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INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

BETHANECHOL

Ileus (Post-op / Neuro) Urinary Retention (Post-op / Neuro)

Cholinergic Agonist Activates bowel + bladder smooth muscle

 

"Bet you it's In the colin (retention)"

CARBACHOL

Glaucoma

Cholinergic Agonist Activates ciliary muscle of eye (open angle) Activates Pupillary sphincter (narrow angle)

 

PILOCARPINE

 
 

DIRECT AGONISTS

NEOSTIGMINE

Myesthenia gravis Ileus (Post-op / Neuro) Urinary Retention (Post-op / Neuro) Antidote - NMJ blockade

Carbamylation of Anticholinesterase ACh -Esterase Ach (endogenous)

 

Oral; Injection

PYRIDOSTIGMINE

Myesthenia gravis

Carbamylation of Anticholinesterase ACh -Esterase Ach (endogenous) Strength

 

Oral

Injection

EDROPHONIUM

Dx

of Myesthenia gravis ie v. short acting

Anticholinesterase / Cholinesterase inhibitor Ach (endogenous)

 
 

PHYSOSTIGMINE

Glaucoma (crosses BBB) Atropine overdose

Anticholinesterase / Cholinesterase inhibitor Ach (endogenous)

 

Eye drops Ointment Physo for my Eyes, Oh!

"Eyes are 'fizzing' from pressure"

 

ECHOTHIOPHATE

Glaucoma

Anticholinesterase / Cholinesterase inhibitor Ach (endogenous)

 

"Echothio = Echo in my eye, Oh!" Demelarium Isoflurophate

Esotropia (X-eyed)

 

INDIRECT AGONISTS

PRALIDOXIME

Pray + Lie = Doxology of DUMBBELLS

Injection

Antidote - ACh-Esterase Toxicity Antidote - Pesticides; Nerve gas Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscle Lacrimation Sweating Salivation

ACh-Esterase Regenerator

ACh-E ANTIDOTE

ATROPINE

Salivation

Muscarinic Antagonist Dilate pupil Secretions (Acid; Airway) GI Motility Tx organophosphate poisoning

Red as a beat - Temperature; Pulse Hot as a hare - Temperature; Pulse Dry as a bone - Dry mouth / Flushed Mad as a hatter - Disorientation Blind as a bat - Cycloplegia; Mydriasis

 

Lacrimation

"A troop blocking SLUD" Mad as a hatter; Hot as a hare Dry as a bone; Blind as a bat

Urination

Defecation

HEXAMETHONIUM

 

Nicotinic Antagonist

 
 

Ganglionic blocker

ANTIMUSCARINICS - R-BLOCK

BENZTROPINE

Parkinson's

Anti-Muscarinic

 

"Park the Benz - Slowly and smoothly"

Tx

Sx's of Reserpine; Haloperidol

Anti-Dyskinetic (Stiffness)

SCOPOLAMINE

Motion Sickness

Anti-Muscarinic

 
 

Pupil Dilator

ANTIMUSCARINICS - CNS

HOMATROPINE

Pupil Dilator Uveitis Post-synechiae (iris sticks to cornea)

Anti-Muscarinic

Mydriasis

 

Cycloplegia

TROPICAMIDE

Pupil Dilator Uveitis Post-synechiae (iris sticks to cornea)

Anti-Muscarinic

Mydriasis

Eye drops

Cycloplegia

Ointment

ANTIMUSCARINICS - EYE

IPRATROPIUM

Asthma

Anti-Muscarinic

 

Inhalant

 

COPD

Bronchodilator

 

ANTIMUSCARINICS - LUNG

Cholinergics

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

SUCCINYLCHOLINE

Muscle paralysis in:

Neuromuscular blockade (depolarizing) Phase I - Prolonged depolarization Antidote = None Phase II - Repolarized, but blocked Antidote = Neostigmine

 
 

Surgery

It "sucks" to be paralyzed

Mechanical ventilation

X-CUR-X

Muscle paralysis in:

Neuromuscular blockade (non-depolarizing) Antidote = Neostigmine; Edrophonium Pyridostigmine

 
 

Surgery

Tubocurarine

Mechanical ventilation

Atracurium

 

Mivacurium

Pancuronium

Vecuronium

Rapacuronium

NEUROMUSCULAR BLOCKADE

DANTROLENE

Halothane + Succinylcholine Malignant hyperthermia Antipsychotic Rx (Phenothiazines) Neuroleptic Malignant Syndrome

Ca2+ release from SR of skeletal muscle

 

"Gets Dan to Lean (relax from rigidity)"

NM Blockade

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

EPINEPHRINE

Anaphylaxis Asthma Hypotension Glaucoma (open angle)

Agonist (direct) α1; α2; β1; β2

 

Epidemic: It gets all the receptors

NOREPINEPHRINE

Hypotension

Agonist (direct) α1; α2; β1

Renal perfusion

 

Near-Epidemic: Almost gets all receptors But it be too (β2) weak

 

ISOPROTERENOL

AV Block (rare use)

Agonist (direct) β1 = β2 No α effects

 

Iso = Equal; Erenol = β Agonist

DOPAMINE

Shock (DA --> Renal perfusion) Heart failure

Agonist (direct) D1 = D2; > β > α

 

DOPA = DDβα

DOBUTAMINE

Shock

Agonist (direct) β2 > β1

 

X-BU-X = β2 > β1

Heart failure

 

CATECHOLAMINES

AMPHETAMINE

ADD

Agonist (indirect) Releases stored catecholamines α1; α2; β1; β2

 
 

Obesity

Aderol

Narcolepsy

EPHEDRINE

Nasal Congestion

Agonist (indirect) Releases stored catecholamines α1; α2; β1; β2 Constricts (no fluid flow)

 
 

Urinary incontinence

Eep! Head run Head run = head:snot; dick:urine Pseudophed

Hypotension

 

CATECHOLAMINES

PHENYLEPHRINE

Hypotension Nasal Congestion Eye exam (Pupil dilator)

Agonist (direct) α1 > α2

 

NE

   

α AGONIST

ALBUTEROL

Asthma

Agonist (direct) β2 > β1

 

TERBUTALINE

X-BU-X = β2 > β1

 

β AGONIST

COCAINE

Local anesthesia

Re-Uptake of Chatecholamine Agonist (indirect)

Vasoconstriction Tachycardia; Arrhythmias

 

CLONIDINE

 

α Agonist (central)

 

α-METHYLDOPA

"Clones NE" (fakes presynaptic-R's)

Central adrenergic outflow

OTHER

α1 B.V.

