Cholinergic agonist

Muscarinic receptor agonist

promote Parasympathetic activity

Bethanechol

Carbachol

Pilocarpine

Methacholine

MOA: Cholinergic agonist

Uses: Post-op and neurogenic ileus

Urinary retention

MOA: Cholinergic agonist

Uses: Glaucoma, Pupillary contraction, Relief of intraocular pressure

MOA: Direct Muscarinic Agonist

Potent simulator of sweat, tears, saliva

MOA: Direct Cholinergic agonist

Challenge test for ASTHMA diagnosis

Indirect Agonist

(Anticholinersterases)

All Increase Endogenous ACh

Neostigmine

Pyridostigmine

Edrophonium

Physostigmine

Donepzil

MOA: Anti-AChE

Post-op & neurogenic ileus & urinary retention

myasthenia gravis

reversal of NMJ blockade

NO CNS penetration

MOA: Anti-AChE

Myasthenia gravis (long-acting)

NO CNS penetration

MOA: Anti-AChE

Diagnose Myasthenia Gravis

MOA: Anti-AChE

Glaucoma

Atropine overdose

DOES cross BBB --> CNS

Watch out for:

COPD exacerbation

Asthma

Peptic ulcers

DUMBBELSS

Sx of excessive ACh stimulation

Diarrhea

Urination

Miosis

Bradycardia

Bronchspasms

Excitation of CNS & Skeletal m

Lacrimation

Sweating

Salivation

Atropine + Pralidoxime

Pralidozime - MOA= reactivates inhibited AChE

Alzheimer Disease meds

and MOA

MOA: Inhibit ACHE

Inc the levels of Endogenous ACh

Donepezil

Galantamine

Rivastigmine

MOA: Anti-muscarinic

Uses: Urge type urinary incontinence

MOA: Anti-muscarinic

Uses: organophosphate poisoning

MOA: Anti-AChE

Use: tx Alzheimers disease

MOA: Regenerator of AChE

uses: 2nd choice for organophosphate poisoning if Atropine does not work

MOA: muscarinic antagonist

uses:improves FEV1 in COPD bc dec bronchoconstriction

MOA: muscarinic antagonist

use: improve FEV1 in COPD bc dec bronchoconstriction

Ipratropium

Tiotropium

MOA: muscarinic antagonist

use: urge type urinary incontinence

Oxybutynin

Tolterodine

Darifenacin

MOA: muscarinic antagonist

uses: tx URGE type urinary incontinence

MOA: Anti-AChE

use: tx Alzheimer dz

1st generation H1 blockers: diphenhydramine, doxylamine, chlorpheniramine

Neuroleptics- Thoridazine, Chlorpromazine

Tricyclic anti-depressants

Amantidine

MOA: inhibit parasympathetics

motion sickness & dec oral secretions

Hot as a Hare - fever

Red as a Beet - flushing

Blind as a Bat - cycloplegia, mydriasis, no accomidation

Dry as a Bone - dec salivation

Mad as a Hatter - delerium

Bloated as a Toad - constipation & urinary retention

Tachycardia

Antiarrhythmics type 3

K+ channel blockers - MOA

Ibutilide, Sotalol, Bretylium, Amiodarone, Dofetilide

"K IS BAD"

INC AP duration- phase3 of graph

INC QT interval: Torsades de pointes;

Monitor PFTs, LFTs, TFTs for Amiodarone

Non specific B agonist

works on both B1 and B2;

B1= Inc cardiac contracility; B2= vaso/broncho-dilation

visual color changes, nausea, vomiting, anorexia, arrhythmias, Hyperkalemia

[The amt of serum K corresponds directly to amt digoxin]

tx: Mg or anti-digoxin Ab fragments

DO NOT give Sodium-Gluconate

Lidocaine or Amiodarone

MOA: selectively depresses depolarization in myocardial cells

stops ventricular tachycardia

Slow down AV conduction

Prolong atrial depolarization

EKG- Inc PR interval

Therefore, Dec HR

MOA: Inc K out of cell --> hyperpolarization

used for dx & tx SVT

toxicity: flushing, hypotension, chest pain

MOA: inhibit NaCl reabsorption in early distal tubule

SE: High BLOOD uric acid, calcium, LDL, glucose

LOW BLOOD K, Na, and hypotension

Doxorubicin, Daunorubicin

MOA: intercalates btwn DNA base pairs and blocks replication; generates free radicals --> dec DNA replication

