All three Exam 1 lectures — antimicrobials, dermatology medications and autonomic pharmacology. Class identity first, then indications, patient education, side effects and contraindications. Drug dosages are not tested.
| Term | What you need to know |
|---|---|
| Bacteriostatic | Inhibits a vital growth pathway without directly killing. Erythromycin, tetracyclines, sulfonamides, trimethoprim, clindamycin. |
| Bactericidal | Disrupts function enough that death occurs. Penicillins, cephalosporins, aminoglycosides, vancomycin, fluoroquinolones, metronidazole. |
| Concentration-dependent | Higher concentration, greater killing. Post-antibiotic effect present. Favors large, widely spaced doses — why aminoglycosides went once daily. |
| Time-dependent | Killing plateaus; what matters is time above the minimal inhibitory concentration, target 40–70% of the interval. No post-antibiotic effect. Favors continuous or frequent infusion. |
| Ribosome selectivity | Bacterial 70S (50S + 30S) versus mammalian 80S (60S + 40S). A difference of degree, not an absolute barrier — hence dose-related toxicity. |
| 50S binders | Macrolides, clindamycin, chloramphenicol, streptogramins. |
| 30S binders | Aminoglycosides, tetracyclines. |
| Six toxicity systems | Gastrointestinal, integument, hematologic, central nervous system, hepatic, renal. |
| Term | What you need to know |
|---|---|
| Penicillin mechanism | The beta-lactam ring mimics two D-alanine residues; the penicillin-binding protein binds it by mistake and is covalently inactivated. Chains still form, cross-links do not. |
| Penicillin G | Syphilis, gas gangrene, meningococcus. Good Gram-positive cocci, NO Staphylococcus, no aerobic Gram-negatives. |
| Dosage forms | Penicillin V potassium oral (acid stable) · penicillin G intravenous · penicillin G benzathine intramuscular depot, one-time dose. |
| Aminopenicillins | Ampicillin, amoxicillin. Enterococcus, Listeria, endocarditis prophylaxis, upper respiratory infection, community-acquired pneumonia. |
| Beta-lactamase inhibitors | Sulbactam + ampicillin (Unasyn) · tazobactam + piperacillin (Zosyn) · clavulanate + amoxicillin (Augmentin). NO antibacterial activity of their own; irreversibly inactivate the enzyme. |
| What the inhibitor buys | Bacteroides and methicillin-susceptible Staphylococcus aureus. Drug of choice for skin/soft tissue, diabetic foot, animal and human bites. |
| Penicillinase-resistant | Nafcillin, oxacillin, dicloxacillin — built solely for methicillin-susceptible Staphylococcus aureus. Defeated by methicillin resistance; vancomycin is then the choice. |
| Cephalosporin generations | Up the generations = more Gram-negative, less Gram-positive — EXCEPT the 4th, which gains Gram-negative without losing Gram-positive. |
| Penicillin cross-sensitivity | Less than 1%. A reported penicillin allergy does not by itself exclude a cephalosporin. |
| Cephalosporins to know | Cefazolin/cephalexin 1st · cefepime 4th (neutropenic fever, nosocomial, pseudomonal) · ceftaroline 5th is the one with methicillin-resistant coverage · ceftolozane 5th is the antipseudomonal one. |
| Ceftriaxone versus cefotaxime | Ceftriaxone needs no renal adjustment but is barred in the first 30 days of life; cefotaxime is preferred in neonatal fever or sepsis. |
