Pica, ingestion if flakes of paint, abdominal colic, acute encephalopathy, wrist drop, mental retardation
Lead
Acute arsenic poisoning
Acute mercury poisoning
Chronic severe lead poisoning
SE: hypertension
Dimercaprol
Chronic lead poisoning (oral treatment)
Succimer
Chronic severe lead poisoning
SE: hypocalcemia
EDTA (Edetate Calcium Disodium)
Rice-water stools, garlicky breath, Meeβs lines, raindrop pigmentation, milk and roses complexion
Arsenic
Hemorrhagic, gastroenteritis, renal failure, loosening of gums and teeth, erethism
Inorganic mercury
Minamata disease (cerebral palsy, deafness, blindness, mental retardation)
Organic mercury
Severe GI necrosis, hemosiderosis, restrictive cardiomyopathy
Iron
Acute iron poisoning, hemochromatosis
Deferoxamine
Hepatotoxicity, Kayser-Fleisher rings, sunflower cataracts
Copper
Copper poisoning, Wilsonβs disease
SE: drug-induced lupus
Penicillamine
Treatment of lymphomas
SE: hemorrhagic cystitis
Rescue agent: Mesna
Cyclophosphamide
Treatment of colon cancer
SE: ototoxicity, nephrotoxicity
Rescue agent: Amifostine
Cisplatin
SE: marked vesicant actions (skin blistering)
Mechlorethamine
SE: Disulfiram reaction, Leukemogenesis
Procarbazine
Testicular and ovarian tumor
SE: Pulmonary fibrosis, bone marrow-sparing
Bleomycin
Treatment of brain tumors
SE: CNS toxicity
Carmustine
Tyrosine kinase inhibitor
Treatment of CML
SE: fluid retention, multiple drug interations
Imatinib
Treatment of metastatic breast cancer, active against cells expressing HER-2/neu
Trastuzumab
Inhibits VEGF, treatment of metastatic cancers
Bevacizumab
Differentiation therapy, treatment of acute promyelocytic leukemia, only vitamin that can cure cancer
All trans retinoic acid (ATRA)
Drugs that cause PULMONARY FIBROSIS
BBBAN ME Bleomycin Busulfan Bromocriptine Amiodarone Nitrofurantoin Methotrexate
Treatment of lymphomas and GTN
Myelosuppression, pulmonary fibrosis
Rescue agent: Leucovorin (folinic acid)
Methotrexate
Treatment of acute leukemias
Myelosuppression, hepatotoxicity, metabolism inhibited by allopurinol
6-Mercaptopurine
Treatment of colorectal and skin cancer, causes thymine-less death of cells
Myelosuppression
5-Flurouracil
Treatment of CML in blast crisis, most specific for the S phase of the cell cycle
Cytarabine
Inhibits ribonucleotide reductase, treatment of pancreatic cancer
Gemcitabine
Vinca alkaloid, prevents microtubule assembly
Peripheral neuropathy
Vincristine
Podophyllotoxin, inhibits DNA topoisomerase II, treatment of lung cancer, non Hodgkinβs lymphoma and GTN
Etoposide
Camptothecin, inhibits DNA topoisomerase I, treatment of small cell lung cancer
Topotecan
Taxane, prevents microtubule disassembly, advanced breast and ovarian cancers
Paclitaxel
Intercalating agent
Dilated cardiomyopathy
Rescue agent: Dexrazoxane
Doxorubicin
Treatment of testicular cancer
Pulmonary fibrosis, most specific for the G2 phase of the cell cycle
Bleomycin
Treatment of melanoma, Wilmβs tumor and GTN
Actinomycin D
Opioid antispasmodic, DOC for noninfectious diarrhea
SE: paralytic ileus (in children)
Loperamide
Stimulant laxative
SE: Melanosis coli
Senna
Osmotic laxative
Treatment of hepatic encephalopathy
Lactulose
Prokinetic agent, antiemetic, DOC for diabetic gastroparesis
Metoclopromide
Irreversible blockage of H+/K+ ATPase, DOC for peptic ulcer disease and Zollinger-Ellison syndrome
Omeprazole
Neutralizes stomach acids
SE: diarrhea-constipation (cancels each other)
Maalox
Greatly suppresses nocturnal acid secretion, H2 blocker
SE: gynecomastia
Cimetidine
Describe the function of osteoblasts and osteoclasts
osteoBlast = Builds Bone
osteoClast = Cleaves/resorbs bone
Function of PTH
ParaThyroid Hormone PTH Phosphate Thrashing Hormone
Signs and symptoms of excess PTH
HYPERPARATHYROIDISM Painful bones Renal stones Abdominal groans Psychiatric overtones
What is the function of calcitonin?
CalciTONin = TONes down
Calcium
(Reduces blood Ca, decreases bone resorption)
Phosphate-binding resin
Sevelamer
Suppresses osteoclast activity, treatment of Pagetβs disease of bone and osteoporosis
SE: esophagitis
Alendronate
Treatment of Pagetβs disease of bone, Hypercalcemia, tumor marker for medullary thyroid CA
Calcitonin
Active vitamin D, treatment of secondary hyperparathyroidism
Calcitriol
Inactive Vitamin D, treatment of rickets and osteomalacia
Ergocalciferol
Why is there paradoxical improvement of diabetes in patients with end-stage renal disease?
Insulin has prolonged half life due to decreased clearance
Which patient are more prone to developing hypoglycemia with insulin use?
