Pharma Tips-344

1736. Anticholinergic side effects include dry mouth, blurred vision, constipation, urinary retention, tachycardia, hallucinations, ataxia, mental slowing, confusion, and memory impairment. Anticholinergic drugs should be used with caution in patients with narrow-angle glaucoma, as they can increase intraocular pressure and may precipitate an acute glaucoma attack.

1737. Anticholinergic drugs are equally effective as a group, but their use is limited by their anticholinergic side effects and reduced effectiveness against bradykinesia.

1738. Drugs that are used to treat parkinsonism are pergolide and bromocriptine, which directly stimulate dopamine receptors. Levodopa is converted to dopamine in the brain; amantadine stimulates the presynaptic release of dopamine; and selegiline inhibits MAO-B and prevents the breakdown of dopamine in the brain. Pramipexole and ropinirole are non-ergot dopamine agents, and tolcapone and entacapone, COMT inhibitors, delay the breakdown of dopamine in the brain.

1739. Dopa-decarboxylase converts levodopa to dopamine, but this reaction is important to happen inside the brain. If the patient is taking pyridoxine (B6), which is a coenzyme for dopa-decarboxylase, that means more levodopa is converted to dopamine peripherally, so less dopamine in the brain.

1740. For the on-off therapy of levodopa for parkinsonism, the use of pramipexole or ropinirole has shown effectiveness as a adjunctive therapy. 

Pharma Tips-343

1731. Diphenhydramine could be used to treat mild, symptomatic tremor in Parkinson's patients.

1732. Biperiden is an anticholinergic agent in the treatment of parkinsonism, the daily dose is 2 - 8 mg, with a maximum dose that could reach up to 16mg.

1733. Benztropine, an anticholinergic drug for parkinsonism, dose 1-6 mg.

1734. Pramipexole is a non-ergot dopamine receptor agonist; the daily dose ranges from 1.5 to 4.5 mg for the treatment of parkinsonism.

1735. Tolcapone 300-600 mg and entacapone 200-1600 mg are both COMT inhibitors; they are adjunctive therapies to levodopa/carbidopa (wearing off) and increase levodopa bioavailability.

Pharma Tips-342

1726. TB testing is performed when the patient uses infliximab, due to its immunosuppressive properties.

1727. Secondary parkinsonism may be caused by dopamine antagonists, such as phenothiazines and butyrophenones (e.g., haloperidol), as well as dopamine-depleting agents such as reserpine.

1728. Secondary parkinsonism may be caused by poisoning with certain chemicals and heavy metals, including manganese, mercury, and cobalt.

1729. Secondary parkinsonism may be caused by infectious diseases such as viral encephalitis and neurosyphilis.

1730. Secondary parkinsonism may be caused by cerebrovascular disease (vascular parkinsonism), neurodegenerative diseases of the CNS, and metabolic disorders.

Pharma Tips-341

1721. Vasopressin and oxytocin are released by the posterior pituitary gland.

1722. Metoprolol is a selective β₁‑blocker. Non‑selective beta‑blockers (e.g., timolol) decrease aqueous humour production; metoprolol does not significantly do so.

1723. Valacyclovir is indicated for the treatment of shingles and genital herpes.

1724. Tegaserod is a 5-HT₄ agonist, used for irritable bowel syndrome in women with constipation predominant.

1725. Ritonavir is a protease inhibitor; it is used for HIV.

Pharma Tips-340

1716. Out-patient on lithium takes 900- 1200 mg to maintain 0.6-0.8 mEq/L (lithium levels). Blood sampling is performed 10-12 hrs after the last dose (usually just before the morning dose).

1717. Desmopressin is used to treat primary nocturnal enuresis.

1718. Insulin glargine is a long-acting insulin analogue; it is used only by subcutaneous route.

1719. Cilastatin is a renal dipeptidase inhibitor; it is co-administered with imipenem to prevent renal metabolism of imipenem.

1720. Growth hormone (somatotropin) is released by the anterior pituitary gland. 

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1711. 25 µg of liothyronine (T₃) is equivalent to 100 µg of levothyroxine sodium (T₄).

1712. Thiamine (Vitamin B₁) deficiency may cause Wernicke's syndrome or Korsakoff's syndrome.

1713. Folic acid deficiency leads to megaloblastic anaemia.

1714. Folic acid supply to pregnant women is essential to prevent neural tube defects, especially fetal spina bifida.

1715. Zollinger-Ellison syndrome results from pancreatic adenomas (gastrin-producing islet cells) or duodenal gastrinomas. It is characterised by ulcer pain and diarrhoea, with proton pump inhibitors  (PPIs) as the drug of choice.

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1706. Pneumonia, cor pulmonale, ciprofloxacin, and heart failure increase serum theophylline levels.

1707. Smoking decreases theophylline serum levels by increasing its elimination.

1708. Verapamil slows impulse conduction within the AV node, so it is used to treat tachycardia.

1709. Atomoxetine is not a CNS stimulant.

1710. PICC = peripherally inserted central catheter, sterilely inserted into the vena cava.