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1
Cholinergic Atropine Competitive antagonist Eye Dry – lo sweat/salivation
Antagonist to muscarinic receptor -Cycloplegic & myadriatic (near -Dilated w/ loss of accommodation
accommodation/dilation) -Flushing of skin
GI/GU -Hot (no sweat i.e. no
-Antispasmodic thermoregulation)
-Antidote for organophosphates -Delusions & toxic psychosis
-Decrease acid productin (peptic
ulcer tx)
Lung
-Antisecretory for surgery
Anesthetic – decreases
secretions
-Tx of parkinsons
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Isoproterenol b2>b1>>>a Bronchodilator -Similar to epi but more potent
-i.e. non selective beta- Stimulate heart -Discontinued from due to deaths
agonist Decreases peripheral resistance from CV involvement
(can distinguish b/w b/c no association w/ alpha
beta and alpha rectp.) receptor
Dopamine Precursor ofr NE Shock – increases BP, enhances Hi dose – arrhythmia
DA>b1>a1 perfusion to renal (SPARING), Similar to epi
splanchnic & coronary arteries DA converted to HVA which can
CHF – contribute to increasing cause
CO Nausea/hypertension/arrhythmia
b1 agonist Dobutamine B1 selective agonist CV Use w/ caution w/ pt. in A-fib
-CHF tx – increase CO w/ little DOBUTAMINE –
change in HR NORMOTENSIVE
-Shock/resucitation – increases DOPAMINE -- HYPOTENSIVE
force more than rate
B2 selective Metaproterenol B2 agonist Lungs -Adverse affects of B2’s
agonists -Little effect on heart -Bronchodilator – asthma --Skeletal muscle tremor,
-Resistant to COMT -Relaxes uterus to prevent restlessness, tachycardia,
Note: Not methylation/degradation childbirth arrhythmia, pulmonary edema in
Specific pregnancy, increased death rate in
asthmatics
Terbutaline B2 agonist SAME
/Albuterol -More selective than
metaproterenol
Ritodrine Same -Primarily against premature CAUTION:
labor -Hyperglycemia in mother &
reactive hypoglycemia in newborn
-Contraindicated in IDDM pt.s
-Risky – CV effects
b1/b2 nonselective Propanolol b1&b2 blocker MAJOR USE: -Contraindicated in acute CHF b/c
antagonists NOTE: don’t give to -Essential Hypertension, cannot give drug to increase CO
pt. w/: heart failure, arrhythmia, --Rebound tachycardia if suddenly
asthma, diabetes -Migraines – blocks catechlamine removed
induced vasodilation in brain -ASTHMA IS ABSOLUTE
-Anxiety CONTRAINDICATION
-Hypethyroidism – blocks -Exercise intolerance – can’t
periphera conversin of T4 to T3, increase CO
decrese sympathetic stimulation -Decreased HR
from hyperthyroidism -Exacerbate CHF
-Angina pectoris – reduction of -Conduction slowing
O2 requirement of heart -Incease TAGS (LDL)
-MI-reinfarct protection -Sexual dysfxn
-Glaucoma -Delays response to hypoglycemics
-Arrhythmics
Naldol Longer acting pure
antagonist
-No CNS involvement
Timolol Glaucoma – reduced ciliary -Watch for systemic effects
epithelial humour production
Labetalol -Also A1 antagonist Hypertension – peripheral Orthostatic hypotension
vasodilator. Decrease BP w/o Dizziness
altering TAG or glucose
concentration
-Antihypertensive w/o reflex
tachycardia
b1 selective Metaprolol/ Anti hypertension/ sympathetic Similar to propanolol
antagonist atenolol cardiac overstimulation
SIMILAR to PROPANOLOL
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Esmolol -Very short t1/2 -Use in ill pt.s where risk of
hypotension or heart failure is
great
-If they start to die, fine…. just
stop giving the med
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A1 selective Phenylephrine/ A1>A2 Tx of mydriasis, hypotension
agonists Methoxamine/ -Slow metabolism w/ --- vasoconstriciton
metaraminol little CNS penetratin -Nasal decongestant – prolonged
vasoconstriction
-Eye drops – decrease redness
via vasoconstriction
-Termination of paroxysmal
atrial tachycardia (via vagal
reflex)
A1 antagonists Phenoxybenzamine Nonselective Decrease BP Only mechanism to overcome is by
-Irreversible covalent -Tx for pheochromocytoma- making new adreno-recptors, which
linkw/ A1 post synaptic induced hypertension. Causes takes approx 24 hrs.
