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  • Very Important Notes
    Prepared by MMM
    1) Acipimox lipid lowering agent oliatum
    2) NaHCO3 cause belching due to co2 release
    3)Granisetron serotonin antagonist kytril
    4) Loperamide ttt of diarrhea lomotil Imodium
    5)SODIUM STIBOGLUCONATE Indications

    leishmaniasis

    6)Amoebicide
    Diloxanide furoate
    Tinidazole
    Metronidazole
    7) PYRIMETHAMINE
    Treatment of falciparum malaria

    Indications

    adjunct to quinine in treatment of Plasmodium falciparum malaria; not recommended for prophylaxis

    8) Rifampicin
    urine, saliva, and other body secretions coloured orange-red;
    Discoloration of nail beds and mucus membranes
    9)Tetracyclines
    Side-effects

    Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associatedcolitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants.
    10) Praziquantel
    (available on named-patient basis from Merck (Cysticide)) is effective against all human schistosomes
    10)Niclosamide
    is the most widely used drug for tapeworm infections
    All the same, an antiemetic can be given before treatment and a laxative can be given 2 hours after niclosamide.
    11)MEBENDAZOLE: Vermox
    Indications


    threadworm, roundworm, whipworm, and hookworm infections
    12) Drugs for cutaneous larva migrans
    (creeping eruption)

    Dog and cat hookworm larvae may enter human skin where they produce slowly extending itching tracks usually on the foot. Single tracks can be treated with topical tiabendazole (no commercial preparation available). Multiple infections respond to ivermectin (available on named-patient basis from IDIS), albendazole (available on named-patient basis from IDIS (Zentel)) or tiabendazole (thiabendazole) (available on a named-patient basis from IDIS (Mintezol, Triasox)) by mouth.
    13) Chronic Hepatitis B
    Peginterferon alfa-2a
    Lamivudine
    Adefovir dipivoxil
    Entecavir
    Tenofovir
    14) Chronic Hepatitis C

    The combination of ribavirin and interferon alfa is less effective than the combination of peginterferon alfa and ribavirin. Peginterferon alfa alone should be used if ribavirin is contra-indicated or not tolerated. Ribavirin monotherapy is ineffective.

    15)ZIDOVUDINE

    Indications:
    HIV infection in combination with other antiretroviral drugs; prevention of maternal-fetal HIV transmission
    16) NICE guidance

    Oseltamivir, zanamivir, and amantadine for prophylaxis and treatment of influenza (February and September 2003)

    The drugs described here are not a substitute for vaccination, which remains the most effective way of preventing illness from influenza. When influenza A or influenza B is circulating in the community:
    amantadine is not recommended for post-exposure prophylaxis, seasonal prophylaxis, or treatment of influenza;
    oseltamivir and zanamivir are not recommended for seasonal prophylaxis against influenza;
    oseltamivir or zanamivir are not recommended for post-exposure prophylaxis, or treatment of otherwise healthy individuals with influenza;
    oseltamivir is recommended for post-exposure prophylaxis in at-risk adults and adolescents over 13 years [oseltamivir now licensed for children over 1 year(1)] who are not effectively protected by influenza vaccine and who can commence oseltamivir within 48 hours of close contact with someone suffering from influenza-like illness; prophylaxis is also recommended for residents in care establishments (regardless of influenza vaccination) who can commence oseltamivir within 48 hours if influenza-like illness is present in the establishment;
    oseltamivir and zanamivir are recommended (in accordance with UK licensing) to treat at-risk adults who can start treatment within 48 hours of the onset of symptoms; oseltamivir is recommended for at-risk children who can start treatment within 48 hours of the onset of symptoms;
    At-risk patients include those aged over 65 years or those who have one or more of the following conditions:
    chronic respiratory disease (including chronic obstructive pulmonary disease and asthma) [but see cautions under Zanamivir ];
    significant cardiovascular disease (excluding hypertension);
    chronic renal disease;
    immunosuppression;
    diabetes mellitus.
    Community-based virological surveillance schemes including those run by the Health Protection Agency and the Royal College of General Practitioners should be used to indicate when influenza is circulating in the community.
    17)Tetracyclines
    The tetracyclines are broad-spectrum antibiotics whose value has decreased owing to increasing bacterial resistance. They remain, however, the treatment of choice for infections caused by chlamydia (trachoma, psittacosis, salpingitis, urethritis, and lymphogranuloma venereum), rickettsia (including Q-fever), brucella (doxycycline with either streptomycin or rifampicin), and the spirochaete, Borrelia burgdorferi .They are also used in respiratory and genital mycoplasma infections, in acne, in destructive (refractory) periodontal disease, in exacerbations of chronic bronchitis (because of their activity against Haemophilus influenzae), and for leptospirosis in penicillin hypersensitivity (as an alternative to erythromycin).
    It is contraindicated in pregnancyc-It is safe in infections caused by Chlamydiad-It can lead to discoloration of teeth if given to children

