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PAT 309 Redew > Give reason > Flashcards

Give reason Flashcards

1
Q

1- Give an account on the relation between B-blocker and sulfonylureas.

A

a. Augment their hypoglycemia & ↓ compensatory hepatic glycogenolysis.

b. Mask sympathetic manifestation of hypoglycemia —> Silent coma.

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2
Q

2- Give reason sulfonylureas cannot be used in type I diabetes.

A

their action depends on presence of preformed endogenous insulin which is not present in patients with DM type 1.

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3
Q

3- Give reason Metformin cannot be used in renal impairment.

A

Cannot excrete lactic acid.

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4
Q

4- Give reason thyroid hormone replacement therapy increase during pregnancy.

A

A higher dose of L-T4 is often required in hypothyroid pregnant. as early development of the fetal brain depends on maternal thyroxine.

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5
Q

5- Give reason, thioamides take long
time for a clinical response to appear.

A

a. The long t1/2 of thyroxine.
b. The large store of the hormones in the gland.

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6
Q

6- Give reason B-blocker is given in cases of hyperthyroidism.

A

Used to control peripheral manifestations of hyperactivity of the sympathetic nervous system occurring secondary to hyperthyroidism.

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7
Q

7- Give reason octreotide is better than somatostatin.

A

Its half-life is longer than that of the natural compound, and depot formulations are available, allowing for administration once every 4 weeks.

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8
Q

8- Give reason desmopressin is better than vasopressin in treatment of diabetes insipidus and nocturnal enuresis.

A

Has minimal activity at the V1 receptor → largely free of vasopressor effects and Is longer acting than vasopressin.

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9
Q

1- Explain the risk associated with removal of bacteriostatic drug before the immune system eradicate the organism.

A

Enough viable organisms may remain to begin a second cycle of infection.

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10
Q

2- Give reason it is advisable to treat patients with monotherapy.

A
  1. reduce the possibility of superinfection.
  2. the emergence of resistant organisms
  3. minimizes toxicity.
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11
Q

3- Give reason Benzyl Penicillin (Penicillin G) not given orally.

A

Acid sensitive = Destroyed by gastric acidity.

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12
Q

4- Give reason Benzyl Penicillin (Penicillin G) not effective in treating
Staphylococcus aureus.

A

Lactamase (Penicillinase) sensitive = NOT effective in β-lactamase secreting organisms as staph. Aureus.

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13
Q

5- Give an account on combination between penicillin and aminoglycoside.

A

Anti-pseudomonal penicillin can be combined with aminoglycoside for pseudomonal infection outside the urinary tract, Synergism and decrease resistance can Occur.

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14
Q

6- Explain why β-Lactamase (Penicillinase) Inhibitors are added to penicillin

A

They bind with the enzyme → Irreversible inhibition → Suicide substrate.

They protect penicillins from inactivation by β-lactamases secreted by some bacteria

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15
Q

8- Give reason Meropenem (Meronam) is better than Imipenem because:

A

a- Not metabolized by dihydropeptidase enzyme.

b- Less liable to produce seizures.

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16
Q

9- Give reason Vancomycin is not given rapid IV infusion.

A

Rapid IV infusion → Histamine release → Red man syndrome & Shock.

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17
Q

10- Explain the relation between tetracyclines and calcium.

A

When they are taken during pregnancy & early childhood Chelated by Ca+2 & deposited in newly formed teeth & Bone:

a. Teeth: Permanent yellow-brown discoloration & Enamel dysplasia.

b. Bone: Deformity & inhibition of growth.

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18
Q

11- Explain why doxycycline is allowed in patients with renal impairment.

A

Because it is excreted in bile.

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19
Q

12- Give reason aminoglycosides is not effective against Anaerobes.

A

Aminoglycosides concentrate inside bacteria by O2-requiring active transport mechanism. NOT effective against Anaerobes.

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20
Q

13- Give reason loop diuretics (frusemide) and aminoglycosides are not preferable combinations.

