PHARMAC IMP

——-

Digoxin induced RX
ATRIAL TACHYCARDIA Propranolol
AV BLOCK Atropine
VENTRICULAR TACHYCARDIA Lignocaine

CCF RX
Controlling symptoms Controlling MORTALITY
Loop diuretic SPIRONOLACTONE
Nitrates, Nesirtide ISOSORBIDE DINITRATE + HYDRALAZINE
Digoxin, PDE3- ACE- , ARB ,ALISKIREN , B Blockers

BLOOD

● TENECTAPLASE = LONGEST ACTING

● ALFIMEPRASE = SNAKE
● DESMOTEPLASE = BAT
● DOC FOR TPA INDUCED BLEEDING = EACA
● APROTININ = USED FOR CARDIAC SURGERY

● WARF : FACTOR 2 IS LAST TO BE INHIBITED

● PURPLE TOE SX = WARFARIN
● WARF DOESNT REQUIRE TDM
DVT , PE 2 - 3 INR
Prosthetic valve 2.5 to 3.5
Op follow up 1.5 to 2

● ANTIDOTE OF WARFARIN = VIT K1 (PHYTONADIONE)

Warf toxicity
INR >3 STOP , RESTART WHEN NORMAL
INR >10 ORAL VIT K , STOP
ANY SYMPTOMATIC PT FFP + INJ VIT K

Prophylaxis of thrombus
NON VALVULAR AF Dabigatran
VALVULAR AF Warfarin
● 2a / Xa inhibitor NOT USED IN VALVE PROBLEMS

For DVT
Apixaban or Rivaroxaban From 1st day onward
Dabigatran/ edoxaban + LMWH/FONDA x 5d first..fb it alone

● FONDAPARINEUX, LEPIRUDIN , ARGATROBAN MAY BE USED IN HIT. DOC FOR HIT = ARGATROBAN
(INJECTABLE MONOVALENT 2a -)

● HEPARIN IS SAFE IN RENAL FAILURE whereas LMWH AND FONDA, LEPIRUDIN ARE EXCRETED
UNCHANGED THROUGH KIDNEY, SO UNSAFE IN RENAL FAILURE
Direct thrombin inhibitors ORAL
Dabigatran
Ximelagatran
INJECTABLE
Monovalent ARGATROBAN
.MELAGATRAN
Bivalent HIRUDIN
Bivalirudin (SYNTHETIC)
Lepirudin (CI IN RENAL FAILURE)
Desirudin

● INJECTABLE Xa inhibitor = OTAMIXABAN

● Warfarin has URTICARIA as SE
● Heparin Causes Rashes and HYPERKALEMIA
● 1mg PROTAMINE NEUTRALISES 100U HEPARIN
● LMWH MONITORING USING ANTIFACTOR 10A , IN RENAL FAILURE AND SEVERE OBESITY
● THROMBOXANE SYNTHWSE - BY DEZOXIBE

TXA2 RECEPTOR BLOCKER

● ALL TROBANS(DALTROBAN, SULTROBAN ETC) EXCEPT ARGATROBAN

● LOSARTAN

● VAPIPROST ( NOT A PROSTAGLANDIN)

● THROMBIXANE A2 BLOCKER ALSO USED FOR BRONCHIAL ASTHMA = SERATRODAST

Prodrugs TICLOPIDINE
CLOPIDOGREL
PRASUGREL
● PRASUGREL HAS HIGH RISK OF BLEEDING SINCE IT IS THE MOST EFFECTIVE AND FASTEST ACTING
 AGENT, SO NOT USED
● TICLOPIDINE IS TOXIC