SE: Dilated cardiomyopaty

Best LONG-term treatment for

1. Pt with Essential HTN WITH CHF or diabetes

2. Pt with Essential HTN without CHF or diabetes

1. ACE inhibitor

2. Thiazide diuretic

Diuretics can be used for Sx relief of acute CHF, but not LONG-term

Throbbing Headache & Cutaneous flushing

Nitrates work on VENOdilation, but at high high doses, they can cause arteriodilation --> side effects

Used for tx Bipolar

Causes: Ebstein anomaly = atrialization of RV, bad tricuspid valve

Acebutolol, Betaxolol, Esmolol, Atenolol, Metoprolol

A BEAM of B1 blockers; good for comorbid pulmonary dz

Propranolol, Timolol, Nadolol, Pindolol,

Please Try Not being Picky

SE: bad for asthma or COPD pts

MOA:  MAO inhibitor, type B

preferntially metabolizes NE > serotonin ; Inc Dopamine levels

use: adjuvant with L-dopa for Parkinson dz

Ca channel blocker; used for RATE CONTROL for A-fib w rapid Ventricular response; Dec conduction through AV node (can cause 1,2,3 AV block), Potent -Inotrope (Do NOT use for CHF); Slows Phase 0 & Phase 2 = No change to QT interval;

SE: Constipation & AV Block & gingival hyperplasia

Sil/Vardenafil: Inhibit cGMP phosphodiesterase

Nitrates: nitrates --> NO causes Inc cGMP (veins)

Use of both is CONTRindicated

Clopidogrel

MOA: inhibits platelet aggregation by irreversibly blocking ADP receptors on platelets

Use if Aspirin allergy: bronchoconstriction & wheezing

Disopyramide, Quinidine, Procainamide

"Double Quarter Pounder"

Inc AP duration; Inc QT interval

Lidocaine, Tocainide, Mexiletine

"Lettuce, Tomato, Mayo"

Dec AP

Moricizine, Flecainide, Propafenone

"More Fries Please"

No affect on AP

Do not use Post-MI

MOA: alpha-blocker

use: Pheochromocytoma

Zafirulukast

Montelukast - good for children

good to for tx asthma since decrease bronchial tone

MOA: Dec syn of mycolic acid; requires microbe to have catalase peroxidase in order to fight against it

toxicity can cause: neurotoxic (peripheral neuropathy), hepatotoxic, lupus

Prevent toxicity by supplementing Vit B6 (Pyridoxine)

The only med used as sole prophylaxis for TB

MOA: activates antithrombin3

improves binding of antithrombin3 to factor 2 (thrombin) & factor 10.

Enoxaparine- LMWH

use: PE, stroke, MI, DVT, pregnancy

Monitor: PTT

antidote: Protamine sulfate (+charge binds to Hep-)

Hirudin derivates

MOA: directly inhibit thrombin (factor 2)

alternative to heparin for anticoagulating pts with Heparin-Induced Thrombocytopenia

MOA: disrupts carboxylation of Vit K depend clotting factors (2, 7, 9, 10) & proteins C, S.

Metabolized by cytochrome p450

Extrinsic pathway; INC PT

antidote: Vit K; for rapid reversal: Fresh Frozen plasma

MOA: monoclonal Ab against CD20

Non-hodgkin lymphoma, RA

MOA: Philadelphia chromosome bcr-abl tyrosine kinase inhibitor

use: CML, GI stromal tumors

MOA: Estrogen receptor modulator

prevents neg feedback to hypothalamus by estrogen so the body will continue to make more estrogen.

