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Epinephrine

12

Catecholamine
EpiNEDA

Norepinephrine

BPHR

Isoproterenol
Dobutamine

Dopamine

D11 ()

Isoproterenol

12

Dobutamine

(HR)

Phenylephrine

Metaproterenol

Abuterol (Salbutamol)
Terbutaline
Fenoterol
Ritodrine

Salmeterol

Formoterol

NE

Ephedrine
Pseudo-ephedrine

Amphetamine

NEEpiDA

Methylphenidate

OTC decongestant

BP
(DA)

Narcolepsy ()
Pheynlpropanolamine

(PPA)
Cocaine

Tyramine

MAOA

MAOI Tyramine DA hydroxylase OctopamineNE HTN

Trimethaphen

Hexamethonium
CNS

Methyl tyrosine

= Metyrosine

Clonidine

2 agonist

opioid

BPHR ()

Methyldopa

Reserpine

NE5-HTDA()

Guanethidine

NE

rebound HTN

12

Phenoxybenzamine

HTN ( HF ) ()

Phentolamine

BPH

HR

Pheochromocytoma

Syncope

Sexual impairment
1 (-zosin) Tamsulosin

BPH + HTN

12

Propranolol

(-olol)

()

SVT

HTN

HR (AV block)

COPD

MI

(class II)

Timolol

(PropranololEsmolol)

HR<50

DM

MI

2-3 AV block

Atenolol

CHF ()

(-olol)

Metoprolol () CHFpost-MI

(Timolol)

() CHF

Acebutolol

ISA ( MI)

(Propranolol)

-blocker

(Propranolol)

Bisoprolol

SVT

tremor ( 2 )

Carvedilol

Esmolol

Betaxolol
(-lol)

Labetalol

Carvedilol

CHF

Metoprolol

Pilocarpine

(-chol) Bethanechol
Carbachol

()

MN ()

()
MG

Physostigmine

anti-AchE

Atropine TCA
Neostigmine

Epinephrine
1 Timolol

+ N MG

Pilocarpine

Tubocurarin ()
Pyridostigmine MG

Physostigmine

Edrophonium MG

AchE=Cholinesterase

Soman > Parathion > Malathion


Atropine( M) +
PAM (Pralidoxime AchE)

M =

Atropine

()

Physostigmine

BPH

Scopolamine

COPD

Tropicamide

COPD ()

(3)

(4) Ipratropium
(Atrovent)

+(M3)
Atropine
Tropicamide
(1)
Phenylephrine

EPS
Propantheline

( Pirenzepine )

Pirenzepine

M1

Trihexyphenidyl EPS

(Artane)

Benztropine
Biperiden
Nn = ()
Nm = ()
d-Tubocurarine ()
(d-Tc)

()

Histamine

N-R antagonist
Fade during titanic

and TOF stimulation

Neostigmine
Vecuronium

Histamine

Pancuronium

M2( Atropine)

Atracurium

ICU

Histamine

Hoffmann elimination
RBC

pH
d-Tc Denzylisoquinolines
Mivacurium

Succinylcholine
(Ach-Ach)

pseudo-AchE

Halothane N-R agonist

Dantrolene

Non-fade

( AchE )

Histamine

Dantrolene

CCB CA2+

Baclofen
Diazepam

GABAB (Gi)

GABAA (Cl-)

Mephenesin
Meprobamate

(Valium)

Botulium toxin

N-M junction Ach

Chloromezanone

Aminoglycoside Ca2+Ach Chlorzoxazone


Ex. Gentamicin


Nitrates

Amylnitrite

Nitroglycerin

NOcGMP()

CHF

(NTG)

(NO Plt )

()
3

V>A
preload > afterload

( loop diuretics )

~ dinitrate

free 8

~ mononitrate

~ tetranitrate

HRSV

ISA

-blocker
CCB

( -blocker )

Nitrite

( Methylhemoglobinemia)
SA/AV node

()

Dihydropyridine

Nifedipine

(DHP)

(Adalate) ()

(angina )

HRSV

Variant angina

Amlodipine

HR

SVT

Unstable angina

SAH

(Norvasc) ()
Nimodipine
Non-DHP

Verapamil

-HF
(Verapamil )
Diltiazem
Aspirine

ACEI

Variant angina

HR Nitrates (Ex. NTG)


-blocker (MI )
Digoxin

-SVT (class IV)

Anti-Plt

CCB (MI )

(Aspirin)
(Heparin)

NTG ()
Nifedipine ()
-blocker

ST LBBB

()

Osmotic
CAI

Mannitol

()

Urea

Acetazolamide

seizure

Thiazide

(-thiazide)

()

( Na+)
PCTNa+H+
+

Na HCO3

( HCO3-)

Ca2+

H+

DCT

Na+/Cl- symporter

( Digoxin )

Mild HF

(Niacin)

Furosemide (Lasix)
Ethacrynic acid

(+Nitrate )

Bumetanide

CHF

( Lasix )

(+)
Loop

Ascending Henle loop

Na+,K+,2Cl- pump

(Vancomycin Aminoglycoside)

(+ N/S)

(MancomycinAminoglycoside
NSAIDAmphotericin B)

K+ sparing Spironolactone

DCTCD

()

Aldosterone ( H+)

Amiloride

CHF

Triamterene

Spironolactone

Na K

V2 ()

(cf. Imipramine)

( Androgen-R )

Desmopressin (DDAVP)

V1GqCa2+()
V2GscAMP

Thiazide +

(ABCDACEI / ARB-blockerCCBDiuretics)
-blocker

renin (SVHR )

Thiazide ()Loop

Angiotensin
antagonist

RAA -blockerACEIARB

ACEI

ACE

(-pril)

Angiotensin I

(Bradykinin)

()
ARB

HFMI LV Bradykinin ()

