DRUGS SUMMARY

DRUGS SUMMARY: DRUG: SIDE EFFECTS or NOTE ANTI EPILEPTICS      carbamazepine:↑ Na channel inactivity Tx: Partial simple & complex, General tonic clonic SE: diplopia benzodiazepine: ↑ GABA action; Tx: Status ethosuximide: Blks thalamic Types Ca channels; TX: Absence: SE: Stevens Johnson syn Phenobarbital: ↑ GABA action; TX Part. S& C, Gen. tonic clonic Phenytoin: ↑ Na channel inactivity: Tx: Partial: simple and complex, general Tonic colonic, status SE:osteoporosis, hirutisim, gingival hyperplasia Valproic acid: ↑ Na channel inactivation, ↑ GABA concentration; TX: General tonic clonic, Absence; SE: neural tube defect Lamotrigine: Blks voltage gated NA : channels; TX: Part, Simple & complex, Gen. tonic clonic; SE Steven Johnson syn Gabapentine: ↑ GABA release; Tx Part S&C, General tonic clonic Topiramate: Blks Na channels, ↑ Gaba action; SE kidney stones     ANESTHETICS: ↓ solubility = fast in/fast out GENERAL  NO: ↓ solubility/ fast but low potency  Halothane: ↑ solubility/ slow but potent: malignant hyperthermia risk LOCAL Esters  Procaine  Cocaine  tetracaine Amides  Lidocaine  Buplvacaine NEURO MUSCULAR BLOCKER: used for surgery DEPOLARIZING  Succinylcholine NON DEPOLORIZING  Tubocuraine  Atracurium  Mivacurium  Pancuronium  Vecuronium  Dantrolene: tx malignant hyperthermia NSAIDS  Aspirin: irreversibly binds  Ibuprofen  Naproxen  Indomethicin: closes PDA  Acetominaphen: not anti-inflammatory, CNS action preference, antidote = N-acytelcysitne COX 2 SELECTIVE  Celecoxib  Valecoxib OPIOD ANALGESICS  Morphine  Fentanyl  Codeine  Heroin  Methadone  Meperidine  dextromethorphan General INTRAVENOUS ANESTHETICS  BARBITURATES: Thiopental: fast in/ for short sx procedures  BENZO: Midazolam: used for endoscopy, SE: post-op respiratory depression/amnesia  KETAMINE: PCP analog: pts appear awake but are unconscious and do not feel pain; SE bad SE = increased cerebral blood flow and post op hallucinations  OPIATES: Morphine, Fentanyl  Propofol: fast, for short procedures SE: respiratory depression, constipation, miosis, addictive, CNS depression Antidote: Naloxone PSYCHIATRIC BARBITUATES: increase Cl channel opening  Phenobarbital Induce P450  Pentobarbital Contra in porphyria  Thiopental CNS depression w/ OH  Scecobarbital BENZODIAZEPINES  Diazepam Antidote: Flumazenil  Lorazepam ANTIPSYCHOTIC Typical  Throidezine  Haliperidol: tx tourrettes and elderly sun downing  Fluphenazine: depot form  Chlorpromazine  Thiothixine Atypical  Clozapine: agranuloctosis  Olanzapine: tx OCD  Risperidone Antimanic  Lithium: reversible diabetes insipidus  Valproic acid: spina bifida ANTIDEPRESSENTS SSRIs: 2 – 3 wks to work  Fluoxetine Serotonin syn. If w/ MAO  Sertraline inhibitors = hyperthermia,  Paroxetine muscular rigidity, cardio collapse Tricyclics: blk NE and 5-HT reuptake  Imipramne: tx bedwetting  Amtriptyline Convulsions,  Desipramine coma, cardio toxic  Nortriptyline  Clomipramine: tx OCD  Doxepin Heterocyclics  Trazodone: priapism  Buproprion: tx smoking, can make psychosis worse  Venlafazine PSYCHIATRIC CONTINUED MAO inhibitors: phobias, hypochondria  Phenelzine  Tranylcypromine  SE: HTN crisis w/ tyrimine foods as well as with meperidine, contraindicated w/ SSRIs or B-agonists CARDIOVASCULAR ANTIHYPERTENSIVES DIURETICS THIAZIDES: DCT:  HTZ: ↓ K, ↑ CA in &lipids in