Autonomic Nervous System

# Parasympathetic NS :
# Parasympathomimetics # Parasympatholytics :
Neurotransmitter : Ach Direct (m/N Agonists) Muscarinic
Antagonists
Rate Choline Uptake
Limiting Step Nicotine Varenicline Decreased Cognition
:
1
.
Nicotine Agonist >
-
, (i) CNS :

Aminoglycosides blocks pre-synaptic Ca'

+

Channels used in
smoking dependance. scopolamine >
-
Narcoanalysis (Truth Serum)
& & Sep Release Ach Thiopentone DOC for Narcoanalysis
Toxicity Poisoning Cholinergic Symptoms Seizure,
>
+
Neuromuscular Nicotinic
of - :
,

· Receptors
: (Ma Calcium)
:
MuscleFasciculation, Arrhythmia ,
Muscle Weak, Shock.
(i) Pupil :
Mydriasis & Cycloplegia >
- Used for Refractive .
Error Test

in
1.
Nicotinic ⑦ in
:
Neuromuscular Junction Atropine is used as antidote for cholinergic excess. Used for Ocular or Decrease pain Ividocyclitis.

Causes Muscle Contraction .

2 . Muscarinic Agents
:
Funds Examn

2 .

Muscarinic :
# Amides : (i) Pilocarpine (DOC for Gloged Angle Glaucoma >
+
Preferred Cycloplegic drug
:
> Tropicamide
For Adults -

Can be Used for Xerostomia. for Children

M2 : 4 (NS &
GIT Secretion >
-
Atropine.
Increased Trabecular outflow. &
M2 :
↓ HR & AV conduction MOA :
vii, Decreased Oropharyngeal Respiratory Secretions :

M3 :
↑ GIT Contraction , Salivation , Broncho constriction.
(i) Cevimeline (DOL for Xerostomia Glycopyrolate >
- Preanesthetic Agent
Bladder Contraction , Pupil Contraction .
# Choline Estery Bronchodilation
Lungs
:
(iv)
-

* Cholinergic Poisoning
:
(i) Acetylcholine - Matabolised by Plasma/Pseudo/Butyry LAMA >
- DOC for COPD

SAMA-Ipratropium (GID closing)

Choline Esterase .
Increased Salivation, Lacrimation Bronchospasm , ,

Urination, diarrhea, Miosis

, Bradychardia. ↑
True/Pseudo choline estorage
IAMA-Aclidinium (BD dosing)
(M1 M2) Rerefenacin (OD dosing)
Treatment
DOC is Atropine . () Bethanechol ,
3 > Used for of CAMA--Tiotropium ,
Umecidinium , .

Post
M/C
Bladder Urine
Atony Op S E Dry Mouth
Anticholinergic Poisoning
: , :
* .

Retention.
>
-
Dry Mouth , Urine Retention, Contipation (ii) Carbachol (M, ,
37 M2) Used as Mitotic
Agent in
(v) Heart : Increased HR & Conduction

Mydriasis ,
delirium, Hyperthermia & occular
Surgery. Atropine (DOC for Bradycardia)
Tachycardia (ii) Methacholine (M2 > M, , 3) Used in Bronchial Challenge (V) GIT :

Test .

&
DOL is
Phypostigmine .
Diagnosis of Asthma >
- Decreased HC/ Secretion :
Pirenzepine Telenzepine

Decreased Contraction
Dicyclomine, Scopolamine , Glycopyrolate
:
>
-

# Sympathetic NS : # Indirect (Ache Blocker) used as

Antispasmodiacs.

I
Neurotransmitter :
Nor Epinephrine . (i) Irreversible (organophosphate) Scopolamine/Hyoscine >
- DOC for Motion Sickness.

Adrenal & Sweat Glands Ach Sarin, Tabun, UX

For Warfare Agents (VI) Decreased Contraction
: :
->
Bladder >
-

Renal Blood vessels :

Dopamine >
- Clinical drugs :
Flusostigmine, Echothiophate Used in Overactive Bladder/Urge Incontinence

Rate Limiting Step Tyrosine Dopa Insecticides & Pesticides Common Cause
of Cholinergic Poisoning Mz
: >
-
>
- : >
- Blocker

Rate
Limiting Enzyme Tyrosine Hydroxylase
:
. Dol-Atropine Non Selective : KlauoX ate, Fesoterodine,
-

Oxybutynin , Trospium .

Drug (ACHE Reactivator)

Tolterodine .
↑ Receptors * Prolidoxime -> Most Specific Selective Darfenacin Solifenacin ,
:
:
,

.
2
Alpha Receptors (Carbamates/Non-carbamates)
~ &Post Synaptic
(ii) Reversible
: -

X2 : Contraction of Blood Vessels , Prostatic Urethra, Lipid Soluble :

Physostigmine
Bladder Sphincter ,
Radial Muscle
(Iris-Mydrianis) >
- Used in Closed Angle Glaucoma # Nicotinic Antagonists :

S/E Cataract MuscleRelaxants

X2 :
Decreases NE Release .
(Presynaptic >
-
(i) NM Blockers :

Exception Bislet Cells - Decreases Insulin Release DOC in Datura , Atropine & Belladonna Poisoning a) Steroidal Compounds (S/E :
Vaguy Block , Tachyarrhythmia
.
:

Postsynaptic) >
-
Drugs used
in Alzheimer's - Pancuronium : Max Arrhythmia

[Increases Cyclic Amp] Donepezil (DOC),

-
Pipecuronium Lesser Risk
of Arrhythmia
:

2.
Beta Receptors

By : Heart >
-
↑sep Contraction , Rate & Conduction. Rivastigmine , Taurine (Hepatotoxic) >
- Vecuronium : Most Cardiostable
(5/3 Polyneuropathy
:

↑sep release of Renin (BP44) galantamine

, >
- Rocuronium : Fastest
Acting NDMR
(NDMR of Choice in Intubation)
Kidney >
-

Rapacuronium Shortest Acting NDMR

Bronchodilation
:

B2 : Smooth muscle Relaxation (Vasodilation ,

& Lipid insoluble drugs
:
Edrophonium
>
-

>
- (b) Benzylisoquinoline Compounds
:
(3/2 : Histamine Release - Bronchoconstriction)

↓>
>
- Cardiac & Skeletal Musclex >
+ Contraction Do for Mys Gravis
.

>
- Skeletal Muscles >
-
Glucogenolysis and
Glucomogenesis Ald of MysGravis & (S/3 Ganglionic Block
: >
-
Hypotension)
(**** glucose Cholinergic Crisis >
- Doxacurium (Most Potent , Longest Acting)

B- islet Cells -> Insulin Release (db Glucose) >

-
Neostigmine
- Miracurium (Metabolized by pseudo cholinesterase)
>
-
Pyridostigmine
Net Effect ofB2 on
Glucose is Hyperglycemia . 4 NDMR Reversal X DOC
for Myasthenia
>
- Atracurium
(Metabolized by Hofmann Elimination)
By Lipolysis
>
- Cobra Bite Gravis .
>
- Cip Atracurium (More potent & lepp toxic
than
Atracurium]
:
Adipocytes >
-

Bladder - Relaxation . - Bladder Atony (i) NN Blockers (Ganglionic Blockery)

-Paralytic Klus >

- Decrease BP (Used in Hypertension)
- Post Operative Urine >
-
Trimethaphan Mecamylamine , ,
Hexamethonium

Retention I
SE : Postural Hypotension .
 BG)
-

# Sympathomimetics : (Direct Acting C

, # Sympathomimetics
:
(Indirect Acting)
Catecholamines (i) Methylphenidate Partial Agonists
:
: >
-
·

(A) Epinephrine (2 ,
B,
B2G) DOC for ADHD
(5/6 :
WorgenpTick &
hap Addiction Celiprolol, Perbutolo ,
Pindolol, Acebutolol, Labetalol

Cardiac Stimulant
Potential
More potent >
- Call Membrane Stabilizers :

DOC in Cardiac Arrest (IV) Atomoxetine : DOC

for ADHD [Tourette
Syd or
Labetalol, Carredilol, Metoprolol, Acbutolo), Propranol
DOC in Anaphylactic Shock (IM :
1 :
1000) Family History of Drug Abuse .
If in Glaucoma
(B) Nor-Epinephrine (41 B1G) Modafinil : DOC in
Narcolepsy >
-
120 soluble :
(Cl in Renal Faliure)
More Potent Vasoconstrictor Bisoprovol Acebutolo Atenolol, Nadolol, Nebivolol, Sotalol
vis Amphetamine Betaxolol ,
:
, ,

DO ( for Vasodilatory/Septic /Neurogenic Used in ADHD

, Narcolepsy & Obesity Celiprolol .

Cardiogenic Shock
.
- Methamphetamine (Crystal Meth) :
Drug of Abuse .
* Uses of B Blockers
:

IV IM cause Muscle Necrosis. Mixed

Acting Sympathomimetics Migraine
:
>
- Only ;
can & DOC for HTN with

Action at rate Anesthesia Induced Disorder

() Dopamine Dope Dependant infusion (i) Ephedrine DOC for Spinal Anxiety
: . :

With
* 0 -
2 - D2 Hypotension Bradycardia . Essential Tremor

> 2-10 B2G (i) Pseudoephedrine Nasal Decongestant Migraine Prophylaxis

>
- : .

7 10 -> 220 (ii) Norephedrine

:
Was used in
Obesity HOCM (Metoprolol)
① Dobutamine Now banned d/t Risk
of stroke .
Aortic Dissection (Esmolo)
⑦ B, in Myocardium >
- Asthma
((Betaxolol is preffered BH)
DOC for Acute
CHF/Used in Stress Echo
#Sympatholytics :
Topical B can be used for Glaucoma .
② Isoprenaline :
(B B2#) , Direct
Acting
in Heart Block & Heart Faliure.
X
Used (i) Non-Selective Reversible & #

& Non-Catacholamines : >

- Tolazoline (Uped in Peripheral Vascular Disease)
Clonidine WithdrawlHTW
4
Agonists Phentolamine DOC for (i)
:
>
- - :
,

(A) Phenylephrine : DOC for Spinal Anesthesia Induced (i) Cheese Rxn

without
Hypotension Bradycardia (ii) Intraoperative HTN in

>
- DOC for Prianism pheochromocytoma
Midodrine Postural Hypotension (ii) Non-Selective Irreversible #
:
(B) :
DOC for
.

>
- X2 Agonists >
-
Phenoxybenzamine (DOC for Preoperative HTN
in)
(A) Clonidine
:
Used in HTN
,
Preanesthetic Medication, Pheochromocytoma
ADHD ,
Not Flashed , Dependence. (iii) Selective < 1 abd #
:

S/E :
Withdraw) HTH dlt &
, downregulation .
Prazosin (DOC for Scorpion Bite)
(B) Tizanidine : Muscle Relaxant Teragos in, Doxazosin .

