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.

Pharma Tips-76

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.

Pharma Tips-71

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.

Pharma Tips-70

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

Pharma Tips-69

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).