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Pharmacology 100B KEY WORDS FOR KEY DRUGS

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Pharmacology 100B KEY WORDS FOR KEY DRUGS

The brief descriptions serve as a rapid review. Use the list in two ways: first, cover the column of properties and test your ability to provide some descriptive information about drugs picked at random from the left column; second, cover the left column and attempt to name a drug that fits the properties described. Abbreviations: ACE, angiotensin-converting enzyme; ANS, autonomic nervous system; AV, atrioventricular; BP, blood pressure; BPH, benign prostatic hyperplasia; CHF, congestive heart failure; CNS, central nervous system; CV cardiovascular system; ECG, lectrocardiogram; ENS, enteric nervous system; EPS, extrapyramidal system; GI, gastrointestinal; HR, heart rate; HTN, hypertension; MI, myocardial infarction; NM, neuromuscular; PANS, parasympathetic autonomic nervous system; SANS, sympathetic autonomic nervous system; Tox, toxicity; WBC, white blood cells.




Abciximab

Monoclonal antibody to fibrin receptor (glycoprotein IIb/IIIa) on platelets. Used to prevent

clotting after coronary angioplasty

Acetaminophen

Antipyretic analgesic: very weak cyclooxygenase inhibitor; not anti-inflammatory. Less

toxic than aspirin but more dangerous in overdose (causes hepatic necrosis-antidote:

acetylcysteine)

Acetazolamide

dorzolamide Carbonic anhydrase inhibitor diuretic: produces a NaHCO3 diuresis, results in bicarbonate depletion, and therefore has self-limited action. Used in glaucoma and mountain sickness.

Dorzolamide

is a topical analog for glaucoma

Acetylcholine

Cholinomimetic prototype: transmitter in CNS, ENS, all ANS ganglia, parasympathetic

postganglionic synapses, sympathetic postganglionic fibers to sweat glands, and some

skeletal muscle vasodilator synapses

Acyclovir

Antiviral: inhibits DNA synthesis in herpes simplex and varicella zoster. Requires

activation by viral thymidine kinase (TK- strains are resistant). Tox: behavioral effects and

nephrotoxicity (crystalluria), but not myelosuppression

Adenosine

Antiarrhythmic: unclassified ('Group V'); parenteral only. Hyperpolarizes AV nodal

tissue, blocks conduction for 10-15 sec. Used for nodal reentry arrhythmias

Allopurinol

Antigout: inhibitor of xanthine oxidase; reduces production of uric acid

Albuterol,

Important 2-agonists; used mainly for asthma.

metaproterenol,terbutaline

Alprazolam

Benzodiazepine sedative-hypnotic: widely used in anxiety states, selectivity for panic

attacks and phobias; possible antidepressant actions. Tox: psychologic and physical

dependence, additive effects with other CNS depressants

Alteplase (rt-PA)

Thrombolytic: human recombinant tissue plasminogen activator. Used in acute MI to

recanalize the occluded coronary. Occasionally used in pulmonary embolism, stroke. Tox:

bleeding

Amiloride

K+-sparing diuretic: blocks Na+ channels in cortical collecting tubules

Aminoglutethimide

Nonsteroid inhibitor of steroid synthesis: reduces conversion of cholesterol to the hormone

precursor, pregnenolone. Used in metastatic breast cancer

Amiodarone

Group IA and III antiarrhythmic: broad spectrum, blocks sodium, potassium, calcium

channels, beta receptors. High efficacy and very long half-life (weeks-months). Tox:

deposits in tissues; hypo- or hyperthyroidism; pulmonary fibrosis

Amitriptyline

Tricyclic antidepressant: blocks reuptake of norepinephrine and serotonin. Tox: atropine-

like, postural hypotension, sedation; cardiac arrhythmias in overdose, additive effects with

other CNS depressants

Amoxicillin

Penicillin: wider spectrum than pen G with activity similar to ampicillin but greater oral

bioavailability; less adverse effects on GI tract than ampicillin. Susceptible to

penicillinases unless used with clavulanic acid. Tox: penicillin allergy

Amphetamine

Indirectly acting sympathomimetic: displaces stored catecholamines in nerve endings.

Marked CNS stimulant actions; high abuse liability. Tox: psychosis, HTN, MI, seizures

Amphotericin B

Antifungal: polyene drug of choice for most systemic mycoses; binds to ergosterol to

disrupt fungal cell membrane permeability. Tox: chills and fever, hypokalemia,

hypotension, nephrotoxicity (dose-limiting, possibly less with liposomal forms)

Ampicillin

Penicillin: wider-spectrum than pen G, susceptible to penicillinases unless used with

sulbactam. Activity similar to pen G, plus E coli, H influenzae, P mirabilis, Shigella.

