11.

AN1InILk1LN2IVI
odskup|na Mehan|zam d[e|ovan[a Uc|nc| k||n|cka pr|m[ena Iarmakok|net|ka NeIe|[en| uc|nc|, |nterakc|[e
1. DIUkL1ICI - MIILNIAIU kAVNC1L2U Na I VCDL
1|[az|d|: k|orta||don,
n|drok|ort|[az|d
- bloklra na/Cl LransporLer u
dlsLalnom zavl[enom kanallcu
- sman[u[e volumen krvl
- hlperLenzl[a, blago zaLa[en[e
srca
- p.o
- uclnak: 8-12 h
- gublLak kall[a
- povecana razlna u serumu: glukoze,
llplda, urlcne klsellne (hlperurlceml[a)
nen|eove pet|[e:
Iurosem|d
- bloklra na/k/2Cl LransporLer u
debelom uzlaznm kraku P.peLl[e
- sman[u[e volumen krvl
- Leska hlperLenzl[a, zaLa[en[e
srca
- p.o, parenLeralno
- uclnak: 2-3 h
- gublLak kall[a
- hlpovoleml[a
- oLoLokslcnosL
Stede ka||[:
Sp|rono|akton
- bloklra recepLor za aldosLeron u
sablrnom kanallcu
- lzluclvan[e na povecano, k
sman[eno
- hlperLenzl[a, kronlcno zaLa[en[e
srca, hlperaldosLeronlzam
- p.o
- uclnak: 24-48 h
- hlperkall[eml[a
- glnekomasLl[a
2. LIILkCVI kCII MIILNIAIU IUNkCIIU SIMA1ICkCG 2IVCANCG SUS1AVA
a) S|mpato||t|c| sa d[e|ovan[em na S2S
Met||dopa
- agonlsL !"#$%&'(%) o
2
recepLora
- snlzu[e slmpaLlckl Lonus
vazomoLorlckog cenLra
- hlperLenzl[a
- p.o
- sedacl[a
- hemollLlcka aneml[a
k|on|d|n - p.o l Lransdermalno
- sedacl[a
- opasnosL od hlperLenzlvne krlze ako
se naglo preklne uzlman[e zbog
povecane slmpaLlcke akLlvnosLl
b) o- b|okator|
razos|n - selekLlvnl o
1
blokaLor
- sman[u[e perlfernl oLpor
- sman[en Lonus gl. mlslca
prosLaLe
- hlperLenzl[a
- benlgna hlperLrofl[a prosLaLe
- p.o
- uclnak: 6-8 h
- orLosLaLska hlpoLenzl[a kod prve
doze
c) - b|okator|
roprano|o|,
Ateno|o|
- neselekLlvnl blokaLor
- sman[en mlnuLnl volumen l
perlfernl oLpor-> sman[en Llak
- lnhlblra oLpusLan[e renlna
- hlperLenzl[a
- druge prlm[ene (anglna,
arlLml[e, Lremor, mlgrene)
- p.o, parenLeralno
- uclnak: 6-8 h
- bronhospazam u asLmaLlcara
- Av blok, zaLa[en[e srca
- sedacl[a, poremeca[l sna
3. VA2CDILA1A1CkI
a) b|okator| Ca kana|a
Verapam||,
D||t|azem
- bloklra L-Llp kalcl[evlh kanala u
srcu l krvnlm zllama
- comblne moderaLe vascular
effecL wlLh sLrong cardlac effecL
- sman[ena frekvencl[a l udarnl
volumen
- sman[en perlfernl oLpor
- hlperLenzl[a
- anglna
- arlLml[e
- p.o, parenLeralno
- uclnak: 6-8 h
- Av blok, zaLa[en[e srca
- konsLlpacl[a
b) star|[| vazod||atator|
n|dra|az|n
- uzroku[e oLpusLan[e duslkova
okslda (nC) lz endoLela sLo
uzroku[e dllaLacl[u arLerl[a
- sman[en perlfernl oLpor
- refleksna Lahlkardl[a
- hlperLenzl[a
(korlsLl se l kod zaLa[en[a srca sa
lzosorbld dlnlLraLom)
- p.o
- uclnak: 6-8 h
- Lahlkardl[a
- zadrzavan[e soll l vode
- slmpLoml nallk nallk na lupus
M|noks|d||
- akLlvnl meLabollL oLvara k
+

kanale u glaLklm mlslclma krvnlh
zlla-> hlperpolarlzacl[a l
vazodllaLacl[a
- Leska hlperLenzl[a
- androgena alopecl[a
- p.o, Loplkalno
- uclnak: 6-8 h
- Lahlkardl[a
- zadrzavan[e soll l vode
- hlrzuLlzam
c) parentera|n| vazod||atator|
N|troprus|d - oLpusLa nC
- [aka vazodllaLacl[a- sman[en
perlfernl oLpor
- hlperLenzlvna krlza
- Lesko zaLa[en[e srca
- parenLeralno
- uclnak: nekollko mlnuLa-
zahL[eva sLalnu lnfuzl[u
- Leska hlpoLenzl[a
- nakupl[an[e cl[anlda kod duge
uporabe
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1. Nabro[| 4 g|avne grupe ant|h|pertenz|vn|h ||[ekova | naved| pr|m[ere ||[ekova za svaku grupu. (Inh|b|tor| ren|na se ne smatra[u posebnom grupom, ko[| |[ek spada u ovu skup|nu).
- d|uret|c|- Ll[azldskl (hldroklorLl[azld, klorLalldon), Penleove peLl[e (furosemld), sman[u[u raz|nu natr|[a | vo|umen krv|
- s|mpato||t|c|- sredlsn[l (meLlldopa, klonldln), blokaLorl alfa recepLora (prazosln), blokaLorl beLa recepLora (propranolol, aLenolol), sman[u[u per|fern| otpor, |nh|b|ra[u srcanu akc|[u, povecava[u vo|umen kapac|tantn|h I||a
- vazod||atator|- blokaLorl Ca kanala (verapamll, dllLlazem), sLarl[l (hldralazln, mlnoksldll), parenLeralnl (nlLroprusld), re|aks|ra[u g|atke m|s|ce | tako s|re krvne I||e-povecan vo|umen kapac|tantn|h I||a
- |nh|b|tor| ang|otenz|na- ACL lnhlblLorl (kapLoprll), blokaLorl recepLora za angloLenzln (losarLan), sman[u[u per|fern| otpor | vo|umen krv|
- allsklren
2. Cp|s| kompenzac|[ske odgovore za svaku od 4 g|avne grupe

3. Nabro[| m[esta d[e|ovan[a ||[ekova ko[| d[e|u[u na s|mpat|ck| I|vcan| sustav | naved| pr|m[er |[eka za ta m[esta.
- sredlsn[l- meLlldopa, klonldlla, o-blokaLor- prazosln, -blokaLor- propranolol, aLenolol
4. Naved| 4 mehan|zma d[e|ovan[a vazod||atatora.
- oLpusLan[e duslkova okslda lz endoLela (nlLroprusld, hldralazln, nlLraLl)
- lnhlblcl[a uLoka kalcl[a (verapamll, dllLlazem, nlfedlpln)
- hlperpolarlzacl[a gl. mlslcnlh sLanlca krvnlh zlla oLvaran[em k kanala (mlnoksldll)
- sLlmulacl[a dopamlnsklh recepLora
S. Naved| g|avne vazod||atatore | op|s| n[|hove uc|nke
- blokaLorl Ca kanala- verapamll, dllLlazem- sman[ena frekvencl[a l udarnl volumen, sman[en perlfernl oLpor
- sLarl[l- hldralazln l mlnoksldll- sman[en perlfernl oLpor, refleksna Lahlkardl[a
- parenLeralnl- na nlLroprusld- [aka vazodllaLacl[a
6. Cp|s| raz||ku |zmedu 2 t|pa antagon|sta ang|otenz|na

7. Nabro[| g|avne neIe|[ene uc|nke protot|pa ant|h|pertenz|va

- ACL- angloLenzln konverLlra[ucl enzlm- preLvara angloLenzln l u angloLenzln ll
- renln- preLvara angloLenzlnogen u angloLenzln l
4. INnI8I1CkI ANGIC1LN2INA
a) ACL |nh|b|tor|
kaptopr|| - ACL lnhlblLor
- sman[u[e preLvorbu
angloLenzlna l u angloLenzln ll
-> sman[eno lucen[e aldosLerona
- snlzen perlfernl oLpor
- hlperLenzl[a
- zaLa[en[e srca
- dl[abeLlcka bolesL bubrega
- p.o
- kasal[
- hlperkall[eml[a
- LeraLogen
b) b|okator| receptora za ang|otenz|n
Losartan - blokaLor A1
1
recepLora
- snlzen perlfernl oLpor
- sman[eno lucen[e aldosLerona
- hlperLenzl[a
- p.o

- hlperkall[eml[a
- LeraLogen
c) |nh|b|tor ren|na
A||sk|ren - lnhlblLor renlna
- sman[u[e preLvorbu
angloLenzlnogena u angloLenzln l
- sman[eno lucen[e aldosLerona
- hlperLenzl[a - p.o
- hlperkall[eml[a
- osLecen[e bubrega
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12. ANGINA Lk1CkIS
odskup|na NI1kA1I 8LCkA1CkI kALCIISkIn kANALA -8LCkA1CkI vazod||atator|
Gener|ck|
naz|v
N|trog||cer|n (g||cer|| tr|n|trat)
Izosorb|d d|n|trat
Izosorb|d monon|trat
Verapam||
D||t|azem
N|fed|p|n
roprano|o|
Ateno|o|
S||denaf|| 7
Mehan|zam
d[e|ovan[a
- meLabollzlran[em oslobada
dus|kov oks|d (nC) u gl. mlslcu,
ko[l akLlvlra gvanllaL-clklazu l
povecava cCM, sLo uzroku[e
defosforllacl[u mlozlnsklh laklh
lanaca l relaksacl[u
- kao nlLrogllcerln,
malo duze Lra[an[e
d[elovan[a
- bloklra L-Llp Ca
2+
kanala u zllama
l srcu
( spr[ecava oLvaran[e kanala l Llme
sman[u[e uLok Ca
2+
, unuLarsLanlcnl Ca
l konLakLllnosL mlslca)
- bloklra L-Llp Ca
2+
kanala
u zllama > srcu
- bloklra slmpaLlcke uclnke na
srce l krvnl Llak
- sman[u[e oslobadan[e
renlna
- povecava cCM
lnhlblcl[om n[egove
razgradn[e
fosfodlesLerazom Llpa 3
Uc|nc|
- relaksacl[a gl. mlslca, posebno u k. zllama, osLallh ne
znaca[no
- vazodllaLacl[a vena (posl[edlcno sman[ena vellclna srca
l mlnuLnl volumen zbog man[eg preloada) l veclh arLerl[a
(sman[u[e Llak)- sman[eno opLerecen[e srca l poLrosn[a
klslka
- preusm[erava koronarnl proLok pomocu kolaLerala
prema lshemlcnom podruc[u
- vazodllaLacl[a (sman[en
vaskularnl oLpor-krvnl Llak)
- sman[ena frekvencl[a l
konLrakLllnosL srca
- vazodllaLacl[a
- uclnak kao verapamll,
man[l uclnak na srce
sman[u[e :
- frekvencl[u l mlnuLnl
volumen srca
- krvnl Llak
- relaksacl[a glaLklh mlslca
nevaskularnog Lklva
kavernoznlh Ll[ela
Ind|kac|[e
- subllngvalno- akuLna anglna pekLorls
- oralno l Lransdermalno za profllaksu
- lv. za akuLnl koronarnl slndrom
- profllaksa anglne
(aLeroskleroLska l vazospasLlcna)
- hlperLenzl[a
- nodalne arlLml[e (Sv1)
- mlgrena
- profllaksa anglne
- hlperLenzl[a
- samo prof||aksa
aLeroskleroLske anglne (ne
akuLnl napad)
- hlperLenzl[a
- arlLml[e
- mlgrena

Iarmako-
k|net|ka
- sub||ngva|no- brz uclnak (1 mln), kraLko d[elu[e (13
mln), brzo se lnakLlvlra u [eLrl
- ora|no- spor uclnak, d[elu[e 2-4 saLa
- transderma|no- spor poceLak, d[elu[e 10 h (po[ava
Lahlfllaksl[e)
- |v.
- subllngvalno
- oralno
- oralno, lv.
- Lra[an[e d[elovan[a 6-8 h
- oralno
- Lra[an[e d[elovan[a 6-8 h
- oralno, lv.
- Lra[an[e d[elovan[a 6-8 h
NeIe|[en|
uc|nc|
- orLosLaLska hlpoLenzl[a (zbog vazodllaLacl[e)
- glavobol[a (vazodllaLacl[a menlngealnlh arLerl[a)
- Lahlkardl[a (refleksno, barorecepLorl-slmpaLlkus)
- 18: sman[en[e odgovora nakon lzlagan[a 10-12 h
- Av blok (bloklra[u provodl[lvosL)
- akuLno zaLa[en[e srca
- konsLlpacl[a
- preLlbl[alnl edeml
- [aka hlpoLenzl[a
- bronhokonsLrlkcl[a (asLma)
- Av blok
- akuLno zaLa[en[e srca,
bradlkardl[a
- sedacl[a, umor

Interakc|[e
- slnerglsLlcka hlpoLenzl[a s lnhlblLorlma fosfodlesLeraze
3 (slldenafll)
- adlLlvnl uclnak s druglm
depresorlma srca l hlpoLenzlvnlm
ll[ekovlma
- adlLlvnl uclnak s druglm
vazodllaLaLorlma
- adlLlvnl uclnak sa svlm
depresorlma srca
- slnerglsLlcka hlpoLenzl[a s
nlLraLlma (razmak 6h)
www.perpetuum-lab.com.hr
1. atof|z|o|og|[a ang|ne:
a) Aterosk|erotska ang|na (anglna u naporu, klaslcna)
- aLeromaLoznl plak d[elomlcno zacepl[u[e [ednu lll vlse koronarnlh zlla, s povecan[em srcanog rada, nedovol[an proLok krvl l nedosLaLak klslka uzroku[e nakupl[an[e klsellh meLabollLa l lsheml[ske proml[ene ko[e
sLlmullra[u srcane zlvcane zavrseLke za bol, odmor dovodl do pobol[san[a sLan[a
b) Vazospast|cna ang|na (varl[anLna anglna)
- reverzlbllnl koronarnl spazam koronarnlh zlla, cesLo na m[esLu aLeroskleroLskog plaka, spazam moze nasLaLl bllokada, cak Ll[ekom spavan[a, moze napredovaLl u nesLabllnu anglnu
c) Nestab||na ang|na (akuLnl koronarnl slndrom)
- povecana ucesLalosL l [aclna napada[a ko[l su rezulLaL komblnacl[e aLeroskleroLskog plaka, agregacl[e LromboclLa l vazospazma (prekursor lnfarkLa mokarda-hlLno sLan[e)
2. Nabro[| na[vaIn|[e odredn|ce srcane potrosn[e k|s|ka
- napeLosL srcane sLl[enke
- frekvencl[a srca
- konLrakLllnosL
3. Uspored| terap|[ske | stetne uc|nke n|trata, -b|okatora | b|okatora Ca kana|a u ||[ecen[u ang|ne.
- anglnozna bol nasLa[e zbog nedovol[ne dopreme klslka naspram poLreba- moze se lspravlLl na dva naclna: povecan[em dopreme klslka, sman[en[em poLrebe za klslkom
- skuplne ll[ekova su:
- n|trat| - Lerapl[skl uclncl - sman[u[u mlnuLnl volumen l krvnl Llak vazodllaLacl[om zlla Le preusm[erava[u kolaLeralama krv u lsheml[ska podruc[a
- nezel[enl uclncl - orLosLaLska hlpoLenzl[a, glavobol[a, Lahlkardl[a
- b|okator| Ca kana|a - Lerapl[skl uclncl- vazodllaLacl[a (sman[en krvnl Llak), sman[en[e frekvencl[e l konLrakLllnosLl srca
- nezel[enl uclncl- Av blok, zaLa[en[e, konsLlpacl[a
- -b|okator| - Lerapl[skl uclncl-
4. Cb[asn| zasto komb|nac|[a n|trata | -b|okatora ||| b|okatora Ca kana|a moIe b|t| uc|nkov|t|[a od monoterap|[e.
- komblnacl[a beLa-blokaLora sa nlLraLlma [e korlsna [er onl sman[u[u nezel[ene uclnkenlLraral- Lahlkardl[u l povecanu konLrakLllnosL
S. 2asto [e komb|nac|[a n|trata | s||denaf||a potenc|[a|no opasna.
- nlLraLl povecava[u slnLezu cCM-a, a slldenafll spr[ecava[u n[egovu razgradn[u pa mogu nasLaLl adlLlvnl uclncl l [aka hlpoLenzl[a l hlpoperfuzl[a zlvoLno blLnlh Lklva
www.perpetuum-lab.com.hr



13. 2A1AILNIL SkCA
odskup|na
1. DIUkL1ICI (nen|eove pet|[e,
t|az|d|, stede k) (pog|.1S)
2. AN1AGCNIS1I
ANGIC1LN2INA (ACL-
INnI8I1CkI, b|okator|
angtn receptora ) (11,12)
L|[ekov| s poz|t|vn|m |notropn|m uc|nkom
6. VA2CDILA1A1CkI 7. -8LCkA1CkI 3. GLIkC2IDI
DIGI1ALISA
4.
1
- SLLLk1IVNI
AGCNIS1I (pog|.9)
S. INnI8I1CkI
ICSICDILS1LkA2L
Gener|ck|
naz|v
Iurosem|d (p.o, |v)
n|drok|ort|az|d (p.o)
Sp|rono|akton (p.o)
kaptopr|| (p.o)
Losartan (p.o)
D|goks|n (p.o, |v) Dobutam|n (|v.) M||r|non (|v.) N|troprus|d (|v.) karved||o| (p.o)
Mehan|zam
d[e|ovan[a
l: sman[u[e reapsorpcl[u naCl l
kCl u debelom uzlaznom kraku
Penleove peLl[e
P: sman[u[e reapsorpcl[u naCl u
dlsLalnom zavl[enom kanallcu
S: farmakoloskl anLagonlsL
aldosLerona (sablrnl Lubull)
- lnhlblra enzlm
angloLenzln-konverLazu-
lnhlblcl[a nasLanka A ll
lnhlblcl[om preLvorbe A l
u A ll
- bloklra uclnke All na A1
recepLore
- lnhlblra na
+
/k
+
A1azu-
povlsen lnLracelularnl na
+

- sman[eno lzbaclvan[e
Ca
2+
- povlsen
lnLracelularnl Ca
2+
u S8 -
kod oLpusLan[a povecana
srcana konLrakLllnosL

1
-selekLlvnl agonlsL
- povecava slnLezu
cAM-a
- povecava cAM
lnhlblcl[om
fosfodlesLeraze 3
l povecava uLok Ca u
srce (sllcno agonlsLlma
recepLora)
- sponLano oLpusLa nC
- akLlvlra gvanllaL-clklazu
- kompeLlLlvno bloklra
1
recepLore

Uc|nc|
l: povecano lzluclvan[e soll l
vode- sman[u[e p|ucn| |
per|fern| edem , sman[u[e
preload
P: lsLo kao furosemld,
all man[e lzrazeno
S: povecava lzluclvan[e
soll l vode
- sman[u[e |ucen[e
a|dosterona
- d||atac|[a arter|o|a |
vena
- kao ACL lnhlblLorl
- povecana kontrakt||nost
(mehanlckl)- zbog Ca
- usporeno AV provoden[e
(elekLrlckl)- zbog
paraslmpaLlkusa (moze
bloklraLl aLropln)
- povecana
kontrakt||nost l
mlnuLnl volumen
- povecana
kontrakt||nost
- vazod||atac|[a
- brza | snaIna
vazod||atac|[a sman[u[e
pre|oad and after|oad
- usporava frekvencl[u
srca
- sman[u[e krvnl Llak
- sman[u[e smrLnosL
Ind|kac|[e
l: akuLno l kronlcno zaLa[en[e,
posebno akuLnl pulmonarnl
edem, hlperkalcl[eml[a
P: blago kronlcno zaLa[en[e,
kronlcnl bubreznl kamencl,
nefrogenl dl[abeLes lnslpldus
S: kronlcno zaLa[en[e,
aldosLeronlzam
- zaLa[en[e srca,
hlperLenzl[a, dl[abeLes
(dl[abeLlcko osLecen[e
bubrega)
- kod pacl[enaLa ko[l ne
podnose ACL lnhlblLore
- zata[en[e srca (suzbl[a
slmpLome, all ne
produzu[e zlvoL bolesnlka)
- arlLml[e- f|br||ac|[a atr|[a
([er usporava Av
provoden[e)
- akuLno zaLa[en[e
(ne sml[e za kronlcno
zbog neuclnkovlLosLl l
arlLml[a)
- akuLno zaLa[en[e
(ne za kronlcno)
- akuLno
dekompenzacl[sko
zaLa[en[e (s
kongesLl[om)
- kronlcno zaLa[en[e
(ne za akuLno)
Iarmako-
k|net|ka
uclnak: 2-4 h,
8-12 h,
24-48 h
- kraLak poluvl[ek, all
kod vellklh doza uclnak
[e 12-24 h
- poluvl[ek 6h
- uclnak 40 h
- slabo se meLabollzlra- 2/3
neproml[en[eno bubregom
(doza se mora prllagodlLl
za bubrezne bolesnlke)
uclnak: nekollko
mlnuLa
- uclnak 3-6 h
- uclnak: nekollko
mlnuLa
- uclnak 10-12h
NeIe|[en|
uc|nc|
l: CLoLokslcnosL, hlpovoleml[a,
hlpokall[eml[a
P: Plpokall[emla, hlpergllkeml[a,
hlperurlceml[a, hlperllpldeml[a
S: Plperkall[eml[a, glnekomasLl[a
- kasal[, hlperkall[eml[a
- hlperkall[eml[a
- srcane arlLml[e! (zbog
povecanog nakupl[an[a Ca)
- mucnlna, povracan[e
prol[ev
- arlLml[e - arlLml[e
- [aka hlpoLenzl[a
- Llocl[anaLl l cl[anldlnsa
LokslcnosL
- bronhospazam
- bradlkardl[a
- Av blok
- akuLna dekompenzacl[a
srca
Interakc|[e
- adlLlvnl uclnak s
druglm angloLenzlnsklm
anLagonlsLlma
- lzvansLanlcnl k l Mg
lnhlblra[u d[elovan[e
- lzvansLanlcnl Ca povecava
rlzlk za nasLanak arlLml[a
- adlLlvno sa
slmpaLomlmeLlclma
- adlLlvno d[elovan[e s
anLlarlLmlclma
- adlLlvnl uclncl s osLallm
vazodllaLaLorlma

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A1CII2ICLCGIIA 2A1LILNIA
- na[vaznl[l poremeca[ u zaLa[en[u srca [e sman[enl mlnuLnl volumen s obzlrom na poLrebe Ll[ela
- [edan od uzroka [e- gublLak funkclonalnog mlokarda npr. zbog lnfarkLa mlokarda
- cesLo se povezu[e s kronlcnom hlperLenzl[om, bolesLl zallsLaka, koronarnlh arLerl[a...
- u veclnl sluca[eva zaLa[en[a prlm[ecu[e se sman[en[e srcane konLrakLllnosLl za vrl[eme slsLole, dok u druglma cvrsLoca venLrlkula
spr[ecava adekvaLno pun[en[e za vrl[eme dl[asLole
- sman[en[e mlnuLnog volumena se moze na[bol[e prlkazaLl uz pomoc lrank- SLarllngove krlvul[e: prom[ene krlvul[e venLrlkularne
funkcl[e odrazava[u kompenzacl[ske mehanlzme- sman[en[e e[ekcl[e l povecana kra[n[a dl[asLollcka dul[lna vlakana sLo povecava
poLrebu za klslkom
- homeosLaLskl odgovor organlzma na sman[enl mlnuLnl volumen [e blLan l posredovan [e veclnom slmpaLlcklm susLavom l renln-
angloLenzln-aldosLeron susLavom, a ukl[ucu[e:
1. 1ah|kard|[u -zbog povecanog Lonusa slmpaLlkusa,
2. ovecan per|fern| otpor- Lakoder zbog slmpaLlkusa,
3. 2adrIavan[e so|| | vode bubrez|ma- posredovano renln-angloLenzln susLavom- povecan[e krvnog volumena uzroku[e edeme l
kongesLl[u pluca l prldonosl povecan[u dul[lne vlakna na kra[u dl[asLole
4. kard|omega||[a- sporl kompenzaLornl mehanlzam posredovan slmpaLlcklm susLavom l angloLenzlnom ll
- Ll mehanlzml prlvremeno popravl[a[u mlnuLnl volumen, all dugorocno povecava[u opLerecen[e srca pa srce l dal[e zaLa[u[e
S. Nastanak apoptoze- sman[en[e bro[a funkclonalnlh mloclLa l n[lhova zam[ena vezlvnlm Lklvom
1LkAIISkL S1kA1LGIIL
- Lerapl[e zaLa[en[a srca ukl[ucu[u:
a) odsLran[en[e vode l soll zadrzane bubrezlma- dlureLlcl
b) sman[en[e afLerloada l sadrzavan[a soll l vode- lnhlblLorl ACL
c) sman[en[e slmpaLlcke sLlmulacl[e- -blokaLorl
d) sman[en[e preloada l afLerloada- vazodllaLaLorl
e) povecan[e konLrakLllnosLl ll[ekovlma sa pozlLlvnlm lnoLropnlm d[elovan[em- dlglLalls l
1
-agonlsLl
Akutno zaLa[en[e se ll[ecl: d|uret|c|ma henleove peLl[e, poz|t|vno |notropn|m ||[ekom (-agonlsL lll lnhlblLor fosfodlesLeraze) l
vazod||atator|ma za opLlmlzacl[u krvnog Llaka l Llaka pun[en[a
kron|cno zaLa[en[e se ll[ecl: d|uret|c|ma (cesLo henleove peLl[e+splronolakLon), ACL-|nh|b|tor|ma l ako dopusLeno -b|okator|ma
DIGI1ALIS
!"#$"%&'()"$(%"
- uclncl na srce:
a) mehan|ck|- povecan[e konLrakLllnosLl-povecana e[ekcl[a, sman[en kra[n[l slsLollckl l dl[asLollckl volumenl, povecan mlnuLnl
volumen l povecana perfuzl[a bubrega)- sman[en[e slmpaLlcke (frekvencl[a, preload l afLerload) l bubrezne kompenzacl[e-
pobol[sana funkcl[a srca
b) e|ektr|cn|- 1. ran| paras|mpat|ck| uclncl- povecan 8 lnLerval- zbog usporenog Av provoden[a (uzrokovano paraslmpaLlkusom l moze se bloklraLl aLroplnom), povecano Av refrakLerno razdobl[e [e blLno kod
flbrllacl[e aLrl[a 2. kasn| ar|tmogen| uclncl- povecana auLomaLlcnosL srca- zbog prevellkog nakupl[an[a kalcl[a moze dovesLl dokasnlh naknadnlh depolarlzacl[a ko[l uzroku[u ekstras|sto|e, tah|kard|[e, f|br||ac|[e
-uclncl na druge susLave: GI sustav-na[veca LokslcnosL dlglLallsa lzvan srca- mucnlna, anoreksl[a povracan[e, prol[ev
+,()(-%" .#($/0)"
1. kongest|vno zata[en[e srca- Lradlclonalno u uporabl zbog pozlLlvnog lnoLropnog uclnka- on sman[u[e slmpLome, all ne produl[u[e zlvoL bolesnlka
- zbog dugog poluvl[eka akumullra se u Ll[elu- mora se pazlLl kod dozlran[a
2. I|br||ac|[a atr|[a- sLan[e u ko[em [e poLrebno sman[lLl provodl[lvosL lll produl[lLl refrakLerno razdobl[e Av cvora kako bl se venLrlkul mogao eflkasno napunlLl l lzbaclLl krv- uclnak ko[l lma dlglLalls zbog
paraslmpaLomlmeLlckog d[elovan[a
1)20#"%3(/0
- povecan[e lzvansLanlcnog kall[a (dlureLlcl! P.peLl[e, Llazldl) l magnezl[a (povracan[e lzazvano dlglLallsom) lnhlblra[u d[elovan[e dlglLallsa, a povecan[e kalcl[a povecava LokslcnosL
4&%5(-)&52
- srce- arlLml[e, Cl- mucnlna, povracan[e, dlare[a
LlsL some poslLlve lnoLroplc drugs oLher Lhan dlglLalls LhaL have been used ln hearL fallure.
uescrlbe Lhe beneflclal effecLs of dlureLlcs, vasodllaLors, ACL lnhlblLors, and oLher drugs LhaL lack poslLlve lnoLroplc effecLs ln hearL fallure.

