1

Pediculocides that act by disrupting ion transport mechanisms at the nerve membranes
Pyrethrin and Permethrin
Pediculocidse that act by suppressing the oxidative degradation mechanisms of the lice
Piperonyl butoxide
Pediculocide contraindicated in pregnant women due to potential neurotoxicity
Lindane
UV that cause sunburn
UVA and UV B
Drug causing phototoxic reaction include
Thiazide, Tetracyclin, Phenothiazine, Sulfonamide, Isotretinoin
Sunscreen that absorbs both UVA and UVB
Benzophenones (Oxybenzone and Dioxybenzone)
A first poison ivy blocker proven safe and effective
Bentoquatum, an organoclay
Pink color in Astringent Calamine caused by
Zinc oxide and Ferric oxide
Side effects of Orlistat
Fatty oily stools, decreased absorption of the fat-soluble vitamins, soft stool, fecal urgency
Most sedative first generation antihistamines caused by
Ethanolamines – diphenhydramine, dimenhydrinate, clemastine, doxylamine
Least sedative first generation antihistamines caused by
Alkylamines – brompheniramine, chlorpheniramine
Second generation antihistmines include
Piperidines – terfenadine, astemizole, loratadine, fexofenadine
Cetirizine and Acrivastine
Cough center is situated in
Medulla
Non-productive cough can be suppressed with
Antitussives
Productive cough responds best to
Increased fluid intake and Expectorants
Examples of antitussives
Codeine, Dextromethorphan, Diphenhydramine, Camphor and menthol
Examples of expectorants
Guaifenesin
Laxatives that are more useful in preventing constipation than treating acute constipation
Bulk-forming laxatives – Psyllium, Malt soup extract, Methylcellulose, Polycarbophil
Lubricant laxative (Mineral oil) can cause side effects
Decreased absorption of fat-soluble vitamins, Lipid pneumonitis (from aspiration)
Pregnant women having constipation should use
Bulk-forming agents or Stool softeners
Heart burn relief is quickest with
Antacids – Sodium bicarbonate, Calcium carbonate, Aluminum hydroxide, Magnesium
hydroxide, Magnesium-aluminum combination antacids
The only systemic antacid is available and used for short-term relief
Sodium bicarbonate
The acid suppression agents have longest duration of action
Proton pump inhibitors (about 3 days) – Omeprazole, Lansoprazole, Pantoprazole
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Proton pump inhibitor that has oral and IV formulation
Pantoprazole
Pyrosis is
Heartburn
Dysphagia is
Difficulty in swallowing
Odynophagia is
Pain when swallowing
Significant interactions of Acetaminophen
Acetaminophen may competitively inhibit metabolism of AZT, resulting in increased AZT
or Acetaminophen toxicity
The viruses most commonly responsible for the common cold
Rhinoviruses (about 50% of cases)
Rhinovirus infection leads to the release of inflammatiory mediators including
Prostaglandins, Leukotrienes, Bradykinin and Thromboxane
Actions of Local anesthetics
Block reversible nerve impulse conduction, block Na influx and produce reversible loss of
sensation
Adverse effects of Aminoglycosides
Ototoxicity, Nephrotoxicity, Neuromuscular paralysis (curare-like actions), Contact
dermatitis (topical neomycin)
On-Off effect seen with antiparkinson drugs can be treated by
Adding a second drug or Reducing dose of first drug and adding the second drug
Factors that increase Lithium concentration
NSAIDs, Thiazides, K sparing diuretics, ACEI, TCA, SSRI, Dehydration
Factors that decrease Lithium concentration
Alkalizing agents, Caffeine (increased frequency of SE)
Drugs used in Manic or Bipolar disorders
Li, Valproic acid , Carbamazepine
Lithium side effects
Dry mouth, altered taste perception, weight gain, increased thirst, impotence, diarrhea, and
kidney abnormalities
LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism
Euthymia is
A word that describes a normal non-depressed, reasonably positive mood.
Euphoria is
A word that describes the mood elevations above the normal range, a state of intense
happiness, Mania and Hypomania
Dysphoria is
A word that describes the mood depression below the normal range, Dysthymia (less severe)
and Depression (the lowest mood point)
Incidence of Depression
Usually occurs more in women than in men (2:1) and initial episode occurs between 25-44
Anhedonia means
Loss of interest or pleasure
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Metabolite of Fluoxetine
Norfluoxetine (long half life 7-9 days)
Serotonin syndrome
Causes HARM: Hyperthermia, Autonomic instability (delirium), Rigidity, Myoclonus
SSRI , Bupropion (SNDRI) should be administered when
In the morning due to stimulatory effect which may result insomnia
Mechanism of action of Venlafaxine and Nefazodone
Serotonin, Norepinephrine reuptake inhibitor (SNRI)
One of antidepressant drugs that is a potent cytochrome P450 3A4 Inhibitor and highly protein bound are
Nefazodone
Most serious side effect of Nefazodone
Hepatic failure
Most common cause of early discontinuation of Venlafaxine therapy
Nausea
Mechanism of action of Mirtazapine
Increase Norepinephrine and Serotonin by blocing Alpha-2, 5-HT 2 and 5-HT 3
The advantage of Mirtazapine over SSRI
Decreased common SSRI side effects (ex. Sexual dysfunction, agitation, insomnia)
Most SSRI metabolized via
Cytochrome P450 2D6 and 3A4 –Inhibitor
Seizure that occurs primarily in children
Atonic seizure
Anti-convulsant has weight loss side effect
Topiramate
Phenytoin is not effective in which of seizure
Absence seizure
Ethosuximide used only for
Absence seizure
Anticonvulsant which has no significant pharmacokinetic interaction with the other anticonvulsants
Gabapentin
Side effects of Phenytoin
P=P450, H=Hirsutism, E=Enlarged gum, N=Nystagmus, Y=Yellow-browning of skin,
T=Teretogenicity, O=Osteomalacia, I=Interference with B12 met. (anemia),
N=Neuropathies (vertigo, ataxia, headache)
Ester local anesthetics (shorter acting)
Cocaine, Procaine, Benzocaine, Tetracaine, Butamben
Amide local anesthetics (longer acting)
Lidocaine, Mepivacaine, Bupivacaine, etc.
Opioid analgesic that should be avoided in renal failure patient
Meperidine (It is metabolized to Normeperidine and accumulate in kidney)
Drug of choice for suppressing opioid withdrawal syndrome
Methadone (opioid agonist)
Common side effects of TCA
Orthostatic hypotension, Weight gain, Sexual dysfunction, Confusion, Anticholinergic SE.
Anterograde amnesia is commonly seen in
Midazolam
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Acetaminophen side effects
Liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort,unusual
bleeding or bruising, severe fatigue), Allergic reaction (urticaria, difficult breathing), Blood
problems (increased INR if used with warfarin)
No skin rash
Toxic shock syndrome is characterized by sudden onset of
High fever, rash on palms and soles, dizziness, nausea, vomiting and diarrhea
Thromboxane A2 is a product of
Platelets
Wernicke-Korsakoff syndrome is a brain disorder involving loss of specific brain functions caused by
Vitamin B1(Thiamine) deficiency (which commonly accompanies habitual alcohol use or
alcoholism.)
Wernicke-Korsakoff syndrome is characterized by
Vision changes, Loss of muscle coordination, Loss of memory, Hallucinations
Laboratory findings of Hyperparathyroidism include
Increased serum PTH, Increased serum Ca, Decreased serum Phosphorous
A condition that appear as white patches on the skin due to loss of melanocytes is known as
Vitiligo
Essential amino acids are
PVT TIMHALL , P=Phenylalanine, V=Valine, T=Tryptophan, T=Threonine,
I=Isoleucine, M=Methionine, H=Histidine, A=Arginine, L=Leucine, L=Lysine
Chancroid is a sexually transmitted disease characterized by painful sores on the genitalia, caused by
Haemophilus ducreyi
Infectious mononucleosis (The kissing disease or Pfeiffer's disease) is a disease seen most commonly in
adolescents and young adults, characterized by fever, enlarged lymph nodes, sore throat and fatigue. It is
caused by
Epstein-Barr virus (EBV) or the cytomegalovirus (CMV).
Infectious mononucleosis is transmitted by
Saliva or blood
The screening test for Infectious mononucleosis
Mono spot tests by examining the patient's blood for increased heterophile antibodies
Warts, small, rough, cauliflower-like growth, typically on hands and feet. are caused by a viral infection,
specifically by
Human Papilloma Virus (HPV)
Viral gastroenteritis (winter diarrhea, stomach flu) are caused by
Rotavirus (most cases), Norovirus (Norwalk virus), Astrovirus, Adenovirus, Saprovirus
Creatinine clearance is used as a measurement of
Glomerular filtration rate
Substances that improve the flow ability of granule or powder or both
Glidant
Eutectic mixture
The mixture of two or more substances that melt at the lowest temperature (Eutectic point)
Gray baby syndrome
- Occurs in prematures and newborn infants when Chloramphenicol is administered
during the first few days of life.
- Due to inability to metabolize Chloramphenical because of Glucoronyl transferase
deficiency
- Glucoronyl transferase is required to detoxify Chloramphenicol
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Pellagra
- Caused due to Niacin (Vit. B3) deficiency
- Caused by failure in converting tryptophan to niacin
- Characterized by dermatitis, diarrhea and dementia
Gonorrhea caused by Neisseria gonorrhea may be treated by
- Cefixime (po, 3rd)
- Ceftriazone (iv, 3rd)
- Ciprofloxacin
Viral encephalitis may be best treated by
Acyclovir
Beta lactamase inhibitors are
Clavulanic acid, Sulbactam and Tazobactam
Emphysema
- Permanent alveolar enlargement distal to terminal bronchioles and destructive changes
of alveolar wall
- Lack of uniformity in air space enlargement resulting in loss of alveolar surface area
- The collapse of small airways result in airflow limitation
Pseudomembranous colitis is an infection of the colon caused by Clostridium difficile can be treated by
Metronidazole or Vancomycin
Antibiotics that often cause Pseudomembranous colitis are
Broad spectrum penicillins, Cephalosporins, Clindamycin
Drug used with Chloroquine in treating Malaria with the purpose to kill parasites in the liver (Plasmodium
vivax) is
Primaquine
Patient with chloroquine-resistant malaria should be treated by
Quinine+Doxycycline or Mefloquine
Antibiotics
Drugs derivated from natural sources that can kill or inhibit bacteria growth.
Amino acid that is an important precursor of hemoglobin
Glycine
Amino acid that is an amino acid neurotransmitter
Glycine
An important enzymatic reaction involved in muscular contraction
ATP-Creatinine phosphokinase reaction
Enzyme is responsible for DNA synthesis
DNA polymerase
The predominant intracellular element
Potassium
The predominant extracellular (interstitial) element
Sodium
Carbohydrate catabolism is characterized by
Without consuming energy, released store energy, Glycogenolysis is an example
Basophil, Eosinophil and Neutrophil are originated from
Myeloblasts
Technetium 99m
- mostly used as radionucletide in nuclear pharmacy
- produced by the radioactive decay of Molybdenum
- has half life 6 hours
 6
Klein Filter syndrome
- Male with enlarge breast, small testis and infertility
- Has 3 sex chromosomes, XXY
Drugs have 1,4 dihydropyridine in structure
Dihydropyridine calcium channel blocker (Nifedipine, Amlodipine, etc.)
Structure of Vitamin K
Quinolone
Structure of Folic acid
Pteridine ring+PABA+Glutamic acid
Structure of Steroid compounds
3 Cyclohexane and 1 Cyclopentane
Drugs containing hydroxyl groups or carboxyl groups are often metabolized by
Glucuronidation
Prion (proteinaceous infectious particle)
- Abnormally-structured forms of a host protein, which are able to convert normal
molecules of the protein into the abnormal structure
- A unique type of infectious agent, as it is made only of protein
- Responsible for some diseases classified as transmissible spongiform encephalopathies
(TSEs) including scrapie (a disease of sheep), Creutzfeldt-Jakob disease (CJD), and
bovine spongiform encephalopathy (BSE or mad cow disease)
Creutzfeldt-Jakob disease (CJD)
- A very rare and incurable degenerative neurological disorder (brain disease) that is
ultimately fatal
- The most common of the transmissible spongiform encephalopathies (TSEs).
- Can be inherited (10-15%) or non-inherited
- The defective protein can be transmitted by human growth hormone products, corneal
grafts, dural grafts or electrode implants.
- It usually begins in middle to late adulthood.
The best drug used to treat uncomplicated diaper rash
Zinc oxide
Therapeutic uses of Coal tar (conc over 10%)
Eczema, Psoriasis, Atopic dermatitis
The common causative agent of opthalmic neonate infection in Canada
Chlamydia trachomatis
Primary transmission of Herpes
Lesions in the skin
Streptococcus viridans can cause
Endocarditis
Rabies caused by
Rhabdoviruses (RNA viruses) in saliva of infected animals
Type of bacterias are found in colon
90% anaerobic and 10% aerobic
The difference between gram positive and negative bacterias
- gram+ stain blue or purple VS gram- stain red or rose-pink
- gram+ has a single bilayer of phospholipid VS gram- has two single bilayer
- gram + has Techoic acid and Peptidoglycan on cell wall VS gram- has
Lipopolysaccharide (have Porins channels) and Peptidoglycan on cell wall
Main substance presents in fungi cell wall
Ergosterol
 7
The most common causative agent of bacterial skin infections
Streptococcus pyogens, Staphylococcus aureus
Papilloma virus causes
Common wart
The most common causative agent of Viral encephalitis
HSV-1
Meningitis is caused by
Bacteria, Virus, Fungi, Parasites, etc.
Osteomyelitis
- May be caused by Staphylococcus aureus, Staphylococcuse epidermidis, P. aeruginosa
- Bacterial infection of bone and bone marrow
- May be treated by vancomycin
The most common causative agent of common cold
Rhinoviruses
The most common causative agent of Otitis media
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarhalis
The most common causative agent of Otitis externa (swimmer’s infection)
Pseudomonas, Fungus
The most common causative agent of Viral gasteroenteritis
Rotaviruses
Salting out
The solubility of non-electrolyte is decreased by adding a solute
Salting in
The solubility of non-electrolyte is increased by adding a solute
Amphiprotic means
A substance which can act both as an acid and as a base (both donate or accept a proton).
Example of Amphiprotic substances
Water, Methanol, Ethanol. Acetic acid, Amino acid
Amphiphilic means
A substance which have both hydrophilic in the end of molecule and the other is
hydrophobic.
