Professional Documents
Culture Documents
1.
a. :(p.o.):(i.v.)(s.c.)(i.m.)
b. :
:
:
c. :
(1) Reverse transporter(P-glycoprotein):
Rifampin P-glycoprotein Digoxin
CCBKetoconazoleAtorvastatin P-gDigoxin
2.
d. :()(eg, iv=100%)
e. :
: Vd=/ = dose/
a. Vd
b. Vd
(1) Albumin
(2) 1-acid glycoprotein
3.
:
a. ()()
b. P450(CYP) 3A4
CYP3A4:
BarbituatePhenobarbitalRifampinCarbamezepineGlu
cocorticoidsPhenytoin
CYP3A4: CimetidineDiltiazamStatin
ErythromycinKetoconazole(furanocoumarin)
4.
:
a. simple passive diffusion
b. diffusion
: AspirinAcetaminophenPhenobarbitalMTX
: AmphetamineMorphine
: Warfarin
5.
MetronidazoleFluconazoleTMP- S-Warfarin
SMX
AmiodaroneDisulfiramCimetidi RS-Warfarin
ne
Cephalosporin
Vit. K
Cholestyramine
Warfarin
BarbiturateRifampin
B.
CYP450 Warfarin
(2) G protein
cAMP system: Gs Adenyl cyclase cAMP
PIP system: Gq Phospholipase C PIP2 IP3DAG
IP3 ER Ca2+DAG protein kinase C
(Therapeutic index, TI):
TI = LD50/ED50(LD: Lethal dose, ED: Effective dose)
2.
Ach Nicotinic R.
Ach Muscarinic R.
Ach Nicotinic R.
Dopamine Dopamine R.
(2)Amphetamine
(3)Tyramine(
octopamine)
(4)Amitriptyline(TCA)Cocai (uptake)
ne
C.
NE
Gq
(PIP2IP3,DAG)
(,,)
Gi (cAMP)
()
Gs (cAMP)
2
Ach
/ juxtaglomerular apparatus
renin
(,,)
M2
Gi (cAMP)
M3
Gq
(PIP2IP3,DAG)
(GI,,),
( blocker)
Epi(),NE(),Dopamine()
Carvedilol, Labetalol()
Phentolamine( Pheo.)
Phenoxybenzamine( Pheo.)
Phenylephrine(,),Midodrine(
Tamsulosin(),Prazosin(
Clonidine(),Methyldopa(
Mirtazapine()
)
1/
Isoproterenol(+=)
Propranolol(,), Nadolol,
Pidolol
Timolol()
1>
Dobutamine()
Atenolol(), Esmolol(
)
Metoprolol, Bisoprolol
2>
Albuterol(),Ritodrine()
1.
2.
-blocker :
-blocker :
D.
1.
(1) Hemicholinium: cholinergic Choline
(2) Botulism:
2. ( Ach Ach esterase )
(1) Neostigmine:
(2) Physostigmine: () BBB Atropine
E.
1. ( Muscarinic receptor)
(1) Bethanechol( M receptor):
(2) Pilocarpine( M receptor)Carbachol(M, N ):(
2.
)
(3) Methacholine:
( Muscarinic receptor)
(1) Atropine:(24hr)
(2)
(3)
(4)
(5)
(6)
Tropicamide:()
Benztropine: Dopamine agonist
Scopolamine:
Ipratropium: agonist,COPD
Pirenzepine:(selective M1R. antagonist)
F.
1. Nicotinic receptor()
(1) Edrophonium: AchE()
(2) Neostigmine, Pyridostigmine: AchE(,)
(3) Succinylcholine:
2. Nicotinic receptor(!!!)
(1)
Diazepam: GABAA
Baclofen: GABAB
(2)
Botulism: (Ach)
(3)
a.
SuccinylcholineDecamethonium
b.
Tubocurarine(,)Pancuronium(,)
G.
1. ABCDP BD: secretion ACP: outflow
A.
1.
(1) : 2 selective agonist()
Clonidine: /Rebound hypertension
Methyldopa: Prodrug
(2)
Trimethaphan(IV): nicotinic receptor
Mecamylamine:
(3)
Reserpine: Dopamine5HT
Guanethidine:
(4)
-blocker: Prazosin(1)
-blocker: Propranolol(1) Renin (1)
2.
