Anti-Infectives and Related Pharmacology

ANTI-INFECTIVES

  • Amoxicillin (Penicillin)
      - MOA: Weakens bacterial cell wall
      - BIG SIDE EFFECT: Allergic reaction (ANAPHYLAXIS)
      - Nursing consideration: ALWAYS ask about penicillin allergy

  • Cefaclor (Cephalosporin)
      - MOA: Cell wall destruction
      - Indication: Middle ear infections, respiratory infections, urinary infections
      - BIG SIDE EFFECT: Cross-allergy with penicillin
      - Nursing consideration: If allergic to penicillin → be cautious

  • Tetracycline
      - MOA: Inhibits protein synthesis (Bacteriostatic)
      - Use: When penicillin is contraindicated
      - BIG SIDE EFFECT: Teeth discoloration (in children)
      - Contraindicated in: Pregnancy and children

  • Gentamicin (Aminoglycoside)
      - MOA: Bactericidal for aerobic negative bacteria
      - BIG SIDE EFFECT: NEPHROTOXICITY + OTOTOXICITY
      - Monitoring: Kidney function and hearing

  • Ciprofloxacin (Fluoroquinolone)
      - MOA: Bactericidal for both negative and positive bacteria
      - Indications: Anthrax, urinary infections, respiratory infections
      - BIG SIDE EFFECT: Tendon rupture
      - Contraindicated in: Athletes and the elderly

  • TMP-SMX (Bactrim)
      - BIG SIDE EFFECT: Stevens-Johnson Syndrome (SJS)
      - Indication: Not specified
      - Monitoring: Stop immediately if rash appears

  • Vancomycin (Glycopeptide)
      - MOA: Bactericidal
      - Indications: Treats Clostridium difficile (C-diff) + Methicillin-resistant Staphylococcus aureus (MRSA)
      - BIG SIDE EFFECT: Red Man Syndrome
      - Administration: Infuse SLOWLY

  • Isoniazid (Antimycobacterial)
      - MOA: Bactericidal
      - Indications: Tuberculosis (TB) + Leprosy
      - BIG SIDE EFFECT: Hepatotoxicity, lupus syndrome, hepatitis
      - Nursing consideration: Give Vitamin B6 to mitigate side effects

  • Oseltamivir (Antiviral - "Tamiflu")
      - MOA: Inhibits viral enzyme
      - Indications: Influenza A
      - BIG SIDE EFFECT: Renal impairment

  • Acyclovir (Antiviral - "Zovirax")
      - MOA: Inhibits viral DNA replication
      - Indication: Herpes infections
      - BIG SIDE EFFECT: Nephrotoxicity
      - Nursing consideration: Hydration is KEY

  • Adefovir (Antiviral)
      - MOA: NRTI (nucleotide reverse transcriptase inhibitor)
      - Indications: Hepatitis A, B, and C
      - BIG SIDE EFFECT: Lactic acidosis

  • Zidovudine (Antiviral - "AZT")
      - MOA: NRTI
      - Indication: HIV infection
      - BIG SIDE EFFECT: Bone marrow suppression

  • Amphotericin B (Antifungal)
      - MOA: Causes fungal cell death
      - Indication: Severe systemic fungal infections
      - BIG SIDE EFFECT: Nephrotoxicity (SEVERE)
      - Nickname: “Ampho-terrible”

  • Clotrimazole (Antifungals - "Mycellx")
      - MOA: Binds to sterols in cell membrane, altering it
      - Indication: Topical antifungal applications

  • Fluconazole (Azole Antifungal - "Diflucan")
      - MOA: Disrupts fungal cell membrane sterols
      - BIG SIDE EFFECT: Fetal toxicity

  • Chloroquine (Antimalarial)
      - MOA: Inhibits protozoal reproduction in liver and protein synthesis
      - BIG SIDE EFFECT: Retinal changes

  • Mebendazole (Anthelmintic - "Vermox")
      - MOA: Blocks glucose uptake needed for survival
      - Indications: Pink worm + roundworm infections
      - BIG SIDE EFFECT: Transient abdominal pain

  • Methotrexate (Antineoplastics)
      - MOA: Inhibits folic acid reductase, leading to inhibition of DNA synthesis
      - BIG SIDE EFFECT: Alopecia + stomatitis
      - Indications: Leukemia, GI cancer, basal cell carcinoma

PAIN / ANTI-INFLAMMATORY

  • Aspirin (Salicylates - "Bayer")
      - MOA: Inhibits synthesis of prostaglandins
      - Indications: Treatment for fever, pain, inflammatory conditions
      - BIG SIDE EFFECT: Bleeding / GI ulcers
      - Caution: Avoid in children due to Reye’s syndrome

  • Ibuprofen (NSAID - "Advil")
      - MOA: Inhibits synthesis of prostaglandins by blocking COX1/COX2
      - Indications: Pain, arthritis, dysmenorrhea
      - BIG SIDE EFFECT: GI bleeding

