and everything CI: HTN, cardiac arrhythmias, chest pain, mitral valve prolapse

*dextroamphetamine

CNS stimulant, amphetamine MOA: non catecholamine sympathomimetic amines stimulate the CNS- cause inc in blood pressure, weak bronchodilatory and respiratory stimulant Use: ADHD, narcolepsy SE: appetite loss *most common, insomnia, abd pain, palpitations, tachycardia, high BP, loss of libido Interaction: MAOI, tricyclic antidepressants, NE, GI alkalinizing agents [sodium bicarb] CI: hyperthyroid, glaucoma, HTN, arteriosclerosis, agitated states, MAOI

Caffeine

CNS stimulant, xanthine MOA: methylxanthine, phosphodiesterase inhibitor, antagonistic effect at central adenosine receptors, respiratory stimulant, bronchodilating and diuretic effects, facilitates performance of muscular work. Use: Migraine SE: insomnia, restlessness, nervousness, mild delirium, nausea, vomiting, gastric irritation Interactions: benzo- reduce effects. cipro increases levels, caution with beta adrenergic agonists, asprin CI: caution in pregnancy, sensitivity

Nystatin

Candida (oral, vaginal, mucosal) MOA: binds to sterols in cell membrane- causes leakage of intracellular components to kill fungal cells USE: topical for myotic cutaneous, mucocutaneous infections from candida spp. SE: very few- allergic rxn on skin, dermatitis and pain on application in some No interactions CI: hypersensitivity

*Digoxin

Cardiac Glycoside antiarrhythmic, inotropic MOA: Na/K-ATPase inhibition positive inotropic-> [enhance cardiac contractility] negative chronotropic [inc. parasympathetic outflow at SA and AV nodes] Uses: LV systolic HF Atrial flutter 2nd choice for dec. ventricular rate SE: Arrhythmias- AV node block, V-fib GI: anorexia, NVD Hypokalemia [blocks K influx] HA, fatigue, confusion **blurred or yellow vision Interactions: hypokalemia [loop, HCTZ, ACE, CCBs], licorice Herbs with dig action: convallaria, leonarus Hydrastis Hypericum C/I: V-tach/ V-fib obstructive cardiomyopathy ARBS, K sparing diuretic

*Cephalexin

Cell wall synthesis inhibitor, beta lactam ABX- first generation cephalosporin MOA: binds PBPs intracellular bacteria and inhibits final step in cell wall synthesis Use: same as amoxicillin + UTI from klebsiella, bone infections from staph/proteus SE: diarrhea, indigestion, gastritis, abd pn Interactions: metformin effects may increase- low blood sugar- DKA, neualgia CI: hypersensitivity, allergy to penicillin *SAFE IN PREGNANCY

**Rivastigmine

Cholinesterase inhibitor, anti-alzheimer's disease agent MOA: inhibits cholinesterase in CNS, inc Ach in CNS to enhance cognition and slow cognitive decline SE: GI, insomnia, bradycardia Interactions, cholinergics, anticholinergics CI: bradycardia, arrhythmia, CHF, CAD, asthma, COPD, ulcers or increased risk of ulcers and GI bleeding.

**Donepezil

Cholinesterase inhibitor, anti-alzheimers agent MOA: inhibits cholinesterase in CNS, increasing ACh transmission, slow decline in cognitive function USe: mild to moderate AD SE: GI upset, bradycardia, insomnia Interactions: increases cholinergic drug effects and decreases anticholinergic effects CI: bradycardia, arrhythmia, CHF, CAD, asthma, COPD, ulcers or increased risk of ulcers and GI bleed

*Sitagliptin

DPP-4 inhibitor, antidiabetic MOA: inhibits DDP-4 [enzyme that inactivates incretin hormones] "inhibits the inhibitor" allowing prolonged incretin action- increases insulin release and decrease circulating glucose Use: DM2 SE: nasopharyngitis, diarrhea, Ha, constipation, peripheral edema, nausea, pharyngitis, OA CI: DM1, DKA

Phenylephrine

Decongestant nasal spray, sympathomimetic, alpha adrenergic agonist *nasal spray MOA: strong alpha adrenergic agonist and weak beta activity. causes vasoconstriction of arterioles of nasal mucosa and conjunctiva activates dilator pupillae muscle to cause contraction [miosis] Use: nasal congestion mydriasis if used as an eye dropper SE: anxiety tachycardia, reflex bradycardia arrhythmias HA cold extremities, gangrene HTN NVD sweating weakness inc salivation, urinary retention tissue necrosis mydriasis hyperglycemia lactic acidosis damaging of cornea, clouding of vision CI: HTN, V tach, closed angle glaucoma

Pseudoephedrine

Decongestant- alpha adrenergic agonist MOA: both alpha and beta adrenergic agonists- vasoconstricts respiratory mucosa and causes bronchial relaxation, inc heart rate and contractility Use: nasal congestion SE: rebound congestion and rhinorrhea, aginal pain, fear, anxiety, tremor Interactions: HTN, arrhythmias with cardiac glycosides, quinidine or TCAs, more vasoconstriction with ergot alkaloids or oxytocin, MAOIs-> HTN crisis CI: severe HTN, pheochromocytoma

*Epinephrine (adrenaline)

Direct acting sympathomimetic, mydriatic, bronchodilator MOA: stimulates alpha AND beta adrenergic receptors- causing muscle relaxation in bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature Use: inhalation- acute asthma IV or IM- anaphylactic shock Eye drops- ocular HTN, open angle glaucoma added to local anesthetics to retard diffusion and limit absorption to prolong duration of effect, lessen danger of toxicity SE: CNS effects, GI, epigastric pain, CV d/o, urinary retention, dyspnea, hyperglycemia, sweating, hypersalivation, weakness tremors, coldness of extremities, hypokalemia, gangrene tissue necrosis CI: HTN. vascular dz, closed angle glaucoma, arrhythmias/tachycardia, local anesthetic combos on digits, ears, nose, penis or scrotum

*Bromocriptine

Dopamine agonist, anti-parkinsonian MOA: ergot derived, D2 and ST receptor agonist- DA agonist acts on pituitary gland to block production and release of growth hormone Use: Hyperprolactinemia, prolactinomas, early parkinsonian syndrome, acromegaly [dec GH] SE: "DOPA" Dyskinesia hypOtension Psychosis Agitated GI- stimulation of vomiting center Arrhythmias Ergot effects- vasospasms of fingers and toes, pulmonary fibrosis in high doses Interactions: drugs affecting liver enzymes increase bromocriptine levels [antifungals, macrolides]. CI: breast carcinoma, uncontrolled HTN, ischemic heart disease Pregnancy B [safe] *should not be used during lactation

Misoprostol

Endocrine-Metabolic Agent, Anti-Ulcer MOA: prostaglandin E1 analogue binds to PG receptors on parietal cells Increases Bicarb secretion-> decreases gastric secretions protects epithelial tight junctions increases mucus layer thickness Uses: prevent NSAID induced peptic ulcers SE: menstrual irregularities ABORTION in pregnancy abd cramps, diarrhea Interactions magnesium antacids- may inc diarrhea food dec absorption P/L: Pregnancy category X

*Canagliflozin

Endocrine-metabolic agent SGLT2 inhibitor MOA: selective sodium glucose transporter-2 inhibitor [SGLT2] lowers renal glucose threshold, results in increase urinary glucose excretion Use: T2DM SE: more commonly female UTI, GU mycotic infections, increase urination, vulvovaginal pruritus, inc. thirst Interactions: may inc risk of dehydration with diuretics CI: 2 fold inc in lower limb amputations in T2DM in pts with CVD, PVD, renal dz

*Estradiol

Estrogen/Progestin Combination MOA: naturally occurring estrogen *dev and maintenance of female reproductive system & secondary sex characteristics *Modulate pituitary secretion of LH, FSH through negative feedback Use: HRT [vulvar and vaginal atrophy], metastatic breast CA, hypoestrogenism, osteoporosis, prostate cancer SE: GI disturbances, GU changes, CV and CNS effects, endocrine/metabolic d/o, cholestatic jaundice, local skin reactions, contact lens intolerance, PE, carbohydrate intolerance Interaction: may enhance hydrocortisone, prednisolone when together CI: vag bleeding, thrombophlebitis/thromboembolic d/o, breast carcinoma except in some being tx for metastatic dz, estrogen dependent tumor, porphyria pregnancy category x

GLP-1 agonists

Exenatide, liraglutide Incretin mimetics not used alone- need insulin or metformin in combo *see Liraglutide slide for more detail

*Ciprofloxacin

Fluoroquinolone, broad spectrum nucleic acid inhibitor MOA: promotes breakage of ds DNA and inhibits DNA gyrase, thus preventing DNA replication USE: pseudomonal infx legionella pneumonia [alternative to macrolide] *UTI- 1st line choice *GI infections- 1st line choice S aureus and s pneumonia [gram positive cocci] meningococcal meningitis Mycobacteria- 2nd line choice for TB SE: *arthropathy in <18 YO *tendinitis rupture peripheral neuropathy liver toxicity agitated GI C diff *Cardiac QT interval prolongation exfoliative dermatitis, photosensitive skin rxn Interactions: decreased absorption with cations [antacids, iron, zinc, bismuth] inc serum levels of warfarin, theophylline CI: children, MG, hypersenstivity

*Liraglutide

GLP-1 receptor agonist, incretin mimetic, antidiabetic MOA: increase insulin secretion in presence of elevate blood glucose, delays gastric emptying to decrease postprandial glucose, also decreases glucagon secretion Use: T2DM, obesity SE: NVD, constipation, HA, anti-liraglutide antibody formation Interactions: reduce rate of absorption of concomitant drugs d/t slowing of GI CI: PHX or FHX of medullary thyroid carcinoma, MEN2 Pregnancy- may result in lack of fetal nourishment, wt loss

Esomeprazole (Nexium)

Gastric acid secretion inhibitor MOA: PPI- blocks H+/K+-ATPase in parietal cells blocks final step in acid production Uses: GERD- *first line choice PUD H.pylori eradication prevent GI bleeds with NSAIDS Zollinger-Ellison syndrome SE: HA** flatulence/indigestion malabsorption of B12 inc risk of bone fractures and C diff diarrhea Interactions: Amoxicillin, Diazepam, Phenytoin, Warfarin Food dec. absorption- take 1 hour ac P/L: safe in pregnancy

**Prednisolone

Glucocorticoid Receptor Agonist MOA: active/metabolite of prednisone, same MOA, slightly longer half life and more synthetic? Use: drug of choice when systemic steroid indicated, available OTC *not recommended for primary adrenal insufficiency SE: same as all Interactions: prodrug- no CYP interactions CI: active systemic infections [same as all]

Mometasone

Glucocorticoid Receptor Agonist inhaled MOA: same as others with very high affinity Use: long-term bronchospasm prevention often combined with salmeterol in asthma and COPD used when getting off oral steroids and weaning off to inhaled SE: respiratory/mouth infx *rinse mouth after use Interactions: CYP3A4 [little systemic absorption] CI: active infections, acute respiratory attacks

*Hydrocortisone

Intermediate corticosteroid *shorter acting compared to others MOA: suppression of PMNs for anti inflammatory effects, immunosuppressive effects, reversal of inc capillary permeability Use: inflammation, acute or chronic adrenal insufficiency SE: sodium/fluid retention, GI upset, K and Ca depletion, muscle wasting, weakness, bone loss, delayed wound healing, hyperglycemia, glycosuria, DM, obesity, moon face buffalo hump, inc risk of infx Interactions: CYP3A4 substrates CI: active infections, internal or topical

*Tofacitinib

JAK inhibitor, immunomodulator MOA: partial and reversible blockage of JAK prevents body from responding to cytokine signals which decrease tissue inflammation [IL7, IL15, IL21, INF ALPHA, INF BETA] USE: RA SE: infections, diarrhea, HTN Interactions: immunosuppressive drugs, CYP3A4 inhibitors CI: active TB, severe Infx

Bisacodyl (Dulcolax)

Laxative, Stimulent MOA: inhibits GI fluid reabsorption Inc. luminal pressure stimulates peristalsis Uses: bowel evacuation before colonoscopy or surgery acute constipation constipation d/t opioid use [use with docusate stool softener] SE: cramping, nausea hypokalemia- fluid and electrolyte depletion Interactions: antacids or milk within 1 hour C/I: obstruction, severe impaction sx of appendicitis or acute surgical abdomen vomiting rectal bleeding gastroenteritis

*Atorvastatin

Lipid-lowering Agent MOA: HMG-CoA reductase inhibitor inc. LDL receptors on hepatocytes Inc. HDL Dec. LDL-c, total cholesterol, TGs Uses: primary hypercholesterolemia [familial and non familial] mixed dyslipidemia SE: inc. liver enzymes myositis, rhabdomyolysis [with P450 inhibitors] Interactions fibrates OCPs increased in serum inc half life of digoxin if taken together *red rice yeast *grapefruit juice- inc levels alcohol- inc hepatotoxicity C/I: liver dz Pregnancy/lactation category X

*Furosemide

Loop diuretic, Antihypertensive MOA: Na/Cl inhibitor in ascending loop loss of Na, Cl, water, Ca, Mg, K, NH3 inc. uric acid inc. plasma renin Uses: pulmonary edema CHF, HTN acute renal failure nephrotic syndrome hepatic cirrhosis Rx related hypercalcemia, hyperkalemia SE: inc uric acid-> gout low K, Mg, Na, Ca Metabolic alkalosis [low NH3] **OTOTOXICITY- reversible with dose dec. rxn if sulfa allergy dec. effectiveness of anti-diabetic drugs Interactions: analgesics reduce effects hypoglycemic agents- monitor gout rx- monitor muscle relaxants *aminoglycoside ABX inc ototoxicity antihypertensives enhanced antagonized by steroids phenytoin reduces effects *licorice-> K+ loss C/I: hypersensitivity to sulfa drugs anuria, renal failure pre comatose states [hepatic encephalopathy] Addison's dz Mineral depletion *pregnancy category C

