📌PHARMA PEARLS COMPLETE Flashcards by Kringkring B

Pica, ingestion if flakes of paint, abdominal colic, acute encephalopathy, wrist drop, mental retardation

Lead

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Acute arsenic poisoning
Acute mercury poisoning
Chronic severe lead poisoning

SE: hypertension

Dimercaprol

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Chronic lead poisoning (oral treatment)

Succimer

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Chronic severe lead poisoning

SE: hypocalcemia

EDTA (Edetate Calcium Disodium)

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Rice-water stools, garlicky breath, Mee’s lines, raindrop pigmentation, milk and roses complexion

Arsenic

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Hemorrhagic, gastroenteritis, renal failure, loosening of gums and teeth, erethism

Inorganic mercury

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Minamata disease (cerebral palsy, deafness, blindness, mental retardation)

Organic mercury

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Severe GI necrosis, hemosiderosis, restrictive cardiomyopathy

Iron

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Acute iron poisoning, hemochromatosis

Deferoxamine

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Hepatotoxicity, Kayser-Fleisher rings, sunflower cataracts

Copper

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Copper poisoning, Wilson’s disease

SE: drug-induced lupus

Penicillamine

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Treatment of lymphomas

SE: hemorrhagic cystitis

Rescue agent: Mesna

Cyclophosphamide

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Treatment of colon cancer

SE: ototoxicity, nephrotoxicity

Rescue agent: Amifostine

Cisplatin

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SE: marked vesicant actions (skin blistering)

Mechlorethamine

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SE: Disulfiram reaction, Leukemogenesis

Procarbazine

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Testicular and ovarian tumor

SE: Pulmonary fibrosis, bone marrow-sparing

Bleomycin

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Treatment of brain tumors

SE: CNS toxicity

Carmustine

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Tyrosine kinase inhibitor

Treatment of CML

SE: fluid retention, multiple drug interations

Imatinib

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Treatment of metastatic breast cancer, active against cells expressing HER-2/neu

Trastuzumab

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Inhibits VEGF, treatment of metastatic cancers

Bevacizumab

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Differentiation therapy, treatment of acute promyelocytic leukemia, only vitamin that can cure cancer

All trans retinoic acid (ATRA)

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Drugs that cause PULMONARY FIBROSIS

BBBAN ME
Bleomycin
Busulfan
Bromocriptine
Amiodarone
Nitrofurantoin
Methotrexate

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Treatment of lymphomas and GTN

Myelosuppression, pulmonary fibrosis

Rescue agent: Leucovorin (folinic acid)

Methotrexate

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Treatment of acute leukemias

Myelosuppression, hepatotoxicity, metabolism inhibited by allopurinol

6-Mercaptopurine

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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 Hodgkin's 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, Wilm's 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 Paget's disease of bone and osteoporosis SE: esophagitis

Alendronate

Treatment of Paget's 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 1. Advanced renal disease 2. Elderly 3. 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 (Ebstein's 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 Parkinson's 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 Parkinson's 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 Won't work due to acidic environment (below pKa = protonated form predominates, so it can't 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, "milk of amnesia" 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

Chaga's 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?

SAMTER's 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?

1. Warfarin's effect requires elimination of preformed clotting factors (8-60h) 2. 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 Parkinson's Disease

TRIhexyphenidyl BENZtropine BIPeriden

Treatment for organophosphate poisoning / nerve gas poisoning

Atropine + Pralidoxine

Motion sickness | Sea sickness

Scopolamine

Chronic obstructive pulmonary disease (COPD)

Ipratropium

Parkinson's 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 1. Ocular symptoms 2. Bulbar symptoms 3. Proximal muscle weakness

What is Sjogren syndrome?

Autoimmune disorder characterized by triad of 1. Xerostomia (dry mouth) 2. Xerophthalmia (dry eyes) 3. 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 Alzheimer's 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