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Statins

Uses Incidence in USA: Estimated 20 million Primary indications include: Hyperlipidemia: HMG-CoA reductase inhibitors (statins) are powerful drugs for lowering LDL cholesterol concentrations, and certain statins—atorvastatin in high doses and rosuvastatin—increase concentrations of healthy HDL cholesterol. Primary and secondary prevention of CV disease: CV benefits (reduction in myocardial infarction and stroke) in pts with hypercholesterolemia. Benefits also in normocholesterolemic pts with elevated markers of inflammation (e.g.,…

Sildenafil Citrate

Uses Treatment of erectile dysfunction (Viagra) Sildenafil (Revatio) is used to improve the ability to exercise in people with pulm arterial Htn Oral sildenafil is used as part of multimodal management of severe periop pulm Htn and right ventricular dysfunction in clinical settings such as: Heart transplantation Pulm Htn associated with CHD Pulm Htn associated with mitral valve disease Perioperative Risks None for elective surgery based…

Serotonin: Agonists, Antagonists, and Reuptake Inhibitors

Uses Serotonin (5-hydroxytryptophan [5-HT]) not given as a drug; is a neurotransmitter that plays many roles within the body; serotonin levels can be affected by drugs called serotonin agonists and antagonists Partially selective receptor agonists used mostly for Rx of acute migraine headaches; they include: Sumatriptan (Imitrex) 5–20 mg IN, 25–100 mg/d PO Naratriptan (Amerge) 2.5 mg/d PO Rizatriptan (Maxalt) 5 mg/d PO Zolmitriptan (Zomig) 5…

Selective Estrogen Receptor Modulators

Uses Critical components in treatment algorithm for invasive and/or in situ breast cancer, breast cancer chemoprevention in high-risk pts, and postmenopausal osteoporosis (raloxifene only) Perioperative Risks VTE, particularly if the pt has a history of recent chemotherapy, prior irradiation, or long-term SERM use Microvascular complications following free-flap breast reconstruction surgery Worry About Periop SERM management Endometrial cancer (tamoxifen only) Unpleasant side effect profile affecting pt quality…

Rifampin

Uses Antibiotic therapy for TB (yearly incidence 2.96:100,000 in USA) and Neisseria meningitidis infection (yearly incidence 0.3:100,000 in USA). Also used to treat Hansen disease (leprosy) and Legionnaires disease and as prophylaxis against Haemophilus influenzae type B. Treatment of opioid-induced pruritus associated with the cholestatic jaundice of malignancy Administered PO or IV 10% of pts receiving rifampin develop chemical hepatitis; 16 deaths per 500,000 receiving drug.…

Pyridostigmine Bromide

Uses Therapy for MG, which is caused by decreased postsynaptic ACh receptors. Antagonism of nondepolarizing NMBDs. Therapy for glaucoma. Therapy for atony of GI and urinary tracts. Perioperative Risks Muscarinic effects on GI, respiratory, and CV systems. Prolonged response to succinylcholine if administered shortly afterward by inhibition of pseudocholinesterase and increased postsynaptic depolarization. Paralysis may be prolonged by excessive doses, which can produce a depolarizing NMB…

Pseudoephedrine

Uses An OTC sympathomimetic commonly used as a nasal decongestant or for opening obstructed eustachian ostia. Used in the symptomatic treatment of reactive airway disease; however, appears to be ineffective as a bronchodilator. Also used for treatment of ejaculatory dysfunction and as a starting material for illicit drug manufacturing. Abuse and addiction to OTC stimulants does occur, particularly in those with eating disorders or erratic work…

Proton Pump Inhibitors

Uses PPIs are used for the prevention and treatment of ulcers in the stomach, esophagus, or duodenum that are caused or exacerbated by stomach acids. People in USA receive approximately 21 million prescriptions annually. Worldwide, $13.6 billion worth of PPIs are consumed annually. PPIs are administered for the treatment of dysphagia, peptic and duodenal ulcer disease, gastroesophageal reflux, Barrett esophagus, Zollinger-Ellison syndrome, ulcers caused by NSAIDs,…

Propylthiouracil—Antithyroid Drugs

Uses RX for hypothyroidism. In USA, 7.5% of pregnant women plus an additional 500,000 people per y develop hyperthyroidism. Rx for goiter associated with hyperthyroidism; second drug to methimazole due to greater side effects with PTU except in pregnancy (methimazole has greater side effects on fetus during pregnancy). Definitive Rx for control of hyperthyroidism in anticipation of spontaneous remission. Rx for hyperthyroidism in conjunction with 131…

Procainamide (Procan, Procanbid, Pronestyl)

Uses Treats recurrent or sustained hemodynamically stable monomorphic VT (IIa/C)/(IIa/C). ∗ ∗ The first number and lowercase letter refer to the ACC/AHA system of classifying guidelines while the uppercase letter refers to the level of evidence. Not indicated for asymptomatic PVCs. Treats focal atrial tachycardia in hemodynamically stable pts (IIa/C). Treats recurrent atrial flutter (only in combination with AV-nodal-blocking agent) (IIb/A). Treats SVT during pregnancy. As…

