Pharmacology

Pulmonary infiltrations inducing drugs "Go BAN Me!": 
Gold 
Bleomycin/ Busulphan/ BCNU 
Amiodarone/ Acyclovir/ Azathioprine 
Nitrofurantoin 
Melphalan/ Methotrexate/ Methysergide




MPTP: mechanism, effect MPTP:
Mitochondrial Parkinson's-Type Poison.
· A mitochondrial poison that elicits a Parkinson's-type effect.

Antimuscarinics: members, action
"Inhibits Parasympathetic And Sweat":
Ipratropium Pirenzepine Atropine Scopolamine
· Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic.

Teratogenic drugs: major non-antibiotics TAP CAP:
Thalidomide Androgens Progestins Corticosteroids Aspirin & indomethacin Phenytoin

Steroid side effects CUSHINGOID:
Cataracts
Ulcers
Skin: striae, thinning, bruising
Hypertension/ Hirsutism/ Hyperglycemia
Infections
Necrosis, avascular necrosis of the femoral head
Glycosuria
Osteoporosis, obesity
Immunosuppression
Diabetes


Beta blockers with CYP2D6 polymorphic metabolism
"I Met Tim Carver, the metabolic polymorph":
· The following beta blockers require dose adjustment due to CYP2D6 polymorphic metabolism:
Metoprolol Timolol Carvedilol (in patients with lower or higher than normal CYP2D6 activity)

Beta blockers with intrinsic sympathomimetic activity
Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels. Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some diabetics or asthmatics despite the fact that they are non-seletive beta blockers.

Muscarinic effects SLUG BAM:
Salivation/ Secretions/ Sweating
Lacrimation
Urination
Gastrointestinal upset
Bradycardia/ Bronchoconstriction/ Bowel movement
Abdominal cramps/ Anorexia
Miosis

Sulfonamide: major side effects
· Sulfonamide side effects:
Steven-Johnson syndrome
Skin rash
Solubility low (causes crystalluria)
Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin)

Epilepsy types, drugs of choice:
"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies":
· Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence)
· Respective drugs: Valproate  Valproate  Valproate ACTH Carbamazepine Ethosuximide

Quinolones [and Fluoroquinolones]: mechanism
"Topple the Queen": Quinolone interferes with Topoisomerase II.

Beta blockers:
B1 selective vs. B1-B2 non-selective
A through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol.
O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol.

Ribavirin: indications RIBAvirin:
RSV
Influenza B
Arenaviruses (Lassa, Bolivian, etc.)
Hypertension: treatment ABCD:
ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also)  Beta blockers
Calcium antagonists
Diuretics

Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugs
Constipation
Respiratory depression
Addiction
Miosis
Sex hormone drugs: male "Feminine Males Need Testosterone":
Fluoxymesterone
Methyltestosterone
Nandrolone
Testosterone

Ca++ channel blockers: uses CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes

Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM:
Procarbazine
Metronidazole
Cefo (Perazone, Mandole, Tetan).

Delerium-causing drugs ACUTE CHANGE IN MS:
Antibiotics (biaxin, penicillin, ciprofloxacin)
Cardiac drugs (digoxin, lidocaine)
Urinary incontinence drugs (anticholinergics)
Theophylline
Ethanol
Corticosteroids
H2 blockers
Antiparkinsonian drugs
Narcotics (esp. mepridine)
Geriatric psychiatric drugs
ENT drugs
Insomnia drugs
NSAIDs (eg indomethacin, naproxin)
Muscle relaxants
Seizure medicines

Morphine: side-effects MORPHINE:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention)
Nausea
Emesis

Therapeutic dosage: toxicity values for most commonly monitored medications
"The magic 2s":
Digitalis (.5-1.5) Toxicity = 2.
Lithium (.6-1.2) Toxicity = 2.
Theophylline (10-20) Toxicity = 20.
Dilantin (10-20) Toxicity = 20.
APAP (1-30) Toxicity = 200.