A

Ototoxicity and nephrotoxicity is increased when this combination is used

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21
Q

14- Give reason Trimethoprim and Sulfamethoxazole are combined to form Co- trimoxazole.

A

More potent, wider spectrum & less bacterial resistance than each drug alone

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22
Q

15- Give reason in TB drug combinations are used.

A

a. ↑ Activity.
b. ↓ Toxicity.
c. ↓ Resistance.

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23
Q

16- Give reason vitamin B6 is given with Isoniazid.

A

↑ I.N.H. → Peripheral neuritis.

Prevented by Vit B6.

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24
Q

After I.V. glucose administration , the veins are flushed with saline

A

To avoid thrombosis & sclerosis .

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25
Q

Patient are advised to change site of insulin injection:

A

To avoid subcutaneous lipodystrophy

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26
Q

Patient are advised to reduce evening insulin dose:

A

To avoid Somogyi effect, which is :
 Rebound hyperglycemia in the morning , that follows insulin – induced hypoglycemia during night.

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27
Q

Sulfonylurea are not indicated for patient with sever pancreatitis :

A

This is because , the main act of sulfonylurea is to increase insulin release from pancreas , and that depend on presence of preformed endogenous insulin

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28
Q

Glyburide is not recommended for patient with creatinine clearance less than 50ml/min:

A

As it’s most likely to accumulate during renal dysfunction & cause hypoglycemia.

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29
Q

A hypoglycemic patient on acarbose , is advised to take glucose & not sucrose:

A

As acarbose is α-glucosidase inhibitor , it inhibits absorption of complex carbs as sucros

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30
Q

Escape phenomenon , in case of aldosterone excess:

A

prolonged hypervolemia to decrease sensitivity of DCT to aldosterone –>no Na & water retention but still K+ execration

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31
Q

Cortisol may be described as the deceiver:

A

As it treats the manifestation rather than the cause

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32
Q

cortisol is C.I with Digitalis toxicity:

A

due to hypokalemia resulting from cortisol, which worsens digitalis toxicity

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33
Q

prednisone is safe in pregnancy:

A

as it’s a prodrug that is not converted to active metabolite (prednisolone ) in the fetal liver –> no effect on fetus

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34
Q

chronically elevated P.T.H will deplete bone store of Ca2+ however, PTH ( teriparatide) is used in the ttt of osteoporosis :

A

as intermittent exposure to PTH will activate osteoblast more than osteoclast, with a net effect of: + new bone formation&  bone mineral density

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35
Q

patient should remain upright for 30min after an oral Bisphosphonate dose:

A

to minimize esophageal irritation risk

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36
Q

natural estrogens have low bioavailability, however, semisynthetic estrogens -as: (ethinyl estradiol) could be taken orally:

A

because ethinyl group protect it from in activate by liver

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37
Q

it’s recommended to add progestogens to estrogen, while treating postmenopausal hormonal therapy (HT):

A

to reduce risk of endometrial carcinoma

38
Q

oral progestogens only contraception is less effective than the combined method:

A

as missing a dose may lead to conception

39
Q

advantage of benzodiazepine over Barbiturate:

A
  • less REM —> less hangover& less rebound paradoxical sleep
  • no HME induction –>less tolerance, dependance& interaction
  • wide safety margin —> safer on R.C & C.V.S.
40
Q

advantage of fluoxetine (SSRI) over (TCA)

A
  • less adverse effect: .no atropine-like effect (safe in glaucoma)

no CVS AEs
no weight gain

  • low acute toxicity: no cardio or hepato-toxicity
41
Q

Advantage of direct dopamine agonist over L- DOPA:

A
  • Does not need synthesizing enzyme& more specific on D2
  • Longer T1/2 less fluctuation in response
  • No toxic oxidative metabolite
42
Q

Patient are advised to take urine alkalinization & plenty of fluid with probenecid

A

To avoid the formation of renal urate stone

43
Q

colchicine or NSAID is affect prophylacticaIly with allopurinol:

