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Autacoids and Nonsteroidal Antiflammatory Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters
[Histamine/Antihistamines] - [Drugs for Motion Sickness] [Serotonin (5-HT) and pharmacology of migraine] [Nitric oxide, donors and inhibitors] - [Eicosanoids] [Treatment of asthma] [Hypersensitivity and Immunopharmacology] [Bradykinin] [Antipyretics and Analgesics] - [Nonsteroidal Antiinflammatory Drugs] -[Disease Modifying Antirheumatic Drugs (DMARDS)] [Antigout Drugs]

Histamine/Antihistamines Histaminic drugs

* * betazole HISTAMINE

H1-Antihistamines
* * * * * * * brompheniramine CHLORPHENIRAMINE DIPHENHYDRAMINE FEXOFENADINE hydroxyzine loratadine promethazine

H2-Antihistamines

* * * *

CIMETIDINE FAMOTIDINE nizatidine RANITIDINE

Antidegranulating drugs
* * CROMOLYN SODIUM nedocromil sodium

Drugs for Motion Sickness

* * * DIMENHYDRINATE promethazine scopolamine

Serotonin (5-HT) and pharmacology of migraine

* * * * * * * * * * * antiemetics (metoclopramide, ONDANSETRON) -adrenergic antagonists (atenolol, propranolol) caffeine calcium channel blockers (amlodipine, verapamil) cyproheptadine ergot derivatives (ERGOTAMINE, dihydroergotamine) METHYSERGIDE NSAIDs and analgesics (aspirin, acetaminophen, ibuprofen, indomethacin, naproxen) phenelzine tricyclic antidepressants (amitriptyline, nortriptyline) triptans (SUMATRIPTAN, zolmitriptan)

Nitric oxide, donors and inhibitors

* * * * nitrates nitrites sodium nitroprusside SILDENAFIL

Eicosanoids
* * * * * * * alprostadil (PGE1) dinoprostone (PGE2) epoprostenol misoprostol MONTELUKAST zafirlukast ZILEUTON

Treatment of asthma
* -adrenergic agonists (non-selective, epinephrine; selective short-acting, ALBUTEROL, bitolterol, METAPROTERENOL; selective longacting, SALMETEROL) anticholinergics (IPRATROPIUM bromide) antidegranulating agents (CROMOLYN SODIUM, nedocromil sodium) anti-IgE antibody (omalizumab) glucocorticoids (BECLOMETHASONE, budesonide, flunisolide, FLUTICASONE) leukotriene inhibitors (MONTELUKAST, zafirlukast, ZILEUTON)

* * * * *

methylxanthines (THEOPHYLLINE, aminophylline)

Hypersensitivity and Immunopharmacology

* * * * * * * * * * * * CYCLOPHOSPHAMIDE CYCLOSPORINE interferon interferon METHOTREXATE muromonab-CD3 mycophenolate mofetil PREDNISONE rapamycin rho(D) immune globulin tacrolimus thalidomide (leprosy, graft-versus-host disease, multiple myeloma)

Bradykinin
* * aprotinin BRADYKININ

Antipyretics and Analgesics

* * * * ACETAMINOPHEN ASPIRIN and related salicylates non-steroidal drugs other than aspirin (see below) combinations - acetaminophen and ASA with opioids and/or caffeine

Nonsteroidal Antiinflammatory Drugs

* * * * * * * * * * * * * * * * * ASPIRIN and related salicylates celecoxib DICLOFENAC SODIUM fenoprofen IBUPROFEN INDOMETHACIN KETOPROFEN KETOROLAC meclofenamate NABUMETONE NAPROXEN OXAPROZIN piroxicam rofecoxib sulindac tolmetin VALDECOXIB

Disease Modifying Antirheumatic Drugs (DMARDS)

* * * * * * * * * azathioprine chloroquine and HYDROXYCHLOROQUINE ETANERCEPT gold salts (auranofin, aurothioglucose) INFLIXIMAB leflunomide METHOTREXATE D-penicillamine sulfasalazine

Antigout Drugs
* * * * * * * ALLOPURINOL COLCHICINE methylprednisolone NSAIDs (e.g. indomethacin, except aspirin) PREDNISONE PROBENECID SULFINPYRAZONE

