Difference between revisions of "Pharmacology"

Revision as of 16:12, 4 March 2013

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 chapter, there are some terms that should be defined.

pharmacology - The term pharmacology is derived from to 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.

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.

legend - 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.

brand name - This is the manufacturers 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 the products being compared in the Orange Book are considered therapeutic equivalents, it will be given a Therapeutic Equivalence (TE) Code of "A". If the products are not considered therapeutic equivalents, they will be given a TE Code of "B". Sometimes these will be referred to as "A" ratings and "B" ratings.

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 it aspirin 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.

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.

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, an excellent free (registration required) resource is Medscape at http://reference.medscape.com.

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

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.

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.

amoxicillin (Amoxil, Moxatag, Trimox) - oral solution, capsule, tablet, chewable tablet, extended-release tablet
ampicillin (Principen) - capsules, oral suspension, powder for injection
nafcillin (Nafcil) - injectable solution, powder for injection
oxacillin (Bactocill) - infusion solution, oral solution, powder for injection
penicillin G (Bicillin, Wycillin) - premixed injectable solution, powder for injectable solution
penicillin V potassium (Pen Vee K, Veetids) - oral solution, tablet
piperacillin (Pipracil) - powder for injection

Penicillin Derivatives with Beta-Lactamase Inhibitors

Sometimes bacteria become resistant to penicillin, and 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.

amoxicillin & clavulanate (Augmentin) - oral suspension, tablet, chewable tablet
ampicillin & sulbactam (Unasyn) - injectable solution, powder for solution
piperacillin & tazobactam (Zosyn) - powder for injection
ticarcillin & clavulanate (Timentin) - 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.

ertapenem (Invanz) - powder for injection
imipenem & cilastin (Primaxin) - powder for injection
meropenem (Merrem) - 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.

cefaclor (Ceclor) - capsule, tablet extended-release
cefazolin (Kefzol) - powder for injection
cefdinir (Omnicef) - capsule, oral suspension
cefepime (Maxipime) - infusion solution, powder for injection
cefotaxime (Claforan) - injectable solution, powder for injection
cefotetan (Cefotan) - injectable solution, powder for injection
ceftaroline (Teflaro) - powder for injection
ceftazidime (Fortaz) - injectable solution, powder for injection
ceftriaxone (Rocephin) - injectable solution, powder for injection
cephalexin (Keflex) - 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).

amikacin (Amikin) - injectable solution
gentamicin (Garamycin) - injectable solution, ophthalmic ointment, ophthalmic suspension
kanamycin (Kantrex) - injectable solution
tobramycin (Nebcin, Tobi, Tobrex) - injectable solution, nebulizer solution, ophthalmic ointment, ophthalmic solution
tobramycin & dexamethasone (TobraDex) - 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.

doxycycline (Vibramycin) - capsule, powder for injection, syrup, tablet, delayed-release tablet
minocycline (Minocin) - oral suspension, tablet, capsule, extended-release tablet, intravenous injection
tetracycline (Sumycin) - capsule, tablet
tigecycline (Tygacil) - 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 medication with large amounts of water.

silver sulfidiazine (Silvadene) - cream
sulfamethoxazole & trimethoprim, SMZ & TMP (Bactrim, Septra, Co-Trimoxazole) - injected solution, oral solution, tablet
sulfasalazine (Azulfidine) - 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 effects 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.

azithromycin (Zithromax, AzaSite) - oral suspension, powder for injection, powder for oral suspension, extended-release powder for oral suspension, tablet, ophthalmic solution
clarithromycin (Biaxin) - oral suspension, tablet, extended-release tablet
erythromycin (Erythrocin, E-Mycin) - 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 have received kidney, heart, or lung transplants.

ciprofloxacin (Cipro) - infusion solution, oral suspension, tablet, extended-release tablet, ophthalmic solution, ophthalmic ointment, otic solution
levofloxacin (Levaquin) - injectable solution, premix infusion solution, oral solution, tablet, ophthalmic solution
moxifloxacin (Avelox) - injectable solution, tablet, opthalmic solution
ofloxacin (Floxin) - 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.

aztreonam (Azactam) - infusion solution, powder for injection
clindamycin (Cleocin) - capsule, injectable solution, oral solution, vaginal cream, vaginal suppository
daptomycin (Cubicin) - injectable solution
linezolid (Zyvox) - injectable solution, oral suspension, tablet
mupirocin (Bactroban) - cream, topical ointment, nasal ointment
nitrofurantoin (Macrobid, Macrodantin) - capsule, oral suspension
vancomycin (Vancocin) - capsule, injectable solution, powder for injection

Antifungals

An antifungal drug is 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.

amphotericin B (Fungizone) - powder for injection, injectable lipid complex, cream, lotion, ointment
betamethasone & clotrimazole (Lotrisone) - cream, lotion - This is a combination of a corticosteroid and an antifungal.
clotrimazole (Gyne-Lotrimin, Mycelex) - troche, vaginal cream, vaginal tablet, cream, topical solution, lotion, powder
fluconazole (Diflucan) - injected solution, oral suspension, tablet nystatin (Mycostatin, Nilstat) - oral powder, oral suspension, oral tablet, troche, cream, ointment, powder, vaginal tablet
terbinafine (Lamisil) - 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 nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath.

metronidazole (Flagyl) - capsule, tablet, extended-release tablet, infusion solution, topical gel, topical cream, topical lotion, vaginal gel
pentamidine (Pentam) - 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).

hydroxychloroquine (Plaquenil) - tablet
quinine sulfate (Qualaquin) - 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 ether 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.

