KAPS Recalls PDF - Pharmacy Review (Australia) APEC Stage 1

800 recalls with correction corrected by Hamdi Gad. For connection : Whatsapp : 00966549841979 Facebook : https://www.facebook.com/profile.php?id=100007573833723&ref=bookmarks correction in 7 pages u must correct the original note. That begin from page 8 to the...

800 recalls with correction corrected by Hamdi Gad. For connection : Whatsapp : 00966549841979 Facebook : https://www.facebook.com/profile.php?id=100007573833723&ref=bookmarks correction in 7 pages u must correct the original note. That begin from page 8 to the last. U must study original one firstly.‫ فقم بتصحيحيها من هنا‬8 ‫يقع التصحيح اوال من حيث الترتيب لكن البد من مذاكرة الملزمة االصلية اوال والتى تبدء من صفحة‬ Questions that I am very sure about it I already correct it. Those that I am not sure just write their numbers. 6- this question and number 421 need confirmation. 7- false. As insulin dec TG synthesis. 1 70-Protamine zinc insulin has a duration of action of about 36hrs (11/2 day) & ultra lente. Ultra lente from 18 to 24 hrs not 36 hrs 71-Gentamycine causes deafness due to its effect on 8th cranial nerve (vestibular damage or auditory damage) Deafness due to auditory nerve only. Vestibular damage cause vertigo 87- Chlorothiazide dose is : Maybe.5 to 1 gm. 93- may be correct. Need confirmation as asthma ttt by anticholinergics. 102- I think l hyoscine more active than atropine mix. 113- Dosage – Chloral hydrate Insomnia: 500 mg to 1 g PO Sedative/Anxiety: 250 mg PO q8hr; not to exceed 2 g/day ; not to exceed 2 g/day 117- SE muscle wasting not muscle development. 2 157- must be said not take aspirin with a low dose as high dose has uricosuric action. 167- most accurate dose Dosage – Cimetidine 200 to 800 mg daily as a single evening dose or 2 divided doses 184-most accurate statement : adrenaline give mydriasis action if taken systemically only. 200- ???. 233- Hydrochlorothiazide (HCTZ or HCT) Hypertension 12.5–25 mg daily no more than 25 mg daily is usually needed to treat hypertension (Recalls 5-25 mg) 250- colchicine dose is: 500 microgram. once or twice daily. Salbutamol: 2–4 mg 3–4 times daily 319- Captopril: Hypertension 3 initially, 12.5 mg twice daily, increased to 25–50 mg twice daily. Heart failure initially 6.25 mg 3 times daily, increased to 25–75 mg twice daily. Maximum 150 mg daily. 327- I think SE of ketoconazole all except a headache. 383- Cholinergic crisis may occur in Myasthenia gravis treatment must write myasthenia gravies treatment. 386- allopurinol not safe with warfarin. 411- TCA causes postural hypotension not hyper if take as monotherapy. If taken with corticosteroid may increase blood pressure. 434-Clonidine used in prophylaxis in a migraine. Prophylactic treatment in a migraine: 1. Propranolol (the most commonly used drug). 2. Anti-serotonin drugs: Methysergide (long use causes fibrosis of the serous membranes as retroperitoneal fibrosis which may lead to renal failure) – Cyproheptadine (in resistant cases, it is also H1-antagonist) – Pizotifen and Ketotifen (as cyproheptadine). 3. Clonidine (in small doses). 4. Calcium channel blockers: Flunarizine- Verapamil. 5. Tri-Cyclic Antidepressants (TCAs) as Amitriptyline. 4 438- butorphanol & levallorphan are mixed agonist-antagonist also. 519- may be wrong as both r HME inhibitor. both inhibit metabolism of each other so increase their action 534- ??? 524 – this question and question 719 : maybe 5 min is correct. 534- ?????????? Maybe correct, not sure. 547- INH cause gynecomastia in very rare condition. Drugs causing Gynecomastia : 1 Digitalis (due to steroid structure) 2 Spironolactone (due to steroid structure) 3 Reserpine Due to decrease dopamine in CNS increase prolactin 4 α-methyldopa 5 Ketoconazole (antifungal, decrease synthesis of androgens) 6 Cimetidine (H2-blocker, used in the treatment of peptic ulcer, causes antiandrogenic action) 7 Estrogen (given to males for treatment of cancer prostate) 548- cough center – centrally in the brain- in the medulla oblongata. 5 But cough Receptor found peripheral in alveoli and …. 626 - not sure about : b-fasten transfer of fertilized ovum others r right. 633- valproic acid is LME inhibitor. not inducer. 637-??? 643- loop diuretic change ph Acidify urine. 653- ??? 668- ???? 690 - !!!! 695- not sure acetaminophen + penicillin ( not take orally ) Ampicillin affected by food. 703- no interaction. 6 732- ??? 738- tropicamide around 6 hrs Cyclopentolate from 6 to 24 Hrs 768 - !!!!!! 781- duration is from 10 to 18 hrs. 792- may be incorrect Strychnine does not have specific antidote but its poisoning ttt Charcoal. Diazepam. phenobarbital. SK muscle relaxant. Tannic acid. Good luck 7 800 Questions :) APEC REVISION Dr. M 1/1/2014  Pharmacy Review (Australia) APEC Stage 1 Previous examination questions 1-Structure of Methyl Salicylate: Methyl 2-hydroxybenzoate 2-structure of diphenhydramine 3-Camphor is ketone. 4- -NH-NH- is present in MAOI's structure (phenelzine). 5-penicillin (-) bacterial wall synthesis by (-) of Transpeptidase. 6-Amylase level increase in pancreatic disease (pancreatitis). 7-Insulin does not reduce synthesis of triglycerides. 8-Structure of Barbituric acid: 9-On discarding stored tetracycline, it changes into more toxic form (Fanconi like Rx). 10-Sulindac is a prodrug (Sulphoxide is reduced to the active sulphide) (more active than the prodrug). 11-Euthyroid=person with normal thyroid function. 2 12- Ascorbic acid acidifies urine. 13-Red meat is not contraindicated immunity I's. 14-Tyramine does not reduce blood pressure. 15-Thiopental sodium is ultra short acting general anesthetic (due to its high lipid solubility. 16-Spironolactone is anti-aldosterone. 17-Ascorbic acid is: -rapidly absorbed from GIT. -Utilized at increased rate during common cold & infection. -protects against scurvy. - Reversibly oxidized to oxalic acid. 18-Vitamin D is not used in hyperthyroidism 19- Vit. E is not proved to be essential for reproduction in man BUT Vit. A is important. 20-Tyrosine is precursor of thyroxin. 21-Cis means 2 gps are on the same side. 22-Oral prednisolone or corticosteroid is not given to a patient 11 years old with chronic asthma, he can be given: *inhaled prednisolone. *Long acting Theophylline. 23-pyuria=pus in urine. 3 24-Drug of Choice for E.coli: is co-trimoxazole. 25-Metabolism of drug occurs at the sub cellular organ in endoplasmic reticulum (smooth) & ribosome. 26-Ventricular fibrillation is the most common complication of MI. 27- Sulphonamides SE are blood dyscariasis, rash &fever. 28-Sweat is used for (function): water excretions, Na+ excretion & temp. regulation. 29-In Nephritis: there is edema. 30- Phenytoin SE is gingival hyperplasia, ataxia & hirsutism. 31-Peripheral neuropathy (neuritis) SE of Isoniazide is due to: INH induced pyridoxine deficiency. 32-Ketoconazole can be administered orally. 33-Nitrazepam is not used in ttt of insomnia in elderly patients. 34-Edrophonium is used in diagnosis of Myasthenia gravis. 35-Promethazine is a potent antiemetic. 36-Osteoarthritis is a degenerative disease. 37-Ortho position= 1 &2 positions on benzene. 38-Corticosteroid action in asthma is reducing the inflammatory response & reducing airway hyper responsiveness. 39-Atropine is an antidote for anticholinestrase. 4 40-Atropine selectively blocks muscarinic receptors. 41-Nitroglycerine mainly reduces preload. 42-One drug with 2 polymorph will differ in: melting point, solubility, dissolution rate, density, stability EXCEPT pH. 43-c AMP is not CNS mediator but it is 2nd messenger. 44-Dyspnea=breathing with difficulty. 45-Noradrenaline acts on postganglionic sympathetic receptor on the effector organ mainly or presynaptic receptors on the nerve endings. 46-Cotrimoxazole is a bactericidal by reducing of Folic acid synthesis. 