Mechanism of action for each class of anti-Arrythmic drugs?

Use the Mnemonic: NBKC

I - Sodium Channel Blockers

II - Beta Blockers

III – K+ channel Blockers

IV - Calcium Channel Blockers

Class IA Antiarrythmics

Quinidine

Procainamide

Dispyrimide

Class IB Antiarrythmics

Lidoicaine

Tocainide

Mexiletine

Phenytoin

Class IC Antiarrythmics

Ecainide

Flecanide

Propophenone

10 Class II antiarrythmics

PPEST-BLAAC

Pindalol

Propranolol

Esmolol

Sotalol

Timolol

Butoxolol

Labetalol

Atenolol

Acebutalol

Carvedilol

Longest acting Beta blocker:

Propranolol

Shortest acting Beta blocker:

Esmolol

Beta blocker that is also K+ channel blocker:

Sotolol

Beta blockers used to treat glaucoma

Timolol

Carvadalol

Beta blocker that is also an alpha blocker

Labatalol, Carvetalol

Beta blocker that is also an agonist

Pindalol

Atenolol

Acebutalol

MC location and function for Beta1 receptors?

• CNS Increased activity

• Ciliary Muscles of eye to produce aqueus humor

• SA Node to increase HR and Contractility

• Alpha cells of pancreas to increase Glucagon

• JG cells of kidney to increase Renin release

MC location & function of 2 receptors?

• Ciliary muscles of eye to produce aqueus humor

• Bronchial Smooth muscle to bronchodilate

• Ventricles to Increase Contractility

• Beta Cells of Pancreas to cause Insulin Release

• Uterus and bladder to cause relaxation

Selective –vs- Non-selective beta blockers?

A-M (-LC) Selective N-Z(+LC) Nonselective

Antiarrythmic causing hemolysis & thrombocytopenia

Quinidine

Fastest acting Na+ channel blocker

Lidocaine

3 antiarrythmics that block 95% of sodium channels

Ecainide

Flecanide

Propophenone

Antiarrythmic that Causes Cinchinism

Phenytoin

Antiarrythmics that cause pulmonary fibrosis

Tocainide

Amiodarone

Antiarrythmics that cause Gingival Hyperplasia

Phenytoin

Antiarrythmic that causes hersutism

Phenytoin

Antiarrythmics used to treat WPW

Quinidine

Procainamide

Phenytoin

Antiarrythmic that is contraindicated in WPW

Digitalis

Antiarrythmics Used to Treat ventricular arrythmias

Class I antiarrythmics

Antiarrythmics Used to

Treat Atrial Arrythmias

Class IV antiarrythmics

Antiarrythmics that causes blue skin (Smurf syndrome)

Amiodarone

Antiarrythmics causing Bad GI upset

Mexiletine

Antiarrythmic that causes Hyper/hypo-thyroidism

Amiodarone

Antiarrythmics Used to decrease vasospasms after subarrachnoid hemorrhage.

Nimodipine

Symptoms of cinchinism?

Tinnitus

Hearing loss

Thrombocytopenia

Two action of Digitalis?

• Blocks potassium arm of NA-K ATPase causing increased contraction

• Stimulates vagus, slowing HR.

Pulmonary fibrosis Rx

Busulfan

Bleomycin

Tocainide

Amiodarone

What is the most common SVT in teenagers?

Wolf-Parkinson White

Pathology of WPW?

There is an accessory pathway from SA node bypassing AV node to ventricle called the Bundle of Kent.

Why are 3 Na+ blocker used to treat WPW?

They are both Na+ and Ca2+ channel blockers.

EKG finding of WPW?

Delta waves.

Antiarrythmic made from iodine?

Amiodarone

Name the class IV antiarrythmics

Verapamil

Ditiazem

Nifedipine

Nicardipine

Nimodipine

Amlodipine

Femlodipine

Cardioselective class IV antiarrythmics?

Verapamil

Diltiazem

Most potent Class IV antiarrythmic?

Verapamil

4 K+ Channel Blockers:

Amiodarone

Bretylium

NAPA NAcetyl-Procainamide)

Sotalol

How do you determine when to use Dopamine –vs-Dobutamine?

DoButamine Low HR

DoPamine Elevated HR

Receptor Dopamine affect 1st, 2nd, at high doses

D2- Dilate Kidney & GI TPR

Beta 1 HR & Contractility

Alpha 1 Vasoconstrict

What conditions give you Shock & Bradycardia?

Cholinergic crisis

Heart Block

Clues for Cinchonism

Tinitis

Hearing Loss

Thrombocytopenia

Name 7 Antimetabolite Chemotherapy drugs

ARA-A

ARA-C

Azothiprine

5-FU

6-Mercaptopurine

Methotrexate

Thioguanadine

Which cancer are treated with antimetabolites?

