Pharma Tips-113

586. Bacitracin is highly nephrotoxic.

587. Famotidine, capecitabine, and gentamicin require dosage adjustment in patients with renal impairment.

588. Influenza vaccine is available in injections and intra-nasal forms.

589. Testosterone is available as an ointment, injections, and transdermal patches.

590. Valacyclovir and cetirizine are not affected by food.

Pharma Tips-112

581. Telithromycin is a ketolide antibiotic.

582. Efalizumab is used to treat plaque psoriasis.

583. Oseltamivir is used in the treatment and prophylaxis of influenza A and B infection.

584. Progestin cause weight gain, headache, fatigue, diarrhea, nausea, and vomiting.

585. Nitrates cause tolerance with prolonged use, so free nitrate treatment periods should be established.

Pharma Tips-111

576. Pyrogens are removed by heat.

577. Propranolol, nifedipine, and nitroglycerin are drugs subjected to first pass effect.

578. Gas sterilization is the most common method to sterilize powders especially talc.

579. Duloxetine is used to treat depression and diabetic neuropathy.

580. Teriparatide is used for post-menopausal osteoporosis.

Pharma Tips-110

571. Soda lime is a reagent for absorption of carbon dioxide.

572. Limulus test is a test for pyrogens.

573. Magnesium stearate is used as a lubricant.

574. Oxycel is an agent that promotes clotting.

575. Bacteria and fungi are removed by 0.22 μm filters.

Pharma Tips-109

566. Bismuth subsalicylate mechanism of action as antidiarrheal is adsorbent of bacteria and toxins.

567. Cellulose acetate phthalate is used as enteric coating material.

568. Cocoa butter (theobroma oil) is useful, because it melts at 37°c, and releases the drug.

569. The most used method for sterilization is the moist heat.

570. Ampholyte is a substance that can act as acid or base like NaH2PO4.

Pharma Tips-108

561. Vanishing creams are O/W bases.

562. Strong acids donate protons readily.

563. Reaction rate increases mostly by temperature.

564. Ethylene glycol may oxidize to form oxalic acid, which is corrosive and quite toxic.

565. Sunscreens that contain PABA should be applied 2 hours before sun exposure.

Pharma Tips-107

556. In acetaminophen toxicity, the first liver enzyme to be elevated is aspartate transaminase.

557. Framingham risk score is the primary risk tool to assess 10 years risk for CVD.

558. 400,000 units of penicillin equal to 250 mg.

559. Freeze drying is based on sublimation.

560. Gums are effective only as binders.

Pharma Tips-106

551. OTC drugs for allergic rhinitis are brompheniramine, cetirizine, chlorpheniramine, diphenhydramine, loratadine, pseudoephedrine NS, normal saline, oxymetazoline, xylometazoline, dextromethorphan. 

552. Periodontitis is a disease that attacks the gum and the bone around the teeth. Antibacterials regimens for periodontitis: 

Ciprofloxacin 500mg BID for 8 days. 

Metronidazole 500mg TID for 8 days. 

Metronidazole + amoxicillin 250mg both TID for 8 days. 

Metronidazole + ciprofloxacin 500mg both BID for 8 days. 

Tetracycline 500mg TID for 21 days. 

553. Candida albicans is the most common cause of oral candidiasis. 

554. Total parenteral nutrition (TPN) contains amino acids, dextrose, fat, electrolyte, alcohol, vitamins, and traces elements. TPN solution should contain 5-7.5% dextrose, 3-5%amino acids. Calcium phosphate forms crystals in TPN, so calcium gluconate is used to prevent crystal formation. 

555. Sensitivity requirement (SR) = weight*error.

Pharma Tips-105

546. Non-pharmacological measures that could be helpful to minimize the menopause symptoms:-

• Avoiding spicy food, alcohol, and caffeine.
• Stop smoking.
• Cool comfortable environment.
• Getting regular exercise.
• For vaginal dryness, use lubricants.

547. St. john’s wort can act as abortifacient.

548. Ginger may be helpful to reduce nausea.

549. OTC drugs for nausea and vomiting in pregnancy are dimenhydrinate, and pyridoxine (vitamin B6).

550. Diclectin is a combination of doxylamine 10 mg, and pyridoxine 10 mg.

Pharma Tips-104

541. Drugs that may cause vaginal dryness are oral contraceptives, antihistamines, antidepressants, antihypertensives,chemotherapy,and antiarrhythmics. 

542. Bacteria found in the vagina are lactobacilli, streptococci, staphyococci, G. vaginalis, C. albicans, and other candida species.

543. Boric acid 600 mg capsules is used intravaginally one or BID for 14 days to treat resistant vaginal candidiasis.

544. Toxic shock syndrome is caused by staphylococcus aureus, and streptococcus pyogenes.

545. Symptoms of menopause are hot flashes, vaginal dryness, painful sexual intercourse, loss of bladder control, skin changes (increase wrinkles), lower sex drive, and memory loss.

Pharma Tips-103

536. Bacitracin has cross sensitivity with neomycin.

537. Steam sterilization (autoclave) 15 minutes at 121°c or 3 minutes at 134°c.

538. REM means roentgen-equivalent man a unit for measuring radiation dose or rapid eye movement sleep.

539. Magnesium controls convulsions by blocking neuromuscular response.

540. Sublimation is the conversion from a solid state to gas state, without going through a liquid phase.

Pharma Tips-102

531. Impetigo is caused by Staphylococcus aureus, its topical treatment of choice is mupirocin 2% ointment.

532. OTC drugs for topical fungal infections are clotrimazole 1% cream, miconazole 2% cream, tioconazole 1% cream, ketoconazole 2% shampoo, tolnaftate 1 %, undecylenic acid, nystatin cream.

