Pregnancy Rates Per 100 Women With or Without Pregnancy Control

1. Combination pill---------------------- less than 1-2
2. Intra-uterine device (IUD)----------  less than 1-6
3. Progestin-only pill------------------------------ 1-5
4. Condom with spermicidal foamer gel--------- 1-6
5. condom---------------------------------------- 2-12
6. Diaphragm with spermicidal foamer gel----- 3-18
7. Spermicide------------------------------------ 3-21
8. Sponge with spermicide---------------------- 3-28
9. Cervical cap with spermicide----------------- 5-18
10. Periodic abstinence (rhythm) all types-----  2-20
11. No birth control------------------------------ 60-85 

Pharma Tips-185

946. There are 400,000 units of penicillin in 250 mg.

947. Treatment with alteplase should only be initiated within 3 hours after the onset of stroke symptoms.
948. Age, weight, and sex; medical conditions; the dose of the medicine; other medicines; and vitamins, herbals, and other dietary supplements can affect how medicines work.
949. Nausea and vomiting may occur with opioid therapy particularly in the initial stages but can be prevented by giving an antiemetic such as haloperidol or metoclopramide.
950. Physical dependence includes tolerance (requiring larger dosages or repeated use) and withdrawal symptoms (mental and physical) when it is stopped.

Pharma Tips-184

941.  Protamine sulfate is the antidote for heparin overdosage.

942. Hydrolysis of penicillin G is rapid in the GIT.

943. Mineral oil acts only by lubricating the intestinal tract. It has very mild or secondary properties of fecal softening.

944. A humectant such as glycerin helps to retain moisture and prevent drying due to evaporation.

945. Vitamins A, D, E, and K are fat soluble.

Pharma Tips-183

936. Trough concentrations are indicative of drug accumulation. To decrease only the trough level and maintain peak concentrations, lengthening the dosing interval is the method of choice.

937. Vitamin K is necessary for the formation of prothrombin.

938. Due to its high pH, sodium bicarbonate is incompatible with many common IV medications.

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

940. The most widely used method for sterilization of pharmaceuticals is moist heat.

Pharma Tips-182

931. Buspirone lacks the anticonvulsant and muscle relaxant properties of BDZs with only increase in sedation.

932. Phenobarbital induces respiratory depression which increases with the use of ethanol.

933. Pergolide is a dopamine agonist may cause daytime sleepiness.

934. Eprosartan may cause severe hypotension in volume-depleted patients. 

935. Scopolamine should be avoided in angle closure glaucoma patients.

Pharma Tips-181

926. Weight loss is caused by levothyroxine, fluoxetine, TCAs, metformin, alpha-interferons, and trazodone. 

927. Pancreatitis is caused by valproic acid, hydrochlorothiazide, metronidazole, pentamidine, cimetidine, ranitidine, alcohol, azathioprine, sulfasalazine, corticosteroids, sulfa drugs, didanosine, 6-MP, zalcitabine, estrogens, tetracycline, thiazides, furosemide, glucocorticoids, mercaptopurine, and diabetes. 

928. Protein urea is caused by captopril, gold, carbamazepine, and penicillamine. 

929. Hyperuricemia is caused by alcohol, diuretics, vitamin B12, levodopa, ASA, niacin, ethambutol, cyclosporine, pyrazinamide, cytotoxic agents, and nitroglycerin. 

930. Folic acid deficiency is caused by phenytoin, carbamazepine, primidone, metformin, sulfasalazine, triamterene, methotrexate, alcohol, and oral contraceptives.

Pharma Tips-180

921. Triazolam is the shortest acting BDZs.

922. Didanosine causes gout.

923. Patient with BP + diabetes and has protein urea give enalapril (ACEI), not captopril, which causes protein urea.

924. Metallic taste is caused by metronidazole, ipratropium, metformin, disulfiram, gold, amiodarone, and penicillamine.

925. Ototoxicity is caused by ASA, NSAIDs, furosemide, vancomycin, erythromycin, ethacrynic acid, and aminoglycosides.

Pharma Tips-179

916. ACEIs increase the sensitivity to insulin so they may cause severe hypoglycemia in patients receiving insulin.

917. Hirsutism is caused by phenytoin, spironolactone, minoxidil, corticosteroids, and cyclosporine.

918. Zalcitabine can cause mouth ulcer (pin sensation).

919. Phenytoin tablets contain 100 % free acid, and 92 % in case of the syrup.

920. Antineoplastic drugs should be prepared and used in 1 hour.

Pharma Tips-178

911. Gabapentin (Neurontin) is indicated for the treatment of partial seizure, and postherpetic pain, which is the pain that lasts for 1-3 months after shingles have healed.

912. The normal heart rhythm known as sinus rhythm originates in specialized cells known as pacemaker cells in the sinoatrial node (SA), or sinus node.

913. Flu season is from October to April, but flu vaccination is from October to mid- November.

914. In choosing glucometer for measuring blood sugar level, always consider the size of the display.

915. Mood stabilizers like valproate and lithium.

Pharma Tips-177

906. Modafinil is used to treat narcolepsy in a single dose (morning).

907. Phenytoin is used to treat tonic-clonic (grand mal), and complex partial seizures.

908. Depakene (valproic acid) is indicated for all types of epilepsy.

909. Carbamazepine (Tegretol) should be taken with food to decrease GI irritation, it stimulates the secretion of ADH (antidiuretic hormone), watch out for edema, nausea, vomiting, sedation, and confusion.