Fast growing cancers

Which cancers are treated with alkylating agents?

A slow growing cancer

5-FU is use to treat which cancer?

Duke stage C Colon Cancer in combination with levamisole

3 drugs used to treat steroid resistant disease

Methotrexate

Azothioprine

Cyclosporin

5-FU mechanism of action Inhibits Thymidilate synthetase

Methoterxate mechanism of action

Inhibits dihydrofolate reductase

To what substance is 6-Mercaptopurine metabolized

Uric acid

How do alkylating agents work?

They bind dsDNA and prevent it from unwinding for replication

Name 13 alkylating agent

Chemotherapy drugs

Adriamycin

Acridine

Bleomycin

Busulfan

Chlorambacil

Cyclophosphamide

Cisplatin

Dacarbazine

Hydroxyurea

Isophosphamide

Mitomycin

Mechlorethamine

Procarbazine

Drugs that cause pulmonary fibrosis

Bleomycin

Busulfan

Amiodarone

Tocainide

Favorite Alkylating agent

Clorambucil

Favorite Antimetabolite

Methotrexate

Drug that causes cardiac fibrosis

Adriamycin (Doxarubicin)

Chemo drug that causes hemorrhagic cystitis

Cyclophosphamide

Chemo drug that causes renal failure

Cisplatin

Chemo drug used to treat sickle Cell

Hydroxyurea

How does hydroxyurea work?

It inhibits Ribonucleotide Reductase

Which two alkylating agents form free radicals

Cyclophosphamide

Adriamycin

Rescue for patient on Adriamycin

Desroxazine Rescue

Rescue for patient on Cyclophosphamide

MESNA Rescue

Rescue for patient on Methotrexate

Leucovorin Rescue

Three alkylating agents used to treat Hodgkins Lymphoma

Mechlorethamine

Dacarbazine

Procarbazine

Name 7 microtubule Inhibitor chemotherapy drugs

Vincristine

Vinblastine

Paclitaxel

Name 1 nutrient depleater chemotherapy drugs

L-Aparaginase

Name 1 immune modulator

Levamisole

How does Levamisole work?

It enhances NK cells

Which Microtubule inhibitor causes neuropathies?

Vincristine

Which Microtubule inhibitor causes aplastic anemia?

Vinblastine

Which Microtubule inhibitor inhibits microtubules after they are made?

Paclitaxil

For what cancer is Paclitaxil used?

Breast

What is the main side effect of L-arginase?

Anaphylaxis

Symptoms of Cholinergic crisis

SLUDGE

Salivation

Lacrimation

Urination

Defication

GI Upset

Emesis

Symptoms of Anticholinergic crisis

Hot as a Hare

Dry as a Bone

Red as a Beet

Mad as a Hatter (Crazy)

Give the location of Alpha 1 receptors

• Radial muscles of the eye to cause Mydriasis without cyclopledgia

• All sphincters

• Arteries to constrict

Give the location of Alpha 2 receptors

• All Presynaptic sympathetic fibers to inhibit NE

• Beta cell of the pancreas to IHN Insulin

What drugs are used to treat HTN in pregnancy?

Alpha-methyl Dopa

Hydralizine

Name 3 alpha 2 agonists

Alpha-Methyl Dopa

Guanabenz

Clonidine

Side effect of Clonidine

Rebound HTN

Side effect of alpha-methyl Dopa

Hemolytic anemia

Anticholinergic drugs

Atropine

Scopalomine

Glycopyrrolate

Bentropine

Trihexyphenadyl

Which anticholinergic is the drug of choice for heart block?

Atropine

Which anticholinergic is used to treat dystonia?

Benztropine

2 Anticholinergics used dry up secretions pre-OP?

Atropine

Scopalomine

Which AchE inhibitor is used to diagnose Myesthenia Gravis?

Edrophonium

Which AchE inhibitor is used to Treat Myesthenia Gravis?

Neostigmine

Pyridostygmine

Why is physostigmine not used to treat Myethenia Gravis?

Too much CNS penetration causing drowsiness

Anticholinergic used to treat organophosphate poisoning

Atropine

What is the mechanism of action of Roloxafen and Tomoxafen?

• INH estrogen receptor at pituitary and Breast

• Pro-estrogen at bone

• Pro-estrogen at liver

Which estrogen receptor blocker promotes enometrial cancer? How?

• Tomoxafen

• Because it stimulates the Endometrium

List 2 alpha blockers used to treat BPH

Terazocin

Doxazocin

What is the MOA of Finesteride?

It is a 5-Alpha-reductase inhibitor

What are the treatment options for BPH?

