Clinical knowledge

Integration

Concept

Smart thinking
A patient with Alzheimer disease needs treatment for
overactive bladder (OAB). Which drug is the best choice
for this patient?

A. Darifenacin

B. Solifenacin

C. Tolterodine

D. Trospium Quaternary ammonium

 P glycoprotein
P-glycoprotein inhibitors- Permeable pump
Verapamil Efflux pump
Amiodarone
Cyclosporine
Itraconazole
Nifedipine
Erythromycin
Quinidine
Enzyme Drug

CYP3A4 >50% of drugs

CYP 2D6
Codeine– morphine
Fluoxetine inhibits CYP2D6 Beta blockers
Tamoxifen activated by CYP2D6 Beta blockers

CYP2C9
Warfarin, Phenytoin, Losartan

CYP2C19 Omeprazole Clopidogrel

Pantoprazole, Rabeprazole

CYP2E1 Paracetamol- NABQIA

 DRC shifted to right
Y Efficacy – remain same
MAXI RESPONSE
Potency - decrease
EFFICACY

D
R Drug
U In the presence of
G Competitive antagonist
R
E
S
P
O
N
S
E
ED 50-
X
POTENCY

Drug concentration
 DRC shifted to down
Y Efficacy – decrease
Potency – remains same

D
R Drug
U
G
In the presence of
R Non Competitive antagonist
E
S
P
O
N
S
E

Drug concentration
 MISOPROSTAL

DES

VI & VII nerve defect Hypospadiasis

Aplastic cutis

THALIDOMIDE
LITHIUM

Thioamide
Fetal hypothyroidism
Phocomelia
 M3 antagonst/ M3 agonist
3 agonist
Contracts detrussor
Relaxes detrussor
Use
Use Atonic bladder
Overactive bladder Post op urinary
retension
Nocturnal enuresis
-Desmopressin
-TCA
1 antagonist

SNRI Relaxes internal

DULOXETIN urethral sphinter

Increases urethral Use

tone BPH

Use
Stress incontinance
Clonidine . HT
Methyl dopa .
Central - SMR
Moxonidine HT
Tizanidine
Rilmonidine

Guanafacine ADHD Dexmedetomidine

Guanabenz TICS Sedation (ICU pts)
Pre anaesthetic

Apraclonidine

Glaucoma
Lid lag

Brimonidine LOFEXIDINE
anterior uveitis Drowsiness Opioid withdrawal
RESPONSE symptoms

Dec aqueous secretion

 &  blocker, NERI  &  Blocker
USE- HT emergency in pregnancy 3rd GEN BETA BLOCKERS Anti oxidant
ADR-Postural hypotension, anti-inflammatory
hepatotoxic CCB
Alpha blocking USE- CCF, HT

LABETALOL BUCINDOLOL CARVEDILOL Bisoprolol

BEVANTOLOL Metoprolol succinate
NIPRADILOL

Release of NO NEBIVOLOL
NIPRADILOL, BOPINDOLOL
CELIPROLOL, CARTEOLOL

Opening Of K+ Channel
TILISOLOL

SOTALOL
K+ Channel Blocker
Calcium blocker Carvedilol, Betaxolol
DOC PROPRANOLOL

PERFORMANCE
HOCM AKATHESIA ANXIETY
 Aphthous ulcer

Anti anginal drug causing aphthous ulcer

Nicorandil
Anti anginal drug aggrevating
movement disorder

TRIMETAZIDINE,
S/L- NTG PETHIDINE
MORPHINE- MI PENTAZOCINE

Anti platelets

RE CANALISATION

Primary angioplasty

Fibrinolytic therapy.
 Drug eluting stent-
PTCA Sirolimus Immunosuppressant-
mTOR inhibitor

Thrombocytopenia
Hyperlipidemia (TGL)
Dual antiplatelet
Aspirin + P2Y12 blocker Paclitaxel
Peripheral neuropathy
Myelosuppression
Arrhythmia & treatment
HYPERKALEMIA EMERGENCY
Insulin + glucose
Calcium gluconate
Salbutamol
 AMIODARONE

Blue man syndrome

 DIURETICS

cirrhosis of liver Pulmonary edema Calcium stones

Indicated Rapid symptom Caused by

relief
Spirinolactone Loop
Furosemide Treated by
Contra
Disease
indicated modifying Thiazide
Acetazolamide Spirinolactone
 CCF

Omecamitiv-
Direct myosine activator

Cardiac contraction
Neprilysin (neutral endopeptidase )
Nesiritide- BNP
Ecadotril, Sacubitril
Selection of appropriate antihypertensive
drugs
HYPERTENSION DIABETES
WITH MELLITUS

ACEI, ARBs
CCB

Diuretics
Beta blockers
HYPERTENSION HYPER
WITH LIPIDEMIA

ACEI, ARBs
Alpha blocker
CCB

Diuretics
Beta blockers
HT EMERGENCY

Hydralazine
Esmolol
Labetalol
Enelaprilat
Nitroprusside
Nicardipine, clevidipine
Fenoldopam
Bil renal artery stenosis

