Pharmacology Flashcards
-Penicillin & Aminoglicosides are never mixed in the same syringe.
≫ Inactivation
Bactericidal & bacteristatic antibiotics shouldn’t be combined for the simultaneous treatment of the same organism
Bactericidal is effective in presence of actively growing bacteria
-It’s better not to use aminoglicoside & vancomycin for long duration
≫ Both can cause ototoxicity & nephrotoxicity
Which antibacterial will have neither systemic nor local effect when given orally?
Penicillin G
Which of the following agents will Not required acidification of urine to enhance its action?
a. Amoxicillin
b. Methenamine
c. Nalidixic acid
d. Nitrofurantoin
Nalidixic acid
Which of the following antibiotics for UTI treatment would not be given orally?
a. Amoxicillin
b. Ciprofloxacin
c. Ceftriaxone
d. Trimethoprim/sulphamethoxazole
Ceftriaxone
Mention three alternative antibiotics for typhoid carrier, with duration of treatment, no doses required
Amoxicillin ———> 6 weeks
Ampicillin ———> 6 weeks
Ciprofloxacin ———-> 28 days
Outline treatment for rheumatic arthritis and carditis.
Analgesics (until diagnosis is confirmed)
1.Paracetamol
2.Codeine
Anti-inflammatory
1.Aspirin for 3-6 wks after improvement
Mention important education points for patients with rheumatic fever
- Antibiotic prophylaxis before dental and other surgical procedures
- Avoid Sodium salicylates
- Take aspirin with food
- Be aware of adverse effects:
- Steroids patient education
a) Monitor for adverse effects:
b) Serum glucose / weight / Blood pressure
c) Sign’s of Cushing syndrome.
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 every 8 hours
Doxycycline every 12 hours
Mention two alternative antibacterial therapies that can be used for the treatment of community-acquired pneumonia for a patient with diabetes mellitus but in absence of risk factors for MRSA.
Amoxicillin and Azithromycin
Amoxicillin and 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
Penicillin based anti-pseudomonal
Cephalosporin based anti-pseudomonal
A 25-year-old male patient came to the ER with very high fever, severe headache, and projectile vomiting. He was labelled as a case of suspected meningitis. It was decided that a CT scan is needed for this patient before he could be subjected to lumbar puncture (LP). Which of the following would be the action of choice?
a. Delay both antibiotics and dexamethasone until LP is done.
b. Delay antibiotics until LP is done but give dexamethasone.
c. Delay dexamethasone until LP is done but give the patient antibiotics.
d. Give both antibiotics and dexamethasone and don’t wait or LP.
e. Give both antibiotics and dexamethasone after CT.
d. Give both antibiotics and dexamethasone and don’t wait or LP.
Outline general rules for antibiotic treatment of bacterial meningitis.
- Parenteral
Start right away - Bactericidal: CSF ➔ impaired humoral immunity
- High doses for long duration
- You may modify and change antibiotic
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 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
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%
- For a Type 2 diabetic patient who remains uncontrolled on metformin and Sulfonylurea, which of the following would NOT be added as a third drug?
a. Sitagliptin
b. Canagliflozin
c. Repaglinide
d. Liraglutide
c. Repaglinide
.Outline the management of hypoglycemia and hypoglycemic coma?
If patient is conscious → Oral glucose or sweets
If patient in Coma = Unconscious → I.V.Glucose 50 ml 25% → Life-saving.
If sterile glucose is not available → Glucagon 1 mg S.C. or I.M
Which of the following is a difference between the management of diabetic ketoacidosis and Hyperosmolar Non-Ketotic Hyperglycemia
(HONK)?
a. Because the presence of ketone bodies is not a feature of HONK, we do not classically need to give NaHCO3.
b. In HONK, no need to worry about hypoglycemia even with prolonged insulin
infusion.
c. In HONK, there will always be an excess of potassium in the blood we don’t usually need to supplement insulin with KCl.
d. Subcutaneous Mixtard insulin can be used instead of regular insulin for the management of HONK.
a. Because the presence of ketone bodies is not a feature of HONK, we do not classically need to give NaHCO3.
