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NMR
NMR
":
Gold
Nitrofurantoin
Cataracts
Ulcers
Infections
Necrosis, avascular necrosis of the femoral head
Glycosuria
Osteoporosis, obesity
Immunosuppression
Diabetes
· The following beta blockers require dose adjustment due to CYP2D6 polymorphic metabolism:
Metoprolol Timolol Carvedilol (in patients with lower or higher than normal CYP2D6 activity)
Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels. Pindolol and Carteolol
have high and moderate ISA respectively, making them acceptable for use in some diabetics or
asthmatics despite the fact that they are non-seletive beta blockers.
Lacrimation
Urination
Gastrointestinal upset
Miosis
Sulfonamide: major side effects
Steven-Johnson syndrome
Skin rash
Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders
like warfarin)
"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies":
· Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence)
Beta blockers:
RSV
Influenza B
Calcium antagonists
Diuretics
Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugs
Constipation
Respiratory depression
Addiction
Miosis
Fluoxymesterone
Methyltestosterone
Nandrolone
Testosterone
Angina
Migranes
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes
Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM:
Procarbazine
Metronidazole
Theophylline
Ethanol
Corticosteroids
H2 blockers
Antiparkinsonian drugs
ENT drugs
Insomnia drugs
Muscle relaxants
Seizure medicines
Morphine: side-effects MORPHINE:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Nausea
Emesis
Diuretics:
CHF
Hypertension
Insipidous
Calcium calculi
Migraine: prophylaxis drugs
Verpamil
Valproic acid
Pizotifen
Amitriptyline
Flunarizine
Methysergide
Propranolol
ABCD:
Alpha = Constrict.
Beta = Dilate.
Antiarrhythmics: classification
I to IV MBA College
Beta blockers
Dependency
Constipation
Analgesics
Respiratory depression
Euphoria
Sedation
Bleomycin
Cisplastin
Dactinomycin/ Doxorubicin
Etoposide
Alkylating agent
CML indication
· If want the next 3 worth knowing, the DNDis also after me:
Tetracycline: teratogenicity
Lipid soluble
Miotic
Natural
Physostigmine
Water soluble
Beta 1 blockers:
Esmolol
Atenolol
Metropolol
CHAMP:
Cyclophosphamide
Methotrexate
Penicillamine
· If didn't learn yet that gold's indication is rheumatoid arthritis, AUR- Acts Upon Rheumatoid.
Ibutilide
Amiodarone
Sotalol
Anxiety
Social phobias
Barbiturates
Diuretic (thiazide)
K-sparing diuretic
Beta blocker
ACEI
NSAID
K supplement
Reserpine action:
Succinylcholine:
action, use Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore. You Suck
stuff in through a mouth-tube, and drug is used for intubation.
Bronchoconstriction
Claudication
Lipids
Major side effect: Splat (vomiting sound)--vomiting so severe that anti-nausea drug needed. Action: Goes
Into the DNA strand.
Vir-named drugs: use"-vir at start, middle or end means for virus": · Drugs:
Abacavir,
Acyclovir,
Amprenavir,
Cidofovir,
Denavir,
Efavirenz,
Indavir,
Invirase,
Famvir,
Ganciclovir,
Norvir,
Oseltamivir,
Penciclovir,
Ritonavir,
Saquinavir,
Valacyclovir,
Viracept,
Viramune,
Zanamivir,
Zovirax.
Prazocin: usage
Anorexia
Analgesics
Miosis
Euphoria
Respiratory depression
Sedation
STRIPE:
P-450 interactions
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenicity
Osteomalacia
The Narcotic Antagonists are NAloxone and NAltrexone. · Important clinically to treat narcotic overdose.
Stick = Injection
Sniff = inhalation
Suck = ingestion
Soak = absorption
zAfirlukast: Antagonist of LT
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine
Anticholinergic side effects
Anorexia
Blurry vision
Constipation/ Confusion
Dry Mouth
Bleomycin: action
"Bleo-Mycin Blows My DNA to bits": Bleomycin works by fragmenting DNA (blowing it to bits). My DNA
signals that its used for cancer (targeting self cells).
