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الرحيم الرحمن الله بسمللهيئة تابعة وأسئلة السابقة اإلمتحانات من أسئلة مجموعة
للجميع والتوفيق بالنجاح األمنيات أطيب مع إنه الله بإذن دائما عليه والقادر ذلك ولى
ســـــــــــــــــؤال 134 هذه الصفحة تحتوى على
1- Ondansteron HCl is used for : a-hypertension b-angina pectoris c-prophylaxis of migraine d-anti-emetic
It is used as anti-emetic with patients receiving cytotoxics due to its serotonin antagonism
Ondansetron is ( Zofran 4 , 8 mg tab. & amp )2- All of these are side effect of Chloramephenicol except : a-irreversible aplastic anaemia b-optic neuritis c-peripheral neuritis d-iron deffeciency anaemia3- Ticlopidine is used for : a-anticoagulant b-antibiotic c-anticholinergic d-antiplatelets4- All these drugs are fibrinolytics except : a-dipyridamole b-streptokinase c-urikinaseAnti-Coagulants : vit. K antagonists , heparin , warfarinFibrinolytics : streptokinase , alteplase , reteplaseAntiplatelets :aspirin,clopidogrel,tirofiban,eptifibatide, abciximab,dipyridamole5- All these drugs can be used for parkinsonism except: a-seligiline HCl b-carbidopa c-pergolide d-nedocromil sod.
Drugs used in Parkinson`s disease Anticholinergic drugs : (Muscarinic Antagonists)Benzatropine,trihexphenidyl,orphenadrineMAO B inhibitors :SelegilineCOMT inhibitors :Entacapone
Dopamenergic drugs : *Dopamine precursor : levodopa (+ carbidopa or Beserazide) *Releases dopamine : amantadine *Dopamine agonists : bromocriptine,cabergoline,pergolide,ropinirole
6- All these cases not cure with thiazides except: a-hypernatrimia b-hyperglycemia c-hypokalaemia d-hyperuricaemia7- Cardiac arrest could be managed by the following except : a-ephedrine b-lidocaine c-propranolol d-normal saline8- Insulin which can be given I.V. is : a-regular type b- 30/70 type c- NPH type d-non of the above9- Drug that used for leishmania is: a-sod. stiboglyconate b-mebendazole c-sod. cromoglyconate10- All these drugs are antibacterial except: a-zalcitabine b-lomefloxacin c- cefopyrazone11- All these are natural Estrogens except : a-mestronol b-oestrone c-oestriol d-oestradiol
Natural Estrogens :Oestrone , Hydroxyoestrone , Oestradiol , Oestriol
Deriv. of nat. Estrogens :Ethenylestradiol , Mestronol
Synth. Estrogens :Stilbesterol , Hexanosterol , Trianiselchlorethylene , Propanestriol , Clomifen
12- Co-Trimethoxazole contains :( Trimethoprim + Sulphamethoxazole )
13- Which of the following has vasodilator effect ? a-nicotine b-cholestyramine c-urokinase d-vit. A14- One of the following is not from Quinolone group : a-naldixic acid b-quinine c-eoxacin d-norfloxacin15- One of the following is not for epilepsy :
a-clorizepam b-phenytoin c-primidone d-imipramine (antidepressant)
16- All of these can be used for leprosy except : a-dapson b-rifampicin c- clofazinine d- INH
17- Sumatriptan is used for : a-hypertension b-treatment of migraine c-angina pectoris d-control of epilepsy
( 5-HT1 agonist )18- Which is enzyme inducer ? a-rifampicin b-cimetidin c-vit. C d-chloramephenicol
Enzyme Inducers:Phenobarbital,carbamazepine,ethanol,rifampicin,polycyclic aromatic hydrocarbons
in tobacco smokersEnzyme Inhibitors :
Cimetidine ,erythromycin19- All of the following for prophylaxis of asthma except : a-ketotifen b-nedocromil sod. c-sod. cromoglycate d-salbutamol
تشبع ال نفس ومن يخشع ال قلب ومن ينفع ال علم من بك أعوذ إنى اللهم لها يستجاب ال دعوة ومن
20- All of the following is NSAH ( Non Sedating Anti-Histamine ) except :
a-loratadine b-cetrizine c-astimazole d-azotodin21- All of the following are controlled drugs except : a-rivotril b-epanutin c-sresolid d-diazepam22- All these drugs are anti-viral except : a-amantadine b-zidovudine c-acyclovir d-aluerin
( it is antispasmodic )23- Which one of these symptoms not occur with morphine ? a-diarrhea b-respiratory depression c-constipation d-vomiting
24- Which one of these drugs not used for acute pain ? a-naproxen b-colchicine c-codeine d-prednisolone25- Which is drug of choice for myxodema ? (hypothyroidism) a-carbimazole b-iodine c-thyroxin sod. d-propyl thiouracil26- Benzyl peroxide is a local treatment for Acne volgaris
27- Vit. A daily dose is 30`000 – 50`000 IU for the correction of deficiency and 100`000 – 200`000 IU for therapy28- The drug of choice for treatment of amoebae : a-chloramephenicol b-tetracycline c-gentamycin d-metronidazole29- To prevent more absorption of the toxic drug we use : a-water b-salt sol. c-saline d-charcoal30- Hepatitis vaccine dose is : a-once/year b-twice/year c-three times/year31- Which one is OTC drug : a-simple analgesic b-warfarin c- ciprofloxacin32- Anticoagulant effect of warfarin is decreased by : a-rifampicin b-aspirin c-vit. K d-verapamil33- One of the following is given once daily : a-amorphous insulin b-protamine zinc insulin(isophan) c-neutral insulin d-regular insulin34- The steady state conc. Of drug in plasma depends on : a-dirct proportion to the rate of administration b-~~~~~~~~~~~~~~~~~~~~~~~~ elimination c-Indirect ~~~~~~~~~~~~~~~~~~~~~~~~~ d-~~~~~~~~~~~~~~~~~~~~~~~~ administration35- All these are anticoagulants except : a-warfarin b-ancord c-heparin d- dipyridamol
( anti-platelet )36- All these are anti-platelets except :
a-dipyridamol b-aspirin c-streptokinase (antifibrinolytic)
d-presantin e-ticlopidine37- Ferrograde is : a-ferrous sulphate b- ferrous citrate c- ferrous gluconate d- ferrous fumarate
وليها ... أنت زكاها من خير أنت ... وزكها تقواها نفسى آت اللهم . وموالها
38- Procainamide is : a-Na channel blocker b-nifedipine c-lisinopril d-quinidine
39- Mechanism of action of vit. K ?Vit. K has an essential role in the synthesis of coagulation factors
by hepatic cells.
40- Thiazide diuretics cause all the following except : a-hypokalaemia b-hypercalcemia c-hyperuricaemia d-hyponatremia e-hyperglycemia f-hypernatremia41- Treatment with anti-arrhythmic drug depends on the following except : a-type of medication b-period of medication c-patient sex
42- Elimination of digoxin is mainly by : a-kidney b-liver c-both d-non of them 43- Dobutamine is given I.V. because : a-it is not stable in the gastric PH b-it is needed in large quantities in case of oral route c-it is eliminated very quickly44- Amloride as trimetren causes : a- CNS disturbance b-hyperkalaemia c-hypokalaemia d-not affect K ( potassium )45- What is the most drug can causes damage if it is given OTC ? a-captopril b-warfarin c-chlorothiazide d-rifampicin46- Drug physical dependence is as same as drug abuse a-true b-false47- Mention two thiazide diuretics ? a-chlorothiazide b-hydrochlorothiazide48- What is the difference between Q.I.D & Q.6H ?
Q.I.D = 4 times /dayQ.6H = every 6 hours
49- What is the difference between the following anti-fungal ?
Miconazole = local & systemicAmphotericin = parentral only
Griseofulvin = oral50- Give the indication of the following :
a- gimfibrazole -------> for hyperlipidaemia
b- cisapred ------------> for gastroesophegyl refluxc- fluexiten SSRI ( selective serotonin reuptake inhibitor ) ------------
Antidepressantd- carbimazole ---------> for hyperthyroidism
e- imipramine -----------> tricyclic antidepressantf- ibratrobium Br ----> antimuscarinic as bronchodilator
51- All are antimetabolites except : a-methotrexate b-flurouracil c- cytarabine d-azathioprine(Imuran) e-cyclophosphamide
(alkylating agent)52- Cefaclor is : a- 1st generation cephalosporin b- 2 nd generation cephalosporin c- 3rd generation cephalosporin d- non of the above
1st gen. :cefadroxil(Duricef),cefazolin(Totacef),cephalexin(Ceporex),
cephalothin ,cephradine(Velocef),cephapirin(Cefatrexyl)2nd gen. :
cefaclor,cefoxitin,cefotitan,cefuroxime(Zinnat),cefprozil(Cefzil),loracarbef3rd gen. :
cefotaxime(Claforan),cefoperazone(Cefobid),cefotriaxone(Rocephin),cifixime(Suprax),
ceftizoxime(Cefizox),proxetil,cefdinir,cefditoren,pivoxil,ceftazidime( Fortum ),ceftibuten,ceftizoxime
4th gen. :cefepime(Maxipime),cefpirome(Cefrom),cefpodoxime
53- Which aminoglycoside antibiotic can be taken orally a-gentamycin b-neomycin c-amikacin d-tobramycin54- Teicoplanin antibiotic has similar effect on G+ve as a-vancomycin b-jamicacin c-gentamycin d-kanamycin55- Which is not tetracycline ? a-minocyllin b-demeclocycline c-doxycycline d-clindamycin56- Which is not Ca++ channel blocker ? a-verapamil b-deltiazem c-amlodipine d-cinnarizine
57- Mesalazine is used for treatment & maintainance of remission of ulcerative colitis58- Mention 4 lipid-soluble vitamins ?
vit. A , D , E & K59- Imipenam ( carbapenam ) It is the 1st thiemamycin beta-lactam antibiotic60- All these medications are used in ttt of TB except a-cyclosporin b-INH c- cycloserin d-rifampicin
Treatment of TB :1st line or primary drugs : Isoniazide(INH) & Rifampicin
2nd line or secondary drugs : Ethambutol , Streptomycin & Pyrazinamide.
