Sketchy Pharm systems

Loop diuretis

(Loop de loop oh henle), *thick ascending LOH* (roller coaster goes up), *sodium/pottasium and 2CL cottransporter* (worker taking peanuts, bannanas and 2 chloride packets from kids on ride), *impermeable to water* (place for water bottles in car), furosemide: sulfur drug (stinky sulfa eggs) (furious kid), *blocks NKCL ct, keeps sodium in lumen, an causes naturesis* (furious kid clinging to his food), *excretion of magnesium and calcium* (another furious kid has magnets and calci-yum ice cream), induce expression of COX-2-> *synthesizing prostaglandins that enhance salt secretion* (pro-slugger is furius), dilates afferent arteriole -> enhances diuresis (*slugger opens afferent path -to ride), *NSAIDS decrease prostaglandin synthesis* (slugger inhibited by fire extinguisher), 1st line for decompensated HF with fluid overload (failing heart balloon), 1st line for crackles in lungs (guy with wet lung life-jacket), treat *ascites* (inner tube and yellow shirt), *hypokalemia*, *hearing loss* (loud gong on coaster track). S.E's: *interstitial nephritis* (kidney filled with blue tickets), *hyperurecemia-> gout* (knitting needles= needle shape uric acid crystals), *contraction alkalosis (due to fluid loss and accumulated pH ex. vomiting) ethacrynic acid: (employee ethics sign) -> *not sulfa drugs*

Barbiturates

(barber shop) -Phenobarbital, pentobarbital, thiopental, secobarbital. -mech: allostericly bind to GABA (cab-A)(differently than benzos)(increase opening times) -> chloride channel -> inhibitory (*dec neuron firing*) -> *long duration* (long tapering flag) -S.E's: induce CYP450, *SEVERE respiratory/cardiac depression* (collapsed heart and lung t-shirt), hypotension (fainting), coma/CNS depression (brain hair dryer), tolerance (all are welcome), addiction (addicted to curls) -*C.I in porphyria* (low heme -> crushed RBC's -> red car) Types: 1) thiopental (tall barber) -> *anesthesia/insomnia* (intubated/asleep customer), IV, rapid onset/short duration- highly lipid soluble (ol quick shave) 2) phenobarbitol (falling worker) -> IV use, use = *seizures* (jackhammer), *FL in neonates - phenobabytal* (young kid in car) 3) primidone (perm is done) - essential tremor (tremoring hand),

Blood/inflammation: Heparin, LMWH, fondaparinux, direct thrombin inhibitors, Xa inhibitors

(beaver damn = fibrin clot, thrombeaver), *thrombin transforms fibrinogen into fibrin* (thrombeaver preparing stick), *factor 2 = thrombin* (beavers 2 teeth), (factor X = foX), *factor 10 converts prothrombin into thrombin* (fox waking up beaver), Heparin: (heppy hunting), *unfractioned heparin binds antithrombin 3* (trap with 3 shaped bars) -> *irreversibly inactivates thrombin and factor 10* (trapped beaver and fox), *monitor PTT* (birdwatching father- bird makes PTTTT sound), PTT = intrinsic (bird inside tree), *also used for DVT* (illiofemoral river), *tx for pulmonary embolism* (birds nest on ischemic branch of lung tree), *tx for acute MI* (broken heart strings), *IV heparin for MI/PE/DVT* (ivy on tree), *s.e's: heparin induced thrombocytopenia (HIT)- IgG against heparin bound to platelet factor 4 (PF4)* (shooting 4 clay plates/broken plates), HIT causes paradoxical thrombocytopenia, *hypoaldosteronism/hyperkalemia* (depleted mineral mine, big K over mine), *osteoperosis* (termite damage on tree), *reversal = protamine sulfate* (protected area deterring hunter), LMWH: *parin* drugs -> (enoxaparin, dalteparin) (heppy hunter daughter), *binds antithombin 3/inhibits factor 10 only* (3 bar cage with fox only), *2-4x longer half life than heparin* (long tapered flag on kidney shaped rock), *safe for pregnancy -> no labs needed/can be subQ* (heppy pregnant mother), less likely to cause HIT (intact clay plates), *Fondaparinux*: (fido with a pair of foxes), *binds anti-thrombin 3 with higher specificity than LMWH* (fido with two fox cages) - affects factor 10 only, *lowest risk of HIT* (fido isnt even shooting plates) *direct thrombin inhibitors: Bivalirudin* (no intrudin sign/gator about to eat thrombeaver), *Argatroban and dabigatran* (big gator), related to leech anticoagulant (leeches on gator), only oral agent in class (gator mouth open), reversal with idarucizumab. direct factor 10 inhibitors: *rivaroxiban, apixaban* (banned foxes cage- all have Xa in name), *oral medications* (open mouth), *use: long term anticoagulation- A-FIB* (irregularly irregular TV screen)

Allergy: Antihistamine

(beehive- hissing bees),

Cladribine, cytarabine, gemcitabine

*all inhibit DNA polymerase* (cracked replication fork on map) and S phase of cell cycle (Stone phase) Cladribine: (clad in bear skins), *purine analog* (purine shaped hammer- 2 rings), *treats hairy cel leukemia* (hairy caveman), S.E's: myelosupression, immunosupression, Cytarabine/Gemcitabine: (saber tooth tiger and gem rock), *pyrimidine analog* (pyrimidine dots on tiger- 6 sides), hematological malignancies (B and T cell type (AML/non hodgkins), scratched out antibody archers and T cell swordsman),

Antiplatelet agents

(clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine) *Clopidogrel, ticagrelor, prasugrel - grel suffix (hot dog grill) and ticlopidine: (ty cobb jersey on griller)* mech: *irreversible binding to P2Y12 ADP receptor* -> prevents 2b/3a expression on platelet surface (grill man catching baseball, *youth ball 2-12 sign)* uses: *ACS/coronary stenting* (corked bat), prevents stroke (black paint stroke) s.e's: *granulocytopenia w/ ticlopimide* (ty cobb griller w/ granule hour glass), TTP (broken plates) *Dipyradimol/cilostazol (two pyramids/lost the ball)*. Mech: *phosphodiesterase inhibitors (don't foster disinterest -> inc cAMP* (sign in for camp) uses: stroke/TIA prevention- combined with aspirin (aspirin umpire in charge of camp) s.e's: *vasodilation/facial flushing* (ump has red face), abdominal pain (ump with body protector) abciximab (abc broadcaster), eptifabatide/tirofiban (tied game). Mech: *blocks 2b/3a* (abc broadcaster) -> *monoclonal Fab fragments* (microphone = Fab shape), s.e = bleeding/thrombocytopenia (broken plates, ketchup on clock) extra: damaged vascular epithelium exposes collagen and vWF (peeling von willenbrand field), *vWF binding to GP1b activates platelets* (kids holding 1b bat), (home plate = active platelet degranulation) *platelet formation factors = ADP, 5HT and TXA2* (agregate da players, happy face helmet), *COX-1 synthesizes prostanoids, TXA2 from AA* (coach cox, AA minor league dugout), *TXA2 causes vasoconstriction* (coach cox twisting hat), good for

Vasoactives/SM: Nitrates:

(dynamite), antianginal therapy (anvil), release NO -> inc cGMP (grump) -> myosin chain dephosphorylation/relaxation, need high dose for artery dilation - *mostly venous dilation* (modestly dilated red sleeves), dec preload, uses: stable angina/prinzmetal, ACS, *avoid in Right MI* (no right sign), pulmonary edema, *sublingual administration* (folded shoe tongue), types: *isosorbide mononitrate/dinitrate* (single/double nitro stick), IV nitro for emergency, S.E's: hypotension, reflex tachy (tx = beta blockers), headaches/flushing, *methemglobinemia* (oxidized iron wheels), tolerance issues - give nitrate free intervals - "monday disease", CI = *PDE-5 inhibitors/sidenafil* (coal filing station sign) and HCOM (hypertrophic onstructive cardiomyopathy)

HTN drugs

(high pressure pipes), *if BP 20/10 > goal: need 2 HTN meds* (20lbs over need 2 lifejackets), primary HTN (primary deck): hydrochlorothiazide (color thighs on high dive), *elderly and AA respond well to CCB* (elderly AA with calcium ice cream), *dihydropyridines* (dippin pool), *ACE inhibitors - first line if HF, diabetes or MI* (ace dealer, candy, broken string), HTN emergency (emergency shut off): *180/120 + end organ damage* (hole in titanic), *IV beta blockers (ivy) -labetalol* (alpha and beta organ stops), S.E's: hypotension and *increase renin levels* (rain umbrella), calcium channel blockers - ex. nicardapine or clevidipine (calcium ice cream on emergency boat; nice card; clover), *hydralazine - safe in pregnancy: reflex tachy/can worsen angina- give w/ beta blocker* (hydro-boat; pregnancy women; anvil), S.E's: *lupus* (lupus wolf), nitrates + hydralazine = *nitroglycerin: for HF - increases cGMP* (failing heart ballon, grump in water), S.E's: *cyanide poisoning* (blue exhaust), *fenoldapam* (old lady pam) - *dopamine 1 agonist -> inc cAMP* (single rope, camping tent) -> arterial/coronary dilation -> *increases renal perfusion -> naturesis * (rope connected to kidney, falling peanuts)

Colestyramine, ezetimibe, evolocamab,

(import and export of lipoproteins), S.I = site of cholesterol and bile acid absorption, bile acids are released into the intestinal lumen (sea"gall" droppings), liver turns cholesterol into bile acids (liver station worker loading sea"gall") -> and secretes into the biliary tract (seagall exiting liver station), 95% of bile recycled back to liver (entero-hepatic circulation, seagull droppings back at liver station), bile acid resins prevent recycling of bile acids to liver (seagull droppings sweeper) -> ex's: cho"lobster" amines (cholestyramine, cholestipol, cholesevelam), mech: *interrupt bile acid recycling and promote synthesis of new bile acids* (depletes liver stores, empty gold stores) -> causes HMG-coA reductase to synthesize more cholesterol (activated crude ore reducer), upregulate LDL receptors/uptake of LDL, *increases VLDL -> hypertriglyceridemia* (cho-lobster scaring away airship), S.E's: cholestural gallstones (seagall stones), constipation/bloating, low vitamin absorbtion A,D,E,K (DEcK A), *decrease statin absorption* (lobster and statin punk clashing), Ezetimibe: (Z shaped eel), *blocks intestinal absorption of cholesterol* (blocking gold delivery at intestine base), blocks livers access to cholesterol (empty chest delivery) -> causes HMG-coA to make more cholesterol (activated crude ore reducer), *up regulation of LDL receptors -> dec circulating LDL* (sunken LDL ship), S.E's: diarrhea (oily water), *inc LFT's*, Evolocamab = antibody (octopus with antibody shaped claws), *PCSK9 inhibitor* (octoPUS man) -> *prevents LDL receptor degradation* (PCSK9 usually causes LDL receptor degradation - Pesky 9 crabs inhibiting Load L workers) -> *causes increases uptake of circulating LDL*

Fibrates, niacin, fish oil

(lipo port house; VLDL -> VDL and free fatty acids) Fibrates (gem fibrozil jellyfish): *fib suffix*, *activate PPAR alpha -> up regulate LPL* (lighthouse worker lighting newsPPAR), decrease serum triglycerides (trident passengers escaping airship), *dec VLDL* (jellyfish attacking VLDL ship) -> decreases LDL (jellyfish sinking LDL ship), increase HDL (elevated high density ship), S.E's: myopathy (elevated crispy chicken), cholesterol gallstones (seagull stones), niacin (loch niacin monster): *most effective for increasing HDL* (raised HDL ship), decreases serum triglycerides/VLDL, S.E's: *flushing/warmth due to prostaglandins (furnace and pro slugger) - tx = NSAIDS* (fire extinguisher), hyperglycemia (elevated candy), hyperuricemia (yellow knitting needles), *raised LFT's * (raised flag), fish oil (omega fish): *can lower serum triglycerides* (sunken tridents), from dec VLDL.

Cyclophosphamide, ifosfamide, busulifan, nitrosureas (carmustine, lomustine, streptozocin)

*all are alkylating agents- cell cycle NON specific* (cross linking ankle chains, donate an alkyl group) Cyclophosphamide: (cyclops), *activated by cytochrome P450* (hepatic enzyme, chrome bumper on horse), heme and solid tumors (torn cancer crab), immunosuppressive therap* (torn antibody lights, ex. autoimmune conditions), *coadministration of mesna prevents hemmorhagic cystitis* (protective maze), S.E's: myelosupression, increases risk of *bladder cancer/red urine* (crab belt buckle/statue urinating red), *hyponatremia/SIADH* (ADH helmet), *infertility/premature menopause* (dried up fruit tree), Busulfan (beautiful sirens), *used prior to bone marrow transplant* (severely depleted pile of bones), S.E's: *lung toxicity* (fibrotic lung on shirt), *hyperpigmentation/tan - "busulfan tan"*), tan siren sounders), Nitrosureas: (centaurs), *mustine suffix and streptomycin* (mustang and stripped zebra), *cross BBB- treat brain tumors* (brain tree), S.E's: neurotoxicity

Statins

(liver station -> import and export of lipoprotein transporters), *cholesterol esters are packaged into interior of cholymicrons, which deliver from intestines to peripheral tissue* (lumen of small intestine, gold bars = cholestural, hot air balloons = chylomicrons), *triglycerides make up most of the cholymicron* (trident passengers) -> have *surface proteins A,B,C,E* (E shaped flag), at tissues -> *hydrolyzed by lipoprotein lipases* (LPP = lipo-port lighthouse), *free fatty acids used for energy by heart/skeletal muscle* (muscle shells) -> or converted back to triglycerides and stored as fat (adipose sea foam), LDL receptor (LoaD L): *binds to Apo-E and transports cholymicrons into liver -> cholesterol remnants used by liver* (endocytosis, pulling in E shaped flag), *HMG-coA reductase synthesizes cholesterol in liver* (hmg crude or reducuer), *first intermediate = mevalonic acid* (evaluator), VLDL: (very low density lipoprotein airship), *triglycerides make up most of VLDL* (trident passengers on ship), *B100 is on bad protein* (LDL/VLDL; B shaped anchor), *deliver from LIVER to peripheral tissue*, *LDL formed as VLDL looses triglycerides from LPP -> LDL's contain core of cholesterol esters* (ship with chest cargo from lighthouse on way to LDL receptor) -> LDL binds ApoB -> endocytosis. HDL: (high density submarine), *extracts cholesterol from peripheral tissue* (deep sea diver collecting gold bars), *LCAT converts free cholesterol into cholesterol esters for HDL* (Load CATch) -> *transfers cholesterol esters to LDL/VLDL for transport back to liver via Scavenger-1 receptor* (scavenger 1 dock), Statins: (steampunk pirate), *inhibit HMG-coA reductase* (knocking over HMG crude ore reducer), increase LDL receptors on hepatocytes -> *clears LDL from circulation* (statin punk threatening to pull in LDL ship), most effective drugs for lowering LDL (30-60%; sinking LDL ship) -> decreases triglycerides (kicking off trident passenger), *increase HDL* (raising HDL submarine), uses: hypercholestrolemia, heart disease/MI in diabetics (yellow coronary crown, broken heart strings, candy), S.E's: teratogenic (tarantula), *myopathy/elevated CK* (crispy chicken bite), *increased LFT's* (raised LFT flag), metabolized by CYP-450 (chrome tank) -> *except pravastatin* (privileged)

