Pharm Review USMLE

211 terms by Unicorny

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Abciximab

Monoclonal antibody to fibrin receptor (glycoprotein IIb/IIIa) on platelets. Used to prevent clotting after coronary angioplasty

Acetaminophen

Antipyretic analgesic: very weak cyclooxygenase inhibitor; not anti−inflammatory. Less toxic than aspirin but more dangerous in overdose (causes hepatic necrosis−antidote:acetylcysteine)

Acetazolamide, dorzolamide

Carbonic anhydrase inhibitor diuretic: produces a NaHCO3 diuresis, results in bicarbonate depletion, and therefore has self−limited action. Used in glaucoma and mountain sickness. Dorzolamide is a topical analog for glaucoma

Acetylcholine

Cholinomimetic prototype: transmitter in CNS, ENS, all ANS ganglia, parasympathetic postganglionic synapses, sympathetic postganglionic fibers to sweat glands, and some skeletal muscle vasodilator synapses

Acyclovir

Antiviral: inhibits DNA synthesis in herpes simplex and varicella zoster. Requires activation by viral thymidine kinase (TK− strains are resistant). Tox: behavioral effects and nephrotoxicity (crystalluria), but not myelosuppression

Adenosine

Antiarrhythmic: unclassified ("Group V"); parenteral only. Hyperpolarizes AV nodal tissue, blocks conduction for 10−15 sec. Used for nodal reentry arrhythmias

Allopurinol

Antigout: inhibitor of xanthine oxidase; reduces production of uric acid

Albuterol, metaproterenol, terbutaline

Important B2−agonists; used mainly for asthma.

Alprazolam

Benzodiazepine sedative−hypnotic: widely used in anxiety states, selectivity for panic attacks and phobias; possible antidepressant actions. Tox: psychologic and physical dependence, additive effects with other CNS depressants

Alteplase

(rt−PA) Thrombolytic: human recombinant tissue plasminogen activator. Used in acute MI to recanalize the occluded coronary. Occasionally used in pulmonary embolism, stroke. Tox:bleeding

Amiloride

K+−sparing diuretic: blocks Na+ channels in cortical collecting tubules

Aminoglutethimide

Nonsteroid inhibitor of steroid synthesis: reduces conversion of cholesterol to the hormone precursor, pregnenolone. Used in metastatic breast cancer

Amiodarone

Group IA and III antiarrhythmic: broad spectrum, blocks sodium, potassium, calcium channels, beta receptors. High efficacy and very long half−life (weeks−months). Tox:deposits in tissues; hypo− or hyperthyroidism; pulmonary fibrosis

Amitriptyline

Tricyclic antidepressant: blocks reuptake of norepinephrine and serotonin. Tox: atropine−like, postural hypotension, sedation; cardiac arrhythmias in overdose, additive effects with other CNS depressants

Amoxicillin

Penicillin: wider spectrum than pen G with activity similar to ampicillin but greater oral bioavailability; less adverse effects on GI tract than ampicillin. Susceptible to penicillinases unless used with clavulanic acid. Tox: penicillin allergy

Amphetamine

Indirectly acting sympathomimetic: displaces stored catecholamines in nerve endings. Marked CNS stimulant actions; high abuse liability. Tox: psychosis, HTN, MI, seizures

Amphotericin

B Antifungal: polyene drug of choice for most systemic mycoses; binds to ergosterol to disrupt fungal cell membrane permeability. Tox: chills and fever, hypokalemia, hypotension, nephrotoxicity (dose−limiting, possibly less with liposomal forms)

Ampicillin

Penicillin: wider−spectrum than pen G, susceptible to penicillinases unless used with sulbactam. Activity similar to pen G, plus E coli, H influenzae, P mirabilis, Shigella. Synergy with aminoglycosides versus enterococci and listeria. Tox: penicillin allergy; more adverse effects on GI tract than other penicillins; maculopapular skin rash

Anistreplase

(APSAC) Thrombolytic: bacterial streptokinase complexed with human plasminogen. Longer acting in body than other thrombolytics (rt−PA, streptokinase, urokinase). Tox: bleeding, allergy to streptococcal protein