| Aztreonam | Gram-negative ONLY, spectrum resembling the aminoglycosides. No cross-reactivity with other beta-lactams — usable in true penicillin allergy. |
| Carbapenems | Very broad: Gram-positive (not methicillin-resistant), Gram-negative, Pseudomonas EXCEPT ertapenem, anaerobes. For extended-spectrum beta-lactamase producers, multidrug-resistant Gram-negatives, meningitis. Seizures with imipenem. |
| Term | What you need to know |
|---|---|
| Vancomycin mechanism | Not a beta-lactam. Binds the two D-alanine residues to block cross-linking — covers the substrate rather than disabling the enzyme, so resistance is harder to develop. |
| Vancomycin coverage | Gram-positive ONLY. Penicillin-allergy infection, methicillin-resistant Staphylococcus aureus, Clostridium difficile by mouth, endocarditis, osteomyelitis. |
| Vancomycin monitoring | Trough drawn 15–30 minutes before the next dose, around the 3rd or 4th dose. Watch renal clearance, ototoxicity, nephrotoxicity. |
| Red man syndrome | Infusion-related reaction, with fever, chills and phlebitis. |
| Minimal inhibitory concentration ≥ 2 mg/L | Target ratio becomes hard to achieve — consider an alternative such as linezolid rather than pushing the dose. |
| Daptomycin | Bacterial depolarization inhibiting DNA, RNA and protein synthesis. CANNOT be used in pneumonia. Monitor muscle pain and creatine phosphokinase. |
| Term | What you need to know |
|---|---|
| Macrolides | 50S, blocks transpeptidation. Gram-positive aerobes plus ATYPICALS (Legionella, Mycoplasma, Chlamydophila, Chlamydia). QT prolongation and torsades. |
| Macrolide interactions | Cytochrome P450 3A inhibition, erythromycin > clarithromycin > azithromycin. Azithromycin is the one to reach for when interactions matter. |
| QT prolongation | Three classes: MACROLIDES, FLUOROQUINOLONES, POSACONAZOLE. Blocks the hERG POTASSIUM channel → slower REPOLARIZATION → longer QT → TORSADES DE POINTES. Risk multiplies with CONGENITAL LONG QT, STACKED QT DRUGS, or ELECTROLYTE disturbance (class Ia and III antiarrhythmics, low K+, low Mg2+). Treatment of torsades: MAGNESIUM SULFATE 2 g. |
| Clindamycin | Gram-positive aerobes including methicillin-resistant Staphylococcus aureus, plus Gram-positive AND Gram-negative anaerobes. NO Gram-negative aerobic coverage. Toxin-mediated disease. Clostridium difficile. |
| Tetracyclines | 30S, binds 16S ribosomal RNA and blocks transfer RNA at the A site. Bacteriostatic. Excellent for atypicals and animal-borne organisms. |
| Tetracycline cautions | Chelate iron and calcium. Photosensitivity, tooth discoloration, skeletal growth depression — avoid under 8 years and in the 2nd and 3rd trimesters. |
| Aminoglycosides | Gram-negatives including Pseudomonas; Enterococcus only at synergy dosing. Post-antibiotic effect → once daily. NEPHROTOXIC and OTOTOXIC. |
| Linezolid | 50S. Resistant Gram-positives — multidrug-resistant pneumococcus, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus. No Gram-negatives. Thrombocytopenia; serotonin syndrome with selective serotonin reuptake inhibitors, tyramine, pseudoephedrine. |
| Tigecycline | Glycylcycline, 30S, bacteriostatic. Complicated skin and intra-abdominal infection. Covers Enterococcus faecalis but NOT vancomycin-resistant Enterococcus. |
