SWORBHP MEDList

We will be publishing updates frequently which will list common medications for certain conditions. For more information about each medication, click on the generic/chemical name.

Please remember that this is not an exhaustive list of all medications within these classes of medications, rather the most common that you will encounter.
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February 2017: Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are a class of medications that are effective in treating depression and sometimes used to treat other conditions, such as anxiety disorders and long-term (chronic) pain; especially nerve pain.


SNRIs work to ease depression by impacting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, SNRIs work by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood to help relieve depression.


SNRIs block the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain.

Brand Name

Generic/Chemical Name

Cymbalta Duloxetine
Fetzima Levomilnacipran
Effexor Venlafaxine
Prestiq Desvenlafaxine

 

October 2016: Adrenal Corticosteroids

When adrenal glands are functioning properly they synthesize and excrete various corticosteroids. These corticosteroids have several functions, including: promoting normal metabolism; increasing resistance to stress by raising plasma glucose levels to increase energy; altering blood cell levels in plasma (move lymphocytes to lymph tissue and increase hemoglobin, erythrocytes and platelets); reduce inflammatory response and suppress immunity and; help in controlling water volume and electrolyte balance.

Semisynthetic derivatives of glucocorticoids vary in their anti-inflammatory potency, the degree to which they cause sodium retention and their duration of action.

They are prescribed for various reasons including:

  • Replacement therapy for primary adrenocortical insufficiency (Addison’s disease)
  • Secondary or tertiary adrenocortical insufficiency
  • Replacement therapy for congenital adrenal hyperplasia (CAH)
  • Relief of inflammatory symptoms (such as found in arthritis, Crohn’s, lupus, asthma, psoriasis)
  • Treatment of allergies

 

Brand Name

Generic/Chemical Name

Class

Cortef, Solu-cortef, Hydrocortone

Hydrocortisone

Short acting glucocorticoid

(8-12 hrs)

Cortef

Cortisone

Short acting glucocorticoid

(8-12 hrs)

Prednisone Intensol, Rayos

Prednisone

Intermediate-acting glucocorticoid (18-36 hrs)

PMS-prednisolone

Prednisolone

Intermediate-acting glucocorticoid (18-36 hrs)

Medrol, Solu-medrol

Methylprednisolone

Intermediate-acting glucocorticoid (18-36 hrs)

Betacort, Betnovate, Celestoderm, Ectosone, Metaderm

Betamethasone

Long-acting glucocorticoid

(1-3 days)

Decadron

Dexamethasone

Long-acting glucocorticoid

(1-3 days)

Reference:

Mycek, M.J., Harvey, R.A., Champe, P.C. (1997).  Pharmacology 2nd Ed. (ed. Harvey & Champe).  Lippincott-Raven: Philadelphia.

Mayo Clinic website (2016). Mayo Foundation for Medical Education and Research. Retrieved from www.mayoclinic.org


May 2016: Antihypertensives

Lifestyle modification is the first recommendation for managing hypertension.  Medications are prescribed with consideration given to causes, contraindications and comorbidities and may include:

Diuretics:

Cause a loss of excess salt and water from the body by the kidneys with resulting drop in preload, stroke volume, and eventually peripheral vascular resistance.

Beta Blockers:

Decrease cardiac output and inhibit renin-angiotension-aldosterone system that raises blood pressure through sodium and water retention.

Angiotensin Receptor Blockers (ARB):

Blocks renin-angiotensin-aldosterone (as above).

Calcium Channel Blockers (CCB):

Reduce peripheral vascular resistance by inhibiting the contractility of vascular smooth muscle.

