MBBS (Second MBBS Examination) Manoj Vimal
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PHARMACOLOGY

  • 1. Pattern of Examination 3
  • 2. Questions for Theory Paper 4
  • 3. Topics for Prescription Writing 29
  • 4. Topics for Pharmacy Practical 30
  • 5. Topics for Experimental Practical 31
  • 6. Topics for Theory Viva 32
  • 7. Drug of Choice 34
  • 8. Explain Why 38
  • 9. Doses of Some Important Drugs in Children 45
  • 10. Important Points 50
2
3
 
1. PATTERN OF EXAMINATION
PHARMACOLOGY
Marks
Theory Paper I
40
Theory Paper II
40
Internal Assessment (Theory)
15
Internal Assessment (Prac.)
15
Prescription Writing
10
Pharmacy Practical
5
Clinical Case
5
Experimental Pharmacology
10
Theory Viva
10
Total
150
Note:
Paper I =
* General Pharmacology
* Autonomic Nervous System
* Somatic Nervous System
* Autacoids
* Respiratory System
* CNS and CVS
* Kidney
Paper II =
* Autacoids
* Hormones
* Blood and GIT
* Antimicrobial Drugs
* Anticancer Drugs
4
 
2. QUESTIONS FOR THEORY PAPER
 
A. GENERAL PHARMACOLOGY
SN:
Half life of a drug (2005)
SN:
Active transport
SN:
Effect of food on absorption of drug
SN:
Luminal effect
SN:
Prodrug (1993)
SN:
Why particle size of drug in a solid form is important in case of certain drugs like aspirin
SN:
Clinical significance of volume distribution.
EW:
Basic drugs are absorbed only when they reach intestine (2005)
SN:
Types of adverse drug reactions (2004)
EW:
Acidic drugs are poorly absorbed in alkaline medium
EW:
Lipid soluble drugs are largely secreted unchanged
EW:
Newborns are more susceptible to many drugs
SN:
Factors affecting drug metabolism
SN:
Clinical pharmacology
LQ:
Routes of drug administration
LQ:
Systemic routes of drug administration
SN:
Pharmacogenomics (2004)
DW:
Parenteral vs oral therapy
EW:
Oral dose of some drugs are several fold higher than their parenteral done
EW:
Action is faster via nasal route
SN:
Fate of drug in body. Illustrate with example
SN:
Microsomal enzyme induction
SN:
First pass metabolism
SN:
Discuss how drugs act through receptor
EW:
A potent agonist antagonizes the action of full agonist
DW:
Drug potency and efficiency
SN:
Advantages and disadvantages of fixed done ratio combination
SN:
Bioequivalence (2004)
SN:
Factors modifying drug action
SN:
Placebo
DW:
Tolerance and resistance of drug
SN:
Side effects
5
SN:
Drug allergy
SN:
Drug dependence
EW:
Fixed dose combinations of drugs are often considered to be of disadvantage (2005)
SN:
Tubular secretion of drugs
SN:
Drug tolerance (2005)
SN:
Clearance
SN:
Plateau principle
SN:
Principles of drug action
SN:
Name drug which act by inhibiting enzymes
SN:
Teratogenicity
SN:
Essential medicines (2005)
SN:
First dosage phenomenon (1991)
SN:
Inverse agonist (1998)
EW:
Half life of a drug varies for drugs undergoing zero order kinetics (2006)
SN:
Polypharmacy (2006)
SN:
Drug tolerance (2006)
SN:
Pharmacovigilance (2006)
SN:
Fixed dose drug combinations (2007)
SN:
Drugs modulating cytochrome P450 enzymes (2007)
SN:
Drug-dependence (2007)
SN:
Therapeutic window (2008)
SN:
Bioavailability (2008).
6
 
B. AUTONOMIC NERVOUS SYSTEM
LQ:
Enumerate anticholinergic agents. Discuss their adverse effects and give their therapeutic based uses (2003)
EW:
Pralidoxime is used in organophosphate poisoning and not in carbamate poisoning (2004)
SN:
Uses and adverse effects of neostigmine
SN:
Myasthenia gravis (2000)
SN:
Treatment of organophosphorus poisoning
SN:
Classification of anticholinergic drugs
SN:
Uses of anticholinergic drugs
SN:
Pralidoxime in organophosphorus poisoning (2005)
SN:
Motion sickness
DW:
Atropine and dopamine
DW:
Adrenaline and ephedrine
EW:
Large doses of acetylcholine causes increase in BP in atropinised animals
EW:
Fenfluramine is used as anorectic over amphetamines
SN:
Dopamine cardiogenic shock
EW:
BAL is used in arsenic poisoning (2004)
SN:
Anorectic agents
SN:
Uses of α-blockers
SN:
Effects of α blockers
EW:
It is desirable to give phenoxybenzamine for 1–2 weeks preoperatively and continue it during surgery
SN:
Propranolol
SN:
Name cardioselective β blockers. How do these differ from nonselective in clinical terms
SN:
Adverse effects of β blockers
SN:
Uses of β blockers
EW:
Acetylcholine is not used therapeutically
SN:
Side effects of acetylcholine
EW:
Pilocarpine is effective in acute congestive and simple glaucoma
SN:
Pilocarpine
EW:
Neostigmine but not physostigmine is used in myasthenia gravis
SN:
Anticholinesterase
SN:
Cholinergic drugs in Alzheimer's disease (2004)
7
EW:
Atropine methonitrate is preferred to atropine sulphate as spasmolytic
SN:
Mydriatics
TS:
Adrenaline in anaphylactic shock
SN:
Cardiac and metabolic effects of synthetic amines
SN:
Classify adrenergic drugs
SN:
Dopamine
LQ:
Classify adrenergic blocking agents. Discuss indications and contraindications with reasoning of β adrenergic blocking agent
EW:
Propranolol but not atenolol is used for treatment of tremors (2003)
SN:
Beta adrenergic blockers in angina pectoris (2004)
DT:
Benign hyperplasia of prostate (2005)
EW:
Atropine is preferred for refraction testing in children (2006)
TS:
Tamsulosin in benign prostatic hypertrophy (2006)
Que:
Discuss rationale for the use of finasteride in benign prostatic hyperstrophy (2006)
EW:
First dose of prazosin should preferably be administered at bed time (2007)
Que:
Give rationale for the therapeutic use of oximes in organophosphorus poisoning (2007)
Que:
Give rationale for the use of BAL in arsenic poisoning (2007)
Que:
Give rationale for the use of sildenafil in erectile dysfunction (2007)
Que:
Give rationale for the use of finasteride in prostatic disease (2007)
Que:
Give the rationale for the therapeutic use of sildenafil in erectile dysfunction (2008).
8
 
C. SOMATIC NERVOUS SYSTEM
SN:
Peripherally acting muscle relaxants (classification)
TS:
Lignocaine
SN:
Bupivacaine
EW:
oxethiazine is a good anaesthesia for gastric mucosa while other local anaesthetise are not
DW
Competitive and depolarizing block
SN:
Beclofen
SN:
Uses of centrally acting muscles relaxants
SN:
Classify local anaesthetics
EW:
d-tubocuranine produces significant fall in BP
EW:
Neuromuscular blockers not absorbed orally
EW:
Thiopentone sodium and succinylcholines solutions should not be mixed in the same syringe
TS:
Dentrolene
LQ:
Centrally acting muscle relaxants
TS:
Diazepam
EW:
Addition of vasoconstrictor to local anaesthetic
DW:
Procaine and lignocaine
SN:
Uses of local anaesthesia
SN:
Epidural anaesthesia
SN:
Spinal anaesthesia (1998)
EW:
Pralidoxime is ineffective as antidote to carbamate poisoning (2006)
Que:
Give rationale for the therapeutic use of tizanidine in spastic disorders (2007)
EW:
Dose of skeletal muscle relaxant should be lowered in patients receiving high doses of gentamicin (2007).
9
 