Example of Amphiphilic substances
Phospholipids, cholesterol, glycolipids, fatty acids, bile acids, saponins, surfactants
Determination of alcohol in blood is done by
Mass spectroscopy
Determination of M+ molecular ion (molecular weight) of the sample is done by
Mass spectroscopy
For a radioisotope to be useful as an organ scanning agent, the emission must be
Gamma rays
Mechanism of action of TLC
Capillary theory
TLC spray reagent
Ninhydrin used to detect amino acids and amino sugars, gives blue spot with amines
Sterilization of hormone is done by
Radiation
Gas is used in Gaseous sterilization (Gas+Humidity)
Ethylene oxide
In the assay of amphetamine in plasma, it can be extracted by
Ether
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The process of activation of a prodrug is called
Bioactivation
The substance as derivative of glutathione conjugation
Mercapturic acid
Plasma proteins that exclusively bind to Basic drugs
Alpha1 acid glycoproteins and Lipoproteins
Plasma proteins that exclusively bind to Acidic drugs
Albumin (55% of all plasma proteins in plasma)

Drugs that increase hepatic microsomal enzyme and increase its own metabolism, it is known as
Tolerance
The best prophylactic of transient ischemic attack
Aspirin
Nicotine patch should be kept in the package until used because
Nicotine could be lost to the air
The most serious side effect of Doxorubicin, Daunorubicin (antibiotic anticancer)
Cardiomyopathy
Erythromycin and Azithromycin should be taken before meals due to
Food may decrease absorption of drugs
Cefuroxime axetil (2nd) should be taken after meals to
Increase bioavailability
Adverse effects of prolonged metronidazole therapy include
Peripheral neuropathy
Topical Clindamycin used in acne treatment does not require an auxillary label against exposure to direct
sunlight unlike
Doxycycline, Tetracycline, Tretinoin, Isotretinoin
Paget disease is characterized by
A localized increase in bone resorption followed by an abnormal bone formation result in a
bone deformation and fracture
Paget disease may be treated by
Calcitonin
ACTH secreted by
Anterior pituitary gland
The platelets are originated from
Megakaryoblasts
Form of Vitamin A are effective in acne treatment
13-Cis retinoic acid (oral) and 13-Trans retinoic acid (topical)
Antiarrhythmic drugs that can cause SLE
Procainamide (IA) and Phenytoin (IB)
Diabetic agents have the greatest risk of hepatotoxicity
Insulin sensitizers (Thiazolidinediones- Pioglitazone, Risoglitazone)
Drug of choice used in Gout treatment in pregnant women
PTU
Diabetic agents can cause the greatest hypoglycemic effect
Insulin secretagogues (Sulfonylureas – Chlorpropramide, Acetohexamide ; Meglitinides –
Repaglinide, Nateglinide)
Structure of Opioid analgesics
p-phenyl-N-alkyl piperidine
 9
Enzyme plays a major role of Epinephrine synthesis
Phenylethanoloamine-N-methyltransferase (Methylation)
Immunoglobulin that protects mucosal colonization by bacteria and other microorganisms
IgA
CD8+ is an identifying antigen for
Cytotoxic T cells
Methanol toxicity is due to accumulation of
Formic acid (Blindness, CNS toxicity)
Antidote of Methanol
Ethanol
Immunoglobulin can cross placenta
IgG
Parathyroid hormone causes increased Ca in plasma by 3 pathways
- Increased Ca reabsorption at Proximal renal tubule
- Increased dissolution of CaPO4 from bone
- Increased Calcium absorption in the intestine by increasing the production of vitamin D
Active form of Vitamin D
1,25 dihydrocholecalciferol (calcitriol) is synthsized in the kidney by regulating of PTH
Patient with Pheochromocytoma (excessive epinephrine) may be treated with
Phentolamine or Phenoxybenzamine (alpha antagonist)+ Propranolol (beta antagonist)
Drugs that decrease serum prolactin levels used to suppress lactation in women who choose not to breast-
fed
Bromocriptine, Ergot alkaloids, L-dopa
Drugs that used to enhance milk production
Metoclopramide and Sulpiride
Drugs can increase serum prolactin levels
Metoclopramide, Sulpiride, Methyldopa, Amphetamine, Haloperidol, Phenothiazine,
Theophylline
The intensity of pharmacological action of the drug is primarily dependent on
Concentration of the drug at receptor site
A mass of adipose tissue that develps at the injection site is usually due to the patient’s neglect to in
rotating the insulin site is known as
Lipohypertrophy
The process of wetting and smoothing Zinc Oxide with Mineral oil in preparation for incorparation into
an ointment base is
Levigation
Antioxidants that can trigger asthma
Sodium bisulfite, Sodium metabisulfite (Sulfites or sulfiting agents can trigger asthma)
The HLB system is used to classify
Surfactants
The process of reducing substances by adding an easily removed solvent is
Pulverization by intervention
Flocculating agents (Potassium stearate, Pot. Laurate, Acryl polymers, Surfactants) used to
- Enhance particles dispersability and form clear boundary when particles are settle
- Don’t change suspension volume
Binders used to
Promote granulation during wet granulation process
Glidants used to
Improve the flow ability of granules or powder or both
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Lubricants used to
Reduce friction when the tablet is ejected from the die cavity
Capping is the tablet processing problem most likely due to
Entrapment of air
Sieve Size that all particles of coarse powder can pass through (USP standards)
20
Sieve Size that all particles of moderate coarse powder can pass through (USP standards)
40
Sieve Size that all particles of fine powder can pass through (USP standards)
80
Sieve Size that all particles of very fine powder can pass through (USP standards)
120
Hypoglycemia symptom
Confusion, Sweating, Tachycardia
The most abundant intracellular anion
Phosphate
The most abundant intracellular element
Potassium (cation)
Example of PGE1 analogs
Misoprostol, Alprostadil
Example of PGE2 analogs
Dinoprostone
Example of PGF2 alpha analogs
Latonoprost, Travoprost
Example of PGI analogs
Epoprostenol
Hormone that is high during the first semester of pregnancy and decline during the second and third
semester
HCG (Human chorionic gonadotropin)
Autoclave is a sterilization process of
Steam sterilization
Type of tocopherol that is a strongest antioxidant
Alpha tocopherol
HPLC resolute means
Resolution of one analyte from the others in substance mixture
Electrophoresis is used to separate
Protein and Protein
Iodine value (Iodine number)
- the mass of iodine in grams that is consumed by 100 grams of a chemical substance
- used to determinate saturation of fatty acids
- double bonds in fatty acids react with iodine (violet color would be disappear)
Pyconometer is used for
Measuring the weight of different liquids that have the same volume.
Red man syndrome (Red neck syndrome) is the side effect of
Vancomycin
Due to
Histamine release caused by rapid infusion resulting in Flushing, hypotension and shock.
Side effects of Vancomycin
Red man syndrome, Ototoxicity, Nephrotoxicity
 11
Perchoric acid is used with Acetic acid in nonaqueous titration because
Perchoric acid is a strong acid, stronger than acetic acid
In gravimetric analysis, pH is adjusted to
Form insoluble hydroxides or hydrous oxides to precipitate
LD50 means
The dose that causes death in 50% of subjects (usually laboratory animals)
Erythromycin estolate may produce the side effect of
Cholestatic jaundice
Phase II reaction is predominate in men
Glucuronidation
Disease caused by decreased Acetylcholine
Alzheimer
Drugs cause secondary parkinson disease
Dopamine antagonist-Phenothiazines ( e.g. chlorpromazine, perphenazine),
Butyrophenones (e.g. haloperidol), Reserpine (antihypertensive drug)
Mechanism of action of allopurinol
Xanthine oxidase inhibitor
Minoxidil is a prodrug that must be conjugated with
Sulfate to be Minoxidil sulfate (active form)
Sclerotic plaques found in brain is seen in disease
Multiple sclerosis
Aldosterone secreted in
Adrenal medulla (inner)
Sciatic nerves are found in
All foot branches
Left ventricular failure, blood pour in
Lung
Embolism is caused by
Obstruction of blood vessels
Pentoxifylline
- It works by decreasing the thickness (viscosity) of blood and this change allows your
blood to flow more easily, especially in the small blood vessels of the hands and feet.
- It is used to improve blood flow in patients with circulation problems to reduce aching,
cramping, and tiredness in the hands and feet.
Koplik’s spot
- A small, irregular, red spot with a minute bluish white speck in the center ,seen on the
buccal mucosa and lingual mucosa.
- Often appear a few days before the rash arrives
- Asscoiated with Measles
Bacteriophages mean
Viruses that infect bacteria
The most abundant immunoglobulin in the body
IgG present about 70% (can cross placenta)
Gray patches on the tonsil or mucus membrane of the nose and throat are associated with
Diptheriae
Antisense
- A piece of DNA producing mirror image of mRNA (antisense) that is opposite in
sequence to one directing protein synthesis
- Used to selectively turn off production of certain proteins
 12
- Used in production recombinant DNA
Transcription
Synthesis of messenger (or any other) RNA on a DNA template
Aerosols
Colloidal systems of very finely subdivided liquid or solid particles dispersed in and
surrounded by gas
Rubbing alcohol (70% alcohol) used in
- External for bedridden patients
- Germicide for instruments
- Skin cleanser prior to injection
Drug used to prevent opioid withdrawal symptoms and help to reduce drug craving
Methadone
Thixotropy (gel to solution)
Decrease in viscosity and Increase in flow ability
Two types of flow follow thixotropy
Plastic flow and Pseudoplastic flow
Detectors commonly used in HPLC
UV , Diode array, Refractive index, Radioactive, Fluorescence
Bathochromic shift means
The shift of absorption to a longer wavelength
Opposite to Hypsochromic shift
Hyperchromic effect means
An increase in absorption intensity
Opposite to Hypochromic effect
Flu shots
An inactivated vaccine containing three influenza viruses – one A (H3N2) virus, one A
(H1N1) virus, and one B virus – are representative of the influenza vaccine strains
recommended for that year.
The best way to protect yourself from flu
To be vaccinated
Priority groups that should be vaccinated
- people aged 65 years and older, with and without chronic health conditions
- people aged 2–64 years with chronic health conditions
- children aged 6–23 months
- residents of long-term care facilities
- pregnant women
- household contacts and out-of-home caregivers of children less than 6 months of age
- children and adolescents on long term acetylsalicylic acid (ASA) therapy
- health care workers, other caregivers and household contacts capable of transmitting
influenza to the above at-risk groups
- people at high risk of influenza complications who are traveling to areas where the flu
virus is likely to be circulating.
Who should not get Flu shots
- Children under six months of age
- People who have had a severe allergic reaction to eggs (viruses for the flu shot are grown
in eggs) or a previous dose of the vaccine.
- Have a history of Guillain-Barré syndrome (GBS).
 13
Guillain-Barré syndrome (GBS)
- A disease in which the body damages its own nerve cells (outside of the brain and spinal
cord), resulting in muscle weakness and sometimes paralysis
- Can last for weeks to months. Most people eventually recover completely or nearly
completely
- It is thought that GBS may caused by a bacterium called Campylobacter jejuni
Who can given Nasal spray of Flu vaccine
Healthy persons aged 5-49 years who are not pregnant at any time.
Mechanism of action of Disulfiram
Acetaldehyde dehydrogenase inhibitor (resulting in blocking conversion of acetaldehyde to
acetic acid)
Disulfiram used to
support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol.
Disulfiram-alcohol reaction
Even small amounts, nausea, vomiting, flushing, headache, tachycardia
The smallest bacteria and lack of a cell wall and containing sterols in plasma membrane is
Mycoplasma
The unique bacteria that lack the abilty to generate ATP
Chlamydia
Sex pili are found in
Only gram negative bacteria, found in very small numbers, act as fragile transport tubes for
DNA exchange
The mode of gene transfer which naked DNA is taken up is called
Transformation
Bacteria that make either a fermentative or respiratiory set of enzymes are known as
Facultative anaerobes
Plasmid means
Extrachromosomal, double-stranded, circular pieces of DNA that carry optional genes
(transposons) that add extra properties.
Nucleoid means
A long, circular, double-stranded DNA without a nuclear membrane
Protozoa are unicellular, nonphotosynthetic eukaryotes that are classified by
Mode of motility
Fungi are eukaryotes that are classified by
Sexual reproductive structures
Dimorphic fungi means
Fungi can be grown in either a yeast (unicellular) or mold (filamentous) phase
ex. Blastomyces
The peptidoglycan backbone of a bacterial cell contains
N-acetylmuramic acid and N-acetylglucosamine
T cells that are released from the thymus gland into circulation are known as
Virgin T cells
3 Major roles of antibodies
- Act as an antigen receptor for B cells
- Aid in the elimination of antigen
- Aid in neutralization of toxins
The first cells in Humoral immunity are present when a specific antigen is encountered (1st time)
Virgin B cells and Virgin T helper cells (secrete IgM and followed by IgG)
 14
A primary immune response to an infection is characterized by
The initial production of IgM, beginning about 4 days after antigen is encountered. The peak
primary immune response occurs 10-14 days after the antigen is encountered, and the serum
contains both IgM and IgG
IgM
- The first immunoglobulin secreted during primary immune responses
- Plays a minor role in memory responses.
- The most potent activator of the complement system
- It opsonizes antigens for phagocytosis
IgG
- Can cross placenta
- Accounts for 70% of adult immunoglobulin
- Has longest serum half life 25-35 days
- It opsonizes antigens for phagocytosis and activates the complement system

IgE
- Binds to IgE receptors located on basophils and mast cells to trigger the secretion of
inflammatory mediators from these cells
- Mediates allergic reaction
IgA
Protects mucosa from colonization by bacteria and other microorganisms
IgD
Has no known function as a secreted immunoglobulin
Cell mediated immunity are
Antibody is not involved in the elimination of antigen.
Good pasture’s syndrome
Organ-specific autoimmunity, antibodies against glomerular capillary basement membrane
leading to glomerulonephritis.
Multiple sclerosis
Organ-specific autoimmunity, antibodies against the basic protein of myelin resulting in
CNS demyelination with sclerotic plaques leads to spasticity
Drugs-induced SLE
Quinidine, Procainamide, Phenytoin, Chlorpromazine, Hydralazine, Methyldopa, Isoniazid
No renal disorder occurs in drugs-induced SLE
Recommended drug used in the treatment of Kaposi’s sarcoma
IFN-alpha
Hashimoto’s thyroiditis, an autoimmune disorder can be classified as which type of hypersensitivity
Type II hypersensitivity
The most common cause of type III hypersensitivity is
The response to drug (ex. Penicillins, Sulfonamides)
Agent is commonly used to treatment Multiple sclerosis
IFN beta-1b
Mechanism of action of Muromonab-CD3, monoclonal antibody
Bind to all T cells resulting in opsonization of T cells for phagocytosis lead to decreased
the total number of T cells
Intravenous human immunoglobulins used to
Replace antibody in immunodeificient individuals
Cytokine is approved for the treatment of certain forms of CA
Interferon alpha (used in Kaposi’s sarcoma)
 15
Fab fragment used to
- Counteract Digoxin toxicity by binding digoxin resulting in prevention digoxin activity.
- It is obtained by the immunization of sheep with a digoxin-protein conjugate and
subsequent proteolytic cleavage of the collected antibody
CD4+ T cells (T helper) bound to MHC class II molecules
CD8+ T cells (Cytotoxic) bound to MHC class I molecules
The outcomes of the activation of the complement system
- Acute inflammation (resulting in increasing of movement of phagocytes)
- Opsonization of immune complexes (resulting in enhancing phagocytosis)
- Cytolytic action (resulting in killing)
In renal and cardiac transplantation, the greatest problem is
Host versus graft (HVG) disease (the rejection of the foreign organ by the immune system
of host)
In bone marrow transplantation, the greatest problem is
Graft versus host (GVH) disease
Cyclosporine used in graft rejection prophylaxis by
Inhibiting activation of T cells and blocking transcription of IL-2
Major side effect of Cyclosporine
Nephrotoxicity
An enzyme that used by HIV to form DNA in the host cell
Reverse transcriptase
An enzyme that cleaves DNA at a specific site
Restrictive endonuclease
An enzyme that seals single-stranded nicks between nucleotides in double-stranded DNA and join DNA
fragments from different sources
DNA ligase
DNA gyrase (Topoisomerase II) found in
Bacterias and some prokaryotes (not found in eukaryotes)
Function of DNA gyrase

- To enable the large DNA molecyle to fit within the bacterium, histone-like proteins bind to
the DNA, seggregating the DNA molecule into around 50 chromosomal domains and making
it more compact. Then an enzyme called DNA gyrase supercoils each domain around itself
forming a compacted, supercoiled mass of DNA approximately 0.2 µm in diameter.