3rd line or tertiary drugs : Ethionamide , Cycloserine & Capreomycin61- All these drugs are anti-cholinergic except : a-ipratropium b-atropine sulphate c-benzatropine methylate d-dobutamine62- All are antibiotics except : a-zalcitobin (ttt of AIDS) b-cefaprozil c-lomefloxacin d-cefopodoxin63- There is one drug used for HIV : a-zalcitabin b-kinasterdin c-cefaprozil d-enoxocin64- Which one is Suprax ? a-cefixime b-itraconazole65- Which is Sporanox? a-cefixime b-itraconazole66- All of these drugs can be used in ttt of leprosy except : a-dapson b-rifampicin c-clofazimin d- INH67- One of these is not like others : a-timolol b-acebutalol c-labetolol d-betaxolol (selective B1 blocker)68- Betahistine HCl :(betaserc) a-for mieniere`s disease b-antihistamine69- Which one is not 5HT3 antagonist? a-tropisetron b-ondansetron c-domperidone d-gransetron70- Which is not oral anti-coagulant? a-warfarin b-enoxaprine c-phenidione d-nicoumolone
الظالمين من كنت ... إنى .. سبحانك أنت إال إله ال71- Which is correct for Diazepam? a-can cause muscle spasm b-it is taken IM only c-it is a derivative from morphine d-it is not used for long term72- Maximum dose of paracetamol is : 4gm / day73- The duration of treatment of TB by CTC is : a-one week b-two months c-one month d-six months
( CTC = Tuberculosis Committee Thoracic Society )74- Metoclopramide is a dopamine antagonist acts
centrally by blocking vomiting center and peripherally acts on the chemo-receptor trigger zone (CTZ) to be used as
antiemetic75- Which one is contra-indicated in pregnancy ? a-sucralfate b-ethambutol c-chlorpheneramine d-ciprofloxacin76- What is the definition of Bioavailability of drug?
The quantity of the active constituent of the drug absorbed by the blood through the intestine or any other route in a certain period of time
OR : The conc. of drug in blood in a certain time77- Give ex. of a drug induces hepatotoxicity
paracetamol,ketokonazole,rifampicin,quinolones78- Give ex. of a drug induces nephrotoxicity
Aminoglycosides( as gentamycin ) 79- What is the generic name of vit. B12 ?
Cyanocobalamine80- Zidvudine ( Zalacitabin ) is used for HIV
رب ... وهو توكلت ... عليه هو إال إله ال الله حسبى العظيم العرش
81- What is the meaning of poor patient compliance?The patient didn`t take the medication properly ( not properly dose , not proper time ) may be due to the dose regimen is not easy or the dose is
high , or the side effect is clear
82- Fluxetine ( Prozac ) is :Selective serotonin re-uptake inhibitor ( SSRI )
83- Omeprazole ( Losec ) is :Proton pump inhibitor
84- Mention two diseases cause Edema?Renal failure Congestive heart failure
85- Give examples of Drug-Drug interactions ?Warfarin--------- ----Aspirin
Insulin --------------- B-BlockerHeparin -------- -----Aspirin & Ampicillin
Warfarin -------- ----Vit. KWarfarin ------------ Phenobarbital
Spironolactone ----- DigoxinACEIS --------------- K-Sparing diuretics
86- Generic name of :Vit. B1 ------------- ThiamineVit. B2 ------------ RiboflavinVit. B6 ------------- Pyridoxin
Vit. B12 ----------- Cyanocobalamine
87- All of these are the components of calamine lotionB.P except: a- ZnO b-calamine c-sod. citrate d-bentonite e-sod. sulphate88- Terbinafene is used topically for : a-eczema b-candida c-fungal infections89- Which one is not contra-indicated in pregnancy ? a-captopril b-enalapril c-lisinopril d-methyldopa90- PCP ( pneumocystis corin pneumonia ) a-virus b-bacteria c-parasite d-mycobacterium91- Which of the following is not antibiotic ? a-erythromycin b-cifixim c- cefprozil d- finasteride
( anti-cancer )
92- Which one is used for benign prostatic hyperplasia (BPHP)
a-flumazenil b-cefprozil c-mivacurim d-finasteride93- All of these are 3rd generation cephalosporin except: a-cifixime b-cefopodoxime c-cefotriaxone d-cefotaxime94- Which of the following is not mucolytic? a-bromohexin b-carbocistene c-ambroxol d-guaphenesin e-dextromethorphan95- Which one is anti-platelet? a-ticlopidine b-desfluron c-aldesleukin d-atovouon
96- All of these are anti-neoplastic except? a-aldesleukin b-taniposide c-pentostatin d-amlodipine (Ca++ channel blocker)
97- Which is not benzodiazipne ? a-temazepam b-nitrozepam c-loprazepam d-clozapine98- Potassium supplement must not be given with triametrin a-false b-true99- MMR vaccine is ?
Measles-Mumps-Rubella vaccine BCG=Bacillus Calmette Guerin DTP=Diphteria&Tetanus toxoids and Pertussis V. Td =Tetanus & diphtheria toxoids OPV=Oral Poliovirus Vaccine HIbV=Haemophilus Influenzae type b,conjugated Virus HAV=Hepatitis A Virus100- Oral re-hydrate solution(ORS) is one of the following : a- sod. citrate,pot. chloride & glucose b- sod. citrate,pot. chloride & sod. chloride c- sod. chloride,pot. citrate, sod. citrate & glucose d- sod. chloride,pot. chloride, sod. bicarbonate & citric acid
101 -The major action of sodium chromoglycate is: a-mast cell stabilization b-bronchodilator
c-prostaglandins modifier d-leukotrienes modifier e-non of the above
102-The action of histamine is: a-capillary constriction b-elevation of blood pressure
c-stimulation of gastric secretion d-skeletal muscle paralysis e-slowing the heart rate
103-One of the following antibiotics is resistant to penicillinase:
a-penicillin V b-penicillin G c-floxapen d-ampicillin
e-amoxicillinPenicillinase Resistant Penicillins: Dicloxacillin,Naficillin,Oxacillin
الملك/ &**** وتقديرى تحياتى مع خالد دأبوالخير/ محمد د
(M.A.S.A)
104 -Inderal is: a-similar in action to ergotamine b-similar in action to tubocurarine
c-used as an antihistamine d-pure -adrenergic receptor blocker e- and – adrenergic receptor blocker105 -Rifampicin is indicated for treatment of:
a-impaired fat absorption b-pulmonary emboli c-tuberculosis d-neoplastic disorders
e-psoriasis 106 -Which of the following is selective 1 blocker?
