Pharmacology Flashcards
1
Q
Km
A
Potency. It is inversely related to the affinity of the enzymes for its substrate. Km= [S] at 1/2 Vmax. The high Km, the lower the affinity.
2
Q
Vmax
A
Efficacy. Vmax represents the maximum rate achieved by the system, at maximum (saturating) substrate concentrations.
3
Q
Michaelis-Menten kinetics
A
Enzymatic reactions that follow a hyperbolic curve when velocity is plotted against [S]. Enzymatic reactions that exhibit a sigmoid curve usually indicate cooperative kinetics (ie hemoglobin).
4
Q
Lineweaver-Burk plot
A
1/V plotted against 1/[S]. Y-intercept= 1/Vmax, an increase in the y-intercept = a decrease in Vmax. X-intercept= -1/Km, the closer to zero, the bigger Km is and the smaller affinity is.
5
Q
Competitive reversible inhibitors
A
There structure resembles the substrate and binds active site of the enzyme. It can be over come by an increase in [S]. There is no effect on Vmax. It increases Km, which decreases the potency.
6
Q
Competitive irreversible inhibitors
A
There structure resembles the substrate but does not bind the active site of the enzyme. It can not be over come by an increase in [S]. It decreases Vmax, which decreases efficacy. There is no effect on Km.
7
Q
Noncompetitive inhibitors
A
They do not resemble substrate and do not bind the active site. It can not be overcome with an increase in [S]. It decreases Vmax, which decreases efficacy. There is no effect on Km.
8
Q
Bioavailability (F)
A
Fraction of administered drug reaching systemic circulation unchanged. For an IV dose, F=100%. Orally, F is less than 100% due to incomplete absorption and first pass metabolism.
9
Q
Volume of distribution (Vd)
A
Theoretical volume occupied by the total amount of drug in the body relative to its plasma concentration. Apparent Vd of plasma protein-bound drugs can be altered by liver and kidney disease (a decrease in protein binding leads to an increase in Vd). Drugs may distribute in more than one compartment. Vd=amount of drug in the body/ plasma drug concentration.
10
Q
Low Vd
A
Usually the compartment is blood. Drug types are usually large/ charged molecules and plasma bound.
11
Q
Medium Vd
A
Usually the compartment is ECF. Drug types are small hydrophilic molecules.
12
Q
High Vd
A
Usually can saturate all tissues, including fat. Drug types are usually small lipophilic molecules, especially if bound to tissue protein.
13
Q
Clearance (CL)
A
The volume of plasma cleared of drug per unit time. Clearance may be impaired with defects in cardiac, hepatic, or renal function. CL= rate of elimination of drug/ plasma drug concentration= Vd x Ke (elimination constant).
14
Q
Half-life (t1/2)
A
The time required to change the amount of drug in the body by 1/2 during elimination (or constant infusion). Property of first order elimination. A drug infused at a constant rate takes 4-5 half-lives to reach a steady state. It takes 3.3 half lives to reach 90% of the steady state level. t1/2=(0.693 x Vd)/ CL. Time to steady state depends primarily on t1/2 and is independent of dose and dosing frequency.
15
Q
Loading dose
A
Loading dose= (Cp x Vd)/F. Cp= target plasma concentration at steady state.
16
Q
Maintenance dose
A
Maintenance dose= (Cp x CL x t)/ F. Cp=target dose, CL= clearance, t= dosage interval (time between doses), if not administered continuously. Cp= target plasma. In renal or liver disease, maintenance dose decreases and loading dose is usually unchanged.
17
Q
Zero- order elimination
A
Rate of elimination is constant regardless of Cp (target plasma); constant amount of drug eliminated per unit of time. Cp decreases linearly with time. Examples of drugs include (PEA- round haped like the 0 in zero-order) Phenytoin, Ethanol, and Aspirin (at high or toxic concentrations). Capacity limited elimination.
18
Q
First order elimination
A
Rate of elimination is directly proportional to the drug concentration (ie constant fraction of drug eliminated per unit of time). Cp decreases exponentially with time. It is flow dependent elimination.
19
Q
Urine pH and drug elimination
A
Ionized species are trapped in urine and cleared quickly. Neutral forms can be reabsorbed. Weak acids, such as phenobarbital, methotrexate, aspirin and TCAs, get trapped in basic environment. Therefore you can treat overdoses with bicarbonate. Weak bases include amphetamines, which get trapped in acidic environments. Treat overdose with ammonium chloride.