+HTN

(-sartan)
CCB

Nifedipine

1-blocker

(-zosin)

BPH+

Hydralazine

Minoxidil

(Methyldopa)

AT1

( Bradykinin)

Lupus=like syndrome

(Procainamide)

K ()
+

Diazoxide

renin ( )

Nitroprusside NO VA

CN-

Aldosterone

Coronary steal

()

(Dipyridamole

Isoflurane)

Trimethaphan

CNS

Methyldopa

Clonidine
Ganethidine
Reserpine

CHF
ACEI / ARB

()CHF

Nitrate ( v) + Hydralazine ( a)

Loop diuretics

+ CHF

Thiazide

Mild CHF

Spironolactone

HR
Digoxin

Digitalis glycosides SVHR() CHF

AV node (PR interval)

Na+/K+ ATPase[ Na+][Ca2+]

CHF

SA/AV nodeHR

Digitoxin

()

HR(<60 )

Digoxin

GI upsetyellow vision ()

()

TI ()

1 agonist

cAMP (SVHR) ()

(DobutamineDA)
PDE3

cAMP (SVHR) ()

(Amrinone

Milrinone)

PDE3 (Cilostazol)cAMP Plt


PDE5 (Sildenafil)cGMP
PDE (Methylxanthine)

K+()

(LidocainePhenytoinProcainamide)
Quinidine
( Digoxin )

Metoprolol

Bisoprolol

renin ()

Carvedilol

ISA

1. RAA
2.
3.CHF RAAsympathetic toneANP () BNP () CNP (CNS)Endothelin

Na+()

Ia

Atropine M HRSVT SVT

VT

Quinidine

Phase 3

AP

phase 0

()

duration

(VTAFPSVT)

(Cinchonism) ()

( class III

QT

()
Procainamide Quinidine
Lidocaine

VT

VT
(SVT)

Torsade de

Lupus-like syndrome (Hydralazine)

pointes VT)

Disopyramide
Ib

IV VT ()

Digoxin

()

VT

SC
Mexiletine

Lidocaine

Tocainide

VT

Phenytoin

Ic

Flecainide

VT

VT

Propafenone Flecainide ( Ic + II)

II

SA

SVT Propranolol
Esmolol

VT>>SVT

()

AFMI
AV block

AF

()
III

K+ phase 3 () QT Torsade de pointes

SVT Amiodarone

t1/2 >50 days ()

VT

class IIIIIIIV

( thyroxine)

(Bleomycin)(Tetracycline)
(Wolff-Chaikoff effect)
Goiter (Jod-Basedow phenomenon)
Digoxin Digoxin

Bretylium
Sotalol
IV

CCBSA/AV node rate

SVT Verapamil
Diltiazem
Adenosine

AFPSVT

HRSV( CHF )

Verapamil
A1 (AV node )Gi

HR
cAMP AV
Ca2+
+
(SV
)
K

()

AFPSVTSVT ()
A2Gs

(IV)
Digoxin

SVTPSVT

GICNS

SA/AV nodeHRSV
Atropine

Sinus bradycardia

MgSO4

PR intervalAdenosine > Class IIIV


QRS durationClass III > Ia >
QT interval Class IIIIa
SVT( K+CCBAdenosineDigoxin)
VT (class IK+)


Plt
TXA2

Aspirin

MI COX
(<325mg)

ADP-R

Ticlopidin

Aspirin

Clopidogrel

(NSAID )
neutropenia (Clozapine)

Gp Ilb/IIIa-R Abciximab

Tirofiban
PDE

Dipyridamole

adenosine uptake Coronary steal

Cilostazol

Intermittent claudication

(50-100mg

(PAOD)

(NitroprussideIsoflurane)

PDE3

bid)

Heparin (LMWH)

Coumarin ()

glycosaminoglycan

(WarfarinDicumarol)

antithrombine IIIThrombin (IIa)

Vit. K

( IIaXa)

Vit. K eposide reductase (KO )

(LMWH Xa)

Protein CProtein S
( Heparin Coumarin )

(1-3 hrs) (LMWH ) (12-24 hrs) ( 1.5 days)

(LMWH )

HeparinDVT

Thrombocytopenia

Protamine ()

FFP

Clotting timeaPTT (1.5-2.5)

Vit. K1 (Phytonadione)
PTINR (2-3)

(LMWH aPTT )

ClofibrateMetronidazoleDisulfiram p450

Warfarin
=(Fribrinolysic agents)
Urokinase

plasminogen plasmin

Streptokinase

Alteplase (tPA)

DNA

fibrin

AMI 6

fibrin

Plasminogen ()

Aminocaproic acid

plasminogen

Tranexamic acid

Aspirin Aspirin

Vit. K

(Phytonadine)

(Coumarin)
Vit. K


Statins

HMG-CoA reductase ()

LDL-R (LDL )

( Fibrates )

Pra-

Atro-
Resins

(Vit. ADEKWarfarin )

Cholestyramin

LDL-R

Cholestiple
Fibrates

TG

PPAR- LPL (VLDL ) ()

Gemfibrozil

HDL

StatinsWarfarin

TG (VLDL)LDLHDL

PPAR-(-glitazone)

TG

VLDL

HDL

(FFA)

Lp(a)

TG (VLDL)LDLHDLLp(a)

ThiazideNiacin

HDL

LDL foam cell

HDL

LDL

QT interval

LDL

Niacin (B5)

Probucol
()
Fish oil

TG LipoproteinHDL

Orlistate ()

lipase

Sibutramine ()

5-HTNEDA ( TCASSRI)

() Dexfenfuramine () 5-HT agonist

()

(Serotonin )
PPA ()

Phentermine ()


-maintain
Nitrous oxide
(N2O)

close gas space

/Des>Sevo>Iso>En>Halo

Halothane

Vit. B12

Second gas effect


Halothane

MAC >100 6.0

MAC potency

( catecholamine )
()

