Drugs: CardioResp Drugs: Alpha Blockers Phenoxybenzine (non reversible, unselective), Prazosin reversible, selective a1 blockers, AT 1 receptor antagonist

st Losartan, blocks receptors for angiotensin II, wivout dry cough Terazosin, Doxazosin a1 antag better life, in +ion to ACEs wiv heart failure Angiotensin coverting enzyme inhibitors (ACEs) Captopril BBs Propranolol, anything ending in olol in context Ca blockers Verapamil (main action on cardiac tissue) + Nifedipine (periphery) Diuretics - Thiazides Bendrofluazide, Loop diuretics - Frusemide, K sparing - Spironactolone (aldosterone inhibitor), Amiloride (Na channel blocker) Osmotic - Mannitol SEs - Thiazide diuretics low K + impotence, BB bronchospasm, lethargy, Calcium antags Flushing, oedema, ACE cough, low BP, ARBs low BP Statins inhibits HMG CoA reduces intracellular cholestrol production, increase LDL receptor, decrease plasma chol simvastatin, rosuvastatin Aspirin diabetics over 50, inhibs thromboxane A2 via cyclo-oxygenase, management for MI Polypill statin + lower BP, antiplatlet Heparin LMWH (low molecular weight heparin) anti Xa effect longer life 4 hours, subcutaneous Warfarin vit K antag (2, 7, 9 + 10), oral 36 hours, delayed onset INR (international normalized ratio) 2-3 Procorolan cardiotonic agent, slows pacemaker Ranolazine inibits Na channels blocks influx of calcium Nicorandil - SmM relaxes, acts on K channels + donates NO 2 endo in bvs only Trimetazine preserves energy met in cells exposed to ischaemia Clopidogrel - antiplatlet tPA tissue plasma activator clot buster Streptokinase activates fibrin degradation products activating plasminogen plasmin breakdown clots Allopurinol reduces uric acid nidus Prostagladin E2 keep ductus arteriosus open GTN Glycerol Trinitrate vasodilation opens coronary collateral arts, can gain tolerance Isosorbide long acting nitrate Digoxin from fox gloves, decrease in electrical impulses through AV node (through increasing vagal act), increase in force of contraction via inhibition of Na/K atpase Doxapram Res stimulant Imatinib Chronic Myeloid Leukeamia drug, inhibits tyrosine kinase Chlorambucil, purine anolgues, campath, Rituximab

Antiarrhythmic agents: All increase AVN refractory period Vaughan Examples Williams Classs 1A Quinidine 1C II III IV Digoxin Flecainide Atenolol Sotalol Verapamil Site of action Block fast Na channels Block fast Na channels Block Badrenergic receptors Block K channels Block slow Cas Blocks Na/K ATpase Sinus node rate No effect reduced reduced reduced Atrial Conduction rate decreased decreased No effect No effect AVN refractory period increased increased increased increased increased increased Ventricular conduction rate Decreased Decreased No effect No effect No effect Slows AV conduction

Small Small reduction reduction No effect increased

RIPE - Rifampicin, isoniazide, pyrazinamide, ethambutol anti TB drugs Antiviral treatments for influenza neuraminidase inhibitors Ipatropium + tritropium short + long acting anit-muscs (M3/cholinergic) Ribavarin anti-viral RSV LTOT long term oxygen therapy, for severe COPD Salbutamol Beta 2 agonist (asthma + COPD) Beclamethasone Steroid inhaler form for asthma and COPD Metabolism Drugs: Diuretics: Decrease Na+ and H20 reabsorption Loop Diuretics: Frusemide inhibits Na+/Cl-/K+ trans in thick ascending limb Thiazides Bendroflumethizide inhibs Na+/Cl- symport distal tubule (vasodil due 2 K+ channel opening) Potassium Sparing prevents K loss by Thiazides + Loops Spironolactone aldosterone antag Amiloride Na channel blocker Osmotic:

Mannitol Reduces H20 reabsorbtion by acting as a non-absorbable protein in the plasma used to lower ICPa Proximal tubule Lactulose osmotic diuretic Diuretics: prevent H20 + Na+ reabsorption TAL Na+/Cl-/K+ transporter, DT Na+/Cl-, both have Cl-/K transporter on basolateral side Proximal tubule Na+/H+ exchanger, Na+/glucose co transporter PT osmotic, TAL Loop diuretics, DT Thiazides, Late DT + CD/CT K+ sparing diuretics Loop diuretics Frusemide inhibs Na+/Cl-/K+, torrential diuresis (15-25% of filtered Na+_ SEs hypokalaemia, hypovolaemia + met acidosis Thiazides Bendroflumethiazide (5-10% filtered Na+) - hypokalaemia + met acidosis vasodil due 2 K+ opening may contribute 2 antihyper affect Potassium sparing diuretics prevent K+ loss by others Spironolactone (aldosterone antag) + Amiloride (Na+ channel blocker) <3% of filtered Na+ affected as late action of nephron Hyperkalaemia increase Na+ delivery to late DT + CD/CT increase exchange Na+/K+, increase flow rate, increase K+ loss Aldosterone binds 2 intracellular rec increase amount of Na+ pumps + Na+/K+ ATpase increase Na+ absorption Increased by low Na+ volume, high K+, angiotensin II (<3% reabsorped) Osmotics: (IV Mannitol) reduces H20 reabsorption by acting as non-reabsorble solute in tubule affective where nephron freely permeable 2 water (PT) in plasma used 2 lower intracranial pressure + intraocular Pa Raises plasma osmolarity but doesnt enter brain or eye Micturition Musc antagonist Oxybutin- for frequency incontinence Overflow (retention) Alpha antagonist prazosin Anti-testosterone Finastride Post op urinary retention Musc agonist bethanaechol Enuresis after 7 Desmopressin replaces vasopressin, decrease urinary output at night Corticosteroids: Inhibits lipid derived inflame mediators PGs, leuks + PAF Decrease cytokins Decreased migration of leuks More stable lysosomes Less activity of T-cells Decreased fibroblasts Elevate lipid + glucose in plasma Mobilised AAs for needy cells 4 synthesis Increase lipocortin suppresses phospholipase A2 Decrease cyclo-oxygenase

Beclomethasone, Prednisolone synthetic (exogenous) Hydrocortisone natural (endogenous) SEs Suppression of healing, suppression 2 synth corticosteroids, met affects osteoporosis, M wasting, cushings syndrome, hypertension, decreased growth, hyperglycaemia, oedema T4 Thyroxin hypothyroidism Anti-Thyroid drugs: Carbimazole + Propylthiouracil (also decreases conversion from T4 T3) prevents hormone synth by inhib thyroperioxidase enzyme Decreases oxidation/activation of Iodide, Iodination of Tyrosine, combo of MIT/DIT Slow onset Meglitinides increased sec of insulin by inhibs hyperpolarisation (by blocking K+ channel) Tolbutimide + Glibenclamide sulphonyurea drugs increase insulin Glitazones activating PPAR (gamma) mimick insulin Metformin Insulin sensitisers Brain and Behaviour Drugs: Parkinsons: Levedopa L-dopa, dopamine 2 pathways, reduce tremors, through BBB On/off effects, hallucinations, mood swings, dyskenisa Selegine increase dopamine (MAOb inhib), prevents degradation of DA Amantidine antiviral, release DA, increase time b4 L-dopa (SEs ankle oedema) Antichols to improve motor AntiMusc atrapine/bezahexol, decrease tremor but dont improve bradykinesia Vit E Antiox? Rotigotine Dopa agonist cause cant swallow (transdermal- is it DA???) COMT inhib inhibs catechol o- methyl transferase, eg pyrogoclol, entacapone Bromocriptine Dopa agonist D2, control symps, increase time b4 L-dopa Apomorphine Dopa agonist, D2 Domperidone antidop drug suppress nausea + vomiting Dexamethone anti-inflam brain injury Parecetamol COX 2 inhib, antipyretic + analgesic NSAIDS: Ibuprofen COX 1 + 2, decrease prostogladins, anal + antiflam, decrease peripheral allodynia + hyperalsia cross BBB Diclofenac high life, high potency, COX 1 + 2, inhibit lipoxygenase (decrease prosto, proinflams + leukos) Aspirin COX-1+2, antiflam + antianalgesic Rofecoxib selective COX-2 (SEs heart disease) Injury Phospholipids A Arachidonic Acid A) COX-1 Constituitive, cytoprotective prostos, gastric mucosae, aid aggreg B) Inflam prostos inducible - inflamm cells

