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Class of Drug Corticosteroids

Example

MOA

Indications Anti-Eicosanoids Indirect inhibtion of Asthma, arthritis (rheumatoid and osteoarthritis), phosphorlipase A1 by inducing systemic lupus erythematosus synthesis of lipocordin

C/I

A/E Teratogenic, peptic ulcers; hyperglycemia, insuline resistance, diabetes mellitus, osteoporosis, etc.

Prednisone Betamethasone Dexamethasone Triamcinolone Thromboxane Antagonists Dazoxiben Pirmagrel Ridogrel NSAIDs Inhibit COX1, 2; inhibit platelet and suppress inflammation Aspirin Non-selective COX inhibition Mild to moderate pain, headache, myalgia, arthralgia, prophylaxis for stroke and MI GI ulcers, bleeding, asthma exacerbation, bronchospasm, angioedema Reversible binding to COX enzymes Similar to aspirin Bleeding

Indometacin Sulindac Meclofenamate Ibuprofen Celecoxib

Preferentially inhibits COX1 over COX2 Preferentially inhibits COX1 over COX2 No preference of inhibition of COX1, 2 No preference of inhibition of COX1, 2 Preferentially inhibits COX2 Osteoarthritis, rheumatoid arthritis, primary over COX1 dysmenorrhea, acute pain in adult's familial adenomatous polyposis

Myocardial infarction, GI bleeding, peripheral edema, asthma

Rofecoxib

Preferentially inhibits COX2 over COX1

Osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, acute pain in adult's familial adenomatous polyposis

Myocardial infarction, GI bleeding, peripheral edema, asthma

Propionic Acid

Mild to moderate pain, fever, osteoarthritis, rheumatoid arthritis, dysmenorrhea, gout

GI hemorrahge, ulceration, perforation, nephrotoxicity, Stevens-Johnson Syndrome

Ibuprofen Naproxen Ketoprofen Flurprofen Acetic Acid Derivatives Indomethacin Sulindac Etodolac Diclofenac Ketorolac Oxicams Piroxicam Ketones Nabumetone Acetaminophen COX3 inhibition Fever, mild to moderate pain Hepatotoxicity, nephrotoxicity and hypothermia Arthritis Inhibition of COX1, 2 Long term treatment of rheumatoid arthritis Closure of patent ductus arteriosus GI disturbances, tinnitus

Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea

More GI bleeding than aspirin

Lipoxygenase Inhibitors

Zileuton

Asthma

Leukotriene Receptor Antagonist

Chronic asthma

Urticaria, abdominal discomfort, dizziness, and insomnia GI distress, hallucination, agitation, allergic granulomatosis angiitis, hepatitis

Montelukast Zafirlukast Example

Perennial allergic rhinitis, seasonal allergic rhinitis

Class of Drug Dinoprostone

MOA PGE2

Indications C/I Eicosanoids Induction of labor at term, 2nd trimester abortions, missed abortions, benign hydatidiform mole

A/E Prolonged vaginal bleeding and severe menstrual cramps can occur if used for menstrual regulation or early abortion

Misoprostol Alprostadil

PGE-1 derivative PGE-1

2nd trimester abortion, resistant postpartum hemorrhage 2nd line drug to treat ED; maintenance of patent ductus arteriosus Pulmonary hypertension Pulmonary hypertension

Sickle cell anemia

GI disturbances, dystonia, pulmonary edema Penile pain; apnea, bradycardia, hypotension, hyperpyrexia Hypotension, rash, GI disturbances, muscle pain

Treprostinil Epoprostenol Latanoprost Bimatoprost Travoprost Unoprostone Class of Drug First Generation AntiHistamines Example

Synthetic PGI2 Synthetic PGI2

Stable, long-acting PGF2-alpha Glaucoma Glaucoma secondary to decreased intraocular pressure Glaucoma secondary to decreased intraocular pressure Glaucoma secondary to decreased intraocular pressure MOA Indications Anti-Histamines Inverse Agonists of histmaine Rhittinis, conjunctivitis, urticaria, puritus, anaphylaxis, insomnia, motion sickness, Parkisonism

C/I Narrow angle glaucoma, peptic ulcer disease

A/E Sedation, dizziness, pupillary dilation, dry eyes and mouth, urinary retention, hesitancy

Ethelendiamine (pyrilamine and triplennamine) Ethanolamines (diphenhydramine, carbinoxamine, clemastine, dimenhydrinate) Alkylamines (chlorpheniramine, brompheniramine) Piperidines (cyrohetadine, phenidamine) Phenothiazine (Promethiazine) Piperazines (hydroxyzine, cyclizine, meclinizine)

Second Generation AntiHistamines Piperazine (Certizine) Alkylamines (Acrivastine) Allergic rhitinitis, allergic urticaria Allergic rhitinitis Somnolence, dry mouth, headache

constipation Class of Drug 5HT Receptor Agonists MOA Indications Serotonin C/I A/E Busiprone 5HT1A agonist Anxiolytic agent Triptans 5HT1D/1B Agonists Acute migraine. dizziness. spirochetes. headache. M. enterocolitis. ebastine. Trachoma. Anthrax. anal pruritis. leptospirosis. GI distress. cluster headache Patients with coronary artery disease. nervousness. Rikettsiae. fatigue.Piperidine (Loratadine. fexofenadine) Allergic rhitinitis. vertigo Chlortetracycline Oxyletracycline Tetracycline Demeclocycline Methacycline Doxycycline Minocycline Chlamydial conjunctivitis ADH-secreting tumors Resistant strains (not a substrate for efflux pump) Resistant strains (not a substrate for efflux pump) Photosensitivity Dizziness. levocabastine. pneumoniae. naratriptan and eletriptan are C/I in patients with hepatic and renal insufficiency Tachycardia. exercitation of bronchitis.M. marinum A/E N/V/D. desloratadine. community-acquired pnemonia. treat plague. tularemia and brucellosis with aminoglycosides. used in combination with PPI to treat H. allergic urticaria H2 Blockers Cimetidine Ranintidine Fomotidine Nisatidine Example Control stomach acid Diarrhea. vagianal or oral candidiasis. pain and local irritation in muscles. sensitive Vibrio infections. vertigo . pylori. relapsing fever. acne. most effective children <8 against . mizolastine. Lyme disease. protozoa (amebas). venous thrombosis. paresthesia Coronary artery vasopasm SSRIs Cisapride Tegaserod 5HT4 Severe toxic effects have decreased use Irritable bowel syndrome with constipation 5HT Receptor Antagonists Ondansetron Class of Drug Tetracyclines Example 5HT3-antagonists MOA Reversibly blocks the 30S ribosomal subunit to prevent protein synthesis Prevent N/V associated with surgery and chemotherapy Indications C/I Tetracyclines Broad spectrum against gram positive and negative Pregnant women and and anaerobes. palpitation. Chlamydia.