a-labitolol b-terazosine c-cloridine d-captopril
e-verapamil
Drugs acting on the sympathetic system
I-Sympathomimetics : *Indirectly acting:
ephedrine,amphetamine(tyramine),cocaine *Directly acting:
-Agonists: / norepinephrine , epinephrine 2 : clonidine , -methylnorepinephrine
1 : phenylephrine , methoxamine -Agonists:
1 / 2 : epinephrine,isoprenaline 2 : salbutamol,terbutaline
1 : norepinephrine,dobutamine
ياطين همزات من بك أعوذ رب بك وأعوذ الشيحضرون أن رب
II- Adrenergic neurone blockers: Reserpine, guanethidine,bethanidine
III- Adrenoceptor antagonists: *- Blockers:
/ : phenoxybenzamine,phentolamine : prazocin
*- Blockers: / : propranolol,madolol,timolol,
pindolol,oxprenolol,carvedilol (cardioselective) :
atenolol,metoprolol,acebutolol
107 -The latabbreviation for " After Meals " is:
a- a.c. b- a.a. c- p.c. d- i.c. e- c.c.108 -The latin abbreviation for " Four Times Daily " is:
a- a.c. b- a.a. c- p.c. d- q.i.d. e- c.c.109 -The latin abbreviation for " Every Night " is :
a- a.c. b- o.n. c- p.c. d- i.c. e- c.c.110 -Erythroped A:
a-is effective against G +ve Cocci b-is a macrolide antibiotic
c-can increase g.i.t. motility d-could be used in pregnant women if need
e-all of the above111 -For the treatment of anaphylactic shock use:
a-salbutamol b-diphenhydramine c-acetazolamide d-epinephrine
e-aminophylline
وارحمنى وعافنى وارزقنى اهدنى اللهم112 -Allopurinol is used as:
a-analgesic agent b-uricosuric agent c-antiinflamatory agent d-antipyretic agent
e-agent which increases renal tubular reabsorption113 -Which of the following is NOT betamethasone side
effect? a-cataract b-hypoglycemia
c-skeletal muscle weakness d-sodium retention e-lowered resistance to infections
114 -A disease which is due to viral infection: a-poliomyelitis b-rabies c-chicken pox d-herpes
e-all of the above115 -The mechanism of action of atropine is:
a-muscarinic antagonist b-muscarinic agonist c-nicotinic antagonist d-nicotinic agonist
e-non of the above116 -Myocardial muscle tissue property to generate
electrical is: a-inotropy b-chronotropy
c-automaticity d-contractility e-non of the above
117 -The heart`s dominant pacemaker is: a- AV node b- SA node
c-pukinje fiber d-internodal pathways e-non of the above
118 -Adenosine is used for: a-ventricular arrythmias b-atrial bradycardia
c-supraventricular tachycardia d-supraventricular bradycardia
e-non of the above119 -Adenosine P produces which of the following:
a-facial flushing b-dyspnea c-marked tachycardia d- a and b e- a , b and c
120 -Which of the following is responsible for buffering
a-magnesium b-chloride c-bicarbonates d-potassium e-troponin
121 -Respiratory acidosis is due to: a- O2 removal b- O2 retention c- CO2 removal d- CO2 retention
e-non of the above122 -Which of the following is NOT colloid solution?
a-albumin 5% b-ringer`s solution c-dextran d-beta starch
e-albumin 20%Some examples of hydrophilic colloids used in pharmacy are acacia, methylcellulose, and proteins, such as gelatin and albumin.examples of substances which form hydrophobic colloids in water are silver iodide, hydrated ferric oxide, sulfur, and gold. arsenous sulfide, aluminum chloride magnesium chloride
123 -The term shock signifies: a-hyperperfusion b-hypoperfusion c-tachycardia d-bradycardia
e-non of the above124 -In treatment of shock , which of the following
should be considered? a-airway control b-IV of crystalloid solution
c-dopamine to support blood pressure d-monitor heart rhythm e-all of the above
قيوم.... برحمتك يا حى واإلكرام.... يا الجالل ذا ياأستغيث
125 -Which of the following is released by bacterial infection?(…. by bacterial cell wall during there growth)
a-endotoxin b-exotoxin c-antibiotics d-cytotoxin e-non of the above 126 -the amount of water in adult male is about:
a-25% b-60% c-80% d-10% e-17%
127 -Which of the following are causes of oedema? a- hydrostatic pressure
b- oncotic pressure
c- capillary permeability d- a and b e- a , b and c
128 -Patients prescribed non reversible monoamine oxidase inhibitor should be advised not to consume food containing tyramine because this combination causes:
a-postural hypotension b-hallucinations c-anaphylactic shock
d-muscle weakness and tremor e-acute adrenergic crisis including sever
hypertention
Effect: Concurrent use of MAO inhibitors (e.g. phenelzine) and anorexiants (e.g. amphetamine) leads to increased amounts of norepinephrine, which increases sympathetic activity. Potential reactions include chest pain, cardiac arrhythmias, hypertensive crisis (headache, hyperpyrexia, and hypertension), seizures, cerebral hemorrhage, and death.
Tyramine-containing foods: aged cheese, aged or spoiled meats, beer, red wine, yeast
ى الله الله به أشرك ..... ال رب شيئا129 -Concerning COX 2 inhibitors , which is NOT true?
a-they have lower risk gastric adverse reactions b-good evidence about their effectiveness
c-cardiac toxicity is a recent concern of this class d-they usually administrated twice daily
e-combination with non selective agents give more effective action
130 -In the treatment of osteoporosis which of the following is NOT true?
a-alendronate should be taken 60 min. before breakfast b-Ca and vit. D are essential
c-hormone replacement therapy should be considered d-outcome should be assessed with periodic bone density
e-raloxifeno is selective oestrogen modulator131 -Which of the following is the first choice in acute
gout?
a-allopurinol b-indomethacin c-colchicine d-probencid e-sulfinylpyrazone
132 -Which of the following is NOT a risk factor for osteoparalysis?
a-minimal exercise b-low calcium intake c-male gender d-family history
e-minimal exposure to sunlight 133 -Early symptoms of aspirin poisoning are:
a-lethergy & fatigue b-skin rash & headache c-throbbing headache & dizziness
d-fluid retention hypotension e-ringing in the ears & blurred vision
134 -Which of the following is NOT true about
infiximab a-IL-1 blocker
b-used for treatment of severe rheumatoid arthritis c-may increase risk of infections
d-administered as IV infusion e-postadministration reactions include fever & chills
سالمين بالدكم إلى وأعادكم غربتكم في الله وفقكم غانمين
دعــــائكم صالح من تنسوني الربـــه عفو الراجي أخوكم
(M.A.S.A أبوالخير د/محمد (
(1 )Quinolones is contraindicated in children becauseAffect :
A( joints)B( Affect liver]
(C )Not affect the child
(2 )Maximum dose of diclofenac sodium is:
(A )50 mg(B )100 mg
(C )75 mg(D )None of the above
(3 )Calciferol is:
(A )1,2 dihydroxy calciferol(B )2,3 dihydroxy calciferol
(C )1,25 dihydroxy calciferol(D )None of the above
(4 )Pharmacodynamic means:
(A )Physiological & biochemical effect of the drug on the body(B )Physiological & biochemical effect of the body on the drug
(C )None of the above
(5 )Child of 10 kg. paracetamol dose for him is:
(A )250-500 mg /4-6 hours
(B )100-150 mg /4-6 hours(C )125-250 mg /4-6 hours
(6 )Sympathomimetic drugs:
(A )Increase blood pressure(B )Increase coronary flow
(C )Increase heart rate(D )All of the above
(7 )Drug which increase action of warfarin is:
(A )Oral contraceptive(B )Carbimazole
(C )Phenobarbitone(D )None of the above
(8 )Co-trimoxazole is:
(A )trimethoprim+Sulphamethoxazole (B )trimethoprim+Sulphonyl urea
(9 )All of the following are controlled drugs except:
(A )Carbamazepine(B )Barbiturates
(C )Diazepam(D )Tylenol)anti pyretic(
(10 )Hepatotoxicity is induced due to these except:
(A )Rifampicin(B )Ketoconazole
(C )Quinolones(D )Dipyridamole
(11 )One of the following not used in epilepsy:
(a )Clonazepam
(b )phenytoin
(c )primidone
(d )Imipramine
(12 )Which is not quinolones:
(a )Nalidixic acid
(b )Quinine
(c )Eoxacin
(d )Norfloxacin
(13 )One of the following should be avoided in pregnancy:
(a )Vitamine A
(b )Calcium
(c )Misoprostol
(d )paracetamol
(14 )Which one is enzyme inducer:
(a )Rifampicin
(b )Cimetidine
(c )Chloramphenicol
(d )Vitamine C
(15 )All the followig are controlled drugs except:
(a )Rivotril
(b )Epanutin
(c )Stesolid
(d )Diazepam
(16 )All are antiviral except:
(a )Amantadine
(b )Zidovudine
(c )Acyclovir
(d )Alverine
(17 )Which one )symptom( does not occur with morphine:
(a )diarrhea
(b )Vomiting
(c )Constipation
(d )Respiratory depression
(18 )Which one has vasodilating effect:
(a )Nicotinic acid
(b )Nalidixic acid
(c )Vitamine A
(d )Urokinase
(19 )Which one is not total )non selective( B blocker:
(a )Atenolol
(b )Labetalol
(c )Acebutalol
(d )Sotalol
(20 )All these are oestrogens except:
(a )Mesterolone
(b )Oestradiol
(c )Oestrone
(d )Oestriol
(21-)ondansetron hcl is used for anti emetic with patient receiving cytotoxics due to is 5ht antagonist(zofran
(22-)all these are side effects of chloramphenicol exept a-irreversible aplastic anemia b- optic neuritis c-peripheral neuritis d-iron deficiency anemia
(23-)ticlopidine is used for anti platelets
(24-)all these drugs are fibrinolytic exept a- dipyridamole b- steptokinase c-urikinase
(25-)ALL these drugs are antibolit exept a-methotraxate b-flurouracil c- cytabrin d- azothioprine e- cyclophosphamide
(26-)druges used for leishmania is NA-stiboglyconate
(27) insulin which can be given I.V. is regular type
(28 )sumatriptan is used for ttt of migraine
(29) drug of choice for ttt of myxodema )hypothyrodism( is thyroxin sod.