20
Q
Phase I drug metabolism
A
Reduction, oxidation, hydrolysis with cytochrome P-450 usually yield slightly polar, water-soluble metabolites (often still active). Geriatric patients lose phase I first.
21
Q
Phase II drug metabolism
A
Conjugation (Glucuronidation, Acetylation, Sulfation- GAS) usually yields very polar, inactive metabolites (renally excreted). Patients who are slow acetylators have an increase in side effects from certain drugs because of a decrease in rate of metabolism.
22
Q
Efficacy
A
The maximal effect a drug can produce. It is represented by the y-value (Vmax). It is unrelated to potency (ie efficacious drugs can have high or low potency). Partial agonists have less efficacy than full agonists.
23
Q
Potency
A
The amount of drug needed for a given effect. An increase in potency (EC50-the concentration of a drug that gives half-maximal response)= a decrease in potency. Unrelated to efficacy (ie potent drugs can have a high or low efficacy).
24
Q
Competitive antagonist
A
They shifts curve right (a decrease in potency, Km), no change in efficacy. Can be overcome by an increase in the concentration of agonist substrate. For example, diazepam is an agonist, while flumazenil is a competitive antagonist on the GABA receptor.
25
Noncompetitive antagonist
They shift the curve down, a decrease in efficacy. It cannot be overcome by an increase in agonist substrate concentration. For example, norepinephrine is an agonist, while phenoxybenzamine is a noncompetitive antagonist on alpha receptors.
26
Partial agonist (alone)
They act at the same site as a full agonist, but with lower than maximal effect, which is a decrease in efficacy (Vmax). Potency is an independent variable. For example, morphine is a full agonist, while buprenorphine is a partial agonistat opiod at mu-receptors.
27
Therapeutic index
A measurement of drug safety. TD50/ED50=median toxic dose/median effective dose= therapeutic index. Safer drugs have a higher TI value. Drugs with a lower TI value include digoxin, lithium, theophylline, and warfarin. LD50 (lethal median dose) often replaces TD50 in animal studies.
28
Therapeutic window
A measure of clinical drug effectiveness for a patient.
29
Botulinum toxin
prevents the release of acetylcholine at cholinergic terminals.
30
Nicotinic ACh receptors
They are ligand gated Na/K channels. Subtypes include Nn (found in autonomic ganglia) and Nm (found in neuromuscular junction).
31
Voluntary motor nerve
It is a somatic nerve. Lower motor neurons synapse on skeletal muscles, releasing the neurotransmitter acetylcholine, which synapse on nicotinic receptors.
32
Muscarinic ACh preceptos
They are G protein coupled receptors that usually act through secondary messengers. The 5 subtypes include M1, M2, M3, M4, and M5.
33
alpha-1 androgenic receptors
It is a Gq-protein linked 2nd messengers. It increases vascular smooth muscle contraction, increases pupillary dilator muscle contraction (mydriases), increases intestinal and bladder sphincter muscle contraction.
34
alpha-2 androgenic receptors
It is a Gi-protein linked 2nd messengers. It decreases sympathetic outflow, decreases insulin release, decreases lipolysis. increases platelet aggregation, and decreases aqueous humor production.
35
beta-1 androgenic receptors
It is a Gs-protein linked 2nd messengers. It increases heart rate, increases contractility, increases renin release, and increases lipolysis
36
beta-2 androgenic receptors
It is a Gs-protein linked 2nd messengers. It causes vasodilation, causes bronchodilation, increases lipolysis, increases insulin release, decreases uterine tone (tocolysis), causes ciliary muscle relaxation, and increases aqueous humor production
37
M1 receptors
It is a Gq-protein linked 2nd messengers. It is located in the CNS and in the enteric nervous system.
38
M2 receptors
It is a Gi-protein linked 2nd messengers. It decreases heart rate and contractility of atria.
39
M3 receptors
It is a Gq-protein linked 2nd messengers. It increases exocrine gland secretions (eg lacrimal, salivary, gastric acid), increases gut peristalsis, increases bladder contraction, causes bronchoconstriction, increases pupillary sphincter muscle contraction (miosis), causes ciliary muscle contraction (accommodation).
40
D1 receptors
It is a Gs-protein linked 2nd messengers. It relaxes renal vascular smooth muscle.