- They are essential in the unwinding, replication, and rewinding of the circular, supercoiled
bacterial DNA
Two classes of antibiotics that inhibit gyrase are
Coumarins (including novobiocin), and Quinolones (including nalidixic acid and
ciprofloxacin)
Glycoprotein is considered a protein linked to
A carbohydrate
Granulocyte colony stimulating factor (G-CSF) is
A class of glycoprotein that regulate the production of many types of blood cells and
components in the body
 16
Example of recombinant human G-CSF
Lenogastrim, Filgastrim
G-CSF used to
Stimulate the release of mature neutrophils from hematopoietic tissue, prolong the survival
and enhance their phagocytic and cytotoxic activity
Alteplase formerly known as tissue plasminogen activator used in
- The treatment of myocardial infarction
- The treatment of massive pulmonary embolism
Side effects of Alteplase
Bleeding, Reperfusion arrhythmia, Reinfarction
Antithrombin III is designated an orphan product used as
Replacement therapy to prevent or treat thromboembolic episodes in congenital deficiency
states
Interleukin III is a hematopoietic growth factor used to
Treat patients with bone marrow failure by improving neutrophil and platelet counts
A human recombinant interleukin II used to treat metastatic renal cell carcinoma
Aldesleukin (Side effects – Hypotension, Flu-like symptoms)
Abciximab, monoclonal antibody has specific affinity to
Platelet glycoprotein IIb-IIIa receptors
Abciximab used in
Reducing fatalities in patients who have unstable angina after they undergo angioplasty
A common storage condition for most biotechnology products after reconstitution is
Cool place
Nephritic syndrome is characterized by
PHAROH = Proteinuria, Hematuria, Azotemia (elevated blood nitrogen), RBC casts,
Oliguria (low urine output <400 mL/day), Hypertension
Nephritic syndrome is
A collection of signs (known as a syndrome) associated with disorders affecting the kidneys,
more specifically glomerular disorders.
Nephrotic syndrome is
A disorder where the kidneys have been damaged, causing them to leak protein from the
blood into the urine. It is a fairly benign disease when it occurs in childhood, but may lead on
to chronic renal failure, especially in adults, or be a sign of an underlying serious disease
such as systemic lupus erythematosus or a malignancy.
Nephrotic syndrome is characterized by
Edema, Proteinuria, Hyperlipidemia, Lipiduria, Hypoalbuminemia
Liver Cirrhosis is characterized by
Replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to
progressive loss of liver function. (Ascitis, Jaundice, Bleeding)
Most common causes of Liver Cirrhosis
Alcoholism and Hepatitis C
Allopurinol should be taken with plenty of fluid to
Help prevent kidney stones
Cotrimoxazole should be taken with plenty of fluid because
It may cause GI upset.
Primary Classes of Medications Responsible for Photosensitizing Reactions
Antihistamines
Coal Tar and Derivatives
Contraceptives, Oral & Estrogens
 17
Non-Steroidal Anti-Inflammatory Drugs
Phenothiazines
Psoralens
Sulfonamides
Sulfonylureas
Thiazide Diuretics
Tetracyclines
Tricyclic Antidepressants
Vitamin A and derivatives
The main Metabolic pathways of cellular respiration include
1. Glycolysis
2. Kreb’s cycle (TCA cycle, Citric acid cycle)
3. Oxidative phosphorylation
Glycolysis means
A series of biochemical reactions by which a molecule of glucose (Glc) is oxidized to two
molecules of pyruvic acid (Pyr).
1Sugar (glucose) → 2 Puruvic acid (end product of Glycolysis) + 2ATP
In eukaryotes, Glycolysis occurs in
Cytosol
Kreb’s cycle means
A series of chemical reactions of central importance in all living cells that utilize oxygen as
part of cellular respiration
2 Pyruvic acid → 4CO2 (end product of Kreb’s cycle) + 2ATP
In eukaryotes, Kreb’s cycle occurs in
Mitochondrial matrix
Oxidative phosphorylation means
A biochemical process in cells. It is the final metabolic pathway of cellular respiration, after
glycolysis and the citric acid cycle.
In eukaryotes, Oxidative phosphorylation occurs in
Inner of the two mitochondrial membranes
Midsagittal plane
Separation of the body into right and left portions equally
Parasagittal plane
Separation of the body into right and left portions unequally
Coronal plane
Separation of the body/ body part into anterior and posterior portions
Transverse plane
Separation of the body/ body part into superior and inferior portions
Oblique plane
Separation of the body/ body part at an angle (neither horizontal _ nor vertical)
Adduction position
Move a limb turn inward a median plane
Abduction position
Move a limb turn outward a median plane
Flexion position
Action of bending a limb or finger
Extension position
Action of stretching out a limb or finger
 18
Chancre means
A painless ulceration formed during the primary stage of syphilis, caused by Treponema
pallidium
Granuloma means
A group of epithelia macrophages surrounded by a lymphocyte cuff, small nodule.
Granuloma can seen in
Tuberculosis (Mycobacterium infection), Syphilis, Crohn’s disease, Sarcoidosis
Penicillamine should be given in emptying stomach
The safetest lipid lowering drug may be used in pregnancy
Cholestyramine
Type of arrhythmia that Digoxin cannot be used
Ventricular tachycardia
st
1 line treatment in mild-moderate CHF
Glycoside+ACEI
Drug used in the treatment of HTN may cause Hemolytic anemia
Methyldopa
Drugs induced Hypertrichosis
Minoxidil, finasteride, cyclosporine, diazoxide, acetazolamide, corticosteroids, phenytoin,
streptomycin, hexachlorobenzene, penicillamine, heavy metals, interferon.
Normal volume of one eye drop
0.05 ml
The capacity of the human eye for instilled ophthalmic drops is approximately
0.01-0.02 ml
A patient with major depression should receive antidepressant for at least
6 months
Antidepressant that may cause seizure
Bupropion (contraindicated in patient with seizure)
Before considering a therapeutic of antidepressant, it must be given at the maximum tolerated dose at least
4-6 weeks
Pharmacokinetics of Lithium
- Bioavailability ranges from 0.8-1.0 for most products
- Food can delay absorption but does not affect the extent of absorption
- Lithium distributes into total body water and penetrates many body tissues
- It is not metabolized
- It is primarily eliminated through the kidneys
- Clearance is directly proportional to glomerular filtration rate
The advangtages of Mirtazapine over SSRI
Diminish the incidence of SSRI side effects (sexual dysfunction, agitation, insomnia) but the
disadvantages of Mirtazapine include somnolence, weight gain, constipation
Drugs may increase Lithium concentration
NSAIDs, Thiazides, ACEI, Sodium loss, Dehydration, Fluoxitine
Treatment of Lithium toxicity
- Correcting water and electrolyte disturbances
- Using emesis or gastric lavage (Charcoal is ineffective)
- Performing hemodialysis or peritoneal dialysis
Therapeutic levels of Li
0.6-1.2 mEq/ L (for bipolar disorder)
1.0-1.5 mEq/ L (for acute mania)
 19
Atypical antipsychotic that cause less sedation
Risperidone (has minimal H1 receptor affinity)
Common causative agents found in Otitis media and Sinusitis
S. pneumoniae, H. influenza, Moraxella catarhalis
Common causative agents found in Otitis externa
Pseudomonas
The most commonly causative agent of Urinary Tract Infection (UTI)
Escherichia coli
The causative agent that can cause Toxic shock syndrome (TSS)
Staphylococcus aureus
The causative agent that can cause Scarlet fever, Rheumatic fever
Streptococcus pyogenes
The most commonly causative agent of Community acquired pneumonia
Streptococcus pneumonia
The causative agent of ophthalmic neonate infection in Canada
Chlamydia trachomatis
Streptococcus viridans can cause
Endocarditis, Dental caries
The most commonly causative agents of Bacterial skin infections
Streptococcus pyogenes, Staphylococcus aureus
Normal skin floras include
Streptococcus difteroids, Staphylococcus aureus, Propionebacterium
The causative agent of Gas gangrene
Clostridium perfringens
The causative agent of Enteric fever (Typhoid)
Salmonella typhi
The causative agent of Plaque (Black death) and DOC
Yersinia petis, DOC is Streptomycin
The most commonly causative agent of Nosocomial infections
Staphylococcus aureus
The causative agent of Lyme disease
Borrelia burgdorferi (Spirochetes)
The causative agent of Ringworm
Dermatophytes
The causative agent of Syphilis
Treponema palladium
The common causative agent of meningitis in young children
H. influenza
Drug of choice in Enuresis (Bed wetting)
Desmopressin acetate (DDAVP)
The most common genetic disorder affecting Canadians
Hemochromatosis
Hemochromatosis means
Excessive storage of iron in the body
Drug of choice for Chlamydial infections (- cocci) –Lymphogranuloma, Psittacosis
Doxycycline or Azithromycin
Lyme disease is characterized by
Skin lesions, head ache, fever, followed by meningoencephalitis and eventually arthritis
 20
Transmitted by
Infected ticks
DOC of Lyme disease
Tetracycline
Rocky Mountain Spotted fever cause by Rickettsia rickettsii (- cocci) is characterized by
Fever, chill, aches in bone and joints, rash
DOC of Rocky Mountain Spotted fever (transmitted by ticks)
Tetracycline
DOC of Cholera (Vibrio cholera)
Doxycycline
DOC of primary atypical pneumonia (Mycoplasma pneumonia)
Tetracycline or Erythomycin
Drug in Tetracyclines that is safetest in patient with renal impairment
Doxycycline (metabolized via bile)
Minocycline has less phototoxicity but has special side effects
Vestibular problems ( dizziness, nausea, vomiting) due to drug concentrates on endolymth in
the ears
Common side effects of Tetracyclines
1. Teeth discoloration and hypoplasia
2. Deposition in the bone in growing children
3. Phototoxicity (avoid prolong sun exposure)
4. GI discomfort
5. Superinfection of Candida (check tongue for fungal infection routinely and stress good
hygiene)
Contraindication of Tetracyclines
Pregnancy (fatal hepatotoxicity), children under 8 yrs, breast feeding
Tetracycline take with or after meals with glass of water (To decrease GI side effects) and avoid taken
with milk, antacids, iron
Doxycycline and minocycline taken regardless of meals, have less chelation with di and trivalent cations
Route of administration of Aminoglycosydies
IV and IM (poor absorbed in GI due to high polar and polycationic structures)
Topical (only neomycin)
Half life of Aminoglycosides
2-4 hours
Aminoglycosides eliminated in 10-20 days and have Post antibiotic effect
Therapeutic uses of Aminoglycosides
1. Chronic UTI (- bacilli)
2. Plaque - Streptomycin
3. Pneumonia tularemia (acquired during rabbit hunting)– Streptomycin
4. Pneumonia caused by sensitive strains of E.coli
5. Infection of P.aeruginosa (Nosocomial infections)
6. Prophylaxis in preoperative procedures (Nosocomial infections)
Side effects of Aminoglycosides
AMINO –A= Allergy (contact dermatitis with neomycin topical), M=neuroMuscular blockade
(curare action), I=Inactivated when physically mixed with beta lactams in the same bottle,
N=Nephrotoxicity, O=Ototoxicity (deafness, tinnitus, vertigo)
Antibacterial sprectrum of Erythromycin
Same as Pen G except Erythromycin can against Mycoplasma
 21
Antibacterial spectrum of Clarithromycin
Same as Erythromycin but more active in Gram + cocci, Chlamydia, H. influenza, Legionella
Antibacterial spectrum of Azithromycin
Less active for Gram + cocci but more active in Gram -, Chlamydia, Mycoplasma and MAC
Therapeutic uses of Macrolides
1. Corynebacterium diphtheriae – Penicillins or Erythromycin
2. Pneumonia Legionnaire’s disease – Erythromycin
3. Syphilis – Pen G or Erythromycin
4. Mycoplasma Pneumonia – Tetracycline or Erythromycin
5. Ureaplasma (cause non-gonococcal urethritis) Erythromycin
6. Chlamydial infections – Doxycycline or Azithromycin
Side effects of Macrolides
Epigastric distress (more with ery), Transient deafness (with erythromycin), Cholestatic
jaundice (especially with erythromycin estolate)
Clarithromycin and Azithromycin suspensions can be stored at room temperature except Erythromycin
Erythromycin and Clarithromycin are enzyme P450 inhibitor but Azithromycin does not undergo
metabolism
Erythromycin and Azithromycin contraindicated in patient with hepatic dysfunction
Clarithromycin contraindicated in patient with renal dysfunction
Chloramphenicol use is restricted to life-threatening infections which there are no alternative because of
its toxicity
Side effects of Chloramphenicol
1. Bone marrow suppression leads to anemia
2. Gray baby syndrome (characterized by poor feeding, depressed breathing,
cardiovascular collapse, cyanosis and death)
3. GI upset
Chloramphenicol inhibits enzyme cytochrome P450
Antibacterial spectrum of Clindamycin
Gram + and Gram – anaerobic Bacteroides fragilis ( abdominal infection with trauma)
Side effect of Clindamycin
Pseudomembranous colitis
Antibiotics that act on 30S ribosomal subunit
Tetracyclines and Aminoglycosides
Antibiotics that act on 50S ribosomal subunit
Macrolides, Chloramphenicol and Clindamycin
The causative agent of Anthrax
Bacillus anthracis (+ bacilli) – Cipro, Doxy, Penicillins
First line treatment of Syphilis (caused by Treponema palladium-spirochete)
Single dose of benzathine penicillin G, 2.4 million U IM
Second line treatment of Syphilis
Tetra, Doxy or Erythro for 2 weeks
First line treatment of uncomplicated gonorrhea (N. gonorrhea)
1. Cefixime 400 mg PO single dose
2. Ceftriaxone 125-250 mg IM single dose
3. Ciprofloxacin 500 mg PO sigle dose
Drugs are recommended as a prophylactic agent of Gonorrhea and should be administerd to all infants
within 1 hour
Silver nitrate (1%) aq. Soln. or Erythromycin (0.5%) ophthalmic ointment
 22
Antibiotic should not be used in patient with cardiovascular disease
Quinolones (because of Torse de pointes side effect)
Quinolones used for
1. Gonorrhea
2. GIT infections – Traveler diarrhea
3. Uncomplicated and complicated UTI
Side effects of Quinolones
1. Diarrhea
2. CNS problem (nausea, headache, dizziness)
3. Nephrotoxicity (crystalluria)
4. Phototoxicity
5. Cartilage erosion (avoid in children under 18 years)
Antibiotics may cause ototoxicity
Vancomycin, Aminoglycosides, Erythromycin
Antibiotics may cause nephrotoxicity
Vancomycin, Aminoglycosides, Quinolones, Penicillins (Nephritis –esp. Methicillin),
Sulphonamides
Antibiotics may cause phototoxicity
Tetracyclines, Quinolones. Sulfonamides, Ceftazidime, Griseofulvins
Tetracyclines and Quinolones should not be taken with antacids, iron or calcium and drink plenty of fluid
while on medication
The common causative agents that cause UTI
SEEK PeoPle ; S=Staph saprophyticus (2nd cause), E=E. coli (1st cause), E=Enterococcus,
K=Klebsiella, P=Proteus, P=Pseudomonas
Drugs used in treatment UTI
1. Acute pyelonephritis (14 days) – Amoxicillin, Cephalosporins, Co-trimox, Ciprofloxacin
(ACCC)
2. Uncomplicated cystitis (3 days) - Amoxicillin, Cephalosporins, Co-trimox, Ciprofloxacin
(ACCC)
3. Acute urethral syndrome (Ureaplasma, Chalmydia) – Doxycycline or Azithromycin
4. Prostatitis – Co-trimox or Ciprofloxacin (CC)
Examples of Urinary tract antiseptics
Methenamine, Nitrofurantoin
Mechanism of action of Methenamin
Produce formaldehyde in acidic urine (pH < 5.5) which is toxic to most bacteria
Methenamine is usually formulated with
Mandelic acid or Hippuric acid (lower the pH of urine resulting in increased decomposition)
Methenamine is contraindicated in
1. Patient with renal insufficiency (because mandelic acid may precipitate)
2. Patient is using sulfonamides (because sulfomides react with formaldehyde)
Side effects of Nitrofurantoin
NitroFurAntoin ; N=Neuropathy (peripheral neuropathy), F=Fibrosis (pulmonary fibrosis)
A=Anemia (hemolytic anemia-G6PD)
Nitrofurantoin may turn the urine brown due to rapidly excreted by glomerular filtration
Ofloxacin has the best activity of all quinolones against both gonorrheal and chlamydial infections
Mechanism of action of Sulfonamides
Bind to Dihydropteroate synthethase by mimicking PABA resulting in inhibition of folic acid
synthesis
 23
Mechanism of action of Trimethoprim
Dihydrofolate reductase inhibitor leads to a decrease in tetrahydrofolic acid for purine,
pyrimidine, and amino acid synthesis
Side effects of Sulfonamides
4S ; SJS, Skin rash, Solubilty low (crystalluria-adequate hydration and alkalinization of
urine can prevent the problem), Serum albumin displaced (Kirnicterus-occur in newborn, free
bilirubin pass into CNS)
Contraindication of Sulfonamides
Pregnant women, Infants less than 2 months, Patient using Methenamine
Co-trimoxazole is combination of
Trimethoprim+Sulfamethoxazole
Sulfasalazine may color urine, skin, soft contact lenses orange, yellow
Most common cause of preventable blindness worldwide
Trachoma (caused by Chlamydia trachomatis)
Sulfasalazine used for
Treatment of ulcerative colitis, Crohn’s disease (because drug is not absorbed from the gut
and acts locally)
Drug used in PCP
Co-trimoxazole, Pentamidine (treatment or prophylaxis)
One of penicillins eliminated through the biliary route
Nafcillin (Antistaphylococcal, Penicillinase-resistant penicillins)
Penicillins that can cause platelet dysfunction
Pen G, Carbenicillin, Ticarcillin
Clofazimine may cause pink to brownish skin pigmentation with a first few weeks (75-100% of patients)
Clofazimine used for the treatment of leprosy and Mycobacterium infections
Only PI (…navir) that can cross BBB
Nelfinavir
Co-trimoxazole can used in UTI but not effective against P.aeruginosa
Isoniazid is usually taken with pyridoxine because INH increases the excretion of pyridoxine, leading
to peripheral neuritis (to prevent symptoms)
Drugs used in infectious diseases that can cause Seizure
PIM-AM ; P=Pen G, IM=Imipenem, A=Amphotericin B, M=Metronidazole plus 3 rd gen
ceph.