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14. AN1IAkI1MICI

1. 8LCkA1CkI Na kANALA 2. -8LCkA1CkI
3. LIILkCVI kCII kCDU2UIU
AkCIISkI C1LNCIIAL
4. 8LCkA1CkI Ca
kANALA
DkUGI
Gener|ck|
naz|v
Ia roka|nam|d Ib L|doka|n Ic I|eka|n|d roprano|o| Am|odaron Verapam|| Adenoz|n
Mehan|zam
d[e|ovan[a
- bloklra na kanale prlmarno
- bloklra k kanale sekundarno
- bloklra na kanale
(akLlvne l lnakLlvne)
- bloklra na kanale
- bloklra recepLore
-> sman[en[e cAM ->
sman[en[e na sLru[e
- !"#$%&' ), na, Ca kanale l -
recepLore
- bloklra L-Llp Ca
2+

kanala u zllama l srcu
- akLlvlra k kanale u
Av cvoru
- bloklra Ca kanale
Uc|nc|
- produzu[e akcl[skl poLencl[al
(l refrakLernosL sLanlca)
- odva[a se od kanala
sredn[om klneLlkom (1-10s)
- usporava brzlnu provoden[a
l frekvencl[u predvodnlka
- lzravno suprlmlra SA l Av
cvor
- nema uclnka na
akcl[skl poLencl[al
- odva[a se od kanala
vrlo brzo (man[e od 1s)
- nema[u uclnak na
Lra[an[e akcl[skog
poLencl[ala
- odva[a[u se od kanala
sporom klneLlkom
(vlse od 10s)
- produzu[e Lra[an[e
akcl[skog poLencl[ala
-> sman[ena frekvencl[a
(SA cvor) l brzlna
provoden[a u Av cvoru
- *&#+,-,./ 0&'.'1./ '$2%.3$#4
poLencl[ala l refrakLernosL
-> sman[ena frekvencl[a (SA
cvor) l brzlna provoden[a u
Av cvoru
- sman[ena frekvencl[a
(SA cvor) l provoden[e
kroz Av cvor
- sman[u[e
konLrakLllnosL srca
- snlzava krvnl Llak
- kraLkoLra[na Av
blokada
k||n|cka
pr|m[ena
- atr|[ske | ventr|ku|arne
arlLml[e
- ventr|ku|arne arlLml[e
nakon lnfarkLa
mlokarda
- arlLml[e uzrokovane
d|goks|nom
- SV1 ar|tm|[e u
bolesnlka s normalnlm
srcem
- atr|[ske arlLml[e
- prevenc|[a ponovnog
lnfarkLa
- Leske ventr|ku|arne | SV1
ar|tm|[e
- SV1 Lahlkardl[a
- parokslzmalna SV1
Lahlkardl[a
Iarmako-
k|net|ka
- p.o, lv, lm
- ellmlnacl[a bubregom
- meLabollL moze uzrokovaLl
0#&3'+/3 +/ *#%10
- lv
- kraLkl poluvl[ek - 2h
- p.o
- dug poluvl[ek- 20h
- p.o, parenLeralno
- 4-6h
- p.o, lv
- dug poluvl[ek ellmlnacl[e (do
nekollko L[edana)5 +'1% %"%
0./+1% +' !% *#30%4'#
+./"#6'1./
- p.o
- lzrazen meLabollzam
prvog prolaska (oprez
kod poremeca[a [eLre)
- lv
- poluvl[ek 10s!
NeIe|[en|
uc|nc|
- hlpoLenzl[a
-slmpLoml nallk lupusu
- arlLml[e
- na[man[e
kardloLokslcan
- rl[eLko neuroloskl
uclncl (kao drugl lokalnl
anesLeLlcl)- paresLezl[e,
Lremor, vrLoglavlca,
konvulzl[e
- proarlLmlk
- Av blok
- akuLno zaLa[n[e srca
- bronhospazam (asLma)

- bradlkardl[a l srcanl blok u
bolesnom srcu
- perlferna vazodllaLacl[a
- nakupl[an[e u Lklvlma (srce,
pluca- plucna flbroza!, [eLra,
koza- foLodermaLlLls, roznlca)
- bloklra perlferno
preLvaran[e 14 u 13- hlpo lll
hlperLlreoza
- negaLlvnl lnoLropnl
- Av blok
- konsLlpacl[a
- hlpoLenzl[a
- crvenllo llca
- sLezan[e u prslma
- vrLoglavlca
kontra|nd|k
ac|[e

- ne upoLrebl[ava se
nakon lnfarkLa
mlokarda [er povecava
ucesLalosL lznenadne
smrLl!

- sa ll[ekovlma ko[l lnhlblra[u
lll lnduclra[u clLokrom
- bolesnlcl s
poremecenom
funkcl[om [eLre

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1S. DIUkL1ICI
odskup|na INnI8I1CkI kAk8CANnIDkA2L DIUkL1ICI nLNLLCVL L1LIL 1IA2IDI DIUkL1ICI kCII S1LDL kALII CSMC1SkI DIUkL1ICI
Gener|ck|
naz|v
Aceta|ozam|d Iurosem|d
n|drok|ort|az|d
k|orta||don
Sp|rono|akton
Am||or|d
1r|amteren
Man|to|
Mehan|zam
d[e|ovan[a
- lnhlblra karboanhldrazu
- lnhlblcl[a na/k/2Cl
LransporLera u uzlaznom
kraku Penleove peLl[e
- lnhlblcl[a na/Cl LransporLera
u dlsLalnom zavl[enom Lubulu
- farmakoloskl anLagonlsL
aldosLerona
- lnhlblLor recepLora za
aldosLeron (androgenl) u
sablrnlm Lubullma kore
- bloklra eplLelne naLrl[ske
kanle u sablrnlm Lubullma
- osmoLlckl zadrzava vodu u
Lubulu sman[en[em
reapsorpcl[e u prokslmalnom
Lubulu, sllaznom kraku
Penleove peLl[e l sablrnom
kanalu
- na perlferl[l- lzvlacl vodu lz
sLanlca (zadrzava u
vaskularnom od[el[ku?)
Uc|nc|
- u prokslmalnlm Lubullma,
sman[ena [e reapsorpcl[a PCC
3
-

(samoogranlcava[uca dlureza) l
na
+
se lzlucu[e sa PCC
3
-

! #$%&'()*'&+$,-. +&/.0*)$,(.
.1$2*3. sman[u[e L[elesnl pP, u
glaukomu sman[u[e lnLraokularnl
Llak (sman[en[em sekrecl[e ocne
vodlce)
- uzroku[e znaca[nu dlurezu
(porasL lzluclvan[a naCl) l
povecano lzluclvan[e Ca
2+

! #$%*(.)$4&+$,-. +&/.0*)$,(.
.)(.)*3.
- uzroku[e sredn[u dlurezu
(porasL lzluclvan[a naCl) l
sman[eno lzluclvan[e Ca
2+

! #$%*(.)$4&+$,-. +&/.0*)$,(.
.)(.)*3.

-klorLalldon- nl[e Ll[azld, all lma
lsLe uclnke
- sman[u[e lzluclvan[e k
+

- sman[u[e reapsorpcl[u na
- sman[u[e lzluclvan[e k
+

- sman[u[e reapsorpcl[u na
+

- znaca[an porasL proLoka urlna
- sman[en[e mozdanog
volumena
- snlzen[e lnLraokularnog Llaka
Ind|kac|[e
- glaukom
- planlnarska (vlslnska) bolesL
- edem s alkalozom
- zaLa[en[e srca
- plucnl edem
- perlfernl edem
- [aka hlperLenzl[a
- akuLno zaLa[en[e bubrega
- akuLno hlper Ca lll k -ml[a
- hlperLenzl[a
- blago zaLa[en[e srca
- hlperkalclurl[a s kamenclma
- nefrogenl dl[abeLes lnslpldus
- kod vellkog gublLka k
+
zbog
uporabe druglh dlureLlka
- aldosLeronlzam
- kod vellkog gublLka k
+

zbog uporabe druglh
dlureLlka
- preLezno u komblnacl[l sa
Llazldlma
- bubrezno zaLa[en[e zbog
povecanog opLerecen[a
oLopl[enlm Lvarlma
(rabdomlollza)
- edem mozga u koml
- glaukom
Iarmako-
k|net|ka
- oralno, parenLeralno
- uclnak: 12h
- oralno, parenLeralno
- uclnak: 2-4 h
- oralno
- uclnak: 8-12 h
- oralno
- uclnak: 24-48 h
- oralno
- uclnak: 10-12 h
- lnLravenskl
- kraLko d[elovan[e
Interakc|[e
- d[elovan[e [e sman[eno
nesLeroldnlm proLuupalnlm
ll[ekovlma
- d[elovan[e [e sman[eno
nesLeroldnlm proLuupalnlm
ll[ekovlma
- lnLerakcl[a s osLallm
l[ekovlma za redukcl[u k

NeIe|[en|
uc|nc|
! +&/.0)$,(. .1$2*3.
5#$%&'()*'&+$,-.6
- bubreznl kamencl
- hlperamonl[eml[a u clrozl eLre
- sedacl[a
- paresLezl[e
! +&/.0*)$,(. .)(.)*3.
5#$%*(.)$4&+$,-.6
- oLoLokslcnosL
- hlpovoleml[a
- gublLak kall[a
- hlpomagnezl[eml[a
! +&/.0*)$,(. .)(.)*3.
5#$%*(.)$4&+$,-.6
- rana hlponaLrl[eml[a
- povecana razlna u serumu:
glukoze, llplda, urlcne klsellne
- hlperkall[eml[a
- glnekomasLl[a
- hlperkall[eml[a
! #$%&'(.)$4&+$,-.
+&/.0*)$,(. .)(.)*3.
- mucnlna
- povracan[e
- glavobol[a
- hlponaLrl[ema ko[u praLl
hlpernaLrl[eml[a
www.perpetuum-lab.com.hr

8|carbonate d|uret|c A dlureLlc LhaL selecLlvely lncreases sodlum blcarbonaLe excreLlon. Lxample: a carbonlc anhydrase lnhlblLor
D||ut|ng segment A segmenL of Lhe nephron LhaL removes soluLe wlLhouL waLer, Lhe Lhlck ascendlng llmb and Lhe dlsLal convoluLed Lubule are acLlve salL-absorblng segmenLs LhaL are noL
permeable by waLer
nyperch|orem|c metabo||c ac|dos|s A shlfL ln body elecLrolyLe and pP balance lnvolvlng elevaLed chlorlde, dlmlnlshed blcarbonaLe concenLraLlon, and a decrease ln pP ln Lhe blood. 1yplcal resulL of blcarbonaLe
dluresls
nypoka|em|c metabo||c a|ka|os|s A shlfL ln body elecLrolyLe balance and pP lnvolvlng a decrease ln serum poLasslum and an lncrease ln blood pP. 1yplcal resulL of loop and Lhlazlde dlureLlc acLlons
Nephrogen|c d|abetes |ns|p|dus Loss of urlne-concenLraLlng ablllLy ln Lhe kldney caused by lack of responslveness Lo anLldlureLlc hormone (AuP ls normal or hlgh)
|tu|tary d|abetes |ns|p|dus Loss of urlne-concenLraLlng ablllLy ln Lhe kldney caused by lack of anLldlureLlc hormone (AuP ls low or absenL)
otass|um-spar|ng d|uret|c A dlureLlc LhaL reduces Lhe exchange of poLasslum for sodlum ln Lhe collecLlng Lubule, a drug LhaL lncreases sodlum and reduces poLasslum excreLlon. Lxample: aldosLerone
anLagonlsLs.
Ur|cosur|c d|uret|c A dlureLlc LhaL lncreases urlc acld excreLlon, usually by lnhlblLlng urlc acld reabsorpLlon ln Lhe proxlmal Lubule. Lxample: eLhacrynlc acld
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22. ANkSICLI1ICI I SLDA1IVI-nINC1ICI
- sman[u[u anksloznosL (pslhlcka napeLosL, os[eca[ L[eskobe l sLraha) l uzroku[u spavan[e
odskup|na 8LN2CDIA2LINI
AN1AGCNIS1
8LN2CDIA2LINA
Csta|| anks|o||t|c|
DILLCMICNI AGCNIS1 S-n1
1

kLCL1CkA
NCVIII nINC1ICI 8Ak8I1UkA1I
Gener|ck|
naz|v
D|azepam normabel
A|prazo|am xanax
1r|azo|am
I|umazen||
8usp|ron
- selekLlvnl ankslollLlk
2o|p|dem
Ienobarb|ta|
1|openta|
- zaml[enlll lh benzodlazeplnl
Mehan|zam
d[e|ovan[a
- vezu se selekLlvno na CA8A
A
recepLore u SZS-
u l poLenclra[u uclnak CA8A-e povecan[em
ucesLalosLl oLvaran[a klorldnlh kanala (ne vezu
se za vezno m[esLo za CA8A vec pored-
alosLerlckl agonlsL)
- povecava[u hlperpolarlzacl[u membrana
- anLagonlsL veznog m[esLa za
benzodlazeplne na CA8A
A

recepLoru
- parcl[alnl agonlsL 3-P1
1

recepLora- sman[u[e oLpusLan[e
seroLonlna l Lako lnLeferlra s
konLrolom budnosLl

- vezu se za CA8A
A
recepLor
(bllzu veznog m[esLa za
benzodlazeplne) l
posp[esu[u oLvaran[e
klorldnlh kanala
- vezu se za CA8A
A
recepLor l !"#$%&%'%
#)*#"+,# -).,'+ klorldnlh kanala
posredovano CA8A-om (vezu se za
drugacl[e vezno m[esLo nego
benzodlazeplnl)
- povecava[u hlperpolarlzacl[u membrana
Uc|nc|
- o dozl ovlsan depresl[skl uclnak na SZS:
- sman[en[e anks|oznost| | sedac|[a
- h|pnot|ck| uc|nak
- anestez|[a (dodaLak)
- ant|konvu|z|vn| uc|nak
- re|aksac|[a ske|etn|h m|s|ca
- depres|[a d|san[a | kard|ovasku|arnog
sustava
- anterogradna amnez|[a
- d[elu[e brzo l uclnkovlLo, all
presLa[e d[elovaLl nakoh 2h
pa se ponovo [avl[a
pospanosL
- ublazu[e anksloznosL bez
znaca[nog sedaLlvnog,
hlpnoLskog lll euforlcnog uclnka

- mlnlmalnl poremeca[
pslhomoLorlcklh funkcl[a

- brza po[ava hlpnoze s
/.,'+ amnesLlcklh uclnaka
- man[a pslhomoLorlcka
depresl[a l pospanosL dan
posll[e
- o dozl ovlsan depresl[skl uclnak na SZS:
sedacl[a, sman[en[e anskloznosLl,
amnezl[a, hlpnoza, anesLezl[a,koma l
depresl[a dlsan[a
- nL sml[u se davaLl obol[ellma od porflrl[e
Ind|kac|[e
- akuLna l generallzlrana ankslozna sLan[a
- nesanlca l poremeca[l spavan[a
- sLaLus epllepLlcus (dlazepam, lv)
- anesLezl[a (mldazolam)
- ublazavan[e slmpLoma usLezan[a kod
odvlkavan[a od alkohola
- predozlran[e
benzodlazeplnlma
- generallzlrana ankslozna
sLan[a (zbog spore po[ave
uclnka 1-2 L[edna nl[e pogodan
za akuLna sLan[a)
- poremeca[l spavan[a
- anesLezl[a (LlopenLal)
- nesanlca (sekobarblLal)
- konvulzl[e (fenobarblLal)
ADML
- peroralno, lv (sLaLus epllepLlcus)
- llposolubllnl- SZS, placenLa, kumulaLlvnl uclncl
- meLabollzam u [eLrl- akLlvnl meLabollLl
- urln- kao glukuronskl kon[ugaLl
- poluvl[ek ellmlnacl[e 2-40h
- lv prlm[ena
- kraLak poluvl[ek ellmlnacl[e
- peroralno
- sLvara akLlvne meLabollLe
- kraLak poluvl[ek ellmlnacl[e
- peroralno
- brz meLabollzam u [eLrl-
kraLak poluvl[ek ellmlnacl[e
- peroralno
- llposolubllnl- SZS, placenLa, kumulaLlvnl
uclncl
- meLabollzam u [eLrl (fenobarblLal ne!)
- poluvl[ek 4-60h
Interakc|[e
- adlLlvna depresl[a SZS s alkoholom l mnoglm
ll[ekovlma

- lnhlblLorl C?3A4 (erlLromlcln,
sok gre[pa) mogu povlslLl
n[egovu razlnu u plazml
- nema adlLlvnlh depresl[sklh
uclnaka na SZS
- adlLlvna depresl[a SZS s
alkoholom l druglm
depreslvlma
- adlLlvna depresl[a SZS s alkoholom l
mnoglm ll[ekovlma
- lnduclra slnLezu clLokroma 430 sLo
ubrzava razgradn[u druglh ll[ekova-
NeIe|[en|
uc|nc|
- po[acanl depresl[skl uclncl na SZS: ovlsnosL
- razvo[ Lolerancl[e (kod vlsoklh doza lll
dugoLra[ne uporabe)
- uzru[anosL, zbun[enosL
- moguc slndrom usLezan[a
- Cl lrlLacl[a
- Lahlkardl[a
- paresLezl[e
- po[acanl depresl[skl uclncl
na SZS: ovlsnosL
- po[acanl depresl[skl uclncl na SZS:
ovlsnosL , Lolerancl[a > benzodlazeplnl
- u vellklm dozama - smrL zbog depresl[e
dlsan[a l kardlovaskularnog susLava
www.perpetuum-lab.com.hr




- ankslollLlcl- smna[u[u anksloznosL, sedaLlvl- smlru[u, hlpnoLlcl- poLlcu l odrzava[u san
- uclnke posLlzu depresl[om SZS

- llnearnl naglb- sLarl[l ll[ekovl- barblLuraLl l alkohol,
- povecan[e doze uzroku[e opcu anesLezl[u
- [os vece doze- depresl[u resplracl[skog l vazomoLorlckog cenLra u produzeno[ mozdlnl sLo vodl u komu l smrL
- odsLupan[a od llnearnog lma[u benzodlazeplnl- poLreban [e vecl porasL doze za sLan[a dubl[a od hlpnoze

Iarmakok|net|ka
- veclna [e llposolubllna l dobro se apsorblra[u lz Cl susLava
- dlsLrlbulra[u se u mozak l prolaze placenLarnu barl[e[ru
- LlopenLal (barblLuraL) [e vrlo llposolubllan- ulazl u SZS vrlo brzo Le se moze korlsLlLl za lndukcl[u u anesLezl[u
- da bl se lzluclll, mora[u se meLabollzlraLl l Lo uglavnom [eLrenlm enzlmlma
- veclna benzodlazeplna se preLvore u akt|vne metabo||te sa duglm poluvl[ekom ellmlnacl[e (moze docl do kumulacl[e ll[eka
kod vlsekraLne prlm[ene Le lzrazlLe pospanosLl) ko[l se zaLlm mora[u kon[uglraLl nakon cega se lzluce urlnom

Iarmakod|nam|ka
- uclncl na SZS ovlse o dozl- od sedacl[e l sman[en[a anskloznosLl, preko hlpnoze do anesLezl[e l kome
- uclncl su adlLlvnl ako se korlsLe dva ll[eka lsLovremeno
1. sedac|[a
- svl ll[ekovl ove skuplne uzroku[u sedacl[u
- ankslollLlckl uclnak pracen oslabl[enlm pslhomoLornlm funkcl[ama
- beznodlazeplnl- .,)+"#0".$,. ./,+12'.- nesposobnosL prls[ecan[a dogada[a nasLallh za vrl[eme d[elovan[a ll[eka (lzvoden[e man[lh klrursklh zahvaLa bez neugodnlh s[ecan[a, "daLe rape")
2. h|pnot|ck| uc|nak
- sedaLlvl-hlpnoLlcl mogu skraLlLl vrl[eme uspavl[lvan[a l produzlLl ukupno Lra[an[e sna
- kod vellklh doza skracu[e se 8LM faza ko[a se nadoknadl nakon presLanka uzlman[a l[eka
- Lolerancl[a na ova[ uclnak nakon 2 L[edna
3. anestez|[a
- prl vlsoklm dozama sLarl[lh ll[ekova- gublLak svl[esLl, refleksa l pamcen[a
- barblLuraLl(LlopenLal)- zbog vellke llposolubllnosLl, lma[u kraLak uclnak zbog redlsLrlbucl[e u druga Lklva, a ne zbog ellmlnacl[e
- benzodlazeplnl (mldazolam)- u komblnacl[l s druglm ll[ekovlma
4. ant|konvu|z|vn| uc|nc|
- dlazepam- konLrola epllepLlcklh napada-sLaLus epllepLlcus (supresl[a konvulzl[a)
S. re|aksac|[a m|s|ca
- dlazepam- relaksacl[a mlslca u cerebralno[ parallzl
6. depres|[a d|san[a | kard|ovasku|arnog sustava
- vlsoke doze uzroku[u depresl[u dlsan[a, hlpoLenzl[u l kardlovaskllarnl kolaps- uzrok smrLl kod predozlran[a

1oks|cn| uc|nc|
- > ps|homotorna d|sfunkc|[a- osLecen[e kognlLlvnlh procesa, sman[eno prosudlvan[e l moLorlcke v[esLlne (upravl[an[e vozllom), nezel[ena sedacl[a po danu
- > ad|t|vna depres|[a S2S- uporaba sedaLlva-hlpnoLlka sa druglm l[ekovlma lz skuplne lll sa alkohollm, anLlhlsLamlnlclma, anLlpslhoLlclma, Lrlclkllcklm anLldepreslvlma, oploldnlm analgeLlclma
- > predoz|ran[e- benzodlazeplnl slgurnl[l od barblLuraLa, Leska depresl[a dlsan[a l kardlovaskularnog susLava
- > drug| stetn| uc|nc|- barblLuraLl lnduclra[u [eLrene enzlme- lnLerakcl[a ll[ekova
www.perpetuum-lab.com.hr







24. AN1ILILL1ICI
odskup|na L|[ekov| za parc|[a|ne | genera||z|rane ton|cko-k|on|cke napada[e
L|[ekov| za ||[ecen[e genera||z|ran|h
konvu|z|[a
Drug| ||[ekov|
Gener|ck|
naz|v
Ien|to|n karbamazep|n Lamotr|g|n V|gabatr|n
Ienobarb|ta|
(barblLuraL)
Ltosukc|m|d Va|proat
D|azepam
k|onazepam
(benzodlazeplnl)
Mehan|zam
d[e|ovan[a
- bloklra na
+
kanale ovlsne o naponu (vezu se
za kanale u lnakLlvlranom sLan[u Le Lako
spr[ecava[u n[lhovo ponovno oLvaran[e l
sud[elovan[e u sLvaran[u akcl[skog poLencl[ala)
- sman[u[e oLpusLan[e gluLamaLa
- bloklra volLazne na
+
l
Ca
2+
kanale
- sman[u[e oLpusLan[e
gluLamaLa
- lreverzlbllnl lnhlblLor
CA8A- Lransamlnaze
(povecan[e
koncenLracl[e CA8A)
- poLenclra uclnak
CA8A-e na CA8A
A

recepLoru
- lnhlblra 1-Llp
volLaznlh Ca
2+
kanala

- bloklra
vlsokofrekvenLna
neuronska lzbl[an[a
- poLenclra uclnak
CA8A-e na CA8A
A

recepLoru- povecava
!"#$%&'($% oLvaran[a
klorldnlh kanala
Ind|kac|[e
- na[cesce korlsLenl

- neuropaLska bol
(vldl analgeLlke)
- sLablllzacl[a
raspolozen[a
(um[esLo llLl[a)
+mloklonlckl l apsans
napada[l
- parcl[alnl napada[l - apsans napada[l
+ parcl[alnl l
mloklonlckl napada[l

- sLablllzacl[a
raspolozen[a (um[esLo
llLl[a)
- sLaLus epllepLlcus
(sLan[e u ko[em se
neprekldno ponavl[a[u
epllepLlckl napada[l)
- apsans napada[l,
mloklonlckl napada[l,
lnfanLllnl spazml
Iarmako-
k|net|ka
- peroralno
- apsorpcl[e ovlsl o
formulacl[l
) +&,( $# -#.# /&
01(%#23# 0'&/4#
- nema akLlvnlh
meLabollLa
- ellmlnacl[a ovlsl o dozl
(ml[en[a se sa 1 na 0kln)
- peroralno
- akLlvnl meLabollLl
- peroralno
- opsezan meLabollzam
- peroralno
- ne maLabollzlra se
- lzlucu[e se urlnom
- peroralno
- dug poluvl[ek
ellmlnacl[e
- peroralno
- dug poluvl[ek
ellmlnacl[e
- peroralno
) +&,( $# -#.# /&
01(%#23# 0'&/4#
- opsezan
meLabollzam (Lokslcnl
meLabollL?)
- peroralno, rekLalno, lv
- akLlvnl meLabollLl (ne
klonazepam)
- dug poluvl[ek
ellmlnacl[e
Interakc|[e
-lnLerakcl[a s mnoglm
ll[ekovlma (lnduclra
sLvaran[e [eLrenlh
enzlma- ubrzanl
meLabollzam ll[ekova)
- lnLerakcl[a s
mnoglm ll[ekovlma
(lnduclra [eLrene
enzlme)
- lnLerakcl[a s mnoglm
ll[ekovlma

- lnLerakcl[a s
mnoglm ll[ekovlma
(lnduclra [eLrene
enzlme)

- lnLerakcl[a s mnoglm
ll[ekovlma (lnhlblra
meLabollzam ll[ekova-
povecana konc. u
plazml)

NeIe|[en|
uc|nc|
- dvosllke
- aLaksl[a
- hlperplazl[a desnl
-hlrzuLlzam
- dvosllke
- aLaksl[a
- glavobol[a
- mucnlna
- dvosllke
-aLaksl[a
- glavobol[a
- vrLoglavlca
- oslp
- vrLoglavlca
- lspadl vldnog pol[a
- pslhoze
- sedacl[a
- sedacl[a
- Lolerancl[a
- aLaksl[a
- Cl poremeca[l
- glavobol[a
- vrLoglavlca
- LeraLogen
- hepaLoLokslcnosL
- mucnlna
- gublLak kose
- porasL L[elesne mase
- sedacl[a
- Lolerancl[a
www.perpetuum-lab.com.hr



