of detainee orgs TSH

pharmacokinetics Pharmacodynamics
Body does to drug drug does to body
A Absorption
D Distribution
M Metabolism
E Excretion
cytP45O
1
Lipid soluble water
soluble
Absorption
Absorptn
Git Blood Tissue
Lipid Distribution
Soluble
Excreted C liver 1
BY kidney Metabolism
d
Making drug water soluble

ROUTE
Mr
OF ADMINISTRATION
mmmm

Omar GI Blood
100 7 804

first pass metabolism

 11T.SK

7112 Time taken to become

by drug
1st order half of it's concentration
fraction 50 1 Memoried
1000M 2hm 500 2hm y 250 125
0 older 1112 1St500 2nd 250 3992g 4th
u
my mg mg 62.5
Amount
1000 M 2hm y 950 900 850
50mg 50mg 50mg x
50mg is removed 800

In 1st order c in 5 half life

drug total will be removed 5904.1

most drugs follow first order kinetics

so it's safe for us

staged
www.PrintablePaper.net
 Systemic
te b
Enteral GIT Paraenferal
oral Ernle TTT Lst d I
pass
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febrile seizure ask Insulin Scopula
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790 20 25o
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 ANS mum

parasympathetic sympathetic
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His NA Adrenaline
c
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somatic cranial Ach Muscarcenic
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Pos Cholinergic MI HIB Symp Adrenergic

Secretion Excretion fear flight fight
Miosis Acomodation Mydriasis
Emesis vomiting
Lacrimation
Salivation
Bronchoconstriction Broncho dilation
t.HR THR
TGI motility y GI motility
T urination to Urination
 PARASYMPATHETIC SYSTEM

_une vesicle of Acetyl

0 Choline transfer
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finch STIGMINE
T P's
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Direct acting drug Chol

4 Le

Clos tertiary amine Eauarter periphery only

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Methacholine I
Mz Heart Max acth
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Used in
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asthma Challenge test

Indirect Acting cholinergic

MOAI Block enzyme called Acetylcholine estarase

aka Anti cholinesterase
de de

Clos tertiary periphery only

amine
Quarternery
Px of Alzheimer myasthenia
Donepaail mace
gravis
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Rivastigmine Edrophonium
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Ste hepatotoxicity preferred for doc test
 a L E

physostigmine Ex ptosis drooping Eyelid

Tf of Atropine toxicity
Dathuna toxicity mycontraon n Edroph
Balladona toxicity Eye open
Tension test
Tk by long acting drug
Neostigmine
pyridostigmine
Other uses
skeletal Mls relaxant
toxicity
E curarelcuraninefcumonium
Cobra bite
Px of post op Ileus Mt
Retentn

Irreversible Reversible
Organophosphate carbamates
pesticides or Insecticides

MOA I Block AChE TTT'T Ack

i
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9999 P.S

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contrac
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Broncho constrict
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Emesis
Lacrimatn
salivath
op
pralidOmf

Px for carbamate toxicity o Atropine only

Px for op poisin Atropine 1 pralidoxime
Entry reactivator

I v Atropine given every 5 mins

signs of Atropinazation
I secretion
Mydriasis
HR 7100
Anti cholinergics It pas
Eadnammniced VAT stases and El
vasa
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mm
E Botulinum
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toxin
mm

MOA f 0 Release of Acetylcholine

Relaxant of muscle
R I Blepharospasm
in mm mm
E Torticollis cervical dystonia tilting of
E Achalasia cardia neck
o
Cosmetics
mmmm

Muscananic Blockers m0 trops

ftp.s
Benzinopine
Benzhexol Trihexiphenidyl
Bipioridine
Used in Px of Drug induced parinsonism
pm I PARK 40012 BENZ

Mydriatic cycloplegia Ae children

Used for ophthalmoscopy fundoscopy
Tropicamide fast acting drug Adult
Atropine Strong cycloplegia
 By syst route its avoided in children
dlt risk of hypothermia I
cyclopentolate

Bronchodilator I
R of COPD Asthma
Ipratropium
Tiotropium
Umeclidinium
Atropine THR ER of Bradyannythmia
cardia

GIT
me 0 acidity bing.FI
Iing.mhg
pinanzepine
Telenzepine

Muscaranic blockers
Antispasmodics Antiemetic
scopolamine scopolamine behind ear
Dicyclomine Transdermal route
DOC
for motion
sickness
 Elle bndag latch
Drug to decrease urination
Px of urinary Incontination
Nocturnal enuresis

Solitenacin fenacin.uroselective.mg
Oxybutinin
Fesoterodin flavoxate
Tolterodin Trospium
Bladder ddarifenacin
 Sympathetic
mm system
mm

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3
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MIC

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t tune in
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prostate urethra of brain
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 Tyrosine catecholamine
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Block tyrosine hydroxylase
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Block release of NA
 Catecholamine BD
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Drug acting in sympathetic system