D. AUTACOIDS
TS:
Ondansetron as an antiemetic (2002)
SN:
5-HT antagonist
LQ:
Angiotensin converting enzyme inhibitors
SN:
Enalapril
DW:
H1, H2 and H3 receptors
SN:
Name the actions of histamine not antagonised by antihistamine
SN:
H1 antagonist and their use
SN:
Cetrizine
SN:
Second generation antihistaminics (2001)
SN:
Cinnarizine
EW:
Enalapril is preferred over captopril
SN:
Uses of ACE inhibitors
TS:
Prostaglandin in obstetrics
EW:
Aspirin is used in children having patent ductus arteriosus
EW:
Prostaglandins are not considered as neurotransmitters
SN:
Leukotrienes
TS:
Prostaglandins for inducing therapeutic action
EW:
Finasteride is used in benign hypertrophy of prostate (2001)
SN:
Ondansetron in chemotherapy induced vomiting (2004)
Que:
Discuss the drug treatment of migraine (2006)
Que:
5 HT3 antagonists in vomiting (2006)
Que:
Give rationale for the therapeutic use of sumatriptan in migraine (2007).
10
 
E. RESPIRATORY SYSTEM
SN:
Ipratropium bromide in chronic obstructive pulmonary disease (2005)
TS:
Salbutamol (1991)
SN:
Terbutaline
EW:
Aminophylline is given by slow IV injection
SN:
Sodium chromoglycate
SN:
KI (potassium iodide)
SN:
Mucolytics
SN:
Name the drug of choice in prophylaxis of chronic bronchial asthma
TS:
Inhalational steroids in bronchial asthma
SN:
Antitussives
SN:
Treatment of cough
SN:
Give a plan of action for treatment of bronchial asthma (1998)
EW:
Antihistamine not used for treatment of bronchial asthma
EW:
Salbutamol is preferred over isoprenaline for treatment of acute bronchial asthma
EW:
Inhalation, administration of β2 agonist is preferred to oral administration is asthma
EW:
Aminophylline is not used in treatment of angina pectoris
TS:
Corticosteroids in bronchial asthma
SN:
Treatment of status asthmatics (2001)
TS:
Ephedrine in cough syrup (2006)
Que:
Discuss the drug treatment of status asthmaticus (2007)
TS:
Leukotriene antagonists in bronchial asthma (2007)
TS:
Sodium chromoglycate in bronchial asthma (2008).
11
 
F. HORMONES
LQ:
Classify oral contraceptives. Discuss the mechanism of action, adverse effects and contraindication of oral contraceptives (2005)
SN:
Mechanism of action of insulin
EW:
Regular insulin is not combined with lente insulin (2005)
EW:
Mifepristone is used for therapeutic abortion (2005)
EW:
Insulin induced hypoglycemia may be affected by concurrent administration of salisalates
SN:
Classify drugs used in diabetes mellitus with mechanism of action and side effects
SN:
Management of diabetic ketoacidosis
SN:
Insulin resistance
EW:
Oral hypoglycemic agents are ineffective in juvenile diabetes mellitus
TS:
Human insulin
SN:
Oxytocin (2005)
SN:
Mechanism of action of steroidal hormones
SN:
Bromocriptine
LQ:
Thyroid hormones and their uses
SN:
Management of thyrotoxicosis
SN:
Classify drugs used in thyroid disorders. Discuss status of iodine
SN:
Myxoedema coma
SN:
Antithyroid drugs
LQ:
Carbimazole
EW:
Iodides are not used for long-term treatment of hyper-thyroidism
EW:
Prophylthiouracil is preferred over methimazole in treatment of thyroid storm
EW:
Lugol's iodine has a limited use as an antithyroid drug
Describe the rationale the drug treatment of hyperthyroidism (2001)
SN:
Radioactive iodine
SN:
Potassium iodide in thyrotoxicosis (2002)
SN:
Raloxifene in osteoporosis (2005)
SN:
Diabetic ketoacidosis (2002)
SN:
More purified insulin preparations
LQ:
Oral hypoglycemia drugs
TS:
Sulfonylureas
Que:
Describe the mechanism of action of sulfonylureas (2001)
12
SN:
Treatment of sulfonylurea induced hypoglycemia
SN:
Pharmacological basis of use of tolbutamide in maturity onset DM (NIDDM)
EW:
Biguanides not used in underweight patient with NIDDM
SN:
Mechanism of action of biguanides
SN:
Status of oral hypoglycemics in DM
Que:
Describe the rationale the drug treatment of postmenopausal syndrome and osteoporosis (2001)
TS:
Biguanids in diabetes mellitus (2002)
SN:
Antiandrogens (2002)
LQ:
Corticosteroids (actions and uses)
SN:
Clomiphene in treatment of infertility (2005)
SN:
Anti-inflammatory effects of corticosteroids
EW:
Glucocorticoids, mechanism of action
DW
Synthetic and natural adrenal corticosteroids
DW
Hydrocortisone and dexamethasone
SN:
Prednisolone
SN:
Replacement therapy
EW:
Corticosteroids are administered in tubercular meningitis
TS:
Corticosteroids in autoimmune diseases
TS:
Corticosteroids in eye diseases
SN:
Explain effect of sudden withdrawal of steroids in bronchial asthma and mechanism involved
EW:
Corticosteroids cause less suppression of pituitary axis if given at 7.00 in morning
SN:
Side effects of androgens
SN:
Rosiglitazone in diabetes mellitus (2005)
EW:
Use of anabolic steroid is on decline
SN:
Uses of anabolic steroids
TS:
Anabolic steroids
SN:
Antiandrogens
EW:
Use of short-term high dose estrogen is not recommended to test pregnancy
SN:
Delayed puberty in girls
TS:
Antiestrogens, e.g. clomiphene citrate
TS:
Tamoxifen citrate
EW:
Progestins added to estrogens in oral contraceptive pills whereas estrogen alone can produce contraception
SN:
Long-term antifertility agents.
EW:
Progesterone is added with oestrogen for hormone replacement therapy (2002)
SN:
Female contraception
13
SN:
Oral contraceptives
SN:
Postcoital pill
LQ:
Classify adrenocorticosteroids. Discuss the pharmacological actions, side effects, contraindications and therapeutic uses of glucocorticoids (2004)
EW:
Estrogen in high doses is effective as postcoital contraception
EW:
Ethinyloestradiol and not estradiol is used in oral contraception preparation
SN:
Mechanism of injectable contraceptives
SN:
Side effects of hormonal contraceptives
SN:
Male contraceptives
SN:
Postcoital (emergency) contraception (2001)
SN:
Oxytocin
SN:
Uterine stimulants
SN:
Tocolytics
SN:
Calcium antagonists and calcium channel blockers
EW:
Vitamin D should be considered as hormone
Que:
Describe the rationale the drug treatment of hyperthyroidism (2001)
DT:
Thyrotoxicosis crisis (2005)
EW:
Bisphosphonates are often prescribed to postmenopausal women (2006)
EW:
Lispro insulin is used in infusion pump devices (2006)
Que:
Discuss rationale for the use of progesterone with oestrogen in hormone replacement therapy (2006)
Que:
Discuss rationale for the use of mifiprestone for termination of early pregnancy (2006)
SN:
Selective oestrogen receptor modulators (2006)
Que:
Classify drugs used in diabetes mellitus. Describe the pharmacology of oral hypoglycemic drugs (2007)
TS:
Bisphosphonates in osteoporosis (2007)
TS:
Tamoxifen in breast cancer (2007)
SN:
Emergency contraceptives (2007)
Que:
Explain why oxytocin and not ergometrine is used for augmenting the labour (2008)
Que:
Give the rationale for the use of propranolol in thyrotoxicosis (2008)
Que:
Give the rationale for the use of alendronate in osteoporosis (2008)
TS:
Rosiglitazone in diabetes mellitus (2008)
SN:
Emergency contraception (2008)
14
 