● TICAGRELORAL = ORAL
● CANNULAGRELOR = IV
● CANGRELOR = ADENOSINE ANALOGUE

● ABCIXIMAB = MAXIMUM BLEEDING SINCE MOST EFFECTIVE GP2/3A-

CHOLESTEROL

● BEZAFIBRATE = NO MYOPATHY
● FIBRATES DOC FOR CHYLOMICRONEMIA SX, T3 HYPERLIPOPROTENEMIA, HYPERTRIGLYCERIDEMIA

● LOVA STATIN AND SIMVA STATIN ARE PRODRUGS

● PRAVASTATIN CAN BE GIVEN IN 8-10YR CHILD, LEAST MYOPATHY, LEAST INTEREFERENCE WITH
FOOD,LEAST DRUG INTERACTION
● ROSES LAST FOR 19HRS = LONGEST ACTING
● PITAVASTATIN = MOST POTENT
● FLUVASTATIN =ALMOST COMPLETELY ABSORBED ( FULLA STATIN)
● MYOPATHY RX = COENZYME Q
● TERATOGENIC
● PREGNANT PT = GIVE CHOLESEVELAM = ALSO RX OF DM

● APIRIN + NIACIN = NO FLUSHING

● MIPOMERSEN = ANTISENSE OLIGONUCLEOTIDE INHIBITOR OF APOLIPOPROTEIN B
● AVASIMIBE - CONVERSION OF CHOLESTEROL TO CHOLESTEROL ESTER
ANTICANCR DRUGS

G1 PHASE L aparaginase, STEROIDS

S PHASEk Purine , Pyramidine, antifolates, Topoisomerase 2
inhibitors (epipodophyllotoxins- etoposide
G2 PHASE Topoisomerase 1 x ( CAMP) - irinotecan , BLEOMYCIN
M PHASE VINCA(- Polymerisn), TAXANES(- disassembly)
● Bleomycin is the only antibiotic anti cancer cell cycle specific agent

ANTIMETABOLITES ON S PHASE
ANTIFOLATE PURINE PYRAMIDINE
METHOTREXATE 6 MP, 6TG CYTARABINE
PEMETREXED FLUDRABINE(DOC FOR CLL) 5FU ( excreted as co2 by lungs)
PRALATREXATE CLADRIBINE(DOC FOR HCL) CAPECITABINE
PENTOSTATIN GEMCITABINE

*METHOTREXATE POLYGLUTAMIDE IS THE ACTIVE FORM, IT IS EFFLUXED BY P GLYCOPROTEIN

● INHIBITION OF ADENOSINE DEAMINASE = PENTOSTATIN

● 6 MP IS A PRODRUG THAT REQUIRES HGPRTASE
● IF ALLOPURINOL IS USED ALONG WITH 6MP , TOXICITY OCCURS, SINCE 6MP REQUIRES XANTHINE
OXIDASE TO GET INACTIVATED

● MINIMUM DOSE OF METHOTREXATE = 7.5mg/Week

Hand foot syndrome CAPECITABINE

 5FU, Pemetrexed , IL 2
● ACTINOMYCIN D = RADIATION RECALL SYNDROME
● MITHRAMYCIN/PLICAMYCIN = USEFUL FOR HYPERCALCEMIA
● DOXORUBICIN = DOSE DEPENDENT CARDIOMYCOPATHY (>550mg/m2)
● Bleomycin metabolised by hydrolase
NOT CAUSING SIGNIFICANT MYELOSUPPRESSION
VINCRISTINE
BLEOMYCIN
L ASPARAGINASE

● ALKYLATING AGENT ALKYLATES N7 GUANINE IN DNA

ALKYLATING AGENTS
BUSULPHAN Venocclusive disease
NITROSOUREAS = Lomustine , carmustine Sustained neutropenia
STREPTOZOCIN Chemical pancreatectomy
CHLORAMBUCIL
CYCLOPHOSPHAMIDE Least myelosuppressiom
Melphalan Max secondary cancer with procarbazine and
melphalan
PROCARBAZINE DISULFIRAM RN , MAX 2ry CANCER, MAO
INHIBITOR, CHEESE REACTION
DACARBAZINE (on RNA) ACTS ON RNA
THIOTEPA
MECHLORETHAMINE SKIN VESICANT ; RX = THIOSULPHATE
TEMOZOLAMIDE 100% ORAL BIOAVAILABILITY
CISPLATIN, CARBOPLATIN
Skin vesicants RX
MECHLORETHAMINE Thiosulphate
VINCRISTINE HYALURONIC acid
DOXORUBICIN Dexrazoxane

