Boards Pharmacology

What are NRTIs and how do they work?

"-dine" suffix (feast) nucleoside reverse transcriptase inhibitors that incorporate into growing viral DNA strands (nucleoside-shaped mace) but lack a hydroxyl at the 3' end, so no phosphodiesterase bond or chain continuation (broken mace piece) inhibit 3' to 5' phosphodiester bond formation (3 and 5 in reverse transcripto book)

MOA: SGLT2 inhibitors

"-flozin" suffix - canagliflozin, dapagliflozin (flossing guy) inhibits sodium glucose cotransporter 2, causing glucosuria

MOA and uses: digoxin

(DJ foxglove) digoxin inhibits Na/K ATPase (knocked over banana vending machine). -> increased intracellular Ca (calci-yum coming in back) and sodium (sodium peanuts) that increases contractility (jacked arm). also stimulates vagus nerve (Vegas sign) to decrease HR and treat arrhythmias (record)

MOA: sildenafil, tadalafil

(FILL pit) PDE5 inhibitors (don't phoster disinterest) that increase cGMP (grump)

MOA: taxanes ("-taxel)

(Tarzan) enhance microtubule production and prevent their degradation, impeding mitosis (monkey stabilizing vine)

MOA and uses: alemtuzumab

(alms) is a monoclonal antitumor antibody that binds CD52 on T and B cells (grabbing archers and knights) to deplete them for chronic lymphocytic leukemia (torn tapestry with archers and knights)

Uses: interferon alpha

(alpha game) hepatitis B and C (hippos) malignant melanoma (dark ghost) hairy cell leukemia (hairy creature) Kaposi sarcoma from HHV8 (posies) condyloma accuminata from HPV (accumulated tokens) renal cell carcinoma (crab toy in kidney machine)

Uses: amifostine

(amethyst sign) to prevent cisplatin nephrotoxicities scavenges free radicals produced by cisplatin in the kidney (free, rare)

MOA: apixaban, rivaroxaban

(banned foxes) bind Xa directly (hunter grabbing fox) and inhibit it oral drug (guy with open mouth)

Uses: interferon beta

(beta game) multiple sclerosis (time and space)

MOA: bevacizumab

(beverage lady) is a monoclonal antitumor antibody that binds VEGF (vegetables) to inhibit growth of blood vessels (chopped red veggies)

Specific uses: tobramycin

(cobra master) similar to gentamicin of G- enterobacter, serratia, klebsiella systemic G- bacteremia Pseudomonas (mona Lisa)

MOA: rutiximab

(coronation ritual) is a chimeric (chimera sigil) antitumor monoclonal antibody that depleted B cells (pulling down B cell archer) by binding CD20 on B cells (grabbing XX straps)

Uses: cyclosporine

(cycle sport) transplant anti-rejection, immunosuppression (cane)

MOA and uses: actinomycin D

(doll artifact) antitumor antibiotic that intercalates into DNA/RNA to prevent synthesis (artifacts in seaweed) for pediatric cancers (child doll)

MOA: cetuximab

(elephant tusks) is a monoclonal antitumor antibody that binds the epidermal growth factor receptor (giraffe), which is a tyrosine kinase (tire swing)

MOA: hydroxyzine, meclizine, promethazine

(fairy cuisine) 1st generation antihistamines to treat allergies (fairy dander)

Uses: interferon gamma

(gamma game) chronic granulomatous disease (destroyed granulomatous asteroid)

MOA: argatroban, dabigatran

(gator) direct thrombin inhibitors

MOA: gemfibrozil, bezafibrate, fenofibrate

(gem fibrizol jellyfish) vibrates activate PPAR alpha (PPAR) to upregulate lipoprotein lipase, which cleaves free fatty acids from VLDL

MOA and uses: hydralazine

(hydro boat) increases cGMP to cause smooth muscle relaxation. Dilates arterioles (red hose) and reduces after load. Use for HTN, HTN in pregnancy (preggo lady getting on hydro boat)

Specific uses: gentamicin

(judo master) G- enterobacter, serratia, klebsiella systemic G- bacteremia (red shogun) Pseudomonas (mona lisa)

Function of lipoprotein lipase?

(lipo port lighthouse) LPL hydrolyze TGs in chylomicrons and VLDLs, leading to free fatty acid release (trident passengers getting off at lighthouse)

MOA and uses: nitrosoureas ("-mustine")

(mustang centaurs) cytotoxic alkylating agents highly lipophilic, so cross the BBB and treat brain cancers (brain tree)

MOA and uses: nimodipine

(need mo' dippin' with berry aneurysm ice cream) L type calcium channel blocker used in subarachnoid hemorrhage

Specific uses: neomycin

(ninjitsu master) bowel prep before colorectal surgery (scalpel near colon tunnel) remains active in GI tract

MOA and uses: fenoldopam

(old lady Pam) treats HTN emergency. selective D1 agonist (holding onto one rope) that dilates arteries (dilated red sleeve), coronary arteries (red crown), and renal arteries (kidney on boat)

Specific uses: paramycin

(pair of mice) is a luminal agent against parasites like E histolytica remains active in GI tract

When would we give HSV prophylaxis?

(prepare) immunocompromised states (cane) pregnant women with recurrent genital herpes (preggo)

MOA: regular insulin, NPH insulin

(rest now) are intermediate acting (delayed peak) insulin analogs given IV (ivy plant)

MOA and uses: sunitinib, sorafenib

(rising sun, soaring eagle) tyrosine kinase inhibitors that block the vascular endothelial growth factor receptor for cancers with VEGF over expression, like renal cell carcinoma (crab buckle on flank)

MOA and uses: anthracyclines ("-rubicin")

(rubies) make free radicals (bubbles) and intercalate into DNA/RNA to block synthesis (rubies in seaweed) hematologic/solid cancers (crab)

Specific uses: streptomycin

(sai master) tularemia from F tularensis (bunny ears) plague from Yersinia (squirrels with fleas)

MOA: etoposide, teniposide

(side of tower) topoisomerase II inhibitors (grabbing two unwinding braids) - topoisomerase relieve DNA supercoiling in synthesis prevent relegation of the double-stranded break induced by topoisomerase II

Adverse effects: lamivudine

(sir Lancelot) mitochondrial toxicity (mito table) lactic acidosis (spilled milk) peripheral neuropathy (stocking and gloves)

MOA and uses: sirolimus (rapamycin)

(sirloin, wrapper) immunosuppression (cane), anti-rejection transplant (especially kidneys because it is not nephrotoxic) binds FK binding protein that inhibits mTOR (fork stuck in broken motor), so no B or T cells can proliferate

Use of streptokinase in clotting

(strepto-connectors) fibrinolytic made by streptococci can cause allergic reaction (kid choking)

MOA and uses: tacrolimus

(taco lime) immunosuppression (cane), anti-rejection for transplant binds FK binding protein (lime binding fork) to inhibit calcineurin (cowl neck) this down regulates IL-2 (interlocking shoes), preventing proliferation of lymphocytes

MOA and uses: trastuzumab

(tapestry weaver) is a monoclonal antitumor antibody that binds epidermal growth factor receptor 2 (her 2 babies) HER2 is a tyrosine kinase (babies in tire swing) for HER2 positive breast cancer (crab bra)

MOA: topotecan, irinotecan

(toucan) topoisomerase I inhibitors (single ponytail strand)

MOA: alteplase, reteplase

(toy play set) that aids in conversion of plasminogen (plasma general) to plasmin, which cleaves thrombin and fibrin clots (shooting fibrin sticks)

MOA and uses: nesiritide

(turn the tide) synthetic BNP that increases cGMP (bump the grump). dilates arterioles and veins (dilated red and blue) and causes naturesis (draining water/peanuts)

MOA and uses: vemurafenib

(venom) small tyrosine kinase inhibitor that blocks B-raf kinase (B franklin) for V600E BRAF positive malignant melanoma (ink spots)

Specific uses: azithromycin

-mycoplasma PNA (mycoplasma mic) -Bortadella pertusis treatment and prophylaxis (PPX pertussi board) -Bartonella henselae (Bart the leopard/cat scratch fever) -with atovaquone for Babesia (babe the vampire) -to prevent MAC infections in HIV/AIDS with a CD4 under 50 (50 calendar under bird) -urethritis/cervicitis from chlamydia (art history A-Z near clam lady)

How long does it take for SNRIs/SSRIs to work?

1-2 months (not for acute treatment)

How do you determine the potency of an inhaled anesthetic?

1/minimum alveolar concentration (inverted bowl of mac and cheese)

Adrenergic receptors are coupled to which G-protein class?

A1 - Q A2 - I B1 - S B2 - S B3 - S (QISS sign in front)

MOA and uses: phentolamine

A1 and A2 antagonist (phantom with burnt out flames). Used for cocaine intoxication (cocoa) and to patients on MAOi who eat cheese for severe HTN (cheese plate)

MOA and uses: phenoxybenzamine

A1 and A2 antagonist (pheonix tattoo with burnt out flames) for pheochromocytoma (frozen colorful dessert)

MOA and uses: prazosin, terazosin, doxazosin, tamsulosin

A1 antagonists (-osin suffix represented by opera singer) for urinary sx of BPH (banister hitting prostate), HTN (dilated sleeves), and PTSD for prazosin (dog tags)

Sympathetic receptor on internal urethral sphincter?

A1 receptor via hypogastric nerve. Acts to contract sphincter. Alpha antagonists relax the sphincter, and are thus used in BPH (huge obstruction to peeing, want to help them pee)

MOA and uses: clonidine

A2 agonist (two claw hand) that causes CNS depression (crossed out sympathy). Used in HTN/HTN urgency (high pressure pipes), ADHD (distracting mirror), Tourette's syndrome (marionette). Can cause hypotension, respiratory depression, bradycardia

MOA and uses: alpha-methyldopa

A2 agonist for HTN (high pressure pipes) in pregnancy (preggo lady). Can cause drug-induced lupus (wolf)

MOA and uses: tizanidine

A2 agonist for muscle relaxant (relaxing chair). can cause hypotension

MOA and uses: mirtazapine

A2 antagonist (burnt out flames near mirth and misery structure). enhances serotonin release for depression (happy/sad face),

Treatment of HTN with DM

ACEi/ARBs first line because they protect against diabetic nephropathy (ace table with candy jar), also Ca channel blockers, thiazides

MOA and uses: physostigmine

ACHEi for anticholinergic toxicity (too much atropine). Crosses BBB

MOA: ticlopidine

ADP receptor inhibitor (Ty Cobb by grill)

What is released from platelet degranulation?

ADP, 5HT, and TXA2 - stimulate platelet aggregation (aggregated players)

Uses: class III antiarrhythmics

AF/flutter to maintain NSR (TV signal with remote control), ventricular tachycardias (both halves of heart lit)

B1 selective blockers

Acebutolol, Betaxolol, Esmolol, Atenolol, Metoprolol (A-BEAM on B1 bugle)

What is the post-ganglionic neurotransmitter and receptor for smooth muscle, glands, and cardiac muscle in the PARASYMPATHETIC nervous system?

Acetylcholine is released onto muscarinic receptors

What is the post-ganglionic neurotransmitter and receptor for sweat glands in the sympathetic nervous system?

Acetylcholine is released onto muscarinic receptors

What is the pre-ganglionic neurotransmitter and receptor for every part of the autonomic nervous system?

Acetylcholine is released onto nicotinic receptors

What is the neurotransmitter and receptor for somatic control at the neuromuscular junction?

Acetylcholine is released onto nicotinic receptors in skeletal muscle

MOA and uses: edrophonium

Acetylcholinesterase inhibitor for diagnosing myasthenia gravis (if it makes symptoms disappear, person has myasthenia gravis). Does not cross BBB

MOA and uses: neostigmine

Acetylcholinesterase inhibitor for reversal of NMJ blockade, urinary retention

MOA and uses: donepezil, rivastigmine, galantamine

Acetylcholinesterase inhibitors for Alzheimer's disease

How do you treat toxicity with weak bases?

Acidify the urine with ammonium chloride

Specific uses: fidaxomicin

C diff colitis (fiddle with colon tunnel)

Sulfonylureas and meglitinides release *blank* in addition to endogenous insulin

C-peptide (Candy wrapper)

GLP-1 agonists and DPP-4 inhibitors release *blank* in addition to endogenous insulin

C-peptide (Candy wrappers)

What is released with endogenous insulin?

C-peptide (Candy wrappers)

What cells does HIV infect?

CD4 T cells, macrophages, dendritic cells

Adverse effects: opiates

CNS depression (CNS hat) respiratory depression (deflated lungs) miosis (constricted hoodie) constipation (plunger) biliary colic (biliary tree) tolerance development (all are welcome) except for miosis and constipation hyperalgesia (screaming in pain)

Side effects: class 1B antiarrhythmics

CNS stimulation or depression (brain trucker hat)

Parasympathetic nerves come from where?

CNs 3, 7, 9, and 10 from cranium, and pelvic splanchnic nerves. Long pre-ganglionic, short post-ganglionic fibers.

*blank* converts dopamine to 3-MT in the CNS

COMT (interCOM guard in the vault)

*blank* converts levodopa to 3-O-methyldopa in the periphery

COMT (interCOM guard shooting L crank)

What synthesizes thromboxane A2?

COX1 (COX1 coach) makes TXA2 (batter's A2 box), which causes vasoconstriction (twisting red hat)

When are COX1 and COX 2 expressed?

COX1 - all the time (COX1 coach) COX2 - only in times of inflammation (assistant coach)

How are anti epileptic drugs metabolized?

CYP450 system (CYP450 bumper on boat)

How is warfarin metabolized?

CYP450 system (CYP450 bumper)

What bacteria are aminoPCNs and extended-spectrum PCNs active against?

G+ organisms (purple coccoid stations) some G- activity (red color) broad spectrum antibiotics (prism) strep pharyngitis from strep pyogenes (red bandana) PNA (lung spots on shirt) Haemophilus influenzae (H winged ship) GI/GU G- rods (intestinal tubes)

Uses: linezolid

G+ staph, strep, enterococcus (purple jewels) MRSA (no mercy) nosocomial MRSA infections (coughing nurse) vancomycin resistant enterococcus (resisting van and purple drums)

Uses: clindamycin

G+ staph/strep (purple dumbbells) strep pyogenes (pie) soft tissue infections (red gloves) MRSA (no mercy/merciless dark lord) anaerobic bacteria (gas mask) - Bacteriodes lung abscesses (lung spots) oral infections/aspiration PNA from Bacteroides (choking on bacteraid) C perfringes (perforated pants) acne vulgaris (snow-capped mountains) with gentamicin, an aminoglycoside, (judo girl with sai), polymicrobial female GU infections (uterus) bacterial vaginosis from Gardnerella (venus fly trap)

What bacteria do anti-staph PCNs work against?

G+ staphylococci (purple coccoid ships) empiric treatment for skin/soft tissue infections (folliculitis) caused by MSSA (red hump on ox) staph endocarditis from MSSA (tricuspid pyramids) staphylococcal osteomyelitis from MSSA (fishbones)

What is a muscarinic ACh receptor?

G-protein coupled receptors acting through second messengers

Uses: GH therapy

GH deficiency, short stature (short kid) Prader-Willi syndrome (Padre Willi) Turner's syndrome (cartwheeling girl)

How does growth hormone affect IGF-1?

GH stimulates liver to produce it (INSIDE mat growing from liver rock)

Adverse effects: valproate

GI distress (nauseated guy in cab) increased appetite/weight gain (fat) tremor (shaking bat) fatal hepatotoxicity (liver spot) pancreatitis (squeezed pancreas sponge) teratogen (tarantula) neural tube defects if taken in pregnancy (tubes)

Adverse effects: mycophenolate motefil

GI distress (nauseated hunchback) immunosuppression (cane)

Adverse effects: ethosuximide

GI distress (punched in stomach) fatigue (sleeping student)

Adverse effects: levodopa

GI distress from peripheral dopamine conversion (nauseated victim) cardiac arrhythmias (arrhythmia rope) orthostatic hypotension (passed out) neuropsychiatric sx - anxiety, insomnia d/t excess dopamine in the CNS (disturbed hostage) wearing off reaction w/ akinesia/dyskinesia at end of each dose (end of rope wearing off) response fluctuations (guy c/o too long at watch) on/off phenomena (on and off lights) therapeutic window narrows as Parkinson's continues w/ unpredictable response to therapy dyskinesia (shaking tongue)

Adverse effects: carbapenems

GI effects (diarrhea puddle) skin rash (red spots) lowers seizure threshold (shaking robot)

Where are mu-opioid receptors located?

GI tract (GI table) to delay stool transit, so opioids can be used to stop diarrhea

Adverse effects: terbinafine

GI upset (mud puddle) hepatotoxicity (liver spot)

Adverse effects: alpha-glucosidase inhibitors

GI upset d/t undigested carbohydrates (leaky bathroom puddle)

Insulin inserts *blank* onto the membrane of peripheral tissues

GLUT4 (4 on open door)

How do loop diuretics affect prostaglandins?

Loop diuretics enhance COX2 expression, which synthesizes prostaglandins (pro-slugger bat) that dilate the afferent arteriole. Thus, NSAIDs that decrease prostaglandin synthesis inhibit loop diuretic action (fire extinguisher inhibiting pro-slugger)

*blank* treats left sided endocarditis caused by strep viridans or strep bovis

PCN G (G shaped hair near emperor viridans)

*blank* is used for intrapartum prophylaxis against strep B

PCN G (a galactic baby)

Which PCN is acid stable?

PCN V (V shaped ship with acid nebula)

MOA: alirocumab, evolocumab

PCSK9 inhibitors (steam-octopus man) that inhibit the degradation of LDL receptors, thus promoting receptor recycling (9 crabs inhibiting load L workers)

MOA: methylxanthines

PDE inhibitors (don't phoster disinterest) that increase cAMP (camping world) given orally (open mouth)

MOA and uses: milrinone

PDE3 inhibitor (don't foster disinterest), inhibits cAMP breakdown and thus more Ca/inotropy (CAMPaign with jacked arm), arteriolar dilation (large red ears)

What gene codes for production of HIV enzymes?

POL gene

What is the precursor to IMP?

PRPP (pentagon pedestal with 3 P hammers)

How do you monitor warfarin activity?

PT - extrinsic pathway, factor 7 (paratrooper) INR - want it between 2-3 (intercom radio)

What do you have to monitor in heparin use?

PTT (hunter watching PTTTTTTTT), which monitors the intrinsic pathway of coagulation (woodpecker inside tree)

MOA: propylthiouracil, methimazole

PTU (PTU shooting agent) inhibits TPO and 5' deiodinase, so less T4 to T3 conversion methimazole (evil math equations) inhibits TPO

Treatment of HTN in pregnancy

Hydralazine, labetalol, methyldopa, nifedipine

MOA and uses: mecasermin

IGF-1 analog (sermon) that treats severe IGF-1 deficiency

What is the precursor to AMP/GMP?

IMP (gargoyle imp) turns into GMP (grumpy statue) and AMP (gramp statue), both of which are purines (purine hats)

How is PCN G administered?

IV (G shaped hair with ivy plant)

How is vancomycin administered?

IV (ivy plant)

Specific uses: ampicillin

IV administration (Ivy plant) anaerobic infections (gas mask) enterococcus (diplococcus drums), though beta-lactamase producing species are resistant (knocked over amp) meningitis from listeria monocytogenes (set LIST)

What is the preferred treatment for acute treatment of status epilepticus?

IV benzodiazepines (Ben's Diner), then phenytoin for maintenance

Uses: acyclovir

IV for HSV, VZV (ivy plant near Hermes) HSV encephalitis (red winged hat) neonatal HSV (baby Hermes)

Uses: barbiturates

IV for anesthesia (intubated customer) seizures (unplugging jackhammer)

Uses: IV insulin

IV insulin can be used to treat hyperkalemia if given with glucose (ivy plant next to eaten banana) DKA (candy key)

What can be used for treatment resistant seizures?

IV phenobarbital (barber shop)

Uses: beta blockers as antiarrthytmics

IV use (ivy) for supraventricular tachycardia (top half of heart glowing) and preventing rapid ventricular response in AF (rate controlling metronome)

Antigen bind to *blank* on *blank* to cause degranulation and release of inflammatory mediators

IgE, mast cells (IgE gun shooting beehive)

Effect of Km on inhibitors?

