PEARI4ACOLOGY is the study of substances that interact with living systems through

chemical processes, specially by binding to regulatory molecules and activatinq

or inhibiting normal- processes.

t
PHARIACY is the study of procurement, preparation and dispensing of drugs.
PEARIaCOGENO4ICS is the study of relation of p to his
response to specific drug.
I

is the study that deals with the

PH.ARIBCOGIIOSY derived frorn
plaqts, animals, and physical and chemical propertids of substances.
L

PHASES: (ADME)
t A. ABSORPTION is the movement of the drug from the site of administration to
bloodstream.
FORM: Lipid-soluble and NON-ionized.
L
DRUGS can cross the cell membranes by:
1. PASSIVE DIFEUSION _ thE MOSI CONTMON.
2" EACILITATED PASSTVE DIEFUSION
L 3. ACTIVE TRANSPORT
4. PINOCYTOSIS
NOTE: IV DRUGS have NO ABSORPTION.
t
A.1 BIOA\fAILABILITY It is assessed by determining the area under the plasma
conccntration-timc rclationship aftcr a singlc dose. This io the rate and extent
L of absorption of a drug.
FACTORS THAT AFEECT THE B]OAVAII,ABTL]TY:
L 1. Enzyme activiLy of c.I.T
2. pH
3. Intestinal motility
L B. DISIRIBUTION is the passage of drug from the circulation to the tissue site.
EACTORS THAT AEFECT DISTR]BUT]ON:
1,. Binding to plasma proteins A. ACIDIC drugs wil-l bind to ALBITMIN
L B. BASTC drugs will bind to ACrD GLYCOPROTEIN
2. The rate of blood flow to various organs
3. Concentration in fatty tissues
t 4- BLOOD-BRAIN BARRIER: Capillary endothelial cel-Is in brain have tight junction
and lack large interce]l-ular pores and above that there is layer of neural
( tissues.
[-,
*
C. MEIABOLISM (BIOTRANSEORI"{ATION) is the activation of the drug.
(
EORM: Lipid ipsoluble, TONIZED form.
PRODRUG is a drug administered in INACTIVE EORM.
l_,

I
Levodopa Dopamine
Li, Enalapri-1 Enalaprilate
Dipivefrine Epinephrine
t1
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I

Sulindac Sulfite metabolite

Proquanil Cycloguanil
Prednisone Prednisolone
Bacampicillin Ampicj-11in
SuIfasal aztne 5-Aminosalicylic acid
Cyclophosphamide Aldophosphamide
Phamide Phosphoramide mustard
Acrolein
Fluorouracil Eluorourldine monophosphate
Mercaptopurine Methylmercaptopurine ribonucleotide
AcVcIovir Acvclovir triphosphate
l-
I pnesps oF BToTRANSFoRMATToN:
A. PIIASEI: Oxidation, reduction, hydrolysis
I onCeN: LIVER vla Cytochrome p450
L
B. PHASE II (GLUCORONIDATION): Conjugation
I ORGAN: PLASMA via PIasma chofinesterase (pseudocholinesterase)
t- HOPE14AI{ ELIMII{ATION rnactivates
druq r-n body f luj-ds by spontaneous molecular
rearrangement without use of any enz\rme.
FIRST ORDER KINETICS implies that a constant fraction of a drug 1s eliminated from
the body per unit time.
NOTE: The higher the concentrati-on, the greater the amount of drug eliminated per
unit time
D. EXCRETION is the neutralization of the druqs.
The HIGHLY ionized drugs are LESS LIPID SOLUBLE, therefore, more rapid
excretion -
MAfN ORGAN: KIDNEYS via urlne-
ft is by Glomerular Eiltration Rate (cER)
MEASURED
It is irr terms of RENA-L PLASI{A CLEA-RANCE
EXPRtrSED
OTHERS: Eeces, PULMONARY, Saliva, Sweat, MiIk.

TYPES OE DRUG ACTION:

L. SUMULATION is a selective enhancement of the levef of activity of specialized
cel1s.
EXAMPLES: A. Adrenaline stimulates heart
B. Pilocarpine stimufates salivary glands.
2. is a selective dirninution of activity of specialized celfs
DEPRESSION
EXAMPI,ES: A. Barbiturates depress CNS
B. Quiniciine depresses HEART
C. Omeprazole depresses gastric acid secretion
3. IRRfIAEION is a non-selective, often noxious effect and is particularly
applied to l.ess specialized ce11.
EXAMPLE: A. Ammonia
4. REPLAC is a tlrpe of drug that uses natural metabolites, hormones or their
congeners in deficiency states.
EXAMPLES: A. I--DOPA in PARKINSON
B. INSULIN in Drabetes n-reliitus
C. I RON -Ln anen'a
-:
DRUG RECEPTORS aTe MACROMOLECULE or binding site located on the surface or ins ide
the effector cefl that serves to recoqnize the signal and initiates response
NOTE: The drus receptor for the brain is MICROMOIECULE-

A. Af'FfNfTY - The abil-ity of the druq to bind to the receptor

B. TNTRTNSIC ACTTCITY (EEEICACY) -Tthe ability of drug to produce a MAXII'IUM
pharmacological effect. The *CEfLING" or "PI,ATEAU" effect of the drug

TYPES OE DRUG_RECEPTOR ]NTERACTION:

A- AGONIST is an agent which activates a receptor to produce an effect It has
affinity and intrinsic activity.
A.1 ADDITT\IE iS a combined two drugs having SAME mechanism eliciting SAME
RESPONSE. (1+1:2)
E)GMPLES : A. Aspirin + Paracetamol (Analgesics)
B. Nitrous oxide + halothane (Generaf anesthesia)
C. Amrociipine + atenolol (Antihypertensive)
D. Glibenclamide * metformin (Antidlabetic)
E. Ephedrine * theophylline (Bronchodilator)

A.2 SUMMATION is a combined two drugs havinq DIEFERENT MECHANISM eliciting the
SAME RESPONSE - (l+1:2)
EXAMPLE: A. Aspirin * codeine
A.3 POIENTIATION (SUPRA-ADDITIVE) is a combined two drugs having SAME
MECIIANISM that is higher than their individual effect. (1+1:3)
EXAMPLES: A. Acetylcholine + Physostiqmine
B. Adrenaline + cocaine
C. Tyramine + MAO inhibitors
D. Local anesthesia + epinephrine
E- Sulphamethoxazole + Trimethoprim
A.4 SYNERGISM is a combined two drugs having DIEFERENT MECHANISM that IS
higher than their individual effect. (1+1:3)
EXAMPLES: A. ASA + Codeine
B. PenG*Gentamycin
B- PARTIAT AGONIST is an agent which activates a receptor to produce submaximal
effect. a
C. AI{TAGONIST is an aqent which prevents the action of an agonist It I]A S
affini rv but NO intrinsic activity.
C.1 PHYSICAI AIflIAGONISM-II is based on physical property of drugs.
EXAMPLE: A. Charcoal in alkaloidal poisoning

C.2 CHEMICAI ANTAGONISM- Where a drng counters the effect of another by simple
chemical reaction or neutralization.
EXAMPLE: A" Calcium sodium edetate form insoluble complexes with ARSENIC.

C"3 PIIXSI IC (FUNCTIONAL) fSM * Two drugr act cn twc different typcs
of receptor: and antagonrze action of each other.
OO
 EXAMPLES: A. InIeracti-on between NfTROGLYCERIN and EPINEPHRINE
B. InLeractlon between GLUCAGON and INSULIN.

A. DOSE is the required amount of drug in I{EfGHT to provide [he desired effect"
B. THERAPEUTIC INDEX (TI) : LD50/ED50. This measure the SAFETY of a drug.
CHILDRENS' DOSE EORMUI,A:
1. YOITNG'S RIIIJ: Age (yr) / Aqe + 12 xAdu1t dose
2. CO?ILING'S RIILE: Age (yr) + 7 / 24 x Adul-t dose
3. CLARK'S R[LE: Weight (Ibs) / 750 x Adul-t dose
INFANT' S DOSE EORMULA:
1. ERIED'S RULE: Age (months) / Averaqe adult weight (150 lbs) x Adult dose

TOXICOLOGY is the study that deals with the AD.YEBqE effects.

A. TOXICAIITS are toxic substances from chemicals.
B. TOXfNS are poisonous substance produced within livlng cells or organisms
C. IERATOGENIC effect is the adverse effects takin in by the mother and
manifested by the fetus.
D. IDfOShICRAIIC REACTION is a reaction to a medication that is UNUSUAL and
UNPREDICTABLE,specific to a particular person.
1. DT'E TO OVERDOSE
A. fiIARCOTICS - Nausea and vomiting
A.1 MORPEINE - Respiratory depression
B. A.SPIRIII - Occult bleeCing
2. DtE TO ALLERGY, it occurs on a first exposure to the medication"
A. PENICIT.T.TN - Dyspnea
I
I
L
and medicines identified by their GENERIC name.
I
I
L REPTBLIC ACT 9165 (DANGEROUS DRUG ACT) Comprehensive Dangerous Drug Act of 2002

CONTROLLED STBSTAIICE ACT of 1970, Comprehensive Drug Abuse Prevention and Control
Act of 7910. The prescriber must have a DRUG ENFORCEMENT AGENCY (DEA)
authorization number in order to prescribe drugs.
I ,.ro" are scheduled from I to V based on:
A."m
t B. Medical use-[uIness.
II C. Degree to which it produces physiological dependence.
E. Degree to wnich it prociuces physicallyrdependence.
The FOOD and DRUG ACT of 1906 regufated interstate commerce in drugs.
DR.UG NOMENCLATURE

I A. CHE!4ICAL I{AME: The first name given to compound of known composition

L B- TRADE NAME: The narne cf the company who manufactured the drug
C. GENERfC TILAME (OEEICIAL) : The universal name of the drugr.
t D. BRAND NAI'{E (PROPRIETARY) : The name of company marketing the product.
I-
PHASES OF CLII,{ICAL RESEARCH prior to marketing a drug.
I 89
I
I
A. PHA.SE I: Testing the DOSE of the drugs
B. PHASE II: TesLing the EFEICACY and SIDE EFFECTS.
C. PHASE fII: Determines the Therapeutic effect.
D. PHASE il/: The post-marketing surveillance.

