Acetazolamide = prevents the reabsorption of NaHCO3 form the proximal convoluted tubules by inhibiting the enzyme carbonic anhydrase.

Acetazolamide is given to treat glaucoma, metabolic alkalosis, and altitude sickness. It decreases the total body HCO3. Spironolactone- is a K+ sparing diuretics that trigger diuresis by acting as competitive antagonists to aldosterone in the cortical collecting duct. Used to treat hyperaldosteronism, CHF, and potassium depletion. Acetaminophen = has antipyretic properties by inhibition of prostaglandin synthesis NSAIDS = inhibit COX 1,2 and TXA2 Aspirine = peripheral vasodilation Hemachromatosis iron overload = DEFEROXAMINE is the chelating agent of choice Carbamazepine causes agranulocytosis in small number of ppl. Fungal treatment = AZOLE- inhbit ergosterol synthesis by inhibiting the P450 enzyme that is needed for its sysntheisis. Without ergosterol membrane permeability is disrubted. Pilocarpine = DOC for acute angle closure glaucoma- it increases the outflow of aqueous by opening the trabecular meshwork and by contraction of ciliary muscle to reduce IOP, Valpoic acid = antieplipetics that can be used as second to lithium to treat bipolar disorder. PID= use cefotaxime Colestipol and cholestyramine = bile acid sequestrants that decrease bile acid reabsorption- they prevent reabsorption of dietary cholesterol. Adverse effect include bloating, constipation, Malabsorption of some drugs. Increase VLDL and triglycerides, malabsortion of lipid soluble vitamins- we dont want to give this in pts with hypertrigylceridemia Bile acid sequestrants = enhance chilestrol loss in the feces and thereby stimulate the new production of bile salt which lowers cholestorl level and LDL plasma level. (statin decrease cholestol level in the liver, Niacin- decrease VLDL synthesis in the liver, Bile salt sequestrants decrease cholestorl absorption in the gut, Gemfibrozil- activates lipoprotein lipase to decrease VLDL, out of all Niacin increase HDL) HMG-COA reductase inhibitors= lovastatin statins= reduce cholesterol synthesis in the liver mainstay hypercholesterolemia. Adverse effect are muscle toxicity, cyotchrome 450 indycer enhace toxicity- no grapefruit with statins, we also need to check liver enzymes and CK levels to check for muscle damage Statins = inhibit the rate limiting enzyme = they lower liver cholesterol, plasma LDL and liver synthsis of VLDL Gemfibrozil = activate lipoprotein lipase to decrease VLDL Nicotinic Acid (Niacin, Vitamin B3) = inhibits VLDL synthesis and increase HDL, the side is flushing so use Aspirin Orlistat= used for weight loss by inhibiting pancreatic lipase to decrease triglyceride breakdown in the intestine, side effects are oily stool, decrease absorption of lipid soluble vitamins so pt should take vitamin supplaments two hours before taking olistat The mechanism action of Asprin is interruption of arachidonic acid metabolism- arachidonic acid is a precursor to the formation of prostaglandis. COX1 and 2 are responsible for the conversion of arachidonic acid to prostaglandins (PGH2) which is the precursor to all other prostaglandins. Bleomycin- is used to control neoplastic cell growth by forming a complex with iron and in the presence of oxygen this complex generates cytotoxic free radicals which causes damage to the DNA strand. Belomycin works at G2 phase of cell cycle By itself ByBleoMYcin. Its adverse effect is to cause pulmonary fibrosis which is restrictive lung disease and it does this by the fact that it produces free radicals in the presence of oxygen (oxygen is high in the lungs) after it forms complex with iron. PPH- is blood loss that is >500 ml = this could be slowed down by using the hormone OXYTOCIN- the hormone ensures uterine contraction and thereby it puts pressure on the site that is bleeding