(30) hepatitis vaccine dose is three times per year
(31) drug of choice for ttt amoebae is metronidazole
(32) benzyl peroxide is alocal ttt for acne vulgaris
vit A daily dose is 30000-50000 IU for correction of deficiency and for therapy from 100000-200000 IU per day
ferrograde is ferrous sulphate
machanism of action of VIT K has essential role in synthesis of coagulation factors by hepatic cells
elimination of digoxin is mainly by kidney
ttt with anti arrhythmic drug depends on exept a-type of medication b-period of medication c- of patient
dobutamin is given I.V. becausea-its not stable in gastric P.H B- ITS NEED LARG QUANTITIES IN CASE OF ORAL ROUT C-ITS ELEMINATED VERY QUICKLY
a-true b- false
drug physical dependence is as same as drug abuse
Qid Meen ; 4 Times Per Day
Q6h Meen; Every 6 Hrs
pareenteral only- griseofulvin oralMICONAZOL
LOCAL &systemic-amphotercin
aminoglycoside antibiotic taken orally;neomycin
teicoplanin&vancomycin has similar effects on gram positive
lipid soluble vitamines are A D E K
MESALAZINE is used for ttt&maintenance of remission of ulcerative colitis
anti cholinergic drugs are ;iprotropium&atropine&benzatropine methylate
drug used for ttt HIV are ZALCITABIN
selective beta blocker ex. is acebutalol
maximum dose of paracetamole is 4 gm/day
بالدكم إلى وأعادكم غربتكم في الله وفقكم غانمين سالمين
دعــــائكم صالح من تنسوني ال
ربـــه عفو الراجي أخوكم د/محمد
M.A.S.A( ( أبوالخير
على تحتوى الصفحة ســــــــــــؤال 37 هذه
Q1( one of the following is not prepared in a horizontal laminar flow? -antibiotics
-chemotherapy -large volume fluid***
-total parental nutrition
Q2( nor epinephrine stimulate B1 adrenergic receptor and alpha adrenergic receptor ?
-increase contractility and heart rate -vasoconstriction and increase blood pressure
-a+b*** -non
Q3( use safely in the trimester?-warfarine
-aspirin-acetaminophen***
-all
Q4( isosorbide nitrate 20 mg & 40 mg (( ساعة بأيبين المدة وما الجرعة نالجرعتي تأخذ
Isosorbide dinitrate is vasodilator effect antianginal in angina pectoris 2-5 mg befor 15 min activity likely to cause angina duration of action up to 12 hours.
In angina pectoris)prevention( sub lingual 2.5-5 mg two or three / dailyInitial= 20 mg 3/4 daily , maintainance = 10-40 mg 2/3 daily
Q5 ) ؟ الطبية بالوصفة يوجد ال شيء
Q6) الباراسيتامول جرعة هي العمر ما من يبلغون الذين شهور 3لألطفالFor child 3 months to 1 year the dose is 60-120 mg )i.e 2.5 -5 ml(4-6 hours to
maximum foure dose daily.
Q7( glucose 5% is not suitable for:-emergency hyperkalemia
-emergency water deficiency-hypoglycemia****
Q8( ACE بين أساسي اختالف هناك مجموعة هلThey are major clinical difference between the different member ACE inh:No they are basically equally effective if used in appropriate dose.
Q9( isoniazide is TB agent that:شي ) كل عنه (اعرف
Isoniazide INH is a known to be liver enzyme inh , therefore its co- administration with drug that metabolized by the liver would lead to:
d( decrease rate of metabolism of that drug lead to increase response of drug
note) INH used in tb for 2 month initial phase and 4 monthes in continous phase(adult dose 300 mg daily , chaild 5-10 mg
Q10( Digoxin is monitoring in: -liver
-kidney-both****
-non
Q11 ) ال عن شيء كل oxytocin اعرفIndication: of labour or stimulate of labour in hypotonic uterin inertia by IV infusion do not use above 5 unit, used also for preventon postpartum haemorrhge after delivery.
Q12( one of this is not use in ascaris infection-niclosamide****
-piperazin-mebendazole
-pyratel
Q13( increase digoxin level in person with( و بالعمر الكبار مثال نسبته تزيد ) ....متىIn elderly with people renal insufficiency the level of digoxin increase.
Q14( phenyl ephrine????? عنه شي كل اعرفIndication of phenylephrine : acute hypotention,mydrasis, decongestant ,sympathomemetic, iv additive, ttt nasal congestion, running nose
Q15( all this controlled drug except:-cabamazepine
-rivotrill-tylerol***-diazepam
Q16 ) ال ادوية اسماء bronchodilator احفظ
Q17( action of the allopurinol??Mechanism of action is xanthin oxidase inh used for 1(prophylaxis of gout 2(ttt of uric acid and ca oxalate renal stone.
Q18( ACE I ل األساسي االستخدام هو ماHypertention and CHF regardless of the cause.
Q19( misoprostol عن شيء كل أحفظSynthetic PEG prostaglandine has antisecretory and protective ,promot healing of gastric ulcer & associated NSAID ulcer common side effect diarrhea its contraindicated in pregnancy.
Q20( nifidipine عن المعلومات كل اعرفIs ca channel blocker is relax smooth muscle vascular muscle and dailate coronary artery Indication rophylaxis angina , hypertention , raynaudes phenomens Caution:withdrow if schemic pain occure.
Contraindication:cardiogenic shock, advanced aoretic stenosis , myocardial infraction.
S.E: hedeach, flushing, diazziness, tachycardia , nausea , conistipation ,diarrhea …. EtcTrade name: adalat
Q21( ischemic heart disease contraindication : -epinephrine
-nadolol-isosorbide nitrate***
-captopril
Q22( time for treatment of Brucellosis is 6 weeks
Q23( what the name of antibacterial that take with vit c to increase activity?
Q24( narcotic prescription ب فيها يحتفظ التي المدة هي ما-10 year
-5 year***-2 year
-non of above
Q25(clonidine عن شيء كلIndication:hypertention ,migraineDose:50-100 microgram 3 time daily increased every second or theird day usually max dose 1.2 mg/dailly
Q26( % elimination of ferrous gluconate:-10%-12%-20%
-30%***-33%
Q27 ) فتحة مساحة اإلبرة كم-25
-24 ***-22-20
Q28( relationship between drug in body and plasma conc:-one compartment model
-volume distribution -half life
-elimination time****
Q29 ) بشعور المريض يشعر حتى تفعل الدكتور ماذا حول during ptnالراحةcounceling on medication what are the things that make ptn feel confidant and comfortable about information your give:
c( assure ptn compliance with his/ her drugs, don’t discuss major side effect with ptn.
الحائط - ع الشهادة تعلقبك - خاصة معلومات عن تخبره
عن - للدواء تخبره الجانبية اآلثارصحيح - ذكر ما كل
Q30( E Coli cause of : -U T I
-Diarrhea -Meningitis
-All of a above***
Q31( which of the following is not cause weight gain: -Insulin
-Pergolide*** -Bioglinide
-Metforme
Q32( aseptic technique use for : -Extemporaneous preparation
-Ophthalmic preparation -Iv injection preparation
-All of above***
Q33( which of one is no effect on platelet: -Aspirin
-Heparin*** -Warfarin
???????? -
Q34( use of glucocorticoid ?Anti-inflammatory, acute hyper sensitivity reaction, suppression of inflammation , allergic disorder, conginetal adrenal hyperplasia , cerebral odema , asthma broncho dilator , rheumatic fever , hepatitis and sarcoidosis , immunosupprssion , aretritis , aphthous ulcer, diagnosis of caushin syndrome ,nausea, vomiting with chemotherapy , eye & ear inflammation, shock
Q35( extemporaneous preparationOf misoprostol gel for cervical ripening: saftley and effeicacy of intravaginal misorostol gel.
Used in oral medicin for children when dug prescriped are unlicensed or off label for liquid, capsul ,powder.The most common extempororanous prep product were solution and suspension. And used in unlamellar liposome and in in perp lisinopril.
Note clamid: aprocess for extemporaneous prep of liposome the divice dialysate for dialysis generator .
Q36( narcotic أدوية تصرف حتى بالوصفة يكتب ان يجب ماذاAccording to MOH regulation narcotic prescription can be dispensed by it pharmacist when:
a(All of above****b(having clear ptn name and identification number written clearly on the
prescription .c(having the presciper number , identification number, signature clearly.d(the prescription can be filled maximum of 3 days after his been written.
Q37( all of these cause GTI upset except: -Valporate
-Pheno barbitone**** -Phenytion
-Chlorpromazine
سالمين بالدكم إلى وأعادكم غربتكم في الله وفقكمغانمين
دعــــائكم صالح من تنسوني الربـــه عفو الراجي أخوكم
) M.A.S.A(أبوالخير د/محمد
Drugs Affecting ANS
Cholinergic Drugs
1. Cholinergic Agonist:
Direct Acting:
Cholinergic agonists (also known as parasympathomimetics) mimic the effects of acetylcholine by binding directly to cholinoceptors.