1 drop (qtt) : 1mI qd: every day aa : before meal

1 tsp : 5m1 od: once a day pc : after meal
.1 tbsp : 15m1 bid:twiceaday po: oraIly
1% solution : 1gl10OmI tid: thrice a day npo: nothingr by mouth
1 grain : 55 mg qi& four times a day prn : as needed
I kg : 2.2 1bs stat : immediately
ad fib: as desired
DRUG EORMS
1. IABLET is a hard, compressed medication in round, oval or square shape.
1. 1 BUCCAI,/STTSLTNGUAI, TABI"ET
L.2 EEFER\IESCENT TABIET is uNcoAted tablet that qenerally contains acid
substances and carbonates which react rapidly in the presence of water by
releasing carbon dioxide.
1.3 CEEIBBLE TABLET is design in pediatric patient.
2. CAPSUI& is a medication in a gelatin container
3. I,oZENCE is a solid preparation consisting of suqar and qum, used to medicate
the mouth and throat for the sl-ow administration of coug,h remedies ( ex.
StrepsiTs)
4- SOtIIIION 1s a cfear liquid preparation for oral use containinq one or more
active ingredients dj-ssolved in a suitable vehicle.
5. EMITLSION is an oil-in-water dispersion.
6- SUSPENSIOI{ is a liqui-d preparation for oral use containing one or more active
i-ngredient suspended in a suitable vehicle.
1. SYIRUP is a concentrated aqueous solution of a sugar (sucrose) -
B. ELIXIR is a pleasantly flavored ciear iiquid that contains high proportion of
ethanol or sucrose together with antimicrobial preservative.
9. SITPPOSITORY is a small solid medicated mass, usually a cone-shaped, where it
melts at body temperature.
10. ENEMA is the procedure of introducing liquids into the rectum and colon
11. COLLYRIITM is a lotion or liquid wash used as a cfeanser for EYES.
ROUTES OF AD}"IINfSIRATION
A. ENTERAL RO(ITE
1. ORAL (30 minutes) is the simplest and most convenient.
FIRST PASS EFEECI ls the process that rapidly deactivates some drugs in the
fiver and was inj-tially perfused into thflhepatic portal circulation.
2. RECTAL(40-50 minutes) is used to avoid acidity and enzymes of the gastric
j uice.

B. PAREIMER&t ROI'TE
It requlres aseptic technique.
They bypass f{rst pass effect.
1. rldTRiAlduscuraR (5 minutes) 90' orientation to the tissue site.
MUSCLES USED: A. Vastus laterafis
B. Deltoid
C " Gluteus maximus

nn
5u
 NOTE: Z-TRACK INJECTION is a type of IM used to prevent Ieakage of
medication into the subcutaneous sk:in.
2. INTRAVENOUS (< 1 min) - 25" orientation, mainly used for emergency.
Most common site: Median cephalic vein (antecubital fossa)
Most common error site: Brachial artery
3. SITBCUTAI{EOUS(15 mlnutes)- 450 orientation, adminrstered as a bolus befow the
dermis.
EXAMPLES: fnsulin shot and morphine.
NOTE: Lidocaine with 1:100,000 epinephrine, the dose is 5OOmg

4. INTRADERIBI (ID) 10-15o, administered jusi into ihe ,j.ermis.

5- INTRATIIECAI is an administration into the subarachnoid space at the leve1 of
_, useful in spinal anesthesia, chemotherapy or pain management "

C" INIIALA:IION (5 minutes) is the most addictive route of administration because

it hits the brain so quickly.
D. StBLfNGUAI (BUCCAI) is administered on the ventral surface of the tongue,
ABSORPTION SITE: .

- mzJt c"[t'd
found in most tissues of the body.
c1<rl
B- baroPni\ ryr,rs* tCh - r4U,atlt h6r4fiil1(
- pl>a-a! b
7
,,,on^(vh-'( hs,hC
V
It has a bronchial response: c,)nstrr r,t

DRUGS: H1-blockers (
MOAs: It competes with free histamine for binding at a receptor site. a,\f fb r,"'( *nh)-;s-
Tt depresses the CNS activity causing sedation.
k 9o".r.-r t^1 - 6'3(g'r. lt L4crnrit
FIRST GENERAIfON Hr-blockers
1 Mcc [i7. C ngd.r0..lntO ntr,)
HAIE-LIEE: 3-6 hours n

t 1. DIPHENHYDRjAIvIINE HCL (B I) is the most conmon.

2. CHLORPHENfRAMINE I{AIEATE (Chl-or-Trimeton)

I 4. IIDROXYZINE (Vistaril) is used 1n chronic urticaria.

iYtal-y r*{ cori n'r\
SECOI{D GENERATION Hr-blockers
L IIAIE-LIEE: 1

L
2. EEXOE'ENAI)=NE HCL (Allegra)
3. LORATADINE (Claritin)
4- DESLORATAEINE (Crarinex)
L is the reaction occurring
A}{IAPI{YI*4,:K}S RE^ACTION mos _dangerous, a.cuLe allerqrc
after drugi administration. It may Lead to STROKE !

1:1,000 I\'_i1.1'4
I consciousness whrle r^,,aitrrig 3rnergency- I

'{ ,.,r;, ,, e. '}u Yl-

t
 7 Fli5 t--^ '-'t'
B. IIISTAI"IINE-2 (Hz), mostly found in stomach that increases
DRUGS : H2-blockers (anti-histamine: )
GERD,
1. CIMETIDTNE (Tagame 3. EAIVIOTIDTNE (Pepcid)
2. RiNiIITIDINE ( Zantac) 4. NIZATTDINE (Axid)
re drugs that ze the qastric acid secreted in
the stomach.
MAJOR CONTENT:
A. Magnesium and afuminum products: Maalox and Mylanta
B. Sodium bicarbonate products: A1ka-Seltzer
C. Cal-cium carbonate products: Amitone, Tums
D- Magnesium hydroxide products: Milk of magnesia
E. Aluminum hydroxide products: Alterna GEL
NOTE:ALIIIIINUM HY-DROXIDE is the most potent.

are drugs that the roduction.

t A. PADIIOPRAZOLE (Protonix) C. OMEPRAZOLE ( Prilosec
B. LAIISOPR;MOr.T: ( Prevacid) (Aciphex)
\ n L"nrn1.g 41..\hnr
of s h
t
METABOLISM w{,utv) hr.i e'4{5
L
"'Xr,l
)

) rHnonoonarqe A2 - Platef ets; Eor

) pnosracYcllNE - Endothelium; Antagonist of
on
Thromboxane A.r.
q ^"',,ffi.
**,ii)^.lf ,,*
L ) pnosree and FEVER
),n) o nA bor<q,rro A

and emotional experience associated with a I

NEUROTRANSMITTER:

A. is pain prof,uced or caused by COI factors

, rather than organic factors -

IL B. REEERRED PAIN is pain in an area rather than the si f origin.

c. pIrAt{ToM pArN is pain f on art 6? the body that has been
z. PArN REACTToN is a
Il- manifestations 1 process expressing the persons overt
of unple

A. NEOTRIGEMINOTEAI.AI"fiC TR,ACT PAIN PERCEPTION contaiNS FIBERS that

I connect ciirect1y to the thalamus where they synapse with fibers that project tc
L the primary somatosensory cortex.
| .4. is an absence of pain.
IL Kt.
I is R is a receptor preferentially sensitive to a noxious stimulus. This
when there are analgesic and anesthetlc drugs.
na
 V: "
&\
a-r, 9t munrr'\ ^4tn'r 9o
kuq=---=--4 rn - tot Pwc'tLcatf\O
6. NEURJALGIA. iS a pain present in ,r."L w,l"u,rt\\tl*t\ \Citrbi,r,aLlr
t r(-grahl)
1. RESHOLD wilf
EACTORS: d.

9. IIYPERPATEIA is an e d
10. HYPERAIGESIA is an j-ncrease response to a stimu-Ius which is normally painful
due to intake of . Nl tr. wt,r- I

f both descending control mechanism and

concerned primarily with the

C. CENTR,AI SIrM!4ATIoN ( ) THEoRY by GOLDSCHIEDER (1894) stated that the pain
is not a separate entj-ty, but resufts from OVER STIMULATION of other primary
sensation.
D- SENSORY INTERACTTON THEORY by Noordenbos (1959) stated that the rapi-dly
conductinq pathway inhibit activity in slowly conducting small fiber
pathway tha ious stimuli.
AhIAIGESICS
EFFECTS: Analgesics, antipyretic and anti-inflammatory
A. PARA,-EMTNOPIIENOLS
EEEECTS: Antipyretic and analgresic

nemia B. is f .i,6d{\')
S
A.2
ORIGIN: Acetanilide TIVE COMPONENT:
ADVERSE EEFECT: ia, a condition r that resu-Its from
conversion of iron in hemogilobin to an oxidized state that cannot effectiveJ-y
carry oxYgen-
SIGNS OE MtrTHEMOGLOBINEMIA: Cyanosis, Dyspnea & Anemia.
B. NON-STEiOTDAT AIITI-rNFr,A!tD4ATORY DRUGS (
lo'tru
s )!N t$b"to
EFEECTS: Anti-inflammatory and analgesic"
MAXIMUM DOSE/day: 3, 600m9
CONTRA]ND]CATIOI'IS : A. Ast--hma B. Chronic l.,idney- disease

MOAs:
B. They interfere with platelet function
C" They ali cause peptlc ufcerations
u - -L ,(dIJIUILAa.E;b

5.:)
 \
i

METHYLSAIICYLATE-Usede qin-cooking.
EXAMPLES: Wintergreen oi1,
ACETYLSATICYLIC ACID iS thE N.

DIELITNISAL(Dolobid) has the longest half-life

8.2 PHENYLPROPION]C ACID DERIVATI\TES- USCd iN
rrit atio

B.3 EENAI4TC ACID DERIVATN/ES (EENAMATES)

B. 3 . 1 MEEEIiIAI"IIC ACID (Ponstan, DoIf enal )
B-3"2 MECIOFEIIIAI4AIE - Used to alleviate pain in ARTHRITIS.
B.4 ARYL-ACETIC ACID DERITATIVES
8.4.1 DTCIOFENAC
8.4 .2 IGTOROLAC is ef fective for milci to moderate POST-operative dentaf
I paln. vt Lt' 0 u^ d(ory r ; ?t
L L nt
^t )oi
B. 5 INDOI,E DERNIATIVE sL dlf rn,u *9,]
B.5.1 II{DOMETIIACINis used iN most potent
inhibitor of p. ns. gfrr tlgaJ
B.5. 2 SULINDAC 'ilr,gwi u"sfigl - trroui

B. 6 PYRAZOI,ONE DERIVATIVE.
8.6.1 PHENYLBUTAZONE It hAS the SEVERE G.] IRRITATlON, obsolete in the
market
8.6.2 OXYPHENBUTAZONE

B-7 COX-INHfBITORS are the tor of prostaglandins.

