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First Aid Pharmacology (ALL)
All the drugs from every section of first aid.
Terms in this set (224)
Antibiotics that block cell wall synthesis by inhibition of peptidoglycan CROSS-LINKING
Beta lactams. Penicillin, methicillin, ampicillin, piperacillin, cephalosporins, aztreonam, imipenem
Antibiotics that block peptidoglycan SYNTHESIS
bacitracin, vancomycin
Antibiotics that block nucleotide synthesis by inhibiting folic acid synthesis
sulfonamides, trimethoprim
Antibiotics that block DNA topoisomerases
Antibiotics that block mRNA synthesis
Antibiotics that damage DNA
Antibiotics that block protein synthesis at the 50S ribosomal subunit
Chloramphenicol, clindamycin, erythromycin (and other macrolides), linezolid, streptogramins (quinupristin, dalfopristin)
Antibiotics that block protein synthesis at the 30S ribosomal subunit
Aminoglycosides (gentamicin, neomycin, amikacin, tobramycin, streptomycin) and tetracyclins
Penicillin G is the ____ form; Pencillin V is the ___ form
Pen G = IV/IM
Pen V = oral
MOA: binds PBP to block peptidoglycan cross linking
Clinical use: bactericidal for gram (+) cocci/rods, gram (-) cocci (Neisseria), and spirochetes
Toxicity: hypersensitivity reactions (type II), hemolytic anemia
Oxacillin, nafcillin, dicloxacillin
MOA: binds to PBP to block peptidoglycan cross linking; beta lactamase resistant due to bulky R group
Clinical use: bactericidal, narrow spectrum- staph aureus only (except MRSA which is still resistant)
Toxicity: hypersensitivity reactions (type II), interstitial nephritis
Ampicillin, amoxicillin
MOA: binds to PBP to block peptidoglycan cross linking; wider spectrum than regular penicillin
Clinical use: bactericidal for gram (+) cocci/rods, gram (-) cocci, spirochetes; extended to cover H. influenza, E. Coli, L. monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci
Toxicity: hypersensitivity reactions (type II), ampicillin rash, pseudomembranous colitis
Ampicillin and amoxicillin HELPSS kill enterococci
H. influenzae, E. coli, L. monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci (extended spectrum penicillins)
Ticarcillin, piperacillin
MOA: binds to PBP to block peptidoglycan cross linking
Clinical use: extended spectrum penicillin (so already bactericidal for gram (+) cocci/rods, gram (-) cocci, and spirochetes; also covers Pseudomonas spp and gram (-) rods
Toxicity: hypersensitivity reactions (type II)
Beta lactamase inhibitors: CAST
Clavulanic Acid, Sulbactam, Tazobactam
Cefazolin, cephalexin
MOA: 1st generation beta lactam drugs that inhibit cell wall synthesis
Clinical use: bactericidal for gram (+) COCCI, PEcK: Proteus mirabilis, E. coli, Klebsiella; cefazolin used prior to surgery to prevent S. aureus wound infections
Toxicity: hypersensitivity rxns, vitamin K deficiency, potentiate nephrotoxicity of aminoglycosides
Cefoxitin, cefaclor, cefuroxime
MOA: 2nd generation beta lactam drugs that inhibit cell wall synthesis
Clinical use: bactericidal for gram (+) COCCI, HEN PEcKS- Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp, Proteus mirabilis, E. coli, Klebsiella, Serratia marcescens
Toxicity: hypersensitivity rxns, vitamin K deficiency, potentiate nephrotoxicity of aminoglycosides
Ceftriaxone, cefotaxime, ceftazidime
MOA: 3rd generation beta lactam drugs that inhibit cell wall synthesis
Clinical use: bactericidal for serious gram (-) infxns resistant to other beta lactams; ceftriaxone good for meningitis and gonorrhea, ceftazidime good for pseudomonas
Toxicity: hypersensitivity rxns, vitamin K deficiency, potentiate nephrotoxicity of aminoglycosides
MOA: 4th generation beta lactam drug that inhibits cell wall synthesis
Clinical use: bactericidal w/ increased activity again Pseudomonas and gram (+) organisms
Toxicity: hypersensitivity rxns, vitamin K deficiency, potentiate nephrotoxicity of aminoglycosides
Organisms not typically covered by cephalosporins are LAME
Listeria, Atypicals (chlamydia, mycoplasma), MRSA, and Enterococci
MOA: monobactam that is resistant to beta lactamases!!!! prevents peptidoglycan cross linking by binding to PBP3
Clinical use: bactericidal for gram (-) RODS only, no activity against gram (+)s or anaerobes; good for pts w/ penicillin allergies or renal insufficiency that can't tolerate aminoglycosides
Toxicity: no cross reactivity w/ penicillins
MOA: imipenem = beta lactamase resistant carbapenem that blocks peptidoglycan cross linking, always administered with cliastatin (inhibits renal dehydropeptidase I to slow inactivation of imipenem)
Clinical use: bactericidal for LIFE THREATENING INFECTIONS due to gram (+) cocci, gram (-) rods, and anerobes when other meds have failed (limits due to seizure potential)
Toxicity: CNS toxicity (seizures) at high plasma levels
MOA: inhibits cell wall peptidoglycan SYNTHESIS by binding D-ala D-ala portion of precursors
Clinical use: bactericidal for gram (+)s only, reserve for serious/multidrug resistant orgs such as MRSA, enterococci and C diff
Toxicity: diffuse flushing/"red man syndrome" when infused too quickly; nephrotoxicity/ototoxicity/thrombophlebitis (some)
Gentamicin, neomycin, amikacin, tobramycin, streptomycin, spectinomycin
MOA: work at the 30S ribosomal subunit to inhibit formation of the initiation complex and cause misreading of the mRNA
Clinical use: bactericidal for serious gram (-) RODS; neomycin for bowel surgery
Toxicity: nephrotoxicity, neuromuscular blockade, ototoxocity, teratogenic
"Mean" GNATSS caNNOT kill anaerobes
aMINoglycosides: Gentamicin, Neomycin, Amikacin, Streptomycin, Spectinomycin; Nephrotoxic, Neuromuscular blockade, Ototoxic, Teratogenic; can't kill anaerobes because require O2 for uptake into the cell
Tetracycline, minocycline, doxycycline
MOA: work at the 30S ribosomal subunit to prevent attachment of charged tRNA to the A site
Clinical use: bacterioSTATIC against Borrelia burgdorferi, Mycoplasma pneumoniae, Rickettsia/Chlamydia (since drug accumulates intracellularly); *
Do not take with milk, antiacids, or iron bc divalent cations inhibit absorption
Toxicity: discoloration of teeth and inhibition of bone growth in kids, photosensitivity, CI in pregnancy
doxycycline is fecally eliminated and can be given to ppl w/ renal impairment
Antibiotic of the tetracycline family, but rarely used as an antibiotic. Has ADH antagonist properties, so used as a diuretic in SIADH.
Azithromycin, clarithromycin, erythromycin
MOA: binds to the 23S rRNA of the 50s ribosomal subunit to inhibit protein synthesis by blocking translocation
Clinical use: bacteriostatic against atypical pneumonias (mycoplasma, chlamydia, legionella), STDs (chlamydia) and gram (+) cocci
Toxicity: MACRO- Motility issues, Arrythmia (due to prolonged QT interval), acute Cholestatic hepatitis, Rash, eOsinophilia
* may specifically increase serum concentration of theophyllines and oral anticoagulants
MOA: works at 50S ribosomal subunit to block the action of peptidyltransferase
Clinical use: bacterioSTATIC against meningitis (H. influenzae, N. meningitidis, S. pneumo)
Toxicity: anemia, aplastic anemia (dose independent), gray baby syndrome (in premies bc they lack liver UDP-glucuronyl transferase)
MOA: works at 50S ribosomal subunit to block peptide transfer
Clinical use: bacterioSTATIC against anaerobic infections above the diaphragm
Toxicity: C. diff colitis
MOA: PABA antimetabolites that inhibit dihydropterate synthase
Clinical use: bacterioSTATIC against gram (+), gram (-), nocardia, chlamydia; triple sulfas or just sulfamethoxazole for simple UTI
Toxicity: hypersensitivity, hemolysis in G6PD deficiency, nephrotoxicity, photosensitivity, kernicterus in infants, displaces other drugs from albumin (ESP WAFARIN)
MOA: inhibits bacterial dihydrofolate reductase
Clinical use: bacterioSTATIC use in combination w/ SMX for UTIs, Shigella, Salmonella, PJP
Toxicity: megaloblastic anemia/leukopenia/granulocytopenia (may be less w/ leucovorin rescue)
(Ie ciprofloxacin)
MOA: inhibits DNA gyrase (topo II) and topo IV
Clinical use: bacteriCIDAL for gram (-) rods of urinary and GI tracts, Neisseria, some gram (+)s
Toxicity: TENDON DAMAGE --> tendonitis, tendon rupture (ppl >60 yrs or on prednisone), leg cramps/myalgias, CI in pregnant women due to cartilage damage
MOA: forms free radicals in bacterial (and protozoal) cells causing DNA damage
Clinical use: PET A Gross Guy on the Metro- h. Pylori, Entamoeba, Trichomonas, Anaerobes, Giardia, Gardnerella vaginalis
Toxicity: disulfiram reaction with alcohol
MOA: inhibits synthesis of mycolic acids (only bacterial have the catalase needed to activate it)
Clinical use: TB (only one that can be used as solo prophylaxis)
Toxicity: INH Injures Neurons and Hepatocytes; also causes B6 deficiency
MOA: inhibits DNA dependent RNAP
Clinical use: TB, in combo w/ dapsone for leprosy, prophylaxis against neisseria meningitis in kids
Toxicity: Orange body fluids, induces P450 enzymes
MOA: acidifies environment of phagolysosomes of macrophages that have engulfed TB
Clinical use: TB
Toxicity: hyperuricemia, hepatotoxicty
MOA: inhibits carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase
Clinical use: TB
Toxicity: red-green colorblindness/optic neuritis (CI in kids <6yo)
Amphotericin B
MOA: binds ergosterol, forming pores in membrane that allow leakage of electrolytes
Clinical use: serious, SYSTEMIC mycoses- cryptococcus, blastomyces, coccidioides, histoplasma, candida, mucor
Toxicity: fever/chills (shake and bake), hypotension, nephrotoxicity (lessened by hydration and supplementation of K/Mg), arrhythmias, anemia, IV phlebitis
MOA: same as Ampho B, but topical only bc too toxic for systemic use
Clinical use: "swish and swallow" for oral candidiasis, topical for diaper rash or vaginal candidiasis
Fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole, posaconazole
MOA: inhibit fungal sterol synthesis by inhibiting the P450 that converts lanosterol to ergosterol
Toxicity: testosterone synthesis inhibition (esp ketoconazole), liver dysfunction due to P450 inhibition
Clinical use: chronic suppression of cryptococcal meningitis in AIDS patients, candida infxns of all types
Clinical use: blastomycoses, aspergillus, coccidioides, histoplasma
Clinical use: topical fungal infections
MOA: inhibits DNA/RnA biosynthesis by conversion to 5-FU by cytosine deaminase
Clinical use: systemic fungal infections-- especially cryptococcal MENINGITIS ("flu" right into the CNS) in combo w/ ampho B
Toxicity: bone marrow suppression (duh... it's 5-FU)
Caspofungin, micafungin
MOA: inhibits cell wall synthesis by inhibiting synthesis of B-glucan (you can see right through casper the ghost)
Clinical use: "deep" infections like invasive aspergillosis, candida (you can see through casper to the deep infections)
Toxicity: flushing due to histamine release
MOA: inhibits fungal squalene epoxidase
Clinical use: dermatophytoses (esp onchomycosis)
Toxicity: abnormal LFTs, visual disturbances
MOA: interferes w/ microtubule function --> disruption of mitosis
Clinical use: oral treatment of superficial infections, inhibits growth of dermatophytes (deposits in keratin containing tissues)
Toxicity: teratogenic, carcinogenic, confusion/HA, induces P450 and warfarin metabolism
MOA: blocks detoxification of heme into hemozoin, accumulated heme is toxic to plasmodia
Clinical use: plasmodial species other than falciparum (too much resistance)
Toxicity: retinopathy
Treatment for P. falciparum
Use combo of artemether/lumifantrine or atovaquone/proguanil
Clinical use: life threatening malaria
Clinical use: toxoplamosis (often with sulfadiazine)
Clinical use: trypanosoma brucei (African sleeping sickness); suramin for blood-borne disease or melarsoprol for CNS penetration
Clinical use: trypanosoma cruzi (Chagas)
Sodium stibogluconate
Clinical use: leishmaniasis