| Term | What you need to know |
|---|---|
| Fluoroquinolone mechanism | DUAL: inhibits DNA gyrase (topoisomerase II) forming a quinolone-DNA-gyrase complex with induced cleavage, and inhibits topoisomerase IV. |
| Levofloxacin versus moxifloxacin | Levofloxacin HAS Pseudomonas coverage; moxifloxacin does not and must NOT be used for urinary tract infection. |
| Fluoroquinolone harms | Tendonitis and Achilles rupture, peripheral neuropathy, central nervous system toxicity, QT prolongation, photosensitivity. Caution under 18. Chelated by iron, antacids, calcium, dairy. |
| Septra mechanism | Two sequential steps: sulfamethoxazole blocks para-aminobenzoic acid → dihydrofolic acid; trimethoprim blocks dihydrofolic acid → tetrahydrofolic acid. |
| Septra uses and harms | Covers methicillin-resistant Staphylococcus aureus, NOT enterococci. Pneumocystis jirovecii treatment and prophylaxis. Stevens-Johnson syndrome, blood dyscrasias, raises the international normalized ratio with warfarin. |
| Metronidazole | Interacts with bacterial DNA causing helical structure loss and strand breakage. Anaerobes and parasites. Drug of choice for Clostridium difficile. DISULFIRAM-LIKE REACTION with ethanol. |
| Polymyxins — BLACK BOX | Nephrotoxicity, neurotoxicity, neuromuscular blockade. The only warnings this deck labels black box. Detergent-like disruption of the Gram-negative outer membrane. |
| Term | What you need to know |
|---|---|
| Herpes simplex 1 versus 2 | Type 1: mouth, face, skin, esophagus, brain. Type 2: genitals, rectum, hands, meninges. |
| Varicella-zoster / cytomegalovirus | Varicella-zoster: chickenpox and shingles. Cytomegalovirus: retinitis, esophagitis, colitis. |
| Acyclovir mechanism | Guanine analog LACKING the sugar moiety. Selectively phosphorylated by VIRAL THYMIDINE KINASE, incorporated into viral DNA; the missing sugar prevents elongation. |
| Acyclovir / valacyclovir | Herpes simplex and varicella-zoster. Valacyclovir is the prodrug with far better oral absorption. |
| Acyclovir harms | Nausea, vomiting, rash, bone marrow suppression, central nervous system effects (seizures, delirium, tremor), CRYSTALLIZES IN THE RENAL TUBULE — maintain hydration. |
| Ganciclovir / valganciclovir | CYTOMEGALOVIRUS in transplant and immunocompromised patients. Neutropenia and thrombocytopenia; about a THIRD must stop intravenous treatment for side effects. |
| Oseltamivir | Prodrug → carboxylate. Inhibits NEURAMINIDASE so budding progeny cannot be cleaved free. Influenza A and B. Oral only, renally adjusted. |
| The 48-hour window | Oseltamivir must start within 48 hours — it blocks release of new virus, so late treatment has little to act on. Acyclovir within 24 hours of chickenpox shortens the illness but does NOT cure it. |
| Four prodrugs | Valacyclovir, famciclovir, valganciclovir, oseltamivir — each exists to solve poor oral absorption of its parent. |
| Term | What you need to know |
|---|---|
| Fungal cell | Eukaryotic. Chitin cell wall, ERGOSTEROL membrane, different ribosomes, distinct nuclear membrane. Resistant to antibiotics. |
| Sort in two questions | Wall or membrane? Echinocandins are the only wall agents. Then: bind ergosterol (polyenes) or block its synthesis (azoles, allylamines)? Griseofulvin and flucytosine sit outside both. |
