Cardiovascular medicine

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

Pharmacology Mnemonics
anti hyprtensive safe for pregnancy are--My N.H.L --M-methyl dopa.. N-nifedipine... H-hydralazine.. L-labetalol. methyldopa 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 Mr. = Acute MI chief = Acute CHF Surgery = maintain hemostasis during surgeries emergency = hypertensive emergencies antihypertensives used in emergencies............. Saurav Ganguly HELP

S-sodium nitroprusside G-GTN H-hydralazine E-esmolol L-labetalol P-phentolamine

Pharmacological classification of drugs

5 HT antagonists Cyproheptadine methysergide kentaserin clozapine risperidone ondansetron granisetron tropisetron 5 HT agonists sumaptriptan, almotriptan naratriptan zolmitriptan rizatriptan ergot alkaloids A. 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 sympathomimeticsadr, na, isoprenaline, phenylephrine, methoxamine, xylometazoline, salbutamol,etc 2. Indirect- tyramine 3. Mixed- ephedrine, amphetamine, mephentermine.

Therapeutic classification 1. Pressor agents na, phenylephrine, ephedrine, dopamine, methoxamine, mephentermine DEM2NP 2. Cardiac stimulants adr, dobutamine isoprenaline ADI 3. Bronchodilators adr, terbutaline, salbutamol(albuterol) iso, salmeterol, formoterol 4. Nasal decong phenylephrine, naphazoline xylometazoline, pseudoephedrine oxymetazoline, phenyl propanolamine 5. Cns stimulants amphetamine, methamphetamine dexamphetamine. 6. Anorectics fenfluramine, sibutramine dexfenfluramine. 7. Uterine relaxants & vasodilators ritodrine, salbutamol isoxsuprine, terbutaline.

Alpha Adrenergic Blockers

1. Nonequiliarium type beta haloalkylamines- phenoxybenzamine

2. Equilibrium type (competitive) | nonselective a. Ergot alkaloids- ergotamine, ergotoxine b. Hydrogenated ergot alkaloids- dihydroergotamine, dihydroergotoxine. c. Imidazolines- tolazoline, phentolamine d. Miscellaneous- chlorpromazine, ketanserin. ||. Alpha-1 selective prazosin, terazosin, doxazosin, tamsulosin |||. Alpha-2 selective- yohimbine

Androgens Natural Testes - testosterone, dihydrotestosterone adrenal cortex - dehydroepiandrosterone, androstenedione (weak androgens) testosterone metabolite - androsterone. Synthetic androgens 17-alkyl substituted derivatives of testosterone methyltestosterone, fluoxymesterone other - testosterone undecanoate, mesterolone.

Anabolic steroids nandrolone, stanozolol, methandienone, oxymetholone. Impeded androgens/antiandrogens danazol cyproterone acetate flutamide bicalutamide 5 alpha reductase inhibitor finasteride - used in male pattern baldness

Antiamoebics 1. Tissue amoebicides (a) for both intestinal & extraintestinal amoebiasis nitroimidazoles - 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 blockers propanolol, 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 opener nicorandil, pinacidil, cromakalim, minoxidil, diazoxide 5. Others dipyridamole, trimetazidine, oxyphedrine clinical classi 1. To abort or terminate attack GTN, isd sublingualy 2. Chronic prophylaxis- other drugs

Anticancer Antimetabolites 1. Folate antagonist methotrexate 2. Purine antagonist 6-mercaptopurine 6-thioguanine azthioprine 3. Pyrimidine antagonist 5-fluorouracil cytarabine

Anti Cholinergics 1. Natural alkaloids-atropine, hyoscine (scopolamine) 2. Semisynthetic derivativeshomatropine, 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 vitro 1. Heparin 150 U for 350 ml blood 2. Calcium complexing agents

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

in vivo 1. Heparin, low molecular weight heparin heparinoids - heparan sulfate, ancrod, lepirudin, danaparoid 2. Oral anticoagulant (a)coumarin derivatives bishydroxycoumarin (dicumarol) warfarin sodium, acenocoumarol (nicoumalone), ethylbiscoumacetate (b) indandione derivative phenindione

Antidepressents 1. Reversible inhibitors of MAO-A (RIMAs) moclobemide, clorgyline 2. Tricyclic antidepressants (TCAs) A. NA + 5-HT reuptake inhibitors imipramine, amitriptyline, trimipramine, doxepin, dothiepin, clomipramine. B. Predominantly NA reuptake inhibitors desipramine, nortriptyline, amoxapine. 3. Selective serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram. 4. Atypical antidpressants trazodone, mianserin, mirtazapine, venlafaxine, tianeptine, amineptine, bupropion.

