SPLE miscellaneous facts: Flashcards
Obesity Drugs used in diabetic patients:
Orlistat (FATLOS) : blocks triglyceride uptake in the gut and may cause loose stools and flatulence.
Sibutramine (Meridia), sertonin and noradrenaline reuptake inhibitor, influences satiety and may increase thermogenic energy. Side effects of this drug include increases in blood pressure and tachycardias.
Rimonabant (Acomplia): , a selective cannabinoid (CB1) receptor inhibitor, decreases appetite and affects energy balance. Although CB1 receptors have been identified on numerous body organs, the major effect of this drug appears to be on the central nervous system.
COMMON COMPOUNDING TECHNIQUES
- Trituration: This technique is used to reduce the particle size of powders. Grinding them into a fine powder makes them easier to mix into creams or put into capsules. The key to doing this correctly is to use a mortar and pestle
- Levigation: Levigation is the act of decreasing particle size of a powder by using a non-soluble liquid. In this technique, you need a flat compounding surface, such a glass tray, a metal spatula, and your powder, mineral oil, lanolin, and/or petroleum jelly.
- Geometric Dilution: This mixing process is used when combining two or more ingredients of varying quantities together to achieve a homogeneous mixture. This can be used to mix powders, creams, or ointments.
USP Chapter 797
sterile preparations and techniques
Sterile non hazardous
USP Chapter 800
sterile hazardous
USP Chapter 795
non sterile non hazardous
the first drug approved for the treatment of Acquired Immuno Deficiency Syndrome (AIDS)
zidovudine
-synthetic dideoxynucleoside
Class:Reverse transcriptase inhibitor
- Phosphate and phosphonate derivatives of azidothymidine: **Nikavir, a new anti-HIV drug, is a phosphonate derivative of AZT
- Modification of Azido group: Results in converting into triazole ring and resultant compounds exhibited anticancer activities in addition to antiviral activities.
Proscar (Finasteride)
category: X with pregnancy in utero exposure to finasteride may lead to abnormal development of the male genital tract
Benzo chemistry
Their core chemical structure is formed by the fusion of a benzene ring and a diazepine ring (Figure 1).
Different compounds have different side groups attached to this central structure in position 1, 2, 5, or 7. The different side groups affect the binding of the molecule to the GABAA receptor and so can modulate the pharmacological properties, the potency of the effect, and the pharmacokinetic conditions (duration of the effect, distribution, etc.).
tests for the detection of alkaloids
Mayer’s reagent: A general presumptive test for cocaine, morphine, heroin, and other alkaloids. Mayer’s reagent is a solution of potassium mercury iodide in water. A positive result is indicated by a cream precipitate.
Dragendorff’s reagent: orange or orange-red precipitate.
Wagner’s reagent; brown or deep brown precipitate
Marme’s reagent; yellow ppt
Fentanyl patch (Duragesic) counseling
Exposure of the DURAGESIC application site and surrounding area to direct external heat credits, such as heating pads or electric blankets, heat or tanning lamps, sunbathing, hot baths, saunas, hot tubs, and heated water beds may increase fentanyl absorption and has resulted in fatal overdose of fentanyl and death
Avoid the use of DURAGESIC in patients with severe renal impairment/hepatic
Each DURAGESIC patch may be worn continuously for 72 hours. The next patch is applied to a different skin site after removal of the previous transdermal system
Test for detection of vit.B12 deficiency
Schilling test
Raloxifene
Increased risk of deep vein thrombosis and pulmonary embolism have been reported with raloxifene. Women with active or past history of VTE should not take raloxifene.
Selective Estrogen Receptor Modulator (SERM); selective binding activates estrogenic pathways in some tissues and antagonizes estrogenic pathways in other tissues. Raloxifene acts like an estrogen agonist in the bone to prevent bone loss and has estrogen antagonist activity to block some estrogen effects in the breast and uterine tissues
Labeled Indications
Osteoporosis: Treatment and prevention of osteoporosis in postmenopausal females.
Risk reduction for invasive breast cancer: Risk reduction of invasive breast cancer in postmenopausal females with osteoporosis
contraindicated during pregnancy.
xaltan is the brand name of
Lanatopros for treatment of glaucoma
A test used to determine the likelihood of a patient having autoimmune diseases such as ankylosing spondylitis (AS), juvenile rheumatoid arthritis (JRA), reactive arthritis (of which one subset is Reiter syndrome), and isolated acute anterior uveitis.