- epllepsl[a- druga na[cesca neuroloska bolesL nakon mozdanog udara (bolu[e 1 sv[eLske populacl[e)
- napada[l su- eplzode mozdane dlsfunkcl[e ko[e nasLa[u kao pos|[ed|ca pret[eranog e|ektr|cnog |zb|[an[a |z moIdan|h neurona
Iarmakok|net|ka
- svl se dobro apsorblra[u nakon oralne prlm[ene, llposolubllnl su [er mora[u dosp[eLl u SZS
- veclna se ne veze za proLelne plezme (oslm fenlLolna l valproaLa)
- vecln a se ellmlnlra [eLrom, lma[u sredn[e dugo do dugo vrl[eme d[elovan[a
Mehan|zam d[e|ovan[a
- opcl uclnak anLlepllepLlka [e sman[en[e ponavl[a[uclh akcl[sklh poLencl[ala u mozgu
a) 8loklran[e na
+
kanala
- fenlLoln, karbamazepln l lamoLrlgln bloklra[u volLazne na kanale u membranama neurona- uzroku[e produl[en[e lnakLlvnog sLan[a na kanala l refrakLernog razdobl[a
b) CA8A meLe
- fenobarblLal l benzodlazeplnl vezan[em za CA8A recepLor poLenclra[u lnhlblcl[ske uclnke CA8A-e
- CA8A amlnoLransamlnaza- enzlm ko[l lnakLlvlra CA8A-u, lnakLlvlra ga vlgabaLrln
c) 8loklran[e Ca
2+
kanala
- eLosukslmld lnhlblra 1-Llp kalcl[evlh kanala
d) urugl mehanlzml
- hlperpolarlzacl[a membrane povecan[em propusnosLl k
+
kanala (valproaL)
- lnhlblcl[a gluLamaLnlh recepLora (fenobarblLal)
k||n|cka uporaba
- generallzlranl Lonlcko-klonlckl napada[l: valproaL, karbamazepln, fenlLoln, lamoLrlgln, fenobarblLal (grand-mal)
- parcl[alnl napada[: karbamazepln, lamoLrlgln, fenlLoln, fenobarblLal, valproaL
- apsans napada[l: eLosukclmld, valproaL (preferlra[u se zbog mlnlmalne sedacl[e), klonazepam, lamoLrlgln
- mloklonlckl napada[l l neLlplcnl slndroml apsansa: valproaLklonazepam, lamoLrlgln
- sLaLus epllepLlcus: lv dlazepam
- drugo: blpolarnl poremeca[l- valproaL (karbamazepln, lamoLrlgln), neuralgl[a Lrlgemlnusa- karbamazepln
NeIe|[en| uc|nc|
- LeraLogenosL- valproaL (splna blflda! Le poremeca[l neuralne cl[evl), karbamazepln, fenlLoln


- ep||eps|[a [e bolesL ko[u karakLerlzlra po[ava napada[a ko[l su posl[edlca naglog sLvaran[a akcl[sklh poLencl[ala u skuplnl neurona (obllk napada[a ovlsl o d[elu mozga ko[l [e zahvacen, od kraLkoLra[nog
poremeca[a pazn[e do konvulzlvnog napada[a u Lra[an[u od nekollko mlnuLa), zahvaca 1 sLanovnlsLva, cesLo nepoznaLog uzroka, farmakolosko l[ecen[e [e usp[esno kod 70 pacl[enaLa
- dvl[e kaLegorl[e napada[a: parcl[alnl l generallzlranl (ko[l mogu blLl [ednosLavnl(bez gublLka svl[esLl) l kompleksnl (s gublLkom svl[esLl))
- parc|[a|n|-lzbl[an[e zapocne u [ednom zarlsLu l osLane lokallzlrano,zahvaca [ednu hemlsferu
- genera||z|ran|- zahvaca[u cl[ell mozak, dolazl do LrenuLacnog gublLka svlesLl, dl[ele se na: - ton|cno-k|on|cne napada[e(grand ma|) -konLrakcl[a muskulaLure, eksLenzornl spazam, zausLavl[an[e dlsan[a, defekacl[a,
sallvacl[a, mokren[e(Lonlcnl dlo , 1mln) zaLlm nlz sllovlLlh Lrza[a(klonlcnl 2-4mln),bolesnlk dolazl svl[esLl os[eca[ucl se zbun[eno , - apsanse(pet|t ma|)- cesLl u d[ece, presLanak akLlvnosLl l gledan[e u [ednu Locku
nekollko sekundl, nesv[esLan svo[e okollne, oporavak [e nagao l nema posl[edlca
- nakon napada[a bolesnlcl se nlceg ne s[eca[u
- ant|ep||ept|c| povlsu[u prag podraza[a zdravlh neurona l Lako sprecava[u napada[e
- mehan|zam d[e|ovan[a: osLvaru[u uclnak na Lrl naclna: 1. po[acava[u uc|nak GA8A-, 2. sman[u[u provod|[|vost Na kana|a, 3. sman[u[u provod|[|vost Ca kana|a
- cll[ [e prevencl[a lzbl[an[a bez uL[eca[a na normalnu Lransmlsl[u
www.perpetuum-lab.com.hr




!"# %&'( )*+,-+-(.(

(*/)0).(1,2( )*+,-+-(.( (*-3)4+*,2( )*+,-+-(.(
567689:;9
7<=9>
/<?@A<7
(hlapl[lva Lekuclna)
(=@B?C8<7
,6>@B?C8<7
DCE9:79 @;F9GC?
(plln)
-9@H67A<?
(barblLuraLl)
I9G<=@?<J
(benzodlazeplnl)
&8@H@B@? 26A<J97
)
D
I
+
- kroz alveolarnu membranu
- sLvaran[e hapaLoLokslcnlh meLabollLa- opasno kod opeLovane prlm[ene
- brzlna nasLanka l presLanka uclnka ovlsl o parLlcl[skom koeflcl[enLu krv:plln
- presLanak d[elovan[a zbog redlsLrlbucl[e u druga Lklva
- vrlo llposolubllan- brz
poceLak d[elovan[a l kraLko
d[elu[e zbog redlsLrlbucl[e u
druge organe
- veze se na albumlne u
plazml
- dlo ko[l se nl[e
meLabollzlrao nakuplL ce se
u masnom Lklvu l lzazvaLl
,mamurluk
- sporl[l poceLak, all
duze d[elovan[e nego
barblLuraLa
- brz poceLak d[elovan[a
l brz oporavak zbog
lnakLlvacl[e
- ne lzazlva mamurluk
- moze se korlsLlLl
samosLalno
- polaganl nasLup
d[elovan[a
I6K<79=<J
GL6?@><7L<
- poLenclra[u lnhlblcl[u CA8A-om
- depresorl SZS
- poLenclra[u lnhlblcl[u CA8A-om puLem CA8A
A
recepLora
- bloklra gluLamaLne nMuA
recepLore l Lako sman[u[e
eksclLacl[u
M:97<;
- povecava[u proLok krvl u mozgu
- haloLan sman[u[e srcanl mlnuLnl volumen
- osLall uzroku[u vazodllaLacl[u
- svl sman[u[u resplraLorne funkcl[e
- sevofluran lzazlva brzu lndukcl[u l oporavak l ne nadrazu[e dlsne puLove
- depresl[a clrkulacl[e l
resplracl[e
- sman[u[e lnLrakranl[alnl
Llak (sman[en proLok krvl
kroz mozak)
- man[e depreslvnl
nego barblLuraLl
- anesLezl[a l sedacl[a
bez gublLka svl[esLl
- vazodllaLacl[a l
hlpoLenzl[a
- kardlovaskularna
depresl[a
- lzazlva ,dlsocl[aLlvnu
anesLezl[u- bolesnlk [e
budan all ne os[eca bolne
podraza[e l amnesLlcan
- kardlovaskularna
sLlmulacl[a!
(7G9;<N9L6
- za odrzavan[e nesvl[esLl
Ll[ekom operacl[e
- za odrzavan[e
nesvl[esLl Ll[ekom
operacl[e
- kao dodaLak druglm
lnhalacl[sklm anesLeLlclma
- ublazavan[e bolova prl
porodu
- uvoden[e u anesLezl[u
- premdlkacl[a
- kao dodaLak
lnhalacl[sklm
- man[l klrurskl zahvaLl
- uvoden[e (lndukcl[a) u
anesLezl[u- lzazlvan[e
sLan[a nesvl[esLl

- man[l zahvaLl u d[ece
*6O6?L679
C:97N9
- depresl[a dlsnog l
kardlo- vaskularnog
susLava (vlsoka
poLenLnosL), hlpoLenzl[a
- ,mamurluk
(llposolubllan)
- rl[eLko, all opasno:
K6H<A@A@;F9:7@FA l
J<?9P7< K9H68A68J9L<
(geneLskl uv[eLovano)

- hlpoLenzl[a
- nadrazu[e dlsne
puLove
- produl[ena l opeLovana
prlm[ena uzroku[e depresl[u
kosLane srzl, aneml[u l
leukopenl[u
- depresl[a resplraLornog l
kardlovaskularnog susLava
- depresl[a SZS
- adlLlvnl uclncl sa druglm
depresorlma SZS
- posLoperaLlvna
resplraLorna depresl[a
(ponlsLava
flumazenllom)
- hlpoLenzl[a (Ll[ekom
lndukcl[e)

- lzazlva haluclnacl[e za
vrl[eme oporavka (moze se
lzv[ecl davan[em
benzodl[azeplna
preoperaLlvno)
- povecan lnLrakranl[alnl
Llak
2@7A8<97G9
;<N9L6

- bolesnlcl s aneml[om zbog
nedosLaLka 812
- lzb[egavaLl kod porflrl[a
www.perpetuum-lab.com.hr


- ll[ekovl ko[l uzroku[u klrursku anesLezl[u (spr[ecava[u reakcl[u bolesnlka l os[eL boll= sasLo[l se od: nesvl[esL, amnezl[a, gublLak odgovora na bolne podraza[e-analgezl[a, gublLak refleksa l mlslcna relaksacl[a)
- prlm[en[u[u se susLavno, poLlsku[u SZS
- sLadl[l anesLezl[e: 1. analgezl[a, 2. eksclLacl[a- amnesLlcan, nepravllno dlsan[e, 3. klrurska anesLezl[a- pravllno dlsan[e, 4. depresl[a produzene mozdlne- Leska depresl[avazomoLorlckog cenLra l cenLra za dlsan[e-
moze nasLaLl smrL
- svl anesLeLlcl prolaze krvno-mozdanu barl[eru
(*/)0).(1,2( )*+,-+-(.(
Q<8J<;@;976A9;<
- brzlna ko[om se posLlze Lerapl[ska koncenLracl[a anesLeLlka u mozgu ovlsl o:
R# A@H?L9>@FA9 <76FA6A9;<- pokazaLel[ Lopl[lvosLl [e parLlcl[skl koeflcl[enL (raspod[ele) krv:plln- deflnlra aflnlLeL anesLeLlka za krv u usporedbl s onlm za udahnuLl plln, koeflc[enL [e nlzak za ll[ekove slabo Lopl[lve
u krvl (dlslcnl oksldul), all parcl[alnl Llak pllna rasLe brzo pa [e lndukcl[a brza
!# ;@7N67A8<N9L9 <76FA6A9;< C CG<K7CA@J =8<;C- povecan[e koncenLracl[e anesLeLlka u udahnuLo[ sm[esl ubrzava lndukcl[u anesLezl[e
S# H?CT7@L >67A9?<N9L9- hlpervenLllacl[a ubrzava lndukcl[u anesLeLlclma ko[l bl lnace lmall spor nasLup uclnka
U# H8@A@;C ;8>9 ;8@= H?CT<- povecan[e proLoka (povecan mlnuLnl volumen) sman[lL ce porasL parcl[alnog Llaka- sporl[a lndukcl[a
"# <8A689@>67F;9 P8<G9L67A ;@7N67A8<N9L6
Lllmlnacl[a
- vrl[eme oporavka ovlsl o brzlnl uklan[an[a anesLeLlka lz mozga
- anesLeLlcl nlske Lopl[lvosLl ellmlnlra[u se brze od Lopl[lvlh
- glavnl puL ellmlnacl[e su pluca lako se nekl meLabollzlra[u u [eLrl (haloLan 40)
Q<8J<;@G97<J;<
Mehanlzam d[elovan[a- posp[esu[u CA8A-om posredovanu lnhlblcl[u na CA8A
A
recepLorlma
- male molekule Lopl[lve u llpldlma
- brzlna lndukcl[e l oporavka ovlsl o: Lopl[lvosLl u krvl, Lopl[lvosLl u llpldlma (odredu[e poLenLnosL l dlsLrlbucl[u), brzlnl alveolarne venLllacl[e, udarnom volumenu srca
- sLo [e parLlcl[skl koeflcl[enL krv/ plln man[l Lo su lndukcl[a l oporavak brzl
- sLo [e llposolubllnosL ll[eka veca Lo se on vlse nakupl[a u masnom Lklvu Le [e oporavak (,mamurluk) duzl
(*-3)4+*,2( )*+,-+-(.(
- d[elu[u puno brze od lnhalacl[sklh l lzazlva[u nesv[esno sLan[e u roku od 20s (kollko [e poLrebno da ll[ek s m[esLa prlm[ene dospl[e u mozak)
- na[cesce se upoLrebl[ava[u u komblnacl[l s lnhalacl[sklm anesLeLlclma (lznlmke su propofol l keLamln kod ko[lh [e duzlna d[elovan[a dovol[na za lzvoden[e kraclh klrursklh zahvaLa)
- barblLuraLl mogu pogorsaLl porflrl[u lndukcl[om enzlma slnLaze ALA (amlnolevlllnska klsellna) u [eLrl
www.perpetuum-lab.com.hr



"#$%&'() '*+&',*)-
-lokalnl anesLeLlcl su esLerl lll amldl
- slabe baze (sa pka 8-9)- prl flzloloskom pP su u kaLlonskom obllku ko[l [e l na[akLlvnl[l
- kad su ln[lclrana u upal[ena (klsela) Lklva- man[a kollclna l[eka [e dosLupna u nelonlzlranom
obllku za dlfuzl[u u Lklva
.)/%0 12%$&#0#-
- Loplkalno (sluznlca nosa, rubovl rana)
- u bllzlnl zavrseLka perlfernlh zlvaca (perlneuralno)
- u bllzlnl vellklh zlvcanlh debala (blokada)
- ln[ekcl[e u eplduralnl lll subarahnoldnl prosLor kral[eznlcne mozdlne
3)2$)(+(%0#,%()-
- lokalnl anesLeLlcl kraLkog l sredn[eg d[elovan[a se brzo apsorblra[u u krv sm[esLa ln[ekcl[e-
moze docl do slsLemne apsorpcl[e l sman[en[a lokalnog uclnka- Lo se moze sprl[eclLl
davan[em vazokonsLrlkcl[sklh Lvarl (npr. adrenalln)
- lokalnl anesLeLlcl duzeg d[elovan[a se [ako vezu za Lklva pa za n[lh d[elovan[e
vazokonsLrlkLora [e man[e d[eloLvorno
- esLerl se meLabollzlra[u u plazml uz pomoc kollnesLeraza (brz meLabollzam prokalna)
- amldl se meLabollzlra[u u [eLrl (clLokrom 430)
- poluvl[ek lldokalna [e 1.3h, buplvakaln do4.3h- moze se povecaLl kod poremeca[a [eLre
- zaklsel[avan[e urlna dovodl do lonlzacl[e lokalnlh anesLeLlka ko[l se brze lzlucu[u lz Ll[ela
4#5)0%6)$ 7&#8+*)0&)-
- bloklra[u naLrl[ske kanale ovlsne o naponu l sman[u[u uLok naLrl[sklh lona, sLo spr[ecava depolarlzacl[u membrane l bloklra provodl[lvosL akcl[skog poLencl[ala
- ll[ek se moze vezaaL za svo[e recepLore lz clLoplazme lll lz membrane- Lo znacl da sLo [e llposolubllnl[l ll[ek Lo ce prl[e nasLaLl uclnak
- s druge sLrane u aksonu lonlzlranl obllk ll[eka [e vlse d[eloLvoran pa oba obllka lma[u blLnu ulogu
- vlsoke koncenLracl[e eksLracelularnog kall[a mogu po[acaLl lnhlblcl[u, a kalcl[a sman[lLl
9/%0:%
a. zlvcl- os[eLl[lvosL zlvaca na d[elovan[e ll[eka ovlsl o vellclnl, ml[ellnlzacl[l, brzlnl okldan[a, anaLomskom sm[esLa[u- man[a vlakna se brze bloklra[u nego veca l ml[ellzlrana brze od neml[ellzlranlh, prl[e se bloklra[u
ona vlakna ko[a brze oklda[u l vlakna sm[esLena na perlferl[l [er su lzlozena veco[ koncenLracl[l ll[eka
b. druga Lklva- srce-kao anLlarlLmlk
"8%0%/() ;1+2)<)
- man[l klrurskl zahvaLl (cesLo sa vazokonsLrlkLorlma)
- splnalna anesLezl[a
- auLonomna blokada u lshemlcnlm sLan[lma
- spora eplduralna lnfuzl[a za poLoperaLlvne bolove
.#=#8&#0% ;/%0:%
- dva glavna obllka LokslcnosLl- slsLemnl uclncl nakon apsorpcl[e s m[esLa prlm[ene l lzravna neuroLokslcnosL zbog vlsoke koncenLracl[e u bllzlnl zlvcanlh debala
>? @A@
- pospanosL, lagana glavobol[a, vldnl l slusnl poremeca[l, nemlr
- prl vlslm koncenLracl[ama nlsLagmus l Lonlcko-klonlckl grcevl
B? ")27%+*)'(;8)20% ';',)*
- vazodllaLacl[a (oslm kokalna)
- bloklra[u na kanale u srcu l sman[u[u abnormalnu predvodnlcku akLlvnosL
C? D2;E+
- u vlsoklm dozama neuroLokslcnosL- osLecen[e zlvca
BF? GH"IG.J I.K@LKLJMJ
N+7'(;1%0)
I4JDJ K@LKOJ
P#0#2%/(%
0)6%*
G%7+()%0 Q;1%*)()%0 N2+()%0
I
D
4
K
- parenLeralna prlm[ena
- meLabollzlra[u se u [eLrl (d[elom preko C?430)
- poluvl[ek ellmlnacl[e: lldokaln < 2 h, buplvakaln 2-4 h
- parenLeralna prlm[ena
- brzl meLabollzam u plazml uz
pomoc esLeraza
- kraLak poluvl[ek ellmlnacl[e
4#5)0%6)$
7&#8+*)0&)
- bloklra[u na
+
kanale ovlsne o naponu - Lo usporava, a zaLlm bloklra slren[e akcl[skog poLencl[ala
9/%0)( - sredn[e dugo d[elovan[e - dugo d[elovan[e - kraLko d[elovan[e
J07%():%&#
- kraLkl zahvaLl
- eplduralna l splnalna
anesLezl[a
- dugoLra[nl[l zahvaLl - vrlo kraLkl zahvaLl
.#=#8&#0%
;/%0:%
- eksclLacl[a SZS-a
- eksclLacl[a SZS-a
- arlLml[e
- vazodllaLacl[a- hlpoLenzl[a
- eksclLacl[a SZS-a
www.perpetuum-lab.com.hr

28. AN1IAkkINSCNICI
- arklnsonova bolesL [e degeneraLlvna bolesL bazalnlh gangll[a ([ako nlska razlna dopamlna u supsLancl[l nlgra l corpus sLrlaLum) cesLo pracena demencl[om (sLarl[a dob bolesnlka)
- glavnl slmpLoml: Lremor u mlrovan[u (zapocln[e u rukama) ko[l se sman[u[e Ll[ekom lzvoden[a vol[nlh akLlvnosLl, rlgldlLeL mlslca (povecan oLpor paslvnom pomlcan[u udova), supresl[a vol[nlh pokreLa- bradlklnezl[a
(oLezano zapocln[an[e l oLezano zausLavl[an[e moLorlcke akLlvnosLl)

kLkUkSCk DCAMINA
AGCNIS1I DCAMINSkIn
kLCL1CkA (D
2
ILI D
3
)
MAC-8 INnI8I1CkI
LIILkCVI kCII C1US1AIU
DCAMIN
AN1AGCNIS1I MUSkAkINSkIn
ACh kLCL1CkA
Gener|ck|
naz|v
Levodopa
8romokr|pt|n
ram|pekso|
Se|eg|||n Amantad|n 8enztrop|n
Mehan|zam
d[e|ovan[a
- prekursor dopamlna- preLvara se u dopamln uz
pomoc enzlma uCA-dekarboksllaze u mozgu l
na perlferl[l
- agonlsL u
2
recepLora
- agonlsL u
3
recepLora
- selekLlvnl lnhlblLor MAC- 8
(enzlm ko[l preLvara dopamln u
noradrenalln l seroLonln)
- anLlvlrusnl ll[ek, sluca[no
oLkrlveno d[elovan[e na 8
- mehanlzam nl[e dovol[no [asan-
povecava slnLezu l oLpusLan[e
dopamlna
- supresl[a M recepLora u bazalnlm
gangll[lma (cl[e podrazlvn[e lma
uclnak suproLan uclnku dopamlna pa
se pokusava se nadoknadlLl man[ak
dopamlna)
Uc|nc|
- sman[u[e rlgldlLeL l bradlklnezl[u (moLorlckl
slmpLoml)
- sman[u[e rlgldlLeL l bradlklnezl[u
- spr[ecava razgradn[u dopamlna
unuLar neurona
- uclncl su kraLkorocnl (nekollko
L[edana)
- sman[u[e rlgldlLeL, bradlklnezl[u
l Lremor
- sman[u[e rlgldlLeL l Lremor (ne
bradlklnezl[u)
k||n|cka
uporaba
- ll[ecen[e arklnsonove bolesLl
- poceLna Lerapl[a arklnsonove
bolesLl
- dodaLna Lerapl[a levodopl
- dodaLna Lerapl[a levodopl
(produl[u[e n[egov uclnak)
- kao monoLerapl[a nema uclnak

- ll[ecen[e 8 bolesnlka ko[l lsLodobno
uzlma[u anLlpslhoLlke (anLlpslhoLlcl
ponlsLava[u uclnak levodope [er su
dopamlnskl anLagonlsLl)
kontra|nd|k
ac|[e
- pslhoLlcnl bolesnlcl (moze po[acaLl pslhozu) - pslhoLlcnl bolesnlcl

Iarmako-
k|net|ka
- oralno
- prolazl kM8 (za razllku od perlfernog
dopamlna)
- Lra[an[e uclnka: 6-8 h
- oralno
- poluvl[ek 8h
- oralno - oralno - oralno
Interakc|[e
- kAk8IDCA- lnhlblra dopa-dekarboksllazu u
perlfernlm Lklvlma- sman[u[e preLvaran[e u
dopamln na perlferl[l l Llme poLrebnu dozu
- LN1AkACN- lnhlblra CCM1- kaLekol-C-
meLllLransferazu- enzlm ko[l razgradu[e levodopu

- ako se korlsLe sa SS8l:
seroLonlnskl slndrom


NeIe|[en|
uc|nc|
- GI poremeca[|- mucnlna, povracan[e, anoreksl[a
- kard|ovasku|arn|- arlLm[e, orLosLaLska
hlpoLenzl[a
- d|sk|nez|[e (nevol[nl savl[a[ucl pokreLl,
zahvaca[u llce l udove, razvl[u se unuLar 2.god)
- b|hev|ora|n| poremeca[|- haluclnacl[e,
konfuzl[a, nesanlca
- fenomen prek|daca (on- off effecL)- lznenadno
pogorsan[e rlgldlLeLa (npr. bolesnlk sLane u hodu
kao da [e ukopan na m[esLu) ko[a Lra[u nekollko
mlnuLa do nekollko saLl, a zaLlm dolazl do
pobol[san[a
- wear|ng-off- gubl uclnkovlLosL nakon oko 2 god.
prlm[ene
- GI poremeca[|- mucnlna,
povracan[e
- kard|ovasku|arn|- orLosLaLska
hlpoLenzl[a
- d|sk|nez|[e
- b|hev|ora|n| poremeca[|-
haluclnacl[e, konfuzl[a, nesanlca

- Cl poremeca[l
- hlpoLenzl[a
- dlsklnezl[e
- prom[ene raspolozen[a


- posLo [e selekLlvan za MAC-8
nema nezel[ene perlferne uclnke
MAC lnhlblLora ko[l se rabe u
depresl[l, ne lzazlva ,reakcl[u na
slr l r[ede sLupa u lnLerakcl[u s
druglm ll[ekovlma
- Cl poremeca[l
- orLosLaLska hlpoLenzl[a
- blhevloralnl poremeca[l- SZS-
haluclnacl[e, konfuzl[a, nesanlca,
razdrazl[lvosL
"#$%&'()*+%#()% ',%#-%:
S2S-pospanosL, nepazn[a, zbun[enosL,
haluclnacl[e, deluzl[e
per|fer|[a- suha usLa, opsLlpacl[a,
poremeca[ vlda, reLencl[a urlna
www.perpetuum-lab.com.hr

1. Neurokem|[sk| d|sba|ans u ark|nsonovo[ bo|est|
- posLo[l man[ak dopamlnerglcnlh pro[ekcl[a ko[e u normalnlm okolnosLlma lnhlblra[u akLlvnosL CA8A-erglcnlh neurona, dok kollnerglcnl neuronl ko[l podrazu[u CA8aerglcne neurone u sLrl[aLumu, d[elu[u normalno
2. Mehan|zm| sman[en[a park|nson|zma:
- levodopa- povecava razlnu dopamlna u mozgu- sman[u[e rlgldlLeL l bradlklnezl[u
- agonlsLl dopamlna- vezan[em za u2 (bromokrlpLln) lll u3 (pramlpeksol) recepLore povecava[u dopamlnerglcko d[elovan[e- sman[u[u rlgldlLeL l bradlklnezl[u
- selegllln- MAC-8 lnhlblLor- sman[u[e razgradn[u dopamlna u mozgu- produl[u[e d[elovan[e levodope
- blokaLorl muskarlnsklh recepLora-benzLropln- sman[u[e rlgldlLeL l Lremor (ne bradlklnezl[u)
3. k||n|cka pr|m[ena | neIe|[en| uc|nc|:
- levodopa- arklnsonova bolesL, Cl poremeca[l, orLosLaLska hlpoLenzl[a, arlLml[e,blhevloralnl poremeca[l (nesanlca, haluclnacl[e, konfuzl[a), Lardlvna dlsklnezl[a, wearlng-off, on-off fenomen
- agonlsLl dopamlnsklh recepLora- bromokrlpLln, pramlpeksol- poceLna Lerapl[a, dodaLna Lerapl[a levodopl, Cl poremeca[l, orLosLaLska hlpoLenzl[a, blhevloralnl poremeca[l, Lardlvna dlsklnezl[a
- MAC-8 lnhlblLorl- selegllln- dodaLna Lerapl[a levodopl, Cl poremeca[l, orLosLaLska hlpoLenzl[a, Lardlvna dlsklnezl[a, blhevloralnl poremeca[l
- ll[ekovl ko[l oLpusLa[u dopamln- amanLadln, dodaLak levodopl, sman[u[e rlgldlLeL, bradlklnezl[u l Lremor, Cl poremeca[l, orLosLaLska hlpoLenzl[a, poremeca[l SZS- haluclnacl[e, nesanlca, konfuzl[a
- blokaLorl muskarlnsklh recepLora- benzLropln, ll[ecen[e bolesnlka ko[l uzlma[u anLlsplhoLlke, dodaLak levodopl, SZS- pospanosL, nepazn[a, zbun[enosL, haluclnacl[e, perlferl[a- suha usLa, reLencl[a urlna, opsLlpacl[a,
zamucen vld
4. Inh|b|tor| dopa-dekarboks||aze | CCM1-a
- karbldopa- lnhlblLor dopa dekarboksllaze (enzlm ko[l preLvara levodopa u dopamln), sman[u[e perlferne uclnke levodope
- enLakapon- perlfernl lnhlblLor CCM1-a (enzlm ko[l levodopu preLvara u 3-CMu omeLlldopu), ne prolazl kM8
- korlsLe se kao dodaLak levodopl za sman[en[e doze l produl[en[e uclnaka
S. L|[ekov| | tvar| ko[| mogu uzrokovat| park|nson|zam
- anLlpslhoLlcl (?)