Most cephalosporins excreted by kidney except
Cefoperazone (3rd) and Ceftriazone (3rd) -2 zone
Fourth generation of Cephalosporins (Cefipime) have greater +cocci and – bacilli (including
P.aeruginosa) but highly resistant to beta-lactamase
Antibiotics contraindicated during pregnancy
MCATS ; M=Metronidazole, C=Chloramphenicol, A=Aminoglycosides, T=Tetracyclines,
S=Sulfonamides
Disulfiram-like reaction inducing drugs
Pre Medical Test in the PM ; PMT(bleeding also)=cefoPerazone, cefoMandole, cefoTetan,
P=Procarbazine, M=Metronidazole
The broadest spectrum beta-lactam antibiotics now
Imipenem/Cilastatin
Cilastatin formulated with Imipenem due to
Cilastatin is a peptidase inhibitor in the kidney that protects imipenem from degradation
Aztreonam (monobactam) shows little cross-reactivity with beta-lactams may be used to treat patient
allergic to penicillins or cephalosporins
 24
The only antibiotic which is effective against methicillin-resistant Staph. Aureus (MRSA)
Vancomycin
Metronidazole used in
Trichomoniasis, Giardiasis, Amoebiasis, Pseudomembranous colitis
Side effects of Metronidazole
Disulfiram like reaction, Neuropathy (cross BBB), metallic taste, epigastric distress,
discoloration of urine
Drugs can cause hemolytic anemia in G-6-PD patients
AAA – Antibiotics (Sufonamides, Chloramphenicol, Nitrofurantoin), Antimalaria
(Primaquine, Quinine), Antipyretics (acetanilide but not ASA or APAP)
Drugs that inhibit Cytochrome P450
SICK MICE Q ; S=Sufonamide, I=INH, C=Clarithromycin, K=Ketoconazole,
M=Metronidazole, I=Itraconazole, C=Chloramphenicol, E=Erythromycin, Q=Quinolones
Enzyme inducers
PC BRAS ; P=Phenytoin, C=Carbamazepine, B=Barbiturates, R=Rifampicin, A=Alcohol
chronic use, S=Sulfapyrazine (uricosuric)
Bilirubin is
A yellow breakdown product of normal hemoglobin catabolism
Metabolism of action of Polyene antifungals (Amphotericin B, Nystatin)
Bind to ergosterol in cell walls resulting in increased K efflux
Metabolism of action of Azole antifungals (Ketoconazole, Miconazole, etc.)
Inhibit ergosterol synthesis (Block conversion of Lanosterol to ergosterol)
Metabolism of action of Flucytosine
Inhibit thymidylate synthase
Ketoconazole does not penetrate CNS but Fluconazole penetrate CNS
Ketoconazole has endocrine effects (gynecomastia, impotence, menstrual irregularities) but Fluconazole
does not have
Ketoconazole inhibits Cytochrome P450 but Fluconazole does not
Ketoconazole excreted via bile route (hepatoxicity) Fluconazole excreted via kidney
Antacids decrease absorption of Ketoconazole
Coca cola (acidic) increase absorption of Ketoconazole
Unlike Ketoconazole, Fluconazole absorption is not dependent on gastric acidity
Ketoconazole has only oral form but Fluconazole has oral and IV form
Ketoconazole and Amphoterin B should not be used together
Amphotericin B parenteral use should only be mixed in D5W and should be protected from light
Anphotericin B is given in only parenteral form because it is not absorbed through GIT
Side effects of Amphotericin B
1. Chills and fever (premedication with hydrocortisone or an antipyretic can prevent, if the
symptoms have started already –use Meperidine)
2. Nephrotoxicity
3. Anemia
4. Neuropathy
5. Thrombophlebitis (add heparin into the infusion can decrease the problem)
Amphotericin B and Flucytosine are synergistic
Amphotericin B and Ketoconazole are antagonize
Antifungal that can cause SJS
Nystatin
Nystatin use is restricted to topical treatment of Candida infections because of its systemic toxicity
Nystatin topical used in Vaginal infection
 25
Nystatin solution (swish and swallow) used in Oral candidiasis
Side effects of Nystatin are rare because of its lack of absorption
Griseofulvin (po) used for
Treatment of superficial mycotic infections-only dermatophytes
Mechanism of action of Griseofulvin
Act on microtubules leading to inhibition of mitosis
Drugs that act on microtubules (mitosis inhibitors)
The MicroTubule Growth Voiding Chemicals ; T = Thiabendazole, M = Mebendazole, T =
Taxol, G = Griseofulvin, V = Vincristine/ Vinblastine, C = Colchicine
Griseofulvin may increase acute intermittent porphyria
Griseofulvin induce enzyme Cytochrome P450
Drugs used to treat Leprosy (Mycobacterium leprae)
Dapsone+Clofazimine+Rifampin for 6-24 months
Mechanism of action of Dapsone
PABA antagonist results in inhibition of folate synthesis
Mechanism of action of Clofazimine
A phenazine dye that binds to DNA and inhibits template synthesis
Dapsone may cause Hemotylic anemia in patient with G-6-PD
Dapsone develops erythema nodosum leprosum but Clofazimine does not (because it has anti-
inflammatory effect)
First line treatment for Tuberculosis
INH+Rifampin+Pyrazinamide (4 months) and INH+Rifampin +/- Ethambutol or
Streptomycin (2 months)
Mechanism of action of INH
Mycolic acid inhibitor leads to disrupt cell wall synthesis
Mechanism of action of Rifampin
Inhibits RNA synthesis
Side effects of INH
1. Peripheral neuritis (corrected by pyridoxine supplementation
2. Hepatotoxicity (caused by a toxic metabolite of monoacetylhydrazine)
INH and Rifampin can cause Hepatotoxicity
Rifampin color urine, feces, contact lenses orange-red color
Pyrazinamide and Ethambutol may cause urate retention and gouty attacks
Aminosalicylic acid and Ethionamide can inhibit the acetylation of INH resulting in prolonged INH
duration
Rifampin is frequently used prophylactically for household members exposed to meningitis caused by
meningococci or H.influenza
Two of anitmalarial drugs that can cause Cinchonism
Quinidine, Chloroquine
Mebendazole should be taken with high fat meal to increase absorption
Drug of choice for Schistosomiasis (fluke worm)
Praziquantel
Pyrevenium pamoate colors urine,feces and stains on vomiting but Pyrantel pamoate and Praziquantel
pamoate do not
Drug of choice for Cestodes (Tapeworms)
Niclosamide
Amantadine and Rimantadine used for
Influenza A only
 26
Oseltamivir and Zanamivir used for
Influenza A and B
Amantadine crosses BBB but Rimantadine does not
Metabolic alkalosis means
An excessive of bicarbonate in the blood or a loss of acid from the blood
Respiratory alkalosis means
A low level of carbon dioxide in the blood that results from rapid or deep breathing
(hyperventilation)
Hypochloremic alkalosis means
An extreme lack or loss of chloride, such as may be caused by prolonged vomiting. The
kidneys compensate for the chloride loss by conserving bicarbonate.
Hypokalemic alkalosis means
The kidneys' reaction to an extreme lack or loss of potassium which may be caused by some
diuretic medications.
Metabolic acidosis means
An excessive acidity of the blood caused by lactic acidosis, ketoacidosis, chronic renal failure,
salicylate toxicity, ethanol, methanol toxicity, massive rhabdomyolysis
Respiratory acidosis means
A condition that occurs when the lungs cannot remove all of the carbon dioxide produced by
the body caused by COPD, severe asthma, etc.
Special substances produced by the kidneys
Erythropoietin
1,25-dihydroxyvitamin D3 (1,25-dihyroxycholecalciferol, calcitriol)
Prostaglandins and thromboxane
Renin
Kallikrein
Molluscum contagiosum are wart-like tumors of the skin caused by DNA poxvirus. It is a STD.
Zwitterions mean
The compound that has a net overall charge of zero therefore it has difficulty dissolving in
aqueous environment.
Functional group reactivity affects
Drug shelf life, stability, storage, in vivo stability and the duration of action
Hydrophilic functional groups include
1. Acidic functional groups (carboxylic acid, beta-dicarbonyl, sulfonamide, sufonylurea,
tetrazole, imide)
2. Basic functional groups (aliphatic and alicyclic amines, aromatic amines, aromatic
heterocyclic nitrogens, imines C=N, hydrazines NH-NH 2, amidines, guanidines)
3. Alcohol groups (eg. Fludrocortisone)
4. Phenols (eg. Estradiol)
5. Quaternary ammonium salts (eg. Ipratropium bromide)
Lipophilic functional groups
1. Alkyl groups (C-C)
2. Alkene groups (C=C)
3. Aromatic hydrocarbons (phenyl groups, napthalene)
4. Ether (R-O-R)
5. Alkyl and aromatic halides
Oxidation of Methane (CH4)
CH 4 (methane) CH3OH (methanol) HCHO (formaldehyde) HCOOH (formic acid)
 27
Oxidation of Ethane (CH3CH3)
CH 3CH 3 CH 3CH2OH (ethanol) CH3CHO (acetaldehyde) CHCOOH (acetic acid)
Oxidation of Ethylene glycol (HOCH2CH2OH)
Ethylene glycol Oxaldehyde Oxalic acid
Oxidation of Alcohol groups
Primary alcohol Aldehyde Carboxylic acid
Secondary alcohol Ketone
Tertiary alcohol is not usually oxidized
Most phenols are primarily unionized at physiological pH
Quaternary ammonium salts are generally not metabolized
The primary route of metabolism for ketones (R-C=O-R)
Reduction (phase I) to alcohol
The primary route of metabolism for esters (R-COO-R), amides (R-CONH-R), lactones (cyclic form of
esters), lactams (cyclic form of amides)
Hydrolysis
Esters and lactones (more susceptible to hydrolysis than amides and lactams) are hydrolyzed to
Alcohols and carboxylic acids
Amides and lactams are hydrolyzed to
Amines (R-NH2 ) and carboxylic acids
Alkyl and aromatic halides are electron-withdrawing functional groups
Aromatic halides are not normally metabolized
Monomeric units of proteins and enzymes
Amino acids (R-CH-NH2 -COOH)
Amino acids are L,alpha-amino acids except Glycine (not optically active)
The simplest of 20 standard amino acids
Glycine (H-CH-NH2 -COOH) , an inhibitory neurotransmitter in the CNS
Proteins are made up of the 20 different amino acids joined by peptide bonds (R-CONH-R)
Reaction that occur between amino acids
A dehydration synthesis reaction (also known as a condensation reaction)
Carbohydrates consist of
- Monosaccharides (glucose, fructose, galactose)
- Disaccharides (Oligosaccharides) – sucrose (glucose+fructose), maltose (glucose+glucose),
lactose (glucose+galactose)
- Polysaccharides consist of long chains of monosaccharides such as cellulose and glycogen
Enzyme acts as
A catalyst for biologic reactions
Enzymes can be divided into 6 groups
1. Oxidoreductases (e.g. dehydrogenase, oxidase, peroxidase) – important in the oxidative
metabolism
2. Transferases catalyze the transfer of groups
3. Hydrolases (e.g. proteolytic enzyme, amylase, esterase) hydrolyze their substrates
4. Lyases (e.g. decarboxylases, deaminases) catalyze the removal of functional groups by
means other than hydrolysis
5. Ligases catalyze the coupling of two molecules
6. Isomerases catalyze various isomerizations
Terpene compounds are
Cholesterol and other steroids, Fat soluble vitamins and Bile acids
Glutamine is formed from glutamate and ammonia in Krebs-Henseleit pathway
 28
Functional group is most susceptible to hydrolysis
Ester (RCOOR)
Examples of polysaccharides
Heparin, Starch, Glycogen, Cellulose, Hyaluronic acid
Monomer units of protiens are known as
Amino acids
The building blocks of proteins
Amino acids
The building blocks of nucleic acids
Nucleotides (purine or pyrimidine + 5-carbon sugar (pentose) + phorphoric acid group)
DNA differs from RNA in
Lacks a hydroxyl group at the pentose C-2 position and contains T rather than U
Cofactor that is firmly bound to an apoenzyme (protein portion)
Prosthetic group
Cofactor that is not firmly bound to an apoenzyme but is actively involved during catalysis
Coenzyme
Enzymes that uncouple peptide linkages are
Hydrolases
Amino acid that is responsible for nitrogen in vivo
Arginine (responsible for NO synthesis)
Enzyme that enables DNA fragments from different sources to be joined
DNA ligase
The most abundant metal ion in human body
Iron (also the most abundant metal on Earth)
Hormone Insulin acts on
Cell wall
The strongest endogenous pain producer
Bradykinin (vasodilator)
The precursor of vitamin A (retinol) formation
Beta-carotene
The precursor of GABA synthesis
Glutamic acid
Amino acid acts as an inhibitory neurotransmitter in the CNS especially spinal cord
Glycine
The most abundant excitatory neurotransmitter in the nervous system
Glutamic acid
Enzyme catalyzes the synthesis of DNA from viral RNA
Reverse transcriptase
Vitamin that can be classified as hormone
Cholecalciferol (Vitamin D3)
Triglycerides stored in fat cells are hydrolyzed into
Three fatty acids and glycerol
Sphingolipids found in
Nerve tissues and membranes
Examples of phosphatidyl compounds
Phosphatidyl choline (Lecithin) is important part of membranes
The end product of proteins
Urea (formed in liver and excreted in kidneys)
 29
The end product of purine catabolism
Uric acid
Disaccharide that is not synthesized during human metabolism
Maltose (glucose+glucose)
Polysaccharide that is not synthesized during human metabolism
Cellulose
Examples of Fibrous proteins (Scleroproteins, Albuminoids)
Keratins, Collagens, Elastins
Hemoglobin degradation occurs in
ER
Hemoglobin synthesis occurs in
Mitochondria and Cytoplasm
Hemoglobin is not enzyme, it is a transporter
Non-protein portion of hemoglobin
Ferrous complex of protoporphyrin IX
The precursor of hemoglobin
Glycine
Element found in the center of Vit B12 (cyanocobalamin)
Cobalt
Niacin is synthesized from
Tryptophan in the liver
The precursor of collagen synthesis
Vitamin C
Eversion - the movement of the sole of the foot away from the median plane.