47-Cartilage covers and protects bone from friction during normal joint activity & osteofies to form bone. 48-Ethyl palmitate is not a surface active agent. 49-Cortisone eye drops should be stored betn 2-8 0C. 50-An ointment base is made of hydrocortisone. 51- A drug 60 mg t1/2 is 1 year, after 3 years the amount remaining is 7.5 gm. 52- Drug with low Vd (volume of distribution) →less accumulation in tissues (or no accumulation at all). 53-Phenyl mercuric nitrate 0.002% is eye drop preservative, bacteriostatic. 54- Insulin lente=70% ultralente (crystalline), 30% semilente (amorphous). 5 55-Sulphonamide must have a non substituted aromatic amino gp essential for anti bacterial activity. Example: 56- Haloperidol is not used in Parkinsonism (as it ↑ EPS). 57- Acetazolamide causes alkaline urinary PH. 58- Heparin anticoagulant activity is monitored by: Activated Partial Thromboplastin Time (APTT). 59- A body placed in hypertonic solution will ↓ in size (crenation occurs). 60-We use occlusive dressing or plaster with corticosteroid to: enhance absorption of it. 61- Botulism antiserum induces passive immunity. 62-Oil, fats &powders are sterilized by dry heat at 16 0c for 2 hrs. 63-Ophthalmic preparation is sterilized by filtration using 0.22 μm microbial filter or heating with bactericidal. 64-Lignocaine has long duration of action because it is amide which is resistant to hydrolysis. 65-Clindamycin to prepare a solution: dissolve in H2O. 66- Essential amino acids= must be supplied with diet. 67-Norethistrone is used in endometriosis (But megestrol & medroxyprogestrone are better). 6 68-Patient with mature onset diabetes can be treated with tolbutamide & diet. 69-t1/2 = time required for conc. Of drug decrease by one half. 70- Protamine zinc insulin has duration of action of about 36hrs (11/2 day) & ultra lente. 71- Gentamycine causes deafness due to its effect on 8th cranial nerve (vestibular damage or auditory damage). 72- Hypokalemia ↑ digoxin toxicity. 73- Fluphenazine deaconate is given IM. 74- Corticosteroid & estrogen causes hypertension except ranitidine. 75-Patient on propranolol or metoprolol has nightmares → shift to more hydrophilic B blocker like atenolol or nadolol. 76- Morphine toxicity causes constipation but not diarrhea!!!! 77- Cimetidine ↓ metabolism of other drugs. 78-To prepare a buffer system at PH 4, we use lactic acid of pka 3.86. 79- Tell a patient treated with Indapamide that the drug may cause k+ loss thus potassium supplement is required. (Orange juice &banana). 80- Prazocin cause 1st dose hypotension. 81-Style pencil is used in minor cuts. 82- Na lauryl SO4 (-ve) is incompatible with cetrimide (+ve). 7 83- Al (OH)3 causes constipation. 84- Absorption of A›B›C 85- Hydralazine (antihypertensive & VD) can precipitate anginal attack due to coronary steal phenomena. 86- Bulk forming laxative (psyllium, methyl cellulose, bran &polycarbophil) are used safely in pregnancy, stool softener (Docusate Na) can be used safely. 87- Doses: *Salbutamol: → 4-8mg or 10mg!!! *Dithranol: → 0.1-1% (for ttt psoriasis) *Chlorothiazide: → 125-500mg or up to 1 gm 88- Patient on phenytoin still has fits we give him dose of 30 mg phenytoin (taken once). 89- Na metabisulphite is antioxidant or reducing agent. 90- Aspirin: *may induce asthma. * interact with sulphonylurea (↑), but not interact with MAOI's. 91-Hypersensetivity & idiosyncrasy is not dose dependent adverse effect. 92-Naloxone is used to block respiratory depression effect caused by Opiates. 93-In asthma, there is no ↑ in cAMP and ↑ in catecholamines. 94-Nalidixic acid & amiodarone cause photosensitivity. 8 95- Strong iodine solution contains 5% w/v, how many mg of iodine are consumed daily; the usual dose is 0.3ml tid→45mg. 96-Cystic fibrosis recessive gene may be present in both mother &father. 97-Main measure of respiratory volume is vital capacity. 98- Allopurinol → (-) xanthine oxidase→ (-) uric acid formation. 99- Anaphylactic reaction occurs after 2nd exposure to antigen. 100- Chloropromazine has longer t1/2 when given IM. 101-Prenicious anaemia is deficiency of Vit B12. 102- Atropine (d-l hyoscyamine mixture) is more active than d- hyoscyamine (L isomer is 100 x more potent than D isomer). 103- The ester gp in atropine is liable to destruction. 104- Str. Of phenyl alkyl amine: 105- Procaine is liable to destruction upon sterilization by heat. 106- Clomiphen is antiestrogen (not estrogenic compound). 107-Trypsin is secreted from pancreas. 108- Organophosphorous compounds act by irreversible ↓ of cholinesterase. 109- Timolol (B-blocker) →↓↓ I.O.P by ↓ of aqueous humor formation, in glaucoma, but has no effect both on pupil size "not mitotic" & on the aq. Humor outflow. 9 110- Erythropioesis= stimulation of Red blood cells formation from bone marrow. 111-Thiazide ↓ HTN by ↓ blood volume. 112-Diphtheria vaccine or tetanus toxoid gives active immunity. 113- Glyceryl trinitrate dose is: 0.3-1.2 mg Atropine dose is: 0.2-2mg Chloral hydrate dose is: 0.3-2g. Chlorbutal "preservative": 0.5% [in eye drops]. 114- Ergotamine tartarate & nitroglycerine can be used sublingually. 115-Ergot alkaloids are used in migraine & prevention of postpartum hemorrhage by ↑ of uterine contraction. 116- Bile conjugation occurs in liver. 117-Corticosteroid function includes the following: *Intermediate in metabolism. *Salt & water regulation *Muscle development. *Haematopoesis. 118-Phenytoin dose 50mg-400mg "max", 2nd dose is 30 mg. 119-When Salbutamol is used with Betamethasone inhaler, Salbutamol is used before inhaled corticosteroid by 10 mins. 120-Penicillinase resistant penicillins are: Methicillin - Nafcillin- Cloxacillin- Dicloxacillin- Floxacillin- Oxacillin. 121-Antipseudomonal penicillins are: Carbenicillin- Ticarcillin- Mezlocillin- Piperacillin. 122-Acid stable (oral) penicillins are: "PAPA": Ampicillin- Amoxicillin- Penicillin V "Phenoxy methyl penicillin" & Penicillin G 123-Drug of choice in H. influenza is Ampicillin*. 10 124-Amoxicillin is used in ttt of Otitis media. 125-MAOI's +cheese → HTN crisis due to tyramine content which ↑ NE conc. 126- Patient taking Metronidazole advice him to stop drinking alcohol (due to disulfuram like Rx). 127-Mebendazole is used as antihelmentic. 128-Cholestyramine is used as anionic exchange resin (bile acid binder) in hyperlipidemia. 129-Lomotil® (diphenoxylate +atropine) don't cause Bronchospasam & atropine ↓ likehood of abuse of the opiate. 130-NaHCO3 (IV) is used to neutralize acidosis of lactic acid (in cardiac arrest). 131-Stoke's Law: (in suspension/ also applied to rate of creaming): Sedimentation rate (v) = N.B sed. Rate is directly prop with (p1-p2) d = particle diameter g=acceleration due to viscosity ᶯ= viscosity of dispersion medium (p1-p2) =difference betn density of! Particle (p1) & density of! Dispersion medium (p2). 132-Na nitroprusside is given by slow IV infusion in emergency lowering of blood pressure as it offers rapid onset &short duration. 133-Alkaline phosphatase (↑) in liver disease. 134-Vit B12 contains cobalt. 135-During ovulation FSH &LH reach highest peak. 136-Corpus luteum "yellow body"→secrets mainly progesterone. 137-Estrogen secretion is controlled by FSH. 11 138-Myexoedema =↓in thyroid hormone secretion in adulthood. 139-Exophthalamus = "protrusion of! eye ball" associated with hyperthyroidism & hyperplasia of thyroid gland. 140-Half life= half the radioactive material to decay. *Shelf life t90= 10% of the radioactive material to decay. 141- Suxamethonium is depolarizing short acting skeletal musclerelaxant. 142- woman taking combined pills for 21 days & 5 days rest but the bleeding does not occur, you advice her to stop the pills as she may be pregnant. 143-BaSO4 is the least soluble compound. 144-Narrow angle glaucoma acute attacks are treated with parasympathomimetics. 145- % of RBCs compared with blood volume (45%) →Hematocrit value. 146-Labetalol is receptor antagonist. 