| Polyenes | Amphotericin B, nystatin, natamycin. Bind ergosterol and form channels — potassium and magnesium leak out. |
| Amphotericin B harms | Fever and chills from interleukin-1 and tumor necrosis factor (pretreat). Hypokalemia, hypomagnesemia, hypotension, renal tubule damage — hydrate with normal saline. Lipid formulations cost 20–50× more, less toxic. |
| Azoles | Inhibit fungal cytochrome P450 14-alpha-demethylase (lanosterol → ergosterol). Because the target is a cytochrome P450 enzyme, they interact with human ones too. |
| Which azole | Fluconazole: best oral absorption, enters the central nervous system, cryptococcal meningitis. Voriconazole: systemic aspergillosis, VISION effects ~30%. Posaconazole: the ONLY azole for Zygomycetes. Itraconazole: blastomycosis, histoplasmosis. Ketoconazole: rarely used. |
| Azoles in pregnancy | ITRACONAZOLE is TERATOGENIC. Fluconazole and voriconazole are TERATOGENIC IN ANIMALS. Check a PREGNANCY TEST before prescribing to anyone of childbearing potential. |
| Echinocandins | Caspofungin, micafungin, anidulafungin. Inhibit 1,3-beta-D-glucan synthase — the one target with no mammalian counterpart. Largely a salvage role. |
| Allylamines | Naftifine (topical), terbinafine (oral and topical). Inhibit squalene epoxidase. Superficial dermatophytes. |
| Griseofulvin | Interrupts mitotic spindles. From Penicillium griseofulvum. Deposited in keratin precursor cells — scalp ~1 month, fingernails 6–9 months, toenails up to 12. High-fat meal increases absorption. NOT Candida; fungistatic. INDUCES cytochrome P450 1A2 and 2C9. |
| Flucytosine | Converted by CYTOSINE DEAMINASE, which human cells lack — that is the selectivity. Inhibits thymidylate synthase. With amphotericin B in cryptococcal meningitis. Bone marrow suppression. |
| Tinea names | Pedis = athlete's foot · corporis = ringworm · cruris = jock itch · unguium = onychomycosis (nails). |
| Term | What you need to know |
|---|---|
| More permeable sites | SCROTUM · FACE · AXILLA · SCALP. The same tube does different things in different places. |
| Drying range | TINCTURES most drying → wet dressings → lotions → gels → aerosols → powders → pastes → creams → foams → OINTMENTS least drying. |
| Match vehicle to lesion | OOZING, VESICULATION, CRUSTING → drying end. SCALING, LICHENIFICATION, XEROSIS → least drying end. |
| Two site rules | AVOID OINTMENT in intertriginous areas. GEL or FOAM for scalp and hairy locations — foams well, low residue. |
| Depot effect | Skin acts as a RESERVOIR, which may permit ONCE DAILY dosing of a short acting drug. |
| Occlusion | Increases efficacy — and the lecture raises TOXICITY in the same breath. |
| Concentration gradient | More concentration means more transfer. Worked example: CORTICOSTEROID RESISTANCE overcome by raising concentration. |
| Term | What you need to know |
|---|---|
| Four major factors | INCREASED SEBUM · ALTERED KERATINIZATION with ductal hyperproliferation · BACTERIAL COLONIZATION (P. acnes) · INFLAMMATORY MEDIATORS. |
| Critical target | The MICROCOMEDONE. Eliminating follicular occlusion arrests the cascade. |
| Lesion split | NONINFLAMMATORY = open and closed comedones. INFLAMMATORY = papulopustular and nodular. |
