Cardiovascular medicine HMG-CoA reductase inhibitors (statins): side effects, contraindications, interactions HMG-CoA:· Side effects:HepatotoxicityMyositis [aka rhabdomyolysis]· Contraindications:Girl during pregnancy/ Growing children· Interactions:Coumarin/ Cyclosporine

Antiarrhythmics: class III members BIAS:BretyliumIbutilideAmiodaroneSotalol

Beta-blockers: main contraindications, cautions ABCDE:AsthmaBlock (heart block)COPDDiabetes mellitusElectrolyte (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 durationPhotosensitivityPigmentation of skin

Peripheral neuropathyPulmonary alveolitis and fibrosisPeripheral conversion of T4 to T3 is inhibited -> hypothyroidism

Beta blockers: members "The NEPAL Prime Minister":TimololNadololEsmololPindololAtenololLabetalolPropranololMetoprolol

Ca++ channel blockers: uses CA++ MASH:Cerebral vasospasm/ CHFAnginaMigranesAtrial flutter, fibrillationSupraventricular tachycardiaHypertension

· Alternatively: "CHASM":Cererbral vasospasm / CHFHypertensionAnginaSuprventricular tachyarrhythmiaMigranes

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

Antiarrhythmics: classification I to IV MBA College· In order of class I to IV:Membrane stabilizers (class I)Beta blockersAction potential widening agentsCalcium channel blockers

Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factor Xa.Monitor Xa concentration, rather than APTT

Pharmacology Mnemonics anti hyprtensive safe for pregnancy are---

My N.H.L ---

M-methyl dopa..N-nifedipine...H-hydralazine..L-labetalol. methyldopaM = mental retardationE = electrolyte imbalanceT = toleranceH = headache/ hepatotoxicity, rebound HTNY = psYchological upsetD = dry mouth, drowsinessO = oedema, orthostatic hypotensionP = ParkinsonismA = Anemia [+ve coomb's test] sodium nitroprusside

clinical uses: MR. CHIEF SURGERY IN EMERGENCY

Mr. = Acute MIchief = Acute CHFSurgery = maintain hemostasis during surgeriesemergency = hypertensive emergencies antihypertensives used in emergencies.............Saurav Ganguly HELP

S-sodium nitroprussideG-GTNH-hydralazineE-esmololL-labetalolP-phentolamine

Pharmacological classification of drugs

5 HT antagonistsCyproheptadinemethysergidekentaserinclozapinerisperidoneondansetrongranisetrontropisetron

5 HT agonistssumaptriptan,almotriptannaratriptanzolmitriptanrizatriptan

ergot alkaloidsA. Natural ergot alkaloids - may be considered as derivatives of lysergic acid.(a) amine alkaloid - ergometrine (ergonovine) : oxytocic(b) amino acid alkaloids - ergotamine, ergotoxine (mixture of ergocristine + ergocornine + ergocryptine) : vasoconstrictor and alpha adrenergic blocker

B. Other semisynthetic derivatives(a) dihydroergotamine (DHE), dihydroergotoxine (codergocrine) : antiadrenergic, cerebroactive(b) 2 -bromo-alpha-ergocryptine (bromocriptine) : dopaminergic(c) methysergide :anti 5 HT

1. Direct sympathomimetics-adr, na, isoprenaline, phenylephrine, methoxamine, xylometazoline, salbutamol,etc

2. Indirect- tyramine

3. Mixed- ephedrine, amphetamine, mephentermine.

Therapeutic classification1. Pressor agentsna, phenylephrine, ephedrine, dopamine, methoxamine, mephentermine DEM2NP

2. Cardiac stimulantsadr, dobutamineisoprenaline ADI

3. Bronchodilatorsadr, terbutaline, salbutamol(albuterol)iso, salmeterol, formoterol

4. Nasal decongphenylephrine, naphazolinexylometazoline, pseudoephedrineoxymetazoline, phenyl propanolamine

5. Cns stimulantsamphetamine, methamphetaminedexamphetamine.

6. Anorecticsfenfluramine, sibutraminedexfenfluramine.

7. Uterine relaxants & vasodilatorsritodrine, salbutamolisoxsuprine, terbutaline.

Alpha Adrenergic Blockers

1. Nonequiliarium typebeta haloalkylamines- phenoxybenzamine

2. Equilibrium type (competitive)| nonselectivea. Ergot alkaloids- ergotamine, ergotoxineb. Hydrogenated ergot alkaloids- dihydroergotamine, dihydroergotoxine.c. Imidazolines- tolazoline, phentolamined. Miscellaneous- chlorpromazine, ketanserin.

||. Alpha-1 selectiveprazosin, terazosin, doxazosin, tamsulosin

|||. Alpha-2 selective- yohimbine

Androgens

NaturalTestes - testosterone, dihydrotestosteroneadrenal cortex - dehydroepiandrosterone, androstenedione (weak androgens)testosterone metabolite - androsterone.