Irreversible competitive and noncompetitive have no effect. Reversible competitive increase it

Effect of Vmax on inhibitors?

Irreversible competitive inhibitors and noncompetitive inhibitors decrease Vmax. Reversible competitive has no effect

The GH receptor is associated with?

JAK tyrosine kinase (tire swing)

Uses: MTX

abortifacent (empty uterus bag) ectopic pregnancy (ectopic key chain) molar pregnancy/choriocarcinoma (mole) psoriasis (scaly knee caps) first line treatment for RA - DMARD (bone ligths) immunosuppressive therapy (torn antibody light)

How do herpesviruses confer resistance to acyclovir?

absence of thymidine kinase (closed bag check)

MOA: acarbose, miglitol

acarbose (A-carb wigglers) inhibit alpha-glucosidase, which decreases conversion of disaccharides to absorbable monosaccharides decrease disaccharidase activity at brush border (brush border flags) delay carbohydrate absorption

MOA: acetaminophen

acetaminophen (icy medicine) inhibits COX2 (spraying onto assistant coach) for antipyretic and analgesia

How are aminoglycosides inactivated?

acetylation enzyme (inactivating ninja stars) like E faecium against tobramycin

Effects of GH secreting pituitary adenoma?

acromegaly in adults or gigantism in children (giant)

Adverse effects: griseofulvin

activate CYP450 (chrome bumper)

Adverse effects: rifampin, rifabutin

activate CYP450 (speeding chrome bumper)

MOA: GLP1 agonists

activate glucagon-like peptide 1 (gulping kid) receptor, causing insulin release and increasing satiety

Antidote: aspirin overdose

activated charcoal (charcoal lines) sodium bicarbonate to alkalinize the urine

Adverse effects: rifampin

activates CYP450 (speeding chrome bumper) orange body fluids (orange fluid)

Binding of vWF to GP1B receptors does what?

activates platelets (kids holding 1B bat near home plate)

What causes migraine pain?

activation of trigeminal nerve afferents in the meninges (three gems on hat) causes release of vasoactive peptides onto meningeal vessels, which causes vasodilation and protein extravasation (dilated sleeves)

MOA: isoniazid

acts on mycobacterial cell wall by inhibiting mycolic acid production - a necessary component for TB (cowboy shot off wall) activated by catalase peroxidase - Kat G (tiger cat)

Treatment of acute gout

acute gout (guy tripping over yarn) is treated by NSAIDs (fire extinguisher), glucocorticoids (moon face), and colchicine (choir singing)

MOA: adenosine as antiarrythmic

adenosine (swing dancers) is a purine nucleotide (purine gate) that activates inhibitory A1 receptors (A1 sign) on the myocardium and AV nodes. this suppresses Ca influx (falling calci-yum) and causes potassium efflux (banana flying away) to decrease AV node conduction (note shaped floor)

Gs and Gi receptors activate what cascade?

adenylate cyclase (though Gi inhibits it) -> cAMP. People who are too (2) MAD inhibit themselves (M2, A2, D2)

Adverse effects: SSRIs

hyponatremia via SIADH (ADH jug) sexual dysfunction (rejected advances) weight gain (fat belly) drowsiness (sleeping on the job) serotonin syndrome (smiley face post its) withdrawal can cause flu-like syndrome (out with the flu)

Adverse effects: sacubitril

hypotension, hyperkalemia, cough. Can't use with ACEi due to angioedema

Adverse effects: amphotericin

hypotension/headache, fever, chills immediately with infusion (fainting, holding head, red frog shaking) thrombophlebitis (blue leg lines) RTA type I (1 acid tube) - associated with hypokalemia (fallen banana peel) hypomagnesemia (falling magnets) anemia from decreased EPO from damaged kidneys - prevent kidney damage with IV normal saline volume expansion (cracked kidney vile, emergency saline wash)

Adverse effects: radioactive iodine`

hypothyroid (small untied bowtie) exacerbation of hyperthyroid (guy sweating) exacerbation of Grave's exophthalmos (wearing bulging goggles)

Adverse effect: antifungal "-azole" drugs

inhibit CYP450 (broken chrome bumper) - voriconazole inhibits mammalian CYP450 (car-crushing vortex) voriconazole - blurry flashes of light (light flashes in vortex), changes in color vision (sepia tone)

MOA: thiazide diuretics

inhibit NaCl reabsorption by blocking the NaCl transporter on apical membrane (thigh diver knocking salt into pool). also increase calcium reabsorption (kid in yellow slide throwing ice cream overboard)

MOA: echinocandins ("-fungins")

inhibit synthesis of beta 1,3 glucan in fungal cell wall (crumbling carb wall)

MOA: anti fungal "-azole" drugs

inhibit the synthesis of ergosterol (crushed wall builder) by inhibiting conversion of lanosterol to ergosterol (lane closed)

MOA: ketonazole

inhibits 17,20 desmolase, the first step in steroid hormone synthesis from cholesterol (key in kidney) inhibits androgen and estrogen production (male and female symbols)

Endocrine effects of spironolactone

inhibits 17alpha hydroxylase, needed for testosterone synthesis (17alpha hydroxylase) treating excess androgens in PCOS (bubbling ovaries and beard) gynecomastia (plates over boobs) impotence (saggy churro)

Adverse effects: cimetidine

inhibits CYP450 (dented chrome bumper) gynecomastia (plates on boobs) impotence (droopy honey wand) hyperprolactinemia (elevated milk)

MOA: rifampin

inhibits DNA-dependent RNAP (shot RNA track switch)

MOA: mycophenolate mofetil

inhibits IMP dehydrogenase, causing decreased GMP synthesis (hunchback knocking over grump statue) and decreased lymphocyte proliferation

MOA: acetazolamide

inhibits carbonic anhydrase and prevents reabsorption of bicarbonate and sodium (battery acid breaking car battery) causing urine to become more alkaline

MOA: terbinafine

inhibits fungal enzyme squalene epoxidase (squealing pigs)

Glucocorticoid effects on NFKB?

inhibits it (inhibited N-Flame Krossbow)

Glucocorticoid effects on phospholipase A2?

inhibits it - PLA2 is the first step in the inflammatory mediator pathway (inhibited cataPuLt A2) inhibits production of arachidonic acid (AA on catapult)

MOA: niacin for cholesterol

inhibits lipolysis in adipose tissue reduces hepatic VLDL synthesis (Loch niacin monster eating VLDL ship)

MOA: cocaine

inhibits norepinephrine (NET) and dopamine transporters, so more catecholamines in synapse (cocoa guy). Adverse: agitation, vasoconstriction (DO NOT GIVE BETA BLOCKERS), HTN, myocardial ischemia, angina (anvil, red crown)

Effect of allopurinol on purines

inhibits purine analog (azathioprine, 6-mercaptopurine) breakdown (nun with lots of purine beads) and increases risk of toxicity

MOA: hydroxyurea

inhibits ribonucleotide reductase (hydro rock area) and blocks thymidine synthesis

MOA: ketamine

inhibits the NMDA receptor complex (hitched nomadic camel)

MOA: loop diuretics

inhibits the Na/K/Cl transporter, which usually reabsorbs the ions and thus water (furious kid keeping food inside roller coaster)

MOA and uses: ranolazine

inhibits the late phase of inward sodium current, reducing diastolic wall tension and oxygen consumption. no effect on HR or BP. for angina refractory to other therapy

Glucocorticoid effects on T and B cells?

inhibits their activation (inhibited T cell knight and antibody archer) decreases their number (falling T knight and archer) most effective at blocking CD4 cells (squire lowest)

Glucocorticoid effects on leukotrienes?

inhibits them (inhibited lacrosse stick)

Glucocorticoid effects on prostaglandins?

inhibits them (inhibited pro-slugger bat)

Effect of aspirin at low doses with kidney stones

inhibits uric acid excretion

MOA: daptomycin

inserts a lipid tail into the cell membrane to depolarize it and cause cell death (taser)

Uses: melatonin and ramelteon

insomnia, ramelteon is safe in the elderly (sleeping old man)

Insulin effects on potassium?

insulin activates the Na/K ATPase, which causes hypokalemia by driving K into cells

Adverse effects: glucocorticoids

insulin resistance (blocked INSIDE mat) chronic use of exogenous corticosteroids can cause adrenal hypotrophy (shriveled adrenal hat) Cushing syndrome from chronic exogenous use - fat redistribution, osteoporosis, skin thinning (cushion) immunosuppression (cane) reactivation of latent infections like TB (pulmonary cacti)

MOA: raltegravir

integrase inhibitor (key deflector)

Adverse effects: acyclovir

interstitial nephritis/nephropathy (kidney sharps) - prevented by hydration (guy drinking) confusion/hallucinations/vertigo (holding head)

MOA: lactulose for hepatic encephalopathy

intestinal bacteria metabolize lactulose into acidic compounds (relaxulose feeding fish), which decreases the pH of the intestinal lumen, causing ammonia to be trapped as ammonium (NH4+) and excreted

Uses: dexrazoxane

iron chelator (on deck with razor) that prevents anthracycline cardio toxicity (chelator heart sac)

MOA: ADP receptor inhibitors

irreversibly block ADP P2Y12 receptor, which prevents platelet aggregation (grill man catching baseball before youth baseball sign)

Uses: fibrinolytics

ischemic stroke (black paint) if given within 3-4.5 hours of symptom onset (3-4:30 sign) DVT/PE (bird nest in pulmonary tree) early MI (broken heart string)

Specific uses: itraconazole

itraconazole (good witch) can treat systemic infections with dimorphic fungi (butterflies) onchomycosis/dermatophytosis (tarnished slipper toes)

Treatment of onchomycosis

itraconazole, terbinafine (chewing nails)

Uses: ketamine

ketamine (snaKE TAMINg) is used for induction of anesthesia (introducing)

Specific uses: ketonazole

ketonazole (key) treats dermatophytosis (tin man) hypercortisolism (moon face)

Treatment of HTN emergency

labetalol, clevidipine, fenoldopam, nicardipine, nitroprusside

Adverse effects: metformin

lactic acidosis (spilled sour milk), risk is increased in renal insufficiency (spilled milk on cracked kidney tray) GI effects - N/V/D (nauseated girl) modest weight reduction (skinny kid)

Additional therapies for absence seizures?

lamotrigine (llama) valproate (farm festiVAL)

MOA: lamotrigine

lamotrigine (llama) increases Na channel inactivation (inactivated peanut basket)

MOA and uses: latanoprost, travoprost

latanoprost (LA sandals) and travoprost (world traveler's boots) are PGF2 alpha (Footwear) analogs that can be used to treat glaucoma by reducing aqueous humor production (leaking eyeballs)

CP: leprosy

leonine facies (lion bandana)

Benefits of nonbenzodiazepines over benzodiazepines

less likely to cause tolerance (no tolerance) less likely to cause withdrawal/dependence (break bad habits)

Function of leukotrienes

leukotrienes LTB4, C4, D4, E4 needed for inflammation (lax players) LTB4 is a chemoattractant for neutrophils (B4 player attracting first responders) C4, D4, E4 increase vascular permeability and bronchoconstriction (constricted lax bronchi)

MOA: levetiracetam

levetiracetam's (elevator) MOA is unknown

How does levodopa get into the CNS?

levodopa (L wheel) crosses the BBB (inside bank vault) and is converted to dopamine via DOPA decarboxylase (rope in vault) in the CNS and in the PNS (rope outside vault)

Treatment of hypothyroidism?

levothyroxine (T4 time bomb) overdose can cause hyperthyroid

MOA: linezolid

linezolid (police line) is a bacteriostatic (paper jam) antibiotic that binds the 50S ribosomal subunit, inhibiting initiation complex formation (ribosome typewriter)

Synthesis of leukotrienes

lipoxygenase (lax coach) converts arachidonic acid (AA) into leukotrienes

Volatile anesthetics, such as isoflurane, halothane, are *blank* at room temperature

liquid (air tank in pool) all are also fluorinated (flower in pool)

Nascent HDL is secreted by?

liver and intestine

Adverse effects: NNRTIs

liver failure w/i 6 weeks of therapy initiation (yellow deer with liver spot) insomnia/nightmares (dark moon) dizziness/headache/psychosis (grabbing head) teratogen (tarantula) varying CYP450 effects (chrome bumper) SJS/TEN (sloughed off mask)

MOA and uses: buprenorphine

long acting (long tapering flag) partial mu agonist to attenuate withdrawal symptoms (blueprint)

Uses: benzodiazepines

long acting IV for alcohol withdrawal (hangover special) seizures/status epilepticus (ivy plant near seizing guy) general anesthesia (intubated customer) conscious sedation for minor procedures (lite) insomnia (sleeping customer) parasomnias in children (crying kid in pajamas) spasm caused by UMN disorders (tremulous hand) GAD (anxious customer) panic disorder (the scream painting)

MOA and uses: methadone

long acting opioid used to attenuate withdrawal symptoms (done timer) long half life (long tapering flag)

Pharmacodynamics: barbiturates

long duration of action (long tapering flag) thiopental has a rapid onset and short DOA (the ol' quick shave). Plasma levels decrease rapidly d/t redistribution to skeletal muscle and adipose

MOA and uses: sacubitril

neprilysin inhibitor. Prevents degradation of natriuretic peptides, angiotensin II, and substance P to cause vasodilation and decreased ECF volume. used with ARBs to treat heart failure with reduced EF

Adverse effects: methylxanthine

nervousness/tremor (shaking kid) tachycardia (holding up heart watch) metabolized by CYP450 system (CYP450 bumper)

Side effects: amiodarone

neurologic effects (skull hat) gray corneal micro deposits (gray sunglasses) hyper or hypothyroidism (big and small bowties) pulmonary fibrosis (fibrotic lung embroidery) heart block (heart shield) can induce heart failure (floppy balloons) hepatotoxicity (liver spot) gray/blue skin discoloration (blue suits) photodermatitis (flash photo) CYP450 inhibitor (broken chrome bumper)

Adverse effects: taxanes

neurotoxicity (stole Christine's glove) alopecia (bald monkey)

Adverse effects: nitrosoureas

neurotoxicity - dizziness, ataxia (dizzy centaur)

What is neonatal abstinence syndrome?

newborn suffering from opioid withdrawal symptoms are diarrhea, sweating, sneezing, crying (irritable baby)

Effect on cholesterol from niacin?

niacin is best at raising HDL (loch niacin monster raising HDL ship) decreases TGs (falling tridents) decreases VLDL (monster eating VLDL) decreases LDL by reducing VLDL (tail sinking LDL ship)

MOA: nitrates

nitrates (dynamite) vasodilate (dilated blue and red sleeves) by increasing cGMP (grump) and NO (NO steam) in vascular smooth muscle primarily a ventilator decreases preload by pooling more blood in veins (preload down arrow)

Are beta lactamases effective against cephalosporins?

no (beta guard blast deflecting)

Are beta-lactamases effective against carbapenems?

no (beta guard can't climb fence)

Are beta-lactamases effective against monobactams?

no (beta guard running away)

Are beta-lactamases effective against vancomycin?

no (beta shield crossed out)

Can daptomycin treat PNA?

no (ineffective cop against rusty chest plate)

Do class 1 antiarrythmic drugs affect SA/AV node conduction?

no, only affect fast sodium channels (sodium channels in myocytes, not pacemaker cells)

What are nevirapine, efavirenz, and delavirdine?

non-nucleoside reverse transcriptase inhibitors (three girls outside knights of the round table) not phosphorylated by cellular enzymes (fleeing P)

How does amphotericin toxicity develop?

non-selective binding to human cholesterol (frog jumping to cholesterol tie)

What is the post-ganglionic neurotransmitter and receptor for smooth muscle, glands, and cardiac muscle in the SYMPATHETIC nervous system?

norepinephrine is released onto alpha 1, alpha 2, and beta 1 receptors

Side effects: acetazolamide

normal anion gap metabolic acidosis (close that gap!), hypokalemia (empty banana peel), type II renal tubular acidosis (two tubes of acid on car), calcium phosphate stone formation (rocks), possible sulfa allergic reaction (sulfur eggs)

Symptoms of adrenal insufficiency?

not enough corticosteroids (cracked moon), so circulatory shock/death (fainted guy) hypoglycemia (fallen candy)

Where does alcohol bind in the nervous system?

an alternate allosteric site from benzodiazepines (drinker on cab A)

Where do barbiturates bind in the nervous system?

an alternate allosteric site from benzodiazepines on the GABA-A receptor (barber on cab A)

Endocrine effects of GH?

anabolic effects in muscle (striated muscle bean) catabolic effects in adipose tissue (falling donut jar)

Effects of insulin?

anabolic hormone causes increased hepatic glycogen stores (full liver candy jar) increased glycogen (glycogen glazed ham) increased triglyceride storage (jar full of donuts)

Uses: metronidazole

anaerobic (gas mask) bacteria in GI (guy stabbed in stomach) Entameba histolytica (do not enter) Giardia (colonel Giardia with protozoan shield) vaginitis/cervicitis from Trichomonas (Mr. Trichomonas with cervix hat) - treat patient and partner (Mrs. Trichomonas) BV from gardnerella (venus fly trap) substitute for amoxicillin in H pylori infection if pt allergic to PCN (helicopter) C diff (chocolate fountain)

MOA: cholestyramine, colestipol, colesevelam

bile acid resins that prevent intestinal absorption of bile acids (cholesterol-lobster), so the liver must use up cholesterol stores to make more (empty gold stores)

MOA: platinum analogs

bind DNA and cause intrastrand and interstrand cross links (platinum cross linked necklace)

MOA: benzodiazepines

bind an allosteric site on GABA-A receptor (cab A) to potentiate GABA activity in the CNS (CNS light) by increasing frequency of ion channel opening (open more frequently) GABA-A is a chloride channel (chlo-rider)

MOA: barbiturates

bind an allosteric site on the GABA-A receptor, which is a chloride channel (chlo-rider) that potentiates GABA transmission in the CNS (CNS light) barbiturates increase the duration of opening on the GABA receptor (open longer hours)

MOA: tetracyclines

bind reversibly to the 30S ribosomal subunit to inhibit translation (30 sec timer near ribosome typewriter) bacteriostatic (paper jam)

MOA: eptifibatide, triofiban

bind the GP IIB/IIIA receptor on activated platelets, preventing aggregation (tied game near 2B 3A seats)

MOA: miraviroc

binds CCR5 to prevent viral entry (CCR5 mare blocking entry)

Function of platelet receptor GP IIB/IIIA?

binds fibrinogen to promote platelet aggregation

MOA: enfuvirtide

binds gp41, inhibiting viral entry (deflector 41 shield)

Function of adenosine diphosphate in clotting?

binds the P2-Y12 receptor on platelets causing aggregation (aggregate da players, youth baseball 2-12 sign)

MOA: cyclosporine

binds to cyclophilin to inhibit calcineurin (cowl neck inhibited), which prevents IL-2 production (interlocking shoes thrown down) so T and B cells cannot proliferate

Uses: lithium

bipolar disorder - acute mania/maintenance (stabilizing lift chair)

Use of B blockers for heart failure

decrease mortality (angel on cardioselectives metoprolol, carvedilol) and decrease cardiac remodeling (remodeling sign)

Uses: macrolides

decrease respiratory inflammation (candle snuffer), so good for URI in chronic lung diseases broad spectrum (prism) community-acquired PNA from strep PNA, H influenzae atypical PNA from chlamydia and legionella (legion of ships and clam lady) mycobacteria avium complex (MAC mockingbird)

Use of B blocker in SVT

decreased AV conduction velocity (type II anti-arrhythmic) (record player)

Adverse effects: fluoroquinolones

decreased absorption with divalent/trivalent ions (medals) risk of prolonged QT (twisted streamer) N/V/D (nauseated guy) tendon/cartilage damage in elderly (old guy chewing tendon) - also risk with steroid use (moon face) teratogen (tarantula) - damage to cartilage not recommended for children under 10 for cartilage damage (kid eating tendon)

Use of B blocker in hypertrophic cardiomyopathy

decreases HR, so increased filling time

Effect on cholesterol from ezetimibe?

decreases LDL (sinking LDL ship)

Glucocorticoid effects on eosinophils?

decreases their number (falling eo slingshot)

Pathogenesis of malignant hyperthermia?

