Mechanism of action for each class of anti-Arrythmic drugs?
Use the Mnemonic: NBKC I - Sodium Channel Blockers II - Beta Blockers
III – K+ channel Blockers IV - Calcium Channel Blockers Class IA Antiarrythmics Quinidine Procainamide Dispyrimide Class IB Antiarrythmics Lidoicaine Tocainide Mexiletine Phenytoin Class IC Antiarrythmics Ecainide Flecanide Propophenone 10 Class II antiarrythmics PPEST-BLAAC Pindalol Propranolol Esmolol Sotalol Timolol Butoxolol Labetalol Atenolol Acebutalol Carvedilol
Longest acting Beta blocker: Propranolol
Shortest acting Beta blocker: Esmolol
Beta blocker that is also K+ channel blocker:
Sotolol
Beta blockers used to treat glaucoma Timolol
Carvadalol
Beta blocker that is also an alpha blocker Labatalol, Carvetalol
Beta blocker that is also an agonist Pindalol
Atenolol Acebutalol
MC location and function for Beta1 receptors?
CNS Increased activity
Ciliary Muscles of eye to produce aqueus humor
SA Node to increase HR and Contractility
Alpha cells of pancreas to increase Glucagon
JG cells of kidney to increase Renin release
MC location & function of 2 receptors?
Ciliary muscles of eye to produce aqueus humor
Bronchial Smooth muscle to bronchodilate
Ventricles to Increase Contractility
Beta Cells of Pancreas to cause Insulin Release
Uterus and bladder to cause relaxation Selective –vs- Non-selective beta blockers?
A-M (-LC) Selective
N-Z(+LC) Nonselective
Antiarrythmic causing hemolysis & thrombocytopenia
Quinidine
Fastest acting Na+ channel blocker Lidocaine
3 antiarrythmics that block 95% of sodium channels
Ecainide Flecanide Propophenone
Antiarrythmic that Causes Cinchinism Phenytoin
Antiarrythmics that cause pulmonary fibrosis
Tocainide Amiodarone
Antiarrythmics that cause Gingival Hyperplasia
Phenytoin
Antiarrythmic that causes hersutism Phenytoin
Antiarrythmics used to treat WPW Quinidine
Procainamide Phenytoin
Antiarrythmic that is contraindicated in WPW
Digitalis
Antiarrythmics Used to Treat ventricular arrythmias
Class I antiarrythmics Antiarrythmics Used to Treat Atrial Arrythmias Class IV antiarrythmics
Antiarrythmics that causes blue skin (Smurf syndrome)
Amiodarone
Antiarrythmics causing Bad GI upset Mexiletine
Antiarrythmic that causes Hyper/hypo-thyroidism
Amiodarone
Antiarrythmics Used to decrease vasospasms after subarrachnoid hemorrhage. Nimodipine Symptoms of cinchinism? Tinnitus Hearing loss Thrombocytopenia Two action of Digitalis?
Blocks potassium arm of NA-K ATPase causing increased contraction
Stimulates vagus, slowing HR. Pulmonary fibrosis Rx
Busulfan Bleomycin Tocainide Amiodarone
What is the most common SVT in teenagers?
Wolf-Parkinson White Pathology of WPW?
There is an accessory pathway from SA node bypassing AV node to ventricle called the Bundle of Kent.
Why are 3 Na+ blocker used to treat WPW?
They are both Na+ and Ca2+ channel blockers.
EKG finding of WPW? Delta waves.
Antiarrythmic made from iodine? Amiodarone
Name the class IV antiarrythmics Verapamil
Ditiazem Nifedipine Nicardipine Nimodipine Amlodipine Femlodipine
Cardioselective class IV antiarrythmics? Verapamil
Diltiazem
Most potent Class IV antiarrythmic? Verapamil 4 K+ Channel Blockers: Amiodarone Bretylium NAPA NAcetyl-Procainamide) Sotalol
How do you determine when to use Dopamine –vs-Dobutamine? DoButamine Low HR DoPamine Elevated HR
Receptor Dopamine affect 1st , 2 nd , at high
doses
D2- Dilate Kidney & GI TPR Beta 1 HR & Contractility Alpha 1 Vasoconstrict
What conditions give you Shock & Bradycardia?
Cholinergic crisis Heart Block
Clues for Cinchonism Tinitis
Hearing Loss Thrombocytopenia
Name 7 Antimetabolite Chemotherapy drugs ARA-A ARA-C Azothiprine 5-FU 6-Mercaptopurine Methotrexate Thioguanadine
Which cancer are treated with antimetabolites?
