PHARMACOLOGY MNEMONICS

Pulmonary infiltrations inducing drugs "Go BAN Me!":GoldBleomycin/ Busulphan/ BCNUAmiodarone/ Acyclovir/ AzathioprineNitrofurantoinMelphalan/ Methotrexate/ Methysergide MPTP: mechanism, effect MPTP:Mitochondrial Parkinson's-Type Poison.· A mitochondrial poison that elicits a Parkinson's-type effect. Antimuscarinics: members, action"Inhibits Parasympathetic And Sweat":Ipratropium Pirenzepine Atropine Scopolamine· Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic. Teratogenic drugs: major non-antibiotics TAP CAP:Thalidomide Androgens Progestins Corticosteroids Aspirin & indomethacin Phenytoin Steroid side effects CUSHINGOID:CataractsUlcersSkin: striae, thinning, bruisingHypertension/ Hirsutism/ HyperglycemiaInfectionsNecrosis, avascular necrosis of the femoral headGlycosuriaOsteoporosis, obesityImmunosuppressionDiabetes  Beta blockers with CYP2D6 polymorphic metabolism"I Met Tim Carver, the metabolic polymorph":· 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) Beta blockers with intrinsic sympathomimetic activityPicture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels. Pindolol andCarteolol 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. 

Muscarinic effects SLUG BAM:Salivation/ Secretions/ SweatingLacrimationUrinationGastrointestinal upsetBradycardia/ Bronchoconstriction/ Bowel movementAbdominal cramps/ AnorexiaMiosis Sulfonamide: major side effects· Sulfonamide side effects:Steven-Johnson syndromeSkin rashSolubility low (causes crystalluria)Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin) Epilepsy types, drugs of choice:"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After CrushingEnemies":· Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence)· Respective drugs: Valproate  Valproate  Valproate ACTH Carbamazepine Ethosuximide Quinolones [and Fluoroquinolones]: mechanism"Topple the Queen": Quinolone interferes with Topoisomerase II. Beta blockers:B1 selective vs. B1-B2 non-selectiveA through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol.O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol. Ribavirin: indications RIBAvirin:RSVInfluenza BArenaviruses (Lassa, Bolivian, etc.)Hypertension: treatment ABCD:ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also)  Beta blockersCalcium antagonistsDiuretics Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugsConstipationRespiratory depression

AddictionMiosisSex hormone drugs: male "Feminine Males Need Testosterone":FluoxymesteroneMethyltestosteroneNandroloneTestosterone Ca++ channel blockers: uses CA++ MASH:Cerebral vasospasm/ CHFAnginaMigranesAtrial flutter, fibrillationSupraventricular tachycardiaHypertension· Alternatively: "CHASM":Cererbral vasospasm / CHFHypertensionAnginaSuprventricular tachyarrhythmiaMigranes Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM:ProcarbazineMetronidazoleCefo (Perazone, Mandole, Tetan). Delerium-causing drugs ACUTE CHANGE IN MS:Antibiotics (biaxin, penicillin, ciprofloxacin)Cardiac drugs (digoxin, lidocaine)Urinary incontinence drugs (anticholinergics)TheophyllineEthanolCorticosteroidsH2 blockersAntiparkinsonian drugsNarcotics (esp. mepridine)Geriatric psychiatric drugsENT drugsInsomnia drugsNSAIDs (eg indomethacin, naproxin)Muscle relaxantsSeizure medicines 

Morphine: side-effects MORPHINE:MyosisOut of it (sedation)Respiratory depressionPneumonia (aspiration)HypotensionInfrequency (constipation, urinary retention)NauseaEmesis Therapeutic dosage: toxicity values for most commonly monitored medications"The magic 2s":Digitalis (.5-1.5) Toxicity = 2.Lithium (.6-1.2) Toxicity = 2.Theophylline (10-20) Toxicity = 20.Dilantin (10-20) Toxicity = 20.APAP (1-30) Toxicity = 200. Diuretics:thiazides: indications "CHIC to use thiazides":CHFHypertensionInsipidousCalcium calculi Migraine: prophylaxis drugs"Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis":VerpamilValproic acidPizotifenAmitriptylineFlunarizineMethysergidePropranolol Adrenoceptors: vasomotor function of alpha vs. betaABCD:Alpha = Constrict.Beta = Dilate. 

Antiarrhythmics: classificationI to IV MBA College· In order of class I to IV:Membrane stabilizers (class I)Beta blockersAction potential widening agentsCalcium channel blockers Opiods: mu receptor effects "MD CARES":MiosisDependencyConstipationAnalgesicsRespiratory depressionEuphoriaSedation

Cancer drugs: time of action between DNA->mRNA ABCDEF: Alkylating agentsBleomycinCisplastinDactinomycin/ DoxorubicinEtoposideFlutamide and other steroids or their antagonists (eg tamoxifen, leuprolide) Busulfan: features ABCDEF:Alkylating agentBone marrow suppression s/eCML indicationDark skin (hyperpigmentation) s/eEndrocrine insufficiency (adrenal) s/eFibrosis (pulmonary) s/e Tricyclic antidepressants: members worth knowing"I have to hide, the CIA is after me":Clomipramine Imipramine Amitrptyline· If want the next 3 worth knowing, the DNDis also after me:Desipramine Norrtriptyline Doxepin Torsades de Pointes: drugs causing APACHE:Amiodarone Procainamide Arsenium Cisapride Haloperidol Eritromycin Serotonin syndrome: components Causes HARM:Hyperthermia Autonomic instability (delirium) Rigidity Myoclonus Tetracycline: teratogenicityTEtracycline is a  TEratogen that causes staining of  TEeth in the newborn.

 Patent ductus arteriosus: treatment"Come In and Close the door": INdomethacin is used to Close PDA. Physostigmine vs. neostigmine LMNOP:Lipid solubleMioticNaturalOrally absorbed wellPhysostigmine· Neostigmine, on the contrary, is: Water solubleUsed in myesthenia gravisSyntheticPoor oral absorption Beta 1 selective blockers"BEAM ONE up, Scotty":Beta 1 blockers:EsmololAtenololMetropolol Antirheumatic agents (disease modifying): membersCHAMP:CyclophosphamideHydroxycloroquine and choloroquinineAuranofin and other gold compoundsMethotrexatePenicillamine  Auranofin, aurothioglucose: category and indicationAurum is latin for "gold" (gold's chemical symbol is Au).Generic Aur- drugs (Auranofin, Aurothioglucose) are gold compounds.· If didn't learn yet that gold's indication is rheumatoid arthritis, AUR- Acts Upon Rheumatoid. Antiarrhythmics: class III members  BIAS:BretyliumIbutilideAmiodaroneSotalol MAOIs: indications MAOI'S:Melancholic [classic name for atypical depression]AnxietyObesity disorders [anorexia, bulemia]Imagined illnesses [hypochondria]

Social phobias· Listed in decreasing order of importance.· Note MAOI is inside MelAnchOlIc. SIADH-inducing drugs ABCD:Analgesics: opioids, NSAIDsBarbituratesCyclophosphamide/ Chlorpromazine/ CarbamazepineDiuretic (thiazide) K+ increasing agents K-BANK:K-sparing diureticBeta blockerACEINSAIDK supplement  Reserpine action:Reserpine depletes the Reserves of catecholamines [and serotonin]. 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.Beta-blockers: side effects "BBC Loses Viewers In Rochedale": BradycardiaBronchoconstrictionClaudicationLipidsVivid dreams & nightmares-ve Inotropic actionReduced sensitivity to hypoglycaemiaCisplatin: major side effect, action "Ci-Splat-In":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. Phenobarbitone: side effectsChildren are annoying (hyperkinesia, irritability, insomnia, aggression).Adults are dosy (sedation, dizziness, drowsiness). Prazocin: usagePrazocin sounds like an acronym of "praszz zour urine".Therefore Prazocin used for urinary retention in BPH. Opioids: effects BAD AMERICANS:Bradycardia & hypotensionAnorexiaDiminished pupilary sizeAnalgesicsMiosisEuphoriaRespiratory depressionIncreased smooth muscle activity (biliary tract constriction) ConstipationAmeliorate cough reflexNausea and vomitingSedation

TB: antibiotics usedSTRIPE:STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol Phenytoin: adverse effects PHENYTOIN:P-450 interactionsHirsutismEnlarged gumsNystagmusYellow-browning of skinTeratogenicityOsteomalaciaInterference with B12 metabolism (hence anemia)Neuropathies: vertigo, ataxia, and headache  

Narcotic antagonistsThe Narcotic Antagonists are NAloxone and NAltrexone. · Important clinically to treat narcotic overdose. Thrombolytic agents USA:Urokinase Streptokinase Alteplase (tPA) Routes of entry: most rapid ways meds/toxins enter body"Stick it, Sniff it, Suck it, Soak it":Stick = InjectionSniff = inhalationSuck = ingestionSoak = absorption Asthma drugs: inhibitor actionzAfirlukast: Antagonist of LTzIlueton: Inhibitor of 5-LO Direct sympathomimetic catecholamines DINED:DopamineIsoproterenolNorepinephrineEpinephrineDobutamine Anticholinergic side effects"Know the ABCD'S of anticholinergic side effects":AnorexiaBlurry visionConstipation/ ConfusionDry MouthSedation/ Stasis of urine Atropine use: tachycardia or bradycardia"A goes with B": Atropine used clinically to treat Bradycardia. 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). Aspirin: side effects ASPIRIN:AsthmaSalicyalism

Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/Premature closure of PDAIntestinal blood lossReye's syndromeIdiosyncracyNoise (tinnitus) Lupus: drugs inducing it HIP:HydralazineINHProcanimide Vigabatrin: mechanism Vi-GABA-Tr-In:Via GABA Transferase Inhibition Morphine: effects at mu receptor PEAR:Physical dependenceEuphoriaAnalgesiaRespiratory depression Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factor Xa. Monitor Xa concentration, rather than APTT. Beta-1 vs Beta-2 receptor location "You have 1 heart and 2 lungs": Beta-1 are therefore primarily on heart. Beta-2 primarily on lungs. SSRIs: side effects SSRI:Serotonin syndromeStimulate CNSReproductive disfunctions in maleInsomnia Ipratropium: action Atropine is buried in the middle:iprAtropium, so it behaves like Atropine. Warfarin: action, monitoring WePT:Warfarin works on the extrinsic pathway and is monitored by PT. 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. Depression: 5 drugs causing it PROMS:

PropranololReserpineOral contraceptivesMethyldopaSteroids Lead poisoning: presentation ABCDEFG:AnemiaBasophilic strippingColicky painDiarrheaEncephalopathyFoot dropGum (lead line)  Myasthenia gravis: edrophonium vs. pyridostigmineeDrophonium is for Diagnosis.pyRIDostigmine is to get RID of symptoms. Morphine: effects MORPHINES:MiosisOrthostatic hypotensionRespiratory depressionPain supressionHistamine release/ Hormonal alterationsIncreased ICTNauseaEuphoriaSedation Inhalation anesthetics SHINE:SevofluraneHalothaneIsofluraneNitrous oxideEnflurane· If want the defunct Methoxyflurane too, make it MoonSHINE. Cholinergics (eg organophosphates): effectsIf you know these, you will be "LESS DUMB":LacrimationExcitation of nicotinic synapsesSalivation

SweatingDiarrheaUrinationMicturitionBronchoconstriction Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure) LOT:Lorazepam Oxazepam Temazepam Benzodiazepines: actions"Ben SCAMs Pam into seduction not by brain but by muscle":Sedationanti-Convulsantanti-AnxietyMuscle relaxantNot by brain: No antipsychotic activity. Botulism toxin: action, related bungarotoxinAction: "Botulism Bottles up the Ach so it can't be the released":Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alpha-bungarotoxin--alpha has different mechanism). Teratogenic drugs "W/ TERATOgenic":WarfarinThalidomideEpileptic drugs: phenytoin, valproate, carbamazepineRetinoidACE inhibitorThird element: lithiumOCP and other hormones (eg danazol) Gynaecomastia-causing drugs DISCOS:DigoxinIsoniazidSpironolactoneCimetidineOestrogensStilboestrol Benzodiazepenes: drugs which decrease their metabolism"I'm Overly Calm":IsoniazidOral contraceptive pillsCimetidine

· These drugs increase calming effect of BZDs by retarding metabolism. Anesthesia: 4 stages "Anesthesiologists Enjoy S & M":AnalgesiaExcitementSurgical anesthesiaMedullary paralysis 4-Aminopyradine (4-AP) use"4-AP is For AP":For AP (action potential) propagation in Multiple Sclerosis. Osmotic diuretics: members GUM:GlycerolUreaMannitol Sodium valproate: side effects VALPROATE:VomitingAlopeciaLiver toxicityPancreatitis/ PancytopeniaRetention of fats (weight gain)Oedema (peripheral oedema)Appetite increaseTremorEnzyme inducer (liver) Nitrofurantoin: major side effects NitroFurAntoin:Neuropathy (peripheral neuropathy)Fibrosis (pulmonary fibrosis)Anemia (hemolytic anemia)Zafirlukast, Montelukast, Cinalukast:mechanism, usage"Zafir-luk-ast, Monte-luk-ast, Cina-luk-ast": · Anti-Lukotrienes for Asthma.· Dazzle your oral examiner: Zafirlukast antagonizes leukotriene-4.Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount":PhenytoinEthanolAspirinZero order· Someone that pees out a constant amount describes zero order kinetics (always the same amount out) Hepatic necrosis: drugs causing focal to massive necrosis

