const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_WIDE"; pres.title = "System-Wise Pharmacology Reference"; pres.author = "Orris Medical Reference"; // ─── COLOR PALETTE ─────────────────────────────────────────────────── const C = { navy: "0D1B2A", teal: "1B998B", gold: "FFBC42", white: "FFFFFF", light: "F0F4F8", red: "E63946", green: "2D9E5F", purple: "6A4C93", orange: "F4884A", blue: "2176AE", gray: "4A5568", lgray: "CBD5E0", darkbg: "101820", }; // ─── HELPERS ───────────────────────────────────────────────────────── function titleSlide(title, subtitle) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkbg } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.06, fill: { color: C.teal } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 7.44, w: "100%", h: 0.06, fill: { color: C.teal } }); sl.addText(title, { x: 0.5, y: 1.8, w: 12.3, h: 1.8, fontSize: 46, bold: true, color: C.white, align: "center", fontFace: "Calibri" }); if (subtitle) sl.addText(subtitle, { x: 0.5, y: 3.8, w: 12.3, h: 0.8, fontSize: 22, color: C.teal, align: "center", fontFace: "Calibri" }); sl.addText("Compiled from Goodman & Gilman | Katzung | Lippincott Pharmacology", { x: 0.5, y: 6.6, w: 12.3, h: 0.4, fontSize: 13, color: C.lgray, align: "center", italic: true }); } function sectionHeader(system, icon, color) { const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: color || C.navy } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: "100%", fill: { color: C.teal } }); sl.addText(icon + " " + system, { x: 0.5, y: 2.8, w: 12.3, h: 1.8, fontSize: 42, bold: true, color: C.white, align: "center", fontFace: "Calibri" }); sl.addText("System-Wise Drug Reference", { x: 0.5, y: 5.0, w: 12.3, h: 0.5, fontSize: 18, color: C.teal, align: "center" }); } function drugSlide(system, drugClass, drugs) { // drugs = [{name, indication, oral, iv, im, se, ci}] const sl = pres.addSlide(); // header bar sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.65, fill: { color: C.navy } }); sl.addText(system + " | " + drugClass, { x: 0.2, y: 0.05, w: 12.9, h: 0.55, fontSize: 17, bold: true, color: C.white, fontFace: "Calibri", margin: 0 }); const colW = [2.1, 2.0, 1.7, 1.5, 1.5, 2.5, 2.0]; const headers = ["Drug", "Indication", "Oral Dose", "IV Dose", "IM Dose", "Side Effects", "Contraindications"]; const hColors = [C.navy, C.teal, C.green, C.blue, C.purple, C.orange, C.red]; // column headers let xPos = 0.1; headers.forEach((h, i) => { sl.addShape(pres.ShapeType.rect, { x: xPos, y: 0.68, w: colW[i], h: 0.42, fill: { color: hColors[i] } }); sl.addText(h, { x: xPos, y: 0.68, w: colW[i], h: 0.42, fontSize: 10.5, bold: true, color: C.white, align: "center", valign: "middle", margin: 2 }); xPos += colW[i] + 0.04; }); // rows const rowH = (7.5 - 1.13) / drugs.length; const actualRowH = Math.min(rowH, 1.0); drugs.forEach((d, ri) => { const rowY = 1.13 + ri * actualRowH; const bg = ri % 2 === 0 ? C.light : C.white; xPos = 0.1; const vals = [d.name, d.indication, d.oral || "—", d.iv || "—", d.im || "—", d.se, d.ci]; vals.forEach((v, ci) => { sl.addShape(pres.ShapeType.rect, { x: xPos, y: rowY, w: colW[ci], h: actualRowH, fill: { color: bg }, line: { color: C.lgray, width: 0.5 } }); const fSize = ci === 0 ? 9.5 : 8.5; const bold = ci === 0; sl.addText(v, { x: xPos + 0.03, y: rowY + 0.02, w: colW[ci] - 0.06, h: actualRowH - 0.04, fontSize: fSize, bold: bold, color: ci === 0 ? C.navy : C.gray, valign: "top", shrinkText: true }); xPos += colW[ci] + 0.04; }); }); // footer sl.addText("Ref: Goodman & Gilman | Katzung | Lippincott", { x: 0.1, y: 7.3, w: 12, h: 0.2, fontSize: 8, color: C.lgray, italic: true }); } // ═══════════════════════════════════════════════════════════════════ // SLIDE 1: Title // ═══════════════════════════════════════════════════════════════════ titleSlide( "System-Wise Pharmacology", "Indications • Doses (Oral / IV / IM) • Side Effects • Contraindications" ); // ═══════════════════════════════════════════════════════════════════ // SECTION 1: CARDIOVASCULAR SYSTEM // ═══════════════════════════════════════════════════════════════════ sectionHeader("Cardiovascular System (CVS)", "❤️", "0A2540"); drugSlide("CVS", "ACE Inhibitors", [ { name: "Enalapril", indication: "HTN, HFrEF, post-MI", oral: "5–40 mg/day (1–2 doses)", iv: "1.25 mg q6h", im: "—", se: "Dry cough, hyperkalemia, angioedema, hypotension, renal impairment", ci: "Pregnancy, bilateral RAS, prior angioedema, hyperkalemia" }, { name: "Lisinopril", indication: "HTN, HF, diabetic nephropathy", oral: "10–40 mg/day", iv: "—", im: "—", se: "Dry cough, hypotension, hyperkalemia, angioedema", ci: "Pregnancy, angioedema history, bilateral RAS" }, { name: "Ramipril", indication: "HTN, HF, post-MI, CKD", oral: "2.5–10 mg/day", iv: "—", im: "—", se: "Cough, hyperkalemia, renal impairment, dizziness", ci: "Pregnancy, bilateral RAS, hyperkalemia" }, { name: "Captopril", indication: "HTN, HF, post-MI, diabetic nephropathy", oral: "25–150 mg TID", iv: "—", im: "—", se: "Cough, rash, dysgeusia, neutropenia, proteinuria", ci: "Pregnancy, bilateral RAS, angioedema" }, ]); drugSlide("CVS", "ARBs (Angiotensin Receptor Blockers)", [ { name: "Losartan", indication: "HTN, HF, CKD in type 2 DM", oral: "50–100 mg/day", iv: "—", im: "—", se: "Hyperkalemia, dizziness, renal impairment (rare angioedema)", ci: "Pregnancy, bilateral RAS, hyperkalemia" }, { name: "Valsartan", indication: "HTN, HFrEF, post-MI", oral: "80–320 mg/day", iv: "—", im: "—", se: "Hypotension, hyperkalemia, headache, dizziness", ci: "Pregnancy, bilateral RAS, severe hepatic impairment" }, { name: "Telmisartan", indication: "HTN, CV risk reduction", oral: "40–80 mg/day", iv: "—", im: "—", se: "Hyperkalemia, dizziness, back pain", ci: "Pregnancy, biliary obstruction" }, { name: "Candesartan", indication: "HTN, HFrEF", oral: "8–32 mg/day", iv: "—", im: "—", se: "Hyperkalemia, renal impairment, dizziness", ci: "Pregnancy, severe hepatic impairment" }, ]); drugSlide("CVS", "Beta-Blockers", [ { name: "Metoprolol (β1 selective)", indication: "HTN, angina, HF, MI, arrhythmia", oral: "25–200 mg/day (succinate) or BID (tartrate)", iv: "5 mg q5min × 3 (MI/arrhythmia)", im: "—", se: "Bradycardia, fatigue, sexual dysfunction, cold extremities, mask hypoglycemia", ci: "Asthma, cardiogenic shock, severe bradycardia, 2nd/3rd degree AV