Document Text Contents
Page 1
Sympathetic
General•
One lane road- vasoconstric1on•
Two lane road- vasodila1on•
Alpha-1 and 2, Beta-1 and 2•
QISS respec1vely○
Alpha-1 (one alpha candle)•
IP3-DAG- increased intracellular Ca lead to vasoconstric1on increasing BP and resistance (map with arrow)•
venoconstric1on leading to increased venous return, good for shock○
mydriasis (binoculars)•
urethral sphincter and prosta1c muscle constric1on (drawstrings on shorts)•
urinary reten1on○
Phenylephrine (guys wearing flannel)•
treats nasal conges1on because of nasal vasoconstric1on○
mydriasis○
vaso/venoconstric1on- increased SVR, diastolic pressure, systolic pressure○
used in shock to increase blood flow and return○
reflex bradycardia○
Norepinephrine (alpha>beta 1)•
some beta-1 ac1vity (bugle)○
vasoconstric1on, increased SVR○
reflex bradycardia○
used in shock○
Alpha-2 (two alpha candles)•
sympatholy1cs- decrease vascular tone leading to vaso/venodila1on•
decreased cAMP (broken tent)•
inhibi1on of neurotransmiSer release (broken extension cord)•
decreased insulin release (rolled up mat)•
decreased lipolysis (pig with doused fire)•
decreased aqueous humor produc1on (water coming out of hat)•
Brimonidine (brim of the hat)•
used in open angle glaucoma○
Beta-1 (bugle)•
increased cAMP leads to increased intracellular Ca, increasing contrac1lity•
Beta-1 found on cardiac myocytes, SA and AV node•
increased heart rate, contrac1lity and output○
increases renin release•
Dobutamine (beta-1>beta-2)•
increased HR○
increased contrac1lity, increased output (heart flashlight)○
increased systolic pressure○
some beta-2 ac1vity (girl with tuba)○
vasodila1on§
decreased diastolic pressure (makes a bicep shape with systolic pressure on pressure tracing)§
good for acute HF and cardiogenic shock○
good for cardiac stress test○
Sympathomime1cs
Page 2
increased HR and contrac1lity (le^ girl in tent)○
vasodila1on, decreased diastolic and decreased SVR (right girl in tent)○
Beta-2 (tuba)•
relaxa1on of smooth muscles, vasodila1on, decreased diastolic BP, decreased SVR•
bronchodila1on (taking a deep breath)•
increased lipolysis (pig on fire)•
increased gluconeogenesis (marshmallows from liver bag)•
increased insulin release (welcome mat)•
hypokalemia due to increased insulin (bananas on floor)•
increased aqueous humor produc1on (girl filling balloon)•
Isoproterenol (beta-1=beta-2)•
increased HR and contrac1lity (le^ girl in tent)○
vasodila1on, decreased diastolic and decreased SVR (right girl in tent)○
Terbutaline + Ritodrine•
relaxes smooth muscles of uterus blocking birth○
Albuterol, Formoterol, Salmeterol•
bronchodila1on○
used for asthma and COPD○
Epinephrine (beta>alpha)•
dose dependent•
low doses give beta effects○
high doses give alpha effects○
bronchodila1on (beta-2 effect)•
vasodila1on (beta-2 effect)•
decreased diastolic pressure (beta-2 effect)•
elevated HR and increased contrac1lity (beta-1 effect)•
increased BP, increased SVR, vasoconstric1on (alpha-1)•
used for anaphylac1c shock•
Isoproterenol (beta-1=beta-2)
Page 44
Omalizumab (limosine)
monocloncal an1body directed against Fc por1on of IgE•
blocks IgE-mediated mast cell ac1va1on/degranula1on (guy grabbing gun)•
used as adjunc1ve therapy for moderate or severe persistent asthma•
used in pts with allergic sensi1za1on •
used in pts with resistance to steroids and beta agonists•
Chromolyn Sodium (lynn's bee control)
inhibits mast cell degranula1on (seda1ng bee spray)•
Acute Severe Asthma Exacerba1on (flying band guy)
inhaled short ac1ng beta-2 agonist•
IV or oral systemic glucocor1coids•
ipratropium bromide (blue caterpillar)•
epinephrine ("epic!" sign)•
Page 45
GI
General•
the nucleus tractus solitarius located in the medulla receives inputs from the GI tract, ves1bular system, and area
postrema (NTS track)
•
the stomach directly communicates with the NTS via vagus nerve s1mula1on (Vegas sign at stomach area)•