Synthetic androgens17-alkyl substituted derivatives of testosteronemethyltestosterone, fluoxymesteroneother - testosterone undecanoate, mesterolone.

Anabolic steroidsnandrolone, stanozolol, methandienone, oxymetholone.

Impeded androgens/antiandrogensdanazolcyproterone acetateflutamidebicalutamide

5 alpha reductase inhibitorfinasteride - used in male pattern baldness

Antiamoebics

1. Tissue amoebicides (a) for both intestinal & extraintestinal amoebiasisnitroimidazoles - metronidazole, tinidazole, secnidazole, ornidazole, satranidazole.Alkaloids - emetine, dehydroemetine.(b) for extraintestinal amoebiasis only chloroquine

2. Luminal amoebicides(a) amide - diloxanide furoate(b) 8 hydroxyquinolines - quiniodochlor (iodochlorohydroxyquin, clioquinol), diiodohydroxyquin (iodoquinol)(c) antibiotics - tetracyclines.

Antianginal Drugs

1. Nitrates (a)short acting- glceryl trinitrate (b)long acting- isosorbide dinitrate (short acting by sublingual route), isosorbide mononitrate, erythrityl tetranitrate, penta erythritol tetranitrate.

2. Beta blockerspropanolol, metoprolol, atenolol and others.

3. Calcium channel blockers(a)phenyl alkylamine- verapamil(b)benzothiazepine- diltiazem(c)dihydropyridines- nifedipine, felodipine, amlodipine, nitrendipine, nimodipine, lacidipine.

4. Potassium channel openernicorandil, pinacidil, cromakalim, minoxidil, diazoxide

5. Othersdipyridamole, trimetazidine, oxyphedrine

clinical classi1. To abort or terminate attackGTN, isd sublingualy2. Chronic prophylaxis- other drugs

Anticancer

Antimetabolites

1. Folate antagonistmethotrexate

2. Purine antagonist6-mercaptopurine6-thioguanineazthioprine

3. Pyrimidine antagonist5-fluorouracilcytarabine

Anti Cholinergics

1. Natural alkaloids-atropine, hyoscine (scopolamine)

2. Semisynthetic derivatives-homatropine, atropine methonitrate, hyoscine butyl bromide, ipratropium bromide, tiatropium bromide.

3. Synthetic compounds(a) mydriatics-cyclopentolate, tropicamide.(b) antisecretory-spasmodics- (1)quaternary compounds-propantheline, oxyphenonium, clidinium, pipenzolate methyl bromide, isopropamide, glycopyrolate.(2)tertiary-dicyclomine, oxybutynin, flevoxate, pirenzepine, telenzepine(c) antiparkinsonian- trihexyphenidyl, procyclidine, biperiden, benztropine, cycrimine, ethopropazine.

AntiCoagulants

In vitro1. Heparin 150 U for 350 ml blood2. Calcium complexing agents

sodium citrate 1.65 g for 350mlsodium edetate 2mg for 1mlsodium oxalate 10mg for 1ml

in vivo1. Heparin, low molecular weight heparinheparinoids - heparan sulfate, ancrod, lepirudin, danaparoid2. Oral anticoagulant(a)coumarin derivativesbishydroxycoumarin (dicumarol)warfarin sodium, acenocoumarol (nicoumalone), ethylbiscoumacetate(b) indandione derivativephenindione

Antidepressents

1. Reversible inhibitors of MAO-A (RIMAs)moclobemide, clorgyline

2. Tricyclic antidepressants (TCAs)A. NA + 5-HT reuptake inhibitorsimipramine, amitriptyline, trimipramine, doxepin, dothiepin, clomipramine.B. Predominantly NA reuptake inhibitorsdesipramine, nortriptyline, amoxapine.

3. Selective serotonin reuptake inhibitors (SSRIs)fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram.

4. Atypical antidpressantstrazodone, mianserin, mirtazapine, venlafaxine, tianeptine, amineptine, bupropion.

Antiemetics

1. Anticholinergicshyoscine, dicyclomine2. H 1 antihistaminicspromethazine, diphenhydramine, dimenhydrinate, cyclizine, meclozine, cinnarizine3. Neuroleptics

chlorpromazine, prochlorperazine, haloperidol, etc4. Prokinetic drugsmetoclopramide, domperidone, cisapride, mosapride5. 5HT antagonistsondansetron, granisetron6. Adjuvant antiemeticsdexamethasone, benzodiazepines, cannabinoids

Antiepileptics

1. Barbiturate - phenobarbitone2. Deoxybarbiturate- primidone3. Hydantoin - phenytoin4. Iminostilbene - carbamazepine5. Succinimide - ethosuximide6. Aliphatic carboxylic acid - valproic acid (sodium valproate)7. Benzodiazepines - clonazepam,diazepam, clobazam.8. Phenyltriazine - lamotrigine9. Cyclic GABA analogue - gabapentin10. Newer drugs - vigabatrin, topiramate, tiagabine, levetiracetam.