3.
(Calcium influx):
(1) DHP:
NifedipineAmlodipineFelodipine
(2) Non-DHP:
DiltiazemVerapamil( Na+)
(3)
:/(RAAS ) -blocker
(1) cGMP
Hydralazine:(artery)Drug-induced lupus system
Nitroprusside: NO cGMP(a./v.)Cyanide
(2) (a.)
Minoxidil(Rogaine ): iii (Hypertrichosis)
4.
Diazoxide: insulinoma
(1) (ACEI):
CaptoprilEnalaprilLisinopril(preloadafterload)
Angiotensin II :/
Bradykinin: Prostaglandin
ACEINitroprusside
(protein )( remodeling)
Bradykinin angioedema
(2) (ARB): LosartanValsartanIrbesartanCandesartan
Angiotensin type1 receptor
B.
1. : Vasospasm
CCB + Nitrate
2. :
-blocker( a. Afterload) + Nitrate( Preload)
3. Nitrate: Nitroglycerin(NTG), isosorbide dinitrate
(1) NO cGMP
(2) v. a. a. a.
(3) a. pulsation throbbing headache
(4) (tolerancetachyphylaxis)
C.
1.
(1) (): Furosemide
Loop diuretics
(2) (): Dobutamine
1 selective agonist
2.
(1) : ACEI(preloadafterload)-blocker( RAA system)
ACEI
-blocker
(2) (): ThiazideSpironolactone(E. ^^)
(3) (): Cardiac glycosidesPDE3
Cardiac glycosides: OuabainDigoxinDigitoxin
Ouabain
Digoxin(
Digitoxin
0%
21
75%
40
>90%
168
D.
1. Class I:Na+
(1) Ia(K+)[ QRS]+[ AP QT]
Quinidine(GI)Procainamide(SLE)Disopyramide(anti-cholinergic
effect)
(2) Ib[ QRS]+[ AP QT]
Lidocaine(IV)Mexiletine()Phenytoin
Phenytoin:
2.
3.
Atropine:
Adenosine()[Paraoxysmal supraventricular tachycardia, PSVT
!!]
Gi protein cAMP Ca2+AV node
E.
1. Osmotic diuretics: Mannitol
:
:()
2.
3.
4.
5.
( Aminoglycoside )+
Thiazide: ChlorothiazideHydrochlorothiazide
Na+-Cl- Na+-Ca2+ Ca2+
:(GFR )
Hyper GLUC:(G)(L)(C)(U)+
K+ sparing diuretics:
Spironolactone/EplerenoneTriamterene/Amiloride
: Aldosterone( Na+Na+-K+ ATPase )
: Na+
(Spironolactone Anti-androgen
)
:(Gynecomastia)
A. -(::)
1. () D2 receptor
(1) Haloperidol:(EPS)
(2) Chlorpromazine:
2.
)
(1) Clozapine:(Agranulocytosis)
(2) Olanzapine()Ziprasidone(QTc )
B. -(Mood stabilizer)
1. Lithium(): Gq PIP IP3 PIP2
[0.4--0.8--1.2mEq/L]>1.5mEq/L
C. - SerotoninNE
1. (TCA): ImipramineClomipramineAmitriptyline
(1) NE Serotonin
(2) :(Muscarinic)(H1)(
adrenergic)
(3) () Imipramine( Anti-M effect)
2.
3.
NESerotonin
(1) Venlafaxine(SNRI): Serotonin, NE SSRI
4.
5.
SSRI Serotonin []
(1) Fluoxetine(Prozac)Sertraline(Zoloft)Paroxetine
(2)
(3) :
(4) : GI
MAOI monoamine oxidase
(1) TranylcyprominePhenelzineIsocarboxazid
(2) (Hypochondriasis)
(3)
a. (Cheese reaction):Tyramine MAO
Octopamine(false transmitter)
Hypertensive crisis
b.
D. - GABA Cl-
1. Barbiturates: GABA GABAA Cl-
(1) Thiopental
(2) SecobarbitalPentobarbital():
(3) Phenobarbital
Porphyria()
2. Benzodiazepines(BDZs): GABA GABAA Cl-
3.