41
D2 receptors
It is a Gi-protein linked 2nd messengers. It modulates transmitter releases, especially in the brain.
42
H1 receptors
It is a Gq-protein linked 2nd messengers. It increases nasal and bronchial mucus production, increases vascular permeability, causes contraction of bronchioles, causes pruritus, and causes pain.
43
H2 receptors
It is a Gs-protein linked 2nd messengers. It increases gastric acid secretion.
44
V1 receptors
It is a Gq-protein linked 2nd messengers. It increases vascular smooth muscle contraction.
45
V2 receptors
It is a Gs-protein linked 2nd messengers. It increases H2O permeability and reabsorption in collecting tubules of the kidney (V2 found in 2 kidneys).
46
Gq receptors
H1, alpha1, V1, M1, M3 (HAVe 1 M&M, or 3). Binding the receptor activates phospholipase C, which cleaves PIP2 into DAG (which activates protein kinase C) and IP3 (which increases Ca, leading to smooth muscle contraction).
47
Gs receptors
beta1, beta2, D1, H2, V2. Gs activates adenyly cyclase, turning ATP to cAMP, which activates Protein kinase A, increasing Ca concentration (in the heart) and activating myosin light-chain kinase (in smooth muscle).
48
Gi receptors
M2, alpha2, D2 (MAD 2's). Gi inhibits adenyly cyclase, reducing cAMP, inhibiting protein kinase A, decreasing Ca concentration (in the heart) and inhibiting myosin light-chain kinase (in smooth muscle).
49
Anticholinergic drug that inhibit choline reuptake in the presynaptic neuron
Hemicholinium
50
Anticholinergic drug that inhibit ACh uptake into vesicles in the presynaptic neuron
Vesamicol
51
Anticholinergic drug that inhibit ACh release from presynaptic neuron
Botulinum
52
Cholinergic drug that inhibit break down of ACh in synaptic cleft
ACh esterase inhibitors
53
Antiadrenergic drug that inhibits the conversion of tyrosine to DOPA in presynaptic neurons
Metryosine
54
Antiadrenergic drug that inhibits vesicular transport of norepinephrine, serotonin, and dopamine in presynaptic neurons
Reserpine
55
Antiadrenergic drug that blocks the release of noradrenaline from nerve terminals in presynaptic neurons
Bretylium
56
Antiadrenergic drug that reduces the release of catecholamines from nerve terminals in presynaptic neurons
Guanethidine
57
Adrenergic drugs that induce amphetamine and ephedrine from nerve terminals in presynaptic neurons
Amphetamine and ephedrine
58
Antiadrenergic drug that inhibit reuptake of catacholines into presynaptic neurons
Cocaine, TCAs, and amphetamine
59
Modulation of norepinephrine release from sympathetic nerve endings
It is inhibited by norepinephrine itself, acting on presynaptic alpha2- receptors
60
Bethanechol
Used for postoperative ileus, neurogenic ileus, and urinary retention. Direct cholinergic agonist. It activates Bowel and Bladder smooth muscle; resistant to AChE. (Bethany, call (bethanechol) me to activate your Bowels and Bladders)
61
Carbachol
Direct cholinergic agonist. Constricts pupil and relieves intraocular pressure in glaucoma. CARBon copy of acetylCHOLine
62
Methacholine
Direct cholinergic agonist. Challenge test for diagnosis of asthma. Stimulates Muscarinic receptors in airway when inhaled.
63
Pilocarpine
Direct cholinergic agonist. Potent stimulator of sweat, tears, and saliva. Used to treat both open angle and closed angle glaucoma. It contracts ciliary muscle of the eye (open angle glaucoma), pupillary sphincter (closed angle glaucoma). It is resistant to AChE. (You cry, drool, and sweat on your PILOw)
64
Donepezil
Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.
65
Galantamine
Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.
66
Rivastigmine
Anticholinesterases (indirect agonists). Used to treat Alzheimer disease. Increases ACh.
67
Edrophonium
Anticholinesterases (indirect agonists). Historically, used to diagnosis of myasthenia gravis (extremely short acting). Myasthenia now diagnosed by anti-AChR Ab (anti-acetylcholine receptor antibody) test. Increases ACh.
68
Neostigmine
Anticholinesterases (indirect agonists). Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative). Increases ACh. Neo CNS= No CNS penetration.