GI irrita1on from infec1on, chemo, or disten1on leads to mucosal serotonin release (smiley face ball)•
serotonin ac1vates 5HT-3 receptors on vagus nerve (1-2-3 sign)○
the ves1bular system communicates to NTS directly via CN 8 (semicircular canal sign)•
the ves1bular system is responsible for ver1go and mo1on sickness○
area postrema is the chemoreceptor trigger zone adjacent to the NTS and reacts to chemo agents (extreme
posture guy next to track)
•
contains D2 receptors (D-ring ropes)○
contains neurokinin 1 receptors (plaNK1) which is bound by substance P (pee sign)○
antagonized by Aprepitant§
Odansetron (dancing woman)
blocks 5HT-3 receptor on vagus nerve in GI tract (blocking the hammer toss)•
treats chemo-induced or post-op vomi1ng•
side effects•
cons1pa1on (smiley face 1ghtening the runners gut)•
headache and dizziness (smiley face hisng runners head)•
prolong QT interval leading to torsades (twisted torsades ribbon)•
serotonin syndrome- rigidity, tremor, hyperthermia, confusion (pile of smiley faces)•
especially with concomitant SSRI therapy○
Histamine Blockers (bee swaSer)
the ves1bular system contains H1 receptors (dandelions next to river)•
1st gen H1 blockers treat mo1on/sea sickness•
side effects•
significant seda1on•
an1muscarinic proper1es (remember tea party) due to M1 antagonism (M1 parking spot)•
Metoclopramide (1ckling guy)
antagonizes D2 receptors in the area postrema (1ckling D2 guy)•
treats chemo-induced vomi1ng•
has upper GI prokine1c effects. Useful in trea1ng delayed gastric emptying from post-op disorders (guy landing on
stomach)
•
side effects•
contraindicated in small bowel obstruc1on (do not obstruct sign)•
diarrhea (brown puddle)•
drowsiness (sleeping judge)•
depression (crying coach)•
extra pyramidal effects like dystonia, akathisia, parkinsonian features (newspaper hat)•
tardive dyskinesia in chronic use (tongue s1cking out)•
neurolep1c malignant syndrome- fever, rigidity, mental status change (NMS on chicken)•
elevated prolac1n levels (squir1ng milk)•
QT prolonga1on leading to torsades (torsades streamer)•
An1eme1cs
Page 87
Kinase Inhibitors
-nib suffix (broken nib of pen)•
Tyrosine Kinase Inhibitors
-1nib suffix (inhibited 1re swing tree)•
Ima1nib (imita1ng pain1ng guy)•
treats hematologic and solid malignancies (cracked crab bell)•
treats CML (colorful packaging peanuts)•
transloca1on of chromosome 9 to 22 ("922 Philadelphia" s1cker on box)○
inhibitor of BCR-ABL protein ("breakable" s1cker on box)•
blocks c-kit tyrosin kinase in GI stromal tumors (congress kit box, guy with fat belly and cancer crab buSons)•
side effects•
fluid reten1on with ankle and periorbital edema (baggy pantaloons on imita1ng guy)○
Erlo1nib (bri1sh Earl of Tinib in window)•
inhibitor of EGFR tyrosine kinase ("Geoffry" on hat)•
treats non-small cell lung cancer (cancer crab badge on lung-shaped lapel)•
side effects•
papulopustular acneiform rash (spoSy rash)○
diarrhea (mud on pants)○
Suni1b and Sorafenib (rising sun and soaring eagle)•
inhibitor of VEGF receptor tyrosine kinase (man inhibi1ng vegetable growth outside)•
treat renal cell carcinoma (bilateral crab buckles)•
side effects•
hyperkeratosis and skin rash (callused and sunburned vegetable guy)○
increased risk of hemorrhage (bleeding wound)○
Vemurafenib (snake venom in drawing)•
inhibitor of BRAF kinase ("B. Fra" signature)•
treats V600E BRAF posi1ve malignant melanoma (ink stains on jacket)•
FA: VEmuRAF-enib is for V600E-mutated BRAF inhibi1on○
The -nibs, Kinase Inhibitors
Page 88
The -mabs
-mab will always be a monoclonal an1body•
monoclonal means all cells are from the same cell line and target the exact same an1gen•
Rituximab (corona1on ritual)•
chimeric, IgG monoclonal an1body (chimera sigil)•
targets B cells by binding CD20 (archer with 2 X's to symbolize 20)•
treats CLL, non-hodgkin lymphoma (worn out T and B cell tapestry)•