PRONE TO HYPOGLYCEMIA
- Advanced renal disease
- Elderly
- Children younger than 7 years
a-glucosidase inhibitor
Flatulence
Acarbose
TZD, acts on PPAR-y, insulin sensitizer
CHF
Pioglitazone
First line anti diabetic drug, decreases gluconeogenesis
SE: lactic acidosis, weight loss (DOC for obese diabetics)
GI upset
Metformin
Newer insulin secretagogue, NO hypoglycemia
Repaglinide
2nd generation SU
Hypoglycemia, weight gain, disulfiram reaction
Glipizide
1st generation SU
Hypoglycemia, weight gain, disulfiram reaction
Chlorpropamide
Most efficacious anti diabetic drug, activates tyrosine kinase
Hypoglycemia, lipodystrophy
Insulin
Treatment of male hypogonadism
SE: virilization, paradoxical feminization
Testosterone
Anabolic steroids, illegal performance enhancers
Oxandrolone
Treatment of prostate cancer, coadministered to prevent acute flare-ups of tumor
Flutamide + Leuprolide
5-a-reductase inhibitor, treatment of benign prostatic hyperplasia and male pattern baldness
Finasteride
Most frequently used synthetic estrogen in OCPs
SE: hypertension, DVT/PE, endometrial CA, contraindicated in women (age >35) who are heavy smokers
Ethinyl estradiol
SE: clear cell vaginal adenoCA in daughter
Diethylstilbestrol
Prevents estrogen-induced endometrial CA
Norgestrel
OCP of choice in lactating women
DMPA
Emergency contraception, Yuzpe regimen
Levonorgestrel
Hormone-responsive breast CA
SE: endometrial CA
TAMOxifen
TAnggal Mammary Mo
Ovulation induction
SE: multiple pregnancies
Clomiphene
Clone Me Phlease
Treatment of endometriosis
Danazol
Medical abortion
Mifepristone
NORgestimate, NORethindrone and NORgestrel are NOT ESTROGENS!
They are PROGESTINS!
Treatment of genetic short stature, failure to thrive
Somatotropin
Treatment of acromegaly, variceal bleeding
Ocreotide
Treatment of hyperprolactinemia, prolactinoma
Bromocriptine
Labor induction/augmentation, control of postpartum hemorrhage
SE: fluid retention
Oxytocin
Treatment of central diabetes insipidus
Desmopressin
Treatment of hypothyroidism, myxedema coma
Levothyroxine
Inhibits thyroid peroxidase, blocks peripheral conversion to T4 to T3
SE: agranulocytosis, DOC in pregnant hyperthyroid patients
PTU
Inhibits thyroid peroxidase
SE: agranulocytosis, teratogen (aplasia cutis)
Methimazole
Preferred treatment for hyperthyroidism
SE: permanent hypothyroidism
Radioactive Iodine
Reduces size and vascularity of thyroid gland
SSKI
Sympathetic treatment of hyperthyroidism, decreases peripheral conversion of T4 to T3
Propanolol
Differentiate Wolf-Chaikoff effect from Jod-Basedow phenomenon
Wolf-Chaikoff effect ingestion of iodine causes hypothyroidism
Jod-Basedow phenomenon ingestion of iodine causes hyperthyroidism
Which antithyroid drug inhibit peripheral conversation to T4 to T3?
PTU, propanolol, hydrocortisone
What drugs can cause drug-induced hyperthyroidism?
Clofibrate
Acute adrenal insufficiency, status asthmaticus, thyroid storm
Hydrocortisone
Prototype oral glucocorticoid
SE: adrenal suppression, Cushing syndrome
Prednisone
Hastens fetal lung maturation
Betamethasone
Mineralocorticoid replacement for chronic adrenal insufficiency (Addison disease)
Fludrocortisone
Why are statins used in the management of coronary artery disease?
Stabilizes atherosclerotic plaque
What are the drugs that cause flushing?
Vancomycin
Adenosine
Niacin
Calcium channel blockers
HMG-CoA reductase inhibitor, lowers LDL
Hepatotoxicity, rhabdomyolysis, myopathy
Simvastatin
Bile acid binding resin, lowers LDL
Constipation, steatorrhea
Cholestyramine
Reduces all building blocks for hyperlipidemia, increases HDL, lowers LDL and TG
Flushing, hyperglycemia, hyperuricemia
Niacin
PPAR-a activator, upregulates lipoprotein lipase, lowers TG
Gallstones, addictive myopathy
Gemfibrozil
Dream-like state, red conjunctiva, tachycardia, dry mouth
Marijuana
Psychedelic effects (out of body experience), mind raveling effects, bad trips
LSD
Most dangerous hallucinogen, psychotomimetic effects, nystagmus
Phencyclidine
Mydriasis, crack lung, teratogen (cystic cortical lesions)
Cocaine
Sexual enhancement, hyponatremia
MDMA (ecstasy)
Euphoria, sleeplessness, self-confidence
Amphetamine
Triad of opioid overdose
OPIOID OVERDOSE P-C-R Pupillary constriction Comatose state Respiratory depression
Which opioids have the shortest and longest half-lives?
REMIFENTANIL = shortest half-life (3-4mins)
BUPRENORPHINE = longest half-life (4-8 hrs)
Prototype opioid (full agonist)
Miosis, respiratory depression, constipation
Morphine
Severe pain, breakthrough cancer pain, available in lollipop form or transdermal patch
Fentanyl
Opioid of choice for acute pancreatitis, does NOT cause miosis
Seizures (normeperidine)
Meperidine
Replacement therapy for opioid dependence
Methadone
Cough suppression
Dextromethorphan
Balanced anesthesia, frequently abused by healthcare professionals
Nalbuphine
Antidote to opioid overdose
Naloxone
Treatment of opioid dependence
Naltrexone
Symptoms of serotonin syndrome
FAT CHD Fever Agitation Tremor Clonus Hyperreflexia Diaphoresis
Drugs that can cause priapism
Tigas PeniS Qu AyaW Bumaba! Trazodone Papaverine Sildenafil Quetiapine Alprostadil Warfarin Bupropion
Drugs that can cause erectile dysfunction
A SORE PEniS can't Fuck Hard! SSRIs Opiates Risperidone Ethanol Propranolol Estrogens Spironolactone Finasteride Hydrochlorothiazide
What are the features of tricyclic antidepressant overdose?
3 Cs TCA Overdose
Coma
Convulsions
Cardiotoxicity
Monoamine oxidase inhibitor
Hypertensive crisis when taken with tyramine (in cheese), serotonin syndrome
Phenelzine
Tetracyclic antidepressant, smoking cessation
Weight loss, priapism, seizures
Bupropion
Serotonin antagonist
Priapism
Trazodone
Serotonin-Norepinephrine reuptake inhibitor (SNRI)
Hypertension
Venlafaxine
Selective serotonin reuptake inhibitor (SSRI), first line drug for major depressive disorder
Erectile dysfunction, serotonin syndrome
Fluoxetin
Tricyclic antidepressant, treatment of enuresis
Atropine-like effects, cardiotoxicity
Imipramine
What are the features of neuroleptic malignant syndrome?
Fever Encephalopathy Vitals unstable Elevated CPK Rigidity
Nephrogenic diabetes insipidus, teratogen (Ebsteinβs anomaly)
Mania
Lithium
Marked hyperprolactinemia
For schizophrenia in the youth
Risperidone
Priapism, hypnagogic hallucinations
2nd generation
Quetiapine
Marked weight gain, hyperglycemia
2nd generation
Olanzapine
DOC for suicidal and refractory schizophrenics
Agranulocytosis
Clozapine
Treatment of floridly psychotic patients
Major EPS (neuroleptic malignant syndrome)
Haloperidole
Prototype typical antipsychotic
Corneal/lens deposits, failure of ejaculation
Chlorpromazine
Drugs that cause livedo reticularis
A man reads FHM and GQ Amantadine Hydroxyurea Minocycline Gemcitabine Quinidine
Primary signs of Parkinsonβs Disease
It's a TRAP! Tremor Rigidity Akinesia Postural instability
Improves tremor and rigidity but has no effect of bradykinesia, atropine-like effects
Benztropine
Antiparkinsonism drug with antiviral properties
SE: livedo reticularis, cerebellar ataxia
Amantadine
Drug of choice for Parkinsonβs disease
Levodopa + Carbidopa
Treatment of hyperprolactinemia
SE: erythromelalgia, pulmonary fibrosis
Bromocriptine
Adjunctive drug for wearing-off phenomena
Entacapone
Prototype nondepolarizing neuromuscular blocker
Orthostatic hypotension
Tubocurarine
Undergoes human elimination
Bronchospasm, most frequently used nondepolarizing neuromuscular blocker
Atracurium
Lethal injection
Strychnine poisoning
Pancuronium
Reversal agent for nondepolarizing neuromuscular blockade
Neostigmine
Depolarizing neuromuscular blocker
Malignant hyperthermia, affected by pseudocholinesterase activity
Succinylcholine
What is the toxic dose if LIDOCAINE?
Toxic dose = 5 mg/kg for any drug or solution
1% = 10 mg/mL
Why should we not inject LIDOCAINE into abscesses?
DONT INJECT LIDOCAINE INTO ABSCESS
Wonβt work due to acidic environment (below pKa = protonated form predominates, so it canβt penetrate tissues)
Which local a esthetics have the shortest and longest half-lives?
PROCAINE = shortest half-life (1-2 mins)
A PRO finishes the race fastest.
ROPIVACAINCE = longest half-life (4.2 hrs)
At the end of the long ROPe.
How will you distinguish whether local anesthetics are esters or amides?
ESTERS have only 1i in their names.
Tetracaine, Procaine, Benzocaine
AMIDES have 2i in their names.
Bupivacaine, Ropivacaine, Lidocaine
Prolonged sedation, βmilk of amnesiaβ
Hypotension
Rate of onset similar to THIOPENTAL but better recovery
Pain at site of injection: mc side effect
Propofol
Anesthesia for patients with limited cardiopulmonary reserve
Adrenal suppression
Etomidate
Dissociative anesthesia, NMDA receptor blocker
Emergence delirium
Used in trauma cases where cardiovascular support is necessary
Catatonia, amnesia, analgesia without LOC
Ketamine
Lowest MAC (highest potency), slowest induction and recovery
Methoxyflurane
Postoperative hepatitis, malignant hyperthermia
Halothane
Pulmonary irritant
Desfurane
Highest MAC (lowest potency)
Euphoria
Nitrous Oxide
Generalized Tonic-Clonic seizures
DOC: Valproic acid, phenytoin, carbamazepine
Alternative: Phenobarbital, lamotrigine, topiramate
Partial seizures
DOC: carbamazepine, lamotrigine, phenytoin
Alternative: felbamate, phenobarbital, topiramate, Valproic acid
Absence seizures
DOC: ethosuximide, valproic acid
Alternative: lamotrigine, levetiracetam, zonisamides, clonazepam
Myoclonic and Atypical absence syndromes
DOC: Valproic acid
Alternative: clonazepam, levetiracetam, topiramate, zonisamide, felbamate
Status epilepticus
DOC: lorazepam, diazepam, phenytoin, phenobarbital
Potent CYP450 inducer
SE: gingival hyperplasia, hirsutism, fetal hydantoin syndrome
PHENYTOIN
Potent CYP450 inducer
DOC for partial seizures and trigeminal neuralgia
SE: blood dyscrasias
CARBAMAZEPINE
Potent CYP450 inhibitor
DOC for GTC and myoclonic seizures
SE: teratogen (spina bifida)
VALPROIC ACID
Potent CYP450 inducer
DOC for seizures in children and pregnant women
SE: porphyria
PHENOBARBITAL
DOC for absence seizures
ETHOSUXIMIDE
DOC for status epilepticus
DIAZEPAM
Treatment of neuropathic pain
GABAPENTIN
SE: Stevens-Johnson syndrome
LAMOTRIGINE
Most frequently abused drug, Wernicke-Korsakoff syndrome in overdose, delirium tremens in withdrawal
ETHANOL
Prevention of Wernicke-Korsakoff syndrome
THIAMINE
Treatment of alcohol withdrawal
DIAZEPAM
Wood alcohol
SE: visual dysfunction due to formaldehyde accumulation
METHANOL
Antifreeze
SE: nephrotoxicity due to oxalic acid accumulation
ETHYLENE GLYCOL
Alcohol dehydrogenase inhibitor
FOMEPIZOLE
Aldehyde dehydrogenase inhibitor
DISULFERAM
SEDATIVE HYPNOTIC POISONING
(Hot Hot Hot DeCisioN) Hypothermia Hypotension Hypoactive BS Disinhibition Coma Nystagmus
What is the most catastrophic symptom of sedative-hypnotic withdrawal?