G. CENTRAL NERVOUS SYSTEM
SN:
Objectives of general anaesthesia
SN:
Factors affecting the partial pressure of anaesthetic attained in brain
SN:
Classify intravenous anaesthetics. Outline their role in anaesthetic practice
EW:
N2O is not considered as complete anaesthetic in abdominal operations
ENU
General anaesthetics
SN:
N2O
SN:
Ether
EW:
Enflurane is preferred over methoxyflurane
SN:
Halothane
EW:
Plasma concentration of phenytoin rises disproportionably at higher doses (2005)
SN:
Recovery with thiopentone is rapid
EW:
Neurolept analgesic should not be used in person with parkinsonism
EW:
Dose of d-Tc is reduced to half in treatment with ether
SN:
Complications of general anaesthesia
SN:
Preanaesthetic medication
SN:
Acute alcohol intoxication
TS:
Disulfiram
SN:
Disulfiram
SN:
Treatment of methyl alcohol poisoning
LQ:
Benzodiazepines
EW:
Benzodiazepines are preferred over barbiturates as hypnotics (2003)
EW:
Dose of phenobarbitone sodium is increased in treatment of neonatal jaundice
TS:
Barbiturates
SN:
Acute barbiturate poisoning
SN:
Uses of diazepam
EW:
Benzodiazepines are preferred over barbiturates as hypnotics
SN:
Flumazenil
SN:
Classify antiepileptic drugs
SN:
Levodopa and carbidopa combination in parkinsonism (2005)
TS:
Phenobarbitone as antiepileptic drug
SN:
Phenytoin
15
SN:
Carbamazepine
SN:
Treatment of epilepsy
SN:
Treatment of GTCS
SN:
Treatment of status epilepticus
TS:
Levodopa in parkinsonism
DT:
Status epilepticus (2005)
SN:
Advantages of carbidopa over levodopa
TS:
Bromocriptine in epilepsy
SN:
Treatment of drug induced parkinsonism
SN:
Selegiline
EW:
Combination of L-dopa and carbidopa is ineffective in drug-induced parkinsonism
SN:
Classify antipsychotic drugs
SN:
Mechanism of action of chlorpromazine
SN:
Olanzapine in schizophrenia (2004)
EW:
Chlorpromazine is not used as local anaesthetic instead of being more potent than procaine
SN:
Enumerate drugs in order of preference which you would like to give in treatment of psychoses
SN:
Haloperidol
LQ:
Classify drugs used in mental illness. Give actions and adverse effects of chlorpromazine
SN:
Pimozide
EW:
Chlorpromazine is not used routinely for anxiety though it has antianxiety activity
EW:
Chlorpromazine is not used in motion sickness
SN:
Treatment of psychoses
SN:
Classify antianxiety drugs. Discuss diazepam
SN:
Buspirone
LQ:
Antidepressants
EW:
Tricyclic antidepressants are preferred over noradrenaline inhibitors for endogenous depression
EW:
Use of physostigmine in treatment of overdose of tricyclic anti-depressants
TS:
Fluoxetine in depression
SN:
Treatment of endogenous depressions
SN:
Lithium carbonate
SN:
Opioid analgesics, uses and adverse effects
TS:
Morphine as analgesic
EW:
Morphine is contraindicated in head injury and bronchial asthma
16
SN:
Acute morphine poisoning
SN:
Pethidine
TS:
Tramadol as analgesic
SN:
Cardiac asthma
SN:
Pentazocine
SN:
Naloxone
LQ:
Classify NSAIDs. Give uses and adverse effects
SN:
Aspirin
EW:
Aspirin causes gastric bleeding
SN:
Phenylbutazone
SN:
Indomethacin
SN:
Ibuprofen
SN:
Mephenamic acid
SN:
Diclofenac sodium
SN:
Ketorolac
SN:
Treatment of acute paracetamol poisoning
TS:
Gold in rheumatoid arthritis
SN:
Treatment of rheumatoid arthritis
SN:
Treatment of acute gout
SN:
Chronic gout
SN:
Allopurinol
EW:
Allopurinol is preferred over probenecid for chronic gout
SN:
Pyritinol
LQ:
Classify the drugs used in treatment of psychosis. Discuss the mechanism of action, side effects with their management and therapeutic uses of haloperidol (2004)
Que:
Give rationale for the use of diazepam in tetanus (2006)
Que:
Give rationale for the use of sodium bicarbonate in salicylate poisoning (2006)
Que:
Discuss the drug treatment of status epilepticus (2006)
EW:
Ethanol is used in methanol poisoning (2007)
EW:
Plasma concentration of phenytoin rises disproportionately at higher doses (2007)
Que:
Classify antidepressant drugs. Write the mechanism of action, adverse effects and therapeutic uses of fluoxetine (2007)
Que:
Discuss the drug treatment of paracetamol poisoning (2007)
EW:
Thalidomide is used for lepra reaction (2007)
Que:
Give rationale for the use of hydroxychloroquine in systemic lupus erythematosis (2007).
17
Que:
Explain why diazepam though a drug of choice for status epilepticus is not recommended for maintenance therapy of epilepsy (2008)
Que:
Explain why halothane is frequently combined with nitrous oxide for general anesthesia (2008)
LQ:
Enumerate commonly used opioids. Write the mode of action, indications and contraindications for the use of morphine (2008)
Que:
Give the rationale for the therapeutic use of combining levodopa with carbidopa in parkinsonism (2008)
Que:
Discuss the drug treatment of generalized tonic clonic seizures (2008)
Que:
Discuss the drug treatment of acute gout (2008)
TS:
Clozapine in schizophrenia (2008)
SN:
Midazolam (2008).
18
 
