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"Yesterday's the past, tomorrow's the future, but today is a gift. That's why it's called the present."
-Bil Keane
Role
Disney enthusiast
Dreamer
Team player
Origins
Toronto, Canada
McMaster University, Hamilton
Yearbook Quote:
Hakuna Matata
Role
Candy Crush aficionado
Excels at vertical tasks
Team player
Origins
Priozersk, Russia
River Edge, NJ
“Hey Olga, are you still Russian?”
- “Yes.”
“Then why don’t you slow down??”
Role
Jack of all trades
Automotive technician
Mechanical engineer
Father of two
Origins
Temple University
Philadelphia, Pennsylvania
Yearbook quote
“Imagination is more important than knowledge”
Role:
Undergrad:
Origins:
Quote:
Nickname: Rubes
Origins:
Favorite Hobbies:
Quote:
I drink Aloe Vera all the time
Distribution
Bacteria can s ynthesize beta-lactamases to cleave the beta-lactam ring of amoxicillin
Renders drug useless as it can't bind the enzyme
Clindamycin is a broad spectrum which can decrease the flora in the intestine and can significantly alter the enterohepatic cycling of certain drugs
Ethinyl estradiol, like in the birth control pill, would have decreased effectiveness in patients on clindamycin
Verapmil is a hypertension drug whose effect is shown to increase with clindamycin usage
Cyclosporine is an immunosuppresant and its effect is decreased with clindamycin
Additionally, d ue to destruction of gut bacteria, diarrhea and watery stool is a common problem in patients on clindamycin.
Other than pizomide, methadone and other other CNS altering drugs should be prescribed with diligence as azithromycin has the potential of altering rates of metabolism and excretion.
Additional Information
Azithromycin is a broad spectrum antibiotic, hence it has the capacity to wipe out much of the gut flora leading to watery diarrhea and watery stool.
This can lead to dehydration as well as loss of electrolytes which can cause ion deficiencies and lead to nausea and vomiting.
Antifungal
Antifungal (Class: Echinocandins)
Antifungal (Class: Azoles)
Antifungal
Sedatives
Sedatives
Sedatives
Sedatives
Morphine primarily acts on the mu receptor of neurons to produce analgesia. It is a G-protein coupled receptor that inhibits the action of adenylyl cyclase, which reduces the amount of available cAMP. Reduced cAMP reduces the amount of available neurotransmitter release, therefore reducing the amount of pain sensed.
Oxycodone is a semisynthetic opoid. Its mechanism of action is very similar to that of morphine (please see previous slide).
Methadone is strictly a mu receptor agonist. Please see morphine for mechanism of action.
Drugs that inhibit CYP3A4 or prolong the QT interval need to be used with caution. Increasing the accumulation of this drug or putting the patient at higher risk for arrhythmia needs to be avoided.
Methadone has been associated with QT prolongation and torsades de pointes.
If prescribed with MAO inhibitors, may result in serotonin syndrome. High levels of serotonin present as increased heart rate, sweating, hallucinations, and coma.
Meperidine was once widely used for labor and delivery but has now grown out of favor
Liver dictates the rate at which lidocaine is metabolized
Half-life can be two to three fold longer in patients with hepatic disease
Renal dysfunction can lead to build-up of metabolites
Bolus injections given intravenously can be very dangerous
CNS toxicity become very apparent with lidocaine plasma levels above 6.0μg per mL
Convulsions have been show in rhesus monkey at 18–21 µg/mL
I njections should be given only after aspiration and over a period of 2-3 minutes per carpule
Possible Oxidizing Agents such as sodium nitrite, thiosulfate and other Local anesthetic agents such as prilocaine
Articaine works very similarly to lidocaine
It blocks nerve conduction and generation by blocking voltage-gated sodium channels
Epinephrine is a vasoconstrictor added to articaine HCl to slow absorption into the general circulation which prolongs the effects of the anesthetic, decreases absorption into blood, and decrease bleeding.