acyclovir (Zovirax) - injectable solution, oral suspension, powder for injection, tablet, capsule, topical cream, topical ointment
ganciclovir (Cytovene) - capsule, powder for injection, oral solution, implant, ophthalmic gel
oseltamivir (Tamiflu) - capsule, oral suspension
valacyclovir (Valtrex) - tablet

Glucocorticosteroids

Glucocorticosteriods (glucocorticoids) 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 start 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

hydrocortisone (Cortef) - tablet, oral suspension, powder for injection, rectal cream, enema, foam, suppositories, topical cream, lotion, gel, topical solution, ointment, pledget

Intermediate-Acting Steroids

fluticasone (Flovent HFA, Flonase) - aerosol inhaler, disk inhaler, nasal spray, cream, ointment, lotion
methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) - tablet, injectable suspension, powder for injection
prednisolone (Delta-Cortef) - oral solution, tablet, ophthalmic suspension, ophthalmic solution
prednisone (Deltasone) - oral solution, tablet
triamcinolone, TAC (Azmacort, Nasocort AQ, Kenalog) - nasal spray, inhalation aerosol, intravitreal injection, cream, ointment, paste, topical spray

Long-Acting Steroids

dexamethasone (Decadron) - tablet, injectable suspension, elixir, oral solution, oral concentrate, ointment, ophthalmic solution, ophthalmic suspension, intravitreal implant

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 is usually activated under conditions of stress cause 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 - injectable solution
epinephrine, EPI (EpiPen, Racepinephrine) - autoinjector, injectable solution, solution for nebulization
norepinephrine, NE (Levophed) - injectable solution
pseudoephedrine, PE (Sudafed) - 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.

clonidine (Catapres, Catapres TTS) - injectable solution, extended-release oral suspension, patch, tablet, extended-release tablet
guanfacine (Tenex) - 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.

doxazosin (Cardura, Cardura XL) - tablet, extended-release tablet
tamsulosin (Flomax) - capsule
terazosin (Hytrin) - capsule

5-Alpha-Reductase Inhibitors

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

dutasteride (Avodart) - capsule
finasteride (Proscar, Propecia) - tablet

Beta-Adrenergic Blocking Agents

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.

atenolol (Tenormin) - Tablet
bisoprolol (Zebeta) - Tablet
carvedilol (Coreg, Coreg CR) - extended-release capsule, tablet
labetalol (Trandate) - injectable solution, tablet
metoprolol (Lopressor, Toprol XL) - injectable solution, tablet, extended-release tablet
nebivolol (Bystolic) - tablet
propranolol (Inderal, Inderal LA) - oral solution, injectable solution, tablet, extended-release capsule
timolol (Timol, Timoptic, Timoptic XE) - 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).

donepezil (Aricept, Aricept ODT) - tablet, orally disintegrating tablet
galantamine (Razadyne, Razadyne ER) - tablet, extended-release tablet, oral solution
neostigmine (Prostigmin) - 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.

atropine (AtroPen, IsoptoAtropine) - injectable solution, tablet, ophthalmic solution, ophthalmic ointment
dicyclomine (Bentyl) - capsule, injectable solution, syrup, tablet
oxybutynin (Ditropan, Ditropan XL) - tablet, controlled-release tablet, syrup, transdermal patch, gel
tolterodine (Detrol, Detrol LA) -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. Medication 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 (i.e., intubation). They can further be broken into two major subgroups depolarizing (succinylcholine) and nondepolarizing (cisatracurium, pancuronium, rocuronium, and vecuronium).

cisatracurium (Nimbex) - injectable solution
pancuronium (Pavulon) - injectable solution
rocuronium (Zemuron) - injectable solution
succinylcholine, SUX (Anectine) - injectable solution
vecuronium (Norcuron) - 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.

baclofen (Lioresal) - tablet, injectable solution
carisoprodol (Soma) CIV - tablet
cyclobenzaprine (Flexeril) - tablet, extended-release capsule
metaxalone (Skelaxin) - tablet
methocarbamol (Robaxin) - tablet, injectable solution
tizanidine (Zanaflex) - tablet, capsule

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.

benzocaine (Solarcaine) - gel, topical solution, otic solution
cocaine CII - topical solution
tetracaine (Pontocaine) - injectable solution, powder for injection, throat spray, ophthalmic solution

Amide Local Anesthetics

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

bupivacaine (Marcaine, Sensorcaine) - injectable solution
lidocaine (Xylocaine, Lidoderm) - injectable solution, infusion solution, oral solution, topical ointment, topical solution, topical jelly, patch

Medications for treating psychological conditions

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 (Clozaril) - tablet, orally disintegrating tablet
haloperidol (Haldol) - tablet, oral concentrate, injectable solution, injectable solution-decanoate
olanzapine (Zyprexa, Zyprexa Zydis) - tablet, orally disintegrating tablet, short-acting IM injection, extended-release suspension IM injection
quetiapine (Seroquel, Seroquel XR) - tablet, extended-release tablet
risperidone (Risperdal, Risperdal Consta) - tablet, orally-disintegrating tablet, oral solution, powder for injection
ziprasidone (Geodon) - 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.

alprazolam (Xanax) CIV - tablet, extended-release tablet, orally-disintegrating tablet, oral solution
clonazepam (Klonopin) CIV - tablet
diazepam (Valium) CIV - tablet, oral solution, rectal solution, injectable solution, intramuscular device
lorazepam (Ativan) CIV - tablet, oral concentrate, injectable solution
temazepam (Restoril) 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.

phenobarbital (Luminal) 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 know to cause a 'hangover' effect.

eszopiclone (Lunesta) CIV - tablet
ramelteon (Rozerem) - tablet
zaleplon (Sonata) CIV - capsule
zolpidem (Ambien, Ambien CR) 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.