    13) METHOTREXATE
    Indications

    moderate to severe active rheumatoid arthritis; Crohns disease; malignant disease, psoriasis
    full blood count and renal and liver function tests before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 23 months
    that patients should be advised to report all symptoms and signs suggestive of infection, especially sore throat
    the patient is warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising, and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort, and dark urine), and respiratory effects (e.g. shortness of breath).
    18)CALCIUM FOLINATE
    Prevention of methotrexate-induced adverse effects, usually started 24 hours after start of methotrexate infusion, by intramuscular injection, or by intravenous injection, or by intravenous infusion, 15 mg, repeated every 6 hours for 24 hours (may be continued by mouth); consult local treatment protocol for further information
    19)iodine is found in all of the following excepta-Cod liver oil
    20)Zinc
    Zinc prevents the absorption of copper in Wilson's disease
    Promotes wound healing and normal growth
    Zinc and Salicylic Acid Paste, BP

    Paste , (Lassar's Paste),
    Indications


    hyperkeratotic skin disorders; acne ; warts and calluses ; scalp conditions ; fungal nail infections
    21)Copper
    Formation of red and white blood cells
    22)Selenium (Antioxidant)
    Protects cells against damage during cellular metabolism
    23) Gold

    Gold can be given by intramuscular injection as sodium aurothiomalateor by mouth as Auranofin
    Auranofinis given by mouth. If there is no response after 6 months treatment should be discontinued. Auranofin is less effective than parenteral gold.
    24) Penicillamine

    Penicillamine has a similar action to gold
    Given on an empty stomach
    25)Magnesium Hydroxide
    May cause diarrhea
    26)A solution of acetic acid 2% acts as an antifungal and antibacterial in the external ear canal
    Astringent preparations as
    Aluminium Acetate
    Wax may be removed by syringing with water (warmed to body temperature). If necessary, wax can be softened using simple remedies such as olive oil ear drops or almond oil ear drops; sodium bicarbonate ear drops are also effective but may cause dryness of the ear canal.
    Otitis externa: If infection is present, a topical anti-infective which is not used systemically (such as neomycin or clioquinol) may be used,
    27) Adrenergic neurone blocking drugs

    Adrenergic neurone blocking drugs prevent the release of noradrenaline from postganglionic adrenergic neurones. These drugs do not control supine blood pressure and may cause postural hypotension. For this reason they have largely fallen from use, but may be necessary with other therapy in resistant hypertension.
    Guanethidine, which also depletes the nerve endings of noradrenaline, is licensed for the rapid control of blood pressure.
    28)Nitroglycerin
    A-Containers must be made of glass and be covered with a tight-fitting ----lc- Close tightly after used- Tablets must be stored at controlled R.Te- Tablets not to be refrigerated
    29) Side-effects of the beta2 agonists: include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, and disturbances of sleep and behaviour. Paradoxical bronchospasm, urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia
    30)Benzylpenicillin (Penicillin G) remains an important and useful antibiotic but is inactivated by bacterial beta-lactamases Benzylpenicillin is inactivated by gastricacid and absorption from the gut is low; therefore it is best given by injection.
    Procaine benzylpenicillin (procaine penicillin) is used for the treatment of early syphilis and late latent syphilis; it is given by intramuscular injection.
    Phenoxymethylpenicillin (Penicillin V) Phenoxymethylpenicillin (Penicillin V) has a similar antibacterial spectrum to benzylpenicillin, but is less active. It is gastric acid-stable, so is suitable for oral administration.
    31) There is some evidence that sudden withdrawal of calcium-channel blockers may be associated with an exacerbation of angina.
    32) Fibrinolytic drugsSTREPTOKINASE Indications


    acute myocardial infarction, deep-vein thrombosis, pulmonary embolism, acute arterial thromboembolism, and central retinal venous or arterial thrombosis33)Verapamil
    Verapamil is used for the treatment of angina , hypertension, and arrhythmias
    Constipation is the most common side-effect
    34) Side-effects of antimuscarinics: include constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria, hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision, and rash. Angle-closure glaucoma
    The antimuscarinic drugs, benzatropine,orphenadrine, procyclidine (Kemadrin), and trihexyphenidyl (benzhexol) a may occur very rarely
    Artane used for the treatment of Parkinsonism?
    35)Diabetes insipidus
    Desmopressin is more potent and has a longer duration of action than vasopressin; unlike vasopressin it has no vasoconstrictor effect. It is given by mouth or intranasally for maintenance therapy, and by injection in the postoperative period or in unconscious patients. Desmopressin is also used in the differential diagnosis of diabetes insipidus
    Desmopressin should not be given intranasally for nocturnal enuresis due to an increased incidence of side-effects.
    Vasopressin (antidiuretic hormone, ADH) is used in the treatment of pituitary (cranial') diabetes insipidus as is its analogue desmopressin

