The Pharm of Old McDonald 5

• alendronate, ibandronate, risedronate, zoledronate
• pyrophosphate analog binding hydroxyapatite in bones to inhibit osteoclasts. Osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, osteogenesis imperfecta (only limits destruction, does not build bone)
• esophagitis (because it's a horse pill, so take with water and remain upright for 30 minutes), osteonecrosis of jaw, atypical stress fractures
• Dr. bone ate (-dronates, osteoclast inhibition, hydroxyapatite)

• bisphosphonate (osteoclast inhibitor by binding hydroxyapatite)
• Dr. bone ate (-dronates, osteoclast inhibition, hydroxyapatite)

• bisphosphonate (osteoclast inhibitor by binding hydroxyapatite)
• Dr. bone ate (-dronates, osteoclast inhibition, hydroxyapatite)

• bisphosphonate (osteoclast inhibitor by binding hydroxyapatite)
• Dr. bone ate (-dronates, osteoclast inhibition, hydroxyapatite)

• bisphosphonate (osteoclast inhibitor by binding hydroxyapatite)
• Dr. bone ate (-dronates, osteoclast inhibition, hydroxyapatite)

• recombinant PTH
• increased osteoblast activity. Osteoporosis (only drug that increases growth instead of limiting destruction
• transient hypercalcemia (PTH classical resorbs bone to increase Ca, but this drug works b/c low and transient levels of PTH activate osteoblasts)

competitive inhibitor of xanthine oxidase, reducing hypoxanthine->xanthine and reducing next reaction xanthine->uric acid (urate). Gout prevention (not treatment), lymphoma/leukemia (prevent tumor lysis from elevated azathioprine and 6-MP metabolized to urate)

inhibitor (not competitive like allopurinol?) of xanthine oxidase, reducing hypoxanthine->xanthine and reducing next reaction xanthine->uric acid (urate). Gout prevention (not treatment), lymphoma/leukemia (prevent tumor lysis from elevated azathioprine and 6-MP metabolized to urate)

• recombinant uricase
• converts uric acid to allantoin, which is more water soluble. Gout prevention (not acute gout treatment or tumor lysis[use rasburicase for tumor lysis])

• recombinant uricase
• converts uric acid to allantoin, which is more water soluble. Tumor lysis syndrome (not for gout [use pegloticase for gout prevention])

• inhibits uric acid tubular reabsorption in PCT. Gout prevention (not treatment)
• uric acid stones, inhibits secretion of penicillin

acute gout pain

• stabilization of tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation. Gout prevention and acute gout pain reduction
• GI side effects

• TNF alpha receptor fused to IgG1 and Fc to bind and degrade TNF alpha. RA, psoriasis, ankylosing spondylitis
• increased risk of infection especially latent TB reactivation b/c TNF alpha forms and stabilizes granulomas
• Adale is etan the certoli influx from an alpha (adalimubab, etanercept, certolizumab, infliximab, TNF-alpha)

• TNF alpha monoclonal antibody to reduce TNF alpha levels. Chron disease, ulcerative colitis, RA, ankylosing spondylitis, psoriasis
• increased risk of infection especially latent TB reactivation b/c TNF alpha forms and stabilizes granulomas

• TNF alpha monoclonal antibody to reduce TNF alpha levels. Chron disease, ulcerative colitis, RA, ankylosing spondylitis, psoriasis
• increased risk of infection especially latent TB reactivation b/c TNF alpha forms and stabilizes granulomas

• TNF alpha monoclonal antibody to reduce TNF alpha levels. Chron disease, ulcerative colitis, RA, ankylosing spondylitis, psoriasis
• increased risk of infection especially latent TB reactivation b/c TNF alpha forms and stabilizes granulomas

• reversible block of H2 histamine receptors (on parietal cells) to decrease parietal cell acid secretion. Peptic ulcers, gastritis, mild GERD
• inhibits P-450, antiandronergic (gynecomastia, prolactin, impotence, decreased libido, crosses BBB (confusion, dizziness, headache), and placenta (but not a teratogen), decreases renal creatinine excretion
• CIM bad for CYP, CNS, CrE, CCR (cimetidine, inhibits CYPs, crosses BBB, decreases Cr excretion, makes you a woman)

• reversible block of H2 histamine receptors (on parietal cells) to decrease parietal cell acid secretion. Peptic ulcers, gastritis, mild GERD
• decreases renal creatinine excretion
• Renaltidine (decreased creatinine excretion)