Antiemetics 1. Anticholinergics hyoscine, dicyclomine 2. H 1 antihistaminics promethazine, diphenhydramine, dimenhydrinate, cyclizine, meclozine, cinnarizine 3. Neuroleptics

chlorpromazine, prochlorperazine, haloperidol, etc 4. Prokinetic drugs metoclopramide, domperidone, cisapride, mosapride 5. 5HT antagonists ondansetron, granisetron 6. Adjuvant antiemetics dexamethasone, benzodiazepines, cannabinoids

Antiepileptics 1. Barbiturate - phenobarbitone 2. Deoxybarbiturate- primidone 3. Hydantoin - phenytoin 4. Iminostilbene - carbamazepine 5. Succinimide - ethosuximide 6. Aliphatic carboxylic acid - valproic acid (sodium valproate) 7. Benzodiazepines clonazepam, diazepam, clobazam. 8. Phenyltriazine - lamotrigine 9. Cyclic GABA analogue - gabapentin 10. 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. Azoles A. Imidazoles (topical) - clotrimazole, econazole, miconazole. (systemic) - ketoconazole B. Triazoles (systemic) - fluconazole, itraconazole. 4. Allylamine - terbinafine 5. Other topical agents

tolnaftate, undecylenic acid, benzoic acid, quininiodochlor, ciclopirox olamine, sod. thiosulfate Antihelminthics Mebendazole, albendazole, pyrantel pamoate, praziquantel, diethyl carbamazine citrate, levamisole, tetramisole, niclosamide, ivermectin, 1. Round worm ascaris lumbricoides - Mebendazole, albendazole, pyrantel 2. Hook worm ancylostomat duodenale Mebendazole, albendazole, pyrantel necator americanus - Mebendazole, albendazole, pyrantel 3. Thread worm enterobius (oxyuris) vermicularis Mebendazole, albendazole, pyrantel 4. Strongyloides stercoralis ivermectin 5. Whip worm trichuris trichiura mebendazole 6. Trichinella spiralis albendazole 7. Filaria wuchereria bancrofti, brugia malayi diethyl carbamazine, ivermectin 8. Guinea worm dracunculus medinesis metronidazole 9. Tape worms taenia saginata praziquantel, niclosamide

taenia solium praziquantel hymenolepis nana praziquantel neurocysticercosis albendazole 10. Hydatid disease echinococcus granulosus, e.multilocularis albendazole

Antihistaminics

Clinical classification 1. Highly sedative diphenhydramine dimenhydrinate promethazine hydroxyzine 2. Moderately sedative pheniramine cyproheptadine meclizine buclizine cinnarizine 3. Mild sedative chlorpheniramine mepyramine cyclizine clemastine triprolidine 4. Second generation antihistaminics terfenadine fexofenadine loratadine astemizole desloratadine cetirizine

azelastine mizolastine ebastine

Antihypertensives

1. ACE inhibitors captopril, enalapril, lisinopril, perindopril, ramipril 2. Angiotensin (AT1) antagonists losartan, candesartan, irbesartan 3. Calcium channel blockers verapamil, diltiazem, nifedipine, felodipine, amlodipine, nitrendipine, lacidipine. 4. Diuretics thiazides- hydrochlorothiazide, chlorthalidone, indapamide high ceiling- furosemide, etc. K+ sparing- spironolactone, triampterene, amiloride 5. Beta adrenergic blockers propranolol, metoprolol, atenolol, etc. 6. Beta + alpha blockers labetalol, carvedilol 7. Alpha adrenergic blockers prazosin, terazosin, doxazosin, phentolamine, phenoxybezamine. 8. Central sympatholytics clonidine, methyldopa 9. Vasodilators arteriolar- hydralazine, minoxidil, diazoxide. Arteriolar + venous- na nitroprusside.

Antileprotics 1. Sulfone - dapsone (DDS) 2. Phenazine derivative - clofazimine 3. Antitubercular drugs - rifampin, ethionamide 4. Other antibiotics - ofloxacin, minocycline, clarithromycin.