Acetylcholine, Pilocarpine, Bethanecol, Carbachol.
Indirect Acting:
Acetylcholinesterase is an enzyme that specifically cleaves acetylcholine to acetate and choline and, thus, terminates its actions. Inhibitors of acetylcholinesterase indirectly provide a cholinergic action by prolonging the lifetime of acetylcholine.
Physostigmine, Neostigmine, Ecothiophate, Rivastigmine, Tacrine.
Reactivation of Actylcholine-esterase:
Pralidoxime.
2. Cholinergic Antagonist:
Antimuscarinic:
Commonly known as antimuscarinics, these agents block muscarinic receptors, causing inhibition of all muscarinic functions.
Atropine, Scopolamine, Ipratropium.
Ganglionic Bolckers:
Ganglionic blockers specifically act on the nicotinic receptors of both parasympathetic and sympathetic autonomic ganglia. Except for nicotine, the other drugs mentioned in this category are nondepolarizing, competitive antagonists.
Mecylamine, Nicotine.
Neuromuscular Bolckers:
These neuromuscular blockers are structural analogs of acetylcholine, and they act either as antagonists (nondepolarizing type) or agonists (depolarizing type) at the receptors on the end plate of the neuromuscular junction. Neuromuscular blockers are clinically useful during surgery for producing complete muscle relaxation
Atracurium, Doxacurium, Succinylcholine, Tubocurarine.
Adrenergic Drugs
1. Agrenergic Agonist:
Direct Acting:
These drugs act directly on α or β receptors, producing effects similar to those that occur following stimulation of sympathetic nerves or release of the hormone epinephrine from the adrenal medulla.
Dopamine, Epinephrine, Norepinephrine, Phenylephrine, Sameterol, Terbutaline.
Indirect Acting:
These agents, which include amphetamine, cocaine and tyramine, may block the uptake of norepinephrine (uptake blockers) or are taken up into the presynaptic neuron and cause the release of norepinephrine from the cytoplasmic pools or vesicles of the adrenergic neuron. As with neuronal stimulation, the norepinephrine then traverses the synapse and binds to the α or β receptors.
Amphetamine, Cocaine, Tyramine.
Mixed:
Capacity both to stimulate adrenoceptors directly and to release norepinephrine from the adrenergic neuron.
Ephedrine, Pseudoephedrine.
2. Adrenergic Antagonist:
α -Blockers:
Drugs that block α-adrenoceptors profoundly affect blood pressure.
Doxazocin, Prazocin, Terazocin, Tamsulosin.
Β - Blockers:
All the clinically available B-blockers are competitive antagonists. Nonselective B-blockers act at both B1 and B2 receptors, whereas cardioselective B antagonists primarily block B1 receptors.
Atenolol, Esmolol, Labetalol, Pindolol.
NT Uptake or Release:
Guanethidine, Reserpine.
CNS Drugs
Anti-Parkinsonism Drugs:
The disease is correlated with destruction of dopaminergic neurons in the substantia nigra.
Levodopa, Carbidopa, Amantidine, Apomorphine, Benzotropine.
Alzheimer Drugs:
Major cause is loss of Cholinergic neurons.
Memantine, Rivastigmine, Tacrine.
Anxiolytic Drugs:
a. Benzodiazepenes:
Alprazolam, Temazepam, Flurazepam, Lorazepam, Oxazepam.
b. Barbiturates:
Amobarbital, Phenobarbital, Pentobarbital, Thiopental.
c. Other Anxiolytic:
Buspirone(mediated by serotonin (5-HT1A) receptors), Hydroxyzine, Anti-depressants.
CNS Stimulants:
a. Psychomotor Stimulants:
Psychomotor stimulants, cause excitement and euphoria, decrease feelings of fatigue, and increase motor activity.
Amphetamine, Cocaine, Caffeine, Theobromine.
b. Hallucinogens:
The hallucinogens, or psychotomimetic drugs, produce profound changes in thought patterns and mood, with little effect on the brainstem and spinal cord.
Lysergic Acid Diethylamide, Tetrahydro Cannabinol.
CNS Drugs
Anti-Depressants:
a. SSRIs:
Cetalopram, Fluoxetine, Fluvoxamine.
b. SNRIs:
Duloxetine, Venlafaxine.
c. Atypical Ads:
Bupropion, Trazodone.
d. TCAs (Older SNRIs):
Amitryptiline, Imipramine, Trimipramine.
e. MAO Inhibitors:
The MAO inhibitors may irreversibly or reversibly inactivate the mitochondrial enzyme (gut and liver), permitting neurotransmitter molecules to escape degradation and, therefore, to both accumulate within the presynaptic neuron and leak into the synaptic space.
Phenelzine, Selegiline.
f. Anti-Mania & Bipolar Disorders:
Valproic Acid, Lithium Salts.
Anti-Epileptics:
By a variety of mechanisms, including blockade of voltage-gated channels (Na+ or Ca2+), enhancement of inhibitory GABAergic impulses, or interference with excitatory glutamate transmission.
Barbiturates, BZDs, Carbamezepine, Gabapentin, Ethosuximide, Levetiracetam, Felbamate, Phenytoin, Zonisamide.
CNS Drugs
Neuroleptic Drugs (Anti-Psychotic or Major Tranquilizers):
They inactivate Dopamine receptors.
a. Typical but low potency:
Chlorpromazine, Prochlorperazine.
b. Typical but high potency:
Haloperidol, Thiothixene.
c. Atypical:
Clozapine, Olanzapine, Risperidone.
Opoids:
Activation of the opoid receptor decreases the Ca2+ influx and increases the K+ efflux. Decrease Ca+ influx decreases the release of excitatory NT and increased K+ efflux decreases the response of post-synaptic neuron to excitatory NT (Glutamate).
a. Strong Agonists:
Meperadine, Methadone, Heroine, Fentanyl.
b. Moderate/Low Agonists:
Codeine, Propoxyphene.
c. Partial Agonists:
Buprenorphine, Pentazocine.
d. Antagonists:
Naloxone, Naltrexone.
e. Others:
Tramadol.
CVS Drugs
Congestive Heart Failure(CHF):
a. Renin Angiotensin System Blockers:
These drugs block the enzyme that cleaves angiotensin I to form the potent vasoconstrictor angiotensin II. Also diminish the rate of bradykinin inactivation. [Note: Vasodilation occurs as a result of the combined effects of lower vasoconstriction caused by diminished levels of angiotensin II and the potent vasodilating effect of increased bradykinin.] By reducing circulating angiotensin II levels, ACE inhibitors also decrease the secretion of aldosterone, resulting in decreased sodium and water retention.
Captopril, Lisinopril, Quinapril, Ramipril, Enalapril (ACE Inhibitors)
ARBs are nonpeptide, orally active compounds that are extremely potent competitive antagonists of the angiotensin type 1 receptor.
Losartan, Valsartan, Telmisartan (ARBs)
b. β -Blockers:
Atenolol, Metoprolol, Carvedilol.
c. Diuretics:
Diuretics decrease plasma volume and, subsequently, decrease venous return to the heart (preload). This decreases the cardiac workload and the oxygen demand.
Bumetanide, Furesamide, Metolazone, Hydrochlorthiazide.
d. Direct Vasodilators:
Hydralazine, Isosorbide dinitrate, Sod nitroprusside.
e. Inotropic Agents:
Enhance cardiac muscle contractility and, thus, increase cardiac output.
Digitoxin, Digoxin, Dobutamine, Amrinone.
f. Aldosterone Antagonist:
Spironolactone.
*Dec. Angiotensin II cause dec. Aldosterone which cause decreased water & sod retention. Plasma vol is decreased and hence preload also decreased & BP lowered.
Anti-Arrythmic Drugs:
Arrhythmias arise either from aberrations in impulse generation (abnormal automaticity) or from a defect in impulse conduction.
a. Na + Channel Blockers:
Quinidine, Procanamide, Propafenone.
b. β -Blockers:
Inhibits Phase 4 depolarization in SA & AV nodes.
Esmolol, Propranolol, Metoprolol.
c. K + Channel Blockers:
Prolongs Phase 3 repolarization in ventricular muscle fibres.
Amiodarone, Sotalol, Dofetilide.
d. Ca 2+ Channel Blockers:
Inhibits action potential in SA & AV nodes.
Diltiazem, Verapamil.
e. Others:
Adenosine, Digoxin.
Anti-Anginal Drugs:
a. Organic Nitrates:
Nitrates decrease coronary vasoconstriction or spasm and increase perfusion of the myocardium by relaxing coronary arteries. In addition, they relax veins, decreasing preload and myocardial oxygen consumption.
Isosorbide dinitrate & mononitrate, Nitroglycerin.
b. β -Blockers:
They decrease the oxygen demands of the myocardium by lowering both the rate and the force of contraction of the heart.
Acebutolol, Atenolol, Metoprolol, Propranolol.
c. Ca Channel Blockers:
The calcium-channel blockers protect the tissue by inhibiting the entrance of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds.