B.7.1 COXI-TNHTBTTORS
B-7.1_1 AS nalgesic druq. MainJ-y a ed
in the c_]J that produces RRITATION It is main concern druq in c'
patients with CORONARY ARTERY DISEASE.
K a
MECHAN]SM OE ACTION: t"
ACTIVE
r-rr.<r u fe
hts r'xr
F \"'t'
COMPONENT
CONTRAINDICATION ;i'i
A. 1rts - 10-30q dose is EATALL-:1: 7 o'li\s rnr&'r
B. Patients taking ANTICO,AGULANT.
ANTIDOTE: Sodium bicarbonate

8.1* .2 COX2-INHIBIEORS
B .1 .2.1 CELECOXIB (Cef ebrex)
B -'l .2 - 2 ETORICOXIB (Arcoxia)
8.1 .2"3 PARECOXTB

cv) "

A]ATIIRAL NARCOTICS of the brain are ENDORPHINS ANd ENKEPH.AT,INS

XCYI is a cor4>ulsive, q! rollable de ndence on a substance, habit or

L
practice to such a degree that cessation causes severe emotional, mental- or
physiological reactions.
2. EABITUATION is an acquired tolerance from repeated exposure to a particular
sti.mulus.
3. IOLERANCE is the phenomenon of decreased responsiveness to a drug foltowing
chronic administration .
A.
Gr.AS@MOM4 SCer,E
Eye opening
Respiratory depression Verbal response
SPECIAI RECEPTOR: -receptor Motor movement
DOSAGE: 10-15mg7" Ot,nlzr\
.
rn e\h') rr\':'r

, but lt DOES NOT produce respiratory depression. This is vailable in

SYRUP. It is added with ACETAMTNOPHEN (TYLENOL)

NOTE: IiIALOXONE (Narcan) is an OPIOID ANTAGONIST, an antidote.

DOSE: 0. 4 0. Bmg

gn5t y '. r^80 trtl

B. S}-I{THEUC OPIOID 6notl- Wxrc
B. 1 EENTAI{:r& (SubIimaz is a t narcotic analgesic. Tt is B0-100times
is also availabfe in LOLLTPOP (Lozenge).
B"2 MEPERIDINE (Demerol) is the most a narcotic drugi.'- Low.p5y f4?nArral
B.4 PROPO)ffPHENE (Darvon) is with acetaminophen and useful for pain control
after surgery.
ADVERSE EEFECTS: Drowsiness and disorientation.

SCHEDT'LE CONTROLLED ST'BSTANCE

They are T

hylamide), E r
HEROfN, HYLENED IO:rY-METIIAI'{PHETA}IfNE ( E c s t a s y )
NOTE: I,IARIJI.JA}iIA is the LEAST DRUG that produces TOLERANCE.
MOA: fmpai cle or motor coordinati-on.
but they have
LEGITIMATE MEDICAI USE. Ii requires DEA number of the prescriber. Prescription is
required but NO REFILL.
EXAMPLES: EENTAITTYL. CODEINE
,
C. SCHEDULE flf are t ential for ABUSE. Prescription is still
requireci and I'{AY BE REEILLED for at least 6 months and NOT more than 5 times "
EXAMPLES : SIEROTDS, KETAI,fiNE, CODEINE IV-ITH ACETAI'IINOPHEN-

D. SCIIEDUAE fV are the drugs with LOW POTENTIAI for ABUSE.

EXAMPLES : DIAZEPAIVI (Valium) , LORAZEPA!,I (Ativan) , IRIAZOLAM (Halcion),
PHENOBARBITAI., CHLORAL HYDRATE, PROPOXYPHEIIE.

E" SCHEDULE V are the Crugs with the I,OWEST POTENTIAL for abuse "
EXAMPLE:
q5
 \

L,

HEMOSTATIC AGENTS
t A- AIITICOAGULANTS,
mechanism of b d.
they directly or rndirectly interfere with the normal clotting

L A.1 HEPARIN the endogenous anticoaqul-ant in the body-

MoAs: . Enhances,/actlvates PLASMA ANTTTHROMBIN rrI
B. Inhibits C.F II and X
ADVERSE EFF'trCTS: A. Hemorrhage, B. Thrombocytopenia
L REQUIRED TEST: Partial ThronlcopLastin Time (PTT)
ANTIDOTE: Heparin sulfate (1mq /100units of heparin)

t 0(Lft\,
.2 COIII4ARIN AIITICOAGUI"AI{TS are the antagonist of VITAMIN K.
MOA: Reduces the synthesis of Vit. K dependent C.E II, Vff, IX and X
A.2.i I{ARFARIN
L A.2.2 DICI'}4AROL
REQUIRED TEST: {ro{Wn^.\jrn {g5t

L SIGIiIIFICAIICE: For the patients who are taking anticoagulants, the most valuable
test used in evafuating the patient as a surgica]- risk is PROTHROMB]N TIME (PT) "
PT resul-t is expressed as an fNR \UAIIJE.
INR walue normal patient \ t5 -- AlE"rn
L INR wa]-ue : patient is taking an coagulan ] J.t15
B. AIiITIPI.ATELEIS (ANT]THROMBOTIC )
L
EXAMPLES: A. DIPYRIDAT'IOLE
B. TR]ELUSAI
L
i
sryprrcs AIID AsrRrNeENrs - coo'5ri'\sr"Y
l_
MOA: Precipitation of proteins - tt
I

LT
D. MECIIA}ITCAL AGENI S

EXAMPLES: GEL E'OAI"I, OXIDIZED CELLLIIOSE. OXIDIZED REGENERATED CELLITIOSE

'(vY(, (b< vro ( aa-r,\ .\bf hY
E. E.IBRINOLYTICS
{UOa, ft promotes breakdown of THROMBI by activation of PLASMINOGEN to PLASMIN.
t EXAMPLES : STREPEOKIIiIASE, UROKil(LASE, TISST E PLASMIN9GEN ACTI\ATOR

I
E. EI(TTFIBRINOLYTICS
t" StabiLizes FIBRIN by inhibiting plasminogen activator
PLE: TRjN{EXAMIC ACfD (Hemostan)
r1
rgt ?Drilns
I
ANESEHESIjB,
DR. ldoREON is the ANESTHES lOLOGI ST
the inventor
L A" LOC.AT A}IESTHESTA*
Eirst: S}&LL INhffELINA.TED EIBERS have grea,ter ratio.
SEcOnd: SMALL MYELINATED
L ThiTd: LARGE UNMYELINATED
Eourth'" T, EB is che lasl and ihe most difficult to anesthetize"
L
 ,F l,ang_t^\ c,rnf!l' t,n-9*"1
') I.
hli +tss ^( ws * r 't'
i1, rfn'lv-Pl S '

TV(O FACTORS AEFECTING THE MAXIMT'M EEEECT OE LOCAI ANESTHESlA

1. Distance of the nerve in contact with the solution # Ar,,\,U[
2" Size of the nerve fiber
K Sosecs
I

L ch ) Propriocepti-on )
1. REGIONAI AIIESTHESIA refers to loss of sensation of pain, temperature,
pressure, motor function over a specific area of the anatomy WITHOUT loss of
consciousness -
EXAMPLES: A. Spinal anesthesia
B. Epidural anesthesia
na^---^ n1^^l-

It- t'n' -:,:-'..{:.,-?:t"r,"E,

.#
'#
e{v y1.,,".1;'?
.& o6,vlurt ^l '!1inlu
I

SIGNfFICAIiICE:If NERVE BLOCK was not effective, Local infiltration is next, then
Intraligaeentarv, and the last resort is INTRAPULPAL.
f ruYr n i^\
2 . LOC.AI TNEILTRA TON A}IESTHESIA
8.1 SOFT TTSSUE INE]LTRAT]ON
B.1.1 SIIBb{UCOSAL, i-nserting the needle fsnea!,t the nigcoqg

OCK i-s the

nw,rc Liw, l, -garr++t^t- oFqlt f'Sf
c^,trr.-< - k4"l
hstra'f-r
B'7'4'5 LPbI BLOCK I fblvt^t' yo\a"}tn'+ v'Lt'/( \t*zar - cokr
I

8.2 INTRA_BONY INEILTRATION

{
I
8.2 .7 r}(IRA-OSSEOUS is the
L. penetrated with special burs and the
8.2.2 INrER-gEPTAlis used for
B. 2. 3 TNTRJh}TGAMENTARY
I and mandibular: i-nfiltration:
,4 l
 A. LABIAL injeetion requires 1.5mI solution
B. LINGUAL / PALATA+ injeetion requires q.3rn]- solution to avoid pain.
b\<,ln (A
ART{AME}{ITARIT,M
1. SYRINGE

B. allows a needle to be twlsted onto the tip and then Locked

in placed. It is afso used for a s.
T€ lal *
to s+ri J' t<
'^ C ''

I,ENGTH GAUGE cor,oR DIAMETER (inch / mm)

SHORT 2Omm (20-25mm) 30-q BLUE 0.07225 / 0.31-72
IONG 32mm (30-35mm) 21 -q YELLOW 0.01625 / 0.4128
25-a RED 0.02025 / 0.5l_44
RBI&TBER:

3. CARTR]DGE lL6,1rg6e

a preservative of
Ll i aarr'rq)
REMEMBER:
the of
B. It produces allergic reaction due to A}{TfGEN-ANTIBODY REjLCTION.
C. It is ciassified as TYPE

anesthesia.
anesthesia. X
is the most toxic and the most conimon.
is the maximum dose for a 0.L^
is the maximum dose for a c Patient.
REMEITIBER: AQ (v ou Sn€ 55
A. Too much epinephri-ne wi-I1 result IoTACIIYCARDIA,
B. PHENOXTBENZAMTNE is
C. Epinephrine will- be 5::J*i:3T;"4;ffi;:l
D. THYROID GI.ATiID is the most sensitive orqan t&
*cs;cava^/ 's rsc
r\l1rui&it'n
B.