Aspirin

NSAID prototype: inhibits cyclooxygenase (COX) I and II irreversibly. Potent antiplatelet agent as well as antipyretic analgesic anti−inflammatory drug

Atenolol

Beta1−selective blocker: low lipid solubility, less CNS effect; used for HTN. (Note mnemonic for beta1−selective blockers: their names start with A through M. [Exceptions: carteolol & labetalol are not selective])

Atropine

Muscarinic cholinoceptor blocker prototype: lipid soluble, CNS effects. Tox: "red as a beet, dry as a bone, mad as a hatter," urinary retention, mydriasis

Azithromycin

Antibiotic: similar to erythromycin, but greater activity versus chlamydia and streptococci; long half−life due to tissue accumulation. Tox: GI distress, but no inhibition of drug metabolism

Baclofen

GABA analog, orally active: spasmolytic; activates GABAB receptors in the spinal cord

Benztropine

Centrally acting antimuscarinic prototype for parkinsonism

Bethanechol

Muscarinic agonist: choline ester with good resistance to cholinesterase; used for atonic bowel or bladder

Botulinum

Toxin: enzyme produced by Clostridium botulinum; interacts with fusion/docking proteins to block release of acetylcholine vesicles

Bromocriptine

Ergot derivative: dopamine agonist in CNS; inhibits prolactin release. Used in parkinsonism and hyperprolactinemia. Tox: CNS, dyskinesias, hypotension

Bupivacaine

Long−acting amide local anesthetic prototype: greater CV toxicity than most local anesthetics

Buspirone

Anxiolytic: atypical drug that interacts with 5HT1A receptors; slow onset. Minimal potentiation of CNS depressants including ethanol; negligible abuse liability

Captopril

ACE inhibitor prototype: used in HTN, diabetic renal disease, and CHF. Tox: hyperkalemia, fetal renal damage, cough ("sore throat")

Carbachol

Nonselective muscarinic and nicotinic agonist: choline ester with good resistance to cholinesterase; used for glaucoma (not a first−line drug)

Carbamazepine

Anticonvulsant: tricyclic derivative used for tonic−clonic and partial seizures; blocks Na+ channels in neuronal membranes. Drug of choice for trigeminal neuralgia; back−up drug in mania. Tox: CNS depression, hematotoxic, induces liver drug−metabolizing enzymes

Cefazolin

First−generation cephalosporin prototype: bactericidal beta−lactam inhibitor of cell wall synthesis. Active against gram−positive cocci, E coli, K pneumoniae, but does not enter CSF. Tox: potential allergy; partial cross−reactivity with penicillins

Cefoxitin

Second−generation cephalosporin: active against a wide spectrum of gram−negative bacteria including anaerobes (B fragilis). Does not enter the CNS

Ceftriaxone

Third−generation cephalosporin: active against resistant bacteria including gonococci, H influenzae, and other gram−negative organisms. Crosses the blood−brain barrier

Celecoxib, rofecoxib

First COX−II−selective NSAIDs. Reduced GI toxicity.

Chloramphenicol

Antibiotic: broad spectrum agent; inhibits protein synthesis (50S); uses restricted to back−up drug for bacterial meningitis, infections due to anaerobes, Salmonella. Tox: reversible myelosuppression, aplastic anemia, gray baby syndrome

Chloroquine

Antimalarial: blood schizonticide used for treatment and as a chemosuppressant where P falciparum is susceptible. Tox: GI distress and skin rash at low doses; peripheral neuropathy, skin lesions, auditory and visual impairment, quinidine−like myocardial depression at high doses

Chlorpheniramine

Antihistamine H1 blocker prototype: Tox: sedation, antimuscarinic

Chlorpromazine

Phenothiazine antipsychotic drug prototype: blocks most dopamine receptors in the CNS. Tox: atropine−like, EPS dysfunction, hyperprolactinemia, postural hypotension, sedation, seizures (in overdose), additive effects with other CNS depressants

