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227 Cards in this Set

  • Front
  • Back
What is used for post op ileus and urinary retention?
Bethanechol
What is carbachol? Use?
cholinomimetic

glaucoma
What is pilocarpine? Use?
cholinomimetic

glaucoma (open and closed)

PILE on the sweat and tears.
What is used as a challenge test for asthma diagnosis?
Methacholine
What are the anticholinesterases that penetrate the CNS? Use?
physostigmine

Glaucoma, Atropine OD
What is Neostigmine used for?
post op ileus/urinary retention

Myasthenia Gravis

postop reversal of neuromusc blockade
What are the drugs that can be used for Myasthenia Gravis?
anticholinesterases

Neostigmine
Pyridostigmine
Edrophonium (test to see if tx is low or too high - inactivation)
What is the antidote for cholinesterase inhibitor poisoning?
atropine

pralidoxime (regen cholinesterase)
How can you get cholinestase inhibitor poisoning?
Parathion

organophosphates
What M - antagonist is used for parkinson's disease?
Benztropine

PARKinsons your BENZ
What is scopolamine? Use?
M ant

motion sickness
What is the M ant used for asthma, COPD?
Ipratroprium

I Pray I can breathe soon!!
What are specific toxicities associated with atropine?
baby : high temp

old man: no pee

old peeps: closed angle glaucoma
What is the treatment for atropine OD?
physostigmine
volume of distribution =
amt drug adminstered / plasma conc
clearance of a drug =
rate of elimination/plasma conc

k x volume of distribution
half life =
(.7 x Vd) / Clearance
loading dose =
Cp x Vd/bioavailability
bioavailability =
AUC oral x IV dose / AUC IV x oral dose
maintenance dose =
Cp x Clearance/bioavailability
What does zero order elimination mean?
fixed amount of drug is eliminated per unit time
What drugs show zero order elimination?
phenytoin, ethanol, aspiring

(PEA looks like zero)
What drugs are weak acids and what do you do for OD?
phenobarbitol, methotrexate, TCAs, aspirin

tx OD with bicarbonate
What happens in phase 1 metabolism?
Cyt p 450

red, ox, hydrolyze - makes more water soluble but can still be active
What happens in phase 2 metabolism?
conjugation

acetylation, glucuronidation, sulfation - yields very polar, inactive metabolites
Competitive inhibitors don't change the enzymes ________.
Vmax
Non-competitive inhibitors don't change the enzymes ________.
Km
What occurs with alpha 1 excitation?
vasocontr, high BP/R
mydriasis
high glucose
decrease pee/GI fn
What occurs with alpha 2 excitation?
decreased symp response
decrease insulin section
decreased platelet aggregation
What occurs with beta 1 excitation?
increased HR, contractility, renin
increased lipolysis
What occurs with beta 2 excitation?
vasodil
bronchodil
increased insulin (and blood glucose??)
decreased uterine tone - delay birthing
What receptors are Gq?
H1, alpha 1, V1
M1, M3

HAVe 1 M&M
What receptors are Gi?
M2, alpha 2, D2

MAD 2's
What is isoproterenol used for?
AV block
What is dopamine used for?
Shock
heart failure
What is dobutamine used for?
shock
heart failure
cardiac stress testing
What is phenylephrine used for?
cause
pupillary dilation
vasoconstriction
nasal decongestion
What is terbutaline/ritodrine used for?
sympathomimetic

used to reduce premature uterine contractions
What are sympathomimetics that are used for asthma treatment?
albuterol (acute)
salmeterol (long term)
How do cocaine, ephedrine and amphetamines work?
amphetamines/ephedrines - released stored catecholamines

cocaine - catecholamine uptake inhibitor
What are the applications of amphetamines?
narcolepsy
obesity
ADD
What are the applications for ephedrine?
nasal decongestion
urinary incontinence
hypotension
What is clonidine? Use?
alpha 2 agonist.