Synergy with aminoglycosides versus enterococci and listeria. Tox: penicillin allergy; more

adverse effects on GI tract than other penicillins; maculopapular skin rash

Anistreplase (APSAC)

Thrombolytic: bacterial streptokinase complexed with human plasminogen. Longer acting

in body than other thrombolytics (rt-PA, streptokinase, urokinase). Tox: bleeding, allergy

to streptococcal protein

Aspirin

NSAID prototype: inhibits cyclooxygenase (COX) I and II irreversibly. Potent antiplatelet

agent as well as antipyretic analgesic anti-inflammatory drug

Atenolol

Beta1-selective blocker: low lipid solubility, less CNS effect; used for HTN. (Note

mnemonic for beta1-selective blockers: their names start with A through M. [Exceptions:

carteolol & labetalol are not selective])

Atropine

Muscarinic cholinoceptor blocker prototype: lipid soluble, CNS effects. Tox: 'red as a

beet, dry as a bone, mad as a hatter,' urinary retention, mydriasis

Azithromycin

Antibiotic: similar to erythromycin, but greater activity versus chlamydia and streptococci;

long half-life due to tissue accumulation. Tox: GI distress, but no inhibition of drug

metabolism

Baclofen

GABA analog, orally active: spasmolytic; activates GABAB receptors in the spinal cord

Benztropine

Centrally acting antimuscarinic prototype for parkinsonism

Bethanechol

Muscarinic agonist: choline ester with good resistance to cholinesterase; used for atonic

bowel or bladder

Botulinum Toxin:

enzyme produced by Clostridium botulinum; interacts with fusion/docking proteins

to block release of acetylcholine vesicles

Bromocriptine

Ergot derivative: dopamine agonist in CNS; inhibits prolactin release. Used in

parkinsonism and hyperprolactinemia. Tox: CNS, dyskinesias, hypotension

Bupivacaine

Long-acting amide local anesthetic prototype: greater CV toxicity than most local

anesthetics

Buspirone

Anxiolytic: atypical drug that interacts with 5HT1A receptors; slow onset. Minimal

potentiation of CNS depressants including ethanol; negligible abuse liability

Captopril

ACE inhibitor prototype: used in HTN, diabetic renal disease, and CHF. Tox:

hyperkalemia, fetal renal damage, cough ('sore throat')

Carbachol

Nonselective muscarinic and nicotinic agonist: choline ester with good resistance to

cholinesterase; used for glaucoma (not a first-line drug)

Carbamazepine

Anticonvulsant: tricyclic derivative used for tonic-clonic and partial seizures; blocks Na+

channels in neuronal membranes. Drug of choice for trigeminal neuralgia; back-up drug in

mania. Tox: CNS depression, hematotoxic, induces liver drug-metabolizing enzymes

Cefazolin

First-generation cephalosporin prototype: bactericidal beta-lactam inhibitor of cell wall

synthesis. Active against gram-positive cocci, E coli, K pneumoniae, but does not enter

CSF. Tox: potential allergy; partial cross-reactivity with penicillins

Cefoxitin



Second-generation cephalosporin: active against a wide spectrum of gram-negative

bacteria including anaerobes (B fragilis). Does not enter the CNS

Ceftriaxone

Third-generation cephalosporin: active against resistant bacteria including gonococci, H

influenzae, and other gram-negative organisms. Crosses the blood-brain barrier

Celecoxib

, rofecoxib First COX-II-selective NSAIDs. Reduced GI toxicity

Chloramphenicol

Antibiotic: broad spectrum agent; inhibits protein synthesis (50S); uses restricted to back-

up drug for bacterial meningitis, infections due to anaerobes, Salmonella. Tox: reversible

myelosuppression, aplastic anemia, gray baby syndrome

Chloroquine

Antimalarial: blood schizonticide used for treatment and as a chemosuppressant where P

falciparum is susceptible. Tox: GI distress and skin rash at low doses; peripheral

neuropathy, skin lesions, auditory and visual impairment, quinidine-like myocardial

depression at high doses

Chlorpheniramine

Antihistamine H1 blocker prototype: Tox: sedation, antimuscarinic

Chlorpromazine

Phenothiazine antipsychotic drug prototype: blocks most dopamine receptors in the CNS.

Tox: atropine-like, EPS dysfunction, hyperprolactinemia, postural hypotension, sedation,

seizures (in overdose), additive effects with other CNS depressants

Cholestyramine,

colestipol Bile acid-binding resins: sequester bile acids in gut and divert more cholesterol from the liver to bile acids instead of circulating lipoproteins. Tox: constipation, bloating; interfere with absorption of some drugs

Cimetidine

H2 blocker prototype: used in acid-peptic disease. Tox: inhibits hepatic drug metabolism;

antiandrogen effects. Less toxic analogs: ranitidine, famotidine, nizatidine

Ciprofloxacin

Fluoroquinolone antibiotic: bactericidal inhibitor of topoisomerases; active against many

gram-negative rods including E coli, H influenzae, Campylobacter, Enterobacter,

Pseudomonas, Shigella. Tox: CNS dysfunction, GI distress, superinfection, collagen

damage (avoid in children and pregnant women). Interactions: caffeine, theophylline,

warfarin

Cisplatin

Platinum-containing alkylating cancer chemotherapeutic agent. Used for several

solid tumors (eg, testes, lung). Carboplatin is similar.