147-Selective receptor antagonists (cardioselective) are atenolol, metoprolol, bisoprolol, esmolol, Acebutolol…… 148-Uricosuric "↑ excretion of uric acid in urine" are: probencid, sulphinpyrazone BUT not Allopurinol. 149-weak acids &bases are more absorbed from the small intestine due to large surface area. 12 150-Acidification of urine ↑excretion of alkaline drugs "like amphetamine" as ionization ↑, thus absorption ↓. 151-Calamine lotion: ZnO + Ferric oxide. 152- Lithium causes nephrogenic diabetes insipidus. 153-Atropine + parlidoxime are used to treat Organophosphorous poisoning. 154-Possible number of stereoisomers for compounds having 4 asymmetric Carbon atoms is 16 →2'no of asymmetric C atoms"→24= 16. 155-Kcl therapy is given by slow IV infusion "not given by IV injection". 156- Ca2+ is not given with digitalis because both ↑ contractility of the heart "synergistic effect " which can lead to arrhythmia also Ca2+ replace K+ from myocardial cells & ↑ digitalis toxicity. 157- Patient on probencid therapy, you advice him not to take aspirin. 158-patient on Kanamycin antibiotic+ FeSO4 therapy can't hear due to damage of 8th cranial nerve &effect on auditory nerve function. 159-Patient infected with infectious mononucleosis experience rash after Ampicillin therapy. 160-Muscle rigidity is one of Parkinsonism's symptoms. 161-Sorbitan monostearate (w/o) is non ionic surfactant. 13 162- This structure is steroid Ethinyl Estradiol 163-This structure is prednisone: 164-Warfarin is active due to specific stereoisomer. 165-Pain of angina is due to ischemia of certain area in myocardium. 166-MAOI's is CI with Guanethidine. 167-Cimetidine (H2 Antagonist) dose is: 400-2000 mg * Cimetidine is CI with Theophylline, Phenytoin, Warfarin, and Carbamazepine. 168-Refractionmeter principle depends on difference in density between 2 substances. 169-Na+ Level (normal) in blood: 135-146 mmol/L K+ Level (normal) in blood: 3.5-5.5 mmol/L 170-Folinic acid (Leucoverin) is antidote for Methotrexate. 171-Methotrexate is antineoplastic (folic acid analogue) & used in acute leukemia. 172-Propranolol is used in combination with Hydralazine to control reflex tachycardia induced by Hydralazine. 14 173-Sulfamethoxazone+ Trimethoprim act in synergism because they block sequential step in the same metabolic pathway. 174- Drug of choice in grand mal epilepsy is→ Na Valproate, while petit mal is→ Ethosuximide & Status epileptics are → diazepam. 175-MAOI's SE is not tachycardia but it is SE OF TCA. 176-Pyrogens are bacterial byproducts which causes febrile reactions. 177-Na cromoglycate stabilizes mast cells thus used in asthma. 178-Furosemide, Bumetanide & Ethacrynic acid (Loop diuretics) → act by ↑ Na+ excretion. 179-In Rx Kaolin, Alum, Chalk →Astringent. 180-Quinine is CI with Digoxin as it ↑Digoxin plasma level "↓Digoxin clearance". 181-Gentamycin is most active # Pseudomonas Aerigonosa & G-ve bacteria in general. 182-Parathormon & 1, 25 dihydroxycholecalciferol (Vit D) affect the absorption of Ca2+. 183- Griseofulvin is prepared in microcrystalline form to enhance its stability & absorption. 184- 1% adrenaline "epinephrine" gives short rapid mydriasis but chronically ↓IOP by ↑ aqueous outflow. 185-Gelatin is protein. 186-Thyrotoxicosis is caused by excessive thyroid excretion. 15 187-Oral drug with weak PH will be more absorbed from stomach. 188-Dissolution rate affect absorption of oral drugs. 189-Spironolactone SE is gynecomastia. 190-Phenol & NH4Cl →acidic, But NaHCO3, Amphetamine &Acetazolamide are basic. 191-Thiazides cause → (↓) glucose tolerance. 192-Aspirin should not be taken with Coumarin. 193- Aspirin→ (↓↓) platelet aggregation. 194-Ampicillin is stored in refrigerator at cold temp 2-8 0c But not freezed. 195-Insulin is stored at 2-8 0c. 196- Phenolphthalein & Castor oil are used as intestinal irritants (stimulant laxatives). 197-Chloramphenicol SE is aplastic anaemia. 198- -blocker is CI in asthmatic patients. 199-Azatidine (sedating antihistamine) SE is drowsiness. 200-Heart Failure+ Lignocaine cause ↑ Lignocaine level due to↓↓ hepatic blood flow, thus clearance ↓ & dose is required to↓↓. N.B *Drugs excreted by glomerular filtration: Ethambutol, aminoglycosides, Methotrexate, digoxin& procainamide. *Drugs excreted by passive tubular secretions are: Aspirin &Amphetamine. *Drugs excreted by active tubular secretions are: Penicillin. *Probencid→ ↓active tubular secretion →↑ blood level. 16 *Also quinine & quinidine → ↑digoxin→↑digoxin toxicity. 201-Cod Liver oil & fish oil contains vitamin A & Vit. D. 202-Suspension is not suitable for IV injection. 203-Penicillin allergic patients do not shift to Cephalosporins due to cross allergy but shift to Erythromycin. 204-On long term use of sympathomimetic blocker, hypotension can occur. 205-Eutectic mixture= when mixing some drugs or chemicals with each other, they melt "liquefy" at a temperature lower than each of their melting point. 206-Phenylbutazone has the longest t1/2 75- 100 hrs & cause Aplastic anemia & blood dyscariasis; it also displaces other drugs from plasma protein. 207-Al (OH) 3 is CI with tetracycline. 208-Cetomacrogel "emulsion wax" → O/W emulsion. Na lauryl SO4 + cetocteryl alc "anionic" →O/W Cetrimide + Cetocteryl alc. "cationic" →O/W Cetomacrogel 1000 + cetocteryl alc "non ionic"→O/W 209-Tricyclic antidepressant causes many SE like sedation & anticholinergic SE. 210- Patients taking phenazopyridazine (Azo dye used as urinary analgesic) should be advised that urine color will be changed. 211- In HTN we don't use Atropine. 212-Guanethidine, Methyldopa, Clonidine cause bradycardia but Hydralazine causes reflex tachycardia. 17 213-Preservatives in eye drops as bactericidal: *benzalkonium chloride: 0.02% *Chlorohexidine acetate: 0.01% Eye dps sterilized either by autoclave (98-100oc for 30 min) or filtration (0.22μm porosity). 214- Carbamazepine → self inducer of its own metabolism, on long term use. 215- Azathioprine (→metabolism→6-mercaptopurine) + Allopurinol →↑ level of both drugs metabolism. 216-Hypertensive crisis occurred by" tyramine +MAOI's" is treated by blocker "Phentolamine". 217-Patient using lithium carbonate advise him not to ↓ normal Na intake "Not restrict salt in diet". 218-Lithium is CI with naturetics "diuretics". 219-Anionic surfactant (Na lauryl SO4) is compatible with Iscthamol. 220-Olive oil +Lime water→ Ca oleate "emulsifier" 221-Bioavailability= amount of drug available in blood "systemic circulation". 222-Glucocorticoid function acts as intermediate in metabolism. 223-Metabolism of Drugs results in more polar compounds. 224-Prostaglandins gp related to fatty acids. 225-Diphenoxylate related to mepridine, it (+) opiate action in GIT→ constipation. 18 226-*Sorbitan monostearate (non ionic) → W/O emulsion. *Na lauryl SO4→ O/W emulsion. *Dioctyl sodium sulphosuccinate→ O/W emulsion. 227-Prostaglandin synthesis ↓↓↓ by NSAIDs. 228-Benzyl peroxide gel should not come in contact with eye or mucous membrane. 229-Initial plasma conc. After IV dose is affected by dose or clearance. 230-SE: *Atropine→ dry mouth, blurred vision, constipation, &tachycardia "it can cause initial bradycardia". *Theophylline: N, V, tachycardia, tremor. 231- Ranitidine dose: 150 mg twice daily, it's H2-blocker→↓gastric acid secretion. 232-Contraindications:*MAOI's CI with Guanethidine. *Haloperidol CI with Guanethidine & methyl dopa *Theophylline is CI with Cimetidine. *Metronidazole CI with alcohol. *TCA is CI with Guanethidine. *B-blocker CI with verapamil (Ca2+ Ch. Blocker). 233-Doses:*Aspirin in rheumatoid arthritis →6 gm *HCTZ →12.5-200mg. *Hydralazine →50-200mg. 234-Oxytocin is used to (+) uterine contraction. 235-Acetylcysteine is mucolytic. 236-Bromohexine "by depolarization of mucopolysaccarides"→↓viscosity of bronchial secretion acts as mucolytic. 