Antileprotics

1. 4-aminoquinolines - chloroquine, amodiaquine 2. Quinoline methanol - mefloquine 3. Acridine - mepacrine (atabrine, quinacrine) 4. Cinchchona alkaloid - quinine 5. Biguanides - proguanil (chloroguanide) 6. Diaminopyrimidines - pyrimethamime 7. 8-aminoquinoline - primaquine, bulaquine 8. Sulfonamides and sulfone - sulfadoxine, sulfamethopyrazine, dapsone. 9. Tetracyclines - tetracycline, doxycycline 10. Sesquiterpine lactones - artesunate, artemether, arteether. 11. Phenanthrene methanol - halofantrine 12. 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 nsaids dipyridamole ticlopidine clopidogrel GP IIb/IIIa antagonist abciximab tirofiban

B-Blockers Nonselective a. Without intrinsic sympathomimetic activity- propranolol, sotalol, timolol b. With intrinsic sympathomimetic activity- pindolol c. With additional alpha blocking poperty- labetalol, carvedilol cardioselective metoprolol, atenolol, acebutolol, bisoprolol, esmolol, betaxolol, celiprolol. Selective beta2 butoxamine, ICI 118551

Drugs For Bronchial Asthama

|] brochodilators (A) sympathomimetics- adrenaline, isoprenaline, salbutamol, formoterol, salmeterol, terbutaline, bambuterol. (B) methylxanthinestheophylline(anhydrous), aminophylline, choline theophyllinate, hydroxyethyl theophylline, theophylline ethanolate or piperazine. (C) anticholinergicsatropine methonitrate, ipratropium bromide, tiatropium bromide. II] leukotriene antagonists

montelukast, zafirlukast III] mast cell stabilizers sodium 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) carcinoma 1. Intratductal carcinoma 2. Lobular carcinoma in situ B. Invasive carcinoma 1. Infiltrating (invasive) duct carcinoma- NOS (not otherwise specified) 2 Infiltrating (invasive) lobular carcinoma 3. Medullary carcinoma 4. Colloid (mucinou) carcinoma 5. Papillary carcinoma 6. Tubular carcinoma 7. Adenoid cystic (invasive cribriform) carcinoma 8. Secretory (juvenile) carcinoma 9. Inflammatory carcinoma 10. Carcinoma with metaplasia C. Paget's disease of the nipple

Cephalosporins
First generation

parenteral oral cephalothin cephalexin cefazolin cephradine cefadroxil second generation parenteral oral cefuroxime cefaclor cefoxitin cefuroxime axetil third generation parenteral oral cefotaxime cefixime ceftizoxime cefpodoxime proxetil ceftriaxone cefdinir ceftazidime ceftibuten cefoperazone fourth generation parenteral cefepime cefpirome

Chelating Agents

Dimercaprol (BAL) dimercaptosuccinic acid calcium disodium edetate calcium disodium DPTA disodium edetate desferrioxamine deferiprone d penicillamine

Corticosteroids

Glucocorticoids 1. Short acting (biological t 1/2 <12 hrs) hydrocortisone (cortisol) cortisone 2. Intermediate acting (12 - 36 hrs) prednisolone methylprednisolone triamcinolone 3. Long acting ( >36 hrs) paramethasone dexamethasone betamethasone

mineralocorticoids desoxycorticosterone acetate (DOCA) fludrocortisone aldosterone

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 likechlorthalidone, metolazone, xipamide, indapamide. 3. Weak or adjunctive diuretics (a) carbonic anhydrase inhibitors- acetazolamide. (b) potassium sparing diuretics. Aldosterone antagonist spironolactone . Directly acting (inhibitors of renal epithelial na+ channels) triamterene, amiloride.

(c) osmotic diuretics mannitol, isosorbide, glycerol. (d) xanthines- theophylline.

Drugs for Constipation

Laxatives (aperients, purgatives, cathartics) 1. Bulk forming dietary fibre: bran, psyllium (plantago) ispaghula, methylcellulose, agar agar 2. Stool softner (emolients) docusates (DOSS), liquid paraffin 3. Stimulant purgatives (a) diphenylmethanes - phenolphthalein, bisacodyl (b) anthraquinones (emodins) senna, cascara sagrada (c) fixed oil castor oil 4. Osmotic purgatives Mg salts - sulfate, hydroxide na salts - sulfate, phosphate sod.pot.tartarate lactulose 5. Newer prokinetics 5 HT3 antagonist alosterone 5 HT4 antagonist tegesterone