block" }, { name: "Carvedilol (α1+β)", indication: "HFrEF, HTN, post-MI", oral: "3.125–25 mg BID", iv: "—", im: "—", se: "Dizziness, hypotension, weight gain, bradycardia, fatigue", ci: "Decompensated HF, severe bradycardia, severe asthma" }, { name: "Atenolol (β1 selective)", indication: "HTN, angina, post-MI", oral: "25–100 mg/day", iv: "2.5–5 mg IV (arrhythmia)", im: "—", se: "Bradycardia, fatigue, cold extremities, depression", ci: "Asthma, heart block, cardiogenic shock" }, { name: "Propranolol (non-selective)", indication: "HTN, angina, arrhythmia, thyrotoxicosis, migraine prophylaxis, tremor", oral: "40–320 mg/day (divided)", iv: "1–3 mg IV slowly", im: "—", se: "Bradycardia, bronchospasm, mask hypoglycemia, fatigue", ci: "Asthma/COPD, heart block, Raynaud's, IDDM" }, { name: "Bisoprolol (β1 selective)", indication: "HFrEF, HTN, angina", oral: "2.5–10 mg/day", iv: "—", im: "—", se: "Bradycardia, fatigue, dizziness, cold extremities", ci: "Cardiogenic shock, heart block, severe asthma" }, ]); drugSlide("CVS", "Calcium Channel Blockers", [ { name: "Amlodipine (DHP)", indication: "HTN, stable angina, vasospastic angina", oral: "5–10 mg/day", iv: "—", im: "—", se: "Peripheral edema, flushing, headache, reflex tachycardia", ci: "Cardiogenic shock, severe aortic stenosis" }, { name: "Nifedipine (DHP)", indication: "HTN, angina, Raynaud's, preterm labor", oral: "30–90 mg/day (XL)", iv: "—", im: "—", se: "Flushing, headache, edema, reflex tachycardia, gingival hyperplasia", ci: "Cardiogenic shock, acute MI (short-acting), unstable angina" }, { name: "Diltiazem (non-DHP)", indication: "HTN, angina, AF/AFL rate control, SVT", oral: "120–360 mg/day", iv: "0.25 mg/kg bolus then 5–15 mg/hr", im: "—", se: "Bradycardia, AV block, constipation, edema, hypotension", ci: "Sick sinus syndrome, 2nd/3rd degree AV block, cardiogenic shock" }, { name: "Verapamil (non-DHP)", indication: "SVT, HTN, angina, hypertrophic CMP", oral: "120–480 mg/day (divided)", iv: "2.5–5 mg bolus", im: "—", se: "Constipation, bradycardia, AV block, hypotension, HF exacerbation", ci: "Heart failure, sick sinus syndrome, AV block, concurrent beta-blocker IV" }, ]); drugSlide("CVS", "Diuretics", [ { name: "Furosemide (Loop)", indication: "Pulmonary edema, HF, hypertensive emergency, edema, hypercalcemia", oral: "20–80 mg/day (up to 600 mg)", iv: "20–80 mg (or 40–200 mg infusion)", im: "20–40 mg", se: "Hypokalemia, hyponatremia, hypomagnesemia, ototoxicity, hyperuricemia, dehydration", ci: "Anuria, sulfonamide allergy (relative), hepatic coma" }, { name: "Hydrochlorothiazide (Thiazide)", indication: "HTN, edema, nephrolithiasis (Ca stones), DI", oral: "12.5–50 mg/day", iv: "—", im: "—", se: "Hypokalemia, hyponatremia, hyperuricemia, hypercalcemia, hyperglycemia, hyperlipidemia", ci: "Anuria, sulfonamide allergy (relative), severe renal impairment (GFR<30)" }, { name: "Spironolactone (K+-sparing)", indication: "HFrEF, hyperaldosteronism, ascites, HTN, hirsutism", oral: "25–400 mg/day", iv: "—", im: "—", se: "Hyperkalemia, gynecomastia, menstrual irregularity, GI upset", ci: "Hyperkalemia, Addison's disease, renal failure, concurrent K+ supps with ACEi" }, { name: "Mannitol (Osmotic)", indication: "Raised ICP, acute glaucoma, acute renal failure prevention", oral: "—", iv: "0.25–2 g/kg infusion over 30–60 min", im: "—", se: "Pulmonary edema, fluid/electrolyte imbalance, headache, nausea", ci: "Anuria (established), severe HF, pulmonary edema, intracranial bleeding" }, ]); drugSlide("CVS", "Antiarrhythmics (Vaughan Williams Classes)", [ { name: "Lidocaine (Class Ib)", indication: "Ventricular arrhythmias (VT/VF) post-MI", oral: "—", iv: "1–1.5 mg/kg bolus; 1–4 mg/min infusion", im: "4–5 mg/kg (auto-injector)", se: "CNS toxicity (seizures, drowsiness), cardiovascular depression", ci: "Stokes-Adams attacks, severe heart block, allergy to amide anesthetics" }, { name: "Amiodarone (Class III)", indication: "VT, VF, AF, AFL rate/rhythm control", oral: "200 mg TID (loading) → 200 mg/day (maint)", iv: "150 mg bolus over 10 min → 1 mg/min × 6h → 0.5 mg/min", im: "—", se: "Pulmonary toxicity, thyroid (hypo/hyper), hepatotoxicity, corneal deposits, photosensitivity, blue-gray skin", ci: "Sinus bradycardia, heart block, iodine allergy, severe thyroid disease" }, { name: "Adenosine (Class misc.)", indication: "SVT (AVNRT, AVRT) diagnosis/termination", oral: "—", iv: "6 mg rapid IV push; repeat 12 mg × 2", im: "—", se: "Transient asystole, flushing, chest tightness, bronchospasm", ci: "Sick sinus syndrome, 2nd/3rd degree AV block, severe asthma" }, { name: "Digoxin (Cardiac glycoside)", indication: "AF rate control, HFrEF (adjunct)", oral: "0.125–0.25 mg/day", iv: "0.5 mg loading (divided doses)", im: "Not recommended", se: "Nausea, visual disturbances (yellow-green), bradycardia, heart block, arrhythmias", ci: "VF, 2nd/3rd degree AV block, WPW syndrome, hypertrophic CMP with obstruction" }, ]); drugSlide("CVS", "Antianginals & Statins", [ { name: "Nitroglycerine (Nitrate)", indication: "Acute angina, acute HF, hypertensive emergency", oral: "SL: 0.3–0.6 mg; Transdermal patch: 0.2–0.8 mg/hr", iv: "5–200 mcg/min infusion", im: "—", se: "Headache, hypotension, reflex tachycardia, methemoglobinemia (high dose)", ci: "Severe hypotension (SBP<90), right ventricular infarction, PDE5 inhibitors concurrent use" }, { name: "Isosorbide Mononitrate", indication: "Angina prophylaxis, esophageal spasm", oral: "20–120 mg/day (extended release)", iv: "—", im: "—", se: "Headache, hypotension, tolerance (nitrate-free interval needed)", ci: "Hypotension, concurrent PDE5 inhibitors, shock" }, { name: "Atorvastatin (HMG-CoA-RI)", indication: "Hyperlipidemia, CV risk reduction, post-ACS", oral: "10–80 mg/day (at night)", iv: "—", im: "—", se: "Myopathy/rhabdomyolysis, elevated LFTs, GI upset, headache", ci: "Active liver disease, pregnancy, breastfeeding, concurrent fibrates (caution)" }, { name: "Rosuvastatin", indication: "Hyperlipidemia, primary prevention", oral: "5–40 mg/day", iv: "—", im: "—", se: "Myopathy, hepatotoxicity (rare), proteinuria (high dose)", ci: "Pregnancy, active liver disease, severe renal impairment (high dose)" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 2: RESPIRATORY SYSTEM // ═══════════════════════════════════════════════════════════════════ sectionHeader("Respiratory System", "🫁", "0D3B1A"); drugSlide("Respiratory", "Bronchodilators – Beta-2 Agonists", [ { name: "Salbutamol / Albuterol (SABA)", indication: "Acute bronchospasm, asthma, COPD (rescue)", oral: "2–4 mg TID-QID; Neb: 2.5 mg q4–6h", iv: "250 mcg slow IV; infusion 5–20 mcg/min", im: "500 mcg IM (severe asthma)", se: "Tachycardia, tremor, hypokalemia, hyperglycemia, palpitations", ci: "Tachyarrhythmia, hypersensitivity" }, { name: "Salmeterol (LABA)", indication: "Asthma maintenance (+ ICS), COPD maintenance", oral: "Inhaler: 50 mcg BID", iv: "—", im: "—", se: "Tachycardia, tremor, paradoxical bronchospasm, hypokalemia", ci: "Monotherapy in asthma (without ICS), tachyarrhythmia" }, { name: "Formoterol (LABA)", indication: "Asthma (+ ICS), COPD maintenance", oral: "Inhaler: 12 mcg BID (DPI)", iv: "—", im: "—", se: "Tachycardia, tremor, hypokalemia", ci: "Monotherapy in asthma (without ICS)" }, { name: "Terbutaline", indication: "Asthma, COPD, preterm labor", oral: "2.5–5 mg TID", iv: "0.25 mg slow IV (severe asthma)", im: "0.25 mg SC/IM", se: "Tremor, tachycardia, hypokalemia, hyperglycemia", ci: "Tachyarrhythmia, eclampsia (in tocolysis)" }, ]); drugSlide("Respiratory", "Anticholinergics & Methylxanthines", [ { name: "Ipratropium (SAMA)", indication: "COPD (first-line), acute asthma (adjunct)", oral: "Neb: 0.25–0.5 mg q4–6h; MDI: 40–80 mcg QID", iv: "—", im: "—", se: "Dry mouth, urinary retention, blurred vision, constipation, paradoxical bronchospasm", ci: "Narrow-angle glaucoma (eye exposure), urinary retention (caution)" }, { name: "Tiotropium (LAMA)", indication: "COPD maintenance (first-line)", oral: "Inhaler: 18 mcg/day (HandiHaler)", iv: "—", im: "—", se: "Dry mouth, urinary retention, constipation, tachycardia, blurred vision", ci: "Narrow-angle glaucoma, urinary retention, severe renal impairment" }, { name: "Theophylline", indication: "Asthma (add-on), COPD (adjunct), neonatal apnea", oral: "5–10 mcg/mL target; 200–400 mg BID (XR)", iv: "Loading: 5 mg/kg; Maint: 0.5 mg/kg/hr", im: "—", se: "Nausea, vomiting, headache, tachycardia, seizures, arrhythmias (toxicity)", ci: "Acute MI, arrhythmias, peptic ulcer, seizure disorder, porphyria" }, ]); drugSlide("Respiratory", "Inhaled Corticosteroids & Anti-asthmatics", [ { name: "Budesonide (ICS)", indication: "Asthma maintenance, COPD, group croup", oral: "Inhaler: 200–800 mcg/day (divided); Neb: 0.25–2 mg/day", iv: "—", im: "—", se: "Oral candidiasis, dysphonia, HPA suppression (high dose), osteoporosis (long-term)", ci: "Active pulmonary TB (relative), not for acute attacks" }, { name: "Fluticasone (ICS)", indication: "Asthma maintenance, COPD", oral: "Inhaler: 100–1000 mcg/day", iv: "—", im: "—", se: "Oral candidiasis, dysphonia, HPA suppression", ci: "Acute asthma attack; not for acute bronchospasm" }, { name: "Montelukast (LTRA)", indication: "Asthma (adjunct/mild), allergic rhinitis, exercise-induced bronchoconstriction", oral: "10 mg/day (adults); 5 mg/day (6–14 yr)", iv: "—", im: "—", se: "Headache, GI upset, neuropsychiatric effects (depression, suicidality – FDA black box)", ci: "Phenylketonuria (chewable tabs), severe psychiatric history" }, { name: "Cromolyn Sodium", indication: "Asthma prophylaxis (exercise/allergen induced), allergic rhinitis, mastocytosis", oral: "Inhaler/Neb: 20 mg QID", iv: "—", im: "—", se: "Cough, throat irritation, bronchospasm (paradoxical)", ci: "Acute asthma attack, hypersensitivity" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 3: CNS / NEUROLOGICAL // ═══════════════════════════════════════════════════════════════════ sectionHeader("Central Nervous System (CNS)", "🧠", "1A0D2E"); drugSlide("CNS", "Opioid Analgesics", [ { name: "Morphine", indication: "Severe pain, pulmonary edema (acute), MI pain", oral: "5–30 mg q4h (IR); 15–200 mg q8–12h (SR)", iv: "2–4 mg slow IV q3–4h; PCA: 0.5–3 mg/h", im: "5–10 mg q4h", se: "Respiratory depression, sedation, constipation, nausea/vomiting, pruritus, euphoria, miosis", ci: "Respiratory depression, paralytic ileus, acute abdomen, MAOIs, head injury (relative), renal failure (accumulation)" }, { name: "Fentanyl", indication: "Procedural analgesia, chronic pain (patch), anesthesia adjunct", oral: "Transmucosal: 200–1600 mcg; Patch: 12–100 mcg/hr q72h", iv: "1–2 mcg/kg bolus; infusion 25–200 mcg/hr", im: "50–100 mcg", se: "Respiratory depression, chest wall rigidity (high IV dose), sedation, nausea, euphoria", ci: "Significant respiratory depression (non-intubated), MAOIs, acute/severe asthma (relative)" }, { name: "Tramadol", indication: "Moderate-severe pain (opioid-SNRI hybrid)", oral: "50–100 mg q4–6h (max 400 mg/day)", iv: "50–100 mg q4–6h", im: "50–100 mg q4–6h", se: "Seizures, serotonin syndrome (+ SSRIs), nausea, dizziness, respiratory depression (less than others)", ci: "MAOIs, seizure disorder, SSRIs/SNRIs (serotonin syndrome risk), acute intoxication" }, { name: "Codeine", indication: "Mild-moderate pain, antitussive (low dose)", oral: "15–60 mg q4–6h", iv: "—", im: "30–60 mg q4h", se: "Constipation, nausea, sedation, respiratory depression (ultra-rapid metabolizers)", ci: "Children post-tonsillectomy (FDA black box), breastfeeding, CYP2D6 ultra-rapid metabolizers" }, ]); drugSlide("CNS", "NSAIDs & Non-Opioid Analgesics", [ { name: "Ibuprofen (NSAID)", indication: "Pain, fever, dysmenorrhea, RA, OA, gout", oral: "200–800 mg TID-QID (max 3200 mg/day)", iv: "400–800 mg q6h", im: "—", se: "GI ulceration/bleeding, renal impairment, fluid retention, HTN, CV events (prolonged), bronchospasm (aspirin-sensitive)", ci: "Active peptic ulcer, severe renal/hepatic failure, 3rd trimester pregnancy, aspirin-exacerbated asthma, CABG perioperative" }, { name: "Aspirin (COX-1/2 NSAID)", indication: "Antiplatelet (75–325 mg), analgesic/anti-inflammatory (higher doses), Kawasaki disease", oral: "75–325 mg/day (antiplatelet); 325–650 mg q4–6h (analgesic); 4–8 g/day (anti-inflammatory)", iv: "—", im: "—", se: "GI bleeding, peptic ulcer, Reye's syndrome (children), salicylism (tinnitus, dizziness), bronchospasm", ci: "Children < 12 yrs with viral illness (Reye's), active bleeding, peptic ulcer, allergy, anticoagulant therapy (caution)" }, { name: "Paracetamol / Acetaminophen", indication: "Pain, fever (all ages including children, pregnancy)", oral: "500–1000 mg