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LIPID LOWERING
Class Drugs Description MoA Uses Adverse P.kinetics
HMG-CoA reductase
Inhibitor
(statins)
AtorvastatinLong Acting
HMG-CoA Cholestrol
Hyper LDL
Atheroma rupture
LDL-Oxidation
Endothelial function
Headache
GI upset
Muscle tender
(CPK)
Take at bedtime
(HMG-CoAr )Rosuastatin
Simvastatin Short Acting
Fibrates
GemfibrosilFibrates + PPRALL
VLDL (TG)Hyper TG
Myalgia
Hepatitis
Gall Stones
G + Statin = myopathy
FenofibrateF/B + Statins = Safe
Bezafibrate
Nicotinic Acid Niacin + HDL
FFA Liver
formation of Hepatic VLDL
circulating TG
Hyper TG
Skin Flush, Heat
Dyspepsia,
Vomitting
Liver Toxicity
+ Statins = myopathy
Ezetimibe Inhibit cholesterol absorption Hyper LDLReversible Liver
ImpairedCombine with statins
Drugs LDL TGL HDL
Statins
Fibrates
Niacin
Ezetimibe
ANTI-ANGINAL
Class Drugs Description MoA Uses Adverse P.kinetics
Organic Nitrate
Nitroglycerin Sublingual
Venodilate (Preload)
Artery Dilate (Afterload)
Unstable Angina
CHFAcute LVF
Acute MI
Cardiac Procedures
HeadacheReflex Tachycardia
Postural Hypotension
+ sidenafil - BP
Less FPMIsosorbide-Dinitrate
Isosorbide-5-mono
CCB
NifedipineDHP (VD)
HR, FC O2 demand
Artery Dilate TPR / afterload
Coronary flow
DVD: Angina, HTN
VD: SV arrhythmia
V: migraine prophylaxis
Constipation
Peripheral Edema
Hypotension
Reflex Tachycardia
(Worsen Angina)
Reflex Tachycardia:
Amlodipine
DHP + Beta-Blocker
Amlodipine
Verapamil VD, FC, HR
Diltiazem VD, FC, HR
HMG-CoAr
X
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Beta-Blocker
AtenololB1-Selective
HR, FC O2 demand
Prophylaxis:
Myocardial Infarction
Angina
(more important in CHF)Metoprolol
PropanololB1 + B2
Timolol
Late Na Current Block Ranolazine Ca in Myocardium Angina Torsades de Pointes No effect on HR, BP
Anti-thrombotic
Low-Dose Aspirin
Prevent clotting Angina Bleeding Combination TherapyHeparin
Warfarin
ANTI-HYPERTENSIVE
Class Drugs Description MoA Uses Adverse P.kinetics
1-blocker
Pra^zosin
Selective Block 1VD (BP)Hypertension
BPH
Ortho. Hypotension
Reflex Tachycardia
Nausea
Rhinitis
Urination
Tera^zosin
Doxa^zosin
Phenoxybenzamine Non-selective
Irreversible
Block 1 + 2 Pheochromocytoma
Phentolamine
2-agonist
ClonidineCentral Acting
+ Imidazoline
sympathetic activity (E, NE)
VD Artery
Hypertension
Menopause
Tiredness
Depression
Dry Mouth
CI: Renal FailureMethyl Dopa
Menoxidine
Beta-Blocker
Atenolol B1 Selective
1. HR, FC CO
2. X-B1 X-Renin X-AT2
3. Block 1 VD
4. Nebivolo +NO
Hypertension
Angina
Post-MI
CHF
Asthma (B2)
++ COPD
Bradycardia
Tiredness
CI: Asthma (B2)
ISA (Intrinsic
Sympathomimetic
Activity)
TimololB1 + B2
Propanolol
Nebivolol B1 + VD
Pindolol (ISA) B1 + B2 + VD
Carvedilol B1 + B2 + 1
Diuretics
Thiazides Na/Cl
Volume BPHypertension
Edema
Hypokalemia
CI: HyperuricaemiaAmiloride
Na BlockerHyperkalemiaTriamterene
Spironolactone X-Aldosterone
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RAAS
Alis^kiren Renin Inhibitors
*Refer RAAS Hypertension
Hypotension
Headache
Angioedema
Val^sartan
ARBIrbe^sartan
Telmi^sartan
Enala^pril ACE Inhibitors
VD
CCB DHP + Diltiazem
VD BP HypertensionMyocardial Ischemia
Peripheral Edam
Hyptension
Reflex Tachycardia
Hydralazine Artery Dilator
Na Nitroprusside Nitro VD
Congestive Heart Failure (CHF)
Class Drugs Description MoA Uses Adverse P.kinetics
Preload
Frusemide Diuretics (X-Na-K-Cl) : PreloadCHF: Class 2, 3, 4