defect in ryanodine receptors in the sarcoplasmic reticulum (defective Ryan banner) too much calcium release leads to excessive uptake by SR, leading to hyperthermia (flame hat) causes muscle damage (chicken wing)

Second line therapy for SIADH

demeclocycline (bicycle)

MOA and uses: denosumab

denosumab (dinosaur outfit) is a monoclonal antibody against RANKL for treatment of osteoporosis (grabbing crank drill) less bone breakdown

Adverse effects: acetaminophen

depletion of glutathione stores and forms toxic tissue byproducts (goat scared by icy medicine spray) hepatotoxicity (liver spot on goat)

MOA: detemir, glargine

detemir, glargine (don't go) are long-acting insulin analogs that provide a steady background level of insulin (flat peak)

What is heparin-induced thrombocytopenia and which forms of heparin are most likely to develop it?

development of IgG antibodies against heparin-bound platelet factor 4. Ab-heparin-PF4 complex activates platelets, which causes thrombosis and thrombocytopenia (shooting four clay plates, beaver building clot, broken plates) unfractionated heparin is biggest risk

Adverse effects: topotecan, irinotecan

diarrhea (bird droppings)

Adverse effects: ezetimibe

diarrhea (brown water near eel) raised LFTs (LFT flag)

Adverse effects: colchicine

diarrhea (muddy foot prints)

Adverse effects: misoprostol

diarrhea (muddy water)

Adverse effect: 5-FU

diarrhea (stained pants) photosensitivity (flash photo) leucovorin does not protect against effects (falling lucky cat)

Adverse effects: metoclopramide

diarrhea d/t pro-kinetic effects (muddy pipe) drowsiness d/t central D2 blockade (guy sleeping) depression d/2 central D2 blockade (crying coach) extrapyramidal effects d/t D2 blockade (triangle hat) tardive dyskinesia (tongue out) neuroleptic malignant syndrome - fever, rigidity, AMS, rhabdo (now more spicy chicken) hyperprolactinemia d/t D2 block (elevated milk) QT prolongation/Torsades (twisted streamer)

Adverse effects: laxatives

diarrhea, dehydration (muddy water)

Adverse effects: didanosine

didanosine (sir Dan) can cause mitochondrial toxicity (mito table) peripheral neuropathy (stocking and gloves) pancreatitis (squeezed sponge) lactic acidosis (spilled milk)

MOA: digoxin as antiarrythmic

digoxin (DJ foxglove) direct vagal stimulation (Vegas sign) on AV node to slow HR

What drug class treats Raynaud phenomenon?

dihydropyridines (blue fingertips near dippin' station)

MOA and uses: amlodipine, clevidipine, nicardipine, nifedipine

dihydropyridines (dairy) block L-type calcium channels (L handle in ice cream store) in smooth muscle (smooth muscle tiles) to decrease contractility and lower BP (high pressure pipes)

Uses: SMX/TMP

first line treatment for UTI (bladder cup) acute prostatitis (egg down pants) gastroenteritis from G- bacteria (zombie guts) G- GI/GU bacteria (red porta potty) MRSA (no mercy) Nocardia (card dealing cowboy) G+ bacteria (purple fence) pneumocystitis jirovecii PNA (ping pong man in PJs) - give prophylaxis if CD4 <200 (address 200) toxoplasmosis prophylaxis if CD4 <100 (address 100 near toxo cat)

Uses: SSRIs, SNRIs

first line treatment for depression (happy/sad faces) generalized anxiety disorder (anxious worker) panic disorder (the scream) PTSD (dog tags) OCD (obsessively neat) bulimia (binge drawer) social anxiety disorder (shy guy) SNRIs - diabetic neuropathy/chronic pain (frayed wire in diasweeties machine) SNRIs - fibromyalgia (fiber bars)

How is ganicyclovir activated?

first phosphorylated to ganicyclovir monophosphate by viral kinase (worker with P label gun), then to ganicyclovir triphosphate by kinases (3 P's) ganicyclovir triphosphate incorporates into viral DNA, halting synthesis (DNAP light blockade)

MOA: fish oils/omega 3s for cholesterol

fish oils (fish) can decrease triglycerides (trident)

Adverse effects: interferon alpha

flu-like syndrome, fatigue, tinnitus (flushed, tired kid on game) myelosuppression (bone shaped game) drug-induced lupus (wolf toy)

Specific uses: flucanzole

flucanazole (flying monkey) can treat candida infections (Canadian flag) - one dose for vaginal systemic flucanazole for esophageal candidiasis (snow in gutter) cryptococcus (crypt), including meningitis (red mohawk)

MOA: flucytosine

flucytosine (flute) inhibits fungal DNA and RNA synthesis (smeared double helix pattern) because cytosine deaminase turns it into 5-FU (C turned into U)

Adverse effects: thiazolidinediones

fluid retention/edema (baggy pants) can exacerbate heart failure (floppy balloon) increased risk of atypical fractures (fractured bone leg)

Adverse effects: imatinib

fluid retention/peripheral edema (puffy pants on imitating guy)

Antidote for nonbenzodiazepine toxicity

flumenazil (fluffy antagonizing dog)

MOA and uses: flumenazil

flumenazil (fluffy dog) is a competitive antagonist at the benzodiazepine receptor to treat benzodiazepine toxicity (dog blocking cab A)

MOA: fluoroquinolones

fluoroquinolones (flowers) inhibit bacterial topoisomerase (unwinding braid)

Adverse effects: adenosine as antiarrythmic

flushing (flushed guy), hypotension, chest pain due to coronary vasodilation (dilated coronary crown, gripping chest), sense of doom

Adverse effects: vancomycin

flushing (red statue) from mast cells (beehive) thrombophlebitis (blue leg lines) ototoxicity (banging gong, broken ear) nephrotoxicity (falling kidney) drug reaction with eosinophilia and systemic symptoms (pink dress, eo-slingshot granules) MUST monitor vancomycin levels!! (undulating sand dunes)

Adverse effects: iloprost and epoprostenol

flushing, headache, hypotension (fainting lady)

Adverse effects: niacin

flushing/warmth that can be reduced by NSAIDs (fire on monster being put out by NSAID extinguisher) hyperglycemia (candy jar) hyperuricemia (knitting needles) hepatotoxicity (raised LFT flag and liver on fire)

Uses: broad spectrum antiepileptics (valproate, topiramate, lamotrigine, levetiracetam)

focal seizures (arm shaking) generalized seizures (whole body shaking) juvenile myoclonic epilepsy (kid shaking)

Uses: narrow spectrum anti epileptics (carbamazepine, phenytoin, phenobarbital, gabapentin)

focal seizures (arm shaking) and generalized tonic-clonic

Adverse effect: MTX

folate deficiency (falling leaves) megaloblastic anemia from folate deficiency (exploding fireworks) myelosuppresion/pancytopenia (empty bone pan) immunosuppression (cane) pulmonary fibrosis (fibrotic lung tree) hepatotoxicity (liver spot) alopecia (bald spot) mucositis (poking mouth)

MOA: fondaparinux

fondaparinux (Fido dog) is a LMWH that binds antithrombin III (three bars) and Factor Xa (foxes) with more specificity lowest risk of HIT (dog with plates intact)

How is uric acid formed?

formed from purine metabolism (purine shaped plate) hypoxanthine (small kid passing XO note) is converted to xanthine (big kid passing XO note) via xanthine oxidase (XO note)

MOA and uses: gabapentin

gabapentin (grab a pint) blocks voltage gated Ca channels (closed calci-yum cooler) seizures chronic pain (chronically frayed wire) diabetic neuropathy (diasweeties machine) fibromyalgia (fiber bars) post-herpetic neuralgia (Zeus)

What gene encodes for the HIV virion core proteins p24, p7?

gag structural gene (gagged prisoners on ship, 24 hour sundial)

What stimulates the enterochromaffin-like cells to release histamine?

gastrin from G cells (gas powered tank activating ECL tree) gastrin also minimally stimulates the parietal cell to release H+ (gas tank near puree pump)

Uses: proton pump inhibitors

gastrinoma causing hypersecretion of gastric acid - Zollinger-Ellison syndrome (gas tank mower with crab) H pylori infection - helicopter hat GERD (gargling)

Adverse effects: CCBs

gingival hyperplasia (gum), constipation (plunger), can cause AV block if used with B blockers (sign), cannot be used in heart failure (floppy heart balloon outside store)

Uses: aminoglycosides

given IV (ivy plant) aerobic G- bacili (red rod wall) - transported into cell via O2 dependent process (bellows)

Treatment of VIPoma and carcinoid syndrome?

octreotide (octagon above crab)

Octreotide effect on histamine and gastrin release?

octreotide (octagon) is a long acting somatostatin analog that inhibits ECL cells/histamine release and G cells/gastrin release

Uses: octreotide

octreotide (octagon) is a somatostatin analog used for acromegaly/gigantism because it inhibits GH secretion VIPoma (VIP crab) carcinoid tumors (customers only) glucagonoma (glucagon packets) gastrinoma (giant gas tank) to control esophageal varices bleeding (variceal pipes)

MOA and uses: omalizumab

omalizumab (limosine) is a monoclonal IgE antibody against the Fc portion of IgE, which prevents mast cell degranulation (limousine driver grabbing IgE gun)

MOA: omeprazole, lansoprazole

omeprazole and lansoprazole (first prize) are proton pump inhibitors (girl blocking H/K ATPase)

What is the extra renal effect of ADH on V2 receptors?

on vascular endothelium, causes release of vWF (von Wille tables) and factor VIII (8 ball)

MOA: ondansetron

ondansetron (ribbon dancer) antagonizes 5HT-3 receptors on the vagal afferents (dancer antagonizing hammer throw)

Geriatric patients lose phase (blank) of drug metabolism first

one

Statin benefit in CAD

only statin to decrease risk of atherosclerotic heart disease (yellow coronary crown) decrease mortality, especially in DM, PVD patients (angel, candy jar, gunky pipe) started after MI (broken heart string)

How do opioid receptors work?

open potassium channels (banana barrels) close voltage-gated calcium channels (closed ice cream vendor), which prevents neurotransmitter release

MOA: fentanyl, morphine

opioid agonists

Adverse effects: ethambutol

optic neuritis - red green color blindness (horse with red and green eyes)

Specific uses: amoxicillin

oral bioavailability (open mouth) otitis media/sinusitis (plugged ears near ammo box) Helicobacter pylori - along with clarithromycin and PPI (helicopter) Lyme disease from borrelia burgdorferi prophylaxis against encapsulated bacteria in asplenic patients (spleen hole) prophylaxis for dental procedures in high risk endocarditis patients (knocked out tooth)

How is warfarin administered?

orally (guy with open mouth)

Adverse effects: nitrates

orthostatic hypotension (girl fainting) reflex tachycardia (reflex hammer), which can be reversed by coadministering beta blockers (muted bugle near doctor) headache/flushing (flushed guy holding head) methemoglobinemia (oxidized iron wheels) Monday disease where explosive workers get headaches on Monday after being home and losing nitrate tolerance (Monday machine)

Side effects: A blockers

orthostatic hypotension (tilted table), reflex tachycardia (reflex hammer)

MOA: mannitol

osmotic diuretic that acts at the proximal convoluted tubule and descending limb of loop of Henle (tall man)

What is an osmotic laxative?

osmotic laxatives (spa water) are non-absorbable substances that draw water into the intestinal lumen, causing peristalsis

Uses: bisphosphonates

osteoporosis hypercalcemia (elevated calci-yum ice cream) hypercalcemia of malignancy (calcified rock with crab fossils) Paget disease - uncontrolled osteoclast resorption with secondary disorganized bone formation (disorganized skeleton)

Adverse effects: loop diuretics

ototoxicity (banging on gong) sulfa allergy (sulfa eggs) interstitial nephritis (kidney ticket bag) gout (knitting needles) contraction alkalosis (squeezing OH- bottle)

Adverse effects: aminoglycosides

ototoxicity (gong) teratogen (tarantula) nephrotoxicity (sai in kidney) acute tubular necrosis (rusty muddy tube) must monitor plasma levels of drug (undulating mountains)

Adverse effects: platinum analogs

ototoxicity - hearing loss, tinnitus (gong earrings) peripheral neuropathy (black gloves) nephrotoxicity/AKI (kidney bag) - IV saline diuresis can prevent this (spraying window) acute tubular necrosis (muddy pipe) myelosuppresion - especially carboplatin (bone marrow case) immunosuppression (cane)

What is a short-acting benzodiazepine?

oxazepam (fast ox) anything ending in "-olam" (all AM on wall)

What is pKa?

pH at which drugs are 50% ionized and 50% nonionized. Low pKa means a very strong acid

Adverse effects: NSAIDs

prolonged bleeding time (ketchup on clock) increased BP (afferent arteriole dilation blocked, decreasing GFR and increasing sodium retention) GIB (ketchup on GI pads from empire) gastric ulcers (PGs protect gastric mucosa) interstitial nephritis (kidney containers) renal papillary necrosis (shedding cleat spikes) increased lithium levels (lithium balloons) aplastic anemia (bone) hypoaldosteronism (depleted mineral mine) hyperkalemia from hypoaldosteronism (giant K)

MOA: vaptans

promote free water excretion to reduce hyponatremia (wet pants)

Aldosterone effects on hydrogen?

promotes excretion of H+ ions (key in alpha-intercontinental van)

Other uses: rifampin

prophylactically given to people in close contact to H influenzae or N meningitidis (close contact to rifle, mohawk, H plane)

COX2 synthesizes what?

prostacyclin (pro-cycler pitching machine), which causes vasodilation (dilated red barrel) and inhibits platelet aggregation (person dispersing plates)

MOA: protease inhibitors

protease inhibitors (sword stuck in stone) prevent protein cleavage, keeping the virion particle immature (young boy)

Site of action: acetazolamide, mannitol

proximal convoluted tubule (pro cart track) acetazolamide - battery acid breaking car battery mannitol - tall man

Uses: calcitriol

psoriasis (knee pads) long-term hypocalcemia (stabilizing broken bones), which is commonly caused by hypoparathyroidism (falling PtHD), which is caused by thyroid surgery (untied bowtie)

Contraindications: levodopa

psychotic patients (damaged psychotic tissue)

MOA and uses: psyllium

psyllium (seaweed pile) is a bulk-forming laxative that absorbs water and causes peristalsis

Uses: sildenafil, tadalafil

pulmonary HTN (high tension tennis rackets) erectile dysfunction (erect bat)

Side effects: mannitol

pulmonary edema due to increasing ECF volume (man with wet lungs), hyponatremia d/t increased ECF volume (wet peanuts falling), can exacerbate heart failure (falling floppy heart balloon), hypernatremia if too much water excreted (elevated salty peanuts)

Adverse effects: bleomycin

pulmonary fibrosis (fibrotic lung coral) skin toxicity/issues (hyper pigmented stripes on beluga) mucositis/stomatitis (urchin poking mouth) alopecia (bald beluga)

Treatment: Grave's disease

radioactive iodine (glowing vial of iodine)

MOA and uses: raloxifine

raloxifine (relax sign) is a selective estrogen receptor modulator that can be used for postmenopausal osteoporosis because it has estrogen agonist activity in the bone and antagonist activity in the breast and uterus

MOA: ranitidine, cemetidine

ranitidine and cimetidine (tie-dye shirts) are H2 receptor antagonists (bee swatters) that inhibit acid secretion by parietal cells (near acid table)

Antidote: warfarin overdose

rapid - fresh frozen plasma (close fighter pilot) slow - vitamin K (distant vit K fighters)

Pharmacodynamics: zaleplon and zolpidem

rapid onset of action (fall asleep fast) short duration of action (quick jump and fall) metabolized by the liver (liver spots on sheep)

Zero order elimination

rate of elimination is constant. Cp decreases linearly with time

First order elimination

rate of elimination is directly proportional to the drug concentration. Cp decreases exponentially with time

Clearance

rate of elimination of drug/ plasma drug concentration = Vd x Ke (elim constant)

ENaC effect on potassium levels?

reabsorption of Na creates a negative luminal potential that promotes potassium excretion via K channels (salt-E snack cart ramming giant banana)

Function of calcitriol in the kidney?

reabsorption of calcium and phosphate (calci-tron gathering bones and P fossils from kidney hole)

Function of calcitriol in the gut?

reabsorption of calcium and phosphate from intestines (calci-tron gathering bones and P fossils from GI truck)

Function: sodium glucose cotransporter 2

reabsorption of glucose in proximal tubule (salty chips near pro cart track sign)

What senses increased serum calcium levels?

receptor in the parathyroid gland (bone receiving in PtHD lab) increased calcium will inhibit parathyroid hormone release

Uses: anti platelet drugs

reduction in cardiovascular events in patients with PVD (greasy pipe) and CAD (angina) MI (broken heart strings) prevention of coronary stent thrombosis (corked bat) prevention of ischemic stroke in patients with atherosclerosis (ischemic black paint)

What steps are included in Phase I drug metabolism?

reduction, oxidation, hydrolysis. leads to a slightly polar metabolite

MOA and uses: pralidoxime

regenerates ACHE in case of cholinergic toxicity, but HAS to be given early

Function: osteoclasts

release calcium (classmate digging up bones) and phosphate (P fossil) from bone

Contraindications: LMWH

renal failure (cracked kidney) due to renal clearance

Adverse effects: foscarnet

renal insufficiency (spilled kidney beans) hypocalcemia (spilled milk) hypomagnesemia (falling magnets) hypokalemia (empty banana peels) seizures (shaking driver)

What is the peptidoglycan wall made of?

repeating cross-linked D-alanyl-D-alanine oligopeptides (D-ala death coccus wall) formed by PCN-binding proteins (planetary building project worker)

Uses: tricyclic antidepressants

resistant depression (happy/sad face near resistant door) diabetic neuropathy/chronic pain (frayed wire in diasweeties machine) migraine prophylaxis (pounding head bell) clomipramine - OCD (obsessively neat)

MOA: NSAIDs

reversibly inhibit COX1 and COX2 and block prostaglandin synthesis (fire extinguisher dousing head and assistant coaches)

Adverse effects: integrase inhibitors

rhabdomyolysis (crispy chicken bite)

Symptoms of opioid withdrawal?

rhinorrhea, lacrimation, hyperventilation, hyperthermia, muscle aches, vomiting, diarrhea (anxious, hot and moist guy)

What are the four drugs used to treat tuberculosis?

rifampin (rifle), isoniazid (isolated ranger), pyrazinamide (the pyro), and ethambutol (Ethyl the horse girl) (RIPE tubers) first, 4 drugs for 2 months, then 2 drugs for 4 months (was $4 for 2, now $2 for 4) isoniazid can be used alone for latent infections (sleeping lone ranger)

MOA: rifaximin for hepatic encephalopathy

rifaximin (fisherman) eliminates ammonia-producing bacteria in the gut

Contraindications: nitrates

right heart failure (no right turn sign) because decreasing RV output can severely drop BP patients using PDE-5 inhibitors (coal filling station) hypertrophic obstructive cardiomyopathy (obstructed heart steam pump)

What protease inhibitor has the highest inhibitory effect on CYP450?

ritonovir (right on!) - boosts protease inhibitor concentrations rifampin activates CYP450 and decreases the concentration (rifle)

MOA and uses: salmeterol and formoterol

salmeterol and formoterol (salute formation) are beta 2 agonists (big tubas) for asthma that are given as oral inhalers (inhaler) and have a long half life (long tapered flag)

HDL delivers cholesterol esters back to liver via

scavenger 1 receptor (scavenger 1 HDL on bottom delivering chest)

Uses: H2 blockers

second-line for GERD (gargling) gastric/duodenal ulcers (ulcerated sidewalk)

Benefits of nortriptyline and desipiramine over other TCAs

secondary amines (Northside Prep) that have less cholinergic effects (protected by secondary sign)

VIP and carcinoid tumors can cause *blank* diarrhea

secretory (VIPoma cancer crab)

Adverse effects: mirtazapine

sedation (sleeping) weight gain (hefty fan)

Effects of hypocalcemia?

seizures (shaking hand) paresthesias, muscle cramps, tetany (tense fist)

MOA and uses: selegiline

selective MAO type B inhibitor (sledge hammer hitting black mouse) to increase dopamine levels in the CNS (brain tied with rope) used in Parkinson's (cog wheel)

MOA: fluoxetine, paroxetine, sertraline, citalopram

selective serotonin reuptake inhibitors (fly out, parrot, desert airline, city)

In addition to levodopa/carbidopa, what are some other possible treatments of Parkinson's?

selegiline - MAO-B inhibitor that increases dopamine (sledgehammer on black mouse) ropinirole - D2 receptor agonist (rope on a roll) pramiprexole - D3 receptor agonist (big pecs) trihexiphenidyl and benztropine - antimuscarinics for tremor and rigidity, no effect on bradykinesia (trembling tri-hex Benz car)

MOA and uses: senna

senna (stimulating suntan lotion) stimulates the enteric nervous system and colonic secretions, causing bowel movements

What gets released in response to GI irritation?

serotonin (smiley face balls near stomach pit), which activates 5HT-3 receptors (1-2-3 sign) on vagal afferents (vegas sign)

MOA: venlafaxine, duloxetine

serotonin norepinephrine reuptake inhibitors (fax machine, dual copier/scanner)

Adverse effects: MAOi

serotonin syndrome (lots of smiley faces)

MOA and uses: sevelamer

sevelamer (shoveling) decreases absorption of phosphate in the gut (shoveling out P fossils) for hyperphosphatemia in CKD

Uses: amphotericin

severe systemic fungal infections (organ systems model) IV administration (ivy plant) intrathecally for fungal CNS infections (tongue on brain) - can cause seizure/other CNS effects

Adverse effects: TCAs

sexual dysfunction (rejected advances) inhibit muscarinic Ach receptors, causing dry mouth, constipation, urinary retention (tea party) contraindicated in the elderly d/t severe anticholinergic and antihistamine effects (confused old man) increased appetite/weight gain (fat kid) sedation (sleeping) orthostatic hypotension (passed out) block cardiac fast Na channels (inactivated peanut jar), causing dangerous arrhythmias widen the QRS complex (wide QRS on heart) can induce Torsades (twisted streamer) can induce seizures (shaking kid) can cause serotonin syndrome (pile of smiles)

MOA: zilueton

zilueton (Godzilla) is a lipoxygenase antagonist (falling on coach lax) for mild persistent asthma

MOA: nonbenzodiazepine hypnotics

zolpidem, zaleplon, and eszopiclone (ZZZ mattress) bind to an allosteric site on the GABA-A receptor (cab A), which is a chloride channel (chlo-rider) potentiate GABA effects in the CNS (CNS light) bind the same site as benzodiazepines (two grabbing same cab handle)

Uses: PCN V

G+ organisms strep pharyngitis caused by strep pyogenes (red bandana on throat) PCN V or G can treat rheumatic fever (exploding heart) caused by strep throat

What bacteria does PCN work against?