Rebound suicide
Shortest acting
THIOPENTAL
TAYO agad!!!
Which drugs are considered date-rape drugs?
DATE-RAPE DRUGS:
Alcohol (most common)
Flunitrazepam (rohypnol)
Gamma-hydroxybutyrate
Which benzodiazepine has the longest half-life?
CHLORDIAZEPOXIDE
longest half-life (36-200 hours) Longest spelling (many letters)
What abnormal sleep pattern results from the use of benzodiazepines?
Decreased REM SLEEP
Seizure disorders in children
SE: precipitates porphyria, potent inducer of CYP450
PHENOBARBITAL
Anesthesia induction, lethal injection, truth serum
THIOPENTAL
Antidote to benzodiazepine overdose
FLUMAZENIL
Date-rape drug
FLUNITRAZEPAM
Seizure disorders (status epilepticus)
Alcohol withdrawal
Tranquilizer
DIAZEPAM
Acute anxiety attacks
Anesthesia induction
Preoperative sedation
MIDAZOLAM
Inhibits helminthology microtubules
Ovicidal
Mebendazole
Inhibits helminthic microtubules
Ovicidal and larvicidal
DOC for hydatid disease (echinococcosis)
Albendazole
DOC for Filaria and Loa loa
SE: filarial fever
DEC (Diethylcarbamazine)
DOC for Strongyloides and Onchocerca
SE: Mazzotti reaction
Ivermectin
DOC for Enterobius
Pyrantel Pamoate
DOC for Trichinosis
Thiabendazole
DOC for trematodes and cestodes EXCEPT echinococcosis (ALBENDAZOLE)
PRAZIQUANTEL
Back-up drug to PRAZIQUANTEL
NICLOSAMIDE
Pneumocystis jerovocii
TMZ-SMX
Chagaβs disease
NIFURTRIMOX
African sleeping sickness
Suramin + Melarsoprol
Toxoplasmosis
Pyrimethamine-Sulfadiazine
Cryptosporidium parvum infection
Nitazoxanide
Amebic dysentery
Trichomoniasis
Bacterial vaginosis
Metronidazole
Asymptomatic cyst carriers of E. Histolytica
Diloximife furoate
DOC for malaria in the Philippines (P. Falciparum)
Co-artem
Chemoprophylaxis (multi-drug resistant areas)
Doxycycline
Chemoprophylaxis (chloroquine-resistant areas)
Mefloquine Malaxone
Eradication of hypnozoites of P. Vivax and ovale
Primaquine
Chloroquine-resistance
Severe malaria
DOC for pregnant patients with malaria
SE: hypoglycemia, Blackwater fever, cinchonism
Quinine
Primary drug for malaria
Prevents heme polymerization into hemozoin
SE: retinal damage, hearing loss
Chloroquine
Binding inhibitor, CCR5 antagonist
Maraviroc
Fusion inhibitor, binds gp41 subunit
Enfuvirtide
Protease inhibitor
SE: fat redistribution syndrome, hyperlipidemia, insulin resistance
Indinavir
Non-nucleoside reverse transcriptase inhibitor (NNRTI)
No phosphorylation required
SE: hepatotoxicity
Delavirdine
Nucleoside reverse transcriptase inhibitor (NRTI)
Requires phosphorylation
Primary drug for HIV
Prevents vertical transmission of HIV
SE: Lactic acidosis
Zidovudine (AZT)
Treatment of hepatitis C and RSV infection
Ribavirin
Treatment of Hepatitis B infection
Lamivudine
Neuraminidase inhibitor
DOC for influenza
Oseltamivir
Prevents viral uncoating
Influenza A coverage
SE: cerebellar dysfunction, livedo reticularis
Amantadine
Treatment of HSV, VZV and CMV
Does NOT require viral thymidine kinase activation
Foscarnet
Treatment of CMV
Requires activation by viral thymidine kinase (neutropenia)
Ganciclovir
Treatment of HSV and VZV
Requires activation by viral thymidine kinase
SE: cystalluria
Acyclovir
Treatment of candidiasis (oropharnygeal, esophageal, vaginal)
Swish and swallow or suppository preparations
Nystatin
Interferes with fungal microtubules
SE: potent CYP450 inducer
Griseofulvin
Prophylaxis and treatment of candidiasis and cryptococcosis
Fluconazole
Topical treatment of dermatophytosis and candidiasis
SE: gynecomastia, CYP450 inducer
Ketoconazole
Most efficacious antifungal drug
Forms artificial pores
SE: nephrotoxicity (RTA, ATN)
Amphotericin B
Which antibiotics are considered drugs of last resort?
