Pupils in overdose: morphine vs. amphetamine

"MorPHINE: Fine. AmPHETamine: Fat"
Morphine overdose: pupils constricted (fine)
Amphetamine overdose: pupils dilated (fat)



Phenobarbitone side effects

Children are annoying (hyperkinesia, irritability, insomnia, aggression)
Adults are dosy (sedation, dizziness, drowsiness)



Atropine: origin tells action or vice versa

Atropine causes your pupils to dilate, and it came from nightshade [belladona]
In the night or in shade, your pupils dilate so you can see



Atropine use: tachycardia or bradycardia

"A goes with B":
Atropine used clinically to treat Bradycardia



Reserpine action

Reserpine depletes the Reserves of catecholamines [and serotonin]



Botulism toxin: action, related bungarotoxin

Action: "Botulism Bottles up the Ach so it can't be the released"
Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alpha-bungarotoxin--alpha has different mechanism)



Ipratropium action

Atropine is buried in the middle: iprAtropium, so it behaves like Atropine



Succinylcholine: action, use

Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore
You Suck stuff in through a mouth-tube, and drug is used for intubation



Cholinergics (eg: organophosphates) effects

If you know these, you will be "LESS DUMB":
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction



Anticholinergic Overdose

Not really a mnemonic:

Blind as a bat
Dry as a bone
Red as a beet
Mad as a hatter
Hot as a hare
and: mydriasis, absent BS, urinary retention



Depression: 5 drugs causing it

PROMS:
Propranolol
Reserpine
Oral contraceptives
Methyl dopa
Steroids



Benzodiapines: actions

"Ben SCAMs Pam into seduction not by brain but by muscle":
Sedation
anti-Convulsant
anti-Anxiety
Muscle relaxant
Not by brain: No antipsychotic activity.



Methyldopa side effects

METHYLDOPA:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity
psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)



Sodium valproate side effects

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



Lead poisoning

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



Lithium side effects

LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism



SSRI side effects

SSRI:
Serotonin syndrome
Stimulate CNS
Reproductive disfunctions in male
Insomnia



Narcotic antagonists

The Narcotic Antagonists are NAloxone and NAltrexone.
Important clinically to treat narcotic overdose.



Inhalation anesthetics

SHINE
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
If want the defunct Methoxyflurane too, make it MoonSHINE.



Opioid effects

BAD AMERICANS:
Bradycardia & hypotension
Anorexia
Diminished pupilary size
Analgesics
Miosis
Euphoria
Respiratory depression
Increased smooth muscle activity (biliary tract constriction)
Constipation
Ameliorate cough reflex
Nausea and vomiting
Sedations



Delerium-causing drugs

ACUTE CHANGE IN MS:
Antibiotics (Biaxin, Penicillin, Ciprofloxacin)
Cardiac drugs (Digoxin, Lidocaine)
Urinary incontinence drugs (Anticholinergics)
Theophylline
Ethanol
Corticosteroids
H2 blockers
Antiparkinsonian drugs
Narcotics (especially Mepridine)
Geriatric psychiatric drugs
ENT drugs
Insomnia drugs
NSAIDs (eg Indomethacin, Naproxin)
Muscle relaxants
Seizure medicines



4-Aminopyradine (4-AP) use

"4-AP is For AP":
For AP (action potential) propagation in Multiple Sclerosis.



Direct sympathomimetic catecholamines

DINED:
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine



Anesthesia: 4 stages

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



Benzodiazepene antidote

"Ben is off with the flu":
Benzodiazepine effects off with Flumazenil.



Narcotic side effects

"SCRAM if you see a drug dealer":
Synergistic CNS depression with other drugs
Constipation
Respiratory depression
Addiction
Miosis



Benzodiazepene: drugs which decrease its metabolism

"I'm Overly Calm":
Isoniazid
Oral contraceptive pills
Cimetidine
These drugs increase calming effect of BZDs by retarding metabolism.



Myasthenia gravis: edrophonium vs. pyridostigmine

eDrophonium is for Diagnosis.
pyRIDostigmine is to get RID of symptoms.



Lithium: side effects

LITHIUm:
Leukocytes
Increased (leukocytosis).
Tremors.
Hypothyroidism.
Increased
Urine (ADH antagonist).



Morphine effects

MORPHINE:
Miosis
Orthostatic hypotension
Respiratory depression
Pain supression
Histamine release/ Hormonal alterations
Increased ICT
Nausea
Euphoria
Sedation



Monoamine oxidase inhibitors: members

"PIT of despair":
Phenelzine
Isocarboxazid
Tranylcypromine
A pit of despair, since MAOs treat depression.









Cardiovascular system



©¬2-adrenergic agonists

"I D-R-E-A-M-T of practicing medicine as easy as ABC."

"I D-R-E-A-M-T" (where Dream rhymes with -ine, -drine)

I-Isoproterenol

D-Dobutamine
R-Ritodrine
E-Epinephrine
A-Albuterol
M-Metaproterenol
T-Terbutaline

©¬2 agonist therapy is indicated in A-B-C

A-Asthma
B-Bronchospasm in Bronchiolitis
C-CHF, COPD



Propranolol and related '-olol' drugs: usage

"olol" is just two backwards lower case b's
Backward b's stand for "beta blocker"
Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol



Warfarin: action, monitoring

WePT:
Warfarin works on the extrinsic pathway and is monitored by PT.



