mechanism of action for each class of anti
TRANSCRIPT
Mechanism of action for each class of anti-Arrythmic drugs?
Use the Mnemonic: NBKC
I - Sodium Channel Blockers
II - Beta Blockers
III – K+ channel Blockers
IV - Calcium Channel Blockers
Class IA Antiarrythmics
Quinidine
Procainamide
Dispyrimide
Class IB Antiarrythmics
Lidoicaine
Tocainide
Mexiletine
Phenytoin
Class IC Antiarrythmics
Ecainide
Flecanide
Propophenone
10 Class II antiarrythmics
PPEST-BLAAC
Pindalol
Propranolol
Esmolol
Sotalol
Timolol
Butoxolol
Labetalol
Atenolol
Acebutalol
Carvedilol
Longest acting Beta blocker:
Propranolol
Shortest acting Beta blocker:
Esmolol
Beta blocker that is also K+ channel blocker:
Sotolol
Beta blockers used to treat glaucoma
Timolol
Carvadalol
Beta blocker that is also an alpha blocker
Labatalol, Carvetalol
Beta blocker that is also an agonist
Pindalol
Atenolol
Acebutalol
MC location and function for Beta1 receptors?
• CNS Increased activity
• Ciliary Muscles of eye to produce aqueus humor
• SA Node to increase HR and Contractility
• Alpha cells of pancreas to increase Glucagon
• JG cells of kidney to increase Renin release
MC location & function of 2 receptors?
• Ciliary muscles of eye to produce aqueus humor
• Bronchial Smooth muscle to bronchodilate
• Ventricles to Increase Contractility
• Beta Cells of Pancreas to cause Insulin Release
• Uterus and bladder to cause relaxation
Selective –vs- Non-selective beta blockers?
A-M (-LC) Selective N-Z(+LC) Nonselective
Antiarrythmic causing hemolysis & thrombocytopenia
Quinidine
Fastest acting Na+ channel blocker
Lidocaine
3 antiarrythmics that block 95% of sodium channels
Ecainide
Flecanide
Propophenone
Antiarrythmic that Causes Cinchinism
Phenytoin
Antiarrythmics that cause pulmonary fibrosis
Tocainide
Amiodarone
Antiarrythmics that cause Gingival Hyperplasia
Phenytoin
Antiarrythmic that causes hersutism
Phenytoin
Antiarrythmics used to treat WPW
Quinidine
Procainamide
Phenytoin
Antiarrythmic that is contraindicated in WPW
Digitalis
Antiarrythmics Used to Treat ventricular arrythmias
Class I antiarrythmics
Antiarrythmics Used to
Treat Atrial Arrythmias
Class IV antiarrythmics
Antiarrythmics that causes blue skin (Smurf syndrome)
Amiodarone
Antiarrythmics causing Bad GI upset
Mexiletine
Antiarrythmic that causes Hyper/hypo-thyroidism
Amiodarone
Antiarrythmics Used to decrease vasospasms after subarrachnoid hemorrhage.
Nimodipine
Symptoms of cinchinism?
Tinnitus
Hearing loss
Thrombocytopenia
Two action of Digitalis?
• Blocks potassium arm of NA-K ATPase causing increased contraction
• Stimulates vagus, slowing HR.
Pulmonary fibrosis Rx
Busulfan
Bleomycin
Tocainide
Amiodarone
What is the most common SVT in teenagers?
Wolf-Parkinson White
Pathology of WPW?
There is an accessory pathway from SA node bypassing AV node to ventricle called the Bundle of Kent.
Why are 3 Na+ blocker used to treat WPW?
They are both Na+ and Ca2+ channel blockers.
EKG finding of WPW?
Delta waves.
Antiarrythmic made from iodine?
Amiodarone
Name the class IV antiarrythmics
Verapamil
Ditiazem
Nifedipine
Nicardipine
Nimodipine
Amlodipine
Femlodipine
Cardioselective class IV antiarrythmics?
Verapamil
Diltiazem
Most potent Class IV antiarrythmic?
Verapamil
4 K+ Channel Blockers:
Amiodarone
Bretylium
NAPA NAcetyl-Procainamide)
Sotalol
How do you determine when to use Dopamine –vs-Dobutamine?
DoButamine Low HR
DoPamine Elevated HR
Receptor Dopamine affect 1st, 2nd, at high doses
D2- Dilate Kidney & GI TPR
Beta 1 HR & Contractility
Alpha 1 Vasoconstrict
What conditions give you Shock & Bradycardia?
Cholinergic crisis
Heart Block
Clues for Cinchonism
Tinitis
Hearing Loss
Thrombocytopenia
Name 7 Antimetabolite Chemotherapy drugs
ARA-A
ARA-C
Azothiprine
5-FU
6-Mercaptopurine
Methotrexate
Thioguanadine
Which cancer are treated with antimetabolites?