ABCIXIMAB
ACETYLSALICYLIC ACID (aspirin)

argatroban CLOPIDOGREL
COBALAMIN (cyanocobalamin, hydroxocobalamin)

danaparoid sodium
darbepoetin alpha (NESP) DEFEROXAMINE desmopressin acetate (DDAVP)

dipyridamole epsilon-aminocaproic acid eptifibatide

rERYTHROPOIETIN (EPOETIN ALPHA) FILGRASTIM (NEUPOGEN) FOLIC ACID fondaparinux GM-CSF G-CSF HEPARIN IRON(FERROUS SULFATE, iron dextran)

LEPIRUDIN
protamine sulfate reteplase sodium ferric gluconate STREPTOKINASE tenecteplase TICLOPIDINE tirofiban TISSUE PLASMINOGEN ACTIVATOR(t-PA) thrombopoietin VITAMIN B-12 VITAMIN K WARFARIN SODIUM

Cardiovascular and Respiratory Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters [Antiarrhythmic Drugs] - [ Inotropic Agents] - [Antihypertensives and Related Drugs] [Antianginal Drugs] - [Antihyperlipidemic Drugs] - [Respiratory Drugs]

Antiarrhythmic Drugs
ADENOSINE AMIODARONE Atropine -ADRENOCEPTOR ANTAGONISTS (e.g. METOPROLOL, SOTALOL) Bretylium CALCIUM CHANNEL BLOCKERS (e.g. DILTIAZEM, VERAPAMIL) digitoxin digoxin disopyramide disopyramide dofetilide flecainide ibutilide LIDOCAINE mexiletine PROCAINAMIDE propafenone QUINIDINE

Management of Acute and Chronic Heart Failure

ANGIOTENSIN CONVERTING ENZYME INHIBITORS (e.g. ENALAPRIL) ANGIOTENSIN RECEPTOR ANTAGONISTS (e.g. LOSARTAN) ADRENOCEPTOR ANTAGONISTS (e.g. CARVEDILOL; METOPROLOL) ADRENOCEPTOR AGONISTS (e.g. DOBUTAMINE; DOPAMINE) DIGOXIN DIURETICS (e.g. Furosemide; SPIRONOLACTONE) inamrinone PHOSPHODIESTERASE INHIBITORS (e.g. INAMRINONE; MILRINONE) NESIRITIDE VASODILATORS (e.g. HYDRALAZINE, NITROPRUSSIDE)

Antihypertensives and Related Drugs

ANGIOTENSIN (I & 11) atenolol CAPTOPRIL CLONIDINE diazoxide DILTIAZEM ENALAPRIL esmolol FUROSEMIDE guanabenz HYDRALAZINE HYDROCHLOROTHIAZIDE indapamide labetalol losartan metazolone methyldopa METOPROLOL minoxidil NIFEDIPINE NITROGLYCERIN (i.v.) nitroprusside pindolol PRAZOSIN PROPRANOLOL quinapril reserpine spironolactone triamterene VERAPAMIL

Antianginal Drugs
ANTIPLATELET AGENTS (e.g. Clopidogrel) ADRENOCEPTOR ANTAGONISTS (e.g. PROPRANOLOL) CALCIUM CHANNEL BLOCKERS (e.g. NIFEDIPINE) VASODILATORS

Antihyperlipidemic Drugs
CHOLESTYRAMINE colestipol

ezetimibe FIBRIC ACID DERIVATIVES (e.g. GEMFIBROZIL, FENOFIBRATE) HMG CoA REDUCTASE INHIBITORS (e.g. ATORVASTATIN, LOVASTATIN, PRAVASTATIN) nicotinic acid

Respiratory Drugs
ALBUTEROL beclomethasone CROMOLYN SODIUM EPINEPHRINE flunisolide IPRATROPIUM BROMIDE isoproterenol sulfate metaproterenol nedocromil oxymetazoline phenylephrine pseudoephedrine salmeterol TERBUTALINE THEOPHYLLINE

Chemotherapy Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters
[Antimicrobial Agent] -[Penicillin plus penicillinase inhibitor ] [Cephalosporins ] - [Vancomycin; Teicoplanin] - [Inhibitors of Protein Synthesis] - [Aminoglycosides ]

- [CHLORAMPHENICOL] - [ERYTHROMYCIN] - [CLINDAMYCIN] - [Tetracyclines] - [Antimetabolites] -[Inhibitors of

DNAsynthesis]- [Sulfonamides] - [Urinary Tract Antiseptics] - [Cationic Surfactants] -[Drugs for Anerobic Bacteria Only] -[Antimycobacterial Drug] [Antifungal Drugs] -[Antiviral Drugs] - [Antiparasitic Drugs] - [Antiprotozoal Drugs] - [Antihelminthic Drugs] -[Anticancer Drugs and Immunosuppressives]

