Given the scope of this request (100% pharmacology syllabus for NEET PG), I'll use my knowledge from Katzung, Lippincott, and Goodman & Gilman (all available in the library) combined with NEET PG patterns to give you a comprehensive tabular revision guide with Hindi mnemonics. This is a large output - I'll cover every major system.
NEET PG Pharmacology - Complete Rapid Revision Guide
Tabular Format | Hindi Mnemonics | Drug of Choice | ADRs | MOA | Interactions
SYSTEM 1: AUTONOMIC NERVOUS SYSTEM (ANS)
1A. Cholinergic Drugs
| Drug | MOA | Drug of Choice For | Key ADRs | Important Interaction | Hindi Trick |
|---|
| Pilocarpine | Direct M agonist | Glaucoma (open-angle), Sjogren's syndrome (dry mouth) | SLUDGE (Salivation, Lacrimation, Urination, Diarrhea, GI cramps, Emesis) | Anticholinergics antagonize | "PIL GAYA AANSU" = Pilocarpine gives tears |
| Bethanechol | Direct M agonist (M3) | Post-op/post-partum urinary retention, neurogenic bladder | Hypotension, bronchospasm | Ganglionic blockers | "BAITH KE PESHAB" = Bethanechol restores urination |
| Carbachol | Direct M+N agonist | Glaucoma (when pilocarpine fails) | SLUDGE | - | - |
| Neostigmine | Reversible AChE inhibitor (does NOT cross BBB) | DOC: Myasthenia gravis crisis reversal, post-op reversal of NMB | Excessive secretions, bradycardia | Succinylcholine (prolongs) | "NEO = NEW antidote" for MG and NMB |
| Physostigmine | Reversible AChE inhibitor (crosses BBB) | DOC: Atropine/anticholinergic overdose | Seizures | - | "PHYSO PAAGAL ka antidote" (crosses brain) |
| Edrophonium | Shortest-acting AChE inhibitor | Tensilon test (diagnosis of MG) | Transient | - | "EDro = EDucation/Diagnosis" |
| Organophosphates | Irreversible AChE inhibitor | Pesticide poisoning | SLUDGE + DUMBELS | Atropine (antidote) + Pralidoxime (2-PAM) | "OP = Opposite of Atropine" |
| Pralidoxime (2-PAM) | Regenerates AChE (must give before "aging") | OP poisoning (within 24-48h) | If given late = useless | - | "PAM = Please Act Markedly (fast)" |
Mnemonic for Cholinergic effects - DUMBELS:
Defecation, Urination, Miosis, Bradycardia, Excitation (muscle), Lacrimation, Salivation/Sweating
1B. Anticholinergic Drugs
| Drug | MOA | Drug of Choice For | Key ADRs | Hindi Trick |
|---|
| Atropine | M receptor blocker | Bradycardia (DOC), OP poisoning, pre-anesthetic, antidote | "ABCDEFG" (see below) | "ATROPINE = A Trite Old Problem Is Now Easy" |
| Scopolamine | M blocker (crosses BBB best) | DOC: Motion sickness (transdermal patch) | Sedation, confusion | "SCOPE dekho MOTION mein" |
| Ipratropium | M3 blocker (inhaled, no BBB) | DOC: COPD (preferred over salbutamol) | Dry mouth, urinary retention | "IP = Inhaled for COPD Patients" |
| Tiotropium | Long-acting M3 blocker | DOC: COPD maintenance (once daily) | Same as ipratropium | "TIO = Try It Once (daily)" |
| Oxybutynin/Solifenacin | M3 blocker | Overactive bladder / urge incontinence | Dry mouth, constipation | "OXY = Overactive bladder" |
| Benztropine/Trihexyphenidyl | Central anticholinergic | DOC: Drug-induced Parkinsonism (EPS) | Confusion in elderly | "BENZ = Balance EPS" |
| Glycopyrrolate | Quaternary M blocker (no BBB) | Pre-anesthetic (reduces secretions) | Tachycardia | - |
Anticholinergic ADRs - Hindi Mnemonic "BAAT CHEET BAND":
Bladder retention, Antiperistalsis (constipation), Antihidrosis (dry skin), Tachycardia | Cycloplegia (blurred vision), Hyperthermia, Euphoria (CNS), Exophthalmos (mydriasis), Tingling/urinary retention | Confusion, Bad memory
1C. Sympathomimetics (Adrenergic Agonists)
| Drug | Receptor | Drug of Choice For | Key ADRs | Hindi Trick |
|---|
| Adrenaline (Epinephrine) | α1, α2, β1, β2 | DOC: Anaphylaxis, cardiac arrest | Hypertension, arrhythmia | "ADRENAline = ALL receptors" |
| Noradrenaline | α1, α2, β1 | DOC: Septic shock (vasopressor of choice) | Reflex bradycardia, tissue necrosis if extravasation | "NOR = NO beta-2 (no bronchospasm)" |
| Dopamine | D1, D2, β1, α1 (dose-dependent) | DOC: Cardiogenic shock | Tachycardia, arrhythmia | "DOPA = Dose-dependent: 1-Diuresis, 2-Cardiac, 3-Vasoconstriction" |
| Dobutamine | β1 (mainly) | DOC: Acute HF (increases contractility) | Tachycardia | "DOBu = DO Beta (cardiac)" |
| Salbutamol (Albuterol) | β2 | DOC: Acute asthma attack (SABA) | Tremor, tachycardia, hypokalemia | "SAL = Salbutamol = Save from Asthma" |
| Salmeterol/Formoterol | β2 (long-acting) | DOC: Asthma maintenance (LABA) | Same, QT prolongation | "SALME = SALMErol = maintenance" |
| Terbutaline | β2 | DOC: Tocolysis (preterm labor) | Tremor, tachycardia | "TER = Tocolysis Effective Route" |
| Phenylephrine | α1 (pure) | Nasal decongestant, hypotension during spinal anesthesia | Reflex bradycardia | "PHENYL = α1 only" |
| Clonidine | α2 (central) | Hypertension, opioid withdrawal, ADHD | Rebound hypertension on withdrawal, sedation | "CLONI = Centrally lowers BP" |
| Pseudoephedrine | α1, β | Nasal decongestion | HTN, insomnia | - |
Dopamine dose mnemonic - "1-2-3":
- 1-4 mcg/kg/min = Dopaminergic = Diuresis (renal)
- 5-10 mcg/kg/min = Beta1 = Boosts heart (cardiac output)
-
10 mcg/kg/min = Alpha = Artery vasoconstriction
1D. Sympatholytics (Adrenergic Blockers)
| Drug | Receptor | Drug of Choice For | Key ADRs | Hindi Trick |
|---|
| Propranolol | β1+β2 (non-selective) | DOC: Anxiety (performance), Thyroid storm, Portal HTN, Migraine prophylaxis, Pheochromocytoma (after alpha-block) | Bronchoconstriction, mask hypoglycemia, bradycardia | "PROP = Prevents many things (P-P-M-T)" |
| Metoprolol/Atenolol | β1 (cardioselective) | HTN, angina, post-MI | Bradycardia, fatigue | "METRO = Makes heart calm, lungs safe" |
| Carvedilol | α1+β1+β2 | DOC: Chronic HF (reduces mortality) | Hypotension, bradycardia | "CARVE = Cardiac remodeling prevented" |
| Labetalol | α1+β (ratio 1:3 IV, 1:7 oral) | DOC: Hypertension in pregnancy, Hypertensive emergency | Orthostatic hypotension | "LABE = Ladies BP Emergency" |
| Prazosin | α1 | DOC: BPH + HTN, Pheochromocytoma (alpha-block first!) | First-dose hypotension | "PRAzosin = Prostate Relief Agent" |
| Tamsulosin | α1A (selective) | DOC: BPH (uroselective, no BP effect) | Retrograde ejaculation | "TAMsulosin = TAM karo prostate" |
| Phentolamine | α1+α2 | DOC: Pheochromocytoma crisis, tyramine-induced HTN | Reflex tachycardia | "PHENTO = PHENomenon of catecholamine block" |
| Yohimbine | α2 blocker | Impotence (obsolete), male sexual dysfunction | Anxiety, HTN | - |
SYSTEM 2: CARDIOVASCULAR DRUGS
2A. Antihypertensives
| Drug Class | Example | MOA | DOC | Key ADRs | Hindi Trick |
|---|
| ACE Inhibitors | Ramipril, Enalapril, Lisinopril | Blocks ACE → ↓AngII → ↓vasoconstriction, ↓aldosterone | DOC: HTN in diabetes (renoprotective), post-MI HF, CKD with proteinuria | Dry cough (bradykinin↑), angioedema, hyperkalemia, teratogenic | "ACE = A Cough Every time" |
| ARBs | Losartan, Valsartan, Candesartan | Block AT1 receptor | When ACE inhibitor not tolerated (no cough) | Hyperkalemia, teratogenic (NO cough) | "ARB = ACE without cough (ARBitrary)" |
| CCBs - Dihydropyridines | Amlodipine, Nifedipine | Block L-type Ca2+ channels (vascular selectivity) | DOC: HTN in elderly, isolated systolic HTN, Raynaud's, Prinzmetal angina | Peripheral edema, flushing, headache, reflex tachycardia | "AMLODIPINE = Ankle swelling" |
| CCBs - Non-DHP | Verapamil, Diltiazem | Block cardiac Ca2+ channels (AV node) | DOC: Angina + HTN with arrhythmia; AF rate control | Bradycardia, AV block, constipation (verapamil) | "VERA = Very slow (AV block)" |
| Thiazides | Hydrochlorothiazide, Chlorthalidone | Blocks NaCl co-transporter (DCT) | DOC: HTN in elderly, isolated systolic HTN, osteoporosis | Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia | "THIAZIDE = Three Highs (uric, glucose, Ca) One Low (K)" |
| Loop Diuretics | Furosemide, Ethacrynic acid | Blocks Na-K-2Cl (loop of Henle) | DOC: Acute pulmonary edema, HF, hypercalcemia | Hypokalemia, ototoxicity, hyperuricemia | "LOOP = Lots Of Output, Potassium gone" |
| K-sparing diuretics | Spironolactone, Eplerenone | Aldosterone antagonist | DOC: HF with aldosterone excess, hyperaldosteronism | Hyperkalemia, gynecomastia (spiro) | "SPIRO = Save K, Spare it" |
| Hydralazine | - | Direct vasodilator (arterioles) | DOC: HTN in pregnancy (with methyldopa) | Lupus-like syndrome, reflex tachycardia | "HYDRA = HTN in prEgnAncy" |
| Methyldopa | - | Central α2 agonist | DOC: HTN in pregnancy (SAFEST, 1st line) | Sedation, +ve Coombs test, hemolytic anemia | "METHYL DOPA = Mother's Drug Of Pregnancy Always" |
| Minoxidil | - | K+ channel opener (vasodilator) | Refractory HTN, alopecia | Hypertrichosis, fluid retention | "MINOXIDIL = Hair grows Minimally but nicely" |
| Sodium Nitroprusside | - | Releases NO (arteries + veins) | DOC: Hypertensive emergency (most potent, fastest) | Cyanide toxicity, methemoglobinemia | "NITRO = Nitroprusside = Nastiest emergency drug" |
Antihypertensive in Pregnancy - Mnemonic "MAL HO":
- Methyldopa (first line)
- Amlodipine
- Labetalol (IV for emergencies)
- Hydralazine
- Other safe: Nifedipine
AVOID in Pregnancy: ACEi, ARBs (teratogenic - "AA = Avoid Always")
2B. Anti-anginal Drugs
| Drug | MOA | DOC | Key ADRs | Interactions |
|---|
| Nitrates (GTN, Isosorbide) | Release NO → cGMP → venodilation | DOC: Acute angina attack (sublingual GTN), Unstable angina | Headache, postural hypotension, tachycardia, tolerance (nitrate-free interval) | FATAL with PDE5 inhibitors (sildenafil) - severe hypotension |