Use: women with PCOS who want to be pregnant

Dec HR, Dec anxiety

Dec peripheral conversion T4 --> T3; so overall less net thyroid hormone effect

HIV drug

MOA: Integrase inhibitor

cannot integrate into the host DNA --> no mRNA syn

HIV drug

MOA: Reverse transcriptase inhbitor

No complementary DNA syn of virus

HIV drug

MOA: CCR5 receptor inhibitor --> HIV cannot bind to host plasma membrane

HIV drug

MOA: Protease inhibitor -->blocks proteolytic cleavage of virion

HIV drug

MOA: Fusion inhibitor --> HIV virion cannot fuse with host plasma membrane

Sx: cardiac arrhythmias, seizures, abdominal pain, diarrhea, vomiting

antidote: gastric lavage, charcoal and cathartics, b-blockers

Sx: bradycardia, hypotension, CV collapse

antidote: Glucagon- Inc intracell cAMP and Inc cardiac contractility

Sx: severe sedation, respiratory depression, miosis

antidote: supportive care & give Naloxone/Naltrexone/Nalmefene

Sx:liver damage

antidote: N-acetyl-cysteine (glutathione donor)

MOA: post synaptic 5-HT receptor agonist

tx: Acute migraines

inhibits vasoactive peptides (CGRP & substance P) release from pre-synaptic neuron

INC vasoconstriction

do not use in CAD or Prinzmetal angina pts

Erythromycin, Macrolides, Amiodarone, Grapefruit juice, Isoniazid, Cimetidine, Ritonavir, Acute Alcohol abuse, Cipro, Ketoconazole (azoles), Sulfonamides

E-MAGIC ROCKS

MOA: bind to GABAa receptors in CNS and enhance inhibitory effect of GABA.

uses: hyponotics (insomnia), anxiolytics (panic/anxiety), anticonvulsants (alcohol related seizures)

SE: daytime drowsiness, falls

Short acting Benzodiazepines

(<10 hrs)

MOA: binds to GABAa receptors in CNS and enhances inhibitory effect of GABA

Alprazolam, Triazolam, Oxazepam

less daytime sleepiness, high addiction risk

Medium acting Benzodiazepines

(10-20hrs)

MOA: bind to GABAa receptors in CNS and enhance inhibitory effect of GABA

Esazolam, Lorazepam, Temazepam

SE: moderately severe side effects

Long-acting Benzodiazepine

(days)

MOA: inhibit GABAa receptor, enhance GABA inhibitiory effects

Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam

SE: HIGH daytime drowsiness, Less addiction

Anabolic steroids - think this when professional athlete

Comedonal nodular eruptions = pimples

Give IM Glucagon

(only give IM glucose if patient is still conscious)

Short acting hypnotic (sleep aid) - short term insomnia

not related to benzodiazepines but same MOA

MOA: bind to same portion of GABAa receptor and enhance inhibitory action of GABA

p450 metabolism

Less tolerance and addiction

Morphine, Fentanyl, Codeine, Heroin, Methadone, Meperidine

MOA: agonist at opiod receptors; OPEN K channels, close Ca channels --> block synaptic transmission. Inhibit ACh, NE, 5-HT, Glutamate, substance P release

antidote: Naloxone or Naltrexone

treats Heroin addiction

MOA: mu receptor agonist; potent, long-acting opiate with good oral bioavailability

LONG-half life = dec withdrawl Sx

due to Inc testosterone levels-> Inc DHT (5-a-reductase)

MOA Spironolactone: blocks androgen receptors at hair follicles & Dec testosterone prod; K-sparing diuretic

In men: it causes gynecomastia & small testicles

ALL, lymphomas (not CLL or Hodgkins)

MOA: Purine (thiol) analog --> Dec de novo purine syn

activated by HGPRT

Metabolized by: Xanthine Oxidase

WARNING: dec dosage when used with ALLOPURINOL

MOA: Inhibits Xanthine Oxidase; dec Uric acid

Dec dose of 6-mercaptopurine if used together

MOA: purine (thiol) analog --> dec de novo purine syn

use: ALL

OKAY to use with Allopurinol (6-TG is not affected by xanthine oxidase)

MOA: Folic acid analog- inhibits dihydrofolate reductase

dec DNA syn & dec protein syn

use: leukemia, lymphoma, abortion, ectopic preg, RA

toxicity: myelosuppression can be reversed w Leucovorin; Macrovesicular fatty change in liver