Fast growing cancers
Which cancers are treated with alkylating agents?
A slow growing cancer
5-FU is use to treat which cancer?
Duke stage C Colon Cancer in combination with levamisole
3 drugs used to treat steroid resistant disease
Methotrexate
Azothioprine
Cyclosporin
5-FU mechanism of action Inhibits Thymidilate synthetase
Methoterxate mechanism of action
Inhibits dihydrofolate reductase
To what substance is 6-Mercaptopurine metabolized
Uric acid
How do alkylating agents work?
They bind dsDNA and prevent it from unwinding for replication
Name 13 alkylating agent
Chemotherapy drugs
Adriamycin
Acridine
Bleomycin
Busulfan
Chlorambacil
Cyclophosphamide
Cisplatin
Dacarbazine
Hydroxyurea
Isophosphamide
Mitomycin
Mechlorethamine
Procarbazine
Drugs that cause pulmonary fibrosis
Bleomycin
Busulfan
Amiodarone
Tocainide
Favorite Alkylating agent
Clorambucil
Favorite Antimetabolite
Methotrexate
Drug that causes cardiac fibrosis
Adriamycin (Doxarubicin)
Chemo drug that causes hemorrhagic cystitis
Cyclophosphamide
Chemo drug that causes renal failure
Cisplatin
Chemo drug used to treat sickle Cell
Hydroxyurea
How does hydroxyurea work?
It inhibits Ribonucleotide Reductase
Which two alkylating agents form free radicals
Cyclophosphamide
Adriamycin
Rescue for patient on Adriamycin
Desroxazine Rescue
Rescue for patient on Cyclophosphamide
MESNA Rescue
Rescue for patient on Methotrexate
Leucovorin Rescue
Three alkylating agents used to treat Hodgkins Lymphoma
Mechlorethamine
Dacarbazine
Procarbazine
Name 7 microtubule Inhibitor chemotherapy drugs
Vincristine
Vinblastine
Paclitaxel
Name 1 nutrient depleater chemotherapy drugs
L-Aparaginase
Name 1 immune modulator
Levamisole
How does Levamisole work?
It enhances NK cells
Which Microtubule inhibitor causes neuropathies?
Vincristine
Which Microtubule inhibitor causes aplastic anemia?
Vinblastine
Which Microtubule inhibitor inhibits microtubules after they are made?
Paclitaxil
For what cancer is Paclitaxil used?
Breast
What is the main side effect of L-arginase?
Anaphylaxis
Symptoms of Cholinergic crisis
SLUDGE
Salivation
Lacrimation
Urination
Defication
GI Upset
Emesis
Symptoms of Anticholinergic crisis
Hot as a Hare
Dry as a Bone
Red as a Beet
Mad as a Hatter (Crazy)
Give the location of Alpha 1 receptors
• Radial muscles of the eye to cause Mydriasis without cyclopledgia
• All sphincters
• Arteries to constrict
Give the location of Alpha 2 receptors
• All Presynaptic sympathetic fibers to inhibit NE
• Beta cell of the pancreas to IHN Insulin
What drugs are used to treat HTN in pregnancy?
Alpha-methyl Dopa
Hydralizine
Name 3 alpha 2 agonists
Alpha-Methyl Dopa
Guanabenz
Clonidine
Side effect of Clonidine
Rebound HTN
Side effect of alpha-methyl Dopa
Hemolytic anemia
Anticholinergic drugs
Atropine
Scopalomine
Glycopyrrolate
Bentropine
Trihexyphenadyl
Which anticholinergic is the drug of choice for heart block?
Atropine
Which anticholinergic is used to treat dystonia?
Benztropine
2 Anticholinergics used dry up secretions pre-OP?
Atropine
Scopalomine
Which AchE inhibitor is used to diagnose Myesthenia Gravis?
Edrophonium
Which AchE inhibitor is used to Treat Myesthenia Gravis?
Neostigmine
Pyridostygmine
Why is physostigmine not used to treat Myethenia Gravis?
Too much CNS penetration causing drowsiness
Anticholinergic used to treat organophosphate poisoning
Atropine
What is the mechanism of action of Roloxafen and Tomoxafen?
• INH estrogen receptor at pituitary and Breast
• Pro-estrogen at bone
• Pro-estrogen at liver
Which estrogen receptor blocker promotes enometrial cancer? How?
• Tomoxafen
• Because it stimulates the Endometrium
List 2 alpha blockers used to treat BPH
Terazocin
Doxazocin
What is the MOA of Finesteride?
It is a 5-Alpha-reductase inhibitor
What are the treatment options for BPH?
