Medication Class

Question 1

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors

Answer 1

• lipid-lowering agents
• indications: dyslipidemia (high LDL, low HDL), hypertriglyceridemia, prevention of coronary heart disease
• contraindicated in active liver disease, persistent elevated AST/ALT, pregnancy, lactation
• inhibits enzyme responsible for catalyzing early step of cholesterol synthesis
• LFTs, cholesterol and TGAs q. 3-6 months
• administer in evening (more cholesterol synthesized at night)
• avoid grapefruit juice
• SE/ADRs: myopathy, hepatotoxicity
• atorvastatin (Lipitor), rosuvastatin (Crestor), lovastatin (Mevacor), simvastatin (Zocor)

Question 2

aldosterone receptor blocker

Answer 2

• potassium-sparing diuretic
• indications: hypertension, edema associated with cirrhosis or nephrotic syndrome, primary aldosteronism, acne, transgender hormone therapy (male to female)
• contraindications: anuria, hyperkalemia, acute renal insufficiency, renal impairment, Addison’s disease, eplerenone
• causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions; inhibits testosterone secretion and androgen binding on androgen receptor
• weak diuresis; used to counteract potassium wasting effect of other diuretics
• SE/ADRs: hyperkalemia
• spironolactone (Aldactone, Carospir)

Question 3

angiotensin converting enzyme (ACE) inhibitors

Answer 3

• RAAS inhibitor, antihypertensive
• blocks conversion of angiotensin I to angiotensin II; prevents degradation of bradykinin and other vasodilatory prostaglandins; increase plasma renin; decrease plasma aldosterone; causes diuresis and natriuresis → vasodilation, decreased blood volume/CO, decreased arterial pressure
• indications: hypertension, heart failure, myocardial infarction, diabetic nephropathy (unlabeled)
• contraindications: pregnancy, lactation
• SE/ADRs: first dose effect, hypotension, angioedema, hypokalemia, hyperkalemia, cough
• captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil)

Question 4

angiotensin II receptor antagonist (ARBs)

Answer 4

• RAAS inhibitor, antihypertensive
• blocks vasoconstriction and aldosterone-secreting effects of angiotensin II at various receptor sites (vascular smooth muscle and adrenal glands) → vasodilation, diuresis, decreased blood volume/CO, decreased arterial pressure
• indications: hypertension, heart failure, MI, diabetic nephropathy, stroke prevention in pts c/ HTN and left ventricular hypertrophy
• contraindications: bilateral renal artery stenosis, pregnancy, lactation
• SE/ADRs: first dose effect, hypotension, angioedema, hypokalemia, hyperkalemia
• losartan (Cozaar), candesartan (Atacand), valsartan (Diovan)

Question 5

anti-emetics

Answer 5

• indication: nausea and vomiting
• SE/ADRs: excessive sedation, respiratory depression
• promethazine (Phenergan), metoclopramide (Reglan), prochlorperazine (Compazine), ondansetron (Zofran)

Question 6

anti-platelets

Answer 6

• treats and prevents thromboembolic events (MI, stroke, PAD)
• inhibits platelet aggregation; irreversibly changes platelets
• ADRs: bleeding, gastric ulceration, renal impairment, ototoxicity, salicylism (N/V, tinnitius)
• aspirin, clopidogrel (Plavix), ticagrelor (Brintilla), 1st generation NSAIDs

Question 7

Anticoagulants

Answer 7

• Interrupt coagulation cascade and thereby reduce fibrin formation
• Indications: venous disease processes; treatment and prevention of VTEs; atrial fibrillation
• prevent clot formation and extension; do not dissolve clots
• contraindicated in coagulation disorders, malignancies, ulcers, recent surgery, active bleeds
• heparin, enoxaparin, warfarin, fondaparinux, rivaroxaban, apixaban, dabigatran

Question 8

beta-1 adrenergic receptor antagonists

Answer 8

• antihypertensive; cardioselective beta blocker
• compete with norepinephrine and epinephrine at beta-1 adrenergic receptor sites in heart resulting in decreased sympathetic activity → decreased heart rate, decreased cardiac contractility
• indications: angina, hypertension, MI/CAD (core measure), heart failure
• contraindications: pulmonary edema, uncompensated HF, cardiogenic shock, bradycardia, heart block
• SE/ADRs: bradycardia, hypotension, fatigue, erectile dysfunction, hypoglycemic unawareness
• do not abruptly discontinue
• metoprolol (Lopressor), atenolol (Tenormin)

