Lara Notes on Drug Interactions - PDF

## WRITTEN BY LARA REVISED BY DR. AHMED ELQAFFAS & MUSTAFA WALLY KAPS FOR ALL ### Cytochrome inhibitors: - 1- 1A2: cimetidine. - 2- 2C9: amiodarone. - 3- 2D6: cimetidine, amiodarone, paroxetine, bupropion. - 4- 3A4: verapamil, diltiazem, clarithromycin, erythromycin and grape fruit juice (grape fru...

## WRITTEN BY LARA REVISED BY DR. AHMED ELQAFFAS & MUSTAFA WALLY KAPS FOR ALL ### Cytochrome inhibitors: - 1- 1A2: cimetidine. - 2- 2C9: amiodarone. - 3- 2D6: cimetidine, amiodarone, paroxetine, bupropion. - 4- 3A4: verapamil, diltiazem, clarithromycin, erythromycin and grape fruit juice (grape fruit juice + saquinavir = ↑ saquinavir level by 150-220%). ### Cytochrome inducers: - 1- 1A2: tobacco, phenytoin and phenobarbital. - 2- 2C9: rifampicin. - 3- 3A4: rifampicin, phenytoin and phenobarbital. ### Cytochrome substrate: - 1- 2D6: codeine and dextromethorphan. - 2- 2B6: bupropion. - 3- 2C9: ibuprofen, celecoxib (NSAIDs), losartan, irbesartan, warfarin and phenytoin. - 4- 2C19: Clopidogrel and phenytoin. - 5- 3A4: ethinylestradiol | Drug | Drug | Drug | Drug | |---|---|---|---| | Rivaroxaban | Erythromycin | Amiodarone | Fluvastatin | | Apixaban | Aripiprazole | Cyclosporin | Colchicine | | Verapamil | Felodipine | | | | Diltiazem | Nifedipine | | | - Rivaroxaban + ketoconazole = ↑ rivaroxaban. - Clarithromycin + verapamil = ↑ level or effect of verapamil. - 2 drugs should not be taken together: verapamil and erythromycin because both affect 3A4 - Erythromycin interacts with oral anti-coagulant, carbamazepine (↓ metabolism→ ↑ toxicity), digoxin and theophylline (↑ their serum level). - Erythromycin + zafirlukast = ↓ zafirlukast effect. - Lidocaine metabolized 90% 1A2 and 10% 3A4. Cyt of it is 1A2. - Ciclosporin + erythromycin, diltiazem, verapamil and Allopurinol = ↑ cyclosporin. - Azathioprine + allopurinol: may be used by dose of azathioprine. Or ↑ level of both drugs. - Digoxin is P-glycoprotein. - Digoxin + amiodarone = ↓ dose of digoxin to half. - Furosemide, chlorthalidone, spironolactone and cimetidine ↑ digoxin toxicity. - Quinine and quinidine are Cl with digoxin as it ↑ digoxin level by its clearance. - Digoxin absorption by kaolin, neomycin and cholestyramine. - Simvastatin + cholestyramine = ↓ statin absorption. - Gemfibrozil + atorvastatin = ↑ atorvastatin toxicity and ↑ myopathy risk. - Colchicine + statin = myopathy. - Colchicine + grape fruit: ↑ its toxicity. - Nifedipine, warfarin, digoxin and phenytoin + grapefruit = no interaction. - PCM + MTX = no interaction. - Famotidine or Gingko biloba + warfarin = no interaction. - Digoxin + Li, theophylline = no interaction. - Doxorubicin and glucosamine = no interaction. - Measure 2C9: NSAIDs specially ibuprofen. - Measure 3A4: erythromycin (has most of it). - Measure 2D6: dextromethorphan (1st choice in cough suppression). - Fluconazole + omeprazole = ↑ omeprazole level. - 4A3 is not important in human metabolism. - Not cyt p 2D6: ciprofloxacin. - Which dose of drug needs to be ↑ esomeprazole is taken every morning? Levothyroxine. - Metronidazole and alcohol: stop alcohol 24 hrs before starting metronidazole. ### Disulfuram like reaction drugs with: - 1- Ethanol. - 2- B-lactams (cephalosporins). - 3- Chloramphenicol - 4- Isoniazid. - 5- Ketoconazole - 6- Griseofulvin. - 7- Metronidazole. - 8- Chlorpropamide - 9- Sulphonylurea. - 10- sulfonamide (methprim). - 11- Chloral hydrate. ## Dose adjustment in renal failure: | Drug | Drug | Drug | |---|---|---| | All Cephalosporin | Digoxin | Morphine | | Ceftazidime | Methyl dopa | Li | | Allopurinol | Amikacin | Vancomycin | | Acyclovir | Enoxaparin | Baclofen | | Ciprofloxacin | Metformin | Prednisolone | | | Prednisone | Hydrocortisone | - Not need for dose adjustment in renal failure: phenytoin, theophylline and diltiazem. - Fosinopril is the only ACEIs that can be used in renal failure as it is excreted in bile. ## Dose adjustment in hepatic failure: | Drug | Drug | Drug | |---|---|---| | Theophylline | Metronidazole | Chloramphenicol | | Amiodarone | Cefoperazone | Morphine | | Heparin | Ceftriaxone | Nafcillin | ## Ketone or aldehyde group in: | Drug | Drug | Drug | |---|---|---| | Phenobarbital | Methadone | Prednisone | | Phenobarbitone | Camphor (ketone) | Hydrocortisone | | (ketone) | Prednisolone | | ## What cause hemolytic anemia? | Drug | Drug | Drug | |---|---|---| | methyldopa (+ve Coombs test) | Primaquine | Nitrofurantoin | | Aspirin | Nalidixic acid | Dapsone | | Quinine | Chloramphenicol | | | | Sulfonamide | | ## Neutral do not change the PH of medium like: | Drug | Drug | |---|---| | Glycerin syrup | Amphoteric drugs | | Ethanol | NaCl and KI syrup | | Na metabisulphite, Phenol and NH4Cl are acidic. ## Alkaline are: | Drug | Drug | Drug | |---|---|---| | Na borate | Amphetamine | KBr | | NHCO3 | Acetazolamide | | ## Ascorbic acid is used with methenamine to acidify urine→↑ formaldehyde which has antibacterial activity. TTT for urinary cystitis. - Methenamine can be taken with all except: Na citrate or tartrate as they alkalinize urine which prevent methenamine hydrolysis to active drug formaldehyde. - Why not alkalinizes with fluroquinolones due to crystal urea. - L-dopa absorption with protein diet. - What the passing levodopa across BBB? Dietary protein. - L-dopa is used in Parkinson because dopamine doesn't readily pass BBB. - Misoprostol (asked in case study) piroxicam also prescribed, ulcers induced by piroxicam. - Olanzapine adjusting in smoking. - Take care theophylline + ethylene diamine = aminophylline. - Suxamethonium (succinyl choline) ↑ gentamicin toxicity. - pseudocholinesterase enzyme → ↑ succinylcholine action. - Suxamethonium is rapidly metabolized by choline esterase. - Diltiazem ↑ aripiprazole effect by affecting 3A4. - Interaction of amphotericin B and azole is antagonistic interaction. - Statin gives more myotoxicity due to ↑ exposure of skeletal muscle to statin → ↑ risk of mitochondrial dysfunction, Ca signaling disruption, prenylation, atrogin 1-mediated atrophy and apoptotic signaling. ## Drugs NO interaction with warfarin activity: - Spironolactone. - Atorvastatin, pravastatin. - Ezetimibe (will not ↓ absorption of another drug). - Morphine. ## Drugs enhance warfarin activity and bleeding: - Simvastatin (statin). - Thyroxin. - Oral contraceptive (levonorgestrel). - Tibolone. - Ciprofloxacin, moxifloxacin. - Itraconazole, voriconazole. - Co-trimoxazole. - All NSAIDs. - Tramadol. - Amiodarone. - Cimetidine. - Metronidazole. ## Drugs inhibit warfarin activity: - Azathioprine (Imuran). - Griseofulvin. - Rifampicin ↓ INR. - St. John's Wart. - Carbamazepine, phenytoin and phenobarbital. ## Doses - Repaglinide: 0.5-4 mg/day. - Acarbose max dose 600 mg, dose 50-100 mg tid. - Acamprosate treatment of alcoholism abstinent pt. 666 mg tid. Duration of therapy at least 3 months. - Donepezil 10 mg. - Perindopril max 10 mg. - Paracetamol 15 mg/kg every 4-6 hours, hepatotoxicity if > 150 mg/kg, child dose 300mg 4 times. - Hydrocortisone in emergency 100 mg IV every 6 hours. - Doxycycline for malaria 100 mg twice daily beginning 2 days before and during for 4 weeks after coming back from malaria place (exposure). - Sildenafil 50-100 mg 1 hr. before intercourse. - Dapsone 50-100 mg. - Digoxin 125-250 µg once daily. - Lisinopril max 40 mg. - Captopril max 150 mg, 25-150 mg t.i.d (only ACEI taken > once), taken 1 hr. before meals. - Doxepin max 300 mg (75-150 mg). - Roxithromycin max 300 mg, 150 mg bid. - Imipramine max 300 mg. - SL glyceryl trinitrate 300-600 µg (recalls 0.5-1 mg). - Vancomycin 0.5 g/day for 7-10 days IV for MRSA, 125-250 oral. - Atropine 2 mg IM for cholinesterase inhibitor, 2-3 mg in TTT of bronchospasm, 0.5-1 mg in bradycardia. - Carbamazepine: 0.2-1.2 gm. - 10 mg SC or IM morphine = 30 mg morphine oral = 100 µg fentanyl SC. - Phenytoin maintenance dose 4-5 mg/kg, increased by 30 mg daily once every 2 weeks according to response, usual range, 200-500 mg daily (once or in 3 divided doses). Loading dose 15-20 mg. - Phenytoin for status epileptic 15-20 mg/kg. - Piperacillin 3 g every 6 hrs., in Cr Cl 2.6 mg/kg/min, in pt with renal insufficiency Cl 1.3, dose should be 3 g every 12 hrs. - Fluoxetine 20 mg. - Venlafaxine 75 mg daily. - Aspirin antiplatelets 75-150 mg/day or 50-325 mg, RA 3-4 gm or 6 gm and as antigout > 5 gm. - Hydralazine 50-200 mg/day (maintenance dose > 100 mg/day are associated with an increased risk of lupus like syndrome). - Cimetidine 200-800 mg. - Misoprostol 200-800 µg. - Diclofenac 200 mg daily. - Prednisolone/ prednisone initially 5-60 mg/day-usual maintenance dose 2.5-15 mg/daily. - Clotrimazole 500 mg single application. - Salbutamol: 2-4 mg 3 or 4 times/d. - Erythromycin base: 0.25-0.5 g/ every 6 hrs, 5 ml per dose. - Colchicine 500 mcg orally with ibuprofen once or twice daily if acute gout (1 mg initially then 500 µg ever 6 hrs until pain relief or toxicity (N, V, D), max dose 6 mg per course, do not repeat the course within 3 days. - Least indicated in acute gout attack? MTX. - Ferrous sulphate: 200-300 mg t.i.d. - Hydrochlorothiazide 12.5-25-50 mg. (5-25 mg) - Chlorthalidone= 2.5-50 mg or up to 100 mg. - Chloral hydrate dose 0.3-2 g. - Methyl dopa: 0.5-2 g (125, 250, 500 mg 2-4 times/d). - Dose of thyroid preparation in adult after surgical removal of thyroid gland is 1.6 µg/kg/day. Or 25 µg/day. - Streptokinase: 1.5 million IV over 60 min. It is not given within 6 months from previous administration due to allergic reaction (Ab- Ag reaction). - Pt on phenytoin still has fits, we give him dose of 30 mg (taken once). - Folic acids counseling to reduce incidence of neural tube defects in pregnancy: once daily month before pregnancy and up to 12 weeks. - Aminoglycoside once daily. - The doses of clomiphene citrate, which is used in the treatment of infertility, should be taken on which of the following days of the menstrual cycle? 5-9. - MTX, RA 7.5-25 mg/week for 6 weeks. Psoriasis 7.5-15 mg/week (max 30 mg/week). - Herpes simplex encephalitis should be treated with acyclovir 10 mg/ kg IV every 8 hrs./ 2 weeks. - Cephalexin 1 g for UTI. - Which treatment course with gentamicin is more likely to cause nephrotoxicity? 1 mg/kg/t.i.d/ 14 days. Gentamicin is conc. dependent antimicrobial. - If a patient has been ordered salbutamol aerosol beclomethasone aerosol both to be inhaled 4 times a day the patient should inhale beclomethasone 10 minutes after salbutamol. - Norethisterone is used to treat a variety of conditions. Which of the following doses in INCORRECT? Hormone is replacement therapy; orally 1.25 mg/day with continuous estrogen. - Dose of progesterone in hormone replacement therapy? 1.25 mg/day 10-14 days with estrogen. - Medroxyprogesterone: 150 mg/ 12 weeks. - What is the range for the daily recommended allowance of Ca for women? 