rasehs. oral or vaginal candidas. anthracis. P. prophylaxis against endocarditis. E. N. Rickettsia . Proteus. S. pertenue. P. pyogenes. typhi) Penillin G and Gram + bacilli ( . CYP inhibitor and reduces metabolism of phenytoin. coagulase negative staph. P. gram negative rods. warfarin Class of Drug Example MOA Structural analogs of D-alanylD-alanine substrate to prevent peptidoglycan synthesis Indications Beta-Lactams C/I A/E Anaphylactic shock. Anaerobic . gonorrhoeae. multiple resistant Acenitobacter. mirabilis. Enterobacteriacae. C. typhi) Antipseudomonals. diphtheriae.Enterobacter. aeruginosa Antistaphylococcal penicillins (Betalactamase resistant) Oxacillin Cloxacillin Dicloxacillin Nafcillin Methicillin .rods .N. P. Gram . S. aureus. coli. Severe rickettsial infections. inlfuenzae. pallidum Beta-hemolytic strep pharyngitis. hematologic toxicities. alernative to beta-lactams against meningococcal meningitis. viridians. E. skin rashes. chloropropamide. coli. diarrhea. Spirochtes T.Tigecycline Resistant strains (not a substrate for efflux pump). influenzae. mirabilis. inlfuenzae. serum sickness.cocci . Gram . H. eye infections A/E N/V/D. with pyrimethamine for AIDS-related toxoplasmosis Indications C/I Chloramphenicol Gram positive and Gram negative. P. Gram . meningitis. neurotoxicity. coli. H.rods . S. Gray Baby Syndrome. influenzae. Pneumococci. monocytogenes L DOC). Chlamydia. pneumoniae. moderate-severe Pneumocystis jirovei in AIDS patients. N.rods (E. H. bacteriodes. MR strains. Rickettsiae. Gram . S. nephritis. Gram .NOT Chlamydia. H. Legionella Class of Drug Clindamycins Example MOA Bind exclusively to 50S ribosome and inhibit protein synthesis Indications C/I Clindamycins Strep.rods (E. neutropenia Class of Drug Example MOA Inhibits 50S ribosomes A/E N/V/D (not in children). perfringens. S. Proteus. Gram + bacilli . Staph. Strep (both penicillin susceptiable and resistant). vancomycin-resistant strains.S. mirabilis. syphilis Penicillin V Benzathine Penicllin G Extended-spectrum penicillins Amoxicillin Ampicillin Piperacillin Ticarcillin Penillin G and Gram + bacilli (L. influenzae. H. aeruginosa Antipseudomonals.C.B. mirabilis. t. cation toxicity Penicillins Penicillin G Gram + cocci . coli. penetrating wounds. monocytogenes).Enterobacter. aplastic anemia. meningitidis. P.

treat pneumonia. K. aureus (MRSA). Citrobacter species. with cefotxaime or ceftriaxone to treat meningitis caused by highly penicillin-resistant pneumococcus Ototoxicity. G. Gram . S. pneumoniae. penicillin-resistant pneumococci) .N. P.L. S. C. P. soft tissue abscesses Cefadroxil Cefazolin Cephalexin Cephradine Second Generation Gram + cocci . sepsis or endocarditis caused by MRSA. pyogenes. Bacteriodes species. Propionbacterium species. Enterobacter species. influenzae.E. Anaerobic cocci Peptococcus. Nocardia species N/V/D. aerogenes.Gram . Proteus species. pneumoniae. K. Gram . mirabilis Cefuroxime Sinusitis. influenzae.rods . UTIs. pneuomniae. epidermidis. E.Gram + cocci . coli. faecalis. K. skin rashes and reactions at site of infusion.N. Anaerobic strep. Gram + peptidoglycan synthesis. vaginalis. E. pneumoniae. Peptostreptococcus species. interfereing with lipid carrier wounds or mucous membranes that transfers peptidoglycan subunits to growing cell wall Example MOA Structural analogs of D-alanylD-alanine substrate to prevent peptidoglycan synthesis Indications Cephalosporins C/I A/E Hypersensitivity reactions Class of Drug First Generation Gram + cocci EXCEPT MRSA. monocytogenes. meningitidis. B. nephrotoxicity increased when given with other drugs (aminoglycosides) Bacitracin Inhibits cell wall formation by Gram + microorganisms. community acquired pneumonia (H.Actinebacter species. Fusobacterium species. influenzae. aeruginosa. pneumoniae.S. surface lesions of skin. Gram + bacilli .rods . K. B. influenzae. monocytogenes. Excessive doses in patients with renal failures leading to seizures Vancomycin Binds to D-Ala-D-Ala terminus Gram + cocci . coli.cocci . Serratia species. preventing crosslinking Strep groups A. pneumoniae.S. P. C. S. Gram . P. bacilli . resistant to beta-lactamases gonorrhoeae (penicllinase-producing strains). pneumoniae. E.Clostridium Peptococcus.cocci . peptidoglycan synthesis mirabilis. Actinomyces. people allergic to penicillins may be allergic to imipenem. S. H. E. Moraxella catarrhalis). cellulitis. E. Gram . epidermidis. Gram . aeruginosa. Salmonella species.rods .E. H.E. H. lower respiratory tract infections (H. N. Peptostreptococcus. gonorrhoeae. Anaerobic clostridium.S. D-alanine substrate to prevent faecalis.N. otitis. and sepsis caused by Gram-negative pathogens Structural analogs of D-alanyl. aureus (MRSA). S. gonorrhoeae.cocci . S. mirabilis. Anaerobic . P. Klebsiella species. Gram . Actinomyces.L.rods . D-alanine substrate to prevent aerogenes. groups A. influenzae. coli. meningitis.Aztreonam Imipenem Structural analogs of D-alanyl. coli.

elevation of liver enzymes. E. influenzae.Cefoxitin Cefotetan Mixed anaerobic infections . mot active against penicillin-resistant strains of pneumococci (DOC) Ceftazidime Ceftriaxone Can cross BBB Meningitis . susceptible Gram-negative rods. incurring lupus erythematosus . disulfiramlike reactions. aeruginosa. S. K. Gram . S. pneumoniae. avoid alcohol. diverticulitis Mixed anaerobic infections . H. influenzae. weight gain. diverticulitis Hypoprothrombinemia and bleeding disorders. aureus. CD86 on APC. aerogenes. vasculitis. when combined with vancomycin . mirabilis.N. pneumoniae.meningitis caused by highly resistant strains of pneumococci. polymyositis. inhibits T-cell proliferation and B-cell antibodies C/I Pregnancy A/E Hepatotoxicity (dose-related).Pneumococci. etc.rods . enterobacteriaceae. meningococci. Neisseria. H. susceptible Gramnegative rods. P. increased blood pressure Non-TNF-directed Mabs Abatacept Binds to CD80. used with methotrexate Plaque psoriasis Must monitor T-cell levels Antibodies to TNF components Can activate latenet TB (must screen prior to prescribing).Peritonitis. highly active against Haemophilus. Meningitis .E. gonorrhoeae. ankylosing spondylitis. when combined with vancomycin meningitis caused by highly resistant strains of pneumococci. psoriasis.cocci . lymphocytes and macrophages juvenile chronic arthritis. P. alcohol-containing medications Third Generation Gram .Pneumococci. Inhibits dihydroorotate dehydrogenase arresting stimualted cells in G1. SLE. coli. influenzae. most active against penicillin-resistant strains of pneumococci (DOC) Fourth Generation P. aeruginosa Cefotaxime Can cross BBB. can penetrate the CSF Class of Drug Methotrexate Cefipime Example MOA Indications DMARDs Inhibit enzymes in Decreases appearance of new erosions in RA. mucosal ulcers Leflunomide Diarrhea. meningococci. H. blocks stimulation of macrophages Targets CD20 B-lymphocytes Attach to a piece of LFA-3 to prevent T-cell activation Rituximib Alefacept RA that is refractory to anti-TNF agents. nausea.Peritonitis.