(DOL for HTN TBPH)

(C) Lofexidine :
Orioid Dependance Selective Ga # :
(iv)

(D) X- Methyl Dopa : PIH >

- Tampulosin (also blocks 22d)
(2) Apraclonidine :
OA Glaucoma (S/
: Lid Retraction ( >
- Silodosin (Most Selective
() Brimonidine Glaucoma (sld Drowsiness, DOC
: :
OA : BPH

Annea in Neonates) (v) Selective &: Blockers :

- By Agonists :
Mirabegron Vibegron ,
. Yohimbine , Idazoxan

Used in
Urge
incontinence (S/E UTI)
:
* B Blockers :

B2 Agonists
:
Inhalational Route 131 Non Selective
>
- >
-
ger
Nadolol Timolol , Penbutolol Pindolol Oxprendol
() SABA : Terbutaline, Salbutamol , , ,

(i) LABA : Salmetrol, Formoterol >

- Cardio Selective

Vilanetrol Metoprolol, Betaxolol Esmolol, Ateneol

(ii) VLABA : Oldateral , ,

zudgen Cardio Selective Celiprolol Bisoprolol Nebirold

:
* Uses :
, ,

SABA) formoterol : Believer in Intermittent Asthma >

- Sidgen (Selective or Non Selective

LABA : Persistent Asthma , COPD X Block : Labetalol Carredid

,

G (LABA + ICS) CCB : Carredila

COPD No Release Nebivotol

Only
:
VLABA :

3/5 Palpitations
:
,
Tremor,
Hyperglycemia Hypokalemia.
, -
Longest Acting
: Nadolol

Esmolo
Shortest Acting
:

>
- Most Cardioselective :
Nebivolo >) Bisoprolol

>
- (12 :
Asthma/COPD
Diabetes (Block Sym of Hypoglycemia)
 Cardiovascular
(iv) #V [Calcium Channel Blocker
Arrhythmic Drugs ligoxin
# Anti : Class :
#
(i) ClayD 2 (NaChannel#) Verapamil ,
Diltiazem

>
- La :
quinidine DOC in SVT/PSUT in patients of asthma & COPD. >
- MOA :
Blocks Na/k Alpape pump
,
which increases

S/E :
< Block Diarrhea >
-
Hypotension S/E : AV Block . 12-Nevir Given with
# intracellular Na -
causing blockade of Na/Ca
Exchanger
Tinnitus , Vertigo -
leading to ↑ intracellular (a.

>
- Procainamide (v) Class (v) Miscellaneous >
- Hence increased Myocardial Contraction

5/2 +
Ganglionic
Block >
-
Hypotension >
- Adenosine :
Blocks AV Node

SLE , Agranulocytosis. >

- DOC in Acute Atlack of PSVT
(Rapid IVpush
6mg) S/3 of Digoxin :
M/c Earliest : Nausea & vomiting
.
>
- Disopyramide -
Helps in maintaining controlled Hypotension in
Surgery. Xanthopsia

SIE :
Dry Mouth , Constipation ,
Urine Retention
S/3 :
M/c Flushing/Dyspnea Arrhythmia (Ventricular Bigeminy M/c)
/I :
Glaucoma , BPH, Chf Atrial Fibrilation , Hypotension . HYPERkalemia

(Most Arrhythmogenic) /COPD. Gynecomastia

.
·
Clapp1c (2 in Asthma

>
- Flecainide (doc for WPW Syndrome) * Contraindications
of Digoxin
:

Channels
Digoxin Toxicity
Ca
Magnesium Sulphate Blocks ↑ Like
:
- Encainide >
-
(i) Conditions that can
:

-
Propefenone DOC in Torsades de points >
- HYPERCalcemia

* Class 1 b :
>
- hypoMAGNESEMIA
>
- Lidocaine (IV) [DOC for Ischemia induced
VT) 1 >
- Atropine : DOC
for Bradycardia (cope > 0 .

5mg) >
- hynoKALEMIA
V Fib
VT/V. Infarction
Myocardial
.

induced AV Block
or
Digoxin Fib >
-
.

Wall M1 induced
>
- Mexiletine Inferior Arrythmia >
- Renal Faliure

>
-
Phenytoin (Digoxin induced VT) >
- Digoxin :
Blocks AV Node
his WOW Syndrome
Used in
SVT/PSVT in chronic Cuf
(ii) Worsened
HOCM

ii , Class IIB blockers :

* Treatment of Digoxin Toxicity :

Heart faliure
DOL >
- Rate Control in A Fib #
Congestive : Antidote ->
Digibind
DOC >
- Idiopathic v . Fib for VT/V. Fib >
- Lidocaine

DOC >
- Ventricular Premature Beats (i) Acute CHF : We need to increase Heart Contraction For AV(Block >
-
Atropine

DOC >
- Catecholamine Induced Arrhythmia >
- DOC : Dobutamine

Pheochromocytoma ,
Halothane -
PDE3#(AKA Conodilators) X

(iii) Class III (K channel#) :

Amrinone >
+
S/2 :
Thrombocytopenia

S/E :

Torsades/GT Prolongation Preferred >

- Milrinone

with
Drugs :
Bretylium -
if pt presents Pulmonary Edema :

Dofetilide ,
Dronedarone DOC : Furosemide

Ibutilide Sotalol
,
IV
Nitroglycerine
Analogue (Nesritide)
Vernakalant ,
Amiodarone BNP

* Amiodarone + MOA
KINa/Ca/b Blocker
: . Give IV & Can be Metabolized by Neutral Endo Peptidase

Longest Acting (53 days)

.
(ii) Chronic CHF :
Our Main Aim Reduce
is to
Mortality
inhibitor
P-glycoprotien * SHIVA Beta

Doc for :
v
.

T/ V. Fib S
spironolactone SGLTz # ,

Rhythm Control in A .

Fib)A .
Flutter H
Hydralazine + IDN

S/3 Pulmonary Fibrosis Irabradine

1
: Pottasium

Channel Corneal deposity v

Vericignat
Blocker Blue/Gray Skin A Ace
Inhibitory/ARB
Makes Myocarditis Beta Beta Blocker.

Granuloma For Symptomatic Management of Chronic CHF :

Liver Liver *

And Alpha block (Hypotension) >

- Start Furosemide for Volume Overload .

Skin
Photosensitivity >
- ACE inhibitor or ARB
after this
Toxic Thyroid (Hypo > Hyper Preferred (Sacubitril + Valsartan)
- Then start #
Ivabradine ,
if inadequate Response Add Spironolactone ,
:
>
-

Hydralazine + IDN
, SGLI#
>
-
if patient still symptomatic >
- Add Digoxin .
 RAAS inhibitory Continued.... # Hypolipidemic drugs :

I
# VASODILATORI : >
-
Angiotensin Receptor Blockers :

Increases Uric AcidExcretion. (i) Stating

Losartan : : MOA-Blocks HMGCoA Reductase
(i) Arterial Dilatory :
Helps in
Decreasing Afterload Used in HTN with
gout .

decreasing LDL. Hence

(a) Calcium Channel Blockers : >

-
Blocks thromboxane As Uped in :
Prophylaxis of ASCVD [MI Stroke, Angina] ,

* Non DHP's * DHP's >

- Stimulates PPAR-J DOC in Type 2 HYPER Lipoprotiehemia.

>
-
Verapamil Amlodipine (longest) Other
Drugs
: Telmisartan ,
Olmesartan .
Drugs : Pitavastatin (Most Potent)
>
-
Diltiazem Nifedipine >
- DRI : Aliskiren ·
) Rosuvastatin (MaseMLDL decrease)
2nd Line HTN. -
*
Effects : Vasodilation Nimodipine used in
Longest Acting Metabolized ,

Normal Hyperkalemia Postural Hypotension

S/3
HR inhibitors
Nicardipine RAAS : .
by CYP2C19
of ,

AV Block Clevidipine (shortes) C/2 of RAAS inhibitory :

Pregnancy ; B/L Renal
Artery Stenosis. : Pravastatin (Statin of Choice for Protease

inhibitor induced Dyslipidemia)

4
Vasodilation
-
Effects :

↑ HR
#BERTNDNF : Metabolised by CYP2C19

* Uses of CCB :
DOC in
Raynaud's Phenomenon
s/E of Stating :
Myopathy Hepatotoxicity , ,
Insulin Resistence

DOC in Cerebral Vasospasm (i) Mild-Moderate :

41 of Stating :
Pregnancy ,
Child ( 10yrs)
<

Nimodipine .
It Line
drugs
:
ACEi/ARB ; CCB ; Thiazides

Side Effects of ClB Headache , Ankle Edema 2nd Line (ii) Bile Acid Resing :
*
drugs < Blockers Bblockers <2 Agonists DRI
Binding
: :
; ; ;

Constipation , AV Block. Spironolactone ; Minoxidil . MOA : Inhibit Enterohepatic Circulation

of Bile Aids.

LDL Cone"
(b) Hydralazine Used HTN
during On the basis of Age Reducing
:
in Hence
emergency
:

Pregnancy. if
Young <55 yry :
Renin
High -
AEEi/ARB or
B blocker
Uses :
( Add on to stating
+
Minoxidil Works by Opening K Channels. Old < 55 yrs ReninLow : Colesevelam for Diabetes Mellitus
if CCB Diuretics.
: :
or
(2) >
-

Children.
Uses Androgenic Alopecia (ii) Severe Hypertension ) DOC in
Pregnancy &
: : :

Resistant Hypertension . >

-
HTNEmergency
:
End
Organ Damage
+
High BP
Drugs Cholestyramine Coletipol
:
, ,
Colesvelam .

Channels.
(Mnemonic Dance) S/E : Hypertriglyceridemia
+
(d) Diazoxide
: Works by opening of K
Upe IV drugs HELEN

Insulinoma . Metabolic Acidosis

DOC for H -
Hydralazine Hypercholeremic ·

. Esmolol Constipation .
(ii) Venodilatory
:
Decreases Preload 3-

>
- Nitrates L- >
Labetalol/Lasix Decreased Absorption of Vit K A, D
, ,
.
E

(a) Nitroglycerine :
High PtPass Metabolism
by 3 -
Enalaprilat 42 : it Binds with other
drugs & Prevent Absorption
Oral Route .

