Medications Use/Consideration

Anesthetics
Amide  LA's  ('I'  in  the  name) metabolized  in  Liver
Ester  LA's  (no  'I') metabolized  by  plasma

Cardiac
Quinidine superventricular  tachyarrhythmias,  atrial  fibrillation,  increase  refractory
Verapamil atrial  fibrillation,  increase  refract.
Phenytoin reverse  digitalis  induced  arrhythmias,  increase  refract,  trigimenal  neuro  tx
Digitalis atrial  fibrillation,  paroxysmal  tachycardia,  CHF,  increase  contraction
Methyldopa central  acting  adrenergic,  cardiac  
Clonidine central  acting  adrenergic,  cardiac
Metroprolol beta-­‐blocker,  cardioselective-­‐(A-­‐M  names)    
Atenolol beta-­‐blocker,  cardioselective-­‐(A-­‐M  names)
Chlorothiazide mild  HTN
Guanethidine severe  HTN
Nitroglycerin angina,  vasodilates  on  smooth  muscles,  cardiac
Captopril ACE  inhibitor,  inhibits  angiotensin-­‐converting  enzyme,  cardiac
Angiotensin increases  BP,  cardiac
Digoxin cardiac  glycoside  for  CHF,  inotropic  action  on  Ca+,  cardiac
Prazosin adrenergic,  inhibit  action  of  nor-­‐epi,  cardiac
Propanolol  (Inderal) prolongs  Lido  presence,  paroxysmal  tachycardia,  agina,  blocks  renin  release  and  nor-­‐epi

Antibiotics
Dicloxacillin for  penicillinase  infections
Ampicillin best  gram  (-­‐)  spectrum,  cross-­‐link  pen  allergy
Erythromycin if  Penicillin  allergy,  estolate  form  =  allergic  hepatitis,  don't  use  with  Seldane
Cephalosporin cross-­‐linked  Pen  allergy
Carbenicillin treats  Pseudomonas/Proteus  species  infections
Penicillin inhibits  cell-­‐wall  synthesis
Tetracycline inhibits  protein  synthesis,  good  for  sulcular  infections,  pg  10  #34,  chelates  Ca+
Sulfonamides competition  in  folic  acid  synthesis
Clyndamycin treats  bone  infections  well,  used  for  Pen  allergy,  cause  colitis  C.  dif
Chloramphenicol Aplastic  Anemia
Acyclovir treating  herpes  simplex
Chlortetracycline broadest  spectrum  (tetracycline)
Trimethoprim similar  to  sulfonamides,  interfere  with  folinic  acid  production
Gentamycin can  cause  deafness

Fungal
Nystatin prototypic  antifungal  agent

NSAIDs
Aspirin  (salicylate) inhibits  prostagladin  synthesis,  destroys  platelets,  antipyretic
Ibuprofen easier  on  the  GI,  
Diflusinal  (Dolobid) longest  half-­‐life
Indomethacin GI  distress

Analgesics
Acetaminophen hepatic  necrosis,  non  anti-­‐inflamatory,  can  cause  Reye's  Synd,
Pentazocine MAA  (mixed  agonist/antagonist)
Nalbuphine  (Nubain) MAA  (mixed  agonist/antagonist)
Methadone treatment  for  detoxification  of  morphine,  less  intense  withdraw
Morphine respiratory  depression,  euphoria,  sedation,  dysphoria,  analgesia,  constipation
Codeine cough  suppressant,  
Meperidine  (Demerol) opioid  analgesic,  

*Opioids  (general) rely  on  loss  of  medullary  sensitivity  to  CO2  which  depresses  resp,  miosis,  overdose  causes  
coma  

Cholinergics  (rest/digest) SLUD=  increased  salavation,  lacramation,  defecation,  urination

Physostigmine rev  anticholinesterases  both  central  and  periphery  (reversible)
Neostigmine  (Prostigmine) rev  anticholinesterases  only  periphery,  inhibits  Ach-­‐esterase  (reversible),  indirectly/direct
Pilocarpine direct  acting  cholinergic  agonist
Methaacholine direct  acting  cholinergic  agonist
Pralidoxime chemical  antidote  to  regenerate  AchE  from  nerve  gas/insecticide  exposure
Organophosphates  (insecticide) inhibit  Ach-­‐esterase  (irreversible,  too  much  SLUD=  death)  
Mecamylamine ganglionic  blocking  agent
Succinylcholine  (Anectine) prevent  laryngospasm,  neuromuscular  junction  blocker
d-­‐tubocurarine