amitriptyline (Elavil) - tablet
doxepin (Sinequan) - 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.

citalopram (Celexa) - tablet, oral solution
escitalopram (Lexapro) - tablet, oral solution
fluoxetine (Prozac) - tablet, capsule, delayed-release capsule, oral solution
fluvoxamine (Luvox) - tablet, extended-release capsule
paroxetine (Paxil) - tablet, extended-release tablet, oral suspension

Serotonin-Noerpinephrine 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.

desvenlafaxine (Pristiq) - extended-release tablet
duloxetine (Cymbalta) - capsule
venlafaxine (Effexor, Effexor XR) - 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). Trazadone is used for a number of things including aggressive behavior, alcohol withdrawal, insomnia, and prevention of migraine.

bupropion (Wellbutrin, Zyban) - tablet, sustained-release tablet, extended-release tablet
mirtazapine (Remeron, Remeron SolTab) - tablet, orally-disintegrating tablet
trazadone (Desyrel, Desyrel Dividose) - 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.

buspirone (BusPar) - 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).

varenicline (Chantix) - 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 can also raise the heart rate to dangerous levels.

amphetamine & dextroamphetamine (Adderall, Adderall XR) CII - tablet, capsule, extended-release capsule
dexmethylphenidate (Focalin, Focalin XR) CII - tablet, extended-release capsule
lisdexamfetamine (Vyvanse) CII - capsule
methylphenidate (Ritalin, Concerta, Daytrana) CII - tablet, chewable tablet, extended-release tablet, capsule, extended-release capsule, oral solution, transdermal patch

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.

phentermine (Adipex P) 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, treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), and off label it is used fatigue in MS patients and for depression.

modafinil (Provigil) 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 chapter are also often used as mood-stabilizing drugs.

lithium, LiCO3 (Eskalith, Lithobid) - 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.

memantine (Namenda) - tablet, extended-release capsule, oral solution

Other Psychiatry Agents

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.

atomoxetine (Strattera) - capsule

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 and 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).

carbamazepine (Tegretol, Equetro) - tablet, extended-release tablet, extended-release capsule, oral suspension
gabapentin (Neurontin) - capsule, tablet, oral solution
lamotrigine (Lamictal) - tablet, chewable tablet, orally-disintegrating tablet, extended-release tablet
levetiracetam (Keppra) - tablet, extended-release tablet, oral solution, injectable solution
oxcarbazepine (Trileptal) - tablet, extended-release tablet, oral suspension
pregabalin (Lyrica) CV - capsule, oral solution
topiramate (Topamax) - tablet, capsule
valproic acid (Depakote, Depakene, Depacon) - tablet, delayed-release tablet, extended-release tablet, capsule, delayed-release capsule, sprinkle capsule, syrup, injectable solution

Antiparkinson drugs

Parkinson 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.

carbidopa & levodopa (Sinemet, Sinemet CR, Parcopa) - tablet, orally-disintegrating tablet, extended-release tablet
pramipexole (Mirapex, Mirapex ER) - table, extended-release tablet
ropinirole (Requip, Requip XL) - tablet, extended-release tablet

Analgesics

Opioid Analgesics

Opioid analgesics are often used to treat acute pain (such as post-operative 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 non-malignant 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 & naloxine 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.

buprenorphine & naloxone (Suboxone) CIII - sublingual tablet, sublingual film
codeine CII - tablet, oral solution
codeine & acetaminophen (Tylenol with Codeine, Tylenol #3, Tylenol #4) CIII as a tablet and C5 as an oral solution - tablet, oral solution
fentanyl (Duragesic, Sublimaze, Actiq) CII - transdermal patch, injectable solution, sublingual tablet, buccal tablet, buccal film, sublingual solution, lollipop
hydrocodone & acetaminophen (Vicodin, Lorcet) CIII - capsule, tablet, oral solution, oral elixir
hydromorphone (Dilaudid) CII - tablet, extended-release tablet, injectable solution, oral solution, suppository, powder for injection
meperidine (Demerol) CII - tablet, injectable solution, syrup
methadone (Methadose, Dolophine) CII - tablet, dispersible tablet, oral solution, injectable solution
morphine (MS Contin, Duramorph, Kadian) CII - tablet, extended-release capsule, controlled-release tablet, oral solution, injectable solution, suppository
oxycodone (OxyContin, Roxicodone) CII - tablet, capsule, extended-release tablet, oral solution
oxycodone & acetaminophen (Percocet, Tylox, Roxicet) CII - tablet, capsule, oral solution
tramadol (Ultram) not federally scheduled - tablet, orally-disintegrating tablet, extended-release tablet, extended-release capsule
tramadol & acetaminophen (Ultracet) not federally scheduled - 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.

celecoxib (Celebrex) - capsule
diclofenac (Voltaren, Cataflam) - tablet, extended-release tablet, capsule, powder packet for oral solution
ibuprofen (Advil, Motrin) - tablet, chewable tablet, oral suspension, injection solution
ketorolac (Toradol) - tablet, injectable solution
meloxicam (Mobic) - tablet, oral suspension
nabumetone (Relafen) - tablet
naproxen (Aleve, Naprosyn, Anaprox, Naprelan) - tablet, oral suspension
piroxicam (Feldene) - 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 and 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 have until January 14, 2014, to comply.