Antimicrobial Agents
Narrow spectrum Penase-sensitive
Pen G NAFCILLIN AMOXICILLIN TICARCILLIN PEN V OXACILLIN AMPICILLIN

Cell Wall Synthesis Inhibitors: Penicillins

Narrow spectrum Penase-resistent (S. aureus)
dicloxacillin

Broad spectrum (aminopenicillins) Primarily antipseudomonal

CARBENICILLIN

Extended spectrum
PIPERACILLIN

Monobactams
Aztreonam

Carbapenems
Imipenem with cilastatin

Penicillin plus penicillinase inhibitor

 Amoxicillin plus clavulanic acid (Augmentin)

Cephalosporins
First generation
CEPHALEXIN

Ticarcillin plus clavulanic acid (Timentin)

CEFAZOLIN CEFACLOR CEFTAZIDIME CEFPROZIL CEFOTAXIME

Second generation
CEFOXITIN

Third generation
CEFTRIAXONE

Fourth generation
CEFEPIME

Vancomycin

Inhibitors of Protein Synthesis

Aminoglycosides
STREPTOMYCIN GENTAMICIN TOBRAMYCIN AMIKACIN NETILMICIN

STREPTOGRAMINS
Quinupristin Dalfopristin (Synercid)

OXAZOLIDINONES MACROLIDES
Clarithromycin Azithromycin LINEZOLID Erythromycin

CHLORAMPHENICOL ERYTHROMYCIN CLINDAMYCIN Tetracyclines

TETRACYCLINE

DOXYCYCLINE

MINOCYCLINE

Inhibitors of DNA synthesis Fluoroquinolones

Norfloxacin

Sulfonamides
Best urine solubility
SULFASOXAZOLE SULFAMETHOXAZOLE

Ciprofloxacin

Levofloxacin

SODIUM SULFACETAMIDE (ophthalmic use)

Topical (burns)
SILVER SULFADIAZINE

TRIMETHOPRIM
Use as TRIMETHOPRIM - SULFAMETHOXZAOLE combo.

Urinary Tract Antiseptics

NITROFURANTOIN POLYMIXIN B

Cationic Surfactants Drugs for Anerobic Bacteria Only

Metronidazole ISONIAZID ETHAMBUTOL Clofazamine

Antimycobacterial Drugs Antifungal Drugs

Polyenes
AMPHOTERICIN B NYSTATIN RIFAMPIN STREPTOMYCIN Rifabutin DAPSONE STREPTOMYCIN

Flucytosine Imidazoles
KETOCONAZOLE MICONAZOLE Terbinafine FLUCONAZOLE ITRACONAZOLE Voriconazole Griseofulvin

Antiviral Drugs
AMANTIDINE and Rimantadine ACYCLOVIR ZIDOVUDINE GANCICLOVIR FOSCARNET Didanosine Valacyclovir Efavirenz Indinavir Lamivudine Zanamivir Ribavirin Lopinavir Nelfinavir

 Nevirapine Interferon alpha

Enfuvirtide

Stavudine

Antiparasitic Drugs
CHLOROQUINE MEFLOQUINE Quinine PRIMAQUINE PYRIMETHAMINESULFASOXINE (Fansidar) atovaquone

Antimalarial

Antiprotozoal Drugs Amebiasis and Trichomonas

METRONIDAZOLE Diloxanide Iodoquinol

Pneumocystis
TRIMETHOPRIM pentamidine SUFAMETHOXAZOLE Clindamycin plus primaquine

Toxoplasmosis
PYRIMETHAMINE plus sulfadiazine Pyrimethamine plus clindamycin

Trichomonas

Antihelminthic Drugs

METRONIDAZOLE

Flatworms
PRAZIQUANTEL

Fluke and Tapeworm Infections Schistosomiasis

PRAZIQUANTEL

Filariasis
diethylcarbamazine ivermectin

Intestinal Roundworms (Ascaris), Enterobius (Pinworm) and Hookworm

mebendazole Albendazole pyrantel pamoate

Angiostroglyliasis
mebendazole

Trichurius (Whipworm) Hookworm

mebendazole albendazole

Trypanosomiasis

 nifurtimox or

suramin

pentamidine

Giadiasis
metronidazole

Anticancer Drugs and Immunosuppressives

[Alkyating Agents] - [Antimetabolites] - [Natural Products] - [Antimitotics] [Antimitotics] - [Hormones] - [Immunosuppressives]

