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Pharmacology Mnemonics

HMG-CoA reductase inhibitors (statins): side effects, contraindications, interactions
HMG-CoA:
· Side effects:
Hepatotoxicity
Myositis [aka rhabdomyolysis]
· Contraindications:
Girl during pregnancy/ Growing children
· Interactions:
Coumarin/ Cyclosporine




Antiarrhythmics: class III members
BIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol


Beta-blockers: main contraindications, cautions
ABCDE:
Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)




Clopidogrel: use
CLOPIdogrel is a drug that prevents
CLots, an Oral Platelet Inhibitor (OPI).




Amiodarone: action, side effects
6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism



Beta blockers: members
"The NEPAL Prime Minister":
Timolol
Nadolol
Esmolol
Pindolol
Atenolol
Labetalol
Propranolol
Metoprolol



Ca++ channel blockers: uses
CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes



Beta-blockers: nonselective beta-blockers
"Tim Pinches His Nasal Problem" (because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol





Antiarrhythmics: classification I to IV
MBA College· In order of class I to IV:
Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers


Enoxaprin (prototype low molecular weight heparin): action, monitoring
EnoXaprin only acts on factor Xa.
Monitor Xa concentration, rather than APTT

anti hyprtensive safe for pregnancy are---

My N.H.L ---

Quote:
M-methyl dopa..
N-nifedipine...
H-hydralazine..
L-labetalol.
methyldopa
Quote:
M = mental retardation
E = electrolyte imbalance
T = tolerance
H = headache/ hepatotoxicity, rebound HTN
Y = psYchological upset
D = dry mouth, drowsiness
O = oedema, orthostatic hypotension
P = Parkinsonism
A = Anemia [+ve coomb's test]
sodium nitroprusside

clinical uses: MR. CHIEF SURGERY IN EMERGENCY

Quote:
Mr. = Acute MI
chief = Acute CHF
Surgery = maintain hemostasis during surgeries
emergency = hypertensive emergencies
antihypertensives used in emergencies.............
Saurav Ganguly HELP
Quote:
S-sodium nitroprusside
G-GTN
H-hydralazine
E-esmolol
L-labetalol
P-phentolamine
Anticholinergic side effects

"Know the ABCD'S of anticholinergic side effects":

Quote:
Anorexia
Blurry vision
Constipation/ Confusion
Dry Mouth
Sedation/ Stasis of urine
Antimuscarinics: members, action

"Inhibits Parasympathetic And Sweat":

Quote:
Ipratropium
Pirenzepine
Atropine
Scopolamine
_Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic.
Aspirin: side effects
ASPIRIN:

Quote:
Asthma
Salicyalism
Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA
Intestinal blood loss
Reye's syndrome
Idiosyncracy
Noise (tinnitus)
Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure)

LOT:

Quote:
Lorazepam
Oxazepam
Temazepam
Benzodiazepenes: antidote

Quote:
"Ben is off with the flu":
Benzodiazepine effects off with Flumazenil.
Benzodiazepenes: drugs which decrease their metabolism
"I'm Overly Calm":
Quote:
Isoniazid
Oral contraceptive pills
Cimetidine
_ These drugs increase calming effect of BZDs by retarding metabolism.
Benzodiazepines: actions
"Ben SCAMs Pam into seduction not by brain but by muscle":
Quote:
Sedation
anti-Convulsant
anti-Anxiety
Muscle relaxant
Not by brain: No antipsychotic activity.
Beta selective blockers
"BEAM ONE up, Scotty":
Quote:
Beta blockers:
Esmolol
Atenolol
Metropolol

Botulism toxin: action, related bungarotoxin

Quote:
Action: "Botulism Bottles up the Ach so it can't be the released":
Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alpha-bungarotoxin--alpha has different mechanism).

Cholinergics (eg organophosphates): effects

If you know these, you will be "LESS DUMB": or SLUDGE
Quote:
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction

Delerium-causing drugs

ACUTE CHANGE IN MS:

Quote:
Antibiotics (biaxin, penicillin, ciprofloxacin)
Cardiac drugs (digoxin, lidocaine)
Urinary incontinence drugs (anticholinergics)
Theophylline
Ethanol
Corticosteroids
H blockers
Antiparkinsonian drugs
Narcotics (esp. mepridine)
Geriatric psychiatric drugs
ENT drugs
Insomnia drugs
NSAIDs (eg indomethacin, naproxin)
Muscle relaxants
Seizure medicines
Direct sympathomimetic catecholamines
DINED:
Quote:
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine
Inhalation anesthetics
SHINE:
Quote:
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
_ If want the defunct Methoxyflurane too, make it MoonSHINE.
Ipratropium: action
Atropine is buried in the middle: iprAtropium, so it behaves like Atropine.