G+ organisms (purple coccoid space stations) Actinomyces israelii (Israel flag on purple rod train) C perfringens (perforated space suit) dog bite wounds infected with pasturella multocida (space dog) syphillis d/t treponema pallidum (red gloves and boots) Neisseria meningitis (red mohawk)

What phase of the cell cycle do MTX, 5-FU, and hydroxyurea block?

S phase (Sushi phase) inhibits DNA synthesis (double helix noodles)

What phase of the cell cycle do 6MP/azathioprine stop?

S phase (stairs out)

What phase of the cell cycle do etoposide and teniposide inhibit?

S phase (stairs out) G2 phase (gone out) - double check and cellular repair

Adverse effects: amoxicillin and ampicillin

SJS/TEN (sloughed off mask) drug-induced liver injury (liver spot) can cause rash in setting of viral illness like Epstein-Bar (Epstein's bar)

MOA: sulfamethoxazole (SMX)

SMX (rotten sulfa eggs) is a PABA analog (panda) that blocks dihydropteroate synthesis (eggs hitting panda)

A high Km means what?

The enzyme has a low affinity for its substrate (requires more substrate in order to reach half of Vmax)

Function: ribonucleotide reductase

converts UDP to deoxy-UDP (crossed out OXY)

Function of LCAT?

converts free cholesterol into cholesterol esters for transport in HDLs (load catch)

Function: HGPRT

converts hypoxanthine to IMP activates 6MP (high priest activating gypsy)

Function of vitamin K epoxide reductase?

converts vitamin K epoxide (inactive) to vitamin K (active)

Adverse effects: triptans

coronary vasospasm (constricted crown) contraindicated in angina patients (anvil in shadow), including Prinzmetal angina (anvil necklace in shadow)

How do corticosteroids treat asthma?

corticosteroids block inflammation and cellular infiltration (moon blocking inflammatory sun)

Adverse effects: ACEi

cough (girl coughing), syncope (guy passed out), teratogen (tarantula), increased creatinine (credit card), hyperkalemia d/t less aldosterone (banana daiquiri), and hypotension (floppy red straps). caution with bilateral renal artery stenosis, because ACEi will further lower GFR and cause renal failure

A1 effects?

coupled to IP3/DAG cascade to increase intracellular calcium (dogs with Ca bone). Vasoconstriction (red leashes), venoconstriction/increase venous return (blue leashes), mydriasis (binoculars), urethral sphincter/smooth muscle contraction (pulling belt), urinary retention (bladder bottle full)

MOA: cromolyn sodium

cromolyn sodium (Lynn's bee control) prevents mast cell degranulation, inhibiting histamine release (releasing anti-bee gas)

MOA: cyclophosphamide

cyclophosphamide (cyclops) is an alkylating agent that cross links DNA (cross linking chains) activated by CYP450 (activating chrome bumper)

Treatment of serotonin syndrome?

cyproheptadine - 5HT2 receptor antagonist (silly pranks prohibited)

MOA and uses: cytarabine, gemcitabine

cytarabine (saber toothed tiger) and gemcitabine (gem stone) are pyrimidine analogs (pyrimidine spots) cytarabine - active only against hematologic malignancies (scratched out B cell archers and T cell knights) gemcitabine - hematologic and solid tumors (crab)

Clinical manifestations of cytomegalovirus

cytomegalovirus (mega low market) presents with CMV retinitis of hemorrhages and infiltrations (pizza box) more common if CD4 <50 (limit 50)

Where is the glucocorticoid receptor found?

cytoplasm activated receptor then enters the nucleus to regulate gene transcription

Precursor to dTMP?

dUMP (dumplings on purine plate going to dumpling with T shaped chopsticks)

Uses: valacyclovir

daily use for recurrent herpes episodes (valet parking daily rate for frequent flyers) improved bioavailability (open mouth)

Treatment of malignant hyperthermia

dantrolene (trampoline), which blocks ryanodine receptors (guy blocking Ryan)

Treatment: leprosy

dapsone (deputy zone) clofazimine for lepromatous leprosy (cloth) rifampin (rifle)

Uses: daptomycin

daptomycin (police department) is used against G+ cell wall (purple protesters) vancomycin resistant strains (van) enterococcus (diplococcus drum set) MRSA (no mercy, merciless dark lord) MRSA bacteremia (it's in our blood) staph endocarditis (three heart peaks)

Use of B blockers for HTN

decrease CO, decrease renin secretion (closed umbrella) (high pressure pipes)

Use of B blockers for angina

decrease HR and contractility

Function of the nucleus tractus solitarius?

the vomiting center (vomiting kid) in the medulla that receives input from the GI tract, area postrema, and vestibular system

Adenosine as antiarrythmic is inhibited by what?

theophylline and caffeine (energy drink blocking A1 gate)

How is the administration of isosorbide mononitrate and isosorbide dinitrate different than other nitrates?

they can be given orally (mouth shaped cave) require larger doses d/t large first pass effect (big pile of dynamite)

What is the effect on HMG-CoA reductase and LDL receptors from bile acid resin use?

they get upregulated because the liver now has to make more cholesterol (HMG crude oil thing being used, activated load L receptor dock) upregulating LDL receptors clears more LDL from circulation

First line therapy for primary HTN?

thiazides (thighs on primary deck)

Possible drug interactions with lithium?

thiazides increase lithium levels (thighs on high dive) diuretics and NSAIDs decrease clearance of lithium (low clearance)

MOA: thiazolidinediones

thiazolidinediones are ligands of PPAR, an intranuclear receptor regulating gene transcription (PPAR-ty shirt) upregulates adiponectin, increases insulin sensitivity and fatty acid oxidation (turtle neck) increase differentiation of fat cells (holding up donut jar) increase storage of TGs - decreased serum TGs (eating fatty donut) upregulate GLUT4 in peripheral tissues (4 on open door) increases insulin sensitivity (put notes INSIDE)

Which segment of the loop of Henle is impermeable to water?

thick ascending limb (water bottle secured in car)

Site of action: furosemide, bumetanide, torsemide

thick ascending limb of loop of Henle (loop de loop of Henle)

Adverse effects: thioridazine

thioridazine (color theory) can cause retinal deposits (retinal palette)

Sympathetic nerves come from where?

thoraco-lumbar. Short pre-ganglionic, long post-ganglionic fibers.

Adverse effects: linezolid

thrombocytopenia (broken plates) optic neuropathy (cut eye camera wire) stocking-glove peripheral neuropathy (hand and feet covers) serotonin syndrome (happy face)

Where is iodide stored as thyroglobulin?

thyroglobulin (tyro-global) is stored in the thyroid follicular lumen (truck)

Site of iodine uptake and thyroid hormone production in the thyroid?

thyroid follicular cell (evil follicu-lair)

Enzyme responsible for iodide oxidation and organification?

thyroid peroxidase (transPOrter) does organification (organic foods) also does coupling of iodinated tyrosine residues (coupled tires)

Half-life

time required to change the amount of drug in the body by half. In first order kinetics, drugs infused at constant rates takes 4-5 half lives to reach steady state. Half life = 0.7(Vd)/clearance (first order)

Use of B blockers for glaucoma

timolol (decreased aqueous humor production - Tim draining water from eye tuba)

Treatment of dermatophytosis

tinea (tin man) is treated with oral griseofulvin (grease in mouth) and terbinafine (turban) oral griseofulvin and terbinafine are first line treatments for tinea capitus in kids (kid with tin man hat)

Function of Na/H exchanger in proximal convoluted tubule?

to let H+ go into lumen (excreted in pee) and reabsorb Na (track worker at gray and yellow line letting H+ helmet into lumen and handing back sodium peanuts)

Why don't we give aspirin to children for viral illnesses, and what is the one exception?

to prevent Reye syndrome (rays), a rapidly progressive encephalopathy [brain hat] with hepatic dysfunction [liver spot] one exception: Kawasaki disease (Kawasaki ATV)

Adverse effects: SNRIs

HTN (pressure steam) withdrawal can cause flu-like symptoms (out with the flu)

Symptoms: tyramine overdose

HTN (steaming ears)

What converts T4 to T3 in the periphery?

5' deiodinase (T4 detonator in periphery from bombs)

What is the onset of action of warfarin?

8-12 hours

What are the symptoms of alcohol withdrawal?

8-12 hours: insomnia, tremulousness, anxiety (anxious customer) 12-48 hours: seizures (shaking customer) 48-96 hours: delirium tremens - agitation, fever (agitated customer)

What type of receptor is the insulin receptor?

a tyrosine kinase (tire swing)

What bacteria are resistant to aminoPCNs?

beta-lactamase producing species (beta bouncer near no ammo sign)

Use of B blocker in hyperthyroidism

decrease HR, tremor (propranolol) (big bowtie and shaking director)

Adverse effects: hydralazine

compensatory tachycardia (reflex hammer) treated with B blockers (muted bugle), drug-induced lupus (wolf)

Function of ENaC?

to reabsorb Na across the luminal membrane of the collecting duct (salt-E snack cart)

Uses: leucovorin

to reverse toxic MTX effects (lucky cat)

What do anions do to the sodium iodine transporter?

competitively inhibit it (anion box obstructing path) treats radioactive iodine exposure

Adverse effects: class IC antiarrythmics

contraindicated in patients with structural or ischemic heart disease (healthy hearts only box)

Uses: acarbose, miglitol

control postprandial glucose spike (eaten cupcake) TIIDM

Treatment of vestibular nausea?

1st generation antihistamines (bee swatters) scopolamine - muscarinic antagonist (sailor outfit)

How do you avoid nitrate tolerance?

24 hour-free nitrate periods (no tolerance for 24 hour workday)

Drug class: quetiapine, olanzapine, risperidone, aripiprazole, ziprasidone, clozapine

2nd gen antipsychotics (quiet please, only whispering appropriate), (zipper), (closet)

MOA and uses: phenylephrine

A agonist (friend in flannel) for nasal congestion (nasal spray), hypotension, ocular procedures where pupil has to dilate

MOA and uses: norepinephrine

A agonist (north compass) with some B activity (bugle) that increases BP (raised map lines) CO (jacked arm) and HR, though can cause reflex bradycardia (lowered heart watch) due to vasoconstriction. for hypotension, septic shock (septic pump)

MOA and uses: labetolol

A and B blocker (alpha and beta notes on organ) causing vasodilation (dilated sleeves). Treats HTN in pregnancy (preggo player), HTN emergency (emergency shut off with ivy to show IV admin), aortic dissection (cracked organ pipe)

How do you treat toxicity with weak acids?

Alkalinize the urine with sodium bicarbonate. Ionized species are trapped in the urine and cleared quickly (RCOOH is lipid soluble, -> RCOO- and H+ in basic environment)

After ACh is released onto nicotinic receptors in the adrenal medulla, epinephrine is released onto what receptors?

Alpha 1, alpha 2, beta 1, and beta 2 in cardiac muscle and vessels

What is potency?

Amount of drug needed for a given effect. Represented by EC50. If EC50 is low, not a lot of drug is needed because it is very potent

MOA and uses: anything ending in "olol"

B blocker (muted bugle). Decreases cardiac contractility (weak arm), suppress AV/SA node conduction (heart notes on piano music with low heart watch), treat chronic stable angina (decrease O2 demand - O2 line flying away)

MOA and uses: dobutamine

B1 agonist that increases cardiac output, heart rate in cardiogenic shock (just do bugling shirt with heart flashlight, jacked arms and falling heart batteries) but also decreases BP due to some B2 activity (spaced blue lines on map)

MOA and uses: isoproterenol

B1, B2 agonist equally (tunnel between B1, B2 house) that decreases BP (dilated sleeves at B2), increases CO and HR (elevated heart watch and jacked arm at B1)

MOA and uses: albuterol, terbutaline

B2 > B1 agonists (bronchodilation, vasodilation, release of fatty acids, insulin release - taking big breath, dilated sleeves, pig roasting, INSIDE mat) for asthma/COPD (roll call sheet because all end in "ol")

Treatment of acute severe asthma exacerbation

B2 agonists (tuba) systemic IV corticosteroids (ivy around moon) ipratropium bromide (caterpillar) SC or IM epinephrine (epic sign)

How does carbonic acid get created in the lumen of the kidney?

Bicarb is already in the lumen (bicarb car) and is joined by H+ ions from the Na/H exchanger on luminal surface (peanut guy). Then carbonic anhydrase (car battery anhydrase) turns H2CO3 into CO2 and H2O, which enter interstitial cells via diffusion (car with exhaust on gray track). Then intracellular carbonic anhydrase converts it back into HCO3- and H+, with the latter recycled back into lumen.

Effects of enzyme inhibition on Lineweaver Burk plot

Competitive inhibitors cross each other, whereas noncompetitive inhibitors do not. Kompetitive inhibitors increase Km.

What inhibitors bind the active sites?

Competitive inhibitors only. Not noncompetitive

Pharmacodynamics of inhibitors?

Competitive reversible decreases potency (need more of drug to get desired effect) while irreversible and noncompetitive inhibitors decrease efficacy (maximal effect is lower)

Dopamine receptors coupled to which G-protein?

D1 - S D2 - I (Dope rope SWING)

What receptors are present in the area postrema?

D2 (2 D-ring ropes)

MOA: metoclopramide

D2 receptor antagonist (guy tickling guy on 2D ropes) for chemotherapy-induced nausea exerts pro-kinetic effects in the upper GI tract to promote gastric emptying (contracted stomach balloon)

Symptoms of cholinergic toxicity and treatment

DUMBBELS - diarrhea, urination, miosis, bronchospasm, bradycardia, lacrimation, salvation). Treatment: atropine

Uses: heparin

DVT prophylaxis and treatment (iliofemoral river) PE (bird droppings on pulmonary tree) acute MI (broken heart string) all use IV (ivy plant) can be used in pregnancy (preggo lady)

Uses: direct thrombin inhibitors

DVT, AF when patients develop HIT from heparin

Uses: apixaban, rivaroxaban

DVT, PE AF (TG signal)

What is the post-ganglionic neurotransmitter and receptor for renal vasculature and smooth muscle in the sympathetic nervous system?

Dopamine is released onto D1 receptors

Bioavailability

Fraction of administered drug that reaches systemic circulation unchanged. IV doses are 100%, oral is <100% due to first pass metabolism

Symptoms of serotonin syndrome

HTN, hyperthermia (high pressure, hot guy) neuromuscular hyperactivity - hyperreflexia/clonus (guy tapping foot) can occur if combined with other drugs affecting serotonin - TCAs, MAOi (mousetraps, tricycle)

H1 histamine receptor is coupled to?

Gq protein (Q dandelion) mediates allergic reactions causes nasal and bronchial mucus production (nose dripping) increases vascular permeability (dripping sap) constriction of bronchial smooth muscle (restricted lungs) functions as a neurotransmitter (brain)

Adverse effects: clindamycin

watery diarrhea (mud puddle) associated with C diff colitis (sewer fountain)

H2 histamine receptor is coupled to?

Gs protein (honeypot with 2 S handles) mediates gastric acid secretion (stomach shaped pot dripping fluid)

Specific uses: clarithromycin

H pylori (crow, keep clear, and helicopter model)

The vestibular system contains what two receptor types?

H1 receptors, coupled to Gq (Q dandelions near semicircular canal) M1 muscarinic receptors (car in M1 parking spot)

Histamine activates *blank* receptors on the parietal cell

H2 receptors on the basolateral membrane, which are coupled to Gs (honey pot with 2 S handles) histamine upregulates the H/K ATPase, increasing acid secretion (kid with honeypot knocking over lemonade into sidewalk)

Function of gp41?

HIV fusion and entry (41 grappling hook)

Abacavir hypersensitivity is associated with *blank*

HLA-B 57:01 allele (HLA-B 57:01 in book) (abracadabra) can cause delayed type IV hypersensitivity reaction

Adverse effects: sirolimus (rapamycin)

HLD (extra fat marbling) hyperglycemia (elevated candy bowl) bone marrow suppression (throwing away bones)

Uses: thiazides

HTN (high pressure pipes) heart failure (floppy heart balloon) nephrogenic diabetes insidious (peeing fountain) hypercalcemia (worker removing stones from slide) osteoporosis (chalk)

Uses: ACEi

HTN (high pressure pipes), heart failure to decrease mortality (angel with floppy heart balloon), to decrease cardiac remodeling (remodeling sign), MI (broken heart string), diabetic nephropathy (kidney candies)

What does a high Vd mean?

In all tissues including fat, small lipophilic molecules

MOA: amiloride and triameterene

K+ sparing diuretics inhibit Na reabsorption through ENaC (almond and tangerine vendors blocking salt-E snack cart)

MOA and uses: diltiazem, verapamil

L type calcium channel blockers (L shaped handle with very vanilla and dark chocolate) that act on cardiac smooth muscle (branching wall pattern) and SA/AV nodes (heart nodes with dangling heart watch) to decrease HR and contractility (weak kid)

Loading dose

LD = (Cp x Vd) / F where Cp is target plasma concentration at steady state and F is the bioavailability

Cholesterol most affected by statins?

LDL (sinking LDL ship) the most TG (trident) mild HDL rise (pulling up HDL sub) mildly

Function of LDL receptor?

LDL receptor on liver (load L receptor on liver station) binds ApoE and transports chylomicron remnant to liver (E flag binding load L receptor) also binds ApoB on LDL

MOA: low-molecular weight heparin

LMWH (heppy hunting daughter) binds/inactivates antithrombin III (three bars) and Factor Xa (fox) longer half-life than unfractionated heparin (tapered flag)

MOA: montelukast, zafirlukast

LTD4 receptor antagonists (Monte the broadcaster blocking D4 shot) for use in mild persistent asthma cause bronchodilation (dilated scarf) given orally (open mouth)

CysLT1 is the receptor for what?

LTD4, the most potent bronchoconstrictor (cysLT1 net)

What is a nicotinic ACh receptor?