Mebendazole, albendazole
MOA: selective inhibition of parasitic microtubules, thereby blocking the uptake of glucose and other nutrients, resulting in the gradual immobilization and eventual death of the helminths
Clinical use: roundworms (pinworms, ascaris lumbricoides, strongyloides stercoralis, toxocara canis/visceral larva migrans), hookworms (ancylostoma duodenale and necator americanus), some tapeworms (neurocysticercosis from injection of taenia solium eggs, echinococcus from dog feces)
Toxicity: CI in pregnancy
Pyrantel pamoate
MOA: neuromuscular depolarizing agent, causes contraction then paralysis in helminths (loose grip on wall of intestine and pass in stool naturally)
Clinical use: pinworms, ascaris, hookworms (ancylostoma and necator)
MOA: enhances inhibitory neurotransmission by opening glutamate gated chloride channels
Clinical use: primarily for Onchocerca volvulus (IVERmectin for rIVER blindness), also strongyloides
MOA: inhibitor of arachidonic acid metabolism in filarial microfilaria
Clinical use: Loa loa, Wuchereria bancrofti (elephantiasis)
MOA: increased cell permeability to calcium, thereby causing contraction/paralysis and allows destruction by immune system
Clinical use: tapeworms and flukes
Zanamivir, oseltamivir
MOA: inhibits influenza neuraminidase (decreasing release of new viruses)
Clinical use: treatment and prevention of influenza A AND B
MOA: competitively inhibits IMP dehydrogenase to stop synthesis of guanine nucleotides
Clinical use: RSV, chronic hep C
Toxicity: hemolytic anemia, SEVERE TERATOGEN
MOA: guanosine analog, preferentially inhibits viral DNAP bc phosphorylation by viral thymidine kinase required for activity; CHAIN TERMINATOR
Clinical use: HSV and VZV; no activity against CMV and no effect on latent forms of HSV/VZV
-Valacyclovir has better oral availability
MOA: guanosine analog, preferentially inhibits viral DNAP bc phosphorylation by viral kinase required for activity; CHAIN TERMINATOR
Clinical use: CMV, especially in immunocompromised
-Valganciclovir has better oral availability
Toxicity: leukopenia/neutropenia/thrombocytopenia, renal toxicity
MOA: inhibits viral DNA polymerase by binding to PPi binding site of enzyme, no viral kinase activation required; CHAIN TERMINATOR
Clinical use: CMV retinitis when ganciclovir fails, acyclovir resistant HSV
Toxicity: nephrotoxicity
MOA: inhibits viral DNAP, does not require viral kinase activation
Clinical use: CMV retinitis in immunocompromised patients, acyclovir reistant HSV
Toxicity: nephrotoxicity-- coadminister w/ probenecid and IV saline to reduce
Protease inhibitors
"Navir tease a protease"
MOA: stops cleavage of HIV polypeptide into functional parts, thus preventing maturation of new viruses
Clinical use: HIV
Toxicity: hyperglycemia, GI intolerance, lipodystrophy; nephropathy, hematuria (indinavir)
-Ritonavir inhibits P450 enzymes
Tenofovir, emtricitabine, abacavir, lamivudine, zidovudine, didanosine, stavudine
MOA: competitive inhibitor of HIV reverse transcriptase (terminate DNA chain bc lack a 3' OH)
Clinical use: HIV active infection, ZDV also used for prophylaxis and during pregnancy to reduce fetal transmission
Toxicity: bone marrow suppression (alleviated by GCSF and EPO, peripheral neuropathy, lactic acidosis, rash
*if patient has concurrent Hep B infection, use tenofovir
Nevirapine, efavirenz, delavirdine
MOA: allosterically inhibit HIV reverse transcriptase
Toxicity: reversible bone marrow suppression, peripheral neuropathy, lactic acidosis, rash
MOA: reversibly inhibits HIV integrase
Toxicity: hypercholesterolemia
α- chronic hep B and C, Kaposi's sarcoma
β- MS
γ- NADPH oxidase deficiency (CGD)
Toxicity: neutropenia, myopathy
Antibiotics to avoid in pregnancy-- SAFe Children Take Really Good Care
Sulfonamides --> kernicterus
Aminoglycosides --> ototoxicity
Fluoroquinolones --> cartilage
Clarithromycin --> embryotoxic
Tetracylines --> discolored teeth, inhibits bone growth
Ribavirin --> teratogenic
Griseofulvin --> teratogenic
Chloramphenicol --> gray baby
MOA: binds to cyclophilins --> inhibits calcineurin --> prevents production of IL-2 --> no differentiation/activation of T cells
Clinical use: suppress organ rejection after transplant
Toxicity: nephrotoxic, HTN, hyperlipidemia, hyperglycemia, tremor, gingival hyperplasia, hirsutism
Tacrolimus (FK-506)
MOA: binds FK binding protein, inhibiting calcineurin and secretion of IL-2 (no T cell activation)
Clinical use: organ transplant recipients
Toxicity: nephrotoxic, HTN, hyperlipidemia, hyperglycemia, tremor, *NO GINGIVAL HYPERPLASIA/HIRSUTISM
Sirolimus (rapamycin)
MOA: inhibits mTOR to inhibit T cell PROLIFERATION in response to IL-2
Clinical use: immunosuppression after kidney transplant (use w/ cyclosporine and corticosteroids)
Toxicity: hyperlipidemia, thrombocytopenia, leukopenia
MOA: precursor of 6-MP, toxic to proliferating lymphocytes
Clinical use: kidney transplantation, autoimmune disoders (glomerulonephritis and hemolytic anemia)
Toxicity: BM suppression (duh); 6-MP is metabolized by xanthine oxidase so toxic effects increased when given w/ allopurinol
Muromonab-CD3 (OKT3)
MOA: monoclonal antibody that binds to CD3 on surface of T cells, blocks T cell signal transduction
Clinical use: prevents ACUTE rejection of kidney transplantation
Toxicity: mouse antibody, so use is limited till when the patient develops antibodies to the antibody
Aldesleukin (IL-2)
Clinical use: renal cell carcinoma, metastatic melanoma
Granulocyte colony stimulating factor-- only granulocytes b/c "Filgrastim is Finicky"
Clinical use: bone marrow recovery
Granulocyte/macrophage colony stimulating factor
Clinical use: bone marrow recovery
Oprelvekin (IL-11)
Clinical use: thrombocytopenia
Infliximab, adalimumab
MOA: TNF α inhibtors
Clinical use: Chron's disease, RA, psoriatic arthritis, ankylosing spondylitis (infliximab only)
MOA: inhibits Gp IIb/IIIa
Clinical use: prevent cardiac ischemia is unstable angina or pts treated w/ percutaneous coronary intervention
Clinical use: targets HER2 receptor in HER2nu positive breast cancer
MOA: targets CD20
Clinical use: B cell non-Hodgkin's lymphoma
MOA: targets IgE
Clinical use: additional treatment for severe asthma
MOA: binds insulin receptor (tyrosine kinase activity), induces glucose--> glycogen in liver and muscle, muscles also increase protein synthesis and K+ uptake, adipose takes up TG
Clinical use: DM type 1 and 2, gestational diabetes, life threatening hyperkalemia, stress induced hyperglycemia
Toxicities: hypoglycemia
Short acting insulins versus long acting insulins
Lispro, aspart and glulisine = rapid acting
Glargine and detemir = long acting
MOA: mechanism unknown; decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake (insulin sensitivity)
Clinical use: 1st line therapy in type 2 DM, can be used in patients w/out islet function
Toxicities: lactic acidosis (contraindicated in renal failure)
Tolbutamide, Chlorpropamide
1st generation sulfonylureas
MOA: close K+ channels in β cell membrane, cell depolarizes → Ca2+ influx → insulin release
Clinical use: stimulate release of endogenous insulin in type 2 DM (useless in type 1)
Toxicities: disulfiram like effects
Glyburide, Glimepiride, Glipizide
2nd generation sulfonylureas
MOA: close K+ channels in β cell membrane, cell depolarizes → Ca2+ influx → insulin release
Clinical use: stimulate release of endogenous insulin in type 2 DM (useless in type 1)
Toxicities: hypoglycemia
Pioglitazone, Rosiglitazone
MOA: increase insulin sensitivity in peripheral tissue, binds to PPAR-γ nuclear transcription regulator
Clinical use: used as a monotherapy in type 2 DM or in combo w/ other diabetes drugs
Toxicity: weight gain, edema, hepatotoxicity, heart failure
Acarbose, Miglitol
α-glucosidase inhibitors
MOA: inhibition at intestinal brush border delays sugar hydrolysis and glucose absorption → ↓ postprandial hyperglycemia
Clinical use: monotherapy in type 2 DM or w/ other diabetes drugs
Toxicities: GI upset
MOA: ↓ glucagon
Clinical use: type 1 AND 2 DM
Toxicities: hypoglycemia, nausea, diarrhea
Exenatide, liraglutide
GLP-1 analogs
MOA: ↑ insulin, ↓ glucagon release
Clinical use: type 2 DM
Toxicities: N/V, pancreatitis
Linagliptin, saxagliptin, sitagliptin
DPP-4 inhibitors
MOA: ↑ insulin, ↓ glucagon release
Clinical use: type 2 DM
Toxicities: mild UTI/URI
Propylthiouracil, methimazole
MOA: block peroxidase, inhibiting organification of iodide and coupling of thyroid hormone synthesis; propylthiouracil also blocks 5'-deiodinase so T4 can't → T3
Clinical use: hyperthyroidism
Toxicity: agranulocytosis, aplastic anemia, hepatotoxicity (propylthiouracil)
Levothyroxine, triiodothyronine
MOA: thyroxine replacement
Clinical use: hypothyroidism, myxedema
Toxicity: tachycardia, heat intolerance, tremors, arrythmias
MOA: long acting somatostatin analog
Clinical use: acromegaly, carcinoid, gastrinoma, glucagonoma, acute variceal bleeds
Toxicity: steatorrhea
Clinical use: stimulates labor, uterine contractions, milk let down; controls uterine hemorrhage
Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone
MOA: decrease the production of leukotrienes and prostraglandins by inhibiting phospholipase A2 and expression of COX2
Clinical use: addison's disease, inflammation, immune suppression, asthma; prednisone used for cancer chemotherapy for CLL, non-Hodgkin's lymphoma
Toxicity: iatrogenic cushing's disease- buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin/easy bruising, osteoporosis, adrenocortical atrophy, peptic ulcers, hyperglycemia, cataracts, hypertension, psychosis
Cimetidine, ranitidine, famotidine, nizatidine
H₂ blockers (take H₂ blockers before you "dine")
MOA: REVERSIBLY block histamine H₂ receptors → ↓ H+ secretion by parietal cells
Clinical use: peptic ulcer, mild esophageal reflux
Toxicity: Cimetidine = potent inhibitor of P450 enzymes, also has antiandrogenic effects (prolactin release, gynecomastia, impotence, ↓ libido in males), can cross BBB and placenta
-Cimetidine and ranitidin ↓ renal excretion of creatinine
Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
MOA: IRREVERSIBLY inhibits H+/K+ ATPase in stomach parietal cells
Clinical use: peptic ulcer, gastritis, esophageal reflux, Zollinger Ellison syndrome
Toxicity: increased risk of C. diff infection, pneumonia; hip fractures, decreased serum Mg2+ with long term use
Bismuth, sucralfate
MOA: bind to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in mucous layer
Clinical use: increase ulcer healing, traveler's diarrhea
MOA: a PGE1 analog, increases production and secretion of gastric mucous barrier, decreases acid production
Clinical use: prevention of NSAID induced peptic ulcers; maintenance of patent ductus arteriosus; induction of labor
Toxicity: CI in women of childbearing potential (abortifacient)
Aluminum hydroxide
Clinical use: antacid
Toxicity: hypokalemia (all antacids), constipation ("aluminimum" amount of feces), hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
Magnesium hydroxide
Clinical use: antacid
Toxicity: hypokalemia (all antacids), diarrhea, hyporeflexia, hypotension, cardiac arrest
Calcium carbonate
Clinical use: antacid
Toxicity: hypokalemia (all antacids), hypercalcemia, rebound acid increase
Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose
MOA: provide osmotic load to draw water out
Clinical use: constipation; lactulose also treats hepatic encephalopathy since gut flora degrade it into lactic acid and acetic acid, which promote nitrogen excretion at NH4+
Toxicity: diarrhea/dehydration
MOA: combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid; activated by colonic bacteria
Clinical use: ulcerative colitic, Chron's disease
Toxicity: sulfonamide toxicity, reversible oligospermia
MOA: 5-HT3 antagonist; powerful central acting antiemetic (At a party but feeling queasy? Keep ON DANCing!")