Lead poisoning: presentation
ABCDEFG:
Quote:
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)
Lithium: side effects
LITH:
Quote:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism
MAOIs: indications
MAOI'S:
Quote:
Melancholic [classic name for atypical depression]
Anxiety
Obesity disorders [anorexia, bulemia]
Imagined illnesses [hypochondria]
Social phobias
_ Listed in decreasing order of importance.
_ Note MAOI is inside MelAnchOlIc.

Methyldopa: side effects
METHYLDOPA:
Quote:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity
psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)
Monoamine oxidase inhibitors: members
"PIT of despair":
Quote:
Phenelzine
Isocarboxazid
Tranylcypromine
_ A pit of despair, since MAOs treat depression.
Morphine: effects
MORPHINES:
Quote:
Miosis
Orthostatic hypotension
Respiratory depression
Pain supression
Histamine release/ Hormonal alterations
Increased ICT
Nausea
Euphoria
Sedation
Morphine: effects at mu receptor
PEAR:
Quote:
Physical dependence
Euphoria
Analgesia
Respiratory depression
Narcotic antagonists
Quote:
The Narcotic Antagonists are NAloxone and NAltrexone.
_ Important clinically to treat narcotic overdose.
Parkinsonism: drugs
SALAD:
Quote:
Selegiline
Anticholinenergics (trihexyphenidyl, benzhexol, ophenadrine)
L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)
Amantadine
Dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide)

Phenytoin: adverse effects
PHENYTOIN:
Quote:
P- interactions
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenicity
Osteomalacia
Interference with B metabolism (hence anemia)
Neuropathies: vertigo, ataxia, headache
Physostigmine vs. neostigmine
LMNOP:
Quote:
Lipid soluble
Miotic
Natural
Orally absorbed well
Physostigmine
_ Neostigmine, on the contrary, is:
Water soluble
Used in myesthenia gravis
Synthetic
Poor oral absorption
Pupils in overdose: morphine vs. amphetamine
"MorPHINE: Fine. AmPHETamine: Fat":
Quote:
Morphine overdose: pupils constricted (fine).
Amphetamine overdose: pupils dilated (fat).
Serotonin syndrome: components
Causes HARM:
Quote:
Hyperthermia
Autonomic instability (delirium)
Rigidity
Myoclonus
Sodium valproate: side effects
VALPROATE:
Quote:
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)
Succinylcholine: action, use
Quote:
Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore.
You Suck stuff in through a mouth-tube, and drug is used for intubation.
Tricyclic antidepressants: members worth knowing
"I have to hide, the CIA is after me":
Quote:
Clomipramine
Imipramine
Amitrptyline
_ If want the next worth knowing, the DNDis also after me:
Desipramine
Norrtriptyline
Doxepin
Tricyclic antidipressents (TCA): side effects TCA'S:
Quote:
ThrombocytopeniaCardiac (arrhymia, MI, stroke)
Anticholinergic (tachycardia, urinary retention, etc)
Seizures
Vigabatrin: mechanism
Vi-GABA-Tr-In:
Quote:
Via GABA Transferase Inhibition
Antibiotics contraindicated during pregnancy
MCAT:
Quote:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline
Busulfan: features
ABCDEF:
Quote:
Alkylating agent
Bone marrow suppression s/e
CML indication
Dark skin (hyperpigmentation) s/e
Endrocrine insufficiency (adrenal) s/e
Fibrosis (pulmonary) s/e
Metabolism enzyme inducers
"Randy's Black Car Goes Putt Putt and Smokes":
Quote:
Rifampin
Barbiturates
Carbamazepine
Grisoefulvin
Phenytoin
Phenobarb
Smoking cigarettes
Morphine: side-effects
MORPHINE:
Quote:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention)
Nausea
Emesis
Therapeutic index: formula
TILE:
Code:
TI = LD / ED
Zero order kinetics drugs (most common ones)
"PEAZ (sounds like pees) out a constant amount":
Quote:
Phenytoin
Ethanol
Aspirin
Zero order
_ Someone that pees out a constant amount describes zero order kinetics (always the same amount out)
Asthma drugs: leukotriene inhibitor action
Quote:
zAfirlukast: Antagonist of lipoxygenase
zIlueton: Inhibitor of LT receptor
Beta- vs Beta- receptor location
"You have heart and lungs":
Quote:
Beta- are therefore primarily on heart.
Beta- primarily on lungs.
Hepatic necrosis: drugs causing focal to massive necrosis
"Very Angry Hepatocytes":
Quote:
Valproic acid
Acetaminophen
Halothane
Adrenoceptors: vasomotor function of alpha vs. beta
ABCD:
Quote:
Alpha = Constrict.
Beta = Dilate.