A

As allopurinol precipitate acute attacks of gout during initiation of treatment

44
Q

O2 is given during recovery from nitrous oxide anesthesia:

A

As N2O produce a diffusion hypoxia during recovery

45
Q

Diazepam is given during recovery from ketamine:

A

To control dreams& terrifying hallucination during recovery

46
Q

Ketamine or halothane are useful in bronchial asthma, while thiopentone is not:

A

As ketamine or halothane —-> bronchodilator

While, thiopentone —> cough, laryngospasm& bronchospasm

47
Q

Morphine is contraindicated in asthmatic patient

A

As it’s produce bronchospasm by it’s direct spasmogenic effect & by increase histamine release

48
Q

tolerance occur with morphine:

A

Due to decrease endogenous endorphin

49
Q

morphine is used in primary neurogenic shock:

A

As it decrease pain that trigger autonomic manifestation, worsening the condition

50
Q

morphine is contraindicated in head injury:

A
  • Miosis -> interfere with diagnosis
  • decrease R.C. -> increase CO2-> cerebral V.D increase CSF synthesis–> increase intra-cranial tension -> more decrease on R.C
51
Q

meperidine + MAOI sever inhibition of R.C, excitation& seizure:

A

As meperidine decrease neuronal uptake of serotonin& nor adrenalin

52
Q

meperidine is used in obstetric analgesia:

A

Due to less inhibition of fetal R.C. —-> less neonatal asphyxia

53
Q

Fentanyl + Droperidol [neurolept-analgesia] is a good combination :

A

As the emetic effect of fentanyl is countered by antiemetic effect of droperidol

54
Q

Hyperthermia in salicylate toxicity:

A

Due to uncoupling of oxidative-phosphorylation

55
Q

toxic dose of aspirin in children may produce metabolic acidosis :

A

Due to impaired CHO metabolism

56
Q

Aminoglycosides & fluroquinolone may be given in higher, less frequent daily, even once daily:

A

As both are antibiotic with concentration-dependent killing and/or strong post-antibiotic effect

57
Q

B-lactams total daily dose may be divided over multiple dose or even by I.V. infusion:

A

As B-lactams are mainly time-dependent antibiotic

58
Q

Culture sample is taken before starting empiric therapy:

A

To avoid interference with the culture result

59
Q

Broad-spectrum antibiotic may be needed initially:

A

Needed for serious infection when:
1- identity of the organism is unknown
2- site of infection makes a polymicrobial likely

60
Q

Duration of prophylactic antibiotic should be closely observed:

A

To prevent the unnecessary development of antibiotic resistance

61
Q

Ampicillin & DicloxaciIlin are better taken l hr before meal or 2hr after meal:

A

As they are usually affected by meal

62
Q

B-lactamase inhibitors are called suicide substrates:

A

As they bind with the enzyme& irreversibly inhibit it

63
Q

Appearance of skin rash on a Patient after taking ampicillin:

A

As ampicillin induce skin rash in 10% of patient& In all patient with:
mononucleosis[EBV], leukemia& allopurinol

64
Q

Lidocaine may be added with Benzathine penicillin and cephalosporins :

A

As they cause pain to site of injection

65
Q

patient on cefoxitin for gynecological infection are advised to stay away from alcohol:

A

Due to Disulfiram like reaction induced by cefoxitin with alcohol

66
Q

Patient on cefoxitin, cefoperazone or cefamandole are advised to take VIT. K l0 mg twice weekly:

A

To prevent hypoprothrombinemia induced by them

67
Q

Celastatin is given with Imipenem:

A

As Imipenem is inactivated by renal tubular dihydropeptidase enzyme, giving a nephrotoxic metabolite

  • So, celastatin is Co-administered to inhibit dihydropeptidase enzyme
68
Q

patient on tetracycline are adviced not to take milky product with their dose of antibiotic:

A

As absorption of tetracycline is decreased by milk leading to chelation of tetracycline

