bind pbps, block transpeptidase cross-linking of cell wall, bacteria autolysin activity
Ampicillin, Amoxicillin (clinical use)
Gram + and H. influenza, E. coli, Listeria, Proteus, Salmonella and enterococci
Ticarcillin, carbenicillin, pipercillin (clinical use)
Pseudomonas and gram - rods
use with clavulanic acid
clavulanic acid, sulbactam, tazobactam
used in combo with antipseudomonals and aminopencillins
Erthromycin, Clindamycin, Sulfamethoxazole, Trimethoprim, Tetracyclines, Chloramphenicol
Vancomycin, Fluoroquinolones, Pencillin, Aminoglycosides, Cephalsporins, Metronidazole
B-lactam drugs that inhibit cell wall synthesis but less suspectible to penicillins
1st generation Cephs (names and clinical use)
Gram + and Proteus, E. coli, Klebsiella
2nd generation Cephs (names)
Cefaclor, Cefoxitin, Cefuroxime, Cefamandole
(its a FACt i want a FOXy FURy MAN)
2nd generation Cephs (clinical use)
H. influenza, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
3rd generation Cephs
Ceftriaxone, Cefotaxime, Ceftazidine
Cross the BBB
Covers serious gram - except LAMEs (Listeria, Atypical, MRSA, Enterococci)
Aztrenam (clinical use)
Gram - rods
DOES NOT WORK ON gram + or anaerobes
No cross-sensitivity with pens and cephs
B-lactamase resistant carbapenem.
Cilastatin inhibits dihydropeptidase I in the kidney
Vancomycin (MAO and clinical use)
inhibits cell wall mucopeptide formation by binding D-ala D-ala
used for MRSA and multidrug resistant gram +
Aminoglycosides (names and MAO)
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
inhibit initiation complex and cause misreading of mRNA
Aminoglycosides (clinical use and toxicity)
MUST HAVE OXYGEN--> ineffective against anaerobes
use for gram - rods
Nephrotoxicity, Ototoxicity, Neuromuscular blockade, Teratogen
transferase enzyme or enzymes that inactivate by adenylation, acetylation, and phosphorylation
prevent attachment of aminoacyl tRNA
DON'T take with milk or iron due to divalent cations which inhibits absorption
Tetracyclines (clinical use)
Vibrio chlorea, acne, Chlamydia, Ureaplasma, Mycoplasma, H. Pylori, Borrelia, Rickettsia
Macrolides (names and MAO)
ACE (azithromycin, clarithromycin, erythromycin)
inhibits protein synthesis by blocking translocation by binding 23S rRNA of the 50S
Gray baby syndrome due to lack of UDP-glucuronyl transferase
hemolysis in G6PD deficiency
kernicterus due to displacement of bilirubin
Trimethoprim (MAO and toxicity)
inhibits bacterial dihydrofolate reductase
toxicity: megaloblastic anemia, leukopenia, granulocytopenia
bind to cell membranes of bacteria and disrupt their osmotic properties
cationic, basic proteins that act like detergents
Polymyxins (clinical use and toxicity)
used for resistant gram - infections
neurotoxicity, acute tubular necrosis
hepatotoxicity, P-450 inducers, orange body fluids
DON'T USE with HIV patients bc affects mitochondrial synthesis of RNA
Flucytosine (MAO and toxicity)
inhibits DNA synthesis by conversion to 5-fluorouracil
bone marrow suppression
Caspofugin (MAO and clinical use)
inhibits cell wall synthesis by inhibiting synthesis of B-glucan
used for invasive aspergillosis
Griseofulvin (clinical use and toxicity)
dermatophytoses (oral treatment)
P-450 inducer, teratogenic, carcinogenic
Amantadine (clinical use and toxicity)
Influenza A and Parkinson's disease
toxicity: ataxia, slurred speech, dizziness (DRUNK)
Inhibits DNA synthesis in HSV, VZV, and EBV. Activated by viral thymidine kinase (TK- strains are resistant).