*Phenelzine

MAOI MOA: inc concentration of NE, DA, ST- atypical antidepressant SE: dizziness, blurry vision, dry mouth, headache, lethargy, sedation, somnolence, insomnia, anorexia, weight gain, loss, sexual dysfunction, hepatitis, paresthesia, orthostatic hypotension, liver failure, mania. Use: major depressive disorder. not favorable for first line. Interaction: hypertensive with tyramine containing, aged cheese, cured meat. SSRI for serotonin reuptake. B6 deficiency. CI: anesthesia within 10 days, elective surgery in 10 days, liver function, hepatic dz

*HAV vaccine

MOA: hepatitis A antigen prepared from inactivated virus Use: active immunization against HAV infx SE: soreness, erythema fever, malaise, anaphylaxis Interactions: immunosuppressants [steroids, antineoplastics] CI: hypersensitivity to egg, severe immunodeficiency, malignant dz being treated with chemo/radiation and 6 mo after stopping, high dose steroids, HIV positive

**Hydralazine

MOA: inc cGMP arteriole vasodilation decrease afterload Use: HTN and congestive heart failure. SE: HA, fast heart rate [reflex tachycardia] *often given with Beta-blocker C/I: renal dz angina CAH aortic dissection *safe in pregnancy and children but not first line even in these groups

Deferoxamine

MOA: Iron Chelator Uses: Hemochromatosis, iron toxicosis, thalassemia SE: bluish fingernails, seizures, blurred vison Interactions: 500mg/day Vitamin C-> cause iron overload, impairment of cardiac function C/I: pregnancy, renal disease

**Carvedilol

MOA: Non-selective beta blocker/alpha-1 blocker. Use: Beta blocker for CHF, LVD after heart attack, and HTN. SE: Dizziness, fatigue, hypotension, diarrhea, weakness, slow rate, weight gain. Interactions: could mask hypoglycemia. CI: Bronchial asthma, 2nd or 3rd degree AV block, sick sinus, bradycardia.

*Pneumococcal polyvalent vaccine

MOA: S. pneumoniae capsular antigens stimulate active immune response-> endogenous antibody production Use: pneumococcal dz prevention SE: local rxn, erythema, HA, malaise CI: febrile dz, acute disease, anaphylactic rxn, immunodeficiency

**Haemophilus influenzae vaccine

MOA: active immunity via stimulation of endogenous antibodies Use: influenza type B immunization SE: fever, pain, diarrhea, rash, vomiting, OM, pain at injection site, erythema, crying CI: anaphylaxis, moderate/severe illness, wait until patient recovers children <6 wks

Penicillamine

MOA: chelating agent- increases Cu excretion by binding and excreting in urine, immunosuppression Use: wilson's dz, arsenic poisoning, lead poisoning, RA SE: bone marrow suppression, dysgeusia, anorexia, NVD** CI: penicillin allergy, renal insufficiency pregnancy category D

EDTA (edetate calcium disodium)

MOA: chelating metals, particularly lead Use: lead chelation mainly SE: fever, chills, fatigue, myalgia, hypotension, cardiac rhythm abnormalities, glycosuria, proteinuria, numbness, HA, NVD, excessive thirst, transient inc in LFTs, transient bone marrow suppression, anemia, zinc deficiency, hypocalcemia CI: anuria, renal or hepatic dz

*HBV vaccine

MOA: hepatitis B surface antigen [HbsAG] Use: immunization against HBV inx SE: GI upset, abd pain, MSK and joint pain, dizziness, sleep disturbance CV effects [hypotension, tachycardia] dysuria, visual disturbances, earache Interactions: immunosuppressants, steroids, antineoplastics CI: anaphylactic reactions, hypersensitivity to egg, immunodeficiency, tx with chemo/radiation, high dose steroids, HIV positive

*Polio Vaccine

MOA: immunization against poliomyelitis SE: pain and tenderness, fever, HA, malaise Interactions: reduced immune response in immunosuppression CI: anaphylactic, immunosuppression

*Influenza vaccine

MOA: inactivated vaccine- induces antibody formation in host to confer immunity Use: immunity to influenza SE: fever, malaise, HA, GI upset, myalgia, oculorespiratory syndrome, lymphadenitis Interactions, immunosuppressants inc antibody response with aspirin CI: hypersensitivity to egg, anaphylactic rxn to previous dose

**Human chorionic gonadotropin

MOA: induce follicular maturation and early luteinization Use: pregnancy tests. infertility, IVF, inducing ovulation in functional infertility vs primary ovarian failure SE: NVD, hemorrhage, ectopic pregnancy, ovarian hyperstimulation, cardiac arrhythmia, hot flashes, urinary incontinence, emotional lability, congenital abnormalities, spontaneous abortion, premature labor, postpartum fever CI: abnormal, undiagnosed V bleeding, endometrial/uterine carcinoma

Dimercaptosuccinic Acid/DMSA

MOA: lead chelation agent 2 sulfhydryl groups complex to lead making it water soluble Use: lead poisoning SE: NVD, abd pain, gas, increased LFTs, fatigue CI: hx of allergy to drug

*MMR vaccine [ProQuad]

MOA: live attenuated measles, mumps and rubella Uses: immunization SE: pain and induration at injection site. fever, rash, measles like rash [3 day] Interactions: may reduce effect of tuberculin tests CI: febrile respiratory illness, infections, immunosuppressive therapy, *Pregnancy, active TB

RGE vaccine (Rotavirus) - Live inactive virus

MOA: live, attenuated vaccine, confers active immunity via endogenously produced antibodies Use: prevent rotavirus gastroenteritis SE: fever, irritability, NVD, hematochezia, flatulence, fatigue, nasopharyngitis, bronchospasm, OM, seizure *may predispose to intussusception Interactions: immunosuppressives CI: hypersensitivity, infants with hx of intussusception or uncorrected congenital malformation of GI tract

*Estriol

MOA: naturally occurring estrogen normalization of vaginal epithelium-only mild proliferative effect on endometrium short retention time in endometrial cells Use: HRT, infertility d/t cervical hostility, atrophic vaginitis SE: breast tension or pain, nausea, spotting, fluid retention, cervical hypersecretion Interactions: reduced efficacy with activated charcoal, barbiturates, carbamazepine CI: pregnancy, thrombosis, estrogen dependent tumor, vaginal bleeding, otosclerosis, previous use of steroids

**Meningococcal polysaccharide vaccine

MOA: serogroups A, C, Y, and W-135 polysaccharide antigens individually conjugated to diphtheria toxoid protein carrier-> stimulates endogenous antibodies Use: meningococcal vaccination SE: fever, restlessness, prolonged crying, loss of appetite, NVD, redness at injection site CI: hypersensitivity, acute febrile illness, infants <6wk

*Estrone

MOA: steroidal estrogen Use: menopausal HRT, osteoporosis prophylaxis SE: GI upset, GU changes, CV and CNS effects, jaundice, Metabolic dz, contact lens intolerance/steeping of corneal curvature, PE, carb intolerance Interactions: anticonvulsants, folic acid CI: undiagnosed vaginal bleeding, thrombo d/o, breast carcinoma unless selected pts treated for metastatic dz, estrogen dependent tumors, porphyria, pregnancy X

*Nitrofurantoin

Macrobid antibiotic, 5 nitrofuran derivative MOA: nitrofurantoin interferes with cell metabolism and cell wall synthesis by blocking acetyl co A *bactericidal to most gram positive and gram negative GU pathogens USE: acute/uncomplicated UTI and prophylaxis [E coli, enterococci] SE: pulmonary toxicity anemia [not with G6PD, hemolytic dz] irritated GI Neurotoxicity Interactions: quinolones [cipro] CI: severe renal dz, hypersensitivity, hemolytic dz, infants <3 mo, pregnancy at derm, during labor or when labor is imminent **enters breast milk

*Azithromycin

Macrolide, bacteriostatic ABX MOA: protein synthesis inhibitor, binds 50S subunit USE: respiratory [OM, sinusitis- strep, pneumococci, H influenza, legionella] single dose for chlamydia urethritis, chancroid, mycobacterium SE: NVD, allergic rxn, cholestatic hepatitis, inc QT interval [arrhythmia like in cipro] Interactions: antacids- aluminum, mag reduce absorption CI: liver dz, hypersensitivity *NOT MANY **SAFE IN PREGNANCY

*Raloxifene

Metabolic Agent, SERM MOA: *estrogen receptor AGONIST in BONE, increases bone density, *decreases risk of fracture, lowers LDL cholesterol *estrogen receptor ANTAGONIST in BREAST tissue Uses: prophylaxis of osteoporosis ONLY in postmenopausal women [rarely actually used] SE: Hot flashes, flu syndrome, leg cramps, HYPERTRIGLYCERIDEMIA arthralgia, sleep disorders, peripheral edema, vaginal bleeding, rashes, GI upset, HTN, HA, sinusitis, hepatic impairment Interaction: Raloxifene with Warfarin may reduce PT response and time, not with other E agonists CI: active of PMH of DVT, PE, and/or retinal vein thrombosis hepatic and renal impairment pregnancy and lactation X

*Norelgestromin/ethinyl estradiol-patch

Monophasic contraceptive combination MOA: progestin- inhibits pituitary release, prevents follicular maturation and ovulation, stimulates growth of mammary tissues Use: contraception SE: HA, nausea, menstrual cramps, breast symptoms CI: active or hx of breast cancer, arterial/thrombo dz, DVT, PE, valvular dz, liver dz, liver tumors

Carisoprodol

Muscle relaxant MOA: blocks interneuronal synaptic activity in descending reticular formation and spinal cord Use: painful muscle spasms SE: dizziness and drowsiness Interactions: additive CNS depression with opioids and hypnotics CI: acute porphyria, lactation

*Ibuprofen-OTC

NSAID, analgesic [Motrin] MOA: anti-inflammatory, analgesic, antipyretic- both central and peripheral effects. COX inhibitor and blocks thromboxane A2 Use: pain, inflammation, fever SE: dizziness, epigastric pain, heartburn, nausea, rash, tinnitus, edema, vomiting, HA **decreases cartilage synthesis Interactions: decreases ACE inhibitors, beta blockers and diuretics, risk of GI bleed with warfarin **do not combine with aspirin CI: PUD, hypersensitivity, neonates with congenital heart dz, active bleeding Pregnancy-3rd trimester!! **use in 3rd trimester can cause fetal heart defects

*Aspirin- OTC

NSAID, nonopioid analgesic, antipyretic, antiplatelet MOA: COX inhibitor- blocks prostaglandin and thromboxane synthesis, inhibits platelet aggregation Use: low dose for angina pectoris to decrease MI risk and TIAs/stroke, fever, mild-moderate pain, rheumatic fever, RA in high doses for inflammation SE: ASPIRIN is HUMBLe ForEVER asthma, salicylism, peptic ulcers, irritated GI, respiratory changes at toxic levels, Reyes syndrome, intolerance [glucose] at toxic levels, nephrotoxicity, hepatotoxicity, uric acid increase, metabolic acidosis/resp alkalosis, Bleeding BI, fever Interactions: alcohol and steroids may inc GI ulceration, increases phenytoin levels CI: PUD, children <12, children with viral infx, lactation, hemophilia or hemorrhagic d/o, gout, renal or hepatic impairment

*Heroin

Narcotic, opioid agonist MOA: agonist to four endogenous NTs USe: tx of acute pain, MI, acute pulmonary edema and chronic pain, opioid replacement SE: respiratory depression, dependence, abscesses, infected heart valves, blood borne infections. Interaction: addiction treated with methadone and naltrexone. Naloxone for OD. CI addiction

Triple antibiotic [bacitracin, neomycin, polymyxin B]

Neosporin Topical preparation of Bacitracin, Neomycin, and Polymyxin B. Use: minor cuts, scrapes, burns SE: allergic contact dermatitis CI: eyes, large areas of body, hypersensitivity

*valacyclovir

Nucleoside analogue, antiviral MOA: rapidly converted to acyclovir in intestinal and hepatic metabolism, inhibits DNA synthesis and viral replication *does not kill viral, just stops multiplication- early admin=more effective Use: HZ, genital HSV 2, prophylaxis of HSV, CMV in immunocompromised patients SE: HA ,NVD, elevated LFTs, neutropenia, nasopharyngitis Interactions: nephrotoxic drugs CI: hypersensitivity

*Zidovudine [AZT]

Nucleotide reverse transcriptase inhibitor, antiretroviral agent MOA: thymidine analogue, phosphorylated in body to active form which interferes with DNA synthesis of retrovirus by inhibiting DNA replication USE: HIV infection, prophylaxis of HIV SE: severe ha, NVD, weakness, anemia Interactions: benzos increase HA, myelosuppression CI: lactation- pregnancy C

**Lansoprazole (Prevacid)-OTC

OTC

*Hydrocodone

Opioid analgesic, antitussive MOA: opioid agonist Uses: moderate to severe pain-> usually used with paracetamol cough suppressant SE: constipation N/V CNS depression, drowsiness, confusion CV disorders dry mouth sweating, flushing Interactions: CNS depressants Cimetidine opioid antagonists alcohol metoclopramide CI: obstructive airway dz infants and young children with acute diarrhea significant respiratory depression