• reversible block of H2 histamine receptors (on parietal cells) to decrease parietal cell acid secretion. Peptic ulcers, gastritis, mild GERD
• relatively side effect free compared to cimetidine and ranitidine

• reversible block of H2 histamine receptors (on parietal cells) to decrease parietal cell acid secretion. Peptic ulcers, gastritis, mild GERD
• relatively side effect free compared to cimetidine and ranitidine

• omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
• irreversible inhibition of H/K ATPase on parietal cells to reduce parietal acid secretion. Peptic ulcers, gastritis, GERD, ZE syndrome
• increase risk of C diff, pneumonia, decrease serum Mg with chronic use

proton pump inhibitor

proton pump inhibitor

proton pump inhibitor

proton pump inhibitor

proton pump inhibitor

• antacid
• hydroxide is a base that increases gastric pH
• hypokalemia, overuse leads to constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
• aluminimum feces and phosphas (aluminum hydroxide, constapation[so you're muscles are tired of straining, also seizures cause muscle weakness], hypophosphatemia[increases PTH causing bone resorption])

• antacid
• carbonate is a base that increases gastric pH
• hypokalemia, chelation and decreased effectiveness of other drugs (tetracycline) overuse leads to hypercalcemia (milk-alkali syndrome), rebound gastric acid

• antacid and osmotic laxative
• hydroxide is a base that increases gastric pH, also draws water into lumen. GI acidity, constipation
• hypokalemia, overuse leads to diarrhea(or maybe you wanted it for the laxative effect), hyporeflexia, hypotension, cardiac arrest, dehydration (laxative), abused for weight loss
• Must Go 2 the bathroom (MG2+, diarrhea)

binds ulcer base to protect it and allow healing and bicarb to reestablish pH in mucosa. Peptic ulcers, traveler's diarrhea

binds ulcer base to protect it and allow healing and bicarb to reestablish pH in mucosa. Peptic ulcers, traveler's diarrhea

• PGE1 analog
• acts as prostaglandin to increase production and secretion of gastric mucosa and reduce acid production, also ripens cervix, also keeps ductus arteriosis patent. Prevents NSAID induced peptic ulcers, abortifacent, maintenance of PDA
• diarrhea, induction of labor (contraindicated in women of childbearing potential)

• somatostatin analog
• long-acting inhibition of splanchnic dilatory hormones, gastric acid secretion, pepsinogen secretion, pancreatic fluid secretion, small intestine fluid secretion, gall baldder contraction, insulin and glucagon release. Acromegally, carcinoid syndrome, variceal bleeds, VIPoma
• nausea, cramps, steatorrhea, cholelithiasis (CCK inhibition)

• osmotic laxative
• draws water into lumen. Constipation
• diarrhea, dehydration, abused for weight loss

• osmotic laxative
• draws water into lumen. Constipation
• diarrhea, dehydration, abused for weight loss

• osmotic laxative
• draws water into lumen, also metabolized by gut flora to lactic acid and acetic acid, promoting NH4 (ammonium) excretion. Constipation, hepatic encephalopathy
• diarrhea, dehydration, abused for weight loss

• sulfapyridine and 5-aminosalicylic acid
• acctivated in the colon by bacteria to work as antibacterial and anti-inflammatory agent. Ulcerative colitis and Cron disease (if colitis is present)
• malaise, nausea, sulfa allergy, oligospermia (reversible)
• sulfasalazine should make you think sulfa (antibiotic) and salicylate (NSAID)

• opioid
• poor CNS penetration, acts on mu receptors in gut to slow motility. Diarrhea
• constipation, nausea
• Low op eramide (below CNS, opioid, loperamide)

• serotonin antagonist
• decreases vagal stimulation, reducing central emesis activity. Postoperative/chemotherapy antiemetic
• headache, constipation, QT interval prolongation
• keep on dancing longer cutie! (on dansetron, antiemetic, prolonged QT)
• an setron looks like anti serotonin?