Clindamycin

Lincosamide antibiotic: bacteriostatic inhibitor of protein synthesis (50S); active against

gram-positive cocci, B fragilis. Tox: GI distress, pseudomembranous colitis

Clomiphene

Estrogen partial agonist: synthetic used in infertility to induce ovulation

Clonidine

Alpha2 agonist: acts centrally to reduce SANS outflow, lowers BP. Tox: rebound HTN if

stopped suddenly

Clozapine

Atypical antipsychotic: low affinity for dopamine D2 receptors, higher for D4 and 5-HT2A

receptors; less EPS adverse effects than other antipsychotic drugs. Tox: ANS effects,

agranulocytosis (infrequent but significant)

Cocaine

Indirectly acting sympathomimetic: blocks amine reuptake into nerve endings. Local

anesthetic (ester type). Marked CNS stimulation, euphoria; high abuse liability. Tox:

psychosis, cardiac arrhythmias, seizures

Colchicine

Microtubule assembly inhibitor: reduces mobility and phagocytosis by WBCs in gout-inflamed joints; useful in acute, not chronic gout. Tox: GI, hepatic, renal damage

Cyclopentolate, tropicamide Antimuscarinics for ophthalmology: shorter duration than atropine (a few hours or less); cause cycloplegia and mydriasis

Cyclophosphamide Antineoplastic, immunosuppressive: cell cycle-nonspecific alkylating agent. Tox:alopecia, gastrointestinal distress, hemorrhagic cystitis, myelosuppression

Cyclosporine Immunosuppressant: antibiotic; inhibits interleukin-2 synthesis, suppresses T cells. Tox:HTN, hirsutism, nephrotoxicity (dose-limiting), seizures (in overdose). Not a myelosuppressant

Dantrolene Blocks Ca2+ release from sarcoplasmic reticulum of skeletal muscle. Used in muscle spasm (cerebral palsy, multiple sclerosis, cord injury) and in emergency treatment of hyperthermia caused by malignant hyperthermia, malignant neuroleptic syndrome, and serotonin syndrome

DDAVP ADH analog: synthetic peptide used for pituitary diabetes insipidus

DDT Insecticide: prevents inactivation of sodium channels, causes uncontrolled neuronal activity. Stored for years in body fat in mammals, birds, fish death; used mainly for solid or superficial tumors. Tox: GI distress, myelosuppression

Deferoxamine Chelator: bacterial product; chelates iron very avidly, aluminum less so

Dexamethasone Glucocorticoid: very potent, long-acting; no mineralocorticoid activity

Dexfenfluramine 5-HT reuptake inhibitor and receptor agonist previously used as anorexic. Tox: produced cardiac valve damage when used in combination with phentermine

Diazepam Benzodiazepine prototype: binds to BDZ receptors of the GABAA receptor-chloride ion channel complex; facilitates the inhibitory actions of GABA by increasing frequency of channel opening. Uses: anxiety states, ethanol detoxication, muscle spasticity, status epilepticus. Tox: psychologic and physical dependence, additive effects with other CNS depressants

Didanosine (DDI) Antiviral: nucleoside inhibitor of HIV reverse transcriptase. Tox: peripheral neuropathy, pancreatitis

Digitoxin Cardiac glycoside: half-life 168 h, excreted in the bile (partially as digoxin); subject to enterohepatic circulation. See digoxin

Digoxin Cardiac glycoside prototype: positive inotropic drug for CHF, half-life 40 h; renal excretion; inhibits Na+/K+ ATPase, also a cardiac parasympathomimetic. Tox: calcium overload arrhythmias, GI upset

Diltiazem Calcium channel (L-type) blocker prototype: like verapamil, has more depressant effect on heart than dihydropyridines (eg, nifedipine). Tox: AV block, CHF, edema, constipation

Dimercaprol (BAL) Chelator (British AntiLewisite): used for arsenic, lead, and mercury poisoning

Dioxin (TCDD) Toxin: byproduct of the manufacture of herbicides 2,4-D and 2,4,5-T. Tox: extremely potent carcinogen in guinea pigs; poorly documented in humans except for chloracne, a skin disorder that occurs acutely upon exposure

Diphenhydramine Antihistamine H1 blocker prototype: used in hayfever, motion sickness, dystonias. Tox: antimuscarinic, anti-alpha, sedative

Disopyramide Group IA antiarrhythmic: used for ventricular arrhythmias. Tox: strong antimuscarinic; may cause CHF

Dopamine Neurotransmitter and agonist drug at dopamine receptors: used in shock to increase renal blood flow, stimulate heart

Doxorubicin Antineoplastic: anthracycline drug (cell cycle-nonspecific); intercalates between base pairs to disrupt DNA functions and forms cytotoxic free radicals. Tox: cardiotoxicity, myelosuppression

Doxycycline Tetracycline antibiotic: protein synthesis inhibitor (30S), more effective than other tetracyclines against bacillary dysentery. Unlike other tetracyclines, it is eliminated mainly in the feces. Tox: see tetracycline

Echothiophate Organophosphate cholinesterase inhibitor: less lipid soluble than most organophosphates; used in glaucoma

Edetate (EDTA) Chelating agent: used in lead poisoning. Tox: renal tubular necrosis

Edrophonium Cholinesterase inhibitor: very short duration of action (15 min). Used to reverse NM blockade and as diagnostic test in myasthenia gravis