prevents activation of decreases rate of formation of new lesions macrophages and interrupts Tcell function Binds to bound TNF RA. asthma.Adalimumab Complexes with soluble TNF. anti-depressants Insomnia. given with bradykinesia) carbidopa to inhibit the conversion of l-dopa to dopamine in periphery Infliximab Etanercept Penicillamine Levamisole Glucocorticoids Class of Drug Levodopa Example C/I Psychotic patients. agitation. alpha. dyskinesias (choreoathetosis of face and distal extremities is most common). reduce bradykinesia. hallucinations. decreases metabolism of L-dopa More on-time for patients taking L-dopa Patients taking meperidine. psoriatic arthritis. D2 D3 receptor Specific for D2 Potent DA agonist Withdrawn Lower L-dopa dose. hypoglycemia . psoriatic arthritis. confusion. and tremor Dopamine Receptor Agonists Bromocriptine Pergolide Pramipexole Ropinirole Apomorphine Acetylcholine blockers Benztropine mesylate Biperiden Orphenadrine Procyclidine Trihexphenidyl Beta-Blockers Specific for D2 Specific for D1. N/V. orange urine. depression. depression. tolcapaone increased liver hepatotoxicity Restlessness. mental disturbances (somnolence. arrhtymias. little effect on bradykinesia Renal impairments Nausea. confusion. nausea. pretreatment with anitemetic Treatment of essential tremor Caution in patients with heart failure. irreversible inhibitor Prolongs antiparkinsonism effect of l-dopa (lower of MAO-B doses) MOA-B inhibitor Neuroprotective agent Inhibit breakdown of dopamine COMT-inhibitor. delusions. insomnia. delusions) Amantadine Unknown . history of melanoma and skin lesions Insomnia. nightmares if taken at night Dyskineas. Progressive-erosive rheumatoid disease collagen and mucopolysaccharides Helminthic infections Inhibits phospholipase A2. hypomania. hallucinations. acute peptid ulcers A/E Anorexia. wearing off reactiosn and onoff phenomenon Monoamine Oxidase Inhibitors Selegiline Rasagiline Catechol-Omethyltransferase inhibitors Entacapone Inhibits breakdown of dopamine Selective. Crohn's disease Binds TNF-alpha Juvenile chronic arthritis and psoriasis Interferes with DNA synthesis. postural hypotension. dyskinesias. reduce affective symptoms of PD Temporary relief of off-periods of akinesia Improve tremor and rigidity. anxiety. angleclosure glaucoma. N/V (take with meals). ankylosing spondylitis.antiviral with antiparkinson properties Short treatments. ankylosing spondylitis. hypertension. inhibits COX II MOA Indications Movement Disorders Biosynthetic precursor of Relieves all clinical features of PD (specifically dopamine. somnolence. hallucinations. postural hypotension. heart block. livedo reticularis Anorexia. rigidity.RA. decreases rate of formation of new lesions.

nasal congestion Suicide and depression Pimozide Tics treatment Reserpine Prevents intraneuronal storage Treatment of Huntington Disease of dopamine Inhibits vesicular monoamine Treatment of Huntington Disease transporter 2 to deplete central monoamines Inhibits gluamate signaling to protect motor neurons from toxic effects of excitatory amino aicds Fluphenazine ALS Tetrabenazine Riluzole Antipsychotics Tics Treatment Tics Treatment Motor or vocal tics in children Indications Anti-Depressants Depression. changes in mental status and vital signs) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Fluvoxamine (Luvox) Escitalopram (Cipralex. myoclonus.Propanolol Antiepileptics Primidone Topiramate Carbamazepine Dopamine receptor antagonists Penothiazines Butyrophenones Haloperidol Symptomatic control of essential tremors Tics treatment Treatment of Huntington Disease Tics treatment Extrapyramidal movement disorders. muscle rigidity. insomnia. tremor. dry mouth. agitation. blurred vision and GI disturbances Hypotension. diarrhea. constipation. dryness of mouth. sedation. depression. sedation. blurred vision and GI disturbances Extrapyramidal movement disorders. sedation. dryness of mouth. Lexapro) Heterocyclic Bupropion Selectively inhibits dopamine reuptake Depression in pediatric populations Can be used with nicotine patches to stop smoking May cause seizures. no sexual dysfunction Nefazadone (Serzone) Blocks 5HT2 receptor WITHDRAWN . nausea. fewer toxic side affects Benzodiazepines Clonazepam Adrenergic agonists Class of Drug SSRIs Clonidine Example MOA Inhibits serotonin uptake C/I A/E Serotonin syndrome when combined with MAO-Inhibitors (hyperthermia. anxiety.

deposits in cornea and lens Prolongation of QT interval. 5HT2A. mental confusion. combined with anti-depressant in the depressed phase of bipolar.Phenothiazine Derivatives Chlorpromazine Thioridazine Fluphenazine Typical . agranulocytosis. Parkisonism. bradyphrenia) Orthostatic hypotension. anxiety. tachycardia. withdrawal and bizarre movements Carbemazepine Valproic acid Clonazepam Quetiapine Anti-convulsant Mania and compulsive aggression Prophylaxis Prophylaxis in patients that are not completely controlled with lithium Antagonist at 5HT1A. deposits in retina. dystonia. anxiety. distress. slurred speech.Thioxanthene Derivatives Thiothixene Haloperidol Atypical antipsychotics Preferentially blocks 5HT2 receptors Olanzapine Risperidone Quetiapine Clozapine Negative symptoms of schizophrenia. leukopenia. Agranulocytosis. decreased mean arterial pressure. QT and RS prolongation Imipramine Nortriptyline (Pamelor) Lithium Substitutes for sodium in generating action potentials. peipheral resistance and stroke volume. polydipsia. weight gain and increased lipid profile Weight gain and increased lipid profile EPS Reduce risk of schizophrenia Weight gain and increased lipid profile. congnition Increased risk of Torsades de Pointes. urinary retention. Used with lithium or depakote. anorexia. used prophylactically in patients with tricyclics and SSRIs to prevent mania and depression. epigastric distress. dry mouth. constipation. D2. orhtostatic hypotension. increased HR Seizures. standard for antidepressants Depression and severe neurogenic pain Combined with anti-psychotics to control mania of Bradycardia-tachycardia bipolar. . akathisia. tremor. inhibits sodium exchange Depression and enuresis. reduces alcoholism in bipolar patients Polyuria. paranoia. tachycardia. adrenergic alpha-1 alleviating depression and alpha-2 receptors Indications Anti-Psychotics C/I A/E Extrapyramidal side effects (tremors. mania and D1.Tricyclics Anti-muscarinic effects blurred vision. MI. H1. does NOT increase QT interval Increased QT interval. de novo seizures. fatal overdoses Class of Drug Typical Antipsychotics Example MOA Preferentially blocks D2 receptors Typical . abnormal ST and T waves.

severe hepatitis N/V. paresthesias. headache. nervousness. blood dyscrasias. acute myopia and glaucoma Drowsiness. primary generalized tonic-clonic protein 2A to modify release of seizures. dizziness. confusion. nausea. SLE Tiagabine Topiramate Potentiates inhibitor effects of Lennox-Gastaut syndrome. CNS depression. gingival hyperplasia. somnolence. mild peripheral neuropathy Carbemazepine Blocks Na channels and inhibits Simple partial seizure. sodium channel. ataxia. West's syndrome. ataxia. postchannels herpetic neuralgia Blocks voltage-gated calcium Partial seizures. tonic-clonic. long term coarsening of facial features. nystagmus and loss of smooth extraocular pursuit movements. uncontrollable seizures Diplopia. Lennox-Gesaut syndrome Felbamate Ethosuximide Generalized seizures Phensuximide Methsuximide . myoclonic seizures in junveile myoclonic glutamate and GABA epilepsy Inhibit GABA uptake Adjunctive therapy of partial seizures Dizziness. depression. high-frequency repetitive firing partial seziures with secondarily generalized tonicof neurons. also treats bipolar disorder. cognitive impairment. GABA Absence seizures. life threatening dermatitis Somnolence. transmission trigeminal neuralgia Enhancement of inhibitory neurotransmission. complex partial seizure. headache. headache. diplopia Somnolence. myoclonias Block of NMDA receptor. lethargy or fatigue. inhibits vesicular GABA transport Inactivation of sodium channels. skin rashes. suicidal ideations Lamotrigine absence and myoclonic seizures in children Gabapentin Pregabalin Lacosamide Levetiracetam Blocks voltage-gated calcium Partial and generalized tonic-clonic seizures. potentiates GABA-A receptor Inhibits calcium currents Partial seizures. CNS depression. dizziness. asthenia. inhibits VGCC Seizures in infant and elderly GI upset and sedation Vigabatrin Permanent vision loss. diplopia. decrease glutamate release and increase GABA release EPS A/E Hirsutism. inhibits partial seziures with secondarily generalized tonicgeneration of repetitive action clonic potentials. dizziness. anemia. nausea. potentiates GABA Irreversible inhibitor of GABA aminotransferase. cognitive slowing. generalized tonic-clonic seizures. weak Partial seizures. Ca channels. tonic-clonic seizures. tremor Euphoria Dizziness. dizziness. metabolic acidosis Aplastic anemia. complex partial seizure. blood dyscrasias Phenobarbital Primidone Blocks voltage-sensitive Na channel. post-herpetic neuralgia channels Enhanced inactivation of Adjunctive therapy for partial seizures in patients sodium over 16 Binds to synaptic vesicle Partial seizures. diplopia and ataxia. difficulty concentrating. carbonic anhydrase inhibitor infantile spasms. binds to GABA-A receptor prolonging chloride channel Partial seizures with secondarily generalized tonicclonic. tremor. somnolence and skin rash. somnolence.Asenapine Neuroleptics Class of Drug Phenytoin Example Typical MOA Indications C/I Anti-Epileptics Prolongs inactive state of Simple partial seizure. pain. reduce synaptic clonic. avoid alcohol Nervousness. confusion. migraine headaches Zonisamide Inhibit Na. fatigue. ataxia Somnolence.