Beta blockers with intrinsic sympathomimetic activity
Quote:
Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels.
Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some
diabetics or asthmatics despite the fact that they are non-seletive beta blockers.
Beta-blockers: main contraindications, cautions
ABCDE:
Quote:
Asthma
Block (heart block)
COPD
Diabetes mellitus
Electrolyte (hyperkalemia)
Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem" (because he has a runny nose...):
Quote:
Timolol
Pindolol
Hismolol
Naldolol
Propranolol
PREANASTHETIC MEDICATION

HOSANA this is a christian word.
Quote:
H-H2blockers
O-opeoids
S-sedatives-antianxiety
A-anticholenergic
N-neuroleptics
A-antiemetics
simple and sobar

anti epeleptic drugs

Dr.BHAISAB's New PC.

Quote:
D...deoxy barbiturates
B...barbiturates
H....hydantoin
A.. aliphatic carb acids
I....iminostilbenes
S....succinimides
B....BZD's
N.... newer drugs
P....Phenyltriazines
C... cyclic gaba analogues
adverse effects of tetracyclins-KAPIL DEV
Quote:
K kidney toxicity
A antianabolic effect
P phototoxicity
I inc ICP
L liver toxicity

D diabetes insipidus
E enamel problems
V vestibular toxicity
GENERAL TOXICITY OF ANTICANCER DRUGS
SHaLi's BF Ghoghari Gautam is Chor.
Quote:
S-skin
H-hyperurecemia
L-lymphoreticular tissue
B-bone marrow
F-Foetus
G-gonads
G-git
C-carcinogenecity
6 H s and 8 H s of adverse effects of thaizide diuretics and loop diuretics respectively.....

'melbourne cricket authority has high funds though players get minor amount' .. for clinical uses of beta blockers...

Drugs causing pulmonary fibrosis:

Quote:
BAB like in baba (father)
Bleomycin
Amiodarone
Busulfan
ADRS OF CHLORAMPHENICOL

smart boys in girls hostel
B.... bone marrow depression
H...hypersensitivity
I....irritative effects
S.....superinfections
G.....Gray baby syndrome
ampicillin uses

UR GMCS BeST
Quote:
UTI
Respi
Gonorrhoea
Maningitis
cholecystitis
septicemias
bacillary dysentry
sabe
typhoid
misch
Acyclovir “I see clover”

I see a three-leaf clover (this is a prodrug that gets converted into a triphosphate – it resembles dNTP and inhibits DNA Polymerase). Imagine putting clovers over herpes sores and genital warts (this is used to treat those).

Amantadine “Homan to Dean” In case you haven’t heard, Dr. Homan is our new SOM dean. His new policy: he won’t let us come to school without our white coats (this drug blocks uncoating, stage 2, in viral infection). Other interesting facts about him: he can pee for 12 hours straight! (The half-life is 12h and it’s excreted unchanged in the kidney .)
Dr. Homan can’t take the pressure of being a new dean so he becomes a nervous drunk with depression, feelings of detachment, insomnia, dizziness, ataxia, slurred speech, and inability to concentrate (these are some of the adverse effects)

Cephachlor “Chlorine” – as in swimming pools
You swim and get water up your nose and in your ears (this drug treats sinusitis and OTITIS media).

Cephadroxil “Drop rocks” While you are peeing you drop rocks (This drug treats UTIs).

Cephalothin “…Loathing”
If your heart is infected, you can’t love, only loathe (this is used to treat severe infections such as endocarditis).