#1- Terazocin, Doxazocin
#2- Finesteride
#3-TURP
MOA of Heparin
Cofactor for ATIII with allow inhibition of Thrombine and factors 9-12
MOA of Warfarin
IHN Vitamin K and thereby factors 10, 9, 7, 2, Protein C, and Protein S
For what is Vitamin K needed?
Gama-carboxylation in the liver
What drug can be used acutely to inhibit GPIIb:IIIa?
Abscixamab
Name three drugs that can be used to inhibit ADP production in the clotting cascade
Ticlopidine
Clopidogrel
Dipyridamole
Which are the side effects of Ticlopidine?
Seizures
Agranulocytosis
Clue for Dipyridamole
Vasodilator used after MI to dilate coronaries
Clue for Clopidogrel
Decreased mortality in combination with ASA in those with risk factors
RX for PCP
Trimethaprim/Sulfamethoxazole
Rx For Patients Allergic to TMP/SULFA
Pentamidine
RX for Leishmania
Stybogluconate
Treat MAI with
Clarithromycin.
Best Rx for C.dif colitis
Vancomycin
Current Rx for C.Dif colitis
Metronidazole
Pregnant woman’s rectum culture returns (+) for Group B Strep. Rx with?
Ampicillin
Treatment for Hookworms
Mebendazole
Stongyloides
Thiabendazole
What is the treatment for flatworms?
Hyclosamine & Niclosamine
How do Hyclosamine & Niclosamine work?
They paralyze the worm's nervous system
What drugs are used to treat Malaria?
Chloroquine
Mefloroquine
Primaquine
Quinine
One dose treatment for candidiasis?
Fluconazole
Imidazole that crosses (BBB)?
Fluconazole
Imidazole inhibits P450?
Ketoconazole
How is it treated?
Tinea Capitis - Griseofulvin
The Infection (Staph Aureus) - Antibiotics
The Inflammatory infection – Steroids
Rx for LYME'S disease?
Penicillin – First Line
Tetracylcinis
4 drugs you can use to treat Herpes?
Pencyclovir - TID
Acyclovir - Five (5) times a day
Demcycovir - TID
Vancyclovir – BID
Rx for CMV
Gancyclovir
Rx for Shingles
Famcyclovir
Rx for RSV
Ribavarin
Rx used to sop viral uncoating
Ramantidine
Amantidine
Rx used to sop viral uncoating
Ramantidine
Amantidine
How soon must Ramantidine & Amantadine must be given?
Within seventy-two (72) hours of exposure
Why do you profiles contacts of people with Influenza with Amantadine for two (2) weeks?
Because IgM takes two (2) weeks to show up.
SE of Ramantadine & Amantadine
Anticholinergic Side effects
Anticholinergic -vs- Sympathetic drugs?
Anticholinergic drugs will not allow you to sweat, but Sympathetic drugs will.
Why is Amantadine used in Parkinson disease?
Amantadine promotes Dopamine release
How does griseofulvin work?
It inhibits microtubules leading to inhibition of fungal replication.
How is Griseofulvin delivered to the infected site?
Through the sweat
How do the IV/Oral antifungal work?
By inhibiting the synthesis of Ergosterol
Topical(creams) antifungal work by?
They bind to Ergosterol and destroy it (Poke holes in the membrane)
What topical antifungal is parenteral?
Amphotericin B
Hyperkalemia + Amphotericin mean?
Systemic Toxicity due to destruction of cholesterol in the cell membrane leading to leaking of K+ into cytoplasm.
Hypokalemia + Amphotericin mean?
Nephotoxicity due to destruction of the cholesterol in the kidney cells and K+ leaks out in urine.
Side Effects of Amphotericin?
Hypokalemia
Hyperkalemia
Renal Failure
2 fungal infections Rx by Griseofulvin?
Tinea Capitis and Tinea Versicolor
What four drugs are used to treat anaphylaxis?
• Epinepherine
• Steroids
• Cromoly/Nadacromyl
• Anti-Histamines
What is a side effect of Cromoly and Nadacromyl?
GI Upset
MOA of Cromoly and Nadacromyl?
Stabilize Mast Cell membranes
Which has a higher affinity for Alpha receptors Epinepherine of Norepinepherine?
Norepinepherine
What receptors does epinephrine have a higer affinity for?
Beta Receptors
What receptors do first generation antihistamines block?
H1
Name 5 class I antihistamines
Diphenhydramine
Hydroxazine
Dramamine
Phenylpropophenolamine
Phenturamine
What sideeffect is seen with 1st generation anti-histamines?
