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Names
Hypothalamic-Anterior
Pituitary Axis
contraception, precocious
long acting GnRH analogs puberty, breast Ca, prostate
leuprolide (essentially antagonists) Ca, endometriosis
contraception, precocious
long acting GnRH analogs puberty, breast Ca, prostate
goserelin (essentially antagonists) Ca, endometriosis
contraception, precocious
long acting GnRH analogs puberty, breast Ca, prostate
nafarelin (essentially antagonists) Ca, endometriosis
diabetic ketoacidosis,
acromegaly, gastinoma,
severe hypoglycemia
long acting somatostatin (insulinoma, B-cell
octreotide analog hyperplasia), VIPoma once/month injections
GH receptor antagonist -
pegvisomant prevents dimerization acromegaly, gigantism
Posterior Pituitary Dz
DDAVP Desmopressin AVP analog central diabetes insipidus long 1/2 life
?
cosyntropin synthetic ACTH ACTH stimulation test
cortrosyn synthetic ACTH ACTH stimulation test
dexamethsone dx of Cushings
adrenal insuff - replaces
fludrocortisone aldosterone
prednisone immune suppression
aminoglutethemide
ketoconazole
Synthroid, hypothyroidism, myxedema
levo-thyroxine (L-T4) Levoxyl synthetic T4 coma
cytomel synthetic T3
require several wks before
methimazole Tapazole block production of T3/4 hyperthyroidism effect
require several wks before
propylthiouracil block production of T3/4 hyperthyroidism effect
Osteoporosis
selective estrogen receptor
raloxifene evista modifier osteoperosis
pyrophosphate analog, bind
hydroxyapatite, inhib
bisphosphonates osteoclasts long skeletal retention
alendronate Fosamax
risedronate Actinel
ibandronate Boniva
calcitonin inhaled
PTH analog, incr
osteoblasts and bone
teriparatide formation intermittent
Hydrocortisone (cortisol) 1 30 mg 1
Prednisone 4 7.5 mg 0.8
Prednisolone 4 7.5 mg 0.8
6a-Methylprednisolone 5 6 mg 0.5
9a-Fluorocortisol 10 0.1 mg 125
(fludrocortisone) (as mineralocorticoid)
11-Desoxycorticosterone 0 NA 20
Cortisone 0.8 37.5 mg 0.8
Corticosterone 0.35 NA 15
Triamcinolone 5 6 mg 0
Paramethasone 10 3 mg 0
Betamethasone 25 1 mg 0
Dexamethasone 25 1 mg 0
Weight Loss
causes early satiety, NE
phentermine Adipex and DA agonist 3-6 mo use
Diabetes
delayed absorption of
CHO, inhibit alpha-
glucosidase in intestinal
wall --> slower absorption,
less post-prandial rise of high carb diet, HbA1c <9%,
alpha-glucosidase inhibitors plasma glucose as combo w/ other tx taken w/ meals,
acarbose Precose
miglitol Glyset
Lipidemias
very few (low dose), n/v, orthostatic hypotension, HA, 2x/wk dosing, expensive, also used for acromegaly (poor
fatigue, constipation, psychosis, sleep changes efficacy)
no vascular SEs
NSAID
monitor thyroid fxn every 6-8 wks -- goal to normalize TSH
MI risk generally not indicated
poor absorption
may incr BP
intestinal cramps, flatus, incontinence, oily spotting;
malabsorption of fat soluble vitamines (take a
multivitamin at a different time of day) improves lipids and blood glucose
wt gain, allergy (rare - sulfur), hypoglycemia; effect reduce HbA1c by 1-2%, requires intact beta cells;
potentiated by NSAIDS, sulfas, ASA, antifungals inexpensive
flatulence, rare liver enzyme elevation not highly effective (1% reduction of HbA1c)
high variability
unstable hexamers
unstable hexamers
unstable hexamers
skin rash, GI bloating, myalgias, gallstones; potentiates lower total cholesterol by 30-50%, reduces CAD risk, more
warfarin; cholestyramine inhibits absorption, decreases effect if greater initial LDL (>160), no reduction of overall
cyclosporine action; CI renal or hepatic dz mortality;
more effective?
not as effective?
catalase, fac
coagulase, anaer
+ Staphylococcus aureus cocci clusters beta hemolytic obe
fac
catalase, beta anaer
+ Staphylococcus epidermidis cocci clusters hemolytic obe
fac
catalase, beta anaer
+ Staphylococcus saprophyticus cocci clusters hemolytic obe
alpha
+ Streptococcus pneumoniea cocci diplo hemolytic
alpha
+ Viridans streptococci cocci diplo hemolytic
aerobi
+ Listeria monocytogenes rods c '+ / -
aerobi
+ Bacillus anthracis rods chains c
aerobi
+ Bacillus cereus rods chains c
aerobi
+ Corynebacter diphtheriae rods c
anaer
+ Clostridium tetani rods obic
anaer
+ Clostridium botulinum rods obic
anaer
+ Clostridium perfringens rods obic
anaer
+ Clostridium difficile rods obic
fac
anaer
- Salmonella sp. rods obe '+/- + - + +
obligat
e
aerob
- Psuedomonas aeruginosa rods oxidase e + - -
- Acetobacter calcoaceticus rods + - -
- Xanthomonas maltophilia rods + - -
- Burkholderia capecia rods + - -
fac
anaer
- Haemophilus influenzae rods obe -
fac
anaer
- Haemophilus ducreyi rods obe -
fac
anaer
- Gardnerella vaginalis rods obe -
fac
anaer
- Bordatella pertussis rods obe -
fac
anaer
- Legionella pneumophila rods obe '+/- -
fac
anaer
- Brucella sp. rods obe '+/- -
fac
anaer
- Francisella tularensis rods obe '+/- -
fac
anaer
- Pasteurella maltocida rods obe -
microa
erophil
- Campylobacter jejuni rods ic + -
fac
anaer
- Vibrio cholerae rods obe -
0 Chlamydia trachomatis +
0 Chlamydia psittaci +
0 Chlamydia pneumoniae +
microa
erophil
- Borrelia burgdorferi spiral ic
- Borrelia recurrentis spiral
aerobi
- Leptospira interrogans spiral c
obligat
e
aerob
0 Mycobacterium tuberculosis rods e '+/-
Mycobacterium avium-
intracellularae (MAI) = avium
0 complex (MAC) rods '+/-
anaer
obic /
microa
+ Actinomycetes israelii rods branching ero
M types, pharyngitis common --> scarlet fever w/ rash (not on face), impetigo,
cellulitis, erysipelas, necrotizing fasciitis, STSS (toxic shock syndr), rheumatic fever
1-4 wks following strep throat (chorea, erythema marginatum, myocarditis, fever),
acute glomerulonephritis (post-inf), virulence factors: Lancefield Group A type C
carbohydrate, M protein (inhibits complement activation), non-immunogenic
hyaluronic capsule, adhesins, C5a peptidase, PDG, SpeA,B,C (erythrogenic
exotoxins via lysogenic conversion), streptolysin O (ASO titer tests for Abs),
pyrogenic exotoxin = erythrogenic toxin (scarlet fever), streptokinase (activates
plamin) rapid GAS test, ASO titer
gut and vaginal flora, vertical txmission to neonate --> infect lungs, brain, sepsis;
virulence factors antiphagocytic capsule, C5a peptidase, hemolysin; screen
pregnant woman 35-37 wks; neonatal meningitis main causes E coli, GBS, Listeria
commensal bowel flora, UTIs, biliary infections, subacute bacterial endocarditis; high
resistance to ampicillin and vancomycin (VRE have D-ala-lactate) bile-esculin agar
spore former; only bacterium with protein capsule, contact w/ hides, goat hair, skin
infect., lung infect., gastroenteritis; cutaneous 5 d incubation, inhaled 7 d incubation,
use macros to replicate in lymphatic sys; virulence plasmid for polyglutamyl capsule
pX02, plasmid for exotoxin pX01 w/ edema factor (EF) [calmodulin-dep adenylate
cyclase, incr cAMP, inhib PMNs, causes edema], protective antigen (PA), lethal
factor (L) [zinc metalloprotease inactivates MAPKK], round black lesion = malignant
pustule,
spore former; gastroenteritis, motile, no capsule, penG resistant, heat labile toxin
causes n/diarrhea, preformed heat stable toxin causes n/v (short incubation); one of
two bacteria capable of producing GI Sx <2h after ingestion; think of reheated rice
and Chinese food
yellow, thick psuedomembrane in pharynx, A-B exotoxin, B binds to cell, A blocks culture potassium tellurite agar,
protein synth by inactivating EF2 Loefler's coagulated blood serum
invade urethral epithelial cells, joints, conjunctivitis in neonate, PID; lots of PMNs,
purulent cervical discharge, epididytitis and orchitis, 50% asymptomatic; virulence
no capsule, pili (high antigenic variation), adhesins, LPS, antigenic variation;
fluoroquinolone resistance, tetracycline resistance; ectopic pregnancy, PID, gm stain urethral swab, culture, rapid
abscesses, peritonitis, Fitz-Hugh-Curtis syndr (capsule of liver infection), septic urine test; Thayer-Martin chocolate
arthritis, bacteremia, ophthalmia neonatorum agar, DNA probe
may have iron binding siderphore; diarrhea, UTIs, neonatal meningitis, sepsis,
pneumonia; ETEC - traveller's diarrhea, secretes exotoxin, heat stable (ST) or heat
labile toxin (LT); EHEC - shiga-like cytoxin, hemorrhagic colitis, HUS [0157:H7 -
does not ferment sorbitol]; EIEC - pus and blood in stool, dysentery; EPEC -
typically infants, binds epithelial BFP, uptake of TIR , intimin to surface --> pedestal
formation
motile, not normal flora, typhoid fever (S. typhi) is human only with abd pain and
occassional rash, undulant fever; lives in macrophages / reticuloendothelial system,
undulent fever, highly virulent, Vi factor, 1-2 wk intracellular growth incubation;
zoonotic w/ animal resevoirs, "two bucket" syndr; enteroinvasive mech attach pili to
M cells, injection of effector proteins --> ruffling --> phagosome --> infection via cell-
