pixorize pharma

ANTIMICROBIALS/ANTIBIOTICS

Penicillin Overview
Penicillin = pencil
Black pencil rings = beta lactam ring
Dollar bill bookmark = D-ala D-ala Analog
Train = transpeptidase; Penicillin binds Transpeptidases (PBD)
Broken lego wall = prevents cross linking of cell wall (Bactericidal)
Allergic hives/rash = cause hypersensitivity reactions
Bursting tomato = hemolytic anemia
Spilling kidney shaped jelly beans = causes nephrotoxicity (tubulointerstitial nephritis
with eosinophilia)
Diffuser = causes Clostridium Difficile infections/pseudomembranous colitis - cus it
destroys other gut flora
Mechanisms of Resistance:
Gold star student = Penicillin G, flexing biceps = injected formulation (IV/IM)
Veggies in V shaped food pyramid = Penicillin V, mouth/eating = oral formulation

Penicillinase-Sensitive Penicillins (PSP) and Penicillinase-Resistant Penicillins (PRP)

Broken pencil = penicillin sensitive penicillins - cleaved via penicillinase aka beta
lactamase
1. Ammo belt = Amoxicillin
2. Amp = Ampicillin
PSPs are broad spectrum (works against gr +ve and -ve)- so can cause C. difficile
overgrowth more
To bypass this, PSPs are administered with beta-lactamase inhibitors (eg clavulanic acid,
sulbactam)
(remember T. Amoxclav or Augmentin)
Which has greater oral bioavailability Amoxicillin or Ampicillin? Its easier to eat an
ammo belt rather than an amp- Amoxicillin has greater oral bioavailability
Mechanical pencil doesn't break = Penicillinase-resistant Penicillin aka Aminopenicillins;
Penicillinase resistant because bulky R group blocks access of β-lactamase to β-lactam
ring
1. Napping = Nafcillin
2. Math = Methicillin
3. Oxford shoes = Oxacillin
Also theres Dicloxacillin and Floxacillin
PRPs are narrow spectrum, used for S.aureus (except for MRSA)
Adverse effects are same: Hypersensitivity, interstitial nephritis, C. difficile overgrowth

Antipseudomonal Penicillins
Pencil = Penicillin, Mona Lisa = Pseudomonas
Smoking a pipe = Piperacillin
Ticket to watch him painting = Ticarcillin
Da vinci got mad, breaking pencil = Sensitive to penicillinase/beta lactamases, so usually
paired with beta lactamase inhibitors like tazobactam
They cover Pseudomonas and anaerobes- used in hospital acquired pneumonia, severe
soft tissue infections(diabetic ulcers), intra abdominal infections (remember piptaz in
surgery)
Cephalosporins aka Beta Lactams Overview
The chef is grading her students harshly
Chef = Cephalosporin
Black pencil ring = Beta lactam antibiotic (Bactericidal)
Sturdy mechanical pencil = resistant to penicillinase
Trainee chef with hives = can cause hypersensitivity reaction
Sneezing has splattered the tomatoes = may cause hemolytic anemia
Red faced trainee with beer = may cause disulfiram like reaction to alcohol
Falling special K cereal box = may cause Vitamin K deficiency (it blocks Vit K epoxide
reductase)--> bleeding
Low rate of crossreactivity even in penicillin-allergic patients.
Increases nephrotoxicity of aminoglycosides.

1st/First Generation Cephalosporins

A baby prodigy chef, who is a picky eater and tried some jam but didnt like it. Today is
an auspicious day for the birth of a prodigy and the stars have aligned aka zodiac.
Onesie = 1st gen, chef = cephalosporin= 1st generation cephalosporins
Zodiac sign baby mobile = zolin ; Cefazolin
Licking = lexin ; Cephalexin
Purple grapes = active against gram positive cocci (Staph, Strep)
Baby food spilled on skin = prevent infection by skin flora (eg Cefazolin prior to surgery
to prevent wound infection from skin flora)
Used for skin infections, UTI
1st generation- ⊕ PEcK: gram +ve cocci, Proteus mirabilis, E.coli, Klebsiella
pneumoniae
2nd/Second Generation Cephalosporins
2 bunk beds = 2nd generation, chef = Cephalosporin
Oxford guide to cooking- oxitin ; Cefoxitin
Coloring book -clor ; Cefaclor
Painted rocks -rox; Cefuroxime
Teeter-totter- tetan; Cefotetan
Eating cluster of purple grapes = active against gram positive cocci
Used in intra abdominal infections, UTI
Same coverage as 1st gen with extended gram negative coverage.
2nd generation - ⊕ HENS PEcK: gram +ve cocci, H.influenzae, Enterococcus,
Neisseria, Serratia + Proteus, E coli, Klebsiella

3rd/Third Generation Cephalosporins

Our culinary prodigy chef has opened a fancy mountainside restaurant in the Alps
3 star restaurant = 3rd generation, chef = Cephalosporin
3 axes -triaxone; Ceftriaxone
Tazo tea = tazidime; Ceftazidime
Mashing purple grapes and red raspberries = treats both gram positive and gram negative
bacteria (broad spectrum)
Chefs hat on fire = treats meningitis (Ceftriaxone can cross BBB)
Gondola going up the Alps = gonorrhea (Ceftriaxone)
Limes = Lyme disease (Ceftriaxone)
Tazi tea spilling onto Mona Lisa painting = Ceftazidime treats Pseudomonas
4th/Fourth Generation Cephalosporins
Four cheese = 4th gen, chef = Cephalosporins
Pimento cheese = Cefepime
Chopping purple eggplants and red tomatoes = treats gram positive and negative bacteria
Mona lisa = treats Pseudomonas
Used in immunocompromised, hospital acquired pneumonia, neutropenic fever,
complicated UTI

5th/Fifth Generation Cephalosporins

5 minute crafts/chef on youtube
Taro = Ceftaroline
Purple boba tea with red strawberries = broad gram +ve and -ve bacteria coverage
Making tea for MaRShAls in police station = active against MRSA
Imagine one police officer got diarrhea after drinking the boba tea; poop = active against
Enterococcus faecalis
NOT active against Pseudomonas
Carbapenem
Construction of panama canal = Carbapenem
Black pencil ring = Beta lactam antibiotic
(beta lactams binds to PBP catalytic site→ cause irreversible inactivation of PBP)
Sturdy mechanical pencil for construction site = resistant to Penicillinase
Shaking from jackhammer = may cause seizures (Imipenem > Meropenem)- remember
Mero is meek it will cause seizures less
GI distress, rash, and CNS toxicity (seizures) at high plasma levels.- muddy puddle (GI
upset) and rusty beam (rash)
Active against gram +ve , gram -ve, Pseudomonas (exception is ertapenem)- remember
ermmmm, actually meme
Inactivated by carbapenemases produced by K pneumoniae, E coli, E aerogenes.
GI distress, rash, and CNS toxicity (seizures) at high plasma levels.- imagine a muddy,
puddle (GI upset) and rusty beam (rash)
Wide spectrum and significant adverse effects limit use to life-threatening infections or
after other drugs have failed.
Always administered with cilastatin (inhibitor of renal dehydropeptidase I) to decrease
inactivation of drug in renal tubules- to increase half life and tissue penetration -
remember: With imipenem, “the kill is lastin’ with cilastatin.”

Monobactam (Aztreonam)
Monocle on the historian = Monobactam
Aztec calendar = Aztreonam
Black pencil ring = beta lactam antibiotic
Broken wall = prevents cell wall cross linking by binding to PBP-3 (remember the aztec
ring looks like a moon or മൂന്ന്)
Sturdy mechanical pencil = resistance to penicillinase
Red chilli peppers are sprouting = active against gram negative rods ONLY
Magical aztec ring is curing the man with allergies = can be used in patients with
penicillin allergy
Glycopeptides: Vancomycin & Bacitracin: Both decrease peptidoglycan synthesis
Van = Vancomycin
Stopped wall construction = blocks bacterial cell wall synthesis (bactericidal)
Construction dollies = binds to D-ala residues (so that transpeptidase cannot attach)
Spilled milk on dolly = D-Ala to D-Lac - mutation of D-Ala to D-Lac leads to bacterial
resistance in some bacteria (eg VRE- Vancomycin resistant Enterococcus - it has vanA
gene)
Falling kidney shaped jelly beans = nephrotoxicity
Covering ears = ototoxicity
Blue vines = thrombophlebitis at injection site
Flowing choco lava cake = Clostridium difficile , choco lava cake is intact and spared
=Vancomycin is bactericidal except for C. difficile, its bacteriostatic
Red faced angry man = Red Man Syndrome
Historical landmark sign above Red Man = Red Man syndrome is histamine mediated
Red Dress = DRESS syndrome
Bacitracin: is a component of a triple antibiotic ointment used for superficial skin
infections. (Neomycin, Bacitracin, Polymyxin B)

Aminoglycosides
Mini golf = Aminoglycosides
Gentlemens room = Gentamicin
American flag = Amikacin
Stripes on flag = Streptomycin
Neon lights = Neomycin
30 days in calendar = blocks 30S ribosomal subunit- causes irreversible inhibition of
initiation complex → misreading of DNA and decreased translocation→ decreased
protein synthesis (theres no initiation of the golf game)
Synergistic with beta lactams (they damage cell wall and allow aminoglycoside to enter
and get to the ribosome)
Windmill = requires O2 oxygen = so theyre ineffective against anaerobes
Tarantula = teratogenic
Frozen in fear = neuromuscular blockade/paralysis (absolute contraindication in
myasthenia gravis pts)
Covering ears = ototoxicity (especially with other ototoxic drugs like loop diuretics)
Falling jelly beans = nephrotoxicity
Tarantula attached to golf ball causes failure = Bacteria creates enzyme attachments
which cause failure (eg by acetylation, phosphorylation, or adenylation)
Neomycin
Neo from the matrix
Remember Neomycin is used for bowel surgery preparation - Neo using scalpel like
knifes to stab someones stomach

Tetracyclines (Doxycycline, Tetracycline , Minocycline)

Training for a race
Cycling = Tetracyclines
30 day calendar month = inhibits 30 subunit of ribosomes (Bacteriostatic; bind to 30S
and prevent attachment of aminoacyl-tRNA)
Useful against Atypical intracellular organisms since the drug tends to accumulate inside
the cell - eg Borrelia, Chlamydia
Fallen milk has made him queasy = Do not take tetracyclines with milk (Ca2+)
Tums = Do not take with antacids (eg, Ca2+ or Mg2+)
Also dont take with iron preparations
This is because tetracyclines bind to divalent cations→ inhibit drugs’ absorption in the
gut.
Broken bone= inhibits bone growth → stunted growth in kids, fractures in adults
(Tetracycline binds to the Ca2+ ions in bones before it can mineralize)
Bloody, knocked out tooth= discoloration of teeth (it demineralizes the teeth bones)
Tarantula = teratogenic
Sunburn in the desert = photosensitivity
Vomit = GI upset
Vomit all over face = Used for acne
Kicking bicycle off the road - keeping drug out of the cell = Resistance occurs through
decreased uptake or increased efflux out of bacterial cells by plasmid-encoded transport
pumps
Minocycline: causes drug induced Lupus
Doxycycline:
Doxx means to make something public which shouldnt be public
And community acquired MRSA should also not be spread through the community
Doxycycline is used for community acquired MRSA

Tigecycline
Tiger = Tigecycline
30 day calendar = blocks 30S ribosomal subunit (binds to 30S and prevents attachment of
tRNA binding)
Tiger has murdered all the other animals = last resort for multidrug resistant organisms
(MRSA, VRE)
Seasick = causes GI upset
Bleeding scratch = causes bleeding (monitor Hct and RBC count) - main reason we use it
as last resort
Chloramphenicol
Chlorine ramp= Chloramphenicol
50 states = inhibits 50S ribosomal subunit - by blocking peptidyltransferase enzyme
Used as 2nd or 3rd line in: Meningitis (H.influenza, N. meningitidis, s.pneum) and
Rickettsial diseases
Gray baby on baby monitor = causes Gray Baby syndrome - seen in premature infants
because they lack liver UDP-glucuronosyltransferase→ present with grey skin, vomiting,
lethargy, cardioresp suppression
Empty wine glass = causes anemia (dose dependent- so increased dose means more
severe anemia, and stopping drug will reverse anemia)
Empty broken bones of dog = causes aplastic anemia/ bone marrow failure due to
autoimmune response (dose independent- stopping drug wont reverse anemia)
Spider = teratogenicity
Spider clinging onto dog = inactivated via acetyl transferase (plasmid encoded)
Just remember both MOA and resistance mechanism is by a trasnferase enzyme
Lincosamide: Clindamycin
Kleenex = Clindamycin
50 cent Kleenex tissues = binds to 50S subunit of bacterial ribosome - blocks/interferes
with peptide transfer (ie translocation) → decreased protein synthesis
Holding breath = used to treat anaerobic infection (above the diaphragm)- eg aspiration
pneumonia, lung abscess, oral infections
Remember Clindamycin ABOVE the diaphragm, Metronidazole BELOW the diaphragm
for anaerobes
Diarrhea like smelly mud = causes C. difficile/ pseudomembranous colitis
Diffuser = difficile
(Clindamycin is broad spectrum, wipes out gut flora and causes C. difficile overgrowth)

Oxazolidinones: Linezolid
Linen = Linezolid
50 cents for laundry machine = binds to 23S rRNA of the 50S ribosomal subunit →
prevents initiation complex formation→ decreased protein synthesis (theres no initiation
of laundry machine)
Used as last resort to treat antibiotic-resistant bacteria (esp MRSA, VRE) - has lots of
side effects
Falling chicken bones = causes bone marrow suppression - anemia, leucopenia,
thrombocytopenia or all three at once (pancytopenia)
Smiley faces = causes serotonin syndrome (cus it inhibits MAO which breaks down
serotonin)
Frayed sparking wire of laundry machine = neuropathy - in periphery (peripheral
neuropathy) or eyes (optic neuritis- loss of vision)
Closing her eyes to smell the laundry = remember optic neuropathy
Macrolides: Azithromycin, clarithromycin, erythromycin)

Macroroni Grill is celebrating its opening of its chain restaurants in all 50 states:
Macaroni = Macroroni Grill
50 states = binds to 23S rRNA of 50S ribosomal subunit - blocks translocation→
decreased protein synthesis
Mechanism of resistance = Methylation of 23 rRNA binding site (imagine that girl is
Anjali Methyl who drank too much and is throwing up lmao)
Throw to win = thromycin suffix (Azithromycin, clarithromycin, erythromycin)
Uses- remember from Sketchy vids - Atypical pneumonias (Mycoplasma, Chlamydia,
Legionella), STIs (Chlamydia), gram ⊕ cocci (streptococcal infections in patients
allergic to penicillin), and B pertussis
Side effects:
1) Liver shaped lever to unfurl the banner = cholestatic hepatitis
2) Beer bong = inhibits sips (doesnt let people calmly sip their drink)= inhibits CYP
3) vomiting = GI motility issues (Hypertrophic pyloric stenosis in infants and laxative
effect esp with Erythromycin) - imagine someone holding a cocktail with an olive in it
(like olive shaped mass)- it is a motilin receptor agonist
4) twisted streamers = Torsades de Pointes - QT prolongation
Clarithromycin- is embryotoxic
Clarithromycin and Erythromycin inhibit CYtochrome P-450 enzymes in liver → can
cause drug interactions:
Increases theophylline and oral anticoagulants (Warfarin) serum levels by decreasing
liver clearance due to CYP3A4 inhibition
(CYP3A4 is a type of enzyme under CYP450)
Azithromycin doesnt affect CYP enzyme so its safe to give in pts with liver problems.