(+ symptoms)Hypomagnesemia
Diuretic Resistance:
Excess Na Intake
+NSAIDs
Renal Impaired
Enalapril
ACE Inhibitors X-AT2: VD, Aldosterone Hypertension
Hypotension
HeadacheDizziness
Ramipril
Lisinopril
Nitroglycerin Venodilators VD Preload CHF Hypotension Sublingual / IV
Afterload Hydralazine Artery Dilator Limit Ca Relax Smooth Muscle+ sympathetic reflex
(CI: angina + MI)
Oxidative Stress
Metoprolol
Beta-Blockers HR
CHF: 2,3 + HPT
Cardiac Remodelling
O2 demand
Asthma (B2)
Bradycardia
Paraesthesia
Worsen CHF (HR)Atenolol
Carvedilol
Contractility Digitoxin Glycosides
X-Na/K: FC SV
Peak Tension + Velocity
(Systole shorten Diastole prolong)
CHF + A.Fib
Notes
Toxicity Treatment
Notes:
Class I No Symptoms ACEI + BB AV Block Atropine
Class II S + Mid Exertion ACEI + D + BB + G Sinus Bradycardia Atropine
Class III S + Less Exertion ACEI + D + BB + G + VD SV Arrhythmia Propanolol
Class IV S at Rest All + IV D + IV VD + IV G V Arrhythmia Lignocaine
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BRONCHIAL ASTHMA
Class Drugs Description MoA Uses Adverse P.kinetics
ACUTE TREATMENT
B2 Agonist Salbutamol Selective SABA +B2 : Bronchodilate First-line Asthma Tremor + Anxiety MDI (Inhale)
Leukotriene Inhibitor Theophylline X-Leukotrienes: Bronchoconstrict Asthma, COPD Arrhythmia, CNS + Found in Coco
Anti-cholinergic Ipratropium Br - Muscarinic : Bronchodilate Second-line Asthma Sedation, Dry Mouth MDI, Nebulizer
Adrenergic Agonist Epinephrine (E) cAMP : Bronchodilate Asthma, Allergy Tachycardia Oral
PROPHYLAXIS
GlucocorticoidBudesonide Anti-
InflammatorySuppress Immune : X mucus Chronic Asthma Super infection Oral, Parenteral
Beclomethasone
B2 AgonistFormoterol
Selective LABA +B2 : Bronchodilate Nocturnal Asthma Wheezing >12h + GlucocorticoidsSalmeterol
Leukotriene InhibitorZafirlukast
Anti-
Inflammatory
X-Leukotrienes: Bronchoconstrict Exercise-Induce Asthma Eosinophilia, Rash Oral, ChildrenMontelukast
Mast Cell Stabilizer Cromolyn Sodium X Histamine Release Allergic Dry Mouth MDI, DPI + LABA
COUGH
Class Drugs Description MoA Uses Adverse P.kinetics
DemulcentsLozenges
+salivation +viscid layer sooth Symptomatic ReliefShort Acting
Effects Vanish w LayerSyrups
ExpectorantsPotassium Iodide SSKI Secretion
Productive Cough
Asthma
Gastric Irritant
Nausea
Require hydration
SSKI: Saturated Solution K I odideGuafenesin Secretion + Ciliary Action
Mucolytics Bromhexine Secretion + Ciliary Action Productive Cough Tears + Runny Nose Add in syrups
Antitussives
(suppress or relief cough)
Codeine
Opioid Suppress cough center selectively Unproductive coughConstipation
Respiratory DistressAdd with NSAIDs
Pholcodine
Noscapine
Non-Opiod Activate sigma receptor Unproductive cough Nausea + Vomitting
Dextropethorphan
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Anti-Histamine
Diphenyhydramine1
stGeneration Block H1 receptor Allergic rhinitis Dizziness, Drowsy Cross BBB
Promethazine
Cetrizine (Zyrtec)2
ndGeneration Block H1 receptor Allergic rhinitis
Dry mouth
Blurred VisionNot cross BBB
Loratidine (Claritin)
Levocetirizine3
rdGeneration Block H1 receptor Allergic rhinitis Safer
Non drowsy
Rapid ActionFexofenadine
Decongestants Ephderine Sympathomimetic +Adrenergic VC Blood Nose blocked Insomnia, Anxiety CI: HypertensionPseudoephderine
HEMATINIC : + RBC
Class Drugs Description MoA Uses Adverse P.kinetics
IRON
Ferrous SulphateDissociable