cell transport; sickle cell pts get Salmonella osteomyelitis blood, urine, stool cultures
non-motile, not normal flora, humans only, Shiga toxin kills intestinal epithelial cells
by inhib 60S ribosome, painful bloody pus diarrhea, highly infectious, HUS possible,
spread cell-to-cell, similar to EIEC, same toxin as EHEC
enteric, motile, OX-19,-2,-K cross react w/ Rickettsia, nosocomial infections UTIs, alkaline urine
motile, animal resevoir, fecal oral (Y. enterocolitica) vs flea bite (Y. pestis = bubonic
plague), invasion of epithelium and lymph nodes, enterotoxin similar to E coli ST stool or blood culture
common nosocomial enteric, high Abx resistance, green pigment (fluorescein) and
blue pigment (pyocyanin), sweet grape-like scent, exotoxins and capsule possible;
causes pneumonia (esp in CF pts), osteomyelitis, burns, sepsis, UTIs,
pyelonephritis, endocarditis (IV drugs), malignant external otitis, corneal infections
(contact lenses); can infect skin as ecthyma gangrenosum via alpha toxin that
inhibits protein synth by binding EF-2
req hematin (factor X) and NAD (factor V) to grow, common URT infections, otitis
media, bronchitis, sinusitis, epiglottitis (stridor, wheezing, drool), septic arthritis;
polysaccharide capsule w/ six types, type B (HiB) most invasive for non-ciliated
epithelium, can invade CNS if capsule, endotoxin in meningitis; kids no capsule
immunity 6mo-3yo
causes chancroid (STD) w/ painful ulcers (syphilis is painless), painful swollen lymph
nodes
causes bacterial vaginitis, used to be Haemophilus vaginalis, but does not require
factorX or V
whooping cough, highly contagious, toxin paralyzes cilia --> catarrhal phase w/
cough, runny nose, fever for 2 wks; paroxysmal stage - mucus production and
inflammation w/ wheezing, lymphocytosis; convalescent stage 4-8 wks, adult
infection is mild; pertussis toxin is exotoxin w/ enzymatic subunit and 5 binding PCR , culture, charcoal blood agar,
subunits (A-B toxin) --> inhibits phagocytosis and PMN/macro function by extra "mercury-like" colonies; must NOT
cytoplasmic adenylate cyclase but incr lymphocytosis, histamine sensitization, incr use cotton swab, use calcium alginate
insulin synth; filamentous hemagglutinin (FHA) binds to ciliated epithelial cells; swab of posterior nares --> Bordet-
tracheal cytotoxin kills ciliated epithelial cells; infants <1yo at risk, immunity from Gengou medium; ELISA, fluorescent
vaccine wanes after 15yo; toxin causes fluid loss by ribosylating Gi Ab test
walking = atypical pneumonia; Legionairres dz (high fever pneumonia) and Pantiac
fever (flu-like non-pneumonia), hepatic and renal dysfunction, thin watery secretions,
dry cough; txmission by aerosolized water inhalation; resistant to macrophages --> fastidious on buffered charcoal yeast
cytokine release (TNF-alpha) --> influx of monos and PMNs --> microabscesses and extract agar, 5 d for culture, DFA test,
cavities; urinary antigen detection
direct contact w/ infected animal meat (goats, cows, pigs, dogs), facultative
intracellular growth in macros --> systemic (fever, etc), undulant fever, rarely fatal;
Brucella abortus can cause endocarditis of aortic >> mitral valves culture of blood, Ab titer
tularemia; resembles bubonic plague, handling rabbits, ticks, deerflies;
ulceroglandular tularemia - skin ulcer w/ black base, fever; pneumonic tularemia,
oculoglandular tularemia, typhoidal tularemia; highly virulent PPD-like skin test, Ab titers
curved rods, infects humans, birds, other animals, chickens, potato salad, shiga-like
toxin, increased risk of Guillian-Barre syndr, invades epithelial cells, secretes LT
toxin, bloody diarrhea,
1st cause of duodenal ulcers, 2nd cause of gastric ulcers (after NSAIDs)
indigenous GI tract, female GU tract; abscesses w/ capsule virulence factor; beta-
lactamase production, NO ENDOTOXIN,
periodontal dz and aspiration pneumonias, abd and pelvic abscesses, otitis media
syphilis; flagella under outer membrane, TROMP but no LPS; primary chancre
(painless) --> dissemination --> 2ndary Sx (rash on palms and soles, condyloma
latum, CNS/eyes/bones/kidneys/joints) --> latent asymptomatic --> tertiary:
neurosyphilis (subacute meningitis, meningovascular, tabes dorsalis, general
paresis), cardiovascular (aortic aneurysm), gummatous dz of skin and bone; Argyll-
Robertson pupil - midbrain lesion, constricts w/ accommodation but no light rxn; rule
of 6's for disease progression; congenital sypnhilis (early is <2yo) like 2ndary darkfield microscopy; RPR, TRUST,
syphilis, late is similar to tertiary syphilis w/ bone and teeth destruction (saber shins, VDRL (1st line) --> TP-PA, FTA,
saddle nose, Hutchinson's teeth, mulberry molars) and eye disease MHATP (2nd confirm)
Lyme dz; Ixodes scapularis and I. persulcatus vectors, white-footed mouse and
white-tailed deer resevoirs, require >24h for tick to infect; bind complement factor H
to prevent opsonization; waxing waning dz, erythema migrans, target lesion --> skin,
CNS, heart (AV block, myocarditis), joints --> chronic arthritis (HLA-DR) PCR of joint, serology ELISA, WB
body louse vector, causes relapsing fever; high veber, HA, muscle aches, +/- rash; Wright or Giemsa stained peripheral
antigenic variation smear, darkfield
urine of animals, abrupt fever, HA, malaise, red conjuctiva, photophobia, relapsing,
meningismus, CSF WBCs; Weil's dz = infectious jaundice - renal failure, hepatitis, culture blood during febrile phase,
hemorrhage, mental status changes shephard's crook appearance
rod-shaped bacillus, lipid wax FA coat (not Gm stain --> acid-fast), mycoside
(mycolic acid + carbo) --> cord factor, sulfatides (inhibit phagosome fusion), waxD
(antigen); lives inside macros, cell-mediated (Tcell) immunity important for
granulomas and caseous necrosis; Ghon focus = calcified tubercle, Ghon focus +
perihilar lymph calcification = Ghon complex, cavitary lesions w/ air-fluid levels, 10%
lifetime risk of TB, 10%/year if HIV; pulmonary Tb, pleural and pericardial infection,
lymph node infection = scrofula, kidney infection, skeletal (Pott's dz), joint arthritis, acid fast, Lowenstein-Jensen slant;
subacute meningitis, brain granulomas, miliary Tb; wt loss, low fever PPD (unless BCG), CXR
no cell wall, modified sterol membrane, 40% comm acq pneumonia (esp young teen cold agglutinin test, complement
or adult), atypical pneumonia, exascerbation of asthma (IL-5 release), H2O2 fixation test, sputum culture, DNA
production paralyzes cilia, P1 adhesin probe, strep MG agglutinins
lower UTIs urease test
energy parasite; arthropod vectors; Rocky Mtn spotted fever, Dermicenter ticks
vector (D. viriabilis, D. anderoni, Rhipecephalus sanguinous, SE an W USA, male 5- DFA skin Bx, serology, latex
9 y.o., Sx vasculitis, petechial rash ankles and wrists, infects endothelial cells, agglutination, Weil-Felix rxn w/
replicates in cytoplasm, overlapping antigens with Proteus vulgaris (OX-2,-19,-K) Proteus antigens
epidemic typhus, , lice vectors, wiped out Napoleon's army in Moscow 1812, flying
squirrel resevoir, abrupt onset fever and HA, pink macules on trunk, delirium,
gangrene of feet or hands, Brill-Zinsser dz = relapse, usually milder
endemic / murine typhus; flea vector, fever HA, maculopapular rash
scrub typhus / tsutsugamushi fever, asia and SW pacific, mite larvae vector
(chiggers), high fever, HA, maculopapular rash
rickettsialpox, txmitted by mites from house mice, fever, red papule to vesicle
trench fever; louse vector from WWI, high fever, rash, HA, back and leg pain,
relapses
cat scratch fever, regional lymphadenopathy, low fever, also causes bacillary
angiomatosis
Q fever, endospore former, tick and cattle resevoirs, inhaled spores cause
pneumonia, fever, sweats (NO rash)
ehrlichiosis, tick vectors, similar to RMSF, high fever and HA, rare rash
penicillin, vancomycin
ampicillin, TMP/SMZ
tx if sepsis
tx if sepsis
penicillin + aminoglycoside
erythromycin or TMP/SMZ
metronidazole
penicillin or doxycycline
fluids, doxycyline
bismuth salts, metronidazole, ampicillin,
tetracycline
metronidazole, some cephalosporins, beta lactam
w/ beta lactamase inhibitor
doxycycline + penicillin
doxy + erythromycin
penicillin or doxycycline
doxycycline
tetracycline, chloramphenicol
tetracycline, chloramphenicol
doxycycline
doxycycline
doxycycline
doxycycline
doxycycline
doxycycline
own viral skin lesions and death; lesions do not blanch when
DNA/RNA pressed; macules --> papules --> vesicles -->
Pox ds c Y D* dep DNA pol smallpox respiratory pustules --> crusts
highly
infectious, acute, fulminant, and chronic hepatits,
blood-blood and asymptomatic carrier, hepatocellular carcinoma,
Hepadna pds i Y RT ? hepatitis B sexual cirrhosis
highly
contagious,
measles / respiratory
rubeola droplet URT infection with viremia, encephalitis, fever, rash
RNA-dep.