anti-histaminergic Prochlorperazine Narcotics Butorphanol Meperidine Oxycodone. phototoxicity Pokilothermic. pancreatitis. post-partum hemorrhage Pregnancy. abdominal pain and heart burn. blurred vision. etc. confusion. lethargy Rizatriptan Eletriptan Sumatriptan Zolmitriptan Naratriptan Frovitriptan Ergot alkaloids Non-selective 5HT1 agonist Acute attacks Acute attacks Migraines. fine tremor. spina bifida risk Sodium valproate Block Na currents. dopaminergic. weak antiHuntington's chorea. schizophrenia. complex partial. stimulate lactation Pheochromocytoma. hepatotoxicity. numbness. full agonist at kappa Intranasal spray for migraines Severe migraine pain Pain killers Acute attacks Sedation. 5HT3 antagonist Acute attacks Migraines. NMDA receptor excitation Generalized seizures. D2 antagonist. antiAnti-emetic. Tourette's syndrome. EPS. spina bifida risk N/V. absence seizures. complex partial. anti-histaminergic Anti-cholinergic. tingling. agranulocytosis Chlorpromazine Anti-cholinergic. blurred vision. sedative). myoclonic seizures. occasional vascular disease. cerebrovascular diseases A/E Sedation Drowsiness. dizziness Addiction liability . GI radiology. constipation. NMDA receptor excitation Generalized seizures. dementia adrenergic. simple partial. dopaminergic. pancreatitis. constipation. fine tremor. abdominal pain and heart burn. hydrocodone. tonic-clonic seizures Benzodiazepines Diazepam Loarzepam Clonazepam Clorazepate dipotassium Acetazolamide Class of Drug Triptans Example Increase GABA inhibition Stops continuous seizure activity Continuous seizure activity Absence and myoclonic seizures adjunct to treat partial seizures Inhibit carbonic anhydrase MOA 5HT Agonist Treats all seizure types Indications Migraines Acute attacks C/I Cardiovascular diseases. dichloralphazone (analgesic. Tourette's syndrome. partial with secondarily generalized tonicclonic seizures. myoclonic seizures. artery disease. weak antiHuntington's chorea. tardive dyskinesia Pokilothermic. simple partial. anti-pyretic. dementia adrenergic. tonic-clonic seizures N/V. gastric stasis. peirpheral Leg weakness. impaired renal and hepatic function Ergotamine Dihydroergotamine Dopamine antagonists Metoclopramide 5HT4 agonist. absence seizures. antiAnti-emetic. isometheptene (potent vasoconstrictor) Partial agonist at mu. hepatotoxicity.Valproic acid Block Na currents. agranulocytosis. schizophrenia. constipation. coronary muscle pain. thrombocytopenia. thrombocytopenia. partial with secondarily generalized tonicclonic seizures. erratic GI absorption hypertension. Amidrine Comgination of acetaminophen. Parkinson's disease Galactorrhea.

migraine prophylaxis Gabapentin Inhbits high VGCC Methysergide 5HT2. used when beta. antidepressants Primary AV bundle branch block. sedations. tranquilizers. ataxia. enhances Generalized tonic-clonic and partial seizures. sedation. sedation. tachycardia. antihistamine. fibrosis of heart valves. pleura C/I A/E Valproic acid Stabilizes sodium channels in active state. inhibits AMPA receptors migraine prophylaxis P450 inducer. migraine prophylaxis.Use of MAO-inhibitors blockers are C/I Tricyclics 5HT and NE reuptake Migraine prophylaxis. drowsiness. orthostatic hypotension. drowsiness. tremor. hair loss.Propranolol Beta-blocker Hypertension. anti-dopamine Amitriptyline Dotheiepin Nortriptyline Topiramate Blocks Na channels. block sodium fatigue syndrome channels. increases GABA Generalized and absence seizures. severe refractory migraines or cluster headhaces Indications Glaucoma Class of Drug Direct muscarinic stimulants Example MOA Reduce intraocular pressure Pilocarpine Methacoline Carbachol Cholinesterase inhibitors Physostigmine Demecarium Echothiophate Isoflurophate Cholinergic agonists AChE inhibitors Beta-adrenergic antagonists Timolol Betaxolol Carteolol Levobunolol Metipranolol Alpha-adrenergic agonists Apraclonidine Birimonidine Example Enhance aqueous outflow Enhance aqueous outflow Enhance aqueous outflow Decrease aqueous inflow Open angle (chronic) glaucoma. bone marrow depression Dizziness. tachyarrhythmias. peripheral edema Retroperitoneal fibrosis. increased intraocular pressure. urinary retention. GABA. weight loss Drowsiness. poor concentration. fetal abnormalities. weight gain. anti-muscarinic effects. systemic and topical use Reduce intraocular pressure Class of Drug MOA Indications Local Anesthetics C/I A/E . poor memory. reflex tachycardia. chronic inhibitors. somnolence. fatigue Weight gain. dizziness Pizotifen Antagonist at 5HT1. 2C Prophylaxis for recurrent migraine. weight gain. 5HT1A antagonists Migraine prophylaxis Highly effective for migraine prophylaxis. constipation. anti-adrenergic effetcs. anti-muscarinic. inhibit T-type calcium channels. pain syndrome. anorexia. blurred vision. decreased libido. postural symptoms. liver abnormalities. angina Asthmatic patients Bronchospasm. dry mouth. confusion. 2A. atrioventricular block.

hypotension. IV regional anesthesia. seizures Bupivacaine Cardiotoxicity Prilocaine Vasoconstriction Articaine Ropivacaine Levobupivacaine Metabolized in plasma and liver Aminoesters Class of Drug Propofol MOA Barbiturates Fast onset and slow recovery. infiltration anesthesia. increased intracranial pressure Adrenocorticol depression. topical anesthesia Indications C/I General Anesthetics Enhance GABA-A transmission Fast onset. lacks pro-convulsive properties of enflurane . epidurals Injected dentistry anesthesia for longer procedures and post-op pain. profound analgesia Bronchodilation. pneumothorax Malignant hyperthermia. treat increased intracranial pressure porphyria depression. induction of anesthesia and maintenance in OR and ICU Enhance inhibitory neurotransmission.interferes with sulfo drugs A/E Cardiovascular and respiratory depression. less cardiotoxic potential than bupivacaine Block voltage-gated sodium channels Cocaine Procaine Tetracaine Example Ophthalmic anesthesia in combination with epinephrine and tetracaine Infiltration anesthesia. after effects. precipitates MI. IV induction Minimal CV and respiratory depression. lacrimation. apnea after induction dose Drowsiness. twitching. no cumulative effects. antidote flumeazenil Ketamine NMDA receptor inhibitor Slow onset. unpleasant emergence reactions. infiltration anesthesia. fast recovery. sedation in outpatient dentistry Induction in children. tinnitus. used when epinephrine is C/I Injected dentistry anesthesia for longer procedures and post-op pain Injected dentistry anesthesia for longer procedures and post-op pain Injected dentistry anesthesia for longer procedures and post-op pain. vasoconstriction and provides neuronal protection from focal leading to gangrene cerebral ischemia Benzodiazepines Enhance GABA-mediated chloride currents Diazepam Midazolam Loarzepam Anxiolysis and anterograde amnesia. airway irritant Isoflurane Maintenance. hypotension. sedative hypnotics. fast recovery. no analgesia. asystole Post-op nausea. dental procedures Spinal.Amiodarones Lidocaine Block voltage-gated sodium channels Topical dentistry anesthesia. induction for routine Patients with intermittent Cardiovascular and respiratory procedures. spinal and topical anesthesia Injected dentistry anesthesia for longer procedures and post-op pain. epidural. maintenance in adults Dexmedetomidine Nitrous Oxide (N2O) Halothane Alpha-2 selective agonist Enflurane Maintenance Heart block. Injected dentistry anesthesia for longer procedures and post-op pain.PABA . anti-seizures. hepatic toxicity. barbiturates in patients with compromised myocardial contractility Short term sedation of intubated and ventilated patients Analgesia. risk of seizures Potent vasodilator. inhibit excitatory Thiopental Methohexital Vasoconstriction Metabolite . pain at injection site Etomidate Enhance GABA transmission Fast onset. alternative to propofol. salivation. dysrhythmia Direct muscle relaxants. severe bradycardia.