HLA-B27
Test for Behçet’s disease
HLA-B51
abacavir (Zaigen) associated testing:
Due to the implications of positive results for the HLA B 5701 allele, using abacavir in treatment is contraindicated
HLA B 5701 perform direct noncovalent bonding with abacavir. Once bonded, the surface complex is altered and is then recognized as foreign by cytotoxic lymphocytes. This interaction results in the release of inflammatory cytokines that facilitate the hypersensitive response
Abacavir is contraindicated in patients with a prior hypersensitivity reaction to abacavir and in HLA-B*5701–positive patients
Type of drug induced Agranulocytosis;
Direct toxicity; clonazipine, phenytoin, diclofenac/endomethacin
Immune-mediated: quinidine (immune complex reaction)
Digoxin volume of distribution is increased with
hypokalemia, HYPERthyrodism,
Digoxin volume of distribution is decreased with
hyperkalemia, with Quinidine use
methotrexate antidote
Leucovorin (folinic acid) is the reduced and active form of folic acid. It selectively “rescues” normal cells from
the toxic effects caused by MTX’s inhibition of the production of reduced folates.
Thymidine rescues cells from the cytotoxic effects of MTX.
Glucarpidase (carboxypeptidase); converts MTX to an inactive form and rapidly lowers MTX blood levels. It is given as a single bolus of 50 units/kg intravenously over 5 minutes.
Leucovorin should be continued for 48 hours after glucarpidase administration.
Antidote for iron overload
Defroxamine
Red urine is a common effect when taking:
Rifampin
Emergency management of anaphylaxis in adults
- IM epinephrine (1 mg/mL preparation): Give epinephrine 0.3 to 0.5 mg IM, preferably in the mid-outer thigh. Can repeat every 5 to 15 minutes (or more frequently), as needed. If epinephrine is injected promptly IM, most patients respond to one, two, or at most, three doses. If symptoms are not responding to epinephrine injections, prepare IV epinephrine for infusion.
- Place patient in recumbent position, if tolerated, and elevate lower extremities.
- Oxygen: Give 8 to 10 L/minute via facemask or up to 100% oxygen, as needed.
- Normal saline rapid bolus: Treat hypotension with rapid infusion of 1 to 2 liters IV. Repeat, as needed. Massive fluid shifts with severe loss of intravascular volume can occur.
- Albuterol (salbutamol)Ventolin : For bronchospasm resistant to IM epinephrine, give 2.5 to 5 mg in 3 mL saline via nebulizer, or 2 to 3 puffs by metered dose inhaler. Repeat, as needed.
HCV & IL28b gene
HCV is a blood borne and transfusion-transmitted infection (TTI).
Ribavirin (RBV) causes birth defects and miscarriage. HCV treatment regimens that include RBV should not be used by pregnant women or by male partners of pregnant women.
HCV has six genotypes, labeled 1 through 6. There are also subtypes labeled with letters, for example, genotypes 1a and 1b
HCV genotype 1 is harder to cure with PEG-IFN and RBV than genotypes 2 and 3
PEG-IFN and RBV are less effective for African Americans and people of African ancestry than people of other races and ethnicities.
The IL28B gene is involved in the immune response to certain viruses, including hepatitis C. There are three IL28B subtypes (called genotypes): CC, CT, and TT. People with the CC genotype have a stronger immune response to HCV infection than people with the CT or TT genotypes
Mirabegron
beta-3 adrenergic receptor agonist, activates beta-3 adrenergic receptors in the bladder resulting in relaxation of the detrusor smooth muscle during the urine storage phase, thus increasing bladder capacity
polystyrene sulfonate
Potassium binder
Oral: 15 g 1 to 4 times daily.
Rectal: 30 to 50 g every 6 hours.
Phosphate Binder
Sevelamer (Renvela)
TYPES OF NUCLEIC ACID DRUGS
Aptamers, Antisense oligonucleotides, Ribozyme nucleic acids, RNA interference and Antigene nucleic acids.
Mythelene blue is an antidote for:
Methmeglobinemia
Epinephrine can be stabilized by adding an antioxidant named;
Sodium bisulfite
Content uniformity test is used to;
Test potency
Codeine to morphine via;
Methylation via CYP 450 2D6
Drug dissolution is predicted by
Noyes Whitney equation
Suspending agents include
Methylcellulose, taraganth and karaya gum
Folic acid dose in non-pregnant women
400mcg/day
Folic acid dose in pregnant women
600mcg/day
Folic acid dose in lactating women
500mcg/day
Which drug will be more absorbed in the presence of Rantidine;
Warfarin
naproxen
Asa
Naproxen
concomitant administration of H2 blockers may increase the dissolution rate of enteric-coated naproxen, causing the drug to be released in the stomach instead of the small intestine.
