Pharmacology Made Simple For NLE NRE Step 1

Pharmacology: Three Types

1. Systemic Pharmacology:
   • Focuses on the study of drugs that affect the entire body through the bloodstream, often targeting multiple organs and systems.
2. Ans Pharmacology (Autonomic Nervous System):
   • Cholinergic:
     • Agonists: Drugs that mimic the action of acetylcholine (e.g., muscarinic agonists).
     • Antagonists: Drugs that block acetylcholine receptors (e.g., atropine).
   • Adrenergic:
     • Agonists: Drugs that stimulate adrenergic receptors (e.g., beta-agonists).
     • Antagonists: Drugs that block adrenergic receptors (e.g., beta-blockers).
3. Antimicrobial Pharmacology:
   • Focuses on drugs that are used to treat infections by targeting microorganisms like bacteria, viruses, fungi, and parasites.

1. CVS Pharmacology – Anti-Hypertensive (Anti-HTN)

• ACE Inhibitors (pril):
  • Side Effects: Dry cough, angioedema
  • Contraindication: Not to be used in pregnancy
• Spironolactone:
  • Side Effects: Gynecomastia, hyperkalemia
• Hydralazine:
  • Side Effect: Drug-induced lupus erythematosus (SLE)
• Alpha-Methyl Dopa:
  • Safe for use during pregnancy
• Procainamide
• Isoniazid

2. Gestational Hypertension (HTN) + Agents Acting on Beta and Alpha Receptors

• Labetalol
• Carvedilol
• Short-acting Intraoperatively:
  • Esmolol
• Dyslipidemia
  • Metoprolol
• Digoxin:
  • Action: Inhibits the Na+/K+ pump
  • Effect: Leads to increased potassium levels and increased contractility of the heart.

3. Lipid-Lowering Agents

• Statins:
  • MOA: Inhibit HMG-CoA reductase
  • Side Effects (S/E):
    • Hepatotoxicity
    • Rhabdomyolysis
    • Combined with fibrates: Increased risk of gallstones
• Niacin (Vitamin B3):
  • MOA: Inhibits liver production of VLDL (very low-density lipoproteins), leading to a reduction in triglycerides and LDL cholesterol.
  • Effect: Increases HDL cholesterol (good cholesterol).
  • Side Effects (S/E):
    • Flushing (due to vasodilation)
    • Hepatotoxicity (in high doses)
    • Hyperglycemia (can worsen diabetes)

4. Antiarrhythmic Medications

1. Na Channel Blockers:
   • Class 1a:
     • Quinidine: Causes cinchonism (ringing in the ears, vertigo, headache)
     • Procainamide: Can cause SLE (Systemic Lupus Erythematosus)
     • Disopyramide: Can lead to heart failure (HF) edema
   • Class 1b:
     • Lidocaine: Used as a local anesthetic
     • Phenytoin: Used for epilepsy, can cause gingival hyperplasia
   • Class 1c:
     • Propafenone: Contraindicated after MI (heart attack)
2. K Channel Blockers:
   • Amiodarone: Used for AIDS treatment, has various arrhythmic indications
   • Ibutilide: Used for atrial arrhythmias
3. Ca Channel Blockers:
   • Diltiazem
   • Verapamil

5.Thyroid Drugs

1. Hyperthyroidism:
   • PTU (Propylthiouracil): Preferred in 1st trimester of pregnancy
   • Methimazole: Used after the 1st trimester of pregnancy
2. Hypothyroidism:
   • Levothyroxine (synthetic T4)

6. Diabetes Mellitus (DM)

• Insulin:
  • Side Effects (S/E):
    • Hypoglycemia
    • Lipodystrophy
• Oral Agents
  • Biguanides:
    • Metformin: First-line for DM2 (especially with obesity)
    • Contraindicated in renal failure
• Sulfonylureas:
  • Glyburide, Tolbutamide
  • Side Effects (S/E):
    • Hypoglycemia
    • Weight gain
• Thiazolidinediones (TZDs):
  • Pioglitazone: Can increase DM2 risk and risk of fractures
• SGLT2 Inhibitors:
  • Empagliflozin
  • Dapagliflozin
  • Increase glucose excretion in urine, leading to reduced blood glucose levels.

7. GIT

Acid Suppression Therapy

• Proton Pump Inhibitors (PPI):
  • Used for: Zollinger-Ellison syndrome
• H2 Blockers:
  • Cimetidine:
    • Side Effect (S/E): Gynecomastia
• Prostaglandin Analogues:
  • Misoprostol:
    • Used for NSAID-induced gastric ulcers
• Antacids:
  • Aluminum Hydroxide:
    • Side Effect (S/E): Constipation
• Magnesium Hydroxide:
  • Side Effect (S/E): Diarrhea

8. Anti-Emetic Medications

1. Ondansetron:
   • MOA: 5HT3 receptor inhibitor
   • Effect: Decreases vomiting and reduces chemotherapy-induced vomiting.
2. Metoclopramide:
   • MOA: Inhibits dopamine receptors in the chemoreceptor trigger zone
   • Side Effects: Parkinson-like symptoms
   • Use: In diabetic gastroparesis
3. Aprepitant:
   • MOA: Acts on NK-1 receptor (neurokinin)
   • Used to control nausea and vomiting, especially related to chemotherapy.
4. Domperidone:
   • MOA: Dopamine antagonist, used to treat nausea and vomiting.

Here are other materials for NLE NRE step 1

9. Laxatives

• Lactulose:
  • Use: Also used in hepatic encephalopathy to reduce ammonia levels in the blood.

10. Antidiarrheal Medications

• Metronidazole:
  • Use: Primarily an antibiotic, used for infections such as Clostridium difficile or giardiasis. It is not a typical antidiarrheal, but it can help treat infections that cause diarrhea.
• Loperamide:
  • Use: A common antidiarrheal that works by slowing down gut motility, helping reduce the frequency of diarrhea.

11. Parasympathetic vs Sympathetic Nervous System

12. Acetylcholine (ACh) Receptors

13. Micturition Control

Receptors & Effects: