Pharmacology Cheatsheet

Cheatsheet Content

### Antimicrobials #### Antibiotics - **Cell Wall Synthesis Inhibitors** - **Penicillins:** Penicillin G/V, Amoxicillin, Ampicillin, Piperacillin/Tazobactam. *Mechanism:* Transpeptidase (PBP) inhibitors. *Side effects:* Hypersensitivity. - **Cephalosporins:** Cefazolin (1st gen), Cefoxitin (2nd gen), Ceftriaxone (3rd gen), Cefepime (4th gen), Ceftaroline (5th gen). *Mechanism:* PBP inhibitors. *Side effects:* Hypersensitivity, C. diff. - **Carbapenems:** Imipenem, Meropenem, Ertapenem, Doripenem. *Mechanism:* Broad-spectrum PBP inhibitors. *Side effects:* Seizures (Imipenem), C. diff. - **Monobactams:** Aztreonam. *Mechanism:* PBP inhibitor, Gram-negative only. *Side effects:* Minimal cross-reactivity with penicillins. - **Vancomycin:** *Mechanism:* Binds D-Ala-D-Ala, prevents peptidoglycan cross-linking. *Side effects:* Nephrotoxicity, ototoxicity, Red Man Syndrome. - **Daptomycin:** *Mechanism:* Depolarizes bacterial cell membrane. *Side effects:* Myopathy, rhabdomyolysis. - **Bacitracin:** *Mechanism:* Interferes with bactoprenol, topical. - **Protein Synthesis Inhibitors** - **Tetracyclines:** Doxycycline, Minocycline, Tetracycline. *Mechanism:* Binds 30S, prevents tRNA attachment. *Side effects:* Photosensitivity, tooth discoloration, GI distress. - **Aminoglycosides:** Gentamicin, Tobramycin, Amikacin, Streptomycin. *Mechanism:* Binds 30S, causes misreading of mRNA. *Side effects:* Ototoxicity, nephrotoxicity. - **Macrolides:** Azithromycin, Clarithromycin, Erythromycin. *Mechanism:* Binds 50S, blocks translocation. *Side effects:* GI motility issues, QT prolongation, ototoxicity. - **Clindamycin:** *Mechanism:* Binds 50S, blocks peptide bond formation. *Side effects:* C. diff. - **Linezolid:** *Mechanism:* Binds 50S, prevents formation of initiation complex. *Side effects:* Myelosuppression, serotonin syndrome. - **Chloramphenicol:** *Mechanism:* Binds 50S, inhibits peptidyl transferase. *Side effects:* Bone marrow suppression, Gray Baby Syndrome. - **Streptogramins:** Quinupristin/Dalfopristin. *Mechanism:* Binds 50S, synergistic inhibition. - **DNA/RNA Synthesis Inhibitors** - **Fluoroquinolones:** Ciprofloxacin, Levofloxacin, Moxifloxacin. *Mechanism:* Inhibits DNA gyrase (topoisomerase II) and topoisomerase IV. *Side effects:* Tendon rupture, QT prolongation, C. diff, photosensitivity. - **Rifamycins:** Rifampin. *Mechanism:* Inhibits bacterial RNA polymerase. *Side effects:* Orange body fluids, hepatotoxicity, potent CYP inducer. - **Metronidazole:** *Mechanism:* Forms toxic free radicals that damage DNA. *Side effects:* Disulfiram-like reaction with alcohol, metallic taste. - **Folate Synthesis Inhibitors** - **Sulfonamides:** Sulfamethoxazole. *Mechanism:* Inhibits dihydropteroate synthase (PABA analog). *Side effects:* Hypersensitivity, SJS, nephrotoxicity, photosensitivity. - **Trimethoprim:** *Mechanism:* Inhibits dihydrofolate reductase. *Side effects:* Bone marrow suppression. - **Co-trimoxazole (TMP/SMX):** Synergistic combination. - **Other Antibiotics** - **Polymyxins:** Polymyxin B, Colistin. *Mechanism:* Disrupts bacterial cell membranes. *Side effects:* Nephrotoxicity, neurotoxicity. - **Fidaxomicin:** *Mechanism:* Inhibits RNA polymerase, primarily for C. diff. #### Antivirals - **Anti-Herpesvirus:** - **Acyclovir, Valacyclovir, Famciclovir:** *Mechanism:* Guanosine analog, inhibits viral DNA polymerase. - **Anti-HIV:** - **NRTIs:** Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine. *Mechanism:* Nucleoside/tide reverse transcriptase inhibitors. - **NNRTIs:** Efavirenz, Nevirapine. *Mechanism:* Non-nucleoside reverse transcriptase inhibitors. - **Protease Inhibitors (PIs):** Ritonavir, Lopinavir, Darunavir. *Mechanism:* Inhibits viral protease, preventing cleavage of polyproteins. - **Integrase Inhibitors (INSTIs):** Raltegravir, Dolutegravir. *Mechanism:* Inhibits HIV integrase. - **Entry Inhibitors:** Enfuvirtide (fusion), Maraviroc (CCR5 antagonist). - **Anti-Influenza:** - **Oseltamivir, Zanamivir:** *Mechanism:* Neuraminidase inhibitors. - **Baloxavir:** *Mechanism:* Polymerase acidic endonuclease inhibitor. - **Anti-Hepatitis C (HCV):** - **Sofosbuvir (+Ledipasvir/Velpatasvir):** *Mechanism:* NS5B polymerase inhibitor. - **Glecaprevir/Pibrentasvir:** *Mechanism:* NS3/4A protease inhibitor + NS5A inhibitor. #### Antifungals - **Polyenes:** Amphotericin B, Nystatin. *Mechanism:* Binds ergosterol, forms pores in fungal cell membrane. *Side effects:* Nephrotoxicity (Ampho B), infusion reactions. - **Azoles:** Fluconazole, Itraconazole, Voriconazole, Posaconazole, Ketoconazole. *Mechanism:* Inhibits ergosterol synthesis (inhibits 14-alpha-demethylase). *Side effects:* Hepatotoxicity, many drug interactions (CYP inhibitors). - **Echinocandins:** Caspofungin, Micafungin, Anidulafungin. *Mechanism:* Inhibits beta-glucan synthesis (cell wall). - **Flucytosine:** *Mechanism:* Converted to 5-FU, inhibits DNA/RNA synthesis. - **Griseofulvin:** *Mechanism:* Interferes with microtubule function, inhibits mitosis. - **Terbinafine:** *Mechanism:* Inhibits squalene epoxidase, prevents ergosterol synthesis. #### Antiparasitics - **Antimalarials:** - **Chloroquine:** *Mechanism:* Inhibits heme detoxification. *Side effects:* Retinopathy. - **Artemisinins:** Artemether/Lumefantrine. *Mechanism:* Forms free radicals. - **Mefloquine:** *Mechanism:* Unknown, possibly heme detoxification. *Side effects:* Neuropsychiatric effects. - **Primaquine:** *Mechanism:* Forms reactive oxygen species, effective against hypnozoites. *Side effects:* Hemolysis in G6PD deficiency. - **Anti-Protozoals:** - **Metronidazole:** (Giardia, Entamoeba, Trichomonas) - **Iodoquinol:** (Entamoeba) - **Nitazoxanide:** (Giardia, Cryptosporidium) - **Anti-Helminthics:** - **Albendazole, Mebendazole:** *Mechanism:* Inhibits microtubule synthesis. - **Praziquantel:** *Mechanism:* Increases Ca2+ permeability, causes paralysis. - **Ivermectin:** *Mechanism:* Activates glutamate-gated Cl- channels, causes paralysis. - **Pyrantel Pamoate:** *Mechanism:* Nicotinic receptor agonist, causes spastic paralysis. ### Autonomic Drugs #### Cholinergic (Parasympathetic) - **Agonists (Direct):** - **Acetylcholine:** *Mechanism:* Non-selective muscarinic and nicotinic. - **Bethanechol:** *Mechanism:* Muscarinic selective, urinary retention. - **Pilocarpine:** *Mechanism:* Muscarinic selective, glaucoma, dry mouth. - **Agonists (Indirect - Cholinesterase Inhibitors):** - **Edrophonium:** *Mechanism:* Short-acting, myasthenia gravis diagnosis. - **Neostigmine, Pyridostigmine:** *Mechanism:* Medium-acting, myasthenia gravis