NAPLEX General Drug Class information

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NAPLEX General Drug Class information
2014-06-25 16:17:43

Basic drug class SE, CI, BBW, MOA, Preg-cat. Not specific drug info.
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  1. Biguanide: 
    • MOA: decreases glucose production, intestinal absorption, improves insulin sensitivity
    • SE: Diarrhe, N/V/flatulence, vit B12 deficency, weight neutral,
    • CI: Scr >1.5 (males), 1.4 (females), CrCl <60, metabolic acidosis, w iodinated contrast media, Hypoxia, Hepatic failure
    • BBW: Lactic Acidosis
    • PREG: B
  2. Sulfonylureas:
    Chlorpropamide, Glipizide, Glimepiride, Glyburide
    • MOA: stimulate insulin secretion from pancreatic beta cells.
    • SE: Hypoglycemia, weight gain
    • CI: w use of Meglitinides (same MOA)
    • Warning: Sulfa Allergy caution
    • PREG: C
  3. Meglitinides:
    Repaglinide, Nateglinide
    • MOA: stimulate insulin secretion from pancreatic beta cells
    • SE: Hypoglycemia, mild weight gain, URTI
    • CI: w use of Sulfonylureas (same MOA)
    • PREG: C
  4. Thiazolidinediones (TZD)
    Pioglitazone, Rosiglitazone
    • MOA: PPARgama agonist (increases peripheral insulin sensitivity therefore glucose uptake)
    • SE: peripheral edema, weight gain, URTI, CHF, LFTs
    • Warning: not if active bladder cancer
    • BBW: HF NYHA class III/IV
    • PREG: C
  5. Alpha-Glucosidase Inhibitors
    Acarbose, Miglitol
    • MOA: AG-I stops conversion of saccharides to glucose in the brush border of the SI
    • SE: GI effects (flatulence, D, abdominal pain), weight neutral
    • CI: IBD, Colonic ulceration, intestinal obstruction
    • PREG: B
  6. Dipeptidyl peptidase IV inhibitors (DPP-4)
    Sitagliptin, Saxagliptin, Linagliptin, Alogliptin
    • MOA: prevent break down of incretin hormones, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) (increase insulin release from pancreatic beta cells, decrease glucagon secretion from pancreatic alpha cells)
    • SE: URTI, UTI, nasopharyngitis, edema, rash, hypoglycemia, (rare-pancreatitiis), weight neutral
    • PREG: B
  7. Sodium Glucose Co-Transporter-2 Inhibitor (SGLT2)
    Canagliflozin (Invokana)
    • MOA: increases urinary glucose excretion in proximal renal tubules
    • SE: Female genital mycotic infections, UTI, hyperkalemia,↑ (urination, thirst), hypo (volemia, tension, hypoglycemia)

    • CI: CrCl<30, ESRD, on dialysis
    • Caution: may lower insulin, or insulin secretagogue
    • PREG: C
  8. Glucagon-Like Peptide-1 agonist (GLP-1)
    Exenatide (Byetta)
    Liraglutide (Victoza)
    MOA: ↑ insulin secretion, ↓ glucagon secretion, slow gastric empyting, improve satiety

    • SE: Nausea, V/D/C, Hypoglycemia, weight loss
    • Warning: Pancreatitis (hx of pancreatitis, gallstones, alcoholism, high triglycerides), CrCl <30, family hx thyroid cancers
    • BBW: possible thyroid C-cell carcinoma, 
    • PREG: C
  9. Synthetic Amylin
    Pramlintide (Symlin)
    • MOA: produced by beta cells for postprandial glucose control, slow gastric emptiying, prevents increased serum glucose, increases satiety
    • SE: Hypoglycemia (reduce meal-time insulins by 50%), Nausea, anorexia, weight loss 
    • CI: gastroparesis, hypoglycemia unawareness
    • BBW: co-administration of insulin
    • PREG: C
  10. Bile Acid Binding Resins
    Colesevelam (Welchol)
    • MOA: blocks reabosrption but unknown how it improves glycemic control.
