Medication Summary.docx

**Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** **ACE Inhibitors** Ramipril (Tritace), Lisinopril (Zestril), Enalapril (Innovace) Block conversion of angiotensin I to angiotensin II, causing blood vessels to relax, lowering BP. Treat...

**Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** **ACE Inhibitors** Ramipril (Tritace), Lisinopril (Zestril), Enalapril (Innovace) Block conversion of angiotensin I to angiotensin II, causing blood vessels to relax, lowering BP. Treats hypertension (high blood pressure), heart failure, prevents heart attacks. Dry cough, increased potassium levels, dizziness, low BP, kidney dysfunction. **Beta Blockers** Bisoprolol (Cardicor), Atenolol (Tenormin), Metoprolol (Betaloc) Block the effects of adrenaline (epinephrine), reducing heart rate and force of contraction. Lowers blood pressure, treats angina, arrhythmias, heart failure, and protects post-heart attack. Fatigue, slow heart rate, dizziness, depression, cold hands and feet. **Calcium Channel Blockers** Amlodipine (Istin), Diltiazem (Tildiem), Verapamil (Cordilox) Prevent calcium from entering heart and blood vessel cells, relaxing the vessels and reducing BP. Used for hypertension, angina, and certain arrhythmias. Swelling (especially ankles), dizziness, headache, constipation, low blood pressure. **Diuretics** Furosemide (Lasix), Bendroflumethiazide (Aprinox), Spironolactone (Aldactone) Increase urine output to reduce blood volume and decrease blood pressure. Treat hypertension, heart failure, and fluid retention (edema). Dehydration, low potassium (for some), dizziness, muscle cramps, increased urination. **Antiplatelet Agents** Aspirin (Anopyrin), Clopidogrel (Plavix), Ticagrelor (Brilique) Prevent platelets from clumping together, reducing the risk of blood clots. Prevents heart attacks, strokes, and other clot-related conditions. Bleeding, stomach upset, bruising, allergic reactions. **Anticoagulants** Warfarin (Marevan), Rivaroxaban (Xarelto), Apixaban (Eliquis) Interfere with the blood clotting process, reducing the risk of clot formation. Used to prevent/treat deep vein thrombosis, pulmonary embolism, stroke (in atrial fibrillation). Bleeding, easy bruising, stomach upset, low platelet count (rare but serious). **Statins** Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin (Crestor) Lower cholesterol by inhibiting HMG-CoA reductase, which the liver uses to make cholesterol. Reduces risk of heart disease, stroke, and heart attacks. Muscle pain, liver enzyme elevation, headache, nausea, increased blood sugar. **Nitrates** Glyceryl Trinitrate (Nitrolingual, Nitrostat), Isosorbide Mononitrate (Imdur) Relax and widen blood vessels by increasing nitric oxide availability, improving blood flow to the heart. Treat angina and heart failure. Headache, dizziness, low blood pressure, flushing, nausea. **ARBs (Angiotensin II Receptor Blockers)** Losartan (Cozaar), Candesartan (Atacand), Valsartan (Diovan) Block angiotensin II from binding to receptors in blood vessels, lowering BP. Treats high blood pressure, heart failure, kidney disease in diabetes. Dizziness, increased potassium, kidney dysfunction, low BP. **Digoxin** Digoxin (Lanoxin) Increases the force of heart contractions and regulates heart rhythm by affecting sodium-potassium balance. Treats heart failure and certain arrhythmias. Nausea, vomiting, dizziness, blurred vision, irregular heartbeat (serious). **Vasodilators** Hydralazine (Apresoline), Minoxidil (Loniten) Directly relax the smooth muscles in blood vessel walls, reducing resistance and lowering blood pressure. Treats hypertension and heart failure. Headache, dizziness, low BP, flushing, swelling. **Biguanides** Metformin (Glucophage) Decreases liver glucose production, increases insulin sensitivity, and improves glucose uptake in muscles. First-line treatment for type 2 diabetes. Lowers blood sugar without causing hypoglycemia. Diarrhea, nausea, stomach upset, lactic acidosis (rare but serious). **Sulfonylureas** Gliclazide (Diamicron), Glibenclamide (Daonil) Stimulate the pancreas to release more insulin by blocking potassium channels in beta cells. Used to treat type 2 diabetes by lowering blood sugar. Hypoglycemia (low blood sugar), weight gain, skin rash, upset stomach. **DPP-4 Inhibitors** Sitagliptin (Januvia), Linagliptin (Trajenta), Saxagliptin (Onglyza) Inhibits DPP-4 enzyme, increasing GLP-1 levels which help lower blood glucose by stimulating insulin release. Used to lower blood sugar in type 2 diabetes. Can be combined with other medications like Metformin. Upper respiratory infection, headache, joint pain, risk of pancreatitis (rare). **GLP-1 Agonists** Liraglutide (Victoza), Dulaglutide (Trulicity), Semaglutide (Ozempic) Mimic the effects of GLP-1, increasing insulin release and slowing digestion to reduce blood sugar levels. Used to lower blood sugar in type 2 diabetes, often with weight loss benefits. Nausea, vomiting, diarrhea, risk of pancreatitis (rare), injection site reactions. **SGLT-2 Inhibitors** Dapagliflozin (Forxiga), Empagliflozin (Jardiance), Canagliflozin (Invokana) Block reabsorption of glucose in the kidneys, increasing glucose excretion through urine. Lower blood sugar in type 2 diabetes, with added benefits for heart and kidney health. Increased urination, genital infections, dehydration, risk of ketoacidosis (rare). **Thiazolidinediones (TZDs)** Pioglitazone (Actos) Increase insulin sensitivity by activating PPAR-gamma receptors, improving glucose uptake in cells. Lowers blood sugar in type 2 diabetes, typically used in combination with other medications. Weight gain, fluid retention, risk of heart failure, bone fractures, bladder cancer (rare). **Insulin** Insulin Lispro (Humalog), Insulin Glargine (Lantus), Insulin Aspart (NovoRapid) Replaces or supplements insulin to help glucose enter cells, lowering blood sugar. Used to treat both type 1 and type 2 diabetes when blood sugar cannot be controlled by other means. Hypoglycemia (low blood sugar), weight gain, injection site reactions. **Meglitinides** Repaglinide (Prandin), Nateglinide (Starlix) Stimulate rapid insulin release from the pancreas in response to meals. Used to control blood sugar in type 2 diabetes, especially around mealtimes. Hypoglycemia, weight gain, nausea, diarrhea. **Alpha-Glucosidase Inhibitors** Acarbose (Glucobay) Slow down the digestion of carbohydrates in the intestines, reducing post-meal blood sugar spikes. Used to control blood sugar in type 2 diabetes, particularly after meals. Flatulence, diarrhea, stomach cramps. **Amylin Analogs** Pramlintide (Symlin, not widely used in Ireland) Mimic amylin, a hormone that slows gastric emptying and reduces post-meal blood sugar levels. Used alongside insulin in both type 1 and type 2 diabetes to improve post-meal blood sugar control. Nausea, vomiting, risk of severe hypoglycemia when used with insulin. **\ ** **Summary of Categories:** - **Biguanides (e.g., Metformin)**: Improve insulin sensitivity, commonly the first line for type 2 diabetes. - **Sulfonylureas (e.g., Gliclazide)**: Stimulate insulin production, used for type 2 diabetes but may cause hypoglycemia. - **DPP-4 Inhibitors (e.g., Sitagliptin)**: Help the body produce more insulin after meals without causing low blood sugar. - **GLP-1 Agonists (e.g., Liraglutide)**: Mimic gut hormones to lower blood sugar and promote weight loss. - **SGLT-2 Inhibitors (e.g., Dapagliflozin)**: Help the body excrete excess glucose through urine, with heart and kidney benefits. - **Thiazolidinediones (e.g., Pioglitazone)**: Increase insulin sensitivity but can have significant side effects. - **Insulin**: Used in type 1 and type 2 diabetes when other treatments are not enough. - **Meglitinides (e.g., Repaglinide)**: Help control blood sugar around meals. - **Alpha-Glucosidase Inhibitors (e.g., Acarbose)**: Reduce blood sugar spikes after meals. - **Amylin Analogs**: Rarely used but can help in combination with insulin. Pain Killer **Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** ---------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- **Non-Opioid