B. IIENYLEPHRINE is r--he r"reakest.

or Ringer's solution" reduces

discomfort during injection.
antibacterial.

a
 d quality of anesthesia.

E.2 LARGE (More than 2mm) - noi ?(bre{11 l?eled

\$7t(2g..rq of hr-lvo
QTIESTIONS:
A. Maximum number of cartridge (1 : 100, 000 epinephrine) in a normal patient? I I
B. Maxi-mum number of cartridge (l:200, 000 epinephrine) in a normaf patient? I 3
C. Maximum number of cartrj-dge (1 : 100, 000 epinephrine) in a cardiac risk patient?
D. Maximum number of cartridqe (1 : 200, 000 epinephrine) in a cardiac risk patient?
St.vtt{-
F. LOEAL A}IESTHESIA
They are fat-solubIe drugs. They are converted to their water-soluble
e salts to aiiow preparation of an inlectabie solution in the form of
E'REE BASE FORM. 77hra
prevent generation of action potential by
TVIO TYPES: Ester and Amide l\r.trt h- inhrbr
--y k !- Lr /t' CrQrqinc'Jiw-
9 r/l qrrt,<) c li,
1. CARDfOVASCIrLAR TOXICITY: Bradycardia and reduction of cardiac e,- n-1 { fg+e"
2. CNS TOXICITY: Convulsive seizure followed by CNS depression
v ttrqst", r \ z- .15
SHORT ACITNG L.A 45 90 minutes
INTERMEDIATE L.A 90 - 180 minutes
I,oNG ACTING L.E 4 - 8 hours (More than 180 minutes)
ESTERS
used
n.
METABOLISM: PLA,SI4. via plasma 'cholinestera ( ps eudochol ineste ras e )
\
A. BENZOIC AC]D DERIVATTVES

vity of amines.
dopami ain resultinq to

anesthetic soluti-on
L

I
IS

I
B. PAIT'\-AI{INO BENZOIC ACID (PABA) DERIVATIVES
The most potent
vasociiiator.
I DRUG ]NTERACTION: It R S ihe effect of
concentration
I ut-es.

99
I
L
Q't5vcic-hom
\6 nt
GENERIC BR;A}ID PKA DT'RATION
PROCATNE Novocaine 9.7 L5-60 minutes
TETRACATNE Pontocaine 8.5 175 minutes (2-3 hours)
PROPOXYCAINE Ravocaine B-5

R&IEIvIBER:
A. pKa determines the fast onset of the anesthesia
B. The fo',rer the pKa, the faster onset.
A}4IDE
They are the most coflrmon d in dental practice.
METABOLISM: LIVER

i. LIDOCAINE (LIGNOCAINE) is the only ultra-short acting amide anesthesia. The

most common in diatric patients.
NOTE: The basic cartri of a 2* contains 1. BmL of L.A with
1:100,000 epinephrine :(36md of Lf DOCAfNE a 0.018rilq of EPTNEPHRINE
RBIEMBER:
A. It is used to correct \ZENTRICULAR I'IBRILLATfON

D. If lidocaine was injected in the r-

I rocker
uses CNS EXCITATION
drus) fl::ffil
ARTERY, ?V"^#"4
2, PRILOCAINE is NOT used wrth respiratory disease. I t produces a
when given over dose.
METABOLITE: Orthotuluidine.

B- The inost comrrron TOPfCAL ANESTHETIC AGENTS are: 0e.r+,oao"rne liffund {-.}orii'rt

t
RBI&IBER:
A. The maximum number of cartridge in a healthy patient is 15-
t B. The nLaximum nunrlcer of cartridge without prociucinq toxicil,y is 10.

4- BUPI\ACAINE is the long;est actinq solution used clinlcally. It 1s the least

I choice in pediatric patient.
REMEN{BER:

I
A. It is the most cardiotoxic.
B- It is useci to treat TIC DOULOUREUX
5- ETIDOCAINE is mosrly used in I"V during surgical procedures during labor and
t delivery. In dentistrlz, it is available in 1 - 1.5% with 200.000 epinephrine.
6. .&&.EI is the only AMIDE the metabolizes in PLASMA. It contains THIOPENE
I NLTCLEUS "

1. ROPfV&CAtrt{E is a long-acting sclution r,vith LESS carciiotoxici[y.

I

t.
L 2T LIDOCAINE Xylocaine 7. 85 30-60 minutes
Lignospan
Lignostab
t 48 PRTLOCAINE Ci tane s t 1.9 60-120 minutes
3I MEPTVACAINE Carbocalne 1-6 45-90 minutes
Scandonest
L O.5T BUPIVACATNE Marcaine 8.1 2-4 hours
1.5T ET]DOCAINE Dur:anest 1 .1 5-10 hours
48 ARTICAINE Septocaine l.o 50 minutes
L 0.75I ROPI\TACAINE As traZeneca 8.1 2-6 hours
giiven after a dental procedure to
NOTE: PHENTOLAI"IINE MESYLATE (OraVerse) is
L reverse the locaI anesthetic effects" It causes 50t decrease in the time for
ased blood flow in injection area"
L
GENERAL AI{ESTHESIA - r}1ed^^l\01
Eor patients who will undergo G-A.:
L A. TEST REQUIRED prior t-o G.A: Urinalysis and CBC
B. FASTING: 5-B hours for solid food, 2 hours for fluids.
MOA: Depresses the CNS to alleviate pain and cause a 1o
L
REMEMBER.(rri j
A. The most resistant part of the brain for G.A. is r:4
L
A. TNTRAVENOUS ANESTHESIA, are widelv used to INDUCE ANESTHES]A.
1. SODII'M THIOPENT
L
2. METIIOHEXITONE/iS more suited for ery. CONTRAINDICATED
L
in patients with history of EPILEPSY.

3. ETOMIDATE has lack of hangover effect. It is suited in asthmatic patients

I and patients with cardiac disease.
I
4 . KETAIIIIiIE has a profound sedation and analgesia. It produces
but not UNCONSCIOUSNESS, so airway reflexes are maj-ntained.
L
5. PROPOFOL is a new phenolic agent often accompanied by EUPHORIA and EXUAI
L C
L)

I
B. INTIAT,ATION A}IESTHESIA, aTe wi d tO MAINTA]N ANESTHESIA.
I 1. GASEOUS AGENTS
1.1 NITROTIS OXIDE (LAUGHING GAS) 1845 by HORACE VIELLS. It is a colorless,
odorless, non-irritatinq gas and non-fIammabIe. It has a WEAK or LIMITED
ANESTHETIC effect. It is used to produce sedation and unable to produce G"A
unfess it will be given at concentrations greater than 80t.
CONCENTRATIONS:
1. 10-20* w:-L]: pur@ 02: Tingling of hands, feet and body warmth
2. 2i)-40* witir pure 02: Piiid sieepirress, reiaxationn some aralgesia
3. Above 508- pure O2: Nausea and sweating.
ONSET: 3-5 ninr-rte s
MOST' CCI*4}4OI'{ CCI4PLAfNT: ldausea and vomiting
 NOIE: N2O is in
02 is in GREEN CYLINDER (600L at a pressure of 2,000 psi)
C1lnically, the correct total liter of fLow of Nitrous oxide conscj-ous sedation
is determined by AMOUNT NECESSARY TO KEEP THE RESERVOIR BAG 7/3 - 2/3 full of
02.

A. Always give patient 100t 02 at the end of procedure to prevent DfEEUgtOiN

B" CONTRAINDICATED in patients with COPD and PREGNANT i1't trimester)

C- It produces BONE I"ARROW DEPRESSION when prolong exposure (24 hours).
D. It causes SECOI{D GAS EFFECT, when a large volume of a gas is taken up from
t afveoli into pulmonary capillary b1ood, the concentration of gases remaining in
the alveoli is increased.

t Tt produces
bronchodilation, making it^ a MOST SUITABLE AGENT for use in patients.
ADVERSE EEEECT: oxic rtrl{ar Al(ust
t
2-216 is halogenared ether wiLh mild sweet odor. It causes
respiratory depression. This should be avoided in ients.
L
2. ISOEI; alogrenated methyl-ethy1 ether that causes decrease in
blood pressure and irregularities.
L
2.4\DEsFLUoRANE decreases respiration and stimulates airway reflexes
causing increased secretion, and laryngospasm.
L

A. Stlmulation of mucous production

t B. Causes nausea and vomiting
C. Tracheobronchial irritation
L 2.6 CHLOROEORM (7846 by SIMPSON) . It is first midwifery.
STAGES OE aIIESIEESIA (GUEDEL)
L I Analgesia & Amnesia Induction Administ tlon of anesthesia
S&S: Eup ria, Perceptual dj-stortion
II Defirium & Excitement Begins wlth I ness
S&S: Excitement, involuntary muscular
I
activity, irreqular breathing,
hypertension, tachycardia
III Surgical anesthesia Malntenance Begins with establishment of regular
L pattern of breathing.
SES: Total loss of consciousness, MIOSIS
rv Pre-mortenr Recover Begins with cessation of breathing.
L S&S: L.{YDRIASIS and non-reactive
AMER,ICA}iI SOCIETY OF "ATiIESTHESIOI,OGY (ASA)
I ASA 1: Healthy patients irvrJf{r, ^.] tr &*oru'o"
ASA II: | ;XtvJn{t
MILD systemic dis - 0Lcui1,c...\1 dv-'urv'0" r

ASA III: SEVERE system-ic di sease -ttctsi

IV-or{ Gt'l''teL
I
ASA IV: SEVERE systemic disease with CONSTI${T threat ip iif e - \rr U'9 .,1
ASA V: MORIBUND patients
102
L
ASA V1: Brain-dead patients - br ..',r M a3
ASA E: Eme rgenc! " - r e g c,t & ll t s nl u.tnL* 9ur",Ll,gnn

A}.ITISPETIC & DISINFECTA}qT

5''
/-- f w,fu@rhJru\
r;'q" PhY
,Lo..r{
EXAMPLE: cent-ian viof et (f ungicide )
2" IIALOGENS work by reacting chemical-Iy with bacterial proteins.
Tt is
EXAMPLE: POVIDONE IODINE (Betadine)

QTIESTIONS: -rtr,- mJ.t sbnf-9

A. What is the effective concentration intra-orally? Io t,
B. What is the effective concentration extra-oraIIv? l.t r

A. YDROGEN PEROXIDE (HzO:) is the first oxidizinq agent and used for more than
100 years. It is used in patlents with ANUG^. It is also used as a bleachingt
agent.
Hrr, .l^
phei\\ ra
B . soD*rM ,ERB,RATE 6"i'"{ih\
-\'
r(
t.nt(n\15 \Nkd'.r\
6. pHENoLs produce the feering of anesthesi d.. |ccxu\ rr"!o

B. DISfNE"ECIAIIT j-s used only in non-l-iving objects.

B. ETHYL

2. AIDEHYDES
A. 0.5% EORI.ALDEHYDE has bactericidaf activity- It will take about 12 hours to
kilt bacteria.

ik
3.'' CHLORIIEIGDIT{E is an antiseptic and disinfectant also. This is the d
s hwash.
CONCENTRATION: 0.2 or 0.72%

B - 11*.r
4. ellent disinfectant for Gram * cocci.
-__
on babies.

