Chapter 4: Drugs Acting on Central Nervous System-I
General Anaesthetics
Introduction
Stages of Anaesthesia
Classification of General Anaesthetics
Inhalational
Gas:-
Nitrous oxide
Volatile liquids:-
Ether Halothane
Isoflurane
Desflurane
Sevoflurane
Intravenous Fast acting drugs
Thiopentone sod. , Methohexitone sod. , Propofol , Etomidate ,Benzodiazepines, Midazolam, Diazepam, Lorazepam
Dissociative anaesthesia
Ketamine
Opioid analgesia
Fentanyl
Analgesic, Antipyretic and Non-Steroidal Anti-Inflammatory Drugs
Introduction
Classification
A. Nonselective COX inhibitors (traditional NSAIDs)
1. Salicylates: Aspirin.
2. Propionic acid derivatives: Ibuprofen, Naproxen, Ketoprofen, Flurbiprofen.
3. Fenamate: Mephenamic acid.
4. Enolic acid derivatives: Piroxicam,
Tenoxicam.
5. Acetic acid derivatives: Ketorolac, Indolmethacin, Nabumetone.
6. Pyrazolone derivatives: Phenylbutazone, Oxyphenbutazone.
B. Preferential COX-2 inhibitors
Nimesulide, Diclofenac, Aceclofenac,
Meloxicam, Etodolac.
C. Selective COX-2 (Cyclooxygenase-2) inhibitors
Celecoxib, Etoricoxib, Parecoxib.
D. Analgesic-antipyretics with poor
antiinflammatory action
1. Paraaminophenol derivative: Paracetamol (Acetaminophen).
2. Pyrazolone derivatives: Metamizol (Dipyrone), Propiphenazone.
3. Benzoxazocine derivative: Nefopam.
Narcotic Analgesics
Introduction
Classification
1) Morphine Analogues: These compounds are closely related to morphine structure and are even synthesised from it. They may be agonists [e.g., morphine, dimorphine (heroin), and codeine], partial agonists (e.g., nalorphine and levorphan), or antagonists (e.g., naloxone).
2) Synthetic Derivatives with Structures Unrelated to Morphine
i) Phenylpiperidine Series: Pethidine and Fentanyl.
ii) Methad one Series: Methadone and Dextropropoxyphene.
iii) Benzomorphan Series: Pentazocine and Cyclazocine.
iv) Semisynthetic Thebaine Derivatives: Etorphine and Buprenorphine.
Anti-Rheumatic Remedies
Introduction NSAIDS
1) Disease Modifying Anti-Rheumatic Drugs (DMARD) Biologic DMARDS
a) Nonbiological drugs:
i) Immuno suppressants:
Methotrexate, Azathioprine , Cyclosporine
ii) Other immuno modulators:
Sulfasalazine, Hydroxychloro quine/chloroquine, Leflunomide, Tofacitinib
b) Biological agents:
i) TNF α-inhibitors:
Etanercept, Infliximab, Adalimumab
ii) Other biologicals:
Anakinra,Abatacept,Rituximab
2) Adjuvant drugs:
Prednisolone and other glucocorticoids
Anti-Gout Remedies
Introduction
Classification
Anti-gout drugs can be classified as follows:
1) Based on Mechanism of Action
i) Inhibit Uric Acid Synthesis: Allopurinol.
ii) Increase Uric Acid Excretion: Probenecid and Sulphinpyrazone.
iii) Inhibit Neutrophil Migration into Joint: Colchicine.
iv) Inhibit Inflammation and Pain: NSAIDS.
2) Based on Clinical Use
i) Drugs Used in Acute Gout: Colchicine, NSAIDS, and Prednisolone.
ii) Drugs Used in Chronic Gout: Allopurinol, Probenecid, and Sulphinpyrazone.
Chapter 5: Drugs Acting on Central Nervous System-II
Sedatives and Hypnotics
Introduction
Classification
1) Urea Derivatives
i) Diureides: Barbiturates.
a) Long Acting Barbiturates: Phenobarbitone and Mephobarbitone.
b) Short Acting Barbiturates: Butobarbitone, Secobarbitone, and Pentobarbitone.
c) Ultra Short Acting: Thiopentone and Hexobarbitone.
ii) Related Ureides: Glutethimide.
2) Benzodiazepines:
i) Hypnotics: Diazepam, Clonazepam, Flurazepam, and Nitrazepam.
ii) Antianxiety Drugs: Chlordiazepoxide, and Lorazepam. Diazepam,
iii) Anticonvulsants: Diazepam, Clonazepam, and Oxazepam
3) Newer Non-Benzodiazepines Hypnotics: Zopiclone and Zolpidem.
4) Miscellaneous: Chloral hydrates, Triclofos, and Paraldehyde.
Psychopharmacological Agents
Introduction
Classification
Psychopharmacological agents are classified based on their clinical use and behavioural changes they induce:
1) Anti-Anxiety Agents (Anxiolytics): These drugs diminish pathological anxiety, tension, apprehension, and agitation without affecting other behaviours.
2) Antipsychotic Agents (Neuroleptics): These drugs are used for treating schizophrenia and other forms of psychoses.
3) Antidepressants: These drugs are used in endogenous depression. These sanup
4) Antimanic Agents: These drugs are used for prophylaxis in bipolar depressions and for manic phase of the disease.
5) Hallucinogens (Psychotomimetics and Psychodysleptics): These drugs induce schizoid symptoms including hallucinations.
Anticonvulsants
Introduction
Classification
1) Hydantoin Derivatives: Phenytoin, Methatoin, and Ethotoin.
2) Barbiturate & Deoxybarbiturate:
Phenobarbitone, and Primidone.
3) Succinimides: Ethosuximide and Methsuximide.
4) GABA Transaminase Inhibitors: Sodium valproate and Vigabatrin
5) Iminostilbenes: Carbamazepine and Oxcarbazepine.
6) GABA Agonist: Gabapentin Clonazepam, Lorazepam,
7) Benzodiazepines: Clobazam, and Diazepam.
8) Phenyltriazine: Lamotrigine.
Analeptics
Introduction
Respiratory stimulant, CNS stimulant
Classification
Analeptics are classified as follows:
1) Based on their Prior Influence on the Definite Domain of the CNS
i) Drugs that Influence the Brain Cortex:
Coffeinum-natrii benzoas.
ii) Drugs that Influence the Medulla Oblongata:
Cordiaminum, Aethimizolum, Camphora, Sulfocamphocainum.
iii) Drugs that Influence the Medulla Spinalis:
Strychnine nitrate.
2) Based on Their Type of Action
i) Analeptics of Direct Action: Coffeinum-natrii benzoas, Aethimizolum.
ii) Analeptics of Reflexive Action: hydrochloridum, Cytitonum. Lobelini
iii) Analeptics of Mixed Action: Cordiaminum, Corbogenun, Sulfocamphocainum, Camphora.