Distribution
Vasoconstrictor
(Vasoconstrictor in general)
(Vasoconstrictor in general)
Vasoconstrictor
Vasoconstrictor
NSAIDs
NSAIDs
NSAIDs
NSAIDs
Methamphetamine
Potent CNS stimulant of the amphetamine class
Sometimes used to treat ADHD and obesity
Used recreationally to elevate mood, increase energy levels, and enhance sexual desire, allowing some users to engage in sexual activity for days
Schedule II drug with the following effects:
Euphoria
Reduced fatigue
Increased adrenergic nerve activity
Methamphetamine
Methamphetamine
Methamphetamine
Cannabis (Marijuana)
Delta-9-tetrahydrocannabinol (THC)
Cannabis
Cannabis
Recent inhalation of marijuana before general anethesia may cause acute uvular oedema and post-operative airway obstruction. During general anesthesia, additive effects of marijuana and potent inhaled anesthetics can result in pronounced myocardial depression, which usually accompanies severe sepsis and septic shock
(http://www.ncbi.nlm.nih.gov/pubmed/8807175)
Cocaine
Cocaine
Cocaine
Cocaine
Alcohol
Alcohol
Alcohol
Alcohol
Alcohol
Weak antagonist to the receptors AMPA, Kainate, GABAc, and 5-HT3
Weak agonist to GABAa and Glycine.
Primary form of excretion is 95% excreted unchanged by exhalation
This compound has a low rate of biotransformation at only 0.17% of the dose being metabolized
Its minimum alveolar concentration (MAC) is 1.15%.
Blood:gas partition coefficient of 1.43
allows for quick induction and reversal of anesthetic
Strongly relaxes vascular smooth muscle, producing a hypotension that can be useful in procedures such as surgical repair of an intracranial aneurysm
Pungent odor, so rarely used for induction
Combines the desirable cardiovascular properties of enflurane with a freedom from seizure activity and less respiratory depression and hepatic metabolism.
Isoflurane is chemically stable, nonflammable, and marketed in brown glass bottles.
Diphenhydramine is a first generation competitive H1 histamine receptor antagonist
Bind to the H1 receptor and reverses the effects of histamine
Pharmacological effects include:
Inhibition of the contraction of GI and bronchial smooth muscle
Inhibition of increased capillary permeability
Inhibition of flare and itch
Antagonize increased secretions of salivary and lacrimal glands
Increase release of epinephrine from the adrenal glands
Other clinically useful effects of antihistamines that are able to cross the blood brain barrier and exhibit CNS effects include:
Sedation
Inhibition of nausea and vomiting (especially associated with motion sickness)
The mechanism of action for the CNS effects of antihistamines is not fully understood
Adverse effects from first generation H1 receptor antagonists like Diphenhydramine include:
Drowsiness
Diminished alertness
Lethargy
Decreased motor coordination
GI disturbances such as nausea and vomiting
However, these adverse effects are relatively rare and rarely have severe drug interactions
Propoxyphene
Propoxyphene is an inhibitor of CYP450 2D6 enzyme in the liver
This could result in an altered metabolism of Diphenhydramine
Aspirin and caffeine:
Can result in altered metabolism of Diphenhydramine as well
Mechanism of action is the same as above
Lidocaine/Potassium Chloride
The mechanism of action of this interaction is the decreased gastric and intestinal motility due to the anticholinergic effects of Diphenhydramine
This increases potassium chlorides contact time with the gastric mucosa which can cause the adverse effects
Loratadine is also a competitive H1 receptor antagonist
However, unlike Diphenhydramine it is a second generation H1 antagonist
The main difference is that it does not have the sedation effect that the first generation H1 antagonists have
Most of the pharmacological effects of Diphenhydramine are the same as Loraradine except for the sedation effects seen in Diphenhydramine and other first generation antihistamines
Well absorbed in the gastrointestinal tract and has a high first pass metabolism
Mainly metabolized by the liver, specifically by enzymes CYP3A4 and CYP2D6
Approximately 97% bound to plasma proteins
Has a metabolite that it is broken down to called Desloratadine, which also has antihistamine effects, and is highly bound to plasma proteins
Half life for Loratidine is approximately 8 hours and the half life for Desloratidine is approximately 27 hours
Both Loratidine and Desloratidine are excreted in the urine and feces