Fibrinolytics (thrombolytics)
Streptokinase urokinase alteplase

Hypolipidemics
1. HMG-CoA reductase inhibitors lovastatin, simvastatin, pravastatin, atorvastatin 2. Bile acid sequestrants (resins) colestipol cholestyramine 3. Activate lipoprotein lipase (fibric acid derivatives) clofibrate, fenofibrate, bezafibrate, gemfibrozil 4. Inhibit triglyceride synthesis and lipolysis nicotinic acid 5. Others gugulipid, probucol

plasma expanders human albumin dextran degraded gelatin polymer polyvinyl pyrrolidone hydroxyethyl starch (hetastarch)

IMMUNOSUPRESENTS
1. HMG-CoA reductase inhibitors lovastatin, simvastatin, pravastatin, atorvastatin 2. Bile acid sequestrants (resins) colestipol

cholestyramine 3. Activate lipoprotein lipase (fibric acid derivatives) clofibrate, fenofibrate, bezafibrate, gemfibrozil 4. Inhibit triglyceride synthesis and lipolysis nicotinic acid 5. Others gugulipid, probucol

plasma expanders human albumin dextran degraded gelatin polymer polyvinyl pyrrolidone hydroxyethyl starch (hetastarch)

Iron Preparations
Oral 1. Ferrous sulfate 20% 2. Ferrous gluconate 12 3. Ferrous fumarate 33% 200mg 4. Colloidal ferric hydroxide 50% 5. Ferrous succinate 6. Ferrous aminoate 7. Iron choline citrate 8. iron calcium complex 9. Ferric glycerophosphate parenteral 1. Iron dextran 50mg/dl 2. Iron sorbitol citric acid complex 50mg/dl

Local Anaesthetics

Injectable 1. Low potency, short duration procaine, chloroprocaine 2. Intermediate potency and duration lignocaine (lidocaine) prilocaine 3. High potency, long duration tetracaine (amethocaine) bupivacaine ropivacaine dibucaine (cinchocaine) surface anaesthetic soluble insoluble cocaine benzocaine lignocaine butylaminobenzoate tetracaine (butamben) benoxinate oxethazaine

Local Anaesthetics
Injectable 1. Low potency, short duration procaine, chloroprocaine 2. Intermediate potency and duration lignocaine (lidocaine) prilocaine 3. High potency, long duration tetracaine (amethocaine) bupivacaine ropivacaine dibucaine (cinchocaine) surface anaesthetic soluble insoluble

cocaine benzocaine lignocaine butylaminobenzoate tetracaine (butamben) benoxinate oxethazaine

Lung tumors

I. Epithelial tumours A. Benign 1. Papilloma 2. Adenoma B. Dysplasia and carcinoma in situ C. Malignant bronchogenic carcinoma 1. Squamous cell (epidermoid) carcinoma 2. Small cell carcinoma a - oat cell carcinoma b - intermediate cell carcinoma c - combined oat cell carcinoma 3. Adenocarcinoma a. Acinar adenocarcinoma b. Papillary adenocarcinoma c. Bronchiolo - alveolar carcinoma d. Solid carcinoma with mucus formatiom 4. Large cell carcinoma 5. Adenosquamous carcinoma other carcinomas 1. pulmonary neuroendocrine tumour (carcinoid tumour) 2. Bronchial gland tumours a. Adenoid cystic carcinoma b. Mucoepidermoid carcinoma II. Soft tissue tumours fibroma, fibrosarcoma; leiomyoma, leiomyosarcoma; lipoma, chondroma, hemangioma, lymphangioma, granular cell myoblastoma

III. Pleural tumours a. Benign mesothelioma b. Malignant carcinoma IV. Miscellaneous tumours 1. Carcinosarcoma 2. Pulmonary blastoma 3. Malignant melanoma 4. Malignant lymphoma V. Secondary tumours VI. Tumour like lesions 1. Hamartomas 2. Eosinophilic granulomas 3. Inflammatory pseudotumours

NSAIDS

A. Nonselective COX inhibitors (conventional NSAIDS) 1. Salicylates - aspirin, diflunisal 2. Pyrayolone derivatives phenylbutazone, oxyphenbutazone 3. Indole derivatives - indomethacin, sulindac. 4. Propionic acid derivatives ibuprofen, naproxen, ketoprofen, flurbiprofen. 5. Anthranilic acid derivative- mephenamic acid 6. Aryl acetic acid derivatives - diclofenac 7. Oxicam derivatives - piroxicam, tenoxicam. 8. Pyrrolo- pyrrole derivative - ketorolac. B. Preferential COX 2 inhibitors nimesulide, meloxicam, nabumetone. C. Selective COX 2 inhibitors celecoxib, rofecoxib, valdecoxib.