Triptans/migranes

(pounding head), migrane due to activation of trigeminal nerve (trigem hat) -> release of vasoactives (vaso sleeve), Triptans: *sumotriptan* (sumo wrestler) -> migrane/cluster headache (lantern cluster) treatment, mech: *5HT-1b/d agonists* (b and d shaped fingers/smiley face) -> cause vasoconstriction and affect *brain stem* -> inhibit pain pathways (hair stem), CI = *angina* -> can trigger printzmetal angina (anvil medals), Other: Nsaids, calcium channel blockers, beta blockers, *valproic acid* (festival pro sumo), *topiramate* (toupe), TCA's (bike)

Ethosuximide

(seize the day), (Ethos circled) uses: *FL for absence seizure* (teacher reading absences list): *lapse in awareness w/ starring/blinks or jerks* (inattentive student), -dx = *3 spiked wave on ECG* (3 spikes/strikes sign), -mech HY: *blocks calcium channels -> T type* (closed calcium chocolate milk and T-thermus), -S.E's: GI distress (punched in stomach), lethargy/fatigue (sleeping student), *valproate/lamotrogine also effective against absence seizure, but second line* (festiVAL banner and lama),

Valproate, topiramate, lamotrigine, levetiracetam

(seize the land) - anti seizure meds, uses: *arm shaking* (focal arm shaking), generalized shaking, *juvenile myoclonic epilepsy* (juvenile shaking arms), valproate (welcome vestiVAL): *blocks sodium channels* (inactivated sodium peanuts), *inc GABA* (elevated cab), S.E's: Gi distress, inc apeitite/weight gain (fat belly king), *tremor* (trembling weapon), *hepatotoxicity/pancreatitis* (liver spot, pancreas sponge), *teratogenic* (tarantula), topiramate (toup'e stuck in hat): *inc sodium inactivation* (inactivated peanut basket), *inc GABA action*(shaking hands with cab driver), S.E's: *urolithiasis* (kidney cannon balls), *somnolence/fatigue* (tired soldiers), *confusion/cognitive slowing* (scratching head), *weight loss* (thin arm), *acute angle glaucoma* (high pressure eye kettle), lamotrogine (llama): increases sodium channel inactivation -> *inhibits glutamate release*(inactivated peanut basket and glue), -S.E's: *stevens johnsons syndrome -> must titrate slowly* (sloughed off red mask), [diplopia (cross eyed llama)] levetiracetam (elevator): S.E's: *neuropsychiatric* -> somnolence/personality change/headache (sleeping on the job)

Carbamazepine, phenytoin, gabapentin, tiagabine, vigabatrin

(seize the night) -> uses: focal seizures, carbamazepine (classic car): sodium channel inactivation (dropped sodium chips), -use: *FL for trigeminal neuralgia* (three gems), *partial seizures -FL- and tonic/clonic* -S.E's: ataxia, diplopia (car lights crossed), *SIADH* (wet head), *agranulocytosis* (sand timer), *DRESS syndrome- eosinophila and distress syndrome* (eosinophilic distress), *teratogenic - cleft lip, spina bifida* (terantula shirt), *neural tube defects - spina bifida* (neural exhaust tube), *steven johnson syndrome* (red mask), *induces cyp-450* (activated chrome bumper) Phenytoin (tow truck): inactivated sodium channels, -S.E's: ataxia (unbalanced burger stack), diplopia, *folate deficiency -> megaloblastic anemia (spilling salad*), gingival hyperplasia (expanding gum), *hirtuism (bushy beard)*, *lupus* (wolf), *DRESS syndrome* (eosinophilic dress), *yellow/brown skin* (yellow windshield of car), *SJS* (red mask), teratogenic - fetal hydantoin syndrome, *decreased bone density* (osteoporotic axle), *induces CYP450*, -uses: *status epilepticus - FL for recurrent seizures (order status sign) -> first line for acute attack are benzodiazopines (ben's diner sign) Gabapentin (grab a pint)(GABA analog): *blocks calcium channels* (calcium ice cream truck) -uses: *peripheral neuropathy/fibromyalgia* (chronically frayed wire/fiber bars), *diabetic neuropathy* (sweets on cart), *post-theurapeutic neuralgia* (zeus/VZV bolt), S.E's: ataxia/dizziness/sedation (unbalanced scoops) Tiagabine/Vigabatrin (cab shop) -> *inc GABA* (cab is raised), -mech: 1) vigabatrin: inhibits *gaba transaminase* (V cab transmission) -> (inc GABA) -S.E -> *permanent visual loss* (block box warning)(headlights off on cab) 2) tigabine: inhibits *GABA reuptake* (tied up cab driver)

Azathioprine, 6- mercaptopurine, allopurinol, mycophenolate mofetil

*PRPP precursor to IMP* (pentagon pedestal with 3 phosphate hammers), IMP is converted to AMP and GMP (GArgoyle *imp*), Azathioprine/6Mercaptopurine (6MP): (azamerelda CAPtured) -> prodrug of 6 mercaptopurine, *HGPRT activates 6MP* (high priest prodding captive), *AZA/6MP blocks synthesis of IMP* (azmerelda kicking over IMP gargoyle statue), (stairs up = block S phase), useful for *immunosupressive therapy* (torn antibody), can treat RA as dmard (hanging RA light), *treats inflammatory bowel disease* (inflamed lanterns in line like colon), S.E's: myelosupression, immunosupression, *pancreatitis and hepatitis* (pancreas sponge and liver stain), Allopurinol: (pure nun), *xanthine oxidase inhibitor* (for gout; nuns with *gout needles/knitting*), increased levels of purine analogs (ex. purine beads), mycophenolate mofetil (quasi mofetil), *IMP dehydrogenase inhibitor and dec GMP*/dec lymphocytes (quasi knocks over Grumpy statue), immunosupressive therapy, RA therapy, S.E's: *GI distress* (nauseated quasi) or immunosupression

Vincristine, vinblastine, paclitaxel

*block M phase of cell cycle- microtubule assembly* (M shape in vines) Vincristine: (christine in vines), vinca alkaloid, *inhibit microtubule production and assembly* (christine breaking vines), S.E's: *neurotoxicity* (glove and stockings on christine), *autonomic dysfunction - constipation* (monkey with plunger), alopecia, myelosupression, Vinblastine: (man blasting vines from gun), heme malignancies, Taxanes (paclitaxel): (tarzan), cytotoxic plant alkaloids, *enhance microtubule production/prevent degradation* (microtubule overproduction = dysfunction; monkey stabilizing the vine),