(Sub Lingual) N +
NTG or
Nitroprusside
>
- DOC in Acute Attack of Stable & VariantAngina Dance >
- DHP
,
Nicardipine (DOC) , Clevidipine. (ii) Ezetimibe : MOA :
Blocks NPC, L, Receptor
>
- Acute Attack
of MI . - HTH
Urgency
: No End
Organ Damage + BP >220/125 Used as add on
(Neimann Pick1 Like 1)
Je
42 :
Should Not be
given if patient is on PDE5@ DOC : Clonidine to stating Decrease Cholestrol Absorption from
For Ex :
Sildenafil/Tadalafil .
Captopril Nifedipine ,
can also be uped. small intestine >
- ↓↓ LDL

b) Ipsorbide Dinitrate :
(ii) Mild to Moderate HTN withComorbidities :
(iv) PCSK-9 inhibitor :
Preventy degradation of LDL
in Acute Attack
of Angina Scleroderma receptors -
>
Decrease LDL.
Used Sublingually >
- HTN with (KD , Nephrotic Syd , Diabetes Mellitus , Used as add on to

Isosorbide Mononitrate DOC

AGEi/ARBs Stating Evolocumab , Alirocumab .
Drugs
:
()
: . . :

1st pass Metabolism . disorder, Tremors

Does not
undergo >
- HTN with Migraine Hyperthyroidism, Anxiety ,

Used in
longterm prophylaxis of Angina DOC :
BBlockers. (v) Fibrates :
MOA-Stimulates PPAR-U- Increases

BPH DOC & Blocker Glofibrate Lipoprotien Lipase - LVLDL ,

HTN with
Drugs
- : >
>
- :

(ii) Mixed Dilators :

↓ Preload & ↑ Afterload . - HTN with
Raynauds disease Cyclosporine induced HTH
Fenofibrate Chylomicrons
&
Triglycerides,
(a) Sodium Nitroprusside : DOC : CCB
Gemfibrozil
MOA :
Metabolized into NO - Vasodilation >
- HTN with Osteoporosis ,
CKD with Edema . Uses : DOC in
Hypertriglyceridemia .

Uses : HTN
Emergency DOC :
Thiazides Doc in
Chylomicronemia Syndrome
Aortic Dissection Always with B .

# ANGINA : DOC in
Type III Hyperlipoprotinemia .

3/5 :
Cynaide Toxicity , Hypothyroidism .
Treatment :
S/2 :
Myopathy , gall stones .

(Bezafibrate do not

(b) RAAS Inhibitors : (i) Acute Attack -> DOC is S/LNTG cause Myopathy)
Captopril Test
in Stable
Angina NTG decrease preload which ↓d Myocardial Niacin & Sensitive Lipase Activity
>
- ACE inhibitory >
-
(vi) : MOA- Hormone
DX of Renovascular
Captopril Lisinopril , Oxygen demand .
↓ (DL , & 4 HDL
(Maximum)
Hypertension
Vasodilation.
Fosinopril Enalapril , >
- in Variant Angina NTG helps in
Coronary uxes : Add on to stating,

Enalaprilat Term Prophylaxis Used in Dyslipidemia with ↓ HDL.

Long
:
(i)

Upes : DOL in HTH associated with Diabetes Mellitus - Variant Angina

:

Long Acting Nitrates ; CCB

S/E : Insulin Resistence ,

CKD/ NephroticSyndrome .
>
- Stable Angina Long Acting Nitrates :
; (CB
; BBlocker ; Ranolazine Hepatotoxicity
S/3 :
Dry Cough , Angioedema . Best .

Flushing (DOL :
Aspirin)
 RENAL SYSTEM
# Diuretics :

(i) Carbonic
Anhydrase Inhibitor :
(ii) Loop Diuretics :
(iii) Thiazides :

Limb Distal Convulated Tubule

Site of Action : Proximal Convulated Tubule Site of Action : Thick
Ascending of LOH Site of Action :

Mechanism of Action : Block Carbonic Anhydrase MOA : Block

Nalk/2Cl Cotransporter Mech. of Action : Block
Na/Cl Cotransporter.

Drugs :
>
- Actazolamide : DOC in Mountain Sickness
upes : Furosemide Uses : DOC for HTN with
Edema)Osteoporosis
4 Also used in Pseudotumor Cerebri DOC for Pulmonary Edema DOC for Nephrogenic Diabetes Insipidus.
>
- Dichlorphenamide : DOL in
Hypokalemic Periodic Renal Insufficiency [GFRC40] Side Effects : Hypokalemia
Paralysis.
Side Effects : Hypokalemia Metabolic Alkalosis

/E : ·

Hypokalemia ·

Hyperammoremia Metabolic Alkalosis Hyperglycemia

·
Metabolic Acidosis ·
Somnolence
Hyperglycemia Hyperuricemia
·
Renal Stones Bone Marrow
Supression Hyperuricemia Hypomagneseria
>
- ClI in Liver Cirrhosis. Hypomagnesemia Hypercalcemia
Hypocalcemia .

Sparring Diuretics
+
# Vasopressin
:
(iv) K (v) Mannitol :
:

Cortical Duct
Site Action
Collecting Desmopressin Effects
:
of Site of Action : PCT & Loop (i) Side :

Mech of Action : Block Mineralo corticoid Receptors in Central Diabetes Insipidus

Mech of Action : Osmotic Agent DOC >
- Water Intoxication

Ex : Spironolactone . Nocturnal Enuresis

Upes : DOC for Cerebral
Edema >
-
Flushing
DOC Cirrhotic Edeman & Resistant HTN Hemophilia A
for DOC for Acute Congestive Glaucoma . >
- Headache .

5/2 -
Hyperkalemia , Metabolic Acidosis,
Side Effects :
Hyper/Hypokalemia Von Willebrand Disease .

Gynaecomastia .
Hyner/Hyno Natrernia
(i) Terlipressin
2nd Mech Acute Vatical
Bleeding
of Action Block ENaC
/Acidosis DOC in
:
Metabolic Alkalosip

En : Amiloride
Pulmonary Edema (ii) Coniraptan (Vasoprenin Antagonist)
DDC for Lithium induced Diabetes Insipidus.
(1 : Active Intracranial Bleed . Used in
Emergency Mx
of SIADH
(IV)
SIG :
Hyperkalemia ,
Metabolic Acidosis.
(iv) Tolvaptan/Mozavaptan (Vasopresin Antagonist)
Term Mx
Used in
Long of SIADH
S/3 :
Tolvaptan in Hepatotoxic

in Free WaterClearance
Effect of Diuretics
:
*

Charance
(i) Carbonic Anhydrase Inhibitors >
- Increase Positive Free Water

water clearance
(i) Thiazide - Decrease the
free
water clearance .
(iii) Loop Diuretics + Decrease both tre & -re
free
 CEN TRAL Nervous S YSTEM

↑I
Channel Blockers Continued... Disorders
#
Neurodeg enerative
:
# Anti Epileptic Drugs : # Na

(i) Calcium Channel Blockers : >

-
Carbamazepine :

mer
DiapeMild/Moderate/Sereve
>
- VALPROATE : ·
DOC in PartialSeizures

MOA- >
Blocky CalNa Channels ;
~
I sep EABA ·
Dol in
Trigeminal Neuralgia Alzheimer's

DOC in STCS/MS ·
Side Effects : Mnemonic - HEADS DO ( : Donepezil .

Drugs Rivastigmine Galantamine,

Tacrine
>
- Mixed Seizure Syd . H ->
Hyponatremia /Hypersensitivity other :
,

>
- Rapid Cyclers E >
- Eosinophilia >
- NMDA Blockers
:

>
- Rheumatic Chores.
I
A >
-
Ataxia/Agranulocytosis)Aplastic Anemia Memantine is used ap Add on to
Cholinergies.
Defect Inhibitor
Effects (i) Neural Tube Diplopia Amyloid
:
Side : D >
- >
-
B

vi) Vomiting ; Nausea (M)2) S >

- Steven Thorson Syndrome Aducanumab (used in Mild
Alzheimer's)
(ii) Alopecia Y A/W HLA-B-1502
gene
.

(iv) Liver Toxicity (ii) ALS ·

ve

(v) Pancreatitis >

-
Oxacarbazepine/Eslicacarbezepine Actate - Riluzole : ↓ Glutamate Release ; Blocks Na Channel .

(vi) Obesity Causes Less

·
Hypersensitivity but more Hyponatremia than
>
- Edaravone : Free Radical Scarenger .

(vi) Increased Ammonia

Carbamazepine

(11) Carnitine Antidote

ammonemia
(iii) Parkinson's Disease :

ve n e e

Hepatotoxicity /Hyo (ii) Increase GABA effect : >

- Levodopa DOC-PD in 765 years.

Tremor. Carbidopa to inhibit peripheral

(ix) >
- Tiagabine : 3 Always Combine with

>
- Ethosuxamide : O
Inhibity GABA reuptake. decarboxylation .

MOA :
Blocks Ca Channel
·
used in Partial Seizure 3/6 of Levodopa
:
Dyskinesia , Orthostatic Hypotension

DOC in Absence Seizures. Psychosis ,

Anorexia, Nausea /Vomiting ,

>
-
Lamotrigine : abatrin :
Mydriasis.
MOA :
Blocks Na/Ca Channels ; Jeep 9Intamale Mot :
Inhibits GABA transaminase
-
Inhibiting GABA Metabolism .
/I in
Glaucoma &
Psychosis.
Used in GTCS/MS/PS/LgS DOC in
Infantile Spasm with Tuberous Schrosis.
>
- MAO inhibitory :
Rapagiline, Selegiline, Safinamide
.

used for Seizure Parkinsonism .

S/E SJS be Partial in
Early Onget
.
: O can also DOC

>
- Topiramate : o
S/3 :
Visual field defects >
- COMT inhibitors :

MOA :
Blocks Na Channels/Ca/AMPA) Kainale- 2
>
-
Pregabalin/ Gabapentin :
En tecapone , Tolapone, Opicapone .

Opens K Channely O
its a
GABA Analogue Used in On-off Phenomenon .

Used in
<Tcs/ps/Lg3 ; Migraine Prophylaxis 8 MOA :
Bindy to
presynaptic X162 Subunit
of Presynaptic Voltage
Calcium Channels.
3/3 : Renal Stones , Angle Closure Glaucoma , Gated
Leg Syd
.
Metabolic Acidosis ; Weight Loss . O
DOC in Restless

DOC in Post Herpetic Neuralgia

(ii) Na Channel Blockers :

Decreasing Glutamate Effect :

>
-
Phenytoin : (iv) Druga
uses : Oral >
-
gics/PS - Perampanel/Telampanel
IV >
- Status Epilepticus .
AMPA blocker Can be used in
;
Partial Seizure .

Effects Mnemonic HYDANTOIN Other

Drugs
side : >
- :
#

H- >
Hirsutism/Hyperplasia of Gump (Hynerglyumia 1 . Levetiracetam >
- DOC
for Epilepsy in
Pregnancy
Y >
- Lymphadenopathy Bindy to SVLA on Vesicle & Modulates Release
of .
Neurotransmitter

Decreased Vit D for Infantile Spasm without Tuberous Schrosis.

D- + Diplopia , 20 ACTH : DOC

A- Ataxia (West Syndrome)

N- > Nystagmus
T + Teratogenic
0- Ostromalacia

Bluding in

-
1- Increased New

N >
- Neutropenia/Anemia .
 ⑧ Opioids used in Anaesthesia :

# Sedative Hypnotic : * Dual Orexin Receptor Antagonists : >

-
Fentanyl + 100 times more
potent than Morphine

Drugs
:
Surovexant/Davidorexant - Sufentanil -> Most Potent Opioid.