HTN, esp with renal disease
What is methyldopa? Use?
alpha 2 agonist

prego HTN
What drug can be used before removing a pheo?
non selective alpha blockers

phenoxybenzamine (noncompetitive)... can't use phentolamine cuz that's competitive and will be overwhelmed by high NE/E
What can prazosin be used for?
alpha 1 blocker

HTN
urinary retention in BPH
What is the antidote for acetaminophen poisoning?
N-acetylcysteine
What is the antidote for salicylates poisoning?
bicarb - alkalinize urine
What is the antidote for amphetamine poisoning?
ammonium chloride - acidify urine
What is the antidote for B blocker poisoning?
glucagon
What is the antidote for iron poisoning?
deferoxamine
What is the antidote for lead poisoning?
EDTA, dimercaprol, penicillamine

'the lead patrol"
What is the antidote for copper poisoning?
penicillamine
What is the antidote for cyanide poisoning?
nitrates -

convert Hb to metHb, which binds CN better --- allows cyt oxidase to work
What is the antidote for methemoglobin poisoning?
Methylene blue
What is the antidote for opiods poisoning?
naloxone, naltrexone

mu receptor antagonists
What is the antidote for benzo poisoning?
flumazenil
What is the antidote for TCAs poisoning?
sodium bicarb - serum alkalinize
What is the antidote for heparin poisoning?
protamine
What is the antidote for warfarin poisoning?
Vit K, fresh frozen plasma
What is the antidote for theophylline poisoning?
B blocker
What drugs cause coronary vasospasm?
cocaine
sumatriptan
What drugs cause cutaneous flushing?
vancomycin
adenosine
nitrates
CCBs

VANC
What drugs cause torsades de pointes?
quinidine (class 1A)
sotalol (class 3)

cuz prolong QT interval!!!!
What drugs cause agranulocytosis?
clozapine (schizo)
carbamazepine (bipolar, partial/tonic clonic seizures)
colchicine
propylthiouracil (hyperthyroid)
dapsone (leprosy)
What drugs cause aplastic anemia?
carbamazapine
chloramphenicol
propylthiouracil
What drugs cause grey baby syndrome?
chloramphenicol
What drugs cause hemolysis in G6Pd deficient patients?
INH
sulfonamides
primaquine
aspirin/ibuprofen
What drugs cause megaloblastic anemia?
phenytoin
methotrexate
sulfa drugs

having a BLAST with PMS
What drugs cause pulmonary fibrosis?
amiodarone
bleomycin
busulfan (alkylating agent)
What drugs cause acute cholestatic hepatitis?
Macrolides
What drugs cause hepatic necrosis?
Halothane
Valproic acid (tonic clonic, myoclonic seizures)
acetaminophen
What drugs cause hepatitis?
INH
What drugs cause pseudomembranous colitis?
clindamycin
ampicillin
What drugs cause boobs?!
spironolactone
digitalis
cimetidine
alcohol
ketoconazole

Some Drugs Create Awesome Knockers
What drugs cause hypothyroidism?
lithium
amiodarone
What drugs cause gingival hyperplasia?
phenytoin, verapamil
What drugs cause gout?
furosemide
thiazide
What drugs cause osteoporosis?
corticosteroids
heparin
What drugs cause photosensitivity?
sulfonamides
amiodarone
tetracycline
What drugs cause Steven Johnson's syndrome?
ethosuximide, lamotrigine, phenytoin, carbamazepine, phenobarbital

sulfa drugs
PCN
allopurinol
What drugs cause SLE-like syndrome?
* dev anti histone Ab

hydralazine
INH
phenytoin
procainamide

it's not HIPP to have lupus
What drugs cause tendonitis?
fluoroquinolones
What drugs cause interstitial nephritis?
methicilin
NSAIDs
furosemide

sulfonamides
rifampin
What drugs cause hemorrhagic cystitis?
cyclophosphamide (prevent with mesna)
What drugs cause diabetes insipidus?
lithium
What drugs cause parkinson-like syndrome?
haloperidol
chlorpromazine
- can give benztropine anti-ach for this

reserpine (prevent DA from being packaged into NE vesicles)
metoclopramide (D2 rec ant for post surgery gastroparesis)
What drugs cause seizures?
bupropion (atypical antidepressant. used for smoking cessation)
imipenam/ciastatin
isoniazid (cuz B6 deficiency)
What drugs cause a disulfiram-like reaction?
metronidazole
some cephalosporins
1st gen sulfonylureas
What drugs cause nephro and ototoxicity?
aminoglycoside
vanco
loop diuretic
cisplatin (cross link DNA)
What drugs are p450 inducers?
carbamezepine, barbs, phenytoin

rifampin

griseofulvin

chronic alcohol
What drugs are p450 inhibitors?
Sulfonamide
Isoniazid
Cimetidine
Ketoconazole