Imatinib, erlotinib, sorafenib, sunitinib, vemurafenib

*nib suffix = kinase inhibitors* (kiNase InhiB's; broken nib on pen), *tinib suffix = tyrosine kinase inhibitors* (t + nib; inhibited tire swing), imatinib: (imitating), heme malignancy tx (*CML* - pink/white/and blue granules), *blocks BCR-ABL in CML- 9:22 translocation* (breakable sign on box, 922 chestnut street), blocks *c-kit tyrosine kinase of GI stromal tumors* (congress kit; crab buttons on belly), S.E's: *fluid retention/edema* (ankle/periorbital edema), erlotinib: (british earl), *blocks epidermal growth factor* (earl Geoffrey), treats solid tumors (crab bandage lapel), S.E's: *pustular/aceneoform rash* (spotty rash), *diarrhea* (muddy pants), suntinib/sorafenib: (rising sun/soaring eagle), *inhibit VEG-F* (inhibiting/swinging at vegetables), S.E's: *hyperkeratosis/skin rash* (callused and sunburned worker), *hemorrhages* (bleeding worker), vemurafenib: (venom; ben franklin drawing snake), *blocks BRAF kinase* (B-FRAnklin), treats BRAF + melanoma

H2 receptor blockers, PPI's

*parietal cells -> acid secretion* (pour it all lemonade) via *H+/K+ ATPase on the lumen* (battery powered puree pump - banana in/lemons out), ATPase = 3 phosphpates, (sidewalk = lumen), *histamine activates H2 receptors on the parietal cell* (bees swarming honey pot) -> receptors on the basolateral membrane -> *increase H+/K+ ATPase -> increases acid secretion* (honey kid nocking over lemonade) Enterochromafin like cells (ECL's; enter carefully): *release histamine* (bees released from ECL tree), *due to gastrin stimulation from G cells* (gas powered blower; Gas trunk with Gas tanks) or *vagal nerve stimulation- M3 Ach receptors (M3 motorcycle spot) on parietal cells -> gastrin release via GRP* (vagus sticker on M3 bike and Gas truck; gate release pull), histamine 2 antagonists (2 bee swatters): *inhibit acid secretion from parietal cells*, Ex's: *tide* suffix (tie dye shirt), uses: GERD (gargling guy), *gastric/duodenal ulcers* (ulcerated sidewalk), *cemetidine* (tie dye kid hand prints in cement) -> antiadrenergic side effects -> *inhibits CYP-450* (chrome bumper), S.E's: *gynecomastia* (pot lids on chest), impotence, elevated prolactin (drooping wand, milk from mouth), PPI's: *inihibt K+/H+ ATPase -> H+ secretion* (girl scout blocking puree pump), Ex's: *prazole* suffix (prize sign), uses: gastrinoma/zollinger ellison syndrome (jumbo gas tank), H-pylori (helicopter hat), S.E's: C. diff infection (chocolate fountain), respiratory infections (dirty lung spots),* decreased ca/mg/Fe absorbtion* (medals on wagon; falling magnets) -> hip fractures/osteoperosis (fractured axel, porous wood

Cisplatin, carboplatin, oxaliplatin, amifostine

*platinum drugs* (all platin suffix, platinum jewelry store, *crosslink strands of DNA* (cross linked helix necklace), treat solid malignancies (crumpled crab bag), S.E's: *ototoxicity* (gong earrings), *peripheral neuropathy- stock and glove* (neuropathic gloves), *nephrotoxicity* (kidney purse*, acute tubular necrosis - *muddy CASTS* (muddy drain tube), myelosupression/immunosupression *Amifostine*: (rare amethyst with purchase), *PREVENTS nephrotoxicity- scavenges free radicals* produced from the kidney (Free, rare Amethyst), Saline fluids: can also prevent nephrotoxicity

Glucocorticoids

*stone* suffix (moon face = glucos) -cortisol is released from adrenals, *gluco receptor located in cytoplasm -> then enters nucleus and txn factor* (septer in outer circle and then moves to inner) -mech: inhibits *phospholipase A2* (cataPuLt-A2) -> *prevents AA formation* (AA frame of catapult), prostaglandins by COX (pro slugger bat), leukotrienes by LOX (lacrosse stick), NF-KB (N-flame KrossBow) -> prevent activation of T and B cells, and lymphocytes (inhibited night and archer, first responders stuck on outside, falling eo slingshot) use: gout, RA, IBD, immunosupresive therapy, *adrenal insufficiency* (but chronic use -> adrenal atrophy), *short term relief only* (no chronic clock) -dx = stimulated gluconeogenesis (liver bag with candy), increase hepatic glycogen stores (sugar filled liver jar), proteolysis (falling meat), liploysis, S.E's; cushing syndrome (moon face, central fat, myopathy (thin arms), *fibroblast inhibition -> impair wound healing*, decrease bone mass -> *fractures* (broken altar), psychosis (cracked moon head), hypoglycemia, *reactivation of TB* (TB plant)

Antineoplastics: Methotrexate/trimethoprim/pyrimethamine, leucovorin, 5-FU, hydrxyurea, leflunomide

All block synthesis of *thymidine* (cytosine/uracil don't rely on folate) (CUT the pie =thymidine, pentagon shape), pyrimidine production: *(aspartate + glutamine + CO2) -> carbomyl phosphate -> orotic acic + PRPP -> UMP -> UDP -> dUDP -> dUMP -> dTMP* UMP -> *dUMP -> dTMP* (dumpling -> pentagon plate with T chopsticks; dTMP last step in pyrimidine base synthesis/by thymidylate synthase (forms thymidine from uracil), (methylated THF (sushi + 4 leaves) -> DHF fuels last step). *di-hydrofolate reductase fuels -> DHF to THF* (*folate = leaves*) boats going around with *two leaves, leaf chef adds two leaves turning DHF to THF (di = 2, tetra = 4)*), all block S phase (Sushi phase), UDP is precursor to dUMP (U dining? Please sign in; converted via ribonucleotide reductase) Leflunomide: *prevents carbomyl phosphate -> orotic acid* (flu guy stopping erotic lady from eating dumplings) Hydroxyurea: (hydro rock area) - *ribonucleotide reductase/ UDP -> dUDP inhibitor* (crossed out OXY and rib like lines) you dinning in sign). reduces sickle crisis (zen sickle) -> by increases HbF (raised baby), 5FU: (FUll guy) *inhibits thymidylate synthase- dUMP to dTMP* (stopping thymine tray, dumpling plates buildup), can be used against many solid tumors (cracked cancer crab, same as MTX), S.E's: *diarrhea* (stained pants), *photosensitivity/hyperpigment reactions* (friend taking picture of full guy), not helped by leucovorin, MTX/TMP/pyrimethamine: (meat stick chef), folate analog, *blocks dihydrofolate reductase* (blocked leaf chef; DHF boats colliding one another). MTX treats malignancies (cracked cancer crab-> cancers), can be used to *CAUSE abortions (forced)* or *treat ectopic pregnancies* (emptying uterus backpack and ectopic key chain), *treats psoriasis* (silver scale kneepads), *1st line for RA* (RA joint lightbulb), S.E's: *folate deficiency* (falling leaves; b/c stops THF formation from DHF), *megaloblastic anemia* (blasting fireworks lamp), pancytopenia/myelosupression (depleted bone pan), immunosupression (cane), *pulmonary fibrosis* (fibrotic lung bonsai), hepatotoxicity, alopecia (bald meat stix chef), *mucositis* (poking mouth), *reversed by leucovorin* (lucky feline next to meat stix chef),