Blood/Gas partition coefficient (=1-FA/FI)


=
=

-
Methoxyfluran

2.0 1.4 1.7 0.75

B/G 0.47 0.45 0.69 1.4 1.8 2.3


N2O

N2O Des Sevo Iso En Halo Methoxy

Halo>En>IsoDes
F

IsoDes>En>Halo

(dose-dependent)
Enflurane

Isoflurane

EEG epileptiform activity

Des>Iso>En>HaloSevo

(PaCO2 60)

Halo>En>IsoDesSevo

Coronary steal

(NitroprussideDipyridamole)
Desflurane
Sevoflurane

Halo>En>IsoDesSevo

Halothane

CO2 (lime soda)

compound A ()

-induction + maintain

Barbiturates IV
Thiopental

Methohexital

(2nd peak)

(BPCOHR)

ICUPropofolBDZ

Acute intermittent porphyria

Propofol

()+Xylocaine

()BDZOpioid

BDZ

opioid

pH

C/S BDZ

BDZ

IM BDZ

TCA

Opioid

the inhibitory tone of GABA

Atropine

GABA synapse activity

BDZ
Midazolam

Diazepam

Droperidol ( D2)

Lorazepam
Propofol

()

Ketamine
IM

opioidlidocaine
6hrs

glutamate NMDA-R

BPHRIOPICP

Opioid
Fentanyl

Droperidol (Haloperidol )( Innovar)


(Ester) pseudocholinesterase (cf. Succinylcholine)
Cocaine

CNS

Na+ channel

()
Epi

(h-Gate of inactived site)

Procaine

IV

PABA ()

Tetracaine

Bezocaine

(Amide) dealkylation (Phase II)


Lidocaine
Prilocaine

CB>A (>>.)

IV VT (class Ib)

pKa

CV collapse

(Epi)

( NaHCO3)

EMLA cream+Lidocaine

Bupivacaine

Cocaine

()

epidural pain
Etidocaine
Ropivacaine

CNS ( CNS Barbiturates BDZ )

Ethanol Alc dehydrogenase Acetaldehyde


Methanol MEOS ()

Aldehyde

Acetate

Formaldehyde dehydrogenase Formate

Disulfiram

ALDHAcetaldehyde()

BDZ (+Thiamine) ( CNS )


visual disturbance
Fomepizole

Alcohol dehydrogenase

Ethanol

()
IV Ethanol ( 100mg/dl)

Hemodialysis

( Ethanol Ethanol )

Folic acid

Formate CO2+H2O

(Ethylene glycol)EthanolFomepizole

Strychnine ()

Glycine-R antagonist

(tonic convulsion)

Glutamate NMDA-R

GABA

Doxapram

()

Picrotoxin ()

GABAA antagonist()

Non-NMDA-R
DA

A.Methylxanthine
Caffeine

CNS

Theophylline ()

PDEcAMP
Aednosine 1-R ()
CNS

>>

CV>>

()

Aminophylline

AdenosineA1GicAMP

=+Ethylenediamine ()
Theobromine (
)
B.Nicotine

relax

Arousal
CV ()
Bupropion
C.

Cl- (GABAA)

()
Amphetamine (Methylphenidate)CocaineEphedrine

10

Opioid

Gi

Glycine

Cl-

Ach
NE
Serotonin


Barbiturates
ThiopentalHexobarbital

GABA GABAA-R

Secobarbital ()Pentobarbital

Amobarbital ()

Phenobarbital

( Cl-)

TI ()

p450

febrile seizure

Porphyrin ()

BDZ

Triazolam (UK )

GABA GABAA-R ( Cl-)

TI

Oxazepam

Alprazolam (Xanax)

()

Flunitrazepam

(FM2)

( Triazolam Temazepam Flurazepam)

Lorazepam (Activan)

(Clonazepam)

Diazepam

(Diazepam)

(>100 )

(Dia-Oxa-Chlordiazepoxide)

()

Flumazenil (BDZ )

OxazepamLorazepamMidazolam

Clonazepam
BDZ
Zaleplon

GABA (Gamma-aminobutyric acid)R


GABAA Cl- (21222)

Zolpidem (Stilnox)

Zolpiclone (Imovane)

(3-4 hrs)

CNS 1 (BDZ )2 ()

Picrotoxin (GABA )Bicuculline ( Cl-)


BarbiturateBDZBDZ(alcoholPropofol)
GABAB Gi protein Ca2+ K+
Baclofen ()

5-HT1A-R
Buspirone

(onset 1-2 wks)

(Diphenhydramine) Ethanol (Baclofen) Chloral hydrate ()

DA5-HT2A
Typical
Chlopromazine
(Wintermine)

D2-R ( M

()

Thioridazine

EPS M ()

Fluphenazine

(High potency)high efficancy

EPS Prolactin

Haloperidol

H11[]5-HT[])
Antipsychosis ()

Prochlorperazine (Novamin)
Metoclopramide (Primperan)
Toarettes syndrome
D2 EPS

Toarettes syndrome

M (Atropine )
Atypical ()
Clozapine

5-HT2D4 (D1D2 )

()

resistant pt EPS
()

Olanzapine

2% neutropenia
(Ticlopidine)

5-HT2-R D1D2D4

()

5-HT2D2 (D1 )

model

Quetiapine

PCP (Phencyclidine)

Risperidone

5-HT2 (high)D2

(>6mg)

EPS

Ziprasidone

5-HT2D2( 5-HT1AD3)

11

- NMDA

NE5-HT1A

TCA

Imipramine

(cf. DDAVP)

NE5-HT H11M

Amitriptyline

( H1 )

CV M H1 () 1 ()

TCA (DM TCACarbamazepine)


