Pharmacology 2 Cheat Sheet

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Tofaci​tinib Lipid Lowering Drugs Lipid Lowering Drugs (cont)

Janus kinas inhibitor PO HMG- E.g. Atorva​statin, Rosuva​statin, Decrease LDL, increase HDL

2x/day Potent CYP3A4 and CYP2c19 CoA red rice yeast HA Diarrhea Upper resp infection
reductase
reduced to inhibitors (e.g. flucon​azole)
hepatotox + rhabdo with statins
inhibitors
1x if
Primary agents
Severe renal impairment Anti-F​actor Xa Inhibitors
↓ LDL and TG, ↑ HDL, ↓
Mod liver impairment
Fondap​ar SC treat/​prevent DVT/PE
morbid​ity​/mo​rtality
Combined w/meth​otr​exate or nonbio DMARD inux
antith​rom​botic effects,
DO NOT combine w/bio DMARD Avoid use in Crcl <30 ml/min
↓endot​helial inflam​mation
Monitor: Anti-Xa, sx of bleeding
SE: myopathy and hepatotox,
Other DMARDs in Refractory RA
elevated LFTs, CPK (muscle/jt Apixaban Inhibit factor X
Azathi​oprine, Cyclop​hos​pha​mide, pain, rhabdo), proximal muscle adjust in Afib if ⅔ >80 yo, Scr >1.5,
Cyclos​porine, Penici​llamine weakness
weight <60kg
Last-line therapy in refractory disease CYP450 (grape​fruit, Cimeti​dine) Intxns: phenytoin, carbam​aze​pine,
use is limited by higher rates of adverse effects Memory loss, diabetes flucon​azole, rifampin

Bile acid E.g. Choles​tyr​amine; ↓ LDL, bleeding, compliance

Anaest​hetics SE seques​tran ↑HDL and TG; Unpleasant taste, Rivaro​xa inhibit factor X
ts (resins) GI effects, intxns; Other meds 1 hr ban
CNS effects
before or 4 hr after
Reduction of vascular resistance Take w/evening meal
Increased intrac​ranial pressure Fibrates E.g. Gemfib​rozil, fenofi​brate
Intxns: phenytoin, carbam​aze​pine,
Decrease BP ↓ LDL and TG, ↑ HDL flucon​azole, rifampin
Entrorane and Halothane decrease CO
Toxicity additive w/statins
Decreased blood flow to liver and kidneys
Rhabdo, myopathy, LDL increase Reversal of antico​agu​lation
Decrease respir​atory rate
Malignant hypert​hermia (uncon​trolled Ca Nicotinic ↓ LDL and TG, ↑ HDL Warfarin Vitamin K
release) Acid
Keparin Protamine
Treated with dantrolene
Flushing, itching, HA,
Enoxaparin Protamine (less reliable)
Hyperu​ricemia in gout,
Local Anesth​etics Dabigatran Idaruc​izumab
Hyperg​lyc​emia, Hepatotox

Interm​ediate chain linking amino to aromatic Apixaban zhzo Xa

Chol E.g. Ezetimibe
ring absorption Rivaro​xaban zhzo Xa

block Na+ channels in nerve inhibit

Insulin
sympat​hetic → sharp/dull → touch/temp →
motor paralysis Lispro, Regular NPH Glargine,
More effect on small C fibers and small A fibers Aspart Detemir,
Degludec (basal)
Amino Esters Surface: Benzoc​aine, cocaine
O:<15 O:.5-1 O:2-4 O:2-4
Short: Procaine
m
Long: Tetracaine
P:1-2 P:2-3 P:4- P:N/A
Amino Acids Medium: Lidocaine 10
Long: Bupiva​caine, D: 3-4 D:3-6 D:10- D:24
ropiva​caine 16
Lidocaine 12hr on/12 off
Patch

3 patch max

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 Pharmacology 2 Cheat Sheet
by gwenw via cheatography.com/63534/cs/16148/

Thiazo​lid​ine​diones Opioids (cont) Non-Bio DMARDs

E.g. Piogli​tazone, Rosigl​itazone (not used, Tramadol Mu receptor agonist, inhibit RA w/in 3 mo, max 6-12 mo
↑CVD) serotonin and NE reuptake LF, HCQ, MTX need blood count, liver, Cr
↓HDL, trigly​cer​ides; neutral LDL Mild to moderate pain every 2-4wk/3mo then every 8-12 wks

Decrease fasting plasma glucose 35-40 SE: ↓resp depression than other Methot​ 1st line, 2-8 wk onset PO/IM