    36)The tricyclic antidepressant Iimipramine (Tofranil) has been approved by FDA for use in :i Enuresis
    3 7) (Timentin) Ticarcillin is now available only in combination with clavulanic acid
    is principally indicated for serious infections caused by Pseudomonas aeruginosaalthough it also has activity against certain other Gram-negative bacilli including Proteus spp. and Bacteroides fragilis
    Tazocin contains the ureidopenicillin piperacillin with the beta-lactamase inhibitor tazobactam. Piperacillin is more active than ticarcillin against Ps. aeruginosa

    38) Flucloxacillin, however, is not inactivated by these enzymes and is thus effective in infections caused by penicillin-resistant staphylococci, which is the sole indication for its use. Flucloxacillin is acid-stable and can, therefore, be given by mouth as well as by injection.
    39) MeropenemMeronem
    is similar to imipenem but is stable to the renal enzyme which inactivates imipenem and therefore can be given without cilastatin. Meropenem has less seizure-inducing potential and can be used to treat central nervous system infection.
    Imipenem,Primaxin
    a carbapenem, has a broad spectrum of activity which includes many aerobic and anaerobic Gram-positive and Gram-negative bacteria. Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin,a specific enzyme inhibitor, which blocks its renal metabolism. Side-effects are similar to those of other beta-lactam antibiotics; neurotoxicity
    40)Ocular peri-operative drugs
    Drugs used to prepare the eye for surgery, drugs that are injected into the anterior chamber at the time of surgery, and those used after eye surgery, are included here
    Non-steroidal anti-inflammatory eye drops such as diclofenac, flurbiprofen, and ketorolac
    Apraclonidine, an alpha2-adrenoreceptor agonist, reduces intra-ocular pressure possibly by reducing the production of aqueous humour
    Intra-ocular sodium hylauronate is used during surgical procedures on the eye.
    Acetylcholine, instilled into the anterior chamber of the eye during surgery, rapidly produces miosis which lasts approximately 20 minutes

    41)Centrally acting antihypertensive drugs42)Vasodilator antihypertensive drugs
    BOSENTAN
    43) MEXILETINE HYDROCHLORIDE


    Indications
    life-threatening ventricular arrhythmias
    43) Opioid dependence
    BUPRENORPHINE is an opioid partial agonist43)Opioid analgesics44)Local Anesthetics is useful for topical administration only
    Benzocaine
    45)The iron preparation given by the intravenous route is
    Iron-dextran
    46) Gaviscon is recommended for dyspepsia in pregnancy
    47) -The maximum daily dose of Glibenclamide is 20 mg/day
    48) A sympathomimetic often present in OTC appetite suppressant is Phenylpropanolamine (PPA)
    49)Prophylaxis of migraine
    The beta-blockers propranolol, metoprolol, nadolol, and timolol are all effective. Propranolol is the most commonly used.
    Pizotifen is an antihistamine and serotonin antagonist structurally related to the tricyclic antidepressants. It affords good prophylaxis but may cause weight gain
    Sodium valproate, Topiramate, Tricyclic antidepressants (e.g. amitriptyline), Cyproheptadine , an antihistamine with serotonin-antagonist and calcium channel-blocking properties, Clonidine (Dixarit). Methysergide
    50)most common side effect of sublingual glyceryl trinitrate is: Throbbing headache
    51) All of the following are common iodine deficiency symptoms
    a- Goiterb- Intellectual disabilityc- Growth retardation
    52) Soluble insulin has the shortest duration of action
    53) Percentage of total body iodine in thyroid glands is 90%
    54) Daily saliva secretion is 2 liters
    55) Normal serum bilirubin is 0.5 - 1 mg %
    56)Major pathway of excretion of Calcium is : Gut
    57) First relay station of pain is :ia- spinal cord
    58) The secretion of aldosterone is controlled by :ia- Angiotensin
    59) Which of the following is the fastest to be absorbed from the stomach? Water
    60) The following are true of insulin
    A-Secreted by beta cellsb- Causes lip genesisc- Promotes glycogen sis
    61) Propylthiouracil
    a-It is used for treatment of hyperthyroidismb-It inhibits the synthesis of thyroid hormonesc-It diminishes peripheral deiodination of T4 and T3d-It inhibits iodide oxidation
    62) Side effect of codeine? &Opioid analgesics
    Side-effects

    nausea and vomiting (particularly in initial stages), constipation, and drowsiness; larger doses produce respiratory depression, hypotension, and muscle rigidity; other side-effects include difficulty with micturition, ureteric or biliary spasm, dry mouth, sweating, headache, facial flushing, vertigo, bradycardia, tachycardia, palpitation, postural hypotension, hypothermia, hallucinations, dysphoria, mood changes, dependence, miosis, decreased libido or potency, rashes, urticaria and pruritus;