I Catecholamine contained ring

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3 Reuptake blockers I cocaine TCA Tricyclicantidepres ant

only vasoconstrictor

I CATECHOLAMINES
mmmm

Endogenous 4
Exogenous
Adrenaline Epinephrine Dobutamine 1311
Noradrenaline Norepinephrine Isoprenaline
Dopamine
o
fenoldopam DIT
Ale Anaphylactic shock
Doc
also used in BP and bronchoconstrict
Bradycardia
Given a local anesthetic
shows vasomotor devensal of Dale
Epinephrine reversal of Dale
Route 8 Iom g Soc

Img 1mL I 1000 dilution

I y route is avoided except in cardiac arrest
1110,000 dilution

Noradrenaline
Used in caudiogenic shock 13
Vasodilatory Shock

Dopamine
Used in caudiogenic shock 13
Doc cardiogienic Shock E Oliguria
for in wenn

Di 1 31 Al less amount
low dose Med High of urine
2mg 2 to 10k0g
s
go
es n
e
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13

Isoprenaline Isoproterenol
Be 132
Px of Px of Asthma
All block

FENOLDOPAM 8 Px of MN emergency
DI

it
Releases I EAT
Ephedrine f pseudoephedrine Nasal decongestant
Amphetamine
Tyramine wine
chees s
cheese eenaetinoy severe Hen

patient taking Mano inhibitor

Amphatamine a related drug

Modafinil Twakefulness
Px of Narcolepsy
Methylphenidate ADHD AHenth deficit Hyperkinetic
DOC disorder

Alpha agonist
I
As
Mydriasis
o
fundoscopy
Vasoconstriction TBP
R of Hypotension
Shock
Mx of congestion
phenylephrine mydriatic decongestant
Oocy xylometaroline Nasal decongestant
Midodrine Px of orthostatic hypotension

phenylephrine also used for septic shock

2 Az Agonist 1 EW
A Methyldopa Px Of PIM i Bp h
SIE Autoimmune hemolytic anemia
coomb's fest I
ve AlpinumRus

Clonidine 8 Px of HIN
R of Ticks Tourette's syndrome
 I CHI
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Px of diarrhea in diabetic pts
R of migraine
SE I Rebound MTN

Tizanidine I centrally acting m s relaxan

common SIE Of drug f SEDATION

B Agonist
I urination
Bz
Px of urinary incontinence
MERABEGRON

132 Agonist effects If

Broncho dilation uterine relaxation la Kt
Tocolysis I HypoKale
Px of preterm contract I Ritodmine Isoxsuprine
Riot Asthma I
SABA 3 Shout acting 132 agonist
Salbutamol Does b c It's fast acting
Tembutalin set
 LABA I long acting 132 agonist
protylaxis of asthma
slow Salmeterol
fast formeterol Acute attack prophylaxis

132 7 signal transduction

T CAMP Broncho dilation
Uto Melaxath
Tremor
SIE Tremors Tachycardia

PDE
132 TCAMP t Bronchodilation

If want more bronchodilation Block PDE

PDE Inhibitor
Methybcanthine Block phosphodiesterase
E
Thiophyline Corals

I Doc Acute attack of asthma I Salbutamol

2 in pregnancy salbutamol
3 in labour Ipratropium
H for prophylaxis of Asthma Steroids
5 Status asthmaticus Salbutamol t
 Ydrocorlison

A Blockers g
non selective Block AI a
R2 Tx of sever
HIN
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Iasb 012 of modpfffaf.ie

Aya blocker Dx Ot BPH only

Non selective A Blocker

I'nniversible Reversible
phenoxybenzamine phentolamine Tolaaoline
phaeocheomocytoma R of Cheeze reacth
Rebound HTN

41 Blockers I Eaocins
price aocine Doc for Pt with HIN
tena 2ocine E BPH
Doc for 117N I
Zoffinesionpion
sting Dyslipidemia

AIA blocker
DOC for BPH patients
Tamsulocin
 B Blockers
mmmm used for disease

Non selective pig Heart pg other than Heart

ystojen
If 13

propranolol My Mumma
Nadolol longest acting T non selective
TIMO101 B blocker

cardio selective 13 Blockers Bio

C Celiprolol Cute MAN BABE

My Metoprolol
B Betoxolol Bisoprolol
E Esmolol shortest acting J
T aTenolol
A Acebutalol
Orde Nebivolol MOST CARDIO SELECTIVE 13 1

3rd Ogen B blockers 8 La beta Carvedi nebi

Rot Oasodilatory effect

Bo t A0 Labetalol
HTN in pregnancy I PIM
DOC
for a
Emergency
 Bo t ca 0 Carveditol

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a Ca cause

Yasna'iacais

2
I HTN not considered as first line I
n nsmiTm
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Angina
3 MI
H CHF
5 Arrythmia

Other dis E
L
migraine propranolol Doc R of Migmai
2 glaucoma Et ag humor product
3 Anxiety Eperformance anxiety propranolol
4 pheochromocytoma
5 Px of tremors
Essential tremor
6 Thyrotoxicosis thyroid storm
TH 73
Eactiveysymptoms
P2 blockers
91 for non selective 13 blocker f
1st Ogren 2nd Ogren
I
132 131 132
M
0 0 0
BD EBuf.co physioloojicalB.D.net
block

fuji physiologicalv.D.me

STRICTY 42 IN can be used in

ASTHMA Asthma

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disease
Ex Raynaud's dis Can use

