Drug Mechanism of Action
Hydrocodone/acetaminophen Hydrocodone - Binds,
(Vicodin, Lortab, Norco) activates mu-opioid
receptor, Acetaminophen
– suspected to inhibit
prostaglandin synthesis
which reduces pain
Lisinopril (Prinivil) Inhibits angiotensin
converting enzyme which
ultimately leads to
reduction in angiotensin 2
(a potent vasoconstrictor)
Simvastatin (Zocor) Inhibits HMG-CoA
reductase – this enzyme is
the rate limiting step in
cholesterol formation
Levothyroxine (Synthroid) Synthetic form of thyroid
hormone (T4)
Amoxicillin (Amoxil) Inhibits penicillin binding
protein which prevents
cell wall synthesis
Azithromycin (Zithromax) Binds 50s ribosomal
subunit and prevents
protein synthesis
Hydrochlorothiazide Blocks sodium
(HCTZ);(Microzide) reabsorption in the distal
convoluted tubule of
kidney
Amlodipine (Norvasc) Blocks the entry of
calcium into smooth
muscle, causing
vasodilation
3 Highly Testable Pearls
• Addiction/dependence risk
• Respiratory depression
• Constipation
• Cough
• Hyperkalemia
• Used to help protect the kidneys in
diabetes
• Myopathy
• Reduces risk of heart attack/stroke
• Dosed at night
• Binding interactions with calcium
and iron can lower concentrations
• TSH is monitored to adjust dose
• Signs of hypothyroid –
fatigue, dry skin,
constipation
• Diarrhea
• Nausea/Vomiting
• Rash
• Longer half-life than many
antibiotics
• GI adverse effects
• Rare risk for QTc prolongation
• Frequent urination
• Elevate uric acid level (exacerbate
gout)
• Can help with edema and
hypertension
• Edema
• No action on the heart (compared to
diltiazem, verapamil)

Alprazolam (Xanax) Enhances GABA activity
which has sedative,
hypnotic, anticonvulsant,
and muscle relaxant
properties
Metformin (Glucophage) Primarily decreases
hepatic glucose
production
Atorvastatin (Lipitor) Inhibits HMG-CoA
reductase – this enzyme is
the rate limiting step in
cholesterol formation
Omeprazole (Prilosec) Inhibits H+/K+ ATPase
pump in gastric parietal
cells (reduces hydrogen
ion – stomach acid
concentration in stomach)
Amoxicillin/Clavulanate Amoxicillin – see agent;
(Augmentin) clavulanate – inhibits
beta-lactamase which is
produced by bacteria to
break down beta lactam
antibiotics
Atenolol (Tenormin) Blocks beta-1 receptors
(found primarily in the
heart); prevents activity of
sympathetic nervous
system leading to
reduction in heart rate
and BP
• Used to help prevent angina
• Used for acute
management of anxiety
• Dizziness/sedation
• Generally avoid in elderly
• Avoid in moderate to severe
kidney disease, rare risk of
lactic acidosis
• GI side effects like diarrhea
is most prominent
• First line agent in type 2
diabetes
• Myopathy
• Reduces risk of heart
attack/stroke
• Higher intensity statin
• Short term only
recommended for GERD
• Associated with low
magnesium and B12
• Most potent acid blocking
medication
class
• Diarrhea
• Nausea/vomiting
• Rash
• Pulse monitoring
• Can blunt beta-agonist activity
(potentially exacerbate asthma,
COPD)
• Can block signs of
hypoglycemia
(exception sweating)
Furosemide (Lasix) Blocks reabsorption of
sodium, chloride and
water from the ascending
limb of the loop of Henle
– increases urine output
Metoprolol (Lopressor) Blocks beta-1 receptors
(found primarily in the
heart); prevents activity of
sympathetic nervous
system leading to
reduction in heart rate
and BP
Sertraline (Zoloft) Inhibits reuptake of
serotonin which leads to
higher concentrations in
the synapse
Zolpidem (Ambien) Enhances GABA activity
which has sedative,
hypnotic effects
Oxycodone/APAP (Percocet) Oxycodone - Binds,
activates mu-opioid
receptor, Acetaminophen
– suspected to inhibit
prostaglandin synthesis
which reduces pain
Esomeprazole (Nexium) Inhibits H+/K+ ATPase
pump in gastric parietal
cells (reduces hydrogen
ion – stomach acid
concentration in stomach)
Clopidogrel (Plavix) Blocks binding of ADP to
the P2Y12 receptor; by
• Hypokalemia
• Frequent urination
• Can lead to
dehydration (rising
creatinine)
• Pulse monitoring
• Can blunt beta-agonist
activity (potentially
exacerbate asthma,
COPD)
• Block signs of
hypoglycemia
(exception sweating)
• Takes a significant
amount of time to
work (usually weeks)
• GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
• Used for insomnia
only
• Dizziness/sedation
• Generally avoid in
elderly
• Addiction/dependence
risk
• Respiratory
depression
• Constipation
• Short term only
recommended for
GERD
• Associated with low
magnesium and B12
• Most potent acid
blocking medication
class
• Prodrug – converted
to its active
 doing this, it prevents metabolite by
platelet aggregation CYP2C19
• Bleed risk
• Often used in
combination with
aspirin following
stenting
Montelukast (Singulair) Blocks leukotriene • Used in asthma and
receptors in the lungs allergies
which reduces • Not a rescue
bronchoconstriction and medication
inflammation • Rare reports of
psychiatric adverse
events
Prednisone (Sterapred) Multiple possible • Suppression of HPA
pathways of reducing axis
inflammation and • Increases blood
suppressing the immune sugars, causes
system (inhibition of insomnia and GI upset
cytokines, chemokines, • Increases risk of
arachidonic acid etc.) osteoporosis
Escitalopram (Lexapro) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Ibuprofen (Advil) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Citalopram (Celexa) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • QTc prolongation risk
(higher doses, elderly
more susceptible)
 • Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Albuterol (ProAir) Beta-2 adrenergic • Tremor
receptor agonist – relaxes • Tachycardia
bronchial smooth muscle • Usual drug of choice
and opens airways for acute relief of
respiratory symptoms
Fluoxetine (Prozac) Inhibits reuptake of • Takes a significant
serotonin which leads to amount of time to
higher concentrations in work (usually weeks)
the synapse • GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
Gabapentin (Neurontin) Not well understood – • Dizziness
possible action on voltage • Sedation
sensitive calcium channels • Can accumulate in
renal disease
Warfarin (Coumadin) Inhibits vitamin K • Bleed risk
dependent production of • Routine INR
clotting factors 2, 7, 9, monitoring require
and 10 (most often goal is 2-3
with a few exceptions)
• Tons of drug
interactions
(metronidazole,
amiodarone, Bactrim
etc.)