910. Ethosuximide is used to treat absence seizures (petit mal).

Pharma Tips-176

901. Fibric acid derivatives (clofibrate) may inhibit the metabolism of anticoagulants and increase the risk of bleeding.

902. Chlordiazepoxide, diazepam, and clonazepam are used in alcohol withdrawal symptoms. 

903. Diazepam and lorazepam are used in status epilepticus (IV).

904. Short-acting BDZs have half-lives of 2-3 days, while the long-acting BDZs have half-lives of 10-20 days.

905. Chlordiazepoxide is not given IM, since it may cause an extreme pain at the injection site.

Pharma Tips-175

896. Attention deficit hyperactivity disorder (ADHD) is divided into 3 subtypes:- 

• A. Predominant inattentive (10-20%).
• B. Predominant hyperactive/impulsive (5-10%).
• C. Combined inattentive & hyperactive (70-80%). 

897. Methylphenidate, dextroamphetamine, atomoxetine, bupropion, clonidine, TCAs like desipramine, imipramine, and nortriptyline, risperidone, all are used to treat ADHD.

898. CNS stimulants like methylphenidate and amphetamine should not be used with MAOIs to avoid the hypertensive crisis.

899. Donepezil, rivastigmine, and galantamine are used to treat dementia.

900. Memantine is N-methyl-D-aspartate receptor antagonist is used to treat dementia.

Pharma Tips-174

891. Treatment of Brain injury + agitation propranolol, carbamazepine, divalproex, and BDZs.

892. Treatment of psychosis risperidone + BDZs (IM), olanzapine should not be combined with BDZs, because of the risk of cardiac and respiratory complications.

893. Treatment of mania + agitation risperidone, olanzapine, or quetiapine.

894. Treatment of agitation and aggression 1st generation antipsychotics + BDZs PO or IM (haloperidol + lorazepam). 

895. Treatment of agitation resulted from alcohol withdrawal use diazepam.

Pharma Tips-173

886. Propylthiouracil causes agranulocytosis, aplastic anemia, it is used in pregnancy.

887. Metoclopramide causes Parkinson’s like symptoms.

888. Unoprostone is a PG analog, it is used to treat glaucoma.

889. Treatment of delirium + agitation haloperidol, loxapine, olanzapine, risperidone, and benzodiazepines (BDZs).

890. Treatment of dementia + agitation risperidone, quetiapine, haloperidol, trazodone, lorazepam, donepezil, and galantamine.

Pharma Tips-172

881. Hydroxychloroquine is used in systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA).

882. Premarin is used in menopause and vaginal atrophy.

883. Procainamide induces lupus-like syndrome.

884. Pantoprazole is the only PPI, that is available as injection form.

885. Fluoxetine causes insomnia, take it in the morning.

Pharma Tips-171

876. Plan B contraception; two separate doses of 0.75 mg levonorgestrel 12 hours, or 1.5 mg within 24 hours. Two separate doses of 100 mcg ethinylestradiol (EE), and levonorgestrel 0.5 mg 12 hours up to 5 days after sex, the side effect of plan B is breast tenderness.

877. In burns assess ABC; airway, breathing, and circulation.

878. Hydroxyzine inhibits the antipsychotic response to neuroleptics, cetirizine is the metabolite of hydroxyzine.

879. Doxepin is used in chronic urticaria.

880. Ketotifen is used in urticaria and mastocytosis.

Pharma Tips-170

871. Diazepam is metabolized to longer acting active metabolite called nordazepam.

872. Aluminum, magnesium, iron, and calcium decrease the absorption of tetracyclines, digoxin, and quinolone antibiotics.

873. The urea breath test is the most widely used test for H. pylori, clarithromycin + amoxicillin or metronidazole + PPI is used to treat peptic ulcer caused by H. pylori.

874. Tachyphylaxis is the loss of effectiveness over time (repeated use).

875. Tamsulosin causes retrograde ejaculation.

Pharma Tips-169

866. Anticholinergic risk drugs such as amitriptyline, atropine, benztropine, dicyclomine, diphenhydramine, oxybutynin, amantadine, baclofen, cetirizine, loratadine, tolterodine, prochlorperazine, Sinemet, entacapone, haloperidol, ranitidine, trazodone, and risperidone.

867. Achlorhydria (no acid secretion) leads to decrease the absorption of ketoconazole, thiamine, calcium, and iron, and increase the absorption of levodopa, erythromycin, and penicillin.

868. Sucralfate and cholestyramine, metal ions decrease the absorption of ciprofloxacin, tetracycline, and levothyroxine.

869. Enteral food (vitamin K) decreases warfarin effect, and high protein meals decrease the effect of levodopa.

870. Drugs that are metabolized to active metabolites include codeine, enalapril, atorvastatin, and clopidogrel.

Pharma Tips-168

861. Medications that can cause confusion and decreased level of consciousness are sedatives, and anticholinergics.

862. Drugs that might cause extrapyramidal symptoms are neuroleptics (antipsychotics), and metoclopramide.

863. Drugs that might cause hypotension, bradycardia and syncope are alpha & beta blockers, CCBs, and diuretics.

864. Drugs that might cause urinary retention are anticholinergics, neuroleptics, antidepressants, and antiemetics.

865. NSAIDs and diuretics may cause pre-renal failure.

Pharma Tips-167

856. Tinidazole is an antiprotozoal agent.

857. Zidovudine may cause anemia.

858. Mupirocin (Bactroban) is used to treat impetigo.

859. Blood pressure (BP) = total peripheral resistance (TPR) X cardiac output (CO).

860. Drugs that are not appropriate or better be avoided if possible in elderly are:-

• Analgesics such as pentazocine, propoxyphene, meperidine, indomethacin, and ketorolac.
• Antianxiety drugs such as long-acting benzodiazepines.
• Antidepressants such as amitriptyline (high anticholinergic side effects), doxepin, & fluoxetine.
• Antispasmodics such as dicyclomine, cyclobenzaprine, hyoscine, and benztropine.
• 1st generations antihistamines such as diphenhydramine, and hydroxyzine.
• Antihypertensives such as methyldopa, and beta-blockers (BBs).
• Long-term laxatives such as mineral oil.