CII IN D M
since 13 blockers will
mask the warning sign
of Hypoglycemia I
Ex tremors
tachycardia etc
 Hypertension
DOI 1st line HIN only I thiazide
Diuretics E t Na t Vol

Zwei

neabsorpt

All diuretics stop the oieabooption

Diuretics
I PCT Carbonic anhydrase inhibitor
Osmotic diuretics

2 LOH hoop diuretics MIX Efficacy Highest

Osmotic diuretics Maximum act
High ceiling diuretics
3 DCT thiazide
moderate Efficacy I

a Aldosterone
cnn.li nediiiEes
iw Iinesmh
ti
 CAI 8 carbonic anhydrase inhibitor
Acetu20lamide U B
Dorzolumide Bicarbonate
Alkali I cn
t
Alkali loosing in urine
Body becomes Acidotic
urine become alkaline so stone formation

may occur

LproduceaQuoushumorITA
blockers use in gladdening
mainly in anffle closure glaucoma
pt present E alkalis
need to make body acidosis
mountain sickness

sie
noesifonmain.T
o.gg
Loop diuretics 5 loop loose Everything
MOA 8 Na k 2cL pump
I Max effect in thick ascending limb
Name furosemide LASIK water looses
Bumetenide
Ethacrynic acid

uses E DOC for pulmonary edema

Doc for pulmonary Edema

SIE I Hypo K Ci Ca Moja Temia also Na

Iot Dephrotoxicity
Hyperglycemia Hyperunicemia
t.dearance.LT

Osmotic diuretic mannitol urea glycine

Manitol Act like magnet for water
Doc cerebral Edema
Doc Acute angle closure glaucoma

Thiazide
mm
8 Thiazide loose tout Moja Ci
MOA Na apump in DCT
Names Hydrochlorothiazide
Chlorthalidone Indupamide Metolazone
Uses I Is line 117N save ca2t in Hypocalcemic
 OS O MO s

Px of renal stone
91 I Hyperglycemia Hyperunicemia
Both thiazide a loop diuretic

Kt sparring diuretics in
MOA f block Aldosterone in CD
E block ENAC Channel in CD
Epithelial Nut Channel

Aldosterone ENAC TNA 1kt d Ht

Block ENAC tweet i 9K TH
paid in
body
uses Aldo 0 Spironolactone Eplemenone
Doc for edema in cirrhosis
Used in CHF
Hyperaldosteronigm.J GER

SIE GYNAECOMASTIA Enay Amiloderahe

EAT Triumteren
E NAC 0 I Amiloride Triumterene
DOC lithium induced Diabetes incipedes

SIE of Kt sparring 8 Acidosis

C a k 51 Rudos
Loth pm
a Thicizide Alkalosis
DI patient will loose water HADH so
Central absence of ADH
Neurogenic I
R E Doc Desmopressin
name of ADH vasopressin

Desmopressin also DOC for central D1

Nocturnal aneuresis
Px of vWF deficiency
Hemophilia A Px
factor 8 Clotting

Nephroojenic
m w
DI
m
o compensetory mech
R I Thiazides 2 receptor in CD

first both D1 9 Thiazide t the water and then

after loosing more water body realize and save Wale
SIADH TTT save water ADH
vaptan drug's
function of save
ADH water

Lithium induced DI Amiloride

 HMU
1st line drugs Thiazide

RAAS Renin angiotensin aldosterone system

kidney Ps B blocker
Block Everything
Direct 1 Aliskinen
renin Renin produced Econtaininna
inhibitor REN
Angio Angiotensin 1
lensinoojen
Angiotensin
liver ACE's pail FACE
convert enzyme
captopril Ellen I a

A72
Aldosterone 2 ATIR
TNA IKI produce vasoconstriction
water
Angiotensin recepton
blockers
Sartan in name
ACEH ARBS It is preventing cardiac
Nephroprotective drug Remodelling
so CHF won't
Doc for HTN
run
DM Occur
urn
DOC for HIN t CKD
urn un

GI in bilateral renal art stenosis

Decrease blood
supply to kidney
SIE o

ACEI I T bradykinin

Dry cough Angioedema

rare I
ARBS don't do bradykinin
run us

Both ACEIIARBS cause Hyperkalemia

91 in pregnancy

11 asodilator
Calcium channel blocker 2
Dihydropyridine Dipine.mg
DHPI
varapamil is ca blockers in Heart
Dittiazem px of Arrythmia
I Nicardipine
Doc for MTN emergency
2 Nifedipine
used as tocolytic
3 Nimodipine
Cerebro selective
used in SAH
Ha Amlodipine
Used commonly f STAMLO