Ligand-gated Na/K channels

What phase of the cell cycle do vinca alkaloids and taxanes interrupt?

M phase (M shape in vines)

Cholinergic receptors act on what G-protein class?

M1 - Q M2 - I M3 - Q

MOA and uses: benztropine, trihexyphenidyl

M1 antagonists for tremor and rigidity in Parkinson's disease and extrapyramidal side effects from antipsychotics

Parasympathetic receptor on detrusor muscle?

M3 receptor - receives parasympathetic input from pelvic splanchnic nerve. Acts to void bladder. Muscarinic antagonists inhibit M3 receptor, and is thus used for urinary incontinence (you want to stop peeing all the time)

Treatment of mycobacterium avium complex

MAC (caged mockingbird) is treated with macrolide (crow) and ethambutol (sheriff Ethyl) rifabutin can be a tertiary agent (buttes), or rifampin (rifle)

Maintenance dose

MD = (Cp x CL x tau) / F where tau is time between doses

How does MRSA work?

MRSA (merciless dark lord) produces altered PCN-binding proteins that are resistant to beta-lactam antibiotics (altered wall worker)

Uses: tetracyclines

MRSA (no mercy) broad spectrum (prism) Yersinia (squirrels with fleas) acne vulgaris (white capped mountains)

Where are melatonin receptors located?

MT1 and MT2 receptors are found in the suprachiasmatic nucleus of the hypothalamus

P450 Inducers

Modafinil, chronic alcohol use, St. John's wort, phenytoin, phenobarbital, nevirapine, rifampin, griseofulvin, carbamazepine (Most chronic alcholics steal phen-phen and never refuse greasy carbs

What does a medium Vd mean?

Mostly in the ECF, small/hydrophilic molecules

Antidote: acetaminophen overdose

N-acetylcysteine

Adverse effects: octreotide

N/V/D (nauseated girl) steatorrhea (yellow stool)

MOA and uses: atomoxetine

NET inhibitor for ADHD (atom on TV)

What drugs, besides triptans, can be used for migraine treatment?

NSAIDs (fire extinguisher)

MOA: ketorolac, diclofenac, indomethacin, meloxicam, piroxicam, naproxen

NSAIDs that reversibly inhibit COX1 and COX2 synthesis (BLAC sox, indigo sox, sox cam, approximately 110 mph)

Ions reabsorbed in distal convoluted tubule?

NaCl (salt scraper by yellow slide), calcium (calci-yum)

Receptor on external urethral sphincter?

Nicotinic via pudendal nerve - under somatic control

Additional uses for dopamine agonists

Parkinson's restless leg syndrome (restless legs)

Gq receptors activate what cascade?

Phospholipase C -> IP3/DAG -> protein kinase C and increased intracellular calcium to cause smooth muscle contraction. HAVe 1 M&M (H1, A1, V1, M1, and M3 receptors use Gq)

Function of RANKL?

RANKL on osteoblast binds RANK on osteoclasts, increasing its activity (more bone breakdown)

Adverse effects: lamotrigine

Stevens-Johnson syndrome (sloughed off mask) diplopia (double-eyed llama)

What makes up the most of VLDL?

TGs make up most (tridents on VLDL) some cholesterol esters (chest loaded on VLDL)

Uses: amylin analogs

TIDM and TIIDM (holding up 1 and 2 fingers) to control postprandial glucose spike (eaten cupcake)

Therapeutic index

TITE: therapeutic index = TD50/ED50 where TD50 is the median toxic dose and ED50 is the median effective dose

MOA: trimethoprim (TMP)

TMP (toilet paper) inhibits dihydrofolate reductase (toilet paper hitting 2 leaf outfit)

Side effects: sotalol, dofetilide, ibutilide

Torsades de Pointes (twisted streamer)

How do we get vitamin D3 in our diets?

UVB radiation (solar D3 battery) or dairy products (cow)

ADH activates *blank* receptors, which are coupled to *blank*

V1 receptors, which are coupled to Gq proteins (V1 flag on Q hole) Gq activates IP3/DAG cascade, increased calcium V2 receptors, which are coupled to Gs proteins (V2 flag on S hole) Gs activates adenylate cyclase, increased calcium

Volume of distribution

Vd = (amount of drug in the body) / (plasma drug concentration)

Function of factor X?

Xa converts prothrombin into thrombin (fox aggravating throm-beaver)

How is acyclovir activated?

a guanosine nucleotide analog (purine luggage) is first converted to acyclovir monophosphate via virus-encoded thymidine kinase (luggage with P sticker), then acyclovir triphosphate with other kinases (luggage with 3 P's) then incorporates into viral DNA, halting synthesis (block at DNA poly light)

MOA of Amphotericin B and Nystatin

amphotericin (amphibian) and nystatin bind ergosterol (non-sterol) to form holes in fungal cell membrane (holes in frog tank) liposomal formulations of amphotericin prevent binding to human cholesterol (fat bubble on frog)

Where is cortisol released from?

adrenal cortex (cortex cap)

Where do indirect sympathomimetics work?

adrenergic nerve terminal (dock)

Adverse effects: clozapine

agranulocytosis (sand timer myocarditis/cardiomyopathy (surreal heart) seizures (shaking clock)

Adverse effects: dapsone

agranulocytosis (sand timer) hemolytic anemia in G6PD (leaking watermelon, bite seeds)

MOA and uses: albuterol, pirbuterol

albuterol and pirbuterol (roll call sheet) are B2 agonists that can treat bronchoconstriction in asthma (inhaler)

Aldosterone effects on ENaCs and K channels?

aldosterone upregulates ENaCs and K channels on the apical membrane, increasing sodium reabsorption (mineral court worker putting key into salt-E snack cart) and potassium excretion

MOA: allopurinol

allopurinol (pure nun) inhibits xanthine oxidase (nun grabbing XO note), thus less conversion of hypoxanthine to xanthine to rate used for chronic gout

Adverse effects: actinomycin D

alopecia (bald kid)

After ACh is released onto nicotinic receptors in the adrenal medulla, norepinephrine is released onto what receptors?

alpha 1, alpha 2, beta 1 receptors in cardiac muscle and vessels

Major site of H+ secretion in collecting duct?

alpha-intercalated cell (alpha intercontinental van pumping out H+ exhaust into gutter)

MOA and uses: alprostadil

alprostadil (dill pickle) is a PGE1 analog (Extreme sports) used for erectile dysfunction (erect bat) vasodilation (dilated red sleeves) maintaining patent ductus arteriosus (open air duct)

What confers resistance to vancomycin?

altered peptidoglycan structure (D-ALA-D-LAC) as in vancomycin resistant enterococcus (D-LAC box)

MOA and uses: amantadine

amantadine (manatee) can treat motor symptoms of parkinson's enhances effect of endogenous dopamine by increasing synthesis and decreasing reuptake (manatee breaking open rope)

Treament of nephrogenic DI?

amiloride - treats Li-induced DI by promoting Li clearance (almond vendor) NSAIDs (fire extinguisher)

Antidote: fibrinolytics

aminocaproic acid that inhibits plasmin activation (cap on paint tube and guarding plasma general) transexamic acid (exam) FFP (FFP plane) cryoprecipitate (cryo hat)

MOA: aminoglycosides

aminoglycosides (sai fighter) are bactericidal (dead ribosome guy) antibiotics that irreversibly bind the 30S subunit (30 min clock) to cause misreading of mRNA (smudged letters) often combined with cell wall active drugs to increase perforation (beta lactam bomb creating hole in wall)

MOA: amoxicillin and ampicillin

amoxicillin (ammo box) and ampicillin (amp) are aminoPCN (Amino's Space Cantina) beta lactam antibiotics (ringed planet) that bind PCN-binding proteins to prevent cell wall synthesis (unfinished death star)

MOA: amylin analogs

amylin analogs (Amy and Lynn) decrease gastric emptying (full stomach bag) decrease glucagon secretion (ripped glucagon packets)

Adverse effects: chloramphenicol

anemia from dose related reversible suppression of RBC production (deflated red tubes) aplastic anemia (bone) accumulation in newborns causing "grey baby syndrome" of flaccidity and hypothermia (grey baby)

Uses: nitrates

angina (angina anvil) - administer sublingually (tongue on shoe) reducing cardiac oxygen demand (O2 line flying away) by reducing preload and wall stress pulmonary edema (lungs on shirt) prinzmetal angina (anvil necklace) ACS (broken heart string) HTN emergency (emergency shut off)

Adverse effects: aspirin

anion gap metabolic acidosis respiratory alkalosis (blowing OH bubbles) tinnitus (tin cans)

Adverse effects: antihistamines

antagonize central muscarinic receptors, thus causing antimuscarinic effects (urinary retention, constipation, glaucoma exacerbation) (antimuscarinic tea party) antagonize serotonin receptors in CNS (cut smiley face cake) stimulate appetite and weight gain (fat fairy) antagonize A1 receptors (extinguished alpha 1 candle), causing dizziness/hypotension (fainted fairy) cognitive impairment in the elderly (confused old man) due to antihistamine/antimuscarinic effects

Where is growth hormone secreted from?

anterior pituitary (along with FSH, LH, ACTH, TSH, prolactin, endorphins, and GH)

Antidote for digoxin toxicity?

anti-digoxin Fab fragment (fabulous Vegas), normalize K slowly

MOA and uses: ipratropium, tiotropium

antimuscarinic for COPD/asthma to cause bronchodilation and reduced secretions

MOA and uses: scopolamine

antimuscarinic for motion sickness (scopolamine sailor)

MOA and uses: atropine

antimuscarinic for muscarinic poisoning (DUMBBELS). Also in Jimson weed, belladonna flower. Causes pupil dilation, cycloplegia

MOA and uses: oxybutynin, tolterodine

antimuscarinic for urinary incontinence (to stop peeing - ox butler and turtle stopping water flow)

Naming 1st gen sulfonylureas

anything ending in "-amide" (maid dressing on sulfa swan) tolbutamide, chlorpropramide

Naming first generation antipsychotics?

anything ending in "-azine" (fluphenazine, chlorpromazine)

Naming partial mu-opioid agonists?

anything ending in "-buphin" (blue fin)

Naming meglitinides, MOA

anything ending in "-glinide" (gliding swan) bind the ATP-dependent K channels on beta cells, causing release of endogenous insulin (gliding swan behind closed banana gate)

Naming thiazolidinediones

anything ending in "-glitazone" (glitter card) rosiglitazone for TIIDM

Naming the protease inhibitors

anything ending in "-navir" (Guinevere)

Naming tyrosine kinase inhibitors

anything ending in "-nib" (broken nib of pen, broken tire swing)

Naming benzodiazepines

anything ending in "-pam" (alprazolam, diazepam)

Naming the carbapenems

anything ending in "-penem" (imipenem - Amy, meropenem)

Naming 2nd gen sulfonylureas

anything ending in "-ride" (gosling riding on mother sulfa swan's back) short duration of action (glipizide has the shortest - short zig zag gosling)

Naming GLP1 agonists

anything ending in "-tide" (exena-tide box) exenatide, liraglutide

Naming ADP receptor inhibitors

anything ending in "grel" (hot dog grill)

Naming ACEi

anything ending in "pril" (April showers casino)

Naming angiotensin II receptor blockers

anything ending in "sartan" (sorry taken sign)

Naming V2 ADH receptor antagonists

anything ending with "vaptan" (vaporizer) used to treat SIADH

MOA and uses: aprepitant

aprepitant (participants) antagonizes the NK1 receptors for chemotherapy-induced nausea

Precursor molecule to leukotrienes and prostanoids?

arachidonic acid (AA), which is hydrolyzed by phospholipase A2 (play2 ball) from the cell membrane

How are LDLs formed?

as VLDLs lose TGs via lipoprotein lipase and hepatic lipase

Specific uses: voriconazole

aspergillosis (walking scarecrow) candida infections (Canadian flag)

Effect of aspirin at high doses with kidney stones

aspirin (ASA empire) at low doses can prevent reabsorption of uric acid (stopping kid from grabbing yarn ball)

MOA: aspirin

aspirin (ASA empire) irreversibly inhibits COX1 and COX2 (empire ejecting coaches) via acetylation (acetylation whistle)

MOA and uses of aspirin in clotting

aspirin (ASA umpire) inhibits synthesis of COX1 and 2 via irreversible acetylation, so no TXA2 to cause platelet activation and clotting (umpire ejecting COX coaches)

MOA and uses: epinephrine

at low doses, B agonist effects (bronchodilation with inhaler, increased HR and contractility with raised heart watch and jacked arm). at low doses, A effects (increased BP and pulse pressure with high lines. Used for anaphylactic shock (anna + phil), asthma

D1 effects?

at low doses: increase renal blood flow (kidney swing) medium: B1 activation on heart (bugle) high: A1 activation of pressors (alpha scout at top)

Adverse effects: phenytoin

ataxia (falling stack) diplopia (misaligned headlights) folate deficiency/megaloblastic anemia (spilled salad) gingival hyperplasia (bubble gum) hirsutism (beard) drug-induced lupus (wolf) drug reaction with eosinophilia and systemic symptoms (eosinophilic dress) Stevens-Johnson syndrome (sloughed off mask) teratogen (tarantula) - can cause cleft palate (cleft trucker hat) induces CYP450 (CYP450 bumper) decreased bone density (fractured bone axel)

Adverse effects: carbamazepine

ataxia (unbalanced stack) diplopia (misaligned headlights) SIADH (wet head) agranulocytosis (sand timer) induces CYP450 (CYP450 bumper) drug reaction with eosinophilia and systemic symptoms - DRESS (eosinophilic dress) teratogen (tarantula) - can cause neural tube defects (neural tube exhaust pipe) Stevens-Johnson syndrome (sloughed off mask) drug-induced lupus (wolf)

Adverse effects: gabapentin

ataxia/dizziness (unbalanced scoops)

MOA: bisphosphonates (alendronate)

attach to hydroxyapatite in bone (large T rex appetite). osteoclasts bind the bisphosphonate, inhibiting their adherence to the bony surface (classmate with hand stuck in donate box) also decrease development and recruitment of osteoclast precursors (preventing class from entering) induce osteoclast apoptosis (balloon being popped)

Uses: bupropion

atypical depression to quit tobacco (pros dont smoke)

Uses: MAOi

atypical/resistant depression (not your typical wine, resistant wine bottle)

MOA and uses: azathioprine

azathioprine (aza-meralda) is a prodrug of 6MP (CAPTured gypsy) azathioprine and 6MP block IMP synthesis, and thus DNA synthesis (gypsy knocking over IMP)

What bacteria are monobactams good for?

aztreonam (AZ-3O) work against aerobic (bellows) G- rods (red rod robot) Pseudomonas (Mona Lisa) PNA (rusty lungs) meningitis (red mohawk) for patients with PCN allergy (stabbing pencil wound)

MOA: chloramphenicol

bacteriostatic (paper jam) antibiotic that acts on ribosome to inhibit peptide bond formation and halting translation (ribosome typewriter)

Treatment of hyperadrenergic symptoms in hyperthyroid?

beta blockers (muted bugle shooting at catfish) inhibit 5' deiodinase, so no conversion of T4 to T3 glucocorticoids (moon face) also inhibit 5'-deiodinase

What cells produce insulin?

beta cells of the islets of Langerhans stimulated by glucose and sympathetic innervation of the autonomic nervous system (B2 tuba)

MOA: cephalosporins

beta lactam (ringed planet) antibiotic that bind PCN-binding proteins (unfinished death coccus) to halt cell wall synthesis

Drug class: monobactams and carbapenems

beta lactams (ringed planet) that bind PCN-binding proteins to inhibit peptidoglycan wall synthesis (unfinished death coccus)

What is clauvanate used for?

beta-lactamase inhibitor (clarinet) sulbactam and tazobactam are beta-lactamase inhibitors (back to back tambourines)

What bacteria are resistant to PCN?

beta-lactamase producing bacteria (beta guard), made by plasmid genes (circular plasmid gun)

First line therapy for osteoporosis?

bisphosphonates ending in "-dronate" (donate box)

Adverse effects: apixaban, rivaroxaban

bleeding

Adverse effects: direct thrombin inhibitors

bleeding

Adverse effects: bevacizumab

bleeding (blood spot) increases risk of clots (iced clotted drink) GI perforation (perforated colon bag)

Adverse effects: fibrinolytic therapy

bleeding/hemorrhagic stroke (red paint)

MOA and uses: bleomycin

bleomycin (beluga whale) binds DNA and makes free radicals (bubbles), which cause breaks in DNA (broken double helix kelp) blocks G2 phase of cycle (GaLLeon) treats hematologic and solid cancers (crab)

MOA: 2nd gen antipsychotics

block D2 receptors in the CNS (broken two ropes) block serotonin receptors (cutting smiley face) block H1 receptors (bee swatter) block A1 receptors (extinguished A1 candle)

MOA: class 1 antiarrhythmic drugs

block sodium channels (soloist gripping peanut butter jar) and decrease slope of phase 0 (tilted microphone stand) Selectively depress tissue that is frequently depolarized

MOA and uses: ARBs

blocks angiotensin receptor. when patient cannot take ACEi, for similar uses to ACEi (HTN, heart failure, diabetic nephropathy)

MOA: ethambutol

blocks arabinosyltransferase, inhibiting carbohydrate formation at the cell wall (Arabian horse at carb fence) bacteriostatic (halting horse)

MOA: ethosuximide

blocks thalamic T-type Ca channels (calci-yum and closed T thermos)

MOA: abciximab

blocks the GP IIB/IIIA receptor, preventing platelet aggregation (ABC reporter grabbing fibrinogen fries) is a monoclonal IgG Ab (ab shaped microphone)

Adverse effects: ganicyclovir/valgancyclovir

bone marrow suppression (eaten marrow), which may be additive in patients getting zidovudine (dove)

MOA and uses: bosentan

bosentan (boss man Stan) is an endothelin inhibitor (end o the line) that can treat pulmonary HTN (high tension tennis rackets) causes vasodilation (dilated sleeves)

Function of osteoclasts?

break down bone (destructive class)

Function of monoamine oxidase B?

breaks down dopamine (black mouse eating rope)

Function of monoamine oxidase A?

breaks down serotonin (white mouse eating smiley face), norepinephrine (white mouse eating north compass), and dopamine (eating rope)

B2 effects?

bronchodilation (big breath with tuba), vasodilation/decreased SVR (dilated sleeves), release of fatty acids (pig fire) promotes GNG (marshmallows from liver bag) insulin release (INSIDE mat), increased aqueous humor production (eye filled with fluid)

B blocker side effects

bronchospasm (player gasping for air), impotence in men (droopy instrument), heart block (heart block sign)

Function of 1-alpha-hydroxylase in the kidney?

converts 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D (1 head added to calci-tron)

Adverse effects: latanoprost, travoprost

brown pigmentation in the iris (brown sunglasses)

Function of osteoblasts?

build bone (bone builder)

MOA: bupropion

bupropion (ball pro) inhibits the norepinephrine and dopamine transporter (net dat ball!) excites CNS (aroused from sleep)

Uses: busulfan

busulfan (beautiful sirens) is a conditioning agent in bone marrow transplant (severely depleted marrow)

MOA and uses: cabergoline, bromocriptine

cabergoline and bromocriptine (burglar with broomstick) are D2 receptor agonists (double rope ladder) that treat acromegaly by inhibiting GH secretion

MOA and uses: calcitonin

calcitonin (curator) tones down calcium and can be used in osteoporosis directly inhibits osteoclasts (grabbing classmate) promotes calcium excretion by the kidney (ice cream falling down flank)

Prevention of hypocalcemia in chronic kidney disease?

calcitriol (calci-tron stabilizing cracked kidney)

What drugs can be used for migraine prophylaxis?

calcium channel blockers (calci-yum ice cream) beta blockers (muted bugle) valproic acid (festival pro) topiramate (toupee) tricyclic antidepressants (tricycle)

Destiny of free fatty acids?

can be used by heart and skeletal muscle (muscle shells) can be converted back into TGs and stored as adipose tissue (sea foam)

Adverse effects: metronidazole

can cause a disulfiram-like reaction with alcohol - flushing, tachycardia, palpitations, N/V (no drinking on metro)

Adverse effects: dipyridamole

can cause coronary steal (stealing base)

