Académique Documents
Professionnel Documents
Culture Documents
19. Ketoconazole.
20. Griseofulvin.
1. Carbamazepine(anti-epileptic).
2. Tricyclic antidepressants (TCA's).
3. Chlorpromazine (anti-psychatic).
4. Erythromycin (antibiotic).
5. Chlorpromazine (anti-diabetic).
6. Oral contraceptives.
7. Rifanpicin(anti-T.B)
8. H2-blockers as Cimetidine (anti-ulcer).
1. a1-Agonists
2. Ergot alkaloids (except dihydroergotoxine)
3. Non selective β-blockers
1. β-blockers
2. M2-Agonists (e.g Methacholine , Edrophonium , Neostigmine)
3. Digitalis (cardiac glycosides)
4. Anti Arrhythmic drugs : quinidine , Ca2+-channel blockers (e.g.
verapamil)
5. a1-Agonists: e.g. Noradrenaline , phenylepherine , Methoxamine
(causes reflex bradycardia following elevation of blood pressure &
contraindicated in hypertensive patients )
1- Thiazide diuretics
2- Loop diuretics
3- C.A. Inhibitors
4- Steroids (Aldosterone - cortisone)
5- Adrenaline (and other drugs acting as β 2-Agonists) due to uptake of K + from
blood into skeletal muscles.
J-Drugs causing hyperkalemia :
1 K+-sparing diuretics
2 ACE-Inhibitors (Captopril , ………)
3 ARBs (Losartan , ………)
4 Drugs that inhibit Aldosterone synthesis (e.g. Metyropone , see
hormones)
5 Succinycholine
6 Non-seletive β-Blocker (e.g. propranolol)
N.B. Digitalis does not cause hypokalemia , but hypokalemia induces digitalis
toxicity.
2-Colchicine(+ hematuria).
3-Gold salts(in treatment of rheumatoid arthritis).
4-Vancomycin.
Anti-
Bacteri
5-Aminoglycosides.
6-Cephalosporins.
7-Methicillin.
8-Sulphonamides.
9-Tetracyclines(especially of expired = Fanconi syndrome).
10-Amphotericin B (Anti-fungal).
11-Acyclovir(Anti-viral).
12-Demeclocycline(Anti-bacterial tetracycline).
13-Lithium(Anti-manic + mood stabilizer).
14-Methoxyflurane(inhald general anaesthesia as halothane).
1 Spironolactone
Aldosterone antagonists
2 Canrenone
3-Trimetaphane
Non-Aldosterone antagonists
4-Amiloride
6-Teratogenic drugs:
1-NSAIDs except paracetamol(Aspirin causes cardiac septal defect,but is the safest
NSAID).
2-Benzodiazepines.
3-Barbiturates.
4-Chlorpromazine(phenothiazine antipsychotic and anti emetic).
5-Lithium.
6-ACE-inhibitors e.g. Captopril.
7- AT1_(Angiotersin) receptor-antagonists e.g. Losartan.
8-Antihistaminics e.g. Cyclizine and Meclizine.
9-Oral anticoagulants e.g. Warfarin.
10-Thiazide and Loop diuretics.
11-Phenytoin. :
12-carbamazepine.
Prodrugs:
1 Inactive drugs converted in the body into active metabolites.
2 Activation usually occurs in the liver.
3 Chlorazepate is converted into active metabolite nordiazepam in the
stomach by gastric acid.
EXAMPLES:
1. Dipivefrin (used in glaucoma).
2. Phenoxybenzamine (α-blocker).
3. Hexoprenaline (selective β2 agonist used in bronchial asthma, it is a
non-catecholamine, converted to active metabolite by COMT).
4. Minoxidil (antihypertensive, converted into minoxidil sulphate).
5. Enalapril,Fosinopril,Ramipril (ACE inhibitors).
6. Proton pump inhibitors ,e.g; Omeprazole (in treatment of peptic ulcer).
7. Cortisone is converted into cortisol (=hydrocortisone).
8. Sulindac and Nabumetone (NSAID).
9. Ampicillin esters(=pro-ampicillins) as
Bacampicillin,Pivampicillin,Talampicillin, converted into ampicillin in
liver and GIT mucosa.
10. Chlorazepate (Benzodiazepine).
11. Propacetamol→Paracetamol, given by injection.
Drug Diagnosis of
1-Phentolamine Sustained type of pheochromocytoma
(non-selective α-blocker) (Phentolamine cause severe hypotension in
these patients). “Regtive test”
2-Clonidine (central α2-agonist ) Sustained type of pheochromocytoma =
clonidine suppression test (Clonidine can’t
supress release of catecholamines from the
tumor)
3-Methacholine (M-agonist) Paroxysmal type of pheochromocytoma =
4-Histamine (Autacoid) provocative test (they cause hypertension in
patients with pheochromocytoma instead of
hypotension in other patients)
5-Ergotamine (ergot alkaloid- Prinzmetal (variant or vasospastic) angina.
oxytocic-weak α1-agonist) (Ergotamine causes marked coronary V.C. in
these patients)
6-Adrenaline (sympathomimetic- Acute hemorrhagic pancreatitis (Lewi’s test).
catecholamine-β and α agonist) (Adrenaline causes active mydriasis in this
case)
7-Methacholine (M-agonist) Bronchial asthma = provocative test
(Methacholine causes marked bronchospasm
and inc. bronchial secretion in these patients)
8-Edrophonuim I.V. Myathenia gravis
9-Neostigmine I.M. + Atropine
(Edrophonium and neostigmine
are reversible anti -
cholinesterases)
10-Edrophonium I.V. Differentiation between myasthenic and
cholinergic crisis in patients of myathenia
gravis.