& A2 presynaptic reflexive incrase in CO from -Postural hypotension
receptors blocked A2 & B1 system -Nasal stuffiness
overrides -Nausea, vomiting
-For dx of pheochromocytoma -Ejaculation problems (shooting
-Frostbite blanks)
-Clonidine w/drawal
-Raynaud’s phenomena
Phentolamine Nonselective Same but reversible
-Blocks A1 & A2
Prazosin Highly A1 selective Decreases BP w/ no reflex Orthostatic hypotension (u’ll get
tachycardia suPRAZed when u stand up)
Antihypertensive -Vertigo
-Nasal congestion
-Drowsiness
Terazosin A1 selective Tx of BPH-associated urinary
retention
-Relaxes SM of prostate
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Drug Epinephrine Norepinephrine Isoproterenol
A & B Agonist B selective
Agonist
Pulse rate Increase Decrease (reflex Increase
bradycardia)
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Autocoids
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Adenosine Adenosine Inhibits all excitable Paroxysmal Supraventricular -Receptors through out body
cells tachycardia -Anginal pain – vasodilation
-Esp. AV node -DOC after failure of valsalva type -Asystole (watch dose)
-Involved in maneuvers --Luckily short acting drug
autoregulation -Diagnostic & curative -Contraindicated in pt. on dipyridamol –
Adenosine stress test – for those potentiates affects (theophylline is
unable to jump on the stairmaster antidote)
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Drug Mechanism NSAIDS Clincal Use Side Effects
Meloxicam/ Selective cyclo- Peripheral jt.s in diseases like RA & Little GI disturbances
peroxicam oxygenase 2 inhibitor osteoarthritis Renal toxicity
Sulindac Pro-drug (hepatic Gouty arthritis Agranulocytosis
activation) Pre-term labor
- Decreases adenomas w/ FAP
RA/Osteoarthritis
Ankylosing spondylitis
Keterolac Injectible form Same as other NSAIDS
Post-op pain –visceral
Like opiates w/o CNS
side effets Allergic conjunctivitis
Non- Accetominophen Non-anti- Analgesia Hepatotoxic @ hi concentration
NSAID inflammatory Fever Acetylcystein is antidote (sometimes
Inhibits Good for pt. on probenecid & uricosuric cimetidine)
cyclooxygenase only in for gout b/c no X-tolerence
CNS
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GI Drugs
Peptic Ulcer Cimetidine -Blocks gastric mucosal -Zollinger-ellison syndrome Primarily Cimetidine
H2 agonists (Tagamet) histamine receptor to (relapse of ulcer after short- -Many drug interactions
Ranitidine decrease acid output term tx or abrupt cessation) -Decrease hepatic blood flow
(Zantac) -Acts to increase gastric pH -GERD -Inhibit P450
Famotidine & decrease pepsin formation -Peptic ulcers-hiatal hernia -Anti-androgenic effects
(Pepsid) -Tylenol O.D. (Cimetidine) (gynecomastia)
Nizatidine -CNS (elderly) – confusion &
(Axid) drowsiness
-Skin rash
-Immunosuppression