Fast growing cancers
Which cancers are treated with alkylating agents?
A slow growing cancer
5-FU is use to treat which cancer? Duke stage C Colon Cancer in combination with levamisole
3 drugs used to treat steroid resistant disease
Methotrexate Azothioprine Cyclosporin
5-FU mechanism of action Inhibits Thymidilate synthetase
Methoterxate mechanism of action Inhibits dihydrofolate reductase
To what substance is 6-Mercaptopurine metabolized
Uric acid
How do alkylating agents work? They bind dsDNA and prevent it from unwinding for replication
Name 13 alkylating agent Chemotherapy drugs Adriamycin Acridine Bleomycin Busulfan Chlorambacil Cyclophosphamide Cisplatin Dacarbazine Hydroxyurea Isophosphamide Mitomycin Mechlorethamine Procarbazine
Drugs that cause pulmonary fibrosis Bleomycin
Busulfan Amiodarone Tocainide
Favorite Alkylating agent Clorambucil
Favorite Antimetabolite Methotrexate
Drug that causes cardiac fibrosis Adriamycin (Doxarubicin)
Chemo drug that causes hemorrhagic cystitis
Cyclophosphamide
Chemo drug that causes renal failure Cisplatin
Chemo drug used to treat sickle Cell Hydroxyurea
How does hydroxyurea work? It inhibits Ribonucleotide Reductase Which two alkylating agents form free radicals
Cyclophosphamide Adriamycin
Rescue for patient on Adriamycin Desroxazine Rescue
Rescue for patient on Cyclophosphamide MESNA Rescue
Rescue for patient on Methotrexate Leucovorin Rescue
Three alkylating agents used to treat Hodgkins Lymphoma
Mechlorethamine Dacarbazine Procarbazine
Name 7 microtubule Inhibitor chemotherapy drugs
Vincristine Vinblastine Paclitaxel
Name 1 nutrient depleater chemotherapy drugs
L-Aparaginase
Name 1 immune modulator Levamisole
How does Levamisole work? It enhances NK cells
Which Microtubule inhibitor causes neuropathies?
Vincristine
Which Microtubule inhibitor causes aplastic anemia?
Vinblastine
Which Microtubule inhibitor inhibits microtubules after they are made? Paclitaxil
For what cancer is Paclitaxil used? Breast
What is the main side effect of L-arginase?
Symptoms of Cholinergic crisis SLUD Salivation Lacrimation Urination Defication
Symptoms of Anticholinergic crisis Hot
Dry Red Crazy
Give the location of Alpha 1 receptors
Radial muscles of the eye to cause Mydriasis without cyclopledgia
All sphincters
Arteries to constrict
Give the location of Alpha 2 receptors
All Presynaptic sympathetic fibers to inhibit NE
Beta cell of the pancreas to IHN Insulin What drugs are used to treat HTN in pregnancy?
Alpha-methyl Dopa Hydralizine
Name 3 alpha 2 agonists Alpha-Methyl Dopa Guanabenz
Clonidine
Side effect of Clonidine Rebound HTN
Side effect of alpha-methyl Dopa Hemolytic anemia Anticholinergic drugs Atropine Scopalomine Glycopyrrolate Bentropine Trihexyphenadyl
Which anticholinergic is the drug of choice for heart block?
Atropine
Which anticholinergic is used to treat dystonia?
Benztropine
2 Anticholinergics used dry up secretions pre-OP?
Atropine Scopalomine
Which AchE inhibitor is used to diagnose Myesthenia Gravis?
Edrophonium
Which AchE inhibitor is used to Treat Myesthenia Gravis?
Neostigmine Pyridostygmine
Why is physostigmine not used to treat Myethenia Gravis?
Too much CNS penetration causing drowsiness
Anticholinergic used to treat organophosphate poisoning Atropine
What is the mechanism of action of Roloxafen and Tomoxafen?
INH estrogen receptor at pituitary and Breast
Pro-estrogen at bone
Pro-estrogen at liver
Which estrogen receptor blocker promotes enometrial cancer? How?
Tomoxafen
Because it stimulates the Endometrium List 2 alpha blockers used to treat BPH Terazocin
Doxazocin
What is the MOA of Finesteride? It is a 5-Alpha-reductase inhibitor
What are the treatment options for BPH? #1- Terazocin, Doxazocin
#2_ Finesteride #3 – TURP MOA of Heparin
Cofactor for ATIII with allow inhibition of Thrombine and factors 9-12
MOA of Warfarin
IHN Vitamin K and thereby factors 10, 9, 7, 2, Protein C, and Protein S
For what is Vitamin K needed? Gama-carboxylation in the liver
What drug can be used acutely to inhibit GPIIb:IIIa?