ACEI
Name the cardiac drug ARBs
C/I in this condition
 DIRECT IIa INHIBITORS
Hepato toxic
XIMELAGATRAN
DABIGATRAN C/I- RF
Reversal-
IV. Idarucizumab
DIRECT Xa INHIBITORS

APIXABAN
IV.Andexanet alfa- RIVAROXABAN
EDOXABAN
Recombinant Xa BETRIXABAN

Common antidote for IIa & Xa inhibitors

CIRAPARANTAG

ORAL ANTICOAGULANTS
Antiplatelets
 Riociguat, Cinociguat

PDEV BLOCKER
CCB
ERBs
PGI2
SELEXIPAG

Rh O kinase inhibitor-
Fasudil (SAH, PHT, Angina)
For opioid deaddiction
METHADONE
Buprenorphine
For treating opioid
Withdrawal symptom
For alcohol deaddiction
Disulfiram
For treating alcohol
Withdrawal symptom

Lofexidine BZD

To prevent relapse
Naltrexone
Opioid induced
constipation
 VALBENAZINE

EPS- Trihexyphenidyl

AKATHESIA- Propranolol

TARDIVE DYSKINESIA
 ANTI EPILEPTICS

Migraine BPD
Valproate Carbamazepine
Topiramate Valproate
Lamotrigine
Gabapentin
Stiripentol
GABA AGONIST

severe myoclonic epilepsy

of infancy (SMEI)

LENNOX GASTAUT SYNDROME

Retigabine
(Ezogabine)
RUFINAMIDE

Na channel block

Potassium channel opener-

partial seizure
 PARTIAL

FIRST LINE
•Carbamazepine
•Lamotrigine
(elderly)
 STATUS EPILEPTICUS

FIRST LINE
Fosphenytoin
I/V Lorazepam Or phenytoin
I/V Diazepam
Sod valproate

Phenobarbitol

Propofol /midazolam
PARKISNON DISEASE PSYCHOSIS

5HT2A INVERSE AGONIST

PIMAVANSERIN
 TCA POISONING:

IV sod bicrbonate

Cardiac arrhythmia Lidcocaine, bretylium

Convulsion Diazepam Avoid
Class Ia
Coma
Metabolic acidosis
. No role for hemodialysis Large Vd
ANTI CHOLINERGIC-

Avoid in elderly male with BPH Aggravate urinary retention

Alzhiemers disease
Calcitonin gene-related peptide
(CGRP)- Vasodilatation

CGRP antagonist

Olcegepant
Telcagepant

ERENUMAB
FREMANEZUMAB
GALCANEZUMAB
BREXANOLONE

NEURO STEROID
Postpartum depression
SUVOREXANT OREXIN ANTAGONIST
SOLRIAMFETOL- NDRI

PITOLISANT- H3 Inverse agonist

MODAFINIL
A 25-year-old woman has a long history of depressive symptoms
accompanied by body aches and pain secondary to a car accident.
Which of the following drugs might be useful in this patient?
A. Fluoxetine
B. Sertraline
C. Bupropione Neuropathy pain
D. Duloxetine Fibromyalgia
Stress incontinence
SNRI VENLAFAXINE- DULOXETINE, Milnacipram
Levo-milnacipram, vilazodone, vortioxetine
(Anti depressants)
Neuropathy pain
Fibromyalgia
Stress incontinence

ADHD
NDRI Bupropion Obesity
Smoking control

ADR
Seizure
More anxiogenic
Depression OCD PTSD

SSRI Premature
USES DOC Ejaculation

Bulimia
P P
A M
N T
I S
C
 m-RNA
DNA

THFA

DHFA

PABA
 steven Johnson syndrome

? 2nd line Anti TB C/I- HIV

Abacavir- HLA B 5701 allele

Carbamazepine- HLA B 1502 gene
 ATT

Safe
Streptomycin
Ethambutol Safe-
Avoid – avoid- Rifampicin
Streptomycin INH INH

Rifampicin Avoid
Pyrazinamide Ethambutol
Pyrazinamde
Streptomycin
 ATT

PSYCHOSIS

INH, UVEITIS
HYPOTHYROIDISM
cycloserine
RIFABUTIN Ethionamide,
PAS
 STAVUDINE
TESAMORELIN

GHRF
Reduces
abdominal fat

in HIV with
lipodystrophy

Lipodystrophy-

Lipoatrophy-
 ANTI RETRO VIRAL

PSYCHOSIS

Effavirenz NEPHROLITHIASIS
INTRA
CRANIAL Hge
INDINAVIR
TIPRANAVIR
 Remdesivir

B
COVID-19
B CELL
pneumonia
ASPERGILLOSIS

VORICONAZOLE
 APPROVED FOR
Posaconazole
Candidiasis, aspergillus,
mucormycosis

Isavuconazole

Mucormycosis
A 63-year-old woman complained to her physician of intermit
tent back pain that was worse at night. History revealed
that the woman had undergone a modified radical mastectomy
2 years earlier for in lnfiltrating ductal carcinoma of the
breast that turned out to be HER-2 (human epidermal growth
factor receptor 2) positive. A computed tomography scan revealed
bone metastases, and she was scheduled for high-dose
combination chemotherapy. Which of the following drugs was
most likely included in her treatment regimen?