• D2 receptor antagonist
• increases GI motility, LES tone without altering gut transport time. Diabetic/postsurgical gastroparesis, antiemetic
• parkinsonian effects, tardive dyskinesia, restlessness, drowsiness, fatigue, depression, diarrhea, drug interaction w/ digoxin and diabetic drugs, containdicated if small bowel obstruction or Parkinson disease

• inhibition of gastric and pancreatic lipase, reducing breakdown and absorption of fats. Weight loss
• steatorrhea, decreased absorption of ADEK

• aka ursodeoxycholic acid
• bear bile acid
• increases bile acid secretion and decreases cholesterol secretion and reabsorption. Primary biliary cirrhosis, gall stone treatment and prevention

• agonist at beta 2 (low doses) for anaphylaxis and asthma and alpha 1 agonist (higher dose) vasoconstriction decreasing synthesis of aqueous humor. open-angle glaucoma NOT closed angle
• mydriasis (contraindicated in closed-angle glaucoma), blurry vision, conjuntival injection, foreign body sensation, ocular allergic reaction, ocular pruritis

• alpha 2 agonist reducing sympathetic output to eye, reducing aqueous humor synthesis
• blurry vision, conjuntival injection, foreign body sensation, ocular allergic reaction, ocular pruritis

• beta blocker
• decrease aqueous humor synthesis. Glaucoma
• no pupillary or vision changes

• cholinomimetic
• direct agonist at M3 receptor, contracting ciliary muscle to open trabecular meshwork and increase outflow of aqueous humor through canal of Schlemm. Emergent treatment of glaucoma(open or closed). Sjogren syndrome
• miosis and cyclospasm (ciliary contraction)
• AChE resistant

• cholinomimetic
• direct agonist at M3 receptor, contracting ciliary muscle to open trabecular meshwork and increase outflow of aqueous humor through canal of Schlemm. Glaucoma (similar to pilocarpine, which is used for emergencies)
• miosis and cyclospasm (ciliary contraction)

• cholinomimetic
• inhibits AChE to inhibit breakdown of ACh, increasing agonism on M3 receptor, contracting ciliary muscle to open trabecular meshwork and increase outflow of aqueous humor through canal of Schlemm. Glaucoma
• miosis and cyclospasm (ciliary contraction)

• cholinomimetic
• irreversible inhibition of AChE to inhibit breakdown of ACh, increasing agonism on M3 receptor, contracting ciliary muscle to open trabecular meshwork and increase outflow of aqueous humor through canal of Schlemm. Glaucoma
• miosis and cyclospasm (ciliary contraction)

• prostaglandin
• increases outflow of aqueous humor
• darkens iris, increased eyelash growth

• prostaglandin (PGF2alpha)
• increases outflow of aqueous humor
• darkens iris, increased eyelash growth

• opioid
• agonist at mu, delta, and kappa opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain, acute pulmonary edema, adjuvant during general anesthesia
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at mu, delta, and kappa opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain, acute pulmonary edema, adjuvant during general anesthesia
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at mu, delta, and kappa opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain, acute pulmonary edema
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at mu(beta-endorphin), delta(enkephalin), and kappa(dynorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. maintenance programs for heroin addicts pain, acute pulmonary edema
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• partial agonist at mu(beta-endorphin), delta(enkephalin), and kappa(dynorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. used with naloxone in maintenance programs for heroin addicts pain, acute pulmonary edema
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at mu(beta-endorphin), delta(enkephalin), and kappa(dynorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain, acute pulmonary edema
• addiction, respiratory depression, constipation, mydriasis, no tolerance to constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at mu(beta-endorphin), delta(enkephalin), and kappa(dynorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Diarrhea, pain, acute pulmonary edema
• addiction, respiratory depression, constipation, miosis, no tolerance to miosis or constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)

• opioid
• agonist at kappa(dynorphin) antagonist at mu(beta-endorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain
• less opioid side effects, withdrawal if taken with naltrexone/naloxone (full antagonists)

• agonist at kappa(dynorphin) partial agonist at mu(beta-endorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P. Pain
• less opioid side effects, withdrawal if taken with naltrexone (full antagonist). Toxicity not well reversed with naloxone

• weak opioid, SNRI
• weak agonist at mu(beta-endorphin), delta(enkephalin), and kappa(dynorphin) opioid receptors to open potassium channels and close calcium channels, reducing synaptic transmission, inhibiting release of ACh, NE, 5-HT, glutamate, and substance P, also inhibiting reuptake of NE and 5-HT. Pain
• addiction, respiratory depression, constipation, miosis, decreased seizure threshold (increases certain neurotransmitters), serotonin syndrome (increased BP, myoclonus, tachycardia, sweating, hypervigilance, insomnia, agitation), no tolerance to constipation, treat toxicity with naloxone or naltrexone (opioid receptor antagonists)
• tram it all (opioid receptors, 5-HT reuptake, NE reuptake)

long-acting opioid antagonist. Relapse prevention after opioid detox