  • Acetaminophen ("Tylenol")
      - MOA: Acts on hypothalamus → leads to vasodilation + sweating
      - Indications: Moderate/mild pain / fever
      - BIG SIDE EFFECT: LIVER TOXICITY
      - Maximum Dose: 4g/day

  • Auranofin (Gold Compound)
      - MOA: Inhibition of phagocytosis
      - Indication: Rheumatoid arthritis
      - BIG SIDE EFFECT: Stomatitis, glossitis, gingivitis

PSYCH MEDS / ANTIDEPRESSANTS

  • Diazepam (Benzodiazepine)
      - MOA: Acts in limbic system + RAS
      - Indications: Treatment of anxiety, acute alcohol withdrawal
      - BIG SIDE EFFECT: Respiratory depression

  • Phenobarbital
      - MOA: Inhibits neuronal impulse in ascending RAS → Decreases cerebral cortex + motor output
      - Indications: Anxiety, insomnia, seizure, sedation
      - BIG SIDE EFFECT: Respiratory depression

  • Imipramine (Tricyclic)
      - MOA: Inhibits reuptake of serotonin (5HT) and norepinephrine (NE), increasing stimulation
      - Indications: Depression and control of chronic pain
      - BIG SIDE EFFECT: Withdrawal syndrome

  • Duloxetine (S.N.R.I)
      - MOA: Decrease reuptake of both serotonin and norepinephrine and inhibit dopamine
      - Indications: Major depressive disorder
      - BIG SIDE EFFECT: Serotonin syndrome

  • Fluoxetine (S.S.R.I)
      - MOA: Blocks reuptake of serotonin + 5HT, increasing levels in the synaptic cleft
      - Indications: Depression, OCD, bulimia, PTSD, panic attack
      - BIG SIDE EFFECT: Serotonin syndrome

  • Phenelzine (MAOI)
      - MOA: Inhibits reuptake of serotonin (5HT) and norepinephrine (NE), increasing stimulation of postsynaptic receptors
      - Indications: Relief of depression and control of chronic pain
      - BIG SIDE EFFECT: Hypertensive crisis (tyramine!)

  • Lithium
      - MOA: Inhibits the release of norepinephrine + dopamine
      - Indications: Bipolar disorder
      - BIG SIDE EFFECT: TOXICITY (narrow therapeutic range)
      - Early sign of toxicity: Tremor

  • Haloperidol (Typical Antipsychotic)
      - MOA: Blocks dopamine receptors
      - Indications: Positive symptoms of schizophrenia
      - BIG SIDE EFFECT: Extrapyramidal symptoms (EPS)

  • Clozapine (Atypical Antipsychotic)
      - MOA: Blocks both dopamine + serotonin receptors
      - Indications: Positive + Negative symptoms of schizophrenia
      - BIG SIDE EFFECT: Agranulocytosis
      - Monitoring: WBC count

  • Methylphenidate ("Ritalin")
      - MOA: CNS stimulation
      - Indications: ADHD + Narcolepsy + Conduct disorder
      - BIG SIDE EFFECT: Growth suppression

SEIZURE / NEURO

  • Phenytoin (Antiseizure Hydantoins)
      - MOA: Sodium channel blocker which reduces tonic-clonic muscular and emotional responses
      - Indication: Seizure
      - BIG SIDE EFFECT: Gingival hyperplasia

  • Ethosuximide (Antiseizure Succinimides)
      - MOA: Suppresses abnormal electrical activity in the brain
      - Indication: Absence seizures
      - BIG SIDE EFFECT: Blood dyscrasias

  • Levodopa (Dopaminergic Anti-Parkinson)
      - MOA: Increases dopamine in the CNS and prevents degradation of levodopa
      - BIG SIDE EFFECT: Dyskinesia

  • Benztropine (Anticholinergic Anti-Parkinson)
      - MOA: Decreases ACh in the CNS
      - BIG SIDE EFFECT: Can worsen glaucoma and benign prostatic hyperplasia (BPH)

  • Donepezil
      - MOA: Inhibits acetylcholinesterase
      - Indication: Alzheimer’s disease
      - BIG SIDE EFFECT: Bradycardia

OPIOIDS / ANALGESICS AND MUSCLE RELAXANTS

  • Morphine
      - BIG SIDE EFFECT: Respiratory depression

  • Naloxone
      - Indication: Opioid overdose
      - BIG SIDE EFFECT: Withdrawal symptoms

  • Baclofen (Centrally Acting)
      - MOA: Works in the CNS to interfere with reflexes
      - Indication: Skeletal muscle relaxant
      - BIG SIDE EFFECT: Arrhythmias

  • Dantrolene (Direct Acting)
      - MOA: Interferes with the release of calcium from muscle tubules
      - Indications: Spasticity + malignant hyperthermia
      - BIG SIDE EFFECT: Hepatocellular damage and crystalline urine

  • Dopamine
      - Indications: Shock, hypotension, low cardiac output
      - BIG SIDE EFFECT: Tachycardia and arrhythmias

  • Phenylephrine
      - MOA: Selective A1 agonist (causing vasoconstriction)
      - Indications: Hypotension, nasal decongestant
      - BIG SIDE EFFECT: Hypertension