19 237- 5-Carboxymethylcysteine is mucolytic & ↓mucous gland hyperplasia. 238-Stearyl alc, cetyl alc &cholesterol are stabilizers. 239- Do not take NaHCO3 with HTN as it ↑Na →↑blood pressure. 240-Needle with smallest diameter carries the largest gauge number "pressure". 241-8.4% NaHCO3 in alc. Shock to neutralize lactic acid (acidosis). 242-Parathion &Malathion are Organophosphorous compounds which act as irreversible anticholinestrases. 243-Thioridazine is phenothiazine derivative with the least extrapyramidal SE because it is piperidine derivative. 244-Hydroxizine has the greatest antihistaminic action of the anxiolytic agents. 245-Penicillamine is chelating agent & used in rheumatoid arthritis (DMARDs). 246-Mestranol is estrogen not progestin. 247-Parasympathomimetics cause miosis &blurred vision. 248-Bundle of His is present in the heart. 249-Vit C is aromatic carboxylic acid , added to blood samples to prevent coagulation. 250- Doses:* Carbamazepine: 0.2-1.2gm *Aspirin:"antigout"> 5 gm, "antiplatelet" 50-325mg 20  *Methyl dopa: 0.5-2gm *Colchicine: 500mg *Salbutamol 2-4 mg (bid) *Prednisone: 5-60 mg 251- Graves disease= form of hyperthyroidism. 252-Thyroid Storm = sudden onset of thyrotoxicosis. 253-Beer Lambert's law: relationship between light absorption by solute& wave length. 254- Dose of chlorocresol is 0.05%. 255- Heparin is the anticoagulant of choice during pregnancy, ↓↓ conversion of prothrombin to thrombin, taken IV for treatment & SC for prophylaxis. 256- Antidote for heparin is Protamine SO4. 257- HCTZ interacts with: digoxin "Hypokalemia" & Lithium "↓Na with Li→ toxicity". 258-Hydroxychloroquine is antimalarial used in SLE & rheumatoid arthritis, also it is CI with Favism "due to G-6-phosphdehydrogenase deficiency". 259- Digoxin absorption ↓↓ by Kaolin, neomycin & cholestyramine. 260-Erythromycin interacts with: * oral anticoagulant *Carbamazepine "↓metabolism"→↑ toxicity. *"digoxin"→↑ serum level" * Theophylline →↑ serum level. 261- A drug with pka 6.2 this drug will be 50% ionized in the small intestine. 21 262-The outer water proof layer of the skin is made up of Keratin. 263-Acne vulgaris is caused by bacterial inflammation "propionibacterium acne. 264- Impetigo is contagious skin infection caused by staph. aureus. 265-Propranolol SE as: cold extremities. 266- Tobramycin & streptomycin resemble each other →"both are aminoglycosides". 267- Suxamethonium is succinylcholine. 268- Respiratory depression is the cause of death in cocaine poisoning. 269-Ethyl stearate or ethyl palmitate is not surface active agent. 270-Nitroglycerin eases the pain of angina bec. it causes venous dilation (↑ venous capacitance pool of the blood). 271-prolonged use of spironolactone causes gynecomastia. 272-E. coli is most common M.O in uncomplicated urinary tract infection. 273-Patient taking -blocker should not take verapamil. 274- Vit E is called Tocopherol, antioxidant & found in Nuts. 275-Tetracycline is CI in pregnancy. 276- Hydrocortisone is not suitable for Rosacea. 277- Tetracyclines may cause hepatic & renal damage. 22 278-Paracetamol has no anti- inflammatory effect. 279- To improve passive absorption of drug→↑↑ partition coefficient. 280-Thirst is controlled by hypothalamus. 281- Waste product of protein is urea. 282- Amiodarone causes ocular & sight problems. 283-Trimethoprim (-) folic acid synthesis "by competing with PABA". 284-Propylthiouracil is preferred over carbimazole in treating hyperthyroidism because in addition to (-) of T3 & T4 synthesis, propylthiouracil blocks peripheral conversion of T4 toT3. 285-Chlorpropramide (antidiabetic) is given once daily. 286- Sarcolema is found in striated muscle cells. 287-Axon is the part of the neuron that carries impulse away from! nerve cell. 288-The part of the ear which is responsible for balance is the Inner ear. 289- The main source of resistance to blood flow is arterioles. 291-Anticholinestrase act by virtue of structure similarity to Acetylcholine. 292- Metoprolol is antagonist. 293- Excretion of muscle (muscle fatigue) is due to accumulation of lactic acid 294-Penicillins have similar M.O.A as Cephaloxin. 23 295-CH3-(CH2)16-COOH is stearic acid. 296-We can monitor renal function by plasma creatinine. 297-Doubling the drug conc. In the blood "that follow 1st order kinetics" will not affect the half life. 298-Benzalkonium Chloride "cationic germicidal surfactant is inactivated by: Soap. 299-Upon exposure to air, aminophylline soln. may develop crystals of Theophylline. 300- Reagent strips impregnated with glucose oxidase, peroxidase & orthotoluidine are dipped in urine as a test for presence of glucose the Rx is→ glucose is oxidized to gluconic & H2O, in presence of peroxidase converts orthotoluidine into blue substance. 301-Acetazolamide "carbonic anhydrase inhibitor" is rarely drug of choice for diuretic therapy because it causes systemic acidosis & alkaline! urine. 302-Mineral oil is not miscible with alcohol. 303-Conformational isomerism "known as Rotamers or Conformers" are non super imposable orientation of a molecule which results from the rotation of atoms about single bonds. 304-Both described as optical enantiomers "have one asymmetric carbon" they are non super imposable mirror images. 24 305-Diastomers have 2 or more asymmetric atoms, they are non super imposable and are not mirror image. 308-Digoxin when given as a soft capsule, in comparison to tablet provides greater bioavailability. 25 309-Common structure of sulfonamides: 310-Niclosamide is used in ttt of tape worm infection. 311- Methyl paraben is ester of p- hydroxybenzoic acid 312-this structure is dimethyl Sulphoxide (DMSO): 313-Soap is formed by reaction between inorganic base + organic acid. 314-Phenothiazines structure: *antiemetic, antipsychotic, anticholinergic BUT not antimalarial. 315-Ethyl amino benzoic acid "Benzocaine": *Local & topical anesthetic *Benzoic acid derivative. 26 *Rapidly hydrolyzed in boiling H2O *insoluble in H2O BUT: soluble in mineral acids "as it reacts with HCl → soluble salt. 316- Patient on Sucralfate "cytoprotective on peptic ulcer disease" should be advised not to take the drug with food or antacid. 317-Terbutaline is 2 agonist "bronchodilator" in asthma (acute attack). 318-Cholinergic= neuron which transmit impulse by releasing acetylcholine. 319-Captopril is ACE inhibitor, Dose 25-50 mg, 3 times daily ,causes hyperkalemia &dry cough. 320-Floxacillin syrup must be refrigerated "2-80C. 321-Insulin administration is SC. 322-Vd of drug will be greater for drug which is concentrated in tissues rather than in plasma. 323-A specific drug with 1st order biological t1/2 of 4 hrs, this t1/2 value will be independent on the initial concentration. 324-Corticosteroid therapy complications include: dissemination of local infection, masking symptoms of infection & ↑ susceptibility to infecrion. 325-Mestranol is steroid structure "estrogen" 326- 2ry oxidation of alcohol gives ketone, while 1ry oxidation of alcohol gives aldehyde. 27 327-SE of ketoconazole: GIT disturbances, headache, gynecomastia & hepatotoxicity. 328-Fixed dose drug eliminated by 1st order kinetic, administered at regular interval, the time required to achieve steady plasma conc. Depends on elimination t1/2 of drug. 329- 1, 25- dihydroxycholecalciferol (Vit D) enhance Ca2+ absorption. 330-Antibodies against the nicotinic acetylcholine receptors on skeletal muscle plasma membrane at NMJ act as competitive antagonist of Ach binding → called Myasthenia gravis. 331-Naproxen structure: t1/2= 13hrs, taken once daily. 332-Caffeine & HCTZ have diuretic effect, but phenyl ephrine is not diuretic. 333-HCTZ can be given with propranolol to↓↓ edema. 334-Phenylephrine is not H1 antagonist (antihistaminic) but cyclizine, diphenhydramine promethazine & Chlorpheniramine are antihistamines. 335-Injection of large amount of purified H2O in RBCs → swelling & burst. 