Clinical use: control vomiting postop and in chemotherapy patients
Toxicity: headache, constipation
MOA: D2 receptor antagonist; increases resting tone, contractility, LES tone, motility (does NOT influence colon transport time)
Clinical use: diabetic and post surgery gastroparesis, antiemetic
Toxicity: increases parkinsonian effects, drug interaction with digoxin and diabetic agents; CI in patients with small bowel obstruction or parkinson's
MOA: cofactor for the activation of antithrombin, decreases thrombin and factor Xa
Clinical use: immediate anticoagulation for pulmonary embolism, acute coronary syndrome, MI, and DVT; used during pregnancy (≠ cross placenta); follow PTT to monitor
Toxicity: bleeding, HIT (IgG antibodies against heparin bound to platelet factor 4 → platelets activated → thrombosis and thrombocytopenia), osteoporosis, drug-drug interactions
Protamine sulfate
Clinical use: rapid reversal of heparin toxicity (positively charged molecule binds negatively charged heparin)
Low molecular weight heparins
MOA: act more on factor Xa, have better bioavailability and 2-4x longer half-life; can be admin subQ and without lab monitoring; not easily reversible
Lepirudin, bivalirudin
MOA: derivatives of hirudin, the anticoagulant used by leeches- inhibits thrombin
Clinical use: alternative for heparin in patients w/ HIT
MOA: interferes w/ normal synthesis and γ-carboxylation of vitamin K dependent clotting factors II, VII, IX and X and proteins C and S; monitor PT
Clinical use: chronic anticoagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in a fib); NOT used in pregnant women bc crosses the placenta
Toxicity: bleeding, teratogenic, skin/tissue necrosis, drug-drug interactions (metabolized by P450s)
Alteplase (tPA), reteplase (rPA), tenecteplase (TNK-tPA)
MOA: directly or indirectly aid conversion of plasminogen → plasmin, which cleaves thrombin and fibrin clots; ↑ PT and PTT, no changes in platelet count
Clinical use: early MI, early ischemic stroke, direct thombolysis of severe pulmonary embolism
Toxicty: bleeding (CI in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding diatheses, or severe HTN)
Aminocaproic acid
MOA: inhibitor of fibrinolysis
Clinical use: treatment of tPA toxicity
MOA: IRREVERSIBLY inhibits COX1 and COX2 by covalent acetylation; lasts until platelets are produced; increases bleeding time, decreases TXA2 and prostaglandins
Clinical use: antipyretic, analgesic, anti inflammatory, antiplatelet (decreases aggregation)
Toxicity: gastric ulceration, tinnitus (CNVIII); chronic use can lead to acute renal failure, interstitial nephritis, upper GI bleeding; Reye's syndrome in children with viral infxn; overdose causes mixed respiratory alkalosis (stimulation of respiratory centers → hyperventilation) and metabolic acidosis
Clopidogrel, ticlopidine, prasugrel, ticagrelor
MOA: inhibit platelet aggregation by IRREVERSIBLY blocking ADP receptors; inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen
Clinical use: acute coronary syndrome, coronary stenting, reduction of incidence or recurrence of thombotic stroke
Toxicity: ticlopidine causes neutropenia
Cilostazol, dipyridamole
MOA: phosphodiesterase III inhibitor; ↑ cAMP in platelets, thus inhibiting platelet aggregation; vasodilators
Clinical use: intermittent claudication, coronary vasodilation, prevention of stroke or TIAs, angina prophylaxis
Toxicity: facial flushing, hypotension, abd pain
Abcicimab, eptifibatide, tirofiban
MOA: bind the glycoprotein receptor IIb/IIIa on activated platelets, preventing aggregation
Clinical use: acute coronary syndrome, percutaneous transluminal coronary angioplasty
Toxicity: bleeding, thrombocytopenia
MOA: Folic acid analog that inhibits dihydrofolate reductase → ↓dTMP → ↓DNA and ↓ protein synthesis (acts on cells in the S phase)
Clinical use: leukemias, lymphomas, choriocarcinoma, sarcomas; non neoplastics- abortion, ectopic pregnancy, RA, psoriasis
Toxicity: myelosuppression (reversible w/ leucovorin rescue), macrovesicular fatty change in liver, mucositis, teratogenic
5 Fluorouracil (5-FU)
MOA: pyrimidine analog bioactivated to 5F-dUMP, which covalently complexes folic caid; complex inhibits thymidylate synthase → ↓ dTMP → ↓ DNA and protein synthesis (acts on cells in S phase)
Clinical use: colon cancer, basal cell carcinoma (topical)
Toxicity: myelosuppression (reversible w/ leucovorin), photosensitivity
Cytarabine (arabinofuranosyl cytidine)
MOA: pyrimidine analog → inhibition of DNAP (acts on cells in S phase)
Clinical use: leukemias, lymphomas
Toxicity: leukopenia, thrombocytopenia, megaloblastic anemia
Azathioprine, 6-mercaptopurine (6-MP), 6-thioguanine (6-TG)
MOA: Purine (thiol) analogs → ↓ de novo purine synthesis; activated by HGPRT (acts on cells in S phase)
Clinical use: leukemias
Toxicity: toxic to bone marrow, GI, liver; Azathioprine and G-MP metabolized by xanthine oxidase so ↑ toxicity if given w/ allopurinol (6-TG no need for dose reduction)
MOA: intercalates in DNA
Clinical use: Wilm's tumor, Ewing's sarcoma, rhabdomyosarcoma (childhood tumor's, "actin" out)
Toxicity: myelosuppression
Doxorubicin (adriamycin), danurubicin
MOA: generate free radicals, noncovalently intercalate in DNA → strand breaks in DNA → ↓ replication (all phases of cell cycle susceptible)
Clinical use: solid tumors (adriamycin is the A in CAF treatment plan for breast cancer), leukemias, lymphomas
Toxicity: cardiotoxic (dilated cardiomyopathy due to free radical damage-- dexrazoxane, iron chelating agent, lessens cardiotoxicity); toxic to tissues following extravasation
MOA: induces free radical damage, causing strand breaks in DNA (acts on cells in G2 phase)
Clinical use: testicular cancer (B in EBC and VBC), Hodgkin's lymphoma (B in ABVD)
Toxicity: pulmonary fibrosis, skin changes, minimal myelosuppression
Cyclophosphamide, ifosfamide
MOA: alkylate DNA at guanine residues, causing interstrand links; requires bioactivation in liver (all phases of cell cycle susceptible)
Clinical use: solid tumors (C in CMF/CAF for breast cancer), leukemia, lymphomas and some brain cancers
Toxicity: hemorrhagic cystitis, partially prevented w/ mesna
Carmustin, lomustine, semustine, steptozocin
MOA: alkylate DNA, cross BBB → CNS; require bioactivation in liver (all phases of cell cycle susceptible)
Clinical use: brain tumors (good CNS penetration), including glioblastoma multiforme
Toxicity: CNS toxicity (dizziness, ataxia)
MOA: alkylates DNA (all phases of cell cycle susceptible)
Clinical use: CML, ablation of patient's bone marrow before BMT
Toxicity: pulmonary fibrosis, hyperpigmentation
Vincristine, vinblastine
MOA: alkaloids that bind to tubulin in M phase and block polymerization of microtubules so that mitotic spindle can't form
Clinical use: solid tumors (vinblastine is V in VBC), leukemias (vincristine is V in VAMP for ALL), lymphoma (vinblastine is V in ABVD for hodgkins/soft tissue lymphomas, vincristine (oncovin) is O in MOPP for hodgkins/other lymphomas)
Toxicity: Vincristine (think trouble getting things moving) = neurotoxicity- areflexia, peripheral neuritis; paralytic ileus
Paclitaxel, other taxols
MOA: hyperstabilize polymerized microtubules in M phase so that mitotic spindle can't break DOWN
Clinical use: ovarian and breast carcinomas
Toxicity: myelosuppresion and hypersensitivity
Cisplatin, carboplatin
MOA: cross links DNA (alkylating agent, non cell cycle specific)
Clinical use: testicular (C in EBC/VBC), bladder, ovary, and lung carcinomas
Toxicity: nephrotoxicity and acoustic nerve damage; prevent nephrotoxicity w/ amifostine (free radical scavenger) and chloride diuresis
Etoposide, teniposide
MOA: inhibits topoisomerase II leading to DNA degredation (acts on cells in S and G2)
Clinical use: solid tumors (E in EBC for testicular CA), leukemias, lymphomas
Toxicity: myelosuppression, GI irritation, alopecia
MOA: inhibits ribonucleotide reductase → decreased DNA synthesis (S phase specific)
Clinical use: melanoma, CML, sickle cell disease (increases HbF)
Toxicity: bone marrow suppression, GI upset
Tamoxifen, raloxifene
MOA: SERMs- receptor antagonists in breast and agonists in bone; block the binding of estrogen to estrogen receptor-positive cells
Clinical use: breast CA tx and prevention, also helps prevent osteoporosis
Toxicity: tamoxifen- partial agonist in endometrium, so increased risk of endometrial cancer, hot flashes (raloxifene is endometrial antagonist, so no increased risk)
Trastuzumab (herceptin)
MOA: monoclonal Ab against HER-2, a tyrosine kinase; helps kill breast cancer cells that overexpress HER-2 (Ab dependent cytotoxicity?)
