Title: Bone Wizardry / Mnemonics / Pharmacology
Tags: bw-mnemonics pharma
On every note of this deck, unless a note says otherwise:
System: pharma

Acronym: GNATS
Title: Aminoglycosides
Emoji: 💉
Path: ? G
. Gentamycin
? N
. Neomycin
? A
. Amikacin
? T
. Tobramycin
? S
. Streptomycin
? Note
. Block 30S initiation factor-2
? Note
. Nephrotoxic + ototoxic
? Note
. Severe Gram(-) coverage

Acronym: Buy AT 30, CCELL at 50
Title: Ribosomal Subunit Targets
Emoji: 🎯
Path: ? A
. Aminoglycosides (30S)
? T
. Tetracyclines (30S)
? C
. Chloramphenicol (50S)
? C
. Clindamycin (50S)
? E
. Erythromycin (50S)
? L
. Lincomycin (50S)
? L
. Linezolid (50S)
? Note
. 30S = bactericidal
? Note
. 50S = mostly bacteriostatic
? Note
. Chloramphenicol = gray baby syndrome

Acronym: CT MAP
Title: Anti-Pseudomonal Penicillins
Emoji: 🦠
Path: ? C
. Carbenicillin
? T
. Ticarcillin
? M
. Mezlocillin
? A
. Azlocillin
? P
. Piperacillin
? Note
. Extended-spectrum PCNs
? Note
. Pip/Tazo = most common today
? Note
. Always cover Pseudomonas with 2 abx

Acronym: SWEPT-D
Title: P450-Dependent Drugs
Emoji: ⚗️
Path: ? S
. Statins
? W
. Warfarin
? E
. Estrogen (OCPs)
? P
. Phenytoin
? T
. Theophylline
? D
. Digoxin
? Note
. Rifampin = P450 INDUCER (speeds up)
? Note
. Ketoconazole = P450 INHIBITOR
? Note
. Drug interactions on boards

Acronym: RIPE
Title: TB Treatment
Emoji: 🫁
Path: ? R
. Rifampin (red secretions, P450 inducer)
? I
. INH (neuropathy, give B6)
? P
. Pyrazinamide (no pregnancy!)
? E
. Ethambutol (optic neuritis)
? Note
. 4 drugs x 2 months for everyone
? Note
. Then R + I x 4 more months
? Note
. INH alone for prophylaxis (+ B6)

Acronym: Zero-Order Drugs: Alcohol, Aspirin, Phenytoin
Title: Saturate enzymes quickly
Emoji: 0
Path: ? Alcohol
. 🍷 Alcohol dehydrogenase saturates: constant amount/hour
? Aspirin
. 💊 At high doses, conjugation enzymes saturate
? Phenytoin
. ⚡ CYP2C9 saturates at therapeutic doses: tiny dose change = toxicity
? Note
. Zero-order = constant AMOUNT per time (not fraction)
? Note
. First-order = constant FRACTION per time (most drugs)
? Note
. Phenytoin: very narrow therapeutic index

Acronym: COX Locations: COX-1=GI, COX-1+2=Joints, COX-2=Vascular
Title: Cyclooxygenase tissue distribution
Emoji: 💊
Path: ? COX-1
. 🛡️ GI tract: protects gastric mucosa (constitutive)
? COX-1+2
. 🦵 Joints: inflammation and pain signaling
? COX-2
. 🫀 Vascular endothelium: inducible, inflammation
? Samter Triad
. 👃 Asthma + aspirin sensitivity + nasal polyps (COX block → leukotrienes)
? Note
. COX-1 inhibition = GI ulcers/bleeding
? Note
. COX-2 selective (celecoxib) spares GI but increases CV risk
? Note
. Aspirin-exacerbated respiratory disease: shunted to LOX pathway

Acronym: Disulfiram-like Reaction: Metronidazole, Cefotetan, Cefamandole, Chlorpropamide
Title: Drugs causing alcohol intolerance
Emoji: 🤮
Path: ? Metronidazole
. 🦠 Antibiotic/antiprotozoal: blocks aldehyde DH
? Cefotetan
. 💊 2nd-gen ceph with MTT side chain
? Cefamandole
. 💊 2nd-gen ceph with MTT side chain
? Chlorpropamide
. 🍬 1st-gen sulfonylurea
? Note
. Acetaldehyde accumulates → flushing, nausea, vomiting
? Note
. MTT side chain also inhibits vitamin K (bleeding risk)
? Note
. Always warn patients to avoid alcohol