#1- Terazocin, Doxazocin

#2- Finesteride

#3-TURP

MOA of Heparin

Cofactor for ATIII with allow inhibition of Thrombine and factors 9-12

MOA of Warfarin

IHN Vitamin K and thereby factors 10, 9, 7, 2, Protein C, and Protein S

For what is Vitamin K needed?

Gama-carboxylation in the liver

What drug can be used acutely to inhibit GPIIb:IIIa?

Abscixamab

Name three drugs that can be used to inhibit ADP production in the clotting cascade

Ticlopidine

Clopidogrel

Dipyridamole

Which are the side effects of Ticlopidine?

Seizures

Agranulocytosis

Clue for Dipyridamole

Vasodilator used after MI to dilate coronaries

Clue for Clopidogrel

Decreased mortality in combination with ASA in those with risk factors

RX for PCP

Trimethaprim/Sulfamethoxazole

Rx For Patients Allergic to TMP/SULFA

Pentamidine

RX for Leishmania

Stybogluconate

Treat MAI with

Clarithromycin.

Best Rx for C.dif colitis

Vancomycin

Current Rx for C.Dif colitis

Metronidazole

Pregnant woman’s rectum culture returns (+) for Group B Strep. Rx with?

Ampicillin

Treatment for Hookworms

Mebendazole

Stongyloides

Thiabendazole

What is the treatment for flatworms?

Hyclosamine & Niclosamine

How do Hyclosamine & Niclosamine work?

They paralyze the worm's nervous system

What drugs are used to treat Malaria?

Chloroquine

Mefloroquine

Primaquine

Quinine

One dose treatment for candidiasis?

Fluconazole

Imidazole that crosses (BBB)?

Fluconazole

Imidazole inhibits P450?

Ketoconazole

How is it treated?

Tinea Capitis - Griseofulvin

The Infection (Staph Aureus) - Antibiotics

The Inflammatory infection – Steroids

Rx for LYME'S disease?

Penicillin – First Line

Tetracylcinis

4 drugs you can use to treat Herpes?

Pencyclovir - TID

Acyclovir - Five (5) times a day

Demcycovir - TID

Vancyclovir – BID

Rx for CMV

Gancyclovir

Rx for Shingles

Famcyclovir

Rx for RSV

Ribavarin

Rx used to sop viral uncoating

Ramantidine

Amantidine

Rx used to sop viral uncoating

Ramantidine

Amantidine

How soon must Ramantidine & Amantadine must be given?

Within seventy-two (72) hours of exposure

Why do you profiles contacts of people with Influenza with Amantadine for two (2) weeks?

Because IgM takes two (2) weeks to show up.

SE of Ramantadine & Amantadine

Anticholinergic Side effects

Anticholinergic -vs- Sympathetic drugs?

Anticholinergic drugs will not allow you to sweat, but Sympathetic drugs will.

Why is Amantadine used in Parkinson disease?

Amantadine promotes Dopamine release

How does griseofulvin work?

It inhibits microtubules leading to inhibition of fungal replication.

How is Griseofulvin delivered to the infected site?

Through the sweat

How do the IV/Oral antifungal work?

By inhibiting the synthesis of Ergosterol

Topical(creams) antifungal work by?

They bind to Ergosterol and destroy it (Poke holes in the membrane)

What topical antifungal is parenteral?

Amphotericin B

Hyperkalemia + Amphotericin mean?

Systemic Toxicity due to destruction of cholesterol in the cell membrane leading to leaking of K+ into cytoplasm.

Hypokalemia + Amphotericin mean?

Nephotoxicity due to destruction of the cholesterol in the kidney cells and K+ leaks out in urine.

Side Effects of Amphotericin?

Hypokalemia

Hyperkalemia

Renal Failure

2 fungal infections Rx by Griseofulvin?

Tinea Capitis and Tinea Versicolor

What four drugs are used to treat anaphylaxis?

• Epinepherine

• Steroids

• Cromoly/Nadacromyl

• Anti-Histamines

What is a side effect of Cromoly and Nadacromyl?

GI Upset

MOA of Cromoly and Nadacromyl?

Stabilize Mast Cell membranes

Which has a higher affinity for Alpha receptors Epinepherine of Norepinepherine?

Norepinepherine

What receptors does epinephrine have a higer affinity for?

Beta Receptors

What receptors do first generation antihistamines block?

H1

Name 5 class I antihistamines

Diphenhydramine

Hydroxazine

Dramamine

Phenylpropophenolamine

Phenturamine

What sideeffect is seen with 1st generation anti-histamines?

