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1506. Common Vitamins and the Condition That Results From Their Deficiency:

• Ascorbic acid (Vitamin C) scurvy – bleeding gums, poor wound healing, bruising.
• Cyanocobalamin (Vitamin B12) Pernicious anaemia – megaloblastic anaemia, neuropathy.
• Folic acid (Vitamin B9) Megaloblastic anaemia, especially in pregnancy, and neural tube defects in the fetus.
• Niacin (Vitamin B3, Nicotinic acid) Pellagra – dermatitis, diarrhoea, dementia.
• Thiamine (Vitamin B1) Beriberi (wet = cardiac, dry = neurologic), Wernicke-Korsakoff syndrome.
• Vitamin D (Calciferol) Rickets (children – bone deformities), Osteomalacia (adults – bone pain, fractures).

1507. Nosocomial infections are treated with 3rd- or 4th-generation cephalosporins, ciprofloxacin, Carbapenems, Vancomycin or linezolid – if MRSA is suspected. or Piperacillin–tazobactam.

1508. Vancomycin is used for treating pseudomembranous colitis associated with antibiotic use.

1509. Colitis can be caused by broad-spectrum penicillins, cephalosporins, and clindamycin.

1510. Primaquine + chloroquine are used to treat plasmodium vivax.

Pharma Tips-297

1501. Bacterial pneumonia may be treated with amoxicillin (outpatient), macrolides or fluoroquinolones, sometimes in combination and for severe cases, aminoglycosides could be used.

1502. Otitis externa may be treated with gentamicin, often combined with corticosteroids.

1503. Raloxifene causes leg cramps and hot flush.

1504. Bacterial meningitis could be treated with penicillins, cephalosporins, and vancomycin.

1505. Herpes simplex virus (HSV) or Varicella zoster virus (VZV) meningitis could be treated with acyclovir IV.

Pharma Tips-296

1496. H. pylori treatment is clarithromycin + amoxicillin + omeprazole +/- metronidazole.

1497. Transdermal Systems Should Be Changed Accordingly:

• Clonidine patch every 7 days. Change on the same day each week.
• Estradiol patch once or twice weekly, depending on the specific brand. Follow your prescription label carefully.
• Fentanyl patch every 3 days (72 hours). Strict adherence to this schedule is critical for safety.
• Lidocaine patch: Once daily (for 12 hours). Apply for 12 hours, then remove for 12 hours.
• Nicotine patch: Every 24 hours, Applied daily, often as part of a tapering schedule.
• Nitroglycerin patch is administered every 24 hours. It usually requires a patch-free period each day to prevent tolerance.
• Oxybutynin patch twice weekly (every 3-4 days). Common schedules are Sundays and Wednesdays, or Mondays and Thursdays.
• Scopolamine patch every 3 days (72 hours). Often used for motion sickness for the duration of a trip. 

1498. Osteoarthritis could be caused by estrogen deficiency, diabetes, and gout.

1499. Amoxicillin is the most widely prescribed antibiotic in chewable form.

1500. Uncomplicated gonorrhea is best treated with ceftriaxone 500mg IM, which may be combined with a single dose of azithromycin 1 g orally; cefixime 800mg can be used if ceftriaxone can not be used.

Pharma Tips-295

1491. Cellulose acetate phthalate is used in the pharmaceutical industry as an enteric coating substance.

1492. Bismuth subsalicylate is an effective absorbent that can absorb toxins, bacteria, and fluids; it has no inherent antimicrobial activity.

1493. The Limulus Amebocyte Lysate (LAL) test is an in vitro test for pyrogens (bacterial endotoxins). It is more rapid, sensitive, and simpler than the traditional rabbit pyrogen test.

1494. Mineral oil primarily acts by lubricating the intestinal tract and the faecal mass, and the secondary effect is the impairment of water reabsorption in the colon, which results in significant faecal softening.

1495. The most effective saline laxatives are the magnesium and sulfate salts, which are dibasic ions and relatively nonabsorbable.

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1486. A patient with hypertension + diabetes could use diuretics, beta-blockers, ACEIs, ARBs, and CCBs.

1487. A patient with hypertension + chronic kidney disease may use ACEIs or ARBs.

1488. A patient with hypertension + recurrent stroke may use diuretics and ACEIs.

1489. Oxacillin and cloxacillin are acid-stable penicillinase-resistant.

1490. Penicillin V is acid-stable and penicillinase-sensitive.

Pharma Tips-293

1481. People with MS (multiple sclerosis) are susceptible to UTIs.

1482. Doxazosin should be taken at bedtime, as it may cause syncope.

1483. A patient with hypertension and heart failure could use (compelling) diuretics, beta-blockers, ACEIs or ARBs, and aldosterone antagonists. 