A. Clomiphene
B. Leuprolide
C. Trastuzumab
D. Flutamide
TRASTUZUMAB emtansine
TRASTUZUMAB
Inhibits microtuble PERTUZUMAB

HER-2 +ve Infusion reaction

Breast cancer Cardiomyopathy

RECEPTOR

HER-2 B CELL

B
TARGET CELL
HER-
1 TKIs- EGFR (HER-1) + HER 2 +Ve BREAST CANCER
EGFR

Lapatinib

TYROSINE Neratinib
KINASE
HER 1, 2 & 4
 CDK 4/6(CYCLIN DEPENDENT KINASE INHIBITOR-
BREAST CANCER
EVEROLIMUS

PALBOCICLIB

ABEMACICLIB

RIBOCICLIB

POLY ADP-RIBOSE POLYMERASE(PARP) INHIBITORS

BREAST CANCER

Talazoparib

Ertumaxomab HER 2 + CD 3 BREAST CANCER

PULMONARY FIBROSIS HAND FOOT SYNDROME
Capecitabine
BLEOMYCIN 5-Flurouracil
BUSULFAN Doxorubicin
Interleukin-2
Pemetrexed
 BLEOMYCIN
Muco cutaneous
reaction ( flagellated
pigmentation on skin )
Multiple Myeloma

BORTEZOMIB
Panobinostat
 ANTIDOTE

Haemorrhagic
cystitis Nephrotoxic
Cardiomyopathy
ANTIDOTE
PEGVISOMANT
S/C
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2 ) INHIBITORS

Serligliflozin
Dapagliflozin
Canagliflozin Dec CV risk
Empagliflozin
Ertugliflozin

SGLT 1 &2
SATAGLIFLOZIN

Glycosuria
COMBINATION DRUGS

Bupropion SR + Naltrexone SR
Bupropion + Zonisamide
Phenteramine+ Topiramate
(sympathetic stimulant)

GLP-1- LIRAGLUTIDE
FDA approved drug for obesity
 HMG CoA+ Acetate
PCSK9 inhibitor-
ALIROCUMAB
HMG CoA reductase STATINS
EVOLOCUMAB

Mevalonic acid

Cholesterol
Promotes osteoblast Inhibits osteoclast

TERIPARATIDE
Abaloparatide Bisphosphonate
VIT D DENOSUMAB
CAlCIUM RALOXIFEN
Anti sclerotic
antibody Strontium ranelate
Romosozumab Dual action
Blosozumab

Osteoporosis
 SERM

Ovulation Dyspareunia
CLOMIPHENE OSPEMIFENE
 Cushing syndrome
Metyrapone

Ketoconazole

Mitotane
Chemical aderenalectomy
Aminoglutethiamide

Trilostane

Pasireotide
Glucocorticoid receptor blocker-
Etomidate (GA) MIFEPRISTONE
 TENATOPRAZOLE
longest t1/2(9hrs),

ILAPRAZOLE

Vonoprazan,
Revaprazan Newer PPI
 For aggressive therapy
- IV
Lesinurad- Rasburicase
Uricosuric Pegloticase

GOUT

IL- 1 blockers
- Canakinumab
- Rilonacept
- Anakinra
 Infliximab
LEFLUNOMIDE
Etanercept
Di hydro oratate
Adalimumab
Dehydrogenase
inhibitor Golimumab
Certolizumab

ANAKINRA- IL1

RHEUMATOID ARTHRITIS
AMYOTROPIC LATERAL SCLEROSIS

Edaravone- Antioxident
Riluzole- NMDA blocker
A 63-year old woman complained to her physician of recurrent
wheezing that caused frequent nocturnal awakening.
She also noted that wheezing occurred when she was anxious
and tense. The woman had been suffering from allergic
rhinitis for 4 years and from atrial fibrilla ion for 1 year. A
diagnosis of mild allergic asthma was made. Which of the
following drug treatment s would be most appropriate for
relief of her bronchospasm?

A. Oral glucocorticoids
B. Oral theophylline
C. Inhaled ipratropium
D. Inhaled salmeterol
 MAB- BRONCHIAL ASTHMA

OMALIZUMAB – Ig E

DUPILUMAB IL-4

ATOPIC DERMATITIS

MEPOLIZUMAB-IL5
TRALOKINUMAB IL-13
RESLIZUMAB-IL5
LEBRIKIZUMAB -IL13
BENRALIZUMAB- IL5
Vitreomacular adhension

Ocriplasmin
 (anterior uveitis) Bronchospasm
Lid lag

Apraclonidine Brimonidine Timolol

Nasolacrimal duct
obstruction
NETARSUDIL,
REPASUDIL – Dipivefrine
Rho kinase Inhibitor
Outflow via trabecular
Beta blockers meshwork GLAUCOMA
Iris Red eye
Pigmentation
Bimatoprost
Ecothiophate
Ecothiophate Hypertrichosis
Heterochromia
iridis
Latanoprost Cystoic macular edema

Bimatoprost