Morphine: side-effects MORPHINE:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention)
Nausea
Emesis
CNS Effects of Morphine
SCREAMNT
S edation
C ough suppression/convulsions
R espiratory depression
E uphoria
A nalgesia
M yosis (but may cause mydriasis in doses causing asphyxia)
N ausea and vomiting
T runcal rigidity (especially with fentanyl)
Cocaine: cardiovascular effect COcaine causes blood
vessels to
COnstrict (unlike other local anesthetics which cause vasodilation).
Aminoglycosides: common characteristics AMINO:
Active Against Aerobic gram negative
Mechanism of resistance are Modifying enzymes
Inhibit protein synthesis by binding to 30S subunit
Nephrotoxic
Ototoxic
Sulfonamides: common characteristics SULFA:
Steven-Johnson syndrome/ Skin rash / Solubility low
Urine precipitation/ Useful for UTI
Large spectrum (gram positives and negatives)
Folic acids synthesis blocker (as well as synthesis of nucleic acids)
Analog of PABA
Diuretics: groups “Leak Over The CAN“:
Loop diuretics
Osmotics
Thiazides
Carbonic anhydrase inhibitors
Aldosterone inhibitors
Na (sodium) channel blockers
· Note: “leak” is slang for urination and “can” is slang for a toilet.
Gynacomastia, Drugs That Cause
“Some Drugs Create Awesome Knockers
S pironolactone
D igistalis
C isplatin
A lcohol
K etoconozole
Thalidomide: effect on cancer cells “Thalidomide
makes the blood vessels hide“:
Use thalidomide to stop cancer cells from growing new blood vessels.
Tuberculosis: treatment If you forget your TB drugs, you’ll
die and might need a PRIEST“:
Pyrazinamide
Rifampin
Isoniazid (INH)
Ethambutol
STreptomycin
Warfarin: interactions ACADEMIC QACS:
Amiodarone
Cimetidine
Aspirin
Dapsone
Erythromycin
Metronidazole
Indomethacin
Clofibrates
Quinidine
Azapropazone
Ciprofloxacin
Statins
Patent ductus arteriosus: which prostaglandin keeps it open
kEEp opEn with prostaglandin E.
Carbamazepine (CBZ): use CBZ:
Cranial Nerve V (trigeminal) neuralgia
Bipolar disorder
Zeisures
Microtubules: drugs that act on microtubules. “The
MicroTubule Growth Voiding Chemicals”:
Thiabendazole
Mebendazole
Taxol
Griseofulvin
Vincristine/ Vinblastine
Colchicine
Insulin: mixing regular insulin and NPH “Not Ready,
Ready Now”:
Air into NPH
Air into Regular
Draw up Regular
Draw up NPH
Benzodiazepins: 3 members that undergo extrahepatic metabolism
“Outside The Liver”:
Oxazepam
Temazepam
Lorazepam
These undergo extrahepatic metabolism and do not form active metabolites.
Guanethidine: mechanism GuaNEthidine prevents NE
(norepinephrine) release.
Parasympathetic vs. sympathetic neurotransmitters “No
sympathy for a Pair of Aces”:
Norepinephren is secreted in by the Sympathetic nervous system
while Acetylcholine is secreted in the Parasympathetic nervous
system.
Drugs undergoing complete first pass metabolism when taken orally
‘F I L T Hy‘
First pass metabolism
Isoprenaline
Lignocaine
Testosterone
Hydrocortisone
Adrenoceptors: vasomotor function of alpha vs. beta ABCD:
Alpha = Constrict.
Beta = Dilate.
Beta 1 selective blockers “BEAM ONE up, Scotty”:
Beta 1 blockers:
Esmolol
Atenolol
Metropolol
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)
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 DND is also after me:
Desipramine
Norrtriptyline
Doxepin
Asthma drugs: leukotriene inhibitor action zAfirlukast:
Antagonist of lipoxygenase
zIlueton: Inhibitor of LT receptor
Torsades de Pointes: drugs causing APACHE:
Amiodarone
Procainamide
Arsenium
Cisapride
Haloperidol
Eritromycin
Serotonin syndrome: components Causes HARM:
Hyperthermia
Autonomic instability (delirium)
Rigidity
Myoclonus
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.
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
Therapeutic index: formula TILE:
TI = LD50 / ED50
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
Ksupplement
Diuretics: thiazides: indications “CHIC to use
thiazides”:
CHF
Hypertension
Insipidous
Calcium calculi
Ribavirin: indications RIBAvirin:
RSV
Influenza B
Arenaviruses (Lassa, Bolivian, etc.)