SIE E
Reflex tachycardia Ek BP THR
constipation Uerapamil
gingival hyperplasia

NO stimulator
can be used in HTN emergency
Nitroprusside

SIE E cyanide toxicity Mad

ER Hydroxycobalamine IV
Amyl nitrite 1 Thiosulfate
Inhalational route
 Hydralazine I
HTN Emergency in pregnancy
SIE I
Drug induced SLE
Other drug cause drug induced SLE
S Sulfonamide
H Hydrceluaine
I NH ft'Ifyiation
DPgocainamine
D psone

Kt
in
Channel
mm openers
u mu
vasodilation

t Kt moves out of cell and

produce relaxation
less electricity
mm
vasodilation
www
open
M Minoxidil SIE I Hypertrichosis body hair 99
R of alopecia
D Diazoxide Rc of Insulinoma I insulin releces
H Hydralaaine
stimulate NO 9 Open Kt channel
 ANOJINA
un mm

TFHar 902 13 THR

f Her 102 13 blocker t.HR

Vasodilator
Doc for angina acute attack
SUBLINGUAL NITROGLYCERIN Ehrig
fast route
No first pass metabolism
pat can spit drug out after angina pain
subsides

Nitrates
11007
Tp cgmp vasodilation
PDE d
NIG SLI
INN Isosorbide mono nitrate
IDW Isosorbide di nitrate
oral transdermal
nitrate used for Px of angina
 SILDENAFIL Viagra
phosphodiesterase 5 pDEII Inhibitor
It shouldn't be combined c nitrates dit
disk of hypotension

Other drugs not dipine bk it'll 9 reflextacky

13 blockers CCB verpamil Diltiazem Angina
Ranolazine late Na current in
myocardia cells
Ivabridine Block If funny current

CHE
Acute CHF Chronic CHF
problem t contract problem f T workload on hear
Tf f Inotrops BE 1 workload on heart

Dobutamine BI RAAS blockers

Milninone PDE37 ACES ARBS
0 blockers
p
palm edema spironolactone
Doc furosemide Aldosterone
0 are 41 in
p
Acute
 4Electricity vasodilation
Hydrala2ine Nitrates
dafterload d preload

BNP Brain natriuretic

peptide indepositycin
Brain natriuretic peptide Nutral Endo Peptidase
release from the Heart x called Sacubituil
BNP should not break by NEP
ARNI
Angiotensin meseptor neprilycin
Inhibitor
Valsartan t sacubitril

DIGOXIN 8
MOA f Act like Inotrope I
Na Kt ATPase 7 T ca't T contract
Anti armythmic
Act as vagiominetic IHR
SIE f
Nausea vomiting MCI
visual problem Halos I

Gynecomastia
Arrhythmia
 Toxicity f Hypokalemia
u mm
starts
mm toxicity

and Dios ist K

Digoxin come
bind Nat Kt ATPase fax
Nak ATPase
Kt will Ojo out of cell K'pump
Later on it will cause hyperkalemia
After toxicity
Bk Intracellular K coming out
of cell

Annythmia E R I Lidocaine
severe toxicity i Icfibind

Arrhythmia phase It current

Na
Kt Retour K'efflux
depor
waseo yphose
3 Influopia
phase0 please 3
phase
4
a SA node ventricle
PEI
1 I see L S
L L 7
2 Sec
by drug Heart rate again
will decrease
Nat Blocking A
 s n
Classificatn g
thanughmen Infilliamm chassnifican 3 so beautiful priyanka
Chopra
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I Sodium E Noeffect on K ChrJ

0
II poeta
0 Torsade EAT
II pot prolonegath J RI MogSog
Iv Ca 0

Nor Channel blockers cain in name

Ia o Torsades ventricular arrhythmia
procainamide
It can be used in WPW syndrome
He
form of accesory pathway
SLE
cause
mm drug inducing
mm

Quinidine Block Na eek

Has antimalarial property
SE E cinchonism Tinnitus

Dlsopyramide
Anti Chol activity
 Ib I Block Na 9 open at
Lidocaine.mg
Doc for MI 9
Digoxin induced
arrhythmia
phenytoin

Tocainide

Ic
Px 8 INPIN
flecainide induce arrhythmia and
propatenone kill the pts

procainamide a flecainamide used to

Dx 1017W

I
B blockers
It
depot in the atrial cell
phase 4T
Ex f Metoprolol Esmolol
Used in Px Of supra ventricular
tachycardia
SVT paroxismal SVT
 Neela 8lb

K Channel blocker SE Torsades

Amiodarone Ibutilide Sota lol

AMIODARONE i
longest acting antiarrhythmic t wide spectrum
antiarrythmic
Avg 53 day

MOA f 0K
Extra Noa 13

SIE Hypothyroidism
Danger palm fibrosis
Bluish discolorath
Blueman syn Smurf skin

