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156. Vitamin B2 (riboflavin) is found in milk, yeast, eggs, meat, liver and green vegetables and deficiency symptoms are cheilitis, red tongue and sensitivity to lights.

157. Vitamin B12 (cyanocobalamin) is found in liver, milk and meat, its deficiency cause pernicious anemia.

158. Vitamin B9 (folic acid) is found in liver, green vegetables, curds and pulses, its deficiency cause macrocytic anemia.

159. Vitamin B6 (pyridoxine) is found in liver, green vegetables and meat, its deficiency causes peripheral neuropathy, fits and convulsion in children.

160. Vitamin C (ascorbic acid) is found in citrus fruit, vegetables, tomatoes and lemon, its deficiency cause scurvy, hemorrhage, bleeding from gum and retard healing.

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151. Menstrual cycle is divided into 3 phases: -

A. Follicular (pre-ovulatory or menstrual) phase.

B. Ovulatory (proliferative) phase.

C. Luteal (post-ovulatory or secretory) phase.

152. Lyme disease is an acute inflammatory disease characterised by a rash with joint swelling and fever, caused by bacteria carried by the bite of a deer tick.

153. Cystic fibrosis is the most common congenital disease; the child's lungs, intestines and pancreas become loaded with thick mucus, caused by a defect in a single gene; no cure is known.

154. Vitamin A (carotene) is found in carrots, milk, fruit, butter, fish, liver oil, eggs, and cheese, and deficiency symptoms are night blindness, xerophthalmia, and dry and rough skin.

155. Vitamin B1 (thiamin) is found in rice, wheat, nuts and germinated seed, and deficiency symptoms are beriberi and polyneuritis.

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146. TCA side effects: weight gain, increased appetite, sedation, dry mouth, constipation, dizziness, drowsiness, palpitation, nausea.

TCA interactions: increase side effects 6 hrs space, grapefruit juice increase side effects, NSAIDs increase risk of bleeding, MAOIs may cause serotonin syndrome 1-2 weeks treatment free period, Antiarrhythmics such amiodarone, quinidine may risk of arrhythmia.

147. Beta-blockers side effects: headache, depression, dizziness, hallucinations, confusion, anorexia, nausea, drowsiness, weakness, abdominal pain, vomiting, muscle cramps, diarrhea, constipation, shortness of breath, heart failure, heart block, and bronchospasm are the most serious side effects.

Beta-blockers interactions: aluminum salts and antacids decrease the absorption of bb, alcohol increase dizziness and drowsiness, drugs that either affect the metabolism of bb by increase like rifampin or decrease like ketoconazole.

148. Cretinism is a hypothyroidism occurs in children with low metabolic rate, boated face with idiotic look, and protruding eye balls.

149. Myxedema is a hypothyroidism occurs mainly in adults with low metabolic rate, puffy face with dry skin, slow speech, amenorrhea, slow pulse and scanty hair.

150. Grave’s disease is a hyperthyroid condition with staring eyes, weight loss, soft skin, fast heart beat, high basal metabolic rate, sharp and anxious mind.

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141. Quinolone antibiotics side effects: nausea, stomach upset, headache, drowsiness, dizziness, insomnia, light-headedness and vomiting. Quinolones interactions: excessive caffeine increases nervousness, The absorption of quinolones is reduced by sucralfate, antacids containing aluminum or magnesium and also by calcium, iron, and zinc salts 2hours before or 6 after, quinolones elevate levels of antidiabetic agents that may cause hypoglycaemia, quinolones increases statins levels causing muscle pain, quinolones enhance the effect of Warfarin risk of bleeding.

142. Benzodiazepines side effects: Sedation, confusion, headache, dizziness, fatigue, amnesia, constipation, urinary retention, nausea, weight gain/loss, diplopia, chest pain, nasal congestion, dry mouth and light-headedness.

Benzodiazepines interactions: coffee, tea decrease sedative effect, alcohol increases side effects of BDZs sedation, headache space them 6 hrs, St. John’s wort increases CNS depression.

143. NSAIDs side effects: headache, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness, and insomnia, epigastric pain, nausea, constipation.

NSAIDs interactions: nephrotoxicity may be increased if given with ACEIs, cyclosporine or diuretics, alcohol, warfarin increase the risk of bleeding, decrease antihypertensive effect of antihypertensives, decrease excretion of lithium and aminoglycosides, increase lithium concentration leads to confusion, tremor, polydipsia and polyuria.