Vasoconstriction

α2 B.V.

Vasoconstriction

Pre-Synaptic

NE Release - (-) Feedback

β1 Heart

HR

β2 Bronchial

Bronchodilation

Smooth M.

Skeletal M.

??

Arterioles

Sympathomimetics

 

INDICATIONS

 

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

PHENOXYBENZAMINE

Pheochromocytoma - HTN

Non-Selective Blocker

Irreversible

 

α

Irreversible

Orthostatic Hypo-TN

"Pheno = Pheo"

 

Reflex tachycardia

PHENTOLAMINE

Pheochromocytoma - HTN

Non-Selective Blocker

Reversible

 

α

Reversible

Orthostatic Hypo-TN

"Phento = Pheo"

 

Reflex tachycardia

X-ZOSINS

HTN

α1-Selective Blocker

1st-Dose Orthostatic Hypo-TN Dizziness Headache

Zosin - Sauce In; HTN

BPH urinary retention

Prazosin

 

Terazosin

Doxazosin

YOHIMBINE

Impotence (controversial)

α2-Selective Blocker

Arrhythmias (no (-) feedback)

α-BLOCKERS

β-BLOCKERS (X-OLOL)

HTN

CO; Renin secretion

Impotence

 

Angina pectoris

HR; Contractility --> O2 demand

Asthma exacerbation

Non-Selective Blockers Propranolol Pindolol

MI

HR; Contractility --> O2 demand; Death

Bradycardia; AV block; CHF

SVT (propranolol; esmolol)

AV conduction velocity

CNS: Sedation; Sleep; Diabetics

CHF

Progression to CHF

 

Timolol Nadolol Labetalol

 

Glaucoma

Secretion of aqueous humor

 
     

β1-Selective Blockers

Atenolol

Betaxolol

"A BEAM of β1's"

Esmolol

Acebutolol

Metoprolol

β-BLOCKERS

Sympathetic Blockers

CNS

Li

Vasopressin (HTN)

Aminoglutethimide

Trilostane (paresthesia)

Mitotane

Heart

Li

Vasopressin (HTN)

TH Agonists

Metyrapone (HTN)

Metformin

TZD

Lung

β Blockers

Liver

PTU

Ketoconazole

SU's (amide; uride; izide; iride) TZD (troglitazones)

Chol

Methimazole

S'statin (g-stone)

GI

Somatostatin

Ketoconazole

Metyrapone

Tilostane

Mitotane

α-Glycosidase Inhibitors - Acarbose; Miglitol Nausea / Vomit

Renal

SU's (amide; uride; izide; iride) Metformin (lactic acidosis)

Acyclovir

K+ Spironolactone Amiloride Hydrochlorothiazide

Ca2+

Thiazides

Heme (bleed)

Spironolactone

Ketoconazole

GnRH (HA fx) Hemolytic Anemia

Ribavirin

Megaloblastic Anemia

Zodovudine

Skin Iodine (eruption) Aminoglutethimide (rash) Thyroid (itis)

Amiodarone

IFN / IL-2 Steroids/Adrenal Cortex

GI S.E.'s

Neuro S.E.'s

   

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

PENICILLINS

PCN G = Strep pneumonia PCN V = Grp A Strep (pharyngitis) Spirochetes (syphilis)

Bactericidal Rx enters bacteria through porin 1) Activates autolytic enzymes 2) Inhibits transpeptidase (PBP) No cross-linkage of cell wall 3) Inhibits cell wall synthesis Osmotic lysis of bacteria

Hypersensitivity Rash Anaphylaxis Hemolytic Anemia; Neutropenia

PCN G (IV Form; Acid labile) 1/2 Life = 30 minutes PCN V (oral; Acid stabile)

Widespread PCN Resistance:
Widespread PCN Resistance:

Widespread PCN Resistance:

 

β-lactamase cleavage of ring

PCNase-RESISTANT PCN's

Staph aureus Sepsis; IE; Cellulitis = Nastycillin

Inhibits cell wall synthesis

Methicillin = I.S. nephritis Meth Messes w/ Neph

 

Nafcillin (I.V.)

Nasty

   

Methicillin (I.V.)

Methy (messy)

Methicillin (I.V.) Methy (messy) Nasty Messy Ox Clocks Staph aureus Knocks it out!!

Nasty Messy Ox Clocks Staph aureus Knocks it out!!

Oxacillin (Oral; I.V. Ox

Dicloxacillin (Oral)

Clocks SA

AMINO-PCN's

Gram(+) - All Gram(-) Rods

AMINO-PCN's Gram(+) - All Gram(-) Rods Inhibits cell wall synthesis Hypersensitivity Rash (Ampicillin) Colitis
AMINO-PCN's Gram(+) - All Gram(-) Rods Inhibits cell wall synthesis Hypersensitivity Rash (Ampicillin) Colitis

Inhibits cell wall synthesis

Hypersensitivity Rash (Ampicillin) Colitis (Ampy-crampy; Colicky-amoxy)

 

Amoxicillin + Clavulanic acid Ampicillin + Clavulanic acid

Bronchitis; Sinusitis

   

UTI's

Clavulanic Acid --> Diarrhea

CA competitively inhibits β-lactamase

HELPS kill entero's H Flu; E. Coli; List.; Prot.; Salm.

TICARCILLIN

PIPERACILLIN

Pseudomonas auruginosa Gram(-) Rods

Pseudomonas auruginosa Gram(-) Rods

Inhibits cell wall synthesis

Hypersensitivity Rash

CARBINICILLIN

Clavulanic Acid --> Diarrhea

"Toke the Pipe and Carb" + hit of Acid! Add Clavulanic acid

Totally pseudo, dude.

 

CEPHALOSPORINS

 

Inhibits cell wall synthesis

Hypersensitivity Rash

 

1st Generation

1st Generation
     

Granulocytopenia

1st Generation

Proteus

 

I.S. Nephritis

Cephalexin

E.

coli

Cephalothin

Cefazolin

2nd Generation

Cefuroxime

Cefotetan

Cefoxitin

Alex is in Alice is in Us all in

Fur ox Teets [use an] Ox tin

3rd Generation Ceftriaxone (oral) - AX 'em!! Cefotaxime - TAX 'em!! Ceftazidime - TAZ 'em!! Cefoperazone - Opera will kill too!! 4th Generation Cefepine

Klebsiella

2nd Generation

H.