    63) Sex hormones and hormone antagonists in malignant disease
    • Oestrogens Diethylstilbestrol (stilboestrol) is rarely used to treat prostate cancer because of its side-effects.
    Ethinylestradiol(ethinyloestradiol) is the most potent oestrogen available; Ethinylestradiol is licensed for the palliative treatment of prostate cancer.MEGESTROL ACETATEMegacebreast cancer, 160 mg daily in single or divided doses
    Endometrial cancer, 40320 mg daily in divided doses
    NORETHISTERONE Indications
    • HRT ,contraception and malignant diseas
    • Androgens
    Hormone antagonistsThe oestrogen-receptor antagonist tamoxifen is effective in premenopausal, perimenopausal, and postmenopausal women.
    The aromatase inhibitorsanastrozoleArimidex, exemestane Aromasin, and letrozoleFemaraare effective in postmenopausal women only
    Aromatase inhibitors act predominantly by blocking the conversion of androgens to oestrogens in the peripheral tissues. They do not inhibit ovarian oestrogen synthesis and should not be used in premenopausal women.
    FULVESTRANT

    Indications

    treatment of oestrogen-receptor-positive metastatic or locally advanced breast cancer in postmenopausal women in whom disease progresses or relapses while on, or after, other anti-oestrogen therapy
    TOREMIFENE

    Indications

    hormone-dependent metastatic breast cancer in postmenopausal women

    Gonadorelin analogues buserelin Suprefactadvanced prostate cancer
    goserelinZoladex,prostate cancer; advanced breast cancer
    leuprorelinProstap SRadvanced prostate cancer;
    , or triptorelinDecapeptyl SRIndications advanced prostate cancer; endometriosis, precocious puberty, reduction in size of uterine fibroids
    Anti-androgens Cyproterone acetateCyprostat,Androcur flutamide Drogenil bicalutamideCasodex64)Epinephrine is not given orally because :ia-It is inactivated in the gastric mucosab-Local vasoconstriction inhibits absorptionc-It is rapidly inactivated in circulation
    65) Laxatives
    • 1.6.1 Bulk-forming laxatives bran Methylcellulose, ispaghula, and sterculia are useful in patients who cannot tolerate bran.
    • 1.6.2 Stimulant laxatives bisacodyl and members of the anthraquinone group, senna and dantron.Powerful stimulants such as cascara (an anthraquinone) and castor oil are obsolete. Docusate sodium probably acts both as a stimulant and as a softening agent.
    • 1.6.3 Faecal softeners Liquid paraffin, arachis oil
    • 1.6.4 Osmotic laxatives Lactulose,Macrogols are inert polymers of ethylene glycol,magnesium hydroxide, Phosphate enemas are useful in bowel clearance before radiology, endoscopy, and surgery.
    • 1.6.5 Bowel cleansing solutions
    66)Protease inhibitors
    Indications HIV infection
    Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes
    AMPRENAVIR67) Riluzole

    Indications :to extend life or the time to mechanical ventilation for patients with amyotrophic lateral sclerosis, initiated by specialists experienced in the management of motor neurone disease


    68) Antibacterial preparations only used topically

    MUPIROCIN69) The polyene antifungals include amphotericin and nystatin; neither drug is absorbed when given by mouth.

    70) The polymyxin antibiotic, colistinnot absorbed by mouth and thus needs to be given by injection for a systemic effect
    72)Linezolid, an oxazolidinone antibacterial, is active against Gram-positive bacteria including meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci.higher incidence of blood disorders and optic neuropathy have been reported in patients receiving linezolid for more than the maximum recommended duration of 28 days.
    Linezolid is not active against Gram-negative organisms

    73) Complications of long-term parenteral nutrition include gall bladder sludging, gall stones, cholestasis and abnormal liver function tests

    74) Intravenous additives
    Problems


    It is considered undesirable to mix beta-lactam antibiotics, such as semi-synthetic penicillins and cephalosporins, with proteinaceous materials on the grounds that immunogenic and allergenic conjugates could be formed

    A number of preparations undergo significant loss of potency when added singly or in combination to large volume infusions. Examples include ampicillin in infusions that contain glucose or lactates
    Blood. Because of the large number of incompatibilities, drugs should not normally be added to blood and blood products for infusion purposes
    reconstituted ampicillin injection degrades rapidly on standing, and also may form polymers which could cause sensitivity reactions.
    It is also important in certain instances that an infusion fluid of specific pH be used (e.g. furosemide (frusemide) injection requires dilution in infusions of pH greater than 5.5).
    Certain injections must be protected from light during continuous infusion to minimise oxidation, e.g. amphotericin, dacarbazine, and sodium nitroprusside.
    Drugs for continuous infusion must be diluted in a large volume infusion. Penicillins and cephalosporins are not usually given by continuous infusion because of stability problems and because adequate plasma and tissue concentrations are best obtained by intermittent infusion.
    Drugs that are both compatible and clinically suitable may be given by intermittent infusion in a relatively small volume of infusion over a short period of time, e.g. 100 mL in 30 minutes. The method is used if the product is incompatible or unstable over the period necessary for continuous infusion; the limited stability of ampicillin or amoxicillin in large volume glucose or lactate infusions may be overcome in this way.
    Intermittent infusion is also used if adequate plasma and tissue concentrations are not produced by continuous infusion as in the case of drugs such as dacarbazine, gentamicin, and ticarcillin.
    Addition via the drip tubing is indicated for a number of cytotoxic drugs in order to minimise extravasation. The preparation is added aseptically via the rubber septum of the injection site of a fast-running infusion. In general, drug preparations intended for a bolus effect should be given directly into a separate vein where possible. Failing this, administration may be made via the drip tubing provided that the preparation is compatible with the infusion fluid when given in this manner
    75)Beta-blockers are used in pre-operative preparation for thyroidectomy. Administration of propranolol can reverse clinical symptoms of thyrotoxicosis within 4 days.
    76) If lithium is to be discontinued, the dose should be reduced gradually over a period of a few weeks and patients should be warned of possible relapse if it is discontinued abruptly
    77)Lithium toxicity is made worse by sodium depletion, therefore concurrent use of diuretics (particularly thiazides) is hazardous and should be avoided
    78) Side-effects OF LITHIUM