Pharma Tips-166

851. Palonosetron is a 5-HT3 antagonist to treat nausea and vomiting from chemotherapy.

852. Antiepileptics produce tolerance, so dose should be monitored.

853. Selenium is used just topically (antifungal, antibacterial, and keratolytic).

854. Bortezomib is indicated for refractory multiple myeloma.

855. Propylthiouracil causes dermatitis, leukopenia, and agranulocytopenia.

Pharma Tips-165

846. Nitroglycerin has a short half-life because it undergoes the first-pass metabolism.

847. Trihexyphenidyl is used to treat Parkinsonism.

848. Isotretinoin is closely related to vitamin A.

849. Colchicine is the most effective medication for acute gout.

850. Linezolid is used to treat vancomycin resistant cocci, nosocomial pneumonia.

Pharma Tips-164

841. Albuterol is usually administered by mouth.

842. Enzyme induction means more enzymes produced.

843. Epinastine is an ocular antihistamine, it is used to treat allergic conjunctivitis.

844. Amrinone is the only synthetic cardiac glycoside. 

845. Efalizumab is used to treat plaque psoriasis.

Pharma Tips-163

836. Lorazepam is used as pre-operative medication, and prior to chemotherapy, it causes sedation, memory loss, and decrease anxiety.

837. Cocaine is a vasoconstrictor, slows its own absorption, so it acts longer.

838. Diethylstilbestrol is the first synthetic estrogen.

839. Carbidopa prevents the degradation of levodopa in the periphery, so more levodopa crosses BBB to convert into dopamine.

840. Hyoscyamine is twice potent as atropine.

Pharma Tips-162

831. Botox (botulinum toxin) is used for strabismus (crossed eyes), blepharospasm (noncontinuous blinking), facial wrinkles, excessive underarm sweating.

832. Cholestyramine blocks the absorption of fat-soluble vitamins (ADEK).

833. Lanthanum reduces serum phosphate in end-stage renal failure.

834. Antipsychotics act on lower brain areas.

835. Treprostinil is prostaglandin used in pulmonary arterial hypertension.

Pharma Tips-161

826. Enteral feeding tube complications include aspiration, pneumonia, diarrhea, hyperglycemia, and fluid and electrolyte disturbance.

827. Bevacizumab is used for short-term treatment of metastatic colon cancer.

828. Nicotine is available as a transdermal patch, nasal spray, and gum.

829. Triamcinolone has all glucocorticoids side effects except increasing appetite.

830. Amoxicillin is more acid-stable than penicillin.

Pharma Tips-160

821. Sulfonamides undergo acetylation.

822. Tinnitus can be caused by salicylates toxicity and from withdrawal symptoms of benzodiazepines.

823. Nalorphine is a narcotic antagonist (it has very little agonistic activity).

824. Aprepitant (Emend) is used for nausea and vomiting induced by chemotherapy.

825. Magnesium is good for enzyme system, muscle contraction, and nerve conduction.

Pharma Tips-159

816. Flu shot is given from October to mid-November.

817. Medications need to be stopped automatically after specific time:-

• PRN-controlled medication after 72 hours
• Anticoagulants 24 hours, 14 days, or by a doctor
• Antibiotics 10 days
• Antineoplastics 24 hours, 7 days, or by doctor
• Parenteral nutrition 4 days
• Schedule II drugs 72 hours, 7 days
• Schedule III drugs 7 days
• Schedule IV drug 7 days
• Schedule V drugs 7 days

818. Amphetamine, and phencyclidine are basic drugs.

819. Lithium and ethanol can cross BBB and the placenta, because they have very small molecular weight (too small particles).

820. Alfuzosin is used to treat BPH.

Pharma Tips-158

811. Cholestyramine decreases the absorption of levothyroxine.

812. Ciprofloxacin damages cartilage in children.

813. Verapamil can cause inhibition of AV node conduction, so it can possibly cause heart block.

814. Flunarizine is calcium channel blocker, it is used for migraine prophylaxis.

815. Pneumocystis carnii is treated by co-trimoxazole, dapsone, or pentamidine.

Pharma Tips-157

806. Clostridia causes gas gangrene.

807. Bacteriophages are viruses.

808. Staphylococci cause furuncles and abscesses.

809. Treponema pallidum causes syphilis.

810. Chloroquine is used to prevent malaria.

Pharma Tips-156

801. LMWH is the drug of choice in pregnancy as an anticoagulant, but it must be stopped at labor.

802. Antacids are usually given between meals, and at bedtime.

803. Lithium adverse effects are fine hand tremor, diarrhea, hypothyroidism, weight gain, and muscle weakness.

804. Anthrax is treated with ciprofloxacin or doxycycline.

805. The heart is damaged by rheumatic fever.

Pharma Tips-155

796. Uterine relaxants (tocolytics), magnesium sulfate is the treatment of choice to suppress preterm labor (<37 weeks of gestation), terbutaline, nifedipine, indomethacin are the 2nd choice after magnesium sulfate.