Abscixamab
Name three drugs that can be used to inhibit ADP production in the clotting cascade
Ticlopidine Clopidogrel
Dipyridamole
Which are the side effects of Ticlopidine? Seizures
Agranulocytosis Clue for Dipyridamole
Vasodilator used after MI to dilate coronaries
Clue for Clopidogrel
Decreaset mortality in combination with ASA in those with risk factors
RX for PCP
Trimethaprim/Sulfamethoxazole
Rx For Patients Allergic to TMP/SULFA Pentamidine
RX for Leishmania Stybogluconate Treat MAI with Clarithromycin.
Best Rx for C.dif colitis Vancomycin
Current Rx for C.Dif colitis Metronidazole
Pregnant woman’s rectum culture returns (+) for Group B Strep. Rx with? Ampicillin
Treatment for Hookworms Mabendazole
Stongyloides Thiabendazole
What is the treatment for flatworms? Hyclosamine &Niclosamine
How do Hyclosamine & Niclosamine work?
They paralyze the worm's nervous system What drugs are used to treat Malaria? Chloroquine
Mefloroquine Primaquine Quinine
One dose treatment for candidiasis? Fluconazole
Imidazole that crosses (BBB)? Fluconazole
Imidazole inhibits P450? Ketoconazole
How is it treated?
Tinea Capitis - Griseofulvin
The Infection (Staph Aureus) - Antibiotics The Inflammatory infection – Steroids Rx for LYME'S disease?
Penicillin – First Line Tetracylcinis
4 drugs you can use to treat Herpes? Pencyclovir - TID
Acyclovir - Five (5) times a day Demcycovir - TID Vancyclovir – BID Rx for CMV Gancyclovir Rx for Shingles Famcyclovir Rx for RSV Ribavarin
Rx used to sop viral uncoating Ramantidine
Amantidine
Rx used to sop viral uncoating Ramantidine
Amantidine
How soon must Ramantidine & Amantadine must be given?
Within seventy-two (72) hours of exposure Why do you profiles contacts of people with Influenza with Amantadine for two (2) weeks?
Because IgM takes two (2) weeks to show up.
SE of Ramantadine & Amantadine Anticholinergic Side effects
Anticholinergic -vs- Sympathetic drugs? Anticholinergic drugs will not allow you to sweat, but Sympathetic drugs will.
Why is Amantadine used in Parkinson disease?
Amantadine promotes Dopamine release How does griseofulvin work?
It inhibits microtubules leading to inhibition of fungal replication.
How is Griseofulvin delivered to the infected site?
Through the sweat
How do the IV/Oral antifungal work? By inhibiting the synthesis of Ergosterol Topical(creams) antifungal work by? They bind to Ergosterol and destroy it
(Poke holes in the membrane) What topical antifungal is parenteral? Amphotericin B
Hyperkalemia + Amphotericin mean? Systemic Toxicity due to destruction of cholesterol in the cell membrane leading to leaking of K+ into cytoplasm.
Hypokalemia + Amphotericin mean? Nephotoxicity due to destruction of the cholesterol in the kidney cells and K+ leaks out in urine.
Side Effects of Amphotericin? Hypokalemia
Hyperkalemia Renal Failure
2 fungal infections Rx by Griseofulvin? Tinea Capitis and Tinea Versicolor What four drugs are used to treat anaphylaxis?
Epinepherine
Steroids
Cromoly/Nadacromyl
Anti-Histamines
What is a side effect of Cromoly and Nadacromyl?
GI Upset
MOA of Cromoly and Nadacromyl? Stabilize Mast Cell membranes
Which has a higher affinity for Alpha receptors Epinepherine of
Norepinepherine? Norepinepherine
What receptors does epinephrine have a higer affinity for?
Beta Receptors
What receptors do first generation antihistamines block?
H1
Name 5 class I antihistamines Diphenhydramine
Hydroxazine Dramamine
Phenylpropophenolamine Phenturamine
What sideeffect is seen with 1st generation
anti-histamines?
