🏷️ Drugs by Class

Grouped by what the drug is for — the class you would name on a care plan. Every one of the 959 drugs is here exactly once. Tap a class to open it; search filters across drug names, class names and the notes.

HA high-alert drug · BBW has a black box warning · click any drug to open its card.

CardiovascularRespiratoryNeurologic & PsychiatricEndocrine & MetabolicGastrointestinalGenitourinary & RenalBlood & HematologyAnti-infectivesPain & AnesthesiaOncology & ImmuneEye, Ear & SkinAntidotes, Vitamins & Other
⚙️ Switch to By Mechanism

Cardiovascular 124

ACE inhibitors15

Block the enzyme that makes angiotensin II, so vessels relax and the kidney dumps sodium. First-line for hypertension, heart failure and kidney protection in diabetes.

  • Dry hacking cough is the giveaway - switch to an ARB if she cannot tolerate it.
  • Watch potassium and creatinine; hold and call for hyperkalemia or a rising creatinine.
  • Angioedema of the lips or tongue is an emergency - stop the drug, never rechallenge.
  • Teratogenic - stop before pregnancy; rise slowly, first-dose hypotension is common.
ARBs (angiotensin II receptor blockers)12

Block angiotensin II at the receptor instead of blocking the enzyme, so blood pressure falls without the ACE cough. Same jobs as ACE inhibitors: hypertension, heart failure, diabetic kidney disease.

  • Same watch list as ACE inhibitors: potassium, creatinine, blood pressure.
  • No cough, but angioedema is still possible.
  • Contraindicated in pregnancy; do not combine routinely with an ACE inhibitor.
Beta blockers9

Slow the heart and soften its contraction by blocking beta receptors, lowering blood pressure and oxygen demand. Used for hypertension, angina, arrhythmias and stable heart failure.

  • Check apical pulse and blood pressure first - hold for pulse under 60 or systolic under 90 unless told otherwise.
  • Never stop abruptly; rebound tachycardia, hypertension and chest pain follow.
  • Nonselective agents can worsen asthma and mask the shakes and tachycardia of hypoglycemia.
Calcium channel blockers9

Keep calcium out of vascular and cardiac muscle so arteries dilate; the non-dihydropyridines also slow the heart rate. Used for hypertension, angina and rate control.

  • Dihydropyridines (-dipine) cause ankle edema, flushing and headache.
  • Verapamil and diltiazem slow conduction - hold for bradycardia or heart block, watch for constipation.
  • No grapefruit juice; it raises drug levels and drops pressure too far.
Loop diuretics3

The strongest diuretics - they block sodium reabsorption in the loop of Henle and pull off large volumes of fluid. First choice for pulmonary edema and fluid overload in heart, kidney or liver failure.

  • Loses potassium, magnesium, sodium and calcium - monitor labs and watch for cramps and arrhythmias.
  • Daily weights and intake/output are the real measure of response; 1 kg equals about 1 L.
  • Ototoxic when pushed fast IV; give slowly and watch with aminoglycosides.
  • Give in the morning, teach position changes for orthostatic dizziness.
Thiazide, potassium-sparing & other diuretics12

The gentler diuretics: thiazides are first-line for everyday hypertension, potassium-sparing and aldosterone blockers hold on to potassium and help heart failure survival. Carbonic anhydrase and osmotic agents sit here too.

  • Thiazides drop potassium and sodium but raise calcium, glucose and uric acid - can flare gout.
  • Potassium-sparing agents do the opposite: hyperkalemia risk, so no salt substitutes or potassium supplements.
  • Spironolactone causes gynecomastia and menstrual changes; thiazides are sulfa-based.
  • Give in the morning, weigh daily, and teach slow position changes.
Antiarrhythmics & digoxin13

Drugs that reset or control heart rhythm by acting on sodium, potassium or calcium channels; digoxin adds contractility while slowing the rate. Used for atrial fibrillation, SVT and ventricular arrhythmias.

  • Continuous ECG - all of them can cause new arrhythmias; watch QT prolongation.
  • Digoxin: apical pulse for a full minute, hold under 60, watch for nausea, visual halos and low potassium.
  • Amiodarone hits thyroid, lungs, liver and eyes - baseline and periodic TSH, LFTs and chest imaging.
Vasopressors & inotropes9

Adrenergic and related drugs that raise blood pressure or squeeze harder in shock and cardiac arrest. Titrated to a mean arterial pressure goal in critical care.

  • Central line preferred - extravasation causes tissue necrosis (antidote is phentolamine).
  • Titrate to ordered MAP, monitor continuous ECG and blood pressure, never bolus.
  • Watch for tachyarrhythmias, chest pain and cold mottled extremities from over-vasoconstriction.
Statins & other lipid-lowering drugs20

Lower LDL cholesterol and triglycerides to prevent heart attack and stroke. Statins block cholesterol synthesis; the others block absorption, bind bile acids, or clear LDL receptors (PCSK9 antibodies).