I AM your Last Shot at Victory IMIPENEM AMIKACIN MEROPENEM LINEZOLID STREPTOGRAMINS VANCOMYCIN
Silver bullet against gram negative bacteria
No gram positive activity with PSEUDO COVERSGE
Aztreonam
Beta-lactamase inhibitor
Clavulanic acid (Tazobactam)
Treatment for MRSA
SE: Red Man Syndrome
Vancomycin
Drug of last resort
Broad spectrum of activity
SE: toxicity
Meropenem
Anaerobic and antiprotozoal coverage
Treatment of pseudomembranous colitis
SE: disulfiram reaction, metallic taste, neurotoxicity
Metronidazole
Treatment of urinary tract infections
SE: pulmonary fibrosis
Nitrofurantoin
Most active drug against M. Leprae
Inhibits folate synthesis
SE: methomoglobinemia (chocolate blood color)
Tx: methylene blue
Dapsone (hemolysis in G6PD)
Inhibits DNA-dependent RNA polymerase
SE: red-orange urine, delays onset of dapsone resistance
Rifampicin
Phenazine dye
Binds to guanine bases
SE: skin discoloration
Clofazimine
Which anti-TB drugs are hepatotoxic?
ISO a Red PYRe! (I saw a red fire)
Isoniazid < Rifampicin < Pyrazinamide
Cidal
Inhibits mycolic acid synthesis
SE: neurotoxicity, hepatotoxicity, sideroblastic anemia, drug-induced lupus, potent CYP450 inhibitor
Isoniazid
Static
Inhibits DNA-dependent RNA polymerase
SE: red orange urine, hepatotoxicity
Rifampicin
Static
Inhibits arabinoglactan synthesis
SE: visual dysfunction (retrobulbar neuritis, color blindness)
Ethambutol
Static but cidal on actively dividing MTB
SE: hyperuricemia, hepatotoxicity (most)
Pyrazinamide
Cidal
Binds to 30S
SE: nephrotoxicity, ototoxicity
Streptomycin
4th generation quinolone
SE: diabetes mellitus
Gatifloxacin
4the generation quinolone
Broad spectrum of activity
Anaerobic coverage
Treatment of ocular infections
Moxifloxacin
3rd generation quinolone
Treatment of pulmonary infections
Levofloxacin
2nd generation quinolone
Treatment of urinary tract infections and GIT infections
TX: tendinitis
Ciprofloxacin
Treatment of burn infections
Sulfadiazine
Sequential blockage in folate synthesis
Urinary tract infections
SE: hypersensitivity (SJS, TEN), kernicterus hemolysis in patients with G6PD
TMP-SMX (pneumocystis, pneumonia)
Blocks dihydrofolate reductase
Trimethoprim
Blocks dihydropteroate synthase
Sulfamethoxazole
Treatment of hepatic encephalopathy
Neomycin
Widest spectrum of activity
Pseudomonas coverage
Narrow therapeutic window
Amikacin
Treatment of drug-resistant gonorrhea
Spectinomycin
Tuberculosis
Streptomycin
Treatment of ocular infections
Tobramycin
Prototype aminoglycoside, bactericidal
Binds to 30S subunit
SE: nephrotoxicity, ototoxicity
Gentamicin
Binds to 50S subunit
Vancomycin-resistance
Linezolid
Binds to 50S subunit
Anaerobic coverage
SE: pseudomembranous colitis
Clindamycin
Binds to 50S subunit
Highest volume of distribution
Single dose administration
Azithromycin
Binds to 50S subunit subunit
DOC for penicillin-allergic patients
SE: diarrhea, choke static jaundice
Erythromycin
Binds to 30S subunit
SE: tooth enamel discoloration, photosensitivity
Tetracycline
Binds to 50S subunit subunit
SE: aplastic anemia, gray baby syndrome
Chloramphenicol
Anti-pseudomonal cephalosporins
Ceftazidine
Cefepime
Cefoperazone
Third generation cephalosporins
Ceftamet Cefpodoxin Cefoperazone Cefixime Ceftriaxone Ceftazidine Cefotaxime Ceftrizoxime Ceftibuten
Cephalosporins causing disulfiram reaction
Cefamandole
Cefmetazole
Cefotetan
Cefoperazone
Which cephalosporin has the best penetrance to the BBB?
