CENTRAL NERVOUS SYSTEM

CHOLINERGIC AGONISTS Direct Acting Agonists 1. Acetylcholine 2. Bethanecol 3. Carbachol 4. Pilocarpine 5. Methacholine 6. Nicotine Indirect Acting Agonists (anticholinesterase) 1. Organophosphates a. Isoflurophate b. Echothiophate c. Parathion 2. Edrophonium 3. Physostigmine Glaucoma 4. Neostigmine 5. Pyrostigmine

Cholinesterase Reactivator 1. Pralidoxime Chemical antagonist used to regenerate cholinesterase Second line drug for organophosphate poisoning

CHOLINERGIC ANTAGONISTS Muscarinic Blockers 1. Atropine The first line medication for cholinesterase inhibitor poisoning includes atropine and the second medication that is used is pralidoxime. 2. Scopolamine 3. Homatropine 4. Cyclpentolate 5. Tropicamide 6. Pirenzepine Other Muscarinic Blockers 1. Anti-Parkinsons drugs: Benztropine 2. Anti-Depressants: Chlorpromazine 3. Anti-Histamines: Diphenhydramine 4. Anti-Asthmatics: Ipratroprium

5. Over Active Bladder: Oxybutynin Neuromuscular Blocking Agents 1. Non- Depolarizing Blocking Agents a. Turbocurarine b. Pancuronium c. Atracurium d. Vecuronium 2. Depolarizing Blocking Agents a. Succinylcholine 3. Ganglionic Blockers a. Nicotien b. Hexamethonium c. Mecamylamine d. Trimethepham

ADRENERGIC AGONISTS- SYMPATHOMIMETICS Alpha Selective Direct Acting Agonists 1. Phenylephrine 2. Methoxamine 3. Clonidine 4. Methyldopa Beta Selective Direct Acting Agonists 1. Dobutamine 2. Isoproterenol 3. Albuterol 4. Metaproterenol 5. Terbutaline 6. Salbuterol Alpha and Beta Selective Direct Acting Agonists 1. Epinephrine 2. Norepinephrine 3. Dopamine Indirect Acting Adrenergic Agonists 1. Tyramine 2. Amphetamine 3. Cocaine Mixed- Direct and Indirect Adrenergic Agonists 1. Ephedrine 2. Metaraminol

ADRENERGIC AGONISTS Alpha blockers 1. Alpha 1 Selective Inhibits alpha 1 receptors on blood vessels st 1 dose orthostatic hypotension When prozosin is first started heart rate and contractility rise to maintain homeostasis because the drug lowers blood pressure. After an extended time period on the drug, blood pressure is lowered while heart rate and contractility return to normal. a. Prazosin b. Doxazosin c. Terazosin 2. Alpha 1A Selective a. Tamulosin 3. Non- Selective a. Phenoxybenzamine Irreversible b. Phentolamine Reversible 4. Alpha 2 Selective a. Mirtazapine b. Yohimbine

Beta blockers 1. Beta 1 Selective a. Atenelol b. Esmolol c. Acebutolol d. Metoprolol e. Betaxolol 2. Non- Selective a. Pindolol b. Lebetalol c. Propranolol d. Timolol e. Nadolol 3. Beta blockers with intrinsic sympathomimetic activity (partial beta agonists) a. Acebutolol b. Pindolol 4. Beta blockers with alpha 1 blocking activity a. Labetalol b. Carvedilol c. Butoxamine Phenylephrine: an alpha agonist- will cause vasoconstriction which increases BP. Phentolamine: : an alpha 1 blocker which would directly reduce BP.

Methacholine: is a muscarinic agonist which would cause vasodilation mediated by synthesis of NO. directly slows heart rate- (would not be inhibited by ganglionic blocker) Isoproterenol: non-selective beta agnosist. It would casue vasodilation via beta 2 and direct increase in heart rate via B1 receptors.

ANXIOLYTICS, HYPTONTICS AND SEDATIVES Benodiazepines 1. Short acting (2-8hrs) a. Trazolam b. Oxazepam c. Midozolam d. Clonazepam 2. Intermediate acting (10-20 hrs) a. Temazepam b. Lorazepam c. Alprazolam 3. Long Acting (1-3 days) a. Chlordiazepoxide b. Diazepam c. Flurazepam Benzodiazepine Antagonist 1. Flumazenil Azopirones 1. Buspirone Barbiturates 1. Phenobarbital 2. Pentobarbital 3. Amobarbital 4. Thiopental Other sedatives 1. Zolpidem 2. Chloral Hydrate 3. Alcohol

ANTIPSYCHOTICS Traditional antipsychotics 1. Phenothiazines a. Chlorpromazine b. Fluphenazine c. Trifluoperazine d. Thioridazine e. Perphenazine 2. Butyrophenones a. Haloperidol b. Droperidol 3. Dibenzoxazepines a. Loxapine 4. Thioxathenes a. Thiothixene Atypical Antipsychotic Drugs 1. Clozapine 2. Risperidone 3. Olanzapine 4. Aripiprazole 5. Quetiapine 6. Ziprasidone