Ferrous Salt*not significant
Iron Def. Anemia
Epigastric pain
Nausea
Metallic Taste
Empty StomachFerrous Fumarate
Ferrous Gluconate
Iron DextranParenteral Iron Def. Anemia GI Upset
CI:Pregnant, Infants,
Children, GIT BleedIron Sucrose
B12
Cyanocobalamin
+ Intrinsic Factor Absorbed
Pernicious Anemia
Tapeworm
Ileectomy
Allergic CI: Folate Def. Anemia
Hydroxycobalamin PP Bound
Folate Increase folateMegaloblastic Anemia
Pregnancy (NTDs)Allergic CI: Pernicious Anemia
EPO Epoetin Alpha Recombinant + BM to produce RBCRenal Failure
Chemotherapy
Blood Viscosity
+ Clot
Flu-Like Symptoms
IV
IMMUNOSUPPRESSANT
Class Drugs Description MoA Uses Adverse P.kinetics
Anti-proliferative
AzathioprineNon-Selective
+ 6-mercaptopurine
(Purine Analogue)
Inf. Bowel Disease
Rheumatoid Arthritis
BM Suppression
Liver ImpairCI: Allupurinol
Cyclophosphomide
Mycophenolate
mofetilIMP X Guanylyl (de novo) Prevent Graft Rejection GI ulceration, Edema
mTOR Inhibitor Sirolimus T-cell Activation Lymphoma Hypertension, Edema CI: Lung Transplant
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Calcineurin InhibitorCyclosporine
Bind to Cyclophilin
X-NFAT : IL2 - T-cell DivisionGraft Rejection Hypertension CI: Renal Impaired
Tacrolimus
CorticosteroidsPrednisone
Steroid Supress IL2 Allergic, Autoimmune Weight Gain, Anxiety Slow Withdrawal
Dexamethasone
IL-2R Inhibitor
Basiliximab
Block IL2 Receptor Prevent Graft Rejection Opp. InfectionDaclizumab
ANTICOAGULANTS & THROMBOLYTICS
Class Drugs Description MoA Uses Adverse P.kinetics
Fibrinolytic
Streptokinase Antigenic
Stroke
Acute MI
++ Pulmonary Embolism
Systemic Lytic
HemorrhageUrokinase Non-Antigenic
Alteplase Human tPA
Anticoagulant
Heparin
Unstable Angina
Bleeding, Osteoporosis Monitor aPTT
Enoxapain
LMW Heparin LessX-F10a Selectively
ThrombocytopeniaTinzaparin
Warfarin Oral
DVT
Pulmonary Embolism
Unstable Angina + MI
Bleeding
Teratogenic
High PP Bound
Start w Heparin (5 Days)
Antidote: Vit K
Anti-Platlet Drugs
LD Aspirin 75135 mgLD: X-TXA2
HD: X-PGI2 Prophylaxis: MI, Angina
Transient Ischemic Attack
Stroke
Coronary Angiplasty
Peri. Vascular Disease
GI Bleed
GI Irritation
Allergy
Thrombocytopenia
Clapidogrel
ADPr Inhibitor Bind to GP IIb/IIIa
Abciximab
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PEPTIC DISEASE
Class Drugs Description MoA Uses Adverse P.kinetics
H2-R Blocker
CimetidineDuodenal Ulcer
Gastric Ulcer
GERD
ZE Syndrome
Headache
Dizziness
Bowel Upset
Enzyme Inhibitor
Anti-Androgenic
RanitidineGood Oral
Antacids AbsorptionFamotidine
Nizatidine
PPI
OmeprazoleOral Duodenal Ulcer
Gastric Ulcer
GERD, ZE Syndrome
NSAIDs Induce Ulcer
Nausea
Headache
Abdominal Pain
Muscle Pain
+ Enteric Coated
(ionized at pH
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5-HT3 BlockerOdan^setron
Anti-Emetic Block 5-HT3 Receptor (CTZ, GIT)Vomitting (X-Labyrinth)
Drug Induced Vomitting
Headache
Constipation5-HT3 = Serotonin
Grani^setron
M Blocker
Scopalamine
Anti Motion
Sickness
Block M Receptor (CTZ, Labyrinth)Prevent Motion Sickness
Otitis
Dry Mouth
Constipation
Blurred Vision
Transdermal Patch
Dicyclomine + with Ototoxic Drugs
(Aminoglycosides)Prochlorperaqzine
H1 BlockerPromethazine
Block H1 Receptor (CTZ, Labyrinth)Sedation
Psychomotor Control
+ D2 Blocker Toxicity
Diphenyhydramine
AdjuvantsDronabinol CB1R Agonist
*not significant Anti-Chemo VomittingPsycho Effect
SympathomimeticCorticosteroids Immunosupp.
