A. BIOCHEMISTRY
- De novo Purine/ Pyrimidines synthesis
● Leflunomide (inhibit DD)
● Hydroxyurea (inhibit RR)
● 5FU and Capecitabine (inhibit TS enzyme) decrease dTMP
● MTX,TMP, pyrimethamine (inhibit DR enzyme) decrease dTMP
● 6MP, azathioprine
● Mycophenolate, Ribavirin (inhibit IMD enzyme)
- Ethanol Met
● Fomepizole
● Disulfiram
- Cytochrome agents
● Rotenone (complex 1)
● Antimycin A (complex 3)
● Cyanide / CO/ Azides (complex 4)
● Oligomycin (complex 5)
● Uncoupling agents (DNT-dinitrophenol, aspirin overdose)
- Ethanol metabolism
● Fomepizole (inhibits acetaldehyde formation)
● Disulfiram (inhibits acetate formation)
B. IMMUNOLOGY
- Immunosuppressant
● Cyclosporine (NEPHROtoxic, HTN, hyperlipidemia, NEUROtoxic, hirsutism,
gingival hyperplasia)
● Tacrolimus (similar to previous; increased risk of Diabetes, NEUROtoxic)
● Sirolimus (rapamycin) -(pancytopenia, insulin resistance, hyperlipidemia)
● Basiliximab (edema, HTN, tremors)
● Azathioprine (pancytopenia)
● Mycophenolate Mofetil (GI upset, pancytopenia, HTN, hyperglycemia, not so
NEPHRO / NEUROtoxic)
● Glucocorticoids (Cushings, osteoporosis, hyperglycemia, diabetes,
amenorrhea, adrenal atrophy, peptic ulcers, psychosis, cataracts, avascular
femoral necrosis)
- Recombinant cytokines
● Erythropoietin
, ● CSF- filgrastim sargramostim
● Romiplostim
● Aldesleukin
● INF- A,B,Y
- Therapeutic antibodies
● Alemtuzumab (CD52)
● Bevacizumab (VEGF)
● Rituximab (CD20)
● Trastuzumab (HER2)
● Adalimumab, infliximab (soluble TNF)
● Eculizumab (complement protein C5)
● Natalizumab (alpha4 integrin)
● Ustekinumab (IL-12 /23)
● Abciximab (platelet glycoprotein 2b/3a)
● Denosumab (RANK-Ligand)
● Omalizumab (IgE)
● Palivizumab (RSV protein-F)
● Emicizumab (factor 9a 10) for Hemophilia
● Others (phentermine, diethylpropion, benzphetamine)
C. MICROBIOLOGY
- Penicillin (hypersensitivity, D.Coombs + , hemolytic anemia, drug-induced
interstitial nephritis)
- Penicillinase -sensitive- amoxicillin, ampicillin, aminopenicillins (hypersensitivity, rash,
P.colitis)
- Penicillinase -resistant- diclo, naf, oxacillin (hypersensitivity, interstitial nephritis)
- Antipseudomonal -Piper, ticarcillin (hypersensitivity)
- Cephalosporin (hypersensitivity autoimmune HA, disulfiram like, vit K deficiency,
low cross reactivity even in penicillin-allergic patients)(increased NEPHROtoxicity
with Aminoglycosides)
- B-lactamase inhibitors- (clavulanate avibactam, sulbactam, tazobactam)
- Carbapenems (GI distress, rash, CNS seizures toxicity at high levels)
- Monobactams - (aztreonam) (nontoxic, maybe GI upset)
,- Vancomycin (NEPHROtoxic, OTOtoxic, Thrombophlebitis, diffuse flushing,
RedManSyndrome, DRESS syndrome)
- Aminoglycoside (NEPHROtoxic, NEUROmuscular block so is contraindicated in
MG, OTOtoxic, Teratogenic)
- Tetracyclines, Glycylcyclines (GI distress, teeth discoloration, inhibit bone growth in
children PHOTOsensitivity)(NOT IN PREGNANCY)(GI upset nausea, vomiting with
glycylcyclines)
- Chloramphenicol (dose induced anemia, aplastic anemia, gray baby syndrome in
premature infants because lack of liver UDP glucuronosyltransferase)
- Clindamycin (P. colitis, fever , diarrhea)
- Oxazolidinones (bone marrow suppression / thrombocytopenia, peripheral
NEUROpathy, Serotonin Syndrome)
- Macrolides (azithro, clarithro, erythromycin) : (GI motility issues, arrhythmias,
prolonged QT, cholestasis hepatitis, rash, eosinophilia)
- Polymyxins ( E and B) (NEPHROtoxic, NEUROtoxic with slurred speech, weakness
and paresthesia, respiratory failure)
- Sulfonamides ( “azoles, azine”) (hypersensitivity, hemolysis in G6PD deficiency,
NEPHROtoxic, tubulointerstitial nephritis, PHOTOsensitivity, Stevens Johnson
Syndrome, kernicterus in infants, displaces other drugs from albumin <ex.
