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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.

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226. Bacterial meningitis treatment includes penicillins cephalosporins and vancomycin, while viral meningitis is mainly treated by acyclovir IV.

227. Pellagra is a disease characterized by deficiency and/or failure of the body to convert tryptophan to niacin. It is mainly characterized by dermatitis, diarrhea and dementia.

228. Treatment of large intestine infection caused by food intoxication include ciprofloxacin and metronidazole with the increase of fluid intake as a non-pharmacological help.

229. Antibiotics that might cause pseudomembranous colitis include broad-spectrum penicillins, celphalosporins, and clindamycin.

230. Vancomycin is a bactericidal agent that acts by inhibiting stage II of cell wall synthesis, prevent polymerization of linear peptidoglycan, side effects of vancomycin include ototoxicity, phlebitis, chills and fever.

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221. The adult male and postmenopausal female require a daily iron intake of 10 to 12 mg. Menstruating women and pregnant women require 18 mg.

222. Patients with moderate asthma have a PEFR of 60% to 80% of normal. Patients with mild asthma have a PEFR >80%.

223. Pill-rolling or bread-crumbling hand movements, muscle rigidity, blank facial stare, drooling, and slurred speech are all symptoms of Parkinsonism.

224. Patient with renal failure, liver cirrhosis should be started with spironolactone because it antagonizes aldosterone effect.

225. Nedocromil eye drops are used for vernal (spring) keratoconjunctivitis, Trifluridine is used to treat keratoconjunctivitis.

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216. Plasma albumin is the major protein for binding of various drugs, it mostly binds to acidic drugs, basic drugs tend to bind to beta-globulin and acid-glycoprotein.

217. Cataplexy is a sudden and transient episode of loss of muscle tone, often triggered by emotions, often associated with people who have narcolepsy and treated with TCAs like imipramine, clomipramine or venlafaxine or sodium oxybate if with narcolepsy.

218. Hemochromatosis is pathology in which iron accumulates in the tissues; characterized by bronzed skin and enlarged liver and diabetes mellitus and abnormalities of the pancreas and the joints.

219. Antacids neutralize existing gastric acid secreted by the parietal cells and increase the pH of the stomach and duodenal bulb. Antacids also inhibit the conversion of pepsinogen to pepsin by increasing pH. Antacids do not inhibit gastric acid secretion.

220. P. aeruginosa is the most common bacterial pathogen isolated from the sputum of cystic fibrosis patients followed by S. aureus and H. influenzae.

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211. Drugs that may cause erectile dysfunction are beta-blockers such as atenolol, labetolol, propranolol, amiloride, indapamide, chlorthalidone, spironolactone, prazosin, hydrochlorothiazide, methyldopa, reserpine, clonidine, guanethidine, amitriptyline, amoxapine, imipramine, clomipramine, venlafaxine, bupropion, chlorpromazine, lithium, pimozide, fluphenazine, thioridazine, famotidine, acetazolamide, alcohol, carbamazepine, cimetidine, clofibrate, digoxin, methazolamide, norethindrone, phenytoin, primidone, finasteride, ketoconazole, methadone, smoking.

212. Drugs that may exacerbate BPH symptoms are amitriptyline, doxepin, nortriptyline, trimipramine, brompheniramine, chlorpheniramine, clemastine, cyproheptadine, loxapine, diphenhydramine, testosterone, fluphenazine, cyclobenzaprine, atropine, bethanechol, glycopyrrolate, hyoscine, ipratropium, procyclidine, pizotifen, selegiline.

213. Drugs that cause dry mouth isoproterenol, TCAs, clonidine, reserpine, propafenone, atropine, hyoscyamine, ipratropium, BDZs, flavoxate, oxybutynin, dicyclomine, loxapine, isotretinoin, cyclobenzaprine, loratadine, selegiline, prochloperazine.

214. Conditions that may decrease albumin level in plasma and thereby decrease the protein binding are burns, pregnancy, cystic fibrosis, chronic liver disease, chronic renal failure, trauma. 

215. Hypothyroidism increases plasma albumin levels and thereby increasing protein binding of drugs.

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206. Non-prescription drugs for treatment of corns and calluses are salicylic acid 12.6% or 17.6% liquid, salicylic acid 40% plasters.