Analgesics (NSAIDs)** Ibuprofen (Nurofen), Diclofenac (Voltaren), Naproxen (Naprosyn) Inhibit COX enzymes, reducing prostaglandins responsible for pain, inflammation, and fever. Treat mild to moderate pain, inflammation, and fever (e.g., arthritis, menstrual cramps, headaches). Stomach ulcers, GI bleeding, kidney damage, increased risk of heart attack (long-term use), nausea. **Paracetamol (Acetaminophen)** Paracetamol (Panadol) Inhibits prostaglandin synthesis in the CNS, reducing pain and fever, but has minimal anti-inflammatory effect. Treats mild to moderate pain and fever (e.g., headaches, osteoarthritis, cold and flu symptoms). Liver damage (in overdose or high doses), rare allergic reactions. **Opioid Analgesics** Codeine (Solpadeine), Morphine (Sevredol), Oxycodone (OxyNorm), Fentanyl (Durogesic) Bind to opioid receptors in the brain and spinal cord, blocking pain signals and altering pain perception. Treats moderate to severe pain, including post-surgical and cancer-related pain. Constipation, nausea, vomiting, drowsiness, addiction, respiratory depression (high doses). **COX-2 Inhibitors** Celecoxib (Celebrex), Etoricoxib (Arcoxia) Selectively inhibit COX-2 enzyme, reducing pain and inflammation with fewer GI side effects than NSAIDs. Treats arthritis, post-surgical pain, and chronic pain conditions (e.g., osteoarthritis, rheumatoid arthritis). Less GI bleeding than NSAIDs, increased risk of heart attack and stroke, kidney damage. **Anticonvulsants** Gabapentin (Neurontin), Pregabalin (Lyrica) Stabilize electrical nerve activity in the brain, reducing neuropathic (nerve) pain. Treats neuropathic pain (e.g., diabetic neuropathy, post-herpetic neuralgia) and fibromyalgia. Dizziness, drowsiness, weight gain, blurred vision, dry mouth. **Antidepressants (for pain)** Amitriptyline (Elavil), Duloxetine (Cymbalta), Nortriptyline (Allegron) Inhibit reuptake of serotonin and norepinephrine, enhancing pain-modulating pathways in the central nervous system. Used for chronic pain conditions, especially neuropathic pain and fibromyalgia. Drowsiness, dry mouth, constipation, weight gain, dizziness, sexual dysfunction. **Local Anesthetics** Lidocaine (Lidoderm, Versatis) Block sodium channels, preventing pain signals from being transmitted along nerves. Used for localized pain relief, such as in dental procedures, post-herpetic neuralgia, or minor injuries. Skin irritation at application site, numbness, allergic reactions (rare). **Muscle Relaxants** Baclofen (Lioresal), Tizanidine (Sirdalud), Diazepam (Valium) Act on the central nervous system or muscles to reduce muscle spasms and associated pain. Treats muscle spasms due to conditions like back pain, multiple sclerosis, or spinal cord injury. Drowsiness, dizziness, weakness, dry mouth, risk of dependence (especially benzodiazepines). **Corticosteroids** Prednisolone (Deltacortril), Dexamethasone (Decadron), Hydrocortisone (Solu-Cortef) Suppress inflammation by inhibiting various immune system components, reducing pain and swelling. Used to reduce severe inflammation in conditions like rheumatoid arthritis, back pain, or sciatica. Weight gain, high blood sugar, mood changes, osteoporosis, increased infection risk. **Topical Analgesics** Capsaicin (Zacin), Diclofenac Gel (Voltarol), Lidocaine Patches (Versatis) Work locally by blocking pain signals or reducing inflammation at the site of application. Used for localized pain, including arthritis, muscle pain, and post-herpetic neuralgia. Skin irritation, redness, burning sensation, allergic reactions (rare). **NMDA Receptor Antagonists** Ketamine (Ketalar) Blocks NMDA receptors, involved in pain transmission and processing. Used for severe chronic pain, typically in hospital settings or palliative care. Hallucinations, confusion, nausea, increased heart rate, dizziness. **Opioid Antagonists (for opioid-induced constipation)** Naloxegol (Moventig), Methylnaltrexone (Relistor) Block opioid receptors in the gut, preventing