Pharmacology

This article is intended to provide a broad overview of pharmacology and medications often used in either community or institutional pharmacy settings and is not intended as sole means towards determining diagnosis and/or treatment of an individual.

This article will cover the following knowledge areas:
 * Generic and brand names of pharmaceuticals
 * Therapeutic equivalence
 * Drug interactions (e.g., drug-disease, drug-drug, drug-dietary supplement, drug-OTC, drug-laboratory, drug-nutrient)
 * Strengths/dose, dosage forms, physical appearance, routes of administration, and duration of drug therapy
 * Common and severe side or adverse effects, allergies, and therapeutic contraindications associated with medications
 * Dosage and indication of legend, OTC medications, herbal and dietary supplements

Terminology
To get started in this article, there are some terms that should be defined.

pharmacology - The term pharmacology is derived from two Greek words "pharmakon" and "logos". Pharmakon can mean sacrament, remedy, poison, talisman, cosmetic, perfume or intoxicant, but in this case, it can be broadly defined as drug. Logos can be translated as a principle of order and knowledge. By combining the terms you can see that pharmacology is concerned with the knowledge of drugs.

pharmacokinetics - Pharmacokinetics is a branch of pharmacology concerned with the rate of drug absorption, distribution, metabolism, and excretion (ADME) by the body.

over the counter (OTC) - Over the counter medications are drugs that do not require the use of a prescription for a patient to obtain it. These medications are generally considered sufficiently safe for a patient to acquire and self medicate with by following the instructions included on the vial.

behind the counter (BTC) - These are medications that do not require a prescription, but can only be obtained at the pharmacy counter. Examples of this include:
 * products containing pseudoephedrine,
 * emergency birth control,
 * insulins, and
 * some states allow cough syrups with small amounts of codeine.

legend drug - Legend drugs are medications that require a prescription prior to dispensing. These medications may or may not be considered abusable, but consultation with a medical professional that has prescribing authority is necessary due to the complex health conditions that these medications may be able to treat or ameliorate. Often, you will see the phrase "Rx only" used to denote legend drugs.

controlled substances - Controlled substances are medications with restrictions due to abuse potential. There are 5 schedules of controlled substances with various prescribing guidelines based on abuse potential counter balanced by potential medicinal benefit as determined by the Drug Enforcement Administration and individual state legislative branches.

dietary supplements - A dietary supplement is intended to supply nutrients, (vitamins, minerals/electrolytes, and amino acids) that are missing or not consumed in sufficient quantity in a person's diet. This category may also include herbal supplements.

vaccines - A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins.

brand name - This is the manufacturer's trademark designation. Each brand name is owned by the company and begins with a capital letter, and it is protected by a trademark. Drugs often have several brand names. The terms trade name and proprietary name may also be used interchangeably with brand name.

generic name - This is the official non-proprietary name assigned by the manufacturer with the approval of the USAN (United States Adopted Name) Council. The Federal Food and Drug Administration (FDA) requires that each drug has a generic name, even if currently it is only available as a brand name product. A generic name may also be referred to as the non-proprietary name.

therapeutic equivalents - Drug products are considered to be therapeutic equivalents only if they are available in the same dosage strength, dosage form, achieve the same blood levels, and if they can be expected to have the same clinical effect and safety profile when compared to the original innovator drug. To ensure that a specific generic product is considered to be a therapeutic equivalent, it is recommended that you refer to the Orange Book, a publication from the Food and Drug Administration (FDA). If the products being compared in the Orange Book are considered therapeutic equivalents, it will be given a Therapeutic Equivalence (TE) Code that begins with an "A". If the products are not considered therapeutic equivalents, they will be given a TE Code that begins with a "B". Sometimes these will be referred to as "A" ratings and "B" ratings. These ratings are typically two letters long and will sometimes include a number as well. Usually, a tablet or capsule that is therapeutically equivalent to the innovator drug will have a TE Code 'AB' (with the first letter establishing whether or not the drugs are therapeutically equivalent, and the second letter establishing dosage form category). If a number is included after the two letter code that must also match to be considered therapeutically equivalent.

National Drug Code (NDC) - Each medication is assigned a unique 10-digit, 3-segment number. This number, known as the National Drug Code (NDC), identifies the labeler or vendor, product, and trade package size.
 * The first 4 or 5 digits indicate the manufacturer
 * The second 3 or 4 indicate the medication, strength, and dosage form
 * The third set of numbers always has 2 digits and indicates the package size

classification - This is how a medication is grouped and is typically defined according to its use in treating a particular disease or disorder. A potential source of confusion is that many medications could be grouped multiple ways. An example of this is aspirin, which can be classified as an analgesic, antipyretic, and anti-inflammatory agent.

indication - This is the primary condition(s) treated by a particular drug. This may include both FDA approved uses as well as off-label (generally based on scientific studies but lacking FDA approval) medication uses.

off-label uses - Off-label use is the use of a medication in a manner different from that approved by the FDA including:
 * for an unapproved indication,
 * in an unapproved age group,
 * unapproved dosage, or
 * unapproved form of administration.

dosage form - A dosage form is the physical form of a dose of medication, such as capsule, patch, or injection. The route of administration is dependent on the dosage form of a given drug. As an example, persistent vomiting may make it difficult to use an oral dosage form; therefore, an antiemetic in suppository form may be desirable.

interactions - Medications have the potential to interact with other medications, dietary supplements, and constituents of various foods. Medications may also interact with various diseases.

contraindication - A contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.

side effect - A side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended. The term is predominantly employed to describe adverse effects, but it can also apply to beneficial consequences of the use of a drug. A side effect of diphenhydramine (an antihistamine) is drowsiness, which would be an adverse effect if someone needed to be alert, but could be beneficial if they required help going to sleep.

pregnancy category - The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. It does not include any risks conferred by pharmaceutical agents or their metabolites that are present in breast milk. The United States FDA has the following definitions for the pregnancy categories:
 * Pregnancy Category A - Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
 * Pregnancy Category B - Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies which have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
 * Pregnancy Category C - Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
 * Pregnancy Category D - There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
 * Pregnancy Category X - Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

excipient - An excipient is anything in a medication other than its active ingredient. Common categories for excipients include antiadherents, binders, coatings, disintegrants, fillers, flavors and colors, glidants, lubricants, preservatives, sweeteners, and printing inks.

Common medications
Pharmacy technicians should be able to categorize drugs into major therapeutic classifications and be able to briefly describe the therapeutic use of each drug. Technicians should also be able to correlate brand name medications with the generic names.

The following subsections will break the drugs down into various therapeutic classes, with descriptions of these classes followed by a list of generic drug names accompanied by their most common brand names and commercially available dosage forms. These lists are not to be considered comprehensive, but instead just provide some of the more common items to serve as a quick refresher. If you want more information on a particular drug, please using additional drug information resources.

Anti-infective agents
An anti-infective (also called an antimicrobial) is a substance that kills or inhibits the growth of microbes such as bacteria, fungi, protozoans or viruses. In this section we will look at antibiotics, antifungals, amebicides, and antivirals.

Anti-infectives are usually given intermittently for a short period of time (3 to 14 days), although there are exceptions to this.

Antibiotics
In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics are divided into two main types: bactericidal and bacteriostatic. Bactericidal drugs are actually lethal; that is they actually kill the bacteria. Bacteriostatic drugs inhibit the reproduction (growth) of bacteria. Many antibiotics can be either bacteriostatic or bactericidal based on which bacteria they are being used against and how high a dose is being administered.

Bacteria treated by antibiotics are usually broken into two categories, gram-positive and gram-negative.

Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain (safranin or fuchsin) and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of peptidoglycan in the cell wall. Gram-positive cell walls typically lack the outer membrane found in gram-negative bacteria. Many antibiotics are able to work against both gram-positive and gram negative infections.

A useful way of looking at antibiotics is how they function against bacteria cells. The image to the right provides a broad overview as to which organelles various antibiotics target when fighting bacteria.

Penicillin derivatives
Penicillin derivatives act by preventing cell wall synthesis during active replication and are therefore bactericidal. Penicillin derivatives have a chemical structure referred to as a beta-lactam ring, which is what allows it to attach to the bacteria. Penicillins are used in the treatment of bacterial infections caused by susceptible, usually gram-positive, organisms. The most common side effects are allergic reactions including rash, hives, or anaphylactic shock.

Amoxil, Moxatag, Trimox (generic name: amoxicillin [pronounced:  am OX i sil in ]) - oral suspension, capsule, tablet, chewable tablet, extended-release tablet

Principen (generic name: ampicillin [pronounced: am pi SIL in ]) - capsules, oral suspension, powder for injection

Nafcil (generic name: nafcillin [pronounced: naf SIL in ]) - injectable solution, powder for injection

Bactocill (generic name: oxacillin [pronounced: ox a SIL in ]) - infusion solution, oral solution, powder for injection

Bicillin, Wycillin (generic name: penicillin G [pronounced: pen i SIL in jee ]) - premixed injectable solution, powder for injectable solution

Pen Vee K, Veetids (generic name: penicillin V potassium [pronounced: pen i SIL in vee poe TASS ee um ]) - oral solution, tablet

Pipracil (generic name: piperacillin [pronounced: PI per a SIL in ]) - powder for injection

Penicillin derivatives with beta-lactamase inhibitors
Sometimes bacteria become resistant to penicillin. One such mechanism of action for them to do that is by creating beta-lactamase, which breaks down the beta-lactam ring in penicillins preventing them from attaching to the bacteria walls. There is a chemical class that can prevent this called beta-lactamase inhibitors that are often coupled with penicillins.

Augmentin (generic name: amoxicillin & clavulanate [pronounced: am OX i sil in & KLAV yoo LAN ate ]) - oral suspension, tablet, chewable tablet

Unasyn (generic name: ampicillin & sulbactam [pronounced: am pi SIL in & SUL bak tam ]) - injectable solution, powder for solution

Zosyn (generic name: piperacillin & tazobactam [pronounced: pi PER a sil in & ta zoe BAK tam SOW dee um ])  - powder for injection

Timentin (generic name: ticarcillin & clavulanate [pronounced: tye kar SIL in & klav yoo LAN ate ]) - powder for injection, infusion solution

Carbapenems
Carbapenems are a class of beta-lactam antibiotics with a broad spectrum of antibacterial activity, and have a structure which renders them highly resistant to beta-lactamases.

Invanz (generic name: ertapenem [pronounced: er ta PEN em ]) - powder for injection

Primaxin (generic name: imipenem & cilastatin [pronounced: IM i PEN em & SYE la STAT in ]) - powder for injection

Merrem (generic name: meropenem [pronounced: mer oh PEH nem ]) - powder for injectable solution

Cephalosporins
The cephalosporins are bactericidal antibiotics that have chemical structures similar to those of penicillins and therefor have the same mechanism of action. Also, due to their similar chemical structure to penicillin, there is a 7-10% potential of cross sensitivity. The cephalosporins are considered to be broad spectrum drugs. Their two main uses are as substitutes for penicillins in cases of allergy or bacterial resistance and in the treatment of certain gram-negative infections.

Ceclor (generic name: cefaclor [pronounced: CEF a klor ]) - capsule, tablet extended-release

Kefzol (generic name: cefazolin [pronounced: sef A zoe lin ]) - powder for injection

Omnicef (generic name: cefdinir  [pronounced: SEF dih neer ]) - capsule, oral suspension

Maxipime (generic name: cefepime  [pronounced: SEF e peem ]) - infusion solution, powder for injection

Claforan (generic name: cefotaxime  [pronounced: SEF oh TAX eem ]) - injectable solution, powder for injection

Cefotan (generic name: cefotetan  [pronounced: SEF oh TEE tan ]) - injectable solution, powder for injection

Teflaro (generic name: ceftaroline  [pronounced: SEF ta ROE leen ]) - powder for injection

Fortaz (generic name: ceftazidime  [pronounced: sef TAY zi deem ])  - injectable solution, powder for injection

Rocephin (generic name:  ceftriaxone  [pronounced: SEF trye AX one ])  - injectable solution, powder for injection

Keflex (generic name: cephalexin  [pronounced: sef a LEX in ]) - capsule, film-coated tablet, oral suspension, tablet for oral suspension

Aminoglycosides
The aminoglycosides are a group of bactericidal antibiotics whose antibacterial spectrum mainly includes gram-negative bacilli. Aminoglycosides have poor oral absorption; therefore, if systemic effects are desired, they are usually given IV or IM. Aminoglycosides are both nephrotoxic (kidney) and ototoxic (ear).

Amikin (generic name: amikacin [pronounced: am E kay sin ]) - injectable solution

Garamycin (generic name: gentamicin [pronounced: gen tah MY sin ])   - injectable solution, ophthalmic ointment, ophthalmic suspension

Kantrex (generic name: kanamycin [pronounced: KAN a MYE sin ]) - injectable solution

Nebcin, Tobi, Tobrex (generic name: tobramycin [pronounced: toe bra MY sin ])  - injectable solution, nebulizer solution, ophthalmic ointment, ophthalmic solution

TobraDex (generic name: tobramycin & dexamethasone [pronounced: TOE bra MYE sin & DEX a METH a son ])  - ophthalmic ointment, ophthalmic suspension - This is a combination of an aminoglycoside and a corticosteroid.

Tetracyclines
The tetracyclines (a group of broad-spectrum bacteriostatic antibiotics) are clinically useful in both gram-positive and gram-negative infections.

When ingested, it is usually recommended that tetracyclines should be taken with a full glass of water, either two hours after eating or one hour before eating. This is partly because tetracycline binds easily with magnesium, aluminum, iron, and calcium, which reduces its ability to be completely absorbed by the body. Dairy products or preparations containing iron are not recommended directly after taking the drug.

Side effects from tetracyclines are not always common; but of particular note is possible photosensitive allergic reaction, which increases the risk of sunburn under exposure to UV light from the sun or other sources. Tetracyclines are teratogens due to the likelihood of causing teeth discoloration in the fetus as they develop in infancy. For this same reason, tetracyclines are contraindicated for use in children under 12 years of age.

Vibramycin (generic name: doxycycline [pronounced: DOX i SYE kleen ]) - capsule, powder for injection, syrup, tablet, delayed-release tablet

Minocin (generic name: minocycline [pronounced: mye no SYE kleen ]) - oral suspension, tablet, capsule, extended-release tablet, intravenous injection

Sumycin (generic name: tetracycline [pronounced: TET tra SYE kleen ]) - capsule, tablet

Tygacil (generic name: tigecycline [pronounced: tye ge SYE kleen ]) - powder for injection

Sulfonamides
Sulfonamides are a group of synthetic bacteriostatic drugs which are effective against both gram-positive and gram-negative infections. Approximately 3% of people using sulfonamides report side effects, the most common of which are hypersensitivity reactions such as rash and hives, but some patients may have more severe reactions.

Sulfonamides have the potential to crystallize in the kidneys due to their low solubility. This is a very painful experience, so patients are recommended to take these medications with large amounts of water.