207. Drugs that may cause hair loss are androgens, heparin, carbamazepine, phenytoin, coumarins, iodine, thiouracil, carbimazole, desipramine, fluoxetine, imipramine, β-blocker, clofibrate, colchicine, interferons, lithium, NSAIDs like ibuprofen, indomethacin, aspirin, OCs, isotretinoin.

208. Toxic shock syndrome is resulting from a serious acute (sometimes fatal) infection associated with the presence of staphylococcus; characterized by fever and diarrhoea and nausea and diffuse erythema and shock; occurs especially in menstruating women using highly absorbent tampons.

209. Woman without risk factors for venous thrombosis should take oral contraceptives two weeks after pregnancy, but incase of history with risk factors such as DVT, surgery, immobilization, chronic disease, smoking or age > 35 years; she should take OCs after 4-6 weeks of delivery.

210. Organic causes of erectile dysfunction (impotence) are endocrine causes such as ↓ testosterone due to testicular failure, hyperprolactinemia, diabetes, hypo or hyperthyroidism. Local/penile causes peyronie’s disease, previous priapism, penile trauma. Surgical procedure like lumbar sympathectomy, renal transplant, spinal cord resection. Neurologic diseases like anterior temporal lobe lesions, spinal cord diseases, loss of sensory input, cerebral vascular disease, peripheral nerves diseases, diabetic neuropathy. Vascular diseases like aortic occlusion, atherosclerotic occlusion, arterial damage from the pelvic radiation, venous leak, sinusoidal spaces diseases.

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201. Drugs may cause weight gain are TCAs, MAOIs, antipsychotics, lithium, valproic acid, carbamazepine, corticosteroids, estrogen, progesterone, testosterone, anabolic steroids, insulin, oral hypoglycemic agents, tamoxifen, flunarizine, pizotifen.

202. Warning signs of anorexia nervosa are loss of weight, continuing diet (even thin), feeling fat, fear of weight gain, cessation of menstrual cycle, preoccupied with food, preferring to eat isolation, exercise vigorously, binging and purging.

203. Warning signs of bulimia nervosa are binging, purging, fasting, vigorous exercise, vomiting, abusing laxatives or diuretics, using bathroom frequently after meals, preoccupied with body weight, depression, mood swings, irregular menstrual periods, dental problems, swollen cheeks or glands, heart burn or bloating.

204. Examples of ergogenic aids that may be found in medications are caffeine, codeine, creatine, cyproheptadine, sympathomimetics like phenylephrine and pseudoephedrine, anabolic steroids, beta-blockers, beta2- agonists, diuretics, erythropoietin, human growth hormone, probenecid, tamoxifen. 

205. Non-prescription drugs of athlete’s foot are clotrimazole 1% cream, miconazole 2% cream, oxiconazole 1% cream, tioconazole 1% cream, butenafine 1% cream, chlorophenesin 1% cream, tolnaftate 1% cream or powder, undecylenic acid ointment or spray.

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196. Drugs that may cause diarrhea are acarbose, alcohol, antacids (magnesium salts), antibiotics, anticoagulants, antihypertensives especially propranolol, antimetabolites especially colchicine, cardiovascular drugs especially digoxin, cholestyramine, cholinergics, cimetidine, cytotoxic agents, domperidone, HIV medications especially nelfinavir, lactose containing pharmaceuticals, lactulose, metoclopramide, misoprostol, NSAIDs especially naproxen, orlistat, potassium supplements, prostaglandins, SSRIs especially paroxetine, sulfasalazine and ticlopidine.

197. Sarcoidosis is a chronic disease of unknown cause marked by the formation of nodules in the lungs and liver and lymph glands and salivary glands.

198. Symptoms of hyponatremia are nausea, malaise, headache lethargy, confusion, obtundation means dull or less sharp.

199. Hypokalemia symptoms are muscle weakness, fatigue, shortness of breath, decreased sensation of arms and legs, abdominal bloating secondary to paralytic ileus.

200. Drug-food interactions:- 

· Anticoagulants effect ↑ by vitamin E and ↓ by vitamin K.

· Anticonvulsants ↑ risk of folic acid and vitamin D deficiency.

· Fluoroquinolones/bisphosphonates absorption ↓ absorption by Mg, Ca, Fe; or Zn separates between them 2-4 hrs before or after.