Parkinsonism: drugs SALAD:
Selegiline
Anticholinenergics (trihexyphenidyl, benzhexol, ophenadrine)
L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)
Amantadine
Dopamine postsynaptic receptor agonists (bromocriptine, lisuride,
pergolide)
Morphine: effects at mu receptor PEAR:
Physical dependence
Euphoria
Analgesia
Respiratory depression
Teratogenic drugs “W/ TERATOgenic”:
Warfarin
Thalidomide
Epileptic drugs: phenytoin, valproate, carbamazepine
Retinoid
ACE inhibitor
Third element: lithium
OCP and other hormones (eg danazol)
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
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 drugsy:
Valproate
Valproate
Valproate
ACTH
Carbamazepine
Ethosuximide
Tricyclic antidipressents (TCA): side effects TCA’S:
Thrombocytopenia
Cardiac (arrhymia, MI, stroke)
Anticholinergic (tachycardia, urinary retention, etc)
Seizures
Bromocriptine [for USA gang members] The CRYPTS are
an LA street gang that likes to smoke DOPE.
BromoCRYPTine is a DOPamine agonist.
Beta blockers: members “The NEPAL Prime
Minister”:
Timolol
Nadolol
Esmolol
Pindolol
Atenolol
Labetalol
Propranolol
Metoprolol
Respiratory depression inducing drugs “STOP
breathing”:
Sedatives and hypnotics
Trimethoprim
Opiates
Polymyxins
Pulmonary infiltrations inducing drugs “Go BAN Me!”:
Gold
Bleomycin/ Busulphan/ BCNU
Amiodarone/ Acyclovir/ Azathioprine
Nitrofurantoin
Melphalan/ Methotrexate/ Methysergide
Migraine: prophylaxis drugs “Very Volatile
Pharmacotherapeutic Agents For Migraine Prophylaxis”:
Verpamil
Valproic acid
Pizotifen
Amitriptyline
Flunarizine
Methysergide
Propranolol
· Bare bones version [eg Lippincott’s two], just Migraine Prophylaxis,
as above.
Benzodiazapines: ones not metabolized by the liver (safe to use in
liver failure) LOT:
Lorazepam
Oxazepam
Temazepam
Vigabatrin: mechanism Vi-GABA–Tr–In:
Via GABA Transferase Inhibition
Depression: 5 drugs causing it PROMS:
Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids
TB: antibiotics used STRIPE:
STreptomycin
Rifampicin
Isoniazid
Pyrizinamide
Ethambutol
Propythiouracil (PTU): mechanism It inhibits PTU:
Peroxidase/ Peripheral deiodination
Tyrosine iodination
Union (coupling)
Enoxaprin (prototype low molecular weight heparin): action,
monitoring EnoXaprin only acts on factor Xa.
Monitor Xaconcentration, rather than APTT.
Beta-blockers: nonselective beta-blockers “Tim Pinches
His Nasal Problem” (because he has a runny nose…):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol
Nicotinic effects MTWTF (days of week):
Mydriasis/ Muscle cramps
Tachycardia
Weakness
Twitching
Hypertension/ Hyperglycemia
Fasiculation
Muscarinic effects SLUG BAM:
Salivation/ Secretions/ Sweating
Lacrimation
Urination
Gastrointestinal upset
Bradycardia/ Bronchoconstriction/ Bowel movement
Abdominal cramps/ Anorexia
Miosis
Phenytoin: adverse effects PHENYTOIN:
P-450 interactions
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenicity
Osteomalacia
Interference with B12 metabolism (hence anemia)
Neuropathies: vertigo, ataxia, headache
Gynaecomastia-causing drugs DISCOS:
Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol
Hypertension: treatment ABCD:
ACE inhibitors/ AngII antagonists (sometimes Alpha agonists
also)
Beta blockers
Calcium antagonists
Diuretics (sometimes vasoDilators also)
Diuretics classification in order of site of action “COLT
Pee:”
· In their sequential site of action along the nephron:
Carbonic anhydrase inhibitors (at the proximal tubule)
Osmotic diuretics (at the Loop of Henle)
Loop diuretics (at the ascending loop)
Thiazides (at the distal tubule)
Potassium-sparing diuretics (at the collecting tubules)
· Diuretics make patient pee like a horse, hence “Colt Pee”.
Clopidogrel: use CLOPIdogrel is a drug that prevents
CLots, an Oral Platelet Inhibitor (OPI).
Teratogenic drugs: major non-antibiotics TAP CAP:
Thalidomide
Androgens
Progestins
Corticosteroids
Aspirin & indomethacin
Phenytoin
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
Prazocin usage Prazocin sounds like an acronym of “praszz
zour urine”.
Therefore Prazocin used for urinary retention in BPH.
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.