Tramadol (Ultram) Binds, activates mu-opioid • Increases seizure risk
receptors leading to • Sedation
analgesic effects • Risk of dependence
and addiction
Clonazepam (Klonopin) Enhances GABA activity • Used for acute
which has sedative, management of
hypnotic, anticonvulsant, anxiety
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly
Lorazepam (Ativan) Enhances GABA activity
which has sedative,
hypnotic, anticonvulsant,
and muscle relaxant
properties
Cephalexin (Keflex) Inhibits penicillin binding
protein which prevents
bacterial cell wall
synthesis
Cyclobenzaprine (Flexeril) Not well understood –
skeletal muscle relaxant
possibly gamma and alpha
motor system effects
Sulfamethoxazole/trimethoprim Sulfamethoxazole –
(Bactrim, Septra) interferes with bacterial
folate synthesis;
trimethoprim blocks
production of
tetrahydrofolic acid in
bacteria by binding
dihydrofolate reductase
Ciprofloxacin (Cipro) Inhibits DNA gyrase in
bacteria which prevents
DNA separation and cell
division
Fluticasone (Flonase) Stimulates glucocorticoid
receptors which leads to
reduced inflammation
Triamterene/HCTZ (Dyazide) Triamterene – blocks
epithelial sodium
channels, causing a
• Used for acute
management of
anxiety
• Dizziness/sedation
• Generally avoid in
elderly
• Diarrhea
• Nausea/Vomiting
• Primarily gram +
bacteria coverage
• Sedating
• Anticholinergic
potential (i.e. dry
mouth, confusion,
etc.)
• Not well tolerated in
the elderly
• Significant interaction
with warfarin
• Beware of patients
with a sulfa allergy –
should not take this
medication
• Take with full glass of
water
• Risk of spontaneous
tendonitis or tendon
rupture
• Dose adjustments
with poor kidney
function
• Binding interaction
with iron and calcium
can reduce absorption
• May work a little
better if taken
routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
• Elevated K+ possible
with triamterene
• Lowers blood pressure
 diuretic type effect in the
kidney
Pravastatin (Pravachol) Inhibits HMG-CoA
reductase – this enzyme is
the rate limiting step in
cholesterol formation
Rosuvastatin (Crestor) Inhibits HMG-CoA
reductase – this enzyme is
the rate limiting step in
cholesterol formation
Fluticasone + salmeterol Corticosteroid combined
(Advair) with long acting beta
agonist – steroid works on
inflammation and
salmeterol opens up the
airway
Trazodone (Desyrel) Possible serotonin type
activity, not well
understood; histamine
blockade may be
responsible for sedative
effect
Alendronate (Fosamax) Inhibits resorption of
bone by osteoclasts
Fexofenadine (Allegra) Selective H1 receptor
antagonist which leads to
relief of allergy symptoms
• In combo with HCTZ
can help even out
potassium levels as
HCTZ lowers levels
• Myopathy
• Reduces risk of heart
attack/stroke
• If patients can’t
tolerate simvastatin or
atorvastatin, this one
is often tried
• Myopathy
• Reduces risk of heart
attack/stroke
• Higher intensity statin
• Rinse mouth following
use of steroid
(Reduces thrush risk)
• Controller medication,
not for rescue
• Beta agonist effects –
increased heart rate,
tremor
• Dry mouth
• Most often used for
sleep, rarely used for
straight depression
• Possibly a little safer in
elderly than Z-drugs
like Zolpidem
• Extremely long half life
• Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use
• Sedation
• Dry mouth
• Once daily dosing
Lovastatin (Mevacor) Inhibits HMG-CoA
reductase – this enzyme is
the rate limiting step in
cholesterol formation
Carvedilol (Coreg) Blocks beta-1 receptors
(found primarily in the
heart); prevents activity of
sympathetic nervous
system leading to
reduction in heart rate
and BP; has some alpha
blockade as well
Paroxetine (Paxil) Inhibits reuptake of
serotonin which leads to
higher concentrations in
the synapse
Meloxicam (Mobic) Non-selective inhibitor of
cyclooxygenase (COX) –
which ultimately reduces
the production of
prostaglandins which are
involved in
pain/inflammation
Diazepam (Valium) Enhances GABA activity
which has sedative,
hypnotic, anticonvulsant,
and muscle relaxant
properties
Valsartan (Diovan) Angiotensin receptor
blocker – prevents the
activity of angiotensin
which is a vasoconstrictor
• Myopathy
• Reduces risk of heart
attack/stroke
• Risk of rhabdomyolysis
(Associated with all
statins)
• Pulse monitoring
• Can blunt beta-agonist
activity (potentially
exacerbate asthma,
COPD)
• Can block signs of
hypoglycemia
(exception sweating)
• Takes a significant
amount of time to
work (usually weeks)
• GI side effects
• Serotonin syndrome
risk (Elevated
temperature, BP,
Heart rate)
• Increase GI Bleed risk;
take with food
• Exacerbates
CHF/edema
• Inhibits platelet
activity
• Used for acute
management of
anxiety/seizure
• Dizziness/sedation
• Generally avoid in
elderly
• Hyperkalemia
• Alternate to ACE
Inhibitor
• Less incidence of
cough compared to
ACE inhibitors
Duloxetine (Cymbalta) Serotonin and • More beneficial for
Norepinephrine reuptake pain than SSRI’s
inhibitor which increases (Neuropathy)
concentrations of both in • Possible increase in
the brain synapses hypertension at high
doses
• GI side effects,
serotonin syndrome
risk
Venlafaxine (Effexor) Serotonin and • More beneficial for
Norepinephrine reuptake pain than SSRI’s
inhibitor which increases (Neuropathy)
concentrations of both in • Possible increase in
the brain synapses hypertension at high
doses
• GI side effects,
serotonin syndrome
risk
Ranitidine (Zantac) Histamine 2 Receptor • Slightly less potent
Antagonist which reduces than the PPI’s
gastric acid secretion • Can accumulate in
leading to relief of kidney disease
heartburn and GI • Tend to work a little
symptoms quicker than the PPI’s
Fluconazole (Diflucan) Inhibits fungal • 3A4 drug interactions
cytochrome P450 enzyme (amiodarone,
14alpha-demthylase phenytoin, warfarin,
etc.)
