Pharma Tips-128

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.

Pharma Tips-127

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.

Pharma Tips-126

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.

Pharma Tips-125

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.

Pharma Tips-124

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.

Pharma Tips-123

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.

Pharma Tips-122

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.

Pharma Tips-121

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.

Pharma Tips-120

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.

Pharma Tips-119

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.

Pharma Tips-118

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.

Pharma Tips-117

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.

Pharma Tips-116

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 

Pharma Tips-115

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.

Pharma Tips-114

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.