ENZYMES, GROWTH FACTORS, PROTEINS, RECEPTORS, CHEMICALS, COMPOUNDS, MOLECULES, AND ELEMENTS

Alpha-1 glycoprotein

Most commonly involved protein in pharmacokinetics; acts as a carrier and storage depot for many substances in the bloodstream

Albumin

Most commonly involved protein in pharmacokinetics; acts as a carrier and storage depot for many substances in the bloodstream

Acidic drugs

Bind to albumin

Basic drugs

Bind to alpha-1 glycoprotein

Free or unbound drugs

Metabolize more quickly, resulting in short-lived action on target organs

Phenytoin

An acidic drug that binds to albumin

Lidocaine

A basic drug that binds to alpha-1 glycoprotein

Warfarin

An acidic drug that binds to albumin; an anticoagulant used to prevent thrombus formation

Aspirin

An acidic drug that binds to albumin; an antiplatelet agent used to prevent blood clot formation

Lipophilic (fat-binding or fat-soluble) drugs

Have a wider volume of distribution (VD) and longer half-life in the elderly due to increased body fat mass

Hydrophilic (water-soluble) drugs

Have a lower volume of distribution (VD), leading to higher serum levels in the elderly due to decreased total body water

Diazepam (Valium)

A lipophilic drug; an anti-anxiety drug with sedative effects

Digoxin (Lanoxin)

A hydrophilic drug used to control rapid heart rate

Propranolol

A basic drug that binds to alpha-1 glycoprotein; a beta blocker used for slowing down heart rates and controlling essential tremors

Nitrates

Vasodilators

Nifedipine

Calcium channel blocker used to control spikes in blood pressure

Aminoglycosides

Antibiotics that raise concerns for nephrotoxicity and ototoxicity in the elderly

Lithium

Drug of choice for bipolar mood disorder that accumulates and causes neurologic manifestations

Metformin

An oral hypoglycemic agent

Furosemide

A loop diuretic

Salbutamol

A bronchodilator

Morphine

An opiate-class analgesic and sedative that exhibits increased effect in the elderly

Acetylcholine

Molecule whose receptors are blocked by certain drugs, leading to anticholinergic effects

Tricyclic Antidepressants (TCAs)

Medications with strong anticholinergic effects in the elderly

Imipramine

A TCA

Amitriptyline

A TCA

Diphenhydramine (Benadryl)

A sedating antihistamine with strong anticholinergic effects

Oxybutynin

A urinary antimuscarinic for overactive bladder with strong anticholinergic effects

Haloperidol

An antipsychotic drug with strong anticholinergic effects

Levodopa

An antiparkinsonian drug with strong anticholinergic effects

Carbidopa

An antiparkinsonian drug with strong anticholinergic effects

Clopidogrel

An antiplatelet agent used to prevent blood clot formation

Gliclazide

A hypoglycemic drug

Insulin

An injectable hormone given to control blood sugar levels for diabetic patients

Rivastigmine

Oral drug for dementia; can cause abdominal pain and vomiting

Metoclopramide

An antiemetic drug that may be prescribed during a prescribing cascade, having strong anticholinergic effects

Buscopan

An antispasmodic drug that may be prescribed during a prescribing cascade, having strong anticholinergic effects

Enalapril

An ACE inhibitor for BP control

Mefenamic acid

Drug that interacts with Enalapril, potentially causing Hyperkalemia

Nitroglycerin

A vasodilator/nitrate derivative

Sildenafil

Drug that interacts with Nitroglycerin, potentially causing Severe hypotension

Verapamil

A calcium channel blocker that slows down HR

Atenolol

Drug that interacts with Verapamil, potentially causing Bradycardia and hypotension

Vitamin K

Compound in leafy vegetables that counters the anticoagulant effects of warfarin

Furanocoumarins

Organic chemical compounds in grapefruit that deactivate one of the CYP450 enzymes

Simvastatin

A statin drug whose metabolism is decreased by furanocoumarins in grapefruit

Atorvastatin

A statin drug

Lovastatin

A statin drug

Ciprofloxacin

A broad spectrum antibiotic whose absorption is prevented by calcium in milk

Calcium

Element/Compound in milk and dairy products that binds with ciprofloxacin molecules, reducing antibiotic effects

Fentanyl

An opioid used mainly for pain control

OxyContin

An opioid used mainly for pain control

Metoprolol

A beta-blocker

Carvedilol

A beta-blocker

Telmisartan

Used for hypertension

Linagliptin/Metformin

Used for diabetes

Memantine

Used for Alzheimer's Disease

Citicoline

Used for Alzheimer's Disease

Rosuvastatin

Used for cholesterol

Hydrochlorothiazide

A thiazide diuretic that can exacerbate gout symptoms

Antigen

A live or inactivated substance (protein or polysaccharide) capable of producing an immune response