TIL
Cat Channel block Non DHP

Verapamil Diltazem

gytThf
qfu
Doc for Px of Psu
 D0CforPSVTtADEN0SlfEmff

SIE I constipation

Miscellaneous drug f
Adenosine f
MOA 8 K Channel open
Gi d CAMP
DOC R for PSUT

Atropine
0
MOA E M THOR
Px of brady arrhythmia

Anti hyperlipidemics
t LDL 1 TG THDL

t
0 Statins 8 Rose Lo Sim pra
Love Simva Rosina Porava

MOA I block HMG co A reductase

 d l f

Pleotropic effects

Long acting statin I ROSUHA

Pravastatin minimum drug inter
risk of myop

SIE Myopathy

2 fibrates I fenotibrate Clotibrate

gemtibro2il

MOA c
PPAR a Lipoprotein lipase

V
DOC I Hyper triglyceridemice ITG

3 NIACIN Nicotinic acid J Vit Bg

799 HDL in body
SIE 8 TT PG synthesis NuoidinDmJ
lead to itching
flushing

I IPG
 Best I Aspinine

4 BILE ACID sequester ants 3

Cholestyoramine
Colestipol
Coveseuelam

MOA I Block enterohepatic circulation of bile acid

Doc dyslipidemia in pref ee children

In pregnant women
PIH Labetalol A Methyldopa Can Used
Emergency Labetalol Hydrcelazine can used
 ox owns.ru oem zsea

Platelet
boooooooox
0000000
fibrin clot
oooo oooo

Anti platelet drugs

Platelet aggregation factor 8

Tx Az 0 I Aspirin Mn
b TICA
ADP 134,2 0 rel CAN TICLO

Tica melon
Can melon
Ticlopidine

Clopidogrel I
prodrug
CYPIC19 A
a

get activated in Body

Omepra2ole CYP2C19 so it inhibits activath Of
clopidogrel
3 gap 2b 3a 0 I strongest centipietiet drug
Abciximah Tirofiban
Eptifibatide Abeiximab
Ti roti been
Epti fiba tide
H PAR I 0 Horapaxar
protease
activated
Mec

Anti coagulant

Int ca't
I
Ext
Xa uit K neg for extrinsic
11 Ya pathway
11 Ha
fibrinogen
n'nombian
fibrin
clot I
uit k req for 21719,10 factor
by IEEbocylation
 Oral
uit k 0 Warfarin coumarin Dicumacol
Xa 0 I Rivaroxaban Apixaban Eboxaban
Direct thrombin Dabigatran
Inhibitor

paraenteral type of anticoa

Indirect I Heparin fondaparinux

MINH r Enoscaparin Deltaparin Tizaparin

DTI Argatreb an Direct thrombin inhibitor

Lepirudin
Hirudin

Indirect MOA 1 AT 3

Antithrombin

UFM AT Xa Ila unfractn

MINH AB Xa Ila Low MIN heparin

fondaparinux AB only Xa
 Heparin Ivor se Warfarin Cora's

Rapid onset Delayed 4 5 days

stimulate A73 Block Vit K
Block 2,7 9 10
PTT PT HURT
xx placenta crosses placenta
Antidote tmrw't factor za 7 a ga wa
protamine sulfate complex
Anticoagulant in 11110 a

and In Vitro not available

d
fresh frozen plasma
then Vit K Mur u 20

SIE g SIE o
Hit Heparin induced purple toe syndrome
thrombocytopenia Dermal vascular
necrosis 1
In vivo only

Xa Antidote Andexanet d
Dabigatran Idolicizumalo
antitode warfarin toxicity phytonidinoe

Antilog fer wit k Warfarin

Heparin protamin sulfate
• Anti-neoplastic drugs commonly damage rapidly dividing cells i.e tumor cells & also normal cells
• General side effects include Nausea Vomiting [Rx: 5HT3 blockers (Ondansetron, Palonosetron) or
NK1 blockers (Arepitant, Fosaprepitant)], mucositis, aloplecia

Cell cycle

Classification
❖ Non-cell cycle specific: Alkylating agents, Platinum compounds, Anti-tumor antibiotics
❖ Cell cycle specific:
S-phase specific – Antimetabolites (Anti-folate, Purine analogs, Pyrimidine analogs), Topoisomerase
inhibitors, Histone deacetylase inhibitors, Hydroxyurea
M-phase specific – Vinka alkaloids, Taxanes

Alkylating agents (AA):

A) Nitrogen mustards → Cyclophosphamide*, Ifosfamide, Melphalan*, Chlorambucil, Mechlorethamine
B) Busulfan
C) Nitrosoureas → Carmustine, Lomustine, Streptozocin
D) AA by methylation →Procarbazine, Dacarbazine, Temozolomide

Platinum compounds (PC): Cisplatin, Carboplatin, Oxaliplatin

➢ MOA: AA & PC bind to DNA at N7 position of guanine which leads to misparing eventually leading
to apoptosis. Although they are non-cell cycle specific most action is seen on G1-S phase

o Cisplatin – it’s the most-wide spectrum anti-cancer drug

Uses: Lung ca (1st line), GIT (DOC for esophageal & gastric ca), Urogenital (DOC for Cervical ca &
also used as 1st line in Ovarian, Bladder & Testicular ca with other drugs), Head & Neck ca,
Osteosarcoma
Side effects:
▪ Most emitogenic drug
▪ Highly Nephrotoxic (prevented by chloride diuresis), Ototoxic and Neurotoxic
▪ Nephrotoxicity & Neurotoxicity of cisplatin is decreased by using Amifostine

o Cyclophosphamide
Side effects:
▪ It’s degradation product is acrolein produces Hemorrhagic cystic (Rx: MESNA)
Cyclophosphamide also causes SIADH Cardiotoxicity, Bone marrow supression