Enterobacter

Neisseria

Flu

K lebsiella 2nd Generation H . E nterobacter N eisseria Flu P roteus E . c

Proteus

E. coli

Klebsiella

Serratia

N eisseria Flu P roteus E . c oli K lebsiella S erratia 3rd Generation X-BBB

3rd Generation X-BBB - Bacterial Meningitis Gram(-) serious infections Gonorrhea (ceftriaxone)

Fn Group β -Lactamase Cuts here
Fn Group β -Lactamase Cuts here
Fn Group β -Lactamase Cuts here

Fn Group

β-Lactamase

Cuts here

A-glycosides + Cephalosporin

Resistance:

β-lactamase cleavage of ring MRSA Enterococci

4th Generation Pseudomonas & Gram(+)

1st = Pro Colie Klub 2nd = Pro Colie Klub+Sarra, Homo, Nice Aunt 3rd = Serious bunch 4th = Pseudo

MONOBACTAMS

Only Aerobic GNR's Klebsiella

Only Aerobic GNR's Klebsiella

Inhibits cell wall synthesis

Non-toxic (usually) GI Sx's (occasional)

 

Aztreonam

P.

auruginosa

   

β-Lactamase resistant Synergistic with Aminoglycosides

Serratia

 

Peaceful Tree: Ok w/ Aminoglycosides Non-toxic (usually) Aerobic (GNR's)

CARBAPENEMS

Everything!!!

 

Inhibits cell wall synthesis

Seizures

   

Skin rash

Imipenem + Cilastatin Hydrolized by Dihydropeptidase Cilastatin inhibits above enzyme Meropenem Not hydrolized by Dihydropeptidase

β-Lactamase resistant

I'm A Pen = X all bugs out

Cilistatin - Dihydropeptidase Dihydropeptidase (renal enzyme) Metabolizes and inactivates imipenem

GI distress

Most powerful bug drug out there

 
 

β Lactam Rings

VANCOMYCIN

 

Gram(+)

Bactericidal Binds to D-analyl-D-analine

Nephrotoxicity when used in combo Tx Vancomycin + aminoglycoside Red Neck Syndrome / Rash Rapid infusion HA release Ototoxicity Resistance: D-ala <-- D-lac; Affinity

 

Staph aureus

Glycopeptide (poorly absorbed)

C.

difficile

Inhibits peptidoglycan synthesis Inhibits cell wall synthesis Poorly absorbed Remains in gut and attacks GI bugs

"Vanc" the deaf red-neck cowboy Kills Staph aureus and gut bugs

Vancomycin Resistance Enterococci (plasma mediated)

Cell Wall Inhibitors

   

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

AMINOGLYCOSIDES

Aerobic GNR's (severe) Aerobes! (amine-O2-glycosides)

Bactericidal O2 Required for uptake (aerobic orgs) Aerobic organism produces metabs' Alters membrane potential Allows uptake of Rx Rx binds to 30S Ribosome Protein synthesis Blocks initiation Misreading Early termination

Nephrotoxic

 

Ototoxic

"G-TANKS" w/ 30-ott Ammo

 

Teratogen

Amp-Gent Combo Tx!!

Gentomycin

Grenade goes off Deaf Hits kidney

Tobramycin

Amikacin

Netilmicin

Ineffective

 

Kanamycin

Anaerobes

Resistance:

Streptomycin

Streptoccoci

Modification of:

H.

Flu

 

Acetylation

Neomycin (topical; not well-absorbed)

Syphilis

Adenylation

Syngergistic with β-Lactams

Phosphorylation

The American Gent, Toby Strips "Neti" in the Kan

TETRACYCLINES

Tet Offensive Dz's STD's - Chlamydia; Ureaplasma Malaria - P. falciparum (doxy) Tick-borne - Rickettsia; Lyme Diarrhea - Vibrio cholera Acne

Bacteriostatic Binds 30S Ribosome subunit Inhibits protein synthesis Aminoacyl-tRNA attachment

Deposited in growing bones Stains teeth gray-brown to yellow Inhibits bone growth in children

Minocycline Doxycycline (take w/ food; fecal elim Demeclocyline Tetracyclines

Don't Take With Milk Antacids Fe2+ containing substances

Fanconi syndrome when expired

"Mine Doxy Demands 4 Tetes" (pups) Takes care of multiple diseases No Milk!

Bio-Rx - B. anthracis Ellas - Pasteurella, etc.

Photosensitivity

Think of newborn pups Sharp gray-brown teeth Shut eyes (photosensitive)

 

Resistance:

Uptake

Export

MACROLIDES

Gram (+) Cocci Streptoccoci Px's w/ PCN Mycoplasma (#1 for CAP) Legionella (#1) Chlamydia Neisseria

CAP Etiology

Bacteriostatic Binds 50S (23S rRNA) Inhibits protein synthesis

Eosinophilia

Azithromycin

GI

Clarithromycin

 

Nausea; Vomiting; Ab cramps Metallic taste (Clarithromycin) Cholestatic hepatitis (Erythromycin) Eat a Big Mac GI upset + cholestatic hep Cardiac Arrhythmia (E'mycin + Terf)

Erythromycin

50c Big Mac

Dirithromycin

"Big Mac ACED his women" Panting = lung infection Thrusting = STD's

Mycoplasma

 

Strep pneumonia

 

Chlamydia

Resistance:

Methylation of rRNA

CHLORAMPHENICOL

Meningitis

Bacteriostatic

BM toxicity Anemia (reversible) Aplastic anemia (irreversible) Pancytopenia Gray Baby Syndrome ΦGlucuronidation Death Resistance:

 

H.