treats rheumatoid arthri1s (bone lantern)•
useful for immunosuppressive therapy in microscopic polyangii1s and wegner's granulomatosis (torn an1body
lantern)
•
side effects•
immunosuppression with increased risk of infec1on (immunocompromised cane○
higher risk of progressive mul1focal leukoencephalopathy (white laurel leaves)○
infusion reac1on- headache, fever, dyspnea, pruri1s, hypotension (fat red angel with ivy)○
serum sickness within 7-10 days (red face and dropped drink)○
Cetuximab (elephant tusks)•
chimeric, IgG monoclonal an1body •
targets EGFR (giraffe on blanket)•
tyrosine kinase receptor (1re swing)○
treats solid tumors (cracked cancer crab)•
side effects•
papulopustular acneiform rash (red spots on giraffes)○
infusion reac1on- headache, fever, dyspnea, pruri1s, hypotension (fat red angel with ivy)○
serum sickness within 7-10 days (red trunk and drink)○
Bevacizumab (beverage lady)•
IgG monoclonal an1body•
inhibi1on of VEGF (chopped up veggies on table) especially in vascular endothelial cells to inhibit growth of blood
vessels in tumors (chopped red veggies)
•
treats metasta1c cancers (cracked cancer crab)•
treats wet macular degenera1on (wet spot on re1na pillow)•
side effects•
can cause bleeding (bloody aprons)○
increased risk of clots (ice clot in pitcher)○
GI perfora1on (perforated veggies in GI-like sac under table)○
Alemtuzumab (guy with "alms" dish)•
IgG monoclonal an1body•
binds to CD52 on B and T cells to deplete them (pulling on archer and knight, "52" design etched into sword)•
treats CLL (worn out T and B cell tapestry)•
side effects•
myelosuppression ○
Trastuzumab (tapestry weaver)•
monoclonal an1body against HER2 (2 babies) "Tras2zumab for HER2"•
a tyrosine kinase receptor (1re swing)○
used in pts with HER2 posi1ve tumors •
breast (cancer crab bra) and gastric cancers○
side effects•
cardiotoxicity○
decreased le^ ventricular ejec1on frac1on§
heart failure§
The -mabs
Sympathetic
General•
One lane road- vasoconstric1on•
Two lane road- vasodila1on•
Alpha-1 and 2, Beta-1 and 2•
QISS respec1vely○
Alpha-1 (one alpha candle)•
IP3-DAG- increased intracellular Ca lead to vasoconstric1on increasing BP and resistance (map with arrow)•
venoconstric1on leading to increased venous return, good for shock○
mydriasis (binoculars)•
urethral sphincter and prosta1c muscle constric1on (drawstrings on shorts)•
urinary reten1on○
Phenylephrine (guys wearing flannel)•
treats nasal conges1on because of nasal vasoconstric1on○
mydriasis○
vaso/venoconstric1on- increased SVR, diastolic pressure, systolic pressure○
used in shock to increase blood flow and return○
reflex bradycardia○
Norepinephrine (alpha>beta 1)•
some beta-1 ac1vity (bugle)○
vasoconstric1on, increased SVR○
reflex bradycardia○
used in shock○
Alpha-2 (two alpha candles)•
sympatholy1cs- decrease vascular tone leading to vaso/venodila1on•
decreased cAMP (broken tent)•
inhibi1on of neurotransmiSer release (broken extension cord)•
decreased insulin release (rolled up mat)•
decreased lipolysis (pig with doused fire)•
decreased aqueous humor produc1on (water coming out of hat)•
Brimonidine (brim of the hat)•
used in open angle glaucoma○
Beta-1 (bugle)•
increased cAMP leads to increased intracellular Ca, increasing contrac1lity•
Beta-1 found on cardiac myocytes, SA and AV node•
increased heart rate, contrac1lity and output○
increases renin release•
Dobutamine (beta-1>beta-2)•
increased HR○
increased contrac1lity, increased output (heart flashlight)○
increased systolic pressure○
some beta-2 ac1vity (girl with tuba)○
vasodila1on§
decreased diastolic pressure (makes a bicep shape with systolic pressure on pressure tracing)§
good for acute HF and cardiogenic shock○
good for cardiac stress test○
Sympathomime1cs
Page 2
increased HR and contrac1lity (le^ girl in tent)○
vasodila1on, decreased diastolic and decreased SVR (right girl in tent)○