CI,ASSIEICATIONS :
A" .&CTION BACTERIOSTATlC BAC'IERICIDAL
7. Tetracycli-ne 1. Penicilf rrr
2. Erythromycin 2- CephalosporirLs
3 . Srrl fonamides 3" Amrnoqlycosides
4 " Chloramphenrcol 4 - Vancomycin

IUJ
t

5- Clindamycin 5. Metronidazole
B. RANGE OE, ACTNTTTY
B.1 IihRROIV-SPECIRIM is the drug that to produce superinfection.
EXAMPLES: PEN G- & \I., PENfCILLINASE-RTSISTANT PENTCILLTN,
METRONIDAZOLE & CLTNDAMTCIN f\ tk^Tk
! i s(\ }*^
'B-2 BROAD-SPECTRUM is the '1qrt.\d.tLv
on to produce superinfection-

B. 3 EXTEIIDED_SPECTRUM
EXAMPLES: Aminoglycosides, 5th gen. of CEPHALOSPORINS, Extended-spectrum of
PEN

C. MECEAI\TISM OF ACTION
1. INETBITION OF CELL ITALL SYICTITESIS
A. N is the first antibiotic discovered. This is the most allergenic
drug approximately 1-10*
S&S: Dermatitis, stomatitis and BRONCHOCONSTRICTION.
DRUG INTERACTION: It wilf be impaired with TETRACYCLINE.
A.1 PENICTLLTN e (benzylpenicillin) is known LIN-
It is more sensitive to acid; therefore, it should be given]M / Pa"tnY.al
A.1.1 PEN e- BENZATHI}IIE (Bicillin C-R) is always given I.M used to

A.2 pENrcrLLrN v is less sensitive to ac i@ -vr"uvc c'\\o<uhbl'c

A.2"I PEN Vt( is the first choice for tls infection caused by

A.3 BROAD SPECTRT'M PENICILLIN

A"3.1 PfPERjACfLLIN * the spectrum among penicillins"
A.3.2 TTCARCITLIN

A. 4 EXTEI{DED SPECTRT'M PENICILLIN

with penicillinase-resistant bacterial i

ADVERSE EEE rash - (J I
A.4.1. i AI{PICILS.IN wl (Unasyn) is qiven I.V or I.M.
A.4-2 CARBENICILIfN is effective against Pseudomonas and Proteus.
A.4.3 ebfOXtCIr.LIN is recommended as the drug of choice for stand.ard
general prophylaxis for bacterial s.

prolonged serum levels of methotrexate.

NOIE: ANTIBIOTTC PR.OPHYT,A]KIS: 19
\ 2g of Amoxicil-1in 30 minutes PRIOR to dental
rocedures. Su! Crrtnn}! \ l^r )^ LiS
"^ "1,t,
A. 4 " 3.1 el,sOxIcILLrN w/ eLAvtIr,ANrC ACrD n) ef f ective
I aqainst Gram (+) & (- an esistant bacterial rn
I A.5 PENICIL}"T E- 5h^\,\-. o.<!rA

I
t

t A.5 - 1 METHICILLIN, not used in Staphylococcal infection, it causes

MRSA. - rn{Vk,q,ou',\ P-t)i(\'U*v )kI^Q\^. \-t*1
L A.5.2 CLOXACILTI
A-5.3 is used in Staphylococcal infections.

L
NOTE: elevates and prolongs the concentration of Ehe
penicil erferinq with tubular handlinq o druss.
V(H^- lrrukf,r*
B- CEPHATPSPORfNS, they are n-like in action and structure- They are
L true antiliotic because it is a semi-synthetic.
B-1 IRST GENERATION (NARROW SPECTRUM) is the most commonly used in
L ON. This is the most coflrmon to have cross-aflergic reaction to

L ( Duricef)
MOA: Most effective aqalnst
Strep-, and Pneumococcus-
t
EXAMPLES: CEFACIOR (Ceclor) , CEEUROXIME (Ceft-in) , CEFOXITIN (Mefoxin) ,
CEEPROZIL (Cefzit)
l_
MOA: Most effective against II. inf l-uenzae and anaerobes -

B-3 fRD GENERAIION (BROAD SPECTRUM), they have the BROADEST spectrum.
L EXAMPLES: CEEIXIME (Suprax) , CEEOPERiA,ZONE (C , CEFIRIN(ONE
( Rocephin )

MOA: Extremely effective against Gram (-), E. coli, K. pneumoniae,

t_ Enterobacter spp. , Sal-moneL_Za and Shi qel1a.
8.4 TH GENER;A,T]ON (BROAD SPECTRTM) , it is resistant tob
EXAMPLE : CEEEPIIIE (Maxiplme )
t MOA: Effective against Pseudomonas aeruginosa

L EXAMPLE:
MOA: Effective against Methicillin-resistant Staph. aureus.
I C. EACITRACIN has NO activity agiainst Gram (-) or anaerobic. This antibiotic
is used only in because of its high nephrotoxicity.
L D. IIAIICOMIfCIN pectrum aqainst Gram (+) cocci.

L
E LOSERINE is used to treat . I
E TREONA}I iS USEd treat T and RESP]RATORY TRACT
L
INE
is given with CILASTATIN to prolong the antibacterial effect.
--. ft
hAS N METHIC]LL]N-RESISTIU{T STAPHYLCCOCCUS AUREUS (MRSA).
I 2 " INT{IBITIObI OF tsROTEIh] ST-T{TIIESIS
2 "L RItsOSODd T, SUBUNIT

\ht g rg Jru c,ho* oV dJ\\

1"05
L

I
 B. ITIACRoLIDES should be administered 2 hours before meals.
ADVERSE EEEECTS: A. G.I disturbaNces
B. El-evated liver enzymes
C. Allergic cholestatic
1.
ERYTEROTtrCIN is the most coillmon macrolides. It has a cross-resistance
to CLINDAMYCIN. It iS safe in I,ACTAT]NG MOIhCrs.
DRUG INTERACT]ON: It has a LETHAL Action with SELDANE.
1. 1 ERYIHROD4YCIN STEARAIE {Erythrocj-n)
L 1. 2 ERYHTRO}fTCIN ETHYLSUCCINATE
!
2- AZITERO}trCfN - Abroader spectrum
3. CLARIIEROMYCfN - .An extended spectrum aqainst facultative and obligate
L anaeroblc and given twice a day schedufe.
NOTE: Erythromycin e Clarithromyein are known druqs that cause IORSADE DE
POINTES - ,-onh ha -. nV rvrr,\
L
C. CLINDAI"IYCIN is primarily used against Gram (-) lnfection and SEVERE

t ODONTOGEN]C INEECTIONS .
INDICATIONS: A. Bone infections like osteomyelltis
B. Actinomycoses infections
ADVERSE EEEECT: A- Pseudomembranous colitis
B. Diarrhea
t_
2.23OS RTBOSODAL SUBULIIT
L IETRjACYCLINE, stored in dentin, enamel and GCF. ft is
A. most affected with
ANTACID DRUGS and it must be given with empty stomach to prevent nausea and
vomi-tinq- It is the MCST hepatotoxic.
CONTRAINDICATIONS: A. Pregnant (1"t and 2'd trimester)
B. Pediatric patient (3 months - 7 years o1d)
C. Antibiotic prophylaxis \q\t ta,t-h
avt, 6*\t.\gd
ADVERSE EEFECT: .t$^ (( tiYq\^
J
1 - TETRACYCLfNE is used to treat acne, qonorrhea, syphilis if allergic to
penicillin, chronic bronchitis, Mycoplasma infecti-ons, Chlamydia and Rickettsia
infections.
2. MINOCYCLfNE (Minocini is used to treat anthrax and meningococcal-
i-nfections.
3. DO:trCxCLIlsE (Vibramycin) is used to treat Chlamydia, Rickettsia,
Mycoplasma and Leptospirosis. It is an alternative to MEFLOQUINE for malaria.
4. CHIORTETRACYCLINE is the BROADEST spectrum of all antibiotics.
L B. E,MTNOGLYCOSIDES
1.NEOD{:fCIhI is topically applied because it is nephrotoxic
L

-2.STREPTOtflfCfN is known for its OTOTOXICITY.

l_ 3 . T(ANA} TCIN

5. TOBRAT.{YCIN
L
3" trNT{IBITION OF NIJCLEIC ACID STTdTBESIS
3. 1 bTUCI,EOTIDE ShITIIESIS
i
106
L

A- SULFOIiIAIffDES & TRIMETIIOPRIM (Bactrim, Cotrimoxazole ) - They are used in

combina'tion to treat U. T. I prostatic infection, Shige)la and Pneumocystis
carinii.
A" 1 SITtEOIiIAMIDE (SULEA DRUG) is structurally simif ar to PABA, therefore,
it competes wrth and it inhibits the action of PABj" PABA is involved in
nthesis. This is the very first EEFECTIVE ANTIBIOTIC against
pyogenic infections. They are NOT USED for treatment of dental infections, they
are primarily used in U-T-I-
ADVERSE EEEECTS: A. Erythema mu1tiforme
B. Megaloblastic anemia
3.2 DNA SWTHESIS
A. FLUOROQUINOLONES, antimalarial drug.
ADVERSE EEEECT: It rnhibrts the cartiiaginous growth.
1-MEFI.OQUINE (Lariam) is useful- in treating aIl species of malaria"
2. OTHERS: CITLOR@UIN, HALOEAIITRINE, QUININE
AI.ITI-TT BERCULAR DRUGS I uu\ *i,.Y
Malnly for This organism tends to develop resistance
to any si COMBINATION THERiAPY is standard in the
treatment of tubercu.l-osis -

1. RIFAI'IPIN is the most E against bacteria underqoingr ce1l division. It can

be bacteriostatic or bactericidal.
MOA: It suppresses RNA synthesis
ADVERSE EFEECT : Urine discoloration ^ r-( ),- o vcar"g4

2- ISONIMID (ISONICOTINYLHYDRAZIDE) is bacteriostatic for resting organisms and

bactericidal for dividing orqanisms.
lvlOA: f t interferes with Iipid and nucleic acid biosynthesis.
ADVEF.SE EEEECTS: A. S
Pa

MOA: Inhibits cell wail synthesis

ADVERSE EEFECT: Optic neuritis
5. STREPTOMICTN is bactericidal only. It is the LEAST drug of choice.
MOA: Interferes with normal protein synthesis
ADVERSE EFFECT: Ototoxi city

RESISTA}iICE is the abllity cf a microorganism to be unaffected by an antibiotic.