MOA: pyrimidine analog; covalently complexes with folic acid --> inhibits thymidylate synthase --> dec DNA syn & dec protein syn

synergistic with MTX

toxicity: myelosuppression - reversible w Thymidine

MOA: binds to ergosterol in cell wall --> fungal wall lysis

use: systemic mycoses

MUST give K & Mg to maintain kidneys

toxicity: fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia. Use Lipsomal amphotericin to reduce toxicity

treat for BOTH C. trachomatis & N. gonorrhea

C trachomatis- Azithromycin/Doxycycline

N. gonorrhea- 3rd gen Cephalosporin

If both are not treated --> infertility

Typical Anti-psychotics (neuroleptics)

High & Low potency

High: Triflupperazine, Fluphenazine, Haloperidol

(Try to Fly High) - extrapyramidal Sx

Low: Chlorpromazine, Thioridazine (Cheating Thieves are Low)

Typical Anti-psychotics (neuroletpics)

High potency

MOA: block Dopamine D2 receptors (Inc cAMP)

Trifluoperazine, Fluphenazine, Haloperidol

Extrapyramidal Sx: Dystonia (4hr), Akinesia (4d), Akathisia (4wk), Tardive dyskinesia (4mo)

tx: Benzitropine - gets rid of Akinesia

by blocking D2, you inc ACh, so muscles have more ACh --> EPS

Typical Antipsychotics (neuroleptics)

Low potency

MOA: block Dopamine D2 receptors

Chlorpromazine, Thioridazine

Chloropromazine- Corneal deposits

Thioridazine- reTinal depostis

No EPS Sx

MOA: unknown, effects on 5-HT, dopamine, a, H1 receptors

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

use: improves Positive & Negative Sx; does not cause

Clozapien - check WBC bc can cause agranulocytosis

Risperidone- causes Amenorrhea, bc blocks dopamine, so inc prolactin --> no mentrual cycle

Positive: Hallucinations (auditory), Delusions, disorganized Speech & behavior

Negative: Dec emotional range, lack of speech, loss on interest in living

Atypical (2nd gen) antipsychotics - improve Pos & Neg Sx

DO NOT give B-blockers

Give Phentolamine: a1 blocker -> Dec BP

Etidronate, Pamidronate, Alendronate, Risedronate, Zoledronate (IV)

MOA: Inhibits osteoclastic activity; Dec formation & resorption of hydroxyapatite

toxicity: osteonecrosis of jaw, n/d

MOA: inhibits Calcineurin --> prevents IL-2 prod

so blocks T cell diff and activation

use: suppresses organ rejection after transplant

MOA: Binds to FK binding protein --> inhibits IL-2

uses: immunosuppresion during transplant

Mifepristone (RU-486)

MOA: Progestin inhibitor at progesterone receptors

Use: abortion; Given with Misoprostol (PGE1)

MOA: inc vWF release from endothelial cells

controls bleeding for mild forms of von Willebrand disease

von Willebrand Factor - secreted from endothelial cells, attaches to factor 8, Inc stability of factor 8; helps with platelet aggreg to endothelial cells --> platelet plug

Opiate/Narcotic Withdrawl

(Heroin, Morphine)

Abd pain, N/V, diarrhea, piloerection, pupil dilation, diaphoresis, fever

tx: Methadone- long acting oral opiate; has withdrawl Sx

Suboxone- Naloxone+Buprenorphine (partial agonist)- long acting with less withdrawl Sx

MOA: bacteriostatic, binds to 30S ribosome subunit, prevents aminoacyl-tRNA from binding to complementary mRNA

Inhibits peptide bond syn.

resistance is plasmid mediated

Niacin --> Nicotinic acid --> Gouty arthritis;

SE: facial flushing & warmth- can be avoided with taking aspirin prior to niacin; Dec hepatic syn of VLDL & triglycerides & Inc HDL syn