DRUGS USED TO TREAT DEPRESSION AND MANIA Tricyclics 1. Tertiary Amine Tricyclics a. Amitriptyline b. Imipramine c. Doxepin d. Clomipramine e. Trimipramine 2. Secondary Amine Tricyclics a. Amoxapine b. Maprotiline c. Protriptyline d. Desipramine e. Nortriptyline Selective Serotonin Reuptake Inhibitors (SSRI) 1. Fluoxetine 2. Sertraline 3. Paroxetine 4. Fluvoxamine 5. Citalopram 6. Escitalopram MAOI 1. Tranylcypromine 2. Phenelzine 3. Isocarboxide 4. Selegiline Heterocyclic (atypical) Antidepressants 1. Trazodone 2. Bupropion Antimanic Agents 1. Lithium Mood stabilizer Used to treat bipolar disorder SE= Nephrogenic diabetes insipidus: kidneys fail to respond to ADH and patient experiences polydipsia and polyuria 2. Valproic Acid Anti seizure drug

3. Carbamazepine Anti seizure drug

ANTICONVULSANTS 1. Phenytoin Tonic clonic seixures Gingival hyperplasia, drowsiness, loss of balance, facial hair growth 2. Carbamazepine/oxcarbazepine Hyponatremia due to syndrome of inappropriate ADH secretion 3. Phenobarbital 4. Primidone 5. Valproic Acid DOC for general tonic-clonic seizures. Inhibits P450 enzymes Also used for bipolar disorder SE may include hepatotoxicity and GI distress 6. Topiramate 7. Ethosuximide 8. Benzodiazepines a. Diazepam b. Clonazepam c. Clorazepate 9. Tiagabine 10. Vigabatrin 11. Gabapentin 12. Lamotrigine Alternative drug for partial seizures May cause Steven-Johnson syndrome 13. Zonisamide

DRUGS USED TO TREAT CNS DEGENERATIVE DISORDERS PARKINSONS DISEASE Drugs used to treat Parkinsons 1. Dopamine agonists a. Levodopa/Carbidopa b. Bromocriptine c. Pergolide d. Pramipexole e. Ropinirole 2. MAOI a. Selegiline 3. Amantadine (antiviral) 4. Antimuscarinic agents a. Benztropine b. Biperiden c. Trihexyphenidyl 5. COMPT Inhibitors a. Entacapone b. Tolcapone Induction of Parkinsons 1. Haloperidol HUNTINGTON DISEASE 1. Haloperidol 2. Tetrabenzine

3. Fluoxetine (for depression) TOURETTES 1. Clonidine 2. Haloperidol ALZHEIMERS DISEASE 1. Acetylcholinesterase inhibiters a. Donepexil b. Rivastigmine c. Galantamine d. Tacrine 2. NMDA Receptor Antagonist a. Memantine

ANESTHETICS General Anesthetics 1. Inhaled agents a. Halothane b. Enflurane c. Isoflurane d. Desflurane e. Sevoflurane f. Methoxyflurane g. Nitrous oxide 2. IV Agents a. Barbiturates i. Thiopental b. Benzodiazepines i. Midazolam ii. Diazepam iii. Lorazepam c. Opioids i. Fentanyl ii. Morphine d. Dissociative agents i. Propofol ii. Ketamine Local Agents

1. Esther anesthetics a. Cocaine b. Benzocaine c. Procaine d. Tetracaine 2. Amide Anesthetics a. Lidocaine b. Mepivacaine c. Bupivacaine d. Prilocaine

CNS STIMULANTS 1. Methylxanthines a. Caffeine b. Theophylline c. Theobromine (coco) 2. Nicotine 3. Amphetamines a. Methylphenidate Indirect acting adrenergic agonist. Increases the levels of NE and dopamine in the brain through reuptake inhibition o fmonamine transporters. b. Methamphetamine c. Dextroamphetamine ALCOHOL AND OTHER DRUGS OF ABUSE Alcohol 1. Ethanol 2. Methanol 3. Ethylene glycol Phencyclidine (PCP) Lysergic acid diethylamide (LSD) Marijuana Cocaine

OPIOID ANALGESICS AND ANTAGONISTS Naturally occurring 1. Enkephalins 2. Endorphins 3. Dynorphins Opioid Agonists 1. Morphine 2. Meperidine Opiods are notorious for causing pinpoint pupils and decreased respiratory effort. However, meperidine is an exception to this rule and will often cause MYDRIASIS (dilated pupils) 3. Methadone 4. Fentanyl 5. Heroine 6. Hydromorphone Moderate or Weak Agonists 1. Codeine 2. Tramadol 3. Propoxyphene 4. Oxycodone 5. Hydrocodone 6. Buprenorphine Opioid antagonists