Strong Anti-Cholinergic effects Anti-histamine to Rx motion sickness Dramamine
Anti-histamine that is part of Phen-Phen Pheturamine
Anti-histamine pulled off market due to arrythmias
Phenylpropanolamine
MC over-the-counter anti-histamine Diphenhydramine (Benedryl)
Anti-histamine used to Rx Vertigo Hydroxazine (Aderax)
Disease where person passes out with positional change
Benign Positional Vertigo Clues for Miner’s disease
Vertigo from Middle Ear
Hearing Loss
Too much Endolymph
Tinitis
2 nd generation Anti-Histamines
Ephedrine Pseudephedrine Phenylephrine
Over the counter 2 generation Anti-nd
Histamines Ephedrine
2 nd generation Anti-Histamine used to
treat Neurogenic Shock Phenylephrine
Which 2 generation Anti-Histaminesnd
Can be used to tighten sphincters Pseudephedrine
Only class of drugs that give Mydriasis without cycloplegia? Alpha agonists Name 4 H2 blockers Cimetidine Rinitidine Famotidine Nizatidine
Which H2 blocker revs up the P450 system?
Cimetidine
List (5) 3rd Generation Anti-Histamine
Terfenadine Loratadine Citrerizine Fesofenodine Astemazol
3 rd Generation Anti-Histamine can treat
both indoor and outdoor allergies Fexofenidine (Allegra)
Benefit of 3 Generation Anti-Histaminerd
Once a day dosing
What is a side effect of ACE-Inhibitors and ARBs? Angioedema 9 Live Vaccines MMR BCG RSV Smallpox Rotavirus Polio Yellow Fever
Vaccines contraindicated with egg allergy MMR
Influenza
What changes are made in vaccination at age 6yo?
DPT dT Drop Hib
If a child has any reaction to DPT what should you do?
Give acellular Pertuus (aP)
Which live vaccine cas still be given to AIDS patients?
MMR
5 actions of Anesthetics
Anesthesia – Total block of sensory info Analgesia – Blocks pain
Muscle Relaxation CNS depressant Sensitize heart to NE
What complication of surgery is due to the muscle relaxation ability of
anesthetics? Aspiration Uninary retention Decrease GI motility
Relaxed diaphram Atelectasis DVT
Pneumonia
What 2 drugs are used for post-op urinary retention?
Carbachol Bethanichol
Which inhaled anesthetic does not sensitize the heart to NE?
Isoflurane
Inhaled anesthetic which causes hepatic necrosis?
Halothane b.c. it contains Bromine Only depolarizing anesthetic used Succinyl-Choline
Clues for Ketamine Dissociative Anesthesia Patient is awake Vivid dreams on waking How do all anesthetics work? They are sodium Channel blockers
Rule for AMIDE –vs- ESTER anesthetics I before “CAINE” Amide Fat soluble No I before “CAINE” Ester water sol What anesthetics cause Malignant Hyperthermia?
Succinyl-Choloine Halothane
What is the treatment for Malignant Hyperthermia?
Dantroline
Name 11 most common Opiates Heroine Methadone Morphine Meperidine Fentanyl Codeine Dextromethorphan Hydrocodone Loperimide Diphenoxylate Pentazosin
What are three effects of Opiates CNS Depressants – Mu-Receptors Analgesics – Kappa-Receptors in S.C. Muscle Relaxants
Most abused Opiate Heroine
Opiate used for Neurolep Anesthesia with Resperidone
Fentanyl
Longest acting Opiate Methadone
MC used Opiate in hospitals for severe pain?
Morphine
MC abused Opiate by physicians Meperidine does not constrict pupils Most Potent Opiate
Fentanyl
Opiate used for Mild/Moderate pain Codeine
MC over-the-counter Opiate Dextromethorphan
Opiates that can be used as Antitussives Codeine
Dextromethorphan
Opiate that comes in a patch form Fentanyl
Opiate that does not constrict the sphincter of Odi
Meperidine
Opiate that causes Histamine release Morphine
Opiate that causes Catecholamine release Meperidine
Opiate that should not be used in head injuries b.c. it causes cerebral edema Morphine
Opiate used to weak patient off Heroine Methadone
Opiate used for moderate pain Hydrocodone
Codeine
Opiates used to treat diarrhea Loperimide (Lomotil)
Diphenoxilate (Imodium) Opiate that is also a blocker Pentazosin
5 Anti-Inflammatory effect of steroids
Kill T-Cells and Macrophages
Inhibit Macrophage Migration
Inhibit Phospholipase A2
Inhibit Mast Cell degranulation
Drugs to treat parkinsonism B - Bromocriptine A - Amantadine L – Levodopa/Carbidopa S - Selegeline A – Anti-Cholinergics Name the Steroid used PO Prednisone
Name the Steroid used Topically Hydrocortisone
Name the Steroid used IV Methylprenisalone
Name the Steroid used as and inhaler Triamcinalone
Steroid with the best CNS penetration Dexamethasone
Steroid with best mineralocorticoid action
Fludrocortisone
Steroid used for nasal allergies Futicasone
Nematosone
Steroid used to stimulate surfactant production is premature babies Betamethasone
Beclmetasone
In what population is Cromalyn and Nadacramyl used?
