antibiotics

1. Penicillins
Another name for this class is the beta-lactam antibiotics, referring to their structural formula. The penicillin class contains five groups
of antibiotics: aminopenicillins, antipseudomonal penicillins, beta-lactamase inhibitors, natural penicillins, and the penicillinase
resistant penicillins. Common antibiotics in the penicillin class include:
penicillin V potassium
amoxicillin
amoxicillin/clavulanate (Augmentin)
2. Tetracyclines
Tetracyclines are broad-spectrum against many bacteria and treat conditions such as acne, urinary tract infections (UTIs), intestinal
tract infections, eye infections, sexually transmitted diseases, periodontitis (gum disease), and other bacterial infections. The
tetracycline class contains well-known drugs such as:
doxycycline
tetracycline
minocycline
3. Cephalosporins
There are five generations of cephalosporins, with increasing expanded coverage to include gram-negative infections. Cephalosporins
treat many infections, including strep throat, ear infections, urinary tract infections, skin infections, and meningitis. The fifth
generation cephalosporin ceftaroline (Teflaro) is active against methicillin-resistant Staphylococcus aureus (MRSA). Youve probably
heard of common medications in this class, like:
cefuroxime (Ceftin)
ceftriaxone (Rocephin)
Cefdinir (Omnicef)
4. Quinolones
The quinolones, also known as the fluoroquinolones, are a synthetic, bactericidal antibacterial class with a broad-spectrum of activity.
The quinolones can be used for difficult-to-treat urinary tract infections when other options are arent effective, hospital-acquired
pneumonia, bacterial prostatitis, and even anthrax or plague. The FDA issued a strong warning about this class in 2016. Familiar
names in the fluoroquinolone class include:
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
moxifloxacin (Avelox)
5. Lincomycins
This class has activity against gram-positive aerobes and anaerobes (bacteria that can live without oxygen), as well as some gram-
negative anaerobes. The lincomycin derivatives may be used to treat serious infections like pelvic inflammatory disease, intra-
abdominal infections, lower respiratory tract infections, and bone and joint infections. These drugs include:
clindamycin (Cleocin)
lincomycin (Lincocin)
6. Macrolides
The macrolides can be use to treat community-acquired pneumonia, pertussis (whooping cough), or for uncomplicated skin infections,
among other susceptible infections. Ketolides are a newer generation of antibiotic developed to overcome macrolide bacterial
resistance. Frequently prescribed macrolides are:
azithromycin (Zithromax)
clarithromycin (Biaxin)
erythromycin
7. Sulfonamides
Sulfonamides are effective against some gram-positive and many gram-negative bacteria, but resistance is widespread. Common
uses for sulfonamides include UTIs, treatment or prevention of pneumocystis pneumonia, or ear infections (otitis media). Familiar
names include:
sulfamethoxazole-trimethoprim (Bactrim, Bactrim DS, Septra)
sulfasalazine (Azulfidine)
sulfisoxazole (combined with erythromycin)
8. Glycopeptide Antibiotics
Members of this group may be used for treating methicillin-resistant staphylococcus aureus (MRSA) infections, complicated skin
infections, C. difficile-associated diarrhea, and enterococcal infections such as endocarditis which are resistant to beta-lactams and
other antibiotics. Common drug names include:
dalbavancin (Dalvance)
oritavancin (Orbactiv)
telavancin (Vibativ)
vancomycin (Vancocin)
9. Aminoglycosides
Aminoglycosides inhibit bacterial synthesis by binding to the 30S ribosome and act rapidly as bactericidal antibiotics (killing the
bacteria). These drugs are usually given intravenously (in a vein through a needle). Common examples in this class are:
gentamicin
tobramycin
amikacin
10. Carbapenems
These injectable beta-lactam antibiotics have a wide spectrum of bacteria-killing power and may be used for moderate to life-
threatening bacterial infections like stomach infections, pneumonias, kidney infections, multidrug-resistant hospital-acquired
infections and many other types of serious bacterial illnesses. Members of this class include:
imipenem/cilastatin (Primaxin)
meropenem (Merrem)
doripenem (Doribax)
ertapenem (Inanz)