Inversion - the movement of the sole towards the median plane. (same as when an ankle is twisted).
Cranial bones consist of
STEP OF 6 – S=Sphenoid, T=Temporal, E=Ethmoid, P=Parietal, O=Occipital, F=Frontal
Bones of arm consist of
Humerus, Radius and Ulna
Bones of leg consist of
Femur (largest bone), Fibula and Tibia
Hip bones
Ilium, Ischium and Pubis
Vertebral column has 33 vertebraes including
Cervical, Thoracic, Lumbar, Sacral and Coccygeal
The largest muscle in the body
Gluteus
The amount of bones in the body
208 bones
Biceps found in
Upper arm (front) and Thigh (posterior and lateral)
Triceps found in
Upper arm (back)
Quadriceps found in
Thigh (front)
Gluteal muscles found in
Buttocks
Trapezius found in
Neck (back)
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Longest muscle is
Sartorius
Smallest muscle is
Stapedius (inside the middle ear)
Strongest muscle is
Messeter
The largest part of the brain
Cerebrum (controls voluntary and involuntary movements)
Cerebrellum functions
Controlling balance and modifying body movements
Brain stem (pons and medulla oblongata) functions
Controlling autonomic functions (respiration, heart rhytm)
Stomach regions include
Fundus, body and pylorus
G cell in body region secretes
Gastrin hormone (stimulates acid secretion)
Parietal cell in body region secretes
Intrinsic factor and Acid
Chief cell in body region secretes
Pepsinogen, Renin (infant) and Lipase (infant)
Bruner’s gland (secretes mucus) found in
Duodenum
Peyer’s patch (immune response) found in
Ileum
Examples of substances that increase gastric acid secretion
Gastrin hormone, Vagal stimuli, Protein meals, Calcium
Examples of substances that inhibit gastric acid secretion
Neurotensin, Somatostatin, Secretin, Cholecystokinin (CCK)
Salivary gland has 3 pairs including
Parotid, Submandibular and Sublingual
Saliva is a mixture of
Mucus and serous fluid
Pancreas secretes enzymes which enter the duodenum via
Pancreatic duct
In endocrine part of pancreas consists of 4 types of cell including
Beta-cell (Insulin), alpha-cell (Glucagon), gamma-cell (Somatostatin), PP cell (pancreatic
polypeptide)
Bile, an alkaline watery greenish fluid is produced by
Liver
Bile contains
Bile salts (Na glycocholate and Na taurocholate), bile pigments (mainly bilirubin, biliverdin),
cholesterol, phospholipid (lecithin)
Bile functions
To emulsify and enhance fat areas
Main function of gall bladder
Increase bile concentration
Hemoglobin decomposition occurs in
Macrophages
 31
Hernia means
A protrusion of a tissue, structure, or part of an organ through the muscular tissue or the
membrane by which it is normally contained.
Hernia has 3 parts including
Orifice, hernial sac and contents
The most common of abdominal hernia
Inquinal hernia (more common in male)
Hiatal hernia
A protusion of a portion of stomach through the diaphragm
Strangulated hernia (incarcerated hernia)
A hernia that blood flow through hernia is restricted, resulting in gangrene, necrosis
Blood volume in human body
5 L (7% of body weight)
Blood contains
Cells (45%) + Plasma (55%)
The blood cells contain
Erythrocytes (96%) + Leukocytes (3%) + Thrombocytes (1%)
RBC and Platelet lack of nucleus but WBC has nucleus
Life span of RBC
120 days
Life span of platelets
7 days
Life span of WBC
Varies about 13-20 days
The most abundant in WBC
Neutrophils (60%)
The least amount in WBC
Basophils ( <1%)
Erythropoietin secreted by kidney stimulating RBC production in bone marrow
Thrombopoietin secreted by kidney and liver stimulating Platelet production in bone marrow
The rate limiting step in synthesis of erythrocytes
Proerythroblast
Blood group A : RBC has A antigen, plasma has B antibodies
Blood group B : RBC has B antigen, plasma has A antibodies
Blood group AB : RBC has A and B antigen, plasma has no antibodies
Blood group O (Universal donor) : RBC has no antigen, plasma has A and B antibodies
The most common blood group
O (1 st), A (2nd)
Rh + have antigens but Rh – lack of antigens
The most common cause of hemolytic disease of the newborn (HDN)
Rhesus D hemolytic disease (caused by mother is Rh – and the baby is Rh +, the mother
produces ab (including IgG) against the Rhesus D antigens on her baby’s RBC)
Prevention of Rh D hemolytic disease
Give IM of anti-Rh antibodies (Rhogam shot) to pregnant women at 28 weeks gestation or at
least within 72 hours after the birth of her first child
Embolus means
Blood clot in the blood stream
Embolism means
Embolus migrates from one part and causes an occlusion
 32
Thrombus means
The formation of a clot within a blood vessel, rather than being carried from elsewhere.
Infarction means
Necrosis of tissue due to the obstruction of blood supply
Anemia can classified by the size of RBC into 3 groups
Microcytic anemia
- Iron deficiency (most common)
- Sickle cell disease (crescent shape of RBC leading to circulatory blockage)
- Thalassemia (synthesis of an abnormal Hb resulting in blood cells are vulnerable to
mechanical injury and die easily)
Normocytic anemia
- Hemolytic anemia (due to increased RBC destruction)
- Acute blood loss
- Anemia of chronic disease
- Aplastic anemia (bone marrow does not produce enough blood cells)
- Myelopthistic anemia (bone marrow failure caused by replacement of normal bone
marrow space by abnormal cells due to metastasis of tumors or etc.)
Macrocytic anemia
- Megaloblastic anemia (caused by Vitamin B12 or folate deficiency or both)
- Pernicious anemia (intrinsic factor deficiency)
- Alcoholism
- MTX, AZT, drugs that inhibit DNA replication
Polycythemia means
Excessive of RBC sometimes due to bone marrow cancer
Hypertrophy
Increase in the size of organ or tissue due to increased the size of cells, increased protein
synthesis, increased intracellular organelles
Hyperplasia
Increase in the size of organ or tissue due to increased the number of cells
Atrophy
Decrease in the size of an organ or tissue due to decreased mass of pre-existing cells
Aplasia
Failure of cell production
Hypoplasia
Decreased cell production
Amenorrhea
Absence menstruation
Dysmenorrhea
Painful menstruation
Examples of free radicals
Hydrogen peroxide, Benzoyl peroxide, Superoxides, Hydroxyl
Examples of antioxidants
Superoxide desmustase, glutathione peroxidase, catalase, cysteine, selenium
Treatment of Hepatitis A
Interferon alpha
Treatment of Hepatitis B
Interferon alpha, Lamivudine, Adefovir
Treatment of Hepatitis C
Interferon alpha 2B+Ribavirin
 33
Cones in retina : react in light and recognize color
Rods in retina : react in dark and recognize white and black
Myopia eye (near sighted) corrected by concave lens
Hyperopia eye (far sighted) corrected by convex lens
Emmetropic eye (normal eye) no need of correction
In Michaelis-Menten equation, the only way to increase Vmax is by
Increasing enzyme concentration
Essential amino acids mean
Amino acids that cannot synthesize in body in sufficient amounts.
Essential amino acids include
PVT TIMHALL : P=Phenylalanine, V=Valine, T=Tryptophan, T=Threonine, I=Isoleucine,
M=Methionine, H=Histidine, A=Arginine, L=Leucine, L=Lysine
Isoelectric point (pl)
The pH at which there is no net charge on the structure
Every structures has one pl but can have many pKa
If pH > pl means
The structure has net negative charge
If pH < pl means
The structure has net positive charge
Wilson’s disease
Excessive copper in the body (treated by penicillamine, taken empty stomach)
Menk’s disease
Genetic disorder that is a defect of copper (treated by copper supplement)
Copper presents in
Cytochrome oxidase (occurs in mitochondria) and Superoxide dismutase
Hemochromatosis
Excessive of iron
Molybdenum presents in
Xanthine oxidase
Zinc deficiency
Poor growth, impaired sexual development, dermatitis
Selenium deficiency
Cardiac myopathy
Chromium deficiency
Impaired glucose tolerance
Blood fats are divided into four types
- Neutral fats
- Lecithins (phosphotidyl choline)
- Cholesterol esters
- Free cholesterol
Essential fatty acids
Polyunsaturated fatty acids that cannot synthesized in the body, must be obtained from food
Contain
- Omega-3 fatty acids e.g. alpha-linolenic acid, EPA, DHA
- Omega-6 fatty acids e.g. linoleic acid, gamma-linolenic acid, arachidonic acid
To be fully utilized by the body, Linoleic acid must be converted to
Gamma-linolenic acid
The first end product of fatty acid synthesis
Palmitate (antioxidant)
 34
Trans fat
An unsaturated fatty acid molecule that contains a trans double bond between carbon atoms
correlating with circulatory diseases such as atherosclerosis and coronary heart disease, than
the same amount of non-trans fats.
The citric acid cycle itself does not use oxygen, but oxidative phosphorylation does
Vitamins cannot be synthesized by mammalian cells and therefore must be supplied in the diet.
The precursor of Vitamin A (retinol)
Beta carotene (yellow, green vegetables, liver, butter, egg and animal products)
Vitamin A deficiency
Night blindness, Xeropthalmia (keratinization of cornea)
Vitamin A stored in
Liver (retinyl esters)
Form of vitamin A found in rods of retina
Cis-11-retinal (Rhodopsin-visual purple), a pigment of retina
Isomers of retinoic acid
Cis-13-retinoic acid (isotretinoin-oral), Trans-13-retinoic acid (tretinoin-topical)
Vitamin A consists of
Retinol, retinal, retinoic acid
Active form of pyridoxine (vitamin B6)
Pyridoxal phosphate
Drugs that cause vitamin B6 deficiency
INH, Penicillamine
Drugs that should not take with vitamin B6
Carbidopa+Levodopa (B6 increases peripheral dopamine levels and may cause nausea,
vomiting)
Vitamin B12 is absorbed at
Ilium
Drugs that decrease vitamin B12 absorption
Metformin
Active form of Vitamin D
1.25 dihydroxycholecalciferol (calcitriol) (converted in the kidney by regulating of PTH and
Hydroxylase)
Vitamin D3 – cholecalciferol
Vitamin D2 – ergocalciferol
Proline ring is present in
Ascorbic acid (vitamin C)
Quinolone ring is present in
Vitamin K
Vitamin E deficiency
Liver necrosis, RBC membrane become fragile
Enzyme that cleaves DNA at specific site
Restrictive endonuclease
The most abuntdant of RNA
Ribosomal RNA (rRNA) 80% - synthesize ribosome
Virus that contain reverse transcriptase
Retrovirus
DNA contains deoxyribose but RNA contains ribose
DNA contains Thymine but RNA contains Uracil
 35
The codons are present in
mRNA
Stop, nonsense, terminated codons are the codes that used to stop the synthesis of peptide chain
UAG, UGA, UAA
Complementary DNA (cDNA)
A DNA synthesized form a mature mRNA template rather than from a DNA template.
Used for cloning or as a DNA probe for locating specific genes in DNA hybridization studies
Sublimation occurs
When a solid is heated directly to the gaseous or vapor state without passing through the
liquid state e.g. camphor, iodine
Deposition
The reverse process of sublimation e.g. colloidal silicon dioxide, some form of sulfur
The attributes of crystalline solids
- Fixed molecular order
- A distinct melting point
- Anisotropicity (their properties are not the same in all directions) except cubic crystals
The attributes of amorphous solids
- Randomly arranged molecules
- Nondistinct melting points
- Isotropicity (their properties are the same in all directions)
Polymorphism
The condition which substances can exist in more than one crytalline form
The different polymorphs have different properties such as
Melting point, solubility, dissolution rate, density, stability
Example of drugs of substances that have high incidence of polymorphism
Steroids, theobroma oil, cocoa butter
When 1 g of a solid is heated and melts, the heat absorbed in the process is known as
Latent heat of fusion
Example of amorphous materials
SiO2 , plastics
Partition coefficient is
A measure of the solubility of a substance in octanol and water, used to measure how
hydrophobic or hydrophilic a substance is
Partition coefficient = conc. In octanol / conc. In water, if partition coefficient is high it
means the substance is hydrophobic
Eutectic mixture
The mixture of two or more substances that melt at the lowest possible temperature (Eutectic
point)
Zeolites is used as
A molecular sieve (a material containing tiny pores of a precise and uniform size that is used
as an adsorbent for gases and liquids) which extracts oxygen from air, in a process involving
the absorbing of atmospheric nitrogen.
Adsorption
A process that occurs when a liquid or gas (called adsorbate) accumulates on the surface of a
solid or liquid (adsorbent), forming a molecular or atomic film (adsorbate).
Absorption
Where a substance diffuses into a liquid or solid to form a "solution"
The three basic methods of tablet preparations
Wet granulation, Dry granulation and Direct compression
 36
Problems in tablet manufacturing
1. Capping (the partial or complete separation of the top or bottom crown from the main
body) – caused by entrapment of air
2. Lamination (separation of a tablet into two or more distinct layers) – caused by
entrapment of air
3. Picking (removal of the surface material of a tablet by a punch) – caused by excessive
moisture or using substances that have low melting temp.
4. Sticking (adhesion of tablet material to a die wall) – caused by excessive moisture or using
substances that have low melting temp.