Strong Anti-Cholinergic effects
Anti-histamine to Rx motion sickness
Dramamine
Anti-histamine that is part of Phen-Phen
Pheturamine
Anti-histamine pulled off market due to arrythmias
Phenylpropanolamine
MC over-the-counter anti-histamine
Diphenhydramine (Benedryl)
Anti-histamine used to Rx Vertigo
Hydroxazine (Aderax)
Disease where person passes out with positional change
Benign Positional Vertigo
Clues for Miner’s disease
• Vertigo from Middle Ear
• Hearing Loss
• Too much Endolymph
• Tinitis
2nd generation Anti-Histamines
Ephedrine
Pseudephedrine
Phenylephrine
Over the counter 2nd generation Anti-Histamines
Ephedrine
2nd generation Anti-Histamine used to treat Neurogenic Shock
Phenylephrine
Which 2nd generation Anti-Histamines
Can be used to tighten sphincters
Pseudephedrine
Only class of drugs that give Mydriasis without cycloplegia?
Alpha agonists
Name 4 H2 blockers
Cimetidine
Rinitidine
Famotidine
Nizatidine
Which H2 blocker revs up the P450 system?
Cimetidine
List (5) 3rd Generation Anti-Histamine
Terfenadine
Loratadine
Citrerizine
Fesofenodine
Astemazol
3rd Generation Anti-Histamine can treat both indoor and outdoor allergies
Fexofenidine (Allegra)
Benefit of 3rd Generation Anti-Histamine
Once a day dosing
What is a side effect of ACE-Inhibitors and ARBs?
Angioedema
9 Live Vaccines
MMR
BCG
RSV
Smallpox
Rotavirus
Polio
Yellow Fever
Vaccines contraindicated with egg allergy
MMR
Influenza
What changes are made in vaccination at age 6yo?
DPT dT
Drop Hib
If a child has any reaction to DPT what should you do?
Give acellular Pertuus (aP)
Which live vaccine cas still be given to AIDS patients?
MMR
5 actions of Anesthetics
Anesthesia – Total block of sensory info
Analgesia – Blocks pain
Muscle Relaxation
CNS depressant
Sensitize heart to NE
What complication of surgery is due to the muscle relaxation ability of anesthetics?
Aspiration
Uninary retention
Decrease GI motility
Relaxed diaphram Atelectasis
DVT
Pneumonia
What 2 drugs are used for post-op urinary retention?
Carbachol
Bethanichol
Which inhaled anesthetic does not sensitize the heart to NE?
Isoflurane
Inhaled anesthetic which causes hepatic necrosis?
Halothane b.c. it contains Bromine
Only depolarizing anesthetic used
Succinyl-Choline
Clues for Ketamine
Dissociative Anesthesia
Patient is awake
Vivid dreams on waking
How do all anesthetics work?
They are sodium Channel blockers
Rule for AMIDE –vs- ESTER anesthetics
I before “CAINE” Amide Fat soluble
No I before “CAINE” Ester water sol
What anesthetics cause Malignant Hyperthermia?
Succinyl-Choloine
Halothane
What is the treatment for Malignant Hyperthermia?
Dantroline
Name 11 most common Opiates
Heroine
Methadone
Morphine
Meperidine
Fentanyl
Codeine
Dextromethorphan
Hydrocodone
Loperimide
Diphenoxylate
Pentazosin
What are three effects of Opiates
CNS Depressants – Mu-Receptors
Analgesics – Kappa-Receptors in S.C.
Muscle Relaxants
Most abused Opiate
Heroine
Opiate used for Neurolep Anesthesia with Resperidone
Fentanyl
Longest acting Opiate
Methadone
MC used Opiate in hospitals for severe pain?
Morphine
MC abused Opiate by physicians
Meperidine does not constrict pupils
Most Potent Opiate
Fentanyl
Opiate used for Mild/Moderate pain
Codeine
MC over-the-counter Opiate
Dextromethorphan
Opiates that can be used as Antitussives
Codeine
Dextromethorphan
Opiate that comes in a patch form
Fentanyl
Opiate that does not constrict the sphincter of Odi
Meperidine
Opiate that causes Histamine release
Morphine
Opiate that causes Catecholamine release
Meperidine
Opiate that should not be used in head injuries b.c. it causes cerebral edema
Morphine
Opiate used to weak patient off Heroine
Methadone
Opiate used for moderate pain
Hydrocodone
Codeine
Opiates used to treat diarrhea
Loperimide (Lomotil)
Diphenoxilate (Imodium)
Opiate that is also a blocker
Pentazosin
5 Anti-Inflammatory effect of steroids
• Kill T-Cells and Macrophages
• Inhibit Macrophage Migration
• Inhibit Phospholipase A2
• Inhibit Mast Cell degranulation
• Stabilize Endothelium
Drugs to treat parkinsonism
B - Bromocriptine
A - Amantadine
L – Levodopa/Carbidopa
S - Selegeline
A – Anti-Cholinergics
Name the Steroid used PO
Prednisone
Name the Steroid used Topically
Hydrocortisone
Name the Steroid used IV
Methylprenisalone
Name the Steroid used as and inhaler
Triamcinalone
Steroid with the best CNS penetration
Dexamethasone
Steroid with best mineralocorticoid action
Fludrocortisone
Steroid used for nasal allergies
Futicasone
Nematosone
Steroid used to stimulate surfactant production is premature babies
Betamethasone
Beclmetasone
In what population is Cromalyn and Nadacramyl used?
