Drug Class Major Indication Prototypes Major Adverse Effects

Prototypes

Drug Class Major Indication Prototypes Major Adverse Effects *Boxed Warning

Peripheral Nervous System Drugs

Muscarinic Agonist (Parasympathomimetic)

Treats urinary retention Bethanechol Mr. Pathetic (cholinergic)-hypotension, bradycardia, bronchoconstriction, miosis, sweating, urination, diarrhea

Muscarinic Antagonists (Anticholinergics, parsympatholytics)

Bradycardia (slow HR) Atropine Anticholinergic effects-BUDCATS- blurry vision (photophobia-increased IOP), urinary retention, dry mouth constipation, anhidrosis, tachycardia, sedation

Overactive bladder Oxybutynin Anticholinergic-BUDCATS Asthma, COPD Ipratropium Anticholinergic-BUDCATS COPD Tiotropium Anticholinergic-BUDCATS

Cholinesterase Inhibitors Myasthenia gravis Neostigmine Mr. Pathetic (cholinergic) Neuromuscular Blocker Surgery, intubation Pancuronium Respiratory arrest

Surgery Succinylcholine Prolonged apnea, malignant hyperthermia, muscle pain, ↑ K Adrenergic Agonists Shock, anaphylaxis Epinephrine Tachycardia, HTN, angina, necrosis, hyperglycemia Alpha1 Blocker BPH, HTN Prazosin Hypotension, reflex tachycardia, nasal congestion, anorgasmia Beta-Adrenergic Blockers Non-cardioselective

HTN, angina, migraines, dysrhythmias, MI, hyperthyroidism

Propranolol* *Abrupt cessation→MI or angina & dysrhythmias Bradycardia, AV heart block, heart failure, rebound tachycardia, hypotension, bronchoconstriction, depression, CNS effects, inhibition of glycogenolysis, masks sign of hypoglycemia-tachycardia

Cardioselective HTN, MI, Heart failure (HF)

Metoprolol* *Abrupt cessation→MI, angina & dysrhythmias Bradycardia, AV heart block, heart failure, rebound tachycardia hypotension, depression, CNS effects,

Alpha2 Agonists (indirect acting anti- adrenergic agents)

Clonidine* *Fetal injury Drowsiness, dry mouth, rebound hypertension, hypotension, bradycardia

Alpha2 Agonists HTN-preferred drug in pregnancy

Methyldopa + Coombs’ Test and hemolytic anemia, hepatotoxicity, hypotension

Drugs for Parkinson’s Disease

Dopaminergics Parkinson’s disease Levodopa/ carbidopa

Nausea and vomiting, dyskinesias, hypotension, dysrhythmias, psychosis, CNS effects, darkens body secretions, activates melanoma

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Dopamine receptor agonists

Parkinson’s disease Restless leg syndrome

Pramipexole Nausea, dizziness, sleep attacks, compulsive behavior, gambling

MAO-B Inhibitors Parkinson’s disease Selegiline Hypertensive crisis with tyramine containing foods Promotes dopamine release

Parkinson’s disease Amantadine CNS effects

Anticholinergic’s Parkinson’s disease to reduce tremor

Benztropine Anticholinergic-BUDCATS

Drugs for Alzheimer’s Disease (AD)

Cholinesterase Inhibitors AD Donepezil Mr. Pathetic (cholinergic) NMDA antagonists AD Memantine Dizziness, confusion, headache, constipation

Drugs for Epilepsy

Antiepileptic drugs (AEDS)

Seizures, cardiac dysrhythmias

Phenytoin* *CV risk (hypotension and bradycardia) with rapid infusion >50 mg/min CNS depression, nystagmus, diplopia, gingival hyperplasia, fatal rash (TEN, SJS), fetal risk, necrosis if infiltrated IV, induces metabolism of other drugs, withdrawal seizures, (mix only with saline)

Seizures, bipolar disorder (BPD)

Carbamazepine* *Aplastic anemia/ agranulocytosis, fatal rash (TEN, SJS) CNS effects, fetal harm, induces metabolism of other drugs, withdrawal seizures

Seizures, BPD, migraine prophylaxis

Valproic acid* *Hepatotoxicity, fetal risk, pancreatitis Elevated ammonia levels, weight gain, hair loss, tremor

Drugs for Migraines

Selective Serotonin Receptor Agonists

Migraines Sumatriptan Chest symptoms (transient pain, pressure, tightness) Coronary vasospasms