  • Isoproterenol
      - MOA: B1 + B2 agonist
      - Indications: Bradycardia + heart block
      - BIG SIDE EFFECT: Tachycardia and dysrhythmias

  • Labetalol
      - MOA: Blocks A1 + B1 + B2 receptors
      - Indications: Hypertension (pregnancy safe)
      - BIG SIDE EFFECT: Orthostatic hypotension

  • Bethanechol
      - MOA: Direct muscarinic receptor agonist, increases parasympathetic effects
      - Indication: Urinary retention (post-op)
      - BIG SIDE EFFECT: Bradycardia + cholinergic excess

  • Pyridostigmine
      - MOA: Inhibits acetylcholinesterase, increasing acetylcholine at neuromuscular junction
      - Indication: Myasthenia gravis
      - BIG SIDE EFFECT: Cholinergic crisis

  • Atropine
      - MOA: Blocks acetylcholine at muscarinic receptors
      - Indications: Bradycardia and pre-operative secretions
      - BIG SIDE EFFECT: Tachycardia + anticholinergic effects

  • Desmopressin
      - MOA: Produces antidiuretic activity in the kidney (increases water reabsorption and decreases urine formation)
      - Indications: Diabetes insipidus + nocturnal enuresis
      - BIG SIDE EFFECT: Adrenal insufficiency / risk of decreased growth in children

  • Levothyroxine (Thyroid Hormone)
      - MOA: Replaces T4
      - Indications: Hypothyroidism and thyroid cancer
      - BIG SIDE EFFECT: Hyperthyroidism

ENDOCRINE

  • Methimazole (Antithyroid agent)
      - MOA: Blocks thyroid hormone synthesis
      - Indications: Graves' disease + hyperthyroidism
      - BIG SIDE EFFECT: Hair loss, staining of teeth + agranulocytosis

  • Propylthiouracil
      - MOA: Inhibits thyroid synthesis by blocking TPO
      - Indication: Thyroid crisis or storm
      - BIG SIDE EFFECT: Hepatotoxicity

  • Hydrocortisone (Mineralocorticoids)
      - MOA: Increases sodium reabsorption + increases potassium excretion
      - Indication: Addison’s Disease
      - BIG SIDE EFFECT: Edema, fluid overload

  • Glyburide (Sulfonylureas)
      - MOA: Stimulates insulin release from functioning beta cells in the pancreas
      - Indication: Type 2 Diabetes
      - BIG SIDE EFFECT: Hypoglycemia

  • Metformin (Biguanide)
      - MOA: Increases production of insulin + uptake of glucose
      - Indication: 1st line for Type 2 diabetes
      - BIG SIDE EFFECT: Lactic acidosis

  • Glucagon (Glucose-elevating)
      - MOA: Increases blood glucose by decreasing insulin levels
      - Indication: Severe hypoglycemia
      - BIG SIDE EFFECT: Hypertension

CARDIO

  • Captopril (ACE inhibitor)
      - MOA: Blocks ACE from converting Angiotensin I to II
      - Indications: Hypertension + heart failure (HF) + myocardial infarction (MI)
      - BIG SIDE EFFECT: Dry cough + angioedema + neutropenia

  • Losartan (ARB)
      - MOA: Blocks Angiotensin II → causes vasodilation
      - Indications: Hypertension + diabetic nephropathy + proteinuria in type 2 diabetes
      - BIG SIDE EFFECT: Hyperkalemia + tooth pain

  • Diltiazem (CCB)
      - MOA: Blocks calcium channels
      - Indications: Hypertension, angina, tachycardia
      - BIG SIDE EFFECT: Bradycardia + edema

  • Nitroprusside (Vasodilators)
      - MOA: Effects of sympathetic stress response
      - Indications: Severe hypotension and acute heart failure
      - BIG SIDE EFFECT: Cyanide toxicity

  • Digoxin
      - MOA: Increases calcium entering myocardial cells during PHASE 4 (slows AV nodes) + Positive inotropic and negative chronotropic effects
      - Indications: Heart failure and atrial fibrillation
      - BIG SIDE EFFECT: Toxicity (arrhythmias) + yellow vision (classic sign)

  • Lidocaine (Class I Antiarrhythmic)
      - MOA: Blocks sodium channels in the heart during PHASE 0
      - Indications: Serious ventricular arrhythmias + tachycardia
      - BIG SIDE EFFECT: CNS toxicity (seizures)

  • Propranolol (Class II Antiarrhythmics)
      - MOA: Blocks beta receptors in the heart / kidneys, depresses PHASE 4
      - Indications: Rapid atrial fibrillation + ventricular tachycardia + hypertension + angina
      - BIG SIDE EFFECT: Slows everything (HR / BP / energy)

  • Amiodarone (Class III Antiarrhythmic)
      - MOA: Blocks potassium channels, prolongs repolarization and PHASE 3
      - Indications: Severe arrhythmias
      - BIG SIDE EFFECT: Pulmonary fibrosis

