HMG-CoA reductase inhibitors (statins): side effects, contraindications,

interactions

HMG-CoA:

· Side effects:

Hepatotoxicity

Myositis [aka rhabdomyolysis]

· Contraindications:

Girl during pregnancy/ Growing children

· Interactions:

Coumarin/ Cyclosporine

Antiarrhythmics: class III members

BIAS:

Bretylium

Ibutilide

Amiodarone

Sotalol

Beta-blockers: main contraindications, cautions

ABCDE:

Asthma

Block (heart block)

COPD

Diabetes mellitus

Electrolyte (hyperkalemia)

Clopidogrel: use

CLOPIdogrel is a drug that prevents

CLots, an Oral Platelet Inhibitor (OPI).

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

Beta blockers: members

"The NEPAL Prime Minister":

Timolol

Nadolol

Esmolol

Pindolol

Atenolol

Labetalol

Propranolol

Metoprolol

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

Beta-blockers: nonselective beta-blockers

"Tim Pinches His Nasal Problem" (because he has a runny nose...):

Timolol

Pindolol

Hismolol

Naldolol

Propranolol

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

Enoxaprin (prototype low molecular weight heparin): action, monitoring

EnoXaprin only acts on factor Xa.

Monitor Xa concentration, rather than APTT

anti hyprtensive safe for pregnancy are---

My N.H.L ---

Quote:

M-methyl dopa..N-nifedipine...H-hydralazine..

L-labetalol.

methyldopa

Quote:

M = mental retardationE = electrolyte imbalance

T = toleranceH = headache/ hepatotoxicity, rebound HTN

Y = psYchological upsetD = dry mouth, drowsiness

O = oedema, orthostatic hypotensionP = Parkinsonism

A = Anemia [+ve coomb's test]

sodium nitroprusside

clinical uses: MR. CHIEF SURGERY IN EMERGENCY

Quote:

Mr. = Acute MIchief = Acute CHF

Surgery = maintain hemostasis during surgeriesemergency = hypertensive emergencies

antihypertensives used in emergencies.............

Saurav Ganguly HELP

Quote:

S-sodium nitroprussideG-GTN

H-hydralazineE-esmololL-labetalol

P-phentolamine

Anticholinergic side effects

"Know the ABCD'S of anticholinergic side effects":

Quote:

AnorexiaBlurry vision

Constipation/ ConfusionDry Mouth

Sedation/ Stasis of urine

Antimuscarinics: members, action

"Inhibits Parasympathetic And Sweat":

Quote:

IpratropiumPirenzepine

AtropineScopolamine

_Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic.

Aspirin: side effects

ASPIRIN:

Quote:

AsthmaSalicyalism

Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA

Intestinal blood lossReye's syndrome

IdiosyncracyNoise (tinnitus)

Benzodiazapines: ones not metabolized by the liver (safe to use in liver

failure)

LOT:

Quote:

LorazepamOxazepam

Temazepam

Benzodiazepenes: antidote

Quote:

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

Benzodiazepenes: drugs which decrease their metabolism

"I'm Overly Calm":

Quote:

IsoniazidOral contraceptive pills

Cimetidine_ These drugs increase calming effect of BZDs by retarding metabolism.

Benzodiazepines: actions

"Ben SCAMs Pam into seduction not by brain but by muscle":

Quote:

Sedationanti-Convulsant

anti-AnxietyMuscle relaxant

Not by brain: No antipsychotic activity.

Beta selective blockers

"BEAM ONE up, Scotty":

Quote:

Beta blockers:EsmololAtenolol

Metropolol

Botulism toxin: action, related bungarotoxin

Quote:

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).

Cholinergics (eg organophosphates): effects

If you know these, you will be "LESS DUMB": or SLUDGE

Quote:

LacrimationExcitation of nicotinic synapses

SalivationSweatingDiarrheaUrination

MicturitionBronchoconstriction

Delerium-causing drugs

ACUTE CHANGE IN MS:

Quote:

Antibiotics (biaxin, penicillin, ciprofloxacin)Cardiac drugs (digoxin, lidocaine)

Urinary incontinence drugs (anticholinergics)Theophylline

EthanolCorticosteroids

H blockersAntiparkinsonian drugs

Narcotics (esp. mepridine)Geriatric psychiatric drugs

ENT drugsInsomnia drugs

NSAIDs (eg indomethacin, naproxin)Muscle relaxants

Seizure medicines

Direct sympathomimetic catecholamines

DINED:

Quote:

DopamineIsoproterenol

NorepinephrineEpinephrineDobutamine

Inhalation anesthetics

SHINE:

Quote:

SevofluraneHalothaneIsoflurane

Nitrous oxideEnflurane

_ If want the defunct Methoxyflurane too, make it MoonSHINE.