Centrally Acting Muscle Relaxants
Introduction
Classification
The centrally acting muscle relaxants may be grouped as:
1) Barbiturates: Phenobarbitone. or Glycerol Ethers: Carisoprodol,
2) Mephenesin Congeners Mephenesin, Methocarbamol, Chormezanone, and Chlorzoxazone.
3) Benzodiazepines: Diazepam. Meprobamate,
4) GABA Derivative: Baclofen.
Anti-Parkinsorism Agents
Introduction
Classification
I. Drugs affecting brain dopaminergics ystem
(a) Dopamine precursor : Levodopa (l-dopa)
(b) Peripheral decarboxylase inhibitors :
Carbidopa, Benserazide.
(c) Dopaminergic agonists: Bromocriptine,
Ropinirole, Pramipexole
(d) MAO-B inhibitor: Selegiline, Rasagiline
(e) COMT inhibitors: Entacapone, Tolcapone
(f) Glutamate (NMDA receptor) antagonist (Dopamine facilitator): Amantadine.
II. Drugs affecting brain cholinergic system
(a) Central anticholinergics: Trihexyphenidyl (Benzhexol), Procyclidine, Biperiden.
(b) Antihistaminics : Orphenadrine,
Promethazine
Local Anaesthetics
Introduction
Classification
1) Injectable anaesthetic
i) Low potency, short duration
Procaine,Chloroprocaine
ii) Intermediate potency and duration
Lidocaine (Lignocaine),
Prilocaine
iii) High potency, long duration
Tetracaine (Amethocaine),
Bupivacaine, Ropivacaine,
Dibucaine (Cinchocaine)
2) Surface anaesthetic
i) Soluble
Benoxinate, Cocaine, Lidocaine, Tetracaine
ii) Insoluble
Benzocaine
Butylaminobenzoate (Butamben)
Oxethazaine
Exercise
Chapter 6: Drugs Acting on Autonomic Nervous System-I
Drugs Acting on Autonomic Nervous System
Introduction
Cholinergic Transmission
Cholinergic Receptors
Cholinergic Drugs
Introduction
Actions of cholinergic drugs (or parasympathomimetic drugs) are similar to that of acetylcholine. They exert their actions by directly binding to the cholinergic receptors (cholinergic agonists) or by increasing the availability of acetylcholine at these sites by indirect acting agents.
Classification
Cholinergic drugs can be classified into:
1) Direct Acting Agents (Cholinergic Agonists): These drugs produce actions similar to ACh by directly interacting with cholinergic receptors:
i) Choline Esters: Acetylcholine, Methacholine, Carbachol, and Bethanechol.
ii) Cholinergic Alkaloids: Muscarine, Pilocarpine, Arecholine, and Oxotremorine.
2) Indirect Acting Agents (Anticholinesterase): These drugs produce actions similar to ACh by increasing the availability of ACh at the sites:
i) Reversible
a) Carbamates
• Tertiary Amines: These can blood brain barrier. For example, Physostigmine.
• Quaternary Amines: These cannot cross blood brain barrier. For example, Distigmine, Pyridostigmine. cross Neostigmine, and
b) Acridine: Tacrine.
ii) Irreversible
a) Organophosphorus Compounds: Disopropyl Parathion, Tabun, Soman, Echothiophate, and TEPP. fluorophosphate, Sarin,
b) Carbamates: They are used as insecticides.
For example, Carbaryl and Propoxur.
Anticholinergic Drugs
Introduction
Classification
Anticholinergic drugs are classified into two classes:
1) Anti-Muscarinic Agents: These act by inhibiting the actions of ACh by blocking the acetylcholine receptors. muscarinic
2) Anti-Nicotinic, Agents: These act by inhibiting the actions of ACh at nicotinic acetylcholine receptors.
i) Ganglionic Blockers (NN Blockers): These interfere with nicotinic ACh receptors and block impulse transmission at the sympathetic ganglia.
ii) Neuromuscular Blockers (NM Blockers): These block the transmission of ACh at the motor end plate.
anti-muscarinic
The anticholinergic drugs that block the action of ACh on muscarinic receptors are called as anti-muscarinic agents, muscarinic receptor antagonist, or atropinic Anti-Muscarinic Agents agents.
Anti-muscarinic agents can be classified as follows:
1) Natural Scopolamine (hyoscine)
2) Semi-Synthetic Agents:
Ipratropium, Homatropine, Propantheline, Tiotropium bromide, and Hyoscine butyl bromide. Classification Occurring Agents: Atropine pue
3) Synthetic Agents:
Pirenzepine, Isopropamide, Oxyphenonium, Dicyclomine, Trihexyphenidyl, and Tropicamide
Ganglionic blockers
Classification
1) Quarternary Ammonium Compounds:
Hexamethonium and Pentolinium.
2) Secondary or Tertiary Amines: Mecamylamine and Pempidine.
3) Monosulphonium Compounds: Trimethaphan camsilate.
4) Persistent Depolarising Blockers: Nicotine (large dose) and Anticholinesterases (large dose)
Chapter 7: Drugs Acting on Autonomic Nervous System-II
Introduction
Adrenergic Transmission Adrenergic Receptors
Adrenergic System
Adrenergic Drugs
Introduction
Adrenergic agonists Or sympathomimetic agents
Classification
1) Direct-Acting Sympathomimetic Agents: They stimulate the adrenergic receptors directly, e-g., Epinephrine or Norepinephrine.
2) Indirect-Acting Sympathomimetic Agents:
They act by stimulating the release of nor-epinephrine from the terminal nerve endings, e.g., Amphetamine.
3) Mixed-Acting Sympathomimetic Agents:
They act both directly (stimulating adrenergic receptor sites) and indirectly (stimulating release of nor-epinephrine from the terminal nerve endings), e.g., Ephedrine.
Adrenergic Receptor Blockers Introduction
Antiadrenergic agent or Adrenoceptor antagonist
A) Classification of α-adrenoceptor blockers
1) Non-Selective: Phenoxybenzamine, Ergotamine, Dihydroergotamine, Tolazoline, Phentolamine, and Chlorpromazine.
2) α1-Selective: Prazosin, Terazosin, Doxazosin, and Tamsulosin.
3) α2-Selective: Yohimbine.
B) Classification of β-adrenoceptor blockers
1) Cardioselective β1 Blockers:
Metoprolol, Acebutolol, Esmolol, Atenolol, and Binoprolol. Amongst them, Acebutolol also exerts an intrinsic sympathomimetic activity.
2) Non-Selective β1, and β2 Blockers
i) Selective β-Blockers: Timolol and Nadolol.
ii) β-Blockers Membrane Stabilising Activity: Propranolol
iii) B-Blockers with Membrane Stabilising and Intrinsic Sympathomimetic Activity:
Oxprenolol and Pindolol.
iv) Miscellaneous: Sotalol.