Ibuprofin NSAID that acts on both COX enzymes which converts arachnidonic acid to various prostaglandisn, prostacllyins and throbomxanses. COX1 is found in many physiological functions whereas COX2 is found in inflammatory cells os to treat infmalatory pain we like to use COX2 inhibition. Adverse effect is peptic ulcer since its a nonselective COX inhibitor. Pulomnary emobilism = the first treatment is heparin or LMWH The first line treatment for benign essential tremors is beta blockers. propranolol or atenolol. If the pt has asthma we cannot give beta blockes since this drug will exacerbate their condition in this case we can give primidone- this drug is anticonvulsant that is effective in treating the condition. Phenotoin used for epilepsy can cause gingival hyperpleasia, the mechanis of action of this drug is to inactive the inactivate Na channels this prevents seizure propagation (prolongs the inactivation phase of the Na channels) the drug has zero order kinitics and its adverse effects are gingival hyperplasia and hiristim also osteomylecia and megaloblastic anemia. Young children who are taking this drug chronically will develop gingival hyperplasia Absent seizures- the mainsty treatment will be Ethosuximide- the MOA of the drug is that it blocks the T type calcium channel in the thalamic nuclei. Belimia nervosa the choice of treatment is Fluoxetine SSRI Rib raising will normalize autonomic activity Cocaine intoxication= euphoria, hypervigilance, anxiety, grandiosity, paranoid, tachycardia, pupilary dilation Carbamazepine = inactivate already inactivated Na channels to prevent AP prppagation, the main treatment it is used for is for tigemianl neurlaigia. The side effect of this medication is that is can cause SIADH, exfolative dermitisis- SJS it can cause spinal bifida, clift lip and platate like phenytoin. Valproic acid- can be used as an alternative treatment for bipolar disorder, its side effects are hepatotoxicity, pancreatitis andn alopecia. The main side effect with valproic acid is that it causes pancreatitis and in young children we should look for hepatotoxicity. If a pt is on birth control med and gets pregnant then she is also on anticonvulsant agent sbecuase these drugs decrease the efficiacy of oral contractpetic by inducing P450 but this is all except valproic acid which causes inhibition of p450 Gabapentin is used for neuoapathic pains like shingle and diabetes Vinblasitn and cincristine = they are anticancer agents that work on the M phase of the cell cycle they work by blocking polymerization of tubules Paclitavel = is another drug that works on the M phase of cell cycle it is an anticancer drug that blocks depolymerization of the microtubules (the two drugs that work on the M phase are VP. Which we can say are VP-Very important- VInblastin/Vincristin and Paclitaxel) they both work on mictotubules, V= prevents polymerization but P prevents depolymerization) and stop cell division of the cancer cells. Vincristin causes neurologic pain pins and needles Cancer cell that woks on the G2 phase is bleomycin and it works by itself by binding to iron and with oxygen it forms radical that damges the DNA the adverse effect is that it causes restrictive lung disease. Drugs that work on S phase all sound like cells Cytarabine, 6- mercaptoPURINE, 6- thoGUANINE, METHOtrexate, hydrocyUREA, etopoSIDE, 5-flURACIL Cisplatin anticancer drug that works at the G0 phase- it is an alkalyting agent that crosslinks DNA its like plaster- cisplasin sicks DNA together, it side effects are nephrotoxicity and neurotoxicity could cause blindness, cayses renal problams Cyclophosphmaide is another alklyting agent that attachks guanine N7 to cause dysfunction DNA the adverse effect is that it causes hemorrhagic cystitis so we use mesna to prevent it (the causing agent is that acrolein which mesna binds to protect and prevent) Doxorubicin- inhibits topisomerase- toxic to hear and cause BMS use dexrazxane

Antiarrhytmic drugsCalss 1= Na channel blockers Class 2 B beta blockers Class 3- P- potassium channel blockers Class 4 C- calcium channel blockers Class 1 Na channel blockers 2 rxs 1- Quinidien, 2 Procanamide
y

y y

1a- Quinidine- blacks active Na channels to increase action potential duration an the effective refractory period ( this means when the Na channels are blocked in the active state then remain open for a long time and will take much time to return to resting state to be activeated again- less likey lto be activated again so it increase the ducation of action potiental and the effective refractory period) adverse effect is cinchonism and prolongs the QT interval leading torsades 1-a Procanimide adverse effect is SLE like syndrome in pts who are slow acytlators 2b= lidocaine- fast Na channel- blocks inactivated channels- helps hypoxic and ischemic tissue, it increases in threshold for excitability and less exciting of the damaged cells, Lidocaine is the choice of drug that is used post MI, IV is used to decrease first pass metabolism and when the pt is going home we can give them the oral version of lidocain mexiletine 2c- blocks fast Na channels- no effect on AP and ANS Flecainide limited use

Class 2- are the beta blockers- block beta receptors and decrease cAMP, decrease SA and AV node activity, decrease slope of phase 4 the diastolic currents of the AP in pacemaker cells we can use Propranolol- non selective and Esmolol and acebutolol selective, use in SVT and esmolol could be used in acute SVT IV. Class 3- potassium clockers
y y y

They slow phase 3 repolarization of AP, effective in purkinjie and ventricular disease Amiodarone- pulmonary fibrosis, blue pigmentation Sotalol- phase 3, decreases HR by blocking beta receptors, decrease av conduction, used in life threatening ventricular arrythmeia

Class 4- calcium channel blockers Verapamile and Diltiazem- SVT, verapamil causes constipation, can cause AV block eith beta blockers or digoxine, Adenosine = it is Gi coupled which decreases cAMP, decrease AV and SA nodal activity- reset Magnesium used for torsades, - drugs that cause torsades are K= channel blockers 1a and class 3. TCA, thioridazin TB treatment pt developed peripheral neuropathy so we should also have been treated with vitamin B6= Isoniazide can induce Vitamine B6 deficiency by forming an inactive derviate with pyridoxal phosphate Inhaled anesthetic- potency is best defined by the MAC- halothane Tension pneuo- always deviates to the opposite side of the injury. So pt in knife fight gets stabbed on the right the trache will deviate to the left so we need to do needle decompression on the right side with is where the lung is collapsed. Dantrolene = fever, rigidity, tremor and autonomic lability in a pt treated with neuroleptic should be treated as neurologic malignant syndrome. The fever that is produced is due to the sustained muscle contractions. Dantrolene is used to treate familial malignant hyperthermia- inhibit the relase of calcium form the SR and decrease the muscle contraction. Another medication that could be used to treat is bromocriptin Acute panic attack- treatment of choice are alprazolam and lorazepam Benzos- can cause sedation to anestheis- they reach plateau in CNS depression, they potentiate GABA (inhibitory) to increase frequency of Cl- channel opening by binding to BZ receptors, BZ1 sedation and BZ2 antianxietty drugs are Alprazolam, Diazepam, Lorazepam, Midazolam, Temazepam, and Oxazepam. alprazolam and lorazepam are used for acute panic acttach