Orthomyxo ss- * h Y R RNA pol influenza (flu) aerosolized viral pneumonia, URT
atypical lymphocytes,
heterophile Ab, Monospot test acyclovir
eosinophilic inclusions
Dx Tx
ELISA and WB, viral load PCR, HAART
supportive
PCR, ELISA
ribavirin, palivizumab
prophylaxis (monoclonal b),
serum RSV Ig
live attenuated vaccine part of
trivalent MMR
ribavirin
oral rehydration
DNA viruses
RNA ss+
RNA ss-
Envelope DNA
Naked RNA
maternal--fetal danger
Notes
biggest DNA virus, only DNA to replicate in cytoplasm; USA eradication in 1971, WHO
eradication in 1977; infects macrophages, replication in spleen and BM; variola major 10-
30% mortality;
swollen cells, multinucleated giant cells; AIDS pts CD4 <50 get viremia, retinitis, and colitis;
post-transplant immunosuppressed get pneumonitis, viremia, colitis (NOT retinitis)
infects squamous epithelial cells and B cells, binds C3d complement receptor --> internalized
--> transformation; replicated as external episome when latent, linear as lytic; type I = benign;
types II and III - more tumorigenic w/ LMP-1 (nasopharyngeal carcinoma [NPC], induced TNF
transcription inhibits p53), up to 9 latency proteins; post-transplant lymphoproliferative dz
(PTLD) in type III; AIDS related Burkitt's lymphoma and oral hairy leukoplakia; assoc
Hodgkin's dz and X-linked lymphoproliferative syndrome
infect squamous epithelial cells, risk of cervical cancer esp w/ types 16,18; most common
STD virus; early genes = non-structural regulatory genes, control host cell growth --> E6
binds p53, E7 binds Rb to promote S phase; replicates as episome in papillomas, integrated
in dysplasia and cancer
only infects bone marrow, fetal liver, fetal heart; life-long immunity
coinfection w/ HIV common; liver injury due to cell-mediated immune response; smallest DNA
virus; intact virus = Dane particle; anti-HBsAg = immunity (Australia antigen); HBeAg is a
marker of active dz; virus packages w/ ssRNA+ and RT --> makes DNA(-) and partial(+);
window period means no HBs Ag or HBs Ab in serum; possesses RNA-dep-DNA poly, can
RT; most pts have subclinical dz followed by spontaneous resolution
Notes
replicates in nucleus; has src oncogene in genome --> transformation;
destruction of CD4+ T-helper lymphocytes, multinucleated giant cells b/c fusion @ gp160; 2
ss RNA dimer w/ 2 LTRs that have sticky ends, gag - codes proteins in envelope
(nucleocapsid, capsid [p24], and matrix), pol - codes protease, integrase, and RT, env - codes
for envelope proteins gp120 + gp41 = gp160 that binds to CD4 receptor; protease is required
to activate viral proteins after translation; other genes are tat, rev, nef, vif, vpr, vpu; fusin on
Tcells and CCR5 on macros are required cofactors for viral binding; B-cell dysfunction and
hypergammaglobulinemia, monocytes and macrophages serve as resevoirs of HIV; CDC
categorizes pts on sx and CD4 ct: "A" is asymptomatic -- "B" is minor sx -- >500 is "1" -- 200-
500 is "2" -- and <200 is "3"
may cause acute hepatitis; 1 mo incubation, mostly young children, often w/o jaundice;
secreted in bile; humans are only resevoir
tropism for Peyer's patches and motor neurons, destruction of presynaptic motor neurons in
anterior horn of spinal cord and postsynaptic neurons leaving cord
>100 serotypes
may cause acute hepatitis (flu-like, w/ jaundice, elevated AST, ALT, GGT, ALP)
may cross placenta to cause birth defects, esp. 1st trimester: heart (patent ductus, IV
septum, PA stenosis, etc), eye (cataracts, chorioretinitis, etc), CNS (retardation,
microcephaly, deafness)
arboviruses = toga + flavi + bunya; Western equine encephalitis, Eastern equine
encephalitis, Venezuelan equine encephalitis
Panama canal
slow migration from wound site to nerve axons --> CNS; glycoprotein attaches to AChRs, 3-8
wk incubation; infects hippocampus and cerebellum
replicate in nucleus; fusion (F) protein causes formation of multinucleated giant cells; NA and
HA together as one glycoprotein
multinucleated giant cells = syncytial cells; lacks NA and HA glycoproteins; main cause of
pneumonia in infants <6 mo; winter and spring outbreaks
replicates in mucus membranes and conjuctival membranes, 2 wk incubation before rash; 3-4
d prodrome (conjuctivitis, photophobia, high fever, hacking cough, rhinitis, malaise) --> 1-2 d
before rash Koplik's spots w/ red-based lesions and blue-white centers in mouth --> 6 d
maculopapular rash from forehead to face to neck to torso to feet; viremia may damage eyes,
myocarditis, encephalitis; fetal death 20% if pregnant; subacute sclerosing panencephalitis
(SSPE) - slow form of encephalitis 6 years after infection; post-infectious encephalomyelitis
requires HBV coinfection (needs HBV envelope and HBsAg, no viral polymerase)
segmented genome; can undergo genetic shift (like influenza)
Mneumonics:
Polly Had A Pretty Pink [Purse] (Hot!)
HHAPPPy
Rumsfeld, Please Credit A Teacher For Caring
Real Parties Only Begin After Finding Drugs (in) Reo
HHPox (envelopes) vs PAP (naked)
aPCR (astro, picorna, calici, reo)
TORCHHES (toxo, rubella, CMV, herpes,…)
URT infections in kids: 1) RSV, 2) parainfluenza, 3) rhinovirus, 4) adenovirus
Phylum Species Common Life Cycle Endemic Region
Name
Protozoa (flagellates) Entamoeba amoeba ingest cysts --> trophozoites form in sm. Int. -->
histolitica ulcerate intestines --> portal vein to liver -->
abscesses and hepatitis
Isospora and
Microsporidia
Plasmodium vivax malaria same as falciparum except timing of RBC rupture tropical - Anopheles
(every 48 hr); may have multiple exoerythrocytic mosquito
cycles in liver as dormant hypnozoites
Plasmodium malaria same as falciparum except timing of RBC rupture tropical - Anopheles
malariae (every 72 hr); may have multiple exoerythrocytic mosquito
cycles in liver (hypnozites)
Plasmodium ovale malaria same as falciparum except timing of RBC rupture tropical - Anopheles
(every 48 hr); may have multiple exoerythrocytic mosquito
cycles in liver as dormant hypnozoites
Babesia microti, babesiosis tick bite --> sporozoite invades RBC --> ring-shaped Ixodes scapularis in NE
divergeris trophozoite --> 4 merozoites "Maltese cross" USA, white-footed mouse
resevoir
Trypanosoma African sleeping cattle and wild animal resevoirs; tsetse fly vector --> Western Africa
brucei gambinese sickness trypomastigote (mobile) to lymph and CNS
Trypanosoma African sleeping cattle and wild animal resevoirs; tsetse fly vector Eastern Africa
brucei sickness
rhodesiense
Trypanosoma Chagas rodents, possums, armadillos --> reduviid bug --> South and Central
cruzi defecates after biting --> trypomastigotes invade skin America
--> lose flagellum to form amastigote -->
multiplication --> invade macro, lymph, skin, distant
organs
Leishmania Leishmaniasis sandfly bites rodent / dog / fox --> promastigote Middle East, Africa, S.