Alkyating Agents
MECHLORETHAMINE CYCLOPHOSPHAMIDE busulfan Nitrosoureas (carmustine, lomustine) procarbazine 6-THIOGUANINE Cytosine arabinoside melphalan

Antimetabolites
METHOTREXATE 6-MERCAPTOPURINE Fludarabine Capecitabine 5-Fluorouracil gemcitabine

Natural Products
dactinomycin DAUNORUBICIN DOXORUBICIN BLEOMYCIN mitomycin C ETOPOSIDE (VP-16) VINBLASTINE asparaginase mitoxantrone Camptothecin analogs: irinotecan and topotecan paclitaxel/docetaxel amsacrine Imatinib

Antimitotics
VINCRISTINE

Miscellaneous
HYDROXYUREA CISPLATIN/ Carboplatin

Hormones
Estrogens Anti-estrogen (TAMOXIFEN) PREDNISONE flutamide leuprolide TACROLIMUS (FK506) goserelin

Immunosuppressives
azathioprine CYCLOSPORIN A

Diuretics and Renal Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters

acetazolamide AMILORIDE bumetanide CHLORTHALIDONE DEMECLOCYCLINE DESMOPRESSIN ACETATE (DDAVP) dopamine

FUROSEMIDE HYDROCHLOROTHIAZIDE mannitol metolazone SPIRONOLACTONE TRIAMTERENE

Endocrine Drug List Pituitary-Hypothalamic Drugs

arginine vasopressin BROMOCRIPTINE cabergoline corticotropin (ACTH) cosyntropin (ACTH 1-24) corticotropin releasing hormone (CRH) demeclocycline DESMOPRESSIN ACETATE ganirelix GONADOTROPIN RELEASING HORMONE (gonadorelin) goserelin GROWTH HORMONE growth hormone-releasing hormone and releasing peptides human chorionic gonadotropin (hCG) human menopausal gonadotropins (hMG) levodopa LEUPROLIDE nafarelin OCTREOTIDE (synthetic somatostatin octapeptide) OXYTOCIN pegvisomant pergolide prolactin recombinant human growth hormone (somatropin, somatorem) somatomedin C (IGF-1) urofollitropin (FSH)

Adrenocorticoids
aldosterone aminoglutethimide androstenedione angiotensin (I, II & III) beclomethasone betamethasone dehydroepiandrosterone (DHEA) DEXAMETHASONE FLUDROCORTISONE fluocinonide HYDROCORTISONE (cortisol) ketoconazole METYRAPONE mifepristone (RU486) mitotane PREDNISOLONE triamcinolone trilostane

Gonadal Hormones
anastrozole bicalutamide

CLOMIPHENE CONJUGATED ESTROGENS (Premarin, estrone, equilin) cyproterone acetate danazol desogestrol DIETHYLSTILBESTROL drospirinone dutasteride ESTRADIOL (in saltsbenzoate, valerate, cypionate) ETHINYL ESTRADIOL ethynodiol exemastane fadrozole faslodex FINASTERIDE fluoxymesterone FLUTAMIDE formestane

ketoconazole letrozole MEDROXYPROGESTERONE megestrol acetate methyltestosterone mestranol methyltestosterone mifepristone (RU 486) nandrolone NORETHINDRONE norgestimate l-NORGESTREL OXANDROLONE oxymethalone phytoestrogens raloxifene spironolactone TAMOXIFEN TESTOSTERONE-salts (propionate, heptanoate, cypionate)

Thyroid/Parathyroid Drugs
alendronate, etidronate, pamidronate, risedronate calcium carbonate calcitonin calcitriol (1,25-dihydroxy Vitamin D3) cinacalcet cholecalciferol dihydrotachysterol ergocalciferol fluoborate fluoride iocetamic acid iopanoic acid LEVOTHYROXINE (T4) liothyronine sodium (triiodothyronine (T3) liotrix (T4 plus T3) lithium methimazole mithramycin (plicamicin) parathyroid hormone POTASSIUM IODIDE potassium perchlorate PROPYLTHIOURACIL radioactive iodide teriperatide (PTH 1-34) thiocyanate thyrotropin stimulating hormone (TRH) zoledronic acid