Muscarinic Prienzepine -Atropine-like compound have -Adjuncts to histamine receptor -Same as atropine
Antagonists only small ability to decrease blocker tx
gastric acid -Not currently used
-Doses cause more side
effects than benefits
Omeprazole -PPI DOC – Z-E Syndrome H/a, dizzy, nausea
(Lansoprazole) -Converted to active form Histamine resistant ulcers -Abd. Pain
(sulphamide) Reflux esophagitis -Long term use may be
-Covalently binds H/K ATPase H. Pylori infection carcinogenic due to hi gastrin
on mucosal side of parietal levels
cell -Hyperplasia of oxyntic mucosal
cells
Misoprostol PGE1 receptor agonist -Prevent NSAID-induced ulcer -Diarrhea
-Gi protein decreases cAMP & -Gastric ulcer -Abdominal pain
inhibit basal & stimulated acid -Duodenal ulcer -Contraindicated in pregnancy
secretion -Abortiion w/ (MTX)
-Enhances mucosal barrier by
increasing mucus & NaHCO3
Sucralfate -Cytoprotective -GI ulcers & erosions No major side effects
-Combines w/ protein -Stimulate PGE production -Alterss bioavailability of other
exudates @ base of the ulcer -Promotes healing (increase drugs
& forms a resistant barrier cell#) -“Large Pill” compliance
(won’t adhere to normal -Constipation
tissue) -Antacids decrease its efficacy
-Coats for >5 hr.s
-Doesn’t effect acid
secretion & absorbs pepsin
Antacids Na-bicarbonate Immediate onset Belching
-Short duration Systemic alkalosis
-May increase gastric pH to Sodium retention
alkaline level which increases
HCl secretion
Ca++ Carbonate Rapid onset Esophagitis Systemic alkalosis
Duodenal ulcer Phosphate imbalance
Hypercalcemia
Gastric rebound
Mg++ Salts Mg(OH)2 – milk of magnesia Osmotic diarrhea
Relativelyinsoluble slows Hypermagnesemia
removal from stomach Belching
Al3+ Hydroxide Least potent Used in combo w/ other antacids Constipation b/c AlCl3
Reacts w/ HCl to produce Binds phosphates
AlCl3
Anti-emetics Phenothiazines Blocks DA receptors in Cisplatin induced N/V Sedation
Prochlorperazine chemoreceptor zone Poisons & visceral afferent pain Parkinson-like
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Promethazine
(Phenergan)
Diphenhydramine Blocks H1 & H2 Motion sickness Sedation
Allergic rhinits/urticaria Don’t give w/ other CNS
Sedation depressants
Dimenhydrinate Antihistamine agent that also Motion sickness (inner ear) Sedation
Cyclizine blocks ACh receptors Vestibular inflammation
Scopolamine
Canabanoids U/k mechanism N/v associated w/ cancer, Hi abuse potential
Nabilone Dronabinol is major chemotherapy Drowsiness
Dronabinol (THC) component of Vomiting caused by higher Ataxia
weed/hash/gangi/dope/hemp/ centers 0 emotions, signts Inability to concentrate
u get the picture smells Disorientation
-Works in higher (yeeaaah!) Glaucoma Anxiety
centers in brain Psychosis
Laughter (that horrible stuff….)