Clinical use: HER-2 positive breast CA
Toxicity: cardiotoxicity
Imatinib (gleevec)
MOA: philadelphia chromosome bcr-abl tyrosine kinase inhibitor
Clinical use: CML, GI stromal tumors
Toxicity: fluid retention
MOA: monoclonal Ab against CD20 (found on most B cell neoplasms)
Clinical use: non-Hodgkin's lymphoma, RA (with MTX)
MOA: small molecule inhibitor of forms of the B-Raf kinase w/ the V600E mutation
Clinical use: metastatic melanoma
MOA: monoclonal Ab against VEGF; inhibits angiogenesis
Clinical use: solid tumors
Ibuprofen, naproxen, indomethacin, diclofenac, ketorolac
MOA: reversibly inhibit COX1 and COX2, blocks prostaglandin synthesis
Clinical use: antipyretic, analgesic, anti-inflammatory; indomethacin used to close a PDA
Toxicity: interstitial nephritis, gastric ulcer (PGs protect gastric mucosa), renal ischemia (PGs vasodilate afferent arteriole)
MOA: selective reversible inhibitor of COX2 (found in inflammatory cells/vascular endothelium), but spares COX1 to help maintain gastric mucosa and has no effect on platelet function (TXA2 production is via COX1)
Clinical use: RA and osteoarthritis, patients w/ gastritis or ulcers
Toxicity: sulfa allergy
MOA: reversibly inhibits cyclooxygenase, most in CNS (inactivated peripherally)
Clinical use: antipyretic and analgesic, but NOT ANTI-INFLAMMATORY
Toxicity: overdose → hepatic necrosis (NAC is the antidote, regenerates glutathione)
Alendronate (other -dronates)
MOA: pyrophosphate analogs, bind hydroxyapatite in bone, inducing apoptosis in osteoclasts
Clinical use: osteoporosis, hypercalcemia, Paget's disease of bone
Toxicity: corrosive esophagitis (1st generation), osteonecrosis of the jaw
MOA: purine analog, competitively inhibits xanthine oxidase (↓ conversion of xanthine to uric acid)
Clinical use: gout; lymphoma/leukemia to prevent tumor lysis syndrome related nephropathy
Toxicity: increases the concentration of azathioprine and 6-MP; DO NOT GIVE w/ salicylates, uric acid clearance ↓
MOA: non-purine analog allosteric inhibitor of xanthine oxidase
Clinical use: gout, lymphoma/leukemia to prevent tumor lysis syndrome
Toxicity: increases concentration of azathioprine and 6-MP (metabolized by XO)
MOA: inhibition of uric acid reabsorption in proximal collecting tubule, also inhibits secretion of penicillin
Clinical use: gout, syphilis
MOA: binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation
Clinical use: gout
Glaucoma drugs
α agonists: ↓ aqueous humor synthesis
β antagonists: ↓ aqueous humor synthesis
Diuretics (acetazolamide): ↓ aqueous humor synthesis via inhibition of carbonic anhydrase
Cholinomimetics: ↑ outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
Prostaglandin (latanoprost, PGF2α): ↑ outflow of aqueous humor
Morphine, fentanyl, codeine, heroin, meperidine
(Opioid analgesics)
MOA: agonists at opioid receptors (mu = morphine, delta = enkephalin, kappa = dynorphin) to modulate synaptic transmission
** open K+ channels, close Ca2+ channels → ↓ synaptic transmission; inhibit release of ACh, NE, 5-HT, glutamate, substance P
Clinical use: pain, acute pulmonary edema
Toxicity: addiction, respiratory depression, constipation, miosis, additive CNS depression w/ other drugs; treat toxicity with naloxone or naltrexone
MOA: opioid receptor agonist
Clinical use: cough suppression
Diphenoxylate, loperamide
MOA: opioid receptor agonists
Clinical use: diarrhea
MOA: opioid receptor agonist
Clinical use: maintenance programs for opiate addicts
MOA: mu-opioid receptor PARTIAL agonist and kappa-opioid receptor agonist; produces analgesia
Clinical use: severe pain (migraine, labor); causes less respiratory depression that full opioid agonists
Toxicity: can cause opioid withdrawal sx if pt is also taking a full opioid agonist (competition for receptors); overdose not easily reversed w/ naloxone
MOA: very weak opioid agonist, also inhibits 5-HT and NE reuptake (works on multiple NT-- "tram it all" with tramadol)
Clinical use: chronic pain
Toxicity: decreases seizure threshold
MOA: increases Na+ channel inactivation
Clinical use: 1st line drug for generalized tonic-clonic seizures
-1st line drug for prophylaxis of status epilepticus
-may also be used for simple or complex partial seizures
Toxicity: nystagmus, ataxia, diplopia, SLE like syndrome, induction of P450s; chronic use --> gingival hyperplasia in kids, peripheral neuropathy, megaloblastic anemia (↓ folate absorption), teratogenic
MOA: increases Na+ channel inactivation
Clinical use: 1st line drug for simple/complex partial seizures and tonic-clonic seizures
-also 1st line drug for trigeminal neuralgia
Toxicity: diplopia, ataxia, agranulocytosis, hepatotoxicity, teratogen, induction of P450, SIADH, steven-johnson syndrome
MOA: blocks voltage gates Na+ channels
Clinical use: simple/complex partial seizures, tonic-clonic seizures
Toxicity: stevens-johnson syndrome
MOA: primarily inhibits high-voltage activated Ca 2+ channels
Clinical use: simple/complex partial seizures, tonic-clonic seizures
-also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder
Toxicity: sedation, ataxia
MOA: blocks Na+ channels, ↑ GABA action
Clinical use: simple/complex partial seizures, tonic-clonic seizures
-Also used for migraine prevention
Side effects: kidney stones, weight loss
MOA: ↑ GABA(A) action
Clinical use: simple/complex partial seizures, tonic-clonic seizures
1st line in children
Toxicity: induction of p450
Valproic acid
MOA: ↑ Na+ channel inactivation, ↑ GABA concentration
Clinical use:
absence seizueres!
-1st line drug for tonic-clonic seizures
-also used for simple/complex partial seizures, myoclonic seizures
Toxicity: rare but fatal hepatotoxicity, neural tube defects in fetus (CI in pregnancy), tremor, weight gain
MOA: blocks thalamic T-type Ca2+ channels
Clinical use: 1st line drug for absence seizures
Toxicity: GI distress, urticaria, stevens-johnson syndrome
MOA: ↑ GABA action by increasing the FREQUENCY of Cl- channel opening
Clinical use: 1st line for acute status epilepticus, also used for seizures of eclampsia (1st line is MgSO4)
Toxicity: dependence
MOA: inhibits GABA uptake
Clinical use: simple/complex partial seizures
MOA: IRREVERSIBLY inhibits GABA transaminase → ↑ GABA
Clinical use: simple/complex partial seizures
Phenobarbital, pentobarbital, thiopental, secobarbital
MOA: facilitate GABA(A) action by ↑ DURATION of Cl- channel opening, thus ↓ neuron firing (barbiDURATes ↑ DURATion of opening)
Clinical use: sedative for anxiety, insomnia
-thiopental for IV induction of anesthesia (high lipid solubility so action is rapidly terminated by redistribution into tissue)
Toxicity: contraindicated in porphyria patients; respiratory/cardiovascular/CNS depression, induces P450s
-overdose treatment is supportive
Triazolam, oxazepam, midazolam
MOA: short acting benzodiazepines, facilitate GABA(A) action by ↑ FREQUENCY of Cl- channel opening, ↓ REM sleep
Clinical use: anxiety, spasticity, detoxification (esp from alcohol withdrawal/DT), night terrors, sleepwalking, general anesthetic, insomnia (hypnotic effect)
midazolam most common IV anesthetic used for endoscopy
Toxicity: higher additive dependence due to short half life, additive CNS depression w/ alcohol, less risk of respiratory depression and coma than w/ barbiturates
MOA: competitive antagonist at GABA benzodiazepine receptor
Clinical use: reversal of benzodiazepine and zolpidem/zaleplon/eszopiclone (nonbenzodiazepine hypnotics)
Zolpidem, zaleplon, eszopiclone
MOA: act via the BZ1 subtype of GABA receptor
Clinical use: insomnia
Toxicity: ataxia, headaches, confusion; cause only modest day-after psychomotor depression and few amnestic effects; lower dependence risk than benzodiazepines
MOA: inhaled anesthetic
Effects: myocardial/respiratory depression, nausea/emesis, ↑ cerebral blood flow (↓ cerebral metabolic demand)
Toxicity: *
*, malignant hyperthermia
MOA: inhaled anesthetic
Effects: myocardial/respiratory depression, nausea/emesis, ↑ cerebral blood flow (↓ cerebral metabolic demand)
Toxicity: *
*, malignant hyperthermia
MOA: inhaled anesthetic
Effects: myocardial/respiratory depression, nausea/emesis, ↑ cerebral blood flow (↓ cerebral metabolic demand)
Toxicity: *
*, malignant hyperthermia
Nitrous oxide
MOA: inhaled anesthetics
Effects: myocardial/respiratory depression, nausea/emesis, ↑ cerebral blood flow (↓ cerebral metabolic demand)
Toxicity: expansion of trapped gas in a body cavity (no malignant hyperthermia like other inhaled anesthetics)
Isoflurane, sevoflurane
MOA: inhaled anesthetics
Effects: myocardial/respiratory depression, nausea/emesis, ↑ cerebral blood flow (↓ cerebral metabolic demand)
Toxicity: malignant hyperthermia
MOA: PCP analog that blocks NMDA receptors; cardiovascular stimulant; dissociative anesthetic
Clinical use: IV anesthetic
Toxicity: disorientation, hallucinations, bad dreams
MOA: potentiates GABA(A)
Clinical use: sedation in the ICU, rapid anesthesia induction, short procedures; less postoperative nausea than thiopental
Procaine, cocaine, tetracaine
Ester local anesthetics
MOA: block Na+ channels by binding to a specific receptor on INNER portion of the channel (most effective in rapidly firing neurons bc have to get inside a channel that has already been activated)
Clinical use: minor surgical procedures, spinal anesthesia
Toxicity: CNS excitation (depression of inhibitory centers), HTN or hypotension, arrhythmias (cocaine), hypersensitivity (if allergic to esters, give amides)
Lidocaine, mepivacaine, bupivacaine
Amide local anesthetics (amide's have two I's)
MOA: block Na+ channels by binding to a specific receptor on INNER portion of the channel (most effective in rapidly firing neurons bc have to get inside a channel that has already been activated)
Clinical use: minor surgical procedures, spinal anesthesia
Toxicity: CNS excitation (depression of inhibitory centers), HTN or hypotension, severe cardiotoxicity w/ bupivacaine
Local anesthetics principles
Principles: can be given with vasoconstrictors (usually epinephrine) to enhance local action - ↓ bleeding, ↑ anesthesia by ↓ systemic concentration
-Infected tissue is more acidic, but alkaline anesthetics are charged and cannot penetrate membrane effectively → need more anesthetic
-Size factor predominates over myelination, so order of nerve blockade = small myelinated > small unmyelinated > large myelinated > large unmyelinated
-Order of loss: (1) pain, (2) temperature, (3) touch, (4) pressure
MOA: DEPOLARIZING neuromuscular blocking drug; strong ACh receptor antagonist → produces sustained depolarization and prevents muscle contraction
Clinical use: muscle paralysis in surgery or mechanical ventilation
Toxicity: hypercalcemia, hyperkalemia, malignant hyperthermia
Reversal of succinycholine
-Phase I (prolonged depolarization): no antidote available, cholinesterase inhibitors would just potentiate the depolarization block
-Phase II (repolarized but blocked): ACh receptors are available, but desensitized; antidote = cholinesterase inhibitors (like neostigmine)
MOA: NONDEPOLARIZING neuromuscular blocking drug; competes w/ ACh for receptors
Reversal of blockade: neostigmine, edrophonium, other cholinesterase inhibitors
MOA: prevents the release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle
Clinical use: treatment of malignant hyperthermia and neuroleptic malignant syndrome
Bromocriptine, pramipexole, ropinirole
MOA: dopamine agonists
Clinical use: Parkinson's disease (when they still have endogenous DA)
MOA: may increase dopamine release
Clinical use: Parkinson's disease; also used as an antiviral against influenza A and rubella
Toxicity: ataxia
MOA: increase level of DA in the brain; L-dopa can cross the BBB (unlike regular DA) and is converted by dopa darboxylase in the CNS → DA
-Carbidopa = peripheral decarboxylase inhibitor, given w/ L-dopa to ↑ bioavailability of L-dopa in brain/limit peripheral side effects
Clinical use: Parkinson's disease
Toxicity: arrhythmias from increased peripheral formation of catecholamines; long term use may → dyskinesia following administration w/ akinesia between doses
MOA: selective inhibitor ofMAO-B (which preferentially metabolizes DA over NE and 5-HT), thereby ↑ availability of DA
Clinical use: adjunctive agent to L-dopa in treatment of PD
Toxicity: may enhance adverse effects of l-dopa
MOA: NMDA receptor antagonist, helps prevent excitotoxicity (mediated by Ca2+)
Clinical use: Alzheimer's
Toxicity: dizziness, confusion, hallucinations
Donepezil, galantamine, rivastigmine
MOA: acetylcholinesterase inhibtors
Clinical use: Alzheimer's
Toxicity: nausea, dizziness, insomnia
MOA: 5-HT 1B/1D agonist; inhibits trigeminal nerve activation; prevents vasoactive peptide release; induces vasoconstriction
Clinical use: acute migraine, cluster headache attacks
Toxicity: coronary vasospasm (CI in patients w/ CAD or prinzmetal's angina
Tetrabenazine, reserpine
MOA: inhibit VMAT (vesicular monoamine transporter); limit DA vesicle packaging and release (since one of the problems in Huntington's is ↑ DA)
Clinical use: Huntington's
MOA: DA receptor antagonist
Clinical use: antipsychotic, also used in Huntington's (since one of the problems in Huntington's is ↑ DA)
Appropriate agents for treating ESSENTIAL HTN
Diuretics, ACE inhibitors, ARBs, calcium channel blokers
Appropriate agents for treating HTN w/ CHF
Diuretics, ACE inhibitors/ARBs, β blockers (generally only in compensated CHF), K+ sparing diuretics
Appropriate agents for treating HTN w/ DM
ACE inhibitors/ARBs, calcium channel blockers, diurectics, β blockers, α blockers
**ACE inhibitors are protective against diabetic nephropathy
Nifedipine, verapamil, diltiazem, amlodipine
Ca2+ channel blockers!