Ergot Alkaloids Migraines Ergotamine* *Peripheral ischemia, vasospasm, cerebral ischemia Ergotism, vasoconstriction

Opioid Analgesics and Antagonists

Pure Opioid Agonists Pain, MI Morphine* *Appropriate use by pain specialists *Addiction, abuse and misuse *Medication error with oral concentrated solution (20mg/mL) *Accidental exposure in children *Neonatal withdrawal syndrome

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*Respiratory depression *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Constipation, hypotension, urinary retention, cough suppression, biliary colic, emesis, ↑ ICP, euphoria/dysphoria, sedation, miosis, fetal injury, neurotoxicity

Codeine* *Medication error risk-confusion between mg and mL with different concentrations *Addiction, abuse and misuse *Respiratory depression *Accidental ingestion in children *Death related to ultra-rapid metabolism of codeine to morphine *Neonatal opioid withdrawal syndrome *use with other sedating agnets can cause death

Agonist-Antagonists Opioids

Pain Pentazocine* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Withdrawal syndrome when given to opioid addicts, increases cardiac work, weird thoughts, nightmares, minimal respiratory depression, REMS required

Opioid Antagonists Reversal of opioids Naloxone No significant adverse effects Non-opioid Centrally Acting Analgesics

Pain, helpful with neuropathic pain

Tramadol* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Seizures, minimal respiratory depression, sedation, headache, dry mouth, constipation, serotonin syndrome with other serotonergic agents

Antipsychotics

Traditional or 1st Generation Antipsychotics

Schizophrenia Chlorpromazine* (low potency)

*Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections Sedation, hypotension, anticholinergic effects, prolongs QT interval, EPS, neuroleptic malignant syndrome (NMS), neuroendocrine effects, sexual dysfunction, photosensitivity

Schizophrenia Haloperidol* *Not approved for dementia-related psychosis. Increased

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(high potency) mortality risk in elderly dementia patients. Deaths due to CV events and infections EPS, less NMS, sedation and anticholinergic effects, prolongs QT interval, neuroendocrine effects,

Atypical or 2nd Generation Antipsychotics

Schizophrenia Clozapine* *Restricted use-REMS required due to severe neutropenia *Orthostatic hypotension, bradycardia, syncope *Increase risk of seizures *Myocarditis/cardiomyopathy *Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections Agranulocytosis, weight gain, diabetes, dyslipidemia, EPS

Schizophrenia BPD Severe depression with aripiprazole

Aripiprazole* Olanzipine* Paliperidone* Quetiapine* Resperidone* Ziprasidone*

*Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections *Increased suicidal ideations (SI) in children, adolescents and young adults Weight gain, diabetes, dyslipidemia, EPS, sedation, anticholinergic-BUDCATS, rash, leukopenia, orthostatic hypotension, cataracts, QT prolongation, gynecomastia (adverse effects vary with each agent)

Antidepressants

SSRIs Depression Fluoxetine* *Increased suicidal ideations (SI) in children, adolescents and young adults Sexual dysfunction, weight gain, serotonin syndrome, withdrawal syndrome, neonatal withdrawal syndrome and pulmonary hypertension of the newborn, fetal harm, rare EPS, bruxism, bleeding, hyponatremia, glaucoma, QT prolongation

SNRIs Depression Venlafaxine* *Increased suicidal ideations (SI) in children, adolescents and young adults Serotonin syndrome, rare EPS, nausea, headache, nervousness, insomnia, HTN, withdrawal syndrome, hyponatremia, mydriasis (increased IOP)

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TCAs Depression Imipramine* *Increased suicidal ideations (SI) in children, adolescents and young adults Hypotension, anticholinergic-BUDCATS, diaphoresis, sedation, dysrhythmias, seizures, hypomania, serotonin syndrome

MAOIs Depression Phenelzine* *Increased suicidal ideations (SI) in children, adolescents and young adults Agitation, hypotension, HTN with tyramine foods

Atypical Antidepressants Depression Smoking cessation

Bupropion* *Increased suicidal ideations (SI) in children, adolescents and young adults *Neuropsychiatric symptoms-hostility, agitation, worsening of psychiatric illness Seizures, dry mouth, constipation, weight loss, GI upset, tachycardia, insomnia

Depression Insomnia

Mirtazapine* *Increased suicidal ideations (SI) in children, adolescents and young adults Somnolence, sedation, weight gain, anticholinergic effects

Depression Insomnia

Trazodone* *Increased suicidal ideations (SI) in children, adolescents and young adults Somnolence, sedation, prolongs QT interval, priapism