(Sanders, p.365-8)

The specific medication prescribed varies depending on underlying comorbiditiies:

  • Heart Failure: diurteic, beta-blocker, ACE inhibitor, ARB, aldosteron antagonist
  • Post-Myocardial Infarction: beta-blocker, ACE inhibitor, aldosterone antagonist
  • Coronary Artery Disease risk: diuretic, beta-blocker, ACE inhibitor, CCB
  • Diabetes: diurtetic, beta-blocker, ACE inhibitor, ARB, CCB
  • Chronic Kidney Disease: ACE inhibitor, ARB
  • Recurrent Stroke Prevention: diuretic, ACE inhibitor

Brand Name

Generic/Chemical Name

Class

Microzide

Hydrochlorothiazide

Thiazide diuretic

Furosemide

Lasix

Loop diuretic

Captopril

Captoril

ACE inhibitor

Ramipril

Altace

ACE inhibitor

Enalopril

Vasotec

ACE inhibitor

Lisinopril

Prinivil, Zestril

ACE inhibitor

Quinapril

Accupril

ACE inhibitor
Loasartan Cozaar Angiotensin receteptor blocker
Valsartan Diovan Angiotensin receteptor blocker
Tenormin Atenolol Beta-blocker, beta-1 selective
Lopressor Metoprolal Beta-blocker, beta-1 selective
Inderal Propranolol Anti-dysrhythmic, beta-blocker, antianginal, anti-migraine
Monocor Bispoprolal Beta-blocker, beta-1 selective
Trandate Labetolal Beta-blocker, alpha-activity
Sectrol Acebutolol Anti-dysrhythmic, beta-blocker, intrinsic sympathomimetic
Hydralazine Hydralazine Vasodilator
Procardia Adalat Nifedipine Calcium channel blocker
Norvasc Amlodipine Calcium channel blocker, antianginal
Cardizem Diltiazem Anti-dysrhythmic, Calcium channel blocker
Isoptin, Covera HS Verapamil Anti-dysrhythmic, Calcium channel blocker
Aldactone Spironolactone Aldosterone antogonist, potassium sparing diuretic
Minipress Prazosin Alpha-blocker, antihypertensive
Cardura Doxasoxin Alpha-blocker
Multiple Examples Combined Preparations Antihypertensive combinations

Reference:

Madhur, M.S. (2014).  Hypertension.  Retrieved from http://emedicine.medscape.com/article/241381-overview

Sanders, M. (2007).  Mosby’s Paramedic Textbook Revised Third Edition.  Missouri: Elselvier.

March 2016: Anti-Anxiety

Anxiety may influence a person’s life in various and sometimes coexisting forms such as phobia, social anxiety disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).  Individuals living with anxiety may have concurrent challenges with addiction, stigmatization and marginalization which can further undermine effective self-advocacy. 

Approaches to managing anxiety may include short term strategies like using benzodiazepines for immediate crisis management and longer term strategies like prescription of selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy. 

Benzodiazepines (examples below) lower neural excitability in the CNS causing anxiolysis, sedation/hypnosis, anticonvulsant effects and muscle relaxation (Mycek, 1997).  They can provide a short-term fix for anxiety however they bring risks of addiction, altered affect and respiratory depression.    Because benzodiazepines may be prescribed for use during crises there is an inherent risk (carefully weighed by prescriber) of intentional or accidental overdose.   Sedation and respiratory depression are the key components of a benzo overdose.

SSRIs (examples below) inhibit serotonin reuptake which allows an accumulation of and functional increase in the amount of serotonin at the presynaptic nerve terminals in the brain (Mycek, 1997).  SSRIs generally take 4-6 weeks of daily use to reveal their intended effects, and may be prescribed for anxiety, depression or both, or for other conditions.  SSRIs have a wide therapeutic window but overdose can have a lethal outcome either through serotonin syndrome, serotonin toxicity or due to co-ingestion of other agents.  Signs and symptoms of an SSRI overdose are confusion, agitation, ataxia, fever, tremor, muscle rigidity and vitals may reveal hypertension, hyperthermia, tachycardia +/- wide QT, diaphoresis and pupil dilation.  Care is supportive with an emphasis on consideration of co-ingestions, and the concurrent management/reversal of those effects prn (Cushing, 2015).