Tamoxifen- non-sterodial esterogen paritial agonists, tamoxifen in breast tissue is antagonist by binding to the estrogen receptor in the breast and prevent endogenous breast estrogen from activating the tumor. The adverse effect of this drug is that it is paritial agonist in the endometrial tissue increasing the risk for endometrial cancer. Warfarin- lipid soluble dervitive of vitamin K- MOA = decreases hepatic synthesis of vitamin K dependent factors, it inhbits vitamin K epoxide and prevents gamma carboxylation and leads to decrease of gamma carboxyglutamte, it is monitored using PT and INR, the liver needs vitamin K to make prothrombin and 2, 7, 9, and 10- to form these products, we need vitamin K dependent carboxylation of gamma carboxyglutamate Codeine = is used for chronic cough potent antiussive agent, it also has analgesic properties useful in treating the pain and malaise accompanying the cough Guillain-Barre syndrome- treatment of choice is IVIG, it helps neutralize myelin antibodies, down regulation of cytokines-INF gammablocking complement cascade, and promote remyelination. Increase the rate of motor recovery Rifampin is a treadtment for TB and its known to cause orange secretions Increasing the level of dopamine has been associated with Tourette syndrome, tourette syndrome is associated with familial link and oftern occurs with OCD Haloperidol typical antipsychotic that is used to treat Tourette syndrome MAO inhibitors = phenelzine and tranylcypromine- increase NE and 5HT, can cause HTNsive crisis if mixed with tyramine, TCA, alpha 1 agoinst, levodopa, TCA and MAO inhibitors = hypertensive crisis Bulb decompression or C4 compression is good tretmetn for pregnant woman in labor to enhace contration Amphetamine used to treat narcolepsy Intoxication of diazepam is treated with flumazenil this is a benzodiazepine antagoinsit it is a competitive inhibitor at the benzo binding site on the GABA receptor Salicylate poisioning it stimulates the central respiratory pathway and causes hyperventilation with an early respiratory alkalosis. Some hours later there will be metabolic acidosis that develops- there is combination of aspirine acidic dereviateive and the excreation of base to balance the res alkalosis of early phase To diagnose gallstone is to use ultrasound- this is the most sensitive and specific test to establilsh diagnosis Oral contraceptive have been thought to cause gallstones due to the high estrogen contents Heroin- an opiate overdose pupilary constriction, constipation, droesiness, slurred speech, respiratory depression, bradycardia, coma ( when the pt goes into withdrawal they will present with N/V lacrimation, rhinorrhea, papillary dilation, insomnia) Alcohol withdrawl = this is treated with diazepam insomnia, tremor, anxiety, delirium tremens, and lofe threatening convulsions- this should be treated with long acting benzodiazepine. The treatment of choice for Herpes Simplex complex II is acyclovir= the MOA- is to inhibit the viral DNA polymerase by being phosphorylated by thymine Kinase. ALS = Amyotophic lateral sclerosis = the choice of treatment is Riluzole- the MOA is not known but it is thought to inactivates voltage dependent sodium channels in the presynaptic terminals and inhbit the excitoatory neurotramitter glutamate the drug is thought to have glutamate toxicity spectator ion

Acetaminophen- hepatotoxicity due to decrease in glutathione, Restless leg syndrome = treatment is with pramipexol Clozapine can cause agranulocytosis Benzodiazipines are administrated for status epliepticus, anxiety, alcohol detoxification- MOA = increase in frequency of opening GABA associated Cl- channels the influx of Cl- channels makes depolarization more difficult decreasing neuronal firing First line treatment for stage one HTN is HCTZ Beta blockers have shown to improve mortality in pts who have suffered a mycoradial infarction. But if the pt has asthma we want to give B1 selective like Atenolol to prevent the non-selective action of brochospasm If pt has renal problem the type of skeletal muscle relaxant we want to use is Atracurium sine this drug is spontaneously inactivated and it is not altered in pts with renal problem (other skeletal muscel relaxants like Doxacurirum, pancuronium, and Tubocurarine are eliminated through renal and could last for a long time in the system in those who have renal failure) the other drug Mivacurium is hydrolyzed by plasma cholinestrases but pt with renal failure have decreases in this enzyme so the drug will stay in the system for a long time.