Drugs for Bipolar Disorder (BPD)

Mood Stabilizer Bipolar Disorder (BPD) Lithium* *Toxicity with ↑levels. Keep drug level below 1.5 mEq/L GI distress, tremor, polyuria, renal toxicity, goiter and hypothyroidism, fetal harm

Drugs for Anxiety and Insomnia and ADHD and Smoking Sensation

Benzodiazepines Anxiety and insomnia Diazepam* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Sedation, physical dependence, withdrawal syndrome, fetal harm

BZD-like drugs Insomnia Zolpidem Sedation, weird nighttime behaviors Reversal agent BZD antidote Romazicon* *Seizure

Dysrhythmias Barbiturates Sedation Secobarbital Sedation, respiratory arrest, suicide, abuse Melatonin agonist Insomnia Ramelteon Sedation, dizziness

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Stimulants ADHD Methylphenidate* *Drug dependence, tolerance, psychotic episodes, Insomnia, weight loss, CNS stimulation, ↑ HR and ↑BP

Diuretics and Cardiovascular Drugs

Loop diuretics Heart failure Furosemide* * Fluid and electrolyte imbalance Hypotension, ototoxicity, hyperglycemia, hyperuricemia

Thiazide diuretic HTN HCTZ Hypoglycemia and other electrolyte imbalances Potassium sparing diuretics (aldosterone blockers)

Heart failure Spironolactone* *Tumor risk Hyperkalemia, endocrine effects (gynecomastia, menstrual irregularities, impotency, hirsutism, deepened voice)

ACE Inhibitors HTN, heart failure Lisinopril* *Fetal risk Angioedema, hypotension, cough, hyperkalemia, renal failure

ARBs HTN, heart failure Losartan* *Fetal risk Angioedema, hypotension, hyperkalemia, renal failure

Direct Renin Inhibitors HTN Aliskiren* *Fetal risk Angioedema, hypotension, cough, hyperkalemia, renal failure, diarrhea

Non-dihydropyridine CCBs

HTN, dysrhythmias, angina Verapamil and diltiazem

Constipation, bradycardia, peripheral edema, dizziness, headache

Dihydropyridine CCB HTN, angina Nifedipine and amlodipine

Hypotension and peripheral edema, flushing, dizziness, reflex tachycardia with nifedipine

Vasodialtors HTN, heart failure Hydralazine Hypotension, reflex tachycardia, increased blood volume, systemic lupus erythematosus-like syndrome

Cardiac Glycosides (Inotropic Agents)

Heart failure Digoxin Dysrhythmias, AV block, bradycardia, anorexia, nausea, vomiting, fatigue and visual disturbances (blurred vision, yellow tinge, and halos). Keep plasma level 0.5-0.8 ng/mL

Antidysrhythmic Drugs Class III

Dysrththmias AF off label (class III)

Amiodarone* *Appropriate use *Pulmonary toxicity *Hepatotoxicity *Proarrhythmic effects (sinus bradycardia, AV block) Thyroid toxicity, optic neuropathy, fetal harm, photosensitivity, CNS effects, hypotension, peripheral neuropathy

Statins (HMG-CoA Hyperlipidemia Atorvastatin Myopathy, rhabdomyolysis, hepatotoxicity, diabetes, fetal

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reductase inhibitors) harm, cognitive impairment Bile-acid sequestrants Hyperlipidemia Colesevelam Constipation, decreased uptake of fat-soluble vitamins Fibrates Hypertriglyceridemia Fenofibrate GI distress, gallstones, myopathy, liver injury Organic Nitrates Angina Nitroglycerin Headache, orthostatic hypotension, reflex tachycardia Anticoagulants Deep vein thrombosis

(DVT) pulmonary embolism (PE)

Heparin Hemorrhage, heparin–induced thrombocytopenia (HIT), hypersensitivity reaction

Vitamin K Antagonists Prevention of thrombosis, atrial fibrillation (AF)

Warfarin* *Hemorrhage Fetal harm

Direct Thrombin Inhibitors

DVT, AF Dabigatran* *Treatment discontinuation→increased thrombosis *Epidural/spinal hematoma risk Bleeding, GI distress

Factor Xa Inhibitors DVT, AF Rivaroxaban* *Treatment discontinuation→increased thrombosis * Epidural/spinal hematoma risk Bleeding