anti arrhythmic drugs

Condition Drug Comments
Sinus tachycardia Class II, IV Other underlying causes may need treatment
Class IA, IC, II, III, IV
Atrial fibrillation/flutter digitalis Ventricular rate control is important goal; anticoagulation required
adenosine
Class IA, IC, II, III, IV
Paroxysmal supraventricular tachycardia
adenosine
AV block atropine Acute reversal
Ventricular tachycardia Class I, II, III
Class II, IV
Premature ventricular complexes PVCs are often benign and not treated
Mg++ salts
Class IB
Digitalis toxicity Mg++ salts;
KCl

Calcium channel blockers

Calcium channel blockers, also known as "calcium antagonists," work by interrupting the movement of calcium into heart and blood vessel tissue.
Besides being used to treat high blood pressure, they're also used to treat angina (chest pain) and/or some arrhythmias (abnormal heart rhythms).
Beta-blockers
Beta-blockers decrease the heart rate and cardiac output, which lowers blood pressure by blocking the effects of adrenalin. They're also used with
therapy for cardiac arrhythmias and in treating angina pectoris.
Anticoagulants
Anticoagulants (blood thinners) work by making it harder for the blood to clot, or coagulate. They aren't designed to dissolve existing blood clots. They
prevent new clots from forming or existing clots from getting larger. Because a common type of stroke is caused by a blood clot obstructing blood flow to
the brain, anticoagulants are often prescribed for people with certain conditions to prevent the occurrence of a first stroke or to prevent the recurrence if
the patient has already had a stroke. Anticoagulants are also given to certain people at risk for forming blood clots, such as those with artificial heart
valves or who have atrial fibrillation.

Anti HPN Drugs

Diuretics, Thiazide
Class Summary
Thiazide diuretics are used as monotherapy, or they can be administered adjunctively with other antihypertensive agents. Thiazide diuretics inhibit
reabsorption of sodium and chloride mostly in the distal tubules. Long-term use of these drugs may result in hyponatremia. [123]
They also increase potassium and bicarbonate excretion and decrease calcium excretion and uric acid retention. Thiazides do not affect normal blood
pressure.
Keep in mind that all available loop and thiazide diuretic agents, except ethacrynic acid, possess a sulfonamide group, which has important clinical
relevance to those individuals with allergies to sulfonamide agents.

Diuretic, Potassium-Sparing
Class Summary
The potassium-sparing diuretics interfere with sodium reabsorption at the distal tubules (primarily in the collecting duct region of the nephron),
decreasing potassium secretion. Potassium-sparing diuretics have a weak diuretic and antihypertensive effect when used alone.

Diuretics, Loop
Class Summary
Loop diuretics act on the ascending limb of the loop of Henle, inhibiting the reabsorption of sodium and chloride. The loop diuretics are highly protein-
bound and therefore enter the urine primarily by tubular secretion in the proximal tubule, rather than by glomerular filtration.
Loop diuretics are commonly used to control volume retention. Generally, thiazide diuretics are recommended for most patients with a diagnosis of
hypertension; however, loop diuretics are more commonly prescribed for patients with decreased glomerular filtration rate or heart failure. Loop diuretics
do not reduce blood pressure as effectively as thiazide diuretics when they are used as monotherapy, especially if they are dosed once daily.
Keep in mind that all available loop and thiazide diuretic agents, except ethacrynic acid, possess a sulfonamide group, which has important clinical
relevance to those individuals with allergies to sulfonamide agents.