opioid-induced constipation without affecting pain relief. Used to relieve constipation caused by opioid use. Diarrhea, stomach pain, flatulence, nausea. **Summary of Categories:** - **Non-Opioid Analgesics (NSAIDs)**: Reduce pain and inflammation (e.g., arthritis, injuries). - **Paracetamol (Acetaminophen)**: Relieves mild to moderate pain and fever. - **Opioid Analgesics**: For moderate to severe pain, but with a risk of addiction and respiratory depression. - **COX-2 Inhibitors**: NSAIDs with fewer GI side effects, used for arthritis and chronic pain. - **Anticonvulsants**: Treat nerve pain (neuropathic pain) and conditions like fibromyalgia. - **Antidepressants (for pain)**: Used for chronic and nerve pain, even if not depressed. - **Local Anesthetics**: Provide localized pain relief for dental procedures, neuralgia, or injuries. - **Muscle Relaxants**: Reduce muscle spasms and associated pain. - **Corticosteroids**: Strong anti-inflammatories for conditions like arthritis or sciatica. - **Topical Analgesics**: Provide localized pain relief for conditions like arthritis or muscle pain. - **NMDA Receptor Antagonists**: Used in hospital settings for severe pain. - **Opioid Antagonists (for opioid-induced constipation)**: Relieve constipation caused by opioid painkillers. Antipsychotic **Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** ----------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- **Typical (First-Generation) Antipsychotics** Haloperidol (Haldol), Chlorpromazine (Largactil), Fluphenazine (Modecate) Block dopamine D2 receptors in the brain, reducing psychotic symptoms. Treats schizophrenia, acute psychosis, and severe agitation. Extrapyramidal symptoms (e.g., tremors, stiffness), sedation, weight gain, tardive dyskinesia, dry mouth. **Atypical (Second-Generation) Antipsychotics** Olanzapine (Zyprexa), Risperidone (Risperdal), Quetiapine (Seroquel), Clozapine (Clozaril) Block both dopamine D2 and serotonin receptors, improving symptoms and reducing side effects. Treats schizophrenia, bipolar disorder, and schizoaffective disorder. Weight gain, sedation, diabetes risk, increased cholesterol, dizziness, risk of agranulocytosis (Clozapine). **Dopamine Partial Agonists (Third-Generation Antipsychotics)** Aripiprazole (Abilify), Brexpiprazole (Rexulti) Partially stimulate dopamine D2 receptors while also blocking serotonin receptors, stabilizing dopamine activity. Used to treat schizophrenia, bipolar disorder, and as an add-on for depression. Insomnia, restlessness, nausea, headache, weight gain (less than atypical antipsychotics), akathisia (restlessness). **Depot Antipsychotics (Long-acting Injections)** Paliperidone Palmitate (Xeplion), Risperidone LAI (Risperdal Consta), Aripiprazole LAI (Abilify Maintena) Long-acting formulations of antipsychotics given as injections, slowly released over weeks or months. Used for long-term treatment of schizophrenia and bipolar disorder to improve medication adherence. Pain at injection site, weight gain, sedation, extrapyramidal symptoms, dizziness. **Mood Stabilizers (also used in psychosis)** Lithium (Priadel), Valproate (Epilim), Lamotrigine (Lamictal) Stabilize mood by affecting neurotransmitter levels (e.g., serotonin, dopamine) and sodium channels in the brain. Used in bipolar disorder and schizoaffective disorder to prevent mood swings and reduce psychosis. Tremor, weight gain, nausea, sedation, thyroid issues (Lithium), liver toxicity (Valproate), rash (Lamotrigine). **Antipsychotic-Sedative Combination** Chlorpromazine (Largactil), Olanzapine (Zyprexa) Antipsychotics with sedative properties, reducing psychotic agitation and promoting calmness. Used in acute psychosis, delirium, and extreme agitation. Sedation, dry mouth, weight gain, hypotension (low blood pressure), extrapyramidal symptoms. **Summary of Categories:** 1. **Typical (First-Generation) Antipsychotics**: Effective for positive symptoms (e.g., hallucinations, delusions) of schizophrenia but have high rates of motor side effects (extrapyramidal symptoms). 