533. Insect repellents are deet, soybean oil, oil of citronella, other essential plant oils like lavender, cedar pine, cinnamon, garlic, pyrethrum, and permethrin.

534. OTC topical antipruritics are ammonium hydroxide, calamine, zinc oxide, camphor, diphenhydramine, menthol, papain, and phenol.

535. Topical antibacterials are bacitracin, gramicidin, mupirocin, and polymyxin.

Pharma Tips-101

526. Athlete’s foot (tinea pedis) is a superficial fungal infection of the feet.

527. Drugs trigger psoriasis are ACEIs, acebutolol, amiodarone, amoxicillin, ampicillin, ASA, BBs, chloroquine, cimetidine, cyclosporine, enalapril, lithium, NSAIDs, tetracycline, terbinafine, trazodone, and tacrine.

528. Drugs that might cause acne corticosteroids, oral contraceptives, ACTH, androgenic hormones, bromide, chloride, iodide, hydantoin derivatives, phenobarbital, ethambutol, INH, cyclosporine, vitamin B12, dantrolene, gold salts, lithium, maprotiline, psoralen, quinidine, quinine, coal tar, carbamazepine, cephalexin,cefazolin, chloramphenicol, co-trimoxazole, diltiazem, furosemide, naproxen, norfloxacin, piperazine, pyrimethamine, and tetracyclines.

529. Acne appears as pimples on the face, chest, back and upper arms, OTC drugs for acne like benzoyl peroxide (8-12 weeks), and salicylic acid.

530. Aluminium chloride is used as an antiperspirant.

Pharma Tips-100

521. Chlorzoxazone, methocarbamol, and orphenadrine are skeletal muscle relaxants.

522. White willow bark is a herb used in muscle cramps.

523. RICE therapy is used for soft tissue injury which is rest, ice, compression, and elevation.

524. Tamoxifen reverses gynecomastia caused by steroids.

525. ACEIs and NSAIDs both can cause renal failure.

Pharma Tips-99

516. Sibutramine is serotonin and norepinephrine reuptake inhibitor (SNRI), enhances satiety.

517. The repeated use of ipecac to induce vomiting can cause cardiotoxicity and dental erosion from the acidic content of the stomach.

518. Sodium restricted diet is useful for hypertension, CHF, renal and liver diseases.

519. Gluten intolerance causes abdominal cramps, diarrhea, and fatigue (celiac disease).

520. Drugs that may cause osteoporosis are corticosteroids like prednisone, levothyroxine (high doses), anticonvulsants like phenytoin, heparin (long-term therapy), antineoplastics, aluminum-containing antacids.

Pharma Tips-98

511. Drugs that might induce hypoglycemia are BBs, alcohol, pentamidine, quinine, quinidine(high doses), salicylates, insulin, and sulfonylureas.

512. Excessive iron may cause liver cirrhosis and skin pigmentation.

513. Elemental iron content in iron salts; ferrous sulfate 300mg contains 60mg iron, ferrous gluconate 300mg contains 35mg iron, ferrous fumarate 200mg contains 66mg iron, ferrous ascorbate 275mg contains 33mg iron.

514. Breast milk may be kept at room temperature (19-22°c), for up to 10 hours, and in a refrigerator (0-4°c) up to 8 days.

515. Guidelines for a healthy weight:-

Zone A: underweight <20 (BMI)

Zone B: acceptable weight; BMI between 20-24.9

Zone C: possibly overweight; BMI between 25-27

Zone D: overweight or obese; BMI > 27

Pharma Tips-97

506. Ostomy means stoma in greek, that means mouth which is used for artificial opening.

507. Drugs might cause hyperglycemia are alpha-interferons, beta-blockers(BBs), nicotinic acid, diazoxide, cyclosporine, corticosteroids (CTs), pentamidine, phenytoin, tacrolimus, thiazide diuretics, thyroid hormone, amiodarone, Li, and oral contraceptives.

508. Classic symptoms of diabetes mellitus are blurred vision, fatigue, frequent infection, weight loss, polyphagia (hunger), polydipsia, and polyuria.

509. Lipid targets for diabetic patients > 30 years of age, LDL<2.5 mmol/L, TC<4 mmol/L, TGs<2 mmol/L.

510. Hypoglycemia symptoms are sweating, hunger, shakiness, palpitations, anxiety, irritability, mood changes, numb lips or tongue, headache, if untreated causes blurred vision, confusion, slurred speech, convulsions, coma, and death.

Pharma Tips-96

501. Inflammatory bowel diseases include Crohn's disease and ulcerative colitis.

502. OTC medications for irritable bowel syndrome (IBS) are dicyclomine, loperamide, magnesium hydroxide, and lactulose. 

503. Enterobiasis is commonly called pinworm or seatworm, it is caused by entrobius vermicularis.

504. Scotch-tape test (cellulose-tape slide test) to be performed at home to detect the presence of pinworm ova.

505. OTC drugs for pinworm infection are piperazine adipate, pyrantel pamoate, and pyrvinium pamoate.

Pharma Tips-95

496. Recipes for homemade ORS:-

A. Fruit Juice 240 ml 

    Honey 2.5 ml 

    Salt 0.5 ml

    Baking Soda ¼ tsp

B. Purified water 1 L

    Salt 1 tsp

    Sugar 8 tsp

497. Common conditions associated with abdominal pain are cancer, cholelithiasis, chronic pancreatitis, crohn’s disease, GERD, IBS, myofacial pain, non-ulcer dyspepsia, PUD, and ulcerative colitis.