1000-1500 mg. - A patient with a superficial wound asks what time period is recommended between tetanus immunizations? Every ten years. - Fosfomycin is used as single dose 3 g in both complicated and uncomplicated UTI. - Dapsone child dose: 1-2 mg/kg, max. 100 mg/day. - About dosing which is least appropriate: infant has more water than adult therefore we ↑ dose of water-soluble drug. - Insulin: - when shifting from twice daily Isophane to once daily Glargine (peak less insulin), the dose should be reduced by 20%. - split mixed regimens (combination of 30% short-acting and 70% long-acting): 2/3 of total dose before breakfast and 1/3 before dinner. - Insulin zinc lente duration of action: 18-24 hrs. - protamine zinc insulin and ultra lente= 36 hrs. - Neutral protamine Hagedorn NPH differ from glargine which has longer duration of action up to 36 hrs.. - Neutral insulin has the t½ < 12 hr. - If gallbladder is removed what will happen? Fat will not be emulsified. - The main cause of acute kidney injury Aki is amphotericin then vancomycin, but if liposomal amphotericin so vancomycin. - Doxycycline can affect oral estrogen supplement by enterohepatic circulation. - Asparaginase: antineoplastic. - Which one is not caused by dopamine, an ↑ in acetylcholine: hyperreflexia. - Amiodarone chooses correct: QT↑ with venlafaxine. - Which ion more affect dehydration: Na. - Dehydration symptoms in children: lethargy, dizziness, confusion and coma. - Symptoms of blood dyskaryosis may include: sore throat and fever. - What is important in health screening: early detection and management of disease. - Saturation of substrate leads no change. - Concerning eplerenone, a spironolactone analogue which is appropriate? Eplerenone has fewer SE than spironolactone. - Which one is antiemetic? Nabilone. - HTN TTT reduce risk of angina. - Not seen in lab in iron anemia: high transferrin. - Tea, toast: iron deficiency anemia. - Low mean corpuscular volume can be seen in anemia caused by: iron deficiency. - Compounds which have opposite actions acting on different receptor are physiological antagonists. - Agonist is called partial agonist it produces less effect than agonist. - Agonist means: favors action, high affinity to receptor with intrinsic activity. - Antagonist means high affinity to receptor with no intrinsic activity. - Nalbuphine, buprenorphine, butorphanol, levorphanol and pentazocine = are mixed agonist-antagonist. - Naltrexone, naloxone and nalmefene are pure antagonists. - Nalorphine is partial agonist antagonist (narcotic) can cause ppt of withdrawal symptoms. - Enterohepatic cycling: after the drug is absorbed and transported to the liver it is secreted with bile into intestine→ reabsorbed back from the intestine to the liver again. - Haloperidol: D₂ blocker, flurobutyrophenone. It is more potent than chlorpromazine. - secretion of posterior pituitary gland results in in: vasopressin and oxytocin. - Hydrochlorothiazide is the same as chlorthalidone. Metolazone is similar in action to chlorthalidone. - Latanoprost is not given in pt has glaucoma and brady arrhythmia. - Betaxolol is CI in HF and aortic stenosis. - Amitriptyline is Cl with angle closure glaucoma and depression in the same time. - TCA is avoided with a adrenergic blockers (terazosin, prazosin and doxazocin) as both ↑ hypotension due to a adrenergic blockage. - MAOIs and TCA are Cl with guanethidine as they its hypotensive action. - Haloperidol is CI with guanethidine and alcohol. - Haloperidol + amiodarone---↑ ventricular arrythmia. - Haloperidol + a-methyl