Flu

Binds 50S peptidyl transferase

"Clears a meningitis Call"

N.

meningitis

Inhibits peptide bond formation

S.

pneumonia

Inhibits protein synthesis

Only as alternative to:

Anaerobes

PCN's Cephalosporins (3rd gen) Tetracycline in pregnancy

Bacteroides fragilis

Modification of acetylation

CLINDAMYCIN

Anaerobes

Bacteriostatic Binds 50S ribosomal subunit Inhibits peptide bond formation Inhibits protein synthesis

GI

 

Clostridium

Causes Pseudomembranous C. Fever P. colitis

Cleans my sin[ister anaerobes]

Bacteroides

Gunshot

Clindamycin = Diaphragm O2 bugs Metronidazole = Diaphragm O2 bugs

Aminoglycosides

   

Clindamycin

50c for Linda

Resistance Methylated rRNA -->no Rx binding

 

Aspiration pneumonia

STREPTOGRAMMINS

Streptococci Staphylococci Enterococcus faecium (bact-static) Not E. Faecalis

Bacteriostatic Binds 50S Ribosome subunit Inhibits protein synthesis

Myalgias

 

Arthralgias

Dalfopristin (Streptogrammin A) Quinupristin (Streptogrammin B)

Phlebitis

 

Bacteriocidal Strep A = Near site of Microlides Strep B = Overlaps with Microlides Used together = synergistic Bacteriocidal

Resistance Methylated rRNA -->no Rx binding

RNA Inhibitors

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

SULFANOMIDES - SMX

TMP-S[MX]

Bacteriostatic

Displaces protein-bound Rx's (Warfarin S.E. = Rare (common w/ AIDS Px's) Hypersensitivity Nephrotoxicity; Kernicterus (infants)

Rotten eggs (oral) Porto-Potty (urinary excretion)

Tree (respiratory) Mouth - GI tract Pee - UTI; Urethritis; Prostatitis Syndrome Dz's - Toxo; PCP; I. Bella

Dihydropteroate Synthase Folate synthesis Purine synthesis (bacterial)

PABA antimetabolite

PABA antimetabolite

DNA synthesis (bacterial) Growth

Hemolysis (if G6PD deficiency) Blood / WBC abnormalities

 

All Bacteria Nocardia Chlamydia Malaria Burns (silver sulfadiazine) UTI's

Chlamydia Malaria Burns (silver sulfadiazine) UTI's Sulfanamide Resistance Altered target (plasmid-mediated)

Sulfanamide Resistance Altered target (plasmid-mediated) Uptake: Impermeability to Rx PABA synthesis

TRIMETHOPRIM - TMP

TMP-S[MX] Tree (respiratory) - PCP Mouth - GI tract (shig.; salm.) Pee - UTI (recurrent); Urethritis Syndrome - Toxo; PCP; I. Bella

Bacteriostatic Dihydrofolate Reductase Inhibitor Folate synthesis

BM Suppression Megaloblastic anemia Leukopenia; Granulocytopenia TMP = Treats Marrow Poorly Tx: Folinic acid

TMP + SMX Combo Tx 20-100x potency of sulfa DHFR (dihydrofolate reductase)

TrimethopRim = Reductase Sulfanomide = Synthase

FLUOROQUINOLONES

Aerobic GNR's UTI's Pseudomonas - Cipro Neisseria Gram (+)

Bactericidal DNA gyrase (Topoisomerase II) Inhibits DNA synthesis

S.E.'s Uncommon - Rare

Quinolone

Tendonitis & Tendon ruptures Fluoroquinolones hurts Attachments to your bones

Nalidixic acid

 

Fluoroquinolones

Olfs are Gyrating (dancing) so much they Hurt their tendons Headache; Dizzy GI Upset

Ciprofloxacin

To See Pro Sparing

   

Sparfloxacin

GI Upset

Mortifloxacin Mortifies

Headaches; Dizziness

Enoxacin

Enough Olfs of the North Gate

 

Superinfections

Ofloxacin

Rash

Norfloxacin

Gatifloxacin

 

Fluoroquinolone Resistance Mutation --> DNA gyrase / T.I.

METRONIDAZOLE

Anaerobes Bacteroides fragilis Clostridium difficile Protozoa Giardia (flagellate) Entamoeba Gardnerella vaginalis Trichomonas (flagellate)

Bactericidal Forms toxic metabolites in cell wall Alters cell membrane e-potential

Alcohol! Disulfiram-like reaction with alcohol Headache

Clindamycin = Diaphragm O2 bugs Metronidazole = Diaphragm O2 bugs

Kills bugs in GI tract lumen

On the metro:

No drinking alcohol! Metallic taste (of train water) GI Upset (from motion)

Gee your aunt's guard tricked me to get on the metro 3X Tx (H, pylori) Metro + Amoxicillin + Bismuth Tetracycline + PPI + Bismuth

POLYMIXINS / POLYPEPTIDES

Resistant Gram (-)

Cationic, basic proteins Act like detergents

Neurotoxicity Acute renal tubular necrosis

 
 

Polymixin B

Colistin

   

Polymixin E

 

Bind to cell membrane Disrupt osmotic integrity

Polymixin Resistance Proteus Serratia Impermeable cell walls Rx cannot reach target

MISC. ANTIBIOTICS

   

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

ISONIAZID - INH

TB

Mycolic acid synthesis

Neurotoxicity (Tx = Pyridoxine [B6]) Hepatotoxicity SLE-like syndrome Hemolysis (if G6PD)

   

Solo prophylaxis

 
 

INH = Injures Neurons and Hepatocyte

RIFAMPIN

M.

TB; M. avian

DNA-dependent RNA polymerase

Hepatotoxic (P450)

4 R's RNA polymerase inhibitor Revs up microsomal P450 Red/orange body fluids Resistance (rapid) if used alone

Leprosy

 

Always used in combo with other Rx's

Meningococcal prophylaxis

H.

Flu B prophylaxis

 

TB DRUGS

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

BACTERIAL PROPHYLAXIS

     

Rifampin (1st line); Minocycline Ceftriaxone PCN G TMP/SMX TMP/SMX (1st line); Pentamidine Fluconazole

Meningococcal Gonorrhea Syphilis Recurrent UTI's PCP Crypto prophylaxis / management

ANAEROBES

 

PCN + Clavulanic Acid Cephalosporins (2nd Gen) Imipenem Chloramphenical Clindamycin Metronidazole Ofloxacin

PSEUDOMONAS

 

Ticarcillin Pipercillin Carbenicillin Cephalosporins (3rd Gen) Imipenem Aztreonam Quinolones (Cipro) Aminoglycosides - Gent; Tobra; Amik

GRAM (+) TOUGHIES

 

Vancomycin

MRSA; Staph; Enteros Enteros Enteros

Ampicillin

Imipenem

Tough Bug Drugs

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

AMPHOTERICIN B

Systemic Mycoses

Binds to membrane ergosterols >> Chol. Forms pore in fungal cell membrane Permeability & leakage of e'lytes Homeostasis Cell death