In which case should we use Omeprazole as a single therapy
gastiritis
Recommended calcium dose for geriatric
1200mg/day
Recommended Vit.D dose for geriatric
> 70; 800iu
<70; 600iu
Human chorionic gonadotropin is used to
Induce ovulation and treat infertility
Mechanism of action of bisacodyl (stimulant laxative
+ enteric nerves to cause colonic contraction
It is used to treat Constipation: 5 to 15 mg once daily
Risk X: Sodium Sulfate with Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased.
Diphenoxylate and loperamide are narcotics or opioid agonists which are used as:
Antidiarrheal
An important cause of waterborne and foodborne disease, daycare center outbreaks, and illness in international travelers:
Giardiasis
It has two morphological forms: cysts ( infectious form of the parasite; they are excreted in stool and can survive in moist environments for prolonged periods) and trophozoites (pear-shaped, binucleate, multi-flagellated parasite forms capable of division by binary fission; they localize principally to the proximal small bowel, attached to the mucosal surface of the duodenum and jejunum and free form that do not adhere to the small bowel move forward to the large intestine, where they revert to the infectious cyst form)
Transmission of infectious Giardia cysts to humans may occur via three routes: waterborne, foodborne, or fecal-oral transmission
Treatment of Giardiasis:
tinidazole and nitazoxanide
- patients ≥3 years of age: tinidazole since it has a longer half-life than nitazoxanide and may be administered as a single dose.
- patients 12 to 36 months of age, we favor nitazoxanide.
- Given limited data regarding use of tinidazole and nitazoxanide for patients <12 months of age, we favor metronidazole for these patients.
Alternative Agents: Metronidazole, MEbemdazole,Albendazole.
Respiratory acidosis is caused by
CO2 retention
The action of epiotin enhanced with:
Iron.
Erythropoietin (EPO) plays a central role in the regulation of red blood cell (RBC) production. Since iron is an essential element for erythropoiesis and hemoglobin (Hb) synthesis, its importance is heightened in patients treated with epoetin alfa
For patient with hepatic and renal failure, which of the following skeletal muscle relaxant can be used:
Atracurium (NImbex)
Intermediate acting
Non-depolarizing neuromuscular blocking agent.
Obese patients: IBW or adjusted body weight.
MOA: Blocks neural transmission by binding to cholinergic receptor sites
After drug metabolism the drug become
&
Drug after metabolized in liver it will become:
POLAR
Antidote for patient with drowsiness, dry mouth and pupil constriction
Naloxone
Beta2 blocker and aspirin are contraindicated with
Asthma
Which of the following anesthetics cause cardiotoxicity
Bupivacaine
Recommended dose of iron in anemia:
Elemental iron: range of 150 to 200 mg/day PO
Ferrous sulfate: it is in the range of (1000 – 1200mg/day) of ferrous sulfate in 3 or 4 divided doses, 1000mg divided in 3 doses and 1200mg divided in 4 doses
Digitalis arrhythmia can be treated with:
Ventricular arrhythmia»_space; Procainamide
Ventricular arrhythmia with heart block»_space; Phenytoin
Digitalis arrhythmia»_space; lidocaine (if the question do not include Lidocaine then the answer is phenytoin)
Cushing like syndrome is due to:
Adrenal hyperplasia
Drug of choice for tape worm:
Drug of choice in tape worms is (praziquantel)…..if it is not available in choices choose (niclosamide) is an acceptable alternative to be used.
Which of the following is colloid solution?
Albumin
Which of the following is released by bacterial cell wall during phagocytosis?
During infection or growth →exotoxin
During phagocytosis→endotoxin
Which Metal Used in treatment of rheumatoid arthiritis?
GOLD
The antimalarial to be avoided in glucose-6-phosphate dehydrogenase deficiency:
Primaquine
To increase duration of lidocaine in anasethia:
administer with Epinephrine
Anticancer from plant alkaloids origin:
Plant origin … Etoposide //
Vinca Plant … Vincristine, Vinplastin
Combination contraceptive act on :
Ovulation
Daily recommended dose for vit. C :
Males: 90mg/day
Females: 75mg/day
Which of following is the drug of choice for treatment of all forms of Schistosomiasis?