Metoclopramide DA antagonist w/in CNS & N/v associated w/ ca Fatigue
(Reglan) ACh agonist w/in GI chemotherapy Insomnia
-Simultaneouslyy inhibits -Reflux esophagitis Parkinson-like
vomiting centrally uremia Acute dystonic rxn
-Enhances UGI motility Extrapyaramidol sx
Ondansetron Serotonin antagonist Ca chemotherapy esp. w/ H/a
-Causes colonic motility cisplatin Diarrhea
-Radiation-inducd vomiting
-Post-op N/V
Laxatives Bran Increases mass Laxatives in general: Virtually safe & effective
Softening (1-3 Methylcellulose -In turn stimulates peristalsis -Constipation -If not taken w/ H2O, then may
days) Psyllium increase water content of -Pre-op or pre-radiological exam cause obstruction/impaction
stool -Maintain insulin control contraindicated:
-Increases motility & -Decrease cholesterol -Bowel obstruction
decreases absorption of NaCl decrease colon ca risk undiagnosed abd. Pain
& H2O
Docusate Stool softener May increase intestinal
-Detergent absorption
-Disperse wetting agents that Hepatotoxicity
permit H2O & lipids to enter
the mass & soften it
Mineral oil Penetrate & soften stool Interferes w/ absorption of
Indigestible essential fat soluble substances
Lipid pneumonitis
Lactulose Osmotic laxative that is Systemic toxicity from
noabsorbable which increases electrolyte imbalance
intraluminal osmotic pressure Dehydration
& increase fluid content of Flatulence
stool
Soft/semifluid Diphenylmethans Acts as irritant to colon Limit use for <10 consecutive Fluid/electrolyte deficit
stool (6-8hr.s) Phenolphthalein -Stimulates auerbach’s plexus days Allergic rxn
(exlax) to promote intestinal motility Turns urine/feces pink
Bisacodyl-
(ducolax)
Atraquinones Similar to diphenylmethanes May turn urine red
Senna
Casarca sagrada
Watery Saline Osmotic or saline laxative Systemic toxicity due to
evacuation cathartics that is nonabsorbable which electrolyte imbalance
(1-3 hr.s) Sodium increases intraluminal osmotic Dehydration
phosphate pressure & hi fluid content of
Magnesiu stool
msulfate/citrate
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Magnesium-OH
Castor oil Irritant to small intestine Too strong for common Fluid/electrolyte deficits
constipation Decrease absorption of
nutrients
Uterine contractions
Diarrhea Morphine-like Synthetic opioids that General diarrhea Habit forming
opiods decrease peristaltic bowel AIDS associated diarrhea Not too addicting b/c they are
Diphenoxylate motility & counteract relatively insoluble
Loperamide excessive secretion Promotes ulcer formation
(Imodium) Little CNS action
Often combined w/ atropine
to decrease addiction
Atropine Block ACh receptors to Diarrhea Only produce the atropine-like
Dicyclomine decrease parasympathetic side effects @ hi doses
tone & motility of GI tract
-Antispasmodic action
Bismuth Anti-bacterial action h. pylori diarrhea
subsalicylate Anti-secretory action
Duretics
Class Drug Mechanisms Side Effects
Clincal Use
Loop diuretic “high Furosemide -Duration 2-3 hours Edema – pulmonary, CHF Ototoxic – esp. w/
ceiling” Bumetanide -Glomerular filtrate, Acute hypercalcemia, aminoglycoside
Torsemide secretion hyperkalemia Hypokalemic metabolic
Ethacrynic acid -Na/K/Cl transport in Anion overdose – Br-, Fl- etc alkalosis
thick ascending limb Forced diuresis Dehydration
-Direct effects on blood HTN, CHF – 2nd line tx Allergy
flow (renal/ pulmonary) (thiazides #1) Nephritis
Secretes: Na+, K+, Ca+ Gout
+, increased urine OH DANG
volume
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Uterine Drugs
UTERINE Mifeprestone -PGE-1 analog -Induction of labor upto 7wk.s Uterine bleeding, malaise, rash
DRUG (RU 486) -The morning after (72 hr)
CI: ectopic, COPD, renal/hepatic,
adrenal failure, steroid therapy
PGE2/PGF2a Cause uterine contractions Induce abortion/labor -GI-nausea, vomiting, diarrhea
Topical – ripen cervix -Hypotension-PGE2
-Hyperthermia
-Bronchospasm
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Antihypertensive Drugs
Diuretics Thiazides See diuretic section -1st line against hypertension -Hyper-GLUC
-CHF –shows the greatest -Hypokalemia – add K+ sparing if this
effect to dec. ventricular is a problem
hypertrophy, morbidity, and
mortality
Loop Diuretics & See diuretic section -K+- sparing is 2nd line
K Sparing
NE release Agent Reserpine -Deplete biogenic amines (NE) from Denervation of sympathetics
neuronal storage vesicles (inhibit -60-80% nasal congestion
reuptake) -Hypersecretion
-Peripheral & CNS -Bronchoconstriction
-Mental depression
Alpha-1 blocker Prazosin -Competitively bocks a1 receptors -Mild HTN -1st-dose Phenomenon:
t ½ 3-4hr. w/out a reflex tachycardia -Low TPR -Weakness and syncope w/in 1hr.