| Beta-blockers | ↓HR, ↓contractility, ↓O2 demand | DOC: Stable angina + HTN/post-MI | Bradycardia, bronchospasm | Verapamil (additive bradycardia) |
| CCBs | Vasodilation, ↓Ca2+ entry | DOC: Vasospastic (Prinzmetal) angina = Nifedipine | Edema, bradycardia (non-DHP) | Beta-blockers (verapamil + BB = AV block) |
| Ranolazine | Late Na+ current blocker | Refractory angina | QT prolongation | CYP3A4 inhibitors (increase levels) |
| Ivabradine | If current (funny current) blocker in SA node | Stable angina when BB contraindicated; HFrEF | Phosphenes (visual), bradycardia | - |
| Nicorandil | K+ channel opener + NO donor | Stable angina (2nd line) | Headache, oral ulcers | - |
2C. Antiarrhythmics (Vaughan Williams Classification)
| Class | Drugs | MOA | DOC | Key ADRs | Hindi Trick |
|---|
| IA | Quinidine, Procainamide, Disopyramide | Na+ channel block (intermediate kinetics) + K+ block → QT prolongation | AF/flutter | Torsades (QT↑), Quinidine syncope, Lupus (procainamide) | "QP Disqo = QT Prolongers" |
| IB | Lidocaine, Mexiletine, Phenytoin | Na+ channel block (fast kinetics) - preferentially in ischemic tissue | DOC: Ventricular arrhythmias post-MI (Lidocaine IV), Digoxin toxicity arrhythmia | CNS toxicity (lidocaine), nystagmus (phenytoin) | "LiMP = Lidocaine in MI preferred" |
| IC | Flecainide, Propafenone | Na+ channel block (slow kinetics) - most potent | DOC: AF/flutter in structurally normal heart | Proarrhythmic (CAST trial - avoid post-MI) | "FC = Flecainide Caution post-MI" |
| II | Propranolol, Metoprolol, Esmolol | Beta-blockade | DOC: Arrhythmias in HF, post-MI, SVT | Bradycardia, bronchospasm | "Beta blockers = Best for MI arrhythmia" |
| III | Amiodarone, Sotalol, Dronedarone, Ibutilide | K+ channel block → ↑refractoriness | DOC: Amiodarone = MOST EFFECTIVE antiarrhythmic, SVT + VT | Amiodarone: Pulmonary fibrosis, thyroid, corneal deposits, photosensitivity, hepatotoxicity, gray-blue skin | "AmioDARONE = Damages ALL Organs (5 P's)" |
| IV | Verapamil, Diltiazem | Ca2+ channel block (AV node) | DOC: SVT (IV), rate control in AF | AV block, bradycardia, constipation | "Vera/Dilti = Very Decisive at AV node" |
| V (misc) | Adenosine, Digoxin, Atropine | - | DOC: Adenosine = First-line for acute SVT | Adenosine: flushing, bronchospasm (very short acting, half-life 10-15 sec) | "ADENO = Adenosine Abolishes SVT instantly" |
Amiodarone ADRs - Mnemonic "PHAT LIPO":
Pulmonary fibrosis, Hepato-toxicity, Arrhythmia (proarrhythmic), Thyroid (hypo+hyper) | Livid/gray skin, Interaction (warfarin), Photosensitivity, Ophthalmologic (corneal deposits)
2D. Heart Failure Drugs
| Drug | MOA | Role in HF | Key ADRs |
|---|
| Furosemide | Loop diuretic | Symptom relief (congestion) | Hypokalemia |
| ACEi/ARBs | RAAS blockade | Reduce mortality, reverse remodeling | Cough (ACEi), hyperkalemia |
| Beta-blockers (Carvedilol, Metoprolol succinate, Bisoprolol) | ↓SNS activation | Reduce mortality (start low, go slow) | Bradycardia, fluid retention initially |
| Spironolactone/Eplerenone | Aldosterone antagonist | Reduce mortality in HFrEF | Hyperkalemia, gynecomastia |
| Sacubitril/Valsartan (Entresto) | ARNI (neprilysin inhibitor + ARB) | DOC: HFrEF (superior to ACEi) | Hypotension, hyperkalemia, angioedema |
| Digoxin | Na-K ATPase inhibitor → ↑intracellular Ca2+ → +ve inotropy | Symptom relief; rate control in HF+AF | Narrow TI; toxicity: bradycardia, AV block, yellow-green vision (xanthopsia), nausea |
| SGLT2 inhibitors (Empagliflozin, Dapagliflozin) | Glucose/Na cotransporter block | Reduce HF hospitalization + mortality | UTI, DKA |
| Hydralazine + Nitrate | Vasodilation | Alternative in ACEi-intolerant (DOC: Black patients with HF) | Lupus (hydralazine) |
| Ivabradine | If-channel blocker | HFrEF + HR >70 on BB | Phosphenes, bradycardia |
HF Drugs that reduce mortality - "BIG AS":
Beta-blockers, Ihibitors (ACEi/ARB/ARNI), Guideline-SGLT2i, Aldosterone antagonists, Sacubitril/Valsartan
2E. Antilipidemic Drugs
| Drug | MOA | DOC | Key ADRs | Interaction | Hindi Trick |
|---|
| Statins (Rosuvastatin, Atorvastatin) | HMG-CoA reductase inhibitor → ↓cholesterol synthesis, ↑LDL receptors | DOC: Primary hypercholesterolemia, CVD prevention | Myopathy/rhabdomyolysis (with fibrates/niacin), hepatotoxicity, teratogenic | Avoid with fibrates (↑myopathy risk) | "STATIN = Stop The Artery Trouble INcrease" |
| Ezetimibe | Blocks NPC1L1 → ↓intestinal cholesterol absorption | Add-on to statin | GI upset, hepatotoxicity | - | "EZE = Easy cholesterol exit" |
| Fibrates (Gemfibrozil, Fenofibrate) | PPARα agonist → ↑LPL → ↓TG, ↑HDL | DOC: Hypertriglyceridemia, mixed dyslipidemia | Myopathy (especially with statin), gallstones | Avoid with statins | "FIBrate = Falls in TG" |
| Niacin (Nicotinic acid) | ↓VLDL synthesis, ↓lipolysis in adipose | ↑HDL most effectively | Flushing (↓by aspirin pretreatment), hyperglycemia, hyperuricemia, hepatotoxicity | - | "NIACIN = Nasty Flushing Niacin" |
| Cholestyramine/Colestipol | Bile acid sequestrants (resins) | DOC: Hypercholesterolemia in pregnancy (SAFE) | Constipation, ↓absorption of fat-soluble vitamins (ADEK) + drugs | Reduces absorption of many drugs (give separately) | "BILE BINDER = Binds and removes bile" |
| PCSK9 inhibitors (Evolocumab, Alirocumab) | Block PCSK9 → ↑LDL receptors | Familial hypercholesterolemia, statin-intolerant | Injection site reactions | - | - |
SYSTEM 3: RESPIRATORY DRUGS
3A. Asthma/COPD
| Drug | Class | MOA | DOC | ADRs | Hindi Trick |
|---|
| Salbutamol | SABA (β2 agonist) | Bronchodilation | DOC: Acute asthma attack | Tremor, tachycardia, hypokalemia | "SAL = Save Airway Life" |
| Ipratropium | SAMA (anticholinergic) | Bronchodilation (blocks M3) | DOC: COPD (preferred over SABA), acute asthma add-on | Dry mouth, urinary retention | "IP = Inhaled for COPD Patients" |
| Tiotropium | LAMA | Bronchodilation | DOC: COPD maintenance | Same as ipratropium | "TIO = Tiotropium = Twice a day? No, Once!" |
| Salmeterol/Formoterol | LABA | Bronchodilation (12h) | DOC: Asthma maintenance (always with ICS) | Hypokalemia, QT prolongation | "SALME = SALMETEROL with Steroid always" |
| Fluticasone/Budesonide | ICS (inhaled corticosteroid) | Anti-inflammatory | DOC: Persistent asthma (maintenance) | Oral candidiasis, dysphonia (gargle after use) | "FLUTI = Fungus in throat (candida)" |
| Theophylline | Methylxanthine (PDE inhibitor) | Bronchodilation, anti-inflammatory | Asthma (narrow TI - 3rd line) | Seizures, arrhythmia, nausea (toxicity) | "THEO = THEOphylline Troubles brain at high dose" |
| Montelukast/Zafirlukast | Leukotriene antagonists | ↓bronchospasm, ↓inflammation | Aspirin-sensitive asthma, exercise-induced asthma | Churg-Strauss vasculitis | "MONTE = MONTElukast blocks Leukotrienes" |
| Omalizumab | Anti-IgE monoclonal antibody | ↓IgE-mediated inflammation | Severe allergic asthma | Anaphylaxis | "OMA = Omalizumab Manages Allergy" |
| Mepolizumab | Anti-IL5 monoclonal antibody | ↓eosinophil production | Severe eosinophilic asthma | Injection site reactions | - |
| Roflumilast | PDE4 inhibitor (oral) | Anti-inflammatory | Severe COPD with frequent exacerbations | GI upset, weight loss, depression | "ROFLU = Reduces Flare-ups in COPD" |
Asthma Step Therapy - "SILLS" (Step 1-5):
- SABA (PRN)
- ICS low dose
- LABA + ICS
- LABA + ICS high dose + LAMA
- Systemic steroids/biologics
3B. Cough & Antihistamines
| Drug | Class | DOC | ADRs | Hindi Trick |
|---|
| Dextromethorphan | Central cough suppressant (NMDA antagonist) | Dry cough | Abuse potential | "DEXTRO = DEXTRO sirup wali khansi ki dawai" |
| Codeine | Opioid (central) | Productive cough (narcotics) | Constipation, dependence | "CODE = Controlled (narcotic) cough" |
| Diphenhydramine | 1st gen H1 blocker | Allergic rhinitis, motion sickness, sleep | Sedation, anticholinergic effects | "DIPHEN = Drowsy" |
| Loratadine/Cetirizine | 2nd gen H1 blocker | Allergic rhinitis (non-sedating) | Headache (minimal sedation) | "LORA = Less Drowsy" |
| Fexofenadine | 2nd gen H1 blocker | Urticaria, allergic rhinitis | NO sedation (does not cross BBB) | "FEX = FEXible no sedation" |
| Chlorpheniramine | 1st gen H1 blocker | Allergic conditions | Sedation | "CHLOR = Chhod do sone ke liye" |
SYSTEM 4: GI DRUGS
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Omeprazole/PPIs | Irreversibly blocks H+/K+ ATPase (proton pump) | DOC: PUD, GERD, H. pylori (triple therapy), Zollinger-Ellison | ↓Mg2+ (hypomagnesemia), ↑risk C. difficile, osteoporosis, B12 deficiency, interstitial nephritis | "PPI = Permanently Pumps Inhibited" |
| Ranitidine/H2 blockers | Competitive H2 receptor block | PUD, GERD (less effective than PPI) | Gynecomastia (cimetidine), drug interactions (cimetidine = CYP inhibitor) | "CIMETI = CYP inhibitor - Many drug Interactions" |
| Sucralfate | Coats ulcer base (no acid reduction) | DOC: PUD in renal failure (no aluminum toxicity concern) | Constipation, ↓drug absorption | "SUCRAL = Surface coating" |
| Misoprostol | PGE1 analogue → ↑mucus/bicarbonate | DOC: NSAID-induced ulcer prevention; cervical ripening | Diarrhea, uterine contractions (abortifacient) | "MISO = Manages NSAID ulcers, Makes uterus contract" |
| Metoclopramide | D2 blocker + 5HT4 agonist (prokinetic) | Gastroparesis, GERD, antiemetic | Tardive dyskinesia, EPS, galactorrhea (↑prolactin) | "META = Motor ENhancement Agent" |