  • Statins: report muscle pain, tenderness or dark urine (rhabdomyolysis) and check CK.
  • Monitor liver enzymes; statins are contraindicated in pregnancy and do not mix with grapefruit juice.
  • Bile acid sequestrants constipate and block other drugs - separate doses by several hours.
  • Niacin flushing eases with aspirin 30 minutes before; diet and exercise stay part of the plan.
Nitrates, vasodilators & other antihypertensives22

Drugs that open vessels directly - nitrates for angina, central alpha-2 agonists and alpha-1 blockers for resistant hypertension, and the endothelin and prostacyclin agents for pulmonary hypertension.

  • Sublingual nitroglycerin: one dose every 5 minutes up to three, call 911 if pain persists after the first.
  • Nitrates or PDE5 inhibitors together cause profound hypotension - absolute contraindication.
  • First-dose syncope with alpha-1 blockers; never stop clonidine abruptly (rebound crisis).
  • Endothelin blockers and riociguat are teratogenic and need monthly pregnancy testing and LFTs.

Respiratory 39

Bronchodilators13

Open narrowed airways either by stimulating beta-2 receptors or by blocking muscarinic ones. Short-acting beta agonists are rescue; the long-acting agents are daily control.

  • Albuterol is the rescue inhaler - if she needs it more than twice a week, control is failing.
  • Expect tachycardia, tremor and jitteriness; beta agonists also drop potassium.
  • Long-acting agents are never used alone as rescue and, in asthma, never without an inhaled steroid.
  • Teach spacer use, rinsing and the order: bronchodilator first, then the steroid inhaler.
Inhaled & nasal corticosteroids7

Steroid delivered straight to the airway to prevent inflammation in asthma, COPD and allergic rhinitis. Controller therapy - it does nothing during an acute attack.

  • Rinse and spit after every dose to prevent oral thrush and hoarseness.
  • Daily use even when well; benefit builds over 1-2 weeks.
  • Combination inhalers with a long-acting beta agonist still are not rescue inhalers.
Asthma biologics, leukotriene modifiers & other lung drugs9

Controller therapies beyond inhalers - oral leukotriene blockers, injectable antibodies for severe asthma, and the CFTR modulators and antifibrotics for cystic fibrosis and pulmonary fibrosis.

  • Montelukast carries a warning for mood change, agitation and suicidal thinking - ask about behaviour.
  • None of these are rescue drugs; the inhaler still goes everywhere with her.
  • Biologics: watch for anaphylaxis after injection and screen for infection.
  • CFTR modulators and antifibrotics need LFT monitoring; take CFTR drugs with fatty food.
Antihistamines, cough & cold drugs10

Block histamine to stop sneezing, itching and hives, or loosen mucus, quiet a cough and shrink swollen nasal membranes. Symptom relief only.

  • First-generation antihistamines sedate and are anticholinergic - avoid in older adults, no driving or alcohol.
  • Antihistamines relieve allergy symptoms but do not treat anaphylaxis - that is epinephrine.
  • Decongestants raise blood pressure; limit nasal sprays to 3 days (rebound congestion).
  • Push fluids with expectorants - hydration is what actually thins mucus.

Neurologic & Psychiatric 163

Benzodiazepines & sedative-hypnotics19

Calm the brain by boosting GABA or by blocking the wakefulness signal - used for anxiety, seizures, alcohol withdrawal, procedural sedation and insomnia. They stack with every other CNS depressant.

  • Watch respiratory rate and sedation, especially with opioids - the combination kills.
  • Flumazenil reverses benzodiazepines but can trigger seizures in chronic users.
  • Big fall risk; taper rather than stop abruptly, and no alcohol.
  • Z-drugs go right at bedtime with 7-8 hours available; buspirone takes weeks and is not a PRN.
Antiseizure drugs23

Stabilise overexcited neurons by damping sodium or calcium channels or boosting GABA. Used for epilepsy and often for neuropathic pain, bipolar disorder and migraine prevention.

  • Never stop suddenly - abrupt withdrawal causes status epilepticus.
  • All carry a suicidal-ideation warning; ask about mood at every visit.
  • Rash matters: lamotrigine and carbamazepine can progress to Stevens-Johnson syndrome.
  • Know the drug-specific labs - phenytoin levels, valproate ammonia and LFTs, carbamazepine CBC and sodium.
SSRIs9

Keep serotonin in the synapse longer to lift depression and anxiety, OCD and PTSD. First-line because they are safer in overdose than older antidepressants.

  • Full effect takes 4-6 weeks; energy returns before mood, so suicide risk peaks early - monitor closely.
  • Serotonin syndrome: agitation, fever, tremor, hyperreflexia, diarrhea - hold and call.
  • Do not stop abruptly; taper to avoid dizziness, flu feeling and electric-shock sensations.
  • Expect GI upset and sexual side effects; warn her so she does not quit silently.
SNRIs, TCAs & other antidepressants18

Antidepressants that are not SSRIs - SNRIs, tricyclics, bupropion, mirtazapine, trazodone and the MAOIs. Also used for neuropathic pain, migraine prevention and smoking cessation.

