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lOMoARcPSD|44175252 PHRM20001: Drugs Summary DRUG CLASS DRUG NAME FUNCTION MECHANISM OF ACTION SIDE EFFECTS NOTES β-adrenoceptor Isoprenaline (β1 and Arrythmia, Full agonist...

lOMoARcPSD|44175252 PHRM20001: Drugs Summary DRUG CLASS DRUG NAME FUNCTION MECHANISM OF ACTION SIDE EFFECTS NOTES β-adrenoceptor Isoprenaline (β1 and Arrythmia, Full agonist Directly agonist β2) bradycardia or - Binding causes sympathomimetic heart-block to increased heartrate β-1 receptors are increase heart and contraction located on the rate heart, kidney Salbutamol (β2) Asthma SABAs (reliever) – short Vasodilation can Partial agonist is (juxtaglomerular treatment, acute acting β-adrenoceptor partial cause a drop in BP preferred because cells) Terbutaline (β2) bronchoconstrict agonist and compensatory it causes less ion - Local administration increased heartrate desensitisation β-2 receptors are - Rapid onset or tachycardia located on smooth Must be used with muscle Muscle tremors due an inhaled to the stimulation of corticosteroid Salmetarol Asthma LABAs (preventer) – long adrenoceptors in Must always be (slow onset, β2) treatment acting β-adrenoceptor skeletal muscle combined with agonist inhaled Formoterol - For prevention Palpitations, corticosteroids (rapid onset, β2) - Reduces the number headaches. of exacerbations - Prolonged Precautions for bronchodilation individuals with cardiovascular disorders, diabetes or sympathomimetic amines. Dobutamine (β1) Acute heart failure, cardiogenic shock β-adrenoceptor Propanolol (β1 and Hypertension Inhibits the activation of Decreased exercise antagonist β2) cardiac β1-adrenoceptors by capacity due to Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 Antenolol (β1) NA and circulation adrenaline reduced CO Side eects are - Decreases HR, SV, CO minimised with β1- and BP Muscle fatigue due to selective Inhibits activation of kidney inhibition of β2- antagonists β1-adrenoceptors adrenoceptor because they are - Decreases renin mediated dilatation cardioselective and secretion and of skeletal muscle more hydrophilic therefore aldosterone blood vessels mediated Na+ / H2O retention Cold extremities due - Decreases blood to fall in BP volume, preload, SV, CO and BP Bronchoconstriction due to inhibition of β2-adrenoceptor mediated relaxation of airway smooth muscle ɑ-adrenoceptor Phenylephrine (ɑ1) Nasal agonist decongestant ɑ1 receptors are located on vascular smooth muscle, radial dilator muscle Clonidine (ɑ2) Hypertension Via CNS mechanisms ɑ2 receptors are located on pre- junctional terminals (esp. sympathetic) ɑ-adrenoceptor Prazosin (ɑ1) Antihypertensive 1. Binds and inhibits 1st dose hypotension antagonist vascular ɑ1 adrenoceptors Nasal decongestion 2. Inhibits NA mediated die to ɑ1 Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 vasoconstriction adrenoceptor 3. Decreases TPR mediated 4. Decreases BP constriction of nasal mucosa arteries Postural hypotension Initial reex tachycardia (baroceptor reex) Yohimbine (ɑ2) Phentolamine (ɑ1 and ɑ2) Mianserin (ɑ2, Depression Few side eects Atypical histamine and antidepressant serotonin antagonist) Mirtazepine (ɑ2) Drugs targeting Botulinum Cosmetic – Blocks the release of Ach Progressive motor ACh release paralysis of 1. Heavy chain binds paralysis supercial with high anity to muscles nerve terminal Diculty swallowing membrane Clinical – 2. Botulinum is Facial weakness unwanted endocytosed movement 3. Light chain detaches Trouble talking disorders, from heavy chain and urinary enters the cytosol to Respiratory paralysis incontinence due cleave SNARE proteins to overactivity, 4. SNARE complex excessive doesn’t form, sweating inhibiting vesicular fusion and Ach release Drugs targeting Physostigmine Glaucoma Reversible cholinesterase ACh inactivation inhibitor Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 (acetylcholinesteras - Selective for e inhibitors) parasympathetic junctions - Medium duration Activation of M3 receptors on the ciliary smooth muscle causes contraction, facilitating the removal of accumulated uid Neostigmine Myasthenia Reversible cholinesterase Gravis inhibitor - Selective for neuromuscular junctions - Medium duration Reverse competitive