    • SE: Constipation, N, bloating, dyspepsia, ↑ TG (5%),

    • CI: bowel obstruction, TG>500, hs TG induced pancreatitis
    • PREG: B
  11. RA Biologic Agents: TNFa-I
    Etanercept (Enbrel)
    Adalimubab (Humira)
    Infliximab (Remicade)
    Certolizumab (Cimzia)
    Golimumab (Simponi)
    • MOA: Tumor Necrosis Factor-α-I
    • SE: injection site reactions, HA, N
    • CI: active systemic infection
    • BBW: Serious infections, lymphomas and malignancies, reactivation of latent TB
    • PREG: B
  12. RA Biologic Agents: CD20 B-cell
    Rituximab (Rituxan)
    • SE: flu-like symptoms, bone marrow supression, angioedema
    • BBW: fatal infusion reactions, Progressive multifocal leukoencephalopathy (PML), Tumor lysis (acute renal failure), SJS, TEN
    • PREG: C
  13. RA Biologics:
    Anakinra (Kineret) IL-1 receptor antagonist
    Abatacept (Orencia) T-cell-I (Binds CD80, 86)
    Tocilizumab (Actemra) IL-6 receptor antagonist
    • Warning: latent TB
    • SE: injection site reations, HA, bone marrow suppression,  
    • PREG: B (anakinra), C
  14. Hypothyroid treatment:
    levothyroxine (Synthroid, Levothroid, Levoxyl)
    Thyroid Desiccated (Arnour thyroid)
    Liothyronine (T3) (Cytomel, Triostat)
    Liotrix (T3, T4) (Thyrolar)
    • MOA: replaces thyroid hormone
    • SE: none if dosed correctly, hyper/hypo thyroid symptoms otherwise,
    • BBW: not for obesity or weight loss
    • CI: Acute MI, Thyrotoxicosis, uncorrected adrenal insufficiency
    • PREG: A
  15. Hyperthyroid treatment:
    Propylthiouracil (PTU) (Propyl-Thyracil)
    Methimazole (Tapazole)
    • MOA:  blocks oxidation of iodine in thyroid gland
    • SE: GI upset, HA, rash, constipation, SLE-like syndrome, Hepatitis, agranulocytosis
    • PREG: D, PTU preferred in 1st Trimester, Methimazole in 2, 3rd trimester
  16. Immunosuppressive agents: 
    Antithymocyte Globulin
    Atgam (Equine)
    Thymocyte (Rabbit)
    • MOA: binds T-lymphocytes (activated)
    • SE: anaphylaxis, flu-like symptoms, rash, leukopenia, chest pain,
    • BBW: anaphylaxis- under direct supervision of experienced physician
    • PREG: C
  17. Immunosuppressive agents: IL-2 r antagonist
    Basiliximab (Simulect)
    • MOA: monoclonal antibody prevents activated T-cell
    • SE: Hypertension, GI upset N/V/cramping, URTI, cough
    • BBW: under physicians care when administered
    • PREG: B
  18. Cordicosterioids
    • MOA: supress inflammation and humoral immune responses
    • Short term SE: fluid retention, stomach upset, emotional instability, insomnia, weight gain, ↑ (glucose, BP, and appetite)

    Long term SE: Adrenal suppression, impaired wound healing, Glaucoma, osteoporosis, GI bleeding, fat redistribution
  19. Immunosuppressive agents: T-lymphocyte I
    Mycophenolate (CellCept)
    Mycophenolic Acid (Myfortic)
    Azathoprine (Azusan, Imuran)
    • MOA: inhibit B cell, T-lymphocyte proliferation by altering purine synthesis
    • SE: GI upset, bone marrow suppression infections, LFT, 
    • BBW: Infections, lymphomas, 
    • Warning: Mycophenolate (congenital malformations, abortifactant), Azathioprine (hematologic toxicities, mutagenic potential)
    • PREG: D
  20. Immunosuppressive agents: Calcineurin Inhibitors
    Tacrolimus (Prograf, Astagraf)
    Cyclosporine (Neoral, Gengraf, Sandimmune, Restasis)
    • MOA: inhibits T-lymphocyte activiation (unknown)
    • SE: Severe GI upset, Nephrotoxicity, QT prolongation, Hyperglycemia, infections, UTI,
    • Warning: Cyclosporine- gingival hyperplasia. Tacrolimus not for liver transplant, 
    • BBW: infection, lymphoma, Renal impairment
    • PREG: C
  21. Immunosuppressive agents: Mammalian Target Rapamycin Kinase Inhibitor (mTor)
    Everolimus (Zortress, Afinitor)
    Sirolimus (Rapamune)
    Belatacept (Nulojix)
    • MOA: inhibits T-lymphocyte activation and proliferaction (synergistic w CNIs)
    • SE: GI upset, pneumonia, hyperglycemia, high lipid panel, electrolyte depletion
    • BBW: infection, lymphoma
    • Warning: Sirolimus, Belatacept not for liver transplant
    • PREG: C
  22. Bisphosphonates:
    Alendronate (Fosamax, Binosto)
    Risedronate (Actonel, Atelvia)
    Ibandronate (Boniva)
    Zoledronic Acid (Reclast) Injectable
    • MOA: inhibit osteoclast activity
    • SE: Hypocalcemia, bone-joint-muscle pain, dyspepsia, N/V esophagitis, Jaw necrosis
    • CI: inability to sit or stand for 30min after dose (hour for Ibandronate)
    • Warning: after 3-5 years stop due to risk of femur fracture, exophageal cancer, osteonecrosis of jaw.