Aspirin, sometimes listed as ASA, inhibits the synthesis of prostaglandin by cyclooxygenase; inhibits platelet aggregation; 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 butalbital, aspirin, and caffeine is considered a controlled substance.

acetaminophen, APAP (Tylenol) - tablet, extended-release tablet, chewable tablet, disintegrating tablet, elixir, suspension, suppository
aspirin, ASA (Bayer, Ascriptin, Bufferin, Ecotrin, St. Joseph Adult Chewable Aspirin) - tablet, delayed-release tablet, effervescent tablet, chewable tablet, suppository
butalbital, acetaminophen, & caffeine (Fioricet) - tablet, capsule, oral solution
butalbital, aspirin, & caffeine (Fiorinal) CIII - tablet, capsule

Serotonin 5-HT Receptor Agonist

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

rizatriptan (Maxalt) - tablet, disintegrating tablet
sumatriptan (Imitrex) - tablet, nasal spray, injectable solution
zolmitriptan (Zomig) - tablet, disintegrating tablet, nasal spray

Medications affecting the cardiac system

Cardiac Glycosides

Cardiac glycosides are drugs used in the treatment of congestive heart failure and cardiac arrhythmia.

digoxin (Lanoxin) - 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 excrertion 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.

bumetanide (Bumex) - tablet, injectable solution
chlorothiazide (Diuril) - tablet, powder for injection
furosemide (Lasix) - tablet, oral solution, injectable solution
hydrochlorothiazide, HCTZ (Microzide) - tablet, capsule
spironolactone (Aldactone) - tablet
triamterene & hydrochlorothiazide (Dyazide, Maxzide) - 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 (Amiodarone) - tablet, injectable solution
dofetilide (Tikosyn) - capsule

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.

candesartan (Atacand) - tablet
irbesartan (Avapro) - tablet
losartan (Cozaar) - tablet
olmesartan (Benicar) - tablet
telmisartan (Micardis) - tablet
valsartan (Diovan) - 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.

benazepril (Lotensin) - tablet
captopril (Capoten) - tablet
enalapril/enalaprilat (Vasotec) - tablet, injectable solution
fosinopril (Monopril) - tablet
lisinopril (Prinivil, Zestril) - tablet
quinapril (Accupril) - tablet
ramipril (Altace) - 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).

amlodipine (Norvasc) - tablet
diltiazem (Cardizem, Cardizem CD, Taztia XT, Tiazac) - tablet, extended-release tablet, extended-release capsule, injectable solution, powder for injection
felodipine (Plendil) - extended-release tablet
nifedipine (Procardia, Procardia XL, Adalat CC) - capsule, extended-release tablet
verapamil (Isoptin, Calan, Covera HS) - 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.

isosorbide (Isordil, Dilatrate-SR, Imdur, ISMO, Monoket) - tablet, sublingual tablet, extended-release tablet, extended-release capsule
nitroglycerin, NTG (Nitrostat, Nitrol, NitroDur, Nitro-Bid, Nitrolingual Pumpspray) - 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 antiotensin I causes a decrease in angiotensin II, a potent blood pressure elevating peptide. This makes renin inhibitors effective in the treatment of hypertension.

aliskiren (Tekturna) - 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.

aliskiren & hydrochlorothiazide (Tekturna HCT) - tablet
amlodipine & benazepril (Lotrel) - capsule
amlodipine & valsartan (Exforge) - tablet
bisoprolol & hydrochlorothiazide (Ziac) - tablet
enalapril & hydrochlorothiazide (Vaseretic) - tablet
irbesartan & hydrochlorothiazide (Avalide) - tablet
lisinopril & hydrochlorothiazide (Prinzide, Zestoretic) - tablet
losartan & hydrochlorothiazide (Hyzaar) - tablet
olmesartan & hydrochlorothiazide (Benicar HCT) - tablet
telmisartan & hydrochlorothiazide (Micardis HCT) - tablet
valsartan & hydrochlorothiazide (Diovan HCT) - 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 fibrilation (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). Below is a short list of the most common anticoagulants and antiplatelet agents.

aspirin & dipyridamole (Aggrenox) - extended-release capsule
clopidogrel (Plavix) - tablet
dabigatran (Pradaxa) - capsule
dalteparin (Fragmin) - injectable solution
enoxaparin (Lovenox) - injectable solution
heparin - heparin lock solution, injectable solution, premixed IV solution
rivaroxaban (Xarelto) - tablet
warfarin - (Coumadin) - 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).

atorvastatin (Lipitor) - tablet
fluvastatin (Lescol, Lescol XL) - capsule, extended-release tablet
lovastatin (Mevacor, Altoprev) - tablet, extended-release tablet
pravastatin (Pravachol) - tablet
rosuvastatin (Crestor) - tablet
simvastatin (Zocor) - tablet

Miscellaneous Hypolipidemic Drugs

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

amlodipine & atorvastatin (Caduet) - tablet
amlodipine & olmesartan (Azor) - tablet
ezetimibe (Zetia) - tablet
fenofibrate (Tricor) - tablet, capsule
gemfibrozil (Lopid) - tablet
niacin, vitamin B3, nicotinic acid (Niacor, Niaspan) - tablet, extended-release tablet, extended-release capsule
omega 3 fatty acids (Lovaza) - chewable tablet, capsule, delayed-release capsule
simvastatin & ezetimibe (Vytorin) - tablet

Antihistamines

Colds and allergy sufferers may desire symptomatic relief from antihistamine and decongestants.