dopa--- ↑ hypotension and EPS. - Guanethidine (orthostatic hypotension) and minoxidil are not used in the TTT of HTN which is caused by Na/ H₂O retention. - Anticoagulants, NSAIDs and ASA CI in peptic ulcer. - CCB + B-blockers= additive -ve chronotropic bradycardia (↓ H.R). Nifedipine + atenolol= additive bradycardia. Amlodipine or verapamil + metoprolol. - Ca is not given with digitalis because both ↑ contractility of the heart (synergistic effect) which can lead to arrythmia, also Ca replaces K from myocardial cell and ↑ digitalis toxicity. - Danazol is CI in pregnancy and genital bleeding. It is used in endometriosis. It is androgen which inhibit gonadotropin release. - Glipizide interacts with co trimoxazole. - Aspirin should not be taken with coumarins and probenecid. Aspirin ↓ platelets aggregation. - MAOIs with cheese leads to hypertension crises due to tyramine ↑ NE conc. It is CI in glaucoma. - Non-selective ẞ blockers (propranolol) are Cl in asthma. - Cimetidine is Cl with warfarin, phenytoin and carbamazepine. - MAOIs with oral contraceptive: inhibits ovulation and follicular growth. - Which cause oral contraceptive failure? Rifampicin, griseofulvin and phenytoin. - Oral contraceptive metabolism of selegiline and ↑ its toxicity. - Esomeprazole absorption of itraconazole. - Ranitidine or famotidine + itraconazole why ranitidine itraconazole activity: less absorption because ranitidine ↑ PH and itraconazole need acidic media. - Omeprazole inhibit conversion of clopidogrel to active form and effect of all azole family except fluconazole. - Doxycycline conc. within 2 hr. of administration esomeprazole and Zn sulphate. - Tetracycline Cl with milk or iron, doxycycline Cl with iron and can be taken with milk. - Tetracycline or ciprofloxacin (not use with iron) with calcium, antacid: chelation. - Ferrous acid and ketoconazole + antacid= absorption of iron is, thus not used together. - Nalidixic acid is not given with antacid and food. - Alendronate less absorption with antacid because complexation with Ca, and avoid it with iron. - Alendronate cause problem to pt if given in lying down because it causes esophageal ulcer. - Theophylline + smoking or rifampicin= ↓ theophylline. - Theophylline + ciprofloxacin, fluvoxamine and cimetidine= ↑ theophylline level, so theophylline dose. - MTX + leflunomide cause hepatoxicity. - Perhexiline (for angina) + SSRI= ↑ perhexiline, hepatotoxicity and hypoglycemia. - Loop diuretics and thiazide are Cl in gout as they cause hyperuricemia. - Sulphonamide Cl in infants as it displaces bilirubin from plasma protein causing kernicterus. - ACEI + spironolactone= hyperkalemia. Meloxicam antagonizes spironolactone. - ACEI + NSAIDs + diuretics like perindopril + celecoxib nephrotoxicity. - NSAIDs are Cl in hypothyroidism and peptic ulcer. - Aripiprazole is not used in duodenal ulcer. - Ketoconazole should not be taken with antacids, H₂- blocker, PPIs, cisapride, amphotericin B or food, but with astemizole and terfenadine (both are anti- histamine) → life threatening arrythmia (prolong QT). - Combined contraceptive is Cl in nursing women because it inhibits milk production. - Sildenafil CI with nicorandil and nitrates. - Captopril (and all ACEIs) CI in bilateral renal artery stenosis and pregnancy. - Do not use aldosterone in hyperkalemia. - Atropine (belladonna alkaloids) is not recommended in glaucoma. In hypertension we don't use atropine. It causes mydriasis for 7 days. - Pioglitazone is Cl in pt has peripheral edema, shorten of breath with chronic coughing and wheezing. - Coal tar should not be used with