Beta-2 (tuba)•
relaxa1on of smooth muscles, vasodila1on, decreased diastolic BP, decreased SVR•
bronchodila1on (taking a deep breath)•
increased lipolysis (pig on fire)•
increased gluconeogenesis (marshmallows from liver bag)•
increased insulin release (welcome mat)•
hypokalemia due to increased insulin (bananas on floor)•
increased aqueous humor produc1on (girl filling balloon)•
Isoproterenol (beta-1=beta-2)•
increased HR and contrac1lity (le^ girl in tent)○
vasodila1on, decreased diastolic and decreased SVR (right girl in tent)○
Terbutaline + Ritodrine•
relaxes smooth muscles of uterus blocking birth○
Albuterol, Formoterol, Salmeterol•
bronchodila1on○
used for asthma and COPD○
Epinephrine (beta>alpha)•
dose dependent•
low doses give beta effects○
high doses give alpha effects○
bronchodila1on (beta-2 effect)•
vasodila1on (beta-2 effect)•
decreased diastolic pressure (beta-2 effect)•
elevated HR and increased contrac1lity (beta-1 effect)•
increased BP, increased SVR, vasoconstric1on (alpha-1)•
used for anaphylac1c shock•
Isoproterenol (beta-1=beta-2)
Page 44
Omalizumab (limosine)
monocloncal an1body directed against Fc por1on of IgE•
blocks IgE-mediated mast cell ac1va1on/degranula1on (guy grabbing gun)•
used as adjunc1ve therapy for moderate or severe persistent asthma•
used in pts with allergic sensi1za1on •
used in pts with resistance to steroids and beta agonists•
Chromolyn Sodium (lynn's bee control)
inhibits mast cell degranula1on (seda1ng bee spray)•
Acute Severe Asthma Exacerba1on (flying band guy)
inhaled short ac1ng beta-2 agonist•
IV or oral systemic glucocor1coids•
ipratropium bromide (blue caterpillar)•
epinephrine ("epic!" sign)•
Page 45
GI
General•
the nucleus tractus solitarius located in the medulla receives inputs from the GI tract, ves1bular system, and area
postrema (NTS track)
•
the stomach directly communicates with the NTS via vagus nerve s1mula1on (Vegas sign at stomach area)•
GI irrita1on from infec1on, chemo, or disten1on leads to mucosal serotonin release (smiley face ball)•
serotonin ac1vates 5HT-3 receptors on vagus nerve (1-2-3 sign)○
the ves1bular system communicates to NTS directly via CN 8 (semicircular canal sign)•
the ves1bular system is responsible for ver1go and mo1on sickness○
area postrema is the chemoreceptor trigger zone adjacent to the NTS and reacts to chemo agents (extreme
posture guy next to track)
•
contains D2 receptors (D-ring ropes)○
contains neurokinin 1 receptors (plaNK1) which is bound by substance P (pee sign)○
antagonized by Aprepitant§
Odansetron (dancing woman)
blocks 5HT-3 receptor on vagus nerve in GI tract (blocking the hammer toss)•
treats chemo-induced or post-op vomi1ng•
side effects•
cons1pa1on (smiley face 1ghtening the runners gut)•
headache and dizziness (smiley face hisng runners head)•
prolong QT interval leading to torsades (twisted torsades ribbon)•
serotonin syndrome- rigidity, tremor, hyperthermia, confusion (pile of smiley faces)•
especially with concomitant SSRI therapy○
Histamine Blockers (bee swaSer)
the ves1bular system contains H1 receptors (dandelions next to river)•
1st gen H1 blockers treat mo1on/sea sickness•
side effects•
significant seda1on•
an1muscarinic proper1es (remember tea party) due to M1 antagonism (M1 parking spot)•
Metoclopramide (1ckling guy)
antagonizes D2 receptors in the area postrema (1ckling D2 guy)•
treats chemo-induced vomi1ng•
has upper GI prokine1c effects. Useful in trea1ng delayed gastric emptying from post-op disorders (guy landing on
stomach)
•
side effects•
contraindicated in small bowel obstruc1on (do not obstruct sign)•
diarrhea (brown puddle)•
drowsiness (sleeping judge)•
depression (crying coach)•
extra pyramidal effects like dystonia, akathisia, parkinsonian features (newspaper hat)•
tardive dyskinesia in chronic use (tongue s1cking out)•