Adverse effect: nitroprussides

can cause cyanide toxicity (blue cyanide exhaust)

Adverse effects: pegloticase

can cause hemolysis in G6PD deficiency (bite cells - watermelon with bite seeds) anaphylaxis (choking kid)

Adverse effects: GLP-1 agonists

can cause pancreatitis (squeezing pancreas sponge) only for use in TIIDM (two fingers) **but do NOT cause hypoglycemia! (candies not falling)

Adverse effects: dopamine agonists

can enhance impulse control disorders (rock and roll tattoo)

Adverse effects: bupropion

can induce seizures (shaking player) contraindicated in bulimia because it can cause seizures (shaking binge snacker) contraindicated in anorexia because it can cause seizures (shaking skinny player)

Adverse effects: partial mu-opioid agonists

can induce withdrawals (falling into withdrawal pool by blue fin)

Adverse effects: probenecid

can precipitate uric acid stones (accumulating yarn balls) can inhibit excretion of many drugs (DRUGS tattoo), including PCN (purple pencil) sulfa allergy (sulfur eggs)

Side effects: beta blockers as antiarrythmics

can prolong PR interval (public relations) can cause heart block (heart shield)

Uses: hydroxyurea

cancer (crab) veno-occlusive crisis in sickle cell anemia (zen sickle) - increases fetal hemoglobin levels (raised baby)

Uses: echinocandins

candida (Canada flag) - IV for systemic (ivy plant) esophageal candidiasis (truck pipe with snow) invasive aspergillosis (scarecrow with lung hyphae)

Adverse effects: inhaled cortiocosteroids

candida infection (Canadian snow with band)

Uses: nystatin

candida infections (Canada) topically for vaginal candidiasis (snow on crotch) oral rinse for oral candidiasis (swish and swallow drinking fountain)

MOA: 5-FU

complexes with THF and inhibits thymidylate reductase (full guy binding carbon donor) causes increased levels of dUMP (increased dumpling trays)

Adverse effects: antidiarrheals

constipation (clogged toilet)

MOA and uses: carbamazepine

carbamazepine (classic car) increases Na channel inactivation (inactivated salty chips) seizures, trigeminal neuralgia (three gems)

Uses: carbapenems

carbapenems (hover car) are broad spectrum (prism) for anaerobic infections (gas mask) or treatment resistant bacteria (when others fail sign) Pseudomonas (Mona Lisa) bacterial meningitis (red mohawk)

MOA and uses: carboprost

carboprost (cardboard box) is a PGF2 alpha (Footwear) analog that can be used to promote uterine contraction to control hemorrhage or terminate pregnancy (open uterus bag)

Adverse effects: trastuzumab

cardio toxicity (unraveling heart on tapestry)

Adverse effects: anthracyclines

cardiotoxicity - dilated cardiomyopathy (dilated bag of rubies) myelosuppression (depleted bone chest) alopecia (bald skeleton)

Function of thymidylate synthase?

catalyzes the conversion of methylated THF to DHF and dUMP to dTMP (transferring C sushi)

How does vagal stimulation affect parietal cells and G cells?

causes parietal cells to release more acid via M3 receptors (Vegas sticker on motorcycle parked in M3 spot) causes G cells to secrete more gastrin via gastrin releasing peptide (Vegas sticker on gas truck with gate release pull handle)

Function of TXA2 in clotting?

causes platelet aggregation and activation (player's box A2) vasoconstriction (COX coach twisting hat)

Function of serotonin in clotting?

causes platelet aggregation and vasoconstriction (smiley hat)

What are the 4th generation cephalosporins and what bacteria are they good for?

cefepime (general Prime) broad spectrum (prism, purple and red stations) bacterial meningitis (red mohawk) Pseudomonas (Mona Lisa)

What are the 5th generation cephalosporins and what bacteria are they good for?

ceftaroline (general Tara) broad spectrum (prism) MRSA (merciless dark lord falling)

What are the 3rd generation cephalosporins and what bacteria are they good for?

ceftazidime (general Taz), ceftriaxone (three axes), and cefotaxime even more G- coverage than 2nd gen (more red stations) 1st line empiric treatment for meningitis (red mohawk) Haemophilus influenzae (H winged ship) community/hospital acquired PNA (rusty chest plate) Pseudomonas (Mona Lisa) endocarditis from strep viridans (emperor viridan) G- GI bugs (intestinal protection) 1st line treatment for N gonorrhea (dripping uterus chandelier) Lyme disease from Borrelia burgdorferi (wanted)

What are the 2nd generation cephalosporins and what bacteria are they good for?

cefuroxime (furious), cefotetan (tea cup), cefoxitin (fox tag) G+ and extended G- coverage (purple coccoid ships and red stations) haemophilus influenzae, neisseria, serraria (red HENS)

MOA: celecoxib

celecoxib (celebrating player) selectively inhibits COX2 (dousing assistant coach in water), which is protective for patients at risk of gastric ulcers (wearing clean GI pads)

Adverse effects: ondansetron

constipation (hammer tightening gut) headache/dizziness (smiley face ball hitting head) QT prolongation/Torsades (twisted streamer) serotonin syndrome - rigidity, tremor, hyperthermia (pile of smiley face balls)

MOA: chlorpheniramine

chlorpheniramine (color fairy) is a 1st generation antihistamine to treat allergies (fairy dander)

Adverse effects: chlorpromazine

chlorpromazine (color pro) can cause yellow corneal deposits (corn yellow)

The main component of LDLs?

cholesterol esters (chests on LDL)

Uses: warfarin

chronic anticoagulation, such as for AF (TV signal) DVT (iliofemoral river) mechanical heart valves

Uses: allopurinol

chronic gout to prevent uric acid stone formation in tumor lysis syndrome, which is common after starting cytotoxic chemotherapy (TLS most common in lymphoma and leukemia) (pure nun sweeping up uric acid crystals) Lesch-Nyhan syndrome (needle in flesh)

Uses: rutiximab

chronic lymphocytic leukemia (torn tapestry with knights and archers) RA - DMARD (bone flags) immunosuppression (torn antibody flags)

What are cholesterol esters packaged into?

chylomicrons

What drugs can be used to treat acyclovir-resistant herpes?

cidofovir, because it does not require phosphorylation (security officer Cid) - directly inhibits viral DNAP (Cid hitting emergency shut off) foscarnet (fast car net) - directly inhibits viral DNAP

What is cilastin used for?

cilastin (cilastin oil) inhibits dehydropeptidase in renal tubules to prevent degradation of imipenem (Amy pouring oil into tubules)

MOA and uses: cinacalcet

cinacalcet (calculator) activates calcium sensing receptor on the parathyroid gland, decreasing production of parathyroid hormone for hypercalcemia due to hyperparathyroidism (calculating pile of calcified bones)

Side effects: class 1A antiarrhythmics

cinchonism (tin cans) quinidine thrombocytopenia (broken plates) quinidine lupus (wolf) procainamide exacerbation of heart failure (floppy heart balloon) disopyramide QT prolongation/Torsades (streamers) all

MOA and uses: cladribine

cladribine (clad in bear skin) is a purine analog (purine hammer) that inhibits DNAP (cracked replication fork) inhibits S phase of cell cycle (Stone phase) treats hairy cell leukemia (hairy man)

MOA: quinidine, procainamide, disopyramide

class 1A antiarrhythmics (prom queen, prom king, disappears headline) with moderate effect on blocking sodium channels (queen lightly holding jar) also mild blocking of K channels, so slightly prolonged phases 2 and 3 (queen pushing back curtain)

MOA: lidocaine, mexiletine, phenytoin

class 1B antiarrythmics (you lied, Mexican flag, friendly towing) with a low binding affinity for Na channels (peanut butter jar dropping) also shorten phases 2 and 3 of cycle (pulling in curtain)

MOA: flecainide, propafenone

class 1C antiarrythmics (flakes and purple phone) with strong affinity for Na channel, thus drastic slowing of phase 0 upstroke (tightly gripping peanut jar)

MOA: beta blockers as antiarrhythmics

class II antiarrythmics (duet with muted bugle) that decrease SA and AV nodal activity (heart nodes sheet music) by decreasing cAMP (broken band cAMP sign), closing Ca channels (calci-yum cartons on the ground), and decreasing the slope of phase 4 (sliding up the keys).

MOA: amiodarone, ibutilide, dofetilide, sotatol

class III (trio) antiarrythmic drugs (amigo, till I die sign, soda) that block potassium channels (pushing back banana curtain), thus elongating action potential and refractory period

MOA: diltiazem, verapamil as antiarrythmics

class IV (quartet) non-dihydropyridine (non-dairy) CCB that block calcium current in the SA/AV nodes (heart nodes). this prolongs phase 4 of cardiac cycle (sliding up the keys) that prolongs conduction time and increases refractory period (public relations guy)

MOA: clindamycin

clindamycin (keep it clean) is a bacteriostatic (paper jam) antibiotic that acts on the 50S ribosomal subunit (ribosome typewriter) to inhibit translocation

Specific uses: clotrimazole

clotrimazole (close trim) treats tinea (tin man) vaginal candida (snow on crotch)

What opioids can be used for cough prevention?

codeine (barcode on magazine of coughing guy) dextromethorphan (orphan) which antagonizes NMDA receptors (hitched nomadic camel)

MOA: colchicine

colchicine (choir singing) binds intracellular tubulin, thus preventing the polymerization of microtubules (spindly palm fronds) also disrupts cytoskeleton of neutrophils, preventing migration and phagocytosis (blocked first responders)

Site of action: spironolactone, eplerenone, amiloride, triamterene

collecting duct (central gutter)

Where does antidiuretic hormone exert its effects?

collecting duct, where it promotes aquaporin expression to increase free water absorption

Loperamide can mildly cross the BBB. How do we prevent abuse?

combine it with atropine

Mycobacterium avium complex in AIDS

common AIDS disease (immunocompromised cane) give macrolide prophylaxis when CD4 count under 50 (speed limit 50)

MOA and uses: dinoprostone

dinoprostone (dino hat) is a PGE2 analog that promotes uterine contraction/ripens cervix to promote labor or terminate pregnancy (open uterus bag)

MOA: diphenhydramine and dimenhydrinate

diphenhydramine and dimenhydrinate (dragonfly fairy) are 1st generation H1 receptor antagonists (bee swatter) to treat allergies (fairy dander)

MOA: dipyridamole, cilostazol

dipyridamole (two pyramids) and cilostazol (lost the ball) PDE inhibitors (don't foster disinterest sign) that increase cAMP (sign up for camp sign)

MOA: NNRTIs

direct binding and allosteric inhibition of HIV reverse transcriptase (arrow in reverse transcripto book) halted DNAP activity (broken double helix)

MOA and uses: aliskiren

direct renin inhibitor that blocks conversion of angiotensinogen to angiotensin I (losing at high risk slots) for HTN

MOA: bivalirudin

direct thrombin inhibitor (no intruding sign) near beaver

MOA: vancomycin

directly binds D-alanyl-D-alanine oligopeptides (D ala on wall)

MOA and uses: amphetamines

displace catecholamines into synapse (friend of mine throwing catfish into water) for ADHD and obesity

Adverse effects: ketamine

dissociative anesthesia where eyes stay open with nystagmus (dissociative gaze) unpleasant emergence reactions - vivid hallucinations cardiovascular stimulation - increased BP, HR (heart cobra)

Site of action: HCTZ, chlorthalidone, metolazone

distal convoluted tubule (distal convoluted tube slide)

MOA and uses: docusate

docusate (boat at dock being penetrated with water) is a stool softener that allows stools to be penetrated by water and fat

Benefits: mirtazapine

does not cause sexual dysfunction (kissing cam)

Benefits: bupropion

does not cause sexual dysfunction (kissing couple) less likely to cause weight gain (stay fit, lose weight)

Symptoms of hypothyroidism

fatigue, weight gain, brittle hair, cold intolerance, bradycardia can lead to hypothyroid coma - stupor, hypothermia, hyponatremia, hypoglycemia, death

MOA: febuxostat

febuxostat (stopped XO note) inhibits xanthine oxidase

How are tetracyclines excreted?

fecally (sewage pipe)

Specific uses: doxycycline

doxycycline for Borrelia, Rickettsia (ticks) Brucella (Bruce the cow) culture negative endocarditis caused by Coxiella (sheep with rusty heart bell) cervicitis/urethritis from Chlamydia (clam seat) PID from Chlamydia (uterus handlebars) bronchitis/atypical PNA from Chlamydia (clam bra) atypical walking PNA from mycoplasma (walking snowshoeing)

Uses: mannitol

draws water out of the CNS, thus useful for elevated intracranial pressure (high pressure head balloon), draws water out of the eye, thus useful for glaucoma (spilling eye cups)

Uses: adenosine as antiarrythmic

drug of choice (#1 ribbon) in terminating SVT (top of heart glowing)

Adverse effects: SGAs

dry mouth, constipation, urinary retention - especially clozapine, but less so than FGAs (tea party painting) orthostatic hypotension (passed out balloon) weight gain (fat face) dyslipidemia (elevated butter) hyperglycemia (lots of candy) EPS from D2 blockade - risperidone highest risk (whispering to hat) hyperprolactinemia from D2 blockade (milk nose) neuroleptic malignant syndrome/rhabdomyolysis (now more spicy) torsades (twisted streamer)

Uses: loop diuretics

edematous states like heart failure (lady with floppy heart balloon), pulmonary edema (inflated lung vest), ascites (water tube around stomach), HTN (high pressure pipes)

How does resistance to tetracyclines occur?

efflux pumps (efflux pump)

Adverse effects: nonbenzodiazepines

elderly are susceptible to CNS effects (confused old man) central ataxia (unbalanced stack) cannot be combined with other CNS depressants or 1st gen antihistamines (cannot combine coupons, bee swatter)

Uses: chloramphenicol

empiric meningitis in developing countries (earth ball) - S PNA, H influenza (space helmet) alternative therapy for serious Rickettsia infections like RMSF (spotted hands and feet)

Adverse effects: emtricitabine

emtricitabine (excalibur) can cause hyperpigmentation of palms and soles (dark gloves)

Function of the pol gene?

encodes for protease, reverse transcriptase, and integrase (which allows for viral DNA to integrate with host DNA)

MOA: entacapone

entacapone (Al Capone at entrance) is a peripheral COMT inhibitor that increases the availability of levodopa

What cell in the GI system releases histamine?

enterochromaffin-like cells (enter carefully sign releasing bees)

What gene encodes for the HIV envelope proteins for infiltration?

env structural proteins (envoy ship coming to shore) - gp41, gp120 env proteins are first sent to the ER (ER reef)

Vmax is directly proportional to what?

enzyme concentration

MOA: eplerenone and spironolactone

eplerenone (apple) and spironolactone (spiral notebook) antagonize the mineralocorticoid receptor (teacher and health inspector antagonizing mineral court worker)

MOA: fexofenadine, cetirizine, loratidine

fexofenadine (fox), cetirizine (satyr), and loratadine (rat) are 2nd generation antihistamines

Benefits of 2nd gen antihistamines?

fexofenadine, cetirizine, and loratadine are less lipophilic and do not cross the BBB, so there are less sedating/antimuscarinic/antiadrenergic effects (animals standing outside brain tree)

What is the fungal cell wall composed of?

ergosterol (emerald wall)

MOA and uses: erlotinib

erlotinib (Britsh Earl) is a tyrosine kinase inhibitor that blocks the epidermal growth factor receptor tyrosine kinase solid tumors with EGFR, like non-small cell lung cancer (crab on lapel)

Effect of estrogen on bone?

estrogen inhibits osteoclast precursor differentiation (female preventing class from entering) estrogen therapy NOT recommended for postmenopausal osteoporosis d/t increased risk of certain cancers

Uses: ethosuximide

ethosuximide is a narrow spectrum anti-epileptic drug for absence seizures (ethos)

Uses: etomidate

etomidate (intimidator) can be used for induction of anesthesia (introducing) can preserve cardiovascular stability (stabilizing patient)

What is SIADH?

excessive secretion of ADH, causing the body to retain too much water

Treatment of central DI?

exogenous ADH desmopressin acetate (desert mobile on brain spot) which has a high affinity for V2 receptor (V2 engine)

HDL function?

extracts cholesterol from peripheral tissues for excretion (deep sea diver putting gold cholesterol bars onto HDL)

MOA: ezetimibe

ezetimibe (Z-shaped eel) prevents cholesterol absorption at the small intestine brush border (eel blocking gold delivery)

What is the first factor to be reduced in warfarin therapy?

factor VII (injured seven deadly sins soldier)

Preferred treatment of VZV

famcyclovir, valacyclovir d/t less frequent dosing (family value with Zeus) most effective if given within 3 days of onset (3 days)

Relatively insoluble inhaled anesthetics have a *blank* onset of action and a *blank* recovery

fast (kid passed out early) fast (passed out kid getting rescued)

Adverse effects: bosentan

fatal hepatotoxicity (liver spot)

Adverse effects: mecasermin

hypoglycemia (falling candy)

Uses: acetazolamide

glaucoma because it decreases aqueous humor production (dripping eye cups), idiopathic intracranial HTN (high pressure head balloon), altitude sickness (high chair)

Treatment for B blocker toxicity

glucagon (glucagon box)

Treatment of Grave's exopthalmy?

glucocoricoids (moon face near bulging goggles)

What happens to ATP-dependent K channels when someone eats?

glucose levels rise, which increases ATP levels inside the beta cells, causing ATP-dependent K channels to close (closed fence around banana candies) closing K channels causes the beta cells to depolarize, leading to calcium influx (girl riding in on calc-yum flower) and insulin secretion

MOA: glulisine, aspart, lispro

glulisine, aspart, and lispro (girls and lads) are rapid acting, short duration (tall immediate peak) for controlling the postprandial glucose spike

Where does gamma carboxylation occur on factors II, VII, IX, and X?

glutamic acid residue (GL) on named factors

MOA: glyburide, glipizide

glyburide and glipizide are sulfonylureas that bind the ATP-dependent K channel on beta cells, causing release of endogenous insulin (sulfa swan behind closed banana gate)

gp120 function

gp120 allows for viral entry (120 battering ram) gp120 binds host cell CD4 and chemokine receptor (squire and CCR5 banner)

Side effects: ticlopidine

granulocytopenia (falling granules)

MOA: griseofulvin

griseofulvin (grease) binds fungal cell microtubules, halting mitosis (broken spindle vines)

Adverse effects: ketonazole

gynecomastia (tin man with boobs)

MOA and uses: haloperidol/1st gen antipsychotics

haloperidol (halo) is a D2 receptor antagonist in the CNS (snapping two ropes)

What is the function of chylomicrons?

have apolipoproteins A, B, C, E (E shaped flags on hot air balloons) carry triglycerides (tridents) from intestine (top row) to periphery (flying away)

Side effects: class IV antiarrythmics

heart block (heart shield) constipation (plunger) prolonged PR interval (PR guy)

Uses: vinca alkaloids

hematologic and solid cancers (cracked crab)

Uses: cyclophosphamide

hematologic and solid tumors (crab) immunosuppression (torn antibody flags)

Uses: 6MP

hematologic malignancies (antibody archers and T cell knights) immunosuppression (torn antibody flags) RA - DMARD (bone flags) IBS (inflamed colonic lanterns)

How can we prevent early hyper coagulable state when starting warfarin?

heparin bridge for the first few days (heppy hunters shooting)

Uses: lactulose

hepatic encephalopathy (relaxulose into brain/liver tank), d/t toxic buildup of ammonia compounds from a cirrhotic liver (dried up liver coral)

Adverse effects: tolcapone

hepatic failure (liver on gangster gun)

Uses: lamivudine

hepatitis B (hippo sigil)

Adverse effects: PTU, methimazole

hepatotoxicity (broken liver beaker) PTU maculopapular rash (spots on suit) agranulocytosis (sand timer) aplastic anemia (bones) drug induced lupus (wolf) ANCA associated vasculitis (red leash) PTU teratogen in 1st trimester (tarantula on math board) methimazole

Adverse effects: zilueton

hepatotoxicity (liver spot on Godzilla)

What is the rate limiting step in acyclovir metabolism?

herpesvirus encoded thymidine kinase (rate limit)

Trifluoperazine and fluphenazine are *blank* potency FGAs

high (trying to fly up on high roof)

Adverse effects: insulin therapy

hypoglycemia (falling candy) hypokalemia (eaten banana)