warfarin>
- Dapsone (hemolysis in G6PD deficiency, methemoglobinemia, agranulocytosis)
- Trimethoprim (hyperkalemia at high doses, megaloblastic anemia, leukopenia,
granulocytopenia which may be avoided using ‘leucovorin’ <folinic acid>
- Fluoroquinolones (‘floxacines’`, ciprofloxacin) (GI upset, superinfections, skin rashes,
headaches, dizziness. May cause leg cramps and myalgias)
- Daptomycin (myopathy, rhabdomyolysis)
- Metronidazole (disulfiram like reactions when used with alcohol, headaches,
metallic taste)
- Rifamycin (minor HEPATOtoxic, induce cytochrome, orange body fluids)
- Rifampin
,- Isoniazid (HEPATOtoxic, p450 inhibition, drug-induced SLE, AGMA, vit B6
deficiency, seizures at high doses, must give B6)
- Pyrazinamide (hyperuricemia, HEPATOtoxic)
- Ethambutol (optic neuropathy with red / green blindness that may be reversible)
- Streptomycin (tinnitus, vertigo, ataxia, NEPHROtoxic)
- Nitrofurantoin (TX for cystitis)
- AMP- B (fever, chills, HYPOtension, NEPHROtoxic, arrhythmias, anemias, IV
phlebitis, hydration decreases NEPHROtoxicity. Liposomal AMP decreased
toxicity)
- Nystatin
- Flucytosine (bone marrow suppression)
- Azoles (testosterone synthesis inhibition, gynecomastia, liver dysfunction, inhibits
p450)
- Terbinafine (GI upset, headaches, HEPATOtoxic, taste disturbance)
- Echinocandins (GI upset, flushing)
- Griseofulvin (teratogenic, carcinogenic, confusions, headaches, disulfiram like,
induces p450 and warfarin metabolism)
- Anti Mite/Louse (permethrin, malathion, lindane) (lindane is NEUROtoxic)
- Chloroquine (retinopathy, pruritus, specially in darkened individuals)
- Antihelminthic (pyrantel pamoate, ivermectin, mebendazole praziquantel,
diethylcarbamazine)
- Antiprotozoals (Pyrimethamine, suramin, melarsoprol, nifurtimox, sodium stibogluconate)
- Oseltamivir, zanamivir
- Acyclovir, famciclovir, valacyclovir (obstructive crystalline NEPHROpathy, AKI)
- Ganciclovir (bone marrow suppression - leukopenia, neutropenia,
thrombocytopenia, NEPHROtoxic)
,- Foscarnet (NEPHROtoxic, electrolyte imbalances: HYPO / HYPERcalcemia /
phosphatemia; hypokalemia, hypomagnesemia; leading to seizures)
- Cidofovir (NEPHROtoxic)
- NRTIS( abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir, zidovudine)
(bone marrow suppression, peripheral NEUROpathy, lactic acidosis with
nucleosides, anemia with Zidovudine, and pancreatitis by Didanosine)(Abacavir
contraindicated in patients with HLA B5701 mutation because of hypersensitivity
risk)
- NNRTIS(delaVIRdine, efaVIRenz, neVIRapine) (Rash and HEPATOtoxic; vivid dreams
and CNS symptoms with Efavirenz)
- Protease inhibitors (“ navirs”) (hyperglycemia, GI intolerance, nausea, vomiting,
lipodystrophy)(NEPHROpathy, hematuria and thrombocytopenia with Indinavir)
(use Rifabutin to minimize reduction in concentrations of protease inhibitors by
cytochrome)
- Integrase inhibitors (“ tegravir”) (increased CK)
- Fusion inhibitors (enfuvirtide, maraviroc) (enfuvirtide bind gp41 inhibiting viral ‘entry’;
maravinoc binds to CCR5 on T Cells and monocytes inhibiting interaction with gp120
and thereby inhibiting ‘docking’)
- NS5A inhibitors (“asvir”) (headaches, diarrhea)
- NS5B inhibitors (“buvir”) (fatigue, headaches)
- NS3/4A inhibitors (“previr”) (PHOTOsensitivity and Rash with Grazoprevir;
Headaches and fatigue with Simeprevir)
- Ribavirin (hemolytic anemia and teratogenic)
- OXIDES / IODINES : are “sporicidal”, all others are Not.
D. PHARMACOLOGY
- Cholinomimetics
● Agonist direct (bethanechol, carbachol, methacholine, pilocarpine)
● Agonist Indirect / anticholinesterases ( donepezil, rivastigmine, galantamine,
edrophonium, neostigmine, physostigmine, pyridostigmine)
- Muscarinic antagonist
, ● Atropine, homatropine, tropicamide (eyes)
● Benztropine, trihexyphenidyl (CNS): acute dystonia and Parkinsons
● Glycopyrrolate (GI, respiratory): reduces airway secretion, drooling and peptic
ulcers.