Acute alcohol
Grapefruit juice
Erythromycin
What kinds of drugs can be used for glaucoma?
alpha agonist (but not in closed angle) - epinephrine

beta blockers - timolol, carteolol

diuretics - acetazolamide

cholinomimetics - pilocarpine, carbachol, physostigmine

prostglandin - latanoprost
Name the basic opiods
codeine, morphine, heroine, fentanyl, dextromethorphan, meperidine, methadone
What is the basic opioid mechanism?
open K channels - decrease synaptic transmission
What drug can be used to decrease tolerance to morphine?
Ketamine - NMDA receptor blocker which inhibits Glu actions
What are first line drugs for
partial
tonic/clonic
absence
status
partial - carbamazapine
tonic/clonic - phenytoin, carbamazapine, valproic acid
absence - ethosuxamide
status - benzos, phenytoin
What drug is used for trigeminal neuralgia?
carbemazepine
What drug is used for myoclonic seizures?
valproic acid
What is the mechanism of phenytoin?
increases Na channel inactivation
What are SE of carbamazapine?
diplopia
ataxia
agranulocytosis, aplastic anemia
Stevens Johnson syndrome
induce p450
What are the SE of phenytoin?
eye stuff - nystagmus, diplopia

ataxia

SLE like syndrome

uggo- gingival hyperplasia, hirsuitism, acne, general lymphadeno

megaloblastic anemia
induce p450
What is unique about thiopental?
short acting barbituate used for anesthesia induction

rapid redistrib to tissue/fat - rapid recovery from anesthesia
What are the different benzos and which ones are most addictive?
short acting -
zolpidem (acts like benzo but isn't)
alprazolam - highest addictive potential

mediam - lorazepam

long - diazepam
What are the characteristics of anesthetics that have rapid induction?
low solubility in blood = low blood/gas coeff = low A/V gradient

(anesthetic starts to work in brain after equilibration in blood)
What are the characteristics of anesthetics that have a high potency?
high solubility in lipids = high potency = 1/MAC

MAC = conc where 50% of population is anesthetized
What is malignant hyperthermia?

what drugs cause it?

what's the treatment for it?
- abnormal ryanodine rec release lots of Ca post anesthesia
- ATP dep sarcoplasmic reuptake
- fever, ridigity

seen with inhaled (halothane, NO, enflurane) and succinylcholine

tx: dantrolene
What are the categories and names of local anesthetics?
esters - one I
amIdes - two I's
What is the mechanism of local anesthetics?
Block Na channels

usu given with epi to enhance local action
What is the order of nerve blockade for local anesthetics?
small myelinated
small unmyelinated
large myelinated
large unmyelinated
What are the different kinds of neuromuscular blockers?
depolarizing - succinylcholine (acts like Ach)
(can't reverse in prolonged depol phase. reverse with neostigmine in repolarized but blocked phase)

non-depolarizing - tubocurarine - compete with Ach for receptors
reverse with neostigmine
What drugs agonize DA receptors in PD?
pramipexole
bromocriptine
What drugs increase dopamine in PD?
Amantadine (also an antiviral)

L-dopa/Carbidopa (decarboxylase inhibitor)
What drugs prevent DA breakdown?
MAO-inhib
- selegiline

COMT inhib
- entacapone (peripheral)
- tolcapone (in brain)
What are the SE of levodopa/carbidopa?
On/off phenomena
behavioral changes

w/o carbidopa, get N/V, tachyarrhythmias, postural hypotension, hot flashes
What are the drugs used for Alzheimer's disease?
Memantine - NMDA ant - prevents excitotoxicity

Donezepil - Ach-esterase inhib
What drug can be used for acute migraines and how does it work?
Sumatriptan

5-HT agonist - vasoconstric - inhib trigeminal activation

SE: coronary vasospasm
What are the low potency antipsychotics and their SE?
thioridazine - reTinal deposits
chlorpromazine - Corneal deposits

block M (dry mouth, constip)
block H (sedation)
block alpha (hypotension)
What are high potency antipsychotics and their SE?
haloperidol, fluphenazine, trifluoperazine