3) Selective B2 Blockers: Butoxamine and ICI 118551.
4) α+β-Blockers: Labetalol, Carvedilol and Celiprolol.
Neuron Blockers
Introduction
Example
Guanethidine ,Reserpine
Neuromuscular Blockers
Introduction
Classification
The classification of muscle relaxants is based on their mode of action, duration of action, and site of action, which is as follows:
1) Drugs Acting Peripherally at the Neuromuscular Junction:
These drugs are further categorised in the following sub-classes: Competitive Blockers or Non-Depolarising Blockers: They may be:
a) Long , Acting (60-120 Minutes):Doxacurium Pancuronium, Pipecuronium and Vecuronium.
b) Intermediate Acting (20-50 Minutes): Atracurium and Rocuronium.
c) Short Acting (10-20 Minutes): Mivacurium.
ii) Depolarising Blockers: Succinyl choline.
iii) Inhibition Botulinus toxins type A and B-Bungarotoxin. of Release of Acetylcholine:
2) Drugs Acting Centrally: Diazepam, Baclofen, and Mephenesin.
3) Drugs Acting Directly on Muscle: Dantrolene.
Myasthenia Gravis
Myasthenia Gravis cause by a breakdown in communication between nerves & muscles
Drugs Used
Following drugs are used in the treatment of Myasthenia Gravis:
1) Modulation of Neuromuscular Transmission:
The Neuromuscular transmission is modulated by administration of anticholinesterases (cholinesterase inhibitors) such as pyridostigmine bromide (Mestinon) and neostigmine bromide (Prostigmin).
2) Immunomodulation: Modulation of the immune system is brought about by:
i) Plasma Exchange:
It helps to remove abnormal antibodies.
ii) Intravenous Immune Globulin (IVIG):
It brings about down-regulation of antibodies directed against AChR.
iii) Immunoabsorption: This procedure helps to remove anti-AChR ABs.
iv) Immunosuppression: Corticosteroids (e.g., prednisone) and other immunosuppressant like azathioprine, cyclosporin, mycophenolate mofetil, and tacrolimus can be used to suppress the immune system thus suppressing the production of abnormal antibodies.
Drugs like aminoglycoside antibiotics, d-tubocurarine (d- TC) and other neuromuscular blockers, B-blockers, ether, phenytoin, etc., should not be used as they aggravate myasthenia and are hence contraindicated.
Drugs Acting on Eye - Mydriatics
Introduction
1) Tropicamide, 2) Phenylephrine
Glaucoma
Introduction
Drugs Used
Acute Congestive (Narrow-Angle) Glaucoma
Osmotic Agents
1) Mannitol (20%) i.v. 2) Glycerol (50%) oral
Carbonic Anhydrase Inhibitors Acetazolamide, i.v., oral
β-Blockers Timolol (0.5%), topical
Miotics Pilocarpine (2%), topical
Prostaglandins Latanoprost (0.005%), topical
Chronic Simple (Wide-Angle) Glaucoma β-Blockers
1) Timolol (0.25%) 2) Betaxolol (0.25%) 3) Carteolol (1%), topical
Prostaglandins Latanoprost (0.005%), topical
Carbonic Anhydrase Inhibitors
1) Dorzolamide (2%), topical
2) Brinzolamide, topical
3) Acetazolamide, oral
α-Adrenergic Agonists
1) Dipivefrine (0.1%), topical
2) Apraclonidine (1%), topical
Miotics
Pilocarpine (0.5%), topical
Exercise
Chapter 8: Drugs Acting on Respiratory System
Introduction
1) Respiratory Stimulants
Doxapram
Prethcamide
Naloxone (Narcan)
Yohimbine
Strychnine, Picrotoxin, and Pentylenetetrazol (PTZ)
2) Expectorants (Mucokinetics)
(a) Bronchial secretion enhancers: Sodium or Potassium citrate, Potassium iodide, Guaiphenesin (Glyceryl guaiacolate), balsum of Tolu, Vasaka, Ammonium chloride.
(b) Mucolytics: Bromhexine, Ambroxol, Acetyl cysteine, Carbocisteine
3. Antitussives (Cough centre suppressants)
(a) Opioids: Codeine, Ethylmorphine,
Pholcodeine.
(b) Nonopioids:
Noscapine, Dextromethorphan, Chlophedianol.
(c) Antihistamines: Chlorpheniramine, Diphenhydramine, Promethazine.
(d) Peripherally acting: Prenoxdiazine.
4. Adjuvant antitussives Bronchodilators: Salbutamol, Terbutalin.
4) Bronchodilators
1) Sympathomimetic Agents (B2 Agonists)
i) Short Acting: Salbutamol and Terbutaline.
ii) Longer Acting: Formoterol, Pirbuterol, and Ibuterol. Salmeterol, Fenoterol,
2) Xanthine Derivatives: Theophylline and Aminophylline.
3) Anti-Cholinergic Agents: Ipratropium bromide and Atropine.
5) Nasal Decongestants
1) Nasal Preparations: Ephedrine hydrochloride 0.5%, Phenylephrine 1-2%, Xylometazoline 0.05%-0.1%," Oxymetazoline 0.025%, Naphazoline 0.05%-0.1%.
2) Oral Preparations: Phenyl propanolamine 25, 50mg tablets, Pseudoephedrine 30mg tablet or 30mg/5ml syrup.
Chapter 9: Autocoids
Autocoids
Introduction
Classification
Histamine
Introduction
Along with histamine, betazole (histalog) and impromidine act as histamine agonists:
1) Betazole: The activity of betazole is ten times greater at H2-receptors than at H₁-receptors.
2) Impromidine: Impromidine is an agent used for investigations with about 10,000 H₂ to H, activity ratio.
3) Methimepip: Methimepip is a histamine agonist acting specifically against H3 receptors.
Antihistamines (Histamine Antagonists)
Histamine antagonists are the drugs or agents that antagonise the action of histamine. Following are the three types of histamine receptor antagonists:
1) H₁-Antagonists: These are classical antihistamines blocking the physiological effects of histamine and used in allergic disorders.
H1-antagonists can be classified as
A) First Generation H₁-Antagonists: They cross blood-brain barrier readily and produce drowsiness.
i) Ethanolamines (e.g., Diphenhydramine hydrochloride, dimenhydrinate).
ii) Ethylenediamines (e.g., Pyrilamine maleate,tripelennamine hydrochloride).
iii) Alkylamines (e.g., Chlorpheniramine maleate,
brompheniramine maleate).
iv) Piperazines (e.g., Cyclizine hydrochloride, meclizine hydrochloride).
v) Piperidines
(e.g.,Cyproheptadine hydrochloride).
vi) Phenothiazines (e.g., Promethazine hydrochloride).
vii) Tricylic Dibenzoxepins (e.g., Doxepin hydrochloride).