Enoxaparin Low molecular weight heparin. Primary effect is anti-factor X. Other low molecular weight heparin-like products: dalteparin, danaparoid. Tox: bleeding

Ephedrine Indirectly acting sympathomimetic: like amphetamine but less CNS stimulation, more smooth muscle effects

Epinephrine Adrenoceptor agonist prototype: product of adrenal medulla, some CNS neurons. Affinity for all alpha and all beta receptors. Used in asthma; as hemostatic and adjunct with local anesthetics; drug of choice in anaphylaxis

Ergonovine Ergot alkaloid: uterine effect prototype, causes prolonged uterine contraction. Used in post-partum bleeding

Ergotamine Ergot alkaloid: vascular effect prototype, causes prolonged vasoconstriction, uterine contraction. Used in migraine, obstetrics

Erythromycin Macrolide antibiotic: inhibitor of protein synthesis (50S); activity includes gram-positive cocci and bacilli, M pneumoniae, Legionella pneumophila, C trachomatis. Tox: cholestatic jaundice, inhibits liver drug-metabolizing enzymes, interactions with astemizole, theophylline, terfenadine, warfarin

Ethacrynic acid Loop diuretic: not a sulfa derivative. Tox: like furosemide but does not increase serum uric acid.

Ethanol Sedative-hypnotic: acute actions include impaired judgment, ataxia, loss of consciousness, vasodilation, and cardiovascular and respiratory depression. Chronic use leads to dependence and liver, cardiovascular, endocrine, gastrointestinal, hepatic, and nervous system pathology. Note: zero-order elimination kinetics

Ethosuximide Anticonvulsant: used in absence seizures; may block T-type Ca2+ channels in thalamic neurons. Tox: GI distress but safe in pregnancy

Etidronate, pamidronate, alendronate Bisphosphonates: reduce turnover of bone calcium. Used in Pagetís disease, osteoporosis; alendronate increases bone formation. Tox: severe esophageal ulceration



Fexofenadine 2nd generation antihistamine; does not enter CNS, little or no sedation Finasteride Steroid inhibitor of 5 -reductase: inhibits synthesis of dihydrotestosterone, the active androgen in prostate. Used in BPH

Flecainide Group IC antiarrhythmic prototype: used in ventricular tachycardia and rapid atrial arrhythmias with Wolff-Parkinson-White syndrome. Tox: arrhythmogenic, CNS excitation

Fluconazole Imidazole antifungal: used for esophageal candidiasis and in coccidioidomycoses; high CSF levels provide prophylaxis versus fungal meningitis in immunosuppressed patients

Fludrocortisone Synthetic corticosteroid: high mineralocorticoid and moderate glucocorticoid activity; long duration of action

Flumazenil Benzodiazepine receptor antagonist: used to reverse CNS depressant effects of benzodiazepines (overdose or when used in anesthesia)

Fluorouracil Antineoplastic: pyrimidine antimetabolite (cell cycle-specific) causes 'thymine-less' cell

Fluoxetine Antidepressant: serotonin selective reuptake inhibitor (SSRI) prototype. Less ANS adverse effects and cardiotoxic potential than tricyclics. Tox: CNS stimulation, seizures in overdose

Flutamide Androgen receptor inhibitor: nonsteroid used in prostatic carcinoma

Foscarnet Antiviral: effective against CMV and HSV (including TK- strains); Tox: electrolyte imbalance, nephrotoxicity

Furosemide Loop diuretic prototype: blocks Na+/K+/2Cl- transporter; high efficacy; used in acute pulmonary edema, refractory edematous states, hypercalcemia. Tox: ototoxicity, K+ wasting, hypovolemia, increased serum uric acid

Ganciclovir Antiviral: effective against CMV; requires bioactivation via thymidine kinase. Tox: myelosuppression, nephrotoxicity

Gemfibrozil, clofibrate Antilipemics: stimulate lipoprotein lipase in peripheral tissues. Used in hypertriglyceridemias and mixed triglyceridemia/hypercholesterolemia

Gentamicin Aminoglycoside prototype: bactericidal inhibitor of protein synthesis (30S); active against many aerobic gram-negative bacteria. Narrow therapeutic window; dose reduction required in renal impairment. Tox: renal dysfunction, ototoxicity; once-daily dosing is effective (post-antibiotic effect) and less toxic

Glipizide, glyburide Oral hypoglycemics: second generation, very potent. Like other sulfonylureas, act by closing K channels in pancreatic B cells, causing depolarization and release of insulin. Tox: hypoglycemia

Glucagon Hormone product of pancreatic A cells. Increases blood sugar via increased cAMP

Guanethidine Postganglionic sympathetic neuron blocker: enters nerve ending by means of uptake-1 and

Haloperidol Antipsychotic butyrophenone: blocks brain dopamine D2 receptors. Tox: marked EPS dysfunction, hyperprolactinemia; less ANS adverse effects than phenothiazines

Halothane General anesthetic prototype: inhaled halogenated hydrocarbon. Causes cardiovascular and respiratory depression and relaxes skeletal and smooth muscle. Use has decreased due to sensitization of heart to catecholamines, and occurrence (rare) of hepatitis and malignant hyperthermia