www.perpetuum-lab.com.hr

- korlsLe se za sman[en[e pslhoLlcnlh slmpLoma u shlzofrenl[l, blpolarnom poremeca[u, pslhoLlcno[ depresl[l, senllno[ pslhozl, pslhozl uzrokovano[ ll[ekovlma
- shlzofrenl[a [e pslhoza ko[u karakLerlzlra[u pozlLlvnl slmpLoml (lluzl[e, haluclnacl[e, poremeca[l mlsl[en[a) l negaLlvnl slmpLoml (povlacen[e lz socl[alnlh konLakaLa, odsuLnosL emocl[a l kognlLlvno osLecen[e)
- Leorl[e nasLanka: dopamlnska (dopamln uzroku[e sLan[e sllcno shlzofrenl[l), seroLonlnska (blokadom 3-P1
2
recepLora modullra se oLpusLan[e dopamlna), gluLamaLna (hlpofunkcl[a nMuA recepLora)
- d[eloLvornosL ll[ekova posredovana [e blokadom u
2
l 3-P1
2
recepLora, a sLeLnl uclncl blokadom M
3
, o-adrenerglcklh l P
1
hlsLamlnsklh recepLora
- poLrebno [e nekollko dana lll L[edana da osLvare svo[ uclnak
- anLlpslhoLlcl se malo razllku[u u eflkasnosLl, all znaLno u nuspo[avama
!"#$"%&'()"$(%"
a. uopamlnerglcnl susLav
- nekollko [e dopamlnerglcnlh puLova vazno za d[elovan[e anLlpslhoLlka: 1. povezan sa ponasan[em l pslhozom, 2. odgovoran za eksLraplramldne funkcl[e (koordlnacl[a l vol[nl pokreLl), 3. luce dopamln ko[l
lnhlblra lucen[e prolakLlna lz hlpoflze, 4. regulacl[a uzlman[e hrane (emeLskl)
b. uopamlnerglcnl recepLorl
- u
2
recepLor spregnuL [e sa C
l
proLelnom, lnakLlvlra adenllaL clklazu l snlzu[e sLanlcnu koncenLracl[u cAM-a, Le lnhlblra Ca kanale, a oLvara k kanale

!"# %&'()*(+,'(-( ( .('(/

0.%*(1&( %'()(1&( .('(/ &,2(/( .(/30,2( 4% 5(),.%6&( ),63738%/
9:;:<=>?=
;@A=B
0CD<E<DF@A=; +@CDE:<=GDC
6=HE:<=GD;
0CDA@E=;I ,C@;A@E=;
2@CE<D@J 0@<K@F@A:E=;
7:L@;=A@F
GM:CDB@;M@
- blokiia uopaminske B2 >>
S-BT2 ieceptoie
- blokiia B2 ieceptoie
- blokiia S-BT2 ieceptoie > B2
ieceptoie
- nejasan, supiesija IP S i BAu
signalizacije (vazni za u i N
tiansmisiju)
- mehanizam nejasan (za bipolaini poiemecaj)
N>=;O=
- blokiia i u1, NS i B1
- uepiesija SZS- seuacija
- smanjenje konvulzivnog piaga
- malo blokiia i u1
- slabija seuacija
- malo blokiia u1, blokaua NS
ieceptoia, vaiijabilno blokiia B1
- spoi nastup ucinka


0C=;=>?@
E<=FM:;@
P EH=L=M@J<=MH?@: schizofienija (pozitivni simptomi), bipolaini
poiemecaj (manicna faza)
- schizofienija (pozitivni i
negativni simptomi), bipolaini
poiemecaj, psihoza u
Alzheimeiu
- bipolaini poiemecaj
- spijecava piomjene
iaspolozenja izmedu manije i
uepiesije (piofilakticki)
- cesto piva linija u
akutnoj bolesti
- stabilizacija iaspolozenja
(kau litij ne ujeluje)
- akutna manija
- piofilaksa u
uepiesivnoj fazi
P ;:EH=L=M@J<=MH?@: antiemeticki - Touiettov sinuiom
Q@<F@?DP
?=;:J=?@
- p.o, paienteialno
- metabolizam u jetii
- uug poluvijek eliminacije
- p.o., ne metaboliziia se
- eliminacija bubiegom (2u h)
- uski teiapijski piozoi (piacenje
iazine u kivi)
- tiaziui i NSAIBi smanjuju
kliiens (povecana iazina u kivi)
- p.o.
! jako se veze za pioteine
plazme
- opsezan metabolizam
- p.o.
- aktivni metaboliti
&:R:CM:;=
S>=;O=
!"#$%&% () *+,+-.#*%T
- paikinsonizam
- taiuivna uiskinezija
- hipeipiolaktinemija
!"#$%&% / *+,+-.#*%:
- suha usta, konstipacija,
ietencija uiina, poiemecaji
viua
!"#$%&% 0 *+,+-.#*%:
- oitostatska hipotenzija
!"#$%&% 12 *+,+-.#*%#
! seuacija
- uebljanje
- :?HJ<@E=<@F=G;@
G=HUS;?O=M@ sa
biauikinezijom, tiemoiom i
iigiuitetom misica
- uijabetes i poiast tezine
(olanzapin, klozapin)
- hipeipiolaktinemija
(iispeiiuon)
klozapin- iijetko,ali opasno-
miokaiuitis, agianulocitoza
- manja inciuencija izazivanja
ekstiapiiamiunih nuspojava
- tiemoi
- hipotiieoza
- uijabetes insipiuus
- euemi
- aiitmije
- tiuunoca- teiatogen
- teiatogen
- hepatotoksicnost
- uI smetnje
- gubitak kose
- poiast tezine
- uvoslike
- ataksija
- hematotoksicnost
www.perpetuum-lab.com.hr
c. Lndokrlnl uclncl
- klaslcnl l rlsperldon- prolakLlneml[a
d. kardlovaskularnl uclncl
- orosLaLska hlpoLenzl[a l Lahlkardl[a (klorpromazln)
+)'(%",(-.
slhl[aLrl[ske
- shlzofrenl[a, blpolarnl poremeca[, pslhoLlcna depresl[a
nepslhl[aLrl[ske
- anLlemeLlckl uclnak (blokada dopamlnerglcnlh recepLora)
- olaksan[e prurlLusa (blokada P
1
recepLora)
/0.0)( 12(),(
- na auLonomnl, sredlsn[l zvcanl l endokrlnl susLav
34567687+ 9+:;37+ <4<53:
blokada 8
=
gublLak akomodacl[e oka, suha usLa, reLencl[a urlna, opsLlpacl[a
blokada > orLosLaLska hlpoLenzl[a, lmpoLencl[a, nemogucnosL e[akulacl[e
<?@A+/7B+ 9+:;37+ <4<53:
blokada A
C
arklnsonov slndrom, akaLlzl[a-nekonLrollranl nemlr, dlsLonl[a (grc mlslca)
preos[eLl[lvosL A
C
Lardlvna dlsklnezl[a
blokada 8
=
Lokslcno konfuzno sLan[e
@7A6D?+7+ <4<53:
blokada A
C
ko[a rezulLlra
hlperprolakLlneml[om
amenore[a-galkLore[a, neplodnosL, lmpoLencl[a
6<53E6
blokada FGH5
C
l H
I
povecan[e L[elesne mase

1. uclncl na ponasan[e- Lokslcna konfuzna sLan[a (anLlmuskarlnskl uclnak)
2. neuroloskl uclncl- eksLraplramldne reakcl[e (arklnsonov slndrom l akuLne dlsLone reakcl[e), Lardlvna dlsklnezl[a
3. uclncl na auLonomnl zlvcanl susLav- anLlmuskarlnskl (reLencl[a urlna lLd.), orLosLaLska hlpoLenzl[a, lmpoLencl[a
4. MeLabollckl l endokrlnl- porasL L[elesne Lezlne, hlperprolakLlneml[a
3. 1okslcne lll alergl[ske reakcl[e- agranuloclLoza (klozapln), kolesLaLska zuLlca
6. Ccne kompllkacl[e- depozlLl u roznlcl l lecl (klorpromazln)- Lamn[en[e vlda
7. kardloLokslcnosL- mlokardldLls (klozapln)
8. neurolepLlcnl mallgnl slndrom- nasLa[e zbog prebrze blokade u recepLora kod pacl[enaLa ko[l su [ako os[eLl[lvl na eksLraplramldne uclnke anLlpslhoLlka, slmpLoml: mlslcna rlgldnosL, nemogucnosL zno[en[a,
vlsoka LemperaLura, auLonomna nesLabllnosL sa proml[en[enlm krvnlm Llakom l bllom
9. Sedacl[a

E(0(- d[elu[e preko dva mehanlzma:
1. bloklra unuLarsLanlcnu slgnallzacl[u puLem fosfaLldlllnozlLola(l): lnhlblra enzlm !"#$!%#&'(#"#')#*)+%+$, ko[l [e poLreban za preLvorbu l
3
u lnozlLol (sa fosfaLldnom klsellnom nasLalom lz uAC rabl za
regeneracl[u u l), nakon akLlvacl[e proLeln klnaze C, uAC se fosforlllra u fosfaLldnu klsellnu, a l
3
se defosforlllra Le spa[a s fosfaLldnom klsellnom pa ponovno nasLa[e fosfolnozlLol-dlfosfaL (l
2
)- llLl[ bloklra La[
puL reclkllran[a
2. sman[u[e prolzvodn[u cAM-a poLaknuLu hormonlma (AuP, 1SP)

www.perpetuum-lab.com.hr



30. AN1IDLkLSIVI

INnI8I1CkI CVkA1NCG UNCSA MCNCAMINA


1. SLLLk1IVNI INnI8I1CkI
CnkANL SLkC1CNINA
(SSkI)
2. SLLLk1IVNI INnI8I1CkI
CnkANL SLkC1CNINA I
NCkADkLNALINA (SNkI)
3. 1kICIkLICkI AN1IDLkLSIVI
(1CA)
4. AN1AGCNIS1I S-n1
2

kLCL1CkA
S. 1L1kACIkLICkI I
MCNCCIkLICkI
6. MAC INnI8I1CkI
Gener|ck|
naz|v
I|uokset|n
Sertra||n
Ven|afaks|n
Am|tr|pt|||n
Im|pram|n
1razodon
M|rtazap|n
8uprop|on
Mok|obem|d
Se|eg|||n
Mehan|zam
d[e|ovan[a
- bloklra seroLonlnske (3-P1)
LransporLere
- bloklra nA l seroLonlnske
(3-P1) LransporLere
- bloklra nA l seroLonlnske (3-P1)
LransporLere (+o , M l P
1
)
- bloklra S-n1
2
recepLore l
um[ereno o recepLore
- bloklra preslnapLlckl o
2

recepLore (+P
1
l 3-P1
2,3
)
- nepoznaL
- lnhlblra MAC-A (meLabollzlra nA,
3-P1, dopamln l Llramln)
- lnhlblra MAC-8 (meLabollzlra
dopamln)
Uc|nc|
- akuLno povecan[e
seroLonlnerglcne slnapLlcke
akLlvnosLl
- akuLno povecan[e
seroLonlnerglcne l
noradrenerglcne slnapLlcke
akLlvnosLl
- akuLno povecan[e
seroLonlnerglcne l
noradrenerglcne slnapLlcke
akLlvnosLl
- blokada auLonomnog zlvcanog
susLava l P
1
recepLora
- povecana razlna seroLonlna
u slnapLlcko[ pukoLlnl
- povecano oLpusLan[e
noradrenallna
- povecava razlnu amlna
sman[en[em n[lhove razgradn[e
(slmpaLomlmeLlckl uclnak na zlvc.
zavrseclma)
k||n|cka
pr|m[ena
- vellkl depreslvnl poremeca[
- anksloznl poremeca[ (CCu,
1S, panlcnl poremeca[)
- slmpLoml u perlmenopauzl
- bullml[a
- vellkl depreslvnl poremeca[
- kronlcnl bolnl poremeca[l
- flbroml[algl[a
- slmpLoml u perlmenopauzl
- vellkl depreslvnl poremeca[ ko[l
ne reaglra na druge ll[ekove
- kronlcnl bolnl poremeca[l
- vellkl depreslvnl poremeca[
- ll[ecen[e nesanlce
- vellkl depreslvnl poremeca[
(zlmska depresl[a)
- hlpnoza (zbog [akog
anLlhlsLamlnskog uclnka)
- odvlkavan[e od pusen[a
- vellkl depreslvnl poremeca[ ko[l
ne reaglra na druge ll[ekove
Iarmako
k|net|ka
- peroralno, cvrsLo se vezu za proLelne plazme
- meLabollzam u [eLrl
- lzlucu[u se bubrezma
-dug poluvl[ek: 13+ h
- fluokseLln lma akLlvne
meLabollLe

- dug poluvl[ek ellmlnacl[e
- akLlvnl meLabollLl
- kratak poluvl[ek ellmlnacl[e
- akLlvnl meLabollLl
- opsezan meLabollzam u [eLrl - dug poluvl[ek ellmlnacl[e
Interakc|[e
- lnhlblcl[a 430 enzlma
- sa MACl ll[ekovlma-
seroton|nsk| s|ndrom
- susLraL 430 enzlma
- supsLraLl 430: lnLerakcl[e s
lnhlblLorlma l lnducerlma
- susLraL 430 enzlma - susLraL 430 enzlma
1. seroton|nsk| s|ndrom sa
seroLonlnerglclma (SS8l)
2. reakc|[a na t|ram|n: po[acanl
slmpaLomlmeLlckl noradrenerglcnl
uclncl na perlferl[l: hlperLenzlvna
krlza- mozdanl udar/lnfarkL
NeIe|[en|
uc|nc|
"#$%&'(' )*+, '-./$(#0.1
- Cl poremeca[l
- seksualnl poremeca[l
- sLlmulacl[a SZS- nesanlca
- predozlran[e- konvulzl[e
- sLlmulacl[a SZS- nesanlca
- hlperLenzl[a
!"#$%&'()*$"'($ &,$"-$.
- suha usLa, konsLlpacl[a, reLencl[a
urlna, zamagl[en vld (mldrl[aza,
Lahlkardl[a)
/01()2) 3 *4-45#1*):
- orLosLaLska hlpoLenzl[a
- sman[en[e provodl[lvlsLl srca
/01()2) 6
7
*4-45#1*):
- sedacl[a
- porasL L[elesne Lezlne
- predozlran[e-3C- koma,konvulzl[e
kardloLokslcnosL (arlLml[e)
/01()2) 896:
;
.
- sedacl[a
- Cl poremeca[l
/01()2) 3.
- orLosLaLska hlpoLenzl[a
- sedacl[a
- porasL L[elesne Lezlne
- orLosLaLska hlpoLenzl[a
- porasL L[elesne Lezlne
- seksusalnl poremeca[l
- sLlmulacl[a SZS- nesanlca
- predozlran[e- konvulzl[e
www.perpetuum-lab.com.hr
- prlmarna lndlkacl[a- vellkl depreslvnl poremeca[: MCnCAMlnSkA hlpoLeza (man[ak funkcl[e lll kollclne monoamlna-seroLonln, noradrenalln, dopamln) l nLu8C18ClnA hlpoLeza (gublLak clmbenlka zlvcanog rasLa uzroku[e
depresl[u, a davan[em clmbenlka povecava se sLvaran[e novlh zlvaca l slnapLlcka povezanosL)
- osLale lndlkacl[e- anksloznl poremeca[ (1S, CCu, socl[alna fobl[a, generallzlranl anksloznl poremeca[, panlcnl poremeca[l), bolnl poremeca[l (neuropaLska bol, flbroml[algl[a, 1CA, Sn8l), premensLualnl dlsforlcnl poremeca[l
(SS8l), odvlkavan[e od pusen[a (buproplon), poremeca[l prehrane (bullml[a- fluokseLln)
- povecava[u koncenLracl[u neklh neuroLransmlLora u slnapLlcko[ pukoLlnl
- poLrebno [e oko dva L[edna da razvl[u d[elovan[e lako uclnak na monoamlnerglcnu Lransmlsl[u nasLupa odmah
- 1CA l MACl su ll[ekovl druge l Lrece llnl[e u ll[ecen[u depresl[e [er su poLencl[alno smrLonosnl prl predozlran[u, lma[u mnoge sLeLne uclnke l sLupa[u u lnLerakcl[e- rabe se kod bolesnlka ko[l ne reaglra[u na druge ll[ekove
- seroton|nsk| s|ndrom: rlgldlLeL mlslca (povlsenl Lonus mlslca ko[l su d[elomlcno sLalno konLrahlranl), mloklonus (Lrzan[e mlslca), hlperLerml[a, kardlovaskularna nesLabllnosL, sLlmulacl[a SZS (ukl[ucu[ucl konvulzl[e)
- t|ram|n [e s|mpatom|met|k ko[l se nalazl u neklm namlrnlcama (slr, plvo, kobaslce, so[a)
- reakcl[a moze nasLaLl l s druglm slmpaLomlmeLlclma- ll[ek za prehladu pseudoefedrln

www.perpetuum-lab.com.hr

33. LIILkCVI 2A LIILCLNIL ANLMIIL | nematopoezn| c|mben|c| rasta
odskup|na 2e|[ezo V|tam|n 812 Io|na k|se||na St|mu|ator| er|tropoeze C|mb. rasta m|[e|o|dne |oze
C|mb. rasta
megakar|oc|tne |oze
Gener|ck|
naz|v
Iero-su|fat (p.o)
2e|[ezo-dekstran (lv)
C|[anokoba|am|n (lv, p.o) (p.o) LkI1kCCL1IN (lv, s.c.)
IILGkAS1IM (s.c.)
(G-CSI granu|oc|te co|ony
st|mu|at|ng factor)
CkLLVLkIN (s.c.)
(IL-11)
Mehan|zam
d[e|ovan[a
- poLrebno za slnLezu hema l
proLelna ko[l sadrzava[u hem
(hemoglobln, mloglobln)
- kofakLor u esencl[alnlm
reakcl[ama u ko[lma:
- nasLa[e LeLrahldrofolaL,
- homoclsLeln se preLvara u
meLlonln
- meLabollzlra se L-meLll
malonll-CoA
- prekursor donora meLllnlh
skuplna ko[l se korlsLl u
slnLezl amlnoklsellna, purlna l
deokslnukleoLlda
- agonlsL erlLropoleLlnskog
recepLora (na prekursorlma
crvenlh sLanlca)
- sLlmullra C-CSl recepLore na
zrellm neuLroflllma l n[lhovlm
prekursorlma
- rekomblnanLnl obllk
endogenog clLoklna
- akLlvlra recepLor za lL-
11
Uc|nc|
- poLrebno za normalnu slnLezu
hema (sman[enem kollclne le
sman[ena [e slnLeza hema)
- poLreban za esencl[alne
reakcl[e u meLabollzmu
amlnoklsellna, purlna l unA
- poLrebna za esencl[alne
reakcl[e u meLabollzmu
amlnoklsellna, purlna l unA
- sLlmullra razvo[ erlLroldne loze l
oLpusLan[e reLlkuloclLa lz kosLane
srzl
- poLlce prollferacl[u l
dlferencl[acl[u prekursora
- poLlce fagoclLnu akLlvnosL
neuLroflla l produl[u[e lm vl[ek
- moblllzlra hemaLopoezne maLlcne
sLanlce
- sLlmullra rasL
llmfoldnlh l ml[eloldnlh
sLanlca, ukl[ucu[ucl
megakarloclLne sLanlce
- povecava bro[
clrkullra[uclh LromboclLa
l neuLroflla
k||n|cka
pr|m[ena
- ll[ecen[e aneml[e zbog
nedosLaLka zel[eza
(slderopenlcna aneml[a,
mlkroclLna)
- ll[ecen[e man[ka vlLamlna
812 (ko[e se oclLu[e
megaloblasLlcnom
aneml[om) l osnova [e
pernlclozne aneml[e
- ll[ecen[e man[ka folne
klsellne (ko[e se oclLu[e
megaloblasLlcnom aneml[om)
- prevencl[a kongenlLalnlh
anomall[a neuralne cl[evl
- aneml[a kod kronlcnog zaLa[en[a
bubrega, Plv lnfekcl[e, raka,
nedonoscadl
- prevencl[a Lransfuzl[e kod
pacl[enaLa kod neklh elekLlvnlh
operacl[a
- neuLropenl[e kod kongenlLalne l
clkllcke neuLropenl[e,
ml[elodlsplazl[a, aplasLlcklh aneml[a
- prevencl[a neuLropenl[e kod
pacl[enaLa ko[l prlma[u
clLoLokslcnu kemoLerapl[u
- moblllzacl[a sLanlca perlferne krvl
u prlpreml za LransplanLacl[u
maLlcnlh sLanlca
- prevencl[a
LromboclLopenl[e kod
pacl[enaLa ko[l prlma[u
clLoLokslcnu
kemoLerapl[u
(neml[eloldnl obllk raka)
Iarmako
k|net|ka
- slozen endogenl susLav konLrole
apsorpcl[e, pohrane l LransporLa
- nema posebnog mehanlzma
ellmlnacl[e (oslm gublLkom krvl lll
sLanlca)
- parenLeralno, moze uzrokovaLl
reakcl[e preos[eLl[lvosLl
- pareneLeralna prlm[ena za
ll[ecen[e pernlclozne
aneml[e l malapsorpcl[skog
slndroma
- oralna prlm[ena, dobra
apsorpcl[a
- vrlo rl[eLko parenLeralno
- lnLravenska lll supkuLana
prlm[ena 1-3 puLa L[edno
- svakodnevna supkuLana prlm[ena
- svakodnevna
supkuLana prlm[ena
NeIe|[en|
uc|nc|
- akuLno predozlran[e uzroku[e
nekroLlzlra[ucl gasLroenLerlLls,
abdomlnalnu bol, krvavl prol[ev,
sok, leLargl[u l dlspne[u
- kronlcno preopLerecen[e
zel[ezom uzroku[e
hemokromaLozu sLo dovodl do
osLecen[a srca, [eLre, gusLerace l
druglh organa pa moze nasLuplLl
oLkazlvan[e funkcl[e organa l smrL
- prekom[erne doze nema[u
Lokslcnlh uclnaka
- prekom[erne doze nema[u
Lokslcnlh uclnaka
- !"#$%&! mogu d[elomlcno
kompenzlraLl l na La[ nacln
prlkrlLl man[ak vlLamlna 812,
- folna klsellna d[elu[e samo
na hemaLoloske, a ne l
neuroloske posl[edlce- vecl
rlzlk od neurolosklh
posl[edlca
- hlperLenzl[a
- LromboLlcke kompllkacl[e
- bol u kosLlma
- umor
- glavobol[a
- vrLoglavlca
- aneml[a
- nakupl[an[e Lekuclne u
pluclma
Interakc|[e
-kelaLor zel[eza- deferoksam|n,
lm., akuLno oLrovan[e zel[ezom

www.perpetuum-lab.com.hr

- VLDL- llpoproLelnl vrlo nlske gusLoce, lucl [eLra l onl prenose Lrlgllcerlde u perlferna Lklva
- uklan[an[em Lrlgllcerlda nasLa[e LuL
- povecana razlna LDL-a moze nasLaLl zbog povecanog lucen[a vLuL lll sman[enog kaLabollzma LuL
- LuL se kaLabollzlra u [eLrl- kolesLerolskl esLer se hldrollzlra l oLpusLa se slobodnl kolesLerol (za slnLezu membrana)
- hepaLoclLl mogl lzluclLl kolesLerol u zuc lll preLvorlLl u zucne klsellne
- LuL ulazl u sLanlce endoclLozom, vezan[em na LuL recepLore
- sLanlce mogu l s|ntet|z|rat| kolesLerol- mehanlzmom u ko[l [e ukl[ucen enzlm PMC-CoA redukLaza (odvl[a se nocu!)
- Lp(a)- nasLa[e od LuL l (a) proLelna
- nDL lzlucu[u [eLra l crl[eva, on prlbavl[a kolesLerol lz perlfernlh Lklva l Lako sLlLl sLanlce
- h|per||p|dem|[a- porasL bllo ko[e vrsLe llpoproLelna, moze uzrokovaLl aLerosklerozu l akuLnu upalu gusLerace
- lzb[egavaLl u Lrudnlca- kolesLerol poLreban za ml[ellnlzacl[u SZS, membrane
- LL- ||poprote|n ||paza, enzlm na povrslnl endoLelnlh sLanlca ko[l odva[a slobodne masne klsellne od Lrlgllcerlda u llpoproLelnlma- sman[u[e udlo
Lrlgllcerlda u vLuL-u pa nasLa[e LuL
- nMG-CoA (hldroksl-meLll-gluLarll koenzlm A)- enzlm ko[l lnhlblra slnLezu kolesLerola
- zucna klsellna- meLabollL kolesLrola
3S. DISLIIDLMIIL
1. Stat|n|
(|nh|b|tor| reduktaze)
2. I|brat| 3. Vez|vac| Iucn|h k|se||na (smo|e)
4. Inh|b|tor| cr|[evne apsorpc|[e
stero|a
S. NIACIN
(n|kot|nska k|se||na, v|tam|n 8
3
)
Gener|ck|
naz|v
SIMVAS1A1IN
Atorvastat|n
ILNCII8kA1
Gemf|broz||
kCLLS1IkAMIN
ko|est|po|
L2L1IMI8

Mehan|zam
d[e|ovan[a
- analog PMC-CoA
- lnhlblra PMC-CoA redukLazu
- agonlsLl A8-o recepLora
(regullra Lranskrlpcl[u gena za
meLabollzam llplda)
- veze Iucne k|se||ne u crl[evlma l
Lako spr[ecava n[lhovu reapsorpcl[u
- lnhlblra LransporLer kolesLerola l
flLosLerola u eplLelnlm sLanlcama
crl[eva
-u [eLrl- sman[u[e slLezu vLuL
- u masnom Lklvu- sman[u[e
akLlvnosL hormonske llpaze
- plazma- povecava konc. apoA-l
(llpoproLeln u PuL)
Uc|nc|
-> sman[u[e !"#$%&' kolesLerola- mall
doprlnos ukupnom uclnku, all poLlce
kompenzacl[skl mehanlzam:
- povecan[e bro[a LuL recepLora na
hepaLoclLlma- clsLl LuL l vLuL lz krvl
-> povecana slnLeza llpoproLeln llpaze-
povecano sman[en[e VLDL u krvl
- u [eLrl- dovodl do oksldacl[e masnlh
klsellna- ne mogu nasLaLl Lrlgllcerldl-
sman[eno sLvaran[e vLuL
- porast nDL (povecan[em apo A-l)
- za sLvaran[e novlh klsellna [e
poLreban kolesLerol pa dolazl do
kompenzacl[sklh mehanlzama:
- povecan[e bro[a LuL recepLora Le
sman[en[e LuL u krvl
- nema uclnak na PuL l Lrlgllcerlde
-> sman[ena reapsorpcl[a ko|estero|a
lzlucenog zucl- kompenzacl[sko
povecan[e slnLeze LuL recepLora l
odsLran[en[e LuL lz krvl
-> sman[en LuL
-> sman[en[e masnlh klsellna l
Lrlgllcerlda u plazml
-> povecan PuL
k||n|cka
pr|m[ena
- prevencl[a aLeroskleroze
- akuLnl koronarnl slndroml
- hlperLrlgllcerldeml[a
- nlskl PuL
- povlsenl LuL (hlperkolesLeroleml[a)
- Lrovan[e dlglLallsom
- za ublazavan[e svrbeza zbog zasLo[a
zucl
- povlsenl LuL (hlperkolesLeroleml[a)
- flLosLeroleml[a
- nlskl PuL
- povlsenl vLuL
(hlperLrlgllcerldeml[a) l LuL
(hlperkolesLeroleml[a)
Iarmako-
k|net|ka
- p.o, meLabollzam u [eLrl - p.o., vezan[e za proLelne plazme
- p. o.
- ne absorblra[u se
- p.o. - p.o
Interakc|[e
- meLabollzam ovlsan o 430
(lnLerakcl[e s lnhlblLorlma)