H. CARDIOVASCULAR SYSTEM
LQ:
Classify antihypertensive drugs. Discuss the mechanism of action, side effects and therapeutic uses of enalapril (2005)
EW:
Enalapril should not be give concurrently with triamterene (2003)
SN:
Treatment of atrial fibrillation
LQ:
Classify antiarrhythmic drugs give mechanism of action
EW:
Paroxysmal tachycardia due to quinidine occurs only in patients of atrial fibrillation
TS:
Lignocaine as antiarrhythmic drugs
LQ:
Cardiac glycosides
SN:
Digoxin induced cardiac toxicity
SN:
Drug treatment of cardiogenic shock
SN:
Drug treatment of congestive heart failure
TS:
Vasodilatation in CHF
EW:
Alteplase is used in the treatment of myocardial infarction (2002)
EW:
Digitalis is used in atrial fibrillation
TS:
Digitalis in CHF
SN:
Amiodarone
TS:
Verapamil in arrhythmia
EW:
Verapamil is not given with propranolol
SN:
Lignocaine in ventricular arrhythmias (2005)
EW:
There is marked difference in action of verapamil and nifedipine whereas both are calcium channel blockers
SN:
Treatment of angina pectoris
EW:
Aminophylline is not used in treatment of angina pectoris
EW:
Propranolol is not used in vasospastic angina
EW:
Streptokinase is used in the treatment of myocardial infarction (2004)
SN:
Classify antianginal drugs
TS:
Glycerol trinitrate
EW:
Nifedipine causes headache
TS:
Calcium channel blockers as antianginal drugs
SN:
Amlodipine
EW:
Drug free period is advocated for transdermal nitroglycerine therapy in patients suffering from angina pectoris (2003)
TS:
Dipyridamole
SN:
Management of myocardial infarction
19
SN:
Classify antihypertensive drugs
EW:
Dopamine is used in the management of shock (2004)
TS:
Calcium channel blockers in hypertension
TS:
Thiazides in hypertension
SN:
Indications and drawbacks of using furosemide in hypertension
SN:
Use of hydralazine in HT
SN:
Treatment of hypertension
SN:
Hypertension in pregnancy
Que:
Discuss the therapeutic status of thrombolytic agents in myocardial infarctions (2001)
SN:
Cavedilol in hypertension (2004)
DT:
Hypertensive emergencies (2004)
Que:
Give rationale for the therapeutic use of adenosine in the treatment of paroxysmal atrial tachycardia (2007)
TS:
ACE inhibitors in heart failure (2007)
EW:
Digoxin is contraindicated in Wolf-Parkinson-White syndrome (2006)
Que:
Enumerate drugs for the treatment of congestive heart failure
Discuss the mechanism of action, therapeutic uses and adverse effects of enalapril (2006)
Que:
Give rationale for the use of carvidelol in heart failure (2006)
Que:
Give rationale for the use of adenosine in supraventricular tachycardia (2006)
Que:
Explain why digoxin but not adrenaline is used in congestive heart failure (2008)
Que:
Give the rationale for the therapeutic use of dopamine in cardiogenic shock (2008).
20
 
I. KIDNEY, BLOOD AND GIT
SN:
Classify diuretics, also give uses
EW:
Furosemide is used in the treatment of acute pulmonary edema (2004)
SN:
Frusemide
SN:
Complications of diuretic therapy
SN:
Potassium sparing diuretics
EW:
Thiazides are used in diabetes insipidus (2004)
SN:
Drug treatment of microcytic hypochromic anaemia
EW:
Furosemide is also known as a high ceiling diuretic (2005)
SN:
Management of acute iron poisoning
EW:
Both folate and Vitamin B12 deficiency produces several common manifestations
EW:
Vitamin B12 is preferred over folic acid for treatment of pernicious anaemia
SN:
Folic acid
EW:
Vitamin B12 is administered parenterally in patients of pernicious anaemia (2002)
SN:
H. pylori infection (2002)
EW:
Use of folinic acid with methotrexate
SN:
Vitamin K
SN:
Warfarin (2002)
EW:
Vitamin K1 used to reverse overdose of oral anticoagulants
SN:
Anticoagulants
EW:
Oral anticoagulants take days to act while heparin takes minute
SN:
Heparin
SN:
Oral anticoagulants
SN:
Treatment of bleeding due to oral anticoagulants
EW:
Cefoperazone should be used cautiously in patients on anticoagulant therapy (2005)
EW:
Oral anticoagulants should not be used in pregnancy
SN:
Fibrinolytic therapy
SN:
Streptokinase
EW:
Streptokinase has little or no benefit if infused after 12 hours of onset of symptoms in MI
TS:
Antifibrinolytics
TS:
Aspirin as antithrombotic drugs
SN:
Uses of antiplatelet drugs
SN:
Clofibrate
21
SN:
Gemfibrozil
EW:
Clofibrate is used in hyperlipoproteinemia
TS:
Lovastatin as hypolipidemic drug
SN:
Statins in dyslipidemia (2005)
SN:
Uses of plasma expanders
Que:
Discuss the therapeutic status of Sulfasalazine in ulcerative colitis (2001)
SN:
Classify drugs used for treatment of peptic ulcer
SN:
Ranitidine
TS:
Omeprazole in peptic ulcer
SN:
Erythropoietin in chronic renal failure (2005)
EW:
Loperamide should be avoided in treatment of infective diarrhoea (2004)
SN:
Five important properties of an ideal antacid
EW:
Magnesium trisilicate is used in treatment of peptic ulcer
EW:
Aluminium hydroxide is used with Mg(OH)2 in antacid gel
Que:
Describe the rationale the drug treatment of H.pylori associated upper gastrointestinal disorders (2001)
TS:
Carbenoxolone sodium
EW:
Mesna is used with ifosfamide (2005)
SN:
Cinnarizine
SN:
Metoclopramide
TS:
Domperidone
SN:
Cisapride
SN:
Stimulant purgatives
SN:
Bisacodyl
SN:
Purgative abuse
SN:
Treatment of diarrhoea
SN:
Oral rehydration therapy
EW:
Use of glucose in ORS
SN:
Diphenoxylate
Que:
Describe the mechanism of action of purgatives (2001)
Que:
Describe the rationale the drug treatment of H.pylori associated upper gastrointestinal disorders (2001)
Que:
Describe the mechanism of action of purgatives (2001)
DT:
Postoperative paralytic ileus (2005)
SN:
Rofecoxib as anti-inflammatory (2005)
EW:
Ketoconazole should not be used with cisapride (2006)
EW:
Low molecular weight heparins are preferred over unfractionated heparin preparations (2006)
22
Que:
Discuss rationale for the use of corticosteroids in ulcerative colitis (2006)
Que:
Discuss the drug treatment of peptic ulcer (2006)
TS:
Folic acid in anaemia (2006)
EW:
Thiazide diuretics cause calcium retention while loop diuretics cause increase in calcium excretion (2007)
TS:
Statins in dyslipidemia
EW:
Heparin and Warfarin are started together in acute thrombo-embolic states (2007)
Que:
Explain why acetazolamide is not preferred as a diuretic agent (2008)
Que:
Give the rationale for the therapeutic use of mannitol in cerebral oedema (2008)
TS:
Terlipress in bleeding oesophageal varices (2008)
Que:
Explain why ondansetron is preferred over prochlor-perazine for the treatment of cancer chemotherapy induced emesis (2008)
Que:
Discuss the drug treatment of peptic Ulcer with H. pylori infection (2008)
SN:
Plasma expanders (2008).
23
 
