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Pharma /B

Selected pharmacology

Medications causing hypothyroidism lithium, sulfonamides, amiodarone
Bisphosphonates? alendronate, risedronate, Etidronate
Demeclocycline Rx of SIADH in addition to water restriction; synthetic tetracycline)
Fomepizole? Rx of methanole and ethylene glycol toxocity (+ thiamine and folate)
Pralidoxime Induces cholinestrase activity in cholinergics toxicity (used with atropin that competes with acethylcholine on muscarinic receptors)
Antibiotics that inhibits cell wall synthesis: β lactam PCNs (e.g. amoxicillin), cephalosporins, carbapenems
Antibiotics that inhibit protein synthesis: Tetracycline, Lincosamides (Lincomycin, clindamycin), Macrolides, Aminoglycosides, linezolid
Mechanism of action of Tetracyclines: inhibit protein synthesis (prevents tRNA binding to ribosomes)
Mechanism of action of Macrolides: inhibit protein synthesis (binds 50S ribosome)
Mechanism of action of Aminoglycosides: Inhibit protein synthesis
Mechanism of action of Quinolones: inhibit DNA gyrase
Mechanism of action of Cyclic peptides (vancomycin): inhibit G- cell wall synthesis
Mechanism of action of Lincosamides (clindamycin): inhibit protein synthesis (binds 50S ribosome)
Mechanism of action of Oxazolidinoes (linezolid): inhibit protein synthesis (translation stage)
Mechanism of action of Sulfa antibiotics (sulfisoxazole): inhibit folate synthesis
Bactriostatic agents tetracyclines, sulphonamides, spectinomycin, trimethoprim, chloramphenicol, macrolides (erythromycin, azithromycin, clarithromycin), lincosamides (lincomycin, clindamycin)
ACE inhibitors: Captopril, enalapril, lisinopril, Ramipril
Ca channel blockers; examples and choice diltiazem or verapamil for SVT; others: amlodipine, nifedipine
AV node blockers: Ca Channel Blockers; β blockers; and digoxin. Adenosine (rapid short acting: 6 mg / 12 mg / 12 mg)
Sertraline (SSRI) CVA, depression, choice for old age (like TCA: nortriptyline)
Ramipril (ACE inhibitor) CHF with cough
Amiodarone side effects Pulmonary fibrosis (most concern; in 10% up to 17%); QT prolongation and Torsades De Pointes; Skin discoloration; hypthyroidism, hepatitis
Dubotamine versus Dopamine Dubotamine: β agonist, inotrope and chronotrope and lowers after-load so improving end-organ perfusion; Dopamine in low doses (< 7.5 microg/min) is vasoconstrictor so increasing afterload
Endocarditis Ampi genta; Vancomycin for MRSA
Prophylaxis: CHF and valvular diseases Amoxi: 50 mg/kg (2 g in adults) 1 hr before procedure: allergic: clindamycin 20 mg/kg (adults 600 mg); no need if Isolated ostium secundum ASD, 6 months after repair and MVP without MR
Prophylaxis: malaria cholorquine for area like Paraguay; atovacuone & proguanil for Brazil; doxycycline for cholorquine resistant areas
Prophylaxis: meningitis household and close contacts of H. influenzae and N. meningitidis; children: rifampin 10-20 mg/kg/d (max 1200) po q12h X2d; adults: cipro 500 mg po X1 OR ceftriaxone 250 mg im X1 (also in pregnancy) OR rifampin 600 mg po q12h X2d
Systemic mycosis (e.g. coccidioidomycosis) Amphotericin B