· Methotrexate should be co-administered with folic acid (1-5mg) to minimize the risk of GI and liver toxicity.

· Orlistat and mineral oil ↓ the absorption of fat-soluble vitamins and β-carotenes.

· Systemic glucocorticoids affect the absorption of calcium and vitamin D.

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191. Causes of nausea and vomiting are appendicitis, cholangitis, cholecystitis, chronic renal dysfunction, uremia, diabetic ketoacidosis, gastric outlet obstruction, gastroenteritis, gastroparesis, head trauma, intracranial pressure, intestinal obstruction, irritable bowel syndrome, non-ulcer dyspepsia, noxious odour, pancreatitis, peptic ulcer disease, post-operative nausea and vomiting, pregnancy, pyelonephritis, vestibular disorders like motion sickness, acute viral hepatitis.

192. Symptoms of dehydration are dry mouth, tongue and skin, few or no tears when crying, decreased urination, sunken eyes, grayish skin, increased thirst, feeling weak and light-headed.

193. Diseases that may cause constipation are autonomic neuropathy, diabetes mellitus, intestinal pseudo-obstruction, multiple sclerosis, Parkinson’s disease, spinal cord injury, stroke, hypothyroidism, hypocalcaemia, systemic sclerosis, pregnancy, cystic fibrosis, panhypopituitarism, irritable bowel syndrome, chronic renal failure, uremia, stricture, diverticulosis, malignant tumor, depression, eating disorder, pain secondary to anal fissures, hemorrhoids.

194. Drugs that cause constipation are amantadine, anticonvulsants, anticholinergics, antidiarheals, antihistamines (first generation), antipsychotics, phenothiazines, BDZs, barbiturates, beta-blockers, CCBs especially verapamil, cation-containing agents aluminum, barium, bismuth, calcium, iron, cholestyramine, clonidine, diuretics, 5-HT3 antagonists like ondansetron, lithium, NSAIDs, opioids, polystyrene sodium sulfonate, TCAs like amitriptyline > nortriptyline, pseudoephedrine, vinca alkaloids.

195. Instructions for administering an enema; lubricate the enema nozzle- lie on left side with knees bent- insert the enema nozzle into the rectum with the nozzle pointing towards the navel- gently squeeze the container until the dose is expelled if discomfort is felt at this point the flow is probably too fast, retain the solution until definite abdominal cramping is felt.

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186. Lithium excretion can be facilitated by the following drugs; IV urea, NaHCo3, acetazolamide, aminophylline; and hemodialysis.

187. Heat stroke symptoms are weakness, nausea and/or vomiting, tachycardia, hypotension, dizziness, headache, irritability, with neurological symptoms such as altered mental status, hallucinations, confusion, convulsion, and coma and core temperature above 40.5˚C; can be managed before emergency by stopping the activity immediately, rest in a cool shaded area, remove excessive clothing, rehydrate, ensure good air circulation.

188. Possible non-allergic causes of acute and chronic rhinitis are viral or bacterial infection, drug induced, hypothyroidism, pregnancy, vasomotor rhinitis, nasal tumors, choanal atresia, nasal septal deviation, enlarged adenoids and tonsils and CSF rhinorrhea.

189. Drugs associated with rhinitis are ACE Is, ASA, NSAIDs, beta-blockers, chlorpromazine, cocaine, guanethidine, methyldopa, oral contraceptives, phentolamine, prazosin, reserpine and topical decongestants.

190. Drugs that may cause ototoxicity are aminoglycosides like neomycin, kanamycin, amikacin, netilmicin, gentamicin, tobramycin, streptomycin. Antineoplastics like cisplatin, nitrogen mustard, methotrexate, vincristine, bleomycin and dactinomycin. Antiparasitics like quinine, chloroqine, ASA, NSAIDs, loop diuretics like ethacrynic acid, furosemide and bumetanide, macrolides like erythromycin, clarithromycin and azithromycin, tetracyclines like doxycycline and minocycline, vancomycin.

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181. Ileostomy is a surgical procedure that creates an opening from the ileum through the abdominal wall to function as an anus; performed in cases of cancer of the colon or ulcerative colitis and it may cause excoriation.

182. Methysergide is used for the prophylaxis of migraine; it may cause retro-peritoneal fibrosis.

183. Ceiling effect is defined as "the phenomenon in which a drug reaches a maximum effect, so that increasing the drug dosage does not increase its effectiveness.