**Clomiphene

Ovulatory Stimulant [nonsteroidal] MOA: 5th day of cycle.repeat 30 days. inhibits estrogen receptors in the hypothalamus. SE: pelvic pain, hot flushes. ovarian cancer, seizures, trouble sleeping. Ovarian enlargement. Use: infertility in women that don't ovulate. PCOS hypogonadism. Interaction: CI: Liver disease, pregnancy, abnormal uterine bleeding, ovarian cysts [not d/t PCOS], uncontrolled thyroid or adrenal dysfunction, intracranial lesion, pituitary tumor

Capsaicin

Pain Pruritis

*Progesterone-oral micronized

Progestin MOA: induces secretory changes in endometrium, promotes mammary gland dev. relaxes uterus, blocks follicular maturation and ovulation, maintains pregnancy Use: amenorrhea, dysfunctional uterine bleeding, contraception, premenstrual syndrome SE: GI, wt changes, fluid retention, libido changes, altered menstrual cycles or irregular bleeding [rare] Interactions: enhanced clearance with enzyme inducing drugs [carbamazepine, phenobarbital, phenytoin] CI: liver dz, thrombo dz, undiagnosed vaginal bleeding, incomplete abortion, hormone dependent CA, pregnancy, arterial dz

Norgestimate/ethinyl estradiol [oral]

Progestin + Estrogen MOA: inhibits gonadotropin release from pituitary, stimulates growth of mammary tissues Use: contraception SE: GI discomfort, appetite changes, wt changes, fluid retention, edema, acne, chloasma [melasma], allergic skin rxn, insomnia, fatigue, HA, menstrual irregularities, serum lipid and LFTs elevations CI: undiagnosed vaginal bleeding, thrombo dz, venous dz, arterial dz, estrogen tumor, hepatic dz, pregnancy X

*Levonorgestrel [Mirena IUD]

Progestin IUD MOA: inhibits ovulation by negative feedback on hypothalamus causing reduced FSH and LH Use: menorrhagia, contraception SE: vaginal bleeding alterations, ectopic pregnancy, spotting, metorrhagia, abdominal pain, ovarian cysts, acne, HA, breast discomfort, fluid retention, edema, changes in libido Interactions: may inhibit cyclosporin metabolism CI: pregnancy X undiagnosed vaginal bleeding severe arterial dz liver adenoma/ liver dz porphyria recent evacuation of hydatidiform mole hx of breast CA

*Medroxyprogesterone acetate [DepoProvera]

Progestin injection MOA: synthetic progestogen- has some androgenic and anabolic activities but not estrogenic effects Use: contraception, endometriosis SE: depression, fluid retention, fatigue, insomnia, dizziness, headache, nausea, breast tenderness, wt gain/loss, anorexia, cholestatic jaundice, pain at injection site Interactions: enzyme inducing drugs [carbamazepine, phenobarbital, phenytoin] may reduce plasma concentrations CI: thrombo d/o, hepatic impairment, undiagnosed vag bleeding, incomplete abortion, hormone dependent carcinoma pregnancy category X

*Clindamycin

Protein synthesis inhibitor, Lincosamide ABX MOA: binds 50 S unit of ribosomes to block protein formation Use: gram positive infections [strep, staph], acne, bacteroides topical use for acne SE: C diff, diarrhea, pseudomembranous colitis**, Interactions: neuromuscular blocking agents potentiated CI: hypersensitivity *note- used when pt is hypersensitive to cephalosporins/beta lactams [penicillin, amoxicillin, cephalexin]

*Tdap and Dtap vaccine

SE: USE: Dtap is for under 7, Tdap is booster at 11 and older Interaction: CI: Mechanism:

*Varicella vaccine

SE: USE: chickenpox vaccine 12-18 then 46 yo Interaction: CI: Mechanism:

**diltiazem

SE: Use: HTN, Angina, arrhythmia. Interaction: CYP3A4, Beta blockers (especially IV), Quinidine: Reduces clearance CI: CHF, SA and AV conduction issues. ,low BP, can increase rate in patients with Wolff Parkinson White Syndrome, Sick sinus syndrume. Mechanism: nondihydropyridine CCB. Relaxes smooth muscle walls of arteries (dilates). Depress AV node. Negative inotropic, chronotropic and dromotropic effects.

**dabigatran

SE: Use: anticoagulant medication, alternative to warfarin, not as monitored. to prevent strokes, a fib, DVT. Interaction: GI upset,dyspepsia CI: active bleeding, reaction, mechanical heart valves. Mechanism: antidote: Idarucizumab. Direct thrombin inhibitor

**cromolyn sodium

SE: Use: replaced by leukotriene receptor antagonists. Asthma, allergies. Interaction: CI: Mechanism: mast cell stabilizer

**cholera vaccine

SE: 85% for 6 months, 50-60 during first year. Ab pain, diarrhea Use: Vaccine that prevents cholera for those traveling to areas with cholera. Interaction: CI: Mechanism: Oral.. Mostly inactivated.

*ceftriaxone

SE: Allergic, C. difficile, hemolytic anemia, GBD, seizures. Not recommended penicillin allergy. Use: Middle ear infections, endocarditis, menigitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infection, UTI, gonorrhea, PID. Injected Interaction: IV calcium CI: allergy Mechanism: prevent bacteria from making a cell wall.

**Alprostadil

SE: Apnea in infanct. Use: Treat ductus arteriousis, ED. Interactions: CI: Mechanism: Prostaglandin E1.

*latanoprost

SE: Blurred vision, darkening of the iris. Use: Relieves pressure inside the eye. Ocular HTN, open angle glaucoma, Eyedrop. Interaction: use with bimatoprost results in increasing pressure. Increased effect with NSAIDS. CI: Mechanism: increases the outflow of the aqueous fluid from eyes through uveoscleral tract.

**cisplatin

SE: Bone marrow suppression, hearing problems, kidney problems, vomiting. numbness, trouble walking, allergy hearing loss Use: Testicular, ovarian, breast, bladder, and head and neck cancer. Interaction: Vaccines CI: Vaccines Mechanism: chemotherapeutic agent. platinum based antineoplastic.

*calcipotriol

SE: Burn, itch, rash Use: Cream topical treatment of psoriasis. Interactions: CI: Hypersensitivity, hypercalcaemia. Exposure to excessive light. Mechanism: Derivative of Vit. D

**mirtazapine

SE: Constipation, dry mouth, appetite. suicide Use: atypical antidepressant, noradrenergic. major depression Interaction: improve SSRI symptoms. fluoxetine, paroxetine increase. MAOI CI: Liver impairment. Mechanism: blocks a2 receptors enhancing NE release.

**erythromycin

SE: Cramps, vomiting and diarrhea, c difficile, liver issues, prolonged QT, allergic. Use: abx, respitory, skin, chlamydia, PID, syphilis. Group B in pregnancy., improve gastric emptying. Interaction: OCP, Warfarin, CYP450, statins: rhabdomyolisis., verapamil (QT) CI: ok in penicillin allergy. pyloric stenosis in a baby in 1st 2 weeks. Mechanism: macrolide decreases bacterial protein

**cefdinir

SE: Diarrhea, vaginal infections, inflammation, nasuea, abdominal pain. TOXIC EPIDERMAL NECROLYSIS, Stevens Johnson. Red stool, clostridium Use: Cephalosporin antibiotic, otitis media, soft tissue, URI, strep throat (penicillin preferred.) Interaction: CI: hypersensitivity, renal impairment, seizure, diabetes, colitis. Mechanism: like beta lactam but more coverage. Disrupt peptidoglycan layer of cell wall.

**benztropine

SE: Dry mouth, blurred vision, cognitive changes, constipation, urinary retention, tachycardia, anorexia, psychosis. Use: parkinson's disease for tremor Interactions: CI: glaucoma, tardive dyskinesia, ileus, BPH. don't use with pottasium. Mechanism: anticholinergic. M1 muscarine receptor in basal ganglia.

**solifenacin

SE: Dry mouth, blurred vision, constipation. Use: overactive bladder and urge incontanence Interaction: p450 and sa4. (ketoconazol) CI: urinary retention, gastric retention, glaucoma, liver disease, hemodialysis, long QT Mechanism: antimuscarinic. M3 receptor

**enoxaparin

SE: Fever, bleeding, fever, swelling of the legs. Thrombocytopenia. Use: anticoagulant for DVT and PE, Acute coronary syndrome. Interaction: Protamine is a reversable. NSAIDS, past history of spinal injury. Slicylates, sulinpyranzone. CI: kidney insufficiency monitoring. Mechanism: low molecular weight heparin. Binds antithrombin inactivating factor X

**rivaroxaban

SE: GI bleed, no antidote., liver toxicity, do not discontinue without healthcare. Use: anticoagulant, to prevent blood clots. Interaction: defitbrotide, miterpristone, CI: hypersensitivity, liver, kidney, Pulmonary embolism, pregnancy, surgery. Mechanism: direct factor xa inhibitor.

**desmopressin

SE: HA, diarrhea, low blood sodium. Use: DI, bedwetting, hemophilia A, von willebrand disease, high blood urea Interaction: anti inflammatory, carbamazepine, chlopromazine, clofibrate, demeclocycline, diuretics, fludrocortisone, lithium, NE, SSRI, TCA CI: kidney disease, low sodium. Mechanism: synthetic vasopressin. limit water that is eliminated. Antidiuretic on renal collecting duct.

**verapamil

SE: HA, slow heart rate, Heart failure USE: HTN, chest pain, supraventricular tachycardia. constipation, dizziness, low bp. Interaction: CI: pregnancy, severe left ventricular dysfunction, hypotension. Mechanism: CCBB

**isosorbide mononitrate

SE: HA, tired, hypotension Use: angina pectoris, prophylactic. Interaction: sildenafil, sulfhydryl containing (NAC), phenylalkyamine CCB verapamil. propranolol CI: Mechanism: dilates blood vessels

**fludrocortisone

SE: HTN, swelling, heart failure, low blood potassium. low imune function, mood changes. Use: adrenogenital syndrome, postural hypotension, and adrenal insufficiency. confirmation testing of conn's disease (should suppress aldosterone). Interaction: Given with hydrocortison. CI: systemic fungal infections. Mechanism: mineralocorticoid

**fingolimod

SE: Head colds, fatigue, infection, fatal, macular edema decreasing vision. ECG for 6 hours after first dose. Use: MS, reducing rate of relapsing/remitting. Chronic demyelinating polyneuropathy. Interaction: skin cancer when taking natalizumab as well. QT prolonging drugs, ketoconazole, Vaccines (live), immunosuppression., beta blockers, CI: MI, unstable angina, CHF, mobitz type 1 block, AV block Mechanism: sphingosine-1-phosphate receptor. Sequesters lymphocytes in lymph nodes.

**infliximab

SE: INFECTION, Hep B, TB, hepatosplenic t cell lymphoma, lupus, demyelinating central nervous system, psoriasis. Use: autoimmune diseases, such as crohn's, UC, psoriasis, psoriatic arthritis, ankylosing spondy, RA. Interaction: P450, immunosuprssants,, methotrexate, abatacept CI: heart failure, hypersensitivity, infection. Mechanism: chimeric monoclonal antibody biologic drug working against TNFa

**denosumab

SE: Joint and muscle pain in the arms and legs. Use: osteoporosis, treatment induced bone loss, and metastases to bone. hypocalcemia, allergy, jaw necrosis. Interaction: anticancer, steroids, immunosuppressants. CI: low blood calcium. sufficient d and calcium. Mechanism: human monoclonal antibody, RANKL inhibitor, prevents development of osteoclasts.6 month injection.

**ketorolac

SE: Liver, bleeding time, BUN serum creatinine, STORKE, MI, GI bleed. drowsiness. Use: analgesic. Short term, moderate to severe. Good with acetaminophen does not depress respiration. Eye surgery Interaction: Probenecid increas adverse, Pentoxifylline increase bleeding. Aspirin decreases and causes GI issues. Genseng, clove, ginger, arnice feverfew increase bleeding. Vitamin C helps. CI: Allergies, PUD, GI bleed, alcohol intolerance, renal impairment, crebrovascular bleed, polyps, angioedema, asthma. Mechanism: NSAID, herocyclic acetic acid derivative. Inhibits prostaclandins.

**fluocinonide-nasal spray

SE: Nasal burning, dryness, bleed, nausea, aftertaste, hoarseness. Use: nasal symptoms of seasonal or perennial rhinitis. Interaction: CI: pediatrics., wounds, nasal infection Mechanism: anti-inflammatory glucocorticosteroid.

*rivastigmine

SE: Nausea and vomitting, decreased appetite, weight loss. Use: parasympathomimetic or cholinergic for mild dementia of alzheimers or parkinsonian. as a patch. Interaction: HTN meds, beta blockers. CI: Cardiac conduction defects, bradyarrhythmias, sick sinus syndrome, asthma, GI bleed, urinary obstruction. Seizures, low weight. Mechanism: reversibly binds to and inactivates acetylcholinesterase.

**Albendazole

SE: Nausea, abdominal pain, headache, bone marrow suppression, Pregnancy. Use: Treats worms like giardia, pinworm, etx... Broad antihelmnthic. Interactions: Carbazepine, phenytoin and pehnobarbital lower concentration. Antacids boost. CI: Allergy Mechanism: benzimadazole

**Acyclovir

SE: Nausea, diarrhoea, safe in pregnancy, low platelets. Use: Antivirals for HSV, shingles, cytomegalovirus, epstien Barr. Interactions: synergy with ketoconazole. Probenecid extends. Same with interferon and zidovudine. C/I: Mechanism: analog of guanisine, decreases viral DNA.

