Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion Sting, Hypercalcemia, Hyertriglyceridemia, ERCP, drugs (sulfa drugs, NRTIs, protease inhibitors). all can lead to acute pancreatitis. Metoprolol, propanolol (non-selective), esmolol, atenolol, timolol (non-selective), and carvedilol (non-selective alpha and beta)
MOA: decrease SA and AV nodal activity by decreased cAMP, supressing slope of phase 4 .
AV node is particulary sensitive- increasing PR interval
Esmolol is very short-acting.
Use: SVT, ventricular rate control in a-fib and atrial flutter
Toxicity: impotence, exacerbation of COPD and asthma (especiallialy non-selectives), cardiovascular effects (bradycardia, AV block , HF). CNS effects (sedation, sleep alterations). May mask signs of hypoglycemia (caution in diabetics). Metoprolol can cause dyslipidemia.
treat overdose with saline, atropine, and glucagon.
Amiodarone, Ibutilide, Dofetilide, Sotalol (AIDS)
Notice that Ibutilide adn Dofetilide both have tilide at their endings (so amiodarone, sotalol and tilides)
MOA: increased AP duration, increase ERP, increase QT interval (torsades)
Use: a-fib, VT (amioadrone, solatol)
Toxicity: torsdaes and also sotalol can cause excessive beta blockade.
AMIODARONE: pulmonary fibrosis, hepatotoxicity, hypothryoidism/hyperthroidism (amidodarone is 40% iodine), corneal deposits, blue gray skin, neurolgoic effects, constipation, cardiovascualr effects (bradycardia, heart block, HF)
Check PFTs, LFTs, and TFTs when taking Amiodarone.
cefoxitin, cefaclor, cefuroxime
Cover Gram positive Cocci, H. flu, enterobacter (enterodactyl), Neisseira, proteus miriablis, E. coli, Klebsiella, Serratia
Or could think of as the sketchy for serratia, enterobacter, and klebsiella + proteus, E. coli and H. flu and neiseria.
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin (mycin but beware because macrolides also have the mycin)
Mean (aminoglycoside) GNATS caNNOT kill anaerobes
Toxcicity = NNOT: neprotoxicity, neurmouscular blockade, ototoxicity (especially with loop diuretics), teratogen
MOA: Bactericidal. Inhibition of hte initiation complex through binding of the 30 S subunit. Requires O2 for uptake, and THEREFORE IS INEFFECTIVE AGAINST ANAEROBES.
Use; severe gram-negative rod infecitons. Synergistic with beta lactam antibiotics. Neomycin for bowel surgery
MOR: bacterial transferase enzymes inactivate the drug by cetylatoin, phosphorlyation, and adenylation.
Azithromycin, clarithromycin, erythromycin
MOA: inhibit translocation (Macroslides) by biding to rRNA on 50S. Bacteriostatic
USE: atypical pneumonias (mycoplasma, chlamydia, Legionella), STIs (Clamydia), gram-postive occci (streptococcal infections in patients allergic to penicillin) and B pertussis.
Toxicity: MACRO: GI Motility issues, Arrhythmia caused by prolong QT, acute Cholestatic hepatitis, Rash, eOsinophillia. Increases serum concentration of theophyllines and warfarin (Always THink When Outdoors). Clarithromycin and Erthromycin inhibit C P450.
MOR methylation of 23S rRNA binding site preventing binding
Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
MOA: inhibits folate synthesis by inhibiting dihydropteroate synthase (PABA was precursor) Bacteriostatic (except when combine with TMP). Dapsone used to treat leprometaous leprosy, is a simialr drug that also inhibits folate synthesis
Use; gram positives, gram-negatives, Nocardia, Clhlamyida. UTIs
Toxicity: hypersensitivity rxns, hemolysis if G6PD deficiency, neprhotoxicty (tubulointerstitial nephritis), photosensitivity, Kernicterus in infants, dispalce other drugs from albumin (warfarin)
MOA: altered enzyme (bacterial dihydropterorate synthase), decrased uptake, or increased PABA synthesis
ciprofloxacin, norfloxacin, levofloxacine, ofloaxin, moxifloxacin, gemifloxacin, adn enoxacin.
MOA: inhibit prokarytoic enzymes topiosomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids.
Use: gram-negative rods of urinary and GI tracts (including pseudomonas), Neisseria,
Toxicity: GI upset, superinfecitons, skin rash, headache, dizinessl Less commonly can cause leg cramps and myalgias. Contraindicated in pregnancy and children < 18 because can cause damage to cartilage. Some may prolong QT. May cause tendonitis or tendon rupture in people > 60 (HOBBS) and in patients taking prednisone.
Fluroquinolones hurt attachments to your bones
MOR: mutations in DNA gyrase, efflux pumps
MOA forms toxic free radic metabolites that damages DNA. Bactericidal but also anti-protozoal.
USE: Treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. difficile). Used with a proton pump inhbiitor and clarithromycin for triple therapy against H. pyrlori
GET GAP: Giardia, Entomoeba, Trichomonas, Garnerella vaginalis, Anerobes (c. diff, bacteroides), and H. Pylori.