"Ampho-terrible"

 

Cryptococcus

Fever; Chills = Shake & Bake (44%) Nausea; Vomiting; Ab. pain; Anorexia Phlebitis (common) Heparin controls this S.E. Anemia (common) Nephrotoxicity (common) Monitor K+, Mg++, BUN, CRE, A-B K+emia

I.V. Not absorbed IM or orally Cross BBB t1/2 = 1 day Intrathecal Fungal meningites (rare)

Blastomyces

Coccidioides

Aspergillus

Histoplasma

 

Candida albicans

"AmphoTears holes in membranes"

Mucor mycoses

NYSTATIN

Oral Candidiasis

Binds to membrane ergosterols >> Chol. Forms pore in fungal cell membrane Permeability Homeostasis Cell death

 

Swish and swallow

IMIDAZOLE DERIVATIVES

#1 Itraconazole > Ketocanazole Blastomycoses Cociidioides Histoplasma Candidiasis (mucocutaneous) Hypercortisolism Fluconazole Cryptococcal meningitis (L. term) Crypto prophylaxis (AIDS) Candida albicans Voriconazole / Itraconazole Aspergillosis!! Clotrimazole / Miconazole Dermatophytosis

C14 demethylase inhibitors (via P450) Ergosterol & FA synthesis in wall Permeability & leakage of e'lytes Homeostasis Cell death

Hormone synthesis inhibition Gynecomastia (Keto) Liver dysfunction (via P450) Fever; Chills Nausea; Anorexia

Itraconazole Ketocanazole (No Amp B!) Fluconazole (X-BBB) Clotrimazole Voriconazole Miconazole (topical)

H2 acids or antacids absorption Liver metabolism

 

Combo Tx - Anti-HA Q-T interval prolongation Torsade de Pointes Voriconazole Visual disturbances (30min after Tx) Warn Px's if driving,etc.

 

Resistance Related to efflux pump

GRISEOFULVIN

Superficial infections

Microtubule function

Deposits in kertin-containing tissues Teratogenic / Carcinogenic CNS: Headaches; Confusion Warfarin metabolism

 

Dermatophytes

Mitosis

Oral Tx

Tinea

Ringworm

Grizzlies are full of ringworm & tinea

Grizzlies interfere with might! (mitosis)

 

CASPOFUNGIN

 

Aspergillosis In amphotericin intolerant Px's Candidiasis Disseminated

   

IV only Renal excretion Liver metabolism No P450 Highly protein bound

Inhibits Beta(1-3) glucan synthesis Fungal cell wall disruption

Well-tolerated HA release possible

5-FLUORO-CYTOSINE - 5-FC

Chromomycosis

RX entry into yeast cell (cytosine permease) 5-FC --> 5-FU (via cytosine deaminase) 5-FU inhibits transcription of RNA Blocks tymidylate synthetase Stops DNA synthesis

BM suppression (#1 problem) Diarrhea (10%) Watch renal failure Px's

 

Candida

Combo Tx (mostly) 5-FC + Ampho B

 

Aspergillosis

Cryptococcal

 
 

Resistance Loss of permease or deaminase Crypto

Anti-Fungal Rx's

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

IVERMECTIN

Onchocerciasis (River blindness) Black flies Fibrous nodules Lizard skin

   

"rIVER blindness" "rIVER es muy ancho"

Kills microfilariae Microfilariae from leaving uteri of worms

MEBENDAZOLE

Nematode / Roundworm Whipworm Pinworm

Paralyzes worm Passes out stool

 

THIOBENDAZOLE

"Bendy, like worms"

 

PYRANTEL PAMOATE

Giant roundworm (Ascaris) Pinworm (Enterobius) Hookworm (Necator/Ancylostoma) Toe rash --> Lung --> GI Fe2+ def. Anemia; Wt. Loss

   

"Pray tell, PAM ATE a GIANT WORM!!

PRAZIQUANTEL

Cysticercosis Schistosomiasis (flukes) Paragonimus Clonorchis All tapeworms

Broad spectrum antiparasitic

 

Praze tha Lord:

"Christ's Sister Schisto is a Paragon Clone"

NICLOSAMIDE

Cestode (tapeworm) D. latum Hymenolepsis nana Taenia solium (#2 Rx)

   

"Nickle = ¢es-toad / Tapeworm" Toad with nickle tape Making a "teeny lata"

Mitochondrial Ox-Phos GLU uptake by parasite

PENTAVALENT ANTIMONY

Leishmania

   

"Leechman is Anti-Money" ie he will leech off you

CHLOROQUINE

Malaria (chloroquine) vivax ovale malariae Quinine (if chloro-resistant) Tx = Artemethol for severe P. falc.

 

P. falciparum = Aggressive 30% of RBC's Mefloquine resistant Chloroquine resistant Quinine resistant

QUININE

Human resistance to Vivax & Falciparim Vivax = ΦDuffy a + b Falcip: SSD-->rupture-->Φinfxn

MEFLOQUINE

 

PRIMAQUINE

Malara (latent hypnozoite--liver) Plasmodium vivax Plasmodium ovale

Exo-RBC cycle: vivax; ovale Liver

Chloroquine resistant Hemolysis in G6PD GI upset

Prima Viva Ova!!

METRONIDAZOLE

Giardia Entameba histolytica

Gardnerella vaginalis Trichomonas (nasty vadge discharge)

 

Metallic taste

Sitting on the METRO gives you Diarrhea Vadge infections

"Gee-ur Aunt's Guard Tricked me to get on the metro"

PENTAMIDINE

I'm all Pent up I might die [AIDS PCP]

Prophylaxis:

Pneumocystis carinii pneumonio

die [AIDS PCP] Prophylaxis: Pneumocystis carinii pneumonio NIFURTIMOX Chagas Dz (Trypanosoma cruzi) SURAMIN Sleeping

NIFURTIMOX

Chagas Dz (Trypanosoma cruzi)

carinii pneumonio NIFURTIMOX Chagas Dz (Trypanosoma cruzi) SURAMIN Sleeping sickness (African tryp) Tripanosomiasis

SURAMIN

Sleeping sickness (African tryp) Tripanosomiasis (tsetse fly)

" I Sure Am Sleepy; I might trip"

Antiparasitics

   

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

AMANTADINE

Influenza A (prophylaxis) Parkinson's Dz

Viral penetration / uncoating

CNS

 

Ataxia

Don't ask "a man to dine" with you if:

Rubella

Dizziness

He has A Flu (sneeze on your dish) He's got Parkinson's (throw food) He's dizzy, ataxic, slurring

Slurred speech

Rimantidine = derivative w/ few S.E.'s

ZANAMIVIR

Influenza Virus A Influenza Virus B Asthmatics (use Oseltamivir)

Influenza Neuraminidase

Bronchoconstriction (asthma) Use Oseltamivir, not Zanamivir

Zanamivir (inhaled)

Oseltamivir (oral)

 

RIBAVIRIN

RSV

 

Hemolytic anemia

Ribavirin is rabid RSV (RibaVirin) Eats the IMP Rabid and bloody (hemolytic)

IMP dehydrogenase Synthesis of guanine nucleotides

Teratogen (severe)!!