Antihistamine

Antihistamines are commonly used for the relief of various allergic reaction 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.

cetririzine (Zyrtec) - tablet, chewable tablet, capsule, oral solution
desloratadine (Clarinex, Clarinex RediTabs) - tablet, disintegrating tablet, syrup
diphenhydramine (Benadryl) - tablet, chewable tablet, disintegrating tablet, capsule, oral solution, cream, gel, ointment, lotion, topical aerosol spray, oral strip, injectable solution
fexofenadine (Allegra) - tablet, disintegrating tablet, oral suspension
hydroxyzine (Vistaril) - tablet, capsule, syrup, oral suspension, injectable solution
loratadine (Claritin) - tablet, chewable tablet, disintegrating tablet, capsule, oral solution
olopatadine (Patanol, Patanase) - ophthalmic drops, nasal spray

Antihistamines and 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 which will be discussed further in the next chapter.

cetirizine & pseudoephedrine (Zyrtec D) - tablet, extended-release tablet
desloratadine & pseudoephedrine (Clarinex-D) - extended-release tablet
fexofenadine & pseudoephedrine (Allegra D) - extended-release tablet
loratadine & pseudoephedrine (Claritin D) - 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 chapter, 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.

albuterol (Proventil HFA, Ventolin HFA, Proair HFA) - tablet, oral liquid, inhalation aerosol, solution for nebulization
albuterol & ipratropium (Combivent, DuoNeb) - inhalation aerosol, solution for nebulization
budesonide & formoterol (Symbicort) - inhalation aerosol
ipratropium (Atrovent) - inhalation aerosol, solution for nebulization, nasal spray
levalbuterol (Xopenex) - inhalation aerosol, solution for nebulization
salmeterol & fluticasone (Advair Diskus, Advair HFA) - disk with powder for inhalation, inhalation aerosol
tiotropium (Spiriva) - capsules for inhalation

Miscellaneous Asthma Treatments

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.

montelukast (Singulair) - tablet, chewable tablet, granules for suspension
zafirlukast (Accolate) - 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.

cimetidine (Tagamet) - tablet, oral solution
famotidine (Pepcid) - tablet, chewable tablet, oral suspension, injectable solution, premixed IV bag
nizatidine (Axid) - capsule, oral solution
ranitidine (Zantac) - 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, 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.

dexlansoprazole (Dexilant) - delayed-release capsule
esomeprazole (Nexium) - delayed-release capsule, granules for suspension, injectable solution
lansoprazole (Prevacid) - disintegrating tablet, delayed-release capsule, oral suspension
omeprazole (Prilosec) - delayed-release tablet, delayed-release capsule, oral suspension, powder for oral suspension
pantoprazole (Protonix) - delayed-release tablet, powder for oral suspension, powder for injection
rabeprazole (Aciphex) - 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, but there is little information about the effect on the fetus, and therefore are typically reserved for times considered strictly necessary.

aprepitant (Emend) - capsule
dolasetron (Anzemet) - tablet, injectable solution
dronabinol (Marinol) CIII - capsule
granisetron (Kytril) tablet, transdermal patch, injectable solution
meclizine (Antivert, Bonine) - tablet, chewable tablet
metoclopramide (Reglan) - tablet, dispersible tablet, oral solution, injectable solution
prochlorperazine (Compazine) - tablet, suppository, injectable solution
promethazine (Phenergan) - oral tablet, syrup, injectable solution, suppository
ondansetron (Zofran) - tablet, dispersible tablet, oral solution, oral film, injectable solution
scopolamine (Transderm Scop) - tablet, transdermal patch, ophthalmic solution, injectable solution
trimethobenzamide (Tigan) - capsule, intramuscular solution

Stool Softener 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.

bisacodyl (Dulcolax) - delayed-release tablet, suppository, enema
docusate (Colace) - tablet, capsule, syrup
docusate & senna (Peri-Colace, Senokot-S) - tablet
lactulose (Enulose, Kristalose) - oral solution, powder for oral solution
polyethylene glycol (MiraLax, Glycolax) - powder for oral solution
polyethylene glycol with electrolytes (GoLytely) - oral solution, powder for oral solution
psyllium (Metamucil) - powder for oral solution
senna (Senokot) - 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 affect 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).

levothyroxine (Synthroid, Levoxyl, Levothroid) - tablet, capsule, powder for injection
liothyronine (Cytomel, Triostat) - tablet, injectable solution
thyroid (Armour Thyroid) - tablet

Osteoporosis Therapy

Osteoporosis and Paget's Disease are diseases in which bones have decreased mass and 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 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.

alendronate (Fosamax) - tablet, weekly tablet, effervescent tablet, oral solution
calcitonin (Miacalcin, Fortical) - injectable solution, nasal spray
ibandronate (Boniva) - monthly tablet, prefilled syringe
risedronate (Actonel) - tablet, weekly tablet
teriparatide (Forteo) - prefilled injectable pen
zoledronic acid (Reclast, Zometa) - 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

This image provides a visual representation of endogenous insulin production in a healthy individual that eats three meals a day.

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 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.

insulin aspart (NovoLog) - vial for injection, prefilled pen
insulin aspart protamine & insulin aspart (Novolog Mix 70/30) - vial for injection, prefilled pen
insulin detemir (Levemir) - vial for injection, prefilled pen
insulin glargine (Lantus) - vial for injection, prefilled pen
insulin glulisine (Apidra) - vial for injection, prefilled pen
insulin lispro (Humalog) - vial for injection, prefilled pen
insulin lispro protamine & insulin lispro (Humalog Mix 50/50, Humalog Mix 75/25) - vial for injection, prefilled pen
insulin NPH (Humulin N, Novlin N) - vial for injection, prefilled pen
insulin NPH & insulin regular human (Humulin 70/30, Novolin 70/30) - vial for injection, insulin pen
insulin regular human (Humulin R, Novolin R) - 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.

metformin (Glucaphage, Glucophage XR) - 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 increased risk of hypoglycemia from sulfonylureas. These medication have a cross-sensitivity with sulfa allergies.

glimepiride (Amaryl) - tablet
glipizide (Glucotrol, Glucotrol XL) - tablet, extended-release tablet
glyburide (Diabeta, Glynase, Micronase) - tablet, micronized tablet

