Advantages of doxycycline over other tetracyclines

• High potency
• Completely absorbed from the intestine with no interference by food
• Long plasma half life (T 1/2) of 18 to 24 hours
• Least effect on the normal flora of the intestine
• Less propensity to cause diarrhoea

Theophylline: Drug interactions

Certain drugs inhibit theophylline metabolism, thus increasing blood levels and cause toxicity
Ciprofloxacin
Cimetidine
Erythromycin
Allopurinol
Oral contraceptives

Some others increase theophylline metabolism, decreasing blood levels
Phenobarbitone
Phenytoin
Rifampicin

Smoking and consumption of charcoal boiled meat also increase theophylline metabolism.

Anterior Pituitary Hormones

Mnemonic: FLAGTOP
Follicle Stimulating Hormone
Luteinizing Hormone
ACTH
Growth Hormone
Thyroid Stimulating Hormone
MSH - melanOcyte stimulating hormone
Prolactin

Proteases in the Duodenum

Mnemonic: Eat Tender Chicken Chunks Elegantly
Enterokinase
Trypsin
Chymotrypsin
Carboxypeptidase
Elastase

Drugs Contraindicated In Breast Feeding

Mnemonic: BREAST
Bromocryptin / Benzodiazepines
Radioactive isotopes / Rizatriptan
Ergotamine / Ethosuximide
Amiodarone/Amphetamines
Stimulant Laxatives / Sex hormones
Tetracyclins / Tretinoin

Hormones that Increase Blood Glucose

Mnemonic: STENGG
Somatotropin (growth hormone)
Thyroid hormones (thyroxine and triiodothyronine)
Epinephrine
Norepinephrine
Glucagon
Glucocorticosteroids
Immunoglobulins

Days of appearance of rashes

Mnemonic: Very Sick Patients Must Take Double Exercise
Varicella (chickenpox)- 1st day
Scarlet fever - 2nd day
Pox (smallpox) - 3rd day
Mumps - 4th day
Typhus - 5th day
Dengue - 6th day
Enteric fever (typhoid) - 7th day

Case Study

After 2 weeks of diarrhea, a 22 year old college female reports to the emergency room feeling faint. She says she recently took a trip to Mexico for spring break and became sick on her last day there. She has now had diarrhea for 2 weeks, with 3 watery bowel movements per day. She denies vomiting. Her mucous membranes are dry, and her capillary refill is 4 seconds. Her respiratory rate is 30 per minute.
What explains her increase respiratory rate?

A.   Anion-gap metabolic acidosis
B.   Normal anion gap metabolic acidosis
C.   Respiratory acidosis
D.   Respiratory alkalosis
E.    Metabolic alkalosis

Signs and Symptoms of Hypernatremia

Mnemonic: Fried
Fever (low grade), flushed skin
Restless (irritable)
Increased fluid retention and increased BP
Edema (peripheral and pitting)
Decreased urinary output, dry mouth

Signs and Symptoms of Increased Serum Potassium

Mnemonic: MURDER
Muscle weakness
Urine - oliguria, anuria
Respiratory distress
Decreased cardiac contractility
ECG changes
Reflexes - hyperreflexia, or areflexia (flaccid)

Causes of Increased Serum Potassium (Hyperkalemia)

Mnemonic: Machine
Medications - ACE inhibitors, NSAIDS
Acidosis - Metabolic and respiratory
Cellular destruction - Burns, traumatic injury
Hypoaldosteronism, Hemolysis
Intake - Excesssive
Nephrons, renal failure
Excretion - Impaired

IMPORTANT POINTS

• The Percentage of blood alcohol in the stage of "dead drunk" is 0.5%.
• Fatal period of Datura poisoning is 24 hours.
• While dispatching blood and urine for chemical analysis, sodium fluoride is added as preservative in concentration of 50 mg/10ml.
• Critical level of alcohol in blood is 0.15%.
• Gas rigidity appears after 72 hours.
• Ratio between ethyl alcohol in blood to urine is 1:1.33.
• Fatal dose of opium is 2 gm.
• Fatal period of sulphuric acid poisoning is 18-24 hours.
• After death, benzidine test is positive upto 150 years. Bones begin to decompose after death in 3-10 years.
•  In poisoning by salicylates, the Gastric lavage is useful upto 24 hours. 
• Physostigmine can be regarded as the specific antidote of Datura.
• Copper sulphate is used as an antidote to phsophorus.
• Haemorrhagic spots are found in poisoning by thallium.
• Amyl nitrate is antidote of cocaine poisoning.
• In sea water drowning, there is steep rise in Na+ and Mg++.
• In methyl alcohol poisoning treatment recommended is ethyl alcohol and sodium bicarbonate.