Chancroid (Haemophilus ducreyi): Cipro, macrolides or sulphamethoxazole-trimethoprim; treat all partneres
Rx; Psittacosis/leptospirosis: Tetracycline
Scabies permethrin 5% cream overnight for 7 days
Lice permethrin 1% cream single use and repeat in a week if necessary
toxoplasmosis Medications for immuno competent adults include pyrimethamine plus sulfadiazine. In pregnancy, spiramycin is usually given
Some specific uses of TCAs Clomipramine (OCD); nortriptyline (elderly depressed patients); amitriptyline (chronic pain)
Bethanecole indication to reduce peripheral anticholinergic effects of some psychotropic medications (like urinary retention
Rx; Hyperkinetic syndrome methylphenidate
Bromocriptine indications; major side effect? Dopamine agonist: Paarkinsonism, Neuroleptic Malignant Syndrome and prolactinoma (if pregnancy desired); S/E: pulmonary fibrosis (like amiodarone)
Octreotide, action, indications? somatostatin agonist; o Acromegaly; sulfonylurea and other hypoglycemic agents toxicity; variceal bleeding if not responsive to EHT and vasopressors
Clozapine (atypical): choice in parkinsonism when hallucinations is developed; (remember myocarditis and BM suppression, need for weekly follow up)
Side effect, Naproxen (NSAID): Increase BUN & Cr
Side effect, Metformin (Diabetes Type II): Lactic acidosis
Side effect, Colchicine (uricosuric): Marrow depression (also with clozapine: TCA), peripheral neuritis (also with INH)
Side effect, Enalapril (ACE inhibitor, anti hypertensive): Angioedema, anaphylaxis, hypotension, neutropenia; dry cough
Side effect, Propylthiouracil & methimazole (hyperthyroidism): reversible agranulocytosis, cholestasis
Side effect, Ampicillin and other PCNs: Rash (especially if given for infectious mono)
Side effect, Alprazolam (Short acting benzodiazepine): Cognitive disorders: confusion, disinhibition, amnesia
Side effect, Trazodone (antidepressant): priapism and mania; also with Prazocin (Antihypertensive)
Side effect, Prazocin (Antihypertensive): priapism, also with trazodone (antidepressant)
Side effect, Cyclophosphamide (anti-neoplastic): hemorrhagic cystitis (to prevent give MESNA)
Ifosfamide (anti-neoplastic): hemorrhagic cystitis
Side effect, Imiperamine (TCA, antidepressant): Blurred vision, dry mouth, orthostatic hypotension
Clinical point, Nortriptyline (TCA) choice in elderlies but avoid in patients with suicidal thoughts
Clinical point, Sildenafil (Viagra): contraindicated with nitrates (severe hypotension)
Side effect, Zidovudine (Anti HIV): myopathy
Side effect, Clozapine (atypical antipsychotic): myocarditis; Bone marrow suppression (also with colchicine); Weekly follow up is essential
Clinical point, Clonidine (antihypertensive): Rebound HTN if stopped abruptly
Hydralazine (antihypertensive): Lupus like synd
Spironolactone (K+ sparing diuretic): gynecomastia
Sulfonamides, antimalarias and foodstuff: G6PD hemolysis
Neuroleptic induced acute dystonia: Antipsychotic medications especially typical ones (Haloperidol )
Antipsychotics and pitutary gland? Antipsychotic induced hyperprolactinemia (infertility, amenorrhea, sexual dysfunction, galactorrhea and weight gain.