Silvadene (generic name: silver sulfadiazine [pronounced: SIL ver SUL fa DYE a zeen ]) - cream

Bactrim, Septra, Co-Trimoxazole (generic name:  sulfamethoxazole & trimethoprim - sometimes abbreviated as SMZ & TMP [pronounced: SUL fa meth OX a zole & trye METH oh prim ]) - injected solution, oral solution, tablet

Azulfidine (generic name:  sulfasalazine [pronounced: SUL fa SAL a zeen ]) - tablet, extended-release tablet

Macrolide antibiotics
The term macrolide refers to the large chemical ring structure that is characteristic of these antibiotics. These antibiotics inhibit bacterial protein synthesis and can be bacteriostatic or bactericidal. Food affects oral absorption of these drugs, although they frequently cause GI problems which may warrant taking them with food. Macrolides may interfere with some medications that require liver biotransformation such as digoxin, warfarin, and cyclosporine; therefore, a different antibiotic choice may be desirable if a patient is currently using any of those medications.

Zithromax, Z-Pak, Zmax, AzaSite (generic name:  azithromycin [pronounced: a ZITH roe MYE sin ]) - oral suspension, powder for injection, powder for oral suspension, extended-release powder for oral suspension, tablet, ophthalmic solution

Biaxin (generic name: clarithromycin [pronounced: kla RITH roe MYE sin ]) - oral suspension, tablet, extended-release tablet

Erythrocin, E-Mycin (generic name: erythromycin [pronounced: er ITH roe MYE sin ]) - tablet, delayed-release tablet, dispertab, injection, oral suspension, ophthalmic ointment

Fluoroquinolones
The fluoroquinolones, often just called quinolone antibiotics, are synthetic antimicrobial agents that are a broad spectrum bactericidal, especially against gram-negative organisms. A black box warning has been added to all fluoroquinolones involving an increased risk of developing tendinitis and tendon rupture in patients of all ages taking fluoroquinolones for systemic use. This risk is further increased in individuals over 60 years of age, taking corticosteroid drugs, and having received kidney, heart, or lung transplants.

Cipro, Ciloxan (generic name: ciprofloxacin [pronounced: SIP roe FLOX a sin ]) - infusion solution, oral suspension, tablet, extended-release tablet, ophthalmic solution, ophthalmic ointment, otic solution

Levaquin (generic name: levofloxacin [pronounced: LEE voe FLOX a sin ]) - injectable solution, premix infusion solution, oral solution, tablet, ophthalmic solution

Avelox (generic name: moxifloxacin [pronounced: moxi FLOX a sin ]) - injectable solution, tablet, ophthalmic solution

Floxin (generic name: ofloxacin [pronounced: oh FLOX a sin ]) - tablet, ophthalmic solution, otic solution

Miscellaneous antibiotics
Some common antibiotics are the only drugs in their respective classes. The following listed medications are examples of those. These drugs each have their own side effects and precautions; for example, IV use of vancomycin may cause a reaction known as red man syndrome characterized by flushing and/or rash that affects the face, neck, and upper torso.

Azactam (generic name: aztreonam [pronounced: AZ tree oh nam ]) - infusion solution, powder for injection

Cleocin (generic name: clindamycin [pronounced: klin da MYE sin ]) - capsule, injectable solution, oral solution, vaginal cream, vaginal suppository

Cubicin (generic name: daptomycin [pronounced: DAP to my sin ]) - injectable solution

Zyvox (generic name: linezolid [pronounced: lin EZ oh lid ]) - injectable solution, oral suspension, tablet

Bactroban (generic name: mupirocin [pronounced: mue PIR oh sin ]) - cream, topical ointment, nasal ointment

Macrobid, Macrodantin (generic name: nitrofurantoin [pronounced: NYE troe fue RAN toin ]) - capsule, oral suspension

Vancocin (generic name: vancomycin [pronounced: VAN koe MYE sin ]) - capsule, injectable solution, powder for injection

Antifungals
An antifungal drug is a medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis, and others.

Antifungals work by exploiting differences between mammalian and fungal cells to kill off the fungal organism without dangerous effects on the host. Unlike bacteria, both fungi and humans are eukaryotes. Thus fungal and human cells are similar at the molecular level. This means it is more difficult to find a target for an antifungal drug to attack that does not also exist in the infected organism. Consequently, there are often side-effects to some of these drugs. Many of these agents are hepatotoxic (liver), and liver function and enzymes must be monitored. It is not uncommon for therapy to last for several months.

Fungizone, Abelcet, AmBisome (generic name: amphotericin B [pronounced: am foe TER i sin BEE ]) - powder for injection, injectable lipid complex, cream, lotion, ointment

Lotrisone (generic name: betamethasone & clotrimazole [pronounced: bay ta METH a sone and kloe TRIM a zole ]) - cream, lotion - This is a combination of a corticosteroid and an antifungal.

Gyne-Lotrimin, Mycelex (generic name: clotrimazole [pronounced: kloe TRIM a zole ]) - troche, vaginal cream, vaginal tablet, cream, topical solution, lotion, powder

Diflucan (generic name: fluconazole [pronounced: floo KOE na zole ]) - injected solution, oral suspension, tablet

Mycostatin, Nilstat (generic name: nystatin  [pronounced: nye STAT in ]) - oral powder, oral suspension, oral tablet, troche, cream, ointment, powder, vaginal tablet

Lamisil (generic name: terbinafine  [pronounced: ter BIN a feen ]) - tablet, oral granules, cream, topical solution

Amebicides
An amebicide (or amoebicide) is an agent used in the treatment of amoebic infections. Alcohol use should be avoided while taking metronidazole because concurrent use may cause a disulfarim-like reaction (nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath).

Flagyl, MetroCream, MetroGel, MetroLotion (generic name:  metronidazole [pronounced: me troe NI da zole ]) - capsule, tablet, extended-release tablet, infusion solution, topical gel, topical cream, topical lotion, vaginal gel

Pentam (generic name: pentamidine [pronounced: pen TAM e deen ]) - powder for injection, powder for nebulizer solution

Antimalarial drugs
Antimalarial drugs are agents used to prevent and cure malaria. Some antimalarial drugs, such as hydroxychloroquine, are also used to treat conditions like rheumatoid arthritis and lupus. One of the most serious side effects is a toxicity in the eye (this primarily occurs with chronic use).

Plaquenil (generic name: hydroxychloroquine [pronounced: hye drox ee KLOR oh kwin ]) - tablet

Qualaquin (generic name:  quinine sulfate [pronounced: KWYE nine SUL fate ]) - capsule

Antivirals
Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for specific viruses. They are relatively harmless to the host, and therefore can be used to treat infections. They should be distinguished from viricides, which actively deactivate virus particles outside the body.

Most of the antivirals now available are designed to help deal with HIV (ganciclovir); herpes viruses (acyclovir, ganciclovir, valacyclovir), best known for causing cold sores and genital herpes, but actually causing a wide range of diseases; the hepatitis B and C viruses, which can cause liver cancer; and influenza viruses (oseltamivir). Researchers are now working to extend the range of antivirals to other families of pathogens.

Antiviral drugs work by inhibiting the virus either before it enters the cell, stopping it from reproducing, or in some cases, preventing it from exiting the cell. However, like antibiotics, viruses may evolve to resist the antiviral drug.

Zovirax (generic name: acyclovir [pronounced: a SYE kloe veer ]) - injectable solution, oral suspension, powder for injection, tablet, capsule, topical cream, topical ointment

Cytovene (generic name: ganciclovir [pronounced: gan SYE kloe veer ]) - capsule, powder for injection, oral solution, implant, ophthalmic gel

Tamiflu (generic name: oseltamivir [pronounced: os el TAM ih veer ]) - capsule, oral suspension

Valtrex (generic name: valacyclovir [pronounced: val a SYE kloe veer ]) - tablet

Glucocorticosteroids
Glucocorticosteroids (glucocorticoids, corticosteroids) are steroids used to treat inflammation and various allergic conditions. They are similar to the steroid created in the adrenal cortex, although they could be either from natural sources or synthetically manufactured. As your body naturally produces a glucocorticoid, introducing an exogenous source through medication interferes with your bodies negative feedback loop for production of these steroids. This is why it is often necessary to taper a patient off of a steroid so their body slowly starts creating its own endogenous source of steroids again.

Long term use of glucocorticoids can have the following negative effects: thinning of skin, decrease wound healing, stunting pediatric growth, moon-face, obesity, and diabetes mellitus.

Short-acting steroids
Cortef (generic name: hydrocortisone [pronounced: hye dro KORT i zone ]) - tablet, oral suspension, powder for injection, rectal cream, enema, foam, suppositories, topical cream, lotion, gel, topical solution, ointment, pledget

Intermediate-acting steroids
Flovent HFA, Flonase (generic name: fluticasone [pronounced: floo TIK a zone ]) - aerosol inhaler, disk inhaler, nasal spray, cream, ointment, lotion

Depo-Medrol, Medrol, Solu-Medrol (generic name: methylprednisolone [pronounced: METH il pred NIS oh lone ]) - tablet, injectable suspension, powder for injection

Delta-Cortef (generic name: prednisolone [pronounced: pred NIS oh lone ])- oral solution, tablet, ophthalmic suspension, ophthalmic solution

Deltasone (generic name: prednisone [pronounced: PRED ni sone ])  - oral solution, tablet

Azmacort, Nasacort AQ, Kenalog (generic name: triamcinolone, TAC  [pronounced: trye am SIN oh lone ])'  - nasal spray, inhalation aerosol, intravitreal injection, cream, ointment, paste, topical spray

Long-acting steroids
Decadron (generic name: dexamethasone [pronounced: dex a METH a sone ]) - tablet, injectable suspension, elixir, oral solution, oral concentrate, ointment, ophthalmic solution, ophthalmic suspension, intravitreal implant

Drugs affecting the autonomic nervous system
The autonomic nervous system (ANS) is the portion of the nervous system that regulates cardiac and smooth muscle (involuntary muscles) of the internal organs and glands. The ANS can either increase or decrease the activity of these organs through two subdivisions of the ANS known as the sympathetic and parasympathetic nervous systems. These subdivisions work in opposition to each other. The table below provides a brief list of the results from stimulation (or innervation) of either system.

Drugs affecting the sympathetic nervous system
The sympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the parasympathetic nervous system, by speeding up the heartbeat and causing contraction of the blood vessels. It regulates the function of the sweat glands and stimulates the secretion of glucose in the liver. The sympathetic nervous system, which is usually activated under conditions of stress, causes the 'fight or flight' response.

The sympathetic nervous system can be excited or inhibited through either stimulating or inhibiting adrenergic receptors. These adrenergic receptors are normally stimulated by endogenous norepinephrine, but they can be stimulated by exogenous chemicals of either natural or synthetic origin. These adrenergic receptors can be further broken up into subgroups called alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors. Excitation of alpha-1 and alpha-2 adrenergic receptors causes contraction of smooth muscle resulting in vasoconstriction of most blood vessels, contraction of sphincter muscles in the GI and urinary tract, and dilation of the pupil of the eye (mydriasis). Stimulation of beta-1 adrenergic receptors cause stimulation of the heart (increased heart rate and force of contraction). Stimulation of beta-2 adrenergic receptors cause bronchodilation. Inhibition (blocking) of these receptors cause the opposite effect to occur.

Let's look at drugs that affect these various receptors.

Adrenergic agonists
These drugs stimulate all the adrenergic receptors to varying degrees and will therefore have the effects related to stimulation of these receptors. This allows these drugs to be used for a multitude of purposes, such as acute hypotension (ephedrine, NE, PE), cardiac arrest (EPI, NE), severe asthma (EPI), bronchodilation (ephedrine), anaphylaxis (EPI), congestion (PE), and can be used to dilate pupils (PE).

ephedrine ([pronounced: e FED rin ])- injectable solution

EpiPen, Racepinephrine (generic name: epinephrine, EPI  [pronounced: EP i NEF rin ]) - autoinjector, injectable solution, solution for nebulization

Levophed (generic name: norepinephrine, NE  [pronounced: nor ep i NEF rin ])  - injectable solution

Sudafed (generic name: pseudoephedrine, PE  [pronounced: SOO doe ee FED rin ])  - tablet, syrup

Alpha-2 adrenergic agonists
Alpha-2 agonists, despite stimulating the alpha-2 adrenergic receptors, actually function against the sympathetic nervous system and sometimes will be classified as sympathetic blocking (sympatholytic) drugs. The net result is a decrease in cardiac output and vasodilation making them useful in the treatment of hypertension.

Catapres, Catapres TTS (generic name: clonidine  [pronounced: KLOE ni deen ])  - injectable solution, extended-release oral suspension, patch, tablet, extended-release tablet

Tenex (generic name: guanfacine  [pronounced: GWAHN fa seen ])  - tablet

Alpha-adrenergic blocking agents
Alpha-adrenergic blocking drugs are primarily used to treat benign prostatic hypertrophy (BPH). These medications also cause vasodilation and reduced blood pressure, making them suitable choices for treating hypertension.

Cardura, Cardura XL (generic name: doxazosin  [pronounced: dox AY zo sin ])  - tablet, extended-release tablet

Flomax (generic name: tamsulosin  [pronounced: tam soo LOE sin ])  - capsule

Hytrin (generic name: terazosin  [pronounced: ter AY zo sin ])  - capsule

5-alpha-reductase inhibitors
5-alpha-reductase inhibitors are a group of medications with antiandrogenic activity, and are used in benign prostatic hypertrophy (dutasteride, finasteride), male pattern baldness (finasteride), and female hirsutism (finasteride).

Women that are pregnant or are trying to become pregnant should avoid handling crushed or broken finasteride tablets.

Avodart (generic name: dutasteride  [pronounced: doo TAS ter ide ])  - capsule

Proscar, Propecia (generic name: finasteride  [pronounced: fih NAH steh ride ])  - tablet

Beta-adrenergic blocking agents
Beta adrenergic blocking agents are commonly called beta-blockers. By blocking the beta-adrenergic receptors, you can decrease the heart rate and the force of contractions causing a decrease in blood pressure. This means the drugs can treat hypertension, angina pectoris, tachycardia, and arrhythmias. Patients with bronchospastic diseases should, in general, not use beta-blockers as they can cause bronchoconstriction.

Tenormin (generic name: atenolol  [pronounced: ah TEN oh lol ])  - Tablet

Zebeta (generic name: bisoprolol  [pronounced: BIS oh PROE lol ])  - Tablet

Coreg, Coreg CR (generic name: carvedilol  [pronounced: KAR ve dil ole ])  - extended-release capsule, tablet

Trandate (generic name: labetalol  [pronounced: la BAY ta lol ])  - injectable solution, tablet

Lopressor, Toprol XL(generic name: metoprolol  [pronounced: me TOE pro lol ])  - injectable solution, tablet, extended-release tablet

Bystolic (generic name: nebivolol  [pronounced: ne BIV oh lol ])  - tablet

Inderal, Inderal LA (generic name: propranolol  [pronounced: pro PRAN oh lol ])  - oral solution, injectable solution, tablet, extended-release capsule

Timol, Timoptic, Timoptic XE (generic name: timolol  [pronounced: TIH mo lol ])  - ophthalmic solution, gel forming ophthalmic solution

Drugs affecting the parasympathetic nervous system
The parasympathetic nervous system is part of the autonomic nervous system that tends to act in opposition to the sympathetic nervous system, by primarily regulating body functions during rest, digestion, and waste regulation. Stimulation of the parasympathetic system increases the activity of the gastrointestinal and genitourinary system while decreasing the activity of the cardiovascular system.