1. Naloxone Antidote to opiate overdose 2. Naltrexone Mixed agonists/antagonists and partial agonists 1. Pentazocine 2. Nalbuphine 3. Butorphanol 4. Buprenorphine

CARDIOVASCULAR SYSTEM ANTIHYPERTENSIVE DRUGS Sympatholytic agents 1. Central Acting Alpha Agonists a. Methyldopa b. Clonidine c. Guanefacine (central acting) 2. Alpha blockers a. Prazosin b. Terazosin c. Doxazosin 3. Beta blockers a. Propranolol b. Metoprolol c. Atenolol d. Labetalol e. Carvedilol 4. Ganglionic Blockers (No longer used but sometimes tested on USMLE) a. Trimethaphan b. Hexamethonium c. Ganglion blockers prevent reflex effects, not direct, autonomic effects. Example: you administer a drug and heart rate slows and blood pressure rises. When you administer a ganglion blocker

the heart rate remains the same and the blood pressure continues to rise- thus the slowed heart rate must be a reflex effect because it was blocked by the ganglion blocker. The BP is a direct effect because it was not prevented by the ganglion blocker. 5. Postganglionic adrenergic neuronal blockers a. Reserpine b. Guanethidine Diuretics 1. Loop diuretics 2. Thiazide diuretics Vasodilators 1. Hydralazine 2. Minoxidil 3. Sodium nitroprusside 4. Diazoxide Calcium Channel Blockers 1. Nifedipine 2. Verapamil 3. Diltiazem Angiotensin converting enzyme inhibitors 1. Captopril 2. Enalapril 3. Lisinopril 4. Benazepril Angiotensin II receptor antagonists 1. Losartan 2. Valsartan 3. Candesartan 4. Irbesartan ANTIARRHYTHMIC DRUGS Class I: Sodium Channel Blockers Class1A 1. Quinidine 2. Procainamide 3. Disopyramide Class 1B 1. Lidocaine 2. Tocainide 3. Mexiletine 4. Phenytoin Class1C 1. Flecainide 2. Propafenone 3. Moricizine Class II: Beta Adrenergic Blockers

1. 2. 3. 4.

Propranolol Metoprolol Atenolol Esmolol

Class III: Potassium Channel Blockers 1. Sotalol 2. Bretylium 3. Amiodarone 4. Ibutilide 5. Dofetilide Class IV: Calcium Channel Blockers 1. Verapamil 2. Diltiazem 3. Nifedipine Others 1. Digoxin 2. Magnesium Sulfate 3. Adenosine

DRUGS USED TO TREAT CONGESTIVE HEART FAILURE Cardiac glycosides 1. Digoxin 2. Digitoxin Bipyridine derivatives 1. Amrinone 2. Milrinone Beta adrenergic agonists 1. Dobutamine 2. Dopamine Vasodilators 1. Nitrates 2. Hydralazine 3. ACE inhibitors

Diuretics 1. Furosemide 2. Hydrochlorothiazide 3. Spironolactone ACE inhibitors 1. Quinapril 2. Enalopril 3. Captopril 4. Lisinopril ARB 1. Losartan Beta adrenergic blockers 1. Carvedilol 2. Metoprolol

DIURETICS Carbonic anhydrase inhibitors 1. Acetazolamide Loop Diuretics 1. Furosemide 2. Ethacrynic acid 3. Bumetadine Thiazide Diuretics 1. Chlorothiazide 2. Hydrochlorothiazide 3. Metolazone 4. Indapamide Osmotic Diuretics 1. Mannitol

2. Urea Potassium Sparing Diuretics 1. Spironolactone 2. Amiloride 3. Triamterene

ANTIANGINAL DRUGS Nitrates 1. Nitroclycerin 2. Isosorbide dinitrate 3. Amyl nitrate Calcium channel blockers 1. Nifedipine 2. Verapamil 3. Diltiazem Beta blockers (the following are cardioselective) 1. Atenolol 2. Timolol 3. Metoprolol Aspirin

ANTICOAGULANT, FIBRINOLYTIC AND ANTIPLATELET DRUGS Anticoagulants 1. Heparin a. LMW Heparin b. Enoxaparin 2. Lepirudin 3. Warfarin Fibrinolytics 1. Streptokinase 2. Urokinase 3. Tissue Plasminogen activator Antiplatelet drugs 1. Aspirin 2. Ticlopidine 3. Clopidogrel 4. Glycoprotein IIB and IIIA inhibitors

a. b. c. d.

