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mcq Flashcards

1
Q

caues allergic obstructive cholestatic jaundice

A

chloropromazine

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2
Q

not cns adverse effect of choropromazine

A

2-Increased body weight.
3- Opacities of cornea and lens.
4- Dry mouth
5- Allergy: Dermatitis, photosensitivity & Agranulocytosis.
6- Tachycardia.
7- Endocrine disturbances e.g. Gynecomastia & galactorrhea.
8- Allergic obstructive cholestatic jaundice.
9- Teratogenic, so not used in vomiting of pregnancy.
10- Postural hypotension.

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3
Q

side effects of thioredazine

A

Similar to Chlorpromazine + Cardiotoxic & Retinopathy.

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4
Q

Phenothiazine causes cardiotoxic and retinopathy side effect

A

Thioridazine

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5
Q

More effective in treatment of negative symptoms of schizophrenia with Less side effects.

A

Atypical (2™ generation) Anti-Psychotic Drugs

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6
Q

Atypical (2™ generation) Anti-Psychotic Drugs

A

Sulpiride
Clozapine
Risperidone
Olanzapine
Quetiapine
Aripiprazole
Pimozide

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7
Q

Pharmacodynamics of fluoxetine

A
  • Antidepressant Effect: Elevate mood in depressed patients by selective block of serotonin uptake by nerve endings
  • The Antidepressant Effect appears after 2-3 WEEKS and lasts for 2-3 WEEKS after stop of SSRI
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8
Q

Therapeutic Uses

A

Psychic depression
panic disorders
Obsessive compulsive disorders (better than the TCA clomipramine).
Eating disorders {Bulimia nervosa} » Ineffective in anorexia nervosa
Post-traumatic stress disorder
Premenstrual syndrome — for 2 weeks in Iuteal phase
Premature ejaculation

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9
Q

Adverse Effects of Fluoxetine

A
  • Anorexia, nausea & diarrhea — Due to Increased serotonin in GIT
    b- Headache, insomnia, hypersomnia.
    c- Weight gain
    d- Increases aggression, violence & suicide.
    e- Category C in pregnancy — Give if benefits outweigh the risk
    d- Fluoxetine + MAQOI — Serotonin syndrome (May be FATAL)— Accumulation of
    serotonin »Reduced neuronal uptake (SSRI) + Reduced metabolism (MAOI) # Triad of
    cognitive (delirium), autonomic (hypertension and tachycardia), and somatic
    manifestations (tremors and myoclonus)
    + Stop fluoxetine 4-56 weeks before initiating MAOIs
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10
Q

contraindication of fluoxetine

A

bipolar depression

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11
Q

non TCA useful in urinary incontinence and anxiety disorders

A

Duloxetine

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12
Q

Synthetic form of the ma or active metabolite of venlafaxine

A

desvenlafaxine

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13
Q

manage fibromyalgia and mention its family

A

milnacipran
non TCA selective na/5HT Reuptake inhibitors

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14
Q

Inhibits NA and dopamine uptake
Slow release formulations help in cessation of smoking

A

Buprion

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15
Q

for managment of ADHD

A

Atomexetine
reboxetine

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16
Q

Blocks alpha-2, 5-HT3, 5-HT2C receptors release of NA and -HT

A

mirtazepine

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17
Q

Blocks 5-HT2A, 5-HT2C receptors ( release of NA and 5-HT) and H1 receptors

A

Trazodone

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18
Q

adverse effect of MAO inhibitors

A

1- Cheese Reaction (NOT with Moclobemide or Selegiline): Eating or drinking foods
that contain TYRAMINE or DOPA such as Aged cheese, Broad beans, Soy products, or
Yogurt — Malignant Hypertension — Stroke and myocardial infarction.
2- -DOPA(Anti-Parkinsonian) — Agitation & Hypertension.
3-Potentiates Indirectly Acting Sympathomimetics e.g. Amphetamine.
1- Avoid over-the -counter flu medications as they contain sympathomimetics
e.g. pseudoephedrine
5- SSRI (Fluoxetine), TCAs, Melatonin & Meperidine— Serotonin Syndrome
6- MAO-1 -Enzyme inhibitors— Potentiate other drugs e.g. Alcohol.

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19
Q

Treatment of cheese reaction caused by MAO inhibitors

A

Treatment by IV Phentolamine or Nitroprusside +B-Blocker.