Antifungal

1. Antibiotics(a) polyenes - amphotericin B (AMB), nystatin, hamycin, natamycin (pimaricin)(b) heterocyclic benzofuran - griseofulvin

2. Antimetabolite - flucytosine (5-FC)

3. AzolesA. Imidazoles (topical) - clotrimazole, econazole, miconazole.(systemic) - ketoconazoleB. Triazoles (systemic) - fluconazole, itraconazole.

4. Allylamine - terbinafine

5. Other topical agentstolnaftate, undecylenic acid, benzoic acid, quininiodochlor, ciclopirox olamine, sod. thiosulfate

Antihelminthics

Mebendazole, albendazole, pyrantel pamoate, praziquantel, diethyl carbamazine citrate, levamisole, tetramisole, niclosamide, ivermectin,

1. Round wormascaris lumbricoides - Mebendazole, albendazole, pyrantel

2. Hook wormancylostomat duodenaleMebendazole, albendazole, pyrantel

necator americanus - Mebendazole, albendazole, pyrantel

3. Thread worm enterobius (oxyuris) vermicularisMebendazole, albendazole,pyrantel

4. Strongyloides stercoralisivermectin

5. Whip wormtrichuris trichiuramebendazole

6. Trichinella spiralis albendazole

7. Filariawuchereria bancrofti, brugia malayidiethyl carbamazine, ivermectin

8. Guinea wormdracunculus medinesismetronidazole

9. Tape wormstaenia saginatapraziquantel, niclosamide

taenia solium praziquantel

hymenolepis nana praziquantel

neurocysticercosis albendazole

10. Hydatid diseaseechinococcus granulosus, e.multilocularisalbendazole

Antihistaminics

Clinical classification

1. Highly sedativediphenhydraminedimenhydrinatepromethazinehydroxyzine

2. Moderately sedativepheniraminecyproheptadinemeclizinebuclizinecinnarizine

3. Mild sedativechlorpheniraminemepyraminecyclizineclemastinetriprolidine

4. Second generation antihistaminicsterfenadinefexofenadineloratadineastemizoledesloratadine

cetirizineazelastinemizolastineebastine

Antihypertensives

1. ACE inhibitorscaptopril, enalapril, lisinopril, perindopril, ramipril

2. Angiotensin (AT1) antagonistslosartan, candesartan, irbesartan

3. Calcium channel blockersverapamil, diltiazem, nifedipine, felodipine, amlodipine, nitrendipine, lacidipine.

4. Diureticsthiazides- hydrochlorothiazide, chlorthalidone, indapamidehigh ceiling- furosemide, etc.K+ sparing- spironolactone, triampterene, amiloride

5. Beta adrenergic blockerspropranolol, metoprolol, atenolol, etc.

6. Beta + alpha blockerslabetalol, carvedilol

7. Alpha adrenergic blockersprazosin, terazosin, doxazosin, phentolamine, phenoxybezamine.

8. Central sympatholytics -clonidine, methyldopa

9. Vasodilatorsarteriolar- hydralazine, minoxidil, diazoxide.Arteriolar + venous- na nitroprusside.

Antileprotics

1. Sulfone - dapsone (DDS)2. Phenazine derivative - clofazimine3. Antitubercular drugs - rifampin, ethionamide4. Other antibiotics - ofloxacin, minocycline, clarithromycin.

Antileprotics

1. 4-aminoquinolines - chloroquine, amodiaquine2. Quinoline methanol - mefloquine3. Acridine - mepacrine (atabrine, quinacrine)4. Cinchchona alkaloid - quinine5. Biguanides - proguanil (chloroguanide)6. Diaminopyrimidines - pyrimethamime7. 8-aminoquinoline - primaquine, bulaquine8. Sulfonamides and sulfone - sulfadoxine, sulfamethopyrazine, dapsone.9. Tetracyclines - tetracycline, doxycycline10. Sesquiterpine lactones - artesunate, artemether, arteether.11. Phenanthrene methanol - halofantrine12. Napthoquinone - atovaquone.

Antiparkingsonian

1. Drugs affecting brain dopaminergic system -(a) dopamine precursor - levodopa(b) peripheral decarboxylase inhibitors - carbidopa, benserazide.(c) dopaminergic agonists - bromocriptine, pergolide, piribedil, ropinirole, pramipexole.(d) MAO-B inhibitor - selegiline(e) COMT inhibitor - entacapone, tolcapone (f) dopamine facilitator - amantadine.