some UV TTT: because it causes photosensitivity. - Do not take NaHCO3 in hypertension as Na ↑ blood pressure. - CI in dehydration: empagliflozin. - Cortisone Cl in tinea as it is mask symptoms. - Terbinafine is not used in hepatotoxicity. It causes diarrhea. - Nitrazepam is not used in TTT of insomnia in elderly pt. - Benzathine penicillin is not used in gonorrhea because of the emergence of penicillin resistant gonorrhea causing bacteria. - Phenothiazine and Cyproheptadine are not used in epilepsy. - All are true about chemotherapy except: horizontal laminar flow is used. - Vagus nerve regulate heartbeat. ++ Vagus nerve--- bradycardia. - All ACEIs are prodrug except: lisinopril and captopril. - Dimercaprol-metal complex have all following except: readily metabolized complex. - Dimercaprol BAL is an antidote for arsenic and all heavy metals (lead, mercury and gold). - The complex formed between British anti-Lewisite BAL (dimercaprol which is sparingly soluble in H₂O) and heavy metals form stable non-toxic, soluble in H₂O compound which is excreted through kidney. - Which does not cause intermittent porphyria? Ketamine. - CI in acute porphyria: barbiturates (phenobarbital) phenytoin and diazepam. - Very important reaction utilizes folate is the synthesis of deoxythymidylate dTMP (deoxythymidine monophosphate). - Which vaccine is problematic in immunocompromised pt: live attenuated vaccine. - What is live virus: - MMR. - Rotavirus. - Varicella zoster. - Yellow fever. - Small pox. - Chicken pox. - Oral salmonella. - Oral polio. - Hepatitis B with viral load 1400, use? Lamivudine. - Hepatitis B vaccine (active) is birth vaccine schedule of dosing: every 8 weeks (0, 2, 4 and 6). It is against B and D. - Hepatitis A: 12-18 months. Before travel 2 weeks: hepatitis A active immunity. - Dose hepatitis A vaccine schedule: inactivated vaccine 2 doses, the second dose normally 6 months after the first. - Which is not active immunity: tetanus antitoxin (artificial passive like diphtheria, gas gangrene and snake bite), Hepatitis B immunoglobulin, antiserum, antitoxin, Ig. - Botulism antiserum induces passive immunity. - Measles MMR vaccination is given for children at age of one year. 1-4 or 6 years. - Tetanus vaccine should be given to a pt with superficial infected (minor wound), if the previous vaccination was taken from > 10 years. It should be given every 10 years as booster. - Tetanus toxoid, diphtheria vaccine and vaccines are active immunity. - Small pox vaccine (long lasting active natural immunity) must be given at 0 week. - Varicella zoster should be frozen, other refrigerated. - Conjugated vaccines: contains polysaccharide combined with protein: - Meningococcal. - N- meningitidis (pure). - Streptococcus pneumonia (pure). - H. influenza type B. - Pneumococcal conjugate vaccine PCV 13,25,20. - Which is not conjugated vaccine? Pneumococcal polysaccharide vaccine PPSV 23. - 3 carries protein conjugated vaccines: tetanus toxoid, diphtheria toxoid and mutant diphtheria toxin. - What is Ab not in plasma: Ig S. - Type I reaction caused by? IgE (least amount). - Ig in immediate hypersensitivity or anaphylaxis reaction: IgE. - Pt taking penicillin has an immediate allergic rxn what should be tested immediately to confirm? IgE. - Pt taking cephalosporin and has skin rxn 10 days later with blistering which is likely responsible? T cells. - Pt was taking penicillin and has rxn 30 min after which of the following should be avoided in the future? Cephalexin. - Cross placenta: IgG (the longest life and stay in baby for 6 months after birth). The highest number