MOA: block voltage gated L type calcium channels of cardiac and smooth muscle and ∴ reduce muscle contractility
-Amlodipine and nifedipine have the most effect on vascular smooth muscle; verapamil has the most effect on the heart
Clinical use: HTN, angina, arrhythmias (except nifedipine), Prinzmetal's angina, raynaud's
Toxicity: cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation
MOA: ↑cGMP → smooth muscle relaxation; vasodilates aterioles > veins (∴ afterload reduction)
Clinical use: severe HTN, CHF. 1st line therapy for HTN in pregnancy (w/ methyldopa)
Toxicity: compensatory tachycardia (often coadministered w/ a β blocker to prevent this) -- CI in patients w/ angina or CAD, fluid retention, angina, lupus-like syndrome
MOA: short acting ↑cGMP via direct release of NO
Clinical use: malignant HTN
Toxicity: can cause cyanide toxicity (releases cyanide)
MOA: D1 receptor agonist; causes coronary, peripheral, renal and splanchnic vasodilation; ↓ BP and ↑ natriuresis (excretion of sodium in the urine via action of the kidneys)
Clinical use: malignant HTN
Nitroglycerin, isosorbide dinitrate
MOA: vasodilate by releasing NO in smooth muscle, causing increase in cGMP and smooth muscle relaxation; dilates veins >> arteries (so ↓ preload)
Clinical use: angina, pulmonary edema
Toxicity: reflex tachycardia, hypotension, flushing, headache, "Monday disease"
Nitrates, effects on: EDV, BP, Contractility, HR, ejection time, MVO2
Nitrates affect preload (dilate veins >> arteries)
-Contractility: ↑ (reflex response)
-HR: ↑ (reflex response)
-ejection time: ↓
β blockers, effects on: EDV, BP, Contractility, HR, ejection time, MVO2
β blockers affect afterload
-Contractility: ↓
-ejection time: ↑
Nitrates plus β blockers, effects on: EDV, BP, Contractility, HR, ejection time, MVO2
Nitrates affect preload (dilate veins >> arteries)
-EDV: no effect or ↓
-Contractility: little/no effect
-ejection time: little/no effect
Lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin
MOA: inhibit conversion of HMG-CoA to mevalonate (HMG-CoA reductase = rate limiting step in cholesterol synthesis)
Clinical use: ↓↓↓ LDL cholesterol
-↑ HDL cholesterol
-↓ TriG
Toxicity: hepatotoxicity (↑LFTs), rhabdomyolysis
Niacin (B3)
MOA: inhibits lipolysis in adipose tissue; reduces hepatic VLDL secretion into circulation
Clinical use: ↓↓ LDL cholesterol
-↑↑ HDL cholesterol (most of all options)
-↓ TriG
Toxicity: red/flushed face (↓ by aspirin or long term use), hyperglycemia (→acanthosis nigricans), hyperuricemia (exacerbates gout)
Cholestryamine, colestipol, colesevelam
Bile acid resins
MOA: prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more
Clinical use: ↓↓ LDL cholesterol
- slight ↑ HDL cholesterol
- slight ↑ TriG
Toxicity: patients hate it!! tastes bad, causes GI upset; ↓ absorption of fat soluble vitamins; cholesterol gallstones
MOA: prevents cholesterol reabsorption at small intestine brush border
Clinical use: ↓↓ LDL cholesterol (no effect on HDL or TriG)
Gemfibrozil, clofibrate, bezafibrate, fenofibrate
MOA: upregulate LPL to ↑ TriG clearance
Clinical use: ↓ LDL cholesterol
-↑ HDL cholesterol
-↓↓↓ TriG (most of all the options)
Toxicity: myositis, hepatotoxicity (↑ LFTs), cholesterol gallstones
MOA: DIRECT inhibition of Na+/K+ ATPase leads to INDIRECT inhibition Na+/Ca2+ exchanger/antiport; ↑ [Ca2+] intracellularly → positive inotropy (increased force of contraction); also stimulated the vagus nerve to ↓ HR
Clinical use: CHF (↑ contractility); A fib (↓ conduction at the AV node and depression of the SA node)
Toxicity: cholinergic- nausea/vomiting, diarrhea, blurry yellow vision
-ECG- ↑ PR, ↓ QT, ST scooping, T wave inversion, arrhythmia AV block
-hyperkalemia is a poor prognostic factor (shows that digoxin is significantly out competing K+ at the ATPase)
**Predisposition to overdose: renal failure (↓ digoxin excretion), hypokalemia (less competition at ATPase), quinidine (↓ digoxin clearance, displaces digoxin from tissue binding sites)
Reversal of digoxin toxicity
-slowly normalize K+
-cardiac pacer
-anti-digoxin Fab fragments
Class I antiarrhythmics are ____ channel blockers that _____ conduction by ____ the slope of phase 0 depolarization and ____ the threshold for firing in abnormal pacemaker cells. ____kalemia causes ↑ toxicity for all class I drugs.
-Na+ channel blockers
-↓ the slope of phase 0 depolarization
-↑ the threshold for firing in abnormal pacemaker cells (selectively depress tissue that is frequently depolarized, as in tachycardia)
-HYPERkalemia ↑ toxicity of class I drugs
Disopyramide, Quinidine, Procainamide
"Double Quarter Pounder"
Class IA antiarrhythmics
MOA: INCREASE AP duration, effective refractory period, and QT interval
Clinical use: both atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia
Toxicity: quinidine - headache/tinnitus
procainamide- drug induced SLE
disopyramide- heart failure
All- thombocyotopenia, torsades de pointes due to ↑QT
Mexiletine, Lidocaine, Tocainide, Phenytoin
"Mayo, Lettuce, Tomato and Pickles"
Class IB antiarrhythmics
MOA: DECREASE AP duration;
Clinical use: acute ventricular arrhythmias (especially post MI) and digitalis induced arrhythmias (preferentially affect ischemic or depolarized purkinje and ventricular tissue)
Toxicity: local anesthetics- CNS stimulation/depression, cardiovascular depression
Flecainide, propafenone
"Fries, Please!"
Class IC antiarrhythmics
MOA: NO EFFECT on AP duration
Clinical use: ventricular tachycardias that progress to VFib and in intractable SVT
-usually only used as a last resort in refractory tachyarrhythmias
Toxicity: proarrhythmic, especially in post MI (contraindicated), significantly prolongs refractory period in AV node
Class II antiarrhythmics
β blockers (metoprolol, propranolol, esmolol, atenolol, timolol)
MOA: decreases SA and AV nodal activity by ↓cAMP, ↓Ca2+ currents, suppress abnormal pacemakers by decreasing the slope of phase 4, ↑ PR interval bc AV node particularly sensitive
Clinical use: ventricular tachycardia, SVT, slowing ventricular rate during a fib and a flutter
Toxicity: impotence, exacerbation of asthma, bradycardia, AV block, sedation, masking of hypoglycemia
-Metoprolol- dyslipidemia
-Propanolol- exacerbate Prinzmetal's angina
Amiodarone, Ibutilide, Dofetilide, Sotalol
Class III arrhythmics
MOA: K+ channel blockers, INCREASE AP duration and ERP, ↑QT interval
Clinical use: when other antiarrhythmics fail
Toxicity: sotalol- torsades de pointes, excessive β block
Ibutilide- torsades
Amiodarone- EVERYTHING! pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism (40% iodine by weight), corneal deposits, blue/gray skin deposits that cause photodermatitis, neurologic effects, constipation, bradycardia, heart block, CHF
Class IV antiarrhythmics
Verapamil, diltiazem
MOA: decrease conduction velocity, increase ERP and PR interval
Clinical use: prevention of nodal arrhythmias (like SVT)
Toxicity: constipation, flushing, edema, CHF, AV block, sinus node depression
MOA: increases K+ out of cells → hyperpolarization of the cell and decreased INTRACELLULAR Ca2+ (only lasts about 15 sec)
Clinical use: DOC in diagnosing/abolishing supraventricular tachycardia
Toxicity: flushing, hypotension, chest pain
-effects blocked by theophylline and caffeine
Clinical use: torsades de pointes digoxin toxicity
First Aid Pharmacology (complete)
371 terms
First Aid Pharmacology (complete)
369 terms
Step 1 First Aid - Microbiology
848 terms
USMLE STEP 1 Pharmacology
870 terms
CK USMLE Pharm: Neuro and Psych
49 terms
KISS Pharm - Immune
44 terms
Adrenergic Pharm
72 terms
Immunology Forgettables
32 terms
10 terms
Micro Block 4
26 terms
Microbio Block 1
10 terms
Gross Anatomy Final
43 terms


text:
3.2.5003 / February 25, 2020
App Information Badminton Club
- App NameBadminton Club
- Package Namecom.sportsgame.badminton
- UpdatedFebruary 25, 2020
- File Size22M
- Requires AndroidAndroid 4.1 and up
- Version3.2.5003
- DeveloperEnjoysports
- Installs1,000,000+
- PriceFree
- CategorySports
- DeveloperUnit 504(51040), Yip Fung Industrial Building, 7 Sheung Hei Street, San Po Kong, Kowloon, Hong Kong
- Google Play Link
Badminton Club Version HistorySelect Badminton Club Version :
Badminton Club 2.8.3029 APK FilePublish Date: 2017 /9/19Requires Android: Android 2.3+ (Gingerbread, API: 9)File Size: 15.3 MBTested on: Android 5.1 (Lollipop, API: 22)File Sha1: 567b3efe5e153823ea4a8bd81a9d6feddeebb2a8
Badminton Club 2.6.119 APK FilePublish Date: 2017 /2/1Requires Android: Android 2.3+ (Gingerbread, API: 9)File Size: 13.3 MBTested on: Android 5.0 (Lollipop, API: 21)File Sha1: fca9c8184fdbc150a9074ccaeb6eae8a593443a0
Badminton Club 2.0.076 APK FilePublish Date: 2016 /1/16Requires Android: Android 2.3+ (Gingerbread, API: 9)File Size: 12.2 MBTested on: Android 5.0 (Lollipop, API: 21)File Sha1: 895113a8b8337dbe22aa3c929e5e9acc3f73421f
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Best Soccer game Football Pro comes!You are a football expert, beatall your competitors to win the game! Either regarding style orquality, it is among the top of the mobile games! The rule issimple, kick the ball to score! Many skills are there!Football ProFeatures:● Physics engine based● Customized gaming system● Manyavatars waiting for you to unlock● Variety of skills will help youto win the game● Leaderboards to challenge with friends● Enjoyablefor soccer fans of all ages● Stunning graphics on smart phones andtabletsFree to play Football Pro. For the world soccer champion!
Football Kicks 3D 1.0.004 APK
Football Kicks 3D is a simple yet addictive 3D footballgame!Practice your free kick skills on Android. Become a soccersuperstar in this challenging game, start your road to World Cup!How to play:- Flick the ball to kick it out- Swipe to adjust the direction of the ball while it's in theair- Gesture a curve on the screen to curve the ballFeatures:- Four game modes: Timed, Wall Kick, Tournament, One Ball- Easy to learn but hard to master- Nice 3D visuals and exciting sound
Moto Race Extreme 1.0.055 APK
Motor Race Extreme is a Freestyle Extreme Motocross Racinggame!Throttle accelerating, wheelie jumping, angle adjusting andeventually safely landing! Have fun in this Motorcycle ExtremeSports!How to play:- Tap screen on the left to brake and tap on the right torefuel.Features:- Simple to control- 30 challenging levels- Three game modes- Amazing Motorcycle Hill Climbing!- Retinal graphic processing engine- Fast reflex physical engine design- Simulated levels composed by different dynamic elementsFeel free to post your ideas, we will try to implement them assoon as possible!