Antibody (Immunoglobulin)

Protein molecule produced by B lymphocytes to help eliminate an antigen

Tetanus Toxoid

The antigen itself that helps the body develop active immunity

Tetanus Immunoglobulin

Pre-formed antibodies that provide temporary protection and fight the infection

HBsAg

Surface antigen of Hepatitis B

AntiHbs

Anti-hepatitis B antibody

Preservatives (eg, 2-phenoxyethanol)

Vaccine components that prevent contamination once a vial is opened

Surfactants

Vaccine components that keep ingredients from blending together, preventing clumping

Diluent

Vehicle for dilution in a vaccine (usually sterile water)

Adjuvant (eg, aluminum salts)

Vaccine components that improve immune response, stimulate local immune cells, and boost the effects of the antigen

Stabilizers (eg, sugars, amino acids, gelatin)

Vaccine components that keep vaccine components from sticking to the vial

Immunoglobulins

Immunizing agents usually coming from humans

Human Specific Ig (Hyperimmune)

Immunoglobulins used for Hepatitis B, Varicella, Tetanus, Rabies (BVTR)

Human Normal Ig

Immunoglobulins used for Hepatitis A, Measles, Polio, Rubella (AMPR)

Antisera (Nonhuman Ig)

Immunizing agents coming from animals, used for Diphtheria, Tetanus, Gas gangrene, Botulism, Rabies

Homologous pooled human antibody (Ig)

Pure immunoglobulins obtained from thousands of adult donors; used for post-exposure prophylaxis (Hep A and measles)

Homologous human hyperimmune globulin

Igs with high titers of specific antibody; used for post-exposure prophylaxis (Hep B, rabies, Tetanus, Varicella)

Heterologous hyperimmune serum (antitoxin)

Animal products (equine) against one antigen (eg, botulism, diphtheria)

Monoclonal Antibodies

Derived from a single type or clone of plasma cells; specific to a single antigen or closely related group of antigens; used for immunization, diagnosis, and therapy

Palivizumab

Monoclonal antibody specific for Respiratory Syncytial Virus (RSV) antibodies

Polyclonal Antibodies

A combination of different antibodies found at the surface of a particular microbe

Toxins

Inactivated ones, called toxoids, are released by bacteria and used to create vaccines

Toxoids

Inactivated toxins released by bacteria; look like toxins but are not poisonous; trigger a strong immune response

Polysaccharide

Antigen type, usually found in the cell membrane of bacteria, used to train the immune system in polysaccharide vaccines

Recombinant carrier protein

Combined with a polysaccharide antigen in conjugate vaccines to stimulate T-cells

HBIG (Hepatitis Immunoglobulin)

Administered along with the Hepatitis B vaccine to infants born to HBsAg positive mothers within the first 12 hours of life

Normal Saline Solution (NSS)

Usually used to reconstitute vaccines, along with sterile water

Antinuclear antibodies (ANAs)

Hallmark of Systemic Lupus Erythematosus (SLE); particularly against DNA, histones, non-histone RNA, and nucleolus

Anti-dsDNA (anti-double-stranded DNA)

Antibody whose presence is diagnostic of SLE

Anti-Sm (anti-Smith antigens)

Antibody whose presence is diagnostic of SLE

Antiphospholipid Antibodies

React with phospholipid binding proteins; present in almost 40% of Lupus patients

LE bodies (Hematoxylin bodies)

Nuclei of damaged cells reacting with ANAs, losing their chromatin pattern and becoming homogeneous

Histones

Antibodies specific for these are frequently seen in drug-induced lupus erythematosus

Rheumatoid factor (RF)

Collective term for IgM and IgA autoantibodies that bind to IgG Fc regions

Anti-citrullinated peptide antibodies (ACPAs)

Diagnostic markers for Rheumatoid Arthritis

Ribonucleoprotein antigens (SS-A and SS-B)

Antibodies directed against these are serologic markers for Sjögren syndrome

IgM and IgA autoantibodies

Make up Rheumatoid Factor; bind to IgG Fc regions

IgG4 antibody

Antibody produced by plasma cells characteristic of IgG4 Related Disease

Anti-Scl 70

Antibody associated with systemic sclerosis; directed against DNA topoisomerase I; linked to pulmonary fibrosis and peripheral vascular diseases

Anti-centromere

Antibody associated with systemic sclerosis; found in patients with CREST syndrome