and presents in secondary immune response. - Ig A prevents attachment of Ag to mucous membrane and pass from mother to baby through colostrum. - Ig M the biggest one. It appears in primary immune response. - Cell mediated hypersensitivity by T-cell. - SLE is not of type I immediate or allergic hypersensitivity. - Thymus gland function includes immunity. - Which is responsible for immunity? Initiated by B cells, activated by T-cell. - Colony stimulating factor CSF: produce granulocytes to treat neutropenia. It is not antiviral. - Pumping blood from heart to lung from right ventricle. - Deoxygenated blood from which artery? Pulmonary. - Oxygenated blood back to heart from lung through left atrium. - Systolic refers to heart muscle contraction. - Which artery is used widely to check pulse: radial artery. - Bundle of His is present in the heart. - Latrogenic HTN is caused by OC, SSRIs, clonidine withdrawal and corticosteroids. - Which route avoid lung: intra-arterial. - Left AV valve select wrong: open while atrial ejection. - Left AV valve pattern: mitral valve. - AV valve is not included in impulse conduction. - With β blocker and cardioselective CCB the interaction is AV block. - Which one is wrong tolerance of nitrates: tolerance is rare with isosorbide dinitrate. - Diastolic is more common, but systolic is more dangerous. - The main source of resistance to blood flow is arterioles (contains a₁ receptors). - Leukocytosis: ↑ leukocytes. Velocity is faster in arteries. - Erythropoietin: a hormone stimulates bone marrow to produce RBCs. It is released from kidney. - Darbepoetin most affects erythrocytes (non-nucleated biconcave discs). - Most in blood→ erythrocytes. Cholesterol cause hardness of artery. - Ezetimibe not cause rhabdomyolysis. - Which one least likely to cause rhabdomyolysis? Ezetimibe. - Not ↑ myopathy effect of statins: ezetimibe. Not ↑ muscle pain with simvastatin: ezetimibe. - Jacob disease causative organism: prion (Infectious proteins). - Causative agent for meningitis age 2-10 years: Neisseria, meningitidis < 2: H. influenza. - Lyme disease is caused by Borrelia burgdorferi. - M.Os resistance to chloramphenicol: chlamydia and pseudomonas. - M.O that would be resistant to cephalexin: Acinetobacter, alpha hemolytic and campylobacter. - Gentamicin active against Gr -ve and pseudomonas aeruginosa. - All the following can be used in TTT pyelonephritis except: gentamicin. - Causative organism in IV pt.? staph. aureus. - Clindamycin is not active against clostridium difficle. - Mycoplasma no cell wall (not destroyed by penicillin). - Endocarditis in children is caused by Streptococcus viridians and Enterococci. - Conc dependent AB: aminoglycoside, metronidazole, quinolones, fluoroquinolones and daptomycin. - Time dependent AB: β lactam, macrolides, clindamycin and linezolid. - Antipseudomonal penicillins are: carbenicillin, ticarcillin, mezlocillin and piperacillin. - Acid stable oral penicillin: phenoxy methyl penicillin (penicillin V), amoxicillin and ampicillin. - Penicillinase is a type of β lactamase, while β lactamase is a group of enzymes produced by bacteria that develop multi-resistance to β lactam antibiotics. - Acid stable and resistant to penicillinase (β lactamase): Oxacillin, cloxacillin, dicloxacillin, flucloxacillin and nafcillin. - Methicillin is penicillinase resistant but acid labile. - TTT of penicillinase producing streptococci? Augmentin. - Which of the following penicillin is useful for treating infection caused by staph. resistant to penicillin G? floxacillin. - Acid labile penicillin: penicillin G (benzylpenicillin). - Ticarcillin can be taken in all of the following cases, except? P. aeruginosa for pt has HF. - Ticarcillin is preferred over carbenicillin: few doses. - Penicillin and cephalosporin cross allergy occur 1/10 or 4-10%. - Used for its long duration of action: procaine penicillin. - Which organism cause pyelonephritis? E. coli or staph, klebsiella, proteus and enterococcus. - UTI inappropriate which is not true: E. coli is not common cause of UTI. - Which whooping cough Bordetella pertussis is not true? Viral infection (is bacterial). - Hydrocortisone is not suitable for Rosacea. - Drug for rosacea: metronidazole, isotretinoin, doxycycline, brimonidine, azelaic acid and ivermectin. - Aspirin toxic in child not use: disodium edetate. - Aspirin toxicity in child called Reye syndrome. - Aspirin toxicity cause respiratory alkalosis and metabolic acidosis. It is treated with urine alkalinization. Na bicarbonate ↑ aspirin excretion. - Not given aspirin toxicity: ethylene diamine tetra acetic acid EDTA, acetazolamide and Ca edetate. - Do not use aspirin to relief pain associated with yellow fever: to avoid risk of internal bleeding. - Aspirin and NSAIDs ↑ MTX toxicity. - MTX toxicity give leucovorin (Ca folinate, folinic acid). For prevention of MTX toxicity give F.A. - NSAIDs except aspirin + lithium= ↑ Li toxicity, diclofenac. - Fluoride toxicity: CaCl2. - CN cyanide toxicity: is due its binding to cytochrome oxidase enzyme or complexing of cytochrome iron. It cannot be treated by milk or ipecac, but hospitalization or using cyanide antidot kit (Dicobalt edetate) which includes: - Amyl nitrite + Na nitrite. - Na thiosulphate. - Oxygen. - NaHCO3 for acidosis. - If no response uses hyperbaric O2. - Procyclidine causes atropine like symptoms (anti- muscarinic). - Which is not effect of atropine? ↑ gastric secretion. - Atropine (Muscarinic antagonist) toxicity: - Tachycardia. - Dry mouth. - Mydriasis (Dilate pupil). - Hot flush skin. - Agitation and delirium. - Cirrhosis: progressive fibrosis and scarring of the liver. - Microcytic anemia is measured by mean corpuscular volume MCV Hb < 80 femtoliter, but normal range is 90+ 10 (80-100) fl. - A defect in one of genes that determine how the body makes blood clotting factor 8 and 9 causes hemophilia. - Hemophilia is hereditary deficiency in clotting factor. - All true about hemophilia except: it is due to deficiency in Hb. - Zollinger- Ellison syndrome is a rare condition in which one or more tumors (adenoma) form in pancreas or the upper part of small intestine (duodenum). It is characterized by hypergastrinemia, gastric hypersecretion and peptic ulcer caused by gastrin--- producing tumor of the pancreas and duodenal wall. TTT omeprazole. - Pityriasis versicolor causes: white to brown spots on the skin due to fungal infection. - Cystic fibrosis is change in protein which alter what? ↑ Cl and Na transport. It is hereditary not contagious (autosomal recessive disease), it is widespread exocrine dysfunction causing GIT, pulmonary (COPD) and pancreatic disease (high sweat electrolyte). Pseudomonas infection is the dominant infection. TTT: - Pancreatic enzyme replacement. - Diet therapy, oral corticosteroids. - Ibuprofen and antibiotics (ciprofloxacin). - What is true for cystic fibrosis: drugs are metabolized quicker (↑ metabolism). - Pharmacokinetics changes in body in: cystic fibrosis. - It is recessive gene may be present in both mother and father. - Complication of cystic fibrosis: neuropathy. - Neonates after birth are usually screened for: cystic fibrosis. - All are used in TTT of cystic