Basketball MVP 1.6.123 APK
Basketball MVP is a simple but extremely addictive sports game!Let's play perfect Passionate Basketball! Shoot for the hoop andscore as many points as you can!Basketball MVP features:- Nicegraphics- Basketball match music- Single player mode andmulti-player mode- 5 lives to go with time limits - Easy tocontrol, fun for every age players- Challenge your friends to get ahigh ranking in the leaderboardHow to play:1. Drag the dotted lineto change the power and angle2. Drag finger left/right to aim thebasketball 3. Release finger to throw the basketball to hoopEnjoymaking basketball shots!
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Badminton Legend 3.6.5003 APK
Badminton is a new released sport game, now you are able toexperience the real life badminton on mobile devices! Badminton isone of the most popular sports game in the world! In CrazyBadminton, compete with badminton players from all over the world!Do a crazy smash to your competitor! Hit your name to the globalleader board! Badminton Game Features: - Completely Free to play -Stunning graphics and real badmintons sound - Coolest characterskills - 4 major scenes, beautiful visuals - Challenge thebadminton master Badminton could never be cooler like this! Go,achieve your champion dream!
Badminton League 5.00.5009.5 APK
The most competitive badminton games ever! Take on your friends in1 vs 1 mode, or win the Badminton League trophy🏆 in TournamentMode! Customizing your character with tons of items. And level upyour ability to do stronger smash and jump!🥇 Now grab your racketto smash, hit the shuttlecock, do a crazy smash to your opponentlike badminton star!🎉 Features: 🏸 Multiple game modes available,play with sports fans in local 🏸 Create your very own character,and level - up 🏸 Easy to control, challenging to win 🏸 Simple andelegant UI design 🏸 Cool stunts and realistic hitting shuttlecockexperience 🏸 Numerous gorgeous badminton outfits Be the topbadminton player, smash now!💥 💓Like us on Facebook:https://www.facebook.com/Badminton-League-203729826806154/
Badminton 3D 2.9.5003 APK
Badminton 3D is the most exciting sports game.. Choose variousunique badminton players, 🆚 compete with different badmintonmasters in the league, 👑 create your own badminton legend. Directyour badminton player to move, tap your finger to jump and smash,hit the shuttlecock, shuttle across the net, 🔥 do a crazy smash toyour opponent. Enjoy extraordinary badminton game experience. Shockyour opponent, take command of this badminton court. Draw your ownbadminton legend! Tips: Unlock badminton equipment, racket or shoesand other garments, have the most matching equipment. Also,complete achievements and claim bonus may help too. ⭐GameFeature⭐ 🏸 Easy to play, two playing modes for you to enjoy 🏸Magnificent graphics, smooth animation 🏸 Stunning stunts, realistichitting shuttlecock experience! 🏸 Well-designed opponents, defeatthem in badminton league. 🏸 Tons of cool badminton equipment,upgrade your role abilities 🏸 4 major badminton courts, beautifulvisuals. 🏃🏻♀ 🏃🏻 Come and get this Crazy Badminton Game, swingyour racket, show you sports talent in each badminton leaguematch.📲 Download for free and have fun!🎉 The game belongs toShenzhen QiXunXinYou Technology Co.,Ltd. 3DGAMES belongs toShenzhen QiXunXinYou Technology Co.,Ltd.
Badminton Super League 2018 1.2 APK
Badminton super league 3D! The most competitive sports game. Playmore effectively with a perfect strung racket. Entertain yourselfwith ultimate badminton challenge games. Be a pro player withinternational badminton games to become a legend superstar in realbadminton championship. Enjoy super badminton game and suggest yourfriends play this one of the best badminton game in the world. Grabyour racket hit the shuttlecock and give tough time to youropponent with the strong smash and high jump and prove that you arethe great champion of this badminton league 3d games. Learn therules regarding badminton tournament challenge and win badmintonmatch by using your perfect jumping and shuttlecock smashingskills. In this free double player fun game, you will learn how toplay badminton games hard so learn the tricks and tips by playingthis new badminton best games of 2018. After playing this realisticbadminton 3d games you can confidently say that you are champion ofbadminton star league.Badminton super league 3D is extreme best andultimate unique badminton game on Google play store. In this game,you will face several challenges you have never before in allbadminton HD games. First of all click on the store button topurchase badminton equipment different strong rackets and a hugevariety of shuttlecocks with shoes and garments. Pick your racketand start the match with pro badminton players. Hit the shuttlecockquickly by making a long jump across the net. Make a high scoreagainst the opponents to win super badminton league. You can playthis premier badminton game in the friendly mode where you have tobeat only one player while in the tournament match you have tocompete with champion players of badminton games. Your main goal isto defeat all other opponent players to win the world bestbadminton league. Play this in door badminton high-quality game andenjoy the 3d badminton championship on your android device. Thisbest free badminton 2018 game develop your skills perfectly andwill train you a pro player of ultimate badminton games.Badmintonsuper league 3d game provide you stunning HD graphics. Beautifulenvironment badminton tournament make this best indoor sports gamemore interesting among other badminton 3d games. This top trendingathletic game will perfectly train you as a best racket and shuttlecock player. Download this much funnier badminton best games fromGoogle play store and win the badminton champion tournament. Playthis challenging free shuttle cock racket league with yourcompetitors and win super badminton championship in tournamentmode.How to play:- Enter player name- Select favorite country- hitracket on shuttlecock to give out- Drag racket to & fro to playshots- Beat your competitor to unlock nextFeatures of Badmintonsuper league 3D:- Easy Simple and smooth game play.- Super biggerand greater badminton championship tournament. - Compete againstmaster badminton players & champions.- Nice and mind blowingsound effect.- Beautiful graphics with real Life Animations &realistic Physics- Practice in friendly mode and challenge intournament mode.- Several attractive badminton outfits- Do a crazysmash to defeat opponentIf you like this Badminton super league 3D,please try other best athletic games by clicking "More fromDeveloper" or by visiting our publisher account. And don't forgetto rate and review.
3D Tennis 1.8.1 APK
Welcome to the most authentic tennis game on Google Play. 3D Tennisis the only tennis game based on 3D PHYSICS. 3D Tennis offers fastand fluid control mode: swipe your finger to hit or slice the ball.The game provides a huge range of unique players to choose from andallow you to steer your favorite player to success in the fourGrand Slam tournaments. It feels like playing the real tennis game.FEEL THE PASSION NOW! Game Features: - Quick Play mode and WorldTour mode - Based on the realistic 3D physics system - Accurate andvisual control mode to truly simulate real game play
Badminton 3D 2.1 APK
Enjoy the ultimate action packed badminton game with Badminton 3D!CAREER MODE Practice your badminton game skills over a set ofchallenging players that will refine your badminton skills toperfection! BADMINTON LEAGUE Choose your country and join theBadminton League to conquer the world! TOURNAMENTS Compete ontournaments and become a legend! Enjoy this exciting, fast pacedgame mode. It's fun for all skill levels! It's free to play!Download Badminton 3D now and have fun! Privacy Policyhttps://www.giraffe-games.com/privacy-policy/ Terms Of Usehttps://www.giraffe-games.com/terms-of-use/
World Soccer League 220.127.116.11 APK
[Game Features] - There are around 60 national teams, 60 clubs andtotal of 2000 players. - Total of 4 modes provided: Exhibition,Cup, League, and Training. - Real football game for you to enjoysplendid dribble and thrilling shooting! - Save and keep greatimage or video of each the moment. - Achievements and GlobalActivity are provided - Support 15 languages - Support tabletdevices Homepage:https://play.google.com/store/apps/dev?id=4864673505117639552Facebook: https://www.facebook.com/mobirixplayen YouTube :https://www.youtube.com/user/mobirix1
LiNing Jump Smash 15 Badminton 1.3.10 APK
#Ramadhan Special Rate for Master Series Tournament #World's No.1most realistic and challenging badminton game. #Voted Best MobileGames from Asia by Game In Asia #Partnered with InternationalSports Brand Li-Ning Get ready for a badminton experience like noother; featuring an all-new intuitive swipe-mode game-play, globalstadiums, Multiplayer mode, original anime characters, and highquality visual effects! GAME FEATURES: • Exhibition Mode:Singles/Doubles mode to earn JS coins. • Tournament Mode: Playthrough the tournament to unlock new character and become the WorldJump Smash Champion! • Multiplayer Mode: Compete with your friendsin local and online tournaments! • Training Mode: Utilise trainingmode to improve your character's individual statistics. • CustoMe™:Customise your own individual character and play with them inTournament and Multiplayer Mode! JS SHOP: Spend it for new rackets,shoes, apparel and training to improve your character's stats.Download now and get ready to JUMP SMASH™! *Recommended devices:Samsung Galaxy Note10.1 and above, Samsung Galaxy Note 3 and above*Recommended Requirements Android 4.0 Ice Cream Sandwich with 1GBRAM memory, Quad-core Processor and 1GB storage size. Stay tuneofficial website for Jump Smash latest news:http://jumpsmashgame.com/
Head Soccer 6.9.2 APK
◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆ 100,000,000 Downloads!!◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆ Move to the side, hard-to-controlsoccer ! A soccer game with easy controls that everyone can learnin 1 second. Beat the opponent with fancy lethal shots such asdragon shoot, ice shoot and lightening shoot and win thetournament. You can also matchup with friends or global usersthrough the gamecenter. Play this fun soccer game anytime,anywhere. ■■ FEATURES ■■ + Various 84 Avatars & Unique SpecialShot !! + 7 Game mode (Arcade, Tournament, Survial, League, HeadCup, Death Mode, Fight Mode) + Online Multiplayer via Google PlayService + Physics based gameplay (Box2d) + Submit Facebook ■■D&D DREAM GAMES ■■ + Dinosaur Slayer + Zombie Sweeper + Crasher+ IChallenger: Return + Tiny Brush + Millionaire Show + HeadBasketball > Website: www.dnddream.com > e-mail:email@example.com > Facebook: Facebook.com/dnddream
Badminton Star 2 1.8.3029 APK
The best super-badminton-competition game now finished itsupgrading! You must be shocked by realistic badminton physics. InBadminton Star 2, racket is far more beyond your imagination! Getready for a Badminton Match!Badminton Star 2 features:- Simpletouch controls- Many rackets for sports equipment- Play yourfavorite characters- With different themes, you will never getbored during gaming- Keep updating!Be a real Badminton Star in thisgame!