Acronym: Beta-1 Selective = A through M (not L,C); Nonselective = N through Z (+ L,C)
Title: Beta Blocker Classification
Emoji: 💊
Path: ? A-M selective
. ❤️ Atenolol, Bisoprolol, Esmolol, Metoprolol (cardioselective)
? N-Z nonselective
. 🫁 Nadolol, Propranolol, Timolol (both B1+B2)
? Exceptions
. ⚠️ Labetalol + Carvedilol = alpha+beta (nonselective despite A-M)
? Note
. B1-selective safer in asthma/COPD
? Note
. Selectivity lost at high doses
? Note
. Labetalol: pregnancy HTN. Carvedilol: heart failure

Acronym: 6 T's of Tetracycline Side Effects
Title: Complete Tetracycline Toxicity
Emoji: 💊
Path: ? T . ☀️ Too much light (photosensitivity) ? T . 🤮 Tummy ache (GI upset, pill esophagitis) ? T . 🦴 Tightly binds Ca (contraindicated kids<8, pregnancy) ? T . 🦷 Teeth grey (permanent discoloration) ? T . ⚙ Turns on P450 (drug interactions) ? T . ⚠️ Too old = Fanconi syndrome (expired tetracycline) ? Note . NEVER in pregnant or children < 8 ? Note . Doxycycline: can take with dairy, less photosensitive ? Note . All tetracyclines bind 30S ribosomal subunit

Acronym: Anaerobic Coverage: Above=Clindamycin, Below=Metronidazole, Anywhere=Cefoxitin
Title: Anatomic Antibiotic Selection
Emoji: 🗺️
Path: ? Above
. 🫁 Clindamycin: oral/pulmonary anaerobes (aspiration PNA)
? Below
. 🫃 Metronidazole: GI/pelvic anaerobes (B. fragilis, C. diff)
? Anywhere
. 💪 Cefoxitin (2nd gen ceph): broad anaerobic coverage
? Note
. Clindamycin risk: C. difficile colitis (ironic)
? Note
. Metronidazole also treats: Giardia, Trichomonas
? Note
. Metronidazole + alcohol = disulfiram reaction

Acronym: Ox-Clox-Diclox + Nafcillin ("Na" = High Sodium)
Title: Anti-Staphylococcal Penicillins
Emoji: 💊
Path: ? Oxacillin
. 🛡️ Penicillinase-resistant: treats MSSA
? Cloxacillin
. 🛡️ Same class, resists beta-lactamase
? Dicloxacillin
. 💊 Oral for outpatient MSSA skin infections
? Nafcillin
. 🧂 "Na" = highest sodium load: watch CHF/renal
? Note
. These treat MSSA only, NOT MRSA
? Note
. MRSA requires vancomycin/linezolid/daptomycin
? Note
. Methicillin withdrawn (nephritis): replaced by nafcillin/oxacillin

Acronym: Staph = 1 Drug, Pseudomonas = 2 Drugs; >48hrs = Add Antifungal
Title: Empiric Coverage Rules
Emoji: 🦠
Path: ? Staph
. 💊 Single anti-staph agent sufficient
? Pseudomonas
. 💊💊 Always double-cover (prevents resistance)
? Who needs it
. 🔥 Neutropenics, burns, CF, diabetic foot
? 48-hour rule
. ⏰ No improvement after 48hrs → add antifungal
? Note
. Anti-pseudomonal: pip-tazo, cefepime, meropenem, cipro
? Note
. Double-coverage prevents resistance emergence
? Note
. Start empiric anti-pseudomonal immediately in neutropenic fever