4.
BDZ /
(1) Alprazolam()
(2) Midazolam()
(3) BDZ BDZ
Lorazepam
Flunitrazepam(FM2) antegrade
amnesia
(4) Diazepam
(5) Flumazenil Benzodiazepines
Non-BDZ BZ1 BDZ
(1) Zolpidem(Stilnox)
(2) Zopiclone(Imovane)
5-HT1A receptor partial agonistBuspirone(pf: Bupropion)
1~2 (slow onset)
5. Baclofen()
BarbiturateBDZ GABA GABAA Cl-
GABAergic nerve
Baclofen GABA GABAB G protein Ca2+
K+!!
E. - DopamineAch
1. Dopamine : Amantadine A
2. Dopamine : Levodopa(L-dopa)+ Carbidopa
L-dopa BBB dopa decarboxylase
dopamine
Carbidopa dopa decarboxylase L-dopa
3.
4.
L-dopa L-dopa
Hypertensive crisis
MAOA
NE, Serotonin,
Tyramine
MAOB
Dopamine
TranylcyprominePhenelzine [
MAO]
Selegiline [ MAOB]
5.
6.
Ach : BenztropineTrihexyphenidylBiperiden
F. -
1. Na+
(1) Carbamazepine:()
Steven-Johnson syndrome
(2) Phenytoin:()
Vit. D
Vit. K-dependent
(3) Primidone: Phenobarbital Phenytoin
2.
3.
4.
Ca
(1) Ethosuximide:() Steven-Johnson
syndrome
Na+Ca2+: Valproic acid
Steven-Johnson syndrome
: GI()2
2+
GABA
(1) Barbiturates
Phenobarbital:()
Primidone: Phenobarbital
(2) BZD
Clonazepam:
5.
Diazepam: IV
:
(1) NMDA : Felbamate
(2) AMPA : Topiramate
(3) Na+: Lamotrigine
(4) GABA: Gabapentin(), Tiagabine(),
Vigabatrine(transaminase)
G. -
1. Ergot alkaloids: partial 5-HT agonist + agonist + dopamine agonist
(1) : ErgotamineErgonovine
(2) : Methylsergide
!!
2.
H. -
1.
(1) : inductionmaintain
a. Thiopental: Barbituate
b. Propofol:
c. Etomidate:
d. Ketamine: Glutamine NMDA IV
(2) : maintain
(MAC): MAC
/=/:/
N2O Des* Sevo* Iso* En* Halothane Methoxy*
(*=flurane)
2.
: MAC/
N2O Halothane
a. Halothane:
Halothane hepatitis:
Myocardial depression:
Arrhythmia: amine Epi.
Malignant hyperthermia: Succinylcholine
: Na+
(1) Ester ()
Pseudocholinesterase
Tetracaine()Cocaine()Procaine()
(2) Amide
(first-pass effect)
Bupivacaine()Lidocaine()Mepivacaine()prilocaine()
Disulfiram Aldehyde dehydrogenase
3.
I. -
1. ( ) Meperidine: Morphine: Fentanyl 0.1: 1: 80
(1) Meperidine: Morphine
(2) MorphineFentanyl:
(2 )morphine
(1) Loperamide:
( )
(1) Codeine: R. weak agonist
(2) Dextromethophan:
A. (Asthma)
1.
(1) 2 selective agonistSalbutamol, Albuterol, Terbutaline(),
Salmeterol()
Adenyl cyclase cAMP
:
(2) Anti-cholinergicIpratropine
2 agonist COPD
(3) Theophylline(:)
Phosphodiesterase(PDE) cAMP
histone deacetylation
2.
(1) SteroidBudesonideFluticasone
cytokine
-adrenergic receptor
(2) Mast cell stabilizerCromolynNedocromil
(3) Leukotriene modifier
Zileuton: 5-lipoxygenase
MontelukastZafirlukast: Leukotriene receptor antagonist
aspirin-induced asthma
B. (Peptic ulcer)
1.