● Hyoscyamine, dicyclomine (GI): antispasmodic for IBS
● Ipratropium, tiotropium (respiratory) for COPD and asthma
● Oxybutynin, solifenacin, tolterodine (Genitourinary) : reduces bladder spasm and
urge urinary
● Scopolamine (CNS) : motion sickness
● Atropine : used to treat bradycardia and ophthalmic complications; blocks
muscarinic effects of anticholinesterases but not nicotinic. (Side effects include
increased body temperature due to decrease sweating, dry mouth,
cycloplegia, dry flushed skin, constipation, disorientation, increased HR)
- Sympathomimetics (direct vs indirect)
● Albuterol, salmeterol, terbutaline (Beta 2> Beta 1)
● Dobutamine (Beta 1> Beta 2, Alpha)
● Dopamine (D1 = D2, Beta, Alpha)
● Epinephrine (Beta > alpha)
● Fenoldopam (D1)
● Isoproterenol (Beta 1= Beta 2)
● Midodrine (alpha 1)
● Mirabegron (Beta 3)
● Norepinephrine (alpha 1 > alpha 2 > beta 1)
● Phenylephrine (alpha 1 > alpha 2)
● Amphetamine, cocaine, ephedrine
- Sympatholytics (alpha 2 agonists)
● Clonidine, guanfacine, alpha-methyldopa (CNS depression, bradycardia,
HYPOtension, respiratory depression, miosis, rebound HTN with abrupt
cessation)(D. Coombs + hemolysis and Drug-induced lupus with
‘alpha-methyldopa’)
● Tizanidine (hypotension, weakness, xerostomia)
,- Alpha blockers
● Non selective (phenoxybenzamine, phentolamine) : (orthostatic HYPOtension,
reflex tachycardia)
● 1-selective (“ozin”) (headaches, dizziness and 1st dose orthostatic
HYPOtensions)
● 2-selective (mirtazapine): (sedation, increased serum cholesterol and
increased appetite)
- Beta Blockers (erectile dysfunction, CV bradycardia, AV block and HF; CNS
seizures and altered sleep: dyslipidemia with ‘metoprolol’ and asthmas/COPD
exacerbations when using nonselective)
● BETA Selective (Acebutolol, atenolol, betaxolol bisoprolol, esmolol, metoprolol)
● BETA Non-Selective (nadolol, nevidolol, pindolol, propranolol, timolol, carteolol)
● ALPHA/BETA Non Selective (carvedilol, labetalol)
- RECEPTORS G-Coupled
● Alpha-Adren - (q, i)
● Beta-Adrenergic - ( s,s,s)
● Muscarinic - (q, i, q)
● Dopamine - (s, i)
● Histamine - (q, i)
● Vasopressin (q, s)
E. CARDIOVASCULAR
- Lipid Lowering Drugs
● Statins ` (HEPATOtoxicity, myopathy)
● Bile acid resins (cholestyramine, colestipol, colesevelam) : (GI upset, decreased
absorption of other drugs and fat soluble vitamins)
● Ezetimibe (increased LFTs, diarrhea)
● Fibrates (“fibrozil, fibrate”) (Myopathy, cholesterol gallstones)
● Niacin (b3) (red flushed face, hyperglycemia, hyperuricemia)
, ● PCSK9 inhibitors ( alirocumab, evolocumab) (myalgias, delirium, dementia,
neurocognitive)
● FIsh Oil / Omega FA (nausea, fish like taste)
- Cardiac glycosides (digoxin): (cholinergic side effects, blurry yellow vision,
arrhythmias, AV block, can lead to hyperkalemia. Hypokalemia, renal failure, drugs
that displace digoxin and decreased clearance by verapamil, amiodarone, quinidine,
predispose to drug toxicity.)
- Antiarrhythmics
● Class 1a (quinidine, procainamide, disopyramide) (Cinchonism, SLE, HF,
torsades de pointes, thrombocytopenia)
● Class 1b (lidocaine, mexiletine) (CNS stimulation/ depression, cardiovascular
depression)
● Class 1c (flecainide, propafenone) (contraindicated in post MI, ischemic heart
disease / pro arrhythmic)
● Class 2 (olol, carvedilol, beta blockers)
● Class 3 (amiodarone, ibutilide, dofetilide, sotalol, bretylium) (torsades de
pointes, pulmonary fibrosis, HEPATOtoxicity, HYPO/HYPER
hypothyroidism, photodermatitis, constipation, bradycardia, heart block,
HF.)
● Class 4 (verapamil, diltiazem ) : (constipation, flushing, edema, HF, AV block,
sinus node depression)
● Others ( adenosine, MG+2) (flushing, HYPOtension, chest pain, sense of
impending doom, bronchospasm)
● Ivabradine (luminous phenomena, visual brightness, HTN, bradycardia)
● Ranolazine late phase Na+ channel): (constipation, dizziness, headaches,
nause)
● Milrinone (selective PDE3 Inhibitor) : (arrhythmias, HYPOtension)
● Sacubitril (prevents degrading natriuretic peptides, AT2, substance P by
neprilysin) increases vasoDILATION. (HYPOtension, hyperkalemia, cough,
dizziness.)