11-Ampicillin Infections mononucleasis (Ampicillin causes
maculopopular rash). “See chemotherapy”
1 The cause of death in acute toxicity is due to depression of R.C., i.e central
respiratory failure.
2 Competitive neuro-muscular blockers cause peripheral respiratory failure
but not central because they don’t cross B.B.B
3 Organophosphorus compund poisoning cause both central and peripheral
respiratory failure.
4 General rules for treatment of acute drug toxicity :
1. Stomach wash = gastirc lavage (if the drug is ingested**)
2.Care for respiration (endotrachial intubation – artificail respiration)
3.Antidote (if there is a specific antidote , e.g. atropine for
organophosphorus poisoning , neostigmine for curare toxicity ,
physostigmine for atropine poisoning)
4.Symptomatic treatment (e.g. anticonvulsant as diazepam)
5.Increase (promote) renal excretion of the drug (by changing pH of urine :
Acidification of urine in toxicity of basic drugs as amphetamine and
ephedrine using ammonium chloride or ascorbic acid , Alkalinization of
urine in toxicity of acidic drugs as salicylates (aspirin) using NaHCO3. The
drug should be completely or partially execreted in urine unchanged)
** In acute morphine toxicity stomach wash is performed although morphine is
given by I.V. injection!! (see CNS)
N.B : The size of the pupil is a useful diagnostic sign.
1. Anticancer drugs.
2. Heparin (anticoagulant).
3. Colchicine (treatment and prophylaxis of acute gouty arthritis).
4. Sodium Valproate (broad spectrum antiepileptic).
5. Oxazolidinediones (antiepileptics in petit-mal epilepsy).
6. Interferons (in treatment of Hepatitis C virus "HCV").
1. Minoxidil sulphate
2. Pilocarpine
15-Drug groups:
1 -zoline group:
2 Naphazoline
2 Tetrahydrozoline α1-Agonists , used locally as nasal decongestants
3 Xylometazoline
4 Tolazoline α-blocker , causes nasal congestion
· -lol group:
3 β-Blockers (Propranolol-Nadolol-Atenolol-Esmolol-…………)
(Butoxamine is selective β2-Blocker)
· -zosin group = selective α1-blockers
2 Prazosin
3 Terazosin
4 Doxazosin
(Tamsulosin = selective α1A-blocker used in prostatic hyperplasia)
2 Apraclonidine
Used in glucoma
3 Brimonidine
4 Tizanidine (central skeletal muscle relaxant)
· -zepine group = selective M1-blocker (useful in treatment of peptic ulcer)
1 Pireuzepine
2 Telenzepine
· -stigmine = carbamates , reversible anticholine-esterases :
2 Physostigmine
3 Rivastigmine (in Alzheimer)
4 Neostigmine
In myasthenia gravis
4 Pyridostigmine
1 -tripan group : used in acute migraine headache , agonists on 5HT 1D
2 Sumatripan
2 Rizotripan
3 Zolmitripan
5 Ranitripan
· -tropium group = Atropine substitutes in bronchia asthma
3 Ipratropium
3 Oxytropium
4 Tiotropium
* -tropine group = Atropine substitutes
1 Benzotropine (in Parkinsonism)
2 Homatropine
Mydriatics
3 Eucatropine
· -curium and curonium group = Competitive neuro-muscular blockers
4 Atracurium
5 Cis-atracurium
6 Mivacurium
7 Pancuronium
8 Vecuronium
9 Alcuronium
1 -tidine group = H2-Blockers used in peptic ulcer
2 Cimitidine (+ HME inhibitor + Gynecomastia and infertility)
2 Famotidine
4 Ranitidine
5 Nizatidine
· -setron group = 5HT3-Antagonists used as anti-emetics in cancer chemotherapy
and radiotherapy
3 Ordansetron
3 Granisetron
5 Tropisetron
· -lukast group = Leukotriene receptor anatgonist used in prophylaxis of bronchial
asthma
4 Montelukast
4 Zafirlukast
· -zolamide group = Carbonic Anhydrase Inhibitors
5 Acetazolamide
5 Methazolamide See diuretics
6 Ethoxzolamide
6 Dorzolamide (eye drops in glaucoma)
· -dipine group = Dihydropyridine calcium channel blockers (cause
arteriodilatation more than cardiac dep.)
6 Nifedipine
6 Amlodipine
7 Nimodipine
7 Felodipine
6 Nicardipine
7 Isradipine
· -pril group = ACE Inhibitors
7 Captopril
7 Lisinopril
8 Enalapril
Take care :
Ø Butyryl choline esterase = Pseudocholine esterase
Ø Scopolamine = Hyoscine
Ø Suxamethonium = Succinyl choline
Ø Isoproterenol = Isoprenaline
Ø Epinephrine = Adrenaline
Ø Norepinephrine = Noradrenaline