    gastro-intestinal disturbances, fine tremor, renal impairment (particularly impaired urinary concentration and polyuria), polydipsia, leucocytosis; also weight gain and oedema (may respond to dose reduction); hyperparathyroidism and hypercalcaemia reported; signs of intoxication are blurred vision, increasing gastro-intestinal disturbances (anorexia, vomiting, diarrhoea), muscle weakness, increased CNS disturbances (mild drowsiness and sluggishness increasing to giddiness with ataxia, coarse tremor, lack of co-ordination, dysarthria), and require withdrawal of treatment; with severe overdosage (serum-lithium concentration above 2 mmol/litre) hyperreflexia and hyperextension of limbs, convulsions, toxic psychoses, syncope, renal failure, circulatory failure, coma, and occasionally, death; goitre, raised antidiuretic hormone concentration, hypothyroidism, hypokalaemia, ECG changes, and kidney changes may also occur;
    79)Prophylaxis with an iron preparation is justifiable in individuals who have additional risk factors for iron deficiency (e.g. poor diet). Prophylaxis may also be appropriate in malabsorption, menorrhagia, pregnancy, after subtotal or total gastrectomy, in haemodialysis patients, and in the management of low birth-weight infants such as preterm neonates.
    80)Parenteral iron
    IRON DEXTRANAnaphylactoid reactions can occur with parenteral administration of iron complexes and patients should be given a small test dose initially
    81)Haemochromatosis :a hereditary disorder in which there is excessive absorption and storage of iron this lead to damage and functional impairment of many organs including the pancrease and endocrine glands. The main features are a bronze color of the skine diabetes and liver failure.
    82)oral iron therapy should not be given until 5 days after last injection

    83)Drugs for arrhythmias: They can also be classified according to their effects on the electrical behaviour of myocardial cells during activity:
    • Class I: membrane stabilising drugs (e.g. lidocaine, flecainide)
    • Class II: beta-blockers
    • Class III: amiodarone and sotalol (also Class II)
    • Class IV: calcium-channel blockers (includes verapamil but not dihydropyridines)
    • 84)Ventricular arrhythmias:
    LIDOCAINE HYDROCHLORIDE
    • MEXILETINE HYDROCHLORIDEmay be given as a slow intravenous injection if lidocaine is ineffective; it has a similar action
    Supraventricular and ventricular arrhythmiasSupraventricular arrhythmias
    ADENOSINE
    Verapamil
    85)Occasionally psoriasis is provoked or exacerbated by drugs such as lithium, chloroquine and hydroxychloroquine, beta-blockers, non-steroidal anti-inflammatory drugs, and ACE inhibitors. Psoriasis may not be seen until the drug has been taken for weeks or months.
    86) lichen simplex chronicus (neurodermatitis):
    Thickened eczematous skin that develops at the site of constant rubbing in suscecptible individuals
    87)lichen planus :
    an extremely itchy skin disease of unknown cause .
    88)lichen sclerosus:
    a chronic skin disease affecting the anogenital area,especially in women
    89)Anthracyclines and other cytotoxic antibiotics
    • BLEOMYCINis given intravenously or intramuscularly to treat metastatic germ cell cancer and, in some regimens, non-Hodgkins lymphoma
    • DACTINOMYCINused to treat paediatric cancers
    • DAUNORUBICINA liposomal formulation for intravenous use is licensed for AIDS-related Kaposi's sarcoma.ass with cardiotoxocity
    • DOXORUBICIN HYDROCHLORIDEis used to treat the acute leukaemias, Hodgkin's and non-Hodgkin's lymphomas, paediatric malignancies and a variety of solid tumour ass with cardiotoxocity
    • EPIRUBICIN HYDROCHLORIDEin the treatment of breast cancer
    • IDARUBICIN HYDROCHLORIDEused in the treatment of haematological malignancies
    • MITOMYCINisgiven intravenously to treat upper gastro-intestinal and breast cancers and by bladder instillation for superficial bladder tumours.
    • MITOXANTRONEis structurally related to doxorubicin; it is used for metastatic breast cancer. Mitoxantrone is also licensed for use in the treatment of non-Hodgkin's lymphoma and adult non-lymphocytic leukaemia