Diuretics:
thiazides: indications "CHIC to use thiazides":
CHF
Hypertension
Insipidous
Calcium calculi

Migraine: prophylaxis drugs
"Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis":
Verpamil
Valproic acid
Pizotifen
Amitriptyline
Flunarizine
Methysergide
Propranolol

Adrenoceptors: vasomotor function of alpha vs. beta
ABCD:
Alpha = Constrict.
Beta = Dilate.

Antiarrhythmics: classification
I to IV MBA College
· In order of class I to IV:
Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers

Opiods: mu receptor effects "MD CARES":
Miosis
Dependency
Constipation
Analgesics
Respiratory depression
Euphoria
Sedation

Cancer drugs: time of action between DNA->mRNA ABCDEF: Alkylating agents
Bleomycin
Cisplastin
Dactinomycin/ Doxorubicin
Etoposide
Flutamide and other steroids or their antagonists (eg tamoxifen, leuprolide)

Busulfan: features ABCDEF:
Alkylating agent
Bone marrow suppression s/e
CML indication
Dark skin (hyperpigmentation) s/e
Endrocrine insufficiency (adrenal) s/e
Fibrosis (pulmonary) s/e

Tricyclic antidepressants: members worth knowing
"I have to hide, the CIA is after me":
Clomipramine Imipramine Amitrptyline
· If want the next 3 worth knowing, the DNDis also after me:
Desipramine Norrtriptyline Doxepin

Torsades de Pointes: drugs causing APACHE:
Amiodarone Procainamide Arsenium Cisapride Haloperidol Eritromycin

Serotonin syndrome: components Causes HARM:
Hyperthermia Autonomic instability (delirium) Rigidity Myoclonus

Tetracycline: teratogenicity
TEtracycline is a  TEratogen that causes staining of  TEeth in the newborn.

Patent ductus arteriosus: treatment
"Come In and Close the door": INdomethacin is used to Close PDA.

Physostigmine vs. neostigmine LMNOP:
Lipid soluble
Miotic
Natural
Orally absorbed well
Physostigmine
· Neostigmine, on the contrary, is:
Water soluble
Used in myesthenia gravis
Synthetic
Poor oral absorption

Beta 1 selective blockers
"BEAM ONE up, Scotty":
Beta 1 blockers:
Esmolol
Atenolol
Metropolol

Antirheumatic agents (disease modifying): members
CHAMP:
Cyclophosphamide
Hydroxycloroquine and choloroquinine
Auranofin and other gold compounds
Methotrexate
Penicillamine


Auranofin, aurothioglucose: category and indication
Aurum is latin for "gold" (gold's chemical symbol is Au).
Generic Aur- drugs (Auranofin, Aurothioglucose) are gold compounds.
· If didn't learn yet that gold's indication is rheumatoid arthritis, AUR- Acts Upon Rheumatoid.

Antiarrhythmics: class III members  BIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol

MAOIs: indications MAOI'S:
Melancholic [classic name for atypical depression]
Anxiety
Obesity disorders [anorexia, bulemia]
Imagined illnesses [hypochondria]
Social phobias
· Listed in decreasing order of importance.
· Note MAOI is inside MelAnchOlIc.

SIADH-inducing drugs ABCD:
Analgesics: opioids, NSAIDs
Barbiturates
Cyclophosphamide/ Chlorpromazine/ Carbamazepine
Diuretic (thiazide)

K+ increasing agents K-BANK:
K-sparing diuretic
Beta blocker
ACEI
NSAID
K supplement


Reserpine action:
Reserpine depletes the Reserves of catecholamines [and serotonin].

Succinylcholine:
action, use Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore. You Suck stuff in through a mouth-tube, and drug is used for intubation.
Beta-blockers: side effects "BBC Loses Viewers In Rochedale": Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia
Cisplatin: major side effect, action "Ci-Splat-In":
Major side effect: Splat (vomiting sound)--vomiting so severe that anti-nausea drug needed. Action: Goes Into the DNA strand.