Cholinergic drugs
The parasympathetic system is regulated by cholinergic receptors. The naturally occurring chemical that stimulates these receptors is called acetylcholine (ACH). Drugs that mimic ACH are therefor called cholinergic drugs. The conditions treated by this class of drugs varies widely. Donepezil and galantamine are each primarily used to treat Alzheimer's disease, while neostigmine is used to treat myasthenia gravis, and is an antidote for nondepolarizing neuromuscular blocking drugs (a group of drugs often used to create a neuromuscular blockade during surgery).

Aricept, Aricept ODT (generic name: donepezil  [pronounced: doe NEP e zil ])  - tablet, orally disintegrating tablet

Razadyne, Razadyne ER (generic name: galantamine   [pronounced: ga LAN ta meen ])   - tablet, extended-release tablet, oral solution

Prostigmin (generic name: neostigmine  [pronounced: nee o STIG meen ])  - injectable solution, tablet

Anticholinergic drugs
A naturally occurring chemical that works opposite of ACH is acetylcholinesterase, and therefor drugs that mimic acetylcholinesterase are often referred to as anticholinergic drugs. The conditions treated by this group of drugs also varies widely. Atropine can be used to increase the heart rate, anesthesia premedication, reversal of cholinergic drugs, treatment of GI spasticity, mydriasis, and enuresis treatment. Dicyclomine is typically used to treat GI disorders such as ulcers and colitis. Oxybutynin and tolterodine are typically used in the treatment of overactive bladder.

AtroPen, IsoptoAtropine (generic name: atropine  [pronounced: AT roe peen ])  - injectable solution, tablet, ophthalmic solution, ophthalmic ointment

Bentyl (generic name: dicyclomine   [pronounced: dye SYE kloe meen ])  - capsule, injectable solution, syrup, tablet

Ditropan, Ditropan XL (generic name: oxybutynin   [pronounced: OX i BUE ti nin ])  - tablet, controlled-release tablet, syrup, transdermal patch, gel

Detrol, Detrol LA (generic name: tolterodine   [pronounced: tol TER oh deen ])  -tablet, extended-release capsule

Skeletal muscle relaxants
Skeletal muscle relaxants are used to treat conditions such as muscle spasticity and to relax muscle tone during surgeries. Medications that block muscle contraction within the spinal cord are referred to as centrally acting skeletal muscle relaxants; conversely peripherally acting skeletal muscle relaxants inhibit muscle contraction at the neuromuscular junction (NMJ).

All patients using skeletal muscle relaxants should avoid additional items that will depress the CNS or impair neuromuscular function such as alcohol, sedatives, and tranquilizers. There is also concern over abuse of these drugs, whether on their own or being used with other medications. Hence, carisoprodol was recently made a schedule IV controlled substance.

Neuromuscular blocking agents
Neuromuscular blocking agents (NMBAs or NMBs), also called peripherally acting skeletal muscle relaxants, are primarily used to prevent muscle contractions during surgeries or procedures where reflexes need to be suppressed (e.g., intubation). They can further be broken into two major subgroups: depolarizing (succinylcholine) and nondepolarizing (cisatracurium, pancuronium, rocuronium, and vecuronium).

Nimbex (generic name: cisatracurium  [pronounced: sis AT ra KURE ee um ])  - injectable solution

Pavulon (generic name: pancuronium  [pronounced: pan kyoo ROE nee um ])  - injectable solution

Zemuron (generic name: rocuronium  [pronounced: ROE kure OH nee um ])  - injectable solution

Anectine (generic name: succinylcholine, SUX   [pronounced: SUX i nil KOE leen ])  - injectable solution

Norcuron (generic name: vecuronium   [pronounced: VEK ue ROE nee um ]) - powder for injection

Centrally acting skeletal muscle relaxants
Centrally acting skeletal muscle relaxants, also called spasmolytics, are primarily used to treat muscle spasms that may be caused by overexertion, trauma, or nervous tension. Baclofen and tizanidine are also used to treat multiple sclerosis.

Lioresal (generic name: baclofen [pronounced: BAK loe fen ]) - tablet, injectable solution

Soma (generic name: carisoprodol  [pronounced: kar eye soe PROE dole ]) CIV - tablet

Flexeril (generic name: cyclobenzaprine [pronounced: sye kloe BEN za preen ]) - tablet, extended-release capsule

Skelaxin (generic name: metaxalone [pronounced: me TAX a lone ]) - tablet

Robaxin (generic name: methocarbamol [pronounced: meth oh KAR ba mal ]) - tablet, injectable solution

Zanaflex (generic name: tizanidine [pronounced: tye ZAN i deen ]) - tablet, capsule

Anesthetics
An anesthetic is a drug that produces anesthesia, a reversible loss of sensation.

Local anesthetics
Local anesthetics, as their name implies, causes a temporary loss of feeling in a confined area of the body. Local anesthetics can be broken into two major groups: amide local anesthetics and ester local anesthetics. Cocaine is also used as a local anesthetic because despite its abuse potential, it is the only local anesthetic that causes vasoconstriction.

Ester local anesthetics
In general, ester local anesthetics have a short or moderate duration of action.

Solarcaine (generic name: benzocaine  [pronounced: BENZ o kane ])  - gel, topical solution, otic solution

cocaine ([pronounced: koe-KANE ]) CII - topical solution

Pontocaine (generic name: tetracaine  [pronounced: TET ra kane ])  - injectable solution, powder for injection, throat spray, ophthalmic solution

Amide local anesthetics
Typically, amide local anesthetics have a long duration of action.

Marcaine, Sensorcaine (generic name: bupivacaine  [pronounced: bue PIV a kane ])  - injectable solution

Xylocaine, Lidoderm (generic name: lidocaine  [pronounced: LYE doe kane ])  - injectable solution, infusion solution, oral solution, topical ointment, topical solution, topical jelly, patch

General anesthetics
While many general anesthetics are available, the most common one for institutional pharmacies to dispense is propofol. Propofol is often used used for induction and maintenance of general anesthesia and ICU sedation for intubated, mechanically ventilated patients.

Diprivan (generic name: propofol  [pronounced: PROE po fole ])  - injectable solution

Medications for treating psychological conditions
There are numerous neurotransmitters located within the brain, including acetylcholine, norepinephrine, dopamine, and serotonin. These neurotransmitters are responsible for the action and function of the brain. If there is an imbalance in any of these neurotransmitters, it can cause a cascade of problems ranging from sleep disorders to hyperkinesis, from seasonal depression to mental illness. Medications used to treat these conditions are typically either excitatory or inhibitory depending on the nature of the imbalance.

Antipsychotic drugs
Antipsychotic drugs, referred to as neuroleptics, are used to suppress the symptoms of schizophrenia and other psychotic conditions. Antipsychotics are associated with a range of side effects. Approximately two-thirds of patients will discontinue use due in part to adverse effects. Side effects may include acute dystonias, akathisia, parkinsonism, tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, intense dreams or nightmares, and hyperprolactinaemia. Side effects from antipsychotics can be managed by a number of different drugs. For example, anticholinergics are often used to alleviate the motor side effects of antipsychotics. Some of the side effects will appear after the drug has been used only for a long time. When discontinuing therapy, patients must be tapered off of these drugs.

Clozapine is of particular concern because it can cause agranulocytosis, CNS depression, leukopenia, neutropenia, seizure disorder, bone marrow suppression, dementia, hypotension, myocarditis, orthostatic hypotension (with or without syncope) and seizures. With these severe side effects in mind, each of the manufacturers of clozapine are required to enroll patients taking their medication into a national registry where they will monitor a patient's white blood cell count (WBC) and their absolute neutrophil count (ANC). If the numbers fall below a particular level their therapy may need to be halted and the national registry has a responsibility to report the information to the nonrechallengeable database, that way if a physician goes to place the patient on the medication again the various manufacturers will know they are not allowed as they always need to check new orders for a patient against the nonrechallengeable database. Once listed in the nonrechallengeable database they may never use clozapine again.

Clozaril, FazaClo ODT, Versacloz (generic name: clozapine  [pronounced: KLOE za peen ])  - tablet, orally disintegrating tablet

Haldol (generic name: haloperidol  [pronounced: HAL oh PER i dol ])  - tablet, oral concentrate, injectable solution, injectable solution-decanoate

Zyprexa, Zyprexa Zydis (generic name: olanzapine  [pronounced: oh LANZ a peen ]) - tablet, orally disintegrating tablet, short-acting IM injection, extended-release suspension IM injection

Seroquel, Seroquel XR (generic name: quetiapine  [pronounced: kwe TYE a peen ]) - tablet, extended-release tablet

Risperdal, Risperdal Consta (generic name: risperidone  [pronounced: ris PER i done ]) - tablet, orally-disintegrating tablet, oral solution, powder for injection

Geodon (generic name: ziprasidone  [pronounced: zi PRAY si done ])  - capsule, powder for injection

Hypnotics
Hypnotics are primarily used to induce and maintain sleep, usually to treat insomnia. There are three major categories of hypnotics: benzodiazepines, barbiturates, and nonbarbiturates. Other medications and substances that cause CNS depression (such as alcohol) should be avoided.

Benzodiazepines
Benzodiazepines are commonly used as anxiolytics, sedatives, hypnotics, anticonvulsants, and skeletal muscle relaxants.

Xanax (generic name: alprazolam  [pronounced: al PRAY zoe lam ])  CIV - tablet, extended-release tablet, orally-disintegrating tablet, oral solution

Klonopin (generic name: clonazepam  [pronounced: kloe NAZ e pam ])  CIV - tablet

Valium (generic name: diazepam  [pronounced: dye AZ e pam ])  CIV - tablet, oral solution, rectal solution, injectable solution, intramuscular device

Ativan (generic name:  lorazepam  [pronounced: lor A ze pam ])  CIV - tablet, oral concentrate, injectable solution

Versed (generic name: midazolam  [pronounced: mye DAZ oh lam ])  CIV - oral syrup, injectable solution

Restoril (generic name: temazepam  [pronounced: te MAZ e pam ])  CIV - tablet

Barbiturates
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants. Barbiturates also have analgesic effects; however, these effects are somewhat weak, preventing barbiturates from being used in surgery in the absence of other analgesics.

Luminal (generic name: phenobarbital  [pronounced: FEE noe BAR bi tal ]) CIV - tablet, elixir, injectable solution

Nonbarbiturate hypnotics
Barbiturates, while strictly considered hypnotics, have been largely replaced by the newer nonbarbiturates for treating insomnia since barbiturates are known to cause a 'hangover' effect.

Lunesta (generic name: eszopiclone  [pronounced: e ZOP i klone ])  CIV - tablet

Rozerem (generic name: ramelteon  [pronounced: ram EL tee on ])  - tablet

Sonata (generic name: zaleplon  [pronounced: ZAH le plon ])  CIV - capsule

Ambien, Ambien CR (generic name: zolpidem  [pronounced: zole PI dem ])  CIV - tablet, extended-release tablet, sublingual tablet, oral spray

Antidepressants
An antidepressant is a psychiatric medication used to alleviate mood disorders such as major depression and dysthymia and anxiety disorders such as social anxiety disorder.

Antidepressants carry a black box warning that in short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults.

Tricyclic antidepressants
The tricyclic antidepressants are used primarily in the clinical treatment of mood disorders such as major depressive disorder, dysthymia, and treatment-resistant variants. They are also used in the treatment of a number of other medical disorders, including anxiety disorders such as generalized anxiety disorder, social phobia also known as social anxiety disorder, obsessive-compulsive disorder, and panic disorder, post-traumatic stress disorder, body dysmorphic disorder, eating disorders like anorexia nervosa and bulimia nervosa, certain personality disorders such as borderline personality disorder, attention-deficit hyperactivity disorder, as well as chronic pain, neuralgia or neuropathic pain, and fibromyalgia, headache, or migraine, smoking cessation, tourette syndrome, trichotillomania, irritable bowel syndrome, interstitial cystitis, nocturnal enuresis, narcolepsy, insomnia, pathological crying and/or laughing, chronic hiccups, ciguatera poisoning, and as an adjunct in schizophrenia.

Elavil (generic name: amitriptyline  [pronounced: a mee TRIP ti leen ])  - tablet

Sinequan (generic name: doxepin  [pronounced: DOX e pin ])  - capsule, tablet, oral concentrate

Selective serotonin reuptake inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs) are believed to work by decreasing the central nervous system's neuronal uptake of serotonin (5-HT). While these drugs can be used for a very broad range of things, you will typically see them used for treating moderate to major depression, generalized anxiety disorder, panic disorders, social anxiety, post-traumatic stress disorder, premenstrual dysphoric disorder, and prevention of migraine.

Celexa (generic name: citalopram  [pronounced: si TAL o pram ])  - tablet, oral solution

Lexapro (generic name: escitalopram  [pronounced: ES sye TAL oh pram ])  - tablet, oral solution

Prozac (generic name: fluoxetine  [pronounced: floo OX e teen ])  - tablet, capsule, delayed-release capsule, oral solution

Luvox (generic name: fluvoxamine  [pronounced: floo VOX a meen ])  - tablet, extended-release capsule

Paxil (generic name: paroxetine  [pronounced: pa ROX a teen ])  - tablet, extended-release tablet, oral suspension

Serotonin-norepinephrine reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitors (SNRIs) prevent the uptake of neuronal serotonin and norepinephrine and are a less potent inhibitor of dopamine reuptake. The increase in these chemicals is believed to be related to their use in treating depression and anxiety. Duloxetine is also commonly used to treat chronic musculoskeletal pain, diabetic peripheral neuropathic pain, and fibromyalgia.

Pristiq (generic name: desvenlafaxine   [pronounced: des VEN la FAX een ])  - extended-release tablet

Cymbalta (generic name: duloxetine   [pronounced: du LOX e teen ])  - capsule

Effexor, Effexor XR (generic name: venlafaxine  [pronounced: VEN la fax een ])  - tablet, extended-release tablet, extended-release capsule

Miscellaneous antidepressants
The medications in this category have varied mechanisms of action, but all function as antidepressants. Bupropion is also used for seasonal affective disorder, and smoking cessation. Mirtazapine is also used for post-traumatic stress disorder (PTSD). Trazodone is used for a number of things, including aggressive behavior, alcohol withdrawal, insomnia, and prevention of migraine.

Wellbutrin, Zyban (generic name: bupropion  [pronounced: byoo PRO pee on ])  - tablet, sustained-release tablet, extended-release tablet

Remeron, Remeron SolTab (generic name: mirtazapine  [pronounced: mir TAZ a peen ])  - tablet, orally-disintegrating tablet

Desyrel, Desyrel Dividose (generic name: trazodone  [pronounced: TRAZ a done ])  - tablet, extended-release tablet

Antianxiety agent, nonbenzodiazepine
While many anxiolytic agents are related to benzodiazepines, one popular alternative is buspirone. It has a high affinity for 5HT1 receptors and a moderate affinity for dopamine D2 receptors. Buspirone is considered to have very little abuse potential; so unlike benzodiazepines, it is not a controlled substance.