• GI upset
• Liver concerns
Naproxen (Aleve) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Doxycycline (Vibramycin) Inhibits bacterial protein • Increases sensitivity to
synthesis by binding to sunburn
the 30s ribosomal subunit • Binding interactions
with calcium and iron
• Avoid in pregnancy
Potassium (Klor-Con)
Amitriptyline (Elavil)
Lansoprazole (Prevacid)
Pioglitazone (Actos)
Methylprednisolone (Medrol)
Potassium replacement • Often used for
patients on diuretics
that deplete
potassium
• GI upset
• Often patient do have
trouble swallowing
larger doses (big pills)
– some forms can be
dissolved in water
Inhibits norepinephrine • Highly anticholinergic
and serotonin reuptake, (sedation, confusion,
leading to increased dry eye, etc.)
concentrations in the • Can be used for pain
synapse syndromes (migraines,
fibromyalgia, etc.)
• Higher risk of cardiac
concerns in overdose
compared to SSRI’s so
less often used for
depression
Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class
Decreases insulin • Weight gain
resistance in the • Edema
periphery; leading to • Generally avoid in CHF
greater uptake of glucose patients
into muscle tissue and
lower blood sugar
Multiple possible • Suppression of HPA
pathways of reducing axis
inflammation and • Increases blood
suppressing the immune sugars, causes
system (inhibition of insomnia and GI upset
cytokines, chemokines, • Increases risk of
arachidonic acid etc.) osteoporosis
Allopurinol (Zyloprim)
Codeine + APAP (Tylenol #3)
Enalapril (Vasotec)
Carisoprodol (Soma)
Tamsulosin (Flomax)
Ezetimibe (Zetia)
Quetiapine (Seroquel)
Inhibition of xanthine • Not meant for acute
oxidase which results in gout flares
less production of uric • Rash
acid and lower levels • Can accumulate in
kidney disease
codeine - Binds, activates • Addiction/dependence
mu-opioid receptor, risk
Acetaminophen – • Respiratory
suspected to inhibit depression
prostaglandin synthesis • Constipation
which reduces pain
Inhibits angiotensin • Cough
converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Not well understood, • Sedation
potential effects at GABA • Controlled substance
receptors • Dizziness
Blocks alpha-1a receptors • Dizziness, low blood
which causes smooth pressure
muscle relaxation of the • Work fairly quickly
bladder neck and prostate compared to 5 alpha
reductase inhibitors
• Rare risk of floppy iris
syndrome in patients
having eye surgery
Inhibits intestinal • GI upset
absorption of cholesterol • Not great evidence
leading to lower levels that indicates it
reduces the risk of
heart attack and
stroke
• 2nd or third line agent
for lowering
cholesterol (statins are
drug of choice)
Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms

Levofloxacin (Levaquin)
Fenofibrate (Tricor)
Clonidine (Catapres)
Promethazine (Phenergan)
Ethinyl estradiol + Drosperinone Oral contraceptive –
(Yaz)
Sildenafil (Viagra)
Inhibits DNA gyrase in
bacteria which prevents
DNA separation and cell
division
Activates lipoprotein
lipase and reduces
synthesis of apoprotein C-
3; both of these
mechanisms work to
lower cholesterol
Stimulates centrally acting
alpha-2 receptors causing
reduced sympathetic
outflow which lowers BP
and pulse
Possible anticholinergic
(blocks acetylcholine) and
antihistamine effects, also
may mildly block
dopamine receptors
estrogen prevents
ovulation and reduces risk
of pregnancy
Inhibition of
phosphodiesterace-5
(PDE-5) causes smooth
muscle relaxation and
increased blood flow to
the penis
• Metabolic syndrome
and QTc prolongation
risk
• Risk of spontaneous
tendonitis or tendon
rupture
• Dose adjustments
with poor kidney
function
• Binding interaction
with iron and calcium
can reduce absorption
• Target for elevated
triglycerides, SE =
myopathy
• Statins reserved for
cardiovascular risk
reduction and LDL
lowering
• Elevated triglycerides
increase risk of
pancreatitis
• Dry mouth
• Dizziness, CNS changes
• Generally avoided in
the elderly
• Used for motion
sickness, nausea and
vomiting
• Sedating
• Anticholinergic side
effects
• DVT/PE
• Hypertension
• Headache/GI
symptoms
• Low blood pressure
• Rare vision adverse
effect
• Avoid using with
nitrates
Celecoxib (Celebrex)
Loratadine (Claritin)
Oxycodone (OxyContin)
Glargine (Lantus, Basaglar)
Mometasone (Nasonex)
Pregabalin (Lyrica)
Amaryl (Glimepiride)
Temazepam (Restoril)
Selective inhibition of • GI side effects
COX-2 leads to reduced generally less than
formation of arachidonic traditional NSAIDs
acid and prostaglandins • Edema risk
• Kidney risk still the
same as traditional
NSAIDs
Selective H1 receptor • Sedation
antagonist which leads to • Dry mouth
relief of allergy symptoms • Once daily dosing
Oxycodone - Binds, • Addiction/dependence
activates mu-opioid risk
receptor • Respiratory
depression
• Constipation
Long acting insulin analog • Weight gain
• Hypoglycemia risk
• Dose once daily and
targets fasting blood
sugars
Stimulates glucocorticoid • May work a little
receptors which leads to better if taken
reduced inflammation routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
Not well known; • Sedation