5. Mottling (unequal color distribution) – caused by degradation color of drug or a drug has a
different color than the excipients
Diluents used to
Make up the required bulk of the tablet when the amount is inadequate, also improve
cohesion, permit direct compression, promote flow
Binders and adhesives used to
Promote granulation, Promote cohesive compacts during direct compression
Disintegrants used to
Facilitate disintegration when the tablet contacts in the GIT
Lubricants used to
Reduce the friction between the walls of the tablet and the die cavity
Glidants used to
Promote the flow ability by reducing friction among particles
Artificial sweeteners used only with chewable tablets or tablets that are intended to dissolve in the
mouth
Adsorbents used to
Hold quantities of fluid in a apparently dry state
Official USP tests to ensure the quality of drug products in tablet form include
1. Weight variation test (used when the active ingredient comprises more than 50% of the
bulk) – test for potency
2. Content uniformity test (used when the tablet is coated or active ingredient comprises less
than 50% of the bulk) –test for potency
3. Disintegration test
4. Dissolution test (may be required instead disintegration test if the component of the tablet
has limited water solubility)
Hardness and friability tests are in-house quality control tests, not official USP tests
The process of reducing the particle size is called
Comminution (Trituration, Levigation and Pulverization by intervention)
Trituration – the particle sizes are reduced by rubbing them in a mortar with a pestle
Levigation - the particle sizes are reduced by adding a suitable levigating agent (e.g. mineral oil) to
form a paste and rub in a mortar with a pestle or use an ointment slab with a spatula
Pulverization by intervention - the particle sizes are reduced by adding solvent that is easily removed
after pulverization
Powder mixing methods – 5 methods include
1. Spatulation – not suitable for large quantities of powders or for powders that contain
potent substances, particularly useful for eutectic mixtures
2. Trituration – a glass mortar is preferable for chemicals that stain a porcelain or ceramic
surface
3. Geometric dilution – used when potent substances must be mixed with a large amount of
diluent
 37
4. Sifting – usually, it is not acceptable for incorporating potent drugs into a diluent base
5. Tumbling – widely used in industry, mixing powders in a large container rotated by a
motorized process
Sizes of hard capsules
000 (largest -600 mg) to 5 (smallest – 30 mg)
Large capsules are available for
Veterinary medicine (10,11,12)
Hygroscopic powders
Substances which absorb moisture
Deliquescent powders
Substances which absorb moisture
Deliquescence occurs when
The vapor pressure of the saturated aqueous solution of a substance is less than the vapor
pressure of the water in the ambient air
Efflorescent powders
Substances which liberate moisture or loss of moisture
Effervescent salts
Substances which liberate carbon dioxide
Ointments are semisolid preparation intended for external use , typically used as
Emollients (to make the skin more pliable), Protective barriers (to prevent harmful
substances), Vehicles (to incorporate medication)
Cold cream is a w/o emulsion but Vanishing cream is an o/w emulsion
Oral drug solutions that include alcohol
Elixirs, Spirits or essences, Tinctures, Fluidextracts
For an ideal emulsion. The maximum concentration of an internal phase is 74%
Rheology (study of flow), according to nature of flow materials.There are 2 types of flow
1. Newtonian flow – the rate of shear (flow) should be directly proportional to the shearing
stress
2. Non-Newtonian flow – don’t obey Newtonian flow
- Plastic flow (Bingham bodies) flow starts from the yield value
- Pseudoplastic flow (Shear thinning system) flow begins at origin
- Dilatant flow (Shear thickening system) increased flow increases resistant to flow
Thixotropy (get to solution transformation) ,
The property of some non-newtonian plastic and pseudoplastic fluids to show a time-
dependent change in viscosity, exhibiting a stable form at rest but becoming fluid when
agitated e.g. ketchup
Anti-thixotropy (solution to gel transformation)
Opposite to thixotropy, rare e.g. dilatant flow
Examples of nonelectrolytes ( substances that don’t form ions when dissolved in water)
Estradiol, glycerin, urea, sucrose
Colligative properties of a solution are dependent on ionization (the total number of ionic and
nonionic solute molecules in the solution) but independent of other chemical properties of the solute
Colligative properties include
1. Lowering of vapor pressure (when a solute is added, it will decrease the vapor pressure of
the liquid)
2. Elevation of boiling point (opposite to vapor pressure)
3. Depression of the freezing point (when a solute is added, it will decrease the freezing
point of the liquid)
 38
4. Osmotic pressure (the pressure that must be applied to the solution to prevent the flow
of pure solvent into the concentrated solution)
Osmosis means
The process by which solvent molecules pass through a semipermeable membrane from a
region of dilute solution to one of more concentrated solution.
Ionization is the complete separation of the ions in a crystal lattice when the salt is dissolved
Dissociation is the separation of ions in solution when the ions are associated by interionic attraction
The particle size of the dispersed solid in suspension is usually greater than
0.5 micrometers
The droplet diameter in emulsion is usually greater than
0.1 micrometers
Zeta potential is measured from the bound layers of ions and solvent molecules on the particle surface
When zeta potential is high, repulsive forces exceed the attractive forces, as a result, the dispersion is
deflocculated
When zeta potential is low, the attractive forces is predominant, as a result, flocculation occurs
Creaming is the reversible separation of a layer of emulsified particles, acceptable.
Cracking is the irreversible separation of a layer of emulsified particles, unacceptable.
t1/2 and t 90% are concentration-independent
Factors that affect reaction rates
- Temperature
- Presence of solvent
- Change in pH
- Presence of additives (buffer salts, surfactants, complexing agents)
Complexing agents (e.g. benzocaine, procaine, tetracaine) increase the half-life in the presence of
caffeine
The pH of a buffer system can be calculated with the Henderson-Hasselbalch equation
The most mechanism is responsible for chemical degradation
Hydrolysis
The equation is used to predict the stability of a drug product at room temperature from experiments at
accelerated temperatures
Arrhenius equation (increase in temp. causes an increase in reaction rate)
The substance is used to lubricate the mold in the fusion method of making cocoa butter suppositories
Mineral oil
The technique is typically used to mill camphor
Pulverization by intervention
The dispensing pharmacist usually blends potent powders with a large amount of diluents by
Geometric dilution
The type of paper best protects hygroscopic and volatile drugs
Waxed paper ( due to its water proof)
Chemical degradation
- As temperature increases, degradation increases
- Most drugs degrade by a first order process
- Chemical degradation may produce a toxic product
- May result in a loss of active ingredient.
- May affect the therapeutic activity of a drug
Zero-order degradation
- Its rate is independent of the concentration
- A plot of concentration versus time yields a straight line on rectilinear paper
- Its half life is a changing parameter
 39
- The change of concentration with respect to time is unchanged (-dc/dt = k)
- The slope of a plot of concentration versus time yields a rate of constant
First-order degradation
- Its rate is dependent on the concentration
- A plot of the logarithm of concentration versus time yields a straight line
- Its half life is a constant parameter, independent of the concentration
- Its t90% is independent of the concentration
- A plot of the logarithm of concentration versus time allows the rate constant to be
determined
The qualities of good suppository base
- Narrow melting range
- Nonirritating and nonsensitizing
- Rapidly dissolve or disintegrate in the body cavity
- Melt upper 30 degrees
- Inert
Forms of water that are suitable for parenteral uses
Water for injection USP and sterile water for injection USP (reconstitute)
The particles in an ideal suspension should be
Uniform in size, stationary or move randomly, should remain discrete (separate), no
sedimentation
The sedimentation rate of a suspension can be slowed by
Reducing density, reducing the size of the suspended particles, increasing its viscosity by
incorporating a thickening agent
Mechanisms that are thought to provide stable emulsification include
Formation of interfacial film, lowering of interfacial tension, presence of charge on the ions
Substances used to insulate powder components that liquefy when mixed (adsorbents)
Magnesium oxide, magnesium carbonate, kaolin, starch , bentonite
Factors that can affect the dissolution rate of tablet in the body
Amount and type of binder added, amount and type of disintegrant added, force of
compression used during tableting
Van der waal’s force is an example of dipole-dipole interaction
Hydrogen peroxide is used topically on skin in the maximum concentration of
10 V
Benzocaine is used as a local anesthetic, the concentration should be at least
5%
We can increase the bioavailability of opthalmic solution by
Increasing the viscosity
Binder can be used in both wet and dry formulation
Cellulose
Salt form of a drug is designed to provide
Lower dissolution, slower bioavialability, longer duration of action, greater stability, less
local irritation at the absorption site or less systemic toxicity
Amorphous forms of a drug have faster dissolution rates than crystalline form
Chirality is
The ability of a drug to exist as optically active stereoisomers or enantiomers
The extent of ionization depends on
pKa of the weak electrolyte and pH of the solution
 40
Bioavailability
A measurement of the rate and the extent of therapeutically active drug that reaches the
systemic circulation
The characteristics of an active transport process include
- Active transport moves drug molecules against a concentration gradient
- Do not follow Fick’s law of diffusion
- A carrier-mediated transport system
- Requires energy
- Active transport of drug molecules may be saturated at high drug concentration
The equation that describes the rate of drug dissolution from a tablet
Noyes-Whitney equation
The conditions that increase the rate of drug dissolution from a tablet
Decreased the particle size, increased the surface area, use of the ionized or salt form of the
drug
Dose dumping (an abrupt release of the drug) is a problem in the formulation of
Modified release drug products (may cause intoxication)
Pyrogen
Metabolic by-products of live or dead microorganisms that cause a pyretic response upon
injection
Gums are used in tablet formulation acting as
Binders
Separation of liquid ingredients from oinment bases is called
Bleeding
The most commonly method is used to sterilize powders
Gas sterilization
HEPA filtered can remove all airborne particle 0.3 mm or larger, with an efficiency of 99.97%
HEPA fitered rooms generally are classified as class 10,000 means
The rooms contain no more than 10,000 particles (≥ 0.5 mm.) per foot3 of air
HEPA filters of laminar flow hoods are classified as Federal class 100 mean
They contain no more than 100 particles (≥ 0.3 mm.) per foot3 of air and have an efficiency of
99.99%
To prepare antineoplastic agents, should use laminar flow hood type
Vertical
Quality control means
The day-to-day assessment of all operations from the receipt of raw material to the
distribution of the finished product, including analytic testing of the finished product
Quality assurance means
An oversight function, involves the auditing of quality control procedures and systems, with
suggestions for changes as needed
Intra-articular injection refers to injection into
Joint space
Peripheral vein injection is used for
Postoperative hydration, administration of nonirritating drugs, isotonic solutions or short
term IV therapy
Central vein injection is used for
Irritating drugs, hypertonic drugs, long-term therapy and dextrose 35%
Aspects of D5W (Dextrose (D-glucose) 5% in water )
Acidic solution (pH ranges from 3.5-6.5), Isotonic, used in IV admixture and should be used
with caution in diabetic patients
 41
The best pore size filter for cold sterilization
0.22 micrometer
Fixed oil can be used as a non-aqueous vehicle in parenteral, must
- Not contain paraffin or mineral oil
- Must meet the requirement of iodine number and saponification number
Iodine number represents
The number of grams of iodine absorbed, under the prescribed conditions, by 100 g of the
substance
Saponification number represents
The number of mg of potassium hydroxide required to neutralize the free acids and saponify
the esters contained in 1 g of the substance
Metered dose inhaler (MDI) uses propellants but dry powder inhaler (turbuhaler) and nebulizer don’t use
propellants
MDI shake before use but DPI no need to shake
Sterility means
Absence of life or absolute freedom from biological contamination, don’t include particles,
don’t include pyrogen
The rate of absorption of IM and SC injections depend on
Vascularity of the muscle site, lipid solubility of the drug and the formulation matrix
The drug absorption rate of SC injection is less rapid than IM because
The SC region is less vascular than muscle tissues
Two forms of erythromycin used in parenteral solution
Erythromycin gluceptate and erythromycin lactobionate
Patient taking barbiturate for the treatment of seizures should not taken with
High vitaminc C (because barbiturate can be displaced from binding site, resulting in
increased urinary excretion of barbiturate)
Phenazopyridine used as
An analgesic in UTI
Hematocrit (HCT) means
The percent of whole blood that is composed of red blood cells. The hematocrit is a measure
of both the number of red blood cells and the size of red blood cells.
For example, an hematocrit of 25% means that there are 25 milliliters of red blood cells in
100 milliliters of blood.
Fosphenytoin is a prodrug of phenytoin
Taking Li with meal can decrease GI distress
In patient taking warfarin, eating green vegetables or vitamin k supplement can cause
Decreased INR and PT
Drug of choice in Obsessive-compulsive disorder (OCD)
Fluvoxamine
Drug of choice for Social anxiety disorder
Paroxetine
Cytotec should be taken with meal to minimize GI distress
Drug of choice for ulcerative colitis
Sulfasalazine
Counseling for Sinemet CR
- Take with food (may reduce side effects)
- When patient has taken levodopa and is going to switch to Sinemet, patient must
discontinue levodopa at least 12 hours before starting Sinemet
 42
- Levodopa induced involuntary movement and on-off phenomenon may appear earlier
with combination therapy
- Levodopa competes with amino acid, absorption of levodopa may be impaired in patient
with high protein diet
- Dosage of Sinemet should be used about 20% of previous levodopa
Myositis
Inflammation of voluntary muscles
TPN should be used by central vein
Schilling test is used for
Detecting people with vitamin B12 deficiency
Food does not affect absorption of Losartan, can be given with or without meal in the same time every
day
Antidote for methanol, ethylene glycol
Ethanol
Lomotil enhances the toxic effect of clindamycin
Hydrocortisone is 4 times less potent than prednisone
Statins are indicated for increasing HDL in patient who has high LDL
Simvastatin, Atorvastatin
Antidote for verapamil overdose
Calcium parenteral
Counseling for using MDI
Shake well before use, Inhale slowly while pressing down on canister, wait 1-2 min before
taking another puff
Type of ulcer pain can be relieved by food
Duodenal ulcer
Counseling for taking tetracycline
Should be given 1 hour before or 2 hours after meals (not with food), avoid exposure to the
sun, don’t take with dairy products, if patient is using OC use other forms instead, don’t take
with antacids containing magnesium, calcium or other metals
In patient giving levodopa alone, should not use multivitamin containing pyridoxine (pyridoxine can
reduce therapeutic effect of levodopa)
Dexamethasone has less both mineralocorticoid effect and sodium retention
Antacids that contraindicated in patient with renal failure
Antacids containing sodium or magnesium carbonate
Antihistamines are contraindicated in nursing mothers
Epinephrine can reduce IOP by
Increasing outflow of aqueous humor and inhibiting production
Rosiglitazone (Avandia) increases both HDL and LDL
Pioglitazone (Actos) increase HDL but has no effect on LDL
Clindamycin suspension don’t refrigerate (14 days) , can be taken with or without food
Clindamycin capsule take with a plenty of water, don’t lie down for 30 mins after taking medication
Anti-HIV drug that can cause pin feeling in the mouth, oral ulcer, stomatitis
Zalcitabine
In penicillin allergic infants under 3 yrs with acute otitis media and high fever, DOC is
Clindamycin
Should not use Clarithromycin or Azithromycin in infants under 3 yrs with AOM and high fever
(because of breakthrough of S. pneumoniae)
Cefuroxime axetil (po, 2nd) is a poor choice in the treatment of AOM (because of resistance and poor
absorbtion), ceftriaxone and cefproxil (po) are better choices
 43
Uncomplicated acute bronchitis
- A non life threatening condition which usually resolves within 10-14 days
- More than 90% of cases caused by non-bacterial cause
- The empirical use of antibiotics is not justified
- Therapeutic choices include analgesic, antipyretic, antitussive, bronchodilator
- Green coloured sputum production is a function of peroxidase release from leukocytes,
and hence implies only inflammation
aa = affected area
ad = right ear
as = left ear
au = each ear
od = right eye
os = left eye
ou = each eye
cc = with food
CID = five times a day
DAW = dispense as written
IVP = intravenous push
IVPB = intravenous piggy bag
qAM = every morning
qOD = every other day
qs = add a sufficient quantity to make …
sig : directions :
syr = syringe
TIW = three times a week
ud or ut dict = as directed
ung = ointment
DIN = Drug Identification Number
Product price – Red book
FDA – approved indication only – PDR
Drug interactions, Side effects – Drug facts and comparisons, CPS, USP DI
Foreign drugs outside North America – Martindale
Drugs available in Canada – CPS
Formulas – Merck index
Compounding calculations – Martindale, Remingtons
Responsibilities of Federal Government in regulating health care
1. New drug approval
2. New drug manufacturing
3. Implementing Canadian Health act
Responsibilities of Provincial Government in regulating health care
1. Establishment of standards of pharmacy practice
2. Registration of pharmacists
3. Maintain hospitals in the province
Canadian Health Act (1984) is a federal legislation that puts in place conditions by which individual
provinces and territories in Canada may receive funding for health care services consisting 5 principles
1. Public Administration: Health-care insurance is to be administered on a non-profit basis by
a public authority responsible to the province and subject to audit
2. Comprehensiveness: All necessary health services, including hospitals, physicians and
surgical dentists, must be insured.
 44
3. Universality: All insured residents are entitled to the same level of health care.
4. Portability: A resident that moves to a different province or territory is still entitled to
coverage from their home province during a minimum waiting period. This also applies
to residents which leave the country. (access anywhere in Canada on the same basis as
local residents)
5. Accessibility: All insured persons have reasonable access to health care facilities. In
addition, all physicians, hospitals, etc, must be provided reasonable compensation for the
services they provide.