Antiplatelets AF, MI Aspirin Bleeding, GI bleed Antiplatelet AF, MI Clopidogrel* *Diminished antiplatelet effect in CYP2C19 poor metabolizers Thrombolytics Embolism Alteplase Bleeding

RBC Builders Renal disease, anemia Epoetin alpha* *Increased mortality and serious CV events in CKD patients when Hgb is >11 g/dL. REMS required *Increased mortality and/or tumor progression in cancer patients *Increased thromboembolic events in surgery patients HTN

WBC Builder Bone marrow disease Filgrastim Bone pain, leukocytosis, hyperuricemia Platelet Builder Thrombocytopenia Oprelvekin Fluid retention, dysrhythmias, anaphylaxis

Drugs for Diabetes

Biguanides Diabetes Mellitus (DM) Metformin* *Lactic acidosis GI distress, diarrhea, decrease B12

Sulfonylureas DM Glyburide Hypoglycemia, weight gain Thiazolidinediones (Glitazones or TZDs)

DM Pioglitazone* *Heart failure Fluid retention, edema, hepatotoxicity, possible bladder cancer

Meglitinides DM Repaglinide Hypoglycemia, weight gain Alpha-glucosidase inhib DM Acarbose Flatulence, cramps, and diarrhea, hypoglycemia, liver

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dysfunction DPP-4 Inhibitors DM Sitagliptin Rare pancreatitis GLP-1 Agonist DM Exenatide GI distress, pancreatitis

DM and weight loss Liraglutide* *Thyroid C-cell tumor risk. Contraindicated in patients with medullary thyroid cancer or family history of multiple endocrine neoplasia syndrome type 2

SGLT-2 Inhibitors DM Canagliflozin Genital mycotic infections, orthostasis Amylin Mimetic DM Pramlintide* *Hypoglycemia

Drugs for Thyroid Disorders

Thyroid hormones Hypothyroidism Levothyroxine* *Not to be used for weight loss, toxicity in ↑ doses Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia with excess dosages

Antithyroid drugs Hyperthyroidism Methimazole Agranulocytosis, hypothyroidism, fetal harm Hyperthyroidism Used in pregnancy and in thyroid storm

Propylthiouracil (PTU)*

*Appropriate use *Hepatotoxicity *Treatment of choice during or just prior to 1st trimester Agranulocytosis, hypersensitivity

Drugs for Disorders of the Adrenal Cortex

Glucocorticoids Adrenal insufficiency (Addison’s disease)

Hydrocortisone Cushions syndrome, hyperglycemia, glaucoma, hypokalemia

Mineralocorticoids Adrenal insufficiency Fludrocortisone Cushing’s syndrome, HTN edema, cardiac enlargement, hypokalemia

Drugs for Erectile Dysfunction and BPH

PDE-5 Inhibitors Erectile dysfunction (ED) Sildenafil Hypotension, priapism, non-arteritic ischemic optic neuropathy, sudden hearing loss, headache, flushing, may worsen sleep apnea. Prolonged QT interval with vardenafil

5-alpha Reductase Inhibitors

BPH Finasteride Decrease libido, gynecomastia. Pregnant women should not handle tabs

Alpha Blockers BPH Tamsulosin Hypotension, somnolence, nasal congestion, retrograde ejaculation, floppy iris syndrome

COX Inhibitors, Anti-inflammatory, Anti-allergic, Immunologic Drugs

1st Generation H1 Blockers Allergies, insomnia, common cold

Diphenhydramine Sedation, anticholinergic-BUDCATS Respiratory depression in child

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Nausea/vomiting Allergic reactions sedation, motion sickness

Promethazine* *Respiratory depression in children less than 2 years of age *Severe tissue injury-gangrene with injection

2nd Generation H1 Blockers

Allergic rhinitis Fexofenadine No sedation

1st Generation NSAIDs Pain, inflammation Fever

ASA Reyes syndrome in child, GI ulceration, bleeding, renal impairment, salicylism, fetal harm, hypersensitivity

Ibuprofen* *Increase risk of CV thrombotic events MI and stroke *Contraindicated after CABG-CV risk *GI risk, bleeding, ulcer, stomach or intestine perforation

2nd Generation NSAIDS Pain, inflammation Celecoxib* *Increase risk of CV thrombotic events MI and stroke *Contraindicated after CABG-CV risk *GI risk, bleeding, ulcer, stomach or intestine perforation

Central COX Inhibitor Pain, fever Acetaminophen Liver damage with ETOH, anaphylaxis, SJS and TEN Glucocorticoids Asthma, RA, SLE,

allergies Prednisone Adrenal insufficiency, osteoporosis, infection, hyperglycemia,