suspected that it might • Dizziness
bind the alpha2-delta • Weight gain
subunits leading to a
reduction in neuronal
excitability
Stimulates pancreatic • Weight gain
beta cells to release • Hypoglycemia
insulin • Inexpensive
Enhances GABA activity • Shorter half-life than
which has sedative, others, so may see this
hypnotic, anticonvulsant, one used for sleep
and muscle relaxant • Dizziness/sedation
properties • Generally avoid in
elderly
Conjugated Estrogen (Premarin) Replacement estrogen in
Folic acid (Folvite)
Spironolactone (Aldactone)
Digoxin (Lanoxin)
Isosorbide Mononitrate (Imdur)
Cefdinir (Omnicef)
Ramipril (Altace)
postmenopausal women
who experience
symptoms like hot flashes,
vaginal dryness, etc.
Supplement of folic acid
Aldosterone antagonist
that blocks the effects of
aldosterone, leading to
lower blood pressure and
a diuretic effect
Inhibits sodium,
potassium ATPase leading
to an increase in the force
of contraction of the heart
Increase in nitric oxide
leads to venous and
arterial dilation
Inhibits penicillin binding
protein which prevents
bacterial cell wall
synthesis
Inhibits angiotensin
converting enzyme which
• DVT/PE
• Hypertension
• Increased risk of
breast cancer
• Tolerability is usually
fine
• Given with
methotrexate for
RA/psoriasis etc.
• Deficiency can lead to
anemia
• Hyperkalemia
• Gynecomastia (Man-
boobs)
• Monitor kidney
function
• Used in atrial
fibrillation or CHF
• Toxicity signs include
GI, CNS changes, visual
changes, and weight
loss
• Can accumulate in
kidney disease and
cause more toxicity
with low potassium
levels
• Headache
• Dizziness
• Can become tolerate
to effects, usually
recommended to have
a nitrate free period
during the day
• Diarrhea
• Nausea/Vomiting
• broader spectrum
coverage than
cephalexin
• Cough
• Hyperkalemia
 ultimately leads to
reduction in angiotensin 2
(a potent vasoconstrictor)
Triamcinolone (Nasacort) Stimulates glucocorticoid
receptors which leads to
reduced inflammation
Losartan (Cozaar) Angiotensin receptor
blocker – prevents the
activity of angiotensin
which is a vasoconstrictor
Methylphenidate (Concerta) Prevents catecholamine
reuptake in CNS synapses
leading to increased
dopamine and
norepinephrine
Glyburide (Diabeta) Stimulates pancreatic
beta cells to release
insulin
Valacyclovir (Valtrex) Inhibits DNA Polymerase
which prevent viral
replication
Oseltamivir (Tamiflu) Inhibits influenza virus
neuraminidase, which
likely alters replication or
release of budding viruses
Tiotropium (Spiriva) Long acting
antimuscarinic
(anticholinergic) that
binds to M3 receptors
which relaxes smooth
muscle leading to
bronchodilation
• Used to help protect
the kidneys in
diabetes
• May work a little
better if taken
routinely
• Nose bleeding,
irritation
• Used in allergic rhinitis
• Hyperkalemia
• Alternate to ACE
Inhibitor
• Less incidence of
cough compared to
ACE inhibitors
• Weight loss
• Insomnia
• Anxiety, tachycardia,
and increased BP
• Weight gain
• Hypoglycemia
• Inexpensive
• Treatment of herpes
and varicella viruses
• GI upset
• Prodrug; converted to
acyclovir
• GI side effects
• Dose adjusted based
on kidney function
• Used in treatment and
prophylaxis of
influenza
• One of the drugs of
choice in COPD
maintenance therapy
• Not intended for acute
relief (rescue) of
symptoms
• Dry mouth
Benazepril (Lotensin)
Lamotrigine (Lamictal)
Olmesartan (Benicar)
Donepezil (Aricept)
Risperidone (Risperdal)
Glipizide (Glucotrol)
Amphetamine salts (Adderall)
Aripiprazole (Abilify)
Inhibits angiotensin • Cough
converting enzyme which • Hyperkalemia
ultimately leads to • Used to help protect
reduction in angiotensin 2 the kidneys in
(a potent vasoconstrictor) diabetes
Inhibits voltage sensitive • Can be used for
sodium channels which seizures or mood
stabilizes neuronal disorders like bipolar
membranes • Drug interaction with
valproic acid
• Rash (possibly severe
Stephen Johnson’s
Syndrome)
Angiotensin receptor • Hyperkalemia
blocker – prevents the • Alternate to ACE
activity of angiotensin Inhibitor
which is a vasoconstrictor • Less incidence of
cough compared to
ACE inhibitors
Acetylcholinesterase • Weight loss
Inhibitor which helps • Diarrhea
increase acetylcholine in • Does not reverse
the brain (Remember dementia
than anticholinergics can
cause confusion)
Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Stimulates pancreatic • Weight gain
beta cells to release • Hypoglycemia
insulin • Inexpensive
Prevents catecholamine • Weight loss
reuptake in CNS synapses • Insomnia
leading to increased • Anxiety, tachycardia,
dopamine and and increased BP
norepinephrine
Blockade of dopamine 2 • Indicated for
receptors is primary augmentation of
mechanism

Verapamil (Verelan)
Clindamycin (Cleocin)
Metronidazole (Flagyl)
Ethinyl Estradiol + Norgestimate Oral contraceptive –
(Ortho Tri-Cyclen)
Tadalafil (Cialis)
Phentermine (Adipex)
Hydroxyzine (Vistaril)
depression as well as
schizophrenia
• Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Non-dihydropyridine; • Used in Afib, HTN, or
Blocks the entry of chronic headaches
