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426 Cards in this Set

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Km: Definition
Km = Substrate at 0.5*Vmax
Km reflects the affinity of the enzyme for its substrate
Vmax indicates what?
Vmax is directly proportional to the enzyme concentration.
Relationship between Km and affinity
-The lower the Km, the higher the affinity
-Smaller Km means enzyme is saturated earlier, which means that small amounts of substrate are picked up by the enzyme.
Reading an inverse curve: Y-intercept equals ?
1/Vmax
The higher the Y-intercept the lower the Vmax
Reading an inverse curve: X-intercept equals ?
(1/-Km)
The further to the right the x-intercept, the greater the Km
Reading an inverse curve: Slope equals ?
Km/Vmax
Reading an inverse curve: Effect of a competitive inhibitor
X-intercept farther to the right, meaning Km is greater, because you need more substrate to get the same effect as the competitive inhibitor is hogging the enzyme.

The y-intercept is the same, meaning Vmax hasn't changed, because there isn't any more enzyme.


The slope is greater, because Km has increased while Vmax has stayed the same.
Reading an inverse curve: Effect of a noncompetitive inhibitor
The x-intercept is the same, meaning Km is the same, because the affinity for the enzyme hasn't changed, there's just less of it.


The y intercept has increased, meaning Vmax has decreased, because enzyme has been inactivated by the noncompetitive inhibitor

The slope is greater, because Vmax has decreased while Km has stayed the same.
Competitive inhibitor: Resemble substrate
Yes
Competitive inhibitor: Overcome by increased substrate?
Yes
Competitive inhibitor: Binds active site?
Yes
Competitive inhibitor: Effect on Vmax
Unchanged. The amount of enzyme has not changed.
Competitive inhibitor: Effect on Km
Increased. A lot more substrate needs to be available to seize the active sites.
Noncompetitive inhibitor: Resemble substrate?
No
Noncompetitive inhibitor: Overcome by increased substrate?
No
Noncompetitive inhibitor: Binds active site?
No
Noncompetitive inhibitor: Effect on Vmax
Decreased. Takes the enzyme out.
Noncompetitive inhibitor: Effect on Km
Unchanged. Does not change the affinity for the enzyme.
Volume of distribution: Abbreviation
Vd
Vd: Stands for what?
Volume of distribution
Volume of distribution: definition
Vd = (amount of drug in the body)/(plasma drug concentration)
Volume of distribution: What alters it?
Liver and kidney disease
Where are drugs with a low Vd distributed?
plasma
Where are drugs with a medium Vd distributed?
extracellular space
Where are drugs with a high Vd distributed?
tissues
Clearance: definition
=(rate of elimination of drug)/(plasma drug concentration)

=Vd x Ke where Ke=elimination constant
Half life: definition
The time required to change the amount of drug in the body by 1/2 during elimination (or during a constant infusion).
What percentage of steady state is a drug at after: 1 half life
50%
What percentage of steady state is a drug at after: 2 half lives
75%
What percentage of steady state is a drug at after: 3 half lives
87.5%
What percentage of steady state is a drug at after: 3.3 half lives
90%
What percentage of steady state is a drug at after: 4 half lives
94%
How many half lives does it take for a drug to reach the following percentage of steady state: 50%
1 half life
How many half lives does it take for a drug to reach the following percentage of steady state: 75%
2 half lives
How many half lives does it take for a drug to reach the following percentage of steady state: 87.5%
3 half lives
How many half lives does it take for a drug to reach the following percentage of steady state: 90%
3.3 half lives
How many half lives does it take for a drug to reach the following percentage of steady state: 94%
4 half lives
Cp stands for what?
target plasma concentration
What is the abbreviation for target plasma concentration?
Cp
In pharmacology, what is F an abbreviation for?
Bioavailability
What is the abbreviation in pharmacology for bioavailability?
F
Loading dose: Definition
Loading dose = (Cp * Vd)/F (where Cp equals the target plasma concentration, Vd equals volume of distribution, and F equals bioavailability)
Maintenance dose: Definition
Maintenance dose = (Cp * CL)/F (where Cp is the target plasma concentration and CL is clearance and F is bioavailability)
Zero-order elimination: definition
Constant elimination over time regardless of drug.
How does Cp vary with time during zero-order elimination?
Cp decreases linearly with time.
Zero-order elimination: Drug examples
-Ethanol
-Phenytoin
-Aspirin (at high concentrations)
First-order elimination: definition
Rate of elimination is proportional to drug concentration
Zero-order elimination vs First-order elimination: Comparison
Zero-order: Constant amount of drug eliminated per unit time

1st-order: Constant fraction of drug eliminated per unit time
How does Cp vary with time during first-order elimination?
Cp decreases exponentially with time.
Urine: Which species get trapped in urine?
Ionized species
In what kind of environment is the following trapped?: Weak acids
Basic environments
In what kind of environment is the following trapped?: Weak bases
Acidic environments
In what kind of environment is the following digested?: Weak acids
Acidic environments (below pKa)
In what kind of environment is the following digested?: Weak bases
Basic environments (above pKa)
How do you treat an overdose of the following?: Weak acids
Bicarbonate
How do you treat an overdose of the following?: Weak bases
Ammonium chloride
Phase I metabolism: Processes
Cytochrome P450
-reduction
-oxidation
-hydrolysis
Phase II metabolism: Processes
Conjugation
-acetylation
-glucuronidation
-sulfation
Phase I metabolism: Metabolites
-slightly polar
-water-soluble
-often still active
Phase II metabolism: Metabolites
-very polar
-renally excreted
-inactive
What phase of metabolism do geriatric patients lose first?
Phase I
Effect on dose/effect curve of: competitive antagonist
Shifts curve to the right, decreasing potency and increasing EC50.
Effect on dose/effect curve of: noncompetitive antagonist
Shifts curve downward, decreasing efficacy
What is EC50?
Dose causing 50% of maximal effect
What is Kd?
Concentration of drug required to bind 50% of receptor sites
How many half lives does it take for a drug to reach the following percentage of steady state: 97%
5 half lives
What percentage of steady state is a drug at after: 5 half lives
97%
Effect on dose/effect curve: Spare receptors
The drug binding and drug effect are independent of each other with effect to the left of binding.