    • PREG: C
  23. Osteoporosis agent:
    Teriparatide (Forteo)
    • MOA: recombinant human PTH 1-34, stimulates new bone formation, depresses osteoclast activity
    • SE: orthostasis, injection site reaction, hypocalcemia, increased HR
    • BBW: Osteosarcoma
    • PREG: C
  24. Osteoporosis agent: 
    Denosumab (Prolia)
    • MOA: monoclonal antibody binds nuclear factor-kappa ligand (RANKL) preventing osteoclast formation
    • SE: fatigue, hypocalcemia, rash, limb weakness and pain, N, dyspnea, cough
    • CI: hypocalcemia
    • Warning: Osteonecrosis of jaw, esophagitis-to cancer, High risk agent
  25. Testosterone Products:
    AndroGel 1%
    Testim gel 1%
    Androderm Patch
    Striant buccal tabs
    Solution (Axiron)
    Gel (Fortesta)
    Depo-Testosterone IM
    • MOA: replaces depleted hormones
    • SE: Hepatotoxicity, sensitive nipples, gynecomastia, dyslipidemia, edema, creatinine and PSA increases
    • BBW: exposure to children/women.
    • CI: Brest-Prostate cancer,
    • Warning: increased BPH symptoms, never apply to breast/genital area
  26. Estrogen Products:
    • MOA: estrogen replacement
    • SE: N, bloating, breast tenderness, increased triglycerides and HDL
    • CI: abnormal vaginal bleeding, Any clotting disorder or hx, liver disease, hormone dependent cancer.
  27. Progestin Only products:
    • SE: breast tenderness, HA, fatigue, moody,
    • Warning: high risk of clots
  28. Pain Management agent:
    Acetaminophen (Tylenol)
    Duel products with opioids
    • MOA: prostaglandin synthesis-I, blocks pain impulse peripherally
    • SE: Hepatotoxicity, rare but SJS, TEN, AGEP and nephrotoxicity
    • BBW: Hepatotoxicity (>4g/day)
    • PREG: B preferred agent in pregnancy
  29. Aspirin and NSAIDS:
    Ibuprofen (Motrin, Advil)
    Naproxen (Aleve, Naprosyn)
    Diclofenac (Cataflam, Voltaren)
    Indomethacin (Indocin)
    Piroxicam (Feldene)
    Ketorolac (Toradol, Sprix)
    • MOA: inhibit Cox, PG, and Thromboxane
    • SE: Dyspepsia, heartburn, GI irritation/bleeding, renal impairment, CNS effects, Rare-SJS, TEN,↑ BP,
    • CI: Aspirin in children (<16)w any viral infection, Avoid in 3rd trimester-C/D
    • BBW: CV thrombotic events, GI bleed, CABG treatment, MEDGUIDE
    • PREG: C/D in 3rd trimester
  30. NSAIDs: COX-2 selective
    Celecoxib (Celebrex)
    Meloxicam (Mobic)
    Etodolac (Lodine)
    Nabumetone (Relafen)
    • MOA: Selective COX-2 inhibition
    • SE: Less GI complication than NSAIDS, Increased risk of MI/stroke, Nephrotoxicity,
    • CI: sufonamide allergy (celebrex)
    • BBW: CV thrombotic events, GI bleed, CABG treatment,
    • PREG: C <30 weeks, D ≥30 weeks
  31. Opioids:
    • MOA: Mu receptor agonist
    • SE: N/V/Constipation, CNS (sedation), pruritis, diaphoresis,
    • BBW: Respiratory Depression
    • PREG: B/C
  32. Opioid agonist/SNRI:
    Tramadol (Ultram, Ultracet)
    Tapentadol (Nucynta)
    • MOA: Mu agonist, SNRI
    • SE: N/C, insomnia/sedation, HA, 
    • Warning: Seizure risk, Serotonin Syndrome
    • BBW: Tapentadol- respiratory depression
    • PREG: C
  33. Addiction/Overdose:
    Burenorphine (Butrans-patch, Buprenex-Inj)
    Naloxone (Nalmefene)
    Combo (suboxone)
    • MOA: Buprenorphine (Mu agonist), Naloxone (opioid antagonist)
    • SE: Sedation, HA, mental impairment, respiratory depression, N/V/C, dry mouth
    • BBW: bupronorphine- QT prolongation (patch > 20mcg/hr)
    • PREG: C
  34. Muscle Relaxant/Spasticity agents:
    Baclofen (lioresal)
    Cyclobenzaprine (Flexmid, Amrix, Flexeril)
    Tizanidine (Zanaflex)
    Carisoprodol (Soma)
    Metaxalone (Skelaxin)
    Methocarbamol (Robaxin)
    • MOA: depresses CNS activity- sedation and analgesic effects
    • SE: Excessive sedation, dizziness, confusion
    • BBW: avoid abrupt withdrawal of intrathecal baclofen causes organ failure and death
    • PREG: B (Cyclobenzaprine) C (rest)