Question 9

beta-1 and beta-2 adrenergic receptor antagonists

Answer 9

• antihypertensive; non-cardioselective beta blocker
• compete with epinephrine and norepinephrine at receptor sites in heart, bronchioles, and vascular smooth muscle resulting in decreased sympathetic activity → decreased HR, decreased contractility, some vasoconstriction, and bronchoconstriction
• indications: angina, hypertension, MI/CAD (core measure), heart failure
• contraindications: asthma, acute bronchospasm, lung issues, uncompensated HF, pulmonary edema, cardiogenic shock, bradycardia, bradyarrhythmias, heart block
• SE/ADRs: bradycardia, hypotension, bronchospasm, fatigue, erectile dysfunction, hypoglycemic unawareness
• carvedilol (Coreg), labetolol (Trandate), propranolol (Inderal)

Question 10

calcium channel blockers

Answer 10

• antihypertensive
• blocks entry of calcium into cells of vascular smooth muscle and myocardium → dilation of coronary arteries and inhibition of vasospasm; diltiazem and verapamil also slow conduction through AV node → slowed HR
• indications: angina, hypertension, coronary artery vasospasm, dysrhythmias (verapamil and diltiazem), cerebral vasospasm (nimodipine; has relatively selective effect on cerebral blood vessels)
• contraindications: bradycardia, heart block (2nd or 3rd degree), decompensated HF
• SE/ADRs: bradycardia, heart block, hypotension, constipation
• verapamil (Calan), diltiazem (Cardizem), amlodipine (Norvasc), nifedipine (Procardia), nicardipine (Cardene)

Question 11

cephalosporins

Answer 11

• broad-spectrum antibiotics
• action: binds to bacterial cell wall membrane, causing cell death
• cross-sensitivity to penicillins
• SE/ADRs: anaphylaxis, rash, diarrhea, CDAD
• cefazolin (Ancef, Kefzol), cephalexin (Keflex), cephtriaxone (Rocephin), cefepime (Maxipime)

Question 12

centrally-acting anti-adrenergics

(alpha II adrenergic agonists)

Answer 12

• antihypertensive
• stimulates alpha receptors in CNS producing decreased sympathetic outflow to heart, blood vessels, and kidneys → inhibits cardioacceleration and vasoconstriction causing decreased blood pressure, peripheral resistance, and heart rate; stimulates alpha receptors in spinal cord to prevent pain transmission to CNS
• indications: hypertension, adjunctive treatment of neuropathic pain, management of opioid withdrawal
• SE/ADRs: rebound hypertension, hypotension, sedation, dry mouth
• methyldopa (Aldomet), clonidine (Catapres)

Question 13

Direct thrombin inhibitor

Answer 13

• anticoagulant
• Treatment and prevention of DVT,PE, and A-fib
• increased RF for GI upset or bleeding
• Antidote is dialysis
• ADR: bleeding, GI disturbanct
• dabigatran (Pradaxa)

Question 14

factor Xa inhibitors

Answer 14

• anticoagulant to treat and prevent PE/DVT and atrial fibrullation
• fondaparinux (Arixtra)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)

Question 15

glucocorticoids

Answer 15

• steroidal anti-inflammatory, immune modulator (immunosuppressant)
• SE/ADRs: osteoporosis, hyperglycemia, fluid retention, impaired wound healing, increased risk for infection
• DO NOT abruptly d/c med; must be tapered off to prevent adrenal insufficiency
• prednisone (Rayos, Sterapred), methylprednisolone (Solu-Medrol, Depo-Medrol), betamethasone, budesonide (Pulmicort), cortisone, dexamethasone, hydrocortisone (Cortef, Solu-cortef), prednisolone (Orapred)

Question 16

loop diuretics

Answer 16

• indications: hypertension, edema due to HF, hepatic impairment, or renal disease
• contraindications: cross-sensitivities with thiazides and sulfonamides possible, hepatic coma, anuria
• inhibits reabsorption of sodium and chloride from loop of Henle and distal renal tubule; increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium
• effective with impaired renal function/decreased GFR
• produces large amounts of diuresis
• monitor I&O, daily weight
• SE/ADRs: dehydration, hypokalemia, electrolyte imbalances
• furosemide (Lasix), bumetanide (Bumex)

Question 17

moderate to strong opioid agonists with acetaminophen

Answer 17

• indication: moderate pain (4-6)
• max 4g/day for acetaminophen
• SE/ADRs: respiratory depression, constipation, urinary retention, cough suppression, change in LOC, sedation
• PO meds
• oxycodone/acetaminophen (Percocet), hydrocodone/acetaminophen (Lortab, Norco, Vicodin)

Question 18

non-steroidal anti-inflammatory drugs (NSAIDs)

Answer 18

• indications: mild to moderate pain, fever, inflammatory conditions
• contraindications: hypersensitivity to aspirin
• action: analgesic and anti-inflammatory effects due to inhibition of prostaglandin synthesis; antipyretic effects due to vasodilation and inhibition of prostaglandin synthesis in CNS
• SE/ADRs: gastric ulcers, bleeding/increased clotting time, renal impairment
• give with food and full glass of water to decrease gastric upset