Ceftriaxone
4th generation cephalosporins
Broad spectrum activity (gram positive and gram negative)
Cefepime
Most efficacious cephalosporin for Pseudomonas aeruginosa
Ceftazidime
3rd generation cephalosporins
Pseudomonas coverage
SE: Disulfiram reaction
Cefoperazone
2nd generation cephalosporins
Added gram negative coverage
SE: Disulfiram reaction
Cefamandole
1st generation cephalosporin
High bone penetration
Surgical prophylaxis
Greatest gram positive coverage
SE: hypersensitivity reaction
Cefazolin
Narrow spectrum penicillins
SE: hypersensitivity
Penicillin G
Penicillinase-resistant penicillins
Interstitial nephritis
Methecillin
Extended-spectrum penicillins
Pseudomembranous colitis
Ampicillin
Antipseudomonal penicillins
SE: hypertension, hypovolemia, bleeding
Ticarcillin
Bacteriostatic antibiotics
Erythromycin Clindamycin Sulfamethoxazole Trimethoprim Tetracycline Chloramphenicol
Bactericidal antibiotics
Vancomycin Fluoroquinolones Penicillins Aminoglycosides Metronidazole
Drug of choice for acute asthma attacks
Albuterol/Salbutamol
Adjunct for asthma maintenance
Salmeterol
Prophylaxis for nocturnal asthma
SE: seizures, antidote: Propanol
Theophylline
Bronchodilator of choice in COPD
Ipratropine
Stabilizes mast cells
No bronchodilator effects
Cromolyn
Drug of choice for asthma maintenance
SE: oral candidiasis, growth stunting
Fluticasone
Lipooxygenase inhibitor
SE: increased AST/ALT
Zileuton
Blocks slow-reacting substances of anaphylaxis (Leukotrienes C4, D4, E4
Montelukast
Prostaglandin E1
PDA, erectile dysfunction
Alprostadil
Prostaglandin E1
Peptic ulcer disease
Abortifacient prevention of NSAIDs-induced gastric mucosal injury
Misoprostol
Prostaglandin F2alpha
Glaucoma
Latanoprost
Prostaglandin E2
Induction of labor
Abortifacient
Dinoprost
Prostaglandin F2alpha
Control of postpartum hemorrhage
Abortifacient
Carboprost
Prostaglandin I2
Pulmonary HPN
Reduces PLT aggregation in dialysis machines
Epoprostenol
SE: retroperitoneal fibrosis
Ergotamine
Treatment of postpartum bleeding
Ergonovine
Adjunct for migraine and cluster headache
Ergotamine
Treatment for postop and postchemo vomiting
Ondansetron
Drug of choice for migraine and cluster headache
Sumatriptan
Treatment of peptic ulcers
SE: gynecomastia
Cimetidine
Treatment of hypersensitivity, non-sedating
Cetirizine
Adjunct for motion sickness, vertigo
Meclizine
Treatment of hypersensitivity (food allergy, rhinitis, hay fever, angioedema)
SE: sedation
Diphenhydramine
Reversibly inhibits cyclooxygenase 1 and 2
Antipyretic of choice in pediatric population
Paracetamol
Irreversibly inhibits cyclooxygenase 2
Celecoxib
Reversible inhibitor of cyclooxygenase 1and 2
Ibuprofen
Irreversibly inhibits cyclooxygenase 1and 2
Aspirin
What are the drugs that cause flushing?
Vancomycin
Adenosine
Niacin (ASA prophylaxis)
Calcium channel blockers
Why are statins used in the management of coronary artery disease?
For stabilization of atherosclerotic plaque
PPAR-a activator
Upregulates lipoprotein lipase
Lowers TG
SE: gallstones, additive myopathy
Gemfibrozil
Reduces all building blocks for hyperlipidemia
Increases HDL
Lowers LDL and TG
SE: flushing, hyperglycemia, hyperuricemia
Niacin
Cholesterol absorption blocker
Lowers LDL
Ezetimibe
Bile acid binding resin
Lowers LDL
SE: constipation, steatorrhea
Cholestyramine
HMG-CoA reductase inhibitor
Lowers LDL
SE: hepatotoxicity, rhabdomyolysis, myopathy
Simvastatin
What is the difference between an inhibitor and an uncoupler of oxidative phosphorylation?
INHIBITORS: completely hat ETC
UNCOUPLERS: dissipate proton gradient without interrupting ETC
What is the difference between in presentation of aspirin intoxication in children and adults?
ADULTS: mixed acid-base disorder, respiratory alkalosis with HAGMA
CHILDREN: pure acid-base disorder, HAGMA
What is the expected acid-base abnormality in salicylate poisoning?
Respiratory Alkalosis with HAGMA
What are the signs of ASA poisoning?
ASPIRIN POISONING: C-H-A-F-S Coma Hyperventilation Acidosis (HAGMA) Fever Seizure
What is the triad of aspirin hypersensitivity?
SAMTERβs triad:
Asthma
Nasal polyp
NSAIDs sensitivity
How many 500mg Aspirin tablets must be ingested to produce toxicity? Death?
Toxic dose: 150mg/kg
150mg/kg x 70kg/500mg/tab = 21 tabs
Lethal dose: 500mg/kg
500mg/kg x 70kg/500mg/tab = 70 tabs
Phosphodiesterase inhibitor
Cardiac stress testing
Dipyridamole
Glycoprotein IIb-IIIa inhibitor
Abciximab
ADP inhibitor
Addictive effects with Aspirin
Clopidogrel
Irreversible COX inhibitor
Instant prevention of arterial thrombosis
SE: tinnitus, hypersensitivity, Reye syndrome
Aspirin
Antidote to thrombolytic overdose
Aminocaproic acid
Tranexamic acid
Bacteria-derived thrombolytic
Decreased effect on subsequent uses due to antibody formation
Streptokinase
Thrombolysis in AMI
Ischemic CVD and PE
SE: bleeding
Alteplase R-TPA
In patients requiring anticoagulation, why is an overlap between heparin and warfarin usually done?
- Warfarinβs effect requires elimination of preformed clotting factors (8-60h)
- To bypass the initial prothrombotic effect of warfarin (skin necrosis)
What laboratory tests will you request to assess the extrinsic and intrinsic coagulation pathways?
PiTT
PTT for intrinsic pathway
PeT
PT for extrinsic pathway
Antidote to warfarin (immediate reversal)
FFP (fast)
Chronic anticoagulation
SE: bleeding, skin necrosis, many drug interactions
Warfarin
Antidote to heparin-induced bleeding
Protamine sulfate
Treatment of heparin-induced thrombocytopenia
Lepirudin
Low molecular weight heparin
Less risk of thrombocytopenia
Does not need monitoring
Enoxaparin
Acute treatment of DVT, PE and AMI
SE: bleeding, thrombocytopenia, monitor with PPT
Treatment of chemotherapy induced thrombocytopenia
Oprelvekin
Treatment of neutropenia and agranulocytosis
Filgrastim
Anemia in chronic kidney disease
Epoetin Alfa
Treatment of Megaloblastic anemia
Prevention of neural tube defects (spina bifida)
Folic acid
Treatment of Megaloblastic anemia
vitamin B12 deficiency
Cyanocobalamin
Treatment of iron deficiency anemia
Ferrous sulfate
What drugs can cause gynecomastia?
