UNIVERSITY EXAM • RAPID RECALL

Pharmacology Command Map

Tap a system, recall the triad: mechanism → main use → major adverse effect.

DRUG
Classify it
then score it

How to use this map

Tap any node. Say the mechanism aloud before revealing the drug anchor. University answer order: Classification → Mechanism → Actions → Uses → ADRs → Contraindications.

1signature use

1killer ADR

1exam trap

ANS: receptor-to-bedside anchors

AtropineM blocker → bradycardia/OP poisoning → dry, hot, blind, urinary retention.

Propranololβ1+β2 block → tremor/thyrotoxicosis → bronchospasm; masks hypoglycaemia.

EsmololUltra-short IV β1 block → SVT/perioperative tachycardia → bradycardia.

Prazosinα1 block → HTN/BPH → first-dose syncope.

SuccinylcholinePersistent depolarisation → rapid intubation → hyperkalaemia, malignant hyperthermia.

PralidoximeReactivates AChE before ageing → OP poisoning; give early with atropine.

Nephron ladder

PCTAcetazolamide: ↓ HCO₃⁻ reabsorption
Mannitol: ↑ tubular osmolarity

TAL → DCTFurosemide: blocks NKCC2; ototoxicity
Thiazide: blocks NCC; ↑ Ca²⁺ retention

Collecting ductSpironolactone: aldosterone block; gynaecomastia
Amiloride: ENaC block; hyperkalaemia

Reveal the calcium trap

Loops lose calcium; thiazides retain calcium. Mannitol is avoided in pulmonary oedema and anuria.

CVS survival anchors

ACE inhibitors↓ Ang II + ↑ bradykinin → HF/diabetic nephropathy → cough, K⁺, angioedema; avoid pregnancy/B/L RAS.

NitratesNO→cGMP→venodilation → angina/pulmonary oedema → headache, hypotension. Never with sildenafil.

DigoxinNa⁺/K⁺ ATPase block → ↑ Ca²⁺ + vagal tone → HF with AF → yellow vision/arrhythmia.

CNS: one-line discriminators

PhenytoinNa⁺ block → focal/GTCS → gingival hyperplasia, hirsutism, ataxia.

Valproate↑ GABA + Na⁺/T-Ca²⁺ block → broad spectrum → liver/pancreas/NTD.

EthosuximideT-type Ca²⁺ block → absence seizure → fatigue/GI upset.

Morphineμ agonist → severe pain → respiratory depression, miosis, constipation; naloxone reverses.

FluoxetineSSRI → depression/OCD → sexual dysfunction, serotonin syndrome.

LevodopaDopamine precursor + carbidopa → Parkinsonism → dyskinesia, wearing-off, hallucinations.

Antimicrobial mechanism wall

Cell wallβ-lactams inhibit transpeptidation.
Vancomycin binds D-Ala-D-Ala.

Protein30S: aminoglycosides, tetracyclines.
50S: macrolides, linezolid.

DNA/RNA/folateFQ: gyrase/topo IV.
Rifampicin: RNA polymerase.
Cotrimoxazole: sequential folate block.

Toxicity signatures

INHHepatitis + neuropathy → give pyridoxine.

RifampicinOrange secretions + enzyme induction.

EthambutolOptic neuritis, red-green defect.

AminoglycosidesOtotoxic + nephrotoxic + NM blockade.

MethotrexateDHFR block; marrow/mucosa/liver → leucovorin rescue.

CyclophosphamideHaemorrhagic cystitis → mesna protection.

Exam trap: ciprofloxacin chelates with antacids/iron; metronidazole causes a disulfiram-like reaction.

Endocrine emergency strips

DKA

IV fluids → IV regular insulin → potassium monitoring/replacement → treat trigger.

Thyroid storm

β blocker → PTU → iodine after 1 hour → hydrocortisone + support.

Steroid withdrawal

Long-term glucocorticoids suppress HPA axis: taper, never abruptly stop.

Drug anchors

Metformin↓ hepatic gluconeogenesis → T2DM → GI upset; rare lactic acidosis.

SulfonylureasClose β-cell KATP → insulin release → hypoglycaemia + weight gain.

InsulinTyrosine-kinase receptor → glucose uptake → hypoglycaemia, K⁺ shift.

PTUBlocks TPO + peripheral T4→T3 → storm/early pregnancy → liver injury/agranulocytosis.

BisphosphonatesInhibit osteoclasts → osteoporosis → oesophagitis/ONJ.

SildenafilPDE5 block → ↑ cGMP → ED/PAH → contraindicated with nitrates.

Checkpoint 1

Which diuretic class decreases urinary calcium?

Thiazides increase distal calcium reabsorption—useful in recurrent calcium stones.

Checkpoint 2

Which sequence is correct in thyroid storm?

Block new synthesis first with PTU; iodine later blocks hormone release.

Checkpoint 3

Which toxicity-protection pair is correct?

Mesna binds the urotoxic metabolite acrolein and prevents haemorrhagic cystitis.

Pharmacology Rapid Recall