serum, synergistic with loops, good to reduce CA kidney stones THIAZIDE LIKE:  Metolozone: good for low GRF, ↓ K  Indapamide: no increase of lipids, ↓ K LOOPS: TALH:  Furoemide: ototoxicity, ↓ K  ethacrynic acid: ototoxicity, ↓ K, SE = acute gout K SPARING: collecting duct, ↑K  Spironlactone: gynecomastia, good w/ acne  Amiloride: photosensitivity  Triamterene  K sparing contra w/ renal insufficiency ACE-I: the “prils”: DCT  Captopril: + effect on lipids, DOC in HTN Diabetic: SE = angio edema, cough, rash, taste change AGII RECP. ANTAG/ ARBS  Losartan: resp. infection, fetal renal toxicity, useful in CHF, ↑K SYMPATHOS: constipation  Methyldopa: liver toxic, anemia, + coombs  Clonidine: rebound HTN,  Hexamethonium: orthostatic Hypo-TN  Reserpine: depression, no ejaculation  Guanethidine: ortho-Hypo., sex-dysf.  Prazosin: 1st dose orth-Hypo.  B-Blockers: Impotency, bradycardia, good w/ CHF (atenolol, metoprolol, carvedilol) VASODILATORS  Hydralazine: SLE like syn., angina, reflex tachy (give with B Blker to avoid)  Minoxidil: pericardial effusion, reflex tachy (give with B Blker to avoid)  Verapimil: CCB: flushing, constipation, nausea, brady, AV block, - ionotrope  Diltiazem  Nitroprusside: Cyanide toxicity OTHERS  Mannitol: decreases intra cranial and intra ocular pressure: SE: pulmonary edema  Acetazolamide: tx altitude sickness; SE sulfa allergy  Digoxin: increase contractility =use for CHF, decrease conduction = use A Fib: SE: blurry yellow vision  Adenosine: the heart stopper, tx AV arrhythmia.  K+: depresses ectopic, tx digoxin toxicity  Mg+: tx torsades and digoxin toxicity ANTIARRHYTMICS CLASS 1 NA CHANNEL BLOCKERS: ↓ CONDUCTION CLASS 1A: ↑QT (can lead to torsades), ↑AP  Quinidine  Amiodarone  Procainamide: SLE like symptoms  Disopyramide CLASS 1B: ↓AP  Lidocaine: DOC for V-Tach  Mexiletine  Tocainide CLASS 1C: no effect on AP, good for V-tach progressed to V-fib, contraindicated post MI  Flecainide  Encainide  Propafenone CLASS 2: B-blockers: ↑PR  Propranolol  Esmolol  Metoprolol  Atenolol  Timolol CLASS 3: K channel blockers, ↑AP, ↑QT  Sotolol: SE:torsades  ibutilide  bretylium  amiodarone: SE: pulmonary fibrosis, hepatotoxic, hyper/hypo-thyroidism: check PFT, LFT, and TFT CLASS 4: Ca channel blockers: ↓conduction, ↑PR  Verapamil  Diltiazem CARDIO CONTINUED LIPID LOWERING AGENTS HMG-COA RECUCTASE INHIBITORS: ↓↓↓LDL, ↑HDL  Lovastatin  Pravastatn  Simvastatin  Aorvastation NIACIN: ↓↓ LDL ↑↑HDL BILE ACID RESIN: ↓↓LDL  Cholestyramine  Colestipol CHOLESTEROL ABSORBERS: ↓↓LDL  Ezetimibe FIBRATES: ↓↓↓ triglycerides  Gemfibrozil  Clofibrate  Bezafibrate  Fenofibrate NEUROLOGIC DRUGS continued SUMATRIPTAN  5-ht agonist, half life < 2 hours. Tx acute migraine, cluster headaches; SE chest discomfort, mild tingling (contraindicated in pts with CAD or Prinzmetals angina) NEUROLOGIC DRUGS PARKINSON’S  DOPAMINE AGONISTS: L-dopa, carbidopa, bromocriptine, pramipexole, ropinirole, amantadine (enhance dopamine release)  MAO type B INHIBITOR: selegiline, adjunct to l-dopa for Parkinson’s  ANTIMUSCARINICS: Benzotropine: improve tremor and rigidity  COMT INHIBITORS: Entacapone, tolcapone: adjuncts to levodopa L-DOPA (LEVODOPA)/CARBIDOPA  Increase dopamine in brain, L-dopa can cross BBB (dopaimine cant) and is converted by dopa decaboxylase in the CNS to dopamine  SE: arrhythmias