4 hrs - dystonia
4 days - akinesia (use benztropine)
4 wks - akasthia (restlessness)
4 mo - tardive dyskinesia
What are the atypical antipsychotics and their mechanism of action?
olanzapine
clozapine
quietiamine
risperidone
aripiprazole
ziprasidone

block 5-HT, alpha, histamine and DA rec

use for + and - schizo symptoms
What are drugs for bipolar disease?
carbamazapine
lithium
valproic acid
What are the SE of lithium?
tremor
DI
hypothyroidism
ebstein's anomaly
What is busipirone?
stim 5-HT receptors

for generalized anxiety disorder

no sedation, low abuse potential
What are the names of tricyclics and their major SE?
imiPRAMINE, amiTRIPTYLINE, doxepin

convulsions
coma
cardiotoxicity (arrythmias, hypotension)

mimic atropine cytotoxicity
Name some SSRIs
fluoxetine
sertraline
paroxetine
citalopram
What is Serotonin syndrome and what drugs cause it?

tx?
SSRIs and MAOi

hyperthermia, rigidity, myoclonus cardiovascular collapse, seizures

tx: cyproheptadine
What drug can be used for diabetic peripheral neuropathy?
duloxetine
Name some MAO-i
phenelzine
selegiline (used in PD)
What is the mechanism of MAOi
block MAO - increase levels of amine NTs (5-HT, DA, NE)

btw, these ARE NOT first line drugs cuz of associated dietary restrictions
Mechanism of tricyclics
inhib NE and 5-HT uptake
What is an atypical antidepressant used for insomnia?
Trazodone.... causes priapism!
What is Bupropion used for?
smoking cessation. good alternative if SSRIs cause sexual dysfn.

increases NE and DA.

can cause seizures
no sexual SE
What drugs are associated with fat redistribution?
glucocorticoids and HAART
What are anti-M effects and what drugs cause them?
flushed skin, mydriasis, dry skin, cant pee....

atropine
TCA
H1 receptor antagonists
low potency antipsychotics
What kind of glaucoma is acute w/ headache and pain?

cause

tx
narrow angle

cause: anti-chol

tx - B blockers: decrease aq humor prod by ciliary epith

cholimimetics (pilocarpine, carbachol) - increase outflow
What are the SE of niacin?
flushed face (high PGE.. prevent with aspirin)

hyperglycemia

hyperuricemia
What lipid lowering agents cause gallstones ?
fibrates (gemfibrozil)

resins (cholestyramine)
What is the mechanism of niacin?
reduce VLDL secretion.

inhibit lipolysis in adipose tissue
What lipid lowering agents cause increases in LFTs?
statins, gemfibrozil
What lipid lowering drugs cause muscle problems?
stains, gemfibrozil
What is the mechanism of gemfibrozil?
upreg LPL - increased TG clearance
What drugs are used for stress testing?
Dobutamine and adenosine
What is the cellular cascade caused by NO or nitrates?
high cGMP - low intracel Ca - myosin gets dephosphorylated - dilated vessels
What are the SE of amphotericin?
renal toxicity - low serum K/Mg

have to supplement those vitamins and drink lots of water
What receptors does epi work on?
alpha 1/2, beta 1/2
What do D1 receptors do?
relax renal vascular smooth muscle
What is the mechanism and excretion of Digoxin?
mechanism -

block Na/K - block Na/Ca - more intracel Ca - greater strength of contraction

also stim vagus - slow AV node cond

excretion - RENAL!
Digoxin SE
blurry yellow vision, delirium

hyperK, arrhythmia (V tach)

N/V, diarrhea

tx: normalize K, lidocaine, anti-dig Fab fragments
Hydralazine mechanism and SE
mech: vasodil arterioles

SE: reflex symp activation - tachy, edema, lupus-like syndrome
Which drugs can be used for atrial arrhythmias?
class IA, verapamil
Name Class 3 antiarhythmics.
amiodarone
bretylium
ibutilide
sotelol
dofetilide
Name Class 1 antiarhythmics.
1A - quinidine, procainamide, disopyramide