Any asthmatic that uses a beta-agonist more than once a day.
MOA for aspirin’s (ASA) anti-inflammatory action
Irriversibly inhibts cyclo-oxygenase MOA for NSAID’s
Reversibly inhibts cyclo-oxygenase Uses for ASA
2nd Strokes
ALL MI’s
Side Effects of Asprin GI Bleeding
Tinitus
Thrombocytopenia
When should you stop ASA in a patient Pre-OP?
Two Weeks Pre-OP
MOA for ASA’s Anti-Coagulation effects
Indication for NSAID’s
Mild to Moderate Inflammatory pain Side Effects of NSAID’s
GI Bleed Renal Failure Interstitial Nephritis
Main Over the counter NSAID Ibuprophen
NSAID used to close PDA Indomethacin
NSAID used for dysmenorrhea Naproxyn
NSAID as strong as Morphine Ketoralac
NSAID with Anti-Cholinergic SE Cyclobenzaprine
NSAID with GABA effects for back pain Baclophen
Most potent NSAID #1 Indomethacin #2 Phenybutazone
NSAID used 2nd line for Gout
Indomethacin
What two drugs block Leucotriene receptors?
Zirfurlekast Montelekast
What drug inhibits Lipoxygenase? Zilutin
Name 3 COX inhibitors Celecoxib
Rofecoxib Valdecoxib
Which COX Inhibitor contains Sulfer? Celecoxib
MOA for sulfonylureas
Cause K+ influx into the Islet cells and cause release of preformed Insulin Which sulfonylureas enhance glucose transport into peripheral tissue? Glipizide
Glyburide
Hyperglycemic drugs that Inhibit Glucoase absorption in GI track Ascarbos
Miglitol
Name the 1st generation Sulfonylureas
Chlorprpamide Tolbutamide Tolezalide
Name the 2nd generation Sulfonylureas
Glipizide Glyburide
Which sulfonylurea causes SIADH? Chlorpropamide
Side effects of 1st generation
sulfonylureas
Sulfur Allergy
Interstitial Nephritis
Hemolytic Anemia
Methhemoglobinemia How does Metformin work? Inhibits gluconeogenesis in the liver Side effect of Metformin
Reacts with IV contrast damages kidney Severe Metabolic Acidosis
(4) Hopoglycemic drugs that upregulate insulin receptors
Pyoglitazone
Troglitazone
Repaglinide
Roglitazone
What blood gases will you see with Immediate (early) ASA toxicity? Resp Alkalosis - PCO2 pH MC gases seen with ASA toxicity? Mixed - PCO2 pH
HCO3-What blood gases will you see with late (obtunded/comatose) ASA toxicity? Combined - PCO2 pH HCO3-Treatment of ASA overdose
HCO3-List the Atypicals
Mycoplasma Chlamydia Legionella Ureoplasma Simple Gm(-) E.Coli H. Influenza MOA of Quinalones
Inhibit Topoisomerase Coverage of Quinalones All GM(+) + Staph aureus Simple Gm(-)
ALL Atypicals
Name the quinaolones
Ciprofloxacin
Gatifloxacin
Ofloxacin
Norfloxacin
Trovofloxacin
Which quinalone caused liver failure Trovofloxacin
Which quinalone is the most acidic Norfloxacin
MOA of Rifampin
Inhibits Beta subunit of RNA Polymerase Coverage of Rifampin
Treatment for TB
Prophylax contacts of H. Influenze Prophylax contacts of Neissaria Side effects of Rifampin
Incr. P450
Myositis
Hepatitis
Orange Secretions
How soon must you prophylax contact with Rifampin?