Unlike clindamycin, treats anaerobic infections below the diaphragm.
Toxicity: Disulfiram-like reaction (severe flushing, tachcardia, hypotension) with alcohol; headache, metallic taste.
MOA: binds ergosterol (unqiue to fungi); forms membrane pores that allow leakage of electrolytes.
AmphoTERicin TEARs holes in the fungal membrane forming pores.
Use: serious, systemic mycoses. Cryptococcus (may use flucytosine as well), Blastomyces, Coccidiodies, Histoplasma, candida, mucor.
Intrathecally for fungal meningitis.
Supplement K+ and Mg+ becuase of altered renal tubule permeability
toxicity: fevers, chills ("shake and bake"), hypotension, nerphrotoxcity, arrythmias, anemia, IV phelbitis (Amphoterrible). Hydration decreases nephrotoxicity.
Abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir, zidovudine (formerly AZT).
Competitively inhibit nucletoide binding to reverse transcriptase. Tenofovir is a nucleotide, the others are nucleosides and must be phosphorlyated to be active.
Zidovudine is used in general prophylaxis and during pregnancy to reduce transmission.
Toxicity: bone marrow supression (prevent with G-CSF), peripheral neuropathyk, lactic acidosis, anemia, pancreatitis (didanosine)
Beclomethasone, dexamethasone, fludrocortisone (mineralcoriticoid and glucocorticoid activity), hydrocortisone, methlpredinosolone, predinsone, triamcinolone
MOA: many effects including metabolic, catabolic, anti-inflammatory, and immunosupressive effects mediated by interactions with glucocorticoid response elements, inhibition of phospholipase A2, and inhibitioin of transcription factors such as NF-KB.
Use: Addison disease, inflammation, immunosupression, asthma
SE: iatrogenic cushing syndrome (hypertesnion, weight gain, moon facies, trunal obesity, buffalo hump, thinning of skin, striae, osteoporosis, hyperglycemia, amenorrhea, immunosupression), adrenocortical atrophy, peptic ulcers, steroid diabetes, steroid psychosis, adrenal insufficiency when drug stopped abruptly after use
Cimetidine, rantidine, famotidine, nizatidine,
Take H2 blockers before you dine. Think "table for 2"- H2
MOA: reversible block of histamine H2-receptors- decreases acid secretoin by parietal cells.
Use: peptic ulcer, gastritis, mild GERD
Toxicity: Cimtediine is potent inhibitor of Cyotochome-p450. Cimetidine also has antiandrogenic effects (p;rolactine release, gynecomastia, and impotence, decreased libido in males. It also can cross the BBB and cause confusion, diziness, and headache. Both Cimteidine and ranitidine decrease renal excretion of creatinine. The other two don't have these side effects.
Inhibits diihydrofolate reductase thus decreased dTMP and decreased DNA syntehsis
Competitive folic acid analog (can be covercome with leucovorin/folinic acid)
Use: leukemias, lymphomas, chroiocarcinoma, sarcoma. Alsoo, ectopic pregnancy, medical abortion (with misoprostol), RA, psoriasis, IBD, vasculitis
toxicity: myelsupression that is reversible. Hepatotoxicty. Mucositis (mouth ulcers), and pulmonary fibrosis.
Note that all the antimetabolites above are S-phase specific
Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethrophan, diphenoxylate, pentazocine
MOA: act as agonists at opiod receptors (mu = morphine, then enkephalin and dynorphin). to modulate synaptic transmisison - open K+ channles, close Ca2+ channels- decreased synpatic transmission. Inhibit release of NE, ACh, 5-HT, and substance P
Use: pain, cough depression (extromethrophan), diarrhea (loperamide, diphenoxylate- keep it on DL that I have diarrhea), maitenance programs for heroin addicts (methadone, buprenorphine + naloxone).
Tox: addiction, respiratory depression, constipation, miosis. Treat with naloxone or naltrexone (opiod recetpor antagonist)
Diazepam, lorazepam, tirazolam, temazepam, oxazepam, midazolam, chloridiazepoxide, alprazolam
MOA: facilitate GABA action by increasing frequency of Cl- channel opening. Decrease REM sleep.
ATOM: alprazolam, traizolam, oxazepam, and midazolam have short half-lives and thus high addictive potential.
Use: anxiety, spastiticty, status epilepticus, detoxification (alcohol withdrawal), night terrors, sleep walking, gneral anesthetic, hypnotic (insomnia)
Tox: dependence, additive CNS depression with alcohol.
Antidote: Flumazenil (compettiive antagonist at GABA receptor)
Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, N2O
Effects: myocardial depression, respiratory depression, N/V, increased cerebral blood flow
Toxicity: hepatotoxcity (Halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), expansion of trapped gas in body cavity (N2O)
Most importnatly: can cause malignant hyperthermia: rare lifethreatening hereditary conditon where inhaled anesthetics (except N2O) and succinylcholine induce fever and severe muscle contraction. Treat with dantrolene.