Polymyxins
Pancake mix, mixer = Polymyxins
Colander = includes Colistin (Polymyxin E)
Tearing open plastic wrap = disrupts cell membranes (Cation polypeptides bind to
phospholipids on cell membrane of gram ⊝ bacteria and increase membrane
permeability)
Uses: not used first line for anything - used as last resort for severe MDR gram -ve
bacteria (K. pneum, E.coli, P. aeruginosa) - cus it has so many side effects

Polymyxin B is a component of a triple antibiotic ointment used for superficial skin

infections. (Polymyxin B, Neomycin, Bacitracin)
Falling kidney shaped jelly beans = nephrotoxicity
Sparking wire of mixer = neurotoxicity eg, slurred speech, weakness, paresthesias - ie
affects both CNS and PNS
Broken vent = Respiratory failure (neurotoxicity of phrenic nerve)
Sulfonamides/ Sulfa Drugs
Imagine a halloween party in Hell - sulfurous flames and sulfurous deviled eggs and
everyone dressed up in costumes
Sulfur flames and eggs = Sulfonamides
Panda costume = PABA analog
Panda sitting on Two illuminati Pyramids = inhibits DiHydroPteroate synthase
Panda eating eggs instead of bamboo = inhibits folate synthesis
SMX (sulfamethoxazole) is bacteriostatic by itself, and becomes bactericidal when
combined with Trimethoprim
Adverse effects:
1) People burning skin in hell = Hypersensitivity reactions, photosensitivity
2) Person burning in hell with red skin melting off his face = Steven Johnson Syndrome
2) crushed red M&Ms on the floor= hemolytic anemia in G6PD drugs (imagine a crashed
G6 jet in hell)
3) falling jelly beans = nephrotoxicity (interstitial nephritis)
4) yellow candy corn = kernicterus in infants
5) deviled eggs without the white = sulfonamides displace other drugs in albumin (eg
warfarin)
6) beer keg = CYP inhibitor
Mechanisms of resistance: Altered DHP synthase enzyme, decreased uptake, or increased
PABA

Trimethoprim:
Panda sitting on a foal = inhibits folate synthesis (inhibits dihydrofolate reductase)
A demon is cooking using the sulfur flames - holding an empty pan (pancytopenia) -
veggies have fallen to the floor (decreased folate) and a huge stalk of bananas are
suspended from the ceiling (hyperkalemia)
Foal melting in white colour acid = Folinic acid (Leucovorin) is co administered to
prevent pancytopenia
Dapsone
Danger zone = dapsone
Rearing foal = inhibits folate synthesis (similar to sulfonamides but different structure)
Leopard = used in leprosy
Coughing man = pneumonia, cane = immunocompromised; treats Pneumocystis jirovecii
G6 jet and smashed tomatoes = causes hemolytic anemia in G6PD deficiency
Pile of broken bones = may cause bone marrow failure/agranulocytosis
Rusty three pronged pitchfork = Fe3+ = may cause methemoglobinemia

Fluoroquinolones
Its the mother bday
Flowers = fluoroquinolones
Floss = -floxacin suffix
Gyro sandwich = inhibits prokaryotic enzyme DNA gyrase (Topoisomerase II) and
Topoisomerase IV→ messes up the DNA unwinding→ dsDNA breaks→ decreased DNA
replication and transcription (Bactericidal)
Top = Topoisomerase IV
Grabbing ankle and sock ripping = causes tendonitis /tendon rupture, especially >60 yrs
Chips (Ciprofloxacin) and beer bong (inhibits sips) = Ciprofloxacin inhibits CYP
enzymes
Tums = avoid with antacids - FQs bind to divalent ions (like Ca2+ in dairy, Mg2+ in
antacids, Fe2+ in oral iron)
No kids allowed to party = avoid in children - causes teeth and bone defects - it binds to
Ca2+ before it can bind to bones
Old beer bong from college days has spiderweb and tarantula = teratogenic - Ca2+
binding causes skeletal defects in fetus
Twisted streamers = torsades de pointes (QT prolongation)
Resistance mechanism: Chromosome-encoded mutation in DNA gyrase, plasmid-
mediated resistance, efflux pumps
Daptomycin
Deputy = Daptomycin
Ripping plastic wrap = disrupts cell membranes (creates transmembrane channels)
Purple grape jelly donuts = treats gram positive bacteria (esp MRSA, VRE)
Broken fan carried out = the drug gets inactivated in lung , ie it cannot treat pneumonia -
it avidly binds to and is inactivated by surfactant
Strained muscle = myopathy → may escalate to rhabdomyolysis

Metronidazole
Metro = Metronidazole
Spilling radishes = forms free radicals (bactericidal, antiprotozoal)
Drunk person who is sick = disulfiram like reaction with alcohol: severe flushing,
tachycardia, hypotension
Hitting tongue on metal pole = metallic taste in mouth
Treats anaerobic infection below the diaphragm vs clindamycin (anaerobic infections
above diaphragm)
Rifamycins: Rifampin, rifabutin, rifapentine
Rifle = Rifamycin
Making ribbon = ribonucleic acid ; inhibits RNA polymerase
Inhibit DNA-dependent RNA polymerase → decreased mRNA synthesis
Orange soda = causes red orange discoloration of bodily fluids- urine, sweat, saliva, tears
(non hazardous adverse effect)
Straw glasses = induces/increasing sips; Rifampin induces CYP enzymes → decreases
levels of other drugs to subtherapeutic levels → Thus in pts with HIV & TB, we use
Rifabutin instead → less metabolization of the anti HIV drugs
Liver shaped lever = causes hepatotoxicity
Rifamycin resistance arises due to mutations in gene encoding RNA polymerase

Isoniazid (INH)
Ice knife = Isoniazid
Popping tube = TB ; impairs synthesis of mycolic acid ie it treats Tuberculosis
Cat knocking over peroxide = activated by bacterial catalase peroxidase (coded by KatG
gene)
KitKAT next to peroxide = INH resistance arises due to mutations in katG gene
Falling settlers board game = acetylators; side effects more common in slow acetylators
ie have low level of acetylase
Acetylase metabolizes the drug in liver - so different INH half-lives in fast vs slow
acetylators- and slow acetylators have more side effects cus drug stays in body for longer
Side effects:
Pyramid of sticks(six) = causes Vitamin B6/pyridoxine deficiency (peripheral
neuropathy, sideroblastic anemia)- so we have to administer INH with Vit B6
Beer bong = inhibits sips; inhibits CYP enzymes
Wolf like husky = causes drug induced lupus (lupus like reaction: discoid rash,
arthralgias) but this is reversible
Liver shaped lever = hepatotoxicity (increased risk with alcohol and older age)
Lemon snowcones = causes anion gap metabolic acidosis
Pyrazinamide
Pirouette off diving board = Pyrazinamide
Floating tube = treats Tuberculosis
Liver lever = hepatotoxic
Stubbed toe ie podagra = causes gout/hyperuricemia
At lower pH ie more acidic conditions, uric acid crystals are formed - and Pyrazinamide
works best in acidic conditions
Lemon on tube = likes acidic conditions (eg hosts phagolysosome)
Ethambutol
Thimble/thumb = Ethambutol
Arabian tapestry, arabic letters = inhibits arabinosyltransferase → decreased
arabinogalactan synthesis→ decreased cell wall synthesis
Pool tube = treats Tuberculosis and also MAC
Old blind woman squinting, blinded by light = optic neuropathy (red green
colorblindness, decreased visual acuity, central blind spot aka scotoma) - but this can be
reversed by stopping the drug

ANTIFUNGALS

Hipster restaurant serving frogs

Amphibian = Amphotericin B
Ear gauge = binds ergosterol
Frog going through hole in ear = creates holes in fungal membrane
Used to treat severe fungal infection - cus it has a lot of side effects
Acute Reactions:
1. Blood streaks down arm = IV phlebitis (pain and redness in arm after infusion)
2. Large flames under pot = fever and chills
3. Falling pressure cooker = hypotension
Chronic Side Effects:
1. Empty red wine vinegar = anemia
2. Falling kidney beans = nephrotoxicity and nephrogenic Diabetes Insipidus
(Nephrotoxicity can be reduced with adequate hydration)
3. Falling fridge magnets = hypomagnesemia- muscle spasms, cramps, arrhythmias
 4. Falling bananas = hypokalemia- fatigue, muscle cramps, arrhythmias (prolonged
QT formula)
Reduced K and Mg are due to altered renal tubule permeability
Liposomal Amphotericin B has reduced toxicity - the fat wrapped around it makes it do
less damage

Nystatin
Nissan car = Nystatin
Ear gauge = binds ergosterol
Ear hole = forms hole in fungal membrane (same as Amp B)
Road map of Canada, Canada flag = treats Candidiasis
Lotion bottle = topical administration - for diaper rash, vaginal candidiasis
Swishing mouthwash = swish and swallow for oral thrush
Its too toxic for systemic use
Swallow to reach back of throat and esophagus - it doesnt enter body it just gets pooped
out

Flucytosine (5-FC)
Fleece = Flucytosine
Fluorescent glow stick = converted into 5-fluorouracil (5-FU)
Broken spiral stairs = inhibits DNA polymerase
Untying ribbon = inhibits RNA polymerase
Ie, inactive flucytosine (5-FC) gets converted to active 5-FU by the fungal enzyme
cytosine deaminase → inhibits DNA and RNA polymerase→ decreased protein synthesis
Crypt coffin = treats Cryptococcus
Broken bones = bone marrow suppression
(5-FU is a chemotherapy drug used for cancer - causes bone marrow suppression in these
pts too)

Azoles
pineCONes = azoles
Falling ear gauge = inhibits ergosterol synthesis ( by inhibiting Cytochrome P-450
enzyme which converts lanosterol to ergosterol- by inhibiting 14 alpha-demethylase)
Beer bong = inhibits sips = inhibits CYP enzymes
Broken android phone = antiandrogenic effect: gynaecomastia, impotence, decreased
libido
Coconut bra on man = gynaecomastia
Keys = Ketoconazole
Keys next to phone = Ketoconazole has greatest anti-androgenic effect
Green and queasy face = GI upset
Liver shaped lever = hepatotoxic (inhibits CYP 450)
Twisted streamers = Torsades de pointes/ QT prolongation
Terbinafine
Turbine= Terbinafine
Squash = inhibits squalene epoxidase (which forms lanosterol)
Tin man = Tinea (aka Dermatophytes)
Dirty fingernails = treats onychomycosis (fungal infn of toes or fingers)
Green queasy face = GI upset
Loss of appetite = loss of taste (dysgeusia)
Painful bump on head = headache
Liver lever of turbine = hepatotoxicity

Echinocandins
Echo, canyon = Echinocandin
Fudge= -fungin endings (caspofungin, micafungin)
Falling bottle of glue = inhibits beta -GLU-can
Hole in wall = prevents cell wall synthesis
Canada patch = treats Candida (remember guy wearing cap in Canada aka Caspofungin)
Asparagus = treats invasive aspergillus
Sizzling liver = hepatotoxicity
Kids face red from yelling = flushing due to histamine release
Griseofulvin
Grease = Griseofulvin
Broken tubing = disrupts microtubules (disrupts mitosis)
Tin man = treats Tinea
Dirty fingernails = onychomycosis (the drug deposits in keratin-containing tissues like
nails)
Sippy straw glasses = induces sips ; induces CYP enzymes - so increases warfarin
metabolism→ decreases warfarin levels→ blood clots
Queasy holding bottle of booze= disulfiram reaction to alcohol
Sunburn = photosensitivity
Tarantula = teratogen

Chloroquine , Hydroxychloroquine
chloro -clean = Chloroquine
Plasma TV = treats Plasmodium species/malaria (except P. falciparum)
Throwing out bottles of chloroclean = resistance develops through efflux - this is why
Plasmodium falciparum is Chloroquine resistant
He-man = heme; blocks heme breakdown (Heme polymerase breaks down heme into
hemozoin)--> toxic heme accumulates
Red irritated eyes = causes retinopathy
Muscle injury = causes myopathy
Itchy skin = causes pruritus
Used to treat SLE also
Antihelminths:
➕Mebendazole - tubes are bendy cus theyre hollow - microtubule inhibitor to treat
“bendy worms”
➕Praziquantel- sounds like pretzel- imagine a cream filled pretzel- full of cream
(increased Ca2+ permeability causes increased Ca2+ in cell) and inside the pretzel there's
a hole for the cream (increased vacuole formation)

Oseltamivir and Zanamivir

Ostrich = Oseltamivir, Zone = Zanamivir
Travel vaccine with influenza checked = treats influenza A & B
Beginning therapy within 48 hours of symptom onset may shorten duration of illness.
Neurds candy = inhibits Neuraminidase
Ostrich catching released neurds = inhibits viral progeny release
Green and queasy face = GI upset
Baloxavir:
Baloo the bear = Baloxavir
Baloo is stopping Kaa (virus) from snatching Mowgli's (host cell) cap = Baloxavir
inhibits cap snatching (transfer of the 5′ cap from cell mRNA onto viral mRNA) activity
of endonuclease activity of influenza virus RNA polymerase→ decreases viral RNA
replication (remember endo since Kaa needs to lay his eggs inside the cap)
Kaa needs the cap to lay his eggs in = inhibits viral replication
Treatment within 48 hours of symptom onset shortens duration of illness
Remdesivir:
Rum = Remdesivir
It's an office Christmas party, everyones drinking alcohol to warm up 🎉
Rum (Remdesivir) and corona beer (Coronavirus) with crochet sleeves on it (sleeve cus
corona is enveloped virus)
Battery powered sleeve = ATP
Remdesivir is prodrug of ATP analog
Christmas present: sun genome necklace mold = RNA dependent RNA polymerase
which uses sun necklace (+ve sense genomic RNA) to make full length -ve sense RNA
Some idiot got drunk and is destroying a gift cus its a shitty gift (its not even a necklace
its just a necklace mold which is useless) 😣
Rum bottle smashing necklace mold = Remdesivir inhibits viral RNA-dependent RNA
polymerase
He didn't get caught by his manager whos outside smoking= Remdesivir evades
proofreading by the viral exoribonuclease (ExoN) which mediates RNA replication
(remember EXOnuclease cus the boss is outside)
Acyclovir, famciclovir, valacyclovir
Recycling = -cyclovir
Valacyclovir is just Val + Acyclovir ; Valacyclovir, a modified prodrug of acyclovir, has
better oral bioavailability
Broken helical pasta which looks like dsDNA = inhibits viral DNA Polymerase
This is a green recycling plant - green for Guanosine analog
Fox = requires Phosphorylation by viral thymidine kinase - without it there chain
termination
Resistance through mutation of viral thymidine kinase
No activity in CMV cus it lacks the thymidine kinase necessary to activate guanosine
analogs
Thymidine kinase does mono phosphorylation (theres only 1 fox) and the next two
phosphates are added by cellular enzymes (to form triphosphate)
Also no effect in virus uninfected cells→ so very few side effects
Simpson = simplex virus (HSV1/2)- treats mucocutaneous , genital lesions, encephalitis
No effect on latent forms of HSV and VZV (ie, it doesnt cure but only prevents
breakouts)
Vermicelli = treats VZV
Falling jelly beans = nephrotoxicity , Crystal bowl = Obstructive crystalline nephropathy
Ganciclovir/Valganciclovir
Gangster = Ganciclovir
Valganciclovir, a prodrug of ganciclovir, has better oral bioavailability
Broken helical pasta that looks like dsDNA = inhibits Viral DNA polymerase
Fox shawl = fox-phates = requires phosphorylation by viral kinases
Resistance: Mutated viral kinase
Gan for Guanosine analog
5′-monophosphate formed by a CMV viral kinase (Only 1 fox)
Triphosphate formed by cellular kinases
CaMperVan = CMV
Empty bone marrow dish = bone marrow suppression & pancytopenia
Falling kidney beans = nephrotoxicity
Gancyclovir is more toxic- it can get activated in normal cells too- inhibits hosts DNA
polymerase - cells that replicate fast eg stem cells in bone marrow are most affected→ so
we may give Gancyclovir with hematopoietic growth factors like G-CSF, GM-CSF
Foscarnet
Faucet = Foscarnet
Broken spiral staircase = inhibits DNA polymerase
Untying ribbon = inhibits RNA polymerase
Broken rewind button of his Walkman = inhibits Reverse Transcriptase
No foxes = no phosphorylation required; Foscarnet directly binds to Pyrophosphate-
binding site of enzyme
Fox on fire = Pyrophosphate
Since no phosphorylation needed→ good for viruses with mutated viral kinases → used
in CMV retinitis and colitis in immunocompromised patients when ganciclovir fails and
used for Acyclovir resistant HSV
Simpson = herpes simplex
CaMperVan = CMV
Falling jelly beans = nephrotoxicity
Falling cow-cium ice cream = hypocalcemia - leads to seizures
Shaking homer = seizures
Cidofovir
Cider farms= Cidofovir
Broken twisted ladder = inhibits DNA Polymerase
No foxes sign = Does not require phosphorylation by viral kinase.
Since no phosphorylation needed→ good for viruses with mutated viral kinases → used
in CMV retinitis and colitis in immunocompromised patients when ganciclovir fails
CamPerVan = treats CMV
Simpson = treats herpes simplex
Falling jelly beans = nephrotoxicity (Cidofovir has long half life)
pH probe for the plants = Probenecid
Coadminister cidofovir with probenecid and IV saline to decrease toxicity

NRTIs
We are at a senior home, there is a cooking fundraiser with stalls to raise money
Broken rewind of VHS player = Nucleoside Reverse Transcriptase Inhibitor/ NRTIs
They are Nucleoside analogs - so they competitively inhibit nucleotide binding to reverse
transcriptase and terminate the DNA chain (lack a 3′ OH group)
NRTIs lack a terminal 3’ OH group→ new nucleotides cant be added → premature chain
termination
Just like the record player is getting jammed - NRTIs jam up the active site of reverse
transcriptase
1. Abacus = Abacavir (ABC)
2. Elmo = Emtricitabine (FTC)
3. Lamp = Lamivudine (3TC)
 4. Ziploc bag = Zidovudine (ZDV, formerly AZT)
5. Stove = Stavudine
6. Dino nuggets = Didanosine
7. Tent = Tenofovir (TDF)
Cane = used for HIV
Parking meter = Phosphorylation needed to convert nucleoside to active nucleotide

Tent is already occupying parking spot = Tenofovir already activated, ie it is a

nucleotide- does NOT require Phosphorylation
Tenofovir can cause Fanconi syndrome→ causes proximal convoluted tubular
dysfunction with glomerular sparing
Rest of NRTIs are Nucleosides
Hypersensitivity = Abacavir causes hypersensitivity
Heinz 57 Beans = This hypersensitivity is associated with HLA-B*5701 mutation
Dino nuggets (Didanosine) in fiery pan (pancreatitis)= Didanosine causes pancreatitis
Bone marrow dish falling = Bone marrow suppression - we can give EPO, G-CSF, GM-
CSF
Bone marrow in Ziploc = Zidovudine especially causes bone marrow suppression
Zidovudine - used for general prophylaxis and for pregnant women (Ziploc has
something inside of it just like a pregnant woman)
Throwing away grease = lipoatrophy - sunken facial appearance, wt loss
Spilled milk = lactic acidosis
Sparking wire = neuropathy
Pan on fire = acute pancreatitis

Non Nucleoside Transcriptase Inhibitors / NNRTIs

Broken rewind on touch display = Non Nucleoside Transcriptase Inhibitors / NNRTIs
This touch display has no active site (unlike the tape recorder) - NNRTIs do not act as
nucleoside analogs and do not competitively inhibit the active site of RT enzyme
Neverland movie = Nevirapine
Dreaming about Elf = Efavirenz
Broken rewind = Inhibit reverse transcriptase
Cane = treats HIV
No parking sign on the highway = No Phosphorylation (P)
Rash around spider bite = rash→ can develop into SJS, TEN syndrome
Tarantula = teratogenic
Liver shaped lever = hepatotoxicity
Elf dream cloud = Efavirenz causes vivid dreams
Kid shaking from impact = Efavirenz causes CNS symptoms

Integrase Inhibitors/Integrase strand transfer inhibitors

Black Friday shopping sale - there is a long line of shoppers and this old man is trying to
cut into the line
Preventing cutting in line = Integrase inhibitor
(Integrase integrates/inserts its viral DNA in between host DNA just like this old man is
trying to wedge himself into this line)
Price tag : all end with -tegravir; Dolutegravir, Raltegravir (teg is from Integrase and
vir is for targeting virus)
Cane = treats HIV
Sore muscles = Myositis - there will be ⬆️creatine kinase
Weight gain = cashier is beefy , heavyweight

Highly Active Antiviral Therapy (HAART):