Heart valves: sequence of flow

Mnemonic: TRIPS BIAS
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar

Drugs that act on Microtubules

Mnemonic: The MicroTubule Growth Voiding Chemicals
Thiabendazole
Mebendazole
Taxol
Griseofulvin
Vincristine/ Vinblastine
Colchicine

Anesthesia stages

Mnemonic: Anesthesiologists Enjoy S &  M 
Analgesia
Excitement
Surgical anesthesia
Medullary paralysis

Emphysema types

Mnemonic: Cigarettes Is Primary Problem":

Types:                                               Important feature 
Centrilobular                                       Cigarrettes
Irregular                                              Inflammation healed to scar
Pancinar                                              Protease inhibitor deficiency (a1-antitrypsin)
Paraseptal                                           Pneumothorax
 

Benign Prostatic Hyperplasia - Symptoms

Mnemonic:  WISE refers to obstructive symptoms:
Weak urinary stream
Intermittent flow
Straining to urinate
Incomplete Emptying


Mnemonic:  FUN refers to irritative symptoms:
Frequency (>8 times in 24 hrs)
Urgency (the strong need to urinate immediately)
Nocturia (frequency of urination at night)

MAO isoenzymes: Location

MAO-A in:                                                               MAO-B in: 
Adrenergic peripheral structures                                  Brain
Alimentary mucosa [intestine]                                      Blood platelets

Progesterone: actions

Mnemonic: PROGESTE
Produce cervical mucous
Relax uterine smooth muscle
Oxycotin sensitivity down
Gonadotropin [FSH, LH] secretions down
Endometrial spiral arteries and secretions up
Sustain pregnancy
Temperature up / Tit development
Excitability of myometrium down

Drugs removed by haemodialysis

Mnemonic: BLAST
Barbiturates
Lithium
Alcohol
Salicylates
Theophylline

Drugs causing pancreatitis

Mnemonic: GLAD Organ Pancreas iS Traumatised n Destroyed Very Much
Glucocorticoids
L-asparaginase
Alcohol
Diuretics
Oral contraceptives
Pentamidine
Sulfonamides
Tetracyclines
Didanosine
Valproate
Methyldopa

Ventricular tachycardia: treatment

Mnemonic: LAMB
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker

Supraventricular tachycardia: treatment

Mnemonic: ABCDE
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)

Cardioselective betablockers

Mnemonic: Betablockers Acting Exclusively At Myocardium
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol

Anti-arrythmics: for AV nodes

Mnemonic: Do Block AV
Digoxin
B-blockers
Adenosine
Verapamil

Nonselective beta-blockers

Mnemonic: Tim Pinches His Nasal Problem

Timolol

Pindolol

Hismolol

Naldolol

Propranolol

Sodium valproate: side effects

Mnemonic: VALPROATE
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)

Inhalation anesthetics

Mnemonic: SHINE
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane

Physostigmine vs. Neostigmine

Physostigmine: LMNO                                                                Neostigmine, on the contrary, is:

Lipid soluble                                                                                          Water soluble
Miotic                                                                                                        Used in myesthenia gravis
Natural                                                                                                      Synthetic
Orally absorbed well                                                                           Poor oral absorption

Torsades de Pointes

Drugs causing  are APACHE
Amiodarone 
Procainamide 
Arsenium 
Cisapride 
Haloperidol 
Eritromycin

Migraine: prophylaxis drugs

Mnemonic:   Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis
Verpamil
Valproic acid
Pizotifen
Amitriptyline
Flunarizine
Methysergide
Propranolol

Ca++ channel blockers: uses

Mnemonic:   CHASM

Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes

Methyldopa: side effects

Mnemonic:   METHYLDOPA

Mental retardation

Electrolyte imbalance

Tolerance

Headache/ Hepatotoxicity

psYcological upset

Lactation in female

Dry mouth

Oedema

Parkinsonism

Anaemia (haemolytic)