**duloxetine

SE: Nausea, somnolence, insomnia, dizziness. sexual side effects. Withdrawal., suicide Use: major depressive disorder, anxiety, fibromyalgia, neuropathic pain. Interaction: MAOI, Warfarrin, cyp1a2 (fluvoxamine, cyp2d6 paroxetine, nsaids, lorazepam CI: hypersensitivity, MAOI, Glaucoma, CNS drugs, thioridazine. Mechanism: selective serotonin norepinephrine and dopamine reuptake inhibitor. SNRI

*clarithromycin

SE: Nausea, vomiting, headaches, diarrhea. QT elongation. Use: ABX, strep, pneumonia, skin infection, h. pylori, lyme. penicillin alternative. Interaction: Don't use with statin. HIV meds, carbamazepine. CI: Macrolid allergy, jaundice, not with colchicine if liver damage. Mechanism: Macrolid, decrease protein production

**ivermectin

SE: Red eyes, dry skin, neurotoxicity. Use: anti parasites: head lice, scabies, river, strongyloidiasis, lymphatic filariasis. Skin or oral Interaction:drugs that inhibit cyp3a4 increase risk of BBB crossing statins, Hiv protease, CCB, gluccocorticoids CI: under 5, under 33 lbs, breast feeding, renal and hepatic disease. Mechanism: increases permeability of cell membrane resulting in paralysis and death of parasite.

meningococcal vaccine

SE: Redness and pain. Use: prevent menigitis. 11 and 12, 16. B for older kids. Interaction: CI: allergy, pregnancy, Mechanism:

**beclomethasone

SE: Respiratory infections, headaches, throat inflammation. Risk of infection, cushings. Use: Asthma, dermatitis, psoriasis UC. Interactions: CI: Mechanism: Steroid, often inhaled for long-term asthma management. Gluccocorticoid.

**tretinoin

SE: SOB, high wbc, muscle pain, HA, dryness, itchiness, hair loss, vomiting, muscle pains, vision changes. USE: acne (Cream) , acute promyelocytic leukemia (oral). Interaction: vitmain A Aminolevulinic cream, isotretinoin, acitretin, doxycycline, minocylcline CI: Peds. Mechanism: forces APL to differentiate,

**budesonide- oral

SE: Side effects include joint pain, feeling tired, vomitting, infection, loss of bone strength, cataracts. Adrenal insufficiency. Use: treat crohn's , UC for symptomatic relief. (inhaler for asthma) Interactions: grapefruiet juice DOUBLES. Echinacia diminishes. fat delays. CI: not for status asthmaticus. Mechanism: Steroid gluccocorticoid

**buprenorphine

SE: Similar to opioids including nausea, vomiting, drowsiness, dizziness, headache, memory loss, cognitive and neural inhibition, perpiration, decreased libido. miosis, urinary retention. Dependence, resp risk. Use: opioid to treat opioid addiction. Moderate acute pain and chronic pain. Often combo with naloxone. occasional antiemetic. Similar to methadone, but partial agonist and not as dangerous. Interactions: pimozide, dronedarone. CI: pregnacy, resp. depression, GI obstruction. QT long. abrupt withdrawal. Mechanism: non selective, mixed agonist-antagonist opioid receptor modulator.

**clobetasol propionate

SE: Skin whitening Use: Skin disorder such as eczema and psoriasis. Poison Ivy, Poison oak. GVHD, alopecia, vitiligo, lichen planus, mycosis fungoides. Interaction: CI: Not beyond 2 weeks. not pregnacy, Mechanism: cortiosteroid in gluccocorticoid class.

**bupivicaine (Marcaine)

SE: Sleepiness, muscle twitching, ringing in the ears, changes in vision, low blood pressure and irregular heart rate. Cartilage issues. Use: injected to decrease feeling. Often mixed with epinephrine, around nerve. cardiotoxic. Interactions: CI: hypersensitivity to amino-amide anesthetics, paracervical blocks. Mechanism: binds to sodium channels and blocks channels influx. prevent depolarization.

**atomoxetine

SE: Suicide, aggression, syncope, htn, mania, xerostomia, headache, abdominal pain, anorexia. Use: ADHD. Interactions: hypertensive. CI: MAO inhibitor use, glaucoma, pheochromocytoma, severe heart disease. Mechanism: selectively inhibits norepinephrine reuptake.

**promethazine

SE: Tardive ydskinesia, confusion, drowsiness, dry mouth, respiratory depression, akathisia, paresthesia, resp depression, tissue injury Use: sedative, antipsychotic, reduces motion sickness, antiemetic anticholinergic. Interaction: cyp2d6, cns depression, dopamine, hyper prolactin effectis, QT affects. CI: SC injection, comatose, under 2, reyes syndrome, sulfite allergy, elderly, with CNS, glacoma., QT> Mechanism: antihistamine

*cefuroxime

SE: Transient SE. Diarrhea, nausea, vomitting, ha, dizziness, ab pain. Use: Crosses BBB, so usable on meningitis, lowers endophthalmitis. Lyme disease, gonorrhoeae, H Flu. Interaction: Contraceptives. CI: severe penicillin allergy. Mechanism: cephalosporin antibiotic (2nd gen)

**losartan

SE: Upper respiratory infx, stuffy nose. kidney disease, diarrhea, fatigue, low bp, low blood glucose. Use: HTN, diabetic nephropathy. First line under 55 with ACE. Interaction: aliskiren CI: Cat X pregnancy Mechanism: ARB angiotensin receptor antagonist.

*tamoxifen

SE: Uterine cancer, stroke, vision problems, PE, irregular periods, weight loss, hot flashes. prevents bone loss. Use: prevent and treat breast cancer for 5 years. ER+ Interaction: cyp2d6, 3a4 CI: coumarin anticoagulation, thromboembolism, breastfeeding, pregnancy. Mechanism: selective estrogen receptor modulator. Decreases the increase and growth of breast cells.

**baclofen

SE: Withdrawal. CNS depression, resp. depression, ataxia, drowsiness, dizziness, weakness, hypotension. Use: muscle relaxant. Spasticity, used in spinal cord injuries and cerebral palsy/MS. Interactions: CI: Not for stroke and parkinson's. Mechanism: GABA receptor agonist.

**tacrolimus

SE: acrdiac damage, HTN, blurred vission, liver and kidney issies, DM, hyperglycemia, lung damage, nightmares, infections, carcinogenesis. Use: immunosuppresive drug, used after allogeneic organ transplant to prevent rejection, eczema in ointment Interaction: Grapefruit. p450. Anti microbial (erythromycin and clarithromycin, azole class CI: breast feeding, hepatic disease, immunosuppression, infants, infection, cancer, oliguria, QT, prolongaction, UV Mechanism: inhibits IL2 and proliferation of T cells.

**pilocarpine

SE: allergic, retinal detatchment, irritation, increased tearing, HA, blurry vision. scoline apnea. Use: pressure in the eye and dry mouth. angle closure glaucoma. Dry mouth in sjogren's Interaction: cholinergic CI: asthma, iritis, cardio, asthma, bronchitis, hepatic impairment, biliary dz, nephrolithiasis, psych disorder. Mechanism: miotics, activates cholinergic receptors in trabecular meshwork.

**Norethindrone

SE: androgenic, estrogenic Use: combo estrogen combo. contraceptive and replacement. Interaction: fosamprenavir, tranexamic acid. CI: pregnancy, breast CA, undiagnosed vaginal bleeding, thromboembolic disorders, smokers. Mechanism: Synthetic progesterone. Prodrugs

**hyoscyamine

SE: anti cholinergic. memory loss. coma. Use: relief of ulcers, IBS, diverticulitis, pacrealitis, colic, cystitis. Pain control. Interaction: CI: Mechanism: tropane alkaloud from solanaceaeL Henbane, Mandrake, belladonna. Like atropine.

*diphenoxylate/atropine

SE: anticholingergic, dizziness, blurred vision, dry mouth. Use: Diarrhea Interaction: ambenoium, pramlintide CI: Infection, liver disease., dehydration. Mechanism: opioid that slows intestinal contractions. Doesn't cross blood brain barrier. Lomotil adds atropine. Discourage abuse, causes anticholinergic if dose exceeded.

**Vitamin k1

SE: anticoagulant resistance, blood clotting hemolytic anemia USE: osteoporosis, cardiovascular health, cancer Interaction: mineral oil, cholestyramine, warfarin CI: heypersensitivity, overanticoagulation, caution in neonates, hereditary hypoprothrombinemia Mechanism:

*methylphenidate

SE: appetite loss, dry mouth, anxiety, nausea, insomnia, abdominal pain, irritability. Addiction! Use: (ritalin) CNS stimulant for ADHD and narcolepsy. Interaction: MAOI, coumarin, TCA, SSRI. CI: MOI, with agitation, tics, tourette's syndrome, glaucoma, hypersensitivity, cardiac abnormalities Mechanism: stimulant of the phenethylamine class. inhibits catecholamine reuptake, primarily dopamine.

**scopolamine

SE: blurred vision, dilated pupils, and dry mouth. Use: motion sickness and post operative nasuea and vomiting. Decrease salive before surgery. Interaction: other anticholinerics, analgesiscs, alcohol, diuretics CI: glaucoma, bowel obstruction. Mechanism: blocks affects of acetylcholine in the nervous systemt, antimuscarinic.

**bethanechol

SE: bronchospasm, tachycardia, seizures. Abdominal cramps, nausea, belching ... Use: treats urinary retention from Diabetes, anaesthesia, or drug reaction. dry mouth. Interactions: CI: no with ashtma, coronary insufficiency, peptic ulcers, intestinal obstruction, hyperthyroidism. Mechanism: parasymphathomimetic choline carbamate. Stimulates muscarinic receptors without any impact on nicotinic.

*potassium chloride

SE: cardiac muscles and death with high iv dose. in lethal injections. bleeding, naausea, vomit. Use: low blood potasium, iv. Interaction: CI: corn hypersensitivity, hyperkalemia, delayed GI transit, esophageal stricture, GI obstruction, renal failure. Mechanism:

*morphine

SE: decreased respiratory effort, low blood pressure. addiction. Constipation, hormone imbalance, TOLERANCE, Dependence. Use: pain medication, MI pain, birth, Interaction: tipranavir anticholinergic, CNS depression. CI: respiratory depressions, acute pancreatitis Mechanism: opiate, on CNS, from poppy

**triamterene

SE: depletion of Na, folic acid, Ca, nausea, vomiting, diarrhea, headache, dizziness, fatigue and dry mouth. Heart palpitation, tingling, numbness, fever chills, sore throat, rash back pain. kidney stones. USE: potassium sparing diuretic used in combo with thiazides Interaction: pregnancy, severe renal dysfunction, anuria, hyperkalemia CI: Causion with DM, hepatic impairment and kidney stones Mechanism: blocks the epithelial sodium channel. on lumen of collecting tubule.

**procaine

SE: depression of neuronal activity. Hypersensitivity to nervous system, convulsions. Tolerance, in myocardium can lead to MI. Use: local anestheti. Reduces pain of menicillin shot, dentists Interaction: bupivicaine, methemoglobinemia CI: hypersensitivity, bupivicaine, heart issues Mechanism: sodium channel blocker.

*terbinafine

SE: diarrhea, HA, cough, rash, elevated liver enzymes. liver and allergy. Cream causes ithcing. USE: antifungal medication for ringworm, pityriasis versicolor, fungal nail infections Interaction: CI: hepatic disease, immunodeficiency, SLE, psoriasis. Mechanism: allyamines family. decreases ability of fungi to make sterols.

**fentanyl

SE: diarrhea, nausea, constipation,d ry mouth, somnolence, confusion, asthenia, sweating, abdominal pain, HA, fatigue, anrexia and weight loss. Resp depression, addiction. Use: CNS depressants, MAO inhibitors, anticholinergics Interaction: opioid pain meds. Patch for palliative people who can't swallow, renal failure. CI: short term (patch), post op, respiratory compromise, paralyzed ileus Mechanism: synthetic opioid pain medication, rapid. agonist of u-opioid receptors in the brain. 100 times more potent than morphine.

**drospirenone/ ethinyl estradiol

SE: diarrhea, rash, sunburn, breast pain, HA, heavy bleed, stomach pain, low libido. Use: birth control., pmdd, and acne. p4503a4, barbituates, carbamazpime, Vit. C, acetaminophen. Interaction: smoking cigarettes, skin issues, St. John's Wart CI: Mechanism: BC

**diclofenac-gel

SE: dizziness, ulcers allergy Use: joint pain, Interaction: anticoagulants, azole antifungals, rifamycins, cyclosporine, lithium, ACE CI: heart disease, allergic, kidney, pregnancy Mechanism: NSAID

**topiramate

SE: dizziness, weight loss, paraesthesia, somnolence, diarrhea, fatigue, nause USE: anticonvulasnt/epilepsy drug. weightloss with phentermine. Interaction: Birth control, other carbonic anhydrase inhibitors (acetazolamide), increase phenytoin. Birth control, alcohol CI: mental allertness, impaired heat regulation, visual field defects, Rebound Mechanism: inhibits carbonic anhydrases

**methocarbamol

SE: drowsiness, dizziness, clumsiness, stomach, flushing, tachy and bradycardia. dkin rash, mood changes. Use: central muscle relaxant Interaction: depressants, alcohol, CI: elderly, renal impairment, latex, seizure disorder Mechanism: inhibition of carbonic anhydrase

**benzonanate

SE: drowsiness, dizziness, dysphagia. Use: antitussive Interactions: Swallow, do not chew or allow to absorb in mouth. CI: Allergy to PABA. Mechanism: non-opiod anti-tussive. decreases the sensitivity of stretch receptors in lungs.

meclizine-OTC

SE: drowsiness, dry mouth, tiredness. dry mouth. Use: nausea vomitting and dizziness from motion sickness and loss of balance. Interaction: antihistamines cream, opioid pain meds, sleep and anciety meds. CI: breathing issues, glaucoma, card, HTN, ulcers, hyperthyroid. Mechanism: CNS depressant. Drying effects and depress nerve conductions.