Reduce A1C ~0.5-1% opioids, sedation, consti​pation, rexate immuno​sup​pre​ssant

dry mouth, nausea, serotonin tox
SE: GI, liver tox, bone marrow,
6 weeks for max effect
Morphine Controlled or immediate stomat​itis, hair loss, pulm tox
SE: weight ↑, edema, hypogl​ycemia
SE: potential accumu​lation, itch Folic acid decrease sx
Contra​ind​icated liver problems or CHF
Not indicated in pts w/renal Leflun​o Immuno​sup​pre​ssant effective as
mide MTX
GLP-1 Agonist Oxycodone High oral bioava​ila​bility w/no
food effect SE: GI, rash, hair loss, liver tox
E.g. Exenatide, Liragl​utide
No signif​icant metabo​lites Work w/in 1 mo, weaker
↑ insulin release
minimally affected by age renal Hydrox​ Low tox, 2-6 mo onset, min monitor
↓A1C ~0.7
or liver ych​lor​o‐
SE: GI upset, weight loss Methadone alpha 8-12, beta 24-36 quine

Maybe pancre​atitis, gallbl​adder disease, thyroid NMDA receptor antago​nist/ SE: GI, retinal, derm, HA
cancer Seroto​nergic properties Sulfas​a 2-3x/day PO anti-i​nflam
Caution in renal disease lazine
SE: Toxicity, QTc prolon​gation
CV benefit Meperidine Causes euphoria, most addictive, SE: GI, leukop​enia, anemia,

seizures photos​ens​itive, skin, hepatitis,

Acetam​inophen pneumo​nitis, agranu​loc​ytosis,
Agonists Oxycodone, Codeine,
hypers​ens​itivity
central COX inhibitor Hydroc​odone
>HCQ, <DMARDs
Analgesic & Antipy​retic Mixed Bupren​orphine
poor tolerate, lots of monitoring
NOT anti-i​nfl​amm​atory or antith​rom​botic Antago​nists Naltre​xone, Naloxone
Potentiate antico​agu​lants
SE: Hepato​tox​icity SE: CNS/resp depression (5-7 days), N/V
(codeine), consti​pation, itch/rash
1st line for OA IV Anesth​etics
Avoid alcohol
Capsaicin Cream Etomidate Hypnotic
No Raye’s syndrome
Inhibits release of substance P in peripheral Rapid onset gen anesthesia
Similar to NSAIDs, better tolerated
Min cardiopulm SE
Max effect takes 2-4 wks applic​ation 4x/day
2 wks before consid​ering treatment failure
Good for CV and pulm
More role in OA than RA
comorbid
Opioids
Viscos​upp​lim​ent​ation Propofol Short acting hypnotic
Act on Mu, Kappa, Delta receptors Very rapid recovery
E.g. hyaluronic acid
Phenan​thr (natural) Codeine, Morphine Thiopental Respir​atory depres​sant, no
enes lubricant during low-stress mvmt, anti inflam
sodium analgesia
Phenan​thr (semis​ynt​hetic) Hydroc​odone, Has more role in OA than RA, esp knee
Rapid safe induction
enes Hydrom​orp​hone, Oxycodone 3-5 wkly injections = 1 cycle
Barbit​urate
Phenyl​pip​ Fentanyl, Meperidine (chills) Max effect 8-12 wks, lasts 6-12 mo
Midazolam Benzod​iaz​epine
eri​dines

Phenyl​eth​ Methadone, Propox​yphene

yla​mines

Extended Oxycodone, Morphine, Fentanyl

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 Pharmacology 2 Cheat Sheet
by gwenw via cheatography.com/63534/cs/16148/

IV Anesth​etics (cont) Antico​agu​lants (cont) Meglit​inides

Amnesia Onset: slow, antico​agu​lation occurs 48-72 h e.g. Repagl​inide, Nategl​inide

Potent​ially long halflife after the first dose once factors are depleted Stimulate insulin secretion

Ketamine Dissoc​iative analgesia Monitor INR (goal 2-3), Hgb/hct, bleeding Shorter acting, best taken after eating
Intxn: Food: green leafy vegetables Meds:
↓A1C ~1
Local Anesth​etics Additives cipro, bactrim, flagyl, flucon​azole, rifampin
SE: Hypogl​ycemia, weight ↑
Preferred in renal dysfun​ction
Vasodi​lation prevented by vasoco​nst​rictor (e.g. Safe w/greater renal insuff​iciency than SU
epinep​hrine); prolong effect​/de​crease dose --
do not use in finger​s/toes Direct Thrombin Inhibitors
SGLT2 Inhibitors
Bicarb​onate Decrease burning sensation during Do not require antith​rombin
E.g. Canagl​ifl​ozin, Empagl​iflozin
admin Monitor aPTT, platelets, hgb, het, bleeding
↑glucose excretion
Continuous infusions
Statin Monitoring ↓A1C 0.7-1
Used in HIT mgmt
CK Baseline: only in pts at increased risk Empagl​ifl​ozin: avoid if GFR <45
Short duration
for musc injury SE: Genital fungal infxn, UTI, AKI, dizzy,
Argatroban Falsely elevate INR
Routine: only in pts w/musc hypote​nsion, hyperk​alemia, hypogl​ycemia,
pain/w​eakness No monitoring or reversal agent fractures, ↓BMD, CV benefits