69
Physostigmine
Anticholinesterases (indirect agonists). Can cause anticholinergic toxicity; it can cross blood-brain barrier into the CNS. Increases ACh. PHYsostigmine "PHYxes" atropine overdose.
70
Pyridostigmine
Anticholinesterases (indirect agonists). Myasthenia gravis (long acting); does not penetrate CNS. Increases ACh; increases muscle strength. PyRIDostiGMine gets RID of Myasthenia Gravis.
71
Toxicity of all cholinomimetic agents
Watch for exacerbation of COPD, asthma, and peptic ulcers when treating susceptible patients.
72
Cholinesterase inhibitor poisoning
Often due to to organophosphates, such as parathion, that irreversible inhibit AChE. Causes Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation. DUMBBELSS. Organophosphates are often components of insecticides; poisoning usually seen in farmers.
73
Treatment of cholinesterase inhibitor poisoning
Atropine (competitive inhibitor) plus pralidoxime (regenerates AChE if given early).
74
Atropine
Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.
75
Homatropine
Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.
76
Tropicamide
Muscarinic antagonists. Targets the eye. Produces mydriasis and cycloplegia.
77
Benztropine
Muscarinic antagonists. Targets the CNS. Treats PARKinson disease (PARK my BENZ). Also treats acute dystonia.
78
Glycopyrrolate
Muscarinic antagonists. Targets the GI and respiratory systems. It is used parenterally, preoperatively, to reduce airway secretions. It is also used orally, to reduce drooling and peptic ulcer.
79
Hyoscyamine
Muscarinic antagonists. Targets the GI system. It is used as an antispasmodics for irritable bowel syndrome.
80
Dicyclomine
Muscarinic antagonists. Targets the GI system. It is used as an antispasmodics for irritable bowel syndrome.
81
Ipratropium
Muscarinic antagonists. Targets the respiratory system. Used to treat COPD, asthma (I PRAy i can breathe soon!)
82
Tiotropium
Muscarinic antagonists. Targets the respiratory system. Used to treat COPD, asthma.
83
Oxybutynin
Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).
84
Solifenacin
Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).
85
Tolterodine
Muscarinic antagonists. Targets the genitourinary system. It reduces bladder spasms and urge urinary incontinence (overactive bladder).
86
Scopolamine
Muscarinic antagonists. Targets the CNS system. It used to treat motion sickness.
87
Atropine
Muscarinic antagonist. Used to treat bradycardia and for ophthalmic applications. It blocks DUMBBeLSS. Skeletal muscle and CNS excitation is mediated by nicotinic receptors. In the eyes, it increases pupil dilation and increases cycloplegia (paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation). In the airway, it decreases secretions. In the stomach, it decreases acid secretions. In the gut, it decreases motility. In the bladder, it decreases urgency in cystitis.
88
Toxicity of atropine
Causes an increase in body temperature (due to a decrease in sweating); rapid pulse; dry mouth; dry, flushed skin; cycloplegia; constipation; disorientation. Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants. Hot as a hare, dry as a bone, red as a beet, blind as a bat, and mad as a hatter. Jimson weed (Datura) causes gardener's pupil (mydriasis due to plant alkaloids).
89
Tetrodotoxin
It is a highly potent toxin that binds fast voltage-gated Na channels in cardiac and nerve tissue, preventing depolarization (blocks action potential without changing resting potential). It causes nausea, diarrhea, paresthesias, weakness, dizziness, and loss of reflexes. Poisoning can result from ingestion of poorly prepared pufferfish (fugu), a delicacy in Japan. Treatment is primarily supportive.
90
Ciguatoxin
It causes ciguatera fish poisoning. It opens Na channels causing depolarization. Symptoms easily confused with cholinergic poisoning. Temperature-related dysesthesia (eg cold feels hot; hot feels cold) is a specific finding of ciguatera. It is caused by consumption of reef fish (eg barracuda, snapper, moray eel). Treatment is primarily supportive.
91
Scombroid poisoning
It is caused by consumption of dark-meat fish (eg bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature. Bacterial histidine decarboxylase converts histidine to histamine. Histamine is not degraded by cooking. It is frequently misdiagnosed as an allergy to fish. It causes acute-onset burning sensation of the mouth, flushing of face, erythema, urticaria, pruritus, and headache. It may cause anaphylaxis-like presentation (ie bronchospasm, angioedema, hypotension). It is treated supportively with antihistamines; if needed, antianaphylactics (eg bronchodilators and epinephrine).
