PHARMACOLOGY MNEMONICS

HMG-CoA reductase inhibitors (statins): side effects, contraindications, interactions

HMG-CoA:

· Side effects:

Hepatotoxicity

Myositis [aka rhabdomyolysis]

· Contraindications:

Girl during pregnancy/ Growing children

· Interactions:

Coumarin/ Cyclosporine

Antiarrhythmics: class III members

BIAS:

Bretylium

Ibutilide

Amiodarone

Sotalol

Beta-blockers: main contraindications, cautions

ABCDE:

Asthma

Block (heart block)

COPD

Diabetes mellitus

Electrolyte (hyperkalemia)

Clopidogrel: use

CLOPIdogrel is a drug that prevents

CLots, an Oral Platelet Inhibitor (OPI).

Amiodarone: action, side effects

6 P's:

Prolongs action potential duration

Photosensitivity

Pigmentation of skin

Peripheral neuropathy

Pulmonary alveolitis and fibrosis

Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism

Beta blockers: members

"The NEPAL Prime Minister":

Timolol

Nadolol

Esmolol

Pindolol

Atenolol

Labetalol

Propranolol

Metoprolol

Ca++ channel blockers: uses

CA++ MASH:

Cerebral vasospasm/ CHF

Angina

Migranes

Atrial flutter, fibrillation

Supraventricular tachycardia

Hypertension

· Alternatively: "CHASM":

Cererbral vasospasm / CHF

Hypertension

Angina

Suprventricular tachyarrhythmia

Migranes

Beta-blockers: nonselective beta-blockers

"Tim Pinches His Nasal Problem" (because he has a runny nose...):

Timolol

Pindolol

Hismolol

Naldolol

Propranolol

Antiarrhythmics: classification I to IV

MBA College· In order of class I to IV:

Membrane stabilizers (class I)

Beta blockers

Action potential widening agents

Calcium channel blockers

Enoxaprin (prototype low molecular weight heparin): action, monitoring

EnoXaprin only acts on factor Xa.

Monitor Xa concentration, rather than APTT

anti hyprtensive safe for pregnancy are---

My N.H.L ---

Quote:

M-methyl dopa..

N-nifedipine...

H-hydralazine..

L-labetalol.

methyldopa

Quote:

M = mental retardation

E = electrolyte imbalance

T = tolerance

H = headache/ hepatotoxicity, rebound HTN

Y = psYchological upset

D = dry mouth, drowsiness

O = oedema, orthostatic hypotension

P = Parkinsonism

A = Anemia [+ve coomb's test]

sodium nitroprusside

clinical uses: MR. CHIEF SURGERY IN EMERGENCY

Quote:

Mr. = Acute MI

chief = Acute CHF

Surgery = maintain hemostasis during surgeries

emergency = hypertensive emergencies

antihypertensives used in emergencies.............

Saurav Ganguly HELP

Quote:

S-sodium nitroprusside

G-GTN

H-hydralazine

E-esmolol

L-labetalol

P-phentolamine

Anticholinergic side effects

"Know the ABCD'S of anticholinergic side effects":

Quote:

Anorexia

Blurry vision

Constipation/ Confusion

Dry Mouth

Sedation/ Stasis of urine

Antimuscarinics: members, action

"Inhibits Parasympathetic And Sweat":

Quote:

Ipratropium

Pirenzepine

Atropine

Scopolamine

_Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic.

Aspirin: side effects

ASPIRIN:

Quote:

Asthma

Salicyalism

Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA

Intestinal blood loss

Reye's syndrome

Idiosyncracy

Noise (tinnitus)

Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure)

LOT:

Quote:

Lorazepam

Oxazepam

Temazepam

Benzodiazepenes: antidote

Quote:

"Ben is off with the flu":

Benzodiazepine effects off with Flumazenil.

Benzodiazepenes: drugs which decrease their metabolism

"I'm Overly Calm":

Quote:

Isoniazid

Oral contraceptive pills

Cimetidine

_ These drugs increase calming effect of BZDs by retarding metabolism.