1B - Lidocaine, Mexiletine, Tocainide

1C - Flecainide, Encainide, Propafenone
What hormones use the cAMP signaling pathway?
flat champ CG
FSH
LH
ACTH
TSH
CRH
hCG
ADH
MSH
PTH
calcitonin
Glucagon
What anti-arrhythmics increase the length of an action potential?
Class Ia, Class 3
What is the preferred drug for supraventricular tachycardia?
Adenosine
What are the SE of amiodarone?
pulm fibrosis
hepatotoxicity
hypo/hyper thyroid

corneal deposits
blue/grey skin
photosensitivity
What are the SE of quinidine?
cinchonism - headache, tinnitus
thrombocytopenia
torsades de pointes
What antiarrhythmics increase the PR interval?
B blockers, CCBs
What are SE of mannitol?
pulm edema
What is the mechanism of mannitol?
osmotic diuretic. (increase plasma and tubular osm) - use to decrease intracranial/intraocular pressure
What are the indications for azetazolamide?
glaucoma
urinary alkalinization
metab alkalosis
altitude sickness
What are the SE of furosemide?
Ototoxicity
HypoK
Dehydration
Allergy
Nephritis
Gout

also, hypo K, Mg, Ca
What are the SE of thiazides?
hyperGLUC
glycemia
lipidemia
uricemia
calcemia

also hypo K, Mg, Na
If patient is on Li, can't take what diuretic?
thiazide

cuz Li gets reabs with Na in collecting ducts - toxic
Name the K sparing diuretics
Aldo Ant
Spironolactone
Eplerenone

Na channel blockers in CT
Amiloride
Triamterene
What are the SE of spironolactone?
antiandrogen effects - testicular atrophy, gynecomastia, impotence
What diuretics cause acidemia?
Carbonic anhydrase inhibitors
K sparing
What diuretics cause alkalemia?
Loop and thiazides
What medicine blocks the actions of adenosine?
Theophylline which causes bronchodil
What med is used for pulm HTN?
Bosentan
What are the SE of PDE inhibitor used for asthma?
theophylline

cardiotoxic, seizures. metab by p450
What drug is a GnRH analog?

Use?
Leuprolide

infertility (pulsatile)
prostate ca (continuous w/ flutamide)
uterine fibroids
What is testosterone used for?
hypogonadism
dev secondary sex traits
stim anabolism to promote recovery after burn/injury
What does ketoconazole do?
inhibits desmolase (and therefore steroids synthesis)

in PCOS - prevent hirsuitism (so does spironolactone)
What does spironolactone do in reproduction system?
inhibits steroid binding...

in PCOS - prevent hirsuitism (so does ketoconazole)
What does Clomiphene do?
partial agonist at E rec in hypoth - prevents normal feedback inhib - increase release of LH/FSH -
stim ovulation

tx for infertility and PCOS
What is Anastrozole?
Aromatase inhib used in postmeno women with breast ca

(inhib androstenedione to estrone conversion)
What drugs are typically used to induce abortion?
Mifepristone (P inhibitor @ receptor)

Misoprostol (PGE1 - induce contractions)
How does viagra work?
inhibit cGMP PDE -
increase cGMP -
smooth muscle relaxation in penis -
increased blood
erection.. yeow!
LT C/D/E function?
broncho/vaso constriction

increased permeability
PGI function?
decreased plt aggregation
broncho/vaso dilation
decreased uterine tone
PGE function?
vasodil
pain
increased uterine tone - abortifactant
maintain GI mucous barrier
increased temp
maintain patent ductus arteriosus
TXA2 function?
increased plt aggregation
vasoconstriction
bronchoconstriction
What is the mechanism of fluid retention with NSAID use?
PGE's inhibited - so less vasodil -
relative ischemia
kidneys retain H20 and Na
In what specific situations are NSAIDs prohibited?
CHF
Li use
What is the treatment for CMV?
Ganicyclovir

if don't work, Foscarnet
Drugs that cause colored vision changes?
Digoxin

Ethambutol (TB)
What lipid lowering drug increases TG?
Cholestyramine
What drug has a similar effect on platelet aggregation as aspirin?
Clopidogrel, ticlopidine
How are heparin and enoxaparin different?
enoxaparin - (low molecular weight heparin)
high bioavail, longer half life, no need for monitoring
What is HIT

instead use?
heparin induced thrombocytopenia

heparin binds plts - autoAb destroy platelets and overactivate remaining ones - so thrombytopenia and hypercoag at the same time!

instead use - lepirudin/bivalirudin/argatroban

these directly inhibit thrombin
What is the different b/w efficacy and potency?
efficacy = Emax (does dont matter)

potency = dose req to prod certain effect - dep on drug-rec affinity and drug access to tissue
What drug irrev blocks ADP rec and inhibits plt aggregation?