92
Albuterol
Direct sympathomimetics. Acts on beta2 more than beta1. Albuterol is used for acute asthma.
93
Salmeterol
Direct sympathomimetics. Acts on beta2 more than beta1. It is used for long term asthma and COPD control.
94
Dobutamine
Direct sympathomimetics. Acts on beta1 more than beta2 and alpha receptors. It is used to treat heart failure (inotropic- contraction more than chronotropic- HR), and cardiac stress test.
95
Epinephrine
Direct sympathomimetics. Acts on beta more than alpha receptors. It is used to treat anaphylaxis, asthma, open-angle glaucoma; alpha effects predominate at high doses. Significantly stronger effect at beta2 receptor than norepinephrine.
96
Dopamine
Direct sympathomimetics. Acts on D1 and D2 more than beta more than alpha. It is used to treat unstable bradycardia, HF, shock; inotropic and chronotropic alpha effects predominate at high doses.
97
Isoproterenol
Direct sympathomimetics. Acts on beta 1 and beta 2 equally. It is used for electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia.
98
Norepinephrine
Direct sympathomimetics. Acts on alpha 1 more than alpha 2 more than beta 1. It is used to treat hypotension (but decreases renal perfusion). It has significantly weaker effect at beta 2 receptor than epinephrine.
99
Phenylephrine
Direct sympathomimetics. Acts on alpha1 more than alpha2. Used to treat hypotension (vasoconstriction), for ocular procedures (mydriatic), and to treat rhinitis (decongestant).
100
Amphetamine
Indirect sympathomimetics. It as indirect general agonist, reuptake inhibitor, also releases stored catecholamines. It is used to treat narcolepsy, obesity, and ADHD.
101
Cocaine
Indirect sympathomimetics. It as indirect general agonist, reuptake inhibitor. It causes vasoconstriction and local anesthesia. Never give a beta blocker if there is a cocaine intoxication is suspected (can lead to unopposed alpha1 activation and extreme hypertension).
102
Ephedrine
Indirect sympathomimetics. It as indirect general agonist, releases stored catecholamines. It is used to treat nasal decongestion, urinary incontinence, and hypotension.
103
Norepinephrine vs isoproterenol
Norepinephrine increases systolic and diastolic pressures as a result of alpha-1 mediated vasoconstriction, leading to an increase in mean arterial pressure, which causes reflex bradycardia. However, isoproterenol (no longer commonly used) has little alpha effect but causes beta-2 mediated vasodilation, resulting in a decrease in mean arterial pressure and an increase in heart rate through beta-1 and reflex activity.
104
Clonidine applications
Sympatholytics (alpha2 agonists). It is used for hypertensive urgency (limited situations); it does not decrease renal blood flow. It is also used to treat ADHD and tourette syndrome. Toxicities include CNS depression, bradycardia, hypotension, respiratory depression, and miosis.
105
alpha methyldopa
Sympatholytics (alpha2 agonists). It is used for hypertension in pregnancy. Toxicities direct Coombs positive hemolysis, SLE-like syndrome.
106
Phenoxybenzamine
Irreversible alpha blocker. Used to treat pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis. Side effects include orthostatic hypotension and reflex tachycardia.
107
Phentolamine
Reversible alpha blocker. Used to give to patients on MAO inhibitors who eat tyramine containing foods. Side effects include orthostatic hypotension and reflex tachycardia.
108
Prazosin
Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat PTSD and hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.
109
Terazosin
Alpha 1 selective blocker. It is used for urinary symptoms of BPH. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.
110
Doxazosin
Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.
111
Tamsulosin
Alpha 1 selective blocker. It is used for urinary symptoms of BPH; it is also used to treat hypertension. Side effects include 1st dose orthostatic hypotension, dizziness, and headache.
112
Mirtazapine
Alpha 2 selective blocker. It is used to treat depression. Side effects include sedation, an increase in serum cholesterol, and an increase appetite.
113
alpha blockade with epinephrine vs phenylephrine
When an alpha blockage is given after epinephrine or phenylephrine. The epinephrine response exhibits reversal of the mean blood pressure changes, from a net increase (the alpha response) to a net decrease (the beta2 response). The response to phenylephrine is suppressed but not reversed because phenylephrine is a pure alpha agonist without beta action.