This means that EC50 is lower than Kd, so very little drug needs to bind to get 50% of the effect.
Effect on dose/effect curve: Partial agonist
-Lower maximal efficacy
-Potency independent (amount of dose to get to maximum effect)
Therapeutic Index: Definition
=(TD50)/(ED50)

where TD50 equals median toxic dose, and ED50 equals median effective dose.
Where are nicotinic receptors found?
Preganglionic synapses before:
-Cardiac and smooth muscle (Parasympathetic and Sympathetic)
-Gland cells (Parasympathetic and Sympathetic)
-Nerve terminals (Parasympathetic and Sympathetic)
-Renal vascular smooth muscle (Sympathetic)

Neuromuscular junctions for skeletal muscle
What is the neurotransmitter at Nictoinic receptors?
Acetylcholine
What is the neurotransmitter at Muscarinic receptors?
Acetylcholine
Where are muscarinic receptors found?
Parasympathetic end plates:
-Cardiac and smooth muscle
-Gland cells
-Nerve terminals

Sympathetic end plate:
-Sweat glands
Where are D1 receptors found?
Sympathetic:
Renal vascular smooth muscle
What type of G-protein is associated with the following receptor type?: alpha-1
Gq
What type of G-protein is associated with the following receptor type?: alpha-2
Gi
What type of G-protein is associated with the following receptor type?: beta-1
Gs
What type of G-protein is associated with the following receptor type?: beta-2
Gs
What type of G-protein is associated with the following receptor type?: M1
Gq
What type of G-protein is associated with the following receptor type?: M2
Gi
What type of G-protein is associated with the following receptor type?: M3
Gq
What type of G-protein is associated with the following receptor type?: D1
Gs
What type of G-protein is associated with the following receptor type?: D2
Gi
What type of G-protein is associated with the following receptor type?: H1
Gq
What type of G-protein is associated with the following receptor type?: H2
Gs
What type of G-protein is associated with the following receptor type?: V1
Gq
What type of G-protein is associated with the following receptor type?: V2
Gs
What types of receptors are associated with the following G-proteins: q
-alpha-1
-M1
-M3
-H1
-V1
What types of receptors are associated with the following G-proteins: i
-alpha-2
-M2
-D2
What types of receptors are associated with the following G-proteins: s
-beta-1
-beta-2
-D1
-H2
-V2
What are the major functions of the following receptor type: alpha-1
Increase vascular smooth muscle contraction
What are the major functions of the following receptor type: alpha-2
-Decrease sympathetic outflow
-Decrease insulin release
What are the major functions of the following receptor type: beta-1
-Increase heart rate
-Increase contractility
-Increase renin release
-Increase lipolysis
-Increase aqueous humor formation
What are the major functions of the following receptor type: beta-2
-Vasodilation
-Bronchodilation
-Increased glucagon release
What are the major functions of the following receptor type: M1
CNS
What are the major functions of the following receptor type: M2
Decrease heart rate
What are the major functions of the following receptor type: M3
Increase exocrine gland secretions
What are the major functions of the following receptor type: D1
Relax renal vascular smooth muscle
What are the major functions of the following receptor type: D2
Modulate transmitter release (especially in brain)
What are the major functions of the following receptor type: H1
-Increase nasal/bronchial mucus production
-Contraction of bronchioles
-Pruritus
-Pain
What are the major functions of the following receptor type: H2
Increased gastric acid secretion
What are the major functions of the following receptor type: V1
Increased vascular smooth muscle contraction
What are the major functions of the following receptor type: V2
-Increased water permeability and reabsorption in the collecting tubules of the kidney
Gq protein pathway
-Receptor stimulated
-Gq protein stimulates Phospholipase C
-Phospholipase C catalyzes the conversion of Lipids to PIP2
-PIP2 splits into IP3 and DAG

IP3 stimulates an increase in Calcium concentration

DAG activates Protein Kinase C
Gs protein pathway
-Receptor stimulated
-Gs protein stimulates Adenylylcyclase
-Adenylylcyclase
catalyzes conversion of ATP to cAMP
-cAMP activates Protein Kinase A
Gi protein pathway
-Receptor stimulated
-Gi protein inhibits Adenylylcyclase
-Decreases conversion of ATP to cAMP
-Decreased activation of Protein kinase A
Cholinergic pathway (presynaptic events to receptor)
1. Choline transported into presynaptic bulb
2. Acetyl-Coa joints with Choline-ChAT to form acetylcholine, and the two are taken up by a vesicle.
3. The vesicle joins with the cell membrane and ACh is exocytosed
4. ACh is released into the synapse
5. Acetylcholine joints with the Cholinoceptor or is degraded by AChE into Choline + Acetate
Hemicholinum: Action and mechanism
Inhibits cholinergic transmission

Mechanism: Inhibits transfer of choline into presynaptic bulb
Vesamicol: Action and mechanism
Inhibits cholinergic transmission

Mechanism: Inhibits uptake of ACh into a vesicle in the presynaptic bulb
Ca2+: Action on presynaptic vesicles
Stimulates exocytosis of neurotransmitters from presynaptic bulb
Botulinum: Action and mechanism
Inhibits cholinergic transmission