Insulins/Oral Hypoglycemic Drugs

acarbose ACETOHEXAMIDE aspart insulin chlorpropramide EXTENDED ZINC INSULIN (ultra-lente) glimipiride GLIPIZIDE glucagon GLYBURIDE Human insulin types: lente insulin, NPH insulin, regular insulin. ultralente insulin) glargine insulin LIS PRO INSULIN (fast acting) METFORMIN miglitol nateglinide pioglitazone repaglinide rosiglitazone somatostatin tolbutamide

Uterine Drugs
carboprost DINOSPROSTONE dinoprostone ERGONOVINE MALEATE MAGNESIUM SULFATE misoprostol OXYTOCIN PROSTAGLANDIN E2 ritodrine terbutaline

Gastrointestinal Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters
[Gastric Antacid/Secretory/Antisecretory Drugs] -[Laxatives and Antidiarrheal Drug] - [Therapy of H. pylori infection] -[Anti-inflammatory Drugs]

Gastric Antacid/Secretory/Antisecretory Drugs

ALUMINUM HYDROXIDE calcium carbonate CIMETIDINE ESOMEPRAZOLE HYDROXIDE LANSOPRAZOLE MAGNESIUM magnesium oxide MISOPROSTOL OMEPRAZOLE Pentagastrin propantheline RABEPRAZOLE RANITIDINE sodium bicarbonate SUCRALFATE

Laxatives Drugs
bisacodyl docusate (dioctyl sodium sulfosuccinate) mineral oil polyethylene glycol lactulose MAGNESIUM HYDROXIDE methylcellulose

Antidiarrheal Drugs
atropine bismuth subsalicylate diphenoxylate LOPERAMIDE octreotide clonidine

Prokinetic Drugs
bethanechol cisapride ERYTHROMYCIN METOCLOPRAMIDE TEGASEROD ALVIMOPAN neostigmine

Therapy of H. pylori infection

bismuth subsalicylate clarithromycin amoxicillin tetracycline metronidazole

Treatment of Inflammatory Bowel Disease (IBD)

Steroids (hydrocortisone, prednisone, prednisolone, budesonide) balgalazide infliximab mesalamine sulfasalazine

Treatment of Irritable Bowel Syndrome (IBS)

 5HT3 antagonists: ALSOSETRON, CILANSETRON

5HT-4 agonists: TEGASEROD

Herbals Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters
Black Cohosh Chamomile Echinachea GINGKO GINGSENG GLUCOSAMINE CHONDROITIN Kava MILK THISTLE SAW PALMETTO ST. JOHN'S WORT Valerian Yohimbe

Priority toxic chemicals and antidotes which should be discussed PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters
ACETAMINOPHEN N-ACETYL-L-CYSTEINE ACTIVATED CHARCOAL AIR POLLUTANTS ALCOHOLS (ETHANOL, METHANOL, ETHYLENE GLYCOL) ARSENIC CARBON MONOXIDE CHELATOR THERAPY (2,3DIMERCAPTOSUCCINIC ACID, DIMERCAPROL, EDETATE) cyanide AND ANTIDOTES DIG-SPECIFIC ANTIBODY FRAGMENTS GLUCAGON HEROIN IRON AND DEFEROXAMINE LEAD MERCURY METHYLENE BLUE NALOXONE SALICYLATES SODIUM BICARBONATE TRICYCLIC ANTIDEPRESSANTS SELECTED PESTICIDES (ANTICHOLINESTERASE, PRALIDOXIME[2-PAM])

Vitamins Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters BIOTIN FOLIC ACID NICOTINIC ACID (NIACIN) panthotenic acid tretinoin VITAMIN A VITAMIN B1 (THIAMIN) VITAMIN B12 (CYANOCOBALAMIN) VITAMIN B2 (RIBOFLAVIN) VITAMIN C (ASCORBIC ACID) VITAMIN D VITAMIN E VITAMIN K

Central and Peripheral (Somatic) Nervous System Drug List

PRIMARY DRUGS - All capital letters SECONDARY DRUGS - Small letters [Endogenous Agents] - [Inhalation and Intravenous Anesthesia] - [Local Anesthetics] - [Opioids] [Antitussives, Expectorants and Mucolytics] - [Drugs for Motor Disorders/Muscle Relaxants] [Antiepileptics] - [Hallucinogens] - [Mood Disorders] - [Sedative-Hypnotics] [Amphetamines, Anorexogenics and CNS Stimulants] - [Anxiolytics] - [Ethanol and Alcoholism] [Drugs of Abuse and Dependence] - [Drugs for Migraine] - [Drugs for Alzheimer's Disease]