498. Drugs that might cause abdominal pain are amiodarone, antibiotics, anticonvulsants, antineoplastics, antiretrovirals, iron supplements, metformin, NSAIDs, neuroleptics, opioids, SSRIs, and sulfasalazine.

499. Gastroparesis is paralysis in GIT.

500. Aluminium antacids decreases the absorption of quinolones, tetracyclines, digoxin, iron, ethambutol, and isoniazid.

Pharma Tips-94

491. Wait for 5-10 minutes after using the eye drop to use the eye ointment.

492. Wait for at least 10 minutes, when you use one eye ointment, before using a second eye ointment.

493. Drugs that cause dizziness are prazosin, gentamicin, alcohol, carbamazepine, desipramine, levodopa, olanzapine, atenolol, verapamil, procainamide, digoxin, HCTZ, morphine, propoxyphene, oral sulfonylureas, and hydralazine.

494. Drugs that may cause nausea and/or vomiting are ASA, NSAIDs, auranofin, colchicine, digoxin, amiodarone, procainamide, BBs, CCBs, antituberculars, erythromycin, tetracycline, sulfonamides, phenytoin, carbamazepine, valproic acid, phenobarbital, acyclovir, levodopa, narcotic analgesics, oral contraceptives, sulfonylureas, and theophylline.

495. Viral infections that are responsible for diarrhea are rotavirus, norwalk like virus, adenovirus, astrovirus, and calcivirus.

Pharma Tips-93

486. Heat cramps may be due to lack of the sodium in the body.

487. Smoking cessation; 

• Set a quit date
• Good results from quitting
• Things to avoid
• Meet someone who could help like a pharmacist
• Tell family and friends about quitting to help you
• Make a diary 
• Use smoking alternatives like gum
• Avoid weight gain (healthy food and sports)
• Follow instructions carefully if you are taking medications to help you quitting

488. Cetirizine is the active metabolite of hydroxyzine.

489. Fexofenadine is the metabolite of terfenadine.

490. Common causes of cough are asthma, chronic bronchitis, CHF, drugs like ACEIs, emphysema, foreign body, GERD, inhaled chemical irritants, postnasal drip (sinusitis, allergic rhinitis), upper and lower respiratory tract infections.

Pharma Tips-92

481.Drugs that may induce headache / migraine include tetracycline, minocycline, cotrimoxazole, nalidixic acid ,  isotretinoin, tamoxifen, cimetidine, indomethacin, diclofenac, nitroglycerin, atenolol, propranolol, captopril, nifedipine, methyldopa, reserpine, hydralazine, ranitidine, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, oral contraceptives, hormone replacement therapy (HRT), caffeine, cyclosporine, danazol, latanoprost, metronidazole, foods containing nitrites, glutamate, aspartame, tyrosine, phenylalanine, tyramine containing products like aged cheese, hot dogs, chocolate, red wine, coffee, tea.

482. Feverfew, magnesium and riboflavin are over the counter products for migraine prophylaxis.

483. Drugs that may induce fever include allopurinol, amphotericin, antacids, antibiotics, anticholinergics, antihistamines, antineoplastics, azathioprine, barbiturates, carbamazepine, cimetidine, clofibrate, corticosteroids, cyclosporine, digoxin, diltiazem, epinephrine, folic acid, griseofulvin, heparin, hydralazine, ibuprofen, iodides, iron dextran, metoclopramide, MAOIs, methyldopa, nifedipine, oral contraceptives, phenytoin, procainamide, propylthiouracil (PTU), quindine, quinine, ranitidine, salicylates, sulindac, tacrolimus, tolmetin, triameterene, and vitamins.

484. Temperature measuring preference; birth- 2 years, rectum>armpit>ear, 2-5 years; rectum>ear>armpit, >5 years; mouth>ear>armpit.

485. Drugs that may affect body temperture are; TCA, anticholinergics, antipsychotics, antihistamines, SSRIs, BBs, alpha-agonists, MAOIs, sympathomimetics, cocaine, and amphetamine.

Pharma Tips-91

476. When the relation is inversely proportional, use the following formula: C1V1=C2V2.

477. 1 centilitre (cL) = 1mL, 1 g = 100 cg, 1 g = 10 dg, 1 mile = 1.61 Km.

478. The smallest quantity to be in a prescription (SQ) = 100%*sensitivity requirement (SR)/ acceptable error.

479. Some latin abbreviations:-

• M = mix
• Ft = make 
• Q.s = sufficient quantity
• Sig. = directions (write on label)
• A.a = of each
• Ad = upto, to make
• Disp = dispense 
• D.t.d = give of such doses
• Non rep. = do not repeat

480. Density = weight/ volume.

Pharma Tips-90

471. Food delays the absorption of cefalexin, cefixime, and cefaclor.

472. Digoxin is used in heart failure, atrial fibrillation, and atrial flutter.

473. Atrial fibrillation is the most common cardiac arrhythmia.

474. Dornase is a mucolytic enzyme, it is used to dissolve mucus of cystic fibrosis patients.

475. Ethacrynic acid is used for patients who can not tolerate furosemide.

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466. Vancomycin has no systemic absorption if given PO.