Regimen consists of 3 drugs to prevent resistance: 2 NRTIs and preferably an integrase
inhibitor.
Most ARTs are active against both HIV-1 and HIV-2 (exceptions: NNRTIs and
enfuvirtide not effective against HIV-2).
Tenofovir + emtricitabine can be administered as pre-exposure prophylaxis
Pre-exposure prophylaxis would be highly used by gay people especially at Pride;
Imagine a pride Tent (Tenofovir) selling gay Elmo (Emtricitabine) pins
Protease Inhibitors/PIs
We’re on a Navy ship, a chef is preparing meat while a hazing for new recruits occurs
Broken meat cleaver = protease inhibitor
Navy = navir ending; Atazanavir Darunavir Lopinavir Ritonavir
Ritz crackers = Ritonavir
Cane = treats HIV
HIV-1 protease (pol gene) cleaves the polypeptide products of HIV mRNA into their
functional parts.
Thus, protease inhibitors prevent maturation of new virion/virus.
Beer bong which inhibits sips = Ritonavir inhibits CYP enzymes → so it can boost
activity of other PIs by allowing a smaller amount of drug be given (since they will get
degraded less by CYP enzymes) BUT it will also increase warfarin, theophylline levels
to supratherapeutic levels → pt will be bleeding risk
All protease inhibitors require boosting with either ritonavir or cobicistat
Rifampin (potent CYP/UGT inducer) reduces protease inhibitor concentrations; use
rifabutin instead.
Bully eating lots of sweets = causes hyperglycemia
seasick and vomiting = GI upset
Kidney shaped water skin = causes renal toxicity
Broken plate = causes thrombocytopenia
Butter on tummy pocket = causes lipodystrophy/Cushing- like syndrome - fat
redistribution to abdomen
Chef cooking with pan in flames = acute pancreatitis

Entry Inhibitors
Secret society is holding an auction and a young kid is spying on the auction, while
stealing their fancy snacks
No entry sign = entry inhibitor
Infused water = Enfuvirtide
Mozart's symphony 41 = Enfurvitide binds gp41
Enfuvirtide inhibits fusion→ virus cant enter cell (Fu stands for fusion)
Marinara sauce = Maraviroc
CamCordeR = CCR; Maraviroc binds CCR5 on T-cells/monocytes
120 Volt outlet = gp120; Maraviroc blocks gp120 from attachment (Maraviroc inhibits
docking)
cane= treats HIV

NS5A Inhibitors
NewsStand on 5th Avenue = NS5A
Advert = -asvir ending: Ledipasvir, Ombitasvir, Velpatasvir, Elbasvir
Inhibits NS5A , a viral phosphoprotein that plays a key role in RNA replication -Exact
mechanism unknown
Hi-C drink = treats Hepatitis C
Asvir = A V(5) inhibitor

NS5B Inhibitors
5$ dollar below store for kids below 5 - store opening
New Store = NS, 5 Below = 5B
Beaver toy = -buvir ending: Sofosbuvir, Dasabuvir
Snapping hair ribbon = inhibit RNA polymerase
Inhibits NS5B, an RNA-dependent RNA polymerase acting as a chain terminator→
inhibits viral RNA replication
Hi-C drink = treats Hepatitis C
Buvir = B V (5) inhibitor

NS3/4A Inhibitors
New students= NS, Platform 3/4= 3/4A
Private = -previr ending: Glecaprevir Grazoprevir (the platform is private- no muggles)
Dudley ran into the wall with a knife trying to kill Harry
Bent steak knife = inhibits viral proteases
Hi-C juice = treats Hepatitis C
Ribavirin
Ribs = Ribavirin
Treats RSV (RIP grave)
3 headed grave robber (3 heads=hydro) looking for IMPurities (IMP) in Pure Ring
(Purine)
Tarantula = teratogenic
Broken red gems = hemolytic anemia

H2 Blockers
Misthrown horseshoes = H2
Cemetery = Cimetidine
Rent sign = Ranitidine (has been recalled, not used anymore)
Family = Famotidine
Hole in shirt = treats peptic ulcers
Spitting beer = treats acid reflux/ GERD
Beer bong = sip inhibition; Cimetidine inhibits CYP enzymes
Coconut bra = Cimetidine causes Gynaecomastia (also (prolactin release, impotence,
decreased libido in males)
Crosses BBB and placenta
Confused drunk man = CNS effects: confusion, dizziness, headaches

Proton Pump Inhibitors (-prazole drugs)

Pretzel = -prazole ending (Omeprazole, lansoprazole, esomeprazole, pantoprazole,
dexlansoprazole)
grapefruit=acid, broken pump = inhibited ; PPIs inhibit acid secretion
Irreversibly inhibit H+/K+-ATPase in stomach parietal cells.
Acid falling through pretzel hole = treats peptic ulcer disease
Acidic vomit = treats acid reflux/GERD
Fractured table = fracture risk; decreases Calcium, Magnesium absorption in gut
Increased susceptibility to infections (cus less acid)- increased risk of C difficile
infection, pneumonia, acute interstitial nephritis
Beer bong = sip inhibiting; CYP 450 inhibitor

Antacids
Neutralizing acid with baking soda = antacids
magnet= Magnesium, water = hydroxide; Magnesium hydroxide (milk of magnesia)
 Spilling water = wet feces aka diarrhea
  Can cause Magnesium toxicity = Hyporeflexia, Respiratory failure, Cardiac arrest
(Remember monitoring for Magnesium toxicity in those eclampsia patients on
MgSO4?)


Ice cream= calcium, soda = Carbonate; Calcium carbonate (Tums)
 Calcium carbonate causes hypercalcemia
 Milk-alkali syndrome is characterized by a triad of elevated calcium levels,
metabolic alkalosis, and acute kidney injury
Aluminum boats, water= hydroxide; Aluminum Hydroxide
 Boats are dry = dry feces aka constipation
 Since Ca and Phosphate are inverse, theres high Ca in ice cream float and
Hypophosphatemia below→ osteodystrophy, proximal muscle weakness, seizures
 (Aluminum hydroxide binds to phosphate to form aluminum phosphate)
Reduced color absorption in flowers = antacids reduce oral absorption of
fluoroquinolones
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering
gastric and urinary pH or by delaying gastric emptying. All can cause hypokalemia.

Bismuth & Sucralfate

Biscuit = Bismuth (Pepto Bismol)
Sucrose packets = Sucralfate
Acidic grapefruit juice dripping through holes = treats peptic ulcer
Biscuits and sugar packets soaking up acid = Bind to ulcer base, providing physical
protection and allowing HCO3 – secretion to reestablish pH gradient in the mucous layer
Spilling coffee over pants = treats secretory diarrhea (ie diarrhea caused by excess
hormones eg VIPoma, carcinoid syndrome) - Bismuth reduces intestinal motility
Pumpernickel bread = causes harmless black stool
Bismuth used in quadruple therapy for H pylori, but not Sucralfate. Why? Cus Sucralfate
requires acidic environment, not given with PPIs/H2 blockers.
Misoprostol
Miso soup = Misoprostol
PaGE 1 = PGE1; prostaglandin PGE1 analog (Miso is basic japanese staple, found on
page 1 of the cookbook)
Lemons in trash = decreases gastric acid production
Mucus like seaweed = increases mucus production
Sled = NSAID, hole in wall = ulcer; Prophylaxis of NSAID induced peptic ulcers
Angry pregnant wife = induces labor/abortion (ripens cervix)
Contraindicated in patients of childbearing potential (abortifacient)

Octreotide
Octagon sign = Octreotide
Stop sign = somatostatin analogue
Monster truck = giant; treats acromegaly/gigantism (inhibits GH release)
Large veins in neck = treats esophageal varices - it inhibits glucagon production (a
splanchnic vasodilator). In advanced liver disease, portal vein gets blocked, leading to
portocaval shunting such as esophageal varices. Somatostatin causes splanchnic
vasoconstriction and thus less blood flowing through esophageal varices.
Leaking brown oil = used in secretory diarrhea (ie diarrhea caused by excess hormones
eg VIPoma, carcinoid syndrome)
Stones falling = increases risk of gallstones (cus it inhibits CCK release)
Diphenoxylate & Loperamide
Dyed socks = Diphenoxylate
Loafers = Loperamide
Muddy shoes = treats diarrhea
Poppy flowers = activates opioid receptors (but have poor CNS penetration- low
addictive potential)
Muddy loafers not allowed inside = Loperamide doesnt cross BBB
Dyed socks allowed inside = Diphenoxylate can cross BBB, so drug abuse is prevented
by giving it with Atropine - anticholinergic and antimuscarinic effects
TROPical theme = Atropine
May cause constipation, n/v
Twisty streamers = Loperamide can lead to QT prolongation / Torsades

Ondansetron, Granisetron
Honda = Ondansetron
Vomiting = antiemetic
Kicking happy face = antagonizing serotonin - serotonin 5-HT3 antagonist- decreases
vagal stimulation
All antiemetics act centrally in chemoreceptor trigger zone of area postrema.
Spilling happy face stickers = serotonin syndrome
Twisty streamers = QT prolongation / Torsades de Pointes
Metoclopramide
Metal claw = Metoclopramide
Ruined dress shoes = D2 receptor antagonist
Antiemetic drug
All antiemetics act centrally in chemoreceptor trigger zone of area postrema.
Squeezing chocolate out of bottle = increases GI motility ie increases gastric emptying
and decreases LES tone - thus useful in gastroparesis (eg, diabetic), persistent GERD
Sticking tongue out = can lead to Tardive Dyskinesia (an extrapyramidal symptom)
NOTE: Metoclopramide is contraindicated in small bowel obstruction because it is a
prokinetic agent that increases gastrointestinal motility. If there is an obstruction,
stimulating motility could lead to increased pressure at the site of the obstruction,
risking bowel perforation or ischemia.
Also contraindicated in patients with defective D2 signalling eg Parkinsons patients
D2 inhibition (by metoclopromide and antipsychotics)--> can cause neuroleptic
malignant syndrome
Aprepitant , fosaprepitant
Apron = Aprepitant
Vomiting = antiemetic
Peas = P; blocks substance P aka Neurokinin-1/NK-1
All antiemetics act centrally in chemoreceptor trigger zone of area postrema.
Blocking NiKon camera = antagonizes NK1 receptors
Cooking a crab = cancer ; used to treat Chemotherapy-induced nausea and vomiting

Orlistat
Oily stain = Orlistat
Dropped butter knife = inhibits gastric and pancreatic lipase
Before and after weight loss pic = used for weight loss
Splattered yellow butter = steatorrhea
Falled vitamin pills = causes fat soluble vitamin deficiency (ADEK)- esp Vit K
deficiency can present with bleeding

Bulk forming laxatives: Psyllium , Methylcellulose

Psyllium = silkworm, methylcellulose = mulberry leaf
Muddy pile of leaves = bulk forming laxative
Dew on leaves = promotes water absorption (water gets pulled into gut lumen, forming
viscous liquid that promotes peristalsis)
Diarrhea like mud = treats constipation/ causes diarrhea

Senna
Sauna = Senna
Belly massage = enteric/intestinal stimulation
Dark brown oil = laxative, causes diarrhea
Tan client = melanosis coli
Docusate: Emollient Laxative
Document = Docusate
Brown coffee spilling = laxative, causes diarrhea
Soft document holder = stool softener
Lubiprostone
Imagine someone having sex in a hot tub with a bottle of Lube oil
Lube = Lubiprostone
Cus of the heavy action, brown lube oil is spilling everywhere = diarrhea
And the chlorinated water is spilling everywhere = Chloride channel activator which
increases intestinal fluid secretion

Loop knots = Leuprolide

Revealing underwear = gonadotropin-releasing
Many small loops = Pulsatile short dosing
More fish = FSH, looking at lighthouse=LH= Pulsatile dosing: increased FSH and LH (ie
GnRH agonist)
One large long loop = Long continuous dosing
Caught no fish, cannot look at lighthouse= continuous dosing causes decreased FSH and
LH (ie GnRH antagonist) - causes decreased estrogen in females and decreased
testosterone in males
Degarelix is a GnRH antagonist without a start up flare- used in prostate cancer
Estrogens (Ethinyl Estradiol)
Womens room = estrogens/ activate estrogen receptors
Desk, dessert = DES/diethylstilbestrol
Venus fly trap overgrowing clear vase = DES causes vaginal clear cell adenocarcinoma
in daughters of the women who take it
Hot flash = used for Hormone Replacement Therapy in post menopausal women
Throwing away wedding ring = contraception
Bloody cotton balls = increased clotting/DVT/PE risk
Dirt on uterus shaped backpack = endometrial cancer risk (if given without progesterone)
Also contraindicated in ER (Estrogen receptor) +ve breast cancer

Clomiphene (Selective Estrogen Receptor Modulators)

Clothes = Clomiphene
blocked/long line= antagonist, womens room = estrogen = blocks Estrogen receptors at
hypothalamus
Normally : Estrogen inhibits hypothalamus from releasing FSH and LH from pituitary
Clomiphene blocks estrogen receptors- so hypothalamus thinks theres low estrogen- so
increases FSH and LH release from pituitary
Falling egg shaped earrings = stimulates ovulation
Baby stroller = treats infertility
pomegranate= polycystic ovaries, facial acne = used in PCOS
Tamoxifen (SERM)
Estrogen Antagonist at breast = used to treat and prevent recurrence of ER/PR +ve
Partial Agonist at uterus and bone
breast cancer, prevent gynaecomastia in patients undergoing prostate cancer therapy
Can cause hot flashes, thromboembolic events, endometrial cancer
Raloxifene (SERM)
Antagonist at breast and uterus
Agonist at bone= used primarily to treat osteoporosis (postmenopausal women are at risk
of osteoporosis due to estrogen decline)
(Tamoxifen only antagonises breast - used for breast cancer
Raloxifene only agonises bone - used for osteoporosis)

Anastrozole (Aromatase Inhibitor)

Astronaut = Anastrozole
Also Letrozole, Exemestane
Pinching nose from aroma = Aromatase Inhibitor
Blocked womens bathroom = blocks estrogen production (inhibits peripheral conversion
of androgens to estrogen)
Pink breast cancer ribbon = treats ER positive breast cancer in postmenopausal females
Broken tripod = bone fractures and osteoporosis are side effects (since decreased
estrogen)

Progestins (Levonorgestrel, medroxyprogesterone, etonogestrel, norethindrone,

megestrol)
Projector = Progestins / activate Progesterone receptors
Jesting in class = gest
North compass = Norethindrone
Confiscated love note = Contraception
Falling eggs ie ovulation = prevents ovulation
Thick jam/mucus = thickens cervical mucus
Falling uterus shaped backpack = reduces growth of endometrial tissue
Progestin challenge - to determine if endometrium can respond to progesterone- if she
bleeds after withdrawal of progestin it indicates responsive endometrium
If she does NOT bleed after withdrawal, consider anatomic defects like Asherman
syndrome, vaginal abnormalities OR low estrogen (HPO dysfunction, premature ovarian
failure, low estrogen states)

Antiprogestin (Mifepristone, Ulipristal)

Falling projector = Antiprogestin
Muffins = Mifepristone
Competitive inhibitors of progestins at progesterone receptors
Girl blocking kiss from guy = Emergency contraception (Ulipristal)
Pink uterus shaped backpack dumping its contents = Abortion (Mifepristone with
Misoprostol)
Spilled red wine = induces vaginal bleeding (cus Progesterone maintains uterine lining)

Terbutaline
Turbo boat = Terbutaline
Rito Carlton = Ritodrine
Boat shoes = beta 2 receptors (activates beta-2 receptors ie beta-2 agonists)
Relaxing pregnant lady, flopping uterine shaped backpack = uterine relaxation/tocolysis
Beta 2 agonist - so can be used for severe asthma (causes bronchodilation)
Danazol
Dance = Danazol
Androgenic = muscular and bearded men
Partial agonist at androgen receptors
Pink mesh bag filled with footballs = treats endometriosis
Red face of coach = treats hereditary angioedema attacks
Masculinization is a side effect - weight gain, edema, acne, hirsutism, masculinization
Helmet on football player = can cause idiopathic intracranial hypertension

Flutamide
Float = Flutamide
Broken android phone = anti-androgen drug
Lump in house = treats Prostate cancer
Men with coconut bras = causes gynaecomastia

PDE-5 Inhibitor
Paddle = PDE, broken = inhibited
High five = 5
Raffle = -afil ending (Sildenafil aka Viagra, Vardenafil, Tadalafil)
Gumdrops = GMP ; increases cyclin GMP (cGMP)
Deflates noisemaker sticks = treats Erectile dysfunction
Squeezing too tightly for a hug = treats Pulmonary hypertension by causing vasodilation
Deflated sticks = causes hypotension (cus of systemic vasodilation)
PDE-5 Inhibitor + NO synergistically causes life threatening vasodilation- so its
contraindicated to use them together

Testosterone
Test tube of Testosterone
Android phone = Androstenedione
Doughnut = DHT = Dihydrotestosterone
Android charging station = activates androgen receptors
Tiny barbells = treats hypogonadism
Muscular guys = Masculinization effects- muscle growth
Acne = causes cystic nodular acne
Injuring groin = gonadal atrophy (exogenous testosterone causes pituitary to release less
FSH and LH to make less testosterone , and it causes gonadal atrophy also)

Finance guy = Finasteride

5th avenue, reduced price tag = Reductase; 5-alpha reductase
Bald patch = treats baldness
Unable to squeeze out yellow liquid = treats BPH
Minoxidil
Mint = Minoxidil
Red drawstring bag = vessel dilation, red= arterial; Direct Arterial Vasodilator
Balding man = treats male pattern hair loss/balding
Bursting pressurized pipe = treats refractory hypertension
Can cause hypertrichosis, reflex tachycardia (compensation to vasodilation)