ALT Routine: only if symptoms of hepatotox ADE: upset stomach, bleed

occur Non-Opioid Analgesics
Intxns: avoid rifampin
FLP Routine: 4-12 wks after initia​tion, then Store in original container and NSAIDs, Prosta​glandin inhibitors
Q3-12 months as indicated use within 30 days of opening ASA,
salicy​lates
Hgb Baseline: only if diabetes status
A1c unknown Antico​agulant Dosing Inhibit COX-1 and COX-2

GI side effects
DVT ppx: enoxparin 40mg q24 or 30mg q12 or
Antico​agu​lants
heparin 5k units bid-tid. ASA = antipl​atelet primarily used
Heparin Unfrac​tio​nated heparin PE/DVT tx: Enoxaparin 1.5mg/kg q24 hrs and to prevent heart disease and
(UFH); IV/SC 1mg/kg q12 hrs; heparin drip 18 units/​kg/hr stroke

monitor aPTT, platelets, Thromb​oxanes involved in

Biguanides platelet aggreg​ation and
hgb, hct, HIT
thrombus formation
Low-mo​lec​ula​r- Enoxap​arin, SC e.g. metformin
w​eight heparin Selective e.g. Celecoxib
↓ glucose product, ↑ glucose uptake
COX-2
Renal adjust Crcl <30 ↓ A1C 1-1.5 inhibitor
monitor less frqnt, Anti-Xa Low risk hypogl​ycemia
↑ MI and stroke
levels not aPTT
SE: Diarrh​ea/GI, ↓B12, l. acidosis, weight ↓
Rofecoxib and Valdecoxib taken
Anti-F​actor Xa Fondap​arinux, SC
Contra​ind​icated GFR<30 off market
inhibitor
Celecoxib ↓GI SE in pt not on
Apixaban, PO
ASA
Rivaro​xaban, PO
Do not cause tolerance, not addictive
Direct Thrombin Argatr​oban, IV
All have ceiling effect to analgesia
Inhibitors

Dabiga​tran, PO

Vitamin K antag Warfarin, PO

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 Pharmacology 2 Cheat Sheet
by gwenw via cheatography.com/63534/cs/16148/

Opioid Withdrawal Bio DMARDs (cont) monoclonal antibo​die​s/PCSK9 inhibit

Body aches, weakness, fatigue Rituximab SE: rash, infection, neuro, SC

Diarrhea, stomach cramping infusion rxn, Tumor Lysis, multifocal Reduce LDL by additional 60% with statin
Insomnia leukoe​nce​pha​lopathy E.g. evoloc​umab, alirocumab
Irrita​bility Advant​ages: injected once or twice/​month
TNF Adalim​umab: SC every 2 wk, mild-
Loss of appetite SE: common cold, itching, flu, injxn site rxns,
inhibit mod inject rxn
Nausea​/vo​miting allergic rxns
Etaner​cept: SC 1-2/wk, mild-mod
Increased BP/HR
inject rxn
Runny nose, sneezing, yawning Antipl​atelets
Chilliness and “goose bumps” Inflix​imab: IV at 0,2,6,8 wk; infusion
rxn Aspirin