ACE Inhibitors
Class Summary
Angiotensin converting enzyme (ACE) inhibitors are the treatment of choice in patients with hypertension, chronic kidney disease, and proteinuria. ACE
inhibitors reduce morbidity and mortality rates in patients with heart failure, patients with recent myocardial infarctions, and patients with proteinuric renal
disease. ACE inhibitors appear to act primarily through suppression of the renin-angiotensin-aldosterone system. ACE inhibitors prevent the conversion
of angiotensin I to angiotensin II and block the major pathway of bradykinin degradation by inhibiting ACE. Accumulation of bradykinin has been
proposed as an etiologic mechanism for the side effects of cough and angioedema. ACE inhibitors can cause injury or even death to a developing fetus.
In pregnant patients, ACE inhibitors should be discontinued as soon as possible.
It is important to note that the blood-pressure-lowering effects of ACE inhibitors and thiazides are approximately additive, and there is also the potential
for hyperkalemia when ACE inhibitors are coadministered with potassium supplements or potassium-sparing diuretics. In addition, a study by Harel et al
found an increased risk for hyperkalemia when aliskiren, a direct renin inhibitor, and ACE inhibitors or angiotensin receptor blockers were used
together. [124] Careful monitoring of serum potassium levels is warranted when these agents are used in combination. [124] Furthermore, in patients with
hypertension plus type 2 diabetes and renal impairment who are at high risk of cardiovascular and renal events, there is an increased risk of nonfatal
stroke, renal complications, hypokalemia, and hypotension when aliskiren is added to ACE inhibitor or ARB therapy.

ARBs
Class Summary
Generally, ACE inhibitors should remain the initial treatment of choice for hypertension. Angiotensin II receptor antagonists or angiotensin receptor
blockers (ARBs) are used for patients who are unable to tolerate ACE inhibitors. ARBs competitively block binding of angiotensin-II to angiotensin type I
(AT1) receptors, thereby reducing effects of angiotensin IIinduced vasoconstriction, sodium retention, and aldosterone release; the breakdown of
bradykinin should not be inhibited. If monotherapy with an ARB is not sufficient, adding a diuretic should be considered.
ARBs can cause injury or even death to a developing fetus. If a patient becomes pregnant, ARBs should be discontinued as soon as possible.
Note that a study by Harel et al found an increased risk for hyperkalemia when aliskiren and ARBs or ACE inhibitors were used together [124] ; therefore,
careful monitoring of serum potassium levels is warranted when these agents are used in combination. [124] Furthermore, in patients with hypertension
and type 2 diabetes and renal impairment who are at high risk of cardiovascular and renal events, there is an increased risk of nonfatal stroke, renal
complications, hypokalemia, and hypotension when aliskiren is added to ACE inhibitor or ARB therapy.

Beta-Blockers, Beta-1 Selective

Class Summary
Beta-blockers are generally not recommended as first-line agents for the treatment of hypertension; however, they are suitable alternatives when a
compelling cardiac indication (eg, heart failure, myocardial infarction, diabetes) is present. Selective beta-blockers specifically block beta-1 receptors
alone, although they can be nonselective at higher doses.
Caution should be used in administering these agents in the setting of asthma or severe chronic obstructive pulmonary disease (COPD), regardless of
beta-selectivity profile. In addition, exacerbations of angina and, in some cases, myocardial infarction have been reported following abrupt
discontinuance of beta-blocker therapy. The doses should be gradually reduced over at least a few weeks.

Beta-Blockers, Alpha Activity

Class Summary
Beta-blockers, such as labetalol and carvedilol, have peripheral vasodilatory effects that act via antagonism of the alpha-1 receptor in addition to beta-
receptors.
Beta-Blockers, Intrinsic Sympathomimetic
Class Summary
Agents such as acebutolol and pindolol possess intrinsic sympathomimetic activity (ISA). These agents can be used alone or in combination with other
antihypertensive agents, particularly with a thiazide-type diuretic.