2. **Atypical (Second-Generation) Antipsychotics**: Effective for both positive and negative symptoms of schizophrenia with fewer motor side effects but higher risk of weight gain, metabolic issues, and sedation. 3. **Dopamine Partial Agonists (Third-Generation Antipsychotics)**: Stabilize dopamine levels, causing fewer metabolic and motor side effects, often used for schizophrenia and as an add-on for depression. 4. **Depot Antipsychotics (Long-acting Injections)**: Long-lasting injectable forms that improve medication adherence in patients requiring long-term treatment. 5. **Mood Stabilizers**: Used in bipolar disorder and schizoaffective disorder, particularly for mood swings and psychotic episodes. 6. **Antipsychotic-Sedative Combinations**: Used for managing agitation, psychosis, and severe restlessness in acute care settings. Parkinson **category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** ------------------------------------------------------ ------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- **Dopamine Precursors** Levodopa/Carbidopa (Sinemet), Levodopa/Benserazide (Madopar) Levodopa is converted to dopamine in the brain, while carbidopa/benserazide prevents its breakdown in the periphery. Treats motor symptoms like tremors, stiffness, and slowness in Parkinson's disease. Nausea, vomiting, dizziness, low blood pressure, dyskinesia (involuntary movements), confusion. **Dopamine Agonists** Pramipexole (Mirapexin), Ropinirole (Requip), Rotigotine (Neupro Patch) Stimulate dopamine receptors in the brain, mimicking the action of dopamine. Treats motor symptoms of Parkinson's disease, especially in the early stages or as add-on therapy. Sleepiness, hallucinations, compulsive behaviors (e.g., gambling), dizziness, low blood pressure. **MAO-B Inhibitors** Selegiline (Eldepryl), Rasagiline (Azilect) Inhibit the enzyme monoamine oxidase B (MAO-B), which breaks down dopamine in the brain. Used to increase dopamine levels, improve motor symptoms, and slow disease progression. Insomnia, nausea, headache, dizziness, increased blood pressure (rare). **COMT Inhibitors** Entacapone (Comtan), Tolcapone (Tasmar) Inhibit catechol-O-methyltransferase (COMT), which breaks down levodopa, increasing dopamine availability. Used in combination with Levodopa to extend its effect and control motor symptoms. Diarrhea, nausea, orange urine, liver toxicity (rare with Tolcapone). **Anticholinergics** Trihexyphenidyl (Artane), Benztropine (Cogentin) Block acetylcholine receptors to reduce tremors and muscle stiffness. Primarily used for tremors in younger patients with Parkinson's disease. Dry mouth, blurred vision, constipation, confusion, urinary retention. **Amantadine** Amantadine (Symmetrel) Increases dopamine release, blocks NMDA receptors, and reduces dyskinesia (involuntary movements). Used to reduce motor symptoms and dyskinesia in Parkinson's disease. Dizziness, dry mouth, swelling of the ankles, confusion, hallucinations. **Deep Brain Stimulation (DBS) - Adjunct Treatment** \- Surgical implantation of electrodes in the brain to modulate abnormal brain activity. Used for patients with advanced Parkinson's disease who do not respond well to medications. Risk of infection, bleeding, or stroke from surgery, mood changes, confusion. **Summary of Categories:** 1. **Dopamine Precursors**: Levodopa is the most effective drug for treating motor symptoms of Parkinson's disease. It is often combined with carbidopa or benserazide to prevent side effects like nausea. 2. **Dopamine Agonists**: These drugs mimic dopamine by stimulating dopamine receptors in the brain, used to manage motor symptoms, especially early in the disease or as an add-on to Levodopa. 3. **MAO-B Inhibitors**: These drugs prevent the breakdown of dopamine, which increases its availability in the brain, helping manage symptoms and potentially slowing disease progression. 4. **COMT Inhibitors**: These drugs are used alongside Levodopa to prolong its effect, making it more effective in controlling motor symptoms for longer. 