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World Cricket Championship 2 - WCC2 2.8.9 APK
Welcome to the Next Generation in Mobile Cricket Gaming! Everycricket lover can now have the most advanced 3D mobile cricket gamein the palm of their hands! You can play the maximum number ofcricket shots including the famous Dil-scoop, the Helicopter shotand the Uper-Cut! This is a game built for you the cricket fan! Youhave loads to look forward to! You can customize your players andcheer your team with customized banners! You can also look forwardto scintillating animations, more cricketing venues, new controls,and new camera angles! 'World Cricket Championship 2' has featuresthat make it the most dynamic and versatile game in the world ofmobile cricket. Be prepared for insane fun!! Features: · Online andOffline 1v1 Multiplayer via Online Rivals and Local Rivals · Ashesto Ashes Test Tournament · 150 different batting animations and 28different bowling actions . Rain Interruption, D/L Method .Hot-Spot & Ultra Edge for LBW and Edge · Enjoy the BlitzTournament for free! · Electrifying fielding with stunning divingcatches & quick throws to surprise the opponent. · ChallengingAI opponent · Realistic ball physics which responds to the pitch(Dead, Dusty, Green) · Player attributes – Players gain extraskills for consistent performance · 18 different internationalteams, 10 domestic teams, 42 different stadiums. TEST Cricket, HotEvents and more than 11 tournaments including World Cup, World T20Cup, Blitz Tournament and ODI Series. · The Gangs of Cricket modewhere the user can form gangs and compete in challenges. ·Challenge A Friend mode enables the user to challenge your friends.· Batsman may get injured for poor shot selection. · The emotionsof the fielders vary according to the circumstances of the match. ·Cinematic cameras and real-time lighting enhance the visual appeal.- 3D Wagon wheel with dynamic game data - Hawk-eye view for bowlingsummary & for LBW appeals - 3D Bar chart for innings run scored· Ultra slow motion Action replays with multiple camera angles ·Over 40+ in-game camera angles · Two different batting controls(Classic & Pro) · Two different batting camera settings(Bowler's end & Batsman's end) · Fielders are configured withadvanced ball - head coordination system · Professional English andHindi commentary with dynamic ground sounds . Night mode inQuickplay and all tournaments with LED stumps · Batting TimingMeter to time your lofted shots. · Manual Field placement tocontrol your opponent in All modes . Share and save game highlightsgenerated at the end of the match. . A user can edit the playing 11team, player names and their roles. . Misfielding, stunningwicketkeeper catches, quick stumping & tight 3rd umpiredecisions to create a realistic cricketing experience. . Newfielding, umpire, toss animations and 110+ new batting shots ·Battle-tested and updated engine to provide fluid 30fps gaming onmost mid-range devices. Awards & Recognition - App AnnieReport- Top Games by Time Spent, India 2016 - App Annie Report- TopGames by MAU, India 2016, 2017 & 2018 - Winner NASSCOM GamingForum Awards 2015 'Game of the Year' People's Choice Award - Googleplay store - Best games of 2015, 2016 & 2017 - Google playstore - Most social games of 2017 Permissions Required:GET_ACCOUNTS - To Sign-in into the game using your Google accountREAD_PHONE_STATE -Enables us to send you push notifications onvarious updates & offers ACCESS_COARSE_LOCATION - To serve youlocation-specific ads & offers WRITE_EXTERNAL_STORAGE &READ_EXTERNAL_STORAGE - For saving your game progress, statistics,game assets, caching ads & offers Recommended SystemSpecifications, - Android OS : 4.1 or higher - 2GB RAM
Dream League Soccer 6.13 APK
Get ready for a new season of top-quality action – Dream LeagueSoccer is here! Soccer as we know it has changed, and this is YOURchance to build THE best team on the planet. Recruit real FIFPro™licensed superstars, build your own stadium, and take on the Worldwith Dream League Online as you march towards glory, on your roadto Soccer Stardom! Download Dream League Soccer for FREE now!***************************************** MANAGE YOUR DREAM TEAMSign top superstar players such as Gareth Bale to create your veryown Dream Team! Choose your formation, perfect your style and takeon any team who stands in your way as you rise through 6 Leagues totop the prestigious Elite Division. Have you got what it takes?REALISTIC NEW GAMEPLAY Be prepared for smart, tactical AI to form achallenging and addictive experience. With all new visuals,realistic animations and 60fps dynamic gameplay (compatible devicesonly), Dream League Soccer is the perfect Soccer package whichcaptures the true essence of the beautiful game. COMPETE FOR GLORYDream League Online puts your Dream Team against the very best inthe world. Work your way through the ranks to prove your team isthe greatest! Brand-new regular events pit your team against thebest in an array of different tournament formats. Claim victory towin unique prizes and medals. FEATURES • FIFPro™ licensed playersbrings the most authentic Dream League Soccer experience to yourhands! • Freedom to create, customize and control your very ownDream Team! • 6 Divisions to work your way through, and over 7 Cupcompetitions! • Take part in regular live events to win prizes andglory! • Build your very own stadium to showcase your superstars! •Develop your players with more accuracy and intent • Seasonobjectives to keep you engaged and coming back! • Google Playachievements & leaderboards to see who ranks on top! •Customise and import your very own kits & logos! • Syncprogress between devices with Google Play Cloud! • Exclusivesoundtrack provided by The Luka State, Sunset Sons, Jack Wins,Vistas & Only The Poets!***************************************** IMPORTANT * This game isfree to play, but additional content and in-game items may bepurchased for real money. * This app uses Wi-fi or mobile data (ifavailable) to download game content and advertising. You candisable mobile data usage on this game from within Settings/MobileData. * This app contains third party advertising. Unrequestedadvertising is disabled if you purchase in game currency from theshop. ***************************************** VISIT US:www.ftgames.com LIKE US: facebook.com/dreamleaguesoccer FOLLOW US:twitter.com/firsttouchgames WATCH US: youtube.com/firsttouchgames
FIFA 15 Ultimate Team 1.7.0 APK
FIFA 15 Ultimate Team by EA SPORTS featuresover 10,000 players from over 500 licensed teams. Plus, over 30real leagues and stadiums! Build a dream squad of footballers andput them to the test. From the English Premier League, La Liga, andMLS, to the German Bundesliga and beyond. Take the thrills with youwherever you are with the most authentic soccer game on GooglePlay.This app offers in-app purchases. You may disable in-apppurchasing using your device settings.** This game has superior graphics and is packed with tons ofreal football leagues, teams, and players. Please make sure youhave at least 1.35GB of free space on your device. **BUILD YOUR ULTIMATE TEAMEarn, trade, and collect superstars like Lionel Messi and EdenHazard to create your own fantasy team. Choose your play style,formation, kits, and more.PLAY IN QUICK SIMULATION MODEPut your management skills to the test with new Quick Simulations.Set up your squad, start the match, and watch it unfold. Make smartsubs, tactical tweaks, and gauge team effort along the way. Yourmatch results depend entirely on your ability to manage playerskills and chemistry – taking authenticity to the next level.OR TAKE IT TO THE PITCH!If you're new to FIFA on mobile, try out our "Casual Controls",with elegantly simple buttons like "shoot", "pass", or "sprint".Once you're feeling comfortable, move on to "Classic Controls",which let you add either "through passes" or "skill moves" to yourgaming arsenal. Or, you can interact with your team directly,tapping on players to pass the ball and swiping towards the net toshoot. Plus, if you have an external controller – don't miss thechance to use it on the pitch for the first timeREAL WORLD MATCH UPSPlay your favorite team's next fixture, plus 3 other majormatch-ups happening around the world – every week!Jump into the action and feel the passion of your favorite sportwith FIFA 15 Ultimate Team!NOTES:Terms of Service: http://www.ea.com/terms-of-servicePrivacy & Cookie Policy: http://www.ea.com/privacy-policyGame EULA: http://tos.ea.com/legalapp/mobileeula/US/en/OTHER/Visit https://help.ea.com/ for assistance orinquiries.EA may retire online features and services after 30 days' noticeposted on www.ea.com/1/service-updatesImportant Consumer Information: This app: Requires acceptance ofEA's Privacy & Cookie Policy, TOS and EULA; Includes in-gameadvertising; Collects data through third party ad serving andanalytics technology (See Privacy & Cookie Policy for details);Contains direct links to the internet and social networking sitesintended for an audience over 13.
eFootball PES 2020 4.6.2 APK
The latest update to PES 2020 mobile (v4.6.2) was released on08/27/2020. Approximately 1.6 GB of free space will be required toinstall this update, so please confirm that you have enough room onyour device before beginning the download. Given the size of thefile, we highly recommend that you connect to a Wi-Fi network todownload it. Additionally, we have received reports from some usersindicating that Google Play does not always display the correctdownload size. As a result, we urge you to wait a while even afterthe download progress bar has reached 100% to ensure that yourdevice is able to finish downloading the complete file. If the filedoesn't finish downloading, you will be unable to start the game.You will also not be able to complete the update if you do not haveenough space to install the file. We realize that this process iscounterintuitive, and we apologize for any inconvenience caused.Furthermore, as a show of appreciation for your continued support,all users that download the v4.6.2 update by 23:59 (UTC) on08/30/2020 and open the Inbox will receive a "Black Ball" SpecialAgent. *Downloading under Wi-Fi is strongly recommended. ■Experience eFootball's Online Mobile Matchplay Here at the PESteam, the eFootball PES 2020 mobile update represents anothertremendous stride towards realizing our goal of providing fans withthe most immersive competitive soccer simulation ever created. Forus, the core concept of PES is defined by the type ofheart-stopping thrills that can only be experienced when facing offagainst real people in real time. This idea is embodied by our newtitle: eFootball, which symbolizes an unprecedented fusion betweenesports and soccer. In alignment with this, PES 2020 will redoublethe series' focus on providing fans the world over with fun andcreative ways to compete against one another, in both local andonline multiplayer. ■ The Thrill of Console Soccer on Your MobileDevice With eFootball PES 2020, we've taken the same criticallyacclaimed console gameplay that won E3 2019's "Best Sports Game"award, and distilled its essence to bring you the most authenticmobile soccer experience to date. Take creative command of the balllike never before thanks to the brand-new "Finesse Dribble"technique, developed in collaboration with iconic Spanishmidfielder Andrés Iniesta. Other enhancements to trapping andoverall ball control will also enable you to take advantage ofsmall differences in the way each player plays on the field. We'vealso added the "Inspire" system, which allows certain players toinfluence the way in which nearby teammates behave. The sum totalof these parts is an experience that accentuates playerindividuality, lending increased importance to choosing the rightplayers for the right situations and tweaking your formation toperfection. ■ Real-Time, Online Matches Experience local matchplaywith a friend on the same couch, or register a friend online toplay together over the internet. In "eFootball", you can face offagainst users from around the world, enter time-limited competitiveevents, and enjoy the very best high-intensity esports gameplay. ■New items added to the SHOP: - 7 purchasable squads - "myClub Coins+ Bonus" packs *See the SHOP for details [System Requirements] Thisapp is an online game. Please enjoy the game with stable internetconnection. [Title Display] If you select Japanese in the languagesettings of the game application, "eFootball Winning Eleven 2020"will be displayed. If you select a language other than Japanese,"eFootball PES 2020" will be displayed.
Real Cricket™ 17 2.8.1 APK
Real Cricket™ is here and here to stay! We have migrated to a brandnew experience with Real Cricket™ 17! The most complete cricketgame in the world! For all you cricket fans out there, Intensity ofa Real Cricket™ game, now on your mobile!!! Welcome to the mostauthentic, complete and surreal Cricket experience on Android -Real Cricket™ 17 ALL NEW MULTIPLAYER Battle it out against yourfriends or other Real Cricket players in a Batting Showdown.Outscore your peers and top the leaderboards! PREMIER LEAGUEAUCTIONS Just like next year – take charge of your favouritefranchise and build a team from scratch! INCLUDES TEST MATCH Brandnew Test Series mode complete with updated rosters, the classicwhites and lunch-tea breaks. CHAMPIONS CUP Be part of the MiniWorld Cup gala and bring the trophy home for your country! UNIQUEAND NOVEL REAL CRICKET CHALLENGE MODE & DAILY CHALLENGES Forthe First Time Players can play out Historical Scenarios with aunique level based saga experience. Also get daily challenges basedon recent and past events! ALL MAJOR T20 DOMESTIC TOURNAMENTS Morecontent than you can imagine. From South Africa, the Caribbean,Down Under, England, Pakistan, Bangladesh. Play them All ALL NEWPLAYER PROFILE Track all yours Stats and Increase you're Rank. Bethe Best FRESH LOOK AND FEEL The game is now smoother than ever andwith the most stunning presentation. ULTRA FLUID SIGNATURE REALCRICKET™ ANIMATIONS Scintillating 2D Motion Captured animations BESTRIKING WITH AUTHENTIC CRICKET EQUIPMENT Authentic Cricketequipment provided by legendary manufacturers – Gray-Nicolls and SSCricket. CRICKET QUIZ New for Trivia maniacs. Think you know itAll? Test your skills with the Cricket Quiz ALL NEW DETAILEDLEADERBOARDS Now Compete with Friends & Players from around theWorld ALL NEW HARDCORE DIFFICULTY Want the Game to Be Harder. Wellwe tried! It's your turn now… This app offers in-app purchases.*Permissions: To deliver the best experience we would need somepermissions from our users: GET_ACCOUNTS: This permission isrequired to access Google Game Play Services including Login,Achievements and Leaderboard. WRITE_EXTERNAL_STORAGE andREAD_EXTERNAL_STORAGE: We need these permissions to cache and readgame content during the gameplay. READ_PHONE_STATE: We need thispermission to serve you relevant notifications on various updatesand offers. ACCESS_FINE_LOCATION: We need this permission to detectyour location so as to provide region specific content as well asanalyze your regions needs and feedback better.