(praziquantel)
Beta blockers with intrinsic sympathomimetic effect:
partial agonists:
APL:
Acebutalol
Pinodolol
Labetalol
Beta blockers with membrane stabilizing activity (local anesthetics):
PALMP:
Propranolol Acebutalol Labetalol Metoprolol Pindolol
selective beta-1 blockers (cardio selective):
NAME.B:
Nebivolol Acebutalol Metoprolol Esmolol Bisoprolol
Amphetamine pharmacological action:
INDIRECT adrenergic agonist
Mechanism of action of clomiphene
inhibit negative feedback of estrogen
Drug used to treat prostate cancer:
Flutamide
Septic shock patient with normal sodium value with high potassium and creatine the treatment is:
- Cardiac shock = Dopamine
- Anaphylactic shock= Epinephrine
- Septic shock=
1. intravenous fluid (normal saline)
2. Dopamine
Septic shock in this question with normal sodium level and renal failure (kidney injury)= Dopamine
Loperamide act as:
opioid agonist antidiarrheal
Which of the following is contraindicated with angina: Isobide ASA Metoprolol Vasopressin
with angina: vasopressin (worsens cardiac output in angina)
with asthma : aspirin
Phentolamine mechanism of action:
Alpha antagonist
Which of the following is used as anti-estrogen and when used can cause abortion?
Anastrolzole
Perphenazine is used in
Nausea and vomiting
Which of the following can be used in treatment of hyperthyrodism?
KCL
NACL
KI
Potassium iodide
Pregnant woman with G6PD deficiency has G-ve. M.o. and UTI, which is the drug of choice to treat her UTI: vancomycin SX/TMP Nitrofurantoin Cefuroxime
Answer: Cefuroxime.
Nitrofurantoin & Sulpha drugs cannot be used in G6PD deficiency patients.
Pregnant woman has (Urinary Tract Infection) which is the drug of choice to treat her UTI:
- Cefuroxime
- Nitrofurantoin is pregnancy category B. It is one of the few drugs commonly used in pregnancy to treat UTI & contraindicated only at term (during labor & delivery).
- vancomycin is the last choice
- Sulphamethoxazole & tetracycline cannot be used in pregnancy
Enkephalins are peptides that:
similar in action to morphine
Ultrashort acting barbiturates are used primarily as:
pre-anesthetics
Methohexital (Brevital), Thiamylal (Surital), and Thiopental (Pentothal).
EnteroHepatic recycling depend on
- Dosage form
- Extent of drug passed in feces.
- Gallbladder state
DAILY intake of vitamin A for adults:
adult male 1000 mcg
adult female 700-800 mcg
pregnant 900 mcg
breastfeed 1200-1300mcg
Enzyme kinetics law:
Michaelis Menten law
“The rate of an enzymatic reaction will increase as substrate concentration increases, and that increased unbinding of enzyme-substrate complexes will decrease the reaction rate.”
(Allopurinol)is:
1- uricosuric drugs are substances that increase the excretion of uric acid in the urine, thus reducing the concentration of uric acid in blood plasma
2- Allopurinol decrease uric acid synthesis (xanthine oxidase inh.) Anti-o=inflammatory
3- Probencid Increase uric acid excretion (prevent uric acid reabsorption) (probenecid is a uricosuric.)
prevents Neural tube defects (birth defects):
vit.B9 & folic acid
BRL-37344
Sodium salt is a potent and selective β3 adrenoceptor agonist not developed for clinical use.
However, assuming agonism of B3 receptors will result in: stimulation of metabolic breakdown of fat stores into free fatty acids.
Acetanilide (Aka N-Phenylacetamide)
a chemical compound containing four types of atoms: Carbon, Hydrogen, Nitrogen and Oxygen, It has an aromatic ring. Classified as an amide (due to its functional grp).
Formula: CH3CONHC6H5
Bambuterol
is a long-acting β adrenoceptor agonist used in the treatment of asthma; it also is a prodrug of terbutalin
Which of the following has catharitic side effect:
Magnesium Sulfate
infusion of hypertonic saline causes
shrinking of blood cells
Treatment of Raynaud phenomenon:
Amlodipine is preferred by the author because of the more favorable safety profile OR nifedipine.
Alternative treatments due to intolerance or lack of response:
Sildenafil.
Fluoxetine
Which of the following prevents Neural tube defects (birth defects)
vitamin b6 & folic acid
Methylparaben is used as:
preservative (antimicrobial)
Ergot derivative used for migraine
Dihydroergotamine and ergotamine
An exaggerated vascular response to cold temperature or emotional stress:
Raynaud phenomenon
infusion of hypotonic saline causes
hemolysis
HLA B 1502 positive indicates:
A marker for carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis
CI:
carbamazapie, pheyntoin
HLA-B*5801 allele, is highly associated with individuals who are at risk for
allopurinol-induced HSS, SJS, or TEN