Predisposing factors to digoxin toxicity?

hypokalemia (guy stuck inside banana machine), renal insufficiency (cracked kidney)

Effects of hypo and hyperkalemia on EKG

hypokalemia - U waves (banana dancer pointing down) hyperkalemia - peaked T waves (banana dancer pointing up)

Adverse effects: desmopressin

hyponatremia (falling peanuts)

Adverse effects: atropine

hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, high pressure as a tea kettle

Effect on cholesterol from PCSK9 inhibitors?

huge decreases in LDL

Effect on cholesterol from fibrates?

huge decreases in serum TGs, VLDL, and LDL (trident guy falling, jellyfish on VLDL and LDL ships) mild increase in HDL (jellyfish raising HDL)

Uses: K sparing diuretics

hyperaldosteronism (crumbling mineral mountain) heart failure (floppy heart balloon) preventing cardiac remodeling (remodeling sign) amiloride for Li induced diabetes insipidus (peeing fountain) Liddle syndrome (gnome)

Adverse effects: thiazide diuretics

hypercalcemia (elevated ice cream on ladder) HLD (elevated butter) hyperglycemia (elevated candy jar) hyperuricemia (knitting needles) elevated lithium levels (lithium balloons) hypokalemia (banana peel) hyponatremia (falling peanuts) sulfa allergy (sulfur eggs) contraction alkalosis (OH- bottle)

Adverse effects: teriparatide and vitamin D

hypercalcemia (raised calci-yum)

Adverse effects: tacrolimus

hyperglycemia (elevated candy bowl) neurotoxicity (frayed wire) nephrotoxicity (falling kidney beans)

Adverse effects: protease inhibitors

hyperglycemia (elevated candy jar) dyslipidemia (elevated butter) lipodystrophy (centrally fat horse)

Adverse effects: ARBs

hyperkalemia (banana drink), teratogen (tarantula), hypotension (guy passed out), decreased GFR

Adverse effects: digoxin

hyperkalemia (banana piles), various arrhythmias (various dancers), scooped concave ST segments on EKG (ice cream scoop), bradycardia (dangling heart watch), heart block (heart shield), N/V/D (guy holding stomach), and yellow vision (yellow glow)

Adverse effects: potassium sparing diuretics

hyperkalemia (elevated bananas) type IV renal acidosis (four acid tubes)

Adverse effects: sunitinib, sorafenib

hyperkeratosis/skin rashes (sunburned, calloused hands) increased risk of hemorrhage (bleeding wound)

Adverse effects: vaptans

hypernatremia (elevated peanuts) central pontine myelinolysis - osmotic demyelination syndrome caused by too rapid correction of sodium (peanuts hitting head)

Adverse effects: bile acid resins

hypertriglyceridemia (cho-lobster scaring away tridents) gallstones (sea gall) constipation (cho-lobster clamping down on pipe) decreased absorption of fat soluble vitamins A, D, E, K (A DEcK sign) decrease statin absorption, have to be given four hours apart (cho-lobster fighting pirate)

Adverse effects: pyrazinamide

hyperuricemia, needle shaped uric acid crystal formation precipitating gout attacks (yellow needles in yarn ball on toe)

Adverse effects: heparin

hypoaldosteronism (depleted mineral mine) hyperkalemia (big K) osteoporosis (porous bone) bleeding

Adverse effect: amylin analogs

hypoglycemia (falling candies) GI effects - N/V/D (nauseated kid)

Adverse effects: sulfonylureas and meglitinides

hypoglycemia (falling candies) weight gain (fat old hag) some 1st gen sulfonylureas can cause a disulfiram-like reaction with alcohol (do not drink) only for use in TIIDM (hag with 2 fingers)

Antidote: dabigatran overdose

idarucizumab

When would you use a meglitinide over a sulfonylurea?

if the patient has a sulfa drug allergy; meglitinides are NOT sulfa drugs (gliding swan above sulfa eggs)

MOA and uses: iloprost and epoprostenol

iloprost (iLOW) and epoprostenol (ePRO) are prostacyclin (pro-cycler) analogs, causing vasodilation (dilated tube) used for pulmonary HTN (high tension pulmonary rackets)

What are interferons?

immunomodulatory cytokines released from virally infected cells (infected manager releasing cyto-coins) upregulated by interleukins (Luke)

Adverse effects: rutiximab

immunosuppression (cane) higher risk of progressive multiracial leukoencephalopathy (white laurel leaves on head) infusion reactions - headache, rash, dizziness (swollen cherub in ivy plant) serum sickness 7-10 days later - fever, rash (poisoned late)

Uses: mycophenolate motefil

immunosuppression (torn antibody flag) RA (bone flags)

D2 effects?

in CNS to modulate NT release (brain helmet on two rope swing)

What are the 1st generation cephalosporins and what bacteria are they good for?

include cephalexin (flexin' general Lex) and cefazolin (fez hat) good for G+ bacteria like staph/strep (purple coccoid ships in front of Lex) skin/soft tissue infections from staph/strep (red gloves and patches) strep pharyngitis from strep pyogenes (red bandana) UTI from G- (UTI cup) surgical prophylaxis (surgery tools)

Effects of prostaglandins?

increase vascular permeability (sprinkler on) increase pain sensitivity (guy holding knee) induce fevers (guy's hat is on fire)

Adverse effects: macrolides

increased GI motility (mud puddle) hepatotoxic (injured liver) biliary tract obstruction/acute cholecystatic hepatitis/jaundice (yellow skin) QT prolongation/torsades (EKG strip) severe delayed hypersensitivity reactions (red mask) inhibit CYP 450 (broken chrome bumper) inhibit Pgp efflux pump in intestines (broken bike pump)

Adverse effects: GP IIB/IIIA inhibitors

increased bleeding time (ketchup on clock) thrombocytopenia (broken plates)

Adverse effects: PPIs

increased risk of C diff infection (chocolate fondue spilling) increased risk of PNA (lung spots) decreased absorption of calcium, magnesium, iron (medals on wagon) increased risk of osteoporosis (fractured bone axel, porous wood) hypomagnesemia (falling magnets)

Adverse effects: SGLT2 inhibitors

increased risk of UTI from increased urinary concentrations of glucose (bladder cup) increased risk of vaginal candidiasis (snow hitting crotch) hypotension (fainting kid) contraindicated in renal insufficiency (cracked kidney tray)

Adverse effects: gliptins

increased risk of nasopharyngitis and URI (clothespin on nose) only for use in TIIDM (two fingers) **but do NOT cause hypoglycemia! (candies not falling)

Adverse effects: celecoxib

increased risk of thrombosis (thromboses ice cubes) sulfa allergy (sulfur eggs)

Thyroid hormone *blank* sensitivity to catecholamines

increases - increased number of beta receptors (bugle in tank with catfish)

B1 effects?

increases cAMP/Ca, increases HR (raised heart watch) increases contractility (jacked arm), increases renin release (umbrella), increased CO

MOA and uses: nitroprusside

increases cGMP and releases NO to cause arteriolar/venous dilation (NO exhaust on nitro pressure speed boat). Can be used in HTN emergency

Effect of parathyroid hormone on 1-alpha-hydroxylase?

increases its activity, increased production of 1,25-dihydroxyvitamin D (calcitriol) (PtHD scientist adding head to calci-tron)

Adverse effects: indinavir

indinavir (indigo princess) can cause nephrolithiasis (stones in kidney fountain) - prevented by adequate hydration (kid drinking) inhibits CYP450 (broken chrome bumper)

Uses: propofol

induction of anesthesia (introducing) maintenance of anesthesia (maintain your fantasy)

Uses: glucocorticoids

inflammatory conditions (RA, gout, asthma, IBD) immunosuppressive therapy (cracked antibody) adrenal insufficiency (exogenous moon face)

Besides albuterol, what other drug can be added for asthma therapy?

inhaled corticosteroids (moon face)

MOA: ACEi

inhibit ACE, causing less angiotensin II and decreased GFR by dilating efferent arteriole (pinched efferent end of straw). also inhibit aldosterone release (mineral bar)

Adverse effects: FGAs

long half life (long tapering flag) block muscarinic receptors - low potency more than high, causing dry mouth, constipation (tea party) orthostatic hypotension (passed out) block A1 receptors (extinguished A1 candle) block H1 receptors (bee swatter) sedation (Van Gogh's bed) extra pyramidal syndrome - high potency more than low (EPS hat on high roof) acute dystonia w/i minutes (cocked head) akathisia (uncomfortable in chair) drug-induced Parkinsonism (cog wheels) tardive dyskinesia (sticking out tongue) hyperprolactinemia - galactorrhea (elevated milk) neuroleptic malignant syndrome (now more spicy) - lead pipe rigidity (lead pipe), AMS/fever (hot), rhabdomyolysis (eaten chicken) torsades (twisted streamer) lower the seizure threshold (shaking)

Adverse effects: warfarin

long half life (tapering flag) teratogen (tarantula) early hyper coagulation because factor C (anticoagulant) degrades quickly skin necrosis (soot on soldier)

MOA: ethacrynic acid

loop diuretic that inhibits Na/K/Cl transporter (code of ethics sign). use in patients with sulfa allergies, as is not a sulfa drug (be sulfa-less on ethics sign)

MOA and uses: loperamide, diphenoxylate

loperamide (lop-eared rabbit) and diphenoxylate (dolphins) are mu-opioid agonists (mu-ssage parlor) in the gut as an anti-diarrheal agent increase colonic phasing/transit time (rabbit hopping back and forth) loperamide does not cross BBB, no potential for addiction

Thioridazine and chlorpromazine are *blank* potency FGAs

low (color theory and color pro on low ground)

Adverse effects: busulfan

lung toxicity (fibrotic lung plate) hyperpigmentation (dark skin)

MOA: macrolides

macrolides - erythromycin, azithromycin, clindamycin (crow) bind the 50S ribosomal subunit to prevent ribosomal translocation (ribosome typewriters) bacteriostatic (paper jam)

What electrolytes are often low in someone taking a loop diuretic?

magnesium (magnets), calcium (calci-yum), potassium (bananas)

Examples of osmotic laxatives?

magnesium hydroxide/citrate (magnets) polyethylene glycol (PEG drain tube) lactulose (relaxulose)

What is the name of skeletal muscle sensitivity to inhaled anesthetics or succinylcholine?

malignant hyperthermia (magnificent birthday banner)

Where is histamine stored?

mast cells and basophils (beehive)

What is efficacy?

maximal effect a drug can produce. Partial agonists have less efficacy than full agonists. Represented by Vmax

Function of insulin-like-growth-factor 1?

mediates the growth-promoting effects of GH (growing INSIDE mat) long bone growth

Adverse effects: senna

melanosis coli - brown pigmentation of the gut (brown gut)

Uses: bevacizumab

metastatic tumors (cracked crab) wet macular degeneration (wet retina pillow)

MOA: metformin

metformin (metaphor) inhibits the mitochondrial enzyme mGPD (bitten mito candy), which decreases hepatic GNG also activates AMPK, which decreases GNG (AMPKandy bag) increases insulin sensitivity (put notes INSIDE) 1st line therapy for TIIDM

MOA: methotrexate

methotrexate (meat sticks) blocks dihydrofolate reductase to prevent THF synthesis (meat sticks blocking leaf chef) causes increased levels of DHF (2 leaf boats backing up)

What steps are included in Phase II drug metabolism?

methylation, glucuronidation, acetylation, and sulfation. leads to a very polar metabolite

Uses: methylxanthines in pulmonary

methylxanthines (flyin') are for mild to severe asthma similar to caffeine (caffeine drink)

MOA: metronidazole

metronidazole (metro) forms free radical metabolites that disrupt bacterial DNA (broken helix tracks)

First intermediate of cholesterol synthesis?

mevalonic acid (evaluator of HMG crude ore thing)

Where does TB first present?

middle lobe (middle lobe bullet hole plant)

Uses: triptans

migraines (pounding head bell) cluster headaches (cluster of lanterns)

What causes nephrogenic diabetes insipidus?

nephron does not respond appropriately to ADH (golfer ignoring water boy in dry kidney spot) causing polyuria (peeing fountain) d/t lithium (lithium balloons), thiazide diuretics (thighs in fountain)

MOA: mirtazapine

mirtazapine (mirth and misery) is an atypical antidepressant that is an A2 blocker (extinguished A2 candles). A2 inhibition increases presynaptic release of serotonin and norepinephrine (smiley faces and compasses) blocks 5HT2 and 5HT3 receptors (retired 52 and 53 jerseys) inhibits H1 receptors (bee swatter)

MOA and uses: misoprostol

misoprostol (missed swing) is an NSAID that promotes protective mucus secretion by gastric mucosa (wearing gut pads) can prevent NSAID-induced peptic ulcer (missed swing on fire extinguisher) uterine contractions to promote labor or terminate pregnancy (open uterus bag)

MOA: tranylcypromine, phenelzine, isocarboxazid

monoamine oxidase inhibitors (try a sip of wine, funnel, boxed wine), which are irreversible (mouse traps)

Uses: fluoroquinolones

mostly G- bacteria (mostly red flowers) G- UTIs (bladder cup) levofloxacin/ciprofloxacin treat Pseudomonas UTI (Mona Lisa drinking UTI cup) pyelonephritis (milky kidney cup) acute prostatitis (flower down pants) G- gastroenteritis (GI feast) salmonella gastroenteritis (salmon) G- osteomyelitis (fish bones) - sickle cell patients at increased risk (sickle near fish bone) anthrax (bloody lung ax) CA PNA (rusty chest plate) atypical walking PNA from mycoplasma PNA (walking snowshoer) or Legionella (legion of ships)

What does a low Vd mean?

mostly in the intravascular compartment, bounded by plasma proteins, large/charged molecules

Besides allergy amelioration, what can 1st gen antihistamines be used for?

motion sickness/vestibular nausea (sailor outfit) because they are lipophilic and can cross BBB insomnia (sleeping fairy) extrapyramidal symptoms caused by antipsychotics, like acute dystonia (extra parking sign)

What receptor in the body mediates analgesia, sedation, and respiratory depression?

mu-opioid receptors (pain relieving acupuncture)

Uses: MTX, 5-FU, hydroxyurea

multiple cancers (cancer crab)

Adverse effects: cidofovir

nephrotoxic - metabolic acidosis, azotemia (broken kidney) - probenecid blocks tubular secretion of cidofovir, which limits the toxicity (probation officer) probenecid prevents excretion and increases plasma concentrations of many drugs

Adverse effects: cyclosporine

nephrotoxicity (fallen kidney bag) gout/hyperuricemia (big toe) HLD (butter stick) gingival hyperplasia (blowing bubble gum) hirsutism (hairy legs) nephrotoxicity (frayed wire)

MOA: bethanechol

muscarinic agonist (lots of parasympathetic activity)

MOA and uses: pilocarpine

muscarinic agonist. Causes accommodation of lens, makes you drool, pupillary constriction. Good for open and closed angle glaucoma

MOA and uses: carbachol

muscarinic agonist. Constricts pupil, relieves intraocular pressure in open-angle glaucoma

MOA and uses: methacholine

muscarinic agonist. Used as a challenge test for diagnosis of asthma

Absolute contraindication to aminoglycosides?

myasthenia gravis because it can cause neuromuscular blockade (motor end plate with sai in it)

How is isoniazid resistance conferred?

mycobacteria down regulate catalase peroxidase - Kat G (sleeping cat)

What is the causative agent of leprosy?

mycobacterium leprae (leaping armadillo)

Adverse effects: cladribine, cytarabine, gemcitabine

myelosuppresion (broken marrow) immunosuppression (cane)

Adverse effects: 6MP/azathioprine

myelosuppresion (empty bone pan) immunosuppression (cane) pancreatitis (squeezed pancreas sponge) hepatitis (liver spot) combination with xanthine oxidase inhibitors (allopurinol - pure nun) increases purine analog concentrations, increasing side effects

Adverse effects: zidovudine

myelosuppresion (empty bone) mitochondrial toxicity (mito table) anemia (pale white dress) agranulocytosis (sand timer) lipdystrophy (centrally fat horse) lactic acidosis (spilled milk)

Adverse effects: cyclophosphamide

myelosuppression (broken bone marrow) hemorrhagic cystitis (peeing blood in fountain) - can be prevented with coadministration of MESNA (maze around fountain) increases risk of bladder cancer (crab buckle over bladder) hyponatremia from SIADH (ADH bucket on head) infertility/premature menopause (dried up fertility tree)

Adverse effects: etoposide, teniposide

myelosuppression (empty bone case) immunosuppression (cane) alopecia (lost hair strands)

Adverse effects: inhaled anesthetics

myocardial depression/decreased cardiac output (deflating heart balloon) depressed respiratory function (deflating lungs) increased cerebral blood flow/decrease cerebral vascular resistance (brain hat) hepatotoxicity - halothane (liver spot on piñata) nephrotoxicity - enflurane (hit in flank) seizures - enflurane (shaking)

Adverse effects: daptomycin

myopathies (chicken leg bite) must monitor CPK levels in patients on prolonged therapy (crispy chicken)

Adverse effects: fibrates

myopathy when used with statins (jellyfish with chicken eating pirate) gallstones (sea gall)

MOA: nafcillin, oxacillin

nafcillin (pencil saber staff) and oxacillin (ox) are beta-lactam ringed (ringed planet) anti-staph PCNs with bulky R groups that prevent beta-lactamases from binding (bulky armor shielding off beta guard)

Treatment of reversal of acute opioid toxicity?

naloxone - mu opioid antagonist (no lax zone) helps maintain abstinence in heroin addicts, reduces cravings in alcoholics and smokers (beer) can induce weight loss (getting fit)

Uses: modafinil

narcolepsy (scout sleeping)

Adverse effects: lithium

narrow therapeutic window (narrow window) acute toxicity - N/V/D (early chair lifter nausea) chronic toxicity - neurologic symptoms (late chair lifter trembling, ataxia) hypothyroid (untied bowtie) nephrogenic diabetes insipidus (insipidus fountain) teratogen (tarantula) causing Ebstein's anomaly - atrialization of the RV (large right head)

Examples of aminoglycosides

neomycin, gentamicin, streptomycin

MOA: tolcapone

tolcapone (tall Al Capone) is a central and peripheral COMT inhibitor that increases the bioavailability of levodopa

What causes central diabetes insipidus?

when the pituitary does not release adequate ADH (no water boys on dehydrated brain pit)

EKG changes for someone on class 1 antiarrhytmic?

widened QRS complex, because slowing ventricular depolarization (wide QRS line on glowing heart)

Contraindications to ACEi

with NSAIDs because can cause AKI (cracked kidney case with NSAID extinguisher), bilateral renal artery stenosis (bilateral kidney straps)

Uses: flucytosine

with amphotericin, cryptococcal meningitis (red mohawk, crypt)

What do NRTIs need to be activated?

phosphorylation by cellular enzymes to be activated to triphosphate nucleotide forms (P scroll)

Uses: zidovudine

zidovudine (dove) is used during pregnancy/breastfeeding (preggo) to reduce transmission of HIV

Specific uses: erythromycin

with antitoxin for Corynebacterium diphtheria (minotaur ghost) to prevent ophthalmia neonatorum (red crow pooping on baby's eyes)

Symptoms of hyperthyroid?

palpitations, fast metabolism/weight loss, heat intolerance, anxiety, insomnia Grave's exopthalmos (bulging infrared glasses) - d/t increased volume of retroorbital connective tissue from cellular proliferation or glycosaminoglycans deposition

Adverse effects: SMX/TMP

pancytopenia (empty pan) megaloblastic anemia (red fireworks) teratogen (tarantula) - d/t antifolate effects fever/urticaria/rash from sulfa allergy (sweaty itchy red devil) hemolytic anemia in G6PD (leaky watermelon, bite cells) Steven-Johnson syndrome (sloughed off mask) type 4 RTA (scientist with 4 tubes), causing hyperkalemia (tubes in K shape) interstitial nephritis (kidney bag with blue candies) photosensitivity (flash photo) kernicterus in neonate (yellow candy corn kid) displace drugs from albumin (photos falling out of album) - like warfarin, which causes bleeding (blood) inhibits CYP450 (vandalized chrome bumper) drug-induced lupus (wolf)

Adverse effects: cetuximab

papulopustular acneiform rash (red spotted giraffe) serum sickness - 7-10 days later fever, rash (poisoned late)