J. ANTIMICROBIAL DRUGS
SN:
Classify antimicrobial drugs
Que:
Describe the factors which govern the selection of an antimicrobial drug for treatment of infections (2001)
SN:
Drug resistance
EW:
Penicillin is lethal to bacterial cell but practicaly non-toxic to mammalian cell (2002)
SN:
Suprainfection
SN:
Advantages and disadvantages of combined use of antimicrobials
Que:
Describe the mechanism of action of aminoglycoside antibiotics (2001)
SN:
Prophylactic use of antimicrobials
Que:
Describe the mechanism of action of aminoglycoside antibiotics (2001)
SN:
Adverse effects of sulfonamides
SN:
Uses of cotrimoxazole
EW:
Sulphadoxine is combined with pyrimethamine (2004)
SN:
Trimethoprim
SN:
Ciprofloxacin, uses and adverse effects
SN:
Mechanism of action of penicillins
SN:
Adverse effects of penicillin specially hypersensitivity
SN:
Uses of penicillins
SN:
Semisynthetic penicillin
SN:
Ampicillin
SN:
Amoxicillin
Que:
Discuss the therapeutic status of metronidazole in anaerobic infections (2001)
SN:
Beta lactamase inhibitors
SN:
Sulbactam
LQ:
Cephalosporins, classification, mechanism of the action, uses and adverse effects
SN:
Third generation cephalosporins
LQ:
Classify tetracyclines, mechanism of action, uses and adverse effects of tetracyclines also give precautions before prescribing tetracycline
SN:
Chloramphenicol
LQ:
Give properties, mech. of action, toxicities and uses of aminoglycoside antibiotics
24
SN:
Streptomycin
SN:
Amikacin
SN:
Neomycin
SN:
Erythromycin
SN:
Roxithromycin
SN:
Nitrofurantoin
SN:
Treatment of urinary tract infections
SN:
Fluoroquinolones in tuberculosis (2005)
SN:
Classify antitubercular drugs
SN:
Isoniazid
SN:
Rifampicin
SN:
Acyclovir in herpes infections (2005)
SN:
Ethambutol
SN:
Pyrazinamide
SN:
Treatment of tuberculosis
SN:
Short course chemotherapy
SN:
Lamotrigine in epilepsy (2004)
TS:
Corticosteroids in treatment of tuberculosis
TS:
Fluoroquinolones in tuberculosis (2002)
SN:
Clofazimine
TS:
Rifampicin in leprosy
SN:
Multibacillary leprosy (2002)
SN:
Treatment of leprosy
SN:
Multidrug therapy of leprosy
TS:
Amphotericin B in fungal infections
SN:
Azole anti-fungal agents (2001)
SN:
Griseofulvin
DT:
Multi-bacillary leprosy (2005)
SN:
Clotrimazole
TS:
Ketoconazole
SN:
Fluconazole
SN:
Acyclovir
SN:
Zidovudine
SN:
Interferon α
EW:
Classify drugs used in the treatment of malaria. Discuss the pharmacology of chloroquine and mefloquin (2002)
SN:
Classify antimalarial drugs
SN:
Radical treatment of malaria
LQ:
Chloroquine
TS:
Mefloquine
25
TS:
Quinine
SN:
Pyrimethamine
SN:
Primaquine
SN:
Classify antiamoebic drugs
SN:
Metronidazole
SN:
Metronidazole in the management of pseudomembranous colitis (2002)
SN:
Imipenem in combination with cilastatin (2002)
TS:
Chloroquine as antiamoebic drug
SN:
Diloxanide furoate
TS:
Mebendazole
SN:
Albendazole
TS:
Pyrantel pamoate
SN:
Ivermectin
SN:
Niclosamide
SN:
Praziquantel
EW:
Cisapride should not be used in patients receiving erythromycin (2001)
EW:
Use of mefloquin is restricted to areas where chloroquine resistance is prevalent (2001)
SN:
Directly observed treatment strategy (DOTS) for tuberculosis (2005)
SN:
Quinine in cerebral malaria (2005)
Que:
Enumerate aminoglycoside antibiotics. Discuss their mechanism of action, anti-bacterial spectrum, therapeutics uses and side effects (2006)
TS:
Fluoroquinolones in tuberculosis (2006)
SN:
Irrational use of antimicrobial agents (2006)
SN:
Macrolide antibiotics (2006)
EW:
Anaerobic microorganisms are resistant to aminoglycoside antibiotics (2007)
Que:
Discuss the drug treatment of MDR tuberculosis (2007)
TS:
Cyclosporine in renal transplants (2007)
SN:
Albendazole (2007)
Que:
Explain why ketoconazole is useful in treatment of Cushing's syndrome (2008)
26
Que:
Give the rationale for the use of diloxanide furoate and metronidazole in amoebiasis (2008)
Que:
Discuss the drug treatment of chronic, recurrent urinary tract infection in females (2008)
LQ:
What is HAART? Write the mode of action, adverse effects and clinically important drug interactions of nevirapine (2008)
TS:
Ivermectin in filariasis (2008)
TS:
Artemisinin in malaria (2008)
SN:
Post antibiotic effect (2008)
27
 
K. ANTICANCER DRUGS
SN:
Classify anticancer drugs
SN:
General toxicity of cytotoxic drugs
SN:
Ondansetron in chemotherapy induced vomiting (2004)
SN:
Tamoxifen in the treatment of carcinoma breast (2002)
SN:
Nucleoside reverse transcriptase inhibitors (2005)
SN:
Cyclophosphamide
SN:
Methotrexate
SN:
Methotrexate in rheumatoid arthritis (2005)
SN:
Vincristine
SN:
Rubidomycin
SN:
5-FU (5-Fluorouracil)
SN:
Tamoxifen in breast cancer (2004)
DT:
Emesis due to cancer chemotherapy (2005)
Que:
Discuss the drug treatment of HIV infection (2007)
SN:
Paclitaxel (2007)
Que:
Explain why dexrazoxane pretreatment is given with doxorubicin therapy (2008)
Que:
Give the rationale for the use of filgrastim in cancer chemotherapy (2008).
28
 
L. MISCELLANEOUS DRUGS
SN:
Vitamin A (2002)
EW:
Deficiencies of folic acid and vitamin B12 have many common features (2001)
SN:
Action of kaolin on GIT
SN:
Astringents
DW:
Irritants and counter irritants
SN:
Mechanism of counter irritation pain relief
SN:
Keratolytics
SN:
Melanizing agents
SN:
Sunscreens
SN:
Treatment of acne vulgaris
SN:
Topical steroids
DW
Antiseptics and disinfectants
SN:
Role of antiseptics in hospitals
SN:
Cetrimide
SN:
Drug of choice for mercury poisoning
SN:
Penicillamine
SN:
Desferrioxamine
DW
Retinol and retinoic acid
SN:
Vitamin E
DW
Calcitonin and vitamin D
SN:
Hypervitaminosis A
SN:
TAB vaccines
SN:
Hepatitis B vaccine
SN:
DPT vaccine
Que:
Discuss the drug treatment of scabies (2006).
Note:
LQ:
Long Questions
SN:
Short Note
DW:
Difference Between
EW:
Explain Why
TS:
Therapeutic Status
DT:
Drug Treatment
Que:
Question
ENU:
Enumeration
Nm:
Normal
Abn:
Abnormal
29
 
3. TOPICS FOR PRESCRIPTION WRITING
  1. Treatment of pulmonary tuberculosis
  2. Treatment of bronchial asthma
  3. Treatment of peptic ulcer
  4. Treatment of scabies
  5. Treatment of infective diarrhoea
  6. Treatment of congestive heart failure
  7. Treatment of non-productive cough
  8. Treatment of hypertension
  9. Treatment of malaria (Both presumptive and radical)
  10. Treatment of migraine
  11. Treatment of meningitis
  12. Treatment of myocardial infarction
  13. Treatment of pneumonia
  14. Treatment of sinusitis
  15. Treatment of UTI.
    30
 