Esters: procaine, cocaine, tetracaine
Amides: lidocaine, mepivacaine, bupivacaine (amides have 2 I's)
MOA: blocks Na+ channels by binding to specific receptors. Preferentially binding to activated sodium channels. Amine local aneshtetics penetrate the membrane in uncharged form and bind to ion channels in charged form.
Can be given with with vasoconstrictors (epi) to enhance local action
In infected (acidic) tissue, alakaline anesthetics are charged and cannot penetrate membrane effectively (need more anesthetic).
Order of nerve blockade: small > big diameter. Myelinated > unmyelinated with size being teh most importnat.
Order of loss; pain, temp, touch, pressure
Use: minor surgical procedures
Toxicity: Severe cardiotoxicty (bupvivicaine), hypertesnion, hypotenison, arrhythmias (cocaine), and methemoglobineima (benzocaine)
Haloperiodol + the azines
Haloperidol., trifuloperazine, fluphenazine, thioridazine, chlopromazine
MOA: block Dopamine D2 receptor (increase cAMP)
Use: Schizophenia (the positive symptoms), psychosis, acute mania, Tourrettes.
SE: highly lipid soluble and stored in fat so very slow to be removed from the body. Has extrapyramidal side effects (4 hr-acute dystonia, 4 days - akathisia (restlessness), 4 weeks- bradykinesia, 4 months- tardive dyskinesia). Treat
Also endocrine side effects: hyperprolactinemia- galactorrhea (in women).
Also side effects from blockign the muscarinic (dry mouth, constipation), alpha 1 (hypotension), and histamine (sedation) receptors.
Prolongs QT (torsades)
High potency: Trifuluoperazine, Fluphenazine, haloperiodl (Try to Fly High) - neurologic side effects- like huntignton disease, delirium, extrapyramidal side effects.
The low potency drugs hae more fo the non-neurologic side effects (anticholinergic, antihistamine, alpha 1 blockade).
Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone (It's atypical for old closets to quietly risper form A to Z).
Use: Schizophrneia (both positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourrete
SE: fewer than typical antipsychotics
Olanzapine/clozapine: may cause signficant weight gain (obese curtains)
CLOZAPINE MAY CAUSE AGRANULOCYTOSIS (must check neutrophil count) and seizure
Risperidoone may increase prolactin leading to lactation and gynecomastia (decreased GnRH, LH, and FSH- fertility issues) All may prolong the QT
Fluoxetine, paroxetine, sertraline, citalopram (FLashback PARalyze, SEnior, CITiznes)
MOA: seroronin reuptake inhibitors
Use: depression, GAD, panic disorder, OCD, bulimia, social phobias, and PTSD
SE: Fewer than TCAs. GI distress, SIADH, SEXUAL DYSFUNCTION.
Serotonin syndrome wiht any drug that increases serotonin: hypertheia, confusion, myoclonus, cardivoasuclar instability, flushing, diarrhea, seizures.
Takes 4-8 weeks to kick in
Amitryptyline, nortriptyline, imipramine, desipramine, clomipramine (notice all the pramine), amoxapine, doxepin.
MOA: block reuptake of NE and 5HT.
Use: major depressoni, OCD (clomipramine), migraine prophylaxis (sumatriptan).
SE: sedatoin alpha 1 blocking effects including posterual hypotension, and atropine-like side effects (anticholinergic)- tachycardia, uriary retention dry mouth. Can prolong QT internval.
amitryptyline has worse side effects than nortripyline.
Tri C's: Convulsions, Coma, Cardiotoxicity (arrythmias).
Sodium bicarb given to prevent arrythmia
Furosemide, bumetanide, torsemide
MOA: Sulfonamides. Inhibits cotransport system (Na+/K+/2CL-) of thick ascending limb. Abolish hypertonicity of medulla, preventing concentraiton of urine. Stimulate PGE relase (vasodilatory effect on afferent arteirole). INCREASE CALCIUM EXCRETION.
Use: Edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia
Tox: ototoxicty, hypokalemia, dehydration, allergy (sulfa), neprhitis (intersitial), Gout
MOA: inhibit NaCl reabosrtion in DCT (decrease diluting capcity of neprhon), decrease calcium excretion
Use: hypertesnion, HF, idiopathic hypercalciuria,
Tox: hypokalemic metabolic alkalosis, hyponatermia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia. Sulfa allergy
Captopril, enalapril, lisinopril, ramipril
MOA: inhibit ACE, decreasing ATII and decreasing GFR by prevening constriction of efferent arteirioles. Also prevents inactivation of bradykinin.
Use; hypertension, HF, diabetic nepropathy. Prevents unfavorable heart remodleing as a result of chronic hypertension. Decreases intraglomerular pressures, slowing GBM thickening in diabetic nepropathy.
Tox: Cough, angioedema, teratogen, (fetal renal malformations), icnreased creatinine (decreased GFR), Hyperkalemia, and hypotension. Must avoid in bilaterla renal stenosis (GFR decreased too much- renal failure)