Mechanism: Inhibits exocytosis of neurotransmitters from presynaptic bulb
Noradrenergic pathway (presynaptic events to receptor)
1. Tyrosine is transferred into the presynaptic bulb
2. Tyrosine is converted into DOPA
3. DOPA is converted to Dopamine
4. Dopamine is converted to Norepinephrine and transferred into a vesicle
5. Norepinephrine is exocytosed from the presynaptic terminal
6. 3 possibilities happen
a. Norepinephrine binds to a beta adrenoreceptor.
b. Norepinephrine is reuptaken by the releasing neuron
c. Norepinephrine binds to an alpha-2 receptor on the releasing neuron
d. It diffuses away/is metabolized.
Metyrosine: Action and mechanism
Action: Inhibits noradrenergic transmission

Mechanism: Inhibits step where tyrosine is converted into DOPA
Reserpine: Action and mechanism
Action: Inhibits noradrenergic transmission

Mechanism: Prevents sequestration of norepinephrine into vesicles
Guanethidine: Action and mechanism
Action: Inhibits noradrenergic transmission

Mechanism: Inhibits exocytosis of Norepinephrine from presynaptic bulb
Amphetamine: Action and mechanism
Action: Stimulates noradrenergic transmission

Mechanism: Stimulates exocytosis of norepinephrine from presynaptic bulb
Tricyclic antidepressant: Mechanism
Decreases reuptake of norepinephrine from synaptic cleft into releasing neuron
Cocaine: Mechanism
Decreases reuptake of norepinephrine from synaptic cleft into releasing neuron
Angiotensin II: Effect on noradrenergic pre-synaptic neurons
Enhances release of NE
Cholinomimetics: Direct agonists
Bethanechol, Carbachol, Pilocarpine, Methacholine
Cholinomimetics: Indirect agonists
Neostigmine (AChE inhibitor), Pyridostigmine, Edrophonium, Physostigmine, Echothiophate
Use of: Bethanechol
Postoperative and neurogenic ileus and urinary retention
Use of: Carbachol
-Glaucoma
-pupillary contraction
-release of intraocular pressure
Use of: Pilocarpine
Potent stimulator of:
-Sweat
-Tears
-Saliva
Use of: Methacholine
Challenge test for diagnosis of asthma
Use of: Neostigmine
AChE inhibitor
-Postoperative/neurogenic ileus/urinary retetnion
-Myasthenia Gravis
-Reversal of neuromuscular junction blockade (postoperative)
-No CNS penetration
Use of: Pyridostigmine
-Myasthenia Gravis (increases strength)
-does penetrate CNS
Use of: Edrophonium
Diagnosis of myasthenia gravis (extremely short acting)
Use of: Physostigmine
-Glaucoma (crosses blood-brain barrier into CNS)
-Atropine overdose
Use of: Ecthiophate
-Glaucoma
Mechanism of indirect cholinomimetics
Increase endogenous ACh
Synonym for indirect cholinomimetics
Anticholinesterases
Synonym for anticholinesterases
indirect cholinomimetics
Bethanechol: mechanism
-Activates bowel and bladder smooth muscle
-Resistant to AChE
Carbachol: mechanism
-Contracts ciliary muscle of eye (open angle)
-Contracts Pupillary sphincter (narrow angle)
-Resistant to AChE
Methacholine: mechanism
Stimulates muscarinic receptors in airway when inhaled
Symptoms of cholinesterase inhibitor poisoning
DUMBBELS SAC

-Diarrhea
-Urination
-Miosis
-Bronchospasm
-Bradycardia
-Excitation of skeletal muscle and CNS
-Lacrimation
-Sweating
-Salivation
-Abdominal Cramping
Antidote to cholinesterase inhibitor poisoning
-Atropine (muscarinic antagonist) +
-Pralidoxime (chemical antagonist used to regenerate active cholinesterase)
Cholinesterase inhibitors
-Parathion
-Other organophosphates
Cholinoreceptor blockers
-Atropine (homatropine, tropicamide)
-Benztropine
-Scopolamine
-Ipratropium
-Methscoplamine (oxybutin, glycopyrrolate)
Cholinoreceptor blockers used to produce: mydriasis and cycloplegia
Atropine, homatropine, tropicamide
Cholinoreceptor blockers used for: Parkinson's disease
Benztropine
Cholinoreceptor blockers used for: Motion sickness
Scopolamine
Cholinoreceptor blockers used for: Obstructive pulmonary disease
Ipratropium
Cholinoreceptor blockers used for: Genitourinary problems
-Methscopolamine
-Oxybutin
-Glycopyrrolate
Application of: Atropine
Produce mydriasis and cycloplegia
Application of: Homatropine
Produce mydriasis and cycloplegia
Application of: Tropicamide
Produce mydriasis and cycloplegia
Application of: Benztropine
Parkinson's Disease
Application of: Scopolamine
Motion sickness
Application of: Ipratropium
Obstructive pulmonary diseases
Application of: Methscopolamine
-Reduce urgency in mild cystitis
-Reduce bladder spasms
Application of: Oxybutin
-Reduce urgency in mild cystitis
-Reduce bladder spasms
Application of: Glycopyrrolate
-Reduce urgency in mild cystitis
-Reduce bladder spasms
Glaucoma drugs: Categories
-alpha-agonists
-beta-blockers
-diuretics
-cholinomimetics
-prostaglandins
Glaucoma drugs - alpha agonists:
Epinephrine
Brimonidine
Which glaucoma drug should not be used in closed-angle glaucoma?
Epinephrine
Epinephrine: Mechanisms and side effects
-M:
--Increased outflow of aqueous humor
-E:
--Mydriasis
--Stinging
--Do not use in closed angle glaucoma
Brimonidine: Mechanisms and side effects
M: Decreased aqueous humor synthesis
E: No pupillary or vision changes
Glaucoma drugs - beta blockers:
Timolol
Betaxolol
Carteolol
Glaucoma drugs - beta blockers: Mechanism and side effects
M: Decreased aqueous humor secretion
E: No pupillary or vision changes
Glaucoma drugs - diuretics: Drugs
Acetazolamide
Glaucoma drugs - diuretics: mechanisms and side effects
M: Decreased aqueous humor secretion due to decreased bicarbonate (via inhibition of carbonic anhydrase)