Within 72 hours MOA of Macrolides
Inhibit 50s subunit by inhibiting translocation
Coverage of Macrolides All GM(+) + Staph aureus Simple Gm(-)
ALL Atypicals
Side effects of Macrolides Inhibit P450
Gi Upset Dysgusia
Name the macrolides
Erythromycin
Clarithromycin
Azithromycin
Macrolide with the longest ½ life Azithromycin
Antibiotic treatment for Mycobacterium Aviun Intracellulare
Azithromycin Clarithromycin
Macrolide with the most dysgusia Clarithromycin
Macrolide with the most GI Upset Erythromycin
One dose treatment for GC
Ceftriaxone – 250mg IM Cefixime Cefoxetin Ciprofloxacin – 500mg PO Gatifloxacin – 400mg PO Ofloxacin – 400 mg PO MOA of Clindamycin
Inhibit 50s subunit by inhibiting translocation
Coverage of Clindamycin All GM(+) + Staph aureus Simple Gm(-)
Anaerobes
MCC pseudomembranous colitis Clindamycin
MOA of Tetracyclines
Inhibit 30s subunit by inhibiting t-RNA Name the Tetracyclines
T(4) Oxytetracycline Minocycline Doxycycline Damecocycline Coverage of Tetracyclines All GM(+) minus Staph aureus Simple Gm(-)
ALL Atypicals Ricketsial Infections
Tetracycline used to treat Acne Minocycline
Tetracycline that is Hepatically excreted Doxycycline
Tetracycline that blocks ADA receptors in kidney and causes nephrogenic DI Domicocycline
Side Effects of Tetracyclines
GI Upset Pill Esophagitis Photosensitivity Fanconi syndrome Binds Ca2+ in GI Incr. P450
Turns teeth Gray MOA of Pyramycin
Inhibits the A site of the 50s subunit MOA of Chloramphenicol
Inbibits the 50s subunit by inhibiting Peptidyl-Transferace
Coverage of Chloramphenicol Gm(+) + Staph Aureus
Ricketsial Infections
Side Effects of Chloramphenicol Gray baby Syndrome
Aplastic Anemia
How does Chloramphenicol Cause gray baby syndrome?
They Inhibit ETC Complex IV MOA of Aminoglycosides
Inhibits the 30s subunit by inhibiting EF2 Coverage for Aminoglycosides
ALL Gram negatives
How do Aminoglycosides cause neurotoxicity?
They Inhibit the presynaptic influx of Calcium
Name the Aminoglycosides GASS Toll No Kash G – Gentamycin A – Amikacin S – Streptomycin S - Spectinomycin T – Tobramycin N – Neomycin K – Kentamycin
Aminoglycoside that is hepaticaaly excreted
Amikacin
Aminoglycosides used in triple antibiotic
Neomycin
Polymixin B
Bacitracin
Aminoglycoside with the most side effects Gentamycin
Aminoglycoside used to treat TB Streptomycin
Ototoxicity Nephrotoxicity Neurotoxicity
How do Aminoglycosides cause neurotoxicity?
They Inhibit the presynaptic influx of Calcium
Causes of dysgusia Zn2+ deficiency Metronidazole Macrolides
Which drugs cause Nephrogenic DI Lithium
Damicocycline
Which part of the triple anti-biotic ointment is responsible for a rash? Neomycin
MOA of Vancomycin
Inhibits cell wall synthesis by inhibiting the Phospholipid carrier
Coverage for Vancomycin GM(+) + Staph Aureus Enterococcus
Staph epidermidis
Side Effects of Vancomycin
Ototoxic
Nephrotoxic
Red man Syndrome
Why does Vancomycin cause Redman syndrome?
Infusion is too fast and causes histamine release
MOA of Metronidazole (Flagyl) Causes release of free radicals Coverage for Metronidazole All Anaerobes
Gardnerella Protozoa
Side effects of Metronidazole
Dysgusia
Disulfram Reaction
G6PD
Methemoglobinemia
Hemolytic Anemia
Big mama drugs for anaerobes
Metronidazole
Clindamycin
Cefoxatin
How do sulfa drugs work? They inhibit PABA
5 Sulfa drugs Sulfamethoxazole Sulfadiazine Sulfapyrizone Sulfaqsalazine Sulfacetmide
(2) drug used with Sulfa drugs that block Dihydrofolate reductase? Trimethaprim
Pyrimethamine
Coverage of sulfadrugs Gm(+) + Staph aureus Simple Gm(-)
Treatment for PCP and UTI’s Sulfamethoxazole/Trimethoprim
Sulfa drugs used to treat burn patients Sulfadiazine (silvadine)
Sulfa drugs used to treat Toxoplasmosis Sulfadiazine/Pyrimethamine
Sulfa drug that comes in an eye drop Sulfacetamide
3 Sulfa drug used to treat ulcerative colitis
Sulfapyrizone
Sulfasalazine
Silfacetamide MOA of Penecillins
Cell Wall inhibitors by inhibiting transpeptidation
Coverae for ALL Penecillins Gm(+) not Staph Aureus ALL Simple Anaerobes Side effects of Penecillins
Anaphylaxis
Drug rash
Interstitial Nephritis
Hemolytic Anemia
Differentiate between the 2 simple Penecillins
PEN V - PO PENG - IV
Two Extended spectrum Penecillins Amoxacillin
Ampicillin
What coverage do the extended spectrum PCN’s add?