  35. Triptans:
    Almotriptan (Axert)
    Eletriptan (Relpax)
    Frovatriptan (Frova)
    Naratriptan (Amerge)
    Rizatriptan (Maxalt)
    Sumatriptan (Imitrex, Sumavel)
    Zolmitriptan (Zomig)
    • MOA: 5HT1 receptor agonist
    • SE: N, Somnolence, dizziness, paresthesias, chest/throat/neck tightness/pain
    • CI: Cerebrovascular disease, uncontrolled HTN
    • Warning: Serotonin syndrome w other 5HT drugs
    • PREG: C
  36. Gout Agent: 
    Colchicine (Colcrys)
    • MOA: inhibits microtubule polymerization preventing neutrophil migration to gout related activity (exact unknown)
    • SE: N/V/D (80%), Myelosuppression, myopathy, neuropathy
    • CI: use of P-gp or 3A4 inhibitor in renal/hepatic impairment
    • PREG: C
  37. Gout Agent: Xanthine Oxidase Inhibitors
    Allopurinol (Zyloprim)
    Febuxostat (Uloric)
    • MOA: block UA production
    • SE: Hepatotoxicity, Rash, acute gout attacks, ↑ LFTs
    • Warning: hypersensitivity reactions, SJS, TEN, HLA-B 5801 (allopurinol)
    • PREG: C
  38. Gout Agent: Uricosuric
    • MOA: Inhibits UA reabsorption at proximal tubule
    • SE: Hypersensitivity reaction, hemolytic anemia
    • CI: w aspirin, UA kidney stones, blood dyscrasias, initiate during acute gout attack
    • Warning: ↑ hemolytic anemia in G6PD deficiency, not recommended CrCl <50 (monotherapy)

    PREG: B
  39. Gout Agent: 
    Pegloticase (Krystexxa)
    • MOA: recombinant uricase enzyme, converts UA to inactive water-soluble metabolite
    • SE: Antibody formation, gout flare, infusion reaction, N, bruising urticaria
    • BBW: anaphylactic reaction, highest if UA>6mg/dL
    • Warning: acute flare upon initiation, do not use with Allopurinol
    • CI: G6PD deficiency
    • PREG: C
  40. Thiazide Diuretics:
    Chlorothiazide (Diuril)
    Chlorthalidone (Thalitone)
    Hydrochlorothiazide (Microzide, etc)
    Metolazone (Zaroxolyn)
    • MOA: inhibit Na reabsorption in distal convoluted tubules
    • SE: ↑ (UA, CH, TG, BG, Ca), ↓ (Na, Mg, K), photosensivity, rash,

    • CI: Sulfonamide-derived drugs, anuria, renal decompensation (CrCl <30)
    • PREG: B
  41. Loop Diuretics:
    furosemide (Lasix)
    Bumetanide (Bumex)
    Torsemide (Demadex)
    Ethacrynic Acid (Edecin)
    • MOA: inhibits reabsorption of Na and Cl in ascending loop of Henle
    • SE: ↓ (K, Na, Mg, Cl, Ca), ↑ (UA, BG, TG, TC), photosensitivity, ototoxicity

    • BBW: fluid and electrolyte depletion
    • CI: Anuria
    • PREG: C with extreme caution, semester specific
  42. Potassium-Sparing Diurectics:
    Amiloride (Midamor)
    Triamterene (Dyrenium)
    +HCTZ (Maxzide, Dyazide)
    Spironolactone (Aldactone)
    Eplerenone (Inspra)
    • MOA: compete with aldosterone in distal convoluted tubule and collecting ducts
    • SE: Hyperkalemia, ↑SCr, impotence, metabolic acidosis (rare), spironolactone (gynecomastia)
    • BBW: Spironolactone has tumor risk
    • CI: CrCl<30
    • PREG: B (Amiloride, Eplerenone), D (Triamterene, Spironolactone)
  43. Angiotensin-Converting Enzyme I (ACE-I)
    Benazapril (Lotensin)
    Captopril (Capoten)
    Enalapril (Vasotec)
    Lisinopril (Prinivil, Zestril)
    Quinapril (Accupril)
    Ramipril (Altace)
    Fosinopril, Moexipril, Perindopril, Trandolapril
    • MOA: inhibit enzyme conversion of AT-1 to AT-2
    • SE: Cough, angioedema, hypotension, HyperKalemia
    • BBW: Preg Cat D, death or injury to fetus
    • CI: Angioedema, bilateral renal artery stenosis, not with Aliskiren in diabetes patients
    • Warning: If GFR <60 not with ACE or ARB
    • PREG: D
  44. Angiotensin R Blocker (ARB):
    Valsartan (Diovan)
    Losartan (Cozaar)
    Irbesartan (Avapro)
    Candesartan (Atacand)
    Olmesartan (Benicar)
    Telmisartan (Micardis)
    Eprosartan (Teveten)
    Azilsartan (Edarbi)
    • MOA: inhibits AT2 binding to vascular smooth muscle