2. Drugs affecting brain cholinergic system - (a) central anticholinergics -

trihexyphenidyl (benzhexol), procyclidine, biperiden.(b) antihistaminics - orphenadrine, promethazine

Antiplatelets Or antithrombotics

Aspirin and other nsaidsdipyridamoleticlopidineclopidogrelGP IIb/IIIa antagonistabciximab

tirofiban

B-Blockers

Nonselectivea. Without intrinsic sympathomimetic activity- propranolol, sotalol, timololb. With intrinsic sympathomimetic activity- pindololc. With additional alpha blocking poperty- labetalol, carvedilol

cardioselectivemetoprolol, atenolol, acebutolol, bisoprolol, esmolol, betaxolol, celiprolol.

Selective beta2butoxamine, ICI 118551

Drugs For Bronchial Asthama

|] brochodilators(A) sympathomimetics- adrenaline, isoprenaline, salbutamol, formoterol, salmeterol, terbutaline, bambuterol.(B) methylxanthines-theophylline(anhydrous), aminophylline, choline theophyllinate, hydroxyethyl theophylline, theophylline ethanolate or piperazine.(C) anticholinergics-

atropine methonitrate, ipratropium bromide, tiatropium bromide.

II] leukotriene antagonistsmontelukast, zafirlukast

III] mast cell stabilizerssodium chromoglycate, nedocromil, ketotifen

iv] corticosteroids(a) systemic- hydrocortisone, prednisolone & others (b) inhalational- beclomethasone dipropionate, budesonide, fluticasone propionate, flunisolide.

Drugs for Carcinoma of breast

A. Non invasive (in situ) carcinoma1. Intratductal carcinoma2. Lobular carcinoma in situ

B. Invasive carcinoma1. Infiltrating (invasive) duct carcinoma- NOS (not otherwise specified)2 Infiltrating (invasive) lobular carcinoma3. Medullary carcinoma4. Colloid (mucinou) carcinoma5. Papillary carcinoma6. Tubular carcinoma7. Adenoid cystic (invasive cribriform) carcinoma8. Secretory (juvenile) carcinoma9. Inflammatory carcinoma10. Carcinoma with metaplasia

C. Paget's disease of the nipple

Cephalosporins

First generationparenteral oralcephalothin cephalexincefazolin cephradinecefadroxil

second generationparenteral oralcefuroxime cefaclorcefoxitin cefuroxime axetil

third generationparenteral oralcefotaxime cefiximeceftizoxime cefpodoxime proxetilceftriaxone cefdinirceftazidime ceftibutencefoperazone

fourth generationparenteralcefepimecefpirome

Chelating Agents

Dimercaprol (BAL) dimercaptosuccinic acidcalcium disodium edetatecalcium disodium DPTAdisodium edetatedesferrioxaminedeferiproned penicillamine

Corticosteroids

Glucocorticoids1. Short acting (biological t 1/2 <12 hrs)hydrocortisone (cortisol)cortisone2. Intermediate acting (12 - 36 hrs)prednisolonemethylprednisolonetriamcinolone3. Long acting ( >36 hrs)paramethasonedexamethasonebetamethasone

mineralocorticoidsdesoxycorticosterone acetate (DOCA)fludrocortisonealdosterone

Diuretics

1. High efficacy diuretics (inhibitors of na+ k+ 2cl- cotransport)(a) sulphamoyl derivatives- furosemide, bumetanide(b) phenoxyacetic acid derivative- ethacrynic acid(c) organomercurials- mersalyl

2. Medium efficacy diuretics (inhibitors of na+ cl- symport)(a) benzothiadiazines (thiazides)- chlorothiazide, hydrochlorothiazide, benzthiazide, hydroflumethiazide, clopamide(b) thiazide like- chlorthalidone, metolazone, xipamide, indapamide.

3. Weak or adjunctive diuretics(a) carbonic anhydrase inhibitors- acetazolamide.(b) potassium sparing diuretics- ¡. Aldosterone antagonistspironolactone¡¡. Directly acting (inhibitors of renal epithelial na+ channels) triamterene, amiloride.(c) osmotic diureticsmannitol, isosorbide, glycerol.(d) xanthines- theophylline.