144. CCBs side effects: headache, nausea, dizziness, drowsiness, palpitation (dihydropyridine), bradycardia (non-dihydropyridine), peripheral edema (ankle edema), fatigue, flushing, flushing.

CCBs interactions: grapefruit juice and ketoconazle increase levels of CCBs, alcohol with CCBs may cause hypotension and increase side effects space between them by 6 hrs, NSAIDs decrease antihypertensive effect of CCBs, St. John’s wort decreases levels of CCBs, beta-blockers increase risk of bradycardia with NHP-CCBs.

145. SSRIs side effects: nausea, headache, drowsiness, dizziness, constipation, diarrhoea, weakness, insomnia, dry mouth, sexual dysfunction, Anorexia and weight loss, weight gain. SSRIs interactions: alcohol increases side effects of SSRIs, valerian, St. John’s wort increase side effects of SSRIs, ASA increase the risk of bleeding.

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136. Alopecia caused by antineoplastics, beta blockers, diazoxide, heparin, verapamil, warfarin, PTU, valproic aid, methimazole, methyl phenidate, ketoconazole, and amiodarone. 

137. Foods rich in potassium include orange juice, potatoes, bananas, avocados, cantaloupes, tomatoes, broccoli, soybeans, brown rice, garlic and apricots, although it is also abundant in most fruits and vegetables.

138. Foods containing tyramine are cheese, dairy products, sour cream, yogurt, cheddar, bananas figs, raisins, soya source, caffeine, tea, coffee, chocolate,

139. Red man syndrome or red neck syndrome, this syndrome, usually appearing within 4–10 minutes after the commencement or soon after the completion of an infusion, is characterized by flushing that affects the face, neck, and upper body or pain and muscle spam of the chest and neck. Less frequently, hypotension and angioedema may also occur. Symptoms may be treated or prevented with antihistamines, including diphenhydramine, and are less likely to occur with slow infusion.

140. ACE inhibitors side effects: dry cough, hypotension, headache, dizziness, fatigue, hyperkalemia, nausea, with rare effect angioedema. ACE inhibitors interactions: first dose at bedtime or sit down to avoid hypotension, swelling in face, mouth, lips, tongue or throat (angioedema). Alcohol, diuretics cause hypotension with ACEIs, NSAIDs decrease hypertensive effect of ACEIs, and ACEIs increase lithium levels, potassium-sparing diuretics with ACEIs may cause hyperkalemia.

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131. Pancytopenia: An abnormal deficiency in all blood cells (red blood cells, white blood cells, and platelets); usually associated with a bone marrow tumour or with aplastic anaemia.

132. Pre-eclampsia is an abnormal state of pregnancy characterised by hypertension, fluid retention and albuminuria; it can lead to eclampsia if untreated.

133. Eclampsia is a toxic condition characterised by convulsions and possibly coma during or immediately after pregnancy.

134. Lyme disease is treated by penicillin in children and doxycycline in adults.

135. Propylthiouracil, carbamazepine and Ticlopidine cause aplastic anaemia and agranulocytosis.

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126. Cardioversion is a procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs.

127. The normal heart rhythm, known as sinus rhythm, originates in specialised cardiac cells, called pacemaker cells, in the sino-atrial (SA) or sinus node and has been defined as a sinus node rate of 60 to 100 beats/minute.

128. Cholestyramine reduces the absorption and entero-hepatic recycling of raloxifene, and they should not be given together or should be separated. Raloxifene should be taken 1 hour before or 4-6 hours after. Raloxifene may decrease the efficacy of warfarin. 

129. Achalasia is a neuromuscular problem where a ring of muscles in the oesophagus is unable to fully relax, causing difficulty swallowing, which can be caused by antimuscarinics.

130. People who are sensitive to ASA may exhibit sensitivity to tartrazine.

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121. Drugs of choice in pregnancy:-

• Allergy→ chlorpheniramine, diphenhydramine, dimenhydrinate, intranasal sodium cromoglycate, beclomethasone, budesonide; loratadine.
• Anticoagulation→ heparin and LMWH, heparin 1st trimester, warfarin 2nd and 3rd trimester and heparin again at term.
• Anxiety→ BDZs.
• Asthma→ inhaled bronchodilators (salbutamol).
• Diabetes→insulin. 