114
Beta blockers
Acebutolol, atenolol, betaxolol, carvedilol, esmolol, labetalol, metoprolol, nadolol, nebivolol, pindolol, timolol.
115
Beta blockers application towards angina pectoris
beta blockers decrease heart rate and contractility, resulting in a decrease in O2 consumption.
116
Beta blockers application towards MI
Beta blockers (metoprolol, carvedilol, and bisoprolol) decreases mortality.
117
Beta blockers application towards supraventricular tachycardia
Metoprolol and esmolol decrease AV conduction velocity (class II antiarrhythmic)
118
Beta blockers application towards hypertension
They decrease cardiac output, decrease renin secretion (due to beta1 receptor blockade on JGA cells)
119
Beta blockers application towards heart failure
they decrease chronic HF
120
Beta blockers application towards glaucoma
timolol decreases secretion of aqueous humor.
121
Toxicity of beta blockers
They can cause impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS adverse effects (seizures, sedation, and sleep alterations), dyslipidemia (metoprolol), and asthma/COPD exacerbations. Avoid in cocaine users due to risk of unopposed alpha adrenergic receptor agonist activity. Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks and is not containdicated.
122
beta1 antagonists
Acebutolol (partial agonist), atenolol, betaxolol, esmolol, metroprolol. Selective antigonists mostly go from A to M (Beta 1 with the 1st half of the alphabet)
123
Nonselective beta agonists
Nadolol, pindolol (partia agonist), propranolol, timolol. Nonseletive antagonists mostly go from N to Z.
124
Carvedilol
Nonselective alpha and beta antagonists.
125
Labetalol
Nonselective alpha and beta antagonists.
126
Nebivolol
Combines cardiac selective beta1 adrenergic blockade with stimulation of beta3 receptors, which activate nitric oxide synthase in the vasculature.
127
Antidote for acetaminophen overdose
N-acetylcysteine (replenishes glutathione)
128
Antidote for AChE inhibitors and organophosphates overdose
Atropine works better than pralidoxime
129
Antidote for amphetamines (basic) overdose
NH4Cl acidifies the urine
130
Antidote for antimuscarinic and anticholinergic overdose
Physostigmine salicylate and control hyperthermia
131
Antidote for benzodiazepines overdose
Flumazenil
132
Antidote for beta-blockers overdose
glucagon
133
Antidote for carbon monoxide overdose
100% O2, hyperbaric O2
134
Antidote for coper overdose
Penicillamine
135
Antidote for arsenic overdose
Penicillamine
136
Antidote for gold overdose
Penicillamine
137
Antidote for cyanide overdose
Nitrate plus thiosulfate or hydroxocobalamin
138
Antidote for digitalis (digoxin) overdose
Anti-dig Fab fragments
139
Antidote for heparin overdose
Protamine sulfate
140
Antidote for iron overdose
DFEroxamine or deFErasirox
141
Antidote for lead overdose
EDTA, dimercaprol, succimer, or penicillamine
142
Antidote for mercury overdose
DiMERCaprol (BAL) or succimer
143
Antidote for arsenic overdose
Dimercaprol (BAL) or succimer
144
Antidote for gold overdose
Dimercaprol (BAL) or succimer
145
Antidote for methanol or ethylene glycol (antifreeze) overdose
Fomepizole works better than ethanol. Dialysis is also an option.
146
Antidote for methemoglobin overdose
METHyleneblue or vitamin C
147
Antidote for opioids overdose
Naloxone or naltrexone
148
Antidote for salicylates overdose
NaHCO3 (alkalinize urine) or dialysis
149
Antidote for TCAs overdose
NaHCO3 (plasma alkalinization)
150
Antidote for tPA overdose
Aminocaproic acid
151
Antidote for streptokinase overdose
Aminocaproic acid
152
Antidote for urokinase overdose
Aminocaproic acid
153
Antidote for warfarin overdose
Vitamin K (delayed effect) or fresh frozen plasma (immediate effect)
154
Drug reactions causing coronary vasospasm
Cocaine, sumatriptan, ergot alkaloids
155
Drug reactions causing cutaneous flushing
Vancomycin, Adenosine, Niacin, Ca channel blockers (VANC)
156
Drug reactions causing dilated cardiomyopathy
Anthracyclines (eg doxorubicin, daunorubicin), can be prevented with dxrazoxane
157
Drug reactions causing torsades de pointes
Class III (eg sotalol) and class IA (eg quinidine) antiarrhythmics, macrolide antibiotics, antipsychotics, TCAs
158
Drug reactions causing adrenocortical insufficiency
Hypothalamic–pituitary–adrenal axis (HPA axis) secondary to glucocorticoid withdrawal.