Class Summary
Vasodilators relax blood vessels to improve blood flow, thus decreasing blood pressure

Calcium Channel Blockers

Class Summary
Calcium channel blockers (CCBs) can be divided into dihydropyridines and nondihydropyridines. Dihydropyridines bind to L-type calcium channels in the
vascular smooth muscle, which results in vasodilatation and a decrease in blood pressure. They are effective as monotherapy in black patients and
elderly patients. Some examples of dihydropyridines include amlodipine, nifedipine, clevidipine, and felodipine. Non-dihydropyridines such as verapamil
and diltiazem bind to L-type calcium channels in the sinoatrial and atrioventricular node, as well as exerting effects in the myocardium and vasculature.
These agents may constitute a more effective class of medication for black patients. [125]

Aldosterone Antagonists, Selective

Class Summary
Aldosterone antagonists compete with aldosterone receptor sites, reducing blood pressure and sodium reabsorption.

Alpha2-agonists, Central-acting
Class Summary
Centrally acting alpha2-agonists stimulate presynaptic alpha2-adrenergic receptors in the brain stem, which reduces sympathetic nervous activity.

Renin Inhibitors/Combos
Class Summary
Renin inhibitors act within the renin-angiotensin system (RAS), a hormone system important in the regulation of blood pressure, electrolyte homeostasis,
and vascular growth. Renin inhibitors have an additive effect when used with diuretics. Avoid the use of these agents in pregnancy.

Alpha-Blockers, Antihypertensives
Class Summary
Alpha-blockers are generally not recommended as initial monotherapy. They selectively block postsynaptic alpha1 -adrenergic receptors. They dilate
arterioles and veins, thus lowering blood pressure. These drugs can be combined with any of the other antihypertensives in other drug classes. Common
side effects seen in this drug class include dizziness, headache, and drowsiness, in addition to orthostatic and first-dose hypotension.

Antihypertensives, Other
Class Summary
Reserpine is a peripherally acting adrenergic agent. It is indicated for mild hypertension and can be used as adjunctive therapy with other
antihypertensive agents in more severe forms of hypertension

Antihypertensive Combinations
Class Summary
Drug combinations using agents that act by different mechanisms have an additive effect. Most clinicians recommend initiating therapy with a single
agent and advancing to the low-dose combination therapy. Some patients will require multiple medications to achieve their blood pressure targets and
will benefit from drug combinations. Drug combination therapy may also help to improve patient compliance.
Drug combinations includebut are not limited tothe following:
- Amlodipine/benazepril (Lotrel)
- Amlodipine/olmesartan (Azor)
- Amlodipine/telmisartan (Twynsta)
- Amlodipine/valsartan (Exforge)
- Amlodipine/valsartan/hydrochlorothiazide (Exforge HCT)
- Amlodipine/aliskiren (Tekamlo)

Oral Antihyperglycemic Drugs

Oral antihyperglycemic agents lower glucose levels in the blood. They are commonly used in the treatment of diabetes mellitus. [1]
Biguanides
Biguanides decrease hepatic glucose production, decrease gastrointestinal glucose absorption, and increase target cell insulin sensitivity
Example: Metformin
Contraindications: Metabolic acidosis with or without coma, abnormal creatinine clearance from any cause including diabetic ketoacidosis, shock, acute
myocardial infarction, septicemia, renal disease (serum creatinine level 1.5 mg/dL in males or 1.4 mg/dL in females), lactation, radiologic contrast
study within 48 hours
Sulfonylureas
Sulfonylureas increase beta-cell insulin secretion, decrease hepatic glucose output, and increase insulin receptor sensitivity at peripheral target tissues
Examples: Glyburide, glipizide, glimepiride, tolazamide, tolbutamide
Contraindications: Sulfa allergy, type 1 diabetes, diabetic ketoacidosis, concomitant use with bosentan
Thiazolidinediones
Thiazolidinediones increase insulin receptor sensitivity and influence the production of gene products involved in lipid and glucose metabolism; their
mechanism of action depends on the presence of insulin for activity
Examples: Pioglitazone, rosiglitazone
Contraindications: Hypersensitivity to product or components, established NYHA class III/IV heart failure
Alpha-glucosidase inhibitors
Inhibit the upper gastrointestinal enzymes that convert dietary starch and other complex carbohydrates into simple sugars, which can be absorbed
Examples: Acarbose (Precose) & Miglitol (Glycet)
Contraindications: Diabetic ketoacidosis; cirrhosis; inflammatory bowel disease, colonic ulceration, partial intestinal obstruction,