Cholestyramine, colestipol

Bile acid−binding resins: sequester bile acids in gut and divert more cholesterol from the liver to bile acids instead of circulating lipoproteins. Tox: constipation, bloating; interfere with absorption of some drugs

Cimetidine

H2 blocker prototype: used in acid−peptic disease. Tox: inhibits hepatic drug metabolism; antiandrogen effects. Less toxic analogs: ranitidine, famotidine, nizatidine

Ciprofloxacin

Fluoroquinolone antibiotic: bactericidal inhibitor of topoisomerases; active against many gram−negative rods including E coli, H influenzae, Campylobacter, Enterobacter, Pseudomonas, Shigella. Tox: CNS dysfunction, GI distress, superinfection, collagen damage (avoid in children and pregnant women). Interactions: caffeine, theophylline,warfarin

Cisplatin

Platinum−containing alkylating cancer chemotherapeutic agent. Used for several solid tumors (eg, testes, lung). Carboplatin is similar.

Clindamycin

Lincosamide antibiotic: bacteriostatic inhibitor of protein synthesis (50S); active against gram−positive cocci, B fragilis. Tox: GI distress, pseudomembranous colitis

Clomiphene

Estrogen partial agonist: synthetic used in infertility to induce ovulation

Clonidine

Alpha2 agonist: acts centrally to reduce SANS outflow, lowers BP. Tox: rebound HTN if stopped suddenly

Clozapine

Atypical antipsychotic: low affinity for dopamine D2 receptors, higher for D4 and 5−HT2A receptors; less EPS adverse effects than other antipsychotic drugs. Tox: ANS effects, agranulocytosis (infrequent but significant)

Cocaine

Indirectly acting sympathomimetic: blocks amine reuptake into nerve endings. Local anesthetic (ester type). Marked CNS stimulation, euphoria; high abuse liability. Tox: psychosis, cardiac arrhythmias, seizures

Colchicine

Microtubule assembly inhibitor: reduces mobility and phagocytosis by WBCs in gout− inflamed joints; useful in acute, not chronic gout. Tox: GI, hepatic, renal damage

Cyclopentolate, tropicamide

Antimuscarinics for ophthalmology: shorter duration than atropine (a few hours or less); cause cycloplegia and mydriasis

Cyclophosphamide

Antineoplastic, immunosuppressive: cell cycle−nonspecific alkylating agent. Tox: alopecia, gastrointestinal distress, hemorrhagic cystitis, myelosuppression

Cyclosporine

Immunosuppressant: antibiotic; inhibits interleukin−2 synthesis, suppresses T cells. Tox: HTN, hirsutism, nephrotoxicity (dose−limiting), seizures (in overdose). Not a myelosuppressant

Dantrolene

Blocks Ca2+ release from sarcoplasmic reticulum of skeletal muscle. Used in muscle spasm (cerebral palsy, multiple sclerosis, cord injury) and in emergency treatment of hyperthermia caused by malignant hyperthermia, malignant neuroleptic syndrome, and serotonin syndrome

DDAVP

ADH analog: synthetic peptide used for pituitary diabetes insipidus

DDT

Insecticide: prevents inactivation of sodium channels, causes uncontrolled neuronal activity. Stored for years in body fat in mammals, birds, fish

Deferoxamine

Chelator: bacterial product; chelates iron very avidly, aluminum less so

Dexfenfluramine

5−HT reuptake inhibitor and receptor agonist previously used as anorexic. Tox: produced cardiac valve damage when used in combination with phentermine

Dexamethasone

Glucocorticoid: very potent, long−acting; no mineralocorticoid activity

Diazepam

Benzodiazepine prototype: binds to BDZ receptors of the GABAA receptor−chloride ion channel complex; facilitates the inhibitory actions of GABA by increasing frequency of channel opening. Uses: anxiety states, ethanol detoxication, muscle spasticity, status epilepticus. Tox: psychologic and physical dependence, additive effects with other CNS depressants

Didanosine

(DDI) Antiviral: nucleoside inhibitor of HIV reverse transcriptase. Tox: peripheral neuropathy, pancreatitis