GI MOTILITY
Class Drugs Description MoA Uses Adverse P.kinetics
Laxatives
Fibre Diet Retain water Volume Functional Constipation - 2-3 days for effects
Docusate SodiumStool Softener
Stool Surface Tension Constipation
Liquid Paraffin Lubricates Hard Faeces Constipation 1-3 days
BisacodylPurgatives Secretions + Peristaltic
ConstipationAbdominal Cramp
Na Picosulfate Constipation
Mg SulfateSaline Laxative Retain water in lumen
Pre-Surgical CleansingFlatulence, Nausea
Lactulose Chronic Constipation Fructose + Lactose
Mosapride5-HT4 cAMP : Secretions
IBS, Chr ConstipationFlatulence
Non-ComplianceTegaserod
Enema Pro-kinetic + Bowel Distension : + Evacuation
Anti-Motility
ORS Rehydration Replace Fluid + Electrolyte Diarrhoea - Chronic : IV
Loperamide
Opiod
agonist : Activity
Non-Infective Diarrhoea
Abdominal Cramp
CI: ChildrenDiphenoxylate Cross BBB
Racecadotril X-Enkepalinase cAMP Nausea
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DIABETES MELLITUS
Class Drugs Description MoA Uses Adverse P.kinetics
Insulin Secretagogues
Glyburide
Sulfonylurea
Block S-R K Ca Influx
Normalization of FBS,
PPBG
HbA1c 1-2%
Hypoglycaemia
Weight Gain
Liver Failure
Renal Failure
: BB, NSAIDs
: Steroids
Take 30 min before meal
(Basal Insulin +)
Glipizide
Gliclazide
Glimepiride
Repoglinide
Meglitinide
Headache
Joint Pain
Weight Gain
Take 10 min before meal
( PP Insulin +)
HypoglycemiaNateglinide
Insulin Sensitizers
Metformin BiguanideSKM: Glucose Uptake
Liver: Gluconeogenesis
HbA1c 1-2%
Diarrhoea
Nausea
Abd Discomfort
Anorexia
Metal taste
Metformin : DOC
Take with Meals
No Weight Gain
CI: Renal Impaired
Pioglitazone
Thiazolidinedione
Activate PPAR-
SkM: Uptake, FA Flux,
Insulin Resistance
Liver: Gluconeogenesis
Rosiglitazone
Glucosidase Inhibitor
Acarbose
HbA1c 0.71.3%
Abdominal Discomfort
Flatulence
Bloating
Take with first bite
Miglitol
DPP-4 Inhibitor Sitagliptin
Inhibit DPP4 : Incretin Degrade
insulin secretions
Glucose Uptake
Hepatic Glucose Production
HbA1c 0.70.8Nasal Mucosa Inflamed
+ UTIIncretin: GLP-1, G1P
INSULIN
Class Drugs Description MoA Uses Adverse P.kinetics
Rapid ActingLispro
3 -5 hoursPPBG Control
(Hypoglycaemia)
Subcutaneous
Dose = meal
515 min a/cAspart
Short Regular 68 hours Ketoacidosis (IV) 30 min a/c
IntermediateIsophane
2024 hoursSuspension
Lante X RegularLente
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Slow
Ultra-Lente 36 hoursPh 5.4 (Dont Mix)
Determir 14 hours
Glargine 24 hours Peakless : Night Use
ANTI-THYROID
Class Drugs Description MoA Uses Adverse P.kinetics
Anti-Thyroid
Propylthiouracil Inhibit Thyroid Peroxidase:X: Iodide tyrosyl
X: Iodide
X: Coupling (MIT, DIT)
X: Peri. Deiodination (T3 T4)
Prep Surgery
Control hypersecretion
Definitive Treatment
MaculopopularRash\Arthralgia
Agranulocytosis
Hypothyroid Baby
Less potent : q.i.dNot Cross Placenta
MethimazoleMore Potent : b.i.d
Cross Placenta
Ionic InhibitorThiocynates
Block Na/I Symporter Clinically Not UsedAplastic Anemia
Metallic Taste*Obselete
Perchlorates
Iodides ++ Iodide Thyroid Constipation Prep Surgery Edema + Swelling + Thioamide Agent
Radioactive Iodine
I127
Trapped in thyroid
+ with iodotyrosine Colloid
I123
- Thyroid Scan
*not fir for surgery
I131hypothyroidism