Morphine: effects at mu receptor

Mnemonic: PEAR

Physical dependence

Euphoria

Analgesia

Respiratory depression

Nitrofurantoin: major side effects

Mnemonic: NitroFurAntoin

Neuropathy (peripheral neuropathy)

Fibrosis (pulmonary fibrosis)

Anemia (hemolytic anemia)

Propythiouracil mechanism

Mnemonic: It inhibits PTU

Peroxidase/ Peripheral deiodination

Tyrosine iodination

Union (coupling)

Captopril (ACE inhibitor): side effects

Mnemonic: CAPTOPRIL

Cough

Angioedema/ Agranulocystosis

Proteinuria/ Potassium excess

Taste changes

Orthostatic hypotension

Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)

Renal failure (and renal artery stenosis contraindication)/ Rash

Indomethacin inhibition

Leukopenia/ Liver toxicity

Prophylaxis Use of antibiotics in emergency conditions

     

        Reference: Medscape

Metronidazole

Class: Nitroimidazole derivative
Mech.: Inhib. DNA synth, degrades DNA, e- acceptor for reduced substrates.


Absorption: Complete, quick oral absorption.
Dist.: Well distrib to all tissues and fluids (including CSF)
Metab.: Hepatic metab.
Excretion, t_:
Toxicity/S.E.s: GI, metallic taste, neurotox (vertigo), disulfiram-like effect w/alcohol, neutropenia. Not for first trimester preg (mutagenic). Not for patients w/active CNS disease or hist. of blood dyscrasias.

Utility: IV treatment of anaerobic infects. Oral for amebiasis, giardiasis, and genital infects of Trichomonas vaginalis. H. pylori (PUD).
Special Features: Antiparasitic and antibacterial activity. All anaerobic cocci and anaerobic gram- bacilli, including Bacterioides. Trichomoniasis, amebiasis, giardiasis.

Cimetidine

Class: H2 Receptor Antagonist
Mech.: Competitive inhib. of the histamine H2 receptor, but not of the H1 receptor → inhib. of fasting and stim. acid secretion. No disruption of circadian rhythm of acid secretion. Inhib. of 80-90% of gastrin and
vagal-stim. acid secretion.

Absorption: Oral → rapid, good absorption. Single nighttime dose.
Dist.:
Metab.: Partial hepatic metab.
Excretion, t_: Excreted intact in urine. 1.5-3 hr.
Toxicity/S.E.s: Uncommon. Diarrhea, headaches, myalgias, skin rashes. Large doses over prolonged periods assoc. w/impotence & gynecomastia. Inhib. cyt. P-450 → dose adjustment with phenytoin, warfarin, & theophylline. Occasional cardiac arrhythmias.
Utility: PUD, Zollinger-Ellison synd., acute stress ulcers, GERD

Special Features: Potency—famotidine > ranitidine/nizatidine > cimetidine.
Tachyphylaxis—50% less effective after 6 months. Rebound hypersecretion 2° to receptor upregulation and inhib. of ATPase recycling.

Omeprazole

Class: Proton Pump Inhibitor
Mech.: Irreversible inhib. of H+/K+ ATPase → > 95% inhib. of acid secretion.

Absorption: Oral → 30-40% bioavail. Peak plasma levels at 0.5-3.5 hr. Give prior to meals, preferably in the morning. Additional dose, if necessary, should be given later in the day.
Dist.:
Metab.:
Excretion, t_: 0.5-1 hr.
Toxicity/S.E.s: Rare headache, diarrhea, rash. Inhib. of cyt. P-450 requires altered doses of warfarin, phenytoin, diazepam, and cyclosporin. Inhib. of vitamin. B12 absorption.

Utility: PUD, erosive esophagitis, Zollinger-Ellison synd., GERD.
Special Features: Mismatch between pharmacokinetics & pharmacodynamics. Short t_, but actions last > 24 hr (irreversible binding). Acid inhib. → ↑ gastrin

Ranitidine

Class: H2 Receptor Antagonist
Mech.: Competitive inhib. of the histamine H2 receptor, but not of the H1 receptor → inhib. of fasting and stim. acid secretion. No disruption of circadian rhythm of acid secretion. Inhib. of 80-90% of gastrin and
vagal-stim. acid secretion.