Benzodiazepines: actions

"Ben SCAMs Pam into seduction not by brain but by muscle":

Quote:

Sedation

anti-Convulsant

anti-Anxiety

Muscle relaxant

Not by brain: No antipsychotic activity.

Beta selective blockers

"BEAM ONE up, Scotty":

Quote:

Beta blockers:

Esmolol

Atenolol

Metropolol

Botulism toxin: action, related bungarotoxin

Quote:

Action: "Botulism Bottles up the Ach so it can't be the released":

Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alpha-bungarotoxin--alpha has different mechanism).

Cholinergics (eg organophosphates): effects

If you know these, you will be "LESS DUMB": or SLUDGE

Quote:

Lacrimation

Excitation of nicotinic synapses

Salivation

Sweating

Diarrhea

Urination

Micturition

Bronchoconstriction

Delerium-causing drugs

ACUTE CHANGE IN MS:

Quote:

Antibiotics (biaxin, penicillin, ciprofloxacin)

Cardiac drugs (digoxin, lidocaine)

Urinary incontinence drugs (anticholinergics)

Theophylline

Ethanol

Corticosteroids

H blockers

Antiparkinsonian drugs

Narcotics (esp. mepridine)

Geriatric psychiatric drugs

ENT drugs

Insomnia drugs

NSAIDs (eg indomethacin, naproxin)

Muscle relaxants

Seizure medicines

Direct sympathomimetic catecholamines

DINED:

Quote:

Dopamine

Isoproterenol

Norepinephrine

Epinephrine

Dobutamine

Inhalation anesthetics

SHINE:

Quote:

Sevoflurane

Halothane

Isoflurane

Nitrous oxide

Enflurane

_ If want the defunct Methoxyflurane too, make it MoonSHINE.

Ipratropium: action

Atropine is buried in the middle: iprAtropium, so it behaves like Atropine.

Lead poisoning: presentation

ABCDEFG:

Quote:

Anemia

Basophilic stripping

Colicky pain

Diarrhea

Encephalopathy

Foot drop

Gum (lead line)

Lithium: side effects

LITH:

Quote:

Leukocytosis

Insipidus [diabetes insipidus, tied to polyuria]

Tremor/ Teratogenesis

Hypothyroidism

MAOIs: indications

MAOI'S:

Quote:

Melancholic [classic name for atypical depression]

Anxiety

Obesity disorders [anorexia, bulemia]

Imagined illnesses [hypochondria]

Social phobias

_ Listed in decreasing order of importance.

_ Note MAOI is inside MelAnchOlIc.

Methyldopa: side effects

METHYLDOPA:

Quote:

Mental retardation

Electrolyte imbalance

Tolerance

Headache/ Hepatotoxicity

psYcological upset

Lactation in female

Dry mouth

Oedema

Parkinsonism

Anaemia (haemolytic)

Monoamine oxidase inhibitors: members

"PIT of despair":

Quote:

Phenelzine

Isocarboxazid

Tranylcypromine

_ A pit of despair, since MAOs treat depression.

Morphine: effects

MORPHINES:

Quote:

Miosis

Orthostatic hypotension

Respiratory depression

Pain supression

Histamine release/ Hormonal alterations

Increased ICT

Nausea

Euphoria

Sedation

Morphine: effects at mu receptor

PEAR:

Quote:

Physical dependence

Euphoria

Analgesia

Respiratory depression

Narcotic antagonists

Quote:

The Narcotic Antagonists are NAloxone and NAltrexone.

_ Important clinically to treat narcotic overdose.

Parkinsonism: drugs

SALAD:

Quote:

Selegiline

Anticholinenergics (trihexyphenidyl, benzhexol, ophenadrine)

L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)

Amantadine

Dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide)

Phenytoin: adverse effects

PHENYTOIN:

Quote:

P- interactions

Hirsutism

Enlarged gums

Nystagmus

Yellow-browning of skin

Teratogenicity

Osteomalacia

Interference with B metabolism (hence anemia)

Neuropathies: vertigo, ataxia, headache

Physostigmine vs. neostigmine

LMNOP:

Quote:

Lipid soluble

Miotic

Natural

Orally absorbed well

Physostigmine

_ Neostigmine, on the contrary, is:

Water soluble

Used in myesthenia gravis

Synthetic

Poor oral absorption

Pupils in overdose: morphine vs. amphetamine

"MorPHINE: Fine. AmPHETamine: Fat":

Quote:

Morphine overdose: pupils constricted (fine).