FIFA 16 Soccer 3.3.118003 APK
Play beautiful with a newer, better, and faster FIFA experience onmobile! FIFA 16 Ultimate Team lets you celebrate every awesomeattack, nail-biting goal, and powerful win like never before withconsole-like graphics. Experience the most realistic set offootball features on Google Play. ** This is a highly detailed gameof superior quality. Please make sure you have at least 1.4GB offree space on your device. FIFA 16 Ultimate Team works best onMotorola Nexus 6, HTC Nexus 9, HTC M8, Asus Nexus 7 2nd Gen,Samsung Galaxy S6, Samsung Galaxy S6 edge, Samsung Galaxy S5,Samsung Galaxy Alpha, Samsung Galaxy Note Edge, Sony EricssonXperia Z2 Tablet, Sony Ericsson Xperia Z3, Samsung Galaxy S4, HTCNexus 4, LG G2. ** ALL-NEW ENGINE Get ready for better skill moves,more exciting goals, more responsive controls, smarter teammates,and improved animations as you play the match. Plus, now it's eveneasier to play like a pro with Enhanced Hybrid Controls that letyou use Gestures or Buttons to control the ball. Gain improvedoffside awareness and more with Attacking Intelligence, then blowpast defenders with ease. Alternatively choose to simulate matches,taking the manager position on the side of the pitch. Also, for thefirst time on mobile, you can trigger unique player celebrations onthe pitch after you score! BUILD AND MANAGE YOUR ULTIMATE TEAMEarn, trade, and transfer superstars like Lionel Messi, JordanHenderson, and Juan Cuadrado to create your own fantasy team.Choose your play style, formation, kits, and more, then balanceplayer chemistry for the strongest squad compositions. CHALLENGINGSKILL GAMES Want to show off your skills on the pitch like neverbefore? Choose your daily challenge – from shooting, groundpassing, and dribbling to crossing, penalties, and more. Then, pickthe right player and beat the challenge to earn rewards! REAL WORLDFOOTBALL Choose from over 10,000 players from over 500 licensedteams and go to battle against other players from real leagues inreal arenas from around the world. Recreate challenges from currentlive-event football matches, too, with Dynamic Accomplishments.PLAYER EXCHANGE Now trade players and items you no longer need fora chance of unlocking something better. The higher value items orplayers you trade, the better the upgrades you'll get back! Readyto play the beautiful game, wherever you are? Get FIFA 16 UltimateTeam now! Important Consumer Information: This app requires apersistent Internet connection (network fees may apply). Requiresacceptance of EA's Privacy & Cookie Policy and User Agreement.. Collects data through third party analytics technology (seePrivacy & Cookie Policy for details). Contains direct links tothe Internet and social networking sites intended for an audienceover 13. User Agreement: terms.ea.com Visit https://help.ea.com forassistance or inquiries. EA may retire online features and servicesafter 30 days' notice posted on www.ea.com/1/service-updates
Real Football 2013 1.6.8b APK
The newest edition of the free footballsimulation is back to score another win for the franchise with awhole new set of moves.Take part in the most immersive free football simulation and showthat you are the best on the pitch. Reinforce your team ofchampions by developing your club's facilities, hiring new staffmembers, dealing with sponsors and more.Join world football champions like our cover athlete, Falcao, onthe pitch. YOU ARE FOOTBALL, YOU ARE REAL FOOTBALL!LEAD YOUR CLUB TO THE TOPTake control of your team on the field during league games or cupgames. Starting with a rookie team, you'll need to improve yourplayers' abilities to reach the top league and compete against thebest teams in the world for the championship and the cup.REALISM PUSHED FURTHERFor the first time in Real Football games, see names and portraitsof over 3,000 top Euro and international champions thanks to theofficial FIFPro licence. Updates for the application will keep yourgame up to date with the most recent player transfers and rosterchanges.DEVELOP YOUR CLUBThe best teams in the world have the most modern facilities. It'stime to be a good fantasy manager. Get your players in shape bydeveloping your training grounds to increase your players'physical, technical and tactical skills as a real manager. Earnmore money and attract fans by expanding your stadium, filling itwith shops and signing big-name sponsors.THE MOST IMMERSIVE EXPERIENCESmooth and realistic graphics make every player come to life onyour screen during games. Witness over 700 motion-captureanimations as you take on an improved AI for a TV-like experienceof games with spectacular effects and cutscenes. It's just likewatching real sports!RF13 is a free simulation sport game in which you'll be able towin a league or cup championship, play with world champions, be amanager of a fantasy team, and more. We're bringing you a real,free fantasy simulation and a comprehensive manager game, all inone soccer package.Whether you like soccer simulations, fantasy manager games oryou're simply a fan of the sport, this free game is for you.----Visit our official site at http://www.gameloft.comFollow us on Twitter at http://glft.co/GameloftonTwitter or like us onFacebook at http://facebook.com/Gameloft to get more infoabout all our upcoming titles.Check out our videos and game trailers on http://www.youtube.com/GameloftDiscover our blog at http://glft.co/Gameloft_Official_Blog for theinside scoop on everything Gameloft.Certain apps allow you to purchase virtual items within the appand may contain third party advertisements that may redirect you toa third party site.Privacy Policy : http://www.gameloft.com/privacy-notice/Terms of Use : http://www.gameloft.com/conditions/End User License Agreement : http://www.gameloft.com/eula/
Real Football 2012 1.6.1d APK
Real Football is back for the new season,bringing football on mobile to a new era! Join the community offans as you create and share content with the Custom Kit Editor.Experience the ultimate football game on smartphone thanks to manymajor improvements and the addition of the most complete andenjoyable community-oriented features.Love football. Share football. Join the community.REPLAY THE GAME YOU JUST WATCHED ON TVEver wish you could control the outcome of a game you watched onTV? Now you can, thanks to Hypergame technology! With just thepress of a button, you can recreate any match-up from the in-gamenews feed and play!STAND OUT ON THE FIELD WITH CUSTOM KITSCreate your own custom team jerseys, shorts and more using adetailed editor, then share it with the rest of the community, orlook for cool designs made by other players and use themyourself.THE BIGGEST, MOST ENJOYABLE FOOTBALL COMMUNITYGet the latest football news thanks to official RSS feeds fromgoal.com, as.com and sports.fr. Send your comments, interact withfriends, upload pictures and videos.FOOTBALL AT ITS FINESTEnjoy smoother and more realistic graphics for both players andstadiums.Over 700 motion-capture-based animations that adjust to players'skills and positions on the field.Smarter moves for your teammates and opponents on the field thanksto an improved AI.New effects and cutscenes during the games for an even more TV-likefootball experience.THE OFFICIAL FIFPRO LICENCEThousands of real players' names, 350 teams and 14 leaguechampionships to play including England, Spain, France, Germany andSouth America.Online updates of the database will keep your game up to date withthe most recent player transfers and lineup changes.MANY GAME MODES TO ENJOYAccess many different game modes including Exhibition, League andvarious International Cup modes, or practise your skills inTraining mode.You can also take over your favourite team as a manager and lead itto glory, or replay the best games of the past by entering Historymode.Certain apps allow you to purchase virtual items within the appand may contain third party advertisements that may redirect you toa third party site.Privacy Policy : http://www.gameloft.com/privacy-notice/Terms of Use : http://www.gameloft.com/conditions/End User License Agreement : http://www.gameloft.com/eula/

subset: commoncrawl


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Your choice of text/labeling on any print!
Originally designed by C.B. Macdonald in 1894, updated to its present configuration by Seth Raynor in 1922, and massaged by Tom Doak in 2002. Uniquely, all the out-of-bounds sits on the left, which legend says speaks to Macdonald's game.
Printed on high-quality, fade resistant photo paper with a matte finish.
Not a product of Chicago Golf Club.


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Teams in England's Premier League are full of imported players. The result is high-quality football, far superior to what I witnessed when living there in the 70s, when the teams were overwhelmingly of local origin. Chalk one up for the free movement of labor, and the benefits that flow from the European Union.
But UEFA wants to fiddle with that.
From the start of the 2007 season, it is proposed that any club qualifying for a European competition must have no more than 25 players in their first-team squad. Four of those players, however, must be home-grown, two of them having been trained between the ages of 15 and 21 by the club's own youth training programme, while two others could be developed by other clubs, provided these clubs are part of the same national association as the buying club.
The Premier League, which sells the most valuable package in the global television market, is understandably not enthused by the proposal. The vote among EPL clubs was 16-4 against supporting UEFA, so they will fight the proposal. Good luck to them.


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SNAKE PRINTED SHIRTTan ADDER SNAKE PRINTED SHIRT in Tan
Delivery Methods
- Standard £5
- Next Day £7
- Same Day £15
- Collect In Store Free
- Saturday £7
Free returns on all UK orders up to 28 days
Orders placed on Friday after 7:00pm will be delivered on Monday
For next working day delivery please order before 7:00pm
For same day delivery within London please order before 1:00pm
For Saturday delivery please order before 3:00pm on Friday
All orders will be delivered by courier and will need to be signed for
The aptly titled 'Americana Collection' takes cues from Western/ sartorial rock-star style. Blending an inherently London sense of style with embossed croc, snakeskin leather and retro Seventies' prints, the collection puts forward a bold statement for the man not afraid to embrace his inner peacock.
The Adder shirt in tan is designed with a bold snake print to ensure you turn heads this summer. Wear it with tailored trousers and Penny loafers for sartorial style with an edge.
- Snake-print design
- Smooth, lightweight & breathable fabrication
- Point collar
- Shoulder piping
- Long sleeves
- Full-buttoned placket
- Regular fit
The model is wearing a size M
Model is 6ft 2 / 188 cm, and a 38" / 97cm chest and a 29" / 74cm waist
Composition - 100% Viscose
Washcare - Machine wash


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A Night With the Classical Mystery Tour and Music of the Beatles [VIDEO]
I thought a night at the symphony would be fun. It would certainly be different. I have always loved all kinds of music and in the past several years have developed a love for strings. I was really excited when at dinner I learned it would the music of the Beatles performed by the Symphony of Southeast Texas and Classical Mystery Tour.
The setting was the Julie Rogers Theatre for the Performing Arts. Classical Mystery Tour was set up in front of the Symphony of Southeast Texas. They looked, performed and sounded so much like the Beatles. It gave everyone who never had a chance to see the Beatles a taste of what their live performance may have been like. The extra bonus was Beatles music performed with a symphony orchestra. I believe that's how their music should be done.
The performance was flawless. From early Beatles like " I Want to Hold Your Hand" to "Sgt Pepper's Lonely Hearts Club Band" to post Beatles breakup hits like "Imagine". I found myself singing along with every song. The show was sold out and the audience was from every generation. You saw and heard teens and seniors singing out loudly when "Hey Jude" was performed.
The Magical Mystery Tour is a must see for everyone from the casual to the fanatical Beatles fan. The Symphony of Southeast Texas is a must see for any true music fan. The standing ovation was richly deserved.
Here is a little taste.


text: Little Miss Gabby was recently sent the cute t-shirt pictured above. The t-shirt is from a new children's line called Stella Blu,designed by Erin Raymer from Chicago. Erin personally designs and silk screens original art work using non-toxic ink on the softest T's available. I was seriously impressed with the quality of the shirt. It really is super soft. My daughter loves it! … [Read more...]


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What's something you need in every diy beauty product tutorial? A container. But instead of buying then, why not make them out of materials you already have. Better yet, why not recycled materials. Learn how to make these containers out of just a plastic bottle, leftover packaging, and glue.
So what do you need? Well, as mentioned, only a plastic bottle(I'm using an empty Sparkling Ice bottle), glue (super glue is best), a piece of flat plastic (I'm using leftover packaging), and sharpies for decorating.