Absorption: Oral → rapid, good absorption. Single nighttime dose.
Dist.:
Metab.: Partial hepatic metab.
Excretion, t_: Excreted intact in urine. 1.5-3 hr.
Toxicity/S.E.s: Uncommon. Diarrhea, headaches, myalgias, skin rashes. Inhib. cyt. P-450 (less than cimetidine) → dose adjustment with phenytoin, warfarin, & theophylline. Occasional cardiac arrhythmias.


Utility: PUD, Zollinger-Ellison synd., acute stress ulcers, GERD
Special Features: Potency—famotidine > ranitidine/nizatidine > cimetidine.
Tachyphylaxis—50% less effective after 6 months. Rebound
hypersecretion 2° to receptor upregulation and inhib. of ATPase recycling.

Antibiotics contraindicated during pregnancy

Mnemonic:     MCAT

 Metronidazole

 Chloramphenicol

 Aminoglycoside

 Tetracycline

Metabolism enzyme inducers

Mnemonic:     "Randy's Black Car Goes Putt Putt and Smokes":

 Rifampin

 Barbiturates

 Carbamazepine

 Grisoefulvin

 Phenytoin

 Phenobarb

 Smoking cigarettes

Respiratory depression inducing drugs

Mnemonic:    "STOP breathing":

 Sedatives and hypnotics

 Trimethoprim

 Opiates

 Polymyxins

Lupus: Drugs inducing it:

Mnemonic:    HIP

Hydralazine

INH

Procanimide

STEROIDS- Side effects

Mnemonic:  BECLOMETHASONE

Buffalo hump

Easy bruising

Cataracts

Larger appetite

Obesity

Moonface

Euphoria

Thin arms & legs

Hypertension/ Hyperglycaemia

Avascular necrosis of femoral head

Skin thinning

Osteoporosis

Negative nitrogen balance

Emotional liability

Levothyroxine sodium

Class: Thyroid Hormone
Mech.: Sodium salt of T4. T3/T4 synergize w/GH effects, increase BMR, potentiate catecholamine effects on heart, promote lipolysis, and decrease serum cholesterol.

Absorption: Incomplete oral absorption—30-40% recovered in stool.
Dist.: Poor placental transfer → okay for pregnant E. Little in milk (use cautiously).
Metab.: Hepatic conjug. w/glucuronic & sulfuric acids. Peripheral deiodination to T3.
Excretion, t_: Bile; some lost in stool due to enterohepatic circ. 6-7 d.
Toxicity/S.E.s: Salicylates and dicumarol compete for albumin binding sites → marked increase of free levels.

Utility: Treat hypothyroidism and goiter (not due to iodine deficiency or hyperthyroidism).
Special Features: 200-300 μg/d. 1/4 the potency of liothyronine sodium, but same efficacy.

Thyroglobulin

Class: Thyroid Hormone
Mech.: T3/T4 synergize w/GH effects, increase BMR, potentiate catecholamine effects on heart, promote lipolysis, and decrease serum cholesterol.


Absorption: Oral
Dist.: Poor placental transfer → okay for pregnant E. Little in milk (use cautiously).
Metab.: T4 & T3 released by proteolysis after ingestion. Hepatic conjug. of T4/T3 w/glucuronic & sulfuric acids.
Excretion, t_: Bile; some lost in stool due to enterohepatic circulation.
Toxicity/S.E.s: Salicylates and dicumarol compete for albumin binding sites →
marked increase of free levels.


Utility: Treat hypothyroidism and goiter (not due to iodine deficiency or hyperthyroidism).
Special Features: 120-180 mg/d. Similar efficacy to levothyroxine sodium and
liothyronine sodium, although dose not standardized by bioassay.

Digitoxin

Class: CHF Rx (Cardiac Glycoside)
Mech.: Inhib. of Na+/K+ ATPase → ↑ release of Ca2+ from SR →
↑ myocardial contractility. Also ↑ sensitivity of AV node to vagal stimulation → ↓ ventricular rate in atrial flutter or fibrillation (i.e., anti-arrhythmic).

Absorption:
Dist.: Strong protein binding.
Metab.: Hepatic metab.
Excretion, t_: Feces. Longer t_ than digoxin.
Toxicity/S.E.s: Low therapeutic index. Toxicity enhanced by hypokalemia. Arrhythmias (possibly life-threatening), anorexia, n/v/d, drowsiness, fatigue, visual disturbances. Verapamil or quinidine → ↑ toxicity.