BusPar (generic name:  buspirone  [pronounced: byoo SPYE rone ])  - tablet

Partial nicotinic receptor antagonist
Varenicline is used as a smoking cessation aid without actually using any form of nicotine. There is a heightened caution with this drug about suicidal ideation (suicidal thoughts). Also, many patients using this medication report abnormal dreams.

Chantix (generic name: varenicline  [pronounced: ver EN e kleen ])  - tablet

Amphetamines
Amphetamines are commonly used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Their ability to improve focus/concentration and boost energy levels has made this class of drugs very desirable for abuse; therefore, all amphetamines are considered schedule II controlled substances. Side effects may consist of severe weight loss; also, dependence may develop during use of this drug. Amphetamines have the potential to raise the heart rate to dangerous levels.

Adderall, Adderall XR (generic name: amphetamine & dextroamphetamine  [pronounced: am FET a meen and DEX troe am FET a meen ]) CII - tablet, capsule, extended-release capsule

Focalin, Focalin XR (generic name: dexmethylphenidate  [pronounced: dex METH il FEN i date ])  CII - tablet, extended-release capsule

Vyvanse (generic name: lisdexamfetamine  [pronounced: lis dex am FET a meen ])  CII - capsule

Ritalin, Concerta, Daytrana (generic name: methylphenidate  [pronounced: METH il FEN i date ]) CII - tablet, chewable tablet, extended-release tablet, capsule, extended-release capsule, oral solution, transdermal patch

Other ADHD treatment agent
Atomoxetine is used to treat ADHD. It functions as a selective inhibitor of presynaptic norepinephrine transport. Unlike amphetamines used to treat ADHD, atomoxetine is considered to have little or no abuse potential.

Strattera (generic name: atomoxetine  [pronounced: AT oh mox e teen ])  - capsule

Anorexiant
Phentermine is indicated as a short-term (a few weeks) adjunct therapy for weight reduction based on increased exercise, behavior modification, and calorie reduction.

Adipex P (generic name: phentermine  [pronounced: FEN ter meen ])  CIV - tablet, orally-disintegrating tablet, capsule

Stimulant
Modafinil may increase dopamine in the brain by decreasing dopamine reuptake. Modafinil is used for treating narcolepsy, shift work sleep disorder, Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), and off label it is used to treat fatigue in MS patients and for depression.

Provigil (generic name: modafinil  [pronounced: moe DAF i nil ])  CIV - tablet

Antimanic drug
Lithium is one of the oldest medications on the market for treating mania and is still quite popular. Lithium is also sometimes used to treat Huntington's disease, neutropenia (due to chemotherapy, or AIDS), cluster headache, PMS, bulimia, alcoholism, syndrome of inappropriate antidiuretic hormone secretion (SIADH), tardive dyskinesia, hyperthyroidism, and psychosis (postpartum or steroid-induced).

Lithium works by altering cation transport in nerve and muscle cells, and influences serotonin and/or norepinephrine reuptake.

Many of the antiepileptic drugs discussed later in this article are also often used as mood-stabilizing drugs.

Eskalith, Lithobid (generic name: lithium  [pronounced: LITH ee um ])  LiCO3  - tablet, extended-release tablet, capsule, syrup

NMDA antagonist
N-methyl-D-aspartate (NMDA) antagonists prevent excessive stimulation of the NMDA-receptor, which is ordinarily stimulated by glutamate. At normal levels, glutamate aids in memory and learning, but if levels are too high, glutamate appears to overstimulate nerve cells, killing them through excitotoxicity.

Memantine has been associated with a moderate decrease in clinical deterioration with only a small positive effect on cognition, mood, behavior, and the ability to perform daily activities in moderate to severe Alzheimer's disease. There does not appear to be any benefit in mild disease.

Namenda (generic name: memantine  [pronounced: meh MAN teen ])  - tablet, extended-release capsule, oral solution

Antiepileptic drugs
Antiepileptic drugs (AEDs) will also sometimes be referred to as anticonvulsants. All of the drugs in this category can be used for treating various types of seizures. Many of these medications have additional uses such as treating trigeminal neuralgia (carbamazepine), bipolar disorder (carbamazepine, lamotrigine, valproic acid), postherpetic neuralgia (gabapentin, pregabalin), muscle cramps (gabapentin), anxiety (gabapentin), diabetic neuropathy (gabapentin, pregabalin), fibromyalgia (pregabalin), neuropathic pain with spinal cord injury (pregabalin), migraine prophylaxis (topiramate, valproic acid), cluster-headache prophylaxis (topiramate), and alcoholism (topiramate).

Tegretol, Equetro (generic name: carbamazepine  [pronounced: kar ba MAZ e peen ])  - tablet, extended-release tablet, extended-release capsule, oral suspension

Neurontin (generic name: gabapentin  [pronounced: GA ba PEN tin ])  - capsule, tablet, oral solution

Lamictal (generic name: lamotrigine  [pronounced: la MOE tri jeen ])  - tablet, chewable tablet, orally-disintegrating tablet, extended-release tablet

Keppra (generic name: levetiracetam  [pronounced: LEE ve tye RA se tam ])  - tablet, extended-release tablet, oral solution, injectable solution

Trileptal (generic name: oxcarbazepine  [pronounced: ox kar BAY zeh peen ])  - tablet, extended-release tablet, oral suspension

Lyrica (generic name: pregabalin  [pronounced: pre GAB a lin ])  CV - capsule, oral solution

Topamax (generic name: topiramate  [pronounced: toe PYRE a mate ])  - tablet, capsule

Depakote, Depakene, Depacon (generic name: valproic acid  [pronounced: val PRO ik A sid ])  - tablet, delayed-release tablet, extended-release tablet, capsule, delayed-release capsule, sprinkle capsule, syrup, injectable solution

Antiparkinson drugs
Parkinson's disease is a common neurologic disorder affecting approximately 1% of the population over the age of 60 (a much smaller percentage of the population will sometimes have this disease at an earlier age) caused by the loss of dopamine receptors. This disease presents a number of motor and nonmotor symptoms related to the loss of dopamine receptors.

Typically, the first motor symptom is a resting tremor in an upper extremity. Over time, additional motor symptoms occur including bradykinesia, rigidity, and gait difficulty. The first affected arm may not swing fully when walking, and the foot on the same side may scrape the floor. As the disease progresses, posture becomes increasingly flexed and strides become shorter causing a shuffling motion from the patient.

Nonmotor symptoms usually begin with the loss of smell, and is followed by rapid eye movements and behavior disorders. The most common treatment is the use of carbidopa & levodopa to provide dopamine replacement therapy. Dopamine agonists (pramipexole, ropinirole) are also useful in decreasing the symptoms.

Dopamine agonists (pramipexole, ropinirole) are also useful in the treatment of restless leg syndrome.

Sinemet, Sinemet CR, Parcopa (generic name: carbidopa & levodopa  [pronounced: KAR bi DOE pa and LEE voe DOE pa ])  - tablet, orally-disintegrating tablet, extended-release tablet

Mirapex, Mirapex ER (generic name: pramipexole  [pronounced: pram i PEX ole ])  - tablet, extended-release tablet

Requip, Requip XL (generic name: ropinirole  [pronounced: roe PIN i role ])  - tablet, extended-release tablet

Analgesics
An analgesic is simply a medication that provides relief from pain whether through the reduction of inflammation or through a dissociative effect where the patient no longer notices the pain. The word analgesic is derived from Greek where an- is a prefix meaning without, algesia or algos simply means pain, and -ic is a suffix that means pertaining to. Placing the whole word together means pertaining to without pain.

Opioid analgesics
Opioid analgesics are often used to treat acute pain (such as postoperative pain), and for palliative care to alleviate the severe chronic, disabling pain of terminal conditions such as cancer, and sometimes for degenerative conditions such as rheumatoid arthritis. There has been an increased use of opioids in the management of nonmalignant chronic pain. Opioids also have antitussive and antidiarrheal effects; therefore, low doses and or weaker forms of these medications will sometimes be used for those purposes as well. These medications do have a potential for abuse due to their addictive nature. While addictive themselves, two of these medications (buprenorphine & naloxone and methadone) can be used to treat opioid addiction. Most of these medications are considered controlled substances and their federal schedules are listed beside them.

Suboxone (generic name: buprenorphine & naloxone  [pronounced: byoo PREH nor feen and NAH lox own ])  CIII - sublingual tablet, sublingual film

codeine ([pronounced: KOE deen ]) CII - tablet, oral solution

Tylenol with Codeine, Tylenol #3, Tylenol #4 (generic name: codeine & acetaminophen  [pronounced: KOE deen and a SEET a MIN o fen ])  CIII as a tablet and CV as an oral solution - tablet, oral solution

Duragesic, Sublimaze, Actiq (generic name: fentanyl  [pronounced: FEN ta nil ])  CII - transdermal patch, injectable solution, sublingual tablet, buccal tablet, buccal film, sublingual solution, lollipop, troche

Vicodin, Lorcet (generic name: hydrocodone & acetaminophen  [pronounced: hye droe KOE done and a SEET a MIN oh fen ])  CIII and is changing to a CII in October 2014 - capsule, tablet, oral solution, oral elixir

Dilaudid (generic name: hydromorphone  [pronounced: HYE droe MOR fone ])  CII - tablet, extended-release tablet, injectable solution, oral solution, suppository, powder for injection

Demerol (generic name: meperidine  [pronounced: me PER i deen ])  CII - tablet, injectable solution, syrup

Methadose, Dolophine (generic name: methadone  [pronounced: METH a done ])  CII - tablet, dispersible tablet, oral solution, injectable solution

MS Contin, Duramorph, Kadian (generic name: morphine  [pronounced: MOR feen ]) CII - tablet, extended-release capsule, controlled-release tablet, oral solution, injectable solution, suppository

OxyContin, Roxicodone (generic name: oxycodone  [pronounced: ox i KOE done ])  CII - tablet, capsule, extended-release tablet, oral solution

Percocet, Tylox, Roxicet (generic name: oxycodone & acetaminophen  [pronounced: ox i KOE done and a SEET a MIN oh fen ])  CII - tablet, capsule, oral solution

Ultram (generic name: tramadol  [pronounced: TRAM a dol ])  CIV - tablet, orally-disintegrating tablet, extended-release tablet, extended-release capsule

Ultracet (generic name: acetaminophen & tramadol  [pronounced: a SEET a MIN o fen and TRAM a dol ])  CIV - tablet

Non steroidal anti inflammatory drugs
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are a class of drugs that provide analgesic and antipyretic effects, and, in higher doses, anti-inflammatory effects. NSAIDs are usually indicated for the treatment of acute or chronic conditions where pain and inflammation are present, such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout, dysmenorrhoea, headache and migraine, postoperative inflammation, muscle stiffness, and fever.

Celebrex (generic name: celecoxib  [pronounced: SEL e KOX ib ])  - capsule

Voltaren, Cataflam (generic name: diclofenac  [pronounced: dye KLOE fen ak ])  - tablet, extended-release tablet, capsule, powder packet for oral solution

Advil, Motrin (generic name:  ibuprofen  [pronounced: EYE bue PROE fen ])  - tablet, chewable tablet, oral suspension, injection solution

Toradol (generic name: ketorolac  [pronounced: KEE toe ROLE ak ])  - tablet, injectable solution

Mobic (generic name: meloxicam   [pronounced: mel OKS i kam ])  - tablet, oral suspension

Relafen (generic name: nabumetone   [pronounced: na BUE me tone ])  - tablet

Aleve, Naprosyn, Anaprox, Naprelan (generic name: naproxen  [pronounced: na PROX en ])  - tablet, oral suspension

Feldene (generic name: piroxicam  [pronounced: peer OX i kam ])  - capsule

Miscellaneous nonopioid analgesics
Some medications do not easily fit into other categories, such as acetaminophen, aspirin and some of the combination analgesics that contain weak barbiturates.

Acetaminophen, sometimes listed as APAP, is a potent analgesic and antipyretic activity with weak anti-inflammatory activity. Acetaminophen-containing products pose a potential to harm liver function; therefore, patients are not to exceed a cumulative dose of 4 g/day of acetaminophen. In January 2011, the FDA mandated that all manufacturers limit acetaminophen in prescription products to 325 mg/dosage unit; manufacturers were required to comply by January 14, 2014.

Aspirin, sometimes listed as ASA, inhibits the synthesis of prostaglandins by cyclooxygenase; inhibits platelet aggregation; and has antipyretic and analgesic activity. While aspirin could technically be classified as a NSAID, it is more often classified as a salicylate.

One thing that surprises many about the combination of butalbital, acetaminophen, and caffeine is that it is not federally scheduled even though the combination of butalbital, aspirin, and caffeine is considered a controlled substance.

Tylenol (generic name: acetaminophen  [pronounced: a SEET a MIN oh fen ])  APAP  - tablet, extended-release tablet, chewable tablet, disintegrating tablet, elixir, suspension, suppository

Bayer, Ascriptin, Bufferin, Ecotrin, St. Joseph Adult Chewable Aspirin (generic name: aspirin  [pronounced: AS pir in ]) ASA  - tablet, delayed-release tablet, effervescent tablet, chewable tablet, suppository

Fioricet (generic name: butalbital, acetaminophen, & caffeine   [pronounced: a SEET a MIN oh fen, bue TAL bi tal, and KAF een ])  - tablet, capsule, oral solution

Fiorinal (generic name: butalbital, aspirin, & caffeine   [pronounced: bue TAL bi tal, AS pir in, and KAF een ])  CIII - tablet, capsule

Serotonin 5-HT receptor agonists
Serotonin 5-HT receptor agonists cause vasoconstriction in cranial arteries to relieve migraines and cluster headaches.

Maxalt (generic name: rizatriptan   [pronounced: RYE za TRIP tan ])  - tablet, disintegrating tablet

Imitrex (generic name: sumatriptan  [pronounced: soo ma TRIP tan ])  - tablet, nasal spray, injectable solution

Zomig (generic name: zolmitriptan  [pronounced: ZOLE mi TRIP tan ])  - tablet, disintegrating tablet, nasal spray

Medications affecting the cardiac system
The word cardiac is derived from the Greek word kardia which simply means heart. The cardiac system is the entire system supporting the heart including the cardiac muscle, its conduction system, and the nerve supply along with the rest of the circulatory system such as arteries, arterioles, capillaries, venules, and veins. Many other organs also interact very directly with the cardiac system such as the lungs and kidneys. The medications affecting the cardiac system work by either exciting or inhibiting various functions either in this system or through other organs that interact with the cardiac system.

Besides the medication categories listed in this section (cardiac glycosides, diuretics, antiarrhythmics, angiotensin-II receptor antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, nitrates, renin-inhibitors, anticoagulants, antiplatelet medications, and various antihyperlipidemic drugs) some of the categories previously discussed have significant effects on the cardiac system particularly the various medications that affected the sympathetic nervous system.