Question 19

penicillins

Answer 19

• anti-infective/anti-antibiotic
• action: binds to bacterial cell wall resulting in cell death
• narrow-spectrum; active against most Gm+, some Gm-, some anaerobic, some spirochetes
• only treatment for enterococcal endocarditis
• SE/ADRs: anaphylaxis/hypersensitivity reactions, rash, diarrhea, seizures
• most common cause of drug allergy
• PenicillinV (PO), PenicillinG (IM, IV), benzathine (IM), procaine (IM)

Question 20

Sedative hypnotic anxiolytics

Answer 20

• Benzodiazepines
• enhance GABA effects in CNS
• rapid-acting
• short-term use r/t RF dependence and withdrawal Sx
• SE/ADRs: CNS depression (dizziness, ataxia, sedation, lightheadedness, decreased cognitive function), anterograde amnesia, oral toxicity (lethargy, confusion), IV toxicity (respiratory depression, sever HoTN, cardiac/respiratory arrest), paradoxical effects
• diazepam and lorazepam for IV use
• flumazenil is antidote; oral gastric lavage, activated charcoal, saline cathartics for PO toxicity
• Contraindications: pregnancy, breastfeeding, sleep apnea, respiratory depression, glaucoma
• Interactions: CNS depressants (alcohol, barbiturates, opioids), grapefruit juice, high fat foods
• alprazolam (Xanax), diazepam (Diastat), lorazepam (Ativan), chlordiazepoxide (Librium), oxazepam (Serax), clorazepate (Tranxene), clonazepam (Klonopin)

Question 21

strong opioid agonists

Answer 21

• indication: severe (7-10) pain
• SE/ADRs: respiratory depression, respiratory arrest, change in LOC, sedation, cough suppression, constipation, urinary retention, hypotension, euphoria/addiction potential
• do not crush/chew pills
• morphine, hydromorphone (Dilaudid)

Question 22

thiazide diuretics

Answer 22

• indications: hypertension (1st line Tx), edema associated with HF, renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy
• contraindications: cross-sensitivities with sulfonamides, lactation, anuria
• inhibits sodium reabsorption in distal convoluted tubule; promotes excretion of water, sodium, chloride, potassium, hydrogen, magnesium, phosphate, and bicarbonate
• takes time to work; not effective with reduced GFR; mild diuresis
• SE/ADRs: electrolyte imbalance, hypokalemia, dehydration
• hydrochlorothiazide/HCTZ (Hydrodiuril, Microzide)

Question 23

vasodilators

Answer 23

• antianginal, nitrates
• indications: hypertension, angina, heart failure
• contraindications: ED meds
• SE/ADRs: hypotension, reflex tachycardia, headache
• isosorbide (Isordil), hydralazine (Apresoline), nitroglycerine (Nitro)

Question 24

tetracyclines

Answer 24

*broad-spectrum antibiotic
*tetracycline, doxycycline, minocycline, tigecycline
*indications: treats unusual organisms (Mycoplasma, Chlamydia, Rickettsia, Borellia burgdorferi); periodontal disease, chlamydia, gonorrhea and syphilis in PCN-allergic pt, H. pylori, acne
*contraindications: children < 8 years (tooth staining), lactation, pregnancy
*SE/ADRs: tooth discoloration, hepatotoxicity, renal toxicity, photosensitivity, GI upset
*notes: binds with calcium; take 2 hours before or 6 hours after antacids, calcium supplements, zinc products, laxatives containing magnesium, iron; do not take with Ca/Fe/milk

Question 25

aminoglycosides

Answer 25

*Treats serious Gram negative organisms when less-toxic ABX contraindicated; only used when causative organism is known *gentamicin (Garamycin), amikacin (Amikin), streptomycin, tobramycin (Nebcin) *contraindication: pregnancy *SE/ADRs: ototoxicity, nephrotoxicity *usually only given parenterally

Question 26

Short-Acting Beta Agonist

Answer 26

*Bronchodilator; relieves bronchospasm associated with asthma or COPD *Emergency inhaler *affects mostly beta-2 receptors, also beta-1 * SE/ADRs: tachycardia, palpitations, tremors, headache, nausea, BP changes, restlessness, nervousness, dizziness, dry/irritated throat, unusual taste, paradoxical bronchospasm *albuterol (Proventil, Ventolin, ProAir); levalbuterol (Xopenex)

Question 27

Long-Acting Beta Agonist

Answer 27

-- Bronchodilator; relieves bronchospasm associated with asthma or COPD -- affects beta-2 receptors -- not for emergency use; maintenance therapy -- taken before steroid inhaler; wait 5 minutes between meds -- SE/ADRs: palpations, tachycardia, tremors, nervousness, headache, nausea, bad taste, dry mouth, BP changes -- formoterol (Foradil, Perforomist), salmeterol (Severent)

Question 28

Tuberculosis meds

Answer 28

-- isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), ethambutol (Myambutol) -- pt on 2-4 meds for 6-12 months; compliance is crucial