mental aberrations. increased risk of hyperkalemia. layrngospasm Reacts with baralyme to irritate airways A/E CNS . monoaminergic Morphine and hydromorphine-resistant pain. salivation. blurred vision. choreiform movements. bronchospasm. increased intraocular pressure. decreased themroregulary sweating Hexamthonium Mecamylamine Trimethaphan Non-depolarizing Neuromuscular Blockers Vecuronium Rocuronium Pancuronium Atracurium Cistracurium Mivacurium Depolarizing Neuromuscular Blockers Adjunct to nicotine patch Hypertensive. tolerance. kappa agonist Used in combination with NSAIDs Used in combination with NSAIDs Used in combination with NSAIDs Used in combination with NSAIDs Treatment of diarrhea Treatment of diarrhea Treat severe. severe orthostatic hypotension. maintenance Sevoflurane Class of Drug Ganglionic Blockers Example MOA Inhalation induction in children Indications C/I Ganglionic and Neuromuscular Blockers Selective ganglionic blocker Treatment of patients undergoing electroconvulsive therapy Airway irritant. sexual dysfunction. pain of renal and biliary colic Example MOA Indications Opioids and Analgesics A/E Addiction.Desflurane Anesthetic. constant pain. constipation. kappa agonists Mu partial agonist. malignant hyperthermia Unhealed skeletal muscle injury C/I Succinylcholine Class of Drug Strong agonists Morphine Heroin Levorphanol Meperidine Fentanyl Sufentanil Alfentanil Ramifentanil Methadone Mild to Moderate Agonists Codeine Oxycodone Hydrocodeine Hydrocodone Diphenoxylate Loperamide Mixed AgonistAntagonist Nalbuphine Butorphanol Mu antagonist. uptake treatment of opiod abuse Respiratory depression Sedation . marked decrease in blood vessel tone. respiratory suppression Tachycardia Seizures in renal failure Respiratory depression Blocks NMDA. obsteric labor pain. post-op myalgia.tremor. profound inhibition of GI motility. urinary retention in men. dissecting aortic aneurysms Compete with Ach at nicotinic Muscle relaxation during surgery and tracheal receptor intubation Metabolite may cause seizures Paralytic agent of choice in ill patients with impaired renal and hepatic functions Muscle relaxation before and during surgery Effects are not reversible. tachycardia. coughing.

moderate pain Hallucinations Propoxyphene Buprenorphine Naloxone Naltrexone Nalmefene Example Combined with aspirin for less severe pain Partial agonist at mu receptor Opioid dependence Pure opiod antagonists Pure opiod antagonists Pure opiod antagonists MOA Treat opiod overdoses Treat opiod overdoses Treat opiod overdoses Indications Sedatives and Hypnotics Class of Drug Barbiturates C/I A/E Pentobarbital Secobarbital Phenobarbital Glutethimide Barbiturate-Like Meprobamate Chloral hydrate Benzodiazepines Enhance GABA-chloride channel without GABA being present Short term treatment for insomnia. reduces REM sleep Possible suicidal ideation Sedative hypnotic Ambulatory surgery Elderly Anxiolytic agent Children Anxiolytic actions Pain at injection site Pain on injection. withdrawal syndrome. respiratory depression. mu weak agonist Mild . can be teratogenic. anxiety Pulmonary compromised Exacerbates ventilatory failure Alprazolam Lorazepam Metoprobamate Chlorazepate Chloridazepoxide Z-hypnotics Zolpidem (Ambien) Zaleplon (Sonata) Propofol Etomidate Benzodiazepines GABA-A type 1 agonist GABA-A type 1 agonist Stimulates GABA release Teratogenic. avoid alcohol to prevent additive effects Panic disorders. tolerance Azapirones Buspirone Possibly inhibit 5HT release 5HT1A agonist that inhibits dorsal raphe activity Long term anxiety. useful in elderly Generalized anxiety Short term anxiety. not short term panic attacks Persistent anxiety. potentiates CNS depressants. myclonus. sedative-hypnotic Alcohol withdrawal Alcohol withdrawal. exhaustion. not panic disorders Propranolol Mirtazapine Ramelteon Class of Drug Haloperidol Risperidone Olanzaprine Lorazepam Cholinesterase inhibitors Tacrine Donepezil Rivastigmine Galantamine Example Melatonin receptor agonist MOA Performance anxiety Depression and anxiety Shortens latency to sleep Indications Cognitive Disorder Treatments Delirium Delirium Delirium Delirium Treatment of Alzheimer's dementia C/I A/E Hepatotoxicity . intoxication.Pentazocine Weaked Agonists/Partial agonist and antagonists Kappa agonist. abuse and dependence. post-op N/V Cognitive and psychomotor impairment. acute psychosis Sedation preoperatively Anterograde amnesia.

dizziness. LDL. syncope. CO C/I A/E Positive chronotropic and Increase CO inotropic actions Low doses .Class Examples MOA Positive inotropic and chronotropic. dizziness. renal peripheral vascular resistance vascular resistance. hypertensive emergencies. Reduce Familial combined HL. HR. angina and arrhythmias. perioperative hypertension.beta-1 agonist. CHF Bronchoconstriction. hypertension and angina indications Lipid Lowering Drugs HMG-CoA reductase. syncope. acute MI. Beta-2 agonist Beta-1 agonist Alpha-1 agonist Alpha-1 agonist Alpha-1 Antagonists Norepinephrine Isoproterenol Dopamine indications Autonomic Pharmacology Increases SV. reduce areteriole and venous SM Highly selective. nodal dysfunction Increase TGs. syncope. moderate to severe HC. dizziness.vasodilation. maintain renal blood flow Prolonged hypotension Methyldopa Beta-1 Antagonist Hypertension. Reduce arterial pressure. CO. discomfort or weakness in skeletal muscle. arrhythmia prophylaxis after MI. MI. Alpha-1 agonist Beta-1 agonist. thyrotoxicosis. reduce Decrease CO. Labetal Beta-1 Antagonist. Asians. myopathy Examples Rosuvastatin . treat BPH Alpha-1 Antagonists. inc HR. CHF Hypertension. vasoconstriction Beta-1 agonist. rhabdomyolysis. elderly A/E Liver failure. drug tolerance Doxazosin Highly selective. CHF Manage hypertension Terazosin Manage hypertension. Beta2 Antagonist Beta-1 Antagonist CHF. Beta-2 agonist D1 agonist. diaphoresis Beta-1 Antagonist Metoprolol Beta-1 Antagonist Nebivolol Beta-1 Antagonist. lower HDL Atenolol Bisoprolol Carvedilol Esmolol Ultra-short acting Beta-Antagonist Beta-1 Antagonist Beta-1 Antagonist Beta-1 Antagonist. treat BPH Phentolamine Prazosin Highly selective. Partial Beta-2 Agonist Class Statins Acebutolol Pindolol Patients that exhibit bradycardia. reduce areteriole and venous SM Manage hypertension. fatigue and exercise intolerance Partial Beta-1 Agonist Partial Beta-1 Agonist. myoglobinuria. reduce areteriole and venous SM Hypertension. higher .Propranolol 2 Antagonist Decreased glycogenolysis. decreased glucagon secretion. reflex tachycardia Orthostatic hypotension. alpha-agonist Beta-1 agonist. Beta. migraine.resistance vasoconstriction Dobutamine Ephedrine Phenylephrine Midodrine Postural hypotension. peripheral vascular disease Hypotension. SV. decrease oxidative stress Familial L-D Apolipoprotein B and vascular inflammation. Beta-2 Epinephrine agonist. drug tolerance Orthostatic hypotension. antioxidant properties SV arrhythmias. increased systemic doses . glaucoma. vasodilation. MI in acutely ill patients Hypertension. mid Diuresis. drug tolerance Orthostatic hypotension. Beta2 Antagonist Alpha-2 Agonists Clonidine Hypotension. renal injury. alpha-1 agonist Beta-1 agonist. SVT. hypertension and angina Patients that exhibit bradycardia. beta-1 agoinst. CC. syncope Decrease HR. angina pectoris Asthma. arrhythmias associated with thyrotoxicosis. diabetes. stable angina. increase stability atherosclerotic lesions MOA C/I Hepatic parenchymal disease.