Drugs for Constipation

Laxatives(aperients, purgatives, cathartics)1. Bulk formingdietary fibre: bran, psyllium (plantago)ispaghula, methylcellulose, agar agar2. Stool softner (emolients)docusates (DOSS), liquid paraffin3. Stimulant purgatives(a) diphenylmethanes - phenolphthalein, bisacodyl(b) anthraquinones (emodins)senna, cascara sagrada(c) fixed oilcastor oil4. Osmotic purgativesMg salts - sulfate, hydroxidena salts - sulfate, phosphatesod.pot.tartaratelactulose5. Newer prokinetics5 HT3 antagonist alosterone5 HT4 antagonist tegesterone

Fibrinolytics (thrombolytics)

Streptokinase urokinasealteplase

Hypolipidemics

1. HMG-CoA reductase inhibitorslovastatin, simvastatin, pravastatin, atorvastatin2. Bile acid sequestrants (resins)colestipolcholestyramine3. Activate lipoprotein lipase(fibric acid derivatives)clofibrate, fenofibrate, bezafibrate, gemfibrozil4. Inhibit triglyceride synthesis and lipolysis nicotinic acid5. Othersgugulipid, probucol

plasma expandershuman albumindextrandegraded gelatin polymerpolyvinyl pyrrolidonehydroxyethyl starch (hetastarch)

IMMUNOSUPRESENTS

1. HMG-CoA reductase inhibitorslovastatin, simvastatin, pravastatin, atorvastatin2. Bile acid sequestrants (resins)colestipolcholestyramine3. Activate lipoprotein lipase(fibric acid derivatives)clofibrate, fenofibrate, bezafibrate, gemfibrozil4. Inhibit triglyceride synthesis and lipolysis nicotinic acid5. Othersgugulipid, probucol

plasma expandershuman albumindextrandegraded gelatin polymerpolyvinyl pyrrolidonehydroxyethyl starch (hetastarch)

Iron Preparations

Oral1. Ferrous sulfate 20%2. Ferrous gluconate 123. Ferrous fumarate 33% 200mg4. Colloidal ferric hydroxide 50%5. Ferrous succinate6. Ferrous aminoate7. Iron choline citrate8. iron calcium complex

9. Ferric glycerophosphate

parenteral1. Iron dextran 50mg/dl2. Iron sorbitol citric acid complex 50mg/dl

Local Anaesthetics

Injectable1. Low potency, short durationprocaine, chloroprocaine2. Intermediate potency and durationlignocaine (lidocaine)prilocaine3. High potency, long durationtetracaine (amethocaine)bupivacaineropivacainedibucaine (cinchocaine)

surface anaestheticsoluble insolublecocaine benzocainelignocaine butylaminobenzoatetetracaine (butamben)benoxinate oxethazaine

Local Anaesthetics

Injectable1. Low potency, short durationprocaine, chloroprocaine

2. Intermediate potency and durationlignocaine (lidocaine)prilocaine3. High potency, long durationtetracaine (amethocaine)bupivacaineropivacainedibucaine (cinchocaine)

surface anaestheticsoluble insolublecocaine benzocainelignocaine butylaminobenzoatetetracaine (butamben)benoxinate oxethazaine

Lung tumors

I. Epithelial tumours

A. Benign1. Papilloma2. Adenoma

B. Dysplasia and carcinoma in situ

C. Malignant bronchogenic carcinoma1. Squamous cell (epidermoid) carcinoma2. Small cell carcinomaa - oat cell carcinomab - intermediate cell carcinomac - combined oat cell carcinoma3. Adenocarcinomaa. Acinar adenocarcinomab. Papillary adenocarcinomac. Bronchiolo - alveolar carcinomad. Solid carcinoma with mucus formatiom

4. Large cell carcinoma5. Adenosquamous carcinoma

other carcinomas1. pulmonary neuroendocrine tumour (carcinoid tumour)2. Bronchial gland tumoursa. Adenoid cystic carcinomab. Mucoepidermoid carcinoma

II. Soft tissue tumoursfibroma, fibrosarcoma; leiomyoma, leiomyosarcoma; lipoma, chondroma, hemangioma, lymphangioma, granular cell myoblastoma

III. Pleural tumoursa. Benign mesotheliomab. Malignant carcinoma

IV. Miscellaneous tumours1. Carcinosarcoma2. Pulmonary blastoma3. Malignant melanoma4. Malignant lymphoma

V. Secondary tumours

VI. Tumour like lesions1. Hamartomas2. Eosinophilic granulomas3. Inflammatory pseudotumours

NSAIDS

A. Nonselective COX inhibitors (conventional NSAIDS)1. Salicylates - aspirin, diflunisal

2. Pyrayolone derivatives - phenylbutazone, oxyphenbutazone3. Indole derivatives - indomethacin, sulindac.4. Propionic acid derivatives -ibuprofen, naproxen, ketoprofen, flurbiprofen.5. Anthranilic acid derivative- mephenamic acid6. Aryl acetic acid derivatives - diclofenac7. Oxicam derivatives - piroxicam, tenoxicam.8. Pyrrolo- pyrrole derivative - ketorolac.