Asthma
Salicyalism
Reye's syndrome
Idiosyncracy
Noise (tinnitus)
Lupus: drugs inducing it HIP:
Hydralazine
INH
Procanimide
Physical dependence
Euphoria
Analgesia
Respiratory depression
Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factor
Xa. Monitor Xa concentration, rather than APTT.
Serotonin syndrome
Stimulate CNS
Insomnia
Ipratropium: action Atropine is buried in the middle:
Propranolol and related '-olol' drugs: usage"olol" is just two backwards lower case b's. Backward b's
stand for "beta blocker". · Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol,
propranolol.
Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Miosis
Orthostatic hypotension
Respiratory depression
Pain supression
Increased ICT
Nausea
Euphoria
Sedation
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
Lacrimation
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction
Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure) LOT: Lorazepam
Oxazepam Temazepam
Benzodiazepines: actions
Sedation
anti-Convulsant
anti-Anxiety
Muscle relaxant
Warfarin
Thalidomide
Retinoid
ACE inhibitor
Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol
Isoniazid
Cimetidine
Excitement
Surgical anesthesia
Medullary paralysis
Glycerol
Urea
Mannitol
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Appetite increase
Tremor
Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount":
Phenytoin
Ethanol
Aspirin
Zero order
· Someone that pees out a constant amount describes zero order kinetics (always the same amount out)
Valproic acid
Acetaminophen
Halothane
Buffalo hump
Easy bruising
Cataracts
Larger appetite
Obesity
Moonface
Euphoria
Hypertension/ Hyperglycaemia
Skin thinning
Osteoporosis
Emotional liability
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Phenelzine
Isocarboxazid
Tranylcypromine ·
Warfarin
Propythiouracil (PTU):
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline
Beta-blockers:
Pindolol
Hismolol
Naldolol
Propranolol
Methyldopa:
Mental retardation
Electrolyte imbalance
Tolerance
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)
Leukocytosis
Tremor/ Teratogenesis
Hypothyroidism
Trimethoprim
Opiates
Polymyxins
B. Opiate Agonists (Morphine, Meperidine, Codeine, Methadone, Heroin, Fentanyl) • Act at mu, kappa,
delta receptors in CNS • Analgesia; Antitussive (Codeine); opiate addiction (Methadone); antidiarrheal
(loperamide) • CNS depression; nausea; respiratory depression; constipation; urinary retention;
dependence
Opiate Mixed Agonists-Antagonists (Pentazocine) • Same as agonists but will cause withdrawal in those
dependent on agonists
Opiate Antagonists (Naloxone, Naltrexone) • Block opiate receptors • Narcotic overdose (no effect if
used alone)
Erythropoietin • Increases RBC production in marrow • Anemia associated with renal failure
G. Flutamide • Blocks inhibitory effects of testosterone on GnRH release • Combo with leuprolide
J. Stool Softeners (psyllium, methylcellulose) • Absorbs water and softens stool bulk peristalsis •
Constipation Mechanism, clinical use, and toxicity of dermatologic agents: CORTICOSTEROIDS:
Synthesized in the zona fascilculata of the adrenal cortex. Cortisol and Cortisone produced. 1)
Glucocorticoids are catabolic. They influence carbohydrate and fat metabolism to insure adequate
delivery of glucose to brain and tissues. 2) Decrease intestinal uptake of calcium; increase renal excretion
of calcium (contribute to osteoporosis). 3) Supress the inflammatory response – Decrease edema, fibrin
deposition, capillary dilatation, leukocyte migration and phagocytic activity. Inhibit prostaglandin and
leukotriene production by inhibiting phospholipase A2. 4) Include: Cortisone (short acting), Prednisone
(intermediate acting), Prednisolone (similar to prednisone but no hepatic metabolism for activity),
Methylprednisolone (similar to prednisolone but better anti-inflamatory and less mineralocorticoid
effects), Triamcinolone (5x more potent than cortisol), Dexamethasone (long acting) & Beclomethasone
(long acting available as aerosol). 5) Toxicity: a) Skin: hirsutism, skin thinning, poor wound healing, striae,
acne and purpura. b) Other: hyperglycemia, hypertension, cataracts, glaucoma, peptic ulcer disease,
osteoporosis, and increased susceptibility to infection.