Digitoxin

Cardiac glycoside: half−life 168 h, excreted in the bile (partially as digoxin); subject to enterohepatic circulation. See digoxin

Digoxin

Cardiac glycoside prototype: positive inotropic drug for CHF, half−life 40 h; renal excretion; inhibits Na+/K+ ATPase, also a cardiac parasympathomimetic. Tox: calcium overload arrhythmias, GI upset

Diltiazem

Calcium channel (L−type) blocker prototype: like verapamil, has more depressant effect on heart than dihydropyridines (eg, nifedipine). Tox: AV block, CHF, edema, constipation

Dimercaprol

(BAL) Chelator (British AntiLewisite): used for arsenic, lead, and mercury poisoning

Dioxin

(TCDD) Toxin: byproduct of the manufacture of herbicides 2,4−D and 2,4,5−T. Tox: extremely potent carcinogen in guinea pigs; poorly documented in humans except for chloracne, a skin disorder that occurs acutely upon exposure

Diphenhydramine

Antihistamine H1 blocker prototype: used in hayfever, motion sickness, dystonias. Tox: antimuscarinic, anti−alpha, sedative

Disopyramide

Group IA antiarrhythmic: used for ventricular arrhythmias. Tox: strong antimuscarinic; may cause CHF

Dopamine

Neurotransmitter and agonist drug at dopamine receptors: used in shock to increase renal blood flow, stimulate heart

Doxorubicin

Antineoplastic: anthracycline drug (cell cycle−nonspecific); intercalates between base pairs to disrupt DNA functions and forms cytotoxic free radicals. Tox: cardiotoxicity, myelosuppression

Doxycycline

Tetracycline antibiotic: protein synthesis inhibitor (30S), more effective than other tetracyclines against bacillary dysentery. Unlike other tetracyclines, it is eliminated mainly in the feces. Tox: see tetracycline

Echothiophate

Organophosphate cholinesterase inhibitor: less lipid soluble than most organophosphates; used in glaucoma

Edetate

(EDTA) Chelating agent: used in lead poisoning. Tox: renal tubular necrosis

Edrophonium

Cholinesterase inhibitor: very short duration of action (15 min). Used to reverse NM blockade and as diagnostic test in myasthenia gravis

Enoxaparin

Low molecular weight heparin. Primary effect is anti−factor X. Other low molecular weight heparin−like products: dalteparin, danaparoid. Tox: bleeding

Ephedrine

Indirectly acting sympathomimetic: like amphetamine but less CNS stimulation, more smooth muscle effects

Epinephrine

Adrenoceptor agonist prototype: product of adrenal medulla, some CNS neurons. Affinityfor all alpha and all beta receptors. Used in asthma; as hemostatic and adjunct with local anesthetics; drug of choice in anaphylaxis

Ergonovine

Ergot alkaloid: uterine effect prototype, causes prolonged uterine contraction. Used in post−partum bleeding

Ergotamine

Ergot alkaloid: vascular effect prototype, causes prolonged vasoconstriction, uterine contraction. Used in migraine, obstetrics

Erythromycin

Macrolide antibiotic: inhibitor of protein synthesis (50S); activity includes gram−positive cocci and bacilli, M pneumoniae, Legionella pneumophila, C trachomatis. Tox: cholestatic jaundice, inhibits liver drug−metabolizing enzymes, interactions with astemizole, theophylline, terfenadine, warfarin

Ethacrynic

acid Loop diuretic: not a sulfa derivative. Tox: like furosemide but does not increase serum uric acid.