Anti-tumor antibiotics: Anthracyclins (Dauno, Doxorubicin, Epirubicin, Idarubicin), Bleomycin,

Actinomycin D (Dactinomycin), Mitomycin C
➢ MOA: Inhibit topoisomerase II in DNA creating free radicals causing DNA damage in all phases
especially G2 phase
➢ Actionmycin D binds to DNA & Drug-DNA complex inhibit RNA. So it works on DNA & RNA
➢ Side effects are due to free radicals that damage heart(cardiomyopathy), lungs (pulmonary fibrosis)

❖ Anthracyclins: create Fe free radicals so antidote is Dexrazoxane

o Doxorubicin (Adriamycin) , Daunorubicin
Side effects
▪ Cardiotoxicity: Dilated cardiomyopathy with Doxo & Daunorubicin
▪ Red urine – Doxo & Daunorubicin
▪ Radiation recall syndrome
 o Bleomycin: Side effect: Pulmonary fibrosis, Flagellated dermatitis
o Actinomycin- D (Dactinomycin): binds to DNA inhibiting RNA polymerase
Side effect is Radiation recall syndrome

Anti-metabolites: They act in the S-phase of cell cycle

Folic acid analogues: Methotrexate, Permetrexed (used in Lung ca)
➢ MOA: inhibits Dihydrofolate reductase that inturn inhibits thymidylate synthase

Methotrexate uses: Mnemonic CANCER

Chron’s disease, Abortion, Non-Hodgkins lymphoma, Choriocarcinoma, Ectopic Pregnancy,
Rheumatoid arthritis
Side-effects:
➢ Bone marrow suppression and Mucositis d/t DNA synthesis inhibition (Rx – Leucovorin rescue
which is folinic acid)

Purine analogues: 6 – Mercaptopurine (Azathioprine – analogue of 6-MP), 6 – Thioguanine,

Pentostatin, Cladribine
➢ MOA: inhibit HGPRT that inhibits de-novo purine synthesis and incorporated into DNA (abnormal
DNA)

Pyramidine analogues: 5- FU, Capecitabine (prodrug of 5-FU), Gemcitabine, Cytarabine

Side effects: Bone marrow suppression, Hand foot syndrome (also from Capecitabine), Pulmonary
toxicity

Mitotic spindle inhibitors:

I. Vinca alkaloids: Vincristine, Vinblastine, Vinorelbine
II. Taxanes – Paclitaxel, Docetaxel
Vincristine causes neurotoxicity, SIADH
Vinblastine causes bone marrow suppression

Topo – isomerase : MOA: DNA replication forms multiple coils which creates tortional stress. DNA
is religated by topoisomerase I (inhibited by Irinotecan &Topotecan), & topoisomerase II (Etoposide
& Tenoposide)

Tyrosine Kinase Inhibitors:

❖ CML: Imatinib, Nilotinib, Dasatinib ( BCR-ABL)
❖ GIST: Sunitinib, Imatinib, Regorafenib
❖ Lung cancer: Ceritinib, Afatinib, Gefitinib, Erlotinib
❖ HCC: Sorafenib
❖ RCC: Pazopanib, Axitinib, Sorafenib, Sunitinib
❖ Medullary ca of thyroid: Vandetinib, Lenvatinib

Drugs/ TOC
Brain tumors – DOC Temozolomide
Head & Neck Ca – Cisplatin + 5FU
Thyroid cancer
• DOC Iodine 131/ Sorafenib
• Medullary Ca of thyroid – Vandetinib
Lung cancer – Cisplatin
GI tumors – DOC Upper (Esophageal, Gastric) – Cisplatin, Lower (Colorectal, Anal) – 5FU
Kidney – Sunitinib/ Sorafenib
HCC – Sorafenib
GU tumors – DOC Cisplatin

Facebook: Salman K
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propyl thiouracil PTU

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Thyroid storm
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Destruct of thyroid gland I

2131 I 123 dye a Roc
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prefered in Heart
mm patient
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Metformin
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increase in blood
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Met is 41 in RF
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 11T.SK11

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 11T.SK11

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property C Hydro water mediumprednisone

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zero mineral
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fludrocontisone Max gluco
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Betamethasone SIE's Glaucoma on Topical use
Zero mineralo Cataract on systemicuse
conticoid property Osteoporosis

Emmutpotent steroid Edema

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maximum glucocorticoid
activity

Reproductive system
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Hare it
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dose 99Every

Male female
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d FSH LH All the functn will decrease
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Busamelin

pulsatile manner when we want to T Hormon

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Continuous manner we want to d Hormone

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Px of prostate cancer
Px of fibroids
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gland prevent the feedback TIESHILH
shomoneer
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SIE Multiple gestation
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Estrogen

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Letrozole a Anastozole
Uses 8 ovulation Induct Tf of infertility
Px of postmenopausal Brest ca
In Breast ca Estrogen TTT