Endogenous Agents
ACETYLCHOLINE (ACH) ADENOSINE TRIPHOSPHATE (ATP) aspartate (asp) Beta-Amyloid BRADYKININ DOPAMINE (DA) NOREPINEPHRINE dynorphins endocannabinoids beta-endorphin met-enkephalin

leu-enkephalin 5-HYDROXYTRYPTAMINE (5HT) GAMMA-AMINOBUTYRIC ACID

(GABA)

GLUTAMATE (glu) glycine HISTAMINE Nerve Growth Factor (and other

growth factors)

substance P

Inhalation and Intravenous Anesthesia

ALFENTANIL DESFLURANE enflurane etomidate fentanyl halothane ISOFLURANE KETAMINE methohexital methoxyflurane MIDAZOLAM MORPHINE NITROUS OXIDE (N20) PROPOFOL SEVOFLURANE SUFENTANIL thiopental

Local Anesthetics
BENZOCAINE bupivacaine cocaine levobupivacaine LIDOCAINE lidocaine/prilocaine eutectic mixture (EMLA) prilocaine PROCAINE ROPIVACAINE tetracaine

Opioids Agonists
CODEINE DIPHENOXYLATE fentanyl heroin loperamide MEPERIDINE METHADONE MORPHINE OXYCODONE d-propoxyphene combinations - opioids plus acetaminophen and ASA

Agonist/Antagonists and Antagonists

BUPRENORPHINE butorphanol nalbuphine nalorphine

NALOXONE NALTREXONE PENTAZOCINE

Antitussives,Expectorants and Mucolytics

acetylcysteine ammonium chloride CODEINE

Drugs for Motor Disorders/Muscle Relaxants

amantadine apomorphine BACLOFEN BENZODIAZEPINES BENZTROPINE bromocriptine CARBIDOPA cyclobenzaprine acetazolamide CARBAMAZEPINE clonazepam DIAZEPAM ETHOSUXIMIDE fosphenytoin GABAPENTIN Lamotrigine

DEXTROMETHORPHAN GUANIFENESIN HYDROCODONE

DANTROLENE ENTACAPONE LEVODOPA (L-DOPA) PRAMIPEXOLE ROPINIROLE SELEGILINE TRIHEXYPHENIDYL

Antiepileptics
LORAZEPAM PHENOBARBITAL PHENYTOIN primidone tiagabine topiramate VALPROIC ACID

Hallucinogens
atropine scopolamine

 LYSERGIC ACID DIETHYLAMIDE (LSD) MARIJUANA MDMA

MESCALINE PHENCYCLIDINE (PCP) dronabinol (delta-9 THC)

Mood Disorders Antidepressants

AMITRIPTYLINE BUPRIOPION CITALOPRAM clomipramine desipramine doxepin FLUOXETINE IMIPRAMINE ARIPIPRAZOLE OLANZAPINE QUETIAPINE RISPERIDONE ZIPRASIDONE maprotiline mirtazapine NORTRIPTYLINE PAROXETINE phenelzine SERTRALINE TRANYLCYPROMINE VENLAFAXINE LITHIUM CARBONATE carbamazepine gabapentin lamotrigine VALPROIC ACID QUETIAPINE RISPERIDONE thioridazine trifluoperazine thiothixene ZIPRASIDONE pentobarbital TEMAZEPAM triazolam ZOLPIDEM zaleplon

Mood Stabilizing drugs

Antipsychotics
ARIPIPRAZOLE CHLORPROMAZINE (CPZ) CLOZAPINE fluphenazine HALOPERIDOL OLANZAPINE chloral hydrate diphenhydramine eszopiclone flurazepam oxazepam

Hypnotics

Amphetamines, Anorexogenics and CNS Stimulants

AMPHETAMINE CAFFEINE COCAINE ephedrine mazindol METHAMPHETAMINE METHYLPHENIDATE MODAFINIL phentermine sibutramine

Anxiolytics Benzodiazepines
alprazolam chlorazepate chlordiazepoxide clonazepam

NonBenzodiazepine
AMITRIPTYLINE FLUOXETINE disulfiram ETHANOL
beta-adrenergic blocking agents BUSPIRONE

DIAZEPAM FLUMAZENIL (antagonist) LORAZEPAM OXAZEPAM

SERTRALINE PAROXETINE VENLAFAXINE

Ethanol and Alcoholism Drugs of Abuse and Dependence

AMPHETAMINES, METHAMPHETAMINE Bufotenin COCAINE DIAZEPAM ETHANOL Glutethimide HEROIN butorphanol CAFFEINE ERGOTAMINE METHYSERGIDE PROPRANOLOL LSD MDMA (ecstacy) Organic solvents MARIJUANA/THC NICOTINE PENTOBARBITAL PHENCYCLIDINE METHANOL fomepizole