C) Leukos Local anaesthetics Lignocaince, bupivocaine, prilocaine, blocks Na+ Epilepsy: Ion channel inhibs: Phenytoin blocks Na+ - in active state, increase refractory state + delay in K+, dose dependant (fast increases in plasma level) enzyme induction Carbamazepine Blocks Na+ - enzyme inducer, L-type Ca+ post synaptic, simpl/complex gen seizures + tonic/clonic, tetrogenic Sodium Valporate Na+ + L-type Ca2+ (post synap), GABA autos, all types, tetrogenic Lamotrigine Blocks Na+ + decrease Ca+2 (N + pq) pre synap Topiramate hypolarises K+ channels Benzodiapine GABAa rec ligands Clobazam, Clonazepam (increase Cl- opening) Barbiturates- Phenobarbitone longer duration (no longer in use) GABAa ampilify response Ca2+ channel blockers: Ethususzimide Ca2+ T-type in thalamus, petit mal Gabapentin GABA agonsts M relaxants Neurotrans release: Levetiracetam inhibs N-type Ca2+, decrease neurotrans relase, protein Sv2A Neurotrans uptake: Tiagabine blocks re-uptake GABA1 + GAT-1 Neurotran synthesis: Vigabatrin blocks GABA autorec, inhib of GABA transaminase So: P.C.S.L.T.C.P.E.G.L.T.V (make acronym) Targets: Opoids mu, delta Cocaine DA, NA + 5-HT uptake systems Amphetamine DA uptake system Ethanol GABAa + NMDA Nicotinic Nicotinic Cannabis CB1 Phenylcyclidine NMDA Hallucinogens 5-HT2A Barbs + Benzos GABAa Ecstasy 5-HT + DA reuptake, 5-HT2 rec + H2 rec + a2 CB1 rec agonists Dronabinol (anorexia wiv AIDS) antag Rimonabant (obesity) Management of addiction: Nicotine:

Nicotine replacement (agonists) maintenance therapy Bupropion MAOI esp DA Opiates: Methadone opoid agonist maintenance + withdrawl Buprenomorphine partial mu rec agonist, kapp antag withdrawl Clonidine + lofexidine a2 agonist withdrawl Naltrexone Opoid antag withdrawl + maintenance (relapse prevention) Alcohol: Benzodiapines GABAa agonists withdrawl, seizures + delirium Antiepis GABA agonist withdrawl + seizures Acamprosate glut decrease neuro withdrawl (maintenance) Naltrexone opoid antag maintenance Disulfram alcohol dehydronase inhib maintenance/relapse SSRIs depressin Vits Thiamin (B1) + ? Neuroleptics: Affects on cognition + behaviour, decreased confusion, agitation + psychomotor + tranquilize, may not effect ve symps D2 family antag can lead to antipyramidial effects dystonia etc Typical: Chlorpromazine (largactil) poor selectivity, prototype Thioridozine, fluphenazine, haloperidol (depot preparations slower) + benperidol (butyrophenomes), flupenthixol (a isomer more specific) SEs psychomotor, extrapyramidal (decrease in atyp), kg inc, sexual dys + tardive dyskinseae (atypical), increase prolactin galactorrhoea + amenorrhoea + postural hypo Atypical: D1 + 5-HT + D2 Sulpiride, amisulpiride, Clozapine (D4), risperidone (5-HT2A blocker), olanzapine May improve cognition, clozapine risk of agranulocytosis Neuropleptic malignant syndrome hyperpyrexia, rigidity, confusion + autonomic instability Antidepressants: Tricyclic (+teta) Antidepressants: (TCAs) - DICA Inhibit NA + 5-HT reuptake, also affinity for other rec (H + adreno), dangerous in overdose (cardiotox), potientiate with alcohol res depression Desipramine, imipramine, clonipramine, Amitriptyline, DICA SEs dry mouth, const, blurred vision + diff pissing, potentiate alcohol, kg gain, post hypo