  • All antidepressants take 4-6 weeks and carry a suicidality warning - monitor closely early on.
  • TCAs are anticholinergic and lethal in overdose (cardiac conduction block) - limit quantities.
  • SNRIs raise blood pressure; bupropion lowers the seizure threshold; mirtazapine sedates and increases appetite.
  • MAOIs need a tyramine-free diet and a 2-week washout from other serotonergic drugs.
Antipsychotics & mood stabilizers20

Block dopamine (and for the atypicals, serotonin too) to quiet hallucinations, delusions and mania. Lithium sits here as the classic bipolar mood stabilizer.

  • Extrapyramidal symptoms: acute dystonia, akathisia, parkinsonism and late tardive dyskinesia - assess with the AIMS.
  • Neuroleptic malignant syndrome - high fever, rigidity, altered mental status, high CK - is an emergency.
  • Atypicals cause weight gain, hyperglycemia and lipid rise; monitor metabolic panel; clozapine needs ANC monitoring.
  • Lithium has a narrow window - check levels, keep sodium and fluids steady, watch for tremor, vomiting and confusion.
Parkinson disease drugs15

Replace or protect dopamine so movement smooths out - levodopa plus carbidopa is the backbone, with dopamine agonists, COMT and MAO-B inhibitors extending it. Anticholinergics help tremor.

  • Expect orthostatic hypotension, nausea and vivid dreams; rise slowly.
  • Levodopa wears off and causes dyskinesias - dosing times are strict; protein-heavy meals blunt absorption.
  • Watch for impulse-control problems (gambling, shopping) with dopamine agonists.
  • Never stop abruptly - risk of a parkinsonism-hyperpyrexia crisis.
Multiple sclerosis drugs9

Disease-modifying therapies that cut relapse rate and new MRI lesions by damping or redirecting immune attack on myelin. They do not reverse existing disability.

  • All are immunosuppressing - screen for infection, hepatitis and JC virus before starting.
  • Interferons cause flu-like symptoms; dose at bedtime and pretreat with acetaminophen.
  • First dose of S1P modulators needs cardiac monitoring for bradycardia; check CBC and LFTs on therapy.
Migraine drugs17

Triptans and gepants stop an attack in progress; CGRP antibodies and some daily drugs prevent them. Triptans constrict dilated cranial vessels, so cardiac history matters.

  • Do not give triptans with ergots or within 24 hours of each other, or in known coronary disease.
  • Take at the first sign of headache - waiting reduces the response.
  • Warn about medication-overuse headache if abortive drugs are used more than about 2 days a week.
Stimulants & wakefulness agents9

Raise dopamine and norepinephrine to improve focus in ADHD or keep people awake in narcolepsy. Most are controlled substances with real misuse potential.

  • Monitor blood pressure, heart rate, weight and growth in children.
  • Give early in the day - late doses wreck sleep; appetite suppression is expected.
  • Atomoxetine is non-stimulant, takes weeks to work and carries a suicidality warning.
Addiction & withdrawal drugs6

Support recovery from alcohol, opioid or nicotine dependence by blocking reward, easing craving or softening withdrawal. Pair them with counselling.

  • Naltrexone requires a fully opioid-free window or it precipitates withdrawal; check LFTs.
  • Disulfiram plus any alcohol (including mouthwash and sauces) causes flushing, vomiting and hypotension.
  • Varenicline and bupropion need mood monitoring; nicotine patches must not be worn while still smoking heavily.
Alzheimer, ALS, spasticity & other neuro agents18

Targeted drugs for dementia, ALS, spinal muscular atrophy, chorea, myasthenia gravis and muscle spasticity. Small, disease-specific classes grouped by the problem they treat.

  • Cholinesterase inhibitors for dementia slow the pulse and cause GI upset - check heart rate before dosing.
  • Amyloid antibodies need MRI monitoring for brain swelling and microbleeds (ARIA).
  • Muscle relaxants sedate - no driving or alcohol; never stop baclofen abruptly.
  • VMAT2 drugs for chorea can worsen depression; dantrolene is also the malignant hyperthermia antidote.

Endocrine & Metabolic 104

Insulins & injectable diabetes drugs13

Insulin replaces the hormone that drives glucose into cells; the GLP-1 agonists mimic gut incretins so insulin rises only when glucose does. Glucagon does the reverse for severe lows.

  • Insulin is high-alert: independent double-check, units never abbreviated, know onset and peak.
  • Treat hypoglycemia with 15 g fast carbs and recheck in 15 minutes; only regular insulin goes IV.
  • GLP-1 agonists cause nausea and early fullness; boxed warning for thyroid C-cell tumours.
  • Report severe abdominal pain radiating to the back (pancreatitis); rotate injection sites.
SGLT2 inhibitors7

Make the kidney dump glucose into the urine, lowering A1C while also protecting the heart and kidneys. Now used in heart failure and CKD even without diabetes.