# GABA Agonists :
DOL in Sleep Maintence . >
- Remifentanil - Fastest & Shortest
Acting Opioid.

(2) Benzodiazepens : 3/2 :

Worsen Depression & Suicidal
Tendency
MOA :
Increase Frequency of Chloride ion channel -
Exogenous Opioids : Mixed
Agonist/ Antagonists
Opening. * D2 Agonists
:
>
- Pentazocine (Uyed as Analgesic)
>
- Ultra Short
Acting :
Remizolam Pramipexole , Ropinirole ,
Rotigotine .
Y ClI in MI

in Pt < 65 yop.
Shortest
Acting Triazolam , Midazolam Doc in Parkinsonism Bupernorphine
.

>
- : -

>
- Short
Acting :
Temazepam Oxazepam , , 3/5 :
Fatigue , Compulsive Gambling/Sexual Activity .
PA at u
, Antagonist at K

Lorazepam , Estazolam Used ap Opioid Dependence ↓

to Withdraw
Symptoms.
safe in Liver Faliure/Elderly * Amantadine :

induced
>
-
Long Acting :
Diazepam , Clorazepate
, DOC in Levodopa Dyskinesia. * Opioid Antagonsist :

Chlordiazepoxide Quazepam , S/E : Ankle Edema , Livedo Reticularis. ii) Central >
- IV Naloxone (DOC for Opioid toxicity)

Flurazepam , Alprazolam Oral Naltrexone (Prevent Opioid Relapse)

8
Uses : # Opioids ,
Alcohol &
Smoking : S/2 >
-
Hepatotoxicity ,
Deprasion

Lorazepam
>
-
: DOC in Status Epilepticus. (ii) Peripheral
>
- Chloradiazepoxide)) Chlorazepate/Diazepam (i) Opioid Receptors
:
>
- Methy/naltrexone
:
Naloxegel , Naldemedine

for Alcohol Dependance . Mnemonic MUSCARINE used in Opioid induce Constipation

>
- u Receptor effects : ->

- Alprazolam :
Anxiety M + Miosis >
- Alvimopan
:
Used in Post Op less.
-
Flunitrazepam (Uped for DateRape) 1 >
- Urine Retention & Withdrawl of Opioids

Midazolam/Lorazepam/Diazepam Anesthesia S Sedation Effects of # Alcohol Dependance

:
:
>
- >
- Opp u

-
Remimazolam : Sedation inShort Procedures. c -> Constipation, Convulsion receptors Eg. Mydriasis .
2 Disulfiram :
Blocks
Aldehyde Dehydrogenase
.

Palpitations
S/3 Anterograde Amnesia
:
. A ->
Analgesia >
- Increases Autylaldehyde >
-
Coming
Sweating (Creates Aversion)
Convulsions,
R >
-
Respiratory Depression & Constipation , Tremors , Dyspnea ,

(2) Z Compounds : 1 >

-
Increased Muscle
Rigidity Miosis do not show Needs Atlast 12 hours of Abstinence before starting
.

MOA :
Selective Agonist & &1 Subunit
of N- > No bile flow Tolerance .

2. Naltrexone :
Opioid Antagonists; Decreases
Craving
.

Craving
GABAA Receptor .
E >
-
Euphoria .
3
. Acamprosate GABA Analog ; Decreases
:

.
Ex :
Zolpidem ; Zalpelon ; Eszopiclone .
Used in Insomnia, Jet Lag
. (ii) K-Receptor Effects :
# Smoking Dependance
:

.
Constipation , Analgesia, Dysphoria 1 .

Bupropion

(3) Barbiturates :
(iii) & Receptor Effects : 2 .
Varenicline (Most Effective)
MOA-GABAA Agonists
: Increases duration
Analgesia ,
Modulate Release
of Hormones & Neurotransmitters). & Partial Agonist at Nicotinic Receptor (44B2)
channel
Chloride
of ion .
3 Nicotine Replacement :
Gums Lozenge , ,
Patch.

Opening. *
Endogenous Opioids :
Enkephalin, Endorphin , Dynorphin .

dogep acty Mimetic

>
- At
high as GABA
>
- Decreases Glutamate .
Exogenous Opioids : Full Agonists
- Ultrashort Acting
:
Thiopentone, Methohexital -> Morphine :
Used in
Acute/Chronic/Severe Pain

Used in Induction
E S/E Increased Intracranial Pressure.
(11 in Trauma
Head
of Anesthesia :

Short : Butobarbital Secobarbital ,

>
-
Acting ,

Pentobarbital (Preanaesthetic) -> Codeine :

Uped Ap Anti-Tussive

Long Acting Phenobarbital Pethidine DOC for Post Operative Chilly.

: :
>
- >
-
-

DOC in Neonatal Seizures Can Also be used for Labour Pain.

DOC in Crigler Najar Syd II S/E :

Neurotoxicity ,
Serotonin Syndrome .

S/E : Acute Intermittent Porphyria .

1/2 with MAO inhibitors
,
& Renal Faliure.

* Melatonin Agonists : >

- Methadone :
Has No Withdrawl Symptoms.
to decrease Withdrawl
·
Rameltin >
- DOC for Sleep Induction &
JetLag .

Uped ap Opioid Dependance Symptoms.

·
Lepp Addiction Potential than 2 compounds. S/E :
GT Prolongation .

·
Aglomelatine >
- Used in
Major Depression >
- Loperamide :
DOC in Non Secretory Diarrhea

·
Taximelton >
- Used in Sleep Awake disorder in
+ Tramadol :
Inhibits Uptake of 5HT/NEL2 Agonists .

Blinds .

41 with MAOO

Can be used in
Mild/Mod Pain & Post Op Chills.
 Side Effects
Anti-Depressants Amphetamine . #Extra Pyramidal
: Similar to :
# >
- Buprapion :

Y Increase NE) DA
(i) Typical Anti Depressants :
used in
Smoking Dependance . (i) Akathesia :
M/C EPS

>
- MAO inhibiters : DOC +
B Blockers

Trancyclopromine, Isocarboxaxid , & Novel Antidepressants :

Acute Dystonia Earliest EPS
Drugs (i)
: :

Phenelzine ,
Moclobemide. () Vilazodone :
No Erectile Dysfunction Abnormal Posturing
4 SSRI &
Used for Atypical Depression .
JHTIA Partial Agonist .
Due to D2 Blockade

S/3 Rxn . ⑦ Benzhexol Promethazine

*
: Serotonin Syndrome , Cheese (i) Vortixetine :
Eretile Dys DOC : >

Y SSRI &
SUTIA/IB Partial Agonists. (iii) Parkinsonism :

>
- Tricyclic Antidepressant :
6 5HTID , JHTz , 5HTy Antagonist. Tremor, Bradykinesia
Drugs :
Comipramine (OCD) Due to D2 Blockade

Imipramine (Nocturnal Aneuresis) * Lithium : Blocks Inositol Monophosphatase. DOC Benzhexol > Promethazine

Desipramine (Cocaine Dependance) DOC

for Mania Prophylaxis (iv) Tardive Dyskinesia :
Most Late EPS

Amitriptyline (Neuropathic Pain) DOC for Bipolar Disorder. Abnormal Movement of Body & Face .

Used as 2nd Line for Atypical Depression . Side Effects :

Hypothyroidism ,
Tremor , Diabetes Insipidus. Due to D2 Upregulation .

S/E >
- MReuptor Block :
Constipation, Hypercalcemia , Leucocytosis ,
Teratogenic. DOC VMAT2 Inhibitors
Urine Retention
, Mydriasis .

- C1 in 1st Trimester of Pregnancy Valbenazine , Deuterabenazine .

Syndrome Most Lethal EPS

Sedation
Toxicity Vomiting Profuse Diarrhea. (v) Neuroleptic Malignant
:
H1 Block Nausea,
: :
>
- >
- ,

>
- H2 & 5HT2 Block :
Obesity Rigidity Hyperthermia
, ,
Autonomic .
Disability
Postural Hypotension
>
- 21 Block : .
# Antipsychotics :
Due to D2 Blockade .

Acidosis & Dantrolene

*
Toxicity cause Metabolic DOC :
can

Arrhythmia (i) Typical Antipsychotics 2nd Bromocriptive .

Line
for Psychosis. Drug
.
Specific
:
: Used ap Most

>
- SNRI : >
- Blocks D2 Receptors

Venlafaxine (Withdrawl Sym )

.

Drugs :
Drugs : Thioridazine

Desvenlafaxine
Milnacipran .
, Duloxetine, Chlorpromazine
Molindone
3 Low
Potency D2#

Trifluoperazine Perphenazine
3 High Potency
>
- SSRI :
Fluphenazine , ,

Drugs :
Fluoxetine (Longest Acting) Haloperidol, Properidol D2 #

Paroxetine (Shortest Acting (ii) Atypical Antipsychotics :

Maxm Withdrawl Sym MOA : Block 5HT2 7 D2

* Uses : DOC for Typical /Atypical Depression Drugs :

(i) Clozapine :
Least Potent D2 Blocker .

DOC for Premenstrual Syndrome . DOC for Resistant Schizophrenia.

DOC for Neurosis (OCD ,
Phobia
eta) Reduces Suicidal Tendency .

* Side Effects :
S/E of Clozapine :
Seizure , Myocarditis Agranulocytosis,
,

Insomnia Sialorrhea .
Increased 5HT + 5HT2 >
-
Anxiety ,

Vivid Dreams ,
Erectile Dysfunction , (ii) Risperidone : Max D2 Blockade.

Anorgasmia ,
Delayed Ejaculation .
vii) Quetiapine
: Can Cause Cataract

+ 5HTz >
-
Nausea/Vomiting (iv) Aripiprazole : Partial Agonist of D2/5HTIA
+ 5HTy >
- Loose stools. (v) Ziprasidore/Lurasidone 5HTIA Agonist. :

(v) Pimavenserin :
Only 5HT2 Blocker

& induced
psychosis
ii) Atypical Antidepressants for Levodopa
: DOC .

Common Side Effects :

>
- 52 Blockers :
(i) D2 Block >
- EPD , Hyperprolactinemia .

·
Trazadone >
- Can cause Prianism & Max by Haloperidol Risperidone ,

Sedation . 4 Min by Thioridazine, Clozapine

·
Nejazodone >
- Can Cause Hepatotoxicity (ii) M Block ->
Constipation , Urine Retention

·
Mirzatazapine >
- Used ap DOC for Depression (ii) H
, Block >
- Sedation

D Dysfunction & Insomnia.

with Erectile (iv) H +
, 5HT2 Block >
-
Obesity
Blocks X2 >
- Release 5H7 & NE . (v) <, Block >
- Postural Hypotension .

Also Blocks 5HT & 5HT3

Blocking H1 causes Sedation

 ANTI MICROBIALS
# B Lactamy :

B and generation
O Used in
:
- Minocycline :
Leprost

10 Penicilin : Narrow Spectrum >

- Cefotetan Cefoxitin , (Anarcobes) >
- Demeclocycline : Used in SIADH

>
- IV Aqueous PenicilinG Used in Lung Abscess, Colorectal Infection,
PID . -
Tigecycline
:
Used in Resistant
Infections (MRSA/VRSA)
&
>
- Oral Penicillin V >
-
Cefuroxime (Gr ve/-ve Arcobes)
+
(Uped (v) or NDM, Beta Lactamage
Producing Bacteria .