Medications causing Depression: Anti-HTN, Anti-Parkinsonism, Hormones, Steroids, Anti-TB, Anti-Neoplastic
Medications that cause Mania: Steroids, Imiperamine (TCA), phenelzine (MAOi), trazodone (TCA), methylphenidate (CNS stimulant; indications: ADHD and narcolepsy), levodopa (dopamine precursor)
Side effect, Gold salts for RA: proteinuria and ascites
Side effect, Phenelzine: (all MOAI: antidepressant and prophylaxis of migraine) contraindicated with tyramine rich foods (cheese)
Side effect, Clomiphene (induces ovulation): Ovarian cyst
Side effect, Phenytoin: bidirectional horizontal nystagmus
Side effect, Lamotrigine (adjunct therapy for refractive seizures): rash and even Stevens-Johnson synd
Side effect, Valproate: hepatotoxicity and thrombocytopenia; in pregnancy may cause NTD (like carbamazepine)
Side effect, Carbamazepine: Trigeminal neuralgia (tic douloureux) and glossopharyngeal neuralgia; in pregnancy may cause NTD (like valproate)
Treatment of Dermatitis herpetiformis: dapsone/gluten free diet
Side effect, clindamycin: pseudo-membranous colitis (by C. difficile) treat with metronidazole and vancomycin
Side effect, Amantadine: Depression, postural hypotension and arrhythmias
Side effect, Amiodarone: pulmonary fibrosis (also with bromocriptine), skin discoloration, hypothyroidism, hepatitis
Side effect, Al Hydroxide: hypophosphatemia
Side effect, Calcium carbonate: constipation and if with excess antiacids: Milk Alkali syndrome
Side effect, Rifampin: red urine and increase hepatic clearance of medications
Side effect, Ethambutol: optic neuritis
Side effect, Isoniazid: Hepatitis (age dependent) and peripheral neuritis (also with colchicine)
Common side effect of ACEi: cough, switch to ARBs if necessary
Antibiotics contraindicated in pregnancy? SAFE Moms Take Really Good Care: Sulfonamides; Aminoglycosides; FQs; Erythromycin; Metronidazole, Tetracyclines; Ribavirin; Griseofulvin; Chloramphenicol; Also: ofloxacin
Safe Antibiotics in pregnancy: ampicillin, cephalosporins, azithromycin from macrolides,
Pregnancy and Sulfonamides: in last trimester increase risk of kernicterus (sulfa containing drugs: sulfamethoxazole, thiazide diuretics, sulfasalazine and sulfonylureas
Pregnancy and Aminoglycosides: ototoxicity (Eight cranial nerve damage, specially with streptomycin)
Pregnancy and Fluoroquinolones (levofloxacin): arthropathies, cartilage damage
Pregnancy and Erythromycin (estolate): acute cholestatic hepatitis in mom; clarithromycin: embryotoxic (azithromycin is safe); erythromycin base and ethylsuccinate are safe (chlamydia, LGV)
Pregnancy and Metronidazole: Mutagenesis (risk in T1), indicated in trichomoniasis
Pregnancy and Tetracyclines: Discolored teeth and inhibition of bone growth
Pregnancy and Ribavirin: Teratogenic
Pregnancy and Griseofulvin: Teratogenic
Pregnancy (and lactation) and Chloramphenicol: Gray baby (fetal circulatory collapse 2° to toxic accumulations)
Pregnancy and anti convulsants o phenytoin associated with fetal hydantoin syndrome in 5-10% (IUGR, MR, facial dysmorphogenesis, congenital anomalies); valporate (and may be carbamazepine) associated with NTD
Pregnancy and ACE inhibitors fetal renal defects, IUGR, oligohydramnios; (use methyldopa or labetalol only if diastolic pressure consistently over 100)
Some other medications contraindicated in pregnancy Beta blockers (except labetolol), Methimazole (use PTU), misoprostol
Pregnancy and lithium or benzodiazepines Ebstein cardiac anomaly, goiter, hyponatremia
Warfarin and pregnancy spontaneous abortion, stillbirth, prematurity, IUGR; o fetal warfarin syndrome (nasal hypoplasia, epiphyseal stippling, optic atrophy, MR, intracranial hemorrhage)
retinoids (vit A; e.g. Accutane™) and pregnancy CNS, craniofacial, cardiovascular, and thymic anomalies
Contraindication for Celestone (betamethasone) in pregnancy: active TB, viral keratitis and maternal DM
Misoprostol Synthetic prostaglandin E1 analog that inhibits gastric acid secretion and exerts mucosal-protective properties (using NSAIDS); also indicated in termination of pregnancy
Medications that may cause hepatitis acetaminophen, chlorpromazine, INH (+ peripheral neuritis), valproate (+ thrombocytopenia), methotrexate, amiodarone (+ pulmonary fibrosis + hypothyroidism + skin discoloration), herbs, some antibiotics (sulfa, tetracyclines)
Created by: Bijan39