A) Second Generation H₁-Antagonists: They do not cross blood-brain barrier readily thus produce less drowsiness.
i) Alkylamines (e.g., Acrivastine).
ii) Piperazines (e.g., Cetirizine hydrochloride).
iii) Phthalazinones (e.g., Azelastine hydrochloride).
iv) Piperidines (e.g., Terfenadine, astemizole, loratadine, fexofenadine).
2) H2-Antagonists: Cimetidine, Ranitidine and Famotidine are H₂-antagonists reducing gastric HCI secretion and used in peptic ulcer diseases.
3) H3-Antagonists: Thioperamide an H-antagonist regulates histamine release from histaminergic neurons of CNS by presynaptic auto-regulatory mechanism. It is not recommended to be used therapeutically.
Serotonin
Introduction
Physiological Role
Prostaglandins
Introduction
Pharmacological Actions
Chapter 10: Cardiovascular Drugs
Introduction Cardiotonics
Antiarrhythmic Agents
Introduction
Classification
Class Basic Mechanism
I Sodium Channel Blocker
Reduce phase 0 slope and peak of action potential.
IA Moderate
Moderate reduction in phase 0 slope: increase APD; increase ERP
Quinidine, Procainamide
IB Weak
Small reduction in phase 0 slope: reduce APD; decrease ERP.
Lidocaine, Phenytoin
IC Strong
Pronounced reduction in phase 0 slope: no effect on APD orERP
Flecainide, Propafenone
II Beta-Blocker:-
Block sympathetic activity; reduce rate and conduction.
Propranolol, Metoprolol
III Potassium- Channel Blocker:-
Delay re-polarisation (phase 3) and thereby increase action potential duration and effective refractory period.
Amiodaron, Bretylium
IV Calcium-Channel Blocker:-
Block L-type calcium-channels; most effective at SA and AV nodes; reduce rate and conduction.
Verapamil, Diltiazem, Nifedipine
Antianginal Agents
Introduction
Classification
1) Vasodilator Drugs
i) Organic Nitrites and Nitrates: a) Amyl nitrite, b) Isosorbide dinitrate, c) Isosorbide mononitrate, and d) Nitro-glycerine.
i) Calcium Channel Blockers: a) Amlodipine, b) Nifedipine, c) Diltiazem, and d) Verapamil.
ii) Potassium Channel Opener: Nicorandil.
2) β-Adrenoceptor Antagonists (β-Blockers) i) Atenolol, ii) Metoprolol, iii) Nadolol, and iv) Propranolol.
3) Metabolic Modifiers i) Ranolazine, and ii) Ranolazine
Antihypertensive Agents
Introduction
Classification
1) Diuretics
i) Thiazides: Hydrochlorothiazide, Chlorthalidone, and Indapamide.
ii) Loop Diuretics: Furosemide, Bumetanide, and Torsemide.
iii) K* Sparing Diuretics: Amiloride, and Triamterene Spironolactone,.
2) Angiotensin Converting Enzyme Inhibitors: Captopril, Enalapril, Lisinopril, Ramipril, Perindopril, Fosinopril, Trandolapril, Quinapril, and Benazepril.
3) Angiotensin II Receptor Antagonists:
Telmisartan ,Losartan, Candesartan, Valsartan, Eprosartan, and Irbesartan.
4) Ganglion Blockers: Trimethaphan.
5) Adrenergic Drugs
i) Centrally Acting Drugs:
Methyldopa, Guanabenz, and Guanfacine, Clonidine,
ii) Adrenergic Neuron Blockers: Guanithidine and Reserpine.
iii) Sympatholytics (Adrenergic Receptor Blockers) :
a) α Blockers
Prazosin, Terazosin, Doxazosin, Phenoxybenzamine, and Phentolamine.
b) β Blockers: Propranolol, Atenolol, Esmolol, and Metoprolol.
c) α & β Blockers: Labetalol, Carvedilol.
6) Ca++ Channel Blockers: Verapamil, Nifedipine, Nicardipine, Nimodipine, Amlodipine, and Felodipine.
7) Vasodilators
i) Arteriolar Dilators: Hydralazine, Minoxidil, and Diazoxide.
ii) Arteriolar and Venular Dilators: Sodium nitroprusside.
Peripheral Vasodilators
Introduction
Mechanism of Action
Drugs Used in Atherosclerosis
Introduction
The build-up of fats, cholesterol and other substances in and on the artery walls.
Classification
The anti- hyperlipidemic drugs are divided into:
1) HMG-CoA Reductase Inhibitors (Statins): Lovastatin, Simvastatin, Pravastatin, and Atorvastatin.
2) Bile Acid Sequestrants (Resins): Cholestyramine and Colestipol.
3) Fibric Acid Derivatives (Fibrates): Clofibrate, Gemfibrozil, Bezafibrate, and Fenofibrate.
4) Triglyceride Synthesis and Lipolysis Inhibitors: Nicotinic acid.
5) Others: Probucol and Omega-3 fatty acids.
Chapter 11: Drugs Acting on Blood and Blood-Forming Organs
Drugs Acting on Blood and Blood Forming Organs Introduction Blood Forming Organs
Haematinics
Introduction Hematinics are substances that are essential to the proper formation of the components of blood.
Iron ,Folic Acid ,Vitamin B12 (Cyanocobalamin)
Coagulants
Introduction
Classification
Vitamin K
i) K1 (from plants, fat-soluble) Phytonadione(Phytomenadione) (Phylloquinone).
ii) K3 Menadione(synthetic)
a) Fat-soluble Menadione Acetomenaphthone.
b) Water-soluble - Menadione sodium bisulfite, Menadione sodium diphosphate.
(2) Miscellaneous
i) Fibrinogen (human),
ii) Antihaemophilic factor,
iii) Desmopressin, iv) Adrenochrome monosemicarbazone, v) Rutin, Ethamsylate.
Anticoagulants
Introduction
Classification
These drugs are used to decrease the coagulability of blood. They can be classified as follow:
1) Injectable Anticoagulants: Lepirudin, Heparin, Ancrod
2) Oral Anticoagulants
i) Coumarin Derivatives: Bishydroxy coumarin (dicumarol), Warfarin sodium, Acenocoumarin, Ethylbiscoumacetate.
ii) Indandione Derivative: Phenindione.
Haemostatics
Introduction
Classification
Local Agents (Styptics) :
Astringents, Adrenaline ,Thrombin, Fibrin glue Gelatin, Calcium alginate, Oxidised cellulose, Russell's viper venom
Systemic Agents :
Vitamin ,Fibrinogen ,Antihaemophilic factor, Adrenochrome, Adrenochrome monosemicarbazone, Ethamsylate, Desmopressin ,Tranexamic acid, Epsilon amino-caproic acid
Blood Substitutes
Introduction
Requisites for Blood Substitutes
Classification of Blood Substitutes
Plasma Expanders
Introduction
Classification
1) Human albumin, 2) Dextran, 3) Polyvinylpyrrolidone, 4) Hetastarch, 5) Degraded gelatine polymer.