>
-
Long Acting IM : Procaine P G
. .
Used in Pneumonia ,otitis ↑ Side Effects of Tetracyclines : PACKET (Mnemonic)
Probenacid P G. P >
- Photosensitivity
.

Benzathine
P
.

G .

@ 3rd Generation (gram-re Arcobes) A -

ALT/AST Raised

3
Uses :
Syphilis >
- Ceftriaxone (IV) DOC for E Coli
.

,
Klibella , Providencia C >
- Cerebri Pseudotumor

(Diabetes Insipidus; Acute Renal Faliure)

.
Streptococcus Typhoid Meningitis Gonorrhea
, , K >
-
Kidney
Yaw& - Cefixime : Oral DOC
Thypoid
for
.
E >
-
Esophagitis Except Doxycline
DOC PG
:
Benzathine
.
.

for Pseudomonas. T in Children -

Leptospirosis leftazidime IV Teeth
Yellowing
: DOC
>
- >
-

gay Gangrene for Neuro Syphilis ↑ C12 in

Pregnancy ,
Children ,
or with
Milk/Antacids.
Rate Bits Fever DOC is
IVAquousp G . 4th generation :
.

Actinomycosis Cofipime/ Cefpirome (IV) >

- Aminoglycosides (Drugs Acting on
30s)
Pseudomonas Enterobacter. Protien Synthesy
>
- Moderate Spectrum :
Usep same as Seftriaxone + +
MOA :
Misreading of
RNA >
- Induce Toxic

(Penicilinage Resistant Penicillin

/Anti-Staph) >
- Gentamycin) Streptomycin : DOC
for Plague & Tularemia

>
- ORAL : Oxacillin , Cloxacillin
,
Dicloxacillin ② 5th Generation :
- Oral Neomycin :
Gut Sterilization in Hepatic Encephelopathy

Used in Mastitis ; Cellulitis. Ceffobiprole/Ceftaroline (IV) S/3 :

Nephrotoxicity ,
Neuromuscular toxicity Ototoxicity
,
.

>
- IV : Oxacillin , Najuillin ,
Methicillin.
Upey same as Ceftriaxone +
Staph/Strep including MRSA .
Max Auditory Ototoxicity : Amikacin

>
- Used in SevereInfections like :
Endocarditis. Maym Vestibular Ototoxicity Streptomycin : .

Er DOC for MRSA : IV Vancomycin 3 .

Carbapenems :
-
VRSA :
Daptomycin DOC for ESBL
,
Enterobacter, Servatia, Acinetobacter. # DrugD Acting
on 50S :

Spectrum Short combined [Cilastatin. Blocks Translocation .

Imipenem
:
>
- Wide :
Acting ; Always (i) Macrolides : MOA

Ticarcillin.
>
-
Carboxy penicilling : Carbenicillin , Metabolised by Renal
Dehydropeptidase >
-
Erythromycin
: DOC in Perfusis ,
.
Diptheria

>
-
Ureidopenicilling : Piperacillin .
S/3 : Micro SD Card (mnemonic
>
- Aminopenicilling : >
- Meropenem, Doriperem, Ertapenem Micro : Motilin Receptor Stimulation .

(Hypertrophic (
·
Amoxicilline Better Oral Absorption 4 .
Monobactamy S : Skeletal Weaknes Pyloric Stenosis

Preffered for systemic Inf" >

- Aztrionam (Gram-re in
penicillin allergic patients) D : Diarrhea

·
Ampicillin : DOC
Jacalis for E .
>
- No Cropp Sensitivity
with
penicilling. Card : Cholestatic Jaundice , Cardiac Arrhythmia .

Less Oral Absorption but preferred Orally for Carithromycin :

Used in
Mycobacterium, H
Pylori.
.

>
-

intestinal Pneumonia
infection Drugs Atypical
* Other : DOC in
>
-
Azithromycin :

IV Ampicilin :
DOC for Listeria meningitis. (1) Vancomycin MOA-Blocksd-ala Blockp
:
, Transglycosylation .
Campylobacter
MRSA and E
* Side Effects of B-Lactamy : DOC
for
.

Faecium . Chlamydia
>
- Hypersensitivity S/E Red Man Syndrome . Cholera in
Pregnancy
>
- Pseudomembranous Enterocolitic (MC) (ii) Fostomycin/fosmidomycin :
Used in UTI. Cholera in Children .

zodgen Cephalosporin) Aminopenicillin .

vii) Bacitracin :
Topical >
- Staphylococcal Nasal Carrier
is oxazolidinidiones :

and Line TB
Disulfiram Like Rxn &
Hypoprothrombinemia (iv) Cycloserine drug Linezolid- S/E Supression
.
Bone Marrow
: :
>
- >
- > :

↓ Mitochondrial
Glamandole Cefotetan Cejoperazone ,
, , Toxicity
Used in Resistant
MAO inhibition
Moxalactam . # ANTIBIOTICD : Protien Synthesis Inhibitory :

infection ,
Seizure Imipenem and
drug (BD closing)
:
>
-
MRSA VRSA & Line TB .

->
Hepatotoxic : Oxacillin , Altreonam
⑧ Drugs Acting on 305 :

>
-
Neutropenia :
Nafcillin * Tetracyclines : MOA-Blocks Receptor Site. >
- Tedizolid :
Longer Acting , Less bone Marrow
Toxicity.
Usually used Orally for Mani
Bioavailabity (Minocycline
.
+ 100.
)
2.
Cephalosporing : >
-
Doxycycline is DOC
for :
My PINK RBC (Mnemonic
(ii) Streptograming (Quinupristin Dalfopristin) +

① Ist gen
:
Gram the Arcobes. My - > Mycoplasma (STD) used in MRSA, URSA , VRE

Cejazolin IV : DOC
for Surgical Prophylaxis Pinke >
Plague prophylaxis S/E :
Pain/Inflammation & Site
of injection .

I
Gladroxil Cephalothin (ORAL) Mastitis, (v) Lincosamide (Clindamycin)
:
,
R >
- Ricketsia

Cellulitis. B >
- Borellia ,
Brucella DOC for TSS, Supradiaphragmatic Anarcobey.
C >
-
Chlamydia ,
Cholera .
S/E Pseudomembranous Enterocolitis.
 - Drug Acting on 505
(Continued :
# Antifungal Drugs :

in Cell Membrane
() Pleuromutiling : Inhibit Peptidyl Transferase. (i) Amphoterecin B : MOA- >
Sequestered Ergogestral (b) HepatiticC :
Interferon &

Retapamulin (Topical Uses >

- DOL in Systemic Fungal Infection DOC -
Hep B with D

Lejamulin : Used in Resistant Pneumonia. S/E :

Hypokalemia, Kalazar, Mucormycosis Not
preferred for Hepatitic (due to Bone Marrow Suppression.

(vi) Mupirocin :
Topical DOC
for Staphylococcal Nephrotoxicity Cryptococcal Meningitis >
- Ribararin : Blocks RNA Polymerase
Nasal Carrier. Talaromyces Oval
for Hepatitis
(

(vii) Fidaxomicin :
Inhibits RNA
Polymerase .
(i) Azoles : MOA-Inhibity Ergogestral Synthesis in Cell Membrane . IV for severe Influenza.
treatment
for Pseudomembranous Entercolitis Demethylase Inhalational :
. 14x-Sterol
.

By inhibiting
. DOC RSV
Doc for

(viii) Chloramphenicol
:
S/E-Bone Marrow
Suppression >
- Fluconazole : DOC in Candida
(Vaginal & Albicans Species DOC for RSV
prophylaxis >
- Palivizumab .

Blue Baby Syndrome

.
- Araconazole :
DOC in Endemic
Mycosis Dermatophytes Sporotrichosis.
,

Invasive Inhibitor
Aspergillus
:
>
- Voriconazole : DOC in # Reverse Transcriptage
& GVHD.
# Drug Acting
on Cell Membrane :
>
- Posconazole :
Mucormycosis ⑦ Nucleoside RTI

(i) Polymyxing : From pseudopores after binding to

(ii) Terbinafine
:
Inhibits Ergogestral Synthesis By inhibiting Squalene - Zidovudine :
1/3-Bone Marrow Suppression .

.
Cell Membrane .
Epoxidage . Myopathy Hepatotoxicity
,

>
- Polymyxin B :
Topical for Skin
Infection used >
- in
Dermatophytes. (42 if Hb < 9g(d()
41T infection (Shigella) (Caspojungin Micajungin Anidulafungin) Lamivudine/Emtricitabine) Tenofovir :
Oral for (iv) Echinocanding , , >
-

Polymyxin E (Colistin) (IV] Glucan Synthase Least toxic NRTI's & preferred Regimen in .
Blocks B
:
>
-

NAMIB Lactamase producing Bacteria Used in Aspergillus and Candida.

>
- Tenofovir :
S/E >
-
Nephrotoxicity
$2 Nephrotoxicity,
: Neuromuscular Toxicity (v) Griseofulvin :
Blocks Microtubules. 1/1 in Renal Faliure , Age < 10
years
.
12 with
Aminoglycosides DOC for Tina Capitis Weight (30 kg
.
(i) Lipopeptide (Daptomycin) :
(vi) Flucytosine :
③ Non-Nuchoside RTI

DOC for URSA (IV) Prodrug of 5FU-Blocks DNA synthesis Nevirapine, Ejavirenz , Etravirine, Rilpivirine

(12 & DOC Perinatal Transmission

S/E
for Cryptococcal Meningitis.
Pneumonia
.
:
Myopathy
:
Used to Prevent of HIV

* DOC in URSA Pneumonia is Linezolid. se Fetal

repatotoxicity
.

# Antiviral Drugs : # Protease Inhibitors :

Antifolate Drugs Metabolized byCYP3A4

:
# All are

CYP2119
>
- Sulfonamides :
Blocks DHPS (i) Anti-Herpes Virus Drugs
:
Except Nelfinavir -
>

>
- Sulfadiazine + Pyrimethamine : Toc Toxoplasmosis (a) Acyclovir/Ganciclovir : MOA-Block DNA
polymerase and All are Inhibitors of CYP3A4

>
- Trimethoprim + Sulfamethoxazole (Cotrimoxazole) DNA chain
elongation .
All cause dyslipidemia Lipodystrophy & ,
Hyperglycemia .

DOC
for Pneumocystic Nocardiosis, >
- Oral Valaciclovir) Acyclovir >
- DOC for MSV/VIV >
- Ritonavir :
Most Potent
Enzyme Inhibitor.