5. **Anticholinergics**: These medications are used to treat tremors and stiffness, particularly in younger patients, but can cause significant side effects in older adults. 6. **Amantadine**: It has multiple mechanisms of action, including increasing dopamine and reducing dyskinesia, making it helpful for both motor symptoms and involuntary movements. 7. **Deep Brain Stimulation (DBS)**: A non-medication treatment option for advanced Parkinson's, used when medications alone are not effective. Heart Failure **Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** -------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------- **ACE Inhibitors** Ramipril (Tritace), Lisinopril (Zestril), Enalapril (Innovace) Inhibit the enzyme ACE, reducing the production of angiotensin II, leading to vasodilation and reduced blood pressure. Reduce symptoms and slow progression of heart failure by reducing blood pressure and preventing heart remodeling. Dry cough, low blood pressure, high potassium levels, dizziness, kidney dysfunction. **Angiotensin II Receptor Blockers (ARBs)** Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand) Block angiotensin II from binding to its receptors, leading to vasodilation and reduced blood pressure. Alternative to ACE inhibitors in patients who cannot tolerate them. Improves heart failure symptoms. Dizziness, low blood pressure, high potassium levels, kidney dysfunction, rare angioedema. **Beta Blockers** Bisoprolol (Cardicor), Carvedilol (Eucardic), Metoprolol (Betaloc) Block the effects of adrenaline on the heart, slowing the heart rate and reducing workload on the heart. Reduce mortality and hospitalization in heart failure by improving heart function and reducing stress on the heart. Fatigue, slow heart rate, dizziness, cold hands/feet, low blood pressure, worsening asthma. **Mineralocorticoid Receptor Antagonists (MRAs)** Spironolactone (Aldactone), Eplerenone (Inspra) Block aldosterone, reducing sodium and water retention, lowering blood pressure, and reducing heart workload. Prevent worsening of heart failure by reducing fluid buildup and preventing heart remodeling. High potassium levels, kidney dysfunction, breast tenderness (gynecomastia with Spironolactone). **Diuretics** Furosemide (Lasix), Bumetanide (Burinex), Torsemide (Torem) Increase excretion of sodium and water by the kidneys, reducing fluid buildup and lowering blood pressure. Relieve symptoms of fluid overload (e.g., swelling, shortness of breath) in heart failure. Increased urination, low potassium levels, dehydration, dizziness, kidney dysfunction. **Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)** Sacubitril/Valsartan (Entresto) Sacubitril inhibits neprilysin, increasing natriuretic peptides, which help reduce blood volume and blood pressure. Combined with ARB for dual action. Improve heart function and reduce symptoms in patients with reduced ejection fraction heart failure. Low blood pressure, high potassium, dizziness, kidney dysfunction, cough. **Ivabradine** Ivabradine (Procoralan) Lowers heart rate by inhibiting the If current in the sinoatrial node without affecting blood pressure. Used in patients with heart failure to reduce hospitalizations and improve symptoms when heart rate is elevated. Bradycardia (slow heart rate), visual disturbances, dizziness, low blood pressure. **Digoxin (Cardiac Glycoside)** Digoxin (Lanoxin) Increases the force of heart contractions and slows the heart rate by inhibiting the Na+/K+ ATPase pump. Used to control heart rate in patients with heart failure and atrial fibrillation. Nausea, dizziness, vision disturbances, arrhythmias, digoxin toxicity (narrow therapeutic window). **SGLT2 Inhibitors** Dapagliflozin (Forxiga), Empagliflozin (Jardiance) Inhibit sodium-glucose co-transporter 2 (SGLT2) in the kidneys, reducing glucose reabsorption and lowering blood sugar. Recently found to reduce hospitalizations and mortality in heart failure, even in non-diabetic patients. Urinary tract infections, increased