**oxybutynin

SE: dry mouth etc..., alzheimers. Use: urinary and bladder difficultins Interaction: CNS depression, anticholinergic, CYP3A4 CI: narrow angle glaucoma. GERD, hh, paralytic ileus, megacolon etx. Mechanism: anticholinergic medications , decreases muscle spasm. calcium antagonist.

*ipratropium bromide

SE: dry mouth, cough, urinary retention, spasms, allergy Use: bronchodilater in asthma, COPD, bronchitis. inhalor. Interaction: TC antidepressants, antiparkinsons, quinidine. CI: allergy to atropine, narrow angle glaucoma Mechanism: anticholinergic and muscarinic agonist causing smooth muscles to relax

**paroxetine

SE: dry mouth, drowsiness, loss of appetite, sweating, trouble sleeping, delayed ejaculation. suicide. mania Use: major depressive, OCD, social anxiety, panic, PTSD, GAD Interaction: any drug on serotonin, NMS. SNRI, and SSRI with triptans, MAOI antipsychotics. Possibly statins, CI: ween off, mania Mechanism: SSRI

**neomycin/polymyxin B/hydrocortisone

SE: ear burning, hearing loss. fungal ear infection. Use: eardrop for treating ear infections. and antiinflamatory. Interaction: CI: allergy. ear problems, hole or middle ear infection. pregnancy. Mechanism:

**timolol

SE: eye irritation, tiredness, slow heart beat, itchiness. Masking low blood sugar USE: mouth or eye drops to treat ocular HTN and glaucoma. , chest apin, and migraines. Interaction: hypoglycemia prolongs PR, bradycaric, 2d6 CI: asthma, heart failure, COPD, Mechanism: non-selective beta blocker.

**cyclosporine ophthalamic

SE: eye pain, lacrimation, occular burning. Use: blepharitis, rosacea Interaction: CI: sensitivity Mechanism:

*trastuzumab

SE: fever, inx, cough, headache, trouble sleeping and rash. heart failure, allergic reactions, lung disease. USE: to treat HER2 receptor positive breast cancer. Chemo medication. Given by slow injection in a vein. Interaction: must use barrier method instead of birth control pills. idarubicin, cardio toxic CI: sesitive to hamster protein. Prior or concurrent cardiotoxicity, treatment for HTN, lung diseae, Mechanism: binds to HER2 slowing down cell duplication

**selenium disulfide

SE: hair loss, weakness, feeling tired. Use: pityriasis versicolor, seborrhoeic dermatitis, lotion Interaction: CI: 2-5 yo, use in pregnancy or breastfeeding Mechanism: antifungal- topical

**olopatadine-ophthalmic

SE: headache, eye burning and or stinging. Blurred vision, dry eyes, foreign body sensation, hyperemia, keratitis, sinusitis. Use: prescription eye drop to treat allergic conjunctivitis. Not for contact lenses. Interaction: CI: Mechanism: antihistamine and mast cell stabilizer

**vancomycin

SE: hearing loss, low blood pressure, bone marrow suppression. nephrotoxicity, thrombocytopenia, bleeding, red man syndrome if too high. USE: antibiotic, IV for skin blood and endocarditis of MRSA. By mouth for C diff Interaction: CI: renal impairment, nephrotoxic drugs, hearing impairment, elderly, ototoxic, intestinal inflammation. Mechanism: glycopeptide anx blocks cell wall.

**tizanidine

SE: hepatocellular liver damage. dizziness, drowsiness, weakness, nervousness, hallucinations, depression, vomiting, dry mouth, constipation. USE: muscle relaxant. for spasms cramping and tight muscles, from MS, ALS, back pain and injuries to spine. Interaction: 1a2 such as amiodarone, verapamil. Fluvox, increases. CNS interaction, alcohol. CI: allergy, avoid withdrawal, renal, hepatic, smoking, CNS depressants, elderly Mechanism: binds alpha 2 adrenergic receptors

**Calcitonin

SE: hypocalcemia, pain, malignancy, anaphylaxis, headache. Use: lowers Ca2+ in blood. Salmon calcitonin used with osteoporosis, hypercalcaemia, paget's, bone metastases, phantom limb pain. Interactions: bisphosphonate. CI: elderly, allergy, bisphophonate use Mechanism: Participates in calcium and ph metabolism. Counters parathyroid hormone. inhibits osteoblast activity. inhibits renal resorption.

**irbesartan

SE: hypotension, impaired renal function. Use: HTN, delay diabetic nephropathy. Interaction: combo with thiazide, agents taht increase potassium, lithium, NSAIDS attack kidney. CI: Pregnancy X, Mechanism: angiotensin 2 receptor blocker.

**bicalutamide

SE: in men: Breast enlargement, tenderness, hot flashes, feminization, sexual disfunction. liver damage Use: Antiandrogen for prostate cancer. Also used for excessive hair growth in woen Interactions: typically used with GNRH analog. CI: Not in women, pregnacy. cytochrome p450. Mechanism: Blocks androgen receptor, does not lower levels.

**memantine

SE: increased libido, confusion, dizziness, drowsiness, HA, insomnia, agitation, hallucinations. vomitting, hypertonia, cystitis. Extrapyramidal. Use: Alzheimer's disease medication. Interaction: drugs that make urine alkaline. reduced 80% alterations urine pH toward alkaline lead to accumulation of the drug. Other NMDA ketamine amantadine. CI: allergy Mechanism: blocks NMDA receptors

**doxazosin

SE: infx, nutrition, palpitation, hot flashes, Use: HTN, Urinary retention dt BPH. not best for HTN. Interaction: PDE5 inhibitor, potentiates alpha blockers CI: monotherapy, orthostatic cwerIN HWer xonsiriona., PDE 5 , Mechanism: quinazoline, alpha 1 selective alpha blocker. Inhibits NE from binding a1. Inhibits vascular smooth muscle tone.

*Fluoxetine

SE: insomnia, mania, loss of appetite, dry mouth, rash, abnormal dreams. Serotonin syndrome. Suicide. sexual dysfunction Use: antidepressant, OCD, bulimia, panic. *first line choice Interaction: quinidine, procarbazine, eliglustat, isocarboxazid, pimozide, etc CI: CNS depressant, alcohol, elderly, pregnancy, hepatic impairment, bleeding, electrolyte, QT elongation CHF, MI, mania. Mechanism: SSRI

**sulfacetamide

SE: irritation, stinging burning, HA, allergic, nettle rash, diarrhea, joiny pain, conjuntivitis Use: sulfonamide antibiotic, lotion for acne and seborrheic dermaitis Interaction: CI: Mechanism: limits bacterially needed folic acid

**ursodeoxycholic acid

SE: leukopenia, thrombocytopenia, Hypersensitivity, anaphylaxis, jaundice, LFT, diarrhea, constipation HA, nausea, dizzy, URI, back pain. USE: bear bile, reduces gallstones, primary biliary cholangitis, imporve bile flow in infants, after bariatric surgery. Interaction: binds anion exchage, polyvalent cations. CI: acute cholecystitis, biliary obstruction, gallstones, fistula. Mechanism: reduces cholesterol absorption and is used to disolve gallstones if people don't want surgery.

**imiquimod

SE: local inflammatory reaction, Use: genital warts, BCC, anctinic keratosis. Interaction: Immune suppressing drugs. CI: Mechanism: immune response modifier. TLRY make interfero A

*donepezil

SE: loss of appetitie, gastrointestinal upset, diarrhea, difficulty sleeping, vomitting, cramping. Use: palliative alzheimers disease. improve cognition but doesn't change course Interaction: NSAIDS CI: heart disease, COPD, asthma, arrhythmias, sick sinus. Mechanism: reversible acetylcholinesterase inhibitor.

**clozapine

SE: low white blood cells, death. seizures, inflammation of the heart, hyperglicemia. drowsiness, hypotension, dizziness. movement tardive dyskinesia. Use: schizophrenia without help from other drugs. Interaction: fluvoxamine, inhibits cloazapine degradation. benzos. decreases effect. CI: Mechanism: atypical antipsychotic

**cyclophosphamide

SE: low white blood cells, loss of appetite, vomit, hair loss, bleeding, infertility, allergy, pulmonary fibrosis. Use: chemo and to suppress immune system, in nephrotic syndrom, after organ transplant, autoimmune Interaction: CI: Pregnancy Mechanism: alkylating, nitrogen, interferes with duplication of DNA and creation of RNA.

glatiramer acetate

SE: lump at injection site, fever, flu like symptom. rapid heart beat, Use: treat MS, reduces relaps. Interaction: natalizumab CI: Hypersensitivity to mannitol, immunosuppresion. Mechanism: glutamic acid, lysine, alanine, tyrosine and decoy for immune system. TH1 to TH2.

**thalidomide

SE: malformation of baby limbs (phocomelia), polyneuropathy, fatigue, skin rash, venous thromboembolism. stroke. USE: immunomodulatory drug Multiple myeloma and leprosy. previously pregnancy. Interaction: limited perhaps sedative, bradycardic items. Oral contraceptives. CI: pregnancy, hypersensitivity, under 12, unable or unwilling to comply with contraception. Mechanism:

**simvastatin

SE: muscle breakdown, liver issues, increased blood sugar levels. Consipation, nausea. Use: hypercholesterolemia Interaction: lower dose with CCB, grapefruit juice. increases rhabdomyolysis risk. not with antifungal CI: pregnancy. Mechanism: decreases making cholesterol in liver.

**mesalazine (mesalamine)

SE: muscles pain, back pain, vomiting hearthburn, burping, constipation. gas, dry mouth, hair loss, chest pain, black tarry stooks, coffee vomit. Use: Treat IBD, UC, inflamed anus, crohn's Interaction: salicylates CI: sulfa allergy, Mechanism: aminosalicylate anti-inflammatory drug.

**somatropin

SE: obesitiy, upper ariway obstruction, intracranial tumors, glucose tollerance, HTN, retinopathy, femoral epiphysis, scoliosis progresion Use: hormone, growth failure without GH, turner syndrome, SGA, hormone deficiency. Injection Interaction: cyp1a2, 3a4, hyperglycemia CI: praderwilli syndrome, cancer, intracranial lesion, close epyphyses, DM, illness Mechanism:

**ketoconazole

SE: pruritis, dermatitis, Use: antifungal cream for tinea and cutaneous candidiasis, seborrheic dermatitis. Interaction: CI: Mechanism:

*ketamine

SE: psychological reactions as the medication wears off. HTN, muscle tremors Use: maintaining anesthasia, trance like with pain relief and memory loss. Other functions remain. Interaction: Drugs that increase blood pressure may interact, additive, stimulants, SNRI and MAOI make arrhythmias. Alcohol, benzos etc CI: HTN, stroke, hemorrhage, head trauma. CAD, CHF Mechanism: NMDA receptor antagonist.

**tramadol

SE: seizures, serotonin syndrome, decreased alertness, and drug addiction. constipation, tchiness, nausea. USE: opioid pain medication for moderately severe pain. Interaction: serotonergics, MOI, TCA, SSRI, SNRI, other opiods, etc. lithium. st. john's wort. CI: kidney and liver issues. suicide risk. Mechanism: binds u opioid receptor, inhibits serototnin and norepinephrine reuptake.

**etanercept

SE: serious infections, sepsis., Use: autoimmune such as RA, JRA, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis. Interaction: Vaccines: minght need to redo. no live vaccines CI: TB, Hep B Mechanism: biologic interferes with TNF-alpha

**ramipril

SE: shakiness, dry cough, dizziness, fatigue, mouth dryness, nausea, fainting, signs of infection, chest pain, neurtropenia, impotence. Use: HTN, CHF Interaction: CI: renovascular disease, renal impairment, angioedema, pregnancy, hypotension. Mechanism: ACE inhibitor. arteriols expand allowing more flow.

**quetiapine

SE: sleepiness, constipation, weight gain, dry mouth. low bp, prolonged erection, high blood sugar, neuroleptic syndrome. Tardive dyskinesia Use: bipolar and major depressive disorder, sleep aid. Interaction: dronedarone, pimozide CI: qt prolongation, electrolyte abnormalities, bradycardia, hypokalemia, arrhythmia, Mechanism: blocks serotonin and dopamine receptors.

**lidocaine

SE: sleepiness, muscle twitch, confusion. low bp. Use: numb tissue in a specific area. Often mixed with adrenaline to lower dose and decrease bleeding. Interaction: CYP3a4 and cyp1a2 increase levels. morphine liposomal and dronedarone. CI: Heart block, sinoarrial block. adverse drug reation, quinidine, amiodarone, Wollf parkinson white. Mechanism: block sodium channel, neurons can't signal brain.

**metoprolol

SE: sleeping, tired, faint, abdominal discomfort., Use: HTN Interaction: CI: liver disease, asthma. Inhalers. Heart failure, dilated neck veins. Mechanism: beta blocker

**Ampicillin

SE: steven johnson, anaphylaxis, c-difficile, nausea, vomiting, rash, black tongue. Use: b strep, endocarditis, meningitis. Interactions: can lower seizure threshold, alters GI flora. CI: Allergies., mono Mechanism: inhibits cell wall mucopeptide synthesis.