Abciximab Eptifibatide Tirofiban Dipyridamole

ANTIHYPERLIPIDEMIC DRUGS 1. Bile acid binding resins May decrease absorption of fat soluble vitamins a. Cholestyramine b. Colestipol c. Colesevelam 2. Ezetimibe 3. HMG-COA Reductase inhibitors HMG-CoA Reductase is the rate determining enzyme in cholesterol synthesis. It converts HMGCoA to mevalonic acid. Statins decrease cholesterol synthesis in the liver, which leads to an increase in LDL receptors on the surface of hepatocytes and a decrease in plasma VLDL/LDL. Thus, they are effective in decreasing LDL and total cholesterol levels . Rare, but it can cause skeletal muscle damage which can lead to rhabdomyolysis and elevated creatine kinase. a. Lovastatin b. Simvistatin c. Pravastatin d. Fluvastatin e. Atorovastatin 4. Fibrinic acid derivatives Gall stones are a potential side effect a. Gemfibrozil b. Clofibrate 5. Niacin (Nicotinic Acid) AGENTS USED TO TREAT ANEMIA 1. 2. 3. 4. Iron Cyanocobalamin (vitamin B12) Folic Acid Erythropoietin

RESPIRATORY SYSTEM DRUGS USED TO TREAT ASTHMA, COUGHS, AND COLDS ANTIASTHMATIC DRUGS 1. Sympathomimetic agents (B2 Adrenergic agonists) a. Albuterol b. Metaproterenol c. Pirbuterol d. Terbutaline e. Salmeterol

2. Corticosteroids (inhaled) a. Beclomethasone b. Flunisolide c. Triamcinolone d. Fluticasone e. Budesonide 3. Anticholinergics a. Ipratropium 4. Leukotrienes inhibitors a. Zileuton b. Zafirlukast Used for asthma c. Montelukast 5. Methylxanthines a. Theophylline 6. Prophylactive mast cell stabilizers a. Cromolyn sodium b. Nedocromil ANTITUSSIVES (COUGH MEDICATIONS) 1. Codeine a. Dextromethorphan 2. Hydrocodone 3. Hydromorphone RHINITIS AGENTS 1. Nasal corticosteroids a. Beclomethasone b. Flunisolide 2. Cromolyn sodium 3. Antihistamines a. Diphenhydramine b. Chlorpheniramine c. Cyproheptadine Serotonin antagonist used for carcinoid d. Promethiazine 4. Alpha adrenergic agonists a. Ephedrine b. Psuedoephedrine ENDOCRINE SYSTEM HYPOTHALAMIC AND PITUITARY HORMONES Hypothalamic Hormones 1. Growth hormone releasing hormone a. Leuprolide b. Goserelin

2. 3. 4. 5. 6.

c. Nafarelin d. Histrelin Somatotropin release-inhibiting hormone (somatostatin) a. Octreotide Gonadotropin releasing hormone Corticotrophin releasing hormones Thyrotropin releasing hormone Dopamine a. Bromocriptine

Anterior Lobe Pituitary Hormones 1. Growth hormone (somatotropin) 2. Adrenocorticotropic hormone 3. Thyroid stimulating hormone 4. Follicle stimulating hormone 5. Luteinizing hormone 6. Prolactin Posterior Lobe Pituitary Hormones 1. Oxytocin 2. Vasopressin (ADH) 3. Desmopressin

THYROID AND ANTITHYROID DRUGST3 and T4 are made from the tyrosine residues of thyroglobulin located in the thyroid gland follicles. In the periphery T3 and T4 bind to thyroid binding globulin (TBG)

Hypothyroidism 1. Levothyroxine sodium (T4) 2. Liothyronine sodium (T3) Hyperthyroidism 1. Propylthiouracil and Methimazole Anti thyroid drug that inhibits organification of iodide (addition of iodine to the tyrosine residues of thyroglobulin) and the coupling reactions between tyrosines to form T3 and T4 thus, prevents synthesis of T3 and T4 in the thyroid gland. Propylthiouracil also decreases peripheral conversion of T4 to T3. The enzyme 5deiodinase converts T4 to T3 in the periphery. This enzyme is inhibited by ipodate, propranolol and propylthiouracil. Safer in pregnancy than methimazole because it is more extensively protein bound thus less of it is free to cross the placenta. Adverse effects= skin rash, agranulocytosis (rare), aplastic anemia 2. Iodine tablets Used preoperatively to reduce thyroid gland size and vascularity. a. Potassium iodide

b. Lugols solution (mixture of potassium iodide and iodine) 3. Ionic inhibitors a. Perchlorate b. Thiocyanate 4. Radioactive iodine SEX STEROIDS AND REPRODUCTIVE DRUGS Estrogens 1. Estradiol 2. Estrone 3. Ethinyl estradiol 4. Quinestrol 5. Mestranol Selective Estrogen receptor modulators 1. Tamoxifen 2. Raloxifen 3. Clomiphene Progestins 1. Medroxyprogesterone acetate 2. Norethindrone 3. Norethindrone acetate 4. Norgestrel Progestin Inhibitors 1. Mifepristone (RU 486) Partial agonist at progesterone, androgen and glucocorticoids receptors 1. Danazole Androgens 1. Four androgens produced by the testes a. Testosterone b. Dihydrotestosterone c. Dehydroepiandrosterone d. Androstenedione 2. Synthetic androgens a. Testosterone cypionate b. Oxandrolone c. Stanozolol d. Fluoxymesterone