1. NATURjAL occurs when an organism has always been resistant to antibiotic WITHOUT
previous exposure to the drug.
2. ACQUIRED occurs when the organism that was previously sensitive to an antibiotic
derre I 6rps the r^es isianCq

CROSS occurs i^rhen antrb ven have the similar rn action Rt it 1t'o*t1P
NOTE: and( Ce OT €-)are two most common to have CROSS Y

TIP TOZ N?S

1" WIf e Im*: (Alr-nia\ used 1o frea,t a"
2. ATO\AQUONE (Mepron) used to treat Pneumocystis carinii-

3. EFIORNITHINE (Vaniqa) used to treat meningo-encephali-tic stagre of Trypanosoma

brucei gambiense infection (sleeping sickness) .

INDICATIONS: A. BEST against ANAEROBIC infections (H.py1ori, C. difficite,

Bacteroides s.pp. , Fusobacterium spp.)
nalis
NOTE : because it can cause severe nausea, vomiting,
cramps. f
A}ITI-E T'NGAI DRUGS

EXCRETION: ^ 9|.a,0(^!

3 AMPHOTERICIN B is used in SEJEBE INEECTIoNS . It is administered

intravenously. -EUNGAI
'- tq: tY t'ot"'".l ^ (db)
ADVERSE EFFECT: Nephrotoxicity fl' Sto'9\z'rv'^rlJi (
4 - IMIDAZOLE is used in the treatment of
AZOLE drugsl (Clotrimazole) interfere with ergosterol biosynthesis.

AI{TI-VIRAL DRUGS
The PRIMARY treatment for viral infection is:
1. OSELTAIfni:tR (Tamifl-u) & ZAlIAlfr\/ltR (Relenza) inhibit influenza A & B virus.
MOA: ft inhibits NEURAMINIDASE enzyme, which inhibits mucoprotein breakdown
and the release of the virus from infected cells.
2. AI4AIITN)INE (Symmetrel) & RII(BNIADINE (Elumadine ) are synthetic anti-viral
drugs -
USES: Inf luenza and Parki-nson' s
MOA: It inhibits transmembrane M2 protein essential for uncoating the virus, a
step essential for vi-ra1 penetration into a host cel1.

MOA: Inhibits DNA synthesis.

NOTE: FOSCARNEf (Foscavir) is used who are either intolerant to ACYCLOVIR or
infected with an acvclovir-resistani strain of HSV.
3.1 PENCICIOVIR is used to treat HERPES LABIALIS in immunocompromised
patients.
4 - GANCICLO1ruR is used to treat CYTOMEGALOVIRUS and complications from AIDS.
108
 MOA: Inhibits viral- DNA poh/rnerases

5. RIBA\ERIN is used to treat chronic Hepatitis C.

MOA: It inhibi-ts viral mRNA.

DRUGS USED FOR A]DS:

6. NUCLEOSIDES
EXAMPLES : DTDANOSINE (Videx), ZALCITABINE (Hivid), ZIDOVUDINE (Retrovir),
IDOXITRIDfNE is also used in herpes infections.
MOA: Inhibits REVERSE TRANSCRIPTASE.

1. PROTEASE INEIBITORS
EXAMPLES: fNDIIiIAVIR(Crixivan), NELFIIiIAVIR (Viracept), RITOtitAvIR (Norvir)
MOA: Suppresses viral replication by inhiblting protease
8 . NON-NUCLEOSIDE REVERSE TRANSCRIPTA,SEINHIBITORS
EXAMPLES: DELAVfRDINE (Rescriptor), NETTIRAPINE (Viramune)
MOA: Inhlbits the catalytic reaction of reverse transcriptase
A}ITT-ANXIETY DRUGS
A. BARBITTRATES - t.!\ hu'S v'ob) u\tXr'r1tt' rto*{of'
They are used to produce sedation and anti-anxiety. They have NO analgesic
property and can cross the placental barrier.
I MOA: Inhibiting the depolarization of neurons by binding to the GABAergic
l_ receptors, which enhances the transmission of CHLORIDE lons.
ADVERSE EFFECT: Respiratory failure if overdose
CONTRAINDICATIONS : A- Acute intermittent porphyria
t_ B. Pregnant
I
TLTRASEORI-ACTING (5 - 20 minutes) (Surital) - mai-nly used for GA.
I
Mainly used for induction of G.A METHOHEXITAL (Brevital )

STORAGE: Adipose tissue tgfur,AL (Pentothar )

SHORT-ACTING (1 - 3 hours) PENTOBARBITAI (Nembutal )

For treatin INSOMNIA SECOBARBTTAI ( Secorial- )

INTERMEDIATE-A,CTING ( 3 6 hours) AI{OBARBITAI (Am1,1a1 1

Eor Lreating INSOMNIA BUTABARBITAI (Butisot )

i
IONG-ACTING (6 - 10 hours) (Luminal ) - for GRAND l4AL"
l_ For treatinq certain types of seizure DRUG CTION: It reduces the
absorption of GRISEOFULVIN
MEPIIOBARBfIAI (Mebaral )

t_ PRIMIDONE (Mysoline)

B. BENZODIJMEPI}iIES (NON_BAR.BITURATES)
I
They are used as oral preparations to all-eviate anxiety and sleep.
They are used as intravenous to cause conscious-sedation for outpatient surqery.
They are consiciered as Ir[fNOR TRAI{QUILIZERS.
MOA: Same with barbiturates and they bind to CHLORIDE IONS.
L

I
t_
j s the m.osf common dosaqe to p,r:ocl ree sedati on.
I
109
t_
 INTRAVENOUS: Needs to be injected in S to prevent thromlcophtebitis.
3- LORAZEPAI{ (Ativan) the LEAST iipid soiuble.

NOTE: ELUI@.ZENIL (Mexicon) is the antidote of benzodiazepine overdosage-

A}ITICO}[VT'LSA}.ITS
They prevent or abolrsh seizure activity in the C.N.S

TYPES OE SEIZURE:
A. PARIIAI SEIZT RE affects one part of the brarn
B. GENERiAIIZED SEIZURE affects all- cf the brain-
B.1 ABSENCE (PETIT MAI)
B.2 TONIC_CLON]C (GRAND MAI)
B.3 STATUS EPILEPTICUS

1" DJIgusau choice of drug for all ac-uLe--sei lzfre

activities. It that causes thrombophlebitis .
SITE OE ACTION: Limbic system
ADVERSE EEFECT: Acute narrow - kv.nn L\ .(\i Dr

2. IPIIENYLITDAI{TOIN (PHENYTOIN) is the choice of druq 1n GRAND }4AI"

ADVERSE EFEECTS: A. Gingival hyperplasia
B. Osteomalacia
3. \AIPROIC ACID is a GABA analogue used to treat ABSENCE SEIZURE.
4 . LONG-ACTING BARBITT'RATES
4.1 PIIENOEARBITAI is mainly used in GRAIID I4AI.
4. RII4IDONE is a metabolite of PHENOBARBITAI.

5. ETHOSIIXIIfiDE & TRIMETBADIONE are used in absence seizure"

5^ CARBAMAZEPINE (Tegretol ) i.e usecl in GRANII MAL anci TIC DOIILOIIRtrIIX-

AhITIDEPRESSA}.ITS
t E]VE MAJOR CATEGORIES:
1. TRICYCLIC ANIIDEPRESSAI'ITS
MOA: Bfockade of the re-uptake of amine neurotransmitter released into the
t synaptic c1eft.
DRUG INTERACTTON: Eatal interaction wlth NARCOTICS.
EXAMPLES: AMITRIPTYLINE (Elavif ), DOXEPIN (Sinequan) , D4IPR;AI'IINE (Tofranil)
L
2. SEROTONIN & NOREPINEPTIRINE RE-UPTAKE INIITBITORS
EXAMPLES: VENI"Atr'A)ilNE (Effexor) , NORTRIPTYLINE (Pamelor) , DESIPR,AMINE
I (Norpramin) , DES\IENLAI'AI$NE (Pristiq) / DULOXETINE (Cymbalta)

NOTE: TRICYCLIC ANTTDEPPRESANTS & SEROTONIN & NOREPINEPHRINE

t INIIIBITORS significantlv INCREASE the arnount of I{OREPINEPHRINE in the .ff;Y331* |

Thev rnduce XEROSTOI4IA up to 75%.