Net tubular reabsorption

Excreted amt << Reabsorbed/Filtered amt

Not secreted or reabsorbed in renal tubules;

filtered amt = excreted amt

Net Tubular Secretion

Excreted amt >> Filtered/absorbed amt

inhibit DNA gyrase (prokaryotic topoiromerase III)

topoisomerases put nicks in the DNA to relieve supercoils

Anti-psychotic (neuroleptic)

tx: Positive Sx of Schizophrenia

Low potency: Chlorpromazine & Thioridazine

MOA: block D2 receptos (Inc cAMP)

Chlorpromazine = Corneal deposits

Thioridazine = reTinal deposits

Do not cause Extrapyramidal side effects

Can cause HyperKalemia; especially if pt has renal disfunction or is taking ACE inhibitors

Spionolactone, Triamterene, Amiloride

Methotrexate MOA: folic acid analog; inhibits dihydrofolate reductase -->dec DNA, dec protein syn. Slow, takes weeks to work.

Corticosteroid MOA: blocks Phospholipase A2 --> no PG, prostacyclines, thromboxane syn. Fast acting relief

converts Plasminogen --> plasmin

Plasmin breaks down fibrin --> thrombolysis

only attacks clots bc only active when fibrin is present

Fever, rash, oliguria at 1-3wks after intiation of tx with B-lactam, NSAIDs, Sulfonamides, Rifampin or Diruetic.

Interstital edema with lymphocytes, macrophages, plasma cells, eosinophils. IgE-mediated hypersensitivity AND cell-mediated rxns --> cause AIN

Somatostatin analog

MOA: inhibits GI and pancreatic hormones.

tx: Serotonin syndrome (wheezing, diarrhea, facial flushing, asthma) in pts with carcinoid tumors (appendix/liver); treats: acute variceal bleeds, acromegaly

MOA: inhibits acetaldehyde dehydrogenase

Use: help EtOH addicts to quit; causes hangovers!!!

MOA: inhibts alcohol dehydrogenase; antidote for methanol or ethylene glycol poisoning.

ethylene glycol toxicity= kidney; creates Ca-oxalate stones!

IRREVERSIBLE COX1 & COX2 INHIBITOR;

at low doses it only blocks COX1, but at higher doses it blocks COX2 also; always irrevrsible. All other NSAIDS are reversible

MOA: HSV & VZV use thymadine kinase to monophorphorylate acyclovir --> activate acyclovir

EBV & CMV does not have thymadine kinase, so cannot activate acyclovir

Cholestyramine, Colestipol, Colesevelam

MOA: prevents intestinal absorption of bile acids, liver must use cholesterol to make more bile;

SE: cholesterol gallstones!

do not use in pts with previous gallbladder hx

Gemfibrozil, Clofibrate, Bezafibrate

MOA: upregulates LPL -> Inc Triglyceride clearance

Dec in triglyrcerides

SE: cholesterol gallstones

Do not use in pts with previous gallstone hx 

Acute Gout

Chronic Gout

Acute: NSAIDS (Indomethacin), Cochicine

Chronic: Allopurinol

defect in RBA membrane- ankyrin & spectrin

small, low MCV, NO central pallor

positive osmotic fragility test; aplastic crisis with B19 infection

Conns syndrome = metabolic alkalosis

salicylates = anion gap metabolic acidosis

MOA:  bile acid sequestrant, which binds bile in the gastrointestinal tract to prevent its reabsorption

Stops the itching assoc with excess bile

Adenosine & Dipyridamole - myocardial perfusion imaging

vasodilation of coronary arterioles in nonischemic regions. leads to dec perfusion pressure within the collateral microvessels supplying the ischemic myocardium, diverting blood flow away from the ischemic areas --> non-ischemic areas.

Gancyclovir, Foscarnet, Cidovovir

Foscarnet- causes HYPOcalemia, HYPOMg

SE: generalized lymphadenopathy, no serum sickness, hirsuitism, coarsening facial features, acneform skin rash, gingival hyperplasia.

WHat does Phenytoin treat?: tonic-clonic & psychomotor seizures

tx: Insomnia; Non-benzodiazepine hypnotic

SE: strange sleep behavior, eating, talking on phone & sleep walking