RETINOIDS: 1) Used to treat the following dermatologic diseases: Acne, psoriasis, icthyosis and has a
potential benefit in early skin cancers (actinic keratosis) 2) Toxicity: in skin it can cause desquamation,
dry skin and pruritus, erythema.
ANTIFUNGALS: 1) Polyene antibiotics are fungicidal against both filamentous and yeastlike fungi
including Histoplasma, Blastomyces, Coccidioides, Cryptococcus, Candida, Aspergillus and Sporothrix.
Polyenes interact with sterols in the cytoplasmic membrane of fungi leading to rapid leakage of small
molecules and death. Sensitive fungi have ergosterol in their membranes. a) Amphotercin B: Broad
spectrum to treat systemic fungal infections. Side effects: Fever, chills, impaired renal function, anemia,
thrombocytopenia. b) Nystatin (Mycostatin): Similar to A but used primarily in topical preparations. Use
in Candida infections and prophylaxis. 2) Imidazoles: Block the synthesis of fungal cell membrane
ergosterols. a) Miconazole & Clomitrazole: Miconazole is the only imidazole that can be administered IV;
clotrimazole is only used topically. i) Intravenous miconazole is rarely used due to toxicity. Treats
ringworm, vulvovaginal candidiasis b) Ketoconazole: Oral administration only. Causes gynecomastia. 3)
Miscellaneous: a) Flucytosine: Administer with amphotercin B in the treatment of cryptococcal
meningitis and other systemic infections (synergistic). b) Griseofulvin: Binds to keratin, treat Tineas
(capitis, corporis etc),
Other new pharmacologic agents: 1) Erythopoietin (EPO): RBC growth factor. Produced in kindneys.
Recombinant form available (epoietin alpha). a) Use for tx of Anemia 2nd to renal failure or zidovudine
(AZT) use HIV patients. b) Use for tx of Anemia 2nd to chemo, or to stimulate rbc production prior to
surgery or to facilitate autologous donation. c) Side effects: Clotting of dialysis tubing and hypertension.
2) RU486 (Mifrepristone): Abortificen. Blocks progesterone receptors and thereby progesterone support
of pregnancy. 80% effective, 95% if used with prostaglandins. a) Complications include incomplete
abortion (2%), ongoing pregnancy (1%), hemorrhage during D&C (<1%). Know About......
1) Complications of empiric antibiotic use: a) Resistance: Must take into account susceptibility patterns
of local settings. Must distinguish between community vs. nosocomial infection, and must take into
account the patient’s immune status. b) Fungal Infections: Due to destruction of normal flora.
(candidiasis). c) Other complications: C. Diff Pseudomembranous colitis. Gentamicin ototoxicity (must
monitor levels), Sulfonamides and Penicillin allergic reactions. 2) Secondary effects of other drugs: a)
Heparinosteoporosis with chronic use. Thombocytopenia – usually transient and mild. b)
ThiazidesHyperlipidemia, hypokalemia. 3) Drugs that block/increase hepatic drug metabolism: a)
Cimetidine: Histamine analog that cab reduce hepatic blood flow and slow clearance of other drugs and
also reduces activity of cytochrome p-450 b) Ethanol: Chronic use induces hepatic microsomal enzymes
and may enhance metabolism of other drugs. c) Phenobarbital: Increased phenobarbital levels in
patients that have ethanol, chloramphenicol or valproic acid on board, since it has microsomal enzyme
metabolism. d) Phenytoin (Dilantin): same as Phenobarb and ETOHMetabolized by microsomal
enzymes. e) Rifampin: Causes jaundice and hepatotoxicity, also interacts with C p-450 system. 4)
Fundamental Pharmacodinamics: a) Partial agonists/agonist: Drugs that bind to receptors and stimulate
them. b) Antagonists: are drugs that bind to receptors and decrease or block the effect of an agonist.