467. Acitretin (soriatane) is an analog of vitamin A, and it is used to treat psoriasis.

468. Information about half-life and pharmacokinetics are found in USPDI.

469. Bacteroides fragilis is treated with metronidazole, clindamycin, and cefoxitin.

470. To avoid complications (swelling), in spinal cord injuries give intravenous methyl prednisolone.

Pharma Tips-88

461. Pneumocystis pneumonia is caused by pneumocystis jirovecii (carinii), and treated by co-trimoxazole used with steroids, pentamidine, atovaqoune, clindamycin may be used, for prevention bactrim, and less frequently inhaled pentamidine.

462. Benzlkonium chloride and thiomersal are preservatives that might cause allergic reactions.

463. Azathioprine, diuretics, alcohol, steroids, cause pancreatitis.

464. Enalapril, and terfenadine are prodrugs.

465. Endocarditis prophylaxis; amoxicillin 2g oral (PO) 1 hour, or clindamycin 600 mg PO 1 hour before the procedure, ampicillin IV 2 g 30 minutes, or clindamycin 600 mg IV 30 minutes before the procedure.

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456. Dobutamine is used in cardiogenic shock.

457. Do not shake turbohaler, disc inhaler, imitrex spray, and flonase (fluticasone) shake it gently.

458. Label for benzoyl peroxide bleaches fabric and clothes.

459. Sulindac is the anti-inflammatory used in case of renal failure.

460. Mycoplasma pneumonia is treated by erythromycin, doxycycline, and 2nd generation of quinolones.

Pharma Tips-86

451. Amiodarone half-life is 50 days.

452. Mineral oil may cause anal pruritus, and aspiratory pneumonia.

453. Morphine stimulates chemoreceptor trigger zone (CTZ), and vomiting, causes pin-point pupil, and respiratory depression.

454. Avoid sucralfate and magnesium containing products in renal failure, sucralfate is used to treat stress ulcer, it causes constipation, xerostomia, and headache.

455. Flurazepam has a very long half-life (40-250 hours), metabolites effects.

Pharma Tips-85

446. Vitamin B6 (pyrodixine) increases the metabolism of L-dopa.

447. Terfenadine increases QT interval.

448. Cheilitis is the inflammation and cracking of the skin of the lips.

449. Tobramycin is aminoglycoside antibiotic used in the treatment of pseudomonal infections.

450. Methotrexate is the fastest drug in the treatment of rheumatoid arthritis (RA).

Pharma Tips-84

441. Hashimoto’s thyroiditis results in hypothyroidism.

442. Plummer disease (toxic nodular goitre) is a form of hyperthyroidism.

443. Penicillamine causes glumerulonephritis, aplastic anemia, and systemic lupus erythematosus.

444. Patients have CHF and severe hypertension (HTN) is treated with ACEIs + thiazide diuretics.

445. Gemfibrozil decreases total cholesterol and triglycerides; it should be taken 30 minutes before morning and evening meals.

Pharma Tips-83

436. Cyclophosphamide is taken on an empty stomach with plenty of water.

437. Schilling test is for the diagnosis of vitamin B¹² anaemia (pernicious anaemia).

438. Meningitis is caused by neisseria meningitidis and streptococcus pneumoniae.

439. All women who are planning to be pregnant, and they have a risk of neural tube defect should take folic acid (4 mg daily), 3 months before, and 3 months after conception.

440. Estrogen deficiency causes atrophic vaginitis, osteoporosis, infertility, and vasomotor symptoms like hot flashes.

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431. Gonorrhoea is treated by azithromycin, cefixime, spectinomycin, ciprofloxacin or metronidazole.

432. Coal tar is used to treat dandruff and psoriasis, it can be given with steroids, it causes photosensitivity, and stains the clothes.

433. Intramuscular gold products are more effective than oral products, gold products can cause proteinuria.

434. Retinopathy is caused by hydroxychloroquine, quinine, hydroquinone, amiodarone, ethambutol, and thioridazine.

435. Metronidazole causes peripheral neuropathy.

Pharma Tips-81

426. Amitriptyline is used to treat depression cases with insomnia.

427. Primary references are journals and trials, secondary references are abstracts and summaries, tertiary references are text books.

428. Pemoline is used in the treatment of ADHD and it is not registered with narcotics.

429. Fiorinal (aspirin + butalbital + caffeine) could be taken in a verbal prescription.

430. Back-order is occurred when a manufacturer send part of order, and will send the rest of the order later.

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421. Streptomycin is not used to treat meningitis, it is only available in an injectable form.

422. Nalidixic acid is a fluoroquinolone analog.

423. Bacterial pneumonia is treated by amoxicillin + aminoglycosides, or clarithromycin, or levofloxacin.

424. First-line treatment of urinary tract infection (UTI) associated with E.coli is sulfamethoxazole/trimethoprim.

425. Peptic ulcer that caused by helicobacter pylori is treated with amoxicillin + clarithromycin + omeprazole ± metronidazole.

Pharma Tips-79

416. Diltiazem inhibits the metabolism of simvastatin.

417. Rasburicase is used to treat severe hyperuricemia associated with the treatment of malignancy.

418. Agglutinins are antibodies that cause bacteria to clump together.

419. Vancomycin is the drug of choice in the treatment of pseudo-membranous colitis associated with antibiotic use.

420. Penicillin should be administered on an empty stomach to improve its bio-availability.

Pharma Tips-78

411. Xalacom eye drops must be discarded after 10 weeks after opening.

412. Taking history from patients: 

History of present illness (HPI); date of onset, precise location, nature, severity, and duratin, exacerbations and remissions, effect of treatment given, relationship to other symptoms, activities, and meals, degree of interference with daily activities.

Past medical history (PMH).

Family history (FH).

Social history (SH).

Medication history (MH).