Strong Anti-Cholinergic effects

Anti-histamine to Rx motion sickness

Dramamine

Anti-histamine that is part of Phen-Phen

Pheturamine

Anti-histamine pulled off market due to arrythmias

Phenylpropanolamine

MC over-the-counter anti-histamine

Diphenhydramine (Benedryl)

Anti-histamine used to Rx Vertigo

Hydroxazine (Aderax)

Disease where person passes out with positional change

Benign Positional Vertigo

Clues for Miner’s disease

• Vertigo from Middle Ear

• Hearing Loss

• Too much Endolymph

• Tinitis

2nd generation Anti-Histamines

Ephedrine

Pseudephedrine

Phenylephrine

Over the counter 2nd generation Anti-Histamines

Ephedrine

2nd generation Anti-Histamine used to treat Neurogenic Shock

Phenylephrine

Which 2nd generation Anti-Histamines

Can be used to tighten sphincters

Pseudephedrine

Only class of drugs that give Mydriasis without cycloplegia?

Alpha agonists

Name 4 H2 blockers

Cimetidine

Rinitidine

Famotidine

Nizatidine

Which H2 blocker revs up the P450 system?

Cimetidine

List (5) 3rd Generation Anti-Histamine

Terfenadine

Loratadine

Citrerizine

Fesofenodine

Astemazol

3rd Generation Anti-Histamine can treat both indoor and outdoor allergies

Fexofenidine (Allegra)

Benefit of 3rd Generation Anti-Histamine

Once a day dosing

What is a side effect of ACE-Inhibitors and ARBs?

Angioedema

9 Live Vaccines

MMR

BCG

RSV

Smallpox

Rotavirus

Polio

Yellow Fever

Vaccines contraindicated with egg allergy

MMR

Influenza

What changes are made in vaccination at age 6yo?

DPT dT

Drop Hib

If a child has any reaction to DPT what should you do?

Give acellular Pertuus (aP)

Which live vaccine cas still be given to AIDS patients?

MMR

5 actions of Anesthetics

Anesthesia – Total block of sensory info

Analgesia – Blocks pain

Muscle Relaxation

CNS depressant

Sensitize heart to NE

What complication of surgery is due to the muscle relaxation ability of anesthetics?

Aspiration

Uninary retention

Decrease GI motility

Relaxed diaphram Atelectasis

DVT

Pneumonia

What 2 drugs are used for post-op urinary retention?

Carbachol

Bethanichol

Which inhaled anesthetic does not sensitize the heart to NE?

Isoflurane

Inhaled anesthetic which causes hepatic necrosis?

Halothane b.c. it contains Bromine

Only depolarizing anesthetic used

Succinyl-Choline

Clues for Ketamine

Dissociative Anesthesia

Patient is awake

Vivid dreams on waking

How do all anesthetics work?

They are sodium Channel blockers

Rule for AMIDE –vs- ESTER anesthetics

I before “CAINE” Amide Fat soluble

No I before “CAINE” Ester water sol

What anesthetics cause Malignant Hyperthermia?

Succinyl-Choloine

Halothane

What is the treatment for Malignant Hyperthermia?

Dantroline

Name 11 most common Opiates

Heroine

Methadone

Morphine

Meperidine

Fentanyl

Codeine

Dextromethorphan

Hydrocodone

Loperimide

Diphenoxylate

Pentazosin

What are three effects of Opiates

CNS Depressants – Mu-Receptors

Analgesics – Kappa-Receptors in S.C.

Muscle Relaxants

Most abused Opiate

Heroine

Opiate used for Neurolep Anesthesia with Resperidone

Fentanyl

Longest acting Opiate

Methadone

MC used Opiate in hospitals for severe pain?

Morphine

MC abused Opiate by physicians

Meperidine does not constrict pupils

Most Potent Opiate

Fentanyl

Opiate used for Mild/Moderate pain

Codeine

MC over-the-counter Opiate

Dextromethorphan

Opiates that can be used as Antitussives

Codeine

Dextromethorphan

Opiate that comes in a patch form

Fentanyl

Opiate that does not constrict the sphincter of Odi

Meperidine

Opiate that causes Histamine release

Morphine

Opiate that causes Catecholamine release

Meperidine

Opiate that should not be used in head injuries b.c. it causes cerebral edema

Morphine

Opiate used to weak patient off Heroine

Methadone

Opiate used for moderate pain

Hydrocodone

Codeine

Opiates used to treat diarrhea

Loperimide (Lomotil)

Diphenoxilate (Imodium)

Opiate that is also a blocker

Pentazosin

5 Anti-Inflammatory effect of steroids

• Kill T-Cells and Macrophages

• Inhibit Macrophage Migration

• Inhibit Phospholipase A2

• Inhibit Mast Cell degranulation

• Stabilize Endothelium

Drugs to treat parkinsonism

B - Bromocriptine

A - Amantadine

L – Levodopa/Carbidopa

S - Selegeline

A – Anti-Cholinergics

Name the Steroid used PO

Prednisone

Name the Steroid used Topically

Hydrocortisone

Name the Steroid used IV

Methylprenisalone

Name the Steroid used as and inhaler

Triamcinalone

Steroid with the best CNS penetration

Dexamethasone

Steroid with best mineralocorticoid action

Fludrocortisone

Steroid used for nasal allergies

Futicasone

Nematosone

Steroid used to stimulate surfactant production is premature babies

Betamethasone

Beclmetasone

In what population is Cromalyn and Nadacramyl used?