urination, dehydration, low blood pressure. **Hydralazine/Isosorbide Dinitrate (Combination)** Hydralazine (Apresoline) + Isosorbide Dinitrate (Isoket) Hydralazine relaxes arteries (vasodilation), and isosorbide dinitrate relaxes veins, reducing heart workload. Used in heart failure, particularly in patients who cannot tolerate ACE inhibitors or ARBs, or in certain populations (e.g., African descent). Headache, dizziness, low blood pressure, nausea, fast heart rate (reflex tachycardia). **Summary of Categories:** 1. **ACE Inhibitors**: Reduce blood pressure and heart stress by inhibiting angiotensin II production, a hormone that narrows blood vessels. They improve heart function and slow the progression of heart failure. 2. **Angiotensin II Receptor Blockers (ARBs)**: Work similarly to ACE inhibitors but block the receptor for angiotensin II. They are used as an alternative for patients who can\'t tolerate ACE inhibitors. 3. **Beta Blockers**: Slow the heart rate and reduce the workload of the heart, improving heart function over time and reducing the risk of heart failure progression. 4. **Mineralocorticoid Receptor Antagonists (MRAs)**: Prevent fluid buildup by blocking aldosterone, a hormone that increases sodium and water retention. These drugs help reduce fluid retention and prevent further heart damage. 5. **Diuretics**: Help eliminate excess fluid in the body, reducing symptoms like swelling and shortness of breath. They are important for controlling fluid overload in heart failure. 6. **Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)**: A combination drug that reduces blood pressure, improves heart function, and prevents worsening of heart failure by enhancing natural peptides that lower blood volume. 7. **Ivabradine**: Lowers heart rate without affecting blood pressure, improving symptoms and reducing hospitalizations in heart failure. 8. **Digoxin**: Increases the strength of the heart\'s contractions and helps control heart rate in patients with both heart failure and atrial fibrillation. 9. **SGLT2 Inhibitors**: Originally developed to treat diabetes, these drugs have been shown to improve outcomes in heart failure, reducing hospitalizations and mortality. 10. **Hydralazine/Isosorbide Dinitrate**: This combination reduces the workload on the heart by dilating blood vessels and is especially useful for patients who cannot tolerate ACE inhibitors or ARBs. Asthma **Category** **Generic Name (Trade Name in Ireland)** **Pharmacology** **Purpose** **Common Side Effects** ----------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- **Short-Acting Beta Agonists (SABA)** Salbutamol (Ventolin), Terbutaline (Bricanyl) Stimulate beta-2 receptors in the lungs, causing bronchodilation (airway widening) and rapid relief of symptoms. Used for quick relief of asthma symptoms, such as wheezing and shortness of breath (rescue inhaler). Tremors, increased heart rate, nervousness, headache. **Long-Acting Beta Agonists (LABA)** Salmeterol (Serevent), Formoterol (Oxis) Stimulate beta-2 receptors in the lungs, causing prolonged bronchodilation. Used as maintenance therapy to prevent asthma symptoms. Usually combined with inhaled corticosteroids. Tremors, increased heart rate, headache, muscle cramps. **Inhaled Corticosteroids (ICS)** Beclometasone (Clenil), Budesonide (Pulmicort), Fluticasone (Flixotide) Reduce inflammation in the airways by inhibiting inflammatory cells and decreasing mucus production. Used as a long-term maintenance treatment to control chronic inflammation and prevent asthma attacks. Oral thrush, hoarseness, sore throat, coughing, long-term use: risk of osteoporosis. **Combination ICS/LABA** Fluticasone/Salmeterol (Seretide), Budesonide/Formoterol (Symbicort) Combines anti-inflammatory effects of corticosteroids with prolonged bronchodilation from LABAs. Used as a long-term maintenance treatment to control chronic asthma and prevent exacerbations. Side effects from both ICS and LABA: oral thrush, increased heart rate, headache, muscle cramps. **Leukotriene