treatment, paralytic reversal. - **Donepezil, Rivastigmine, Galantamine:** *Mechanism:* CNS-acting, Alzheimer's disease. - **Organophosphates:** Irreversible, pesticides, nerve gas. - **Antagonists (Muscarinic Blockers):** - **Atropine:** *Mechanism:* Blocks muscarinic receptors. *Uses:* Bradycardia, organophosphate poisoning. *Side effects:* Dry mouth, blurred vision, urinary retention, constipation ("hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter"). - **Scopolamine:** *Mechanism:* Motion sickness, sedation. - **Ipratropium, Tiotropium:** *Mechanism:* Bronchodilators (COPD, asthma). - **Oxybutynin, Tolterodine:** *Mechanism:* Overactive bladder. - **Antagonists (Nicotinic Blockers):** - **Neuromuscular Blockers:** Vecuronium, Rocuronium (non-depolarizing). Succinylcholine (depolarizing). - **Ganglionic Blockers:** Hexamethonium (rarely used). #### Adrenergic (Sympathetic) - **Agonists (Alpha-1):** - **Phenylephrine:** *Mechanism:* Vasoconstriction, decongestant, mydriasis. - **Agonists (Alpha-2):** - **Clonidine:** *Mechanism:* Reduces sympathetic outflow (CNS), hypertension. - **Agonists (Beta-1):** - **Dobutamine:** *Mechanism:* Increases cardiac contractility, heart failure. - **Agonists (Beta-2):** - **Albuterol, Salmeterol, Formoterol:** *Mechanism:* Bronchodilation (asthma, COPD). - **Agonists (Mixed Alpha/Beta):** - **Epinephrine:** Alpha-1, Beta-1, Beta-2. *Uses:* Anaphylaxis, cardiac arrest. - **Norepinephrine:** Alpha-1, Beta-1. *Uses:* Septic shock. - **Dopamine:** D1, Beta-1, Alpha-1 (dose-dependent). *Uses:* Shock. - **Antagonists (Alpha Blockers):** - **Prazosin, Terazosin, Doxazosin:** *Mechanism:* Alpha-1 selective, hypertension, BPH. *Side effects:* First-dose orthostatic hypotension. - **Tamsulosin:** *Mechanism:* Alpha-1A selective, BPH. - **Phenoxybenzamine (irreversible), Phentolamine (reversible):** *Mechanism:* Non-selective alpha blockers, pheochromocytoma. - **Antagonists (Beta Blockers):** - **Non-selective:** Propranolol, Nadolol, Timolol. *Side effects:* Bradycardia, bronchoconstriction (avoid in asthma), fatigue. - **Beta-1 selective ("Cardioselective"):** Metoprolol, Atenolol, Esmolol. *Uses:* Hypertension, angina, arrhythmia, heart failure. - **Mixed Alpha/Beta Blockers:** Carvedilol, Labetalol. *Uses:* Hypertension, heart failure (Carvedilol), hypertensive emergencies (Labetalol). ### CNS Drugs #### Antiepileptics - **Sodium Channel Blockers:** Phenytoin, Carbamazepine, Lamotrigine, Valproate, Topiramate. - **GABA Enhancers:** Phenobarbital (barbiturate), Benzodiazepines (Diazepam, Lorazepam), Gabapentin, Pregabalin, Valproate. - **Calcium Channel Blockers:** Ethosuximide (absence seizures). - **Other:** Levetiracetam (unknown mechanism). - **Key Side Effects:** - **Phenytoin:** Gingival hyperplasia, hirsutism, SJS, teratogenicity. - **Carbamazepine:** Aplastic anemia, SJS, hyponatremia. - **Valproate:** Hepatotoxicity, pancreatitis, teratogenicity (neural tube defects). - **Lamotrigine:** SJS. #### Antipsychotics - **First-Generation (Typical):** Haloperidol, Chlorpromazine, Fluphenazine. *Mechanism:* D2 receptor blockade. *Side effects:* Extrapyramidal symptoms (EPS), tardive dyskinesia, neuroleptic malignant syndrome (NMS). - **Second-Generation (Atypical):** Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole. *Mechanism:* D2 