Inhibits DNA synthesis. Effective against herpes viruses CMV and HSV; for CMV requires bioactivation via viral phosphotransferase.
Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme. Does not require activation by viral kinase.
Foscarnet (clinical use and toxicity)
Uses: CMV retinitis in immunocomp pts. when gancyclovir fails. Tox: Nephrotoxicity
Protease Inhibitors (-navir) (MAO)
inhibit maturation of new virus by blocking protease in progeny virus
ritonavir P450 inhibitor
Zidovudine, Abacavir, Didanosine (ddI), Lamivudine (3TC), Stavudine (d4T), and Zalcitabine (ddC
Reverse transcriptase inhibitors (MAO)
inhibit reverse transcriptase of HIV
inhibits 5' -->3' phosphodiester linkage formation
Reverse transcriptase inhibitors (toxicity)
bone marrow suppression, peripheral neuropathy, lactic acidosis (NRTI), rash (NNRTI)
bind viral gp41 subunit
inhibit conformational change required for fusion with CD4 cells
BLOCK VIRAL PENTRATION
Glycoproteins synthesized by virus-infected cells block replication of both RNA and DNA viruses
Praziquantel (MAO and clinical use)
Increases membrane permeability to Ca2+ causing muscle contraction followed by paralysis.
Used for flukes and tapeworms
Intensifies GABA-mediated neurotransmission in nematodes, but no access to CNS in humans.
Nifurtimox (MAO and clinical use)
Forms intracellular oxygen radicals, which are toxic to the organism. Used against TRYPANOSOMA CRUZI.
precursor of 6-mercaptopurine
interfers with metabolism and synthesis of nucleic acids
blocks tyrosine kinase. binds to mTOR.
inhibit T-cell proliferation in response to IL-2
alpha 1 receptor
increase vascular smooth muscle contraction, pupil dilator muscle (mydriasis), increase intestinal and bladder sphincter muscle contraction, decrease renin release
Beta 2 receptor
vasodilation, bronchodilation, increase heart rate and contractility, increase insulin release, decrease uterine tone
Cholinomimetic. Activates bowel and bladder smooth muscle. Resistant to AChE. Uses: Postoperative and neurogenic ileus and urinary retention
Cholinomimetic. ACh analog. Uses: Glaucoma, pupillary constriction, and relief of intraocular pressure.
Cholinomimetic. Contracts ciliary muscle of eye (open angle), pupillary sphincter (narrow angle). Resistant to AChE. Uses: Glaucoma, Sjoren, Stimulator of tears, sweat, and saliva.
Cholinesterase inhibitor. Increase endogenous ACh. Little CNS effect. Uses: Postoperative ileus and urinary retention, MG, reversal of neuromuscular blockade.
DON'T ENTER CNS
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation.
Antidote: Atropine + pralidoxime
toxicity: "red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare"
Don't use Atropine in ...
acute angle glaucoma in elderly
hyperthermia in infants
Nicotinic antagonist (blocks para and sympathetic). Uses: Ganglionic blocker. In experimental models, prevents vagal reflex responses to changes in blood pressure - prevents reflex brady.
Tox: Orthostatic Hypotension, Blurred vision, constipation, sex dysfunction
Direct sympathomimetics. affinity for all receptors. low doses (B1), high doses (alpha1).
Adrenoceptor agonist prototype: acts at B1- and all A adrenoceptors
increase BP, TPR, HR and pulse pressure
Norepinephrine (clincal use and toxicity)
Tox: ischemia, arrhythmias, HTN, reflex bradycardia.
Isopropterenol (low dose epi)
B1 and B2 agonist catecholamine prototype: bronchodilator, cardiac stimulant. Always causes tachycardia because both direct and reflex actions increase HR. Tox: arrhythmias, tremor, angina.
Neurotransmitter and agonist drug at dopamine receptors: used in shock to increase renal blood flow (low dose) and positive inotropic effects (moderate dose).
increase HR, contractility, conduction velocity and myocardial oxygen consumption
Nonselective alpha blockers
Used in pheochromocytoma. Tox: excess hypotension; GI distress.