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20
Q

Therapeutic Uses: mood stabilizer for:

A

1- Prophylaxis of Manic-Depressive disorder.
2- Prophylaxis of recurrent endogenous depression.
3- Acute mania but slow onset. So, add antipsychotic drug as haloperidol
4- Management of aggressive & violent behavior in prisoners.

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21
Q

Hallucinogens,

A

1- Lysergic Acid Di-Ethylamide
2- Mescaline
3- Khat
4- Phencyclidine
4- Psilocybin
5- Ketamine
6- Salvia divinorum
7- Gamma-hydroxybutyric acid

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22
Q

Dynamics of L-DOPA:

A

1- L-DOPA (Prodrug) by Central Dopa Decarboxylase (CDD)—Dopamine—{ D2-
receptors
2- Best results are obtained in the first few (3-4) years (loss of dopaminergic
nigrostriatal nerve terminals occurs later)
3- Treats all manifestations of Parkinsonism, especially Bradykinesia>Tremors by
stimulating D2 receptors in basal ganglia.

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23
Q

MAO b inhibitor

A

selegilline

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24
Q

Desirable = Favorable: increase L-DOPA effect

A

1- Peripheral Dopa Decarboxylase Inhibitor as carpidopa( sinemet) and bsenserazide (Madropar
2- MAO-B inhibitor e.g. Selegiline
3- COMT-Inhibitors e.g. Tolcapone&Entacapone.
4- Anti-Muscarinic drugs e.g. Benztropine.

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25
Q

Undesirable = Unfavorable: decrease Ldopa

A
  • Dopamine (o2 receptor blockers:
    a- Neuroleptics e.g. Phenothiazines & Butyrophenones.
    b- Anti-emetics e.g. Metoclopramide.
    2- Pyridoxine (Vit Bs)—r PDD—Accelerates peripheral decarboxylation — Dopamine.
    B- With Non-selective MAQ-l— Severe hypertension.
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26
Q

Contraindications of Direct Dopamine Agonist

A

Psychotic illness
Active peptic ulcer
Peripheral Vascular Diseases

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26
Q

Adverse effects of direct dopamine agonists:

A

a- GIT: Anorexia and nausea and vomiting which can be minimized by taking the
medication with meals. Constipation, dyspepsia & Bleeding from peptic ulceration.
b- CVS:
Postural hypotension may occur, particularly at the initiation of therapy.
Painless digital vasospasm is a dose-related complication of long-term
treatment with the ergot derivatives (bromocriptine or pergolide).
o Cardiac arrhythmias occur (an indication for discontinuing treatment).
Cardiac valvulopathy may occur with pergolide.
c CNS Dyskinesia
d- Mental disturbances.
e- Erythromyalgia (swollen, red, hot & tender feet).

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27
Q

latrogenic Parkinsonism = Drugs Contra-indicated in parkinsonism

A

1- Blockers of Central D,-receptors:
a- Neuroleptic drugs: Phenothiazines & Butyrophenones.
b- Antiemetics: Metoclopramide.
2- Reserpine — Depletion of Dopamine stores
3- Alpha-methyl Dopa — Inhibition of Dopamine synthesis
4- Destruction of Dopamine neurons: MPTP.
5- Parasympathomimetic drugs that pass BBB: Physostigmine & Pilocarpine.

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28
Q

Adverse Effects of Phenytoin:

A

1- CNS:— Confusion & Hallucinations. Ataxia, Nystagmus & Vertigo (dose-dependent)
2- GIT: Gastric irritation (highly alkaline) —anorexia, nausea, vomiting— Used after
meals.
3- Blood: megaloblastic anemia, hypoprothrombinemia
4- Bone: osteomalacia
5- Hirsutism (Androgenic effect).
6- Hepatotoxicity.
7- Hypersensitivity - Lymphadenopathy (Misdiagnosed for Hodgkin’s disease) & Lupus.
8- Hormones — { Release of A.D.H. & Insulin Hyperglycemia.
9- Gum (Gingival) Hyperplasia especially in Children — Irreversible — Consult Dentists.
10- During Pregnancy:
a- First trimester — Teratogenic — Fetal Hydantoin Syndrome — Hare lip & Cleft palate

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29
Q

Carbamazepine MoA

A

It blocks sodium channels, thereby inhibiting the generation of repetitive action potentials in the epileptic focus and preventing their spread
-Related to Tri-cyclic Anti-depressants — Useful as Mood Stabilizer in patients with Manic-Depressive Disorders.