ACYCLOVIR

HSV

Phosphorylated by viral thymidine kinase Diphosphate --> Triphosphate (active) Competes w/ Deoxyguanose TRFP Viral HSV DNA polymerase DNA synthesis

Delerium

 

VZV

Tremor

A cycle of Di-p --> Tri-p --> DNA Zovirax ACV Valacyclovir (pro-drug)

EBV

Nephrotoxicity

Prophylaxis (compromised Px's)

Resistance: CMV

FAMCYCLOVIR

HSV-1 (labialis) Denavir cream (oral)

Potent inhibitor of HBV DNA P-ase Nucleoside Analogue Deacylated + oxidized in liver Converted to Pencyclovir Taken up by infected cells Phosphorylated by viral TK Affinity for P-ase

Rarely side effects Headache; Nausea

 

Zovirax ACV Valacyclovir (pro-drug)

HSV-2

 

Acute (3x/day) Recurrent; Suppression (2x/day) VZV (3x/day)

 

HBV

GANCICLOVIR

CMV

Phosphorylated by viral thymidine kinase Viral CMV DNA polymerase

Leukopenia; Thrombocytopenia Nephrotoxicity

 

"C MoVe the GAN GAN (kankan)"

 

Toxicity: Ganciclovir > Acyclovir

   

DHPG (dihydroxy-2-propoxymethyl guanine) GCV Ctyovene Valgancyclovir (pro-drug)

 

GCSF: G'cyle stim. Factor

FOSCARNET

Use when Ganciclovir fails

Binds to pyrophosphate binding site

E'lytes

 

CMV

Viral CMV DNA polymerase

Thrombophlebitis

IV only Pyrophosphate analog (Foscarnet) Foscavir

CMV

 

retinitis in immunocomrpomised No need for phosphorylation

INTERFERONS

HBV

(chronic)

Viral RNA and DNA synthesis

Neutropenia

 

HBC

(cronic)

Glycoproteins from Leukocytes

Kaposi's Sarcoma

Antivirals

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

BARBITURATES (BARBITALS

Sedative Anxiety Seizures Insomnia Anesthesia induction (thiopental)

Cl- channel open duration Neuronal firing GABAa facilitator

Dependence CNS depression w/ alcohol --> Death Cyt. P450 - Rx interactions

Phenobarbital

Pentobarbital

   

Thiopental

Barbiturates DURATion of Cl- ch.

Secobarbital

 

Porphyria

BENZODIAZEPINES (EPAMS)

Anxiety Spasticity Status epilepticus (diazepam) Detoxification (delerium tremens)

Cl- channel open duration Neuronal firing GABAa facilitator

Sedation Dependence CNS depression w/ alcohol --> Death Benzo's < Barb's in CNS depression ie respiratory depression

Diazepam

Lorazepam

 

Temazepam

 

Chlordiazepoxide

Insomnia

Flumazenil (overdose Tx) GABA-r (competitive antagonist)

Overdose Tx = Flumazenil

Short-Acting

Triazolam

like "TOM's thumb" Tri = three

Oxazepam

Midazolam Frequency Frenzodiazepines (FREquent)

ANTIPSYCHOTICS

Schizophrenia (excess DA) Psychosis

D2-r

Sedation; Extrapyramidal S.E.'s Endocrine S.E.'s Muscarinic-r's; HA-r's; ≠α-r's

"Clears thy halo fluff, Psycho!"

Neuroleptic Malignant Syndrome Rigidity; Autonomic instability; Hyperreflex Tardive dyskiniesia Stereotyped oral-facial mvnts (chr. use)

   

Chlorpromazine

Dystopnia (4 hrs) Akinesia (4 days) Akathisia (3 wks) Tardive dyskinesia (4 mos)

Thioridazine

Haloperidol

 

Fluphenazine

ATYPICAL ANTIPSYCHOTICS

Schizophrenia - (+) & (-) Sx's

5HT2-r's + DA-r's

Fewer extrapyramidal S.E.'s

Olanzapine

O lands!

OCD (olanzapine) Anxiety (olanzapine) Depression (olanzapine)

Clozapine = agranulocytosis (monitor)

Clozapine

A Close!

Risperidone

A respite!

LITHIUM

Bipolar affective disorder Acute manic events (relapse) Mood stabilizer

??PIP Cascade??

Tremor Hypothyroidism Polyuria (ADH antagonist) Teratogen / Toxic!

 

TRICYCLIC ANTIDEPRESSANT (IPRAMINE; TRIPTYLINE)

Depression Bed wetting (imipramine) OCD (clomipramine)

NE & SE reuptake

Sedation α-Blocking S.E.'s Anticholinergic S.E.'s TRI - C's Convulsions Coma Cardiotoxicity (arrhythmias) 3' > 2' (Amitriptyline > Nortriptyline) Desipramine is least sedating

Nortriptyline (2')

Holy trinity / TRI-C Nor tripping Doxology Clomping Am I Desciple

Doxepin

 

Clomipramine

Amitriptyline (3')

Imipramine

Desipramine

SSRI's

Depression

SE reuptake (serotonin-specific) 2-3 wks for effect

SSRI's < TCA's CNS - Anxiety; Insomnia; Tremor Nausea; Vomiting Serotonin Syndrome w/ MAOI's Hyperthermia; Rigidity; CV collapse

Fluoxetine

Sertraline

 

Paroxetine

Citalopram

 

HETEROCYCLICS

Major depressive disorders

   