- omeLa[u apsorpcl[u neklh ll[ekova l
vlLamlna


NeIe|[en|
uc|nc|
- mlopaLl[a
- [eLrena dlsfunkcl[a
- LeraLogen
- mucnlna
- [eLrena dlsfunkcl[a
- kolesLaza
- konsLlpacl[a
- naduLosL
- dobro se podnosl
- crvenllo
- lrlLacl[a zeluca
- hepaLoLokslcnosL
- hlperurlceml[a
- moze sman[lLl Lolerancl[u
glukoze
www.perpetuum-lab.com.hr
- flLosLerol- bol[nl sLerol ko[l se apsorblra u eplLelne sLanlce crl[eva, all odmah LransporLlra naLrag u lumen- nakupl[a se kod geneLskle bolesLl flLosLeroleml[a
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www.perpetuum-lab.com.hr
AN1I8IC1ICI kCII DILLUIU NA S1ANICNU S1IILNkU
8eta|aktamsk| ant|b|ot|c| GLIkCL1IDI
odskup|na
LNICILINI CLIALCSCkINI
kAk8ALNLMI I
MCNC8Ak1AMI


Vankom|c|n (p.o, lv.)
1elkoplanln (lv., lm)

en|c|||n| uskog spektra
Ant|staf||okokn|
pen|c|||n|
en|c|||n| pros|renog spektra
1. cefa|eks|n (p.o.)
2. cefuroks|m (p.o., lv.)
3. ceftr|akson (lv., lm.)
cefLazldlm (lv.)
4. cefep|m (lv.)
Im|penem (lv.)
+ cllasLaLln

Aztreonam (lv.)
Gener|ck|
naz|v en|c|||n G (lv.)
en|c|||n V (p.o)
8enzat|n pen|c|||n G (lm.)
Met|c|||n
Cksac|||n (lv.)
Nafc|||n
Amlnopenlclllnl-
Amp|c|||n (lv.)+
sulbakLam
Amoks|c|||n (p.o.)
karboksl- l
ureldopenlclllnl
1|karc|||n (lv.)
|perac|||n (lv.)+
LazobakLam
ADML
- penlcllln v samo kod man[lh lnfekcl[a (zam[enlo ga amokslcllln)
- [edlno amokslcllln se sml[e uzlmaLl s hranom (osLall se razgrade)
- polarne molekule- slabo se meLabollzlra[u
-brzo lzlucu[u se bubregom (glomerularna fllLracl[a l Lubularna sekrecl[a)
- nafcllln l oksacllln se lzlucu[u zucl
- kraLak poluvl[ek ellmlnacl[e- poLrebno ucesLalo dozlran[e(svaka 4h)
- prolaze kM8 samo kod upale menlnga
- glavnl ellmlnacl[skl mehanlzam [e
lzluclvan[e bubregom (akLlvna
Lubularna sekrecl[a)
- kraLak poluvl[ek
- cefLlakson- ellmlnacl[a zuc
- 3. generacl[a prolazl kM8
- ellmlnacl[a bubregom-
hldrollzlra ga bubrezna
dehldropepLldaza
- cllasLaLln lnhlblra bubreznl
meLabollzam lmlpenema
(spr[ecava nefroLokslcnosL)
- ellmlnacl[a bubregom
- dug poluvl[ek
- ne apsorblra se lz crl[eva
Mehan|zam
d[e|ovan[a
- veze se za 8 (proLelnl ko[l vezu penlcllln) l lnhllra[u LranspepLldaze: lnhlblra slnLezu sLanlcne sLl[enke (akLlvacl[e auLollLlcklh enzlma sLanlce sLo uzroku[e lezl[e u sL.
sLl[encl)
- lnhlblra slnLezu sL.
sLl[enke vezan[em za u-
alanll-u-alanln zavrseLak
pepLldogllkana (lnhlblra
Lransgllkozllazu)
Uc|nc| bakter|c|dan uc|nak
NeIe|[en|
uc|nc|
- penlclllnl su lzrazlLo neLokslcnl
- preos[eLl[lvosL (3-6), ukrlzena preos[eLl[lvosL (anafllakLlckl sok-vrlo rl[eLko, reakcl[e Llpa
serumske bolesLl -urLlkarl[a, groznlca, edeml oko zglobova, svrbez- rl[eLko, koznl oslpl)
- Cl poremeca[l (mucnlna, povracan[e, prol[ev) kod vlsoklh doza
- nefroLokslcan- nl[e vlse u uporabl
- pseudomembranoznl kollLls, nealergl[skl koznl oslp
- reakcl[e preos[eLl[lvosLl (2)
-ukrlzena reakLlvnosL (ponekad se
mogu ll[eclLl alerglcnl na penlcllln)
- Cl poremeca[l
- kod vlsoklh doza lll zaLa[en[a
bubrega- konvulzl[e (SZS)
- ukrlzena reakLlvnosL sa
penlclllnlma
- Cl poremeca[l
- nema ukr|Iene reakt|vnost|
s pen|c|||n|ma !
- slndrom "crvenog
cov[eka" (zbog brze
lnfuzl[e ko[a uzroku[e
oslobadan[e hlsLamlna)

- rl[eLko nefroLokslcnosL
Ind|kac|[e
-sLrepLokokl, menlngokokl
- slfllls
- sLafllokokl ko[l
sLvara[u beLa
lakLamaze
- gram- bakLerl[e
- korlsLe se sa sa lnhlblLorlma -lakLamaze
(amplcllln+ sulbakLam,
plperacllln+LazobakLam)
-za ll[ecen[e ozbll[nlh lnfekcl[a
1. lnfekcl[e koze, meklh Lklva,
urlnarne (dobro g+, lose d[elu[u na g-
bakLerl[e)
2. S.pneumonlae l P.lnfluenze (man[e
g+, proslren g-)
3. slroka upoLreba (upa|a p|uca,
menlnglLls,gonore[a, po[acano g-)
4. slroka upoLreba (-lakLamaza
sLabllno, g+ l g-)
- slrok spekLar-ozbll[ne
lnfekcl[e popuL pneumonle l
sepse
- anaerobl, g- ko[l prolzvode
beLa lakLamazu

- d[elu[e samo na g- baclle (za
bolesnlke os[eLl[lve na
penlcllln)
- ozbll[ne slsLemske
sLafllokokne (M8SA),
sLrepLokokne (8S) l
enLerokokne lnfekcl[e
- gram +
-p.o-pseudomembranoznl
enLerokollLls C.dlfflclle [er
se ne apsorblra lz Cl
- urolnfekcl[e,
slnuslLls, oLlLls
- pseudomonas
kontra|nd|
kac|[e
- bolesnlcl sa zaLa[en[em
bubrega - konvulzl[e

- osobe s anafllakLlckom reakcl[om na
penlclllne

Interakc|[e
- vrl[ednosLl penlclllna u krvl se mogu povlslLl prlm[enom robeneclda (p.o) ko[l sman[u[e
Lubularnu sekrecl[u
- u komblnacl[l s lnhlblLorlma beLa-lakLamaze (klavulanska klsellna) proslren spekLar
- slnerglsLlcko d[elovan[e sa amlnogllkozldlma
- povecava[u nefroLokslcnosL
amlnogllkozlda
- slnerglsLlcko d[elovan[e s
amlnogllkozldlma
- slnerglsLlcko d[elovan[e s
amlnogllkozldlma
www.perpetuum-lab.com.hr


- grada pen|c|||na: 6 amlno-penlcllanska klsellna: beLalakLamskl prsLen (anLlbakLerl[ska l farmakoloska svo[sLva ) + Llazolldlnskl prsLen
- mehan|zm| bakter|[ske rez|tenc|[e na beLa-lakLamske anLlbloLlke:
1. lucen[e enzlma -lakLamaze ko[l razgradu[e beLa-lakLamskl prsLen,
2. proml[ene u gradl cll[nog 8,
3. kod g- bakLerl[a- proml[ene u gradl porlna u van[sko[ sL. sLl[encl onemogucava[u prodor ll[eka do cll[nog 8-a,
4. efluks- lzbaclvan[e ll[eka lz sLanlce posebnlm energenLsklm pumpama)
- |nh|b|tor| beta-|aktamaze: klavulanska klsellna, LazobakLam, sulbakLam- korlsLe se s ll[ekovlma os[eLl[lvlm na hldrollzu beLa-lakLamazom
- baclLracln- nl[e beLa-lakLamskl ll[ek, pepLldnl anLlbloLlk ko[l lnhlblra slnLezu sL. sLl[enke- zbog nefroLokslcnosLl se korlsLl Loplkalno za dezlnflclran[e rana
- cllasLaLln- prlm[en[u[e se s lmlpenemom, lnhlblLor [e bubrezne dehldropepLldaze

- penlclllnl se ne sml[u davaLl sa bakter|ostat|c|ma [er [e poLreban rasL bakLerl[a za n[lhovo d[elovan[e (farmakoloskl anLagonlzam) l ora|n|m kontracept|v|ma [er se esLrogenl reclkllra[u puLem
enLerohepaLlckog meLabollzma, a panlclllnl uL[ecu na Cl floru
- nuspo[ave cefalosporlna- dlsulflram llke reakcl[e (dlsulflram [e ll[ek ko[l se korlsLl za obesrabren[e konzumlran[a alkohola [er lzazlva neugodne nuspo[ave podlzucl razlnu aldehlda)













kCkl
- sLafllokok +
- sLrepLokok +
- nelserrla menlnglLldls -
- nelsserla gonorrhoeae - (gonokok)
- enLerokok +

8AClLl
- enLerobakLerl[e -
- campylobakLer -
- klebslela pneumonle -
- corynebacLerlum dlphLerlae +
- closLrldlum + (anaerobna)
- akLlnomlceLe + (anaerobna)
- bakLeroldes - (anaerobna)

Sl8CPL1L kCkC8AClL
- Lreponema palldum - - haemophllus lnfluenze -
- pseudomonas aureglnosa -

en|c|||n G streptokok, men|ngokok, gram + bac||| | sp|rohete, s|f|||s
en|c|||n V orofar|ngea|ne |nfekc|[e
Met|c|||n, oksac|||n staf||okokne |nfekc|[e otporne na pen|c|||n
Amp|c|||n | amoks|c|||n kao pen|c|||n G, enterokok|, "#$%&'#( )*+*,-%*.&+&$/ 0$,1&'#,1#( ,*2#/ 3'*%&4$ )#'(5#2#$/ 6(&)*71#24$ #+824&+9(& # :*'(;&22( ,(%(''1(2#$
|perac|||n | t|karc|||n gram - bac||| (3$&4<*)*+($/ 0+%&'*5(,%&' | ponekad =2&5$#&22(>
Cefa|eks|n (1.) gram + kok| (staf||okok, ob|cn| streptokok), 0? ,*2# # =? 7+&4)*+#(&
Cefuroks|m (2.) pros|ren spektar za gram - bakter|[e, |nfekc|[e s|nusa, uha | resp|ratorne |nf. sa 6?#+824&+9(& ||| :? ,(%(''1(2#$
Ceftaz|d|m (3.)
pros|ren spektar za gram -bakter|[e otporn| na druge beta-|aktamske ||[ekove (3'*@#<&+,#(/ A&''(%#( )(',&$,&+$/ te 6? #+824&+9(& | B&#$$&'#(>/ 3$&4<*)*+($
Ceftr|akson (3.)
pen|c|||n rez|stentn| pneumokok (kS), gorore[a (g- kok|), upa|a sredn[eg uha
Cefep|m (4.) gram - bakter|[e (0+%&'*5(,%&'/ 6(&)*71#24$/ B&#$$&'#(>/ neke pen|c|||n-rez|stentne pneomokoke, gram+ bakter|[e kao ||[ekov| 1. generac|[e
Aztreonam gram - bac||| (=2&5$#&22(/ 3$&4<*)*+($/ A&''(%#(>
Im|penem + c||astat|n gram - bac|||, anaerob|, gram + kok|, seudomonas (sa am|nog||koz|d|ma)
Vankom|c|n MkSA, pen|c|||n-rez|stentn| pneumokok, C2*$%'#<#4) <#88#,#2&
odskup|na LNICILINI CLIALCSCkINI
kAk8ALNLMI I
MCNC8Ak1AMI
GLIkCL1IDI

en|c|||n| uskog spektra
Ant|staf||okokn|
pen|c|||n|
en|c|||n| pros|renog spektra
1. cefa|eks|n (p.o.)
2. cefuroks|m (p.o., lv.)
3. ceftr|akson (lv.)
cefLazldlm (lv.)
4. cefep|m (lv.)
Im|penem (lv.)
+ cllasLaLln

Aztreonam (lv.)
Vankom|c|n
(p.o, lv.)
1elkoplanln (lv.,
lm) Gener|ck| naz|v
en|c|||n G (lv.)
en|c|||n V (p.o)
8enzat|n pen|c|||n (lm.)
Nafc|||n
Met|c|||n
Cksac|||n (p.o.)
Amlnopenlclllnl-
Amp|c|||n (lv.)
Amoks|c|||n (p.o.)
karboksl- l
ureldopenlclllnl
1|karc|||n (lv.)
|perac|||n (lv.)
C + kokl
baclll
splroheLe
+
+

+



+


+


+


+


+
+
+

+
+

C- kokl
baclll
splroheLe

+
+



+
+
+

+


+

+
+

+
+


+

+
anaerobl + +
www.perpetuum-lab.com.hr

!"#$%$&#$'$ ) $"*$%$#&+$ ,$"#-.- /+&#-$"!
/012345678 9:&+!;<-"$9&: #-#+!'$9:$"$ ;!9+&:$=$ :$"9&.!;$=$ ,#+-/#&>+!;$"$ &9,!.&:$=$"&"$
>?7?@6A36
78B6C
(p.o, lv)
#?D@8E63F67 (p.o.)
=0326E63F67 (p.o, lv)
#6G?E63F67 (lv)
-@6D@0H6E67 (p.o, lv)
9F8@6D@0H6E67 (p.o.)
!B6D@0H6E67 (p.o, lv)
9F6718H6E67 (p.o, lv) 9C6745@62D67I=8FJ05@62D67 (lv.) :67?B0F61 (p.o, lv)
!=;-
- ellmlnacl[a [eLrom
(lnakLlvacl[a enzlmom
glukuronozll-Lransferazom)
- prolazl kM8 l placenLu
- apsorpcl[a poremecena
hranom l (Ca, le)
- prolazl kM8 l placenLu
- ellmlnacl[a bubregom l
[eLrom
- dokslcllln- dug poluvl[ek
- erlLromlcln- L zuc
- klarlLromlcln- M [eLra L urln
- azlLromlcln- A omeLa hrana,
L- neproml[en[en urlnom
- azlLromlcln vrlo dug
poluvl[ek (>40 h)-1x dan
- meLabollzam l ellmlnacl[a
[eLrom
- ukrlzena oLpornosL s
!"#$%&'('!")

- ellmlnacl[a [eLrom
- komblnacl[a dva ll[eka-
produzen poluvl[ek-
posLanLlbloLskl uclnak
- ellmlnacl[a [eLrom (4-
6h)
- ne posLo[l ukrlzena
oLpornosL s druglm
lnhlblLorlma slnLeze
proLelna
;?K876B8H
1L?F0C87L8
kao makrolldl
- lnhlblra slnLezu proLelna
vezan[em na MN,
pod[edlnlcu rlbosoma
- lnhlblra slnLezu proLelna
vezan[em na ON, pod[edlnlcu
rlbosoma
kao makrolldl kao makrolldl
prl[ecl slnLezu proLelna
vezan[em 78 PM, 8nA
na ON, pod[edlnlcu
rlbosoma
QA67E6 bakLerlosLaLskl bakLerlcldnl bakLerlosLaLskl
"?R?FL?76
4A67E6
- Cl smeLn[e
- kosLana srz- lnhlblra
sazrl[evan[e erlLroclLa
-slndrom slvog d[eLeLa
(nedosLaLak glukuronozll-
Lransferaze kod d[ece)
- lnhlblra [eLrene enzlme
- Cl smeLn[e,
hepaLoLokslcnlsL,
foLosenzlLlvnosL,
odlagan[e u kosLl l zube

- Cl smeLn[e,
hepaLoLokslcnlsL, produl[en[e
C1 lnLervala
- lnhlblra clLokrom 430
(oslm azlLromlclna)
- Cl smeLn[e
- pseudomembranoznl
kollLls- superlnfekcl[a
- Leska ml[algl[a l arLralgl[a
uzrokovana lnfuzl[om
- lnhlblra clLokrom 430
- supresl[a kosLane srzl
ovlsno o Lra[an[u
Lerapl[e
- neuropaLl[a l opLlckl
neurlLls
$71638E6L?)
,5?3D8@
- slrok spekLar (pneumokok,
menlngokok u os[eLl[lvlh na
beLalakLame),all se rl[eLko
rabl zbog LokslcnosLl
- cesLa Loplkalna prlm[ena
- lnfekcl[e mlkoplazmama,
klamldl[ama, rlkecl[ama,
neklm splroheLama,
malarl[a, P.ylorl, akne (u
nlsklm dozama)
- ambulanLna pneumonl[a,
hrlpavac, korenlbakLerl[e,
klamldl[e
- lnfekcl[e koze l meklh Lklva
- anaerobne lnfekcl[e
(*"+,-$%'(-.)
- profllaksa endokardlLlsa
(%./-,&/'0'1 3" 4-3'+'&'3
pacl[enaLa s bolesnlm
zallsclma)
- lnfekcl[e sLafllokoklma l na
vankomlcln rezlsLenLnlm
so[evlma 567"-+'8! (8S,
M8SA, v8SA, v8L)
- M8SA- meLlcllln
rezlsLenLnl sLafllokokl
- 8S- penlcllln
rezlsLenLan
S.neumlnlae
- v8L- vankomlcln
rezlsLenLnl enLerokokl
907D@86716
38E6L?
- u Lrudnocl
$7D?@83E6L?
- produzu[e poluvl[ek
ll[ekova ko[l korlsLe [eLrene
enzlme (npr. fenlLoln,
varfarln)

- produzu[e poluvl[ek ll[ekova
ko[l korlsLe [eLrene enzlme
(anLlkoagulansl,
karbamazepln, dlgoksln,
Leofllln) oslm azlLromlclna!

- produzu[e poluvl[ek ll[ekova
ko[l korlsLe [eLrene enzlme
(npr. clklosporln, dlazepam,
varfarln)
seroLonlnskl slndrom
kod lsLodobne prlm[ene
seroLonlnerglcnlh
ll[ekova (npr. selekLlvnl
lnhlblLorl ponovnog
unosa seroLonlna- SS8ls)
www.perpetuum-lab.com.hr

- na[vlse se rabe za g- crl[evne baclle (bakLerl[eml[a l sepsa), sa penlclllnom lll vankomlclnom za endokardlLls,
Luberkuloza
!"#$"%&%'()*'%" ' ,)-(&%#"*(& -&.'#"(,)
- amlnogllkozldl su !"#$%$&$'()*+ molekule ko[e ne ulaze u sLanlce
- '$,( (&#$)&."/( lz probavnog susLava (samo ako posLo[e ulceracl[e)
- oblcno se prlm[en[u[u lnLravenskl u obllku 012 "'" 312 4"*56*"7 "*859"/(
- dnevna doza se da[e u Lrl d[ela, a u odredenlm kllnlcklm uv[eLlma kao [ednokraLna doza
- amlnogllkozldl pokazu[u /0'("% /1',"(," 1"%*)#'," &2'3"( & %&(4)(*#"4','- povecana koncenLracl[a ll[eka ubl[a
vecl bro[ bakLerl[a l vecom brzlnom
- lma[u l 5&3*"(*'1'&*3%' /0'("%- anLlbakLerl[ska akLlvnosL Lra[e l kada razlna ll[eka nl[e m[erl[lva (nekollko saLl)
- [ednokraLna prlm[ena dnevne doze [e [ednako uclnkovlLa l man[e Lokslcna kao l vlsekraLna
- koncenLracl[e ll[eka u serumu Lreba praLlLl radl sman[en[a LokslcnosLl
- poLrebno [e &)"'(:$;"6" ;$95 &)" #4(*/+*$/ <5<)+=*$/ 85*%."/"
- amlnogllkozldl se lzlucu[u <5<)+:$4- kllrens [e lzravno razm[eran kllrensu kreaLlnlna (120mL/mln)
- poluvl[ek ellmlnacl[e 2-3h kod normalne bubrezne funkcl[e
6)7"('."$ -,)8&2"(,"
- paslvnom dlfuzl[om prolaze van[sku membranu, zaLlm se prenose u clLoplazmu &)$.+#$4 $!"#*"4 $ %"#"%5
(zaLo ne d[elu[u na anaerobe!)
- unuLar sLanlce se vezu za 30S pod[eclnlcu rlbosoma
- lnhlblra[u slnLezu proLelna na Lrl naclna:
"9 spr[ecava nasLa[an[e '('4',"4',3%&: %&$58)%3"
19 5&:#);(& &0'*"2"(,) $<=> dovodl do ugradn[e krlvlh amlnoklsellna
49 spr[ecava *#"(38&%"4',/
- osLall ll[ekovl: Lobramlcln, amlkacln
6)7"('.$' #).'3*)(4',)
1. sLvaran[e enzlma Lransferaza ko[l lnakLlvlra[u amlnogllkozlde
2. sman[en[e propusnosLl membrane za ll[ek (brlsan[e porlna)
3. prom[ena recepLora na 30S
=)?)8,)(' /0'(4'
- svl amlnogllkozldl su *+8)$6$%#">*" l $6$6$%#">*" (pogoLovo kod duze Lerapl[e, vlsoklh doza, sLarl[lh l[udl,
bubrezne lnsuflcl[encl[e)
- lsLodobna prlm[ena dlureLlka Penleove peLl[e (furosemld) l druglh nefroLokslcnlh anLlmlkrobnlh ll[ekova
(vankomlcln-wL?) Lreba se lzb[egavaLl
- oLoLokslcnosL- gublLak sluha lll ravnoLeze
- na[ranl[l pokazaLel[ nefLoLokslcnosLl- porasL na[nlze serumske koncenLracl[e ll[eka prl[e lduce doze
@8'('0%" 5#'$,)("
- za g- crl[evne bakLerl[e
- cesLo u komblnacl[l sa - lakLamlma (penlcllln+amlnogllkozld za enLerokoknl endokardlLls)
>6A=BCDA@BEAFA G HA<IJI<EAKAD=A9 A=LAKAMB<A NA=MIEI O<BMIA=>
C)()#'0%'
(".'2
CI=M>6APA= (lv.!) NM<IOMB6APA= (lv.!,lm!.)
>F6I
- polarne molekule- ne apsorblra[u se lz Cl (lv. 30-60mln)
- ne prolaze kM8
- ellmlnacl[a bubregom (glomerularna fllLracl[a)
- prom[ene renalne funkcl[e uL[ecu na konc. u plazml
- m[eren[e doze u plazml kako bl se lzb[egla LokslcnosL
- lzluclvan[e [e lzravno proporclonalno kllrensu kreaLlnlna
- poluvl[ek 2-3h
6)7"('."$
-,)8&2"(,"
- spr[ecava slnLezu proLelna vezan[em na 30S
pod[edlnlcu rlbosoma l d[elu[u na 3 naclna
(lnlcl[acl[skl kompleks, m8nA, Lranslokacl[a)
- spr[ecava slnLezu proLelna vezan[em na 12S
pod[edlnlcu rlbosoma
Q0'(4'
- bakLerlcldan
- uclnak ovlsan o koncenLracl[l
- posLanLlbloLskl uclnak
=)?)8,)('
/0'(4'
- nefroLokslcnosL (reverzlbllna)
- oLoLokslcnosL (lreverzlbllna)
- rl[eLko- neuromuskularna blokada
A(-'%"4',)G
N5)%*"#
- g- aerobne bakLerl[e!
- sepsa, pneumonl[a
- endokardlLls (slnerglsLlckl) sLrepLokok,
sLafllokok, pneumokok
- ll[ek druge llnl[e za ll[ecen[e Luberkuloze
- enLerokoknl endokardlLls (s penlclllnom)
@&(*#"'(-'
%"4',)
- Lrudnoca- gluhoca d[eLeLa
A(*)#"%4',) - slnerglzam sa beLa-lakLamlma l vankomlclnom
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AN1I8IC1ICI - INnI8I1CkI SIN1L2L ICLNL kISLLINL I NUkLLINSkL kISLLINL
odskup|na SULICNAMIDI ILUCkCkCNCLCNI
Gener|ck|
naz|v
1r|metopr|m- Su|fametoksazo|
(p.o, |v.)
Su|fad|az|n (p.o) (+/- lrlmeLamln)
Su|fasa|az|n (p.o)
1r|metopr|m (p.o) CIkCILCkSACIN (p.o, |v.) LLVCILCkSACIN (p.o, |v.)
ADML - ellmlnacl[a bubregom
- vezu se za proLelne plazme (m[esLo za
blllrubln l varfarln)
- meLabolozam u [eLrl
- lzluclvan[e bubregom
- sulfasalazln se ne apsorblra
- slaba baza
- ellmlnacl[a bubregom
neproml[en[en
- ellmlnacll[a bubregom (akLlvna Lubularna sekrecl[a- bloklra se
probenecldom)
- poLrebno prllagodlLl dozu kod bolesLl bubrega
- kaLlonl omeLa[u oralnu apsorpcl[u
Mehan|zam
d[e|ovan[a
- bloklra slnLezu folne klsellne
- sekvenc|[ska b|okada (bloklra[u
uzasLopne korake u slnLezl folaLa)
- sLrukLurnl analog A8A-e
- lnhlblra d|h|dropreroat s|ntazu l Llme
sunLezu folne klsellne
(l[udl uzlma[u folnu klsellnu hranom)
- lnhlblra dlhldrofolaL
redukLazu( l Llme
slnLezu folne klsellne)
- omeLa[u slnLezu unA vezan[em l lnhlblcl[om topo|zomeraze II (unA
glraza)(gram-negaLlvnl organlzml) l topo|zomeraze IV (gram-pozlLlvnl
organlzml)
Uc|nc| bakter|c|dan bakter|ostatsk| bakter|ostatsk|
bakter|c|dan
postant|b|otsk| uc|nak
NeIe|[en|
uc|nc|
- oslp, vuclca, supresl[a kosLane
srzl, hlperkall[eml[a
- Cl poremeca[l
- preos[eLl[lvosL (oslp, vruclca)
- nefroLokslcnosL (krlsLalurl[a)
- ukrlzena reakLlvnosL medu
sulfonamldlma (Le hlpogllkemlclma l
Llazldlma)

- megaloblasLlcna
aneml[a, leukopenl[a
(zbog nedosLaLka folne
klsellne)