| Route by severity | MILD–MODERATE topical. MODERATE–SEVERE systemic. |
| Benzoyl peroxide | Crosses stratum corneum UNCHANGED, converts to BENZOIC ACID. Counsel: BLEACHES hair, clothing, bedding. |
| Topical retinoid | FIRST LINE for comedonal acne. AVOID IN PREGNANCY. Tretinoin is PHOTOLABILE — apply at night. |
| The interaction | BENZOYL PEROXIDE INACTIVATES TRETINOIN. Adapalene is the one stable in sunlight AND with benzoyl peroxide. |
| Retinoid branches | TAZAROTENE acne + psoriasis · ALITRETINOIN Kaposi sarcoma · BEXAROTENE T-cell lymphoma. |
| Topical antibiotic | CLINDAMYCIN preferred. Erythromycin losing efficacy to P. acnes RESISTANCE. |
| Isotretinoin | CONTRAINDICATED in pregnancy and breastfeeding; iPledge. Raised SERUM LIPIDS. MONITOR FOR DEPRESSION. |
| Tetracyclines | Chelate CALCIUM, blocking neutrophil and monocyte CHEMOTAXIS. CONTRAINDICATED under 8 years and in pregnancy. |
| Azelaic acid | Give it SIX TO EIGHT WEEKS. Can cause HYPOPIGMENTATION. |
| Drug-induced acne | SYSTEMIC CORTICOSTEROIDS (not hydrocortisone) · antiepileptics · tuberculostatics · lithium. Withdrawal causes an INITIAL WORSENING. |
| Term | What you need to know |
|---|---|
| Atopic triad | Atopic dermatitis + ASTHMA + ALLERGIC RHINO-CONJUNCTIVITIS. SKIN BARRIER DYSFUNCTION plays the major role. |
| Major indicators | PRURITUS · rash in TYPICAL AREAS · CHRONIC or repeated · FAMILY HISTORY. (Raised IgE and skin tests are MINOR.) |
| Gold standard | TOPICAL CORTICOSTEROIDS, chosen by severity and SITE. |
| Potency by site | LOW for face, intertriginous areas, infants — and better long term. MEDIUM for body. Exacerbation: MEDIUM–HIGH for one to two weeks then STEP DOWN. |
| What drives adverse effects | POTENCY · DURATION · AREA COVERED · OCCLUSIVENESS (ointment > cream > lotion). |
| Local vs systemic | LOCAL: skin atrophy, acne, rosacea, allergic dermatitis to the vehicle. SYSTEMIC: adrenal suppression, infections, hyperglycemia, GLAUCOMA, CATARACTS, growth retardation in children. |
| Immunomodulators | TACROLIMUS, PIMECROLIMUS inhibit T cell, mast cell and keratinocyte activation. SECOND LINE. Possible cancer risk; avoid if immunosuppressed. Counsel BURNING and HIGH SPF. |
| Oral steroid course | Needs a TAPER to prevent a flare-up. |
| Term | What you need to know |
|---|---|
| Bacitracin | Prevents CELL WALL synthesis. Gram positives. NO SYSTEMIC TOXICITY. |
| Mupirocin | Binds bacterial TRANSFER RNA. MRSA. Eliminates NASAL CARRIAGE of S. aureus. |
| Polymyxin B | Interrupts CYTOPLASMIC MEMBRANE. Gram negatives. AVOID high dose on OPEN or DENUDED skin — neuro- and nephrotoxicity. |
| Neomycin | Frequently causes SENSITIZATION. Class can accumulate systemically. |
| Azoles | Inhibit FUNGAL P450, preventing cell wall formation. Treatment is PROLONGED, two to three weeks. |
| Ciclopirox nail lacquer | LESS THAN 12% EFFECTIVE for onychomycosis. Say so before starting. |
| Allylamines | NAFTIFINE, TERBINAFINE — inhibit ERGOSTEROL production. |
| Coverage gaps | TOLNAFTATE has NO CANDIDA activity. NYSTATIN is the candidal agent, NO ORAL ABSORPTION. |
| Topical antivirals | ACYCLOVIR, PENCICLOVIR — guanine analogs, recurrent OROLABIAL herpes simplex. |