Cephamandole “…Man doll” You have to inflate your man doll and you get an upper respiratory infection. If you “use” this anatomically correct man doll, he will give you pelvic inflammatory disease (This drug is indicated for URI and PID). He’s also so real that he bleeds!!! (Adverse effect: It affects Vit-K dependent clotting function)

Cephazolin “…Soul in” You want to keep your soul in and not die if you go to surgery (this drug is used prophylactically for surgery).

Cephoperazone “…Opera zone” Going to the opera makes me want to get drunk to the point of illness. These drugs, when mixed with ethanol interfere with ALDH, affecting alcohol metabolism (you end up with increased acetaldehyde – a DISULFIRAM-LIKE REACTION).
Also, if you see Phantom of the Opera, expect to see some blood! (This affects Vit-K dependent clotting function.)

Cephotaxime “…Tax time” IRS is hard to kill off – they are MULTIPLE DRUG RESISTANT (Use this drug against MDR strains.).

Clindamycin “Clean the mice”
You’re cleaning the mice because they are covered with ticks (this drug is used to treat Lyme Disease). You have to use SOS kitchen cleaner to clean the mice (SOS = 50 S ribosomal unit – where this drug acts).
Richard Gere likes to put mice in “where the sun don’t shine” and this is a very FRAGILE procedure (Clindamycin may cause Pseudomembranous enterocolitis and it’s also used to treat B. fragilis infections).

Fluconazole “Flu cone” Imagine an emaciated AIDS patient eating an ice cream cone made of the flu and he gets an oral and esophageal fungal infection. (This is used to treat oral and esophageal candidiasis in AIDS patients).

Foscarnet “Fox cARRR net” If you catch foxes in a net, they won’t reproduce (this drug is a stage 3 inhibitor). ARRR… it inhibits RNA polymerase and Reverse transcriptase to block Reproduction. You’re going to put the foxes into a car that’s made out of bones instead of metal (this drug binds to bones and decreases Ca2+ and Mg2+).
Also, a foxy lady is HOT (this drug will cause a fever) and never wear fox urine to hunt (this is excreted in the kidney and causes renal insufficiency).

inhalational corticosteroids

Bed Bug Flew To Florida
Quote:
B-BECLOMETHASONE DIPROPIONATE
B-BUDESONIDE
F-FLUTICASONE PROPIONATE
T-TRIAMCINALONE
F-FLUNISOLIDE
Succinylcholine: action, use

Quote:
Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore.
You Suck stuff in through a mouth-tube, and drug is used for intubation
Cholinergics (eg organophosphates): effects
If you know these, you will be "LESS DUMB":
Quote:
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction
Steroids: side effects
BECLOMETHASONE:
Quote:
Buffalo hump
Easy bruising
Cataracts
Larger appetite
Obesity
Moonface
Euphoria
Thin arms & legs
Hypertension/ Hyperglycaemia
Avascular necrosis of femoral head
Skin thinning
Osteoporosis
Negative nitrogen balance
Emotional liability
Methyldopa: side effects
METHYLDOPA:
Quote:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity
psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)
Sodium valproate: side effects
VALPROATE:
Quote:
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)
Captopril (an ACE inhibitor): side effects
CAPTOPRIL:
Quote:
Cough
Angioedema/ Agranulocystosis
Proteinuria/ Potassium excess
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension)
Renal failure (and renal artery stenosis contraindication)/ Rash
Indomethacin inhibition
Leukopenia/ Liver toxicity
Lithium: side effects
LITH:
Quote:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism
Opioids: effects
BAD AMERICANS:
Quote:
Bradycardia & hypotension
Anorexia
Diminished pupilary size
Analgesics
Miosis
Euphoria
Respiratory depression
Increased smooth muscle activity (biliary tract constriction)
Constipation
Ameliorate cough reflex
Nausea and vomiting
Sedations

Ca++ channel blockers: uses
CA++ MASH:
Quote:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
·
Alternatively: "CHASM":
Quote:
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes
Pupils in overdose: morphine vs. amphetamine
MorPHINE: Fine.
AmPHETamine: Fat
"Morphine overdose: pupils constricted (fine)
Amphetamine overdose: pupils dilated (fat)


Phenobarbitone side effects
Children are annoying (hyperkinesia, irritability, insomnia, aggression)
Adults are dosy (sedation, dizziness, drowsiness



Atropine: origin tells action or vice versa
Atropine causes your pupils to dilate, and it came from nightshade [belladona]In the night or in shade, your pupils dilate so you can see

Atropine use: tachycardia or bradycardia
"A goes with B":

Atropine used clinically to treat Bradycardia


Reserpine action
Reserpine depletes the Reserves of catecholamines [and serotonin]

Sodium channel blockade: Procainamide, Quinidine, Disopyramide

"Quaker Preachers Discussed Sobriety."