donovani invates macros --> (non-motile) amastigote multiplies and Central America
in RE system
Platyhelminthes Schistosoma Trematode eggs hatch in feshwater --> larvae swim to snail --> tropical, E Asia
(flatworms) japonicum (fluke) mature larvae released --> infect human through skin
--> inrahepatic mature and mate --> migrate to veins
around intestine and lay eggs --> eggs excreted in
feces
Schistosoma Trematode eggs hatch in feshwater --> larvae swim to snail --> tropical S America, Africa,
mansoni (fluke) mature larvae released --> infect human through skin Puerto Rico
--> inrahepatic mature and mate --> migrate to veins
around intestine and lay eggs --> eggs excreted in
feces
Schistosoma Trematode eggs hatch in feshwater --> larvae swim to snail --> tropical Africa
haematobium (fluke) mature larvae released --> infect human through skin
--> inrahepatic mature and mate --> migrate to veins
around bladder and lay eggs --> eggs excreted in
urine
Taenia solium Pork tapeworm ingestion of pork w/ larvae (cysticerci) --> tapeworm Central and South
(cestode) attaches to intestinal mucosa --> grows 2-8 meters America, SE Asia,
--> eggs released in feces --> eaten by pigs --> Philippines
larvae spread throughout pig --> cysticercus (fluid +
larvae in muscle)
Diphyllobothrium Fish tapeworm larvae ingested in raw freshwater fish --> adult
latum (cestode) matures in human intestine --> eggs in water -->
mature to larvae --> ingested by crustacean -->
ingested by fish
Hymenolepis Dwarf tapeworm humans ingest eggs --> mature to adult --> pass southern USA
nana (cestode) eggs
Echinococcus Hydatid disease humans ingest eggs --> hatch in intestine, mature to areas where dogs used to
granulosus and larvae --> disseminate, mostly to liver, lungs, kidney, herd livestock
multilocularis brain --> fluid filled cysts = hydatid --> budding to
form protoscolices and daughter cysts
Nematoda Ascaris roundworm eggs ingested --> mature to larvae in sm intestine --> tropics, mountains of S
(roundworms) lumbricoids penetrate to bloodstream to lungs --> coughed up USA
and swallowed --> mature to adult in sm intestine,
produce 200,000 eggs / day
Enterobius pinworm eggs ingested --> mature in cecum and ascending
vermicularis colon --> female migrates to perianal area at night to
lay eggs (infectious 4-6 hr later) --> autoinfection by
fecal-oral
eggs ingested --> hatch in GI and migrate to cecum,
ascending colon --> mature adult produces eggs for
1 year, eggs must incubate in moist soil before
Trichuris trichuria whipworm infective
Trichinella spiralis ingestion of larval cyst in pork muscle --> sm
intestine, mature to adults --> adult males passed in
feces, females enetrate intestinal mucosa, produce
larvae --> larvae spread to organs and muscle and
encyst
Necator hookworm filiaform larvae penetrates skin of bare foot --> lungs
americanus --> coughed and swallowed --> mature to adult in sm
intestine, attach by mouth and suck blood, release
eggs
Ancylostoma hookworm filiaform larvae penetrates skin of bare foot --> lungs
duodenale --> coughed and swallowed --> mature to adult in sm
intestine, attach by mouth and suck blood, release
eggs
Ancylostoma cutaneous larval
braziliense migrans dog and cat hookworm larvae penetrate skin SE USA
larvae penetrates skin of foot --> lung --> coughed
and swallowed --> sm intestine, mature to adult and
lay eggs --> eggs mature to larvae and may: 1)
autoinfect, 2) pass in feces --> once in feces may
infect human as larvae or mature and mate
Strongyloides
stercoralis
Wuchereria elephantiasis mosquito bite --> microfilariae mature to adults in Pacific islands, Africa
bancrofti lymph of genitals and legs --> adults mate and
microfilariae infect blood
Brugia malayi elephantiasis mosquito bite --> microfilariae mature to adults in Malay Peninsula, SE Asia
lymph of genitals and legs --> adults mate and
microfilariae infect blood
Lao lao / African eye black fly bite --> larvae mature into adults in skin Africa, C. and S. America;
Onchocerca worm, filariasis nodule --> micro-filariae migrate through dermis and black flies need water to
volvulus connective tissue, may migrate to eye mate
may be asymptomatic in E. dispar (can pass cysts in stool exam for cysts / trophozoites (w/ RBC in iodoquinol if local to intestines;
stool); GI -- bloody diarrhea, portal infection and liver cytoplasm), 1-4 nuclei; CT or US of liver for metronidazole
abscesses --> spread to lung and pulmonary abscesses; chromotoid bodies (aggregates of
abscesses ribosomes) in precyst; "flask shaped ulcer"
coats small bowel wall, steatorrhea, foul odor, greasy "falling leaves" on Bx; stool exam shows metronidazole
diarrhea, gas, cramps, NO blood oval or elliptical thick-walled cysts;
severe diarrhea in immunocompromised large almond-shaped cysts in stool TMP/SMX for Iso, albendazole for
Microsporidia
GU infection - itching, dysuria, vaginal secretions motile parasite on wetmount; may show in metronidazole
(thin, watery, frothy, malodorous discharge), urinalysis
asymptomatic in males;
meningoencephalitis - fever, HA, stiff neck, n/v CSF exam - high PMNs and protein, low intrathecal amphotercin B
glucose (just like bacterial, but Gm stain
shows no bacteria), motile amoeba on
microscopic exam but NO cysts
chronic granulomatous meningoencephalitis in CSF exam shows cysts and trophozoites, antifungals with pentamidine;
immunocompromised; HA, fever, seizures, focal corneal scraping antimicrobial eye drops
neuro; may infect cornea (even
immunocompetent) esp if contact lenses
fever, nodes, hepato/splenomegaly, meningitis, CT scan shows contrast-enhancing mass, pregnant women need to avoid
encephalitis (esp in AIDS --> HA, focal neuro, retina retinal inflammation, elevated Ig titers cats; sulfa + pyrimethamine
infection, chorioretinitis --> visual loss), yellow-white
fluggy cotton patches on retina
severe fevers and chills w/ sweating; anemia; thin and thick smears, trophozoites and chloroquine; mefloquine or
trophozoites make RBCs sticky --> plugged schizontes w/in erythrocytes doxycycline prophylaxis if
capillaries in kidney (renal failure), lungs (pulmonary resistant area
edema), brain (coma)
less severe fever and chills thin and thick smears, trophozoites and chloroquine and primaquine
schizontes w/in erythrocytes
less severe fever and chills thin and thick smears, trophozoites and chloroquine
schizontes w/in erythrocytes
less severe fever and chills thin and thick smears, trophozoites and chloroquine and primaquine
schizontes w/in erythrocytes
fever and hemolysis, usually asymptomatic; worse if thick and thin blood smears, "Maltese cross" quinine and clindamycin
asplenic pt
damage lymph, blood, CNS; painful skin ulcer, blood smear - trypomastigotes, suramin, pentamidine,
fever/HA/dizz/nodes, intermittent fevers, drowsiness Winterbottom's sign melarsoprol, elfornithine
in day, difficulty walking, slurred speech, coma;
slowly progressive fevers, wasting, late neuro sx
same as above, but more severe, death w/in weeks blood smear - trypomastigotes, suramin, pentamidine,
to months Winterbottom's sign melarsoprol, elfornithine
acute dz - chagoma at entry site, fever, swollen blood smear - trypomastigotes; nifurtimox benznidaole for acute
nodes, CNS and heart infection (tachycardia, xenodiagnosis - allow reduviid bugs to feed
meningoencephalitis) --> intermediate phase on pt, then see if reduviids contain T. cruzi
(asymptomatic, but pt has Ab in blood) --> chronic dz
- heart arrhythmias, block, v-tachy, dilated
cardiomyopathy; megadisease of colon and
esophagus (regurgitation, odynophagia, dysphagia,
constipation, abd pain)
Simple cutaneous lesions, Diffuse cutaneous lesions skin PPD-like test if cell-mediated immunity stibogluconate, amphotercin B
(nodules -- cell-mediated immunity defect), intact, visualization of protozoans if not
Mucocutaneous leishmaniasis, Visceral
leishmaniasis w/ abdominal pain and distention and
splenomegaly (severity depends on host cell-
mediated immunity)
dermatitis, Katayama fever (hives, HA, wt loss, eggs in feces, eosinophilia praziquantel
cough, fever) as adults lay eggs, chronic fibrosis of
intestine, hepatosplenomegaly; eggs in circulation
(lung, liver, brain) causes granulomas, increased
portal hypertension --> hematuria, chronic abd pain
and diarrhea, pulmonary arterial HTN
dermatitis, Katayama fever (hives, HA, wt loss, eggs in feces, eosinophilia praziquantel
cough, fever) as adults lay eggs, chronic fibrosis of
intestine, hepatosplenomegaly; eggs in circulation
(lung, liver, brain) causes granulomas, increased
portal hypertension --> hematuria, chronic abd pain
and diarrhea, pulmonary arterial HTN
dermatitis, Katayama fever (hives, HA, wt loss, eggs in urine, eosinophilia praziquantel
cough, fever) as adults lay eggs, chronic fibrosis of
intestine, hepatosplenomegaly; eggs in circulation
(lung, liver, brain) causes granulomas, increased
portal hypertension --> hematuria, chronic abd pain
and diarrhea, pulmonary arterial HTN
NO cysticercosis, benigh, malnutrition, wt loss proglottids and eggs in feces praziquantel or niclosamide
cysticercosis (after ingestion of eggs) --> cysts in proglottids +/- eggs in feces, cysticercosis w/ praziquantel