4. TOPICS FOR PHARMACY PRACTICAL
You are provided raw material and allowed to prepare the drug and you are supposed to know:
  • Method of preparation
  • Uses
  • Leading questions
Drugs
  1. Calamine lotion
  2. Mendel's paint
  3. ORS
  4. Carminative mixture.
    31
 
5. TOPICS FOR EXPERIMENTAL PRACTICAL
An experimental animal, e.g. frog, rabbit, cat's ileum to provided to you and you are asked to demonstrate the effects of various drugs on these animals or organs of the animals:
  1. Frog's heart
  2. Rectus abdominis of frog
  3. Ileum of cat
  4. Rabbit's eye.
    32
 
6. TOPICS FOR THEORY VIVA
  • Various routes of drug administration
  • First pass metabolism
  • Plasma half life
  • Plateau principal
  • Drug potency and efficacy
  • Side effects of drug
  • Muscarinic and nicotinic receptors
  • Treatment of migraine
  • Cholinergic and anticholinergic drugs
  • Atropine
  • Adrenaline in anaphylactic shock
  • Centrally acting muscle relaxants
  • Uses and limitations of local anaesthetics
  • Spinal anaesthesia and its complications
  • Epidural anaesthesia
  • Treatment of bronchial asthma
  • Oral hypoglycemia
  • Management of diabetes mellitus
  • Complications of diabetes mellitus
  • Uses of steroids
  • Anabolic steroids
  • Tocolytics
  • Calcium metabolism
  • Stages of general anaesthesia
  • Preanaesthetic medication.
  • Disulfiram
  • BZDs
  • Treatment of epilepsy
  • Lithium carbonate
  • Morphine
  • Paracitamol poisoning
  • Treatment of rheumatoid arthritis
  • Digitalis
  • Treatment of cardiac arrhythmias
  • GTN
  • Nifedipine
  • Treatment of hypertension
  • Various iron preparations
    33
  • Treatment of anaemias
  • Plasma expanders
  • Treatment of peptic ulcer
  • Treatment of constipation, diarrhoea
  • Indications of use of antimicrobial drugs
  • Ciprofloxacin, ofloxacin
  • Amoxycillin uses
  • Cephalosporins
  • Uses and limitations of tetracyclines
  • Gentamycin, erythromycin
  • Doses and adverse effects of antitubercular drugs
  • Local and systemic antifungal drugs
  • Antiviral drugs
  • Antimalarial drugs
  • Cyclophosphamide
  • Methotrexate
  • 5-FU
  • Sunscreens
  • Vitamin E.
    34
 
7. DRUG OF CHOICE
1. Actinomycosis
Penicillin-G (IM)
2. Acute congestive glaucoma
Pilocarpine nitrate (drops)
3. Acute LVF
Morphine (IV)
4. Acute severe asthma
Aminophylline (IV)
5. Alcohol addiction
Disulfiram
6. Amoebiasis
Metronidazole (oral)
7. Amoebic liver abscess
Metronidazole, emitine, chloroquine
8. Anaphylactic shock
Adrenaline (SC)
9. Asthma
Salbutamol (inhalation), Aminophylline
10. Belladonna poisoning
Phyostigmine (IV)
11. Brucellosis
Tetracycline (oral)
12. Burkitt's lymphoma
Cyclophosphamide (oral)
13. Campylobacter enteritis
Fluoroquinolones
14. Chlamydia
Tetracycline (oral)
15. Chanceroid
Cotrimoxazole (oral)
16. CHF
Digoxin (oral)
17. Chronic congestive glaucoma
Pilocarpine nitrate (topical)
18. Chronic gout
Probenecid (oral)
19. Chronic gout
Probenecid (oral)/Allopurinol
20. Chronic myeloid leukemia
Busulfam (oral)
21. Cirrhotic edema
Spironolactone (oral)
22. Clostridium difficale
Vancomycin
23. Cryptococcal meningitis
Fluconazole
24. Cyanide poisoning
Sodium nitrate (IV)
25. Cystinuria
Penicillamine
26. Diazepam poisoning
Flumazenil (IV)
27. Digitalis induced tachycardia
Phenytoin
28. Diphtheroids
Vancomycin (IV)
29. Dissociated analgesia
Ketamine (IV), Ethylate (IV)
30. Drug induced parkinsonism
Trihexyphenidyl
35
31. Endogenous depression
Imipramine, trazodone
32. Endometriosis
Danazol (oral)
33. Enteric fever
Ciprofloxacin (oral)
34. Estrogen dependent breast cancer
Tamoxifen
35. Fibrinolysis
Alteplase (rt-PA) (IV)
36. Filariasis
Diethylcarbamazine citrate (oral)
37. Gameticidal
Primaquine (oral)
38. Genital herpes
Acyclovir (topical) (oral)
39. Gonorrhoea
Procaine, penicillin (IM)
40. Gout (acute attack)
NSAID (Indomethacin)
41. Grand mal epilepsy
Phenytoin (oral)
42. Guinea worm infestation
Niridazole (oral)
43. H. influenzal meningitis
Chloramphenicol (IV)
44. H. influenzal pneumonia
Chloramphenicol (oral)
45. H. nana infestation
Praziquantel (oral)
46. H. simplex keratoconjunctivitis
Idoxuridine (topical)
47. Heparin antagonist
Protamine sulphate
48. Hg poisoning
Dimercaprol (IV)
49. Hookworm infestation
Pyrantel pamoate (oral), Mebendazole
50. Hydatid disease
Albendazole
51. Hypertensive emergency
Sodium nitroprusside (IV), GTN (IV), Diazoxide (IV)
52. Insecticide poisoning
Pralidoxime and atropine (IV)
53. Iron poisoning
Desferrioxamine
54. Kala azar (resistant)
Pentamidine (IM)
55. Legionnaire's pneumonia
Erythromycin (oral)
56. Lepra reaction
Clofozemine (oral)
57. Listerosis
Penicillin-G (IM)
58. Lymphogranuloma venerum
Tetracycline (oral)
59. Male contraceptives
Gossipol (oral)
60. Malignant hyperthermia
Dentrolene (IV)
61. Mania-depressive
Lithium carbonate (oral)
62. Meningococcal pneumonia (prophylaxis)
Rifampicin (oral)
36
63. Methecillin resistance
Vancomycin (IV)
64. Methotrexate poisoning
Folinic acid (IV)
65. Methyl alcohol poisoning
4-methyl pyrazole (IV)
66. Microprolactenemia
Bromocriptine
67. Migraine (prophylaxis)
Propranolol (oral)
68. Monilial vaginitis
Nystatin (oral)
69. Morphine poisoning
Naloxone (IV)
70. Motion sickness
Hyoscine (oral, IV)
71. Myasthenia gravis
Neostigmine (oral)
72. Mycoplasmal pneumonia
Erythromycin (oral)
73. Myxoedema coma
Liothyronine (IV)
74. Nephrogenic diabetes Inspidus
Thiazide
75. Neurocysticercosis
Praziquantel (oral)
76. Neurogenic diabetes mellitus
ADH (intranasal)
77. Neurolept analgesia
Fentanyl droperidol (IV)
78. Noctural enuresis
Imipramine (oral)
79. Obssessive-compulsive/phobic state
Trazodone (oral)
80. Obstetric local analgesia
Bupivacaine
81. Organophosphate poisoning
Atropine (IV)
82. Paraoxymal supra-ventricular tachycardia
Verapamil (IV)
83. Pb poisoning
Calcium disodium EDTA
84. PCM poisoning
N-acetylcystine (IV),
85. Penicillinase resistance
Methecillin (IM/IV)
86. Peptic ulcer
Omeprazole (oral)
87. Petit mal epilepsy
Ethosuximide (oral)
88. Pneumococcal pneumonia
Penicillin (IM)
89. Pneumocystitis carinii
Pentamidine + Cotrimoxazole (IV)
90. Postmenopausal syndrome
Estrogen (oral)
91. Postpartum hemorrhage
Methyl ergotamine
92. Radical cure
Primaquine (oral)
93. Raised intracranial pressure
Mannitol (IV)
37
94. Refractory CHF
Amrinone (IV)
95. Relapsing fever
Tetracycline
96. Rheumatic fever
Aspirin (oral)
97. Rheumatoid arthritis
NSAID (Aspirin)
98. Roundworm infestation
Albendazole (oral)
99. Scabies
Benzyl benzoate (topical)
100. Schizophrenia
Chlorpromazine
101. Shigella enteritis
Norfloxacin (oral)
102. Spastic constipation
Dietary fibre
103. Strongyloides stercoralis
Thiabendazole
104. Syphilis
Benzathine-Penicillin (IM)
105. Tapeworm infestation
Praziquantel (niclosamide) (oral)
106. Thyrotoxicosis
Carbimazole + Ppt surgery
107. Tobacco amblyopia
Hydrocobalamine
108. Transient insomnia
Triazolam, Temazepam
109. Trichomonial, vaginitis
Metronidazole (oral)
110. Trigeminal neuralgia
Carbamazepine (oral)
111. Trypanosomiasis
Pentamidine
112. Tuberculosis
INH + R + Z + E (oral)
113. Type III hyperlipidemia
Gemfibrozil
114. Type IV hyperlipidemia
Nicotinic acid (oral)/Gemfibrozil
115. Type V hyperlipidemia
Nicotinic acid (oral) Gemfibrozil
116. Ulcerative colitis
Sulfasalazine (oral)
117. Uterine contraceptive
Gossypol (oral)
118. Uterine relaxant
Ritodrine (IV), Salbutamol
119. Ventricular Es
Lidocaine (IV)
120. Ventricular tachycardia
Lidocaine (IV)
121. Visceral leishmaniasis
Sodium stibogluconate (IM)
122. Whip worm
Mebendazole/Albendazole
123. Whooping cough
Erythromycin (oral)
124. Wilson's disease
d-penicillamine (oral)
125. Yersenia enterocolitis
Cotrimoxazole
38
 