Loratidine causes less sedative effects when compared with other first generation H1 antihistamines
It crosses the blood brain barrier to a lesser extent
Therefore it is less likely to exert any of its effects on the CNS
Cimetidine is a competitive antagonist of the H2 histamine receptor
The H2 receptor is largely associated with the secretory function of the gastric mucosa
Antagonism of the H2 receptor results in:
Reduction of H+ ion output
Reduction in pepsin activity
Reduction of the total volume of gastric secretion
The drug can be administered orally or parenterally
Oral administration and parenteral administration both result in favorable therapeutic doses
The half life of Cimetidine is approximately 4-5 hours
The drug can be metabolized to a sulfoxide metabolite and it is mostly excreted through the urine
More of the parent compound, Cimetidine is recovered in the urine when administered IV
Warfarin
When administered together with Cimetidine increased bleeding may result
This adverse drug interaction is believed to occur due to Cimetidine inhibiting metabolism of Warfarin
Results in increased anti-coagulative effects and ultimately leads to increased bleeding
Ibuprofen/Oxycodone
Cimetidine’s minorly inhibits the liver enzyme CYP2D6
Results in decreased metabolism of Ibuprofen and Oxycodone which results in increased plasma concentrations
The most common therapeutic usage of H2 receptor antagonists such as Cimetidine is ability to inhibit both basal and stimulated secretion of gastric acid
This allows them to be used to accelerate the healing of duodenal and gastric ulcers
Some adverse effects of Cimetidine include:
Dizziness
Lethargy and fatigue
Hallucinations
Seizures
Although all the H2 histamine receptor antagonists have similar therapeutic effectivness, Cimetidine has the most side effects when compared with the other H2 antagonists
Even still, adverse effects are minimal and rare
Like Cimetidine, Ranitidine is a competitive H2 histamine receptor antagonist
It is hydrophilic and is unable to cross the blood brain barrier
Results in weak CNS and local anesthetic effects
Ranitidine also results in:
Decreased H+ ion output
Reduction in pepsin activity
Reduction of the total volume of gastric secretion
Grapefruit juice irreversibly inhibits and degrades the CYP-3A4 enzyme in the small intestine as well as translation of mRNA into protein.
The most likely constituents responsible for the interaction of grapefruit juice and other drugs are: glycosides, furanocoumarins, and sesquiterpen.
As a result of the inhibition of CYP-3A4, the first-pass metabolism of many drugs is decreased, and the bioavailability of these drugs is increased. Therefore, any drugs that are ingested orally and metabolized by CYP-3A4 should be avoided with grapefruit juice, especially those with active metabolites.
Caffeine is an adenosine receptor antagonist. It promotes the release of neurotransmitters and stimulates the medullary vagal, respiratory, and vasomotor centers. .
The overall result is an increased state of alertness, decreased drowsiness, elevated heart rate, and bronchodilation.
Drugs that inhibit or are metabolized by CYP1A2 may lead to an increase in plasma levels of caffeine, leading to potentially toxic effects such as delirium or seizure.
95% of caffeine is metabolized by CYP1A2, which makes it a great probe for the assessment of this enzyme’s activity.
It inhibits 11β-hydroxysteroid dehydrogenase, which is responsible for converting cortisone to cortisol, which makes it responsible for the levels of active glucocorticoids in the body
Tyramine acts as a neurotransmitter and gets taken up into nerve terminals and causes the release of catecholamines – dopamine, norepinephrine, and epinephrine.
There is a very dangerous interaction with MAO-Inhibitors because they block the function of the enzyme. The consumption of tyramine-rich foods (like chocolate) and MAO-Is can lead to hypertensive crisis because excess levels of tyramine displace other neurotransmitters.
Chocolate also contains tryptophan, which is essential for the catabolism of serotonin, and may be responsible for the feeling of overall happiness when consuming chocolate.
We tried to make this fun and we had to summarize the main points for each drug. To see our complete research please click the following link:
https://docs.google.com/document/d/194xWanHPfh6lGIeXuJCu0mQhehJn5AL0f7wvAGe0-Ms/edit?usp=sharing
**These are the most used. The rest are in the document.