calcium into smooth • Monitor pulse
muscle and heart, causing • Edema
vasodilation and slowing
of heart rate
Bind 50s subunit of • GI side effects
bacterial ribosome which • Higher risk of colitis
prevents protein synthesis and C.diff
• Good for anaerobic
bacteria
Disrupts bacterial DNA • Interaction with
synthesis warfarin
• Avoid alcohol when
taking medication
• Used for Anaerobic
bacteria
• DVT/PE
estrogen prevents • Hypertension
ovulation and reduces risk • GI/Headache
of pregnancy
Inhibition of • Low blood pressure
phosphodiesterace-5 • Rare vision adverse
(PDE-5) causes smooth effect
muscle relaxation and • Avoid using with
increased blood flow to nitrates
the penis
Sympathetic amine – • Used for weight loss
increases adrenaline, • Monitor for cardiac
dopamine, and possibly concerns; increase in
serotonin BP and pulse
• Can cause insomnia or
anxiety
H1 receptor antagonist • Anticholinergic effects
which leads to relief of • Used for anxiety
 allergy symptoms and • Considered a 1st
causes sedation generation
antihistamine
(sedating)
Diclofenac (Cataflam) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Metoclopramide (Reglan) Inhibition of D2 receptors • Risk of movement
in chemoreceptor trigger disorders like EPS
zone • Often used in
gastroparesis
• Can exacerbate
Parkinson’s disorder
Gemfibrozil (Lopid) Not well known - targets • Risk of myopathy
triglycerides and can • Interaction with
possibly help raise HDL statins (increases risk
of myopathy and
rhabdomyolysis)
• Indicated for
significantly high
triglycerides
Diltiazem (Cardizem) Non-dihydropyridine; • Used in Afib, HTN, or
Blocks the entry of chronic headaches
calcium into smooth • Monitor pulse
muscle and heart, causing • Edema
vasodilation and slowing
of heart rate
Divalproex (Depakote) Not well known, possibly • Sedation
increasing GABA in the • Weight gain
brain • Ataxia, CNS changes
Nitrofurantoin (Macrobid) Altered by bacterial • GI upset
flavoproteins to reactive • Nitrofurantoin lung
intermediates which (rare)
breakdown bacterial • Avoid use if suspected
ribosomal proteins kidney/systemic
infection, good for UTI
only
Mirtazapine (Remeron) Multiple potential • Weight gain
mechanisms include • Sedating
blocking alpha-2 • Classified as
receptors, as well as antidepressant but
serotonin subtypes and often used for
histamine blockade sleep/sedative
properties
Latanoprost (Xalatan) Prostaglandin agonist • Used for glaucoma
which increases aqueous • Will help eye lashes
humor outflow and grow
reduces intraocular • Can alter color of the
pressure eye
Sitagliptin (Januvia) DPP-4 inhibitor – DPP-4 • Rare pancreatitis risk
breaks down incretins like • GI side effects
GLP-1 which are • Low risk of
hormones that can reduce hypoglycemia when
blood sugars by used alone
promoting fullness
Acyclovir (Zovirax) Inhibits DNA Polymerase • Treatment of herpes
which prevent viral and varicella viruses
replication • GI upset
• Can accumulate in
kidney disease
Doxazosin (Cardura) Blocks alpha receptors • Orthostasis risk
which causes smooth • Not selective for
muscle relaxation of the bladder so can be
bladder neck and prostate used for HTN and BPH
and vasodilation • Usually dosed at night
Eszopiclone (Lunesta) Enhances GABA activity • Used for insomnia
which has sedative, only
hypnotic effects • Dizziness/sedation
• Generally avoid in
elderly
Niacin (Niaspan) Inhibition of triglyceride • Can cause flushing
synthesis by stimulating • Increases uric acid
intracellular Apo-B • Option in reducing
degradation and reduces triglycerides
release of VLDL and LDL
Propranolol (Inderal) Non-selective beta • Pulse monitoring
blocker; reduced heart • Can blunt beta-agonist
rate, blood pressure; may activity (potentially
have higher risk for exacerbate asthma,
adverse effects due to COPD)
 non-selectivity (also lot of
unique uses – tremor,
esophageal varices,
migraines)
Buprenorphine/naloxone Partial opioid agonist that
(Suboxone) has a peak effect on
stimulating the mu
receptors combine with a
full opioid antagonist
(naloxone), used to treat
opioid use disorder
Bupropion (Wellbutrin) Inhibits reuptake of
norepinephrine,
dopamine and possibly
serotonin to help treat
depression
Guaifenesin (Robitussin) Increases volume and
reduces thickness of
mucous (expectorant)
Topiramate (Topamax) Blocks voltage dependent
sodium and calcium
channels, may have some
activity on GABA as well
Buspirone (Buspar) Serotonin partial agonist
and 5HT1A receptors;
possible activity at
dopamine receptors as
well
Meclizine (Antivert) Antihistamine effects at
H1 receptors
• Can block signs of
hypoglycemia
(exception sweating)
• Possible opioid like
effects to a certain
extent
• Prevents full opioid
agonists from binding
in management of
addiction
• Need a special
prescribing certificate
to prescribe for opioid
use disorder
• Used in smoking
cessation
• Avoid in patients with
seizures
• Can contribute to
insomnia
• Well tolerated
• Questionable
effectiveness
• Take with lots of water
• Cognitive slowing,
confusion
• Sedation
• Antiseizure
medication, but often
used for migraines
• Takes a while to work
• Used in anxiety
• Pretty well tolerated
compared to
benzodiazepines
especially in elderly
• Sedation
• Anticholinergic side
effects
• Primarily used for
nausea and motion
sickness
Tolterodine (Detrol)
Lisdexamfetamine (Vyvanse)
Quinapril (Accupril)
Mupirocin (Bactroban)
Methotrexate (Rheumatrex)
Polyethylene Glycol (Miralax)
Fentanyl (Duragesic)
Benzonatate (Tessalon Pearls)
Irbesartan (Avapro)
Antagonist at muscarinic
(M2 and M3) receptors
which helps in the
management of
overactive bladder
Prevents catecholamine
reuptake in CNS synapses
leading to increased
dopamine and
norepinephrine
Inhibits angiotensin
converting enzyme which
ultimately leads to
reduction in angiotensin 2
(a potent vasoconstrictor)
Inhibits bacterial protein
and RNA synthesis
Inhibition of dihydrofolate
reductase (anticancer)
also is classified as a
disease modifying anti-
rheumatic drug (DMARD)
Osmotic laxative that
draws moisture into the
bowel to help relieve
constipation
Binds, activates mu-opioid
receptor
Anesthetic type effects
which can numb the
throat and suppress
cough
Angiotensin receptor
blocker – prevents the
activity of angiotensin
which is a vasoconstrictor
• Dry mouth
• Confusion
• Can exacerbate
urinary retention
• Weight loss
• Insomnia
• Anxiety, tachycardia,
and increased BP
• Cough
• Hyperkalemia
• Used to help protect
the kidneys in
diabetes
• Topical antibiotic
• Skin irritation
• MRSA coverage (but
only as a topical
agent)
• Low doses used for RA
• Need to supplement
with folic acid
• Dose once weekly and
monitor liver function
• Diarrhea
• Mix with 8oz. of fluid
• Rare possibility for
electrolyte
abnormalities
• Patch formulation
• NOT for acute pain
• Very slow onset/offset
• Sedation
• GI upset
• Make sure you aren’t
masking ACE inhibitor
cough
• Hyperkalemia
• Alternate to ACE
Inhibitor

Albuterol + Ipratropium
(Duonebs, Combivent)
Ibandronate (Boniva)
Methadone (Methadose)
Clotrimazole + Betamethasone
(Lotrisone)
Sumatriptan (Imitrex)
Nifedipine (Procardia)
Famotidine (Pepcid)
• Less incidence of
cough compared to
ACE inhibitors
Combination beta-agonist • Dry mouth
and short acting • Tachycardia
anticholinergic • Tremor
Inhibits resorption of • Extremely long half life
bone by osteoclasts • Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use
Binds, activates mu-opioid • Addiction/dependence
receptor risk
• Respiratory
depression
• Constipation
Combination antifungal • Fungal infections can
and topical corticosteroid take a while to treat
• Skin thinning with
prolonged use
• Skin irritation
Serotonin agonist at • Caution in patients at
5HT1D receptors – high risk of
thought to cause cardiovascular
vasoconstriction, but concerns
maybe a little more • Treatment of acute
unknown now? migraine
• CNS adverse effects
like confusion
Blocks the entry of • Edema
calcium into smooth • No action on the heart
muscle, causing (compared to
vasodilation diltiazem, verapamil)
• Used to help prevent
angina and manage
blood pressure
Histamine 2 Receptor • Slightly less potent
Antagonist which reduces than the PPI’s
gastric acid secretion
 leading to relief of • Can accumulate in
heartburn and GI kidney disease
symptoms • Tend to work a little
quicker than the PPI’s
Finasteride (Proscar) Inhibits 5 alpha reductase • Sexual dysfunction
which prevent side effect
dihydrotestosterone • Can be used for hair
formation which growth in baldness
contributes to • Takes months to
enlargement of the shrink prostate
prostate
Ferrous Sulfate (Feosol) Iron replacement • Deficiency can cause
anemia and RLS
• GI upset
• Constipation
Terazosin (Hytrin) Blocks alpha receptors • Orthostasis risk
which causes smooth • Not selective for
muscle relaxation of the bladder so can be
bladder neck and prostate used for HTN and BPH
and vasodilation • Usually dosed at night
Fish Oil (Lovaza) Not well understood, but • Burping/fish taste
can help reduce • GI upset
triglycerides and increase • Rare potential to
HDL interfere with platelet
aggregation (usually
help around surgery)
Tizanidine (Zanaflex) Central alpha-2 receptor • Sedation
agonist which inhibits • Dizziness
motor neurons and • Maybe a little better
reduces spasticity tolerated in the
elderly than
cyclobenzaprine
Risedronate (Actonel) Inhibits resorption of • Extremely long half life
bone by osteoclasts • Administration
without other drugs,
food – with a plain
glass of water, patient
to remain upright
after
• Usually reassessed
after 5 years of use
Memantine (Namenda) Inhibition of N-methyl-d-
aspartate (NMDA)
receptors
Insulin Aspart (Novolog) Rapid acting insulin
analog
Aspirin Non-selective inhibitor of
cyclooxygenase (COX) –
which ultimately reduces
the production of
prostaglandins which are
involved in
pain/inflammation
Clobetasol (Temovate) Topical corticosteroid that
can reduce inflammation,
redness and itching
Bisoprolol (Zebeta) Blocks beta-1 receptors
(found primarily in the
heart); prevents activity of
sympathetic nervous
system leading to
reduction in heart rate
and BP
Nitroglycerin (NitroStat) Relaxes vascular smooth