**lamotrigine

SE: stevens johnson, DRESS, Toxic epidermal necrolysis. in first 2-8 weeks. rash, fever, fatigue., double vision, memory problems, weight loss. decreased wbc. Use: anticonvulsant in treatment of epilepsy and bipolar. Adjunct depression. Focal seizures. , lennox gastaut syndrome. Interaction: contraceptive decrease levels. worse in pill free week. CI:renal, suicide, hepatic, pregnancy Mechanism: enhances action of GABA

**indomethacin

SE: stomach and intestines mucousal lining. diarhea Use: fever pain, stiffness, swelling, from inflammation. Interaction: potassium sparing diuretics, lithium salts. CI: peptic ulcer, allergy, polyps, patent ductus arteriosus, bleeding, parkinson's Mechanism: NSAID, inhibits prostaglandins.

**flecainide

SE: structural heart, hypokalemia. torsades de pointes. Use: prevents tachyarrhythmias, AFib, Supraventricular Tachy, and Ventricular Tachy Interaction: antiarrhythmic agents, alocohol, amiodarone, cimetidine, digoxin, paroxetine, propafenone, quinidine. CI: structural heart disease, liver, kidney disease. care with pace makers. Mechanism: class 1c antiarrhythmic agent. Regulates sodium in the heart, prolonging action potential.

**rifaximin

SE: superinfection, c. difficile, angioedema, anaphylaxis, exfoliative dermatitis. Use: traveler's diarrhea, IBS, and hepatic encephalopathy. Poor absorption. Interaction: alters GI flora CI: hypersensitivity, hepatic impairment, recent abx dt colitis. Mechanism:

*isotretinoin

SE: transient worsening, dry lips, fragile skin, susceptibility to sunburn, depression. Vitamin A toxicity, Anemia, thrombocytopenia. stop ong bone growth. Use: severe nodular acne, SCC Interaction: glucose, st. johns, corticosteroids CI: pregnancy, psych disorders, pancreatitis, liver, IBD, lipids, Mechanism: induces apoptosis in sebaceous gland.

**gentamicin drops

SE: ulcers, burning, irritation Use: ocular bacterial infection. Interaction: CI: hypersensitivity Mechanism:

*permethrin

SE: unclude rash and irritation at the area of use. nausea, ha, muscle weakness, excessive salivation Use: anti lice and scabies Interaction: CI: allergy Mechanism: pyrethroid family. neurons of lice and scabies.

**botulinum toxin

SE: unintended paralysis, flu likeVaries with location. Use: Types a and b treat muscles spasms, and overactive muscle, migraine. Post stroke spasms of vocal chords.. Interactions: CI: urinary issues. Mechanism: prevents acetylcholine release, flaccid paralysis. We uses types a and b.

nepafenac

SE: visual acuity decreased, foreign object sensation, eye pressure, sticky Use: non steroidal anti-inflammatory drug, eye drop. pain from cataract surgery. Interaction: german chamomile, antiplatelet. CI: ASA,phenylacetic acid derivatives, contact lens, ocular surgery, dry eye. Diabetes. Mechanism: prodrug cox 1 and 2 inhibitor.

**valproate

SE: vomiting, nausea, sleepiness, dry mouth, liver issues, pancreatitis, suicide risk. USE: used to treat epilepsy and bipolar and to prevent migraines Interaction: aspirin, benzo, carbapenem, cimetidine, eryhtromycine, ethosuximide, felbamate, mefloquine, oral contraceptives, primidone., rifampin, warfarin, zidovudine CI: pregnancy, elderly, liver disease, urea cycle disorder, mitochondrial disorder, pancreatitis, porphyria Mechanism: anticonvulsant due to blockage of voltage sodium channels and increased GABA

**megestrol acetate

SE: weight gain, nausea, vomting and nightmares, impotence, edema, breakthrough bleeding, shortness of breath. thromboembolism. Use: steroidal progestin in the treatment of breast cancer and is an appetite stimulant. Interaction: insulin, maitake, taurine CI: pregnancys, thrombophlebitis, breast cancer, for weight loss Mechanism:

**ezetimibe

SE:HA, diarrhea, myalgia, LFT increase. Use: Hyperlipidimia, reduces LDL Interaction: Works well with statins, cyclosproine, and other fibrates not fenofibrate. CI: Allergic reaction, liver disease Mechanism: decreases absorption in small intestine

**levofloxacin

SE:nausea, diarrhea, trouble sleeping, tendon rupture, inflammation, seizures, psychosis, nerve damage. Use: antibiotic, for sinusitis, pneumonia, UTI, chronic prostatitis. Interaction: magnesium, NSAIDS. corticosteroids. CI: children due to MS injury. Epilepsy, prolong QT Mechanism: fluoroquinolones.

*venlafaxin

SNRI MOA: inhibits reuptake of ST, NE, DA USE: depression, panic disorder, GAD, social anxiety disorder SE: HA, nausea, vomiting, asthenia, dry mouth, diaphoresis, abnormal ejaculation, impotence Interactions: MOA inhibitors- neuroleptic malignant syndrome [hyperthermia, seizures and death], ST syndrome CI: MAOI within 2 weeks

*escitalopram

SSRI SE: Suicide, libido, weight gain, long QT, withdrawal, bradycardia with beta blockers Use: antidepressant, anxiety, MDD, OCD, eating disorders, GAD [up to 8 weeks] Interaction: St. John's Wort. omeprazole. DXM (serotonin syndrome) risperidone, tramadol, beta blockers, MOIs, TCAs Serotonin syndrome: weakness, enhanced reflexes and incoordination] CI: suicidal ideation, mania, seizures, renal or hepatic impairment *pregnancy C

Sodium phosphate enema

Saline laxative, phosphoric acid salt MOA: exerts osmotic effect in SI by drawing water into lumen promotes peristalsis P promotes bone deposition, Ca metabolism, utilization of B vitamins, buffer in acid-base balance Uses: colonoscopy natural cathartic laxative constipation SE: *acute renal failure *hypocalcemia *hypernatremia *hyperphosphatemia C/I: *2-11 YO, elderly N/V abdominal pn renal impairment ascites

*cyclobenzaprine

Skeletal muscle relaxant MOA: centrally acting in brain stem, decreasing tonic somatic motor activity Use: painful muscle spasms SE: drowsiness, dizziness. Interactions *MANY CI: MAOI, nervous system depressants., MAOI, life threatening. surgery meds, recent MI, arrhythmias, severe liver disease

*nicotine-patch

Smoking Cessation Agent MOA: CNS stimulant, paralyzes autonomic ganglia with small dose- large dose produce medullary type convulsions Use: nicotine replacement therapy, for smoking cessation SE: tobacco specific nitrosamines Interaction: dofetilide CYP2A6, hyperglycemia CI: arrhythmias, MI, hepatic impairment, renal impairment, asthma, cardiovascular dz, HTN, PVD, hyperthyroid, PUD, seizure, pheochromocytoma

*varenicline

Smoking cessation Aid MOA: nicotinic receptor agonist, acts on mesolimbic DA system- prevents nicotine stimulation- stimulates nicotine but to a lesser degree than nicotine SE: nausea, HA, difficulty sleeping, nightmares, change in taste, vomiting, abdominal pain, flatulence, constipation. USE: treat nicotine addiction. Interaction: none CI: renal, psych, seizure, alcohol, cardio

Docusate (Colase)

Stool softening laxative surfactant/detergent agent MOA: hydration of fecal material->soften stool NO peristalsis action Uses: constipation- in combo with stimulant laxative fecal impaction- give as enema SE: abd cramping, diarrhea bitter taste throat irritation Interactions Mineral oil- may inc absorption and cause toxicity C/I: intestinal obstruction undiagnosed abd pn prolonged use

*USP thyroid

T3 and T4 desiccated thyroid MOA: acts as endogenous thyroid hormone (hypothyroidism), 80% T4, 20% T3 Use: Hypothyroidism SE: decrease bone mineral density hyperthyroid symptoms decreased insulin sensitivity CI: low TSH with normal T4, T3 porcine derivative- if person is allergic or doesn't consume pork untreated adrenal insufficiency thyrotoxicosis

*Adalimumab

TNF alpha blocks, antirheumatic, immunomodulator, DMARD MOA: DNA derived human IgG1 monoclonal Ab, binds to TNF alpha and blocks cytokine inflammatory rxn USE: RA, AS, UC, IBD, plaque psoriasis, psoriatic arthritis SE: injection site pn, creatine phos increase, URTI, activate latent TB risk, HA, rash, sinusitis **ask about TB- do PPD first! Interactions: avoid with live vaccines CI: active TB, severe infx

*Doxycycline

Tetracycline, bacteriostatic, broad spectrum ABX MOA: protein synthesis inhibitor, binds 30S and 50S ribosomes USe: RMSF, Chlamydia, Mycoplasma [TB, borrelia [Lyme] *acne, cholera, gonorrhea, syphilis in penicillin allergy *not for staph infx SE: teeth discoloration, black tongue, photosensitivity, NVD Interactions: reduced absorption with antacids, calcium, magnesium and iron [like cipro], decreased effects of penicillin CI: children <8 YO *pregnancy D, lactation severe hepatic dysfunction

*Pioglitazone

Thiazolidinedione, antihyperglycemic, PPAR-gamma agonist MOA: PPAR-gamma receptor agonist in adipose, skeletal muscle and liver, inc gene transcription, insulin sensitivity and glucose transporters, suppresses hepatic glucose output Use: DM2, 2nd line choice after Metformin SE: wt gain with fracture risk in upper hands, hands and feet in females Liver toxicity Fluid retention TG lower, but HDL and LDL inc. avoid in patients with heart failure and liver dz Interactions: drugs that interact with P450 [CYP3A4] can reduce effectiveness/increase toxicity CI: CHF, liver dz, Pregnancy C, insulin preferred for gestational diabetics

*Levothyroxine [Synthroid]

Thyroid hormone, tetraiodothyronine/T4 MOA: converted to T3 in peripheral tissues, binds nuclear receptors to increase metabolic rate, protein synthesis, gluconeogenesis, cell growth and differentiation, and CNS dev. Use: Hypothyroidism SE: insomnia, irritability, tachycardia, wt loss, "hyperthyroid sx" Interactions: bile acid sequestrants decrease absorption, estrogens can increase thyroid requirement CI: untreated subclinical or overt thyrotoxicosis, acute MI, uncorrected adrenal insufficiency.

*Liothyronine [Cytomel]

Thyroid supplement/T3 MOA: synthetic T3 increases BMR, utilization and mobilization of glycogen stores, promotes gluconeogenesis Use: Hypothyroidism, non-toxic goiter, myxedema SE: tachycardia, hypotension, MI Interactions: do not take with sodium iodide CI: acute MI, untreated adrenal insufficiency, caution in agina, CV dz, hypopituitarism, DM

PPD skin test

Tuberculin Purified Protein Derivative [of M tuberculosis] MOA: pt becomes sensitized to certain antigenic compounds of organism Use: dx of TB- inject 0.1 mL intradermally, result is read 48-72 hrs later. Positive result if 10 mm induration SE: pain, itch, discomfort at site, vesiculation, ulceration in sensitive patients CI: hypersensitivity

Zoster Vaccine

USES: Prevent Varicalla-Zoster AE: **Fever and injection site reactions. Short term risk of Zoster infection post vaccine. **Not recommended for seriously ill people, pregnant women, who are allergic to gelatin or neomycin, people on high doses of steroids, those in treatment for cancer with radiation or chemotherapy, and any who have received blood products or transfusions during the past five months. **HIV: May be used those who have normal blood counts and are currently receiving appropriate HIV treatment.