Terazosin -No effect on A2 -Low BP by relaxing arterial after 1st dose. You’ll be suPRAZEd
t ½ 12hr and venous smooth muscle when you stand up.
Doxazosin -Decrease LDL, increase HDL -HTN/BPH use Terazosin -Postural hypotension
t ½ 22hr -h/a, dizziness
Alpha-2 agonist Clonidine -A2 agonist -2nd line tx for HTN -Dry mouth
-Central effects -Other, w/d sx in -Sedation
-Decreases CO, reduce peripheral alcohol/heroin etc. -Orthostatic Hypotension
resistance w/ maintanence of renal -Alcoholic delirium -w/drawal symptoms: Rebound
blood flow -Postmenopausal syndrome (High BP, headache, tremor,
-Therapy-resistant diarrhea sweathing, tachycardia)
- Bradycardia
Dry SOW
B-blockers Propanolol -Do not use in asthma, COPD, CI: pregnancy, IDDM,
Atenolol -increase LDL TAGs, decrease HDL CHF, SA or AV node abn (Blocks sympathetic response to
Metoprolol hypoglycemia therefore pt could
Pindolol drop dead due to hypoglycemia with
Labetol no symptoms)
Carvedilol
Esmolol
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Angina
ANGINA Propranolol -Decrease severity/freq of -Cardioprotective post-MI Contraindications
B-blockers Atenolol exertional angina (keep on for 2-3 yr.s) -Astham/COPD
Metoprolol -Ineffective in unstable -May worsen vasospastic -CHF
-(-) Inotropic effect angina -IDDM-see above
-(-) Chronotropic effect Angina associated w/: -Fatigue
-Decreased sys BP w/ exercise Exertional -Can mask hyperthyroidism (inhibits
NET EFFECT: decrease heart O2 Ventricular arrhythmia peripheral conversion of T3 to T4)
demand <40
Ca++ blockers Verapamil Binds serum proteins Angina associated w/: Dihydropyradines
Diltiazem -Hepatic metabolism, renal secretion Vasospastic -Dizzy, h/a, flush, digital dyasthesia,
Nifedipine -Blocks L-type Ca++ receptors – COPD/asthma peripheral edema, constipation,
(dihydropyridine) cardiopressant & vasodilation >65 reflex tachy
-Decrease afterload
-Increased risk of MI in HTN Verapamil, diltiazem – bradycardia,
patient slow SA & AV
Nitrates Nitrates -Relax all SM -HTN Vasodilation: h/a, flush
(Nitroglycerine) -Mostly venous relaxation, some -Acute angina Hypotension: reflex tachy
(Isosorbide arteriolar -Prolonged preventive therapy Dizziness, weakness, cerebral
dinitrate) -Decreased myocardial demand -Spasmolytic in colic pain ischemia
(Isosorbide -Buccal, IV, transdermal, sublingual Tolerance: must give time off b/c
mononitrate) -Decrease preload uses up sulfhydryl system
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CHF Medication
CHF Captopril -Renal elmination -1st line drug—Hypertension -Hypotension