E: No pupillary or vision changes
Glaucoma drugs - Cholinomimetics: Drugs
Direct: Pilocarpine, Carbechol

Indirect: Physostigmine, Ecthiopate
Glaucoma drugs - Cholinomimetics: Mechanism and Side effects
M:
-Increase outflow of aqueous humor
-Contract ciliary muscle and open trabecular meshwork
-Use pilocarpine in emergencies
-Very effective at opening canal of Schlemm

E:
-Miosis
-Cyclospasm
Glaucoma drugs - Prostaglandins: Drugs
Latanoprost (PGF-2alpha)
Glaucoma drugs - Prostaglandins: Mechanism and Effects
M: Increase outflow of aqueous humor

E: Darkens color of iris (browning)
Atropine: General effects mnemonic
Blocks BUMBLED ASS

B: Bradycardia
U: Urination
M: Miosis
B: Bronchospasm
L: Lacrimation
E: Excitation of skeletal muscle and CNS
D: Diarrhea
A: Abdominal cramping
S: Sweating
S: Salivation
Atropine: Side effects
-Hot as a hare (Increased body temperature; hyperthermia in infants)
-Dry as a bone (Dry mouth and dry skin; Urinary retention in men with prostatic hypertrophy; Constipation)
-Red as a beet (Flushed skin)
-Blind as a bat (Cycloplegia, Acute angle-closure glaucoma in elderly)
-Mad as a hatter (disorientation)
Atropine: Mechanism
Muscarinic antagonist
Atropine: Effects on organ system: Eye
-Increased pupil dilation
-Cycloplegia
Atropine: Effects on organ system: Airway
-Decreased secretions
Atropine: Effects on organ system: Stomach
-Decreased acid secretion
Atropine: Effects on organ system: Gut
-Decreased motility
Atropine: Effects on organ system: Bladder
-Decreased urgency in cystitis
Hexamethonium: Mechanism
Nicotinic ACh receptor antagonist: Ganglionic blocker
Hexamethonium: Clinical use
Prevents vagal reflex responses to changes in blood pressure (eg prevents reflex bradycardia caused by NE)
Sympathomimetics: Catecholamines: List
-Epinephrine
-Norepinephrine
-Isoproterenol
-Dopamine
-Dobutamine
Sympathomimetics: Non-catecholamines: List
-Amphetamine
-Ephedrine
-Phenylephrine
-Albuterol
-terbutaline
-Cocaine
-Clonidine
-Alpha-methyldopa
Catecholamines: Epinephrine: Mechanism/selectivity
-alpha-1
-alpha-2
-beta-1 (low doses beta-1 selective)
-beta-2
Catecholamines: Epinephrine: Applications
-Anaphylaxis
-Glaucoma (open angle)
-Asthma
-Hypotension
Catecholamines: Norepinephrine: Mechanism/selectivity
More selective
-alpha-1
-alpha-2

Less selective
-beta-1
Catecholamines: Norepinephrine: Applications
Hypotension (but decreased renal perfusion)
Catecholamines: Isoproterenol: Mechanism/selectivity
beta-1 = beta-2
Catecholamines: Isoproterenol: Applications
AV block (rare)
Catecholamines: Dopamine: Mechanism/selectivity
In decreasing order:
-D1=D2
-beta
-alpha
Catecholamines: Dopamine: Applications
-Shock (Increased renal perfusion)
-Heart failure
Catecholamines: Dobutamine: Mechanism/selectivity
In decreasing order:
-Beta-1
-Beta-2
Catecholamines: Dobutamine: Applications
-Shock
-Heart failure cardiac stress testing
Catecholamines: Amphetamine: Mechanism/selectivity
-Indirect general agonist
-Releases stored catecholamines
Non-catecholamine sympathomimetics: Amphetamine: Applications
-Narcolepsy
-Obesity
-ADD
Non-catecholamine sympathomimetics: Ephedrine: Mechanism/selectivity
-Indirect general agonist
-releases stored catecholamines
Non-catecholamine sympathomimetics: Ephedrine: Applications
-Nasal decongestion
-Urinary incontinence
-Hypotension
Non-catecholamine sympathomimetics: Phenyephrine: Mechanism/selectivity
alpha-1 more than alpha-2
Non-catecholamine sympathomimetics: Phenyephrine: Applications
-Pupil dilator
-Vasoconstriction
-Nasal decongestion
Non-catecholamine sympathomimetics: Albuterol: Mechanism/selectivity
Beta-2 > Beta-1
Non-catecholamine sympathomimetics: Albuterol: Applications
Asthma
Non-catecholamine sympathomimetics: Terbutaline: Mechanism/selectivity
Beta-2 > Beta-1
Non-catecholamine sympathomimetics: Terbutaline: Applications
Asthma
Non-catecholamine sympathomimetics: Cocaine: Mechanism/selectivity
-Indirect general agonist
-Uptake inhibitor
Non-catecholamine sympathomimetics: Cocaine: Applications
-Vasoconstriction
-Local anesthesia
Non-catecholamine sympathomimetics: Clonidine: Mechanism/selectivity
-Centrally acting alpha-2 agonist
-Decreases central adrenergic outflow
Non-catecholamine sympathomimetics: alpha-methyldopa: Mechanism/selectivity
-Centrally acting alpha-2 agonist
-Decreases central adrenergic outflow
Non-catecholamine sympathomimetics: Clonidine: Applications
Hypertension (especially with renal disease, as there is no decrease in blood flow)
Non-catecholamine sympathomimetics: alpha-methyldopa: Applications
Hypertension (especially with renal disease, as there is no decrease in blood flow)
Sympathomimetics selective for: alpha-1
-Phenylephrine (alpha-1 more than alpha-2)
-Norepinephrine (alpha-1 and alpha-2 more than beta-1)
Sympathomimetics selective for: alpha-2
-Clonidine
-alpha-methyldopa
-Norepinephrine (alpha-1 and alpha-2 more than beta-1)
-Phenylephrine (alpha-1 more than alpha-2)
-Norepinephrine (alpha-1 and alpha-2 more than beta-1)
Sympathomimetics selective for: beta-1
-Dobutamine (beta-1 more than beta-2)
-Isoproterenol (beta-1 = beta-2)
-Epinephrine (at low doses)
-Albuterol, terbutaline (beta-2 more than beta-1)
Sympathomimetics selective for: beta-2
-Albuterol, terbutaline (beta-2 more than beta-1)
-Isoproterenol (beta-1 = beta-2)
-Dobutamine (beta-1 more than beta-2)
Sympathomimetics selective for: None (general agonists)
-Amphetamine
-Ephedrine
-Cocaine
-Epinephrine (alpha and beta)
Effect on blood pressure: Norepinephrine
Increases from 100 to 150