Thrombolytics

Alteplase (tPA)/ reteplase (rPA)/ tenecteplase (TNK-tPA -> (toy play set), streptokinase (strepto kinectors) aid conversion of plasminogen to plasmin -> cleaves thrombin/fibrin clots (plasma beams destroying wall). *prolong PT AND PTT- BOTH -> doesn't change platelet count* (parachuter toy and bird, non- broken plates), uses: ischemic stroke (black paint stroke), *SEVERE DVT/PE treatment*, tx for MI, S.E's: *hemmorhagic stroke* (red paint stroke/two sized eyes) -> dont give to patients with history of bleeding. reversal: *transexamic acid/aminocaproic acid (anti-fibrinolytic, mom holding exams)(cap on paint tube), *FFP/PCC* (FFP/PCC plane), *cryoprecipitate* (cryo ice pack on kids head)

class 5

DK foxglove (anti-arythmic) -> parasympathetic affects, -use: a fib, a flutter, other: *magnesium* (magnesium magnet) -> *treats torsades* (torn/twisted streamers), [hypokalemia/hyperkalemia can induce arrhythmia's] -> *hyperkalemia = spiked T waves, hypokalemia = U waves at end of T*, *Adenosine* (swing dancing): purine nucleotide (purine shaped gate) -*inhibited by caffeine, theophylline* (energy drink blocking gate) -mech: *activates inhibitory A1 receptors on SA/AV nodes (A1 swing) -> suppresses inward calcium (falling ice cream) (hyperpolariztion), increase outward K (banana), -> heart block, decrease AV node conduction , coronary dilation -use: supraventy arythmias S.E = flushing (red face), SOB/chest pain/*sense of doom* (clutching chest), HA/hypotension (holding head)

Neuro/Psych: Benzodiazepines, flumazenil

Benzos' = (bens diner), *pam* suffix (pam cakes): -Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam -short acting: oxazepam (fast ox), others: *olam* suffix (all A.M) -> potential for addiction (addictive flavor), liver metabolism ([ATOM]: Alprazolam, Triazolam, Oxazepam, and Midazolam) -mech: *bind to GABA receptor* (taxi gaba) -> a chloride channel (chlo-rider ad on taxi) -> inhibitory (take it easy). Increase frequency of ion channel opening (now open more frequently), alcohol binding, -use: *alcohol withdrawl* (hangover special), sx = tremors/insomnia/anxiety (8-12 hours); seizures (12-48 hours), delerium/fever/sever agitation (48-96 hours) -> (use long acting benzo's): -long acting: *diazepam, chlorodiazepoxide* (by alcoholics)(*dizzy*)- give IV -other use: *1st line for acute epilepsy* -HY (jackhammer), anesthesia (sleeping at booth) -> insomnia, spasticity of UMN disorders (relaxing chair), generalized anxiety/panic (anxious customer), *eclapmsia seizures (1st line = MgSO4) -S.E's: tolerance (all are welcome sign), anterograde amnesia (question mark hat), central ataxia (in old people; falling pancake stack), *avoid with 1st gen antihistamines* (bee swatter) -tx = flumazenil (reverses benzo toxicity)(fluffy the muzzled dog antagonizing the store) -> can precipitate seizures by causing acute benzodiazepine withdrawal. -*Oxazepam, Temazepam, and Lorazepam are OK for Terrible Livers* -barbituates bind a seperate GABA receptor (barber shop next door)

Bleomycin, doxorubicin, daunorubicin, actinomycin D

Bleomycin: (baluga whale), *antitumor antibiotic*, binds DNA/produces *free radicals -> single/ds breaks* (oxide bubbles, broken double helix kelp), *blocks G2* phase (Ga11eon ship), heme malignancies (crab), S.E's: *pulmonary toxicity* (lung coral), *skin toxicity* (hyperpigmented striae), *mucositis/stomatitis* (poking mouth), alopecia (bald baluga), Anthracyclines: (santa anthracycline), *rubicin suffix* (ruby treasure), produces free radicals (oxide bubbles), *intercalates DNA* (blocks DNA/RNA synthesis; rubies inserted into helix weeds), (cancer crab), S.E's: *cardiotoxicity* (dilated heart ruby sacks)- prevented by *dexrazoxane* (iron chelator; chelating heart sack; on deck with razor), myelosupression, alopecia, Actinomycin D: (doll artifact), intercalates into DNA, *treats pediatric malignancies* (doll = childs artifact), s/e = alopecia

Antiarythmics: class 1

Class 1 (solist), upstroke = Na, plateua = ca, repolarization = K (bannana curtain), -class 2 aar's bind to sodium channels (peanut butter jar) -> *decreases slope of phase 0*, use dependent, no action on SA/AV node, widens QRS, -class 1: quinidine, procainamide, disopyramide, *intermediate binding for Na* (lightly held peanut butter), *also block K* (pushing away curtain), treat *WPW -wolf parkinson white* (wolf flag), SE = =QT prolongation (twisted torades streamer) *quinidine* (dining prom queen): S.E's *cinchonism - dizziness/tininitis/HA* (tin cans), *thrombocytopenia* (broken plates), *procainamide* (prom king) - *S.E = lupus like syndrome* *disopyramide* (disapears): SE = *heart failure* -class 2: ex's: lidocaine, phenytoin, mexelitine mech: *low binding for Na* (dropped peanut butter), shorten phase 2 and 3 (pulling on curtain), use: ventricular arthmia (illuminated/cracked heart), ischemia induced arythmias, S.E's = *neurological -paresthesia/tumor/convulsions* (brain trucker hat) *phenytoin* (friendly towing), *mexelitine* (mexican flag), *lidocaine* (lied), class 3: types - propafenone, flecainide, *strong Na binding* (tight holding of peanut butter), *don't affect cardiac AP* (untouched potassium curtain), use: *supreventrivcular tachy/arrythmias* (illuminated top and bottom of heart), *afib* (tv), restore sinus rythm, SE's- *CI in heart disease* -*flecainide* (flakes), *propafanone* (purple phone),

Thiazides

DCT (DCT slide), sodium/pottasium pump, *Na/Cl cotransporter* (worker scraping sodium/chloride salts from slide), *calcium is resorbed* (slider dropping calci-yum ice cream off slide)- regulated by PTH, Thiazides: *cholrotiahzide and cholorothalidone* (cholored thighs on high dive), inhibits na/cl resorption (workers knock over na/cl bucket into pool)-> causes natureisis, *enhanced calcium resorbtion*, tx for HTN (high pressure pipes) and HF (floppy heart baloon), treat *nephrogenic diabetes insipidus* (insipidus peeing fountain) -> reduce polyuria/polydypsia, prevention of calcium stones and *hypocalciurea* (worker removing large stone from slide), cause hypercalcemia, *hyperglycemia/hyperlipidema* (elevated candy bar and stick of butter), *hyperuricemia* (knitting needles), *decrease lithium clearance* (liftium baloons, inc in serum lithium levels), *hypokalemia* (potassium depleted banana peels; *hyponatremia*, sulfa drugs (rotten eggs), *contraction alkalosis* (contracted bleach bottle; hypovolemia induced metabolic acidosis)

Etoposide, teniposide, topotecan, irinotecan

Etoposide/teniposide: (side of tower), *inhibit toiposomerase 2 and prevent religation* (rapunsel supercoiling of braids, and breaking), block S phase or G2 phase (Stairs out and Gone 2 forest signs), heme malignancies (cancer crab flag), S.E's: myelosuppression (spilling bone luggage), immunosuppression, alopecia (lost hair), topotecan/irinotecan: (flying toucan), *inhibit toiposomerase 1* (single ponytail strand on prince charming), s.e's: *diarrhea* (bird stools falling on charming),