Regarding the treatment of myxedema coma, indicate whether each of the following is True or False
a. T3 has a longer t1/2 than T4 and so a loading dose is usually needed.
b. T4 is more cardiotoxic than T3.
c. Hydrocortisone is needed to manage the expected unmasking of adrenocortical insufficiency.
d. Antibiotics are needed in every case.
e. Only intravenous thyroxine is reliable.
a) FALSE
b) FALSE
c) TRUE
d) FALSE
e) TRUE
Enumerate the lines of management of acute adrenal
insufficiency?
1- 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
Explain each of the following:
Combined treatment of moderate hypercalcemia with calcitonin and pamidronate.
Calcitonin is weak but rapidly acting, pamidronate is more potent but slow to act.
- A patient with acute adrenal insufficiency might need supplementation with all of the following EXCEPT:
a. Ca
b. Glucose
c. K
d. Na
c. K
- 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
MOA and one SE Orlistat
Gastric and pancreatic lipase inhibitor
Decreases fat absorption
Oily rectal leakage
MOA and one SE Phenteramin / Topiramate
This combination works by increasing satiety
Increase HR
MOA and one SE
They work synergistically in hypothalamus to promote satiety, decrease food intake, and increase energy expenditure
Sleep disorder
MOA and one SE Semaglutide
Glucagon like peptide (GLP-1) analogue
-improves satiety and delays gastric emptying
Increase HR
MOA and one SE Liraglutide
Glucagon like peptide (GLP-1) analogue
-improves satiety and delays gastric emptying
Increase HR
MOA and one SE Setmelanotide
Acts on MC4R pathway to reverse hyperphagia
and promote weight loss through decreased caloric intake and increased energy expenditure
injection rejection
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.
Impaired absorption of extended -release preparations
Patients may have reduced bioavailability. This can be important in critical drugs such as anti-epileptics
Decreased absorption of Acetyl salicylic acid
Gastric bypass or sleeve gastrectomy, lead to decreased production of HCI and an increase in gastric pH. This might decrease absorption of acidic drugs
Increased absorption of Allopurinol
Gastric bypass or sleeve gastrectomy, lead to decreased production of HCI and an increase in gastric pH. This might increase solubility of certain basic medications as allopurinol
More rapid onset of orally administered Morphine and Midazolam
After bariatric surgery, patients may be more prone to rapid gastric emptying time, higher absorption rates and quicker drug onset of sedatives or opioids such as midazolam and morphine
It is better to give liquid formulation after bariatric surgeries.
Because the absorption of drugs is affected after bariatric surgery because of reduced bioavailability as a result of a significant portion of the gastric tract being bypassed
In general, what supplements are usually needed after bariatric surgery?
- Zinc: Zinc deficiency induces hair loss, impaired sense of taste, and sexual dysfunction
- Selenium is absorbed primarily in the duodenum; therefore, patients after malabsorptive procedures are at risk of selenium deficiency
- 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
How do benzodiazepines produce CNS depression?
They bind to GABAA receptors at a site different from where GABA binds —> increase the affinity of GABA for the GABA-binding site —►increase the frequency of the opening of the ion channel controlled by the GABAA receptor Opening of the central ion channel, allows chloride entry—► hyperpolarization of the neuron and decreases neurotransmission by inhibiting the formation of action potentials.
It is recommended to prescribe benzodiazepines for the shortest duration possible
►To avoid occurrence of Psychological and physical dependence
Tolerance to benzodiazepines is considered dynamic in nature.
►As Tolerance to BZs occur due to changes in responsiveness of the CNS
The anti-depressant, mirtazapine might be effective as a hypnotic.
►Because it is considered an older tricyclic anti-depressant + it has Strong antihistamine properties
Describe withdrawal to benzodiazepines
in case of sudden withdrawal of the drug, this will lead to withdrawal symptoms such as: Anxiety, Restlessness, Confusion
Based on kinetic properties, why would eszopiclone cause less tolerance (milder withdrawal) than that caused by zaleplon?
> Eszopiclone—> Long duration
> Zaleplon ——–> Shorter duration, half-life of one hour
Withdrawal is more common with the short acting
Mention the name and the mechanism of action of an over-the- counter OTC product for insomnia.
Antihistamines with sedating properties (1st generation antihistaminic) which also have anticholinergic effects
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
- Combinations of antianxiety agents should be avoided
Describe the sequence of use of analgesics according the WHO’s analgesic ladder.