Heparin Anticoagulant: large polymeric molecule with antithrombin, and anti-factor X activity. Primary rapid onset, in vitro and in vivo anticoagulation. Antidote: protamine. See also enoxaparin

Hydralazine Antihypertensive: arteriolar vasodilator, orally active; used in HTN, CHF. Tox: Tachycardia, salt and water retention, lupus-like syndrome

Hydrochlorothiazide Thiazide diuretic prototype: acts in distal convoluted tubule; blocks Na+/Cl- transporter; used in HTN, CHF, chronic renal stone syndrome. Tox: increased serum lipids, uric acid, glucose; K+ wasting

Ibuprofen NSAID prototype: short duration. Inhibits cyclooxygenase (both I and II) reversibly. Used in arthritis, dysmenorrhea, muscle inflammation. Tox: peptic ulcer, renal damage

Imipenem Antibiotic: carbapenem beta-lactam active against many aerobic and anaerobic bacteria including penicillinase-producing organisms; a bactericidal inhibitor of cell wall synthesis. Used with cilastatin (which inhibits metabolism by renal dehydropeptidases). Tox: allergy (partial cross-reactivity with penicillins), seizures (overdose)

Imipramine Tricyclic antidepressant prototype: blocks reuptake of norepinephrine and serotonin. Tox: ANS (alpha and muscarinic) blockade, cardiac arrhythmias

Indinavir Antiviral; HIV protease inhibitor used as component of combination regimens in AIDS. Tox: anemia, nephrolithiasis, inhibits P-450 drug metabolism reactions. Other protease inhibitors: ritonavir, nelfinavir, saquinavir

Indomethacin NSAID prototype: highly potent. Usually reserved for acute inflammation (eg, acute gout),

Insulin Hypoglycemic peptide hormone of B (beta) cells of the pancreas: stimulates transport of glucose into cells and glycogen formation; inhibits lipolysis and protein catabolism

Interferon- Important cytokine for the treatment of hepatitis B and C infection.

Ipodate Antithyroid: iodine-containing radiocontrast medium; also used in thyrotoxicosis. Reduces peripheral conversion of T4 to T3; may also reduce release of hormone from thyroid

Ipratropium Antimuscarinic agent: aerosol for asthma, COPD. Good bronchodilator in 20-30% of patients. Not as effective as 2 agonists

is stored in the ending (effect reversed by TCAs, cocaine). Tox: severe orthostatic hypotension, sexual dysfunction

Isoniazid Antimycobacterial: primary drug in combination regimens for tuberculosis; used as sole agent in prophylaxis. Metabolic clearance via N-acetyltransferases (genetic variability). Tox: hepatotoxicity (age-dependent), peripheral neuropathy (reversed by pyridoxine), hemolysis (in G6PD deficiency)

Isoproterenol Beta1, beta2 agonist catecholamine prototype: bronchodilator, cardiac stimulant. Always causes tachycardia because both direct and reflex actions increase HR. Tox: arrhythmias, angina

Ketoconazole Antifungal azole prototype: active systemically; inhibits the synthesis of ergosterol. Used for C albicans, dermatophytes and for non-life-threatening systemic mycoses. Tox: hepatic dysfunction, inhibits steroid synthesis and P450-dependent drug metabolism

Labetalol Alpha- and beta-blocker: used in HTN. Tox: AV block, hypotension

Leuprolide GnRH analog: synthetic peptide used in pulse therapy to stimulate gonadal steroid synthesis (infertility); used in continuous or depot therapy to shut off steroid synthesis, especially in prostate carcinoma

Levodopa Dopamine precursor: used in parkinsonism, usually combined with carbidopa (a peripheral inhibitor of dopamine metabolism). Tox: dyskinesias, hypotension, on-off phenomena, behavioral changes

Lidocaine Local anesthetic, medium duration amide prototype: highly selective use-dependent Group IB antiarrhythmic; used for nerve block and post MI ischemic ventricular arrhythmias. Tox: CNS excitation

Lithium Antimanic prototype: drug of choice in mania and bipolar affective disorders; blocks recycling of the phosphatidyl inositol second messenger system. Tox: tremor, diabetes insipidus, goiter, seizures (in overdose), teratogenic potential (Ebsteinís malformations)

Lovastatin Antilipemic HMG-CoA reductase inhibitor prototype: acts in liver to reduce synthesis of cholesterol. Other statins: atorvastatin, fluvastatin, pravastatin, simvastatin. Tox: liver damage (elevated enzymes), muscle damage

LSD Lysergic acid diethylamide, 'Acid:' semisynthetic ergot derivative; orally active; hallucinogen

Malathion Organophosphate insecticide cholinesterase inhibitor: pro-drug converted to malaoxon. Less toxic in mammals and birds because metabolized to inactive products

Meperidine Opioid analgesic: synthetic, equivalent to morphine in efficacy, but orally bioavailable.