Brand Name

Generic/Chemical Name

Class

Prozac

Fluoxetine

SSRI: Anti-Anxiety, Anti-Depressant

Paxil

Paraxetine

SSRI

Celexa

Citalopram

SSRI

Laxapro

Escitalopram

SSRI

Zoloft

Sertaline

SSRI

Remeron

Mirztazapine

SSRI Alpha-2 Antagonist

Ativan

Lorazepam

Benzodiazepine

Valium Diazepam Benzodiazepine

Reference:

Cushing, T. (2015). Selective Serotonin Reuptake Inhibitor Toxicity Clinical Presentation.  Medscape.  Retrieved from http://emedicine.medscape.com/article/821737-overview

Gresham, C. (2015).  Benzodiazepine Toxicity Treatment & Management. Medscape. Retrieved from http://emedicine.medscape.com/article/813255-treatment

Mycek, M.J., Harvey, R.A., Champe, P.C. (1997).  Lippincott’s Illustrated Reviews: Pharmacology, 2nd ed. Lippincott-Raven: Philadelphia.Yates, W.R. et al (2015) Anxiety Disorders Treatment & Management. Retrieved from http://emedicine.medscape.com/article/286227-treatment#d8

 

January 2016: Statins

Statins are medications used to lower low density lipoprotein (LDL) cholesterol (the bad cholesterol), and have modest triglyceride-lowering and high density lipoprotein (HDL) cholesterol raising effects at higher doses. Here are the most common statins you’ll see in the prehospital setting.

Brand Name

Generic/Chemical Name

Lipitor

Atorvastatin
Lescol Fluvastatin

Mevacor

Lovastatin

Pravachol
Pravastatin
Crestor
Rosuvastatin
Zocor Simvastatin

 

November 2015: Your Autoimmune Disease Patient

Often when we respond to sick patients, we're provided with a 'bag of meds'. Here is what you might find in that bag if your patient suffers from an autoimmune condition such as Chrohn's Disease, Rheumatoid Arthritis, etc.

Brand Name

Generic/Chemical Name

Class

Prednisone

Prednisone

Immunosuppressant Steroid/

Anti-Inflammatory

Medrol

Methylprednisolone

Immunosuppressant Steroid/

Anti-Inflammatory

Methotrexate

Methotrexate

Immunosuppressant Steroid/ Antirheumatic Agent

Imuran

Azathioprine

Immunosuppressant

Cytoxan

Cyclophosphamide

Immunosuppressant/ Antineoplastic

5-ASA/Pentasa

Mesalamine

Anti-Inflammatory

Azulfidine

Sulfasalizine

Anti-Inflammatory

Enbrel Etanercept Immunomodulator

Remicade

Infliximab

Immunomodulator

Rituxan

Rituximab

Immunosuppressant/ Antineoplastic

 

September 2015: Your Diabetic Patient

With diabetic patients making up a significant number of your sick patient calls, do you ever wonder what the difference is between the myriad of Insulin types they are using? Here is a list of the most common types of insulin and their specifics.

Insulin Type - Rapid Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Humalog (Lispro)
10-15 min. 1-2 hr.
3.5-4.75 hr.
Within 15 min. before or immediately after meals
NovoRapid (Aspart) 10-15 min. 1-1.5 hr. 3-5 hr. Within 5-10 min. before or immediately after meals
Apidra (Glulisine) 10-15 min. 1-1.5 hr. 3-5 hr. Within 15 min. before or within 20 min. after meals

Insulin Type - Short Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Humulin R
30 min. 2-3 hr. 6.5 hr. 30-45 min. before meals
Novolin ge Toronto 30 min. 2-3 hr. 6.5 hr. 30-45 min. before meals

Insulin Type - Intermediate Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Humulin N
1-3 hr. 5-8 hr. Up to 18 hr.

When mixed with a rapid acting insulin: 15 min. before meals

When mixed with a short acting insulin: 30 min. before meals

Novolin ge NPH 1-3 hr. 5-8 hr. Up to 18 hr.