Utility: Treat heart failure.
Special Features: Active metabolites. Longer t_, more GI absorption, and more protein binding than digoxin.

Digoxin

Class: CHF Rx (Cardiac Glycoside)
Mech.: Inhib. of Na+/K+ ATPase → ↑ release of Ca2+ from SR →
↑ myocardial contractility. Also ↑ sensitivity of AV node to vagal stimulation → ↓ ventricular rate in atrial flutter or fibrillation (i.e., anti-arrhythmic).


Absorption:
Dist.: Strong protein binding.
Metab.: Hepatic metab.
Excretion, t_: Feces. Longer t_ than digoxin.
Toxicity/S.E.s: Low therapeutic index. Toxicity enhanced by hypokalemia. Arrhythmias (possibly life-threatening), anorexia, n/v/d, drowsiness, fatigue, visual disturbances. Verapamil or quinidine → ↑ toxicity.


Utility: Treat heart failure.
Special Features: Active metabolites. Longer t_, more GI absorption, and more protein binding than digoxin.

Minocyclin

Class: Tetracycline
Mech.: Active uptake into bacteria →inhib protein synth by binding to 30S ribosome. Bacteriostatic

Absorption: Good oral absorption. Impaired by divalent cations. IM painful. IV may cause thrombophlebitis. Never intrathecal.
Distribution: Good CSF. Conc. in liver → enterohepatic circ. Penetrates most tissues and fluids. Also enters tears and saliva. Crosses placenta.
Metab.: Liver, but not critical.
Excretion, t_: bile; doesn’t require renal excretion
Toxicity/S.E.s: Vestibular toxicity; GI — burning, discomfort, nausea, vomitiing; superinfection - due to broad spectrum, candida albicans (1°), staph enterocolitis, pseudomemb. colitis; hepatotoxicity (esp. in pregnancy); renal toxicity; Fanconi synd.; perm. brown discoloration of teeth; slowing of bone growth; phototoxicity;
thrombophlebitis; hematopoetic changes; rare hypersens. rxns.

Utility: gram - cocci, gram - bacilli, acid fast bacilli, chlamydiae, mycoplasma, rickettsia, spirochetes. No effect on viruses or fungi. Also used for acne, prophylaxis for Travelers’ diarrhea.
Special Features: Broad spectrum. Decreased effect of oral contraceptives.

Doxycycline

Class: Tetracycline
Mech.: Active uptake into bacteria →inhib protein synth by binding to 30S ribosome. Bacteriostatic

Absorption: Good oral absorption. Impaired by divalent cations. IM painful. IV may cause thrombophlebitis. Never intrathecal.
Distribution: Good CSF. Conc. in liver → enterohepatic circ. Penetrates most tissues and fluids. Crosses placenta.
Metab.:
Excretion, t_: bile; doesn’t require renal excretion
Toxicity/S.E.s: GI — burning, discomfort, nausea, vomitiing; superinfection — due to broad spectrum, candida albicans (1°), staph enterocolitis, pseudomemb. colitis; hepatotoxicity (esp. in pregnancy); renal toxicity; Fanconi synd.; perm. brown discoloration of teeth; slowing of bone growth; phototoxicity (more than others); thrombophlebitis; hematopoetic changes; rare hypersens. rxns.


Utility: gram - cocci, gram - bacilli, acid fast bacilli, chlamydiae, mycoplasma, rickettsia, spirochetes. No effect on viruses or fungi. Also used for acne, prophylaxis for Travelers’ diarrhea.
Special Features: Broad spectrum. Decreased effect of oral contraceptives.

Tetracycline

Class: Tetracycline
Mech.: Active uptake into bacteria →inhib protein synth by binding to 30S ribosome. Bacteriostatic


Absorption: Oral adequate, but incomplete. Impaired by divalent cations. IM painful. IV may cause thrombophlebitis. Never intrathecal.
Distribution: Good CSF. Conc. in liver → enterohepatic circ. Penetrates most tissues and fluids. Crosses placenta.
Metab.:
Excretion, t_: filtration (1°), bile
Toxicity/S.E.s: GI — burning, discomfort, nausea, vomitiing; superinfection — due to broad spectrum, candida albicans (1°), staph enterocolitis, pseudomemb. colitis; hepatotoxicity (esp. in pregnancy); renal toxicity; Fanconi synd.; perm. brown discoloration of teeth; slowing of bone growth; phototoxicity; thrombophlebitis; hematopoetic changes; rare hypersens. rxns.