Typical Antipsychotics / 1st Generation Antipsychotics

Scream painting in a museum = Typical Antipsychotics
1. Bright flashlight = high potency
Halo glare = Haloperidol
Flip phone = Fluphenazine
2. Dim flashlight = low potency
Chlor bleach = Chlorpromazine (risk of Corneal deposits- Chlorine will fuck up
your eyes)
Two (2) fraying (antagonism) ropes (dopamine = D2 Dopamine antagonist
Wild, crazy eyes = treats psychosis/ schizophrenia (Typical antipsychotics primarily treat
positive symptoms)
Agitated guard = treats acute agitation
Restless security guard = induces Akathisia, an extrapyramidal symptom
Robbers head tilting = acute Dystonia (eg neck muscle contractions which contort head to
one side aka torticollis, or oculogyric crisis)
Sticking tongue out = Tardive Dyskinesia
Rattling walker = Parkinsonism
(Treat Extrapyramidal symptoms with Benztropine - Dopamine and Acetyl choline have
opposing effects in basal ganglia - cholinergics can improve dopamine signaling)
Empty, breaking cola bottle = Low potency Antipsychotics have
anticholinergic/antimuscarinic effects– so fewer Extrapyramidal symptoms
Knocked over history sign = Low potency have antihistaminic side effects (eg sedation)
Dizzy robber = Low potency can cause orthostatic hypotension (anti-alpha 1 adrenergic;
alpha 1 adrenergic receptors are responsible for blood vessel contraction when you stand
up, so that blood can be pumped up to the brain. If this is blocked, can lead to orthostatic
hypertension and even syncope)
Milk bottle = Hyperprolactinemia - can cause galactorrhea, oligomenorrhea,
gynaecomastia
Sweating guard with lead pipe = Neuroleptic Malignant Syndrome (have lead pipe
rigidity and autonomic dysfunction like increased sweating)- sustained muscle
contractions can cause rigidity and hyperthermia, there will be increased creatine kinase
and myoglobinuria due to increased muscle breakdown
Twisted party streamers= Torsade de Pointes / QT prolongation

Atypical Antipsychotics/ 2nd Generation

Scream painting in cave = Atypical Antipsychotics
Armpits = Aripiprazole - partial D2 agonist
Oil lamp = Olanzapine
Claws = Clozapine
Shushing quiet = Quetiapine
Whisper = Risperidone (highest risk of galactorrhea)
Zipper = Ziprasidone
Fraying two ropes = Dopamine D2 antagonism
Crazy eyes = psychotic disorders/schizophrenia (treats positive and negative symptoms)
Claws are aggressive = Clozapine is highly potent - used for treatment resistant psychotic
disorders or with persistent suicidality
Happy and sad faces = treats Bipolar disorder (have mood stabilizing properties)
Atypical Antipsychotics are much weaker anti D2 antagonists than Typical, so they cause
less extrapyramidal and anticholinergic side effects.
broken /empty bones under claws = Clozapine causes agranulocytosis (monitor WBCs
closely)
Overweight caveman = metabolic syndrome - weight gain, hyperglycemia, dyslipidemia
(especially Olanzapine, Clozapine)
Lead pipe and sweating = Neuroleptic Malignant Syndrome (lead pipe rigidity and
sweating, hyperthermia)
QuilT with twisted stitching on zipper bag = Ziprasidone causes Torsades de Pointes/
prolonged QT
Baby bottle = Hyperprolactinemia → galactorrhea(Highest risk with Risperidone),
oligomenorrhea, gynecomastia

Lithium
Lithium battery in stage mic = Lithium
Happy and sad drama masks = treats bipolar disorder (mood stabilizer)
(Lithium is similar to Sodium, so it might compete with Na to stop action potentials)
Narrow gap in curtains = narrow Therapeutic Index - requires close monitoring of serum
levels
Disheveled tie = causes hypothyroidism
Throwing kidney shaped jelly beans = causes nephrotoxicity - causes nephrogenic
diabetes insipidus
(Lithium accumulates in cells of Collecting Duct→ interferes with ADH signalling→
nephrogenic DI)
Trembling = causes tremors/ neuromuscular excitability
Tarantula cause him to drop the mic = Teratogenic - causes Ebstein anomaly
(atrialization of RV)

Buspirone
Bus = Buspirone
Emoji happy faces/peeling happy face sticker = Serotonin (5-HT1A) Partial Agonist
Anxious face = treats General Anxiety Disorder
Next bus in 2 weeks (thats why hes so anxious) = slow onset around 1-2 weeks

SSRIs/ Selective Serotonin Reuptake Inhibitors

SuShi RIce = SSRI
Parrot fish = Paroxetine
Flour = Fluoxetine
Escalator = Escitalopram/Citalopram
Server = Sertraline
Happy faces on to go bags = increases Serotonin (by inhibiting 5-HT/serotonin reuptake)
Crying couple = treats Depression
Anxious face on server = treats Anxiety Disorder
SSRI onset takes 4-8 weeks
Rejecting kiss = Sexual dysfunction
Overloaded with happy face to go bags = Serotonin Syndrome - overactive reflexes,
clonus
Can precipitate mania if underlying bipolar disorder
Can cause SIADH

SNRIs/ Serotonin- Norepinephrine Reuptake Inhibitors

SuNRISe = SNRI
Duel = Duloxetine (used to treat depression with fibromyalgia- duels make your muscles
hurt)
VENom = Venlafaxine, Desvenlafaxine
Smiley faces = Increases serotonin signaling
North on treasure map = Increases Norepinephrine signaling
Sad crying = treats Depression
Nervous sidekick = treats Anxiety disorders
Sparking wires = treats Neuropathic pain (eg fibromyalgia, diabetic peripheral
neuropathy)
Blocking kiss = causes sexual impotence/dysfunction
Bunch of smiley faces = causes Serotonin syndrome
High pressure jetpack = causes hypertension

Tricyclic Antidepressants / TCAs

Tricycle = Tricycle
Tripping = Amitriptyline, Nortriptyline
Amazon Prame delivery service = -ipramine endings: Imipramine, Clomipramine,
Desipramine
Happy faces on survey, flying up = increases serotonin
North on map = Increases Norepinephrine
Crying delivery man = treats Depression
Also used for neuropathic pain, migraine prophylaxis
Empty cola bottle = Anticholinergic effects - dry mouth, constipation, dry skin,
tachycardia, urinary retention
Happy faces = Serotonin syndrome
Dizzy while falling = can cause orthostatic hypotension (anti-alpha 1 adrenergic; alpha 1
adrenergic receptors are responsible for blood vessel contraction when you stand up, so
that blood can be pumped up to the brain. If this is blocked, can lead to orthostatic
hypertension and even syncope)
Hearts on doormat and apron = Cardiotoxicity - arrhythmia due to Na+ channel inhibition
- prolonged QT
Baking soda = reverse toxicity with sodium bicarbonate
Bupropion
Bootprints = Bupropion
North compass = increases NE signaling (by inhibiting NE reuptake)
Rope = Increases Dopamine signalling (by inhibiting Dopamine reuptake)
Crying sad climber = treats depression (especially atypical depression, characterized by
mood reactivity)
Dropping cigarette= used for smoking cessation
Shivering = seizures, skinny/loose pants = causes seizures in anorexia/ bulimia
(contraindicated)
Kissing the climber= no sexual side effects
Loose waist of pants = causes weight loss

Mirtazapine
Mermaid = Mirtazapine
Alligator stew = alpha-2, spilling = antagonism; acts as Alpha-2 antagonist
Crossed out smiling face = acts as serotonin receptor antagonist
Harpoon gun= H1, dumping = antagonism, acts as H1 Histamine antagonist
Crying mermaid = treats major depressive disorder
Poacher sleeping in food coma - causes sedation (used for insomnia)- since its histamine
antagonist
Overweight poacher = causes weight gain , increased appetite
Guy sleeping with mouth open = dry mouth
Trazodone
Tragedy = Trazodone , traffic cone = Trazodone
Jacket with crossed out smiley face = blocks serotonin receptors
Broken harpoon gun = Histamine H1 receptor antagonist→ sedation
Dropped bottle of A1 steak sauce = blocks Alpha 1 adrenergic receptors→ priapism,
postural hypotension
Crying cop = treats Major depressive disorder
Yawning cop = sedation (Trazodone is mainly used for insomnia, cus high doses are
needed for antidepressant effects)
Large hot dog = causes priapism
Deflated car tire = hypotension

Vilazodone
Village = Vilazodone
Pile of smiley face cookies = increases H-HT(Serotonin) signalling by partial agonist of
serotonin receptor (half eaten cookie in boys hand) and inhibiting serotonin reuptake
Crying girl = treats major depressive disorder
Excess smiley cookies = causes serotonin syndrome
sick/queasy boy = causes GI symptoms
Vortioxetine
Vortex mixer = Vortioxetine
Smiley face shopping bags = increases serotonin signaling
Crying girl = treats major depressive disorder
Piles of happy face takeout bags = causes serotonin syndrome
Nauseous boy from eating so much takeout = causes Gi symptoms
Working late at night = sleep disturbance
Also sexual dysfunction

Varenicline
Varnish = Varenicline
Nicotine cigarette over ashtray = partial nicotinic agonist ( he is smoking but about to put
it out in the ashtray)--> diminishes effect on reward system
Customer backing away = withdrawal, nicotine withdrawal treatment
Overflowing brown paint = GI discomfort
Side effect: sleep disturbances
Valproic Acid / Valproate
Valet = Valproic acid
Falling Salt shaker = blocks Na+ channel
Garbage can = increases GABA
Body Shaking = acts as a broad spectrum antiepileptic
happy / sad theatre masks = treats Bipolar disorder
Also used for migraine prophylaxis
Liver shaped lever = hepatotoxicity
Tarantula = Teratogenic
Used to treat JME- Juvenile Myoclonic Epilepsy

Carbamazepine
Car magazine = Carbamazepine
Salt shaker - increases refractory period of Na+ channels
Three gems in a row = treats trigeminal neuralgia
Shaking hands = treats focal seizures (only hands are shaking)
happy / sad theater mask = treats bipolar disorder
Empty granola bar = causes agranulocytosis (and also aplastic anemia)
Straw sippy glasses= induces sips, induces CYP enzymes
Too much ADHesive = causes SIADH
Tarantula = causes teratogenicity
Lamotrigine
Limousine = Lamotrigine
Salt shaker = blocks Na + channels
breakdancing/shaking = acts as a broad spectrum antiepileptic
happy/sad masks = treats bipolar disorder
Red stain on shirt = causes Steven Johnson Syndrome
Wheel of cheese (looks like a pacman, ie phagocyte) with lymph-like garnish = causes
hemophagocytic lymphohistiocytosis (HLH)

Full Opioid Agonists

Poppy seed muffins = full opioid agonists
Mu-ffin = work on Mu opioid receptors
Phone ripped out of wall = reduces synaptic transmission
Melting ice cream (it didn't go inside fridge) = decreased Calcium influx/conductance →
prevents vesicle fusion and thus neurotransmitter release → decreased synaptic
transmission → decreased pain
Banana crate falling = increased Potassium efflux/conductance
Fountain = Fentanyl
Muffins = Morphine, Hydromorphone, Oxymorphone
barCODE = Codeine, Hydrocodone, Oxycodone
Mother = Methadone
Hero cape = Heroin
Moped for delivery = Meperidine (Meperidine is only opioid which causes Mydriasis
and decreases seizure threshold)
Causes analgesia and CNS depression
Broken fan = respiratory depression
Cannot squeeze brown frosting out of bag = Constipation
narrowing/squinting eyes in frustration = miosis (pinpoint pupils)
Fountain sink not draining, looks green = biliary colic/ Sphincter of Oddi contraction
Loyalty card = Dependence
Methadone is 1st line drug for long term maintenance of opioid use; it suppresses
withdrawal symptoms and substance cravings

Partial Opioid Agonists

Partial poppyseed muffin = Partial Opioid Agonists
Mu-ffin = activate Mu opioid receptors
Blueprint = Buprenorphine
Nails = Nalbuphine
Paint = Pentazocine
Boot = Butorphanol
The blueprint Buprenorphine is in a sheet = its used as a sublingual film to suppress
opioid withdrawal and for maintenance therapy
Pain from stepping on nail = used for analgesia
Used to wean patients from Opioids
Jumping backwards = withdrawal

Naloxone
No lox bagels = Naloxone
Destroying poppyseed bagels = Opioid antagonist
Used to treat acute opioid overdose, particularly to treat respiratory and CNS depression
Clerk backing away = acute withdrawal
Manager comes running = fast acting (used for acute opioid intoxication)

Naltrexone
No trucks = Naltrexone
Truck crushing poppy flowers = Opioid antagonist
Long detour = Long acting - used after detoxification to prevent relapse
Bar is too far = reduces alcohol dependence (it reduces cravings)

Dextromethorphan
Desktop monitor = Dextromethorphan
Poppy seed = Opioid
Its an opioid agonist
Coughing up bagel = Cough suppressant

Benzodiazepines
Benz car = Benzodiazepine
Garbage = GABA; increases GABA A activity (its an allosteric modulator- binds to site
other than the receptor)
Spinning wheel = increasing frequency of Chloride channels
Shaking car = treats Generalized seizures/ status epilepticus (Lorazepam)
Drunk driver = treats Alcohol/ Benzodiazepine withdrawal
Pregnant woman squeezing water bottle = treats eclampsia
Anxious woman = treats Anxiety disorder
Fainting salesman = causes sedation/ CNS and Respiratory depression
Renewal membership = causes tolerance/ dependence
Fumes = Flumazenil is used to reverse benzo overdose

Barbiturates
Barbeque = Barbiturates / -barbital ending
Tide pen = Thiopental
Garbage = GABA ; increases GABA A signaling
Turning dial on timer = increased duration; Increases duration of Chloride channel
opening
Shaking infant formula = treats seizures, especially in neonates (first line) -
Phenobarbitone
Used for sedation, anesthesia
Sippy straw glasses- induces sips; Induces CYP enzymes
Stain on apron looks like a rash = can cause acute intermittent prophyria
Can also cause acute intermittent porphyria, CNS and Resp depression,
tolerance/dependence
Amphetamines
Amphitheater = Amphetamines
Tired mom = treats narcolepsy
Hyperactive kid = treats ADHD

Thiazides
Thigh high boots = Thiazide diuretics
Salter shaker contaminating chlorinated pool = blocks Na/Cl cotransporter (cus both salt
shaker and chlorinated pool are ruined)
Distant pool tubes = this cotransporter is located in Distal Convoluted Tubule (DCT)
Fallen salt shaker = decreases Sodium reabsorption, which also prevents Water
reabsorption
Fallen banana sandwich = decreased Potassium reabsorption (Aldosterone gets released
when kidney senses low sodium)
Increased Cow-cium ice cream = increased Calcium Ca2+ reabsorption and blood Ca2+
levels→ reduces risk of osteoporosis
Spilled water by pool = causes diuresis, used for treating fluid overload and edema
Deflated pool floaty = treats hypertension (decreases water reabsorption)
Used to treat nephrogenic Diabetic Insipidus: Thiazides decrease blood Na level and
hypovolemia → to compensate this Na and H2O reabsorption is stimulated in PCT
Lithium batteries = increases Lithium toxicity (Thiazides stimulate Na and H2O
reabsorption in PCT along with Lithium reabsorption→ Lithium toxicity)
Red, swollen big toe = Hyperuricemia/ Gout ( Increased PCT reabsorption can also cause
Hyperuricemia)
Deflated float = Hypotension
Contraction Alkalosis = Thiazides stimulate RAAS→ excess Aldosterone can cause
excess H+ excretion→ metabolic alkalosis / volume contraction alkalosis
Increased PCT reabsorption can also cause Hyperglycemia & Hyperuricemia
Contraindicated in Hyperlipidemia - cus it increases LDL and TGs
Acetazolamide
Japanese candy factory, take off shoes before entering
Cedar sole = Acetazolamide
Broken charcoal dehydrator = Carbonic anhydrase inhibitor
Twisted tube(tubule) of food processor(proximal) = acts on proximal convoluted tubule
(PCT)
Build up of lemons = decreased excretion of acid/ causes metabolic acidosis
Carbonic anhydrase excretes H+ into urine and reabsorbs HCO3- (bicarbonate) back into
blood. If inhibited→ causes decreased H+ excretion and decreased HCO3- reabsorption
Decreased H+ excreted → urinary alkalinization→ used to treat salicylate overdose ,
cystinuria
Causes metabolic acidosis→ treats alkalosis eg: Altitude sickness (alkalosis induced by
hyperventilation at high altitudes)
Steam coming out ears = high ICP ; treats Idiopathic Intracranial HTN (It acts on Choroid
plexus where CSF is made→ decreased CSF reduces BP)
Foggy goggles = treats Glaucoma (decreases aqueous humor prodn by ciliary epithelium-
used for open angle or open closure glaucoma)
Smelly eggs = Sulfa drug allergy (contains same sulfonamide group- avoid in patients
with sulfa drug allergy)

Mannitol
Tall man = Mannitol
Gatorade with electrolytes = Hypertonic fluid
Pooling sweat = osmotic diuretic (increased serum osmolality pulls water out- from
interstitium to intravascular space)
Steam coming out of ears = treats elevated intracranial pressure , also intraocular pressure
(used to treat glaucoma)
Water spraying fan =side effect is pulmonary edema (contraindicated in CHF)- it draws
water into blood vessels, so temporarily increases blood vol→ in CHF pt the heart can't
handle it→ increased hydrostatic pressure in lungs→ fluid leaks out into lungs
Salt lake city, salty peanuts = hypernatremia (Initially when water enters blood vessels it
causes hyponatremia→ over time mannitol gets excreted in urine→ it draws water into
urine→ dehydration and hypernatremia)
Thus contraindicated in anuria - can cause life threatening hypernatremia

Loop Diuretics
Loop Diuretics
Loop racetrack = Loop Diuretics
Furious = Furosemide
Taurus = Torsemide
Boombox = Bumetanide
Peanut and bananas fallen into chlorinated pool = inhibits Na+/K+/2Cl- cotransporter in
ascending loop of Henle → abolishes hypertonicity of medulla→ stops water
reabsorption→ prevents urine concentration (diuresis)
NKCC inhibition→ loss of electrochemical gradient→ prevents reabsorption of Ca2+ and
Mg2+ → increased Ca2+ and Mg2+ loss in urine (hypocalcemia and hypomagnesemia)
Cleaning eggs off car by Dumping water = induces diuresis/ treats volume overload (HF,
cirrhosis, nephrotic syndrome, pulmonary edema)
Deflating tire = treats hypertension (reduced blood volume)
Covering ears = Ototoxicity
Rotten sulfurous eggs thrown on car = Sulfa allergy
Empty bucket = causes hypovolemia/ hypotension → RAAS activation→ increased Na+
and H+ excretion in urine→ metabolic alkalosis/ contraction alkalosis
Fallen bananas in pool = Hypokalemia , Hypochloremia
Also causes hyperuricemia/gout
Ethacrynic Acid
Ethan allen = Ethacrynic acid
Huge looped bow = Loop diuretic - block NKCC cotransporter in thick ascending loop of
Henle
Rotten eggs = used in patients with Sulfa allergies (non sulfonamide inhibitor)
Red swollen toe = may cause hyperuricemia/gout
Covering ears from scream = ototoxicity (more than furosemide)