and 5-HT2A receptor blockade. *Side effects:* Metabolic syndrome, agranulocytosis (Clozapine), QT prolongation. #### Antidepressants - **SSRIs:** Fluoxetine, Sertraline, Paroxetine, Escitalopram, Citalopram. *Mechanism:* Selective serotonin reuptake inhibition. *Side effects:* Sexual dysfunction, GI upset, serotonin syndrome. - **SNRIs:** Venlafaxine, Duloxetine. *Mechanism:* Serotonin and norepinephrine reuptake inhibition. - **TCAs:** Amitriptyline, Imipramine, Nortriptyline. *Mechanism:* Block NE and 5-HT reuptake. *Side effects:* Anticholinergic, orthostatic hypotension, QT prolongation (cardiotoxicity in overdose). - **MAOIs:** Phenelzine, Tranylcypromine, Selegiline. *Mechanism:* Monoamine oxidase inhibition. *Side effects:* Hypertensive crisis with tyramine-rich foods, serotonin syndrome. - **Atypical Antidepressants:** - **Bupropion:** NE and DA reuptake inhibitor. *Side effects:* Seizures (contraindicated in eating disorders). - **Mirtazapine:** Alpha-2 antagonist, 5-HT2/3 antagonist. *Side effects:* Sedation, weight gain. - **Trazodone:** 5-HT2 antagonist, alpha-1 blocker. *Side effects:* Sedation, priapism. #### Anesthetics - **Local Anesthetics:** Lidocaine, Bupivacaine. *Mechanism:* Block voltage-gated Na+ channels. - **General Anesthetics:** - **Inhalational:** Halothane, Isoflurane, Sevoflurane, Nitrous Oxide. - **IV:** Propofol, Etomidate, Ketamine, Thiopental. ### Cardiovascular Drugs #### Antihypertensives - **Diuretics:** - **Thiazides:** Hydrochlorothiazide, Chlorthalidone. *Mechanism:* Inhibits Na+/Cl- cotransporter in DCT. *Side effects:* Hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia. - **Loop Diuretics:** Furosemide, Torsemide, Bumetanide. *Mechanism:* Inhibits Na+/K+/2Cl- cotransporter in ascending limb of loop of Henle. *Side effects:* Hypokalemia, ototoxicity, dehydration. - **Potassium-Sparing Diuretics:** Amiloride, Triamterene (ENaC blockers); Spironolactone, Eplerenone (Aldosterone antagonists). *Side effects:* Hyperkalemia. - **RAAS Inhibitors:** - **ACE Inhibitors:** Lisinopril, Enalapril, Ramipril. *Mechanism:* Inhibits ACE, prevents Ang I to Ang II conversion. *Side effects:* Cough, angioedema, hyperkalemia, teratogenicity. - **ARBs:** Losartan, Valsartan. *Mechanism:* Blocks AT1 receptor. *Side effects:* Hyperkalemia, teratogenicity (no cough/angioedema). - **Direct Renin Inhibitor:** Aliskiren. - **Calcium Channel Blockers:** - **Dihydropyridines:** Amlodipine, Nifedipine. *Mechanism:* Primarily vascular smooth muscle relaxation. *Side effects:* Peripheral edema, flushing, headache. - **Non-dihydropyridines:** Verapamil, Diltiazem. *Mechanism:* Cardiac depression (rate, contractility), some vasodilation. *Side effects:* Bradycardia, AV block, constipation (Verapamil). - **Vasodilators:** Hydralazine, Minoxidil, Nitroprusside. - **Alpha-1 Blockers:** Prazosin, Terazosin. - **Beta Blockers:** Metoprolol, Carvedilol. #### Antiarrhythmics (Vaughan Williams Classification) - **Class I (Na+ Channel Blockers):** - **IA:** Procainamide, Quinidine, Disopyramide. *Mechanism:* Lengthens APD, increases ERP. - **IB:** Lidocaine, Mexiletine. *Mechanism:* Shortens APD, decreases ERP. - **IC:** Flecainide, Propafenone. *Mechanism:* No effect on APD, marked conduction slowing. - **Class II (Beta Blockers):** Metoprolol, Propranolol, Esmolol. *Mechanism:* Decreases