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pharma labs Flashcards

1
Q

The anti-depressant, mirtazapine might be effective as a hypnotic

A

an older tricyclic anti-depressant + it has Strong antihistamine properties

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2
Q

Based on kinetic properties, why would eszopiclone cause less
tolerance (milder withdrawal) than that caused by zaleplon?

A

→Eszopiclone→ Long duration, half-life of six hours
→Zaleplon→ Shorter duration, half-life of one hour
Withdrawal is more common with the short acting

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3
Q

over-thecounter OTC product for insomnia

A

Antihistamines with sedating properties (1st generation antihistaminic) which
also have anticholinergic effects , such as
Diphenhydramine, Hydroxyzine, Promethazine

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4
Q

Describe the sequence of use of analgesics according the WHO’s analgesic ladder

A

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

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5
Q

Inhibit serotonin metabolism

A

Linezolid
MAO inhibitors

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6
Q

Inhibit serotonin uptake

A

Antidepressants (SSRIs, TCSs, atypicalduloxetine, venlafaxine)
Dextromethorphan
Meperidine
St. John’s wort
Tramadol

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7
Q

increase serotonin synthesis

A

L-Tryptophan

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7
Q

Serotonin receptor agonist

A

Buspirone
Ergot derivatives
Triptans

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8
Q

SSRIs

A

Inhibit serotonin uptake

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8
Q

Dextromethorphan

A

Inhibit serotonin uptake

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9
Q

Ergot

A

Serotonin receptor agonist

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10
Q

TCSs

A

Inhibit serotonin uptake

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11
Q

atypical duloxetine

A

Inhibit serotonin uptake

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12
Q

Phenytoin

A

no relation to 5ht

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13
Q

Ensuring a gradual rise in plasma concentration of NaCl is important to avoid …………………….syndrome

A

Osmotic demyelination syndrome

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13
Q

Lactated Ringer will not act as a buffer in hypoxia

A

due to In hypoxia, lactate couldn’t be converted to sodium bicarbonate due to oxygen lack

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14
Q

Lactated Ringer cannot be used to dilute blood products

A

Ringer lactate contains calcium which inactivates citrate (anticoagulant in blood products)……blood coagulation

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15
Q

D5W cannot be used as a plasma expander

A

As it is a hypotonic solution which concentrates mainly intracellular

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16
Q

We cannot directly give pure water intravenously

A

As there is a risk of hemolysis

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17
Q

Adverse effects of Nacl solution

A

● Hyperchloremic metabolic acidosis
● Acute renal injury
● Interstitial edema

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18
Q

Enumerate indications of lactated Ringer solution

A

● Ideal fluid during and after surgery
● Initial management of injured, burned, and wounded case
● To correct metabolic acidosis with hypokalemia

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19
Q

. Mention 3 medications that can’t be used with lactated Ringer

A

● Ceftriaxone
● Cortisone
● Amphotericin B

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20
Q

Penicillin & Aminoglicosides are never mixed in the same syringe

A

Inactivation (form a complex that decrease antimicrobial activity)

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20
Q

It’s better not to use aminoglicoside & vancomycin for long duration

A

Both can cause ototoxicity & nephrotoxicity

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20
Q

Bactericidal & bacteristatic antibiotics shouldn’t be combined for the simultaneous treatment of the same organism

A

Bactericidal is effective in presence of actively growing bacteria

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20
Q

No antibiotic prophylaxis is used in neurosurgery procedure

A

Clean wound

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20
Q

Colorectal surgery

A

Gentamicin +
metronidazole

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20
Q

Coronary bypass grafting

A

First-generation
cephalosporin

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20
Q

Infective endocarditis

A

Amoxicillin

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20
Q

Hip replacement in a penicillin-allergic
patient

A

Erythromycin

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21
Q

Spontaneous bacterial peritonitis

A

Ciprofloxacin

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21
Q

Rheumatic fever

A

Benzathine penicillin
اديله بنزين ركبه تبقي زين

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21
Q

Meningitis

A

Rifampicin

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22
Q

Tonsillectomy

A

No prophylaxis

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23
Q

what agents will NOT require acidification of urine to enhance
its action

A

Nalidixic acid

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24
Q

Which of the following agents will require acidification of urine to enhance
its action

A

a. Amoxicillin
b. Methenamine
d. Nitrofurantoin

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25
Q

Mention three alternative antibiotics for typhoid carrier, with duration of treatment, no doses required.