Utility: gram - cocci, gram - bacilli, acid fast bacilli, chlamydiae, mycoplasma, rickettsia, spirochetes. No effect on viruses or fungi. Also used for acne, prophylaxis for Travelers’ diarrhea.
Special Features: Broad spectrum. Decreased effect of oral contraceptives.

Chloramphenicol

Mech.: Bacteriostatic. Inhib protein synth by binding to 50S subunit.

Absorption: Rapid oral absorption
Distribution: Body fluids, good CSF. Crosses placenta. Milk.
Metab.: Liver (glucuronyl transferase)
Excretion, t_: Urine (filtration, secretion), 1.5-3.5 hr.
Toxicity/S.E.s: Bone marrow depression (anemia, leukopenia, thrombocytopenia, prob. due to inhib. of mitoch. protein), aplastic anemia (allergic/idiosync, rare, irreversible, often fatal), Gray Baby Syndrome (neonate overdose due to reduced ability to conjuate CA and secrete metabolites), superinfection (S. aureus,
Pseudomonas, fungi, can be life threatening).

Utility: DOC for severe Bacteroides infects (esp. CNS), backup for memingitis, rickettsial infects, brucellosis.
Special Features: Never use if safer antibiotic avail. Never use for mild infects.

Trimethoprim-Sulfamethoxazole

Mech.: Acts on two sequential steps in synth of folic acid. PABA competitive
inhib, dihydrofolate reductase inhib. Bacteriostatic.
Absorption: Oral, IV
Distribution:
Metab.:
Excretion, t_:
Toxicity/S.E.s: Megaloblastic anemia, leukopenia, granulocytopenia (prevented by admin. of folic acid)
Utility: Uncomp. UTIs, otitis media, acute exacerbations of chronic bronchitis, various pneumonias. DOC for Travelers’ diarrhea, P. carinii pneumonia, Shigella enteritis, systemic Salmonella infects, prostatitis.
Special Features: Trimethoprim = highly selective inhib. of bacterial dihydrofolate reductase.

Sulfasalazine

Class: Sulfonamide
Mech.: Comp. inhib. of PABA incorp. into dihydropteric acid → inhib. of folic acid.

Absorption: Poorly absorbed in GI tract.
Distribution: GI tract
Metab.: Hydrolized to active form by intest. bacteria.
Excretion, t_: feces
Toxicity/S.E.s: Interferes w/normal flora → ↓ vit. K synth.

Utility: Active in bowel lumen. Used prior to surgery to reduce microbe population. Treat inflammatory bowel disease, rheumatoid arthritis
Special Features: Broken down in intestines to liberate 5-aminosalicylate (antiinflammatory).

Sulfadiazine

Class: Sulfonamide
Mech.: Comp. inhib. of PABA incorp. into dihydropteric acid → inhib. of folic acid. Bacteriostatic.


Absorption: Rapidly absorbed in GI tract. Parenteral.
Distribution: Widely distrib; good CSF. Crosses placenta.
Metab.: Acetylated in liver
Excretion, t_: Renal filtration, secretion
Toxicity/S.E.s: Hypersensitivity—fever, rash, photosensitivity; UT disturbances-deposition of crystalline aggregates; hematopoetic disorders—dyscrasias


Utility: Uncomplicated UTIs, trachoma (contag. disease of eyelid, conjunct, cornea), nocardiosis (tuberculosis-like infect.), prophylaxis (burnt skin, suppressing recurring UTIs, rheumatic fever)
Special Features: Spectrum—gram +, gram -.

Sulfamethoxazole

Class: Sulfonamide


Mech.: Comp. inhib. of PABA incorp. into dihydropteric acid → inhib. of folic acid. Bacteriostatic.
Absorption: Rapidly absorbed in GI tract (slower than isoxazole). Parenteral.
Distribution: Widely distrib; limited CSF. Crosses placenta.
Metab.: Acetylated in liver
Excretion, t_: Renal filtration, secretion
Toxicity/S.E.s: Hypersensitivity—fever, rash, photosensitivity; UT disturbances— deposition of crystalline aggregates; hematopoetic disorders—dyscrasias


Utility: Uncomplicated UTIs, trachoma (contag. disease of eyelid, conjunct, cornea), nocardiosis (tuberculosis-like infect.), prophylaxis (burnt skin, suppressing recurring UTIs, rheumatic fever)
Special Features: Spectrum—gram +, gram -.