B. Preferential COX 2 inhibitorsnimesulide, meloxicam, nabumetone.

C. Selective COX 2 inhibitors celecoxib, rofecoxib, valdecoxib.

D. Analgesic- antipyretics with poor antiinflammatory action1. Paraaminophenol derivative- paracetamol (acetaminophen)2. Pyrazolone derivatives - metamizol (dipyrone), propiphenazone.3. Benzoxazocine derivative - nefopam

Opioids

opiumsPhenanthrene derivativesmorphinecodeinethebaine- nonanalgesic

benzoisoquinoline derivativespapaverinenoscapine(narcotine)both nonanalgesic

opioid analgesics

1. Natural opium alkaloids - morphine, codeine2. Semisynthetic opiates- diacetylmorphine (heroin), pholcodeine.3. Synthetic opiods - pethidine (meperidine), fentanyl, methadone, dextropropoxyphene, tramadol, ethoheptazine.

Complex action & opiod antagonists

1. Agonists - antagonists(a) not used as analgesicnalorphine(b) used as analgesic (kappa acting) - pentazocine, nalbuphine, butorphanol.

2. Partial/weak mew agonistbuprenorphine

3. Pure antagonistsnaloxone, naltrexone, nalmefene

Oral Hypoglycemics

SULFONYLUREASfist gen second gentolbutamide glibenclamidechlorpropamide (glyburide)glipizidegliclazideglimepiride

BIGAUNIDESphenformin metformin

MEGLITINIDE analoguesrepaglinide nateglinide

THIAZOLIDINEDIONESrosiglitazone pioglitazone

AIPHA GLUCOSIDASE INHIBITORSacarbose miglitol

holinergic agonists-

1.choline esters 2.Alkaloidsacetylcholine muscarinemethacholine pilocarpinecarbachol arecholinebethanechol

ANTICHOLINESTERASES

(1) Reversiblecarbamates acridine

physostigmine tacrineneostigminepyridostigmineedrophoniumrivastigminedonepezil

(2) irreversibleorganophosphates carbamates

dyflos carbarylecothiophate propoxur

insect-parapthionmalathiondiazinonnerve gas-tabunsarin soman

Quinolones

Nalidixic acid

first generation fluoroquinolones

norfloxacinofloxacinCiprofloxacinPefloxacin

Second gen

lomefloxacinSparfloxacinlevofloxacinGatifloxacinMoxifloxacin

Drugs for Scabies

Permethrinlindan (BHC gamma benzene hexachloride)benzyl benzoatecrotamitonsulfurdicophane (DDT)ivermectin

Semisynthetic Penicillins

1. Acid resistant alternative to penicillin Gphenoxymethyl penicillin (penicillin V)2. Penicillinase resistant penicillinsmethicillin, oxacillin, cloxacillin3. Extended spectrum penicillins(a) aminopenicillins - ampicillin, bacampicillin, amoxicillin(b) carboxzpenicillins - carbenicillin, carbenicillin indanyl, carbenicillin phenyl (carfecillin), ticarcillin(c) ureidopenicillins - piperacillin, mezlocillin(d) mecillinam (amdinocillin)

beta lactamase inhibitorsclavulanic acidsulbactamtazobactam

Skeletal Muscle Relaxants

Peripherally acting1. neuromuscular blocking agentsA. Non depolarizing (competitive) blockers(a) long acting- d-tubocurarine, pancuronium, pipecuronium, doxacurium.(b) intermediate acting - vecuronium, rapacuronium, rocuronium, atracurium, cisatracurium(c) short acting - mivacurium

B. Depolarising agentssuccinylcholine (suxamethonium) (c-10), decamethonium

2. Directly acting agentsquinine, dantrolene sodium.

Centrally acting1. Mephenesin groupmephenesin, carisoprodol, chlorzoxazone, chlormezanone, methocarbamol.2. Benzodiazepines diazepam and others3. GABA derivative - baclofen4. Central alpha 2 agonisttizanidine.

Sulphonemides

1. Short actingsulfadiazine2. Intermediatesulfamethoxazole, sulfamoxole3. Longsulfamethopyrazine4. Special purposesulfacetamide sod. , sulfasalazine, mafenide, silver sulfadiazine.

Thyroid Inhibitors

1. Inhibit hormone synthesis (antithyroid drugs)propylthiouracil, methimazole, carbimazole.

2. Inhibit iodide trapping ( ionic inhibitors)thiocyanates (-SCN), perchlorates (-CLO4), nitrates (-NO3).

3. Inhibit hormone releaseiodine, iodides of na & k, oranic iodide.

4. Destroy thyroid tissueradioactive iodine ( 131 i, 125 i, 123 i)

1 & 2 are called goitrogens

Uterine Drugs

Uterine stimulants(oxytocics, ecbolics, abortifacients)1. Posterior pituitary hormoneoxytocin2. Ergot alkaloidsergometrine (ergonovine), methylergometrine3. ProstaglandinsPGE 2, PGF 2alpha, 15-methyl PGF 2alpha, misoprostol4. Miscellaneousethacridine, quinine

uterine relaxants/tocolytics1. Adrenergic agonistsritodrine, salbutamolisoxsuprine, terbutaline.2. Magnesium sulfate3. Ccbspecially nifedipine4. Prostaglandin synthesis inhibitoraspirin, ibuprofen, indomethacin5. Ethyl alcohol6. Progesterone7. Miscellaneousnitrates, diazoxide, atropine, phhenothiazines