Chapter 12: Drugs Affecting Renal Function
Diuretics
Introduction
Classification On the basis of their intensity, diuretics can be categorised
1) High Efficacy Diuretics (Inhibitors of N+-K+- 2Cl- Co-transport)
i) Sulphamoyl Derivatives:
Bumetanide ,Furosemide
ii) Phenoxyacetic Acid Derivatives:
Ethacrynic acid.
iii) Organomercurials: Mersalyl.
2) Medium Efficacy Diuretics (Inhibitors of Na*- Cl Symporter)
i) Benzothiadiazines (Thiazides): Chlorothiazide, Hydrochlorothiazide, Hydroflumethiazide, Clopamide. Benzthiazide,
ii) Thiazide like Diuretics (Related Heterocyclics): Chlorthalidone, Xipamide, Indapamide. Metolazone,
3) Weak or Adjunctive Diuretics
i) Carbonic Anhydrase Inhibitors: Acetazolamide.
ii) Potassium Sparing Diuretics
a) Aldosterone Antagonists: Spironolactone.
b) Directly Acting Diuretics (Inhibitors of Renal Epithelial Na* Channel): Triamterene, Amiloride.
iii) Osmotic Diuretics: Mannitol, Isosorbide, Glycerol.
iv) Xanthines: Theophylline.
Antidiuretics
Introduction
Classification
1) Antidiuretic Hormone (ADH, Vasopressin), e.g., Desmopressin, Lypressin, Terlipressin.
2) Thiazide diuretics, e.g., Amiloride.
3) Miscellaneous, e.g., Indomethacin, Chlorpropamide, Carbamazepine.
Chapter 13: Hermones and Hormone Antagonists
Hormones and Hormone Antagonists Introduciion
Classification
1) Pituitary
i) Anterior Pituitary
a) Growth Hormone (GH), Prolactin (Prl),
b) Adrenocorticotropic Hormone (ACTH,Corticotropin),
c) Thyroid Stimulating Hormone (TSH, Thyrotropin),
d) Gonadotropins Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).
ii) Posterior Pituitary
a) Oxytocin,
b) Antidiuretic Hormone (ADH, Vasopressin).
2) Thyroid: Thyroxine (T4), Triiodothyronine (T3), Calcitonin.
3) Parathyroid: Parathormone (PTH).
4) Pancreas: Insulin, Glucagon.
5) Adrenals
i) Cortex
a) Glucocorticoids (hydrocortisone),
b) Mineralocorticoids (aldosterone),
c) Sex steroids (dehydroepiandrosterone).
ii) Medulla: Adrenaline, Noradrenaline
6) Gonads
i) Androgens (testosterone), ii) Estrogens (estradiol), iii) Progestins (progesterone).
Hormone Antagonists
Hypoglycaemic Agents
Introduction
Classification
A. Enhance Insulin secretion
1. Sulfonylureas (KATP Channel blockers)
First generation: Tolbutamide
Second generation: Glibenclamide (Glyburide),Glipizide, Gliclazide, Glimepiride
2. Meglitinide/phenylalanine analogues
Repaglinide, Nateglinide
3. Glucagon-like peptide-1 (GLP-1) receptor agonists (Injectable drugs)
Exenatide, Liraglutide
4. Dipeptidyl peptidase-4 (DPP-4) inhibitors
Sitagliptin, Vildagliptin, Saxagliptin, Alogliptin,
Linagliptin
B. Overcome Insulin resistance
1. Biguanide (AMPK activator)
Metformin
2. Thiazolidinediones (PPARγ activator)
Pioglitazone
C. Miscellaneous antidiabetic drugs
1. α-Glucosidase inhibitors
Acarbose, Miglitol, Voglibose
2. Amylin analogue
Pramlintide
3. Dopamine-D2 receptor agonist
Bromocriptin
4. Sodium-glucose cotransport-2 (SGLT-2) inhibitor
Dapagliflozin
Anti-Thyroid Drugs
Introduction
Classification
1. Inhibit hormone synthesis (Antithyroid drugs)
Propylthiouracil, Methimazole, Carbimazole.
2. Inhibit iodide trapping (Ionic inhibitors)
Thiocyanates (–SCN), Perchlorates (–ClO4),
Nitrates (–NO3).
3. Inhibit hormone release
Iodine, Iodides of Na and K, Organic iodide.
4. Destroy thyroid tissue:
Radioactive iodine (131I, 125I, 123I).
Sex Hormones
Androgens
Androgens are classified in two classes:
1) Naturally Occurring Androgens
i) Testosterone,
ii) Dihydrotestosterone,
iii) Dehydroepiandrosterone, and
iv) Androsterone.
2) Synthetic Androgens
i) Methyl testosterone,
ii) Fluoxymesterone,
iii) Testosterone undecanoate,
iv) Mesterolone.
Estrogens
Estrogens are classified as given below:
1) Natural Estrogens
i) Estradiol (the most common type in women of child bearing age),
ii) Estrone (the only estrogen body makes after menopause), and
iii) Estriol (the main estrogen during pregnancy).
2) Synthetic Estrogens
i) Steroidal a) Ethinylestradiol, b) Mestranol, and c) Tibolone.
ii) Nonsteroidal a) Diethylstilbestrol (stilbestrol), b) Hexestrol, and c) Dienestrol.
Progesterone
1) Natural Progestin: Progesterone.
2) Synthetic Progestins
i) Progesterone Derivatives
a) Older Compounds •Medroxyprogesterone androgenic acetate (weak ),
•Megestrol acetate,
•Dydrogesterone,
• Hydroxyprogesterone caproate (long acting injection).
b) Newer Compound: Nomegestrol acetate.
ii) 19-Nortestosterone Derivatives
(a) Older Compounds
Norethindrone (Norethisterone),
Norethynodrel, Ethynodiol diacetate, Lynestrenol (Ethinylestrenol), Allylestrenol, Norgestrel (Gonane), Levonorgestrel.
b) Newer Compounds (Gonanes)
Desogestrel,
Norgestimate,
Gestodene.
Oral Contraceptives
COMBINED PILLS
1.Norgestrel 0.3mg Ethinylestradiol30 µg
2. Norgestrel 0.5 mg Ethinylestradiol 50 µg
3. Levonorgestrel 0.25 mg Ethinylestradiol 50 µg
4. Levonorgestrel 0.15 mg Ethinylestradiol 30 µg
5. Levonorgestrel 0.1 mg Ethinylestradiol 20 µg
6. Desogestrel 0.15 mg Ethinylestradiol 30 µg
7. Desogestrel 0.15 mg Ethinylestradiol 20 µg
POSTCOITAL PILL
1. Levonorgestrel 0.25 mg Ethinylestradiol 50 µg
2. Levonorgestrel 0.75 mg ,1.5 mg
MINI PILLS
1. Norethindrone 0.35 mg
2. Norgestrel 75 µg
Corticosteroids
Introduction
Classification
Two types of corticosteroids are given below:
1) Glucocorticoids: They control carbohydrate, fat and protein metabolism. They are showing anti-inflammatory action by inhibiting the phospholipid release, reducing the eosinophil action and a number of other mechanisms.
a) Short acting Hydrocortisone (Cortisol)
b) Intermediate acting Prednisolone, Methyl prednisolone, Triamcinolone, Deflazacort
c) Long acting Dexamethasone, Betamethasone
2) Mineralocorticoids: They regulate the electrolyte and water levels by stimulating the sodium retention in the kidney.
