ANTI-SMOKING DRUGS & Other Antidotes😍

Visual S/E

• Brown vision: Thioridazine

• Blue vision: Sildenafil

• Yellow vision: Digoxin

• ↓ Visual acuity: Ivabradine (Phosphenes).

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• Ivan () SOo (in SA Node) FUnny (inhibit Na+ channel [Funny current])
• But cannot see ()

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• Corneal deposits: Amiodarone

• Visual field defects
• Pegvisomant
• S/E: Visual field defects
• Mnemonic: Peg () adichal kazhcha povum (Visual field defect) → Grow cheyyicha antiye (GH receptor antagonists) keripidikkum
• Mnemonic: Soman (somatotrophs) Peg (Pegvismoant) adichapo Kayyi veerthu vannu (spade like hand)

• Barbie () aspirin () + Alcohol () kudichitt thee () Lit () cheyth → needed dialysis

• Thallium

Drugs causing DM:

• Steroids

• Thiazide (also gout) > Loop diuretics

• Niacin (also gout)

• Phenytoin

• IFN alpha

• Protease Inhibitors

• Clozapine → atypical

• β Agonists (opp. to β blockers)

1. Nicotine Replacement Therapy (NRT)

• Most common

• Long acting
• Patch (16 - 24 hrs)
• For Maintenance

• Short Acting
• For breakthrough carving
• Nasal spray > Lozenge > Gums
• Nasal spray → (Schedule H) → most effective.
• Lozenges
• Higher bioavailability than gums

• Avoid tea or coffee for 15 min post-NRT
• Gums and Lozenge require alkaline saliva for absorption
• should not be used within 15 minutes of drinking anything

• e-Cigarettes are now banned in India.

2. Bupropion

• Antidepressant (NDRI).

• Anti-smoking
• Mnemonic: Pion is a Smoker

• Vs. Buspirone (anti-anxiety)
• Mnemonic: Rona → with anxiety

• Contraindications:
• Seizure Disorders.
• Bulimia or Anorexia Nervosa.

• Uses:
1. Antidepressant,
2. Smoking cessation,
3. ADHD

3. Varenicline

• DOC

• Most effective for maintenance.

• Partial agonist at the NE receptor (α4β2) → Nicotinic receptor

• Full agonist → α7

• Derived from Cytisine (Plant derivative)
• Mnemonic: Varane A4B2 sitil ninn kitti

• Adverse Effects:
• Neuropsychiatric:
• Somnambulism
• Vomiting
• Depression,
• suicidal ideations.
• Cardiovascular:
• CCF,
• Arrhythmia (in at-risk patients).

• Mneumonic:
• Varan akumbo smoking nirthum
• Suicide cheyyan thonnum, depression avum

C. Disulfiram Like Reaction

• Should not be given with alcohol.

• Include:
• Cephalosporins like Cefoperazone, cefamandole
• ⛔ aldehyde dehydrogenase → MOA
• Moxalactam

• Other drugs with effects
• Metronidazole (+ other nidazoles)
• Griseofulvin
• Procarbazine (anticancer - alkylating drug)
• Sulfonylurea like chlorpropamide

NOTE: Lilles index

Maddreys discriminant function

• In ALD → decide whether to give steroid

• Give steroid if > 32

• Monitor response after steroid → Lille index

• Mad () Lille () took steroid after alcohol

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CHELATING AGENTS

• Used for heavy metal poisoning

1. BAL (British Anti Lewisite)/ Dimercaprol

• Indications: BAL/MAL
• B - Bismuth poisoning
• M - Inorganic Mercury
• A - Arsenic poisoning
• L - Lead poisoning

• C/I of BAL (MIC)
• Cadmium
• Fe - Iron
• Organic mercury
• Mnemonic: Dont bring BAL to cafe

2. Ca Na 2 EDTA

• Mnemonic: MILK

• ↑ Renal excretion of poison

• C/I in renal failure and mercury

• Indications:
• M – Manganese poisoning
• I – Iron poisoning
• L – Lead poisoning
• K – Cadmium poisoning

3. d- Penicillamine

• Used for Cu poisoning and Wilson disease
• Other Chelating agents for Wilsons
• Zinc (↓ absorption of copper)
• Trientine
• Copper get stuck → try ent → trientine

4. Fe chelating agents

PDE-5 inhibitor

• MOA: ↑cGMP → ↑NO activity

• Drugs:
• Vardenafil
• Tadalafil (Longest acting)
• Sildenafil
• DOC for Erectile Dysfunction
• DOC for pulmonary artery hypertension (if vasoactive test -).
• S/E
• Blue vision - Cyanopsia
• D/t PDE6 inhibition
• Heart burn

• Nitrates should not be given with Sildenafil [Risk of Severe hypotension].

SLEEP Disorders

Narcolepsy

• Modafinil (Drug of Choice)

Insomnia (Drug of Choice)

• BZD: Clonazepam > Alprazolam

• For patients with history of drug abuse/elderly:
• Dual Orexin Receptor Antagonists (DORA)
• MOA: Inhibits wakefulness
• Blocks Orexin-1 (OX1) and Orexin-2 (OX2) receptors
• Orexin neurons located in lateral hypothalamus
• Active during wakefulness
• Drugs:
• Suvorexant
• Daridorexant
• These promote sleep induction & maintenance
• Mnemonic: Night urangan DORA () Save (Suvo) Dari () Story

• For other patients:
• Z drugs → act on α1 of GABA
• Zolpidem
• Zaleplon (shortest → sale)
• Zopiclone (longest → shopping)
• These promote sleep induction & maintenance
• Ramelteon (Melatonin Agonist)
• For sleep induction only
• Ramettan → urakkum

• For blind patients with night insomnia
• Circadian rhythm disorder
• known as Non 24hr sleep wake rhythm disorder
• DOC: Tasimelteon
• Taxi for blind to sleep