for peripheral conversion to dopamine (carbadopa given with it to less this), Dyskinesias  RESPIRATORY H1 BLOCKERS: reversible inhibit. h1 receptors FIRST GENERATION: use for allergy, motion sickness, sleep aid  Diphenhydramine  Dimenhydrinate  Chlorpheniramine SECOND GENERATION: allergies  Loratadine  Fexofenadine  desloratiadine ASTHMA NON SPECIFIC B-AGONISTS  Isoproterenol: se = tacy (B2)  Metaproterenol: bronchodilator Tx asthma B2 AGONISTS  Albuterol: tx acute exacerbations  Salmeterol: long acting prophylaxis METHYLXANTHINES  Theophylline: useful for chronic therapy of asthma; SE: narrow use, cardio toxic MUSCARINIC ANTAGONIST  Ipratropium CORTICOSTEROIDS  Beclomethasone  Prednisone ANTILEUKOTRIENES  Zileuton  Zafirlukast, montelukast Lansoprazole OTHERS  Bismuth, Sucralfate: binds ulcer base for physical protection, heals ulcers  Misoprostol: ↑ mucous production: SE =abortifacient  Infliximab: tx Crhons, RA: SE resp. infection  Sulfasalazine: tx UC and Crhons  Ondansetron: central antiemetic, Tx nausea in chemo pts, SE HA and constipation ANTACIDS  Aluminum hydroxide: constipation, hypophos (minimum feces)  Magnesium hydroxide: diarrhea, hypo-K (MG= must go) REPRODUCTIVE INHBIT cGMP phos. = ↑ cGMP = fill the penis  Sildenafil  Vardenafil  Tadalafil  SE: blue-green color vision, potent. Fatal Hypo-TN if taken with nitrates CLOMIPHENE:↑LH and FSH > stimulates ovulation; SE = visual disturbance, multiple preg., hot flashes MIFEPRISTONE (RU-486): ↓ progesterone at receptor; abortifacient; SE = bleeding N/V/ abdominal pain Oral contraceptives:  GOOD: decrease risk of endometrial and ovarian cancer, ectopic pregnancy, and PID  BAD: increase triglycerides, depression, weight gain, hypercoagulable state, HTN GASTROINTESTINAL H2 BLOCKERS: tx ulcer, gastritis, reflux  Cimetidine: ↓ parietal cell gastric acid production; TX peptic ulcer SE: inhibits P450, ↓renal creatinine excretion  Rantidine: ↓ parietal cell gastric acid production; TX peptic ulcer  Famotidine  Nizatidine PROTON PUMP INHIBITORS: tx ulcer, reflux, Zollinger-Ellison syndrome  Omeprazole HEMATOLOGICS  HEPARIN: activation antithrombin III, ↓ thrombin and Xa,: Immediate anticoag for PE ect.: Ok in preg.: antidote is protamine sulfate: intrinsic path, PTT WARFARIN: ↓ vit K depend. Clotting factors, 2,7, 9, 10, protein C and S: extrinsic path, PT.: Don’t use in preg. (x-placenta): antidote is IV vit K & FFP ASPIRIN: antiplatelet, no effect on PT or PPT: SE: tinnitus (CN VIII) Reye’s syn CLOPIDOGREL: ↓ Aggregation, prevent gp IIb/IIIa expression TICLOPIDINE: ↓ Aggregation, prevent gp IIb/IIIa expression; SE: thrombocytopenia ABCIXIMAB: binds gbII/IIIa; SE: thrombocytopenia diabetes continued ALPHA-GLUCOSIDAS INHIBITORS: ↓ hydrolysis of sugar > ↓ postprandial; SE = GI hyperglycemia  Acarbose  Miglitol OTHER ENDOCRINE  LEUPROLIDE: tx: uterine fibroids, pulsitile = infertility, contin. w/ flutamide = prostate cancer  PROPYLTHIOURACIL (↓ peripheral T4 to T3), METHIMAZOLE: both tx hyperthyroid; SE = rash, agranulocutosis, aplastic anemia ANTIANDROGENS  Finasteride: tx BPH and male pattern baldness  Flutamide: tx prostate carcinoma  Ketoconazole, Spironlactone: tx polycyctic ovarian syndrome to prevent hiritusum GLUCOCORTICOIDS: ↓ expression of COX-2  Hydrocortisone Tx Addison’s,  Prednisone inflammation,  