Androgen antagonists 1. Gonadotropin releasing analogues a. Gonadorelin b. Leuprolide 2. Receptor inhibitors a. Flutaminde and Bicalutamide b. Cyproterone 3. Steroid synthesis inhibitors a. Ketoconazole b. Spironolactone 4. 5 alpha reductase inhibitors a. Finasteride Implantable or injectable contraception 1. Progesterone only intrauterine device a. Norgestrel Erectile dysfunction 1. Sildenafil 2. Vardenafil 3. Tadalafil

CORTICOSTEROIDS AND INHIBITORS Corticosteroids 1. Glucocorticoids (cortisol) a. Prednisone b. Triamcinolone c. Dexamethasone d. Beclomethasone e. Betamethasone f. Chronic use of corticosterioids can cause peptic ulcers or worsen existing ulcers 2. Mineralocorticoids (aldosterone) a. Fludrocortisones b. Desoxycorticosterone Adrenocorticosteroid antagonists 1. Aminoglutethimide 2. Metyropone 3. Ketoconazole

4. Mifepristone and Spironolactone

INSULINS AND ORAL HYPOGLYCEMIC DRUGS Treatment strategies for diabetes: 1. Type I: absolute deficiency of insulin because of enormous beta cell destruction. Diet and exercise Parenteral insulin (usually a mix) 2. Type II: frequently associated with low to normal insulin levels and target organ insulin resistance. Diet modification Weight reduction Oral hypoglycemic agents: mono or combo therapy Insulin for cases not controlled with above Insulin Insulin binds to proteins in circulation and cell membrane (TYROSINE KINASE) receptors. Does NOT enter cell nucleus. Acts on almost every cell in the body. Important targets include: Liver: promotes glucose storage as glycogen. TG synthesis Muscle: facilitates protein and glycogen synthesis as well as potassium uptake Adipose: activates lipoprotein lipase improved TG storage, reduction in circulating FFA Onset, peak and duration of action determined by zinc protamine and other substances to insulin determines the rate of release Adverse Effects Hypoglycemia (diaphoresis, vertigo, tachycardia) Insulin allergy: IgE mediated Insulin antibodies: IgG mediated, most commonly seen with animal insulin preps Lipodystrophy: change in fatty tissue surrounding injection site 1. Short acting a. Insulin lispro Management of hyperglycemic emergencies (IV- work rapidly) b. Insulin aspart c. Insulin glulisine d. Regular insulin Management of hyperglycemic emergencies (IV- work rapidly) 2. Intermediate acting a. Isophane insulin suspension (neutral protamine Hagedorn [NPH]) b. Insulin zinc suspension (lente) 3. Long acting a. Insulin zinc suspension extended (ultralente)

b. Insulin Glargine Oral Hypoglycemic Agents 1. Sulfonylureas Secratagogues Closes K+ channels on beta cell membrane depolarization Ca++ influx insulin release from pancreatic beta cells Contraindications: liver, renal insufficiency, pregnancy. (Metabolized in the liver and excreted by kidneys). a. First generation i. Chlorpropamide Longest duration of action Tendency for disulfiram like reaction if taken with ethanol ii. Tolbutamide iii. Autohexamide b. Second generation i. Glyburide High potency ii. Glipizide High potency iii. Glimepiride 2. Meglitinides a. Repaglinide b. Nateglinide 3. Biguanides a. Metformin b. Phenformin 4. Alpha glucosidase inhibitors Inhibits intestinal brush border alpha glucosidases. This inhibits the breakdown of starch into glucose and the decreased glucose absorption decreased postprandial hyperglycemia decreased demand for insulin. a. Acarbose b. Miglitol 5. Thiazolinediones (glitazones) When used alone, do not cause hypoglycemia AE= hepatotoxicity a. Rosiglitazone b. Pioglitazone Increase the sensitivity of tissues to insulin by increasing transcription of insulin responsive genes.

DRUGS THAT AFFECT CALCIUM HOMEOSTASIS AND BONE METABOLISM Hypocalcemia 1. Calcium salt preparations a. Calcium chloride b. Calcium gluceptate c. Calcium gluconate d. Calcium carbonate 2. Vitamin D agents a. Calcitriol b. Ergocalciferol c. Calciferol Hypercalcemia 1. Bisphosphonates a. Etidronate b. Pamidronate c. Alendronate d. Risedronate 2. Pamidronate 3. Alendronate 4. Risedronate Other agents: 1. Thiazides: increase serum calcium 2. Loop diuretics: reduce serum calcium