Mirtazapine

Heterosexuals "Mirt & Bupee Vem la pra Tranzar"

Depression; Depression; Smoking cessation Depression; Anxiety disorder Depression;

α2 Antagonist --> NE & SE release; 5HT2-r ??? DA & SE reuptake; 5HT2-r antagonist SE reuptake

Sedation; Cholesterol; Appetite Tachycardia; Dry mouth; Psychosis Anxiety; Agitation; Headache; Insomnia Sedation; Nausea; Priapism; HypoTN

Buproprion

Venlafaxine

Trazodone

CNS Rx's

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

MOA INHIBITORS (GENERAL)

Atypical depressions Depression + Psychosis Depression + Phobias Anxiety Hypochondriasis

Monoamine Oxidase Inhibition Degredation of monamines

MAO I + Tyramine + Meperidine HTN crisis CNS stimulation SSRI's; ≠β-Agonists

Phenylzine

Tranylcypromine

 

MAO-B INHIBITOR

   

Enhances L-DOPA S.E.'s

Selegiline (Deprenyl)

Parkinson's adjuvant Rx L-DOPA + Selegiline

MAO-B selective inhibition DA availability

L-DOPA + CARBIDOPA

Parkinson's

L-DOPA L-DOPA crosses BBB Dopa decarboxylase conversion DA (in brain)

Arrhythmias (from periferal conversion) Dyskinesias

 

Carbidopa Dopa decarboxylase in periphery S.E.'s; Bioavailability of DA in brain

 

OPIOID ANALGESICS

Pain Cough (dextromethorphan) Diarrhea (loperamide; diphenoxylate) Acute pulmonary edema Withdrawal (methadone)

Opioid-r Agonists mu = morphine delta = enkephalin kappa = dynorphin Modulate synaptic transmission

Addiction

 

CNS depression

"MMM, Dexter Fenan's Code is Heroin"

Respiratory distress

Pinpoint pupils

Morphine

Constipation

Meperidine

   

Methadone

Toxicity Antidote

Dextromethorphan

Naloxone

Fentanyl

Naltrexone

Codeine

Heroin

SUMATRIPTAN

Acute migraine

5-HT1d Agonist 1/2 life < 2 hrs

Chest discomfort

 

Mild tingling

Cluster headache attacks I assume a trip and you 5HiT your head

 

Headaches; Migraines

Prinzmetal's Angina; CAD

ONDANSETRON

Vomiting (control) Post-op vomit control Cancer Tx vomit control

5-HT3 Antagonist Central-acting anti-emetic

Headache

"On Dan it runs (vomit)"

Diarrhea

5-HT3 Antagonist Central-acting anti-emetic Headache "On Dan it runs (vomit)" Diarrhea CNS Rx's

CNS Rx's

INDICATIONS MECHANISM OF ACTION SIDE EFFECTS / TOXICITY PHENYTOIN Grand mal seizures ≠Na+ Channels (use-dependent)
INDICATIONS
MECHANISM OF ACTION
SIDE EFFECTS / TOXICITY
PHENYTOIN
Grand mal seizures
≠Na+ Channels (use-dependent)
"Fee Na+ To In"
Na+ has a fee to enter so it can't
Nystagmus; Diploplia
Ataxia; Peripheral neuropathy
Lethargy; Megaloblastic Anemia (↓B12)
Gingival hyperplasia
Hirsutism
Teratogenic - Fetal hydantoin syndrome
Megaloblastic Anemia (↓B12) Gingival hyperplasia Hirsutism Teratogenic - Fetal hydantoin syndrome CNS Rx's

CNS Rx's

 

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

ACETAZOLAMIDE

Glaucoma Alkalosis (metabolic; urinary) Altitude sickness

Carbonic anhydrase in PCT NaHCO3 diureses HCO3 excretion

Acidosis (hyperchloremic metabolic) Neuropathy NH3 toxicity Sulfa allergy

"Aceta acidifies"

   

"Aceta acidifies"

FEROSEMIDE

Edema (CHF; Cirrhosis; Pulm) HTN

Na+ / K+ / 2Cl- Cotransporter in TAL Hypertonicity of medulla Concentration of urine Diuresis / Dilute urine Na+ to DT --> K+ swapping K+-emia Ca2+ excretion --> Ca2+-emia

K+-emia

 

Ca2+-emia

Sulfonamide loop diuretic

Ca2+-emia

Ototoxicity

I.S. Nephritis

Allergy (sulfa)

Gout

Dehydration

ETHACRYNIC ACID

Edema

Na+ / K+ / 2Cl- Cotransporter in TAL Hypertonicity of medulla Concentration of urine Diuresis / Dilute urine Na+ to DT --> K+ swapping K+-emia Ca2+ excretion --> Ca2+-emia

K+-emia

 

HTN

Ca2+-emia

Phenoxyacetic acid derivative Not sulfonamide

Ca2+-emia

Ototoxicity I.S. Nephritis Dehydration No uricemia (no gout) No sulfa allergies

NOTE:

"Ferocious Etha cryin" cuz she got sulfa allergies

Diuresis in Px's w/ sulfa allergies

HYDROCHLOROTHIAZIDE

HTN CHF

NaCl reabsorption in early DT Diluting capacity of nephron Ca2+ excretion

K+ metabolic alkalosis Na+emia

 

Thiazide diuretic

Ca2+uria

Ca2+emia

Nephrogenic Diabetes Insipidus

 

GLU

HyperGLUC

Lipids

Uricemia

Sulfa allergy

K+ SPARING DIURETICS

ALD

Competitively binds ALD-r in CCT (Spiro) Na+ channel in CCT (Triam; Amilo)

K+emia Endocrine effects - gynecomastia Blocks ALD --> backflow

 

K+ Depletion

"Try and Sprint A mile" - Km sparing

CHF

 

Triamterene

 

Spironolactone

Amiloride

MANNITOL

Shock Drug overdose Intraocular pressure (decreases it)

Osmotic Diuretic

Pulmonary edema

 

Dehydration

Anuria

CHF

DIURETIC E'LYTE CHANGES

URINE

BLOOD

Carbonic Anhydrase Inhibitors K+ Sparing Loops Thiazides

NaCl (All) K+ (except K+ sparing) Ca2+ (loops) Ca2+ (thiazides)

pH (acidosis) - Carb-A Inhib.; K+ sparing pH (alkalosis) - Loops; Thiazides

Diuretics

   

INDICATIONS

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

β-BLOCKERS

   

Impotence Bronchospasm Bradycardia; AV block Sedation; Sleep alterations TG's and HDL

 

Ca2+

Ca2+

β1 Selectivity (heart only) Atenolol Betaxolol Esmolol Acebutolol Metoprolol β1 = β2 Propranolol Pindolol Nadolol Labetalol

HTN

CO; Renin

Ca2+

Angina

HR; Contractility

Ca2+

Ca2+

MI

Mortality

Ca2+

Ca2+ P cAMP ATP
Ca2+
P
cAMP
ATP

cAMP Ca2+ influx HR, Contractility Refractory period

 

SVT

AV conduction velocity

 

CHF

Progression

Glaucoma

Secretion

Asthma

β1

!Diabetics!