Amlodipine, Diltiazem, Verapamil, Nicardipine, Nifedipine.
Anti-Hyperlipidemics:
a. HMG CoA Reductase Inhibitors:
Analogs of HMG(precursor of Cholesterol). Because of their strong affinity for the enzyme, all compete effectively to inhibit HMG CoA reductase, the rate-limiting step in cholesterol synthesis (de novo synthesis).
Atorvastatin, Lovastatin, Provastatin, Simvastatin.
b. Fibrates:
Gemfibrozil, Fenofibrate.
c. Niacin:
Niacin strongly inhibits lipolysis in adipose tissue, the primary producer of circulating free fatty acids.
d. Bile Acid Sequestrants:
Colestipol, Colestyramine, Colesevelam.
e. Cholesterol Absorption Inhibitors:
It inhibits intestinal absorption of dietary and biliary cholesterol in the small intestine, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood.
Ezetimibe.
Anti-Hypertensives:
a. Diuretics:
They cause increased water and sodium excretion leading to decreased extracellular volume & decreased cardiac output.
Bumetanide, Furosamide, Spironolactone, Hydrochlorthiazide.
b. β -Blockers:
Decrease Cardiac Output.
Atenolol, Carvedilol, Labetalol, Metoprolol.
c. ACE-Inhibitors:
ACE inhibitors decrease conversion into angiotensin II and increase bradykinin levels. Vasodilation occurs as a result of the combined effects of lower vasoconstriction caused by diminished levels of angiotensin II and the potent vasodilating effect of increased bradykinin.
Captopril, Enalapril,Fosinopril, Lisinopril, Ramipril.
d. ARBs:
Same As ACEIs but no Cough or Angiodema.
Candesartan, Losartan, Telmisartan, Valsartan.
e. Ca Channel Blockers:
Verapamil, Nifedipine, Nicardipine, Diltiazem, Amlodipine.
f. α -Blockers:
They decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle.
Doxazocin, Prazocin, Terazocin.
g. Others:
Clonidine, Hydralazine, Sod. nitroprusside, Minoxidil, α-Methyldopa.
Diuretics:
a. Thiazides:
These drugs increase the concentration of Na+ and Cl- in the tubular fluid by decreasing the reabsorption of Na in the distal convulated tubule.
Chlorothiazide, Chlorthalidone, Indapamide, Hydrochlorthiazide.
b. Loop Diuretics:
Loop diuretics inhibit the cotransport of Na+/K+/2Cl- in the luminal membrane in the ascending limb of the loop of Henle. Therefore, reabsorption of these ions is decreased. Most efficacious.
Bumetanide, Furosamide, Torsemide.
c. Potassium Sparing Diuretics:
Amiloride, Spironolactone, Triamterene.
d. Carbonic Anhydrase Inhibitors:
Acetazolamide.
e. Osmotic Diuretics:
Mannitol, Urea.
Antibiotics (Antimicrobials)
Cell Wall Inhibitors:
These drugs interfere with the last step of bacterial cell wall synthesis (transpeptidation or cross-linkage), resulting in exposure of the osmotically less stable membrane. Cell lysis can then occur,
either through osmotic pressure or through the activation of autolysins. These drugs are thus bactericidal.
a. B-lactams:
i- Penicillins:
Amoxicillin, Ampicillin, Piperacillin, Oxacillin, Methicillin, Nafcillin.
ii- Cephalosporins:
1st Generation (Cefadroxil, Cefalexin)
2nd Generation (Cefaclor, Cefoxitin, Cefprozil)
3rd Generation (Cefixime, Cefotaxime, Cefibuten, Ceftriaxone)
4th Generation (Cefepime)
iii- Carbapenems:
Meropenem, Imipenem.
Iv- Monobactam:
Aztreonam.
b. Other Antibiotics:
Bacitracin, Vancomycin, Daptomycin.
Protein Synthesis Inhibitors:
a. Tetracyclines:
The drug binds reversibly to the 30S subunit of the bacterial ribosome, thereby blocking access of the amino acyl-tRNA to the mRNA-ribosome complex at the acceptor site. By this mechanism, bacterial protein synthesis is inhibited.
Doxycycline, Minocycline, Tetracycline.
b. Glycylcyclines:
Also binds reversibly to the 30S of the ribosomal unit.
Tigecycline.
c. Aminoglycosides (derived from Streptomyces have -mycin suffixes, whereas those derived from Micromonospora end in –micin):
Also binds reversibly to the 30S ribosomal subunit & inhibiting protein translation.
All aminoglycosides should be given parenterally except neomycin.
Amikacin, Gentamicin, Neomycin, Tobramycin, Streptomycin.
d. Macrolides/Ketolides:
The macrolides bind irreversibly to a site on the 50S subunit of the bacterial ribosome, thus inhibiting the translocation steps of protein synthesis.
Azithromycin, Clarithromycin, Erythromycin, Telithromycin.
e. Chloramphenicol (50S subunit)
f. Clindamycin
g. Dalfopristin/Quinupristin (50S subunit)
h. Linezolid (binds to a site on the 50S subunit near the interface with the 30S subunit)
Fluoroquinolones:
These drugs enter the bacterium by passive diffusion through water-filled protein channels (porins) in the outer membrane and then inhibit the replication of bacterial DNA by interfering with the action of DNA gyrase (topoisomerase II) and topoisomerase IV during bacterial growth and reproduction.
Nalidixic Acid, (Ciprofloxacin, Ofloxacin, Norfloxacin), Levofloxacin, Moxifloxacin.
Folate Synthesis Inhibitors:
Silver Sulfadiazene, Sulfamethoxazole, Sulfasalazine, Sulfisoxazole.
Folate Reduction Inhibitors:
Pyrimethamine, Trimethoprim.
Combination of Above two:
Co-trimoxazole.
UTI Antiseptics:
Methenamine, Nitrofurantoin(urine discoloration).
Where Sulfonamides and Trimethoprim act ??
Pteridine + p-ABA + Glutamate Dihydrofolic Acid (Sulfonamide) (microbes)
Dihydrofolic Acid Tetra hydro folic Acid (Trimethoprim) (humans)
Tetrahydrofolic Acid Amino Acid Synthesis + Purine Synthesis + Thymidine Synthesis
Antimycobacterials And Antifungals
Anti-TB drugs:
Isoniazid(altering cell membrane function), Ethambutol(inhibit normal arabinogalactin cell wall), Rifampicin(inhibits synthesis of mRNA), Pyrazinamide(unknown). (1st line drugs)
Aminoglycosides, Macrolides, Cycloserine, Ethionamide,. (2nd line drugs)
Anti-Leprosy Drugs:
Clofazimine, Dapsone, Rifampin.
Subcutaneous and Systemic Mycoses:
Amphitericin B, Fluconazole, Ketoconazole, Micafungin, Capsofungin.
Cutaneous Mycoses:
Butoconazole, Griseofulvin, Nystatin, Terbinafine.
Antiprotozoals & Antihelminthics
Amebiasis:
Chloroquine, Emetine, Dehydroemetine, Metronidazole, Paramomycin.
Malaria:
Artemisinin, Primaquine, Pyrimethamine, Mefloquine, Quinine/Quinidine.
Trypanosomiasis:
Benznidazole,Suramin, Nifurtimox, Melarsoprol.
Leishmaniasis:
Sodium stibogluconate.
Toxoplasmosis:
Pyrimethamine.
Giardiasis:
Metronidazole, Nitazoxanide, Tinidazole.
Anti-Nematodes (Ascaris, Hookworms, Filarias. Enterobius, Trichinella):
Ivermectin, Pyrantel pamoate, Diethylcarbamazine.
Anti-Trematodes (Schistosomes):
Praziquantel.
Anti-Cestodes (Tapeworms):
Niclosamide, Albendazole.
Anti-Virals
Respiratory Virus Infections:
Amantadine, Rimantadine, Ribavirin, Zanamivir.
Hepatic Viral Infections:
Interferon, Adefovir, Entecavir.
HIV Infections:
Abacavir, Didanosine, Etravirine, Fosamprenavir, Tenofovir.
Anti-Cancers
Antimetabolites:
Methotrexate, Gemcitabine, 6-Mercaptopurine, Cytarabine.
Antibiotics:
Bleomycin, Doxorubicin, Daunorubicin.
Alkylating Agents:
Cyclophosphamide, Busulfan, Ifosfamide, Mechlorethamine, Streptozocin.
Microtubule Inhibitors:
Docetaxel, Vincristine, Vinblastine, Vinorelbine.
Steroids, Hormones and their Antagonists:
Prednisone, Tamoxifen, Estrogens, Goserelin, Letrozole.
Monoclonal Antibodies:
Cetuximab, Rituximab.
Others:
Asparaginase, Interferons, Cisplatin, Etoposide, Imanitib, Topotecan, Oxaliplatin.
Anti-Inflammatory
NSAIDs:
Aspirin, Diclofenac, Indomethacin, Fenamates, Ibuprofen, Piroxicam, Sulindac.