Pharmac Mneumonic (Random) PHARM PNEUMONICS

Pulmonary infiltrations inducing drugs "Go BAN Me!” Gold Bleomycin/ Busulphan/ BCNU Amiodarone/ Acyclovir/ Azathioprine Nitrofurantoin Melphalan/ Methotrexate/ Methysergide

MPTP: mechanism, effect MPTP: Mitochondrial Parkinson's-Type Poison. • A mitochondrial poison that elicits a Parkinson's-type effect.

Antimuscarinics: members, action "Inhibits Parasympathetic And Sweat": Ipratropium Pirenzepine Atropine Scopolamine • Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic.

Teratogenic drugs: major non-antibiotics TAP CAP: Thalidomide Androgens Progestins Corticosteroids Aspirin & indomethacin Phenytoin

Steroid side effects CUSHINGOID: Cataracts Ulcers Skin: striae, thinning, bruising Hypertension/ Hirsutism/ Hyperglycemia Infections Necrosis, avascular necrosis of the femoral head Glycosuria Osteoporosis, obesity Immunosuppression Diabetes

Beta blockers with CYP2D6 polymorphic metabolism"I Met Tim Carver, the metabolic polymorph": • The following beta blockers require dose adjustment due to CYP2D6 polymorphic metabolism:

Metoprolol Timolol Carvedilol (in patients with lower or higher than normal CYP2D6 activity)

Beta blockers with intrinsic sympathomimetic activity 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.

Muscarinic effects SLUG BAM: Salivation/ Secretions/ Sweating Lacrimation Urination Gastrointestinal upset Bradycardia/ Bronchoconstriction/ Bowel movement Abdominal cramps/ Anorexia Miosis

Sulfonamide: major side effects• Sulfonamide side effects: Steven-Johnson syndrome Skin rash Solubility low (causes crystalluria) Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin)

Epilepsy types, drugs of choice:"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies": • Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence) • Respective drugs: Valproate Valproate Valproate ACTH Carbamazepine Ethosuximide

Quinolones [and Fluoroquinolones]: mechanism"Topple the Queen": Quinolone interferes with Topoisomerase II.

Beta blockers: B1 selective vs. B1-B2 non-selective A through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol. O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol.

Ribavirin: indications RIBAvirin: RSV Influenza B Arenaviruses (Lassa, Bolivian, etc.) Hypertension: treatment ABCD: ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also) Beta blockers Calcium antagonists

Diuretics

Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugs Constipation Respiratory depression Addiction Miosis Sex hormone drugs: male "Feminine Males Need Testosterone": Fluoxymesterone Methyltestosterone Nandrolone Testosterone

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

Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM: Procarbazine Metronidazole Cefo (Perazone, Mandole, Tetan).

Delerium-causing drugs ACUTE CHANGE IN MS: Antibiotics (biaxin, penicillin, ciprofloxacin) Cardiac drugs (digoxin, lidocaine) Urinary incontinence drugs (anticholinergics) Theophylline Ethanol Corticosteroids H2 blockers Antiparkinsonian drugs Narcotics (esp. mepridine) Geriatric psychiatric drugs ENT drugs Insomnia drugs

NSAIDs (eg indomethacin, naproxin) Muscle relaxants Seizure medicines

Morphine: side-effects MORPHINE: Myosis Out of it (sedation) Respiratory depression Pneumonia (aspiration) Hypotension Infrequency (constipation, urinary retention) Nausea Emesis

Therapeutic dosage: toxicity values for most commonly monitored medications "The magic 2s": Digitalis (.5-1.5) Toxicity = 2. Lithium (.6-1.2) Toxicity = 2. Theophylline (10-20) Toxicity = 20. Dilantin (10-20) Toxicity = 20. APAP (1-30) Toxicity = 200.

Diuretics: thiazides: indications "CHIC to use thiazides": CHF Hypertension Insipidous Calcium calculi

Migraine: prophylaxis drugs "Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis": Verpamil Valproic acid Pizotifen Amitriptyline Flunarizine Methysergide Propranolol

Adrenoceptors: vasomotor function of alpha vs. betaABCD: Alpha = Constrict. Beta = Dilate.