Responsibilities of National Association of Provincial Regulatory Authorities (NAPRA)
1. Regulate pharmacy profession, practice in Canada
2. Determine eligibility of pharmacy qualifications examination for pharmacy license in
Canada
3. Determine drugs for schedule (The harmonized National drug model)
Health Canada has similar functions as FDA in US. – responsible for new drugs approval,
determination of prescription price
Manufacturer must submit an IND (Investigational new drug) for approval
Phase I trial – detects the side effects of drug in a small amount of healthy subjects
Phase II trial – determine the safety and efficacy of drug in a small amount of patients
Phase III trial – randomized-double blind study, a large amount of subjects
Phase IV trial – Post marketing surveillance
The harmonized national model consists of three schedules or four categories of drugs
Schedule I drugs – prescription required e.g. all pure narcotics – codeine 8 mg.
Schedule II drugs - prescription not required, dispensed pharmacist, under the counter (no
public access)
Schedule III drugs - prescription not required, pharmacist intervention required
Unscheduled drugs – OTC
Tylenol I = APAP 300 mg + codeine 8 mg + caffeine 15 mg Schedule II – no prescription required,
pharmacist intervention required
Tylenol II = APAP 300 mg + codeine 15 mg + caffeine 15 mg - Schedule I (verbal narcotic) – verbal
or written prescription required, refill allowed
Tylenol III = APAP 300 mg + codeine 30 mg + caffeine 15 mg - Schedule I (verbal narcotic) – verbal
or written prescription required, refill allowed
Tylenol IV = APAP 300 mg + codeine 60 mg – Schedule I (straight or pure narcotic) only written
prescription required, no refills or transfer allowed
Tylenol with codeine elixir – Schedule I written prescription required
Pr = By prescription only
N = Narcotics
C = Controlled drugs
The ethical principles include
Beneficence = doing good
None-maleficence = not doing harm, preventing harm
Autonomy = Patient has right to choose (independence)
Veracity = Telling the truth (honesty) without deception
Justice = First come first serve
Fidelity = Promise keeping, loyalty
SKU = Stock keeping unit, each size, strength, format of stock items in one unit
UPC = Universal product code
POS = Point of sale
DIN = Drug identification number
 45
Different drugs, different strength (same drug) have different DINs
Same drug with different quantity in package have the same DINs
Inventory turn over rate is a measure of a pharmacy’s efficacy
Liquidity = Ability to turn assets into cash quickly in order to repay debt from short term capitalization
Solvency = Ability to repay debt from long term capitalization
Common causes for Traveler’s diarrhea
E.coli, Campylobacter, Salmonella, Shigella
Drugs used in the prevention of Traveller’s diarrhea
Bismuth subsalicylate, co-trimoxazole, doxycycline, fluoroquinolones
Loperamide (Imodium) should not be used in children under 3 years
Bismuth subsalicylate contraindicated in children under 3 years and pregnant women
The most common cause of dysentery in Thailand
Campylobactor
Fluoroquinolones are highly resistant in Thailand, therefore Azithromycin (not recommended for
prophylaxis) is a first line for treatment traveler’s diarrhea there.
Empiric antibiotics for bacterial meningitis
Ceftriazone or Cefotaxime + Vancomycin
General length of therapy in uncomplicated bacterial meningitis
10-14 days
DOC used in Post-exposure prophylaxis for bacterial meningitis
Rifampin
For pregnant woman, use Ceftriazone instead of rifampin
Long acting inhaled beta2 agonists
Salmeterol, Formoterol (intended for regular twice daily treatment of asthma)
The most common causative agents in exacerbations of COPD
Virus
Ascites (portal hypertension) is
An accumulation of fluid in the peritoneal cavity (high plasma aldosterone levels), most
commonly due to cirrhosis and severe liver disease
Diuretic of choice for ascites
Spironolactone
Spontaneous Bacterial Peritonitis (SBP)
A form of peritonitis that occurs in patients with cirrhosis. It occurs in 10-30% of
hospitalized patients with ascites. It is characterized by fevers, chills, nausea, vomiting,
abdominal tenderness and general malaise. Patients may complain of abdominal pain and
worsening ascites.
Drug of choice for SBP
If ascetic fluid PMN cell count > 250 mm3 , start cefotaxime (3 rd) or ceftriaxone (3 rd)
Drugs used in hepatic encephalopathy
First – find and eliminate or treat precipitating factors and also use lactulose, metronidazole
Drugs used in cholestatic pruritus
Cholestyramine, For antihistamines – No proven benefit
Cholestatic = a condition where bile cannot flow from the liver to the duodenum.
Primary sclerosing cholangitis (PSC) is
An inflammatory disease of the bile duct, which leads to cholestasis (blockage of bile
transport to the gut).
Primary biliary cirrhosis (PBC) is
An autoimmune disease of the liver marked by the slow progressive destruction of the small
bile ducts within the liver.
 46
Drugs used in PBC and PSC
Ursodeoxycholic acid (UDCA)
Drugs used in hemochromatosis
Reduce dietary iron intake, phlebotomy, deferoxamine (chelating agent) if patient is unable to
tolerate phlebotomy
Drugs used for women with Irritable bowel syndrome (IBS) and constipation
Tegaserod (5-HT4 agonist)
Diarrhea – Loperamide
Constipation – Psyllium, Tegaserod
Abdominal pain – TCA
Drug of choice for treatment urge incontinence (leakage of moderate to large amounts of urine due to
inablility to delay voiding)
Oxybutynin, tolterodine (anticholinergics)
Empiric therapy for Sinusitis in adults
Acute sinusitis – amoxicillin (10 d), co-tri (beta-lactam allergy) or clarithro or azithro
Chronic sinusitis (symptoms >3 months) – amoxicillin-clavulanate (3 wks), clindamycin
(beta-lactam allergy)
Drugs used in treatment UTI
Acute pyelonephritis (10-14 days) – Amoxicillin, Cephalosporins, Co-trimox, Ciprofloxacin
(ACCC)
Uncomplicated cystitis (3 days) - Amoxicillin, Cephalosporins, Co-trimox, Ciprofloxacin
(ACCC)
Acute urethral syndrome (Ureaplasma, Chalmydia) – Doxycycline or Azithromycin
Prostatitis (4-6 wks) – Co-trimox or Ciprofloxacin (CC)
Empiric therapy for UTI
Acute pyelonephritis – Quinolones (po) 10-14 days
Uncomplicated cystitis – Co-tri 3 days or Nitrofurantoin 7 days
Complicated cystitis – 10 days
Prostatitis – acute AG IV +/- Cloxa IV , chronic quinolones (po) 4-6wks
Antineoplastic agents can cause hemorrhagic cystitis
Ifosfamide and cyclophosphamide
Antineoplastic agent may cause hemolytic-uremic syndrome
Mitomycin
Antineoplastic agents commonly cause pulmonary toxicity
Bleomycin (mucositis), carmustine, cyclophosphamide, mitomycin
Antineoplastic agents commonly cause neurotoxicity
Vinca alkaloids
The most common phase I biotransformation
Oxidation (occurs mainly in the liver)
Cytochrome P450 are bound to
Smooth endoplasmic reticulum of the liver
Six mammalian families are involved in steroid and bile acid metabolism
CYP 7, 11, 17, 19, 21 and 27
Four mammalian families are involved in xenobiotic or drug metabolism
CYP 1, 2, 3 and 4
The enzymes in phase II reactions are called
Tranferases
The most common conjugation pathway (phase II reaction)
Glucuronidation
 47
Fast acetylators are more prone to hepatotoxicity from INH than slow acetylators whereas slow
acetylators are more prone to INH’s other toxic effects
Advantages of prodrugs
1. An increase in water solubility
2. An increase in lipid solubility – increased duration of action, increased oral absorption,
increased topical absorption, increased palatability
3. A decrease in GI irritation
4. Site specificity
5. Increased shelf life
Conditions that tend to increase the action of an orally administered drug that undergoes phase II
metabolism include
Enterohepatic circulation, enzyme saturation
Metabolic reactions likely to be affected by a protein-deficient diet include
Glycine conjugation
Examples of prodrugs
Methyldopa is metabolized to alpha-methyldopamine in the CNS
Omeprazole, Methenamine, Olsalazine, Diethystilbestrol diphosphate, Cefamandol naftate,
Cyclophosphamide, Sulindac, Nabumetone, Enalapril, Sufasalazine – ASA+Sulfapyridine,
Dirithromycin, Cefpodoxime proxetil
Prophylaxis Malaria
Chloroquine
Prophylaxis Chloroquine-resistant Malaria
Mefloquine, Doxycycline, Atovaquone/pagaunil
Prophylaxis Malaria for pregnant women
Chloroquine, Mefloquine
Most serious side effect of Clozapine
Agranulocytosis
Most serious side effect of Bleomycin
Pulmonary toxicity, Respiratory damage
Carbon monoxide binds to hemoglobin cause carboxyhemoglobin resulting in
Decreasing the oxygen-carrying capacity of the blood
Antidote of iron toxicity
Deferoxamine
Examples of urinary alkalinizer
Potassium citrate, Sodium bicarbonate
Selegiline is classified as
MAO-B inhibitor
Drugs indicated for the treatment of both diarrhea and constipation
Bulk laxatives (e.g. polycarbophil)
Miconazole is classified as
A broad spectrum antifungal agent
Mafenide cream (Sulfamylon) is a sulfonamide
Oxaprozin is classified as NSAIDs
Zaleplon has the short duration of hypnotic action (t1/2 = 1 hr) useful for decreasing onset, not useful for
prolonging total sleep time or for decreasing the number of awakening
Examples of progestins
Norethynodrel, norethindrone, ethynodiol diacetate, levonorgestrel
Mestranol is an estrogen
Danazol is used for treatment of endometriosis
 48
Torsemide and bumetanide are loop diuretics
Modafinil can be used in the treatment of narcolepsy
Tamoxifen is an antiestrogen used in breast CA but Mifepristone is an antiprogesterone used for
termination of early pregnancy
Dosage form of fentanyl
Transdermal patch, transmucosal, IV, IM
Examples of anabolic steroids
Testosterone, Methandrostenolone, Stanozolol, Oxymetholone, Oxandrolone,
Fluoxymesterone, Methenolone
But Fluorometholone is a corticosteroid
Oxybutynin is classified as an antispasmodic
Lactulose is used to treat
Constipation, hepatic encephalopathy (to prevent ammonia accumulation)
Atomoxetine is used for
The treatement of ADHD, should not be use with MAOI (because it is norepinephrine
reuptake inhibitor), unlike most ADHD drugs it does not have amphetamine like effects
Each mg of penicillin G pure drug is equivalent to
1,600 units of activity
Propofol (Diprivan) is classified as
A sedative-hypnotic agent used to induce and maintain general anesthesia
Heroin = Diacetylmorphine
In mixing regular insulin and NPH, should withdraw regular (first) and then NPH
If separately injected, inject NPH (first) and then regular
Serving instead of someone or something else (e.g. a pharmacist misread a Tamoxifen prescription and
dispensed Tamocor instead)
Negligence
Vicarious = Sympathetic
Liquidity means
Measurement a pharmacy’s ability to meet its current liabilities with little or no interruption
in the regular conduct of business
1-methylcyclopentane is an isomer of cyclohexane (constitutional isomer)
Glutathione usually conjugate with
Electrophilic funtional groups (e.g. halides, epoxides , a cyclic ether with only three ring
atoms)
The common metabolic pathway for primary amines (R-NH2)
Oxidative deamination, Acetylation, Methylation
Aldosterone secreted in
Adrenal medulla (inner)
Point of Sale (POS) system means
- Combination of hardware, software, cash register that capture the product information
at time of sale or when it is received into inventory
- Provide accurate information more promptly overstocks and out of stock situations can
be reduced through early detection
Maximum of codeine can be dispensed without prescription
8 mg. / tablet only combination if pure prescription required
Arsenic antidote
Dimercaptol
Iron antidote
Deferoxamine
 49
Haloperidol can be used with narcotics in depressed cancer patient
Chicken pox (Varicella) is caused by
Varicella Zoster virus
Shingles (Herpes zoster)
A reactivation of Varicella Zoster virus
Small pox is caused by
Variola virus
Assertive skill means
How much we stand up for our own and how much considerations we have for others
Acute hyperkalemia treated by
1. Electrolyte supplement – Calcium chloride or Calcium gluconate to reduce the risk of
ventricular fibrillation
2. Antidotes -- Insulin is administered with glucose to facilitate the uptake of glucose into the
cell, bringing potassium with it.
3. Alkalinizing agents – Sodium bicarbonate to increase the pH, which results in a temporary
potassium shift from the extracellular to the intracellular environment
4. Beta2-adrenergic agonists – Albuterol. These agents promote cellular reuptake of
potassium
5. Diuretics – Furosemide. These agents cause the loss of potassium through the kidney
6. Binding resins - Sodium polystyrene sulfonate (Kayexalate).These agents promote exchange
of potassium for sodium in GI system.
Therapeutic index
= TD50/ED50 ; the greater therapeutic index – the safer drug when used at the effective
dosage
Margin of safety
= TD0.1/ED99.9, more practical
Percent ionization
Can be approximated by using the rule of nines
If the pH-pKa = 1, 90:10 ratio
If the pH-pKa = 2, 99:1 ratio
If the pH-pKa = 3, 99.9 : 0.1 ratio
Salts of strong acids dissociate in an aqueous medium to yield an acidic solution
Salts of strong bases dissociate in an aqueous medium to yield a basic solution
Salts of weak acids and weak bases dissociate in an aqueous medium to yield an acidic, basic or neutral
solution depending on Ka
Salts of strong acids and strong bases (e.g. NaCl, Magnesium sufate) don’t alter the pH of an aqueous
medium
Quaternary ammonium salts (-onium, -inium) form neutral aqueous solutions
ED50 = The dose of each drug producing 50% of maximum effect
Hydromorphone is a more potent analgesic than morphine (because it has a smaller ED50)
But Hydromorphone has the same analgesic efficacy to morphine (because they have the same Emax)
Lower pKa, higher pH, greater ionization
Enantiomers are identical in physical and chemical properties (dissolution, distribution, interatomic
distances and solubility) but are different in biological activity (e.g. receptor selectivity)
Aryloxypropanolamines = beta blockers
Almost all salts are strong electrolytes
Weak acids are weak electrolytes
A neutralization reaction occurs when acidic solutions are mixed with basic solutions, possibly occurs
precipitation
 50
A
XZ. Here X is the chemical symbol for the element, A is the number of neutrons and protons
combined, called the mass number, Z is the atomic number. For instance, ordinary hydrogen is written
1 2 3
H1, deuterium is H1, and tritium is H 1.
Isotopes are nuclides having the same number of protons ex. deuterium is 2H 1, and tritium is 3H1.
Isotones are nuclides having the same number of neutrons ex. Boron-12 and Carbon-13, both have 7
Neutrons.
