First Aid Classic/Relevant Treatments

Petrolatum (petroleum jelly: emollient that provides a BARRIER to the skin to lessen water loss --> forms an occlusive coating on surface of stratum corneum to retain moisture within skin --> prevents transepidermal water loss)

Treatment for dry, cracked, desquamated skin

IV insulin (insulin increases Na+/K+ ATPase pump, which drives K+ into cells --> increases intracellular K+ and decreases serum K+ levels --> REQUIRED to give glucose + IV insulin to prevent life-threatening hypoglycemia)

Treatment for hyperkalemia

Neostigmine (AChE inhibitor that increases ACh in synaptic cleft --> quaternary amine so does NOT cross BBB)

Treatment for post-op and neurogenic ileus, urinary retention, myasthenia gravis, and reversal of NMJ blockade post-op

Oxytocin (usually used to induce labor/stimulate uterine contractions but also used to control uterine hemorrhage)

Treatment for postpartum hemorrhage

Amphotericin B

Treatment for primary amoebic meningoencephalitis (caused by Naegleria fowlerii infection)

Cabergoline or bromocriptine (dopamine antagonists)

Treatment for prolactinoma

Flutamide

Treatment for prostate adenocarcinoma

Cholestyramine (bile acid-binding resin: binds negatively-charged bile acids/salts in small intestine --> excreted in feces --> prevents bile acids from returning to liver --> increased conversion of cholesterol into bile acid in liver --> reduces cholesterol pool AND up-regulates LDL receptors, significantly increases TG levels in patients with pre-existing TG and does not appear to reduce CV events --> side effect: increased hepatic production of TGs, increased release of VLDL, and binds warfarin in intestine so it DECREASES warfarin levels, thus decreasing INR/PT)

Lipid-lowering agent contraindicated in someone with hypertriglyceridemia

Niacin (vitamin B3: inhibits hormone-sensitive lipase to inhibit lipolysis in adipose tissue, as well as reduces hepatic VLDL synthesis and secretion --> also reduces hepatic synthesis of TGs and decreases release of FFAs from fat stores --> also reduces LDL and increases HDL --> MOST EFFECTIVE at raising HDL --> less effective than statins or BARs but very cheap, so often used in developing countries --> side effects: facial flushing, hyperglycemia, hyperuricemia)

Lipid-lowering agent that antagonizes VLDL cholesterol secretion

Niacin (vitamin B3: inhibits hormone-sensitive lipase to inhibit lipolysis in adipose tissue and reduces hepatic VLDL synthesis/secretion --> reduces TGs and reduces release of FFAs from fat stores --> also reduces LDL and increases HDL --> less effective than statins or BARs but very cheap, so often used in developing countries --> side effects: facial flushing, hyperglycemia, hyperuricemia that can cause gout)

Lipid-lowering agent that causes flushing, hyperglycemia, and hyperuricemia

Ezetimibe (blocks NPC1L1 in small intestine brush border --> blocks transport of cholesterol into intestinal cells --> cholesterol is excreted via lumen --> side effects: severe diarrhea)

Lipid-lowering agent that prevents cholesterol absorption in small intestine

Fibrates (Gemfibrozil, Bezafibrate, Fenofibrate: inhibition of 7-alpha-hydroxylase increases risk of cholesterol gallstones --> MAO: activate PPAR-alpha which increases transcription of lipoprotein lipase to increase TG clearance --> increases breakdown of VLDL and TGs to drastically lower TG levels and raise HDL levels, but less effect on LDL than statins --> used to treat hypertriglyceridemia as it lowers risk of pancreatitis --> side effects: myopathy when combined with statins + cholesterol gallstones)

Lipid-lowering drug that inhibits 7-alpha-hydroxylase (risk of cholesterol gallstones)

Alirocumab and evolocumab (PCSK9 inhibitors: inhibits degradation of LDL receptors --> increased LDL receptors on hepatocyte membranes to increase clearance of LDL from blood --> side effects: myalgia, delirium, dementia, other CNS symptoms)

Lipid-lowering drugs that block LDL receptor degradation

Zoster vaccine (live attenuated vaccine given to prevent shingles)

Live attenuated vaccine recommended for adults >60y/o and HIV patients with CD4 >200

Ca2+ supplement and bone density monitoring (PPIs such as omeprazole, lansoprazole, esomeprazole, etc: irreversibly inhibit H+/K+ ATPase in parietal cells --> inhibit H+ secretion into gastric mucosa --> used to treat gastric/duodenal and NSAID-induced ulcers, gastritis, GERD, Zollinger-Ellison syndrome, part of H. pylori therapy, stress ulcer prophylaxis --> side effects: C. diff infection, pneumonia, acute interstitial nephritis, decreased absorption of divalent cations Ca2+/Mg2+/Fe2+, low serum Ca2+ causing increased risk of falls in elderly --> elderly patients should be given Ca2+ supplements and have bone density monitoring)

Special considerations for elderly patients on proton pump inhibitors

Sulfonamides, sulfasalazine, sulfonylureas, probenecid, furosemide, acetazolamide, celecoxib, thiazides (risk of mild to life-threatening symptoms in patients with sulfa allergy --> associated with fever, UTIs, SJS/TEN, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, urticaria/hives)

Sulfa drugs

Itraconazole or oral potassium iodide

Treatment for Sporothrix schenckii (rose gardener's disease --> ascending lymphangitis)

Iron chelation and gastric lavage (use deferoxamine, deferasirox, or deferiprone)

Treatment for acute iron poisoning

Adenosine (anti-arrhythmic that causes transient conduction delay thru AV node by increasing K+ efflux --> hyperpolarizes AV nodal tissue to decrease AV node conduction for 10-15s --> side effects: flushing, hypotension, chest pain, sense of impending doom, bronchospasm)

Treatment for acute termination of PSVT

Fresh frozen plasma

Treatment for acute warfarin reversal

Bevacizumab (anti-VEGF monoclonal antibody --> inhibits vascular endothelial growth factor, thus targeting neovascularization in eyes --> also used to treat neovascular macular degeneration and proliferative diabetic retinopathy --> can also be used to inhibit angiogenesis in solid tumors --> side effects: hemorrhage, blood clots, impaired wound healing)

Treatment for age-related wet macular degeneration and proliferative diabetic retinopathy

Tiotropium (long-acting muscarinic anatgonist/LAMA: blocks M3 receptors in bronchial smooth muscle --> decreased IP3/Ca2+ --> causing bronchodilation, mucus glands causing decreased mucus secretion, and vagus nerve causing decreased bronchoconstriction/mucus secretion --> side effects: anticholinergic symptoms such as dry mouth, mydriasis, urinary retention, tachycardia, constipation)

Treatment for airway symptoms in mild COPD

Beta-blockers, benztropine, or benzodiazepines (beta-blockers: block B1 and B2 adrenergic receptors to decrease tremors --> benztropine: blocks mACh receptors in CNS to reduce acute dystonia --> benzodiazepines: increase FREQUENCY of Cl- channel opening in GABA-A receptor to cause CNS depression)

Treatment for akathisia (restlessness) caused by typical antipsychotics

Lorazepam, Oxazepam, Temazepam (drinking a "LOT" requires a LOT: do NOT require metabolization by liver into active metabolites, so useful for treating patients with hepatic insufficiency --> still bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening to reduce psychomotor agitation/tremors/delirium tremens in acute alcohol withdrawal --> side effects: higher addictive potential due to short effects, possible breakthrough seizures due to acute benzo withdrawal)

Treatment for alcohol withdrawal in patients with cirrhosis/hepatic insufficiency

Bendazoles (causes microtubule dysfunction which immobilizes worms --> NOTE: immobilization of large # of worms can cause obstruction)

Treatment for all intestinal nematodes

Praziquantel (increases Ca2+ permeability of parasite membranes to induce vacuolization --> solo treatment for Diphyllobothrium latum, Schistosoma, Clonorchis, and Paragonimus --> combine with albendazole for Taenia solium)

Treatment for all tapeworms and flukes (EXCEPT Echinococcus granulosus)

Metronidazole (forms toxic free radicals that damage DNA --> side effects: disulfiram-like reaction with alcohol, headache, metallic taste --> NOTE: can also give paromycin or iodoquinol for asymptomatic cyst passers, which are luminal agents that eliminate cysts in intestinal lumen to decrease transmission)

Treatment for amebiasis (Entamoeba histolytica infection)

Caspofungin (echinocandin anti-fungal drug: inhibits synthesis of beta-glucans to inhibit fungal cell wall synthesis --> used to treat resistant systemic Candida infections and invasive aspergillosis --> side effects: flushing and GI upset)

Treatment for amphotericin-resistant systemic Candida albicans infection

Clindamycin (bind to 50S ribosomal subunit to block translocation/peptide transfer ---> effective against anaerobic gram-negative rods such as Bacterioides, Fusobacterium, Peptococcus in aspiration pneumonia/LUNG ABSCESS/oral infections --> also effective against gram-positives such as invasive group A strep infections, gas gangrene caused by C. perfringens, moderate to severe inflammatory acne caused by Cutibacterium --> 2nd line treatment against gram-variable Gardnerella vaginalis and combined with gentamicin to treat endometritis --> side effects: pseudomembranous colitis)

Treatment for anaerobic infection above diaphragm (ex: lung abscesses)

Metronidazole (forms toxic free radical metabolites in bacterial cell that damage DNA --> used to treat Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, GI anaerobic infections such as Bacterioides/C. difficle --> side effects: disulfiram-like reaction with alcohol, metallic taste, headaches, paresthesia, dizziness)

Treatment for anaerobic infection below diaphragm (ex: intra-abdominal abscesses)

Epinephrine (stimulates all adrenergic receptors: stimulation of A1 causes vasoconstriction of cutaneous and viscera vasculature, increasing BP --> stimulation of B1 increases CO and BP to further improve peripheral perfusion --> stimulation of B2 results in bronchodilation)

Treatment for anaphylactic shock

Exogenous EPO

Treatment for anemia of chronic disease due to cancer

Amphotericin B (binds ergosterol in fungal cell membranes to create membrane pores and allow leakage of electrolytes --> side effects: nephrotoxicity thus supplement with K+ and Mg2+, fever/chills, hypotension, arrhythmias, anemia, IV phlebitis)

Treatment for angioinvasive aspergillosis

Heparin (unfractionated heparin derived from endogenous heparin in mast cells --> binds to antithrombin III via pentasaccharide in heparin chain --> results in conformation change of ATIII to inhibit factor Xa and neutralize thrombin, promoting IMMEDIATE anti-coagulation --> does NOT cross placenta so safe for pregnancy)

Treatment for anticoagulation during pregnancy

Lidocaine or mexiletine (Class IB anti-arrhythmics: ischemic myocardium has higher resting MP than normal myocardium, delaying voltage-dependent recovery of Na+ channels from inactivated to resting in phase 3 repolarization --> class IB antiarrhythmics such as lidocaine and mexiletine both slow phase 0 depolarization and SHORTEN phase 3 repolarization by very quickly dissociating from Na+ channels, thus DECREASING AP duration --> preferentially affects ischemic Purkinje and ventricular tissue, thus highly effective against ventricular arrhythmias)

Treatment for arrhythmia in damaged cardiac tissue (aka acute ventricular arrhythmias post-MI)

Dimercaprol and succimer (dimercaprol: displaces arsenic irons from sulfyhydryl groups of enzymes involved in cellular respiration and allows chelation of non-toxic soluble metabolites --> succimer: also used for chelation)

Treatment for arsenic and mercury poisoning

Surgical debridement and voriconazole

Treatment for aspergillomas

Sodium bicarbonate (used to alkalinize urine, which prevents aspirin absorption as it requires an acidic environment)

Treatment for aspirin overdose (salicylate toxicity)

Paromycin or iodoquinol (luminal agents that eliminate cysts in intestinal lumen to decrease transmission)

Treatment for asymptomatic cyst passers with Entamoeba histolytica cysts

Atovaquone and azithromycin

Treatment for babesiosis (caused by Babesia infection)

Amoxicillin (beta-lactam antibiotic that is same as penicillin but with wider spectrum due to improved activity against gram-negative bugs --> can treat S. pneumoniae, H. influenzae, and Moraxella catarrhalis which are the 3 most common causes of sinusitis/otitis media --> side effects: SJS, drug-induced liver injury, maculopapular rash if given to patients with infectious mono)

Treatment for bacterial sinusitis and otitis media

Metronidazole or Clindamycin (Metronidazole: forms toxic free radicals that damage DNA, SE include disulfiram-like reaction with alcohol/headaches/metallic taste --> Clindamycin: inhibits 50S subunit to inhibit protein synthesis, SE include C. diff colitis/fever/diarrhea)

Treatment for bacterial vaginosis (caused by Gardnerella vaginalis)

Flumazenil (competitive inhibitor at benzodiazepine receptor in GABA-A --> used to reverse benzodiazepine sedation following general anesthesia, procedural sedation, overdose --> in rarely used because it can cause immediate benzo withdrawal, which causes seizures)

Treatment for benzodiazepine toxicity

Atropine, glucagon, and saline

Treatment for beta-blocker overdose

Saline, atropine, glucagon (beta-blocker overdose: seen in patients with pheochromocytoma or cocaine toxicity who take beta-blockers --> results in "unupposed alpha" aka unopposed alpha-1 antagonism that may lead to hypertensive crisis)

Treatment for beta-blocker overdose

Suramin

Treatment for blood-borne Trypanosoma brucei infection

Acetazolamide (carbonic anhydrase-inhibiting diuretic --> acts on PCT to produce NaHCO3 diuresis --> results in bicarb depletion and metabolic acidosis --> has self-limited diuretic but persistent bicarb-depleting action)

Treatment for both glaucoma and altitude sickness

Leuprolide (long-acting GnRH analog: needs to be given in CONTINUOUS stimulation to suppress pituitary LH release to reduce production of testosterone by Leydig cells/estrogen by granulosa cells --> NOTE: can initially cause transient rise in LH/testosterone on initial administration --> side effects: hypogonadism, low libido, ED, nausea, vomiting)

Treatment for both prostate adenocarcinoma and uterine fibroids

Tamoxifen (SERM: blocks estrogen receptors in breast tissue, but serves as AGONIST to estrogen receptors in endometrium --> side effects: endometrial hyperplasia/carcinoma and increased risk of thromboembolic events)

Treatment for breast cancer that increases risk of endometrial polyps

CBT, nutritional rehab, and Fluoxetine (SSRI)

Treatment for bulimia nervosa

100% O2 and hyperbaric O2 (hastens dissociation of CO from carboxyhemoglobin)

Treatment for carbon monoxide poisoining

Octreotide (somatostatin analog: inhibits secretion of bioactive peptides from carcinoid tumor --> side effects: steatorrhea, increased risk of cholelithiasis due to CCK inhibition)

Treatment for carcinoid syndrome

Pericardiocentesis (decompresses pericardial sac --> allows increased ventricular filling and greater cardiac output)

Treatment for cardiac tamponade

Dobutamine (beta-1 agonist with weak beta-2 and alpha-1 activity: stimulates beta-1 receptors on myocytes, causing Gs-GTP binding/activation of AC/production of cAMP --> cAMP increases intracellular Ca2+ concentration, freeing myosin-binding site and increasing myocardial contractility --> increased cAMP also increases Na+ and Ca2+ channel activation in pacemaker cells, thus making the drug both positive INOTROPIC and CHRONOTROPIC agent --> in blood vessels, mild alpha-1 activity causes vasoconstriction while beta-2 activity causes some vasodilation, resulting in a balanced mild vasodilation --> thus, increased cardiac contractility + decreased SVR + NO CHANGE in BP improves CO and end-organ perfusion in patients with severe LV systolic HF and cardiogenic shock)

Treatment for cardiogenic shock

Gluten-free diet (symptoms should resolve with weeks --> followed by normalization of histology and antibody levels)

Treatment for celiac disease

Desmopressin (ADH analog: stimulates V2 receptors ONLY on kidney collecting ducts --> increased insertion of aquaporin channels on principal cells of CDs --> increases H2O reabsorption to increase urine concentration and retain body water --> used to treat central DI and sleep enuresis --> ALSO used to treat von Willebrand disease and hemophilia A because it pushes stored vWF and factor 8 out of endothelial cells --> side effects: hypervolemia, hyponatremia)

Treatment for central diabetes insipidus

Ondansetron, metroclopramide, aprepitant (ondansetron: inhibits 5-HT3 receptor on CTZ, SE include prolonged QT/torsades de pointes and serotonin syndrome --> metoclopramide: inhibits D2 receptor on CTZ, SE include EPS/Parkinsonian features/depression/elevated prolactin/neuroleptic malignant syndrome --> aprepitant: inhibits NK1 receptors on CTZ, very few SE)

Treatment for chemotherapy-induced vomiting

Aciclovir (uses HSV/VZV viral kinase to form triphosphate --> preferentially inhibits viral DNA polymerase --> given to children <12y/o and immunocompromised patients)

Treatment for chickenpox

Doxycycline and ceftriaxone

Treatment for chlamydia/gonorrhea co-infection

Topical erythromycin (given as eye ointment to prevent neonatal blindness)

Treatment for chlamydial conjunctivitis in infants

Mefloquine or atovaquone/proguanil (note: CANNOT use primaquine in chloroquine-resistant malaria because it is not effective against erythrocyte form of plasmodia, aka merozoites and trophozoites)

Treatment for chloroquine-resistant malaria

Class IB and Digoxin (shorten duration of AP --> manifests as shortened QT interval on ECG)

Anti-arrhythmics that SHORTEN QT interval

Quinidine, Procainamide, Disopyramide (class IA anti-arrhythmics: block Na+ channels to decrease slope of phase 0 depolarization --> also have some K+ blocking effect that increases ERP and prolongs phase 3 repolarization, thus INCREASING AP duration --> used for re-entrant and ectopic SVT and VT --> side effects: cinchonism, thrombocytopenia, torsades de pointes due to prolonged QT)

Anti-arrhythmics that mainly slow phase 0 depolarization, with moderate prolonged phase 3 repolarization

Verapamil and diltiazem (class IV anti-arrhythmics: block L-type Ca2+ channels in cardiac pacemaker cells --> slow down phase 4/spontaneous depolarization AND phase 0/depolarization to reduce conduction velocity thru SA and AV nodes, thus slowing sinus rate --> also slows recovery of inactivated Ca2+ channels in phase 3, thus prolonging ERP/repolarization --> used as prophylaxis/rate control for atrial flutter, AFib, and recurrent nodal tachyarrhythmias such as PSVT --> side effects: constipation, bradycardia, systolic HF, gingival hyperplasia, contraindicated in patients taking beta-blockers)

Anti-arrhythmics that prolong PR interval

Flecainide and Propafenone (class IC anti-arrhythmics: blocks Na+ channels to STRONGLY decrease slope of phase 0 depolarization --> has slow rate of receptor dissociation, causing NO CHANGE in AP duration or QT interval duration --> LENGTHENS QRS duration in use-dependent manner, aka increased Na+-blocking effects with increased HR due to less time for medication to dissociate from receptor --> preferentially affects highly depolarized tissue, such as in AV node and accessory bypass tracts --> used to treat SVTs including AFib, useful against tachyarrhythmias due to use dependence --> side effects: pro-arrhythmias at high HRs due to rate-dependent prolonged QRS)

Anti-arrhythmics that slow phase 0 depolarization and have slow rate of receptor dissociation

Lidocaine and Mexiletine (class IB anti-arrhythmics: block Na+ channels to WEAKLY decrease slope of phase 0 depolarization --> also blocks "plateau" Na+ current to shorten phase 3 repolarization, thus DECREASING AP duration --> preferentially affects ischemic or depolarized Purkinje/ventricular tissue --> used to treat post-MI ventricular arrhythmias)

Anti-arrhythmics that slow phase 0 depolarization and shorten phase 3 repolarization

Warfarin (cannot use for HIT because history of HIT increases risk of warfarin skin necrosis --> vitamin K reductase inhibitor: decreases production of factors 2/7/9/10, thus inhibiting extrinsic pathway --> initial depletion of factor 7 causes early rise in PT --> later depletion of factor 2 causes peak PT, usually ~3 days after warfarin initiation --> therefore, warfarin has GRADUAL increase that will level off after a few days --> long-term anticoagulant required for thrombogenic prosthetic mitral valves that may cause systemic emboli, VTE prophylaxis, stroke prophylaxis in patients with AFib --> side effects: warfarin skin necrosis, bleeding, teratogenic due to crossing placenta, levels INCREASE with CYP450 inhibitors and DECREASE with CYP450 inducers --> require regular PT/INR monitoring)

Anti-coagulant contraindicated in treatment of heparin-induced thrombocytopenia

Warfarin (vitamin K reductase inhibitor: decreases production of factors 2/7/9/10, thus inhibiting extrinsic pathway --> initial depletion of factor 7 causes early rise in PT --> later depletion of factor 2 causes peak PT, usually ~3 days after warfarin initiation --> therefore, warfarin has GRADUAL increase that will level off after a few days --> long-term anticoagulant required for thrombogenic prosthetic mitral valves that may cause systemic emboli, VTE prophylaxis, stroke prophylaxis in patients with AFib --> side effects: warfarin skin necrosis, bleeding, teratogenic due to crossing placenta, levels INCREASE with CYP450 inhibitors and DECREASE with CYP450 inducers --> require regular PT/INR monitoring)

Anti-coagulant that inhibits vitamin K epoxide reductase

Abciximab, eptifibatide, tirofiban (bind to Gp2b/3a proteins on activated platelets to prevent binding to fibrinogen, thus inhibiting platelet aggregation --> used to treat unstable angina, and given to patients before undergoing percutaneous coronary intervention --> side effects: bleeding and thrombocytopenia)

Anti-coagulants that directly inhibit Gp2b/3a proteins

Apixaban and rivaroxaban (direct factor Xa inhibitors that can be given ORALLY: used as prophylaxis and treatment for DVT/PE and stroke prophylaxis for patients with AFib --> does NOT require lab monitoring when taken orally --> lab findings: increased PT/PTT, no effect on thrombin time --> side effects: bleeding, which is not easily reversible)

Anti-coagulants that directly inhibit factor 10a

Bivalirudin, Argatroban, Dabigatran (direct thrombin inhibitors: directly inhibit activity of free- and clot-associated thrombin --> used to treat DVT, AFib, and heparin-induced thrombocytopenia --> useful because it DOES NOT require lab monitoring, and Dabigatran is oral agent --> side effects: bleeding)

Anti-coagulants that directly inhibit thrombin (factor 2a)

Clopidogel, prasugrel, ticagrelor, ticlopidine (ADP receptor inhibitors: irreversibly block ADP/P2Y12 receptor to prevent expression of Gp2b/3a proteins on platelet surface --> inhibit binding to fibrinogen and platelet aggregation --> used for acute coronary syndrome, given before coronary stenting, and decreases incidence/recurrence of thrombotic strokes --> side effects: TTP, ticlopidine causes neutropenia)

Anti-coagulants that inhibit ADP receptors

Cilostazol and dipyridamole (anti-platelet PDE inhibitors: increase cAMP in platelets to inhibit platelet aggregation, and also cause coronary vasodilation --> used to treat intermittent claudication/PAD, coronary vasodilation especially in cardiac stress testing, and combined with aspirin to prevent strokes/TIAs --> side effects: nausea, headache, facial flushing, hypotension, abdominal pain)

Anti-coagulants that inhibit platelet PDE

Phenytoin (narrow-spectrum anti-convulsant that promotes Na+ channel INACTIVATION: inhibits neuronal high-frequency firing by reducing ability of Na+ channels to recover from inactivation --> used to treat partial seizures and SECONDARY tonic-clonic seizures --> zero-order kinetics: rate of elimination is constant and does not depend on/vary with diff drug dose or plasma concentration of drug, so very narrow therapeutic index --> side effects-PHENYTOIN: CYP450 induction, hirsutism, enlarged gums/gingival hyperplasia, nystagmus, yellow-brown skin, teratogen, osteopenia, inhibits folate absorption, neuropathy --> rarer side effects include SJS/TEN, DRESS syndrome, drug-induced lupus, diplopia/ataxia/sedation)

Anti-convulsant associated with gingival hyperplasia, hirsutism, and osteopenia

Mycophenolate mofetil (reversibly inhibits IMP dehydrogenase, a critical step in de novo purine synthesis --> selectively targets lymphocytes, reducing B and T cell proliferation and inducing T-cell apoptosis --> used to treat lupus nephritis and as adjunct to transplant rejection --> side effects: pancytopenia, HTN, hyperglycemia, invasive CMV infection)

Immunosuppressant drug associated with invasive CMV infection

Glucocorticoids (Prednisone: binds to cytoplasmic receptors that translocate to nucleus and interact with GC receptor elements to decrease transcription of cytokines/adhesion proteins --> also inhibits NFkB and induces T-cell apoptosis --> used to treat transplant rejection as part of cocktail, many autoimmune conditions, asthma, CLL, non-Hodgkin lymphoma --> side effects: Cushing syndrome, osteoporosis, hyplerglycemia/diabetes, amenorrhea, adrenocortical atrophy, peptic ulcers, psychosis, cataracts, avascular necrosis of femoral head)

Immunosuppressant that interacts with nuclear response elements to decrease production of inflammatory cytokines/adhesion proteins

Basiliximab and daclizumab (Basiliximab: used for kidney transplant rejection prophylaxis, SE include edema/HTN/tremor --> Daclizumab: used to treat relapsing multiple sclerosis)

Immunosuppressants that block IL-2 receptor

Aldesleukin and IFN-alpha (Aldesleukin: IL-2 analog that enhances T cell response against tumor --> IFN-alpha: up-regulates MHCI expression of tumor cells to enhance CD8+ killing, SE include flu-like symptoms, neutropenia, myopathy, tinnitus, retinopathy, confusion/depression, myelosuppression, pneumonitis)

Immunotherapy for renal cell carcinoma

Statins (Atorvastatin, Simvastatin, Lovastatin, Pravastatin: inhibit rate-limiting step in cholesterol synthesis, aka HMG-CoA reductase that converts HMG-CoA into mevalonate --> low cholesterol levels cause protease to cleave SRBEP, resulting in nuclear translocation of SRBEP --> binds to gene promoter to produce more LDL receptors on surface of hepatocytes --> LDL receptors bind to and take up LDL from plasma, clearing even MORE cholesterol from blood to dramatically reduce LDL levels --> used to decrease LDL, increase HDL, and decrease TGs which has been shown to reduce risk of acute coronary events --> side effects: hepatotoxicity and myopathy)

Indicated for secondary prevention in all patients with known atherosclerotic CV disease, regardless of baseline lipid levels

Enflurane (volatile inhaled anesthetic --> other side effects: myocardial depression leading to hypotension/↓ CO, respiratory depression leading to ↓minute ventilation and hypercapnia, inhibited mucociliary elevator leading to post-op atelectasis, increased cerebral blood flow leading to ↑intracranial pressure, and malignant hyperthermia)

Inhaled anesthetic associated with nephrotoxicity and seizures

Halothane (volatile inhaled anesthetic with high blood solubility, indicating high potency/slow induction --> not used in the US anymore since it causes halothane-associated hepatitis, aka massive hepatic necrosis about 2 days-4wks after exposure to anesthetic --> biopsy shows widespread central lobular hepatic necrosis --> has up to 80% mortality rate)

Inhaled anesthetic that can cause massive hepatic necrosis

Exenatide and liraglutide (GLP1 analogs: similar to GIP released from K cells in duodenum/jejunum --> INHIBIT glucagon release and gastric emptying while INCREASING glucose-dependent insulin release/satiety to promote weight loss --> increases BOTH insulin and C-peptide release, but does NOT cause hypoglycemia because it depends on glucose to work --> side effects: nausea/vomiting and PANCREATITIS)

Injectable anti-diabetic medication that blocks glucagon release/stimulate insulin release

Lactulose (non-absorable disaccharide that is degraded by colonic bacteria, producing acidic metabolites such as lactic acid and acetic acid --> metabolites then acidify GI contents, including toxic ammonia/NH3 into soluble ammonium/NH4+ --> causes "ion trapping" in which more NH3 diffuses into lumen, furthering conversion into NH4+ --> osmotic effect established in colon, resulting in luminal distension and peristalsis --> often combined with rifaximin/neomycin to decrease NH3 levels to improve symptoms of hepatic encephalopathy --> side effects: diarrhea and dehydration)

Laxative used as treatment for hepatic encephalopathy

Elderly, alcoholics, liver disease (these conditions increased serum half-life of benzos, thus increasing risk of overdose/major CNS depression with symptoms such as somnolescence, confusion, disorientation, ataxia with increased risk of falls --> can give short-acting benzos to these patients --> treat overdose with flumazenil)

Populations that should be given long-acting benzodiazepines with caution

Prenatal folic acid

Prevention for neural tube defects in pregnant women

IVC filter (IVC courses thru abdomen and inferior thorax ANTERIOR to right half of vertebral bodies --> formed by merging of common iliac veins at L5 --> joined by renal veins at L1/L2)

Prevention of DVT embolism in patients with contraindications to anti-coagulation

Cromolyn (and nedocromil: inhibit mast cell degranulation --> used to PREVENT acute allergy attacks rather than treat acute attacks, as they do not influence bronchial constriction directly)

Prophylactic agent for seasonal allergies, aspirin hypersensitivity, and exercise-induced asthma

Rifampin (inhibits DNA-dependent RNA polymerase in prokaryotes, which makes all 3 types of RNA --> inhibits mRNA synthesis --> side effects: orange body fluids, CYP450 inducer)

Prophylaxis for H. influenzae (give to close contacts of children with H. influenzae type b)

Azithromycin (macrolide: inhibits 50S subunit to block translocation and inhibit protein synthesis --> can prevent disseminated M. avium infections that presents with fever, night sweats, weight loss, anemia, lymphadenopathy, hepatosplenomegaly --> weekly azithromycin should be given to HIV patients with CD<50)

Prophylaxis for M. avium

Misoprostol (PGE1 analog: decreases cAMP in parietal cells to inhibit H+ secretion into gastric lumen --> stimulates production of mucin, phospholipids, and HCO3- by gastric epithelial cells to promote gastric mucous barrier --> also cause local vasodilation, leading to increased perfusion of gastric epithelium --> side effects: diarrhea, hypotension, and uterine contractions/cervical ripening which causes spontaneous abortions in pregnant women)

Prophylaxis for NSAID-induced gastritis and peptic ulcer formation

Rifampin, ciprofloxacin, or ceftriaxone (rifampin: #1 choice due to oral agent and good penetration into URI to eliminate nasopharyngeal colonization --> ciprofloxacin: fluoroquinolone rarely used in children due to risk of cartilage damage --> ceftriaxone: 3rd gen cephalosporin given IM and effective, but not widely used due to painful admin)

Prophylaxis for Neisseria meningitidis

Palivizumab (IgG monoclonal antibody against fusion protein --> targets RSV F protein)

Prophylaxis for RSV infection in premature infants

Penicillin (also evaluate for colon cancer if linked to endocarditis)

Prophylaxis for S. bovis

Penicillin V (acid-stable oral form of penicillin: D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidoglycans in cell wall --> oral/V form has poor bioavailability, 4X/day dosing, and narrow spectrum so not used often --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Prophylaxis for S. pyogenes

Isoniazid (inhibits mycolic acid synthesis to inhibit mycobacterial cell wall formation --> requires bacterial catalase-peroxidase encoded by KatG to convert INH into active metabolite --> disrupted cell wall structure results in decreased virulence factors and less "acid-fast" coloration due to less resistance to acid-alcohol decolorizing agent --> major side effect: vitamin B6 deficiency causing sideroblastic anemia due to decreased heme synthesis and peripheral neuropathy, thus REQUIRED to take vitamin B6/pyridoxine supplement while taking isoniazid --> other side effects: hepatotoxicity and possible hepatitis, CYP450 inhibitor, drug-induced SLE, anion gap metabolic acidosis --> mechanism of resistance: mutations leading to underexpression of KatG, thus preventing catalase-peroxidase metabolism of isoniazid into active metabolite)

Prophylaxis for TB (Mycobacterium tuberculosis)

TMP/SMX

Prophylaxis for Toxoplasma gondii (given to HIV patients with CD4 <100 and positive anti-Toxoplasma IgG antibodies)

TMP-SMX

Prophylaxis for UTI

Aprepitant (substance P antagonist: blocks neurokinin-1/NK1 receptors in CTZ of area postrema --> inhibits signaling to nucleus solitarius to decrease vomiting --> VERY FEW side effects because it does not interact with serotonin/dopamine, so no risk of serotonin syndrome or EPS)

Anti-emetic that inhibits NK1 receptors in brain

Nitazoxanide (anti-protozoal --> can be used in immunocompetent hosts, especially HIV patients)

Treatment for Cryptosporidium infection

Carbidopa (DOPA decarboxylase inhibitor) and Entacapone (COMT inhibitor --> both should ONLY be used in conjunction with levodopa)

Drugs that decrease peripheral levodopa degradation

Rifampin, griseofulvin, nevirapine (CYP450 inducers: DECREASE warfarin levels, thus decreasing PT/INR and increasing risk of clots --> rifampin: anti-TB drug that inhibits RNA polymerase --> griseofulvin: anti-fungal that interferes with microtubule function --> nevirapine: NNRTI that inhibits HIV reverse transcriptase)

Anti-microbial agents that cause CYP450 induction

Streptomycin (aminoglycoside that binds to 30S subunit to irreversibly inhibit initiation complex in translation, also causes misreading of mRNA --> used 2nd line to treat TB if RIPE regimen fails --> side effects: TINNITUS, vertigo, ataxia, nephrotoxicity --> mechanism of resistance: modification of 30S ribosomal protein)

2nd line agent to treat TB (if patient develops resistance to RIPE regimen)

Clopidogrel (irreversibly bocks ADP/P2Y12 receptor to prevent expression of Gp2b/3a on platelet surface --> inhibits platelet aggregation --> used to treat acute coronary syndrome, including stable angina if patient cannot tolerate aspirin --> also used before coronary stenting --> reduces incidence/recurrence of thrombotic strokes --> side effects: TTP)

2nd line maintenance treatment for stable angina (prevent attacks)

Finasteride (5-alpha-reductase inhibitor that blocks testosterone conversion into DHT to reduce prostate gland size --> also effective against male pattern baldness --> not 1st line because it takes 6-12 months to see effects --> side effects: gynecomastia, low libido, erectile dysfunction)

2nd line treatment for BPH

IV fluids, IV insulin, potassium (need to give insulin and K+ concurrently to prevent hypokalemia, since insulin drives K+ into cells and the body is already depleted of K+ during DKA)

Treatment for DKA

SSRIs (Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Escitalopram, Citalopram: inhibit serotonin transporter/SERT to block serotonin reuptake --> increased availability of serotonin in synaptic cleft, but normally takes 4-8wks to see effect --> side effects: serotonin syndrome if combined with MAOIs, GI distress, SIADH, sexual dysfunction, risk of inducing mania in patients with possible bipolar disorder)

1st line for panic disorder maintenance therapy

Lithium (possibly inhibits phosphoinositol cascade --> MOOD STABILIZER used to treat acute manic episodes and prevent relapse in bipolar disorder --> side effects: tremor, hypothyroidism, nephrogenic DI, TERATOGENIC and causes Ebstein anomaly in fetuses --> almost exclusively excreted by kidneys and mostly reabsorbed at PCT via Na+ channels due to being a divalent cation --> impaired lithium clearance can cause toxicity, associated with thiazide diuretics/NSAIDs)

1st line maintenance treatment for bipolar disorder

Aspirin (irreversibly inhibits COX to impair PG synthesis --> inhibition of COX1 in platelets prevents synthesis of TXA2, thus preventing platelet aggregation and vasoconstriction --> reduces risk of occlusive thrombus formation/subsequent MI --> side effects: gastric ulcers, tinnitus, type 1 HSR in patients with asthma/nasal polyps, exacerbation of COPD/asthma --> chronic use can lead to acute kidney injury, interstitial nephritis, GI bleeding)

1st line maintenance treatment for stable angina (prevent attacks)

Methylphenidate (CNS stimulant that increases catecholamines in synaptic cleft, especially NE and dopamine --> side effects: decreased appetite/weight loss, nervousness, agitation, anxiety, insomnia, tachycardia, hypertension, tics)

1st line treatment for ADHD

Donezepil, Rivastigmine, Galantamine (AChE inhibitors that increases ACh in synaptic cleft --> tertiary amines so freely cross BBB to reach cortex)

1st line treatment for Alzheimer disease

Terazosin and tamsulosin (alpha-1A/D adrenergic antagonists: relax smooth muscle in bladder neck/prostate capsule/prostatic urethra, and does NOT affect vascular smooth muscle --> work within days-weeks, but do NOT affect prostate volume --> side effects: orthostatic hypotension, dizziness)

1st line treatment for BPH

Ganciclovir (guanosine analog that requires CMV viral kinase, preferentially inhibits viral DNA polymerase --> used to treat CMV, especially in immunocompromised patients --> side effects: bone marrow suppression and renal toxicity --> mechanism of resistance: mutated viral kinase)

1st line treatment for CMV

Ganciclovir (uses CMV viral kinase to form triphosphate --> preferentially inhibits viral DNA polymerase --> U97 gene mutation in CMV forms resistance)