  • Diltiazem (Class IV Antiarrhythmics / Antianginal)
      - MOA: Blocks calcium channels, delays PHASE 1/2 and slows AV nodes
      - Indications: Angina and hypertension
      - BIG SIDE EFFECT: AV block

  • Nitroglycerin (Nitrates Antianginal)
      - MOA: Acts directly on smooth muscle to relax and depress muscle tone
      - Indications: Prevent and treat attacks of angina
      - BIG SIDE EFFECT: Hypotension

  • Metoprolol (Beta-Blocker Antianginal)
      - MOA: Block beta receptors in the heart
      - Indications: Chronic angina and Prinzmetal angina
      - BIG SIDE EFFECT: Bradycardia + peripheral edema

BLOOD + LIPIDS

  • Warfarin (Anticoagulant)
      - MOA: Inhibits synthesis of clotting factors affecting the extrinsic pathway
      - Indications: Prevent clot formation
      - BIG SIDE EFFECT: Bleeding

  • Heparin (Anticoagulant)
      - MOA: Inactivates thrombin and factor Xa, affecting the intrinsic pathway
      - Indications: Prevent clot formation
      - BIG SIDE EFFECT: Heparin-induced thrombocytopenia (HIT)

  • Alteplase (Thrombolytics)
      - MOA: Activates natural anticlotting system, needs active plasminogen in blood
      - Indications: Dissolution of formed thrombus for acute MI, pulmonary embolism (PE) and ischemic stroke
      - BIG SIDE EFFECT: Bleeding (potentially fatal)

  • Aminocaproic acid (Hemostatic agent)
      - MOA: Inhibits plasminogen-activating substances
      - Indication: Prevent body-wide or systemic clot breakdown to prevent blood loss
      - BIG SIDE EFFECT: Excessive clotting and intrarenal obstruction

  • Cholestyramine (Bile Acid Sequestrants Lipid Lowering)
      - MOA: Binds bile acids in the GI tract = decreases LDL (Powder formulation)
      - Indication: Hypercholesterolemia
      - BIG SIDE EFFECT: Vitamin A + E deficiencies + constipation

  • Atorvastatin (HMG-CoA Reductase Inhibitor Lipid Lowering)
      - MOA: Blocks HMG-CoA synthesis of cholesterol = increases HDL + decreases LDL
      - Indications: Prevention of coronary artery disease (CAD) + increased cholesterol/triglycerides and LDL
      - BIG SIDE EFFECT: Rhabdomyolysis

  • Ezetimibe (Cholesterol Absorption Inhibitors)
      - MOA: Inhibits absorption of cholesterol in the small intestine
      - Indication: Familial hyperlipidemia
      - BIG SIDE EFFECT: Hepatitis + hepatotoxicity

ANEMIA

  • Ferrous Sulfate (Iron Supplement)
      - MOA: Elevates serum iron concentration
      - Indications: Anemias
      - BIG SIDE EFFECT: Dark stool and tooth staining + GI irritation

  • Folic Acid (Megaloblastic Anemias)
      - MOA: Converted to tetrahydrofolate for DNA synthesis and RBC production
      - Indications: Megaloblastic anemia and pregnancy
      - BIG SIDE EFFECT: Mild diarrhea

  • Epoetin Alfa (Erythropoiesis Stimulating)
      - MOA: Stimulates production of RBC in bone marrow
      - Indications: Anemia associated with renal failure or kidney disease
      - BIG SIDE EFFECT: Hypertension

  • Vitamin B12
      - MOA: Helps normal maturation of RBC
      - Indication: Pernicious anemia
      - BIG SIDE EFFECT: Hypokalemia

  • Hydroxyurea (Hemolytic/Aplastic Anemia)
      - MOA: Increases amount of fetal hemoglobin produced in the bone marrow
      - Indications: Sickle cell anemia and leukemia
      - BIG SIDE EFFECT: Bone marrow suppression

REPRODUCTIVE SYSTEM

  • Estradiol (Estrogen)
      - MOA: Binds to estrogen receptors, inhibits ovulation, and promotes bone formation
      - Indications: Contraception + hypogonadism + ovarian failure
      - BIG SIDE EFFECT: Breakthrough bleeding + weight gain

  • Sildenafil (Penile Erectile Dysfunction)
      - MOA: PDE5 inhibitors, increases blood flow to corpus cavernosum
      - Indications: Erectile dysfunction + pulmonary hypertension
      - BIG SIDE EFFECT: Priapism + hearing loss

DIURETICS

  • Hydrochlorothiazide (Thiazide)
      - MOA: Blocks reabsorption of sodium + chloride at the convoluted tubule
      - Indication: 1st line for hypertension
      - BIG SIDE EFFECT: Hypokalemia + hypotension

  • Acetazolamide (Carbonic Anhydrase Inhibitors)
      - MOA: Blocks effects of carbonic anhydrase
      - Indication: Glaucoma
      - BIG SIDE EFFECT: Metabolic acidosis + renal calculi + hypokalemia