When mixed with a rapid acting insulin: 15 min. before meals


When mixed with a short acting insulin: 30 min. before meals

Insulin Type - Long Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Lantus (Glargine)
90 min. N/A Up to 24 hr. Usually once daily at the same time every day (sometimes twice daily)
Levemir (Detemir) 90 min. N/A 16-247 hr. Usually once daily at the same time every day (sometimes twice daily)

Insulin Mixtures - Rapid Acting/Intermediate Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Humalog Mix 25
Faster than Humulin 30/70 0.75-2.5 hr.

Effective: 10-14 hr.
Max: Up to 18-24 h

Usually within 15 min. meals
Novomix 30
10-20 min. 1-4 hr. Up to 24 hr. Usually 5-10 min. before meals

Insulin Mixtures - Short Acting/Intermediate Acting

Brand Name Onset of Action

Peak Response

Duration of Action Self Administration
Humulin 30/70
30-60 min. 2-4 hr. Effective: 10-14 hr.
Max: Up to 18-24 hr.
Usually ~30 min. before meals
Novolin ge 30/70
Novolin ge 40/60
Novolin ge 50/50
30 min. 2-8 hr. Max: Up to 24 hr. Usually ~30 min. before meals

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July 2015: Your Arrhythmia Patient

Have you responded to a call recently for a patient with a pre-existing cardiac arrhythmia? You may have found that he/she was taking a number of medications. Below is a list of the common medications you might find that your arrhythmia patient taking.

Anticoagulant/Antiplatelet

Brand Name

Generic/Chemical Name

Coumadin

Warfarin
ASA/Aspirin Acetylsalicylic Acid

Xarelto

Rivaroxaban

Eliquix
Apixaban
Pradaxa
Dabigatran

Antidysrhythmic

Brand Name

Generic/Chemical Name

Lanoxin

Digoxin

Tambocor Flecainide
Rythmol Propafenone
Cordarone Amiodarone
Procan Procainamide

Beta Blockers (The LOLs)

Brand Name

Generic/Chemical Name

Betapace

Sotalol

Sectral Acebutolol
Tenormin Atenolol
Zebeta Bisoprolol
Lopressor Metoprolol
Corgard Nadolol
Inderal Propranolol

Calcium Channel Blockers

Brand Name

Generic/Chemical Name

Cardizem

Diltiazem

Isoptin Verapamil

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March 2015: Your Asthma/COPD Patient

Often when we respond to sick patients, we are provided with a "bag of meds". Here is what you might find in that bag if your patient suffers from Asthma or COPD.

Brand Name

Generic/Chemical Name

Class

Ventolin

Salbutamol

Short acting beta agonist

Oxeze

Formoterol

Long acting beta agonist

Serevent

Salmeterol

Long acting beta agonist

Flovent

Fluticasone

Inhaled steroid

Qvar

Beclomethasone

Inhaled steroid

Advair

Salmeterol/Fluticasone

Combination: Inhaled steroid and long acting beta agonist

Symbicort

Budesonide/Formoterol

Combination: Inhaled steroid and long acting beta agonist

Atrovent

Ipratropium

Short acting anticholinergic bronchodilator

Spiriva

Tiotripium

Long acting anticholinergic bronchodilator

Prednisone

Prednisone

Corticosteroid used for acute asthma exacerbations (course of 5 days)

Common Respiratory Antibiotics used for COPD Exacerbations

Brand Name

Generic/Chemical Name

Class

Levaquin

Levofloxacin

Fluroquinolone

Avelox

Moxifloxacin

Fluroquinolone

Clavulin

Amoxicillin/Clavulanate

Penicillin

Zithromax

Azithromycin

Macrolide

Biaxin

Clarithromycin

Macrolide

Ceftin

Cefuroxime

Cephalosporin

Amoxil

Amoxicillin

Penicillin

Vibramycin

Doxycycline

Tetracycline

Septra

Trimethoprim/Sulfamethoxazole

Sulfonamide

 

January 2015: Transdermal Patches

Transdermal patches are used to deliver medication via absorption through the skin into the bloodstream. If you come across a patient who has a patch applied that might be the cause of their current presentation, you might want to consider removing the patch. For example, a patient who has a Nitro patch applied and is hypotensive; this patch should be removed. Or how about a suspected overdose patient with a Fentanyl patch on (or perhaps even several patches)? This should also be removed. It is also advisable to remove any transdermal patches from VSAs as part of your differential diagnosis. It is entirely possible that the patch has contributed to the patient’s cardiac arrest.