Anti-­‐Cholinergic
Atropine decrease  saliva,  blocks  vagal  control  of  heart  rate=  tachycardia,  used  for  cholin.  crisis
Scopolamine motion  sickness,  blocks  AchE  action,  decrease  saliva
Propantheline muscarinic  blocker  in  periphery,  decrease  saliva
Methantheline synthetic  Atropine

Overdose  Meds
Naloxone antagonist  for  overdose,  blocks  opioid  receptor
Flumazenil benzodiazepines
Physostigmine for  scopolamine  OD
Pralidoxime nerve  gas/insecticide  exposure
Prazone epinephrine  reversal  

Adrenergics
Guanethidine inhibit  catecholamine  release
Reserpine inhibits  reuptake  of  nor-­‐epi,  indirect  sympatholytic  (old  drug)
Methyldopa false  transmitter  and  works  on  central  nuclei,  for  HTN
Levodopa tx  for  Parkinson's,  causes:  arryth,  psychosis,  nausea,  invol  movement
Carbidopa block  decarboxylase    which  metabolises  levodopa
Clonidine works  at  central  nucleim,  for  HTN
Amphetamine rapid  release  of  the  mediator
Phentolamine non-­‐specific  alpha  blocker
Albuterol beta  2  agonist

Benzodiazepines work  on  GABA,  increase  saliva/bronchial  secretions,  sedatives,  anti-­‐anxiety

Diazepam  (Valium) status  epilepticus,  anxiety,  mild  sedative,  Lido  toxicity,  causes  thrombophlebitis,  
Midazolam  (Versed) rapid  onset,  short-­‐acting,  no  phlebitis
Oxazepam short-­‐acting
Lorazepam short-­‐acting
(endings  -­‐am)

Barbituates non-­‐analgesics,  may  increase  pain,  respiratory  depressants

Thiopental short  onset/acting,  can  cause  laryngospasm
Phenobarbital   long-­‐acting

Physcopharmacology
Antipsychotics blockade  of  dopaminergic  site  in  brain,  side  effects:  anticholin.  and  tardive  dyskinesia
Haldol  (1st  gen) D2  blocker
Phenothiazine tardive  dyskinesia
Chlorpromazine
Clozapine  (2nd  gen) block  dopamine  and  serotonin  receptors  (fewer  side  effects)

Antidepressants block  amine  reuptake  and  seretonin  reuptake,  side  effects:  atropine,  anticholin.
Imipramine
Amitriptyline
Tranylcypromine MAO  inhibitors
Phenylene MAO  inhibitors
Fluoxetine  (Prozac,  2nd  gen) SSRIs
Trazodone  (2nd  gen) SSRIs
Lithium manic  phase  psychosis  (bipolar)

Anti-­‐inflammatory   corticosteriods/gulcocorticoids  side  effects:  immunosuppressant,  ulcers,  adrenal  insuff.,  

hyperglycemia,  osteoporosis
 Contraindicated  pt's AIDS,  Candidiasis,  TB,  Peptic  Ulcers
Hydrocortisone glucocorticosteroid,  suppress  imflammatory  response
Adrenal  Steroids corticosteroid,  cause  gastric  ulcers

General  Anesthetics more  soluble  in  blood-­‐-­‐>more  must  be  given  (rate  of  induction)
4  stages  of  anesthesia:  1)  analgesia  2)  delirium  3)  surgical  anes.  4)  medullary  paralysis
Halothane  (Fluothane) halogenated  hydrocarbon,  hepatoxicity,  inhaled,  liver  damage,  increases  salivation
Chloroform halogenated  hydrocarbon,  liver  damage

Antihistamines H1  and  H2  antihistamines-­‐  H1:  competitive  antagonism(histamine  blockers)

Chlorpheniramine  (Chlor-­‐Tri) H1  antihistamine,  dermatologic  allergic  response,  cold  treatment
Promethazine  (Phenergan) H1  antihistamine,    preop  med  for  sedation,  antiemetic,  anticholin.  
Diphenhydramine  (Benadryl) H1  antihistamine,  parkinsonism,  anticholinergic
Cimetidine  (Tagament) H2  antihistiamine,  inhibit  gastric  secretions/heartburn  
Cyclizine motion  sickness
Dimenhydrinate motion  sickness
Meclizine vertigo

General  Info
Epinephrine cause  cardiac  arrrythmia,  vasoconstriction  at  site
Alcohol removal  of  inhibitory  activity  of  cortex
Sulfonyl  ureas direct  stimuli  of  beta  cells  to  secrete  insulin,  beta  agonist