| Ondansetron | 5HT3 blocker (antiemetic) | DOC: Chemotherapy-induced nausea/vomiting (CINV) | QT prolongation, headache, constipation | "ONDAN = NO Nausea in chemo" |
| Domperidone | D2 blocker (peripherally) | Gastroparesis, GERD (does not cross BBB) | QT prolongation, galactorrhea | "DOM = Domestic use (less CNS effects)" |
| Cholestyramine | Bile acid sequestrant | Cholestyramine-associated diarrhea, Crohn's | Constipation | - |
| Loperamide | Peripheral opioid (↓gut motility) | DOC: Non-infectious diarrhea, traveler's diarrhea | Constipation, ileus | "LOPE = Lowers Output (poop)" |
| Lactulose | Osmotic laxative | Constipation, hepatic encephalopathy | Bloating, diarrhea | "LACTU = Loose aao naturally" |
| Infliximab | Anti-TNFα monoclonal antibody | DOC: Moderate-severe Crohn's, Ulcerative colitis | TB reactivation (screen!), opportunistic infections | "INFLI = Inflammation Fighter" |
| Mesalazine (5-ASA) | Anti-inflammatory (unknown mech) | DOC: Mild-moderate UC | Nephrotoxicity, Stevens-Johnson | "MESA = Mesalazine = Mild UC" |
SYSTEM 5: CNS DRUGS
5A. Sedatives & Anxiolytics
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Diazepam/Benzodiazepines | Enhance GABA-A (↑frequency of Cl- channel opening) | Status epilepticus (IV diazepam/lorazepam), anxiety, alcohol withdrawal | Dependence, respiratory depression, anterograde amnesia | "BENZO = Benzodiazepine boosts GABA" |
| Flumazenil | Competitive BZD antagonist | DOC: BZD overdose reversal | Seizures (in chronic BZD users) | "FLUMA = Flipping BZD effects" |
| Zolpidem/Zopiclone | Bind BZD site (GABA-A), selective Z-drugs | DOC: Insomnia (short-term) | Sleep-walking, dependence | "ZOLPI = Zzz sleep (Z-drug)" |
| Buspirone | Partial 5HT1A agonist (no sedation, no dependence) | DOC: GAD (Generalized Anxiety Disorder) | Dizziness, nausea (no abuse) | "BUS = Buspirone Unburdened by Sedation" |
| Barbiturates (Phenobarbitone) | GABA-A (↑duration of Cl- opening) | Epilepsy (phenobarbitone), anesthesia (thiopental) | High dependence, respiratory depression, CYP induction | "BARBI = Barbiturate = Broad CYP inducer" |
BZD vs Barbiturate - "F vs D":
- BZD: ↑Frequency of Cl- channel opening
- Barbiturate: ↑Duration of Cl- channel opening
5B. Antiepileptics
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Phenytoin | Blocks voltage-gated Na+ channels | DOC: All types EXCEPT absence; status epilepticus (IV fosphenytoin) | Gingival hyperplasia, hirsutism, teratogenic (fetal hydantoin syndrome), zero-order kinetics, nystagmus, ataxia, folate deficiency | "PHENY = Phenytoin = Pretty ugly face (gums+hair)" |
| Carbamazepine | Na+ channel blocker | DOC: Partial seizures, Trigeminal neuralgia, Bipolar disorder | SIADH (hyponatremia), aplastic anemia, Stevens-Johnson syndrome (HLA-B*1502 in Asians), CYP inducer, teratogenic | "CARBA = Causes SIADH And reduces sodium" |
| Valproate | Multiple (Na+ block, GABA↑) | DOC: Absence + myoclonic + all seizure types, Bipolar, Migraine | Neural tube defects (folic acid!), weight gain, hepatotoxicity, thrombocytopenia, pancreatitis, teratogenic | "VALPR = VAlproate = Very hazardous in pregnancy" |
| Ethosuximide | T-type Ca2+ channel blocker | DOC: Childhood absence epilepsy ONLY | GI upset, drowsiness | "ETHO = Ethosuximide = Only Absence" |
| Lamotrigine | Na+ + Ca2+ channel blocker | DOC: Pregnancy (safest), Lennox-Gastaut, absence | Stevens-Johnson syndrome (slow titration prevents) | "LAMO = Least harmful in mOthers (pregnancy)" |
| Levetiracetam | SV2A vesicle protein blocker | Add-on for partial + generalized seizures | Behavioral changes, mood | "LEVE = LEVEl up mood (sometimes worsen)" |
| Gabapentin/Pregabalin | α2δ subunit Ca2+ channel | DOC: Neuropathic pain, Postherpetic neuralgia, Fibromyalgia (pregabalin) | Sedation, dizziness, weight gain | "GABA = GABA-like but different target" |
| Topiramate | Na+ block + GABA↑ + AMPA block | DOC: Migraine prophylaxis, epilepsy, obesity | Cognitive slowing ("DOPAMAX"), kidney stones, glaucoma | "TOPIR = TOPiramate = TOPS for migraine" |
| Benzodiazepines (Clonazepam) | GABA-A | DOC: Absence + myoclonic (clonazepam), Status epilepticus (diazepam/lorazepam) | Sedation, dependence | - |
| Phenobarbitone | GABA-A | DOC: Neonatal seizures (drug of choice) | Sedation, CYP induction, cognitive impairment | "PHENOBARB = BABY's first choice seizure drug" |
Status Epilepticus Management - "BALD":
- Benzodiazepine (IV lorazepam/diazepam) - 1st line
- Antiepileptic (IV phenytoin/fosphenytoin or valproate) - 2nd line
- Levetiracetam (alternative 2nd line)
- Drug-induced anesthesia (propofol/thiopentone) - refractory
5C. Antidepressants
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| SSRIs (Fluoxetine, Sertraline, Escitalopram) | Block serotonin reuptake | DOC: Depression (1st line), OCD, Panic disorder, PTSD, Bulimia (fluoxetine) | Sexual dysfunction, weight gain, GI upset, serotonin syndrome (with MAOIs), SIADH | "SSRI = Select Serotonin, Reduce Intake" |
| SNRIs (Venlafaxine, Duloxetine) | Block 5HT + NE reuptake | DOC: Depression + anxiety, Diabetic neuropathy (duloxetine), Fibromyalgia | HTN, nausea, sexual dysfunction | "SNRI = Same as SSRI but better for pain" |
| TCAs (Amitriptyline, Imipramine) | Block 5HT + NE reuptake + multiple receptors | DOC: Nocturnal enuresis (imipramine), Chronic pain, Neuropathic pain | Anticholinergic (ABCDEFG), cardiac arrhythmia (QRS widening), 3 C's of OD: Coma, Convulsions, Cardiac arrhythmia | "TCA = Three Channels Affected (Na, K, muscarinic)" |
| MAOIs (Phenelzine, Tranylcypromine) | Irreversible MAO inhibition | DOC: Atypical depression, Refractory depression | Hypertensive crisis with tyramine (cheese, wine, beer), serotonin syndrome with meperidine/SSRIs | "MAOI + CHEESE = CRISIS" |
| Mirtazapine | α2 + H1 + 5HT2/5HT3 blocker | Depression + insomnia + poor appetite | Weight gain, sedation | "MIRTA = More appetite, More sleep" |
| Bupropion | Blocks NE + DA reuptake (no serotonin) | DOC: Depression + smoking cessation, ADHD, seasonal SAD | Seizures (contraindicated in bulimia/anorexia!), NO sexual dysfunction, weight LOSS | "BUPRO = Butt out (smoking) + No sex problems" |
| Trazodone | 5HT2 blocker + SSRI | Insomnia, depression | Priapism, sedation, postural hypotension | "TRAZO = Trazocome = gets up as priapism" |
| Lithium | Mood stabilizer (modulates IP3/cAMP) | DOC: Bipolar disorder (most effective long-term), mania | Tremor, polyuria, hypothyroidism, teratogenic (Ebstein anomaly), narrow TI | "LITHO = Lithium Like a Stone in kidney (NDI)" |
Serotonin Syndrome vs NMS - "SS vs NMS":
| Feature | Serotonin Syndrome | NMS |
|---|
| Cause | SSRIs + MAOIs | Antipsychotics |
| Onset | Fast (hours) | Slow (days) |
| Tremor | Yes | Rigidity ("lead pipe") |
| Temp | ↑ | ↑↑ |
| Treatment | Cyproheptadine | Dantrolene/Bromocriptine |
5D. Antipsychotics
| Drug | Class | MOA | DOC | ADRs | Hindi Trick |
|---|
| Haloperidol | Typical (high potency) | D2 blocker | DOC: Acute psychosis, Tourette's, delirium | EPS (high), tardive dyskinesia, low sedation | "HALO = HIGH EPS halo" |
| Chlorpromazine | Typical (low potency) | D2 blocker + multiple | Psychosis, antiemetic | EPS (low), sedation (high), anticholinergic, photosensitivity, QT prolongation | "CHLORO = Chlorpromazine = Chaotic side effects" |
| Clozapine | Atypical | D1/D2/5HT2A/muscarinic block | DOC: Treatment-resistant schizophrenia (ONLY when 2 others fail), Parkinson's psychosis | Agranulocytosis (weekly CBC mandatory!), seizures, myocarditis, weight gain, NO EPS | "CLOZE = CLOZapine = CBC CLOSEly monitored" |
| Risperidone | Atypical | D2 + 5HT2A | Schizophrenia, Bipolar, Irritability in autism | Hyperprolactinemia, EPS (at high dose), weight gain | "RISPERI = Respectable atypical with minimal metabolic" |
| Olanzapine | Atypical | Multiple receptor block | Schizophrenia, Bipolar mania | Highest metabolic syndrome risk (weight gain, DM, dyslipidemia) | "OLAN = OLANzapine = Obese, Lipids, and Diabetes" |
| Quetiapine | Atypical | D2 + 5HT2A (low D2 affinity) | Schizophrenia, Bipolar, Parkinson's psychosis | Sedation, orthostatic hypotension, minimal EPS, cataract | "QUETI = Quiet (sedating), QT prolongation" |
| Aripiprazole | Atypical | Partial D2 agonist + 5HT1A | Schizophrenia, Bipolar, Adjunct in depression | Akathisia, weight neutral | "ARI = ARI = D2 partial agonist (ARIstocrat)" |
EPS side effects - "4 E's" (time-based):
Early: Acute dystonia (hours-days) → Akathisia (days-weeks) → Parkinsonism (weeks-months) | Late: Tardive dyskinesia (months-years)
EPS Treatments:
- Acute dystonia → Benztropine/Diphenhydramine IV
- Akathisia → Propranolol
- Drug-induced Parkinsonism → Benztropine/Trihexyphenidyl
- Tardive dyskinesia → Clonazepam, Valbenazine, stop drug
5E. Opioid Analgesics
| Drug | MOA | DOC | ADRs | Interactions |
|---|
| Morphine | Full μ-opioid agonist | DOC: Severe acute pain, Pulmonary edema (DOC), Cancer pain | Respiratory depression, constipation, miosis (pinpoint pupils), nausea, histamine release, urinary retention | MAOIs (serotonin syndrome), CNS depressants |
| Codeine | Prodrug (CYP2D6 → morphine) | Mild-moderate pain, cough | Same as morphine (less potent) | CYP2D6 inhibitors (↓efficacy) |
| Fentanyl | Full μ agonist (100x morphine) | DOC: Severe pain (patch), intraoperative analgesia | Same + chest wall rigidity (rapid IV) | CYP3A4 inhibitors (↑toxicity) |