M-S Severe peptic disease Familial HyperTG. angiodema. dry cough. impotence. high risk of CV disease. HTN with acute MI. diverticulitis bloating). LDL. inhibits NPC1L1 blocking intestinal absorption of cholesterol and phytosterols MOA Decrease HR. FC HL. claudication. fatigue. myopathy. cannot be Elevated serum triglycerides given simultaneously with and decreased HDL. dysgeusia. white. functional renal failiure Trandolapril Ramipril Captopril Hypoglycemia . ARBs First dose hypotension. Biliar tract levels of aminotransferases. FCHL. Familial L-D apoliprotein B. decrease CC. impairs absoprtion of other drugs Colestipol Cholestyramine Colesevelam Ezetimibe Inhibits intestinal absoprtion of Reduce LDL levels. Heterozygous familial HC. increased aminotransferase activity.CardioSelective Atenolol Metoprolol Beta-Blockers Vasodilating Agents Carvedilol Labetalol Beta-Blockers . Primary chylomicronemia. decreases circulating levels of aldosterone Young. Lp(a). patients taking potassium supplements. NSAIDs.Primary Chylomicronemia. Dysbeta dysfunction. hyperuricemia and gout Fibric Acid Derviatives Fibrates Ligand for PPAR-alpha Decrease TG. chronic kidney diseases.Vitamin B3 Atorvastatin Simvastatin Pravastatin Lovastatin Fluvastatin Niacin Inhibits lipolysis in adipose tissue. cholesterol patients. obese rhabdomyolysis. Lp(a) hyperlipoproteinemia Cutaneous vasodilation and sensation of warmth. anemia. increase potassium. impaired carbohydrate tolerance.ISA Pindolol Acebutolol ACE-Inhibitors Inhibit synthesis of angiotensin. decrease renal renin secretion indications Anti-Hypertensives HTN with ischemic HD. dysbetalipoproteinemia. cold extremities and vivid dreams. disease or patients at high decreased WBC or hematocrit. all potassium-sparing drugs. CHF.Niacin . HTN patients with diabetic neuropathy Pregnancy. HF. VLDL. Acanthosis nigricans. FLD-A phytosterols and cholesterol. Hepatic or renal GI symptoms. increases HDL. high M-S F HTG. developmental defects in newborns. Indications . Raynaud's syndrome. Asian. risk (women. dissecting aneurism C/I Not a CYP450 Substrate Class Beta-Blockers Examples A/E HF. hyperglycemia. LDL. accumulation of bradykinin. FHC. FHC. verapamil bronchospasm. decreases drug metabolism Beta-Blockers . FC HL. high plasms renin activity. nausea and abdominal discomfort. Asthma. decrase TG synthesis in liver and reduce VLDL secretion to decrease LDL Decrease VLDL. Native Americans) gallstones Gemfibrozil Fenofibrate Bile-Acid Binding Resins Form insoluble complex to promote excretion Primary HC Patients with homozygous GI disturbances (constipation.

fever . exacerbate HF Calcium ChannelBlockers Decrease total peripheral resistance Edlerly patients. headache. nursing mothers Angioedema. low potential to cause dry cough. Decrease aldosterone. depression. decrease PV and total peripheral resistance Losartan Candesartan Eprosartan Irbesartan Olmesartan Telmisartan Valsartan Pregnancy First dose hypotension. GI disturbances Well-tolerated. less increased serum potassium. severe HTN in pregnancy smooth muscle Cyanide toxicity Hydralazine Headache. diarrhea. hepatitis. Decrease risk of MI and stroke. slows AV nodal conduction IV . Alpha-2 Receptor Inhibitors Phenoxybenazmine Phentolamine Alpha-1 Selective Blocker Alpha-1 Selective Blocker Alpha-1 Selective Blocker Centrally Acting Drugs Prazosin Doxazosin Terazosin Diagnose and treat pheochromocytoma. less occurrence of angioedema Aliskiren Inhibits renin Pregnancy. stimulates alpha-2 cannot tolerate other drugs receptors to decrease sympathetic outflow Drowsiness. requires coIV for severe HTN emergencies administration with a betablocker Direct vasodilator on vascular Severe refractory HTN. patients who terminals.circulation collapse in patients with beta-blockers. immune hemolytic anemia. coarseness of facial features Minoxidil Sulfate metabolite to activate Severe refractory HTN with a beta-blocker and loop potassium channel and relax diuretic vascular SM Relax vascular SM by preventing NE from interacting with alpha-1 receptors Alpha-Adrenergic Receptor Inhibitors First dose hypotension. effective against BPH Limited by sever postural hypotension Alpha-Methyldopa Taken up by adrenergic nerve DOC for HTN during pregnancy. Angina. can worsen angina Decrease CC.Angiontenin-II Receptor Blockers (ARBs) Inhibit angiontensin-2 receptors. Caribbean patients. urinary incontinence Diagnose and treat pheochromocytoma Alpha-1 Receptor Inhibitors. fluid retention. systemic lupus-like symptoms Hirsutism. ankle swelling. combined with clonidine and propranolol withdrawal syndrome Add-on to treat resistant HTN Bladder outflow tract obstruction. used with quinine for atrial flutter Calcium ChannelBlockers Dihydropyridines Amlodipine Nifedipine Calcium ChannelBlockers Nondihydropryidines Verapamil Vasodilation Flushing. hypotension. African Americans. hyperkalemia. constipation Diltiazem Vasodilators Nitroprusside Decrease CC Releasing NO. postural hypotension. tachycardia. flushing. exacerbate HF.

decrease excretion rates of K. history of TIA. mucosal inflammation or erosion and bleeding. Permanently disables TXA2 production in exposed platelets indications Anti-Thrombolytics Survival benefit in CV conditions C/I Allergy to ASA. decrease syndrome. hypochloremic metabolic alkalosis. Life-threatening hyperkalemia. headaches Weak folic acid antagonist. osteopenic women reabsoprtion of divalent CHF comibed with isotonic saline for severe cations.Class Loop Diuretics Examples indications C/I Diuretics Inhibits Na/K/2 Cl transporter Acute pulmonary edema and edema of nephrotic Postmenopausal in the Loop of Henle. acute glomerulonephritis. impaired carb tolerance. ataxia. drowsiness. hepatic cirrhosis. K-sparing. decrease libido. K wasting hypercalcemia. lethargy. History of asthma and nasal polyps A/E GI upset. gastritis. body weight <60 kg . tinnitus Dyspepsia. Mg Offset excretion of potassium and hyrogen Patients with renal failure. hemorrhagic strokes. exacerbates megaloblastosis. leg cramps and dizziness Hyperkalemia Potassium Sparing Diuretic. H. deepening of voice and menstrual irregularities. hirsuitism. HF. skin rash. Aldosteone Antagonist Spironolactone Primary aldostenosim. diarrhea. taking: ACE-I. HTN secondary to thiazides sufficiency. Ca. treatment of nephrogenic diabetes insipidus. DOC in patients with hepatic cirrhosis Gastric ulcers Impotence. nephrotic syndrome. neutropenia A/E of thienopyridines are most common with this drug. bleeding. ashthma exacerbation (especially with nasal polyps). hyperlipidemia. increase urine flow in drug overdose MOA A/E Hypokalemia. pentamide. refractroy edema. hyperuricemia and gout Alter composition of endolyphm leading to ototoxicity Furosemide Ethacrynic acid Torsemide Bumetanide Thiazides Inhibit Na/Cl symport in the DCT Best therapy for uncomplicated HTN. confusion. gastric bleeding and peptic ulcers. CVA. hypomagnesemia. purpura Thienopyridines Ticlopidine Inhibit ADP-mediated platelet activtion Clopidogrel Prasugrel Used with ASA to treat ACS after stenting With ASA to treat patients who had PCI Patients over 75. chronic liver fialure. treatment of calcium nephrolithiasis and osteoprosis Hypokalemic metabolic alkalosis and hyperuriciemia. increase quinidineinduced Torsades De Pointes Hydrochlorothiazide Chlorothiazide Chlorthalidone Indapamide Potassium Sparing Diuretics Decrease transepithelial voltage. headache Class Eplerenone Examples Aspirin MOA Irreversibly acetylates cyclooxygenase to inhibit TXA2 production. K N/V supplements. induce diarrhea. trimethoprime Amiloride Triamterene Blocks Lithium transport to treat lithium-induced nephrogenic diabetes Hepatic transformation caution in hepatic and renal insufficiency Inhibit mineralocorticoid receptor in epithelial cells to conserve potassium at the expense of sodium Diarrhea.