Drugs for Migraine

PROSTAGLANDINS (carboprost, tromethamine, dinoprostone, dinoprost) SUMATRIPTAN (other triptans)

Drugs for Alzheimers Disease

DONEPEZIL GALANTAMINE MEMANTINE rivastigmine tacrine

By Duy Thai, 1997

Pharmacology Semester 1 page 1 of 4

STEROIDAL ANTI-INFLAMMATORY DRUGS & DRUGS USED TO TREAT RHEUMATOID ARTHRITIS AND GOUT Steroidal anti-inflammatory drugs are also known as corticosteroids

Functions Anti-inflammatory Immunosuppressant Mechanisms of action Corticosteroids, being steroids, are highly lipophilic and can thus penetrate cell membranes fairly easily. They bind to intracellular receptors which modify gene transcription. Corticosteroids have wider ranging effects than NSAIDs because they inhibit a wider variety of enzymes by reducing their synthesis: Inhibit phospholipase A2 Inhibit COX 2 (not COX 1) Inhibit cytokine system Glucocorticoid

Glucocorticoid receptor

Reduction in the synthesis of: Cytokines COX 2 Phospholipase A2

nGRE

Negative glucocorticoid response element Glucocorticoids bind to a glucocorticoid receptor in the cytosol. Once bound, the drug-receptor complex (in this case the negative glucocorticoid response element) goes into the cell nucleus and acts on the promoter region of a gene to block the transcription of cytokines, COX 2 and phospholipase A2. By inhibiting phospholipase A2 we are able to achieve a higher level of anti-inflammation by reducing the synthesis of all eicosanoids (both prostinoids and leukotrienes). The nGRE inhibits the transcription of certain genes. There is also the formation of a +GRE which increases the transcription and synthesis of lipocortin 1. Glucocorticoid

Glucocorticoid receptor mRNA

+GRE

Increased synthesis of lipocortin 1

Positive glucocorticoid response element

By Duy Thai, 1997

Pharmacology Semester 1 page 2 of 4

Lipocortin 1 is an endogenous anti-inflammatory agent. Normally, phospholipase A2 is inactive and must be activated for it to breakdown phospholipids into arachidonic acid. If it were always active, cell membranes would be constantly breaking down. Lipocortin 1 binds to the inactive phospholipase A2 and keeps it inactive. Normally, inflammation will activate protein kinase C which converts lipocortin 1 into an inactive form It then releases phospholipase A2 which can now become active. Corticosteroids act to increase the synthesis of lipocortin. Note that the inflammatory system is still active (we have done nothing to inhibit it) and so it is still acting to inactivate lipocortin. However, since at the same time, we are stimulating the synthesis of active lipocortin at a faster rate, there will be a net increase in lipocortin levels. Lipocortin is thus more likely to hold phospholipase A2 in an inactive form. Also, there is reduced synthesis of phospholipase A2 which makes it even better, because lots of lipocortin can find and bind easily with small levels of PLA2.

Uses Usage of these drugs are associated with a higher level and more severe adverse effects. Anti-inflammatory E.g. Asthma. Local inhalation of beclomethasone. Topical (local)administration to a specific site E.g. On the skin, or eyes A topical administration is useful to try and diminish the systemic side effects Rheumatoid arthritis Treated with prednisolone This is a systemic treatment and is often used only as a last resort. We tend to use NSAIDs as the first resort. Adverse effects Suppression of endogenous glucocorticoid synthesis. High levels of steroids negatively feed back on the pituitary to decrease the release of ACTH from the anterior pituitary. ACTH, apart from stimulating the release of adrenal hormone, is also trophic to the adrenal cortex. Hence, reduced ACTH will eventually lead to atrophy of the adrenal glands. If we try to remove steroid treatment, we often get symptoms similar to a withdrawal effect, e.g. fever, muscle pain If steroid treatment is initiated, it is often for life. In order to stop treatment, we need to slowly reduce the dosage over a long period of time to minimise withdrawal effects. Suppression of the response to infection or injury These drugs are immunosuppressants and also suppress wound repair due to the reduction in protein synthesis. E.g. For an eye infection, we may treat the inflammation but the micro-organisms which caused the inflammation is still around (because the bodys immune system has not responded to eliminate the organism) and so things can get worse. E.g. Sometimes a combination of steroid treatment with NSAIDs are given. NSAIDs may cause gastric ulceration and GIT disorders, but the steroids only exacerbate the adverse effects of NSAIDs because they suppress the repair of the ulcers. The point is that we must treat the cause, not the symptoms. We may be able to treat the inflammation associated with a wound but will not get any wound repair. Behavioural disturbances Cataract, glaucoma An increase in intraocular pressure is the normal response to steroidal treatment. Fluid and electrolyte disturbances. Similarity to aldosterone or cortisol increased reabsorption of Na, increased secretion of K. Metabolic effects Osteoporosis