| Tramadol | Weak μ agonist + SNRI | Moderate pain | Seizures, serotonin syndrome (with SSRIs/MAOIs), minimal respiratory depression | Avoid with MAOIs |
| Methadone | Full μ agonist + NMDA antagonist | DOC: Opioid maintenance/detoxification, chronic pain | QT prolongation (torsades) | Multiple CYP interactions |
| Buprenorphine | Partial μ agonist + κ antagonist | DOC: Opioid dependence (with naloxone) | Ceiling effect (safer overdose), sublingual | - |
| Naloxone | Competitive opioid antagonist | DOC: Opioid overdose (acute reversal) | Precipitates withdrawal, very short acting (30-90 min) | - |
| Naltrexone | Long-acting opioid antagonist | DOC: Alcohol dependence, Opioid relapse prevention | Hepatotoxicity | - |
Opioid Overdose Triad - "3 M's" (Hindi: "TIN MERI"):
Miosis (pinpoint pupils), Midbrain depression (unconscious), Muffled breathing (respiratory depression)
5F. Anti-Parkinson's Drugs
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Levodopa + Carbidopa | L-DOPA (DA precursor) + peripheral decarboxylase inhibitor | DOC: Parkinson's disease (most effective) | Wearing off, on-off fluctuations, dyskinesias, hypotension, psychosis, nausea | "LEVO = Levodopa = Leader of PD" |
| Dopamine agonists (Pramipexole, Ropinirole) | D2/D3 agonist | Early PD or adjunct to L-DOPA | Impulse control disorder, hallucinations, orthostatic hypotension, sleepiness | "PRAMI = Pramipexole = Pathological gambling (impulse)" |
| MAO-B inhibitors (Selegiline, Rasagiline) | Inhibit DA breakdown | Early PD (neuroprotective?), adjunct | Selegiline → amphetamine metabolites (insomnia), cheese reaction (weak) | "SELEGI = Selectively Elegantly Guards Dopamine" |
| COMT inhibitors (Entacapone, Tolcapone) | Prevent COMT-mediated L-DOPA breakdown | Adjunct to levodopa (extends "on" time) | Tolcapone: hepatotoxicity (monitor LFTs), orange urine | "ENTA = ENTAcapone Extends levodopa action" |
| Amantadine | ↑DA release + NMDA block | DOC: Drug-induced dyskinesias, mild early PD, influenza A (antiviral) | Livedo reticularis, ankle edema, hallucinations | "AMANTA = AMANTA-dine = Anti-dyskinesia + Antiviral" |
| Bromocriptine | D2 agonist | Adjunct to L-DOPA, hyperprolactinemia, NMS, acromegaly | Nausea, hallucinations, ergo-toxicity (pleuropulmonary fibrosis) | "BROMO = BROMOcriptine = DA agonist (Breast milk↓)" |
| Benztropine/Trihexyphenidyl | Central anticholinergic | DOC: Drug-induced Parkinsonism / tremor-dominant PD | Confusion (avoid in elderly), urinary retention | "BENZ = Balance EPS" |
SYSTEM 6: ANTIMICROBIALS
6A. Beta-Lactam Antibiotics
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Penicillin G | Inhibit cell wall synthesis (PBP binding) | DOC: Streptococcal pharyngitis, Syphilis (all stages), Diphtheria, Anthrax, Actinomycosis | Hypersensitivity (anaphylaxis), Jarisch-Herxheimer reaction | "PEN G = Pen for Gram-positive Ghosts" |
| Amoxicillin | Extended-spectrum PCN | DOC: H. pylori (with PPI+Clarithromycin), Otitis media, Lyme disease (early) | Ampicillin rash in EBV (maculopapular) | "AMOX = H-P cure + O-M treat" |
| Amoxicillin-Clavulanate | β-lactamase inhibitor combination | DOC: Animal/human bites, Sinusitis, Community LRTI | Diarrhea, hepatotoxicity (clavulanate) | "AUGMENTIN = AUGmented protection" |
| Antistaphylococcal PCN (Oxacillin, Nafcillin) | Resistant to staphylococcal β-lactamase | DOC: MSSA infections (not MRSA) | - | "OX = OXacillin for Staph aureus" |
| Cephalosporins | PBP binding (cell wall) | Vary by generation (see below) | Bleeding (3rd/4th gen), cross-sensitivity with PCN (~1-2%) | "CEPHALON = 1-2-3-4 generations" |
Cephalosporin Generations - "GENerations Coverage":
| Gen | Drug | Coverage | DOC |
|---|
| 1st | Cephalexin, Cefazolin | G+ cocci | Surgical prophylaxis |
| 2nd | Cefaclor, Cefuroxime | G+ + some G- | Sinusitis, otitis |
| 3rd | Ceftriaxone, Cefotaxime, Ceftazidime | G- (enter CSF) | DOC: Meningitis (ceftriaxone), Gonorrhea (ceftriaxone) |
| 4th | Cefepime | G+ + G- + Pseudomonas | Hospital acquired G- infections |
| 5th | Ceftaroline | MRSA | MRSA infections |
Mnemonic for Ceftriaxone - "CEFT-TRIO":
Ceftriaxone = Meningitis, Gonorrhea, Typhoid, Lyme, Pelvic infections
Carbapenems (Imipenem, Meropenem): Broadest spectrum, DOC for ESBL-producing organisms. Imipenem + Cilastatin (prevents renal tubular breakdown). ADR: Seizures (imipenem > meropenem).
6B. Macrolides, Fluoroquinolones, Aminoglycosides
| Drug | MOA | DOC | ADRs | Interactions | Hindi Trick |
|---|
| Azithromycin | 50S ribosome inhibitor (23S rRNA) | DOC: Community pneumonia, Atypical pneumonia (Mycoplasma, Chlamydia, Legionella), STD (Chlamydia - single dose 1g), Whooping cough | QT prolongation, GI upset, cholestatic jaundice (erythromycin) | Warfarin (↑effect), QT-prolonging drugs | "AZI = Atypical bug's enemy" |
| Erythromycin | 50S ribosome inhibitor | Prokinetic (gastroparesis), Legionnaire's, Diphtheria | Cholestatic jaundice, CYP3A4 inhibitor (drug interactions!), QT prolongation, GI upset | Statins (↑myopathy), warfarin, theophylline | "ERY = CYP inhibitor (ERYTHROGENIC interactions)" |
| Ciprofloxacin | DNA gyrase + Topoisomerase IV inhibitor | DOC: UTI (complicated), Anthrax (prophylaxis), Typhoid (resistance), Cholera, Traveler's diarrhea, Prostatitis | Tendinitis/Achilles tendon rupture, QT prolongation, photosensitivity, cartilage damage (avoid in children/pregnancy) | Antacids (↓absorption), warfarin (↑effect), theophylline | "CIPRO = Cartilage Problems in children" |
| Gentamicin/Aminoglycosides | 30S ribosome inhibitor (30S irreversible) | DOC: Severe G- infections, Plague (streptomycin), Tularemia, Brucellosis (gentamicin + doxycycline) | Ototoxicity (irreversible), Nephrotoxicity, neuromuscular blockade | Loop diuretics (↑ototoxicity), NSAIDs (↑nephrotoxicity), NMBAs | "AMINO = AUDI damage (ototoxicity) + renal damage" |
| Tetracyclines (Doxycycline) | 30S ribosome inhibitor (30S reversible) | DOC: Atypical pneumonia (Mycoplasma, Chlamydia), RMSF, Lyme disease, Acne, Cholera (adult), Brucellosis, Q fever, Syphilis (PCN-allergy) | Teeth staining (children < 8 yrs), photosensitivity, hepatotoxicity, Fanconi syndrome (outdated) | Antacids/milk/Fe/Ca2+ (↓absorption - chelation) | "TETRA = Take without milk - 4 bad things in kids" |
6C. Drugs Affecting Cell Wall / Special Bacteria
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Vancomycin | Binds D-Ala-D-Ala → blocks cell wall | DOC: MRSA, C. difficile (oral - not absorbed), PCN-resistant Streptococcal meningitis | Red man syndrome (histamine release - slow infusion), ototoxicity, nephrotoxicity | Aminoglycosides (↑nephro/ototoxicity) |
| Linezolid | 50S inhibitor (prevents initiation complex) | DOC: VRE, MRSA (alternative), drug-resistant TB | Serotonin syndrome (with SSRIs), myelosuppression (thrombocytopenia), MAO inhibitor (tyramine interaction!) | SSRIs, MAOIs |
| Daptomycin | Depolarizes cell membrane (G+) | DOC: MRSA skin/soft tissue, Bacteremia, VRE | Myopathy (↑CK), inactivated by lung surfactant (NOT for pneumonia) | Statins (↑myopathy) |
| Metronidazole | Forms free radicals → DNA damage (anaerobes) | DOC: Anaerobic infections, C. difficile (mild), H. pylori, Trichomonas, Giardia, Amoeba, BV | Disulfiram-like reaction (alcohol), peripheral neuropathy, metallic taste | Alcohol (severe reaction!), warfarin |
| Clindamycin | 50S ribosome inhibitor (23S) | DOC: Anaerobic infections above diaphragm, Aspiration pneumonia, Toxoplasmosis (with pyrimethamine) | Pseudomembranous colitis (C. difficile) | - |
| Chloramphenicol | 50S inhibitor (peptidyl transferase) | DOC: Meningitis in PCN allergy (H. influenzae, N. meningitidis), Rickettsial diseases in pregnancy | Gray baby syndrome, aplastic anemia (idiosyncratic) | - |
| Doxycycline | 30S inhibitor | DOC: RMSF (Rocky Mountain Spotted Fever), Lyme disease | Teeth staining | - |
6D. Antitubercular Drugs (RIPE + Streptomycin)
| Drug | MOA | Key ADRs | Hindi Trick |
|---|
| Rifampicin | Inhibits RNA polymerase | Orange-red discoloration of body fluids, hepatotoxicity, CYP inducer (many drug interactions) | "RIF = Red IF you take rifampicin" |
| Isoniazid (INH) | Inhibits mycolic acid synthesis (InhA) | Peripheral neuropathy (B6 deficiency → give pyridoxine), hepatotoxicity, lupus, seizures (OD) | "INH = Injures Neurons & Hepatocytes" |
| Pyrazinamide | Disrupts membrane transport | Hyperuricemia (gout!), hepatotoxicity, arthralgia | "PYRA = PYRAmid of uric acid (gout)" |
| Ethambutol | Inhibits arabinosyl transferase (arabinogalactan) | Retrobulbar neuritis (red-green color blindness!), hyperuricemia | "ETHAM = ETHAM-But-not-for-eyes (optic neuritis)" |
| Streptomycin | 30S inhibitor (aminoglycoside) | Ototoxicity (vestibular > cochlear), nephrotoxicity | "STREP = Stereo gone (vestibular)" |
TB Treatment Mnemonic - "RIPE":
Rifampicin + Isoniazid + Pyrazinamide + Ethambutol (2 months RIPE → 4 months RI)
Rifampicin Interactions - "ROPE":
Reduces OCP efficacy, Reduces anticoagulants (warfarin), Reduces HIV drugs (ARVs), Reduces many drugs (broad CYP inducer)
6E. Antifungal Drugs
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Amphotericin B | Binds ergosterol → pores in membrane | DOC: Invasive aspergillosis, Cryptococcal meningitis (with flucytosine), Mucormycosis, Severe systemic fungal infections | Nephrotoxicity ("shake and bake" = fever/chills), hypokalemia, hypomagnesemia, anemia | "AMPHO = Awful nephrotoxic drug" |