30
Q

causes steven johnson syndrome

A

carbamazepine
lamotrigine

31
Q

written

Adverse Effects of carbazepine

A

a- CNS: Ataxia, Nystagmus & Vertigo — Cerebello-Vestibular
b- GIT: Anorexia, nausea, vomiting — G.I.T. upset
¢-Blood: Bone marrow inhibition—leukopenia, agranulocytosis
d- Anti-diuretic — Fluid retention, hyponatremia
e- Hepatitis
f- Teratogenic — Similar to Fetal Hydantoin Syndrome.
g- Allergy, Stevens-Johnson syndrome

32
Q

written

Mechanism of Antiepileptic Action of Valproic Acid & Sodium Valproate

A

a- Block Na*-channels— Similar to Phenytoin. Effective in Partial &Grand Mal epilepsy.
b- Block T-Ca-Channels— Similar to Ethosuximide — Effective in Absence seizures.
c- {_GABA-transaminase enzyme —»{t GABA (membrane hyperpolarization)
d- Antagonize excitatory transmitters e.g. Aspartat

33
Q

w

Therapeutic use of valproic acid & sodium valproate

A

a- Broad Spectrum Anti-epileptic useful in Grand mal epilepsy, Partial seizures& Petit
mal epilepsy (Not drug of choice — Sedation & Hepatotoxic).
b- Drug of choice in patients with:
- Mixed Petit mal + Grand mal epilepsy.
- Myoclonic epilepsy.
c- Other Uses:
a- Mood stabilizer in manic depressive disorders.
b- Migraine headache

34
Q

w

Adverse Effects of Valproic acid

A

a- C.N.S. - Sedation
b- G.L.T. - Nausea & Vomiting.
c-Blood — Thrombocytopenia & ¢ Platelet aggregation - Hemorrhage.
d- Hepatotoxicity.
e- Temporary loss of hair — Thin curly hair
f- Teratogenic — neural tube defect (Spina bifida).
g- Allergy

35
Q

Therapeutic Uses of Morphine

A

1- Pain: Analgesic in Severe Visceral Pain
a- Cardiac pain e.g. Myocardial infarction
b- Cancer pain especially in terminal stages
¢- Colic: Add Atropine in Biliary & Renal colic.
d- Bone Fractures (Except Skull, Morphine is contraindicated in Head injury).
e- Postoperative: Except Biliary & Eye operations.
2- Pulmonary Edema due to Acute Left Ventricular Failure:
3 -Primary Neurogenic shock
4-Preanesthetic medication:

36
Q

used in Neurolept-Anesthesia

A

Fentanyl + Droperidol + Nitrous oxide

37
Q

action of salicylates on blood

A
  • In inflammation, Aspirin — Decrease Elevated Erythrocytic Sedimentation Rate &
    Decrease Leukocytosis to normal (No leucopenia).
  • Hypoprothrombinemia: Aspirin Large Dose for long time — warfarin like - Compete
    with Vit-K in liver - Decrease Synthesis of activated Prothrombin & factors VII, IX & X.
  • Decrease_Platelet Aggregation: Aspirin Small dose (75 — 150 mg) — Irreversible
    inhibition of thromboxane Az (TXA2) synthesis.
  • Hemolysis(Idiosyncrasy)in patients with (G6PD deficiency) as Favism.
38
Q

w

Therapeutic Uses of Salicylates:

A

A) Local Uses:
1- Salicylic acid:
a- Keratolytic in coms & warts (Salicylic acid 20% in collodion).
b- Fungistatic in Tinea of Skin (Salicylic acid + Benzoic acid).
c- Antiseptic in Hyperhidrosis (Salicylic acid + Talcum powder).
2- Methyl-Salicylate (Oil of Wintergreen) — Counter-irritant in Arthritis & Myositis.
B) Systemic Uses:
(Uses 1. 2 & 3: Dose 1 - 2 g/day in divided doses,
Uses 4. 5 & 6: Dose 6 g/ day in divided doses)
1- Anti-pyretic— Non-specific & Non-causal.
2- Analgesic in Mild superficial pains e.g. Headache, toothache, myalgia, arthralgia &
Neuralgia. Effective in dysmenorrhea (PG) but may Increase Bleeding.
3- Common cold— Treat Fever, headache, muscle and joint pains.
4- Rheumatic fever (Arthritis) — Treat fever, arthritis, decreases ESR, decreases
Leukocytosis. NOT effective in Carditis, Chorea or Cutaneous nodules.
5- Rheumatoid arthritis
6- Chronic gout (Alkalinize urine & increase Fluid intake).
7- Antiplatelet (75-150 mg/day) — Prophylaxis against thromboembolic diseases.