brain and skeletal muscle, seizures, CT scan or Bx, serologic tests, eosinophilia
hydrocephalus, focal deficits
unilocular cystic lesions in liver, if cyst bursts, may be CT scan and tissue Bx albendazole, surgical
fatal (allergic rxn), compression of organ (lungs, liver,
brain, kidney) gives Sx
mild or asymp, abd cramping, invasion of bile ducts, high eosinophil ct, eggs in feces, larvae in mebendazole, albendazole,
gall bladder, appendix, liver; malnutrition, cough, sputum thiabendazole, pyrantel pamoate
pulmonary infiltrate; LARGE worms
severe perianal itching scotch tape test, NO eosinophilia mebendazole, albendazole,
thiabendazole, pyrantel pamoate
mebendazole, albendazole,
thiabendazole
diarrhea, abd pain, wt loss, Fe deficiency anemia, eosinophilia, eggs in feces mebendazole, albendazole,
itching and rash on feet, cough, pulmonary infiltrate thiabendazole, pyrantel pamoate
diarrhea, abd pain, wt loss, Fe deficiency anemia, eosinophilia, eggs in feces mebendazole, albendazole,
itching and rash on feet, cough, pulmonary infiltrate thiabendazole
non-invasive, so no immunity
chronic
Exophiala werneckii dark brown and black pigmentation on soles of feet and hands
Dermatophytes
ring lesion w/ raised border and healing center
red itchy patches in groin
cracking and peeling b/w toes
scaly red lesions on scalp, mostly in children
thickened, discolored, brittle nails
Sporothrix schenckii subcutaneous nodule --> necrotic and ulcerates, lymphatic spread
Phialophora and Cladosporium small violet wart-like lesion --> cauliflower lesions
inhalation of soil / bird droppings / vegetation aerosolized --> lungs
--> bloodstream; pneumonia, meningitis, bone lytic granulomas,
skin granulomas and ulcers, other organ lesions if
Histoplasma capsulatum immunocompromised
inhalation of soil / bird droppings / vegetation aerosolized --> lungs
--> bloodstream; pneumonia, meningitis, bone lytic granulomas,
skin granulomas and ulcers, other organ lesions if
Blastomyces dermatitidis immunocompromised
inhalation of soil / bird droppings / vegetation aerosolized --> lungs
--> bloodstream; pneumonia, meningitis, bone lytic granulomas,
skin granulomas and ulcers, other organ lesions if
Coccidioides immitis immunocompromised
VOCABULARY
yeast unicellular, spherical, ellipsoidal, budding, pseudohyphae
hyphae branching cylindrical tubules, longitudinal excision
multicellular colonies, intertwined hyphae, produce spores or
molds longitudinal excision
spores reproductive bodies of molds
dimorphic can grow as yeast or mold
saprophytes use organic matter as energy source
Dx Tx
pityriasis versicolor, skin scraping mix w/ KOH reveals
spherical yeast and hyphae (spaghetti and meatballs) selenium sulfide shampoo or topical antifungal imidazoles
biopsy of affected tissue, Broad Based Budding itraconazole or amphoB for months
blood culture always means pt is immunocompromised, KOH imidazole (oral, vaginal, topical); systemic infection use
prep skin scraping; pseudohyphae amphoB or fluconazole (an imidazole)
yeast
trophozoite form and cyst form, most people exposed by 2yo, non-
inflammatory pneumonia
Antibiotics
sulfonamides dirupted pteroate synthase, inhib PABA toxoplasmosis, nocardosis,
conversion in DNA/RNA/protein synth uncomplicated acute UTIs
trimethoprim (w/ Bactrim, Septra inhibits dihydrofolate reductase (DHFR) broad specturm, UTIs, shigella enteritis, PCP;
sulfamethoxazole) bacterial >> mammalian, prevents second choice for RTIs (H. flue, Spneumo),
DNA/RNA/protein synth plasmodium falciparum, Nocardia, gm neg
bacilli (Salmonella, Brucella, Vibrio cholera)
Quinolones / inhibit DNA replication by blocking DNA broad spectrum, oral, esp for Gm- rods;
Fluoroquinolones gyrase ---> selective more than for ineffective against anaerobes; UTIs inc
mammalian topoisomerase II Pseudomonas aeruginosa, Neisseria
gonorrhoeae, Salmonella, Shigella, E. coli,
Campylobacter; chronic osteomyelitis,
intracellular bugs
ciprofloxacin, oxafloxacin,
norfloxacin
levofloxacin, ofloxacin, improved Gm+ coverage and atypicals,
sparfloxacin community acquired pneumonia
trovafloxacin broad spectrum, improved Gm+ and
anaerobic coverage
nalidixic acid urinary tract antiseptic; DNA gyrase uncomplicated UTI w/ Gm-
inhibitor
nitrofurantoin macrobid urinary tract antiseptic; reduced by uncomplicated UTI w/ Gm-
bacterial enzymes, reactive to destroy
DNA
Cell Wall Synthesis
Inhibitors (bacteriocidal)
Beta-lactams bactericidal in growing bacteria only, Gm+, Gm- if permeable outer membrane
inhibit cell wall synth as an analogue to
D-ala-D-ala that forms a acyl-enzyme
complex inactivating PBPs, prevents
carboxypeptidation and transpeptidation
act identically to b-lactams, but resistant Staph and Enterococci are RESISTANT; 1st
cephalosporins to penicillinases gen covers Gm+, 3rd gen covers Gm-
Gm+ cocci, tx non-threatening surfact
cephalexin (1st gen) Keflox infections
aminoglycosides prevent initiation complex 30S, highly mod to severe aerobic Gm neg (exception is
charged, inhibited by divalent cations Gm+ Staphylococci), and aerobic enterococci
(Ca and Mg), require O2 dependent (w/ penicillin); ineffective alone vs GM pos,
active txport ineffective vs anaerobes; mostly used if other
Abx won't work b/c high toxicity
(except
spectinomycin)
spectinomycin blocks translocation of ribosome to next alt tx for Neisseria gonorrhea resistant to
codon, bacteriostatic; not actually an pen / tetracycline / pregnant women
aminoglycoside
gentamicin, tobramycin, systemic infections
netilmicin, amikacin
neomycin topical infections, oral prophylaxis for
colorectal surgery
streptomycin, kanamycin TB
streptogramins bind to 50S subunit and constrict exit vancomycin resistant E. faecium (NOT E
channel to inhibit peptide exit --> cell faecalis), penicillin resistant Strep pneumo,
Dalfopristin + death from loss of free tRNA; MRSA
quinupristin = dalfopristin / quinupristin always
Syndercid combined for greater effect 16x
Protein Synthesis
Inhibitors (Bacteriostatic)
linezolid (Zyvox)
metronidazole taken up by anaerobic bacteria and anaerobes only, pseudomembraneous colitis
parasites --> converted to metabolite that by C difficile, Bacteroides fragilits,
Flagyl, MetroGel, disrupts DNA trichomoniasis, giardia, amebiasis
Noritate PARASITES
topical antifungals
oral, esophageal, gastric Candidiasis, topical
nystatin binds ergosterol vaginal candidiasis
clotrimazole, miconazole
Antivirals
phosphorylated by viral thymidine kinase
--> inhibits DNA poly as a chain
acyclovir Zovirax terminator HSV, varacella, zoster
valacyclovir prodrug form of above HSV, varacella, zoster
Trifluorothymidine Viroptic framentation of viral DNA herpes keratitis
blocks uncoating of influenza A by
amantadine Symmetrel binding M2 influenza prophylaxis
blocks uncoating of influenza A by
rimantadine binding M2 influenza prophylaxis
AIDS Tx HIV
Nevirapine,
delaviridine,
non-nucleoside RT efavirenz
inhibitors (NNRTIs)
Retrovir, AZT,
azidothymidine Zidovudine RT inhibitor; thymidine analog decr rate of txmission to newborns
Anti-Parasitics
quinine alkaloid from cinchona tree (S.America) drug resistant falciparum / prophylaxis
artemether drug resistant falciparum
systemic toxicity
topical
excreted by kidney except nafcillin and least toxic of all Abx; hypersensitivity and
cefoperazone (bile); oral probenicid blocks anaphylaxis
renal secretion
oral
nafcillin excreted in bile, oxacillin, methicillin causes interstitial nephritis
cloxacillin, dicloxacillin all acid-stable
for oral or parenteral admin
oral
topical
topical skin / mucus membranes; not
absorbed orally too toxic for iv,
oral
inhaled
less toxic
lipodystrophy, hyperlipidemia
leukocytosis, BM suppression,
leucopenia, anorexia, abd pain, n/v,
oral, slowly absorbed, rapidly excreted hemolysis; G6PD defic --> hemolysis
HA, Gi upset
cinchonism: ear ringing, HA, nausea,
visual changes; G6PD defic -->
IM hemolysis
less toxic
two drugs are synergistic b/c block 2 pts in same folate pathway; resistance by
overproduction of DHFR, expression of altered DHFR
older quinolone
1st generation ceph uses 'PH', except for cefazolin and cefadroxil
resistance by efflux pump (major), TetM protein protects ribosome (minor); cannot
take with milk
see above
least potent
Lidocaine block Na channels; normalizes V arrh (V-tach or V-fib -> #1 1st pass hepatic metabolism;
conduction by blocking damaged cells drug)
Dofetilide block K channels SV arrhythmias (A-fib or A- oral; interact w/ drugs that inhib cation
flutter) transport
Bretylium block K channels V-fib (last-line) IV
Class IV
Verapamil block Ca channels; prolong PR
Miscellaneous
Adenosine incr. outward K current -> hyper- SV arrhythmias extremely rapid metabolism -> IV
polarization; slows conduction in AV node bolus only
long-acting nitrates angina prophylaxis less frequent dosing; slow onset (not
for acute angina)
β−βλοχκερσ decr. HR & contractility -> decr. O2 angina, HTN, tachycardia,
demand; (also, decr. renin) prior MI, hyperthyroidism,
migraines
Ca-channel blockers
Verapamil non-dihydropyridine; decr. HR, angina prophylaxis; decr. slow onset
contractility, afterload -> decr. O2 vasospasm (Prinzmetal's),
demand; decr. vasoconstriction -> HTN
vasodilation
Diltiazem non-dihydropyridine; decr. HR, angina prophylaxis; decr. slow onset