Ipratropium: action

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

Lead poisoning: presentation

ABCDEFG:

Quote:

AnemiaBasophilic stripping

Colicky painDiarrhea

EncephalopathyFoot drop

Gum (lead line)

Lithium: side effects

LITH:

Quote:

LeukocytosisInsipidus [diabetes insipidus, tied to polyuria]

Tremor/ TeratogenesisHypothyroidism

MAOIs: indications

MAOI'S:

Quote:

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.

Methyldopa: side effects

METHYLDOPA:

Quote:

Mental retardationElectrolyte imbalance

ToleranceHeadache/ Hepatotoxicity

psYcological upsetLactation in female

Dry mouthOedema

ParkinsonismAnaemia (haemolytic)

Monoamine oxidase inhibitors: members

"PIT of despair":

Quote:

PhenelzineIsocarboxazid

Tranylcypromine_ A pit of despair, since MAOs treat depression.

Morphine: effects

MORPHINES:

Quote:

MiosisOrthostatic hypotensionRespiratory depression

Pain supressionHistamine release/ Hormonal alterations

Increased ICTNausea

EuphoriaSedation

Morphine: effects at mu receptor

PEAR:

Quote:

Physical dependenceEuphoriaAnalgesia

Respiratory depression

Narcotic antagonists

Quote:

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

Parkinsonism: drugs

SALAD:

Quote:

SelegilineAnticholinenergics (trihexyphenidyl, benzhexol, ophenadrine)

L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)Amantadine

Dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide)

Phenytoin: adverse effects

PHENYTOIN:

Quote:

P- interactionsHirsutism

Enlarged gumsNystagmus

Yellow-browning of skinTeratogenicityOsteomalacia

Interference with B metabolism (hence anemia)Neuropathies: vertigo, ataxia, headache

Physostigmine vs. neostigmine

LMNOP:

Quote:

Lipid solubleMiotic

NaturalOrally absorbed well

Physostigmine_ Neostigmine, on the contrary, is:

Water solubleUsed in myesthenia gravis

SyntheticPoor oral absorption

Pupils in overdose: morphine vs. amphetamine

"MorPHINE: Fine. AmPHETamine: Fat":

Quote:

Morphine overdose: pupils constricted (fine).Amphetamine overdose: pupils dilated (fat).

Serotonin syndrome: components

Causes HARM:

Quote:

HyperthermiaAutonomic instability (delirium)

RigidityMyoclonus

Sodium valproate: side effects

VALPROATE:

Quote:

VomitingAlopecia

Liver toxicityPancreatitis/ Pancytopenia

Retention of fats (weight gain)Oedema (peripheral oedema)

Appetite increaseTremor

Enzyme inducer (liver)

Succinylcholine: action, use

Quote:

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.

Tricyclic antidepressants: members worth knowing

"I have to hide, the CIA is after me":

Quote:

ClomipramineImipramineAmitrptyline

_ If want the next worth knowing, the DNDis also after me:DesipramineNorrtriptyline

Doxepin

Tricyclic antidipressents (TCA): side effects TCA'S:

Quote:

ThrombocytopeniaCardiac (arrhymia, MI, stroke)Anticholinergic (tachycardia, urinary retention, etc)

Seizures

Vigabatrin: mechanism

Vi-GABA-Tr-In:

Quote:

Via GABA Transferase Inhibition

Antibiotics contraindicated during pregnancy

MCAT:

Quote:

MetronidazoleChloramphenicolAminoglycoside

Tetracycline

Busulfan: features

ABCDEF:

Quote:

Alkylating agentBone marrow suppression s/e

CML indicationDark skin (hyperpigmentation) s/e

Endrocrine insufficiency (adrenal) s/eFibrosis (pulmonary) s/e

Metabolism enzyme inducers

"Randy's Black Car Goes Putt Putt and Smokes":

Quote:

RifampinBarbiturates

CarbamazepineGrisoefulvinPhenytoinPhenobarb

Smoking cigarettes

Morphine: side-effects

MORPHINE:

Quote:

MyosisOut of it (sedation)

Respiratory depressionPneumonia (aspiration)

HypotensionInfrequency (constipation, urinary retention)

NauseaEmesis

Therapeutic index: formula

TILE:

Code:

TI = LD / ED

Zero order kinetics drugs (most common ones)

"PEAZ (sounds like pees) out a constant amount":

Quote:

PhenytoinEthanolAspirin

Zero order_ Someone that pees out a constant amount describes zero order kinetics

(always the same amount out)

Asthma drugs: leukotriene inhibitor action

Quote:

zAfirlukast: Antagonist of lipoxygenasezIlueton: Inhibitor of LT receptor

Beta- vs Beta- receptor location

"You have heart and lungs":

Quote:

Beta- are therefore primarily on heart.Beta- primarily on lungs.