ACE-inhibitors -Angiotensin II Antagonist -CHF – decrease sudden death, -Cough/bronchospasm (bradykinin)
-Decreased vasoconstriction, NE, progression, morbidity, -Angioneurotic edema
aldosterone -MI – if started in preinfarct -Hyperkalemia
Bradykinin – vasodilation period -Proteinuria
-No: -Progressive renal disease -Dysgeusia (taste)
-Reflex tachy -Hypercalcemia
-Change in CO -Less efficacious in Black CI – renal artery stenosis, renal
- Na/H2O retention Patients. failure, pregnancy (physical
-Decreased sympathetic tone deformity), hx of angioedema
Vasodilates venous blood vessels to -1st DOC-first line of choice in Toxicity – hypotension w/o
decreased pre-load and aterioles to the Rx of CHF w/ diuretics tachycardia
lower TPR. Decreased Na/fluid Interactions: NSAID (bradykinin
retention pthway), K+ spare/waste diuretic,
increased digoxin, lithium levels
Enalapril/ -Enalapril is prodrug (hepatic -More potent than captopril,
enalaprilat conversion) slower onset, longer action
Fosinopril -Enalaprilat – IV for HPT emergency
Moexipril -Fosinopril, moexipril – only hepatic
CHF Digitalis -(+) Inotropic effect – increased Ca++ -CHF – NYHA III, IV -Arrhythmia, bradyarrhythmiaPVC,
(Digoxin) load via inhibition of Na/K ATPase -A-fib, flutter V-fib, etc. parox/nonparoxysmal A-
-(-) Chronotrophic) via vagal input tach
-Decrease AV conduction (prolong Non-indicated -GI-anorexia, vomiting, diarrhea
ERP) -Myocarditis, cor pulmonale -Neurologic-“digitalis delirium”
-Increased automaticit & excitability -Uncontrolled HTN (headache, fatigue, neuralgia, and
atria, purkinje, ventricles -Bradyarrhythmias mental symp’s)
-Visual disturbances - color
ECG -Gynecomastia – rare
Atria- P changes Tx of digoxin overdose:
AV – PR prolonged -Decrease or w/d drug Precipitating factors for toxicity
Ventricles – short QT, depressed ST, -Monitor dig & K+ levels, ECG -Hypokalemia or hyperkalemia
T -Correct electrolyte -Hypo Mg++, or hyper Ca++
-V-tach – lidocaine, Mg++, K+ (aggravates effects of Dig)
-Decreases morbidity but no effect (take to normal hi), -Resp. disease – increase digoxin
on mortality Severe response
-Temporary pacemaker ->65, skinny, fever
-Digitalis Ab -Acid base imbalance
-Etc, etc, etc
Amrinone Phosphodiesterase inhibitors. -Like coffee it relaxes vascular Milrinone has actually shown to have
Milrinone Increased cAMP which increases (Ca) and bronchial smooth muscle an increase in mortality
I to higher contractility
BETA-AGONISTS Dopamine Increased cAMP, which activates -Acute CHF episode See autonomics
Dobutamine proten kinase to phosphorylate Ca- -Shock -Use with caution in atrial fib.