Any asthmatic that uses a beta-agonist more than once a day.
MOA for aspirin’s (ASA) anti-inflammatory action
Irriversibly inhibts cyclo-oxygenase
MOA for NSAID’s
Reversibly inhibts cyclo-oxygenase
Uses for ASA
2nd Strokes
ALL MI’s
Side Effects of Asprin
GI Bleeding
Tinitus
Thrombocytopenia
When should you stop ASA in a patient Pre-OP?
Two Weeks Pre-OP
MOA for ASA’s Anti-Coagulation effects
Indication for NSAID’s
Mild to Moderate Inflammatory pain
Side Effects of NSAID’s
GI Bleed
Renal Failure
Interstitial Nephritis
Main Over the counter NSAID
Ibuprophen
NSAID used to close PDA
Indomethacin
NSAID used for dysmenorrhea
Naproxyn
NSAID as strong as Morphine
Ketoralac
NSAID with Anti-Cholinergic SE
Cyclobenzaprine
NSAID with GABA effects for back pain
Baclophen
Most potent NSAID
#1 Indomethacin
#2 Phenybutazone
NSAID used 2nd line for Gout
Indomethacin
What two drugs block Leucotriene receptors?
Zirfurlekast
Montelekast
What drug inhibits Lipoxygenase?
Zilutin
Name 3 COX inhibitors
Celecoxib
Rofecoxib
Valdecoxib
Which COX Inhibitor contains Sulfer?
Celecoxib
MOA for sulfonylureas
Cause K+ influx into the Islet cells and cause release of preformed Insulin
Which sulfonylureas enhance glucose transport into peripheral tissue?
Glipizide
Glyburide
Hyperglycemic drugs that Inhibit Glucoase absorption in GI track
Ascarbos
Miglitol
Name the 1st generation Sulfonylureas
Chlorprpamide
Tolbutamide
Tolezalide
Name the 2nd generation Sulfonylureas
Glipizide
Glyburide
Which sulfonylurea causes SIADH?
Chlorpropamide
Side effects of 1st generation sulfonylureas
• Sulfur Allergy
• Interstitial Nephritis
• Hemolytic Anemia
• Methhemoglobinemia
How does Metformin work?
Inhibits gluconeogenesis in the liver
Side effect of Metformin
Reacts with IV contrast damages kidney
Severe Metabolic Acidosis
(4) Hopoglycemic drugs that upregulate insulin receptors
• Pyoglitazone
• Troglitazone
• Repaglinide
• Roglitazone
What blood gases will you see with Immediate (early) ASA toxicity?
Resp Alkalosis - PCO2 pH
MC gases seen with ASA toxicity?
Mixed - PCO2 pH HCO3-
What blood gases will you see with late (obtunded/comatose) ASA toxicity?
Combined - PCO2 pH HCO3-
Treatment of ASA overdose
HCO3-
List the Atypicals
• Mycoplasma
• Chlamydia
• Legionella
• Ureoplasma
Simple Gm(-)
E.Coli
H. Influenza
MOA of Quinalones
Inhibit Topoisomerase
Coverage of Quinalones
All GM(+) + Staph aureus
Simple Gm(-)
ALL Atypicals
Name the quinaolones
• Ciprofloxacin
• Gatifloxacin
• Ofloxacin
• Norfloxacin
• Trovofloxacin
Which quinalone caused liver failure
Trovofloxacin
Which quinalone is the most acidic
Norfloxacin
MOA of Rifampin
Inhibits Beta subunit of RNA Polymerase
Coverage of Rifampin
Treatment for TB
Prophylax contacts of H. Influenze
Prophylax contacts of Neissaria
Side effects of Rifampin
• Incr. P450
• Myositis
• Hepatitis
• Orange Secretions
How soon must you prophylax contact with Rifampin?