neurolep1c malignant syndrome- fever, rigidity, mental status change (NMS on chicken)•
elevated prolac1n levels (squir1ng milk)•
QT prolonga1on leading to torsades (torsades streamer)•
An1eme1cs
Page 87
Kinase Inhibitors
-nib suffix (broken nib of pen)•
Tyrosine Kinase Inhibitors
-1nib suffix (inhibited 1re swing tree)•
Ima1nib (imita1ng pain1ng guy)•
treats hematologic and solid malignancies (cracked crab bell)•
treats CML (colorful packaging peanuts)•
transloca1on of chromosome 9 to 22 ("922 Philadelphia" s1cker on box)○
inhibitor of BCR-ABL protein ("breakable" s1cker on box)•
blocks c-kit tyrosin kinase in GI stromal tumors (congress kit box, guy with fat belly and cancer crab buSons)•
side effects•
fluid reten1on with ankle and periorbital edema (baggy pantaloons on imita1ng guy)○
Erlo1nib (bri1sh Earl of Tinib in window)•
inhibitor of EGFR tyrosine kinase ("Geoffry" on hat)•
treats non-small cell lung cancer (cancer crab badge on lung-shaped lapel)•
side effects•
papulopustular acneiform rash (spoSy rash)○
diarrhea (mud on pants)○
Suni1b and Sorafenib (rising sun and soaring eagle)•
inhibitor of VEGF receptor tyrosine kinase (man inhibi1ng vegetable growth outside)•
treat renal cell carcinoma (bilateral crab buckles)•
side effects•
hyperkeratosis and skin rash (callused and sunburned vegetable guy)○
increased risk of hemorrhage (bleeding wound)○
Vemurafenib (snake venom in drawing)•
inhibitor of BRAF kinase ("B. Fra" signature)•
treats V600E BRAF posi1ve malignant melanoma (ink stains on jacket)•
FA: VEmuRAF-enib is for V600E-mutated BRAF inhibi1on○
The -nibs, Kinase Inhibitors
Page 88
The -mabs
-mab will always be a monoclonal an1body•
monoclonal means all cells are from the same cell line and target the exact same an1gen•
Rituximab (corona1on ritual)•
chimeric, IgG monoclonal an1body (chimera sigil)•
targets B cells by binding CD20 (archer with 2 X's to symbolize 20)•
treats CLL, non-hodgkin lymphoma (worn out T and B cell tapestry)•
treats rheumatoid arthri1s (bone lantern)•
useful for immunosuppressive therapy in microscopic polyangii1s and wegner's granulomatosis (torn an1body
lantern)
•
side effects•
immunosuppression with increased risk of infec1on (immunocompromised cane○
higher risk of progressive mul1focal leukoencephalopathy (white laurel leaves)○
infusion reac1on- headache, fever, dyspnea, pruri1s, hypotension (fat red angel with ivy)○
serum sickness within 7-10 days (red face and dropped drink)○
Cetuximab (elephant tusks)•
chimeric, IgG monoclonal an1body •
targets EGFR (giraffe on blanket)•
tyrosine kinase receptor (1re swing)○
treats solid tumors (cracked cancer crab)•
side effects•
papulopustular acneiform rash (red spots on giraffes)○
infusion reac1on- headache, fever, dyspnea, pruri1s, hypotension (fat red angel with ivy)○
serum sickness within 7-10 days (red trunk and drink)○
Bevacizumab (beverage lady)•
IgG monoclonal an1body•
inhibi1on of VEGF (chopped up veggies on table) especially in vascular endothelial cells to inhibit growth of blood
vessels in tumors (chopped red veggies)
•
treats metasta1c cancers (cracked cancer crab)•
treats wet macular degenera1on (wet spot on re1na pillow)•
side effects•
can cause bleeding (bloody aprons)○
increased risk of clots (ice clot in pitcher)○
GI perfora1on (perforated veggies in GI-like sac under table)○
Alemtuzumab (guy with "alms" dish)•
IgG monoclonal an1body•
binds to CD52 on B and T cells to deplete them (pulling on archer and knight, "52" design etched into sword)•
treats CLL (worn out T and B cell tapestry)•
side effects•
myelosuppression ○
Trastuzumab (tapestry weaver)•
monoclonal an1body against HER2 (2 babies) "Tras2zumab for HER2"•
a tyrosine kinase receptor (1re swing)○
used in pts with HER2 posi1ve tumors •
breast (cancer crab bra) and gastric cancers○
side effects•
cardiotoxicity○
decreased le^ ventricular ejec1on frac1on§
heart failure§
The -mabs