Sulfisoxazole

Class: Sulfonamide

Mech.: Comp. inhib. of PABA incorp. into dihydropteric acid → inhib. of folic acid.

Bacteriostatic.

Absorption: Rapidly absorbed in GI tract. Parenteral.

Distribution: Widely distrib; CSF. Crosses placenta.

Metab.: Acetylated in liver

Excretion, t_: Renal filtration, secretion

Toxicity/S.E.s: Hypersensitivity—fever, rash, photosensitivity; UT disturbances- deposition of crystalline aggregates; hematopoetic disorders-dyscrasias

Utility: Uncomplicated UTIs, trachoma (contag. disease of eyelid, conjunct, cornea), nocardiosis (tuberculosis-like infect.), prophylaxis (burnt skin, suppressing recurring UTIs, rheumatic fever)

Special Features: Spectrum—gram +, gram -. Less renal toxicity than other sulfas. Protoype.

Nicotinic effects

Mnemonic: MTWThF (days of week)

Mydriasis/ Muscle cramps

Tachycardia

Weakness

Twitching

Hypertension/ Hyperglycemia

Fasiculation

Antihypertensives contraindicated in pregnancy

Mnemonic: DARSAN 

Diuretics

Angiotensin I antagonists

Reserpine

Sodium nitroprusside

ACE inhibitors

Non selective β blockers

Drugs and conditions: when to stop before surgery?

Mnemonic: SEMLA 54321

Smoking: 5-6 weeks (atleast, earlier the better)

Estrogen pills: 4 weeks

MAO-A irreversible inhibitors: 3 weeks

Lithium: 2 weeks

Aspirin: 1 week

Lithium: Adverse effects

Mnemonic: LITHIUM

Lethargy / Leucocytosis

Intentional Tremor

Teratogenicity

Hypothyroidism

Insipidus [Diabetes insipidus]

Urine excess

Metallic taste

Drugs undergo high first pass metabolism in liver:

Mnemonic: V. P Singh Not A Popular P.M

 Verapamil

 Propanolol

 Salbutamol

 Nitroglycerine

 Amitriptyline

 Propoxyphene

 Pethidine

 Methyltestosterone

Lead poisoning presentation

Mnemonic : ABCDEFG
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)

Direct sympathomimetic catecholamines

Mnemonic: DINED
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine

Classification of hypersensitivity reactions

Mnemonic: ACID
Type I Anaphylaxis
Type II Cytotoxic - mediated
Type III Immune - complex
Type IV Delayed hypersensitivity

Angina  -- Management through lifestyle alterations 

Mnemonic: SLEW 
 Smoking cessation 
 Low-fat diet 
 Exercise 
 Weight loss

Clinical presentation of Impetigo 

Mnemonic: IMPETIGO
Infection with Staphylococcus aureus, Streptococcus pyogenes or both 
Mostly in young children 
Particularly around nose and surrounding parts of face 
Erythematous base with honey-coloured crusts 
Treat with Topical antibiotic such as fusidic acid for localized lesions 
Individuals are highly contagious from skin-to-skin contact; Improve hygiene; do not share towels 
Gram stain and culture of swab diagnostic 
Oral flucloxacillin required for widespread impetigo 

Symptoms of hypothyroidism 

Mnemonic: MOMʼS SO TIRED

Memory loss 

Obesity 

Malar flush/Menorrhagia 

Slowness / Skin and hair become dry 

Onset is gradual 

Tired 

Intolerance to cold 

Raised blood pressure 

Energy levels are low 

Depressed 

Symptoms of hyperthyroidism 

Mnemonic: SWEATING 
Sweating 
Weight loss 
Emotional lability 
Appetite is increased 
Tremor/Tachycardia due to AF
Intolerance to heat/Irregular menstruation/Irritability 
Nervousness 
Goitre and Gastrointestinal problems (loose stools/diarrhoea)