Allergies (drugs, food, or environment).

Physical examination; general appearance, vital signs (VS), blood pressure, respiratory rate, temperature.

413. Drug therapy problems:-

Inappropriate indication; patient requires additional drug therapy, or patient is taking unnecessary drug therapy.

Ineffective drug therapy; drug is not effective, or dose is too low.

Unsafe drug therapy; adverse drug reaction, or dose is too high.

Non-compliance; the patient is unable or unwilling to take medication as prescribed.

414. The basic pain history questions:- 

Location; where is it located? Where does hurt the worst?

Quality; what is it feel like?

Severity; how bad is it?

Context; how did it happen? When did you notice it?

Timing; when did it start? how long have you had it? how frequently does it happen?

Modifying factors; what makes it better? What makes it worse?

Associated symptoms; what other symptoms are you having?

415. Drug therapy problems are indication, effectiveness, safety, and compliance.

Pharma Tips-77

406. Clindoxyl gel should be discarded after 120 days from opening.

407. Sulfasalazine (flamazine) cream, tubes to be discarded 7 days after opening, and 500 grams jar after 24 hours.

408. Fucithalmic viscous eye drops to be discarded after 1 month of opening.

409. Miacalcin nasal spray (NS) must be used within 4 weeks.

410. Xalatan eye drops must be discarded after 6 weeks after opening.

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401. Chlordiazepoxide is used in anxiety, insomnia, muscle spasm, and alcohol withdrawal symptoms.

402. Folinic acid (calcium folinate) is used to decrease the toxicity of methotrexate and in the pretreatment of 5-FU to prolong survival in the palliative treatment of patients with advanced colorectal cancer.

403. Testosterone capsules ( andriol) should be stored in 2-8°c in the pharmacy, and 15-25°c at home, and should be used within 90 days.

404. Clarithromycin (biaxin) suspension must not be refrigerated, and should be used within 14 days.

405. Clavulin suspension to be refrigerated.

Pharma Tips-75

396. Valproic acid increases the levels of phenobarbital by 40%, when given together.

397. Types of medication errors; omission of dose, extra-dose, non-compliance, under dosage, incorrect dose, incorrect strength or concentration, incorrect drug, or dosage form, incorrect technique, incorrect route, incorrect duration, error in monitoring, deteriorated drug, drug-drug or disease or food interaction, error in transcribing, incorrect labelling, error in prescribing, failure to adjust dose as needed, lack of preventive therapy.

398. Look-alike medications; 

• Celebrex = cerebyx = celexa
• Ceftin = cefzil
• Hycomine = hycodan
• Inderal = isordil = toradol = adderall = imdur = imuran
• Lamisil = lomotil = lamictal
• Percodan = percocet
• Tobrex = tobradex
• Trusopt = cosopt
• Xanax = zantac
• Xenical = xeloda = senokot
• Ampicillin = amoxicillin = aminophylline
• Azithromycin = erythromycin
• Chlorpromazine = chlorpropamide = clomipramine = prochlorperazine = promethazine = clomiphene
• Dimenhydrinate = diphenhydramine
• Enalapril = ramipril
• Dicetel = diclectin
• Hydralazine = hydroxyzine
• Tanacet (feverfew) = tramacet

399. Some abbreviations; 

• SID = once daily
• CC = with meals
• BT = bedtime
• OJ = orange juice
• Per os = orally 
• Qn = nightly
• SS = sliding scale
• HS = half strength = at bedtime
• TIW = three times a week
• Tbsp = tablespoonful
• Tsp = teaspoonful
• AZT = zidovudine
• HCT = hydroxycortisone
• HCTZ = hydrochlorothiazide
• MS = morphine sulfate 
• MTX = methotrexate 
• Nitro drip = nitroprusside
• Norflox = norfloxacin
• IV Vanc = intravenous vancomycin

400. Serum fentanyl conc. (skin patch) increases by 1/3, when the body temperature reaches 40˚c, due to increased skin permeability. Fentanyl is extensively metabolized by P450 3A4 enzymes. Fentanyl overdose symptoms include; shallow breathing, tiredness, extreme sleepiness, inability to think, talk, or walk normally, feeling faint, dizzy, or confused.

Pharma Tips-74

391. Fluoxetine has the least cardiotoxic effects among all SSRIs.

392. The dosage of salicylates; in arthritis = 3-6 g/day, in pain = 1 g/day.

393. Hydralazine is a vasodilator, it can be used in renal insufficiency as it increases renal blood flow, and it is used in patients with depression.

394. Reserpine, guanithidine, methyldopa, and clonidine, all can cause depression.

395. All anticonvulsants can disturb folic acid levels and cause abnormal mental state.

Pharma Tips-73

386. OCD; O=onset, C=character, D=duration.

387. FIFE; F=feeling, I=idea, F=function, E=expectation.

388. Clarithromycin causes QT prolongation with amiodarone, procainamide, propafenone, sotalol, TCA, venlafaxine, ondansetron, phenothiazines, pimozide, atomoxetine.

389. Cisplatin is prepared in vertical laminar flowhead, it increases creatinine level.

390. The time to steady state conc. (Css) depends on the half-life of the drug, reaching 90%, 95%, or 99% of Css without loading dose takes 3.32, 4.32, or 6.65 half-lives respectively.

Pharma Tips-72

381. Drugs induce hepatotoxicity include; amiodarone, rifampin, valproic acid, isoniazide, fluconazole, and erythromycin.

382. Meperidine should be avoided in elderly, because its metabolite which is called normeperidine (t½ 15-30 hours), may cause delirium.