neuromuscular block 1. Prevents ACh metabolism 2. Enables lateral diusion of ACh to bind unaected nAChRs and rebinding of ACh to multiple nAChRs 3. Restores cholinergic transmission in NMJ leading to symptomatic improvement Nicotinic d-Tubocurarine Neuromuscular Competitive reversible Hypotension due to cholinergic blocking drug for antagonist ganglion block antagonists surgical - Neuromuscular paralysis junctions but also Replaced with drugs Nicotine receptors autonomic ganglia at that are less are located on higher concentrations eective at Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 autonomic ganglia autonomic ganglia and skeletal muscle Hexamethonium First eective Reversible cholinesterase Many adverse eects anti- inhibitor hypertensive - Indiscriminate block of sympathetic and parasympathetic ganglia Muscarinic Atropine Reduce - Non-selective (M1, cholinergic secretions M2, M3) muscarinic antagonists during antagonist anaesthesia - By blocking the M3 Muscarinic receptors receptor it decreases are located on Anticholinestera the release of tissues with se intracellular calcium parasympathetic (organophosphat from the sarcoplasmic innervation and e) poisoning reticulum and thereby sweat glands causes smooth muscle relaxation Hyoscine Motion sickness Competitive antagonist of Constipation, dry Low bioavailability hydrobromide ACh at M1 receptors mouth, tachycardia but high anity for Diarrhoea - Symptomatic relief receptors. (spasmolytic) Doesn’t cross the BBB so acts peripherally. Oral, IV or IM administration Bezhexol, Parkinson’s Restores dopaminergic Dry mouth, Benzotropine, Disease cholinergic imbalance. lacrimation, Biperiden, Adjunct to LDOPA only. urination, defecation, Orphenadrine memory impairment NSAIDS Salicylates (Aspirin) Headache, Inhibits cyclooxygenase Regular action of NSAIDs can cause menstrual pain, prostanoids is oesophagitis and Propionic acids musculoskeletal Anti-inammatory: inhibition inhibited dyspepsia, (Naproxen/Ibuprofen) pain, acute and of vascular dilation and Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 chronic pain synergism with other Increased change of Acetic acids mediators that enhance GI ulceration or (Indomethacin/Diclof vascular leakiness bleeding due to enac) inhibition of stomach - Used mostly Analgesic: inhibition of acid secretion which for long term synergism with other protects the stomach treatment of mediators mucosa pain Antipyretic Selective COX2 AVOID use COX2 inhibition far greater Increased risk of Shows how inhibitors when pts have than COX1 cardiovascular death enhanced (Celecoxib/Rofecoxib or are at risk of (thrombosis and selectivity can be ) having stroke) because bad cardiovascular COX2 is present in disease endothelial cells but not platelets, thus the selective inhibition shifts the balance towards pro- coagulation (too much TXA2) Paracetamol Analgesic, Weak inhibitor of COX1 and The metabolite has antipyretic COX2 activity at some ion channels and Potent inhibitor of COX3 cannabinoid receptors. It chemically inactivates at sites of inammation H1 receptor Ioratadine Hayfever Inhibits the degranulation of Not useful for antagonist (allergic rhinitis), mast cells which release asthma (antihistamine) urticaria, histamine. Histamine anaphylaxis and increases vascular leakiness angioedema (swelling), vascular dilation (adjunct to (redness), bronchospasms adrenaline) and recruits mediators of the Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 inammatory response. Promethazine Motion sickness Antagonist at H1 receptors Sedation and (Phenergan) on the CNS, specically the drowsiness vestibular nuclei Meclizine (Bonine) Anti-IgE Omalizumab Severe asthma, Monoclonal antibody therapy Therapeutic chronic (chemical antagonism) Antibody idiopathic - Binds to free IgE to urticaria prevent interactions with cell surface IL Inhibitors Dupilumab Asthma Dup. is a receptor antagonist that binds to IL4 receptor Mepolizumab Mepol. Is a chemical antagonist that binds to IL5 Adalimumab Rheumatoid Ad. Is a chemical antagonist Arthritis that binds to TNFalpha Tocilizumab Tox. Is a receptor antagonist that binds to Il6 receptors Immunosuppressa Cyclosporin Organ rejection Acts at an early stage of the nt prevention immune