159
Drug reactions causing hot flashes
Tamoxifen, clomiphene
160
Drug reactions causing hyperglycemia
Tacrolimus, Protease inhibitors, Niacin, Hydrochlorothiazide (HCTZ), Corticosteroids (Taking Pills Necessitates Having blood Checked)
161
Drug reactions causing hypothyroidism
Lithium, amiodarone, sulfonamides
162
Drug reactions causing acute cholestatic hepatitis and jaundice
Erthromycin
163
Drug reactions causing diarrhea
Metformin, Erythromycin, Colchicine, Orlistat, Acarbose (Might Excite Colon On Accident)
164
Drug reactions causing focal to massive hepatic necrosis
Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen (liver HAVAc)
165
Drug reactions causing hepatitis
Rifampin, isoniazid, pyrazinamide, statins, fibrates.
166
Drug reactions causing pancreatitis
Didanosine, Corticosteroids, Alchol, Valproic acid, Azathioprine, Diuretics (furosemide, HCTZ) (Drugs Causing A Violent Abdominal Distress)
167
Drug reactions causing pseudomembranous colitis
Clindamycin, ampicillin, caphalosporins. (antibiotics predispose to superinfection by resistant C difficle.
168
Drug reactions causing agranulocytosis
Ganciclovir, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil (Gangs CCCrush Myeloblasts and Promyelocytes)
169
Drug reactions causing aplastic anemia
Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil (Can't Make New Blood Cells Properly)
170
Drug reactions causing direct Coombs-positive hemolytic anemia
Methylodopa, penicillin
171
Drug reactions causing gray baby syndrome
Chloramphenicol
172
Drug reactions causing hemolysis in G6PD deficiency
Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (hemolysis IS D PAIN)
173
Drug reactions causing megaloblastic anemia
Phenytoin, Methotrexate, Sulfa drugs (Having a blast with PMS)
174
Drug reactions causing thrombocytopenia
Heparin
175
Drug reactions causing thrombotic complications
OCPs, hormone replacement therapy
176
Drug reactions causing fat redistribution
Protease Inhibitors, Glucocorticoids (Fat PIG)
177
Drug reactions causing gingival hyperplasia
Phenytoin, Ca channel blockers, cyclosporine
178
Drug reactions causing hyperuricemia (gout)
Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine (Painful Tophi and Feet Need Care)
179
Drug reactions causing myopathy
Fibrates, niacin, colchicine, hydroxychloroquine, interferon-alpha, penicillamine, statins, glucocorticoids
180
Drug reactions causing osteoporosis
Corticosteroids, heparin
181
Drug reactions causing photosensitivity
Sulfonamides, Amiodarone, Tetracyclines, 5-FU (SAT for Foto)
182
Drug reactions causing Stevens-Johnson syndrome
Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin. (Steven Johnson has epileptic ALLergy to sulfa drugs and penicillin)
183
Drug reactions causing SLE-like syndrome
Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept (having lupus is "SHIPP-E"
184
Drug reactions causing teeth discoloration
tetracyclines
185
Drug reactions causing tendonitis, tendon rupture, and cartilage damage
Fluoroquinolones
186
Drug reactions causing cinchonism
Quinidine, quinine
187
Drug reactions causing parkinson-like syndrome
Antipsychotics, Reserpine, Metoclopramide (cogwheel rigidity of ARM)
188
Drug reactions causing seizures
Isoniazid (due to vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Enflurane (With seizures, I BItE my tongue)
189
Drug reactions causing tardive dyskinesia
Antipsychotics, metoclopramide
190
Drug reactions causing diabetes insipidus
Lithium, demeclocycline
191
Drug reactions causing Fanconi syndrome
Expired tetracycline
192
Drug reactions causing hemorrhagic cystitis
Cyclophosphamide, ifosfamide (prevent by coadministering with mesna)
193
Drug reactions causing interstitial nephritis
Methicillin, NSAIDs, furosemide
194
Drug reactions causing SIADH
Carbamazepine, Cyclophosphamide, SSRIs (Can't Concentrate Serum Sodium)
195
Drug reactions causing dry cough
ACE inhibitors
196
Drug reactions causing pulmonary fibrosis
Bleomycin, Amiodarone, Busulfan, Methotrexate (Breathing Air Badly from Medications)
197
Drug with antimuscarinic reactions
Atropine, TCAs, H1-blockers, antipsychotics
198
Drug reactions causing a disulfiram like reaction
Metronidazole, certain cephalosporins, griseofulvin, procarbazine, 1st generation sulfonylureas
199
Drug reactions causing nephrotoxicity/ototoxicity
Aminoglycosides, vancomycin, loop diuretics, cisplatin. Cisplatin toxicity may respond to amifostine
200
Cytochrome P-450 inducers
Chronic alcohol use, St John's wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine (Chronic alcoholics STeal Phen-PHen and Never Refuse Greasy Carbs.