Any asthmatic that uses a beta-agonist more than once a day.

MOA for aspirin’s (ASA) anti-inflammatory action

Irriversibly inhibts cyclo-oxygenase

MOA for NSAID’s

Reversibly inhibts cyclo-oxygenase

Uses for ASA

2nd Strokes

ALL MI’s

Side Effects of Asprin

GI Bleeding

Tinitus

Thrombocytopenia

When should you stop ASA in a patient Pre-OP?

Two Weeks Pre-OP

MOA for ASA’s Anti-Coagulation effects

Indication for NSAID’s

Mild to Moderate Inflammatory pain

Side Effects of NSAID’s

GI Bleed

Renal Failure

Interstitial Nephritis

Main Over the counter NSAID

Ibuprophen

NSAID used to close PDA

Indomethacin

NSAID used for dysmenorrhea

Naproxyn

NSAID as strong as Morphine

Ketoralac

NSAID with Anti-Cholinergic SE

Cyclobenzaprine

NSAID with GABA effects for back pain

Baclophen

Most potent NSAID

#1 Indomethacin

#2 Phenybutazone

NSAID used 2nd line for Gout

Indomethacin

What two drugs block Leucotriene receptors?

Zirfurlekast

Montelekast

What drug inhibits Lipoxygenase?

Zilutin

Name 3 COX inhibitors

Celecoxib

Rofecoxib

Valdecoxib

Which COX Inhibitor contains Sulfer?

Celecoxib

MOA for sulfonylureas

Cause K+ influx into the Islet cells and cause release of preformed Insulin

Which sulfonylureas enhance glucose transport into peripheral tissue?

Glipizide

Glyburide

Hyperglycemic drugs that Inhibit Glucoase absorption in GI track

Ascarbos

Miglitol

Name the 1st generation Sulfonylureas

Chlorprpamide

Tolbutamide

Tolezalide

Name the 2nd generation Sulfonylureas

Glipizide

Glyburide

Which sulfonylurea causes SIADH?

Chlorpropamide

Side effects of 1st generation sulfonylureas

• Sulfur Allergy

• Interstitial Nephritis

• Hemolytic Anemia

• Methhemoglobinemia

How does Metformin work?

Inhibits gluconeogenesis in the liver

Side effect of Metformin

Reacts with IV contrast damages kidney

Severe Metabolic Acidosis

(4) Hopoglycemic drugs that upregulate insulin receptors

• Pyoglitazone

• Troglitazone

• Repaglinide

• Roglitazone

What blood gases will you see with Immediate (early) ASA toxicity?

Resp Alkalosis - PCO2 pH

MC gases seen with ASA toxicity?

Mixed - PCO2 pH HCO3-

What blood gases will you see with late (obtunded/comatose) ASA toxicity?

Combined - PCO2 pH HCO3-

Treatment of ASA overdose

HCO3-

List the Atypicals

• Mycoplasma

• Chlamydia

• Legionella

• Ureoplasma

Simple Gm(-)

E.Coli

H. Influenza

MOA of Quinalones

Inhibit Topoisomerase

Coverage of Quinalones

All GM(+) + Staph aureus

Simple Gm(-)

ALL Atypicals

Name the quinaolones

• Ciprofloxacin

• Gatifloxacin

• Ofloxacin

• Norfloxacin

• Trovofloxacin

Which quinalone caused liver failure

Trovofloxacin

Which quinalone is the most acidic

Norfloxacin

MOA of Rifampin

Inhibits Beta subunit of RNA Polymerase

Coverage of Rifampin

Treatment for TB

Prophylax contacts of H. Influenze

Prophylax contacts of Neissaria

Side effects of Rifampin

• Incr. P450

• Myositis

• Hepatitis

• Orange Secretions

How soon must you prophylax contact with Rifampin?