A

amoxicillin or ampicillin
plus probencid
or co-trimixazole
6weeks

ciprofloxacin or norfloxacin 28 days

26
Q

Which of the following antibiotics for UTI treatment would not be given orally?

A

Ceftriaxone

27
Q

List antimicrobials for eradication of Group A beta Hemolytic Streptococci (GAS) for penicillin allergic and non-allergic patients

A

Penicillins (drug of choice):
Benzathine penicillin G IM
Penicillin V Oral
For patients allergic to penicillin:
Azithromycin Or
Clarithromycin Or
Clindamycin

28
Q

Outline treatment for rheumatic arthritis and carditis

A

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&raquo_space;> prednisone or prednisolone (plus aspirin in severe arthritis & in
carditis)

29
Q

Mention important education points for patients with rheumatic fever

A
  1. Antibiotic prophylaxis before dental and other surgical procedures to protect
    against endocarditis is so important if there is a cardiac lesion.
  2. Avoid Sodium salicylates e.g. Rheumatic carditis and hypertension.
  3. Take aspirin with food, milk, or 1 to 2 teaspoons of antacid, and drink at least
    240 m of water.
  4. Be aware of adverse effects:
    a) Bleeding.
    b) Hearing changes.
  5. 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
30
Q

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

A

amoxicillin
or doxycycline
or macrolide if locan pneumococcal resistance
azithromycin
clarithromycin
extended-release clarithromycin

31
Q

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)

A

one of these:
penicllin based antipseudmonal
cephalosporin based antipseudmonal
antipseudmonal flouroquinolone
Carbapenem

32
Q

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.

A

one antipseudomonal drug or aztreonam
plus vancomycin or linezolid

33
Q

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

A

two antipseudomonal from different classes
plus vancomycin or linezolid

34
Q

M: Streptococcus pneumonia

A

Vancomycin plus a third-generation cephalosporin

35
Q

M: Neisseria meningitides

A

Third-generation cephalosporin

36
Q

M: Hemophilus influenza

A

Third-generation cephalosporin

36
Q

M: Listeria monocytogenes

A

Ampicillin or penicillin G

37
Q

M: Herpes simplex

A

Acyclovir

37
Q

g. Helminths.
h. Fungi.
i. Protozoa.

A

Albendazole can be effective for many of them
Fluconazole or amphotericin B
TM/SMZ

38
Q

CMV.
d. Listeria
e. Mycoplasma.
f. Mycobacteria.

A

Ganciclovir
Ampicillin or TMP/SMZ
A macrolide or a fluoroquinolone
A combination of 4 anti-TB drug

39
Q

Explain the role of dexamethasone in the treatment of meningitis?

A
  • Decreases neurological complications.
  • Given before or with the first antibiotic dose.
  • Continue if Gram stain reveals Streptococcus pneumonia
39
Q

Mention 3 types of insulin that can be used for basal blood glucose control and mention the administration frequency for each of them

A

NPH BID (twice daily)
Glargine OD (once daily)
Detemir OD-BID (once/twice daily)

40
Q

What is the function of basal insulin injections?

A

To control fasting glucose and suppress overnight hepatic glucose production

41
Q

What is the function of prandial insulin and when should it be given?

A
  • To control post-prandial glucose spikes
  • It is given with each meal.
  • Given as a rapid-acting insulin analogue
41
Q

Mention 3 types of insulin for prandial blood glucose control

A

Insulin Lispro, insulin Aspart and insulin Glulisine

42
Q

When should insulin Glulisine be given in relation to meals and how would it be administered?