process. Cyclosporin blocks calcineurin which prevents the dephosphorylation and therefore the transport of NFAT. Decreased NFAT in the nucleus decreases the transcription of IL2 and dampens cell proliferation. Antibody Therapy Pembrolizumab Cancer Blocks the inhibitory pathways between T cell and cancer cell (PD1 and PD1L) Dopamine Domperidone Nausea and Antagonists of D2 receptors Increased gastric receptor (Motillum) vomiting at the CTZ emptying due to antagonists increased Metoclopramide Constipation Increases GI motility via gastromotility Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 (Maxolon) antagonism of D2 receptors. Dopamine signalling inhibits Restlessness, anxiety ACh smooth muscle activity. and drowsiness By antagonising these receptors, the parasympathetic smooth muscle movement is increased. Phenothiazines Nausea and Mainly D2 receptor Common and include (Stemetil) vomiting, antagonist but also extrapyramidal antipsychotic muscarinic and H1 receptor eects and anti- antagonist cholinergic eects Antagonist at the CTZ and ACh at vomiting centre at higher doses Serotonin (5HT3) Ondansetron Nausea and Activity at CTZ, vomiting receptor (Zofran) vomiting centre and GIT antagonist - 3 times daily associated with Dolasetron chemotherapy - Once daily and post- operative management Antacids Ulcer and reux Neutralises HCl by binding to Many drug disease bile acids and decreasing interaction pepsin activity - Symptomatic relief Generally contains AlOH because aluminium decreases bowel activity, CaCO3, magnesium salts as it increases bowel movement and NaHCO3. H2 receptor Cimetidine Competitively binds to the Used particularly antagonist H2 receptor, blocking the for peptic ulcer (antihistamine) Famotidine binding of histamine on disease, GORD, Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 gastric parietal cells thereby dyspepsia. Ranitidine reducing acid secretion. Drug interaction with CYP450 enzyme (especially Cimetidine). Cim is a non-selective inhibitor of CYP450 and delays the clearance of drugs metabolised by CYP450. This increases BP levels and drug accumulation. Proton pump Omeprazole Prodrugs require an acidic Used particularly inhibitor - Noncompetiti environment to activate. The for ulcerative ve antagonist drug is converted in an acidic oesophagitis or environment to a cation unresponsive Iansoprazole which binds irreversibly to gastric ulcer. the parietal cell H+ or K+ Reduces acid Esomeprazole ATPase proton pump to block secretion (Nexium) active transport of H+ ions. irrespective of secretion stimulation. Omeprazole is an activator of cytoP450. Cytoprotective Misoprostol (PGE1 Prevents ulcer formation by drugs prostaglandin decreasing acid secretion (prostaglandin analogue) and increasing mucus analogues) secretion. Sucralfate Sucralfate dissocates in HCl to become a sticky adherent Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 gel and neutralising agent which is protective. Opioids Codeine Diarrhoea Bind to Ɣ – opioid receptors Oral administration in the gut wall (myenteric Morphine plexus). This reduces Short term use secretions and propulsive only - Misuse Ioperamide movements of the smooth common (Imodium) muscle, prolonging the transit of intestinal contents Imodium doesn’t and water absorption. cross the BBB like the others so is less addictive. Glucocorticoids Asthma The dimerization of the Inhaled – dysphonia, glucocorticoid receptors in oral thrush the nucleus causes an increase in anti-inammatory Systemic (oral) – gene expression, annexin 1 suppression of the and β2 adrenoceptors. It hypothalamic causes a decrease in pituitary adrenal axis inammatory gene after chronic use, expression, inammatory mood changes, enzymes, cytokines and weight gain, daibetes adhesion molecules. Cysteinyl- Aspirin or Inhibits the binding of Mood and behaviour leukotriene exercise induced cysteinyl leukotrienes (LTC4, changes (rare) receptor asthma LTD4, LTE4) to receptors. This antagonists causes modest bronchodilation/ ACE inhibitors Hypertension 1. Inhibits angiotensin II 1st dose hypotension Safe in asthmatics formation and benecial 2. Less AT1-R mediated Hyperkalaemia eects on vasoconstriction thus (increase in K+ in cardiovascular lower TPR