contractility, afterload -> decr. O2 vasospasm (Prinzmetal's),
demand; decr. vasoconstriction -> HTN
vasodilation
dihydropyridine; vasodilation (no angina prophylaxis, HTN
direct heart depression)
STEP I
Diuretics renal Na excretion, fluid loss (diuresis); HTN drug inter: severe hypotension w/
reduces vascular responsiveness to NE ACE inhibitor
β−βλοχκερσ decr. contractility; decr. renin release HTN, non-vasospastic never stop abruptly -> high rebound
angina, tachycardia, prior tachycardia upon re-exposure to NE
MI, hyperthyroidism,
migraines
AII receptor blocker only blocks AII receptors -> decr. HTN, CHF
vasoconstriction, decr. aldosterone
STEP II sympathetic inhibitors
Central a-agonist stim. a-2 receptors -> decr. sympathetic HTN never stop abruptly -> high rebound
effect -> decr. vasoconstriction, decr. tachycardia
contractility, decr. BP
STEP III
Hydralazine direct-acting vasodilator (like NTG -> HTN (last line), CHF (w/ rapid response
EDRF-NO) nitrates)
HTN Emergencies
Nitroprusside organic nitrate (like NTG); direct-acting 1st choice for HTN metabolized to cyanide; IV infusion
vasodilator emergencies; intraop only -> immediate onset -- must
surgery monitor closely
Diazoxide direct-acting vasodilator HTN urgency IV push -> usu. works in 1 dose
Trimethaphan autonomic ganglionic blocker -> HTN urgency
vasodilation
Dyslipidemias
Statins inhib. HMG-CoA reductase -> decr. lower cholesterol; drug inter: incr. SE risk w/ niacin,
cholesterol; incr. LDL receptor, decr. hyperlipidemia (1st line) gemfibrozil, cyclosporin, or
VLDL production erythromycin
Fibrates incr. lipolysis of TG -> incr. VLDL TG lower triglycerides; drug inter: displace plasma protein-
clearance hypercholesterolemia (w/ bound drugs (warfarin,
statin) hypoglycemics), incr. statin myopathy
Niacin decr. chol. by decr. hepatic secretion of w/ statin for hyperchol +/- drug inter: incr. statin myopathy;
VLDL; decr. TG by decr. lipolysis, incr. hyperTG antagonizes all anti-diabetic drugs
VLDL clearance
Bile acid sequestrants decr. intestinal absorption of bile acids -> lower cholesterol drug inter: interferes w/ absorption of
incr. excretion -> incr. conversion of many oral drugs & fat-sol vitamins
cholesterol to bile acids (A,D,E,K)
COX inhibitors
Aspirin (ASA) irrev. acetylates & inhib. COX -> inhib. acute MI, after MI, unstable oral (chewed faster); affects platelet
TXA2 production angina, post-CABG, for 10-day lifespan
angioplasty
Abciximab (ReoPro) chimeric Ab vs. GPIIaIIIb; steric percutaneous coronary short T1/2, but extensively bound
hindrance of fibrinogen binding artery interventions to plasma proteins
Eptifibatide (Integrilin) analog of C-term fibrinogen (mimicry), percutaneous coronary
blocks GPIIaIIIb artery interventions
Tirofiban (Aggrestat) non-peptide, small molecule; inhib. percutaneous coronary
GPIIaIIIb artery interventions
Dipyridamole inhib. phosphodiesterase -> incr. cAMP
-> decr. ADP
(Aggrenox) dipyridamole + aspirin stroke prevention
Anti-Coagulant prevent clot formation & extension DVT
Heparin (UFH) accel. ATIII inhibition of FXa & FIIa parenteral only (IV bolus (1 hr T1/2)
(thrombin) or SC bid (few hr T1/2)); does not
cross placenta - OK pregnant
low MW heparin (LMWH) accel. ATIII inhibition of FXa only better bioavailability (less binding) &
longer T1/2 than UFH
Thrombolytic activate fibrinolysis -> plasmin dissolves acute MI; stroke, pulm. tPA inhib. by PAI-1; plasmin inhib. by
thrombi (also restore flow, reduce infarct) emboli, DVT a2-antiplasmin
Tissue Plasminogen serine-protease from endothelial cells acute MI (treat quickly) slightly better than streptokinase (but
Activator (t-PA) activates plasminogen at site of clotted more $$); no systemic effects w/ MI
fibrin (specific)
Streptokinase (SK) not an enzyme; binds free blood acute MI (treat quickly) systemic effects (binds plasminogen
plasminogen, exposes active site -> in blood); cheaper than tPA
activates other free plasminogen to
plasmin
Other
spironolactone aldosterone receptor antagonist; CHF
potassium sparing diuretic
CI/SE Notes
Singh - Vaughn Williams classification
can cause arrhythmias & AV block include flecainide, moricizine, propafenone; only
(sudden death) used in pt. w/ serious heart problems
reflex tachycardia; headache, flushing, prototype; pts at risk for acute angina -> always
dizziness -> SE decrease over time carry sublingual (SL) NTG tablets; overdose ->
(tolerance); CI: EtOH, anti- hypotension, decr. LAD/RCA flow, tachycardia ->
hypertensives, sildenafil (excess underperfusion -> acute MI or stroke; 3 dose, dial
hypotension), sympathomimetics 911 rule
(counteract NTG effects)
CI: pregnant
myopathy, rhabdomyolysis, SE manifest 1st as muscle ache; ex)
myoglobinuria, renal failure, Atorvastatin, etc.
hepatotoxicity
cholelithiasis ex) Gemfibrozil (prototype)
GI upset (b/c PGE2 decr.); hemorrhagic COX aka PG-H2 synthase; inhib COX-1 more
stroke; decr. renal fxn; impaired ACE than COX-2; also minor inhib. PGI2 (prostacyclin)
inhibitor efficacy by endothelial cells; primary prevention: no
reduced mortality, decr. nonfatal MI, incr. stroke
transient effect
GI upset, bleeding, TTP, neutropenia block platelet activation; more expensive than
ASA -> used less
GI upset, bleeding, TTP block platelet activation; used more often b/c less
neutropenia
high risk = failed ASA, ST depression, troponin
elevation, angioplasty
bleeding, thrombocytopenia plasma levels fall quickly, but see effect up to 15
days
bleeding, thrombocytopenia
bleeding, thrombocytopenia
coumadin skin necrosis (if warfarin monitor carefully & regularly by PT (FVII T1/2
alone 1st -> APC inhibited rapidly); OD -> PT incr. first) -> varies by thromboplastin
-> prolonged INR -> bleeding -> Tx by source -> use INR correction factor (pt. range
VitK + FFP (coag Fx); embryopathy = 2-3); reversible by VitK
(teratogenic wks 6-12) -> CI: pregnant;
blue-toe syndrome
hemorrhagic stroke, minor bleeding treat acute MI within 6 hrs (best 1 hr); tPA also for
vascular patency, cell migration; also,
staphylokinase, urokinase, reteplase (r-PA),
lanoteplase (n-PA), tenecteplase (TNK)
"kringle" domain
levalbuterol Xopenex
metaproterenol Alupent
terbutaline Brethaire
pirbuterol Maxair
salmeterol Serevent partial B2 agonists (less desensitization), inhibit exercise-induced asthma, nocturnal asthma
mast cell degranulation, edema, inc mucus
clearance
fomoterol Foradil partial B2 agonists (less desensitization), inhibit exercise-induced asthma, nocturnal asthma
mast cell degranulation, edema, inc mucus
clearance
theophylline inhibits cAMP PDE, inc cAMP; antagonizes exercise-induced asthma, nocturnal asthma
adenosine mediated bronchoconstriction
muscarinic antagonists
Anti-inflammatory
beclomethazone Beclovent
triamcinolone Azmacort
flunisolide Aerobid
fluticasone Flovent
budesonide Pulmicort
fluticasone + salmeterol Advair
leukotriene modifiers inihib action of esp leukotriene D4 effective in pts who suffer asthma attacks after
NSAID use
zafirlukast Accolate leukotriene receptor antagonist
montelukast Singulair leukotriene receptor antagonist
zileuton Zyflo 5-lipoxygenase inhibitor
mast cell modifiers
cromolyn sodium Intal aerosolized NSAID; inhib mast cell maint. Tx for asthma
degranulation
nedocromil Tilade aerosolized NSAID; inhib mast cell maint. Tx for asthma
degranulation
Omalizumab Xolair injected anti-IgE antibody binds free IgE to severe asthma
prevent membrane-bound IgE's available on
mast cells --> recuded atopy of mast cells and
basophils
prostacyclin agonists
(epoprostenol, treprostenil, prostacyclin synth by endothelial cells, stim
iloprost) SMC Gs to incr cAMP --> vasodilation PAH
epoprostenol
treprostinil
ilioprost
requires actively dividing cells; inhib synth of mycobacteria, MAC (w/ azithromycin /
ethambutol Myambutol arabinogalactan (cell wall) clarithromycin)
inc BP, HR
MDI or nebulized
MDI or nebulized
many
large first pass effect metab to prevent systemic oropharyngeal candidaisis, hoarseness,
side effects throat irritation, decr bone density
longer lasting
longer lasting
absorbed buccal, skin, lungs --> direct to brain EPI release, tachycardia / bradycardia,
(7sec), 1/2-life 2hrs, metab in liver C-oxidation NMJ wkness, analgesia, tremors,
by CYP2A6 convulsions, vomiting, release of DA (nuc
accumbens, VTA)
liver toxicity
oral, excreted kidney, 1/2life 4hrs hepatotoxicity (<5%), gout-like Sx, n/v/fever
use as prophylaxis controversial; small number of B2 receptors in heart can inc HR;
may increase inflammation in asthma if used chronically
requires 4 doses/day
expensive ($12,000 / year)
INH, rifampin, pyrazinamide 2mo --> INH and rifampin 4mo; OR INH, rifampin,
ethambutol, pyrazinamide 6mo; fluoroquinolones if resistant
resistance 1 in 10^7, via mutations in RNA poly; will turn body secretions orange-red
ribavirin Copegus, Rebetol, purine nucleotide analog, inhibits HCV, viral pneumonia in infants
Virazole replication by inhib inosine-5-phosphate and young children
dehydrogenase inhibiting GTP -->
blocked mRNA synth and 5'-capping;
decr GTPase cycling and signaling
Portal HTN
propranolol non-selective beta blocker; decr portal
pressure and decr risk of bleeding from
varices; splanchnic vasodilation?