| Fluconazole | Inhibits 14-α demethylase (ergosterol synthesis) | DOC: Candidiasis (esophageal, vaginal, cryptococcal prophylaxis), Cryptococcal maintenance | Hepatotoxicity, teratogenic, QT prolongation, CYP2C9/3A4 inhibitor | Warfarin (↑), statins (↑), azithromycin |
| Itraconazole | Same as fluconazole | DOC: Histoplasmosis, Blastomycosis, Sporotrichosis | Hepatotoxicity, drug interactions | "ITRA = Itra-CELLULAR fungi (dimorphic)" |
| Voriconazole | Same mechanism | DOC: Invasive Aspergillosis (1st line), Candida krusei/glabrata | Visual disturbances (hallucinations, photophobia), hepatotoxicity, QT prolongation | - |
| Caspofungin | Inhibits β-glucan synthase (cell wall) | DOC: Invasive candidiasis/aspergillosis (amphotericin B failure) | Infusion reactions, hepatotoxicity, minimal nephrotoxicity | - |
| Griseofulvin | Disrupts microtubules (fungal) | DOC: Dermatophytosis (tinea capitis in children) | Photosensitivity, teratogenic, lupus, CYP inducer | Warfarin (↓effect), OCP (↓efficacy) |
| Terbinafine | Inhibits squalene epoxidase → squalene accumulation | DOC: Onychomycosis (nail fungus), Tinea | Hepatotoxicity, taste disturbance | - |
| Nystatin | Binds ergosterol (like ampho B) | DOC: Oral/GI candidiasis (not absorbed systemically) | Bitter taste, GI upset (topical only) | - |
6F. Antivirals
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Acyclovir | Guanosine analogue (inhibits viral DNA polymerase, requires viral thymidine kinase) | DOC: HSV infections, VZV, Herpes encephalitis (IV), Genital herpes | Nephrotoxicity (crystalluria - hydrate well), CNS toxicity | "ACY = ACYclovir ACquires thymidine kinase (virus specific)" |
| Valacyclovir | Prodrug of acyclovir | Genital herpes, zoster | Better bioavailability than acyclovir | - |
| Ganciclovir | Guanosine analogue (CMV-specific, phosphorylated by UL97 kinase) | DOC: CMV retinitis (HIV patients), CMV in transplant | Myelosuppression (leukopenia, thrombocytopenia), nephrotoxicity | Zidovudine (additive myelosuppression) |
| Oseltamivir (Tamiflu) | Neuraminidase inhibitor | DOC: Influenza (treatment within 48h, prophylaxis) | GI upset, rarely neuropsychiatric | - |
| Ribavirin | Guanosine analogue | DOC: RSV (inhaled), HCV (with pegIFN or DAAs), Hantavirus, Lassa fever | Hemolytic anemia, teratogenic, bronchoconstriction | - |
| Interferon-α | Immunomodulatory (multiple antiviral mechanisms) | DOC: Hepatitis B, Hepatitis C (with ribavirin), Condylomata | Flu-like symptoms, depression, myelosuppression, autoimmunity | - |
6G. HIV Antiretrovirals (ARVs)
| Class | Drug Examples | MOA | Key ADRs |
|---|
| NRTIs | Zidovudine (AZT), Tenofovir, Emtricitabine, Abacavir | Nucleoside RT inhibitors (chain termination) | AZT: Myelosuppression, lactic acidosis; Tenofovir: Nephrotoxicity, osteoporosis; Abacavir: Hypersensitivity (HLA-B*5701) |
| NNRTIs | Efavirenz, Nevirapine, Rilpivirine | Non-nucleoside RT inhibitors (allosteric) | Efavirenz: CNS effects (vivid dreams), teratogenic; Nevirapine: Hepatotoxicity, Stevens-Johnson |
| PIs (Protease Inhibitors) | Ritonavir, Atazanavir, Lopinavir | Inhibit HIV protease | Metabolic syndrome, lipodystrophy, GI; Indinavir: Nephrolithiasis; Atazanavir: Indirect hyperbilirubinemia |
| Integrase Inhibitors | Raltegravir, Dolutegravir, Bictegravir | Inhibit HIV integrase | CK elevation, weight gain |
| Entry/Fusion Inhibitors | Enfuvirtide (T20), Maraviroc | Fusion inhibition/CCR5 antagonist | Injection site reactions (enfuvirtide) |
HAART Mnemonic - DOC first-line: TDF + FTC + DTG (Tenofovir + Emtricitabine + Dolutegravir)
"TEN-EMTRI-DOLTE = Triple combo"
HIV DOC quick list:
- Post-exposure prophylaxis (PEP): TDF + FTC + RAL (within 72h)
- Prevent PCP: TMP-SMX (CD4 <200)
- Prevent MAC: Azithromycin (CD4 <50)
- Prevent Toxoplasma: TMP-SMX (CD4 <100)
- Prevent CMV: Ganciclovir (CD4 <50)
- Cryptococcal prophylaxis: Fluconazole (CD4 <100)
6H. Antiparasitic Drugs
| Drug | DOC For | ADRs | Hindi Trick |
|---|
| Metronidazole | Giardia, Trichomonas, Amoeba (intestinal), BV, Anaerobes, H. pylori | Disulfiram reaction with alcohol, metallic taste | "METRO = GTA (Giardia, Trichomonas, Amoeba)" |
| Diloxanide furoate | DOC: Asymptomatic intestinal amoebiasis (luminal agent) | GI upset | "DILOXA = Diet luminal amoeba" |
| Tinidazole | Giardia, Trichomonas, Amoeba (better than metronidazole for Giardia) | Same as metronidazole | - |
| Chloroquine | DOC: Vivax/Ovale malaria (still sensitive), Falciparum (if sensitive), Rheumatoid arthritis, SLE | Retinopathy (long-term), pruritus in Africans, QT prolongation | "CHLORO = Chloroquine = Classic anti-malarial" |
| Artemisinin/Artesunate | DOC: Falciparum malaria (all cases - WHO guideline) | GI upset, first trimester (avoid) | "ART = Artesunate ARTacks falciparum" |
| Primaquine | DOC: Radical cure of Vivax/Ovale (kills hypnozoites), Terminal prophylaxis | Hemolytic anemia in G6PD deficiency (CHECK G6PD BEFORE GIVING!) | "PRIMA = PRIMA donna hypnozoite killer (liver stage)" |
| Pyrimethamine + Sulfadoxine | DOC: Falciparum (resistant areas), Toxoplasmosis (with sulfadiazine) | Stevens-Johnson, folate deficiency | - |
| Mebendazole/Albendazole | DOC: All intestinal helminths (roundworm, hookworm, whipworm, pinworm), Hydatid cyst (albendazole) | GI upset, teratogenic | "MEBEN = MEBEN-dazole Murders worms" |
| Praziquantel | DOC: All trematodes (Schistosoma, Clonorchis), Tapeworms (Taenia) | Headache, dizziness | "PRAZI = PRAZIquantel = Parasite crasher" |
| Ivermectin | DOC: Onchocerciasis (River blindness), Strongyloidiasis, Scabies, Filariasis (microfilariae), COVID? (controversial) | Mazzotti reaction (fever, rash), CNS (avoid in CNS disease) | "IVER = IVERMECTIN = River blindness cure" |
| Diethylcarbamazine (DEC) | DOC: Lymphatic filariasis, Tropical eosinophilia, Loiasis | Mazzotti-like reaction | "DEC = DECompresses lymphatics" |
| Pentamidine | DOC: Pneumocystis pneumonia (PCP; alternative to TMP-SMX), Leishmaniasis (2nd line), African sleeping sickness | Hypoglycemia, QT prolongation, nephrotoxicity | "PENTA = PEntamidine for PCP" |
| TMP-SMX | DOC: PCP (Pneumocystis jirovecii) - first line, UTI, Nocardia, Toxoplasma (prophylaxis) | Stevens-Johnson, hemolytic anemia in G6PD, megaloblastic anemia | "TMP-SMX = TMP-SMX = Two-for-one antibiotic" |
SYSTEM 7: ENDOCRINE DRUGS
7A. Diabetes Mellitus
| Drug | Class | MOA | DOC | Key ADRs | Hindi Trick |
|---|
| Metformin | Biguanide | Activates AMPK → ↓hepatic gluconeogenesis | DOC: T2DM (1st line), PCOS, Obesity + DM | Lactic acidosis (rare; hold in renal failure, contrast), GI upset, B12 deficiency, NO weight gain | "METFOR = METFORmin = Mother of DM drugs" |
| Sulfonylureas (Glibenclamide, Glipizide, Gliclazide) | K-ATP channel closer → ↑insulin secretion | T2DM (2nd line) | Hypoglycemia (most common), weight gain | "SULFA = Sugar lowering, Fat gaining" | |
| Repaglinide/Nateglinide | Meglitinides (K-ATP channel block, short-acting) | Post-prandial hyperglycemia | Hypoglycemia (less than SU) | "REPAG = Rapid acting for meals" | |
| Pioglitazone (TZD) | PPARγ agonist → ↑insulin sensitivity | DOC: Insulin resistance, NAFLD, T2DM | Weight gain, fluid retention, bladder cancer risk, bone fractures, CHF worsening | "PIO = Pudgy (weight) and Pee bladder cancer" | |
| Sitagliptin (DPP-4 inhibitors) | Inhibit DPP-4 → ↑GLP-1, GIP → ↑insulin | T2DM (add-on) | Pancreatitis (rare), nasopharyngitis, NO hypoglycemia, weight neutral | "GLIPTIN = GLIP over DPP-4" | |
| Exenatide/Liraglutide (GLP-1 agonists) | GLP-1 receptor agonist → glucose-dependent insulin | DOC: T2DM + Obesity + CVD | Nausea/vomiting, pancreatitis, C-cell tumors (thyroid), Liraglutide: REDUCES CV events | "GLP-1 = Gut-Linked insulin, Pounds lost" | |
| Empagliflozin/Dapagliflozin (SGLT2i) | Block SGLT2 in PCT → ↑urinary glucose excretion | DOC: T2DM + HF + CKD + CVD | UTI/genital infections (glycosuria), DKA (euglycemic), Fournier's gangrene, volume depletion | "SGLT2 = Sugar Goes to Let-out Through Urine 2" | |
| Acarbose (Alpha-glucosidase inhibitor) | Inhibit intestinal α-glucosidase → ↓carb absorption | Post-prandial hyperglycemia | Flatulence, diarrhea (no systemic effect) | "ACARB = ACARBose = Acidity in gut" | |
| Insulin | - | DOC: T1DM, Gestational DM, T2DM (uncontrolled), Hyperkalemia, DKA | Hypoglycemia, weight gain, lipohypertrophy | "INSULIN = Most Important drug in DM" | |
Insulin types - "RAPID LONG":
| Type | Onset | Duration | DOC |
|---|
| Lispro/Aspart/Glulisine (rapid) | 15 min | 3-5h | Pre-meal |
| Regular insulin | 30-60 min | 6-8h | DKA, hyperkalemia |
| NPH (intermediate) | 2-4h | 12-18h | Background coverage |
| Glargine/Detemir (long-acting) | 1-2h | 20-24h | Basal insulin (once daily) |
| Degludec (ultra-long) | 1h | >42h | Once daily basal |
7B. Thyroid Drugs
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Propylthiouracil (PTU) | Blocks TPO + peripheral T4→T3 conversion | DOC: Hyperthyroidism in 1st trimester pregnancy, Thyroid storm | Agranulocytosis (most dangerous), hepatotoxicity, ANCA-vasculitis | "PTU = Preferred in Trimester U (first)" |
| Methimazole (Carbimazole) | Blocks TPO (no peripheral conversion block) | DOC: Hyperthyroidism (2nd/3rd trimester, non-pregnant adults) | Agranulocytosis, aplasia cutis (fetal) | "MMI = Most used in Mother Initially" |
| Radioactive iodine (RAI) | Destroys thyroid tissue | DOC: Graves' disease (non-pregnant adults) | Hypothyroidism (desired), radiation thyroiditis, exacerbation of ophthalmopathy | "RAI = Radioactive kill" |