8. EXPLAIN WHY
 
 
SOME EXAMPLES (SOLVED)
  1. Rationale for combined used of Al hydroxide with Mg hydroxide in antacid gel.
BECAUSE:
  • Mg(OH)2 is laxative and Al2(OH)3 constipating. Combination annual each others effect and bowel movement is not affected.
  • Mg(OH)2 hastens gastric emptying while Al2(OH)3 decrease gastric emptying. Combination has no effect on gastric emptying.
  1. Mg trisilicate in treatment of peptic ulcer.
BECAUSE:
  • Mg trisilicate produces silica by reacting with HCl. Silica produced is gelatinous, it is absorbed and inactivates pepsin and protects ulcer base by forming coating over it and prevents contact of HCl to ulcer base.
  • Has good ANC.
  • Does not increases pH more than 3.
  1. ACH is not used therapeutically.
BECAUSE:
  • (i) It is irritant, (ii) Because of evanescent and nonselective action and degrades fastly (t½: 2 to 5 min).
  1. Atropinic drugs also prevent laryngospasm.
    • Atropinic drugs have no action on laryngeal muscles as they are skeletal muscles. Atropinic drugs reduce respiratory secretions that reflexly predispose to laryngospasm and hence prevent laryngospasm.
  2. Ephedrine is orally active while adrenaline is not.
    • Ephedrine is resistant to MAO (monoamine oxidase) so it is not degraded by liver and hence is orally active.
    39
  3. Sch first causes stimulation and then paralysis of skeletal muscles.
    • Sch is a depolarizing blockers and has intrinsic activity for NM receptors. It depolarizes muscle end plate by opening Na+ channels and initially producing twitching and fasciculations. It does not dissociate rapidly from receptor then all Ach gets depleted and hence causes paralysis.
  4. D-TC causes fill in BP.
BECAUSE:
  • Ganglionic blockade,
  • Histamine release and
  • Reduces venous return.
  1. Sch in some individual causes prolonged apnoea.
    • Normally pseudocholinesterase breaks Sch into succinic acid and choline. In some individuals pseudocholinesterase is absent hence Sch is not hydrolysed and causes prolonged apnoea by phase II blockade resulting in muscle paralysis and apnoea lasting hours.
  2. Oxethazine is a good anaesthetic for gastric mucosa while other LA are not.
    • Oxethazine is a good, potent topical anaesthetic. It has unique property to ionise to a very small extent even at low pH. It is therefore highly effective in anesthesing gastric mucosa by acting on receptors from inside.
  3. Salbutamol is preferred over isoprenaline in treatment of bronchial asthma.
BECAUSE:
  • Salbutamol is highly β2 selective whereas isoperaline is β1 + β2 selective isoprenaline causes tachycardia via β1 receptor whereas this disadvantage is not encountered with salbutamol.
  • Salbutamol is safer and longer acting than isoprenaline.
  1. Aminophylline is given by slow IV injection.
    • Rapid IV injection of aminophylline causes precordial pain syncope and even sudden death due to marked fall in BP. Ventricular arrhythmias or asystole hence given by slow IV injection.
    40
  2. Antihistamines are ineffective in bronchial asthma.
BECAUSE:
  • LT and PAF are more important mediators than histamine which are not antagonised by antihistamines.
  • Concentration at site may not be sufficient to block high concentration of histamine.
  • They do not have bronchodilator action.
  1. Halothan causes malignant hyperthermia.
    • Due to intracellular release of Ca++ from sacroplasmic reticulum causing persistent muscle contraction and increased heat production hence cause malignant hyperthermia.
  2. Morphine causes vasodilatation.
BECAUSE:
  • Direct action decreases tone of muscles
  • Histamine release
  • Depression of vasomotor centre.
↓BP
  1. Neurolept analgesic should not be used in person with parkinsonism.
    • In parkinsonism extrapyramidal symptom are due to ↓ in dopamine. Droperidol in neurolept analgesic is a dopamine antagonist it will further aggravate parkinsonism so it is not given in parkinsonism.
  2. Antipsychotic drugs are ineffective in motion sickness.
    • These drugs act via dopaminergic pathway through CTZ which is not involved in motion sickness. Hence, ineffective in this condition.
    EW:
    Half life of a drug varies for drugs undergoing zero order kinetics (2006)
    SN:
    Polypharmacy (2006)
    SN:
    Drug tolerance (2006)
    SN:
    Pharmacovigilance (2006).
  3. Oxazepman used in elderly and in patients with liver disease as antianxiety.
    • Its hepatic metabolism is in significant and of short duration of action hence used. Also used in short lasting anxiety cases.
    41
  4. Why there is not antidote for acute barbiturate poisoning.
    • In barbiturate poisoning patient is in comatose. If antidote used in attempt to awaken the patient (e.g. Metrazole) then it is dangerous because it may precipitate convulsion and morbidity and mortality is increased, hence no antidote.
  5. Gastric lavage is done in morphine poisoning even if drug is injected.
    • Morphine is a basic drug, it is partitioned to gastric acid juice. To prevent its diffusion back into blood gastric lavage is done with KMnO4.
  6. Morphine is contraindicated in bronchial asthma.
BECAUSE:
  • Morphine can precipitate attack of bronchial asthma by histamine release
  • It depresses respiratory and cough centre, hence contraindicated.
  1. Overdose of pathidine produces many excitatory effects while it is equally sedative as morphine.
    • In overdose of pathidine, its metabolite norphathidine accumulates which has excitatory action.
  2. Why morphine is used in acute left ventricular failure.
BECAUSE:
  • It decreases preload on heart by causing peripheral pooling of blood.
  • It tends to shift blood from pulmonary to systemic circulation.
  • It calms air hunger by causing respiratory depression.
  • It cuts sympathetic innervation by calming the patient → Reduces cardiac work.
  1. Aspirin causes gastric bleeding.
