pharma labs Flashcards
The anti-depressant, mirtazapine might be effective as a hypnotic
an older tricyclic anti-depressant + it has Strong antihistamine properties
Based on kinetic properties, why would eszopiclone cause less
tolerance (milder withdrawal) than that caused by zaleplon?
→Eszopiclone→ Long duration, half-life of six hours
→Zaleplon→ Shorter duration, half-life of one hour
Withdrawal is more common with the short acting
over-thecounter OTC product for insomnia
Antihistamines with sedating properties (1st generation antihistaminic) which
also have anticholinergic effects , such as
Diphenhydramine, Hydroxyzine, Promethazine
Describe the sequence of use of analgesics according the WHO’s analgesic ladder
First Step - Mild pain: non-opioid analgesics such as nonsteroidal antiinflammatory drugs (NSAIDs) with or without adjuvants
Second Step - Moderate pain: weak opioids (codeine,
tramadol) with or without non-opioid analgesics and with or without adjuvants
Third Step - Severe and persistent pain: potent opioids (morphine, methadone, fentanyl) with or without non-opioid analgesics, and with or without adjuvant
Inhibit serotonin metabolism
Linezolid
MAO inhibitors
Inhibit serotonin uptake
Antidepressants (SSRIs, TCSs, atypicalduloxetine, venlafaxine)
Dextromethorphan
Meperidine
St. John’s wort
Tramadol
increase serotonin synthesis
L-Tryptophan
Serotonin receptor agonist
Buspirone
Ergot derivatives
Triptans
SSRIs
Inhibit serotonin uptake
Dextromethorphan
Inhibit serotonin uptake
Ergot
Serotonin receptor agonist
TCSs
Inhibit serotonin uptake
atypical duloxetine
Inhibit serotonin uptake
Phenytoin
no relation to 5ht
Ensuring a gradual rise in plasma concentration of NaCl is important to avoid …………………….syndrome
Osmotic demyelination syndrome
Lactated Ringer will not act as a buffer in hypoxia
due to In hypoxia, lactate couldn’t be converted to sodium bicarbonate due to oxygen lack
Lactated Ringer cannot be used to dilute blood products
Ringer lactate contains calcium which inactivates citrate (anticoagulant in blood products)……blood coagulation
D5W cannot be used as a plasma expander
As it is a hypotonic solution which concentrates mainly intracellular
We cannot directly give pure water intravenously
As there is a risk of hemolysis
Adverse effects of Nacl solution
● Hyperchloremic metabolic acidosis
● Acute renal injury
● Interstitial edema
Enumerate indications of lactated Ringer solution
● Ideal fluid during and after surgery
● Initial management of injured, burned, and wounded case
● To correct metabolic acidosis with hypokalemia
. Mention 3 medications that can’t be used with lactated Ringer
● Ceftriaxone
● Cortisone
● Amphotericin B
Penicillin & Aminoglicosides are never mixed in the same syringe
Inactivation (form a complex that decrease antimicrobial activity)
It’s better not to use aminoglicoside & vancomycin for long duration
Both can cause ototoxicity & nephrotoxicity
Bactericidal & bacteristatic antibiotics shouldn’t be combined for the simultaneous treatment of the same organism
Bactericidal is effective in presence of actively growing bacteria
No antibiotic prophylaxis is used in neurosurgery procedure
Clean wound
Colorectal surgery
Gentamicin +
metronidazole
Coronary bypass grafting
First-generation
cephalosporin
Infective endocarditis
Amoxicillin
Hip replacement in a penicillin-allergic
patient
Erythromycin
Spontaneous bacterial peritonitis
Ciprofloxacin
Rheumatic fever
Benzathine penicillin
اديله بنزين ركبه تبقي زين
Meningitis
Rifampicin
Tonsillectomy
No prophylaxis
what agents will NOT require acidification of urine to enhance
its action
Nalidixic acid
Which of the following agents will require acidification of urine to enhance
its action
a. Amoxicillin
b. Methenamine
d. Nitrofurantoin
Mention three alternative antibiotics for typhoid carrier, with duration of treatment, no doses required.
amoxicillin or ampicillin
plus probencid
or co-trimixazole
6weeks
ciprofloxacin or norfloxacin 28 days
Which of the following antibiotics for UTI treatment would not be given orally?