HYDRALAZINE

HTN (severe)

cGMP Smooth muscle relaxation Arterioles > Veins Relaxation Afterload

Nausea; Headache Hypotension; Reflex tachycardia Fluid retention SLE-like syndrome

"Hydra-relaxing"

CHF

 

Hydra (H2O-retention)

ACE INHIBITORS

HTN CHF Diabetic Renal Dz

Antiotensin-converting enzyme

Cough Angio-edema Proteinuria Taste changes HypO-TN Pregnancy problems (fetal renal injury) Rash Increased Renin Lower A-II Hyperkalemia

CAPTOPRIL

Captopril

Angiotensin I

Enalapril

 
ACE ↓ AT II

ACE

AT II

 

Lisinopril

Angiotensin II-R Antagonist Losartan (no cough S.E.)

Vasoconstriction

 

≠↑Na+/H2O

≠↓Bradykinin ≠↓Sympathetics Renin release (compensatory)

NITRATES

Angina Edema (pulmonary) Aphrodesiac; Erection enhancer

NO release from smooth muscle cGMP

 

Tachycardia Hypotension "Monday Dz" Tolerance during work week Intolerance on weekends Tachycardia Dizziness; Headache

 

Nitroglycerin

 

Isosorbide Dinitrate

 

Smooth muscle relaxation Vasodilation (veins > arteries)

GLYCOSIDES

CHF

Na+/K+ ATPase Na+ I.C. Na+ / Ca2+ swap

Na Na+ Na+ Na+ Na+ K+ Ca2+ Ca2+ Ca2+ Ca2+ Ca2+ Na+ Ca2+
Na
Na+
Na+
Na+
Na+ K+
Ca2+
Ca2+
Ca2+
Ca2+
Ca2+
Na+
Ca2+

Ca2

Na+

 

Nausea; Vomiting; Diarrhea Blurry yellow vision (Van Gogh) Arrhythmia

Digoxin 75% bioavailability 25% protein-bound t1/2 = 3 days Peed out

Atrial Fib

Na+

Renal Failure Excretion Risk for toxicity K+ Potentiates glycosides --> Toxic!! Quinidine Clearance of digoxin

 

Na+ (IC) Ca2+ (IC)

Na+

Na+

Antidote = K+; Lidocaine; Pacer; Anti-dig Fab fragments

PHOSPHODIESTERASE INHIB

     
 
AMP P-Diesterase cAMP ATP
AMP
P-Diesterase cAMP
ATP

β1

Cardiovascular

 

INDICATIONS

 

MECHANISM OF ACTION

SIDE EFFECTS / TOXICITY

CLASS IA

Atrial arrythmias Ventricular arrhythmias

Local anasthetics / Conduction Slope of phase 4 depolarization Threshold in abnormal pacemaker cells Slectively depress frequent depolarizers

Quinidine:

Quinidine

Queen Amy Proclaims Dis Ol' pyramid

Headache; Tinnitus Thrombocytopenia Torsade de pointes (QT) Procainamide:

Amiodarone

 

Procainamide

Disopyramide

 

SLE-like syndrome (reversible)

 

K+ Channel K+ (IC) ↑↑Repol.

K+ K+ K+ K+ K+ K+ K+ K+
K+
K+ K+
K+
K+
K+
K+
K+

PR

QRS

↑↑QT

CLASS IB

Acute ventricular arrhythmias Post-MI Digitalis-induced arrhythmias

AP duration Affects ischemic or depolarized Ventricula tissue Purkinje tissue

Local anesthetic CNS stimulation/depression Cardiovascular depression

Lidocaine

Mexiletine

   

Tocainide

 

CLASS IC

Last resort b/c of toxicities Ventricular Tach / Fib SVT (intractable)

 

Proarrhythmic

Flecainide

Encainide

 

No effect on AP duration

Propafenone

CLASS II - β-BLOCKERS

Suppress abnormal pacemakers

caMP; Ca2+ currents Phase 4 slope Abnormal pacemakers PR interval AV Node sensitive

Esmolol (short acting) Metoprolol Timolol Atenolol Propranolol

Esmo

Met

Tim

A 10

 

Pro

CLASS III - K+ CH. BLOCKERS

Use when other antiarrythmics fail

AP duration

Sotalol - Torsade de pointes Ibutilide - Arrhythmias; HypoTN Bretylium Amiodarone - Pulmonary fibrosis Hepatotoxicity Hypo/Hyper-Thyroidism Neuro; Skin; Photoderm

 

ERP

Sotalol

QT interval

Ibutilide

Bretylium

Amiodarone

CLASS IV Ca2+ CH. BLOCKERS

Nodal arrhythmias (ie SVT) Prevention

Affect AV nodal cells Conduction velocity ERP PR interval

Constipation Flushing Edema CHF; AV block; SN dep. Torsades de pointes (bepridil)

Verapamil

Diltiazem

 

Ca2+ CHANNEL BLOCKERS

HTN

L-type Ca2+ channels (cardiac; smooth m) Contractility

Cardiac depression

 

Angina

Peripheral edema

"Knife Dealt [you] A Vera!!"

Arrhythmias

 

Flushing; Dizziness

Constipation

Nifedipine > Diltiazem > Verapamil

Smooth muscle: Knife dealt you a vera

Verapamil > Diltiazem > Nifedipine

Heart: Vera dealt a knife

MISCELLANEOUS

     

Adenosine

#1 Rx for AV nodal arrhythmias Ectopic pacemakers; Digoxin toxicity Torsades de pointes; Digoxin toxicity

K+

Mg+

Antiarrhythmics