Mechanism:
1. Stimulates alpha more than beta
2. Systolic blood pressure goes up along with but more than diastolic blood pressure
3. Mean blood pressure rises
Effect on blood pressure: Epinephrine
Mean pressure stays at 100, with wide pulse-pressure (100)

Mechanism:
1. Nonselectively stimulates both alpha and beta receptors
2. Alpha receptors: Systolic blood pressure goes up
AND
beta receptors: Diastolic blood pressure goes down
3. Mean blood pressure stays the same
4. Pulse pressure is wide
Effect on blood pressure: Isoproterenol
Mean blood pressure goes down to 50, but pulse-pressure becomes wider (~75).

Mechanism:
1. Stimulates beta more than alpha.
2. Diastolic drops along with but more than systolic blood pressure
3. Mean blood pressure drops with wide pulse pressure
Effect on heart rate: Norepinephrine
1. Mean pressure goes up
2. Goes down to 50 (reflex bradycardia)
Effect on heart rate: Epinephrine
1. Beta-1 receptors are stimulated
2. Increases to 100
Effect on heart rate: Isoproterenol
1. Beta-1 receptors are stimulated more than alpha receptors
2. Increases to ~125
Sympathomimetic of choice for: Anaphylaxis
Epinephrine
Sympathomimetic of choice for: Open-angle glaucoma
Epinephrine
Sympathomimetic of choice for: Asthma
-Albuterol
-Terbutaline
-Epinephrine
Sympathomimetic of choice for: Hypotension
-Epinephrine
-Norepinephrine (though with decreased renal perfusion)
-Ephedrine
Sympathomimetic of choice for: AV block
Isoproterenol
Sympathomimetic of choice for: Shock
-Dopamine (increased renal perfusion)
-Dobutamine
Sympathomimetic of choice for: Heart failure
Dopamine
Sympathomimetic of choice for: Heart failure cardiac stress testing
Dobutamine
Sympathomimetic of choice for: Narcolepsy
Amphetamine
Sympathomimetic of choice for: Obesity
Amphetamine
Sympathomimetic of choice for: Attention defecit disorder
Amphetamine
Sympathomimetic of choice for: Nasal decongestion
-Ephedrine
-Phenylephrine
Sympathomimetic of choice for: Urinary incontinence
Ephedrine
Sympathomimetic of choice for: Dilation of pupils
Phenylephrine
Sympathomimetic of choice for: desired vasoconstriction
-Phenylephrine
-Cocaine
Sympathomimetic of choice for: Local anesthesia
Cocaine
Sympathomimetic of choice for: Treatment of hypertension
Clonidine and alpha-methyldopa (especially for those with renal disease, no decrease in blood flow to kidney)
alpha-blockers: drug list
Non-selective
-Irreversible: Phenoxybenzamine
-Reversible: Phentolamine
alpha-1 selective
-Prazosin
-Terazosin
-Doxazosin
alpha-2 selective
-Mirtazapine
Phenoxybenzamine: Mechanism
irreversible nonselective alpha-blocker
Phentolamine: Mechanism
reversible nonselective alpha-blocker
Prazosin: Mechanism
alpha-1 blocker
Terazosin: Mechanism
alpha-1 blocker
Doxazosin: Mechanism
alpha-1 blocker
Mirtazapine: Mechanism
alpha-2 blocker
Nonselective alpha blockers: Application
Pheochromocytoma
alpha-2 blockers: Application
Depression
alpha-1 blockers: Application
-Hypertension
-Urinary retention in BPH
Nonselective alpha blockers: Toxicity
-Orthostatic hypotension
-Reflex tachycardia
alpha-2 blockers: Toxicity
-Sedation
-Increase in serum cholesterol
-Increase in appetite
alpha-1 blockers: Toxicity
-1st-dose orthostatic hypotension
-dizziness
-headache
Which class of alpha blockers should you use for: Pheochromocytoma
Nonselective alpha blockers
Which class of alpha blockers should you use for: Hypertension
alpha-1 blockers
Which class of alpha blockers should you use for: Urinary retention in bph
alpha-1 blockers
Which class of alpha blockers should you use for: Depression
alpha-2 blockers (Mirtazapine)
beta-blockers: mechanism in control of: hypertension
-decreased cardiac output
-decreased renin secretion
beta-blockers: mechanism in control of: angina pectoris
1. decreased heart rate and contractility
2. result: decreased O2 consumption
beta-blockers: mechanism in control of: MI
decrease in mortality (no mechanism given)
beta-blockers: mechanism in control of: supraventricular tachycardia
decreased AV conduction velocity
beta-blockers: mechanism in control of: congestive heart failure
slows progression (no mechanism given)
beta-blockers: mechanism in control of: glaucoma
decreased secretion of aqueous humor
which beta-blockers are used in control of: supraventricular tachycardia
-Propranolol
-Esmolol
which beta-blockers are used in control of: glaucoma
Timolol
beta-blockers: toxicity: non-CV, non-CNS
-Impotence
-Asthma exacerbation
beta-blockers: toxicity: Cardiovascular
-bradycardia
-AV block
-congestive heart failure
beta-blockers: toxicity: CNS
-sedation
-sleep alterations
Non-selective beta blockers
-Propranol
-Timolol
-Nadolol
-Pindolol (partial agonist)
-Labetalol (partial agonist)
beta-1-selective beta-blockers
A BEAM of beta-1 blockers