They do not stimulate the receptors. i) Competitive antagonist: Reversibly binds to the receptor and
prevents binding of the agonist. ii) Non competitive antagonist: Usually binds to the receptor irreversibly
and prevents any agonist action. c) Efficacy: Maximal effect produced by a drug. d) Potency: Activity of a
drug compared to a reference standard; depends on the drug’s ability to reach the receptors and its
affinity to the receptor. 5) Drug efficacy and potency as demonstrated on dose-response curves: a) ED50
(effect dose)- Dose which produces half-maximal response (ie., observed effect seen in 50% of patients);
used as a measure of potency (the lower the ED50, the more potent the drug). b) TD50 (toxic dose)-
Minimum dose which produces a specific toxic effect in 50% of individual (or animals). c) LD50 (lethal
dose)- Minimum dose which kills 50% of animals. d) Therapeutic index- Ratio of dose required to
produce a toxic effect to the dose needed for a therapeutic effect. Used as an indication of drug safety.
Expressed as :
TI= TD50 or TI= LD50 You want drugs with a high therapeutic index (low ED 50 ED50 side effects at usual
doses).
6) Pharmacogenetics: drugs whose metabolism is affected by inheritance: a) Isoniazid: Most commonly
used drug for the treatment of TB. i) Inhibits biosynthesis of mycolic acids. ii) Metabolized in the liver
(acetylated); speed of acetylation and consequently isoniazid’s half life is genetically determined (fast vs.
slow acetylators). 7. Treatment of Anemia A. Anemia is due to increased destruction or decreased
production. B. Microcytic anemia 1. Iron – absorbed in the duodenum and proximal jejunum. Iron
deficiency seen in premature infants, pregnant and lactating women. Ferrous oral salts can be given; give
for 3-6 months to replenish iron stores. IV iron can also be given. 2. Iron toxicity a. N/V, cramps,
constipation, diarrhea – dose-related so decrease the dose b. Acute toxicity – seen in kids, necrotizing
gastroenteritis followed by shock, lethargy, dyspnea c. Chronic iron toxicity - hemochromatosis C.
Megaloblastic anemia – lack of vitamins needed for normal DNA synthesis, so the RBC gets biggger
(macrocytic) 1. Vitamin B12 (normally obtained in meats), requires intrinsic factor for absorption
(pernicious anemia decreases absorption), gastrectomy also decreases absorption. B12 is stored in the
body (years supply) a. B12 deficiency also shows nervous defects b. B12 shots can be given if oral
absorption is a problem c. Folate will NOT correct neurological features, but WILL help with the anemia
2. Folic Acid – from green leafy veggies, body stores of folate are lower (1-6 months) a. Deficiency
doesn’t have neurological deficits b. Folic acid is well absorbed orally D. Decreased production 1.
Erythropoietin – used for renal failure, bone diseases, chemotherapy a. Toxicity – too rapid increase in
hematocrit can lead to HTN, thrombotic complications 2. Colony stimulating factors (G-CSF, GM-CSF) a.
Increase recovery after myelosuppressive chemotherapy or BMT 8. Prevention/treatment of
cerebrovascular disease K. Aspirin 1. Irreversibly blocks cyclooxygenase, = inhibits thromboxane (TxA2)
formation from platelets 2. Only requires a small daily dose L. Ticlopidine 1. Inhibits platelet aggregation
(inhibits ADP pathway) 2. Decreases TIAs, completed strokes, unstable angina pectoris 3. Diarrhea in
20%, leukopenia in 1% (must monitor white count) M. Thrombolytics – catalyze formation of plasmin, a
generalized lytic state in body is produced 1. Streptokinase – cheap, allergic reactions possible 2.
Urokinase 3. Tissue plasminogen activators (t-PA) – expensive, from recombinant DNA 9. Treatment of
rheumatoid arthritis A. Drugs that alter Pain 1. Aspirin – 1st line drug, GI problems 2. NSAIDS - 3. COX-2
inhibitors – less GI problems B. Drugs that Decrease Progression 1. Methotrexate and
immunosuppressives – more toxic side effects 2. Gold – dermatitis is common side effect 10. Vaccines:
indications, potential side effects A. Indications 1. Active immunization – antigen is given so host
develops antibodies (long protection) a. Give to children 2. Passive – immunoglobins are given (short
term protection) a. Give to those recently exposed (Tetanus, Botulinum, HBV, Rabies) or to travelers
(Polio, tetanus, Measles, diphtheria) B. Side Effects 1. Giving live attenuated vaccines may cause the
disease (eg. Polio vaccine) 2. Killed vaccine will not cause the disease 3. Allergic reactions are possible
11. Chemotherapeutic agents: risk of possible secondary cancer