  • Glucosuria means genital yeast and urinary tract infections - teach hygiene and reporting.
  • Volume depletion and orthostatic hypotension, especially with a diuretic - watch blood pressure.
  • Euglycemic DKA can occur with normal glucose - report nausea, vomiting and rapid breathing.
  • Hold before surgery or during acute illness as ordered.
Metformin, sulfonylureas & other oral diabetes drugs15

The oral toolkit for type 2 diabetes: metformin lowers hepatic glucose output, sulfonylureas and glinides squeeze out insulin, glitazones improve sensitivity, DPP-4 inhibitors protect incretins.

  • Metformin: hold before and 48 hours after IV contrast; stop for hypoxia, sepsis or renal decline (lactic acidosis).
  • Sulfonylureas cause real hypoglycemia - time with meals and teach carrying fast sugar.
  • Take metformin with food; monitor B12 on long-term therapy.
  • Glitazones cause fluid retention and can worsen heart failure - watch weight and edema.
Thyroid & antithyroid drugs6

Replace thyroid hormone in hypothyroidism or shut down over-production in hyperthyroidism. Dosing is titrated to TSH, and small changes matter.

  • Levothyroxine: same time every morning, empty stomach, separate from calcium, iron and antacids by 4 hours.
  • Too much shows up as tachycardia, weight loss, heat intolerance and insomnia - report it.
  • Antithyroid drugs can cause agranulocytosis - report sore throat and fever; watch LFTs.
  • Monitor TSH about 6-8 weeks after any dose change; therapy is usually lifelong.
Systemic corticosteroids7

Broad anti-inflammatory and immunosuppressive hormones used for everything from asthma flares to autoimmune disease and adrenal insufficiency. The side effects come from the same power.

  • Never stop abruptly after more than about 2 weeks - taper to avoid adrenal crisis.
  • Expect hyperglycemia, hypertension, fluid retention, mood swings and insomnia; give in the morning with food.
  • Long term brings osteoporosis, cataracts, thin skin and infection risk - masks fever and other signs of infection.
  • Monitor glucose, potassium, weight and blood pressure.
Sex hormones, contraceptives & obstetric agents17

Estrogens, progestins and androgens for contraception, menopause, hypogonadism and fertility, plus the uterine drugs used to induce labour and stop postpartum bleeding.

  • Estrogen raises clot risk - not with smoking over 35; teach the ACHES warning signs.
  • Oxytocin is high-alert - continuous fetal monitoring, stop for tachysystole or a nonreassuring pattern.
  • Check blood pressure before methylergonovine; it is contraindicated in hypertension and preeclampsia.
  • Report calf pain, chest pain, sudden headache or vision change immediately.
Bone & calcium regulators14

Slow bone breakdown or push new bone formation to treat osteoporosis, plus the vitamin D and calcium agents that keep serum calcium in range. Bisphosphonates are the core class.

  • Oral bisphosphonates: first thing in the morning, full glass of plain water, stay upright 30-60 minutes, nothing else by mouth (esophagitis).
  • Correct calcium and vitamin D before starting - hypocalcemia is a real risk, especially with denosumab.
  • Rare but classic: osteonecrosis of the jaw and atypical femur fracture - dental check before therapy.
Gout & uric acid drugs7

Lower uric acid production, boost its excretion, or damp the inflammatory attack itself. Urate-lowering drugs prevent attacks; colchicine and NSAIDs treat the flare.

  • Starting a urate-lowering drug can trigger a flare - expect prophylaxis for the first months, and do not stop during an attack.
  • Push fluids to 2-3 L a day unless contraindicated; avoid alcohol, organ meats and shellfish.
  • Allopurinol rash can progress to a severe hypersensitivity syndrome - stop and report; colchicine causes diarrhea first.
Pituitary hormones, weight & metabolic agents18

Replacements and blockers for pituitary hormones (ADH, growth hormone, somatostatin, GnRH) plus obesity drugs and the targeted therapies for rare inherited metabolic disease.

  • Desmopressin causes water intoxication - monitor sodium, daily weight and fluid intake.
  • Vaptans raise sodium fast; correct slowly to avoid osmotic demyelination.
  • Orlistat causes oily stools - supplement fat-soluble vitamins.
  • Enzyme replacement infusions can cause anaphylaxis - premedicate and monitor throughout.

Gastrointestinal 50

PPIs, H2 blockers & antacids10

Reduce or neutralise stomach acid for GERD, ulcers and stress-ulcer prevention. PPIs shut the proton pump down, H2 blockers block histamine, antacids neutralise what is already there.

  • PPIs work best 30-60 minutes before the first meal; do not crush delayed-release forms.
  • Long-term PPI use is linked to C. difficile, pneumonia, low magnesium and B12, and fractures.
  • Separate antacids from other oral drugs by 1-2 hours; aluminum constipates, magnesium loosens.
  • Sucralfate needs an empty stomach; misoprostol is contraindicated in pregnancy.
Antiemetics14

Block the receptors that trigger vomiting - serotonin, dopamine, histamine, substance P or muscarinic - depending on the cause. Chemo, post-op, motion and pregnancy nausea each favour a different one.