CoX-2 Inhibitors:
Celecoxib.
Other Analgesics:
Acetaminophen.
Anti-Arthritis:
Adalimumab, Anakinra, Infliximab, Gold salts, D-Penicillamine.
Drugs for Gout:
Allopurinol, Colchicine, Probenecid, Sufinpyrazone.
Autocoids & Their Antagonists
Prostaglandins:
Misoprostol.
H1-Antihistamines:
H1 receptors present in exocrine excretion, bronchial smooth muscles, intestinal smooth muscles and sensory nerve endings.
H1 & H2 receptors present in CVS & Skin.
H2 receptors found only in stomach.
First Generation (Chlorpheniramine, Diphenhydramine, Dimenhydrinate)
Second Generation (Cetrizine, Fexofenadine, Loratadine)
Migraine Headache:
Almotriptan, Naratriptan, Riztriptan, Sumatriptan, Zolmitriptan.
Facts to Remember
Substance P Blocker: APREPITANT
Isoniazid written as INH represents IsoNicotinic acid Hydrazide.
Uterus Parts: Fundus; Body; Corporis; Cervix.
Fallopian tube connects ovary with uterus.
Female Reproductive System: Ovary; Fallopian Tube; Uterus; Vagina.
Embryo life cycle: 1-8weeks
Fetus: After 8weeks
Uterus walls: Endometrium Myometrium; Parametrium.
Endo & Myometrial walls involved in the production of Prostaglandins.
F2α: Vasoconstrictor(dysmenorrhia)
E2: Vasodilator (menorraghia)
I2: Myometrial relaxation; vasodialtion; anti-platelets.
Menarchie: First Periods of a woman (8-16yrs) Avg: 13yrs.
Most regularized periods:20-40yrs.
Average cycle: 28days (24-36days)
Average Flow: 3-7days; Typical Flow: 5days
Starts light then heavy then again light.
ACEIs contraindicated in bilateral renal artery stenosi.
Desmopressine used in nocturnal enuresis.
Ovulation: Release of ova from the ovary.
Range: Day 8th-20th (14th day).
A woman has almost 2000days of periods in her life (400cycles) except pregnancy and illness.
Menstrual cycle: Menstruation; Proliferation; Ovulation; Secretory.
Menstruation: Day 1-5.
Proliferation: Day 6-13.
Ovulation: Day 14th.
Secretory: Day 15-28.
Graffian Follicle before ovulation secrete estrogen and after ovulation is is known as Corpeus Luteum and secretes Progesterone which develops thick wall of uterus (endometrium).
Cervix: Neck of uterus.
Basal Body Temperature (BBT):Temp at relaxed body state.
Nociceptives: Nerve Endings that sense pain.
Anhedonia: An unprovoked stimuli could result in painful sensation normally not painful.
Gestational Diabetes: Diabetes that occurs during pregnancy and soon disappears after child birth.
Major Adverse effect of Adenosine is Dyspnea.
Verapamil is contraindicated with CNS Depressants.
Daily dose of Folic Acid is 400-500µg.
Types of Pain:
a. Nociceptive: Pain due to sensitization of nociceptive nerve endings due to certain tissue damage.
b. Neuropathic: Any lesion or damage to the nerve fibres, resulting in pain. E.g. Diabetic Peripheral Neuropathy (DPN)
c. Mixed: Low back pain; Ankolysing Spondylitis.
Mechanism of Feeling pain:
a. Reception: Stimulation of nociceptives by PGs.
b. Conduction: From Nerve ending to brain.
c. Perception: Cortex & Thallamus receive impulse.
d. Suffering: Reaction.
Pain & Inflammation Mediators: Histamine; Bradykinins; Kinins; Substace P; PGs.
PGs increase blood flow to the injury site and accelerate the transfer of WBCs and Platelets.
Inflammation: Natural response to the injury to inactivate causative agent.
PGs increase vascular permeability and WBCs migration and sensitization of Nociceptives.
PAE: The postantibiotic effect (PAE) is a persistent suppression of microbial growth that occurs after levels of antibiotic have fallen below the MIC.
Myasthenia gravis: (Muscle weakness)Autoimmune disorder due to blockade of cholinoceptors by circulating antibodies. Treatment by Neostigmine, physostigmine.
Diabetes Type-I: Insulin Dependant; when the body stops making insulin. Also called brittle or labile diabetes.
Diabetes Type-II: Non Insulin Dependant; body is making insulin either in insufficient amount or the cells do not respond to body made insulin.
Menorrhagia: Excess Blood flow in frequency, duration or amount; upto 80ml. (20-30ml)
PGE2: Inc. vasodilation; Dec. platelet adhesion & aggregation…… Inc. Blood Flow.
PGF2α: Inc. vasospasm; Inc. uterine contractions…… Painful Menses.
Hyperalgesia: Intensed Pain.
Articular: Bones & Joints. Non-Articular: Tendons; Ligaments; Bursa.
Epicondyl: Bony projections at the end of long bones.
Sprains: Injury to the ligament.
Stills Disease: Juvenile Idiopathic Arthritis.
In enteral route duodenum is the major site for drug absorption.
Bioavailability: Fraction of the drug that reaches the blood stream.
Total body water in 70kg human=42litres.
Intracellular( 28ltrs) + Interstitial(10ltrs) + Plasma(4ltrs)= 42 litres.
Volume of Distribution: Hypothetical volume of fluids into which drug is dispersed.
Albumin has the strongest affinity with anionic and hydrophobic drugs.
Each cell may have 10,000 receptors e.g. heart has B-receptor for norepinephrine and muscarinic receptor for acetylcholine.
Potassium is administered as Slow IV infusions.
Receptor: Biological molecule to which drug binding produce measurable response.
Receptor Types:
a. Ligand gated Ion Channels: GABA (Fastest reception)
b. G-protein Coupled: Sildenafil
c. Enzyme Linked: Insulin
d. Intracellular Receptors: Steroids (Slowest reception)
Competitive Antagonism: Same site on same receptor e.g. Prazocin & Norepinephrine.
Non-competitive Antagonism/Allosteric: Different sites on same receptor e.g. Protamine & Heparin.
Functional/Physiologic Antagonism: Different receptors involved e.g. Epinephrine & Histamine.
Quantal-Dose Response: Study of dose-response on a population that responds.
Therapeutic Index: Ratio of toxic dose to effective dose.
Drugs with High Therapeutic Index is SAFER to use.
Catecholamines have brief duration & rapid onset of action and do not cross BBB.
Non-catecholamines have longer duration of action and can be administered orally.
Narcolepsy: Narcolepsy is a relatively rare sleep disorder that is characterized by uncontrollable bouts of sleepiness during the day. It is sometimes accompanied by catalepsy, a loss in muscle control, or even paralysis brought on by strong emotions, such as laughter.
P450 enzyme INDUCERS: Smoking, Omeprazole, Rifampicin, Carbamazepine, Phenytoin, Phenobarbital.
P450 enzyme INHIBITORS: Cimetidine, Fluvoxamine, Isoniazid Quinidine, Macrolides, Chloramphenicol.
INR: A laboratory test to called INTERNATIONAL NORMALISED RATIO measures the time it takes for a blood sample to clot and compares it with average clotting time(5-11min). Average CT measured by Dale’s method (taking a blood sample in a thin capillary and the end of tube is broken every 30sec until clot formed).
Bleeding Time: It is the time until which the blood continues oozing from the injured site(1-5min). Measured by Duke’s method (pricking a finger and taking the blood sample every 30sec. on a filter paper until blood stops coming).
Norepinephrine is ineffective orally.
Alpha Methyldopa is the only ani-hypertensive used in pregnancy.
Major side effect of Doxorubicin is tissue necrosis.
Oxidation is Phase-I reaction.
In overdosage of Digoxin we use Antidote FAB fragment.
Digitoxin toxicity reflects in ECG as to prolong PR interval.
Myxodema (Hypothyroidism) treated by Thyroid sodium.
Vit A daily dose is 30,000-50,000 IU.
Vit C daily dose is 400mg for both men and women.
Floxapen (flucloxacillin) is resistant to penicilinnase.
Chelators are drugs that form covalent bonds with cationic metals.
Antibiotics showing Conc. dependant killing involve aminoglycosides, flouroquinolones, carbapenems.
While those showing time dependant killing involve β-lactams, macrolides, clindamycin.
Narrow Spectrum: Covering single or limited group of microbes. e.g Isoniazid.
Extended Spectrum: Covering gram +ve and also significant gram –ve bacteria. e.g Ampicillin
Broad Spectrum: Covering a wie variety of microbes; also the beneficial microbes causing Candida albicans. e.g Tetracyclines, Chloramphenicol.
Angina Pectoris: It is a characteristic sudden, severe, pressing chest pain radiating to the neck, jaw, back, and arms. It is caused by coronary blood flow that is insufficient to meet the oxygen demands of the myocardium, leading to ischemia.