Brand Name

Generic/Chemical Name

Use
Estradot Estradiol Patch
Estrogen Replacement Therapy
Ortho Evra Norelgestromin / Ethinyl Estradiol Transdermal System Contraception
Androderm Testosterone Transdermal Testosterone Replacement Therapy
Nitro-Dur / Minitran Nitroglycerine Angina
Nicoderm, Habitrol Nicotine Patch Smoking Cessation
Duragesic Fentanyl Analgesia
BuTrans Buprenorphine Analgesia
Exelon Rivastigmine Dementia / Alzheimer’s Disease

Transderm Scop

Scopolamine Motion Sickness

 

November 2014: Antihistamines

As you know, histamine is released in response to the presence of an allergen. Reactions can be mild, moderate or severe, with severe cases resulting in anaphylaxis. Antihistamines are used to block histamine receptors and help relieve the symptoms associated with the mild or moderate reaction.


First generation antihistamines like Diphenhydramine tend to cause more side effects than others, however the list of potential side effects includes, but is not limited to drowsiness, dry mouth, dizziness, nausea, vomiting, restlessness, blurred vision and confusion.

Remember, if you’ve administered Diphenhydramine to a patient for a mild or moderate allergic reaction, do not administer Dimenhydrinate for nausea or vomiting in addition. Administering these medications together could potentially result in an anticholinergic excess causing dry mouth, mild hyperthermia, tachycardia, dilated pupils and CNS changes like confusion, sedation, paradoxical excitation, or even seizure (AskMAC, Nov 22, 2013).

Brand Name

Generic/Chemical Name

Atarax

Hydroxyzine

Allegra

Fexofenadine

Benadryl

Diphenhydramine

Dimetane

Brompheniramine

Clariten, Alavert

Loratidine

Nighttime Cold/Flu

Chlorpheniramine

Aerius

Desloratadine

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September 2014: Puffers

Puffers, or inhalers, represent a route of administration rather than a class of medication in itself.  Several classes of medications may be delivered in this manner and include bronchodilators (short and long-acting β2 adrenergic agonists and anticholinergics), corticosteroids, and newer products that combine the two.  These medications are used to treat a variety of respiratory illnesses, predominantly asthma and COPD.

Bronchodilators

Brand Name Generic/Chemical Name
Oxeze
Formoterol
Onbrez Indacaterol
Atrovent Ipratropium
Salvent, Ventolin, Albuterol Salbutamol
Serevent Salmeterol
Bricanyl Terbutaline
Spiriva Tiotropium

Steroids

Brand Name Generic/Chemical Name
QVAR
Beclomethasone
Pulmicort, Rhinocort Budesonide
Alvesco Ciclesonide
Flovent Fluticasone
Asmanex Mometasone

Combination Inhalers

Brand Name Generic/Chemical Name
Duovent
Fenoterol/Ipratropium
Advair Fluticasone/Salmeterol
Combivent Salbutamol/Ipratropium

 

April 2014: Opioids

Opioids are an ancient group of medications that includes natural extracts from the opium poppy, as well as newer semi-synthetic and synthetic derivatives.  While most commonly used in the treatment of acute and chronic pain, opioids may also be used to treat diarrhea and cough.  The opioid ingestion toxidrome consists of pinpoint pupils, respiratory depression, and coma.  The opioid withdrawal syndrome may last more than one week and consists of severe drug craving, anxiety, perspiration, rhinorrhea, anorexia, muscle cramping, nausea, and vomiting.