- Cl poremeca[l
- uclncl na SZS (vrLoglavlce,
glavobl[a)
- LendlnlLls zbog uclnka na
hrskavlcu (lzb[egavaLl u male d[ece l
Lrudnlca)
- Cl poremeca[l
- C1c (lzb[egavaLl sa 1A l lll
anLlarlLmlclma)
Ind|kac|[e-
Spektar
- ur|narne |nfekc|[e
- neumoclsLls pneumonl[a
- Loksoplazmoza
- nokardloza
- [ednosLavne ur|narne |nfekc|[e
- lnfekcl[e oka lll opekllne (Loplkalno)
- toksop|azmoza (sulfadlazln +
plrlmeLamln)
- upalne crl[evne bolesLl (sulfasalazln)
- nokardloza
- lnfekcl[e don[eg
mokracnog sustava
(kod alerglcnlh na
sulfonamlde)
- urogen|ta|ne |nfekc|[e
- lnfekcl[e Cl susLava
- osLeoml[ellLls
- "resp|rac|[sk|" fluoroklnolon s
pobol[sanom akLlvnoscu prema
pneumokoku
Interakc|[e
- naL[ecu se s varfarlnom l
meLoLreksaLom l blllrublnom za vezno
m[esLo na proLelnlma plazme

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!"#$%"&'()*' !'&,)-$#'
- Lrl su glavna prlsLupa ll[ecen[u karclnoma: klrurskl zahvaL, radloLerapl[a l kemoLerapl[a (ovlsl o Llpu Lumora l razvo[u, kemoLerapl[a se moze prlm[en[lLl kao [edlna Lerapl[ska mogucnosL)
- !"#$%&' (&'#)&"*!+,& [e u sllcnosLl zlocudnlh l normalnlh sLanlca- posLo [e veclna anLlLumorsklh ll[ekova anLlprollferaLlvnl- d[elu[u na sLanlce ko[e se dl[ele (od[el[ak A, clne 3 Lumora, od[el[ak 8 su sLanlce u
mlrovan[u, all se poLencl[alno mogu d[ellLl L[. nadom[esLlLl od[el[ak A, od[el[ak C - sLanlce ko[e nlsu sposobne dl[ellLl, all prldonose volumenu Lumora) Lumorske, all l na normalne sLanlce ko[e se brzo dl[ele
- nasLa[u ./01 234356321 781291: :3/;3<16= >.?@=23 <;41, .?@3032. 9163563263 ;=2=, A=.<@=@=> 7 ;=<@7, <@3;151@3@B C7D1@=> :5=>=B @3;@.C32.<@B .?@303263 3/1@35= E), veclna uzroku[e mucnlnu l povracan[e -
CnuAnSL18Cn (anLagonlsL 3-P1 recepLora) proLlv mucnlne

'F!)F)&'*GH) I($*"J) '-%)#"%'K$F)%) ,)%$%$!I)L-) '-%)K)$%),) K)F*-) (&$MG!%)
N$&#$-) ) F)*"!$J) I
GL)-!$# -' N$&#$-"
- sLvara[u kovalenLne veze s unA l
Lako spr[ecava[u n[ezlnu repllkacl[u
- bloklra[u lll narusava[u
meLabollcke puLove ukl[ucene u
slnLezu unA
- ll[ekovl podrl[eLla lz
mlkroorganlzama ko[l spr[ecava[u
sLanlcnu dlobu
- osLecu[u funkcl[u mlkroLubula l
posl[edlcno sLvaran[e dlobenog
vreLena
- na[vaznl[l su sLeroldl (glukokorLl-
koldl, esLrogenl, androgenl)
- anLagonlsLl hormona
(;3:<@=O2191
(generlckl nazlv)
,1>5.P.<P=Q1:
,1</5=@12
#3@.@;3><=@
,1@=;=D12
M.><.;7D1912
J12>;1<@12
(=>51@=><35
%=Q.><1P32

- na[cesce korlsLen alklllra[ucl ll[ek
- anLagonlsL folne klsellne- na[cesce
korlsLen anLlmeLabollL
- analog plrlmldlna
- dlrekLno d[elovan[e na unA- kocl
Lopolzomerazu ll (unA glraza)
- koce funkcl[u mlkroLubula
- anLagonlsL homona esLrogena
(anLlesLrogen)
-=812 /;1Q6323
-peroralno lll lv
- spora lv ln[ekcl[a lll lnfuzl[a
- per os (lnLramuskularno, lv) - lv lnfuzl[a - lv lnfuzl[a
'

-slabo llposolubllan- slabo prolazl
kM8, u sLanlce ulazl LrasporLnlm
susLavom folne kls.

# - akLlvlra se u [eLrl uz pomoc oksldaza
clLokroma -430

#3R=21A=Q
:635.O=26= - pos[edu[u alkllne skuplne (veclnom
dvl[e) ko[e uz pomoc kA88CnluM
lCnA(aLom ugl[lka sa samo 6
elekLrona u van[sko[ l[uscl, vrlo
reakLlvan) mogu sLvaraLl kovalenLne
veze sa unA Le lzazvaLl nepravllno
lnLralancano, lnerlancano l unakrsno
vezan[e baza- defekLna repllkacl[a-
osLecen[e unA- apopLoza
- kocl slnLezu LlmldllaLa l purlnsklh
nukleoLlda
(za cl[u [e slnLezu poLrebna folna
klsellna), ko[l su neophodnl za
slnLezu unA l dlobu sLanlce
- lnhlblra enzlm .+/+."#0#%*)
"&.1()*21 (ko[l [e poLreban za
preLvorbu folna kls. u
LeLrahldrofolaL lP
4
)
- lnhlblra unA pollmerazu
- lnhlblra slnLezu unA l 8nA
- vezu se za Lubulln l lnhlblra[u
n[egovu pollmerlzacl[u u
mlkroLubule (spr[ecava[u sLvaran[e
dlobenog vreLena u meLafazl
mlLoze)

- sLablllzlra[u mlkroLubule
(,smrzava[u) u pollmerlzlranom
sLan[u ( spr[ecava[u sLvaran[e
dlobenog vreLena u meLafazl
mlLoze)
- u Lklvu do[ke se naL[ece sa
endogenlm esLrogenlma za
esLrogenske recepLore l lnhlblra
Lranskrlpcl[u gena odgovornlh za
prepoznavan[e esLrogena
-34356321 781291
- depresl[a kosLane srzl-uglavnom
osLecu[e llmfoclLe, mala
ml[eloLokslcnosL
- mucnlna l povracan[e
- poremeca[l Cl susLava, sLerlllLeL,
nellmfoclLna leukeml[a
- nefroLokslcan (obavezna hldracl[a l
forslrana dlureza)
- depresl[a kosLane srzl
- osLecen[e eplLela Cl

- kod vellklh doza nefroLokslcnosL

- mucnlna l povracan[e
- depresl[a kosLane srzl
- mucnlna l povracan[e
- gublLak dlaka
- kod vellklh doza kardloLokslcnosL
(arlLml[e l zaLa[en[e)
- eksLravazacl[a ll[eka na m[esLu
prlm[ene - lokalna nekroza
- paresLezl[e
-slabosL mlslca
- blago ml[elosupreslvno

- depresl[a kosLane srzl
- kod vellklh doza neuroLokslcnosL

)2:1>=9163
- Lumor LesLlsa l [a[nlka
- kao lmunosupreslv ([er lma lzrazeno
d[elovan[e na llmfoclLe)
- karclnom do[ke
- karclnom do[ke (cl[ rasL ovlsl o
hormonu)
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- mallgnl Lumor (mallgna neoplazma, karclnom)- bolesL kod ko[e dolazl do 3&(#3)"#%+"*3& .+#$& 2%#41.3# !"&#$"*5&3+/ 6)*3+7* 8%*6)+)#9 #"9*3+2'* l n[lhova slren[a organzmom
- nasLa[e zbog poremecene ekspresl[e gena u sLanlcama karclnoma sLo [e rezulLaL muLacl[e gena (muLacl[a vlasLlLe unA dovodl do akLlvacl[e proLo-onkogena u onkogene l/lll
lnakLlvacl[e gena supresl[e Lumora)
- )1"'#"6(* 6)*3+7* #. 3#"'*%3& 6& "*2%+(1,& s ceLlrl blLne znaca[ke:
ST 23>.2@;.51;=2= /;.51P3;=916= (opcenlLo zlocudne sLanlce ne prollferlra[u brze od normalnlh, vec n[lhova prollferacl[e nl[e regullrana normalnlm regulaLornlm proceslma L[. nema
konLrole prollferacl[e),
UT <Q=2632= :1P3;32916=916= 1 C7D1@=> P72>9163,
VT 12O=A1O2.<@ (normalne sLanlce pod uL[eca[em su lnhlblcl[sklh clmbenlka zbog cega posLo[e odredenl prosLornl odnosl lzmedu sLanlca razllclLlh Lklva Le ako se nadu negd[e lzvan
orlglnalnog okruzen[a podll[ezu apopLozl, zlocudne sLanlce kroz muLacl[e gube lnhlblcl[ske clmbenlke sLo omogucu[e prodlran[e u Lklva druglh organa),
WT Q3@=<@=A3 (sekundarnl Lumorl ko[l na druga m[esLa dolaze krvozllnlm lll llmfnlm puLem lll prodorom u L[.supl[lnu)
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key Words for key urugs
Common abbrev|at|ons and acronyms: ACL, angloLensln converLlng enzyme, AuPu, aLLenLlon deflclL hyperacLlvlLy dlsorder,
AnS, auLonomlc nervous sysLem, Av, aLrlovenLrlcular, 8, blood pressure, CnS, cenLral nervous sysLem, CCM1, caLechol-!-
meLhyl Lransferase, uMA8u, dlsease-modlfylng anLlrheumaLlc drug, LnS, enLerlc nervous sysLem, LS, exLrapyramldal sysLem,
CA8A, -amlnobuLyrlc acld, Cl, gasLrolnLesLlnal, Pl, hearL fallure, P8, hearL raLe, P1n, hyperLenslon, LMW, low molecular welghL,
MAC, monoamlne oxldase, Ml, myocardlal lnfarcL, nSAlu, nonsLeroldal anLl-lnflammaLory drug, 8A, rheumaLold arLhrlLls, SAnS,
sympaLheLlc auLonomlc nervous sysLem, 1CA, Lrlcycllc anLldepressanL, 1nl, Lumor necrosls facLor, "#$% LoxlclLy, W8Cs, whlLe
blood cells.
Drug ropert|es
Abc|x|mab Monoclonal anLlbody LhaL lnhlblLs Lhe blndlng of plaLeleL glycoproLeln llb/llla (Cllb/llla) Lo
flbrlnogen. used Lo prevenL cloLLlng afLer coronary angloplasLy and ln acuLe coronary syndrome.
Lpt|f|bat|de and t|rof|ban are also Cllb/llla lnhlblLors. (34)
Acetam|nophen AnLlpyreLlc analgeslc: very weak cyclooxygenase lnhlblLor, noL anLl-lnflammaLory. Less Cl dlsLress
Lhan asplrln buL dangerous ln overdose. "#$& hepaLlc necrosls. '()*+#),& acety|cyste|ne. (36)
Acetazo|am|de Carbonlc anhydrase-lnhlblLlng dlureLlc acLlng ln Lhe proxlmal convoluLed Lubule: produces a
naPCC3 dluresls, resulLs ln blcarbonaLe depleLlon and meLabollc acldosls. Pas self-llmlLed dlureLlc
buL perslsLenL blcarbonaLe-depleLlng acLlon. used ln glaucoma and mounLaln slckness.
"#$& paresLheslas, hepaLlc encephalopaLhy. Dorzo|am|de and br|nzo|am|de are Loplcal analogs for
glaucoma. (13)
Acety|cho||ne ChollnomlmeLlc proLoLype: LransmlLLer ln CnS, LnS, all AnS ganglla, parasympaLheLlc
posLgangllonlc synapses, sympaLheLlc posLgangllonlc flbers Lo sweaL glands, and skeleLal muscle
endplaLe synapses. (6, 7)
Acyc|ov|r AnLlvlral: lnhlblLs unA synLhesls ln herpes slmplex vlrus (PSv) and varlcella-zosLer vlrus (vZv).
8equlres acLlvaLlon by vlral Lhymldlne klnase (1k
-
sLralns are reslsLanL). "#$& behavloral effecLs and
nephroLoxlclLy (crysLallurla) buL mlnlmal myelosuppresslon. Iamc|c|ov|r, penc|c|ov|r, and
va|acyc|ov|r are slmllar buL wlLh longer half-llves. (49)

Adenos|ne AnLlarrhyLhmlc: mlscellaneous group, parenLeral only. Pyperpolarlzes Av nodal Llssue, blocks
conducLlon for 10-13 s. used for nodal reenLry arrhyLhmlas. "#$& hypoLenslon, flushlng, chesL paln.
(14)
A|butero|
roLoLyplc rapld-acLlng
2
agonlsL, lmporLanL use ln acuLe asLhma. "#$& Lachycardla,
arrhyLhmlas, Lremor. CLher drugs wlLh slmllar acLlon: metaprotereno|, terbuta||ne. Slow-acLlng
analogs: formoLerol, salmeLerol, used for prophylaxls. (9, 20)

A|endronate 8lsphosphonaLe: chronlc LreaLmenL wlLh low doses lncreases bone mlneral denslLy and reduces
fracLures. Plgher doses lower serum calclum. used ln osLeoporosls and for Lhe hypercalcemla ln
ageL's dlsease and mallgnancles. "#$& esophageal lrrlLaLlon aL low oral doses. 8enal dysfuncLlon
and osLeonecrosls of Lhe [aw ln hlgh doses. CLher blsphosphonaLes lnclude et|dronate,
pam|dronate, r|sedronate, eLc. (42)
A||opur|no| lrreverslble lnhlblLor of xanLhlne oxldase, reduces producLlon of urlc acld. used ln gouL and
ad[uncLlvely ln cancer chemoLherapy. lnhlblLs meLabollsm of purlne analogs (eg, mercapLopurlne,
azaLhloprlne). Iebuxostat ls slmllar. (36)
A|tep|ase (t-A) 1hrombolyLlc: human recomblnanL Llssue plasmlnogen acLlvaLor. used Lo recanallze occluded blood
vessels ln acuLe Ml, severe pulmonary embollsm, sLroke. ketep|ase and tenectep|ase are slmllar.
Streptok|nase ls a bacLerlal proLeln wlLh LhrombolyLlc properLles. "#$& bleedlng. (34)
Am||or|de k
+
-sparlng dlureLlc: blocks eplLhellal na
+
channels ln corLlcal collecLlng Lubules. "#$& hyperkalemla.
(13)

Am|odarone Croup 3 (and oLher groups) anLlarrhyLhmlc: broad specLrum, blocks sodlum, poLasslum, calclum
channels, recepLors. Plgh efflcacy and very long half-llfe (weeks Lo monLhs). "#$& deposlLs ln
Llssues, skln coloraLlon, hypo- or hyperLhyroldlsm, pulmonary flbrosls, opLlc neurlLls. (14)
Amphetam|ne lndlrecL-acLlng sympaLhomlmeLlc: dlsplaces sLored caLecholamlnes ln nerve endlngs. Marked CnS
sLlmulanL acLlons, hlgh abuse llablllLy. used ln AuPu, for shorL-Lerm welghL loss, and for
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narcolepsy. "#$& psychosls, P1n, Ml, selzures. CLher lndlrecL-acLlng sympaLhomlmeLlcs LhaL
dlsplace caLecholamlnes: ephedr|ne, pseudoephedr|ne, methy|phen|date, tyram|ne. (9, 32)
Amphoter|c|n 8 AnLlfungal: polyene commonly a drug of cholce for some sysLemlc mycoses, blnds Lo ergosLerol Lo
dlsrupL fungal cell membrane permeablllLy. "#$& chllls and fever, hypoLenslon, nephroLoxlclLy (dose
llmlLlng, less wlLh llposomal forms). (48)
Amp|c||||n enlclllln: wlder specLrum Lhan penlclllln C, suscepLlble Lo penlcllllnases unless used wlLh
sulbacLam. AcLlvlLy slmllar Lo LhaL of penlclllln C, plus - /#0*% 1 *(203,(45,% 6 7*859*0*:% ;<*=,005>
Synergy wlLh amlnoglycosldes versus -(),8#/#//3: and ?*:),8*5> "#$& penlclllln allergy, more
adverse effecLs on Cl LracL Lhan oLher penlcllllns, maculopapular skln rash. Amox|c||||n has greaLer
oral bloavallablllLy and less Cl effecLs, also used wlLh clavulanaLe, a penlcllllnase lnhlblLor. (43)
Anastrozo|e AromaLase lnhlblLor: proLoLype lnhlblLor of Lhe enzyme LhaL converLs LesLosLerone Lo esLradlol.
used ln esLrogen-dependenL breasL cancer. Letrozo|e ls slmllar, exemestane ls an lrreverslble
aromaLase lnhlblLor. (40, 34)
Asp|r|n nSAlu proLoLype: lnhlblLs cyclooxygenase (CCx)-1 and -2 lrreverslbly. AnLlplaLeleL agenL as well as
anLlpyreLlc, analgeslc and anLl-lnflammaLory drug. "#$& Cl ulcers, nephroLoxlclLy, rash,
hypersenslLlvlLy leadlng Lo bronchoconsLrlcLlon, sallcyllsm. CLher nSAlus: |buprofen,
|ndomethac|n, ketoro|ac, and naproxen. (34, 36)
Ateno|o| 8eLa
1
-selecLlve blocker: low llpld solublllLy, less CnS effecL, used for P1n, anglna. (Mnemon|c:
Cenerlc names of
1
-selecLlve blockers sLarL wlLh A Lhrough M excepL for carLeolol, carvedllol,
and labeLalol.) "#$& asLhma, bradycardla, Av block, hearL fallure. (10)

Atrop|ne Muscarlnlc chollnocepLor blocker proLoLype: llpld-soluble, CnS effecLs, anLldoLe for chollnesLerase
polsonlng. "#$& "red as a beeL, dry as a bone, bllnd as a baL, mad as a haLLer," urlnary reLenLlon,
mydrlasls. Cyc|opento|ate, trop|cam|de: anLlmuscarlnlcs for ophLhalmology, cause cycloplegla and
mydrlasls. G|ycopyrro|ate: anLlmuscarlnlc wlLh decreased CnS effecLs. (8, 37)
Az|thromyc|n Macrollde anLlbloLlc: slmllar Lo eryLhromycln buL greaLer acLlvlLy agalnsL 1 *(203,(45,% chlamydlae,
and sLrepLococcl, long half-llfe wlLh renal ellmlnaLlon. "#$& Cl dlsLress buL no lnhlblLlon of drug
meLabollsm. C|ar|thromyc|n ls slmllar buL has a shorLer half-llfe, and lnhlblLs drug meLabollsm. (44)
8ac|ofen CA8A analog, orally acLlve: spasmolyLlc, acLlvaLes CA8A
8
recepLors ln Lhe splnal cord. (27)

8enztrop|ne Muscarlnlc chollnocepLor blocker: cenLrally acLlng anLlmuscarlnlc proLoLype for parklnsonlsm. "#$&
excess anLlmuscarlnlc effecLs. (8, 28)
8otu||num 1oxlns produced by @0#:)8*+*37 9#)30*(37& enzymes LhaL cleave nerve Lermlnal proLelns
(synapLobrevln, oLhers) and block LransmlLLer release from aceLylchollne veslcles. ln[ecLed Lo LreaL
muscle spasm, smooLh wrlnkles, and reduce excesslve sweaLlng. "#$& paralysls. (6, 27)
8romocr|pt|ne LrgoL derlvaLlve: proLoLype dopamlne agonlsL ln CnS, lnhlblLs prolacLln release. used ln
hyperprolacLlnemla and a rarely used alLernaLlve drug ln parklnsonlsm. "#$& CnS, dysklneslas,
hypoLenslon. (16, 28, 37)
8up|vaca|ne Long-acLlng amlde local anesLheLlc proLoLype. "#$& greaLer cardlovascular LoxlclLy Lhan mosL local
anesLheLlcs. (26)
8uprenorph|ne
Cplold: long-acLlng parLlal agonlsL of recepLors. Analgeslc (noL equlvalenL Lo morphlne) and
effecLlve for deLoxlflcaLlon and malnLenance ln oplold dependence. CLher mlxed agonlsL-
anLagonlsLs: na|buph|ne acLlvaLes and weakly blocks recepLors, pentazoc|ne,
agonlsL and weak anLagonlsL or parLlal agonlsL. (31)
8uprop|on AnLldepressanL & used ln smoklng cessaLlon: mechanlsm uncerLaln, buL no dlrecL acLlons on CnS
amlnes. "#$: aglLaLlon, anxleLy, aggravaLlon of psychosls and, aL hlgh doses, selzures. (30)
Captopr|| ACL lnhlblLor proLoLype: used ln P1n, dlabeLlc nephropaLhy, and Pl. "#$& hyperkalemla, feLal renal
damage, cough ("sore LhroaL"). CLher "prlls" lnclude benazepr||, ena|apr||, ||s|nopr||, qu|napr||. (11,
13, 17)
Carbamazep|ne AnLlselzure drug: used for Lonlc-clonlc and parLlal selzures, blocks na
+
channels ln neuronal
membranes. urug of cholce for Lrlgemlnal neuralgla, backup drug ln blpolar dlsorder. "#$& CnS
depresslon, myeloLoxlc, lnduces llver drug-meLabollzlng enzymes, LeraLogenlclLy. (24, 29)
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Carved||o|
AdrenocepLor blocker: racemlc mlxLure, one lsomer a nonselecLlve blocker and Lhe oLher an
1
blocker. used ln P1n, prolongs survlval ln Pl. "#$& cardlovascular depresslon, asLhma.
Labeta|o| ls slmllar. (10, 11, 13)

Caspofung|n
AnLlfungal: echlnocandln proLoLype, lnhlblLor of (1-3)-glucan synLhesls, a cell wall componenL.
used lv for dlssemlnaLed @5(+*+5 and ':A,8=*003: lnfecLlons. "#$& Cl effecLs, flushlng. lncreases
cyclosporlne levels (avold comblnaLlon). (48)
Cefazo||n llrsL-generaLlon cephalosporln proLoLype: bacLerlcldal beLa-lacLam lnhlblLor of cell wall synLhesls.
AcLlve agalnsL gram-poslLlve coccl, - /#0*% B A(,37#(*5,, buL does noL enLer Lhe CnS. "#$& poLenLlal
allergy, parLlal cross-reacLlvlLy wlLh penlcllllns. (43)
Ceftr|axone 1hlrd-generaLlon cephalosporln: acLlve agalnsL many bacLerla, lncludlng pneumococcl, gonococcl (a
drug of cholce), and gram-negaLlve rods. LnLers Lhe CnS and ls used ln bacLerlal menlnglLls.
Cefotax|me and ceftaz|d|me are oLher Lhlrd-generaLlon cephalosporlns. (43)
Ce|ecox|b SelecLlve CCx-2 lnhlblLor. Less Cl LoxlclLy Lhan nonselecLlve nSAlus. "#$& nephroLoxlclLy, lncreased
rlsk of myocardlal Lhrombosls and sLroke. (36)
Ch|oramphen|co| AnLlbloLlc: broad-specLrum agenL, lnhlblLs proLeln synLhesls (30S), uses resLrlcLed Lo backup drug
for bacLerlal menlnglLls, lnfecLlons due Lo anaerobes, ;507#(,005> "#$& reverslble myelosuppresslon,
aplasLlc anemla, gray baby syndrome. (44)
Ch|oroqu|ne AnLlmalarlal: blood schlzonLlclde used for LreaLmenL and prophylaxls ln areas ln whlch 6 250/*A5837
ls suscepLlble. 8lnds Lo hemln, causlng dysfuncLlonal cell membranes, reslsLance resulLlng from
efflux vla -glycoproLeln pump. "#$& Cl dlsLress and skln rash aL low doses, perlpheral neuropaLhy,
skln leslons, audlLory and vlsual lmpalrmenL, qulnldlne-llke cardloLoxlclLy aL hlgh doses. (32)
Ch|orphen|ram|ne AnLlhlsLamlne flrsL-generaLlon P
1
blocker proLoLype. "#$& less sedaLlon and AnS-blocklng acLlon
Lhan d|phenhydram|ne. (16)

Ch|orpromaz|ne henoLhlazlne anLlpsychoLlc drug proLoLype: blocks mosL dopamlne recepLors ln CnS.
"#$& aLroplne-llke, LS dysfuncLlon, hyperprolacLlnemla, posLural hypoLenslon, sedaLlon, selzures
(ln overdose), addlLlve effecLs wlLh oLher CnS depressanLs. CLher phenoLhlazlnes: f|uphenaz|ne,
tr|f|uoperaz|ne (anLlpsychoLlcs), proch|orperaz|ne (anLlemeLlc), promethaz|ne (preoperaLlve
sedaLlon). (29)
Cho|estyram|ne AnLlhyperllpldemlc: blle acld-blndlng resln proLoLype LhaL sequesLers blle aclds ln guL and dlverLs
more cholesLerol from Lhe llver Lo blle aclds lnsLead of clrculaLlng llpoproLelns. used for
hypercholesLerolemla "#$& consLlpaLlon, bloaLlng, lnLerferes wlLh absorpLlon of some drugs.
Co|est|po| and co|eseve|am are slmllar. (33)
C|met|d|ne P
2
blocker proLoLype: used ln acld-pepLlc dlsease. "#$& lnhlblLs hepaLlc drug meLabollsm,
anLlandrogen effecLs. Less Loxlc analogs: ran|t|d|ne, famot|d|ne, n|zat|d|ne. (16, 39)

C|prof|oxac|n Second-generaLlon fluoroqulnolone anLlbloLlc: bacLerlcldal lnhlblLor of Lopolsomerases, acLlve
agalnsL - /#0*% 1 *(203,(45,% @57AC0#95/),8% -(),8#95/),8% 6:,3+#7#(5:% ;<*=,005> "#$& CnS
dysfuncLlon, Cl dlsLress, superlnfecLlon, collagen dysfuncLlon (cauLlon ln chlldren and pregnanL
women). D(),85/)*#(:& lnhlblLs meLabollsm of caffelne, Lheophylllne, warfarln. See also |evof|oxac|n.
(46)
C|sp|at|n AnLlneoplasLlc: plaLlnum-conLalnlng alkylaLlng anLlcancer drug. used for solld Lumors (eg, LesLes,
lung). "#$& neuroLoxlc and nephroLoxlc. Carbop|at|n, oxa||p|at|n are slmllar. (34)
C||ndamyc|n Llncosamlde anLlbloLlc: bacLerlosLaLlc lnhlblLor of proLeln synLhesls (30S), acLlve agalnsL gram-
poslLlve coccl, E 285=*0*:> "#$& Cl dlsLress, pseudomembranous collLls. (44)
C|om|phene SelecLlve esLrogen recepLor modulaLor (SL8M): synLheLlc, used ln lnferLlllLy Lo lnduce ovulaLlon by
blocklng plLulLary esLrogen recepLors. May resulL ln mulLlple blrLhs. (40)
C|on|d|ne Alpha
2
agonlsL: acLs cenLrally Lo reduce SAnS ouLflow, lowers 8. used ln P1n and ln drug
dependency sLaLes. "#$& mlld sedaLlon ln normal doses, rebound P1n lf sLopped suddenly. See also
methy|dopa. (9, 11, 32)