Within 72 hours
MOA of Macrolides
Inhibit 50s subunit by inhibiting translocation
Coverage of Macrolides
All GM(+) + Staph aureus
Simple Gm(-)
ALL Atypicals
Side effects of Macrolides
Inhibit P450
Gi Upset
Dysgusia
Name the macrolides
• Erythromycin
• Clarithromycin
• Azithromycin
Macrolide with the longest ½ life
Azithromycin
Antibiotic treatment for Mycobacterium Aviun Intracellulare
Azithromycin
Clarithromycin
Macrolide with the most dysgusia
Clarithromycin
Macrolide with the most GI Upset
Erythromycin
One dose treatment for GC
• Ceftriaxone – 250mg IM
• Cefixime
• Cefoxetin
• Ciprofloxacin – 500mg PO
• Gatifloxacin – 400mg PO
• Ofloxacin – 400 mg PO
MOA of Clindamycin
Inhibit 50s subunit by inhibiting translocation
Coverage of Clindamycin
All GM(+) + Staph aureus
Simple Gm(-)
Anaerobes
MCC pseudomembranous colitis
Clindamycin
MOA of Tetracyclines
Inhibit 30s subunit by inhibiting t-RNA
Name the Tetracyclines
• T(4)
• Oxytetracycline
• Minocycline
• Doxycycline
• Damecocycline
Coverage of Tetracyclines
All GM(+) minus Staph aureus
Simple Gm(-)
ALL Atypicals
Ricketsial Infections
Tetracycline used to treat Acne
Minocycline
Tetracycline that is Hepatically excreted
Doxycycline
Tetracycline that blocks ADA receptors in kidney and causes nephrogenic DI
Domicocycline
Side Effects of Tetracyclines
• GI Upset
• Pill Esophagitis
• Photosensitivity
• Fanconi syndrome
• Binds Ca2+ in GI
• Incr. P450
• Turns teeth Gray
MOA of Pyramycin
Inhibits the A site of the 50s subunit
MOA of Chloramphenicol
Inbibits the 50s subunit by inhibiting Peptidyl-Transferace
Coverage of Chloramphenicol
Gm(+) + Staph Aureus
Ricketsial Infections
Side Effects of Chloramphenicol
Gray baby Syndrome
Aplastic Anemia
How does Chloramphenicol Cause gray baby syndrome?
They Inhibit ETC Complex IV
MOA of Aminoglycosides
Inhibits the 30s subunit by inhibiting EF2
Coverage for Aminoglycosides
ALL Gram negatives
How do Aminoglycosides cause neurotoxicity?
They Inhibit the presynaptic influx of Calcium
Name the Aminoglycosides
GASS Toll No Kash
G – Gentamycin
A – Amikacin
S – Streptomycin
S - Spectinomycin
T – Tobramycin
N – Neomycin
K – Kentamycin
Aminoglycoside that is hepaticaaly excreted
Amikacin
Aminoglycosides used in triple antibiotic
• Neomycin
• Polymixin B
• Bacitracin
Aminoglycoside with the most side effects
Gentamycin
Aminoglycoside used to treat TB
Streptomycin
Side effects of Aminoglycosides
Ototoxicity
Nephrotoxicity
Neurotoxicity
How do Aminoglycosides cause neurotoxicity?
They Inhibit the presynaptic influx of Calcium
Causes of dysgusia
Zn2+ deficiency
Metronidazole
Macrolides
Which drugs cause Nephrogenic DI
Lithium
Damicocycline
Which part of the triple anti-biotic ointment is responsible for a rash?
Neomycin
MOA of Vancomycin
Inhibits cell wall synthesis by inhibiting the Phospholipid carrier
Coverage for Vancomycin
GM(+) + Staph Aureus
Enterococcus
Staph epidermidis
Side Effects of Vancomycin
• Ototoxic
• Nephrotoxic
• Red man Syndrome
Why does Vancomycin cause Redman syndrome?
Infusion is too fast and causes histamine release
MOA of Metronidazole (Flagyl)
Causes release of free radicals
Coverage for Metronidazole
All Anaerobes
Gardnerella
Protozoa
Side effects of Metronidazole
• Dysgusia
• Disulfram Reaction
• G6PD
• Methemoglobinemia
• Hemolytic Anemia
Big mama drugs for anaerobes
• Metronidazole
• Clindamycin
• Cefoxatin
How do sulfa drugs work?
They inhibit PABA
5 Sulfa drugs
• Sulfamethoxazole
• Sulfadiazine
• Sulfapyrizone
• Sulfaqsalazine
• Sulfacetmide
(2) drug used with Sulfa drugs that block Dihydrofolate reductase?