only for life-threatening ventricular arrhythmias. reduce endpoint in patients who underwent a CABG ACS when PCI is anticipated Bleeding Thrombocytopenia GP IIB/IIIA Inhibitors Abciximab Eptifibatide Tirofiban Dipyridamole Heparin (UFH and LMWH) Bind to activated GP IIb/IIIa receptors Increase cAMP levels to reduce Enhances effect of other antithrombotics aggregation Combine with antithrombin III LMWH has a more predictable anticoagulant effect to inhibit factor Xa Bleeding. ventricular myocytes . hypertrophic obstructive cardiomyopathy. skin necrosis indications Anti-Arrhythmias Atrial Fibrillation and flutter. rash.block cardiac sodium channels. atrial tachycardia. decrease phase 4 slope. atropine-like activity leads to urinary retention. directly depress SA and AV nodes. does not interfere with platelet function Inhibits formation of reduced form of vitamin K Variability in effect by drug interactions. alopecia. does not treatment of DVT and pulmonary embolisms inactivate formed thrombin. neurocardiogenic syncope Obstructive uropathy or glaucoma.slow upstroke and inhibit potassium channels to increase AP duration. knee orthopedic surgery. N/D. skin necrosis. temperature. hepatic byprouct (NAPA) . thrombocytopenia (HIT). agranulocytosis Procainamide Non-specific blockade of K channels.Class III effects (QT prolongation) SV arrhythmias. ECG . hypoaldosteronism Bleeding Direct Thrombin Inhibitors Inhibit thrombin activity independently of antithrombin III. sinus node dysfunction Strong negative inotropic effect can precipitate HF or in pre-existing LV dysfunction. osteoporosis. DO NOT cause HIT Lepirudin Bivalirudin Argatroban Dabigatran Fondaparinux Synthetic Heparin Analog Binds to antithrombin III to DVT prophylaxis for hip. specifical inhibit Xa. hepatitis.Non-Thienopyridine ADP Ticagrelor Antagonist Reversibly binds to ADP receptors Used in combo with ASA to reduce composite endpoint in MI. new onset atrial fibrillation. Bleeding. decrease occurance of reentrant arrhythmias in patients with an MI. treat VT . diltiazem. CVA. prolong QRS and QT Disopyramide Anti-muscarinic effects Requires verapmil. effective against circulating and clot-bound thrombin. CV death. blurred vision Lupus-Like symptoms. dry mouth. fever. embryopathy. monitoring of PT/INR. conduction block between atria and ventricles. beta-blockers. SVT C/I Use with caution in patients with LV dysfunction A/E Prolongation of QRS and QT interval could lead to TDP-type arrhythmias Warfarin Class Class 1A Drugs Examples MOA SA Nodal cells .decreased conduction velocity. ganglionic blocking effects leads to hypotension. dietary vitamin K content. digoxin for effectiveness. increase hold for firing.

thrombocytopenia and hepatitis.increase condution at AV node. high risk of TDP. Decrease RP and shorten AP duration. SV arrhythmias Lidocaine Prophylaxis for ventricular fibrillation after DC cardioversion in an ischemic setting. N/V. not effective in atrial TDP flutter or fibrillation. digoxin. sinus bradycardia and bronchospasm . must have normal EF and require AP with no effect on duraction. decrease conduction velocity and conduction block Propafenone Some beta-blocking activity. local anesthetic. inhibit late-inactivating sodium channels in phase 2 of ventricular AP. paroxysmal SVT QT prolongation.affect lidocaine. verapamil. CNS disturbances confusion. Purkinje fibers. Suppress automaticity of ectopic pacemaker cells Administered with beta-blockers. horizontal gaze nystagmus Class 1C Drugs Profound Na channel blocker. Prophylaxis for SV arrhythmias in a patient with a decrease upstroke potential of normal heart. gravis. no EADs. safe for use in patient with long QT syndrome Low toxicity. profound cardiac depression and pro-arrhythmic effects Flecainide Last resort for life-threatening refractory paroxysmal SVT or VT. syncope Selective for diseased or ischemic cells. inpatient monitoring for pro-arrhythmias decrease conduction velocity in atrial. DOC in acute suppression of ventricular arrhythmias. increase RP in AV node and accessory bypass tracts Pro-arrhythmias including VF and Torsade. mexiletine. seizures. congenital prolonged QT syndrome when beta-blockers fail. anti-cholinergic effect . M. ventricular tachycardia after congenital surgery. maintain AV conduction in digoxin-induced arrhythmias. rifampin Mexiletine Analog of lidocaine Life-threatening ventricular arrhythmias. suppress premature VA Severe exacerbation of arrhythmias in patients with pre-existing VTs. constipation. levels altered by inducers like phenytoin. ventricular arrhythmias in young children. increase digoxin levels. useful in patients that have concurrent seizures and VAs Phenytoin Sodium channel blocker Inducer of CYP3A4 . exacerbate arrhythmias. HF require lower doses of lidocaine. relive chronic pain from peripheral neuropathy. or diltiazem. ventricular. combined with Satolol or quinidine to increase anti-arrhythmic effect and minimize toxicity. sinus node dysfunction. blurred vision. ventricular No QT prolongation.dizziness. Gingival hyperplasia. does not prolong Aps Primarily for SV arrhythmias Metallic tase. BBB. dizziness. dizziness.Quinidine Class 1B Drugs Prolong AP by blocking K channels. accumulation if used concurrently with a betablocker or cimetidine CNS . tremor. continuous infusion only. exhibits anti-alphaadrenergic effects to cause hypotension Block fast sodium channels (mild decrease in phase 0 slope). increase suicide risk. N/V/D. slurred speech (improved if taken with food). heart disease and ventricular ectopy. prevent recurrence of VT. arrhythmias (digitalis toxicity). quinidine. sick sinus Excessive QT prolongation syndrome. confusion. combined with amiodarone in patients that have ICDs and in patients with recurrent VTs Antio-seizure. cinchonism liver failure with tinnitus. SV arrhythmias in patients with normal hearts. atrial fib and flutter.