Triamcinolone immune suppression,  Dexamethasone asthma  Beclomethasone  SE: Iatrogenic Cushing’s synd. w/ buffalo hump, moon face, truncal obesity, muscle wasting, osteoporosis, adrenocortical atrophy      THROMBOLYTICS: cleave fibrin and plasminogen  Streptokinase Contra. in severe HTN  Urokinase  TPA ENDOCRINE DIABETES  INSULIN: ↑ glucose storage and K uptake: SE = hypoglycemia  METFORMIN: ↑ glycolysis, ↓ serum glucose; SE = lactic acidosis SULFONYLUREAS: ↑ endogenous insulin; SE = disulfiram like effect  Tolbutamide  Chlorpropamide  Glyburide  Glipizide GLITAZONES: ↑ response to Insulin; SE = weight gain  Pioglitazone  rosiglitazone carcinoma; SE = nephrotoxicity, acoustic nerve damage RHEUMATOLOGIC GOUT  NSAIDS: INDOMETACIN: tx acute gout  CLOCHICINE: tx acute gout, SE: GI  PROBENECID: tx chronic gout, ↓ uric reabsorption, increases penicillin action  ALLOPURINOL: tx chronic gout, ↓ uric acid production Oncologic continued DOXORUBICIN: breaks DNA strands; TX part of combo for Hodgkin’s; SE = Cardio toxic, alopecia BLEOMYCIN, DACTINOMYCIN: ↑ free radical > DNA breaks; Tx testicular CA, Lymphoma; SE = pulmonary fibrosis, skin change ETOPOSIDE: hits G2 stage increases DNA degradation; Tx oat ell CA of lung and prostate, testicular ca; SE = myelosuppression, alopecia PREDNISONE: triggers apoptosis; Tx CLL, Hodgkin’s, and autoimmune dx; SE = Cushing like syn., immunosupression, cataracts, acne, osteoporosis, HTN, ulcers, hyperglycemia, psychosis TAMOXIFEN, RALOXIFENE: blks estrogen binding; Tx breast CA, prevents osteoporosis; SE = ↑ risk of endometrial CA TRASTUZUMAB (HERCEPTIN): monoclonal antibody against erb-B2; Tx metastatic breast Ca; SE = cardiotoxic VINCRITINE, VINBLASTINE: hits M phase, blks mitotic spindle formation; Tx lymphoma, Wilms tumor and choriocarcinoma; Se: neurotoxicity PACLITAXEL: hits M phase, blks mitotic spindle breakdown so anaphase can’t occur; Tx ovarian and Breast CA; SE = myelosuppression and hypersensitivity ONCOLOGIC METHOTREXATE: hits S phase: used for leukemia, lymphoma, chorisocarcinoma, sarcoma, abortion, ectopic pregnancy, RA, psoriasis; SE = reversible myelosuppression, fatty liver change 5-FLUOROURACIL: hits S phase; Tx colon cancer, basal cell carcinoma; SE = Non reversible myelosuppression, photosensitivity 6-MERCAPTOPURINE (6-MP): blocks purines: leukemia; SE = bone marrow, increased toxicity with Allopurinol BUSULFAN: Alkylates DNA; Tx CML; SE = pulmonary fibrosis, hyperpigmentation CYTARABINE: ↓ DNA polymerase: Tx AML; SE = leukopenia, thrombocytopenia, megoblast anemia CYCLOPHOSPHAMIDE, IFOSFAMIDE: cross links DNA; Tx Non Hodgkin’s; SE = meylosuppression, hemorrhagic cystitis NITROSOUREAS: CARMUSTINE, LOMUSTINE, SEMUSTINE, STREPTOZOCIN: Alkylate DNA; SE: CNS toxicity, dizzy, ataxia CISPLATIN, CARBOPLATIN: alkylating agents; Tx testicular, bladder, ovary , lung IMMUNMOSURPPRESANT AND CYTOKINE THERAPY CYCLOSPORINE: ↓ IL2 > ↓ T cell action; Tx suppress organ rejection; SE = increase risk of infection, nephrotoxic (preventable w mannitol) TACROLIMUS: ↓ IL2 > ↓ T cell action; TX potent immunosurppression for organ transplants; SE = neprotoxicity, peripheral neuropathy, HTN AZATHIOPRINE: ↓ nucleic acid synthesis, toxic to proliferating lymphocytes; Tx kidney transplants, autoimmune dxs RECOMINANT CYTOKINES AN THEIR USE          