TCA Physostigmine

MAOI

Tranylcypromine ()

MAOINE5-HTDA

Phenelzine

MAOI Tyramine (cheese)SSRIL-dopaTCA

Moclobemide

( 6 )

RIMAs

MAO-B DA

(MAOIA)
SSRIs

MAO-A NE5-HT ()()

Fluoxetine

(Prozac)
Citalopram

5-HT
MAOI serotonergic syndrome

ParoxetineSertraline

p450

Citalopram
SNRIs

()

()

Venlafaxine

SSRI

Trazodone

TCA M

Nefazodone

NaSSA Mirtazapine

5-HTNE ( TCA)
SNRI 5-HT2A
2 autoreceptor NE5-HT
5-HT2A5-HT3H1

NARI

Reboxetine

Bupropion

NE

Lithium

PIP2

Na+

GI ()

Valproic acid

(Deparkin)

()

Carbamazepine
ClozapineOlanzapineRisperidone
SSRIBDZ(LamotrigineGabapentinTopiramate)

12

model Pentylenetetrazol

Carbamazepine Na+Glutamate

Stevens-Johnson syndrome (PhenytoinAllopurinol)

()

CNS depression
C/D

Phenytoin

Na+

()

p450 Vit. DVit.K

(class Ib)

D
(ex.D5W)

Phenobarbital

GABA GABAA-R

()

seizure

Primidone

Phenobarbital

Ethosuximide

T-type Ca2+ influx ()

CNS

Valproic acid

CNS

CNS

DiazepamLorazepamMidazolam (IV)GABAA

Clonazepam

Carbamazepine

bipolar disorder

Phenytoin

Acetazolamide seizure

Lamotrigine

Felbamate

NMDA-R

EthosuximideValproic acid

Topiramate

AMPA-R

GABA BarbiturateBDZ

Lamotrigine

Na+ channel blocker like Phenytoin

Vigabatrin

GABA-transaminase

Gabapentin

GABA analog

Tiagabine

VigabatrinGabapenitn
Tiagabine
NMDA Felbamate

()

Topiramate

GABA

Lamotrigine

Parkinsons Dz DAAch
DA
Levodopa

DA

Dopa decarboxylation DA

decarboxylase

(Domperidone- D2 )

(CarbidopaBenserazide)
L-dopa

5
ON-OFF (Apomorphine )()

()

Vit.B6
( L-dopa decarboxylation)
(cf. INH Vit. B6 )
DA

Amantadine

DA-R

Influenza A

Parkinsonism

MPTP ( MAO-B MPP+


dopaminergic neuron )- model

Bromocriptine (D2)
Pergolide

Reserpine

(D2D1)

CO
6-hydroxydopamine

Pramipexole
(-ole)

Ropinirole

MAO-B

Selegiline

Deprenyl

COMT

(-capone)

TolcaponeEntacapone

Ach
Trihexyphenidyl (Artane)BenztropineBiperidenresting tremor
Diphenhydramine H1 ( M)

13

Endorphins () Enkephalins Dynorphins


()
Morphine

Morphine

() receptorGiCa2+ K+

()

4-5 hrs ()()

(+Nitrate)

AMI
Codeine
Papaverine

=Methylmorphine

()

cGMP

(-)(2-)
( )( CTZ D2-R)
(2-) Oddi BP
histamine

()
Noscapine

( IICP)BPH

Naloxone ()Natrexone ()

Heroin

Apomorphine

Parkinsonism OFF
( CTZ D2-R)

Methadone ()
Opioids
(antagonist actions)

Meperidine (Demerol)

=Pethidine (IM)

(2-4hrs)

Norpethidine()

Methadone

Morphine

()
Morphine
Dextromethophan (Medicon)

()

Loperamide (Imodium)

mesenteric plexus -R ()Ach

Fentanyl

IV (Durogesic)

Sulfentanil

(>Fentanyl)

-
Buprenorphine

agonist + partial agonist


Dynorphin Morphine ( Fentanyl )(6-8hrs)

Methadone Morphine

Pentazocine
Nalbuphine

agonist + partial agonist


Narcotic

14

(Autacoids)
Amine

Polypeptide

Lipid

Serotonin (5-HT)

Angiotensin

Prostaglandin (PG)

Histamine (

Bradykinin ( ACEI)

Leukotriene (LT)

Substance P

Thromboxane (TXA)

)
Platelet activating factor (PAF)

Agents

Curare alkaloid ()OpiatesAtropineHydralazineDextran

Chemical HistamineSRS-A (LTC4LTD4LTE4)PGTXA2AchBradykinin

()

Diphenhydramine (Vena)

Brompheniamine

OTC

H1

Chlorpheniamine

OTC

(Gq

Promethazine

Cyproheptadine
Phenindamine

+ 5-HT

H2

(Gs)

MeclizineCycli-Bucli-

HRSV

()()

H1 M15-HTNa+
()

Cetirizine (Zyrtec)

QD

Loratadine (Claritin)

QD

()

Fexofenadine (Allergra)

BID

GI ()BPH

Terfenadine

p450 (CYP3A4)

Astemizole

QT prolong

Ach Parkinsonism EPS

Cisapride

H. pylori

Mg(OH)2

Al(OH)3
CaCO3

NaHCO3

PPI > H2 >M1M3


H2

Cimetidine

p450

(Tagamate)

Ranitidine (Zantac)
Fametidine
M1M3

Nizatidine

Propantheline

Pirenzepine

Pirenzepine M (M1)

Gastrin-R Proglumide

PPI

Omeprazole (Losec)

H+/K+ ATPase

Lansoprazole

Misoprostol

PGE1

NSAID-induced ulcer

Sucralfate

pH<4 ( 1hrs )