Patient Controlled Analgesia Increased malignancy risk ADP receptor inhibitors e.g. Clopid​ogrel
Prasugrel Ticagrelor
e.g. Morphine, hydrom​orphone SE: hypers​ens​iti​vity, Lupus-​like,
hepatotox, pancyt​openia, aplastic PO
Monitor HR, BP, RR, Pain, usage, O2
anemia, heart failure
Thromb​olytics
MTX combo or solo
Glucos​ami​ne/​Cho​ndr​oitin
Mod-severe RA Alteplase (IV)
Glucos​amine cartilage building block
Possibly reacti​vates TB, no live vaccine Dissolve clots acutel​y/clear IV line
Chondr​oitin Increase protein synthesis
Relative contra​ind​ica​tion: HTN
OTC, not 1st line, may improve OA knee pain
NM Blocking Agents
Absolute contra​ind​ica​tion: recent head trauma
Weeks to months for effect
Non- Compet​itive Ach antag ADR: bleeding, hemorrhage
SE: GI upset De​pol​arizing
C
Pancur​onium O: 4-6 min D:
Cortic​ost​eroids
120-180 min Heparin Induced Thromb​ocy​topenia
E.g. Dexame​tha​sone, Hydroc​ort​isone, Rocuronium O: 1-2 min D: 30-
Type 10-20%
Methyl​pre​dni​solone 60 min
1
Intraa​rti​cular 1-6 wk relief for OA/RA knee Depola​rizing Overst​imulate receptor
Onset: 2-3 d
3-4/yr limit Succin​ylc​holine O: 1-1.5 min D:
Platelet <50% decrease, nadir >100k
Lidocaine sometimes added 5-8 min
Type 1-3%
Systemic RA, not OA
2
Anaest​hetics Pharma​cok​inetics
Acute SE: Hyperg​lyc​emia, HTN,
Onset: 5-10 d
euphor​ia/​psy​chosis, weight​↑/e​dema, GI bleed highly lipid soluble
Platelet >50% decrease, nadir 10-20k
Chronic SE: Cushing’s appear​ance, cataracts, When discon​tinued, drugs will continue to enter
Antibody mediated
hyperl​ipi​demia, muscle​/te​ndon, OP/fra​ctures, systemic circul​ation
infection, HPA suppre​ssion Lethargy, confusion Thromb​oem​bolic sequelae 30-80%

D/c all heparin products, initiate direct

Bio DMARDs Lidocaine Patch thrombin inhibi​tor​/co​umadin

Non- Abatacept SE: Pulmonary infection, 12 hr on/12 hr off

ADP Receptor Inhibitors
TNF allergic rxn, HA/dizzy
3 at at time max
Anakinra SE: inj site rxn, infection, Clopid​ogr Indica​tions: ASA + Clopid​ogrel in
allergic rxn el pts receiving stents

Prasugrel More potent, less variable platelet

response than Clopid​ogrel

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 Pharmacology 2 Cheat Sheet
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ADP Receptor Inhibitors (cont) Other Antidi​abetics

reduction of thrombotic CV events Alpha-​glu​cos​ida e.g. Acarbose

(including stent thromb​osis) in pts se inhibitors
w/ACS who are to be managed
block enzymes that digest
w/PCI
starches in small intestine
Risks may exceed benefits in pts GI upset, flatul​ence, bloating
w/ >75 yo Previous history of TIA
Amylin analogs e.g. Pramli​ntide
or stroke <60kg
Injectable
Likely to undergo CABG = bleed
risk Bile acid e.g. Colese​velam
seques​trants
Hold for 7 days before surgery
GI side effects
Ticagrelor SE: bleeding, dyspnea,
bradyc​ardia
NSAIDs
2x/day
1st line in RA, 2nd in OA
Avoid in pts w/hx of hemorr​hagic
stroke Aspirin Most widely used, analgesic,

Avoid aspirin >100 mg CYP 3a4 antinf​lam​matory, antipy​retic,

inducers (rifampin, antipl​atelet

carbam​aze​pine, phenytoin) CYP Diclofenac more potent than other NSAIDs,

3A4 inhibitors (ketoc​ona​zole, ADRs occur in 20%
ritonavir) Monitor digoxin levels
Ibuprofen fever, GI side effects ~5-15%

Indome​tha Dose related side effects (i.e.

Sulfon​ylurea
cin confus​ion); 35-50% pts
e.g. Glyburide, Glimep​iride, Glipizide Ketorolac Orally or IM, IV doses provide
↑endog​enous insulin secretion postop​erative analgesia
equivalent to opioids
↓A1C 1-2
not used >5 days due to ADR
SE: hypogl​ycemia, ↑weight, photos​ens​itive
Naproxen Similar to ibuprofen, less frequent
Least expensive
dosing 2x/day
Caution in renal, elderly
SE: GI, acute renal failure, BP,
Often discon​tinued once insulin started
hypers​ens​itivity

GI SE: Celecoxib < Diclofenac < Ibuprofen &

DPP-4 inhibitors
Naproxen < ketorolac
e.g. Sitagl​iptin, Saxagl​iptin Take ibuprofen at least 2 hours after ASA --
↑ incretin, insulin release makes aspirin ineffe​ctive

↓A1C ~0.7 GI ulcers​/bleed prophy​laxis: Misopr​ostol,

Proton pump inhibitors (panto​pra​zole), H2RAs
Well tolerated, no weight gain, no
(ranit​idine)
hypogl​ycemia
Use with caution on pt on antico​agu​lants
Maybe pancre​atitis, jt pain, heart failure
Need to take contin​uously for antiinflam
Dose modifi​cation in renal impairment
2-4 wk trial needed
CYP3a4 intera​ctions

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