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.