urine) remodelling 3. Less AT1-R mediated aldosterone secretion Acute renal failure thus less Na+ / H2O due to less Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 retention glomerular profusion 4. Lower preload and and ltration lower BP Dry cough due to increase in bradykinin Ca+ channel Dihydropyridine Prevent channel opening so Initial reex antagonists (Nifedipine) that there is lower tachycardia: fall in BP intracellular [Ca2+]. This and TPR activates Benzothiazepine decreases vascular the baroreceptor (Diltiazem) contractile tone and BP. reex. Phenylalkylamine Flushing (Verapamil) Headache Glyceryl Trinitrate Angina pectoris GTN is a prodrug that’s Reex tachycardia Usually converted to NO. It and increased administered stimulates guanylate cyclase vascular tone. sublingually for in vascular smooth muscle angina so that it and increases cGMP Venodilatation may avoids hepatic rst therefore increases cause venous pooling pass metabolism. vasodilation of collateral and postural vessels. This increases O2 hypotension. supply and decrease O2 demand. Flushing and headache Glucagon-like Liraglutide Obesity GLP1 is released from L cells Nausea, vomiting, Subcutaneous peptide (GLP) 1 in response to the digestion diarrhoea, injection injection agonist of carbs, fats and proteins. site reactions GLP1 agonists mimic the eects of endogenous GLP1 Pancreatitis (rare) released by L cells and binds to the GLP1 receptors on the vagus nerve. This potentiates glucose mediated insulin secretion Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 and suppresses glucagon secretion. Dietary fat Orlistat (Xenital) Does not suppress appetite. Explosive diarrhoea, Must be combined absorption faecal fat leakage with a low fat diet inhibitor Inhibits gastric and and vitamin pancreatic lipases (which are supplementation usually secreted into the intestine after a meal) thus Has poor decreasing dietary fat compliance absorption. because of the explosive poop The pancreatic and gastric lipases hydrolyse triglycerides into free fatty acids and monoglycerides, which can be absorbed through the mucosal cells and transposed back into triglycerides. Orlistat binds to the lipases to inhibit their interaction with dietary triglycerides, so they can't be converted into FA and MG to be absorbed. The triglycerides will be excreted in faeces. Indirectly acting Phentermine Amphetamine derivative Tachycardia, Short term use sympathomimetic (Duromine) - Taken up into the insomnia, agitation, only because presynaptic neuron dry mouth tolerance via NET → taken into develops. synaptic vesicles VMAT to displace NE Can’t be used with into the cytoplasm of MAO inhibitors, the neuron SSRIs - Creates a Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 concentration Low risk of gradient where there's addiction greater NE in the neuron cytoplasm than in the synapse - Results in non calcium dependent exocytosis of NE via NET Increases NA available to bind to receptors in the presynaptic nerve terminal. This suppresses appetite and increased energy expenditure by increasing sympathetic activity. - Can also increase levels of dopamine and serotonin Tyramine Bronchodilation, 1. Structurally similar to Eects heightened peripheral NA thus transported by MAO inhibitors vasoconstriction, by NET into nerve increased terminal (can limit heartrate and neuronal reuptake). contractile force, This indirectly inhibition of gut increases [NA] in motility junction 2. Transported into vesicles by VMAT in exchange for NA. NA is displaced into cytosol. 3. Some of the displaced cytosolic NA enters junction via NET (leakage). 4. Increased NA in Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 junction leads to activation of post- junctional adrenoceptors to elicit tissue response therefore sympathomimetic. 