Quaker-Quinidine
Preachers-Procainamide
Discussed-Disopyramide
Sobriety-Sodium channel blockade


Class IB - Sodium channel blockade: Lidocaine, Phenytoin, Mexiletine, tocainide


"Philadelphians Like Salty Mexican Tacos."

Philadelphians-Phenytoin
Like-Lidocaine
Salty-Sodium channel blockade
Mexican-Mexiletine
Tacos-Tocainide



Class IC - Sodium channel blockade: Flecainide, Encainide, Propafenone

"Flea Encrusted Prophets."

Flea-Flecainide
Encrusted-Encainide
Prophets-Propafenone


Class II - Beta-adrenergic blockade: Propranolol

"Betting Professionals."

Betting-Beta-adrenergic blockade
Professionals-Propranolol



Class III - Prolong repolarization: Amiodarone, Bretylium, Solatol

"Britain Repossessed American Soaps."

Britain-Bretylium
Repossessed-Repolarization is prolonged.
American-Amiodarone
Soaps-Solatol



Class IV - Calcium channel blockade: Verapamil, Diltiazem

"Calligraphist's Verbal Dilemma."

Calligraphist-Calcium channel blockade
Verbal-Verapamil
Dilemma-Diltiazem


Antiarrhythmic agents:

"A Dubious Quality Product...
Bought To Preserve Little Money...
Can Fabricate Enough Problems."

A-1a B-1b C-1c

1a-A:
D-Disopyramide
Q-Quinidine
P-Procainamide

1b-B:
T-Tocainamide
P-Phenytoin
L-Lidocaine
M-Mexiletine

1c-C:
F-Flecainamide
E-Encainamide
P-Propafenone


Mnemonics For Side Effects.

ACEI, Side Effects
CAPTOPRIL

Cough,
anaphylaxis,
palpitations,
taste,
orthostatic ↓BP,
Potassium (↑K+),
Renal impairment,
impotence,
leucocytosis



Anti-epileptic side Effects
ABCDEFGH

Ataxia,
blood dyscrasia,
cleft lip,
dupuytrens / vit D def,
exfoliation of skin & Stevens Johnson’s. Fits,
GI upset / gum hypertrophy,
hepatitis / hairy




Barbiturate side Effects
ABCD

Ataxia,
behavioural disturbance,
↓concentration / coma,
depression / drowsy / diplopia



Cholinergic OD side Effects
DUMB BELS

Diarrhoea,
Urination,
Miosis / muscle weakness,
bronchorrea
Bradycardia,
emesis,
lacrimation,
salivation / sweating


Cyclosporin Side Effects
4HRT

4H - Hyper K+, hypertension, gum hypertrophy, hairy
R – Renal toxicity
T - Tremor



Digoxin S/E
GECCKO

GIT – n&v, abdo pain, ulcers
Eyes – blurring, halo, xanthopsia
CNS – depression, confusion, delirium, hallucinations
Cardiac – ANY arrhythmia
K - low


MAOI side Effects
3Hs

Hepatocellular jaundice,
Hyperthermia,
hypertension



TCAD side Effects
CAN WOO
Cvs,
Anticholinergic,
Neuro,
Withdrawal,
Overdose,
Others




Steroids Side Effects
HIGH COMPACT IMPS

Hypertension,
Immunosuppression,
Gastric Ulcer (bleeding),
Heartburn
Cataract,
Osteoporosis,
Muscle weakness,
Path # / Psychosis,
Acne / Altered Glucose,
Cushingoid,
Thin skin
Increased appetite,
Myopathy,
poor wound healing,
stress response reduced


AM CUSHINGOID


Acne,
Myopathy (prox) / muscle wasting (prox)
Cushingoid / Cataract,
Ulcers,
Striae, skin thin (bruising),
Hypertension / hairy,
Infection,
Glycosuria,
Obesity / Osteoporosis / Oedema,
Immunosuppression / Insomnia,
Depression

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