Trimethaprim
Pyrimethamine
Coverage of sulfadrugs
Gm(+) + Staph aureus
Simple Gm(-)
Treatment for PCP and UTI’s
Sulfamethoxazole/Trimethoprim
Sulfa drugs used to treat burn patients
Sulfadiazine (silvadine)
Sulfa drugs used to treat Toxoplasmosis
Sulfadiazine/Pyrimethamine
Sulfa drug that comes in an eye drop
Sulfacetamide
3 Sulfa drug used to treat ulcerative colitis
• Sulfapyrizone
• Sulfasalazine
• Silfacetamide
MOA of Penecillins
Cell Wall inhibitors by inhibiting transpeptidation
Coverae for ALL Penecillins
Gm(+) not Staph Aureus
ALL Simple Anaerobes
Side effects of Penecillins
• Anaphylaxis
• Drug rash
• Interstitial Nephritis
• Hemolytic Anemia
Differentiate between the 2 simple Penecillins
PEN V - PO
PENG - IV
Two Extended spectrum Penecillins
Amoxacillin
Ampicillin
What coverage do the extended spectrum PCN’s add?
Simple Gm(-) coverage
What is added to the simple PCN’s to cover Staph Aureus?
Amoxacillin/Clauvulinic Acid
Ampicillin/Sulbactam
Extended spectrum Penecillins which causes Jarisch-Herxeheimer reaction?
Ampicillin
What infections are the most common causes of Jarisch-Herxeheimer reaction?
• EBV
• CMV
• Syphilis
Drug of choice for UTI inpregnant women
Ampicillin/sulbactam
MC used in pediactrics
Amoxacillin (pink stuff)
5 Anti-Staph PCN’s (Beta Lactamase resistant)
• Metahcillin
• Nafcillin
• Oxacillin
• Cloxacillin
• Dicloxacillin
MCC of Interstitial Nephritis
#1 Methacillin
#2 Ampicillin
3 PO Anti-Staph PCN’s
• Oxacillin
• Cloxacillin
• Dicloxacillin
IV Anti-Staph PCN
Nafcillin
Anti-Staph PCN with a high Sodium load
Nafcillin
5 Anti-Pseudomonal PCN’s
• Pipercillin
• Ticarcillin
• Azocillin
• Mezocillin
• Carbenicillin
Anti-Pseudomonal PCN with a high sodium load
Carbenicillin
What drug are added to the Anti-Pseudomonal PCN’s to cover staph
Pipercillin/Tazobactam
Ticarcillin/Clauvulnic Acid
MOA of Cefalosporins
Cell Wall inhibitors by inhibiting transpeptidation
Coverage of Cefalosporins
Gm(+) + Staph Aureus
Simple Gm(-)
1st generation Cephalosporin that is parenteral
Cefazolin
1st generation Cephalosporin that is the #1 cause of Interstitial Nephritis
Cephalotin
Name 5 1st generation Cephalospoirins
• Cefazolin
• Cefalotin
• Cefalexin
• Cefadoxil
• Cefadroxil
Name 5 2nd generation Cephalospoirins
• Cefaclor
• Cefotetan
• Cefomandol
• Cefuroxime
• Cefoxatin
Name 6 3rd generation Cephalospoirins
• Ceftriaxone
• Cefixime
• Cefotaxime
• Ceftazidine
• Cefperazome
• Maxalactam
Most commonly used Cefalosporin in children
Cefaclor
Cefalosporin used to treat H. Influenza B
Cefuroxime
Cefalosporin used to treat Anaerobes
Cefoxatin
Cefalosporin with the best CNS penetration
Ceftriaxone
Hepatically excreted Cefalosporin
Ceftriaxone
First line for Meningitis > 2 month old
Ceftriaxone
First line for Meningitis < 2 month old
Cefotaxime
First line for Pseudomonas
Ceftazidine
Four Cefalosporins with MTT side chains
• Cefotetan
• Cefomandol
• Cefaperazone
• Moxalactam
What does the MTT chain do?
Inhibits Vitamin K
Only oral 3rd generation Cefalosporin
Cefixeme
Drugs that cause a disulfram reaction
Cefotetan
Cefomandol
Metronidazole
Cefalosporin with the highest allergic reaction in Pediatrics
Cefaclor
MOA Of Benzodiazapines
Increase GABA channel Frequency
Indication for Benzodiazepines
Anxiety
Insomnia
Seizure
Muscle Cramps
What is the cause of death for Benzo’s and Barbituates?
Respiratory Failure
Which Anxiolytinc is used for people who cannot be sedated?