Within 72 hours

MOA of Macrolides

Inhibit 50s subunit by inhibiting translocation

Coverage of Macrolides

All GM(+) + Staph aureus

Simple Gm(-)

ALL Atypicals

Side effects of Macrolides

Inhibit P450

Gi Upset

Dysgusia

Name the macrolides

• Erythromycin

• Clarithromycin

• Azithromycin

Macrolide with the longest ½ life

Azithromycin

Antibiotic treatment for Mycobacterium Aviun Intracellulare

Azithromycin

Clarithromycin

Macrolide with the most dysgusia

Clarithromycin

Macrolide with the most GI Upset

Erythromycin

One dose treatment for GC

• Ceftriaxone – 250mg IM

• Cefixime

• Cefoxetin

• Ciprofloxacin – 500mg PO

• Gatifloxacin – 400mg PO

• Ofloxacin – 400 mg PO

MOA of Clindamycin

Inhibit 50s subunit by inhibiting translocation

Coverage of Clindamycin

All GM(+) + Staph aureus

Simple Gm(-)

Anaerobes

MCC pseudomembranous colitis

Clindamycin

MOA of Tetracyclines

Inhibit 30s subunit by inhibiting t-RNA

Name the Tetracyclines

• T(4)

• Oxytetracycline

• Minocycline

• Doxycycline

• Damecocycline

Coverage of Tetracyclines

All GM(+) minus Staph aureus

Simple Gm(-)

ALL Atypicals

Ricketsial Infections

Tetracycline used to treat Acne

Minocycline

Tetracycline that is Hepatically excreted

Doxycycline

Tetracycline that blocks ADA receptors in kidney and causes nephrogenic DI

Domicocycline

Side Effects of Tetracyclines

• GI Upset

• Pill Esophagitis

• Photosensitivity

• Fanconi syndrome

• Binds Ca2+ in GI

• Incr. P450

• Turns teeth Gray

MOA of Pyramycin

Inhibits the A site of the 50s subunit

MOA of Chloramphenicol

Inbibits the 50s subunit by inhibiting Peptidyl-Transferace

Coverage of Chloramphenicol

Gm(+) + Staph Aureus

Ricketsial Infections

Side Effects of Chloramphenicol

Gray baby Syndrome

Aplastic Anemia

How does Chloramphenicol Cause gray baby syndrome?

They Inhibit ETC Complex IV

MOA of Aminoglycosides

Inhibits the 30s subunit by inhibiting EF2

Coverage for Aminoglycosides

ALL Gram negatives

How do Aminoglycosides cause neurotoxicity?

They Inhibit the presynaptic influx of Calcium

Name the Aminoglycosides

GASS Toll No Kash

G – Gentamycin

A – Amikacin

S – Streptomycin

S - Spectinomycin

T – Tobramycin

N – Neomycin

K – Kentamycin

Aminoglycoside that is hepaticaaly excreted

Amikacin

Aminoglycosides used in triple antibiotic

• Neomycin

• Polymixin B

• Bacitracin

Aminoglycoside with the most side effects

Gentamycin

Aminoglycoside used to treat TB

Streptomycin

Side effects of Aminoglycosides

Ototoxicity

Nephrotoxicity

Neurotoxicity

How do Aminoglycosides cause neurotoxicity?

They Inhibit the presynaptic influx of Calcium

Causes of dysgusia

Zn2+ deficiency

Metronidazole

Macrolides

Which drugs cause Nephrogenic DI

Lithium

Damicocycline

Which part of the triple anti-biotic ointment is responsible for a rash?

Neomycin

MOA of Vancomycin

Inhibits cell wall synthesis by inhibiting the Phospholipid carrier

Coverage for Vancomycin

GM(+) + Staph Aureus

Enterococcus

Staph epidermidis

Side Effects of Vancomycin

• Ototoxic

• Nephrotoxic

• Red man Syndrome

Why does Vancomycin cause Redman syndrome?

Infusion is too fast and causes histamine release

MOA of Metronidazole (Flagyl)

Causes release of free radicals

Coverage for Metronidazole

All Anaerobes

Gardnerella

Protozoa

Side effects of Metronidazole

• Dysgusia

• Disulfram Reaction

• G6PD

• Methemoglobinemia

• Hemolytic Anemia

Big mama drugs for anaerobes

• Metronidazole

• Clindamycin

• Cefoxatin

How do sulfa drugs work?

They inhibit PABA

5 Sulfa drugs

• Sulfamethoxazole

• Sulfadiazine

• Sulfapyrizone

• Sulfaqsalazine

• Sulfacetmide

(2) drug used with Sulfa drugs that block Dihydrofolate reductase?