muscle and dilates
arteries and veins
• CNS side effects like
sedation, confusion
• Dose adjusted in
kidney impairment
• Used in delaying
progression of
dementia
• Hypoglycemia
• Weight gain
• Targets post-prandial
elevations in blood
sugars
• Risk of Reye’s
syndrome in pediatrics
• Typically used for
cardiovascular
protection as low dose
81-325 mg once daily
• GI bleed risk
• Skin thinning
• Possible systemic
effects with large
quantities over longer
periods of times
• Used for psoriasis and
dermatitis
• Pulse monitoring
• Can blunt beta-agonist
activity (potentially
exacerbate asthma,
COPD)
• Can block signs of
hypoglycemia
(exception sweating)
• Dizziness
• Headache
• Use for acute chest
pain (angina);
administer 3 tablets
over 15 minutes, call
911 if still having chest
pain
Varenicline (Chantix) Partial nicotine agonist • Vivid dreams and
which prevents nicotine nightmares
from binding and reduces • GI upset
reward sensation from • Insomnia
smoking
Raloxifene (Evista) Selective estrogen • DVT/PE risk
receptor modifier; blocks • Hot flashes
activity at some estrogen • Vaginal dryness
receptors and helps at
others in management of
reducing breast cancer
risk and can help in
osteoporosis
Olanzapine (Zyprexa) Blockade of dopamine 2 • Sedation and
receptors is primary orthostasis risk
mechanism • Extrapyramidal
symptoms
• Metabolic syndrome
and QTc prolongation
risk
Ondansetron (Zofran) Inhibits 5-HT3 (serotonin) • Rare QTc prolongation
receptors in the risk
chemoreceptor trigger • Often used in patient
zone to reduce nausea receiving emetogenic
chemotherapy
• CNS side effects
Ropinirole (Requip) Dopamine agonist that • Edema
can be used for • Obsessive behaviors
Parkinson’s where there is like excessive
a shortage of dopamine; gambling, eating
more commonly used in • GI side effects
RLS
Dicyclomine (Bentyl) Anticholinergic that can • Constipation
be helpful in managing • Dry eyes/dry mouth
diarrhea and relaxing • Confusion
smooth muscle in patients
with GI spasms and pain
Insulin Lispro (Humalog) Rapid acting insulin • Hypoglycemia
analog • Weight gain
• Targets post-prandial
blood sugars
Nabumetone (Relafen) Non-selective inhibitor of • Increase GI Bleed risk;
cyclooxygenase (COX) – take with food
 which ultimately reduces • Exacerbates
the production of CHF/edema
prostaglandins which are • Inhibits platelet
involved in activity
pain/inflammation
Clarithromycin (Biaxin) Binds 50s ribosomal • Numerous CYP3A4
subunit and prevents drug interactions
protein synthesis (inhibitor)
• GI adverse effects
• Rare risk for QTc
prolongation
Lidocaine patch (Lidoderm) Binds to neuronal • Local pain relieving
membrane receptors and effects
inhibits sodium ion • 12 hours on/12 off
influxes and prevents cell • Systemic side effects
action potential usually minimal
Dutasteride (Avodart) Inhibits 5 alpha reductase • Sexual dysfunction
which prevent side effect
dihydrotestosterone • Fatigue
formation which • Takes months to
contributes to shrink prostate
enlargement of the
prostate
Phenytoin (Dilantin) Not well understood, • Ataxia, CNS changes
possibly blocking voltage with toxicity
gated sodium channels • Highly protein bound
drug, low albumin can
increase toxicity risk
• Enzyme inducing type
effect on CYP3A4 and
others
Colchicine (Colcrys) Binds to tubulin and • Diarrhea
prevents microtubule • Rare indication for
polymerization – reduces prophylaxis and
a gout flare and prevents treatment
it as well • Dose adjusted with
poor kidney function
Moxifloxacin (Avelox) Inhibits DNA gyrase in • Risk of spontaneous
bacteria which prevents tendonitis or tendon
DNA separation and cell rupture
division • Considered a
respiratory
fluoroquinolone only

Baclofen (Lioresal)
Hydroxychloroquine (Plaquenil)
Enoxaparin (Lovenox)
Atomoxetine (Strattera)
Diphenhydramine (Benadryl)
Ketoconazole (Nizoral)
• Binding interaction
with iron and calcium
can reduce absorption
Not well understood; • Used in management
skeletal muscle relaxant of spasms
• Sedation, confusion
• Can be used on an as
needed basis
Not well understood, • Eye exams required
originally was used as • LFT/CBC monitoring
antimalarial drug, in US, • Takes a while to begin
primarily used as DMARD working (not a quick
in RA and Lupus acting medication in
RA or Lupus)
Increases activity of • Injection
antithrombin that • Bleed risk
ultimately inactivates • Risk of heparin
factor 10a; some activity induced
against clotting factor 2a thrombocytopenia
(thrombin), but less than
heparin
Possible inhibition of • Insomnia, anxiety,
norepinephrine weight loss
transporter – used in • Not a controlled
ADHD substance (compared
to methylphenidate
and amphetamine
derivatives)
• Can worsen agitation,
irritability and possibly
cause suicidal
thoughts
H1 receptor antagonist • Anticholinergic effects
which leads to relief of • Used for itching, mild
allergy symptoms and to moderate allergic
causes sedation reactions
• Over the counter
availability
Inhibits fungal • 3A4 drug interactions
cytochrome P450 enzyme (amiodarone,
14alpha-demthylase phenytoin, warfarin,
etc.)