| Potassium iodide | Wolff-Chaikoff effect → ↓T3/T4 | Pre-thyroid surgery, thyroid storm | Iodism (metallic taste, rash) | "KI = Kill thyroid temporarily before surgery" |
| Propranolol | Beta-blocker (symptomatic relief + blocks T4→T3 in thyroid storm) | DOC: Thyroid storm (symptomatic), thyrotoxicosis while awaiting definitive treatment | Bradycardia, bronchospasm | "PROP = Pause thyroid symptoms" |
| Levothyroxine (T4) | Synthetic T4 → converted to T3 peripherally | DOC: Hypothyroidism (1st line) | Over-dosage: Palpitations, weight loss, osteoporosis | "LEVO = Lets thyroid hormone back in body" |
7C. Corticosteroids
| Drug | Relative Potency | Duration | Main Use |
|---|
| Hydrocortisone | 1 | Short | Adrenal insufficiency, anaphylaxis |
| Prednisolone | 4 | Intermediate | Asthma, IBD, autoimmune |
| Methylprednisolone | 5 | Intermediate | IV pulse therapy |
| Dexamethasone | 25 | Long | DOC: Cerebral edema, meningitis (reduce inflammation), fetal lung maturity, anti-emetic, COVID-19 (severe) |
| Fludrocortisone | 0 glucocorticoid; high mineralocorticoid | - | Adrenal insufficiency (mineralocorticoid replacement) |
Corticosteroid ADRs - "STEROID" mnemonic:
Skin - thin skin, striae, bruising | Thinning of bones (osteoporosis) | Elevated sugar (hyperglycemia) | Raised BP, Redistribution of fat (moon face, buffalo hump) | Osteopenia | Immunosuppression, Infection | Depression/Psychosis, Dyslipidemia
SYSTEM 8: RENAL DRUGS
8A. Diuretics Summary
| Drug | Site of Action | Key Ions Lost | DOC | ADRs |
|---|
| Furosemide | Loop of Henle | Na, K, Cl, Ca, Mg | Acute pulmonary edema, HF, hypercalcemia | Hypokalemia, ototoxicity, hyperuricemia |
| HCTZ/Thiazides | Distal convoluted tubule | Na, K, Cl; RETAINS Ca | HTN, osteoporosis | Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia |
| Spironolactone | Collecting duct | Na out, K retained | Conn's syndrome, HF, cirrhosis ascites | Hyperkalemia, gynecomastia (anti-androgen) |
| Acetazolamide | PCT (carbonic anhydrase inhibitor) | Na, K, HCO3 | Glaucoma (reduce aqueous humor), mountain sickness, metabolic alkalosis, epilepsy (adjunct) | Metabolic acidosis, hypokalemia, sulfa allergy |
| Mannitol | Freely filtered (osmotic) | Water | DOC: Cerebral edema (acute), glaucoma (acute), acute renal failure prevention | Pulmonary edema (initial volume expansion) |
| Triamterene/Amiloride | Collecting duct (ENaC block) | Na out, K retained | Hypokalemia prevention | Hyperkalemia |
Diuretic Mnemonic - "SALT" (Site + Electrolytes):
Loop = Loses everything (K, Ca, Mg, Na) | Thiazide = Traps calcium (hypercalcemia) | Spiro = Saves potassium | Acetazolamide = Acidosis (HCO3 loss)
SYSTEM 9: BLOOD & COAGULATION
9A. Anticoagulants
| Drug | MOA | DOC | ADRs | Antidote | Hindi Trick |
|---|
| Heparin (UFH) | Binds antithrombin III → ↑inactivation of IIa+Xa | DOC: Acute DVT/PE, MI (acute), pregnant women, dialysis | HIT (Heparin-Induced Thrombocytopenia), bleeding, osteoporosis | Protamine sulfate | "HEPARIN = Anticoagulation with Antidote protamine" |
| LMWH (Enoxaparin) | Binds ATIII → mainly Xa inhibition | DOC: DVT prophylaxis, Preferred in pregnancy (no teratogenicity) | Less HIT than UFH, bleeding | Partial reversal by protamine | "LMWH = Less Messy, Works Harmlessly in pregnancy" |
| Warfarin | Inhibits Vit K epoxide reductase → ↓factors II, VII, IX, X + Protein C, S | DOC: Atrial fibrillation, mechanical heart valves, DVT/PE (long-term) | Bleeding, skin necrosis (protein C deficiency early), teratogenic (warfarin embryopathy) | Vitamin K (slow) + Fresh Frozen Plasma (fast) | "WARFARIN = Watch the INR daily" |
| Rivaroxaban/Apixaban | Direct Xa inhibitors (DOACs) | DOC: AF, DVT/PE (non-valvular AF - replace warfarin) | Bleeding | Andexanet alfa | "RIVAROX = Rivaroxaban Removes Xa" |
| Dabigatran | Direct thrombin (IIa) inhibitor | AF, DVT/PE | Bleeding, dyspepsia | Idarucizumab | "DABIG = Dabigatran Directly inhibits IIa" |
Warfarin Drug Interactions - "WIPE CDs":
- Warfarin INCREASED by: CYP2C9 inhibitors (fluconazole, amiodarone, metronidazole, cimetidine), Vit K deficiency, broad-spectrum antibiotics
- Warfarin DECREASED by: CYP inducers (rifampicin, carbamazepine, phenytoin, phenobarbitone), Vitamin K supplements, cholestyramine
9B. Thrombolytics & Antiplatelets
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Alteplase (tPA) | Activates plasminogen → plasmin (clot lysis) | DOC: Acute STEMI (<12h), Ischemic stroke (<4.5h), Massive PE | Bleeding, intracranial hemorrhage | "TPA = Tissue Plasminogen Activator" |
| Streptokinase | Activates plasminogen | STEMI (if tPA unavailable) | Allergic reactions (don't repeat in 6 months), hypotension | "STREPTOKINASE = Streptococcal antigen (allergic)" |
| Aspirin | Irreversibly inhibits COX-1 + COX-2 → ↓TXA2 | DOC: Antiplatelet (MI, stroke prevention), analgesic, antipyretic, anti-inflammatory | GI bleeding, Reye's syndrome (children), NSAID-induced asthma, tinnitus (toxicity) | "ASPIRIN = Absolute Standard Platelet Inhibitor" |
| Clopidogrel | ADP receptor (P2Y12) blocker (prodrug, CYP2C19) | DOC: ACS (dual antiplatelet with aspirin - DAPT), PCN allergy in coronary stenting | Thrombotic Thrombocytopenic Purpura (TTP), bleeding | "CLOPI = CLOPI (copies aspirin)" |
| Ticagrelor | ADP receptor (P2Y12) blocker (direct, NOT prodrug) | DOC: ACS (preferred over clopidogrel - PLATO trial) | Dyspnea, bleeding, bradycardia | "TICAG = Ticks faster (more potent than Clopi)" |
| Abciximab (GPIIb/IIIa inhibitor) | Block final common pathway of platelet aggregation | High-risk PCI | Thrombocytopenia, bleeding | "ABCI = ABsolutely maximal platelet inhibition" |
| Dipyridamole | PDE inhibitor + adenosine uptake → ↓TXA2 + ↑cAMP | Antiplatelet (with aspirin for stroke), stress test (pharmacological) | Flushing, headache, angina exacerbation | "DIPYRI = DIlates vessels + Prevents clotting" |
9C. Hematopoietic Drugs
| Drug | DOC | Mechanism |
|---|
| Iron (ferrous sulfate) | Iron deficiency anemia | Fe2+ absorbed in duodenum/jejunum; increase with Vitamin C; decrease with antacids/tea |
| B12 (Cyanocobalamin) | Pernicious anemia, B12 deficiency | IM injection preferred in malabsorption |
| Folic acid | Megaloblastic anemia, Neural tube defect prevention (periconception) | Absorbed in proximal jejunum |
| Erythropoietin (Epoetin) | Anemia in CKD, Chemotherapy-induced anemia | Stimulates RBC production |
| G-CSF (Filgrastim) | Neutropenia (post-chemotherapy), Mobilize stem cells | Stimulates neutrophil production |
| Thrombopoietin agonists (Romiplostim, Eltrombopag) | ITP (immune thrombocytopenia) refractory | Stimulate megakaryocytes |
Iron Absorption - "ACID HELPS":
Ascorbic acid, Citric acid, Iron in Fe2+ form, Duodenum absorbs it | Hinders: antacids, tetracyclines, Eggs (phytates), Lactation, Proton pump inhibitors, Soy
SYSTEM 10: CHEMOTHERAPY
10A. Cancer Drug Classification
| Category | Drug | MOA | DOC | Key ADRs | Hindi Trick |
|---|
| Alkylating agents | Cyclophosphamide, Ifosfamide | Cross-link DNA | DOC: Lymphomas, Leukemias, Breast cancer | Hemorrhagic cystitis (give Mesna!), myelosuppression, SIADH, bladder cancer | "CYCLO = CYCLOphos = Cystitis risk (give Mesna)" |
| Antimetabolites | Methotrexate (MTX) | DHFR inhibitor → ↓folate synthesis | DOC: ALL, NHL, Choriocarcinoma, RA, Psoriasis, Ectopic pregnancy | Myelosuppression, mucositis, hepatotoxicity, nephrotoxicity, pneumonitis | Give Leucovorin rescue to save normal cells |
| 5-Fluorouracil (5-FU) | Thymidylate synthase inhibitor | Colorectal cancer, Breast cancer | Myelosuppression, mucositis, hand-foot syndrome, cerebellar ataxia | "5-FU = Five fingers (hand-foot syndrome)" |
| Cytarabine (Ara-C) | DNA polymerase inhibitor | AML | Myelosuppression, cerebellar toxicity | - |
| 6-Mercaptopurine (6-MP) | HGPRT substrate → blocks purine synthesis | ALL maintenance | Myelosuppression; Allopurinol inhibits metabolism → ↑toxicity (reduce dose!) | "6-MP + ALLOPURINOL = dangerous combo" |
| Anthracyclines | Doxorubicin, Daunorubicin | Intercalate DNA + inhibit Topoisomerase II | Breast cancer, lymphomas, leukemias | Cardiomyopathy (dose-dependent, irreversible), myelosuppression, alopecia | "DOXO = Damages heart (cardiomyopathy)" |
| Vinca Alkaloids | Vincristine, Vinblastine | Inhibit microtubule polymerization | DOC: Vincristine = ALL, lymphoma; Vinblastine = testicular, Hodgkin's | Vincristine: Peripheral neuropathy (no myelosuppression); Vinblastine: Myelosuppression | "VinCRISTINE = Neuropathy, VinBLastine = BLood cells" |
| Taxanes | Paclitaxel, Docetaxel | Stabilize microtubules (prevents depolymerization) | Breast, Ovarian, Lung cancer | Myelosuppression, peripheral neuropathy, hypersensitivity | "TAXANE = Ties down tubulin" |
| Bleomycin | DNA strand breaks (oxidative) | Hodgkin's lymphoma (ABVD), testicular cancer | Pulmonary fibrosis (dose-limiting), skin toxicity | "BLEO = Bleomycin BLOws up lungs (fibrosis)" | |
| Platinum agents | Cisplatin, Carboplatin, Oxaliplatin | Cross-link DNA | Cisplatin: Testicular cancer (curative), lung, bladder | Cisplatin: Nephrotoxicity (hydration!), ototoxicity, peripheral neuropathy, nausea; Carboplatin: Myelosuppression | "CISPLATIN = Cisplatin's issue = Kidney" |
| Topoisomerase I inhibitors | Irinotecan, Topotecan | Stabilize Topo I-DNA complex | Colorectal cancer (irinotecan), ovarian cancer (topotecan) | Diarrhea (irinotecan - delayed!), myelosuppression | - |