MAOIs: PIT Irreversible action, limited spec for a + b, cheese affect tyramine, interact wiv pethidine + other symp, hepatoxicity, atypical dep (kg gain, hyperinsomnia) Phenalzine, Isocarboxazide, Tranylpromine PIT Reversible + specific A moclobemide Best in atypical depression SSRIs Selective Seritonin Reuptake Inhibitors (5-HT1A) Sir PFC Sertraline Paroxetine, Fluoxetine, Citalapram, Sir PFC Increased selectivity for serotinin (citalapram most effective) No antichol affects, safe in overdoes, no cardiotox Less effective than TCAs SEs incrsd aggression, sexual dys, gastro, anxiety, more likely suicide in severe dep S-citalapram more fast acting? 50% relapse Atypicals: bupropion, trazadone, Mirtazapine BT Men fewer SEs + less toxic 5-HT + NA reuptake inhibs (SNRIs) Venlafaxine synergy wiv SSRIs NA reuptake inhibs: (NRIs) Reboxetine Electroconvulsive therapy high success rate in severe depression Consider the characteristics of dep, SE, suicide risk, previous response 25% do not respond, 6 months recovery, 12 months in 2ndary care, re-occurrence 10 years Lithium bipolar, mood stabiliser, renal (Thiazides increase risk of toxicity) + thyroid function need checking Increased ICPa mannitol (decrese swelling), Dexamethasone Treat of anxiety: 5-HT1A agonists Buspirone, BB, others Benzos positive allosteric modulators of GABAa rec, Diazapam (IV for status epilectus), clobezam, clonozepam, trialozem (1.5 5 life) Flumazenil overdose management short life Rebound insomnia M cramps, seizures etc in tolerance + dependence Non benzo hypnotics Zalepon, Zolpidem, augment GABA actions Melatonin rec agonists - Ramelteon

Morphine : Morphine (importance of titration, active metabolite) Heroin (high solubility compared to morphine; drug of choice in cachexia) Methadone (half-life increases on repeated dosing) Meptazinol (less respiratory depression?) Pethidine (poor oral bioavailability) Caveats: respiratory depression, potentiation of the effect on blood pressure of benzodiazepines and phenothiazines, dysphoric effects with pentazocine, toxicity of norpethidine, accumulation of methadone, accumulation of M6G if renal function is impaired) Use of naloxone: opiate antagonist with short half-life! Serotonin drugs: 5-HT3 rec anti-emetic drugs Granisetron (antag), antag - chemotherapy Paroxymal depolarising shift NMDA rec glut Sumatriptan 5-HT1D vasocon treatment of migraine (5-HT2A - antags propholaxis) 5-HT1A recs inhibit 5-HT release

Human Development drugs: Clomiphene anti-oestrogen ovulation induction Syntocinon oxytocin contractions (vaginal at birth) Ergometrine assist delivery and prevent haemorrhage SmM in b.v.s 2 narrow Prostoglandin (E2) used to keep foramen ovale open in neonates with heart probs Metronidiazole agent against protozoa and anaerobs (treatment of bacterial vaginitis and others) Doxycyline antibiotic used against Chlamydia and others Acyclovir treatment of herpes Jenicillin used in treatment of syphilis Cervarix vaccine for HPV, just protects against type 16 and 18, used by NHS Gardisil HPV vaccine types 6, 11, 16 and 18 Imiquimod anti-viral typically a cream Podophyllotoxin gel/solution for treating genital warts Locomotor Drugs: Azathioprine Immuno suppressant, interferes wit purine met = down regulation of B + T cells, used in juvenile and rheumatoid arthritis

Methotrexate Folate met antagonist decreases epidermal turnover, inhibits dihydrofolate reductase (LFTs need regular testing), used in juvenile and rheumatoid arthritis Ciclosporin Immuno sup inhib T + IL-2 (kidney function needs testing), used in juvenile and rheumatoid arthritis Deflazacort Glucosteroid, used in juvenile and rheumatoid arthritis Salazopyrin used to treat enthesitis arthritis Anti TNFa entanerecpt/etanerecpt, infliximab (decrease osteoblasts), treatment of arthritis (rheumatoid and juvenile) and other conditions Cyclophosphamide if unresponsive particularly in severe systemic juvenile arthritis Diathemine laser/heat for cervical cancer Cyrotherapy - freezing SERMs Selective eostrogen reuptake modulators raloxifine, vit D + calcium, HRT, can be used in treatment of cancer, menstral probs, menopause and as contraception Clomiphene a SERM (selective oestrogen receptor modulator), Sildenofil male erection probs Biphophonates Alendronae, risedronate, inhibs osteoclasts, treatment of osteoporosis Stontium ranaelate inhibs osteoclasts + promotes osteoblasts, treatment of osteoporosis Psorosis treatment - Tar, dithranol (can burn skin), steroid creams, Vit A Retinoids tarzarotene, Vit-D ointments calipotirol, tacalitol PUVA UVA + psorelin (photosensitizing agent) Types of Antibiotics: Macrolides mycins inhib protein synthesis Quinolones broad spectrum, DNA replication (DNA gyrase), floxoin Tetracyclines inhib protein synth MNRA rib