201
Cytochrome P-450 substrates
Anti-epileptics, Theophylline, Warfarin, OCPs (Always Think When Outdoors)
202
Cytochrome P-450 inhibitors
Acute alcohol abuse, Ritonavir, Amiodarone, Cimetidine, Ketoconazole, Sulfonamides, Isoniazid (INH), Grapefruit juice, Quinidine, Macrolides (except azithromycin) (AAA RACKS IN GQ Magazine)
203
Sulfa drugs
Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas. (Popular FACTSSS) Patients with sulfa allergies may develop fever, urinary tract infection, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria (hives). Symptoms range from mild to life threatening.
204
Drugs ending with -azole
Ergosterol synthesis inhibitor, eg ketoconazole
205
Drugs ending with -bendazole
Antiparasitic/antihelmintic, eg mebendazole
206
Drugs ending with -cillin
Peptidoglycan synthesis inhibitor, eg ampicillin
207
Drugs ending with -cycline
Protease synthesis inhibitor, eg tetracycline
208
Drugs ending with -ivir
Neuraminidase inhibitor, eg oseltamivir
209
Drugs ending with -navir
Protease inhibitor, eg ritonavir
210
Drugs ending with -ovir
DNA polymerase inhibitor, eg acyclovir
211
Drugs ending with -thromycin
macrolide antibiotic, eg azifthromycin
212
Drugs ending with -ane
Inhalational general anesthetic, eg halothane
213
Drugs ending with -azine
Typical antipsychotic, eg thioridazine
214
Drugs ending with -barbital
Barbiturate, eg phenobarbital
215
Drugs ending with -caine
Local anesthetic, eg lidocaine
216
Drugs ending with -etine
SSRI, eg fluoxetine
217
Drugs ending with -ipramine or -triptyline
TCA, eg imipramine, amitriptyline
218
Drugs ending with -triptan
5-HT1B/1D agonists, sumatriptan
219
Drugs ending with -zepam or -zolam
Benzodiazepine, eg diazepam or alprazolam
220
Drugs ending with -chol
Cholinergic agonist, eg bethanechol/carbachol
221
Drugs ending with -curium or -curonium
Nondepolarizing paralytic, eg atracurium, vecuronium
222
Drugs ending with -olol
beta-blocker, eg propranolol
223
Drugs ending with -stigmine
AChE inhibitor, neostigmine
224
Drugs ending with -terol
beta2-agonist, eg albuterol
225
Drugs ending with -zosin
alpha1-antagonist, eg prazosin
226
Drugs ending with -afil
PDE-5 inhibitor, eg sildenafil
227
Drugs ending with -dipine
Dihydropyridine CCB, eg amlodipine
228
Drugs ending with -pril
ACE inhibitor, eg captopril
229
Drugs ending with -sartan
Angiotensin-II receptor blocker, eg losartan
230
Drugs ending with -statin
HMG-CoA reductase inhibitor, eg atorvastatin
231
Drugs ending with -dronate
Bisphosphonate, eg alendronate
232
Drugs ending with -glitazone
PPAR-gamma activator, eg rosiglitazone
233
Drugs ending with -prazole
Proton pump inhibitor, eg omeprazole
234
Drugs ending with -prost
Prostaglandin analog, eg latanoprost
235
Drugs ending with -tidine
H2-antagonist, eg cimetidine
236
Drugs ending with -tropin
Pituitary hormone, eg somatotropin
237
Drugs ending with -ximab
Chimeric monoclonal Ab, basiliximab
238
Drugs ending with -zumab
Humanized monoclonal, eg daclizumab