● CYCLOPHOSPHAMIDE IS A PRODRUG , ACTIVE FORM IS ALDO PHOSPHAMIDE

● DOC FOR PANCREATIC CANCER = GEMCITABINE

● PONATINIB = 3RD GEN ( T315 MUTANT CASES)

● VGFR BLOCKERS PRODUCE HYPERTENSION

Rituximab uses
● CLL

● HEMOLYTIC ANEMIA

● ITP

● NHL

● RHEUMATOID ARTHRITIS

Ibritumomab Yttrium 90
Tositutumab I 131

● DRUGS FOR HEMORRHAGIC CYSTITIS = CARBOPROST, FORMALIN,NAC , MESNA

● CISPLATIN = COASTING EFFECT NEUROPATHY = PROGRESSES EVEN AFTER TREATMENT COMPLETION

 ● CISPLATIN NEPHROTOXICITY = AMIFOSTINE
● CARBOPLATIN = MAXIMUM MYELOSUPPRESSION
● OXALIPLATIN= LARYNGOPHARYNGEAL PARASTHESIA

M phase
● AMONG ALL ANTICANCER DRUGS , MAXIMUM PERIPHERAL NEUROPATHY IS BY VINCRISTINE

*RALOXIFEN CAN BE USED FOR OSTEOPOROSIS

Chemical ADRENALECTOMY AMINOGLUTETHIMIDE

Chemical pancreatectomy STREPTOZOCIN

● OS PEMIFENE = RX OF DYSPAREUNIA
SPRM ULIPRISTAL
ASOPRISNIL
TELAPRISTONE = Endometrosis, Fibroid Uterus

● THALIDOMIDE USED FOR RX OF APHTHOUS ULCER IN HIV PATIENTS

● R ISOMER CAUSES TERATOGENICITY AND THERAPEUTIC ABILITY
● S ISOMER = SEDATION
● adr of thalidomide = CONSTIPATION, SENSORY NEUROPATHY

● EPO RECEPTOR STIMULANT = PEG IN ESATIDE

● THROMBOPOEITIN RECEPTOR AGONIST = ELTROMBOPAG, ROMIPLOSTIM

Most emetogenic CISPLATIN

Least emetogenic VINCRISTINE

Ondansetron Mc side effect = HEADACHE

GRANISETRON Transdermal
DOLASETRON Qt prolongn. Therefore not used in prophylaxis of n and
v
PALONOSETRON No qt prolongn , HIGHLY SELECTIVE BLOCK, MAX
POTENCY, LONGEST ACTING

● AIDS asso Anorexia and wt loss = DRONABINOL

● DELAYED PHASE VOMITING OF CISPLATIN = BEST : APREPITANT
● HERIDITARY ANGIOEDEMA = DOC BEFORE SX = EACA

Tacrolimus Cyclosporine
MAX NEPHROTOXICITY Hyperuricemia
HYPERKALEMIA Hyperlipidemia
Hyperglycaemia Hirsuitism
Gum hyperplasia
● CISPLATIN, AMPHOT B = HYPOKALEMIA
● CYCLOSPORINE = HYPERKALEMIA
● * SIROLIMUS = HUS, ORAL ULCER

● Azathioprine converted by XANTHINE OXIDASE TO 6MP (ACTIVE FORM IS 6THIOSINIC ACID)