ALDESLEUKIN: renal cell carcinoma, metastatic melanoma ERYTHROPOIETIN: anemia, renal failure FILGRASTIM: recovery of bone marrow SARGROMOSTIM: recovery of bone marrow ALPHA – INTERFERON: hep B and C, Kaposi’s, leukemia, malignant melanoma BETA- INTERFERON: multiple sclerosis GAMA-INTERFERON: chronic granulomatous dx OPERELVEKIN, INTERLUKIN 11: thrombocytopenia THROMBOPOEITIN: thrombocytopenia SE for cephalosporin’s: penn cross hypersensitivity, nephrotoxicity of aminoglycosides, disulfiram like rxn with OH Antimicrobials continued ANTIMICROBIAL Term CWI = cell wall inhibitor    PENICILLIN: cell wall inhibitor, Tx gram + cocci, and rods; gram – cocci and spirochetes; SE: allergic, hemolytic anemia METHCILLIN, NAFCILLIN, DICLOXACILLIN: CWI; Tx S aureus; SE: methicillin = interstitial nephritis AMPICILLIN, AMOXICILLIN: CWI; Tx extended spectrum, H flu, E coli, Listeria, Proteus, Salmonella, Enterococci: SE: ampicillin rash, psseudomembranous colitis CARBENICILLIN, PIPERACILLIN, TICARCILLIN: CWI; TX; pseudomonas, gram – rods, use with clauvulanic acid   AZTREONAM: CWI; Tx klebsiela, pseudomonas, serratia: no action on g+ or anaerobes: no x-allergy with penicillin IMIPENEM/CILASTATIN: CWI; always used with cilastatin to save renal tubules; Tx Enterobacter DOC; SE rash, seizures at high conc VANCOMYCIN: CWI; Tx gram +, S aureus, C difficile; SE: usually NOT many problems; nephrotoxicity, ototoxicity, red-man synd. – take antihistamine to lessen   CEPHALOSPORINS: CWI FIRST GENERATION: tx gram – cocci: proteus m., E coli, klebsiella p. (PEK)  CEPHALOTHIN  CEPHALEXIN  CEPHAPIRINE  CEPRADINE  CEFADROXIL  CEFAZOLIN SECOND GENERATON: Tx gram – cocci, H flu, Enterobacter, Neisseria, Proteus, E coli, Klebsiela, Serratia (hen peks)  CEFALCOR  CEFAMANDOLE  CEFONICID  CEFORANIDE  CEFOXITIN  CEFUROXIME  CEFUROXIMEAXETIL THIRD GENERATION: serious gram –  CEFTIZOXIME  CEFOTAXIME: gonorrhea (gets to CNS)  CEFTRIAXONE  CEFTAZIDINE: pseudomonas  CEFOPERAZONE  CEFIXIME PROTEIN SYNTHESIS INHIBITORS 30s:  Aminoglycosides: streptomycin, gentamicin, tobramycin, amikacin: Bactericidal  Tetracyclines: bacteriostatic 50s  Chloramphenicol: b-static  Erythromycin: b-static  Lincomycin: b-static  Clindamycin: b-static AMINOGYCOSIDES: causes mRNA misread  Gentamicin  Neomycin: bowel sx  Amikacin  Tobramycin  Streptomycin  SE: teratogen: Nephrotoxic w/ cephalosporin’s; ototoxicity with Loop diuretics TETRACYCLINES: don’t take with milk or antacids: Tx Vibrio, Acne, Chlamydia, Mycoplasma p, borrelia, Rickettsia, Tularemia; SE: tooth discolor in bone inhibition in kid  Tetracycline  Doxycycline: fecal elimination, good for renal pts  Demeclocycline infections; SE neurotoxin, acute renal tubular necrosis Antimicrobials continued Antimicrobials continued MACROLIDES: inhibit protein synthesis; Tx URI, STD, Mycoplasma, Legionella, Chlamydia, Neisseria; SE acute cholstatic hepatitis, rash  Erythromycin  Azithromycin  clarithromycin  CHLORAMPHENICOL: Inhibits at 50s; Tx meningitis, H flu, Neisseria, strep p.; SE anemia, aplastic anemia, gray baby syndrome (lack of UDP-glucuronyl transferase) CLINDAMYCIN: blks bond at 50s; Bacteroides f., C. perfringens; SE pseudomembranous colitis (c diff overgrowth ANTI-TB: hepatotoxic  Rifampin: RNA polymerase inhibitor, Revs up P450, Red body fluids, Rapid resistance if used