MUSCULOSKELETAL SYSTEM ANTI-INFLAMMATORY DRUGS AND ACETOMINOPHEN NSAIDS 1. Salicylates a. Acetylsalicylic acid (aspirin) b. Diflunizal 2. Pyrazolones a. Phenylbutazone 3. Indoleacetic acids a. Indomethacin b. Sulindac c. Etodolac d. Diclofenac e. Ketorolac f. Tolmetin g. Nabumetone 4. Propionic acids a. Naproxen b. Ketoprofen c. Ibuprofen d. Flurbiprofen e. Oxaprozin 5. Oxicams a. Piroxicam b. Meloxicam 6. Fenamates a. Mefenamic acid b. Meclofenamic acid 7. COX 2 selective inhibitors a. Celecoxib b. Rofecoxib c. Valdecoxib Corticosteroids, such as prednisone are also used to treat inflammation- see steroids

Antirheumatic drugs 1. Disease modifying antirheumatic drugs (DMARDs) a. Methotrexate b. Leflunoamide c. Etanercept d. Infliximab e. Anakinra f. Adalimumab g. Penicillamine h. Gold salts i. Hydroxychloroquine j. Sulfasalazine 2. NSAIDs and COX-2 Inhibitors 3. Glucocorticoids 4. Analgesic drugs Acetominophen (tylenol) NSAIDs such as aspirin exacerbate peptic ulcers, not acetaminophen. This is because acetaminophen is a much weaker COX-1 inhibitor than aspirin.

DRUGS USED TO TREAT GOUT Acute gout 1. Indomethacin 2. Phenylbutazone 3. Colchicines Chronic gout 1. Colchicines 2. Uricosuric agents a. Probenecid b. Sulfinpyrazone 3. Allopurinol

AUTACOIDS AND AUTOCOID ANTAGNOISTS Two principle autocoids within the body: 1. Serotonin 2. Histamine Serotonin agonists 1. Sumatriptan 2. Naratriptan 3. Rizatriptan 4. Eletriptan 5. Almotriptan 6. Zolmitriptan Serotonin inhibitors 1. Ondansetron 2. Cyproheptatide Histamine (H1) blockers Seasonal allergies 1. First generation a. Diphenhydramine b. Hydroxyzine c. Promethazine d. Clemastine e. Chlorpheniramine 2. Second generation Does not enter CNS and thus does not cause drowsiness like first generation blockers do a. Fexofenadine b. Loratadine c. Cetirizine d. Desloratadine Histamine (H2) blockers 1. Cimetidine 2. Ranitidine 3. Famotidine 4. Nizatidne Ergot Alkaloids 1. Bromocriptine 2. Ergonovine 3. Ergotamine

GASTROINTESTINAL SYSTEM DRUGS USED TO TREAT GI DISORDERS Acid Peptic Disease 1. Antacids a. Calcium carbonate b. Aluminum hydroxide c. Magnesium hydroxide 2. H2 Receptor Blockers a. Cimetidine b. Ranitidine c. Famotidine d. Nizatidine 3. Proton Pump Inhibitors a. Omeprazole b. Lansoprazole c. Rabeprazole d. Pantoprazole e. Esomeprazole 4. Mucosal protective agents a. Sucralfate Protective coating over ulcers and promotes healing b. Bismuth c. Misoprostol 5. Antimicrobial therapy a. Bismuth, metronidazole, tetracycline Prokinetic Agents 1. Cisapride 2. Metoclopramide Antiemetic Drugs 1. H1 antihistamines a. Diphenhydramine 2. Phenothiazines a. Prochlorperazine 3. Marijuana a. Dronabinol 4. 5-HT3 Inhibitors a. Ondansetron 5. Corticosteroids a. Dexamethasone

6. Benzamides a. Metoclopramide

Inflammatory Bowel Disease 1. Sulfasalazine 2. Antibiotics a. Metronidazole b. Ciprofloxacin 3. Glucocorticoids 4. Immunosuppressive agents a. Azathioprine 5. Methotrexate 6. Cyclosporine 7. Immunomudulators a. Infliximab Antidiarrheal Agents 1. Loperamide 2. Diphenoxylate Laxatives 1. Stimulants a. Castor oil b. Senna c. Phenolphthalein d. Bisacodyl 2. Bulking Agents a. Hydrophilic colloids b. Agar c. Methylcellulose d. Bran 3. Osmotic agents a. Saline cathartics i. Magnesium citrate ii. Magnesium hydroxide b. Nondigestible sugars i. Lactulose ii. Sorbitol 4. Stool softeners a. Mineral oil b. Docusate sodium

IMMUNE SYSTEM ANTINEOPLASTIC DRUGS Cell cycle specific (CCS) antineoplastic agents 1. Antimetabolites 2. Mitotic inhibitors 3. Bleomycin 4. Etoposide 5. Steroid hormones Cell cycle nonspecific drugs 1. Alkykating agents 2. Cisplatin 3. Nitrosoureas 4. Antibiotics Antineoplastic agents 1. Alkylating agents a. Nitrogen mustards i. Mechlorethamine ii. Cyclophosphamide iii. Infosamide iv. Melphalan v. Chlorambucil b. Nitrosoureas i. Carmustine ii. Lomustine iii. Streptozocin c. Others i. Cisplatin ii. Carboplatin iii. Oxaliplatin iv. Busulfan v. Dacarbazine vi. Temozolomide vii. Procarbazine 2. Antibiotics a. Dactinomycin b. Doxorubicin c. Daunorubicin d. Idarubicin e. Eprubicin

