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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
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