Ethanol

Sedative−hypnotic: acute actions include impaired judgment, ataxia, loss of consciousness, vasodilation, and cardiovascular and respiratory depression. Chronic use leads to dependence and liver, cardiovascular, endocrine, gastrointestinal, hepatic, and nervous system pathology. Note: zero−order elimination kinetics

Ethosuximide

Anticonvulsant: used in absence seizures; may block T−type Ca2+ channels in thalamic neurons. Tox: GI distress but safe in pregnancy

Etidronate, pamidronate, alendronate

Bisphosphonates: reduce turnover of bone calcium. Used in Paget's disease, osteoporosis;

alendronate

increases bone formation. Tox: severe esophageal ulceration

Fexofenadine

2nd generation antihistamine; does not enter CNS, little or no sedation

Finasteride

Steroid inhibitor of 5-alpha−reductase: inhibits synthesis of dihydrotestosterone, the active androgen in prostate. Used in BPH

Flecainide

Group IC antiarrhythmic prototype: used in ventricular tachycardia and rapid atrial arrhythmias with Wolff−Parkinson−White syndrome. Tox: arrhythmogenic, CNS excitation

Fluconazole

Imidazole antifungal: used for esophageal candidiasis and in coccidioidomycoses; high CSF levels provide prophylaxis versus fungal meningitis in immunosuppressed patients

Fludrocortisone

Synthetic corticosteroid: high mineralocorticoid and moderate glucocorticoid activity; long duration of action

Flumazenil

Benzodiazepine receptor antagonist: used to reverse CNS depressant effects of benzodiazepines (overdose or when used in anesthesia)

Fluorouracil

Antineoplastic: pyrimidine antimetabolite (cell cycle−specific) causes "thymine−less" cell death; used mainly for solid or superficial tumors. Tox: GI distress, myelosuppression

Fluoxetine

Antidepressant: serotonin selective reuptake inhibitor (SSRI) prototype. Less ANS adverse effects and cardiotoxic potential than tricyclics. Tox: CNS stimulation, seizures in overdose

Flutamide

Androgen receptor inhibitor: nonsteroid used in prostatic carcinoma

Furosemide

Loop diuretic prototype: blocks Na+/K+/2Cl− transporter; high efficacy; used in acute pulmonary edema, refractory edematous states, hypercalcemia. Tox: ototoxicity, K+ wasting, hypovolemia, increased serum uric acid

Foscarnet

Antiviral: effective against CMV and HSV (including TK− strains); Tox: electrolyte imbalance, nephrotoxicity

Ganciclovir

Antiviral: effective against CMV; requires bioactivation via thymidine kinase. Tox:myelosuppression, nephrotoxicity

Gemfibrozil, clofibrate

Antilipemics: stimulate lipoprotein lipase in peripheral tissues. Used in hypertriglyceridemias and mixed triglyceridemia/hypercholesterolemia

Gentamicin

Aminoglycoside prototype: bactericidal inhibitor of protein synthesis (30S); active against many aerobic gram−negative bacteria. Narrow therapeutic window; dose reduction required in renal impairment. Tox: renal dysfunction, ototoxicity; once−daily dosing is effective (post−antibiotic effect) and less toxic

Glipizide, glyburide

Oral hypoglycemics: second generation, very potent. Like other sulfonylureas, act by closing K channels in pancreatic B cells, causing depolarization and release of insulin. Tox: hypoglycemia

Glucagon

Hormone product of pancreatic A cells. Increases blood sugar via increased cAMP

Guanethidine

Postganglionic sympathetic neuron blocker: enters nerve ending by means of uptake−1 and is stored in the ending (effect reversed by TCAs, cocaine). Tox: severe orthostatic hypotension, sexual dysfunction

Haloperidol

Antipsychotic butyrophenone: blocks brain dopamine D2 receptors. Tox: marked EPSdysfunction, hyperprolactinemia; less ANS adverse effects than phenothiazines

Halothane

General anesthetic prototype: inhaled halogenated hydrocarbon. Causes cardiovascular and respiratory depression and relaxes skeletal and smooth muscle. Use has decreased due to sensitization of heart to catecholamines, and occurrence (rare) of hepatitis and malignant hyperthermia

Heparin

Anticoagulant: large polymeric molecule with antithrombin, and anti−factor X activity. Primary rapid onset, in vitro and in vivo anticoagulation. Antidote: protamine. See also enoxaparin

Hydralazine

Antihypertensive: arteriolar vasodilator, orally active; used in HTN, CHF. Tox: Tachycardia, salt and water retention, lupus−like syndrome