(1) (antacids): MgOAl(OH)3CaCO3
(2) H2 blocker: CimetidineRanitidineFamotidine
(3) M1 blocker: Pirenzepine(selective)Propantheline(:)
M3
(4) Proton pump inhibitor(PPI):
Omeprazole Lansoprazole Exomeprazole
H+,K+-ATPase GERD
2.
(1) Sulcrafate: prostaglandin( proton pump/&HCO3-)
C.
1.
(1) D2 receptor antagonists: MetoclopramideDomperidone
BBB
(2) Cholinomimetic agents: Bethanechol
M3 receptor
(3) 5-HT4 agonist: Cisapride
ENS (QT prolong)
2.
3.
(1) : PsylliumMethylcelluloseNormacol
(2) : Glycerin suppositoryMineral oil
(3) : Magnesium oxideLactulose
(4) : Castor oil()
Enteric nervous system
4.
(1) : Kaolin-Pectin
(GlucocorticoidCyclosporineAzathioprine)
A.
TRH(+)
TSH
Thyroxine(T4)Triiodothyrodine(T3)
ACTH
GlucocorticoidMineralocorticoidAndrog
CRH(+)
en
GnRH(+)
GHRH(+)
FSHLH
EstrogenProgesteroneTestosterone
GH
Somatostatin(-
)
Dopamine(-)
PRL
Oxytocin
Vasopressin(ADH)
1.
2.
(2) (Oxytocin)
B. -()
1. : iodide(thyroidal peroxidase) iodine Thyroglobulin Tyrosin
MIT/DIT
2.
3.
4.
(Thyrotoxicosis)
(Hypothyroidism)
Alkaline
phosphatase LDH AST
(1) Liothyronine(T3):(24hr)
(2) Levothyroxine(T4): T3(7day)
(3) Hashimotos thyroiditis: Anti-TPO AbAnti-Tg Ab Levothyroxine
(1) Thioamides :
MethimazoleCarbimazolePropylthiouracil(PTU)
Thyroglobulin
(Deiodination)
3~4
(10%)(0.1~0.5%)
(2) Iodides:(2~7 )jodbasedow (
(3)
(4)
(5)
(6)
)
-blocker: T4T3
Hydrocortisone:(Thyroid storm)
T4T3
Radioactive iodine media(131I):
Levothyroxine
Graves disease:(type II) TSH receptor
: Thioamides()
C. -(PTH) D(Calcitonin)
1. []
::
2. D[]
3.
[]
D. -(Somatostatin)
1.
(1) :
(2)
(3)
(4)
(5)
2.
SGLT
GLUT1
RBC
GLUT2
GLUT3
GLUT4
GLUT5
(Fructose)
3.
(1)
a. Sulfonylurea(SU):
GlimepirideGlibenclamideGliclazideGlipizide
K+
:
b.
c.
Glinides : RepaglinideNateglinide
SU K+
SU
GLP-1(Glucagon like peptide-1): Sitagliptin()
GLP-1 (Incretin)
GLP-1 (DPP-4) GLP-1
Incretin
(2)
a. Biguanide : Metformin
lipid profile
()
b.
TZD(Glitazone): RosiglitazonePioglitazone
PPAR lipolysis FFA
GLUT4
lipid profile
()(ALT 2.5 )
(3)
a. glucosidase inhibitor: Acarbose
Sulfonylur
ea
(2-5hr)
SU
GI
Glinides
GLP-1
Biguanide
TZD
glucosidas
e inhibitor
4.
E. -(Glucocorticoid)
1. Phospholipase A2
2. (GFR)
3. (Agonist)
(1) :
HydrocortisonePrednisoloneMethylprednisolone(
4.
)
(2) :
BetamethasoneDexamethasone
:(Synthetic inhibitor)
(1) Metyrapone: 11-hydroxylation cortisol & corticosterone
F. -
1.
2.
(Estrogen):
(1) PTH
(2) HDLLDL Leptin
(3) IIVIIIXX antithrombin III
3.
(Progesterone):
(1)
(2) CO2
(1) : Estrogen
a. (Unopposed estrogen):
b. (Estrogen + Progesterone)
Estrogen Progesterone
withdraw
4.
5
c. Selective estrogen receptor
modulator=SERM(Tamoxifen Raloxifen)
Agonist Antagonist
Tamoxifen Raloxifen
(2) : Mifepristone(RU486) progesterone receptor
5.