f. Valrubicin g. Bleomycin h. Mitomycin 3. Antimetabolites a. Folate analogs i. Methotrexate b. Purine analogs i. 6-mercaptopurine ii. 6-thioguanine iii. Fludarabine iv. Cladrabine c. Pyrimidine analogs i. Cytarabine ii. 5 Fluorouracil iii. Capecitabine iv. Gemcitabine d. Hydroxyurea 4. Hormones and related agents a. Flutamide b. Nilutamide c. Bicalutamide d. Tamoxifen e. Toremifene f. Raloxifene g. Aromatase inhibitors i. Aminoglutethimide ii. Formestane iii. Anastroloze and letroxole iv. Exemestane h. Leuorplide i. Goserelin j. Glucocorticoids i. Prednisone ii. Hydrocortisone 5. Mitotic inhibitors a. Vinblastine b. Vincristine c. Etoposide d. Paclitaxel e. Docetaxel 6. Monoclonal antibodies a. Rituximab b. Trastuzumab

c. Bevacizumab d. Cetuximab e. Gemtuzumab f. Alemtuxumab 7. Others a. Hydroxyurea b. Etoposide c. Teniposide d. Asparaginase e. Imatinib f. Gefinitib g. Ironotecap h. Topetecan

IMMUNOMODULATORS Immunosuppressants 1. Antibiotics a. Cyclosporine b. Tacrolimus c. Sirolimus 2. Cytotoxic drugs a. Azathioprine b. Cyclophosphamide 3. Enzyme inhibitors a. Mycophenolate mofetil 4. Adrenocortical steroids a. Prednisone b. Methylprednisone c. Betamethasone d. Dexamethasone 5. Antibody reagents (monoclonal antibodies) a. Muromonab-CD3 b. Daclixumab, Basiliximab c. RH0 (D) Immune Globulin (RHOGAM) d. Antithymocyte globulin Immunostimulants 1. Aldesleukin 2. Interferon a. Alpha b. Beta c. Gamma

ANTIMICROBIAL DRUGS Classes of antimicrobial agents 1. Cell wall synthesis inhibitors a. Penicillins b. Cycloserine c. Cephalosporins d. Vancomycin 2. Protien synthesis inhibitors a. Tetracycline b. Aminoglycosides c. Erythromycin d. Clindamycin e. Chloramphenicol 3. DNA synthesis inhibitors a. Quinolones b. Flouroquinolones c. Rifampin d. Sulfonamides 4. Cell membrane disrupters a. Polyene antimicrobials (amphotercin B) PENICILLINS 1. Natural penicillins A beta lactam drug comprised of four lactam rings Bactericidal agent Beta lactamase a bacterial enzyme that hydrolyzes the amide bond of the beta lactam ring. It is also known as penicillinase. Similarly, acid may degrade the lactam ring, thus, with the exception of amoxicillin, these drugs should be administered 1-2 hours before or after a meal. Penicillin Binding Proteins (PBP) enzymes that are involved in the synthesis of the cell wall and maintenance of the morphologic structure of bacteria Penicillins bind to PBPs and inhibit the transpeptidase step, which results in bacterial cell lyses. They also release autolysins, bacterial degradative enzymes involved in the normal remodeling of the bacterial cell wall. Normally do not distribute to the CNS unless the meninges are inflamed. a. Penicillin G b. Penicillin V c. Penicillin G procaine d. Penicillin G benzathine 2. Antistaphylococcal penicillins (Penicillinase- Resistant PCNs) These drugs are the only penicillins that by themselves are RESISTANT to penicillinase!!!

a. Methicillin b. Nafcillin c. Oxacillin d. Dicloxacillin e. Cloxacillin 3. Antipseudomonal penicillins a. Piperacillin b. Ticarcillin 4. Extended spectrum penicillins a. Amoxicillin Best bioavailability from GI tract (better than ampicillin) b. Ampicillin Beta lactimase inhibitors 1. Clavulanic acid 2. Sulbactam 3. Tazobactam CELPHALOSPORINS AND OTHER CELL WALL SYNTHESIS INHIBITORS Cephalosporins 1. First generation cephalosporins (a decrease in gram positive coverage) a. Cefadroxil b. Cephalexin c. Cephradine d. Cefazolin 2. Second generation cephalosporins (an increase in gram negative coverage) a. Cefaclor b. Cefuroxime axetil c. Loracarbef d. Cefotetan e. Cefoxitin f. Cefuroxime 3. Third generation cephalosporins (an increase in CNS penetration) a. Cefoperazone b. Cefotaxime c. Ceftazidime d. Ceftriaxone e. Cefpodoxime f. Cefdinir g. Ceftibuten 4. Fourth generation cephalosporins (an increase in resistance to beta lactamase) a. Cefepine Other cell wall synthesis inhibitors 1. Monobactams-Aztreonam