  • Furosemide (Loop)
      - MOA: Blocks chloride pump in loop of Henle
      - Indication: Acute heart failure (HF), acute pulmonary edema
      - BIG SIDE EFFECT: Hypokalemia + alkalosis + ototoxicity

  • Spironolactone (Potassium-sparing Diuretic)
      - MOA: Blocks aldosterone, promoting excretion of sodium + water while conserving potassium
      - Indications: Hyperaldosteronism + HF + edema
      - BIG SIDE EFFECT: Hyperkalemia

  • Mannitol (Osmotic Diuretic)
      - MOA: Elevates osmolarity of the glomerular filtrate, leading to loss of water, sodium, and chloride
      - Indications: Shock, trauma, cerebral edema, drug overdose
      - BIG SIDE EFFECT: Pulmonary edema

URINARY

  • Fosfomycin (Anti-infective)
      - MOA: Bactericidal
      - Indication: Urinary Tract Infection (UTI)
      - BIG SIDE EFFECT: Pruritus, urticaria, and blood dyscrasias

  • Trimethoprim-sulfamethoxazole (Bactrim)
      - Indication: UTI (for children)

  • Oxybutynin (Anticholinergics)
      - MOA: Blocks the spasm of urinary tract muscles
      - Indication: Bladder spasm + overactive bladder
      - BIG SIDE EFFECT: Tachycardia + dry mouth

  • Doxazosin (Alpha Adrenergic Blocker)
      - MOA: Relaxes the smooth muscles of the prostate to improve urine flow
      - Indication: Benign prostatic hyperplasia (BPH)
      - BIG SIDE EFFECT: Sexual dysfunction + hypotension

RESPIRATORY

  • Dextromethorphan (Antitussives)
      - MOA: Acts directly on the medullary cough center to depress cough
      - Indication: Dry cough
      - BIG SIDE EFFECT: Dizziness

  • Phenylephrine (Nasal Decongestant)
      - MOA: Selective A1 agonist causing vasoconstriction
      - Indication: Nasal decongestant
      - BIG SIDE EFFECT: Hypertension + rebound congestion

  • Pseudoephedrine (Oral Decongestants)
      - MOA: Stimulates A and B receptors to cause vasoconstriction in nasal mucosa
      - Indications: Rhinitis + sinusitis
      - BIG SIDE EFFECT: Insomnia + rebound congestion

  • Diphenhydramine (Antihistamine - "Benadryl")
      - MOA: Blocks effects of histamine at H1 receptors
      - Indications: Allergies, urticaria, angioedema, motion sickness
      - BIG SIDE EFFECT: Sedation

  • Guaifenesin (Expectorants - "Mucinex")
      - MOA: Decreases thickness of secretions for productive cough
      - Indication: Moist cough
      - BIG SIDE EFFECT: GI upset

  • Acetylcysteine (Mucolytics)
      - MOA: Breaks up disulfide bonds
      - Indications: Cystic fibrosis + chronic bronchitis
      - BIG SIDE EFFECT: Bronchospasm + stomatitis

  • Albuterol (Sympathomimetics)
      - MOA: Binds to beta 2 receptors in the lungs
      - Indication: Emergency use for acute asthma attack
      - BIG SIDE EFFECT: Tachycardia

  • Ipratropium (Anticholinergics)
      - MOA: Blocks ACh in the lungs, causing bronchodilation
      - Indication: Bronchospasm in COPD
      - BIG SIDE EFFECT: Dry mouth

  • Budesonide (Inhaled Steroids for Inflammation)
      - MOA: Decreases inflammation
      - Indication: Prevents and treats asthma
      - BIG SIDE EFFECT: Oral thrush

GI SYSTEM

  • Omeprazole (Proton Pump Inhibitor)
      - MOA: Inhibits H+/K+ ATPase in the stomach, decreasing gastric acid secretion
      - Indications: GERD, peptic ulcer disease
      - BIG SIDE EFFECT: Risk of C. difficile infection

  • Sucralfate (GI Protectant)
      - MOA: Forms a protective barrier over ulcers
      - Indication: Peptic ulcer disease
      - BIG SIDE EFFECT: Constipation

  • Cimetidine (H2 Receptor Blocker)
      - MOA: Blocks H2 receptors, decreases acid secretion
      - Indications: GERD, ulcers
      - BIG SIDE EFFECT: Gynecomastia

  • Sodium Bicarbonate (Antacids)
      - MOA: Neutralizes gastric acid, increases pH
      - Indications: GERD, heartburn, metabolic acidosis
      - BIG SIDE EFFECT: Metabolic alkalosis + sodium overload

  • Senna (Stimulants)
      - MOA: Stimulates intestinal motility
      - Indication: Constipation
      - BIG SIDE EFFECT: Diarrhea + electrolyte imbalances

  • Psyllium (Bulk Forming Agents)
      - MOA: Absorbs water to form bulky stool, promoting bowel movement
      - Indication: Constipation
      - BIG SIDE EFFECT: Esophageal obstruction (if not taken with water)