A. First Step - Mild pain: non-opioid analgesics such as (NSAIDs)
B. Second Step - Moderate pain: weak opioids with or without non-opioid analgesics and with or without adjuvants
C. Third Step - Severe and persistent pain: potent opioids with or without non-opioid analgesics, and with or without adjuvants
Mention three examples of analgesic adjuvants.
Tricyclic antidepressants (TCAs) such as amitriptyline
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Fluoxetine
- Anticonvulsants like gabapentin
Mention the basic principles of the WHO analgesic ladder.
“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 (patient-controlled analgesia).
to efficiently deliver pain relief at a patient’s preferred dose and schedule by allowing them to administer a predetermined bolus dose of medication on-demand at the press of a button.
For which type/s of pain can PCA (patient-controlled analgesia) be used
PCA is used to treat acute, chronic, postoperative
Which administration routes can be used for PCA (patient-controlled analgesia)?
These medications can be administered intravenously, epidurally, through a peripheral nerve catheter, or transdermally.
Which drugs are commonly used for PCA (patient-controlled analgesia)?
Drugs commonly administered are opioids and local anesthetics.
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?
The euphoria, indifference to stimuli, and sedation usually caused by the opioid analgesics, especially when injected intravenously, tend to promote their compulsive use.
- Outline the management of opioid addiction.
- Methadone or buprenorphine: Replace heroin or morphine by methadone. Gradual withdrawal of methadone (longer-acting) is less severe.
. Naltrexone: Given chronically after detoxification to block opioid receptors, loss of euphoric effects of opioids, loss of desire to take the drug.
- Symptomatic treatment of withdrawal symptoms:
* Anxiolytics - antiemetics - antispasmodics.
* Clonidine: inhibits sympathetic discharge.
- Chronic bronchitis and airway injury is a feature of the heavy consumption of which of the following?
a. Cannabis
b. Clonidine
c. Fentanyl
d. Morphine
a. Cannabis
- Describe the effects of cannabis on mood and perception.
Euphoria and relaxation. Feelings of well-being, grandiosity, and altered perception of passage of time.
visual distortions, drowsiness,
diminished coordination, and memory impairment may occur.
Some countries legalize cannabis and approve it for some indications. Mention three examples of such indications
Treatment of chronic pain in MS
Treatment of spasticity in MS
Co-adjuvant anti-tumor therapy in cancer patients
Mention two examples of drugs or drug classes that can cause neurolept malignant syndrome.
Typical neuroleptics
Atypical neuroleptics
Outline the treatment of neurolept malignant syndrome.
1- Discontinue, switch or reduce antipsychotics depending on severity
2- Anticholinergics are contraindicated in NMS
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
Explain the mechanism of action of IVIG in the treatment of Guillain- Barre Syndrome.
Although the mechanism of action of IVIG is not understood fully, proposed mechanisms include suppression of IgG production
- Hypertonic electrolyte solutions:
a. Mainly distribute intracellularly
b. Are considered plasma expanders as they contain proteins.
c. Replace lost interstitial fluid.
d. Exert osmotic power on interstitial water.
d. Exert osmotic power on interstitial water.
- Giving which of the following solutions is equivalent to giving pure water?
a. D5W
b. Lactated Ringer
c. Saline 0.45%
d. Saline 0.9%
a. D5W
Ensuring a gradual rise in plasma concentration of NaCI is important to avoid ___________ syndrome.
Osmotic demyelination syndrome
Lactated Ringer will not act as a buffer in hypoxia.
In hypoxia, lactate couldn’t be converted to sodium bicarbonate due to oxygen lack
We use lactated Ringer cautiously in hepatic impairment.
In liver impairment, there is a risk of lactate accumulation when using ringer lactate
We use lactated Ringer cautiously in renal impairment.
In renal impairment, there is a risk of hyperkalemia when using ringer lactate
We use lactated Ringer cautiously in calcium or potassium deficiency.
As ringer lactate contains insufficient amounts of calcium and potassium to replace these electrolytes
Lactated Ringer may lead to cerebral edema in cases of closed head injury.
As ringer lactate is slightly hypotonic solution
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
Mention adverse effects of giving NaCI solution.
- Hyperchloremic metabolic acidosis
- Acute renal injury
- Interstitial edema
Which of the following is regarded as a balanced electrolyte solution?
a. Dextran
b. D5W
c. Isotonic saline
d. Lactated Ringer solution
d. Lactated Ringer solution
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