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

Opiods: mu receptor effects "MD CARES": Miosis Dependency Constipation Analgesics Respiratory depression Euphoria Sedation

Cancer drugs: time of action between DNA->mRNA ABCDEF: Alkylating agents Bleomycin Cisplastin Dactinomycin/ Doxorubicin Etoposide Flutamide and other steroids or their antagonists (eg tamoxifen, leuprolide)

Busulfan: features ABCDEF: Alkylating agent Bone marrow suppression s/e CML indication Dark skin (hyperpigmentation) s/e Endrocrine insufficiency (adrenal) s/e Fibrosis (pulmonary) s/e

Tricyclic antidepressants: members worth knowing"I have to hide, the CIA is after me": Clomipramine Imipramine Amitrptyline • If want the next 3 worth knowing, the DNDis also after me:Desipramine Norrtriptyline Doxepin

Torsades de Pointes: drugs causing APACHE:

Amiodarone Procainamide Arsenium Cisapride Haloperidol Eritromycin

Serotonin syndrome: components Causes HARM: Hyperthermia Autonomic instability (delirium) Rigidity Myoclonus

Tetracycline: teratogenicity TEtracycline is a TEratogen that causes staining of TEeth in the newborn.

Patent ductus arteriosus: treatment "Come In and Close the door": INdomethacin is used to Close PDA.

Physostigmine vs. neostigmine LMNOP: Lipid soluble Miotic Natural Orally absorbed well Physostigmine • Neostigmine, on the contrary, is: Water soluble Used in myesthenia gravis Synthetic Poor oral absorption

Beta 1 selective blockers"BEAM ONE up, Scotty": Beta 1 blockers: Esmolol Atenolol Metropolol

Antirheumatic agents (disease modifying): membersCHAMP: Cyclophosphamide Hydroxycloroquine and choloroquinine Auranofin and other gold compounds Methotrexate Penicillamine

Auranofin, aurothioglucose: category and indicationAurum is latin for "gold" (gold's chemical symbol is Au). Generic Aur- drugs (Auranofin, Aurothioglucose) are gold compounds. • If didn't learn yet that gold's indication is rheumatoid arthritis, AUR- Acts Upon Rheumatoid.

Antiarrhythmics: class III members BIAS: Bretylium Ibutilide Amiodarone Sotalol

MAOIs: indications MAOI'S: 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.

SIADH-inducing drugs ABCD: Analgesics: opioids, NSAIDs Barbiturates Cyclophosphamide/ Chlorpromazine/ Carbamazepine Diuretic (thiazide)

K+ increasing agents K-BANK: K-sparing diuretic Beta blocker ACEI NSAID K supplement

Reserpine action: Reserpine depletes the Reserves of catecholamines [and serotonin].

Succinylcholine: action, use Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore. You Suck stuff in through a mouth-tube, and drug is used for intubation. Beta-blockers: side effects "BBC Loses Viewers In Rochedale": Bradycardia Bronchoconstriction Claudication Lipids Vivid dreams & nightmares -ve Inotropic action Reduced sensitivity to hypoglycaemia

Mnemonics Related to Side Effects..!! Mnemonics For Side Effects...!!

ACEI, Side Effects CAPTOPRILCough, anaphylaxis, palpitations,

taste, orthostatic ↓BP, Potassium (↑K+),Renal impairment, impotence, leucocytosis

Anti-epileptic side EffectsABCDEFGHAtaxia, blood dyscrasia, cleft lip,dupuytrens / vit D def, exfoliation of skin & Stevens Johnson’s. Fits, GI upset / gum hypertrophy, hepatitis / hairy

Barbiturate side EffectsABCDAtaxia, behavioural disturbance, ↓concentration / coma, depression / drowsy / diplopia

Cholinergic OD side EffectsDUMB BELS Diarrhoea, Urination, Miosis / muscle weakness, bronchorreaBradycardia, emesis, lacrimation, salivation / sweating

Cyclosporin Side Effects4HRT4H - Hyper K+, hypertension, gum hypertrophy, hairyR – Renal toxicityT - Tremor

Digoxin S/E GECCKOGIT – n&v, abdo pain, ulcersEyes – blurring, halo, xanthopsiaCNS – depression, confusion, delirium, hallucinationsCardiac – ANY arrhythmiaK - low

MAOI side Effects 3Hs Hepatocellular jaundice, Hyperthermia, hypertension

TCAD side EffectsCAN WOOCvs, Anticholinergic, Neuro, Withdrawal, Overdose,Others

Steroids Side EffectsHIGH COMPACT IMPSHypertension, Immunosuppression, Gastric Ulcer (bleeding), HeartburnCataract, Osteoporosis, Muscle weakness, Path # / Psychosis, Acne / Altered Glucose,Cushingoid, Thin skinIncreased appetite, Myopathy, poor wound healing, stress response reduced

Or AM CUSHINGOIDAcne, Myopathy (prox) / muscle wasting (prox)Cushingoid / Cataract, Ulcers, Striae, skin thin (bruising), Hypertension / hairy, Infection,Glycosuria, Obesity / Osteoporosis / Oedema, Immunosuppression / Insomnia, Depression