Mestranol Synthetic estrogen: used in many oral contraceptives Metformin, phenformin Oral biguanide ypoglycemics: mechanism not understood, different from sulfonylurea oral hypoglycemics. Some efficacy in the absence of functioning pancreatic B cells

Methadone Opioid analgesic: synthetic mu agonist, equivalent to morphine in efficacy, but orally bioavailable with longer half-life (used to suppress withdrawal symptoms and in maintenance programs). Tox: see morphine

Methotrexate Antineoplastic, immunosuppressant: cell cycle-specific drug that inhibits dihydrofolate reductase. Major dose reduction required in renal impairment. Tox: gastrointestinal distress, myelosuppression. Leucovorin rescue used to reduce toxicity after very high doses

Methyldopa Antihypertensive: prodrug of methylnorepinephrine, a CNS-active 2 agonist. Reduces SANS outflow from vasomotor center. Tox: positive Coombs test, hemolysis

Methysergide Ergot alkaloid: used as prophylactic in migraine. Tox: retroperitoneal and subendocardial fibroplasia

Metoprolol Beta1-selective blocker: used in HTN and for prevention of post-MI sudden death arrhythmias

Metronidazole Antiprotozoal antibiotic: drug of choice in extraluminal amebiasis and trichomoniasis; active against bacterial anaerobes including B fragilis and in antibiotic-induced colitis due to C difficile. Tox: peripheral neuropathy, gastrointestinal distress, ethanol intolerance, mutagenic potential

Mexiletine Group IB antiarrhythmic drug: like lidocaine but orally active

Mifepristone (RU 486) Progesterone and glucocorticoid inhibitor: abortifacient, antineoplastic

Minoxidil Antihypertensive: pro-drug of minoxidil sulfate, a high efficacy arteriolar vasodilator. Used in HTN; topically for baldness. Tox: tachycardia, salt and water retention, pericardial effusion

Misoprostol PGE1 derivative: orally active prostaglandin used to prevent peptic ulcers in patients taking

Morphine Opioid analgesic prototype: strong mu receptor agonist. Poor oral bioavailability. Effects include analgesia, constipation, emesis, sedation, respiratory depression, miosis, and urinary retention. Tolerance may be marked; high potential for psychologic and physical dependence. Additive effects with other CNS depressants

Nafcillin Penicillinase-resistant penicillin prototype: used for suspected or known staphylococcal infections; not active against methicillin-resistant staphylococci. Tox: penicillin allergy

Nalbuphine Opioid: mixed agonist-antagonist analgesic that activates kappa and weakly blocks mu receptors. Effective analgesic, but with lower abuse liability and less respiratory depressant effects than most strong opioid analgesics

Naloxone Opioid mu receptor antagonist: used to reverse CNS depressant effects of opioid analgesics (overdose or when used in anesthesia)

Neostigmine Cholinesterase inhibitor prototype: quaternary nitrogen carbamate with little CNS effect

Nevirapine Prototype nonnucleoside inhibitor of HIV reverse transcriptase (NNRTI).Others : efavirenz, delavirdine

Niacin Antilipemic: reduces release of VLDL from liver into circulation. Tox: flushing

Nifedipine Calcium channel blocker prototype: vasoselective (less cardiac depression); used in angina, HTN. Tox: constipation, headache

Nitroglycerin Antianginal vasodilator prototype: releases NO in smooth muscle of veins, less in arteries, and causes relaxation. Standard of therapy in angina (both atherosclerotic and variant). Tox: tachycardia, orthostatic hypotension, headache

Norepinephrine Adrenoceptor agonist prototype: acts at all alpha and at beta1 adrenoceptors; used as vasoconstrictor. Causes reflex bradycardia. Tox: ischemia, arrhythmias, HTN



Norfloxacin Fluoroquinolone antibiotic: inhibits bacterial DNA gyrase; active against many urinary pathogens including E coli, H influenzae, Klebsiella, Enterobacter, Pseudomonas, Serratia. Tox: see ciprofloxacin

Norgestrel Progestin: used in many oral contraceptives and Norplant implantable contraceptive

not chronic; neonatal patent ductus arteriosus. Tox: GI (bleeding), renal damage

NSAIDs for arthritis. Tox: diarrhea

Olanzapine Atypical antipsychotic; high affinity antagonist at 5HT2A with minimal extrapyramidal side effects; improves both positive and negative symptoms of schizophrenia

Omeprazole Antiulcer: irreversible blocker of H+/K+ ATPase proton pump in parietal cells of stomach. Used in Zollinger-Ellison syndrome, gastroesophageal reflux disease (GERD)

Ondansetron, granisetron 5-HT3 receptor blockers: very important antiemetics for cancer chemotherapy; also used

Paraquat Toxic herbicide: very small oral (but not inhaled) doses cause lethal pulmonary fibrosis

Parathion Organophosphate acetylcholinesterase inhibitor prototype: used as insecticide. Pro-drug: converted in body to paraoxon. Other organophosphates: DFP, soman, tabun, echothiophate. Tox: 'DUMBELS' mnemonic

Penicillamine Chelator, immunomodulator: copper and sometimes lead, mercury, arsenic. Used in Wilsonís disease and rheumatoid arthritis