Ceftriaxone
List antimicrobials for eradication of Group A beta Hemolytic Streptococci (GAS) for penicillin allergic and non-allergic patients
Penicillins (drug of choice):
Benzathine penicillin G IM
Penicillin V Oral
For patients allergic to penicillin:
Azithromycin Or
Clarithromycin Or
Clindamycin
Outline treatment for rheumatic arthritis and carditis
Analgesics (until diagnosis is confirmed)
1.Paracetamol (till relief or NSAIDs start)
2.Codeine (till relief or NSAIDs start)
Anti-inflammatory
1.Aspirin (relieves all inflammation except chorea), for 3-6 wks after improvement
Or
2.Naproxen (if intolerant to aspirin)
3.Steroids»_space;> prednisone or prednisolone (plus aspirin in severe arthritis & in
carditis)
Mention important education points for patients with rheumatic fever
- Antibiotic prophylaxis before dental and other surgical procedures to protect
against endocarditis is so important if there is a cardiac lesion. - Avoid Sodium salicylates e.g. Rheumatic carditis and hypertension.
- Take aspirin with food, milk, or 1 to 2 teaspoons of antacid, and drink at least
240 m of water. - Be aware of adverse effects:
a) Bleeding.
b) Hearing changes. - Steroids patient education
a) Monitor for adverse effects:
b) Serum glucose / Electrolytes (Ca – K) / Body weight / Blood pressure
c) Sign’s of Cushing syndrome. / Signs and symptoms of G.I.T complications.
d) Emotional changes
e) Don’t ever stop suddenly
Mention two alternative antibacterial therapies that can be used for the treatment of community-acquired pneumonia in absence of comorbidities and absence of risk factors for MRSA
amoxicillin
or doxycycline
or macrolide if locan pneumococcal resistance
azithromycin
clarithromycin
extended-release clarithromycin
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the absence of risk for MRSA and for
mortality. (No doses required)
one of these:
penicllin based antipseudmonal
cephalosporin based antipseudmonal
antipseudmonal flouroquinolone
Carbapenem
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the presence of risk for MRSA in the absence of mortality risk.
one antipseudomonal drug or aztreonam
plus vancomycin or linezolid
Mention two alternative antibacterial therapies that can be used for the treatment of hospital-acquired pneumonia in the presence of risk for MRSA and
for high mortality risk
two antipseudomonal from different classes
plus vancomycin or linezolid
M: Streptococcus pneumonia
Vancomycin plus a third-generation cephalosporin
M: Neisseria meningitides
Third-generation cephalosporin
M: Hemophilus influenza
Third-generation cephalosporin
M: Listeria monocytogenes
Ampicillin or penicillin G
M: Herpes simplex
Acyclovir
g. Helminths.
h. Fungi.
i. Protozoa.
Albendazole can be effective for many of them
Fluconazole or amphotericin B
TM/SMZ
CMV.
d. Listeria
e. Mycoplasma.
f. Mycobacteria.
Ganciclovir
Ampicillin or TMP/SMZ
A macrolide or a fluoroquinolone
A combination of 4 anti-TB drug
Explain the role of dexamethasone in the treatment of meningitis?
- Decreases neurological complications.
- Given before or with the first antibiotic dose.
- Continue if Gram stain reveals Streptococcus pneumonia
Mention 3 types of insulin that can be used for basal blood glucose control and mention the administration frequency for each of them
NPH BID (twice daily)
Glargine OD (once daily)
Detemir OD-BID (once/twice daily)
What is the function of basal insulin injections?
To control fasting glucose and suppress overnight hepatic glucose production
What is the function of prandial insulin and when should it be given?
- To control post-prandial glucose spikes
- It is given with each meal.