alone;  Ethambutol  Streptomycin  Pryrazinamide  Isoniazid: can be used as solo prophylaxis for TB; SE hemolysis if G6PD defic, neurotoxic (avoid with B6), SLE like synd  SULFONAMIDES: anti PABA; Tx Nocardia, Chlamydia; SE hemolysis if G6PD defic. Nephrotoxic, kernicterus in infants  Sulfamethoxazole:(SMX) simple UTI  Sulfisoxazole  Triple sulfa: simple UTI  sulfadiazine  TRIMETHOPRIM: ↓ DNA synth.; Tx use with sulfonamide = TMP-SMX, recurrent UTI, shigella, salmonella, P carinii; SE megoblastic anemia FLUOROQUINOLONES: Tx pseudomonas, Neisseria; SE tendon and cartilage damage  Ciprofloxacin  Norfloxacin  Ofloxacin  METRONIDAZOLE: Tx antiprotozoal, Giradia, Entamoeba, Trichomonas (GET on Metro), use with bismuth and amoxicillin for H. pylori; SE disulfiram like rxn with OH POLYMYXINS B and E: disrupt membrane osmotics, like a detergent; Tx gram – ANTIFUNGALS  AMPHOTERICIN B: binds ergosterol > leaky membrane; Tx Cryptococcus, blastomyses, coccicioides, aspergillus, histoplasma, Candida, mucor, does not cross BBB; SE fever and chills, hypo-tn, nephrotoxicity, arrhythmias  NYSTATIN: binds ergosterol > leaky membrane; Tx swish and swallow for Candida, ok with preg  FLUCYTOCINE: ↓ DNA synth; Tx Candida, Cryptococcus; SE N/V/D, bone marrow suppression  CASPOFUNGIN: CWI; Tx aspergillosis; flushing  TERBINAFINE: ↓ squalene epoxidase; Tx dermatophytes i.e. onychomycosis  GRISEOFULVIN: disrupts mitosis; Tx; Oral tx of superficial infections, tinea, ringworm AZOLES: ↓ ergosterol synth.; Tx mycoses; SE gynecomastia, ↓ P450, fever, chills  Fluconazole: cryptococcal men. In AIDS pts, and Candida  Ketoconazole: blastomyces, coccidioides, histoplasma, Candida A, hypercortisolism  Clotrimazole  Miconazole  Itraconazole   ANTIVIRAL  AMANTADINE: blks viral penetration; Tx prophylaxis for Influenza A; Parkinson’s; SE ataxia dizzy, slurred speech  ZANAMIVIR, OSELTAMIVIR: Tx Influenza A and B  RIBAVIRIN: inhibits syth of guanine; Tx RSV, chronic Hep C; SE teratogen  ACYCLOVIR: Tx HSV, VZV, EBV, Prophylaxis in immunocompromised; SE delirium, tremor, nephrotoxic  GANCICLOVIR: inhibits CMV DNA polymerase; Tx CMV; SE leucopenia, neutropenia, thrombocytopenia  FOSCARNET: DNA polymerase inhibitor; TX CMV retinitis in immunocomp. Pts when ganciclovir fails; SE nephrotoxic HIV PROTEASE INHIBITORS  SAQUINAVIR  RITONAVIR  INDINAVIR: thrombocytopenia  NELFINAVIR  AMPRENAVIR REVERSE TRANSCRIPTASE INHIBITORS NUCLEOSIDES  ZIDOVUDINE(AZT)  DIDANOSINE  ZALCITABINE  STAUVUDINE  LAMIVUDINE  ABACAVIR NON-NUCLEOSIDES  NEVIRAPINE  DELAVIRDINE  EFAVIRENZ  SE: bone marrow suppression, lactic acidosis, rash, megoblastic anemia INTERFERONS Glycoproteins from human leukocytes blck viral RNA and DNA synthesis; Tx chronic hep B and C, Kaposi’s; SE neutropenia ANTIPARASITICS and what they tx  IVERMECTIN: onchorcerciasis (river blindness)  MEBENDAZOLE/THIABENDAZOLE: nematode/roundworm  PYRANTEL PAMOATE: ascaris, hook worm, enterobius (pinworm)  PRAZIQUANTEL: trematode/fluke, shcitosomes, paragonimus, clonorchis  NICLOSAMIDE: cestode, diphyllobothrium, taenia  PENTAVALENT ANTIMONY: leishmaniasis  CHLOROQUINE AND QUININES: malaria  PRIMAQUINE: plasmodium v. P. ovale  METRONIDAZOLE: Giardia, entamoeba histolytica, gardnerella v, trichomonas  PENTAMIDINE: pneumocystis carinii p prophylaxis  NIFURTIMOX: Chagas = American