(2) :
a. GnRH analog: Leuprolide
b. FinasterideDutasteride: 5-reductase inhibitor DHT
c.
d.
A.
lactam Transpeptidase
Glycopeptide : D-alanine-D-alanine G(+) peptidoglycan
1.
Penicillin(PCN):(GP)
Penicillin lactamase
inhibitor(Clavulanate Sulbactam Tazobactam)
i.
Aminopenicillin(Anti-staphylococcal PCN)
Amoxicillin(PO): Streptococcus
Augmentin = Amoxicillin+ ClavulanateUnasyn =
Ampicillin + Clavulanate :
ii.
2.
(CAP)
Carboxypenicillin(Anti-peudomonal PCN)
Ticarcillin + ClavulanatePiperacillin + Tazobactam
(Pseudomonas)
(HAP)
(2) Penicillin binding protein(PBP): Penicillin
MRASPRSP
(3) Porin : Penicillin
Cephalosporin : Penicillin
(1) : CefazolinGPC GN
(2) :CefuroximeGP GN
(3) :Cefmetazole
(4) :Ceftriaxone*1Ceftazidime*2Cefoperazone(CPZ)GP GN
*1 BBB*2
(5) :Cefepime:GPC()GN()
CefmetazoleCeftriaxoneCefoperazone(CPZ)
lactamase
a. AmpC -lactamase:~ Cephalosporin lactam
Cefepime Carbapenems
b. Extended-spectrum -lactamase(ESBL):Penicillin~
Monobactam
Carbapenems Cephamycin ()
3.
4.
5.
6.
Carbapenems : ImipenemMeropenemErtapenem
GPCGNB MRSA
Monobactam : Aztreonam
GNB (P. aeruginosa)Penicillin
Glycopeptides : VancomycinTeicoplanin
GPC MRSAPRSP
Bacitracin: Neomycin
B.
1. 50S
(1) Clindamycin():
GPC()
PCN Clindamycin + Aztreonam
(2) Macrolide (): Erythromycin Azithromycin
GPC() 50S G(-)
Mycoplasma Azithromycin
(3) Oxazolidinones (): Linezolid
: MRSAPRSPVRE( Vancomycin )
(4) Chloramphenicol():
()
2.
30S
(1) Aminoglycoside : GN
:/
a. Streptomycin:
b. Gentamycin:GNB ()
c. Tobramycin:
d. Amikacin:
(2) Tetracycline :
: Aminoacyl-tRNA 30S ribosome
i.
(!!)
ii.
iii.
a. Tetracycline: 60-70%
b. MinocyclineDoxycycline:(95-100%)
c. Tigecycline:
MRSAPRSPVRE
Tetracycline
: Ca2+
C.
1.
2.
Trimethoprim(TMP)/Sulfamethoxazole(SMX)
SMX PABA Dihydropteroate synthaseTMP Dihydrofolate
reductase
AIDS (Pneumocystis carinii)Norcardiosis
!
Fluoroquinolone
Ciprofloxacin(2nd)Levofloxacin(3rd)Moxifloxacin(4th)
DNA DNA
2nd: G(-)() G(-)()()
3rd: G(+)(CAP)
4th:
!!
3.
Metronidazole DNA
(Protozoa)
Disulfiram
4.
D. HERZ
Isoniazid(INH, H)
Mycolic acid
Pyridoxine(Vit. B6)
Ethambutol(EMB,
E)
Rifampin(RIF, R)
RNA polymerase
Pyrazinamide(PZ
A, Z)
phagosome
Streptomycin(SM) 30S
1.
2.
3.
4.
IsoniazidRifampin Ethambutol
Streptomycin
(H, R, Z)(E, SM)
CiprofloxacinAmikacinParamimosalicylate(PAS)Cycloserin
Mycobacterium leprae(Leprosy )
(1) Dapsone:G6PD
(2) Rifampin: 600mg Leprosy Dapsone
E.
1. Azole
CYP450 lanosterol
(ergosterol,)
2.
3.