- Given as a rapid-acting insulin analogue
Mention 3 types of insulin for prandial blood glucose control
Insulin Lispro, insulin Aspart and insulin Glulisine
When should insulin Glulisine be given in relation to meals and how would it be administered?
Insulin Glulisine starts working in 5 to 10 minutes. It is given with meals administered as Subcutaneous injection
Why is regular insulin considered pre-prandial and not prandial insulin?
Regular insulin is considered a pre-prandial insulin because it takes about 30 minutes to start working
What would happen if a diabetic patient took his regular insulin just before the meal?
His blood glucose level will increase (postprandial hyperglycemia), because regular insulin takes about 30 minutes to start working.
Mention insulin injection and insulin use instructions.
1- If meal is OMITTED: Do Not Take Medication.
2- Protect insulin from Heat & Freezing.
3- Store insulin that has not been opened in the Refrigerator.
4- Do Not shake insulin because of:
a- The resulting froth prevents withdrawal of an accurate dose.
b- May damage protein molecules.
- Mention the HbA1c value at or above which oral diabetic therapy should be escalated to the next step.
HBA1C ≥ 6.5%
Outline the management of hypoglycemia and hypoglycemic coma?
If patient is conscious → Oral glucose or sweets
If patient in Coma = Unconscious → I.V. Glucose → Life-saving.
If sterile glucose is not available → Glucagon 1 mg S.C. or I.M
Enumerate the lines of management of acute adrenal insufficiency?
- Steroid replacement - hydrocortisone
- Mineralocorticoid replacement: fludrocortisone
2- Intravenous fluids for Shock or moderate to severe dehydration
3- To Treat hypoglycemia: Bolus: IV dextrose
4- To Treat Hyperkalemia: monitor by ECG: If Potassium is >7.0 mmol/ Treat with either calcium gluconate or insulin infusion
To Treat Hyperkalemia in acute adrenal
insufficiency
calcium gluconate or insulin infusion
Combined treatment of moderate hypercalcemia with calcitonin and pamidronate
Calcitonin is weak but rapidly acting, pamidronate is more potent but slow to act
Describe precautions with calcium infusion
1-Slow infusion
2-Clinical Monitoring: pulse and cardiac auscultation to detect early tachycardia
3-ECG: continuous ECG monitoring, as rapid replacement can elicit cardiac arrythmias.
4-Magnesium levels should also be checked Hypomagnesemia
Orlistat moa and SE
Gastric and pancreatic lipase inhibitor
Decreases fat absorption
Oily rectal leakage
Phenteramin /
Topiramate ms
Phenteramine is an indirect sympathomimetic
Topiramate is an anti-epileptic (GABA agonist,
Glutamate antagonist).
This combination works by increasing satiety
Increase heart rate
glutides ms
Glucagon like peptide (GLP-1) analogue
-improves satiety and delays gastric emptying
Increase heart rate
Nausea, vomiting,
diarrhea
Naltrexone /
Buproprion ms
-Naltrexone is an Opioid receptor antagonist
-Bupropion is DA and NE reuptake inhibitor
-They work synergistically in hypothalamus and
mesolimbic dopamine circuit to promote satiety,
decrease food intake, and increase energy
expenditure
Sleep disorder
Setmelanotide ms
Acts on MC4R pathway to reverse hyperphagia
and promote weight loss through decreased
caloric intake and increased energy expenditure
injection site reaction and hyperpigmentatuin
Mention the effect of morbid obesity on drug: absorption and distribution
-The effects on absorption:
* The gastric emptying time is shortened, that can reduce the
absorption of some oral drugs.
* Absorption from the subcutaneous issue will be slowed due to poor blood flow to subcutaneous fat.
-The effects on distribution:
* An important increase of the volume of distribution for lipophilic drugs.
In general, what supplements are usually needed after bariatric surgery?
- Nutritional Supplementation (B-Ca-D)
- Zinc: Zinc deficiency induces hair loss, impaired sense of taste, and sexual dysfunction
- Selenium
- The separation of calcium and iron supplements is recommended.