Cardiac glycosides
Cardiac glycosides are drugs used in the treatment of congestive heart failure and cardiac arrhythmia. Any medications in this category work by increasing the forcing of contraction of the heart, providing an overall increase in cardiac output.

Lanoxin (generic name: digoxin  [pronounced: di JOX in ])  - elixir, tablet, injectable solution

Diuretics
A diuretic elevates the rate of urination which removes fluid from the body and has a net result of decreased blood pressure. There are various mechanisms of action for these diuretics. Loop diuretics, such as bumetanide and furosemide, inhibit the reabsorption of sodium and chloride ions in the ascending loop of Henle within the kidneys' nephrons. By decreasing this reabsorption, an increased amount of fluid is excreted. Thiazide diuretics, such as chlorothiazide and hydrochlorothiazide (often abbreviated HCTZ), inhibit sodium reabsorption in distal renal tubules resulting in increased excretion of sodium and water. Loop diuretics and thiazide diuretics also cause patients to lose a lot of potassium. Potassium sparing diuretics, such as spironolactone and triamterene, have an effect on renal distal tubules to inhibit sodium reabsorption causing the excretion of sodium and water but allows for the retention of potassium.

Bumex (generic name: bumetanide  [pronounced: byoo MET a nide ])  - tablet, injectable solution

Diuril (generic name: chlorothiazide  [pronounced: KLOR oh THYE a zide ])  - tablet, powder for injection

Lasix (generic name: furosemide  [pronounced: fur OH se mide ])  - tablet, oral solution, injectable solution

Microzide (generic name: hydrochlorothiazide  [pronounced: hye dro klor o THY a zide ]) HCTZ  - tablet, capsule

Aldactone (generic name: spironolactone  [pronounced: spir ON oh LAK tone ])  - tablet

Dyazide, Maxzide (generic name:  triamterene & hydrochlorothiazide  [pronounced: trye AM ter een and HYE dro klor oh THY a zide ])  - tablet, capsule

Antiarrhythmics
Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation.

Cordarone (generic name: amiodarone   [pronounced: A mi OH da rone ])  - tablet, injectable solution

Multaq (generic name: dronedarone  [pronounced: droe NE da rone ]) - tablet

Angiotensin-II receptor antagonists
Angiotensin-II receptor antagonists (AIIRAs), also called angiotensin receptor blockers (ARBs), are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system. Their main uses are in the treatment of hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes), and congestive heart failure.

Atacand (generic name: candesartan  [pronounced: kan de SAR tan ]) - tablet

Avapro (generic name: irbesartan  [pronounced: ir be SAR tan ])  - tablet

Cozaar (generic name: losartan  [pronounced: loe SAR tan ]) - tablet

Benicar (generic name: olmesartan  [pronounced: OL me SAR tan ])  - tablet

Micardis (generic name: telmisartan  [pronounced: TEL mi SAR tan ])  - tablet

Diovan (generic name: valsartan  [pronounced: val SAR tan ]) - tablet

Angiotensin-converting enzyme inhibitors
Angiotensin-converting enzyme inhibitors (ACE inhibitors) causes dilation of blood vessels which results in lower blood pressure. In treating heart disease, ACE inhibitors are usually used with other medications. A typical treatment plan will often include an ACE inhibitor, beta blocker, a long acting nitrate, and a calcium channel blocker in combinations that are adjusted to the individual patient's needs.

Lotensin (generic name: benazepril   [pronounced: ben AY ze pril ]) - tablet

Capoten (generic name: captopril  [pronounced: KAP toe pril ])  - tablet

Vasotec (generic name: enalapril/enalaprilat   [pronounced: e NAL a pril /en AL a pril AT ])  - tablet, injectable solution

Monopril (generic name: fosinopril  [pronounced: foe SIN oh pril ])  - tablet

Prinivil, Zestril (generic name: lisinopril   [pronounced: lyse IN oh pril ])  - tablet

Accupril (generic name: quinapril  [pronounced: KWIN a pril ])  - tablet

Altace (generic name: ramipril  [pronounced: RAM i pril ])  - capsule

Calcium channel blockers
These drugs are used to treat hypertension. Calcium channel blockers work by inhibiting the influx of calcium ions into myocardial and vascular tissues thereby preventing contractions and causing the dilation of the main coronary and systemic arteries.

Patients should avoid grapefruit and its constituents while taking calcium channel blockers. Grapefruit inhibits an isoenzyme called CYP3A4 that helps breakdown calcium channel blockers. Inhibiting this enzyme causes patients to effectively be overdosed by their calcium channel blockers. Interactions related to grapefruit are often referred to as grapefruit juice drug interactions (GJDI).

Norvasc (generic name: amlodipine  [pronounced: am LOE di peen ])  - tablet

Cardizem, Cardizem CD, Taztia XT, Tiazac (generic name: diltiazem  [pronounced: dil TYE a zem ]) - tablet, extended-release tablet, extended-release capsule, injectable solution, powder for injection

Plendil (generic name: felodipine  [pronounced: fe LOE di peen ])  - extended-release tablet

Procardia, Procardia XL, Adalat CC (generic name: nifedipine  [pronounced: nye FED i peen ])  - capsule, extended-release tablet

Isoptin, Calan, Covera HS (generic name: verapamil  [pronounced: ver AP a mil ])  - tablet, extended-release tablet, extended-release capsule, injectable solution

Nitrates
Nitrates relax smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial oxygen demand. Nitrates also improve coronary collateral circulation, lowers blood pressure, and increases heart rate. Nitrates are used for both the relief and prevention of angina pectoris, treatment of perioperative hypertension, control of congestive heart failure during a myocardial infarction, and you will see these used off label for the treatment of anal fissures. Typically, patients need a nitrate free interval to minimize tolerance. This nitrate free interval is often provided at night.

Nitroglycerin also has special storage requirements due to its relative reactivity with certain plastics. As a result, the sublingual tablets should be stored in glass; typically, this means that patients should keep them in their original container from the manufacturer. Also, the nitroglycerin intravenous solution is infused with special tubing to prevent the drug from leaching into the plastic of most infusion sets.

Isordil, Dilatrate-SR, Imdur, ISMO, Monoket (generic name: isosorbide  [pronounced: EYE soe SOR bide ])  - tablet, sublingual tablet, extended-release tablet, extended-release capsule

Nitrostat, Nitrol, NitroDur, Nitro-Bid, Nitrolingual Pumpspray (generic name: nitroglycerin  [pronounced: NYE troe GLIS er in ]) NTG - sublingual tablet, extended-release capsule, translingual solution, transdermal patch, intravenous solution, transdermal ointment, rectal ointment

Renin inhibitor
A renin inhibitor prevents the conversion of angiotensinogen to angiotensin I. The decrease in angiotensin I causes a decrease in angiotensin II, a potent blood pressure elevating peptide. This makes renin inhibitors effective in the treatment of hypertension.

Tekturna (generic name: aliskiren  [pronounced: a LIS ke rin ])  - tablet

Combination antihypertensive agents
Many antihypertensive medications are provided in combinations in order to combine effects and improve patient compliance by decreasing the number of medications the patient may need to take. As all the medications listed below have already been discussed in this chapter, you may refer to the previous information concerning each active ingredient within the combination medications listed below.

Tekturna HCT (generic name: aliskiren & hydrochlorothiazide  [pronounced: a LIS ke rin and HYE droe KLOR oh THYE a zide ])  - tablet

Lotrel (generic name: amlodipine & benazepril   [pronounced: am LOE di peen and ben AY ze pril ])   - capsule

Azor (generic name: amlodipine & olmesartan   [pronounced: am LOE de peen and  ol me SAR tan ])  - tablet

Exforge (generic name: amlodipine & valsartan   [pronounced: am LOE de peen and val SAR tan ])  - tablet

Ziac (generic name: bisoprolol & hydrochlorothiazide  [pronounced: bi SOE proe lol  and HYE droe klor oh THYE a zide ])  - tablet

Vaseretic (generic name: enalapril & hydrochlorothiazide  [pronounced: en AL e pril  and HYE droe KLOR oh THYE a zide ])  - tablet

Avalide (generic name: irbesartan & hydrochlorothiazide  [pronounced: ir be SAR tan and HYE droe KLOR oh THYE a zide ])  - tablet

Prinzide, Zestoretic (generic name: lisinopril & hydrochlorothiazide  [pronounced: lyse IN oh pril and HYE droe KLOR oh THYE a zide ])  - tablet Hyzaar (generic name: losartan & hydrochlorothiazide  [pronounced: loe SAR tan  and HYE droe KLOR oh THYE a zide ])  - tablet

Benicar HCT (generic name: olmesartan & hydrochlorothiazide  [pronounced: OL me SAR tan  and HYE droe KLOR oh THYE a zide ])  - tablet

Micardis HCT (generic name: telmisartan & hydrochlorothiazide  [pronounced: TEL mi SAR tan and HYE droe KLOR oh THYE a zide ])  - tablet

Diovan HCT (generic name: valsartan & hydrochlorothiazide  [pronounced: val SAR tan and HYE droe KLOR oh THYE a zide ])  - tablet

Anticoagulants and antiplatelet agents
A broad range of chemicals with various mechanisms of action fall into this category. Anticoagulants and antiplatelet drugs are used for the following treatments: prophylaxis after a myocardial infarction or stroke (aspirin & dipyridamole, clopidogrel, warfarin), acute coronary syndrome (clopidogrel, heparin), peripheral arterial disease (clopidogrel), coronary artery disease (clopidogrel), stenting (clopidogrel), atrial fibrillation (dabigatran, rivaroxaban, warfarin), thromboembolism (dabigatran, dalteparin), deep vein thrombosis (dalteparin, enoxaparin, heparin, rivaroxaban, warfarin), pulmonary embolism (heparin, rivaroxaban, warfarin), unstable angina (dalteparin, enoxaparin, heparin), anticoagulation therapy (dalteparin, heparin), catheter patency (heparin), cardiac valve replacement (warfarin).

Medication interactions are a common concern with these drugs as many pain relievers (most NSAIDs and aspirin) may slow a patient's clotting time. These pain relievers should not be taken in combination with the various anticoagulant and antiplatelet drugs without first consulting a physician.

Warfarin also provides a significant food-drug interaction. Warfarin prevents coagulation by binding vitamin K; therefore foods rich in vitamin K (such as dark leafy greens, broccoli, and asparagus) should be avoided as they will interfere with warfarin.

Below is a short list of the most common anticoagulants and antiplatelet agents.

Aggrenox (generic name: aspirin & dipyridamole  [pronounced: AS pi rin and dye peer ID a mole ])  - extended-release capsule

Plavix (generic name: clopidogrel  [pronounced: kloe PID oh grel ])  - tablet

Pradaxa (generic name: dabigatran  [pronounced: da BIG a tran ])  - capsule

Fragmin (generic name: dalteparin  [pronounced: DAL te PAR in ])  - injectable solution

Lovenox (generic name: enoxaparin  [pronounced: ee nox AP a rin ])  - injectable solution

heparin [pronounced: HEP a rin ] - heparin lock solution, injectable solution, premixed IV solution

Xarelto (generic name: rivaroxaban  [pronounced: RIV a ROX a ban ])  - tablet

Coumadin (generic name: warfarin  [pronounced: WAR far in ]) -  - tablet, powder for injection

HMG-CoA reductase inhibitors
HMG-CoA reductase inhibitors (commonly referred to as statins)  block the pathway for synthesizing cholesterol in the liver. This is significant because most circulating cholesterol comes from internal manufacture rather than the diet. When the liver can no longer produce cholesterol, total levels of cholesterol in the blood will fall, particularly LDL-cholesterol and triglycerides. They also increase "good cholesterol" -- HDL cholesterol. Cholesterol synthesis appears to occur mostly at night, so statins with short half-lives are usually taken at night to maximize their effect. The most common adverse side effects are raised liver enzymes and muscle problems (most frequently muscle cramps).

Patients should avoid grapefruit and its constituents while taking HMG-CoA reductase inhibitors. Grapefruit inhibits an isoenzyme called CYP3A4 that helps breakdown HMG-CoA reductase inhibitors. Inhibiting this enzyme causes patients to effectively be overdosed by their HMG-CoA reductase inhibitors. Interactions related to grapefruit are often refereed to as grapefruit juice drug interactions (GJDI).

Lipitor (generic name: atorvastatin  [pronounced: a TOR va sta tin ])  - tablet

Lescol, Lescol XL (generic name: fluvastatin  [pronounced: FLOO va sta tin ])  - capsule, extended-release tablet

Mevacor, Altoprev (generic name: lovastatin  [pronounced: LOE va sta tin ])  - tablet, extended-release tablet

Pravachol (generic name: pravastatin  [pronounced: PRAV a STAT in ])  - tablet

Crestor (generic name: rosuvastatin  [pronounced: roe SOO va sta tin ])  - tablet

Zocor (generic name: simvastatin  [pronounced: SIM va sta tin ])  - tablet

Miscellaneous hypolipidemic drugs
There are a number of other medications used to reduce cholesterol with various mechanisms of action. Caduet (amlodipine & atorvastatin) is used in combination to treat both hypertension and reduce cholesterol.

Caduet (generic name: amlodipine & atorvastatin  [pronounced: am LOE di peen and a TOR va sta tin ])  - tablet

Zetia (generic name: ezetimibe [pronounced: ez ET i mibe ]) - tablet

Tricor (generic name: fenofibrate  [pronounced: FEN oh FYE brate ])  - tablet, capsule

Lopid (generic name: gemfibrozil   [pronounced: jem FYE broe zil ])  - tablet

Niacor, Niaspan (generic names: niacin, vitamin B3, nicotinic acid [pronounced: NYE a sin, VYE ta min B3, NIK oh TIN ik AS id ]) - tablet, extended-release tablet, extended-release capsule

Lovaza (generic name: omega 3 fatty acids  [pronounced: oh MEG a three fa te AS ids ])  - chewable tablet, capsule, delayed-release capsule

Vytorin (generic name: simvastatin & ezetimibe  [pronounced: SIM va stat in  and ez ET i mibe ])  - tablet

Antihistamines
An allergy is a hypersensitivity to a substance (an allergen) that is normally harmless. Allergy sufferers may endure a wide variety of symptoms such as inflammation of the nasal passages and the conjunctiva (a membrane covering the white part of the eye), skin conditions such as hives and eczema, and asthma attacks. Some allergic conditions can be more serious and even involve anaphylaxis! Exposure to allergens that an individual has become sensitive causes their bodies to release histamines. Patients that desire symptomatic relief may use antihistamines and decongestants.

Antihistamine
Antihistamines are commonly used for the relief of various allergic reactions including allergic rhinitis, perennial & seasonal allergies, pruritus, and allergic conjunctivitis. First generation antihistamines (diphenhydramine and hydroxyzine) can cross the blood brain barrier. As a result, diphenhydramine may be used to treat insomnia, and hydroxyzine may be used to treat nausea and vomiting.