Trimethaprim

Pyrimethamine

Coverage of sulfadrugs

Gm(+) + Staph aureus

Simple Gm(-)

Treatment for PCP and UTI’s

Sulfamethoxazole/Trimethoprim

Sulfa drugs used to treat burn patients

Sulfadiazine (silvadine)

Sulfa drugs used to treat Toxoplasmosis

Sulfadiazine/Pyrimethamine

Sulfa drug that comes in an eye drop

Sulfacetamide

3 Sulfa drug used to treat ulcerative colitis

• Sulfapyrizone

• Sulfasalazine

• Silfacetamide

MOA of Penecillins

Cell Wall inhibitors by inhibiting transpeptidation

Coverae for ALL Penecillins

Gm(+) not Staph Aureus

ALL Simple Anaerobes

Side effects of Penecillins

• Anaphylaxis

• Drug rash

• Interstitial Nephritis

• Hemolytic Anemia

Differentiate between the 2 simple Penecillins

PEN V - PO

PENG - IV

Two Extended spectrum Penecillins

Amoxacillin

Ampicillin

What coverage do the extended spectrum PCN’s add?

Simple Gm(-) coverage

What is added to the simple PCN’s to cover Staph Aureus?

Amoxacillin/Clauvulinic Acid

Ampicillin/Sulbactam

Extended spectrum Penecillins which causes Jarisch-Herxeheimer reaction?

Ampicillin

What infections are the most common causes of Jarisch-Herxeheimer reaction?

• EBV

• CMV

• Syphilis

Drug of choice for UTI inpregnant women

Ampicillin/sulbactam

MC used in pediactrics

Amoxacillin (pink stuff)

5 Anti-Staph PCN’s (Beta Lactamase resistant)

• Metahcillin

• Nafcillin

• Oxacillin

• Cloxacillin

• Dicloxacillin

MCC of Interstitial Nephritis

#1 Methacillin

#2 Ampicillin

3 PO Anti-Staph PCN’s

• Oxacillin

• Cloxacillin

• Dicloxacillin

IV Anti-Staph PCN

Nafcillin

Anti-Staph PCN with a high Sodium load

Nafcillin

5 Anti-Pseudomonal PCN’s

• Pipercillin

• Ticarcillin

• Azocillin

• Mezocillin

• Carbenicillin

Anti-Pseudomonal PCN with a high sodium load

Carbenicillin

What drug are added to the Anti-Pseudomonal PCN’s to cover staph

Pipercillin/Tazobactam

Ticarcillin/Clauvulnic Acid

MOA of Cefalosporins

Cell Wall inhibitors by inhibiting transpeptidation

Coverage of Cefalosporins

Gm(+) + Staph Aureus

Simple Gm(-)

1st generation Cephalosporin that is parenteral

Cefazolin

1st generation Cephalosporin that is the #1 cause of Interstitial Nephritis

Cephalotin

Name 5 1st generation Cephalospoirins

• Cefazolin

• Cefalotin

• Cefalexin

• Cefadoxil

• Cefadroxil

Name 5 2nd generation Cephalospoirins

• Cefaclor

• Cefotetan

• Cefomandol

• Cefuroxime

• Cefoxatin

Name 6 3rd generation Cephalospoirins

• Ceftriaxone

• Cefixime

• Cefotaxime

• Ceftazidine

• Cefperazome

• Maxalactam

Most commonly used Cefalosporin in children

Cefaclor

Cefalosporin used to treat H. Influenza B

Cefuroxime

Cefalosporin used to treat Anaerobes

Cefoxatin

Cefalosporin with the best CNS penetration

Ceftriaxone

Hepatically excreted Cefalosporin

Ceftriaxone

First line for Meningitis > 2 month old

Ceftriaxone

First line for Meningitis < 2 month old

Cefotaxime

First line for Pseudomonas

Ceftazidine

Four Cefalosporins with MTT side chains

• Cefotetan

• Cefomandol

• Cefaperazone

• Moxalactam

What does the MTT chain do?

Inhibits Vitamin K

Only oral 3rd generation Cefalosporin

Cefixeme

Drugs that cause a disulfram reaction

Cefotetan

Cefomandol

Metronidazole

Cefalosporin with the highest allergic reaction in Pediatrics

Cefaclor

MOA Of Benzodiazapines

Increase GABA channel Frequency

Indication for Benzodiazepines

Anxiety

Insomnia

Seizure

Muscle Cramps

What is the cause of death for Benzo’s and Barbituates?

Respiratory Failure

Which Anxiolytinc is used for people who cannot be sedated?