336-Vit B12 is the drug of choice in pernicious anemia. 337-Structure of Warfarin: 338-Structure of succinic acid: 28 Structure of Hydrocortisone: 339- agonist in asthma act by (+) 2 receptor thus (+) adenylyl cyclase→↑cAMP → bronchodilation. 340-Cephalosporins (↓↓) cell wall synthesis by (↓↓) of transpeptidase step "like penicillin". 341-Major determinant of myocardial O2 consumption is Cardiac output. 342-Danazol is used in endometriosis. 343-Danazol is androgen which (-) gonadotropin release. 344-…………. 345-Phenol is metabolized by glucuronidation & sulfonation. 346-Activity Of phenol (↑) by (↑) temperature. 347-If salicylic acid is added to chloroform, then HNO3 acid is added → salicylic acid will precipitate in the lower layer. 348-More than 50% of H2O & Na+ reabsorbed from proximal tubule by passive transport (about 60% is reabsorbed). 349-K+ reabsorption occurs in proximal tubule but K+ secretion occurs in the distal tubule. 350-Glucose cannot be measured by using UV light. 29 351-UV light spectrum is 200-400nm (which most drugs show absorbance within this range). 352-Nalidixic acid absorption ↓ by food or antacid. 353-Spironolactone SE →menstrual irregularities. 354-Theophylline is CI with Cimetidine as Cimetidine ↑Theophylline toxicity. 355-Monounsaturated organic acid → oleic acid {CH3(CH2)7 – CH=CH(CH2)7COOH} 356-Polyunsaturated organic acid → linoleic acid. 357-Volatile oils are rich in terpentines. 358-Mineral oil is petroleum derivative "aliphatic hydrocarbon"& it is immiscible with alcohol or castor oil. 359-Neutral compounds absorbed from lipid biological membrane depends on partition coefficient. 360- Cystic fibrosis is hereditary not contagious, (it is widespread exocrine dysfunction causing pulmonary & pancreatic disease) 361-Rate of creaming in emulsion depends on viscosity. 362-Tardive dyskinesia is irreversible SE of phenothiazines. 363-Penicillin should be administered on empty stomach. 364-Tetracycline gives different absorption & dissolution patterns because it is amphoteric"form salt with acid or base &capable of forming internal salt" 365- 2parents do not have congenital disease, but their son got congenital disease.This means that both parents have recessive gene. 366-Local anesthetic not administered topically is→ procaine. 30 367-Glycerin syrup does not change the pH of the medium. 368-MAOIs is psychotropic, antidepressant & psycoanaleptic, SE: hallucination, tremor, hyperthermia or hyperpyrexia &anticholinergic SE "dry mouth, constipation, failure of ejaculation…..etc". 369-Allopurinol is not taken with tea. 370-L-propoxyphene is antitussive; D- Propoxyphene is analgesic "not anti- inflammatory". 371-Inflammation of synovial fluid or synovial membrane is called synovitis, But inflammation of joint is called arthritis. 372-Arthritis is accompanied by inflammation in synovial fluid. 373-Loop diuretic & thiazide are CI in gout as they cause Hyperuricemia(as most diuretics except spironolactone) 374-Structure of Ethacrynic acid: 375-Structure of Quinidine: 376-Prednisolone is more active than hydrocortisone because it differs in the conformation at ring A. 377-Adsorption is a physical phenomenon. 378-Mechanism of action of agonist "adrenaline like" ↑ adenylyl cyclase→ ↑cAMP→↑ Ca2+ entry to myocardial cells →↑ +ve inotropic action. 31 379-Long residence of CO2 in body →↑pCO2 "hypoventilation in serum"→ ↓[HCO3]→Lactic acidosis, but ↓Pco2 "hyperventilation" →respiratory alkalosis. LOOK at Q715. 380-Chloral hydrate, cephalosporins, sulphonylurea & Metronidazole → ↑↑Alcohol disulfiram like reaction. 381-Ionization constant of H2O at 250C is 1x10-14. 382-Stool softener frequently contain anionic SAA "Dioctyl Na sulphosuccinate= Docusate Na" SE of ketoconazole 383-Cholinergic crisis may occur in Myasthenia gravis. 384-Measles vaccination is given at age of one year old. 385- Tetanus vaccine should be given to a patient with superficial infected "minor wound if the previous vaccination was taken from more than 10 years. 386-Warfarin is safe to be taken with Allopurinol. 387-Thiazides SE → hyperglycemia. 388-Tachycardia is uncommon effect which is unlikely to occur with blocker. 389-Drug A has t1/2 24 hrs, if you give 2mg of it after 72 hrs, the conc will be 0.25mg. 390-Emulsion is liquid in liquid dispersion system. 391-phosphodine I2 (E.D) is stored at 2-80C. 32 392-Insulin zinc suspension has duration of action from 18-24hrs. 393-Minocin ®"minocycline" adverse effects are GIT disturbances "N, V, D" & Vestibular toxicity "dizziness" (its main use is in oral ttt of acne vulgaris). 394- Al(OH)3 +Mg(OH)2 gel "antacid" is given hourly "dose every hr" in duodenal ulcer. 395-Bioequivalent drugs= both products are pharmaceutical equivalent & its rate &extent of systemic absorption do not show a statistically significant difference when administered in the same dose of the active ingredient in the same chemical form , in a similar dosage form, by the same route of administration, & under the same condition. 396-Sterilization of contact lens→ soaking in a saline or preservative solution. 397-Nitrazepam has t1/2 25-35 hrs "produce long day time sedation which should be avoided in elderly" to avoid falls &fractures due to accumulation of nitrazepam sedative effect. 398-Tetracycline should not be taken in pregnancy. 399-Patient taking aspirin, advise him not to take probencid "or vice versa". 400- Biphosphonates,Ca2+,calcitonin,Vit D, Na Fluoride, progesterone, androgens & calcitriol→ all these can be used in the management of osteoporosis. 401-Polysorbates"Tweens" are used as detergents & solubilizing agents, Sorbitan "Spans" are used as wetting agents (W/O emulsifying agent). 402- Blood volume =5-6 liters. 403-Adrenaline 1% eye drops produce 1-2 hrs duration of action. 33 404-Corticosteroid in asthma→ ↓release of mediators & ↓ immune reaction or immune edema. 405-Rifampicin may cause orange coloring of contact lenses (damage soft contact lenses). 406-Ketoconazole should not be taken with antacids, H2 blockers, proton pump inhibitors, cisapride, amphotercin B or food, But with astemizole & terfinadine → life threatening arrhythmia (prolong QT). 407-Vit E is insoluble thus it is better formulated as emulsion in heavy mineral oil. 408-Lidocaine or Lignocaine are not taken orally as it has substantial 1st pass metabolism. 409-Phenytoin & Theophylline have narrow therapeutic index. 410-TCA can cause sedation, anticholinergic SE & CI in glaucoma. 411- TCA & corticosteroids can cause HTN "hypertension" but not Cimetidine. 412-Belladonna alkaloids (Atropine) are not recommended in glaucoma. 413-Buffer solution is used to resist pH changes. 414-Phenyl group in phenyl mercuric nitrate leads to less solubility than other inorganic salts. 415- -blockers used in glaucoma: Timolol, levobunolol, Carteolol, metapranolol, Betaxolol. 416-Al (OH)3 is abrasive, removes comedone. 34 417-SE of Clindamycin: diarrhea. 418-Rifampicin colourifies the urine red (orange red). 419-Digoxin toxicity →↑ with Cimetidine. 420-Drug its oral dose show bioavailability of 20 % of its IV dose thus in terms of bioavailability it is poorly absorbed from the stomach. 421-In pancreatic disease→ lipase & trypsin ↑↑. 422-Rx Verapamil Propranolol Captopril Slow K you expect that the patient has bradycardia. 423-Theophylline + Ethylene diamine produce Aminophylline. 424-Ergot alkaloid in (+) of uterine contraction also oxytocin & ergometrine. 425- - lactam ring is found in amoxicillin. 426-Agranulocytosis (↓ in polymorphonuclear leukocytes) caused by as a result of Bone marrow depression. 427-Generic = drug having same ingredient as the brand or original drug. 428- Nystatin is used for treatment of Candida. 429- Patient taking Theophylline, when he stops smoking the serum level of Theophylline ↑↑ (as smoking (+) metabolism of Theophylline). 