| Imiquimod | Immunomodulator — warts, ACTINIC KERATOSES, BASAL CELL CARCINOMA. Irritation in VIRTUALLY ALL patients, and the DEGREE OF INFLAMMATION PARALLELS EFFICACY. |
| Term | What you need to know |
|---|---|
| The tree | Nervous system → CENTRAL / PERIPHERAL. Peripheral → AFFERENT / EFFERENT. Efferent → SOMATIC / AUTONOMIC. Autonomic → ENTERIC, PARASYMPATHETIC, SYMPATHETIC. |
| Autonomic vs somatic | Autonomic is TWO NEURONS — PREGANGLIONIC within the CNS, POSTGANGLIONIC from a ganglion, generally NONMYELINATED. The somatic route does not relay that way. |
| Enteric | The BRAIN OF THE GUT — gut, pancreas, gallbladder. FUNCTIONS INDEPENDENTLY of the CNS, modulated by the other two. |
| Cholinergic steps | SIX: synthesis · storage · release · receptor binding · DEGRADATION by acetylcholinesterase · RECYCLING of choline. (Adrenergic has FIVE.) |
| Muscarinic subtypes | Five subclasses, ONLY M1, M2, M3 functionally characterized. M1 neurons + gastric parietal · M2 neurons + CARDIAC + smooth muscle · M3 neurons + BLADDER + exocrine glands. |
| Nicotinic receptor | FIVE SUBUNITS, LIGAND-GATED ION CHANNEL. TWO acetylcholine molecules open it to sodium. CNS, adrenal medulla, ganglia, neuromuscular junction. |
| Nicotine's twist | STIMULATES at low concentration, BLOCKS at high. |
| Alpha vs beta location | ALPHA-1 POSTSYNAPTIC on the effector organ. ALPHA-2 PRESYNAPTIC on nerve endings. |
| Potency orders | ALPHA: epinephrine ≥ norepinephrine >> isoproterenol. BETA: isoproterenol > epinephrine > norepinephrine. |
| Catecholamine breakdown | COMT postsynaptically, MAO within the neuron. Noncatecholamines escape both — longer acting, more CNS penetration. |
| Term | What you need to know |
|---|---|
| Muscarinic — DUMBBELS | Defecation · Urination · Miosis · Bradycardia · Bronchorrhea · Bronchospasm · Emesis · Lacrimation · Salivation. |
| Nicotinic — MTWHF | Mydriasis · Tachycardia · Weakness · Hypertension · Fasciculations. |
| Anticholinergic | Mad as a hatter · Blind as a bat · Red as a beet · Dry as a bone · Hot as Hades. Plus constipation, urinary retention, TACHYCARDIA. |
| How to tell them apart | PUPIL AND HEART FIRST: muscarinic is SMALL pupil, SLOW heart. Nicotinic and anticholinergic are both BIG pupil, FAST heart. Then WET vs DRY separates those two. |
| Ganglionic blockade | Blocks the ENTIRE autonomic output at nicotinic receptors. Vasodilation, plus atony of bladder and gut, cycloplegia, xerostomia, tachycardia. |
| Term | What you need to know |
|---|---|
| Direct vs indirect | DIRECT bind the receptor (choline esters, pilocarpine). INDIRECT = ANTICHOLINESTERASES, raising acetylcholine. |
| Bethanechol | Resists acetylcholinesterase, MUSCARINIC ONLY. Stimulates DETRUSOR, relaxes trigone and sphincter → urinary retention. |
| Pilocarpine | Miosis + ciliary contraction → GLAUCOMA. Also XEROSTOMIA. |
| Edrophonium vs pyridostigmine | EDROPHONIUM short acting — DIAGNOSING myasthenia gravis. PYRIDOSTIGMINE — CHRONIC MANAGEMENT. |
| Physostigmine | ENTERS THE BRAIN. Antidote for ANTICHOLINERGIC OVERDOSE. |
| Neostigmine | Does NOT enter the brain. Bladder and gut, reversing blockade, myasthenia gravis. |
| Alzheimer agents | DONEPEZIL · RIVASTIGMINE · GALANTAMINE. Deficiency of CENTRAL cholinergic neurons. |
