PharmGIAaron2.txt

H2 agonist on parietal cells (tagamet)

renal impair equals low dose

Most side effects of any H2

anti androgenic

H2 antagonist on parietal cell (pepcid)

renal impair equals low dose

Longer action than NaHCO3

up Mg in blood

Cathartics and up intestinal motility

H2 antagonist on parietal cell

Renal impair= now dose

H2 antagonis on parietal cells

Inhibits acid by gastrin, muscarinic agonists and basal and meal induced

• down volume of juice
• down pepsin, down IF

Renal impair equals low dose

Baking soda

short acting

transient metabolic alkalosis

Na+ load= fluid retention

exacerbated GERD, belching

Not for: GERD, peptic ulcers, HTN

Complex Al-sucrose sulfate

Coats ulcer

Acid/pepsin barrier

No-antacid effect

Stimulates prostaglandin E

activated by acid environmenbt

lower availability of tetracycline, phenytoin, digoxin, cimetidine

least metabolized CYP2D1A

rapid onsed

PPI

before meal

PPI

OTC

before meal

PPI

before meal

PPI

before meal

PPI

before meal

PPI

before meal

Stimulant/irritant laxative

aloe, senna, cascara

5HT3 antagonist

severe IBS

Nausea, bloating, pain

Bad: constipating

pepto bismol

may prevent colonization w/ e. coli

prostaglandin= diarrhea

inhibit cox=antimotility

bad: tinnitus, constipate

active compound of opiate diphenoxylate

and atropine= lomotil

opiate for diarrhea

inhibits pre-synaptic cholinergic neurons in submucosal and myenteric plex.

Few systemic side efx

Anticholinergic for IBS muscarinic

Anti-spasmodic

Anti-cholinergic for IBS

anti-spasmodic for pain and discomfort

inhibit muscarinic receptors nin myenteric plexus and smooth muscle

opioid (imodium)

doesn't cross BBB

inhibit pre-synaptic cholinergic neurons in submucosal and myenteric plexus

for diarrhea

Hydrophilic colloid

Chronic constipation

Osmotic agent

Flatulence

Stool softener

Allow H2) and lipids to penetrate

hydrophilic colloid

chronic constipate

osmotic agents

CHF=change in intravasc. volume

Osmotic agent

Flatulence

Hydrophilic colloids

Chronic constip

Colonic cleansing before endoscopy

balanced= no electrolyte shifts

opiate antagonist for opiate constipation

does not cross BBB

hydrophilic colloids

1st line chronic constipation

Chloride channel activator

For: chronic constipation

Up liquid into lumen, shortens transit

D2 receptor antagonist

Inhibie smooth muscle stim

Up peristaltic amplitude

Up lower esophageal sphincter pressure

enhance gastric empty

low transit tiimes

For: anti emetic

5-HT4 agonist

Stimulates 2nd order neurons of myenteric plexus=peristalsis

Benzo

Before chemo for anxiety and anticipaqtory vomit

Benzo

Prior to chemo for anticipatory vomit

Reduce vomit from anxiety

Neurokinin antagonist

NK1 antaqgonist= first ever cancer chemo and PONV

Used w/ serotonin agents

blocks action of substance P

Cannabinoid antiemetic

1st pass hepatic meetab

appetite stim

For: chemo w/ others

Bad: euphoria, dysphoria, sedate, hallucinate, potentiates psychoactive

Anti-muscarinic anti emetic

1st line for motion sickness

transdermal patch

antihistamine anti emetic

Bad: sedation, drowsy, dry mouth, urine reatin, cycloplegia

Antimistamine anti emetic

sedation, dry mouth, confuse, urine retain, cycloplegia

D2 antagonist

antipsychotic and sedative

antiemetic via central domamine

Bad: proarrythmic, extrapyramidal, hypotension

D2 receptor antagonist

Central dopamine block

Bad: Extrapyramidal, restless, dystonia

inhibits dopaminergic, muscarinic, and histaminergic

Anti emetic via central dopamine blockade

Bad: Sedative=histamine

5HT3 antagonist

vagal stim emesis

Acute chemo, surg, rads

5HT3 antagonist

vagal stim emesis

acute surg, rads, chemo

5ht3

Intestin vagal afferents, and central receptors in vomit center and CTZ

Only emesis from vagal stim.