1st line treatment for CMV (especially immunocompromised patients)

Methotrexate (folic acid analog that competitively inhibits DHFR, thus decreasing synthesis of dTMP and inhibiting DNA synthesis --> used to treat autoimmune conditions such as severe psoriasis, psoriatic arthritis, and rheumatoid arthritis --> can also be used in chemo treatment of ALL, lymphoma, choriocarcinoma, and sarcomas --> side effects: pulmonary fibrosis, myelosuppression, hepatotoxicity/cirrhosis, nephrotoxicity, mouth ulcers, folate deficiency --> can reverse MTX toxicity with folinic acid)

1st line treatment for MAINTENANCE therapy in rheumatoid arthritis

Clomiphene (SERM: estrogen receptor antagonist in hypothalamus --> decreases negative feedback from estrogen on hypothalamus, increasing GnRh release --> increases LH and FSH release from pituitary --> restores ovulation)

1st line treatment for PCOS in patients who want to become pregnant

Psychotherapy and SSRI (either Sertraline or Paroxetine)

1st line treatment for PTSD

Fluid restriction (followed by salt tablets, IV hypertonic saline, diuretics --> can give V2 receptor antagonists such as conivaptan and tolvaptan --> LAST RESORT drug is demeclocycline --> side effect: central pontine syndrome, aka osmotic demyelination syndrome, that occurs with too-rapid correction of hyponatremia in brain --> increased ECF Na+ enters neurons, pulling H2O along with it --> causes neuronal swelling, cerebral edema, and massive axonal demyelination ESPECIALLY in pons)

1st line treatment for SIADH (syndrome of inappropriate antidiuretic hormone secretion: excessive free water retention, euvolemic hyponatremia with urinary Na+ excretion, urine osmolality > serum osmolality)

Metformin (biguanide: activates AMPK enzyme which inhibits mGPD, aka mitochondrial glycerophosphate dehydrogenase --> inhibits actions of glucagon such as hepatic gluconeogenesis, and promotes actions of insulin such as glycolysis and peripheral glucose uptake --> therefore INCREASES insulin sensitivity and decreases hyperglycemia --> promotes WEIGHT LOSS, and does NOT cause hypoglycemia because it requires glucose to work --> side effects: GI upset, LACTIC ACIDOSIS --> contraindication: renal insufficiency)

1st line treatment for T2DM

Ethosuximide (blocks thalamic T-type Ca2+ channels, which trigger and sustain rhythmical burst discharge in thalamic neurons --> side effects: nausea, vomiting, hyperactivity)

1st line treatment for absence seizures

Ethosuximide (blocks thalamic T-type/low-voltage Ca2+ channels --> side effects-EFGHI: Ethosuxamide causes fatigue, GI distress, headache, itching/urticaria, SJS)

1st line treatment for absence seizures

Pilocarpine (cholinomimetic: increases outflow of aqueous humor --> stimulates M3 receptor of ciliary muscle, causing ciliary contraction and miosis --> iris moves further away from cornea, widening anterior chamber angle and opening trabecular meshwork into canal of SChlemm for better drainage of aqueous humor --> useful for acute closed-angle glaucoma because it rapidly decreases intraocular pressure --> side effects: miosis and cyclospasm)

1st line treatment for acute closed-angle glaucoma

Loop diuretics (Furosemide, Torsemide, Bumetanide: MOST POTENT diuretics used for rapid relief of symptoms with acute decompensated HF --> inhibit Na+/K+/2Cl- symporter in thick ascending limb of LoH --> blockade of NaCl reabsorption decreases medullary concentration gradient, impairing kidney's ability to concentrate urine --> increases overall excretion of Na+, Cl-, and H2O --> side effects-OHH DAANG: otoxicity, hypokalemia, hypomagnesemia, dehydration, allergy to sulfa, alkalosis, nephritis, gout)

1st line treatment for acute decompensated heart failure

NSAIDs (COX inhibitor that inhibit PG synthesis --> exerts broad anti-inflammatory effect that includes neutrophil inhibition --> CONTRAINDICATED in peptic ulcer disease due to loss of PG protecting gastric mucosa, as well as renal failure due to loss of PG dilation of afferent arteriole)

1st line treatment for acute gout attack

Scopolamine (blocks M1 muscarinic receptors in vestibular system/CN8 to prevent signaling to nucleus solitarius --> prevents vestibular nausea/motion sickness --> side effects: pupil dilation, increased body temp, tachycardia, dry mouth, dry mouth/dry skin, constipation)

Anti-muscarinic used to treat motion sickness

IV diazepam or lorazepam (IV long-acting benzodiazepines: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> CNS depression, thus reducing generalized tonic-clonic seizure activity --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

1st line treatment for acute status epilepticus

Diazepam or chlordiazepoxide (IV long-acting benzodiazepines with active metabolites: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> since this is the same receptor as alcohol, it is useful in preventing alcohol withdrawal seizures/delirium tremens which are caused by decreased GABA-A tone --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

1st line treatment for alcohol withdrawal

CBT and nutritional rehab (little evidence to support use of pharmacotherapy, but can give olanzapine as adjunct to CBT to promote weight gain --> if no response to CBT give mirtazapine --> inhibits autoreceptors alpha-2 and 5-HT1A to increase NE and serotonin levels, and also increases appetite/promotes weight gain)

1st line treatment for anorexia nervosa

CBT

1st line treatment for binge eating disorder

Ondansetron (powerful central acting anti-emetic: 5-HT3/serotonin antagonist that decreases vagal stimulation in area postrema --> used to control vomiting post-op and in patients undergoing chemo --> side effects: headache, constipation, QT prolongation, serotonin syndrome)

1st line treatment for chemotherapy-induced nausea and vomiting

Inhaled corticosteroids (fluticasone + budesonide: suppresses late asthmatic response but does NOT prevent airway remodeling --> inhibits synthesis of virtually all cytokines --> induces apoptosis of eosinophils/Th2 cells --> reduces leukocyte extravasation into respiratory epithelium, thus temporarily causing neutrophil INCREASE --> blocks PLA2 to prevent arachidonic acid formation, lowering LT and PG levels --> increase transcription of B2 receptors to prevent B2 desensitization --> decrease smooth muscle proliferation and mucus production by goblet cells --> side effects: oral candidiasis, osteoporosis, cataracts, glaucoma, adrenal suppression, high blood glucose)

1st line treatment for chronic asthma

Allopurinol (xanthine oxidase inhibitor --> prevents conversion of xanthine into uric acid to decrease uric acid levels in blood --> also used to prevent tumor lysis syndrome in patients with lymphoma/leukemia)

1st line treatment for chronic gout

Haloperidol (high-potency typical antipsychotic: blocks D2 receptors --> high lipid solubility/storage in fat so longer half-life --> used to treat agitation/psychosis associated with acute delirium --> side effects: minimal when used in small doses, usually associated with sedative/anti-cholinergic effects and extrapyramidal symptoms/EPS such as acute dystonia, akathisia, bradykinesia, tardive dyskinesia)

1st line treatment for delirium

SSRIs (Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Escitalopram, Citalopram: inhibit serotonin transporter/SERT --> inhibition of serotonin reuptake --> increased availability of serotonin in synaptic cleft, but normally takes 4-8wks to see effect --> 1st line treatment for MDD, GAD, panic disorder, OCD, bulimia nervosa, social anxiety disorder, PTSD, premature ejaculation, PMDD --> side effects: serotonin syndrome if combined with MAOIs, GI distress, SIADH, sexual dysfunction, risk of inducing mania in patients with possible bipolar disorder)

1st line treatment for depression

Metoclopramide (D2 receptor antagonist: decreased dopamine signaling increases GI resting tone, contractility, LES tone, motility and promotes gastric emptying --> does NOT influence colon transport time --> used to treat neurogenic gastroparesis, chemotherapy-induced vomiting, and persistent GERD --> side effects: EPS/Parkinsonian symptoms/ tardive dyskinesia/elevated prolactin similar to anti-psychotics, DEPRESSION, drowsiness, diarrhea, neuroleptic malignant syndrome, interaction with digoxin and diabetic agents --> contraindications: small bowel obstruction or Parkinson disease)

1st line treatment for diabetic and post-op gastroparesis

Thiazide diuretics (HCTZ, chlorthalidone, metolazone: DIURETICS that inhibit Na+/Cl- co-transporter in early DCT --> inhibits NaCl reabsorption to cause Na+ and H2O excretion in urine and decrease intravascular volume --> decreases Na+ intracellular concentration, which activates Na+/Ca2+ antiporter that pulls Na+ from ECF into cell, thus decreasing intracellular Ca2+ and enhancing Ca2+ absorption --> used to treat HTN, heart failure, recurrent kidney stones, nephrogenic DI, and osteoporosis --> note: low blood volume causes compensation by RAAS, which increases aldosterone levels leading to increased K+ and H+ secretion into urine, resulting in hypokalemia and metabolic alkalosis --> other side effects: low Na+, hyperglycemia, elevated lipids, elevated uric acid/gout, elevated serum Ca2+)

1st line treatment for essential hypertension in general population

Primidone and propranolol (primidone: barbiturate that is metabolized into active phenobarbital, which increases DURATION of Cl- channel opening in GABA-A receptors to decrease tremor amplitude --> propranolol: inhibits B1 and B2 adrenergic receptors, thus dampening SNS agitation that may be related to essential tremor)

1st line treatment for essential tremor

Motelukast (or zafirlukast: block LT receptors --> decreased IP3/Ca2+ --> block late response bronchial hyperactivity and massive vasodilation via bronchodilation, less mucus production, less vascular permeability, and less chemotaxis of inflammatory cells --> for EIA: use daily or 2hrs before exercise)

1st line treatment for exercise-induced asthma, aspirin-intolerant asthma, and asthma+allergic rhinitis

Foscarnet (binds to pyrophosphate-binding site of viral DNA polymerase, does NOT require viral kinase activator --> used to treat ganciclovir-resistant CMV and acyclovir-resistant HSV --> side effects: nephrotoxicity, and electrolyte-deficiency seizures due to abnormalities in Ca2+ and phosphate, hypokalemia, hypomagnesemia --> mechanism of resistance: mutated DNA polymerase)

2nd line treatment for CMV (when ganciclovir fails)

Pyrantel pamoate

Anti-protozoal treatment safe for pregnant women

Proton pump inhibitors (PPIs such as omeprazole, lansoprazole, esomeprazole, etc: irreversibly inhibit H+/K+ ATPase in parietal cells, thus blocking H+ secretion from all three major stimulators --> faster and more effective than H2 receptor blockers --> also used as 1st line treatment for gastritis, Zollinger-Ellison syndrome, part of H. pylori therapy, and stress ulcer prophylaxis --> side effects: C. diff infection, pneumonia, acute interstitial nephritis, decreased absorption of divalent cations Ca2+/Mg2+/Fe2+, low serum Mg2+ and Ca2+ causing increased risk of falls in elderly --> elderly patients should be given Ca2+ supplements and have bone density monitoring)

1st line treatment for gastric/duodenal ulcers, NSAID-induced ulcers, and GERD

Proton pump inhibitors (PPIs such as omeprazole, lansoprazole, esomeprazole, etc: irreversibly inhibit H+/K+ ATPase in parietal cells, thus blocking H+ secretion from all three major stimulators --> faster and more effective than H2 receptor blockers --> side effects: C. diff infection, pneumonia, acute interstitial nephritis, decreased absorption of divalent cations Ca2+/Mg2+/Fe2+, low serum Mg2+ and Ca2+ causing increased risk of falls in elderly --> elderly patients should be given Ca2+ supplements and have bone density monitoring)

1st line treatment for gastrinomas (Zollinger-Ellison syndrome)

SSRIs and SNRIs (SSRIs: inhibit serotonin reuptake, normally take 4-8wks for effect --> SNRIs: inhibit serotonin and NE reuptake, SE include hypertension/stimulant effect/sedation/nausea)

1st line treatment for generalized anxiety disorder

Statin

1st line treatment for hypercholesterolemia

Calcium disodium EDTA (can also give dimercaprol, succimer, or penicillamine)

1st line treatment for lead poisoning

Desmopressin (ADH analog: binds to V2 receptors on principal cells in kidney collecting duct to increase # of aquaporins and increase H2O absorption --> causes ↓plasma osmolarity and ↑blood volume --> prevents diuresis/urination at night --> ALSO used to treat central DI, von Willebrand disease, and hemophilia A --> side effects: hypovolemia, hyponatremia)

1st line treatment for nocturnal enuresis (bedwetting)

Beta blockers (ex: propranolol)

1st line treatment for performance-only anxiety disorder

TMP-SMX

1st line treatment for pneumocystis jirovecii pneumonia

Typical antipsychotics (block dopamine D2 receptors with high lipid solubility/storage in fat so long half-life --> high-potency drugs such as Haloperidol, Trifluoperazine, Fluphenazine that have more extrapyramidal symptoms/EPS --> low-potency drugs such as Chlorpromazine and Thioridazine have more anti-cholinergic, anti-histamine, and alpha-1 blockade effects --> used to treat positive schizophrenia symptoms, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD --> MANY side effects: hyperprolactinemia, dyslipidemia/weight gain, QT prolongation, EPS such as acute dystonia, akathisia, bradykinesia, tardive dyskinesia)

1st line treatment for psychosis

Furosemide (loop diuretic: inhibits Na+/K+/Cl- of thick ascending limb to abolish hypertonicity of medulla to prevent urine concentration, and also vasodilates afferent arterioles via PGE release --> for PE: acts rapidly and significantly to relax smooth muscle in pulmonary vessels --> side effects--OHH DAANG: otoxicity, hypokalemia, hypomagnesemia, dehydration, allergy to sulfa, alkalosis, nephritis, gout)

1st line treatment for pulmonary edema due to CHF exacerbations

Atypical antipsychotics (Risperidone, Olanzapine, Clozapine, Quetiapine: 5-HT2 and D2 antagonists with varied effects on alpha-adrenergic and H1 receptors --> used to treat BOTH positive and negative symptoms of schizophrenia --> clozapine ONLY used for treatment-resistant schizophrenia, schizoaffective disorder, and schizophrenia with suicidality --> side effects: all atypicals have prolonged QT, risperidone associated with hyperprolactinemia, olanzapine/clozapine associated with metabolic syndrome aka weight gain/diabetes/hyperlipidemia, and clozapine associated with agranulocytosis and seizures)

1st line treatment for schizophrenia

SSRI and CBT (can also give venlafaxine if no response to SSRI --> treat performance-only subtype with beta-blockers)

1st line treatment for social anxiety disorder

CBT with exposure (best for long-term management --> for acute treatment if therapist unavailable or insufficient time, can give short-acting benzodiazepines such as Alprazolam, Triazolam, Oxazepam, Midazolam)

1st line treatment for specific phobia

Carbamazepine (narrow-spectrum anti-convulsant that inhibits neuronal high-frequency firing by reducing ability of Na+ channels to recover from inactivation --> effective in pain reduction for up to 80% of patients --> auto-inducer of its own clearance, so dosage needs to be increased over the course of administration --> side effects: CYP450 inducer, aplastic anemia, SIADH, SJS, diplopia/ataxia, teratogen that causes neural tube defects and cleft lip/palate)

1st line treatment for trigeminal neuralgia (tic douloureux)

NSAIDs (ibuprofen, naproxen, acetaminophen --> patients should also be advised to maintain regular moderate activity)

1st line treatment for uncomplicated low back pain

Orlistat (intestinal lipase inhibitor that reduces absorption of dietary fat --> fat then gets excreted thru GI lumen --> used for WEIGHT LOSS --> side effects: abdominal pain, flatulence, bowel urgency/frequent bowel movements, steatorrhea with oily spotting, decreased absorption of fat-soluble vitamins A/D/E/K)

1st line treatment for weight loss refractory to dietary modification/exercise

Phenobarbital (barbiturate that increases duration of Cl- channel opening in GABA-A receptor to decrease neuronal firing --> used as a SEDATIVE --> side effects: hypotension, CV/respiratory depression, CNS depression/coma, physical dependence, CYP450 inducer)

1st line treatment in non-febrile neonatal seizures

TMP-SMX (give prophylaxis to HIV/AIDS patients with CD4<200 --> note: SMX is a sulfa drug)

1st line treatment/prophylaxis for Pneumocystis jirovecii

Allopurinol and Febuxostat (irreversible xanthine oxidase inhibitors → interferes with conversion of hypoxanthine/xanthine to uric → blocks production of uric acid and shunts system toward more soluble compounds, while also inhibiting metabolism of purine analogs → allopurinol is recommended because it is CHEAPER than Febuxostat)

1st line treatments for chronic gout

Valproic acid (broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION and causes a rise in GABA --> mainly used to treat primary generalized seizures such as tonic-clonic --> side effects: nausea/vomiting, acute pancreatitis, fine tremor, increased appetite/weight gain, and rare but fatal hepatotoxicity so need to measure LFTs during initiation of therapy --> ALSO teratogenic and increases risk of neural tube defects)

2nd line treatment for absence seizures (if patient cannot tolerate ethosuximide)

Colchicine (binds and stabilizes tubulin to inhibit microtubule polyermization --> impairs neutrophil chemotaxis, phagocytosis, and degranulation --> inhibition of neutrophils will relieve intense inflammation in joints)

2nd line treatment for acute gout attack (peptic ulcer disease, renal failure)

Mirtazapine (atypical anti-depressant that blocks alpha-2 and 5-HT1A inhibitory auto-receptors --> increases release of NE and serotonin --> increase appetite and promote weight gain, which is desirable for elderly and anorexia patients)

2nd line treatment for anorexia nervosa (if no response to CBT)

Lisdexamfetamine

2nd line treatment for binge eating disorder (if no response to CBT)

Valproic acid, carbamazepine, lamotrigine, quetiapine (valproic acid: broad-spectrum anti-convulsant that increases Na+ channel inactivation and increases GABA and can be used as ADJUNCT to lithium for acute mania/maintenance, SE include liver failure/pancreatitis/ tremor/weight gain/causes neural tube defects in pregnant women --> carbamazepine: narrow-spectrum anti-convulsant that also blocks Na+ channels and can be used for acute mania and maintenance, SE include diplopia/ataxia/aplastic anemia/SIADH/SJS --> lamotrigine: broad-spectrum anti-convulsant that also blocks Na+ channels and inhibits glutamate release but can only be used for MAINTENANCE, SE include SJS and hemophagocytic lymphohistiocytosis --> quetiapine: atypical antipsychotic, SE include prolonged QT/metabolic syndrome)

2nd line treatment for bipolar disorder (minimal effects seen with lithium)

Erythromycin (macrolide antibiotic: besides antibiotic activity, also causes activation of motilin receptor in smooth muscle of upper GI tract --> results in coordinated peristaltic contractions that begin in stomach and move through entire upper GI system --> propels food into colon --> used to treat diabetic gastroparesis in patients that cannot metoclopramide --> side effects-MACRO: motility issues, arrhythmias with prolonged QT, cholestasis, rash, eosinophilia)

2nd line treatment for diabetic gastroparesis (for patients that cannot tolerate metroclopramide)

Octreotide (somatostatin analog that inhibits secretion of various GI hormones including gastrin, insulin, glucagon, serotonin, CCK --> also directly inhibits H+ secretion and decreases gallbladder contraction --> side effects: nausea, cramps, steatorrhea, cholelithiasis due to CCK inhibition)

2nd line treatment for gastrinoma/Zollinger-Ellison syndrome (if PPIs fail)

Buspirone (serotonin agonist that stimulates 5-HT1A receptors --> causes serotonin-like effects in CNS --> used to treat GAD, usually takes 1-2wks for effect --> does NOT cause sedation, addiction, or tolerance and does NOT interact with alcohol)

2nd line treatment for generalized anxiety disorder

Atovaquone

2nd line treatment for pneumocystis jirovecii pneumonia (ex: patient with sulfa allergy)

Probenecid and pegloticase (probenecid: inhibits reabsorption of uric acid in kidney PCT --> or pegloticase: recominant uricase catalyzing uric acid conversion to water-soluble allantoin)

2nd treatments for chronic gout

Stellate sympathectomy (surgical interruption of stellate/cervicothoracic ganglion --> decreases SNS activity to upper extremities)

Treatment for hyperhidrosis of hands

Regular weight-bearing exercise (most likely to decrease pathologic fractures --> can also recommend calcium and vitamin D supplements throughout adulthood)

Lifestyle changes recommended for osteoporosis prophylaxis

Inhibit IL-2 transcription (prevents SYNTHESIS of IL-2 to inhibit T-cell proliferation: cyclosporine binds to cyclophilin and is associated with gingival hyperplasia and hirsutism --> tacrolimus binds FK506 binding protein and does NOT cause gingival hyperplasia/hirsutism)

Action of calcineurin inhibitors

Inhibits IL-2 signal transduction (prevents RESPONSE to IL-2 to inhibit T-cell proliferation: binds to FK-506 binding protein, forming a complex that inhibits mammalian target of rapamycin/mTOR signaling pathway --> interrupts IL-2 signal transduction, aka preventing G1 to S phase progression in T cells --> blocks T cell proliferation and B-cell differentiation --> side effects: pancytopenia, insulin resistance, hyperlipidemia, but NOT NEPHROTOXIC so useful in patients with kidney transplants)

Action of sirolimus (rapamycin)

Ribavirin (competitively inhibits IMP dehydrogenase to prevent synthesis of guanine nucleotides --> side effects: hemolytic anemia and teratogenicity)

Adjunct therapy for chronic hepatitis C refractory to newer medications

Calcitonin (directly inhibits osteoclasts and promotes Ca2+ excretion by kidney to decrease serum Ca2+ levels --> used as ADJUNCT with bisphosphonates to treat hypercalcemia of malignancy and Paget disease of bone)

Adjunct therapy used for treatment of hypercalcemia of malignancy and Paget disease of bone

Bismuth (binds to ulcer base to facilitate ulcer healing --> provides physical protection and allows HCO3- secretion to reestablish pH gradient in mucous layer --> used for ulcer healing, travelers diarrhea, and QUADRUPLE therapy for H. pylori)

Adjunct treatment added to H. pylori triple therapy if concerned about macrolide resistance

Tamoxifen (SERM: estrogen ANTAGONIST at breast so used to treat ER/PR-positive breast cancer, as well as prevent recurrence --> estrogen AGONIST at bone and uterus, therefore does not cause osteoporosis but does increase risk of endometrial cancer --> side effects: risk of thromboembolic events, especially in smokers)

Adjuvant therapy for ER(+) breast cancer

Vertigo and psychosis

Adverse neurologic effects caused by glucocorticoids

Nitrosureas (Carmustine, Lomustine: cross-link DNA and cross BBB to reach CNS, require bioactivation --> used to treat brain tumors, including glioblastoma multiforme --> side effects: convulsions, dizziness, ataxia, other CNS toxicity)

Alkylating agent that can cross BBB to target brain tumors

NNRTIs (Delavirdine, Efavirenz, Nevirapine --> inhibit HIV DNA synthesis from RNA template by terminating DNA chain elongation --> does NOT require phosphorylation for activation --> side effects: rash, hepatotoxicity, vivid dreams/CNS symptoms with efavirenz, nevirapine induces CYP450)

Allosteric HIV reverse transcriptase inhibitors

Prazosin (selective alpha-1 adrenergic antagonist --> can be used to treat hypertension and BPH, but has also been shown to treat symptoms of PTSD --> side effects: 1st dose orthostatic hypotension, dizziness, headache)

Alpha-blocker used to treat PTSD

Midazolam or Lorazepam (IV benzodiazepines: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> induces CONSCIOUS SEDATION to maintain patent airway but still allow patients to follow commands during procedure, also potent muscle relaxant/light amnesia --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Anesthetic that should be given during minor procedures/surgeries (ex: colonoscopy)

Aluminum hydroxide (alters gastric/urinary pH and delays gastric emptying to help with GERD/ulcers --> side effects: constipation and hypophosphatemia, which causes proximal muscle weakness, osteodystrophy, and seizures)

Antacid that can cause hypophosphatemia

Alemtuzumab (used to treat CLL and MS)

Anti-CD52 monoclonal antibody

Hydralazine (increases cGMP in vascular smooth muscle of ARTERIOLES to cause SM relaxation --> reduces afterload to decrease wall tension and LV hypertrophy --> used to treat acute severe HTN, pregnancy HTN, and HF in combo with nitrate --> side effects: baroreceptor activation leads to SNS stimulation, causing compensatory tachycardia/increased contractility/CO, fluid retention due to RAAS activation, headaches, angina, SLE-like syndrome --> can administer with beta-blockers to prevent reflex tachycardia)

Anti-HTN drug that selectively vasodilates arterioles

Pyrazinamide (unclear mechanism, but part of RIPE regimen to treat TB --> side effects: HYPERURICEMIA and hepatotoxicity)

Anti-TB drug associated with exacerbation of gout

Ethambutol (inhibits arabinosyl transferase, thus preventing carbohydrate polymerization of mycobacterium cell wall --> part of RIPE regimen to treat TB --> side effect: optic neuropathy manifesting as decreased visual acuity, central scotoma, or color blindness that is REVERSIBLE upon discontinuation of drug)

Anti-TB drug associated with optic neuropathy

Ethambutol (inhibits arabinosyl transferase, thus preventing carbohydrate polymerization of mycobacterium cell wall --> part of RIPE regimen to treat TB --> side effects: OPTIC NEUROPATHY, manifesting as decreased visual acuity/central scotoma/color blindness, REVERSIBLE upon discontinuation of drug --> mechanism of resistance: mycobacteria increases production of arabinosyl transferase to overcome ethambutol)

Anti-TB drug that inhibits synthesis of mycobacterial cell wall

Isoniazid

Anti-TB drug that requires bacterial catalase-peroxidase for activation

Adalimumab and infliximab (anti-TNF-alpha monoclonal antibodies: used to treat IBD, rheumatoid arthritis, ankylosing spondylitis, and psoriasis --> side effect: reactivation of latent TB, therefore all patients require screening for TB before starting drug)

Anti-TNF alpha monoclonal antibodies

Flutamide (non-steroidal competitive inhibitor at androgen receptors --> blocks testosterone in prostate gland to prevent carcinoma from enlarging)

Anti-androgen used for prostate carcinoma

Class II (beta-blockers: mask hypoglycemia because they inhibit autonomic warning signs such as tachycardia, tremor, palpitations)

Anti-arrhythmic class contraindicated in diabetics

Class III (Amiodarone, Ibutilide, Dofetilide, Sotalol: potent K+ channel blockers that have increased effect during SLOW HR, thus more prolonged QT during bradycardia --> makes them useful in treating atrial flutter and AFib, but risk of prolonged QT at slow HR)

Anti-arrhythmic class that prolongs QT interval in reverse-use dependent manner

Class III (Amiodarone, ibutilide, dofetilide, solatol: K+ channel blockers that prolongs phase 3 repolarization by increasing ERP --> INCREASES AP duration via INCREASED QT interval, but no effect on QRS duration --> used for ACUTE treatment of atrial flutter and AFib --> side effects: sotalol causes torsades de pointes and excessive beta blockade, ibutilide causes torsades de pointes, amiodarone causes pulmonary fibrosis/hepatotoxicity/hyperthyroidism/skin discoloration and photodermatitis/corneal deposits but does NOT cause torsades de pointes)

Anti-arrhythmic class that prolongs phase 3 repolarization in myocardium

Class II (beta-blockers such as propranolol, metroprolol, esmolol, atenolol, carvedilol, labetalol: BOTH negative inotropic and chronotropic agent that reduces contractility + HR to decrease myocardial O2 demand and reduce size of ischemic myocardium --> block beta-adrenergic receptors on SA and AV nodes to decrease intracellular cAMP/Ca2+ levels, thus decreasing contractility and conduction --> also prolongs phase 4 depolarization in pacemaker cells, thus decreasing HR --> used to treat SVTs and prophylaxis for prevention of ventricular arrhythmias post-MI)

Anti-arrhythmic class that slows conduction through AV node and prolongs phase 4 depolarization in pacemaker cells

Class IV (Ca2+ channel blockers such as verapamil and diltiazem: block L-type Ca+ channels in cardiomyocytes to prolong phase 2 repolarization/slow down conduction --> blocks Ca2+ influx to decrease contractility of myocardium --> slows Ca2+ recovery during phase 3 repolarization to increase ERP/prolong conduction --> decreases slope of phase 0 upstroke in pacemaker cells, thus slowing down sinus rate --> used as prophylaxis/rate-control for atrial flutter, AFib, and recurrent nodal tachyarrhythmias such as PSVT --> side effects: gingival hyperplasia, constipation, flushing, edema, bradycardia, AV block, heart failure)

Anti-arrhythmic class that slows phase 2 depolarization of myocyte, slows conduction through SA and AV nodes, and prolongs phase 3 repolarization in pacemaker cells

Digoxin (cardiac glycoside that directly inhibits Na+/K+ ATPase on cardiac myocytes --> indirectly inhibits Na+/Ca2+ exchanger in myocardium to INCREASE intracellular Ca2+ and increase contractility --> also stimulates vagus nerve to increase ERP and decrease conduction at AV and SA node, thus decreasing HR --> used to treat chronic systolic HF and AFib --> side effects: hyperkalemia, arrhythmias such as PVC, bradycardia and AV node block, nausea/vomiting, abdominal pain, diarrhea, delirium/confusion, yellow-tinted vision --> contraindications: hypokalemia, renal insufficiency, and patients taking beta-blockers, verapamil, diltiazem, amiodarone, quinidine --> NOTE: long-term digoxin use causes T wave changes, shortened QT interval, and "scooped" concave ST segments, but these are NOT associated with toxicity)

Anti-arrhythmic drug that increases contractility and decreases conduction

Flecainide and Propafenone (Class 1C anti-arrhythmics: potent Na+ channel blockers that have increased effect at faster HR, aka use-dependence --> makes them more effective at treating tachyarrhythmias --> can also caused prolonged QRS duration at higher HR, risk of arrhythmias)

Anti-arrhythmic that prolongs QRS duration in use-dependent manner

Adenosine (coronary arteriole vasodilator, but also anti-arrhythmic that increases K+ efflux to cause hyperpolarization of cell --> fast-acting and short-lived blockage of AV node conduction --> temporarily blocks signal conduction from atria to ventricles --> terminates re-entrant circuit and converts PVST to normal sinus rhythm)

Anti-arrhythmic whose side effects include hypotension, flushing, chest burning, high-grade AV block

Flecainide and Propafenone (class IC anti-arrhythmics: do not change AP duration, but significantly prolong ERP in AV node and accessory bypass tracts --> pro-arrhythmic in post-MI, thus contraindicated)

Anti-arrhythmics contraindicated in structural and ischemic heart disease (post-MI)

Valproic acid (broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION and causes a rise in GABA --> mainly used to treat primary generalized seizures such as tonic-clonic --> also used for myoclonic seizures, bipolar disorder, migraine prophylaxis --> side effects: nausea/vomiting, acute pancreatitis, fine tremor, increased appetite/weight gain, and rare but fatal hepatotoxicity so need to measure LFTs during initiation of therapy --> ALSO teratogenic and increases risk of neural tube defects)

Anti-convulsant that causes CYP450 inhibition

Carbamazepine, lamotrigine, phenobarbital, phenytoin (carbamazepine: promote Na+ channel inactivation --> lamotrigine: block voltage-gated Na+ channels and inhibit release of glutamate --> phenobarbital: increase DURATION of Cl- channel in GABA-A receptor --> phenytoin: promote Na+ channel inactivation with zero-order kinetics)

Anti-convulsants associated with SJS/TEN

Phenytoin, phenobarbital, carbamazepine (CYP450 inducers: DECREASE warfarin levels, thus decreasing PT/INR and increasing risk of clots --> phenytoin: blocks Na+ channels --> phenobarbital: increases duration of Cl- channel in GABA-A receptor --> carbamazepine: blocks Na+ channels)

Anti-convulsants that cause CYP450 induction

Trazodone (blocks 5-HT2, alpha-adrenergic, and H1 receptors and weakly inhibits 5-HT reuptake --> rarely used to treat depression, but primarily used to treat insomnia --> side effects: sedation, nausea, orthostatic hypotension, PRIAPISM)

Anti-depressant and anti-insomnia drug associated with priapism

SSRIs (Fluoxetone, Fluvoxamine, Paroxetine, Sertraline, Escitalopram, Citalopram: inhibits 5-HT reuptake to increase serotonin levels in synaptic cleft --> usually takes 4-8wks to see effect --> 1st line treatment for MDD, GAD, panic disorder, OCD, bulimia, binge-eating disorder, PTSD with CBT, social anxiety disorder, premature ejaculation, and premenstrual dysphoric disorder --> side effects: serotonin syndrome, SIADH, sexual dysfunction, risk of "electric shock" sensations and irritability if abruptly discontinued)

Anti-depressant drug class associated with sensory disturbances and irritability upon abrupt discontinuation

Buproprion (NE and DA reuptake inhibitor) and mirtazapine (alpha-2 agonist)

Anti-depressants that do not cause sexual side effects

Metformin (biguanide: activates AMPK enzyme which inhibits mGPD, aka mitochondrial glycerophosphate dehydrogenase --> inhibits actions of glucagon such as hepatic gluconeogenesis, and promotes actions of insulin such as glycolysis and peripheral glucose uptake --> therefore INCREASES insulin sensitivity and decreases hyperglycemia, used as 1st line treatment for T2DM --> promotes WEIGHT LOSS, and does NOT cause hypoglycemia because it requires glucose to work --> side effects: LACTIC ACIDOSIS, as well as GI upset --> contraindication: renal insufficiency)

Anti-diabetic drug that can cause lactic acidosis

Linagliptin, saxagliptin, sitagliptin (DPP4 inhibitors: inhibit DPP-4 enzyme, which normally deactivates incretins GLP-1 and GIP --> increases GLP-1 and GIP levels --> inhibits glucagon release from alpha cells, stimulates insulin release from beta cells, and inhibits gastric emptying to promote satiety/weight loss --> increases BOTH insulin and C-peptide release, but does NOT cause hypoglycemia because it depends on glucose to work --> side effects: mild URIs such as nasopharyngitis, mild urinary infections, but NO WEIGHT CHANGES)

Anti-diabetic drugs that can cause nasopharyngitis

Exenatide and liraglutide (GLP1 analogs: similar to GIP released from K cells in duodenum/jejunum --> INHIBIT glucagon release and gastric emptying while INCREASING glucose-dependent insulin release/satiety to promote weight loss--> increases BOTH insulin and C-peptide release, but does NOT cause hypoglycemia because it depends on glucose to work--> side effects: PANCREATITIS, as well as nausea/vomiting)

Anti-diabetic drugs that can cause pancreatitis

Insulin preps, pramlintide, sulfonylureas, meglitinides (insulin preps: bind insulin receptors on peripheral tissues, SE include fat necrosis at injection site --> pramlintide: amylin/IAPP analog that decreases gastric emptying and glucose release, SE include nausea and anorexia --> sulfonylureas and meglitinides: close ATP-dependent K+ channel to depolarize beta cells, SE include weight gain)

Anti-diabetic medications that can cause hypoglycemia

Sulfonylureas, meglitinides, and glitazones (Sulfonylureas and meglitinides: close ATP-dependent K+ channel to depolarize beta cells, SE include hypoglycemia --> glitazones: activate PPARy nuclear TF to increase insulin sensitivity and decrease serum TGs, SE include fluid retention/edema/HF and osteoporosis)

Anti-diabetic medications that can cause weight gain

GLP1 analogs, metformin, and SGLT2 inhibitors (GLP1 analogs: exenatide and liraglutide that inhibit glucagon release/stimulate insulin release, SE include pancreatitis --> metformin: inhibits glucagon action, SE include lactic acidosis --> SGLT2 inhibitors: inhibit glucose reabsorption in kidney PCT, SE include UTIs and vaginal yeast infections)

Anti-diabetic medications that promote weight loss

Rapid acting insulin preps, pramlintide, and acarbose (rapid-acting insulin preps: Lispro, Aspart, Glulisine, SE include hypoglycemia and lipodystrophy --> pramlintide: amylin/IAPP analog that decreases gastric emptying and glucagon release, SE include hypoglycemia and anorexia --> acarbose: blocks glucose reabsorption in intestines, SE include diarrhea/flatulence)

Anti-diabetic medications used to control post-prandial glucose spike

Detemir and Glargine (long-acting insulin injectables: do not really have a peak, therefore able to provide low levels of insulin throughout the day)

Anti-diabetic medications used to give steady background levels of insulin in T1DM patients

Metoclopramide (D2 receptor antagonist: decreased dopamine signaling increases GI resting tone, contractility, LES tone, motility and promotes gastric emptying --> does NOT influence colon transport time --> used to treat diabetic/post-surgery gastroparesis, chemotherapy-induced vomiting, and persistent GERD --> side effects: EPS/Parkinsonian symptoms/ tardive dyskinesia/elevated prolactin similar to anti-psychotics, DEPRESSION, drowsiness, diarrhea, neuroleptic malignant syndrome, interaction with digoxin and diabetic agents --> contraindications: small bowel obstruction or Parkinson disease)

