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.  

Pharma Tips-351

1771. ACEIs and ARBs decrease lithium clearance.

1772. Flunarizine is used in migraine prophylaxis; it may take several weeks to be effective and should not be used in depressed patients or those with EPS.

1773. Ketorolac for moderate to severe pain, 30mg is equianalgesic 12mg of morphine; it is used to treat renal colic.

1774. Trigeminal neuralgia (tic douloureux) is a sudden, brief, sharp episodic pain in one or more branches of the fifth cranial nerve. 

1775. Bell's palsy is caused by the herpes simplex virus one, predinsolone is the drug of choice 1mg/kg for 5 days and taper for 5 days; and antiviral therapy may be added.

Pharma Tips-350

1766. Carbamazepine treats seizures and trigeminal neuralgia and may cause aplastic anaemia and agranulocytosis.

1767. Migraine decreases gastric emptying, limiting the effectiveness of analgesics. 

1768. Hypothyroidism increases sensitivity to digoxin and opioids.

1769. Hyperthyroidism increases sensitivity to warfarin and decreases sensitivity to digoxin.

1770. Topiramate may increase the risk of nephrolithiasis during treatment; more hydration is recommended.

Pharma Tips-349

1761. Oxacillin and nafcillin are useful to treat β-lactamase-producing staphylococcal infections. 

1762. Acitretin is used to treat psoriasis; it is CI in pregnancy, so two negative pregnancy tests must be done before taking it, and two effective birth control methods must be used for one month before starting and for 3 years after stopping it.

1763. Mesalamine is a metabolite of sulfasalazine, and it is used to treat chronic ulcerative colitis.

1764. Tigecycline could be used to treat methicillin- and vancomycin-resistant bacteria; it is a structural analogue of tetracycline. 

1765. Antacids may decrease the absorption of gabapentin; it should be taken 2 hours after antacids. 

Pharma Tips-348

1756. NNRTIs include delavirdine, efavirenz, and nevirapine.

1757. Infliximab is used to treat rheumatoid arthritis, Crohn's disease, ulcerative colitis, and ankylosing spondylitis.

1758. Almotriptan is used for acute migraine.

1759. Metoclopramide could be used for symptomatic gastroesophageal reflux and diabetic gastroparesis.

1760. Lactase enzyme is used to manage lactose intolerance.

Pharma Tips-347

1751. Heart rate and blood pressure are the parameters to watch when administering beta-blockers to patients with MI for acute treatment; if the heart rate and BP are too low, don't give beta-blockers.

1752. Hyperkalemia can be treated by stabilising the cardiac membrane with IV calcium, shifting potassium intracellularly with insulin and dextrose, and removing potassium from the body with dialysis or potassium-binding agents such as sodium polystyrene sulfonate. 

1753. Elemental iron percentage in ferrous gluconate is 12%, in ferrous sulfate is 20%, and in ferrous fumarate is 33%.

1754. Protease inhibitor antivirals include amprenavir, indinavir, nelfinavir, ritonavir, and saquinavir. Other HIV protease inhibitors include atazanavir, darunavir, fosamprenavir, and lopinavir.

1755. NRTIs (nucleoside reverse transcriptase inhibitors) include zalcitabine, lamivudine, and stavudine. Other important NRTIs include abacavir, emtricitabine, didanosine, tenofovir, and zidovudine.