    90) Monoamine-oxidase inhibitors(for ttt of depression) TRANYLCYPROMINE is the most hazardous of the MAOIs because of its stimulant action91) metabolism of ethyl Alcohol involves all the following pathways
    a- Oxidationb- Conversion to acetaldehyde and acetatec- Excreted unchanged through the lungs and kidneys
    92) Vinca alkaloids and etoposide92)Alkylating drugs

    BUSULFAN Myleran
    • 94)Antimetabolites
    CAPECITABINE95) Antiproliferative immunosuppressants
    AZATHIOPRINE96)Flumazenil is a benzodiazepine antagonist for the reversal of the central sedative effects of benzodiazepines after anaesthetic and similar procedures
    97)Tricyclic and related antidepressant drugs
    AMITRIPTYLINE HYDROCHLORIDESelective serotonin re-uptake inhibitors
    CITALOPRAMCipramilOther antidepressant drugs
    DULOXETINE98)Sunscreen preparations containing p amino benzoic acid should be
    Applied 2 hrs before exposure
    99) The active constituents of saline laxatives are
    No absorbable cat ions and anions
    100)Bismuth subsalicylate is used in antidiarrheals for its
    Adsorbent action
    101) the most widely used method for sterilization of pharmaceutical is
    Moist heat
    102)Drugs used in neutropenia
    Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils and may reduce the duration of chemotherapy-induced neutropenia
    FILGRASTIMNeupogen (unglycosylated rhG-CSF)
    • LENOGRASTIM (glycosylated rhG-CSF)
    • PEGFILGRASTIMis a polyethylene glycol-conjugated (pegylated) derivative of filgrastim
    103) The mode of action of sodium cromoglicate and nedocromil is not completely understood. They may be of value in asthma with an allergic basis
    104) Antiplatelet drugs
    Dipyridamole(persantine)
    Clopidogrel
    A glycoprotein IIb/IIIa inhibitor (abciximab, eptifibatide, and tirofiban) should be considered in the management of unstable angina or non-ST-segment-elevation myocardial infarction.
    ticlopidine
    104)Oral anticoagulants PHENINDIONE

    105)Potassium-sparing diuretics and aldosterone antagonists
    AMILORIDE HYDROCHLORIDE(SPIRONOLACTONE)
    106) Aminoglycosides

    These include amikacin, gentamicin, neomycin, netilmicin, streptomycin, and tobramycin
    aminoglycosides are not absorbed from the gut (although there is a risk of absorption in inflammatory bowel disease and liver failure) and must therefore be given by injection for systemic infections.
    Most side-effects of this group of antibiotics are dose-related therefore care must be taken with dosage and whenever possible treatment should not exceed 7 days. The important side-effects are ototoxicity, and nephrotoxicity; they occur most commonly in the elderly and in patients with renal failure
    Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide (frusemide))
    107)The glycopeptide antibiotics vancomycin(12 hr) and teicoplanin (once daily)have bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci
    108)Spironolactone is also used inprimary hyperaldosteronism (Conn's syndrome).
    109)Antibiotic-associated colitis (pseudomembranous colitis) is caused by colonisation of the colon with Clostridium difficile
    it is a particular hazard of clindamycin
    Oral vancomycin or metronidazole are used as specific treatment; vancomycin may be preferred for very sick patients
    110)Chronic inflammatory bowel diseases include ulcerative colitis and Crohns disease. Effective management requires drug therapy, attention to nutrition, and in severe or chronic active disease, surgery.
    Aminosalicylates (balsalazide, mesalazinePentasa, olsalazine, and sulfasalazine), and corticosteroids (hydrocortisone, budesonide, and prednisolone) form the basis of drug treatment.
    5-aminosalicylic acid alone can still cause side-effects including blood disorders (see recommendation below) and lupus-like syndrome also seen with sulfasalazine.
    111)Breast pain (mastalgia)Bromocriptine is used in the management of breast pain but is associated with unpleasant side-effects; it acts within 2 months.
    Danazolis licensed for the relief of severe pain and tenderness in benign fibrocystic breast disease which has not responded to other treatment.
    Tamoxifen may be a useful adjunct in the treatment of mastalgia [unlicensed indication]
    112)
    Give examples of drug - drug interactions ?