797. Tolterodine is a muscarinic receptor antagonist, relaxes urinary bladder to treat overactive bladder.

798. Estrogen and progestin combinations cause abdominal pain, bloating, chest pain, shortness of breath, headache, eye problems, and severe leg pain.

799. Increase arterial blood flow, and decrease venous blood flow in the penis leads to erection after sexual stimuli (viagra). Erection lasts 4-6 hours (priapism), sildenafil causes a headache, dyspepsia, nasal congestion, and rhinitis. Tadalafil (Cialis) erection last for 36 hours.

800. Drugs that might cause syncope are alcohol, antiparkinson drugs, diuretics , alpha and beta- blockers, vasodilators, nitrates, phosphodiesterase 5-inhibitors (sildenafil, tadalafil, and vardenafil).

Pharma Tips-154

791. Parkinsonism includes bradykinesia, mask-like face, drooling, tremor, and gait problems.

792. Acute dystonia is the spasms of face, tongue, neck, and back.

793. Akathisia is compulsive restless movement, anxiety, and agitation.

794. Rhogam is given to Rh-ve mom, and Rh+ve baby, to prevent the developing of antibodies for the future children, it is given in 28 weeks of gestation, and within 72 hours of birth.

795. Calcium gluconate is the antidote for magnesium sulfate.

Pharma Tips-153

786. Serotonin syndrome symptoms include agitation, confusion, disorientation, and hallucination.

787. Avoid taking MAOIs with cheese, wine, preserved meet (tyramine), or with drugs like barbiturates, TCAs, CNS depressants, antihypertensives, and OTC cold medications, because it may increase the blood pressure to a very high level.

788. Extra-pyramidal symptoms are tardive dyskinesia, acute dystonia, akathisia, and parkinsonism.

789. Haloperidol is used in schizophrenia, acute psychosis, Tourette's syndrome, tics, and uncontrolled body movements. 

790. Tardive dyskinesia is the twisting movement of the face and tongue, and lips smacking.

Pharma Tips-152

781. Colchicine causes nausea, vomiting, abdominal cramps, and diarrhea.

782. Probenecid causes vomiting, diarrhea, anorexia, and kidney stones.

783. Allopurinol causes drowsiness, headache, abdominal cramps, and rash.

784. Bisphosphonates should be taken 30-60 minutes before meals, and 30 minutes before any other medication, with a full glass of water, and the patient should remain in upright position for 30-60 minutes.

785. Order of potency for opioids; morphine > hydrocodone = oxycodone > codeine > Narcan = propoxyphene = naloxone.

Pharma Tips-151

776. Atropine toxicity symptoms include hot as a hare (temperature), mad as a hatter (confusion and delirium), red as a beet (flushed face), dry as a bone (decrease secretions, thirsty).

777. Potassium is necessary for nerve impulses, conduction, and heart excitation.

778. ASA toxic levels for 30 lb child = 12 adult tablets (325 mg), or 48 tablets (81 mg).

779. Toxic levels of Li = 2 mEq/L digoxin = 2 ng/ml, and theophylline 20 mcg/ml. Li therapeutic levels 0.8-1.4 mEq/L (sodium depletion is the main cause), digoxin 0.5-0.8 ng/ml (hypokalemia), and theophylline (5-15 mcg/mL).

780. Vitamin B6 antagonizes the effect of levodopa. INH and alcohol cause deficiency of vitamin B6.

Pharma Tips-150

771. Insulin types:

• Insulin lispro (humalog)- onset:15-30 minutes- peak:0.5 -2.5 hours, duration:3-5 hours.
• Insulin aspart (novolog)- onset:10-20 minutes-peak:1-3 hours, duration:3-5 hours
• Insulin glulisine (apidra)-onset:10-15 minutes-peak:1.1.5 hours,duration:3-5 hours
• Regular Insulin (humulin R), onset:30-60minutes, peak:1-5 hours, duration:6-10 hrs
• NPH (humulin N) onset:60-120 mins, peak:6-14 hrs, duration:16-24 hrs
• Detemir (levemir) peak:6-8 hrs, duration:12-24 hrs
• Glargine (Lantus) onset:70 mins, no peak effect, duration:24 hrs
• Inhaled (short duration slow acting) onset: 15-30mins, peak:0.5-1.5hrs, duration: 6.5 hours.

Note: NPH (Humulin N) is the only cloudy insulin.

772. Hypoglycemia symptoms are fatigue, hunger, cool moist skin, increased anxiety, dizziness, and palpitations.

773. Psyllium acts within 12-36 hours and milk of magnesia (MOM) acts within 6-12 hours.

774. Aluminum hydroxide is used to treat hyperphosphatemia in renal insufficiency.

775. Sodium polystyrene sulfonate is used to treat hyperkalemia.

Pharma Tips-149

766. Chemotherapy and HIV patients taking zidovudine (AZT) may experience an elevation in BP.

767. Iron causes nausea, heartburn, constipation, bloating, anaphylaxis(IV), and may discolor teeth (in case of solutions, use a straw), its absorption decreases by antacids and tetracyclines, and increases by vitamin C.