Potassium sparing diuretics/ENaC blockers

Broken salt crust = epithelial Na+ channel/ ENaC blockers
Trampoline = Triamterene
MILIpede = Amiloride
Falling salt crust = Increased Na+ excretion
Caught bananas and lemons on the pot lid = decreased K+ and H+ secretion
Caught water pitcher = treats nephrogenic diabetes insipidus (prevents diuresis)
Pot lid = treats Liddle disease , a gain of function mutation which increases Na+
reabsorption
Caught bananas and lemons on the pot lid = can cause Hyperkalemia and Metabolic
acidosis
Potassium sparing diuretics/ Aldosterone Receptor Antagonists
duster-alDUSTERone, falling-blocked = Aldosterone Receptor Antagonist → inhibits
Aldosterone and RAAS activation→ diuresis (used to treat fluid overload states)
Treats hyperaldosteronism
Spire = Spironolactone
Pear = Eplerenone
Caught bananas = decreased K+ secretion (side effect is hyperkalemia)
Caught lemon = Decreased H+ secretion (side effect is metabolic acidosis)
Broken android phone = Antiandrogen (side effects like gynaecomastia, decreased libido,
impotence)
Male mannequin with a bra = causes Gynaecomastia (especially Spironolactone)
Hairy arms = treats hirsutism
Heart shaped box of chocolates = treats Systolic heart failure (diuresis lowers blood
volume)
It confers long term mortality benefit in heart failure

ACE Inhibitors
Aces = ACE inhibitor / Angiotensin-converting enzyme inhibitors
Pearl necklace = ends with -pril (Captopril, Lisinopril, Enalapril, Ramipril)
Angel = decreases Angiotensin II (a potent efferent arteriole vasoconstrictor - decreases
GFR- stimulates Aldosterone release) → decreases systemic vascular resistance and
blood volume → lowers afterload on heart and lowers BP
Loss of negative feedback leads to increased Renin production
Long braids = increases Bradykinin, a potent vasodilator (side effect is cough and
angioedema and is contraindicated in hereditary angioedema where theres C1 esterase
inhibitor deficiency)
Deflating pool ring = treats HTN - prevents long term mortality by preventing
unfavorable heart remodeling (side effect is hypotension)
Heart beating out of chest = treats Heart failure
Kidney shaped jelly beans = protective effects at kidney - vasodilation of efferent
arteriole → decreased pressure in glomerulus and decreased GFR → thus used in CKD to
decrease intraglomerular pressure and slows GBM thickening
Decreased GFR→ thus contraindicated in Bilateral renal artery stenosis, can lead to renal
failure
Duckface = angioedema
Coughing man = dry cough
Banana split = causes Hyperkalemia (Aldosterone causes hypokalemia due to increased
activity of Na+/K+ pump)
Tarantula = teratogenic (ACE is essential for fetal kidney development→ low levels can
cause fetal renal malformations)

Angiotensin II Receptor Blockers (ARBs) / -sartans

Satan = -sartan ending (Losartan, Valsartan, Candesartan)
Blocking angel = blocked Angiotensin II receptors
Deflating balls = treats Hypertension (prevent Angiotensin mediated vasoconstriction and
Aldosterone production) - side effect hypotension
Same effect as ACE inhibitors, but DONT increase bradykinin (ARBs are only used
when patient is intolerant to ACE inhibitors eg cough, angioedema)
Torn up heart on love letter = treats Systolic heart failure
Candy jar of kidney shaped jelly beans = treats Diabetic nephropathy (decreases GFR and
slows thickening of GBM)
Bananas in lunch bag = Hyperkalemia (due to inhibition of Aldosterone)
Decreased GFR - contraindicated in B/L renal artery stenosis, and causes increased
Creatinine
Loss of negative feedback leads to increased Renin production
Tarantula = teratogenic (fetal renal malformations)
 Aliskiren (Kills Renin)
Alaska = Aliskiren
Umbrella is a Rain inhibitor = Direct Renin Inhibitor (blocks conversion of
Angiotensinogen to Angiotensin I)
Deflating bicycle tire = treats HTN
Adverse effects: All the adverse effects from ACEi and ARBs (due to decreased action of
Angiotensin and Aldosterone) ie Hyperkalemia, decreased GFR, hypotension,
angioedema
Relatively contraindicated in patients taking ACEi or ARBs
Tarantula = Teratogenic

Colchicine
Coach = Colchicine
Breaking up tube shaped noodles = inhibits microtubule polymerization (especially affects
neutrophils, so affects neutrophil chemotaxis)
(It also affects axonal transport - thus causes peripheral neuropathy)
Swollen toe = treats gout
Player throwing up = causes GI upset
NSAIDs
Sled = NSAID
Ibex = Ibuprofen (Advil)
Napping = Naproxen
Indian = Indomethacin
Knocking out (inhibition) cocks (COX); reversibly inhibits COX enxymes (non selective
inhibition of COX 1 and 2)
Fire extinguisher = anti-inflammatory
PDA kissing couple = Indomethacin closes PDA
Hole in wall = causes GI ulcers
Clutching chest = increased risk of thrombotic events (MI, stroke)
Dropped kidney shaped waterskin = causes kidney damage

Aspirin
Spear = Aspirin
Killed cocks = COX inhibitor (irreversible)
Big spear = high dose, 2 cocks killed and small spear only 1 cock killed = dose dependent:
High dose blocks COX 1 and 2, Low dose blocks COX1 preferentially
Putting out flames = anti inflammatory and antipyretic
Broken plate = antiplatelet agent (blocks TXA2)
Knife = given with Niacin (reduced flushing side effect of Niacin)
Colon shaped sausage = reduces risk of colon cancer (reduces growth of adenomatous
polyps)
Holes in shirt = causes GI ulcers
Covering ears = tinnitus
Lemons = metabolic acidosis with anion gap
Young daughter holding plate of liver = Reye’s Syndrome

Acetaminophen / Paracetamol / Tylenol

Mini fan = Acetaminophen
Spilled cock/chicken soup = COX inhibition
fever/sweating = antipyretic
Painful grimace = analgesic
Liver shaped lever = hepatotoxicity
Napkin = NAPQI (toxic metabolite of acetaminophen which causes liver toxicity by
depleting glutathione)
NAChos = reverse with NAC (N-acetyl Cysteine)

NAC/ N-Acetylcysteine
NAChos = NAC
Tired glutes = replenishes Glutathione
Mini fan = treats Acetaminophen toxicity
Melting cheese = liquifies mucus (mucolytic)
Allopurinol, Febuxostat
Aloe Purinell = Allopurinol
Fusebox = Febuxostat
van= xanthine, rusty= oxidase ; inhibits Xanthine Oxidase
Painful swollen toe = treats hyperuricemia/gout
AZAleas = increases Azathioprine
Military Police /MP = increases 6-MP (6-mercaptopurine)
(Thus, use of Allopurinol with either of these is contraindicated as these drugs are
metabolized via xanthine oxidase)
Peeling paint = causes rash/ DRESS syndrome/ SJS syndrome
Liver shaped lever = Febuxostat causes hepatotoxicity

Probenecid
Probe = Probenecid
Acidic urine colored water = increases uric acid secretion through urine (Uricosurics)
Swollen toe = treats chronic gout
Stones in swamp = increased risk for uric acid calculi
Catching giant pencil = reduced secretion of penicillin ie increases penicillin serum levels
Dantrolene
Dandelion = Dantrolene
Ryan Osling = blocks Ryanodine receptors (in sarcoplasmic reticulum) ie RYR1
Empty cow-cium cream, cannot get white milk from stalk = inhibits Ca2+ release from
Sarcoplasmic Reticulum
Bursting thermometer = treats Malignant Hyperthermia
NaMaSte = NMS = Neuroleptic Malignant Syndrome (due to antipsychotics)

Celecoxib
Celery = Celecoxib (Celective Cox Inhibitor)
Two cocks = Selective COX 2 inhibitor NSAID
Happy belly rub = Low GI ulcer risk (doesnt inhibit COX1 which produces GI mucus)
Anti-inflammatory effects like NSAIDs
Cream stuffed inside celery stalk = increased risk of thrombotic events (inhibits platelet
prostaglandin synthesis without inhibiting thromboxane synthesis)
Sulfurous hard boiled eggs = contraindicated in sulfa allergy
Bisphosphonates (Alendronate, Risedronate)
Drones = -dronate ending
Pyrotechnics = Pyrophosphate analog
Dropped jackhammer = inhibits bone resorption by osteoclasts
Burned throat of fire breather = corrosive esophagitis
Slack jawed man = osteonecrosis of the jaw

Teriparatide
Teriyaki sauce = Teriparatide (paratide is parathyroid hormone analog)
Parrot tie = Parathyroid hormone analog
Pouring cement = increases osteoblast activity
(Normal PTH produced is a constant stimulation→ suppresses osteoblasts
Intermittent PTH stimulation via Teriparatide → activates osteoblasts)
Short intermittent teriyaki lunch break
Broken beams and scaffolding = treats osteoporosis
Ice cream cart with lots of ice cream = causes hypercalcemia
-tecan = Toucan
Irinotecan, Topotecan
top=topo, gun=1; inhibits Topoisomerase I
Bird poop = diarrhea

-poside drugs: Teniposide, Etoposide

Poseidon for -poside drugs
top=topoisomerase, shoe=2; inhibits Topoisomerase 2

Vincristine, Vinblastine
Vineyard = Vinca alkaloids
Unconnected irrigation tubes = blocks microtubule formation
Frayed wire = peripheral neuropathy (neurons use microtubules to transport
neurotransmitters)
Vinblastine blasts the bone marrow (these drugs will affect rapidly dividing cells)
Paclitaxel (Taxane)
Packing (Paclitaxel)
Tax return = Taxanes (you paid for this trip with your tax return)
Unable to deflate pool tube = this drug blocks Microtubule formation (thus microtubules
cannot shorten, and chromosomes cant separate during mitosis)
Frayed wire = peripheral neuropathy

Rasburicase
Raspberry jam = Rasburicase
Yurt = Uric acid
Recombinant Uricase enzyme , hence the name
Aluminum can = Allantoin
Adding water to raspberries = Water-soluble
Rasburicase degrades Uric acid into Allantoin which is more water soluble and can be
easily excreted in urine
Crushed raspberries = Tumor cell lysis; Rasburicase used to treat Tumor Lysis Syndrome
Etanercept
Tanner bed = Etanercept
TiN Foil = TNF, dropped = inhibition; inhibits TNF signaling
Acts as a decoy TNF-alpha receptor ; Etanercept intercepts TNF
Fire extinguisher = anti-inflammatory action
Banged knee = treats Rheumatoid Arthritis (its a DMARD)
Tube = may reactivate latent TB (screen for TB before giving)

Cyclobenzaprine
Cyclone Blender = Cyclobenzaprine
Straining, spasming muscle = treats Involuntary muscle spasms/ antispasmodic
Hitting head = centrally acting/ acts on CNS
Falling empty cola = Anticholinergic side effects (impairs rest and digest)

TNF-alpha Inhibitors:
Flick = Infliximab
Dali painting = Adalimumab
Gold frame = Golimumab
Certificate = Certolizumab
TiN Foil dropping = Antibody against TNF
Fire extinguisher = anti inflammatory effects

Leflunomide
Leaf = Leflunomide
Two oars = inhibits Dihydroorotate Dehydrogenase (used in Purine pathway ie DNA
synthesis)
Fire extinguisher = anti-inflammatory

Board = Bortezomib
Car fire = Carfilzomib
Meat grinder = Proteasome Inhibitor
ProteaZOM inhIBitor = -ZOMIB ending
Cancer cells use Proteasome to degrade pro-apoptotic factors (like p53 which regulates
G2→ M phase)
Thus Proteasome Inhibitors induce G2→ M phase arrest and stops growth of cancer cells
and apoptosis of cancer cells
Multiple meats = treat Multiple Myeloma
Ezetimibe
EZ bake = EZetimibe
Coal = Cholesterol
Cannot put coal into cell-shaped oven = reduced absorption of Cholesterol into
enterocytes (via the NPC1L1 transporter)
Dropped LaDLe = decreased LDL
Spilled batter = diarrhea

Statins / HMG-CoA Inhibitors

Statue = statins
Hamburgers = HMG-CoA reductase inhibitors (inhibits formation of melavonate, an imp
substrate for cholesterol synthesis)
(This is rate limiting step of cholesterol synthesis in liver→ but liver needs a basal
amount of cholesterol to function, thus liver increases LDL uptake from the blood via
LDL receptors→ thus serum LDL drops)
Falling LaDLe = decreased LDL
Leg cramp = myopathy (especially with fibrates or niacin) - via increased Ca2+ release
from S.R.
Liver shaped steak = hepatotoxicity
Fibrates
Fiberglass factory = Fibrates
Fence = Fenofibrate
Jeff “Bezas” = Bezafibrate
Gems = Gemfibrozil
Paparazzi =activates PPAR-alpha
Raised butter knife = upregulates Lipoprotein Lipase
Falling triGLASSerides = lowers TGs (increased TG cleavage by LPL)
HeaDLamp = elevates HDL (increases HDL synthesis)
Lowered veil = lowers VLDL
Crushed arm muscles = Myopathy (increased with statins)
Liver lever = hepatotoxicity
Water cutter= hydroxylase, stopped = inhibited 7-alpha hydroxylase (catalyses the rate
limiting step of bile synthesis → decreased bile acid synthesis→ supersaturation of bile
with cholesterol)
Stone buildup = precipitates gallstone formation

PCSK9 Inhibitors
Philly CheeseSteak = PCSK
Alley = Alirocumab
Evil man = Evolocumab
Falling LaDLe = decreased LDL
(Monoclonal antibodies are expensive, so theyre used only if pt cant tolerate statins)
Omega-3 / Fish Oil
o-Mega man = Omega-3
triGLASSeride oil bottles being shot = Triglycerides lowered
Chewed up VeiL = decreased VLDL

Class IA Antiarrhythmics
1-Armed pushups = 1A Antiarrhythmics
Queen = Quinidine
Proclamation = Procainamide
Diamond pyramid = Disopyramide
Salty peanut butter and banana sandwiches = sodium and potassium channel blockers
(Binds moderately = Moderately decrease the slope of Phase 0 depolarization ie increases
duration of Action Potential (AP) upstroke cus it mainly blocks Sodium channel ,but also
prolongs QT a little by prolonging Phase 3 Repolarization due to small amount of K
channel block)
Rhythmic fanfare = Rhythm Control (helps restore sinus rhythm) - used in
tachyarrhythmias like SVT, VT
Slows conduction in myocytes and terminates arrhythmia
Heart on muscly arm = function at non-pacemaker cardiomyocytes (vs pacemaker cells
that use Ca2+ for AP)
This is why they're rhythm control drugs and not rate control drug
Twisty streamers = QT prolongation / Torsades de Pointes (means twisting of peaks)
This is cus blocking K+ slows the Repolarization of cardiomyocyte→ prolonged QT
interval→ if repolarization starts now→ multiple firing points in ventricles→ deadly
Torsades de Pointes, as it can evolve into VF
Wolf under the Proclamation = Procainamide induced Lupus (This risk is especially high
in slow acetylators, ie ppl whos liver is slow at breaking down drugs via acetylation)
They will have all the features of Lupus, but only associated wiith anti-histone antibodies
Quinidine - can cause Cinchonism (headache, hearing loss, tinnitus, confusion, delirium,
dizziness, flushing, disturbed sleep, ataxia, and blurry vision)
Class IB Antiarrhythmics
Mexican flag = Mexiletine
Lighter = Lidocaine
Phenytoin
1st base = 1B Antiarrhythmic
Dropped salt shaker = Na+ channel blocker
Lighter creates transient flame = binds Na+ channel weakly, thus very transient action
Lighter goes out fast = Lowest Use Dependence in Class 1 (Example: Flecainide, a class
Ic antiarrhythmic, shows use dependence by more effectively blocking sodium channels
during high-frequency activity, thus stabilizing cardiac rhythm during arrhythmias while
sparing normal heart function at lower rates)
Customer having heart attack = used Post-MI
(Ischemia → less O2 to heart→ less intracellular ATP available for heart→ reduced
activity of Na+-K+ ATPase pump, which contributes to the cells resting membrane
potential→ higher than normal resting membrane potential→ Class 1B antiarrhythmics
preferentially inactivate Na+ channels in their inactive state → after Phase 0
(Depolarization) is when Na+ channels start to get inactivated ie Phase 1 (Initial
Repolarization) → Class IB drugs act here, preventing Na+ channels from reopening →
since the resting potential in ischemic tissue is high, it will spend more time above the
action potential , at which the Na+ channels are inactivated and 1B drugs can act→
decreased Action Potential duration, QT prolongation, shortened QT interval)
Dizzy baseball player = CNS effects (Lidocaine used as Anaesthetic)
Rhythmic mariachi music = used in Rhythm control in Non-Nodal tissue (since it acts on
cardiac myocytes)
Heart on muscly arm = acts on Cardiac Myocytes
Class 1C Antiarrhythmics
1st Class = 1C
Flock of birds = Flecainide
Propeller = Propafenone
Salty peanuts = blocks Na+ channels strongly (thus increases duration of phase 0 and
prolongs QT interval) = thus may be pro arrythmic and is contraindicated in IHD
Tightly gripping seat = high binding affinity = High Use Dependence
Heart tattoo on muscle = acts on non-nodal cardiomyocytes
Rhythm = Rhythm Control in arrhythmia