GI Functional
Control
H. pylori ABX
proton pump inhibitors inhib H/K-ATPase; prodrug, req GERD, Zollinger-Ellison Syndrome
activation in acidic environment
omeprazole Prilosec
lansoprazole Prevacid
rabeprazole Aciphex
pantoprazole Protonix
esomeprazole Nexium
cimetidine Tagamet
ranitidine Zantac
famotidine Pepcid
nizatidine Axid
stimulate mucin secretion and HCO3
Prostaglandin analogs secretion, "cytoprotective" prevent NSAID injury
binds to PGE2R, EP3, --> decr cAMP
levels in parietal cell to inhibit H+
secretion; also protects from NSAID
injury by stimulating bicarb and mucus
misoprostol Cytotec secretion
NaHCO3, CaCO3, Mg(OH) buffering
antacids agents
lines epithelial cells, inhibits acid
sucralfate hydrolysis of proteins
anticholinergics
cytoprotective agents
carbenoxolone (licorice
root) alters mucin
Rebamipide increase prostaglandins (Asia)
Ecabet increase prostaglandins (Japan)
binds to peptic ulcers, promotes HCO3
Bismuth and mucin production ulcers, H pylori
Nasuea Control
emetics poisoning or drug OD
ipecac syrup acts on CTZ
apomorphine acts on CTZ
anti-emetics
chemotherapy anti-emesis,
irradiation anti-nausea, tx of
ondansetron Zofran 5HT3 receptor antagonist hyperemesis in pregnancy
chemotherapy anti-emesis,
irradiation anti-nausea, tx of
granisetron Kytril 5-HT receptor blocker hyperemesis in pregnancy
chemotherapy anti-emesis,
irradiation anti-nausea, tx of
dolasetron Anzemet 5-HT receptor blocker hyperemesis in pregnancy
phenothiazines:
prochlorperazine,
thiethyperazine,
chlorpromazine, dopamine receptor antagonists (antag of
metaclopramide D2 in CTZ) anti-nausea, anti-emetics
GI Function
Miscellaneous
cisapride
IBD treatment
sub cut.; clearance by kidney, flu-like, neuropsych depression, hemato Sx 10-20% response rate
dose every 24-48 hrs (BM suppression --> cytopenia tx w/ EPO);
cirrhosis (IFN can cause hepatocyte lysis)
iv or sub cut.
oral, peak plasma conc in hrs, preferred over PPI for initial Tx; take between
metab in liver, excreted in d/HA, fatigue, drowsiness, muscle pain, supper and bedtime to prevent nocturnal H+
kidney constip secretion
gynecomastia (binding to androgen
receptors), impotence, prolactin secretion;
inhibits CYP450
rapid absorption and metab, diarrhea, cramps; worsens IBS Sx; can
excreted in kidneys cause abortions / contractions in pregnant
systemic alkalinazation, acid rebound,
constip, diarrhea
take on empty stomach,
activated by acid constipation
respiratory suppression
patch
diarrhea
erythromycin has motilin receptor activity -->
prokinetic
oral rehydration
decr bioavailability of any pos charged drug
constipation, anticholinergic
constipation, anticholinergic
oral
cytotoxic
cytotoxic
Antihypertensives
sympathoplegics
methyldopa bind to alpha adrenergic
receptors in medulla to
inhibit sympathetic NS
clonidine bind to alpha adrenergic
receptors in medulla to
inhibit sympathetic NS
ganglion blocking agents inhibit symp NS
guanethidine uptaken into NE vesicals
presynaptically replacing
NE and decr symp NS
vasoconstriction; also
blocks Na channels
beta blockers
alpha-1 blockers decrease IP3 levels in
arterioles and venules -->
vasodilation
prazosin alpha blocker
terazosin alpha blocker
doxazocin alpha blocker
vasodilators
hydralazine dilates arterioles only long term outpatient HTN
dilates arterioles only;
opens K+ channels to
minoxidil hyperpolarize SMC long term outpatient HTN
dihydropyridines
anti-angiotensin drugs
ARBs blockade of AT1 receptor antihypertensive
--> inhib Ca release in
SMCs --> vasodilation; pre-
synaptic inhib NE release
and dis-inhibited NE uptake
(clearance) from synapse;
inhib aldosterone release
from adrenal cortex
losartan
valsartan
candesartan
iprosartan
irbesartan
telmisartan
ACE inhibitors inhibit angiotensin I
converting enzyme; inhib
AngII and incr bradykinin
1/2 life --> vasodilation
captopril decr TPR w/o incr HR,
promote Na excretion and
H2O loss
enalapril
benazapril
Transplant
Immunosuppresives
azathioprine cell cycle inhibitors
mycophenolate mofetil cell cycle inhibitors
cdk : cyclin balance --> inhib
sirolimus (rapamycin) cell cycle
cyclosporine calcineurin inhib --> block
signal 1
calcineurin inhib --> block
tacrolimus signal 1
binds CD3 to prevent APC--
OKT3 TCR binding
glucocorticoids
daclizumab IL2 receptor inhibitor
basiliximab IL2 receptor inhibitor
Transplant
Immunosuppresives
secondary hyperparathyroidism
sevelamer phosphate binder in CKD
secondary hyperparathyroidism
vitD analogues in CKD
calcimemetic, sensitizes
parathyroid to [Ca] to
cinacalcet decrease PTH ESRD
erythropoietin anemia of CKD
darbopoietin anemia of CKD
Urological
alpha blockers (prazosin,
doxazosin) Cardura BPH, HTN
tamsulosin alpha blocker kidney stones
5alpha reductase inhib Proscar BPH
(finasteride)
sildinafil Viagra ED
tadalafil Cialis ED
vardenafil Levitra ED
LHRH agonist / GHRH
agonsit, inhibiting
gonadotropin hormone
lupron Leuprolide release prostate cancer, infertility
LHRH agonist / GHRH
agonsit, inhibiting
gonadotropin hormone
goserelin release prostate cancer, infertility
synthetic PGE1,
intracavernosal injection to
alprostadil increase SMC relaxation ED
prevention of kidney stones
acetohydroxamic acid urease inhibitor (struvite)
citrate kidney stone prevention
antimuscarinics overactive bladder
Kinetics CI/SE Notes
hyponatremia, low ECFV, hypoCa, K+ backleak drives reabsorption of Ca and Mg; large increase in urine
hypoMg, hypoK, hypoH (alkalosis), volume, U-Na and U-Cl and U-Ca and U-Mg
ototoxic, hyperuricemia, hyperglycemia,
sulfonamide hypersensiticity
iv contra in CHF, pulmonary edema; neg lumen potential b/c more Na delivery and uptake in CT -->
excessive loss of H2O and electrolytes, promotes K+ secretion
hypokalemia
hypokalemia not very effective, alkaline urine, small incr urine volume
i.v.
i.v.
i.v.