383. Domperidone is preferred over metoclopramide in elderly patients, because it does not cross blood brain barrier, so less CNS side effects like drowsiness and agitation.

384. CHADS; C= congestive heart failure, H= hypertension, A=age ≥ 75, D= diabetes, S= stroke or systemic embolism.

385. VASc; V=vascular disease, A=age between 66-77, Sc=Sex category: female.

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376. Wheat bran is the best choice to promote regular bowel movement.

377. Hypertension treatment: uncomplicated hypertension; 1st-line, thiazide (HCT); 2nd-line, combos of 1st line; isolated systolic hypertension (ISH); 1st-line, thiazide, calcium channel blockers (CCBs) the dihydropyridine type, angiotensin receptor blockers. 2nd-line, ACEIs+ CCBs> ACEIs+ HCT. Hypertension + diabetes (nephropathy); 1st-line, ACEIs or ARBs. 2nd-line, addition of thiazide, HCT<25mg. Hypertension+diabetes(no nephropathy); 1st-line, ACEIs or ARBs or thiazide or DHP-CCBs. 2nd-line, 1st-line+ cardiodelective beta-blocker or non-DHP-CCB. Hypertension (ISH) with diabetes and no nephropathy; 1st-line, ACEIs or ARBs or thiazide or CCBs- DHP. Hypertension + coronary artery disease; 1st-line, ACEIs or ARBs. 2nd-line, CCB-DHP. Hypertension+ angina; 1st-line, beta-blocker ±ACEIs or CCBs. 2nd-line, ARBs or ( hydralazine+ isosorbide dinitrate), amlodipine, or felodipine, thiazide/loop diuretic as additive. Hypertension + TIA; ACEIs + diuretic (perindopril + indapamide). Hypertension + prior to MI; 1st-line, beta-blocker (BB) + ACEIs or ARBs. 2nd-line, CCBs. Hypertension + heart failure; 1st-line, ACEIs or ARBs + BBs ( bisoprolol, carvedilol, metoprolol) ± diuretic ( spironolactone). Hypertension + renal diseaese and proteinuria; 1st-line, ACEIs + diuretics as a dditive therapy. 2nd-line, ACEIs + ARBs. Hypertension + left ventricular hypertrophy (LVH); ACEIs, ARBs, CCBs-LA, diuretics, BBs.

378. Dyslipidemia and peripheral arterial disease (PAD) does not affect the initial treatment of hypertension.

379. Avoid the use of hydralazine and minoxidil incase of left-ventricular hypertrophy (LVH).

380. Incase of PAD avoid using BBs, and CCBs would be a useful approach.

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371. Prescription price= cost of ingredients +(cost of ingredients * markup %).

372. Empiric treatment for pneumonia is amoxicillin-macrolides.

373. Ceftriaxone or cefotaxime are the empirical treatment for meningitis. 

374. Spansule is a sustained release capsule.

375. The recommended daily intake fibre is: 

• Men age 19-50 = 38 g/day
• Men age 51+ = 30 g/ day
• Women 19-50 = 25 g/day
• Women 51+ = 21 g/ day

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366. pH= pKa+log salt/acid, pH= pKw-pKb+log base/salt.

367. mOsmol/L = weight (g)/ molecular weight*no.of species*1000.

368. For any dilution calculation use the following formula; C1Q1=C2Q2.

369. Benefit to cost analysis= benefits/ costs.

370. Cost to effective analysis= cost/ therapeutic effect (units).

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361. Ideal body weight (males)= 50 + 2.3 Kg for each inch height over 5 feet.

362. Ideal body weight (females)= 45.5 + 2.3 Kg for each height over 5 feet.

363. Creatinine clearance (Crcl) males=98-0.8*(age in years-20)/serum creatinine (mg/dL).

364. Crcl females= 0.85 * males Crcl.

365. Adjusted Crcl= BSA/1.73*Crcl.

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356. 1 oz = 28.349 grams, I foot = 12 inches = 30.48 cm, 15.4 grains = 1 gram.

357. Dose calculation in children: Young’s rule;

Child dose (CD) = age/ age+12* adult dose.

Cowling’s rule (CD)

CD = age at next birthday*adult dose/24

Fried’s rule 

CD= age in months*adult dose /150

Clark’s rule

CD= weight in bounds*adult dose/150

358. To convert from mmol/L to mg/dL multiply by 18.

359. Loading dose (LD) = ideal body weight (IBW)*drug dose per Kg.

360. Maintenance dose (MD)= ideal body weight (IBW)* dose per Kg per dosing interval.

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351. Attention deficit hyperactivity disorder (ADHD) treatment program: first-line; stimulants, second-line; atomoxetine, third-line; bupropion, fourth-line, tricyclic antidepressants.

352. Postpartum depression is treated with citalopram, paroxetine, and sertraline; all are the first-line drugs.

353. Aminoglycosides are less toxic in infants than adults.

354. If nitrite is detected in urine that means urinary tract infection.

355. Drug of choice in treatment of syphilis is benzathine benzylpenicillin.

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346. Beta2- agonists (short-acting) are the most effective against exercise induced asthma.

347. Peak expiratory flow rate (PEFR) with moderate asthma= 60-80%, PEFR for mild asthma >80%.

348. Low density lipoprotein (LDL) = total cholesterol (TC) – high density lipoprotein (HDL) – triglycerides (TGs)/5.

349. Absolute bioavailability =Fab= AUCpo*Div/AUCiv*Dpo*100.

350. Atomoxetine is a controlled substance.

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341. 1 mmol = molecular weight (mg). 1 mEq = weight*valence/ molecular weight. Mmol= weight/ molecular weight.