Zyrtec (generic name: cetirizine  [pronounced: se TI ra zeen ])  - tablet, chewable tablet, capsule, oral solution

Clarinex, Clarinex RediTabs (generic name: desloratadine  [pronounced: DES lor A ta deen ])  - tablet, disintegrating tablet, syrup

Benadryl (generic name: diphenhydramine  [pronounced: DYE fen HYE dra meen ])  - tablet, chewable tablet, disintegrating tablet, capsule, oral solution, cream, gel, ointment, lotion, topical aerosol spray, oral strip, injectable solution

Allegra (generic name: fexofenadine  [pronounced: FEX oh FEN a deen ])  - tablet, disintegrating tablet, oral suspension

Vistaril (generic name: hydroxyzine  [pronounced: hye DROX ee zeen ])  - tablet, capsule, syrup, oral suspension, injectable solution

Claritin (generic name: loratadine  [pronounced: lor AT a deen ])  - tablet, chewable tablet, disintegrating tablet, capsule, oral solution

Patanol, Patanase (generic name: olopatadine  [pronounced: OH loe PAT a deen ])  - ophthalmic drops, nasal spray

Antihistamines with decongestants
Patients with either colds or congestion related to their allergies may desire an antihistamine in combination with a decongestant. Since pseudoephedrine is the most commonly included decongestant, many of the medications need to be kept behind the counter in order to limit their availability. This is a result of the Combat Methamphetamine Epidemic Act, an act intended to decrease the number of clandestine methamphetamine labs in the United States.

Zyrtec D (generic name: cetirizine & pseudoephedrine   [pronounced: se TIR i zeen and SOO doe e FED rin ])  - tablet, extended-release tablet

Clarinex-D (generic name: desloratadine & pseudoephedrine  [pronounced: DES loe RAT a deen and SOO doe ee FED rin ])  - extended-release tablet

Allegra D (generic name: fexofenadine & pseudoephedrine  [pronounced: FEX oh FEN a deen and SOO doe ee FED rin ])  - extended-release tablet

Claritin D (generic name: loratadine & pseudoephedrine  [pronounced: lor AT a deen and SOO doe ee FED rin ])  - extended-release tablet

Respiratory medications
Some patients may have respiratory conditions such as asthma or bronchitis. Patients may receive glucocorticosteroids, bronchodialators, leukotriene receptor antagonists, or even epinephrine to treat or prevent acute episodes. Glucocorticosteroids and epinephrine have already been discussed in this article; therefore, this section will focus on bronchodialators and leukotriene receptor antagonists.

Bronchodialators
A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. The bronchodialators on this list can be further broken down into beta-2 agonists (albuterol, levalbuterol, and salmeterol) and anticholinergics (ipratropium and tiotropium). Fluticasone, which may be used on it own or in combination with other drugs, is classified as a glucocorticosteroid.

Proventil HFA, Ventolin HFA, Proair HFA (generic name: albuterol  [pronounced: al BYOO ter all ])  - tablet, oral liquid, inhalation aerosol, solution for nebulization

Combivent, DuoNeb (generic name: albuterol & ipratropium   [pronounced: al BYOO ter all and IP ra TRO pee um ])  - inhalation aerosol, solution for nebulization

Symbicort (generic name: budesonide & formoterol  [pronounced: bue DES oh nide and for MOE te rol ])  - inhalation aerosol

Atrovent (generic name: ipratropium  [pronounced: IP ra TRO pee um ])  - inhalation aerosol, solution for nebulization, nasal spray

Xopenex (generic name: levalbuterol  [pronounced: leh val BYOO ter all ])  - inhalation aerosol, solution for nebulization

Advair Diskus, Advair HFA (generic name: salmeterol & fluticasone  [pronounced: sal ME te rol and floo TIK a sone ])  - disk with powder for inhalation, inhalation aerosol

Spiriva (generic name: tiotropium  [pronounced: tye oh TROE pee um ])  - capsules for inhalation

Leukotriene receptor antagonists
Leukotriene receptor antagonists have been shown to improve asthma symptoms, reduce asthma exacerbations, and limit markers of inflammation. These medications are also used for allergies.

Singulair (generic name: montelukast  [pronounced: mon te LOO kast ])  - tablet, chewable tablet, granules for suspension

Accolate (generic name: zafirlukast  [pronounced: za FIR loo kast ])  - tablet

Medications affecting the gastrointestinal system
The gastrointestinal system stretches from mouth to anus and includes the esophagus, stomach, and intestines. The long portion of the body can have a plethora of ailments from heart burn and reflux, to stomach and duodenal ulcers, to emesis and diarrhea. This section endeavors to look at some of the more common medications utilized to cover these conditions.

H2-receptor antagonists
H2-receptor antagonists are used to block the action of histamine on parietal cells in the stomach, decreasing the production of acid by these cells. H2-antagonists are used for peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), dyspepsia, and the prevention of stress ulcers.

Tagamet (generic name: cimetidine  [pronounced: sye ME ti deen ])  - tablet, oral solution

Pepcid (generic name: famotidine  [pronounced: fam OH ti deen ])  - tablet, chewable tablet, oral suspension, injectable solution, premixed IV bag

Axid (generic name: nizatidine  [pronounced: ni ZA ti deen ])  - capsule, oral solution

Zantac (generic name: ranitidine  [pronounced: ra NI ti deen ])  - tablet, chewable tablet, effervescent tablet, capsule, syrup, injectable solution, premixed IV bag

Proton pump inhibitors
Proton-pump inhibitors (PPIs) produce a pronounced and long-lasting reduction of gastric acid production. These drugs are used to treat dyspepsia, duodenal ulcers, peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD), laryngopharyngeal reflux, Barrett's esophagus, stress gastritis prevention, gastrinomas and other conditions that cause hypersecretion of acid, and Zollinger-Ellison syndrome. PPIs are also used, in combination with antibiotics, to treat helicobacter pylori.

Dexilant (generic name: dexlansoprazole  [pronounced: DEX lan SOE pra zol ])  - delayed-release capsule

Nexium (generic name: esomeprazole  [pronounced: ee so MEP ra zol ])  - delayed-release capsule, granules for suspension, injectable solution

Prevacid (generic name: lansoprazole  [pronounced: lan SOE pra zol ])  - disintegrating tablet, delayed-release capsule, oral suspension

Prilosec (generic name: omeprazole  [pronounced: oh MEP ra zol ])  - delayed-release tablet, delayed-release capsule, oral suspension, powder for oral suspension

Protonix (generic name: pantoprazole  [pronounced: pan TOE pra zole ])  - delayed-release tablet, powder for oral suspension, powder for injection

Aciphex (generic name: rabeprazole  [pronounced: ra BEP ra zole ]) - delayed-release tablet

Antiemetics
Antiemetics are used to treat nausea and vomiting associated with a number of things including motion sickness, the side effects of opioid analgesics and general anesthetics, and chemotherapy directed against cancer. Antiemetics are also used for morning sickness; however there is little information about the effect on the fetus, and therefore are typically reserved for times considered strictly necessary.

Emend (generic name: aprepitant  [pronounced: a PREP i tant ]) - capsule

Anzemet (generic name: dolasetron  [pronounced: doe LAS e tron ])  - tablet, injectable solution

Marinol (generic name: dronabinol  [pronounced: droe NAH bih nol ])  CIII - capsule

Kytril (generic name: granisetron  [pronounced: gra NIS e tron ]) - tablet, transdermal patch, injectable solution

Antivert, Bonine (generic name: meclizine  [pronounced: MEK li zeen ])  - tablet, chewable tablet

Reglan (generic name: metoclopramide  [pronounced: MET oh KLOE pra mide ])  - tablet, dispersible tablet, oral solution, injectable solution

Zofran (generic name: ondansetron   [pronounced: on DAN se tron ])  - tablet, dispersible tablet, oral solution, oral film, injectable solution

Compazine (generic name: prochlorperazine  [pronounced: pro klor PER a zeen ])  - tablet, suppository, injectable solution

Phenergan (generic name: promethazine  [pronounced: pro METH a zeen ])  - oral tablet, syrup, injectable solution, suppository

Transderm Scop (generic name: scopolamine   [pronounced: skoe PAH lah meen ])  - tablet, transdermal patch, ophthalmic solution, injectable solution

Tigan (generic name:  trimethobenzamide  [pronounced: trye METH oh BENZ a mide ])  - capsule, intramuscular solution

Stool softeners and laxatives
Stool softeners and laxatives are taken to loosen stool and treat constipation. Some laxatives are used to evacuate the colon for rectal and/or bowel examinations.

Dulcolax (generic name: bisacodyl  [pronounced: bis AK oh dil ])  - delayed-release tablet, suppository, enema

Colace (generic name: docusate  [pronounced: DOK ue sate ])  - tablet, capsule, syrup

Peri-Colace, Senokot-S (generic name: docusate & senna  [pronounced: DOK yoo sate and SEN a ])  - tablet

Enulose, Kristalose (generic name: lactulose  [pronounced: LAK too lose ])  - oral solution, powder for oral solution

MiraLax, Glycolax (generic name: polyethylene glycol  [pronounced: pol I ETH I leen GLY kol ])  - powder for oral solution

GoLytely (generic name: polyethylene glycol with electrolytes  [pronounced: pol I ETH I leen GLY kol with ee LEK troe lite ])  - oral solution, powder for oral solution

Metamucil (generic name:  psyllium  [pronounced: SIL ee um ])  - powder for oral solution

Senokot (generic name: senna   [pronounced: SEN nah ])  - tablet, chewable tablet, syrup

Drugs affecting the thyroid gland and bone degeneration
The thyroid gland secretes three hormones: triiodothyronine (T3), thyroxine (T4), and thyrocalcitonin. Triiodothyronine and thyroxine help regulate tissue growth and mitochondrial metabolism in most of the cells in the human body. Thyrocalcitonin primarily affects bone formation.

Thyroid replacement therapy
Thyroid replacement therapies are primarily used to treat hypothyroidism. These therapies use medications that replace T3 (liothyronine), T4 (levothyroxine), or both T3 and T4 (thyroid).

Synthroid, Levoxyl, Levothroid (generic name: levothyroxine   [pronounced: LEE voe thye ROX een ])  - tablet, capsule, powder for injection

Cytomel, Triostat (generic name: liothyronine  [pronounced: LYE oh THYE roe neen ])  - tablet, injectable solution

Armour Thyroid (generic name: thyroid  [pronounced: THYE roid ])  - tablet

Osteoporosis therapy
Osteoporosis and Paget's Disease are diseases in which bones have decreased mass and are more fragile. While calcium and vitamin D (both discussed further when talking about dietary supplements in a later section) are important to developing and maintaining strong bones, other medications are used to specifically combat these diseases, such as calcitonin (used to supplement thyrocalcitonin), bisphosphonate derivatives (such as alendronate, ibandronate, risedronate, and zoledronic acid), and parathyroid hormone analog (teriparatide). Patients should be instructed to remain upright for 60 minutes after taking a bisphosphonate derivative to prevent stomach upset, and inflammation and erosion of the esophagus.

Fosamax (generic name: alendronate  [pronounced: a LEN dro nate ])  - tablet, weekly tablet, effervescent tablet, oral solution

Miacalcin, Fortical (generic name: calcitonin  [pronounced: kal si TOE nin ])  - injectable solution, nasal spray

Boniva (generic name: ibandronate  [pronounced: eye BAN dro nate ])  - monthly tablet, prefilled syringe

Actonel (generic name: risedronate  [pronounced: rih SED ro nayt ])  - tablet, weekly tablet

Forteo (generic name: teriparatide  [pronounced: ter i PAR a tide ])  - prefilled injectable pen

Reclast, Zometa (generic name: zoledronic acid  [pronounced: zole DRO nik AS sid ])  - injectable solution

Medications for treating diabetes mellitus
Diabetes mellitus refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. There are two primary types of this disease: type 1 diabetes and type 2 diabetes.

Type 1 diabetes, also known as insulin dependent diabetes mellitus (IDDM) or juvenile diabetes, typically appears during childhood or adolescence. Individuals with type 1 diabetes require insulin therapy as their bodies do not produce insulin.

Type 2 diabetes, also known as non-insulin dependent diabetes mellitus (NIDDM), usually occurs in adults. Individuals with type 2 diabetes either don't produce enough insulin or their cells have become insulin resistant. These patients will usually receive non-insulin therapies, although they may receive insulin therapy, or even a combination of insulin and non-insulin therapies.

Insulins
Insulin therapy is required in type 1 diabetes, and may be necessary in some individuals with type 2 diabetes. The general objective of insulin replacement therapy is to approximate the physiological pattern of insulin secretion. This requires a basal insulin throughout the day, supplemented by prandial insulin at mealtime. Insulin injections are intended to mimic the natural process, as shown in the image on the right.

A combination of rapid-acting (insulin aspart, insulin glulisine, insulin lispro) or short-acting (insulin regular) given in combination with either an intermediate-acting (insulin NPH) or long-acting (insulin detemir, insulin glargine) insulin are typically used. Sometimes an insulin vial or prefilled syringe may have a mixture of insulins (insulin aspart protamine & insulin aspart, insulin lispro protamine & insulin lispro, insulin NPH & insulin regular human) to help reduce the number of injections a patient requires.

NovoLog (generic name: insulin aspart  [pronounced: IN soo lin AS part ])  - vial for injection, prefilled pen

Novolog Mix 70/30 (generic name: insulin aspart protamine & insulin aspart  [pronounced: IN soo lin AS part PROE ta meen and IN soo lin AS part ])  - vial for injection, prefilled pen

Levemir (generic name: insulin detemir [pronounced: IN soo lin DE te mir ]) - vial for injection, prefilled pen

Lantus (generic name: insulin glargine [pronounced: IN soo lin GLAR jeen ])  - vial for injection, prefilled pen

Apidra (generic name: insulin glulisine [pronounced: IN soo lin gloo LIS een ]) - vial for injection, prefilled pen

Humalog (generic name: insulin lispro [pronounced: IN soo lin LYE sproe ])  - vial for injection, prefilled pen

Humalog Mix 50/50, Humalog Mix 75/25 (generic name: insulin lispro protamine & insulin lispro [pronounced: IN soo lin LYE sproe PROE ta meen and IN soo lin LYE sproe ]) - vial for injection, prefilled pen

Humulin N, Novlin N (generic name: insulin NPH [pronounced: IN soo lin N P H ]) - vial for injection, prefilled pen

Humulin 70/30, Novolin 70/30 (generic name: insulin NPH & insulin regular human [pronounced: IN soo lin N P H and IN soo lin REG yoo ler hoo man ]) - vial for injection, insulin pen

Humulin R, Novolin R (generic name: insulin regular human [pronounced: IN soo lin REG yoo ler hoo man ]) - vial for injection, prefilled pen, concentrated vial for injection

Biguanide
Metformin decreases hepatic glucose production, decreases GI glucose absorption, and increases target cell insulin sensitivity.

Glucophage, Glucophage XR (generic name: metformin [pronounced: met FOR min ]) - tablet, extended-release tablet, oral solution

Sulfonylureas
Sulfonylureas initially increase insulin secretion, increase insulin receptor sensitivity, and may decrease liver production of glucose. Some patients have an increased risk of hypoglycemia from sulfonylureas. These medications have a cross-sensitivity with sulfa allergies.