Isobars are nuclides having the same mass number ex. Carbon-12 and Boron-12
Tegaserod is classified as
5HT4 agonist
Nitrates are the organic esters of nitric acid (HNO3) e.g. Nitroglycerine, Isosorbide
Nitrites are the organic esters of nitrous acid (HNO2) e.g. Amyl nitrite
Pheochromocytoma is
A catecholamine-secreting tumor of the adrenal medulla (inner)
Disease is caused by hypofunction of adrenal cortex
Addison’s disease
Disease is caused by hyperfunction of adrenal cortex
Cushing’s syndrome
The difference between LTC4 and LTD4
The presence of glutamine
Zileuton is classified as Lipoxygenase inhibitor but Zafirlukast and Montelukast are classified as
Leukotriene antagonists
The only salicylates that irreversibly inhibits COX by covalent acetylation of the enzyme
Aspirin
Acetaminophen is an active metabolite of
Phenacetin and acetanilid
Examples of uricosuric agents
Phenylbutazone, oxyphenbutazone, azapropazone, sulfinpyrazone, probenecid
Triptans, 5HT1d/1b agonists contraindicated in
Patient with angina (can cause vasoconstriction)
Tegaserod, 5HT4 agonist used for
A female patient with diarrhea-related irritable bowel syndrome (IBS)
Indomethacin may be use in the the treatment of gouty arthritis by 2 mechanisms
Inhibits inflammatory activity and posses uricosuric activity
Colchicine toxicity is characterized by
Alopecia, Blood dyscrasias, Severe GI upset
Cisapride and Zafirlukast should be taken with food to increase absorption
Cisapride is classified as
5HT4 agonist
Hormones of Anterior pituitary gland
F L A G T O P , F: Follicle Stimulating Hormone, L: Lutinizing Hormone ,A: ACTH
G: Growth Hormone ,T: Thyroid Stimulating Hormone ,O: MSH ,P: Prolactin
Hormones of Posterior pituitary gland
ADH (vasopressin) and Oxytocin
Unlike other steroid hormones, all estrogens have
An aromatic A ring
Examples of estrogens
Ethinyl estradiol, Mestranol, Quinestrol, Diethylstilbestrol, Dienestrol
Antiestrogens used to treat estrogen-dependent breast cancer
Tamoxifen, toremifene, fulvestrant
 51
Antiestrogen used to induce ovulation in women who have ovulation failure
Clomiphene
Enzyme responsible for the conversion of androgens to estrogens in Zona reticularis
Aromatase
Examples of aromatase inhibitors
Anastrozole, letrozole (selective aromatase inhibitors) used to treat breast cancer
Exemestane (only steroidal irreversible aromatase inhibitors)
Raloxifene has estrogen-like effects on
Bone and lipid metabolism
Has estrogen antagonist effects on
Uterine and breast tissue
Estrogen – C-18 steroid, Progesterone – C-21 steroid, Androgen – C-19 steroid
17alpha-hydroxyprogesterones- a methyl group (C-6) and acetoxyl group (CH3OCO-) (C-17) increase
lipid solubility, decrease first pass, increase oral activity and the progestin effect
Examples of progestins
Medroxyprogesterone acetate, Megestrol acetate, Norethindrone, Norethynodrel, Norgestrel,
Ethynodiol diacetate(17alpha-ethinylandrogens-more liposoluble and less first pass)
Enzyme responsible for conversion of testosterone to dihydrotestosterone in cytoplasm
5alpha reductase
Dihydrotestestorone binds to
An androgen receptor in the nucleus
Antiandrogens used to treat prostate cancer by combining with LHRH agonists
Flutamide, Bicalutamide, Nilutamide
Adrenal cortex synthesizes
Mineralocorticoids, Glucocorticoids and Sex steroids
Adrenal medulla synthesizes
Epinephrine and NE
All adrenocorticoids (mineralocorticoids and glucocorticoids) are derived from
C-21 pregnane nucleus
All adrenocorticoids must have
17beta ketol-side chain, 4-ene, 3-ketone
Levothyroxine is less potent than liothyronine but has a longer duration of action (6-7 days versus 1-2
days)
Dexamethasone has the small potency of sodium retention
T4 is converted to T3 by
5-deiodinase
Antidiabetic agents that stimulate the release of insulin from beta cells
Sulfonylureas and Meglitinides
Insulin that contains a modifying protein
Isophane insulin (NPH) –intermediate containing protamine (basic protein) (reduces
solubility of Zn and lengthens duration of action)
All lente are free of modifying proteins which contributes to their hypoallergenic properties
Regular insulin (rapid) contains only Zn insulin crystals
Adverse effects of androgens
Hepatotoxicity and Jaundice, urinary retention, azoospermia, prostatic hypertrophy,
priapism, paradoxical gynecomastia
The termination of heparin activity by protamine sulfate is due to
An acid (heparin)-base (protamine sulfate) interaction
 52
Cardiac glycosides (e.g. digoxin) are not used in
The treatment of ventricular tachycardia
Preferable form of oral iron given in iron-deficiency anemia
Ferrous ion
Trimethaphan (IV) (ganglionic blocker) is used in
Hypertensive emergencies
Digitoxin has the longer duration of action than digoxin due to
Greater protein binding, greater liposolubitily, greater tubular reabsorption
Adverse effects of warfarin
Hemorrhage, urticaria, purpura, alopecia
Drug of choice for anaphylactic reaction
Epinephrine
Neuromuscular blocker can cause muscarinic responses (e.g. bradycardia, increased glandular secretion)
Succinylcholine, gallamine (noncompetitive depolarizing agents)
Atropine is not used for the treatment of glaucoma
The duration of action of an ultra-short acting barbiturate is due to
A rapid rate of redistribution from the brain due to its high liposolubility
Side effects of levodopa
Sialorrhea (excessive salivation),GI effects, hypotension, delusion, confusion, depression,
dyskinesia and dystonia
Livedo reticularis can be found in patient using
Amantadine, Bromocriptine
Fluoxetine can be used to treat a patient with depression and OCD
Thiopental antagonist
Aminophylline
Tetradotoxin
Sodium channel blocker
Alpha bungarotoxin
Nicotinic blocker
Beta bungarotoxin
Increased Ach release
Botulinus toxin
Inhibits Ach release
Diuretics can cause thrombocytopenia
Penicillamine can be used in
Wilson’s disease, Chronic lead poisoning, Active RA, Prevention kidney stones
Thyroid disease diagnosis tests
Free T4 and Sensitive TSH
Common tests for monitoring patients receiving replacement therapy for hypothyroidism
Sensitive TSH, Free thyroxine index (FTI), Total thyroxine (TT4), Resin triiodothyronine
uptake (RT3U)-not use Thyrotropin (TSH) stimulation test
Epinephrine – increased SBP, decreased DBP but NE – increased both SBP and DBP
Precursor of serotonin
Tryptophan
Side effects of disulfiram
Fatigue, restlessness, impotence, metallic taste, peripheral neuritis, skin eruption
Efficacy of a drug is measured by
Emax (a drug maximum effect)
 53
Potency of a drug is measured by
Comparing the different doses of different drugs needed to produce the same effect (ED50)
Smaller ED50, the greater potency
In selecting drug, a drug with greater efficacy might be needed to achieve the therapeutic outcome
Intravenus bolus injection and single oral dose exhibit the pharmacokinetic of first-order absorption
and first-order elimination
Intravenous infusion exhibits the pharmacokinetic of zero-order absorption and first-order elimination
Creatinine and Inulin are not actively secreted or reabsorbed, used to measure the glomerular filtration
rate (GFR)
p-Aminohippurate (PAH) is actively secreted by active tubular secretion, used to measure effective
renal blood flow (ERBF)
Renal clearance means
The volume of the drug contained in the plasma that is removed by the kidney per unit time
Mechanism of warfarin
Inhibits vitamin K epoxide reductase (blocks conversion of oxidized vitamin K to reduced
vitamin K) resulting in Prothrombin precursor can not be changed into prothrombin
The time required to reach 95% of the Css is equal 4.3 times the half life
The time required to reach 99% of the Css is equal 6.6 times the half life
The onset time for a drug given orally is the time for the
Drug to reach the minimum effective concentration (MEC)
The initial distribution of a drug into tissue is determined chiefly by the
Rate of blood flow to tissue
Parameters used to describe bioavailability
Cmax, AUC and Tmax
Span w/o 1-9 but Tween o/w 11-20
Factors affect rate of distribution
Blood flow and membrane permeability
Factors affect extent of distribution
Lipid solubility, pH, pKa, plasma protein binding
Aspirin increases effects of
Anticoagulants, thrombolytic agents, hypoglycemics
Examples of ganglionic blockers (block both sympathetic and parasympathetic)
Hexamethonium, Trimethaphan, Mecamylamine
Ach – accommodation for near vision
Clozapine (atypical antipsychotic) has the least EPS effect but has high weight gain effect
Side effects of Nitroglycerin (vasodilator)
Headache (most common), postural hypotension, facial flushing and tachycardia
Ketoconazole should be taken with food (increase absorption and decrease GI upset)
Symptoms of hypoglycemia
Sweating, hunger, confusion, dizziness, fainting, fatigue
Symptoms of hyperglycemia
Polyurea, Polydipsia, neuropathic pain, blurred vision
Normal phase chromatography : mobile phase – non polar, non aqueous, organic
Reverse phase chromatography : opposite
Parametric tests
Population must have the same variances e.g. t-test, mean, SD
Non parametric tests (distribution free)
Don’t require same variances e.g. Median, mode, chi-square test
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Type I error, also known as a "error of the first kind", an α error, or a "false positive": the error
of rejecting something that should have been accepted.
Type II error, also known as a "error of the second kind", a β error, or a "false negative": the error
of accepting something that should have been rejected.

Statistics - Hypothesis Test

Null Hypoth True Null Hypoth False

Reject Null Hypothesis Type I Error Correct

Fail to Reject Null

Hypothesis
Correct Type II Error

68-95-99.7 = 1SD, 2SD, 3SD

Secondary causes of hypertension
Primary aldosteronism (decreased K level), Pheochromocytoma (increased urinary
catecholamine level), Cushing’s syndrome (increased blood cortisol level)
5 Major risk factors (according to the JNC-7) that can predispose HTN
DM, smoking, age (men >55, women >65), family history of CVD and dyslipidemia
Don’t stop taking beta blockers immediately due to the risk of withdrawal syndrome
Beta blocker should be used with caution in patients with
- Diabetes (can mask hypoglycemic symptoms e.g. tachycardia)
- Raynaud’s phenomenon or peripheral vascular dz. (vasoconstriction can occur)
- Neurological disorders because several beta-blockers enter CNS, potentiating side effects
Beta blockers can cause impotence
Esmolol has an ultrashort duration of action, used only IV
Centrally active alpha-2 agonists
Methydopa, Clonidine, Gunabenz, Guanfacine
For Centrally active alpha-2 agonists, should not stop taking immediately because they can cause
rebound hypertension
Side effects of Methydopa
Sedation, dry mouth, positive coombs’ test, hemolytic anemia, impotence (men), lactation
(women), orthostatic hypotension
Clonidine is safe in patient with renal disease because it does not decrease renal blood flow or GFR
Clonidine is commonly administered with diuretic because it can cause Na/water retention
Methyldopa is a drug of choice for pregnant women
Reserpine can classified as
Postganglionic adrenergic neuron blocker (central and peripheral)
Reserpine contraindicated in
Patient with a history of depression, Patient with peptic ulcer
Hydralazine can induce SLE
Minoxidil can cause sodium and water retention, using diuretic can minimize this side effect
Thiazides and ACEI may be diminished by NSAIDs
ACEI can cause an altered sense of taste (dysgeusia) , neutropenia (rare but serious), proteinuria
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CCB when used with Beta blocker may induce CHF and bradycardia
Verapamil can cause constipation
Hydralazine can cause reflex tachycardia like alpha 1 blockers (prazosin, terazosin)
The only one alpha1 blockers that has no antihypertensive action
Tamsulocin (used for the treatment of BPH)
Most common side effects of Quinidine
GI side effects (nausea, vomiting, diarrhea)
Antiarrythmias for AV nodes
Do Block AV ; D=Digoxin, B=Beta blockers, A=Adenosine, V=Verapamil
Class III antiarrhytmics used for ventricular arrhythmias except
Ibutilide, Dofetilide (used for acute atrial fibrillation and flutter)
DOC for treatment of acute atrial fibrillation
Procainamide or Ibutilide
DOC for treatment of shock refractory ventricular fibrillation/tachycardia
Amiodarone
Side effects of Amiodarone
Pulmonary fibrosis, Hepatotoxicity, Thyroid dysregulation and corneal deposits
Disopyramide (IA) has strong anticholinergic effect
DOC for paroxysmal supraventricular tachyarrhythmia (PSVT)
Class IV-Verapamil, Diltiazem
Drugs contraindicated in systolic heart failure (LVSD)
Calcium channel blockers (however amlodipine may be used in specific causes of CHF)
But CCB can be used in diastolic heart failure – most commonly use of CCB is verapamil
Antiarrythmic may be used in CHF
Class III (Sotalol, Amiodarone)
First line in patient with systolic heart failure
ACEI
First line in patient with diastolic heart failure
Loop diuretics
Treatment of Digitalis toxicity
Potassium supplement (contraindicated in pt. with severe AV block), Lidocaine or phenytoin
(to treat arrhythmias), cholestyramine (to prevent absorption), Fab fragment antibodies
Electrolyte imbalance that can predispose digitalis toxicity
Hypercalcemia, hypokalemia, hypomagnesemia
Examples of glycoprotein IIb/IIIa inhibitors (antiplatelet)
Abciximab, Eptifibatide, Tirofiban (used in patient with unstable angina or who are
undergoing PCI)
Coronary artery disease (CAD)-IHD are divided
Stable angina, Unstable angina/NSTEMI, STEMI (Acute coronary syndrome-ACS)
First line treatment in stable angina pectoris
Antiplatelet + ACEI + Statin (if non fasting total cholesterol ≥ 3.5 mmol/L)
DOC in Prinzmetal’s angina
CCB
Drugs should be avoided in patient with Prinzmetal’s angina
Beta blockers
The only ACEI that has been shown to prevent major cardiovascular outcomes in patient with stable
angina
Ramipril
Which type of CAD that thrombolytic agents can be used
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STEMI (thrombolytic agents not recommended in patient with unstable angina/NSTEMI)
Beta blockers should be given during the acute MI to help prevent sudden death
CCB not recommended in patient with STEMI because it can increase morbidity, mortality
Streptokinase should not be used in patient who have receive SK within the previous 6 months due to
systemic antibody formation
Myocardial oxygen demand is increased by
Exercise, smoking, cold temperature, beta-agonists
Drugs causing gout
CANDLE CAP : C=Chlorthalidone, A=Aspirin, N=Nicotinic acid, D=Diuretics, L=Levodopa,
E=Ethambutol, C=Cyclosporine, A=Alcohol, P=Pyrazinamide
Virchow’s triad consists
VIRchow : V=Vascular trauma, I=Increased coagulability, R=Reduced blood flow (stasis)
Tests are used to monitor antithrombotic therapy (heparin)
aPTT and heparin assay
Antibiotics can increase warfarin effect (increased INR) by eliminating bacterial flora and, thereby,
producing vit k deficiency
LMWH – longer t1/2, does independent renal clearance, antifactor Xa : IIa affinity ratios (2:1-4:1)
Heparin – shorter t1/2, dose dependent renal clearance, antifactor Xa : IIa (1 : 1)
Fondaparinux (selective Xa inhibitor) contraindicated in
Patient who weigh less than 50 kg., severe renal impairment
Fondaparinux has no known effect on platelet function
First line treatment in patient with hypertension
Isolated systolic HTN – Diuretics or Long acting dihydropyridine CCB
Black people - Diuretics or Long acting dihydropyridine CCB
DM – ACEI or ARB
Angina – Beta blockers (not recommended as initial therapy to patient over age 60)
Prior MI – Beta blockers or/and ACEI
Systolic dysfunction – ACEI
After acute TIA – ACEI+Diuretic
Pregnancy – Methyldopa or Hydralazine
Renal disease – ACEI
The only CCB that may cause MI
Diltiazem
Digitalis is contraindicated in the treatment of
MI
Statins are metabolized by CYP3A4 except
Fluvastatin and Pravastatin
Endorphins are endogenous opioid peptides , not neurotransmitters
Hansen’s disease = Leprosy
Dronabinol (Marijuana dev.) is indicated for
The treatment of emesis
Docasanol is indicated for
The treatment of cold sore
Aluminum (aluminum hydroxide) is an effective phosphate binder can be used to treat
Hyperphosphatemia
Betamethasone-the greatest anti-inflammatory potency when administered systemically
Gastric intrinsic factor is classified as
A glycoprotein