Anti-emetic agent contraindicated in patients with Parkinson disease

Azoles (ketoconazole, fluconazole, itraconazole, voriconazole: inhibit CYP450 enzymes to block conversion of lanosterol to ergosterol, thus disrupting fungal cell membranes --> used to treat local/less serious systemic mycoses such as Candida, Blastomyces, Coccidiodes, Histplasma, Sporothrix schenckii, Aspergillus, Mucor --> side effects: human CYP450 inhibition + testosterone synthesis inhibition causing gynecomastia)

Anti-fungal drugs that inhibit CYP450, increasing warfarin levels/bleeding risk (increased PT)

Thiazide diuretics (HCTZ, chlorthalidone, metolazone: DIURETICS that inhibit Na+/Cl- co-transporter in early DCT --> inhibits NaCl reabsorption to cause Na+ and H2O excretion in urine and decrease intravascular volume --> decreases Na+ intracellular concentration, which activates Na+/Ca2+ antiporter that pulls Na+ from ECF into cell, thus decreasing intracellular Ca2+ and enhancing Ca2+ absorption --> used to treat HTN, heart failure, recurrent kidney stones, nephrogenic DI, and osteoporosis --> note: low blood volume causes compensation by RAAS, which increases aldosterone levels leading to increased K+ and H+ secretion into urine, resulting in hypokalemia and metabolic alkalosis --> other side effects: HYPERGLYCEMIA so contraindicated in diabetics, HYPERURICEMIA so contraindicated in gout, HYPERCALCEMIA so contraindicated in patients with high Ca2+ --> other side effects: hyponatremia, elevated lipids)

Anti-hyerptensive medication contraindicated in diabetics, gout, and hypercalcemia

Thiazide diuretics (HCTZ, chlorthalidone, metolazone: DIURETICS that inhibit Na+/Cl- co-transporter in early DCT --> inhibits NaCl reabsorption to decrease intravascular volume, which decreases Na+ intracellular concentration --> this activates Na+/Ca2+ antiporter that pumps Na+ from ECF into cell, thus decreasing intracellular Ca2+ and enhancing Ca2+ absorption --> elevated serum Ca2+ suppresses PTH --> low blood volume causes compensation by RAAS, which increases aldosterone levels leading to increased K+ and H+ secretion into urine, resulting in hypokalemia and metabolic alkalosis --> other side effects: hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia/gout, hypercalcemia)

Anti-hypertension drug class associated with hypokalemia and metabolic alkalosis

Aliskiren (direct renin inhibitor --> considered "last resort" treatment for hypertension that is refractory to ACE inhibitors and ARBs, but CONTRAINDICATED in patients taking these drugs due to additive hyperkalemic/low GFR effects --> side effects: hyperkalemia, low GFR, hypotension, angioedema, teratogenic)

Anti-hypertension drug that blocks conversion of angiotensinogen to AngI

Thiazide diuretics (HCTZ, chlorthalidone, metolazone: DIURETICS that inhibit Na+/Cl- co-transporter in early DCT --> inhibits NaCl reabsorption to decrease intravascular volume, which decreases Na+ intracellular concentration --> this activates Na+/Ca2+ antiporter that pulls Na+ from ECF into cell, thus decreasing intracellular Ca2+ and enhancing Ca2+ absorption --> used to treat HTN, heart failure, recurrent kidney stones, nephrogenic DI, and osteoporosis --> note: low blood volume causes compensation by RAAS, which increases aldosterone levels leading to increased K+ and H+ secretion into urine, resulting in hypokalemia and metabolic alkalosis --> other side effects: low Na+, hyperglycemia, elevated LDL cholesterol, elevated uric acid/gout, elevated serum Ca2+)

Anti-hypertensive medication associated with hyperglycemia and elevated LDL cholesterol

Minoxidil (Rogaine: direct arteriolar vasodilator --> used to treat androgenetic alopecia/male pattern baldness --> also used to treat severe refractory HTN)

Anti-hypertensive that can also be used to treat male pattern baldness

Methyldopa (alpha-2 agonist: inhibits central SNS outflow --> decreases NE/EPI release to lower BP, safe in pregnancy --> side effects: drug-induced SLE and direct Coombs-positive hemolytic anemia)

Anti-hypertensive used in pregnancy that can cause drug-induced SLE

Hydralazine, methyldopa, labetalol, nifedipine (Hypertensive Moms Love Nifedipine)

Anti-hypertensives that can be given to pregnant mothers

Corticosteroids (Prednisone: immunosuppressive agents that inhibit NF-kB to suppress transcription of many cytokines --> decreased # of peripheral lymphocytes within minutes due to inhibition of Ig synthesis, apoptosis of T cells and eosinophils, and lymphocyte distribution to spleen/lymph nodes/bone marrow--> decreased # of monocytes/macrophages due to inhibition of peripheral extravasation and redistribution to lymphoid tissue --> also causes DEMARGINATION, aka pushing neutrophils out of infected tissues and into bloodstream --> used to treat many autoimmune and inflammatory disorders such as SLE, adrenal insufficiency, asthma, CLL, non-Hodgkin lymphoma --> side effects: Cushing syndrome, osteoporosis, hyperglycemia, diabetes, amenorrhea, peptic ulcers, psychosis, cataracts, avascular necrosis of femoral head, adrenocortical atrophy that can cause adrenal insufficiency if drug is stopped abruptly after chronic use)

Anti-inflammatory agent that causes artificial leukocytosis (demargination)

Cyclophosphamide (cross-links DNA at guanine to prevent DNA synthesis, requires bioactivation by liver --> used to treat solid tumors, leukemia, lymphomas, polyarteritis nodosa, granulomatosis with polyangiitis, and microsopic poylangiitis --> side effects: myelosuppression, SIADH, hemorrhagic cystitis, transitional cell carcinoma --> prevention of side effects: supplement with mesna to bind toxic metabolites + adequate hydration)

Anti-inflammatory agent with risk of transitional cell carcinoma

NSAIDs (Ibuprofen, naproxen, indothematcin, ketorolac, diclofenac, etc: reversibly inhibit COX1 and COX2 to block prostaglandin synthesis --> used to treat fevers, pain, inflammation --> side effects: RENAL ISCHEMIA due to vasodilation of AFFERENT arterioles, interstitial nephritis, gastric ulcers, aplastic anemia)

Anti-inflammatory drug class associated with renal ischemia

NSAIDs (Ibuprofen, naproxen, indothematcin, ketorolac, diclofenac, etc: reversibly inhibit COX1 and COX2 to block prostaglandin synthesis --> used to treat fevers, pain, inflammation --> side effects: RENAL ISCHEMIA due to vasodilation of afferent arterioles, interstitial nephritis, gastric ulcers, aplastic anemia)

Anti-inflammatory drug class that vasodilates afferent arterioles of kidneys

Glucocorticoids (Prednisone: decrease osteoblastic activity and increase osteoclastic activity --> risk of osteoporosis in patients on long-term treatment --> bone-density testing recommended)

Anti-inflammatory drug that requires bone density testing

Chloroquine, mefloquine, quinidine, artesunate, primaquine (anti-malarial drugs that can cause hemolysis in patients with G6PD deficiency)

Anti-malarials that are contraindicated in patients with G6PD deficiency

Chlorpromazine (low-potency typical antipsychotic: block dopamine D2 receptors but has more anti-cholinergic, anti-histamine, and alpha-1 blockade effects --> high lipid solubility/storage in fat so long half-life --> used to treat psychosis, positive schizophrenia symptoms, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD --> MANY side effects in addition to CORNEAL deposits: hyperprolactinemia, dyslipidemia/weight gain, anti-muscarinic such as dry mouth/constipation, anti-histamine such as sedation, anti-alpha1 such as orthostatic hyoptension, QT prolongation)

Anti-psychotic associated with corneal deposits

Risperidone (atypical antipsychotic: 5-HT2 and D2 antagonists with varied effects on alpha-adrenergic and H1 receptors --> most associated with hyperprolactinemia due to D2 receptor antagonism in tuberoinfundibular pathway --> used 1st line for schizophrenia as it treats both positive and negative symptoms --> also used to treat bipolar disorder, OCD, anxiety disorders, depression, mania, Tourette syndrome --> side effects: all atypicals have prolonged QT, risperidone associated with hyperprolactinemia that can present with amenorrhea, galactorrhea, gynecomastia)

Anti-psychotic associated with elevated prolactin levels

Olanzapine and clozapine (mechanism fairly unknown, but serve as 5-HT2 and D2 antagonists with varied effects on alpha-adrenergic and cholinergic receptors --> used as 1st line treatment for schizophrenia as it is effective for both positive/negative symptoms --> clozapine also used for schizoaffective disorder --> side effects: prolonged QT and metabolic syndrome with weight gain, diabetes/hyperglycemia, and dyslipidemia --> should monitor with BMI, fasting glucose/lipid panel, BP, and waist circumference --> NOTE: clozapine also causes agranuloyctosis/impaired renal function, should be monitored with absolute neutrophil count)

Anti-psychotic drugs associated with metabolic syndrome

Clozapine (atypical antipsychotic: 5-HT2 and D2 antagonists with varied effects on alpha-adrenergic and H1 receptors --> mainly used to treat refractory schizophrenia, schizophrenia with suicidality, and schizoaffective disorder --> side effects: all atypicals have prolonged QT, olanzapine/clozapine associated with metabolic syndrome aka weight gain/diabetes/hyperlipidemia, and clozapine associated with agranulocytosis and seizures)

Anti-psychotic that requires monitoring of absolute neutrophil count

Acetaminophen (mostly inhibits COX in CNS with weak effect in peripheral tissues --> therefore not really anti-inflammatory, but strong anti-pyretic and analgesic effect --> can use instead of aspirin in children to avoid Reye syndrome --> side effects: overdose due to NAPQI metabolite depleting glutathione, causing toxic byproducts to form in liver and resulting in hepatic necrosis --> treat overdose with N-acetylcysteine to regenerate glutathione)

Anti-pyretic agent that reversibly inhibits COX in CNS

Lamotrigine (broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION --> almost 10% of patients get skin rash, while 1% of patients experience SJS/TEN with necrotic skin sloughing, usually in CHILDREN --> also associated with diplopia)

Anti-seizure medication associated with SJS/TEN in children

Topiramate (broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION and directly binds to allosteric site on GABA-A receptor to increase GABA levels --> mainly used to treat primary generalized seizures such as tonic-clonic --> side effects: somnolescence/fatigue, confusion, cognitive slowing, "word-finding difficulty," kidney stones, weight LOSS, and acute angle closure glaucoma/myopia --> if patient experiences any visual problems, need to stop drug IMMEDIATELY)

Anti-seizure medication associated with acute angle closure glaucoma and myopia

Valproic acid (need to measure LFTs during first few months of use: broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION and causes a rise in GABA --> mainly used to treat primary generalized seizures such as tonic-clonic --> side effects: nausea/vomiting, acute pancreatitis, fine tremor, increased appetite, weight GAIN, and rare but fatal hepatotoxicity --> ALSO teratogenic due to causing low serum folate and increases risk of neural tube defects)

Anti-seizure medication associated with fatal hepatotoxicity

Vigabatrin (irreversible inhibitor of GABA transaminase: increases GABA levels to suppress neurotransmission in CNS --> 1st line treatment for infantile spasms/West syndrome --> also used as ADJUNCT therapy to treat partial seizures --> side effect: permanent visual loss, has black box warning)

Anti-seizure medication that can cause permanent visual loss

Levetiracetam (binds to synaptic vesicle protein S2VA to modulate vesicular release of GABA/glutamate NTs --> mainly used to treat primary generalized seizures such as tonic-clonic seizures --> side effects: neuropsychiatric symptoms such as personality changes, fatigue, drowsiness, headaches)

Anti-seizure medication that modulates GABA and glutamate release

Carbamazepine, lamotrigine, phenytoin, topiramate, valproic acid (reduce ability of Na+ channel to recover from inactivation in cortical neurons --> decreases Na+ current and increases refractory period of neuron, inhibiting neuronal high-frequency firing --> NOTE: topiramate and valproic acid also increase GABA release, but carbamazepine, lamotrigine, and phentyoin do NOT)

Anti-seizure medications that promote Na+ channel inactivation

PTU (propylthiouracil: blocks thyroid peroxidase--inhibiting oxidation of iodine AND organification/coupling of iodine-- as well as 5'-deiodinase to block peripheral conversion of T4 to T3 --> not really used to treat hyperthyroidism EXCEPT during 1st trimester pregnancy, due to methimazole teratogenicity and risk of aplasia cutis, and during thyroid storm --> side effects: HEPATOTOXICITY, maculopapular rash, agranulocytosis, aplastic anemia, ANCA-associated vasculitis)

Anti-thyroid treatment associated with hepatotoxicity

Cephalosporins (beta-lactam drug that inhibits cell wall synthesis: 1st gen cefazolin used prior to surgery to prevent S. aureus wound infection --> 2nd gen against basically everything --> 3rd gen ceftriaxone crosses BBB to treat serious gram-negative infections, meningitis, gonorrhea, Lyme disease --> 5th gen ceftaroline covers MRSA and E. faecalis)

Antibiotic class less susceptible to beta-lactamase

Erythromycin (macrolide that binds to 23s rRNA of 50S subunit to inhibit translocation during protein translation --> used to treat atypical pneumonias, Chlamydia, streptococcal infection in patients allergic to penicillin, and B. pertussis --> binds to motillin receptors in stomach/duodenum to stimulate smooth muscle contraction in upper GI --> side effects-MACRO: motility issues, arrhythmia due to prolonged QT, cholestatic hepatitis, rash, eosinophilia, CYP450 inhibitor --> also TERATOGENIC and associated with hypertrophic pyloric stenosis in utero)

Antibiotic that acts as an agonist at motilin receptors

Fluoroquinolones (Ciprofloxacin, Ofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin: CONTRAINDICATED in pregnancy and children <18y/o due to risk of cartilage damage --> inhibit DNA gyrase and topoisomerase IV --> prevent nick formation during DNA replication, which causes supercoils and disrupts DNA replication --> used to gram-negative rod infections such as complicated UTIs, acute pyelonephritis, acute prostatitis, and gastroenteritis with coverage against Pseudomonas --> also used to treat sickle cell osteomyelitis and atypical pneumonia caused by Mycoplasma/Legionella --> side effects: GI upset, leg cramps/myalgias, prolonged QT, risk of TENDONITIS or TENDON RUPTURE in elderly --> note: reabsorption blocked by divalent cations, so do NOT take with milk or antacids)

Antibiotic that can cause cartilage damage in fetuses/children

Fluoroquinolones (Ciprofloxacin, Ofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin: high risk for tendonitis/tendon rupture in ELDERLY and those taking PREDNISONE --> inhibit DNA gyrase and topoisomerase IV --> prevent nick formation during DNA replication, which causes supercoils and disrupts DNA replication --> used to gram-negative rod infections such as complicated UTIs, acute pyelonephritis, acute prostatitis, and gastroenteritis with coverage against Pseudomonas --> also used to treat sickle cell osteomyelitis and atypical pneumonia caused by Mycoplasma/Legionella --> side effects: GI upset, leg cramps/myalgias, prolonged QT, teratogenic and damages cartilage in children so contraindicated in pregnancy and children <18y/o --> note: reabsorption blocked by divalent cations, so do NOT take with milk or antacids)

Antibiotic that can cause tendonitis/tendon rupture

Fluoroquinolones (Ciprofloxacin, Ofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin: reabsorption blocked by Ca2+/Mg2+/Fe2+ so cannot take with milk or antacids --> inhibit DNA gyrase and topoisomerase IV --> prevent nick formation during DNA replication, which causes supercoils and disrupts DNA replication --> used to gram-negative rod infections such as complicated UTIs, acute pyelonephritis, acute prostatitis, and gastroenteritis with coverage against Pseudomonas --> also used to treat sickle cell osteomyelitis and atypical pneumonia caused by Mycoplasma/Legionella --> side effects: GI upset, leg cramps/myalgias, prolonged QT, risk of TENDONITIS or TENDON RUPTURE in elderly or those taking prednisone, teratogenic and damages cartilage in children so contraindicated in pregnancy and children <18y/o)

Antibiotic that cannot be taken with milk or antacids

Daptomycin (lipopetide that creates transmembrane channels in gram-positive cocci, disrupting cell membrane --> used to treat Staph aureus skin infections especially with MRSA, bacteremia, endocarditis, VRE --> side effects: myopathy and rhabdomyolysis --> NOTE: cannot be used for pneumonia because inactivated by surfactant)

Antibiotic that creates transmembrane channels in gram-positive cocci

Polymyxin (Colistin, Polymyxin B: cation polypeptides that bind to phospholipids on cell membranes of gram-negative bacteria --> disrupt membrane integrity, causing leakage of cellular components and cell death --> used as SALVAGE THERAPY for multi-drug resistant gram-negatives such as Pseudomonas, E. coli, Klebsiella --> note: Polymyxin B part of triple antibiotic ointment used for superficial skin infections --> side effects: nephrotoxicity, neurotoxicity with slurred speech/weakness/paresthseias, respiratory failure)

Antibiotic that disrupts cell membrane integriy of gram-negative bacteria

Macrolides (Azithromycin, clarithromycin, erythromycin: inhibit 23S rRNA of 50S bacterial subunit to block ELONGATION during translation --> inhibits protein synthesis --> used to treat atypical penumonia, Chlamydia, strep infections in patients allergic to pencillin, and B. pertussis --> side effects-MACRO: motility issues, arrhythmia due to prolonged QT, cholestatic hepatitis, rash, eOsinophilia --> also TERATOGENIC and associated with hypertrophic pyloric stenosis in utero --> clarithromycin and erythomycin are CYP450 inhibitors)

Antibiotic that inhibits 23S rRNA of 50S ribosomal subunit

TMP (trimethoprim: inhibits DHFR in bacteria to prevent synthesis of dTMP --> inhibits pyrimidine synthesis to prevent cell growth)

Antibiotic that inhibits DHFR in bacteria

Tetracyclines (Tetracycline, doxycycline, minocycline: inhibit attachment of tRNA to A site in 30S ribosomal subunit, thus interfering of tRNA anticodon reading of mRNA codon --> accumulates intracellularly, so useful to treat Borrelia burgdorferi, M pneumoniae, Rickettsia, Chlamydia, P. acne, and community-acquired MRSA --> side effects: GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity, teratogenic --> NOTE: mechanism of resistance is plasmid-encoded efflux pumps)

Antibiotic that inhibits binding of aminoacyl-tRNA to 30S ribosomal subunit

Penicillin (D-Ala-D-Ala structural analog --> binds transpeptidase, aka penicillin binding protein --> blocks transpeptidase cross-linking of peptidogylcans in cell wall --> used to treat gram-positive organisms such as group A strep, group B strep, Actinomyces, Clostridum perfringens, Pasteurella multocida + gram-negative organisms such as Neisseria meningitidis + sphirochetes such as Treponema pallidum that causes syphilis)

Antibiotic that inhibits peptidogylcan wall synthesis

Chloramphenicol (inhibits peptidyltransferase within rRNA of 50S subunit --> inhibits peptide bond formation, thus blocking ELONGATION during bacterial protein synthesis --> not really used clinically due to toxicity, but used in developing world to treat bacterial meningitis and rickettsial diseases --> side effects: dose-dependent anemia, dose-independent aplastic anemia, and gray baby syndrome due to blockage of mitochondrial translation in humans)

Antibiotic that inhibits peptidyltransferase at 50S ribosomal subunit

Fluoroquinolones (Ciprofloxacin, Ofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin: inhibit DNA gyrase and topoisomerase IV --> prevent nick formation during DNA replication, which causes supercoils and disrupts DNA replication --> used to gram-negative rod infections such as complicated UTIs, acute pyelonephritis, acute prostatitis, and gastroenteritis with coverage against Pseudomonas --> also used to treat sickle cell osteomyelitis and atypical pneumonia caused by Mycoplasma/Legionella --> side effects: GI upset, leg cramps/myalgias, prolonged QT, risk of TENDONITIS or TENDON RUPTURE in elderly or those taking prednisone, teratogenic and damages cartilage in children so contraindicated in pregnancy and children <18y/o --> note: reabsorption blocked by divalent cations, so do NOT take with milk or antacids)

Antibiotic that interfere with DNA supercoiling to inhibit DNA synthesis

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin --> bind to 30S subunit to IRREVERSIBLY inhibit P site, thus inhibiting initiation complex --> also bends rRNA to cause misreading of mRNA --> used to treat severe gram-negative rod infections and Enterococcus, neomycin for bowel surgery --> side effects-NNOT: nephrotoxicity, NMJ blockade, OTOTOXICITY especially with loop diuretics, teratogen --> contraindicated in patients with MYASTHENIA GRAVIS and those taking LOOP DIURETICS --> mechanism of resistance: plasmid-encoded aminoglycoside-modifying enzymes that inactivate antibiotic via methylation, phosphorylation, or adenylation --> Pseudomonas developed resistance via decreasing antibiotic entry)

Antibiotic that irreversibly inhibits 30S ribosomal subunit to inhibit protein synthesis

TMP-SMX

Antibiotic used to treat Pneumocystis jirovecii, Toxoplasma gondii, and Nocardia

Moxifloxacin (fluoroquinolone: has POOR Pseudomonal coverage)

Antibiotic used to treat bacterial infections related to COPD exacerbations, sinusitis, and CA-pneumonia

Ceftriaxone (3rd gen cephalosporin)

Antibiotic used to treat community-acquired pneumonia and bacterial meningitis

Ceftriaxone (3rd gen cephalosporin: beta-lactam that inhibits peptidoglycan cell wall synthesis but less susceptible to penicillinases --> crosses BBB so highly useful against meningitis --> side effects: autoimmune hemolytic anemia, disulfiram-like reaction with alcohol, vitamin K deficiency, enhances nephrotoxicity of aminoglycosides --> mechanism of resistance: cephalosporinases and structural change in PBP)

Antibiotic used to treat meningitis, gonorrhea, and disseminated Lyme disease

Rifaximin or neomycin (non-absorbable antibiotic that alters GI flora --> inhibits NH3 producing gut bacteria --> often combined with lactulose to decrease NH3 levels and improve symptoms of hepatic encephalopathy --> side effects: diarrhea and dehydration)

Antibiotics given to patients with hepatic encephalopathy

Sulfonamides, chloramphenicol, clarithromycin, erythromycin, ciprofloxacin (sulfonamides: folate synthesis inhibitors that inhibit dihydropteroate synthase --> chloramphenicol: 50S inhibitor by blocking peptidyltransferase --> macrolides: 50S inhibitors by blocking translocation --> ciprofloxacin: quinolone that blocks DNA gyrase and topoisomerase IV)

Antibiotics that cause CYP450 inhibition

Amoxicillin, carbapenems, clindamycin, metronidazole (clindamycin for anaerobic infections ABOVE diaphragm --> metronidazole for anaerobic infections BELOW diaphragm)

Antibiotics that cover anaerobic bacteria

Daptomycin and polymyxin (daptomycin for gram-POSITIVE bacteria --> polymyxin for gram-NEGATIVE bacteria, but usually used as "salvage therapy" for MDR gram-negative bugs such as Pseudomoas, Klebsiella, E. coli)

Antibiotics that disrupt cell membrane integrity

Penicillins, cephalosporins, and vancomycin (disrupt peptidoglycan cell wall of bacteria, which provides shape and resistance to osmotic stress --> usually not destroyed by variations in tonicity, but addition of anti-cell wall antibiotics allow bacterial destruction in hypotonic solutions)

Antibiotics that inhibit ability of organisms to survive osmotic stress

Ampicillin and clindamycin (also associated with PPIs, indicating gastric acid may be protective against C. difficle)

Antibiotics with highest risk of C. difficile infection

Bupropion (inhibits reuptake of NE and dopamine --> used to treat depression, and often preferred by patients because it does NOT cause sexual dysfunction and does NOT cause weight gain --> can also be used for smoking cessation --> side effects: stimulant effects such as tachycardia, insomnia, headache, seizures in patients with seizure disorders or electrolyte abnormalities such as bulimia/anorexia)

Antidepressant contraindicated in patients with seizure disorders

N-acetylcysteine (regenerates glutathione in liver, which is depleted by acetaminophen toxic metabolite NAPQI)

Antidote for acetaminophen overdose

Physostigmine (AChE inhibitor that increases ACh in synaptic cleft --> tertiary amine so freely crosses BBB so useful for treatment against atropine)

Antidote for anti-cholinergic toxicity

Idarucizumab (reverses dabigatran, aka oral direct thrombin inhibitor used for VTEs, AFib, and heparin-induced thrombocytopenia)

Antidote for dabigatran-associated bleeding

Thioridazine (low-potency atypical antipsychotic: block dopamine D2 receptors but has more anti-cholinergic, anti-histamine, and alpha-1 blockade effects --> high lipid solubility/storage in fat so long half-life --> used to treat psychosis, positive schizophrenia symptoms, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD --> MANY side effects in addition to RETINAL deposits: hyperprolactinemia, dyslipidemia/weight gain, anti-muscarinic such as dry mouth/constipation, anti-histamine such as sedation, anti-alpha1 such as orthostatic hyoptension, QT prolongation)

Antipsychotic associated with retinal deposits

Aripiprazole

Antipsychotic with partial D2 agonism

Dextromethorphan (synthetic codeine analog that works at mu opioid receptor to open post-synaptic K+ channel and close pre-synaptic Ca2+ channels to decrease synaptic transmission --> also antagonizes NMDA glutamate receptors --> used to treat chronic persistent cough --> side effects: N/V, respiratory depression, miosis, mild abuse potential, serotonin syndrome)

Antitussive agent that can cause constipation

Amantadine (enhances effects of endogenous dopamine by increasing DA synthesis/release and inhibiting DA reuptake --> side effects: ataxia, livedo reticularis, hallucinations)

Antiviral drug used to treat dyskinesia in Parkinson patients (motor fluctuations during "end of dose" phenomenon)

Ribavarin (inhibits IMP dehydrogenase, thus decreasing levels of GMP and inhibiting de novo purine synthesis --> used to treat chronic Hep C and RSV infections)

Antiviral that inhibits synthesis of guanine nucleotides to inhibit viral protein synthesis

Bupropion (NE and dopamine reuptake inhibitor --> has favorable side effect profile so indicated for patients with depression and decreased libido --> also used for smoking cessation --> side effects: increased risk of developing seizures in patients with electrolyte disturbances, stimulatory effects, headaches)

Atypical antidepressant that is contraindicated in patients with anorexia and bulimia nervosa

Propanolol (non-selective beta blocker that blocks both B1 and B2 --> blockage of B2 in bronchial smooth muscle can promote bronchoconstriction)

Autonomic drug contraindicated in patients with obstructive pulmonary disease (asthma, COPD, etc.)

Diazepam, chlordiazepoxide, flurazepam (half life >50hrs)

Long-acting benzodiazepines

Heart failure

Major side effect of disopyramide (class IA anti-arrhythmic --> prolongs AP duration)

Dicloxacillin (effective against Staph aureus --> also should encourage woman to continue breastfeeding)

Treatment for lactational mastitis

Thiopental (increases DURATION of Cl- channel opening in GABA-A receptors --> ultra rapid onset/offset due to LARGE redistribution effect --> rapidly distributes into muscle/fat, lowering plasma levels and brain levels within a few minutes --> decreases cerebral blood flow, compared to ketamine which INCREASES cerebral blood flow --> not really used anymore due to many side effects: hypotension, CV/respiratory depression, CNS depression/coma, physical dependence, CYP450 inducer)

Barbiturate used for induction of anesthesia

Smoking cessation

Best lifestyle change to decrease recurrence of H. pylori gastritis

Hyperkalemia (digoxin: cardiac glycoside that directly inhibits Na+/K+ ATPase on cardiac myocytes --> indirectly inhibits Na+/Ca2+ exchanger in myocardium to INCREASE intracellular Ca2+ and increase contractility --> also stimulates vagus nerve to increase ERP and decrease conduction at AV and SA node, thus decreasing HR --> used to treat chronic systolic HF and AFib --> side effects: hyperkalemia, arrhythmias such as PVC, bradycardia and AV node block, nausea/vomiting, abdominal pain, diarrhea, delirium/confusion, yellow-tinted vision --> contraindications: hypokalemia, renal insufficiency, and patients taking beta-blockers, verapamil, diltiazem, amiodarone, quinidine --> NOTE: long-term digoxin use causes T wave changes, shortened QT interval, and "scooped" concave ST segments, but these are NOT associated with toxicity)

Best method to diagnose digitalis toxicity and predict mortality

Fenoldopam (D1 receptor agonist: causes coronary, peripheral, renal, and splanchnic ARTERIOLAR vasodilation --> main effects are arteriolar dilation, renal perfusion, diuresis, and natriuresis --> used to treat hypertensive emergency in patients with acute kidney injury AND given post-op for HTN prophylaxis --> side effects: hypotension and tachycardia)

Best treatment for hypertensive emergency in patients with renal insufficiency

ACE inhibitors (Captopril, Enalapril, Lisinopril, Ramipril: REDUCES BP and SLOWS DOWN damaging effects of diabetes on renal and CV systems --> inhibit ACE to decrease levels of AngII, thus preventing constriction of efferent arterioles and decreasing GFR --> 1st line treatment for heart failure and diabetic nephropathy, due to decreasing intraglomerular pressure slowing down GBM thickening --> also used to treat hypertension and given post-MI to prevent unfavorable heart remodeling --> major side effect is hyperkalemia due to decreased aldosterone and K+ retention in collecting ducts --> other side effects: cough and angioedema due to elevated bradykinin, elevated serum creatinine, elevated renin, hypotension --> contraindicated in BILATERAL renal artery stenosis, completely fine for unilateral renal artery stenosis)

Best treatment for patients with hypertension and diabetes

Beta-blockers (propranolol, metroprolol, esmolol, atenolol, carvedilol, labetalol: beta-blockers are BOTH negative inotropic and chronotropic agents that reduce contractility and HR to decrease myocardial O2 demand and reduce size of ischemic myocardium, thus useful for CHF and coronary artery disease --> block B1 receptors on SA and AV nodes to decrease intracellular cAMP/Ca2+ levels, thus decreasing contractility and conduction and making them useful against SVT and ventricular arrhythmias post-MI --> also prolongs phase 4 depolarization in pacemaker cells, thus decreasing HR and making them useful against angina and HOCM --> also decrease CO and renin secretion via B1 receptor blockage, thus useful against hypertension --> NOTE: decreases mortality in CHF and post-MI --> side effects: bradycardia, AV block, erectile dysfunction, seizures, sleep alterations, asthma/COPD exacerbations)

Best treatment for patients with hypertension, coronary artery disease, and CHF

Timolol (non-selective beta-blocker: inhibits both B1 receptors and B2 receptors, especially B2 receptors on ciliary body --> decreases aqueous humor synthesis --> minimal side effects with NO pupillary or vision changes)

Beta-blocker used to treat glaucoma

Nadolol, pindolol, propranolol, timolol, carvedilol, labetalol (non-selective beta-blockers that antagonize both B1 and B2: nadolol, pindolol, propranolol, timolol --> non-selective alpha/beta-blockers that antagonize B1, B2, and A1: carvedilol and labetalol)

Beta-blockers that are contraindicated in patients with obstructive lung disease (COPD/asthma)

Clavulanic acid, avibactam, sulbactam, tazobactam (CAST: often added to penicillin antibiotics to protect them from destruction by beta-lactamase)

Beta-lactamase inhibitors

Teriperatide

Bone growth-promoting drug contraindicated in Paget disease and anyone with elevated AlkPhos

Teriparatide (recombinant PTH analog that increases osteoblastic activity when administered in pulsatile fashion --> used to treat osteoporosis, causes MORE bone growth compared to bisphosphonates --> side effects: risk of osteosarcoma and transient hypercalcemia)

Bone-growing drug contraindicated in Paget disease of bone, patients with elevated AlkPhos, or history of cancer

Lamotrigine, levetiracetam, topiramate, valproic acid (broad-spectrum anti-epileptics: can be used to treat most seizure types including primary partial seizures, partial with 2° generalized seizures, and primary generalized seizures including juvenile myoclonic epilepsy --> aka use broad-spectrum when patient presents with MULTIPLE seizure types --> note that these are metabolized by CYP450 enzymes)

Broad-spectrum anti-convulsants

Dronabinol (cannabinoid analog --> used as anti-emetic in some chemotherapy patients, and as appetite stimulant in AIDS patients --> side effects: euphoria, anxiety, paranoid delusions, impaired judgement, dry mouth, conjunctival injection, hallucinations)

Cannabinoid used as an anti-emetic and appetite stimulant

Drug-induced SLE (presents with lupus-like symptoms such as myalgia, arthralgia, serositis, cytopenias --> positive for ANA and anti-histone antibodies)

Major side effect of procainamide (class IA anti-arrhythmic --> prolongs AP duration)

Cyclosporine (binds to cyclophilin to inhibit IL-2 transcription) and tacrolimus (binds to FK-506 binding protein to inhibit IL-2 --> BOTH have similar side effects such as NEPHROTOXICITY, HTN, hyperlipidemia, diabetes, neurotoxicity)

Calcineurin inhibitors

Modafinil, chronic alcohol use, phenytoin, phenobarbital, carbamazepine, rifampin, griseofulvin, nevirapine, St. John's wort (CYP450 inducers will DECREASE warfarin levels --> DECREASE INR/PT --> high risk of clots)

CYP450 inducers

Tacrolimus (binds to FK506 binding protein, which directly inhibits calcineurin --> inhibits IL-2 transcription to decrease T-cell proliferation --> used to treat transplant rejection, psoriasis, rheumatoid arthritis --> side effects: still associated with nephrotoxicity)

Calcineurin inhibitor NOT associated with gingival hyperplasia and hirsutism

Cyclosporine (binds to cyclophilin in T cells --> causes conformational change that allows cyclophilin to bind to calcineurin, a protein phosphatase that activates IL-2 transcription --> calcineurin can NO LONGER dephosphorylate nuclear factor of activated T cells/NFAT, a critical TF for IL-2 transcription --> inhibits IL-2 transcription to decrease T cell proliferation --> used to treat transplant rejection, psoriasis, rheumatoid arthritis --> side effects: in addition to gingival hyperplasia and hirsutism, associated with RENAL TOXICITY due to dose-dependent renal vasoconstriction and tubular cell damage)

Calcineurin inhibitor associated with nephrotoxicity, hypertension, gingival hyperplasia and hirsutism

Membrane efflux pumps (efflux pumps use H+ to expel drug out of bacteria --> also seen in fluoroquinolone resistance)

Cause of chloroquine resistance

Methyldopa, hydralazine, procainamide, isoniazid, carbamazepine, phentyoin (drug-induced SLE: presents with lupus-like symptoms such as myalgia, arthralgia, serositis, cytopenias --> removal of drug will cause remission of symptoms --> positive for ANA and anti-histone antibodies)

Causes of drug-induced SLE

Class 1A and 3 antiarrhythmics, macrolides, fluoroquinolones, haloperidol, TCA, ondansetron (remember anti-ABCDE: antiarrhythmics, antibiotics, anti-psychotics, anti-depressants, anti-emetics --> prolonged QT also associate with hypokalemia and hypomagnesemia)

Causes of prolonged QT (can lead to Torsades de pointes)

Pheochromocytoma and cocaine toxicity

Causes of unopposed alpha in patients taking beta-blockers

Listeria, MRSA, Enterococcus, Mycoplasma, Chlamydia (Listeria, MRSA, Enterococcus: formation of resistant penicillin-binding proteins/PBP --> Mycoplasma and Chlamydia: atypical bacteria that lack cell wall)

Cephalosporin-resistant organisms

Vincristine (vinca alkyloid that binds beta-tubulin to inhibit microtubule polymerization --> preventions formation of mitotic spindle to cause M-phase arrest --> used to treat solid tumors, leukemias, Hodgkin and non-Hodgkin lymphoma)

Chemotherapy agent associated with areflexia, peripheral neuritis, and constipation

Doxorubicin (anthracycline: topoisomerase II inhibitor --> intercalates in DNA and causes DNA strand breaks during replication --> decreased DNA replication --> AC combo: used in combo with cyclophosphamide to treat breast cancer --> side effect: cardiotoxicity/dilated cardiomyopathy due to oxidative stress and iron chelation, which causes patchy cardiomyocyte necrosis with diffuse myocardial fibrosis on biopsy --> can treat cardiotoxicity with dexrazoxane)

Chemotherapy drug most often associated with dilated cardiomyopathy/CHF

Vincristine (vinca alkyloids that bind to beta-tubulin --> block microtubule polymerization --> prevent mitotic spindle formation to cause M-phase arrest --> used to treat non-Hodgkin lymphoma --> side effects: areflexia and peripheral neuritis + constipation, including paralytic ileus)

Chemotherapy drug most often associated with peripheral neuropathy

Methotrexate (folic acid analog that competitively inhibits dihydrofolate reductase/DHFR --> decreases dTMP --> decreases DNA snythesis --> used to treat acute lymphocytic leukemia, lymphoma, choriocarcinoma, and sarcomas --> more often used to treat severe psoriasis, psoriatic arthritis, and rheumatoid arthritis --> reverse MTX toxicity with folinic acid)