Some Drugs Create Awesome Knockers! Spironolactone Digoxin Cimetidine Alcohol Ketoconazole
Adverse effects of Thiazide Diuretics
THIAZIDE TOXICITIES HYPER GLUC Glycemia Lipidemia Uricemia Calcemia
What are the adverse effects associated with loop diuretics?
OH DANG! Ototoxicity Hypokalemia Dehydration Allergy to sulfa Nephritis Gout
NAGMA
Non Anion Gap Metabolic Acidosis Hyperalimentation Acetazolamide RTA Diarrhea Ureteral diversion Pancreatic fistula
HAGMA
High Anion Gap Metabolic Acidosis Methanol Uremia Diabetic Ketoacidosis Paraldehyde Isoniazid Lactic acid Ethanol Salicylates
Acts on PCT, DCT and CCD
Treatment of rhabdomyolysis and increased ICP
Contraindicated in heart failure
Mannitol
Acts on CCD
SE: Gynecomastia, Hyperkalemia
Spironolactone
Acts on DCT
SE: hyperglycemia, hyperlipidemia, hypercalcemia
Hydrochlorothiazide
Acts on TAL
Treatment of pulmonary edema
Most efficacious diuretics
SE: ototoxicity, hypokalemia, hypocalcemia
Furosemide
Acts on PCT
Treatment of glaucoma and mountain sickness
SE: NAGMA, hepatic encephalopathy
Acetazolamide
Why are dihydropyridine calcium channel blockers not useful as antiarrhythmics?
Dihydropyridine CCBs evoke compensatory sympathetic discharge which facilitates arrhythmics rather than terminating them
AMIODARONE TOXICITY
Pulmonary fibrosis Parethesias Tremors Thyroid dysfunction Corneal deposits Skin deposits
What are the effects of class1 antiarrhythmics on action potential?
Class I: prolongs AP duration
Class IB: shortens AP duration
Class IC: no effect on AP duration
Outpatient management of SVT
SE: gingival hyperplasia
Verapamil
Most efficacious antiarrhythmic
SE: skin deposits, pulmonary fibrosis, hyper/hypothyroidism
Amiodarone
SE: dose-dependent torsades de pointes
Sotalol
Perioperative and thyrotoxic arrhythmias
SVT
Esmolol
Contraindicated post-MI
Refractory arrhythmias
Flecainide
Post-MI arrhythmias
Digitalis arrhythmias
SE: seizures
Lidocaine
SE: cinchonism (headache, tinnitus, vertigo)
Quinidine
Treatment of all types of arrhythmias
WPW syndrome
SE: drug-induced lupus
Procainamide
What drugs have been shown to improve survival in cases of heart failure?
ABA! Bahay ka pa!
ACE inhibitors
Beta-blockers
Aldosterone Antagonists
Improves survival in CHF patients of African-American descent
Hydralazine & ISDN
Decreases hospitalization in CHF
Digoxin
Improves survival (decreases mortality) in CHF
ACE-I / ARBS
Beta blockers
Spironolactone
First line drug for chronic CHF
Cardioprotective
ACE-I
ARBS
Treatment of pulmonary edema in CHF
Furosemide
Positive inotrope for heart failure
SE: arrhythmias (PVC, AVB), RG color blindness, yellow visual halos
Digoxin
What drugs can cause gingival hyperplasia?
Nifedipine
Cyclosporine
Phenytoin
Verapamil
Why do patients taking nitrate usually experience throbbing headaches?
Due to meningeal artery dilatation
Why is calcium-dependent neurotransmission or hormone release not affected by CCBs?
CCBs block L-type calcium channels other functions use N-, P-, and R-types
Supraventricular tachycardia
Cardiac > Vascular effect
SE: gingival hyperplasia
Verapamil
Angina maintenance Vascular < Cardiac effect Vasospastic angina Raynaud's phenomenon Does not cause gingival hyperplasia
Diltiazem
Angina maintenance
Vascular > Cardiac effect
SE: flushing, edema, gingival hyperplasia
Nifedipine
Relief of acute anginal attacks
SE: headache
Nitroglycerin + ISDN
What is the antidote for cyanide poisoning?
Inhaled amyl + nitrate + IV sodium nitrate + IV sodium thiosulfate
Which portion of the electron transport chain is affected by cyanide?
IV cytochrome oxidase
Treatment of cyanide poisoning
Amyl nitrite
Hypertensive emergency
SE: cyanide poisoning
Nitroprusside
Hypertensive emergency
SE: hypertrichosis
Minoxidil
Pre-eclampsia (acute BP lowering)
SE: reflex tachycardia, drug-induced lupus
Hydralazine
Pre-eclampsia (maintenance medication)
SE: hemolytic anemia (positive Coombs test)
Methyldopa
Hypertension with comorbid BPH
Prazosin
ACE-inhibitor intolerance
Losartan
Hypertension with comorbid CHF/DM
SE: cough, angioedema, contraindicated in bilateral RAS
Captopril
First-line drug for essential hypertension
Hydrochlorothiazide
What is the expanded formula for your blood pressure?
BP = hr x sv x svr
What is the formula for blood pressure?