| Targeted therapy | Imatinib (Gleevec) | BCR-ABL tyrosine kinase inhibitor | DOC: CML (Ph+ chromosome), GIST | Edema, GI upset, hepatotoxicity | "IMATINIB = I MATched tyrosine kinase" |
| Trastuzumab (Herceptin) | Anti-HER2 monoclonal Ab | DOC: HER2+ Breast cancer | Cardiomyopathy (HF), infusion reactions | "TRAS = TRASh HER2 = Herceptin" |
| Rituximab | Anti-CD20 monoclonal Ab | DOC: CD20+ B-cell lymphomas, CLL, RA | PML (JC virus), infusion reactions, hepatitis B reactivation | "RITU = RITU mab = Removes CD20" |
| Bevacizumab | Anti-VEGF monoclonal Ab | Colorectal, NSCLC, glioblastoma | Impaired wound healing, HTN, thromboembolism | "BEVA = BEVA-sizumab = Blocks VEGF" |
Chemotherapy Toxicity Summary - "Each drug's unique ADR":
Cardio: Doxorubicin, Trastuzumab | Pulmonary: Bleomycin, Busulfan, Methotrexate | Neuro: Cisplatin, Vincristine | Renal: Cisplatin, Methotrexate | Hemorrhagic cystitis: Cyclophosphamide | Ototoxic: Cisplatin
Hindi Mnemonic for ABVD (Hodgkin's):
Adrian (Doxorubicin) Bhool Vincristine Dalton = "ABVD = Adriamycin, Bleomycin, Vinblastine, Dacarbazine"
SYSTEM 11: REPRODUCTIVE & HORMONES
| Drug | Class | DOC | Key ADRs | Hindi Trick |
|---|
| OCP (Combined estrogen-progestin) | Contraceptive | DOC: Contraception, Dysmenorrhea, Acne, Endometriosis, PCOS | DVT/PE, stroke (especially smokers >35), ↑BP, ↓risk ovarian/endometrial cancer | "PILL = Prevents Implantation + Luteal shutdown" |
| Progesterone-only pill (POP) | Contraceptive | DOC: Lactating mothers, contraindication to estrogen | Irregular bleeding | "POP = Protected breastfeeding mom" |
| Mifepristone (RU486) | Progesterone antagonist | DOC: Medical abortion (<63 days, with misoprostol), Post-coital contraception | Uterine bleeding, GI cramps | "RU486 = ARE YOU pregnant? 486 blocks it" |
| Clomiphene | SERM (anti-estrogen at pituitary) | DOC: Anovulatory infertility (PCOS) | OHSS, multiple pregnancy, hot flashes, visual disturbances | "CLOMI = CLOMIphene = Comes with multiples" |
| GnRH agonists (Leuprolide) | Paradoxical ↓LH/FSH (pulsatile → continuous suppresses) | DOC: Prostate cancer, Endometriosis, Uterine fibroids, Precocious puberty | Hot flashes, osteoporosis, loss of libido | "LEUPROLIDE = Lowers sex hormones (paradoxical)" |
| Tamoxifen | SERM (antagonist in breast, agonist in uterus/bone) | DOC: ER+ Breast cancer (pre-menopausal) | Endometrial cancer (uterine agonism), DVT, hot flashes | "TAMOX = Tames breast cancer, Troubles uterus" |
| Aromatase inhibitors (Letrozole, Anastrozole) | Inhibit estrogen synthesis | DOC: ER+ Breast cancer (post-menopausal), anovulation | Osteoporosis, arthralgias, hot flashes | "LETRO = LETRozole = Lets no estrogen through" |
| Finasteride | 5α-reductase inhibitor (type II) | DOC: BPH (5mg), Male pattern baldness (1mg) | Gynecomastia, sexual dysfunction, teratogenic | "FINAS = FINASter = FINishing DHT" |
| Oxytocin | Uterine smooth muscle contraction | DOC: Induction of labor, post-partum hemorrhage | Uterine hyperstimulation, water retention (ADH-like) | "OXY = OXYtocin Opens cervix" |
| Ergometrine/Ergonovine | α-adrenergic + 5HT agonist → uterine contraction | DOC: Post-partum hemorrhage (2nd line, after oxytocin) | Hypertension (avoid in HTN), coronary spasm | "ERGO = ERGOnometrine = Emergency PPH" |
| Dinoprostone (PGE2) | PGE2 receptor | Cervical ripening, labor induction | Uterine hyperstimulation | - |
SYSTEM 12: MUSCULOSKELETAL & ANALGESICS
12A. NSAIDs
| Drug | MOA | DOC | ADRs | Interactions |
|---|
| Aspirin | Irreversible COX-1+2 inhibitor | DOC: Antiplatelet (low dose), Antipyretic, Analgesic, Kawasaki disease, Pericarditis | GI bleeding, Reye's syndrome (children with viral fever), tinnitus | Warfarin, alcohol |
| Ibuprofen/Naproxen | Reversible COX-1+2 inhibitor | Mild-moderate pain, fever, dysmenorrhea | GI ulcers, renal failure, CHF exacerbation, CVD risk | ACEi (↓antihypertensive effect), lithium (↑levels) |
| Celecoxib (COX-2 inhibitor) | Selective COX-2 inhibitor | DOC: Arthritis in patients with GI risk (less GI bleeding than NSAIDs) | ↑CVD risk (thrombotic events), HTN, renal failure | Warfarin (↑INR) |
| Indomethacin | Strong non-selective COX inhibitor | DOC: Gout (acute flare), Close PDA in neonates, Ankylosing spondylitis | GI toxicity (most potent NSAID for GI ADRs), headache | - |
| Ketorolac | Potent NSAID (IV/IM available) | DOC: Post-op pain (short-term), renal colic | GI bleeding, renal toxicity (max 5 days) | - |
12B. Gout Drugs
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Indomethacin | COX inhibitor | DOC: Acute gout (1st line) | GI bleeding | "INDO = Instant destruction of gout" |
| Colchicine | Inhibits microtubule polymerization → ↓neutrophil migration | DOC: Acute gout (alternative), Familial Mediterranean Fever (FMF), Pericarditis | GI (diarrhea, nausea), myopathy | "COLCHI = COLCHIcine = COLchicine Cramps GI" |
| Allopurinol | Xanthine oxidase inhibitor → ↓uric acid synthesis | DOC: Chronic gout (long-term prophylaxis), Tumor lysis syndrome | Hypersensitivity (allopurinol hypersensitivity syndrome, SJS - HLA-B*5801 risk), ↑6-MP toxicity | "ALLO = ALLOpurinol ALLOws less uric acid" |
| Febuxostat | Non-purine XO inhibitor | Chronic gout (when allopurinol not tolerated) | CVD risk | - |
| Probenecid | Uricosuric (blocks URAT1 → ↑uric acid excretion) | Chronic gout (uric acid overexcretion contraindicated) | GI, kidney stones, avoid in renal failure | "PROBE = PROBEcid promotes uric acid exit" |
| Rasburicase | Recombinant uricase (converts UA → allantoin) | DOC: Tumor lysis syndrome (TLS) prevention/treatment | Contraindicated in G6PD deficiency (hemolysis) | - |
| Pegloticase | Pegylated uricase | Refractory chronic gout | Infusion reactions, gout flare | - |
12C. DMARDs (Disease-Modifying Anti-Rheumatic Drugs)
| Drug | MOA | DOC | ADRs |
|---|
| Methotrexate | DHFR inhibitor + adenosine accumulation | DOC: RA (anchor DMARD - 1st line) | Myelosuppression, hepatotoxicity, pulmonary fibrosis, mucositis; folic acid reduces toxicity |
| Hydroxychloroquine | Lysosomal pH alteration (anti-inflammatory) | DOC: Mild RA, SLE | Retinal toxicity (bull's-eye maculopathy) - annual eye exam |
| Sulfasalazine | Anti-inflammatory (salicylate + sulfonamide) | RA, IBD | GI upset, hemolytic anemia (G6PD), oligospermia |
| Leflunomide | DHODH inhibitor → ↓pyrimidine synthesis | RA (alternative to MTX) | Hepatotoxicity, teratogenic (washout with cholestyramine) |
| TNF inhibitors (Infliximab, Adalimumab, Etanercept) | Block TNFα | DOC: Moderate-severe RA (failed MTX), Psoriatic arthritis, Ankylosing spondylitis, IBD | TB reactivation (screen with TST/IGRA before starting!), opportunistic infections, lymphoma risk, demyelination |
| Abatacept | Blocks T-cell costimulation (CD80/86-CTLA4-Ig) | RA (failed TNF inhibitor) | Infections |
| Tocilizumab | Anti-IL-6 receptor | RA, GCA (giant cell arteritis), Cytokine storm (COVID) | Infections, ↑LFTs, neutropenia, ↑lipids |
| Tofacitinib (Jakinibs) | JAK1/3 inhibitor | RA, PsA, UC | Infections (herpes zoster!), VTE risk |
SYSTEM 13: ANESTHESIA & MUSCLE RELAXANTS
13A. General Anesthesia
| Drug | Class | MOA | Key ADRs | Hindi Trick |
|---|
| Thiopental | Barbiturate (IV induction) | GABA-A (↑Cl- duration) | Laryngospasm, apnea, no analgesia, reduces ICP | "THIO = THIOblast unconscious fast" |
| Propofol | Phenol derivative (IV induction/maintenance) | GABA-A + NMDA + glycine | "Propofol infusion syndrome" (lactic acidosis + cardiac failure), pain on injection, hypotension | "PROPOFOL = PROP-Off + Foul burning" |
| Ketamine | NMDA receptor antagonist | Dissociative anesthesia | Emergence reactions (hallucinations), ↑BP/HR, ↑ICP/IOP, bronchodilation | "KETA = Ketamine = KETamine gives Key Dreams" |
| Etomidate | GABA-A potentiator | Induction (hemodynamically stable) | Adrenal suppression (inhibits 11β-hydroxylase), myoclonus | "ETO = ETOmidate = ETOnomics adrenal issue" |
| Halothane | Volatile inhalational | Unknown (GABA+) | Halothane hepatitis, malignant hyperthermia, triggers (all volatile agents + succinylcholine) | "HALO = HEPATO toxic Halo" |
| Nitrous oxide (N2O) | NMDA antagonist + opioid? | Analgesic + mild anesthetic (no full anesthesia) | Bowel distension, vitamin B12 inactivation (megaloblastic), diffusion hypoxia | "N2O = Nice laughing gas but No full anesthesia" |
| Dantrolene | Inhibits RyR1 → blocks Ca2+ release from SR | DOC: Malignant hyperthermia (life-threatening), NMS | Hepatotoxicity, muscle weakness | "DANT = DANT (teeth) lock in malignant hyperthermia" |
Malignant Hyperthermia - Key facts:
- Triggered by: Succinylcholine + Volatile anesthetics (halothane, isoflurane, desflurane)
- Treatment: Dantrolene IV (DOC), cooling, supportive care
- Mechanism: Abnormal RYR1 → ↑Ca2+ → muscle rigidity + hyperthermia
13B. Local Anesthetics
| Drug | Duration | Ester/Amide | Special |
|---|
| Lidocaine | Intermediate (2-3h) | Amide | Most used; also antiarrhythmic Class IB |
| Bupivacaine | Long (6-8h) | Amide | DOC: Spinal anesthesia, epidural; Cardiotoxic (most) |
| Ropivacaine | Long | Amide | Less cardiotoxic than bupivacaine |
| Procaine | Short | Ester | - |
| Cocaine | - | Ester | Only LA with vasoconstriction; ENT procedures |
MOA of ALL Local Anesthetics: Block voltage-gated Na+ channels (preferentially in rapidly firing neurons). Unionized form crosses membrane → ionized form blocks Na+ channel from inside.