 • Primarily used as
topical agent (if so,
side effects are pretty
minimal)
• Liver concerns
Nortriptyline (Pamelor) Inhibits norepinephrine • Highly anticholinergic
and serotonin reuptake, (sedation, confusion,
leading to increased dry eye, etc.)
concentrations in the • Can be used for pain
synapse syndromes (migraines,
fibromyalgia, etc.)
• Higher risk of cardiac
concerns in overdose
compared to SSRI’s so
less often used for
depression
Benztropine (Cogentin) Anticholinergic that is • Anticholinergic side
centrally acting and can effects like dry eyes,
inhibit dopamine uptake dry mouth, confusion,
in the synapse – used to sedation
prevent EPS from • If patients are
antipsychotics and benefitting from
possible benefit in antipsychotics but
Parkinson’s experiencing EPS, this
drug may be used
• Not well tolerated in
elderly
Minocycline (Minocin) Inhibits bacterial protein • Increases sensitivity to
synthesis by binding to sunburn
the 30s ribosomal subunit • Binding interactions
with calcium and iron
• Most often used for
skin disorders (i.e.
acne)
Pantoprazole (Protonix) Inhibits H+/K+ ATPase • Short term only
pump in gastric parietal recommended for
cells (reduces hydrogen GERD
ion – stomach acid • Associated with low
concentration in stomach) magnesium and B12
• Most potent acid
blocking medication
class
Cefuroxime (Ceftin) Inhibits penicillin binding
protein which prevents
bacterial cell wall
synthesis
Oxybutynin (Ditropan) Antagonist at muscarinic
receptors which helps in
the management of
overactive bladder
Levetiracetam (Keppra) Not well known; possible
anti-seizure activity due to
inhibition of presynaptic
calcium channels
Hydralazine (Apresoline) Not well understood,
direct vasodilator, reduces
blood pressure
Liraglutide (Victoza) Acts like human incretin
(GLP-1 agonist) which can
aid in promoting fullness,
decrease appetite and
possibly stimulate insulin
release
Prasugrel (Effient) Blocks binding of ADP to
the P2Y12 receptor; by
doing this, it prevents
platelet aggregation
Mirabegron (Myrbetriq) Acts as an agonist at Beta-
3 type receptors which
causes detrusor smooth
muscle relaxation and can
help with overactive
bladder
• Diarrhea
• Nausea/Vomiting
• broader spectrum
coverage than
cephalexin
• Dry mouth
• Confusion
• Can exacerbate
urinary retention
• Sedation
• Confusion
• Can accumulate in
kidney disease
• Dosed multiple times
per day
• Can exacerbate, cause
Lupus
• Low blood pressure,
dizziness risk
• Weight loss effect as
well as lowering blood
sugars
• Injection, GI side
effects
• Avoid in patients
who’ve had thyroid
cancer
• Bleed risk
• Often used in
combination with
aspirin following
stenting
• Costlier than
clopidogrel
• Increase in blood
pressure
• Increase heart rate
• Unique mechanism
from anticholinergic
medication used for
OAB
Canagliflozin (Invokana) Inhibits SGLT-2 which
helps keep glucose in the
urine – so ultimately
reduces blood sugar
Apixaban (Eliquis) Inhibits clotting factor 10a
to prevent blood clots and
stroke
Tradjenta (Linagliptin) DPP-4 inhibitor – DPP-4
breaks down incretins like
GLP-1 which are
hormones that can reduce
blood sugars by
promoting fullness
Dulaglutide (Trulicity) Acts like human incretin
(GLP-1 agonist) which can
aid in promoting fullness,
decrease appetite and
possibly stimulate insulin
release
Morphine (MS Contin) Binds, activates mu-opioid
receptor
Empagliflozin (Jardiance) Inhibits SGLT-2 which
helps keep glucose in the
urine – so ultimately
reduces blood sugar
Rivaroxaban (Xarelto) Inhibits clotting factor 10a
to prevent blood clots and
stroke
• Risk of urinary tract
infections
• Mild diuretic effect
• Monitor kidney
function
• Dose adjustments based on
age, weight, and kidney
function
• Alternative to warfarin
without routine INR
requirement
• Bleed risk
• Rare pancreatitis risk
• GI side effects
• Low risk of hypoglycemia
when used alone
• Weight loss effect as well as
lowering blood sugars
• Injection (once
weekly), GI side effects
• Avoid in patients
who’ve had thyroid
cancer
• Addiction/dependence risk
• Respiratory
depression
• Constipation
• Risk of urinary tract
infections
• Mild diuretic effect
• Monitor kidney
function
• Dose adjustments based on
age, weight, and kidney
function
• Alternative to warfarin
without routine INR
requirement
 • Bleed risk
Amiodarone (Cordarone) Class 3 antiarrhythmic; • LFT monitoring
likely inhibits potassium • TSH monitoring
and sodium channels • Can cause pulmonary fibrosis
which increase the
duration of ventricular
and atrial muscle
contraction
Carbamazepine (Tegretol) Sodium channel • Potent enzyme inducer, lots
antagonist used in the of drug interactions
management of seizure, • LFT monitoring
bipolar, and trigeminal • Hyponatremia risk
neuralgia