Receptor Antagonists (LTRA)** Montelukast (Singulair), Zafirlukast (Accolate) Block leukotriene receptors, reducing airway inflammation, bronchoconstriction, and mucus production. Used to prevent asthma symptoms and exercise-induced bronchospasm, especially in allergic asthma. Headache, abdominal pain, dizziness, mood changes (rare). **Theophylline (Methylxanthines)** Theophylline (Uniphyllin, Slo-Phyllin) Inhibits phosphodiesterase, leading to bronchodilation and reduced airway responsiveness. Used as a maintenance therapy to control asthma, particularly in severe cases. Nausea, vomiting, tremors, insomnia, arrhythmias, risk of toxicity (narrow therapeutic window). **Long-Acting Muscarinic Antagonists (LAMA)** Tiotropium (Spiriva Respimat) Block muscarinic receptors in the airways, leading to bronchodilation. Used as an add-on therapy in severe asthma to improve lung function and prevent exacerbations. Dry mouth, throat irritation, urinary retention, constipation. **Oral Corticosteroids** Prednisolone (Deltacortril), Hydrocortisone (Solu-Cortef) Systemically reduce inflammation by suppressing the immune response. Used for short-term treatment of severe asthma attacks or exacerbations. Weight gain, mood swings, increased blood sugar, osteoporosis, risk of infections (long-term). **Biologics (Monoclonal Antibodies)** Omalizumab (Xolair), Mepolizumab (Nucala), Benralizumab (Fasenra) Target specific immune pathways (e.g., IgE or eosinophils) to reduce airway inflammation and asthma symptoms. Used for severe asthma, especially allergic asthma or eosinophilic asthma, unresponsive to other therapies. Injection site reactions, headache, fatigue, risk of infection. **Short-Acting Anticholinergics** Ipratropium Bromide (Atrovent) Block muscarinic receptors, causing bronchodilation and reducing mucus production. Used as a quick relief bronchodilator in acute asthma attacks, often combined with SABAs. Dry mouth, blurred vision, throat irritation, urinary retention (rare). **Summary of Categories:** 1. **Short-Acting Beta Agonists (SABA)**: These are fast-acting bronchodilators used for quick relief during an asthma attack or before exercise to prevent symptoms. They open up the airways quickly but are short-lasting. 2. **Long-Acting Beta Agonists (LABA)**: These bronchodilators last longer (up to 12 hours) and are used for daily maintenance to prevent asthma symptoms. They are usually used in combination with inhaled corticosteroids. 3. **Inhaled Corticosteroids (ICS)**: These are the mainstay of long-term asthma management, reducing airway inflammation and preventing symptoms. They must be used regularly to control chronic asthma. 4. **Combination ICS/LABA**: These inhalers combine an inhaled corticosteroid with a long-acting bronchodilator, providing both anti-inflammatory and bronchodilatory effects for long-term control of asthma. 5. **Leukotriene Receptor Antagonists (LTRA)**: These oral medications reduce inflammation and bronchoconstriction caused by leukotrienes, particularly useful in allergic asthma or exercise-induced asthma. 6. **Theophylline (Methylxanthines)**: Theophylline is a bronchodilator that is used for asthma control, particularly in more severe cases. However, it requires careful monitoring due to its narrow therapeutic range. 7. **Long-Acting Muscarinic Antagonists (LAMA)**: These are inhaled medications that help open up the airways and are usually used in severe asthma or COPD as an add-on therapy. 8. **Oral Corticosteroids**: These are systemic anti-inflammatory medications used for severe asthma attacks or exacerbations. Due to significant side effects, they are used only for short-term treatment. 9. **Biologics (Monoclonal Antibodies)**: These advanced treatments target specific parts of the immune system, used in patients with severe asthma that does not respond to standard therapies. 10. **Short-Acting Anticholinergics**: These are bronchodilators used during asthma attacks. They are often combined with short-acting beta agonists for quick relief.