Amaryl (generic name: glimepiride [pronounced: glye MEP ir ide ]) - tablet

Glucotrol, Glucotrol XL (generic name: glipizide [pronounced: GLIP i zide ]) - tablet, extended-release tablet

Diabeta, Glynase, Micronase (generic name: glyburide [pronounced: GLYE bue ride ]) - tablet, micronized tablet

Metaglitinide
Metaglitinides increase insulin secretion.

Starlix (generic name: nateglinide [pronounced: na ta GLYE nide ]) - tablet

Prandin (generic name:  repaglinide [pronounced: re PAG li nide ]) - tablet

Thiazolidinediones
Thiazolidinediones improve cellular response to insulin and decreases the liver's production of glucose. Thiazolidinediones, particularly products containing rosiglitazone, may cause or exacerbate congestive heart failure in some patients.

Actos (generic name: pioglitazone   [pronounced: PYE o GLIT a zone ]) - tablet

Avandia (generic name: rosiglitazone  [pronounced: row zi GLI ta zone ])  -tablet

Dipeptidyl peptidase-4 inhibitors
Dipeptidyl peptidase-4 (DPP-4) degrade incretin hormones. DPP-4 inhibitors increase and prolong incretin hormone activity. Incretins increase insulin release and synthesis.

Tradjenta (generic name: linagliptin  [pronounced: LIN a GLIP tin ])  - tablet

Onglyza (generic name: saxagliptin  [pronounced: SAX a GLIP tin ])  - tablet

Januvia (generic name: sitagliptin  [pronounced: SI ta glip tin ])  - tablet

Glucagonlike peptide-1 agonists
Glucagonlike peptide-1 mimic incretin, causing an increase in insulin release and synthesis.

Byetta (generic name: exenatide  [pronounced: ex EN a tide ])  - injectable solution

Victoza (generic name: liraglutide  [pronounced: LIR a GLOO tide ])  - injectable solution

Oral antidiabetic combination drugs
Often, type 2 diabetics will require multiple medications. Combination products provide convenience and improved patient compliance.

Metaglip (generic name: glipizide & metformin  [pronounced: GLIP ih zyd and met FOR min ])  - tablet

Glucovance (generic name: glyburide & metformin   [pronounced: GLYE bure ide and met FOR min ])  - tablet

Janumet (generic name: sitagliptin & metformin  [pronounced: SI ta glip tin  and met FOR min ])  - tablet

Antineoplastic agents and monoclonal antibodies
Antineoplastics and monoclonal antibodies are types of chemotherapy. Chemotherapy is the use of medications to kill cancer cells. Chemotherapy is used for diffuse tumors and is used after surgery and irradiation of solid tumors in the attempt to eliminate remaining cancer cells that have metastasized.

Antineoplastic agents
Antineoplastic agents are primarily concerned with inhibiting uncontrolled new cell growth (cancer). The following is a table intended to give a succinct list of which antineoplastic agents can be used to treat various cancers. This list is not considered complete, but focuses on the antineoplastic agents discussed in this article.

Sometimes these antineoplastic agents are used for diseases other than cancer. Bleomycin can be used for pleural sclerosing. Cyclophosphamide can be used for nephrotic syndrome, juvenile idiopathic arthritis, lupus nephritis, and systemic sclerosis. Methotrexate can be used psoriasis and rheumatoid arthritis.

These drugs often work during specific phases of the cell cycle as depicted in the image.

Unfortunately, antineoplastic agents can not differentiate between cancer cells and healthy cells which is responsible for many of the common side effects from these treatments as there is rapid cell growth in bone marrow, the GI tract, hair follicles, and skin cells. This often results in anemias, nausea, vomiting, diarrhea, hair loss, photosensitivity, and thinner skin. Many of these medications also have their own unique adverse effects.

Alkylating agents
These medications are considered phase non-selective for when they work; therefore, they work during all phases, except for the G0 phase.

Besides the broad grouping of side effects common to antineoplastic agents, these drugs have the following side effects as well: carboplatin causes delayed thrombocytopenia; cisplatin has ototoxicity and can cause renal damage; cyclophosphamide can cause hemorrhagic cystitis; oxaliplatin has neurotoxicities, renal toxicity, and can trigger hypersensitivity reactions.

Paraplatin (generic name: carboplatin  [pronounced: KAR boe PLA tin ])  - powder for injection, injectable solution

Platinol (generic name: cisplatin  [pronounced: sis PLA tin ])  - injectable solution

Cytoxan (generic name: cyclophosphamide  [pronounced: sye kloe FOSS fa mide ])  - powder for injection, tablet

Eloxatin (generic name: oxaliplatin  [pronounced: ox AL i PLA tin ])  - powder for injection

Anthracyclines
These medications are considered phase non-selective for when they work; therefore, they work during all phases, except for the G0 phase.

Besides the broad grouping of side effects common to antineoplastic agents, they can cause stomatitis and have cardiotoxicities. These drugs are also considered vesicants.

Cerubidine (generic name: daunorubicin  [pronounced: DAW noe ROO bi sin ])  - injectable solution, powder for injection

Adriamycin (generic name: doxorubicin  [pronounced: DOX oh ROO bi sin ])  - injectable solution, powder for injection

Antibiotics
These drugs are G2 phase specific.

These medications have pulmonary toxicities. Bleomycin may cause fever/chill and skin erythema. Mitomycin is also considered a vesicant.

Blenoxane (generic name: bleomycin  [pronounced: BLEE oh MYE sin ])  - powder for injection

Mitomycin C, Mutamycin (generic name: mitomycin  [pronounced: MYE toe MYE sin ])  - powder for injection

Antimetabolites
These drugs are S phase specific.

All of these medications may cause stomatitis. Gemcitabine may also cause a flu-like syndrome. Methotrexate can cause renal dysfunction.

Xeloda (generic name: capecitabine  [pronounced: KAP e SYE ta been ])  - tablet

Adrucil, Efudex (generic name: fluorouracil, 5-FU [pronounced: FLOOR oh URE a sil ]) - injectable solution, cream, topical solution

Gemzar (generic name: gemcitabine  [pronounced: jem SYE ta been ]) - powder for injection

Trexall, Rheumatrex (generic name: methotrexate, MTX  [pronounced: meth oh TREX ate, M T X ])  - injectable solution, powder for injection, tablet

Antimicrotubular drugs
These drugs are mitosis phase specific.

Additional side effects with these medications include peripheral neuropathy and hypersensitivity reactions.

Taxotere (generic name: docetaxel   [pronounced: doe se TAX el ])  - injectable solution

paclitaxel ([pronounced: PAK li TAK sel ]) - injectable solution

Podophyllotoxin derivatives
This drug is G2 phase specific.

An additional side effect of etoposide is that it can cause or exacerbate hypotension.

VePesid, vp 16 (generic name: etoposide   [pronounced: e TOE poe side ])  - capsule, injectable solution, powder for injection

Topoisomerase inhibitors
This drug is mitosis phase specific.

Camptosar (generic name: irinotecan   [pronounced: EYE ri noe TEE kan ])  - injectable solution

Vinca alkaloids
These drugs are mitosis phase specific.

These drugs have neurotoxicities and they are both also considered vesicants.

Velban (generic name: vinblastine [pronounced: vin BLAS teen ]) - injectable solution, powder for injection

Oncovin (generic name: vincristine [pronounced: vin KRIS teen ]) - injectable solution

Hormone antagonists
Tumors that involve the reproductive organs (breast, ovaries, uterus, prostate and testes) are often hormone-dependent. The hormones that are often responsible for developing and maintaining these organs are now functioning as growth factors for these cancerous cells. Hormone antagonists can be useful in the treatment of these cancers. Hormone antagonists tend to work best during the G1 phase by pushing these cancer cells into the G0 phase.

These medications are often used in combination with surgery and/or radiation therapy.

Many of the side effects from other chemotherapies are not as severe or are often absent.

Selective estrogen receptor modulators
Tamoxifen is typically used in premenopausal women for 5-10 years.

Nolvadex (generic name: tamoxifen  [pronounced: ta MOX i fen ])  - tablet, oral solution

Aromatase inhibitors
Arimidex (generic name: anastrazole  [pronounced: an AS troe zole ])  - tablet

Aromisin (generic name: exemestane  [pronounced: ex e MES tane ])  - tablet

Femara (generic name: letrozole  [pronounced: LET roe zol ])  - tablet

GnRH agonists
Lupron (generic name: leuprolide  [pronounced: LOO proe lide ])  - solution for injection, prefilled syringe

Monoclonal antibodies
Monoclonal antibodies, often referred to as targeted therapy, only works against specific cells. To take that a step further, they only react with specific epitopes or antigens. This can reduce or even eliminate many of the side effects, but the medications tend to be very limited as to which cancers and autoimmune diseases they can treat. This is a result of monoclonal antibodies being monospecific antibodies that are all identical, because they are made by immune cells that are all clones of a unique parent cell. This specificity can also be problematic if the antigen becomes minimally changed.

The following table lists the types of cancers that can be treated by monoclonal antibodies.

Monoclonal antibodies are also used to treat age related macular degeneration (bevacizumab), Wegener granulomatosis (rituximab), idiopathic pulmonary fibrosis (infliximab), respiratory syncytial virus (palivizumab), sarcoidosis (infliximab), rheumatoid arthritis (adalimumab, infliximab, rituximab), psoriatic arthritis (adalimumab, infliximab), ankylosing spondylitis (adalimumab, infliximab), Crohn's disease (adalimumab, infliximab), ulcerative colitis (adalimumab, infliximab), plaque psoriasis (adalimumab, infliximab), microscopic polyangiitis (rituximab), and immune thrombocytopenic purpura (rituximab).

Humira (generic name: adalimumab  [pronounced: AY da LIM ue mab ])  - prefilled pen

CamPath (generic name: alemtuzumab  [pronounced: AL em TOOZ ue mab ]) - injectable solution

Avastin (generic name: bevacizumab  [pronounced: bev a CIZ oo mab ])  - injectable solution

Remicade (generic name: infliximab  [pronounced: in FLIX ih mab ])  - powder for injection

Synagis (generic name: palivizumab  [pronounced: PAL i VIZ oo mab ])  -  injectable solution

Rituxan (generic name: rituximab  [pronounced: ri TUX i mab ])  - injectable solution

Herceptin (generic name: trastuzumab  [pronounced: tras TOO zoo mab ])  - powder for injection

Miscellaneous drug categories
There is a wide array of medications with just a few medications in each category. This section provides information on various common medications that could not be grouped into previous sections.

Hemopoietic agents
These medications affect the hemopoietic stem cells in bone marrow causing an increase in either red blood cells (darbepoetin, epoetin), white blood cells (filgrastim), or platelets (oprelvekin). Dialysis, chemotherapy, and various other causes of anemia make this class of medications extremely useful.

Aranesp (generic name:  darbepoetin alfa  [pronounced: DAR be POE e tin AL fa ])  - injectable solution, prefilled syringe

Epogen, Procrit (generic name:  epoetin alfa   [pronounced: e POE e tin AL fa ])  - injectable solution

Neupogen (generic name: filgrastim   [pronounced: fil GRAS tim ])  - injectable solution, prefilled syringe

Neumega (generic name: oprelvekin   [pronounced: oh PERL ve kin ])  - powder for injection

Gouty arthritis treatment
Gouty arthritis is painful inflammation (often of the big toe and foot) resulting from elevated levels of uric acid in the blood and the deposition of urate crystals around the joints. This disease has a greater occurrence in men. The condition can become chronic and result in deformity.

Allopurinol, azathioprine, and colchicine can all be used to treat gouty arthritis. Allopurinol is also used to treat antineoplastic induced hyperuricemia. Azathioprine can also be used for prevention of kidney transplant rejection, rheumatoid arthritis, lupus nephritis, Behcet's syndrome, Crohn's disease, myasthenia gravis, and multiple sclerosis. Colchicine can also be used for familial Mediterranean fever, and Behcet's syndrome.

Zyloprim (generic name: allopurinol  [pronounced: al oh PURE i nole ])  - tablet, powder for injection

Imuran (generic name: azathioprine  [pronounced: ay za THYE oh preen ]) - tablet, powder for injection

Colcrys (generic name: colchicine  [pronounced: KOL chi seen ])  - tablet

Rheumatoid arthritis treatment
Etanercept binds and inactivates tumor necrosis factors (TNF), thereby preventing synovial inflammation.

Enbrel (generic name: etanercept   [pronounced: ee TAN er sept ])  - injectable solution, prefilled syringe

PDE-5 inhibitors
A phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) is a drug used to block the degradative action of phosphodiesterase type 5 on cyclic GMP in the smooth muscle cells lining the blood vessels supplying the corpus cavernosum of the penis. These drugs are used in the treatment of erectile dysfunction, and were the first effective oral treatment available for the condition. Because PDE-5 is also present in the arterial wall smooth muscle within the lungs, PDE-5 inhibitors have also been used in the treatment of pulmonary hypertension, a disease in which blood vessels in the lungs become overloaded with fluid, usually as a result of failure of the left ventricle of the heart.

Viagra, Revatio (generic name: sildenafil  [pronounced: sil DEN a fil ])  - tablet, injectable solution

Cialis, Adcirca (generic name: tadalafil [pronounced: ta DAL a fil ])  - tablet

Levitra, Staxyn ODT (generic name: vardenafil [pronounced: var DEN a fil ])  - tablet, orally disintegrating tablet

Antitussives and expectorants
A cough medicine is a medication used in an attempt to treat coughing and related conditions. For dry coughs, treatment with cough suppressants, antitussives (benzonatate, codeine, dextromethorphan), may be attempted to suppress the body's urge to cough. However, in productive coughs (coughs that produce phlegm), treatment is instead attempted with expectorants (guaifenesin) to loosen mucus from the respiratory tract.

Tessalon, Tessalon Perles (generic name: benzonatate  [pronounced: ben ZOE na tate ])  - capsule, gelcaps

Cheratussin AC, Guiatuss AC (generic name: codeine & guaifenesin [pronounced: KOE deen and gwye FEN a sin ])  CV - oral liquid

Benylin DM (generic name: dextromethorphan [pronounced: dex troe meth OR fan ])  - oral suspension, gelcaps, capsule, syrup, lozenge

Mucinex (generic name: guaifenesin [pronounced: gwye FEN e sin ])  - caplet, extended-release tablet, oral syrup

Sudafed PE Non-Drying Sinus Caplets (generic name: guaifenesin & phenylephrine [pronounced: gwye FEN e sin and FEN il EFF rin ])  - caplet

Prostaglandins
Latanoprost is a prostaglandin F2-alpha analog, which causes an increase in the outflow of aqueous humor. This reduces intraocular pressure.

Xalatan (generic name: latanoprost [pronounced: la TAN oh prost ]) - ophthalmic solution

Estrogens and progesterones
Estrogen by itself (including conjugated estrogens and estradiol) are used for menopausal vasomotor symptoms, atrophic vaginitis, Kraurosis vulvae, female hypogonadism, osteoporosis prevention, prostate cancer, abnormal uterine bleeding, female castration, primary ovarian failure, and breast cancer.