trypanosomiasis = T cruzi  SURAMIN: African trypanosomiasis = sleeping sickness AUTONOMICS CHOLINOMIMETICS: ↑ Ach = ↑ M in para = ↑ DUMBBELSS Direct agonists: stimulate the Ach receptors  Betanechol: Tx post op ileus and urinary retention  Carbachol, Pilocarpine: Tx glaucoma Indirect agonist: decrease Ach-ase = ↑ Ach  Neostigmine: TX post-op and neurogenic ileus, myasthenia gravis  Pyridostigmine: TX myasthenia gravis  Edrophonium: USE diagnosis of MG, short acting  Physotigmine: Tx glaucoma, and antidote for atropine overdose  Echothiophate: TX glaucoma CHOLINESTERASE INHIBITOR POISIONING: PARATHION AND OTHER ORGANOPHOSPHATES Symptoms: Diarrhea, Urination, Miosis, Broncospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation (DUMBBELSS) Antidote: Atropine plus pralidoxime MUSCARINIC CHOLINORECEPTOR BLOCKERS: ↓ Ach = ↓ Para down and out  Atropine, homatropine, tropicamide (eye exam): Tx eye to produce mydriasis (big pupil); toxicity= high temp, high pulse, dry mouth, flushed, disorientated, constipated  Benzotropine: Tx CNS, Parkinson’s  Scopolamine: TX CNS, motion sickness  Ipratropium: Tx respiratory, Asthma, COPD SYMPATHOMIMETICS CATECHOLAMINES: rapid onset, brief duration of action, not given orally, don’t cross BBB  Epinephrine: Tx anaphylaxis, open angle glaucoma, asthma, hypo-tn  NE: TX hyp0-tn,  Isoproeterenol: Tx AV block  Dopamine: Tx shock, heart failure SYMPATHOMIMETICS Non CATECHOLAMINES: longer duration of action, can be given orally  Amphetamine: Tx narcolepsy, obesity, ADD  Ephedrine: mixed action ( direct and indirect) releases stored NE from nerve endings and directly stimulates alpha and beta receptors; TX nasal decongestion, urinary incontinence, hypo-tn  Phenylephrine: use pupil dilator, to vasoconstriction, nasal decongestion  Albuterol, tervutaline: Tx asthma  Cocaine: causes vasoconstriction and local anesthesia  Clonidine: Tx HTN, especially with renal dx as no decrease in blood flow to kidney ALPHA BLOCKERS NONSELETIVES  Phenoxbenzamine: Tx pheochromocytoma; SE ortho hypo-tn, reflex tachy ALPHA 1 SELECTIVE: Tx hypo-tn, urinary retention in BPH; SE 1st dose ortho hypo-tn  Prazosin  Terazosin  doxazosin ALPHA 2 SELECTIVE:  Mirtazapine: Tx depression; SE sedation, increase serum cholesterol, increase appetite  B BLOCKERS: decrease cardio output, decrease rennin secretion, decrease heart rate and contractility > less O2 consumption, decrease mortality, Tx MI, CHF etc; SE impotency, worse asthma, CNS effects CARDIO SELECTIVE  ACEBUTOLOL  METROPOLOL  ESMOLOL: Tx SVT  BETAXOLOL  ATENOLOL GLUCOMA DRUGS  Epinephrine: open angel only, increased outflow of aqueous humor  Brimonidine: decreases aqueous humor synthesis Glaucoma drugs continued  Timolol, Betaxolol, Cartelol: decreases AQ secretion  Pilocarpine, carbechol, physostigmine, echothiopahe: increase outflow of AQ,  contract ciliary muscle and open trabecular meshwork; SE miosis, cyclospasm  Prostaglandin, Latanoprost: increases outflow of AQ humor; SE darkens color of the iris (browning) Warfarin tPA, streptokinase Vit. K, FFP Aminocaproic acid DRUG REACTIONS Drug reaction Pulmonary fibrosis Hepatitis Focal to massive hepatic necrosis Anaphylaxis SLE-like syndrome ANTIDOTES TOXIN ANTIDOTE/ TREATMENT acetaminophen n-acetylcysteine Salicylates Alkalinize urine, dialysis