Digoxin/milrinone/nesiritide

HF drugs: DJ foxglove, inhibition of Na/K pump -> increased intracellular sodium/extracellular pottasium (knocked over banana vending machine), *calcium influx (calci-yum ice cream) -> increased contractility* (flexed arm), *tx for chronic systolic HF* (deflated heart baloon), stimulation of vagus nerve (Las Vegas sign), S.E's: hyperkalemia (pile of bananas outside), arythmias (dancers on heart dance floor), *scooped concave ST* (tasty scoop ice cream), CI in SA node heart block or beta blockers (dancers on nodes), *objects appear yellow* (yellow spotlight), tx= digoxin immune fAB (fabulous las vegas) Milrinone: (one in a million), *inhibits phosphodiesterase* (don't foster disinterest sign), increases contractility (flexing arms), SE = *arteriolar dilation- watch for hypotension* (dilated, red donkey ears) Nesiritide: (turn the tide), *BNP analog that increases cGMP* (BuMP the GruMP), arteriolar *and venous* dilation (red ears and blue legs), *natuiresis* (salty sodium stream from elephant)

Calcium channel blockers

HTN/angina drugs: *target L-calcium channels* (L shaped handle), *dihydropyridines* (smooth muscle, dairy sign) and *non-dihydropyridines* - decrease contractility, and SA/AV node (cardiac muscle- non dairy heart sign w/ music notes), uses: HTN, stable angina, *prinzmetal angina* -(coronary vasoconstriction/at rest; anvil medal), dihydropyradines: *dilation* (dilated nozzle-dairy ice cream), *dippin* drugs, *HTN emergency - nifedepine for pregnancy* (preg lady with knife; clevidipine/nicardipine = other), uses: *raynauds* (blue fingertips), berry aneurysm (berry ice cream), *subarachnoid hemorrhage -> use nimodipine* (strawberry syrup, need mo dippin), non-dihydropyradines: verapamil-*migrane prophylaxis* (very vanilla, pounding head bell), dilitaizem - *some dilation* (delicious dark chocolate, medium nozzle), sx = bradycardia/ coronary dilation/dec afterload, uses: *arythimias*(jukebox), S.E's: *lighthead/headache* (lightheaded patron), *peripheral edema* (baggy pants), *tachycardia - AVOID in unstable angina* (reflex hammer; knife cutting heart), *constipation* (clogged toilet), gingival hypertrophy (expanding gum), *heart block exacerbation* (door should remain unblocked), worsen HF (failing heart balloon)

Endocrine: insulin, sulfonylureas, meglitinides, GLP-1 agonists, DPP-4 inhibitors

Insulin: (welcome inside mat), islets of langerhaans in pancreas - beta cells (*langer-hansel*; beta 2 tubules), glucose = most stimulant of insulin -> inc ATP levels in beta cells -> *closes K+ channels* (depolarization; closed gate around banana flowers) -> *voltage gated calcium channels opens* -> insulin secretion (gretel with calci-yum flower), -> *c peptide release* (c wrapper). Insulin receptor is a *tyrosine kinase (tire swing)* -> inserts GLUT-4 into tissue (adipose/muscle; 4 on open door) -> inc hepatic glycogen stores (liver candy jar, glycogen glazed ham, fatty donut jar) *glusine, aspart, lispro* (Girls And Lads) -> *rapid acting/short duration* (tall, immediate peak) -> control *postprandial* insulin spike (after meals; birds nibbling at peak), regular insulin/NPH = intermediate acting (rest now sign) -> delayed onset (delayed peak), can be given *IV* (ivy) -> *IV useful for hyperkalemia*/give with glucose (ivy next to banana), DKA (candy key) -> vomiting/fatigue/polyuria -> *use regular insulin* (ivy next to candy), *insulin DECREASES serum K -> increases Na/K ATPase in skeletal muscle (eaten banana candy)* Detemir, Glargine (don't go)-> *long acting and steady levels* (flat roof), S.E's -> *hypoglycemia*, tachy/palpitations/sweating/naseau, Sulfonureas (sulfa eggs): *bind ATP K+ channels -> release of insulin* (sulfa swan lake behind closed banana gate), 1st generation = *amide* suffix (mother swan in maid outfit; rarely used, long acting), 2nd generation = *ride* suffix (goslings on mothers back, small dosing, long acting) -> glipizide -> shortest duration/lowest risk of hypoglycemia Meglitides -> *glinide* suffix (gliding bird) -> bind K+ channels/release insulin (behind closed banana gate), not sulfa drugs -> used for *patients with sulfa allergy*, S.E's: hypoglycemia, weight gain (fat old hag), disulfiram *reaction with alcohol* (do not drink), uses: *type 2 diabetes* (2 fingers, require functional beta cells), GLP-1 agonists -> *tide suffix* (tide detergent) -> activate *glucagon like peptide receptor -> increased insulin release* (glucagon -> glucose -> insulin release), DPP-4 inhibitors (4 dripping laundry items) -> *gliptin suffix* (clipped in), -> *prevent GLP breakdown* (increase GLP levels; maid gulping), dec glucagon, *dec gastric emptying* (sealed gastric container), S.E's: *nasopharynx, URT infection* (clothespin over nose), *pancreatitis* (pancreas sponge), *no hypoglycema* (candies not falling), uses: type 2 diabetes (need beta cell functioning) -> increase C peptide levels (candy wrapper)

Laxatives, antipdiarrheal's

Laxatives -> draw water into intestinal lumen -> distension/peristalsis (spa water), ex's: *mangesium compounds* (magnets), *PEG* (polyethylene glycol; peg drain cover), *lactulose* (relaxulose) -> metabolized by bacteria into acidic metabolites (NH4+) -> lowers pH (fish eating relaxulose, acidic pH meter. NH4+ release valve), useful for hepatic encephalopathy (pouring into liver/brain coral tank), *rifaxamin* (antibiotic; fisherman removing fish) also treats hepatic encephalopathy, *psyillium* (indigestible coloid, bulky seaweed), *docusate* (stool softener, water penetrating canoe at dock), *senna* (stimulation of enteric NS, suntan lotion) -> s.e = *melanosis coli* (brown pigmentation of gut) general S.E's: diarrhea/dehydration (spilling mud bath). Anti-diahreals: (muddy slippers outside massage room), Ex's: *opiods -> mew receptors* (diphenoxylate/loperamide, utopia massage room), *loperamide -> doesn't cross BBB* (no addiction, loop eared rabbits- not banging heads) -> mech: increases transit time (hopping back and fourth), *diphenoxylate can cross BBB -> combine with atropine to prevent abuse* (dolphins smashing heads), C.I = *patients with bloody diarrhea or fever* (candle and red slippers), S.E's: constipation (clogged sign on door), uses: *VIPoma and carcinoid tumor* (VIP customers only crab) -> ex. *octreotide* (octagon stop sign)

Acetazolamide/mannitol

PCT (pro cart track), sodium, chlorine, potasium glucose, amino acids and bicarb absorbtion (85%-bicarb cars), na/K atpase (bannan vending machine, na/h+ exchanger- sodium in/protons out (worker giving peanuts in track and letting helmets-h+ out), lumen carbonic anhyrdase (car battery anhydrase; carbonic acid to h20 and co2), water and solutes absorbed Azetazolamide: inhibits CA (spilled easy (azeta) substance on car battery) *forces bicarb to stay in lumen* (urine alkalization), *prevents sodium reabsorption* (spilling salty peanuts in tubule, hyponatremia), *hyperchloremic state (no sodium to exchange for potassium) - NORMAL anion gap, metabolic acidosis* (close the gap sign), use: *decrease aqueous humor production* (spilled eyeball cups), *decrease CSF*- use for intracranial HTN/tumor cerebri (high pressure head baloon), *mountain sickness* (high elevation chair), dec uric acid/kidney stones (bicarb makes urine basic = no stones, stones being thrown out of tubule), *hypokalemia* (no potassium absorbtion; banana peels), type 2 tubular acidosis (two tubes of acid), sulfa drug (sula eggs), Mannitol: (tall man), decreases pressure in CNS (high pressure head balloon), decreases IOP, *pulmonary edema s.e* (tall man causing wet lungs),