-Acebutolol (partial agonist)
-Betaxolol
-Esmolol (short acting)
-Atenolol
-Metoprolol
Antidote for: Acetaminophen
N-acetylcysteine
Antidote for: Salicylates
1. Alkalinize urine
2. Dialysis
Antidote for: Anticholinesterases
-Atropine
-Pralidoxime
Antidote for: Organophosphates
-Atropine
-Pralidoxime
Antidote for: Anti-muscarinic anti-cholinergic agents
Physostigmine salicylate
Antidote for: beta-blockers
Glucagon
Antidote for: Digitalis
1. Stop digitalis
2. Normalize potassium
3. Lidocaine
4. anti-digitalis Fab fragments
5. Magnesium
Antidote for: Iron
Deferoxamine
Antidote for: Lead
1st line: CaEDTA & Dimercaprol
2nd line?: Penicillamine
Kids: Succimer
First Aid lists Penicillamine in the antidotes section, but not in the section below, hence the ?
Antidote for: Arsenic
-Dimercaprol (BAL)
-Succimer
-Penicillamine
Antidote for: Gold
-Dimercaprol (BAL)
-Succimer
-Penicillamine
Antidote for: Mercury
-Dimercaprol (BAL)
-Succimer
Antidote for: Copper
Penicillamine
Antidote for: Cyanide
-Nitrite
-Hydroxocobalamin
-Thiosulfate
Antidote for: Methemoglobin
Methylene blue
Antidote for: Carbon Monoxide
-100% Oxygen
-Hyperbaric Oxygen
Antidote for: Methanol
-Ethanol
-Dialysis
-Fomepizole
Antidote for: Ethylene glycol (antifreeze)
-Ethanol
-Dialysis
-Fomepizole
Antidote for: Opioids
Naloxone/naltrexone
Antidote for: Benzodiazepines
Flumazenil
Antidote for: Tricyclics
NaHCO3 (nonspecific)
Antidote for: Heparin
Protamine
Antidote for: Warfarin
-Vitamin K
-Fresh frozen plasma
Antidote for: tPA
Aminocaproic acid
Antidote for: streptokinase
Aminocaproic acid
For what drug(s) is the following an antidote?: N-acetylcysteine
Acetaminophen
For what drug(s) is the following an antidote?:
1. Alkalinize urine
2. Dialysis
Salicylates
For what drug(s) is the following an antidote?: Atropine
-Anticholinesterases
-Organophosphates
For what drug(s) is the following an antidote?: Pralidoxime
-Anticholinesterases
-Organophosphates
For what drug(s) is the following an antidote?: Physostigmine salicylate
Antimuscarinic, anticholinergic agents
For what drug(s) is the following an antidote?: Glucagon
beta-blockers
For what drug(s) is the following an antidote?: Deferoxamine
Iron
For what drug(s) is the following an antidote?: CaEDTA
Lead
For what drug(s) is the following an antidote?: Dimercaprol
Dimercaprol is GLAMorous

-Gold
-Lead
-Arsenic
-Mercury
For what drug(s) is the following an antidote?: Succimer
-Lead
-Arsenic
-Mercury
-Gold
For what drug(s) is the following an antidote?: Penicillamine
-Lead
-Copper
-Arsenic
-Gold
For what drug(s) is the following an antidote?: Nitrite
Cyanide
For what drug(s) is the following an antidote?: Hydroxocobalamin
Cyanide
For what drug(s) is the following an antidote?: Thiosulfate
Cyanide
For what drug(s) is the following an antidote?: Methylene blue
Methemoglobin
For what drug(s) is the following an antidote?: Oxygen
Carbon monoxide (Oxygen should be 100% or hyperbaric)
For what drug(s) is the following an antidote?: Ethanol
-Methanol
-Ethylene glycol (antifreeze)
For what drug(s) is the following an antidote?: Dialysis
-Methanol
-Ethylene glycol (antifreeze)
-Salicylates
For what drug(s) is the following an antidote?: Fomepizole
-Methanol
-Ethylene glycol (antifreeze)
For what drug(s) is the following an antidote?: Naloxone/Naltrexone
Opioids
For what drug(s) is the following an antidote?: Flumazenil
Benzodiazepines
For what drug(s) is the following an antidote?: NaHCO3
Tricyclic Antidepressants
For what drug(s) is the following an antidote?: Protamine
Heparin
For what drug(s) is the following an antidote?: Vitamin K
Warfarin
For what drug(s) is the following an antidote?: Fresh, frozen plasma
Warfarin
For what drug(s) is the following an antidote?: Aminocaproic acid
-tPA
-streptokinase
Lead poisoning: Signs and symptoms
LLEEAADD

-Lead Lines on:
--gingivae
--epiphyses of long bones on x-ray
-Encephalopathy
-Erythrocyte basophilic stippling
-Abdominal colic
-sideroblastic Anemia
-wrist Drop
-foot Drop
Lead poisoning: 1st line treatment for adults
Both:
-Dimercaprol
-EDTA
Lead poisoning: 1st line treatment for children
Succimer