768. BBs (beta-blockers) can mask symptoms of hypoglycemia.

769. Phenytoin causes gingival hyperplasia and bradycardia.

770. Valproic acid causes hepatic toxicity.

Pharma Tips-148

761. Azithromycin causes diarrhea, nausea, vomiting, and abdominal pain.

762. Ethacrynic acid increases ototoxicity of aminoglycosides.

763. Ca. gluconate (IV) for the treatment of neuromuscular blockade.

764. Amphotericin B, cephalosporins, polymixins, vancomycin, ASA, and NSAIDs increase nephrotoxicity of aminoglycosides.

765. Erythropoietin is used in anemia caused by renal failure.

Pharma Tips-147

756. INH cause vitamin B6 deficiency, its side effects are peripheral neuritis, clumsiness, unsteadiness, muscle ache, epigastric distress, jaundice, INH is taken on an empty stomach or 1 hour before, or 2 hours after meals.

757. Quinolones and tetracyclines are contraindicated in pregnancy.

758. The number of doses = total quantity/ size of the dose.

759. Part per million (PPM) = 1 g in 1000000 g , 1 g in 1000000 ml.

760. Ciprofloxacin causes GI upset, nausea, vomiting, diarrhea, dizziness, and headache, space out antacids, iron, milk by 2 hours before, or 4-6 hours after taking it.

Pharma Tips-146

751. Ear drops if not instilled at room temperature the patient might experience vertigo, dizziness, and nausea.

752. Aminoglycosides like gentamicin, and neomycin cause nephrotoxicity and ototoxicity.

753. Cephalosporins cause a rash, anorexia, GI pain, and hypersensitivity reaction, cross-reaction with penicillins.

754. Tetracyclines like doxycycline should not be given to children <11 years of age, and to a pregnant woman, they cause teeth stains, nausea, abdominal cramps, vomiting, diarrhea, superinfection, and photosensitivity. Tetracyclines must be taken on an empty stomach, antacids, milk products, and iron should be taken 2 hours before, or 4 hours after taking tetracyclines.

755. Metronidazole side effects are nausea, dry mouth, headache, metallic taste, dark urine, and seizure. It is contraindicated in nursing and in the 1st trimester of pregnancy.

Pharma Tips-145

746. Propranolol increases the serum levels of rizatriptan.

747. Verapamil increases the levels of digoxin by 50-75%, monitor levels within 1 week.

748. Ticlopidine increases the levels of theophylline, and you must monitor neutrophils levels every 2 weeks for 3 months.

749. Eplerenone is an aldosterone antagonist, it does not produce gynecomastia.

750. Alteplase should be administered 3 hours of a stroke.

Pharma Tips-144

741. SSRIs + MAOIs or TCAs or meperidine may cause serotonin syndrome.

742. Iron poisoning leads to hematemesis and bloody diarrhea, deferoxamine is the antidote.

743. Lead poisoning causes anemia, neuropathy, nephropathy (proteinuria failure), the antidote is succimer (PO), or dimercaprol.

744. Antidotes:-

• Flumazenil for BDZs
• Digoxin immune fab for digoxin
• Phentolamine for dopamine
• Protamine for heparin
• Leucovorin (folinic acid) for methotrexate
• Naloxone for morphine (opioids)
• Sodium thiosulfate for nitrogen mustard
• Pralidoxime/PAM for organophosphates
• Vitamin K for warfarin
• Acetylcysteine for acetaminophen overdose
• Deferoxamine for iron poisoning 
• Dimercaprol for arsenic, gold, mercury, and lead poisoning 
• Succimer for mild lead and mercury poisoning 
• EDTA as a backup in lead poisoning and for cadmium, chromium, calcium, manganese, and zinc poisoning
• Oxygen for carbon dioxide poisoning 
• Penicillamine for copper poisoning (Wilson's disease).

745. Neuroleptic malignant syndrome, sedation, extrapyramidal symptoms, weight gain, diabetes, and dyslipidemia are side effects of antipsychotic drugs.

Pharma Tips-143

736. Alpha2- receptors are the predominant receptors in beta-cells of the pancreas and their activation will lead to decrease insulin release.

737. Metformin is a euglycemic drug, does not cause hypoglycemia, when it is given alone, it increases insulin sensitivity, and decrease gluconeogenesis.

738. Alendronate is the drug of choice for steroid-induced osteoporosis, it should be taken on an empty stomach with plenty of water, and the patient should stay in a vertical position for at least 30 minutes.

739. Physostigmine crosses BBB, that’s why it is used as an antidote in atropine toxicity.

740. Naloxone should be given at frequent intervals because it has a short half-life.

Pharma Tips-142

731. Clomiphene (fertility pill) increases FSH and LH which increases ovulation leading to pregnancy and may lead to multiple births.

732. Tamoxifen is used in breast cancer, and to stimulate ovulation in anovulatory infertility. 

733. Medroxyprogesterone injection gives contraception for 3 months (IM injection).

734. Progestin decreases HDL and increases LDL.

735. Finasteride inhibits 5alpha-reductase to prevent the formation of dihydrotestosterone, it is used in the treatment of BPH, and male baldness.

Pharma Tips-141

726. Purple toe syndrome occurs when cholesterol released from the plague and goes to other places.

727. ASA displaces warfarin from protein binding site.

728. Pergolide is the drug of choice for the treatment of hyperprolactinemia.

729. Desmopressin is used in diabetes insipidus, hemophilia A, and nocturnal enuresis.

730. Ipodate, propranolol, and propylthiouracil prevent the conversion of T4 to T3.

Pharma Tips-140

721. Prostacyclin = epoprostenol (PGI2) is used in primary pulmonary hypertension (vasodilator). 

722. Colchicine binds to tubulin decreases leukotriene B4 (LTB4) decreases leukocyte migration to inflammation site. 

723. Allopurinol inhibits xanthine oxidase, so inhibits the formation of uric acid, and by this mechanism allopurinol increases levels of 6-mercaptopurine (6-MP) increases its toxicity. 