Hydrochlorothiazide

Thiazide diuretic prototype: acts in distal convoluted tubule; blocks Na+/Cl− transporter; used in HTN, CHF, chronic renal stone syndrome. Tox: increased serum lipids, uric acid, glucose; K+ wasting

Ibuprofen

NSAID prototype: short duration. Inhibits cyclooxygenase (both I and II) reversibly. Used in arthritis, dysmenorrhea, muscle inflammation. Tox: peptic ulcer, renal damage

Imipenem

Antibiotic: carbapenem beta−lactam active against many aerobic and anaerobic bacteria including penicillinase−producing organisms; a bactericidal inhibitor of cell wall synthesis. Used with cilastatin (which inhibits metabolism by renal dehydropeptidases). Tox: allergy (partial cross−reactivity with penicillins), seizures (overdose)

Imipramine

Tricyclic antidepressant prototype: blocks reuptake of norepinephrine and serotonin. Tox: ANS (alpha and muscarinic) blockade, cardiac arrhythmias

Indinavir

Antiviral; HIV protease inhibitor used as component of combination regimens in AIDS. Tox: anemia, nephrolithiasis, inhibits P−450 drug metabolism reactions. Other protease inhibitors: ritonavir, nelfinavir, saquinavir

Indomethacin

NSAID prototype: highly potent. Usually reserved for acute inflammation (eg, acute gout), not chronic; neonatal patent ductus arteriosus. Tox: GI (bleeding), renal damage

Insulin

Hypoglycemic peptide hormone of B (beta) cells of the pancreas: stimulates transport of glucose into cells and glycogen formation; inhibits lipolysis and protein catabolism

Interferon-alpha

Important cytokine for the treatment of hepatitis B and C infection.

Ipodate

Antithyroid: iodine−containing radiocontrast medium; also used in thyrotoxicosis. Reduces peripheral conversion of T4 to T3; may also reduce release of hormone from thyroid

Ipratropium

Antimuscarinic agent: aerosol for asthma, COPD. Good bronchodilator in 20−30% of patients. Not as effective as 2 agonists

Isoniazid

Antimycobacterial: primary drug in combination regimens for tuberculosis; used as sole agent in prophylaxis. Metabolic clearance via N−acetyltransferases (genetic variability). Tox: hepatotoxicity (age−dependent), peripheral neuropathy (reversed by pyridoxine), hemolysis (in G6PD deficiency)

Isoproterenol

Beta1, beta2 agonist catecholamine prototype: bronchodilator, cardiac stimulant. Always causes tachycardia because both direct and reflex actions increase HR. Tox: arrhythmias, angina

Ketoconazole

Antifungal azole prototype: active systemically; inhibits the synthesis of ergosterol. Used for C albicans, dermatophytes and for non−life−threatening systemic mycoses. Tox: hepatic dysfunction, inhibits steroid synthesis and P450−dependent drug metabolism

Labetalol

Alpha− and beta−blocker: used in HTN. Tox: AV block, hypotension

Leuprolide

GnRH analog: synthetic peptide used in pulse therapy to stimulate gonadal steroid synthesis (infertility); used in continuous or depot therapy to shut off steroid synthesis, especially in prostate carcinoma

Levodopa

Dopamine precursor: used in parkinsonism, usually combined with carbidopa (a peripheral inhibitor of dopamine metabolism). Tox: dyskinesias, hypotension, on−off phenomena, behavioral changes

Lidocaine

Local anesthetic, medium duration amide prototype: highly selective use−dependent Group IB antiarrhythmic; used for nerve block and post MI ischemic ventricular arrhythmias. Tox: CNS excitation

Lithium

Antimanic prototype: drug of choice in mania and bipolar affective disorders; blocks recycling of the phosphatidyl inositol second messenger system. Tox: tremor, diabetes insipidus, goiter, seizures (in overdose), teratogenic potential (Ebstein's malformations)