Class II Antiarrhythmics
Lollipop = -lol suffix (Metoprolol, Esmolol, Propranolol, Atenolol, Carvedilol)
Flipflops or shoes(two) = Class II
Aviators = AV nodal block (SA and AV node have beta receptors which respond to
Sympathetic stimulation)
Beta blockers block this Sympathetic stimulation of AV node and decrease heart rate and
contractility
No Running sign = Rate Control drugs
Ice cream = Calcium Ca2+ pathway is affected (it inhibits cAMP thus decreases
intracellular Ca2+ thus Pacemaker Action Potential is slowed)
Atrial fibrillation EKG on display = indication for Class II drugs (reduced heart rate, thus
giving ventricles enough time to fill with blood and normalize CO)
Also used to treat Atrial Flutter and Supraventricular Tachycardia (SVT)
It has no effect on rhythm, thus these drugs are given short term to prevent death, then
later antiarrhythmics are started
Difficulty breathing = side effect is bronchospasm (non selective beta blockers can affect
beta-2 receptors which are responsible for airway dilation by bronchioles)

Class III antiarrhythmics

Duffle bag = Dofetilide
Butterfly = Ibutilide
Banana tree(three) = blocks Potassium K+ channel, Class III
Blocks K+ channel → delays Vent Repolarization / Phase 3 → QT prolongation and
increased Action Potential duration
Twisted streamers = QT prolongation and Torsades de Pointes
Heart tattoo on arm muscle = target non nodal cardiac myocytes
Rhythmic dancing = Rhythm control

Class III Antiarrhythmics

Soda = Sotalol
Lol-lipop = Beta Blocker = -lol suffix
Since it has some beta blocking action, Sotalol prolongs PR interval
Banana = potassium, tree = III; Class III Antiarrhythmics block K+ channel
Blocked K+ channel = delayed Vent. Repolarization / Phase 3 = QT prolongation and
increased Action Potential duration
Twisted streamers = QT prolongation and Torsades de Pointes
Dancing kid = Rhythm control
Heart tattoo on arm muscle = works on Cardiac Myocytes
Class III Antiarrhythmic: Amiodarone
Amoeba = Amiodarone
Heart tattoo on arm muscle = acts on non nodal cardiac myocytes
Rhythmic dancing = Rhythm control
Banana tree(three) = blocks K+ channel, Class III
(delayed K+ channel→ delayed Vent Repolarization→ QT prolongation and increased
Action Potential duration)
Twisted streamers = QT prolongation / Torsades de Pointes
Beer bong = inhibits sipping ; CYP450 Inhibitor
Dusty fan = Pulmonary Fibrosis
Failed liver experiment = Hepatotoxicity
Dishevel tie = Thy(tie)roid dysfunction (Amiodarone has iodine in its name, it can affect
thyroid function)
Dirty grey soil all over body and eyes = Blue grey deposition in to skin and cornea

Class IV Antiarrhythmics (Non-DHP Calcium Channel blockers)

Dilta airlines = Diltiazem
Viper = Verapamil (most cardioselective)
Bathroom door(four) = Class IV
Static on screen = antiarrhythmic
Falling Calcium ice cream = Calcium channel blocker
L- type Ca+ channel block→ prolonged Phase 4 and Phase 0 of Pacemaker Potential
(affect SA and AV node to reduce heart rate)
Slow watch/time = Rate Control
Tapping foot quickly = Treats SVT, eg Atrial Fibrillation (static on screen)
Big bulge in viper , occupied bathroom = causes constipation
Slow time = Bradycardia (negative chronotropy)
Milk bottle = Hyperprolactinemia

Dihydropyridine / DHP Calcium Channel Blockers

2 water(hydro) pyramids
Dippin = dipine ending (like dihydropyridine)
Closing door of voltage dependent Cow-cium L shaped ice cream chute = blocks voltage-
gated L-type Calcium channels
Smoothie relaxation = cause Smooth Muscle Relaxation
Dilating hoses, red one more than blue = Vasodilation; Arteries > Veins
(Arteries exert more effect on BP than veins, cus of SVR , thus it used to lower BP)
Treating sudden muscle cramp squeezing hose = treats Vasospasm
Fixing the bleeding submarine arachnid = treats Subarachnoid Hemorrhage (by
preventing vasospasm)
Treating cold hands turning colors = treats Raynauds phenomenon
Treating chest pain = treats Chest Pain (Angina)
Deflating high pressure cuff = treats Hypertensive Emergency , treats HTN
Swollen water balloon pants = causes Edema
Blushing = causes Flushing
Big gum = causes Gingival Hyperplasia
Dizzy = causes dizziness

Adenosine
Admiral = Adenosine
Slow moving crewman = slows Nodal Tissue
Spilled bananas = Potassium Efflux (thus reduced K+ in cell)
Dropped Cow-cium ice cream = blocked Calcium influx / inhibition of L-type Ca2+
channels → prolongs Phase 4 (Hyperpolarization of AV node)
Stoppage of fast beat drum roll = treats Paroxysmal SVT (PSVTs are caused by reentry
of electrical impulse- Adenosine disrupts this)
Short plank = Short acting (around 15 seconds)
Fear on crewmans face = sense of impending doom
Nervous red face = flushing
Clutching chest = burning chest pain

Digoxin / Digitoxin / Digital

DIGital camera = Dig prefix
Banana costume, salted hand = reversible Na+/K+ inhibition
Squeezing lime hard = increases contractility (it increases intracellular Ca2+ in
ventricles)
Vegas sign = increased Vagal tone (thus slows pacemaker to slow conduction)
AViator glasses = acts at AV node and can cause AV block
Wet heart failure = treats heart failure (it increases contractility)
Static on TV = treats Atrial Fibrillation (by reducing heart rate)
Vomiting out of window = narrow therapeutic window (hence used as 2nd line to beta
blockers)
Yellow tinted glasses = yellow discoloration to vision
Guy in AViators blocking his friend = AV block
Y shaped light = treats toxicity with Anti-Digoxin Fab
Magnesium
Magnet = Magnesium
Empty cow-cium ice cream = Ca2+ channel block thus decreased intracellular Ca2+
Bulging vessel on pregnant woman = treats preeclampsia / eclampsia
Twisty streamers = treats Torsades de Pointes (also Digoxin toxicity)

Ivabradine
Ivory bead = Ivabradine
Stuck in quicksand but still holding ivory = decreased Rate but unchanged Contractility
(affects Chronotropy but not Inotropy)
Monkey laughing = inhibits funny Na+ channel (thus prolongs Phase 4 and takes longer
to cross threshold ie less contractions/reduced heart rate)
Used in chronic angina and patients with systolic heart failure who cant take beta
blockers (slowing heart rate reduces work and oxygen demand of heart)
Especially good for patients with reduced ejection fraction (cus Ivabradine doesnt
decrease contractility)
Flashlight = Luminous Phenomena (feeling of enhanced brightness)
Ranolazine
Renovation = Ranolazine
Worker hit in chest = Refractory Angina
Wall inhibiting salty wave = inhibits Late phase of Sodium current (decreased
intracellular Na+ reduces Ca2+ influx by the Na+-Ca2+ pump → reduces intracellular
Ca2+ → relaxes heart and reduces oxygen demand of heart

Doxorubicin , Daunorubicin / Anthracyclines

Dock = Doxorubicin (aka Adriamycin)
Donkey = Daunorubicin
Donkey breaking board = breaks DNA strands (via free radicals/reactive oxygen species)
Donkey getting stuck in dock = intercalates into DNA
Donkey shoe = 2, knocking over tops=TOPoisomerase inhibition; inhibits Topoisomerase
II
Work on rapidly dividing cells(cancer cells) - but side effect is myelosuppression and
alopecia
Hearts on cards = Cardiotoxicity (causes Dilated Cardiomyopathy)
Deck of cards = prevent heart damage with Dexrazoxane (chelating agent which reduces
formation of reactive oxygen species) - this is because anthracyclines cause cumulative
dose-dependent toxicity
Trastuzumab / Herceptin
Trashed zoo = Trastuzumab
Hearse = HER2 / neu receptor inhibitor
(it is a Tyrosine Receptor Kinase)
Pink ribbon = treats breast cancer
Heart shaped memorial = cardiotoxicity
Reversible cardiotoxicity - cus HER2 is also found on cardiomyocytes - presents with
lowered LV ejection fraction due to impaired myocardial contractility

Glycoprotein IIb/IIIa Inhibitors

Gp(general practitioner) , 23 and me report = GP IIb/IIIa inhibitor
Abcinthe = Abciximab
Tears = Tirofiban
Epitaph = Eptifibatide
Broken plates = blocks platelet aggregation (by inhibiting fibrinogen binding to platelets)
Clutching chest = used in Acute Coronary Syndrome to prevent clot formation, and
before PCI
Heparin
Hairpin = Heparin
Broken trombone = antithrombin; activates antithrombin:
Broken 2 buck-teeth = Factor 2 (inhibits Factor IIa / Thrombin)
Broken TENnis = Factor X (inhibits Factor Xa)
Splattered red cake (cake chunks falling apart like a blood clot being broken up =
anticoagulant
PoTaTo chips flying in air = elevated PTT (deranged intrinsic and common pathway)
Laughing pregnant woman = safe for pregnancy
Bleeding foot = Bleeding
Broken plates, door =4; Heparin-induced Thrombocytopenia via Anti-PF4 (anti-Platelet
Factor 4)
Pro-team jersey = reverse with Protamine

LMW/ Low Molecular Weight Heparin

Tiny hairpins = LMW Heparin
Doll = Dalteparin
Knee socks = Enoxaparin
Fondue = Fondaparinux
Broken trombone = Activates Antithrombin III
Broken TENnis racket = selectively inhibits Factor Xa (doesnt affect Factor
IIa/Thrombin)
Unmonitored child = No Monitoring Needed (so patients can administer SC injections by
themselves at home)
Pregnant mother = safe during Pregnancy
Used for Anticoagulation , less risk of Bleeding

Thrombolytics
Tee-pee = tPA / -teplase drugs (Reteplase, Tenecteplase)
Striped kite = Streptokinase
Euro kite = Urokinase
Breaking ice boulder = breaks up blood clots
Plasma welder = Plasminogen Activation / Cleavage (tPA = tissue plasminogen activator)
Used in MI, PE, Stroke
Bleeding captain = Bleeding risk
Army captain, gesturing to stop = Aminocaproic Acid used for Reversal
Train tracks = Tranexamic Acid used for Reversal
Streptokinase is an analog of tissue plasminogen activator (tPA) that exhibits diminished
response upon repeated administration due to antibody formation, which subsequently
neutralizes the drug upon repeated use (its derived from Streptococcus)

Cyclophosphamide, Ifosfamide
Fossil = Ifosfamide
Cyclops = Cyclophosphamide
Leg cuffed to chain = crosslinks DNA (alkylating agents)
Cyclops wakes up = requires Bioactivation (occurs in liver via CYP enzyme)
Falcon = Fanconi Syndrome (defect in reabsorption in proximal tubule)
Peeing into bloody pool = hemorrhagic cystitis
Messenger bag = Mesna prevents cystitis
ADH / Vasopressin Antagonist
Vapor = -vaptan ending
Toll = Tolvaptan
Cones = Conivaptan
velcro (V) shoe(two) taking off(antagonist) = V2 Receptor Antagonist
Excess ADHesive = treats SIADH (by blocking ADH)

Dopamine agonist / Ergot Dopamine Agonists

Broom = Bromocriptine
Cap = Cabergoline
Rope = activates Dopamine D2 receptors
Rattling walker = treats Parkinson's disease
Milk bottle = prolactin; treats Hyperprolactinemia (Dopamine inhibits Prolactin
production at Ant. Pituitary)
Used to treat Neuroleptic Malignant Syndrome (cus its due to Dopamine blockade)
Also 2nd line for Acromegaly (suppresses GH release)
Desmopressin
Demolition , pressing button = Desmopressin
D-Day = also known as DDAVP
Putting on = activates, velcro shoes=V2; agonist at V2 receptors
vWF car = treatment of Von Willebrand Disease (increases vWF)
Bleeding soldier = treatment of Hemophilia A (vWF stabilizes Factor VIII)
Water spilling on head = treatment of Central Diabetes Insipidus
Peeing in pants = treatment of Nocturnal Enuresis (cus it reduces urine volume)

Demeclocycline (a type of Tetracycline)

Democrat = Demeclocycline
Rejecting ADHesive = blocks ADH / Vasopressin Signaling
Too much ADHesive envelopes = treatment of SIADH
Water spilling, dry tongue = may cause Diabetes Insipdus

Liothyronine vs Levothyroxine
lions=liothyronine, 3 lions = T3 (more active but short half life, so less preferred drug)
Levo jeans, crossed legs look like 4 = T4 (less active, but longer half life, so preferred)
Refilling tea = replacement of endogenous T3 and T4
Disheveled tie = treats Hypothyroidism
Irregular static on TV = Thyrotoxicosis is a complication- causes Atrial Fibrillation

Thionamides: Propylthiouracil (PTU) vs Methimazole

Plateau = PTU / Propylthiouracil
Metal muzzle = Methimazole
Broken tie = reduces Thyroid Hormones , used to treat Hyperthyroidism
Peroxide on floor = inhibits Thyroid Peroxidase (inhibits production of T3 and T4)
Broken down car = 4 tires to 3 tires = Reduced conversion of T4 to T3 (by PTU only)
Dry empty bone = causes bone marrow suppression
PTU:
Liver lever car jack= causes Hepatotoxicity
Methimazole:
Tarantula = Teratogen (can cause Cretinism)

Sevelamer
Salami = Sevelamer
Trapping fox = acts as Phosphate Binder
Many foxes = fox-phate; treats Hyperphosphatemia
Pooping bird = causes GI upset
Cinacalcet
Cinnamon ice cream = Cinacalcet
Froyo mimics ice cream, dairy free = Calcimimetic
Spilled on parrot tie = acts on Parathyroid Gland (so Parathyroids think Ca is high, thus
reduces PTH secretion)
Falling parrot tie = reduces PTH secretion

Insulin Overview
Insulation = Insulin
Diabetes sugar monitor = treats Diabetes
Tire swing, Kite = Tyrosine Kinase
(Insulin binds to and activates Insulin Kinase receptor)
Ana with ball building snowman = promotes Anabolism
Candy = Glucose
Candy transporter 4x4 = stimulates Glucose Transporter 4 (GLUT4)

Taking candy = Insulin increases Glucose uptake

Falling banana peels = lowers Potassium (thus used to treat Hyperkalemia)
Increased candy storage synthesis = increased Glycogen Synthesis
Increased synthesis of tri-glass oil = increases Triglyceride Synthesis
Increased meat synthesis = Increases Protein Synthesis
Do not cross placentas = Insulin doesnt cross placenta
Heavy weight warning = causes weight gain
Empty sugar canister = causes Hypoglycemia
Fat bump at injection site = Lipohypertrophy at injection site (local growth effect)
Fat destroying injection = causes Lipoatrophy at injection site (immune system attacks -
creates hole-like depression)
Allergic reaction = causes Hypersensitivity/ allergy

Insulin Preparations
Insulation = Insulin
Diabetes sugar monitor = treats Diabetes
Rapid response = Rapid Acting
<1 hour to peak (taken right after a meal)
Asphalt = Aspart
List pro app = Lispro
Glue listing = Glulisine
Short parking = Short Acting
2-3 hours parking = 2-3 hours to peak (taken 1-2 hours before meal, inconvenient)
Regular insulation = Regular Insulin
IV bag = Regular Insulin can be given IV (acts in few minutes- used for diabetic
emergencies)
Intermediate difficulty = Intermediate Acting
4-10 hours to peak (used to maintain baseline glucose with 2 injections/day)
Neil Patrick Harris/NPH = NPH
Long road = Long Acting
No peak = no real peak; very slow and smooth thus no observable peak
Used to maintain baseline glucose with only 1 injection/day
Base camp = establishes Basal levels , thus called Basal Insulins
Dented mirror = Detemir
Gargling = Glargine
Metformin
Metal formin’ = Metformin
Big iguana ride = Biguanide
Diabetes sugar monitor = treats Diabetes
Machine Gun Police Department inhibited = MGPD inhibited (Mitochondrial
Glycerophosphate Dehydrogenase)
Increasing Chopping candy = increases Glycolysis
Candy generator is chopped, liver lever = decreased Hepatic Gluconeogenesis
Broken glue gun = decreased Glucagon activity
Stuffing candy into pockets = increased Glucose uptake
Increased Insulation sensors = Increased Insulin Sensitivity (thus increased Glucose
uptake)
Sour milk = Lactic acidosis

Damaged kidney beans, use with caution = use with caution in Renal Insufficiency
Vomiting = causes nausea/vomiting
Broken cobalt blue bee clock = causes Vit B12 Deficiency
Lose weight = causes Weight Loss
Does not cause hypoglycemia chips = does not cause Hypoglycemia
SGLT-2 Inhibitors
Inhibition of Salt-sugar transporter with #2 pencil = inhibition of Sodium-Glucose
Cotransporter 2 (SGLT)
Glee Flozen = gliflozin ending
Diabetes sugar monitor = treats Diabetes
Blocking sugar from entering kidney beans = blocks Glucose reabsorption in Kidneys
Proximal twisty tube slide = mainly acts on Proximal Convoluted Tubule
Candy in urinal = causes Glycosuria
Dirty infected urine = causes UTIs (cus of increased glucose in urine)
No water in fountain = causes dehydration (glucose in urine pulls water along with it)
Loose pants = causes weight loss
Vagina shaped cupcakes with Canada flags = causes Vaginal Candidiasis (cus of glucose
in urine)
Use with caution on kidney beans = use with caution in Renal Insufficiency
Does not cause hypoglycemia chips = does NOT cause Hypoglycemia

GLP-1 Analogs
GuLP #1 imitation drink = GLP-1 Analogs
Exxon tide = Exenatide
Lyrical guide = Liraglutide
Diabetes sugar monitor = treats Diabetes
Activating the Insulation release machine, the machine uses cotton candy = stimulates
Glucose-dependent Insulin release
Glue gun releasing machine is broken = decreased Glucagon release
Decreased Emptying of Stomach shaped fanny pack = decreases Gastric Emptying
Rubbing full belly = increases Satiety
Vomiting = causes nausea/vomiting
Pan on fire = causes Pancreatitis
Loose pants = causes weight loss
Does not cause hypoglycemia chips = does NOT cause Hypoglycemia