3. SELECTI1rE SEROTOb{T1T RS_UPTAKE INHTBTTORS (SSRI)
I

i Jv
I
 EXAMPLES: CfIAI,oPR;AI, (Celexa) , ESCITAIOPRAI"T (Lexapro) , ELUOXETINE (Prozac) ,
P,AROXETINE (Paxil), SERTRALINE (Zoloft)
4. OXIDASE INHIBIIORS (MAO-I)
IvIONO-AIVITNE
DRUG INTERACTIONS: A. Fatal interaction with TYRAMTNE resulting to
HYPERTENSION.
B. LOCAI ANESTHESIA w/ EPINEPHR]NE is contraindicated.
EXAMPLES: ISOCARBOXAZTDE (Marplan), TRiA}I:ILCYPROMINE (Parnate)

E SECOND GENERATION MISCELI.A}IEOUS

EXAMPLES : BUPROPION (Well-butrin), TRAZODONE (Desyrel-), NEFAZODONE (Serzone)

OTHERS:
1. LIIHIITM CARBOI{IATES is used to treat MANIC state j-n BIPOLAR (DEPRESSIVE-MANIC)

2. A}iITIPSYCHOTIC (NEUROLEPTICS) is the MAJOR TRANQUILIZER.

MOA: Blockade of DOPAMTNERGIC sites in the BASAI, GANGLTA.
USES: A. Psychoses
B. Acute mania
C. SCHIZOPHRENIA
ADVERSE EEFECTS: A. Extrapyramicial syndrome (EPS)
B. Tardive dyskinesia
C. Longer QT j-nterval (Torsades de pointes)
ANTfPSYCHOTIC AGENTS:
2.1 PEENOTHIAZINES:
2.7.I CHI,ORPROIA,ZINE is the first antipsychotic drug.
2.7.2 PERPEENAZTNE
2.7.3 THIORIDAZINE
2 .I .4 PROCEI,ORPERAZINE

2 .2 BUTY:ROPHENONES
2.2. OL is highly effective drug used to treat SCHIZOPHRENIA and
TOURETTE

2.3 TEIOXAI{ITEENES is the t antipsychotic drugs.

AUTONOMIC NERVOUS SYSTEM DRUGS
1. ADRENERGIC DRUGS are s\rmpathomimetic drugs.
MECTIANISMS:

2. CLONTDINE&METHYLDOPA (ALPHA2) is an ANTIHYPERTENS]VE.

3. DOBIIIAIIfNE (ALPllAl& BETAI) is a cardiac stimulant
4. TERBTITALTNE (BETA2) is a BRONCHODI],ATOR
5{SALBUTEROL (BETA2) is a BRONCHODILATOR
6. ISOPROTERENOL (BETA1,2) is a BRONCHODILATOR
7*EPfNEPHRINE (Af,PlIA1,2& BETA1,2) is used in anaphylaxis, vasoconstriction
B. NOREPINEPHRINE (Af-PHA1,2& BETAI) is a VASOCONSTRICTOR
B. INDIRECT ACTING releases NOREPINEPHRINE from the terminals.
EXAMPLES: AMPEETEMINE is used to treat ADHD.
MOA: Causing a rapid release of the mediator.
2. EPHEDRTNB is used to treaT HYPOTENS]ON
3. TYRJBMI!{E

lLL
2. ADRENERGIC BLOCKERS suppress the activity within the sympatheti-c.
B.1 AIPEA-BIOCKERS
EFEECT: Inhibits vasoconstriction resufting to hypotensron.
B. 1. 1 A.I,PHA1-SELECTI\IE BLOCKERS
A|VERSE EFEECT: Orthostatic hypotension
P-BAZOSTN (Minipress) used to treat hypertension
DOXASOSfN (Cardura) used to treat hypertension t longer action.
3. TERAZOSIN & IALISULOSIN used to treat prostatic hyperplasia
B.\.2 NONSELECTN/E BLOCKERS (ALPHAI & ALPHA2)
1. PHENTOLAI4fNE & PHENOXYBENZAI'IINE is used in pre-surgical
management of pheochromocytoma.

8.1. RESERPINE- It has a catechol-amine-depleting sympatholytic effect.

MOA: Stabilize the axon terminaf membrane thus preventing Ehe rel-ease of
norepinephrine -
OV,OL
B.2 BETA-BLOCKERS
EEEECT: lncreases vasoconstrj-ction and reduce tachycardia.
ADVERSE EFEECTS: Weakness and drowsiness
8.2.7 BETAI-SELECTTVE BLOCKERS
1. ATENOLOL & METORPOLOL are both
competitive b]ockers & long-acting
that are used for hypertension and acute angina pectoris.
2 - ACEBUTOIOL is used to controf ventricul-ar arrhythmias.
3. BETAXOI,OL
4 - ESt'rOrpL
5. BISOPROIOL
8.2.2 NONSEI,ECTWE BIPCKERS (BETAI& BETA2)
1. PROPB,AI{OIOL 4. NADOLOL
2. CARTEOI.OL 5. PENBUTOI,O
3 - SOTAIOL 6. TIIVTOI.oL

NOIE: I.ABETAIOL & CARVEDIIOL aTe NONSELECT]VE BETA_BLOCKERS with Af-PHAI-BLOCKING

activitv. Thev are used for HEART EAILURE.
3. CHOLINERGIC DRUGS are compounds that mimic the action of the endogenous
neurotransmitter ACETYLCHOLINE -
NOTE: SYMPTOMS Of CHOLINERGIC CR]SIS:
A. Bradycardia D. Vasoconst ri ction
B. Lacrimation +E.
C. Weakness of volunta muscle

A. MUSCARINIC RECEPTORS
.
MoA: Direct actinq upon the chofin reEE[tor.
2. BETIIAIIECOL is used to treat urinary retention.
3. ACETYLCHOLINE CHIORIDE&CARBACIIOL are used to produce miosis.
B. NICOTINIC RECEPTORS
B.1 NEITROMUSCULAR BLOCKERS are important for producj,ng complete skefetal
muscl-erelaxation.
1 " N0$*DEPCII"ARIZING competitively competes with acetyJ-chcline at [he
nrcotinrc receptor: r:esuf ting to I,IUSCLE PARALYSIS.
112
t_
7.7 TTBOCURARE is the prototype used to treat TETANUS, Poliomyelitis
and Encephalitis
2. DEPOLARIZING is a non-competitive which depolarizes the neuromuscular
end plate "

2 - UCCINIfLCHOLINE used for larynqospasm.

B.2 GANGLfONIC BI,OCKER is seldom used because of its adverse effects"
1. MECAI"f:fLAMINE (fnversine) rs used for severe or malignant hypertension
c. CHoLTNESTEBASE rNIIrB_TTORS (ANTTCHOLTNESTERASE)
1. NEOSTIGD4TNE is used to treat glaucoma and myasthenia gravis. It is also
used to reverse the action of NON-DEPOLARIZING NEUROMUSCULAR drugs, also
PYRIDOSTIGMTNE.

2. PHYSOSIfGMINE is useful in atropine& scopolamine overdose. It potentiates

the ACETYLCHOLINE to l-ower the blood pressure.
3. DONEZAPIL, RfVASTfGDIINE, GALANTAI'IINE&TACRINE are used in ALZHEfMER'S
DISEASE
4 ENDROPHoNIUM is used to DTAGNOSE myasthenia gravis -

5. PYRIDOSTIGMINE is used to TREAT myasthenia qravis.

4. A}ITTCHOLINERGIC DRUGS
EEFECTS: Mydriasis, antispasmodic & reduces gastric e salivary secretions.
ETI.ADOTqA AIKALOIDS
. ATROPfNE an anti-sialagogue w/out sedative effect.
ADVERSE EEEECTS: A. CNS ExCitAtiON
B. Tachycardia due to blockade of vagus nerve.
2. SCOPOLAMfNE an anti-sialaqogue w/ sedative effect. It used to reduce motion
sickness.
ADVERSE EEEECTS: A. Drsorrentatron, B- Confuslon, & C. Hallucination
3. HYOSCYAI4INE is used to treat peptic u]cer and bowel syndrome.

B. PROPAIITIIELINE BROI4IDE is the antagonist of acetylcholine. It is used to treat

TRAVELER'S DIARRHEA.

C. BENZOTROPTNE MESYI,ATE&TRIIIH(YPIIENIDYL HCL aTe used foT PARKTNSONISM.

D. GLYCOPYRROLATE inhiblts salivation and controls upper airway secretions.
REME}IBER:
A. PRAIIDOXIME is best to admrnister after poisoning by an organophosphate
cholinesterase inhibitor.
B. The immediate cause of death from irreversible cholinesterase inhibitor is
RESPIRATORY PARALYSIS .

I *:*"""*
1. DIGITOXIN is the marn drug for COIiIGESTIVE HEART EAILURE.
MOA: Increases m-uscle conl-ract i Lity by inducing

2 . SI fN came f r:om DIGITALIS (f o>. gl ove ) plant- -

4 4'1
-L L.1
I
I

L
USES: A" It is for EDEMA by effect.
I B. ATRIAI fibritlation.
l- sronacs: HEART e skeletar muscle
ADVERSE EEFECTS: A. PREMATURE VENTRICULAR BEAT 1s The most ComTnon"
,. Sinus bradycardia
|
I

" B. ANTr-ARRHYTEMT.;Ar. DRUGS

i MOA: To increase refractory period of cardiac muscles.
I
I
, 1. CI,ASS I (SODTUM C}ANNEL BLOCKERS)
i l. f CLASS I-A: QUINIDINE is the prototype primarily used to treat
I sueneveNTRrculAR TACHvARRHvTHMTAS& ATRrA-r- FTBRTLLATToN.
L PROCAIIIAMIDE is used to treat ATRIAI EIBRILLATION,
i PANOXYSMAL ATRIAI TACHYCARD]A & VENTRICULAR TACHYCARD]A.
I
I
I
DrSOP]-RjhMrDE
L
i 1.2 CLASS I-B: LIDOCAINE, MEiXILEIIIfE. TOCAfNIDE
I

I
It- l-.3 CLASS I-C: I'IORICIZINE, EI,ECAINIDE, PROPAI'ENO!{E

I z. cr.Ass rr (BETA-BLoCKERS) - pRopRANorpI, is the prototype.

I
I
? 3" CI,ASS ITI (POTASSIUM CHANNEL BLOCKERS) SOTAI"oL
BRETYLIT'M
AI'IIODARONE is the most potent "

4. CI.ASS IV (CAICIUM CHANNEL BLOCKERS) : VERJAPAMTL is the prototyPe.

NIFEDIPIIjIE
DILTIAZEM
They are useful as anti-anginal and antihypertensive as well.
' C. AIflTI-HYPERTENSIVE DRUGS
'IYPEiS OF HYPER.'IENSlON
1-. PRIIdARY (90-958): No underlying systemic causes
CAUSES: A. Hypertrophy of artery and arterioles
B- Decreased capillary and arteriol-e density
2- SECONDARY: There is und-erlying systemic disease"
EXAMPLES: A. Cushing syndrome
B. Di-abetes mellitus
C. Pheochromocytoma
D. Hvperthvroidism
1. DIUREUCS
1.1 THIAZIDE DRUGS
MOA: It DECREASES the permeability of DCT & excretes SODfUM ions.
DRUG INTERACTION: Increases the toxicity of DIGITALIS.