ICU stress ulcer

Bismuth

Amoxicillin

Metronidazole

PPI

Clarithromycin

Tetracycline

Three-drug regimens

15


Phospholipase A2 Corticosteroid

>

Cyclooxygenase

NSAID

>

COX-2

Celecoxib (Celebrex) >


Rofecoxib (Vioxx)

Lipooxygenase

Zileuton

Leucotriene

Zafirlukast

Lipocortin

Montelukast

NSAIDAcetaminophen NSAID
NSAID COX
Lipooxygenase LTC4
Renal insufficiency(SulindacNabumetone )
Na+ retention

Aspirin

=Acetylsalicylic acid

( Acetylation

() PGE2

Reye syndrome (Influenza virusChickenpox )

COX

( bradykinin)

Plt )

()

Plt ()

AMI (Salisulism)()
5-7
Salsalate
Propionate

Naproxen

()

Ibuprofen

(OTC )
NSAID

Acetate

Indomethacin

Ketorolac

IV NSAID

DiclofenacEtidolacNabumetone
Fenamate

Mefenamic acid

Oxicam

Piroxicam

(20 hrs)

NSAID
COX-2

Celecoxib
Rofecoxib

(Vioxx)

NSAID
COX-3 Acetaminophen

(PanadolScanol)

Acetylcystein ( GSH) (8 hrs )


phase II

Prostaglandins
PGE1 Alprostadil
Misoprostol

PGE2PGI2

Mifepristone (RU-486)

GFR
Fetal ductus arteriosus

PGE2 Dinoprostone Ripening of the cervix


PGF2 Carboprost
Latanoprost
PGI2

NSAID-induced ulcer

()

PGE2PGF2

PG

TXA2PGF2
TXA2

Etoprostenol

Treprostinil

Colchicine /

Neutrophils tubilin microtubule

()

()

IndomethacinKetorolac

Aspirin

agranulocytosis
NSAID

Allopurinol Azathioprine6-Mercaptopurine (6MP)

Xanthine oxidase (XO)

XO 1/4 Steven-Johnson syndrome (CarbamazepinePhenytoin)


Probenecid
(PenicillinSulfonamides)

()

16

RA
NSAID

DMARDs

DMARDs

Hydroxychloroquine lysosome GI
()
Gold

lysosome

GI (Dimercaprol )

Gold Na thiomalate (IM)


Auranofin (PO)
Sulfasalazine

( IBD)

GI leukopenia ()

D-Penicillamine

()

GI thrombocytopenia ()

Methotrexate

DMARDs
BM ulceration

Azathioprine6-Mercaptopurine

Lymphocytes

Cyclosporin ( BM )

IL-2 ( T )
HTNp450

Anticytokine Etancercept

TNF-

Infliximab

Serotonin (5-HT5-Hydroxytryptemine)
5-HT1A GicAMP

Raphe nuclei

Buspirone

5-HT1A

()
Premenstrual syndrome

5-HT1D GicAMP
Sumatriptan
5-HT2 GqIP3

5-HT1D

Plt
Plt ()

Ketanserin

5-HT1C5-HT21

Ritanserin

5-HT2

Thromboxane

Clozapine

5-HT2D2

5-HT2

Risperidone
Trazodone

5-HT3 Na K GICNS
+

Chemo receptor reflex (Bezold-Jarish reflex)

(-setron)
5-HT4 GscAMP

5-HT3

CNS

Ach motility-enhancing

myenteric neuron

protein kinetic effect


Carcinoid tumor 5-HT

Cisapride

5-HT4

Metoclopramide

5-HT4

(Primperan)

D2-R

GERDgastroparesis

Cisapride

Methysergide

5-HT21

Ergotamine

( Caffeine )

5-HT12

Ergonovine

()(+Transamine)

Bromocriptine

Hyperprolactinemia

DA-R

Parkinsons Dz
Lysergide(LSD) ()

17


Insulin

Insulin Lispro

Insulin Aspart

()

Regular insulin (RI)

IV

NPH

(+Protamine)

Lente

(+)

Ultralente

(+)

Insulin glargine

peak

Insulin

RI (30%)+NPH (70%)

insulin

Sulphonylurea

Tolbutamide ()

ATP-dependent

Acetohexamide ()

()

Ca2+insulin

Chlorpropamide ()
Meglitinides
insulin Thiazolidine

diones (TZD)

K+ channel ()

(Gli- / Gly-)

Repaglinide

Sulfonylurea Insulin

(Novonorn) ()

GlibencliamideGlipizideGliclazideGlimeperide

Troglitazone

()

PPARGLUT-4

Rosiglitazone (Avandia)

Pioglitazone

()

( insulin )
Fibrates (PPAR)

Biguanides

Metformin (Glucophage)

or

()

PCOS

()

insulin
GI distress

-glucosidase
inhibitors

Acarbose (Glucobay)

or

-glucosidase

Miglitol

GI effect
( -glucosidase)

18


()
Sulfonamide PABA FH2

G(+)G(-) ()

Dihydropteroate synthetase

Cotrimoxazole (Baktar)

TMP )

(PABAp-aminobenzoic acid)

AOM

=Sulfamethoxazole (SMX) 400mg + (TMP 80mg)

ShigellaSalmonella

(+)

(Sulfacetamide)

Acetylation

IBD (Sulfasalazine=+Aspirin)

()

Procaine PABA

Trimethoprim FH2 FH4


(TMP)

(Silver Sulfadiazine)

G6PD (Chloromycin)

Dihydrofolate reductase

Thrombocytopenia

(MTX )

-lactam

Penicillin

lactamase
S. aureus

Penicillin G

-lactam

Benzathine ~

IM

Acyl-D-alanyl-D-alanine

Penicillin V

()

PBPs (Penicillin-binding protein)

Methicillin

PRSP

Nafcillin

MRSA() transpeptidase
peptidoglycan
Naf-()