Vir-named drugs: use"-vir at start, middle or end means for virus": · Drugs:
Abacavir,
Acyclovir,
Amprenavir,
Cidofovir,
Denavir,
Efavirenz,
Indavir,
Invirase,
Famvir,
Ganciclovir,
Norvir,
Oseltamivir,
Penciclovir,
Ritonavir,
Saquinavir,
Valacyclovir,
Viracept,
Viramune,
Zanamivir,
Zovirax.

Phenobarbitone: side effects
Children are annoying (hyperkinesia, irritability, insomnia, aggression).
Adults are dosy (sedation, dizziness, drowsiness).

Prazocin: usage
Prazocin sounds like an acronym of "praszz zour urine".
Therefore Prazocin used for urinary retention in BPH.

Opioids: effects BAD AMERICANS:
Bradycardia & hypotension
Anorexia
Diminished pupilary size
Analgesics
Miosis
Euphoria
Respiratory depression
Increased smooth muscle activity (biliary tract constriction) Constipation
Ameliorate cough reflex
Nausea and vomiting
Sedation

TB: antibiotics used
STRIPE:
STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol

Phenytoin: adverse effects PHENYTOIN:
P-450 interactions
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenicity
Osteomalacia
Interference with B12 metabolism (hence anemia)
Neuropathies: vertigo, ataxia, and headache


Narcotic antagonists
The Narcotic Antagonists are NAloxone and NAltrexone. · Important clinically to treat narcotic overdose.

Thrombolytic agents USA:
Urokinase Streptokinase Alteplase (tPA)

Routes of entry: most rapid ways meds/toxins enter body
"Stick it, Sniff it, Suck it, Soak it":
Stick = Injection
Sniff = inhalation
Suck = ingestion
Soak = absorption

Asthma drugs: leukotriene inhibitor action
zAfirlukast: Antagonist of lipoxygenase
zIlueton: Inhibitor of LT receptor

Direct sympathomimetic catecholamines DINED:
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine

Anticholinergic side effects
"Know the ABCD'S of anticholinergic side effects":
Anorexia
Blurry vision
Constipation/ Confusion
Dry Mouth
Sedation/ Stasis of urine

Atropine use: tachycardia or bradycardia
"A goes with B": Atropine used clinically to treat Bradycardia.

Bleomycin: action
"Bleo-Mycin Blows My DNA to bits": Bleomycin works by fragmenting DNA (blowing it to bits). My DNA signals that its used for cancer (targeting self cells).

Aspirin: side effects ASPIRIN:
Asthma
Salicyalism
Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA
Intestinal blood loss
Reye's syndrome
Idiosyncracy
Noise (tinnitus)

Lupus: drugs inducing it HIP:
Hydralazine
INH
Procanimide

Vigabatrin: mechanism Vi-GABA-Tr-In:
Via GABA Transferase Inhibition

Morphine: effects at mu receptor PEAR:
Physical dependence
Euphoria
Analgesia
Respiratory depression

Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factor Xa. Monitor Xa concentration, rather than APTT.

Beta-1 vs Beta-2 receptor location "You have 1 heart and 2 lungs":
Beta-1 are therefore primarily on heart. Beta-2 primarily on lungs.

SSRIs: side effects SSRI:
Serotonin syndrome
Stimulate CNS
Reproductive disfunctions in male
Insomnia

Ipratropium: action Atropine is buried in the middle:
iprAtropium, so it behaves like Atropine.

Warfarin: action, monitoring WePT:
Warfarin works on the extrinsic pathway and is monitored by PT.

Propranolol and related '-olol' drugs: usage"olol" is just two backwards lower case b's. Backward b's stand for "beta blocker". · Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol.

Depression: 5 drugs causing it PROMS:
Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids

Lead poisoning: presentation ABCDEFG:
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)


Myasthenia gravis: edrophonium vs. pyridostigmine
eDrophonium is for Diagnosis.
pyRIDostigmine is to get RID of symptoms.