channels to increased (Ca) I, which -BP up with increased
increases contractility. Also has perfusion to Kidneys,
some vasodilating effects
17
Antiarrhythmic Drugs
Class Drug Mechanism Indications Adverse Effects
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II Propranolol Rx’s Decrease Phase 4 -Recovery from MI to Hypotension
(Overload and -Depresses SA-node freq prevent sudden death Aggravation of CHF
re-entry) ==> sinus bradycardia -Control SVT & A-fib Asystole
Acebutol (B1) -Depresses automaticity of -Exercise/stress induced CI – asthma etc
Esmolol (B1) purkinje vent. Arrhythmias
Satolol -Decreased conduction AV-
(Non-sel) node -In ICU give esmolol
-Suppress ectopic (short t ½ IV)
ventricular depolarization
-Hemodynamic activity
III Satolol -Renal excretion Tx/prophylaxis severe -Postural Hypotension
(unchanged) ventricular -Proarrhythmic
-Block K+ channels – prolong tachyarrhythmias -Torsades des pointes
AP-phase 3 -Atrial arrhythmias
-non-selective B-blocker
III Amiodarone Prolongs the AP & ERP -Supraventricular -Pulmonary Fibrosis
- Blocks inactivated Na- Arrhythmia -“Grey man syndrome”
channels (class I) -Ventricular tachycardia Caused by iodine accum in the
-Blocks K+ channels – -Anti-anginal skin
prolong AP -Low dose for atrial -Thyroid disorder
-Mostly effects arrhythmia -Photosensitivity
purkinje/ventricular (long -Corneal depositis
plateau) -Hepatotoxicity
-Variable t ½ 30-120 days – -Thyroid (hi iodide)
steady state when A & DEA
is equal (2 weeks) Drug interaction – digoxin,
warfarin, quinidine, theophylline
IV Verapamil -Blocks L-type Ca++ DOC-Atrial -Negative inotropic effect
Diltiazem channels fibrillation/flutter – -Contraindicated in depressed
Bepridil -Lg effect on AV conduction decrease ventricular cardiac function.
rate
-Re-entry SVT
-SVT
-Ischemic heart disease
& HTN
Adenosine -Enhance K+ conductance Hyperpolarization -Flushing, bronchoconstriction
-Inhibits cAMP-mediated -A-fib, V-fib
influx hyperpolarization
(esp. AV node)
Potassium
Magnesium -Mech u/k Tx for torsades des
-Fxnal Ca++ antagonist pointes
-Digitalis induced
arrhythmia
-Acute MI
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Things u shouldn’t do
CHF
Sx/problem Approach
Fatigue Rest, + intotrope
Edema Salt restriction
Diuretic
Digitalis (+ inotropre)
Dyspnea Diuretic (thiazide, loop)
Congestion Nitrovasodilator
Poor cardiac + Inotrope, digitalis
contractility
Increased ACE-I
preload/afterload Ang-block
Ven-vasodilators
Cardiac tissue ACE-I
remodeling Ang-block
B-block
Spironolactone
Irreversible heart Transplant
failure
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CLASSIFICATION
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Chemotherapy drugs
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OTHERS Methenamine Liberates formaldehyde w/ -Gastritis
mandelate urinary pH <5.5 -Chemical cystitis
(Methenamine + Metabolite caustic to bugs -Hematuria
mandelic acid) in urinary system. -Painful/frequent micturition
-DO NOT GIVE W/
SULFONAMIDES – insoluble
complex (crystaluria)
Nitrofurantoin -Bacteriostatic UTI’s – E. Coli Interstitial fibrosis
-U/k mechanism Peripheral neuritis
-Turns urine brown Hemolytic anemia G6PD def.