Chemotherapy drug whose side effects include myelosuppression, fatty change in liver, mouth ulcers, pulmonary fibrosis, folate deficiency, nephrotoxicity

Cisplatin (formation of DNA adducts --> cross-linking of DNA --> strand breaks --> cell death --> side effects: nephrotoxicity, otoxicity, peripheral neuropathy)

Chemotherapy drugs most often associated with otoxicity and nephrotoxicity

Methotrexate, bleomycin, busulfan

Chemotherapy drugs most often associated with pulmonary fibrosis

Bleomycin, dactinomycin, doxorubicin (bleomycin: induces free radical formation to form breaks in DNA strands, SE include pulmonary fibrosis and skin hyperpigmentation --> dactinomycin: intercalates into DNA to prevent RNA synthesis, SE include bone marrow suppression --> doxorubicin: intercalates in DNA to cause breaks in DNA strands, SE include dilated cardiomyopathy/bone marrow suppression/alopecia)

Chemotherapy drugs that inhibit G2 phase in cell cycle

Vincristine, vinlbastine, paclitaxel (vincristine/vinblastine: vinca alkaloids that bind beta-tubulin and inhibit polymerization in microtubules to prevent mitotic spindle formation, SE include peripheral neuropathy/bone marrow suppression/constipation --> paclitaxel: taxane that hyperstabilizes polymerized microtubules in M phase to prevent mitotic spindle breakdown, SE include myelosuppression/ neuropathy/type 1 HSR)

Chemotherapy drugs that inhibit M phase in cell cycle

Antimetabolites, etoposide, irinotecan, hydroxyura (antimetabolites: include purine inhibitors such as azathioprine and cladribine, pyrimidine inhibitors such as cytabarine and 5-FU, and DHFR inhibitors such as methotrexate --> etoposide: inhibits topoisomerase II to promote DNA degradation, SE include bone marrow suppression/alopecia --> irinotecan: inhibits topoisomerase I to prevent DNA unwinding/replication, SE include bone marrow suppression and diarrhea --> hydroxyurea: inhibits ribonucleotide reductase to inhibit BOTH purine/pyrimidine synthesis, SE include bone marrow suppression)

Chemotherapy dugs that inhibit S phase in cell cycle

Cisplatin (cross-links DNA --> used to treat testicular, bladder, ovarian, and lung carcinomas --> side effect: damages apical stereocilia on hair cells in cochlear membranous labyrinth --> loss of response to high-frequency sounds)

Chemotherapy that causes tinnitus and hearing loss in children

Amiodarone (class 3 anti-arrhythmic: blocks Na+ channels, K+ channels, Ca2+ channels, and beta-adrenergic receptors --> overall effect is prolongation of phase 3 repolarization to increase AP duration --> high efficacy and very long half-life, thus used to treat atrial flutter, AFib, ventricular tachycardia, and acute treatment of VFib --> side effects: pulmonary fibrosis, hepatotoxicity, thyroid problems, corneal deposits, blue/gray skin discoloration leading to photodermatitis)

Class III anti-arrhythmic with lowest risk of causing torsades de pointes

Indomethacin (NSAID that blocks COX enzyme --> decreased PG production --> closure of PDA)

Closes PDA

AV node and left atrium (AV node: located in interatrial septum near opening of coronary sinus/insertion of tricuspid valve septal leaflet --> LA: opening of pulmonary veins in LA often site of AFib due to having their own electrical activity)

Common sites for cardiac ablation for treatment of AFib

NRTIs (Tenofovir, emtricitabine, lamivudine, abacavir, zidovudine --> inhibit HIV DNA synthesis from RNA template by terminating DNA chain elongation --> REQUIRE phosphorylation for activation --> ZDV used for general prophylaxis during pregnancy --> side effects: bone marrow suppression, peripheral neuropathy, lactic acidosis, ZDV causes anemia, didanosine causes pancreatitis, abacavir causes type 1 HSR in patients with HLA-B*5701)

Competitive nucleoside/nucleotide HIV reverse transcriptase inhibitors

Retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia (remember movement of "RIB" in baby with NRDS)

Complications of therapeutic supplemental O2 given to a newborn with NRDS

Putamen and globus pallidus (putamen associated with initiation of movement --> globus pallidus externus associated with stimulation of movement --> globus pallidus internus associated with inhibition of movement)

Composition of lentiform nucleus

Hyperthyroidism (amiodarone is a class III anti-arrhythmic that blocks K+ channels to increase ERP and prolong AP duration in myocardium --> 40% iodine by weight, so it can cause either hypo- or hyperthyroidism)

Contraindication for amiodarone

Myasthenia gravis and loop diuretics (aminoglycosides block NMJ so should NEVER be used with MG --> loop diuretics enhance ototoxicity)

Contraindications for aminoglycosides

Hypokalemia and renal insufficiency (ALSO contraindicated in patients taking beta-blockers, verapamil, diltiazem, amiodarone, quinidine --> digoxin: cardiac glycoside that directly inhibits Na+/K+ ATPase on cardiac myocytes --> indirectly inhibits Na+/Ca2+ exchanger in myocardium to INCREASE intracellular Ca2+ and increase contractility --> also stimulates vagus nerve to increase ERP and decrease conduction at AV and SA node, thus decreasing HR --> used to treat chronic systolic HF and AFib --> side effects: hyperkalemia, arrhythmias such as PVC, bradycardia and AV node block, nausea/vomiting, abdominal pain, diarrhea, delirium/confusion, yellow-tinted vision --> NOTE: long-term digoxin use causes T wave changes, shortened QT interval, and "scooped" concave ST segments, but these are NOT associated with toxicity)

Contraindications for digoxin use

Topoisomerase II (eukaryotic DNA replication protein that introduces negative supercoils to DNA to relieve tension created during DNA strand unwinding --> etoposide/teniposide prevent nick formation during DNA replication, which disrupts DNA replication and causes cell death)

DNA replication protein inhibited by etoposide/teniposide

Topoisomerase I (eukaryotic protein that removes DNA supercoils during transcription and DNA replication --> irinotecan/topotecan prevent nick formation during DNA replication, which disrupts DNA replication and causes cell death)

DNA replication protein inhibited by irinotecan/topotecan

Serum TSH (if ELEVATED, consider primary hypothyroidism --> if DECREASED, consider primary hyperthyroidism)

Diagnosis of hypothyroidism and hyperthyroidism

Ketogenic diet (high fat/low carb diet that increases level of ketone bodies, such as beta-hydroxybutyratic acid, in the brain)

Dietary treatment for refractory epilepsy

Carbachol and Pilocarpine (Carbachol: used to constrict pupils and relieve intraocular pressure in open-angle glaucoma --> Pilocarpine: same uses as carbachol plus crosses BBB so used as treatment of cclosed-angle glaucoma thru pupillary sphincter, and potent stimulator of sweat/tears/saliva for treatment of Sjogren)

Direct ACh agonists that are resistant to AChE

Acute intermittent porphyria (AIP: autosomal dominant disorder characterized by defective PBG deaminase, which converts porphobilinogen into HMB in the heme pathway --> usually asymptomatic, but AIP attacks occur in presence of ALA synthase inducers: increased progesterone in puberty/OCPs, CYP450 inducers such as barbiturates/anti-epileptics, alcohol, fasting --> presents with 5Ps: painful abdomen, port wine-colored urine that darkens on exposure to light/air, polyneuoropathy that is motor/sensory, psychological disturbances, precipitated by drugs/alcohol/starvation --> lab findings: ↑porphobilinogen and ALA in urine)

Disease that is contraindicated for phenobarbital use

Ethacrynic acid (non-sulfonamide loop diuretic: inhibit Na+/K+/Cl- of thick ascending limb to abolish hypertonicity of medulla to prevent urine concentration --> side effects: OTOXICITY!!)

Diuretic given to patients with sulfa allergy

Mannitol (osmotic diuretic that increases tubular fluid osmolarity and urine flow --> used to treat drug overdoses and elevated intracranial/intraocular pressure --> side effects: pulmonary edema, dehydration, and hypo- or hypernatremia)

Diuretic that is contraindicated in patients with anuria or heart failure

Ethacrynic acid (non-sulfonamide loop diuretic: inhibit Na+/K+/Cl- of thick ascending limb to abolish hypertonicity of medulla to prevent urine concentration --> used to treat edema in patients with sulfa allergy)

Diuretic that is highly ototoxic

Selegiline, Rasagiline (MAO-B inhibitors) and Entacapone (COMT inhibitor)

Drugs that decrease central dopamine degradation

Mannitol (osmotic diuretic that INCREASES tubular fluid osmolarity, which causes water to move into tubular lumen --> in kidneys, occurs in PCT to produce diuresis/increase urine flow --> in brain, redistributes water from tissues to plasma to reduce cerebral edema --> used to treat drug overdoses and cerebral edema/increased ICP --> side effects: dehydration and hypernatremia due to excess volume depletion OR PULMONARY EDEMA, hyponatremia, hyperkalemia, metabolic acidosis due to rapid volume expansion and increased overall hydrostatic pressure --> CONTRAINDICATIONS: anuria and heart failure)

Diuretic with risk of causing pulmonary edema

Loop diuretics (Furosemide, bumetanide, torsemide: inhibit Na+/K+/Cl- of thick ascending limb to abolish hypertonicity of medulla to prevent urine concentration, and also vasodilate afferent arterioles via PGE release --> used to treat any type of edema, including HF, cirrhosis, nephrotic syndrome, PE, HTN, hypercalcemia --> side effects--OHH DAANG: otoxicity, hypokalemia, hypomagnesia, dehydration, allergy to sulfa, alkalosis, nephritis, gout)

Diuretics that cause increased Ca2+ excretion

Fenoldopam (D1 receptor agonist: causes coronary, peripheral, renal, and splanchnic ARTERIOLAR vasodilation --> mainly used to increase renal perfusion, decrease BP, and increase natriuresis --> treats hypertensive emergency especially in patients with acute kidney injury, AND used post-op as HTN prophylaxis --> side effects: hypotension and tachycardia)

Dopamine agonist used to treat hypertensive emergency

Bromocriptine, Pramipexole, Ropinirole (alleviate dyskinesia/motor fluctuations associated with L-DOPA --> used EARLY in treatment to delay/reduce "end of dose" phenomenon --> side effects: impulse control disorders, orthostatic hypotension, pulmonary and retroperitoneal fibrosis)

Dopamine agonists used in Parkinson treatment

Everolimus (mTOR inhibitor that blocks cell cycle between G1 and S phase to reduce smooth muscle proliferation --> also prevents response to IL-2, thus blocking T cell activation and B cell differentiation --> added to intracoronary stents to form drug-eluting stent that prevents intimal hyperplasia and stent restenosis --> side effects: NON-NEPHROTOXIC but can cause pancytopenia, insulin resistance, and hyperlipidemia)

Drug added to intracoronary stents to prevent coronary artery restenosis (drug-eluting stent)

Aspirin (irreversibly inhibits COX1 and COX2 --> inhibition of adenoma-carcinoma sequence in polyps: normal colon develops APC inactivation, causing disorder cell growth/adhesion --> methylation mutations/COX2 overexpression allow hyperproliferative endothelium --> KRAS activation and DCC inactivation causes dysplastic mucosa and development of pre-malignant adenomatous polyp --> TP53 inactivation causes transition to colonic adenocarcinoma)

Drug associated with lower risk of colonic adenoma and colonic adenocarcinoma

Barbiturates (Phenobarbital, pentobarbital, thiopental, secobarbital, primidone: rarely used due to side effects, but can given as sedative for critically ill patients in hospital/neonatal seizures with phenobarbital/rapid induction of anesthesia with thiopental --> side effects: hypotension, CV/respiratory depression, CNS depression/coma, physical dependence, CYP450 inducer --> contraindicated in ELDERLY and acute intermittent porphyria, as it precipitates AIP attacks)

Drug class that increases DURATION of Cl- channel opening in GABA-A receptor

Benzodiazepines (bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> used to treat ACUTE anxiety/panic disorder symptoms, spasticity, ACUTE status epilepticus, eclampsia, alcohol withdrawal, night terrors, sleep walking, insomnia --> longer-lasting benzos such as Diazepam, Lorazepam, Midazolam metabolized into active metabolites to allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Drug class that increases FREQUENCY of Cl- channel opening in GABA-A receptor

Proton pump inhibitors (PPIs such as omeprazole, lansoprazole, esomeprazole, etc: irreversibly inhibit H+/K+ ATPase in parietal cells --> inhibit H+ secretion into gastric mucosa --> used as 1st line treatment for gastric and duodenal ulcers, NSAID-induced ulcers, GERD, gastritis, Zollinger-Ellison syndrome, part of H. pylori therapy, and stress ulcer prophylaxis --> side effects: C. diff infection, pneumonia, acute interstitial nephritis, low serum Mg2+ and Ca2+ causing increased risk of falls in elderly --> elderly patients should be given Ca2+ supplements and have bone density monitoring)

Drug class that inhibits H+/K+ ATPase in stomach parietal cells

ACE inhibitors (Captopril, Enalapril, Lisinopril, Ramipril: inhibit ACE to decrease levels of AngII, thus preventing constriction of efferent arterioles and decreasing GFR --> 1st line treatment for heart failure and diabetic nephropathy, due to decreasing intraglomerular pressure slowing down GBM thickening --> also used to treat hypertension and given post-MI to prevent unfavorable heart remodeling --> major side effect is hyperkalemia due to decreased aldosterone and K+ retention in collecting ducts --> other side effects: cough and angioedema due to elevated bradykinin, elevated serum creatinine, elevated renin, hypotension --> contraindicated in BILATERAL renal artery stenosis since they have reduced renal perfusion and are dependent on AngII-induced efferent vasoconstriction to maintain GFR --> ACE inhibitors reduce BP, preventing overcoming of stenosis and causes drop of in renal blood flow, ALSO dilates efferent arteriole leading to further reduced GFR)

Drug class used to both reduce blood pressure and slow damaging effects of diabetes on renal and CV systems

TCA (tricyclic antidepressants such as amitriptyline, imipramine, desipramine, clomipramine: inhibit reuptake of NE and serotonin --> mostly used for migraine prophylaxis --> rare, but can be used for insomnia or adjunctive pain management when other medications are not effective --> side effects: NE block causes tremor, cardiac fast-Na+ channel block causes arrhythmias/prolonged QT, mACh receptor block causes confusion/dry mouth/urinary retention/constipation/ileus, alpha-1 adrenergic block causes orthostatic hypotension, and histamine block causes sedation)

Drug class with many side effects including tremor, arrhythmias/prolonged QT, confusion, dry mouth, constipation, urinary retention, orthostatic hypotension, and sedation

Benzodiazepines (Diazepam, Lorazepam, Midazolam: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> causes CNS depression --> decreases GABA-A sensitivity over time, developing tolerance requiring larger dose + physical dependence --> acute benzo withdrawal will cause CNS excitation similar to alcohol withdrawal --> seen especially in short-acting benzos such as Alprazolam, Triazolam, Oxazepam, Midazolam)

Drug class withdrawal symptoms include tremors, anxiety, perceptual disturbances, dysphoria, psychosis, seizures

Sacubitril-valsartan (Entresto: sacubitril is a neprilysin inhibitor, thus preventing breakdown of ANP/BNP, AngII, and substance P --> presence of ANP and BNP increase cGMP in vascular smooth muscle to cause vasodilation, decrease Na+ reabsorption in CD to promote natriuresis, and dilate afferent arteriole/constrict efferent arteriole to promote diuresis --> since presence of AngII would counteract these effects, addition of valsartan/AngII receptor blocker prevents AngII-mediated vasoconstriction and fluid retention --> sacubitril-valsartan combo used to treat systolic heart failure with reduced EF via vasodilation + decreased ECF volume --> side effects: hypotension, hyperkalemia, cough, dizziness --> contraindication: ACE inhibitors and hereditary angioedema due to angioedema)

Drug combination that causes vasodilation, natriuresis, and diuresis

Ace inhibitors (Captopril, enalapril, lisinopril, ramipril: inhibit ACE to decrease AngII, preventing renal efferent arteriole constriction to decrease GFR --> also inhibits bradykinin breakdown, thus increasing levels of this potent vasodilator --> C1 esterase inhibitor deficiency already has a state of high bradykinin, so ACE1 + hereditary angioedema can cause life-threatening swelling)

Drug contraindicated in C1 esterase inhibitor deficiency

Epinephrine (alpha-1 agonist: decreases aqueous humor via vasoconstriction --> increases intraocular pressure, therefore cannot be used in closed-angle glaucoma --> side effects: mydriasis, blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritis)

Drug contraindicated in closed-angle glaucoma

Selegiline (selectively inhibits MAO-B to block conversion of dopamine to DOPAC in CNS --> side effect: metabolized to methamphetamine so causes stimulatory side effects such as insomina, hallucinations, etc.)

Drug for Parkinson treatment that is metabolized to amphethamine/methamphetamine

Amoxicillin (beta-lactam antibiotic that is same as penicillin but with wider spectrum due to improved activity against gram-negative bugs --> doctor mistakenly diagnoses mono for strep pharyngitis --> causes maculopapular rash in patients with EBV infection --> NOT a hypersensitivity reaction, mechanism unknown)

Drug given to patients with mononucleosis that causes maculopapular rash

Corticosteroids (decrease activation of neutrophil ADHESION molecules, thus impairing migration out of vasculature into sites of inflammation, so increased neutrophil plasma levels --> however, also sequesters eosinophils in lymph nodes and causes apoptosis of lymphocytes)

Drug that causes eosinopenia, lymphopenia, neutrophilia

TMP-SMX (specifically SMX/sulfamethoxazole: inhibits dihydropteroate synthase to inhibit folate synthesis --> used to treat UTIs, Nocardia, Shigella, Salmonella --> mechanism of kernicterus: SMX displaces bilirubin bound to serum albumin, thus increasing free UCB in neonate --> other side effects: hypersensitivity, SJS/TEN, type 4 renal tubular acidosis/interstitial nephritis, photosensitivity, increases warfarin levels)

Drug that causes kernicterus in neonates when mother takes it during 3rd trimester

Pilocarpine (DIRECT cholinergic mAChR agonist --> allows pupillary constriction in a denervated eye)

Drug that causes pupillary constriction in a denervated eye

Spironolactone (aldosterone receptor antagonist: prevents aldosterone from binding to receptors in DCT --> increased Na+ and H2O excretion, while conserving K+ ions --> blocks deleterious effects of aldosterone on heart, causes regression of myocardial fibrosis, and improves ventricular remodeling --> recommended to add to ACE inhibitors and beta-blockers for standard HF therapy --> also used to treat hyperaldosteronism/Conn syndrome, hypokalemia, hepatic ascites, and anti-androgen --> side effects: hyperkalemia/arrhythmias and gynecomastia --> contraindications: hyperkalemia and renal failure)

Drug that causes regression of myocardial fibrosis and improves ventricular modeling

Isoproterenol (beta-1 and beta-2 agonist: binds to B1 receptors on heart to increase HR/contractility/conduction --> binds to B2 receptors on vascular smooth muscle to cause vasodilation, thus decreasing vascular resistance and mean BP)

Drug that increases cardiac contractility/HR/conduction thru AV node, while also decreasing BP

Rifampin (inhibits DNA-dependent RNA polymerase in prokaryotes, which makes all 3 types of RNA --> inhibits mRNA synthesis --> used to treat TB and tuberculoid form of leprosy, prophylaxis for N. meningiditis, and prophylaxis for H. influenzae type b --> side effects: orange body fluids, CYP450 inducer --> remember Rifampin's 4 Rs: RNA polymerase inhibitor + red/orange body fluids + ramps down CYP450 + rapid resistance if used alone)

Drug that inhibits DNA-dependent RNA polymerase in eukaryotes

Mycophenolate mofetil (reversibly inhibits de novo purine synthesis --> selectively targets lymphocytes, reducing B and T cell proliferation and inducing T-cell apoptosis --> used to treat lupus nephritis and as adjunct to transplant rejection --> side effects: pancytopenia, HTN, hyperglycemia, invasive CMV infection)

Drug that inhibits IMP dehydrogenase in humans

Cilastatin (renal dehydropeptidase I inhibitor: inhibits dipeptidase in kidney PCT --> inhibits brush border hydrolysis of carbapenems to decrease inactivation of drug in renal tubules --> thus increases carbapenem antimicrobial effects in urine)

Drug that inhibits PCT brush border hydrolysis of carbapenems

Leflunomide (inhibits DHODH, thus blocking conversion of carbamoyl phosphate into orotic acid to inhibit de novo pyrimidine synthesis --> used to treat rheumatoid arthritis and psoriatic arthritis --> side effects: diarrhea, hypertension, hepatotoxicity, teratogenicity)

Drug that inhibits dihydroorotate dehydrogenase (DHODH)

Orlistat (decreases breakdown and absorption of dietary fats so they are excreted through GI lumen --> used for weight loss --> side effects: abdominal pain, flatulence, bowel urgency/frequent bowel movements, steatorrhea, decreased absorption of fat-soluble vitamins A/D/E/K)

Drug that inhibits gastric and pancreatic lipase

Acarbose (anti-diabetic drug that inhibits pancreatic alpha-amylase and alpha-glucosidase in small intestine brush border to prevent breakdown of complex carbs --> inability to produce monosaccharides delays carb hydrolysis and glucose absorption, causing carbs to remain in gut lumen --> used to treat post-prandial hyperglycemia after feeding --> side effects: diarrhea, flatulence, abdominal pain due to GUT BACTERIA digesting remaining luminal carbohydrates --> CONTRAINDICATED in renal insufficiency)

Drug that inhibits intestinal alpha-glucosidase

Probenecid (sulfa drug that inhibits organic anion transporters in kidney --> used to treat GOUT due to inhibition of urate transporters on APICAL side of tubule, thus INCREASING uric acid excretion --> also inhibits OAT on BASOLATERAL side of kidney, thus INHIBITING penicillin excretion --> often co-administered with penicillin to increase serum penicillin levels, especially in patients with gonorrhea, neurosyphillis, or penicillin resistance --> ALSO co-administered with cidofovir to decrease nephrotoxicity --> side effects: can precipitate uric acid calculi due to increased uric acid levels in urine)

Drug that inhibits renal tubular secretion of penicillin

5-FU (5-fluorouracil: inhibits thymidylate synthase, which blocks production of dTMP from dUMP --> inhibits de novo pyrimidine synthesis --> can INCREASE potency with addition of folate)

Drug that inhibits thymidylate synthase

Sildenafil (PDE-5 inhibitor: local release of NO + inhibition of PDE-5 increases cGMP in smooth muscle cells --> relaxation of smooth muscle cells surrounding cavernous venous sinuses of corpora cavernosa --> increased blood flow into corpora cavernosa, causing it to become enlarged to sustain erection --> CONTRAINDICATED in patients taking nitrates--which also increase cGMP--due to life-threatening hypotension)

Drug that is contraindicated in patients taking nitrates (sublingual nitroglycerin, hydralazine with isosorbide dinitrate, etc.)

Cholestyramine (bile-acid resin that prevents intestinal reabsorption of bile acids, thus forcing liver to use more cholesterol to make more --> increases cholesterol excretion --> mostly decreases LDL with little effect on HDL and TGs --> side effect: binds warfarin in intestine, thus decreasing warfarin levels and lowering INR/PT and increased clot risk)

Drug that is not a CYP450 inducer, but still decreases warfarin levels

Raloxifene (SERM: estrogen AGONIST at bone to inhibit osteoclast differentiation --> estrogen ANTAGONIST at breast/uterus to reduce risk of breast and endometrial cancer --> side effects: thromboembolic events, especially with smoking --> NO increased risk of endometrial cancer, compared to tamoxifen)

Drug that prevents both post-menopausal osteoporosis and breast cancer

Ketamine (NMDA receptor ANTAGONIST: causes dissociative anesthesia, aka patient's eyes remain open with slow nystagmic gaze --> also sympathomimetic and causes CV stimulation with elevated HR/BP/CO and minimal respiratory depression with bronchodilation --> INCREASES cerebral blood flow --> side effects: unpleasant emergence reaction with disorientation, out of body experiences, hallucinations, and vivid colorful dreams)

Drug used for anesthesia induction in mentally challenged patients and uncooperative pediatric patients

Etomidate (potentiates GABA-A receptor complex but also preserves CV stability after bolus injection --> minimal change in HR/BP/CO, so useful for patients with CV compromise)

Drug used for anesthesia induction in patients with decreased cardiac contractility (severe CV dysfunction)

Methacholine (inhaled muscarnic agonist --> can directly activate M3 receptors on bronchial smooth muscle --> Gq protein so increased PLC --> cleavage of PIP2 from lipids --> release of DAG to produce PKC --> release of IP3 to increase intracellular Ca2+ --> bronchial smooth muscle contraction)

Drug used in airway challenge test to diagnose asthma

Edrophonium (Tensilon test: AChE inhibitor to increase ACh in NMJ --> if edrophonium improves symptoms, you can diagnose myasthenia gravis aka blockage of post-synaptic ACh receptor --> if edrophonium does NOT improve symptoms, it may indicate Labert-Eaton myasthenic syndrome, aka blockage of presynaptic Ca2+ channels and indicates underlying malignancy)

Drug used to historically diagnose myasthenia gravis

Natalizumab (anti-A4 integrin monoclonal antibody: blocks WBC adhesion --> used to treat MS and Crohn disease --> side effect: risk of PML due to reactivation of JC virus, presents as progressive demyelinating disease associated with non-enhancing brain lesions)

Drug used to treat multiple sclerosis that can cause PML in patients with latent JC virus

Digoxin (cardiac glycoside that directly inhibits Na+/K+ ATPase on cardiac myocytes --> indirectly inhibits Na+/Ca2+ exchanger in myocardium to INCREASE intracellular Ca2+ and increase contractility --> also stimulates vagus nerve to increase ERP and decrease conduction at AV and SA node, thus decreasing HR --> used to treat chronic systolic HF and AFib --> side effects: hyperkalemia, arrhythmias such as PVC, bradycardia and AV node block, nausea/vomiting, abdominal pain, diarrhea, delirium/confusion, yellow-tinted vision --> contraindications: hypokalemia, renal insufficiency, and patients taking beta-blockers, verapamil, diltiazem, amiodarone, quinidine --> NOTE: long-term digoxin use causes T wave changes, shortened QT interval, and "scooped" concave ST segments, but these are NOT associated with toxicity)

Drug whose side effects include fatigue, yellow-tinted vision, nausea/vomiting, diarrhea, confusion, AV conduction block

Didanosine, corticosteroids, alcohol, valproic acid, azathioprine, furosemide, sulfasalazine ("Drugs Causing A Violent Abdominal Feeling Sad:" Didanosine: NRTI that inhibits HIV reverse transcriptase --> corticosteroids: anti-inflammatory drug that inhibits cytokines/T cells --> alcohol --> valproic acid: anti-convulsant that promotes Na+ channel inactivation used to treat majority of seizures --> azathioprine: pro-drug of 6-MP that inhibits protein synthesis used to treat rheumatoid arthritis/Crohn disease --> furosemide: loop diuretic used to treat advanced heart failure --> sulfasalazine: combo of aspirin + sulfa antibiotic used to treat IBD)

Drugs associated with acute pancreatitis

Cyclosporine, calcium-channel blockers, phenytoin ("can cause puffy" gums --> cyclosporine: immunosuppressant that inhibits IL-2 transcription, other SE include nephrotoxicity/hirsutism --> Ca2+-channel blockers: block L-type Ca2+ channels in vascular smooth muscle and heart to treat hypertension and arrhythmias, other SE include bradycardia/AV block --> phenytoin: narrow-spectrum anti-convulsant used to treat partial seizures, other SE include hirsutism/osteopenia/drug-induced SLE)

Drugs associated with gingival hyperplasia

Foscarnet, calcium carbonate, succinylcholine, thiazide diuretics (hypercalcemic states associated with "stones, bones, thrones, groans, psychiatric overtones" --> muscle weakness, constipation, confusion, polyuria/polydipsia, kidney stones, acute pancreatitis --> can progress to renal failure if left untreated)

Drugs associated with hypercalcemia

Foscarnet, amphotericin B, aminoglycosides, proton pump inhibitors, and loop diuretics (low Mg2+ can lead to TORSADES DE POINTES, tetany, hypokalemia, hypocalcemia --> foscarnet and amphotericin B: alter renal tubule permeability so cause many electrolyte disturbances --> aminoglycosides and PPIs: inhibit GI absorption of divalent cations Ca2+/Mg2+/Fe2+ --> loop diuretics: decreased Na+/K+/Cl- absorption prevents K+ backleak, which indirectly induces paracellular reabsorption of Mg2+ and Ca2+ in thick ascending LoH)

Drugs associated with hypomagnesemia

Statins, fibrates, niacin, colchicine, daptomycin, IFN-alpha, penicillamine, corticosteroids

Drugs associated with myopathy/rhabdomyolysis

Anabolic steroids, lithium, EGFR inhibitors

Drugs associated with nodular/comedonal acne post-puberty

Bisphosphonates, tetracyclines, NSAIDs, ferrous sulfate, potassium chloride (patients recommended to take pills with adequate water and keep upright posture for 30mins to minimize caustic effect)

Drugs associated with pill-induced esophagitis

Alcohol, barbiturates, neuroleptics, 1st generation antihistamines (diphenhydramine, chlorpheniramine, dimenhydrinate --> all of these are also CNS depressants, so can potentiate side effects such as confusion, somnolescence, disorientation, ataxia/increased risk of falls)

Drugs contraindicated in patients taking benzodiazepines or non-benzodiazepine hypnotics

Mebendazole, Griseofulvin, Colchinine, Vincristine/Vinblastine, Paclitaxel ("Microtubules Get Constructed Very Very Poorly": mebendazole is anti-helminthic --> griseofulvin is anti-fungal --> colchicine is anti-gout --> vincristine/vinblastine and paclitaxel are anti-cancer)

Drugs that act on microtubules

Primaquine, chloroquine, quinidine, artesunate, sulfonamides, dapsone, nitrofurantoin, isoniazid (oxidizing agents such as FAVA BEANS increase ROS species in RBCs --> lack of G6PD lowers amount of reduced glutathione, thus making RBCs susceptible to oxidative stress --> denatured Hb precipitates into Heinz bodies, which are subsequently removed by splenic macrophages to form bite cells --> increased intravascular hemolysis leads to hemolytic anemia)

Drugs that are contraindicated in patients with G6PD deficiency

Carbamazepine, methimazole, NSAIDs, benzene, chloramphenicol, PTU ("can't make new blood cells properly" --> most important is chloramphenicol: binds to 50S ribosomal subunit to inhibit peptidyl transferase)

Drugs that can cause aplastic anemia

Sulfonylureas, Procarbazine, Cephalosporins, Griseofulvin, Metronidazole ("sorry pals, can't go mingle" --> only 1st gen sulfonylureas such as chlorpromaide or tolbutamide)

Drugs that can cause disulfiram-like reactions with alcohol (severe flushing, tachycardia, hypotension)

Ketoconazole, cimetidine, risperidone, flutamide, finasteride, spironolactone, anabolic steroids (ketoconazole: anti-fungal that also inhibits cholesterol desmolase to inhibit testosterone production in adrenal cortex --> cimetidine: H2 receptor antagonist that also inhibits testosterone receptor --> risperidone: anti-psychotic that causes D2 antagonism in tuberoinfundibular pathway --> flutamide: competitive inhibition of testosterone receptor --> finasteride: 5-alpha-reductase inhibitor that decreases conversion of testosterone to DHT --> spironolactone: inhibits testosterone synthesis and inhibits binding to testosterone receptor --> anabolic steroids: aromatization of excess androgens to estrogen)

Drugs that can cause gynecomastia in men

Inhaled anesthetics and succinylcholine (inhaled anesthetics: halothane, desflurane, isoflurane --> succinylcholine: strong ACh receptor agonist that keeps nAChR channel open for a long time to depolarize muscle cell and form longer EPP, putting Na+ in inactive state that won't be able to activate until repolarization thus preventing muscle contraction --> malignant hyperthermia: usually associated with AD mutation in RYR1 gene that causes excess Ca2+ release from SR, resulting in very high-grade fever and severe muscle rigidity)

Drugs that can cause malignant hyperthermia

Vancomycin, opioids, radiocontrast dye (induce mast cell degranulation via activation of PKA and PI3 kinase --> release of histamine, bradykinin, heparin, enzymes, chemotactic factors --> presents with diffuse itching and pain, bronchospasm, urticaria)

Drugs that can induce IgE-independent mast cell activation

Anti-TNF-alpha drugs (Adalimumab, Infliximab: monoclonal antibody against TNF-alpha --> used to treat IBD, RA, psoriasis, ankylosing spondylitis --> causes breakdown of sequestered granulomas, resulting in disseminated disease/miliary TB)

Drugs that can reactivate latent TB and cause systemic TB (miliary TB)

Adenosine, dipyridamole, regadenoson (coronary vasodilators that stimulate generalized coronary vasodilation caused by exercise --> since arterioles DISTAL to coronary stenosis are maximally dilated, increased blood flow causes normal arterioles to dilate while post-stenotic arterioles remain unchanged --> blood is SHUNTED from ischemic areas to well-perfused areas --> results: blood flow to normal area is INCREASED, while blood flow to ischemic area is REDUCED --> exacerbation of myocardial ischemia)

Drugs that cause "coronary steal" syndrome

SATANN (sulfa drugs --> allopurinol --> TMP-SMX --> anti-convulsants: including carbamazepine, lamotrigine, phenobarbital, phenytoin --> NSAIDs, NNRTIs)

Drugs that cause SJS/TEN

Amiodarone, methotrexate bleomycin, busulfan

Drugs that cause pulmonary fibrosis

Bivalirudin, Argatroban, Dabigatran (direct thrombin inhibitors: directly inhibit activity of free- and clot-associated thrombin --> used to treat DVT, AFib, and heparin-induced thrombocytopenia --> does NOT require lab monitoring, and Dabigatran can be given orally --> side effects: bleeding)

Drugs that increase PT, PTT and thrombin time (TT)

Apixaban and rivaroxaban (direct factor Xa inhibitors that can be given ORALLY: used as prophylaxis and treatment for DVT/PE, as well as stroke prophylaxis for patients with AFib --> does NOT require lab monitoring when taken orally --> side effects: bleeding, which is not easily reversible)

Drugs that increase both PT and PTT, but have no effect on thrombin time

Amlodipine, ibuprofen, amitryptyline, diazepam

Drugs that increase fall risk in elderly

PTU, beta-blockers, corticosteroids (all three inhibit 5-deionidase, thus inhibiting peripheral conversion of T3 to T4 --> PTU: also inhibits TPO, SE include hepatotoxicity/ agranulocytosis/aplastic anemia --> beta-blockers: inhibit autonomic symptoms of hyperthyroidism, SE include bradycardia/AV block --> corticosteroids: anti-inflammatory effects, SE include Cushing syndrome, osteoporosis, avascular necrosis of femoral head, hyperglycemia, amenorrhea, adrenal insufficiency)

Drugs that inhibit 5-deiodinase

Methotrexate, TMP, pyrimethamine (methotrexate: inhibits DHFR in humans to inhibit pyrimidine synthesis --> TMP: inhibits DHFR in bacteria --> pyrimethamine: inhibits DHFR in some parasites to help treat malaria and toxoplasmosis)

Drugs that inhibit DHFR in folic acid pathway

6-MP and azathioprine (inhibits de novo purine synthesis by decreasing levels of IMP, activated by HGPRT --> 6-MP: used to treat leukemia, inflammatory arthritis, and some valve diseases --> azathioprine: 6-MP prodrug used to treat Crohn disease, rheumatoid arthritis, glomerulonephritis --> side effects: pancytopenia due to bone marrow suppression, GI toxicity, cholestasis, hepatitis --> metabolized by xanthine oxidase thus you need to LOWER 6-MP dosage when combining 6-MP + allopurinol)

Drugs that inhibit PRPP amidotransferase (converts PRPP into IMP)

Unfractionated heparin and direct thrombin inhibitors (unfractionated heparin: activates antithrombin III and causes inactivation of factor Xa and thrombin/2a to increase PTT and TT --> direct thrombin inhibitors: bivalirudin/argatroban/ dabigatran directly inhibit thrombin/factor 2a to increase PT, PTT, and TT)

Drugs that prolong thrombin time (TT)

Nifedipine and terbutaline (tocolytics: relax the uterus to decrease contraction frequency --> allows time for administration of corticosteroids like dexamethasone to promote fetal lung maturity OR transfer mother to appropriate medical center with OB care --> nifedipine: Ca2+ channel blocker that inhibits MLCK phosphorylation to relax myometrium --> terbutaline: B2 agonist that increases cAMP in myometrial cells to inhibit MCLK and relax smooth muscle)

Drugs used to delay preterm labor

ACE inhibitors, ARBs, beta-blockers, spironolactone, hydralazine with nitrate (standard HF therapy: ACE inhibitors + beta-blockers + spironolactone --> can replace ACE inhibitors with ARBs if patient cannot tolerate --> hydralazine with nitrate improves both symptoms/mortality in African-American patients)