teratogenic, hypotension, renal failure no cough, more complete blockade of angII effects than ACEi's
post-transplant hyperlipidemia
post-xplant DM, HTN, hyperlipidemia
rapid effect decrease serum Ca, inhibit PTH synth and secretion
nitroprusside
long half life nitroprusside
quick onset nitroprusside, virapamil
General
Anesthetics disruption of lipid bilayer
(Gasses) voltage gated ion channels
dantrolene neuroleptic malignant
syndrome (NMS),
malignant hyperthermia
General
Anesthetics
(Injected)
thiopental barbiturate; potentiate
GABAa actions ultra short-acting
methohexital barbiturate ultra short-acting
thiamylal barbiturate ultra short-acting
propofol
tolerance of ICU ventilation rapid recovery
dexmedetomidine
tolerance of ICU ventilation rapid recovery
etomidate rapid anesthesia in
cardiovascular dz pts rapid
midazolam
benzodiazepine; potentiate short dental procedures for
GABAa channel anterograde amnesia
diazepam Valium benzodiazepine
lorazepam benzodiazepine
ketamine
to produce dissociative
anesthesia, tx hypovolemic
NMDA receptor blockade shock
morphine
mu-receptor opiod agonist
meperidine
mu-receptor opiod agonist
remifentanil
mu-receptor opiod agonist short surgical procedures
alfentanil
mu-receptor opiod agonist short surgical procedures
fentanyl '+ droperidol --> neuroleptic
analgesia; + droperidol +
N2O --> neuroleptic
mu-receptor opiod agonist anesthesia
sufentanil
mu-receptor opiod agonist
Antipsychotic
inapsine delirium 3rd line im or iv, rapid onset
benzodiazepine
alcohol withdrawal delirium,
akathisia
benztropine
Parkinsonism SE of typical
Cogentin anticholinergic antipsychotics, akathisia
trihexylphenidine Parkinsonism SE of typical
Artane anticholinergic antipsychotics
typical,
1st generation neuroleptic,
antipsychotics tranquilizer D2 blockers
chlorpromazine Thorazine agitation in schizo low potency
thioridizine
Mellaril low potency
haloperidol
Haldol delirium 1st line, schizo high potency
fluphenazine high potency
loxapine mid potency
perphenazine Trilafon mid potency
2nd generation positive sx; 1st line
antipsychotics psychosis, bipolar disorder
atypical 5-HT2a / D2 antagonists (acute care)
clozapine
Movement Dz
converted by aromatic
amino acid decarboxylase much broken down in liver (no
levodopa to form DA Parkinson's brain access)
carbidopa inhibits peripheral
Sinemet breakdown of L-DOPA Parkinson's
entacapone
COMT inhibitor -- prevents
Stelevo breakdown of DA Parkinson's
ropinirole Parkinson's, restless leg
Requip DA2/3 agonist syndrome
pramipexole Mirapex DA2/3 agonist Parkinson's
pergolide Permax D2 agonist Parkinson's
bromocriptine Parkinson's, neuroleptic
Parlodel D2 agonist malignant syndrome
amantidine Mirapex NMDA antagonist, flu Parkinson's
rimantidine NMDA antagonist, flu Parkinson's
benzotropine akathisia, drug induced
Cogentin anticholinergic (muscarinic) Parkinson's, dystonia im or iv
trihexylphenidine drug induced Parkinson's,
Artane anticholinergic (muscarinic) dystonia im or iv
diphenhydramine antihistamine and
Benadryl anticholinergic dystonia im or iv
selegiline deprenyl MAO-B inhibitor Parkinson's
carbergoline Dostinex D2 agonist Parkinson's
MPTP
Cognition
donepezil Aricept ChE inhibitor mild to mod AD, dementia once/day dosing
Antiepileptics
phenytoin Dilantin block Na channels partial, tonic-clonic
carbamazepine Tegretol block Na channels partial, tonic-clonic
oxcarbazepine Trileptal block Na, modulate K partial, tonic-clonic
Anti-
inflammatory
leukotrienes
thromboxanes
prostaglandins
PGE
prostacycline
PGI
leukotriene effective in pts who suffer CYP450 metabolism rxns
modifiers asthma attacks after NSAID (warfarin, theophylline)
use
zafirlukast Accolate LTD4 receptor antagonist chronic asthma oral
mast cell
modifiers
cromolyn sodium Intal aerosolized NSAID; inhib maint. Tx for asthma
mast cell degranulation
Omalizumab Xolair injected anti-IgE antibody severe asthma one injection / 2-4 weeks
binds free IgE to prevent
membrane-bound IgE's
available on mast cells -->
recuded atopy of mast cells
and basophils
NSAIDs
chloroquine,
hydroxychloroquine RA, malaria
penicillamine RA
methotrexate RA
anti-microtubule agent,
blocks leukocyte migration
cholchicine and phagocytosis limit inflammation from gout
Hypnotics
barbiturates
banzodiazepines
Other Agents
zolpidem Ambien act at BZD site on GABAa trouble sleeping through metab liver, CYP450
channels (alpha1 subunit) night oxidation; rapid onset, short
duration
zaleplon Sonata act at BZD site on GABAa rapid onset sleep metab liver, CYP450
channels (alpha1 subunit) oxidation; rapid onset, short
duration
eszopiclone Lunesta act at BZD site on GABAa metab liver, CYP450
channels (alpha1 subunit) oxidation; rapid onset, short
duration
chloral hydrate CNS depressant
anti-histamines
(diphenhydramine, 1st generation H1
doxylamine, Nytol, Sominex, antagonist -- anticholinergic
chlorpheniramine) Unisom effect
antidepressants sedating antidepressants,
(nefazodone, but have other receptor
trazodone) effects
kava kava CNS depressant
Migraine
triptans
enkephalin endogenous
dynophrin endogenous
endorphins endogenous
morphine full agonist 4-6 hrs duration
meperidine Demerol full agonist
fentanyl full agonist general anesthesia highly potent
codeine weak agonist crosses BBB
methadone long acting substitute for opiate addiction crosses BBB
opiates
oxycodone Percocet
(hydrocodone)
tramadol Ultram
propoxyphene Darvocet
dextromethorphan antitussive
heroin, full agonist fast acting, crosses BBB
acetylmorphine
buprenorphine partial agonist / antagonist
naloxone Narcan antagonist heroine overdose reversal short acting (1-2 hrs) IV only
naltrexone ReVia antagonist maintenance of opiod long acting (10-48 hrs), ~40%
abuse tx, EtOH abuse oral bioavailability
pentazocine k-agonist, u partial agonist
Buspirone Buspar 5-HT 1A agonist generalized anxiety slow acting (~2 wks)
disorder
Lithium carbonate / bipolar disorder (esp 2-3 wks to reach steady state,
citrate manic) excreted only (not
metabolized); monitor serum
electrolytes to maintain
therapeutic dose
pentobarbital
secobarbital
amobarbital
benzodiazepines GABAa -- increased anxiolytics, high lipid solubility --> rapid
frequency of Cl- opening sedative/hypnotic (faster onset, completely absorbed
sleep initiation, longer PO; metab in liver; mostly
duration), EtOH detox, Phase I transformation to
muscle relaxer, desmethyldiazepam (active
anticonvulsant metabolite) --> increased 1/2
life up to 1 wk
trazodone Desyrel weak 5HT reuptake inhib / sleep aid, used short term
partial agonist; alpha1 for pts starting SSRI
antag; H1 antag;
TCAs block reuptake of 5-HT and panic disorder tertiary broken down to
NE 2ndary --> both have effect
moclobemide reversible
CI/SE Notes
S enantiomer
hypotension
low anti-cholinergic SEs, and very little alpha1-blockade most potent D2 blocker
agranulocytosis (monitor WBC), seizures, mycarditis, doctors resistant to prescribing; only clozapine is proven to
wt gain, sedation, orthostasis, tachycardia, be better than typicals; 30% tx rate in tx-resistant pts; more
constipation, sialorrhea, no prolactin SE, no EPS effective tx of negative sx
freezing, dyskinesias -- too much DA release requires existing DA neurons, wears off
valvular heart disease (5-HT mediated)
neuraminidase inhibitors
neuraminidase inhibitors
D2 receptors on ACh interneurons in striatum (block to treat)
innervate GABAergic
constipation, insomnia, dizziness, HA, hallucinations slows rate of decline and improves cognition
high cardiovascular disease risk
CYP450 inhib
CYP450 inducer
CYP450 inhib
monocyte and granulocyte chemotaxis, constrict airways
activate platelets
stimulate mucus and HCO3 production, increase kidney
perfusion, regulate temperature at hypothalamus
inhibit platelets
vasodilation
induces abortion
cardiovascular events,
removed from market
highly toxic
chemotherapeutic
GI toxicity
GI irritation
sedation, GI effects, n/v/d/constipation, dry mouth, second generation drugs do not penetrate CNS --> less
urinary retention, hypersensitivity, photosensitivity sedation and anti-muscarinic effects
sedation
sedation
sedation
see Anxiolytics
see Anxiolytics
do not mix with EtOH, preserve sleep architecture, less next day effect, minimal
REM rebound, low risk tolerance, dependence
do not mix with EtOH, preserve sleep architecture, less next day effect, minimal
REM rebound, low risk tolerance, dependence
do not mix with EtOH, preserve sleep architecture, less next day effect, minimal
REM rebound, low risk tolerance, dependence
cheap
NOT schedule IV agents
do not mix w/ EtOH --> coma; liver toxicity
analgesia, euphoria, sedation, cough suppression; withdrawal has low mortality, altough physical effects are
hypotension, bradycardia, constipation (no tolerance), severe
decreased GI motility, urinary retention, mast cell
histamine release, prolonged labor, decreased uterine
contractions, respiratory suppression, miosis (no
tolerance); potentiation of effects w/ BZD, EtOH,
tricyclics, antipsychotics, MAO-Is
cough suppressant
schedule II
withdrawal
withdrawal
renal dysfunction, arrhythmias, GI distress, tremor, anticonvulsants (carbamazepine or valproic acid) may also
cognitive impairment, hypothyroidism, 1st semester be used to tx bipolar disorder; mechanism unknown, may
congenital abnormalities (heart defects); edema, inhib inositol production or inhib cAMP synth?; very low
polydypsia, polyuria, mental status changes, ataxia; therapeutic index… toxic > 1.5 mEq/L
interactions with diuretics, NSAIDs
do not give if mixed OD with EtOH or TCA, can ppt no effect on other CNS depressants
withdrawal if pt is dependent
narrow margin of safety; respiratory depression, CYP rarely used
induction, tolerance/dependence, withdrawal; incr
porphyrin synth
tolerance/dependence if long term, potential OD decreased sleep latency, decreased stage 4 and REM,
when combined w/ other sedating drugs --> increased stage 2, increased total sleep time; toxicity can
(respiratory suppression, coma, seizures, death), take 7-10 days to occur, steady state can take 1-2 wks;
drowsiness, ataxia, disinhibited, paradoxical cross-tolerance to barbiturates, severe alcoholics; schedule
aggression (rare), allergic (rare), anterograde IV drugs, reduce dose w/ elderly, rapid tolerance in 1-2 wks;
amnesia (esp short-acting agents), morning wider safety margin than barbiturates
drowsiness; discontinuation can cause rebound
anxiety, incr REM sleep (less physically restful),
withdrawal if abrupt; CIs: liver damage, age, COPD,
sleep apnea; tobacco decreases BDZ levels via
induction; crosses placenta and breast milk; do not
mix with EtOH
pseudoparkinsonism dangerous if OD
low risk seizures (0.01%), CI if head injury, seizure hx, no sexual side effects, no serotonin effects
eating disorder
also blocks ACh (alpha1 and muscarinic) and three ring structure
antihistamine (sedating): dry mouth, constipation, dizzy,
tachycardia, urinary retention, decr libido, orthostatic
hypotension, wt gain; cardiotoxicity (arrhythmias),
delerium, respiratory depression, potentiation of sedating
drugs; high risk suicide b/c low therapeutic index
stimulates appetite