Prazosin, Terazosin, "-osins"
Alpha1-selective blocker prototype: used in HTN and benign prostatic hyperplasia. Tox: first-dose orthostatic hypotension but less reflex tachycardia than nonselective a blockers.
Alpha 2 blockers
Mirtazapine (depression) and Yohimbine
Tox: sedation, increase serum cholesterol and appetite
(Inducers) Queen Barb Steals Phen-phen and Refuses Greasy Carbs Chronically
Quinidine, Barbiturates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic alcohol use
metabolized faster where it doesn't work
(Inhibitors) Inhibit yourself from drinking beer from a KEG because it makes you Acutely SICk
Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erythromycin, Grapefruit juice, Acute alcohol use
Bile acid resins (cholestyramines)
Prevent intestinal reabsorption of bile acids. Liver must use cholesterol to make more
Antihypertensive. Arteriolar vasodilator, orally active. Uses: Severe HTN, CHF, HTN in preg (with Methyldopa). Metabolized by Acetylation. Tox: Tachycardia, Salt and H2O retention, Lupus like syndrome.
K+ channel opener that hyperpolarizes and relaxes vascular smooth muscle. Uses: Severe HTN, baldness. Tox: Hypertrychosis, Pericadial effusion, Reflex tachy, Angina, Salt retention.
Dyhydropiridine calcium channel blocker. Vasoselective (N>D>V). Uses: Hypertension, Angina, Printzmetal's angina, Reynaud's. Tox: Cardiac depression, AV block, edema, flushing, dizziness, constipation.Others: Amlodipine (HF), Nimodipine (subarachnoid hemmorhage), Nicardipine
D1 receptor antagonist. Relaxes smooth muscle. Powerful vasodilator. Uses: Hypertensive emergencies
Cardiac glycoside. Direct inhibitor of Na+/K+ pump leading to indirect inhibition of Na+/Ca++ exchanger and increasing intracellular calcium levels. Stim. vagus. T1/2 40hrs. Uses: CHF, A-fib. Tox: Calcium overload arrhythmias, GI upset.
Class 1A antiarrhythmic
Quinidine, Procainamide, Disopyramide
. Uses: Atrial and vetricular arrhythmias. Tox: Cinchonism - headache, tinnitus, Thrombocytopenia, Torsades. Others: Procainamide, Dysopyramide. Increase AP
Class 1B antiarrhythmic.
Lidocaine, Mexiletine, Tocainide
Selectively affects ischemic or depolarized vent. tissue. Uses: Acute V-arrhythmias (post MI) and digoxin tox. Tox: Local anesthetic, CNS stim/ dep, cardiovascular depression. Others: Mixeiletine (Oral), Tocainide. Decrease AP
Class 1C antiarrhythmic
Flecainide, Encainide, Propafenone
Class 1C antiarrhythmic. No effect on AP. Uses: V-tach and rapid SVT with WPW. Tox: Proarrhythmic (post MI), Prolongs refractory period in AV. Others: Encainide, Propafenone
Unclassified antiarrhythmic. Parenteral only. Hyperpolarizes AV nodal tissue causing block for 10 - 15 secs. Very short acting. Uses: Drug of choice in abolishing/ diagnosing SVT. Tox: flushing, hypotension, chest pain
Lispro, Aspart, Regular Insulin
Short acting insulin analogs. Bind insulin receptor (TK). Liver - Increase glucose stored as glycogen. Muscle - Increase glycogen and protein synthesis, K+ uptake. Fat - Aids TG storage. Uses: DM1, DM2, Hyper K+. Tox: Hypoglycemia
Intermediate acting insulin analog. Bind insulin receptor (TK). Liver - Increase glucose stored as glycogen. Muscle - Increase glycogen and protein synthesis, K+ uptake. Fat - Aids TG storage. Uses: DM1, DM2, Hyper K+. Tox: Hypoglycemia
Long acting insulin analogs. Bind insulin receptor (TK). Liver - Increase glucose stored as glycogen. Muscle - Increase glycogen and protein synthesis, K+ uptake. Fat - Aids TG storage. Uses: DM1, DM2, Hyper K+. Tox: Hypoglycemia
Blocks K+ channels in pancreatic B cells, causing depolarization and release of insulin. Uses: Only DM2. Tox: hypoglycemia, weight gain, cholestatic jaundice
Oral biguanide hypoglycemic. Decreases hepatic gluconeogenesis, Increase Glycolysis, and peripheral glucose uptake (insulin sensitivity). Uses: Oral, can be used in DM1. Minimal hypoglycemia or weight gain. Tox: Lactic acidosis. DON'T use in renal failure
peroxisome proliferator-activator receptors (PPARs) enhances target tissue sensitivity to insulin.