Drugs used to treat CHF that reduce mortality

Phenytoin, ethanol, aspirin (PEA: you will "pee" out the drug at a constant rate of elimination that is INDEPENDENT of drug concentration)

Drugs with zero-order kinetics

Epoetin alfa (erythropoetin analog: used to treat anemia, especially in renal failure)

EPO analog

Decreased PT (CYP450 inducers increase metabolism of warfarin --> decreased levels of warfarin in blood --> decreased INR --> increased clot risk, but decreased bleeding risk --> ex: modafinil, chronic alcohol use, phenytoin, phenobarbital, carbamazepine, rifampin, griseofulvin, nevirapine, St. John's wort)

Effect of CYP450 inducers on PT

Increased PT (CYP450 inhibitors block metabolism of warfarin --> increased levels of warfarin in blood --> increased INR --> decreased clot risk, but increased bleeding risk)

Effect of CYP450 inhibitors on PT

Tachycardia (EPI: binds to B1 receptors in heart to increase HR/contractility --> atropine: muscarinic antagonist that blocks PSNS tone on heart, thus further increasing HR)

Effect of combining epinephrine with atropine

Hypotension and tachycardia (referred to as "reversal" of EPI blood pressure response --> EPI: binds to B1 receptors in heart to increase HR/contractility and B2 receptors in vascular smooth muscle to induce vasodilation, but A1 activity results in net increase in BP --> phentolamine: A1/A2 inhibitor that would cause loss of SNS tone on vascular smooth muscle and induce vasodilation, thus preventing A1 activity in EPI and causing net DECREASE in BP, also drop in BP would induce reflex tachycardia that would combine with EPI-mediated increase in HR)

Effect of combining epinephrine with phentolamine

Antihistamine prophylaxis and slow infusion rate

Method of preventing red man syndrome when administering vancomycin

Hand hygiene, barrier precautions, chlorhexidine prep of insertion site, avoidance of femoral vein, and prompt removal of catheter

Methods to reduce catheter infections

Haloperidol, Trifluoperazine, Fluphenazine (more neurologic side effects with extrapyramidal symptoms: block dopamine D2 receptors with high lipid solubility/storage in fat so long half-life --> used to psychosis, treat positive schizophrenia symptoms, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD --> MANY side effects: hyperprolactinemia, dyslipidemia/weight gain, QT prolongation, EPS such as acute dystonia, akathisia, bradykinesia, tardive dyskinesia)

High-potency typical antipsychotics

Filgrastim (granulocyte colony-stimulating factor/G-CSF: used to recover granulocyte counts in neutropenia)

G-CSF analog

Sargramostim (granulocyte -macrophage colony-stimulating factor: used to recover granulocyte AND leukocyte counts in leukopenia)

GM-CSF analog

Latanoprost (prostaglandin PFG2-alpha analog corneal esterases convert it to active metabolite --> increased outflow of aqueous humor via decreased collagen content in uveoscleral pathway--> 1st line medication for glaucoma --> side effects: darkens color of iris, causes eyelash growth)

Glaucoma medication that increases outflow of aqueous humor via decreased resistance of flow in uveoscleran pathway

Timolol, apraclonidine, brimonidine, acetazolamide (timolol: beta-blocker, no SE --> apraclonidine and bromonidine: alpha-2 adrenergic AGONISTs, SE include blurry vision/ocular hyperemia/foreign body sensation/ocular allergic reactions/ocular pruritis --> acetazolamide: diuretic, decreases synthesis via inhibition of carbonic anhydrase, no SE)

Glaucoma medications that decrease aqueous humor synthesis

Probenecid (inhibits reabsorption of uric acid in PCT --> also inhibits excretion of certain drugs in PCT --> increases plasma concentrations of penicillins and fluoroquinolones)

Gout medication that competitively inhibits renal tubular drug secretion

Cimetidine (H2 receptor blocker: reversibly blocks histamine H2 receptors on parietal cells --> decreases H+ secretion in stomach --> side effects: CYP450 inhibitor, decreases renal excretion of creatinine, anti-androgenic effects such as gynecomastia/impotence/low libido in males, crosses BBB to cause confusion/dizziness, and teratogenic/crosses placenta)

H2 receptor blocker that causes gynecomastia, impotence, low libido in males

Cimetidine (H2 receptor blocker: reversibly blocks histamine H2 receptors on parietal cells --> decreases H+ secretion in stomach --> side effects: CYP450 inhibitor, decreases renal excretion of creatinine, anti-androgenic effects such as gynecomastia/impotence/low libido in males, crosses BBB to cause confusion/dizziness, and teratogenic/crosses placenta)

H2 receptor blocker that is also CYP450 inhibitor

Maraviroc (fusion inhibitor: inhibits interaction between HIV's gp120 and macrophages' CCR5 --> used to treat HIV)

HIV drug that binds CCR5 on surface of macrophages, inhibiting docking with gp120

Enfuvirtide (fusion inhibitor: blocks gp41 to inhibit entry of HIV virus into CD4+ T cells --> used to treat HIV)

HIV drug that binds gp41, inhibiting viral entry

Protease inhibitors (Atazanavir, Darunavir, Lopinavir, Ritonavir: inhibit HIV-1 protease encoded by pol gene, which normally cleaves polypeptide products of HIV mRNA into functional parts --> protease inhibitors prevent polypeptide cleavage so virus can never mature --> side effects: HYPERGLYCEMIA, lipodystrophy aka Cushing-like syndrome with "buffalo hump" appearance with central obesity and peripheral wasting, indinavir associated with nephropathy and kidney stones, plasma levels reduced by CYP/UGT inducers like Rifampin)

HIV therapy that prevent protein processing (prevent maturation of new viruses)

Nevirapine (non-nucleoside reverse transcriptase inhibitor: directly binds and allosterically inhibits HIV reverse transcriptase to halt DNA polymerase --> used to treat HIV --> side effects: CYP450 INDUCER so it can lower plasma levels of warfarin, hepatotoxicity/liver failure within 6wks, SJS, vivid dreams/nightmares, insomnia, CNS symptoms such as drowsiness, dizziness, headaches, psychosis)

HIV treatment associated with CYP450 induction

Delaviridne, efavirenz, nevirapine (non-nucleoside reverse transcriptase inhibitors: directly bind and allosterically inhibit HIV reverse transcriptase to halt DNA polymerase --> do NOT require phosphorylation by intracellular kinases --> side effects: hepatotoxicity/liver failure within 6wks, SJS, vivid dreams/nightmares, insomnia, CNS symptoms such as drowsiness, dizziness, headaches, psychosis, nevirapine causes CYP450 induction)

HIV treatment associated with SJS/TEN

Indinavir (protease inhibitor: inhibits HIV-1 protease encoded by pol gene, which normally cleaves polypeptide products of HIV mRNA into functional parts --> prevents polypeptide cleavage so virus can never mature --> side effects: nephropathy and nephrolithiasis, HYPERGLYCEMIA, lipodystrophy aka Cushing-like syndrome with "buffalo hump" appearance with central obesity and peripheral wasting, plasma levels reduced by CYP/UGT inducers like Rifampin)

HIV treatment associated with nephropathy and kidney stones

Ritonavir (protease inhibitor: inhibits HIV-1 protease encoded by pol gene, which normally cleaves polypeptide products of HIV mRNA into functional parts --> prevents polypeptide cleavage so virus can never mature --> side effects: POTENT CYP450 inhibitor so used to "boost" concentrations of other drugs, HYPERGLYCEMIA, lipodystrophy aka Cushing-like syndrome with "buffalo hump" appearance with central obesity and peripheral wasting, plasma levels reduced by CYP/UGT inducers like Rifampin)

HIV treatment associated with potent CYP450 inhibition

Dolutegravir, elvitegravir, raltegravir (integrate inhibitors: inhibit HIV integrase to block HIV genome integration into host cell chromosomes --> side effects: rhabdomyolysis and elevated CK)

HIV treatment that inhibits viral DNA from integrating with host cell genome

Clonidine (alpha-2 agonist)

HTN medication with side effects including bilateral throbbing headache and severe rebound hypertension

ACE inhibitors and ARBs

HTN medications that decrease BOTH preload and afterload

Nesiritide (BNP analog: BNP normally released from ventricular myocytes in response to increased WALL TENSION --> increases cGMP to induce BOTH arteriolar and venous vasodilation to decrease preload/afterload --> also decreases Na+ absorption at renal CD to promote natriuresis and dilates afferent arteriole/constricts renal arteriole to increase GFR/promote diuresis --> mainly used to treat acute heart failure by decreasing BP, promoting natriuresis, and diuresis to decrease blood volume)

Heart failure treatment that is a natriuretic peptide analog

Lispro, Aspart, Glulisine (rapid-acting insulin injectables: given SQ after meals and binds to insulin TK receptors on peripheral tissues --> increases glycogen storage in liver and muscle, increases protein synthesis in muscle, increases TG storage in adipocytes, and increases K+ uptake in multiple tissues --> side effects: hypoglycemia, fat necrosis at injection sites, rare hypersensitivity reactions)

Insulin preps used to control post-prandial glucose spike in T1DM patients

Oxazepam, alprazolam, lorazepam, clonazepam (half life 6-50hrs)

Intermediate-acting benzodiazepines

Spironolactone, Eplerenone, Amiloride, Triamterene (Spironolactone and Eplerenone: inhibit aldosterone receptor in cortical CD --> Amiloride, Triamterene: inhibit Na+ channels in cortical CD --> used to treat hyperaldosteronism, hypokalemia, heart failure, hepatic ascites, nephrogenic DI, and anti-androgen --> side effects: hyperkalemia, spironolactone can cause gynceomastia)

K+ sparing diuretics

PGE analogs (PDA remains patent thru either PGE or low O2 tension)

Keeps PDA open

Fondaparinux (still binds to antithrombin III and results in conformation change of ATIII, but ONLY inhibits factor Xa to induce anti-coagulation --> have better bioavailability and 2-4X longer half-life than heparin --> can be administered SQ without lab monitoring and LOWEST risk of HIT)

LMWH-related drug that acts only on factor Xa

Theophylline (PDE inhibitor: blocks cAMP breakdown --> increased cAMP within bronchial smooth muscle causing bronchodilation --> increased cAMP in mast cells causes inhibition of mediator release --> increased cAMP in vagal nerve endings causes inhibition of ACh release --> side effects: blocks adenosine in heart causing tachycardia and arrhythmia, blocks adenosine in CNS causing insomnia, headaches, seizures --> treatment of theophyillin overdose: activated charcoal to reduce GI absorption + beta-blockers for tachyarrhythmias)

Last-resort asthma drug with narrow therapeutic index

Senna (colonic stimulant/cathartic: directly stimulates enteric nerves to induce colonic contraction --> used to produce bowel movements in hospitalized patients, occurring 6-12hrs after ingestion --> side effects: diarrhea and melanosis coli, aka brown pigmentation of colon)

Laxative associated with melanosis coli

Enoxaparin and dalteparin (LMWH: still binds to antithrombin III and results in conformation change of ATIII, but PREDOMINANTLY inhibits factor Xa to induce anti-coagulation --> have better bioavailability and 2-4X longer half-life than heparin --> can be administered SQ without lab monitoring and lower risk of HIT)

Low molecular weight heparins

Chlorpromazine and Thioridazine (more anti-cholinergic, anti-histamine, and alpha-1 blockade effects: block dopamine D2 receptors with high lipid solubility/storage in fat so long half-life --> used to treat psychosis, positive schizophrenia symptoms, bipolar disorder, delirium, Tourette syndrome, Huntington disease, OCD --> MANY side effects: hyperprolactinemia, dyslipidemia/weight gain, anti-muscarinic such as dry mouth/constipation, anti-histamine such as sedation, anti-alpha1 such as orthostatic hyoptension, QT prolongation, Chlorpromazine causes corneal deposits, Thioridazine causes retinal deposits --> NOTE: lower risk of extrapyramidal symptoms compared to high-potency such as Haloperidol)

Low-potency typical antipsychotics

Daptomycin (creates transmembrane channels in GRAM-POSITIVE cell membranes that cause intracellular ion leakage --> causes depolarization of bacterial cell membrane and inhibition of DNA/RNA/protein synthesis used to treat skin infections and bacteremia caused by S. aureus, including MRSA --> NOTE: ineffective against gram-negatives due to inability to permeate outer membrane + inactivated by pulmonary surfactant so ineffective against pneumonia --> side effects: myopathy/muscle pains and elevated CK, especially in patients taking statins/fibrates --> CPK level monitoring recommended for patients taking daptomycin)

MRSA treatment associated with myopathy

Linezolid (binds to 50S subunit to prevent formation of initiation complex and inhibit bacterial protein synthesis --> mostly used to treat multi-drug resistant gram-positive bugs such as MRSA and VRE --> side effects: thrombocytopenia, peripheral neuropathy, serotonin syndrome, OPTIC NEURITIS --> mechanism of resistance: point mutation of ribosomal RNA)

MRSA treatment associated with optic neuritis and serotonin syndrome

Erythromycin and clarithromycin (macrolides: inhibit 23S rRNA of 50S bacterial subunit to block ELONGATION during translation --> inhibits protein synthesis --> used to treat atypical penumonia, Chlamydia, strep infections in patients allergic to pencillin, and B. pertussis --> side effects-MACRO: motility issues, arrhythmia due to prolonged QT, cholestatic hepatitis, rash, eOsinophilia --> also TERATOGENIC and associated with hypertrophic pyloric stenosis in utero)

Macrolides that inhibit CYP450 (INCREASE warfarin levels)

Retinopathy (rare, and only related to prolonged use)

Main side effect of chloroquine

Agranulocytosis (clozapine recommended for treatment-resistant schizophrenia and schizoaffective disorder, as well as suicidality in schizophrenia --> use requires frequent WBC monitoring)

Main side effect of clozapine (atypical antipsychotic)

Torsades de pointes (prolongation of AP duration can lead to prolonged QT interval)

Main side effect of ibutilide, sotalol, and dofetilide (class III anti-arrhythmics --> prolong AP duration)

Hyperprolactinemia (causes amenorrhea, galactorrhea, gynecomastia)

Main side effect of risperidone (atypical antipsychotic)

Paresthesias and hepatic encephalopathy

Main side effects of acetazolamide

Hypotension, flushing, chest burning (adenosine: coronary arteriole vasodilator, but also anti-arrhythmic that increases K+ efflux to cause hyperpolarization of cell --> fast-acting and short-lived blockage of AV node conduction --> temporarily blocks signal conduction from atria to ventricles --> terminates re-entrant circuit and converts PVST to normal sinus rhythm)

Main side effects of adenosine

Pulmonary fibrosis, hepatotoxicity, thyroid problems, corneal deposits (also causes blue/gray skin deposits that result in photodermatitis, neurologic effects, constipation, bradycardia, heart block, heart failure --> class III anti-arrhythmic that blocks K+ channels to increase ERP and prolong AP duration)

Main side effects of amiodarone

Fluconazole (initially treat cryptococcal neoformans with Amphotericin B + flucytosine --> fluconazole given for maintenance, primarily in AIDS patients)

Maintenance treatment for Cryptococcus neoformans meningitis

Cardiotoxicity (trastuzumab/anti-HER2 monoclonal antibody causes "myocardial stunning" --> results in decreased myocardial contractility without cardiomyocyte destruction/fibrosis --> patients usually experience asymptomatic decline in LV ejection fraction, but sometimes overt HF can occur --> reversible with discontinuation of treatment)

Major side effect of trastuzumab

Myopathy (pain/soreness/weakness/cramps --> can potentially lead to rhabdomyolysis with myoglobinuria and renal failure)

Major side effect that occurs when combining statins + fibrates

Hypoglycemia and lipodystrophy (protease inhibitors include Atazanavir, Darunavir, Indinavir, Ritonavir, Lopinavir: inhibit HIV-1 protease encoded by pol gene, which normally cleaves polypeptide products of HIV mRNA into functional parts --> protease inhibitors prevent polypeptide cleavage so virus can never mature --> cause insulin resistance/hyperglycemia resulting in diabetes --> also cause "Cushing-like" syndrome due to fat deposition on back/abdomen causing buffalo hump, and decreased adipose on face/extremities/buttocks causing central obesity and peripheral wasting --> other side effects: nephropathy and kidney stones associated with indinavir, CYP450 inhibitors)

Major side effects of HIV protease inhibitors

Dyslipidemia, bradycardia, advanced AV block

Major side effects of metroprolol (class II anti-arrhythmic --> decreases AV node activity)

Mefloquine or Atovaquone/Proguanil (also good treatments for chloroquine-resistant malaria --> test for G6PD deficiency when using mefloquine)

Malaria prophylaxis for travelers

Mutated DNA gyrase (chromosome-encoded mutation in DNA gyrase prevents quinolones from binding --> also associated with efflux pumps and plasmid-mediated resistance)

Mechanism of resistance against flouroquinolones

Mutated RNA polymerase (mutation reduces drug binding to RNA polymerase --> commonly seen in rifampin monotherapy)

Mechanism of resistance against rifampin

Bacterial transport pumps (plasmid-encoded transport pumps that EITHER decrease uptake or increase efflux out of bacterial cells)

Mechanism of resistance against tetracyclines

Pol gene mutation (pol gene codes for reverse transcriptase, protease, and integrase --> therefore, a mutation in pol gene would cause abnormal RT, protease, and integrase thus preventing activity of HIV anti-retroviral therapy against these drugs)

Mechanism of resistance in HIV against NRTIs, NNRTIs, protease inhibitors, integrate inhibitors

Altered PBP target site (mutated penicillin-binding protein --> makes MRSA resistant to extended-spectrum penicillins like amoxicillin, staphylococcal penicillins like nafcillin, 1st-4th gen cephalosporins --> therefore treat need to treat MRSA with vancomycin, linezolid, daptomycin, ceftaroline --> doxycycline is 2nd line --> tigecycline is last resort)

Mechanism of resistance in MRSA

Mutated peptidoglycan cell wall (single AA substitution of D-Ala-D-Alanine to D-Ala-D-Lactate in the synthesis of pentapeptide proteoglycan precursors, causing mutated peptidoglycan cell wall --> prevents vancomycin from binding to pentapeptides, thus making these bugs resistant)

Mechanism of resistance in VRE (vancomycin-resistant Enterococci)

Bacterial transferase enzymes (aminoglycoside-modifying enzymes that inactivate drug via via acetylation, phosphorylation, or adenylation --> resistance also associated with mutated ribosomal subunit proteins or mutated porin proteins)

Mechanism of resistance to aminoglycosides (Gentamicin, Amikacin, etc.)

Bacterial efflux pumps (active-efflux pump mechanism: increases efflux of drug from within bacterial cell --> can also become resistant via prodic

Mechanism of resistance to tetracyclines

Cytoskeleton degradation (decreased tissue size/mass occurs via ubiquitin-proteasome pathway and autophagy, leading to decrease protein synthesis and/or number of cells --> causes include disease, denervation, loss of blood supply, loss of hormonal stimulation, and poor nutrition)

Mechanism of tissue atrophy

Diazepam (long-acting benzodiazepine: increases FREQUENCY of Cl- channel opening in GABA-A receptors --> side effects: sedation, impaired coordination, decreased memory and concentration, confusion --> contraindicated with alcohol, barbiturates, neuroleptics, 1st gen antihistamines)

Medication indicated for GAD/panic attacks, short-term insomnia treatment, status epilepticus, UMN disorders/tetanus

Steroids

Medication with risk of avascular necrosis of femoral head

Carbamazepine, phenobarbital, phenytoin, anastrozole, medroxyprogesterone, leuprolide, omeprazole, prednisone (carbamazepine, phenobarbital, phenytoin: anti-convulsants that induce CYP450 and increase vitamin D catabolism --> anastrozole: aromatase inhibitor that decreases estrogen --> medroxyprogesterone: decreases estrogen --> leuprolide: GnRH agonist that decreases FSH/LH secretion when given continuously --> omeprazole: proton pump inhibitor that causes loss of acidic pH in GI tract and decreases Ca2+ absorption --> prednisone: corticosteroid that decreases osteoblast activity)

Medications associated with osteoporotic fractures

Proton pump inhibitors, bismuth, antibiotics (SUPPRESS bacterial growth but do not eradicate H. pylori --> therefore patient with negative urea breath test CANNOT have H. pylori infection ruled out)

Medications that can cause false negative on urea breath test

Strongyloides (threadworm) and Onchocerca (river blindness)

Microbes that are treated with Ivermectin

Denosumab (mAb against RANKL, which is found on osteoblasts that bind to RANK receptor on osteoclasts --> inhibits osteoclast maturation --> used to treat osteoporosis)

Monoclonal antibody that mimics osteoprotegrin

Rituximab (mAb against CD20, which is found on B cells --> reduces B cell levels via complement-mediated lysis, ADCC via NK cells, and induction of apoptosis --> used to treat non-Hodgkin B cell lymphomas like follicular lymphoma, CLL, rheumatoid arthritis, ITP, multiple sclerosis)

Monoclonal antibody that targets CD20

Denosumab (mAb against RANKL, which is found on osteoblasts that bind to RANK receptor on osteoclasts --> inhibits osteoclast maturation, thus mimicking osteoprotegrin --> used to treat osteoporosis)

Monoclonal antibody that targets RANKL

Propofol (potentiates GABA-A receptors to cause sedation --> highly lipophilic and preferentially enters brain/spinal cord, so useful for RAPID induction --> can also be used for maintenance anesthesia either alone or with combo of inhaled anesthetic + sedative hypnotic + opioid --> complication: massive hypotension due to vasodilation of BOTH arteries/veins, decreasing preload and afterload)

Most common drug used for anesthesia induction

Sexual dysfunction (SSRIs such as Sertraline or Fluoxetine: inhibit serotonin reuptake to increase levels of serotonin in synaptic cleft --> sexual dysfunction seen in 50% of patients and frequent cause of non-adherence --> SSRIs can cause decreased arousal, anorgasmia in women, and increased ejaculatory latency in men --> other side effects: serotonin syndrome if combined with MAOIs, GI distress, SIADH)

Most common side effect associated with SSRIs

Constipation (opioids stimulate mu receptor in GI tract, which decreases motility + increases colonic phasing segmented activity --> squeezes down on stool instead of pushing it out --> INCREASES stool transit time, so that stool is pushed back/forth between haustra --> this effect of opioids is UTILIZED in anti-diarrheals loperamide and diphenoxylate)

Most common side effect of opioid analgesics

Smoking cessation (decreased mucus plugs/anti-trypsin inhibition)

Most likely to slow rate of pulmonary function decline in COPD patients

Zidovudine (ZDV: nucleoside reverse transcriptase inhibitor: REQUIRES PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> given to women at 14wks gestation and taken until 6wks post-partum to reduce risk of fetal transmission, REGARDLESS OF VIRAL LOAD --> side effects: mitochondrial toxicity, myelosuppression, lipodystrophy, ANEMIA, AGRANULOCYTOSIS)

NRTI associated with anemia and agranulocytosis

Emtricitabine (nucleoside reverse transcriptase inhibitor: REQUIRES PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> used to treat HIV)

NRTI associated with hyperpigmentation of palms and soles

Didanosine (nucleoside reverse transcriptase inhibitor: REQUIRES PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> side effects: mitochondrial toxicity, myelosuppression, PANCREATITIS)

NRTI associated with pancreatitis

Abacavir (risk of delayed type 4 HSR in patients with HLA-B*5701: nucleoside reverse transcriptase inhibitor: REQUIRES PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> used to treat HIV)

NRTI contraindicated in HLA-B*5701

Tenofovir (TDF: nucleotide reverse transcriptase inhibitor --> REQUIRE PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> used to treat HIV and chronic HBV --> side effects: mitochondrial toxicity, myelosuppression)

NRTI that is a nucleotide

Lamivudine, stavudine, and didanosine (nucleoside reverse transcriptase inhibitors --> REQUIRE PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> side effects: mitochondrial toxicity, myelosuppression, peripheral neuropathy)

NRTIs associated with peripheral neuropathy

Tenofovir and lamivudine (nucleotide/nucleoside reverse transcriptase inhibitors --> REQUIRE PHOSPHORYLATION by intracellular kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> side effects: mitochondrial toxicity, myelosuppression, peripheral neuropathy)

NRTIs used to treat both HIV and chronic hepatitis B

Simeprevir and Grazoprevir (inhibit NS3/4A, a viral protease --> prevents viral replication --> side effects: Grazoprevir causes photosensitivity reactions/rash while Simeprevir causes fatigue and headache)

NS3/4A inhibitors used to treat chronic hepatitis C

Sofosbuvir and Dasavubir (inhibit NS5B, an RNA-dependent RNA polymerase acting as chain terminator --> prevents viral RNA replication --> side effects: fatigue and headache)

NS5B inhibitors used to treat chronic hepatitis C

Aspirin (acetylsalicylic acid: covalently acetylates COX1 to prevent generation of TXA2 and increase bleeding time --> acetylates COX2 to prevent formation of PG production in inflammatory cells --> causes anti-inflammatory, antipyretic, anti-thrombotic, and analgesic effects --> side effects: gastric ulcers, tinnitus, allergic reactions in patients with asthma or nasal polyps, risk of Reye syndrome in children with viral infections)

NSAID that irreversibly inhibits COX1 and COX2

Celecoxib (reversible selective inhibition of COX2, which is only found on inflammatory cells and vascular endothelium and main mediator of inflammation/pain --> PRESERVES function of COX1, which maintains GI mucosa, so not as corrosive on GI lining --> also does NOT affect platelet aggregation as TXA2 mostly produced by COX1 --> used to treat rheumatoid arthritis and osteoarthritis --> side effects: sulfa allergy, increased risk of THROMBOSIS/CV EVENTS due to inhibition of COX2-mediated prostacyclin--which inhibits platelet aggregation--but preservation of COX1-mediated TXA2, which promotes platelet aggregation)

NSAID that selectively inhibits COX2

Carbamazepine, gabapentin, phenobarbital, phenytoin, tiagabine, vigabatrin (narrow-spectrum anti-epileptics: effective for treating focal seizures and secondary generalized seizures --> NOT effective for treating primary generalized epilepsy --> carbamazepine and phenytoin are mainly used for focal seizures, with gabapentin/tiagabine/ vigabatrin used as adjunct therapy --> phenytoin and phenobarbital can also be used as PROPHYLAXIS for status epilepticus)

Narrow-spectrum anti-convulsants

Tiagabine and vigabatrin (both used as ADJUNCT therapy for treatment of partial seizures --> tiagabine: inhibits GABA reuptake to increase GABA levels in synaptic cleft --> vigabatrin: inhibits GABA transaminase to decrease breakdown, also used to treat infantile spasms and West syndrome)

Narrow-spectrum anti-convulsants that increase GABA levels

Cholestyramine (bile acid-binding resin: binds negatively-charged bile acids/salts in small intestine --> excreted in feces --> prevents bile acids from returning to liver --> increased conversion of cholesterol into bile acid in liver --> reduces cholesterol pool AND up-regulates LDL receptors, but has no effect on HDL and elevates TGs --> side effect: binds warfarin in intestine so it DECREASES warfarin levels, thus decreasing INR/PT)

Next step in managing patient with persistently high LDL already on statin

Tadalafil (inhibits PDE-5 --> increases cGMP --> prolonged smooth muscle relaxation in response to NO --> increases blood flow in corpus cavernosum of penis and prostate --> side effects include headache, flushing, dyspepsia/indigestion, cyanopia/blue-tinted vision)

Only PDE-5 inhibitor indicated for treatment of BPH

Cefepime (4th gen cephalosporin: beta-lactam drug that inhibits cell wall synthesis, but less susceptible to penicillinases --> 4th gen covers mostly gram-negative organisms with high activity against Pseudomonas --> side effects: type 1 HSR, autoimmune hemolytic anemia, disulfiram-like reaction, vitamin K deficiency)

Only cephalosporin that treats Pseudomonas

Loperamide (also Diphenoxylate: opioid agonist that stimulates mu receptor in GI tract, which decreases motility + increases colonic phasing segmented activity --> squeezes down on stool instead of pushing it out --> INCREASES stool transit time, so that stool is pushed back/forth between haustra --> side effects: constipation and nausea, does NOT cross BBB so no analgesic effects --> contraindications: BLOODY DIARRHEA and FEVER)

Opioid agonist used as an anti-diarrheal

Tramadol (weak mu agonist, but also inhibits reuptake of NE and serotonin --> similar side effects to opioids, may also caus serotonin syndrome)

Opioid mainly used to treat neuropathic pain

Glitazones (Thiazolidinediones/TZDs such as pioglitazone and rosiglitazone: binds to PPARy nuclear transcription regular in peripheral tissues --> TZD-PPARy-RXR complex binds to DNA --> increases GLUT4 expression causing increased insulin sensitivity in fat cells/skeletal muscle --> ALSO increases adiponectin, causing increased # of adipocytes and increased FA oxidation, which DECREASES serum TGs --> decreases TNF-alpha and leptin --> does NOT interact with pancreatic beta cells so it does NOT cause hypoglycemia --> side effects: fluid retention/peripheral edema that can EXACERBATE HF, weight gain, osteoporosis/increased risk of fractures)

Oral anti-diabetic medication contraindicated in patients with heart failure

SGLT2 inhibitors (Canaglifozin, dapaglifozin, empaglifozin: blocks reabsorption of filtered glucose in PCT --> increases urinary glucose --> usually used as alternative to insulin therapy in T2DM patients who fail to achieve glycemic goals --> side effects all related to excess glucose in urine: glucosuria, UTIs, vaginal yeast infections, hyperkalemia, orthostatic hypotension, weight loss --> CONTRAINDICATED in renal insufficiency)

Oral anti-diabetic medication that blocks reabsorption of glucose in kidney PCT

Glitazones (Thiazolidinediones/TZDs such as pioglitazone and rosiglitazone: binds to PPARy nuclear transcription regular in peripheral tissues --> TZD-PPARy-RXR complex binds to DNA --> increases GLUT4 expression causing increased insulin sensitivity in fat cells/skeletal muscle --> ALSO increases adiponectin, causing increased # of adipocytes and increased FA oxidation, which DECREASES serum TGs --> decreases TNF-alpha and leptin --> does NOT interact with pancreatic beta cells so it does NOT cause hypoglycemia --> side effects: fluid retention/peripheral edema that can EXACERBATE HF, weight gain, osteoporosis and decreased bone mineral density which can increase FRACTURE RISK in elderly)

Oral anti-diabetic medication that both increases insulin sensitivity and decreases serum TGs

Acarbose (alpha-glucosidase inhibitor: inhibits intestinal brush-border enzyme alpha-glucosidase, which normally breaks down disaccharides into monosaccharides --> inability to produce monosaccharides delays carb hydrolysis and glucose absorption, causing carbs to remain in gut lumen --> prevents spike in glucose after feeding --> side effects: diarrhea, flatulence, abdominal pain due to GUT BACTERIA fermenting undigested carbohydrates --> CONTRAINDICATED in renal insufficiency)

Oral anti-diabetic medication that decreases post-prandial hypoglycemia

DPP4 inhibitor (Linagliptin, saxagliptin, sitagliptin: inhibit DPP-4 enzyme, which normally deactivates incretins GLP-1 and GIP --> increases GLP-1 and GIP levels --> inhibits glucagon release from alpha cells, stimulates insulin release from beta cells, and inhibits gastric emptying to promote satiety/weight loss --> increases BOTH insulin and C-peptide release, but does NOT cause hypoglycemia because it depends on glucose to work --> side effects: mild URIs such as nasopharyngitis, mild urinary infections, but NO WEIGHT CHANGES)

Oral anti-diabetic medication that increases GLP-1 to block glucagon release/stimulate insulin release

Glitazones (Thiazolidinediones/TZDs such as pioglitazone and rosiglitazone: binds to PPARy nuclear transcription regular in peripheral tissues --> TZD-PPARy-RXR complex binds to DNA --> increases GLUT4 expression causing increased insulin sensitivity in fat cells/skeletal muscle --> ALSO increases adiponectin, causing increased # of adipocytes and increased FA oxidation to DECREASE serum TGs --> decreases TNF-alpha and leptin --> does NOT interact with pancreatic beta cells so it does NOT cause hypoglycemia --> side effects: weight gain, fluid retention/peripheral edema, osteoporosis/increased risk of fractures --> CONTRAINDICATED in patients with heart failure)

Oral anti-diabetic medication that increases GLUT4 expression and increases # of adipocytes, but does NOT cause hypoglycemia

Glitazones (Thiazolidinediones/TZDs such as pioglitazone and rosiglitazone: binds to PPARy nuclear transcription regular in peripheral tissues --> TZD-PPARy-RXR complex binds to DNA --> increases GLUT4 expression causing increased insulin sensitivity in fat cells/skeletal muscle --> ALSO increases adiponectin, causing increased # of adipocytes and increased FA oxidation, which DECREASES serum TGs --> decreases TNF-alpha and leptin --> does NOT interact with pancreatic beta cells so it does NOT cause hypoglycemia --> side effects: osteoporosis and decreased bone mineral density which can cause high FRACTURE RISK in elderly patients, fluid retention/peripheral edema that can EXACERBATE HF, weight gain)

Oral anti-diabetic medication with increased risk of fractures in elderly

Nateglinide and repaglinide (Meglitinides: close ATP-dependent K+ channel to depolarize pancreatic beta cells at diff binding site than sulfonylureas --> increases Ca2+ influx to cause vesicular release of insulin --> side effects: hypoglycemia and weight gain)

Oral anti-diabetic medications that can increase endogenous insulin in patients with sulfa allergy

Sulfonylureas and Meglitinides (Sulfonylureas: glimepiride, glipizide, glyburide --> Meglitinides: nateglinide, repaglinide)

Oral anti-diabetic medications that close ATP-sensitive K+ cells on pancreatic beta cells

Sulfonylureas, meglitinides, GLP1 analogs, DPP4 inhibitors (Sulfonylureas and meglitinides: close ATP-dependent K+ channel to depolarize beta cells, SE include hypoglycemia and weight gain --> GLP1 analogs and DPP4 inhibitors: increase GLP1 levels to inhibit glucagon release/gastric emptying and increase insulin release/promote satiety)

Oral anti-diabetic medications that increase endogenous insulin release AND C-peptide release

Metformin, sulfonylureas, meglitinides, SGLT2 inhibitors, acarbose

Oral anti-diabetic medications that should be used with caution in patients with renal insufficiency

Dabigatran (directly inhibits activity of free and clot-associated thrombin/factor 2a --> used to treat DVT, AFib, and heparin-induced thrombocytopenia --> does NOT require lab monitoring --> side effects: bleeding, can be reversed with idarucizumab)

Oral direct thrombin inhibitor

Amantadine (inhibits M2 proton channel in influenza A to prevent viral uncoating, but no longer used due to resistance --> now used as adjunct treatment in Parkinson's because it increases endogenous dopamine availability)

Outdated treatment for the flu, but now used as adjunct treatment for Parkinson's

Ketamine (NMDA receptor ANTAGONIST: causes dissociative anesthesia, aka patient's eyes remain open with slow nystagmic gaze --> also sympathomimetic and causes CV stimulation with elevated HR/BP/CO and minimal respiratory depression with bronchodilation --> INCREASES cerebral blood flow --> used as anesthesia for mentally challenged patients and uncooperative pediatric patients --> side effects: unpleasant emergence reaction with disorientation, out of body experiences, hallucinations, and vivid colorful dreams)

Patient emerges out of anesthesia and begins to experience hallucinations and out of body experiences. Which drug was used to induce anesthesia?