39
Q

w

Adverse Effects & Toxicity of Salicylates:

A

2- Salicylism: Large dose for Long time — Tinnitus, blurring of vision, GIT upset,
irritability & hyperventilation. Reversible after stopping salicylates.
3- Hypoprothrombinemia — Bleeding tendency.
4- G.1.T. irritation — Nausea, voting, pain, ulceration & bleeding (Misoprostol is a PGE1
analog useful in treatment of NSAID-induced peptic ulcer).
5- Allergy (Hypersensitivity) — Rash, urticaria, angioedema & Bronchial asthma.
*Bronchial asthma may be Ag/Ab reaction or inhibit COX — Shift to LOX —increases
LT. LOX-inhibitors (Zileuton) & Cysteinyl LT-1 receptor blocker (Montelukast) are
useful in Aspirin-induced asthma
6- Reye’s syndrome: Aspirin in some children with viral infection (e.g. Influenza or
Chicken pox) — Encephalopathy & Hepatotoxicity.
7- Teratogenicity — Cardiac septal defect.
8- |diosyncrasy — Hemolysis in patients with Favism.
9- Nephropathy.

40
Q

Pyrazolone Derivatives

A

Azapropazone: uricosuric

41
Q

Indole Derivatives and uses

A

Indomethacin
Very Potent Antipyretic analgesic & Anti-Rheumatic
Uses:
- closure of patent ductus arteriosus.
- Acute gouty arthritis

42
Q

uses of diclofenac

A

a- Inflammations e.g. Arthritis, Myositis & Acute Gout.
b- Colic e.g. Dysmenorrhea.
c- Eye drops to treat ocular inflammations e.g. Postoperative.

43
Q

Selective COX-ll Inhibitors uses

A

It is used for the short-term treatment of postoperative
pain. It is given by intravenous or intramuscular injection.

44
Q

w

Dynamics of Paracetamol

A

1- Inhibit COX-3 in C.N.S.Mainly— Anti-pyretic Analgesic — As potent as Aspirin.
2- Aimost No peripheral Action — Almost No Anti-inflammatory & Aimost No effect on
respiration, C.V.S., Platelet aggregation, Gastric acidity or Uric acid.

45
Q

w

Therapeutic uses of Paracetamol

A

** Antipyretic Analgesic **(1/2 - 1 g) especially in patients who cannot
tolerate aspirin e.g. Allergy to Aspirin, Bronchial asthma, Children with viral infection,
Bleeding tendency, Peptic ulcer & Gout.

46
Q

w

Adverse Effects & Toxicity of parcetamol

A

1-Toxic dose of Paracetamol (> 10 g in Adults & 4 g in Children) — Depletion of
Glutathione-SH —>Hepatotoxic & Nephrotoxic— Fatal.
Management: |.V. N-Acetylcysteine (Rich in S-H) + Oral Methionine.
2- Allergy (Hypersensitivity).

47
Q

Actions of colchicine

A

A) Anti-Gout Effect:
1-Effective in treatment of Acute Attack of Gout.
2- NOT effective in other types of arthritis.
3- NOT affect uric acid synthesis or excretion or blood level.
4- 1t binds to Microtubular protein (Tubulin) of polymorph nuclear leucocytes
(P.M.N.L) -8 Migration of P.M.N.L. to joints -NO Phagocytosis of Mono-sodium
urate crystals —-NO Ruptures of leukocytes —NO release of lactic acid -NO
Inflammatory acidity — NO further precipitation &NO release of chemotactic factors
e.g. Glycoproteins, IL-1 or LTB4 of urate crystals
B) Anti-Mitotic Effect—Inhibits cell division.
At higher doses than are used to treat gout, colchicine inhibits mitosis, carrying a
risk of serious bone marrow depression.

48
Q

Therapeutic Uses of colchicine

A

1- Acute attacks of gout
2- Prophylaxis of Gout:
3- Prophylaxis of Familial Mediterranean Fever (Polyserositis).

49
Q

Adverse Effects of colchicine

A

1- G.L.T.— Nausea, vomiting &Diarrhea.
2- Hepatotoxicity
3- Nephrotoxicity —» Hematuria & Oliguria.
4- Bone marrow depression
5- Myopathy.
6- Reversible alopecia.