Uses: DM2. Tox: weight gain, edema, hepatotoxicity, cardiotoxicity
Alpha-glucosidase inhibitors. Delayed sugar hydrolysis and glucose absorption leads to decreased postprandial hyperglycemia. Uses: DM2. Tox: GI disturbances.
Mimetic.(amylin analog) Decreases glucagon release. Uses: DM2. Tox: Hypoglycemia, nausea, diarrhea
GLP-1 analog. Increased insulin, decreased glucagon release. Uses: DM2. Tox: Nausea vomiting, pancreatitis, weight loss
Antithyroid drug. Inhibits tyrosine iodination and coupling reactions. Orally active. Uses: Hyperthyroidism. Tox: Rash, agranulocytosis (rare). Methimazole is a possible teratogen
Thyroid replacement. Uses: Hypothyrodism, myxedema. Tox: Tachycardia, heat intolerance, tremors, arrhythmias.
Decrease production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX2. Uses: Addisons disease, inflammation, immune suppression, asthma. Tox: Cushing's syndrome. Adrenal insufficiency when drug is stopped after chronic use.
Binds to ulcer base, provides physical protection, and allows HCO3- secretion to establish pH gradient in mucous layer. Uses: Ulcer healing and traveler's diarrhea.
PGE1 analog. Increased production of mucus and decreased acid secretion
Uses: Orally active prostaglandin used for GI ulcers caused by NSAIDs. Maintenance of ductus arteriousus and induction of labor. Tox: diarrhea, ABORTIFACIENT
Can affect absorption, bioavailability, or excretion of other drugs due to alteration of gastric/ urine pH. Tox: Aluminum Hyd.- conspitation, Mag Hyd. - Diarrhea, Cacium Carb - Hypercalcemia. All can cause hypokalemia.
A combination of Sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory). Activated by colonic bacteria. Uses: UC, Crohn's. Tox: Malaise, nausea, sulfonamide toxicity, reversible oligospermia.
D2 receptor antagonist. Increase resting tone, contractility, LES tone, motility. Uses: Diabetic and post-surgery gastroparesis. Tox: Parkinsonian effects, Restlessness, Drowsiness, Drug interactions with Digoxin and diabetic agents.
chelating agent used in treatment of arsenic poisoning by displacing arsenic ions from sulfhydryl
Thrombolytic. Protein from streptococci that accelerates
plasminogen-to-plasmin conversion. Increase pT and pTT. Uses: Early MI, stroke. Tox: bleeding, allergy. Tox treated with Aminocaproic acid.
Thrombolytic. Human recombinant tissue plasminogen
activator. Used in acute MI (to recanalize the occluded
coronary artery), pulmonary embolism, stroke. Tox: bleeding. Others: Urokinase, APSAC
Blocks platelet ADP receptors irreversibly and inhibits platelet
aggregation. Used in transient ischemic attacks and to prevent
strokes and restenosis after placement of coronary stents.
Tox: bleeding, neutropenia. Others: Ticlopidine (higher risk
of neutropenia and TTP)
Alpha agonist used in Glaucoma. Decrease aqueous humor synthesis. No pupillary or visual changes.
B- blockers: Timolol, betaxolol, carteolol
Decrease aqueous humor synthesis. No pupillary or visual changes.