Dicloxacillin, nafcillin, oxacillin (same as penicillin, but contain bulky R group to block access of beta-lactamase to beta-lactam ring --> mostly used to treat MSSA/methicillin-sensitive S. aureus infections such as impetigo, folliculitis, abscesses, endocarditis, osteomyelitis --> CANNOT treat MRSA due to altered penicillin binding site)

Penicillinase-resistant penicillins

Tetrabenazine or Fluphenazine (both decrease dopamine levels in synapse, also need to add CBT/habit reversal training --> Tetrabenazine: VMAT inhibitor that inhibits vesicular monoamine transporter, thus preventing packing of dopamine into vesicles and decrease DA release --> Fluphenazine: typical antipsychotic that blocks dopamine D2 receptor)

Pharmacologic treatment for Tourette syndrome

Terazosin/tamsulosin, finasteride, tadalafil, tolterodine (Terazosin/tamsulosin: alpha-1a adrenergic antagonists that relax smooth muscle in bladder neck/prostate capsule/prostatic urethra, SE include orthostatic hypotension and dizziness --> finasteride: 5-alpha-reductase inhibitors inhibit conversion of testosterone to DHT to reduce prostate gland size, SE include low libido and ED --> tadalafil: PDE5 inhibitor --> tolterodine: anti-muscarinic that treats overactive bladder and frequency, SE include urine retention and dry mouth)

Pharmacologic treatment for benign prostatic hyperplasia

Disulfiram, acamprosate, naltrexone, supportive care (disulfiram: aldehyde dehydrogenase inhibitor that allows accumulation of acetaldehyde to cause exaggerated hangover effects --> acamprosate: modulates glutamate transmission at NMDA receptor --> naltrexone: long-acting mu-opioid agonist that reduces alcohol cravings)

Pharmacologic treatment for chronic alcoholism

Duloxetine, milnacipran, gabapentin (duloxetine and milnacipran: SNRIs that inhibit serotonin and NE reuptake, SE include HTN/stimulant effects/sedation/nausea --> gabapentin: anti-convulsant that inhibits Ca2+ channels on presynaptic membranes, SE include confusion/sedation/ataxia)

Pharmacologic treatment for fibromyalgia

Varenicline or bupropion (varenicline: partial nACh receptor agonist that helps reduce nicotine cravings, SE include sleep disturbances/depression --> bupropion: inhibits reuptake of NE and dopamine and used to treat both smoking and depression WITHOUT sexual side effects, SE include stimulant effects/headaches/seizures in bulimic/anorexic patients, history of seizure disorder, electrolyte abnormalities)

Pharmacologic treatment for nicotine addiction

Hydroxychloroquine (anti-malarial drug --> can also use phlebotomy + decreased sun exposure)

Pharmacologic treatment for porphyria cutanea tarda

Continuous leuprolide (GnRH analog that is antagonistic when given continuously by down-regulating GnRH receptor in pituitary --> decreases FSH/LH --> decreased androgen) and flutamide (non-steroidal competitive inhibitor at androgen receptors)

Pharmacologic treatment for prostate adenocarcinoma

Clozapine (atypical antipsychotic that blocks both serotonin and dopamine receptors --> high risk of agranulocytosis, so patients need to receive weekly WBC counts to monitor ANC --> other side effects: seizures, neutropenia, myocarditis, metabolic syndrome)

Pharmacologic treatment for refractory schizophrenia (no results after having tried >2 antipsychotics)

Amoxicillin (beta-lactam antibiotic that is same as penicillin but with wider spectrum due to improved activity against gram-negative bugs --> protective against viridans streptococci, S. bovis, Enterococcus, etc. --> side effects: SJS, drug-induced liver injury, maculopapular rash if given to patients with infectious mono)

Prophylaxis for dental procedures to prevent endocarditis

Rhogam (anti-Rh/D IgG antibodies: given to Rh-negative mother carrying Rh-positive child at 28wks and immediately postpartum --> anti-Rh/D IgG bind to Rh-positive fetal RBCs that enter maternal circulation and sequester/eliminate them via mother's spleen, thus preventing their interaction with maternal immune system --> does NOT cause significant transplacental fetal hemolysis because quantity of anti-Rh/D administered is very small compared to typical immunologic reaction)

Prophylaxis for hemolytic disease of the newborn

Sirolimus (Rapamycin: binds to FK-506 binding protein, forming a complex that inhibits mammalian target of rapamycin/mTOR signaling pathway --> interrupts IL-2 signal transduction, aka preventing G1 to S phase progression in T cells --> blocks T cell proliferation and B-cell differentiation --> side effects: pancytopenia, insulin resistance, hyperlipidemia, but NOT NEPHROTOXIC so useful in patients with kidney transplants)

Prophylaxis for kidney transplant rejection

Propranolol, topiramate, valproate, amitriptyline

Prophylaxis for migraines

Penicillin G (IV form of penicillin: D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidogylcans in cell wall --> given INTRAPARTUM during delivery for prophylaxis against group B strep/S. agalactiae --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Prophylaxis for neonatal group B strep meningitis (if woman has positive culture)

Calcium/vitamin D supplementation

Prophylaxis for osteoporosis

Phenytoin (inhibits neuronal high-frequency firing by reducing ability of Na+ channels to recover from inactivation --> also commonly used for partial seizures tonic-clonic seizures --> zero-order kinetics: rate of elimination is constant and does not depend on/vary with diff drug dose or plasma concentration of drug, so very narrow therapeutic index --> side effects-PHENYTOIN: CYP450 induction, hirsutism, enlarged gums/gingival hyperplasia, nystagmus, yellow-brown skin, teratogen, ostepoenia, inhibits folate absorption, neuropathy --> rarer side effects include SJS/TEN, DRESS syndrome, drug-induced lupus, diplopia/ataxia/sedation)

Prophylaxis for status epilepticus (recurrent seizures >5mins that result in brain injury)

Nadolol, propranolol, and carvedilol (beta-blockers: block B1 receptors in heart to decrease CO, and block B1 receptors in JG cells of kidney to decrease renin secretion --> low renin decreases RAAS activation and allows vasodilation with limited reflex tachycardia --> decreases hepatic venous pressure gradient in portal hypertension, thus preventing portosystemic varices --> side effects: bradycardia, AV block, erectile dysfunction, seizures, sleep alterations, asthma/COPD exacerbations)

Prophylaxis for variceal bleeding in portal hypertension

Warfarin (vitamin K reductase inhibitor: decreases production of factors 2/7/9/10, thus inhibiting extrinsic pathway --> initial depletion of factor 7 causes early rise in PT --> later depletion of factor 2 causes peak PT, usually ~3 days after warfarin initiation --> therefore, warfarin has GRADUAL increase that will level off after a few days --> long-term anticoagulant required for thrombogenic prosthetic mitral valves that may cause systemic emboli, VTE prophylaxis, stroke prophylaxis in patients with AFib --> side effects: warfarin skin necrosis, bleeding, teratogenic due to crossing placenta, levels INCREASE with CYP450 inhibitors and DECREASE with CYP450 inducers --> require regular PT/INR monitoring)

Prophylaxis given to patients who receive mechanical prosthetic valves

Dexamethasone (or betamethasone, aka corticosteroids: accelerate the maturation of type II pneumocytes to increase surfactant production, which begins around week 20 but dramatically rises around week 33 when L/S ratio >1.9 --> given to MOTHERS at risk of premature labor <32wks: premature rupture of membranes, gestational diabetes, vasa previa, illicit drug use during pregnancy)

Prophylaxis to prevent surfactant deficiency in pregnant mothers at risk for preterm labor

Verapamil (Ca2+ channel blocker)

Prophylaxis treatment for chronic cluster headaches

Beta-blockers, amitriptyline (TCA), valproic acid, topiramate (anti-epileptics)

Prophylaxis treatment for chronic migraines

Benzodiazepines (Diazepam: increases frequency of Cl- channel opening in GABA-A receptor --> elderly people have increased volume of distribution --> slower benzo elimination --> higher risk of adverse effects --> major risks: falling, respiratory depression, coma)

Psychiatric drug that can cause confusion, anterograde amnesia, psychomotor retardation in elderly

Teriparatide (recombinant PTH analog: increases osteoblastic activity when administered in pulsatile fashion --> stimulates maturation of pre-osteoblasts into bone-forming osteoblasts, and also increases GI absorption and renal tubular reabsorption of Ca2+ --> causes MORE bone growth compared to bisphosphonates --> side effects: increased risk of osteosarcoma and transient hypercalcemia --> contraindications: Paget disease of bone, elevated AlkPhos, prior cancer, radiation therapy)

Recombinant PTH analog used to treat osteoporosis

Vitamin B6 (pyridoxine: lack of vitamin B6 while taking isoniazid will cause sideroblastic anemia and peripheral neuropathy --> vitamin B6 involved in synthesis of heme, niacin, histamine, serotonin, EPI, NE, dopamine, GABA)

Required supplement when taking isoniazid

Delaviridne, efavirenz, nevirapine (non-nucleoside reverse transcriptase inhibitors: directly bind and allosterically inhibit HIV reverse transcriptase to halt DNA polymerase --> used to treat HIV --> side effects: hepatotoxicity/liver failure within 6wks, SJS, vivid dreams/nightmares, insomnia, CNS symptoms such as drowsiness, dizziness, headaches, psychosis)

Reverse transcriptase inhibitors that do not require phosphorylation

Oral (works predominantly in LIVER --> slow onset of action, limited by half-lives of clotting factors in which factor 7 has shortest half-life --> lasts for a few days --> monitor via PT/INR --> CONTRAINDICATED in pregnancy since it can cross placenta and is teratogenic)

Route of warfarin administration

IV or SQ (works predominantly in BLOOD --> rapid onset of action --> short half-life so only lasts for a few hours --> monitor via PTT)

Routes of heparin administration

Wrapping worm around stick and metronidazole (forms toxic free radicals that damage DNA --> side effects: disulfiram-like reaction with alcohol, headaches, metallic taste)

Treatment for Dracunculus medinesis

Barbiturates (Phenobarbital, pentobarbital, thiopental, secobarbital, primidone: increases DURATION of Cl- channel opening in GABA-A receptors --> rarely used due to side effects, but can given as sedative for critically ill patients in hospital/neonatal seizures with phenobarbital/rapid induction of anesthesia with thiopental --> side effects: hypotension, CV/respiratory depression, CNS depression/coma, physical dependence, CYP450 inducer --> contraindicated in ELDERLY and acute intermittent porphyria, as it precipitates AIP attacks)

Sedative with high risk of severe hypotension, CV/respiratory collapse, coma, physical dependence, CYP450 induction

Triazolam and midazolam (half life <6hrs)

Short-acting benzodiazepines

PML (progressive multifocal leukoencephalopathy: caused by JC virus infection --> part of polyomavirus family, aka naked circular dsDNA --> kills oligodendrocytes, resulting in progressive demyelinating disease associated with non-enhancing brain lesions --> virus is present in over 50% of population and asymptomatic, but reactivates in HIV patients with CD4 <200 + taking alpha-4 integrin inhibitor natalizumab + taking CD20/B-cell inhibitor rituximab)

Side effect of natalizumab and rituximab

First dose hypotension (occurs in patients who are given ACE inhibitors but have underlying high plasma renin, usually due to heart failure or volume depletion from diuretics --> initiation of ACE inhibitor therapy causes removal of vasoconstrictive effects of AngII, resulting in decreased peripheral vascular tone and large drop in BP --> patients with low blood volume cannot manage this vasodilation, resulting in extreme hypotension, lightheadedness, and near-syncope)

Side effect seen when combining ACE inhibitors with thiazide diuretic

Quinidine (class IA anti-arrhythmic AND strong anti-malarial: blocks Na+ channels to decrease slope of phase 0 depolarization --> also has some K+ blocking effect that increases ERP and prolongs phase 3 repolarization, thus INCREASING AP duration --> used for re-entrant and ectopic SVT and VT --> side effects: cinchonism, thrombocytopenia, torsades de pointes due to prolonged QT)

Side effects include cinchonism (headache, tinnitus, blurry vision)

Cough, angioedema, teratogen, high creatinine (decreased GFR), hyperkalemia, hypotension (remember CATCHH: cough/angioedema due to elevated bradynin, a potent vasodilator --> teratogenic due to fetal renal malformations --> decreases GFR by preventing vasoconstriction of efferent arterioles --> hyperkalemia and hypotension due to aldosterone inhibition --> NOTE: need to use ACE inhibitor with caution in patients with renal artery stenosis

Side effects of ACE inhibitors

Alopecia, GI irritation, myelosuppression

Side effects of etoposide (chemo drug that inhibits eukaryotic topoisomerase II to increase DNA degradation)

Hypothyoidism, Ebstein anomaly in newborn, nephrogenic DI, tremor (mnemonic of LiTHIUM: low thyroid, heart, insipidus, unwanted movement)

Signs of lithium toxicity

Isthmus between tricuspid valve and IVC

Site of cardiac ablation for treatment of atrial flutter

Mesna (sulfhydryl group of mesna binds to acrolein, a toxic metabolite of cyclophosphamide --> can also give adequate hydration --> prevents myelosuppression, SIADH, hemorrhagic cystitis, and bladder cancer)

Supplement given with cyclophosphamide to attenuate side effects

Dexrazoxane (iron-chelating agent: prevents dilated cardiomyopathy seen with use of anthracyclines, including doxorubicin and danurorubicin)

Supplement given with doxorubicin to prevent cardiotoxicity

Amifostine and chloride diuresis (amifostine: free radical scavenger used to decrease nephrotoxicity and dry mouth --> chloride/saline diuresis: allows adequate hydration to flush free radicals into urine)

Supplements given with cisplatin to prevent nephrotoxicity

Methyldopa (alpha-2 receptor agonist: binds to A2 receptors in CNS to inhibit SNS outflow --> decreases SNS tone throughout body to reduce BP, safe to use in pregnancy --> side effects: direct Coombs-positive hemolytic anemia and drug-induced SLE)

Sympatholytic used to treat hypertension in pregnancy

Tizanidine (alpha-2 agonist: binds to alpha-2 receptors on CNS to inhibit SNS outflow --> decreases SNS tone throughout body --> used as a muscle relaxant --> side effects: hypotension, weakness, xerostomia/dry mouth)

Sympatholytic used to treat muscle spasticity

Clonidine (alpha-2 receptor agonist: binds to A2 receptors in CNS to inhibit SNS outflow and decrease SNS tone throughout body --> used to treat hypertensive emergencies, ADHD refractory to other treatment, and Tourette syndrome --> side effects: CNS depression, bradycardia, hypotension, respiratory depression, miosis, risk of REBOUND HTN with abrupt cessation)

Sympatholytic used to treat refractory ADHD

Albuterol, dobutamine, EPI, isoproterenol (decrease diastolic pressure via B2 adrenergic receptor activity, which decreases SVR and causes vasodilation --> albuterol: only B2 agonist --> dobutamine: B1 > B2 agonist --> low-dose EPI: equal B1/B2 agonist with A1 activity at higher doses --> isoproterenol: equal B1=B2 agonist)

Sympathomimetics that decrease diastolic pressure

Dobutamine, EPI, isoproterenol, NE (increase pulse pressure via B1 adrenergic receptor activity, which increases HR/contractility to increase systolic BP --> dobutamine: agonist for B1 > B2 --> low-dose EPI: mostly B1/B2 agonist, can get A1 activity at higher doses --> isoproterenol: equal B1=B2 agonist --> NE: mostly A1 > A2 > B1, so some activity on B1)

Sympathomimetics that increase pulse pressure

Romiplostim and eltrombopag (TPO analog and TPO receptor agonist, respectively: used to treat autoimmune thrombocytopenia and stimulate platelet synthesis)

TPO analogs

Carbamazepine, Phenytoin, Phenobarbital, Valproic acid (all 4 associated with decreased serum folate, therefore high-dose folate supplementation recommended --> cause neonatal neural tube defects, cardiac defects, cleft palate/lip, and skeletal abnormalities such as phalanx/nail hypoplasia and facial dysmorphism --> valproic acid is contraindicated in pregnancy)

Teratogenic anti-seizure medications

Macrolides (Azithromycin, clarithromycin, erythromycin: inhibit 23S rRNA of 50S bacterial subunit to block TRANSLOCATION --> inhibits protein synthesis --> used to treat atypical penumonia, Chlamydia, strep infections in patients allergic to pencillin, and B. pertussis --> side effects-MACRO: motility issues, arrhythmia due to prolonged QT, cholestatic hepatitis, rash, eOsinophilia --> also TERATOGENIC and associated with hypertrophic pyloric stenosis in utero --> clarithromycin and erythomycin are CYP450 inhibitors)

Teratogenic antibiotic associated with fetal pyloric stenosis

Warfarin (high LIPID solubility so can freely diffuse into placenta --> causes warfarin embryopathy)

Teratogenic medication associated with fetal midfacial hypoplasia, chondrodysplasia punctata, hemorrhage, organ hypoplasia, and CNS defects

Entacapone (inhibits peripheral AND central COMT to prevent conversion of L-DOPA to 3-OMD --> prevents degradation of L-DOPA to increase L-DOPA availability in CNS to avoid dyskinesia near the end of carbidopa/levodopa, and akinesia between doses --> important because in advanced PD, motor fluctuations can occur independently of medication dosing and may become unpredictable)

Treatment for "on-off" phenomenon in Parkinson patients

Voriconazole

Treatment for ABPA (allergic bronchopulmonary aspergillosis)

NSAID and sumatriptan (triptans: agonist on 5-HT1B/1D receptors located on CN5/trigeminal nerve, meningeal vessels, and brainstem --> inhibit CN5 release of vasoactive peptides such as CRGP/substance P/neurokinin A to prevent vasodilation --> inhibit meningeal vessels directly to attenuate inflammation and induce vasoconstrictor, preventing stretch of pain receptors --> inhibit brainstem directly to decrease activity of pain pathways --> side effects: coronary vasospasm, mild paresthesia, possible serotonin syndrome --> contraindicated: CAD and Prinzmetal angina as they can induce coronary vasopasms)

Treatment for ACUTE migraines

Methylphenidate, amphetamines (increase NE and dopamine in synaptic cleft)

Treatment for ADHD

ACE inhibitors (Captopril, Enalapril, Lisinopril, Ramipril: inhibit ACE to decrease levels of AngII, thus preventing constriction of efferent arterioles --> overall effect is decreased GFR, which slows down GBM thickening that occurs with renal diseases --> 1st line treatment for heart failure, diabetic nephropathy, and proteinuria --> also used to treat hypertension and given post-MI to prevent unfavorable heart remodeling --> major side effect is hyperkalemia due to decreased aldosterone and K+ retention in collecting ducts --> other side effects: cough and angioedema due to elevated bradykinin, elevated serum creatinine, elevated renin, hypotension --> contraindicated in BILATERAL renal artery stenosis)

Treatment for ADPKD if proteinuria and HTN persist

Amiodarone (group 3 anti-arrhythmic that blocks Na+ channels, K+ channels, Ca2+ channels, and beta-adrenergic receptors --> overall effect is prolongation of phase 3 repolarization to increase AP duration --> high efficacy and very long half-life, but many side effects: pulmonary fibrosis, hepatotoxicity, thyroid problems, corneal deposits, blue/gray skin discoloration leading to photodermatitis)

Treatment for AFib, atrial flutter, ventricular tachycardia, and acute treatment of VFib

All-trans retinoic acid (ATRA: binds disrupted RAR in myeloid blasts, allowing them to mature and become neutrophils --> should be given immediately after diagnosis because of high rate of early mortality from DIC/hemorrhage)

Treatment for APL (acute pro-myelocytic leukemia)

Penicillin (D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidogylcans in cell wall --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Treatment for Actinomyces

Suramin or melarsoprol (suramin: for blood-borne disease --> melarsoprol: for CNS penetration)

Treatment for African sleeping sickness (Tyrpanosoma brucei)

Mebendazole (can also be used to treat pinworm, threadworm, hookworms, whipworm, Trichinella spiralis, and Toxocara canis)

Treatment for Ascaris lumbricoides infection

Smoking cessation

Treatment for Buerger disease (medium-vessel vasculitis with intermittent claudication, gangrene, auto-amputation of digits)

Foscarnet (given to CMV with U97 gene mutation --> does NOT require kinase activation and inhibits viral DNA/RNA polymerase)

Treatment for CMV retinitis when ganciclovir fails

Nystatin, fluconazole, echinocandins (nystatin preferred because it is a LIQUID that you can swish and swallow in your mouth/throat)

Treatment for Candida albicans oral/esophageal infection

Oral fluconazole or topical azole (azoles: anti-fungal drugs that inhibit demthylation of lanosterol into egosterol, which is an essential component of fungal cell membrane --> causes disruption of fungal cell membrane --> side effects: testosterone synthesis inhibition causing gynecomastia + CYP450 inhibition/liver dysfunction)

Treatment for Candida albicans vulvovaginitis

Benznidazole or nifurtimox

Treatment for Chagas disease (Tyrpanosoma cruzi: intracellular protozoan)

Azithromycin or doxycycline (azithromycin preferred because 1-time treatment: macrolide that binds to 50S subunit to block translocation, SE include prolonged QT, cholestatic hepatitis, rash, eosinophilia --> doxycycline: tetracycline that binds to 30S subunit to prevent attachment of aminoacyl-tRNA, SE include photosensitivity and discolored teeth/bone growth in children)

Treatment for Chlamydia trachomatis only

Antitoxin

Treatment for Clostridium botulinum or tetani

Oral vancomycin, metronidazole, fidaxomicin (oral vancomycin: binds to D-Ala-D-Ala portion of cell wall precursors to inhibit cell wall peptidoglycan formation, SE include nephrotoxicity/ototoxicity/red man syndrome with IgE-independent mast cell degranulation --> metronidazole: forms toxic free radicals that damage DNA, SE include disulfiram-like reaction with alcohol/ headache/metallic taste --> fidaxomicin: macrolide-related antibiotic that inhibits sigma subunit of RNA polymerase to inhibit protein synthesis)

Treatment for Clostridium difficile

Spironolactone or eplerenone (K+ sparing diuretics: competitive aldosterone receptor antagonists in cortical collecting tubule --> used to treat hyperaldosteronism, hypokalemia, heart failure, hepatic ascites, and anti-androgen --> side effects: hyperkalemia, gynecomastia)

Treatment for Conn syndrome (primary hyperaldosteronism)

Corticosteroids, infliximab, azathioprine (corticosteroids: inhibit cytokine transcription, suppress B/T cell function, and induce T cell/eosinohpil apoptosis --> infliximab: anti-TNF alpha monoclonal antibody --> azathioprine: inhibits PRPP amidotransferase to block de novo purine synthesis)

Treatment for Crohn disease

Amphotericin B and flucytosine

Treatment for Cryptococcus neoformans infection (associated with pigeon droppings)

Anastrozole (aromatase inhibitor similar to Letrozole and Exemastane: prevents conversion of androgen to estrogen in periphery --> decreases circulating estrogen levels --> used to treat ER-positive breast cancer in postmenopausal women --> LESS effective in premenopausal women due to massive upregulation of aromatase due to high gonadotropin levels)

Treatment for ER-positive breast cancer in post-menopausal women

Surgical removal of cysts and albendazole (albendazole: anti-worm agent that disrupts helminthic microtubules)

Treatment for Echinococcus granulosus

Metronidazole (forms toxic free radicals that damage DNA --> side effects: disulfiram-like reaction with alcohol, headache, metallic taste)

Treatment for Giardiasis (Giardia lamblia infection)

Plasmapheresis

Treatment for Goodpasture syndrome

Ceftriaxone (3rd gen cephalosporin: beta-lactam that inhibits peptidoglycan cell wall synthesis but less susceptible to penicillinases --> crosses BBB so highly useful against meningitis)

Treatment for H. influenzae meningitis

Amoxicillin/clavulanic acid (Augmentin: amoxicillin is extended-spectrum penicillin with good coverage against encapsulated bacteria --> clavulanate is beta-lactamase inhibitor that prevents resistance --> side effects of amoxicillin: SJS, drug-induced liver injury, maculopapular rash if given to patients with infectious mono)

Treatment for H. influenzae mucosal infections

Amoxicillin, clarithromycin, and proton pump inhibitor (triple therapy required to treat acute H. pylori gastritis, as well as regression of gastric MALToma --> amoxicillin: extended-spectrum beta-lactam antibiotic --> if concerned about macrolide resistance, add bismuth --> if allergic to penicillin, give PPI + metronidazole + clarithromycin)

Treatment for H. pylori and MALT lymphoma

Trastuzumab (anti-HER2 monoclonal antibody: blocks the HER-2/c-erbB2 tyrosine kinase receptor to inhibit HER-2 intracellular signaling --> helps kill cancer cells directly and via antibody-dependent cytotoxicity with NK cells --> used to treat breast cancer and gastric cancer --> side effect: cardiotoxicity, manifesting as "myocardial stunning" aka decreased myocardial contractility without cardiomyocyte destruction/fibrosis)

Treatment for HER2/neu(+) breast cancer

Tesamorelin (GHRH analog)

Treatment for HIV-associated lipodystrophy

IV acyclovir (guanosine analog that is initially monophosphorylated by HSV/VZV thymidine kinase --> then host cell enzymes form triphosphate that integrates into viral DNA and causes chain termination, thus inhibiting viral DNA synthesis --> side effect: acute kidney injury due to formation of acyclovir crystals causing obstructive crystal nephropathy, need to give proper IV hydration for prevention)

Treatment for HSV encphalitis

VMAT inhibitors (Reserpine, Tetrabenazine, Valbenazine, Deutetrabenazine: inhibit vesicular monoamine transport/VMAT to decrease packaging of dopamine into vesicles --> inhibits DA release)

Treatment for Huntington disease and tardive dyskinesia

Sulfasalazine (combination of anti-bacterial sulfapyridine and anti-inflammatory 5-aminosalicylic acid --> activated by colonic bacteria to inhibit cytokine/PG/LT synthesis during inflammation in COLON --> therefore effective in treating ulcerative colitis and colon component of Crohn disease --> side effects: malaise, nausea, sulfa allergy, reversible oligospermia)

Treatment for IBD (ulcerative colitis and Crohn disease)

Lying on left side (removes weight of gravid uterus from IVC)

Treatment for IVC compression in pregnant woman

IVIG and high-dose aspirin

Treatment for Kawasaki disease (medium-vessel vasculitis in Asian children <4y/o: conjunctivitis, rash on palms and soles, cervical adenopathy, strawberry tongue, fever)

Macrolide or fluoroquinolone (Macrolides: inhibit 23S rRNA of 50S bacterial subunit to block translocation and inhibit, SE include MACRO: motility issues, arrhythmia due to prolonged QT, cholestatic hepatitis, rash, eOsinophilia, associated with hypertrophic pyloric stenosis in utero --> fluoroquinolone: inhibit DNA gyrase to prevent bacterial DNA synthesis, SE include GI upset/skin rashes/headaches/dizziness/ leg cramps and myalgias/tendonitis or tendon rupture in elderly and patients taking prednisone)

Treatment for Legionella pneumophila

Amiloride

Treatment for Liddle syndrome (increased Na+ reabsorption in renal collecting tubules)

Ampicillin (penicillinase-sensitive penicillin: bind penicillin-binding proteins to block transpeptide cross-linking of peptidoglycan in cell wall, thus inhibiting bacterial cell wall synthesis --> extended-spectrum penicillin that is used against H. influenzae, H. pylori, E. coli, Listeria, Proteus, Salmonella, Shigella, and eenterococci --> side effects: SJS, drug-induced liver injury, HIGH RISK of C. diff infection --> mechanism of resistance: beta-lactamase)

Treatment for Listeria monocytogenes

Vancomycin, daptomycin, linezolid, ceftaroline (can no longer give methicillin due to altered penicillin-binding protein --> acquired resistance via mecA gene from staphylococcal chromosomal cassette)

Treatment for MRSA (methicillin-resistant staph aureus)

Dicloxacillin, nafcillin, oxacillin (same as penicillin, but contain bulky R group to block access of beta-lactamase to beta-lactam ring --> mostly used to treat MSSA/methicillin-sensitive S. aureus infections such as impetigo, folliculitis, abscesses, endocarditis, osteomyelitis --> CANNOT treat MRSA due to altered penicillin-binding site)

Treatment for MSSA (methicillin-sensitive staph aureus)

Macrolides, doxycycline, or fluoroquinolone (macrolides: inhibit 50S ribosomal subunit to block translocation, SE include prolonged QT/cholestatic hepatitis/rash --> doxycycline: inhibit 30S ribosomal subunit, SE include GI upset/discolored teeth/poor bone growth in children/photosensitivity --> fluoroquinolone: inhibit DNA gyrase, SE include rash/myalgia/tendon rupture or tendonitis/cartilage problems in fetuses)

Treatment for Mycoplasma pneumonia

Pilocarpine (direct ACh agonist that is resistant to AChE and crosses BBB/tertiary amine: constricts pupil to treat open-angle glaucoma --> acts on pupillary sphincter to treat closed-angle glaucoma --> potent stimulator of sweat/tears/saliva for treatment of Sjogren and xerostomia)

Treatment for Sjogren syndrome

Phentolamine (REVERSIBLE alpha-1 and alpha-2 antagonist --> inhibits effects of NE/EPI and induces vasodilation, which can help with NE leakage and vasoconstriction into tissues surrounding IV site --> MUST be given within 12hrs of extravasation to be effective --> also used to treat tyramine-induced hypertensive emergency and cocaine-induced HTN --> side effects: orthostatic hypotension and reflex tachycardia)

Treatment for NE extravasation at IV sites

Misoprostol (PGE1 analog: decreases cAMP in parietal cells to inhibit H+ secretion into gastric lumen --> stimulates production of mucin, phospholipids, and HCO3- by gastric epithelial cells to promote gastric mucous barrier --> also cause local vasodilation, leading to increased perfusion of gastric epithelium --> used as prophylaxis for NSAID-induced ulcers in patients on long-term NSAID therapy --> side effects: diarrhea, hypotension, and uterine contractions/cervical ripening which causes spontaneous abortions in pregnant women)

Treatment for NSAID-induced ulcers that is CONTRAINDICATED in pregnant women

Ceftriaxone and azithromycin (ceftriaxone: 3rd gen cephalosporin that cures isolated gonorrhea --> azithromycin: protects against chlamydia co-infection)

Treatment for Neisseria gonorrhoeae

Ceftriaxone or penicillin G

Treatment for Neisseria meningiditis

TMP-SMX (combo that inhibits folate synthesis thus bactericidal --> trimethoprim: inhibits DHFR, SE include pancytopenia and megaloblastic anemia --> sulfamethoxazole: inhibits dihydropteroate synthase, SE include hypersensitivity, SJS/TEN, hemolysis if G6PD deficient, type 4 renal tubular acidosis/interstitial nephritis, photosensitivity, kernicterus in neonate if mother takes during 3rd trimester, increases warfarin levels due to displacement from albumin)

Treatment for Nocardia

Artesunate or Atovaquone/Proguanil (need to test for G6PD deficiency to prevent severe anemia)

Treatment for P. falciparum malaria

Weight loss and OCPs (weight loss can reverse insulin resistance and restore normal ovulatory function --> OCPs/dual estrogen-progestin pill minimize endometrial proliferation, reduce androgenic symptoms like acne/hirsutism, and prevent unwanted pregnancy)

Treatment for PCOS in patients who do not wish to become pregnant

Benzotropine or amantadine (benztropine: blocks mACh receptors in CNS to reduce acute dystonia --> amantadine: increases dopamine release and blocks dopamine reuptake)

Treatment for Parkinsonism (bradykinesia) caused by typical antipsychotics

Amoxicllin/clavulanate (can also give penicllin, but want to add beta-lactamase inhibitor to prevent resistance --> side effects: SJS, drug-induced liver injury)

Treatment for Pasteurella multocida infection

Lumacaftor and ivacaftor (lumacaftor: corrects misfolded proteins and improves their transport to cell surface --> ivacaftor: opens Cl- channels to improve Cl- transport)

Treatment for Phe508 deletion-specific cystic fibrosis

Primaquine (eradicate hypnozoite form of P. vivax/ovale in liver, therefore preventing malaria relapses --> CANNOT use primaquine in chloroquine-resistant malaria because it is not effective against erythrocyte form of plasmodia, aka merozoites and trophozoites --> test for G6PD deficiency to prevent severe anemia)

Treatment for Plasmodium vivax/ovale hypnozoite (dormant form) in liver

Amoxicillin or cefazolin (amoxicillin: extended-spectrum penicillinase-sensitive penicillin, SE include type 1 HSR, erythema multiforme, pseudomembranous colitis--> cefazolin: 1st gen cephalosporin that targets gram-positive cocci + UTI-causing bugs such as Proteus/E coli/Klebsiella, SE include type 1 HSR, autoimmune hemolytic anemia, disulfiram-like reaction, vitamin K deficiency)

Treatment for Proteus infection

Piperacillin/tazobactam, aminoglycosides, carbapenems (these are the main 3, but you can remember "CAMPFIRE" drugs: carbapenems, aminoglycosides, monobactams, polymyxins, fluoroquinolones, 3rd and 4th gen cephalosporins such as ceftazidime/cefepime, and extended-spectrum penicillins such as piperacillin and ticarcillin)

Treatment for Pseudomonas aeruginosa

Benzodiazepines (Diazepam, Lorazepam, Midazolam: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> treats emotional anxiety, but also treats somatic symptoms such as headaches/muscle tension/insomnia within minutes to hours --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Treatment for RAPID RELIEF of panic disorder symptoms

Ribavarin (inhibits IMP dehydrogenase, thus decreasing levels of GMP and inhibiting de novo purine synthesis in HCV)

Treatment for RSV infection in infants

Amlodipine or nifedipine (dihydropyridine Ca2+ channel blocker: blocks voltage-dependent L-type Ca2+ channels in vascular smooth muscle --> causes peripheral vasodilation, which increases blood flow to skin and prevents ischemia-inducing color changes in finger/toes --> side effects: gingival hyperplasia, peripheral edema, flushing, dizziness)

Treatment for Raynaud phenomenon

Doxycycline or chloramphenicol

Treatment for Rickettsia ricketsii (Rocky Mountain spotted fever)

Vancomycin (coagulase-negative staph such as S. epidermidis and S. saprophyticus should be assumed to methicillin-resistant, especially in nosocomial settings --> therefore need to treat with vancomycin, which can still kill staph with altered penicillin-binding proteins via inhibiting D-Ala-D-Ala portion of peptidoglycan cell wall precursors --> side effects: nephrotoxicity, ototoxicity, thrombophlebitis)

Treatment for S. epidermidis and S. saprophyticus

Vancomycin (binds D-alanyl-D-alanine termini in cell wall pentapeptide proteoglycan precursors, thus preventing bacterial cell wall synthesis --> used for very serious gram-positive bugs such as MRSA, S. epidermidis, non-resistant Enterococcus species, and C. difficile in oral form --> side effects: nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing/red man syndrome, and DRESS --> can prevent red man syndrome with antihistamine prophylaxis and slow infusion rate --> NOTE: vancomycin-resistant Enterococcus/VRE occurs via AA modification of D-Ala-D-Alanine to D-Ala-D-Lactate)

Treatment for S. pneumoniae meningitis

Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE: rifampin inhibits bacterial DNA-dependent RNA polymerase, SE include red-orange body fluids/rash/cytopenias --> isoniazid inhibits mycolic acid synthesis using bacterial catalase-peroxidase, SE include vitamin B6 deficiency and hepatotoxicity --> pyrazinamide has unkonwn mechanism, SE include hepatotoxicity and hyperuricemia/gout --> ethambutol inhibits synthesis of mycobacterial cell wall, SE include optic neuropathy)

Treatment for TB (Mycobacterium tuberculosis)

Sodium bicarbonate (used to overcome Na+ channel blocking activities of TCA to prevent arrhythmia --> can also add activated charcoal)

Treatment for TCA toxicity

Sulfadiazine and pyrimethamine (pyrimethamine inhibits DHFR in protozoa to decrease dTMP synthesis and inhibit pyrimidine synthesis)

Treatment for Toxoplasma gondii

Sulfadiazine and pyrimethamine

Treatment for Toxoplasma gondii infection

Penicillin G (IV form of penicillin: D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidogylcans in cell wall --> given single dose of penicillin G to treat primary, secondary, tertiary syphilis AND pregnant mothers --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Treatment for Treponema pallidum (syphilis)

Metronidazole (for both patient and partner: forms toxic free radicals that damage DNA --> side effects: disulfiram-like reaction with alcohol, headache, metallic taste)

Treatment for Trichomonas vaginalis

Octreotide (somatostatin analog that inhibits secretion of various GI hormones, including VIP from pancreatic islet cells --> inhibition of VIP secretion prevents watery diarrhea and achlorhydria seen in VIPoma --> side effects: nausea, cramps, steatorrhea, cholelithiasis due to CCK inhibition)

Treatment for VIPoma

Linezolid, Daptomycin, or Tigecycline (linezolid: binds 50S subunit and prevents initiation complex to inhibit protein synthesis, SE include thrombocytopenia, peripheral neuropathy, serotonin syndrome --> daptomycin: creates transmembrane channels to disrupt cell membrane, SE include myopathy and rhabdomyolysis --> Tigecycline: binds 30S subunit to inhibit protei synthesis, SE include nausea/vomiting)

Treatment for VRE (vancomycin-resistant enterococci)

Pencillamine or trientine (penicillamine: chelates copper by binding to accumulated copper and eliminating it thru urine --> trientine: oral zinc that also binds copper)

Treatment for Wilson disease

Procainamide (or any other class IA antiarrhythmic: block Na+ channels --> slow conduction velocity in the atria, ventricles, and Purkinje fibers --> slows phase 0 --> increased QRS duration on ECG; also blocks K+ channels --> increases ERP --> increases AP duration)

Treatment for Wolff-Parkinson-White syndrome

Benzyol peroxide, isotretinoin, antibiotics (benzyol peroxide is anti-microbial to prevent P. acne inflammation --> isotretinoin is vitamin A derivative that prevents formation of keratin)

Treatment for acne

Isotretinoin (isomer of ATRA, a derivative of vitamin A: inhibit follicular epidermal keratinization, loosening keratin plugs of comedones and facilitating their expulsion --> also reduces size of sebaceous glands and inhibit sebum production --> used to treat severe acne with scarring OR acne that has failed to be treated with topical tretinoin/benzoyl peroxide and antibiotics --> HIGHLY TERATOGENIC that can cause spontaneous abortion and severe fetal malformations, so requires negative pregnancy test + 2 forms of contraception + monthly pregnancy tests for treatment --> other side effects: hyperlipidemia, chelitis/dry skin, myalgias, and pseudotumor cerebri)

Treatment for acne with significant scarring

Topical diclofenac (topical NSAID)

Treatment for actinic keratosis (solar keratosis)