q4–6h (max 4 g/day; 2 g/day in liver disease)", iv: "1 g q4–6h (over 15 min)", im: "—", se: "Hepatotoxicity (overdose – N-acetylcysteine antidote), rash (rare)", ci: "Severe hepatic impairment, alcoholism (caution), paracetamol allergy" }, { name: "Celecoxib (COX-2 selective)", indication: "OA, RA, ankylosing spondylitis, pain, familial adenomatous polyposis", oral: "100–200 mg BID", iv: "—", im: "—", se: "CV events (MI, stroke), fluid retention, renal impairment, less GI toxicity than non-selective NSAIDs", ci: "Sulfonamide allergy, post-CABG, active peptic ulcer, advanced renal disease, 3rd trimester pregnancy" }, ]); drugSlide("CNS", "Antiepileptics (AEDs)", [ { name: "Phenytoin", indication: "Focal & tonic-clonic seizures, status epilepticus, trigeminal neuralgia, neuropathic pain", oral: "300–400 mg/day (adult maintenance)", iv: "15–20 mg/kg loading (≤50 mg/min); maint 100 mg q6–8h", im: "Not recommended (erratic absorption)", se: "Gingival hyperplasia, hirsutism, ataxia, nystagmus, SJS/TEN, folic acid deficiency, teratogenicity, hypotension (IV)", ci: "Bradycardia, SA/AV block, porphyria, pregnancy (relative), concurrent delavirdine" }, { name: "Valproate / Valproic Acid", indication: "Absence, tonic-clonic, myoclonic seizures; bipolar disorder; migraine prophylaxis", oral: "500–2500 mg/day (divided)", iv: "Loading 15–45 mg/kg; maint 1–4 mg/kg/hr", im: "—", se: "Hepatotoxicity (children <2yr at highest risk), teratogenicity (neural tube defects), pancreatitis, weight gain, tremor, alopecia, thrombocytopenia", ci: "Hepatic disease, pregnancy (esp. neural tube defects – absolute contraindication in childbearing), mitochondrial disorders (Alpers)" }, { name: "Carbamazepine", indication: "Focal & tonic-clonic seizures, trigeminal neuralgia, bipolar disorder", oral: "200–1600 mg/day (divided)", iv: "—", im: "—", se: "Diplopia, ataxia, SJS/TEN (HLA-B*1502 - Asian populations), SIADH, hyponatremia, aplastic anemia, agranulocytosis", ci: "AV block, bone marrow depression, MAOIs, porphyria; test HLA-B*1502 in Asians" }, { name: "Levetiracetam", indication: "Focal seizures, JME, tonic-clonic, status epilepticus (off-label IV)", oral: "500–3000 mg/day (BID)", iv: "Same dose range; loading 20–60 mg/kg for SE", im: "—", se: "Somnolence, behavioral changes (irritability, aggression, depression), dizziness, headache", ci: "Hypersensitivity; caution in renal impairment (dose reduce)" }, ]); drugSlide("CNS", "Antidepressants", [ { name: "Sertraline (SSRI)", indication: "MDD, OCD, panic disorder, PTSD, social anxiety, PMDD", oral: "50–200 mg/day", iv: "—", im: "—", se: "GI upset, sexual dysfunction, insomnia, serotonin syndrome (overdose/interactions), SIADH, QT prolongation (rare)", ci: "MAOIs (14-day washout), pimozide, linezolid, methylene blue, uncontrolled seizures" }, { name: "Fluoxetine (SSRI)", indication: "MDD, OCD, bulimia nervosa, panic disorder, PMDD", oral: "20–80 mg/day", iv: "—", im: "—", se: "Insomnia, agitation, GI upset, sexual dysfunction, weight loss initially, serotonin syndrome", ci: "MAOIs (5-week washout after fluoxetine; 2 weeks before), thioridazine, pimozide" }, { name: "Venlafaxine (SNRI)", indication: "MDD, GAD, social anxiety, panic disorder, neuropathic pain", oral: "75–225 mg/day (XR: once daily)", iv: "—", im: "—", se: "Hypertension (dose-dependent), sexual dysfunction, nausea, dizziness, discontinuation syndrome", ci: "MAOIs, uncontrolled HTN, concurrent linezolid/methylene blue" }, { name: "Amitriptyline (TCA)", indication: "MDD, neuropathic pain, migraine prophylaxis, fibromyalgia, IBS", oral: "25–150 mg/day (usually at night)", iv: "—", im: "—", se: "Anticholinergic (dry mouth, urinary retention, constipation, blurred vision), sedation, orthostatic hypotension, QT prolongation, cardiac toxicity (OD)", ci: "Recent MI, arrhythmias, glaucoma (narrow angle), urinary retention, MAOIs, concurrent QT-prolonging drugs" }, ]); drugSlide("CNS", "Antipsychotics & Mood Stabilizers", [ { name: "Haloperidol (FGA)", indication: "Schizophrenia, acute psychosis, mania, delirium, Tourette's, nausea/vomiting", oral: "0.5–20 mg/day", iv: "2–10 mg IV (delirium/agitation)", im: "2–10 mg IM (acute agitation); depot: 50–300 mg q4wks", se: "EPS (akathisia, dystonia, parkinsonism, tardive dyskinesia), NMS, QT prolongation, sedation, hyperprolactinemia", ci: "NMS, Parkinson's disease, CNS depression, QT prolongation, pheochromocytoma" }, { name: "Olanzapine (SGA)", indication: "Schizophrenia, bipolar disorder (mania, maintenance), agitation (IM)", oral: "5–20 mg/day", iv: "—", im: "10 mg IM (acute agitation)", se: "Metabolic syndrome (weight gain, dyslipidemia, DM), sedation, EPS (less), orthostatic hypotension, anticholinergic effects", ci: "Narrow-angle glaucoma (caution), QT prolongation, dementia-related psychosis (black box)" }, { name: "Lithium (Mood stabilizer)", indication: "Bipolar disorder (acute mania & prophylaxis), schizoaffective disorder, augmentation in MDD", oral: "900–2400 mg/day (TID-QID); target serum: 0.6–1.2 mEq/L", iv: "—", im: "—", se: "Tremor, polyuria, polydipsia, weight gain, hypothyroidism, nephrotoxicity (long-term), teratogenicity (Ebstein's anomaly), toxicity (narrow TI)", ci: "Renal impairment, sodium-depleted states, pregnancy (1st trimester), diuretics/NSAIDs (increase levels), hypothyroidism" }, { name: "Clonazepam (Benzodiazepine)", indication: "Panic disorder, seizures (absence, akinetic), acute anxiety, status epilepticus", oral: "0.25–4 mg/day (BID-TID)", iv: "0.5–1 mg slow IV (seizures)", im: "0.5–1 mg IM", se: "CNS depression, dependence/tolerance, amnesia, respiratory depression, paradoxical excitability in children", ci: "Acute narrow-angle glaucoma, severe hepatic disease, myasthenia gravis, respiratory depression, pregnancy (relative)" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 4: ANTIMICROBIALS // ═══════════════════════════════════════════════════════════════════ sectionHeader("Antimicrobials (Anti-infectives)", "🦠", "1A1400"); drugSlide("Antimicrobials", "Penicillins & Cephalosporins", [ { name: "Amoxicillin (Aminopenicillin)", indication: "RTI, UTI, H. pylori, otitis media, Lyme disease (early)", oral: "250–500 mg TID or 875 mg BID", iv: "—", im: "—", se: "Diarrhea, nausea, rash (maculopapular in EBV), anaphylaxis, pseudomembranous colitis", ci: "Penicillin allergy, infectious mononucleosis" }, { name: "Amox-Clavulanate (Co-amoxiclav)", indication: "Community-acquired pneumonia, sinusitis, animal bites, skin & soft tissue infections", oral: "500/125 mg TID or 875/125 mg BID", iv: "1.2 g q8h", im: "—", se: "Diarrhea (clavulanate), cholestatic jaundice, rash, C. diff", ci: "Penicillin allergy, previous amox-clavulanate cholestatic jaundice" }, { name: "Cefazolin (1st gen Ceph)", indication: "Surgical prophylaxis, skin/soft tissue, UTI", oral: "—", iv: "1–2 g q8h (or q12h)", im: "0.5–1 g q8–12h", se: "Rash, GI upset, thrombophlebitis (IV), neutropenia (rare), C. diff", ci: "Cephalosporin allergy; cross-reactivity with penicillin (≈1–2%)" }, { name: "Ceftriaxone (3rd gen Ceph)", indication: "Meningitis, pneumonia, gonorrhea, Lyme disease, typhoid", oral: "—", iv: "1–4 g/day (max 4 g)", im: "0.5–2 g/day (IM with lidocaine)", se: "Biliary sludge/cholecystitis, diarrhea (C. diff), rash, phlebitis, disulfiram-like reaction (cefoperazone)", ci: "Neonates with hyperbilirubinemia, hypersensitivity" }, ]); drugSlide("Antimicrobials", "Macrolides, Fluoroquinolones & Tetracyclines", [ { name: "Azithromycin (Macrolide)", indication: "Community-acquired pneumonia, atypical pneumonia (Mycoplasma/Chlamydia/Legionella), STIs (Chlamydia), MAC prophylaxis", oral: "500 mg Day 1, then 250 mg Days 2–5 (Z-pack); 1 g single dose (STI)", iv: "500 mg/day", im: "—", se: "GI upset, QT prolongation, cholestatic jaundice (rare), hepatotoxicity", ci: "QT prolongation, torsades history, myasthenia gravis (worsening), hepatic impairment (IV)" }, { name: "Ciprofloxacin (Fluoroquinolone)", indication: "UTI, traveler's diarrhea, anthrax, typhoid, STIs (gonorrhea), pseudomonal infections", oral: "250–750 mg BID", iv: "200–400 mg q8–12h", im: "—", se: "Tendinopathy/tendon rupture (black box), QT prolongation, CNS effects, phototoxicity, peripheral neuropathy, dysglycemia", ci: "Pregnancy, children <18 (growing cartilage), myasthenia gravis, concurrent QT-prolonging drugs, seizure disorder" }, { name: "Doxycycline (Tetracycline)", indication: "Atypical pneumonia, Lyme disease, RMSF, malaria prophylaxis/treatment, STIs (Chlamydia/PID), acne, brucellosis", oral: "100 mg BID (loading 200 mg Day 1)", iv: "100–200 mg/day", im: "—", se: "Photosensitivity, GI upset (take with food), esophagitis, tooth discoloration/enamel hypoplasia (children), teratogenicity", ci: "Pregnancy, children <8 years, severe hepatic impairment" }, ]); drugSlide("Antimicrobials", "Metronidazole, Vancomycin & Antifungals", [ { name: "Metronidazole (Nitroimidazole)", indication: "Anaerobic infections, C. difficile, H. pylori, BV, Trichomonas, amebiasis, Giardia", oral: "400–500 mg TID; 2 g single dose (Trich/BV)", iv: "500 mg q6–8h", im: "—", se: "Metallic taste, nausea, peripheral neuropathy (long-term), seizures (high dose), disulfiram-like reaction with alcohol", ci: "Alcohol consumption (disulfiram-like), first trimester pregnancy (relative), concurrent warfarin (increase INR)" }, { name: "Vancomycin (Glycopeptide)", indication: "MRSA, C. difficile colitis (PO), MRSA meningitis (IV+IT), severe Gram+ infections", oral: "125–500 mg QID (only for C. diff – not absorbed)", iv: "15–20 mg/kg q8–12h (target AUC/MIC); monitor troughs", im: "Not recommended", se: "Red man syndrome (infuse >60 min), nephrotoxicity, ototoxicity, thrombophlebitis, neutropenia", ci: "Rapid IV infusion, concurrent nephrotoxins (caution), severe allergy to glycopeptides" }, { name: "Fluconazole (Azole Antifungal)", indication: "Candidiasis (oral, esophageal, vaginal, systemic), Cryptococcal meningitis (consolidation), coccidioidomycosis", oral: "100–400 mg/day (150 mg single dose for vaginal candidiasis)", iv: "Same doses", im: "—", se: "Hepatotoxicity, nausea, headache, QT prolongation, drug interactions (CYP2C9/3A4 inhibitor)", ci: "Concurrent QT-prolonging drugs, pimozide, terfenadine, pregnancy (teratogenic at high doses)" }, { name: "Amphotericin B (Polyene)", indication: "Invasive fungal infections (Aspergillosis, Cryptococcosis, Candida, Mucormycosis)", oral: "—", iv: "Conventional: 0.3–1 mg/kg/day; Liposomal: 3–5 mg/kg/day", im: "—", se: "Nephrotoxicity (dose-limiting), infusion reactions (fever/chills/rigors), hypokalemia, hypomagnesemia, anemia", ci: "Hypersensitivity; use liposomal form for pre-existing renal impairment" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 5: ENDOCRINE SYSTEM // ═══════════════════════════════════════════════════════════════════ sectionHeader("Endocrine System", "⚗️", "0D2A1A"); drugSlide("Endocrine", "Antidiabetics – Oral", [ { name: "Metformin (Biguanide)", indication: "Type 2 DM (first-line), PCOS, pre-diabetes, obesity", oral: "500 mg–2550 mg/day (BID-TID with meals)", iv: "—", im: "—", se: "GI upset (nausea, diarrhea), lactic acidosis (rare, especially renal impairment), B12 deficiency", ci: "eGFR <30 (hold if <45 for contrast), hepatic failure, alcoholism, contrast medium use (hold 48h), heart failure (NYHA III-IV – relative)" }, { name: "Glibenclamide/Glyburide (Sulfonylurea)", indication: "Type 2 DM", oral: "2.5–20 mg/day (BD)", iv: "—", im: "—", se: "Hypoglycemia (prolonged), weight gain, GI upset, SIADH", ci: "T1DM, renal/hepatic impairment (risk of prolonged hypoglycemia), sulfonamide allergy, pregnancy" }, { name: "Sitagliptin (DPP-4 inhibitor)", indication: "Type 2 DM (monotherapy or combination)", oral: "100 mg/day (50 mg if eGFR 30–50; 25 mg if eGFR <30)", iv: "—", im: "—", se: "Nasopharyngitis, UTI, pancreatitis (rare), arthralgia, bullous pemphigoid (rare)", ci: "T1DM, DKA, history of pancreatitis (caution), severe renal impairment (dose reduce)" }, { name: "Empagliflozin (SGLT-2 inhibitor)", indication: "Type 2 DM, CV risk reduction, HFrEF, CKD", oral: "10–25 mg/day", iv: "—", im: "—", se: "Genital mycotic infections, UTI, DKA (euglycemic), polyuria, volume depletion, Fournier's gangrene (rare)", ci: "eGFR <20 (for glycemic), eGFR <45 for most indications, recurrent UTIs, DKA, T1DM" }, ]); drugSlide("Endocrine", "Insulin Types", [ { name: "Insulin Lispro/Aspart (Rapid-acting)", indication: "T1DM, T2DM prandial coverage, DKA (infusion)", oral: "—", iv: "0.05–0.1 units/kg/hr (DKA infusion) – only regular insulin by IV technically but lispro/aspart can be used in pumps", im: "SC: 0.1–0.2 