Sulfonylureas
Sulfur urine = sulfonylureas
Diabetes sugar monitor = treats diabetes
1st Gen older parent = 1st Generation
Tollbooth maid = Tolbutamide
Clor Pro maid = Chlorpropamide
2nd Gen child = 2nd Generation
Glimmer pier ride = Glimepiride
Guy bride = Glyburide
Glip n slide = Glipizide
Beta fish in membrane like bag = acts on Beta cell Membrane
Pan = acts on Pancreas
1. Closing banana chute = close Potassium channel
 2. Thawing bananas under De-Polarizer = Depolarization
3. Cow-cium ice cream poured inside = Calcium influx

4. Insulation release = cause Insulin release

C-peptide bars released = C-Peptide is released along with Insulin

High C-peptide levels mean that Insulin is being released directly from Pancreas
Use with caution on damaged kidney beans = use with caution in Renal Insufficiency
Allergic to sulfur = can trigger Sulfa Allergies
Heavy weight caution = can cause weight gain
Empty sugar canister = can cause Hypoglycemia
Sick after drinking alcohol =1st Gen causes Disulfiram-like reaction

DPP-4 Inhibitors / Gliptins

Inhibited Dr. PePPer 4-pack = DPP-4 Inhibitors
Glipton tea = Gliptins
Set of Glipton = Sitagliptin
Line of Glipton = Linagliptin
Sacks of Glipton = Saxagliptin
Diabetes sugar monitor = used to treat Diabetes
Increased GuLP #1 drink = increases GLP-1 (by inhibiting GLP-1 breakdown)
Inhibited emptying of stomach shaped fanny pack = decreases gastric
emptying (decreases blood sugar spike after meal)

Rubbing full belly = increased satiety

Activating sugar dependent insulation machine = stimulates glucose-dependent Insulin
release

Broken glue gun machine = inhibits Glucagon release

Infected urine = UTIs

Blowing nose = causes URTIs
Does not cause hypoglycemia chips = does NOT cause Hypoglycemia
Unchanged weight = no effect on weight

Meglitinides / Glinides
Meg light inside = Meglitinide
Glee night = -glinide ending
Diabetes sugar monitoring = treats Diabetes
Beta fish in membrane like bag = acts on Beta cell Membrane
Pan = acts on Pancreas
1.Closing banana chute = closes K+ channel
2.Thawing bananas under De-Polarizer = Depolarization
3. Pouring Cow-cium cream inside bowl = Calcium Influx
4.Insulation release = Insulin release
5.C-Peptide bar release = C-Peptide released along with Insulin
Heavy weight caution sticker = causes weight gain
Empty sugar canister = can cause Hypoglycemia
Use with caution on damaged kidney beans = use with caution in Renal Insufficiency

Glitazones, Thiazolidinediones(TZDs)
TaZmanian Devil = TZDs
Glitter Zone = -glitazone endings
Pie glitter zone = Pioglitazone
Rose glitter zone = Rosiglitazone
Diabetes sugar monitor = treats Diabetes
PPARty Gramma = activates PPAR-Gamma
Nuclear receptacle = acts on Nuclear Receptors
Adipose necktan = increases Adiponectin
Lots of Insulation sensors = increased Insulin sensitivity
Swollen water balloon pants = causes pitting edema /fluid retention
Does not cause Hypoglycemia chips = does NOT cause Hypoglycemia
Caution heavy weight = can cause weight gain
Delayed for several weeks = delayed onset for several weeks (since it acts on nuclear
receptors to change gene expression this takes more time)
Broken bone = can cause bone fractures
Heart shaped pump perfume is broken = Heart failure (cus of fluid retention)
Clutching chest, i heart MI shirt = increases risk of Heart Attack (MI)
Dead heart = increases risk of Cardiovascular Death

Alpha-Glucosidase Inhibitors
Alpha frat , Glucose slide race inhibited =Alpha Glucosidase Inhibitors
Car bows = Acarbose
McLittle = Miglitol
Diabetes sugar monitor = treats Diabetes
Broken Watery Bread cutter = decreased Carbohydrate Hydrolysis

Brush on Intestine shaped sausages = acts at Intestinal Brush border cells

Sugar blocked from entering Intestine shaped sausages = decreases Glucose Absorption
inside Intestines
After meal candy bowl broken = decrease in Postprandial Hyperglycemia
Use with caution on damaged kidney beans = use with caution in Renal Insufficiency
Does not cause Hypoglycemia chips = does NOT cause Hypoglycemia
Unchanged weight = no effect on weight
Diarrhea = causes GI upset (cus undigested carbohydrates absorbs water and gets
fermented by bacteria - causes diarrhea, flatulence)

Amylin Analogs / Pramlintide

Amy and Lynn twins = Amylin analogs
Pram in tide = Pramlintide
Diabetes sugar monitor = treats diabetes
Broken glue gun machine = decreased Glucagon release
Inhibited emptying of stomach shaped fanny pack = delayed gastric emptying
Rubbing full belly = early satiety
Empty sugar canister with insulation = risk of Hypoglycemia if used with Insulin

Nausea = causes nausea/vomiting

Loose pants = can cause weight loss

Edrophonium
Headphones = Edrophonium
Mayan Graves = diagnosis of Myasthenia Gravis
Cola disposal bin tipping over = Cholinesterase Inhibitor
Tense cord = aka Tensilon Test
Cola bottles spilling out = Cholinergic overload (DUMBELS)
Cannot enter central HQ = Peripheral only (cant enter brain)

Neostigmine
Neon signs = Neostigmine
Cola disposal bin kicked over = Cholinesterase Inhibitor
Mayan graves = treats Myasthenia Gravis
Paralyzed person being carried out backwards = Reversal of Paralysis
Cola bottles spilling out on ground = Cholinergic Overload (DUMBELS)
Outside of club, denied entry = works peripherally / cannot cross BBB
Physostigmine
Physician = Physostigmine
Knocking over cola disposal bin = Cholinesterase Inhibitor
Cola bottles spilling out on ground = Cholinergic Overload (DUMBELS)
Atropicana juice = treats Atropine poisoning (Atropine is an anticholinergic)
Open door to restricted area = crosses BBB

Nondepolarizing Neuromuscular-blocking Drugs/ Paralytics

Cure = Curare-derivatives (Vecuronium, Rocuronium, Pancuronium, Atracurium,etc)
Paralyzed husband = NMJ block / Paralysis
No smoking sign = blocks Nicotinic Receptors (Post-Synaptic)

Progressively smaller graduated cylinders = TOF (train of four) stimulation shows

progressive reduction
Neon sign = Reversal with Neostigmine
(NMJ blockers used for paralysis during surgery and Neostigmine is used to wake them
up)
Deflated mattress = Hypotension
Broken fan = Respiratory Depression

Succinylcholine / Depolarizing Paralytics

Sucker = Succinylcholine
Boy frozen up = Paralyzing Agent
Smoking nicotine cigarette over ashtray = Nicotinic Receptor Agonist
Getting shocked = Depolarization of Motor Endplate (continuous depolarization inhibits
further Action Potentials)
Cutting tops off bananas equally = Equal Reduction in TOF (train of four) during Phase 1
Phase 1 is NOT reversible (cus of continuous depolarization)
Second guy not shocked = Repolarization during Phase 2
Decreasing cup sizes = Progressive Reduction in TOF during Phase 2
Neon sign = Reverse with Neostigmine in Phase 2
(Desensitization of Receptors in Phase 2 makes it act like Non-Depolarizing paralytics-
Progressive reduction seen)
Bursting hot thermometer = Malignant Hyperthermia
Banana stand = Hyperkalemia (binds to AchR and opens cation channels, thus Na moves
in and K moves out of cell)
Gabapentin
Garbage Pen = Gabapentin
Falling cow-cium ice cream , next to Voltage fence= inhibits Voltage-Gated Ca2+
channels
Frayed sparking wire = treats Peripheral Neuropathy / Post-Herpetic Neuralgia
Arm shaking = treats Focal/Partial seizures (hence called a Narrow spectrum
antiepileptic)

Ethosuximide
Earth = Ethosuximide
Tea = T-type , ice cream = Ca2+ ; blocks T-type Ca2+ channels
Absent kids = Absent , shaking in anger = seizure ; treats Absence Seizures
Dark spots on apple = causes Steven Johnsons Syndrome /SJS

Levetiracetam
Levitating = Levetiracetam
Shaking = treats Generalized Seizures

Glycopyrrolate
Glass plate = Glycopyrrolate
Taking down mask = Muscarinic Antagonist
(Muscarinic receptors are activated by Ach→Parasympathetic response→ cause
DUMBELS - diarrhea, urination , miosis , bronchorrhea , bronchoconstriction , emesis ,
lacrimation , salivation - basically a bunch of fluid production)
Muscarinic Antagonists inhibit all this, especially bronchoconstriction
Spitting glassblower = reduces saliva/secretions (very useful during surgery, chronic
drooling in cerebral palsy)
Burnt holes in apron = treatment for Peptic Ulcers (reduces stomach acid production)

Pyridostigmine
Pier dock = Pyridostigmine
Knocking down cola disposal bin = Cholinesterase Inhibitor
Spilling cola bottles = increased Ach levels
Mayan Graves = treats Myasthenia Gravis
Being blocked from entering = no CNS penetration (thus first line treatment)
Spilling cola bottles = increased Ach levels (can cause Cholinergic overload -
DUMBELS)
Vigabatrin
Vegas Bar = Vigabatrin
Garbage = GABA; increases GABA concentration (GABA is inhibitory)
Shaking arm = treats Focal/Partial Seizures
Blinded = may cause Permanent Vision Loss

Topiramate
Toupee = Topiramate
Salt shaker = blocks Na+ channels
Shaking in fear = acts as Broad Spectrum Antiepileptic
Sore bump on head = treats Migraine
Whiskey stones = causes Kidney stones

Donepezil , Rivastigmine , Galantamine

Donkey = Donepezil
River = Rivastigmine
Gauntlet = Galantamine
Knocking down cola disposal bin = Cholinesterase Inhibitor
Confused old knight = treats Alzheimer Disease (by increasing Ach - only treats
symptoms, its not neuroprotective)
Spilling cola = increased Ach levels (can cause Cholinergic overload - DUMBELS)

Pilocarpine
Pile of carp = Pilocarpine
Putting on Mask = Muscarinic Agonist (thus cause DUMBEL symptoms)
Customer squinting = Miosis
Tired red eyes = treats Glaucoma
Drooling = increased Salivation (used to treat dry mouth)

Carbachol
Car buckle = Carbachol
Putting on mask = Muscarinic Agonist (causes DUMBEL symptoms)
Squinting = induces Miosis
Black eye = treats Open Angle Glaucoma
Bethanechol
Bath = Bethanechol
Mask = Muscarinic Agonist ie Cholinomimetic (causes DUMBEL symptoms)
Running to toilet = stimulates GI and Bladder movements
Thus used to treat ileus and non obstructive urinary retention
Sweating = induces Diaphoresis

Methacholine
Metal cola = Methacholine
Putting on mask = Muscarinic Agonist (causes DUMBEL symptoms)
Inhaler = used for Asthma Diagnosis
Asthma challenge test: tests reactivity of airways to the bronchoconstriction induced by
Methacholine via M3 receptor

Halothane and Fluranes

Florist = Flurane
Halos = Halothane
NOTE: Enflurane has increased risk of Seizure activity due to increased Cerebral blood
flow
sniffing/inhaling flowers = Inhaled Anesthetics
Closing her eyes = CNS depression / Anaesthesia
Flower soaking in red fluid = high blood solubility = High blood/gas partition coefficient
Slow reaction time = Slow Induction and Recovery (since its a gas, theres high blood
solubility, but also it takes more time to mix into blood)
Flowers soaked in oil = High Lipid Solubility (thus high potency cus it can cross BBB
quickly)
Strong green fumes = High Potency
Knocked down MACbook = low MAC (Minimum Alveolar Concentration needed) - this
is the minimum amount of drug needed to cause anesthesia - since high potency, low
MAC (inverse relationship)
Breaking heart = Cardiac Depression / Collapse (bradycardia, hypotension)
Computer fan breaking = Respiratory Depression (hypercapnia)
Steam coming out of florists ear = Increased ICP / Increased Cerebral Blood Flow
Liver shaped rag = Hepatotoxicity
Breaking thermometer = Malignant Hyperthermia

Local Anaesthetics
Sugar cane = CAINE suffix
Army = Amide Local Anaesthetics
Lighter = Lidocaine
Vacancy = -vacaine drugs
Falling salt shaker = blocks Na+ channels
Painful cut = Pain is first sensation lost
Cauterizing with heat = Temperature lost after Pain
Binding gauze = Touch and Pressure Lost After Temperature
(this is cus local anesthetics affect small myelinated fibers before large unmyelinated
fibers)
Dropped heart shaped chocolate box = Cardiovascular Toxicity
(cus it can affect Na+ channels in the heart also - thus we give local anesthetics with local
vasoconstrictors like epinephrine, so it cant reach heart)
Bench = benzocaine, metal He-man = methemoglobinemia; Benzocaine causes
Methemoglobinemia

Thiopental
Tide pen = Thiopental
Barbeque = type of Barbiturate
Food coma = CNS Depression / Anesthesia
Friend running fast = Rapid Onset
Melting block of butter = High Lipid Solubility (hence crosses BBB quickly thus rapid
onset, but also dissolves into muscles and fat quickly thus short acting)
Knocked over fan = Respiratory Depression

Nitrous Oxide (N2O) / Laughing Gas

N2O tank = Nitrous Oxide
Passed out patron = Inhaled Anesthetic
Falling ketchup = Low Blood Solubility / Low Blood/Gas Partition Coefficient
Fast server recovery = Fast Onset and Fast Recovery
Raised MAC computer = High MAC (minimum dose needed to induce anesthesia) ie
Low Potency
Separated fat in gravy = Low Lipid Solubility = Low Potency (hard to enter BBB,
muscles)
Steam coming from ears = increased Intracranial Pressure (by increasing cerebral blood
flow)
Falling heart shaped chocolates = Cardiac Depression
Bubble in bread = Risk of Air Embolism
Propofol
Profile = Propofol
Passed out = Anaesthesia
Garbage = potentiates GABA (chief inhibitory transmitter in CNS)
Deflated air mattress = Hypotension (due to decreased SVR and myocardial depression)
NOTE: Propofol is that milky white injection they give during Anaesthesia - its white cus
its a lipid emulsion→ thus side effect is hypertriglyceridemia

Ketamine
Kettle = Ketamine
NoMaD backpacker on ground = NMDA Receptor Antagonist (NMDA is an excitatory
neurotransmitter)
Passed out = Anesthesia (CNS Depression / Anesthesia)
Ready to fight or flight = Sympathomimetic (increased HR, BP, RR, bronchodilation)
Steaming pressurized kettle = increased Intracranial Pressure
Atropine , Homatropine , Tropicamide
Atropicana juice = Atropine
Fallen mask = Muscarinic Antagonist (inhibit DUMBEL symptoms)
Big pupil = Mydriasis
Blurry eye = Cycloplegia (eye is unable to focus due to paralysis of ciliary muscles)
Slow time =bradycardia ; treats Bradycardia
Physician = Physostigmine reverses Atropine (its an Acetylcholinesterase inhibitor)

Hyoscyamine and Dicyclomine

Hyena = HYoscyamine
Dyso cyclone vacuum = Dicyclomine
Taking off mask = M3 Muscarinic Antagonist (inhibits DUMBEL symptoms)
Painful belly, diarrhea = treats Irritable Bowel Syndrome (by reducing GI motility)

Oxybutynin , Solifenacin , Tolterodine

Ox butt = Oxybutynin
Turtle = Tolterodine
Solitaire = Solifenacin
Taking off mask = M3 Muscarinic Antagonist (inhibits DUMBEL symptoms)
Kid has to pee = treats Bladder Spasms and Urge Incontinence/Overactive Bladder

Scopolamine
Scope = Scopolamine
Falling mask = Muscarinic Antagonist (inhibits DUMBEL symptoms)
Scuba mask on head , snorkel looks like 1 = It inhibits Central M1 receptor
Se sick vomiting = treats Motion Sickness

M1 Muscarinic Receptors
Machine gun = M1 Receptor
Big brain = CNS signalling
Mask = Muscarinic Receptor
GQ photoshoot = Gq-subunit
M1 exerts effects via Gq subunit signalling
M1 Antagonists treat Motion sickness
M1 signalling via Ach is reduced in Alzheimers Disease
M2 Receptors
Muddy shoe(two) = M2
Mask = Muscarinic Receptor
G.I. soldier = associated with Gi subunit
Stomping heart on love letter = decreases Heart Rate & Contractility

M3 Receptor
Mp3 = M3
Mask = Muscarinic Receptor
GQ photographer = associated with Gq subunit
Relaxing = Parasympathetic / Rest and digest Signalling
Sweating and crying = increased Secretions (sweat, tears, saliva, airway secretions)
Lemon = Gastric Acid secretion
Gasping for breath = Bronchoconstriction
Yellow and brown stains on shorts = Bladder Contraction and Gut Peristalsis
Squinting = Miosis
Focusing camera lens = Lens Accomodation
Insulated drink cooler = Insulin Release
Bulging veins = Vasodilation (by inducing N2O release→ cGMP production→
relaxation of vascular smooth muscle→ vasodilation)
Gq Signalling Pathway
GQ photoshoot = Gq-coupled receptor
PLaying Cards = PLC / Phospholipase C
DAGger = DAG
PoKer Chips = PKC / Protein Kinase C
iPad 3 = iP3
Cow-cium ice cream = Calcium influx
Squeezing syrup bottle = Smooth Muscle Contraction

HAVe 1 or 3 M&Ms = H1, Alpha1, V1, M1, M3 act on GQ receptor

MAD2 = M2, Alpha2, D2 act on Gi receptor
Everything else (Beta1, Beta2, V2, D1, H2, V2) act on Gs receptor