(follicular necrosis)CI : PregnancyI
131
I123
Scan
Beta - BlockerPropanolol
HRControl symptomsof
hyperthyroidsmAtenolol
ADRENOCORTICOSTEROIDS
Class Drugs Description MoA Uses Adverse P.kinetics
Steroid CorticosteroidGlucocorticoid
Mineralocorticoid
Glucose:
Gluconeogenesis, UptakeAddisons Disease
Rheumatic Disease
Renal Disorders
Allergic Reaction
Bronchial Asthma
Infectious Disease
Ocular Disease
Skin Disease
GIT Disease
Chemotherapy
Skin: Delayed Healing
MSSK: osteoporosisCNS: Psychoses
Endocrine: Hypogonad
CVS: Hypertension
Immune: Opp. Infxn
GIT: Peptic Ulcer
Most: Oral
Dexamethasone: IM/IV
Insoluble: Intradermal
Local: Aerosol, Topical
Lipid:Fat Redistribution:
Buffalo Hump, Moon Face
Fluid & Electrolyte: Aldosterone
Skeletal Muscle:
Weakness, Myopathy, Ca
CNS: Mood, Psychosis
Stomach: ++ peptic ulcer
Anti-Inflammatory: Lipocortin
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KIDNEY
Class Drugs Description MoA Uses Adverse P.kinetics
Loop Diuretic
Frusemide
X-Na/K/Cl SympX:Na/K/ClThick Asc. Limb
(Block NaCl Reabsorption)
Pulmonary Edema
Cardio + Renal Edema
Forced Diuresis: Overdose
Fluid & Electrolyte Imb
Alkalosis
Ototoxicity
Hypomagnesemia
X-Sulfonylurea
X-NSAIDsTorasemide
Thiazides
Hydrochlorothiozde
X-Na/Cl Symp X-Na/ClDistal Conv. Tubule(Block NaCl Reabsorption)
Hypertension
Cardio + Renal EdemaKidney Stones
Fluid & Electrolyte Imb
UricaemiaSexual Dysfunction
Photosensitivity
X-NSAIDs ()
X-Digoxin ()
+K sparing (Amiloride)
Polythiazide
Indapamine
Chlorthalidone
K+ Sparing
Spironolactone
X-Aldosterone
Block Aldosterone Receptor
Late Distal Tubule + C.Duct
(Na, H20 + K secretions)
Hyperaldosterone (Conn)
Hypertension, Edema
Altered Sexual
CharacterCI: Hyperkalemia (K)
Eplerone
AmilorideX-ENaC
X-ENaCCollecting Duct
(Na, H20 Secretions)Hypertension, Edema
Hyperkalemia (K)
Photosensitivity
*ENaC: Epi Na Channel
+ Thiazides (K loss)Triamterene
Osmotic Diuresis Mannitol GFR (Prox. Conv Tubule) Cerebral Edema CI: Edema
CA InhibitorsAcetazolamide X-CA : X formation of H2CO3
(+ Metabolic Acidosis)
Secretions of Na, K, Cl, HCO3
Glaucoma
Altitude Sickness
Allergic
Bone Marrow Suppress
Not useful to mobilize
edemaDorzolamide
ORAL CONTRACEPTIVES
Class Drugs Description MoA Uses Adverse P.kinetics
CombinedOestrogen
Gn Release X-FSH + LH Peak
X Ovulation
Modify F. Tubes contraction
Implantation of Blastocyst
Oral ContraceptivesThrombophlebitis
Thromboembolism
Hypertension
Cancer
Gall Stones
CI: Hypertension
X-antibiotics
X-Enzyme Inhibitors
Progesterone
Sequential Pill
Oestrogen 16 days
O + P 5 days
DF 7 daysMini Pill Progesterone Low Dose Less Effective
Post-CoitalMifepristone 72 hours
+ IUD after 5 daysNorgestrel 12 hours
Implant Norplant 6 Levonorgestrel
Contraceptives
Most Effective
Vaginal Hormone Nuvaring EE + Etonogastrel Flexible (Upper Vagina)
Transdermal Norgestimate EE + Norgestrmn
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IUD
Copper
Progesterone
Levonorgestrel
PARKINSON
Class Drugs Description MoA Uses Adverse P.kinetics
DA Precursor Levo-dopa DA in Basal Ganglia Parkinson
GI Upset
Ortho. Hypotension
CNS: confusion
+ Peri. Dopa-
Decarboxylase Inhibitor
(Carbidopa)
+Drug Holiday
DA-R AgonistPergolide
Ergot Alkaloids+DA Receptor at Corpus Striatum