Penicillin G Penicillin prototype: active against common streptococci, gram-positive bacilli, gram- negative cocci, spirochetes, and enterococci (if used with an aminoglycoside); penicillinase-susceptible. Tox: penicillin allergy

Phenobarbital Long-acting barbiturate prototype: used as a sedative and for tonic-clonic seizures. Facilitates GABA-mediated neuronal inhibition (by increasing duration of channel opening) and may block excitatory neurotransmitters. Partial renal clearance that can be increased by urinary alkalinization. Chronic use leads to induction of liver drug- metabolizing enzymes and ALA synthase. Tox: psychologic and physical dependence liability; additive effects with other CNS depressants

Phenoxybenzamine Alpha-blocker prototype: irreversible action. Used in pheochromocytoma

Phentolamine Alpha-blocker prototype: reversible action. Used in pheochromocytoma

Phenytoin Anticonvulsant: used for tonic-clonic and partial seizures; blocks Na+ channels in neuronal membranes. Serum levels variable due to first-pass metabolism and dose-dependent nonlinear elimination kinetics. Tox: sedation, diplopia, gingival hyperplasia, hirsutism, respiratory depression in overdose, teratogenic potential. Drug interactions via effects on plasma protein binding or induction of hepatic metabolism

Physostigmine Cholinesterase inhibitor prototype: alkaloid tertiary amine carbamate, enters eye and CNS readily. Used in glaucoma

Pilocarpine Muscarinic agonist prototype: tertiary amine alkaloid. May cause paradoxical hypertension by activating excitatory muscarinic EPSP receptors in postganglionic sympathetic neurons. Used in glaucoma. Tox: muscarinic excess

Piroxicam NSAID with longest duration of action (t1/2 about 40 h)

post-operatively to reduce vomiting

Pralidoxime Acetylcholinesterase regenerator: very high affinity for phosphorus in organophosphates

Prazosin, terazosin,doxazosin Alpha1-selective blockers: used in HTN. Tox: first-dose orthostatic hypotension

Prednisone Glucocorticoid prototype: potent, short-acting; much less mineralocorticoid activity than cortisol but more than dexamethasone or triamcinolone

Probenecid Uricosuric: inhibitor of renal weak acid secretion and reabsorption in S2 segment of proximal tubule; prolongs half-life of penicillin, accelerates clearance of uric acid. Used in gout

Probucol Antilipemic: unknown mechanism; recently withdrawn but new evidence suggests efficacy in preventing restenosis of coronaries after angioplasty.Tox: causes arrhythmias

Procainamide Group IA antiarrhythmic drug: short half-life; similar to quinidine but may cause lupus erythematosus

Propranolol Nonselective beta-blocker prototype: local anesthetic action but no partial agonist effect. Used in HTN, angina, arrhythmias, migraine, hyperthyroidism, tremor. Tox: asthma, AV block, CHF

Propylthiouracil Antithyroid drug prototype: reduces iodination of tyrosine and coupling of MIT and DIT in

Prostacyclin PGI2: prostaglandin vasodilator and inhibitor of platelet aggregation

Pyridostigmine Cholinesterase inhibitor: long-acting (8 h) quaternary carbamate; used in myasthenia gravis

Quinidine Group IA antiarrhythmic prototype: used in atrial and ventricular arrhythmias. Tox: cinchonism, GI upset, thrombocytopenic purpura, arrhythmogenic

Quinine Antimalarial: blood schizonticide; no effect on liver stages. Isomer of quinidine, same toxicity

Ranitidine H2 blocker: like cimetidine but less inhibition of hepatic drug metabolism; no antiandrogenic effects

Reserpine Antihypertensive: selective inhibitor of vesicle catecholamine/H+ antiporter; used in HTN, causes depletion of catecholamines and 5-HT from their stores. Tox: severe depression, suicide, ulcers

Rifampin Antimicrobial: inhibitor of DNA-dependent RNA polymerase used in drug regimens for tuberculosis and the meningococcal carrier state. Tox: hepatic dysfunction, induction of liver drug-metabolizing enzymes (drug interactions), flu-like syndrome with intermittent dosing

Risperidone, olanzapine,sertindole Newer atypical antipsychotics. Higher potency, more blocking of 5-HT2 receptors than older antipsychotic agents. Low extrapyramidal toxicity.

Selegiline MAO-B inhibitor: selective inhibitor of the enzyme that metabolizes dopamine (no tyramine interactions). Used in parkinsonism as adjunct

Sildenafil Viagra. Blocks phosphodiesterase that splits cGMP; enhanced smooth muscle relaxation causes erection. Important interaction with nitrates.