Mifepristone i
decrease progesterone receptor
used in abortion

Block androgen blocking property

Alter
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male pattern baldness

DHT A size of prostate BPH I

Male pattern baldness

Androgen receptor is
flutamide Nilutamide
Apalutamide
 Osteoporosis
Most drug inhibit osteoclastic action
bone resorption
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t
osteoclastic action

Oral E Alandronate
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Calcitonin Salcatonin
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no activath of osteoclast
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No bone resorption
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selective estrogen receptor
modulator

stimulate bone formation

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funboner
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Hormonal Replacement therapy

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L Brest i ti risk of breast ca

L Endometrium IT end ca
L Liver A clotting factor
99 risk Of thrombosis

SERM I good for osteoporosis

block Estrogenact used in Px of brest ca
Lb t risk of Endometrial ca
lb T clotting factor
thrombosis

Egg
Raloxifine post menopausal osteoporosis
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GERD down regulator

Pure anti estrogen activity only on brest
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full estrogen antagonist

Doc for Tamoxifen resistant brest cancer

 Epilepsy T Electrical activity of brain

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called convulsion
I
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i
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glutamate Blocker
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Topioramate
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ur in

seizure drug
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0
partial Ina In elderly 7 Lamotorigine
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can03 If 22 yr I Ethosuximide

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status Epilepticus
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febrile seizure Rectal diazepam
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Infantile spasm 1 Tuberous sclerosis 3
Ks Vigabatrin
 2 649
Lennox gestaut syndrome Valproate
Drouet's syndrome Valproate stiripentol
Infant safe

1st line drug Eaa to Internal medicine

Gas lamotregine valproate Levitiracetam
focal seizure lamotreojine Levitimacetum
Carbumezapam phenytoin
Absent seizure Halproate Ethosuximide
Lamotreigine

I Myamp

phenytoin i
Block Na
Used in partial S2 orcs
ventricular aworythmia
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500 450 400 350 300

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SIE gum hypertrophy

Hirsutism
d folate Megaloblastic anemia Neural tube
t uit D osteomalacia defect
 CO s I e g
Hemorrhagic bleeding Of newborn
Teratogenic f fetal hydantoin syndrome
phenytoin Hydantoin
Carbamazepine
c

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DOC for trigeminal
in mm neuralgia
mm err

can use it for orcs

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SIADH Editutional hyponatremia

Eat
salt will be same water
more in body so it shows

hyponatremia

Wide spectrum
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It
Pcos
most teratogenic drug reversible

Toxic epidermal near

f
Lamotorigine Ste Steven johnson syndrome
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married she pregnant she is on phenytoin
What to do should change to Levitimacetum
No Just continue E phenytoin

duetoseizure
Young female then she marry after
unable to marry

taking phenytoin After marraige what to do

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Topioramate wide spectrum Use for weight

blocks Nat glutamate gain
SIE o
form stone
carbonic enhydrase Inhibitor

Used in
migraine
this Drug also t craving of Alcohol

Gabapentin preojabalin
Doc for peripheral neuropathy
egg Herpes neuralgia
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un w w

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GABA broken by gaba transaminase

Doc for Infantile spasm tuberous
sclerosis

Benzodiazepine Sedective hypotonics

Melatonin Ramel tem

SIE Sedation
Anxiolytic

As I Antiepileptic a muscle relaxant

Barbiturate
produce exact same effort
effect secretive hypnosis Anesthetic coma death

2 drug
only stimulate as receptor
good for insomnia Doc for insomnia
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 Barbiturate Benzodiazepines
mm

phenobarbitone
phenobarbital long acting B2b
Thiopentone
thiopental
Benzodiazepam
long acting short acting
Diazepam Excreted Esta201am
flunitrazepam Eutside oxazepam
Clonazepam the Temezapam
Nitrazepam Liver Lorazepam

Long
91 in Liver failure safe in liver failure
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in liver failure
41 in Elederly
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 Enzyme inducers a Inhibitor

et enzyme some drug 49 the enzyme

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inhibitor excrete it from body
Show excess effort
and sometime toxicity

Enzyme inducer decrease the effect of other

drug i
Enzyme inhibitor TT

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It is enzyme Riffy can cause OCP
inducer failure

Dopamines
If Tt called psychosis If t.lv Called Parkinson
If you decrease dopamine more
while Tf of psychosis cause
drug induced Parkinson

i'Dopamine TT vomiting
 01 M l s M U 11N

It Dopamine It vomiting is Antipsychotic work as

Antiemetic
t.lu Dopamine TT Prolacting i Risk of prolactinoma

Drug to TT
Dopamine
Levadopa DD Dopa decarboxylase

DOPA
DD DOPA
CNS 4i
BBB
i

Hiphery levodopa
D
dopa DD Dopamine B
Ls
carbidopa di
Is
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Levodopa is a
prodrug drug that can activate
in the body
That is metabolized by DD into Dopamine
carbidoper is peripheral PD inhibitor