"Very Angry Hepatocytes":Valproic acidAcetaminophenHalothane Steroids: side effects BECLOMETHASONE:Buffalo humpEasy bruisingCataractsLarger appetiteObesityMoonfaceEuphoriaThin arms & legsHypertension/ HyperglycaemiaAvascular necrosis of femoral headSkin thinningOsteoporosisNegative nitrogen balanceEmotional liability Amiodarone: action, side effects 6 P's:Prolongs action potential durationPhotosensitivityPigmentation of skinPeripheral neuropathyPulmonary alveolitis and fibrosisPeripheral conversion of T4 to T3 is inhibited -> hypothyroidism  Monoamine oxidase inhibitors:Members "PIT of despair":PhenelzineIsocarboxazidTranylcypromine ·       A pit of despair, since MAOs treat depression  Warfarin: metabolism SLOW:· Has a slow onset of action.· A quicK Vitamin K antagonist, though.Small lipid-soluble moleculeLiver: site of actionOral route of administration.Warfarin

  Propythiouracil (PTU):Mechanism It inhibits PTU:Peroxidase/ Peripheral deiodinationTyrosine iodination Union (coupling)  Antibiotics contraindicated during pregnancy  MCAT:MetronidazoleChloramphenicolAminoglycosideTetracycline Beta-blockers:nonselective beta-blockers"Tim Pinches His Nasal Problem"(because he has a runny nose...):TimololPindololHismololNaldololPropranolol Methyldopa:side effects METHYLDOPA:Mental retardationElectrolyte imbalanceToleranceHeadache/ Hepatotoxicity psYcological upsetLactation in femaleDry mouthOedemaParkinsonismAnaemia (haemolytic) Lithium: side effects  LITH:LeukocytosisInsipidus [diabetes insipidus, tied to polyuria]Tremor/ TeratogenesisHypothyroidism Respiratory depression inducing drugs "STOP breathing":Sedatives and hypnoticsTrimethoprim

OpiatesPolymyxins  Benzodiazepenes: antidote "Ben is off with the flu":Benzodiazepine effects off with Flumazenil.

 

PHARMACOLOGY Mechanisms A. Scopolamine • Anti-muscarinic • Motion Sickness; preoperatively to reduce secretions • Anti-muscarinic toxicities (mydriasis & cycloplegia; decreased secretions & sweating; flushing; bradycardia (low doses); tachycardia (high doses); urinary retention; drowsiness, hallucinations, coma)

Typical Anti-psychotics (Chlorpromazine, Haloperidol, Thioridazine) • Dopamine antagonists • Schizophrenia; psychosis • Lactation; Extrapyramidal effects (parkinsonism, akathisia (motor restlessness), tardive dyskinesia (lip smacking, jaw movements, etc.)); anti-cholinergic effects (antimuscarinic, alpha-antagonistic (orthostatic hypotension), and anti-histamine (sedation)). Toxicities are a tradeoff—higher extrapyramidal effects coincide with lower anticholinergic effects and vice-versa. The higher the extrapyramidal effects, the higher the potency (haloperidol > chlorpromazine > thioridazine)

Atypical anti-psychotics (Clozapine) • Dopamine antagonist • Schizophrenia; psychosis • NO extrapyramidal effects or lactation; agranulocytosis (fatal); Neuroleptic Malignant Syndrome (catatonia, autonomic instability, stupor); anti-cholinergic effects as above

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

RU486 (Mifepristone) • Progestin antagonist • Early-term abortion • Uterine bleeding, possible incomplete abortion

C. Acarbose • Alpha-glucosidase inhibitor—decreases absorption of glucose • NIDDM; adjunct to insulin in IDDM • Flatulence; diarrhea; abdominal cramping

D. Losartan • Angiotensin II antagonist • Hypertension • Similar to ACE inhibitors but no cough (decreased bradykinin activation)

E. Myasthenia Gravis Drugs • Inhibit cholinesterase • Diagnosis (edrophonium); long-term treatment (Neostigmine, Pyridostigmine); open-angle glaucoma; reversal of non-depolarizing nm blockade • Fasciculations & weakness

F. Leuprolide • GnRH analog desensitization of pituitary receptor decreased FSH, LH secretion • Prostate Cancer • Transient excess testosterone production (prevent by combining with flutamide); impotence, hot flashes, tumor flare

G. Flutamide • Blocks inhibitory effects of testosterone on GnRH release • Combo with leuprolide

H. Aminoglutethimide • Inhibits Cholesterol pregnenelone conversion (like metyrapone) • Metastatic breast cancer (decreased estrogen) • Induces P450; transient CNS depression; rash

I. Metformin • Decreases gluconeogenesis; improves lipid profile (HDL rises, LDL falls) • NIDDM – lower risk of hypoglycemia • GI side effects; lactic acidosis (rare); long-term interference w B12 absorption

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

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