1484. A patient with hypertension and post-MI could use beta-blockers, ACEIs, and aldosterone antagonists.

1485. A patient with hypertension + high coronary disease risk could use diuretics, beta-blockers, ACEIs, and calcium-channel blockers. 

Pharma Tips-292

1476. Basic drugs pass more readily into breast milk than acidic drugs.

1477. Indinavir should be taken on an empty stomach with fluid to prevent nephrolithiasis.

1478. HAART = highly active anti-retroviral therapy.

1479. Enalapril is three times more potent than captopril and has no sulfa group.

1480. Symptoms of diabetes mellitus: excessive thirst, frequent urination, weight loss, fatigue, skin infection, slow healing cuts and bruises, and blurred vision.

Pharma Tips-291

1471. Ziprasidone may cause QT prolongation, so a baseline ECG is needed before starting.

1472. Doxycycline oral gel is used for periodontitis.

1473. Norethindrone causes breakthrough bleeding.

1474. The influenza vaccine is available as an injection and intranasal spray.

1475. Chlamydia treatment is:

• Doxycycline.
• Azithromycin.
• Amoxicillin (in pregnancy).

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1466. zidovudine (AZT) may cause anaemia.

1467. Carbamazepine is used in trigeminal neuralgia. 

1468. Antimuscarinics are contraindicated in narrow-angle glaucoma, paralytic ileus, pyloric or intestinal obstruction, and achalasia of the oesophagus and bladder neck obstruction. 

1469. Oseltamivir (tamiflu) is used in the treatment and prophylaxis of influenza. 

1470. Furosemide increases the toxicity of digitalis. 

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1461. Some antiepileptics can cause tolerance.

1462. Selenium sulfide is used topically.

1463. Cascara, senna, castor oil, and bisacodyl are stimulant laxatives. 

1464. Docusate is a stool softener.

1465. Propylthiouracil may cause agranulocytopenia, leukopenia, or dermatitis.

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1456. Limulus test for pyrogens.

1457. Propranolol, nifedipine, and nitroglycerin are subject to first-pass metabolism.

1458. Vitamin C can cause a false positive or negative result on a glucose urine test.

1459. Stadol = butorphanol (opioid).

1460. Prednisone is converted by the liver to prednisolone.

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1451. The Noyes-Whitney equation is used to determine the dissolution rate.

1452. Strong acid donates a proton easily. 

1453. Ethylene glycol oxidises to oxalic acid (toxic). 

1454. Bismuth subsalicylate is an effective absorbent that can absorb toxins and bacteria.

1455. Sublimation is converting a solid to a vapour.

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1446. Turbohalers must be changed after a certain time or after a specific number of doses.

1447. The antidote for methotrexate is leucovorin (folinic acid).

1448. Aminoglycosides like gentamycin cause nephrotoxicity and ototoxicity.

1449. Magnesium controls neuromuscular activity by modulating calcium influx at the neuromuscular junction.

1450. Capsules are available in two sizes: largest (000) and smallest (5).

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1441. AZT (zidovudine) causes anaemia, headache, insomnia, myalgia, leucopenia, and nausea. 

1442. The skin infection drug of choice is cloxacillin.

1443. SAL = simvastatin, atorvastatin, and lovastatin to be avoided with grapefruit juice. 

1444. SLF = simvastatin, lovastatin, and fluvastatin to be used at night. 

1445. Terazosin should be taken at night and started at a low dose. 

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1436. SSRI + St. John's wort = serotonin syndrome.

1437. Rosacea treatment involves metronidazole gel and tetracycline or erythromycin for 6 weeks to 6 months in some cases.

1438. Leflunomide washout by cholestyramine 8 grams TID for 11 days or 50 grams of activated charcoal BID for the same period. 

1439. COPD complicated cases are given fluoroquinolones.

1440. Vincristine causes peripheral neuropathy and severe constipation.

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1431. Vancomycin is not absorbed orally.