5. Can be metabolised by MAO Pseudoephedrine Nasal Constricts the arteries in the decongestant nasal mucosa with. Same mechanism as Tyramine. Biguanides Type II Diabetes - Increases insulin GI disturbances Oral absorption, mediated glucose short half life uptake Lactic acidosis if - Reduces hepatic improperly Excreted glucose production by prescribed (can’t be unchanged via activation of AMP used with pts with kidney which activated protein renal or liver decreases damage kinase in liver to dysfunction) to nephrons inhibit gluconeogenesis No weight gain - Decreases carbohydrate absorption - Reduce LDL cholesterol and triglyceride levels Sulfonylreas Mimics the rapid peak in Hypoglycemia Oral absorption, insulin that’s absent in type long half life II diabetes Weight gain - Acts on β cells to Metabolised by stimulate insulin liver and excreted secretion (phase 1 like via kidney – spike) clearance can be - Binds to K+ ATP impaired in pts Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 channel to reduce K+ with renal or liver permeability and disease prevent K+ eux - This causes membrane depolarisation which triggers opening of Ca2+ channels for Ca2+ entry and insulin release into bloodstream Na+ - glucose Increases the excretion of Kidney disease Oral absorption, cotransporter 2 glucose long half life (SGLT-2) inhibitors - Passive Na+ Diuretic in elderly movement via Metabolised in transporter causes Hypoglycemia when liver and excreted glucose to also be combined with via kidneys transported due to the insulin decline in [Na+] - By inhibiting the Thrush, polyuria, SGLT2, this drug weight loss, UTI, decreases the thirst resorption of blood glucose from the PCT and increases glucose excretion ɑ-glucosidase Inhibits intestinal ɑ- Flatulence and No systemic inhibitor glucosidase which is what abdominal absorption digests carbohydrates discomfort required as it - Delays carb works in the GIT absorption therefore Loose stool undigests carbs are within the intestinal Contraindicated in tract for longer and pts with can reach the distal inammatory bowel bowel disease Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 - Decreases post prandial rise in glucose - Works in the GIT Exogenous insulin Increases insulin to Hypoglycemia physiological levels Drug interactions - Beta blockers mask indicators of low blood glucose - Corticosteriod s oppose the actions of insulin - Diuretics overwork the kidneys - Alcohol inhibits hepatic glucose synthesis and gluconeogene sis Dopamine Methylphenidate ADHD Increases synaptic reuptake inhibitor (Ritalin) concentrations of dopamine and NA by blocking reuptake Selective NA Atomoxetine Learning and reuptake inhibitor (Strattera) ADHD Reboxetine Depression Few side eects Atypical antidepressant Modanil Provigil Learning Exact mechanism unclear. Dopamine related - May increase side eects – nausea, monoamine levels by vomiting, anxiety Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 blocking reuptake - Dopamine in the striatum and nucleus accumbens, NA in the hypothalamus and ventrolateral preoptic nucleus, serotonin in the amygdala and frontal cortex Activates glutamatergic circuits while inhibiting GABAergic neurotransmission Amino acid L-DOPA Parkinson’s L-DOPA peripherally converts Anorexia, nausea, Requires some isomer Disease to dopamine and NA. It vomiting, functional reduces rigidity, tremors and tachycardia and dopaminergic other symptoms. ventricular neurones - It’s able to cross the dysrhythmias, - Dopamine BBB in contrast to orthostatic synthesis dopamine hypotension, pupil can produce - Selective for dilation ROS which dopaminergic neurons leads to cell and is released via Visual and auditory death action potential ring hallucination, Eectiveness abnormal motor decreases over movement, mood time due to changes, depression continued and anxiety degeneration of dopaminergic nerves Dopamine agonist Bromocriptine Can be used as a Similar to LDOPA Not as targeted as monotherapy. L-DOPA because Cabergoline Hallucination, DA agonists bind Improves bradykinesia and confusion, delirium, to all dopamine rigidity. nausea and receptors, doesn’t hypotension require an action Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 Dopamine cannot cross the potential BBB so dopamine agonists Arrythmia and are required. myocardial infarction - Bind to D1 and D2 like receptors Cholinesterase Tacrine, Donepezil, Alzheimer’s Inhibits the breakdown of Ecacy in mild to Inhibitor Rivastigmine Disease ACh so that cholinergic moderate AD function may stabilise Secretases MAO Inhibitors Depression Inhibit MAO concentration in Nausea, insomnia, Many drug the cytoplasm to increase agitation, weight interactions