Anticholinesteasse, Atropine, pralidoxime Organophosphates Antimuscarinic, Physostigmine salicylate anticholinergic agents B-blockers Glucagons Digitalis Stop dig, normalize K, Lidocaine, anti-dig, Mg2 Iron Deferoxamine Lead caEDTA, dimercaprol succimer, penicillamine Arsenic, mercury, Dimercaprol, succimer gold copper arsenic Penicillamine gold Cyanide Nitrite, hydroxocobalamin, Thiosulfate Methemoglobin Methylene blue Carbon monoxide 100% O2, hyperbaric O2 Methanol, ethylene Ethanol, dialysis, glycol (antifreeze) fomepizole Opiods Naloxone/naltrexone Benzodizepines Flumazenil TCAs NaHCO3 Heparin Protamine Hemolysis in G6PD deficient Pts Thrombotic complications Adrenocortical insufficiency Photosensitivity rxns Tubulinterstitial nephritis Hot flashes Cutaneous flushing Cardiac toxicity Agranulocytosis Stevens-Johnson syndrome Cinchonism Causal agent Bleomycin, amiodarone, busulfan Isoniazid (INH), halothane Halothane, valproic acid Penicillin Hydralazine, Isoniazid, Procainamide, Phenytoin (not HIPP to have lupus) Sulfonamides, INH, aspirin, ibuprofen, primaquine, nitrofurantoin, pyrimethamine, chloramphenicol Oral contraceptives, estrogen, progestins Withdrawal of glucocorticoids Sulfonamides, Amiodarone, Tetracycline (SAT for photo) Sulfonamides, furosemide, methicillin, rifampin, NSAIDs(except aspirin) Tamoxifen Niacin, Ca channel blk, adenosine, vancomycin Soxorubicin Clozapine, carbamazepine, cholchicine Ethosuximide, sulfonamides, lamotrigine Quinidine, quinine Tendonitis, tendon rupture & cartilage damage in kids Flouroquinolones Disulfiram-like reactions Ototoxicity and nephrotoxicity Drug-induced Parkinson’s Torsades de pointes Aplastic anemia Neuro/nephrotoxicity Pseudomembraneous colitis Gynecomastia Atropine-like side effects Cough Gingival hyperplasia Diabetes insipidus Tardive dyskinesia Fanconis syndrome Gray baby syndrome Extrapyramidal side effects Osteoporosis Coronary vasospasm Metronidazole, certain cephalosporin’s, procarbazine, sulfonylureas Aminoglycosides, loop diuretics, cisplatin Haloperidol, chlorpromazine, reserpine, MPTP Class III (sotalol), Class 1A(quinidine) antiarrythmics Chloramphenicol, benzene, NSAIDs Polymixins Clindamycin, ampicillin Spironolactone, Digitalis, Cimetidine, chronic Alcohol use, Estrogens, Ketoconazole (Some Drugs Create AwEsome Knockers) Tricyclics ACE-inhibitors Phenytoin Lithium Antipsychotics Expired tetracycline’s Chloramphenicol Chlorpromazine, thioridazine, haloperidol Cortixosteroids, heparin, phenytoin cocaine DRUG ENDING TIPS Ending Category -afil Erectile dysf -ane Inhalation, gen Anesthetic -azepam Benzodiazepine -azine Phenothiazine (neruoleptic, antiemetic) -azole Antifungal -barbital Barbiturate -caine Local anesthetic -cillin Penicillin -cycline Antibiotic, protein synthesis inhibitor -ipramine TCA -navir Protease inhibitor -olol B blocker -operidol Butyrophenone (neruoleptic) -oxin Cardiac glycoside (iontropic agent) -phylline Methylxanthine -pril ACE inhibitor -terol B2 agonist -tidine H2 antagonist -triptyline TCA -tropin Pituitary hormone -zosin Alpha 1 antagonist Example Sildenafil Halothane Diazepam Chlorpromazine Ketoconazole Phenobarbital Lidocaine Methcillin Tetracycline Imipramine Saquinavir Propranolol Haloperidol Digoxin Theophylline Captopril Albuterol Cimetidine Amitriptyline Somatotropin prazosin