  • Magnesium Citrate (Osmotic)
      - MOA: Pulls water into intestines to increase bowel movement
      - Indications: Constipation + bowel prep
      - BIG SIDE EFFECT: Diarrhea + dehydration

  • Docusate (Lubricants)
      - MOA: Allows water and fats into the stool to soften it
      - Indication: Constipation
      - BIG SIDE EFFECT: Diarrhea

  • Loperamide (Antidiarrhea)
      - MOA: Slows intestinal motility (by acting on opioid receptors) to decrease diarrhea
      - Indication: Diarrhea
      - BIG SIDE EFFECT: Constipation

  • Metoclopramide (Antiemetics - Non-phenothiazine)
      - MOA: Dopamine (D2) antagonist, increases GI motility
      - Indications: Nausea/Vomiting + gastroparesis
      - BIG SIDE EFFECT: EPS symptoms

  • Ondansetron (Antiemetic)
      - MOA: Blocks serotonin receptor in the GI tract to decrease nausea and vomiting
      - Indications: Nausea and vomiting
      - BIG SIDE EFFECT: QT prolongation (risk for arrhythmias)

FINAL EXAM POWER TIPS

  • If you remember NOTHING else:
      1. Kidney drugs: Nephrotoxicity (e.g., gentamicin, amphotericin)
      2. Liver drugs: Hepatotoxicity (e.g., acetaminophen, isoniazid)
      3. Psych drugs: Serotonin syndrome / EPS / lithium toxicity
      4. Cardiac drugs: Bradycardia, hypotension, arrhythmias
      5. Anticoagulants: Always risk of bleeding

MEMORY HACKS

  • “MYCINS = TOXIC” → gentamicin, vancomycin

  • “STATINS = MUSCLE DAMAGE”

  • “PRILS = COUGH”

  • “SARTANS = POTASSIUM ↑”

  • “LOOP = LOSE K+”

SUPER EXAM POWER TIPS

ANTI-INFECTIVES — “WHAT WILL KILL THE PATIENT FAST”

  • Always think:
      - Kidney damage → aminoglycosides, acyclovir, amphotericin
      - Liver damage → isoniazid, acetaminophen
      - Allergy → penicillins, cephalosporins

EASY PICKS:

  • Rash after antibiotic → STOP drug (risk for SJS)

  • Red flushing with vancomycin → infuse slower

  • TB drug + neuropathy → add Vitamin B6

  • Anti-infective + organ damage = correct answer

PAIN MEDS — “BLEED OR LIVER”

  • NSAIDs → GI BLEEDING

  • Acetaminophen → LIVER FAILURE

  • If patient drinks alcohol → NEVER pick acetaminophen

PSYCH — 3 DEADLY SYNDROMES (MUST KNOW)

  • Serotonin Syndrome (Fluoxetine, Duloxetine): agitation + sweating + hyperreflexia

  • Hypertensive Crisis (Phenelzine): Tyramine (cheese, wine)

  • Lithium Toxicity: tremor → confusion → seizures

  • ANY of these = STOP DRUG immediately

ANTIPSYCHOTICS

  • Haloperidol → EPS

  • Clozapine → NO WBC = DANGER

  • Fever + sore throat = agranulocytosis

SEIZURE / PARKINSON

  • Phenytoin → gum overgrowth

  • Levodopa → uncontrolled movements

  • Benztropine → anticholinergic → glaucoma worse

  • If patient has glaucoma → avoid anticholinergics

OPIOIDS

  • Morphine → respiratory depression

  • Naloxone → withdrawal

  • If RR < 12 → HOLD opioid

CARDIO — “SLOW, LOW, OR TOXIC”

  • PATTERNS:
      - ACE (Captopril) → cough + angioedema
      - ARB (Losartan) → ↑ K+
      - Beta blockers → ↓ HR
      - CCB → ↓ HR + edema

  • DIGOXIN: Exam favorite
      - Toxicity = arrhythmia + yellow vision
      - Low K+ → MORE TOXIC
      - If K is low → HOLD digoxin

  • AMIODARONE:
      - Lung damage → pulmonary fibrosis
      - SOB = red flag

  • NITROGLYCERIN:
      - ↓ BP
      - If hypotensive → HOLD

BLOOD DRUGS — ALWAYS BLEEDING

  • Warfarin: check INR

  • Heparin: check aPTT

  • Alteplase: can kill with bleeding

  • ANY bleeding sign = STOP drug

ENDOCRINE — “SUGAR + HORMONES”

DIABETES:

  • Glyburide / insulin → HYPOGLYCEMIA

  • Metformin → LACTIC ACIDOSIS
      - If NPO → HOLD diabetic meds

THYROID:

  • Levothyroxine → hyperthyroid symptoms

  • Methimazole → NO WBC

STEROIDS (Hydrocortisone)

  • Fluid retention + infection risk

DIURETICS — POTASSIUM GAME

  • Furosemide → ↓ K+

  • Spironolactone → ↑ K+

  • Potassium question = EASY POINT

RESPIRATORY — EASY FREE POINTS

  • Albuterol → tachycardia

  • Ipratropium → dry mouth

  • Budesonide → THRUSH → rinse mouth
      - If patient didn’t rinse → that’s your answer