Atenolol, betaxolol, bisoprolol, esmolol, metroprolol (beta-1 selective antagonists: beta-blockers that ONLY work on B1 receptor --> decrease HR/contractility/O2 consumption in heart and decrease renin release from kidneys --> used for treatment of angina, hypertension, acute MI, and SVT in patients with stable obstructive lung disease --> NO B2 activation prevents peripheral vasopasms, bronchoconstriction, hypoglycemia, hyperkalemia --> side effects: bradycardia, AV block, worsens heart failure)

Treatment for acute MI in patient with COPD

Nifurtimox

Treatment for acute Trypanosoma cruzi infection

Sumatriptan and 100% O2 (sumatriptan: agonist for 5-HT1B/1D receptors on trigeminal nerve, meningeal vessels, and brainstem --> INHIBIT release of vasoactive peptides, thus resulting in vasoconstriction --> used to treat acute migraines and cluster headache attacks --> side effects: coronary vasospasms, mild paresthesias, serotonin syndrome --> contraindications: coronary artery disease and vasospastic angina)

Treatment for acute cluster headache attacks

Ketoconazole

Treatment for acute coccidiodomycosis (pneumonia + erythema nodosum)

Benzotropine or diphenhydramine (benztropine: blocks mACh receptors in CNS to reduce acute dystonia --> diphenhydramine: 1st gen H1 blocker that also has sedative, anti-muscarinic, and anti-alpha-adrenergic effects)

Treatment for acute dystonia caused by typical antipsychotic

IV steroids

Treatment for acute flares of multiple sclerosis

IV steroids (can also give gabapentin for neuropathic pain)

Treatment for acute flares of multiple sclerosis

Benzodiazepines (Diazepam, Lorazepam, Midazolam: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> treats emotional anxiety, but also treats somatic symptoms such as headaches/muscle tension/insomnia within minutes to hours --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Treatment for acute generalized anxiety (ex: before medical procedures)

Hemin and glucose (inhibit ALA synthase to reduce accumulation of 5-ALA and PBV in blood, tissues, urine)

Treatment for acute intermittent porphyria

Oral rehydration solution (contains water, GLUCOSE, Na+ and K+ --> glucose added because it is required for SGLT1 on enterocytes, aka Na+/glucose symporter --> allows BOTH glucose and Na+ to be absorbed into intestinal cells, with water following as well --> thus increases absorption of Na+ AND H2O to allow for faster rehydration)

Treatment for cholera

Atropine and pralidoxime (2-PAM: atropine is competitive muscarinic antagonist to block smooth muscle symptoms in cholinergic poisoning, but NO effect on CNS or skeletal muscle --> pralidoxime regenerates AChE if given early, used as ADJUNCT to atropine to degrade excess ACh to treat BOTH muscarinic and nicotinic effects)

Treatment for cholinesterase inhibitor poisoning (organophosphate poisoning)

IFN-gamma (stimulates CD8+ T cells and NK cells to kill infected cells --> side effects: flu-like symptoms, neutropenia, myopathy, profound fatigue, tinnitus, retinopathy, confusion/depression, pneumonitis, myelosuppression, drug-induced SLE)

Treatment for chronic granulomatous disease

IFN-alpha (down-regulates protein synthesis in virally infected cells to resist viral replication AND up-regulates MHCI expression to enhance CD8+ killing of infected cells --> used to treat chronic HBV/HCV except NOT 1ST LINE for HCV, hairy cell leukemia, malignant melanoma, Kaposi sarcoma caused by HHV-8, condyloma acuminatum caused by HPV, renal cell carcinoma --> side effects: flu-like symptoms, neutropenia, myopathy, profound fatigue, tinnitus, retinopathy, confusion/depression, pneumonitis, myelosuppression, drug-induced SLE)

Treatment for chronic hepatitis B/C

Ribavirin, simeprevir, sofosbuvir (ribavarin inhibits IMP dehydrogenase to decrease GMP and inhibit de novo purine synthesis in HCV --> simeprevir: NS3/4A inhibitor that inhibits viral protease to prevent viral replication, SE include headache/fatigue --> sofosbuvir: NS5B inhibitor that inhibits RNA-dependent RNA polymerase to prevent viral RNA replication, SE include fatigue/headaches)

Treatment for chronic hepatitis C infection

Lubiprostone (fatty acid derived from PGE1 that activates Cl- channels on GI epithelial cells --> increased secretion of Cl- and fluids --> allow softening of stool, increased motility, and promote spontaneous bowel movements)

Treatment for chronic idiopathic constipation

IFN-beta and natalizumab (IFN-beta/beta-interferon: decreases protein expression of infected cells/upregulates MHCI expression to guide CD8+ killing, SE include flu-like symptoms/neutropenia/myopathy/depression --> natalizumab: alpha-4 integrin inhibitor that blocks WBC adhesion, SE includes risk of PML due to JC activation)

Treatment for chronic multiple sclerosis

Colchicine (binds to tubulin --> inhibits microtubule polymerization --> impairs neutrophil chemotaxis and degranulation)

Treatment for chronic pseudogout (calcium pyrophosphate deposition disease)

Ceftriaxone and doxycycline

Treatment for co-infection of gonorrhea (Neisseria gonorrhea) and lymphogranuloma venereum (C. trachomatis)

Alpha-blockers and benzodiazepines

Treatment for cocaine overdose

Polyethylene glycol (OSMOTIC laxative: non-absorbable substance that attracts water into intestinal lumen, thus distending intestinal wall and increasing peristalsis --> rapid effect --> used more then magnesium hydroxide due to MgOH2's questionable efficacy and lack of evidence)

Treatment for constipation in elderyl

Sodium stibogluconate

Treatment for cutaneous leishmaniasis

Hydroxocobalamin (forms cyanocobalamin that can be excreted --> can also give combo of nitrites + thiosulfate: nitrites oxidize Hb to MetHb, which can trap cyanide as cyanomethemoglobin, then thiosulfates convert cyanide to thiocyanate, which is readily excreted)

Treatment for cyanide poisoning

Mesna (sulfhydryl group of mesna binds to toxic metabolites of cyclophosphamide, such as acrolein --> can also give adequate hydration --> prevents myelosuppression, SIADH, hemorrhagic cystitis, and bladder cancer)

Treatment for cyclophosphamide-induced hemorrhagic hemorrhagic cystitis

Albuterol, DNase, hypertonic saline, azithromycin, ibuprofen (Albuterol: helpful for bronchiectasis/bronchitis --> DNase: aerosolized dornase alfa --> hypertonic saline: facilitates mucus clearance --> azithromycin: used as anti-inflammatory agent and increases GI motility --> ibuprofen: slows progression of disease)

Treatment for cystic fibrosis

Pancreatic lipase (can be given as a supplement to enhance macronutrient and vitamin absorption)

Treatment for cystic fibrosis

Urine alkalinization and low sodium diet (urine alkalinization: use potassium citrate or acetazolamide --> chelation: use penicilllamine --> combo will increase solubility of cystine stones to remove them from urinary tract)

Treatment for cystinuria

Low carb diet and insulin

Treatment for diabetes mellitus type 1

Low carb diet, oral hypoglycemics, insulin

Treatment for diabetes mellitus type 2

ACE inhibitors (Captopril, Enalapril, Lisinopril, Ramipril: inhibit ACE to decrease levels of AngII, thus preventing constriction of efferent arterioles --> does not necessarily treat, BUT will slow down progression of GBM thickening by decreasing pressure at efferent arteriole --> decreases GFR and intraglomerular pressure --> slows hyperfiltration injury/microalbuminuria --> major side effect is hyperkalemia due to decreased aldosterone and K+ retention in collecting ducts --> other side effects: cough and angioedema due to elevated bradykinin, elevated serum creatinine, elevated renin, hypotension)

Treatment for diabetic glomerulonephropathy

Ceftriaxone (3rd gen cephalosporin: beta-lactam that inhibits cell wall synthesis but less susceptible to penicillinases --> side effects: type 1 HSR, autoimmune hemolytic anemia, disulfiram-like reaction with alcohol, vitamin K deficiency, nephrotoxic if combined with aminoglycosides)

Treatment for disseminated Lyme disease (heart block or encephalopathy)

Benzotropine and trihexyphenidyl (anti-cholinergics that inhibit central muscarinic AChRs --> useful for tremor and rigidity, but no effect on bradykinesia --> side effects: anti-cholinergic such as dry mouth, constipation, urinary retention, mydriasis)

Treatment for drug-induced Parkinsonism and Parkinson disease with severe tremor

Danazol (synthetic androgen: acts as partial agonist at androgen receptors, and also functionally inhibits estrogen by decreasing steroid hormone synthesis --> used to treat endometriosis and hereditary angioedema --> side effects: weight gain, edema, acne, hirsutism, masculinization, hepatotoxicity, pseudotumor cerebri in females)

Treatment for endometriosis and hereditary angioedema

Gentamicin and clindamycin (need to give TWO antibiotics because female genital tract infections are often polymicrobial --> gentamicin: aminoglycoside that binds 30S subunit to block initation complex and covers severe gram-negative rods, SE include OTOTOXICITY, nephrotoxicity, NMJ blockade --> clindamycin: binds 50S subunit to block peptide translocation and covers anaerobic bacteria such as Bacteroides, SE include pseudomembranous colitis)

Treatment for endometritis and septic abortions

Vancomycin or aminopenicillins and cephalosporins

Treatment for enterococci

Sildenafil (PDE-5 inhibitor: local release of NO + inhibition of PDE-5 increases cGMP in smooth muscle cells --> relaxation of smooth muscle cells surrounding cavernous venous sinuses of corpora cavernosa --> increased blood flow into corpora cavernosa, causing it to become enlarged to sustain erection --> CONTRAINDICATED in patients taking nitrates due to life-threatening hypotension)

Treatment for erectile dysfunction

Sildenafil, tadalafil, vardenafil

Treatment for erectile dysfunction

Octreotide and ADH (octreotide: somatostatin analog that inhibits endogenous hormones such as glucagon/VIP that normally induce splanchnic vasodilation, thus decreasing portal blood flow and variceal pressure, SE include nausea/abdominal cramps/steatorrhea/ gallstones due to CCK inhibition --> ADH/vasopressin: binds to V1 receptors and directly vasoconstricts mesenteric arterioles to reduce portal pressure, SE include systemic hypertension and hypervolemia)

Treatment for esophageal varices

Fomepizole (alcohol dehydrogenase inhibitor)

Treatment for ethylene glycol/methanol intoxication

Aminocaproic acid (blocks activation of plasminogen to plasmin --> decreases effects of plasmin on fibrinogen to restore clotting ability)

Treatment for fibrinolysis disorders

Praziquantel or Niclosamide (Praziquantel: increases Ca2+ channel permeability of parasite membranes to induce vacuolization --> Niclosamide: inhibits glucose uptake by worms)

Treatment for fish tapeworm (Diphyllobothrium latum)

Surgical debridement and pencillin

Treatment for gas gangrene (C. perfringens infection)

Glucocorticoids

Treatment for giant cell arteritis

Bendazole (causes microtubule dysfunction to immobilize worms --> in PREGNANT women, give pyrantel pamoate)

Treatment for giant roundworm (Ascaris lumbricoides)

Cyclophosphamide or corticosteroids (cyclophosphamides: alkylating agent that cross-links DNA at guanine to prevent DNA synthesis and requires bioactivation by liver, SE include myelosuppression/ SIADH/hemorrhagic cystitis that can cause transitional cell carcinoma --> corticosteroids: inhibit NFkB to prevent production of cytokines, and induce apoptosis of T-cells and eosinophils)

Treatment for granulomatosis with polyangiitis (small-vessel vasculitis: triad of granulomas in nasopharynx, lung, kidneys)

Penicillin V (acid-stable oral form of penicillin: D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidogylcans in cell wall --> oral/V form has poor bioavailability, 4X/day dosing, and narrow spectrum so not used often --> mostly used to treat gram-positive Strep infections, Actinomyces, C. perfringens, Pasteurella multocida --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Treatment for group A strep pharyngitis and rheumatic fever

Octreotide (somatostatin analog that decreases hormone secretion) or Pegvisomant (GH receptor antagonist)

Treatment for growth hormone adenoma

Cladribine or pentostatin (Cladribine/2-CDA and pentostatin are both adenosine deaminase inhibitors that allows adenosine to build up to toxic levels and kill neoplastic B cells)

Treatment for hairy cell leukemia

Phlebotomy and iron chelation (can use deferasirox, deferoxamine, deferiprone)

Treatment for hemochromatosis

Desmopressin (binds to V2 receptors on endothelium, which are Gs and cause release of cAMP to increase intracellular Ca2+ --> pushes out vWF and factor 8 stored in endothelium --> side effects: hypovolemia, hyponatremia due to ADH inhibition at kidney CD)

Treatment for hemophilia A

Protamine sulfate (positively-charged molecule that binds to negatively-charged heparin)

Treatment for heparin reversal

Bivalrudin or argatroban (direct thrombin inhibitors: directly inhibits activity of free and clot-associated thrombin to treat massive thrombosis/thombocytopenia caused by HIT)

Treatment for heparin-induced thrombocytopenia

Spironolactone (K+ sparing diuretic: competitive aldosterone receptor antagonist in kidney cortical CD --> used to treat hyperaldosteronism, hypokalemia, heart failure, hepatic ascites, and anti-androgen --> side effects: hyperkalemia that leads to arrhythmias/wide QRS and peaked T waves/muscle weakness, as well as gynecomastia/other anti-androgen effects)

Treatment for hepatic ascites

Splenectomy (will resolve anemia but spherocytes and Howell-Jollly bodies will be seen on peripheral smear)

Treatment for hereditary spherocytosis

Ketoconazole and spironolactone (ketoconazole: inhibits cholesterol desmolase to block steroid hormone synthesis in adrenal gland --> spironolactone: inhibits cholesterol desmolase AND inhibits steroid binding)

Treatment for hirsutism (especially in women with PCOS)

Cysteine, vitamin B6, vitamin B12, folate (also need to give methionine-restricted diet)

Treatment for homocystinuria

Thoracic sympathectomy (surgical interruption of thoracic sympathetic trunk at T2 segment --> decreases SNS activity to axillae)

Treatment for hyperhidrosis of axilla

Cinacalcet (DECREASES serum PTH/serum Ca2+ levels: sensitizes Ca2+-sensing receptor/CASR in parathyroid gland to circulating Ca2+ --> DECREASES release of PTH from parathyroid glands --> used to treat 1° hyperparathyroidism if surgery fails, as well as 2° hyperparathyroidism in CKD --> side effect: hypocalcemia)

Treatment for hyperparathyroidism

Sevelamer (non-absorbable phosphate binder that BLOCKS phosphate absorption in GI tract --> used to treat hyperphosphatemia in chronic kidney disease, especially patients on dialysis --> side effects: GI upset and hypophosphatemia)

Treatment for hyperphosphatemia in CKD

Hydroquinone (inhibits tyrosine hydroxylase, which normally oxidizes tyrosine to DOPA --> since DOPA is used to form melanin, lack of DOPA prevents melanin synthesis)

Treatment for hyperpigmentation (ex: melasma)

ARBs (angiotensin II receptor blockers such as Losartan, Candesartan, Valsartan, Irbesartan: selectively block binding of AngII to AT1 receptor, preventing constriction of efferent arterioles and decreasing GFR --> same effect as ACE inhibitors EXCEPT no increase in bradykinin, so no cough/angioedema side effects --> side effects: hyperkalemia due to decreased aldosterone, hypotension, elevated serum creatinine, teratogenic)

Treatment for hypertension, heart failure, proteinuria, CKD/diabetic nephropathy with intolerance to ACE inhibitors

Nitrates (IV vasodilators such as nitroglycerine or sodium nitroprusside: metabolized within vascular smooth muscle to NO, which activates GC and increases cGMP --> cGMP decreases intracellular Ca2+, thus reducing activity of MCLK --> promotes dephosphorylation of MCLK and vascular smooth muscle relaxation --> causes dilation of BOTH arteries and veins to reduce afterload and preload, thus improving heart failure)

Treatment for hypertensive emergency

Nitroprusside (short-acting NO analog that increases cGMP in blood vessels, causing BOTH arterial and venous vasodilation --> decreases LV preload and afterload, allowing adequate CO to be delivered at lower LV-EDP, thus maintaining SV --> side effect: causes release of cyanide, so may cause cyanide toxicity)

Treatment for hypertensive emergency that may cause risk of cyanide toxicity

Fibrate

Treatment for hypertriglyceridemia

0.9% saline (aka normal saline: mimics tonicity of normal body, so does not cause hypertonic or hypotonic ECF --> used to treat low BP in hypovolemic and distributive shock)

Treatment for hypovolemia

Heparin (unfractionated heparin derived from endogenous heparin in mast cells --> binds to antithrombin III via pentasaccharide in heparin chain --> results in conformation change of ATIII to inhibit factor Xa and neutralize thrombin, promoting IMMEDIATE anti-coagulation due to short half-life --> used for IMMEDIATE anti-coagulation in PE, acute coronary syndrome, MI, DVT, and pregnancy --> need to follow PTT --> low molecular weight heparin/LMWH act mostly on factor Xa and has better bioavailability/2-4X longer half-life)

Treatment for immediate anticoagulation (aka patient in hospital with active DVT)

Corticosteroids, IVIG, rituximab, TPO (can give TPO analog Romiplostim or TPO receptor antagonist eltrombopag --> if refractory ITP, can undergo splenectomy which will eliminate BOTH primary source of auto-antibody against Gp2b/3a AND site of destruction)

Treatment for immune thrombocytopenia

3% saline (hypertonic saline: used to pull water out of neurons into ECF to reduce cerebral edema --> also used to restore Na+ concentrations in patients with low Na+ from Legionella, SIADH, cirrhosis, MDMA overdose, thiazide diuretics --> if being used to treat hyponatremia, need to give SLOWLY to prevent central pontine myelinolysis aka osmotic demyelination syndrome)

Treatment for increased ICP and severe hyponatremia

Pulsatile GnRH (when given in PULSATILE fashion, can increase LH and FSH secretion --> stimulates ovulation in women who have low GnRH and/or ovulatory failure --> requires pituitary and ovarian function to work)

Treatment for infertility due to hypogonadotropic hypogonadism

Clomiphene (blocks estrogen receptors in HYPOTHALAMUS to prevent negative feedback --> increases release of LH and FSH to stimulate ovulation in women with ovulatory failure who have normal GnRH, normal prolactin, and euthyroid)

Treatment for infertility due to ovulatory failure (normal GnRH and prolactin)

IVF (patients given estrogen and progestin supplementation to develop thick endometrial lining --> then given donated ovum for pregnancy rates approaching 60%)

Treatment for infertility in Turner syndrome

Oseltamivir (inhibits neuraminidase)

Treatment for influenza

Oseltamivir or zanamivir (inhibit influenza NA --> prevent release of progeny virus --> need to begin therapy within 48hrs of symptom onset, aka before progeny have already been released)

Treatment for influenza

Zolpidem (or Zaleplon or Eszoplicone: non-benzodiazepine hypnotics that bind to same BZ1 binding site on GABA-A receptor, but more specific for hypnotic effects and less likely to cause tolerance/physical dependence/addiction --> short half-lives and rapid onset/offset so used to treat insomnia with difficulty FALLING asleep, except eszopiclone whose half-life of 5hrs used to treat both sleep onset/maintenance difficulty --> side effects: ELDERLY patients may experience excessive sedation, cognitive impairment, delirium, night wandering, agitation, central ataxia/increased risk of falls)

Treatment for insomnia due to difficult sleep onset

Ramelteon (melatonin receptor agonist: binds and activates MT1 and MT2 receptors in suprachiasmatic nucleus of hypothalamus --> used to treat insomnia in geriatric patients because it does NOT bind to GABA-A/not related to CNS depression --> does not change sleep architecture, so does NOT cause rebound insomnia or tolerance/dependence/withdrawal symptoms)

Treatment for insomnia in ELDERLY patients

Glucagon (elevates blood sugar levels during fasting state/hypoglycemia --> promotes glycogenolysis, gluconeogenesis, lipolysis, ketogenesis)

Treatment for insulin-induced hypoglycemia (typically seen in T1DM patients)

Corporal aspiration, IC phenylephrine, or surgical decompression (priapism: painful sustained erection lasting >4hrs --> can be caused by sickle cell disease, sildenafil, trazodone --> can cause ischemia of penis)

Treatment for ischemic priapism

Penicillin G (IV form of penicillin: D-Ala-D-Ala structural analog that binds transpeptidase, aka penicillin binding protein, to block transpeptidase cross-linking of peptidogylcans in cell wall --> side effects: type 1 HSR, direct Coombs hemolytic anemia, drug-induced interstitial nephritis --> mechanism of resistance: beta-lactamase that cleaves beta-lactam ring, encoded by plasmid genes)

Treatment for left-sided endocarditis caused by Viridans streptococci or S. bovis

Dapsone, rifampin, and clofazimine (need to take for 2-5yrs --> dapsone: inhibits dihydropteroate synthase to block folate synthesis, SE include hemolysis if G6PD deficient, agranulocytosis, methemoglobinemia --> rifampin: inhibits bacterial RNA polymerase, SE include orange-red body fluids/cytopenias/liver toxicity --> clofazimine: inhibits DNA replication to block replication)

Treatment for lepromatous form of M. leprae infection

Pyrethoids, malathion, ivermectin lotion, nit combing

Treatment for lice (caused by Pediculus humanus or Phthirus pubis)

IV quinidine or artesunate (test for G6PD deficiency --> also remember quinidine can cause cinchonism: headache, tinnitus, blurry vision)

Treatment for life-threatening malaria

Diethycarbamazine (DEC: effective against microfilariae)

Treatment for loa loa and elephantiasis (Wuchereria bancrofti infection)

Tamoxifen (SERM: estrogen ANTAGONIST at breast so used to treat ER/PR-positive breast cancer, as well as prevent recurrence --> ALSO given for LCIS to reduce size of tumor since LCIS has low risk of progression to invasive lobular carcinoma --> estrogen AGONIST at bone and uterus, therefore does not cause osteoporosis but does increase risk of endometrial cancer --> side effects: risk of thromboembolic events, especially in smokers)

Treatment for lobular carcinoma in situ (LCIS)

Fluconazole or itraconazole (used to treat lung histoplasmosis, lung blastomycosis, lung paracoccidiodomycosis,

Treatment for local fungal infections

Doxycycline

Treatment for localized cutaneous or facial nerve palsy-associated Lyme disease

Warfarin, dabigatran, rivaroxaban, apixaban (Dabigatran is direct thrombin inbhitor --> Rivaroxaban and Apixaban are direct factor Xa inhibitors that prevent thrombin formation)

Treatment for long-term anticoagulation

Mycophenolate mofetil (reversibly inhibits IMP dehydrogenase, a critical step in de novo purine synthesis --> selectively targets lymphocytes, reducing B and T cell proliferation and inducing T-cell apoptosis --> used to treat lupus nephritis and as adjunct to transplant rejection --> side effects: pancytopenia, HTN, hyperglycemia, invasive CMV infection)

Treatment for lupus nephritis

Itraconazole (used to give potassium iodide, but no longer recommended)

Treatment for lymphocutaneous sporotrichosis (caused by Sporothrix schenckii infection)

Chloroquine (blocks Plasmodium heme polymerase)

Treatment for malaria in sensitive areas (Caribbean, Central America west of Panama canal, and Middle East)

Dantrolene (ryanodine receptor antagonist --> prevents release of Ca2+ in sarcoplasm to allow muscle relaxation)

Treatment for malignant hyperthermia

Mifepristone

Treatment for medical abortion

Vemurafenib (potent inhibitor of mutated BRAF: small molecule inhibitor of BRAF oncogene --> often coadministered with MEK inhibitors such as trametinib --> used to treat metastatic melanoma)

Treatment for melanoma with (+)BRAF mutation V600E

Fomepizole (alcohol dehydrogenase inhibitor: blocks conversion of methanol into formaldehyde/ethylene glycol into oxalic acid --> these metabolites are the toxic substances, so if you prevent their formation you improve symptoms)

Treatment for methanol/ethylene glycol intoxication

IV methylene blue and vitamin C (methylene blue helps reduce Fe3+ back to Fe2+ state --> vitamin C helps catalyze this reaction)

Treatment for methemoglobinemia

Corticosteroids

Treatment for minimal change disease

Diphenhydramine or Scopolamine (prevent VESTIBULAR NAUSEA, aka motion sickness --> diphenydramine: histamine antagonist that blocks H1 receptors in vestibular system/CN8, SE include sedation and anti-cholinergic effects --> scopolamine: blocks M1 muscarinic receptors in vestibular system/CN8, SE include anti-cholinergic effects)

Treatment for motion sickness

Surgical debridement and amphotericin B (need to clean mucor/rhizophus abscesses in brain --> usually infects patients with DKA)

Treatment for mucormycosis (Mucor or Rhizopus infection)

Bortezomib (26S proteosome inhibitor: boronic acid-containing dipeptide with high affinity for proteasome catalytic site --> inhibition of proteasome prevents degradation of pro-apoptotic factors to induce arrest at G2-M phase and induces apoptosis --> targets and shuts down plasma cells, and increasing plasma cell apoptosis)

Treatment for multiple myeloma

Pyridostigmine (ACHe inhibitor: increases ACh levels in synaptic cleft to increase muscle strength --> quarternary amine so does NOT cross BBB --> used with glycopyrrolate, hyoscyamine, or propantheline to control side effects)

Treatment for myasthenia gravis

Valproic acid (broad-spectrum anti-seizure drug that promotes Na+ channel INACTIVATION and causes a rise in GABA --> mainly used to treat primary generalized seizures such as tonic-clonic --> also used for myoclonic seizures, bipolar disorder, migraine prophylaxis --> side effects: nausea/vomiting, acute pancreatitis, fine tremor, increased appetite/weight gain, and rare but fatal hepatotoxicity so need to measure LFTs during initiation of therapy --> ALSO teratogenic and increases risk of neural tube defects)

Treatment for myoclonic seizures

Good sleep hygiene, daytime stimulants (amphetamines/modafinil), nighttime sodium oxybate (GHB)

Treatment for narcolepsy

Morphine and methadone (gradually increase dose until symptoms controlled, then wean off over several weeks --> CANNOT give naloxone as it can cause more severe withdrawal syndromes and result in seizures)

Treatment for neonatal abstinence syndrome

HCTZ, amiloride, indomethacin (HCTZ: thiazide diuretic that inhibits NaCl absorption in kidney DCT to balance salt and water secretion, SE include hypokalemia/hyponatremia/metabolic alkalosis/high blood glucose/high Ca2+/ gout --> amiloride: K+ sparing diuretic that blocks ENaC in kidney CD, also blocks lithium reabsorption so useful for lithium-induced nephrogenic DI --> indomethacin: NSAID)

Treatment for nephrogenic diabetes insipidus

Praziquantel and albendazole (praziquantel: increases Ca2+ channel permeabilty and vacuolization of helminths --> albendazole: anti-worm agent that disrupts helminthic microtubules)

Treatment for neurocysticercosis (Taenia solium)

Dantrolene and bromocriptine (dantrolene: RYR antagonist that prevents release of Ca2+ from skeletal muscle SR --> bromocriptine: dopamine agonist)

Treatment for neuroleptic malignant syndrome

Benzodiazepines (Diazepam, Lorazepam, Midazolam: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> induces sedation/hypnosis/muscle relaxation, which is useful for violent night movement --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Treatment for night terrors/sleepwalking in children

Vitamin K (since warfarin inhibits vitamin K epoxide reductase, elevated levels of vitamin K will overwhelm warfarin and cause activation of factors 2/7/9/10)

Treatment for non-acute warfarin reversal

Bethanecol (direct ACh agonist that activates bowel and bladder smooth muscle ONLY --> has NO effect on nicotinic receptors and resistant to AChE)

Treatment for non-obstructive urinary retention (atonic bladder)

Resection

Treatment for non-small cell lung cancer

Methadone or buprenorphine (both are LONG-ACTING opioids with longer half-lives, therefore effects are attenuated over a long time and decreasing plasma levels causing a much smoother transition off opioids --> buprenorphine is only a PARTIAL mu agonist, so it is SAFER than methadone)

Treatment for opioid withdrawal (abstinence syndrome)

Nystatin, fluconazole, or echinocandins

Treatment for oral and esophageal thrush (Candida albicans infection)

Bisphosphonates (Alendronate, Risedronate: pyrophosphate analogs that attach to hypoxyapatite binding sites on bone surfaces to inhibit osteoclast-mediated bone resorption --> also decrease osteoclast proton production, induce osteoclast apoptosis, and decrease development/recruitment of osteoclast precursor cells --> overall slows down rate of bone loss --> side effects: osteonecrosis of jaw, atypical femoral stress fractures, PILL-INDUCED ESOPHAGITIS --> patients advised to take with water and remain upright for 30mins after taking meds)

Treatment for osteogenesis imperfecta, Paget disease of bone (osteitis deformans), and osteoporosis

Vitamin D supplementation

Treatment for osteomalacia/rickets

Biphophosphonates, PTH analogs, SERMs, calcitonin, denosumab

Treatment for osteoporosis

Eculizumab (monoclonal antibody that targets terminal complement protein C5)

Treatment for paroxysmal nocturnal hemoglobinuria

Fibrates (Gemfibrozil, Bezafibrate, Fenofibrate: activate PPAR-alpha which increases transcription of lipoprotein lipase to increase TG clearance --> increases breakdown of VLDL/TGs to drastically lower TG levels and raise HDL levels, but less effect on LDL than statins --> used to treat hypertriglyceridemia as it lowers risk of pancreatitis --> side effects: myopathy when combined with statins + cholesterol gallstones due to inhibition of 7-alpha-hydroxylase)

Treatment for patients with very high triglyceride levels (>500)

Gabapentin (inhibits high-voltage activated Ca2+ channels on presynaptic membranes, thus decreasing NT transmission --> often used as adjunct therapy for refractory focal seizures, but MOSTLY used for painful diabetic peripheral neuropathy, post-herpetic neuralgia, and fibromyalgia --> side effects: confusion, sedation, ataxia with higher risk in ELDERLY)

Treatment for peripheral neuropathy

Phenoxybenzamine (irreversible alpha-1 and alpha-2 antagonist --> inhibits effects of NE/EPI and induces vasodilation --> NON-COMPETITIVE/ IRREVERSIBLE antagonist, therefore NE levels cannot overcome alpha-1 blockage despite how high NE levels become --> used PRE-OP a few days before removal of pheochromocytoma to prevent massive release of catecholamines, need to follow with beta-blockers --> side effects: reflex tachycardia and orthostatic hypotension)

Treatment for phenochromocytoma

Mebendazole or pyrantel pamoate (mebendazole: 1st line treatment, causes microtubule dysfunction to immobilize worms --> pyrantel pamoate: alternative treatment for pregnant patients)

Treatment for pinworm (Enterobius vermicularis) and hookworms (Ancylostoma duodenale or Necactor americanus)

Thoracocentesis (removes/reduces fluid between pleural layers)

Treatment for pleural effusion

Amoxicillin (beta-lactam antibiotic that is same as penicillin but with wider spectrum due to improved activity against gram-negative bugs --> good coverage against encapsulated bacteria --> can also give as PROPHYLAXIS for S. pneumoniae and H. influenzae in asplenic/sickle cell patients --> side effects: SJS, drug-induced liver injury, maculopapular rash if given to patients with infectious mono)

Treatment for pneumonia caused by S. pneumoniae or H. influenzae

Phlebotomy, hydroxyurea, ruxolitinib (phlebotomy: reduces RBC mass --> hydroxyurea: inhibits ribonucleotide reductase to decreases purine and pyrimidine synthesis, thus decreasing DNA synthesis and decreasing production of RBCs --> ruxolitinib: JAK1/2 inhibitor that directly targets JAK2 mutation in polycythemia vera)

Treatment for polycythemia vera

Ruxolitinib (JAK2 inhibitor)

Treatment for polycythemia vera and myelofibrosis

Gabapentin (inhibits high-voltage activated Ca2+ channels on presynaptic membranes, thus decreasing NT transmission --> often used as adjunct therapy for refractory focal seizures, but MOSTLY used for painful diabetic neuropathy, post-herpetic neuralgia, and fibromyalgia --> side effects: confusion, sedation, ataxia with higher risk in ELDERLY)

Treatment for post-herpetic neuralgia

Acetazolamide (carbonic anhydrase inhibitor: inhibits CA within lumen of PCT to cause self-limited NaHCO3 diuresis, thus decreasing total body stores of HCO3- --> used to treat metabolic alkalosis, altitude sickness, glaucoma, pseudotumor cerebri, and cystinuria as it alkalinizes urine --> side effects: proximal renal tubular acidosis/type 2 RTA, paresthesia, NH3 toxicity, sulfa allergy, hypokalemia, Ca2+ phosphate kidney stones)

Treatment for pseudotumor cerebri (idiopathic cerebral hypertension)

Topical coricosteroids and vitamin D analogs (ex of vitamin D analogs: calcipotriene or calcitriol, inhibit T cell proliferation and keratinocyte proliferation, and stimulate keratinocyte differentiation --> can also give PUVA aka Psoralen and UV-A light: UV-A light disrupts keratinocyte proliferation, and psoralen makes skin more sensitive to UV-A light)

Treatment for psoriasis

Pirfenidone (TGF-beta inhibitor: blocks collagen deposition and fibroblast proliferation --> may slow progression of pulmonary fibrosis)

Treatment for pulmonary fibrosis

Sildenafil, bosentan, epoprostenol (Sildenafil is PDE5 inhibitor --> Bosentan is endothelin receptor antagonist --> Epoprostenol is prostacyclin analog)

Treatment for pulmonary hypertension

Topical mupirocin

Treatment for purulent S. aureus cellulitis

Glucocorticoids (ex: Prednisone: inhibit PLA2 to decrease PG and LT synthesis --> also inhibit NFkB to prevent transcription of multiple cytokines/adhesion proteins, leading to reduced leukocyte recruitment and activation --> also induce apoptosis of T cells and eosinophils --> side effects: artificial leukocytosis, Cushing syndrome, osteoporosis, hyperglycemia/diabetes, amenorrhea, peptic ulcers, psychosis, cataracts, avascular necrosis of femoral head, adrenal insufficiency with long-term use)

Treatment for rapid relief of rheumatoid arthritis symptoms

Thiazide diuretics (HCTZ, chlorthalidone, metolazone: inhibit NaCl reabsorption in early DCT, thus decreasing diluting capacity of nephron --> also decrease Ca2+ excretion by decreasing intracellular Na+ concentrations inside DCT cell, thus pulling in Na+ from interstitium and pumping out Ca2+ --> thus decrease Ca2+ excretion to prevent formation of calcium oxalate and calcium phosphate kidney stones --> side effects: hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia/gout, hypercalcemia)

Treatment for recurrent kidney stones

Milrinone (selective PDE3 inhibitor --> in cardiac myocytes: increases cAMP in cardiac tissues to promote Ca2+ influx, thus increasing cardiac contractility/positive inotropy --> in vascular smooth muscle: increases cAMP to inhibit MLCK and cause systemic ARTERIOLAR vasodilation, thus decreasing BP/afterload --> side effects: arrhythmias and hypotension, so usually only used to for short-term treatment of acute decompensated HF)

Treatment for refractory acute left heart failure with systolic dysfunction

Ropinirole or pramipexole (non-ergot dopamine agonists: treatment for restless leg syndrome --> side effects: impulse control disorder/gambling, postural hypotension, hallucinations, confusion)

Treatment for restless leg syndrome

Ivermectin (anti-parasitic agent that binds Cl- ion channels in invertebrate nerve and muscle cells)

Treatment for river blindness (Onchocerca volvulus)

Permethin cream (impairs voltage-gated Na+ channels to block mite neutrotransmission --> can also add oral ivermectin for crusted scabies seen in HIV patients)

Treatment for scabies (caused by Sarcoptes scabei)

ACE inhibitors (Captopril, Enalapril, Lisinopril, Ramipril: inhibit ACE to decrease levels of AngII, thus preventing constriction of efferent arterioles --> overall effect is decreased GFR, which slows down GBM thickening that occurs with renal diseases --> 1st line treatment for heart failure and diabetic nephropathy, also used to treat hypertension and given post-MI to prevent unfavorable heart remodeling --> major side effect is hyperkalemia due to decreased aldosterone and K+ retention in collecting ducts --> other side effects: cough and angioedema due to elevated bradykinin, elevated serum creatinine, elevated renin, hypotension --> contraindicated in BILATERAL renal artery stenosis)

Treatment for secondary hypertension due to renal abnormality (EXCEPT renal artery stenosis)

Cyproheptadine (1st generation antihistamine with non-specific 5-HT1 and 5-HT2 receptor antagonism)

Treatment for serotonin syndrome

Cardioversion (sending electrical impulses via electrodes to the heart to restart rhythm)