Example
Desoxycorticosterone acetate (DOCA), Fludrocortisone, Aldosterone
Chapter 14: Drugs Acting On Digestive System
Drugs Acting on Digestive System
Introduction
Carminatives
Bitters
Introduction
Classification
Antisecretory Agents
Antacids
Drugs Used in Peptic Ulcer
1. Reduction of gastric acid secretion
(a) H2 antihistamines: Cimetidine,
Ranitidine, Famotidine, Roxatidine
(b) Proton pump inhibitors: Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, Rabeprazole, Dexrabeprazole
(c) Anticholinergic drugs: Pirenzepine, Propantheline, Oxyphenonium
(d) Prostaglandin analogue: Misoprostol
2. Neutralization of gastric acid (Antacids)
(a) Systemic: Sodium bicarbonate,
Sod. citrate
(b) Non systemic: Magnesium hydroxide,
Mag. trisilicate, Aluminium hydroxide
gel, Magaldrate, Calcium carbonate
3. Ulcer protectives: Sucralfate, Colloidal bismuth subcitrate (CBS)
4. Anti-H. pylori drugs: Amoxicillin,
Clarithromycin, Metronidazole, Tinidazole, Tetracycline
Ulcer Protectives
Laxatives (Purgatives)
Introduction
Classification
1. Bulk forming:
Dietary fibre: Bran, Psyllium (Plantago)
Ispaghula, Methylcellulose
2. Stool softener:
Docusates (DOSS), Liquid paraffin
3. Stimulant purgatives:
(a) Diphenylmethanes
Phenolphthalein, Bisacodyl, Sodium
picosulfate
(b) Anthraquinones (Emodins)
Senna, Cascara sagrada
(c) 5-HT4 agonist
Prucalopride
(d) Fixed oil
Castor oil
4. Osmotic purgatives:
Magnesium salts: sulfate, hydroxide
Sodium salts: sulfate, phosphate
Sod. pot. tartrate
Lactulose
Antidiarrhoeals
Introduction
Classification
1 ) Anti - Motility Agents : Morphine ,Codeine , Loperamide , and Bismuth subsalicylate .
2 ) Cannabinoid Receptor Agonists: Tetrahydrocannabinol and Cyclohexylphenols .
3 ) Adsorbents : Kaolin , Pectin , Chalk , Charcoal , Methyl Cellulose , and Activated attapulgite .
4 ) Antispasmodic Agents : Dicyclomine , Mebeverine and Propantheline .
Emetics
Introduction
Mechanism of Action
Anti-Emetics
Introduction
Classification
1. Anticholinergics: Hyoscine, Dicyclomine
2. H1 antihistaminics: Promethazine,
Diphenhydramine,
Dimenhydrinate,
Doxylamine,
Meclozine (Meclizine),
Cinnarizine.
3. Neuroleptics(D2 blockers): Chlorpromazine,
Triflupromazine,
Prochlorperazine,
Haloperidol,
4. Prokinetic drugs: Metoclopramide,
Domperidone, Cisapride, Mosapride, Itopride
5. 5-HT3 antagonists: Ondansetron,
Granisetron,
Palonosetron,
Ramosetron
6. NK1 receptor antagonists: Aprepitant,
Fosaprepitant
7. Adjuvant antiemetics Dexamethasone,Benzodiazepines,
Dronabinol, Nabilone
Chapter 15: Chemotherapy of Microbial Diseases - I
Introduction
Classification of Antimicrobial Agents
Classification
1) Based on the Chemical Structure
i) Antibiotics
a) β-Lactam Antibiotics:
Cephalosporins, Carbapenems ,
Penicillins, Monobactams,
b) Aminoglycosides: Streptomycin, Gentamycin, Framycetin, Neomycin,
c) Macrolide Antibiotics:
Roxithromycin,
Azithromycin,
Erythromycin, Clarithromycin,
d) Tetracyclines: Doxycycline, Minocycline, Oxytetracycline,etc.
e) Nitrobenzene Derivatives:
Chloramphenicol, etc.
f) Polypeptide Antibiotics: Polymyxin-B, Colistin, Bacitracin, Tyrothricin, etc.
g) Polyene Antibiotics: Nystatin. Hamycin, Amphotericin-B, etc.
h) Miscellaneous Agents:
Rifampicin, Lincomycin, Vancomycin, Fusidic acid, Cycloserine, Viomycin, Griseofulvin, etc.
ii) Chemotherapeutic Agents Other than Antibiotics
a) Sulphonamides and Related Agents:
Sulfadiazine, Sulfamethoxazole, Sulfones (Dapsone) Para aminosalicylic acid (PAS),etc.
b) Diaminopyrimidines: Pyrimethamine.
c) Quinolones and Fluoroquinolones:
Nalidixic acid, Norfloxacin, Ciprofloxacin,ofloxacin, etc.
d) Nitrofuran Derivatives: Nitrofurantoin,
Furazolidone, etc.
e) Nitroimidazoles: Metronidazole, Tinidazole etc.
f) Imidazole Derivatives: Miconazole,
Clotrimazole, Ketoconazole, Fluconazole,etc.
g) Nicotinic Acid Derivatives: Isoniazid, Pyrazinamide, Ethionamide, etc.
h) Miscellaneous Agents: Ethambutol,
Thiacetazone, Clofazimine, etc.
2) Based on the Mechanism of Action
i) Inhibit Cell Wall Synthesis: Penicillins, Cephalosporins, Cycloserine, Vancomycin,
Bacitracin.
ii) Cause Leakage from Cell Membranes: Polypeptides Polymyxins, Colistin, Bacitracin. Polyenes-Amphotericin B, Nystatin, Hamycin.
iii) Inhibit Protein Synthesis: Tetracyclines,Chloramphenicol, Erythromycin, Clindamycin, Linezolid. iv) Cause Misreading of m-RNA Code and Affect Permeability: Aminoglycosides - Streptomycin,
Gentamicin, etc.
v) Inhibit DNA Gyrase: Fluoroquinolones
Ciprofloxacin and others.
vi) Interfere with DNA Function: Rifampin, Metronidazole.
vii) Interfere with DNA Synthesis: Acyclovir, Zidovudine.
viii) Interfere with Intermediary Metabolism: Sulphonamides, Sulphones, PAS, Trimethoprim, Pyrimethamine, Ethambutol.