Amides vs Esters - "Amides have 2 'I's (lIdocaIne)" and Esters = "ONE I" (procaIne):
Esters: Procaine, Cocaine, Benzocaine, Tetracaine | Metabolized by plasma cholinesterase | More allergenic
Amides: Lidocaine, Bupivacaine, Ropivacaine | Metabolized by liver | Less allergenic
13C. Neuromuscular Blocking Agents (NMBAs)
| Drug | Type | MOA | ADRs | Reversal |
|---|
| Succinylcholine | Depolarizing | ACh mimic → sustained depolarization (Phase I → Phase II) | Hyperkalemia (burns, denervation), malignant hyperthermia, bradycardia, ↑IOP/ICP | Pseudocholinesterase metabolizes (cannot be reversed pharmacologically!) |
| Rocuronium/Vecuronium | Non-depolarizing | Competitive ACh block at NMJ | No significant ADRs (vecuronium minimal CVS) | Neostigmine + Glycopyrrolate; Sugammadex (for rocuronium/vecuronium - superior reversal) |
| Atracurium/Cisatracurium | Non-depolarizing | Competitive ACh block | Histamine release (atracurium), Hofmann elimination (no liver/renal needed) | Neostigmine |
| Pancuronium | Non-depolarizing | Competitive ACh block | Tachycardia (vagolytic), prolonged in renal failure | Neostigmine |
SYSTEM 14: DRUGS OF ABUSE & DEPENDENCE
| Drug | Withdrawal Features | Treatment | Hindi Trick |
|---|
| Alcohol | Tremors, seizures, delirium tremens (DT), CIWA scale | DOC: Benzodiazepines (diazepam/lorazepam - prevent DT), Thiamine (Vit B1 - BEFORE glucose!), Naltrexone (relapse prevention) | "ALCOHOL withdrawal = BENZO saved me" |
| Opioids | Anxiety, yawning, lacrimation, mydriasis, piloerection, muscle cramps | Methadone (maintenance), Buprenorphine/Naloxone (Suboxone), Clonidine (autonomic symptoms) | "OPIOID withdrawal = MYDRIASIS (opposite of overdose!)" |
| Benzodiazepines | Anxiety, seizures, insomnia (life-threatening like alcohol) | Gradual taper with long-acting BZD (diazepam) | - |
| Cocaine/Amphetamines | Fatigue, depression, increased sleep, increased appetite | Supportive; Dopamine agonists (bromocriptine) | - |
| Nicotine | Craving, irritability, weight gain, difficulty concentrating | Varenicline (partial nicotinic agonist - DOC), Bupropion, NRT | "VAREN = VARENicline Vanquishes nicotine" |
SYSTEM 15: IMMUNOSUPPRESSANTS & BIOLOGICS
| Drug | MOA | DOC | ADRs | Hindi Trick |
|---|
| Cyclosporine | Inhibits calcineurin → ↓IL-2 → ↓T-cell activation | DOC: Organ transplantation, Psoriasis, RA | Nephrotoxicity, HTN, gingival hyperplasia, hirsutism, neurotoxicity | "CYCLO = Cyclosporine = Calcineurin Curtailed" |
| Tacrolimus (FK506) | Binds FKBP12 → inhibits calcineurin → ↓IL-2 | DOC: Organ transplantation (preferred over cyclosporine) | Nephrotoxicity, neurotoxicity > cyclosporine, diabetes, alopecia | "TACRO = TACRO kidney = Nephrotoxic TACRO" |
| Mycophenolate | IMPDH inhibitor → ↓purine synthesis → ↓B+T cell proliferation | Transplant rejection prevention | GI upset, myelosuppression, teratogenic | "MYC = MYCophenolate = Muscles out B+T cells" |
| Azathioprine | Prodrug → 6-MP → ↓purine synthesis | Transplantation, Autoimmune conditions | Myelosuppression; Fatal interaction with allopurinol | "AZA = AZAthioprine+Allopurinol = Avoid" |
| Sirolimus (Rapamycin) | Inhibits mTOR (mechanistic target of rapamycin) | Transplant (non-nephrotoxic), Tuberous sclerosis | Hyperlipidemia, impaired wound healing, thrombocytopenia, pneumonitis | "SIRO = SIRO = non-nephrotoxic (unlike tacro/cyclo)" |
| Muromonab (OKT3) | Anti-CD3 monoclonal Ab | Acute rejection | Cytokine release syndrome | - |
SYSTEM 16: SPECIAL TOPICS (HIGH-YIELD NEET PG)
DOC Quick Reference Table (Most Tested)
| Condition | Drug of Choice |
|---|
| Anaphylaxis | Epinephrine (adrenaline) IM |
| Malignant hyperthermia | Dantrolene |
| NMS (Neuroleptic Malignant Syndrome) | Dantrolene + Bromocriptine |
| Serotonin syndrome | Cyproheptadine (+ stop offending drug) |
| Digoxin toxicity (arrhythmia) | Digibind (Digoxin Fab antibodies) |
| OP poisoning | Atropine + Pralidoxime |
| Cyanide poisoning | Hydroxocobalamin (or Sodium thiosulfate + amyl nitrite) |
| Methanol/Ethylene glycol poisoning | Fomepizole (or ethanol) |
| Heparin overdose | Protamine sulfate |
| Warfarin overdose | Vitamin K + FFP (emergency) |
| BZD overdose | Flumazenil |
| Opioid overdose | Naloxone |
| Acetaminophen overdose | N-acetylcysteine (NAC) |
| Beta-blocker overdose | Glucagon + Atropine |
| Ca2+ channel blocker overdose | Calcium gluconate + Glucagon |
| TCA overdose | Sodium bicarbonate (for arrhythmia) |
| Iron overdose | Deferoxamine |
| Lead poisoning | DMSA (children), CaNa2EDTA (adults), DMSA+EDTA (severe) |
| Mercury poisoning | DMPS (Dimercaptopropanesulfonate) / Dimercaprol |
| Arsenic poisoning | Dimercaprol (BAL) |
| Methemoglobinemia | Methylene blue (if G6PD normal) |
| Digoxin toxicity | Digoxin immune Fab |
| Vitamin K deficiency | Phytomenadione |
Drug-Drug Interactions (HIGH YIELD)
| Combination | Effect | Mnemonic |
|---|
| Sildenafil + Nitrates | Fatal hypotension | "NO to NITRO with Sildenafil" |
| MAOIs + SSRIs | Serotonin syndrome | "MAOI + SSRI = Serotonin BLAST" |
| MAOIs + Tyramine (food) | Hypertensive crisis | "MAOI + CHEESE = CRISIS" |
| MAOIs + Meperidine | Serotonin syndrome + hyperpyrexia | "MEPERI-dine + MAOI = Massive problem" |
| Allopurinol + 6-MP/Azathioprine | ↑toxicity of 6-MP (XO inhibition → ↑6-MP levels) | "ALLO + AZA = AVOID" |
| Aminoglycosides + Loop diuretics | Additive ototoxicity | "AMINO + LOOP = LOST hearing" |
| Cyclosporine + Statins | ↑statin levels → myopathy | "CYCLO + STATIN = Muscle problem" |
| Rifampicin + OCP | ↓OCP efficacy (CYP induction) | "RIFAM RuIns contraceptive" |
| Methotrexate + NSAIDs | ↑MTX toxicity (↓renal excretion) | "MTX + NSAID = More toxicity" |
| Cimetidine (H2 blocker) | CYP2C9/3A4 inhibitor - multiple interactions | "CIMETI = CYP inhibitor" |
| Warfarin + Amiodarone | ↑INR (CYP2C9 inhibition) | "AMIO + WARFARIN = Watch INR" |
| Tetracycline/Fluoroquinolones + Antacids | ↓antibiotic absorption (chelation) | "ANTI-chelation with ANTACIDS" |
Phase 0 Kinetics (Unique Pharmacokinetics)
| Concept | Drugs |
|---|
| Zero-order kinetics (constant amount eliminated regardless of concentration) | Phenytoin (at high doses), Alcohol, Aspirin (high dose) |
| Saturation kinetics → non-linear | Phenytoin (small dose ↑ → massive level ↑) |
| Autoinduction (induces its own metabolism) | Carbamazepine |
| Enterohepatic circulation | Estrogens (OCP), Tetracyclines, Digoxin, Rifampicin |
| First-pass metabolism (high oral bioavailability loss) | Morphine, GTN (sublingual avoids first pass), Lidocaine, Propranolol |
| Prodrugs | Codeine→Morphine, Enalapril→Enalaprilat, Clopidogrel→active, Cyclophosphamide→active |
Pregnancy Drug Safety (Quick Reference)
| Category | Examples |
|---|
| SAFE in pregnancy | Penicillin, Cephalosporins, Azithromycin, Metronidazole (2nd/3rd trimester), Methyldopa, Labetalol, Hydralazine, Heparin/LMWH, Insulin, Lamotrigine, Levothyroxine |
| ABSOLUTELY AVOID | ACEi/ARBs (renal agenesis), Warfarin, MTX, Thalidomide, Isotretinoin, Valproate, Phenytoin, Carbamazepine, Lithium (Ebstein), Tetracycline (teeth), Fluoroquinolones (cartilage), Aminoglycosides (ototoxic fetus) |
| Safest antiepileptic | Lamotrigine |
| Safest antihypertensive | Methyldopa (1st choice), Labetalol, Nifedipine |
| Safest antibiotic | Penicillin, Cephalosporins, Azithromycin, Clindamycin |
Mnemonic for AVOID in pregnancy - "WANT MORE":
Warfarin, ACEi/ARBs, NSAIDs (3rd trimester), Tetracyclines | Methotrexate, OCPill (if pregnant), Retinoids, Epileptic drugs (most)
Drug Mechanisms - Receptor Summary Table
| Receptor | Agonist Example | Antagonist Example |
|---|
| M1/M2/M3 | Pilocarpine, Bethanechol | Atropine, Scopolamine |
| N (nicotinic) | Nicotine, Succinylcholine | Tubocurarine, Mecamylamine |
| α1 | Phenylephrine | Prazosin, Tamsulosin |
| α2 | Clonidine | Yohimbine, Phentolamine |
| β1 | Dobutamine | Metoprolol, Atenolol |
| β2 | Salbutamol | Propranolol (non-selective) |
| H1 | Histamine | Diphenhydramine, Loratadine |
| H2 | Histamine | Cimetidine, Ranitidine |
| D2 | Bromocriptine | Haloperidol, Metoclopramide |
| 5HT3 | 5-HT | Ondansetron |
| GABA-A | Muscimol | Flumazenil (BZD site) |
| NMDA | Glutamate | Ketamine, Memantine |
| μ-opioid | Morphine | Naloxone |
MASTER REVISION MNEMONICS (HINDI)
| Topic | Mnemonic | Meaning |
|---|
| TB drugs ADR | "RIPE SAHI" | R=Red urine (Rifampicin), I=INH neuropathy, P=Pyrazinamide gout, E=Ethambutol eye |
| Aminoglycoside ADR | "AMINO BAHRA KARTA" | BAHRa = deaf (ototoxic) |
| Antipsychotic EPS | "Pehle Ghabra, Phir Aram" | Early = Akathisia/Dystonia, Late = Tardive dyskinesia |
| Drugs causing SJS | "CAPS Lock karo SJS ke liye" | Carbamazepine, Allopurinol, Phenytoin, Sulfonamides, Lamotrigine |
| Teratogenic drugs | "WAR METTLE" | Warfarin, ACEi/ARBs, Retinoids, Methotrexate, Etretinate, Thalidomide, Lithium, Epileptics |
| Hepatotoxic drugs | "RANI MAHAL" | Rifampicin, Amiodarone, Nitrofurantoin, Isoniazid, MTX, Alcohol, Halothane, ALcohol |
| Drugs causing gynaecomastia | "DISCO" | Digoxin, INH, Spironolactone, Cimetidine, OCP, Ketoconazole |
| DOC for pregnancy HTN | "MAHI" | Methyldopa, Amlodipine, Hydralazine, Ivermectin (No - Hydralazine) |
| Drugs causing pancreatitis | "DIVAS" | Didanosine, Isoniazid, Valproate, Azathioprine, Steroids |
| Drugs causing SIADH | "OVIC-CD" | Oxcarbazepine, Vincristine, Ifosfamide, Carbamazepine, Cyclophosphamide, (Chlorpropamide) Diabetes drug |
FINAL HIGH-YIELD DRUG COMPARISONS
| Comparison | Drug A | Drug B | Key Difference |
|---|
| Clopidogrel vs Ticagrelor | Prodrug (CYP2C19) | Direct action | Ticagrelor: faster, more potent, better outcomes (PLATO) |
| Heparin vs LMWH | Anti-IIa + Xa | Anti-Xa mainly | LMWH: predictable, no monitoring, safer in pregnancy |
| Morphine vs Fentanyl | Less potent, histamine release | 100x more potent, NO histamine | Fentanyl better for allergy patients |
| Cyclosporine vs Tacrolimus | More CVS side effects | More neurotoxic, more diabetes | Tacrolimus preferred post-transplant |
| Furosemide vs Thiazides | Loop, ↓Ca | DCT, ↑Ca | Furosemide for hypercalcemia; Thiazides for hypocalciuria/osteoporosis |
| Metronidazole vs Tinidazole | Shorter half-life | Longer half-life | Tinidazole: single-dose treatment available |
| Haloperidol vs Clozapine | High EPS, low sedation | No EPS, high sedation, agranulocytosis | Clozapine: treatment-resistant schizophrenia only |
| ACEi vs ARB | Cough (bradykinin) | No cough | ARB when ACEi not tolerated |
Exam Strategy for NEET PG Pharmacology:
- DOC list - memorize system by system (30+ marks potential)
- Unique ADRs - each drug's "signature" side effect (high yield MCQ)
- Drug interactions - especially life-threatening ones (5-8 marks)
- Pregnancy safety - always asked (3-5 marks)
- Antidotes - complete list (5+ marks)
- Classification - Vaughan Williams, antibiotic mechanisms (2-3 marks)
- New drugs (SGLT2i in HF, DOACs, biologics) - recent papers ask these
All the best for NEET PG! Focus on understanding mechanisms - rote learning alone won't work for clinical application questions.