NA, 5HT, DA in presynaptic change, loss of libido terminals by preventing breakdown of monoamines. This means more NA/Da is packaged into vesicles so more in the synaptic cleft - More DA means there’s also NA as DA is a precursor for NA - Down regulation of receptors causing a change in secondary messenger systems and long term changes in neuronal architecture Selective Selective for 5HT uptake, serotonin weak inhibition of NA, DA reuptake inhibitor uptake. (SSRI) Sulfonamides Anti-infectives - Targets and inhibits Mammalian cells dihydropteroate are not dependent synthase enzyme on endogenous - Blocks the synthesis synthesis of folic of folate which is an acid and generally Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 important cofactor for lack DHPS, thus DNA synthesis this drug is - No DNA synthesis selective. means that bacteria cannot replicate Resistance develops very quickly and bacteria have mechanisms to circumvent sulfonamides. Trimethoprim - Targets and inhibits Unlike DHPS, dihydrofolate humans require reductase, another dihydrofolate part of the folic acid reductase for pathway synthesis of DNA- - Same mechanism of immunosuppressio action as n. However sulfonamides trimethoprim has a much higher inhibitory potency for bacterial DHFR. Cell wall Penicillins (β-lactam) Antibiotics - Targets bacterial Selectivity because production transpeptidase mammalian cell inhibitors Cephalosporins (β- enzyme the D-Alanine walls are dierent lactam) active site to bacteria. - This inhibits cross Carbapenems (β- linking required to Many Gram lactam) form the cell wall negative organisms are Glycopeptides intrinsically (vancomycin and resistant. teicoplanin) Monobactam (aztreonam) Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 Protein synthesis Streptomycin - Aminoglycoside Selectivity as inhibitors antibiotic humans have Gentamicin - Bactericidal dierent ribosomes - Inhibits protein Erythromycin synthesis by binding to the 30S ribosomal Doxycycline subunit to disrupt translation - Blocks further translation, elicits premature termination and incorporation of the wrong amino acid Acyclovir Antiviral for - Acyclovir is becomes Herpes acyclovir monophosphate due to the action of viral thymidine kinase. - Acyclovir triphosphate has higher anity for viral DNA polymerase than cellular DNA polymerase - ACV triphosphohate competes with the deoxyguanosine triphosphate (dGTP) as a substrate for viral DNA polymerase to inhibit replication Anti-HIV drugs NRTIs Antiviral for HIV - High selectivity for the reverse transcriptase NNRTIs that makes a double stranded DNA copy of Protease inhibitors viral RNA - Also high selectivity Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 for proteases Covid-19 Drugs Sotrovimab Covid-19 - Binds to spike proteins to prevent other cell infection Remedesivir - Interferes with the viral polymerase therefore inhibiting replication by interrupting the viral nucleic acid Molnupiravir - Inhibitor of viral polymerase by implanting mutations which stop growth, because they’re less subject to resistance mechanisms Cytotoxic agents Cisplatin Cancer - Binds covalently to Causes severe the nucleophilic cell nausea and vomiting, components nephrotoxic and neurotoxic Methotrexate - Inhibits folate Immunosuppressa synthesis by inhibiting nt drug by DHFR which later interfering with converts to THF and folate synthesis. DHF - THF is required for Used at much purine synthesis higher doses when - Thus preventing cell used for treating synthesis rheumatoid arthritis. Tumour Growth Imatinib Mesylate - Small molecule Pathway tyrosine kinase inhibitors inhibitor - Selective inhibitor of BCR-ABL kinase, binds Downloaded by Isra Eski ([email protected])  lOMoARcPSD|44175252 to the kinase domain and stabilises the protein Antibodies for Bevacizumab Angiogenesis - Binds to VEGF and Cancer Therapy inhibitor for neutralises it to cancer inactivate the VEGF Cetuximab EGFR inhibitor - Induces apoptosis in for cancer EGFR+ tumour cells by blocking ligand binding and receptor dimerisation Pembrolizumab Checkpoint - Blockade of inhibitory inhibitor for pathway between T advanced cell and cancer cell metastatic (PD1 and PDL1L) cancer Downloaded by Isra Eski ([email protected])