Rituximab, cetuximab, bevacizumab, alemtuzmab, trastuzumab

Rituximab: (coronation ritual), chimeric monoclonal antibody (chimera sigil), *depletes B cells- binds CD20* (boy pulling down antibody archer- grabbing XX straps), *treats CLL* (chronic tapestry with antibody knights and archers), treats RA, treats *vascular diseases- polyangitis, wegners granulomatosis* (torn antibody light), S.E's: immunosuppression, *high risk of PML* (white laurel leaves - JC video), *infusion rxtion - headache/fever/rash/pruritis* (swollen cherub/statue with ivy), *serum sickness- delayed onset poisoning- fever/rash* (red and dropping cup), Cetuximab: (Tusks), *binds EGFR- tyrosine kinase* (growth factor- giraffe on elephant cloth and swinging tire), S.E's: *pustule/acneoform rash* (red spots on giraffes), Bevacizumab: (beverage lady), *binds VEG-F/inhibits blood vessel growth* (chopping vegetables, in line line vessels), treats metastatic cancers (crab), *treats wet macular degeneration* (wet center of retina pillow), S.E's: *bleeding/thrombotic events* (blood splatter/ice clots), *GI perforation* (colon shape vegetable bag), Alemtuzmab: (Alms/poor person), *depletes B and T cells- binds CD52* (52 symptols on T cell sword), treats CLL Trastuzumab: (tapestry weaver), *binds EGF 2: HER-2, eERB-2- tyrosine kinase receptor* (tapestry weaver with 2 babies swinging on tire), *HER-2 = breast cancer* (crab bra), S.E's: *cardiotoxicity* (unraveling heart blanket)

Metformin, thiazolidinediones, pramlinitide, SGLT2 inhibitors

Type 2 diabetes tx (2nd grade) Metformin (metaphor card): *first line*, *activates AMP kinase -> increases insulin sensitivity* (AMPKandy, place valentines INSIDE), decreases hepatic gluconeogenesis (stopping candy release from bag), S.E's: lactic acidosis (sour milk) -> increased by renal insufficiency (cracked kidney tray), *GI side effects* (nauseated face), weight loss (skinny guy), Thiazolidinediones: *glittazone suffix* (glitter zone), ligands of PPAR (life of the PPAR shirt) -> *upregulated fibronectin (regulates gene trxn*; turtle neck) -> insulin sensitivity/fatty acid oxidation -> *increase adipocyte number, decreases triglycerides* (elevated fatty donuts, eating fatty donut), *upregulate GLUT-4* (4 on mailbox door), S.E's: *weight gain* (fat belly), edema (baggy pants), HF (falling heart balloon), *inc fractures* (fractured chair leg) Amylin analogues (amy and lin) -> *ex = pramlitide* -> dec gastric emptying (closed gastric water cooler), *dec glucagon secretion* (empty/falling glucagon packets), uses: *type 1 and type 2 diabetes* (1 and 2 fingers), post-prandial glucose spike (eaten cupcake), s.e=hypoglycemia, GI effects (nausea), Acarbose/miglitol: *alpha glucosidase inhibitors* (a-card wigglers) -> *decreases disaccharide to monosaccharide conversion* (monosaccharide free), dec disacharidases in intestinal border (brush border flags) -> delay carbohydrate absorption (delayed opening of bag), S.E's = GI symptoms (fermentation of undigested carbs of gut bacteria, leaky bathroom puddle), SGLT-2 inhibitors -> *flozin suffix* (flossing), *sodium glucose transporter -> resorbs glucose in the PCT (salty glucose company chips, Pro Cart Track), S.E's: *increase risk of UTI's* (bladder cup), *vaginal candiasis* (snow hitting crotch, canada flag), hypotension (fainted kid), *CI in renal insufficiency* (cracked kidney tray)

class 3

class 3 (trio): -mech: *block K+ channels - prolonging phase 2/3* (pushing away potassium curtain) -use: supraventricular arythmias (heart illuminated), *amiodaron* (amigo) - shares properties of class 1, 2, 3 and 4, s.e's = neurological (skull hat), gray microdeposits (gray sunglasses), thyroid disease, pulmonary fibrosis, heart block/HF, hepatitis (cow), gray/blue skin (mariachi outfit), photodermatitis (photo), inhibits CYP450 (bumper sticker), *tilide* suffix (till i die), *solatol* (soda)(also a beta blocker), a fib (tv),

class 4

class 4 (quartet): -non dihydropyramide calcium blockers at SA/AV node (non dairy fy, music notes) -> types [dilitiazem, verapamil] - *mech: prolong phase 4 -> decrease pacemaker* (sliding UP keys) -> *decrease AV conduction* (boy breaking heart sign), -use: supravent arrythmias, afib, a-flutter (fluttering metrodome) S.E = heart block, prolong *PR interval* (pr interval)

K+ sparing

collecting duct (central gutter), mineral-o-food court (site of action of aldosterone), *Na/K/H20* transport (principal court/principal cell), *Na resorption* (salt-e-snac cart), *K+ excretion* (banana stand dumping bananas into tubule), *H+ excretion*(alpha intercalated cell- alpha food truck -> pumping acid into the water)-> causes *metabolic alkalosis* (H+ excretion), *Triamterene/amiloride -> block na resorption* (tangerines/almonds blocking salty snack cart) -> natureisis, for *liddle's syndrome* (gnome blocked by almonds/tangerines; overactive sodium resorption -> HTN) *eplerenone/spirinolactone -> antagnoize minerocorticoid receptor* (apple with teacher and health inspector spiral notebook antagonizing mineral court service-man), useful for hyperaldosteronism (conn), for HF, for *lithium caused D.I* (insipidis fountain; increases excretion of lituium), *hyperkalemia*, inhibit effects of aldosterone, S.E's -> spirinolacone can block testosterone synthesis (steroid drug), inhibits 17 alpha hydroxylase -> *treats polycystic ovarian syndrome*, but can cause hirsutism or *gynecomastia (breast formation)/decreased libido* (androgen excess-bushy bearded man with plates over breasts)

Prostaglandins, prostacyclin, bosentan, PDE5 inhibitors

cox 1 and 2 produce prostaglandins (pro slugger), PGE1/2 (naturally occurring prostaglandins, extreme sports), types: 1) *alprostadil* (PGE1; dill pickle) -> treats ED/dilates, maintains patent ductus arteriosus (NSAIDS = closure of PDA), 2) misoprostol -> protects gastric mucosa (intestine armour), *can prevent NSAID causes gastric ulcer*, promotes uterine contraction (uterus bags), s.e = diarrhea (flooding bathroom), 3) *dinoprostone* (dino hat; PGE2), promotes uterine contraction, PGFa: (footwear) 1) *carboprost* (cardboard box) -> uterine contraction, 2) *latanoprost* (LA tan sandals) and *travoprost* (traveler boots) -> *treat glaucoma* (inc outflow; leaking bottle), s.e = brown iris (sunglasses), prostacyclin analogs: *pro suffix* (pro cycler) use: HTN (broken rackets), s/e = flushing/headache, PDE5 inhibitors (don't phoster disinterest): *fill suffix* (fill tank for cycler), mech: *inc cGMP* (grump), use = HTN, ED Bosentan (boss man stan): treats pulmonary HTN, *endothelin inhibitor* (end o the line), s.e = fatal hepatotoxicity (liver spot)