184. Tissue plasminogen activator is a thrombolytic agent (trade name Activase) that causes fibrinolysis at the site of a blood clot; used in treating acute myocardial infarction.

185. Calcium carbonate is cheaper, has good absorption; and good elemental calcium.

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176. Mixing and solubility is found in Remington, peer review article in journals, non-approved uses of drugs can be found in Medline (internet), USPDI, you can find the bioavailability of an American drug in AHFS, for information about new drugs; you can call drug information center or the manufacturer.

177. Drug dosage forms can be found in CPS, Martindale, USPDI, AHFS, Drug Fact and Comparison, unapproved uses of drugs can be found in Drug Fact and Comparison, Martindale Extra Pharmacopia, USPDI, AHFS, Medline.

178. Adverse reactions can be found in Martindale, CPS, investigational drug resources can be found in Drug Fact and Comparison, Martindale Extra Pharmacopeia.

179. Gonorrhea common venereal disease transmitted by sexual intercourse and caused by the bacterium Neisseria gonorrhoeae; symptoms are painful urination and pain around the urethra.

180. The following medications can cause folic acid deficiency; INH, valproic acid, phenytoin, metformin, methotrexate, sulfasalazine, triamterene, barbiturates, primidone, Oral contraceptives, and trimethoprim.

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171. The book that is concerned with pharmaco-kinetics and half-life of the drugs is CPS, the book that is talking about solubility (buffer solution) is Martindale and Remington, where you find the bio-equivalence of certain medicines is Ontario Drug Benefit, the book where you find information about drugs in foreign countries is Martindale, for unknown drug to look for physical characters like color consult the following sources CPS, Lexicomp Clinical Reference, and Drug Facts and Comparison.

172. For orphan drugs that used to treat or prevent a rare disease consult National Information Center for Orphan Drugs.

173. Approved uses of drugs are found in CPS, USPDI, Mircomedex and Drug Facts and Comparison.

174. Drug-drug interactions can be found in CPS, Drug Interaction Facts and Drug Facts and Comparison.

175. Herbal drugs can be found in Patient Self-Care, Compendium of Non-prescription Drugs and Laurence Book for Herbal Drugs.

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166. Epilepsy treatment as follows; 

• Generalized seizure→ carbamazepine, phenytoin, lamotrigine and valproic acid.
• Absence seizure→ ethosuximide, valproic acid.
• Partial seizure→ carbamazepine, valproate, lamotrigine, oxacarbazepine, topiramate and phenytoin.
• Myoclonic seizures→ the drug of choice is valproate, lamotrigine may also be used in juvenile myoclonic seizure; others may be used as 2nd line like clobazam, clonazepam and ethosuximide.
• Lennox-Gastaut syndrome→ valproate is 1st choice and lamotrigine or topiramate are 1st line alternatives, also clobazam, clonazepam and ethosuximide could be used.

167. Varicella zoster vaccine is given in two doses at 12-15 months and 4-6 years and for people older than 13 years two doses are given with 4-8 weeks apart.

168. Robaxacet is a skeletal muscle relaxant; used as in muscle spasm and can change the color of the urine into dark color; it may cause seizure, hypotension, blurred vision and GI upset.

169. Meningitis an infectious disease characterized by inflammation of the meninges (the tissues that surround the brain or spinal cord) usually caused by a bacterial infection like S. pneumoniae and H. influenzae; symptoms include headache and stiff neck; fever and nausea.

170. Cost-utility analysis (CUA) is a form of economic analysis used to guide procurement decisions. The most common and well-known application of this analysis is in pharmacoeconomics, especially health technology assessment (HTA), study gives good evidence is cohort study.

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161. Vitamin D is found in cod liver oil, shark oil, eggs, milk, butter and ghee, its deficiency causes rickettsia and osteomalacia.

162. Vitamin E is found in leafy vegetables, wheat, germ oil and milk, its deficiency causes degeneration of heart and nerve muscles.

163. Vitamin K is found soybeans, tomatoes; autosynthesize in intestine, its deficiency causes thrombocytopenia, bleeding disorder and erythroblastosis foetalis.

164. Lithium toxicity treated by stopping lithium, use osmotic diuretic mannitol, and in severe cases dialysis.

165. Primary source of information is journals.