Lovastatin

Antilipemic HMG−CoA reductase inhibitor prototype: acts in liver to reduce synthesis of cholesterol. Other statins: atorvastatin, fluvastatin, pravastatin, simvastatin. Tox: liver damage (elevated enzymes), muscle damage

LSD

Lysergic acid diethylamide, "Acid:" semisynthetic ergot derivative; orally active; hallucinogen

Malathion

Organophosphate insecticide cholinesterase inhibitor: pro−drug converted to malaoxon. Less toxic in mammals and birds because metabolized to inactive products

Meperidine

Opioid analgesic: synthetic, equivalent to morphine in efficacy, but orally bioavailable. Strong agonist at mu opioid receptors; blocks muscarinic receptors. Tox: see morphine

Mestranol

Synthetic estrogen: used in many oral contraceptives

Metformin, phenformin

Oral biguanide hypoglycemics: mechanism not understood, different from sulfonylurea oral hypoglycemics. Some efficacy in the absence of functioning pancreatic B cells

Methadone

Opioid analgesic: synthetic mu agonist, equivalent to morphine in efficacy, but orally bioavailable with longer half−life (used to suppress withdrawal symptoms and in maintenance programs). Tox: see morphine

Methotrexate

Antineoplastic, immunosuppressant: cell cycle−specific drug that inhibits dihydrofolate reductase. Major dose reduction required in renal impairment. Tox: gastrointestinal distress, myelosuppression. Leucovorin rescue used to reduce toxicity after very high doses

Methyldopa

Antihypertensive: prodrug of methylnorepinephrine, a CNS−active 2 agonist. Reduces SANS outflow from vasomotor center. Tox: positive Coombs test, hemolysis

Methysergide

Ergot alkaloid: used as prophylactic in migraine. Tox: retroperitoneal and subendocardial fibroplasia

Metoprolol

Beta1−selective blocker: used in HTN and for prevention of post−MI sudden death arrhythmias

Metronidazole

Antiprotozoal antibiotic: drug of choice in extraluminal amebiasis and trichomoniasis; active against bacterial anaerobes including B fragilis and in antibiotic−induced colitis due to C difficile. Tox: peripheral neuropathy, gastrointestinal distress, ethanol intolerance, mutagenic potential

Mexiletine

Group IB antiarrhythmic drug: like lidocaine but orally active

Mifepristone

(RU 486) Progesterone and glucocorticoid inhibitor: abortifacient, antineoplastic

Minoxidil

Antihypertensive: pro−drug of minoxidil sulfate, a high efficacy arteriolar vasodilator. Used in HTN; topically for baldness. Tox: tachycardia, salt and water retention, pericardial effusion

Misoprostol

PGE1 derivative: orally active prostaglandin used to prevent peptic ulcers in patients taking NSAIDs for arthritis. Tox: diarrhea

Morphine

Opioid analgesic prototype: strong mu receptor agonist. Poor oral bioavailability. Effects include analgesia, constipation, emesis, sedation, respiratory depression, miosis, and urinary retention. Tolerance may be marked; high potential for psychologic and physical dependence. Additive effects with other CNS depressants

Nafcillin

Penicillinase−resistant penicillin prototype: used for suspected or known staphylococcal infections; not active against methicillin−resistant staphylococci. Tox: penicillin allergy

Nalbuphine

Opioid: mixed agonist−antagonist analgesic that activates kappa and weakly blocks mu receptors. Effective analgesic, but with lower abuse liability and less respiratory depressant effects than most strong opioid analgesics

Naloxone

Opioid mu receptor antagonist: used to reverse CNS depressant effects of opioid analgesics (overdose or when used in anesthesia)

Neostigmine

Cholinesterase inhibitor prototype: quaternary nitrogen carbamate with little CNS effect

Nevirapine

Prototype nonnucleoside inhibitor of HIV reverse transcriptase (NNRTI).Others : efavirenz, delavirdine

Niacin

Antilipemic: reduces release of VLDL from liver into circulation. Tox: flushing

Nifedipine

Calcium channel blocker prototype: vasoselective (less cardiac depression); used in angina, HTN. Tox: constipation, headache

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