430-Reduction of particle size does not show difference of X-ray. 35 431-Polymorphs affect the solubility of the drug. 432-If pH increases (alkaline)→ excretion of acids increases (eg salicylic acid). 433-Gentamycin is bactericidal used for pseudomonas aeruginosa infection. 434-Clonidine has no significant effect as prophylactic in ttt of migraine but propranolol may. 435-Isotonic solution is isoosmotic with blood "has the same osmotic pressure of blood". 436-Phenytoin dose 50-400 mg "max" & chloral hydrate is 0.5-2gm. 437-TCA is avoided with adrenergic blocker "terazocin, prazocin, doxazocin" as both ↑ hypotension due to -adrenergic blockade. 438-*Naluphine & buprenophine are mixed agonist-antagonist. *Naltrexone, naloxone & nalmefene are pure antagonists *butorphanol & levallorphan are morphinan derived antagonists 439-Structure of mepridine: 440-Structure of Methicillin: 441-Structure of sulphonamides: 36 442-Structure of sulfonylurea: 443-Structure of dimethyl Sulphoxide (DMSO): 446-Niclosamide is used for Tapeworm infection. 447-Benzylpenicillin is used in the treatment of pneumonia. 448-Sulphonamides are metabolized in humans by Acetylation. 449-Amoxycillin is more absorbable than Ampicillin because it has Para hydroxyl gp (OH). 37 450-Oxidation of 2ry alcohol → ketone. 451-Cocaine overdose→ Respiratory failure. 452-Lactic acid "optically active"→oxidation→ pyruvic acid "isomer/optically inactive". 453-100 ml distilled H2O is injected IV what will happen to RBCs? → Swelling & rupture occurs. 454-↓↓ of GABA level occurs in Huntington's chorea. 455-Diflunisal is not metabolized to Salicylate in body. 456-Quinine is optical isomer of Quinidine. 457- Overdose of paracetamol is treated by glutathione and/or N-acetyl cysteine. 458-Cyproheptadine is NOT used in ttt of Epilepsy. 459-Alprostadil "prostaglandin, PGE analog" is used for temporary maintenance of a patent ductus arteriosus in a waiting corrective surgery for congenital heart defect & in treating impotence due to erectile dysfunction. 460-Nystatin, Amphotercin B are used in treatment of fungal infection eg Aspragellus by Nystatin not ampho. B, but Candida albicans by both. 461-I2 in high doses only ↓ Iodide uptake by thyroid gland but carbimazole, propylthiouracil & estrogen do not ↓ Iodide uptake by the thyroid. 462-Psoriasis is treated by Methotrexate & is characterized by shiny scales, also calcipotriol is used in the topical ttt of psoriasis, salicylic acid is used as keratolytic, also coal tar is used in ttt of psoriasis. 463- Allopurinol is not uricosuric agent. 38 464-Tricyclic antidepressant does not cause salivation, as it has anticholinergic SE. 465-Plasma % of blood = 55%, it is about 5% of total body weight & = 3500ml of total body volume. 466-Heparin mode of action: (-) conversion of fibrinogen to fibrin & catalyzes the (-) thrombin by antithrombin III (HEPARIN COFACTOR). 467-ACE inhibitor mode of action: blocking the conversion of angiotensin I to the potent vasoconstrictor angiotensin II, the reduced angiotensin II → ↓Aldosterone conc. →↓Na retention. 468-Glucocorticoid used in inflammation as it ↓ synthesis of prostaglandin. 469- Corticotrophin secretion is stimulated by corticotrophin releasing hormone "from the anterior pituitary" from the hypothalamus. 470-Phenylephrine is not diuretic but caffeine "methyl xanthines" has diuretic effect. 471-Damage of the posterior pituitary gland cause ↓↓ in the level (or (-) release) of vasopressin & oxytocin. 472-Ferrous salts are the form (of iron) which is absorbed while ferric salts & elemental iron are not absorbed well. 473-Clonidine is not drug of choice in chronic treatment of HTN (SE: sedation). 474- -methyldopa mode of action is ↑ presynaptic 2-inhibitory response → ↓sympathetic output & ↓ peripheral resistance. 475-Vit D is not decomposed by sunlight. 476-↑↑Level of thyroid hormone (as in hyperthyroidism) signals the pituitary to stop releasing TSH (-ve feedback). 39 477-Structure of Cimetidine (Tagamat): 478-Estrogen is secreted from ovarian follicle. 479-In hyperkalemia, don't use spironolactone. 480-Tolbutamide & phenphormin both (↓) plasma glucagon level & are used in ttt of NIDDM. 481-Cartilage may change to bone in Ossification. 482-Urea is the waste product of protein (outcome of protein metabolism). 483-Sudden death in MI is due to ventricular fibrillation. 484- M.O.A of Nitroglycerin: directly relaxes vascular smooth muscle (by N.O) = nitric oxide. 485- Impetigo prognosis: Impetigo is a superficial vesiculopustular skin infection caused by staph aureus. Prognosis untreated→ cellulitis, lymphangitis or furunculosis. BUT not cause endocarditis. If treated→ prompt recovery. 486-Shingles= Herpes Zoster: is infection with varicella- Zoster virus primarily involving the dorsal root ganglia & characterized by vesicular eruption & neuralgic pain in the dermatome of the affected root ganglia. 487- Dose of Sildenafil (Viagra®) is 100 mg 40 (50-100 mg). Mode of Action: (+) NO effect on vascular smooth muscle→ ↑blood flow to penis → ↑ erection (upon sexual arousal) through (-) phosphodiestrase type 5) C.I with nitrates S.E: Headache Use: Erectile dysfunction. 488- Racemic mixture is optically inactive (which contains equal amount of D & L stereoisomers). 489- Dose of Erythromycin base = 0.25-0.5 g every 6 hrs 490- Clarithromycin is active against Mycoplasma, Chlamydia & Legionella (organisms). 491- Structure of Amoxacillin: 492-Structure of Phenobarbitone or Phenobarbital: 493- SAA is added to tablets to act as binder & adhesive (e.g. gelatin, Acacia) & improve dissolution & bioavailability. 494- Dose of Thyroid preparation in Adult after Surgical removal of thyroid gland is 1.6 g/ kg/day. 495- CaCO3 is given to patient with terminal renal failure to ↑ Ca2+ in serum & correct hypocalcaemia. 496- 41 497- Atenolol is the least lipid soluble B-blocker. 498- Lithium is used in Bipolar Affective disorder. 499- Constipation due to morphine agonist is treated by: a) Increasing fiber content in diet. b) Stool softener (Docusate Na 100 mg Bid or tid) c) Stimulant laxative (Senna) *If constipation persist use Osmotic laxative (Magnesium citrate or Lactulose) 500- The diagnostic element in blood for AIDS patient is detecting antibody to HIV (ELISA assay). 501- Glucose is not detected by (UV method) 502- Chlorohexidine is compatible with cetrimide 503- KOH+ organic acid→ soap 504- Na Valproate can be used to treat both grand mal and petit mal epilepsy. 505- Cystic fibrosis is an inherited" autosomal recessive" disease of the exocrine glands primarily affecting the GI, respiratory system and usually characterized by COPD, exocrine pancreatic insufficiency and abnormally high sweat electrolytes. Pseudomonas infection is the dominant infection. Treatment: 1-Pancreatic enzyme replacement 2-Diet therapy 3-Oral corticosteroid 4-Ibuprofen 42 5-Antibiotics "e.g. ciprofloxacin" 506-Addison disease is due to adrenocortical insufficiency. 507- Cholecalciferol "Vit D3" is secosteroid produced in the skin from 7-dehydrocholestrol by UV radiation, its main function is to increase calcium absorption from intestine, increase bone formation and mineralization. 508- Thyroid hormone is responsible for: a-protein synthesis b-increase activity of Na, K ATPase pump to increase oxygen consumption. c- increase secretion of growth hormone 509- Zollinger Ellison syndrome characterized by marked by hypergastrinemia, gastric hypersecretion and peptic ulceration caused by gastrin producing tumor of the pancreas or duodenal wall. 510- Structure of Zwitter ion" of amino acids" »»» R-CH-COO- NH3+ 511- Microcytic anemia: is measured by MCV "Mean Corpuscular Hb" < 80 fl but normal range 90 ± 10fl. 512- Patient taking phenytoin experience ataxia, what to do?? Decrease dose of phenytoin. 513-Ileum is the last part of the small intestine. 