Bupropion
Name (10) Benzodiazepines
Floureapam
Zolpiden
Oxazepam
Triazelam
Tomazepam
Diazepam
Lorazepam
Clonezapam
Chlordiazepoxide
Midazolam
Shortest Acting Benzo
Florezepam
Longest Acting Benzo
Zolpidem
Medium duration Benzo
Oxazepam
Triazelam
Benzo used for elderly who have trouble initiating sleep
Triazelam
Benzo used with 20 minutes antegrade amnesia
Triazelam
Benzo used for people who have difficulty maintaining sleep
Tomazepam
(4) Benzos MC used for Seizures
• Diazepam
• Lorazepam
• Clonazepam
• Chlordiazepoxide
(2) Benzos MC used for Status Epilepticus
• Diazepam
• Lorazepam
Benzo MC used for Absance Seizures in children
Clonazepam
Benzo MC used for restless leg syndrome
Clonazepam
Benzo that comes in sopository
Diazepam
Benzo that is best for anxiety in middle aged females
Lorazepam
Benzo MC used for Alcoholic withdrawal
Chlordiazepoxide
Benzo used for short procedures
Midazelam
Benzo with 45min antegrade amnesia
Midazelam
Antedote for Benzo Overdose
Flumazenil
MOA of Barbituates
Increase GABA channel Duration
Indication for Barbituates
Insomnia
Seizure
Muscle Cramps
Why are Barbituates not indicated for Anxiety
Because they are too sedating
Longest acting barbituate
Phenobarbital
Shortest acting Barbituate
Thiopental
Barbituate most commonly abused on the street
Secobarbital
Treatment for Barbituate Overdose
HCO3- + Doxapram
Barbituate most commonly used for generalized seizures on children
Phenobarbital
3 drugs used to treat Bipolar
#1 Lithium
#2 Valproic Acid
#3 Carbamazapine
MOA of lithium
Looks like Sodium and stabilizes cell membranes
Side effects of Lithium
• Hyponatremia
• Hypothyroidism
• Hyperthyroidism
• Hypercalcemia
• Hypophosphatemia
• Nephrogenic DI
• Epsteins Anomoly
How does Lithium cause Nephrogenic DI?
It inhibits ADH receptors are the kidney
How does Lithium cause Hyponatremia?
Because it looks like Sodium, the kidney hold onto it instead of Sodium
How does Lithium cause hypothyroidism?
How does Lithium cause
How does Lithium cause hypercalcemia?
It binds to PTH receptors
MOA of Carbamazapine
Sodium Channel Blocker
Side effects of Carbamazepine
Agranulocytosis
SIADH
Indication for Carbamazepine
• Temporal Lobe Seizures
• 3rd Line for Bipolar Disorber
• Shooting Neuropthy
How does Carbamazapine cause SIADH
It stimulates the ADH receptors in kidney
MOA of Valproic Acid
Indication for Valproic Acid
• 2nd Line for Bipolar
• 1st Line for Myotonic Seizures
• 1st Line for Mixed Seizures
Side Effects of Valproic Acid
BM Suppression
What is the main cause of depression
Serotonin
Norepinepherine
MOA of Tri-Cyclic Anti-depressants
Blocks reuptake of ALL Catecholamines
Strong Anti-Cholinergic affects
Block 1 receptors by accident
Block A-V conduction in heart
Clue for Anti-Cholinergic effects
Sympathetic with Hot Dry Skin
Name (5) TCA’s
C - Clomipramine
A - Amitryptaline
N - Nortryptaline
D - Desipramine
I - Imipramine
TCA used for bedwetting in children
Imipramine
TCA used for Chronic Pain or neuropathy
Amitryptaline
TCA used for OCD
Clomipramine
Shortest acting TAC’s
Nortryptaline
Desipramine
MOA of SSRI’s
Inhibit the reuptake of Serotonin
Name (4) SSRI’s
F - Fluoxetine
L – Luvoxatine
i
P - Paroxatine
S – Sertraline
Side effects of SSRI’s
Anorgasmia
Name (4) MAOI’s
P - Phenylzine
I - Isocarboxazid
T - Tranylcypramine
S - Selegeline
Foods avoided when on MAOI’s
Wine and Cheese
Wine & cheese contraindicated with MAOI’s because
The interaction can cause Seratonin Syndrome
When switching from SSRI to MAOI, how long is the washout period?
One Month
Name the MAOBI
Selegeline
MOA of Bupropion
Blocks reuptake of Seratonin
Indication for Bupropion
• Used if sexual dysfunction occurs with other antidepressants
• Help stop smoking
Side effects of Bupropion
Decreased Seizure threshold
Indications for Electroconvulsive Therapy
Person who is actively suicidal or with intractable depression
#1 Side effect of ECT
Amnesia
Treatment for Methemoglobinemia
Methyline Blue
Rx for Acute intermittent Porphorya
• Sugar
• Fluids
• Hematin
How does Hematin Work?
It inhibits D-ALA Synthase
Treatment for Cyanide Poisoning
• Amylnitrate
• Sodium Thiosulphate
• Methyline Blue
• Transfusion
Rx for Carbon Monoxide Poisoning
Hyperbaric Oxygen
Rx used for the Used for the Cystic Fibrosis sweat test & to Treat glaucoma
Pilocarpine
For what was Methacholine Previously used?
To diagnose Asthma because is Causes Broncho spasm
How do Amphetamines work?
They cause the release of preformed catecholamines.