Cystitis, Cyclosporiasis, used. Inhibitor Used with Atazanavir,

Prostatitix , in HSV Encephalitis : IV
Acyclovir ip >
- Cobicistat :
Enzyme
Isoporiasis, Jarcocystosis. >
- Oral Valganciclovir >
Ganciclovir -
> DOC for CMV Refinitis Darunavir , Elvitegravir.
Topical Patient Causes Nephrolithiasis.
DOC in Burn
S/3 Crystallaria
.
Sulfadiazine Acyclovir Indinavir
: : :
- : >
-

Bone Marrow Bone Marrow Suppression

3/3 Kernicterus , Supression. Canciclovir
.
After Birth
:
:

Acute Intermittent Porphyria (b) Foscarnet : Block pyrophosphate binding site of DNA polymerase. #
Integrape Inhibitory :

Methglobinemia ,
Rash ,
Crystaluria DOC for Acyclovir/Ganciclovir Resistant Herpep .
Raltegravir , Dolutegravir, Bictegravir Elvitegravir ,

.
S/E :
Electrolyte Abnormality
# DNA Gyrase Inhibitory :
(2) Cidojovir : Same ap Acyclovir # Entry Inhibitors :

for Recurrent Laryngeal Papillomatosis .

Enjuvirtide (S/C)
fluroquinolones : DOC
GP41 Blocker :
(i) >
-

>
- Norgloxacin
: Used in UTIs
,
Travellery Diarrhea . >
- (Dy Blocker : Idalizumab (IV)
Traveller's Diarrhea, blocker Fostemsavir
DOC for (i) Anti-Influenza Drugs
:

Ciprofloxacin GP-120
: >
-
>
- >
-

Typhoid Carrier,
Shigella, (9) Amantidine/Rimantidine :
Blocks M Protieh >
- CCR5 blocker : Maraviroc .

Pyleonephritis, Meningococcal & Less Preferred dit Resistence .

Meningitis
Oseltamiriv/Zanamivir Neuraminidase Block Viral Release
.

(B) Block
: >
-

Ciprofloxacin, Levofloxacin Pseudomonas

influenza AlB & Bird Flu
:
>
- Oral Opeltamivir : DOC

& TB
Ofloxacin Moxifloxacin Leprosy Inhalational Lanamivir Oseltamivir Resistence .
:
- ,
:
DOL in

>
-
Gemifloxacin Moxifloxacin Levofloxacin
,
,

Pneumonia
Respiratory Quinolones (ii) Anti-Hepatitis Drugs
-
:

S/E :
Peripheral Neuropathy (9) Hepatitis B :
Entecavir , Adedorir dipiroxil .

(Specific Drugs)
Rash (Photosensitivity) Non Specific Anti HIV drugs : Tenoforir ,
Clevudine
,
Telbirudine

Seizure, Tendinitis Lamirudine.

1/2 & Children .

in
Pregnancy
 # Anti-Helminthic Drugs :
# Anti-Tubercular Drug : Trichinella Spiralis (b) Chloroquine :
>
- Albendazole : DOC for
Isoniazid MoA Activated by Catalage Peroxidase Enterobins Vermicularis DOC Vivax Malaria
for
:
(i)
(A1) Synthesis. Primaquine for 7 days for
then Blocks Mycolic
Acid Echinococcus , Neurocysticercosis. * Add or
Tafenoquine once

Lik
>
- Hap Bactericidal Effect .
& Soil Transmitted Helminths :
Radical Cure .

Whip Hook Worm. Corneal Deposits.

>
- S/E :
Decrease Vit B6 >
- Round Worm, Worm
, -
S/E : Bull's Eye Retinopathy &

Decrease GABA >

- Neuropathy Euphoria
, ->
Triclabendazole :
DOC for Fasciola hepatica .
↑ Malaria in
Pregnancy
Hallucination , Psychosis- Ivermectin :
DOC
for Strongyloides, >
- Vivax :
Doc Chloroquine
Decrease Haem
: Anemia. Onchocerca volvulous. >
- falciparum
:
It Trimester :
Quinine .

(R)
(ii) Rifampicin : MOA-Blocks RNA
Polymerase. Oral DOC for Scabies. 2nd & 3rd Trimester : AlT

Maym Bactericidal Effect S/E Mazzoti Like Reach

Lymphadenopathy.
.

: - Fever , Rash,

X
in Renal Faliure.
Safe Praziquantel
:
>
- Most >
-

S/E :
Orange discolouration of
Urine
DOC : DISH TV (Mnemonic) S/E Impaired
:

flu like symptoms D >

- D .
Latum Alertness.

Thrombocytopenia Pulmonary Syndrome ,

.
I >
- Intestinal T Soleum
(2)
.

(iii) Pyrazinamide :
MOA-Blocks Fatty Acid Synthase.
S >
- Schistosomiasis

Bactericidal Effect H >

- H Nana

S/3 : Most Hepatotoxic T- > T .

Saginata
Hyperuricemia-gout v >
- Vertebrates Infected Lung/Liver Flukes .

Arthralgia .
# Anti-Protozoal Drugs :

(d)
(iv) Ethambutol :
MOA- Blocks Arabinosyl Transferase .
① Amoebiapis :

Bacteriostatic Effect (9) Intestinal Asymptomatic :

.

in Renal Faliure Diloxanide Furate

Most Unsafe
.
S/E :
Eye Toxicity , Optic Neuritis Red Green Colour Blind
,
lodoquinol
Paromomycin .

# New 2nd Line TB

Drug
:
(b) Intestinal Symptomatic

(i) Bedaquiline : Doc :

Metronidazole.
MOA-> Blocks ATP Synthase Chloroquina (Hepatic)
Taken Orally with Food. * Metronidazole :
Produces Nitroanion free Radicals.

S/E :
It prolongation DOC in
Supradiaphragmatic Anarcob inf-

Cl in
Arrhythmia >
- Amoebiasis , Trichomoniasis, Tetanus

(i) Delamanid : >

- Bacterial Vaginosis Giardiasis.
,

MOA-Free Nitro Anion Radical Production .

SE : Disulfiram Like Reaction

Plasma Protien 12 with Alcohol .

High Binding
PI if Serum Albumin <2 .

8g/dL. ② Leishmaniasis :

S/E :
GT prolongation (a) Visceral Kala-Azar
: DOC IV Liposomal Amphotericin B
.

C/I :
Arrhythmia. Oral DOC :
Miltefosine .

Pretomanid (b) Post Kala Azar (Dermal Leishmaniasis) Oral Miltefosine

:
: DOC
vii)

MOA- > Free Nitro Anion Radical Production. (4) Cutaneous

:
DOC Sodium Stibogluconate .

Metabolized by Microsomal Enzymes ③ Cryptosporidosis : DOC Nitazoxanide.

S/E :
Hepatotoxic S/6 :
Green Urine

CI : Liver Faliure. ④ Babesiosis : Tol :

Atoraquone +
Azithromycin .

# Anti Leprosy Drugs : ⑤ Malaria (Plasmodium,

4) Artemisinin Group
:

(i) First Line Drugs - >

Malaria
:
) Rifampicin
: Most Cidal >
- IV Artesunate : DOC for Severe Falciparum
Malaria &
: Dapsone :
Block DHPS (Bacteriostatic) >
- ORAL ACT : To for Uncomplicated Falciparum
Y S/6 Hemolysis : in
GGPD deficiency Neuropathy , Chloroquine Resistant Virax Malaria.

: Clojazimine >
- S/2 :
kthyosis >
- ORAL Artesunate + Sulfadoxime +
Pyrimethamine

(ii) 2nd Line Drugs

:
used in All States.

Bactericidal Lumefantine
Olfloxacin/Moxifloxacin ORAL Artemether + North East.
: :
: >
-

Bacteriostatic
· Clarithromycin :

Minocycline Bacteriostatic.
&
:
 -

RESPIRATORY # Antitussives : # PROKINETICS :

Bronchial Asthma
#
Dry Cough
:
D2 Blockers :
:
*
(1)
(i) Bronchodilators Opioids >
- Codeine ,
Pholcodeine,
Ethy/ Morphine .
Metoclopramide :
Cangep Acute Dystonia & Parkinsonism .

>
- B2 Agonists for Mild/Mod Cough . Domperidone :
Doep not cause this Sla.

Methadone .
>
-
Anticholinergies severe Cough :
Morphine ,

>
-
Methylxanthines >
- Non Opioids : Dextromethorphan (ii) JHTy Agonists :
Mosapride , Prucalopride
Y Blocky
Oral Theophyline) Aminophylline : Persistent NMDA

Asthma
IV Aminophylline : Acute Attack S/E : Hallucination, Dependance . # Antiemetics :

of Asthma . Antillistaminic
>
-
:
Diphenhydramine (i) 5HTz Blocker :

Normal Range
:
5-15mg/L Ondansetron >
- DOC for Cheno Induced Nausea)Vomiting
Toxicity : < 20mg/L *
Directly Acting on
Lungs :
Lidocaine
, Bupivacaine Mogustine
,
.
(ii) NK1 > Aprepitant
Antagonists -
S/3 Guaigenesin Dronabinol , Nabilone
Adenosine Receptor Block Expectorant (ii) Canabinoid Receptor Agonist
: :
: &

PDE-4 Block &

Mucolytics :
N-Acetylcysteire 3/3 Hypotension : .

PDE - 3 Block Ambroxol, Bromohexine. (iv) Dexamethasone .

(i, Mast Cell Stabilizers :

INTESTINAL=
-GASTRO
Sodium, Nedocromil. #AntiDiarrheal Doug
:
Chromolyn
Block (a Channel in Mast Cell, Prevent associated Diarrhea
MOD :
Loperamide : DOC for IBS

& Histamine Release . Diarrhea

Degranulation # Peptic Ulcera Octrcotride : DOC for Secretory
Inhalational Route Asthma aspociated Diarrhea in Females .
>
- for (i) Proton Pump Inhibitors : Alsation : IBS

e Preferred for Children (safest) Omeprazole

(iii) Steroids : Esomeprazole # Laxatives :

>
- Inhalational : Fluticasone (Most Potent) Rabeprazole (Most Potent +
Longest Acting (i) Le Secretory :

Budesonide, Ciclesonide are

DOC for
:
Peptic Ulcer Disease Lubiprostone :
Stimulates Type 2 Cl-Channes

Soft Steroids , Less Side Effects.

Zollinge Ellison Syndrome Linaclotide :
Stimulate quanylate cyclase
DOC in Persistent Asthma Barret's Esophagus (ii) Tenapanor
:
Block NalH Exchanges.

Intermittent Asthma.
Toc in H ·

Pylori (ii) Stimulants

:
Bisacodyl , Senna
S/E :
Hoarsness of Voice (M/2) S/E : Pneumonia, Pseudomembranous Enterocolitis.
(iv) Osmotic : Mannitol

Oropharyngeal Candidiasis. Doccusate

↓ Absorption of Ca
,
Fo
,
Vit B12 (v) Stool softner
:
Na/Ca .

SystemicSteroids Osteoporosis , Hypergastrinemia

: .
>
-

X
Oral Prednisolone & Prednisone : (ii) He Blocker :

Y ICS Resistant Asthma & Acute Excaerbation Limetidine, Ranitidine, famotidine .

of Asthma. DOC for Post Op Aspiration Pneumonia Prevention.