724. Adenosine is a bronchoconstrictor. 

725. Oxygen, beta2-agonist, steroids (IV), and aminophylline (IV) are used for status asthmaticus.

Pharma Tips-139

716. Misoprostol (PGE1) increases mucus and bicarbonate secretion, it is used to treat NSAIDs peptic ulcer.

717. Ondansetron (Zofran), (5-HT3) antagonist, it is used to treat emesis, nausea, and vomiting that caused by the use of chemotherapy.

718. Ergometrine = ergonovine, it is used as IM injections after placental delivery, it contracts the uterus. Ergonovine and methysergide are used for prophylaxis of a migraine.

719. Alprostadil is used in male impotence, and to maintain the patency of ductus arteriosus in neonates with congenital heart disease till surgery.

720. Dinoprost (PGF2α), it is abortifacient, and latanoprost (PGF2α), is used in glaucoma.

Pharma Tips-138

711. Acyclovir causes crystalluria, and neurotoxicity, maintain hydration while taking it.

712. HAART is high active antiretroviral therapy.

713. Stibogluconate is the drug of choice in leishmaniasis.

714. Nifurtimox is the drug of choice in Chagas disease.

715. Prophylaxis of malaria; pyrimethamine + sulfadoxine, or mefloquine.

Pharma Tips-137

706. Imipenem and meropenem IV drugs are resistant to beta-lactamases.

707. INH, rifampin, and ethambutol are used to treat tuberculosis.

708. Isoniazid (INH) side effects are hepatitis (elderly patients), peripheral neuritis (use vitamin B6), hemolysis (G6PD), systemic lupus erythematosus (SLE) in slow acetylator.

709. Rifampin side effects proteinuria, hepatitis, flu-like symptoms, increases metabolism of other drugs, thrombocytopenia, red-orange metabolites in urine and other body fluids.

710. Ethambutol causes retrobulbar neuritis, and decreases visual acuity (sharpness), aluminum salts decrease its absorption.

Pharma Tips-136

701. Ticarcillin has more activity against gram-negative bacteria like Pseudomonas aeruginosa.

702. Cefaclor is used against Haemophilus influenzae and otitis media.

703. Ceftriaxone (IM), and cefixime (PO) are used to treat gonorrhea.

704. Cefepime is a 4th generation cephalosporin.

705. Probenecid inhibits renal clearance of some penicillins and cephalosporins, thus increase their conc. and extend their effects.

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696. Drugs that might be used instead of Li are valproic acid, carbamazepine, clonazepam ( pregnancy), and gabapentin.

697. Antibiotics that inhibit cell wall synthesis include penicillins, cephalosporins, imipenem, and vancomycin.

698. Antibiotics that inhibit protein synthesis include aminoglycosides, chloramphenicol, linezolid, macrolides, and tetracyclines.

699. Penicillinases break ring structure (staphylococcus species).

700. Nafcillin, methicillin, and oxacillin are used in beta-lactamase resistance.

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691. Tardive dyskinesia occurs with long-term use of antipsychotic drugs such as haloperidol and fluphenazine, and it is irreversible.

692. Clozapine causes agranulocytosis ( decrease white blood cells), and weight gain.

693. Thioridazine causes retinal deposits and cardiotoxicity.

694. Depression is characterized by low levels of norepinephrine, serotonin, and dopamine.

695. Lithium toxicity occurs with the use of diuretics, or low Na levels, side effects of Li are tremors, ataxia, acne, edema, seizures, polyuria, and polydipsia.

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686. Dopamine main side effect is psychosis.

687. Pergolide is a dopamine agonist, it is used in Parkinson's disease.

688. Parkinsonism signs and symptoms are resting tremor, bradykinesia, muscle rigidity, postural instability, flat face. It is characterized by the presence of too much acetylcholine and too little dopamine. L-dopa crosses BBB to form dopamine.

689. Chlorpromazine, haloperidol, and thioridazine lower seizure threshold, they block dopamine receptors and cause pseudo-parkinsonism, bradykinesia, rigidity, akathisia, and dystonia.

690. Muscarinic blocking drugs may cause acute dystonia.

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681. Valproic acid causes spina bifida (teratogenic).

682. Cocaine blocks the reuptake of norepinephrine and causes an increase in the heart rate.

683. Morphine and meperidine are the drugs of choice in moderate and severe pain management.

684. Methadone is used to treat withdrawal symptoms of opioids.

685. Dyskinesia is irregular muscle movements.

Pharma Tips-131

676. Serotonin receptors are excitatory or inhibitory.

677. Opioid receptors are inhibitory.

678. Metronidazole + ethanol cause a disulfiram-like reaction.

679. Lorazepam and diazepam are used in status epilepticus (IV), and phenytoin.

680. Lamotrigine causes a life-threatening rash.

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671. Gemfibrozil activates lipoprotein lipase, increases the metabolism of VLDL.

672. Glutamic acid is excitatory (NMDA receptors) target of ketamine, and phencyclidine (PCP), but GABA is inhibitory, increases chloride influx, receptors targeted by anticonvulsants and sedatives.