122. Panic disorder can be treated with SSRIs like citalopram, escitalopram, TCA such as imipramine, clomipramine, mirtazapine, MAOI phenelzine and tranylcypromine, BDZs like alprazolam, clonazepam, lorazepam and diazepam.

123. Social anxiety disorder (social phobia) escitalopram, venlafaxine, Paroxetine, sertraline, propranolol, moclobemide.

124. Obsessive-compulsive disorder SSRIs fluoxetine, fluvoxamine, Paroxetine, sertraline, 2nd line option is clomipramine, venlafaxine, citalopram, and mirtazapine, risperidone may be used for augmentation.

125. Modafinil is a central nervous system stimulant that promotes wakefulness in the treatment of narcolepsy.

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116. Dexrazoxane is used as a cardio-protective agent from cardiac toxicity associated with doxorubicin treatment; Mesna is a uro-protectant from hemorrhagic cystitis secondary to cyclophosphamide or ifosfamide treatment.

117. Vinca-alkaloids cause autonomic neuropathy, which presents with constipation and abdominal pain and stool softeners or stimulant laxatives are used. Amifostine is a cytoprotectant used to reduce xerostomia (dry mouth) in patients undergoing radiation therapy for head and neck cancer.

118. Bronchiectasis is an abnormal dilation of airways in the lungs, causing excessive mucus production.

119. Pertussis is a disease of the respiratory mucous membrane.

120. Possible teratogenic effects of some drugs:-

• Diazepam= cleft lip and palate abnormality
• Fluconazole= multiple synostosis, congenital heart defects, skeletal anomalies, and dysmorphic facial features
• Statins= CNS and limb anomalies
• Lamotrigine= isolated oral clefts
• Methimazole= scalp defects such as aplasia cutis congenita
• Paroxetine= cardiac malformations
• Penicillamine= connective tissue disorders (cutis laxa).

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111. Tenesmus is a painful spasm of the anal sphincter along with an urgent desire to defecate without the significant production of faeces; associated with irritable bowel syndrome.

112. Campylobacter is a fluoroquinolone-resistant bacterium, and azithromycin is the doc in this case; it can also be used in children and pregnancy.

113. Doxycycline decreases the absorption of bismuth subsalicylate, and the qid dose is better than bid in the treatment of travellers’ diarrhoea.

114. Dexamethasone + serotonin antagonist is the most effective treatment for acute nausea and vomiting. Dexamethasone + metoclopramide is the most effective regimen for delayed nausea and vomiting.

115. Corticosteroids' side effects are mood changes, weight gain, masked signs of infection, increased appetite, GI irritation, ulceration and fluid retention.

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106. Antifungal creams contain mineral or vegetable oil weaken latex condoms or diaphragms.

107. Erythromycin estolate is not used during pregnancy due to reports of cholestatic hepatitis. 

108. Varicella virus vaccine is given to healthy children from12 months to 12 years in one dose and two doses for adults and more than 12 years given in 4-8 weeks apart. Varicella vaccines are not recommended in pregnancy.

109. HAART, or highly active antiretroviral therapy, is the standard of care in HIV treatment by using a combination of at least three drugs.

110. Odynophagia is severe pain on swallowing due to a disorder of the oesophagus.

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101. Erythromycin monotherapy is not used in COPD because of lowered activity against Haemophilus influenzae.

102. Co-administration of aminoglycosides with vancomycin or loop diuretics increases the risk of ototoxicity and nephrotoxicity and co-administration with penicillins result in aminoglycoside inactivation.

103. Telithromycin may cause fatal hepatotoxicity and it is contraindicated in myasthenia gravis.

104. SMX ∕ TMP cause SJS increases the effect of sulfonylureas and warfarin.

105. Aminoglycosides like gentamicin, tobramycin and amikacin are the treatment of choice for acute pyelonephritis.

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96. Thiazide diuretics increase the excretion of Na, K, Cl, and water; they can lead to hypokalemia, hyponatremia, photosensitivity, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia, and may exhibit cross-hypersensitivity with sulfa drugs.

97. Loop diuretics, streptomycin, and cisplatin may cause nephrotoxicity. 

98. NSAIDS, K supplements, ACEIS, ARBS, K-sparing diuretics, digoxin overdose, cyclosporine, penicillin G, tacrolimus, TMP and SMX, heparin, beta-blockers, pentamidine, succinylcholine, renal failure, crush injury, trauma, hemolysis, and tumour lysis can all lead to hyperkalemia.