Acute chemo, rads, surgery

Bad: HA, dizzy, constipate

• For cutaneous larva migrans
• S. stercoralis

Also nematode trichinosis, T. spiralis (does not destroy larva in muscle)

Inhibits glucos uptake, acute reductase

adults, eggs, larva

Bad Olfactory, disturb, crystalluria, leukopenia, hallucinate, Stevens-Johnson, hepatic

For: nematodes

depolarizes myoneural junct. Spastic paralysis

Worms alone whjen passed

poorly absorbed= less toxic

Bad: no preggo, less y/o, or w/ piperazine

For: all cestode and trematode

Up permeability to Ca2+

Impairs attachment

40mg/kg initially, lethal only for adults

Treat whole house

Bad: fever sedation, HA, abd. discomfort

Alt. drug for trematode S. mansoni

Converted to unstable ester yielding reactive electrophiles

For: cestodes- tapeworms

Inhibits glucose uptake

Causes detachment and pooping out

oral but not absorbed so up conc in intestines

Alt for treamatode S. haemotobium

Organophosphate inhibitor of cholinesterase

Insecticide

Treat urinary schistosomas in africe

Inhibits plasma cholinesterase or host

Bad: vertigo, lassitude, nausea, colic

For: most GI nematodes- pinworms

given to all household members

Inhibits glucose uptake adult t regg inhibits microtubule poly by B-tubulin

Oral but poor absorbed

Abd. discomfort and diarrhea

Not: preggo

For: nematodes, O. volvulus, and S. stercoralis

Tonic paralysis of peripheral musculature

Potentiates GABA

Not in meningitis

Bad: itching, swollen glands, postural hypo, CNS

For: microfilaria, W. bancrofti, B. malavi, L. Loa in blood

Alt for nematod, O. volvulus

No effect for adult worm or microfilaria in lymph node

Hyper polarizes helm. muscle

Alters surface membanes

May cause system rxn from massive kill, start with small dose.

Encephalopathy w/ L. Loa

For CDC only

For: trematode F. hepatica

Also- chinese liver flukes

oral

Bad: vomit, diarrhea, uticaria, photosensitivity

New, broad spectrum anti helinthic.

Aot for hookworkm pinworm, porkworms, and threadworms

Drug of choice: hydatid dz, cysticercosis

Inhibits glucose uptake in helm. kills adults and eggs

Take- empty stom- for intraluminal w/ fatty- tissue

Not: preggo

Synthetic allylamine

Inhibits fungal squalene eposidase.

Accumulates squalene epoxide (toxic)

Bad: GI upset and headache

daily for 12 wks= 90% rare

on chymycosis

better than griseo

Inhibits fungal mitosis by producing multinucleated cells.

Interacts w/ polyenergized microtubules

Bad: now w/ prophyria, induces liver enzymes, anti-inflammation

Teratogen and carcinogen

For: skin infections, microsporum, trichophyton, epidermophyton

Echinocandin

Disrupts fungal cell wall synthby inhibiting B-(1,3)-D- glucan synth .

very expensive

Refractory invasive aspergillosis

Toxic and old

Ulsed topically

0.5%- skin

3-10%- vaginal

Newest and very expensive

Broad spectrum

For: aspergillosis

Available as oral suspension

Newer than kero

less toxic and broader spectrum

triazole

Inhibits sterol 14-alpha-dmethylase

Greater GI absorb, cross BBB

Bad: no endocrine effects, N/V, renal, hepatic

Relapse cryptomening..

Prophylax in AIDS for candidiasis

imidazole

inhibits sterol 14 alpha demethylase

• absorbed well from GI
• H2 blockers down absorption

Bad: N/V, menstrual irreg, gynecomastia renal insuf. and heptotox

For: non-meningeal syst. blusto, histo, cocciolis

inside fungal cell deaminated to 5FU anoalog of deoxyuridylic acid

5FU blocks thymidylate synthase

well abosrbed GI and corss BBB

Bad: bone marrow suppress, up LFT

Polyene

Same as Amp B.