Physostigmine, Eserine

Uses Central anticholinergia; used for diagnosis and treatment in patients with a Hx of anticholinergic ingestion and/or exposure: Atropine, scopolamine, belladonna, jimson weed, toxic mushrooms, tricyclics, phenothiazines, antihistamines, benzodiazepines, opiates, inhalation anesthetics, propofol, GHB. “Blind as a bat”: Mydriasis and loss of accommodation “Dry as a bone”: Urinary retention and dry mucous membranes “Hot as a hare”: Hyperthermia from loss due to sweating “Red as a…

Phenytoin

Uses Management of generalized tonic-clonic (grand mal) and complex partial seizures Prophylaxis against seizures after trauma or surgical intervention Treatment of ventricular arrhythmias, especially those associated with digitalis or tricyclic antidepressant toxicity Treatment of prolonged QT interval Treatment of epidermolysis bullosa and chronic pain syndromes Overview/Pharmacology Drug of choice for status epilepticus Treatment for acute and chronic seizures Onset of action: 30–60 min Protein binding >90%…

Phenylephrine (Neo-Synephrine)

Uses Prescribed mainly as nasal decongestant or ophthalmically for treatment of mydriasis, capillary decongestion. Reliable vasopressor in treatment of hypotension. Used in obstetric anesthesia for hypotension after spinal. More effective as a prophylactic infusion than bolus doses. Prolongs local anesthetic duration in regional anesthesia. Available as parenteral IM/IV and various ophthalmic and/or nasal preparations. Perioperative Risks Risk of Htn increases left heart work; may precipitate myocardial…

Phenoxybenzamine

Uses Incidence in USA: 3600 per y Rx for preop pheochromocytoma; occasionally for chronic Rx of pheochromocytoma and sympathetic hyperactivity states, carcinoid syndrome, BPH Perioperative Risks Drug interactions: Sometimes requires very high doses of α-adrenergic agents to produce vasoconstriction. Vasodilation, orthostatic hypotension accentuated in hypovolemic pts. Worry About Occasionally associated with confusional states. Associated with fatigue and prolonged sedation. Drop attacks on preop standing to urinate.…

Phenothiazines

Uses Phenothiazine compounds are clinically useful antipsychotic and antiemetic medications. Phenothiazine antihistamines such as promethazine (phenergan) and prochlorperazine (compazine) are highly effective antiemetics. Phenothiazine neuroleptics such as chlorpromazine (thorazine) are used in the treatment of schizophrenia and psychosis. Chlorpromazine can also effectively treat uncontrollable hiccups and acute migraine headaches. Perioperative Risks Common side effects of sedation and delirium may be particularly notable in the postop period…

Phencyclidine

Uses DEA Schedule I drug of abuse with no present medical indications; street terms for PCP include angel dust, supergrass, killer weed, embalming fluid, rocket fuel, wack, and ozone. Common routes of administration: Smoking (often laced in marijuana cigarettes), oral ingestion; less common is IV injection. Experimentally used for animal models of schizophrenia, neurodegenerative diseases and seizure disorders, ischemic neuroprotection, and anesthesia-induced neurotoxicity. Risk Psychosis, seizures,…

Penicillins

Uses Prescribed for pts with infections due to sensitive organisms, primarily Pneumococcus and those in genera Streptococcus , Staphylococcus , Neisseria , Pseudomonas , Proteus , Haemophilus , Helicobacter , Moraxella, and so on; used as prophylaxis for subacute bacterial endocarditis (penicillin G benzathine). Can be administered PO, IM as regular or slow-release repository form, or IV. Worry About Hypersensitivity reactions (0.7–4%): rash, fever, bronchospasm, vasculitis,…

P2Y 12 Receptor Blockers

Uses P2Y 12 RBs used alone or in combination with ASA (DAPT). ACS, those undergoing PCI with stent placement, and pts with NSTEMI or STEMI. Continue for 6–12 mo after insertion of drug-eluting stent (DES), and 4–6 wk after insertion of bare metal stent (BMS). Peripheral arterial disease AF when warfarin/coumadin is contraindicated Ischemic cerebrovascular disease, carotid or vertebral artery dissection (3–6 mo), postcarotid endarterectomy (long…

Oral Hypoglycemic Agents

Uses Oral hypoglycemic agents are used to manage type 2 diabetes mellitus. The term oral hypoglycemic agents is becoming obsolete and is being replaced by the term noninsulin glucose-lowering drugs because the glucagon-like peptide 1 analogues are injected. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Oral Contraceptives

Uses Prevention of pregnancy Treatment of the following: Dysmenorrhea Menorrhagia/iron-deficiency anemia Acne Endometriosis Functional ovarian cyst Hyperandrogenism and/or polycystic ovarian disease Premenstrual syndrome and/or premenstrual dysphoric disorder Perimenopausal vasomotor symptoms Mittelschmerz Perioperative Risks Hypercoagulability; increased risk of venous and arterial thrombosis when given without concomitant aspirin, especially in women with blood type A+. Worry About Thromboembolic events; increased relative risk of 2.7 (without aspirin). Hyperkalemia (drospirenone…