Hepatic necrosis: drugs causing focal to massive necrosis

"Very Angry Hepatocytes":

Quote:

Valproic acidAcetaminophen

Halothane

Adrenoceptors: vasomotor function of alpha vs. beta

ABCD:

Quote:

Alpha = Constrict.Beta = Dilate.

Beta blockers with intrinsic sympathomimetic activity

Quote:

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.

Beta-blockers: main contraindications, cautions

ABCDE:

Quote:

AsthmaBlock (heart block)

COPDDiabetes mellitus

Electrolyte (hyperkalemia)

Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem"

(because he has a runny nose...):

Quote:

Timolol

PindololHismololNaldolol

Propranolol

PREANASTHETIC MEDICATION

HOSANA this is a christian word.

Quote:

H-H2blockersO-opeoids

S-sedatives-antianxietyA-anticholenergic

N-neurolepticsA-antiemetics

simple and sobar

anti epeleptic drugs

Dr.BHAISAB's New PC.

Quote:

D...deoxy barbituratesB...barbituratesH....hydantoin

A.. aliphatic carb acidsI....iminostilbenesS....succinimides

B....BZD'sN.... newer drugs

P....PhenyltriazinesC... cyclic gaba analogues

adverse effects of tetracyclins-KAPIL DEV

Quote:

K kidney toxicityA antianabolic effect

P phototoxicityI inc ICP

L liver toxicity

D diabetes insipidusE enamel problemsV vestibular toxicity

GENERAL TOXICITY OF ANTICANCER DRUGS

SHaLi's BF Ghoghari Gautam is Chor.

Quote:

S-skinH-hyperurecemia

L-lymphoreticular tissueB-bone marrow

F-FoetusG-gonads

G-gitC-carcinogenecity

6 H s and 8 H s of adverse effects of thaizide diuretics and loop diuretics

respectively.....

'melbourne cricket authority has high funds though players get minor amount' ..

for clinical uses of beta blockers...

Drugs causing pulmonary fibrosis:

Quote:

BAB like in baba (father)Bleomycin

AmiodaroneBusulfan

ADRS OF CHLORAMPHENICOL

smart boys in girls hostel

B.... bone marrow depression

H...hypersensitivity

I....irritative effects

S.....superinfections

G.....Gray baby syndrome

ampicillin uses

UR GMCS BeST

Quote:

UTIRespi

GonorrhoeaManingitis

cholecystitissepticemias

bacillary dysentrysabe

typhoid

misch

Acyclovir “I see clover”

I see a three-leaf clover (this is a prodrug that gets converted into a

triphosphate – it resembles dNTP and inhibits DNA Polymerase). Imagine putting

clovers over herpes sores and genital warts (this is used to treat those).

Amantadine “Homan to Dean” In case you haven’t heard, Dr. Homan is our new

SOM dean. His new policy: he won’t let us come to school without our white

coats (this drug blocks uncoating, stage 2, in viral infection). Other interesting

facts about him: he can pee for 12 hours straight! (The half-life is 12h and it’s

excreted unchanged in the kidney .)

Dr. Homan can’t take the pressure of being a new dean so he becomes a

nervous drunk with depression, feelings of detachment, insomnia, dizziness,

ataxia, slurred speech, and inability to concentrate (these are some of the

adverse effects)

Cephachlor “Chlorine” – as in swimming pools

You swim and get water up your nose and in your ears (this drug treats sinusitis

and OTITIS media).

Cephadroxil “Drop rocks” While you are peeing you drop rocks (This drug treats

UTIs).

Cephalothin “…Loathing”

If your heart is infected, you can’t love, only loathe (this is used to treat severe

infections such as endocarditis).

Cephamandole “…Man doll” You have to inflate your man doll and you get an

upper respiratory infection. If you “use” this anatomically correct man doll, he

will give you pelvic inflammatory disease (This drug is indicated for URI and

PID). He’s also so real that he bleeds!!! (Adverse effect: It affects Vit-K

dependent clotting function)

Cephazolin “…Soul in” You want to keep your soul in and not die if you go to

surgery (this drug is used prophylactically for surgery).