Acronym: INH = Injures Nerves and Hepatocytes
Title: Isoniazid Side Effects
Emoji: ⚠️
Path: ? I
. 🧠 Injures NERVES: peripheral neuropathy (depletes B6)
? N
. 💊 Neuropathy PREVENTED by B6 supplementation
? H
. 🫁 Hepatotoxicity: monitor LFTs, worse in elderly/alcoholics
? P450
. 🚫 Inhibits P450 (increases phenytoin, warfarin levels)
? Note
. Best drug for TB prophylaxis (latent TB)
? Note
. Slow acetylators: more neuropathy and hepatitis
? Note
. Also causes drug-induced lupus (anti-histone Ab)

Acronym: Rifampin "R" = Red-Orange Secretions + Revs Up P450
Title: Rifampin Side Effects
Emoji: 🔴
Path: ? Red
. 🔴 Red-orange urine, tears, sweat (not harmful)
? Revs P450
. ⚡ Potent CYP450 INDUCER: reduces OCPs, warfarin, HIV meds
? Note
. Women on OCPs need backup contraception
? Note
. Mechanism: binds DNA-dependent RNA polymerase
? Note
. Most potent CYP450 inducer of all antibiotics

Acronym: Drug-Induced Hemolytic Anemia: PCN, Cephalosporins, Sulfa, Methyldopa, PTU, Antimalarials, Dapsone
Title: Medications Causing Hemolysis
Emoji: 💊
Path: ? Penicillins
. 💊 Hapten mechanism: drug on RBC → antibody targets complex
? Sulfonamides
. ⚡ Immune complex (innocent bystander)
? Methyldopa
. 🩸 True autoantibody mechanism (warm AIHA)
? Antimalarials
. 🦟 Oxidative hemolysis (especially in G6PD)
? Dapsone
. 💊 Methemoglobinemia + dose-dependent hemolysis
? Note
. Direct Coombs positive
? Note
. Methyldopa: classic drug-induced warm AIHA
? Note
. G6PD patients: avoid sulfa, antimalarials, fava beans

Acronym: PCN Allergy: Rash = Safe to Use Cephalosporins; Anaphylaxis = Do NOT
Title: Penicillin Cross-Reactivity
Emoji: ⚠️
Path: ? Rash only
. ✅ Safe to use cephalosporins and carbapenems (~2% cross-react)
? Anaphylaxis
. 🚫 Do NOT use carbapenems (imipenem ~50% cross-react)
? Alternative
. 💊 Aztreonam (monobactam): ZERO cross-reactivity
? Note
. Most "PCN allergies" are NOT true IgE-mediated (only ~10%)
? Note
. Cross-reactivity from shared R-group side chains
? Note
. Aztreonam: only covers gram-negatives

Acronym: Penicillin Classes by Coverage
Title: 4 tiers of penicillin coverage
Emoji: 💊
Path: ? Simple (Pen V, Pen G): gram positives + simple anaerobes
. 🟢 basic coverage
? Extended (Amoxicillin, Ampicillin): adds simple gram negatives + staph
. 🟡 pediatric workhorse
? Beta-lactamase resistant (Nafcillin, Methicillin, Oxacillin, Cloxacillin, Dicloxacillin): staph aureus
. 🟠 anti-staph
? Anti-pseudomonal (Azlocillin, Mezlocillin, Carbenicillin, Piperacillin, Ticarcillin): pseudomonas
. 🔴 broadest penicillin

Acronym: Cephalosporin Generation Selection Rule
Title: Which generation for which infection pattern
Emoji: 💊
Path: ? 1st gen: mostly gram-positive infections
. 🟢 cefazolin, cephalexin
? 2nd gen: mixed gram-positive AND gram-negative
. 🟡 cefuroxime, cefoxitin
? 3rd gen: mostly gram-negative infections
. 🟠 ceftriaxone (CSF penetration), ceftazidime (pseudomonas)
? 4th gen: not much above 3rd gen
. 🔴 cefepime
? 5th gen: MRSA and C. diff coverage
. ⚫ ceftaroline

Acronym: Antifungal Drug Classes by MOA
Title: 4 mechanisms of antifungal action
Emoji: 💊
Path: ? Bind ergosterol: Amphotericin B, Nystatin, Miconazole, Clotrimazole, Tolnaftate, Terbinafine
. 🔗 direct membrane binding
? Antimetabolite: Flucytosine (5FC)
. 🧬 disrupts nucleic acid synthesis
? Inhibit ergosterol synthesis: Fluconazole, Itraconazole, Ketoconazole, Voriconazole
. 🚫 block synthesis pathway
? Inhibit microtubules: Griseofulvin
. 🧵 disrupts cell division