SA/AV nodal activity, prolongs PR interval. - **Class III (K+ Channel Blockers):** Amiodarone, Sotalol, Dofetilide, Ibutilide. *Mechanism:* Prolongs repolarization and APD. *Side effects (Amiodarone):* Pulmonary fibrosis, thyroid dysfunction, hepatotoxicity, corneal deposits, skin discoloration. - **Class IV (Ca2+ Channel Blockers):** Verapamil, Diltiazem. *Mechanism:* Decreases SA/AV nodal activity. - **Other:** - **Adenosine:** *Mechanism:* Activates K+ channels, reduces Ca2+ current in AV node. *Uses:* SVT. *Side effects:* Flushing, chest pain, dyspnea (very short half-life). - **Digoxin:** *Mechanism:* Inhibits Na+/K+ ATPase, increases vagal tone. *Uses:* Heart failure, atrial fibrillation. *Side effects:* Yellow vision, arrhythmias (toxicity). - **Magnesium:** *Uses:* Torsades de Pointes. #### Heart Failure Meds - **Diuretics:** Loop diuretics (symptom relief). - **RAAS Inhibitors:** ACEIs, ARBs, Aldosterone antagonists (Spironolactone, Eplerenone). - **Beta Blockers:** Metoprolol, Carvedilol, Bisoprolol (mortality benefit). - **Digoxin:** Symptom relief, not mortality. - **Sacubitril/Valsartan:** Neprilysin inhibitor + ARB. - **Hydralazine/Isosorbide Dinitrate:** For African Americans with HFrEF. ### Endocrine Drugs #### Diabetes Mellitus - **Insulin:** Rapid (Lispro, Aspart, Glulisine), Short (Regular), Intermediate (NPH), Long (Glargine, Detemir, Degludec). *Mechanism:* Activates insulin receptors. - **Oral Hypoglycemics:** - **Biguanides:** Metformin. *Mechanism:* Decreases hepatic glucose production, increases insulin sensitivity. *Side effects:* Lactic acidosis (rare), GI upset. - **Sulfonylureas:** Glyburide, Glipizide, Glimepiride. *Mechanism:* Stimulates insulin release from beta cells. *Side effects:* Hypoglycemia, weight gain. - **Meglitinides:** Repaglinide, Nateglinide. *Mechanism:* Stimulates insulin release (faster onset, shorter duration than sulfonylureas). - **GLP-1 Receptor Agonists:** Exenatide, Liraglutide, Semaglutide. *Mechanism:* Increases glucose-dependent insulin secretion, slows gastric emptying, promotes satiety. *Side effects:* Pancreatitis, thyroid C-cell tumors (Liraglutide, Semaglutide). - **DPP-4 Inhibitors:** Sitagliptin, Saxagliptin. *Mechanism:* Inhibits breakdown of GLP-1. - **SGLT2 Inhibitors:** Canagliflozin, Dapagliflozin, Empagliflozin. *Mechanism:* Blocks glucose reabsorption in PCT. *Side effects:* UTIs, candidiasis, euglycemic DKA. - **TZDs (Glitazones):** Pioglitazone, Rosiglitazone. *Mechanism:* Activates PPAR-gamma, increases insulin sensitivity. *Side effects:* Fluid retention, heart failure, bone fractures. - **Alpha-Glucosidase Inhibitors:** Acarbose, Miglitol. *Mechanism:* Delays carbohydrate absorption. *Side effects:* Flatulence, diarrhea. #### Thyroid Drugs - **Hypothyroidism:** Levothyroxine (T4). - **Hyperthyroidism:** - **Thioamides:** Propylthiouracil (PTU), Methimazole. *Mechanism:* Inhibits thyroid peroxidase. *Side effects:* Agranulocytosis, hepatotoxicity (PTU). - **Radioactive Iodine (RAI):** Destroys thyroid tissue. - **Beta Blockers:** Symptomatic relief. #### Steroids - **Glucocorticoids:** Prednisone, Dexamethasone, Hydrocortisone. *Mechanism:* Anti-inflammatory, immunosuppressive. *Side effects:* Cushing-like symptoms, osteoporosis, hyperglycemia, adrenal