Beta-blockers side effects

"BBC Loses Viewers In Rochedale":
Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia



Captopril (an ACE inhibitor) side effects

CAPTOPRIL:
Cough
Angioedema/ Agranulocystosis
Proteinuria
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis
Renal failure (and renal artery stenosis contraindication)/ Rash
Increased potassium
Leukopenia/ Liver toxicity



Beta-blocker main contraindications / cautions

ABCDE:
Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)



Ca++ channel blockers: uses

CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter/fibrillation
Supraventricular tachycardia
Hypertension
Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes



Antihypertensives

AA-ABCD

AA-Angiotensin II Antagonists
A-ACE inhibitors
B-Beta blockers
C-Calcium channel blockers
D-Diuretics

AB: most effective in hypertensive patients who are young and white
A and B grades are reserved for the young and white, but¡¦

CD: most effective in hypertensive patients who are elderly and African-American
C and D grades are given to the elderly and black.



Hypertensive Emergencies

Lucy and Desi Arnaz of the I Love Lucy fame were an intense, Hypertense couple,
but now...

"Lucy and Desi's Ghosts Reside in the Night Sky."

Lucy - Labetol
Desi - Diazoxide
Ghosts - Ganglionic blocking agent: Trimethaphan
Reside - Reserpine
Night - Nitroglycerin, nifedipine
Sky - Sodium Nitroprusside



CHF treatment

"Captains Fumble Call Girls' Butts":

In order from 1st to 5th:
Captopril
Furosemide, diuretics
Calcium channel blokers
cardiac Gycosides
dobutamine

:

Drugs that may exacerbate CHF

"AAABC"

A-Antiarrhythmic drugs
A-Aspirin (NSAIDs)
A-Alcohol
B-Beta blockers
C-Calcium channel blockers










WARFARIN METABOLISM

SLOW:
Has a slow onset of action.
A quicK Vitamin K antagonist, though.

Small lipid-soluble molecule
Liver: site of action
Oral route of administration.
Warfarin



AMIODARONE: ACTION, SIDE EFFECTS

6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism



Patent ductus arteriosus: treatment

"Come In and Close the door":
INdomethacin is used to Close PDA.







Pulmonary system



Therapy for Asthma -

A-S-Th-M-A
A-Albuterol
S-Steroids (corticosteroids)
Th-Theophylline
M-Muscarinic antagonists: ipratropium
A-Aminophylline





Gastrointestinal system



Endotracheal tube deliverable drugs

NAVEL:
Narcan
Atropine
Valium
Epinephrine
Lidocaine



Hepatic necrosis: drugs causing focal to massive necrosis

"Very Angry Hepatocytes":
Valproic acid
Acetaminophen
Halothane



Misoprostol

"You need this in BED":
gastric mucous Barrier
PGE1
Diarrhea














Amphotericin B --- A-B-C-D-E-F

A-Aspergillosis
B-Blastomycosis
C-Coccidiodes immitis
D-Disseminated histoplasmosis
E-swEEt Candida sp.
F-F**ed up brain, e.g., AIDS patients with cryptococcal meningitis
___________________________________________________________________________________________






5-flucytosine - 3C

Candidiasis - localized infections
Chromomycosis
Combination therapy with amphotericin B: Cryptococcal meningitis

____________________________________________________________________________________________

*F*luconazole - 3C + 1F

CS*F* penetration is good.
Candidiasis
Cryptococcal meningitis: prophylaxis in AIDS patients

____________________________________________________________________________________________




Opioid effects, intoxication, antagonists

See the Hopi [Opioids] Indians on Horseback [Heroin] B-U-R-N B-A-D A-M-E-R-I-C-A-N-S.

B-Biliary smooth muscle constriction and spasm of sphincter of Oddi
UR - Urinary Retention
N-Naloxone, Naltrexone, Nalmefene are opioid antagonists.

B-Bradycardia and hypotension
A-Antitussive effect (cough reflex suppression)
D-Deep tendon reflexes are Depressed.

A-Analgesic effect
M-Miosis
E-Euphoria
R-Respiratory depression
I-Intracranial pressure is increased. (This effect is minimal with normal or low pCO2.)
C-Constipation
A-Acute opiate intoxication morbidity and mortality due to A-Anaphylaxis, ARDS, Acute respiratory Acidosis,
and Aspiration pneumonitis.
N-Nausea and vomiting
S-Sedation

Acute opiate intoxication is characterized by abnormal mental status, decreased respiration, and miotic pupils [2].

Hopi [Opioids] means a Calm, Peaceful people" [reduced HR, BP, temperature, respirations].
They use their eagle Eyes to hunt down a Pin [Pinpoint pupils indicate overdose: use antagonists].

ARDS: Adult respiratory distress syndrome (noncardiogenic pulmonary edema)




Cholinergic Overdose

"SLUDGE"

S - Salivation
L - Lacrimation
U - Urination
D - Diarrhea
G - Gastric upset
E - Emesis

or, alternatively:

"Dumbbels"

D - Diarrhea
U - Urination
M - Miosis/muscle weakness
B - Bronchorrea
B - Bradycardia
E - Emesis
L - Lacrimation
S - Salivation/ sweating