Brand Name Generic/Chemical Name

Suboxone, Butrans

Buprenorphine
222s, Tylenol #1/#2/#3 Tylenol with Codeine
Abstral, Duragesic Fentanyl
Hycodan, Tussionex Novahistine Hydrocodone
Dilaudid, Hydromorph contin              Hydromorphone
Metadol, Methadose Methadone
Kadian, MS Contin, M-eslon Morphine
OxyNeo, Percocet, Oxycocet, Oxycontin, Endocet Oxycodone
Nucynta Tapentadol
Raliva, Tramacet, Tridural, Zytram, Ultram, Durela Tramadol


February 2014: Anticoagulants

Anticoagulants are used primarily in patients with a moderate to high stroke risk, atrial fibrillation, myocardial infarctions, deep vein thrombosis, pulmonary embolism, and mechanical heart valves. They act by targeting clotting factors to increase the amount of time it takes to form blood clots. Bleeding is a common side effect, which can result in mild bruising or epistaxis, but 1-2% will be have more serious bleeding complications (i.e. hemorrhagic stroke, increased risk of intracranial bleeds from trauma, GI bleeds, spontaneous retroperitoneal bleeds etc).

Anticoagulant therapy is a contraindication for the administration of Ketorolac (Toradol) in the Moderate to Severe Pain Medical Directive.

Vitamin K Antagonist

Inhibits clotting factors that depend on Vitamin K for synthesis (Factors II, VII,IX,X).  Require monitoring of INR to ensure therapeutic range.

Brand Name Generic/Chemical Name

Coumadin

Warfarin

Unfractionated Heparins
Not available in oral forms and requires IV or subcutaneous injection for delivery. Binds to antithrombin III and activates this factor. Antithrombin III inactivates multiple coagulation factors, thus preventing the formation of blood clots.

Brand Name Generic/Chemical Name

Heparin

Heparin

Low Molecular Weight Heparin
As the name implies, these are heparins that are made up of molecules with lower weight than that of unfractionated heparins. These medications bind to Antithrombin, leading to an inhibition of thrombin and factor Xa in the coagulation cascade. These medications are given through subcutaneous injections.

Brand Name Generic/Chemical Name

Arixtra

Fondaparinux
Lovenox Enoxaparin
Fragmin Dalteparin

Direct Thrombin Inhibitors
Directly prevent the action of thrombin, a major coagulation factor and platelet activator.

Brand Name Generic/Chemical Name

Pradaxa

Dabigatran

Factor Xa Inhibitors
Act directly on Factor X in the coagulation cascade to prevent the formation of blood clots.

Brand Name Generic/Chemical Name

Eliquix

Apixaban
Xarelto Rivaroxaban

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December 2013: Oral Hypoglycemics / Oral Antihyperglycemics

There are multiple classes of oral hypoglycemic agents (also known as oral antihyperglycemic agents) used in the treatment of type 2 diabetes.  These agents act by lowering the glucose level in the blood through the enhancement of insulin production, decreasing glucose production, or increasing the cells ability to uptake glucose.

Biguanides

These are the first line pharmacological treatment for type 2 diabetes.  Also used in gestational diabetes and polycystic ovarian syndrome.  Causes few adverse effects (mainly GI symptoms upon initiation) and are associated with a very low risk of hypoglycemia.  Metformin works by suppressing liver glucose production.

Brand Name Generic/Chemical Name

Glucophage, Glumetza, Glycon

Metformin

Sulfonylureas

These agents work by stimulating the pancreas to release more insulin.  Sulfonylureas block ATP sensitive potassium channels in the Beta-cells of the pancreatic islets.  This results in cell depolarization, leading to an influx of calcium into the cell, resulting in increased insulin secretion from the Beta-cells.  Patients on sulfonylureas are at higher risk for having hypoglycemic events.

Brand Name Generic/Chemical Name

Diabeta, Euglucon

Glyburide
Diamicron Gliclazide
Amaryl Glimepiride
Diabinese Chlorpropamide

Meglitinides

These medications have a quick onset of action and have a short duration of effect.  They are structurally different than sulfonylureas and exert their effects via different receptors, but act similarly by regulating ATP dependent potassium channels in pancreatic beta cells, resulting in increased insulin secretion.