A

Insulin Glulisine starts working in 5 to 10 minutes. It is given with meals administered as Subcutaneous injection

43
Q

Why is regular insulin considered pre-prandial and not prandial insulin?

A

Regular insulin is considered a pre-prandial insulin because it takes about 30 minutes to start working

44
Q

What would happen if a diabetic patient took his regular insulin just before the meal?

A

His blood glucose level will increase (postprandial hyperglycemia), because regular insulin takes about 30 minutes to start working.

45
Q

Mention insulin injection and insulin use instructions.

A

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.

46
Q
  1. Mention the HbA1c value at or above which oral diabetic therapy should be escalated to the next step.
A

HBA1C ≥ 6.5%

47
Q

Outline the management of hypoglycemia and hypoglycemic coma?

A

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

48
Q

Enumerate the lines of management of acute adrenal insufficiency?

A
  • 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
49
Q

To Treat Hyperkalemia in acute adrenal
insufficiency

A

calcium gluconate or insulin infusion

50
Q

Combined treatment of moderate hypercalcemia with calcitonin and pamidronate

A

Calcitonin is weak but rapidly acting, pamidronate is more potent but slow to act

51
Q

Describe precautions with calcium infusion

A

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

52
Q

Orlistat moa and SE

A

Gastric and pancreatic lipase inhibitor
Decreases fat absorption

Oily rectal leakage

53
Q

Phenteramin /
Topiramate ms

A

Phenteramine is an indirect sympathomimetic
Topiramate is an anti-epileptic (GABA agonist,
Glutamate antagonist).
This combination works by increasing satiety

Increase heart rate

54
Q

glutides ms

A

Glucagon like peptide (GLP-1) analogue
-improves satiety and delays gastric emptying

Increase heart rate
Nausea, vomiting,
diarrhea

55
Q

Naltrexone /
Buproprion ms

A

-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

56
Q

Setmelanotide ms

A

Acts on MC4R pathway to reverse hyperphagia
and promote weight loss through decreased
caloric intake and increased energy expenditure

injection site reaction and hyperpigmentatuin

56
Q

Mention the effect of morbid obesity on drug: absorption and distribution

A

-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.

57
Q

In general, what supplements are usually needed after bariatric surgery?

A
  • 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
57
Q

How can bariatric surgery affect drug distribution

A

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)

58
Q

It is recommended to prescribe benzodiazepines for the shortest duration possible

A

avoid occurrence of Psychological and physical dependence

59
Q

Tolerance to benzodiazepines is considered dynamic in nature

A

due to changes in responsiveness of the CNS

60
Q

Describe withdrawal to benzodiazepines

A

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

61
Q

Mention three cautions with writing hypnotic prescriptions

A

*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

62
Q

Mention three examples of analgesic adjuvants

A
  • 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)
63
Q

Mention the basic principles of the WHO analgesic ladder

A

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

64
Q

What is the goal for PCA

A

efficiently deliver pain relief at a patient’s preferred dose on-demand at the press of a button

65
Q

type/s of pain can PCA

A

acute, chronic, postoperative, and labor pain

66
Q

administration routes can be used for PCA

A

intravenously, epidurally, through a
peripheral nerve catheter, or transdermally

67
Q

Why do you think does PCA (patient-controlled analgesia) increase patient satisfaction

A

PCA has proven to be more effective at pain control and results in higher patient satisfaction

68
Q

What feelings promote compulsion on the use of opioids

A

euphoria, indifference to stimuli, and sedation, especially when taken IV

69
Q

Outline the management of opioid addiction

A

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

70
Q

Describe the effects of cannabis on mood and perception

A

Euphoria
relaxation
feeling of well-being
grandiosty
altered perception of passage of time
drowsiness
diminshed coordination
memory impairment

71
Q

Mention two examples of drugs or drug classes that can cause neurolept malignant syndrome

A

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

72
Q

Outline the treatment of neurolept malignant syndrome

A

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)

73
Q

mechanism of action of IVIG in the treatment of GuillainBarré Syndrome

A

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

74
Q
A

Pharma (7 decks)

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