1432. Sucralfate should be taken on an empty stomach. 

1433. SSRI + TCA = serotonin syndrome.

1434. SSRI + MAOIs = serotonin syndrome.

1435. MAOIs + St. John's wort = serotonin syndrome.

Pharma Tips-282

1426. Xalatan = latanoprost =PGF2.

1427. Cisplatin increases creatine levels.

1428. Food increases the bioavailability of lovastatin. 

1429. Calcitriol is given in end-stage renal failure.

1430. Zofran (5-HT3 antagonist) is ondansetron. 

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1421. Zaleplon is used to induce sleep.

1422. Aurothioglucose is a gold preparation; it was used in the treatment of arthritis, and it takes approximately 6 weeks to be effective.

1423. Cefuroxime absorption is increased with food.

1424. Norflox = norfloxacin.

1425. Hyaluronidase is used to enhance the absorption and dispersion of subcutaneous and intramuscular fluids or drugs. By breaking down hyaluronic acid, it reduces tissue resistance, which can help decrease injection-site swelling and discomfort.

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1416. Zostrix is capsaicin. 

1417. Paxil is paroxetine. 

1418. Menopausal age is around 51. 

1419. Vasomotor symptoms of menopausal women are heat intolerance, flushing, perspiration, night sweats, fatigue, mood changes, and reduced productivity. 

1420. FSH and LH will be high if menopause has occurred.

Pharma Tips-279

1411. pH = pKa at half-neutralisation point.

1412. Cystic fibrosis patients clear aminoglycosides more rapidly due to increased renal clearance and volume of distribution, and therefore require individualised dosing intervals and often higher doses.

1413. Polyethene glycol = carbowax.

1414. F = 9/5C + 32. C = 5/9(F - 32).

1415. Avoid taking vitamin C with allopurinol because of the risk of kidney stone formation. 

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1406. Penicillin G is administered by IM injection only because it undergoes hydrolysis in the gastrointestinal tract (GIT).

1407. Niacin causes GIT disturbances and hyperglycemia.

1408. Freons are fluorinated hydrocarbons used as propellants in aerosols.

1409. 15.4 grains = 1g; pint = 473 ml; fluid ounce = 29.57ml.

1410. The normal hardness range for tablets is 3.5 to 7 kg.

Pharma Tips-277

1401. Zolmitriptan (zomig) oral dispersible tablet and spray.

1402. Osteoporosis risk factors are age, gender, caucasian or asian, low weight, menopause, sedentary lifestyle, smoking, and decreased calcium intake. 

1403. Saw palmetto is used for the treatment of benign prostatic hyperplasia (BPH).

1404. Tacrolimus and pimecrolimus are calcineurin inhibitors used in the treatment of eczema. For a good treatment outcome, avoid covering the skin and exposure to UV light; these medicines have no cutaneous atrophy.

1405. Rifampin discolour both urine and faeces (red).

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1396. A meta-analysis should be used to determine the efficacy of an antibiotic.

1397. Trifluridine (Viroptic) is stored under refrigeration.

1398. Valacyclovir is recommended for the treatment of ocular viral infections caused by both herpes simplex virus (HSV) and herpes zoster virus (VZV).

1399. Raloxifene (Evista) is used to prevent osteoporosis in postmenopausal women.

1400. Phenelzine (Nardil) and tranylcypromine (Parnate) are irreversible MAOIs that can cause edema, postural hypotension, insomnia, sexual dysfunction, and a hypertensive crisis when taken with tyramine-rich foods.

Pharma Tips-275

1391. ACE inhibitors (ACEIs) are the drug of choice for treating blood pressure in patients with diabetes.

1392. Doxycycline should not be taken with iron or food, and may cause photosensitivity.

1393. Levothyroxine needs 6 weeks to reach steady state after initial dose adjustment.

1394. Beta-antagonists side effects may include bronchospasm, heart failure, sleep disturbances, dizziness, fatigue, anorexia, nausea, AV block, bradycardia, claudication, Raynaud's, and drowsiness. 

1395. Rizatriptan (maxalt) fastmelt (wafers) can be taken without water.

Pharma Tips-274

1386. Sulfasazine decreases the gastrointestinal absorption of digoxin.

1387. Gentamycin in high doses causes nephrotoxicity and ototoxicity (reversible).

1388. Type I diabetes mellitus has beta cell destruction (insulin deficiency). 

1389. Type II diabetes mellitus is characterised by insulin resistance and defects in secretion (obese).

1390. Diagnosis of diabetes mellitus:-

• Random plasma glucose ⩾ 11.1 mmol/L.
• Fasting plasma glucose (FBG) 8 hours ⩾ 7 mmol/L.
• Plasma glucose level ⩾ 11.1 mmol/L (2 hrs after 75g oral glucose).
• HbA1c ≥ 6.5% (48 mmol/mol).