1.2 IIUROSAMIDE DRUGSare high ceiling or loop-actinq diuretics

MOA: It prevents absorption of too much salt in the body.
ADVERSE EFEECT: Ototoxicity.

1.3 SPIRONOLACTONE is a potassium-sparing diuretic"

MOA: Antagonist of Aldosterone

2- BETA BTffI(ERS
z\4
t_
-L PROPRANOIOL is a non-sel-ective beta-blocker used Lo treat anqina pectoris
2
by reducing oxyqen demand by preventing chronotropic responses to endogenous
epinephrine, emotions and exercise-
2 -2 I"IFTOPROIOI, & ATENOLOL are the selective beta-bl ockers "

3. AIPIIA BI.@KERS
3.1 PRMOSIN is a sefective alpha-1 blocker-
MOA: It inhibits binding of nerve induceci release of NE resulting it
vasodi Iation.
4. ACE INTIIBITOR DRUGS
MOA: It blocks Angiotensin Converting Enzyme
EXAMPLES : CAPTOPRIL, RiAIEPRIL, BEIiIAZEPRfL, LTOEXIPRIL, ELAIIAPRIL

5. ANGIOTENSIN fI ANTAGONIST
EXAMPLES : LOSARTAII, \IAI,SARTAI{, IELD4ISARTAI{, EPROSARTA}iI

6 " CAICIT'M CTIANNEL BIOCKER

MOA: It decreases the contractile force by blockinq calcium
1. arE reservEd drug fOr SEVERE HYPERTENSION.
NEI,ROIIIAL BIOCKERS
MOA: Uncoupling of the action potential from the norepinephrine rel-ease
mechanism
I exeuei,e , Guanethidine
l-
D" AI.ITT-HYPERLIPTDII4IC DRUGS (HMG-CoA REDUCTASE INI{IBITORS)
I UOa: ft reduces cholesterol by increasing the concentration of
I exelapr,ss: LoVASTATTN, srllta'srATrN, FLtryAsrATrN

I OTHERS
l.
ANTI -DIABETES MELLITUS
1. SIILFONTYUREAS is the first anti-diabetic drus.
1.1 EIRST GENERATION
EXAMPLES : TOLBUTAMIDE, TOLAZAI"IIDE, CHLORPROPAIvIIDE

i.2 SECOND GENERATION

EXAMPLES : GLIPIZIDE, GLYBI,RTDE, GLIMEPTRIDE

2. INSULIN SHOT acts to increase cellular glucose utilization

DURATTON
INSULIN ASPART 3-5 hours
INSULIN GLULTSINE 3-4 hours
INSULIN DETEM]R 6-24 hours
]NSULIN G],ARGINE 20-24 hours
3. METFORMIN decreases hepatic glucose production"
I
I
! ent:.-HYPERTt{yRorDrsb{ Trvg$
1. THIObIA}fIDES 1 . CASTOR OIL
II z - PRoPHYLTTTT rL 2 - MrtK oF sr.&
I 3. IODINE THE
r

)<ANTHINE.DERIVATTVE
MOAs: A. Bronchodilation
B. Increased heart rate by increasing the force of contraction
C. Anti-arrhythmia at high concentrations
7. CAFFEINE is the only available OTC.
ADVERSE EEFECT: Caffeinism if drinking more than 10 cups of coffee a day.
BREWED COFEEE 100-150 mq
INSTANT COEEEE 50-100 mq
DECAEEEINATED 2-35 mg
TEA 40-110 mq
COLA DRINKS 35-60 mq
2. THEOBROMINE
3. THEOPHYLLINE is the best bronchodilator used for ASTHMA.
4. METEYI,XA}ITEINES

AI{TI-TUSSilTE
1. GUAIFENESIN (Carbocisteinesolmux) has mucolytic effect.
A}ITI.RHEI'I{ATIC DRUGS
1 - ETAIIERCEPT is used to reduce the signs and symptoms of active rheumatoid
arthritis.
2. INFLIXII'AB is used to treat Crohn's disease and R.A
3. ADAIIMUI'IAB is used in R.A-, Psoriatic arthritis and ankylosing spondylitis-
AI.ITI-GoUT
1. COLCHICINE is used to reduce inflammation during acute attacks.
2. AII,oPTRINOLis used to treat CHRONIC GOUT by DECREASING URIC ACID PRODUCTION"
3. PROBENECID&SITLFINPYRAZONE are uricosuric agents by enhancing uric acid
clearance.
MAfN ACTION SITE: PCT of kidneys.
DRUG INTERACTfON: They are used to slow down the excretion of penicillin and
ccphalosporins.

AT{TI-PARKINSON' S AGENTS
1. LEVODOPA is the precursor of dopamine. It is given with CARBIDOPA to increase
the effectiveness and reduce the side effects.
NOTE: MOA: (L-dopa) It replenishes the otherwise deficient dopamine in
patients with Parkinsonism
I'IOA: (Carbidopa) - It decreases the peripheral metabolism of levodopa.
2. BROMOCRIPTTNE&PER@LIDE aTe DOPAMINE AGONISTS.
3. AMANTADINE potentiates DOPAMINERGTC responses.

A}ITI.ADHD (ATTENTIoN DEFICIT HYPERACTIVITY DISoRDER)

1. MEIHYLPHENfDATE (Ritalin) is a mild central nervous stimufant.
EEFECTS: A. Increases attention span
B. Reduction in hyperactivity
C. Improvement in behavior
2. DEXMETIIYLPHENIDATE (Focalin)
3. ATEI4OXETINE (Strattera) is the first non-stimulant approved for treating ADHD.

116
4. MODAE'INIL (Provigil) has an unlabeled use to treat ADHD to IMPROVE WAKEFULNESS
IN PATIENTS with EXCESSIVE DAY TIME SLEEPINESS associated with narcolepsy.
AI{TIDOTE E1CR METAI POISONING
1. BRITISH A}{II-LEffiSIIE (BAI)/ DIMERCAPROL & PENICILLAMTNE are the drugs used
for MERCURY, lead and other meta1s.
NOTE:MERCURY (HS) is 100% absorbed in G.I.T with average half-life of 55 days.
SIGtit: Excessive salivation
2. EDETATE CAICITM DISODfITM is used to tread LEAD poisoning.
3. PENICILLAMINE is also effective chelator of COPPER.
4. DEEEROXAI'fINE is used to chelate IRON.
5. 10Ot O](YGEN is used for CARBON MONOXIDE & CYANIDE POISONING.
6. SODIUM NITRITE&SODII,M TIIIOST,LEATE are sued for CYANIDE POISONING.
BISPHOSPTIANATES
1. ZOI.EDRONTC ACID 4. IBA}IDROI.i[ATE
2. PAI"IIDROIiIATE 5. A].EIIDRONATE
3. RISEDROIiIATE
USES: Paget's disease, Osteoporosis
MOA: ]t inhibits OSTEOCI,ASTIC BONE RESORPTION.
ADVERSE EFFECT: BIONJ

CORTICOSTEROTDS
1. affect carbohydrat-e, lipid & protein metabol-ism.
GLUCOCORTICOfDS
EFFECTS: A. Anti-infJ-ammatory
B. Immunosuppres.sant-
2 - MINERiAIffORTICOIDS regulate sodium e potassium metabolism

INHAI-ED CORTICOSTEROIDS : TRIFTMCINOLONE,BECLOMETHASONE, FLUTICASONE, BUDESONIDE

CHETIOTHERiAPY DRUGS
1. AI,I(I:LATING AGEMIS alkylate DNA such that it cannot replicate.
EXAMPLES : CTSPLAI IN&CYCLOPHOSPIIAMIDE

2. Afii:IHRiilCYCLil.IES destroy DNA such that the celi cannot replicate

EXAMPLES : DAUNORUBTCIN&DOXORITBICIN

3. AIIIIBIOTICS are used for cancer chemotherapy.

EXAMPLE: DACIINOMYCIN

4. AIflIIMETABOLITESaTe cell cycle-specific drug inhibitors (S-phase) .

EXAMPLES: S-FLUOROIIRjACIL, 5-MERCAPTOPITRINE & METHOIREXATE.

5. AIITIMfCROIUBUIAR affects the microtubular assembly with cells to inhibit ceIl

nLitosis.
EXAMPLE: PACLITA}GL

6- ANTI-ESTROGEN blocks the tumors on which estrogen has a stimulatory effect.

EXAMPLE: TA}€XIEEN

1 . YINCA AI,I(AIOIDS are mitotic spindle poisons.

EXAMPLE S : VTNBI,ASTINE &\IIHCRI STINE

LL7
B. GONADOTROPIN HORIIONE-RELEjASING AIIIfGEN inhibits gonadotropin secretion, an
action which is effective in reducing certain carcinomas.
EXAMPLE: LEUPROLIDE

ADVERSE EFFECTS OF CHEMOTHERAPEUT]C DRUGS

1. Anemia 5. Nausea & vomiting
2. Fatigue 6. LOW WBCs
3. Hair Ioss (Alopecia) 1. Xerostomi-a
4. Increased bleeding B. Mucositis
HERBAL PI-.A}ITS
1. TSAAI{G GIJBAT 1s a LOCAL plant with fl-uoride.
2- YERBABUEIiIA is an INDIGENOUS plant with fluoride.
3. TTLSI PLANT absorbs excess fluoride in the water.
4. LAGIIIDI is a local plant with ANAIGESIC effect.
5. Sf . ;IOHN'S WORT inhibits re-uptake of serotonin.
6. GINK@ BII0BA is a peripheral artery vasodilator
1. GARLIC lowers cholesterol and inhibits platelet aqqregation
B. GINSENG stimulates the immune system.
9. ECHIIi[ACEA is used for common colds and seasonal flu
10. PEPPERMTNT is best for cold & flu but LEAST EFEECTIVE in children.
11. CHAI'IODIILE has an anti-inf Iammatory & eases spasm.
72. SAII PALMETIO is used to treat enlarged prostate g1and.

118