Amphetamine overdose: pupils dilated (fat).

Serotonin syndrome: components

Causes HARM:

Quote:

Hyperthermia

Autonomic instability (delirium)

Rigidity

Myoclonus

Sodium valproate: side effects

VALPROATE:

Quote:

Vomiting

Alopecia

Liver toxicity

Pancreatitis/ Pancytopenia

Retention of fats (weight gain)

Oedema (peripheral oedema)

Appetite increase

Tremor

Enzyme inducer (liver)

Succinylcholine: action, use

Quote:

Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore.

You Suck stuff in through a mouth-tube, and drug is used for intubation.

Tricyclic antidepressants: members worth knowing

"I have to hide, the CIA is after me":

Quote:

Clomipramine

Imipramine

Amitrptyline

_ If want the next worth knowing, the DNDis also after me:

Desipramine

Norrtriptyline

Doxepin

Tricyclic antidipressents (TCA): side effects TCA'S:

Quote:

ThrombocytopeniaCardiac (arrhymia, MI, stroke)

Anticholinergic (tachycardia, urinary retention, etc)

Seizures

Vigabatrin: mechanism

Vi-GABA-Tr-In:

Quote:

Via GABA Transferase Inhibition

Antibiotics contraindicated during pregnancy

MCAT:

Quote:

Metronidazole

Chloramphenicol

Aminoglycoside

Tetracycline

Busulfan: features

ABCDEF:

Quote:

Alkylating agent

Bone marrow suppression s/e

CML indication

Dark skin (hyperpigmentation) s/e

Endrocrine insufficiency (adrenal) s/e

Fibrosis (pulmonary) s/e

Metabolism enzyme inducers

"Randy's Black Car Goes Putt Putt and Smokes":

Quote:

Rifampin

Barbiturates

Carbamazepine

Grisoefulvin

Phenytoin

Phenobarb

Smoking cigarettes

Morphine: side-effects

MORPHINE:

Quote:

Myosis

Out of it (sedation)

Respiratory depression

Pneumonia (aspiration)

Hypotension

Infrequency (constipation, urinary retention)

Nausea

Emesis

Therapeutic index: formula

TILE:

Code:

TI = LD / ED

Zero order kinetics drugs (most common ones)

"PEAZ (sounds like pees) out a constant amount":

Quote:

Phenytoin

Ethanol

Aspirin

Zero order

_ Someone that pees out a constant amount describes zero order kinetics (always the same amount out)

Asthma drugs: leukotriene inhibitor action

Quote:

zAfirlukast: Antagonist of lipoxygenase

zIlueton: Inhibitor of LT receptor

Beta- vs Beta- receptor location

"You have heart and lungs":

Quote:

Beta- are therefore primarily on heart.

Beta- primarily on lungs.

Hepatic necrosis: drugs causing focal to massive necrosis

"Very Angry Hepatocytes":

Quote:

Valproic acid

Acetaminophen

Halothane

Adrenoceptors: vasomotor function of alpha vs. beta

ABCD:

Quote:

Alpha = Constrict.

Beta = Dilate.

Beta blockers with intrinsic sympathomimetic activity

Quote:

Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels.

Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some

diabetics or asthmatics despite the fact that they are non-seletive beta blockers.

Beta-blockers: main contraindications, cautions

ABCDE:

Quote:

Asthma

Block (heart block)

COPD

Diabetes mellitus

Electrolyte (hyperkalemia)

Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem" (because he has a runny nose...):

Quote:

Timolol

Pindolol

Hismolol

Naldolol

Propranolol

PREANASTHETIC MEDICATION

HOSANA this is a christian word.

Quote:

H-H2blockers

O-opeoids

S-sedatives-antianxiety

A-anticholenergic

N-neuroleptics

A-antiemetics

simple and sobar

anti epeleptic drugs

Dr.BHAISAB's New PC.