BP = co x svr
What is the pharmacologic advantage of a1 selectivity?
Reflex tachycardia is less common and less severe
What drugs are used to control blood pressure in pheochromocytoma?
Phenoxybenzamine
Phentolamine
Labetalol
Combined alpha and beta blockade
Labetalol
Treatment of glaucoma
Timolol
Beta-1 selectivity
Atenolol / Metoprolol
Intrinsic sympathomimetic activity
Pindolol
Angina prophylaxis
Hyperthyroidism
Masks hypoglycemia in diabetes
SE : Bronchospasm, erectile dysfunction
Propranolol
Benign prostatic hyperplasia
SE: first dose orthostatic hypotension
Prazosin
Treatment of rebound hypertension
Phentolamine
Pre-operative treatment of pheochromocytoma
Phenoxybenzamine
Tocolysis for preterm labor
Terbutaline
Bronchial asthma, COPD
Salbutamol
SE: Hemolytic anemia (positive Coombs test)
Methyldopa
SE: Rebound hypertension on discontinuation
Clonidine
Nasal congestion
Mydriasis without cycloplegia
Phenylephrine
Drug of last resort for shock
Norepinephrine
Acute CHF, shock (cardiogenic, septic)
Dopamine
DOC for anaphylactic shock
Adjunct to local anesthesia
Cardiac arrest
Croup
Epinephrine
What are the signs of atropine toxicity?
HOT as a hare DRY as a bone RED as a beet BLIND as a bat MAD as a hatter
Why is ipratropium the preferred bronchodilator in patients with comorbid COPD and heart disease?
IPRATROPIUM
less likely to cause tachycardia and cardiac arrhythmias
Muscarinic Antagonists for Parkinsonβs Disease
TRIhexyphenidyl
BENZtropine
BIPeriden
Treatment for organophosphate poisoning / nerve gas poisoning
Atropine + Pralidoxine
Motion sickness
Sea sickness
Scopolamine
Chronic obstructive pulmonary disease (COPD)
Ipratropium
Parkinsonβs disease
Benztropine
Sinus Bradycardia
Atropine
Induction of mydriasis and cycloplegia
Tropicamide
What are the signs and symptoms of organophosphate poisoning?
(MALATHIONE PESTICIDE)
DUMBBELSS Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation (skeletal muscle and CNS) Lacrimation Sweating Salivation
Small cell cancer may present with a myasthenia-like paraneoplastic syndrome. What is this condition called?
LAMBERT-EATON SYNDROME
How does EDROPHONIUM differentiate myasthenic crisis from cholinergic crisis?
EDROPHONIUM
Improves muscle strength in myasthenic crisis
Weakens muscle strength in cholinergic crisis
Excessive activation of cholinoceptors (skeletal muscle weakness and parasympathetic signs) due to OVERmedication
Cholinergic Crisis
Acute worsening of symptoms due to infection, stress or UNDERmedication
Myasthenic Crisis
What is myasthenia gravis?
Autoimmune destruction of nicotonic ACH receptors, characterized by fluctuating muscle weakness
- Ocular symptoms
- Bulbar symptoms
- Proximal muscle weakness
What is Sjogren syndrome?
Autoimmune disorder characterized by triad of
- Xerostomia (dry mouth)
- Xerophthalmia (dry eyes)
- Rheumatoid arthritis
Bowel and bladder atony
Betanechol
Sjogren syndrome (Xerostomia, Xerophthalmia, & rheumatoid arthritis)
Pilocarpine
Diagnosis of myasthenia gravis
Differentiation of myasthenia and cholinergic crisis
Edrophonium
Treatment of myasthenia gravis
Reversal of nondepolarizing neuromuscular block
Neostigmine
Treatment of glaucoma
Physostigmine
Diagnosis of bronchial hyperreactivity
Methacoline
Treatment of Alzheimerβs disease
Donepezil
Peripheral neuropathy
Vincristine
Bone marrow suppression
Vinblastine
For Hodgkins lymphoma, leukemias, Wilms tumor, Ewings sarcoma
Vincristine
For Hodgkins disease, testicular CA
Vinblastine
Inhibits topoisomerase 1
Camptothecins
Pyrimidine analog
5-Fluorouracil
Cytarabine
Inhibits thymidilate synthetase
5-Fluorouracil
For breast CA and GI carcinoma, colorectal CA, pancreatic CA, ovarian CA
5-Fluorouracil
Prevents elongation of DNA
Cytarabine
For AML ONLY
Cytarabine
For ALL and AML
6-Mercaptopurine
Pyrimidine analogs
Capecitabine, Cytarabine, Fluourouracil, Gemcitabine
Inhibits toposiomerase II
Etoposide, Teniposide, Poside
Podophyllotoxins
Promote microtubule assembly and stabilizatiom thus inhibiting cell division
Taxanes
Taxanes drugs
Docetaxel, Paclitaxel, Taxel
Promotes microtubule formation but prevents disassembly that malformed microtubules
Paclitaxel
For ovarian and breast ca
Paclitaxel
Estrogen antagonist
Tamoxifen
Treatment of ER + breast ca
Tamoxifen
Competitive inhibitor of estradiol
Tamoxifen
DOC for estrogen-receptor positive breast ca
Tamoxifen
Adverse effects of Tamoxifen
Hor flushes
Nausea, vomiting
Menstrual bleeding
Thromboembolic disease
Endometrial CA
Tamoxifen
Inhibits translocation of androgen receptor to the nucleus
Flutamide
For prostate CA
Flutamide
Side effects of Flutamide
Diarrhea, hot flushes, impotence, gynecomastia, reversible hepatotoxicity
Inhibits release of FSH and LH
Leuprolide
For prostate and endometriosis
Leuprolide