    • SE: Hyperkalemia, angioedema, hypotension, acute renal failure
    • BBW: Preg Cat D: death or injury to fetus
    • CI: Angioedema, bilateral renal artery stenosis, w aliskiren in diabetic patients
    • Warning: if GFR <60 not with ACE or ARB
    • PREG: D
  45. Direct Renin Inhibitor:
    Aliskiren (Tekturna)
    • MOA: inhibits renin which converts angiotnsinogen to AT-1
    • SE: Hyperkalemia, angioedema, hypotension
    • BBW: Preg Cat D, injury or death to fetus
    • CI: bilateral renal artery stenosis, w ACE or ARB in diabetic patient, Angioedema
    • Warning: if GFR <60 no ACE or ARB
    • PREG: D
  46. Beta-Blockers: 
    General as a class
    • MOA: inhibits NE at beta1 and 2 adrenergic receptors causing reduction of BP and HR
    • SE: hypotenison, fatigue, dizziness, depression, reduced (libido, insulin secretion, HDL), increased (BP, TG, weight gain),
    • BBW: not withdrawn abruptly,
    • CI: 2nd or 3rd degree heart block, active asthma exacerbation, sinus  bradycardia
    • PREG: C/ D (atenolol)
  47. Dihydropyridines (CCB):
    Amlodipine (Norvasc)
    Felodipine (Plendil)
    Nifedipine (Adalat, Procardia, Afeditab)
    Nicardipine (Cardene)
    • MOA: inhibit Ca in slow (voltage) channel to dilate peripheral smooth muscle
    • SE: HA, flushing, tachycardia/reflex, gingival hyperplasia
    • PREG: C
  48. Non-Dihydropyridines (CCB):
    Diltiazem (Cardizem, Cartia, Dilacor, Tiazac)
    Verapamil (Calan, Verelan)
    • MOA: inhibit Ca in slow (voltage) channels of smooth muscle in myocardium (↓HR-neg inotrope) and reducing vasoconstriction
    • SE: Edema, HA, AV block, bradycardia, hypotension Arrhythmias, HF, constipation, gingival hyperplasia
    • CI: SBP<90, 2nd, 3rd degree heart block, acute MI, pulmonary ongestion, cardiogenic shock
    • PREG: C
  49. Central acting Alpha2 Agonist:
    Clonidine (Catapres, Duracion-IV)
    Guanfacine (Tenex, Intuniv)
    • MOA: Stimulate alpha2 in brain reducing sympathetic outflow from the CNS
    • SE:Bradycardia, drowsiness, hypotension, sexual dysfunction, depression, psychotic reactions,
    • Warning: methydopa also hepatitis, myocarditis, hemolytic enemia, Lupus-like syndrome
    • Do not stop abruptly, must taper
    • PREG: B (Guanfacine, Methyldopa) C (Clonidine, Guanabenz)
  50. Direct Vasodilators:
    + Isosorbide dinitrate (BiDil)
    Isosorbide Mononitrate (Monoket)
    • MOA: direct vasodilation of arteriioles, Isosorbide (venous side)
    • SE: HA, dizziness, freflex tachycardia, palpitations, anorexia, Lupus-like syndrome
    • CI: nitrates (PDE-5 I)
    • Warning: need 10-12hr nitrate free interval
    • PREG: C
  51. Alpha Blockers: for (HTN not BPH)
    Prazosin (Minipress)
    Terazosin (Hytrin)
    Doxazosin (Cardura)
    • MOA: bind alpha1 receptors resulting in vasodilation or arterioles and veins
    • SE: Orthostatic hypotension, syncope, fatigue HA, fluid retention, Priapism
    • PREG: C
  52. Statins: HMG-CoA reductase inhibitors
    Atorvastatin (Lipitor)
    Simvastatin (Zocor)
    Rosuvastatin (Crestor)
    Pravastatin (Pravachol)
    Lovastatin (Mevacor, Altoprev)
    Fluvastatin (Lescol)
    Pitavastatin (Livalo)
    • MOA: prevents conversion of HMG-CoA to mevalonate, rate limiting step in cholesterol synthesis
    • SE: Myalgias, arthralgias rhabdomyolysis, cognitive impairment, ↑ (CPK, BG, A1C, cataracts, LFT)
    • BBW: active liver disease, pregnancy, breastfeeding
    • Warning: skeletal muscle effects
    • PREG: X
  53. Dyslipidemia: Other
    Ezetimibe (Zetia)
    + simvastatin (Vytorin)
    + atrovastatin (Liptruzet)
    • MOA: inhibits absorption of cholesterol at the brush border of SI
    • SE: URTI, D arthralgias, myalgias, pain
    • Warning: avoid in moderate to severe hepatic impairment
    • PREG: C (alone)
  54. Bile Acid Sequestrants/binding resins:
    Cholestyramine (Questran, Prevalite)
    Colesevelam (Welchol)