Pharma Tips-273

1381. Ipratropium (atrovent) causes nosebleeds, dryness of the nose, mouth or throat.

1382. Beclomethasone (maximum effect 7-14 days). Liquids have a greater effect than MDIs.

1383. Olopatadine eye drops cause pruritus, photophobia, and headache.

1384. Hypothyroidism symptoms are fatigue, weight gain, impaired memory, constipation, cold intolerance, dry skin and hair, and bradycardia.

1385. Hyperthyroidism symptoms are weight loss, heat intolerance, diarrhoea, anxiety, palpitations, moist skin, hypertension and hyperflexia.

Pharma Tips-272

1376. Fexofenadine; aluminium, magnesium antacids decrease levels, and fruit juices decrease bioavailability.

1377. Loratadine causes xerostomia and is taken on an empty stomach.

1378. Pseudoephedrine decreases the antihypertensive effect of beta-blockers, and its use is contraindicated with MAOIs or within 14 days of MAOIs discontinuation.

1379. Montelukast causes flu-like symptoms, headache, and abdominal pain.

1380. Levocabastine needs priming; discontinue if no improvement for 3 days.

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1371. Intranasal corticosteroids (INCS) are the preferred treatment for allergic rhinitis.

1372. Aspirin toxicity may include pulmonary oedema, respiratory alkalosis, systemic acidosis, tremor, confusion, and coma; give charcoal and IV fluids plus bicarbonate. 

1373. TCA toxicity may include tachycardia, blurred vision, constipation, urinary retention; give charcoal, bicarbonate to protect the heart. 

1374. First-generation antihistamines to be stopped 2-4 days before skin testing for allergy.

1375. Cetrizine causes somnolence, vomiting, and pharyngitis; it is a metabolite of hydroxyzine.

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1366. Zidovudine (AZT) causes myositis, myocarditis, leukopenia, and liver steatosis (fat formation).

1367. Oxybenzone protects against UVA and UVB. 

1368. First-generation antihistamines cause sedation, learning impairment in children, and increase intraocular pressure (narrow-angle glaucoma). 

1369. Mometasone and fluticasone are recommended in the treatment of allergic rhinitis because of their low systemic bioavailability and absence of growth suppression. 

1370. Budesonide is used as a nasal spray in allergic rhinitis in children. 

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1361. Drugs associated with erectile dysfunction may include acetazolamide, alcohol (acute and chronic use), alpha-blockers, atenolol, barbiturates, carbamazepine, cimetidine, clofibrate, clonidine, digoxin, finasteride, ketoconazole, labetalol, lithium, MAOIs, methadone, phenytoin, metoclopramide, propranolol, phenothiazines, SSRIs, TCAs, and thiazides.

1362. Clomiphene can cause hot flashes and visual disturbances. 

1363. Aluminium, magnesium, and ferrous reduce the absorption of ciprofloxacin. 

1364. Chlorohexidine causes brown teeth.

1365. Sucralfate should be taken on an empty stomach.

Pharma Tips-268

Hierarchy of Scientific Evidence Pyramid

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1356. Meperidine is contraindicated with fluoxetine.

1357. Amlodipine is not used in myocardial infarction.

1358. Norovirus (Norwalk) causes diarrhoea.

1359. Lactose intolerance causes diarrhoea.

1360. Antibiotics, colchicine, laxatives, and magnesium antacids can cause diarrhoea. 

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1351. Endotoxin is a lipopolysaccharide in the cell wall of Gram-negative bacteria and causes intravascular coagulation.

1352. Pyrexia (fever) can be caused by penicillins. cephalosporins, vaccines, heparin, phenytoin, quinidine, carbamazepine, lamotrigine, vancomycin, methyldopa, sulfonamides.

1353. An increase in INR increases the risk of bleeding, while a decrease in INR increases the risk of clotting (coagulation).

1354. Meperidine can cause seizures.

1355. Codiene < meperidine < oxycodone < fentanyl as a pain killer, and the least potent is the most allergic.

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1346. Captopril and alpha-adrenergic blockers decrease insulin resistance.