● MMF = IMPDH - , GI TOXICITY

● IL 17R BLOCKER = BRODALUMAB

 ● SECUKINUMAB = IL 17A
● IL 23 = TILDRAKIZUMAB, GUSELKUMAB
● USTEKINUMAB = IL 12 AND IL 23

Ifn a Antiviral
Ifn b Multiple Sclerosis
ifn g CGD

● LEVAMISOLE = IMMUNOSTIMULANT @ LOW DOSES

● RESIQUIMOD = HSV
● ALEFACEPT = PSORIASIS
● LEFLUONAMIDE = -DHODH
● MTx + LEFLUONAMIDE = severe hepatotoxic

GOUT

● COLCHICINE = BLOODY DIARRHOEA

● ALLOPURINOL = HLA B5801, ALLERGY THEN USE OXYPURINOL

URIC ACID EXCRETORS =

● PROBENECID

● SULFINPYRAZONE

● BENZBROMARONE (EFFECTIVE EVEN IN RENAL FAILURE)

● LESINURAD (urate Transporter inhibitor)

● LOSARTAN

INCREASED METABOLISM OF URIC ACID (URICASE)

 ● RASBURICASE
● PEGLOTICASE (USED IN CC GOUT NOT REPONDING TO ALLOPURINOL)

ANTIHISTAMINES
PROMETHAZINE Hypotension (alpha 2 -)
CYPROHEPTADINE(migraine prophylaxis, Serotonin sx, H1 , 5HT3 BLOCK + ANTICHOLINERGIC
Appetizer)

● H3 receptor is presynaptic
● BZD : W1 RECEPTOR = SEDATION, ALL OTHER ACTIONS W2
● ZALEPLON = SHORTEST ACTING
● ZOLPIDEM = M/C

● BICUCULIN = GABA R COMPETITIVE ANTAGONIST, NON COMPETITIVE AT BZD

● phenytoin = S/E = RICKETS,PURPLE GLOVE SX, ARENEOXIDE IS THE TERATOGEN

● CARBEMAZEPINE IS DOC FOR TEMPORAL LOBE EPILEPSY

Valproate MoA
Na channel block
T type Ca channel block
ANTI NMDA
GABA AGONIST
● CARBEMAZEPINE IS AN AUTOINDUCER

● CARNITINE USED TO CONTROL HEPATOTOXICITY OF VALPROATE

 ● LEVATIRACETAM = NO DRUG INTERACTION

● CA INHIBITOR = CAUSE URINARY STONES = TOPIRATE, ZONISAMIDE

● K CHANNEL OPENER = RETIGABINE, EZOGABINE

● ANTIEPILEPTICS CAUSING WEIGHT GAIN = GABAPENTIN , VALPROATE

OPIOIDS

● CONSTIPATION, ANALGESIA = ALL RECEPTORS

MU
MIOSIS Urine retention
MUSCLE RIGIDITY eUphoria
MOTILITY DECR Resp depression
SPHINCTER CONTRACTION LEADING TO CONSTIPN
D = ENKEPHALIN ,
● DYNORPHIN = KAPPA ( DYSPHORIA , DIURESIS, SEDATION)

● MORPHINE = RELEASES HISTAMINE, VASODILATATION( SO USED TO TREAT PULM EDEMA)

● CYP2D6
● CODEIEN = METHYL MORPHINE

● SEMISYNTHETIC = APOMORPHINE, PHOLCODEINE, DAM (HEROIN)

● PETHIDINE IS C/I FOR RENAL FAILURE
● METHADONE = NMDA BLOCK, -REUPTAKE OF SER/NE , ORAL:PARENTRAL = 2l1 , ASSO WITH QT
PROLONGATION
u antagonist , K agonist u agonist, k antagonist
Only Analgesia, no side effects Happiness
Only Analgesia, no side effects Happiness
NALORPHINE Buprenorphine
PENTAZOCINE
BUTORPHANOL (blocks u vasodilation)