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C|op|dogre| AnLlplaLeleL agenL: lrreverslbly lnhlblLs plaLeleL Au recepLors and plaLeleL aggregaLlon. used ln
LranslenL lschemlc aLLacks and Lo prevenL sLrokes and resLenosls afLer placemenL of coronary
sLenLs. "#$& bleedlng, neuLropenla. 1|c|op|d|ne ls slmllar, buL hlgher rlsk of neuLropenla and
LhromboLlc LhrombocyLopenlc purpura (11). (34)
Coca|ne lndlrecL-acLlng sympaLhomlmeLlc LhaL blocks amlne reupLake lnLo nerve endlngs: local anesLheLlc
(esLer Lype). Marked CnS sLlmulaLlon, euphorla, hlgh abuse and dependence llablllLy. "#$&
psychosls, P1n, cardlac arrhyLhmlas, selzures. (9, 26, 32)
Co|ch|c|ne MlcroLubule assembly lnhlblLor: reduces macrophage moblllLy and phagocyLosls, used ln chronlc
gouL. "#$& Cl (ofLen severe), hepaLlc, renal damage. (36)
Cyc|ophospham|de AnLlneoplasLlc, lmmunosuppresslve: cell cycle-nonspeclflc alkylaLlng agenL. "#$& alopecla, Cl
dlsLress, hemorrhaglc cysLlLls (use mesna), myelosuppresslon. (34, 33)
Cyc|ospor|ne lmmunosuppressanL: lmmunophllln llgand, lnhlblLs 1-cell synLhesls of cyLoklnes. "#$&
nephroLoxlclLy, hyperLenslon, perlpheral neuropaLhy, selzures. 1acro||mus and s|ro||mus are
slmllar. (36, 33)
Cytok|nes, recomb|nant unA Lechnology producLs: aldesleukln (lL-2, used ln renal cancer), erythropo|et|n (epoeLln alfa,
used ln anemlas), f||grast|m (C-CSl, used ln neuLropenla), |nterferon- (used ln hepaLlLls 8 and
C and ln cancer), |nterferon- (used ln mulLlple sclerosls), |nterferon- (used ln chronlc
granulomaLous dlsease), opre|vek|n (lL-11, used ln LhrombocyLopenla), and sargramost|m (CM-
CSl, used ln neuLropenla). (33, 36, 49, 34, 33)
Dantro|ene Muscle relaxanL: blocks Ca
2+
release from sarcoplasmlc reLlculum of skeleLal muscle. used ln muscle
spasm (cerebral palsy, mulLlple sclerosls, cord ln[ury) and ln emergency LreaLmenL of mallgnanL
hyperLhermla. (23, 27, 29)

Desmopress|n vasopressln (AuP) analog, more selecLlve for v
2
recepLors: used for plLulLary dlabeLes lnslpldus and
mlld hemophllla A or von Wlllebrand dlsease. Vasopress|n (AuP), an agonlsL for v
1
and v
2

recepLors, ls used ln plLulLary dlabeLes lnslpldus and bleedlng esophageal varlces. Con|vaptan, an
5()5=#(*:) aL v
1a
and v
2
recepLors and to|vaptan, an anLagonlsL aL v
2
recepLors, are used for
hyponaLremla. (13, 34, 37)

D|azepam 8enzodlazeplne (8Z) proLoLype: blnds Lo 8Z recepLors of Lhe CA8A
A
recepLor-chlorlde lon channel
complex, faclllLaLes Lhe lnhlblLory acLlons of CA8A by lncreaslng Lhe 28,F3,(/C of channel openlng
(compare phenobarblLal). uses: anxleLy sLaLes, eLhanol deLoxlflcaLlon, muscle spasLlclLy, sLaLus
epllepLlcus. CLher benzodlazeplnes lnclude a|prazo|am, |orazepam, m|dazo|am & tr|azo|am. "#$&
dependence, addlLlve effecLs wlLh oLher CnS depressanLs. (22, 24, 27, 32)

D|gox|n Cardlac glycoslde proLoLype: poslLlve lnoLroplc drug for Pl, half-llfe 40 h, lnhlblLs na
+
/k
+
A1ase,
also a cardlac parasympaLhomlmeLlc. "#$& calclum overload arrhyLhmlas, Cl upseL. (13, 14)

D|phenhydram|ne AnLlhlsLamlne (flrsL-generaLlon) P
1
blocker: used ln hay fever, moLlon slckness, dysLonlas. "#$&
anLlmuscarlnlc, adrenocepLor blocker, sLrong sedaLlve. Doxy|am|ne ls slmllar. (16, 39)

Dopam|ne neuroLransmlLLer and agonlsL drug aL dopamlne recepLors: used ln shock Lo lncrease renal blood
flow (low dose) and cardlac ouLpuL (moderaLe dose). (6, 9, 13, 21, 28, 29, 37)
Doxorub|c|n AnLlneoplasLlc: anLhracycllne drug (cell cycle-nonspeclflc), lnLercalaLes beLween base palrs Lo
dlsrupL unA funcLlons, lnhlblLs Lopolsomerases, and forms cyLoLoxlc free radlcals. "#$&
cardlomyopaLhy (dexrazoxane ls anLldoLe), myelosuppresslon. Daunorub|c|n ls slmllar. (34)
Doxycyc||ne 1eLracycllne anLlbloLlc: proLeln synLhesls lnhlblLor (30S), more effecLlve Lhan oLher LeLracycllnes
agalnsL chlamydla and ln Lyme dlsease, malarla prophylaxls. unllke oLher LeLracycllnes, lL ls
ellmlnaLed malnly ln Lhe feces and has longer half-llfe. "#$& see tetracyc||ne. (44, 33)
Ldrophon|um ChollnesLerase lnhlblLor: very shorL duraLlon of acLlon (13 mln). used ln dlagnosls of myasLhenla
gravls and Lo dlsLlngulsh myasLhenlc crlsls from chollnerglc crlsls. (7)
Lfav|renz nonnucleoslde reverse LranscrlpLase lnhlblLor (nn81l): used ln comblnaLlon reglmens for Plv. "#$&
skln rash, CnS effecLs, avold ln pregnancy. CLher nn81ls: de|av|rd|ne, nev|rap|ne. (49)
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Lnfuv|rt|de AnLlvlral: Plv fuslon lnhlblLor used ln comblnaLlon reglmens. "#$& ln[ecLlon slLe reacLlons and rare
hypersenslLlvlLy. (49)
Lnoxapar|n LMW heparln: used parenLerally for anLlcoagulaLlon. rlmary effecL ls on facLor xa, less on
Lhrombln. 1he a11 LesL ls unrellable. CLher LMW heparlns lnclude da|tepar|n, t|nzapar|n. "#$&
bleedlng. (34)
Lntacapone CCM1 lnhlblLor: enhances levodopa access Lo CnS neurons, ad[uncLlve use ln arklnson's dlsease.
"#$& exacerbaLes levodopa effecLs. 1o|capone ls slmllar ln acLlon and use buL can be hepaLoLoxlc.
(28)
Lphedr|ne lndlrecLly acLlng sympaLhomlmeLlc: llke amphetam|ne buL less CnS sLlmulaLlon, more smooLh
muscle effecLs. ln boLanlcals (eg, ma huang) and producLs for welghL loss LhaL are banned ln Lhe
unlLed SLaLes. "#$& hyperLenslon, sLroke, Ml. (9, 61)
Lp|nephr|ne AdrenocepLor agonlsL proLoLype: producL of adrenal medulla, some CnS neurons. AfflnlLy for all
and all recepLors. urug of cholce ln anaphylaxls, used as hemosLaLlc and as ad[uncL wlLh
local anesLheLlcs, cardlac sLlmulanL, LradlLlonal use ln asLhma. "#$& Lachycardla, hyperLenslon, Ml,
pulmonary edema, and hemorrhage. (6, 9)
Lrgot a|ka|o|ds Lrgonov|ne, ergotam|ne: cause prolonged vasoconsLrlcLlon and uLerlne conLracLlon. used ln
mlgralne and obsLeLrlcs. "#$& vasospasm (lncludlng coronarles). (16, 28)
Lrythromyc|n Macrollde anLlbloLlc: bacLerlosLaLlc lnhlblLor of proLeln synLhesls (30S), acLlvlLy lncludes gram-
poslLlve coccl and bacllll, G A(,37#(*5,% ?,=*#(,005 A(,37#A<*05% @ )85/<#75)*:> "#$& cholesLaLlc
[aundlce (avold esLolaLe ln pregnancy), lnhlblLs llver drug-meLabollzlng enzymes, lnLeracLlons wlLh
clsaprlde, Lheophylllne, warfarln. CLher macrollde anLlbloLlcs lnclude az|thromyc|n and
c|ar|thromyc|n. (44)
Lrythropo|et|n PemaLopoleLlc growLh facLor: sLlmulaLes 88C producLlon and release from bone marrow. used ln
anemla assoclaLed wlLh renal fallure and anemlas secondary Lo cancer chemoLherapy. Darbepoet|n
a|fa has a longer half-llfe. (33)
Ltanercept
uMA8u: recomblnanL proLeln LhaL blnds 1nl- . Inf||x|mab has a slmllar mechanlsm of acLlon.
LffecLlve ln rheumaLold arLhrlLls and oLher chronlc lnflammaLory dlseases. "#$& ln[ecLlon slLe
reacLlons lnclude eryLhema, lLchlng, and swelllng, posslble lncreased raLes of lnfecLlon and
mallgnancy. (36, 33)
Lthambuto| AnLlmycobacLerlal: lnhlblLor of arablnogalacLan synLhesls, a cell wall componenL, commonly used ln
sLandard anLlLubercular drug reglmens. "#$: dose-dependenL ocular dysfuncLlon, dlzzlness,
headache, hyperurlcemla. (47)
Lthano| SedaLlve-hypnoLlc: acuLe acLlons lnclude lmpalred [udgmenL, aLaxla, loss of consclousness,
vasodllaLlon, and cardlovascular and resplraLory depresslon. Chronlc use leads Lo dependence and
dysfuncLlon of mulLlple organ sysLems, feLal alcohol syndrome. H#),& zero-order ellmlnaLlon
klneLlcs. (23, 32)
Lth|ny| estrad|o| SynLheLlc esLrogen: used ln many hormonal conLracepLlves. Mestrano| ls slmllar. (40)
Lthosux|m|de AnLlconvulsanL: used ln absence selzures, may block 1-Lype Ca
2+
channels ln Lhalamlc neurons. "#$&
Cl dlsLress, safe ln pregnancy. (24)

Lzet|m|be AnLlhyperllpldemlc: cholesLerol-lowerlng drug LhaL lnhlblLs Cl LransporLer of dleLary cholesLerol and
Lhe cholesLerol secreLed ln blle. used for hypercholesLerolemla, usually ln comblnaLlon wlLh a
sLaLln. "#$& posslble lncreased rlsk of hepaLlc damage when comblned wlLh sLaLln. (33)
Ientany| ShorL-acLlng poLenL oplold agonlsL (see morphlne) used commonly ln anesLhesla and for chronlc
paln (Lransdermal form). kem|fentan|| and sufentan|| are slmllar. (23, 31, 32)
I|naster|de
AnLlandrogen: sLerold lnhlblLor of 3 -reducLase LhaL lnhlblLs synLhesls of dlhydroLesLosLerone.
used ln benlgn prosLaLlc hyperplasla and male-paLLern baldness. Dutaster|de ls slmllar. (40)
I|eca|n|de Croup 1C anLlarrhyLhmlc proLoLype: used ln venLrlcular Lachycardla and rapld aLrlal arrhyLhmlas
wlLh Wolff-arklnson-WhlLe syndrome. "#$& arrhyLhmogenlc, CnS exclLaLlon. (14)
I|uconazo|e lmldazole anLlfungal: lnhlblLs ergosLerol synLhesls. CnS enLry and renal ellmlnaLlon. used ln
esophageal and vaglnal candldlasls, ln coccldloldomycosls, and ln Lhe prophylaxls and LreaLmenL of
fungal menlnglLls. Adverse effecLs slmllar Lo Lhose of ketoconazo|e buL less severe. (48)
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I|udrocort|sone SynLheLlc corLlcosLerold: hlgh mlneralocorLlcold and moderaLe glucocorLlcold acLlvlLy, long duraLlon
of acLlon. used ln Addlson's dlsease. (39)
I|umazen|| 8enzodlazeplne recepLor anLagonlsL: used Lo reverse CnS depressanL effecLs of benzodlazeplnes,
zo|p|dem, eszop|c|one and za|ep|on. (22, 38)
I|uorourac|| AnLlneoplasLlc: pyrlmldlne anLlmeLabollLe (cell cycle-speclflc), lrreverslbly lnhlblLs LhymldylaLe
synLhase, resulLlng ln d1M deflclency and "Lhymlne-less" cell deaLh, used malnly for solld Lumors.
"#$& Cl dlsLress, myelosuppresslon, neuroLoxlclLy. (34)
I|uoxet|ne AnLldepressanL: selecLlve seroLonln reupLake lnhlblLor (SS8l) proLoLype. Less AnS adverse effecLs
and cardloLoxlc poLenLlal Lhan Lrlcycllcs. "#$& CnS sLlmulaLlon, sexual dysfuncLlon, selzures ln
overdose, seroLonln syndrome. CLher SS8ls: c|ta|opram, esc|ta|opram, f|uvoxam|ne, paroxet|ne,
sertra||ne. (30)
I|utam|de AnLlandrogen: proLoLype androgen recepLor anLagonlsL used ln prosLaLlc carclnoma. CLhers:
b|ca|utam|de, n||utam|de. (40)
Iurosem|de Loop dlureLlc proLoLype: blocks na
+
/k
+
/2Cl
-
LransporLer ln Lhlck ascendlng llmb, hlgh efflcacy, used
ln acuLe pulmonary edema, refracLory edemaLous sLaLes, hypercalcemla, and P1n. "#$& oLoLoxlclLy,
k
+
wasLlng, hypovolemla, lncreased serum urlc acld. 8umetan|de and torsem|de dlffer only ln half-
llfe. Lthacryn|c ac|d ls slmllar buL causes less hyperurlcemla and may even reduce urlc acld levels.
(13, 13)

Gabapent|n AnLlconvulsanL: sLrucLural analog of CA8A LhaL faclllLaLes lLs lnhlblLory acLlons ln Lhe CnS, used for
parLlal selzures, for neuropaLhlc paln, and ln blpolar dlsorder. "#$& sedaLlon, movemenL dlsorders.
(24, 27, 29)
Ganc|c|ov|r AnLlvlral: effecLlve agalnsL herpesvlruses (cyLomegalovlrus [CMv] and herpes slmplex vlrus [PSv]),
for CMv requlres bloacLlvaLlon vla vlral phosphoLransferase. "#$& myelosuppresslon,
nephroLoxlclLy, neuroLoxlclLy. (49)
Gemf|broz|| AnLlhyperllpldemlc: flbraLe proLoLype used for hyperLrlglycerldemla. Lowers serum vLuL and
Lrlglycerldes and lncreases PuL by acLlvaLlng peroxlsome prollferaLor-acLlvaLed recepLor-
nuclear recepLors. "#$& Cl dlsLress, cholellLhlasls, lncreased rlsk of myopaLhy when comblned wlLh
sLaLlns or nlacln. (33)
Gentam|c|n Amlnoglycoslde proLoLype: bacLerlcldal lnhlblLor of proLeln synLhesls (30S), acLlve agalnsL many
aeroblc gram-negaLlve bacLerla. narrow LherapeuLlc wlndow, dose reducLlon requlred ln renal
lmpalrmenL. "#$& renal dysfuncLlon, oLoLoxlclLy, once-dally doslng ls effecLlve (posLanLlbloLlc effecL)
and less Loxlc. Am|kac|n and tobramyc|n are slmllar. (43, 31)
G||p|z|de Cral anLldlabeLlc: second-generaLlon, poLenL sulfonylurea secreLagogue. 8locks k
+
channels ln
pancreaLlc 8 cells, causlng depolarlzaLlon and release of lnsulln. "#$& hypoglycemla, welghL galn.
8elaLed drugs: g|ybur|de and older sulfonylureas such chlorpropamlde and LolbuLamlde, shorL-
acLlng secreLagogues lnclude repag||n|de and naLegllnlde. (41)

G|ucagon Pormone from pancreaLlc A cells. lncreases blood glucose vla lncreased cycllc adenoslne
monophosphaLe. used ln severe hypoglycemla and as an anLldoLe ln -blocker overdose. (41,
38)
na|oper|do| AnLlpsychoLlc buLyrophenone: blocks braln dopamlne u
2
recepLors. "#$& marked LS dysfuncLlon,
hyperprolacLlnemla, fewer AnS adverse effecLs Lhan phenoLhlazlnes. (29)

na|othane Ceneral anesLheLlc proLoLype: lnhaled halogenaLed hydrocarbon. "#$& cardlovascular and
resplraLory depresslon and relaxaLlon of skeleLal and smooLh muscle. use ls decllnlng because of
senslLlzaLlon of hearL Lo caLecholamlnes and occurrence (rare) of hepaLlLls. newer lnhaled
anesLheLlcs lnclude |sof|urane and sevof|urane. (23)
nepar|n AnLlcoagulanL: large polymerlc molecule wlLh acLlvlLy agalnsL Lhrombln and facLor x. 8apld onseL,
parenLeral admlnlsLraLlon. LMW heparlns (eg, enoxaparln) and fondaparlnux have a slmllar
mechanlsm of acLlon, alLhough Lhey are more selecLlve for facLor x. "#$& bleedlng. '()*+#),&
protam|ne. (34)
nexamethon|um roLoLyplc gangllon blocker, now obsoleLe excepL for research use. Causes marked block of boLh
AnS and SAnS, hypoLenslon. newer analogs tr|methaphan, mecamy|am|ne are rarely used. (6)
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nydra|az|ne AnLlhyperLenslve: arLerlolar vasodllaLor, orally acLlve, used ln severe P1n, Pl. M|nox|d||, a slmllar
buL more powerful anLlhyperLenslve, ls also used Loplcally ln baldness. "#$& Lachycardla, salL and
waLer reLenLlon, lupus-llke syndrome (hydralazlne). (11, 13)
nydroch|oroth|az|de 1h|az|de dlureLlc proLoLype: acLs ln dlsLal convoluLed Lubule Lo block na
+
/Cl
-
LransporLer, used ln
P1n, Pl, nephrollLhlasls. "#$& hypersenslLlvlLy reacLlons, lncreased serum llplds, urlc acld, glucose,
k
+
wasLlng. (11, 13, 13)

nydroxych|oroqu|ne uMA8u: lmmunosuppressanL used for rheumaLold arLhrlLls. "#$& rash, Cl dlsLress, ocular LoxlclLy,
myopaLhy, neuropaLhy. CLher uMA8us: methotrexate, su|fasa|az|ne, go|d sa|ts, pen|c|||am|ne.
(36)
Ibuprofen nSAlu: nonselecLlve CCx lnhlblLor wlLh analgeslc, anLlpyreLlc, and anLl-lnflammaLory acLlons slmllar
Lo asplrln, buL no low-dose anLlplaLeleL effecL. "#$& Cl, renal. (36)
Im|penem roLoLype carbapenem anLlbloLlc: acLlve agalnsL many aeroblc and anaeroblc bacLerla, lncludlng
penlcllllnase-produclng organlsms, a bacLerlcldal lnhlblLor of cell wall synLhesls. used wlLh cllasLaLln
(whlch lnhlblLs meLabollsm by renal dehydropepLldases). "#$& allergy (parLlal cross-reacLlvlLy wlLh
penlcllllns), selzures. Meropenem and ertapenem are slmllar buL do noL requlre cllasLaLln and are
less llkely Lo cause selzures. (43)
Im|pram|ne 1rlcycllc anLldepressanL (1CA): blocks reupLake of noreplnephrlne and seroLonln. "#$& aLroplne-llke,
posLural hypoLenslon, sedaLlon, cardlac arrhyLhmlas ln overdose, addlLlve effecLs wlLh oLher CnS
depressanLs. CLher 1CAs: am|tr|pty||ne, c|om|pram|ne, doxep|n. (30)
Ind|nav|r AnLlvlral: Plv proLease lnhlblLor (l) used as a componenL of comblnaLlon reglmens ln AluS. "#$&
anemla, nephrollLhlasls, meLabollc dlsorders, lnhlblLs 430 drug meLabollsm. CLher ls:
amprenav|r, ne|f|nav|r, r|tonav|r (ma[or 430 lnhlblLor, see below), and saqu|nav|r. (49)
Indomethac|n nSAlu: hlghly poLenL. usually reserved for acuLe lnflammaLlon (eg, acuLe gouL), neonaLal paLenL
ducLus arLerlosus. "#$& Cl LoxlclLy, renal damage. (36)
Interferon
CyLoklne: LreaLmenL of hepaLlLls 8 and C vlral lnfecLlons and some mallgnancles. "#$& "flu-llke"
syndrome, myelosuppresslon, neuroLoxlclLy. (49, 33)
Ipratrop|um AnLlmuscarlnlc agenL: aerosol for asLhma, chronlc obsLrucLlve pulmonary dlsease (CCu). Cood
bronchodllaLor ln 30-60 of paLlenLs. 1|otrop|um ls slmllar wlLh longer acLlon. noL as efflcaclous as
2
agonlsLs buL less Loxlc ln CCu. "#$& dry mouLh. (8, 20)

Ison|az|d AnLlmycobacLerlal: prlmary drug ln comblnaLlon reglmens for Luberculosls, used as sole agenL ln
LreaLmenL of laLenL lnfecLlon. MeLabollc clearance vla H-aceLylLransferases (geneLlc varlablllLy).
"#$& hepaLoLoxlclLy (age-dependenL), perlpheral neuropaLhy (reversed by pyrldoxlne), hemolysls (ln
glucose-6-phosphaLe dehydrogenase deflclency [C6u] deflclency). (47)
Isoprotereno|
8eLa
1
and
2
agonlsL caLecholamlne proLoLype: bronchodllaLor, cardlac sLlmulanL. Always
causes Lachycardla because boLh dlrecL and reflex acLlons lncrease P8. "#$& arrhyLhmlas, Lremor,
anglna. (9)

Ivermect|n AnLlhelmlnLhlc: drug of cholce for onchocerclasls and Lhreadworm lnfecLlons. lnLenslfles CA8A-
medlaLed neuroLransmlsslon ln nemaLodes, buL no access Lo CnS ln humans. "#$& ln onchocerclasls
causes headache, fever, hypoLenslon, [olnL paln. (33)
ketoconazo|e AnLlfungal azole proLoLype: acLlve sysLemlcally, lnhlblLs Lhe synLhesls of ergosLerol. used for @
509*/5(:% dermaLophyLosls, and non-llfe-LhreaLenlng sysLemlc mycoses. ls someLlmes used Lo
suppress adrenocorLlcold or gonadal hormone synLhesls. "#$& hepaLlc dysfuncLlon, lnhlblLs sLerold
synLhesls and C?430-dependenL drug meLabollsm. CLhers: f|uconazo|e, |traconazo|e, and
vor|conazo|e have a wlder specLrum and less lnhlblLory effecLs on hepaLlc cyLochromes 430. (39,
40, 48)
ketoro|ac nSAlu: malnly used as a sysLemlc analgeslc, only nSAlu avallable ln parenLeral form, see also
asplrln. (36)
Lam|vud|ne nucleoslde reverse LranscrlpLase lnhlblLor (n81l) also known as 31C. LeasL Loxlc n81l. noLable for
use ln chronlc hepaLlLls 8 ln addlLlon Lo Plv lnfecLlon. (49)
Lamotr|g|ne newer anLlepllepLlc drug for absence and parLlal selzures, also used ln blpolar affecLlve dlsorder.
"#$& rash, posslbly llfe LhreaLenlng, especlally ln pedlaLrlc paLlenLs. (24, 29)
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Latanoprost
rosLaglandln l
2
analog used Loplcally ln closed angle glaucoma. 8|matoprost, travoprost are
slmllar. (18)

Lef|unom|de uMA8u: dlhydrooroLaLe dehydrogenase lnhlblLor LhaL arresLs 1 cell prollferaLlon. used orally ln
rheumaLold arLhrlLls. "#$& dlarrhea, lncreased llver enzymes. (36, 33)
Leupro||de Cn8P analog: conLlnuous Lherapy used Lo suppress gonadoLropln and gonadal hormone synLhesls,
especlally ln concerL wlLh gonadoLroplns for ovulaLlon lnducLlon and ln advanced prosLaLe cancer.
Gosere||n and nafare||n are slmllar. Gan|re||x ls a Cn8P recepLor 5()5=#(*:) wlLh slmllar effecLs.
"#$& hoL flushes, decreased bone denslLy wlLh prolonged use, gynecomasLla (men). (37, 40, 34)
Levodopa uopamlne precursor: used ln parklnsonlsm, usually ln comblnaLlon wlLh carbldopa (a perlpheral
lnhlblLor of dopamlne meLabollsm). "#$& dysklneslas, hypoLenslon, on-off phenomena, behavloral
changes. (28)
Levof|oxac|n lluoroqulnolone: 8acLerlcldal lnhlblLor of Lopolsomerases, one of several "resplraLory"
fluoroqulnolones (gem|f|oxac|n, mox|f|oxac|n) wlLh greaLer acLlvlLy Lhan clprofloxacln agalnsL
pneumococcl. "#$: see c|prof|oxac|n. (46)
Levonorgestre| rogesLln: used ln many conLracepLlves lncludlng comblned oral conLracepLlves, progesLln-only oral
conLracepLlves, Lhe levonorgesLrel luu, subcuLaneous lmplanLs, and Lhe lan 8 emergency
conLracepLlve. (40)
L|doca|ne Amlde local anesLheLlc, medlum-duraLlon amlde proLoLype: hlghly selecLlve use-dependenL group
18 anLlarrhyLhmlc, used for nerve block and acuLe posL-Ml lschemlc venLrlcular arrhyLhmlas.
arenLeral only. "#$& CnS exclLaLlon. Mex||et|ne: llke lldocalne, buL orally acLlve, longer duraLlon.
(14, 26)
L|th|um AnLlmanlc proLoLype: a prlmary drug ln manla and blpolar affecLlve dlsorders, blocks recycllng of
Lhe phosphaLldyllnoslLol second messenger sysLem. "#$& Lremor, dlabeLes lnslpldus, golLer, selzures
(ln overdose), LeraLogenlc poLenLlal (LbsLeln's malformaLlons) now quesLlonable. (29)
Loratad|ne Second-generaLlon P
1
anLlhlsLamlne: used ln hay fever. "#$& Much less sedaLlon Lhan flrsL-
generaLlon anLlhlsLamlnes, no AnS effecLs. CLhers: des|oratad|ne, cet|r|z|ne, fexofenad|ne. (16)

Losartan AngloLensln A1
1
recepLor blocker (A88) proLoLype: used ln P1n. LffecLs and LoxlclLy slmllar Lo Lhose
of ACL lnhlblLors buL causes less cough. CLher A1
1
blockers: candesartan, eprosartan, |rbesartan,
o|mesartan, te|m|sartan, va|sartan. (11, 13, 17)