Types of Antihyperlipidemic agents

Please refer to the drug classes listed below for further information.
Antihyperlipidemic agents promote reduction of lipid levels in the blood. Some antihyperlipidemic agents aim to lower the levels of
low-density lipoprotein (LDL) cholesterol, some reduce triglyceride levels, and some help raise the high-density lipoprotein (HDL)
cholesterol. By reducing the LDL cholesterol, they can prevent both the primary and secondary symptoms of coronary heart disease.
Niacin and ezetimibe are available in combination with statins, as single dose forms. Antihyperlipidemic agents are also available in
combinations with antihypertensive agents. By having one pill with a couple of agents makes it easier to take and increases
compliance.

Bile acid sequestrants

What are Bile acid sequestrants
Bile acid sequestrants are used to reduce low density lipoprotein (LDL) cholesterol levels. After oral administration, they are not
absorbed but bind to bile acids (which contains cholesterol) in the intestine and prevent their reabsorption into the body. The bound
complex is insoluble and is excreted in the faeces. Decrease in bile acid leads to an increase in hepatic synthesis of bile acids from
cholesterol. Depletion of cholesterol increases LDL receptor activity, therefore increases removal of LDL cholesterol from the blood.
What are Cholesterol absorption inhibitors
Cholesterol absorption inhibitors reduce the absorption of dietary and biliary cholesterol through the intestines. Therefore it deceases
the amount of intestinal cholesterol that is delivered to the liver. Reduced levels of cholesterol delivered to the liver results in
increased hepatic LDL (low density lipoprotein) receptor activity, which leads to increased clearance of LDL cholesterol.
Cholesterol absorption inhibitors are used to treat hyperlipidemia, by lowering LDL cholesterol and total cholesterol.
What are Fibric acid derivatives
Fibric acid derivatives or fibrates are regarded as broad-spectrum lipid lowering drugs. Their main action is to decrease triglyceride
levels but they also tend to reduce low density lipoprotein (LDL) cholesterol levels and help to raise high density lipoprotein (HDL)
cholesterol. Fibrates appear to activate a protein called peroxisome proliferator-activated receptor alpha (PPAR-alpha). PPAR-alpha
activates the enzyme lipoprotein lipase and ultimately results in decreased formation of very low-density lipoprotein (VLDL)
cholesterol (which is converted into LDL cholesterol) and triglycerides and an increase in HDL cholesterol.
What are Miscellaneous antihyperlipidemic agents
Miscellaneous antihyperlipidemic agents are used to treat hyperlipidemia. They help to decrease total cholesterol by lowering low-
density lipoprotein (LDL) cholesterol and triglycerides and raising high-density lipoproteins (HDL) cholesterol. Niacin (nicotinic acid) is
a water-soluble B vitamin, which inhibits the synthesis of cholesterol and triglycerides, therefore lowers total cholesterol and
triglyceride levels, and raises HDL cholesterol levels.
What are PCSK9 inhibitors
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme that binds to low-density lipoprotein receptors (LDL receptors),
which stops LDL being removed from the blood, leading to an increase in blood levels of LDL. The PCSK9 inhibitor blocks the PCSK9
enzyme, resulting in more LDL receptors available to remove LDL from the blood, which produces in a decrease in LDL blood levels.
What are Statins
Statins, also known as HMG-CoA reductase inhibitors, inhibit HMG-CoA reductase (3-hydroxy-3-methylglutaryl coenzyme A reductase)
an enzyme involved in the synthesis of cholesterol especially in the liver. Decreased cholesterol production leads to an increase in the
number of LDL (low density lipoprotein) membrane receptors, which increases clearance of LDL cholesterol from circulation.