SE?
clopidogrel/ticlopidine

neutropenia
What is the function of

Cox 1 and Cox 2
COX 1 - GI, plt stuff

COX 2 - inflam
SE of opioids?
Sphincter of Odi contraction
What lipid lowering drugs are used to treat high TG?
Niain
Fibrates
names of protease inhibitors
ritoNAVIR, saquiNAVIR
SE of protease inhibitors
hyperglycemia
lipodystrophy
GI sympt
inhib p450
What is a nucleoside RT inhibitor? SE?
ZidoVUDINE, zalcitaBINE

SE: BM suppression, lactic acidosis, megaloblastic anemia
Names of non-nucleoside RT inhibitors?
Nevirapine, Efavirenz, Delavirdine

NEVIR EFAVer Deliver
Use of heparin
immediate anticoag for

PE, stroke, acute coronary syndrome, MI, DVT
Use of warfarin
chronic anticoag for thromboemb
What drugs inhibit DHF reductase?
methotrexate
trimethoprim
pyrimethamine
Name alkylating agents

function?
cisplatin, cyclophosphamide, busulfan

cross link DNA
What do dactinomycin/doxorubicin do?
intercalate DNA
What drugs block at the G2 phase? How?
bleomycin - causes DNA breaks

etoposide - inhib topoisom II
What drugs decrease purine synth?

Differences in activation and excretion?
6-MP and 6-TG

both activated by HGPRT

6-MP excreted by xanthine oxidase - toxicity with allopurinol
What is trastuzumab
AKA herceptin

AntiB against HER-2 (erb-B2)

use in metastatic breast ca
What is imatinib?
Philly chr bcr-abl kinase inhib

use in CML
What is azathioprine?
interferes with purine synth ... prodrug form of 6-MP

use in transplantation
name NSAIDs
ibuprofen
naproxen
indomethacin
ketorolac
Acetominophen mechanism
COX inhib in CNS (analgesic, anti-pyretic)

inactiv peripherally
Name bisphosphonates

mechanism?
etiDRONATE

analog of pyroP (component of hydroxyapatite) - inhib osteoclast activity
What are acute gout tx?
NSAIDs
colchicine - impair PMN chemotaxis
GC (if renal failure)
What are the TNF inhibitors?
Etanercept - decoy receptor

Infliximab - anti-TNF antiB

Adalimumab - blocks receptor


*** do PPD test before beginning therapy
What insulin is used

post meal
DKA
super long acting
lispro/aspart

regular

glargine
mechanism of Sulfonylurea?
close K channel - depol cell - Ca influx - release insulin
glitazone mechanism
decrease insulin resistance by changing glu/lipid metab genes
glitazone SE?
weight gain, edema, CV toxicity

Hepatotoxic
Mechanism of methimazole
inhib thyroid peroxidase (like propylthiouracil)


btw, propylthiouracil also decreases peripheral T4 to T3 converson
What is sucralfate?
(like Bismuth.. peptobismol)

use for ulcer healing, travelers diarrhea
What is sulfasalazine?
combo of
sulfapyridine (antibacterial)
5-aminosalicylic acid (inhib PGE and LT synth durng inflam)

use for UC, Crohns
Drug for cirrhosis related hepatic encephalopathy?
lactulose
What is an antiemetic for chemo patients?
ondansetron... 5-HT antagonist
Name the 1st generation H1 blockers.

SE?
diphenhydramine, chlorpheniramine

SE - sleepy, anti-M, anti-alpha adren
Name the 2nd generation H1 blockers
Loratidine, cetirizine
What drugs cause softies?
anti-HTN
SSRIs
neuroleptics
ethanol