3) Based on their Range of Action
i) Broad Spectrum Antibiotics: Those effective against Gram +ve, Gram -ve, rickettsia and chlamydia. For example, Tetracycline,
Chloramphenicol etc.
ii) Relative Broad Spectrum Antibiotics: Those effective against gram +ve and gram-ve bacteria. For example, Ampicillin group, Cephalosporins, Rifamycins, etc.
iii) Narrow Spectrum Antibiotics
a) Those effective only against gram +ve bacteria, e.g., Penicillin, Erythromycin
group, Vancomycin.
b) Those effective only against gram -ve
bacteria, e.g., Streptomycin and other aminoglycoside antibiotics, Colistin, Polymyxin-B.
c) Antifungal Antibiotics: Hamycin, Nystatin, Griseofulvin etc.
d) Anticancer Antibiotics: Actinomycin Bicomycin, Mitomycin, Mithramycin etc.
4) Based on Types of Organisms Against which Primarily Active
i) Antibacterial: Penicillins, Aminoglycosides, Erythromycin, etc.
ii) Antifungal: Griseofulvin, Amphotericin-B, Ketoconazole, etc.
iii) Antiviral: Acyclovir, Amantadine, Zidovudine,etc.
iv) Antiprotozoal:
Chloroquine, Pyrimethamine,
Metronidazole, Diloxanide, etc.
v) Anthelmintic: Mebendazole,
Pyrantel, Niclosamide, Diethylcarbamazine, etc.
5) Based on the Type of Action
Table 15.1: Primarily bacteriostatic
Sulphonamides
Erythromycin Ethambutol
Tetracyclines Chloramphenicol
Clindamycin Linezolid
Table 15.2: Primarily Bactericidal
Penicillins
Cephalosporins
Aminoglycosides
Vancomycin Nalidixic Acid
Polypeptides
Rifampin Isoniazid
Ciprofloxacin
Metronidazole Pyrazinamide Cotrimoxazole
6) Based on the Source of Antibiotic i) Fungi: Penicillin, Griseofulvin, Cephalosporin.
ii) Bacteria: Polymyxin B, Tyrothricin. Colistin, Aztreonam, Bacitracin.
iii) Actinomycetes: Aminoglycosides, Macrolides, Tetracyclines, Polyenes, Chloramphenicol.
Sulphonamides
Classification
1) Short acting (4-8 hours): Sulfadiazine, etc.ction
2) Intermediate acting(8-12 hours):
Sulfamethoxazole, Sulfamoxole, etc.
3) Long acting (~7 day)
Sulfamethopyrazine,
Sulfadoxine,
4) Special Purpose Sulphonamides: Sulfacetamide, Sulfasalazine , Mafenide, Silver sulfadiazine, etc.
Penicillin
Classification
1. Acid-resistant alternative to penicillin G
Phenoxymethyl penicillin (Penicillin V).
2. Penicillinase-resistant penicillins
Methicillin, Cloxacillin, Dicloxacillin.
3. Extended spectrum penicillins
(a) Aminopenicillins: Ampicillin,
Bacampicillin, Amoxicillin.
(b) Carboxypenicillins: Carbenicillin.
(c) Ureidopenicillins: Piperacillin,
Mezlocillin.
β-lactamase inhibitors Clavulanic acid
Sulbactam, Tazobactam
Cephalosporins
First generation cephalosporins
Parenteral: Cefazolin
Oral:Cephalexin, Cefadroxil
Second generation cephalosporins
Parenteral
Cefuroxime
Cefoxitin*
Oral
Cefuroxime axetil ,Cefaclor,
Cefprozil
Third generation cephalosporins
Parenteral
Cefotaxime
Ceftizoxime
Ceftriaxone
Ceftazidime
Cefoperazone
Oral
Cefixime
Cefpodoxime proxetil
Cefdinir
Ceftibuten
Ceftamet pivoxil
Fourth generation cephalosporins
Parenteral
Cefepime
Cefpirome
Fifth generation cephalosporins
Parenteral
Ceftaroline fosamil
Ceftobiprole medocaril
Tetracyclines
Chloramphenicol
Classification Aminoglycosides Quinolones Macrolides
Urinary Antiseptics
Introduction
Nitrofurantoin,
Methenamine (Hexamine),
Phenazopyridine
Chapter 16: Chemotherapy of Microbial Diseases - II
Anti-Tubercular
Introduction
Classification
• First line drugs
1. Isoniazid (H) 4. Ethambutol (E)
2. Rifampin (R) 5. Streptomycin (S)
3. Pyrazinamide (Z)
• Second line drugs
• Ethionamide (Eto) Fluoroquinolones
• Prothionamide (Pto) • Ofloxacin (Ofx)
• Cycloserine (Cs) • Levofloxacin (Lvx/Lfx)
• Terizidone (Trd) • Moxifloxacin (Mfx)
• Para-aminosalicylic acid (PAS) • Ciprofloxacin (Cfx)
• Injectable drugs
• Rifabutin • Kanamycin (Km)
• Thiacetazone (Thz) • Amikacin (Am)
• Capreomycin (Cm)
Anti-Fungal
Agents Introduction
Classification
1. Antibiotics
A. Polyenes: Amphotericin B (AMB),
Nystatin, Hamycin
B. Echinocandins:Caspofungin, Micafungin,
Anidulafungin
C. Heterocyclic benzofuran: Griseofulvin
2. Antimetabolite: Flucytosine (5-FC)
3. Azoles
A. Imidazoles
Topical: Clotrimazole, Econazole,
Miconazole, Oxiconazole
Systemic: Ketoconazole
B. Triazoles: Fluconazole,
(systemic) Itraconazole,
Voriconazole,
Posaconazole
4. Allylamine: Terbinafine
5. Other topical agents:
Tolnaftate, Undecylenic acid, Benzoic acid,
Quiniodochlor, Ciclopirox olamine, Butenafine,
Sod. thiosulfate.