AV blockade and bradycardia. sexual impotence Propranolol Atenolol Esmolol Metoprolol Class 3 Drugs Block outward potassium Ventricular arrhythmias channels in phase 3 repolarization. No effect on atrial ttisues Blocks K-R. pulmonary fibrosis. caution in patients with SN dysfunction and sick sinus syndrome Bretylium Dronedarone Anti-HTN. oral and IV use in ventricular arrhythmias refractoriness of cardiac tissue. dose mbased creatinine clearance QTC greater than 440 msec Excessive QT prolongation or low K/Mg present. Smurf Syndrome. excessive negative inotropic effect. precipitate HF. weak alphaadrenergic and calcium channel blocking effects. risk of TDP. treat atrial receptors in SA and AV nodes arrhythmias. TDP Amiodarone Pneumonitis.and hyperthryoid states. prevent recurrent infarction and sudden death. require continuous known sinus node ECK monitioring for 4 hours dysfunction or if any group 3 agent in system . decrease peripheral conversion. Na and Betablockers. N/V/C. inhibit conduction in accessory bypass tracts Block delayed rectifier potassium current to cause hypokalemia Treatment of life-threatening VT or fibrillation when all else has failed Profound orthostatic hypotension Maintain sinus rhythm after conversion from atrial fib. acute HF. K-S. restore normal sinus rhythm in atiral fib. prolongs AP and action. hypotension and hepatic toxicity. exercise-induced or catecholamineinduced arrhtymias (during exercise or emotional stress) Bronchospasm.Class 2 Drugs block beta-1 adrenergic Most useful anti-arrhythmic agents. corneal deposition (halo vision). prolong AP duration and increase RP in ventricular and Purkinje fibers. increases activities of warfarin and digoxin. initiated in hopsital with ECK monitoring Slow repolarization by blocking Conversion of atrial fib and flutter K-R. substitute for amiodarone. increase RP of atrial and ventricular tissues. betablocking effects. lower incidence than amiodarone Sotalol Fatigue and bradycardia may occur. symptomatic bradycardia. photosensitivity. enhance slow inward sodium current that prolong repolarization Hypokalemia and bradycardia <50 Dose-dependent QT prolongation. prolong AP of Purkinje and ventricular muscle fibers. broad spectrum of anti-arrhythmic potassium. (first line) in patients with HF or recent MI block sodium channels to derpess phase 0 slope. Blocks rapid current of SV arrhythmias. can create hypo. structural analog of amiodarone with no iodine Block Beta-receptors. little or no effects on phase 0 depolarization or conduction velocity.sleep disturbance and depression. Class III. excreted exclusively in kidneys and dose must be adjusted in renal diseases. slows HR and AV conduction Bradycardia and heart block. Block NE release and can cause orthostatic hypotension. TDP Dofetilide Ibutilide Maintain and restore sinus rhythm in atrial fibrillation after cardioversion. CNS . cold extremities. decrease mortality or hospitalization in patients with atrial fib Severe ventricular and SV arrhythmias. prevent atrial flutter and fib Similar to amiodarone. block ptoassium channels and prolong AP. prolonged QT interval leading to EADs. impotence due to the beta-2 blockade in the periphery.

decrease phase 0 slope. treatment of reentrant PSVT. diagnose and K channels and inhibit calcium treat arrhtymias currents. vasospastic angina. peak T waves and slur QRS complexes. DOC for decreasing peripheral vascular chronic therapy of LV dysfunction. effective adjunt to quinine or disopyramide Diltiazem Other Drugs Adenosine Activate outward rectifier K DOC for rapid termination of narrow-complex PSVT. TDP. Na channels. decrease CC and decrase BP Sick Sinus. AV block Verampil L-type calcium blockade. constipation. Vbigeminy. slow ventricular rate beta-blocker or CCBs bradyarrhythmias in atrial fib an flutter.fatal if acute Class Loop Diuretics Examples MOA A/E Volume depletion or electrolyte imbalance Furosemide Torsemide Bumetanide Thiazide Diuretics Hydrochlorothiazide Chlrothiazide Chlorthalidone Vasodilators Nitrates Dilate veins to decrease VR. given before ibutilide to prevent VT/VF Hyperkalemia .decrease ectopic pacemaker acitivty. elevate threshold potential. influence Na/K ATPase. current via G-protein coupled IV for termination of resistant AVNRT. K therapy is only used to normalize K gradients and pools in the body indications Treatment of Heart Failure Restore normal volume stauts in patients with HF C/I Hypokalemia . Reentrant paroxysmal SVT type calcium channels. AV block. Decrease pulmonary congestion and improve increase capacitance.pro-arrhythmia. congestion and afterload decrease maladaptive LV remodeling by decreasing aldosterone Captopril Trandolapril Lisinopril Enalapril Bilateral renal artery stenosis Excessive amounts can lead to a hypotensive state Restore normal volume stauts in patients with HF Hydralazine ACE-Inhibitors . slow conduction and increase RP of the AV node Hypertension. more potent in SA and AV nodes. decreases resistance and vasodilation. decrease AV conduction and increase AV RP. very short half life Digoxin Bradycardia. K channels and Ca channels Potassium Digitalis-induced arrhythmias when hypomagnesaemia is present. decreased Used if major symptom is fatigue afterload and increase SV Decrease afterload by Prolong survivial of patients with CHF. slows SA node automaticity and AV conduction velocity. hyperkalemia . effects are inhibited by caffeine and theophylline Vagal stimulation. very narrow therapeutic index. suppress SA node. decrease dyspnea ventricular filling pressure and hydrostatic force Arterial vasodilator. SOB and chest burning. low potassium exacerbates toxicity Cause AV block Magnesium Unknown.SVT.Class 4 Drugs Selective inhibition of cardiac L. secondary to calcium channels and beta-blockers Flushing. use is for the Caution with concomitant Hypotension. slow conduction through AV node and bundle of His Control VR in atrial flutter and fib.

synergistic short-term hemodynaic support after MI. propensity to produce tachycardia and ventricular arrhtymias. inhibit HF with ventricular dysfunction. with beta-agonists cardiac transplant candidates Inamrinone Milrinone Tachyarrhythmias. improve survivial and hospitalization in patients that are stable (no congestion) Metoprolol Carvedilol Bisoprolol Risk of acute deterioration (due to negative inotropic effect) Other Drugs Nesiritide Anti-Coagulants Human recombinant B-type natriuretic peptide Prevent intra-cardial thrombosis if LV severely impaired Promote diuresis. DOC for chronic therapy of LV dysfunction. acute HF with depressed CO and poor tissue perfusion pro-arrhythmic. Atrial flutter and Na/K ATPase.alpha-1 agonist Cardiogenic shock. acute cardiogenic circulatory faillure that have borderline channel to cause calcium influx angina Low doses . hypercalcemia. decrease fibrillation and paroxysmal SVT. increase mortality in patients with severe HF Thrombocytopenia Increased mortality Aldosterone Antagonists Spironolactone Eplerenone Beta-Blockers Decrease mortality and hospitalization in patients with HF. Not suitable for patients phosphorylates calcium acute HF. increase automaticity and ectopic rhythms.D1 agonist. Most commonly used inotropic agent for acute HF. relief of bronchospasm.beta-2 agonist. increase oxygen demand and proangina Unpredictable vasodilator effect. IV lidocaine Digoxin Digitoxin Beta-Adrenergic Receptor Agonists Dobutamine Positive inotropic agent Preferred over digoxin with heart failure and concomittant kidney disease Beta-1 and Beta-2 agonist. HF and conduction through AV node. concomitant SVT inhibit sympathetic outflow and enhance vagus tone Pro-arrhythmic (shorten AP duration. exacerbated by hypokalemia. tolerance Dopamine Other Beta-Adrenergeric Receptor Agonists Epinephrine Norepinephrine Isoproterenol Vasopression Phosphodieterase (PDE) Inhibitors Positive inotropic agent Short term use due to A/E Not appropriate for patients who are borderline angina Increase oxygen demand of the heart Resuscitation after cardiac arrest. selective inhibition. decreases congestion and afterload Losartan Candesartan Telmisartan Valsartan Digitalis Positive inotropic agent. high doses . decrease congestion. hypomagnesaemia. administered with ACE-Is Decrease hemodynamic deterioration and improve survival secondary to decreased chronic sympathetic stimulation. Intoxication requires anti-digoxin antibody. PDE-3 Poor systemic circulation and/or cardiogenic shock. prone to ischemia. mid doses . life-threatening tachycardia Positive inotropic agent. surgery. GI disturbances (N/V. less negative RMP. heart block). arrhythmias may be treated with potassium. anorexia).ARBs Prolong survivial of patients with CHF. combined with diuretics and inotropic drugs .

Anti-Arrhythmias (amiodarone) .