673. Cholinergic receptors, M1 receptors are excitatory; decrease potassium efflux, M2 receptors are inhibitory; increase potassium influx.

674. Dopamine receptors are inhibitory, increase c-AMP.

675. Norepinephrine receptors are excitatory or inhibitory.

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666. Thiazide diuretics increase LDL, and TGs in chronic use, and decrease libido.

667. Potassium-sparing diuretics cause hyperkalemia, and increase hydrogen ion conc. causing acidosis.

668. Cholestyramine increases VLDL and TGs and decreases the absorption of digoxin, thiazide, tetracyclines, warfarin, and vitamin K.

669. Statins slightly decrease TGs and increase liver function tests (LFTs).

670. Niacin is the drug of choice to increase HDL, it causes flushing, so ASA is used to decrease this effect, it causes GIT disturbances and hyperglycemia.

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661. Drugs that dilate veins like nitrates.

662. Orthostatic hypotension (postural hypotension) results from venular dilatation, not arteriolar dilatation.

663. Nitrates can be used in cyanide poisoning promoting the formation of cyanide-methemoglobin complex, and this treated with thiosulfate to form thiocyanate which is less toxic.

664. Carvedilol is equivalent to dinitrate in the treatment of angina.

665. Loop diuretics increase urinary Na, Ca, Mg, K, and CL.

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656. Homeostatic mechanism is a compensatory mechanism by the body to compensate some actions of drugs like tachycardia, or sodium (Na) and water retention.

657. Pindolol and acebutolol have intrinsic activity.

658. Diazoxide causes hyperglycemia because it inhibits the release of insulin.

659. ACEIs lower BP by preventing the formation of angiotensin II (vasoconstrictor), and preventing the formation of aldosterone (Na & water retention), and preventing bradykinin metabolism (vasodilator), bradykinin also responsible for the dry cough side effect associated with the use of ACEIs.

660. Drugs that dilate arteries like diazoxide, hydralazine, and minoxidil.

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651. Dopamine receptors are mainly renal, dopamine causes vasodilation by increasing c-AMP.

652. Tyrosine is the precursor for dopamine, norepinephrine, and epinephrine.

653. Amiodarone blocks sodium, potassium, and calcium channels, its side effects include pulmonary fibrosis, photosensitivity, thyroid dysfunction, and eye problems.

654. Verapamil is the prototype of CCBs.

655. Magnesium could be used in arrhythmia caused by K-channel blockers.

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646. Protein → amino acids → glucose.

647. Fat → fatty acids → acidic ketones (like beta-hydroxybutyric acid) + glucose.

648. Insulin + carbohydrates ratio → 1 unit per 10-15 grams.

649. CSII → continuous subcutaneous insulin infusion, the absorption rate of insulin; from the highest is; abdomen>arm>thigh.

650. The infusion rate is independent on time to get to the steady state.

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641. Oximetry measures arterial blood gases.

642. Chronic obstructive pulmonary disease (COPD) management → smoke cessation, prophylaxis or prevention (vaccination), bronchodilator therapy, regular exercise, and follow up.

643. Glycogenolysis → breakdown of glycogen → glucose.

Gluconeogenesis → synthesis of glucose in liver from proteins → amino acids → triglycerides → fatty acids.

644. Type I (IDDM) → DKA (acetone, fruity odor)

Type II (NIDDM) → hyperglycemic hyperosmolar state (HHS)

Hyperglycemia → glucosuria → weight loss

Osmotic diuresis → polyuria → polydipsia → fluid loss → dehydration → blurred vision.

645. Hypovolemia → weak pulse → reflex tachycardia.

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636. FEV = forced expiratory volume, FVC = forced vital capacity, PEF = peak expiratory flow.

637. Airways are narrow in the early morning (4am), and wide in the afternoon (4pm).

638. Spirometry is the definitive diagnosis of asthma.

639. Treatment of asthma:-

• Fast acting beta-agonist (FABA) + inhaled CTs( ICS)
• FABA + ICs + Leukotriene receptor antagonist(LTRA) or long-acting BA (6-11years)
• FABA + ↑dose ICS + LABA + LTRA (≥12 years)
• Theophylline in adults
• Severe asthma--> add prednisone
• Omalizumab may be added to ≥ 12 years in poorly controlled atopic asthma

640. Fluticasone + salmeterol = Advair, budesonide + formeterol = Symbicort.

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631. Acetylcholine slows the heart, but norepinephrine stimulates the heart.

632. Glucose levels for diabetic patients:- (plasma glucose)

• Random PG ≥ 11.1 mmol/L
• Fasting PG ≥ 7 mmol/L (≥ 8 hours without food?.
• PG ≥ 11.1 mmol/L (2 hours after 75 g oral glucose)

633. Schizophrenia and its treatment are risk factors for diabetes.

634. HbA1c is ≥ 9 % in hyperglycemic patients, HbA1c should be tested every 3-4 months. Normal HbA1c is 3-5 %.

635. Some drug-drug interactions:-

• Benzodiazepines (BDZs) cause poor memory, confusion, falls, urinary retention when they are given with opiates, antipsychotics, and anticholinergic drugs. 
• Elevated serum creatinine or potassium (K), due to NSAIDs.
• Gatifloxacin + calcium and antacids may cause the absorption of gatifloxacin decreases.
• Ciprofloxacin + olanzapine; ciprofloxacin inhibits CYP1A2 increasing olanzapine levels, so increase rigidity and falls.
• Ciprofloxacin + glibenclamide may cause hypoglycemia.
• Anticholinergics decrease donepezil effect (antagonism).
• Low albumin + phenytoin more free phenytoin, so more side effects like somnolence (drowsiness), ataxia, and confusion.
• Ginkgo biloba + aspirin decrease platelet function and adhesion, the risk of bleeding.
• Alcohol + BDZ more sedation and increase risk of falls.
• Metoclopramide + Parkinson’s disease increase the block of dopamine receptors, worse the case.
• Corticosteroids + sulfonylurea antagonism ( CTs cause hyperglycemia)
• Terfenadine displaces carbamazepine from protein binding increases free drugs, increases side effects.
• CCBs + cyclosporine decrease the metabolism of cyclosporine, so increase its immunosuppressant effect.

