Diuretics and Antihistamines PDF

BLOCK 3 DIURETICS Carbonic anhydrase inhibitor: Potassium sparing diuretics (late distal Acetazolamide (proximal convoluted tubule) tubule & collecting duct) MOA: Inhibit carbonic anhydrase - prevent Aldosterone antagonist: Spironol...

BLOCK 3 DIURETICS Carbonic anhydrase inhibitor: Potassium sparing diuretics (late distal Acetazolamide (proximal convoluted tubule) tubule & collecting duct) MOA: Inhibit carbonic anhydrase - prevent Aldosterone antagonist: Spironolactone, H+ formation & Na-H exchange - Na Eplerenone - hyperaldosteronism, CHF excreted with bicarbonate & H2O Direct inhibitors of Na channel: Amiloride, TU: High altitude sickness, Glaucoma, Triamterene - lithium-induced polyuria Urinary alkalinization TU: combination with thiazide/loop to counteract K loss Osmotic diuretics: Mannitol, glycerol (all AE: Hyperkalemia, hyperchloremic except thick ascending limb) metabolic acidosis, gynecomastia MOA: ↑ osmolarity of plasma - intracellular fluid -> extracellular fluid Drug interactions: TU: Cerebral edema, Acute congestive Lithium & loop/thiazide - absorption of glaucoma, Oliguria, Haemodialysis lithium in PCT - lithium toxicity AE: Hyperkalemia, hypernatremia, NSAIDs - diminish action of diuretic by hyponatremia (renal impairment) inhibiting PG in kidney - Na & H2O retention Digoxin - digoxin toxicity Loop diuretics: Furosemide, bumetanide Aminoglycosides - ↑ risk of ototoxicity (thick ascending limb of loop of Henle) HIGH-CEILING DIURETIC ANTIASTHMATIC MOA: block Na/K/2Cl cotransporter - Na & SABA: Salbutamol Cl excreted along H2O - ↑ Na in distal LABA: Salmeterol tubule promote loss of H & K - metabolic MOA: Activate B2 receptor & adenyl cyclase alkalosis - ↑ excretion Ca & Mg - ↑ cAMP - Bronchodilation TU: Edematous condition associated with AE: Tremors, tachycardia, hyperglycemia, CHF, hypertensive emergencies, acute hypokalemia pulmonary edema, acute hypercalcemia Muscarinic antagonist (M3): Ipratropium AE: Hyperuricemia, ototoxicity, hypokalemia (preferred bronchodilator in COPD) metabolic alkalosis Phosphodiesterase III inhibitor: Aminophylline, theophylline (narrow Thiazide: Hydrochlorothiazide therapeutic index) Thiazide-like diuretic: Chlorthalidone,indapamide (early part of Inhalational corticosteroids: Budesonide, distal tubule) fluticasone, beclomethasone LOW-CEILING DIURETIC (oropharyngeal candidiasis) MOA: block Na/Cl symport - Na & Cl excreted along H2O - ↑ reabsorption of Ca TU: Mild hypertension, nephrolithiasis AE: Impaired carbohydrate tolerance, hyperlipidemia ANTITUSSIVES & ANTIHISTAMINES Antitussive & Demulcent (non-productive ANEMIA cough): Codeine, pholcodine, Oral iron (30mg): dextromethorphan, benzonatate, noscapine, - Ferrous sulphate lozenges, linctuses, liquorice - Ferrous fumarate (productive cough) - Ferrous gluconate Mucolytics: Bromhexine, ambroxol - Ferrous succinate (depolymerize mucopolysaccharide, ↑ - Iron calcium complex lysosomal activity - thick sputum -> thin - Ferric ammonium citrate copious bronchial secretion), acetylcysteine AE: Metallic taste, teeth discoloration, (open disulfide bond, ↓ mucus viscosity) blackening of stool Mucokinetics: Ammonium chloride, Na or Parenteral iron (malabsorption, K citrate, guaifenesin (stimulate secretory intolerance): cells & ciliary movement) - Iron sorbitol citric acid complex - Iron dextran complex (Z-track technique) H1 Antihistamines - Ferric carboxymaltose & ferrous sucrose 1st gen: Diphenhydramine, doxylamine, Treatment iron toxicity: Desferrioxamine promethazine, chlorpheniramine, cinnarizine Vit B12: 2nd gen: Fexofenadine, cetirizine, - Cyanocobalamin (IM/SC) levocetirizine, loratadine - ↑ duration of - Hydroxocobalamin (IM) - for tobacco action, ↓ permeability to BBB (↓ amblyopia drowsiness), ↓ sedating, x anticholinergic - Methylcobalamin (oral) - for diabetic & side effects neuropathy Folic acid - prevent neural tube defects ANTITUBERCULAR Folinic acid (calcium leucovorin) - for 1st line drug methotrexate toxicity, adjuvant in methanol Isoniazid (Peripheral neuritis, hepatotoxicity) poisoning + Pyridoxine (to prevent ⤣) Rifampin (Red-orange urine, hepatitis, flu-like syndrome) (Chemoprophylaxis) Pyrazinamide (Hepatotoxicity, hyperuricemia) Ethambutol (Optic neuritis, hyperuricemia) Streptomycin 2nd line drug: Paraaminosalicylic acid, Cycloserine, Amikacin, Capreomycin, Ciprofloxacin, Clarithromycin Intensive phase - 4 drugs for 2 months Continuation phase - 2 drugs for 4 months ANTICOAGULANT CHF Parenteral Drugs w/o +ve inotropic effect HMWH Diuretics: Furosemide LMWH: Enoxaparin, dalteparin ACEi: Enalapril Synthetic heparin: Fondaparinux ARB: Losartan Thrombin inhibitor: Lepirudin, bivalirudin, B1 blocker: Carvedilol, meroprolol argatroban, danaparoid (prevent progression of heart failure) Oral Vasodilator: Hydralazine - Warfarin Drugs with +ve inotropic effect - Dicumarol Cardiac glycoside: Digoxin (Chronic) - Direct oral anticoagulant: Dabigatran, MOA: inhibit Na-K-ATPase - ↑ Ca rivaroxaban, apixaban, edoxaban MOA: HMWH binds with antithrombin III - factor IIa/Xa binding AE: Haematuria (1st sign), heparin induced thrombocytopenia, osteoporosis Treatment for heparin overdose: Protamine sulphate Warfarin overdose: Vit K1 (Phytonadione) ANTIPLATELET TXA2 synthesis inhibitor: Aspirin (irreversibly inhibit COX1 & TX synthase) Phosphodiesterase inhibitor: Cilostazol, dipyridamole ADP receptor antagonist: Clopidogrel, ticlopidine Glycoprotein IIb/IIIa receptor antagonist: Abciximab, tirofiban ANTIANGINAL Acute: Sublingual nitroglycerine/GTN, isosorbide dinitrate Chronic: Oral Isosorbide mononitrate, B blocker (Propranolol), CCB MOA: Nitric oxide - guanylyl cyclase - ↑cGMP AE: Extensive vasodilation, Tolerance