Prostaglandin used in Glaucoma. Increase outflow of aqueous humor. Tox: Darkens color of iris (browning)
Opioid Analgesics (MAO)
agonists at opoid receptors to modulate synaptic transmission-- open K+ channels, close Ca2+ channels --> decrease synaptic transmission
Inhibits release of ACh, NE, 5HT, glutamate, substance P
Opioid Analgesics (Clinical use)
Pain, cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), maintence program for addicts
Opioid Analgesics (Toxicity)
respiratory depression, pinpoint pupils, CNS depression
treat with naloxone
Partial agonist at opioid mu receptors, agonist at kappa receptors. Uses: Pain, causes less resp. depression than full agonists. Tox: Causes withdrawal if on full opioid agonist.
Anticonvulsant. Used for tonic-clonic and partial seizures;
blocks Na+ channels in neuronal membranes. Inhibit glutamate release from excitatory presynaptic neuron. Serum levels
variable because of first-pass metabolism and nonlinear
sedation, diplopia, gingival
hyperplasia, hirsutism, peripheral neuropathy, nystagmus, megaloblastic anemia, teratogenic potential (cleft palate). Drug interactions
via induction of hepatic metabolism. CYP450 INDUCER.
Facilitate GABA by increasing DURATION of Cl- channel opening --> decrease neuron firing
additive CNS depression with alcohol, respiratory and CV depression. Induction of P450
Anticonvulsant: structural analog of GABA that facilitates its
inhibitory actions in the CNS; used for partial seizures, for
neuropathic pain, and in bipolar disorder. Tox: sedation,
Newer antiepiliptic drug for absence and partial seizures; also
used in bipolar affective disorder. Tox: Steven's Johnson rash, possibly life threatening.
Anticonvulsant: used for tonic-clonic and partial seizures;
blocks Na+ channels in neuronal membranes. DOC
for trigeminal neuralgia; backup drug in bipolar disorder. Tox:
CNS depression, myelotoxic, induces liver drug-metabolizing
Anticonvulsant: primary drug in clonic-tonic, absence, and
myoclonic seizure states. Also used commonly for bipolar
disorder. Tox: GI distress, hepatic necrosis (rare), teratogenic
(spina bifida), inhibits drug metabolism.
Anticonvulsant: primary in absence seizures; may block T-type Ca2+ channels in thalamic neurons. Tox: GI distress; safe in
Facilitate GABAa action by increasing FREQUENCY of Cl- channel opening. decrease REM sleep
Benzo's (clinical use)
anxiety, spastic, status epilepticus, detox, night terrors and sleepwalking
General anestheti. Inhaled halogenated hydrocarbon. Tox: cardiovascular and respiratory depression and relaxation of skeletal and smooth muscle. Use is declining because of sensitization of heart to catecholamines and occurrence (rare) of hepatitis. Others: Fluranes + NO.
Most common drug used for endoscopy. Used adjuntively with gaseous anesthetics and narcotics. May cause severe postoperative respiratory depression, decrease in BP, and amnesia.
PCP analog that acts as dissociative anesthetic. Block NMDA receptors. Cardovascular stimulant. Cause disorientaion, hallucination, and bad dreams. Increase cerebral blood flow.
Depolarizing neuromuscular relaxant. Short duration
(5 min) if patient has normal plasma cholinesterase (genetically
determined). No antidote. Implicated in malignant hyperthermia.
Nondepolarizing neuromuscular blocking agent. Competitive nicotinic blocker (ACh). Releases histamine and may cause hypotension. Analogs: pancuronium, atracurium, vecuronium, and other "-curiums" and "-oniums." Tox: respiratory paralysis. Antidote: cholinesterase inhibitor, eg, neostigmine.
Dantrolene (clinical use)
used in treatment of malignant hyperthermia and to treat neuroleptic malignant syndrome
prevents the release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle by blocking ryanodine receptors
Dopamine precursor: used in parkinsonism, usually combined
with carbidopa (a peripheral inhibitor of dopamine metabolism).