By Duy Thai, 1997

Pharmacology Semester 1 page 3 of 4

Muscle wasting Due to mimicking the actions of cortisol. Hyperglycemia Inhibition of bone growth in children Steroids cause fusion of the epiphyseal plates. A lot of children are given steroids to treat asthma not good! The use of topical steroids is more desirable to reduce the systemic effects. Both NSAIDs and steroid treatment aim to treat the symptoms (reduce pain, inflammation and discomfort), but may not do a good job in treating the cause of the disease. Unless the cause is treated, the disease will keep on getting worse.

Anti rheumatoid drugs NSAIDs are the first line of defense Alternatively, specific drugs used to treat the rheumatoid arthritis can be used. These drugs do not have general anti-inflammatory effects. The drugs are often known as Slow acting anti rheumatoid drugs (SAARDs) or Disease modifying anti rheumatoid drugs (DMARDs). The following drugs used for rheumatoid arthritis are effective but we do not know their mechanism of action. Gold compounds Aurothiomalate Intramuscular injection Auranofin Oral, less common lymphocyte proliferation lysosomal enzyme release superoxide production neutrophil chemotaxis IL-1 synthesis May take months to see a beneficial effect. Adverse effects: Commonly allergic type reactions at the skin and mucous membranes Renal injury Blood dyscrasias (any adverse change in blood function) Chloroquine Is used in the treatment of malaria An anti-inflammatory only in rheumatic disease Less adverse systemic effects but tends to seriously affect the eyes The cornea of the patient undergoing this treatment needs to be monitored carefully. Retinopathy which occurs may be irreversible, causing blindness. Very slow onset (months) Sulphasalazine A combination of sulphonamide and salicylate A free radical scavenger? Free radicals cause cell injury and inflammation Has marked GI irritation and so is only available with an enteric coating. Methotrexate Immunosuppresant Folate antagonist Also used to treat cancer (see lecture enzymes 1) Penicillamine Adverse effects similar to gold compounds. Not as effective, most probably be obsolete soon. All these drugs are slow releases, with the effects being seen in weeks to months. Once the effects are observed, they will slow the disease progress, not just treating the inflammation.

By Duy Thai, 1997

Pharmacology Semester 1 page 4 of 4

Drugs used in the treatment of gout Gout is due to an accumulation of uric acid (a breakdown product of adenosine). High concentrations of uric acid leads to crystallisation and deposition in the synovium of joints, resulting in arthritic pain. Acute treatment of gout involves: NSAIDs (but NOT aspirin because aspirin inhibits the excretion of uric acid) Colchicine Glucocorticoids Chronic treatment involves: Allopurinol Colchicine Probenecid Adenosine

Hypoxanthine Xanthine oxidase Xanthine Xanthine oxidase Uric acid

Synovial deposition (inflammation, classically in the big toes) Colchicine An antimitotic agent. It interferes with tubulin, which prevents leukocyte migration Reduced leukocytes in the synovial joints affected by gout would reduce the pain and discomfort as a result of the cytokines released by neutrophils. Can be used as an acute treatment Also can be used as a chronic treatment as prevention (prohpylacticaly) in conjunction with allopurinol. Allopurinol An analogue of hypxanthine It thus competitively inhibits the enzyme xanthine oxidase, preventing hypoxanthine from binding. The product of allopurinol with xanthine oxidase is alloxanthine. Alloxanthine is an irreversible inhibitor of xanthine oxidase. Thus, there is decreased synthesis of uric acid and the concentrations fall. Probenecid A uricosuric agent (increases the excretion of uric acid) It inhibits the tubular reabsorption of uric acid in the kidneys It has a limited use, not as effective as allopurinol It is used when a person has an inability to excrete uric acid (in most patients, an increased uric acid is mainly due to an increase in production and so allopurinol is better suited).