(It "sucks" to be a kid who eats lead)
Causal agent for the following reaction: Atropine-like side effects
Tricyclic Antidepressants
Causal agent for the following reaction: Cardiac toxicity
-Doxorubicin (Adriamycin)
-Daunorubicin
Causal agent for the following reaction: Coronary vasospasm
Cocaine
Causal agent for the following reaction: Cutaneous flushing
-Niacin
-Ca2+-channel blockers
-Adenosine
-Vancomycin
Causal agent for the following reaction: Torsades des pointes
-Class III antiarrhythmics (sotalol)
-Class IA antiarrhytmics (quinidine)
-Cisapride
Causal agent for the following reaction: Agranulocytosis
-Clozapine
-Carbamazepine
-Colchicine
Causal agent for the following reaction: Aplastic anemia
-Chloramphenicol
-Benzene
-NSAIDs
Causal agent for the following reaction: Gray baby syndrome
Chloramphenicol
Causal agent for the following reaction: Hemolysis in G6PD-deficient patients
G6PD IS PAIN

-Isoniazid
-Sulfonamides
-Primaquine
-Aspirin
-Ibuprofen
-Nitrofurantoin
Causal agent for the following reaction: Thrombotic complications
oral contraceptive pills
Causal agent for the following reaction: Cough
ACE inhibitors (not ARBs)
Causal agent for the following reaction: Pulmonary fibrosis
-Bleomycin
-Amiodarone
-Busulfan
Causal agent for the following reaction: Acute cholestatic hepatitis
Macrolides
Causal agent for the following reaction: Focal to massive hepatic necrosis
-Halothane
-Valproic acid
-Acetaminophen
-Amanita phalloides
Causal agent for the following reaction: Hepatitis
INH
Causal agent for the following reaction: Pseudomembranous colitis
-Clindamycin
-Ampicillin
Causal agent for the following reaction: Adrenocortical insufficiency
Glucocorticoid withdrawal (HPA suppression)
Causal agent for the following reaction: Gynecomastia
Some Drugs Create Extra-Awesome Knockers

-Spironolactone
-Digitalis
-Cimetidine
-estrogens
-Alcohol (chronic use)
-Ketoconazole
Causal agent for the following reaction: Hot flashes
Tamoxifen
Causal agent for the following reaction: Gingival hyperplasia
Phenytoin
Causal agent for the following reaction: Osteoporosis
-Corticosteroids
-Heparin
Causal agent for the following reaction: Photosensitivity
SAT for a photo

-Sulfonamides
-Amiodarone
-Tetracycline
Causal agent for the following reaction: SLE-like syndrome
(It's not HIPP to have lupus)

-Hydralazine
-INH
-Procainamide
-Phenytoin
Causal agent for the following reaction: Tendonitis, tendon rupture, and cartilage damage
Fluoroquinolones (kids)
Causal agent for the following reaction: Fanconi's syndrome
Expired tetracycline
Causal agent for the following reaction: Interstitial nephritis
Methicillin
Causal agent for the following reaction: Hemorrhagic cystitis
-Cyclophosphamide
-Ifosfamide
Causal agent for the following reaction: Cinchonism
-Quinidine
-Quinine
Causal agent for the following reaction: Diabetes insipidus
-Lithium
-Demeclocycline
Causal agent for the following reaction: Seizures
-Bupropion
-Imipenem/cilastatin
Causal agent for the following reaction: Tardive dyskinesia
Antipsychotics
Causal agent for the following reaction: Disulfiram-like reaction
-Metronidazole
-Certain cephalosporins
-Procarbazine
-Sulfonylureas
Causal agent for the following reaction: Nephrotoxicity/neurotoxicity
Polymyxins
Causal agent for the following reaction: Nephrotoxicity/ototoxicity
-Aminoglycosides
-Loop diuretics
-Cisplatin
P-450 Inducers
Queen Barb takes Phen-phen and Strictly Refuses Greasy Carbs

-Quinidine (CYP3A4)
-Barbiturates
-Phenytoin
-St. John's Wort
-Rifampin
-Griseofulvin
-Carbamazepine
P-450 Inhibitors
Inhibitors Quickly Stop Cyber-Kids from Eating Grapefruit

-Isoniazid
-Quinidine (CYP2D6)
-Sulfonamides
-Cimetidine
-Ketoconazole
-Erythromycin
-Grapefruit juice
P-450 inducer or inhibitor: Quinidine
Inhibitor: CYP2D6 (more prominent)
Inducer: CYP3A4
P-450 inducer or inhibitor: Barbiturates
Inducer
P-450 inducer or inhibitor: Phenytoin
Inducer
P-450 inducer or inhibitor: Rifampin
Inducer
P-450 inducer or inhibitor: Griseofulvin
Inducer
P-450 inducer or inhibitor: Carbamazepine
Inducer
P-450 inducer or inhibitor: St. John's wort
Inducer
P-450 inducer or inhibitor: Isoniazid
Inhibitor
P-450 inducer or inhibitor: Sulfonamides
Inhibitor
P-450 inducer or inhibitor: Cimetidine
Inhibitor
P-450 inducer or inhibitor: Ketoconazole
Inhibitor
P-450 inducer or inhibitor: Erythromycin
Inhibitor
P-450 inducer or inhibitor: Grapefruit juice
Inhibitor
Active metabolite of ethylene glycol
Oxalic acid
Active metabolite of methanol
-Formaldehyde
-Formic acid
Active metabolite of ethanol
Acetaldehyde
Pathway and toxicities of metabolism of: ethylene glycol
1. Ethylene glycol is converted by alcohol dehydrogenase to
2. Oxalic acid causes:

-Acidosis
-Nephrotoxicity
Pathway and toxicities of metabolism of: methanol
1. Methanol is converted by alcohol dehydrogenase to
2. Formaldehyde and formic acid which cause:

-Severe Acidosis
-Retinal damage
Pathway and toxicities of metabolism of: ethanol
1. Ethanol is converted by alcohol dehydrogenase to
2. Acetaldehyde which causes:

-Nausea
-Vomiting
-Headache
-Hypotension
What enzyme is inhibited by disulfiram?
Acetaldehyde dehydrogenase
What inhibits acetaldehyde dehydrogenase?
Disulfiram
Clinical uses/toxicities for: Echinacea
Use: Common cold

Toxicities:
-GI distress
-dizziness
-headache
Clinical uses/toxicities for: Ephedra
Uses: As for ephedrine

Toxicities:
-CNS and cardiovascular stimulation
At high doses:
-Arrhythmias
-Stroke
-Seizure
Clinical uses/toxicities for: Feverfew
Use: Migraine

Toxicities:
-GI distress
-Mouth ulcers
-Antiplatelet actions
Clinical uses/toxicities for: Ginkgo
Use: Intermittent claudication

Toxicities:
-GI distress
-anxiety
-insomnia
-headache
-antiplatelet actions
Clinical uses/toxicities for: Kava
Use: Chronic anxiety

Toxicities:
-GI distress
-sedation
-ataxia
-hepatotoxicity
-phototoxicity
-dermatotoxicity
Clinical uses/toxicities for: Milk thistle
Use: Viral hepatitis

Toxicities: Loose stools
Clinical uses/toxicities for: Saw palmetto
Use: Benign prostatic hyperplasia

Toxicities:
-GI distress
-Decreased libido
-Hypertension
Clinical uses/toxicities for: St. John's wort
Use: Mild to moderate depression

Toxicities:
-GI distress and phototoxicity
-serotonin syndrome with SSRIs
-induces P-450 system
Clinical uses/toxicities for: DHEA
Uses: Symptomatic improvement in females with SLE or AIDS

Toxicities:
-Androgenization (premenopausal women)
-Estrogenic effects (post menopausal)
-Feminization (young men)
Clinical uses/toxicities for: Melatonin
Use:
-Jet lag
-Insomnia

Toxicities:
-Sedation
-Suppresses midcycle LH
-Hypoprolactinemia
Category for drug names ending with: -afil
Erectile dysfunction (eg Sildenafil)
Category for drug names ending with: -ane
Inhalational general anesthetic (eg Halothane)
Category for drug names ending with: -azepam
Benzodiazepine (eg Diazepam)
Category for drug names ending with: -azine
Phenothiazine (neuroleptic, antiemetic) (eg Chlorpromazine)
Category for drug names ending with: -azole
Antifungal (eg Ketoconazole)
Category for drug names ending with: -barbital
Barbiturate (eg Phenobarbital)
Category for drug names ending with: -caine
Local anesthetic (eg Lidocaine)
Category for drug names ending with: -cillin
Penicillin (eg Methicillin)
Category for drug names ending with: -cycline
Antibiotic, protein synthesis inhibitor (Tetracycline)
Category for drug names ending with: -ipramine
Tricyclic Antidepressant (eg Imipramine)
Category for drug names ending with: -navir
Protease inhibitor (eg Saquinavir)
Category for drug names ending with: -olol
beta-blocker (eg Propranolol)
Category for drug names ending with: -operidol
Butyrophone (neuroleptic) (eg Haloperidol)
Category for drug names ending with: -oxin
Cardiac glycoside (inotropic agent) (eg Digoxin)
Category for drug names ending with: -phylline
Methylxanthine (eg Theophylline)
Category for drug names ending with: -pril
ACE inhibitor (eg Captopril)
Category for drug names ending with: -terol
beta-2 agonist (eg Albuterol)
Category for drug names ending with: -tidine
H2 antagonist (eg Cimetidine)
Category for drug names ending with: -triptyline
Tricyclic antidepressant (eg Amitryptyline)
Category for drug names ending with: -tropin
Pituitary hormone (eg Somatotropin)
Category for drug names ending with: -zosin
alpha-1 antagonist (eg Prazosin)
Common ending for drug names in the following category: Erectile dysfunction
-afil (eg Slidenafil)
Common ending for drug names in the following category: Inhalational general anesthetic
-ane (eg Halothane)
Common ending for drug names in the following category: Benzodiazepine
-azepam (eg Diazepam)
Common ending for drug names in the following category: Phenothiazine (neuroleptic, antiemetic)
-azine (eg Chlorpromazine)
Common ending for drug names in the following category: Antifungal
-azole (eg Ketoconazole)
Common ending for drug names in the following category: Barbiturate
-barbital (eg Phenobarbital)
Common ending for drug names in the following category: Local anesthetic
-caine (eg Lidocaine)
Common ending for drug names in the following category: Penicillin
-cillin (eg Methicillin)
Common ending for drug names in the following category: Bacterial protein synthesis inhibitor
-cycline (eg Tetracycline)
Common ending for drug names in the following category: Tricyclic antidepressant
-ipramine (Imipramine)
-triptyline (Amitriptyline)
Common ending for drug names in the following category: Protease inhibitor
-navir (Saquinavir) (Mnemonic: Navir tease a pro)
Common ending for drug names in the following category: beta-antagonist
-olol (Propranolol)
Common ending for drug names in the following category: butyrophenone (neuroleptic)
-operidol (Haloperidol)
Common ending for drug names in the following category: Cardiac glycoside
-oxin (Digoxin)
Common ending for drug names in the following category: Methylxanthine
-phylline (eg Theophylline)
Common ending for drug names in the following category: ACE inhibitor
-pril (Captopril)
Common ending for drug names in the following category: beta-2 agonist
-terol (eg Albuterol)
Common ending for drug names in the following category: H2 antagonist
-tidine (eg Cimetidine)
Common ending for drug names in the following category: Pituitary hormone
-tropin (eg Somatotropin)
Common ending for drug names in the following category: alpha-1 antagonist
-zosin (eg Prazosin)