Progesterone only drugs (levonorgestrel, medroxyprogesterone, and norethindrone acetate) are used for amenorrhea, contraception, endometriosis, immune thrombocytopenic purpura, and paraphilia.

Estrogen and progesterone combinations (desogestrel & ethinyl estradiol, drospirenone & ethinyl estradiol, etonogestrel & ethynil estradiol, norelgestromin & ethinyl estradiol, norethindrone acetate & ethinyl estradiol, and norgestimate & ethinyl estradiol) are used for contraception, premenstrual dysphoric disorder, dysmenorrhea, endometriosis, and polycystic ovarian syndrome. Many of these combinations are also used for acne.

Premarin (generic name: conjugated estrogens [pronounced: KON joo gay ted ES troe jenz ])  - tablet, powder for injection

Desogen, Apri, Micrette (generic name: desogestrel & ethinyl estradiol  [pronounced: des oh JESS trel  and EH thih nill ess tra DYE ole ])  - tablet

Yasmin, Yaz, Ocella (generic name: drospirenone & ethinyl estradiol  [pronounced: droe SPYE re none  and EH thih nill ess tra DYE ole ])  - tablet

Estrace, Vivelle-Dot, Estraderm, Estring, Femring (generic name: estradiol  [pronounced: ess tra DYE ole ])  - gel, injectable solution, tablet, transdermal patch, topical emulsion, vaginal cream, vaginal ring, vaginal tablet

NuvaRing (generic name: etonogestrel & ethinyl estradiol  [pronounced: e toe noe JES trel and EH thih nill ess tra DYE ole ])  - intrauterine device

Mirena, Plan B (generic name: levonorgestrel  [pronounced: LEE voe nor JES trel ])  - intrauterine device, tablet

DepoProvera, Provera (generic name: medroxyprogesterone  [pronounced: me DROX ee proe JES ter one ])  - tablet, injectable suspension, prefilled syringes

Ortho Evra, Evra Transdermal System (generic name: norelgestromin & ethinyl estradiol  [pronounced: nor ell JESS tro min and EH thih nill ess tra DYE ole ])   - transdermal patch

Aygestin (generic name:  norethindrone acetate   [pronounced: nor eth IN drone  as e tay t ])  - tablet

Loestrin, Microgestin, Junel (generic name:  norethindrone acetate & ethinyl estradiol  [pronounced: nor eth IN drone  as e tay t and EH thih nill ess tra DYE ole ])  - tablet

Ortho Cyclen, Ortho Tri-Cyclen, Trinessa (generic name:  norgestimate & ethinyl estradiol  [pronounced: nor JESS ti mate and EH thih nill ess tra DYE ole ])   - tablet

Dietary supplements
Medications, biological agents, and injectables are heavily regulated by the Food and Drug Administration (FDA), whereas dietary supplements intended for oral consumption are only regulated as food by the FDA. To learn more about how dietary supplements are regulated, you may want to review pertinent information from the Dietary Supplement Health and Education Act.

A dietary supplement is intended to supply nutrients, (vitamins, minerals/electrolytes, and amino acids) that are missing or not consumed in sufficient quantity in a person's diet. This category may also include herbal supplements. Dietary supplements often make health related structure function claims.

Micronutrients
A micronutrient is a substance needed only in small amounts for normal body function (vitamins and minerals); as opposed to macronutrients (fats, proteins, and carbohydrates) which are required in much larger quantities.

Vitamins
Vitamins can be defined as any organic compounds that are essential, in small quantities, for the normal functioning of metabolism in the body. They cannot usually be synthesized in the body but they occur naturally in certain foods. Insufficient supply of any particular vitamin results in a deficiency disease, hence the common need for vitamin supplements. Vitamins A, D, E, and K are fat soluble and therefore can be stored in adipose tissue. All other vitamins are considered water soluble.

M.V.I.-12, Infuvite (generic name: multivitamin infusion  [pronounced: MUL tee VYE ta min in fu zhun ])  - injectable solution - Multivitamin infusions are commonly used for parenteral nutrition or for treatment of a nutritional deficiency.

PreNexa, Nexa, NesTabs (generic name: prenatal vitamins  [pronounced: pre na tal  VYE ta mins ])  - tablet, capsule - Prenatal vitamins are intended for use by women while trying to conceive and throughout their pregnancy to ensure adequate vitamin intake.

Retinol A, Aquasol A (generic name: vitamin A, beta carotene  [pronounced: VYE ta min A BAY ta KARE oh teen ])  - capsule, injectable solution, tablet - Vitamin A affects growth, development, and maintenance of epithelial tissue. Vitamin A deficiency causes night blindness, dry eyes, susceptibility to infections, and follicular hyperkeratosis.

vitamin B1, thiamine ([pronounced: VYE ta min B1, THIGH a min ]) - tablet, injectable solution - Vitamin B1 affects carbohydrate metabolism and treats/prevents beriberi.

Niacor, Niaspan (generic name: vitamin B3, niacin, nicotinic acid  [pronounced: VYE ta min B3, NYE a sin, NIK oh TIN ik AS id ])  - tablet, extended-release tablet - Vitamin B3 affects lipid metabolism making it a treatment for hyperlipidemia.

Folvite (generic name: vitamin B9, folic acid  [pronounced: VYE ta min B9, FOE lik AS id ])  - cream, ointment, tablet, injectable solution. Vitamin B9 is necessary for red blood cell formation and prevents neural tube defects.

Cobex (generic name: vitamin B12, cyanocobalamin  [pronounced: VYE ta min B 12 sye AN oh koe BAL a min ])  - tablet, injectable solution, nasal spray - Vitamin B12 affects red blood cell production and can treat pernicious anemia.

vitamin C, ascorbic acid ([pronounced: VYE ta min C as KORE bik AS id ]) - tablet, extended-release tablet, capsule, extended-release capsule, oral solution, injectable solution - Vitamin C is required for collagen biosynthesis. Vitamin C deficiency can cause scurvy.

Drisdol, Calciferol (generic name: vitamin D2, ergocalciferol   [pronounced: VYE ta min D 2 ER goe kal SIF e role ]) - tablet, capsule, oral solution - Vitamin D affects maintenance of calcium & phosphorus homeostasis, cellular differentiation, gene regulation, and membrane integrity. Vitamin D deficiency leads to rickets in kids, osteomalacia in adults, and low calcium levels.

vitamin D3, cholecalciferol ([pronounced: VYE ta min D 3 KOE le kal SIF e role ]) - tablet, capsule, oral solution - Vitamin D affects maintenance of calcium & phosphorus homeostasis, cellular differentiation, gene regulation, and membrane integrity. Vitamin D deficiency leads to rickets in kids, osteomalacia in adults, and low calcium levels.

Aquasol E (generic name: vitamin E, tocopherol   [pronounced: VYE ta min E to kof er ol ])  - tablet, capsule, oral solution - Vitamin E functions as a lipid antioxidant, protects membrane phospholipids, intracellular antioxidant, and inhibits platelet aggregation. Vitamin E has been used to treat skin conditions, leg cramps, sexual dysfunction, heart disease, aging, PMS, and to increase athletic performance.

Mephyton, AquaMephyton (generic name: vitamin K1, phytonadione   [pronounced: VYE ta min K1 fye toe na DYE own ]) - tablet, injection emulsion - Vitamin K1 is an essential lipid-soluble vitamin that plays a vital role in the production of coagulation proteins. Vitamin K1 can be used as an antidote for warfarin.

Electrolytes
Electrolytes when dissolved in solution break apart into ions (anions and cations). The movement of these ions across cell membranes are intended to create an electrolyte balance between both the extracellular and intracellular environments. In particular, the maintenance of precise osmotic gradients of electrolytes is important. Such gradients affect and regulate the hydration of the body as well as blood pH, and are critical for nerve and muscle function.

OS-Cal, Tums, PhosLo, Citracal calcium with various salts - tablet, effervescent tablet, chewable tablet, injectable solution, injectable suspension - Calcium is used to prevent osteoporosis and kidney stones and to treat hypocalcemia, hyperkalemia, hypermagnesemia, calcium channel blocker overdose, and it can be used as an antacid.

Slow Fe, Feosol, Ferrlecit, INFeD iron, ferrous with various salts - tablet, extended-release tablet, oral solution, oral liquid drops, oral suspension drops, injectable solution - Iron is necessary for red blood cell formation. Iron is used to treat iron defcient anemia.

Mag-Ox 400, Uro-Mag, Magonate magnesium with various salts - tablet, capsule, powder for oral solution, oral solution, injectable solution, infusion solution - Magnesium is one of the major intracellular cations. For normal neuromuscular activity, humans need normal concentration of extracellular calcium and magnesium. Intracellular magnesium is an important cofactor for various enzymes, transporters, and nucleic acids that are essential for normal cellular function, replication, and energy metabolism.

Klor-Con, KDur, Slow K, K Phos potassium with various salts - tablet, extended-release tablet, extended-release capsule, effervescent tablet, injectable solution, premix infusion - Potassium is used to treat or prevent hypokalemia.

zinc - tablet, capsule, gum, lozenge, ointment, paste, injectable solution - Zinc is an essential nutritional requirement and serves as a cofactor for more than 70 different enzymes, including carbonic anhydrase, alkaline phosphatase, lactic dehydrogenase, and both RNA and DNA polymerase. Zinc facilitates wound healing, helps maintain normal growth rates, normal skin hydration, and the senses of taste and smell. Zinc is also used to topically treat diaper rash and various topical irritations. Some oral types are used to ameliorate cold symptoms.

Multitrace, M.T.E. multiple trace elements - injectable solution - Multiple trace elements are used to provide various trace elements in a parenteral infusion.

Herbals
Herbal supplements are often used for an array of purposes. A common challenge to the use of herbal supplements is the lack of scientific studies for their use; however, there is a plethora of anecdotal evidence (although, sometimes the anecdotal evidence can be conflicting). The following is a brief list of the most commonly used herbal supplements, along with what they are used for. Acknowledgement of their use for the proceeding purposes does not mean that their is sufficient scientific evidence to assure that these supplements will achieve the desired effects.

chondroitin - Chondroitin is often used for osteoarthritis, particularly of the knee.

coenzyme Q10, CoQ10 - Coenzyme Q10 is used to treat angina, chronic fatigue syndrome, CHF, diabetes mellitus, doxorubicin-induced cardiotoxicity (prevention), HIV/AIDS immunostimulant, hypertension, mitochondrial cytopathies, muscular dystrophies, myopathy (statin-induced).

cranberry - Cranberry is used for UTI prevention, and as a urinary deodorizer for incontinent patients.

creatine - Creatine is used for myotrophic lateral sclerosis, CHF, exercise performance enhancement, gyrate atrophy, McArdle disease, mitochondrial cytopathies, muscle mass builder, muscular dystrophies, neuromuscular disease, rheumatoid arthritis, and Parkinson's disease.

fish oil - Fish oil is used for coronary heart disease, hyperlipidemia, HTN, hypertriglyceridemia, Raynaud's syndrome, rheumatoid arthritis, and stroke prevention.

glucosamine - Glucosamine is used for relief of symptoms of osteoarthritis and temporomandibular joint arthritis.

marijuana - Marijuana is used to decrease intraocular pressure and provide analgesia; it has antiemetic effects and functions as an appetite stimulant.

phytoestrogens - Phytoestrogens are used to treat menopausal vasomotor symptoms, osteoporosis, decrease risk of breast cancer, and cardiovascular disease.

St. John's wort - St. John's wort is used to treat depression (mild-moderate), psychosomatic disorder, obsessive-compulsive disorder, anxiety, premenstrual syndrome, burning mouth syndrome, and neuropathy.

wild yam - Wild yam is used for estrogen replacement therapy, painful menstration, libido, breast enlargement, diverticulosis, dysmenorrhea, estrogen replacement, gallbladder colic, libido enhancement, osteoporosis, postmenopausal vaginal dryness, premenstrual syndrome, and rheumatoid arthritis.

Vaccines
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters. Vaccines do not guarantee complete protection from a disease. The efficacy or performance of the vaccine is dependent on a number of factors, including the disease itself (for some diseases, vaccination performs better than for other diseases); the strain of vaccine (some vaccinations are for different strains of the disease); whether one kept to the timetable for the vaccinations; individuals who are "non-responders" (they do not generate antibodies even after being vaccinated correctly); or other factors such as ethnicity, age, or genetic predisposition. When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.

A common allergy concern for both the influenza virus vaccine and for various measles vaccinations is that they are produced in chicken embryos and therefore they may contain some egg proteins. If a patient has an egg allergy, it may be advisable to avoid the influenza vaccine and should use caution with various vaccines for measles.

Decavac, Tenivac, Td, DT (generic name: diphtheria & tetanus toxoids  [pronounced: dif THEER ee a and TET a nus  TOKS oydsl ])  - IM injection

ActHIB, Hiberix (generic name: haemophilus influenza type b vaccine  [pronounced: he MOF fi lus in floo EN za type B vak SEEN ])  - IM injection

Havrix, Vaqta (generic name: hepatitis a vaccine inactivated  [pronounced: hep a TYE tis A vak SEEN in ak  ti VAY ted ])  - IM injection

Engerix B, Recombivax HB (generic name: hepatitis b vaccine  [pronounced: hep a TYE tis B vak SEEN ])  - IM injection

Gardasil (generic name: human papillomavirus vaccine  [pronounced: HYOO man pap il OH ma VI rus vax EEN ])  - IM injection

Fluarix, Fluzone, Afluria, FluMist (generic name: influenza virus vaccine  [pronounced: infloo en za VI rus vax EEN ])  - IM injection, ID injection, Nasal Spray

M-M-R-II (generic name: measles mumps and rubella vaccine  [pronounced: MEE zels, mumpZ and roo BEL a  vax EEN ])  - SC injection

Menactra (generic name: meningococcal A C Y and W-135 diphtheria conjugate vaccine  [pronounced: me NIN joe kok al A C Y and W-135 dif THEER ee a KON joo gate vak SEEN ])  - IM injection

Pneumovax 23, Prevnar 13 (generic name: pneumococcal vaccine  [pronounced: noo moe KOK al  vak SEEN ])  - SC/IM injection

IPOL (generic name: poliovirus vaccine inactivated  [pronounced: POE lee oh VYE rus  vak SEEN in ak  ti VAY ted ])  - SC/IM injection

HDCV, Imovax (generic name: rabies vaccine  [pronounced: RAY beez vak SEEN ])  - IM injection

Rotarix rotavirus oral vaccine - oral solution

Adacel, Boostrix, Tdap (generic name: tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine  [pronounced: TET a nus and RE doo ced dif THEER ee a TOKS oyds / ay CEL yoo lar per TUS sis vak SEEN  ])  - IM injection

Varivax (generic name: varicella virus vaccine live  [pronounced: VAR i SEL a VYE rus vax EEN LYV ])  - SC injection

Zostavax (generic name: zoster vaccine live  [pronounced: ZOS ter vak SEEN LYV ])  - SC injection