GI — MATCH THE FUNCTION

  • Omeprazole → acid ↓↓↓

  • Sucralfate → coats ulcer

  • Metoclopramide → EPS risk

  • Ondansetron → QT prolongation
      - If arrhythmia risk → pick ondansetron

RAPID FIRE ASSOCIATIONS (MEMORIZE THIS)

  • “MYCIN” → kidney + ear damage

  • “STATIN” → muscle breakdown

  • “PRIL” → cough

  • “SARTAN” → potassium ↑

  • “LOOP” → potassium ↓

TOP 10 “AUTO-CORRECT” ANSWERS

  • If you see this → pick it immediately:
      1. RR low + opioid → Naloxone
      2. Yellow vision → Digoxin toxicity
      3. Muscle pain + statin → Rhabdomyolysis
      4. Fever + clozapine → Agranulocytosis
      5. Cough + ACE inhibitor → Switch drug
      6. Diarrhea after antibiotics → C. diff infection
      7. Tremor + lithium → Toxicity
      8. Rash + sulfa → SJS
      9. Hypotension + nitrate → Hold drug
      10. Oral thrush + steroid inhaler → Didn’t rinse

PHARMACOKINETICS

  1. Therapeutic: What it treats

  2. Pharmacologic: How it works

CONTROLLED SUBSTANCES (DEA SCHEDULES)

Schedule

Abuse Risk

Example

I

Highest, NO medical use

Heroin

II

High, medical use

Morphine

III

Moderate

Codeine combo

IV

Low

Benzos (diazepam)

V

Lowest

Cough meds

DRUGS IN PREGNANCY (VERY HIGH YIELD)

  • AVOID THESE (MEMORIZE):
      - ACE inhibitors (Captopril)
      - ARBs (Losartan)
      - Warfarin
      - Tetracycline
      - Lithium
      - “Pregnant = NO ACE, NO WAR, NO TETRA, NO LITHIUM”

PHARMACOKINETIC STEPS

  1. Absorption: Drug enters blood

  2. Distribution: Goes to tissues

  3. Metabolism: Liver breaks it down

  4. Excretion: Kidney removes it

THE 5 RIGHTS (automatic answer if unsure):

  • Right patient

  • Right drug

  • Right dose

  • Right route

  • Right time

NURSING PROCESS -> ADPIE

  • Assess, Diagnose, Plan, Implement, Evaluate

BACTERIOCIDAL VS BACTERIOSTATIC

  • Cidal: Kills bacteria

  • Static: Stops growth

SUPERINFECTION

  • New infection after antibiotics

  • Example: C. difficile diarrhea

PEAK & TROUGH

  • Peak: Highest level → toxicity risk

  • Trough: Lowest level → effectiveness

MECHANISMS OF ACTION

  • Cell wall destruction: Penicillin

  • Protein synthesis inhibition: Tetracycline

  • DNA/RNA inhibition: Antivirals

INFLAMMATION SIGNS (ALWAYS TESTED):

  • Redness -> Rubor

  • Swelling -> Tumor

  • Heat -> Calor

  • Pain -> Dolor

IMMUNITY TYPES

  • Active Immunity: Body MAKES antibodies

  • Passive Immunity: GIVEN antibodies
      - Example 1: Vaccines
      - Example 2: Immune serum

IMMUNE RESPONSE (BODY DEFENSES)

  1. First Line (Barrier): Skin + Mucous membranes
       - If broken → infection risk ↑

  2. Second Line (Innate Immunity):
       - Inflammation + Fever    - FAST + NON-SPECIFIC

  3. Third Line (Adaptive Immunity):
       - T cells + B cells + Antibodies

IMMUNE TABLE

Cell

Function

Neutrophils

First responders, kill bacteria

Macrophages

Eat pathogens (phagocytosis)

NK cells

Kill virus + cancer cells

Basophils

Histamine → inflammation

Eosinophils

Parasites + allergies

B cells

Make antibodies

T cells

Coordinate + kill infected cells

Memory cells

Long-term immunity

PARTS OF THE NERVOUS SYSTEM

TWO MAIN DIVISIONS (MUST KNOW):

  • Central Nervous System (CNS): Brain + Spinal cord
      - Think: Control center

  • Peripheral Nervous System (PNS): All nerves outside CNS
      - Think: Communication lines

  • Somatic Nervous System:
      - Voluntary movement (e.g., walking)

  • Autonomic Nervous System:
      - Involuntary movement (e.g., breathing)

Autonomic Nervous System Divisions

  • Sympathetic: (FIGHT OR FLIGHT)

  • Parasympathetic: (REST & DIGEST)