Quote:

D...deoxy barbiturates

B...barbiturates

H....hydantoin

A.. aliphatic carb acids

I....iminostilbenes

S....succinimides

B....BZD's

N.... newer drugs

P....Phenyltriazines

C... cyclic gaba analogues

adverse effects of tetracyclins-KAPIL DEV

Quote:

K kidney toxicity

A antianabolic effect

P phototoxicity

I inc ICP

L liver toxicity

D diabetes insipidus

E enamel problems

V vestibular toxicity

GENERAL TOXICITY OF ANTICANCER DRUGS

SHaLi's BF Ghoghari Gautam is Chor.

Quote:

S-skin

H-hyperurecemia

L-lymphoreticular tissue

B-bone marrow

F-Foetus

G-gonads

G-git

C-carcinogenecity

6 H s and 8 H s of adverse effects of thaizide diuretics and loop diuretics respectively.....

'melbourne cricket authority has high funds though players get minor amount' .. for clinical uses of beta blockers...

Drugs causing pulmonary fibrosis:

Quote:

BAB like in baba (father)

Bleomycin

Amiodarone

Busulfan

ADRS OF CHLORAMPHENICOL

smart boys in girls hostel

B.... bone marrow depression

H...hypersensitivity

I....irritative effects

S.....superinfections

G.....Gray baby syndrome

ampicillin uses

UR GMCS BeST

Quote:

UTI

Respi

Gonorrhoea

Maningitis

cholecystitis

septicemias

bacillary dysentry

sabe

typhoid

misch

Acyclovir “I see clover”

I see a three-leaf clover (this is a prodrug that gets converted into a triphosphate – it resembles dNTP and inhibits DNA Polymerase). Imagine putting clovers over herpes

sores and genital warts (this is used to treat those).

Amantadine “Homan to Dean” In case you haven’t heard, Dr. Homan is our new SOM dean. His new policy: he won’t let us come to school without our white coats (this drug blocks uncoating, stage 2, in viral infection). Other interesting facts about him: he can pee for 12 hours straight! (The half-life is 12h and it’s excreted unchanged in the kidney .)

Dr. Homan can’t take the pressure of being a new dean so he becomes a nervous drunk with depression, feelings of detachment, insomnia, dizziness, ataxia, slurred speech, and inability to concentrate (these are some of the adverse effects)

Cephachlor “Chlorine” – as in swimming pools

You swim and get water up your nose and in your ears (this drug treats sinusitis and OTITIS media).

Cephadroxil “Drop rocks” While you are peeing you drop rocks (This drug treats UTIs).

Cephalothin “…Loathing”

If your heart is infected, you can’t love, only loathe (this is used to treat severe infections such as endocarditis).

Cephamandole “…Man doll” You have to inflate your man doll and you get an upper respiratory infection. If you “use” this anatomically correct man doll, he will give you pelvic inflammatory disease (This drug is indicated for URI and PID). He’s also so real that he bleeds!!! (Adverse effect: It affects Vit-K dependent clotting function)

Cephazolin “…Soul in” You want to keep your soul in and not die if you go to surgery (this drug is used prophylactically for surgery).

Cephoperazone “…Opera zone” Going to the opera makes me want to get drunk to the point of illness. These drugs, when mixed with ethanol interfere with ALDH, affecting alcohol metabolism (you end up with increased acetaldehyde – a DISULFIRAM-LIKE

REACTION).

Also, if you see Phantom of the Opera, expect to see some blood! (This affects Vit-K dependent clotting function.)

Cephotaxime “…Tax time” IRS is hard to kill off – they are MULTIPLE DRUG RESISTANT (Use this drug against MDR strains.).

Clindamycin “Clean the mice”

You’re cleaning the mice because they are covered with ticks (this drug is used to treat Lyme Disease). You have to use SOS kitchen cleaner to clean the mice (SOS = 50 S ribosomal unit – where this drug acts).

Richard Gere likes to put mice in “where the sun don’t shine” and this is a very FRAGILE procedure (Clindamycin may cause Pseudomembranous enterocolitis and it’s also used to treat B. fragilis infections).