(+ GP internal)Advance PD
Similar to L-Dopa
Retroperi. Fibrosis
Digital Vasospasm
Start w Low DoseBromocriptine
MAO-I Selegiline X-MAO-BSelective Irr. Inhibit MAO-B
DA Breakdown, DA EffectsEarly Mild PD Dry Mouth. Insomnia X-Cheese (Tyrosine)
Muscarinic Antagonist
Diphenyhydramine
ACh Block Ach ReceptorDrug-Induced PD
(metoclopromide)
Drowsiness
Confusion
Dry Mouth
Start w Low Dose
CI: BPH, Glaucoma
Benztropine
Bipiredin
COMT-ITolcapone
Adjuvant The amount of L-Dopa Cross BBB Adjunct: L-Dopa/Carbi HepatotoxicityEntacapone
Anti-Parkinsonism Amantidine Anti-Viral Alter uptake + release of DA Mild PD Lethargy, Insomnia Less Efficacious
SEDATIVES & HYPNOTICS
Class Drugs Description MoA Uses Adverse P.kinetics
Benzodiazepines
(TLAD)
Triazolam Rapid-Acting
(
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Non-Benzodiazepines
Zolpidem
Bind to GABA-A Receptor InsomniaHallucinations
AmnesiaCI: Driving, Elder, GERDZaleplon
Zopiclone
Atypical Anxiolytics Buspirone Serotonin 5HT1A Partial Agonist GAD:Gen Anxiety Disorder Dizziness, Nausea Less Sedation & Depndce
Beta-Blocker Propanolol X-Beta Adrenergic Receptor Performance-Induced
Misc.
Melatonin Reset Circadian, Jet Lag
Note:
Sedative : + calm
Hypnotics : + sleep
Promethazine Anti-histamine Surgical PrepOpiod
Amytriptyline SSRIs, TCA Anti-Depressant
OPIOD ANALGESICS
Class Drugs Description MoA Uses Adverse P.kinetics
agonist
Morphine
Analgesic Pathway - Sensory
LimbicTranquillity, Euphoria
Locus Cerulus - Fear, Anxiety
Cough Center - Cough
Respiratory Center - Resp.
+ CTZ-VomitingEWN-Pupil Constriction (Pin-Point)
+Histamine : VD, Skin Itchy
Pain - COCardio-protective
GIT: Peristaltic, Secretions
Spasm of Sphincter of Oddi
Cancer Pain
Fracture Pain
Post-Op Pain
Biliary Colic
MI, LVF
Balanced Anesthesia
Visceral Pain (X-MSSK)
Nausea, Vomiting
Constipation
Biliary Tract Pressure
Urinary Retention
Hypotension, PruritusDrowsiness
Mental Clouding
Resp Depression
+ Tolerance
+ Dependence
+ Abuse
Precaution:
Pulmonary DiseaseHypotension, Shock(VD)
Head Injury
(ICP by CO2 Retention)
Neonate
Renal, Liver Impaired
CodeineMorphine
CongenersCough Center Dry Cough, MSSK Pain
Constipation
DrowsinessLess Analgesic Effects
Tramadol Serotonin, NE ReuptakeDepression
Fibromyalgia
Nausea, Vomiting
Constipation
+ Dependence
Better Oral Efficacy
Less Resp. Depression
Less Constipation
Pethidine Bind to , and also receptorObstetrics
(Labor Pain)
Resp. Depression
Tachycardia (IV)
Pupil Dilation
+ Dependence
Aka: Meperidine,Demerol
CI: MAO-I
Fentanyl Bind to receptor
Epidural: Post-Op, Labor
Transdermal: Cancer
IV: During Surgery
Hypoventilation100x Analgesic: Morphine
Rapid + Short Acting
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Gametocidal
Primaquine Unknown
Radical Cure
Infection Control
Prevent Relapse
(Kill Hypnozoites)
Abdominal Pain
GI Upset
MetHbnemia +
cyanosis
CI: G6PD
Radical Cure
Others
Mefloquine
Clinical Cure
(+Artesunate)ACT Rationale:
Resistance to Chq Protect resistance declined efficacy More effective
P. falciparum:
20x merozoites Cerebral toxicty Bilirubin load Hypovolemia Chq Resistance
PYR+Sulfadoxine (+Artesunate)
Lumefantrine (+Artemether)
Doxycycline (+Quinine)
Proguanil Chemoprophy.