Lovastat|n AnLlhyperllpldemlc: PMC-CoA reducLase lnhlblLor proLoLype used for hypercholesLerolemla. AcLs ln
llver Lo reduce synLhesls of cholesLerol and lndlrecLly lncrease LuL recepLor synLhesls. CLher
"sLaLlns": atorvastat|n, f|uvastat|n, pravastat|n, rosuvastat|n, s|mvastat|n. "#$& hepaLoLoxlclLy
(elevaLed enzymes), muscle damage, LeraLogen. (33)
Ma|ath|on CrganophosphaLe lnsecLlclde chollnesLerase lnhlblLor: prodrug converLed Lo malaoxon. Less Loxlc ln
mammals and blrds because meLabollzed Lo lnacLlve producLs. CLher organophosphaLes: parath|on
converLed Lo paraoxon, and Lhe nerve gases (eg, sar|n, soman). (7, 37)
Mann|to| CsmoLlc dlureLlc: used shorL Lerm for reducLlon of lnLracranlal pressure or Lo promoLe excreLlon of
renal Loxlns ln hemolysls, rhabdomyolysls. "#$& lnlLlal expanslon of exLracellular fluld volume wlLh
resulLlng hyponaLremla, headache, nausea. WlLh excesslve use, dehydraLlon and hypernaLremla.
(13)
Mebendazo|e AnLlhelmlnLhlc: lmporLanL drug for common nemaLode lnfecLlons. lnhlblLs mlcroLubule synLhesls
and glucose upLake ln nemaLodes. "#$& Cl dlsLress, cauLlon ln pregnancy. A|bendazo|e (wldely used)
and th|abendazo|e (more Loxlc) are relaLed anLlhelmlnLhlcs. (33)
Medroxyprogesterone rogesLln: used ln comblnaLlon wlLh an esLrogen for LreaLmenL of menopausal sympLoms and used
as a long-acLlng ln[ecLlon (uepo-rovera) for conLracepLlon. (40)
Mef|oqu|ne AnLlmalarlal: unknown mechanlsm of acLlon. used for prophylaxls agalnsL and LreaLmenL of
chloroqulne-reslsLanL malarla, buL reslsLance emerglng. "#$& Cl dlsLress, dlzzlness, selzures ln
overdose, arrhyLhmlas. (32)
Meper|d|ne Cplold analgeslc: synLheLlc, equlvalenL Lo morphlne ln efflcacy buL orally bloavallable. SLrong
agonlsL aL oplold recepLors, blocks muscarlnlc recepLors, seroLonerglc acLlvlLy. "#$& see
morphlne, normeperldlne accumulaLlon may cause selzures, seroLonln syndrome wlLh SS8ls. (31)
www.perpetuum-lab.com.hr
Metform|n Cral anLldlabeLlc: proLoLype blguanlde, lnhlblLs hepaLlc and renal gluconeogenesls, mlnlmal
hypoglycemla or welghL galn. "#$& Cl dlsLress, lacLlc acldosls posslble buL rare. (41)
Methadone
Cplold analgeslc: synLheLlc agonlsL, equlvalenL Lo morphlne ln efflcacy buL orally bloavallable
and wlLh a longer half-llfe. used as analgeslc, Lo suppress wlLhdrawal sympLoms, and ln
malnLenance programs. "#$& see morphlne. (31, 32)
Meth|mazo|e AnLlLhyrold drug: lnhlblLs Lyroslne lodlnaLlon and coupllng reacLlons, orally acLlve. "#$& rash,
agranulocyLosls (rare). ropy|th|ourac|| ls slmllar. (37)
Methotrexate AnLlneoplasLlc, uMA8u, lmmunosuppressanL: cell cycle-speclflc drug LhaL lnhlblLs dlhydrofolaLe
reducLase. Ma[or dose reducLlon requlred ln renal lmpalrmenL. "#$& Cl dlsLress, myelosuppresslon,
crysLallurla. Leucovor|n rescue used Lo reduce LoxlclLy. (36, 34, 33)
Methy|dopa
AnLlhyperLenslve: prodrug of meLhylnoreplnephrlne, a CnS-acLlve
2
agonlsL. 8educes SAnS
ouLflow from vasomoLor cenLer. See also c|on|d|ne. "#$& sedaLlon, poslLlve Coombs LesL, hemolysls.
(11)

Metoc|opram|de roklneLlc agenL: dopamlne u
2
recepLor agonlsL used Lo sLlmulaLe upper Cl moLlllLy ln paLlenLs wlLh
gasLroparesls and used as an anLlemeLlc. "#$& resLlessness, lnsomnla, aglLaLlon, exLrapyramldal
effecLs, elevaLed prolacLln. (39)

Metron|dazo|e AnLlproLozoal anLlbloLlc: drug of cholce ln exLralumlnal ameblasls and Lrlchomonlasls (t|n|dazo|e ls
equlvalenL), effecLlve agalnsL bacLerlal anaerobes, lncludlng E 285=*0*: and ln anLlbloLlc-lnduced
collLls resulLlng from @ +*22*/*0,> "#$& perlpheral neuropaLhy, Cl dlsLress, eLhanol lnLolerance,
muLagenlc poLenLlal. (30, 32)
M|fepr|stone rogesLln and glucocorLlcold recepLor anLagonlsL: used ln comblnaLlon wlLh prosLaglandln analogs
for medlcal aborLlon ln early pregnancy. (39, 40)
M|soprosto| rosLaglandln L1 derlvaLlve: orally acLlve prosLaglandln used Lo prevenL Cl ulcers caused by nSAlus.
Also used wlLh m|fepr|stone as aborLlfaclenL. "#$& dlarrhea. (18, 40, 39)
Monte|ukast LeukoLrlene recepLor blocker (especlally L1u
4
) used for prophylaxls ln asLhma. Crally acLlve, once
dally admlnlsLraLlon. 2af|r|ukast ls slmllar. "#$& mlnlmal (20)

Morph|ne
Cplold analgeslc proLoLype: sLrong recepLor agonlsL. oor oral bloavallablllLy. "#$&
consLlpaLlon, emesls, sedaLlon, resplraLory depresslon, mlosls, and urlnary reLenLlon. 1olerance
may be marked, hlgh poLenLlal for psychologlcal and physlologlc dependence. AddlLlve effecLs wlLh
oLher CnS depressanLs. (31, 32)
Nafc||||n enlcllllnase-reslsLanL penlclllln: narrow specLrum, used for suspecLed or known sLaphylococcal
lnfecLlons, noL acLlve agalnsL meLhlclllln-reslsLanL ; 538,3: (M8SA). "#$& penlclllln allergy. CLhers ln
group lnclude meth|c||||n (Lhe proLoLype, rarely used), oxac||||n, c|oxac||||n, and d|c|oxac||||n. (43,
31)
Na|oxone
Cplold recepLor anLagonlsL: used Lo reverse CnS depressanL effecLs of oplold analgeslcs
(overdose or when used ln anesLhesla). Na|trexone (orally acLlve), a relaLed compound, ls used ln
eLhanol dependency sLaLes. (31, 38)
Neost|gm|ne ChollnesLerase lnhlblLor: proLoLype synLheLlc quaLernary nlLrogen carbamaLe wlLh llLLle CnS effecL.
"#$& excess chollnomlmeLlc effecLs. yr|dost|gm|ne ls slmllar buL longer-acLlng. hysost|gm|ne ls a
llpld-soluble planL alkalold. Lchoth|ophate ls a rarely used organophosphaLe chollnesLerase
lnhlblLor for Loplcal ophLhalmlc use. (7, 27)
N|ac|n AnLlhyperllpldemlc: lnhlblLs vLuL synLhesls and release of faLLy aclds from adlpose Llssue. Lowers
LuL cholesLerol and Lrlglycerldes and ralses PuL cholesLerol. "#$& flushlng, prurlLus, llver
dysfuncLlon, lncreased rlsk of myopaLhy when comblned wlLh sLaLlns. (33)
N|fed|p|ne ulhydropyrldlne calclum channel blocker proLoLype: less cardlac depresslon Lhan verapam||,
d||t|azem, used ln anglna, P1n. "#$& consLlpaLlon, headache, Lachycardla, arrhyLhmlas (avold rapld-
onseL forms). CLhers ln Lhe dlhydropyrldlne group lnclude am|od|p|ne, fe|od|p|ne, n|card|p|ne. (11,
12)
N|tr|c ox|de Lndogenous vasodllaLor released from vascular endoLhellum, neuroLransmlLLer. MedlaLes
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vasodllaLlng effecL of aceLylchollne, hlsLamlne, and hydralazlne. AcLlve meLabollLe of nlLroprusslde
and of nlLraLes used ln anglna. used as pulmonary dllaLor ln neonaLal hypoxla. "#$& excesslve
vasodllaLlon, hypoLenslon. (19)
N|trog|ycer|n AnLlanglnal vasodllaLor proLoLype: releases nlLrlc oxlde (nC) ln velns, less ln arLerles, and causes
smooLh muscle relaxaLlon. SLandard of Lherapy ln anglna (boLh aLheroscleroLlc and varlanL). "#$&
Lachycardla, orLhosLaLlc hypoLenslon, headache. Cral nlLraLes: |sosorb|de d|n|trate, |sosorb|de
monon|trate. (12, 13)
Norep|nephr|ne
AdrenocepLor agonlsL proLoLype: acLs aL all adrenocepLors and
1
adrenocepLors, used as
vasoconsLrlcLor. Causes reflex bradycardla. "#$& lschemla, arrhyLhmlas, P1n. (6, 9)

C|anzap|ne ALyplcal anLlpsychoLlc: hlgh-afflnlLy anLagonlsL aL 3-P1
2a
recepLors wlLh mlnlmal exLrapyramldal
slde effecLs, lmproves boLh poslLlve and negaLlve sympLoms of schlzophrenla. CLher aLyplcals:
quet|ap|ne (shorL half-llfe), r|sper|done (posslble LS dysfuncLlon), sert|ndo|e (C1 prolongaLlon),
c|ozap|ne (agranulocyLosls). (29)

Cmeprazo|e roLon pump lnhlblLor proLoLype: lrreverslble blocker of P
+
/k
+
A1ase proLon pump ln parleLal cells
of sLomach. used ln Cl ulcers, Zolllnger-Llllson syndrome, gasLroesophageal reflux dlsease (CL8u).
CLher "prazoles": |ansoprazo|e, pantoprazo|e, rabeprazo|e. "#$& hypergasLrlnemla. (39)

Cndansetron 3-P1
3
recepLor blocker proLoLype: very lmporLanL anLlemeLlc for cancer chemoLherapy, also used
posLoperaLlvely Lo reduce vomlLlng. "#$& exLrapyramldal effecLs. CLher "seLrons":
gran|setron, dolaseLron, pa|onosetron. (16, 39)

Cse|tam|v|r AnLlvlral: neuramlnldase lnhlblLor blocklng release of maLure vlrlons of lnfluenza A and 8 and
decreaslng Lhelr lnfecLlvlLy. rophylacLlc and shorLens duraLlon of flu sympLoms. 2anam|v|r ls
slmllar ln acLlon and use. (49)
Cxybutyn|n Muscarlnlc chollnocepLor blocker: used Lo relleve bladder spasm and lnconLlnence. 1o|terod|ne,
weaker buL more selecLlve for M
3
recepLors, has slmllar uses. (8)

ac||taxe| AnLlneoplasLlc planL alkalold: cell cycle (M phase)-speclflc agenL, lnhlblLs mlLoLlc splndle
dlsassembly. "#$& hemaLoLoxlclLy, perlpheral neuropaLhy, hypersenslLlvlLy reacLlons. Docetaxe| ls
slmllar. (34)
en|c|||am|ne ChelaLor, lmmunomodulaLor: LreaLmenL of copper, lead, mercury, and arsenlc polsonlng. Also used
ln Wllson's dlsease and formerly used ln rheumaLold arLhrlLls. (36, 37)
en|c||||n G enlclllln proLoLype: acLlve agalnsL common sLrepLococcl, gram-poslLlve bacllll, gram-negaLlve coccl,
splrocheLes (drug of cholce ln syphllls), and enLerococcl (lf used wlLh an amlnoglycoslde),
penlcllllnase suscepLlble. "#$& penlclllln allergy. (43, 31)
hene|z|ne lrreverslble nonselecLlve MAC lnhlblLor. 8ackup drug for aLyplcal depresslon. "#$& MallgnanL
hyperLenslon wlLh lndlrecL-acLlng sympaLhomlmeLlcs and Lyramlne, seroLonln syndrome wlLh
seroLonerglc drugs. (30)
henobarb|ta| Long-acLlng barblLuraLe: used as a sedaLlve and for Lonlc-clonlc selzures. laclllLaLes CA8A-medlaLed
neuronal lnhlblLlon (by lncreaslng +385)*#( of channel openlng) and may block exclLaLory
neuroLransmlLLers. arLlal renal clearance LhaL can be lncreased by urlnary alkallnlzaLlon. Chronlc
use leads Lo lnducLlon of llver drug-meLabollzlng enzymes and ALA synLhase. "#$& psychologlcal and
physlologlc dependence, addlLlve effecLs wlLh oLher CnS depressanLs. (22, 24)
henoxybenzam|ne Alpha-blocker proLoLype (nonselecLlve): lrreverslble acLlon. hento|am|ne: slmllar wlLh compeLlLlve
acLlon. used ln pheochromocyLoma. "#$& excess hypoLenslon, Cl dlsLress. (10)
henyto|n AnLlconvulsanL: used for Lonlc-clonlc and parLlal selzures, blocks na
+
channels ln neuronal
membranes. Serum levels varlable because of flrsL-pass meLabollsm and nonllnear ellmlnaLlon
klneLlcs. "#$& sedaLlon, dlplopla, glnglval hyperplasla, hlrsuLlsm, LeraLogenlc poLenLlal (feLal
hydanLoln syndrome). urug lnLeracLlons vla effecLs on plasma proLeln blndlng or lnducLlon of
hepaLlc meLabollsm. (24)

||ocarp|ne Muscarlnlc recepLor parLlal agonlsL proLoLype: LerLlary amlne alkalold. May cause paradoxlc
hyperLenslon by acLlvaLlng muscarlnlc exclLaLory posLsynapLlc poLenLlal recepLors ln posLgangllonlc
sympaLheLlc neurons. used ln S[gren's syndrome, xerosLomla, glaucoma. "#$& muscarlnlc excess.
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(7)
|perac||||n LxLended-specLrum penlclllln acLlve agalnsL selecLed gram-negaLlve bacLerla, lncludlng
6:,3+#7#(5: 5,83=*(#:5 (synerglsLlc wlLh amlnoglycosldes). SuscepLlble Lo penlcllllnases unless
used wlLh LazobacLam. "#$& penlclllln allergy. (43)
ra||dox|me AceLylchollnesLerase regeneraLor: anLldoLe (wlLh aLroplne) for organophosphaLe polsonlng,
chemlcal anLagonlsL wlLh very hlgh afflnlLy for phosphorus ln organophosphaLes. "#$&
neuromuscular weakness. (8, 37, 38)
ram|pexo|e uopamlne u3 recepLor agonlsL ln CnS (rop|n|ro|e slmllar): ofLen a flrsL-llne drug ln parklnsonlsm.
"#$& posLural hypoLenslon, dysklneslas (boLh drugs less LoxlclLy Lhan Lhe ergoL bromocr|pt|ne). (28)
raz|quante| AnLlhelmlnLhlc: lmporLanL drug for LremaLode (fluke) and cesLode (Lapeworm) lnfecLlons. lncreases
membrane permeablllLy Lo Ca
2+
causlng muscle conLracLlon followed by paralysls. "#$& headache,
dlzzlness, Cl dlsLress, fever, poLenLlal aborLlfaclenL. (33)

razos|n Alpha
1
-selecLlve blocker proLoLype: used ln P1n and benlgn prosLaLlc hyperplasla. "#$& flrsL-dose
orLhosLaLlc hypoLenslon buL less reflex Lachycardla Lhan nonselecLlve blockers. CLher "oslns":
terazos|n, doxazos|n. 1amsu|os|n slmllar, buL used only ln benlgn prosLaLlc hyperplasla. (10, 11)

redn|sone ClucocorLlcold proLoLype: poLenL, shorL acLlng, less mlneralocorLlcold acLlvlLy Lhan corLlsol buL
more Lhan dexamethasone, betamethasone, or tr|amc|no|one. (20, 36, 39, 34, 33)
robenec|d urlcosurlc: lnhlblLor of renal weak acld secreLlon and reabsorpLlon ln proxlmal Lubule, prolongs
half-llfe of some anLlmlcroblal drugs, acceleraLes clearance of urlc acld. used ln gouL.
Su|f|npyrazone ls slmllar. (36)
roca|nam|de Croup 1A anLlarrhyLhmlc drug proLoLype: shorL half-llfe, meLabollzed by H-aceLylLransferase. "#$&
may cause a lupus-llke syndrome and Lorsade de polnLes arrhyLhmla. Slmllar Lo qu|n|d|ne buL more
cardlodepressanL. (14)
roprano|o|
nonselecLlve -blocker proLoLype: local anesLheLlc acLlon buL no parLlal agonlsL effecL. used ln
P1n, anglna, arrhyLhmlas (group 2), mlgralne, hyperLhyroldlsm, Lremor. "#$& asLhma, Av block, Pl.
(8, 11, 14, 28, 38)
rostacyc||n Cl
2
: endogenous prosLaglandln vasodllaLor and lnhlblLor of plaLeleL aggregaLlon. An analog,
epoprosteno|, ls used ln prlmary pulmonary P1n. (18)

yr|metham|ne AnLlproLozoal: anLlfolaLe LhaL lnhlblLs uPl reducLase and synerglsLlc, vla sequenLlal blockade, wlLh
sulfadlazlne agalnsL "#$#A05:75 =#(+**> lollnlc acld ls needed Lo offseL hemaLologlc LoxlclLy. (46,
32)
u|n|ne AnLlmalarlal: blood schlzonLlclde, no effecL on llver sLages. lnLerferes wlLh nuclelc acld meLabollsm
ln plasmodlum. lsomer of qu|n|d|ne. "#$& clnchonlsm, Cl upseL. (32)
kame|teon PypnoLlc: agonlsL aL braln melaLonln recepLors, noL a conLrolled subsLance. "#$& faLlgue, lncreased
prolacLln and decreased LesLosLerone. (22)
keserp|ne AnLlhyperLenslve (rarely used): selecLlve lnhlblLor of veslcle caLecholamlne-P
+
anLlporLer (vMA1),
used ln P1n, causes depleLlon of caLecholamlnes and 3-P1 from Lhelr sLores. "#$& severe
depresslon, sulclde, ulcers, dlarrhea. (6, 11)

k|famp|n AnLlmlcroblal: lnhlblLor of unA-dependenL 8nA polymerase used ln drug reglmens for Luberculosls
and Lhe menlngococcal carrler sLaLe. "#$& hepaLlc dysfuncLlon, lnducLlon of llver drug-meLabollzlng
enzymes (drug lnLeracLlons), flu-llke syndrome wlLh lnLermlLLenL doslng. k|fabut|n slmllar buL
assoclaLed wlLh fewer drug lnLeracLlons. (47)
k|tonav|r AnLlvlral: Plv proLease lnhlblLor (l) used aL low dose as a componenL of comblnaLlon reglmens ln
AluS Lo lnhlblL meLabollsm of oLher drugs (See |nd|nav|r). "#$& lmpllcaLed ln many drug lnLeracLlons
when used as sole l.
kos|g||tazone Cral anLldlabeLlc: Lhlazolldlnedlone sLlmulaLor of peroxlsome prollferaLor-acLlvaLor recepLors
(A8) and enhances LargeL Llssue senslLlvlLy Lo lnsulln. Less hypoglycemla and welghL galn Lhan
secreLagogue anLldlabeLlcs. "#$& fluld reLenLlon, hearL fallure, fracLures ln women. |og||tazone ls
slmllar. (41)
Se|eg|||ne MAC-8 lnhlblLor: selecLlve lnhlblLor of Lhe enzyme LhaL meLabollzes dopamlne (no Lyramlne
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lnLeracLlons aL normal dosage). used ln arklnson's dlsease. "#$& Cl dlsLress, CnS sLlmulaLlon,
dysklneslas, seroLonln syndrome lf used wlLh selecLlve seroLonln reupLake lnhlblLors. kasag|||ne
slmllar and used more commonly. (28)
S||denaf|| lnhlblLs phosphodlesLerase (uL)-3, prevenLlng breakdown of cycllc guanoslne monophosphaLe
(cCM), whlch promoLes vasodllaLlon and smooLh muscle relaxaLlon. used for erecLlle dysfuncLlon
and pulmonary hyperLenslon. 1ada|af||, vardenaf|| are slmllar. "#$& severe hypoLenslon when
comblned wlLh nlLraLes, lmpalred blue-green color vlslon. (12)
Sota|o|
Croup 3 anLlarrhyLhmlc proLoLype: blocks l
k
channels and recepLors. used for aLrlal and
venLrlcular arrhyLhmlas. "#$& Lorsade de polnLes arrhyLhmlas. CLhers ln group: |but|||de, dofet|||de.
(14)

Sp|rono|actone AldosLerone recepLor anLagonlsL: k
+
-sparlng dlureLlc acLlon ln Lhe collecLlng Lubules, used ln
aldosLeronlsm, P1n, and female hlrsuLlsm (androgen recepLor-blocklng acLlon). "#$& hyperkalemla,
gynecomasLla. Lp|erenone, used ln P1n and hearL fallure, ls a more selecLlve aldosLerone
anLagonlsL. (13, 13, 39, 40)

Streptogram|ns AnLlbloLlcs: Synercld ls Lhe comblnaLlon of qulnuprlsLln and dalfoprlsLln, bacLerlcldal lnhlblLors of
proLeln synLhesls. lnLravenous use for drug-reslsLanL gram-poslLlve coccl lncludlng M8SA
(meLhlclllln-reslsLanL ; 538,3:), v8L (vancomycln-reslsLanL enLerococcl), and pneumococcl. "#$&
lnfuslon-relaLed paln, arLhralgla, myalgla. L|nezo||d ls anoLher lnhlblLor of proLeln synLhesls used for
drug-reslsLanL gram-poslLlve coccl, lncludlng 8S (penlclllln-reslsLanL ; A(,37#(*5,) sLralns. (44)
Succ|ny|cho||ne uepolarlzlng neuromuscular relaxanL proLoLype: shorL duraLlon (3 mln) lf paLlenL has normal
plasma chollnesLerase (geneLlcally deLermlned). no anLldoLe (compare wlLh Lubocurarlne).
lmpllcaLed ln mallgnanL hyperLhermla. (7, 27)
Su|fasa|az|ne 3-AmlnosallcylaLe (3-ASA) anLl-lnflammaLory drug: used for lnflammaLory bowel dlsease (l8u) and
rheumaLold arLhrlLls. "#$& rash, Cl dlsLurbances, leukopenla. CLher 3-ASA drugs used for l8u are
mesa|am|ne, ba|sa|az|de, o|sa|az|ne. (36, 39)
Sumatr|ptan 3-P1
1u
recepLor agonlsL: used Lo aborL mlgralne aLLacks. "#$& coronary vasospasm, chesL paln or
pressure. Slx oLher "LrlpLans" are currenLly avallable. (16)

1amox|fen SelecLlve esLrogen recepLor modulaLor (SL8M): blocks esLrogen recepLors ln breasL Llssue, acLlvaLes
endomeLrlal recepLors. used ln esLrogen recepLor-poslLlve cancers, posslbly prophylacLlc ln hlgh-
rlsk paLlenLs. 1orem|fene ls slmllar. ka|ox|fene, approved for osLeoporosls, acLlvaLes bone esLrogen
recepLors buL ls an anLagonlsL of breasL and endomeLrlal recepLors. (40, 34)
1erb|naf|ne AnLlfungal: funglcldal lnhlblLor of squalene epoxldase. MosL effecLlve agenL ln onychomycosls, oral
and Loplcal forms. "#$: Cl upseLs, headache, and rash. (48)
1etracyc||ne AnLlbloLlc: LeLracycllne proLoLype, bacLerlosLaLlc lnhlblLor of proLeln synLhesls (30S). 8road
specLrum, buL many reslsLanL organlsms. used for mycoplasmal, chlamydlal, rlckeLLslal lnfecLlons,
chronlc bronchlLls, acne, cholera, a backup drug ln syphllls. "#$& Cl upseL and superlnfecLlons,
lanconl's syndrome, phoLosenslLlvlLy, denLal enamel dysplasla. CLher LeLracycllnes lnclude
doxycyc||ne (see above) and t|gecyc||ne (lv) used for mulLldrug-reslsLanL nosocomlal paLhogens.
(44)
1heophy|||ne MeLhylxanLhlne derlvaLlve found ln Lea, used ln asLhma. 8ronchodllaLor, mlld CnS sLlmulanL.
Caffe|ne (coffee), theobrom|ne (cocoa) are slmllar. "#$& selzures. (20)
1r|methopr|m-
su|famethoxazo|e (1M-
SM2)
AnLlmlcroblal drug comblnaLlon: causes synerglsLlc sequenLlal blockade of follc acld synLhesls.
AcLlve agalnsL many gram-negaLlve bacLerla, lncludlng ',8#7#(5:% -(),8#95/),8% 1 *(203,(45,%
B0,9:*,005% G#85$,005% ;507#(,005% ;,885)*5% and ;<*=,005> "#$& malnly due Lo sulfonamlde, lncludes
hypersenslLlvlLy, myeloLoxlclLy, kernlcLerus, and drug lnLeracLlons caused by compeLlLlon for
plasma proLeln blndlng. (46, 32)
1ubocurar|ne nondepolarlzlng neuromuscular blocklng agenL proLoLype: compeLlLlve nlcoLlnlc blocker. Analogs:
pancuronlum, aLracurlum, vecuronlum, and oLher "-curlums" and "-onlums." "#$& resplraLory
paralysls. 8eleases hlsLamlne and may cause hypoLenslon, Lherefore rarely used.
'()*+#),& chollnesLerase lnhlblLor, for examples, neosLlgmlne. (8, 26)
1yram|ne lndlrecL-acLlng sympaLhomlmeLlc proLoLype: releases or dlsplaces noreplnephrlne from sLores ln
nerve endlngs. resence ln cerLaln foods may cause poLenLlally leLhal hyperLenslve responses ln
paLlenLs Laklng MAC lnhlblLors. (6, 27)
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Va|pro|c ac|d AnLlconvulsanL: prlmary drug ln absence, clonlc-Lonlc, and myoclonlc selzure sLaLes. Also used
commonly for blpolar dlsorder. "#$& Cl dlsLress, hepaLlc necrosls (rare), LeraLogenlc (splna blflda),
lnhlblLs drug meLabollsm. (24, 29)
Vancomyc|n ClycopepLlde bacLerlcldal anLlbloLlc: lnhlblLs synLhesls of cell wall precursor molecules. A drug of
cholce for meLhlclllln-reslsLanL sLaphylococcl and effecLlve ln anLlbloLlc-lnduced collLls. uose
reducLlon requlred ln renal lmpalrmenL (or hemodlalysls). "#$& oLoLoxlclLy, hypersenslLlvlLy, renal
dysfuncLlon (rare). (43, 31)
Verapam|| Calclum channel blocker proLoLype: blocks L-Lype channels, cardlac depressanL and vasodllaLor,
used ln P1n, anglna, and arrhyLhmlas (group 4). "#$& Av block, Pl, consLlpaLlon. D||t|azem, llke
verapamll, has more depressanL effecL on hearL Lhan dlhydropyrldlnes (eg, n|fed|p|ne). (11, 12, 14)
V|ncr|st|ne AnLlneoplasLlc: cell cycle (M phase)-speclflc planL alkalold, lnhlblLs mlLoLlc splndle formaLlon. "#$&
perlpheral neuropaLhy. V|nb|ast|ne, a congener, causes myelosuppresslon. (34)
Warfar|n Cral anLlcoagulanL proLoLype: causes synLhesls of nonfuncLlonal verslons of Lhe vlLamln k-
dependenL cloLLlng facLors (ll, vll, lx, x). "#$& bleedlng, LeraLogenlc. '()*+#),& vlLamln k, fresh
plasma. (34)
2|dovud|ne (2DV) AnLlvlral: proLoLype n81l used ln comblnaLlons for Plv lnfecLlons and ln prophylaxls for
needlesLlcks and verLlcal Lransmlsslon. "#$& severe myelosuppresslon. CLher n81ls: abacav|r,
d|danos|ne (ddl), |am|vud|ne (31C), stavud|ne (d41), and za|c|tab|ne (ddC). (49)
2o|p|dem nonbenzodlazeplne hypnoLlc: acLs vla Lhe 8Z
1
recepLor subLype and ls reversed by flumazenll, less
amnesla and muscle relaxaLlon and lower dependence llablllLy Lhan benzodlazeplnes. 2a|ep|on and
eszop|c|one are slmllar. (22)

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