D. Analgesic- antipyretics with poor antiinflammatory action 1. Paraaminophenol derivative- paracetamol (acetaminophen) 2. Pyrazolone derivatives - metamizol (dipyrone), propiphenazone. 3. Benzoxazocine derivative - nefopam

Opioids

opiums Phenanthrene derivatives morphine codeine thebaine- nonanalgesic benzoisoquinoline derivatives papaverine noscapine(narcotine) both nonanalgesic opioid analgesics 1. Natural opium alkaloids - morphine, codeine 2. Semisynthetic opiatesdiacetylmorphine (heroin), pholcodeine. 3. Synthetic opiods pethidine (meperidine), fentanyl, methadone, dextropropoxyphene, tramadol, ethoheptazine.

Complex action & opiod antagonists 1. Agonists - antagonists (a) not used as analgesic nalorphine (b) used as analgesic (kappa acting) - pentazocine, nalbuphine, butorphanol.

2. Partial/weak mew agonist buprenorphine 3. Pure antagonists naloxone, naltrexone, nalmefene

Oral Hypoglycemics
SULFONYLUREAS fist gen second gen tolbutamide glibenclamide chlorpropamide (glyburide) glipizide gliclazide glimepiride BIGAUNIDES phenformin metformin MEGLITINIDE analogues repaglinide nateglinide THIAZOLIDINEDIONES rosiglitazone pioglitazone AIPHA GLUCOSIDASE INHIBITORS acarbose miglitol

holinergic agonists1.choline esters 2.Alkaloids acetylcholine muscarine methacholine pilocarpine carbachol arecholine bethanechol

ANTICHOLINESTERASES
(1) Reversible carbamates acridine physostigmine tacrine neostigmine pyridostigmine edrophonium rivastigmine donepezil (2) irreversible organophosphates carbamates dyflos carbaryl ecothiophate propoxur insect-parapthion malathion diazinon nerve gas-tabun sarin soman

Quinolones
Nalidixic acid

first generation fluoroquinolones norfloxacin ofloxacin Ciprofloxacin Pefloxacin

Second gen lomefloxacin Sparfloxacin levofloxacin Gatifloxacin Moxifloxacin

Drugs for Scabies

Permethrin lindan (BHC gamma benzene hexachloride) benzyl benzoate crotamiton sulfur dicophane (DDT) ivermectin

Semisynthetic Penicillins
1. Acid resistant alternative to penicillin G phenoxymethyl penicillin (penicillin V) 2. Penicillinase resistant penicillins methicillin, oxacillin, cloxacillin 3. 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 inhibitors clavulanic acid sulbactam tazobactam

Skeletal Muscle Relaxants

Peripherally acting 1. neuromuscular blocking agents A. 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 agents succinylcholine (suxamethonium) (c-10), decamethonium 2. Directly acting agents quinine, dantrolene sodium.

Centrally acting 1. Mephenesin group mephenesin, carisoprodol, chlorzoxazone, chlormezanone, methocarbamol. 2. Benzodiazepines diazepam and others 3. GABA derivative - baclofen 4. Central alpha 2 agonist tizanidine.

Sulphonemides
1. Short acting sulfadiazine 2. Intermediate sulfamethoxazole, sulfamoxole 3. Long sulfamethopyrazine 4. Special purpose sulfacetamide 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 release iodine, iodides of na & k, oranic iodide. 4. Destroy thyroid tissue radioactive iodine ( 131 i, 125 i, 123 i)

1 & 2 are called goitrogens

Uterine Drugs
Uterine stimulants (oxytocics, ecbolics, abortifacients) 1. Posterior pituitary hormone oxytocin 2. Ergot alkaloids ergometrine (ergonovine), methylergometrine

3. Prostaglandins PGE 2, PGF 2alpha, 15-methyl PGF 2alpha, misoprostol 4. Miscellaneous ethacridine, quinine

uterine relaxants/tocolytics 1. Adrenergic agonists ritodrine, salbutamol isoxsuprine, terbutaline. 2. Magnesium sulfate 3. Ccb specially nifedipine 4. Prostaglandin synthesis inhibitor aspirin, ibuprofen, indomethacin 5. Ethyl alcohol 6. Progesterone 7. Miscellaneous nitrates, 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 albuminbinders 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. beta ABCD: 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): members CHAMP: Cyclophosphamide Hydroxycloroquine and choloroquinine Auranofin and other gold compounds Methotrexate Penicillamine Auranofin, aurothioglucose: category and indication Aurum 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 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 Johnsons. 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 Or 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