PUD Drugs for Rheumatoid Arthritis, Gout, and Osteoporosis

Disease Modifying Anti- rheumatic Drugs (DMARDs)

Rheumatoid arthritis (RA) Methotrexate* *Appropriate use *Fetal injury *Hepatotoxicity *Impaired drug elimination in CKD *Pulmonary toxicity *GI toxicity *Malignant lymphoma *Tumor lysis syndrome *Skin reactions *Opportunistic infections *Concomitant Radiotherapy *Aplastic anemia if used with NSAIDs

RA, lupus Hydroxychloroquine sulfate (Plaquenil)*

*Prescribers should be familiar with prescribing information Agranulocytosis, seizures, hypersensitivity reaction, hepatotoxicity, retinopathy, dizziness, headache, GI distress

TNF Antagonists RA Etanercept* *Infection, reactivation of TB *Malignancy Severe allergic reaction, heart failure, cancer, hematological disorders, liver injury, CNS demyelinating disorders

Urate Lowering Drugs Gout Allopurinol Hypersensitivity syndrome, rash, may elicit an acute gouty attack, GI distress, neurologic effects, cataracts with prolonged use

Anti-inflammatory Gout Colchicine Nausea, vomiting, diarrhea, bone marrow suppression, muscle injury

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Bisphosphonates Osteoporosis Alendronate Esophagitis, atypical fractures, osteonecrosis of the jaw, ocular problems

Selective Estrogen Receptor Modulators (SERMS)

Breast cancer Osteoporosis

Raloxifene* *Venous thromboembolism DVT, PE, stroke Fetal harm, hot flashes

Respiratory Drugs

Inhaled Glucocorticoids Asthma Beclomethasone Oral candidiasis, dysphonia, slowed growth in children, bone loss, cataracts

Oral Glucocorticoids Asthma Prednisone Adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, growth suppression in children, increased risk of infection, insomnia, increased risk of cataracts

Leukotriene Inhibitors Asthma, allergic rhinitis Zileuton Liver injury Montelukast Possible neuropsychiatric events such as mood changes

Beta2 Agonists SABA Asthma, COPD Albuterol Tachycardia, angina, tremor, seizures, cardiac arrest-use more than 2/week is an indication of poor asthma control

Beta2 Agonists LABA Asthma, COPD Salmeterol* *Asthma related death *Pediatric & adolescents-increase risk of death-use fixed combo Tachycardia, angina, tremor, seizures

Anticholinergic SAMA Asthma, COPD Ipratropium Anticholinergic-BUDCATS Anticholinergic LAMA COPD Tiotropium Anticholinergic-BUDCATS IgE Antagonists Severe asthma

Allergic rhinitis Omalizumab* *Anaphylaxis

Injection site reaction, URI Methylxanthines Severe asthma Theophylline GI distress, toxicity, dysrhythmias, keep serum level less than 20

mcg/mL Nasal Steroids Allergic rhinitis Beclomethasone Dry nose, burning, itching, sore throat, epistaxis Nasal Decongestants Common cold Phenylephrine Rebound congestion with topical agents, hypertension,

dysrhythmias Antitussives Cough Dextromethorphan Euphoria in high doses Opioid Antitussives Cough Codeine* *Death in children related to ultra-rapid metabolism of codeine

to morphine leading to respiratory depression *Risk from concomitant use with other CNS depressants

Gastrointestinal Drugs

H2 Receptor Blockers GERD, ulcer Cimetidine Anti-androgenic effects (gynecomastia, reduced libido, impotence, CNS effects in older adults, increased risk of

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pneumonia Proton Pump Inhibitors GERD, ulcer Omeprazole Headache, GI distress, increased risk of pneumonia, fractures,

rebound acid secretion, hypomagnesemia, C. difficile infection (CDI)

Mucosal Protectant Antiulcer Sucralfate Constipation Prostaglandin Analogs Antiulcer Misoprostol* *Abortion, premature birth, or birth defects

*Don’t use in women of child bearing age Diarrhea, fetal expulsion

Serotonin antagonist Antiemetic Ondansetron HA, diarrhea, dizziness, QT interval prolonged Substance P Antiemetic Aprepitant Fatigue, asthenia, hiccups, dizziness, diarrhea Dopamine antagonist Antiemetic, anxiety,

schizophrenia Prochlorperazine* *Not used for dementia related psychosis-↑ infections and CV

events Tardive dyskinesia (TD), NMS, blood dyscrasias Respiratory depression in child, anticholinergic effects, hypotension