  • Give before the trigger (chemo, surgery, travel), not after vomiting starts.
  • Ondansetron prolongs the QT interval; check ECG and electrolytes with other QT drugs.
  • Metoclopramide and phenothiazines cause extrapyramidal reactions and tardive dyskinesia - limit duration.
  • Sedation and dry mouth with the antihistamine and anticholinergic ones - fall precautions.
Laxatives, antidiarrheals & IBD drugs26

Drugs that move the bowel along, slow it down, or calm the inflammation in ulcerative colitis and Crohn disease. Which one is right depends entirely on the underlying problem.

  • Never give a laxative with abdominal pain, rigidity or suspected obstruction; fluid and fibre come first.
  • Hold antidiarrheals for fever, bloody stool or possible C. difficile - do not trap the organism.
  • Lactulose is titrated to 2-3 soft stools a day in hepatic encephalopathy; track ammonia and mental status.
  • Sulfasalazine is a sulfa drug - push fluids, add folic acid, expect orange-yellow urine.

Genitourinary & Renal 27

BPH, erectile & sexual function drugs11

Relax the prostate and bladder neck or shrink the prostate to fix obstructive urinary symptoms; the PDE5 inhibitors also treat erectile dysfunction.

  • Alpha blockers cause first-dose orthostatic hypotension and dizziness - take at bedtime, rise slowly.
  • PDE5 inhibitors plus any nitrate equals life-threatening hypotension - absolute contraindication.
  • 5-alpha reductase inhibitors take months to work, lower PSA, and are absorbed through skin - pregnant women must not handle broken tablets.
Overactive bladder & urinary agents8

Calm an overactive detrusor muscle (antimuscarinics, beta-3 agonists) or help a sluggish bladder empty. Used for urgency, frequency and incontinence.

  • Anticholinergic effects: dry mouth, constipation, blurred vision, confusion in older adults, urinary retention.
  • Contraindicated in narrow-angle glaucoma and in true urinary obstruction.
  • Phenazopyridine turns urine orange and stains contacts and clothing; it numbs, it does not treat infection.
Electrolytes, phosphate & potassium binders8

Replace electrolytes that are too low or bind the ones the failing kidney cannot clear. Core drugs in chronic kidney disease and dialysis care.

  • IV potassium is never pushed - always diluted, on a pump, with cardiac monitoring; check the site for burning.
  • Phosphate binders must be taken with meals to work; potassium binders bind other drugs, so separate doses.
  • Recheck the level after treating - both over- and under-correction cause arrhythmias.

Blood & Hematology 53

Anticoagulants11

Interrupt the clotting cascade to prevent new clots from forming or growing - in atrial fibrillation, DVT, PE and after orthopedic surgery. High-alert: the risk is bleeding.

  • Warfarin: INR is the monitor, vitamin K is the antidote, keep leafy greens consistent, huge interaction list.
  • Heparin: aPTT or anti-Xa, watch platelets for HIT, protamine reverses it.
  • DOACs need no routine levels but do need renal dosing; andexanet or idarucizumab reverses them.
  • Teach bleeding precautions: soft toothbrush, electric razor, report black stools, bruising or a fall with head strike.
Antiplatelet drugs11

Stop platelets from clumping onto arterial plaque - the arterial side of clot prevention. Standard after stents, MI and stroke.

  • Bleeding and bruising are the expected risk; hold before surgery per the ordered interval.
  • Do not stop dual therapy after a stent without cardiology approval - stent thrombosis is often fatal.
  • Clopidogrel needs CYP2C19 activation - omeprazole blunts it; check for GI protection alternatives.
Thrombolytics3

Dissolve a clot that has already formed by converting plasminogen to plasmin. Used in acute ischemic stroke, STEMI and massive PE, inside a tight time window.

  • Screen hard for contraindications: recent surgery, head trauma, bleeding, uncontrolled hypertension.
  • Neuro checks and vital signs frequently; any sudden headache or change in mental status means stop and scan.
  • No arterial punctures, IM injections or unnecessary sticks during and after infusion.
Blood cell growth factors, iron & blood products28

Push the marrow to make red cells, white cells or platelets, replace the iron needed for hemoglobin, or replace missing clotting factors and plasma volume outright.

  • ESAs raise clot and stroke risk if hemoglobin is pushed too high - target the ordered range and check iron.
  • Filgrastim causes deep bone pain - treat with acetaminophen and monitor ANC.
  • Oral iron on an empty stomach with vitamin C; expect dark stools, use a straw with liquids, keep away from children.
  • Factor products are dosed by unit and weight - verify product and dose; albumin can overload volume.

Anti-infectives 148

HIV antiretrovirals30

Attack HIV at different points of its life cycle - reverse transcriptase, protease, integrase or cell entry. Always combined, and most modern regimens are single-tablet combinations.