    1- Warfarin
    Aspirin



    2- Insulin

    B-Blockers(cause hypoglycemia)


    3- Heparin

    Aspirin & Ampicillin

    4- Warfarin
    Vit. K



    5- Warfarin
    Phenobarbital( )


    6- Spironolactone
    Digoxin



    7- ACEI

    Pot. Sparing diuretics

    113)Fluconazole is very well absorbed after oral administration. It also achieves good penetration into the cerebrospinal fluid to treat fungal meningitis.Diflucan
    Itraconazole is active against a wide range of dermatophytesSporanox
    Terbinafine is the drug of choice for fungal nail infectionsLamisil
    KetoconazoleNizoral AMPHOTERICINFungizoneAnaphylaxis
    The CSM has advised that anaphylaxis occurs rarely with any intravenous amphotericin product and a test dose is advisable before the first infusion; the patient should be carefully observed for at least 30 minutes after the test dose. Prophylactic antipyretics or hydrocortisone should only be used in patients who have previously experienced acute adverse reactions (in whom continued treatment with amphotericin is essential)
    Counselling for antifungle drugs
    Patients should be told how to recognise signs of liver disorder and advised to seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain or dark urine develop
    114)Drugs for pneumocystis pneumonia(protozoal infection occure in immunoseppsant patiant)
    Co-trimoxazole ,pentamidine isetionate
    115)Antipsychotic drugsAntipsychotic drugs are considered to act by interfering with dopaminergic transmission in the brain by blocking dopamine D2 receptors(Antipsychotic usually act on the Lower brain areas)
    CHLORPROMAZINE HYDROCHLORIDELargactil
    HALOPERIDOLHaldol
    PIMOZIDEOrap
    ZUCLOPENTHIXOL ACETATEClopixol Acuphase
    Atypical antipsychotics
    ARIPIPRAZOLEAbilify
    CLOZAPINE
    OLANZAPINEZyprexa
    QUETIAPINESeroquel
    RISPERIDONERisperdal
    116)Zinnat contains : Cefuroxime
    117)Praziquantil is : Biltracid is the trade name
    118)Vitamin D and analogues
    Calcipotriol, calcitriol, and tacalcitol are used for the management of plaque psoriasis.
    Give an example of cardio selective B blocker ?

    a- Atenolol





    b- Bisoprolol





    c- Esmolol






    d- Betaxolol





    e- Metoprolol





    f- Acebutolol





    Hands should be washed thoroughly after application to avoid inadvertent transfer to other body areas. Aggravation of psoriasis has also been reported.
    119)Drugs used in Parkinsonism
    Dopamine receptor agonistsLevodopaSinemet CR(levodopa+carpidopa) ,,,,,,,,,,,,,
    Stalevo (levodopa+carpidopa+entacapone )
    Carpidopa(is dopa-decarboaxylase inhibitor)
    Monoamine-oxidase-B inhibitors
    RASAGILINECatechol-O-methyltransferase inhibitorsallowing more levodopa to reach the brain
    ENTACAPONEAmantadine is a weak dopamine agonist with modest antiparkinsonian effects
    Antimuscarinic drugs used in parkinsonism
    BENZATROPINE MESILATE120)Alverine, mebeverine, and peppermint oil are believed to be direct relaxants of intestinal smooth muscle and may relieve pain in irritable bowel syndrome and diverticular disease
    121)The conc. Of the drug on Exp. Date is:
    From 90-110%
    122)sialadenitis: inflammation of salivary gland
    134)pharmacodynamics: The interaction of drugs with cells.
    135)pharmacokinetics: the study of how drugs are handled within the body ,including their absorbtion ,distribution metabolism,and excretion it is concerns with such matters as how drug concentration in the body changes with time , how drug pass across cell membranes , how often they should be given ,what the effect of long term admininstration may be .how drug interact with each other .and how individual variations affect all these things.
    135)Mucolytics are prescribed to facilitate expectoration by reducing sputum viscosity gusifenesine
    bromohexine
    ambroxol
    Dornase alfa(DNAase) for ttt cystic fibrosis

    137)Disulfiram:adrug used in the ttt uf chronic alcoholism. It acts as a deterrent by producing unpleasant effects when taken with alcohol, including flushing,headach,breathing difficulties,palpitation ,nauesea ,vomiting .
    138)Meniere disease:adisease of inner ear characterized by episodes of deafness ,buzzing in ears (tinnitus).ttt by betahistine (histamine analouge)
    139)Dobutamine: sympayhomimetic drug B-agonist used to assist in heart failure *used in surgery*