Individual Drugs
Anti-Viral
Drugs Introduction
Classification
1. Anti-Herpes virus
Idoxuridine, Trifluridine, Acyclovir,
Valacyclovir, Famciclovir, Ganciclovir,
Valganciclovir, Cidofovir, Foscarnet,
Fomivirsen
2. Anti-Influenza virus
Amantadine, Rimantadine, Oseltamivir,
Zanamivir
3. Anti-Hepatitis virus/Nonselective antiviral drugs
Primarily for hepatitis B: Lamivudine,
Adefovir dipivoxil, Tenofovir
Primarily for hepatitis C: Ribavirin,
Interferon α
4. Anti-Retrovirus
(a) Nucleoside reverse transcriptase inhibitors (NRTIs): Zidovudine (AZT),Didanosine, Stavudine,
Lamivudine, Abacavir, Emtricitabine,
Tenofovir (Nt RTI)
(b) Nonnucleoside reverse transcriptase inhibitors (NNRTIs): Nevirapine, Efavirenz, Delavirdine
(c) Protease inhibitors: Ritonavir,
Atazanavir, Indinavir, Nelfinavir,
Saquinavir, Amprenavir, Lopinavir
(d) Entry (Fusion) inhibitor: Enfuvirtide
(e) CCR5 receptor inhibitor: Maraviroc
(f) Integrase inhibitor: Raltegravir
Anti-Leprotic Drugs
Introduction
Classification
1. Sulfone: Dapsone (DDS)
2. Phenazine derivative: Clofazimine
3. Antitubercular drugs: Rifampin,
Ethionamide
4. Other antibiotics Ofloxacin,
Moxifloxacin,
Minocycline,
Clarithromycin
Chemotherapy of Protozoal Diseases-
Anti- Malarial
Drugs Introduction
Classification
1. 4-Aminoquinolines Chloroquine (CQ)
Amodiaquine (AQ)
Piperaquine
2. Quinoline-methanol Mefloquine
3. Cinchona alkaloid Quinine, Quinidine
4. Biguanide Proguanil
(Chloroguanide)
5. Diaminopyrimidine Pyrimethamine
6. 8-Aminoquinoline Primaquine
Tafenoquine
7. Sulfonamides Sulfadoxine
and sulfone Sulfamethopyrazine Dapsone
8. Antibiotics Tetracycline
Doxycycline
Clindamycin
9. Sesquiterpine Artesunate
lactones Artemether
Arteether
Arterolane
10. Amino alcohols Halofantrine
Lumefantrine
11. Naphthyridine Pyronaridine
12. Naphthoquinone Atovaquone
* WHO: World Malaria Report, Dec. 2011
Anthelmintic Drugs
Introduction
Classification
1. ROUNDWORM Mebendazole, Albendazole, Piperazine, Levamisole
Ascaris lumbricoides Pyrantel Ivermectin
2. HOOKWORM
Ancylostoma Pyrantel, Mebendazole, Levamisole
duodenale Albendazole
Necator americanus Mebendazole, Albendazole Pyrantel
3. PIN WORM Pyrantel, Mebendazole, Piperazine
Enterobius (Oxyuris) Albendazole
vermicularis
4. THREAD WORM
Strongyloides stercoralis Ivermectin Albendazole
5. WHIPWORM
Trichuris trichiura Mebendazole Albendazole
6. Trichinella spiralis Albendazole Mebendazole
7. FILARIA Diethyl carbamazine, Albendazole
Wuchereria bancrofti, Ivermectin
Brugia malayi
8. GUINEAWORM Metronidazole Mebendazole
Dracunculus medinensis
9. TAPEWORMS
Taenia saginata Praziquantel, Niclosamide Albendazole
Taenia solium Praziquantel Niclosamide, Albendazole
Hymenolepis nana Praziquantel Niclosamide, Nitazoxanide
Neurocysticercosis Albendazole Praziquantel
10. HYDATID DISEASE
Echinococcus granulosus, Albendazole Mebendazole
E. multilocularis AlbendazoleIndividual Drugs
Chemotherapy of Cancer
Introduction
Classification
A. Cytotoxic drugs
1. Alkylating agents Mechlorethamine
Nitrogen mustards (Mustine HCl)
Cyclophosphamide,
Ifosfamide,
Chlorambucil,
Melphalan
Ethylenimine Thio-TEPA
Alkyl sulfonate Busulfan
Nitrosoureas Carmustine (BCNU),
Lomustine (CCNU)
Triazine Dacarbazine (DTIC),
Temozolomide
Methylhydrazine Procarbazine
2. Platinum Cisplatin,
coordination Carboplatin,
complexes Oxaliplatin
3. Antimetabolites
Folate Methotrexate (Mtx)
antagonist Pemetrexed
Purine 6-Mercaptopurine (6-MP),
antagonist 6-Thioguanine (6-TG),
Azathioprine, Fludarabine
Pyrimidine 5-Fluorouracil (5-FU),
antagonist Capecitabine, Cytarabine
(cytosine arabinoside)
4. Microtubule Vincristine (Oncovin),
damaging Vinblastine, Vinorelbine
agents Paclitaxel, Docetaxel
Estramustine
5. Topoisomerase-2 Etoposide
inhibitors
6. Topoisomerase-1 Topotecan,
inhibitors Irinotecan
7. Antibiotics Actinomycin D
(Dactinomycin),
Doxorubicin,
Daunorubicin
(Rubidomycin),
Epirubicin,
Mitoxantrone,
Bleomycins,
Mitomycin C
8. Miscellaneous Hydroxyurea,
L-Asparaginase,
Tretinoin,
Arsenic trioxide
B. Targeted drugs
1. Tyrosine protein- Imatinib,
kinase inhibitors Nilotinib
2. EGF receptor Gefitinib, Erlotinib
inhibitors Cetuximab
3. Angiogenesis Bevacizumab
inhibitors Sunitinib
4. Proteasome Bortezomib
inhibitor
5. Unarmed Rituximab,
monoclonal Trastuzumab
antibody
C. Hormonal drugs
1. Glucocorticoids Prednisolone and
others
2. Estrogens Fosfestrol,
Ethinylestradiol
3. Selective estrogen Tamoxifen,
receptor modulators Toremifene
4. Selective estrogen Fulvestrant
receptor down
regulators
5. Aromatase Letrozole,
inhibitors Anastrozole,
Exemestane
6. Antiandrogen Flutamide,
Bicalutamide
7. 5-α reductase Finasteride,
inhibitor Dutasteride
8. GnRH analogues Nafarelin, Leuprorelin
Triptorelin
9. Progestins Hydroxyprogesterone
acetate,
Exercise
Chapter 17: Disinfectants and Antiseptics
Disinfectants and Antiseptics Introduction
Classification
1. Phenol derivatives: Phenol, Cresol,
Hexylresorcinol, Chloroxylenol,
Hexachlorophene.
2. Oxidizing agents: Pot. permangnate,
Hydrogen peroxide, Benzoyl peroxide.
3. Halogens: Iodine, Iodophores, Chlorine,
Chlorophores.
4. Biguanide: Chlorhexidine.
5. Quaternary ammonium (Cationic): Cetrimide, Benzalkonium chloride, Dequalinium chloride.
6. Soaps: of Sod. and Pot.
7. Alcohols: Ethanol, Isopropanol.
8. Aldehydes: Formaldehyde, Glutaraldehyde.
9. Acids: Boric acid, Acetic acid.
10. Metallic salts: Silver nitrate, Silver
sulfadiazine, Mild silver protein, Zinc
sulfate, Calamine, Zinc oxide.
11. Dyes:Gentian violet, Acriflavine, Proflavine.
12. Furan derivative: Nitrofurazone
Exercise Solved
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