342. 0.2 sodium chloride equivalent means 1 g of the substance is equal to 0.2g of Nacl.

343. Loading dose (LD) = desired plasma conc. * Vd.

344. Latin abbreviations; O= eye; os=left eye, od= right eye, ou= both eyes; A=ear, as= left ear, ad= right ear, au= both ears.

345. 60-90% of digoxin is excreted unchanged by the kidneys.

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336. Initial conc. (C◦) = IV dose/ Vd. 

337. Body surface area (BSA) = (weight kg × height cm/ 3600)². 

338. Relative risk reduction (RRR) = absolute relative risk (ARR)/ CER, ARR= EER-CER, NNT= 1/ARR. 

339. Half-life (t½) = 0.693 X Vd/CL (clearance). 

340. Turnover = sales/capital.

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331. Methanol has neurotoxicity from formaldehyde (ocular damage).

332. Ethanol produces acetaldehyde which causes hangover effect.

333. Ethosuximide treats absence seizures.

334. Carbamazepine is the drug of choice in treating trigeminal neuralgia, it increases the secretion of antidiuretic hormone.

335. Phenobarbital is considered the safest anti-epileptic drug during pregnancy.

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326. Cyclosporine, phenytoin, and nifedipine cause gingival hyperplasia.

327. Loop and thiazide diuretics are powerful vasodilators by affecting prostaglandins.

328. Indapamide does not cause hyperlipidemia.

329. Respiratory depression can be caused by antihistamines, opiates, beta-blockers, benzodiazepines, and barbiturates.

330. Ethylene glycol has nephrotoxicity from oxalic acid.

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321. Overstimulation of receptors may cause desensitization, which means receptors, will not respond anymore.

322. Physostigmine is tertiary amine crosses the blood brain barrier, so it is used in atropine toxicity.

323. Pralidoxime (2- PAM) regenerates acetylcholine esterase (AchE) within 2 hours of toxicity with organophosphates (malathion).

324. Amiodarone and bleomycin both can cause pulmonary fibrosis.

325. Tricyclic antidepressants, potassium channel blockers, and antipsychotics cause torsades reaction.

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316. Zidovudine decreases the vertical transmission from the mother to the fetus by 80%.

317. Volume of distribution (Vd) = Dose (D) / Initial concentration (C˚).

318. Half-life (t1/2) = 0.693/ K.

319. Infusion rate (K◦) = Clearance (CL) * steady state concentration (Css).

320. Therapeutic index (TI) = toxic dose (TD) 50/ effective dose (ED) 50.

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311. The half-life of drugs is variable in zero-order kinetics, and constant in first-order kinetics, in zero-order a constant amount is being eliminated.

312. LD (loading dose)= Vd (volume of distribution) × Css (steady state concentration).

313. Maintenance dose (MD) = clearance (CL) * Css *  (dose interval).

314. Steady state concentration (Css) means the rate of drug enter the body is equal to the rate of drug exits the body.

315. Rate in = amount / time, rate out = volume/ time, Css= rate in /rate out (clearance).

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306. Tegaserod is an agonist of 5- hydroxytryptamine IV (5-HT4), it is used to treat irritable bowel syndrome in women (constipation predominant form).

307. Hypokalemia may lead to sudden cardiac death.

308. Phenytoin precipitates in dextrose solution, therefore they should not be administered on the same IV set.

309. Amphotericin precipitates in saline.

310. Gentamicin is inactivated by most of beta-lactam agents.

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301. Sulindac is mainly metabolized by liver.

302. Sucralfate needs acid pH to form a protective gel, so it should be taken on an empty stomach.

303. Mineralocorticoids activity = aldosterone activity = sodium and water retention.

304. Buspirone is a partial agonist of 5- hydroxy tryptamine Ia (5-HTIa) receptors, and it is used to treat anxiety.

305. Triptans such as sumatriptan, zolmitriptan are agonists of 5- hydroxy tryptamine Id (5-HTId) receptors, and they are used to treat migraine.

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296. No DNA replication means no myelosuppression that’s why drugs are only affecting newly formed cells, because they are dividing so fast.

297. CL (total body clearance) = K × Vd (volume of distribution).

298. Vd = total amount of drug/ Initial plasma concentration (C◦).

299. Insulin receptors belong to tyrosine kinase family.

300. Sulfonamides + dihydrofolate reductase inhibitors such as trimethoprim, and penicillins + aminoglycosides are the best examples of synergy.

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291. Aztreonam is only used with gram negative bacteria.

292. Neomycin is very toxic systemically, so it is only used topically.

293. Sulphonamides, tetracyclines, quinolones cause photosensitivity.

294. Azithromycin has no effect on CYP450 enzymes.

295. Valproic acid, didanosine, and zalcitabine cause pancreatitis.

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286. Epstein-Barr virus causes infectious mononucleosis.

287. Catechol-O-methyltransferase (COMT) converts levodopa to 3-O-methyldopa.

288. Bruxism is the grinding of teeth and it is one of the most sleep disorders.

289. Nafcillin is the most lipid soluble penicillin.

290. Chlamydia and mycobacteria are atypical bacteria (has no cell wall).

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281. Sulfa drugs cause kernicterus to infants at a late stage of the pregnancy.

282. Cilastatin inhibits a peptidase enzyme to prevent imipenem from forming nephrotoxic metabolite.

283. Human papillomavirus is the cause of common warts.

284. Herpes simplex virus I causes cold sores.

285. Herpes simplex virus II causes genital herpes.

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276. Vecuronium is a neuromuscular blocking agent (IV) for skeletal muscle relaxation in surgery.