    140)Drugs for malignant hyperthermia:
    Malignant hyperthermia is a rare but potentially lethal complication of anaesthesia. It is characterised by a rapid rise in temperature, increased muscle rigidity, tachycardia, and acidosis. The most common triggers of malignant hyperthermia are the volatile anaesthetics.
    Dantrolene is used in the treatment of malignant hyperthermia
    141)Malignant hypothermia is usually a side effect of :
    Anesthesia
    142)Non-depolarising muscle relaxants (also known as competitive muscle relaxants) compete with acetylcholine for receptor sites at the neuromuscular junction and their action may be reversed with anticholinesterases such as neostigmine
    ATRACURIUM BESILATE143) Depolarising muscle relaxants ex:
    Suxamethonium has the most rapid onset of action of any of the muscle relaxants and is ideal Suxamethonium acts by mimicking acetylcholine at the neuromuscular junction but hydrolysis is much slower than for acetylcholine; depolarisation is therefore prolonged, resulting in neuromuscular blockade. Unlike the non-depolarising muscle relaxants, its action cannot be reversed and recovery is spontaneous; anticholinesterases such as neostigmine potentiate the neuromuscular block
    144)Control of epilepsy
    Carbamazepine and oxcarbazepineTegretolTrileptal146) Antimuscarinics(used as anti-spasmodic)
    ATROPINE SULPHATE147)Multiple sclerosis(MS.disseminated sclerosis)
    a chronic disease of the nervous system affecting young and middle-aged adults,the myelin sheaths surrounding nerves in brain and spinal cord are damaged, which affects the function of the nerves involved.*ttt by steroids and B-interpherone*
    148)CNS stimulants and drugs used for attention deficit hyperactivity disorder
    ATOMOXETINEStrattera149)Treatment of glaucomaProstaglandin analogues
    BIMATOPROSTLumiganSympathomimetics
    BRIMONIDINE TARTRATEAlphagan

    DIPIVEFRINE HYDROCHLORIDEPropine
    Dipivefrine is a pro-drug of adrenaline (epinephrine). It is claimed to pass more rapidly than adrenaline through the cornea and is then converted to the active form
    Carbonic anhydrase inhibitors and systemic drugs
    ACETAZOLAMIDE BRINZOLAMIDE DORZOLAMIDE
    Diamox SRAzoptTrusoptCosopte timolol
    Miotics
    PILOCARPINESELens opacity


    150)Anxiolytics
    Benzodiazepines
    DIAZEPAM151)Wilson's disease(ttt)
    PENICILLAMINE152) Fabry's disease(lysosomal storage disorder caused by deficiency of alpha-galactosidase A).
    ttt AGALSIDASE ALFA and BETA
    153)Gaucher's disease154)Pompe disease
    ALGLUCOSIDASE ALFA
    155) Cigarette smoking
    BUPROPION HYDROCHLORIDE156) Centrally acting appetite suppressants
    RIMONABANTAcomplia*Dexfenfluramine, fenfluramine, and phentermine have been associated with valvular heart disease*
    157)Orlistat, a lipase inhibitor, reduces the absorption of dietary fat xenical
    158)Danaparoid is a heparinoid used for prophylaxis of deep-vein thrombosis in patients undergoing general or orthopaedic surgery
    • 159)HirudinsBIVALIRUDIN a hirudin analogue, is a thrombin inhibitor which is licensed as an anticoagulant for patients undergoing percutaneous coronary intervention.
    • LEPIRUDIN a recombinant hirudin, is licensed for anticoagulation in patients with Type II (immune) heparin-induced thrombocytopenia who require parenteral antithrombotic treatment
    160)The limulus test is relatively new method of testing for
    Pyrogens

    161)a specific narcotic antagonist is
    Nalorphine
    162)the following dosage nicotine is available when used as smoking detergent? I
    A- transdermal (nicotine patch)
    B- nasal drop
    C- gum(

    163)Primidone, used in the treatment of generalized tonic-clonic seizures , is metabolized to
    Phenobarbital
    164) parasympathomimitic
    Acetylcholine,,,,,,,,,, Bethanecol,,,,,,,,,,,,,, Methacholine

    165) enzyme inducer as:
    Rifampicin, Phenobarbitone, Barbiturates, Allopurinol, INH, oral contraceptive
    166)Liotrix is a thyroid preparation that contains
    Liothyronine sodium,,,,,,,,,,,,,,, Levothyroxine sodium


    166)Lipid-regulating drugs:
    • Anion-exchange resinsColestyramine (cholestyramine) and colestipol are anion-exchange resins used in the management of hypercholesterolaemia. They act by binding bile acids, preventing their reabsorption; this promotes hepatic conversion of cholesterol into bile acids; the resultant increased LDL-receptor activity of liver cells increases the clearance of LDL-cholesterol from the plasma(other drugs should be taken 1 hr before or 4-6 hrs after taking anion exchange resin)
    • Ezetimibeinhibits the intestinal absorption of cholesterol(ezetrol)
    • Fibratesact mainly by decreasing serum triglycerides; they have variable effects on LDL-cholesterol
    • Statinscompetitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis
    • Nicotinic acid groupit lowers both cholesterol and triglyceride concentrations by inhibiting synthesis ACIPIMOX Olbetam
    • Omega-3 fatty acid compounds
    167)(hansen disease=leprosy)
    168)which one of the following tetracycline has the longest duration of action?

    Doxycline (Vibramycin)

    169) theophylline is structurally(methyl xathine) related to caffeine so exert almost the same pharmacological effect as caffeine as
    A) Cardiac stimulation
    B) Relaxation of smooth muscle
    C) Diuresis
    D) CNS stimulation

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