    Colestipol (Colestid)
    • MOA: bind bile acid in the intestine forming a complex excreted in feces
    • SE: Constipation, dyspepsia, N, abdominal pain, cramping, gas, bloating, hypertriglyceridemia, LFTs
    • CI: cholestyramine (complete biliary obstruction), Colesevelam (Bowel obstruction, TG>500, TG induced pancreatitis,
    • Warning: Binds to everything (DDI)
    • PREG: B
  55. Fibrates:
    Fenofibrate (Tricor, Trilipix, Firicor, Lipofen, Triglide)
    Gemfibrozil (Lopid)
    • MOA: PPARα activator, enhanced elimination and ↓ synthesis of VLDL
    • SE: abdominal pain, dyspepsia, URTI, ↑ LFT and CPK
    • CI: Severe Liver disease, CrCl<30, Gallbladder disease, nursing mothers
    • Warning: myopathy, higher if w statin, diabetes, renal failure, hypothyroidism, risk of cholelithiasis
    • PREG: C
  56. Niacin (Vitamin B3):
    Niacor, Niaspan, Slo-Niacin
    • MOA: decreases rate of hepatic snthesis of VLDL (↓TG/LDL)
    • SE: Flushing, pruritus, N/V/D/GI distress, hepatotoxicity, hyperglycemia, hyperuricemia, cough, orthostatic HTN
    • CI: active liver diseasse, PUD, arterial bleeding
    • Warning: caution unstable angina or acute MI, Hepatotoxicity
    • PREG: C
  57. Fish oil:
    Omega-3 Acid ethyl Esters (Lovaza)
    Icosapent ethyl (Vascepa)
    • MOA: may be due to reduction of hepatic synthesis of TG
    • SE: Eructation, dyspepsia, taste perversions (Lovaza), arthalgias (Vascepa), increased risk of bleeding
    • Warning: hypersensitivity to fish/shellfish, possible Afib or flutter during 1st month
    • PREG: C
  58. Homozygous Familial Hypercholesterolemia (HoFH) agent:
    Lomitapide (Juxtapid)
    Mipomersen (Kynamro)
    • MOA Lomitapide: inhibits microsomal triglyceride transfer protien (MTP) in endoplasmic reticulum, ↓ production of chylomicrons and VLDL
    • MOA Mipomersen: oligonucleotide inhibitor of apo B-100 synthesis, lowers VLDL
    • SE: D/N/V/C dyspepsia, abdominal pain, flatulence, chest back pain, ↑ LFTs
    • BBW: Hepatotoxicity
    • CI: active liver disease, w 3A4 inhibitors (Lomitapide)
    • Warning: Gi SE significant could lower absorption
    • PREG: X (Lomitapide) B (Mipomersen)
  59. Positive Inotropes:
    Digoxin  (Lanoxin, Digitec)
    • MOA: inhibits Na/K ATPase pump, results in positive inotropic (↑CO), and neg chronotropic effect (↓HR)
    • SE: dizziness, HA, D/N/V, anorexia, mental disturbances
    • CI: 2nd, 3rd degree heart block
  60. Vasodilators:
    Nesiritide (Natrecor)
    Nitroprusside (Nitropress)
    • MOA: dilate smooth muscle venous but some arterial
    • SE: hypotension, HA, tachycardia
    • CI: SBP <100 (Nesiritide) SBP <90 (Nitroglycerin, Nitroprusside)
    • BBW: Nitroprusside- Cyanide Toxicity
    • PREG: C
  61. Anticoagulants: Heparin
    • MOA: binds AT to inactivate thrombin (FIIa, FXa, IXa, XIa, XIIa) and plasmin, also prevents fibrinogen to fibrin
    • SE: Bleeding, HIT, Hyperkalemia, Osteoporosis,
    • BBW: contains benzyl alcohol, CI in neonates/infants
    • CI: uncontrolled active bleeding, severe throbocytopenia, hx of HIT, Pork hypersensitivity
    • Warning: do not give IM due to hematoma risk
    • Antidote: Protamine
    • PREG: C
  62. Low Molecular Weight Heparin:
    Enoxaparin (Lovenox)
    Dalteparin (Fragmin)
    • MOA: binds AT to inactivate thrombin (FIIa)(less than heparin), (FXa greater than heparin)
    • SE: bleeding, thrombocytopenia, hyperkalemia, anemia
    • BBW: epidural, spinal anesthesia or spinal puncture are at risk of hematoma and subsequent paralysis
    • CI: Hx HIT, active major bleed, hypersensitivity to pork
    • Warning: do not give IM (hematoma)
    • Antidote: Protamine only 60%
    • PREG: B
  63. Indirect Factor Xa Inhibitors:
    Fondaparinux (Arixtra SQ)
    • MOA: synthetic pentasaccharide inhibits AT to indirectly inhibit FXa
    • SE: Bleeding, Thrombocytopenia, anemia, N, injection site reation.