68
Q

Aminoglycosides are poorly absorbed from the intestine:

A

Because of there higher polar nature.so, if given orally, there effect will be restricted to only GIT

69
Q

FDA had to issue a block box warning against Tigecycline:

A

As tigecycline was associated with a small but significant increase in the risk of death, so it should be reserved for situations where alternative ttt, are not suitable

70
Q

1 inezolid is contraindicated with patient taking MAOI or within 2 weeks of taking MAOI:

A

As it may have drug interaction that lead to serotonin syndrome

71
Q

NSAIDs are avoided with Fluoroquinolone, especially in epileptic:

A

As fluroquinolone induce seizures, especially if used with NSAIDs

72
Q

Fluoroquinolone are avoided with elderly on glucocorticoids:

A

As it may cause rupture of tendons [ Achilles tendon]

73
Q

Fluoroquinolone are adviced not to be taken along with food or other drugs, as : Sucralfate& antiacid:

A

As they decrease the absorption of fluoroquinolone

74
Q

Patient on Sulfonamide are adviced to take plenty of fluid& urine alkalinization:

A

As sulfonamides are excreted & concentrated in urine, so it may produce crystalluria

75
Q

Even thought sulfonamides decrease folic acids, but they have no effects on mammalian cells:

A

As mammalian cells use preformed folic acid

76
Q

Sulfonamide are avoided during pregnancy & lactation:

A

As they are bound to plasma proteins—>displace bilirubin —-> kernicterus

77
Q

Rifampicin can cause failure of contraception:

A

As it increase same enzymes that metabolize contraceptive pill

78
Q

Sulfonamide can cause phenytoin toxicity:

A

As it decrease enzymes that metabolize phenytoin

79
Q

Clarithromycin increase risk of rhabdomyolysis:

A

As it decreases enzymes that metabolize Simvastatin

80
Q

Rifampicin cause withdrawal manifestation whin given to patient, whom are being treated from morphine addiction:

A

As Rifampicin is a HME inducer, which increase metabolism of Methadone used in ttt of Morphine addicts by substituting it…

81
Q

Normal saline infusion is administered with the daily dose of Amphotericin B:

A

In order to attenuate the nephrotoxic cumulative adverse effect of amphotericin B

82
Q

Developmental of new lipid drug formulation with amphotericin B :

A

To reduce toxicity as it bind to mammalian membrane less readily permitting the use of effective doses of the drug with lower toxicity

83
Q

Flucytosine has a selective toxicity against fungi only:

A

As human cells are unable to convert the parent drug to its active metabolite

84
Q

Combination of flucytosine with amphotericin B may by synergistic:

A

Due to enhanced penetration of flucytosine through amphotericin B damaged fungal cell membrane

85
Q

Azol has a selective toxicity against fungi:

A

Due to their greater affinity for fungal than for human cytochrome P450 enzyme

86
Q

Despite that fluoroquinolone are often advised not to be taken with food or antiacid, Itraconazole are recommended along with food or low gastric HCL

A

Itraconazole’s absorption from capsule is increased by food &low gastric PH

87
Q

On prescribing Voriconazole to a hyperlipidemic patient on statins, doctor chose to reduce statin dose:

A

This is because Voriconazole is an inhibitor of mammalian CYP 3A4, required in the metabolism of HMG-CoA reductase inhibitor

88
Q

Co-administration antihistamine with anidulafungin might be needed in the some cases:

A

This is in order to antagonize the increase amount of histamine released by anidulafungin

89
Q

Griseofulvin id administered for 2-6 weeks for skin& hair infection:

A
  • To allow the replacement of infected keratin by the resistant one
  • As its is action to prevent infection of these new skin structure
  • By depositing in newly forming skin, where it binds to keratin , protecting the skin from new infection
90
Q

Co-administration of Griseofulvin with fatty food:

A

As its absorption is increased whin given with fatty food

PAT 309 Redew (9 decks)

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