Simple Gm(-) coverage
What is added to the simple PCN’s to cover Staph Aureus?
Amoxacillin/Clauvulinic Acid Ampicillin/Sulbactam
Extended spectrum Penecillins which causes Jarisch-Herxeheimer reaction? Ampicillin
What infections are the most common causes of Jarisch-Herxeheimer reaction?
EBV
CMV
Syphilis
Drug of choice for UTI inpregnant women
Ampicillin/sulbactam MC used in pediactrics Amoxacillin (pink stuff)
5 Anti-Staph PCN’s (Beta Lactamase resistant) Metahcillin Nafcillin Oxacillin Cloxacillin Dicloxacillin MCC of Interstitial Nephritis #1 Methacillin #2 Ampicillin 3 PO Anti-Staph PCN’s Oxacillin Cloxacillin Dicloxacillin IV Anti-Staph PCN Nafcillin
Anti-Staph PCN with a high Sodium load Nafcillin 5 Anti-Pseudomonal PCN’s Pipercillin Ticarcillin Azocillin Mezocillin Carbenicillin
Anti-Pseudomonal PCN with a high sodium load
What drug are added to the Anti-Pseudomonal PCN’s to cover staph Pipercillin/Tazobactam
Ticarcillin/Clauvulnic Acid MOA of Cefalosporins
Cell Wall inhibitors by inhibiting transpeptidation
Coverage of Cefalosporins Gm(+) + Staph Aureus Simple Gm(-)
1 st generation Cephalosporin that is
parenteral Cefazolin
1 st generation Cephalosporin that is the
#1 cause of Interstitial Nephritis Cephalotin
Name 5 1st generation Cephalospoirins
Cefazolin
Cefalotin
Cefalexin
Cefadoxil
Cefadroxil
Name 5 2nd generation Cephalospoirins
Cefaclor
Cefotetan
Cefomandol
Cefuroxime
Cefoxatin
Name 6 3rd generation Cephalospoirins
Ceftriaxone Cefixime Cefotaxime Ceftazidine Cefperazome Maxalactam
Most commonly used Cefalosporin in children
Cefaclor
Cefalosporin used to treat H. Influenza B Cefuroxime
Cefalosporin used to treat Anaerobes Cefoxatin
Cefalosporin with the best CNS penetration
Ceftriaxone
Hepatically excreted Cefalosporin Ceftriaxone
First line for Meningitis > 2 month old Ceftriaxone
First line for Meningitis < 2 month old Cefotaxime
First line for Pseudomonas Ceftazidine
Four Cefalosporins with MTT side chains
Cefotetan
Cefomandol
Cefaperazone
Moxalactam
What does the MTT chain do? Inhibits Vitamin K
Only oral 3 generation Cefalosporinrd
Cefixeme
Drugs that cause a disulfram reaction Cefotetan
Cefomandol Metronidazole
Cefalosporin with the highest allergic reaction in Pediatrics
Cefaclor
MOA Of Benzodiazapines Increase GABA channel Frequency Indication for Benzodiazepines Anxiety
Insomnia Seizure Muscle Cramps
What is the cause of death for Benzo’s and Barbituates?