Cephoperazone “…Opera zone” Going to the opera makes me want to get drunk

to the point of illness. These drugs, when mixed with ethanol interfere with

ALDH, affecting alcohol metabolism (you end up with increased acetaldehyde –

a DISULFIRAM-LIKE REACTION).

Also, if you see Phantom of the Opera, expect to see some blood! (This affects

Vit-K dependent clotting function.)

Cephotaxime “…Tax time” IRS is hard to kill off – they are MULTIPLE DRUG

RESISTANT (Use this drug against MDR strains.).

Clindamycin “Clean the mice”

You’re cleaning the mice because they are covered with ticks (this drug is used

to treat Lyme Disease). You have to use SOS kitchen cleaner to clean the mice

(SOS = 50 S ribosomal unit – where this drug acts).

Richard Gere likes to put mice in “where the sun don’t shine” and this is a very

FRAGILE procedure (Clindamycin may cause Pseudomembranous enterocolitis

and it’s also used to treat B. fragilis infections).

Fluconazole “Flu cone” Imagine an emaciated AIDS patient eating an ice cream

cone made of the flu and he gets an oral and esophageal fungal infection. (This

is used to treat oral and esophageal candidiasis in AIDS patients).

Foscarnet “Fox cARRR net” If you catch foxes in a net, they won’t reproduce

(this drug is a stage 3 inhibitor). ARRR… it inhibits RNA polymerase and Reverse

transcriptase to block Reproduction. You’re going to put the foxes into a car

that’s made out of bones instead of metal (this drug binds to bones and

decreases Ca2+ and Mg2+).

Also, a foxy lady is HOT (this drug will cause a fever) and never wear fox urine to

hunt (this is excreted in the kidney and causes renal insufficiency).

inhalational corticosteroids

Bed Bug Flew To Florida

Quote:

B-BECLOMETHASONE DIPROPIONATEB-BUDESONIDE

F-FLUTICASONE PROPIONATET-TRIAMCINALONE

F-FLUNISOLIDE

Succinylcholine: action, use

Quote:

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

Cholinergics (eg organophosphates): effects

If you know these, you will be "LESS DUMB":

Quote:

LacrimationExcitation of nicotinic synapses

SalivationSweatingDiarrheaUrination

MicturitionBronchoconstriction

Steroids: side effects

BECLOMETHASONE:

Quote:

Buffalo humpEasy bruising

CataractsLarger appetite

ObesityMoonfaceEuphoria

Thin arms & legsHypertension/ Hyperglycaemia

Avascular necrosis of femoral headSkin thinningOsteoporosis

Negative nitrogen balanceEmotional liability

Methyldopa: side effects

METHYLDOPA:

Quote:

Mental retardationElectrolyte imbalance

ToleranceHeadache/ Hepatotoxicity

psYcological upsetLactation in female

Dry mouthOedema

ParkinsonismAnaemia (haemolytic)

Sodium valproate: side effects

VALPROATE:

Quote:

VomitingAlopecia

Liver toxicityPancreatitis/ Pancytopenia

Retention of fats (weight gain)Oedema (peripheral oedema)

Appetite increaseTremor

Enzyme inducer (liver)

Captopril (an ACE inhibitor): side effects

CAPTOPRIL:

Quote:

CoughAngioedema/ AgranulocystosisProteinuria/ Potassium excess

Taste changesOrthostatic hypotension

Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)

Renal failure (and renal artery stenosis contraindication)/ RashIndomethacin inhibition

Leukopenia/ Liver toxicity

Lithium: side effects

LITH:

Quote:

LeukocytosisInsipidus [diabetes insipidus, tied to polyuria]

Tremor/ TeratogenesisHypothyroidism

Opioids: effects

BAD AMERICANS:

Quote:

Bradycardia & hypotensionAnorexia

Diminished pupilary sizeAnalgesics

MiosisEuphoria

Respiratory depressionIncreased smooth muscle activity (biliary tract constriction)

ConstipationAmeliorate cough reflex

Nausea and vomitingSedations

Ca++ channel blockers: uses

CA++ MASH:

Quote:

Cerebral vasospasm/ CHFAngina

Migranes

Atrial flutter, fibrillationSupraventricular tachycardia

Hypertension

·

Alternatively: "CHASM":

Quote:

Cererbral vasospasm / CHFHypertension

AnginaSuprventricular tachyarrhythmia

Migranes

Pupils in overdose: morphine vs. amphetamine

MorPHINE: Fine.