K+/mg++ pore

only topical

For: candidiasis

Polyene

forms ion channel K+ Mg++

Binds ergosterol

No GI abosrption

Monitor renal-creatinine

Bad: neurotox, hypersiensitivity

For: life threatining mycotics

Water soluble arteminins

• P. falciparum
• iron from heme reduces peroxide bond

Lipid soluble artemisinis

WHO drug

Worldwide for P. falciparum

iron form heme reduces peroxide bondin artemisinis

= high valent iron-oxo spears

Aralen phosphate

Suppressive trends and acute uncomplicated malaria

effective against erythrocytic forms so ameliorates symptoms.

Fast acting- afebrile ulcer 1-2d

Blocks synth DNA and RNA

Oral/IV Protoporphyrin IX

Slowing divided doses

MDR durg resist

Not in: Psoriasis and porphyria

Cinchona alkaloid

Clinical cure against severe chloroquine resistant P. falciparum

Best for cerebral malaria

Not by itself

Weak base- accumulates in food vacuoles

Bad: HTN, cinchonium - sweat, tinnitus, blurred vis, blood dyscrasias, hypoglycermia

Not: myasthenia gravis, tinnitus and optic something.

Geniutal trichomoniasis

Intes6tinal and hepat6ic amoebiasis

Asymptomatic amebiasis

Drug of choice - giardiasis

+ electron sink in protozoa, nitro group reduced

Oral, IV = Up levels CSF

Bad: metallic taste, neurotoxin, red brown urine, urethral burning, phlebitis

Not: preggo, alcohol, CNS dz, dyscrasias, preggo

Alt. drug for amebic hepatitis and amebic abscess

Followed by chloroquine and iodoquinol

Cardiovascular effect, UI tox, weakness, neuropathy

Not: w. preexisting cardio, muscular, neuro

Used for: giardiasis 90% cure rate

Binds DNA through an intercalation. prevents synth of nucleic acid blocking DNAand RNA poly

Oral

Bad: yellow stain of skin and sclera. blue and black pigment in nail beds.

Mulitdrug resistant P. flaciparum, as suppressive and clinical.

affects membranes

only give for short time to avoid reistance

Bad: 50%= dizzy, ataxia, and HA Neuropsych

For: uncomplicated cases of multiresistant as a suppressive and clinical agent

Interferes w/ 2 diff path in pyrimidine biosynth

Inhibits mitochondrial, ETC, and dihydrofolate reductase

Take w/ food or milk- not with tetracycline

Antiarrythmic drug

Dextrostereoisomer of quinine

Anti-malarial

Drug of choice for asymptomatic amebiasis - only from CDC.

Well tolerated, some GI, pruritis

Pentavalent antimonial

Drug of choice for all 3 forms leishmaniasis

inhibits phosphofructokinase IV, IM, oral infiltrate

Bad: myalgia, ECG, pruritus, rash, myocardial damage

Chloroquine-resistant infections

Not in acute setting by itself

Inhibits dihydrofolate reductase blocks purine and pyrimidines.

Synergistic w/ sulfonamides

Bad: flase acid problems, S/S if given w/ sulfaloxine

a tetracycline for suppressive therapy against multi drug reistant

P. falciparum

Pts nable to take mefloquine

acute malaria w/ quinine

Active against blood stages but not liver stages

Alt. drug amebic hepatitis and abscess.

Then use chloroquine and iodoquinol

Severe amebic dysentery-cannot cure

Replaced METRANIDOZOLE

Inhibits proetin synth by blocking chain elongation- prevents translocation

SQ or IM

Bad: CV effects- arrhythmias, EKG changes, GI tox, muscle weak, peripheral neuropath

Acute and chronic CHAGAS dz

Superoxide radical

oral

Adverse w/ EtOH

Bad: HA, insomnia, convulsions, myalgia