Adverse effects: erlotinib

papulopustular acneiform rash (spotty rash) diarrhea (stained pants)

Function of parathyroid hormone?

parathyroid hormone (PtHD scientist) stimulates osteoblasts to express RANKL (scientist convincing osteo-builder to give crank drill) maturation of osteoblasts and increased bone formation increased renal resorption of calcium

What cells are responsible for acid secretion in the stomach?

parietal cells (pour it all) H+/K+ ATPase on luminal membrane pumps H+ into lumen (puree pump) and takes K+ out

Contraindications: aspirin

patients with AKI (NSAIDs in kidney case) pregnant women in 3rd trimester d/t fear of premature closing of ductus arteriosus (preggo lady)

Contraindications to fibrinolytic therapy

patients with active bleeding recent intracranial surgery (bloody scalpel) severe HTN (squeezing red paint bottle)

Contraindications: antidiarrheal agents

patients with bloody diarrhea or fever (red stool and candle outside mu-ssage parlor)

MOA and uses: pegloticase

pegloticase (holy water) converts uric acid to water soluble allantoin for IV use (ivy) in chronic gout

MOA and uses: pegvisomant

pegvisomant (ants on tire) is a GH receptor antagonist that treats acromegaly

MOA: penicillin

penicillin (princess Ellen) is a beta-lactam antibiotic (ringed planet) that binds PCN binding proteins, inhibiting cell wall synthesis

Contraindications: MAOi

people eating meat, cheese, wine from tyramine tyramine normally broken down by MAO-A in GI tract (white mouse eating GI meat), but if these inhibited, tyramine acts as sympathomimetic (lots of north compasses) when taking other drugs increasing serotonin - TCAs, SSRIs (tricycle)

MOA: carbidopa

peripheral DOPA decarboxylase inhibitor (police car in periphery) and increases bioavailability of levodopa by preventing peripheral conversion into dopamine

Adverse effects: vincristine

peripheral neuropathy (Christine in gloves) autonomic dysfunction - constipation (plunger) alopecia (bald monkey) myelosuppression - all vincas and taxanes (broken bone marrow)

Adverse effects: isoniazid

peripheral neuropathy (bandit in stockings and gloves) higher risk of side effects if slow acetylator - isoniazid is metabolized by N-acetyltransferase (slowly reaching for acetyl gun) promotes vit B6 excretion (six dice) - coadminister B6 with isoniazid to prevent neuropathy (ungloved hand holding dice) seizures (motion lines) hepatotoxicity (liver spot)/rise in LFTs (raised LFT flag) drug-induced lupus (wolf) anion gap metabolic acidosis (MUD PILES) inhibits CYP450 (broken chrome bumper)

What ions are responsible for the phases in fast cardiac cycle?

phase 0: sodium fast channels in phase 2 plateau: calcium in phase 3 downslope: potassium out

What ions are responsible for the phases in slow cardiac cycle?

phase 4: sodium in through funny channel phase 0: calcium phase 3: potassium out

Treatment of tyramine toxicity from MAOi

phentolamine - A1 and A2 blocker (phantom)

MOA and uses: phenytoin

phenytoin (towing truck) increases Na channel inactivation (inactivated sodium peanuts) seizures, especially acutely for management of status epilepticus (status) can be class 1B anti arrhythmic

partial B blockers

pindolol (pin), acebutolol (plastic bugle). AVOID IN HEART FAILURE PATIENTS (popped heart failure balloon)

MOA and uses: piperacillin and ticarcillin

piperacillin (piper) and ticarcillin (tiger stripes) are extended spectrum PCNs for anaerobic bacteria (gas mask) pseudomonas infections (Mona Lisa)

How do we get vitamin D2 in our diets?

plants (D2 battery near tree)

Uses: SGAs

positive and negative symptoms of schizophrenia (good and bad voices on shoulder) treatment resistant depression (hard to open bottle with happy/sad faces) OCD (obsessively neat) Tourette's - risperidone (marionette)

Uses: 1st gen antipsychotics

positive symptoms of schizophrenia (blocked positive voices on shoulder) acute psychosis (crazy kid on peak) acute agitation/aggression (agitated guy on peak) Tourette's syndrome (marionette)

What is pseudogout and how is it treated?

positively birefringent under blue light, forms rhomboid shaped crystals (blue rhomboid) treated same as acute gout (colchicine, glucocorticoids, NSAIDs)

MOA and uses: protamine sulfate

positively charged particle (positively charged sign) that binds heparin in heparin overdose (protected area)

Where is ADH released from?

posterior pituitary

Effect of adding a competitive antagonist

potency decreases. Efficacy unchanged

Effect of adding a noncompetitive antagonist

potency unchanged. Efficacy decreased

Effect on CYP450: barbiturates

potent inducers (chrome bumper)

Adverse effects: benzodiazepines

potential for addiction (addictive flavor) tolerance/downregulation of GABA-A receptor (all are welcome banner) anterograde amnesia (question mark on intubated guy) elderly patients susceptible to CNS effects (disoriented old guy) central ataxia (falling pancakes) can cause drug interactions with 1st gen antihistamines (bee swatter)

MOA: propofol and etomidate

potentiate chloride current through GABA-A receptor complex (cab A)

MOA: DPP-4 inhibitors (gliptins)

prevent breakdown of GLP-1 (dripping laundry), which increases insulin release and promotes satiety decrease glucagon secretion (falling glucagon packets) decrease gastric emptying (full stomach bag) "-gliptin" suffix - sitagliptin, saxagliptin (clipped in clothespins)

Glucocorticoid effects on neutrophils?

prevent production of neutrophil adhesion molecules (first responders blocked from adhering) so no demmargination or migration

Adverse effects: trazodone

priapism (erect trombone) orthostatic hypotension (fainting guy) sedation (sleeping players) sexual dysfunction (rejected advances) serotonin syndrome (pile of smiles)

MOA and uses: primidone

primidone (perm is done) is a barbiturate for tremors (shaking hand) and seizures

What cell reabsorbs sodium and potassium in the collecting duct of kidney?

principal cells (principal court)

MOA: probenecid

probenecid (probation officer Cid) inhibits reabsorption of uric acid in the proximal convoluted tubule (officer stopping guy from grabbing yarn out of tubule)

Adverse effects: barbiturates

profound cardiac and respiratory depression (old woman with lungs on shirt) hypotension (old lady passed out) severe CNS depression - avoid in elderly tolerance development (all are welcome) physical dependence (addicted to curls)

Effects on PT, PTT in thrombolytics?

prolong PT (paratrooper) and PTT (spitting PTTTTTT)

Uses: nonbenzodiazepines

sleep onset insomnia (sleeping customer) eszopiclone has the longest DOA and can be used for sleep onset insomnia and sleep maintenance insomnia

More soluble inhaled anesthetics have a *blank* onset of action and a *blank* duration of action

slow (kid in closer lane passed out at the end) longer (long tapering flag)

Contraindications: metoclopramide

small bowel obstruction (do not obstruct sign)

Where are free fatty acids and cholesterol absorbed?

small intestine

Synthesis of thyroid hormone?

sodium and iodine enter cell through sodium/iodine transporter (salty peanuts entering lair), concentrating iodine inside cell thyroid peroxidase oxidizes iodine to iodide (oxidized rust spots on truck) iodide residues get coupled T3 (T3 time bomb), the more potent one, and T4 are cleaved from thyroglobulin residues

Treatment for widened QRS and ventricular arrhythmia caused by TCA overdose?

sodium bicarbonate (baking soda near heart stand)

P450 inhibitors

sodium valproate, isoniazid, cimetidine, ketoconazole, flucanozole, acute alcohol abuse, chloramphenicol, erythromycin, sulfonamides, ciprofloxacin, omeprazole, metronidazole, amiodarone, ritonavir, grapefruit juice (SICKFACES.COM when I Am Really drinking grapefruit juice)

Uses: small molecule kinase inhibitors

solid and hematologic cancers (cracked crab) CML (copious pink, white, and blue granules for mature eosinophils, neutrophils, and basophils) imatinib (imitating) - blocks the BCR/ABL fusion protein (breakable sticker) from Philadelphia chromosome (Philly sticker, translocation b/w c 9 and 22) imatinib - blocks c-kit tyrosine kinase in GI stromal tumors (Congress kit, crabs on belly)

Uses: etoposide, teniposide

solid and hematologic malignancies (cracked crab)

Uses: platinum analogs

solid malignancies (cancer crab)

Uses: cetuximab

solid tumors (cracked crab)

Somatostatin effect on histamine and gastrin release?

somatostatin (stop sign) inhibits histamine release from ECL cells (on tree) and inhibits gastrin release by G cells (stop sign on gas truck)

Adverse effects: levetiracetam

somnolence (sleeping on elevator)

Adverse effects: topiramate

somnolence (sleeping soldiers) confusion/cognitive slowing (scratching head) weight loss (thin arm) kidney stones (kidney cannon balls) acute angle closure glaucoma (high pressure eye kettle)

Other uses of calcium channel blockers

stable angina (anvil), coronary vasodilation (dilated coronary crown), decreasing myocardial oxygen demand (O2 line flying away), and prinzmetal angina (anvil necklace)

MOA: statin drugs

statins (steampunk pirate) inhibit HMG-CoA reductase (knocking over crude oil thing) cause increased LDL receptor expression to clear away more LDL particles (pirate sticking load L workers)

Adverse effects: allopurinol

steven-johnson syndrome (sloughed off mask) eosinophilia (eo-slingshot granules) drug reaction with eosinophilia and systemic system (DRESS syndrome - eosinophilic dress)

Endocrine effects: glucocorticoids

stimulate GNG (liver bag producing candy) increase hepatic glycogen storage (liver filled with sugar) lipolysis (falling fatty donut jar) proteolysis (falling ham leg) decreased bone mass (fractured bone) glucocorticoid-induced psychosis (moon face confused) hypokalemia (eaten banana)

Calcitriol effect on bone?

stimulates osteoblasts to express RANKL to activate osteoclasts inhibits parathyroid hormone production (calci-tron antagonizing PtHD scientist) stimulates osteoblast formation (calci-tron teaching TA) and can be used to treat osteoporosis

The area postrema also contains NK1 receptors, which are activated by what?

substance P (substance pee check at plaNK1 bar)

What are absence seizures?

sudden lapse in awareness accompanied by staring, blinking, or clonic jerks (distracted kid) manifest as 3 Hz spike wave complex on EKG (3 spikes)

Treatment: toxoplasma gondii

sulfadiazine and pyrimethamine (Ghandi cat with dyed sulfur eggs, pyramid hat)

Uses: class 1A antiarrhythmics

supra ventricular and ventricular arrhythmias (fully lit heart) Wolf-Parkinson-White (wolf sign)

Uses: class IC antiarrythmics

supra ventricular and ventricular tachycardias (bottom and top of heart glowing) and AF (TV signal)

A2 effects?

sympatholytics (sympathy scratched out), decrease cAMP (tent) inhibit NT release (rolling up wire), decrease insulin release (rolled up insulin mat), inhibit lipolysis (putting out pig fire), decreased aqueous humor production (pouring out eyeball)

COX1 and COX2 effect on afferent arteriole?

synthesize prostaglandins that dilate the afferent arteriole (pro-slugger bat at open afferent tunnel)

How is TXA2 made?

synthesized from arachidonic acid via COX1 (AA near COX1 coach)

Function of HMG-CoA reductase?

synthesizes cholesterol in the liver (HMG crude ore thing making gold cholesterol bars)

Pathogensis: aspirin induced asthma

taking too much aspirin (which inhibits COX pathway) shifts to LOX pathway, making hella leukotrienes (ASA umpire grabbing coach cox)

Do reversible competitive inhibitors, irreversible competitive inhibitors, and noncompetitive inhibitors resemble substrate?

yes, yes, no

MOA and uses: tenofovir

tenofovir (sir Tristan) is a nucleotide (sailing the tide) hepatitis B (hippo sigil)

Adverse effects: statins

teratogen (tarantula) myopathy (bite out of chicken) elevated CK (crispy chicken bucket) mildly raised LFTs (LFT flag) metabolized by CYP450 except for pravastatin (CYP450 bumper)

Adverse effects: tetracyclines

teratogen (tarantula) - fetal teeth deposits/bone deformity decreased absorption of multivalent cations (medals) tooth discoloration in young babies (chewing ugly colored Ca medal) N/V/D (mud puddle) photosensitivity (flash photo) Fanconi syndrome with expired tetracyclines (fan cone)

MOA: teriparatide

teriparatide (teaching assistant) is recombinant PTH that stimulates maturation of osteoblasts and increases bone formation can treat osteoporosis increases calcium resorption by the kidney (TA gathering bones in kidney hole) increases activity of 1-alpha-hydroxylase, increased production of 1,25-dihydroxyvitamin D (calcitriol)

What particles is apolipoprotein B100 on?

the "bad" cholesterol LDL and VLDL (B anchor on VLDL and LDL)

On Lineweaver Burk plots, being closer to 0 on the x-axis means what?

the Km is higher. The higher the Km, the lower the affinity the enzyme has for the substrate

How are bile salts made?

the liver metabolizes them from cholesterol and conjugates them to become water soluble (sea gall getting loaded by liver station worker) then secreted into the biliary tract (sea gall exiting liver station and flying up biliary structure) most bile salts/acids are recycled

On Lineweaver Burk plots, being closer to 0 on the y-axis means what?

the Vmax is higher

Function of the area postrema?

the area postrema (extreme postures next to NTS) is adjacent to the NTS (in 4th ventricle, outside BBB) and responds to emetogenic substances, like chemo drugs

What is the minimum alveolar concentration (MAC)?

the dose of an anesthetic that causes 50% of people to become unresponsive to painful stimuli (1 of 2 kids passed out near mac and cheese)

What does a higher blood:gas partition coefficient mean?

the drug has a higher solubility and thus a slower onset of action (less steep slope on graph)

Specific uses: miconazole

topical miconazole (my cone) treats tinea vaginal candida (snow on crotch)

MOA: topiramate

topiramate (toupee) increases Na channel inactivation (inactivated basket of peanuts) and allosterically binds GABA-A receptor (shaking cab driver's hand)

MOA and uses: tramadol

tramadol (train) is a partial mu-opioid agonist and norepinephrine/serotonin reuptake inhibitor (north-south compass) for chronic pain management

Function of reverse transcriptase?

transcribes viral RNA into double stranded DNA inhibited by NRTIs and NNRTIs

Function of VLDLs?

transfer TG from liver to periphery

Function of thrombin (factor II)?

transforms fibrinogen into fibrin (throm-beaver preparing stick for fibrin clot)

Effects of renal V2 activation by ADH?

translocation of aquaporins to the apical membrane of the collecting duct to promote free water reabsorption (translocating free water at S hole)

MOA: trazodone

trazodone (trombone) is a serotonin modulator that inhibits 5HT reuptake and antagonizes 5HT receptors (smiley face drummer) inhibits 5HT2 receptors (retired 52 jersey) antagonizes A1 receptors (extinguished A1 candle) antagonizes H1 receptors (bee swatter)

Uses: class IV antiarrhythmics

treat SVTs (glowing top of heart) AF/flutter (TV signal) and rate control to prevent RVR (metronome)

Uses: bethanechol

treating non-obstructive GI dysmotility, urinary retention

Uses: andexanet alfa

treatment of apixaban or rivaroxiban overdose

Uses: cilostazol

treats claudication from PVD (dirt on legs) can cause coronary artery vasodilation (red crown)

MOA: imipramine, amitriptyline, nortriptyline

tricyclic antidepressants (imprint, tripping) that inhibit presynaptic uptake of serotonin and norepinephrine (north south compass) also block H1 histamine receptors (bee swatter) and A1 receptors (extinguished alpha candle)

What makes up most of a chylomicron?

triglycerides (tridents in chylomicron hot air balloons)

MOA: triptans

triptans (sumo wrestler) are 5H1b and 5H1d receptor agonists (making b and d with fingers), which cause vasoconstriction (tightening head band) of cerebral vessels receptors found on meningeal vessels (headband), brain stem (hair stem)

Function of dihydrofolate reductase?

turns dihydrofolate into tetrahydrofolate (chef adding two leaves, becomes four leaf boat) THF is then re-methylated to restart the cycle (boat gets C sushi)

Adverse effects: PCN

type I hypersensitivity reaction (IgE missiles) drug-induced autoimmune hemolytic anemia (exploding RBC asteroids) - IgG antibodies bind against PCN on the surface of RBCs (antibody on RBC asteroid) drug-induced interstitial nephritis (kidney star with blue spots)

How are catecholamines made?

tyrosine -> L-DOPA -> dopamine (tire in water to dope rope) dopamine -> norepinephrine in presynaptic neuron vesicle (sea vessel with north compass)

MOA: unfractionated heparin

unfractionated heparin (heppy hunting father) binds antithrombin III (three bars on cage), which inactivates thrombin and factor Xa (throm-beaver and fox in cage)

Adverse effects: bisphosphonates

upper GI effects - esophagitis, GERD (corroded neck) osteonecrosis of the jaw (falling jaw bone) hypocalcemia (fallen calci-yum ice cream)

Effect on HMG-CoA reductase from ezetimibe?

upregulates it since cholesterol absorption is now blocked and liver has to make more (HMG crude oil thing)

MOA: magnesium as antiarrythmic

useful to stop Torsades de Pointes (magnet guy in streamers)

Uses: valgancyclovir

valgancyclovir (value) has better oral availability (open mouth) and it/ganicyclovir are for high risk transplant recipients (organs on ice)

MOA: valproate

valproate (festiVAL) increases Na channel inactivation (inactivated salty peanuts) and GABA levels in the CNS (elevated cab)

Other drugs for bipolar disorder?

valproate - acute and maintenance (festiVAL) carbamazepine - acute and maintenance (classic car) lamotrigine - maintenance only (llama) 1st and 2nd gen antipsychotics - acute only (psychotic painting)

What bacteria are susceptible to vancomycin?

vancomycin (van) has activity against G+ staph/strep (purple coccoid temples) MRSA (merciless dark lord) staph aureus (golden rod) empiric treatment of bacterial meningitis with ceftriaxone (red mohawk) MRSA osteomyelitis (fishbones) nosocomial MRSA infections (coughing nurse) staph epidermidis (biofilm on car valves) endocarditis (heart shaped staff) enterococcus (diplococcus drums) C diff (temple of flowing chocolate)

Where is COX2 expressed?

vascular endothelial and smooth muscle cells (assistant coach in endothelial dugout)

Where are extra renal V2 receptors located?

vascular endothelium (endothelial tile)

Effects of renal V1 activation by ADH?

vasoconstriction on vascular smooth muscle, increase BP (constricted club with steam in ears on Q hole)

Adverse effects: propofol

vasodilation/hypotension (dilated sleeves)

Uses: class 1B antiarrhytmics

ventricular arrythmias (only lower part of heart glowing) special preference for ischemic tissue, like post-MI (you're dead to me sign)

MOA: warfarin

warfarin (warhead) inhibits VKOR (warhead destroying supply boat) prevents activation of vitamin K

P450 substrates

warfarin, anti-epileptics, theophylline, OCPs (War against the OCPs)

How does the vestibular system communicate with the nucleus tractus solitarius?

via CN VIII (vests at the semicircular canal) vestibular system is responsible for motion sickness (vest guy puking)

How does the GI system communicate with the nucleus tractus solitarius?

via CN X (welcome to Vegas sign)

MOA: vigabatrin, tiagabine

vigabatrin and tiagabine increase GABA (raised cab) vigabatrin - irreversibly inhibits GABA transaminase, which decreases GABA degradation (cab transmission) tiagabine - inhibits GABA reuptake (tied up cab driver)

MOA: vinca alkaloids

vincristine (Christine in vines) and vinblastine (blasting vines) inhibit microtubule production and prevent mitotic spindle assembly (broken vines)

Function in clotting: vitamin K

vitamin K (vit K medic) needed for gamma carboxylation (gamma bandaid) of clotting factors II (beaver), VII (deadly sins devil), IX (nine lives cat), X (fox), and anticlotting factors protein C (corporal), and protein S (sergeant)

Besides central DI, what else can desmopressin treat?

von Willebrand disease by causing release of vWF (desert mobile on von Wille tables) hemophilia A (A-shaped frame) night enuresis (wet mattress)