ANTI-TUBERCULOSIS
Class Drugs Description MoA Uses Adverse P.kinetics
Anti-Tuberculosis
Isoniazid INH Inhibit Mycolic Acid (Cell Wall)
Bactericide:Rapid Multiply
Bacteristatic: Slow Grow
Intra & Extracellular
Hepatic Toxicity
PNS & CNS Toxicity
Urinary Retention
+ Resistance
Enzyme Inhibitor
I: Phenytoin
Rifampicin
X-DNA-Dependent RNA Polymerase
X RNA Transcription
Bactericide: All Subpop.(Except DormanT)
Intra & Extracellular
Resistance Prevention
Hepatitis
Flu-Like Syndrome
Orange Body Secretion
Enzyme Inducer
Pyrazinamide PZA
Pyrazinamidase convert PZA to
Pyrazinoic Acid (active form) ++
Disrupt Membrane Potential
Interfere with Energy +
Short-Term therapy for
Uncomplicated TB
Intracellular
Decrease Relapse Rate
Liver Damage
Hyperuricemia + Gout
Arthralgia
Rash + Fever
Bacteriostatic
Ethambutol EMB Inhibit Cell Wall SynthesisCombination Therapy
Suppress Growth Res. TBVisual Disturbance CI: Children (< 6 y/o)
Streptomycin Aminoglycoside Bind to 30SInterfere Proofread ExtracellularX-Vestibulocochlear (8)
NephrotoxicityIM Injection only
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ANTIBIOTICS
Class Drugs Description MoA Uses Adverse P.kinetics
PROTEINSYNTHESISINHIBITORS
Macrolides
Erythromycin
Bind to 50s
X-Translocation
Gram +ve
Resp. Tract Infxn
Drug of choice:
M. pneumonia
Chlamydia
Diphteria
Pertussis
H pylori
H influenzae
Salmonella
Toxoplasmosis
Alternative:
Tetanus
Strep Tonsillitis
Pharyngitis
Pneumonia
Prophylaxis:
Rheumatic Fever
Endocarditis
Skin Rash
Thrombophlebitis
GI Disturbance
Torsades-de-Pointes
X-Cross BBB
Phagocytosis
into Synovial
Eliminated in Bile
Enzyme Inhibitors
(AE of other drugs)
X-statins:
Rhabdomyolysis +
myopathy
X-OCS:
Loss Effectiveness
H pylori
(Clarithro + Amoxicillin)
Clarithromycin
Gramve
H. influenzae
H pylori
Pharyngitis
Resp. Tract Infxn
Skin Rash
Nausea + Vomitting
Jaundice
AAD
Azithromycin
Gonorrhoea
Thyphoid
Chlamydia
T gondii
Abdominal Pain
Nausea + Diarrhoea
Cholestatic Hepatitis
AAD
Ketolides TelithromycinBind to 50s
X-Translocation
S. pneumonia (Erythromycin Res)
H influenzae, B pertussis*same as Clarithro
10x affinity for 50s bind
than erythromycin
LincosamidesClindamycin Bind to 50s
X-Translocation
Gram +ve (MRSA), Anaerobic
Protozoa (Malaria)
Thrombocytopenia
Diarrhoea, RashTopical: Acne Treatment
Lincomycin
Streptogramins
Quinupristin 3Bind to 50s
Dalfopristin change
ribosome structure
+ Quinupristin bind
Gram +ve : MRSA, VRENausea
Myalgia + Arthralgia
*combination reduce
resistanceDalfopristin 7
Fusidic Acids Sodium Fusidate Narrow-SpectrumBind to 50s
X-Translocation
Gram +ve, C perfringens
Conjuctivitis + Skin Infection
Teratogenic
Jaundice
Bacteriostatic
+Statins: Rhabdomyolysis
Fluoroquinolones
Norfloxacin 1st
GenerationX-bDNA gyrase
X-Supercoiling
X-bDNA synthesis
Salmonella, Shigella
UTi, Enteric Fever, Enterocolitis
Res. Tuberculosis, Meningitis
Nausea + Vomiting
Allergic
CNS Effects
Arthropathy
Norfloxacin: Topical
Enzyme Inhibitors (AE)
CI: Pregnancy
Ciprofloxacin 2nd
Generation
Levofloxacin 3rd
Generation
Trovafloxacin 4th
Generation
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PSI
Aminoglycosides
Streptomycin
Natural
Bind to 30s
Interfere
Proofreading
+Abnormal Protein
Bacteriocidal
(*depends on conc)
Resistant Tuberculosis
Ototoxicity
Renal Failure
+ INH / EMB / PZA
Neomycin Gut Sterilization Topical
Tobramycin Gramve (pseudomonas)
Kanamycin Research (isolate bacteria)
GentamicinSynthetic
MRSA, Enterococci +Vancomycin: MRSA
Amikacin Multidrug-Res. Gram -ve
CELLWALLSYNTHESISINHIBI
TORS
BETA-LACTAMS
Penicillins
Penicillin G Natural
+-lactam Ring
Bind to PBP
X-transpeptidase
Inhibit Petidoglycan
Synthesis on Bact.