Metaglitinide

Metaglitinides increase insulin secretion.

nateglinide (Starlix) - tablet
repaglinide (Prandin) - tablet

Thiazolidinediones

Thiazolidinediones improve cellular response to insulin and decreases the livers production of glucose. Thiazolidinediones, particularly product containing rosiglitazone, may cause or exarcebate congestive heart failure in some patients.

pioglitazone (Actos) - tablet
rosiglitazone (Avandia) -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.

linagliptin (Tradjenta) - tablet
saxagliptin (Onglyza) - tablet
sitagliptin (Januvia) - tablet

Glucagonlike Peptide-1 Agonists

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

exenatide (Byetta) - injectable solution
liraglutide (Victoza) - injectable solution

Oral Antidiabetic Combination Drugs

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

glipizide & metformin (Metaglip) - tablet
glyburide & metformin (Glucovance) - tablet
sitagliptin & metformin (Janumet) - 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 intended to inhibit uncontrolled new cell growth. Antineoplastic agents are used to treat breast cancer (anastrazole, capecitabine, cyclophosphamide, docetaxel, doxorubicin, exemestane, fluorouracil, gemcitabine, letrozole, leuprolide, mitomycin, paclitaxel, tamoxifen), non-small cell lung cancer (cisplatin, docetaxel, gemcitabine, irinotecan, mitomycin, paclitaxel), small cell lung cancer (carboplatin, doxorubicin, etoposide, paclitaxel, vincristine), pleural sclerosing (bleomycin), brain cancer (paclitaxel, vincristine), head and neck cancer (bleomycin, carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil, mitomycin, paclitaxel, vinblastine), thyroid cancer (doxorubicin), Hodgkin's disease (bleomycin, etoposide, vinblastine, vincristine), Non-Hodgkin's disease (bleomycin, cyclophosphamide, docetaxel, etoposide, paclitaxel, vincristine), lymphoma (bleomycin, carboplatin, vinblastine, vincristine), leukemia (daunorubicin, etoposide), meningeal leukemia (methotrexate), lymphoblastic leukemia (methotrexate), osteosarcoma (cisplatin, methotrexate), multiple myeloma (mitomycin), esophageal cancer (cisplatin, fluorouracil, mitomycin, paclitaxel), stomach cancer (docetaxel, doxorubicin, fluorouracil, mitomycin, paclitaxel), colon cancer (capecitabine, fluorouracil, irinotecan, oxaliplatin), colorectal cancer (capecitabine, fluorouracil, irinotecan, oxaliplatin), rectal cancer (fluorouracil, irinotecan), bladder cancer (cisplatin, fluorouracil, gemcitabine, mitomycin, vinblastine, vincristine), urothelial cancer (docetaxel, paclitaxel), ovarian carcinoma (carboplatin, cisplatin, docetaxel, doxorubicin, fluorouracil, gemcitabine, irinotecan, letrozole, oxaliplatin, paclitaxel, vinblastine), cervical cancer (bleomycin, carboplatin, cisplatin, fluorouracil), vulvar cancer (bleomycin), endometrial cancer (cisplatin, fluorouracil), endometriosis (leuprolide), uterine fibroids (leuprolide), testicular carcinoma (bleomycin, carboplatin, cisplatin, etoposide, vinblastine), prostate cancer (cisplatin, docetaxel, doxorubicin, fluorouracil, leuprolide, paclitaxel, vinblastine), penile cancer (bleomycin), pancreatic cancer (bleomycin, fluorouracil, gemcitabine, irinotecan, mitomycin, paclitaxel), kidney cancer (cisplatin), liver cancer (doxorubicin, fluorouracil), melanoma (docetaxel, paclitaxel, vinblastine, vincristine), actinic keratoses (fluorouracil), superficial basal cell carcinoma (fluorouracil), Kaposi's sarcoma (etoposide, paclitaxel, vinblastine, vincristine), rhabdomyosarcoma (vincristine), neuroblastoma (vincristine), neoplasms (methotrexate), Wilm's tumor (etoposide, vincristine), soft tissue sarcoma (docetaxel), malignant neoplastic diseases (cyclophosphamide), psoriasis (methotrexate), nephrotic syndrome (cyclophosphamide), juvenile idiopathic arthritis (cyclophosphamide), rheumatoid arthritis, (methotrexate), lupus nephritis (cyclophosphamide), and systemic sclerosis (cyclophosphamide).

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. To learn more about these drugs go to http://reference.medscape.com/drugs/oncology.

Alkylating Agents

carboplatin (Paraplatin) - powder for injection, injectable solution
cisplatin (Platinol) - injectable solution
cyclophosphamide (Cytoxan) - powder for injection, tablet
oxaliplatin (Eloxatin) - powder for injection

Anthracyclines

daunorubicin (Cerubidine) - injectable solution, powder for injection
doxorubicin (Adriamycin) - injectable solution, powder for injection

Antibiotics

bleomycin (Blenoxane) - powder for injection
mitomycin (Mitomycin C, Mutamycin) - powder for injection

Antimetabolites

capecitabine (Xeloda) - tablet
fluorouracil, 5-FU (Adrucil, Efudex) - injectable solution, cream, topical solution
gemcitabine (Gemzar) - powder for injection
methotrexate, MTX (Trexall, Rheumatrex) - injectable solution, powder for injection, tablet
tamoxifen (Nolvadex) - tablet, oral solution

Antimicrotubular Drugs

docetaxel (Taxotere) - injectable solution
paclitaxel - injectable solution

Aromatase Inhibitors

anastrazole (Arimidex) - tablet
exemestane (Aromisin) - tablet
letrozole (Femara) - tablet

GnRH Agonists

leuprolide (Lupron) - solution for injection, prefilled syringe

Podophyllotoxin Derivatives

etoposide (VePesid, vp 16) - capsule, injectable solution, powder for injection

Topoisomerase Inhibitors

irinotecan (Camptosar) - injectable solution

Vinca Alkaloids

vinblastine (Velban) - injectable solution, powder for injection
vincristine (Oncovin) - injectable solution

Monoclonal antibodies

Monoclonal antibodies, often referred to as targeted therapy, only works against specific cells. This can reduce or even eliminate many of the side affects, but the medications tend to be very limited as to which cancers they can treat. This is because monoclonal antibodies are monospecific antibodies that are all identical because they are made by immune cells that are all clones of a unique parent cell.