Phenazopyridine

Urinary analgesic [nonopioid] MOA: azo dye- analgesic effect in urinary tract Uses: cystitis prostatitis urethritis SE: GI disturbances HA rash hepatotoxicity hemolytic anemia, methemoglobinemia discoloration of urine and other body fluids crystal deposits in urine straining of contact lens Interactions: non specific CI: severe hepatitis renal impairment

Oxytocin (pitocin)

Uterine Stimulant, posterior pituitary hormone MOA: induces rhythmic uterine contraction proliferates oxytocin receptors to increase tone and amplitude of contractions at small doses Uses: postpartum hemorrhage, induction of labor, incomplete or inevitable abortion SE: fetus or neonate- jaundice, arrhythmias, bradycardia, brain/CNS damage, seizure, retinal hemorrhage, low Apgar score Mother-transient hypotension, reflex tachycardia, nasal irritation, rhinorrhea, lachrymation, uterine bleeding, violent contractions, hypertonicity, spasm, N/V Interactions: possible HTN if given 3-4 hrs coadministered with vasoconstrictors [caudal block anesthesia] Cyclopropane anaesthesia may inc risk of hypotension and maternal sinus bradycardia with abnormal AV rhythms concurrent use may inc vasopressor effect of sympathomimetics CI: cephalopelvic disproportion, abd presentation of fetus, hydramnio * previous C-section or other uterine surgery *hypertonic uterus, uterine rupture when vaginal delivery is contraindicated [invasive cervical cancer, active herpes, prolapsed cord, placenta previa or vasa previa] fetal distress pre-eclamptic toxemia **pregnant x grade in women who are or may become pregnant [prior to fetal expulsion]

*sumatriptan

Vascular HA suppressant , MOA: 5HT1 agonist- causes vasoconstriction of cranial arteries and or inhibition of neurogenic inflammatory processes in CNS. small delay in gastric emptying occurs USE: migraine HA, cluster HA SE: injection site rxn, paresthesia, dizziness, warm hot sensation Interaction: vasospastic reaction with ergotamine and related compounds, SSRIs, SNRIa, MAOIs CI: not for prophylactic use, MI, strokem hepatic impairment, IHD, uncontrolled HTN, PVD, **sulfa allergy

*HPV quadrivalent vaccine [Gardasil]

Viral Vaccine MOA: prepared from L1 protein of types 6, 11, 16, 18 Uses: prevention of diseases caused by above strains->precancerous or dysplastic lesion in girls and women 9-26 years SE: HA, fever, nausea, dizziness, local injection rxn tonic clonic movements, seizure like activity Interactions: immunosuppressants CI: <9 YO or >26 YO, severe allergic rxn to yeast [component of the vaccine]

**Terazosin

alpha 1 receptor adrenergic antagonist MOA: blocks adrenaline on smooth muscle of bladder and blood vessels walls. SE: dizziness, drowsiness, headache, constipation, loss of appetite, fatigue, nasal congestion, dry eyes. priapism, ED USE: used to treat BPH, and hypertension. Interaction: antihypertensive. CI: elderly, cataract surgery

*Testosterone

anabolic steroid MOA: T binds intracellular receptors in hepatocytes and skeletal muscle, converted to DHT which binds receptors in reproductive organs Use: primary hypogonadism [testicular dysfnx] secondary hypogonadism [hypothalamic/pituitary dysfunction] cachexia associated with HIV, CA SE: **Men priapism, impotence dec spermatogenesis, infertility [FSH, LH downregulation] gynecomastia [DHT shunt to E if pathway flooded] BPH, prostatitis inc. PSA **Women acne, facial hair, deep voice, hot flashes, male pattern baldness, menstrual changes **children abnormal sexual dev. premature closing of growth plate Interactions: **MANY!! CYP3A4, 2D6, 2C8, 2C9, 2C19 CI: unapproved to inc lean body mass, muscle, endurance in athletes before growth plate closure prostate CA *pregnancy polycythemia vera *caution in fluid retention, hyperlipidemia, hepatic/renal impairment, glucose intolerance

*DHEA [dehydroepiandrosterone]

anabolic steroid MOA: inc production of estrogens and testosterone; dec cortisol production; possible effect on neurotransmitters Use: Addisons; adrenal insufficiency, cognitive d/o [alzheimer's, depression], postmenopausal hot flashes/vaginal atrophy, SLE, immunostimulant, ED, reversing aging, wt loss SE: acne, hirsutism, insomnia, hair loss, aggression, voice deepening Interaction: monitor closely with amiodarone, atorvastatin, buspirone, cortisone, diazepam, warfarin CI: breast CA, endometriosis, hormone sensitive conditions, ovarian CA, Uterine CA, uterine fibroids

*Celecoxib

analgesic MOA: Cox-2 selective nonsteroidal anti-inflammatory drug [decreases prostaglandins without effects in GI tract, kidneys and platelets, which are COX-1 specific Use: OA, RA, dysmenorrhea, pain relief SE: HA, HTN, abd pain, diarrhea, nausea, URI Interaction: Avoid with CYP2C9 inhibitors- coadmin with fluconazole inc plasma concentrations. inc GI bleeding with steroids, anticoagulants or alcohol, NSAIDS. CI: aspirin allergy, chronic hepatitis, perioperative pain from coronary artery bypass graft surgery Pregnancy D and lactation

*Acetaminophen-OTC

analgesic, antipyretics [tylenol] "non anti-inflammatory" MOA: inhibit prostaglandin synthesis in CNS, blocks of pain impulses, fever reduction from vasodilation and increased peripheral blood flow in hypothalamus [clears heat and lowers body temp] Use: pain and fever alternative in patients with aspirin induced asthma, PUD, bleeding, gout, children for febrile viral infections [can't use aspirin- Reye's syndrome] SE: asthma, hypersensitivity [skin rxn], hepatotoxic**, acute renal necrosis in high doses- nephrotoxicity Interactions: 3 grams with alcohol can shut down liver function CI: renal, liver dz, with alcohol, do not exceed 4 grams daily

*tolterodine

anticholinergic, urinary antispasmodic MOA: competitive muscarinic receptor antagonist [similar actions to atropine]. Use: urinary incontinence, urgency, frequency *overactive bladder SE: dry mouth, chest pain, HA, fatigue, dry skin, abd pain, constipation, urinary retention, dry eyes [all sympathetic] Interactions: potent CYP3A4 inhibitors [macrolides, azole antifungals] CI: severe UC, toxic megacolon, urinary retention, gastric retention, MG, narrow angle glaucoma, pregnancy, BPH

*Pregabalin

anticonvulsant, analgesic MOA: unknown but GABA analogue binds to voltage gated calcium channels in CNS. interactions with descending noradrenergic and ST pathways from brain stem appear to reduce neuropathic pain transmission in spinal cord Use: chronic neuropathic pain, fibromyalgia, post herpetic neuralgia, adjunct of partial seizures SE: dizziness, somnolence, dry mouth, wt gain tremor, blurred vision Interactions: ACE inhibitors- may inc swelling and hives, CNS depressants CI: pregnancy C- not during lactation

Carbamazepine

anticonvulsant, antiseizure MOA: blocks sodium dependent channels to inhibit action potential firing, anticholinergic, central antidiuretic and antiarrhythmic, muscle relaxant and antidepressant [blocks NE release], sedative and neuromuscular blocking Use: mania, bipolar disorder, partial seizures, trigeminal neuralgia [blocks pain] SE: ataxia, dizziness, drowsiness, nausea and vomiting Interactions: reduces tolerance to alcohol, shortens half life of doxy, decreased efficacy of oral OCP CI: pregnancy D- causes neural tube defects, bone marrow depression, MAOIs

*buproprion

antidepressant, smoking cessation aid MOA: inhibits reuptake of DA, ST, NE SE: GI upset, agitation, anxiety, insomnia, psychosis, somnolence, seizures Use: Antidepressant and anti-smoking. reduces smoking withdrawal. [requires several weeks to kick in] Interactions: paroxetine, sertraline, fluoxetine, diazepam: increase of bupropion concentration. Reduced with carbamazepine, rifampicin, st. john's wart (CYP2b6 inducers) CI: Epilepsy, anorexia, alcohol/benzo use. MAOI's (2 week washout)

Insulin

antidiabetic, pancreatic hormone MOA: replaces endogenous insulin in diabetics Use: DM1, DM2 DM1- long acting plus pre meal and pre snack rapid insulin SE: hypoglycemia Interactions: beta blockers can mask signs of hypoglycemia and prolong recovery, thiazides and steroids can increase insulin requirements, alcohol, NSAIDS, sulfonylureas and warfarin can decrease insulin requirements CI: hypoglycemia Lispro/aspart insulin: Rapid, peak 1 hour, short acting 3-4 hours Regular: peak 2-3 hours, short acting 5-7 hours Glargine: slow onset, peak 12 hours; long acting- 24 hours

**Naloxone

antidote MOA: opioid antagonist Use: acute opioid OD, reducing respiratory or mental depression, preventing opioid abuse SE. little effect if opioids are not present, increased sweating nausea restlessness, trembling vomiting flushing and HA- rarely associated with heart rhythm changes, seizures and pulmonary edema Interactions: none significant CI: CVD, seizures, avoid excessive dose after use of opioids in surgery- may cause nausea vomiting, edema, tachycardia, sweating and may unmask pain

*Hydroxychloroquine

antimalarial, antirheumatic, anti-inflammatory, aminoquinoline MOA: 4-aminoquinoline similar action to chloroquine- interferes with digestive vacuole function with in malarial parasites by inc pH and interrupting lysosomal degradation of Hb thus impeding normal cell function of sensitive parasites USE: RA, SLE, prophylaxis of malaria, acute malaria- also porphyria tarda SE: retinopathy, photosensitivity, hair loss, myopathy, tinnitus, seizure, cardiomyopathy Interactions: digoxin, alcohol CI: retinal of vision changes, long term use in children

*interferon alpha and beta

antineoplastic, antiviral MOA: alpha interferons bind cell surface receptors, activate response cascade that culminates in expression of multiple interferon genes- block viral protein synthesis USE: INTERFERON ALPHA - chronic HBV, HCV, genital warts by pappillomavirus [HPV-conduloma acuminatum], tumors: leukemia, AIDS related KS, malignant melanoma INTERFERON BETA -MS [reduces exacerbations] SE: bone marrow suppression, flu like dx, neurotoxicity, autoimmune d/o, liver elevations, proteinuria, hypotension with tachycardia, alopecia CI: Zidovudine- enhance myelosuppression Autoimmune hepatitis, transplant recipients Infants Pregnancy category C

*Clopidogrel

antiplatelet drug MOA: antiplatelet agent- blocks ADP binding to platelet P2Y receptor- blocks formation of platelet plug SE: Headache, nausea, easy bruising, itching, heartburn. bleeding, purpura. Use: reduce risk of heart disease and stroke in high risk, with aspirin in heart attacks. best with smokers. Interaction: naproxen (Gastric bleeding. ) CI: active bleeding [PUD, intracranial hemorrhage] coagulation disorders

*Metronidazole

antiprotozoal, nitroimidazole MOA: converted to reduction products that destroy DNA structure leading to protein synthesis and cell death in susceptible organisms USE: anaerobic bacterial infections [bacteroides fragilis, clostridium difficile in pseudomembranous colitis and H pylori] Anaerobic protozoal infections: trichomonas, amoeba, giardia SE: neurotoxic, GI and GU irritation, N/V induced by alcohol **do not drink metallic taste in mouth Interactions: phenytoin, other antimicrobials CI: breastfeeding

*Rifampin

antitubercular agent, rifamycin derivative MOA: inhibits DNA dependent RNA polymerase USE: TB, leprosy, prophylaxis of meningococcal meningitis and H influenza type B SE: red discoloration of tears, urine, saliva and sweat Interactions: CYP inducer- may reduce levels of other drugs, can reduce birth control efficacy, phenytoin, warfarin, steroids, opioids, verapamil CI: live bacterial viruses, antivirals

Dextromethorphan

antitussive , levorphanol derivative MOA: central antagonist action on cough center in medulla Use: cough suppressant SE: dizziness, GI, hallucinations, fever, HTN, shallow breathing Interactions: Fluoxetine & Trazodone- associated w/ increased risk of ST syndrome MAOI- HTN crisis CI: risk for respiratory failure, acute attack, MAOI use or prior 2 weeks after d/c, persistent or chronic cough

*Oseltamivir

antiviral, neuraminidase inhibitor MOA: inhibits neuraminidase required for viral replication in influenza A and B, prevents release of virus from infected host cell Use: influenza A and B prevention, resistant to type A H1N1** effective for Type A H3N2 and Type B strains SE: nausea, vomiting, bronchitis, abd pn NO interactions CI: severe renal impairment, hypersensitivity

**Diazepam

anxiolytic, anticonvulsant, benzo MOA: long acting benzo- binds GABA enhances chloride permeability causing hyperpolarization Use: severe anxiety, insomnia with anxiety, muscle spasms, alcohol withdrawal, seizures, anesthesia IV, mania SE: drowsiness, dependence, impaired judgement, anterograde amnesia, suppression Interactions: increased clearance with anticonvulsants, may inc effectiveness of levodopa CI: MG, CNS depression, respiratory depression, sleep apnea, severe hepatic impairment, acute glaucoma children <6 months pregnancy D, lactation

*aripiprazole

atypical antipsychotic MOA: blocks 5HT2 and DA receptors in limbic system, decreasing response to excitation. Use: schizophrenia, Bipolar disorder, adjunctive in MDD, irritability associated with Autism Disorder SE: CNS- HA, anxiety, insomnia, suicidal thoughts, seizures GI- N/V/C Weight gain Interactions: CYP3A4, 2d6- caution in diabetics *grapefruit juice may increase drug level CI: severe CV dz, CVD, seizures, pregnancy C

Risperidone

atypical antipsychotic MOA: blocks 5HT2 and DA receptors in CNS Use: schizophrenia and other psychotic disorders SE: aggressive behavior, dizziness, extrapyramidal reactions, sleep disturbances, insomnia, sedation, constipation or diarrhea, wt gain, inc prolactin [blocks DA] Interactions: DA agonists CI: lactation, CT disease, pregnancy, renal or hepatic impairment, hypotension

**epoetin alfa

biological response modifier, recombinant human EPO MOA: stimulates differentiation and proliferation of erythroid precursors, release of reticulocytes into circulation and synthesis of cellular Hb thus regulation erythropoiesis Use: anemia SE: HTN, joint pain, migraine, flu symptoms. retinopathy, worse cancer Interaction: Lenalidomide (thrombosis), cyclosporin, ACE. CI: anything other than cancer and such- uncontrolled HTN, hypersensitivity to albumin

*Alendronate

bisphosphonate, bone resorption inhibitor MOA: binds hydroxyapatite crystals in bone, inhibits osteoclast activity, dec mineral release and collagen breakdown in bone Use: tx and prevention of osteoporosis in postmenopausal F, inc bone mass in men on OP, pagets dz of bone in men and women SE: *dyspepsia, GERD, hypocalcemia, hypophosphatemia, abd pn, msk pain Interactions: mineral water, coffee juice will interfere with bioavailability *take away from food and other meds- also must take in upright position 30 min away from food *long half life- stays in bone for 10 years CI: hypocalcemia, upper GI mucosal dz/irritation, renal dz, inability to stand or sit upright for 30 minutes