AmPHETamine: Fat

"Morphine overdose: pupils constricted (fine)

Amphetamine overdose: pupils dilated (fat)

Phenobarbitone side effects

Children are annoying (hyperkinesia, irritability, insomnia, aggression)

Adults are dosy (sedation, dizziness, drowsiness

Atropine: origin tells action or vice versa

Atropine causes your pupils to dilate, and it came from nightshade [belladona]In the night or

in shade, your pupils dilate so you can see

Atropine use: tachycardia or bradycardia

"A goes with B":

Atropine used clinically to treat Bradycardia

Reserpine action

Reserpine depletes the Reserves of catecholamines [and serotonin]

Sodium channel blockade: Procainamide, Quinidine, Disopyramide

"Quaker Preachers Discussed Sobriety."

Quaker-Quinidine

Preachers-Procainamide

Discussed-Disopyramide

Sobriety-Sodium channel blockade

Class IB - Sodium channel blockade: Lidocaine, Phenytoin, Mexiletine, tocainide

"Philadelphians Like Salty Mexican Tacos."

Philadelphians-Phenytoin

Like-Lidocaine

Salty-Sodium channel blockade

Mexican-Mexiletine

Tacos-Tocainide

Class IC - Sodium channel blockade: Flecainide, Encainide, Propafenone

"Flea Encrusted Prophets."

Flea-Flecainide

Encrusted-Encainide

Prophets-Propafenone

Class II - Beta-adrenergic blockade: Propranolol

"Betting Professionals."

Betting-Beta-adrenergic blockade

Professionals-Propranolol

Class III - Prolong repolarization: Amiodarone, Bretylium, Solatol

"Britain Repossessed American Soaps."

Britain-Bretylium

Repossessed-Repolarization is prolonged.

American-Amiodarone

Soaps-Solatol

Class IV - Calcium channel blockade: Verapamil, Diltiazem

"Calligraphist's Verbal Dilemma."

Calligraphist-Calcium channel blockade

Verbal-Verapamil

Dilemma-Diltiazem

Antiarrhythmic agents:

"A Dubious Quality Product...

Bought To Preserve Little Money...

Can Fabricate Enough Problems."

A-1a B-1b C-1c

1a-A:

D-Disopyramide

Q-Quinidine

P-Procainamide

1b-B:

T-Tocainamide

P-Phenytoin

L-Lidocaine

M-Mexiletine

1c-C:

F-Flecainamide

E-Encainamide

P-Propafenone

Mnemonics For Side Effects.

ACEI, Side Effects

CAPTOPRIL

Cough,

anaphylaxis,

palpitations,

taste,

orthostatic ↓BP,

Potassium (↑K+),

Renal impairment,

impotence,

leucocytosis

Anti-epileptic side Effects

ABCDEFGH

Ataxia,

blood dyscrasia,

cleft lip,

dupuytrens / vit D def,

exfoliation of skin & Stevens Johnson’s. Fits,

GI upset / gum hypertrophy,

hepatitis / hairy

Barbiturate side Effects

ABCD

Ataxia,

behavioural disturbance,

↓concentration / coma,

depression / drowsy / diplopia

Cholinergic OD side Effects

DUMB BELS

Diarrhoea,

Urination,

Miosis / muscle weakness,

bronchorrea

Bradycardia,

emesis,

lacrimation,

salivation / sweating

Cyclosporin Side Effects

4HRT

4H - Hyper K+, hypertension, gum hypertrophy, hairy

R – Renal toxicity

T - Tremor

Digoxin S/E

GECCKO

GIT – n&v, abdo pain, ulcers

Eyes – blurring, halo, xanthopsia

CNS – depression, confusion, delirium, hallucinations

Cardiac – ANY arrhythmia

K - low

MAOI side Effects

3Hs

Hepatocellular jaundice,

Hyperthermia,

hypertension

TCAD side Effects

CAN WOO

Cvs,

Anticholinergic,

Neuro,

Withdrawal,

Overdose,

Others

Steroids Side Effects

HIGH COMPACT IMPS

Hypertension,

Immunosuppression,

Gastric Ulcer (bleeding),

Heartburn

Cataract,

Osteoporosis,

Muscle weakness,

Path # / Psychosis,

Acne / Altered Glucose,

Cushingoid,

Thin skin

Increased appetite,

Myopathy,

poor wound healing,

stress response reduced

AM CUSHINGOID

Acne,

Myopathy (prox) / muscle wasting (prox)

Cushingoid / Cataract,

Ulcers,

Striae, skin thin (bruising),

Hypertension / hairy,

Infection,

Glycosuria,

Obesity / Osteoporosis / Oedema,

Immunosuppression / Insomnia,

Depression

http://imedrx.blogspot.com/2010/02/physiology-and-pharmacology-video.html