Gs vs Gi Signalling Pathways
GPCRs / G Protein Coupled Receptors are membrane bound receptors
Gas=Gs / G Stimulatory
G.I.= Gi / G Inhibitory
cAMPfire = cAMP
Gas increases cAMPfire = Gs increases cAMP
G.I trying to stop gas = Gi decreases cAMP
PicKAxe = PKA / Protein Kinase A
It's the direct downstream product of cAMP, thus sometimes called cAMP dependent
Kinase
MoLotov CocKtail = MLCK /Myosin Light Chain Kinase
PicKAxe breaking the MoLotov CocKtail = PKA inhibits MLCK thus inhibits Smooth
Muscle Contraction
Cow-cium ice cream , heart tattoo = Ca2+ in Heart increased

Entacapone , Tolcapone
Capoccino = capone ending
Tall cappuccino = Tolcapone
Tall cappuccino crossing window = Tolcapone crosses BBB
Entrance = Entacapone
Enter sign does not cross window = Entacapone does not cross BBB
Commute inhibited = COMT Inhibitor
Rattling walker = treats Parkinson's Disease
Liver lever = Tolcapone causes Hepatotoxicity
Amantadine
Manta ray = Amantadine
Rope = increases Dopamine availability
Rattling walker = treats Parkinson's Disease
Taking off coat to get flu shot = treats Influenza Virus by Inhibiting Uncoating
Falling cola = causes Anticholinergic symptoms (dry mouth, hallucinations ,
constipation, altered mental status, blurry vision)
By increasing levels of endogenous Dopamine, Amantadine can cause Orthostatic
Hypotension

Levodopa , Carbidopa
Leavened , doughboy = DOPA; Levodopa / L-DOPA
Rope = dopamine; Levodopa converted into Dopamine
Rattling walker = treats Parkinson's Disease
Leavened biscuits entering oven = Levodopa crosses BBB
Carpet = Carbidopa
Broken doughboy cardboard box = decardboxylase ; Carbidopa blocks DOPA
decarboxylase
Carpet cannot enter oven = Carbidopa cannot cross BBB
Thus Carbidopa prevents peripheral breakdown of Levodopa
On/off switch = Levodopa causes On/Off Phenomenon (over time, therapeutic window
shortens)
Vomiting = causes nausea / vomiting (due to peripheral breakdown of Levodopa,
Dopamine acts on emetic centers in medulla, since these receives blood supply from
outside the BBB)
Other peripheral Dopamine side effects: arrhythmias, anxiety , agitation, hallucinations,
hypotension
These side effects are treated via Carbidopa

Memantine
Mummy = Memantine
Dropping = antagonist, NoMAD = NMDA; NMDA Receptor Antagonist (NMDA is an
excitatory neurotransmitter)
Confused old man = treats Alzheimer Dementia

Ramelteon
Ramen = Ramelteon
Melon = increases Melatonin
Food coma = causes Sedation / induces Sleep
Does not cause dependence
Riluzole
Relay = Riluzole
Glute pain = reduces Glutamate Excitotoxicity
Wheelchair = treats ALS or Lou Gehrig’s Disease

Tetrabenazine
Tetris = Tetrabenazine
VR MAT = inhibits VMAT / Vesicular Monoamine Transporter
Falling rope = Decreases Dopamine release (used to treat Tardive Dyskinesia ,
Huntington's chorea- movement disorders due to excess dopamine)

Pramipexole , Ropinirole
Prom = Pramipexole
Robe = Ropinirole
Ropes = activates Dopamine receptors
Rattling walker = treats Parkinson's Disease
Shaking legs while dancing = treats Restless Leg Syndrome
Eating all the cookies = causes Impulse Control Disorder
Since it is a direct Dopamine Agonist, there is risk of Sleep attacks ie sudden onset
somnolence
Triptans
Tripod = Triptans
Happy face = activates Serotonin / 5-HT 1B/1D Receptors
Holding head = treats Migraine (by causing vasoconstriction of cranial blood vessels)
Cluster of grapes thrown in the eye = treats Cluster Headache
Mother clutching chest causes Coronary Vasospasm / Chest Pain
Can also cause Serotonin Syndrome , Paraesthesias

Benztropine , Trihexyphenidyl
Bench = Benztropine
Tri-hex honeycomb = Trihexyphenidyl
Falling cola = Anticholinergic
Rattling walker , falling pills = treats Tremors in Parkinsons Disease and Drug-Induced
Falling cola can = causes Anticholinergic Side effects

MAO-B Inhibitor (Monoamine oxidase inhibitors)

Gelato = -giline ending: Selegiline, Rasagiline
Sledgehammer = Selegiline
Raisins = Rasagiline
Mouse = MAO
Rope railings = increases Dopamine release
Rattling walker = treats Parkinson's disease
Used to treat atypical depression

Suvorexant
SUV = SUVorexant
Oregon, Oreos = Orexin Receptor Antagonist
(Orexins are chemicals produced by hypothalamus for wakefulness and arousal)
Passed out = treats Insomnia / Induces Sleep
Does not cause dependence

Tramadol
Tramadol = Tramp stamp
Painful tattoo = Analgesic
Poppyseed muffin = Mu Opioid Agonist
Narwhal = norepinephrine; Inhibits NE reuptake
Smiley face = serotonin; inhibits Serotonin Reuptake
Shaking hand = lowers Seizure Threshold
Excessive smiley faces = Serotonin Syndrome
Baclofen
hunchBACk = BAClofen
Hunched back = treats Muscle Spasms
Garbage = GABA; GABA-B receptor Agonist (GABA is major inhibitory
neurotransmitter)

Zolpidem , Zaleplon , Eszopiclone (Non-Benzodiazepine Hypnotics)

ZZZs from sleeping = Z-drugs
ZZz = treats Insomnia by inducing sleep
BuZzer = BZ1 ; binds BZ1 Receptor
Pushes alarm into garbage can = potentiates GABA (GABA is major inhibitory
neurotransmitter)

Alpha-1 Adrenergic Receptor

A1 steak sauce = Alpha-1
GQ magazine = Gq subunits (Alpha-1 receptors have Gq protein subunits - its a Gq
coupled receptor)
Sympathetic response:
Squeezing red sauce bottle = Vasoconstriction (thus increases SVR, BP, organ perfusion)
Googley eye pupils = Pupil Dilation /Mydriasis
Stream of sauce of narrow nozzle = Sphincter Contraction (Bladder) - thus prevents urine
to flow out (alpha-1 blockers are used in BPH)

Alpha-2 Adrenergic Receptors

Alligator stew(two) = Alpha-2
GI soldiers = Gi protein subunit coupled to Alpha-2 receptors
GIs relaxing, decreased fight or flight = decreased Sympathetic outflow (thus decreases
BP, treats ADHD)
Fallen insulation cooler = decreased Insulin release
Dead alligator eyes = decreased Aqueous Humor Production (used to treat open angle
glaucoma)

Beta-1 Receptors
BB gun(one) = Beta-1
GaS = Gs protein subunit
Heart tattoo = increased Heart Rate and Contractility
Rain umbrella = increased Renin
Beta-2 Receptors
boat=beta, shoe=2
Gas = Gs protein subunit
Blowing into life vest = Bronchodilation
Water in goggles = Increased aqueous humour production
Lifting insulated cooler = increased Insulin
Pregnant lady relaxing = decreased Uterine tone
Eating banana = increased K+ uptake

Beta-3 Adrenergic Receptors

Bonsai tree = Beta-3
Gas = Gs subunit
Heat = Thermogenesis

D1 Dopamine Receptors
Dart gun=D1
Rope = Dopamine
Gas canister on gun = Gs subunit
Flank dart , kidney shaped water pouch = Renal Vasodilation (increased Na+ excretion,
thus diuresis, thus lower BP)
Fenoldopam is a D1 agonist used to increase renal perfusion

D2 Dopamine Receptors
Dress shoe = D2
Rope = Dopamine
GI soldier = Gi subunit
Remote control car = motor control; Basal Ganglia/Motor Control
Falling breast pump = inhibits Prolactin
Angry,stressed mother = Psychosis

Histamine H1 Receptor
Harpoon Gun=H1
Historical = binds Histamine
GQ photographer = Gq subunit
Slimy algae patch = mucus production
Hole in red deck = Vasodilation (systemic vasodilation in anaphylaxis leads to shock)
Water rushing into boat = increased Vascular Permeability
Kinked smokestack / blocked airway = Bronchospasm
Nervous scratching rash = Pruritus /Urticaria
Histamine H2 Receptors
Horseshoe = H2
Historical = Histamine
Gas tank = Gs subunit
Lemonade = Gastric Acid production

V1 Vasopressin Receptors
Vampire gun = V1
GQ photoshoot = activates Gq subunit
Squeezing blood transfusion = Vasoconstriction

V2 Vasopressin Receptors
Velcro shoe = V2
Gas = Gs subunit
Water bottle dispenser = Water Reabsorption
vWF beetle = increases von Willebrand factor (vWF)
Hydroxyurea
Urine in water = Hydroxyurea
Ranger stopping = inhibits RNR (ribonucleotide reductase- converts ribonucleotides to
deoxynucleotides) → decreased DNA synthesis→ cell cycle stopped in S phase
Thus used in myeloproliferative disorders
Sickle shaped popsicle = treats Sickle Cell Anemia
Baby He-Man = increased Fetal Hemoglobin / HbF

Dactinomycin / Actinomycin D
Actor = Actinomycin
Dagger = Dactinomycin
Dagger stuck(inserting) into steps (base pairs) of helical staircase = Intercalates into DNA
This inhibits DNA polymerase

Milrinone
Military boot camp = Milrinone
Paddle =PDE; selective PDE-3 inhibitor
Camp = increased cAMP (thus increased intracellular Ca2+--> increased heart
contractility/Inotropy)
Wringing shirt = contracting; increased Contractility (used for decompensated heart
failure)
Deflated boat = Hypotension (cus it can cause vasodilation in blood vessels)

Sacubitril (Neprilysin Inhibitor)

NePrilysin - breaks down/lyses ANP and BNP and AT-II
Scuba trail = Sacubitril
ARBys bag = coadministered with ARBs (Valsartan)
Fixing Broken heart shaped pump = treats heart failure
Stretching vessel-like hose = Vasodilator
Dumping salt into urine = increases Sodium exretion through urine/Natriuresis
Nap pre-lesson inhibited = Neprilysin Inhibitor
Angel tension, 2 angels = Angiotensin II
Inhibiting breakdown of angel tension figurine = inhibits breakdown of Angiotensin II
(this is why we combine with an ARB)
Blocking breakdown of Nature peptide bars = inhibits breakdown of ANP and BNP
Blocking breakdown of Substance pea = inhibits Substance P degradation
Blocking destruction of Brady canine = blocks Degradation of Bradykinin
Swollen face = angioedema
Coughing = cough
Deflating BP cuff = Hypotension
Dizzy = dizziness
No gambling/ACE cards = contraindicated with ACE inhibitors (cus they also increase
bradykinin)
Crate of bananas = Hyperkalemia
Trainee label on chef coat = Tranylcypromine
Fennel = Phenelzine
Trapped MAOSE = MAO inhibition (Monoamine Oxidase is an enzyme that breaks
down neurotransmitters like NE, Serotonin, Dopamine)
Bittersweet sadness = treats Atypical Depression
Pressure cooker, cheese = causes Hypertensive Crisis with Tyramine-Containing Foods
(MAO breaks down Tyramine also→ if MAO is inhibited, high concentrations of
Tyramine can cause release of NE, epinephrine→ adrenergic crisis→ treat with
Phentolamine, an alpha-1 blocker since has epinephrine has stronger alpha agonist action)
Overflow of happy face cookies = causes Serotonin Syndrome

Phentolamine
Phantom = Phentolamine
Alligator stew(two) , spilled = Alpha-2 Receptor Blockade
A1 sauce, falling = Alpha-1 Receptor Blockade (inhibits vasoconstriction- thus reduces
BP)
Phoenix = treats Pheochromocytoma
Trapping MAOUSE = treats Hypertensive crisis due to MAO Inhibitor
Can cause Orthostatic Hypotension and Reflex tachycardia (increased HR in response to
low BP)
Dabrafenib , Vemurafenib
Dabbing veteran
Bamboo raft = BRAF kinase inhibitor
Vemurafenib = V600E MUtated bRAF InhIBition (Valine residue switched for Glutamic
Acid)
Mole like mud spot = metastatic melanoma

Cisplatin, Carboplatin, Oxaliplatin

Platinum card = Platinum containing drugs, -platin
Handcuffs = Crosslinks DNA (thus changes DNA shape→ cant be accessed by DNA
polymerases→ stops protein synthesis)
Kidney shaped amethyst = Nephrotoxicity
Falcon = Fanconi Syndrome
Amethyst = Amifostine (a free radical scavenger→ prevents nephrotoxic side effects)
Covering ears from alarm = Ototoxicity
Frayed wire = Peripheral neuropathy
Bleomycin
Blender = Bleomycin
Spiral going into blender = breaks DNA strands (by binding to DNA during G2 phase
and induces free radical formation)
Lymph node like vegetables = treats Hodgkin Lymphoma (ABVD regimen)
Gonad like oranges in bag = treats Testicular Cancer
Dirty fan = Pulmonary Fibrosis
Also skin hyperpigmentation and Myelosuppresion

Busulfan
Businessman = Busulfan
Ankle cuffs = crosslinks DNA (an Alkylating agent)
Bone marrow dish = Bone Marrow Ablation (done before a bone marrow transplant)
Side effect is severe Myelosuppression
CaMeL = treats CML
Dirty ceiling fan = Pulmonary Fibrosis
Imatinib & Dasatinib
Mat = Imatinib
Dash = Dasatinib
Cockpit = C-kit (acts on c-kit, a tyrosine kinase)
VCR cable = BCR-ABL
Cracked liberty bell = Philadelphia chromosome
9:22 = t(9;22) translocation
Camel = CML Tx
Buildup of water bottles = Fluid Retention

Factor Xa Inhibitors (Apixaban, Rivaroxaban, Edoxaban)- DOAC (DIrect Oral

Anticoagulants)
Xa ban = Xa inhibitor
Xbox = Xaban drugs
10 game review = Factor Xa Inhibitor
Clogged bulging pipe = treats DVT/venous thromboembolisms
Irregular static on screen = used in Atrial Fibrillation (cus risk of thrombosis)
Guy not looking = doesnt require monitoring
Direct Thrombin Inhibitors (Argatroban , Dabigatran, Bivalirudin)
Punching out two front teeth = Direct Thombin / Factor II inhibitors
Route 66 = rudin drugs
Dabbing = Dabigatran
Arm band = Argatroban
Uses:
Irregular static = treats Atrial Fibrillation
Bulging blue water bottle = DVT
Broken plates = Heparin-induced Thrombocytopenia / HIT (due to antibody against
Platelet Factor-4)

Warfarin
Warfare game = Warfarin
Spilled Super K cereal = reduced Vitamin K-Dependent factors:
2 buck teeth = Factor 2
7-up = Factor 7
9 volt batteries = Factor 9
10/10 rating = Factor 10
CS textbook = Protein C and S
Melting candy bar = Anticoagulation
Increased PaperTowels = increased PT (since extrinsic pathway is dependent on Factor 7)
BINDERs = increased INR (the normalized PT)
Uses:
Irregular static = Atrial Fibrillation
Clogged, bulging pipes = DVT
Sippy straw = CYP inducer (metabolized by CYP enzymes)
Bleeding arm = Bleeding Risk
Tarantula = Teratogen
Rotting apple skin = Skin Necrosis (cus first few days patient becomes Protein C
deficient→hypercoagulable state→ thus we give Heparin also for first few days)
For toxicity: reverse with FFP or PCC (to replenish the Factors), or Vit K

Senicapoc
Gardos channel inhibitor
CaPo = it inhibits this Calcium activated Potassium channel , thus reduces solute and
water loss→ preserves RBC shape and integrity→ decreases polymerization of HbS

Epinephrine
Epee = Epinephrine
Dose dependent effects:
kid=low dose , BB gun = beta-1; Beta-1 Agonist at Low Doses
kid=low dose, boat shoes = beta-2; Beta-2 Agonist at Low Doses
adult=high dose, A1 sauce = alpha-1; Alpha-1 Agonist at High Doses
Allergic man with swollen throat and hives = treats Anaphylaxis (by increasing CO,
bronchodilation, vasoconstriction, decreased mast cell degranulation)
Heart monitor flatline = treats Cardiac Arrest / ACLS
Puffy eyes = treats Open Angle Glaucoma (vasoconstriction→less blood flow to eye→
less aqueous humor production)

Phenylephrine , Pseudoephedrine
Final exam = Phenylephrine
Sudoku = Pseudoephedrine
A1 sauce = Alpha-1 receptor agonists
Runny nose = treats Rhinitis and congestion (intranasal spray- causes local
vasoconstriction of vessels around nose and sinuses)
Deflated tire = treats Hypotension
Widening pupils = induces Mydriasis (useful for ophthalmic procedures)
Side effects: cns stimulation, hypertension, rebound congestion

Norepinephrine
Narwhal = Norepinephrine
Cerulean blue water = formed in Locus Coeruleus
A1 sauce = Alpha-1 Receptor Agonist
Squeezing red tube = Vasoconstriction
BB gun = Beta-1 Receptor Agonist
Popped balloon = treats Hypotension
Black inside of balloon around horn = Local tissue necrosis
Server checking watch = slow time; Reflex Bradycardia (due to sudden elevation of BP)

1st Generation Antihistamines (Chlorpheniramine, Diphenhydramine,

Promethazine, Hydroxyzine)
Colored fin = Chlorpheniramine
Diving hydra = Diphenhydramine (Benadryl)
Harpoon gun, broken = inhibits H1 receptor
Removing mask = Muscarinic Antagonist
Falling A1 sauce = Alpha-1 Antagonist (causes vasodilation→ dizziness, hypotension,
headache, reflex tachycardia)
Puffy face, hives = treats Allergies
Seasick = treats Vestibular Nausea / motion sickness
Taking off mask = Anticholinergic symptoms (dry mouth, constipation, hallucinations,
confusion) - thus contraindicated in elderly patients
Passed out person = Sedation

2nd Generation Antihistamines (Fexofenadine, Loratadine , Cetirizine)

Lottery = Loratadine , Desloratidine
Fax = Fexofenadine
Cider = Cetirizine
Harpoon gun , thrown away = inhibits H1 receptors
Hives, allergic symptoms = treats Allergies
Minimal adverse effects
Dont cross BBB- no sedation