SIE I D2 0
Vomiting Px of vomiting NO EPS
Domperidone
1
Dz0 c

not used
Metochlorpromide
 s f E
Levadopa broken down by
MAO B CONT

for save Ldopa should US

MAO B Inhibitor
Selegelline
Rasaojelline

COMT Blocker
Entacapone in periphery only
TolaCapone P t CNS
c
Tox Liver Hepatotoxic

D2 agonist
Ergot derivative Non Ergot derivative
Stimulate vasospasm No vasospasm

Bromocriptine Pramipaxok
Caberojoline Rotprolactinoma Ropirinole
Doe for Parkinson
disease
Restless leg
syndrome
 Drug Induced
mm
Parkinsonism
2 nm
Ach
la t
Doc Ben2hexol p
Bipinidine To make
Benztropine balance

1st gen antihistamine

Diphenhydramine
Amantadine Antiviral
Ste I Livido deticularis
pink web like pattern on extrimities

Anti psychotics

1st Ogren Dz blocked

Typical
low potency Thionidazine
SE M0 04 Chlorpromazine
H

High potency fluphenazine

SE Extra pyramidal side effect Haloperidol
Droperidol
 2nd en drug
D20 t
51172A
Atypical antipsychotic contain PINE
Clozapine olanzapine Quetiapine
Ziprasidone Risperidone

Aripiprazole is not ppi it is Antipsychotic

Risperidone IT EPS
High potency

Zipra T'T 07 prolong.at

Clozapine Doc resistant schizophrenia

SIE 5 Sedation
Agranulocytosis
t disk of EPS
 EPS Extra pyridimal sideeffect
AMD muscular dystonia
Ex Neck contract Torticollis

drop dopamine and ACh down for psychotic

pt
Rc centrally acting anticholinergic
Botulinium toxin

0
Akuthesia R i p
DIP R I Benztropine etc

Tardive Change to drug c less EPS

dyskinesia Latest R Valbenazine

Anti Emetic
Riot chorea 3
Huntington's chorea
Doc Tetrabenzine

Tick disorder ETourettes

 Antidepressants
Monoamine E t 5h7 d NA d DOP
lead to depression
Lf stopto
quae backpeuptake
Inhibitor

Reuptake inhibitors
3 type
cis SSRI t 5117 SNRI TCA
95117 TNA

SSRI
fluoxetine longest acting
fluvoxamine short acting
Paroxetine
citalopram Escitalopram
Sertraline SNRI DULO HEI NA MILNA

510122 I Duloxetine venlafaxine Milnacipman

Al
TCA Amitryptamine Imipramine Amoxapine
0M 0A Nontryptalline Desipramine
Histamine
 MAO Inhibitor i
Nonselective MAO Inhibitor
phenelaine Isocarboxazid
Tranyl cypromine
Selective MAO A Inhibitor
Modobemide

Atypical anti dep

571920 0
Trazodone
a 0
Mintazepine
presynaptic
T NT 3 Bupropion Antidepressant
n m
used in smoking
cessation

TCA
SIE block M d Histamine
Amytryptamine Max anticholinergic act
Imipramine Used in Nocturnal Eneunesis
by m

Doc Desmopressin
QE convulse Arrhythmia Sedation
SSRI I
Used for
Depression OCD phobia PTSD
Eating dlo panic attack post traumatic
Anorexia Bullemia stress Dio
GAD Generalized Anxiety dice
I 1
Acute BED Chronic SSRI

SIE o Nausea vomiting loose stool

Delay ejaculation ER of premature
Ejaculation

BIPOLAR DIO I
BDNF Brain derived neurotrophic factor
T BDNF Mania violent
1 BDNF Depression silent

Acute mania in R Anti psychotic fast acting

BED
Be Of BPD 3 Doc Lithium slow onset
 MOA Lithium M
GSK 3 Glycogen synthase kinase
T BDNF

IMP Inositol monophosphate

t BDNF
u

Mood stabilizer

SIE
Tremors L Leukocyte Increase
I
Leucocytosis Tremor
Heart problem
Nephroojenic DI I Diabetes
U Increase urinath Nep
Ebstein's anoma Ingi
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 11T.SK11

opioids potty plant

U K 8
Analgesics Analgesic Analgesic
Miosis
Constipation Afforest Morphine Methadone
Resp depression mepereclinepethidine Tramadol
Euphoria Loperamide codein
Analgesics
Morphine Tramadol
mmmm
severepain mild moderate
42in head
injury asthma MORPHIN Use in
ventricular failure
rum
codein dextromethorphan Antitussives
Loperamide Diphenoxylate Antidiarrheal

uneceptor antagonist
Naloxone Doc for op toxicity paraenteral
Naltrexone maintainance Oral

Ethanol Alcohol Acetaldehyde Acetyl Acetic acid

dehydrogenase dehydro choice This can block by
methanol y formaldehyde formic acid
blockby fomeporazole FDI Danger
More aldehyde more sick feeling Disulfiram
So can use Disulfiram to stop alcohol
OMEPERIZONE Use for alcohol toxicity Cause blindness
soured
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than I Use for methanol toxicity death