Cell Wall
Chronic Disease
Meningitis, Pneumonia, Syphilis
Endocarditis (+Gentamycin)
Allergy
Opp. Infections
Diarrhoea
(with Amoxicillin)
Rare:
Hemolysis
Nephritis
Neurtoxicity
Most Potent
Acid Labile
(-lactamase sensitive)
Penicillin V Semi-Synthetic Oral Infections Acid Stable
Methicillin
Penicillinase Res.
Identify MRSA
Anti-staphylococcal(Skin + Soft Tissue)
Cloxacillin
Oxacillin
Ampicillin Extended
Spectrum
Bite Wound Infections (ie. Bedbugs)
Amoxicillin Sinusitus, URT Infections Less Diarrhoea
PiperacillinNosocomial Pneumonia
Anti-pseudomonas
Piperacillin:
Most Potent
+TazobactamCarbenicillin
Ticarcillin
Cephalosporin
Cephazolin1
stGeneration
Bacteriocidal
Bind to PBP
X-transpeptidase
Inhibit Petidoglycan
Synthesis on Bact.
Cell Wall
Klebsiella sp, Surgical ChemoprophylaxisAllergic
Hemolytic Anemia
Thrombocytopenia
Neutropenia
-Liver Function
Opp. Infection
(AAD)
Cephalexin
Cefoxitin2
ndGeneration Diverticulitis, Pneumonia (+CAP)
Cefaclor
Cefixime3rdGeneration Gonorrhoea Cross BBB
Ceftriaxone
Cefepime4
thGeneration Nosocomial Pneumonia (Pseudomonas)
Cefpirome
Monobactam Aztreonam Gramve, Penicillin allergic patients Nausea + Vomiting Non-Toxic
CarbapenemsImipenem Wide Range Gram +ve Gramve
(except Chlamydia)
Allergic
CNS Effects
Highly Resistance to
-lactamaseMeropenem
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Beta-Lactamase
Inhibitors
Clavulanic AcidInactivate
Beta-Lactamase
Protect Antibiotics
(from destroyed by B-Lactamase)Combined with PenicillinSulbactam
Tazobactam
OthersVancomycin MRSA, Pseudomembranous Colitis
+Gentamycin
+Metronidazole
Bacitracin Strep. Pyogenes, Topical Antibiotics
BRO
AD-SPECTRUM
ChloramphenicolBind to50S
X-Transpeptidation
Bacterial Meningitis, Staph Brain Abscess
Enteric Fever
Intra-Abd Abscess (B fragillis):
+Metronidazole
Tetracycline Resistance:
Cholera, Rickettsia
GI Disturbance
Opp. Infection
Bone Marrow
Aplastic Anemia
Gray-Baby Syndrome
Cross Placental + BBB
Highly Toxic
Inactivated by Hepatic
Glucoronyltransferase
Bacteriostatic + cidal
Tetracycline
Tetracycline
Short Acting Bind to 30S
Inhibit the
attachment of tRNA
X-transcription
Rickettsia, Psittacosis, Chlamydia
Brucellosis, CholeraGI Disturbance
Super-Infection
Hepatic, Renal Toxicity
Photosensitivity
Vestibular Toxicity
Impaired by Food+
(Ca, Dairy, Iron, Al)
Cross Placenta
CI: Pregnancy
Chlortetracycline
OxytetracyclineDemoclocycline Intermediate Lyme, Acne, Bronchitis + SIADH
DoxycyclineLong Acting
Psittacosis, Syphilis, Chlamydia + Malaria
Chemoprophylaxis : AnthraxMinocycline
Co-trimoxazole
Trimethoprim 1Ind: Bacteristatic
Comb: Bactericide
HIV:prophylaxis for P. carinii
Bact:Travelers Diarrhoea, UTI
Protozoa: Isosporiasis, Toxoplasmosis
Nausea + Vomitting
Skin Rash
Stevens-Johnson
CI: PregnancySulfamethoxazol
e5