(Penicillinase-

Oxacillin (ORSA) +()

N. gonorrhea

resistant

Cloxacillin

P. aeruginosa

penicillins)

Dicloxacillin

()

Ampicillin

+Sulbactam =Unasyn ()

()

Amoxicillin

Ampicillin q68h
+Clavulanate =Augmentin

G(+)(-)

Carbenicillin

()

Ticarcillin

+Clavulanate =Timentin

Piperacillin

+Tazobactam =Tazocin

sporin

BBB Cefadroxil

Cephalexin

GPC
PneumococcusMeningococcus
Treponema pallidumSpirochetes

G(+)>G(-) Aminopenicillin

Cephalo-

(Skin test Epi)

(+Probenecid )()
(+BenzathineProcaine )
Penicillin Erythromycin
LincomycinClindamycin

q6h G(+)()

q12h G(-)()

Penicillin

Cefazoline

q8h Cefazoline

G(+)G(-)

Cephradine

q6h

Penicillin

Cefuroxime

-lactamase

G(+) G(-)

BBB Cefamandol
Cefoxitin

Cefmetazole

Cefoperazone (CPZ) q8-12h

CPZ

Ceftazidime (Fortum)

BBB Cefotaxime
Ceftriaxone

GNBGPC

CPZ
GNBGPC

qd

Ceftriazone

Penicillin 10%
Cephalosporins

Ceftizoxime

Cefapime (=+) -lactamase Cover G(+)

Carbapenem Imipenem

(G(+)(-))+Cilastatin (=Tienam)

Etrapenem

AB

Meropenem ()

Imipenem G(-)

Aztreonam

-lactam only G(-)

=Teicoplanin ()

Vancomycin

Bacitracin

ORSA (MRSA)

Cycloserine

TB ()

-lactam G(+)

Fosfomycin

UTI ()

Echinocandins

Vancomycin (500mg/vial)

Caspofungin

(1,3)--D-glucan synthase
Mucomycosis

Metronidazole

TDM

Cryptococcus

19

glycopeptide
G(+)
G(-)

Red man syndrome


Aminoglycoside


Tetracyclines
( BBB)

Tetracycline

Minocycline bid

G(+)(-)

()

Doxycycline bid qd Acne

Aminoglycosides Streptomycin
()

( GNB)
G(+)
S. aureus
Coagulase(-) Sta.
Strep. viridans
Enterococci
(PCN )

Gentamicin

( tRNA binding)

(<8y/o )

(Amiodarone)

Superinfection

BUN
G(-)

30S

TB

Penicillin

30S

()>

-lactam

pH

Tobramycin

(Incorrect reading of mRNA)

Kanamycin

Amikacin

( UTI )

(Amikin)

TB

(FurosemideAmphotericin B)

Gentamicin

ICU

()

Neomycin

Cr TDM

weaning

Erythromycins

Erythromycin

Most cost-effect

G(+) Clarithromycin

H. pylori

LegionellaMycoplasma

GNB

Compliance

Penicillin

(Azithromycin )

p450TerfenadineAstemizole

-lactam

(qd)

Cisapride QT

>

Azithromycin

/)

(Macrolide)
50S
( translocation)
(GI )

Digoxin

Chloramphenicol

G(+)(-)

Gray baby syndrome

50S

S. aureus

Blood dyscrasia

( transpeptidation)

H. influenzaS. pneumonia

G6PD

Neisseria meningitides
<8y/o Tetracycline
Lincosamide

Lincomycin

BBB

Clindamycin

Erythro-

G(+) Erythromycin

Penicillin

20

Thrombocytopenia
Leukopenia
Granulocytopenia


Quinolones Nalidixic acid

()

Fluoroquinolones

100mg/#

Norfloxacin

qd( UTI)

400mg

Lomefloxacin

Acquire

q12h

resistance

Ciprofloxacin

easily

Levofloxacin
Moxifloxacin

Rifampin

G(-)

G(+)(-)

DNA gyrase
Topoisomerase II IV

(
Nitrofurantoin-)
G(-)

DNA

GNB Aminoglycosides +

G(+)

Ofloxacin

()

G(+)(-)

<18y/o

Trovafloxacin

Moxifloxacin

Gatifloxacin

UTI GU

()

GI (Sucralfate
)

TB
Isoniazid (INH)

Mycolic acid

TB

(Vit.B6 )

(N-

Rifinah (RFN)

acetyltransferase)
Rifampin (RIF)

DNA-dependent RNA

Ethambutal (EMB)

TB

p450

polymerase

Pyrazinamide (PZA)

pH<5

Streptomycin

Rifater (+INHRIF)

>

LevofloxacinAmikacinPara-aminosalicylate (PAS)Cycloserine
Griseofulvin

microtubles mitosis

()

()

Flucytosin

5-FU DNA ( Amphotericin B )


()

()

Polyene

Amphotericin B

macrolides

(ex.)
()
fever and chills

Lanosterol

Imidazole ()

Ergosterol

P450

Nystatin

(--) ()

Natamycin

Ketoconzole

()()
()

steroid

Cushings syndrome

( Lanosterol

Miconazole

Clotrinazole

Isoconazole
Triazole ()

Fluconazole (Difucan)

CSF
Itraconazole

Amphotericin B
Ketoconazole

Voriconazole

Lanosterol 1,4--demethylase (Triazole )


24-methylene dihydrolanosterol demethylase ()
( Mucomycosis )

Squalene

Alkylamines

Terbinafin ()

epoxidase

(OTC)

2wks

-lactamVancomycinAminoglycosides
AminoglycosidesQuinolonesMetronidazole ( qd )
PAE (Postantibiotic effect)-lactam G(+) PAE G(-) PAE