NEUROTRANSMITTER TABLE

Neurotransmitter

Function

Acetylcholine

Rest & digest, muscles

Norepinephrine

Fight or flight

Dopamine

Movement + pleasure

Serotonin

Mood

GABA

Calm/relax

NEUROTRANSMITTER IMBALANCE

  • Depression: ↓ serotonin

  • Parkinson's disease: ↓ dopamine

SEROTONIN SYNDROME

  • CAUSED BY: Too much serotonin (SSRIs, SNRIs, MAOI combination)

  • SIGNS: Agitation, Sweating, Hyperreflexia, Tachycardia

NEUROLEPTIC MALIGNANT SYNDROME (NMS)

  • CAUSED BY: Antipsychotics (e.g., haloperidol)

  • SIGNS: High fever, Muscle rigidity, Confusion

SEIZURES (VERY TESTED)

TYPES:

  1. Generalized: Whole brain → Loss of consciousness

  2. Focal: One part of the brain → May stay conscious

  3. Status Epilepticus: Continuous seizure (EMERGENCY)

MUSCLE SPASM

  • Sudden, painful, short-term (e.g., injury)

MUSCLE SPASTICITY

  • Continuous stiffness – Neurologic cause (e.g., Parkinson’s, MS)

PAIN TYPES:

  1. Acute Pain: Short term / Injury

  2. Chronic Pain: Long term / Disease

AGONIST vs ANTAGONIST

  • AGONIST: (Morphine)
      - ENHANCES opioid effect
        - Pain relief + Sedation
        - BIG SIDE EFFECT: Respiratory depression

  • ANTAGONIST: (Naloxone)
      - BLOCKS opioid effect
        - Reverses overdose
        - BIG SIDE EFFECT: Withdrawal symptoms

TYPES OF ANESTHESIA

  • Local Anesthesia: Numbs a small area – Patient remains awake (e.g., lidocaine)

  • General Anesthesia: Patient is unconscious – Full body effect – Respiratory depression

  • Inhalation Anesthesia: Gas used in the OR to maintain anesthesia

PITUITARY GLANDS (MASTER CONTROL)

Anterior Pituitary

  • Controls OTHER glands
      - ACTH → adrenal
      - TSH → thyroid
      - GH → growth
      - “Anterior = ACTS on glands”

Posterior Pituitary

  • Stores & releases hormones
      - ADH (water balance)
      - Oxytocin

ADH DISORDERS

  1. DIABETES INSIPIDUS (DI): Not enough ADH → Signs: Dehydration

  2. SIADH: Too much ADH → Signs: Water retention + confusion

THYROID DISORDERS

  • Hypothyroidism: Low metabolism → Weight gain, cold, slow HR

  • Hyperthyroidism: High metabolism → Weight loss, heat, fast HR

ADRENAL DISORDERS

  1. Cushing Syndrome: Too much cortisol → Moon face + weight gain + high BP

  2. Addison Disease: Not enough cortisol → Weight loss + weakness + low BP

DIABETES TYPES

  1. Type 1: No insulin – needs insulin replacement, usually in childhood

  2. Type 2: Insulin resistance, progressive loss of beta cells
       

HYPOGLYCEMIA

  • Symptoms: Low sugar → Shaky, sweaty, confused → Give glucose

HYPERGLYCEMIA

  • Symptoms: High sugar → Thirst + frequent urination

LAB VALUES

  1. Fasting: 126 mg/DL

  2. 2-HOUR plasma glucose: > 200 mg/DL

  3. HbA1c: > 6.5%
       

  • Signs of hyperglycemia: 200 mg/DL

HEART STRUCTURE + FUNCTION

  • Flow of Blood: Right → Lungs → Left → Body
       - Right heart → lungs (pulmonary circulation)
       - Left heart → body (systemic circulation)
       - Systole: Contraction (pumping)
       - Diastole: Relaxation (filling)

CARDIAC CONDUCTION

  • Pathway: SA node → AV node → Bundle of His → Purkinje Fibers

HEART MECHANICS

  • Preload: Volume in heart before contraction → Fluid volume

  • Afterload: Resistance heart pumps against → Blood pressure

HEART FAILURE

  1. Left-Sided: Affects the lungs → pulmonary edema, crackles, shortness of breath (SOB)

  2. Right-Sided: Affects the body → edema, jugular vein distension (JVD), weight gain

ASCVD (ATHEROSCLEROSIS)

  • Definition: Cholesterol buildup + Plaque

  • Risk Factors: Smoking, Diabetes, High cholesterol, Obesity

CLOTTING DISORDERS

  • Thrombus: Clot remains stationary

  • Embolus: Clot travels

KIDNEY + NEPHRON

  • FUNCTION: Filters blood, balances fluids, removes waste

  • RAAS System: ↑ BP + ↑ Fluid retention

UTI / CYSTITIS

  • Signs: Burning urination + Frequency

RESPIRATORY SYSTEM

  • FUNCTION: Gas exchange → O2 → CO2
      - Upper: Nose, Throat
      - Lower: Lungs

GI — PEPTIC ULCERS

  • Main Cause: H. pylori

  • Types:
      - 1) Gastric ulcer → Worse with food
      - 2) Duodenal ulcer → Better with food

  • Excess acid (GERD)