2. Carbapenems a. Imipenem b. Meropenem 3. Vancomycin 4. Bacitracin 5. Cycloserine

PROTEIN SYNTHESIS INHIBITORS Antibiotics that work on the 30s ribosomal subunit 1. Aminoglycosides a. Amikacin b. Netilmicin c. Neomycin d. Tobramycin e. Gentamycin f. Streptomycin 2. Tetracyclines Side effects include teeth discoloration and photosensitivity a. Tetracycline b. Doxycycline c. Demeclocycline d. Minocycline 3. Spectinomycin Antibiotics that work on the 50s ribosomal subunit 1. Chloramphenicol Side effects include gray baby syndrome and anemia 2. Macrolides Work by binding to the 50S ribosome and inhibiting the translocation step of protein synthesis. This action is bacteriostatic for some and bactericidal for others. Resistance may develop through two microbe mechanisms (1) defective uptake or efflux (2) bacterial plasmids coding for enzymes that inactivate these drugs May cause significant QT interval prolongation and risk of arrhythmia a. Erythromycin

3. 4. 5. 6.

Acts upon may of the same organisms as PCN, and therefore, can be used as an alternative for PCN allergic patients. It is effective against: Mycoplasma Legionella C. trachomatis Corneybacterium diphtheria B. pertussis b. Clarithromycin Extends the spectrum by including H. influenzae N. gonorrhea H. pylori Mycobacterium avium intracellulare c. Azithromycin Generally less effective than erythromycin against Gram positives, but more effective against respiratory infections from microbes such as H. influenzae M. catarrhalis FIRST LINE for mycobacterium avium intracellulare complex in AIDS patients. C.trachomatus urethritis responds well Lincosamides a. Clindamycin Telithromycin Quinupristin/Dalfopristin Linezolid

QUINOLONES AND DRUGS USED TO TREAT URINARY TRACT INFECTIONS Quinolones 1. Dalidixic acid 2. Cinoxacin Fluoroquinolones 1. Norfloxacin 2. Levofloxacin 3. Ciprofloxacin 4. Ofloxacin 5. Sparfloxacin 6. Moxifloxacin 7. Gatifloxacin Urinary Antiseptics 1. Nitrofurantoin 2. Methenamine FOLATE ANTAGONISTS Sulfonamides

1. 2. 3. 4. 5. 6. 7. 8.

Sulfamethoxasole Sulfisoxazole Sulfamethizole Sulfasalazine Sulfacetamide Silver sulfadiazine Mafenide Sulfadiazine

Trimethoprim

ANTIFUNGAL DRUGS Systemic and Subcutaneous Mycoses 1. Amphotercin B 2. Flucytosine 3. Ketoconazole 4. Fluconazole 5. Itraconazole 6. Voriconazole 7. Caspofungin Superficial Mycoses 1. Griseofulvin 2. Nystatin 3. Miconazole 4. Clotrimazole 5. Econazole 6. Terbinafine ANTHELMINTIC DRUGS Anthelmintics for Nematodes 1. Mebendazole 2. Thiabendazole 3. Albendazole 4. Pyrantel pamoate 5. Diethylcarbamazine 6. Ivermectin Cestodes and trematodes 1. Praziquantel

ANTIPROTOZOAL DRUGS

Malaria 1. Chloroquine 2. Quinine 3. Mefloquine 4. Pyrimethamine 5. Pyrimethamine/sulfadoxine 6. Atovaquone/Proguanil 7. Primaquine Toxoplasmosis 1. Pyrimethamine + sulfadiazine Leishmaniasis 1. Sodium stibogluconate (DOC) 2. Pentamidine (visceral) 3. Metronidazole (cutaneous) 4. Amphotercicin B (mucocutaneous) Trypanosomiasis 1. Melarsoprol 2. Pentamidine 3. Nifurtimox 4. Suramin Amebiasis 1. Mixed a. Metronidazole 2. Lumenal a. Paromomycin b. Iodoquinol c. Tetracycline 3. Systemic a. Emetine b. Dehydroemetine c. Chloroquine

ANTIVIRAL DRUGS Herpesvirus and CMV

1. Foscarnet 2. Ganciclovir 3. Idoxuridine 4. Vidarabine 5. Acyclovir 6. Cidofovir For herpes, GIV acyclovir HSV-1, HSV-2 VZV, CMV, EBV Others 1. Famciclovir 2. Penciclovir 3. Valacyclovir 4. Trifluridine Drugs used to treat respiratory viruses 1. Amantadine 2. Rimantadine 3. Ribavirin 4. Oseltamivir 5. Zanamivir Antihepatitis Agents 1. Interferons a. Adefovir b. Lamivudine c. Ribavarin

DRUGS USED TO TREAT HIV INFECTIONS AND AIDS

AIDS, caused by HIV, is characterized by a CD4 count