21


(Anthelmintic)(Mematodes)(Trematodes)(Cestodes)
Mebendazole

Microtubules

()

Pyrantel Pamoate

(Antiprotozoal)
Metronidazole (Flagyl) tid

() (ClindamycinLincomycin)

Emetine

()

Chloroquine

RBC

Primaquine

RBC ()

Quinine =Cinchonism + Pyrimethamine + Sulfadiazine ()

5
Parkinsonism

Amantadine

A ( uncoating)
Rimatadine

Acyclovir

()
Ganciclovir

CMV

Famciclovir
INF- C ()

Ribavirin

Lamivudine
Interferon-

HCV
Multiple sclerosis

Enfurotide T-

(Immunomodulatory)
HIV fusion

20

Bone Marrow Growth Factors


GM-CSF Sargramostim
G-CSF

Filgrastim
Lenograstim

Clonidine

Opioid

Physostigmine

Atropine TCA

Neostigmine

Tubocurarin

Atropine + PAM

Nitrite

CN-

Sodium thiosulfate
Lidocaine Digoxin ( Quinidine)
Flumazenil

BDZ

Naloxone

Morphine

Acetylcystein

Acetaminophen

Deferoxamine

Dimercaprol (BAL)

EDTA

Penicillamine

22


(Antimetabolites) (CCSS ) (BM )
Methotrexate (MTX) (M)

Dihydrofolate reductase (DHFR)

Immunosuppression

Leucovorin(

FH2 FH4

N5, N10- Methylene-FH4 Thymidine

Leukemias
non-Hodgkins Dz

MTX DHFR)

(Trimethoprim )

Folate ()
6-Mercaptopurine (6-MP) ALL ()

Allopurinol XO 6-MP

Fluorouracil (5-FU) (F)

Leucovorin
( covalent ternary
complex of TS and 5F-dUMP)

hand and foot syndrome

dUMP dTMP
prodrug(5F-dUMP)

Dihydrouracil
dehydrogenase

Thymidylate synthase (TS)

Tegafur

5-FU

Uracil+Tegafur

(UFUR)

Capecitabine

Cytarabine (ara-C)

AML

Cytosine tumor cell kinases

Gemcitabine (Gemzar)

NSCLC

Cytidine DNARNA

(Difluoro-deoxycytidine)

5-FU prodrug

()

Alkylating agents (CCNS) DNA G DNA G1S


BM
Nitrogen Mechlorethamine

Hodgkins Dz

mustard

prodrug p450

Cyclophosphamide (C)

()

( acrolein (Mensa

non-Hodgkins lymphoma
Ifosfamide

Chlorambucil

Melphalan
Busulfan

WBC

Thiotepa
Nitroso-

Carmustine

ureas

Lomustine

Platium
()

BM

CNS

Cisplatin (P)

Cisplatin

(Amifostine

( D5W )

Phenytoin )

Carboplatin

cytotoxic free radicals all stages

(5-FUOxaliplatinIrinotecan)

BM

(Cisplatin + Paclitaxel)

Oxaliplatin

Oxaliplatin 5-FU

( N/S )

(Paclitaxel)

Procarbazine (P)

Hodgkins lymphoma

Disulfirum like

Dacarbazine

()

Procarbazine MAOI

(CCNS)() DNA DNA RNA Natural product


Anthra-

Doxorubicin (A H)

cycline

(Adriamycin)

<550mg/m2)BM Intercalate DNA

Daunorubicin (D)

Leukemias

( Idarubicin (I) AML)

()

((E))

Topoisomerases II (Podophyllotoxins)
BM

free radical

Actinomycin D (Dactinomycin)

Wilms tumor

Bleomycin (B) (CCSG2 )

SCC ()

(Amiodarone)

DNA DNA-dependent RNA polymerase


glycopeptide free radical DNA

Mitomycin

Alkylating agent

Plant alkaloids (CCS CCNS)Natural product (+L-Asparaginase)

Vincristine (Oncovin) (O)

tubules

(M )

(VWCD)

(DTR)

( mitotic spindle)

BM

(cf. Clochicine)

Vinblastine (V)

BM

Vinorelbine

NSCLC

Paclitaxel ( D5W )

NSCLC

(Oxaliplatin)

Paclitaxel Cisplatin

(M )

Docetaxel

NSCLC

Tubulin

Podophy- Etoposide (VP-16)

Late S early G2

llotoxins

Teniposide

Topoisomerase II DNA

Topotecan

Topoisomerase I DNA

NSCLC

(Campto- Irinotecan ( prodrug)

thecins)

( 5-FU )

(Cholinergic diarrhea)

23


L-Asparaginase

Asparagine ()

ALL

( Natural product)

IFN-

CMLMMHairy cell leukemialow grade non-Hodgkins lymphoma


RCC ( -2A type)

Tretinoin

Acute promyelocytic leukemia

Arsenic trioxide (As2O3)

Acute promyelocytic leukemia

Retinoic acid

Thioamid Propylthioruacil
e

(PTU)

I-I0 (Peroxidase)I0MIT/DIT ()

T4T3()()

Methimazole

PTU

(MMZ)

Agranulocytosis( Thioamide )

Carbimazole

Methimazole

()

(CMZ)

GI

Lugols solution

Iodide

SSKI

Proteolysis T3T4

I131

(I125 )

Propranolol

10-40mgqid ( HR<100)

T4T3()
-receptor

Hydrocortisone

T4T3()

PTU (200-300mgq6h) Methimazole ( T4T3)


PTU 2hrs Iodide ( T4T3 )
Propranolol (40mgq6hpo)
Hydrocortisoneantipyretics
I131

Tyroxine

()

Levothyroxin T4 ( T3) ()
e

Liothyronine

T3

()IV coma

(G) Mineralcoticoids Desoxycorticosterone


(Aldosteron)

