step II

inhibits xanthine oxidase

• B6 pyridozine deficiency leading to peripheral neuropathy and sideroblastic anermia
• MOA nicotinic acid derivative that inhibits synthesis of mycolic acid in mycobacterial cell wall

• depolarizing agent/muscle relaxant during sugery
• binds to nicotinic receptors in skeletal muscle causing persistent depolarizaiotn at motor end plate
• hydrolyzes plasma cholinesterase
• initial fasciculations followed by muscle paralysis
• duration of action 5-10min
• effects not reversed by cholinesterase inhibitors, no pharmacologic antidote to overdose
• soem pts ahve atypical cholinesterase and canot metabolize the drug - malignant hyperthermia -tx dandrolene?

• activates muscarinic and nicotinic receptors.
• muscariniceffects -
• pupillary miosis (constracts iris sphincter),
• accommondation of lens for near vision (contracts ciliary muscles),
• bronchoconstrictor,
• slow HR (SA node effect),
• increase PR inverval (AV node affect),
• sitmulate GI secretions and motility
• micturation (stimulate detrusor muscle which relaxes internal sphincter of bladder)

• potent casodilator synthesized in endothelial cells
• activates cGMP - which inactivates myosin light chain kinase in sm muscle cells leading to vasodilation
• Ach can lead to its synthesis when injected into vessels

terbutaline - selective B2 adrenergic agonist tha tinhibits uterine contractions

• decrease PGE2 synthesis (vasodialator) leading to unopposed AT II effect
• renal papillary necrosis

• blocks dihydrofolate reductase, S phase inhibitor
• leucovorin rescue
• side effects :
• macrocytic anemia due to folate deficiency
• intersitital fibrosis in lung

vincristine

• ciscous polymer of sucrose octasulfate +aluminum hydroxide that adheres to ulcer crater
• stimulates PGE2 in mucous cells - responsible for mucus barrier

rhabdomyolysis - remember each drug on its own can produce rhabdomyolysis

• binds ergosterol in fungal cell membrane which increases its permeability
• nystatin has same mechanism

• inhibits ergosterol synthesiss
• other azole compounds have similar action

inhibits nucleic acid synthesis

inhibits microtubule function and mitosis

• DOC for decreasing synthesis of thyroid hormone in graves disease
• only drug that can be used in pregnancy
• side affect - agranulocytosis

• isoproterenol
• dobutamin
• dopamine - in low dose best for renal vasodilation

• sulfone that inhibits synthesis of folic acid by M leprae
• side effects
• hemolytic anemia in G6PD pts
• methemoglobinemia
• nephrotic syndrome
• peripheral neuropathy

quinidine

phenytoin via revving up cytochrome system in liver and causing vit D deficiency - increased metabolism of 25 hydroxy vit D

• selective serotonin 5ht3 receptor antagonist
• useful in bocking chemoreceptor trigger zone nausea in the area postrema

• respiratory depression - respiratory acidosis
• miotic pupils - pin point

IV thiamine to prevent acute wernickes encephalopathy

• mcc of thombocytopenia in hospital
• MOA - binds antithrombin III catalyzing inactivation of thrombin and other clotting factors

• fresh frozen plasma if serious
• IM vitamin K for less serious bleeds

• concentrated in urine
• urinary tract antiseptic

• activated in the liver
• side effects
• hemorrhagic cystitis
• transitional cell carcinoma

metabolized in the liver

• prevent by giving allopurinol - xanthine oxidase inhibitor
• danger of urate nephropathy

initial effect of succinylcholine

MOA blocks peripheral dopa decarboxylase

• albuterol inhaler most often for mild to moderate
• corticosteroid inhaler next
• then add long acting B2 agonist

• tx adenosine
• including its association with WPW syndrome

activates a2adrenergic and imidazole receptors in the CNS which reduces sympathetic outflow from the vasomotor center in the medulla

• blocks ACE which breaks down bradykinin
• bradykinin side effects - cough and angioedema

• HTN tx during pregnancy
• better tolerated in fast acetylators
• cause of drug induced SLE - antihistone antibodies . ( also procainamide)

• tx: ARB - losartan a AT II receptor antagonist ....blocks aldo
• blocking aldo causes NA to be lost and K retained

loop diuretics...decreases preload

naloxone - competative opioid receptor antagonist

• selective alpha 1 blocker - relax sm muscle in bladder neck and prostate
• prazosin, terazosin

antiandrogen effect - blocks androgen uptake and availability without alerting serum levels, shrinks transitional zone of prostate around urethra

amphetamines

before 32 wks ?, glucocorticoids to increase surfactant synthesis

loop diuretics

hydrochlorothiazide

salicylate intoxication

methotrexate

6 mercaptopurine, allopurinol could cause toxicity since th drug is a purine

5 flurorocuracil

actinomycin D (dactinomycin)