Brand Name Generic/Chemical Name

GlucoNorm

Repaglinide
Starlix Nateglinide

Thiazolidinediones

This class of medications increases insulin sensitivity by acting on adipose, muscle and liver to increase glucose utilization and decrease glucose production.  It is thought they may also improve blood glucose levels by preserving pancreatic Beta-cell function.

Brand Name Generic/Chemical Name

Avandia

Rosiglitazone
Actos Rosiglitazone
Avandamet Rosiglitazone and Metformine

DPP-4 Inhibitors

These agents are not considered as initial therapy in treatment of type 2 diabetes.  They help achieve glucose control through several mechanisms including enhancement of glucose dependent insulin secretion, delayed gastric emptying, regulation of postprandial glucagon and decreased appetite.  These agents do not cause hypoglycemia.

Brand Name Generic/Chemical Name

Januvia

Sitagliptin
Onglyza Saxagliptin
Janumet Sitagliptin and Metformin

Alpha-glucosidase Inhibitors

These medications inhibit gastrointestinal enzymes (alpha-gluosidases) that convert complex polysaccharide carbohydrates into monosaccharides in a dose dependent fashion.  They act by slowing the absorption of glucose from the GI tract.

Brand Name Generic/Chemical Name

Glucobay

Acarbose

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October 2013: Tricyclic Antidepressants

TCAs are used in the treatment of depression, anxiety and panic disorder, attention deficit disorder, pediatric enuresis, obsessive compulsive disorder and chronic pain disorders. Patients with a TCA overdose can present with CNS effects including sedation, confusion, delirium, or hallucinations. Arrhythmias, hypotension, and anticholinergic toxicity (hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, and sinus tachycardia) are common.  Patients who present with a TCA overdose have the potential to deteriorate rapidly despite their initial well appearance.

An overdose of TCAs is a contraindication for diphenhydrinate (Gravol) administration.  The below list contains TCAs that are approved for use in Canada. 

Brand Name Generic/Chemical Name
Elavil, Levate, Triptyn Amitriptyline
Anafranil Clomipramine
Desipramine Desipramine
Sinequan, Silenor Doxepin
Pramine, Impril, Tripamine Imipramine
Maprotiline Maprotiline
Aventyl, Norventyl Nortriptyline
Tripramine Trimipramine

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August 2013: Phosphodiesterase 5 (PDE5) Inhibitors

Phosphodiesterase inhibitors are a class of drugs that block one or more subtype of the enzyme phosphodiesterase. The most common out of hospital use of this class of medication are those drugs that are PDE5 selective inhibitors. These medications are used to treat erectile dysfunction and are occasionally used in the treatment of pulmonary hypertension.

Phosphodiesterase Inhibitor use within 48 hours is a contraindication for nitroglycerin administration as it can significantly enhance nitroglycerin’s vasodilatory effect and cause profound hypotension.

Brand Name Generic/Chemical Name
Viagra, Revatio Sildenafil
Cialis, Adcirca Tadalafil
Levitra, Staxyn Vardenafil
Stendra, Spedra (not approved for use in Canada) Avanafil

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June 2013: Common Ministerial Anti-Inflammatory Drugs (NSAIDs)

Here are some of the common NonSteroidal Anti-Inflammatory Drugs (NSAIDs) that you might encounter when treating patients. This is not an exhaustive list, but one that you will hopefully recollect. Recognizing these will come in handy when considering ASA for Cardiac Ischemia or Ibuprofen/Ketorolac for pain. Keep in mind that an allergy or sensitivity to NSAIDs is a contraindication for the administration of ASA, Ibuprofen, and Ketorolac.

Brand Name Generic/Chemical Name
Advil, Motrin Ibuprofen
Anaprox, Naprosyn, Aleve, Vimovo Naproxen
Celebrex Celecoxib
Voltaren Diclofenac
Indocid Indomethacin
Mobicox Meloxicam
Arthrotec Diclofenac Sodium with Misoprostol

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