Cholestatic jaundice
GI irritation
Phenazopyridine -Used along w/ urinary -Used to decrease burning -Orange urine
antiseptics piss -Overdosage can produce
methemaglobinemia
CELL WALL Penicillin -Inhibits cell wall synthesis -Strep Hypersensitivity
INHIBITORS (bacteriocidal) -Neisseria Herxheimer rxn (syphilis)
PENICILLINS -Binds PBP (penicillin -Gram + bacilli (clostridium Superinfection
binding protein) to inhibit diptheria, perfringents, b. Interstitial nephritis
transpeptidase anthracis) (methicillin) not used now
-Activates autlytic enzymes -Spirochetes (especially CNS toxicity – convulsions
-B-lactams synergistic w/ sensitive) Electrolyte imbalance (salts)
aminoglycosides
Penicillin G -IV or IM Serious life threatening
(Benzyl penicillin) -Orally ineffective disease
Acid Labile -SHORT DURATION
-Poor CNS effects (unless
meningitis)
Penicillin V Orally – acid stable Prophylaxis/mild infections
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CEPHALOSPORINS Cephalosporins Similar to penicillin 1st generation Pain @ injection site
Less susceptible to B- -Gram + Thrombophlebitis
lactamase -Gram – (community acquired) Diarrhea
-3 generations -UTI Nephrotoxicity
-Proteus
-E. Coli
-Klebsiella Produces false + urine test
2nd Generation for glucose
-<Gram +
->Gram – Anti-vit. K effect
-#’S 4-6 of 1st generation -Moxalactam, cefamandole
-h. flu & cefoperazone cause
-Enterobacteriaceae disulfiram –like rxns
-Neisseria
-Serratia
1st generation PARENTERAL -Not liphophilic HEN-PEcK
Cefazolin -Don’t cross into CSF H. Flu
Cephalothin Enterobacteriaceae
Cephapirin Neisseria
Cephradine Proteus
ORAL E. Coli
Cephalexin Klebsiella
Cefadroxil
Cephadrine
2nd generation PARENTERAL Enter CSF HEN-PEcK (S)
Cefamandole -Cefuroxime -Serratia
Cefotetan Cefaclor
Cefonicid Biliary excretion
Cefuroxime sodium -Cefaamandole naftate
Cefoxitin Tx B. Fragilis
Ceforanide -Cefotetan disodium
-Cefoxatin sodium
ORAL
Cefaclor
Cefuroxime axetil
3rd generation PARENTERAL CNS – cefotAXime, All penetrate CNS EXCEPT
Cefoperazone ceftriAXone cefoperazone
Ceftriaxone --Think of an AX to the head.
Ceftazidime
Cefotaxime
Ceftizoxime
Moxalactam
ORAL
Cefiximne
4th generation Cefepine -Extended spetrum Gram – resistant bacillit to
-Increased stability to 3rd generation cephalo’s
beta-lactamases
SPECIAL Cefamandole – 2gen Eliminated vial biliary
CEPHALO’S Cefoperazone – 3 ge For pt.s w/ renal problems
Ceftriaxone- 3 gen
Cefamandole – 2gen Cause disulfiram-like rxn w/ Hypoprothrombinemia
Cefoperazone 3 gen alcohol disulfiram-like rxn
Moxalactam – 3 gen
Ceftazidime – 3gen Pseudomonas
-Taz haz pseudomonas so tx
it
Cefotetan – 2gen All tx B. fragilis b. Fragilis
Cefoxitin – 2 gen
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Ceftizoxime – 3gen
Moxalactam – 3gen
OTHERS Cycloserine -Inhibits conversion of L-- 2nd line tx for TB & CNS – psychoses
>D-alanine mycobacteria infxn Delirium
Nocardia infection if Confusion
sulfonamides fail (CNS) H/a
Convulsions
Tremors
ERYTHROMYCIN Erythromycin Binds 50s -DOC in atypical pneumonia -GI irritation
-Inhibits translocation -Legionella, mycoplasma, -Hypersensitivity –
-No CNS chlamydia cholestatic jaundice (esp.
-Excreted in bile -Campylobacter jejuni w/ estolate salt of
-Alternate in penicillin -Strept/mastoiditis … erythromycin)
resistance penicillin 1st -Inhibit cyt P450 enzymes
Clarithromycin Clarithromycin
Azithromycin -Toxoplasmosis encephalitis,
cryptosporidium diarrhea,
peptic ulcer from H. Pylori
Clindamycin Same Gram + cocci
Anaerobes
PCP
Toxoplasma
Resistant flaciparum, vivax
Vancomycin -Inhibits cell wall synthesis SERIOUS staph infections Must be given slowly
- -Oral tx of FONT
pseudomembranous colitis Flushing
- Ototoxic
Nephrotoxic
Thrombophlebitis
Metronidazole DOC for amoebic dysentery
-Anaerobes …B. Fragilis
DOC – C. Difficile
25
Chemotherapy
26