Monoclonal antibodies are used to treat glioblastoma (bevacizumab), age related macular degeneration (bevacizumab), breast cancer (bevacizumab, trastuzumab), non-small cell lung cancer (bevacizumab), peritoneal carcinoma (bevacizumab), leukemia (alemtuzumab, rituximab), Non-Hodgkin's disease (rituximab), renal cell carcinoma (bevacizumab), stomach cancer (bevacizumab), gastric cancer (trastuzumab), colorectal cancer (bevacizumab), fallopian tube carcinoma (bevacizumab), ovarian cancer (bevacizumab), pancreatic cancer (bevacizumab, trastuzumab), melanoma (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).

adalimumab (Humira) - prefilled pen
alemtuzumab (CamPath) - injectable solution
bevacizumab (Avastin) - injectable solution
infliximab (Remicade) - powder for injection
palivizumab (Synagis) - injectable solution
rituximab (Rituxan) - injectable solution
trastuzumab (Herceptin) - powder for injection

Miscellaneous drug categories

The remaining medications in this list are difficult to group together with other drugs. The following is a short list of unrelated categories.

Hemopoietics

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.

darbepoetin alfa (Aranesp) - injectable solution, prefilled syringe
epoetin alfa (Epogen, Procrit) - injectable solution
filgrastim (Neupogen) - injectable solution, prefilled syringe
oprelvekin (Neumega) - 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, multiple and sclerosis. Colchicine can also be used for familial Mediterranean fever, and Behcet's syndrome.

allopurinol (Zyloprim) - tablet, powder for injection
azathioprine (Imuran) - tablet, powder for injection
colchicine (Colcrys) - tablet

Rheumatoid Arthritis Treatment

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

etanercept (Enbrel) - 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.

sildenafil (Viagra, Revatio) - tablet, injectable solution
tadalafil (Cialis, Adcirca) - tablet
vardenafil (Levitra, Staxyn ODT) - 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) in an attempt to loosen mucus from the respiratory tract.

benzonatate (Tessalon, Tessalon Perles) - capsule, gelcaps
codeine & guaifenesin (Cheratussin AC, Guiatuss AC) CV - oral liquid
dextromethorphan (Benylin DM) - oral suspension, gelcaps, capsule, syrup, lozenge
guaifenesin (Mucinex) - caplet, extended-release tablet, oral syrup
guaifenesin & phenylephrine (Sudafed PE Non-Drying Sinus Caplets) - caplet

Prostaglandins

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

latanoprost (Xalatan) - 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, polycystic ovarian syndrome, and many of these combinations are also used for acne.

conjugated estrogens (Premarin) - tablet, powder for injection
desogestrel & ethinyl estradiol (Desogen, Apri, Micrette) - tablet
drospirenone & ethinyl estradiol (Yasmin, Yaz, Ocella) - tablet
estradiol (Estrace, Vivelle-Dot, Estraderm, Estring, Femring) - gel, injectable solution, tablet, transdermal patch, topical emulsion, vaginal cream, vaginal ring, vaginal tablet
etonogestrel & ethynil estradiol (NuvaRing) - intrauterine device
levonorgestrel (Mirena, Plan B) - intrauterine device, tablet
medroxyprogesterone (DepoProvera, Provera) - tablet, injectable suspension, prefilled syringes
norelgestromin & ethinyl estradiol (Ortho Evra, Evra Transdermal System) - transdermal patch
norethindrone acetate (Aygestin) - tablet
norethindrone acetate & ethinyl estradiol (Loestrin, Microgestin, Junel) - tablet
norgestimate & ethinyl estradiol (Ortho Cyclen, Ortho Tri-Cyclen, Trinessa) - 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.

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).

Vitamins

Vitamins can be defined as any of a group of substances 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 therefor can be stored in adipose tissue. Other vitamins are considered water soluble.

multivitamin infusion (M.V.I.-12, Infuvite) - injectable solution - Multivitamin infusions are commonly used for parenteral nutrition or for treatment of a nutritional deficiency.
prenatal vitamins (PreNexa, Nexa, NesTabs) - tablet, capsule - Prenatal vitamins are intended for use by women while trying to conceive and throughout their pregnancy to ensure adequate vitamin intake.
vitamin A, beta carotene (Retinol A, Aquasol A) - 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 - tablet, injectable solution - Vitamin B1 affects carbohydrate metabolism and treats/prevents beriberi.
vitamin B3, niacin, nicotinic acid (Niacor, Niaspan) - tablet, extended-release tablet - Vitamin B3 affects lipid metabolism making it a treatment for hyperlipidemia.
vitamin B9, folic acid (Folvite) - cream, ointment, tablet, injectable solution. Vitamin B9 is necessary for red blood cell formation and prevents neural tube defects.
vitamin B12, cyanocobalamin (Cobex) - tablet, injectable solution, nasal spray - Vitamin B12 affects red blood cell production and can treat pernicious anemia.
vitamin C, ascorbic acid - 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.
vitamin D2, ergocalciferol (Drisdol, Calciferol) - 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 - 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 E, tocopherol (Aquasol E) - 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.
vitamin K1, phytonadione (Mephyton, AquaMephyton) - 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 are needed by cells to regulate the flow of water molecules across cell membranes.

calcium with various salts (OS-Cal, Tums, PhosLo, Citracal) - 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.
iron, ferrous with various salts (Slow Fe, Feosol, Ferrlecit, INFeD) - 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.
magnesium with various salts (Mag-Ox 400, Uro-Mag, Magonate) - 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.
potassium with various salts (Klor-Con, KDur, Slow K, K Phos) - 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.
multiple trace elements (Multitrace, M.T.E.) - injectable solution - Multiple trace elements are used to provide various trace element 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, but there is a plethora of anecdotal evidence. The following is a brief list of the most commonly used herbal supplements.