Nausea/vomiting Allergic reactions sedation, motion sickness

Promethazine* *Respiratory depression in children < 2 years old *Severe tissue injury, gangrene with injection

GERD, diabetic gastroparesis, nausea/vomiting

Metoclopramide* *Tardive dyskinesia (TD)

Cannabinoids Antiemetic Dronabinol QT prolongation Antibiotics and Antifungals, Antivirals

PCN Infections PCN Allergic reaction Cephalosporins Infections (gram +) Cephalexin Allergic reactions, c. diff infection (CDI) Carbapenems Infections Imipenem GI effects Other antibiotic Infections Vancomycin Renal failure, ototoxicity, red man syndrome, thrombophlebitis,

immune-mediated thrombocytopenia Tetracyclines Infections

MRSA Tetracycline Minocycline Doxycycline

GI distress, staining of teeth, suppress bone growth not for children less than 8 years or pregnant women), sunburn, CDI, hepatotoxicity, renal toxicity

Macrolides Infections Erythromycin Azithromycin Clarithromycin

GI distress QT prolongation and sudden cardiac death

Clindamycin Infections, MRSA Clindamycin* *CDI

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Aminoglycosides Gram (-) infections Gentamycin* *Neurotoxicity (vertigo, numbness, tingling, seizures *Ototoxic, *Nephrotoxicity *Neuromuscular blockade (flaccid paralysis causing respiratory depression) Hypersensitivity reactions, rash, blood dyscrasias

Sulfonamides UTI MRSA

Trimethoprim/ sulfamethoxazole

Hypersensitivity reactions, rash, SJS, TEN, hemolytic anemia in patients with G6PD deficiency, kernicterus in newborns (don’t use in infants younger than 2 years or in late pregnancy), renal damage, photosensitivity, CDI

Nitrofurantoin UTI Nitrofurantoin GI effects, pulmonary reactions, hematologic effects, peripheral neuropathy, hepatotoxicity, birth defects (don’t give near end of pregnancy-or in 1st trimester), CNS effects

Fluoroquinolones Infections Ciprofloxacin* Levofloxacin* Moxifloxacin*

*Tendon rupture *Peripheral neuropathy and CNS effects *Avoid in myasthenia gravis *Don’t use for sinusitis, bronchitis or uncomplicated UTI GI effects, fetal harm, photosensitivity, QT prolongation, CDI

Antiprotozoal Drugs Protozoal infections and anaerobic bacterial infections

Metronidazole* *Carcinogenic in rats and mice, avoid unnecessary use GI effects, headache, dry mouth, metallic taste, darkening urine, hypersensitivity reactions, SJS, neurologic injuries, disulfiram if used with alcohol (wait 24-72 hours before consuming ETOH)

Antifungals Fungal infections Amphotericin* *Use only in life threatening fungal infections *Overdose prevention Infusion reaction (delirium, hypotension, hypertension, wheezing, hypoxia), nephrotoxicity, hypokalemia, anemia

Azole antifungals Fungal infections Itraconazole* *Don’t use in patients with CHF *Many interactions GI effects, liver toxicity, cardiac suppression, rash, headache

Anti-tuberculosis drugs TB Isoniazid* Rifampin Pyrazinamide Ethambutol

*Hepatotoxicity Change in color body fluids, peripheral neuropathy

Anti-viral Herpes simplex Acyclovir Phlebitis, renal toxicity (IV) GI distress NRTIs HIV Zidovudine* *Severe anemia

*Myopathy

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*Lactic acidosis and severe hepatomegaly with fatty liver GI effects, diabetes, hyperlipidemia, lipoatrophy

NNRTIs HIV Efavirenz CNS symptoms, rash, fetal harm, liver damage Protease Inhibitors HIV Lopinavir/ritonivir GI distress, AV block, QT prolongation,

Hyperglycemia/diabetes, reduced bone density, elevation of liver transaminases, fat redistribution, hyperlipidemia

Integrase Inhibitors HIV Ralgetavir Insomnia, headache, myopathy, hypersensitivity reactions (SJS and TEN), liver injury

Infusion Inhibitor HIV Enfuvirtide Injection site reaction, pneumonia, hypersensitivity reaction

CCR5 antagonists HIV Maraviroc* *Hepatotoxicity Cough, dizziness, rash

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