Morphine: effects MORPHINES:
Miosis
Orthostatic hypotension
Respiratory depression
Pain supression
Histamine release/ Hormonal alterations
Increased ICT
Nausea
Euphoria
Sedation

Inhalation anesthetics SHINE:
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
· If want the defunct Methoxyflurane too, make it MoonSHINE.

Cholinergics (eg organophosphates): effects
If you know these, you will be "LESS DUMB":
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction

Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure) LOT: Lorazepam Oxazepam Temazepam

Benzodiazepines: actions
"Ben SCAMs Pam into seduction not by brain but by muscle":
Sedation
anti-Convulsant
anti-Anxiety
Muscle relaxant
Not by brain: No antipsychotic activity.

Botulism toxin: action, related bungarotoxin
Action: "Botulism Bottles up the Ach so it can't be the released":
Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alpha-bungarotoxin--alpha has different mechanism).

Teratogenic drugs "W/ TERATOgenic":
Warfarin
Thalidomide
Epileptic drugs: phenytoin, valproate, carbamazepine
Retinoid
ACE inhibitor
Third element: lithium
OCP and other hormones (eg danazol)

Gynaecomastia-causing drugs DISCOS:
Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol

Benzodiazepenes: drugs which decrease their metabolism
"I'm Overly Calm":
Isoniazid
Oral contraceptive pills
Cimetidine
· These drugs increase calming effect of BZDs by retarding metabolism.

Anesthesia: 4 stages "Anesthesiologists Enjoy S & M":
Analgesia
Excitement
Surgical anesthesia
Medullary paralysis

4-Aminopyradine (4-AP) use"4-AP is For AP":
For AP (action potential) propagation in Multiple Sclerosis.

Osmotic diuretics: members GUM:
Glycerol
Urea
Mannitol

Sodium valproate: side effects VALPROATE:
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)

Nitrofurantoin: major side effects NitroFurAntoin:
Neuropathy (peripheral neuropathy)
Fibrosis (pulmonary fibrosis)
Anemia (hemolytic anemia)
Zafirlukast, Montelukast, Cinalukast:
mechanism, usage"Zafir-luk-ast, Monte-luk-ast, Cina-luk-ast": · Anti-Lukotrienes for Asthma.
· Dazzle your oral examiner: Zafirlukast antagonizes leukotriene-4.
Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount":
Phenytoin
Ethanol
Aspirin
Zero order
· Someone that pees out a constant amount describes zero order kinetics (always the same amount out)

Hepatic necrosis: drugs causing focal to massive necrosis
"Very Angry Hepatocytes":
Valproic acid
Acetaminophen
Halothane

Steroids: side effects BECLOMETHASONE:
Buffalo hump
Easy bruising
Cataracts
Larger appetite
Obesity
Moonface
Euphoria
Thin arms & legs
Hypertension/ Hyperglycaemia
Avascular necrosis of femoral head
Skin thinning
Osteoporosis
Negative nitrogen balance
Emotional liability

Amiodarone: action, side effects 6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism


Monoamine oxidase inhibitors:
Members "PIT of despair":
Phenelzine
Isocarboxazid
Tranylcypromine ·    
A pit of despair, since MAOs treat depression

 Warfarin: metabolism SLOW:
· Has a slow onset of action.
· A quicK Vitamin K antagonist, though.
Small lipid-soluble molecule
Liver: site of action
Oral route of administration.
Warfarin


Propythiouracil (PTU):
Mechanism It inhibits PTU:
Peroxidase/ Peripheral deiodination
Tyrosine iodination Union (coupling)


Antibiotics contraindicated during pregnancy  MCAT:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline

Beta-blockers:
nonselective beta-blockers"Tim Pinches His Nasal Problem"
(because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol

Methyldopa:
side effects METHYLDOPA:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)

Lithium: side effects  LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism

Respiratory depression inducing drugs "STOP breathing":
Sedatives and hypnotics
Trimethoprim
Opiates
Polymyxins


Benzodiazepenes: antidote "Ben is off with the flu":
Benzodiazepine effects off with Flumazenil.