Respiratory Failure
Which Anxiolytinc is used for people who cannot be sedated? Bupropion Name (10) Benzodiazepines Floureapam Zolpiden Oxazepam Triazelam Tomazepam Diazepam Lorazepam Clonezapam Chlordiazepoxide Midazelam
Shortest Acting Benzo Florezepam
Longest Acting Benzo Zolpidem
Medium duration Benzo Oxazepam
Triazelam
Benzo used for elderly who have trouble initiating sleep
Triazelam
Benzo used with 20 minutes antegrade amnesia
Triazelam
Benzo used for people who have difficulty maintaining sleep
Tomazepam
(4) Benzos MC used for Seizures
Diazepam
Lorazepam
Clonazepam
Chlordiazepoxide
(2) Benzos MC used for Status Epilepticus
Diazepam
Lorazepam
Benzo MC used for Absance Seizures in children
Clonazepam
Benzo MC used for restless leg syndrome Clonazepam
Benzo that comes in sopository Diazepam
Benzo that is best for anxiety in middle aged females
Lorazepam
Benzo MC used for Alcoholic withdrawal Chlordiazepoxide
Benzo used for short procedures Midazelam
Benzo with 45min antegrade amnesia Midazelam
Antedote for Benzo Overdose Flumazenil
MOA of Barbituates
Increase GABA channel Duration Indication for Barbituates Insomnia
Seizure Muscle Cramps
Why are Barbituates not indicated for Anxiety
Because they are too sedating Longest acting barbituate Phenobarbital
Shortest acting Barbituate Thiopental
Barbituate most commonly abused on the street
Secobarbital
Treatment for Barbituate Overdose HCO3- + Doxapram
Barbituate most commonly used for generalized seizures on children Phenobarbital
3 drugs used to treat Bipolar #1 Lithium
#2 Valproic Acid #3 Carbamazapine MOA of lithium
Looks like Sodium and stabilizes cell membranes
Side effects of Lithium
Hyponatremia Hypothyroidism Hyperthyroidism Hypercalcemia Hypophosphatemia Nephrogenic DI Epsteins Anomoly
How does Lithium cause Nephrogenic DI?
It inhibits ADH receptors are the kidney How does Lithium cause Hyponatremia? Because it looks like Sodium, the kidney hold onto it instead of Sodium
How does Lithium cause hypothyroidism?
How does Lithium cause
How does Lithium cause hypercalcemia? It binds to PTH receptors
MOA of Carbamazapine Sodium Channel Blocker Side effects of Carbamazepine Agranulocytosis
SIADH
Indication for Carbamazepine
Temporal Lobe Seizures
3rd Line for Bipolar Disorber
Shooting Neuropthy
How does Carbamazapine cause SIADH It stimulates the ADH receptors in kidney MOA of Valproic Acid
Indication for Valproic Acid
2nd Line for Bipolar
1st Line for Myotonic Seizures
1st Line for Mixed Seizures
Side Effects of Valproic Acid BM Suppression
What is the main cause of depression
Serotonin
Norepinepherine
MOA of Tri-Cyclic Anti-depressants Blocks reuptake of ALL Catecholamines Strong Anti-Cholinergic affects
Block 1 receptors by accident Block A-V conduction in heart Clue for Anti-Cholinergic effects Sympathetic with Hot Dry Skin Name (5) TCA’s C - Clomipramine A - Amitryptaline N - Nortryptaline D - Desipramine I - Imipramine
TCA used for bedwetting in children Imipramine
TCA used for Chronic Pain or neuropathy
Amitryptaline TCA used for OCD Clomipramine
Shortest acting TAC’s Nortryptaline
Desipramine MOA of SSRI’s
Inhibit the reuptake of Serotonin Name (4) SSRI’s F - Fluoxetine L – Luvoxatine i P - Paroxatine S – Sertraline
Side effects of SSRI’s Anorgasmia Name (4) MAOI’s P - Phenylzine I - Isocarboxazid T - Tranylcypramine S - Selegeline
Foods avoided when on MAOI’s Wine and Cheese
Wine & cheese contraindicated with MAOI’s because
The interaction can cause Seratonin Syndrome
When switching from SSRI to MAOI, how long is the washout period? One Month
Name the MAOBI Selegeline
MOA of Bupropion Blocks reuptake of Seratonin Indication for Bupropion
Used if sexual dysfunction occurs with other antidepressants
Help stop smoking Side effects of Bupropion Decreased Seizure threshold Indications for Electroconvulsive Therapy
Person who is actively suicidal or with intractable depression
#1 Side effect of ECT Amnesia
Treatment for Methemoglobinemia Methyline Blue
Rx for Acute intermittent Porphorya
Sugar
Fluids
Hematin
How does Hematin Work? It inhibits D-ALA Synthase Treatment for Cyanide Poisoning
Amylnitrate
Sodium Thiosulphate
Methyline Blue
Rx for Carbon Monoxide Poisoning Hyperbaric Oxygen
Rx used for the Used for the Cystic Fibrosis sweat test & to Treat glaucoma Pilocarpine
For what was Methacholine Previously used?
To diagnose Asthma because is Causes Broncho spasm
How do Amphetamines work? They cause the release of preformed catecholamines.