277. Sorbic acid is a mold and yeast inhibitor.

278. Drugs that cause insomnia include; alcohol, amantadine, bupropion, monoamine-oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin re-uptake inhibitors (SSRIs), beta-receptors agonists and antagonists, corticosteroids, caffeine, donepezil, decongestants, diuretics, dopamine agonists, levodopa, selegiline, methylphenidate, theophylline, and thyroid hormones.

279. E.coli is the most common cause of urinary tract infections such as cystitis.

280. Cephalosporins not penicillins are effective against klebsiella.

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271. Clarithromycin increases the levels of theophylline.

272. In osteoporosis treatment; alendronate may be administered as 10 mg daily or 70 mg weekly.

273. The elemental iron content of ferrous sulfate is 20 %.

274. Pneumococcal infections are responsible for deaths in children under 3 years of age who have sickle cell anemia.

275. Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the renal elimination of unchanged methotrexate.

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266. Acetylcysteine is used in acetaminophen overdose and in cystic fibrosis as mucolytic.

267. Thyroid hormones increase the requirements for insulin and hypoglycemic agents, thus they cause hyperglycemia.

268. Tinea pedis causes athlete’s foot.

269. Toxic shock syndrome symptoms include; high fever, rash of palms and soles, dizziness, nausea, vomiting, and diarrhea.

270. Glycogen converts to D-glucose.

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261. Folic acid supplements should be used with Isoniazid, methotrexate, and lamotrigine.

262. Quinidine is associated with cinchonism, which its symptoms include; blurred vision, headache, tinnitus, nausea, and mental changes.

263. 3-6 weeks are necessary to observe a response from methotrexate therapy of rheumatoid arthritis.

264. Phenytoin, allopurinol, lamotrigine, sulphamethoxazole/trimethoprim are associated with Stevens–Johnson syndrome.

265. Ganciclovir, foscarnet, and cidofovir are antivirals for the treatment of cytomegalovirus (CMV) retinitis.

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256. Ciprofloxacin is not recommended for use in children and pregnant women.

257. PMDD = premenstrual dysphoric disorder.

258. Sodium bicarbonate is associated with milk-alkali syndrome.

259. Sickled cells are quite fragile with half-life span of 10-20 days.

260. Anticholinergic side effects are; constipation, dry mouth, loss of memory, urinary retention, blurred vision, decrease gastric function, tachycardia and palpitation.

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251. Diabetic coma symptoms are; dehydration, hypotension, nausea, vomiting, and polydipsia.

252. Valproic acid is effective in the treatment of absence seizures.

253. The half life of gentamicin in a patient with normal renal function is 2-4 hours.

254. Cromoglycate has no parenteral form.

255. Amoxicillin + clavulanate ear drops are used for otitis media; should be used within 10 days, and should be kept in refrigerator during that period, diarrhea and stomach upset are the most common side effects of the drug.

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246. Phenytoin should not be administered intravenously, due to venous irritation and cardiac adverse effects.

247. Carbamazepine is an enzyme inducer, it induces its own metabolism, dose adjustment is needed when it is used with phenytoin within 2-4 weeks of being added or discontinued.

248. Barbiturates suppress the signal transmission across the synapses and thereby raise the seizure threshold.

249. Lantus insulin should not be mixed with any other insulin.

250. It takes 10-21 days for optimal response to lithium therapy.

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241. Acetone breath and dry skin are classic symptoms of diabetic ketoacidosis.

242. Chlorpropamide has the longest duration of action among all sulfonylureas drugs up to 60 hours.

243. Misoprostol is in category X for pregnancy, it should be taken with food to lessen gastrointestinal distress and decrease the incidence of diarrhea.

244. Ethanol competes with methanol for alcohol dehydrogenase, so it prevents the formation of the toxic metabolite formic acid.

245. Diazepam is the drug of choice in status epilepticus.

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236. Acarbose inhibits the enzyme responsible for the breakdown of starch and sucrose in the small intestines.

237. Diabetic neuropathy may cause inconinence, gastric atony, diarrhea, and impotence.

238. Non-Insulin Dependent Diabetis Mellitus patients are at risk of hyperlipidemia, hypertension, nephropathy, and neuropathy.

239. Amitriptyline, fluoxetine, carbamazepine, gabapentin are used to treat neuropathic syndromes.

240. Hypoglycemia treatment include the use of 10-20 grams of rabidly absorbed carbohydrates, and for unconscious patients use parenteral glucagon or glucose.

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231. Osteoporosis can be caused by menopause, hyperparathyroidism, hyperthyroidism, diabetes, cushing syndrome, malabsorption syndrome, anorexia nervosa, inflammatory bowel disease, osteogenesis imperfecta, rheumatoid arthritis, chronic renal disease, and multiple myeloma, may follow organ or tissue transplantation, or prolonged immobilisation, or by drugs like corticoseroids, thyroid hormones, anticonvulsants, heparin and gonadorelin analogues.

232. Acetate, chloride, and phosphate salts of potassium are used in diabetic ketoacidosis (DKA).

233. Daily monitoring of skin especially feet is necessary in diabetic patients, they should never self-treat corns or calluses, because of the risk of infection and gangrene.

234. Sibutramine is contra-indicated in patients with poorly controlled hypertension, or taking or have taken monoamino-oxidase inhibitors (MAOIs) within 2 weeks.

235. In hyperglycemic coma blood glucose levels can reach 800 mg/dL.