Bupropion

Name (10) Benzodiazepines

Floureapam

Zolpiden

Oxazepam

Triazelam

Tomazepam

Diazepam

Lorazepam

Clonezapam

Chlordiazepoxide

Midazolam

Shortest Acting Benzo

Florezepam

Longest Acting Benzo

Zolpidem

Medium duration Benzo

Oxazepam

Triazelam

Benzo used for elderly who have trouble initiating sleep

Triazelam

Benzo used with 20 minutes antegrade amnesia

Triazelam

Benzo used for people who have difficulty maintaining sleep

Tomazepam

(4) Benzos MC used for Seizures

• Diazepam

• Lorazepam

• Clonazepam

• Chlordiazepoxide

(2) Benzos MC used for Status Epilepticus

• Diazepam

• Lorazepam

Benzo MC used for Absance Seizures in children

Clonazepam

Benzo MC used for restless leg syndrome

Clonazepam

Benzo that comes in sopository

Diazepam

Benzo that is best for anxiety in middle aged females

Lorazepam

Benzo MC used for Alcoholic withdrawal

Chlordiazepoxide

Benzo used for short procedures

Midazelam

Benzo with 45min antegrade amnesia

Midazelam

Antedote for Benzo Overdose

Flumazenil

MOA of Barbituates

Increase GABA channel Duration

Indication for Barbituates

Insomnia

Seizure

Muscle Cramps

Why are Barbituates not indicated for Anxiety

Because they are too sedating

Longest acting barbituate

Phenobarbital

Shortest acting Barbituate

Thiopental

Barbituate most commonly abused on the street

Secobarbital

Treatment for Barbituate Overdose

HCO3- + Doxapram

Barbituate most commonly used for generalized seizures on children

Phenobarbital

3 drugs used to treat Bipolar

#1 Lithium

#2 Valproic Acid

#3 Carbamazapine

MOA of lithium

Looks like Sodium and stabilizes cell membranes

Side effects of Lithium

• Hyponatremia

• Hypothyroidism

• Hyperthyroidism

• Hypercalcemia

• Hypophosphatemia

• Nephrogenic DI

• Epsteins Anomoly

How does Lithium cause Nephrogenic DI?

It inhibits ADH receptors are the kidney

How does Lithium cause Hyponatremia?

Because it looks like Sodium, the kidney hold onto it instead of Sodium

How does Lithium cause hypothyroidism?

How does Lithium cause

How does Lithium cause hypercalcemia?

It binds to PTH receptors

MOA of Carbamazapine

Sodium Channel Blocker

Side effects of Carbamazepine

Agranulocytosis

SIADH

Indication for Carbamazepine

• Temporal Lobe Seizures

• 3rd Line for Bipolar Disorber

• Shooting Neuropthy

How does Carbamazapine cause SIADH

It stimulates the ADH receptors in kidney

MOA of Valproic Acid

Indication for Valproic Acid

• 2nd Line for Bipolar

• 1st Line for Myotonic Seizures

• 1st Line for Mixed Seizures

Side Effects of Valproic Acid

BM Suppression

What is the main cause of depression

Serotonin

Norepinepherine

MOA of Tri-Cyclic Anti-depressants

Blocks reuptake of ALL Catecholamines

Strong Anti-Cholinergic affects

Block 1 receptors by accident

Block A-V conduction in heart

Clue for Anti-Cholinergic effects

Sympathetic with Hot Dry Skin

Name (5) TCA’s

C - Clomipramine

A - Amitryptaline

N - Nortryptaline

D - Desipramine

I - Imipramine

TCA used for bedwetting in children

Imipramine

TCA used for Chronic Pain or neuropathy

Amitryptaline

TCA used for OCD

Clomipramine

Shortest acting TAC’s

Nortryptaline

Desipramine

MOA of SSRI’s

Inhibit the reuptake of Serotonin

Name (4) SSRI’s

F - Fluoxetine

L – Luvoxatine

i

P - Paroxatine

S – Sertraline

Side effects of SSRI’s

Anorgasmia

Name (4) MAOI’s

P - Phenylzine

I - Isocarboxazid

T - Tranylcypramine

S - Selegeline

Foods avoided when on MAOI’s

Wine and Cheese

Wine & cheese contraindicated with MAOI’s because

The interaction can cause Seratonin Syndrome

When switching from SSRI to MAOI, how long is the washout period?

One Month

Name the MAOBI

Selegeline

MOA of Bupropion

Blocks reuptake of Seratonin

Indication for Bupropion

• Used if sexual dysfunction occurs with other antidepressants

• Help stop smoking

Side effects of Bupropion

Decreased Seizure threshold

Indications for Electroconvulsive Therapy

Person who is actively suicidal or with intractable depression

#1 Side effect of ECT

Amnesia

Treatment for Methemoglobinemia

Methyline Blue

Rx for Acute intermittent Porphorya

• Sugar

• Fluids

• Hematin

How does Hematin Work?

It inhibits D-ALA Synthase

Treatment for Cyanide Poisoning

• Amylnitrate

• Sodium Thiosulphate

• Methyline Blue

• Transfusion

Rx for Carbon Monoxide Poisoning

Hyperbaric Oxygen

Rx used for the Used for the Cystic Fibrosis sweat test & to Treat glaucoma

Pilocarpine

For what was Methacholine Previously used?

To diagnose Asthma because is Causes Broncho spasm

How do Amphetamines work?

They cause the release of preformed catecholamines.