Fluconazole “Flu cone” Imagine an emaciated AIDS patient eating an ice cream cone made of the flu and he gets an oral and esophageal fungal infection. (This is used to treat oral and esophageal candidiasis in AIDS patients).

Foscarnet “Fox cARRR net” If you catch foxes in a net, they won’t reproduce (this drug is a stage 3 inhibitor). ARRR… it inhibits RNA polymerase and Reverse transcriptase to block Reproduction. You’re going to put the foxes into a car that’s made out of bones instead of metal (this drug binds to bones and decreases Ca2+ and Mg2+).

Also, a foxy lady is HOT (this drug will cause a fever) and never wear fox urine to hunt (this is excreted in the kidney and causes renal insufficiency).

inhalational corticosteroids

Bed Bug Flew To Florida

Quote:

B-BECLOMETHASONE DIPROPIONATE

B-BUDESONIDE

F-FLUTICASONE PROPIONATE

T-TRIAMCINALONE

F-FLUNISOLIDE

Succinylcholine: action, use

Quote:

Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore.

You Suck stuff in through a mouth-tube, and drug is used for intubation

Cholinergics (eg organophosphates): effects

If you know these, you will be "LESS DUMB":

Quote:

Lacrimation

Excitation of nicotinic synapses

Salivation

Sweating

Diarrhea

Urination

Micturition

Bronchoconstriction

Steroids: side effects

BECLOMETHASONE:

Quote:

Buffalo hump

Easy bruising

Cataracts

Larger appetite

Obesity

Moonface

Euphoria

Thin arms & legs

Hypertension/ Hyperglycaemia

Avascular necrosis of femoral head

Skin thinning

Osteoporosis

Negative nitrogen balance

Emotional liability

Methyldopa: side effects

METHYLDOPA:

Quote:

Mental retardation

Electrolyte imbalance

Tolerance

Headache/ Hepatotoxicity

psYcological upset

Lactation in female

Dry mouth

Oedema

Parkinsonism

Anaemia (haemolytic)

Sodium valproate: side effects

VALPROATE:

Quote:

Vomiting

Alopecia

Liver toxicity

Pancreatitis/ Pancytopenia

Retention of fats (weight gain)

Oedema (peripheral oedema)

Appetite increase

Tremor

Enzyme inducer (liver)

Captopril (an ACE inhibitor): side effects

CAPTOPRIL:

Quote:

Cough

Angioedema/ Agranulocystosis

Proteinuria/ Potassium excess

Taste changes

Orthostatic hypotension

Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)

Renal failure (and renal artery stenosis contraindication)/ Rash

Indomethacin inhibition

Leukopenia/ Liver toxicity

Lithium: side effects

LITH:

Quote:

Leukocytosis

Insipidus [diabetes insipidus, tied to polyuria]

Tremor/ Teratogenesis

Hypothyroidism

Opioids: effects

BAD AMERICANS:

Quote:

Bradycardia & hypotension

Anorexia

Diminished pupilary size

Analgesics

Miosis

Euphoria

Respiratory depression

Increased smooth muscle activity (biliary tract constriction)

Constipation

Ameliorate cough reflex

Nausea and vomiting

Sedations

Ca++ channel blockers: uses

CA++ MASH:

Quote:

Cerebral vasospasm/ CHF

Angina

Migranes

Atrial flutter, fibrillation

Supraventricular tachycardia

Hypertension

·

Alternatively: "CHASM":

Quote:

Cererbral vasospasm / CHF

Hypertension

Angina

Suprventricular tachyarrhythmia

Migranes

Pupils in overdose: morphine vs. amphetamine

MorPHINE: Fine.

AmPHETamine: Fat

"Morphine overdose: pupils constricted (fine)

Amphetamine overdose: pupils dilated (fat)

Phenobarbitone side effects

Children are annoying (hyperkinesia, irritability, insomnia, aggression)

Adults are dosy (sedation, dizziness, drowsiness

Atropine: origin tells action or vice versa

Atropine causes your pupils to dilate, and it came from nightshade [belladona]In the night or in shade, your pupils dilate so you can see

Atropine use: tachycardia or bradycardia

"A goes with B":

Atropine used clinically to treat Bradycardia

Reserpine action

Reserpine depletes the Reserves of catecholamines [and serotonin]

Sodium channel blockade: Procainamide, Quinidine, Disopyramide

"Quaker Preachers Discussed Sobriety."