Fludrocortisone

(F) Glucocorticoids
(Cortisol
Cortison)

(Addisons Dz )

(>2wks )

Hydrocortisone

20

Predinisone

0.8

Prednisolone

0.8

( Vit. D)

Methylprednisolone

0.5

Mental dysfunction

Triamcinolone

Dexamethasone

25

0.75

Betamethasone

25

0.75

ACTH ( 6-12 )
Prednisolone /

(Becolmethasone)
(BudesonideFluticasone)

(R) Sex hormone


(Androgen)

24

Corticosteroid antagonist
Receptor

Spironolactone

antagonist

Aldosterone-R

Androgen

Mifepristone (RU486) Progestin-R


Synthesis inhibitors Aminoglutethimide

Cushings syndrome

Glucocorticoid-R

Misoprostol

Pregnelolone

Cushings syndrome

Tamoxifen
Trilostane

3--dehydroxylation

Cushings syndrome

Ketoconazole

17--hydroxylationp450c17

Cushings syndrome

(Cortisol Sex hormone)


Metyrapone

11--hydroxylation

(Aldosterone Cortisol Androgen)

/
Androgen
Androgen

Testosterone propionate
Danazol

Endometriosis

Flutamide

Flutamide

GnRHa (GoserlinLeuprolide)
Finasteride (Proscar)
Estrogens

Estradiol

5-reductase DHT

BPH(Minosidil )

()

Estrone

(factor VII~Xplasminogen

Estriol

Antithrombin III)

Conjugated estrogens

HRT

() (Premarin)
Ethylestradiol

HRT

Ethinylsetradiol
Diethylstilbestrol (DES)
Estrogens

Clomiphene

Estrogen-R

Tamoxifen
Toremifene

()

SERM
Estrogen

Tamoxifen

Raloxifen

Progestins

()

1st
2

nd

Progesterone
Medroxyprogesterone (Provera)

HRT Progestin

Dydrogesterone
Norethisterone acetate
Levonorgestrel ()
Progestins

72hrs 1#12hrs 1#

Estrogen

Tamoxifen ER (+)

Mifepristone (RU486)

Aromatase Aminoglutethimide
Anastrozole

Letrozole
Exemestane

Estrogen + Progesterone

Estrogen ( 14-16 )

Progesterone( 5-6 )
Progestins ()
Depot Medroxyprogesterone

Northisterone
12wks

Levonorgestrel

25

( DEXA (Dual-Energy X-ray Absorptiometry)(BMD)BMD<2.5 SD T-score<-2.5)


Raloxifen (SERM)

+++

HRT SERM

Salmon calcitonin

()

()

Pagets Dz

PTH

()

Estrogen (HRT)

Bisphosphonates

+++ ++

( hydroxyapatite OC )
Etidronate

(Potency) OC ( Osteomalacia)
1

Pagets Dzheterotopic ossification

10

Pamidronate

100

()

Alendronate

1000

5-10mg/d35mg/wk

(<5%)

Clodronate

10mg/d70mg/wk
Risedronate

5000

GI

PTH (Teriparatide)

+++ ++ ( OB )

(IM)

Calcium ()+Vit. D

Dimenhydrinate (OTC )

Diphenhydramine
Promethazine
Meclizine
Cyclizine

Scopolamine ()

D2

Prochlorperazine (Novamine)

Medication-toxin-metabolic-induced emesis

Metoclopramide (Primperan)

Primperan 5-HT4

Droperidol
5-HT3
TCA

(-setron)

Amitriptyline

Functional nausea

Nortriptyline
BDZ

Lorazepam

Anticipatory nausea and vomiting with C/T

Alprazolam
Glucocorticoids

Methylprednisolone (Solu-Medrol)
Dexamethaxone

X Cannabinoids (

Tetrahydrocannabinol

(Prokinetic)
5-HT4

Cisapride

(Gastroparesis)GERD

5-HT4 +D2-R Metoclopramide

functional dyspepsia

EPS

D2-R

Domperidone

functional dyspepsia

Motilin agonist

Erythromycin

Somatostatin analogue

Octretide

Intestinal pseudoobstruction

Bethanechol

Myenteric plexusAch

Simethicone

Parkinsonism L-dopa

(Gascon)

26


Loperamide (Imodium)

Myenteric plexus -R (GiK+) Ach


BBb

2-4mg (Max8mg)
Kaolin ()Pectin ()Charcoal ()

Kaopectin=Kaolin + Pectin
Fiber

()
Stimulants

Castor oil

( Ricinolic acid) 15ml

Bisacodyl (Ducolax)

Anthraquinone
Bulk (

Cascara ()Senna ()Aloes ()

Methyl celluloseagar

)
Osmotic

MgSO4MgOLactuloseSorbitol H2O retension

ParaffinGlycerol

//

KI ()

Guaifenesin (Glyceryl guaiacolate)


Acetylcystein

Acetaminophen

Bromhexine

Codeine

(15-30mgq4-6h)

() Dextromethophan (Medicon)

Benzonatate (Bensau)

(10-20gmq4-6h)
/(100mgtid)

Salmeterol ()

2-R ACcAMP

Formoterol ()
Methylxanthine Theophylline

PDE Adenosine-1 receptor

Aminophylline

()

Ipratropium (Atrovent)

2 2

Corticosteroids Prednisolone
()

Methylprednisolone
Beclomethasone ()
Budisonide ()

()

Fluticasone ()
Leudotriene Zileuton (qid)

5-Lipoxygenase

Zafirlukast (bid)

Leukotriene-R antagonist

Montelukast (qd)

Mast cell Cromolyn

Ca2+ pul. Mast celldegranulation


()/

Nedocromil

COPD ()
()

2 ()

Glucocorticoid

()

()

MethylxanthineTheophylline

Leukotriene

COPD

50%

27