● CC ALVIMOPEN USE LEADS TO = MI

● NALFURAFINE = PERIPHERAL K ANTAGONIST, RX OF PRURITIS IN CKD

ANTIBIOTICS

CYCLOSERINE = ALANINE LIGASE / RACEMASE

FOSFOMYCIN = ENOL PYRUVATE TRANSFERASE
BACITRACIN = DEPHOSPHORHYLATION OF BACTOPRENOL
VANCOMYCIN = TRANSGLYCOSYLSE

Aminoglycoside Inhibits initiatio complex , Mis reading of mRNA

Tetracycline tRNA to A SITE ON 30S

LINEZOLID Initiation -
CHLORAMPHENICOL TRANSPEPTIDASE -
MACROLIDES, LINCOSAMIDES,STREPTOGRAMMINS Translocation-

● VRSA DOC = DAPTOMYCIN

● MLS RESISTANCE = DUE TO METHYLATION @ 50S RIBOSOME
● CHLORAMPHENICOL RÉSISTANCE = ENZYME DEGRADATION BY ACETYL TRANSFERASE
● AMINOGLYCOSIDES = ENZYMATIC DEGRADATION
● STREPTOMYCIN = ALTERED RIBOSOME STR
● Amikacin and Neomycin = NOT DEVELOPED RESISTANCE

● CEFOPERAZONE CAUSES BLEEDING, DISULFIRAM LIKE REACTION

● Emergency contraceptive: MIFEPRISTONE 10mg single dose
● INDOMETHACIN CAUSES DIZZINESS IN DRIVERS
● DRUG OF CHOICE FOR ACUTE GOUT IS INDOMETHACIN
● PCM ACTS ON COX 3 IN BRAIN
● PCM GETS INACTIVATED BY PEROXIDASES, LACKS ANTIINFAMATORY ACTION
● CANAGLIFOZIN = ASSO WITH OSTEOPOROSIS AND BLADDER CANCER
● SIROLIMUS BLOCKS ACTION OF IL 2 (THUS CAUSES BONE MARROW SUPPRESSION)
● NAFCILLIN = NEUTROPENIA
● DOC FOR ESBL = CARBAPENEMS
● VANCOMYCIN NOT EFFECTIVE AGAINST PSEUDOMONAS
● MOTHERS WITH PREVS EXPOSURE TO NVP = GIVE ZIDOVUDINE
● FOSCARNET = EFFECTIVE AGAINST HSV,CMV,HERPES,HIV
● CIDOFOVIR = HSV,CMV,POX,ADENOVIRUS
● TIGECYCLINE = VIA LIVER (BILE ) EXCRETION
● TYPHOID = AMINOGLYCOSIDES ARE NOT EFFECTIVE
● DOC FOR CRYPTOCOCCUS = FLUCANAZOLE (CHECK)
● CUTANEOUS LEISHMANIASIS = SODIUM STIBOGLUCONATE

● DPP 4 INHIBITORS ARE CONTRAINDICATED IN RENAL FAILURE EXCEPT LINAGLIPTIN ( SAFE IN RENAL
FAILURE)
● DPP 4 RESEMBLES CD 26 . THEREFORE INHIBITION CAUSES URTI

● Adverse effects of PPI = OSTEOPOROSIS, VIT B12 DEFCY, PNEUMONIA, CARCINOID TUMOR (IN ANIMAL
MODEL)
● DOC FOR ALL ULCERS INCLUDING NSAID INDUCED = PPI
● PEMBROLIZUMAB =HEAD AND NECK CANCER
● CETUXIMAB = HEAD AND NECK + CETUXIMAB

Ibs
Constipation LUBIPROSTONE,LINACLOTIDE
diarrhoea LOPERAMIDE, ALOSETRON
● RX OF NEPHROGENIC DI = THIAZIDES
● RAPAGLINIDE USED ONLY FOR PP HYPERGLYCAEMIA
●