suppression. - **Mineralocorticoids:** Fludrocortisone. *Mechanism:* Aldosterone analog. #### Sex Hormones - **Estrogens:** Ethinyl estradiol. *Uses:* Contraception, HRT. - **Progestins:** Levonorgestrel, Medroxyprogesterone. *Uses:* Contraception, HRT. - **Antiandrogens:** Spironolactone, Flutamide. - **Androgens:** Testosterone. ### Other High-Yield Drugs #### NSAIDs - **Aspirin:** *Mechanism:* Irreversible COX-1 and COX-2 inhibitor. Antiplatelet, antipyretic, analgesic, anti-inflammatory. *Side effects:* GI ulceration, Reye syndrome (children). - **Ibuprofen, Naproxen, Indomethacin, Celecoxib:** *Mechanism:* Reversible COX inhibitors. *Side effects:* GI ulceration, renal dysfunction, increased cardiovascular risk (Celecoxib less GI, but higher CV risk). #### Gout Drugs - **Acute Gout:** NSAIDs (Indomethacin), Colchicine, Glucocorticoids. - **Chronic Gout (Urate Lowering):** - **Allopurinol, Febuxostat:** *Mechanism:* Xanthine oxidase inhibitors, decrease uric acid production. - **Probenecid, Lesinurad:** *Mechanism:* Uricosuric agents, increase uric acid excretion. #### Chemotherapy - **Alkylating Agents:** Cyclophosphamide, Carmustine. *Mechanism:* Cross-link DNA. *Side effects:* Myelosuppression, hemorrhagic cystitis (Cyclophosphamide). - **Antimetabolites:** Methotrexate, 5-Fluorouracil. *Mechanism:* Interferes with DNA/RNA synthesis. *Side effects:* Myelosuppression, mucositis. - **Antitumor Antibiotics:** Doxorubicin, Bleomycin. *Mechanism:* Intercalation, free radical formation (Doxorubicin); DNA strand breaks (Bleomycin). *Side effects:* Cardiotoxicity (Doxorubicin), pulmonary fibrosis (Bleomycin). - **Microtubule Inhibitors:** Vincristine (inhibits polymerization), Paclitaxel (inhibits depolymerization). *Side effects:* Peripheral neuropathy (Vincristine), myelosuppression (Paclitaxel). - **Topoisomerase Inhibitors:** Etoposide (Topo II), Irinotecan (Topo I). *Side effects:* Myelosuppression, diarrhea (Irinotecan). - **Targeted Therapies:** Imatinib (BCR-ABL inhibitor), Trastuzumab (HER2 antibody). #### Immunosuppressants - **Calcineurin Inhibitors:** Cyclosporine, Tacrolimus. *Mechanism:* Inhibits calcineurin, preventing IL-2 production. *Side effects:* Nephrotoxicity, neurotoxicity, hypertension, hirsutism (Cyclosporine). - **Antiproliferative:** Azathioprine, Mycophenolate Mofetil. *Mechanism:* Inhibits lymphocyte proliferation. *Side effects:* Myelosuppression, GI upset. - **mTOR Inhibitors:** Sirolimus, Everolimus. *Mechanism:* Blocks IL-2 signaling. *Side effects:* Myelosuppression, hyperlipidemia. - **Glucocorticoids:** Prednisone. - **Biologics:** Infliximab (TNF-alpha inhibitor), Rituximab (CD20 antibody). #### GI Meds - **GERD/PUD:** - **PPIs:** Omeprazole, Pantoprazole. *Mechanism:* Irreversible H+/K+ ATPase inhibitor. - **H2 Blockers:** Ranitidine, Famotidine. *Mechanism:* Reversible H2 receptor blocker. - **Antacids:** Aluminum hydroxide, Magnesium hydroxide. - **Prokinetics:** Metoclopramide. *Mechanism:* D2 receptor antagonist, 5-HT4 agonist. *Side effects:* EPS. - **Antiemetics:** Ondansetron (5-HT3 antagonist), Metoclopramide, Prochlorperazine (D2 antagonist). - **Laxatives:** Bulk-forming (Psyllium), Osmotic (Lactulose, PEG), Stimulant (Bisacodyl), Stool softeners (Docusate). - **Antidiarrheals:** Loperamide (opioid agonist), Diphenoxylate/Atropine.