Stable Angina(Typical): It is characterized by a burning, heavy, or squeezing feeling in the chest. It is caused by the reduction of coronary perfusion due to a fixed obstruction produced by coronary atherosclerosis.
Unstable Angina: In unstable angina, chest pains occur with increased frequency and are precipitated by progressively less effort.(lies b/w Angina and MI)
Prinzmetal/Variant/Vasopastic Angina: It is an uncommon pattern of episodic angina that occurs at rest and is due to coronary artery spasm. Symptoms are caused by decreased blood flow to the heart muscle due to spasm of the coronary artery.
Mixed Angina: Patients with advanced coronary artery disease may present with angina episodes during effort as well as at rest, suggesting the presence of a fixed obstruction associated with endothelial dysfunction.
Angiodema: Angioedema or Quincke's edema is the rapid swelling (edema) of the dermis, subcutaneous tissue, mucosa and submucosal tissues. Also known as angioneurotic oedema. Due to increased bradykinin(vasodilator) levels which occurs in ACEIs treatment.
Hydralazine causes Lupus Like Syndrome.
Hypothyroidism & Antidepressants causes Weight Gain.
Low Density Lipoproteins LPLs act as Carriers of cholesterol in Plasma.
HDLs cause atherosclerosis.
Sites of Antibiotics: Cell wall synthesis(B-lactams); metabolism(sulfonamides); protein synthesis(macrolides); nucleic acid function or synthesis(cipro); cell membrane function(isoniazid).
Drugs Affecting Other Organs
Respiratory System:
a. Asthma:
β2-Adrenergic Agonists, Corticosteroids, Montelukast(Cysteinyl leukotriene antagonist), Theophylline, Omalizumab.
b. Allergic Rhinitis:
α-Adrenergic Agonists, Antihistamines, Corticosteroids, Cromolyn.
c. COPD: β-Adrenergic Agonists, Corticosteroids, Ipratropium.
d. Cough: Dextromethorphan, Opiates.
GIT Drugs:
Parietal cell is acted upon by Acetylcholine, Gastrin, Histamine & Prostaglandin. PG has inhibitory effect while others increase acid release.
a. Anti-Microbials:
Amoxycillin, Clarithromycin, Tetracycline, Metronidazole.
b. H2-Receptor Antagonist:
They are competitive antagonists of histamine and are fully reversible. These agents completely inhibit gastric acid secretion induced by histamine or gastrin.
Cimetidine, Ranitidine, Famotidine.
c. PPIs:
They bind to the H+/K+-ATPase enzyme system (proton pump) of the parietal cell, thereby suppressing secretion of hydrogen ions into the gastric lumen. The membrane-bound proton pump is the final step in the secretion of gastric acid
Esomeprazole, Omeprazole, Lansoprazole.
d. Prostaglandins:
Prostaglandin E2, produced by the gastric mucosa, inhibits secretion of HCl and stimulates secretion of mucus and bicarbonate.
Misoprostol (Prostaglandin E2 analog).
e. Antacids:
Aluminium Hydroxide, Magnesium Hydroxide.
f. Mucosal Protective Agents:
Sucralfate.
Anti-Emetics:
a. Phenothiazines:
Prochlorperazine (Block dopamine receptors)
b. 5-HT3 receptor blocker:
They selectively block 5-HT3 receptors in the periphery (visceral vagal afferent fibers) and in the brain.
Ondansetron, Granisetron, Dolasetron.
c. Butyrophenones:
Droperidol, Haloperidol (Block Dopamine receptors).
d, Substance P/Neurokinin-I Blocker:
Aprepitant (It targets the neurokinin receptor in the brain and blocks the actions of the natural substance)
Anti-diarrheals:
a. Anti-motility agents:
Both are analogs of meperidine and have opioid-like actions on the gut, activating presynaptic opioid receptors in the enteric nervous system to inhibit acetylcholine release and decrease peristalsis. At the usual doses, they lack analgesic effects.
Diphenoxylate, Loperamide.
b. Adsorbents:
Bismuth subsalicylate, Methylcellulose, Aluminum hydroxide.
c. Agents that modify fluid and electrolyte transport:
Bismuth subsalicylate. (Traveller’s diarrhea)
Laxatives:
a. Irritants & Stimulants:
Senna, Bisacodyl.
b. Bulk Laxatives:
They form gels in the large intestine, causing water retention and intestinal distension, thereby increasing peristaltic activity.
Methylcellulose, Psyllium seeds, Bran.
c. Stool softeners: (Emollient laxatives/Surfactants)
Docusate sodium, Docusate calcium, Docusate potassium.
d. Lubricant Laxatives:
Mineral oil & Glycerin suppositories. (Facilitate the passage of hard stools)
Other Therapies
Erectile Dysfunction (PDE-5 Inhibitors):
Sildenafil, Vardenafil.
Osteoporosis:
Alendronate, Ibandronate, Calcitonin, Zoledronic Acid.
Obesity:
Orlistat (lipase inhibitor), Sibutramine (anorexiant), Phentermine (anorexiant).
Adrenal Hormones
Structure : Inner part Medulla secreting Epinehprine. Outer part cortex. Cortex is further divided into three parts. Inner most of cortex is Reticularis which secretes Adrenal androgens; Middle part called Fasciculata secreting Glucocorticoids and outer most is the Glomerulosa which secretes Mineralocorticoids.
Physiology:
Hypothalamus A Pituitary Adrenal Gland
Glucocorticoids & Mineralocorticoids are collectively known as Corticosteroids.
Cortisol also acts as a feedback mechanism and inhibits both processes from hypothalamus to anterior pituitary and pituitary to adrenal glands.
Glucocorticoids:
a. Short Acting (1-12 hrs): Hydrocortisone, Cortisone.
b. Intermediate Acting (12-36hrs): Prednisone, Prednisolone, Methylprednisolone.
c. Long Acting (36-55hrs): Betamethasone, Dexamethasone.
Mineralocorticoids: Deoxycorticosterone, Fludrocortisone.
Glucocorticoids act as anti inflammatory by inhibiting PGs and Leukotrienes & also redistribute WBCs to other body sites; also reduce histamine release from mast cells and basophils; decrease ability of macrophages and leukocytes to antigens and mitogens.
Also used in Treatment of Allergies and Diagnosis of Cushing’s disease (Overproduction of glucocoricoids)
Biopharm Concepts
Metabolism can happen in two phases.
Phase I reactions involve hydrolysis, oxidation and reduction (results in low hydrophilicity).
Phase II reactions involve glucoronidation, sulfonation, acetylation, methylation, conjugation with glutathione or amino acids(cause high hydrophilicity).
Phase I may or may not precede Phase II.
Clearance is the volume of plasma cleared off drug per unit time. Its unit is ml/min.
Pharmacokinetics involves the movement of drug or its metabolites into or out of the body and also evaluates its metabolism rates.
Zero order kinetics is independent of drug concentrations; usually seen when reaction system is saturated.e.g Metabolism of Phenytoin, Constant rate IV Infusion.
In First order kinetics rate of drug elimination at particular time is directly proportional to the amount of drug in the body at that time; Semi Logarithmic plot of Plasma Drug Conc vs time is a straight line.
Elimination rate constant, Vd, clearance and half life are independent of the dose of the drug.
First order kinetics is also known as monoexponential kinetics; in which rate of reaction is directly proportional to the drug concentration in the reaction.
Mixed Order Kinetics depends on the dose of the drug and are thus known as Dose Dependant or Non-Linear Kinetics. Generally described by Michelis Menten Equation.
Biopharm Concepts
Pharmacokinetic Models are imaginary compartments.
Central Compartment represents plasma and tissues which rapidly equilibrate with drugs.
Peripheral Compartments represents tissues or organs which equilibrate slowly.
Number and site of compartments is determined by the blood perfusion capacity and drug physicochemical properties.
Michelis Menten Equation:
-dc = Vmax x C
dt Km + C
Plasma albumin has 4 binding sites .i.e Warfarin, Diazepam, Tamoxifen, Digoxin.
Total body tissue comprises 40% of the total body.
Pharmaceutical Equivalents: If two drugs contain same amount of active ingredient in same dosage form. They may contain different excipients.
Pharmaceutical Alternatives: If two drugs contain same drug molecule but in different chemical form e.g different salt or strength.
Bioavailability: Rate and extent to which a drug is absorbed from the site of administration and become available at the site of action.
Bioeuivalence: Drugs showing same bioavailability are said to be bioequivalent.
Essentially Similar Product: A copy of the research or Innovator Product. (ME 2)
Biopharm Concepts
Therapeutic Equivalents: If two drugs provide the same desired therapeutic effect with same safety and efficacy.
Cmax: Maximum Drug Plasma concentration partly depends on the rate of release of drug from the formulation.
Tmax: Time required to reach maximum Plasma drug concentration; also dependant on rate of drug release.
T1/2: Elimination half life.
Mean Residence Time (MRT): Time a drug molecule spends in the body before it gets excreted out.
Metabolism reactions are also said to be Bioactivation reactions.
Metabolism is basically involved in converting a drug more hydrophilic to facilitate its excretion from the body.