50
Q

Actions Xanthine-Oxidase Inhibitors- Allopurinol

A

1- Allopurinol is metabolized by Xanthine Oxidase enzyme(XOE) — Alloxanthine
2- Both Allopurinol & Alloxanthine — Occupy & inhibits X.0.E. — deceases Synthesis of uric acid.
3- It has NO effect on renal excretion of uric acid.

50
Q

Therapeutic Uses of allopurinol

A

first line therapy for treatment of Hyperuricemia & Chronic
Gout between attacks especially in:
a- Gouty nephropathy & urate renal stones.
b- Associated with the use of Anti-Cancer drugs.
¢- If uricosuric drugs are ineffective or contraindicated.

51
Q

first line therapy for treatment of Hyperuricemia & Chronic Gout

A

Adverse Effects
a-Precipitates acute attacks of gout during initiation of treatment ( (possibly as a
result of physicochemical changes in the surfaces of urate crystals as they start to redissolve and also due to sudden lowering of serum urate)— Add Colchicine or NSAID
prophylactically.
b- C.N.S. - Headache & psychological changes.
¢- Allergic skin reaction (mainly rash)
d- G.I.T. disturbances.
e- Hepatomegaly.
f- Leucopenia.
g- Better avoided in children & during lactation (safety not yet established).
h- Drug Interaction:
o & Metabolism of Probenecid & Mercaptopurine (which is inactivated by xanthine
oxidase) — Toxicity.
The effect of warfarin is increased because its metabolism is inhibited

51
Q

As with allopurinol, prophylactic treatment with colchicine or NSAID should be started
at the beginning of therapy to avoid gout flares

A

Febuxostat

52
Q

More selective and potent inhibitor of xanthine oxidase than allopurinol.

A

Febuxostat

53
Q

Therapeutic Uses Of aminophylline

A

1- Bronchial Asthma: acute attacks and status athmaticus
2- Chronic Obstructive Pulmonary Diseases emhysema
3- Cardiac Asthma

53
Q

CNS stimulants

A

Analeptic stimulants:
Psychomotor stimulants:
Methylxanthines:
Psychotomimetic stimulants (hallucinogenic drugs).

54
Q

Caffeine uses

A

1- With Ergotamine — Cafergot in acute attack of Migraine headache.
With Aspirin or paracetamol in simple headache.
2- Fatigue (Physical or mental).
3- With Neostigmine in Myasthenia Gravis.
4- Overdose of C.N.S. depressants e.g. Hypnotics.

55
Q

methylxanthine derivative used in treatment of:
- Chronic occlusive arterial diseases e.g. intermittent claudication:

A

Pentoxifylline

56
Q

w

Anti-Bacterial Activity: of b lactams antibiotics

A

1- Bactericidal Antibiotics.
2- They bind to specific_Penicillin-Binding-Protein (PBP), at least 7 types:
a- inhibit Transpeptidase enzyme responsible for cross-linking of peptidoglycans, a final step in cell wall synthesis —{ Cell Wall Synthesis.
b- Activate Autolytic enzymes (Autolysins) — Lysis of cell wall.
c- Bacteria imbibe water due to its interior high osmotic pressure — Rupture and DEATH of the microbe.
d- They affect mainly growing bacteria rather than resting one.
3- Selectivity: Human cells do not contain peptidoglycan cell wall.
4- Resistance:
a- Natural absence of peptidoglycan cell wall e.g. Mycoplasma.
b- Acquired resistance:
o Production of B-lactamase enzymes (Too many types).
Some of them are specific penicillinases & cephalosporinases.

57
Q

Sulbactam + Ampicillin

A

Unasyn

58
Q

Tazobactam + Piperacillin

A

Tazocin

59
Q
A
59
Q
A
60
Q
A
61
Q
A
62
Q

w

Antibiotic associated (Pseudomembranous) colitis. Caused by enterotoxins produced by Staph. or Clostridium difficil. Treated by

A

Oral Vancomyein or
Metronidazole.

63
Q

prophylactic uses of penicillin

A
  1. streptococcal infection in rhematic fever
  2. bacterial endocarditis
  3. gonorrheal neonatal ophtalmia
64
Q

against gram positive organisms and gram negativ bacilli including E.coli and klebsiellla pneumonia, but not H. influenza , proteus , P. aeruginosa

A

first generation cephalosporins

65
Q

bacteria spectrum of second generation cephalosporins

A

less active against gram positive
more active against gram negative h influenza

66
Q

fourth generation cephalosporins

A

cefepime

67
Q

oganism resistant to tigecycline

A

P.aeruginosa

68
Q
A

Pharma (7 decks)

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