| Poisoning, both ways | INSECTICIDE (anticholinesterase) → ATROPINE + PRALIDOXIME. ANTICHOLINERGIC overdose → PHYSOSTIGMINE. Getting the direction wrong doubles the poisoning. |
| Pralidoxime limits | Does NOT enter the brain. CANNOT overcome reversible inhibitors such as physostigmine. |
| Atropine | Persistent MYDRIASIS + CYCLOPLEGIA. BRADYCARDIA at low dose, TACHYCARDIA at higher. Greatest inhibition on bronchial tissue, sweat, saliva. |
| Scopolamine | Greater CENTRAL action — MOTION SICKNESS, blocks SHORT-TERM MEMORY. Patch: WASH HANDS or you blur your vision. |
| Synthetic antimuscarinics | IPRATROPIUM, TIOTROPIUM inhaled for COPD · GLYCOPYRROLATE secretions and drooling · bladder agents lower pressure and raise capacity. |
| Neuromuscular blockade | NONDEPOLARIZING is COMPETITIVE — MORE ACETYLCHOLINE REVERSES IT. Face and eye first, DIAPHRAGM LAST, recovery in reverse. |
| Succinylcholine | The ONLY depolarizing agent. Acts LIKE acetylcholine and is not destroyed — an anticholinesterase makes it WORSE. Risk: MALIGNANT HYPERTHERMIA with halothane → COOLING + DANTROLENE. |
| Term | What you need to know |
|---|---|
| Epinephrine by dose | BETA effects at LOW dose, ALPHA at HIGH. Raises SYSTOLIC, lowers DIASTOLIC. |
| Epinephrine uses | ANAPHYLAXIS · CARDIAC ARREST · acute bronchospasm. In local anesthetic to PROLONG the block by vasoconstriction. |
| Epinephrine + beta blocker | ALPHA EFFECTS LEFT UNOPPOSED → peripheral resistance and blood pressure RISE. |
| Norepinephrine | Mostly ALPHA. REFLEX BRADYCARDIA via baroreceptor. EXTRAVASATION → PHENTOLAMINE. |
| Dopamine | Beta-1 cardiac · dopaminergic dilates RENAL and SPLANCHNIC · alpha-1 vasoconstriction only at VERY HIGH dose. Cardiogenic and septic shock. |
| Dobutamine | Selective BETA-1. Acute heart failure. BARELY RAISES MYOCARDIAL OXYGEN DEMAND. Caution in ATRIAL FIBRILLATION. |
| Alpha-1 vs alpha-2 agonist | PHENYLEPHRINE alpha-1 → vasoconstriction, REFLEX BRADYCARDIA. CLONIDINE alpha-2 → reduces CENTRAL SYMPATHETIC OUTFLOW. |
| Two rebound warnings | OXYMETAZOLINE longer than THREE DAYS → rebound congestion. CLONIDINE stopped abruptly → REBOUND HYPERTENSION. |
| Indirect agonists | AMPHETAMINE · COCAINE · TYRAMINE — release norepinephrine or block reuptake. EPHEDRINE and PSEUDOEPHEDRINE are MIXED. |
| Tyramine trap | Normally destroyed by MAO IN THE GUT. On an MAO INHIBITOR it reaches the terminal — serious vasopressor effect. Fermented cheese and wine. |
| Phenoxybenzamine | IRREVERSIBLE, noncompetitive — needs NEW RECEPTORS, at least a day. EPINEPHRINE REVERSAL: vasoconstriction blocked, vasodilation left. |
| Alpha-1 blockers split | PRAZOSIN, TERAZOSIN, DOXAZOSIN for hypertension. TAMSULOSIN, ALFUZOSIN for BPH. Signature: FIRST-DOSE SYNCOPE. |
| Propranolol | Nonselective → BRONCHOCONSTRICTION, CONTRAINDICATED in asthma and COPD. MASKS HYPOGLYCEMIA. Abrupt stop → arrhythmia from RECEPTOR UP-REGULATION. |
| Propranolol beyond BP | MIGRAINE PREVENTION · HYPERTHYROIDISM · ANGINA · after MYOCARDIAL INFARCTION. |
| The rest by property | TIMOLOL glaucoma · SELECTIVE BETA-1 lose selectivity at higher doses · ACEBUTOLOL and PINDOLOL have ISA · LABETALOL IV for hypertensive emergency · CARVEDILOL mortality in heart failure. |
| Storage agents | RESERPINE blocks uptake INTO vesicles. GUANETHIDINE blocks release FROM them. |