Streptokinase Thrombolytic: protein from streptococci that accelerates plasminogen-to-plasmin conversion. Tox: bleeding, allergy

Strong agonist at mu opioid receptors; blocks muscarinic receptors. Tox: see morphine

Succimer (DMSA) Chelator: dimercaptosuccinic acid; used to chelate lead and arsenic

Succinylcholine Depolarizing neuromuscular relaxant prototype: short duration (5 min) if patient has normal plasma cholinesterase (genetically determined). No antidote (compare with tubocurarine)

Sumatriptan, other '-triptans' 5-HT1D receptor agonists: used to abort migraine attacks

Tamoxifen, raloxifen Estrogen partial agonists 'selective estrogen receptor modulators': used in breast carcinoma, osteoporosis

Tetracaine Local anesthetic: long-acting ester prototype

Tetracycline Antibiotic: tetracycline prototype; bacteriostatic inhibitor of protein synthesis (30S). Broad spectrum, but many resistant organisms. Used for Lyme disease, mycoplasmal, chlamydial, rickettsial infections, chronic bronchitis, acne, cholera; a back-up drug in syphilis. Tox: GI upset and superinfections (Candida, staphylococci), antianabolic actions, Fanconiís syndrome (outdated drug), photosensitivity, dental enamel dysplasia

Tetrodotoxin Toxin: very potent sodium channel blocker; blocks action potential propagation in nerve, heart, and skeletal muscle. From puffer fish, California newt. Tox: paresthesias, paralysis

The following list is a compilation of the drugs that are most likely to appear on the USMLE examination

the thyroid; orally active. Tox: rash, agranulocytosis (rare)

Thiazides Diuretic prototype: block Na+/Cl- transporter in distal convoluted tubule; used in HTN, CHF, chronic stone formers. Tox: K+ wasting; increased serum lipids, uric acid, and glucose

Thioridazine Antipsychotic phenothiazine: blocks most dopamine receptors in the CNS. Tox: atropine- like effects (marked), ECG abnormalities, postural hypotension, retinal pigmentation, sedation, additive effects with other CNS depressants (but less EPS dysfunction than other phenothiazines)

Thyroxine, triiodothyronine Major hormones produced by the thyroid: stimulate metabolism, growth, and development

Ticarcillin Extended spectrum penicillin active against selected gram-negative bacteria including Pseudomonas aeruginosa (synergistic with aminoglycosides). Susceptible to penicillinases unless used with clavulanic acid. Tox: penicillin allergy

Ticlopidine, clopidogrel Newer antiplatelet agents. Used to prevent strokes, postangioplasty occlusion.

Tolbutamide, tolazamide,chlorpropamide,acetohexamide Oral hypoglycemics: older sulfonylurea group. (See glipizide.) Chlorpropamide has longest duration of action

Trimethoprim-sulfamethoxazole Antimicrobial drug combination: causes synergistic sequential blockade of folic acid synthesis. Active against many gram-negative bacteria including Aeromonas, Enterobacter, H influenzae, Klebsiella, Moraxella, Salmonella, Serratia, Shigella. Possible back-up agent for methicillin-resistant staphylococci. Tox: mainly due to sulfonamide; includes hypersensitivity, hematotoxicity, kernicterus, and drug interactions due to competition for plasma protein binding

Tubocurarine Nondepolarizing neuromuscular blocking agent prototype: competitive nicotinic blocker. Releases histamine and may cause hypotension. Analogues: pancuronium, atracurium, vecuronium, and other '-curiums' and '-curoniums.' Antidote: cholinesterase inhibitor, eg, neostigmine

Tyramine Indirectly acting sympathomimetic prototype: releases or displaces norepinephrine from stores in nerve endings. Usually inactive by the oral route because of high first pass effect but will cause potentially lethal hypertensive responses in patients taking MAO inhibitors

Valproic acid Anticonvulsant: used in absence, clonic-tonic, and myoclonic seizure states, migraine prophylactic. Tox: GI distress, hepatic necrosis (rare), teratogenic (spina bifida); inhibits drug metabolism

Vancomycin Glycopeptide bactericidal antibiotic: inhibits synthesis of cell wall precursor molecules. Drug of choice for methicillin-resistant staphylococci and effective in antibiotic-induced colitis. Dose reduction required in renal impairment (or hemodialysis). Tox: ototoxicity, hypersensitivity, renal dysfunction (rare)

Verapamil Calcium channel blocker prototype: blocks 'L-type' channels; cardiac depressant and vasodilator; used in HTN, angina, and arrhythmias. Tox: AV block, CHF, constipation

Vesamicol Inhibitor of vesicle ACh/H+ antiporter in cholinergic nerve endings: prevents storage of ACh. No clinical applications

Vincristine Antineoplastic plant alkaloid: cell cycle (M phase)-specific agent; inhibits mitotic spindle formation. Tox: peripheral neuropathy. Compare with vinblastine, a congener that causes myelosuppression

Warfarin Oral anticoagulant prototype: causes synthesis of nonfunctional versions of the vitamin K- dependent clotting factors (II, VII, IX, X). Tox: bleeding, teratogenic. Antidote: vitamin K, fresh plasma

Zanamivir, oseltamivir Neuraminidase inhibitors that can be used to reduce severity and duration of influenza symptoms. Prevents penetration of the virion.

Zidovudine (AZT) Antiviral: prototype nucleoside inhibitor of HIV reverse transcriptase (NRTI). Tox: severe myelosuppression. Others: lamivudine, stavudine, didanosine, zalcitabine.

Zolpidem Non-benzodiazepine hypnotic, acts via the BDZ1 (omega1) receptor subtype and is reversed by flumazenil; less amnesia and muscle relaxation; lower dependence liability






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