units/kg per meal (inject 0–15 min before meal)", se: "Hypoglycemia (most important), lipodystrophy at injection sites, weight gain", ci: "Hypoglycemia, hypersensitivity" }, { name: "Regular Insulin (Short-acting)", indication: "DKA, hyperkalemia (with dextrose), pre-meal coverage, IV infusions", oral: "—", iv: "0.05–0.1 units/kg/hr infusion (DKA); 10 units with 50% dextrose (hyperkalemia)", im: "SC: 0.5–1 unit/kg/day (T1DM total split)", se: "Hypoglycemia, hypokalemia (DKA protocol), lipodystrophy, weight gain", ci: "Hypoglycemia" }, { name: "NPH Insulin (Intermediate-acting)", indication: "T1DM (basal), T2DM", oral: "—", iv: "—", im: "SC: 0.5–1 unit/kg/day (T1DM basal-bolus regimen)", se: "Hypoglycemia (nocturnal peak), weight gain, lipodystrophy", ci: "Hypoglycemia, hypersensitivity" }, { name: "Insulin Glargine/Detemir (Long-acting)", indication: "T1DM and T2DM basal insulin coverage", oral: "—", iv: "—", im: "SC: 0.2–0.4 units/kg/day once daily (glargine) or BID (detemir)", se: "Hypoglycemia (less nocturnal than NPH), weight gain, injection site reactions", ci: "Hypoglycemia, hypersensitivity; do NOT mix with other insulins (glargine)" }, ]); drugSlide("Endocrine", "Thyroid & Adrenal Drugs", [ { name: "Levothyroxine (T4)", indication: "Hypothyroidism, myxedema coma (IV), thyroid cancer (TSH suppression)", oral: "25–200 mcg/day (titrate by TSH)", iv: "200–500 mcg loading (myxedema coma)", im: "—", se: "Hyperthyroid symptoms if over-replaced (tachycardia, weight loss, anxiety, osteoporosis)", ci: "Uncorrected adrenal insufficiency, thyrotoxicosis, recent MI, allergy" }, { name: "Propylthiouracil (PTU)", indication: "Hyperthyroidism, thyroid storm (preferred in 1st trimester & thyroid storm), Grave's disease", oral: "100–150 mg q8h (maint 50–300 mg/day)", iv: "—", im: "—", se: "Agranulocytosis, hepatotoxicity (black box – fulminant hepatic necrosis), rash, ANCA vasculitis", ci: "Hepatic disease, prior PTU-associated hepatotoxicity; 2nd/3rd trimester pregnancy preferred methimazole" }, { name: "Prednisolone / Prednisone", indication: "Asthma, RA, IBD, nephrotic syndrome, adrenal insufficiency, allergic reactions, autoimmune diseases", oral: "5–60 mg/day (varies by condition)", iv: "—", im: "—", se: "Cushingoid features, hyperglycemia, osteoporosis, HTN, GI ulceration, infection susceptibility, adrenal suppression, cataract, glaucoma, psychosis", ci: "Active untreated infections, live vaccines during high-dose therapy, GI perforation" }, { name: "Hydrocortisone", indication: "Adrenal insufficiency (replacement), severe asthma, septic shock (relative adrenal insuff.)", oral: "20–30 mg/day in divided doses (replacement)", iv: "100–300 mg/day (stress doses); 200 mg/day in septic shock", im: "100 mg IM (acute adrenal crisis)", se: "Same as other glucocorticoids; mineralocorticoid effects (Na retention, hypokalemia) at high doses", ci: "Systemic fungal infections, live vaccines (immunosuppressed doses)" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 6: GASTROINTESTINAL // ═══════════════════════════════════════════════════════════════════ sectionHeader("Gastrointestinal (GI) System", "🫃", "1A0F00"); drugSlide("GI", "Acid Suppression & Prokinetics", [ { name: "Omeprazole (PPI)", indication: "GERD, peptic ulcer, H. pylori (triple therapy), Zollinger-Ellison syndrome, NSAID gastroprotection", oral: "20–40 mg/day (before meal)", iv: "40 mg/day; 80 mg bolus then 8 mg/hr (bleeding ulcer)", im: "—", se: "Headache, diarrhea, hypomagnesemia (long-term), C. diff risk, B12/Fe deficiency, fracture risk (long-term), CYP2C19 drug interactions", ci: "Concurrent clopidogrel (consider alternative PPI), hypersensitivity, concurrent nelfinavir/rilpivirine" }, { name: "Ranitidine / Famotidine (H2RA)", indication: "GERD, peptic ulcer, dyspepsia, stress ulcer prophylaxis (famotidine preferred post-ranitidine withdrawal)", oral: "Famotidine: 20–40 mg BID; Ranitidine discontinued (NDMA contamination)", iv: "Famotidine: 20 mg q12h", im: "Famotidine: 20 mg q12h", se: "Headache, dizziness, constipation; IV ranitidine: bradycardia; gynecomastia (cimetidine)", ci: "Porphyria (cimetidine), severe renal impairment (dose reduce)" }, { name: "Metoclopramide (Prokinetic/Antiemetic)", indication: "GERD, gastroparesis, nausea/vomiting, migraine (adjunct), small bowel intubation", oral: "10 mg TID (before meals)", iv: "10–20 mg slow IV", im: "10–20 mg IM", se: "EPS/tardive dyskinesia (black box – >3 months), drowsiness, hyperprolactinemia, depression", ci: "GI obstruction/perforation, Parkinson's disease, pheochromocytoma, seizure disorder, prolactin-dependent tumor" }, { name: "Ondansetron (5-HT3 antagonist)", indication: "PONV, chemotherapy-induced N&V, radiation-induced N&V, hyperemesis gravidarum", oral: "4–8 mg BID-TID", iv: "4–8 mg slow IV", im: "4–8 mg IM", se: "Headache, constipation, QT prolongation (dose-dependent), serotonin syndrome (rare)", ci: "Congenital long QT, concurrent apomorphine, concurrent QT-prolonging drugs" }, ]); drugSlide("GI", "Laxatives, Antidiarrheals & IBD Drugs", [ { name: "Mesalazine / 5-ASA", indication: "Ulcerative colitis (induction & maintenance), Crohn's (limited efficacy)", oral: "2–4 g/day (varied formulations)", iv: "—", im: "—", se: "GI upset, nephrotoxicity (interstitial nephritis – rare), rash, headache", ci: "Salicylate allergy, severe renal impairment, G6PD deficiency (risk of hemolysis)" }, { name: "Infliximab (Anti-TNF biologic)", indication: "Crohn's disease, UC, RA, AS, psoriasis, psoriatic arthritis, fistulizing Crohn's", oral: "—", iv: "5–10 mg/kg infusion at 0, 2, 6 wks, then q8wks", im: "—", se: "Infection risk (TB reactivation – screen beforehand), infusion reactions, lymphoma, demyelination, worsening HF", ci: "Active infection/sepsis, TB (until treated), HIV, severe HF (NYHA III-IV), malignancy (recent)" }, { name: "Loperamide (Antidiarrheal)", indication: "Acute & chronic diarrhea, IBS-D", oral: "4 mg initial dose, then 2 mg after each loose stool (max 16 mg/day)", iv: "—", im: "—", se: "Constipation, abdominal cramping, toxic megacolon (in IBD/C. diff – contraindicated)", ci: "Bloody diarrhea/dysentery, pseudomembranous colitis, IBD acute flare, children <2 yrs" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 7: ANTICOAGULANTS & ANTIPLATELETS // ═══════════════════════════════════════════════════════════════════ sectionHeader("Anticoagulants & Antiplatelets", "🩸", "2A0505"); drugSlide("Anticoagulants", "Anticoagulants", [ { name: "Heparin (UFH)", indication: "VTE treatment/prophylaxis, ACS, PE, DVT, AF (bridging), DIC, ECMO/dialysis circuit", oral: "—", iv: "80 units/kg bolus then 18 units/kg/hr (therapeutic); monitor APTT 1.5–2.5× normal", im: "Not recommended (hematoma)", se: "HIT (heparin-induced thrombocytopenia – check platelet day 5–10), hemorrhage, osteoporosis (long-term), hypoaldosteronism", ci: "HIT, active bleeding, severe thrombocytopenia, intracranial hemorrhage; antidote: Protamine sulfate" }, { name: "Enoxaparin (LMWH)", indication: "VTE prophylaxis/treatment, ACS (NSTEMI), bridging therapy", oral: "—", iv: "—", im: "Prophylaxis: 40 mg SC OD; Treatment DVT/PE: 1 mg/kg SC q12h", se: "Bleeding, HIT (less than UFH), thrombocytopenia, injection site bruising, hyperkalemia", ci: "Active major bleeding, HIT, eGFR <30 (use UFH or adjust dose), spinal/epidural anesthesia (timing required); antidote: Protamine sulfate (partial)" }, { name: "Warfarin (Vitamin K antagonist)", indication: "AF (stroke prevention), VTE (treatment/secondary prevention), mechanical heart valves, antiphospholipid syndrome", oral: "2–10 mg/day (titrate to INR 2–3; INR 2.5–3.5 for mechanical valves)", iv: "—", im: "—", se: "Hemorrhage (major), skin necrosis (protein C/S deficiency), purple toe syndrome, teratogenicity, drug/food interactions (Vit K)", ci: "Pregnancy, active bleeding, poorly controlled HTN, recent surgery (relative), non-compliant patient; antidote: Vitamin K, FFP, 4-factor PCC" }, { name: "Rivaroxaban (Direct Xa inhibitor)", indication: "AF (stroke prevention), VTE treatment/prophylaxis, post-arthroplasty prophylaxis, ACS adjunct", oral: "10–20 mg OD with food (dose varies by indication)", iv: "—", im: "—", se: "Bleeding, hepatotoxicity (rare), wound complications", ci: "Active major bleeding, severe hepatic impairment (Child-Pugh C), pregnancy, eGFR <15; antidote: Andexanet alfa" }, { name: "Dabigatran (Direct thrombin inhibitor)", indication: "AF (stroke prevention), VTE treatment/prophylaxis", oral: "150 mg BID (110 mg BID if >80 yr or bleeding risk); 220 mg OD (post-surgery prophylaxis)", iv: "—", im: "—", se: "Bleeding, GI upset (dyspepsia), GI bleeding (higher than warfarin)", ci: "Severe renal impairment (eGFR <30), mechanical heart valves, active bleeding, severe hepatic disease; antidote: Idarucizumab" }, ]); drugSlide("Anticoagulants", "Antiplatelet Agents", [ { name: "Aspirin (low-dose antiplatelet)", indication: "ACS secondary prevention, PCI post-stenting (DAPT), stroke (ischemic) prevention, MI prophylaxis", oral: "75–325 mg/day", iv: "—", im: "—", se: "GI bleeding, peptic ulcer, bronchospasm (aspirin-sensitive), Reye's syndrome (children)", ci: "Active peptic ulcer, bleeding disorders, aspirin allergy, children with viral illness" }, { name: "Clopidogrel (P2Y12 inhibitor)", indication: "ACS, post-PCI DAPT (with aspirin), peripheral artery disease, stroke prevention", oral: "75 mg/day (loading: 300–600 mg)", iv: "—", im: "—", se: "Bleeding, thrombotic thrombocytopenic purpura (TTP – rare), GI upset, rash, neutropenia (rare)", ci: "Active bleeding, severe hepatic impairment; avoid with omeprazole/esomeprazole (CYP2C19 interaction)" }, { name: "Ticagrelor (P2Y12 inhibitor)", indication: "ACS (superior to clopidogrel in ACS), post-ACS maintenance", oral: "Loading: 180 mg; Maint: 90 mg BID (for 12 months then 60 mg BID)", iv: "—", im: "—", se: "Dyspnea (bradykinin-related, not bronchospasm), bleeding, bradycardia, headache, hyperuricemia", ci: "Active bleeding, prior intracranial hemorrhage, severe hepatic impairment, concurrent strong CYP3A4 inhibitors, high-dose aspirin (>100 mg/day)" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 8: RENAL & UROLOGY // ═══════════════════════════════════════════════════════════════════ sectionHeader("Renal & Genitourinary", "🫘", "001A2A"); drugSlide("Renal/GU", "Drugs in Renal & Urological Conditions", [ { name: "Tamsulosin (Alpha-1 blocker)", indication: "BPH, ureteric stones (medical expulsive therapy)", oral: "0.4–0.8 mg/day (after meals)", iv: "—", im: "—", se: "Orthostatic hypotension, dizziness, retrograde ejaculation, intraoperative floppy iris syndrome", ci: "Concurrent strong CYP3A4 inhibitors (ketoconazole), severe hepatic impairment, concurrent PDE5 inhibitors (significant hypotension)" }, { name: "Finasteride (5-alpha reductase inhibitor)", indication: "BPH, androgenic alopecia", oral: "5 mg/day (BPH); 1 mg/day (alopecia)", iv: "—", im: "—", se: "Sexual dysfunction (ED, decreased libido, ejaculatory disorder), gynecomastia, teratogenicity (crushed tabs – pregnant women avoid contact)", ci: "Pregnancy/women of childbearing potential, children" }, { name: "Desmopressin (ADH analogue)", indication: "Central DI, nocturia, nocturnal enuresis, von Willebrand disease (type I), hemophilia A (mild)", oral: "0.1–0.4 mg BID-TID; Intranasal: 10–40 mcg/day", iv: "0.3 mcg/kg infusion over 15–30 min (vWD/hemophilia)", im: "0.3 mcg/kg IM (emergency)", se: "Hyponatremia (dilutional), water retention, seizures (from hyponatremia), headache, flushing", ci: "Polydipsia, psychogenic polydipsia, hyponatremia, moderate-severe renal impairment (eGFR<50), vWD type IIB" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 9: CHEMOTHERAPY / ONCOLOGY // ═══════════════════════════════════════════════════════════════════ sectionHeader("Oncology / Chemotherapy", "💊", "0F1A0A"); drugSlide("Oncology", "Key Chemotherapy Agents", [ { name: "Methotrexate (Antimetabolite – DHFR inhibitor)", indication: "Leukemia (ALL), RA, psoriasis, ectopic pregnancy, osteosarcoma, lymphoma", oral: "RA: 7.5–25 mg/week; Psoriasis: 10–25 mg/week", iv: "High-dose: 1–12 g/m² (with leucovorin rescue)", im: "15–30 mg/week (RA/psoriasis)", se: "Hepatotoxicity, pulmonary toxicity (pneumonitis), bone marrow suppression, mucositis, teratogenicity, renal toxicity (HD-MTX), folate deficiency", ci: "Pregnancy, breastfeeding, significant renal/hepatic impairment, immunodeficiency, active infection, pleural effusion/ascites (high-dose)" }, { name: "Cyclophosphamide (Alkylating agent)", indication: "Lymphoma, leukemia, multiple myeloma, solid tumors, SLE nephritis, vasculitis, RA (severe)", oral: "1–5 mg/kg/day", iv: "600–1000 mg/m² q3–4wks (pulsed)", im: "—", se: "Hemorrhagic cystitis (MESNA prevents), bone marrow suppression, alopecia, SIADH, infertility, secondary malignancy (bladder cancer)", ci: "Pregnancy, severe bone marrow suppression, urinary tract obstruction; always co-administer MESNA" }, { name: "Doxorubicin (Anthracycline)", indication: "Breast cancer, leukemia, lymphoma, sarcoma, multiple myeloma, thyroid cancer", oral: "—", iv: "60–75 mg/m² q3wks (cumulative lifetime max ~500 mg/m²)", im: "—", se: "Cardiotoxicity (dilated CMP – dose-dependent, irreversible), alopecia, mucositis, bone marrow suppression, hand-foot syndrome (pegylated liposomal), red/orange urine", ci: "Severe cardiac impairment (LVEF<40%), cumulative dose exceeded, severe hepatic dysfunction, prior mediastinal radiation to heart" }, { name: "Cisplatin (Platinum compound)", indication: "Testicular, ovarian, lung, bladder, head & neck cancers, cervical cancer", oral: "—", iv: "50–100 mg/m² per cycle (with aggressive pre-hydration)", im: "—", se: "Nephrotoxicity (dose-limiting – hydrate aggressively), peripheral neuropathy, ototoxicity (high-frequency hearing loss), severe nausea/vomiting, myelosuppression, hypomagnesemia, hypokalemia", ci: "Pre-existing renal impairment, pre-existing neuropathy, hearing impairment, pregnancy, bone marrow failure" }, ]); // ═══════════════════════════════════════════════════════════════════ // SECTION 10: MUSCULOSKELETAL // ═══════════════════════════════════════════════════════════════════ sectionHeader("Musculoskeletal System", "🦴", "1A0A0A"); drugSlide("Musculoskeletal", "DMARDs, Gout & Bone Drugs", [ { name: "Allopurinol (Xanthine oxidase inhibitor)", indication: "Gout (chronic prophylaxis), hyperuricemia (tumor lysis syndrome)", oral: "100–800 mg/day (start low, titrate)", iv: "200–400 mg/m²/day (TLS)", im: "—", se: "SJS/TEN (especially HLA-B*5801 – Asian populations), rash, hepatotoxicity, bone marrow suppression, GI upset", ci: "Acute gout attack (don't initiate during), concurrent azathioprine (toxic accumulation – reduce AZA dose by 75%), HLA-B*5801 in Asians" }, { name: "Colchicine (Alkaloid)", indication: "Acute gout attack, gout prophylaxis, pericarditis, FMF", oral: "1.2 mg then 0.6 mg 1 hr later (acute gout); 0.5–1 mg/day (prophylaxis)", iv: "Not recommended (severe toxicity)", im: "—", se: "GI toxicity (diarrhea, nausea, vomiting – dose-limiting), bone marrow suppression (overdose), myopathy, neuropathy", ci: "Severe renal impairment (GFR<30), severe hepatic impairment, concurrent strong CYP3A4 inhibitors (clarithromycin, ritonavir) – life-threatening toxicity" }, { name: "Alendronate (Bisphosphonate)", indication: "Osteoporosis (postmenopausal, glucocorticoid-induced), Paget's disease, bone metastases (zoledronate)", oral: "70 mg once weekly (osteoporosis prevention/treatment); take fasted with full glass of water, remain upright 30 min", iv: "—", im: "—", se: "Esophagitis/esophageal ulceration, GI upset, osteonecrosis of jaw (ONJ), atypical femur fracture (long-term), hypocalcemia, atrial fibrillation (IV)", ci: "Esophageal abnormalities (stricture, achalasia), inability to remain upright 30 min, hypocalcemia, severe renal impairment (GFR<35)" }, { name: "Hydroxychloroquine (DMARD/Antimalarial)", indication: "RA, SLE, malaria treatment/prophylaxis, Sjögren's syndrome", oral: "200–400 mg/day (≤5 mg/kg actual body weight/day)", iv: "—", im: "—", se: "Retinopathy (dose/duration-dependent – annual eye exam after 5 yrs), cardiomyopathy, QT prolongation, GI upset, rash, hypoglycemia", ci: "Pre-existing retinopathy, G6PD deficiency (risk of hemolysis), porphyria, QT prolongation" }, ]); // ═══════════════════════════════════════════════════════════════════ // CLOSING / SUMMARY SLIDE // ═══════════════════════════════════════════════════════════════════ const sl = pres.addSlide(); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.darkbg } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.06, fill: { color: C.gold } }); sl.addShape(pres.ShapeType.rect, { x: 0, y: 7.44, w: "100%", h: 0.06, fill: { color: C.gold } }); sl.addText("Systems Covered in This Reference", { x: 0.5, y: 0.5, w: 12.3, h: 0.8, fontSize: 26, bold: true, color: C.gold, align: "center" }); const systems = [ ["❤️ Cardiovascular", "ACE-I, ARBs, Beta-blockers, CCBs, Diuretics, Antiarrhythmics, Nitrates, Statins"], ["🫁 Respiratory", "SABAs, LABAs, SAMAs, LAMAs, Theophylline, ICS, Montelukast"], ["🧠 CNS / Neurological", "Opioids, NSAIDs, Paracetamol, AEDs, Antidepressants (SSRI/SNRI/TCA), Antipsychotics, Benzodiazepines"], ["🦠 Antimicrobials", "Penicillins, Cephalosporins, Macrolides, Fluoroquinolones, Tetracyclines, Metronidazole, Vancomycin, Antifungals"], ["⚗️ Endocrine", "Oral antidiabetics (Metformin/SU/DPP4/SGLT2), Insulin types, Thyroid drugs, Corticosteroids"], ["🫃 Gastrointestinal", "PPIs, H2RAs, Prokinetics, Antiemetics, 5-ASA, Anti-TNF biologics, Loperamide"], ["🩸 Anticoagulants / Antiplatelets", "UFH, LMWH, Warfarin, DOACs (Rivaroxaban/Dabigatran), Aspirin, Clopidogrel, Ticagrelor"], ["🫘 Renal / GU", "Alpha-blockers, 5-ARIs, Desmopressin"], ["💊 Oncology", "MTX, Cyclophosphamide, Doxorubicin, Cisplatin"], ["🦴 Musculoskeletal", "Allopurinol, Colchicine, Bisphosphonates, Hydroxychloroquine"], ]; const cols = 2, rows = 5, cw = 6.3, ch = 1.1; systems.forEach(([title, drugs], i) => { const col = i % cols; const row = Math.floor(i / cols); const x = 0.3 + col * (cw + 0.4); const y = 1.5 + row * (ch + 0.1); sl.addShape(pres.ShapeType.rect, { x, y, w: cw, h: ch, fill: { color: "1A2A3A" }, line: { color: C.teal, width: 1.0 } }); sl.addText([ { text: title + "\n", options: { bold: true, fontSize: 12, color: C.gold, breakLine: false } }, { text: drugs, options: { fontSize: 9, color: C.lgray } } ], { x: x + 0.1, y: y + 0.05, w: cw - 0.2, h: ch - 0.1, valign: "top" }); }); sl.addText("For clinical use, always verify doses against local formulary and patient-specific factors.", { x: 0.5, y: 7.1, w: 12.3, h: 0.3, fontSize: 10, color: C.lgray, align: "center", italic: true }); // WRITE FILE pres.writeFile({ fileName: "/home/daytona/workspace/pharmacology-reference/SystemWise_Pharmacology_Reference.pptx" }) .then(() => console.log("✅ PPTX written successfully")) .catch(e => console.error("❌ Error:", e));