1347. Acarbose inhibits alpha-glucosidase and decreases glucose levels.

1348. The most effective medications in GERD are proton pump inhibitors. 

1349. Ciprofloxacin is contraindicated in pregnancy. 

1350. Sulfa drugs increase INR.

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1341. Chloasma pigmentation is treated with hydroquinone. 

1342. Dimenhydramine can be taken before the trip by 30 minutes before.

1343. Plan-B side effect is breast tenderness. 

1344. Otitis media can be treated with ceftriaxone IM.

1345. Haemoglobin A1C is monitored every three months.

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1336. Cisplatin is nephrotoxic and causes hearing loss. 

1337. Pinpoint pupil and respiratory depression are caused by narcotic analgesics.

1338. A pregnant woman with a UTI can take amoxicillin.

1339. A patient with renal failure can not take NSAIDS, just acetaminophen.

1340. Mirtazepine causes lower rates of sexual dysfunction. 

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1331. Miacalin spray needs priming, and shaking gently.

1332. Levostin eye drops (levocabastine), shake well before using.

1333. Spiriva do not shake it.

1334. Antiarrhythmic classes:

1. Na channel blockers:

a. Prolong AP (action potential); eg. quinidine, and procainamide. 

b. Shorten AP; eg. lidocaine, and phenytoin. 

c. No effect on AP; eg. flecainide, and propafenone.

2. Beta-blockers (block beta one activation); eg. atenolol, bisoprolol, metoprolol, and sotalol. 

3. Potassium/ multichannel blockers; prolong AP, and suppress atrial and ventricular arrhythmias, eg. amiodarone, dronedarone, dofetilide, and sotalol.

4. Calcium channel blockers; slow AV nodal conduction. eg. verapamil, and dilitiazem.

5. Miscellaneous; eg. adenosine, digoxin, and magnesium.

1335. Fosinopril can be used in renal failure without dose adjustment.

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1326. Over-the-counter products and cold products may contain; acetaminophen, brompheniramine, chlorpheniramine, pyrilamine, diphenhydramine, triprolidine, codeine, dextromethorphan, phenylephrine, pseudoephedrine, ammonium chloride as expectorant, guaifensin, and sodium citrate. 

1327. Normal values for some elements in the body; 

Sodium 135-145 mEq/L

Potassium 3.5-5 mEq/L

Chloride 95-108 mEq/L

Magnesium 1.5-2.2 mEq/L

Calcium 8.5-10.5 mEq/L

Phosphate 2.5-4.5 mEq/L

1328. Pregnant women with candidiasis can use clotrimazole.

1329. Latanoprost causes iris pigmentation.

1330. Mesna is a uroprotectant used to prevent hemorrhagic cystitis caused by cyclophosphamide, and ifosfamide.

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1321. Limewater is calcium hydroxide.

1322. Sweet oil is olive oil. 

1323. Highly protein-bound drugs may include; barbiturates, sulfur, sulfonamides, clofibrate, tolbutamide, salicylate, and warfarin. 

1324. Drugs that inhibit cytochrome P450 may include; allopurinol, warfarin, metronidazole, anabolic agents, chloramphenicol, MAOIs, cimetidine, disulfiram, INH, macrolides antibiotics. 

1325. Drugs that induce cytochrome P450 may include; alcohol, nicotine, chloralhydrate, phenobarbital, cortisone, chlordiazepoxide, prednisone, imipramine, and testersterone.

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1316. Drugs that might cause insomnia include; amantadine, amphetamines, anticholinergics, appetite suppressants, beta2 agonists, beta-blockers, bupropion, caffeine, calcium channel blockers, clonidine, cocaine, alcohol, corticosteroids, daunorubicin, decongestants, diuretics, goserelin, leuprolide, levodopa, LSD, medroxyprogesterone, mefloquine, methylphenidate, nicotine, oral contraceptives, pentostatin, phenytoin, progesterone, quinidine, reserpine, SSRIs, selegiline, theophylline, thyroid hormone.

1317. Drugs that could be taken without food may include; penicillin, labetalol, lansoprazole, cefaclor, levodopa, didanosine, lithium, digoxin, metoprolol, diltiazem, nimodipine, etidronate, penicillamine, furosemide, propranolol, indinavir, rifampin, INH, zafirlukast.

1318. Medications that are not used with antacids may include; digoxin, ketoconazole, fluoroquinolones, quinidine, iron preparations, INH, tetracycline, warfarin, 

1319. Burow's solution contains aluminium acetate (astringent).

1320. Dakin's solution contains sodium hypochlorite.