  • Adherence is everything - missed doses breed resistance; never give as monotherapy.
  • Check for drug interactions constantly; ritonavir and cobicistat are boosters that raise other drug levels.
  • Abacavir needs HLA-B*5701 screening - hypersensitivity reaction is fatal on rechallenge.
  • Monitor CD4 count, viral load, renal function, lipids and for lactic acidosis with the older NRTIs.
Beta-lactam antibiotics (penicillins, cephalosporins, carbapenems)19

Break down the bacterial cell wall so the organism bursts. Penicillins, cephalosporins by generation, and the broad-spectrum carbapenems and monobactams reserved for resistant organisms.

  • Ask about penicillin allergy every time - know the difference between a rash and anaphylaxis.
  • Stay with her for the first 30 minutes after a parenteral dose and keep epinephrine nearby.
  • Ceftriaxone must not run with calcium-containing solutions in neonates; imipenem lowers the seizure threshold.
  • Finish the course; report diarrhea with fever and cramping (C. difficile).
Macrolides & tetracyclines10

Protein-synthesis blockers used for atypical pneumonia, chlamydia, tick-borne illness and acne, and as the go-to when penicillin is not an option. Bacteriostatic rather than bactericidal.

  • Macrolides prolong the QT interval and inhibit CYP enzymes - check the med list, potassium and magnesium.
  • Tetracyclines are not for pregnancy or children under 8 (tooth staining).
  • Both chelate: separate from antacids, calcium, iron and dairy by about 2 hours.
  • Strong photosensitivity with tetracyclines - sunscreen and covered skin; take sitting up with water.
Fluoroquinolones5

Block bacterial DNA gyrase, giving broad coverage with excellent oral absorption. Reserved now because of serious musculoskeletal and nerve toxicity.

  • Tendon rupture and tendinitis - stop at the first tendon pain, higher risk over 60 and on steroids.
  • Separate from antacids, calcium, iron and dairy by at least 2 hours - they chelate the drug.
  • Watch QT prolongation, photosensitivity, peripheral neuropathy and confusion in older adults.
Aminoglycosides5

Powerful bactericidal drugs for serious gram-negative infection, given IV because they are not absorbed orally. Narrow therapeutic window with two signature toxicities.

  • Nephrotoxic and ototoxic - monitor creatinine, urine output, hearing and balance.
  • Draw peaks and troughs at the right times; the trough is what predicts toxicity.
  • Avoid stacking with loop diuretics, vancomycin or contrast dye when possible.
Vancomycin & other antibacterials18

The MRSA drugs (vancomycin and relatives) plus the remaining antibiotic families - sulfonamides, nitroimidazoles, oxazolidinones, lincosamides and urinary agents.

  • Infuse vancomycin over at least 60 minutes and monitor trough or AUC levels plus creatinine.
  • Metronidazole plus alcohol causes a disulfiram reaction - none during and for 3 days after.
  • Sulfamethoxazole-trimethoprim: push fluids, watch potassium, stop for rash (Stevens-Johnson risk).
  • Clindamycin is the classic C. difficile offender; linezolid can cause serotonin syndrome and low platelets.
TB & mycobacterial drugs8

Long multi-drug regimens (RIPE) needed to kill slow-growing mycobacteria and prevent resistance. Months of therapy, so adherence support is part of the care plan.

  • Rifampin turns urine, sweat and tears orange and ruins soft contact lenses and oral contraceptives.
  • Isoniazid causes hepatitis and peripheral neuropathy - give pyridoxine, monitor LFTs, no alcohol.
  • Ethambutol causes optic neuritis - baseline and periodic vision and colour testing.
  • Directly observed therapy is standard; never treat active TB with a single drug.
Antifungals19

Attack the fungal cell membrane (azoles, polyenes) or cell wall (echinocandins) for everything from thrush to invasive aspergillosis. Topical forms treat skin and vaginal infection.

  • Azoles are major CYP inhibitors and are hepatotoxic - check LFTs and the interaction list.
  • IV amphotericin B causes fever, chills, rigors and nephrotoxicity - premedicate, hydrate, monitor potassium and magnesium.
  • Topical courses run longer than symptoms; teach her to finish them.
Antivirals (herpes, flu, COVID, hepatitis)24

Block viral replication in herpes and shingles, influenza, COVID, CMV and hepatitis B and C. The hepatitis C direct-acting antivirals actually cure; the rest shorten or suppress illness.

  • Start influenza and COVID antivirals within about 48 hours of symptoms or the benefit fades.
  • Push fluids with IV acyclovir (crystal nephropathy); ganciclovir suppresses bone marrow - check CBC.
  • Screen for hepatitis B before hepatitis C therapy - reactivation can be fulminant.
  • Ribavirin is teratogenic and causes hemolytic anemia; adherence is required for HCV cure.
Antimalarials & antiparasitics10

Kill protozoa and worms - malaria prophylaxis and treatment, giardia, toxoplasmosis, helminths. Hydroxychloroquine doubles as a mild DMARD in lupus and RA.