Tox: dyskinesias, hypotension, on-off phenomena, behavioral
Alzheimers drug. NMDA receptor antagonist; Helps prevent excitotoxicity (mediated by Ca++). Tox: Dizziness, confusion, hallucinations
Reserpine + tetrabenazine - amine depleting. Haloperidol - dopamine receptor antagonist. Dz - Increase dopamine, decrease GABA + ACh.
5-HT1D receptor agonist: used to abort migraine attacks. Tox:
coronary vasospasm, chest pain, or pressure. Other "triptans":
naratriptan, rizatriptan, zolmitriptan.
Haloperidol + azines
Antipsychotic: blocks brain dopamine D2 receptors (Increase cAMP). Uses: Schizophrenia, Psychosis, Acute mania, Tourette's. Tox: marked EPS dysfunction (Hal, Flu drugs), hyperprolactinemia; neuroleptic malignant syndrome, tardive dyskinesia
Sterotypic oral-facial movements due to long-term antipsychotic use. Often irreversible
Atypical antipsychotic; high-affinity antagonist at 5-HT2 receptors with minimal extrapyramidal side effects; improves
both positive and negative symptoms of schizophrenia. Also OCD, Depression, mania, Tourrette's. Other atypicals: Quetiapine (short half-life), Risperidone (possible EPS dysfunction), Sertindole (QT prolongation).
Atypical antipsychotic: low affinity for dopamine D2 receptors, higher for D4 and 5-HT2A receptors; fewer EPS adverse
effects than other antipsychotic drugs. Tox: ANS effects, Wt. gain, agranulocytosis (infrequent but significant).
Antimanic prototype: a primary drug in mania and bipolar affective disorders; blocks recycling of the phosphatidylinositol
second messenger system. Tox: tremor, hypothyroidism, diabetes insipidus, goiter, seizures (in overdose), nephrogenic diabetes insipidus, teratogenic potential (Ebstein's malformations).
Anxiolytic: partial agonist that interacts with 5-HT1A receptors; slow onset (1-2 weeks). Uses: GAD. Minimal potentiation of CNS depressants, including ethanol; negligible abuse liability.
TCAs (Imipramine, Amytriptyline, Clomipramine, Doxepin)
blocks reuptake of norepinephrine and serotonin. Uses: Major depression, bedwetting (Imi), OCD (Clop), fibromylagia.
atropine-like, postural hypotension, sedation, cardiac arrhythmias in overdose, additive effects with other CNS depressants. 3-C: Convulsions, Coma, and Cardiotox.
SSRIs (Fluoxitine, Paroxitine, Sertaline, Citalopram) (MAO and clinical use)
selective serotonin reuptake inhibitor
Uses: Depression, OCD, Bulimia, Phobias.
Tox: CNS stimulation, sexual dysfunction, seizures
in overdose, serotonin syndrome (SS). SS Tx: Cyproheptadine (Serotin receptor antagonist)
Serotonin and NE reputake inhibitors. Uses: Depression. Venla - GAD. Dulo - Diabetic peripheral neruopathy. Tox: Hypertension
Phenelzine, Tranylcypromine, Isocarboxazid (MAO and clinical use)
Irreversible nonselective monoamine oxidase (MAO) inhibitor. Increases level of neurotransmitters. Uses: backup drug for atypical depression, hypochondrias
Phenelzine, Tranylcypromine, Isocarboxazid (toxicity)
Tox: malignant hypertension with indirect-acting sympathomimetics and tyramine, serotonin syndrome with serotonergic drugs.
MAO-B inhibitor: selective inhibitor of the enzyme that metabolizes dopamine (no tyramine interactions). Uses: Parkinson's disease. Tox: GI distress, CNS stimulation, dyskinesias, serotonin syndrome if used with selective serotonin reuptake inhibitors.
Atypical antidepressant. Used in smoking cessation. Increases NE and dopamine via unknown mech. Tox: Stimulant effect, headache, seizure in bulemic patients.
Atypical antidepressant. Alpha 2 agonist (increase release of NE + Ser) and potent Serotonin receptor antagonist. Used in anorexia. Tox: Sedation, Increased appetite, weight gain, ortho hypotension.