514- Insulin lent act for 24 hr. 515- Highest calories per gram given by fat. 1g of protein=4 Kcal. 1g of carbohydrate=4 kcal. 1g of fat=9 kcal. 43 516-Discarded Chloramphenicol loses potency. 517- Septrin mode of action: (-) purine and DNA synthesis. PABA Dihydrofolic acid THF purines DNA. 518- Androgens "nandrolone" are used for both decreased growth and osteoporosis. 519-Erythromycin does not affect bioavailability of ketoconazole. 520-Furosemide causes metabolic alkalosis "systemic alkalosis" Acetazolamide systemic acidosis + urinary alkalosis ascorbic acid urinary acidosis. 521- Amiodarone causes: a-pulmonary fibrosis b-yellow deposits on cornea c-skin deposits and change in color d-CNS effects e-Thyroid dysfunction " hypo and hyper" f- Photosensitivity 522- when giving furosemide dose check renal function and current dose furosemide " as t1/2 is dependent on renal clearance". 523-Rifampin cause harmless orange color in urine. 524- Contact lens is sterilized by heating with saline for 5 min. 525- Warfarin mode of action is interference with Vit K dependent hepatic synthesis of the active clotting factors II, VII, IX, X and the anticoagulant protein C & S, these agents prolong clotting time in vivo only. 526- Warfarin has optical isomers (Racemic Mixture). 527- Streptokinase: *dose 1.5 million IV infused over 60 min 44 *not given within 6 months from the previous administration due to allergic reaction "Ab-Ag reaction) 528-Chloramphenicol mode of action: (-) bacterial protein synthesis [(-) peptidyl transferase step]. S.E:*GIT disturbance *BM depression *Aplastic anemia *Gray baby syndrome. 529- Boric acid is not used in the topical skin preparation for infants because it cause boiled lobster rash 530- structure of cisplatin: 531- (++) of Vagus nerve bradycardia. 532- patient taking Loperamide advise him that it is not used for infectious diarrhea as it cause stasis of M.O. 533- Amphoteric drugs don't change pH. 534- Dihydroergotamine is not taken sublingually but ergotamine tartarate is taken sublingually. 535-Clonidine S.E:*Dry mouth, sedation, withdrawal life threatening hypertensive crisis " tachycardia, headache, sweating" but not cause nasal stiffness. 536-Tophus is characteristic of Gout. 537- We mix 20% rose oil with cream on glass plate by slow agitation. 45 538- benzodiazepines+ drug (LME inducer) to overcome the problem add Cimetidine “LME inhibitor”. 539- Methyldopa passes B.B.B 540- Sulphonamides are contraindicated in infants because it displaces bilirubin from plasma protein causing Kernicterus. 541- Anaphylaxis has manifestations: (treated by epinephrine). *agitation, coughing, sneezing, urticaria, edema, difficult breathing, and bronchospasm. * Shock, CVS collapse. 542- Some drugs show irrelevance between of activity and plasma conc. Because they are quickly metabolized. 543 Mode of action of aspirin as antiplatelet is irreversible acetylation of cyclo-oxygenase enzyme causing decrease of thromboxane A2 synthesis - decrease platelet aggregation, dose 75-325 mg/day “for 1ry prophylaxis from MI”. 544- Piroxicam has long t ½ taken once daily. 545-acetaminophen is given for chronic pain in the elderly patient. 546- Diet with fibers decrease constipation - diarrhea. 547- Drugs causing gynecomastia: Cimetidine , digoxin, Isoniazide, methyl dopa, estrogen, spironolactone, and testosterone. 548- The receptor for cough suppression effect of codeine in the CNS “in the brain stem” in medulla oblongata. 549- COX II inhibitor”celecoxib” can be used as NSAID in patient with peptic ulcer (which is not active). N.B [Rofecoxib “vioxx” is withdrawn from market due to its relation with MI occurrence”. 46 550-Captopril and all ACEIs are contraindicated in: a) renal artery stenosis, b) pregnancy. 551- Echothiophate iodide is cholinesterase inhibitor “indirect acting miotics", increase aqueous humor outflow & cause accommodation thus used in glaucoma treatment. 552- Tetanus vaccine should be given as booster dose, 10 years. 553- Management of acute asthma attack: a- O2 therapy b-bronchodilators”B2 agonist” or IV aminophylline. c- Systemic corticosteroids “1st oral if no response” d- epinephrine SC. thus we can say that IV aminophylline is taken in acute asthma. 554- after taking inhaler in asthma, the case may worsen due to: a-improper way to use b-down regulation of receptor” causing tachyphlaxis” c-case become progressed. 555- Sucralfate should not be taken with food or antacid. 556- Ciprofloxacin + Theophylline - increase toxicity of Theophylline thus we need to decrease dose of Theophylline. 557- Agents used to coat enteric coated tablets are shellac, cellulose acetate phethalate. 558- Which is optically active? Levofloxacin, Carvedilol, are optically active and ephedrine also. 559- KCL is given in enteric coated tablets to protect gastric mucosa” to prevent irritation of gastric mucosa” a-to prevent destruction of the drug by gastric juice. b-to prevent irritation of the stomach lining by drug. c- To allow absorption of drug in the intestine not in the stomach. 47 560- Cromolyn Na is used for prophylaxis of asthma. 561- Sterile water for injection is prepared by distillation then autoclaving. 562- Vit B1 Thiamine, B2 Riboflavin, B3 Niacin, B6 pyridoxine, B12 Cyanocobalamine. 563- pKa= negative log of ionization constant” indicates the relative strength of acid or base”. 564- Creatinine clearance is used to assess the renal function, normal value 75-120 ml/min. 565 Zinc helps in wound healing. 567- Anticoagulants, NSAIDS, ASA (acetylsalicylic acid) are contraindicated in peptic ulcer. 568- Glucose and fructose are monosaccharide. 569- B Lactams are metabolized by hydrolysis. 570- Hepatotoxicity of INH is due to its conversion by phase II is due to its conversion by phase II reaction into more toxic metabolite. 571-Distal tubule is sensitive to thiazide derivatives, and spironolactone act on the late distal convoluted tubule. 572-patient on digoxin should not take laxative to prevent hypokalemia which increase digitalis toxicity. 573- Weak base drug is easily excreted by NH4 salts "Acidifying agents". 574- Number of RBCs in blood of healthy person= 5 x 106 l. 48 575- 50% of glomerular filtration returns back to blood from distal tubule. 576- 180 liter of fluid is filtered in glomerular filtration. 577- Conjugation with bilirubin occurs in liver. 578- Dose of Aspirin in rheumatoid arthritis is 3-6 gm 579- Drug dose 4mg, t ½ is 1.6, when does it reach 1 gm?? 4 after 1.6 hr 2 1.6 hr 1 after 3.2 hr. 580- One of the critical drug interactions is: *Cimetidine with warfarin * Cimetidine with Theophylline. 581- *Metabolism of: methyl alcohol---oxidation---->formaldehyde----[O]---> formic acid. *Metabolism of: ethyl alcohol-----oxidation---->acetaldehyde----[O]---------> acetic acid. 582- We use simple ointment with hydrocortisone. 583-Methadone is morphine agonist not narcotic antagonist. 584- Urine retention is least likely to occur in diabetic patient??? 585- Majority of HTN is essential hypertension. 586- Carbenoxolone “derivative of glycerhyzic acid, extracted from liqourice” used in treatment of gastric and duodenal ulcer, S.E aldosterone like effect→ HTN, Fluid retention. 587- Not used to treat HTN caused by Na and H2O retention is Guanethidine or Minoxidil. 49 588- Miosis= contraction of eye pupil. 589- Dextromethorphan is 1st choice cough suppressant. 590- Hydralazine cause nasal congestion. 591- Reserpine cause nasal stuffiness. 592- Destruction or removal of posterior pituitary cause deficiency of ADH” vasopressin and oxytocin”. 593-Structure of Neostigmine: 594 Example of MAOI is Tranylcypromine, phenelzine, Moclobemide. 595- Deterioration of this structure: occurs by oxidation of aldehydic group to carboxylic” 596- Sulphonamides are antimicrobial “AB” but are not antiviral. 