(1) Ketoconazole:
(2) Itraconazole:
(3) Fluconazole: BBB
(4) Voriconazole:30% Amphotericin B
(5) ClotrimazoleEconazole
Polyene
(1) Amphotericin B:()
Aspergillus Candida
(2) Nystatin:(thrush)
F.
1.
(1) Acyclovir: HSV1HSV2VZV
Thymidine kinase DNA polymerase
DNA
DeliriumSeizure
(2) Ganciclovir: CMV
Acyclovir HSVVZV CMV Acyclovir
100
(3) Fomivirsen: CMV
Antisense nucleotide CMV mRNA
(4) Foscarnet: HSVCMV
DNARNA polymerase
2.
Nelfinavir
:ZDV()ddI()ddC()
Lamivudine(3TC) HBV
(2) (Non-nucleotide reverse transcriptase
inhibitor, NNRTI)
NevirapineDelavirdineEfavirenz
(2)Topoisomerase II inhibitors
(Anthracycline):Daunorubicin, Doxorubicin
Etoposide(VP-16)
3.
M phase:
(1)Vinca alkaloids()
Vinblastine, Vincristine
(2)Taxanes()
Paclitaxel(Taxol), Docetaxel(Taxotere)
:(Corticosteroid) :
A.
1.
Glucocorticoid, Prednisolone, Cyclosporine
ProstaglandinLeukotriene ()
IL-2 T cell
2. Th ( IL2 )
Cyclosporine, Tacrolimus, Sirolimus
Cyclosporine, Tacrolimus Calcineurin
Sirolimus mTOR G1-S phase
3.
TB ()
(1)Cyclophosphamide
DNA
(2)Azathioprine
6-MP purine purine
DNA
()
6-MP xanthine oxidase allopurinol(xanthine oxidase
inhibitor)
(3)Mycophenolate mofetil (MMF)
Inosine monophosphate dehydrogenase purine
(de novo pathway) purin3
:Prednisolone + Tacrolimus + MMF
B.
1. (Interferons)
(1)IFN-()IFN-() Type I IFN
RNA
2. TNF-
(1)
Thalidomide
TNF- T cell
(2)
(3)
A.
1. ()
(1) Aspirin:
Cyclooxygenase(COX)
Thromboxane(TXA)Prostaglandin(PG)
(2) ClopidogrelTiclopidine:
P2Y Adenosine diphosphate(ADP)
Aspirin
(3) Abciximab()Tirofiban:
GP IIb/IIIa
(4) Dipyridamole(Persantin):
Phosphodiesterase(PDE) cAMP
cAMP Coronary steal
phenomenon
2.
()
( PT):3710[ 10]
( aPTT):12119810[ 10]
Thrombin(2a) 5811Protein CS 5811
(1) : Warfarin()
Vit. K Factor 2,7,9,10Warfarin Vit. K
3.
Factor 7 PT
()
(1)
Anti-thrombin III Thrombin 5a8a
Protein C/ Protein S 5a8a
Plasmin Fibrin
(2) Heparin(IV, SC)
Heparin 10a Antithrombin 2a aPTT
(3) UrokinaseStreptokinasetPA
Plasminogen Plasmin Fibrin
Thrombin: Fibrinogen FibrinPlasmin: Fibrin Fibrin split
product
B.
1. Desmopressin(= DDAVP)
Receptor V1:Receptor V2: VIII, vW
2.
(1) Terlipressin(V1):
(2) Desmopressin(V2):ESRD
Aminocaproic acidTranexamic acid( IV )
UrokinaseStreptokinasetPA Plasminogen
Plasmin
C.
MCV < 80flIDA()Thalassemia()
MCV > 100flMegaloblastic anemia( B12 )
Transferrin ferritin hemosiderin
Fe2+ Fe3+HClVit. C
1.
2.
D.
1. EPO
2. G-CSF(Filgrastim,)
3.
E.
1. HMG CoA reductase inhibitor(statin ):Cholesterol (LDL)
Cholesterol HMG CoA
2.
3.
4.
5.
Nicotinic acid(Niacin):(Wiki )
(1) adipose tissue Triacylglycerol fatty acid( lipolysis)
(2) cholesterol VLDL VLDL
(3) lipoprotein lipase VLDL VLDL
(4) HDL HDL