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626. Elimination half-life (t½) = 0.693*Vd/CL.

627. Drugs need about 6-7 half-lives to reach Css.

628. The nearer of the drug response curve to the Y-axis, so the drug is more potent and has a stronger affinity. The further the drug response curve from the X-axis, the more the efficacy. If the drugs are parallel, that means they work on the same receptors.

629. Codeine is a partial agonist, morphine is a full agonist if the conc. of partial agonist increases, so that leads to decrease the effect of the full agonist (antagonism).

630. Phenoxybenzamine forms an irreversible covalent bond.

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621. Zero-order elimination is independent on plasma concentration of the drug like ethanol. Phenytoin converts from 1st order to zero-order when enzyme saturated. 1st order is dependent on the levels of the drug; means increase conc. Increase elimination like 80 mg à 40 mgà 20 mgà 10 mg. Most drugs follow 1st order kinetics, so each has fixed half-life.

622. Dose = Vd*C◦(initial plasma conc.).

623. Loading dose = Vd*Css.

624. Infusion rate (IR) = clearance (CL)*Css.

625. Maintenance dose (MD) = CL*Css*(dosing interval).

PS, Vd is volume of distribution, Css is steady state concentration.

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616. Succinylcholine is a skeletal muscle relaxant, it is used as adjunctive to anesthetics in some surgical procedures, it causes fasciculation (muscle twisting) after anesthesia.

617. Haloperidol is an inhibitor of CYP2D6.

618. Monoamine-oxidase enzyme metabolizes dopamine (DA), norepinephrine (NE), 5-HT, and tyramine.

619. Alcohol dehydrogenase metabolizes alcohol to an aldehyde which is metabolized by acetaldehyde dehydrogenase, aldehyde metabolism is inhibited by disulfiram leading to accumulation of aldehyde, causing many effects like hangover and flushing (redness of face), disulfiram-like reaction.

620. Morphine is metabolized to an active metabolite by glucuronidation. Acetalyation is done for INH, procainamide, hydralazine. Sulfation is done for minoxidil, steroids. Glutathione conjugation is done for acetaminophen.

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611. Symptoms of digoxin toxicity are nausea, vomiting, bradycardia, ventricular and atrial arrhythmia, confusion, headache, drowsiness, visual disturbances such as photophobia.

612. Reye’s syndrome causes hypoglycemia.

613. Diabetic ketoacidosis (DKA) results from a shortage of insulin, and the body starts to burn fatty acids producing ketone bodies, that cause most symptoms, and complications like vomiting, dehydration, deep gasping, confusion, and coma.

614. Alcohol (ethanol) in case of acute intoxication, it acts as an enzyme inhibitor, and in case of chronic intoxication, it acts as enzyme inducer.

615. People who are fast hydroxylators need more dose of some drugs like codeine and metoprolol.

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606. Heparin causes thrombocytopenia.

607. Cimetidine, erythromycin, ciprofloxacin and Ocs increases theophylline conc.

608. Lactose = galactose + glucose.

609. Pethidine (meperidine) is metabolized into norpethidine, which is pharmacologically active.

610. About 60-90% of digoxin is excreted by kidneys.

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601. Theophylline toxicity symptoms are sinus tachycardia, insomnia, seizure, nausea, and vomiting.

602. Insulin resistance is often due to upper body obesity and acute renal failure.

603. Bulk-forming laxatives are used to treat constipation and chronic watery diarrhea.

604. Ergot alkaloids cause vasoconstriction.

605. Erythromycin estolate is associated with cholestatic hepatitis.

QUESTION 1

A patient does not want to take pain medication because he is scared of its side effects, the doctor told the pharmacist to give the pain medication and inform the patient that it is a natural vitamin ; the doctor is acting on which ethical principle:

A) Non-maleficence

B) Beneficence 

C) Autonomy 

D) Veracity 

E)  Paternalism 

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596. Gefitinib is used to treat non-small cell lung cancer.

597. Modafinil, methylphenidate, and dextroamphetamine are approved to treat narcolepsy.

598. Succimer increases renal excretion of lead, by chelating with lead and forming water-soluble complexes.

599. Mirtazapine is a potent antagonist of 5-HT2 and 3 receptors.

600. Fat-soluble vitamins (ADEK) should be given to cystic fibrosis patients, due to lipase deficiency.

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591. Aluminum and magnesium antacids are not used with dialysis patients.

592. Melatonin is an endogenous hormone, secreted by the pineal gland, and regulates sleep and circadian rhythm.

593. Miglustat is used to treat Gaucher’s disease.

594. Simvastatin is the highest elevator of HDL levels. 

595. Sibutramine is used with patients who are > 30 Kg/m², and should not be used with MAOIs, and poorly controlled hypertension patients.