99. Influenza is an acute viral illness of the respiratory tract caused by the influenza A and B viruses. The influenza season typically runs from mid-October to the end of April, with the recommended time for vaccination being from October to mid-November.

100. Headache, fever, myalgia, nasal congestion, and cough are symptoms of influenza-like illness.

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91. Psoriasis is a chronic skin disease characterised by dry red patches covered with scales; it occurs especially on the scalp, ears and genitalia and the skin over bony prominences.

92. Angina is a disorder of the heart that develops because of an imbalance between oxygen supply and demand.

93. Reteplase should not be administered with heparin in the same IV line due to physical incompatibilities.

94. Ticlopidine causes neutropenia and agranulocytosis that can be started within 3 weeks to 3 months of therapy.

95. Pentoxifylline decreases the blood viscosity and increases the flexibility of RBCs; it is used in the treatment of intermittent claudication.

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86. Endometriosis is the presence of endometrium elsewhere than in the lining of the uterus; causes premenstrual pain, dysmenorrhea, and infertility.

87. Osteoarthritis: Chronic breakdown of cartilage in the joints; the most common form of arthritis occurring usually after middle age.

88. Rheumatoid arthritis is a chronic autoimmune disease with inflammation of the joints and marked deformities; something (possibly a virus) triggers an attack on the synovium by the immune system, which releases cytokines that stimulate an inflammatory reaction that can lead to the destruction of all components of the joint.

89. Whiplash is an injury to the neck (the cervical vertebrae) resulting from rapid acceleration or deceleration (as in an automobile accident).

90. Rosacea skin disease of adults (more often women) in which blood vessels of the face enlarge, resulting in a flushed appearance.

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81. Crohn’s disease is a serious, chronic and progressive inflammation of the ileum producing frequent bouts of diarrhoea with abdominal pain and nausea, fever and weight loss.

82. Ulcerative colitis is a serious chronic inflammatory disease of the large intestine and rectum characterised by recurrent episodes of abdominal pain and fever, chills and profuse diarrhoea.

83. Ulcerative proctitis is an inflammation of the rectum, marked by bloody stools and a frequent urge to defecate; frequently associated with Crohn's disease or ulcerative colitis.

84. Propafenone and Flecainide are used in life-threatening arrhythmias.

85. Irritable bowel syndrome is recurrent abdominal pain and diarrhoea (often alternating with periods of constipation); often associated with emotional stress.

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76. Hypothyroidism symptoms are fatigue, weight gain, impaired memory, constipation, cold intolerance, dry skin and hair, hypertension, and bradycardia; severe cases may include myxedema coma and hypothermia.

77. Drugs that can cause hypertension are NSAIDs, corticosteroids, OCs, decongestants, cyclosporine, erythropoietin, MAOIs, midodrine, liquorice root, stimulants like cocaine, salt, excessive alcohol use, and sleep apnea.

78. Symbicort = budesonide + formoterol, Advair = fluticasone + salmeterol. 

79. Hemochromatosis pathology in which iron accumulates in the tissues; characterised by bronzed skin and enlarged liver, diabetes mellitus and abnormalities of the pancreas and the joints.

80. Wilson’s disease is a rare inherited disorder of copper metabolism; copper accumulates in the liver and then in the red blood cells and brain. It is treated with copper chelating agents like penicillamine, and pyridoxine 25 mg daily is used to compensate for the antipyridoxine properties of penicillamine. Food rich in copper should be avoided, like peanuts, chocolate, liver, shellfish and mushrooms.

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71. Terbutaline and albuterol are used to treat asthma, exercise induced asthma, main side effects is tremors, anxiety, fear, restlessness, insomnia, confusion, irritability, headache, and psychotic states; dyspnoea, weakness, anorexia, nausea, and vomiting.

72. Anticancer drugs toxicity:

• Renal toxicity: cisplatin, methotrexate (crystallisation).
• Hepatic: 6-MP, bussulfan and cyclophosphamide.
• Cardiac: doxorubicin, daunorubicin.
• Neurologic: vincristine, cisplatin, paclitaxel.
• Immunosuppressant: cyclophosphamide, MTX and cytarabine.
• Others: cyclophosphamide (hemorrhagic cystitis), procarbazine (leukaemia), asparaginase (pancreatitis).