Oxymetazoline nasal spray

decongestant, nasal spray Imidazoline MOA: direct acting sympathomimetic- vasoconstrictor effect on mucosal blood vessels- reduces edema and vasoconstricts mucosal blood vessels Use: nasal congestion conjunctival decongestant as eye drop SE: local burning, sneezing, dryness in mouth/throat prolonged use by cause rebound congestion Ha, insomnia, tachycardia, HTN, nervousness, Nausea, dizziness, palpitations, arrhythmias dry eyes CI: glaucoma, hyperthyroidism, heart dz, HTN, arteriosclerotic conditions children <6 YO

*Prednisone

glucocorticoid MOA: synthetic corticosteroid for immune suppression , dec migration of PMNs and reversal of increased capillary permeability, suppresses adrenal function at high doses, reduces activity and volume of lymphatic system to reduce immune system SE: I'M THE HOPE iatrogenic cushing syndrome infections myopathy hypokalemia hypomania osteoporosis osteonecrosis of femoral and humeral heads peptic ulcers pancreatitis edema eye d/o [glaucoma, cataracts] Interaction: CYP3A4 GI ulcer with NSAIDS, decreased effect with barbiturates, phenytoin, salicylates and vaccines, ethanol may inc gastric irritation CI: serious infections [except TB and meningitis], varicella, systemic fungal infections

**Pentoxifylline

hematologic agent MOA: reduces blood viscosity by inc deformability of leukocytes and erythrocytes and decreasing neutrophil adhesion/activation. improves microcirculation and peripheral tissue. use in cerebrovascular disorders Use: peripheral vascular disease SE: NV, dizziness, HA, flushing, angina, palpitations, arrhythmias, hepatitis, jaundice, thrombocytopenia Interactions: cipro use may inc levels CI: sensitivity to xanthine products [caffeine, theophylline, theobromine]

*cyclosporine

immunosuppressant, polypeptide antibiotic Use: transplantation, psoriasis, RA SE: nephrotoxic, inc tramor, HTN HA, hyperlipidemia, gum hyperplasia, hirsutism Interaction: CCBs, antifungals, ABX, glucocorticoids, hypericum [CYP3A4 inhibitors] CI: lactation, nephrotoxic drugs

*Fluticasone

inhaled glucocorticoid receptor agonist MOA: anti-inflammatory, immunosuppressant Use: bronchospasm prevention in long term asthma patients, combined with salmeterol often maintenance of airways in COPD SE: can inc risk for respiratory/mouth infections, IOP, hypercortisolism *advised to rinse mouth after use Interactions CYP3A4, crosses placenta CI: for acute airways attacks, abrupt d/c, increased IOP [glaucoma], hypersensitivity

*lithium

mood stabilizer, antimanic agent MOA: dec neuronal response to ST and NE by decreasing cAMP and inositol triphosphate- monitor serum levels Use: MDD, bipolar affective disorder SE: constipation** and drowsiness polyuria, fatigue, impaired emory, acne, tremor muscle weakness, ECG changes, GI distress, hypothyroidism, leukocytosis Interaction: increased with diuretics (especially loop like furosemide and thiazides and NSAIDS. ACE. Sensitive to water and electrolyte balance. Serotonin syndrome with antidepressants.. Haloperidol, fluphenazine and flupenthixol = encephalopathy. CI: pregnancy, COPD, infants and young children with acute diarrhea, respiratory depression

*oxycodone

narcotic analgesic, opioid agonist MOA: opioid agonist SE: can get paradoxical pain sensitivity. addiction. Euphoria, cardiac depression, seizure, paralytic ileus, constipation, apnea Use: pain killer, moderate to severe Interaction: MAO, mifepristone, alprazolam, CI: Resp distress, GI obstruction, paralytic ileus, coma, circulatory shock, avoid abrupt withdrawal. Alcohol children <18 years old pregnancy D at high doses, lactation

*Buspirone

non benzo anxiolytic MOA: Not a benzo (not gaba agonist. ) Delayed action of 2 - 4 weeks to act. high affinity for serotonin 5-HT1A and 5-HT2 receptors. Moderate affinity for DA2 receptors **no GABA affinity Use: anxiolytic to treat GAD. SE: Dizziness, headaches, nausea, nervousness, paresthesia. **almost no risk for dependence unlike benzos Interactions: itraconazole, neladodone increased, rifampicin decreased, haloperidol increased. GRAPEFRUIT. CI: Hypersensitivity, metabolic acidosis, not with MAO inhibitors, renal dysfunction.

**Entecavir

nucleotide transcriptase inhibitor

**Morphine

opioid analgesic MOA: opioid agonist Use: moderate to severe pain, cough, analgesia during labor SE: pruritus, urinary retention, vomiting, constipation, HA, somnolence Interactions: serotonergic drugs, TCAs, QT prolongation, diuretics CI: respiratory depression- acute asthma, MAOIs, alcoholism

*Codeine

opioid analgesic, antitussive MOA: blocks ascending pain pathways by binding to opioid receptors in CNS, suppress cough by direct action in medulla Use: mild to moderate pain, cough suppressant, acute diarrhea SE: constipation, drowsiness, dependence, withdrawal symptoms, tachycardia/bradycardia, lightheadedness and weakness Interactions: alcohol, anaesthetics, anxiolytics, hypnotics, TCAs, antipsychotics, MAOIs CI: acute abd condition, diarrhea with toxins, respiratory depression, inflammatory bowel disease, respiratory impairment, acute asthma

Glucagon

polypeptide hormone MOA: increase glucose levels in the blood [gluconeogenesis, glycogenolysis] secondary to IV glucose administration Use: hypoglycemic emergency, parenterally administered 1mg/mL or less SE: N/V CI: hyperglycemia

Conjugated Estrogens

replacement hormone, antineoplastic, antiosteoporotic MOA: recplace endogenous estrogen, important for maintenance of female reproductive system, antiandrogenic effect Use: atrophic vaginitis, female hypogonadism, osteoporosis, prostate cancer, abnormal uterine bleeding, breast cancer palliation SE: abdominal pain, back pain, breast tenderness, HA, joint pain, diarrhea Interactions: CYP3A4 inhibitors [erythromycin, clarithromycin, grapefruit uice] *may inc plasma concentrations CI: angioedema, blood coagulation d/o, liver dz, DM with vascular involvement, undiagnosed abnormal vaginal bleeding

Melatonin

sedative MOA: hormone secreted by pineal gland, plays a key role in circadian rhythms- bings MT receptors for sedative effects Use: disturbed biorhythms, sleep disorders SE: increased seizure activity, drowsiness, HA, disruption of normal rhythms, may worsen in patients with depression Interactions: none CI: immunosuppressive tx

Zolpidem

sedative, hypnotic [nonbarbiturate] MOA: BZD benzo receptors [in cerebellum] of GABA complex- strong sedative actions, weak anxiolytic. rapid onset but short duration Use: insomnia- less side effects [yeah right..] SE: HA, dry mouth, allergy, back pain, flu like symptoms, chest pain, heart palpitations, drowsiness, dizziness. lethargy. sleepwalking, sleep driving, night eating hangover withdrawal USE: trouble sleeping. initiating sleep. Interaction: 1a2, 3a4, cns depression CI: alcohol, hepatic impairment, CNS use, alcohol, depression, respiratory isues, elderly, smoking, PKU allergy. Abrupt withdrawal.

**Octreotide

somatostatin analog MOA: inhibitory hormone from hypothalamus to suppress GH inhibits release of GH, TSH, insulin, glucagon and gastrin- decreases gastric emptying Use: carcinoid tumors Bleeding associated with esophageal varices- [cause vasoconstriction] GH secreting tumors [acromegaly] VIPomas *IM injection SE: abdominal flatulence, steatotthea, diarrhea, nausea

*Pregnenolone

steroid hormone Use: memory enhancement SE: poorly documented

*sulfamethoxazole/trimethoprim

sulfonamide, ABX, folate antagonist MOA: trimethoprim inhibits folate reduction; sulfamethoxazole inhibits folate synthesis USE: pneumocystis in AIDS pts URI- alternative to Beta lactam for acute OM, sinusitis caused by s pneumonia, moraxella, h influenza UTI and prostatitis from gram negative rods [proteus, e coli, enterobacter, klebsiella, serratia] GI infections [salmonella, shigella] Interactions: phenytoin, methotrexate further cause folate def. hypoglycemia effects, diuretic induced thrombocytopenia, warfarin inc risk of bleeding CI: severe renal, hepatic dz, folate def [megaloblastic anemia], sensitivity to sulfonamides *SLE *infants <2 mo G6PD def PREGNANCY D

Phentermine

sympathomimetic weight loss agent, appetite suppressant MOA: indirect sympathomimetic with alpha and beta receptor activity. stimulates cerebral cortex suppressing appetite Use: short term for obesity [moderate to severe] SE: rash, GI upset, sympathetic overdrive Interactions: TCAs, MAOIs, decreased excretion with antacids, carbonic anhydrase inhibitors [decrease bicarb] CI: HTN, hyperthyroid, CVD, glaucoma, drug/alcohol abuse, MAOI, lactation, pulm HTN, arteriosclerosis

*Albuterol (inhaled)

sympathomimetic, beta 2 adrenergic agonist MOA: selective B2 agonist causes bronchodilation, decreases uterine contractility, anti-asthmatic Use: acute bronchospasm COPD SE: muscle tremor [esp in hands]** HTN angina vomiting vertigo CNS stimulation taste changes dryness/irritation of oropharynx Interactions: diuretics steroids xanthines may augment hypokalemia CV effects potentiated by MOIs, TCAs, sympathomimetics reduces serum levels of digoxin inc absorption of sulfamethoxazole when used together CI: eclampsia, severe preeclampsia, intra-uterine infx/ fetal death, antepartum hemorrhage, placenta previa and cord compression, threatened miscarriage, cardiac dz, tachycardia

**Leuprolide

synthetic GnRH MOA: exogenous administration decreases downstream products through negative feedback Uses: E dominant illness- endometriosis, uterine fibroids, breast cancer Precocious puberty Prostate cancer SE: menopause andropause Interactions: Rx or botanicals that aim to increase sex hormones CI: pregnancy, abnormal V bleeding

*Triamcinolone

synthetic glucocorticoid *inhaled and topical MOA: potent glucocorticoid, longer acting, minimal to no mineralocorticoid activity- prevents inflammation by suppressing migration of PMNs and fibroblasts and reversing capillary permeability, suppress immune system Uses: anaphylactic allergies, asthma [need short acting beta blocker-albuterol to treat attack], topical skin conditions *allergic rhinitis *RA, MS, inflammation or allergic systemic conditions SE: same as all with more respiratory effects [URI, thrush, etc] Interactions: CYP3A4 CI: active respiratory infx, thin skin/skin infections, ITP, live or attenuated vaccines, immunosuppressive doses of steroids

*Dexamethasone

synthetic glucocorticoid agonist MOA: same as others, most CNS penetrance- longer acting and most synthetic; very minimal mineralocorticoid activity [least water retention] Use: antiemetic/anti fatigue during chemo chemotherapeutic for hematologic malignancies [b and t cell] reducing CNS inflammation [brain tumor] for the dx of Cushing's dz SE: thrush, bone loss, cataracts, weakness. Interaction: CYP3A4 interactions CI: infx, hypersensitivity, cerebral malaria, systemic fungal infx, live viral vaccine.

*Methylprednisolone

synthetic glucocorticoid receptor agonist *longer acting compared to prednisone/more synthetic MOA: synthetic [methyl group added]; glucocorticoid receptor agonist *also called medroxy dose pack for acute flare ups Use: often IM, intra articular injections for RA, autoimmune conditions. given over the course of a week [high dose and then wean off] SE: same as all steroids Interactions: CYP3A4 interactions

*fluconazole

systemic antifungal, Triazole MOA: dec ergosterol synthesis, blocking cell membrane formation USE: systemic candida, bone marrow transplant prophylaxis, cryptococcal meningitis, candida UTI, candidal balanitis SE: HA most common, NVD, flatulence Interactions: hypoglycemics, warfarin, phenytoin, myelosuppressive agents, thiazides CI: hepatic dz, pregnancy C, D

*Mupirocin

topical antibiotic MOA: protein synthesis inhibitor, blocks isoleucyl transfer RNA synthetase USE: active against gram positive and some gram negative impetigo [staph, strep], infected traumatic skin lesions SE: burning, stinging, itching, erythema, dryness, tenderness, dermatitis, rash Interactions: none CI: caution in burn patients- potentially toxic amounts of PEG contained in vehicle may be absorbed with extensive skin damage/absorption

*Naltrexone

toxicology antidote agent, opioid antagonist MOA: competitive antagonist at opioid receptor sites. blocks action of opioids and precipitated withdrawal sx in opioid dependent patients Use: opioid dependence, adjunct in alcohol dependence SE: injection site rxn, nausea, HA, dec appetite, insomnia, vomiting, dizziness, arthralgia, pharyngitis, URI, diarrhea, anxiety Interactions: reduce effects of opioids preps used for cough suppression CI: patients concurrently dependent on opioids, acute hepatitis or hepatic failure, acute opioid withdrawal, patients on therapeutic opioid analgesics

*Amitriptyline

tricyclic antidepressant MOA: NE and ST reuptake inhibitor, blocks muscarinic and alpha adrenergic receptors USe: mood depression, chronic pain SE: lethargy, anticholinergic effects [sympathetic], orthostatic hypotension, wt gain, wide QRS complex with OD, V tach Interactions: 2 weeks away from MOAIs, SSRI inhibitors- 5 weeks away from, clonidine may cause hypertensive crisis CI: severe CVD, recent MI, atherosclerosis, Hyperthyroid