Treatment for severe aortic stenosis with AFib

Dobutamine (beta-1 agonist with weak beta-2 and alpha-1 activity: stimulates beta-1 receptors on myocytes, causing Gs-GTP binding/activation of AC/production of cAMP --> cAMP increases intracellular Ca2+ concentration, freeing myosin-binding site and increasing myocardial contractility --> increased cAMP also increases Na+ and Ca2+ channel activation in pacemaker cells, thus making the drug both positive INOTROPIC and CHRONOTROPIC agent --> in blood vessels, mild alpha-1 activity causes vasoconstriction while beta-2 activity causes some vasodilation, resulting in a balanced mild vasodilation --> thus, increased cardiac contractility + decreased SVR + NO CHANGE in BP improves CO and end-organ perfusion in patients with severe LV systolic heart failure, as well as cardiogenic shock)

Treatment for severe decompensated systolic heart failure

Omalizumab (anti-IgE monoclonal Ab: SQ injection --> binds to unbound serum IgE to prevent IgE binding to mast cells --> lower IgE and reduce allergen-induced bronchial constriction)

Treatment for severe persistent asthma (resistant to inhaled steroids and LABA)

Famciclovir (uses VZV viral kinase to form triphosphate --> preferentially inhibits viral DNA polymerase --> effective on latent forms of VZV)

Treatment for shingles (herpes zoster)

Hydroxyurea (inhibits ribonucleotide reductase --> decreases purine and pyrimidine synthesis --> decreased DNA synthesis/stops S phase --> used to treat sickle cell because it increases fetal Hb)

Treatment for sickle cell disease

Chemotherapy

Treatment for small cell lung cancer

Nimodipine (Ca2+ channel blocker that blocks voltage-gated L-type Ca2+ channels in cerebral vasculature --> prevents vasoconstriction, thus preventing ischemic vasospasm 3-10 days after subarchnoid hemorrhage)

Treatment used to prevent vasopasms after subarachnoid hemorrhage

Benzodiazepines (Diazepam, Lorazepam, Midazolam: bind to allosteric site on GABA-A receptor to increase FREQUENCY of Cl- channel opening --> induces muscle relaxation to treat spastic movements in UMN disorders, but NOTE that it can also cause sedation as the dose for muscle relaxation is quite high --> longer-lasting active metabolites allow smoother course/tapering effect for eventual cessation of benzos, but require functional liver for metabolization into active metabolites --> side effects: CNS depression in elderly/if combined with alcohol/liver disease due to increased serum half-life)

Treatment for spasticity in UMN disorders (ex: MS, stroke, spinal cord trauma, tetatus)

Baclofen (GABA-B receptor agonist in spinal cord --> used to treat muscle spasticity/dystonia in MS --> NOTE: can also give tizanadine, an alpha-2 agonist, which acts centrally to decrease muscle spasticity in MS/ALS/cerebral palsy)

Treatment for spasticity in multiple sclerosis

Sublingual nitroglycerin

Treatment for stable angina (acute episodes)

Ceftriaxone, vancomycin, and ampicillin (ceftriaxone protects against gram-negative causes such as N. meningiditis and H. influenzae --> vancomycin protects against gram-positive causes --> ampicillin protects against Listeria)

Treatment for suspected Listeria meningitis

Rituximab (anti-CD20 mAb that inhibits B cells --> used to treat non-Hodgkin B cell lymphomas, CLL, rheumatoid arthritis, ITP, multiple sclerosis --> side effect: risk of PML in patients with JC virus)

Treatment for sympomatic follicular lymphoma

Amphotericin B (if resistant, then give caspofungin)

Treatment for systemic Candida albicans infection

Amphotericin B (binds ergosterol in fungal cell membranes to create membrane pores that allow leakage of electrolytes --> used to treat systemic histoplasmosis, systemic blastomycosis, systemic coccidiodomycosis, systemic paracoccidiodomycosis, systemic candidiasis, mucormycosis, cryptococcus with addition of flucytosine --> side effects: distal tubular renal acidosis so need to supplement with K+ and Mg2+, fever/chills, hypotension, arrhythmias, anemia, IV phlebitis)

Treatment for systemic fungal infections

Clozapine or VMAT inhibitors (need to switch from typical anti-psychotic to one of these other drugs: clozapine is an atypical antipsychotic associated with agranulocytosis and seizures --> VMAT inhibitors such as reserpine, tetrabenazine, valbenazine, deutetrabenazine decrease packaging of dopamine into vesicles to inhibit DA release)

Treatment for tardive dyskinesia (orofacial chorea caused by long-term antipsychotic use)

High-dose steroids

Treatment for temporal arteritis (large-vessel vasculitis in branches of carotid artery: unilateral headache, jaw claudication)

Oral griseofulvin (interferes with microtubule function to inhibit fungal mitosis --> deposits in keratin-containing tissues to inhibit growth of dermatophytes in nails --> side effects: CYP450 inducer, teratogenic, carcinogenic, confusion, headaches, disulfiram-like reaction)

Treatment for terbinafine-resistant tina unguium (dermatophyte infection of nails)

Activated charcoal and beta-blockers (activated charcoal: reduce GI absorption --> beta-blockers: to reduce tachyarrhythmias)

Treatment for theophyilline intoxication (seizures and tachyarrhythmias)

Ivermectin or bendazole (ivermectin: antiparasitic agent that binds Cl- ion channels in invertebrate nerve and muscle cells --> bendazole: anti-worm agent that disrupts helminthic microtubules)

Treatment for threadworm (Strongyloides stercoralis)

Foscarnet or cidofovir (foscarnet: pyrophosphate analog that inhibits viral DNA polymerase --> cidofovir: nucleotide analog of CMP that uses CELLULAR kinases to become triphosphate form and inhibit viral DNA polymerase)

Treatment for thymidine kinase-deficient shingles (VZV infection)

Topical azole

Treatment for tinea capitis, corporis, cruris, and pedis (dermatophyte infection)

Oral terbinafine (inhibits fungal enzyme squalene epoxidase to inhibit dermatophytes --> side effects: headaches, hepatotoxicity, taste disturbance, GI upset --> NOTE: if resistant, can add oral griseofulvin which interferes with microtubule formation to disrupt fungal mitosis and deposits in keratin-containing tissue)

Treatment for tinea unguium (dermatophyte infection of nails)

Selenium sulfide (selsum blue: causes shedding of stratum corneum of skin epithelium, which is where Malassezia furfur reside)

Treatment for tinea/pityriasis versicolor (caused by Malassezia furfur)

Levetiracetam, phenytoin, valproate, carbamazepine

Treatment for tonic-clonic seizures

Magnesium sulfate

Treatment for torsades de pointes

Magnesium sulfate (can also be useful to treat digoxin toxicity)

Treatment for torsades de pointes

Monoamine oxidase inhibitors (MAOIs such as Phenelzine, Tranylcypromine, Isocarboxazid: non-selective MAO inhibition --> increases pre-synaptic levels of serotonin, NE, and dopamine --> side effects: hypertensive crisis due to tyramine and serotonin syndrome brought on by SSRIs, TCAs, St. John's worst, meperidine, dextromethorphan --> NOTE: for atypical depression, CBT and SSRIs are still 1st line due to side effect profile of MAOIs)

Treatment for treatment-resistant depression and atypical depression

Metronidazole (forms toxic free radicals that damage DNA --> need to give to BOTH patient and partner for prophylaxis, since men are usually asymptomatic --> side effects: disulfiram-like reaction with alcohol, headache, metallic taste)

Treatment for trichomoniasis (vaginitis caused by Trichomonas vaginalis)

Dapsone and rifampin (dapsone: inhibits dihydropteroate synthase to block folate synthesis, SE include hemolysis if G6PD deficient, agranulocytosis, methemoglobinemia --> rifampin: inhibits bacterial RNA polymerase, SE include orange-red body fluids/cytopenias/liver toxicity)

Treatment for tuberculoid form of M. leprae infection

Allopurinol (xanthine oxidase inhibitor --> prevents conversion of xanthine into uric acid to decrease uric acid levels in blood --> prevents tumor-lysis associated urate nephropathy)

Treatment for tumor lysis syndrome

Cholestyramine (bile acid-binding resin: binds negatively-charged bile acids/salts in small intestine --> excreted in feces --> prevents bile acids from returning to liver --> increased conversion of cholesterol into bile acid in liver --> reduces cholesterol pool AND up-regulates LDL receptors, but has no effect on HDL and slightly elevates TGs --> side effect: binds warfarin in intestine so it DECREASES warfarin levels, thus decreasing INR/PT)

Treatment for type IIa and IIb familial hyperlipidemia

Ceftriaxone or fluoroquinolone

Treatment for typhoid fever (caused by Salmonella typhi)

Phentolamine (REVERSIBLE alpha-1 and alpha-2 antagonist --> inhibits effects of NE/EPI and induces vasodilation, especially in patients on MAO inhibitors who eat tyramine-containing foods --> also used to treat cocaine-induced HTN and NE extravasation at IV sites --> since it is a COMPETITIVE, REVERSIBLE antagonist super-high levels of NE can overcome the A1 inhibition of these drugs, therefore NOT used in the treatment of pheochromocytoma --> side effects: orthostatic hypotenion, reflex tachycardia)

Treatment for tyramine-induced hypertensive emergency

Bismuth (binds to ulcer base to provide physical protection/allow HCO3- secretion to reestablish pH gradient in mucous layer --> used to treat ulcer healing and travelers diarrhea --> side effects: NOT given with PPIs/H2 blockers because it requires acidic environment)

Treatment for ulcer healing

Sulfasalazine, azathioprine, infliximab, colectomy (sulfasalazine: combo of antibacterial sulfapyridine + anti-inflammatory 5-ASA to inhibit inflammation, activated by colonic bacteria --> infliximab: anti-TNF alpha monoclonal antibody --> azathioprine: inhibits PRPP amidotransferase to block de novo purine synthesis)

Treatment for ulcerative colitis

Preformed antibodies (target diphtheria toxin directly, but needs to be given ASAP as it cannot inhibit toxin that has already entered cells --> allow passive immunity, but only last about 3 weeks --> patients also given penicillin or erythromycin to reduced continued elaboration of DT from nasopharyngeal infection)

Treatment for unvaccinated patients affected by diphtheria

Preformed antibodies (form of passive immunity --> antibodies only last about 3 weeks, hopefully will clear infection in that time)

Treatment for unvaccinated patients affected by tetanus, botulism, HBV, VZV, rabies, or diphtheria

Low protein diet and arginine (low protein diet: ensures that body receives essential AAs needed for growth and development, but not too much such that excessive ammonia is formed --> arginine: helps produce downstream water-soluble intermediates such as ornithine/citrulline that lead to nitrogen disposal and decreased plasma ammonia --> can also add: lactulose to acidify GI tract and trap NH4+ for excretion --> rifamixin/neomycin: destroy NH3-producing bacteria in gut --> benzoate, phenylacetate, phenylbutyrate: react with glycine/glutamine to form nitrogen products that can be excreted renally)

Treatment for urea cycle disorders

Oxybutynin (anti-muscarinic specific to genitourinary system --> treats overactive bladder by reducing bladder spasms/urge incontinence, such as in multiple sclerosis --> can also give solifenacin or tolterodine)

Treatment for urge incontinence (overactive bladder)

Oral fluconazole and topical azole

Treatment for vaginal yeast infection (caused by Candida albicans)

Amlodipine and nifedipine (dihydropyridine Ca2+ channel blockers: block voltage-gated L-type Ca2+ channels on VASCULAR smooth muscle to prevent muscle contraction and allow coronary vasodilation --> does NOT affect the heart as much as non-dihydropyridine Ca2+ channel blockers like verapamil --> also used to treat hypertension and Raynaud phenomenon --> side effects: gingival hyperplasia, peripheral edema, flushing , dizziness)

Treatment for vasospastic (Prinzmetal) angina

Lidocaine (class 1B antiarrythmic: can also use mexiletine --> decreases AP duration, thus decreasing absolute refractory period)

Treatment for ventricular fibrillation

Amphotericin B

Treatment for visceral leishmaniasis

Desmopressin (binds to V2 receptors on endothelium, which are Gs and cause release of cAMP to increase intracellular Ca2+ --> pushes out vWF and factor 8 stored in endothelium --> side effects: hyponatremia due to ADH inhibition at kidney CD)

Treatment for von Willebrand disease

Desmopressin (ADH analog: binds to V2 receptors on principal cells in kidney collecting duct to increase # of aquaporins and increase H2O absorption --> causes ↓plasma osmolarity and ↑blood volume --> prevents diuresis/urination at night --> ALSO pushes vWF and factor 8 stored in endothelium out into bloodstream --> side effects: hypovolemia, hyponatremia)

Treatment for von Willebrand disease, hemophilia A, central DI, and nocturnal enuresis

Flumazenil (competitive inhibitor at benzodiazepine receptor in GABA-A --> used to reverse non-benzodiazepine hypnotic sedation, although this rarely occurs due to less CNS depression --> rarely used since it precipitates seizures)

Treatment for zolpidem/zaleplon/eszopiclone toxicity

Zidovudine (ZDV: nucleoside reverse transcriptase inhibitor: REQUIRES PHOSPHORYLATION by viral kinases to become activated triphosphate --> incorporates into growing viral DNA strand, but lacks 3'-OH group so it terminates DNA chain to inhibit reverse transcriptase --> given to women at 14wks gestation and taken until 6wks post-partum to reduce risk of fetal transmission, REGARDLESS OF VIRAL LOAD --> side effects: mitochondrial toxicity, myelosuppression, ANEMIA, AGRANULOCYTOSIS)

Treatment given to HIV(+) pregnant and breastfeeding mothers to reduce risk of fetal transmission

Carotid sinus massage (increased pressure on carotid sinus causes stretch --> activation of afferent baroreceptor firing --> signal sent via glossopharyngeal nerve to solitary nucleus of medulla --> activation of PSNS --> efferent vagus nerve increases vagal tone on heart --> increased ERP/phase 3 repolarization in AV node --> decreased HR --> restoration of sinus rhythm)

Treatment of AVNRT (AV nodal re-entrant tachycardia)

Platelets (given to patients with thrombocytopenia or qualitative platelet disorders like Bernard-Soulier or Glanzmann thrombasthenia --> increases platelet count by ~5000)

Type of blood transfusion therapy given for significant bleeding

Irradiated packed RBCs

Type of blood transfusion therapy given to patients with SCID and severe anemia

Prednisone (corticosteroid: inhibit NFkB to decrease cytokine transcription and suppress B/T cell function --> also induces apoptosis of T cells and eosinophils --> anti-inflammatory effects decrease severity of inflammation and reduce excess extraocular volume --> side effects: Cushing syndrome, osteoporosis, avascular necrosis of femoral head, hyperglycemia and diabetes, peptic ulcers, amenorrhea, cataracts, psychosis, adrenal insufficiency)

Treatment of Graves ophthalmopathy

Chronic transfusions (risk of 2° hemochromatosis: each transfusion provides iron to the patient, but body has no method of iron elimination --> progressively increasing levels of iron can eventually lead to iron overload presenting with cirrhosis, diabetes mellitus, bronze skin, arthropathy due to Ca2+ pyrophosphate deposition, heart failure, hypogonadism --> histology shows brown pigment/hemosiderin deposits in hepatocytes and positive Prussian blue stain --> risk of HCC)

Treatment of beta thalassemia major

Imatinib (tyrosine kinase inhibitor of BCR-ABL, which is fusion protein formed by Philadelphia translocation t9:22, and c-KIT, which is common in many GI stromal tumors --> side effect: fluid retention)

Treatment of chronic myelogenous leukemia (CML) and GI stromal tumor (GIST)

PTU (propylthiouracil: blocks thyroid peroxidase--inhibiting oxidation of iodine AND organification/coupling of iodine-- as well as 5'-deiodinase to block peripheral conversion of T4 to T3 --> not really used to treat hyperthyroidism due to hepatotoxicity EXCEPT during 1st trimester pregnancy due to methimazole teratogenicity and risk of aplasia cutis --> prevents thyroid storm --> side effects: HEPATOTOXICITY, maculopapular rash, agranulocytosis)

Treatment of hyperthyroidism during FIRST trimester of pregnancy

Methimazole (blocks thyroid peroxidase, inhibiting oxidation of iodine AND organification/coupling of iodine --> normally used to treat hyperthyroidism in non-pregnant individuals, but is teratogenic/risk of aplasia cutis so can only be given during 2nd and 3rd trimester pregnancies to prevent thyroid storm --> side effects: agranulocytosis and aplastic anemia)

Treatment of hyperthyroidism during SECOND and THIRD trimesters of pregnancy

Eszoplicone (Lunesta: non-benzodiazepine hypnotics that binds to same BZ1 binding site on GABA-A receptor, but more specific for hypnotic effects and less likely to cause tolerance/physical dependence/addiction --> half-life of 5hrs used to treat both sleep onset/maintenance difficulty --> side effects: ELDERLY patients may experience excessive sedation, cognitive impairment, delirium, night wandering, agitation, central ataxia/increased risk of falls)

Treatment of insomnia for both sleep onset and sleep maintenance difficulty

Doxycyline (effective treatment against C. trachomatis, types L1-L3)

Treatment of lymphogranuloma venereum

Fast-acting carbohydrates (usually give 15-30g of oral carbs such as glucose tables, sweetened fruit juices, hard candy)

Treatment of mild hypoglycemia (anxiety, tremor, sweating)

UMP or uridine triacetate (bypasses defective UMP synthase to move along de novo pyrimidine synthesis)

Treatment of orotoric aciduria

TIPS (transjugular intrahepatic portosystemic shunt: shunt placed between portal vein and hepatic vein --> relieves portal HTN by bypassing liver and shunting portal circulation to systemic circulation --> side effect: hepatic encephalopathy, due to lack of blood detoxification)

Treatment of portal hypertension

Bosentan (endothelin receptor antagonist: competitive inhibition of endothelin-1 receptor on vascular smooth muscle in pulmonary arteries ---> vasodilation of pulmonary arteries --> side effect: hepatoxicity, so need to regularly monitor LFTs)

Treatment of pulmonary arterial hypertension (PAH)

IV glucose or IM glucagon (IV glucose: given in hospital settings, contains 50% dextrose --> IM glucagon: given in non-medical settings to increase hepatic glycogenolysis and gluconeogenesis to increase blood glucose, typically causes return to consciousness within 10-15mins of administration --> if IM glucagon not available, can give buccal/sublingual glucose or sucrose via glucose paste/cake frosting/sugar packets, but absorption of glucose from oral mucosa is slow/erratic and may be ineffective --> NOTE: oral glucose NOT recommended for unconscious patients due to risk of aspiration)

Treatment of severe hypoglycemia (unconsciousness)

IFN-beta (up-regulates MHC expression to facilitate CD8+ killing of infected/inflamed CNS cells --> side effects: flu-like symptoms, neutropenia, myopathy, profound fatigue, tinnitus, retinopathy, confusion/depression, pneumonitis, myelosuppression, drug-induced SLE --> NOTE: can also give glatiramer or natalizumab, aka alpha-4 integrins that block WBC adhesion)

Treatment to halt/slow progression of multiple sclerosis

Naltrexone (mu opioid antagonist given every few days to block effects of heroin --> also helps reduce cravings for alcohol/nicotine --> when combined with bupoprion, can help with obesity/weight loss)

Treatment to help maintain abstinence in heroin addicts

Vitamin A

Treatment to reduce morbidity and mortality from measles

Folinic acid (leucovorin: reduced form of folic acid that does not require DHFR to be converted to THR, therefore unaffected by methotrexate --> rescues bone marrow, GI, and other mucosal cells from MTX toxicity --> ALSO potentiates cytotoxic action of 5-FU by helping it bind to thymidylate synthesis --> used as supplement to REDUCE MTX toxicity and PROMOTE 5-FU action)

Treatment to reverse methotrexate toxicity

Testosterone (agonist at androgen receptors --> used to treat hypogonadism, promote development of 2° sexual characteristics, and stimulate anabolism to promote recovery after burn/injury --> side effects: masculinization in females, gonadal atrophy due to inhibition of LH and decreased intratesticular testosterone, premature closure of epiphyseal plates, increased LDL, decreased HDL)

Treatment to stimulate anabolism after burn/injury

Albuterol (short-acting B2 agonist/SABA: stimulates Gs protein on B2 receptors in bronchioles --> increased cAMP/decreased Ca2+ --> increased K+ conductance --> bronchodilation --> inhaled form has less cardiac effects due to going directly to airways --> side effect: hypokalemia, tachycardia, muscle tremor, high blood glucose)

Treatment used for acute asthma exacerbation

Packed RBCs (carry high Hb and high O2 carrying capacity)

Type of blood transfusion therapy given to patients with acute blood loss or severe anemia

Alteplase (t-PA: human recombinant tissue plasminogen activator that helps convert plasminogen to plasmin in order to cleave thrombin and fibrin clots --> promotes THROMBOLYSIS to break down active clots and restore arterial blood flow --> lab findings: elevated PT/PTT but NO change in platelet count --> side effects: severe bleeding that can result in intracranial hemorrhage/other internal bleeding --> CONTRAINDICATED in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding disorder, or severe hypertension --> reversal: anti-fibrinolytics, platelet transfusion, factor corrections with cryoprecipitate, FFP, PCC)

Treatment used to recanalize occluded blood vessels in acute MI, severe PE, and strokes

G-CSF and erythropoietin (granulocyte colony-stimulating factor such as Filgrastim used to treat neutropenia --> EPO analog such as Epoetin alfa used to treat anemia)

Treatment used to reverse bone marrow suppression

Oseltamivir/Zanamivir (Tamiflu: inhibits influenza NA glycoprotein to prevent release of progeny virus from host cell --> needs to be given within 48hrs of symptom onset, aka before the progeny have already been released)

Treatment/prevention for influenza A and B

Pentamidine (give prophylaxis to HIV/AIDS patients with CD4<200)

Treatment/prophylaxis for Pneumocystitis jirovecii in patients with sulfa drug allergy

Potassium iodide (saturates thyroid gland with stable non-radioactive iodine --> prevents ionizing radiation from causing hypothyroidism, thyroid nodule formation, papillary thyroid cancer later in life in people exposed to nuclear accidents)

Treatment/prophylaxis for radiation-induced damage to thyroid

Cimetidine and omeprazole (cimetidine: H2 channel blocker to decrease H+ secretion by parietal cells --> omeprazole: proton pump inhibitor that irreversibly inhibits H+/K+ ATPase in parietal cells)

Treatments for peptic ulcers/GERD that cause CYP450 inhibition

Hereditary spherocytosis and ITP (hereditary spherocytosis: defect in RBC membrane skeleton resulting in small round RBCs with no central pallor, removed by spleen and results in splenic work hypertrophy --> ITP: splenectomy will eliminate BOTH source of auto-antibodies against platelet Gp2b/3a AND site of platelet-Ab complex destruction)

Two indications for splenectomy

Myopathy and hepatotoxicity (increased risk of myopathy when combined with fibrates such as Gemfibrozil, bezafibrate, fenofibrate OR niacin)

Two major side effects of statins

Azathioprine and 6-MP (both normally metabolized by xanthine oxidase, so XO inhibition by allopurinol will increase these levels)

Two substances that are associated with increasing plasma levels of allopurinol

FFP and PCC (FFP: fresh frozen plasma that increases ALL coagulation factor and plasma protein levels --> PCC: prothrombin complex concentrate that only contains factors 2/7/9/10, protein C, and protein S --> side effects of blood transfusions: allergic/ABO reactions, iron overload, hypocalcemia, hyperkalemia, infection transmission)

Type of blood transfusion therapy given for DIC, cirrhosis, and warfarin reversal

Packed RBCs (contain increased Hb with high O2 carrying capacity --> increases SaO2)

Type of blood transfusion therapy given for acute blood loss and severe anemia

Cryoprecipitate (contains fibrinogen, factor 8, factor 13, vWF, and fibronectin --> side effects of blood transfusions: allergic/ABO reactions, iron overload, hypocalcemia, hyperkalemia, infection transmission)

Type of blood transfusion therapy given for hemophilia and fibrinogen deficiency

Fresh frozen plasma (FFP: contains all coagulation factors and plasma proteins --> can also give prothrombin complex concentrate/PCC: generally contains factors 2/7/9/10, protein C, protein S)

Type of blood transfusion therapy given to patients with cirrhosis or need to reverse anti-coagulation immediately

Cryoprecipitate (contains fibrinogen, factor 8, factor 13, vWF, and fibrinonectin)

Type of blood transfusion therapy given to patients with coagulation factor deficiencies involving fibrinogen and factor 8

Sulfasalazine (combo of antibacterial sulfapyridine + anti-inflammatory 5-ASA to inhibit inflammation, activated by colonic bacteria --> used to treat ulcerative colitis and colitis component of Crohn disease --> side effects: malaise, nausea, sulfonamide toxicity, reversible oligospermia)

Ulcerative colitis treatment associated with low sperm count

Anti-inflammatory (irreversibly inhibits COX1/COX2 to decrease synthesis of prostaglandins and TXA2 --> decreased PGs prevent activation of inflammatory cytokines IL-1/IL-6/TNF-alpha to prevent fever and hypotension --> side effects: gastric ulcers, tinnitus, allergic reactions, AKI/interstitial nephritis, Reye syndrome in children, overdose causes early respiratory alkalosis that then transitions into mixed metabolic acidosis-respiratory alkalosis)

Use of high-dose aspirin (2400-4000mg/day)

Antipyretic and analgesic (irreversibly inhibits COX1/COX2 to decrease synthesis of prostaglandins and TXA2 --> decreases activation of inflammatory cytokines IL-1/IL-6/TNF-alpha to prevent fever and hypotension --> also decreases pain pathways --> side effects: gastric ulcers, tinnitus, allergic reactions, AKI/interstitial nephritis, Reye syndrome in children)

Use of intermediate-dose aspirin (300-2400mg/day)

Decreased platelet aggregation (irreversibly inhibits COX1/COX2 to decrease synthesis of prostaglandins and TXA2 --> decreased TXA2 production prevents platelet aggregation --> increases bleeding time, but no effect on PT or PTT --> effects last until new platelets are produced --> given as prophylaxis for people at risk of blood clots, such as post-MI or post-DVT --> side effects: gastric ulcers, tinnitus, allergic reactions, AKI/interstitial nephritis, Reye syndrome in children)

Use of low-dose aspirin (<300mg/day)

Inhaled anesthetics (Halothane, Desflurane, Enflurance, Isoflurane: unknown mechanism, but these drugs have variable solubility/potency so various onset/offset speeds and MAC --> side effects: myocardial depression leading to hypotension/↓ CO, respiratory depression leading to ↓minute ventilation and hypercapnia, inhibited mucociliary elevator leading to post-op atelectasis, increased cerebral blood flow leading to ↑intracranial pressure, and malignant hyperthermia)

Volatile liquid compounds used for anesthesia induction

Low MAC (indicates a LOWER concentration required to prevent 50% of patients from moving in response to noxious stimuli --> therefore if you need less drug, the drug is MORE POTENT --> potency = 1/MAC)

What MAC value will an anesthetic have if it is highly potent?

Metabolism to active metabolites (morphine metabolized by liver/kidney/brain via conjugation with glucoronic acid --> ACTIVE form conjugated with 6th hydroxyl carbon --> these active metabolites can accumulate and cause opioid overdose during initiation of therapy)

What causes morphine overdose in elderly during initiation of therapy?

Acute migraines and cluster headache attacks (combine with NSAID for acute migraines --> combine with inhaled O2 for acute cluster headaches)

What is sumatriptan used to treat?

Increased neutrophils (artificial leukocytosis: due to demargination effect of corticosteroids --> push neutrophils OUT of infected tissue and into bloodstream, thus causing neutrophilia but increases risk of infection)

What is the hallmark of corticosteroid use on a CDC?

HLA-B*1502 (causes severe SJS/TEN when taking carbamazepine or phenytoin --> need to screen ASIAN PATIENTS before starting this drug)

What should be screened in Asian patients with partial seizures before prescribing carbamazepine or phenytoin?

HLA-B*5801 (causes severe hypersensitivity skin reaction such as SJS/TEN when taking allopurinol)

What should be screened in Han Chinese/Thai patients and Korean patients with CKD before prescribing allopurinol for chronic gout?

Low-dose aspirin (low-dose salicyclate: will DECREASE uric acid excretion in kidney PCT --> therefore more uric acid will be absorbed, exacerbating hyperuricemia and gout)

Which NSAID is contraindicated in an acute gout attack?

Maraviroc and enfurvirtide (fusion inhibitors: maraviroc blocks gp120 to inhibit viral docking on CCR5-positive T cells and macrophages --> enfurvirtide blocks gp41 to inhibit viral entry --> since gp41/gp120 are encoded by ENV GENE instead of pol gene, they would NOT be affected by mutant pol gene, which would form resistance against NRTIs, NNRTIs, protease inhibitors, and integrase inhibitors)

Which anti-HIV drugs would still be effective in HIV strains with mutant pol gene?

Daptomycin

Which antibiotic cannot be used to treat pneumonia due to inactivation by surfactant?

Low blood solubility (since they are less soluble in blood, they have a smaller "blood reservoir" so it takes less time to reach the brain --> more rapid anesthesia induction and offset --> will have STEEP arterial tension curve --> example: nitrous oxide)

Which characteristic of an anesthetic allows it to have fast induction/recovery, but low potency?

High blood solubility (since they are more soluble in blood, they have a larger "blood reservoir" that needs to fill before it reaches the brain --> slower anesthesia induction and offset --> will have LESS STEEP and more linear arterial tension curve --> example: halothane, propofol, thiopental)

Which characteristic of an anesthetic allows it to have slow induction/recovery, but high potency?

Class II (beta-blockers: inhibits autonomic warning signs of hypoglycemia such as tachycardia, tremor, palpitations --> non-selective beta-blockers also block B2 receptors in liver to inhibit gluconeogenesis and glycogenolysis, and blocks B3 receptors in adipose tissue to block lipolysis thus exacerbating hypoglycemia --> selective B1 blockers/beta-blockers with intrinsic agonist activity are preferred for DIABETICS due to minimal effect on glucose metabolism/adrenergic symptoms)

Which class of anti-arrhythmics can mask the signs of hypoglycemia?

Elderly (decreased total body water + decreased total body mass + increased body fat --> cause slowing in drug elimination with age --> increased drug half-life --> increased likelihood of toxicity)

Which demographic has increased volume of distribution for drugs?

Asthma or COPD (opioid agonists cause dose-dependent respiratory depression due to inhibition of breathing centers in brainstem, leading to hypoventilation and increased PaCO2 --> since asthma/COPD patients already have compromised respiration, addition of opioids could lead to fatal respiratory impairment)

Which diseases would prompt you to give opioid analgesics with caution?

Digoxin (cardiac glycoside that directly inhibits Na+/K+ ATPase on cardiac myocytes --> indirectly inhibits Na+/Ca2+ exchanger in myocardium to INCREASE intracellular Ca2+ and increase contractility --> also stimulates vagus nerve to increase ERP and decrease conduction at AV and SA node, thus decreasing HR --> used to treat chronic systolic HF and AFib --> side effects: hyperkalemia, arrhythmias such as PVC, bradycardia and AV node block, nausea/vomiting, abdominal pain, diarrhea, delirium/confusion, yellow-tinted vision --> contraindications: hypokalemia, renal insufficiency, and patients taking beta-blockers, verapamil, diltiazem, amiodarone, quinidine)

Which drug causes "scooped" concave ST segments on ECG with long-term use?

Rifampin (should use rifabutin instead for patients taking protease inhibitors such as Atazanavir, Darunavir, Lopinavir, Ritonavir)

Which drug induces CYP/UGT enzyme, thus decreasing plasma levels of HIV-1 protease inhibitors?

Allopurinol (xanthine oxidase inhibitor --> XO normally metabolizes 6-MP due its structural similarity to xanthine, but if inhibited by allopurinol, there is decreased 6-MP metabolism --> increased 6-MP levels --> therefore you need to LOWER 6-MP dose with allopurinol)

Which drug, when added to a regimen of 6-MP, would require LOWER doses of 6-MP?

Beta-blockers, quinidine, amiodarone, verapamil, diltiazem (beta-blockers: also decrease SA/AV node conduction so increase risk of heart block --> quinidine: class IA antiarrhythmic/Na+ channel blocker that decreases renal clearance of digoxin --> amiodarone: class III antiarrhythmic/K+ channel blocker that decreases renal clearance of digoxin --> verapamil and diltiazem: class IV antiarrhythmic/non-dihydropyridine Ca2+ channel blockers that decrease renal clearance of digoxin)

Which drugs are considered contraindications for digoxin use?

Magnesium and calcium (PPIs such as omeprazole, lansoprazole, esomeprazole, etc: irreversibly inhibit H+/K+ ATPase in parietal cells --> inhibit H+ secretion into gastric mucosa --> used to treat peptic ulcers, gastritis, GERD, Zollinger-Ellison syndrome, part of H. pylori therapy, stress ulcer prophylaxis --> side effects: C. diff infection, pneumonia, acute interstitial nephritis, decreased absorption of divalent cations Ca2+/Mg2+/Fe2+, low serum Mg2+ and Ca2+ causing increased risk of falls in elderly --> elderly patients should be given Ca2+ supplements and have bone density monitoring)

Which electrolytes need to be monitored when starting proton pump inhibitor therapy?

Beta-blockers (decrease contractility and conduction/HR --> decrease CO --> results in peripheral vasoconstriction and cold hands/feet)

Which hypertension medication is associated with cold extremities?

Hydralazine (selective arteriolar vasodilator that reduces afterload, but cases baroreceptor stimulation and subsequent SNS activation --> results in reflex tachycardia, increased contractility, and increased CO which would exacerbate angina/CAD --> can co-administer with beta-blockers to prevent reflex tachycardia)

Which hypertension medication is contraindicated in patients with angina/CAD?

Buprenorphine, nalbuphine, butorphanol, pentazocine (mixed mu agonist/antagonist: usually works as an opioid agonist, but can precipitate opioid withdrawal symptoms when given to someone taking a full mu agonist such as morphine/meperidine --> due to competition at opioid receptor)

Which opioid drugs can precipitate withdrawal symptoms if given immediately after chronic opioid use?

Coronary artery disease or vasospastic angina (Sumatriptan: 5-HT1B/1D agonist that inhibits activation of trigeminal nerve, meningeal vessels, and brainstem --> inhibits release of vasoactive peptides to induce vasoconstriction --> used to treat acute migraines and cluster headache attacks --> side effects: CORONARY VASOSPASMS, mild paresthesia, serotonin syndrome)

Which patient population is contraindicated for sumatriptan use?

Cough and angioedema (thus, ACE inhibitors contraindicated in hereditary angioedema/C1 esterase inhibitor deficiency)

Which side effects of ACE inhibitors are mediated by increased bradykinin?

Calcium and vitamin D (also regular bone density monitoring is recommended due to high risk of osteopenia --> phenytoin is narrow-spectrum anti-convulsant that promotes Na+ channel INACTIVATION --> used to treat partial seizures and SECONDARY tonic-clonic seizures --> zero-order kinetics: rate of elimination is constant and does not depend on/vary with diff drug dose or plasma concentration of drug, so very narrow therapeutic index --> side effects-PHENYTOIN: CYP450 induction, hirsutism, enlarged gums/gingival hyperplasia, nystagmus, yellow-brown skin, teratogen, osteopenia, inhibits folate absorption, neuropathy --> rarer side effects include SJS/TEN, DRESS syndrome, drug-induced lupus, diplopia/ataxia/sedation)

Which supplements are recommended in patients taking phenytoin?

Potassium and magnesium (amphotericin B causes distal tubular renal acidosis, aka inability of alpha-intercalated cells to secrete H+ so no new HCO3- generated --> causes hypokalemia --> increases risk for Ca2+ phosphate kidney stones due to basic urine pH)

Which supplements should be given with amphotericin B to renal tubule alterations?

PFTs, LFTs, and TFTs (pulmonary function tests, liver function tests, and thyroid function tests: amiodarone is a class III anti-arrhythmic that blocks K+ channels to increase ERP and prolong AP duration --> MANY side effects, including pulmonary fibrosis, hepatotoxicity, and hypo- or hyperthyroidism --> also cause corneal deposits, photodermatitis with blue-gray skin discoloration, constipation, and CV depression)

Which tests should be monitored while taking amiodarone?

PCI (percutaneous coronary intervention: putting a balloon catheter into blocked coronary artery to relieve narrowing, and then placing a stent to keep blood vessel open --> preferred over fibrinolysis due to lower rates of intracerebral hemorrhage and recurrent MI)

Which treatment is recommended for patients with acute MI who present within 12hrs of symptom onset?

Lithium and amiodarone (lithium: unknown mechanism used to treat bipolar disorder, SE include hypothyroidism + nephrogenic DI + tremor + Ebstein anomaly in newborns --> amiodarone: class III anti-arrhythmic that blocks K+ channels to increase ERP and AP duration, SE include pulmonary fibrosis + hepatoxicity + thyroid anomalies + corneal deposits + photodermatitis/blue-gray skin deposits + constipation + CV depression)

Which two drugs often require a thyroid function test before starting therapy?

Miosis and constipation (therefore patients on prolonged opioid therapy should be given a prophylactic bowel regimen --> increased fluid intake, fiber, laxatives, etc. to minimize constipation)

Which two effects of opioid analgesics do patients NOT develop a tolerance to?

Live attenuated (contains live versions of measles virus, mumps virus, and rubella virus)

Which type of vaccine is MMR?