597- Inotropic action of B-stimulant of cardiac muscle is by increasing Calcium influx entry to the myocardial cell. 598- Neuron structure: Myelinated fatty acid structured sheath around nerve. 599-Agranulocytosis is accompanied with necrotic lesions of mouth and throat. 50 Agranulocytosis=Leukemia=neutropenia. 600- Eye drops are sterilized by filtration with porosity 0.2 um diameter. 601- Paraldehyde is acetaldehyde polymer, its structure 602-stratum corneum is outer layer of skin. 603-Griesovalvin and phenothiazine cause photosensitivity. 604- Inflammation of synovial fluid and membrane found in rheumatoid arthritis. 605- Moniliasis or candidiasis “yeast infection of skin” caused by overuse of: *cortisone *antibacterial *immunosuppressive therapy *pregnancy *Diabetes 606- Nystatin treats Moniliasis “Candida Albicans” 607- Erythromycin structure is macrocyclic lactone ring attached to sugar moiety. 608-all are hormones and mediators except cAMP: ( Adrenaline- Insulin- Serotonin-CAMP). 609-Carbachol is cholinergic agonist drug, Probucol is antihyperlipidemic drug. 610-phenotthiazine not used in epilepsy. 611- Ranitidine preferred than Cimetidine because Cimetidine is hepatic microsomal inhibitor and there are many drug interaction with Cimetidine. 51 612- Myasthenia gravis is autonomic disease of parasympathetic system. 613- d-propoxyphene has (½) analgesic activity of codeine. 614- Sulpha drugs are not liable to decompose by heat. 615- 1st choice in acute gout attacks is Colchicine or NSAID`Indomethacin` 616- Cystic Fibrosis is inherited disease not contagious. 617- Thiazides are used to relieve Na & H20 retention “edema” 618- Adrenaline mechanism in glycogenolysis lead to increased glucose release into the circulation “through its effect on B-receptor”. 619-Nalidixic acid S.E is visual disturbance. 620-Aminocaproic acid is antifibrinolytic agent. 621- The complex formed between BAL “Dimercaprol” which is sparingly soluble in H20 and heavy metals from stable nontoxic, soluble in H2O compound which is extracted through kidney. 622- Linoleic CH3 (CH2) 4CH=CHCH 2CH= CH (CH2)7COOH is polyunsaturated fatty acid. 623- Optical activity is due to asymmetric C atoms. 624- Additional instruction for penicillin preparation “except Amoxacillin) take 2 hr before food and preferred to be taken on empty stomach. 625- Adrenaline is used with local anesthetic to: prolong its action “by vasoconstriction” 626- Combined pills (estrogen + progesterone) act by: a- (-) implantation b-fasten transfer of fertilized ovum c-produce 52  hostile cervical mucus (increase viscosity). d- (-) ovulation 627- NaCl (neutral) does not change pH of the medium. 628- Sulfa methoxypyridine is long acting as it is highly bound to plasma proteins. 629- Diuretics which are used safely in sulpha or sulphonamide allergic patients are: *Ethacrynic acid *spironolactone 630- CN “cyanide toxicity” is due to its binding to Cytochrome oxidase enzyme or complexing of Cytochrome iron. 631-cetomacrogol “non ionic SAA” is incompatible with tannic acid, NH4 salts & phenol. 632- Erythromycin is contraindicated with Theophylline as it decrease hepatic metabolism of Theophylline. 633- Phenytoin drug interaction: a- Decrease b- Increase c-drugs impaired by phenytoin level by phenytoin level by phenytoin increasing decreasing metabolism. metabolism. 53 Antiepileptic drugs: Disulfiram 1-Cortiocosteroids 1-carbamazpine 1-INH 2-Digitalsi 2-Valproic acid 2-Chloramphenicol 3-doxycyline 3-Clonazepam 3-Propoxyphene 4-estrogen 4-Phenobarbitol 4-coumarin 5-furosemide 5-Warfarin 6-contraceptives 7-oral anticoagulant 8-gaunedine 9-Rifampin 10-Theophylline 11-Vit D 12-Enteral Nutrition 634- Chlorohexidine “disinfectant” is cationic thus to prepare O/W emulsion we can use cetrimide “which is also cationic” because it is compatible with Chlorhexidine. 635- Polypropylene syringes can withstand autoclaving while other plastics used for syringe are gas sterilized. 636-Solvent used with hydrocortisone (I.V injection) is: propylene glycol. 637-Phenobarbitione Na+ Chloramphenicol→ ppt of barbituric acid. 638-Atropine is soluble in acids, forming atropine SO4. 639-Plasma volume=55 ml/Kg body wt. 640- alpha methyl dopa + HCTZ “diuretic” is used to decrease edema” fluid accumulation” caused by alpha methyl dopa. 641-life threatening interaction: *Haloperidol + amiodarone → increase ventricular arrhythmia another common interaction: *Haloperidol+ alpha methyl dopa → increase hypotension, EPS 642- Tranexamic acid and Aminocaproic acid antifibrinolytic used in overdose of streptokinase and altepase which are fibrinolytic agents. 643- Loop diuretic mode of action “act at the ascending loop of Henle decrease the co-transport of Na, K, Cl from the luminal filtrate → increase 54 excretion of H20, Na, K, Ca, Cl, decrease uric acid secretion and cause no change in urinary pH. 644- Radial Walker test used to estimate disinfectant activity. 645- Antihelmentic of Choice: #Tapeworm-- Niclosamide #Threadworm Thiobendazole #Pinworm & Roundworm- Pyrantel Pamoate #Whipworm & Hookworm- Mebendazole. 646- Uses of Vit D are in: Rickets and Osteomalacia. 647- Sulphonylureas mode of action: stimulate B cells of pancreas to release insulin. S.E: Hypoglycemia 648-Chloropromazine I.M gives better bioavailability 649- Causes of Osteoporosis: a- long term use of steroids b- hyperparathyroidism c-postmenopausal due to decrease in estrogen level 650- Emulsifier used with salicylic acid preparation is wool alcohol. 651- On long term use of sympathomimetics- HTN can occur. e.g. Nasal decongestant “phenyl propanolamine” 652- Guanethidine cause diarrhea because the parasympathetic tone predominant as Guanethidine blocks the sympathetic outflow. 653- Safest sulfa to allergic patient is Sulfamethizole (t ½ is short & 90% is protein bound) 654- Tobramycin is not used with TB. 655- Procainamide is metabolized to N-acetyl procainamide. 656- Chlorthalidone is the longest acting diuretic of t ½= 40-65hr, dose=2.5- 50mg or up to 100mg. 657- Metabolic acidosis is due to [HC03] loss. 55 658- Most potent respiratory stimulant is: increase Pco2 in blood “respiratory acidosis”. 659- Oligurea=low urine excretion. 660- Vasomotor and respiratory centers are located in medulla. 661- The sympathetic ganglia located near the spinal cord. 662- Haemoglobin quantity in 100 ml blood= 15gm. 663- Function of Vagus is: regulation of heart rate. 664- Pacemaker of the heart is SA node which is located in the right atrium. 665- Cirrhosis = progressive fibrosis and scarring of the liver. 666- Xerostomia=dryness of the mouth 667- Bilirubin is end product of haemoglobin decomposition 668- The human cells has 46 chromosomes while gonade cells has 23 chromosomes either 22+X or 22+y “sperm and ova” 669- Blood makes 1/15 of body wt. 670- Sulfasalazine is : * poorly absorbed from GIT. *used in treating ulcerative colitis and regional enteritis 671- Chenodiol is used to dissolve cholesterol gall bladder stones. 672- Cyclosporine is immunosuppressant. 673- Emergency case patient with hypotension, shock, the 1st choice therapy is dopamine because it has: a- +ve inotropic effect on the heart(B agonist action b- release norepinephrine from its stores ( increase B.P) c- + dopamine receptors within kidney increase renal blood flow infusion is interrupted to decrease tachycardia as dopamine has very short t ½. 674- A good antacid should raise pH from normal value of 1-2 to pH of 3.5. 56 675- Gentamycin enhances SE” Ototoxicity” of Ethacrynic acid and also aminoglycosides “Gentamycin” increase nephrotoxicity of loop diuretic. *Aminoglycosides “streptomycin "enhance nephrotoxicity of Cephalothin, cisplatin, Amphotericin b and methoxyflurane. 676- Lymph gland principal function is filter out solids by phagocytosis. 677- Phenol, menthol and camphor if mixed together will melt and give eutectic mixture. 678 strong analgesic pain killer→ pentazocine. 679- Normal blood glucose level: *fasting