IV Hydrocortisone
: Acute Excaerbation
of Asthma 3/E of Limetidine :
Impotence, Gynaecomastia ,
Galactorhea
.

vii) Ms Blocker
:
Pirenzepine ,
Telenzepine

(v) Anti-Leukotrienes :

(T (y) Dy Blocker : Montelenkast , Zafirlenkast (iv) Gastroprotective Agents :

Lox Blocker : Zileator >

- Misoprostol :
PGEL Analong
Ulur.
S/E :
Hepatotoxic Most Specific Drug for NSAID induced
Gastric
Monoclonal Antibodies S/3 Sever Abdominal Gramp + Diarrhea
(v)
:

(11 Inflammatory Bowel Disease.

Omalizumab : Anti
IgE Mab :

Used in Resistant Asthma >

- Sucralfate :
Aluminium +
Octasulfate of Sucrose.
1/2 in
Atopic dermatitis S/3 :
Constipation , Begoars

124 and /15 inhibitor (11 Taken 2 hours before

Other Drugs
:
:
->

Duplimumab (124) Food : Taken I hour before

Reslizumab (125- Antacids : Taken after 30 mins.

Benralizumab (125) -> Bismuth Subsalicylate & Subcitrate :

used in Severe Eosinophilic Asthma. used in H .

Pylori, Travellers Diarrhea

S/3 :
Black Colour Stool & Tongue.

() Antacids : Combination of Alluminium & Magnesium .

Used in :
Peptic Ulcer
, GERD Dyspepsia
,

Alginate >
- For
GERD
Simethicone >
- GERD & Flatulence
(i) GURH
-
Agonists
:
ENDOCRINOLOGY # Anti-Diabetic Drug :
Goserelin Najarelin , , Buyerelin, Leuprolide (i) GLP-1 Agonists :

>
- Pulsatile Doping
:
↑ Sex Hormones. # Drugs used in Osteoporosis :
Livaglutide Albiglutide 3 Injectible
,

S/E Pancreatitis , Nausea , vomiting

Used For Anovulation , Oligospermia, Resorption .
:

(i) Inhibit Bone

:

Semaglutide() Livaglutide far Obesity

.
relayed puberty .
(a) Bisphosphonates :
-
DOC

S/6 :
Multiple Gestation ,
OvaryCyst/Carcinoma .
Oval : Alendronate, Risedronate ii) Dpp-4 inhibitory
:

>
- Continous Doping
:
↓ Sex Hormone . IV : Pamidronate , Zoledronate .

(Most Potent,
Longest Acting Sitagliptin Saxagliptin Linagliptin (oral)
, ,

Can be used in Renal Faliure.

Used in Er + ve Breast Ca
Uses : DOC in Osteoporosis CORAL)
Endometriosis , Fibroids. Disease (iv) S/c Pancreatitis Angioedema weight Neutral Infection
-
in
Pagets
:
DOC , , ,

Prostate Ca.
DOC for S/3 :
Esophagitis , Osteonecrosis of Jaw, Bone Fracture. (iii) Suljony/Ureas
(i) GnRH Antagonist
.
C11 in Renal Faliure. Glyburide Gliczide Glimepiride Glipizide.
, , ,

Granirelix ,
Abarclix , Letrorelix,
Elagolix Dagrelix
,
(b) Denosumab : Blocks RANK Ligand. S/G :
Hypoglycemia, weight gain
Renal Faliure, Hepatic Faliure.
Simillar to GnRH Agonist & Continous dosing
. Used in Postmenopausal Osteoporosip [High Risk of Fracture. 4/1 :

Sle Females & Estrogen SERM .

Biguanidep (Metformin) & Hepatic Glucose .
: In :
Osteoporosis, (2) Raloxifen :
(iv)
Vaginal Atrophy, Not Flashes
Used in Postmenopausal Osteoporosis. Blocks Gluconeogenesis.
In Males :
Osteoporosis · Impotence , Gynaecomastia .

(d) Calcitonin : used in : DOC

for RX and Prophylaxis of DM-

Used in Post Menopausal Osteoporosis Ovulation

# Aromatage Inhibitory :
, Hypercalcemia Paget's Disease .
, PLOD >
-

Letrozole : DOC in ERtve Post Menopausal Breast Ca Non AlcoholicFattyLiver.

DOC in Anorulation due to PCOS .

(i) Drugs Increasing Bone Formation :
S/E : ↓ Vit B12 Absorption.
Anti Androgens : Lactic Acidosis
.
#
(a) Teriparatide :
PTH Analog
.
(i) 5 x Reductase # :
(b) Abaloparatide :
PTHrp Analog (v) Pioglitazone/Rosiglitazone :

finasteride : Used in BPH,

used in Post Menopausal Osteoporosis [V .

High Risk of Fracture , Decrease Insulin Resistence ; Stimulates PPAR-(

.
for Androgenic Alopecia Bisphosphonates induced Fracture.
DOC
S/6 :
Stimulates ENaC-Edema
,
CHF
, weight Gain .

(ii) Androgenic Receptor Antagonist

:
S/E : Osteosarcoma c/2 Paget's
:
Dipeage. Bone Fracture inFemales

Prostate (a
Flutamide : Used in
() Romosozumab :
Blocks Sclerostin. Hepatotoxicity
SId :
Impotence &
Gynaecomastia .
Used in Post Menopausal Osteoporosis, JV . High Risk
of Macular Edema

Fracture.
# Drugy Acting
on
Reproductive System * Strontium Ranelete both inhibitsResorption Bladder Cancer .

(i) SERM : and stimulates formation .

(vi) Acarbope/Voglibope/Miglitol :

ERte Breast Ca in Disorders Hyperglycemia

.
>
- Tamoxifen : DOC for # Thyroid : Used in Post Prandial

Premenopausal Women .
>
- Hyperthyroidism : 3/6 : Flatulence (M C ). .

,
Osmotic Diarrhea.

S/3 : Hot Flashes , Utrine Ca , Thrombosis.

Methimazole : in
General Population or
2nd/3rd Trimester (vii) SqLT-2 inhibitors :

1st Trimester.
- Raloxifen : Used in Post Menopausal ostroporosis Propy/Thio Uracil : DOC in
Canagliflozin Common S/3 :
Vaginal Infection ,

Ca
in Females with
High Risk of Breast >
- Thyroid Storm : DOC - PTU Dapagliflozin UTI
, Hypotension Dehydration ,
.

>
-
Ospemifine :
Used in Post menopausal Dysparennia S/3 : Common >
- Rash Agranulocytosis
+
Empagliflozin
Choanal Atregia/CutipAplasia Emptying.
(i) JERD :
Methimazole >
-
(viii) Pramlintide :
Amylin Analog Delays .

Gastric
(a) Fulvestant >
+ Used in Resistant ER the Breast (a
PTU >
- Hepatotoxic used S/c for Post Prandial Hyperglycemia .

in Post Menopausal Females .

↑ Potlasium Iodide/Lugols Iodine :
Block Release of T3) Ty Sk : Nausea /vomiting , weight Loss .

(b) Clomiphene Doc for Anovulation .

Used prior to thyroid Sx
: .

# Insulin :
* Radioactive Iodine : Used in
Hyperthyroidism in Elderly
# Growth Hormone
Drugs :
Patients with Arrhythmia Thyroid
(a
, Ultrashort
Acting
:
Alfrezza (Shortep + Fastest Acting
(i) Somatostatin Analogues :
Sk : 20 Cancer C1I :
Pregnancy
Inhalational, taken
immediately before
Octotide, Lanreotide , Papireotide. >
- Hypothyroidism : food .

DOC
for Acromegaly Secretory Diarrhea ,
for Ty Replacement Gluisine, Lispro, Aspart.
.
Fast Actin
Levothyroxine DOC
* : :
, -

Glaucagonoma , Vipoma .
Used in Thyroid Ca/Myxedema Coma
S/c Route ; Taken 15 mins before
Food .

S/E :
Hypothyroidism gall stones. , 3/3 Thyrotoxicosis Osteoporosis Atrial Fibrilation
: , ,
.
>
- Intermediate Acting : NPH
,
Cente

Liothyronine (Tzsalt) Used in Myxedema Coma S/c Route (BD/TDS)

:

vis Pegrisomant
:
Block &H Receptors *

Used in Resistant
Acromegaly >
- Long Acting
: Detemir, Glargine Deglude (longest)
,

S/5 :
Pitutary Adenoma
-after
/ hour

Diabetic Ketoacidosis IV insulin

(ii) GH Analogs
:
Somatrem, Somatropin. * : DOC -
Regular inj.
DOL for Dwarfism . IV Juidy (Ns) Min I hour

S/3 : CTS
, Hyperglycemia ,
Leukemia,
0 1
.

u/kg/ hour .

Diabetes Mellitus .
 Non Selective NSAIDS-CoX#
AUTACOIDS- IMMUNO MODULATOR
:
-

Aspirin
:
>
-

# Anti-Histaminics (HeBlocker) Dose :

50-325mg OD -
Antipyretic (i) Calcineurin Inhibitory
:

Promethazine , Diphenhydramine Dimenhydrinate ,

325-650mg Sos >
-
Antipyretic & Analgesic. MOA :
Block Calcineurin >
- Decrease Transcription of 11-2

used in Motion Sickness , Meniere's disease , Eps.

3-4gm/day -
Anti-Inflammatory. Drugs
:
Cyclosporine, Tacrolimus

>
- Doxylamine : DOC
for Morning
Sickness S/E :
Reye's Syndrome
.
Used in GVHD, Graft Rejection
.

>
- Doxepin : Used ap TCA
Potency & Toxicity :
Tacrolimus) Cyclosporine .

Used ap 5HT2 More Cardiotoxic ; Lepp GlT ip used , if inadequate upe Tacrolimus.
Blocker
>
-
Cyproheptadine
:
# Selective COX-2 : Oker First Cyclosporine
& 2nd
Generation Hy Blockery :
Does Not Cross BBB
(i) Celecoxib, Etoricoxib :
Analgesic , Anti-inflammatory. Common S/E :
Hepatotoxicity 3/6 f Cyclosporine :

Cetirizine
, Levocitrizine, Fexofenadine (i) Parecoxib
: Post Op Pain Nephrotoxicity Hirsutism

# Serotonin Related : vii) Rafecoxib, Valdecoxib : Banned dff M2

Neurotoxicity Hyperlaxia of Guns
Drugs
(i) JHT2 Agonists
:
(iv) Indomethacin
:
Hypertension Hyperuricemia
Buspirone, Ipsapirone, Gepirone. MOA- > Inhibition of Cox2/ Hyperkalemia Hyperlipidemia .

Used ap Anxiolytic Inhibition of Phospholipase AlC Hyperglycemia

(i) 5HTIB/1D Agonists
: Inhibition of Lymphocyte Migration) Proliferation .
(i) m-ToR inhibitory :

DOC Jor Acute Attack of Migraine .

DOC >
- Acute Gout , Bartler Syndrome .
(a) Sirolimus
: Used in GVHD & Graft Rejection .