- If iron concentrations continue to remain low with oral
supplementation, intravenous iron is recommended
How can bariatric surgery affect drug distribution
Decrease in fat decreases the Vd of fat-soluble drugs
Many patients experience hypoalbuminemia after bariatric surgery, with decreased plasma protein binding of drugs and this increases the free plasma fraction and causes decrease in the volume of distribution (Vd)
It is recommended to prescribe benzodiazepines for the shortest duration possible
avoid occurrence of Psychological and physical dependence
Tolerance to benzodiazepines is considered dynamic in nature
due to changes in responsiveness of the CNS
Describe withdrawal to benzodiazepines
more common with the short acting preparations and in case of sudden withdrawal of the drug, this will lead to withdrawal symptoms
ISHRAC مفيش
insomnia
seizures
hypotension orthostatic
restlessness
anxiety
Confusion
Mention three cautions with writing hypnotic prescriptions
*A dose that does not impair mental activity or motor functions during waking hours.
* Prescriptions should be written for short periods
* Assess the efficacy of therapy from the patient’s subjective responses.
* Combinations of antianxiety agents should be avoided
* Patients should be cautioned about the consumption of alcohol and the concurrent use of over-the-counter medications containing antihistaminic or anticholinergic drugs
Mention three examples of analgesic adjuvants
- Tricyclic antidepressants (TCAs) such as amitriptyline and nortriptyline.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine.
- Anticonvulsants like gabapentin and pregabalin
- Topical therapies (e.g., capsaicin)
Mention the basic principles of the WHO analgesic ladder
The three main principles of the WHO analgesic ladder are:
“By the clock, by the mouth, by the ladder.”
This means that drugs should be taken regularly and at regular intervals, orally whenever possible, and analgesics should be prescribed starting at Step 1 (nonopioid analgesics) and titrated upward as needed
What is the goal for PCA
efficiently deliver pain relief at a patient’s preferred dose on-demand at the press of a button
type/s of pain can PCA
acute, chronic, postoperative, and labor pain
administration routes can be used for PCA
intravenously, epidurally, through a
peripheral nerve catheter, or transdermally
Why do you think does PCA (patient-controlled analgesia) increase patient satisfaction
PCA has proven to be more effective at pain control and results in higher patient satisfaction
What feelings promote compulsion on the use of opioids
euphoria, indifference to stimuli, and sedation, especially when taken IV
Outline the management of opioid addiction
Methadone:Replace heroin or morphine by methadone.
Gradual withdrawal of methadone is less severe
Naltrexone: Given chronically after detoxification to block opioid receptors (loss desire to take a drug and become addict again)
Clonidine: inhibits sympathetic discharge
Anxiolytics - antiemetics – antispasmodics
Describe the effects of cannabis on mood and perception
Euphoria
relaxation
feeling of well-being
grandiosty
altered perception of passage of time
drowsiness
diminshed coordination
memory impairment
Mention two examples of drugs or drug classes that can cause neurolept malignant syndrome
1- Typical neuroleptics: e.g. haloperidol, chlorpromazine.
2- Atypical neuroleptics: e.g. olanzapine, clozapine, risperidone
3 Anti-dopaminergic antiemetics: e.g. metoclopramide
4- Withdrawal of dopaminergic agents: e.g. levodopa
Outline the treatment of neurolept malignant syndrome
1- Discontinue, switch or reduce antipsychotics depending on severity
2- Anticholinergics are contraindicated in NMS, unless very mild with only rigidity.
3- Lorazepam for stupor or confusion
4- fluids and cooling
5- Bromocriptine and amantadine may be used in moderate case
6- Dantrolene for severe cases (blocker of ryanodine receptor, preventing Ca release from the sarcoplasmic reticulum)
mechanism of action of IVIG in the treatment of GuillainBarré Syndrome
suppression of IgG production, accelerated catabolism of
IgG, neutralization of complement-mediated reactions, neutralization of pathogenic
antibodies,
down-regulation of inflammatory cytokines and inhibition of
autoreactive T lymphocytes