  • Chloroquine-type drugs cause retinal damage - annual eye exams on long-term use.
  • Take malaria prophylaxis before, during and for the full period after travel.
  • Check G6PD status before primaquine or tafenoquine - hemolysis risk.

Pain & Anesthesia 34

Opioid analgesics17

Bind mu receptors in the CNS to blunt moderate to severe pain. High-alert drugs: the same receptor that stops pain also stops breathing.

  • Respiratory rate and sedation score before and after every dose - hold for RR under 12 or rising sedation.
  • Naloxone is the reversal; keep it available and know that it wears off before the opioid does.
  • Constipation never improves with tolerance - start a bowel regimen with the first dose.
  • Reassess pain 30-60 minutes after dosing and document; no crushing extended-release forms.
NSAIDs & non-opioid analgesics12

Block prostaglandins to relieve pain, fever and inflammation without sedation or dependence. Acetaminophen sits here too - it treats pain and fever but not inflammation.

  • GI bleeding and ulcers: take with food, watch for black stools and epigastric pain.
  • NSAIDs blunt renal blood flow - avoid in dehydration, heart failure and CKD; monitor creatinine.
  • Acetaminophen ceiling is about 4 g a day (less if liver disease or alcohol use) - check combination products.
  • Aspirin in children with a viral illness risks Reye syndrome.
Anesthetics & neuromuscular blockers5

Induce and maintain unconsciousness, or paralyse skeletal muscle for intubation and surgery. Paralytics provide zero sedation or pain relief on their own.

  • Airway first - a paralysed patient must be ventilated; confirm sedation is running with any blocker.
  • Succinylcholine can trigger hyperkalemia and malignant hyperthermia; dantrolene must be available.
  • Monitor with train-of-four; sugammadex or neostigmine reverses non-depolarising agents.
  • Propofol supports bacterial growth - discard tubing and vials within the stated hours.

Oncology & Immune 166

Alkylating & platinum chemotherapy11

Classic cytotoxics that cross-link DNA so the cancer cell cannot divide. Cell-cycle nonspecific, so they hit fast-growing normal tissue too.

  • Nadir bone marrow suppression - monitor CBC, watch for fever with neutropenia (an emergency).
  • Cyclophosphamide and ifosfamide cause hemorrhagic cystitis - hydrate hard, give mesna, report pink urine.
  • Cisplatin is severely emetogenic, nephrotoxic and ototoxic - premedicate, hydrate, monitor creatinine, magnesium and hearing.
  • Handle as hazardous drugs: gloves, gown, closed system; many are vesicants.
Antimetabolite chemotherapy11

Fake building blocks that slot into DNA or RNA synthesis and stall the S phase. Methotrexate also serves as a low-dose DMARD in rheumatoid arthritis and psoriasis.

  • Mucositis and diarrhea are signature - inspect the mouth daily, use a soft brush and bland rinses.
  • Methotrexate: weekly not daily, give folic acid, leucovorin is the rescue, avoid NSAIDs and alcohol.
  • Monitor CBC, renal and liver function every cycle; teach infection and bleeding precautions.
Cytotoxic antibiotics & mitotic inhibitors16

Anthracyclines and related drugs that intercalate DNA, plus the vinca alkaloids and taxanes that freeze the mitotic spindle. Heavy-hitting chemo with organ-specific toxicities.

  • Anthracyclines are cardiotoxic and have a lifetime cumulative dose - baseline ejection fraction, watch for heart failure; red urine is expected.
  • Vesicants: check blood return often, stop for burning or swelling, and know the extravasation protocol.
  • Vincristine is fatal if given intrathecally - IV only, and it causes peripheral neuropathy and constipation.
  • Taxanes cause hypersensitivity reactions - premedicate with steroid and antihistamine, monitor the first minutes closely.
Kinase & targeted pathway inhibitors38

Oral targeted drugs that switch off the specific growth signal driving a tumour - BCR-ABL, EGFR, ALK, BTK, CDK4/6, mTOR, PI3K and the BRAF/MEK cascade. Daily pills rather than infusion cycles.

  • Interaction minefield - check CYP3A4 inhibitors and inducers, and no grapefruit.
  • Monitor LFTs, CBC and QT interval; neutropenia is dose-limiting for the CDK4/6 drugs.
  • Report new shortness of breath (pneumonitis), bleeding, swelling or severe diarrhea.
  • mTOR inhibitors cause mouth ulcers, high glucose and high lipids; adherence and food rules are drug-specific.
Cancer antibodies & immunotherapy22

Monoclonal antibodies that flag tumour antigens (HER2, CD20, EGFR, VEGF) and checkpoint inhibitors that release the brakes on T cells. Given IV in cycles.

