Pharma Tips-362

1826. Initial dose of atropine in the treatment of sinus bradycardia may exacerbate bradycardia (typically <0.5 mg).

1827. Quinidine is a class Ⅰa antiarrhythnic agent used as a sustained-release tablet to decrease gastrointestinal side effects and to provide more even plasma levels and less frequent dosing.

1828. Low doses of aspirin and other salicylates inhibit tubular secretion of uric acid, increasing uric acid levels, leading to gout or worsening the case. 

1829. Nicotinic acid reduces uric acid excretion in kidneys, increasing uric acid levels, leading to gout.

1830. Cytotoxic drugs increase nucleic acid levels that are metabolised to uric acid, increasing the risk of gouty attacks. 

Pharma Tips-361

1821. The normal serum concentration of lithium should be between 0.6 and 1.2 mEq/L.

1822. Foscarnet may cause severe renal toxicity; monitor CrCL closely.

1823. The dose of beta-blocker in the treatment of heart failure should be closely titrated up to the optimal dose and should not be suddenly stopped, as may that induce acute coronary event.

1824. Left-sided heart failure signs are shortness of breath, rales, orthopnea, fatigue and paroxysmal nocturnal dyspnea. 

1825. Furosemide causes venodilation and decreases excess sodium and water, decreasing venous return and decreasing preload and relieving pulmonary congestion. 

Pharma Tips-360

1816. Bismuth subsalicylate can cause darkening of the tongue and greyish-black stool.

1817. Concurrent use of loperamide with opioids may cause severe constipation.

1818. Rivastigmine may cause urinary retention, seizures, and increased gastric acid secretion.

1819. Cyclobenzaprine is not recommended for longer than 2–3 weeks for acute musculoskeletal spasms.

1820. Famciclovir is an orally administered pro-drug of penciclovir.

Pharma Tips-359

1811. Amiodarone is used to treat ventricular fibrillation and ventricular tachycardia and may cause pulmonary fibrosis; it has a very long half-life of about 50 days.

1812. Norepinephrine is the drug of choice in the treatment of septic shock for adults.

1813. Anticoagulants: warfarin is active only in vivo; LMWH is active in vivo and minimally active in vitro; and heparin is active in vivo and in vitro. 

1814. Cyclophosphamide may cause severe hemorrhagic cystitis and pulmonary fibrosis; patients should drink plenty of fluids before and after doses.

1815. Bactrim may cause megaloblastic anemia due to folic acid deficiency and may cause hemolytic anemia in patients with G6PD. 

Pharma Tips-358

1806. Beta-blockers decrease the positive inotropic effect of dobutamine.

1807. If alteplase is to be administered, wait 24 hrs before initiating aspirin.

1808. Nimodipine is used for subarachnoid haemorrhage.

1809. Donepezil may increase gastric acid secretion. 

1810. Milk thistle has renal and hepatoprotective properties due to antioxidant effects.

Pharma Tips-357

1801.  For organic nitrates10-12 hours nitrate free period each day is needed to avoid tolerance in angina treatment.

1802. Dual antiplatelet therapy with clopidogrel + Aspirin is essential for a patient with coronary stenting to prevent acute stent occlusion and ischemic outcomes.

1803. Alcohol, doxorubicin, cocaine, cyclophosphamide, imatinib, and trastuzumab may exacerbate heart failure. 

1804. New York Heart Association functional classification (NYHA):

1.  No symptoms
2. Symptoms occur with ordinary activity
3. Symptoms occur with less than ordinary activity
4. Symptoms occur at rest or with minimal activity 

1805. Isosorbide dinitrate + hydralazine decrease mortality and morbidity in black patients with NYHA Ⅲ and Ⅳ.

Pharma Tips-356

1796. Beta-blockers are not recommended as an initial therapy in patients > 60 years of age.

1797.  ACEIs are not recommended as an initial therapy in hypertension fro black people. 

1798. A Combination of ACEI and ARB is not recommended in hypertension. 

1799. Hydralazine and minoxidil can increase left ventricular hypertrophy. 

1800. Avoid ACEI and ARB in hypertensive patients with bilateral renal artery stenosis or unilateral disease with one kidney. 

Pharma Tips-355

1791. Orlistat (Xenical) decreases the absorption of fat-soluble vitamins A, D, E, and K (ADEK). A multivitamin containing these vitamins should be taken at least 2 hours before or after orlistat. Cyclosporine should be administered at least 3 hours after orlistat because concomitant use can decrease cyclosporine absorption.

1792. HSCRP = high-sensitivity C-reactive protein.

1793. Pregnant women with hypertension are at increased risk of intrauterine growth restriction, placental abruption, preterm delivery, neonatal prematurity, and pre-eclampsia.

1794. Atenolol may cause intrauterine growth restriction (IUGR) in pregnant women.

1795. Methyldopa, labetalol, and extended-release nifedipine are commonly used for hypertension in pregnancy. Hydralazine is used particularly for acute severe hypertension. Other agents such as clonidine and some beta-blockers may be used in selected circumstances, but are not all considered preferred first-line choices.

Pharma Tips-354

1786. For age-related macular degeneration (AMD), patients who are smokers should not use a formula containing beta-carotene due to an increased risk of lung cancer.

1787.VEGF = vascular endothelial growth factor.

1788. For photodynamic therapy, wet AMD patients should avoid exposure of the skin or eyes to sunlight or bright indoor light for 2-5 days.

1789. FNAB = fine needle aspiration biopsy.

1790. Diabetic ketoacidosis management (DKA) includes fluids, potassium, insulin, bicarbonate in severe metabolic acidosis, laboratory tests and supportive care. 

Pharma Tips-353

1781. Prostaglandin eye drops like Lumigan may cause brown pigmentation of the iris, darkening of the periocular skin, and thickening and elongation of eyelashes. 

1782. Dorzolamide 2% preservative-free (Trusopt) for patients who cannot tolerate preservatives.

1783. Most topically administered eye drops used in therapy can cause irritation and toxicity.

1784. Corticosteroids may worsen herptic/fungal keratitis, and long-term use of corticosteroids may cause glaucoma and/or cataracts.

1785. Trifluridine is used for herpes simplex virus-only infections; chronic use may cause corneal epithelial toxicity.

Pharma Tips-352

1776. RRMS = relapsing-remitting multiple sclerosis.

1777. PPMS = primary progressive multiple sclerosis. 

1778. SPMS = secondary progressive multiple sclerosis. 

1779. Fingolimod is used to treat multiple sclerosis; avoid live vaccines during treatment and for 2 months after stopping.

1780. Separate the administration of different eye drops by 5-10 minutes, sometimes 15 minutes for convenience or if the drops are irritating.