73. Hemorrhagic cystitis caused by cyclophosphamide can be prevented by using mesna, which traps acrolein, the metabolite of the drug, so it is protective.

74. Clozapine= clozaril; olanzapine= zyprexa, quetiapine= seroquel, risperidone= risperdal are 2nd generation antipsychotics.

75. Alcohol withdrawal treatment gives thiamine, Vitamin B1, to prevent Wernicke’s encephalopathy.

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66. Azithromycin is used in pregnancy and does not inhibit P450 enzymes.

67. Clindamycin causes pseudomembranous colitis, neomycin is used topically.

68. Fanconi syndrome occurs from outdated tetracyclines characterized by polyuria, polydipsia, and back pain, and causes photosensitivity.

69. Chloramphenicol causes bone marrow depression, rare aplastic anaemia and gray baby syndrome in neonates and optic neuritis in children; it inhibits the metabolism of phenytoin, sulfonylureas and warfarin.

70. NRTIs (nucleoside reverse transcriptase inhibitors) are zidovudine, stavudine, Didanosine, Zalcitabine, Lamivudine.

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61. AMA is acebutolol; Metoprolol and atenolol are beta 1 selective.

62. Pilocarpine causes miosis by contracting the ciliary muscles, opening the canal of schlemm leads to drainage of aqueous humour and a decrease in IOP. 

63. Alpha 2 agonists’ ↓ NE release ↓ aqueous humour formation ↓ IOP.

64. Beta antagonists block the NE actions, so they decrease aqueous humour formation.

65. Medical conditions and drugs most used to treat:

• Angina--> beta-blockers, CCBs.
• Diabetes and heart failure--> ACEIs, ARBs, and diuretics.
• Post MI--> beta-blockers.
• BPH--> alpha-blockers.

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56. Dopamine acts on dopamine receptors in renal vasculature, causing vasodilation, increasing GFR, and increasing renal blood flow (RBF), and sodium excretion.

57. Dobutamine has beta1>beta2 increases HR, used in CHF and causes tachyphylaxis.
58. NE acts on alpha 1 & 2, beta 1, and has no beta 2 actions, increases HR, and increases PVR.

59. EP low doses affect beta-receptors, and a high dose affects alpha-receptors; it is used in anaphylaxis.

60. Dopamine in low dose effects renal blood flow, medium increases HR.

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51. Alpha1-receptors in the sex organs inhibit ejaculation and in the liver cause glycogenolysis.

52. Alpha2-receptors present in the pre-junctional nerve terminals decrease the release and synthesis of NE, platelet aggregation and decrease insulin secretion.

53. Beta1-receptors in the heart in the SA node increase HR (+ve inotropic effect), AV node increases conduction velocity (+ve dromotropy).

54. Beta2-receptors in the blood vessels cause vasodilation leads to decreased PVR, decreased diastolic pressure, decreased afterload, uterus relaxation, and bronchioles dilation.

55. Beta2-receptors in skeletal muscles increase glycogenolysis, leading to contractility (tremor), in liver cause glycogenolysis, in pancreas increase insulin secretion.

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41. Physostigmine is a tertiary amine that can cross the BBB used in glaucoma and atropine toxicity. 

42. Neostigmine and pyridostigmine are used in ileus and myasthenia gravis.

43. AChE inhibitors poisoning causes (DUMBELS) which are diarrhoea, urination, miosis, bronchoconstriction, excitation (muscle and CNS), and lacrimation, salivation and sweating.

44. The antidote for AChE inhibitor poisoning is Atropine and Pralidoxime (2-PAM) to activate the esterase enzyme; atropine is used first.

45. Vagal stimulation slows the heart caused by a low dose of atropine.

46. Physostigmine, a tertiary amine carbamate, is the antidote to atropine. 

47. Benztropine is used in Parkinsonism and the treatment of dystonias.

48. MAO A in the liver and anywhere it metabolises NE, 5HT, tyramine, and MAO B in the brain it metabolises DA. Cocaine blocks the reuptake of NE.

49. Adrenergic receptors in the eye, alpha1-receptors cause contraction of radial muscles, leading to mydriasis, and in arterioles of skin and viscera cause contraction lead to an increase in afterload and an increase in PVR.

50. Veins alpha1-receptors activation causes contraction, leading to venous return and decreasing the preload. In the bladder, contraction of both the trigone and sphincter leads to urinary retention.