  • Infusion reactions - fever, chills, rigors, hypotension - premedicate and monitor closely during the first infusions.
  • Checkpoint inhibitors cause autoimmune 'itis' anywhere: colitis, pneumonitis, hepatitis, thyroiditis - report new diarrhea, cough or fatigue.
  • Trastuzumab is cardiotoxic - baseline and periodic ejection fraction.
  • Rituximab needs hepatitis B screening; watch for tumour lysis syndrome early in therapy.
Hormonal cancer therapy14

Starve hormone-driven breast and prostate cancer by blocking estrogen or androgen, or by shutting off the pituitary signal that makes them. Taken for years, not cycles.

  • Aromatase inhibitors cause joint pain, hot flashes and bone loss - monitor bone density, add calcium and vitamin D.
  • Tamoxifen raises the risk of clots and endometrial cancer - report leg swelling or abnormal vaginal bleeding.
  • Androgen blockade causes hot flashes, fatigue, loss of muscle and mood change - it is not a failure of therapy.
Proteasome, PARP & other targeted cancer drugs13

The rest of the targeted arsenal: proteasome inhibitors, PARP inhibitors, HDAC blockers, immunomodulators and cell therapies. Each is tied to a specific tumour or mutation.

  • Bortezomib causes painful peripheral neuropathy - assess sensation each cycle.
  • PARP inhibitors and HDAC inhibitors suppress marrow - watch CBC, fatigue and bleeding.
  • Lenalidomide-type drugs are teratogenic and thrombogenic - REMS program plus clot prophylaxis.
Immunosuppressants & DMARDs23

Damp the immune system so it stops attacking a transplanted organ or the patient's own joints and skin. Includes calcineurin inhibitors, TNF blockers, other biologic DMARDs and the oral JAK inhibitors.

  • Screen for latent TB and hepatitis B before biologics; hold any of these for active infection.
  • Transplant drugs are dosed by trough level - draw right before the next dose, no brand switching, no grapefruit.
  • Monitor creatinine, glucose, blood pressure, CBC and lipids; no live vaccines.
  • JAK inhibitors carry boxed warnings for serious infection, clots and cardiac events - report shingles early.
Interleukin blockers, complement inhibitors & immune globulins18

Antibodies that shut down a single interleukin or the complement cascade for psoriasis, eczema and rare immune disease, plus the pooled immune globulins and interferons that supply or boost immunity.

  • Same infection rules as other biologics - screen first, hold for active infection, no live vaccines.
  • Complement blockers require meningococcal vaccination before the first dose (boxed warning).
  • Give immune globulin as soon as possible after exposure; Rho(D) within 72 hours.
  • Infuse slowly at first - headache, chills and flushing are common; interferons cause flu-like symptoms and depression.

Eye, Ear & Skin 52

Glaucoma eye drops10

Drops that lower pressure inside the eye, either by draining more fluid out or making less of it. Used long term to protect the optic nerve in glaucoma.

  • Teach punctal occlusion - press the inner corner 1 minute to limit systemic absorption.
  • Beta-blocker drops (timolol) can still drop heart rate and trigger bronchospasm - ask about asthma and COPD.
  • Prostaglandin drops darken the iris, lashes and lid skin; warn her it may be permanent.
  • Stress that glaucoma is silent - drops must continue even when the eye feels fine.
Eye drops: infection, inflammation & retina19

Everything else that goes in the eye - antibiotic and antiviral drops for infection, steroid and antihistamine drops for inflammation and allergy, and the VEGF blockers injected for wet macular degeneration.

  • Keep the dropper tip off the eye and lashes, and finish antibiotic courses even after redness clears.
  • Steroid drops raise eye pressure and slow corneal healing - never for an undiagnosed red eye.
  • After an intravitreal injection, report eye pain, floaters or vision loss right away.
  • Wait 5 minutes between different drops; no contact lenses during treatment.
Topical steroids & other skin agents23

Creams, gels and ointments for inflamed or infected skin - topical corticosteroids for eczema and psoriasis, retinoids for acne, and parasiticides for lice and scabies.

  • Steroid creams: thin layer, shortest time; long use thins skin and can suppress the adrenal axis.
  • Avoid steroids on the face and groin or under occlusion unless specifically ordered.
  • Isotretinoin is a powerful teratogen - two forms of contraception and monthly pregnancy tests.
  • Retinoids dry and photosensitise the skin; for lice and scabies treat contacts and wash bedding.

Antidotes, Vitamins & Other 21

Antidotes, chelators & vitamins21

Reverse a specific drug or toxin - opioids, benzodiazepines, heparin, digoxin, acetaminophen, heavy metals - plus the vitamins and minerals used for deficiency and as rescue agents.

  • Learn the pairs: naloxone-opioid, flumazenil-benzodiazepine, protamine-heparin, vitamin K-warfarin, acetylcysteine-acetaminophen.
  • Naloxone wears off faster than the opioid - keep monitoring and be ready to redose.
  • Chelators strip minerals as well as toxins - monitor renal function and electrolytes.
  • Fat-soluble vitamins (A, D, E, K) accumulate and can reach toxic levels; folic acid prevents neural tube defects.
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Drug Guide · study summary only, no dosing · always check the current package insert, your course materials and facility policy.