Drugs- > Froratriptan (Slowest Acting) 3/3 Hypokalemia Thrombocytopenia

.
Oral (v) Ibuprofen :
DOC Jor Closure of PDA . :
,

Rizatriptan (Fastest Acting S/E :

Aseptic Meningity (b) Everolimus
:
Used in Graft Rejection , Renal Cell Ca,

Intranasal >
-
Sumatriptan (vi) Diclofenac :
Good for Arthritis Renal Angiomyolipoma .

Zolmitriptan S/E Hepatotoxic

:
(c) Myophenolate Mojetil
:

Skorug- > Sumatriptan (overall Fastest) (III) Piroxicam :

Undergoes Enterohepatic Circulation. MOA- >
Blocks IMP Dehydrogenase

S/E : Pain in Neck & Jaw Used in

Graft Rejection IBD , Myauthenia Gravis. ,

Chest Pain (Coronary vasoconstriction) # GOUT :

S/E :
41T uppet

(iii) JHTIf Agonists :

(iv) 12-2 Blocker :

Lasmiditan (OraL) : Treatment for Acute Attack (i) Acute

Gout - Noc Indomethacin Daclizumab : Used in Multiple Sclerosis.

used
of Migraine Prophylaxis of Acute Graft Rejection
& Colchicine be too.
.
Steroids can
Basiliximab :
Used in .

(iv) JHTy Agonists :

(ii) Gout Aim to decrease Uria Acid. (v) 3 Blocker :
Chronic :
is CD -

Locaserin (Now Banned d/t Risk

of Cancer) >
- Xanthine Oxidase Inhibitor Muromonab :
Used of Acute
in treatment Graft Rejection .

() 54T2 Antagonists :
(i) Allopurinol + DOC for Chronic
Gout /3 :
Cytokine Release Syndrome .

used in Migraine Prophylaxis. DOC for Tumor Lysic Syndrome .

(vi) Azathioprine :

Cyproheptadine , Pizotifen Methysergide Hypersensitivity Rheumatoid Arthritis,

.
,
3/E :
Uses :
Graft Rejection ,

# Miscellaneous Drugs for Migraine : (ii) Oxypurinol :

Used in Chronic
Gout if patient has Multiple Sclerosis , Inflammatory Bowel Disease .

.
(i) Ergotamine
: Acute Attack of Migraine . Allopurinol Hypersensitivity S/E : Bone Marrow Supression

S/3
.
: can cause gangrene of organs
2
(iii) Febuxostat
:
Used ip Allopurinol ip ineffective Hepatotoxicity
end Arteries.
S/E (vii) Thalidomide
:
Common : Xanthine Stones.
-

(i) Propanolol : DOC for Prophylaxis of Migraine

.
Causes Phocomelia (Terafogen)
(ii) GGRP Ligand Blockers :
Eptirezumab , >
- Uricosuric
Agents :
Uses : Anti inflammatory 3/5 : Sedation

Fremanezumab , Gelcanezumab .
Probenacide , Sulfinapyrazone ,
Benebromarone . Immunosuppressive Peripheral Neuropathy
used in Migraine Prophylaxis .
S/E Urate stones. Anti Angiogenic occular

# NSAIDS-COX Blockers :
Antineoplastic . Rash

Lepp Cardiotoxic ; More 41T Uler

Neoplasia Thrombosis
Non Selective Uricase Analog
:
: >
-
(i)
- Acetaminophen (Paracetamol) Pegloticabe
:
Resistant Chronic Gout Rheumatoid A Constipation .

MOA : TRPV1 & Cannabinoid Receptor Agonism . Rasburicage : DOC for Tumor
Lysis Syndrome .
X
MCC of Drug Poisoning. # Rheumatoid Arthritis :

55 Hepatotoxicity
: .

(Used Risk in Chronic

Alcoholic) Methotrexate +> Doc .
(increases Adenosine
and fasting
. +

if inadequate Sulfasalazine
Steroids - add
Cause NAPPI deplets Glutathione HCG +
. :
:
NSAIDs or

Dose >
20g >
- Fatal - Thfx inhibitory :
Infliximab ,
Adalimumab,
Golimumab Etanercept
,

DOC for this is >

-
N-Acetyl Cystiene .
- IL6 Blocker : Tocilizumab, Sarilumab

Fulminant Liver Faliure Anakinra

if No Response [L-1 Blocker
>
- +>
:

d Rituximab
> CD 20 Blocker :

Transplant+
-

Need Liver
(D
>
- -

80/86 Blocker :
Abatacept.
 -
ANTI-CANCER DRUGB-
* Prevention of Anticancer
drug Induced Toxicity :

*
Alkylating Agents : ⑧ Platinum Compounds

if -
Gosomide Lipplatin , Carboplatin

Bus -
Buyuljan NE Max Vomiting , Nephrotoxic ,
Ottotoxic.

Not >
- Nitrosurea

Prepent >
- Procarbazine * Antimetabolite :
(DHFRaseO)
Take >
- Temozolomide Methotrexate (DOC for Choriocarcinoma)
my >
-
Mitomycin ↑ Mitotic Spindle O :

Vinblastin
Cycle >
- Cyclopshamide Vincristine,

Does Not Cause Bone Marrow Supression .

* Topiramape inhibitory :

Doxorubicin Cardiotoxic
>
-

Daunorubicin to
T
Dexarazone

Cancer
# Monoclonal Antibodies for
:

Cetuximab
>
-
HER1 - Colorectal (a Rituximab Mab
against
Panitumumab CD-20

Transtuzumab (Cardiotoxic) HER-2 - Breast (a

-
Perfuzumab

Treatment of Anti-Cancer Drug S/E

# :

Maxd/t Cipplatin Satron Pitant

① CIN vomiting : -
Early - Late -

② Diarrhea >
- Lopramide

③ Anemia -
Darbopositin

④ Leukopenia -
filgrastin
⑤ Thrombocytopenia >
-
Opeluckin
⑥ Tumor-Lysis Syndrome -
Rasburicase

⑦ Heng Cystitis
>
- To Prevent Mena- >
Steroids

⑧ Nephrotoxicity d/f Cisplatin >

-
Amigostine
⑨ Cardiotoxicity dif Rubicin >
-
Dexrazoxane

Pulmonary Fibrosis >

-
Piperidone .
 -3100D-
I
# Oral Anticoagulanty :

Thrombin Inhibitor

II
(i) ORAL Direct # Antiaggregants :

>
-
Dabigatran # Hematopolitic Agenty :

Xa Inhibitor (i) Aspirin (ORAL)

:
(i) ORAL

Apixaban , Rivaroxaban , Edoxaban MOA :

BlockpCOX-1- > ↓Synthesis of Thromboxane AL (i) Erythropolitin Analogy
:

UCD : DOC for

treatment &
prophylaxis of Dry
used :
Prophylaxis of M2 and Stroke.
Epoetin , Darbopolitin
in Chronic Renal Faliure
DOC
for prophylaxis of thrombosis DOL
for Anemia dit :

Non valvular Atrial Fibrilation. (i) P2412 inhibitory :

(Ireversible) Chemotherapy, Zidovudine ,

Antidotes for toxicity Clopidogrel Used prophylaxis of M2 Dialysis

:
& >
- : in ·

Idarucizumab /XP2C19
>
-
Dabigatran
:
variable effect due to
polymorphism .
SE I :
Hypertensis ,
Thrombosis , Pure Red Cell Aplasia,

>
- Oral XaO : Andexanet alla. Cl2 with Omeprazole .
Fe
deficiency .

Spectrum Antidote for

Ciraparantag Wide Ticlopidine Toxic
G-CSF Analog Filgraptim Lipegfilgrastim
: : : .
-
(ii) ,

Dabigation, Oral XaO , LMWH, UFU & Fondaparinux. S/c :

Agranulocytosis , TTP-HOD , Upset GIT
.
ii1 GM-CSF Analog
:
Jargamostim
>
- Prayagree : Fastest & Most Efficacious Used in Neutropenia d/t HN
, Chemotherapy
*
Warfarin :
Used in PCI in M1
S/E : Bone Pain

Block UKOR- ↓ Activated Vit K. S/E Intracranial Bleed

MOA : :
(r) 1221 Analoge
:
Opalerkin

Coagulation Factor : 11
,
VII
,
IX
,
X Cll :
TIA) Stroke .

used in Chemo induced thrombocytopenia

Anticoagulation Factor : Protien C & S
.
(ii) P2X12 inhibitors :
(Reversible) (V) Thrombopositin Agonist -

Romiplotio,

Ticagrelor Long Acting /Oval Used ITP

for prophylaxis of Thrombosis in
Uses Doc
Eltrombopag
: : : ·

in valvular Atrial Fibrilation (Mech Value)

.

Used in Prophylaxis of M1 & Stroke

.

X
3/6 : Skin Necrosis (Mc limbs) (iv) Vorpaxar (oral)
Protease Activated .
Teratogenic, MOA-Blocks Receptor
Toe
Purple Uph >
-
Prophylaxis of
M1

.
Bleeding. 3/2 >
- Increase Intracranial Blud

& Monitor PT/INR C12 - Stroke/TIA

>
- INR 3-10 (No bleeding)
Restart when INR normal
Stop Warfarin, H fibrinolytics
- :

- INR > 10 (No Bluding (i) Streptokinage

:

Vit . K MOA :
Binds to plasminogen & Uncovery TPA

Prothrombin Comply. Binding Site.

Bleeding DO2 -

# Parential Anticoagulants : Clot Non Specific :

HigherRisk o Bluding

>
- Parential Direct Thrombin Inhibitor :
Requires Higher dope ; Lepp Preferred .

Desirudin Used in DVT Analoga

:
(i) TPA

Biralirudin Use in PCI in MI

Alteplace , Reteplass, Teneteplace
:

Argatroban
:
DOC in HIT Most Clot Specific.

Upd in :
STEMI , Ischemic Stroke, Massive Pulmonary
Indirect Thrombin Inhibitor
:
- Embolism .

* UFH - ↓ Dep Factor X & 11 S/E :

Bleeding (TIE : Tranexemic Acid)

S/c- Prophylaxis 12-TIt .

12 : Brain Tumor/Aneurysm
Antidote : Protamine Sulphate Recent Sx)Trauma
S/3 :
Alopecia , Hyperkalemia Osteoporosis, , Aortic Dissection

Intracranial Bued .
Thrombosis , Thrombocytopenia .

Liver Cirhosis
Cl :
Thrombocytopenia Non Compressive Vascular
punctures.
Endocarditis Severe Hypertension
Alcoholics Eye surgery
& Fondaparinux :
& Factor X only

Dosing OD
,
Both S/2 or IV

DVT Treatment and

preffered for
:

prophylaxis, M1
,
Pulm Embolism .
 -

Note -

whose using this 20th Nbof

Everyone
mind
pharmacology , please do keep in

that this is a review notebook .

Please practice lot

of questions ,
while

review this notebook .

you
The content in these above 17
pages is

at the least that you

something very
should Memorize Heart Iva fried to
by .

conscie it as much as possible keeping

all the impa high yield stuff infact

Sir Pharma
I've used content from Ranjan
Cerebellum and
Book, GRG Sir Lectures from
Murrow RR notex
-

& Shivansh-studies