    • BBW: hematoma risk in neuraxial anestheis (epidural, spinal, or spinal puncture and subsequent paralysis
    • CI: Severe renal impairment CrCl<30, active major bleed,bacterial endocarditis, thrombocytopenia w antibodies, wt<50kg
    • Warning: do not give IM (hematoma)
    • Antidote: None
    • PREG: B
  64. Direct FXa Inhibitors:
    Rivaroxaban (Xarelto PO)
    Apixaban (Eliquis PO)
    • MOA: directly bind to inhibit FXa
    • SE: Bleeding
    • BBW: Neuraxial anesthesia Epidural, spinal, or spinal puncture for risk of hematoma and subsequent paralysis
    • CI: Active major bleeding, mod-severe hepatic impairment, severe renal impairment, avoid in prosthetic heart valves
    • Antidote: None
    • PREG: C
  65. Direct Thrombin (FIIa) Inhibitors:
    Argatroban (DoC in HIT)
    Bivalirudin (Angiomax)
    Desirudin (Iprivask)
    • MOA: binds Thromin FIIa
    • SE: Bleeding, anemia, hematoma
    • CI: active major bleeding
    • Antidote: None
    • PREG: B
  66. Vitamin K epoxide reductase enzyme (VKORC1):
    Warfarin (Coumadin, Jantoven)
    • MOA: binds VKORC1 reducing Vit K epoxide and clotting factors II, VII, IX, X, and protein C, S
    • SE: Bleeding, skin necrosis, pruple toe syndrome
    • BBW: may cause major or fatal bleeding
    • CI: Hemmorrhagic tendencies, blood dyscrasias, Pregnancy, uncontrolled HTN
    • Antidote: Vit K (Phytonadione, 4 F prothrombin, 3 F prothrombin)
    • PREG: D/X
  67. Glycoprotein IIb/IIIa receptor Antagonists (Gp IIb/IIIa:
    Abciximab (ReoPro)(irreversible)
    Eptifibatide (Integrilin)
    Tirofiban (Aggrastat)
    • MOA: binds platelet Gp IIb/IIIa inhibiting other factors from activating
    • SE: Bleeding, Thrombocytopenia, hypotension
    • CI: Thrombocytopenia (<100k), Active internal bleeding, surgery within 6 months, Hx stroke, severe uncontrolled HTN, Hypersensitivity to murine (abciximab)
    • PREG: B (eptifibatide, Tirofiban), C (Abciximab)
  68. P2Y12 Inhibitors:
    Clopidogrel (Plavix)
    Prasugrel (Effient)
    Ticagrelor (Brilinta)
    • MOA: binds P2Y12 subunit on ADP receptors on platelets
    • SE: Bleeding, bruising, rash
    • BBW: Cyp2C19*2,*3 allele neg (clopidogrel),
    • CI: PUD, ICH, 
    • Warning: do not start 5-7 days before CABG (5 Clopid, Ticag) (7 prasugrel)
    • PREG: B (Clop, Pras) C (ticag)
  69. Fibrinolytics: STEMI only
    Alteplase (t-PA, Activase)
    Tenecteplase (TNKase)
    Reteplase (Retevase)
    Streptokinase (Streptase)
    • MOA: binds fibrin and converts plasminogen to plasmin in clots
    • SE: Bleeding, hypotension, intracranial hemorrhage, fever
    • CI: active internal bleeding, Hx stroke, intracranial surgery/trauma (<3 months), aneurysm, aortic dissection, ischemic stroke (<3 months), Severe uncontrolled HTN, PUD, anticoagulants
    • Warning: STEMI only
    • PREG: C/ D (streptokinase)
  70. Prostacyclin Analogues:
    Epoprostenol (Flolan, veletri)
    Terprostinil (Remodulin)
    Iloprost (Ventavis)
    • MOA: replace prostacyclin, vasodilation in pulmonary and systemic vascular beds
    • SE: HA, N/V/D, anxiety, chest pain, palpitations, tachycardia, edema, jaw claudication
    • Note: chronic use- anxiety, flu-like symptoms, jaw pain, thrombocytopenia
    • PREG: B/ C (Iloprost)
  71. Endothelin Receptor antagonists (ERAs):
    All in REMS program

    Bosentan (Tracleer)
    Ambrisentan (Letairis)
    Macitentan (Opsumit)
    • MOA: blocks endothelin receptors on pulmonary artery smooth muscle blocking vsoconstriction, reduced Hgb
    • SE: HA, URTI, edma, LFTs, spermatogenesis
    • BBW: Hepatoxicity, Pregnancy
    • CI: pregnancy, use w cyclosporine or glyburide
    • PREG: X
  72. Beta2 Agonists:
    • MOA: Bind Beta2 receptors causing bronchial smooth muscle bronchodilation
    • SE: Tremor, shakiness, cough, palpitations, hypokalemia, tachycardia, hyperglycemia
    • BBW: Long-acting increase risk of asthma deaths
    • PREG: C
  73. Corticosteroids:
    • MOA: depress migration of polymorphonuclear (PMN) leukocytes, fibroblasts, preventing inflammation
    • SE: inhaled- dysphonia, oral candidiasis, cough, hoarseness, URTI, hyperglycemia, fractures, pneumonia, growth retardation
    • CI: primary treatment of status asthmaticus
    • PREG: C
  74. Corticosteroids:
    • MOA: depress migration of polymorphonuclear (PMN) leukocytes, fibroblasts, preventing inflammation
    • SE Short term: wt gain, increase appetite, fluid retention, emotional instability, insomnia, indigestion
    • SE Long term: cushings, fat redistribution, impaired wound healing, dermal thinning, hyperglycemia/diabetes, osteoporosis, hirsutism, insomnia, nervousness, GI bleed
    • CI: active systemic infection
    • PREG: D
  75. Leukotriene Modifying Agents:
    Zafirlukast (Accolate)
    Montelukast (Singulair)
    Zileuton (Zyflo)
    • MOA: Leukotriene-receptor antagonists, Zileuton is 5-lipoxygenase inhibitor stops formation
    • SE: HA, dizziness, abdominal pain LFT, URTI, pharyngitis, sinusitis
    • CI: Hepatic impairment (zafilukast), active liver disease (zileuton)
    • Warning: neuropsychiatric events, Hepatotoxicity, churg-Strauss possible
    • PREG: B
  76. 1st Generation Antihistamines:
    Clemastine (Tavist)
    Diphenhydramine (Benadryl)
    Carbinoxamine (Karbinal)
    Chlorpheniramine (Chlor-Trimeton)
    Promethazine (Phenergan)
    • MOA: block H1 receptors
    • SE: Sedation, cognitive impairment, strong anticholinergic effects, seizures, arrhythmias
    • CI: Carbinoxamine/ promethazine do not use in children <2, lactation, w MAO-I
    • PREG: B/ C (promethazine, carbinoxamine)
  77. 2nd Generation Antihistamines:
    Cetirizine (Zyrtec)
    Desloratadine (Clarinex)
    Fexofenadine (Allegra)
    Levocetirizine (Xyzal)
    Loratadine (Claritin)
    Azelastin (Astelin)
    Olopatadine (Patanase)
    • MOA: Blocks H1 receptors 
    • SE: less CNS effects then 1st gen
    • Warnings: cardiovascular disease, diabetes, glaucoma, prostate enlargement, renal impairment, seizures, thyroid disorders
    • PREG: B
  78. Decongestants:
    Phenylephrine (Sudafed PE)
    Pseudoephedrine (Sudafed)

    Naphazoline (Privine)
    Oxymetazoline (Afrin)
    Phenylephrine (Neo-Synephrine)
    Tetrahydrozoline (Tyzine)
    Xylometazoline (Otrivin)
    • MOA: alpha adrenergic agonists causing vasoconstriction
    • SE: Cardiovascular stimulation, CNS stimulation, dizziness, HA, anorexia
    • CI: 14 day of MAOI
    • Warning: Caution: HTN, CV disease, hyperthyroidism, diabetes, bowel obstruction, gluacoma, BPH
    • PREG: C
    • Intranasal: stinging, sneezing, dryness, rebound congestion if used > 3 days
  79. Erythropoietin Stimulation Agents:
    Epoetin alfa (Epogen, Procrit)
    Darbepoetin (Aranesp)
    • MOA: stimulates bone marrow to produce RBC
    • SE: Hypertension, fever, HA, arthralgia/bone pain, pruritis, N, cough thrombosis, edema, chills, dizziness
    • BBW: ESAs increase risk of serious cardiovascular events, thromboembolic, target >11g/dL, CKD, Tumorogenesis
    • CI: uncontrolled HTN, PRCA,
    • PREG: C
  80. SSRIs:
    Fluoxetine (Prozac, Sarafem)
    Paroxetine (Paxil, Brisdelle)
    Fluvoxamine (Luvox)
    Sertraline (Zoloft)
    Citalopram (Celexa)
    Escitalopram (Lexapro)
    Vilazodone (Viibryd)(+ 5HT1a agonist)
    • MOA: increases synaptic 5HT
    • SE: Somnolence, insomnia, N, HA< tremor, diaphoresis, Sexual SE, SIADH, Restless leg, ↑ bleeding, fall risk
    • BBW: suicidal thinking
    • CI: SSRIs w MAOIs
    • Warning: Citalopram >20mg d -Qt prolongation
    • PREG: C/ D (Paroxetine)
  81. SNRIs:
    Venlafaxine (Effexor)
    Desvenlafaxing (Pristiq)
    Duloxetine (Cymbalta)
    Levomilnacipran (Fetzima)
    • MOA: increase synaptic supply of 5HT and NE
    • SE: sexual dysfunction, insomnia, HA, N, tremor, bleeding, fall risk, HTN, pulse dilated pupils, dry mouth, constipation
    • BBW: suicidal thinking
    • PREG: C
  82. TCAs:
    Tertiary amines:
    amitriptyline (Elavil)
    Doxepin (Zonalon)
    Clomipramine (Anafranil)
    Imipramine (Tofranil)
    Trimipramine (Surmontil)

    Secondary Amines:
    Nortriptyline (Pamelor)
    Protriptyline (Vivactil)
    Desipramine (Norpramine)
    • MOA: NE and 5HT reuptake inhibitors and inhibitors of ACh and Histamine
    • SE: QT prolongation, orthostatis, tachycardia, brymoutn, blurred vision, urinary retention, constipation, vivid dreams, weight gain Myoclonus
    • BBW: suicidal thinking
    • CI: w MAOIs. w urinary retention or narrow-angle glaucoma
    • PREG: C (Tertiary)/ D (secondary)