Warfarin

interferes with gamma-carboxylation of vitamin-k dependent clotting factors 2,7, 9,10 and protein C and S -> *acts on liver* (vit K medic stopping bleeding) (medic and gamma shaped bandage, GL soilder ID) (corporal and sergeant holding troops back), (factor 2 = thrombin, factor 7 = seven deadly sins helmet, factor 9 = 9 lives cat helmet, fox helmet = factor 10), *metabolism affected by polymorphisms in gene for vitamin K epoxide reductase complaex (VKORC1)* (Vkor supply boat), *factor 7 is first to be reduced* (wounded 7 deadly sins soldier), *delayed action: 8-12 hours* (delayed detonation), *oral administration and long half life* (open mouth, tapered flag), , *monitor with PT* (paraTrooper), PT = extrinsic pathway (extrinsically parachuting in), *factor 7 is main factor for extrinsic pathway* (seven deadly sins soldier on parachute), *INR used to measure warfarin- goal = 2-3* (international normalized ratio; intercom radio between setting 2 and 3), *used for LT a fib* (irregularly irregular heart on boat), used for DVT (illiofemoral river), -s.e's: *hemorrhage/abnormal bone formation in utero* (terantula on warhead), *HY- skin necrosis (black soot on corporal) due to hypercoagulation* (protein C has short half life and depletes before warfarin can reduce factor 2 and 10 production -> *heparin bridge* = prevents early hyper coagulable state (heparin hunters on bridge - heparin activates antithrombin which protects against transient hypercoagulation of warfarin), *reversed with vitamin K administration (minor) or fresh frozen plasma (major)* (FFP fighter plane), increased effect with CYP450 inhibitors

Lithium

mood stabilizers (stabilizing poles) -> bipolar disorder (polar bear). *lithium* - (lithium lift): -mech: *very small therapeutic index* (narrow window to get off lift), -mech: possibly related to inhibition of phosphoinositol cascade. -S.E's: GI/nausea (ill on lift), *tremor* (trembling pole), *ataxia* (falling from lift), *hypothyroid* (penguin undone bowtie) -> dry skin, weight gain, hair loss, *diabetes insipidus* (insipidus fountain), *thiazide diuretics and NSAIDS increase lithium levels* (thighs on high dive w/ extinguisher), Teratogenic (terantula) -> *HY- Ebsteins anomaly (if taken by pregnant mother) -> atrialization of right ventricle, ASD and malformed tricuspid* (large right head; no tricuspid formation = no right ventricle) -(LiTHIUM = low thyroid, heart (ebsteins), insipidus, unwanted movements) *Valproate* (winter festiVAL), *Carbamazepine* (car carving), *lamotrigine* (Llama) -> treats bipolar disorder

GI: Antiemetic's

nucleus tractus solitarius: received input from GI tract via *Vagus nerve* (solitary track runner; las vegas sign) -> *coordinates vomiting response* (vomiting on track). Gi irritation -> *serotonin release* (smiley balloons at stomach area) -> activates *5HT-3 receptors on vagal efferents* (1, 2, 3 hammer throw), vestibular system feeds NTS via *CN 8- vestibulococclear nerve* (semicircular canal sign, vests on rowers) -> *vertigo/motion sickness* (rower seasick), Area postremia: *adjacent to NTS* (extreme postures next to track) in 4th ventricle, responds to chemotherapeutic agents, has D2 receptors (2 D rings) -> *antagonized by metoclopromide* (tickler blocking D2 rings) -> *pro kinetic effects:* used for delayed gastric emptying/diabetic gastropauresis (contracted stomach cushion) -> *CI in small bowel obstruction* (do not obstruct sign), S.E's: diarrhea (mud puddle), drowsiness (sleeping judge), *depression* (crying coach), *extrapyramidial symptoms* (extra pyramid newspaper hat) -> *tardive dyskenesia* (judge sticking out tongue), *NMS* (neuroleptic malignant syndrome - fever, rigidity, mental status change, rhabdomyolysis; spicy chicken bucket), *elevated prolactin* (milk secretions), *QT prolongation* (like odansetron; torsadde streamer). *NK1 receptors activated by substance P* (PlaNK1 station, substance P check sign), *antagonization by aprepitant* (participants line) -> treats chemo induced vomiting. Ondansetron (ribbon dancer): *blocks 5HT-3 receptor* (ribbon dancer blocking hammer throw), uses: vomiting , S.E's: constipation (hammer tightening gut), headache/dizziness (hammer hitting head), *prolong QT interval* (twisted torsades streamer), *serotonin syndrome -> confusion, rigidity/tremor, hyperthermia*, Vestibular system: has H1 receptor (allergy receptors, dandelions), *blockers: diphenhydramine, meclizine* -> treat nausea (bee swatters), M1 receptor blockers: scopolamine (telescope)

class 2

phase 4 = Na and other ions, phase 0 = calcium, phase 3 = pottasium, class 2 (duet): beta blockers (muted beta buggle), block SA/AV nodes, decrease cAMP -> membrane Ca channels close (crushed calcium ice cream), -*beta blockers prolong phase 4-> decrease pacemaker activity* (sliding up the keys), decrease AV conduction (disconnected heart bottom), -uses: supraVent arrhythmia (Ex. a fib w/ RVR) (heart lit up to top), IV use (ivy), A fib (tv), -S.E -> heart block (hat shielding heart) -> *prolonged PR interval* (PR interview)

Ace inhibitors, angiotension receptor blockers, aliskiren

renin (rain umbrella), angiotension is cleaved by renin, coverted to angiotensin 1 at juxtagolmerular aparatus (loose tie guy to tight tie guy after getting JGA spin), angiotenson 1 to angiotensin 2 by ACE in lungs causing vasoconstriction (2 tone-tight suspenders guy and lung vest), angiotensin 2 increases GFR- constricts efferent arteriole (coffee grinding machine in back- pinched end of straw), angiotensin 2 increases sodium absorption and aldosterone release (salty peanuts at pro cart track, suspenders at mineral bar) ACE inhibitors: (ace on table), *pril* suffix (april showers casino), prevent AT1 to AT2 (suspenders with losing hand), *creatinine inc* (credit card on table), hypotension and syncope, *inc angiotensin 1 and renin* (cheering tight neck tie), *hyperkalemia* (banana daquari; b/c dec aldosterone), 1st line for HF/reduce mortality (failing heart balloon, angel), 1st line for HTN (high pressure candy storage), slow progression of *diabetic neuropathy* (candy shop), for pt's with *albuminuria* (wedding album) S.E's: *cough* (coughing dealer), inc bradykinin (braids on dealer), C.I in *hereditary angioedema* (C shaped ring on fat lip),* inc fetal hypotension risk* (tarantula sweater), *ACE + NSAIDS cause kidney injury* (fire extinguisher in cracked kidney class), inc creatinine (credit card), ARB's (blocking seat): *sartan* suffix (sorry taken sign on seat), inc bradykinin, *hyperkalemia* (daquari on seat) *Aloskerin: direct renin inhibitor* (high risk slots), hyperkalemia