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 - Marjuana is used to treat decrease intraocular pressure, analgesia, antiemetic effects, and as an appetite stimulant.
phytoestrogens - Phytoestrogens are used to treat menopausal vasomotor symptoms, osteoporosisDecrease 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, some individuals 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. Please look up the generic name and the appropriate dosage routes for the following vaccines. Include additional notes you consider pertinent.

A common allergy concern for the influenza virus vaccine is that it is produced in chicken embryos and therefore contains some egg proteins. If a patient has an egg allergy it may be advisable to avoid the influenza vaccine.

diphtheria & tetanus toxoids (Decavac, Tenivac, Td, DT) - IM injection
haemophilus influenza type b vaccine (ActHIB, Hiberix) - IM injection
hepatitis a vaccine inactivated (Havrix, Vaqta) - IM injection
hepatitis b vaccine (Engerix B, Recombivax HB) - IM injection
human papillomavirus vaccine (Gardasil) - IM injection
influenza virus vaccine (Fluarix, Fluzone, Afluria, FluMist) - IM injection, ID injection, Nasal Spray
measles mumps and rubella vaccine (M-M-R-II) - SC injection
meningococcal A C Y and W-135 diphtheria conjugate vaccine (Menactra) - IM injection
pneumococcal vaccine (Pneumovax 23, Prevnar 13) - SC/IM injection
poliovirus vaccine inactivated (IPOL) - SC/IM injection
rabies vaccine (HDCV, Imovax) - IM injection
rotavirus oral vaccine (Rotarix) - oral solution
tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine (Adacel, Boostrix, Tdap) - IM injection
varicella virus vaccine live (Varivax) - SC injection
zoster vaccine live (Zostavax) - SC injection

References

Medscape Reference, http://reference.medscape.com/medscapetoday
Medscape Android App, https://play.google.com/store/apps/details?id=com.medscape.android&feature=nav_result#?t=W251bGwsMSwxLDMsImNvbS5tZWRzY2FwZS5hbmRyb2lkIl0.
Online Facts and Comparisons, http://online.factsandcomparisons.com/
Wikipedia, http://www.wikipedia.org/
Center for Disease Control, http://www.cdc.gov/
Drugs@FDA, FDA Approved Drug Products, http://www.accessdata.fda.gov/scripts/cder/drugsatfda/
Orange Book Preface, http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm

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	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 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.

Difference between revisions of "Pharmacology"

Difference between revisions of "Pharmacology"

From Rx-wiki

Revision as of 16:12, 4 March 2013

Contents

Terminology

Common medications

Anti-infective agents

Antibiotics

Penicillin Derivatives

Penicillin Derivatives with Beta-Lactamase Inhibitors

Carbapenems

Cephalosporins

Aminoglycosides

Tetracyclines

Sulfonamides

Macrolide Antibiotics

Fluoroquinolones

Miscellaneous Antibiotics

Antifungals

Amebicides

Antimalarial Drugs

Antivirals

Glucocorticosteroids

Short-Acting Steroids

Intermediate-Acting Steroids

Long-Acting Steroids

Drugs affecting the sympathetic nervous system

Adrenergic Agonists

Alpha-2 Adrenergic Agonists

Alpha-Adrenergic Blocking Agents

5-Alpha-Reductase Inhibitors

Beta-Adrenergic Blocking Agents

Drugs affecting the parasympathetic nervous system

Cholinergic Drugs

Anticholinergic Drugs

Skeletal muscle relaxants

Neuromuscular Blocking Agents

Centrally Acting Skeletal Muscle Relaxants

Local Anesthetics

Ester Local Anesthetics

Amide Local Anesthetics

Medications for treating psychological conditions

Antipsychotic Drugs

Hypnotics

Benzodiazepines

Barbiturates

Nonbarbiturate Hypnotics

Antidepressants

Tricyclic Antidepressants

Selective Serotonin Reuptake Inhibitors

Serotonin-Noerpinephrine Reuptake Inhibitors

Miscellaneous Antidepressants

Antianxiety Agent, Nonbenzodiazepine

Partial Nicotinic Receptor Antagonist

Amphetamines

Anorexiant

Stimulant

Antimanic Drug

NMDA Antagonist

Other Psychiatry Agents

Antiepileptic drugs

Antiparkinson drugs

Analgesics

Opioid Analgesics

Non Steroidal Anti Inflammatory Drugs

Miscellaneous Nonopioid Analgesics

Serotonin 5-HT Receptor Agonist

Medications affecting the cardiac system

Cardiac Glycosides

Diuretics

Antiarrhythmics

Angiotensin-II Receptor Antagonists

Angiotensin-Converting Enzyme Inhibitors

Calcium Channel Blockers

Nitrates

Renin Inhibitor

Combination Antihypertensive Agents

Anticoagulants and Antiplatelet Agents

HMG-CoA Reductase Inhibitors