Acronym: NSAID Specific Properties
Title: Which NSAID for what
Emoji: 💊
Path: ? Indomethacin
. 💪 Most potent; treats gout; closes PDA
? Phenylbutazone
. 💪 Second in potency
? Ibuprofen
. 🏪 MC over the counter
? Naproxen
. 🩸 Best for dysmenorrhea; high sodium load
? Ketorolac
. 💊 Morphine-strength analgesic

Acronym: 5 Anti-Inflammatory Actions of Steroids
Title: How steroids reduce inflammation
Emoji: 💊
Path: ? Kill T-cells and eosinophils
. ⬇️ Decrease immune system
? Inhibit PLP-A
. 🚫 Cannot make arachidonic acid
? Inhibit macrophage migration
. 🚫 Cannot process antigens
? Stabilize mast cells
. 🚫 Cannot degranulate
? Stabilize endothelium
. 🚫 Macrophages cannot enter tissues

Acronym: 6 Drugs Causing Disulfiram-Like Reaction
Title: Avoid with alcohol
Emoji: 💊
Path: ? Metronidazole
. 💊 Antibiotic
? Cefotetan
. 💊 Cephalosporin
? Cefamandole
. 💊 Cephalosporin
? Etoperidone
. 💊 Antidepressant
? Moxalactam
. 💊 Cephalosporin
? Chlorpropamide
. 💊 Sulfonylurea

Acronym: 4 Chemotherapy Rescue Drugs
Title: Prevent specific toxicities
Emoji: 💊
Path: ? Mesna
. 🛡️ Prevents cyclophosphamide hemorrhagic cystitis
? Dexrazoxane
. 🛡️ Prevents doxorubicin cardiotoxicity
? Amifostine
. 🛡️ Prevents cisplatin nephrotoxicity
? Leucovorin
. 🛡️ Reverses methotrexate myelosuppression

Acronym: PDE Inhibitors
Title: Phosphodiesterase inhibitor drugs
Emoji: 💊
Path: ? Caffeine
. ☕ Inhibits cAMP breakdown
? Theophylline
. 🫁 Inhibits cAMP breakdown
? Sildenafil
. 💊 Inhibits cGMP breakdown (PDE-5)
? Vardenafil
. 💊 Inhibits cGMP breakdown (PDE-5)
? Tadalafil
. 💊 Inhibits cGMP breakdown (PDE-5)

Acronym: TNF Blockers
Title: Drugs that block tumor necrosis factor
Emoji: 💊
Path: ? Etanercept: blocks TNF from binding receptor
. 🛡️ receptor decoy
? Infliximab: antibody against TNF
. 💉 monoclonal antibody
? Adalimumab: antibody against TNF
. 💉 fully human monoclonal
? Golimumab: antibody against TNF
. 💉 monthly injection
? Certolizumab: antibody against TNF
. 💉 pegylated Fab fragment

Acronym: Steroid Drugs and Their Clinical Roles
Title: Which steroid for which route/indication
Emoji: 💊
Path: ? Prednisone: main oral form
. 💊 PO workhorse
? Hydrocortisone: main topical and injectable, replaces aldosterone in adult adrenal insufficiency
. 🧴 versatile
? Methylprednisolone: main IV form
. 💉 acute flares
? Triamcinolone: main inhaled form
. 🫁 inhaler steroid
? Fluticasone/Mometasone: nasal allergy
. 👃 intranasal
? Fludrocortisone: mineralocorticoid for pediatric adrenal insufficiency
. 👶 replaces aldosterone in kids
? Dexamethasone: best CNS penetration, increases surfactant in preemies
. 🧠 crosses placenta fastest
? Danazol: most androgenic, treats endometriosis
. ⚡ causes endometrial atrophy
? Cyproterone: blocks DHT receptors for prostate cancer
. 🛡️ anti-androgen
? Megestrol: increases appetite in cancer patients
. 🍽️ appetite stimulant