Quaker-Quinidine

Preachers-Procainamide

Discussed-Disopyramide

Sobriety-Sodium channel blockade

Class IB - Sodium channel blockade: Lidocaine, Phenytoin, Mexiletine, tocainide

"Philadelphians Like Salty Mexican Tacos."

Philadelphians-Phenytoin

Like-Lidocaine

Salty-Sodium channel blockade

Mexican-Mexiletine

Tacos-Tocainide

Class IC - Sodium channel blockade: Flecainide, Encainide, Propafenone

"Flea Encrusted Prophets."

Flea-Flecainide

Encrusted-Encainide

Prophets-Propafenone

Class II - Beta-adrenergic blockade: Propranolol

"Betting Professionals."

Betting-Beta-adrenergic blockade

Professionals-Propranolol

Class III - Prolong repolarization: Amiodarone, Bretylium, Solatol

"Britain Repossessed American Soaps."

Britain-Bretylium

Repossessed-Repolarization is prolonged.

American-Amiodarone

Soaps-Solatol

Class IV - Calcium channel blockade: Verapamil, Diltiazem

"Calligraphist's Verbal Dilemma."

Calligraphist-Calcium channel blockade

Verbal-Verapamil

Dilemma-Diltiazem

Antiarrhythmic agents:

"A Dubious Quality Product...

Bought To Preserve Little Money...

Can Fabricate Enough Problems."

A-1a B-1b C-1c

1a-A:

D-Disopyramide

Q-Quinidine

P-Procainamide

1b-B:

T-Tocainamide

P-Phenytoin

L-Lidocaine

M-Mexiletine

1c-C:

F-Flecainamide

E-Encainamide

P-Propafenone

Mnemonics For Side Effects.

ACEI, Side Effects

CAPTOPRIL

Cough,

anaphylaxis,

palpitations,

taste,

orthostatic ↓BP,

Potassium (↑K+),

Renal impairment,

impotence,

leucocytosis

Anti-epileptic side Effects

ABCDEFGH

Ataxia,

blood dyscrasia,

cleft lip,

dupuytrens / vit D def,

exfoliation of skin & Stevens Johnson’s. Fits,

GI upset / gum hypertrophy,

hepatitis / hairy

Barbiturate side Effects

ABCD

Ataxia,

behavioural disturbance,

↓concentration / coma,

depression / drowsy / diplopia

Cholinergic OD side Effects

DUMB BELS

Diarrhoea,

Urination,

Miosis / muscle weakness,

bronchorrea

Bradycardia,

emesis,

lacrimation,

salivation / sweating

Cyclosporin Side Effects

4HRT

4H - Hyper K+, hypertension, gum hypertrophy, hairy

R – Renal toxicity

T - Tremor

Digoxin S/E

GECCKO

GIT – n&v, abdo pain, ulcers

Eyes – blurring, halo, xanthopsia

CNS – depression, confusion, delirium, hallucinations

Cardiac – ANY arrhythmia

K - low

MAOI side Effects

3Hs

Hepatocellular jaundice,

Hyperthermia,

hypertension

TCAD side Effects

CAN WOO

Cvs,

Anticholinergic,

Neuro,

Withdrawal,

Overdose,

Others

Steroids Side Effects

HIGH COMPACT IMPS

Hypertension,

Immunosuppression,

Gastric Ulcer (bleeding),

Heartburn

Cataract,

Osteoporosis,

Muscle weakness,

Path # / Psychosis,

Acne / Altered Glucose,

Cushingoid,

Thin skin

Increased appetite,

Myopathy,

poor wound healing,

stress response reduced

AM CUSHINGOID

Acne,

Myopathy (prox) / muscle wasting (prox)

Cushingoid / Cataract,

Ulcers,

Striae, skin thin (bruising),

Hypertension / hairy,

Infection,

Glycosuria,

Obesity / Osteoporosis / Oedema,

Immunosuppression / Insomnia,

Depression