    • It is a acidic drug and remains unionised and diffusible in gastric acid juice → enters mucosal cell and ionise and become indiffusible (ion trapping).
    • Further aspirin particles coming in contract with gastric mucosa promote local back diffusion of acid → focal necrosis of mucosal cells → acute ulcers, erosive gastritis, congestion and microscopic bleeding → gastric bleeding.
    42
  2. PCM has no anti-inflammatory property.
    • At the site of inflammation peroxidase is formed, which inhibits PCM and hence it is not able to inhibits cox in presence of peroxidase → no anti-inflammatory property.
  3. KCl is given in diabetic ketoacidosis.
    • K+ is lost in urine during ketoacidosis and serum K+ is usually normal due to exchange with intracellular stores when insulin therapy is started, ketoacidosis subsides and K+ is driven intracellular → dangerous hypokalemic can occur hence KCl is given in diabetic ketoacidosis.
  4. Biguanides not used in underweight patients with NIDDM.
    • They have anorectic action and can further reduce weight and complications may appear so not given in underweight patients with NIDDM. Biguanides also inhibit intestinal absorption of glucose, amino acids and vitamin B12.
  5. Progesterone is added to estrogen in OC while later alone can promote contraception.
BECAUSE:
  • Progesterone ensure prompt bleeding at the end of cycle and blocks the risk of developing endometrial carcinoma due to estrogen hence it is added with estrogen.
  • Both estrogen and progesterone synergist to inhibit ovulation.
  1. Estrogen in high doses is effective as post-coital contraception.
    • High dose of estrogen with or without progesterone given for few days and then discontinued induces bleeding → the postcoital pill may thus dislodge a just implanted blastocyst or may interfere with fertilization or implantation.
  2. Estrogen is favourable to sperm penetration.
BECAUSE:
  • Increase rhythmic contraction of fallopian tubes and uterus.
  • Induces a watery secretion from cervix.
43
  1. Estrogen component of OC is mainly responsible for venous thromboembolism.
BECAUSE:
  • Increase blood coagulation factors,
  • Decrease antithrombin III
  • Decrease plasminogen activator in endothelium, and
  • Increase platelet aggregation.
  1. Oxytocin is given by slow IV infusion and in low doses.
BECAUSE:
  • Because of its shorter t½ and slow IV infusion, intensity of action can be controlled and action can be quickly terminated.
  • Low concentrate allow Normal relaxations between contraction → foetal oxygenation does not suffer.
  • Lower segment is not contracted → foetal descent is not compromised.
  1. Ergotamine and methyl ergotamine are preferred over oxytocin to stop bleeding.
    • Because they cause sustained tonic contraction → the perforating arteries are compressed by myometrial mesh work → bleeding stops which is not achieved by oxytocin. Hence preferred over oxytocin.
  2. Estrogen is contraindicated during pregnancy.
BECAUSE:
  • It increases incidence of vaginal cancer is ? offspring.
  • Increases incidences of genital abnormalities in ? offspring.
Hence it is contraindicated in pregnancy.
  1. Caffeine and ergotamine are given in migraine.
BECAUSE:
  • Caffeine constricts cerebral vessels → reduces headache.
  • Caffeine ↑es absorption of ergotemine.
  • They act synergistically.
  1. Doxycycline is safest in renal failure.
BECAUSE:
  • Ninety percent drug is excreted in feces as conjugated.
  • t½ is not affected by renal failure.
  • It does not aggravate azootemia.
  • Higher levels are maintained longer → less toxicity.
44
  1. Tetracycline should not be given to children.
BECAUSE:
  • It has antianabolic effect.
  • Tetracycline forms orthophosphate complex which gets deposited in developing bones and teeth and cause brown discoloration of teeth.
  • Defective enamel causes hypoplasia of teeth.
  • Increases risk of caries.
  1. Tetracycline should not be given to pregnant women.
    • Because it crosses placenta and temporarily suppresses bone gowth → retardation of fetal bone growth and it also causes ↑ in intracranial pressure in some infants.
  2. Penicillin is not toxic to man but is toxic to microorganism.
    • Penicillin inhibits peptidoglycan cell wall synthesis and human beings have no cell wall. Also it is needed in low concentration hence not toxic to man.
  3. Tetracycline is not given in sore throat.
BECAUSE:
  • Sore throat is usually viral in origin where it is ineffective.
  • Resistance develops and it is also costly and other more effective antibiotics are available.
  1. NaHCO3 is not the antacid of choice.
BECAUSE:
  • In the intestine it is unable to neutralize HCO3¯ and hence causes systemic alkalosis.
  • Short duration of action.
  • ↑ es pH >2.5 and hence impair digestion.
  • Produces CO2 in stomach → abdominal discomfort.
  • It may worsen CHF and edema by ↑ ing Na+ load.
    45
 
9. DOSES OF SOME IMPORTANT DRUGS IN CHILDREN
Method of calculation of drug dose in children in general, Clark's rule is applicable if adult dose is known
  1. SA × Adult dose
    1.7
  2. SA of child in M2 × 60 = % of Adult dose.
 
 
A. ANALGESICS, ANTIPYRETICS AND ANTI-INFLAMMATORY DRUGS
  1. Acetylsalicyclic acid—30–65 mg/kg/day 6 hr oral
  2. Codeine phosphate—3 mg/kg/day qid
  3. Dextropropoxyphane hydrochloride—2–4 mg/kg/day bd
  4. Diclopherol Na—2–5 mg/kg/day tds
  5. Ibuprofen—20 mg/kg/day tds
  6. Indomethacin—3 mg/kg/day tds
  7. Morphine SO4—0.1–0.2 mg/kg/day SC
  8. Nimesulide—5 mg/kg 8–12 hr
  9. Paracetamol—30–60 mg/kg/day 4–6 hr oral
    or 10 mg/kg/day injection
    or injection 5 mg/kg/day single dose
  10. Pethidine hydrochloride—1–2 mg/kg/dose IM or IV.
 
B. ANTHELMINTICS
  1. Albendazole—200 mg single dose (1–2 yrs)
    400 mg > 2 yrs children and adult.
  2. Levamisol—2 mg/kg single dose at night for ascariasis.
  3. Mebendazole—100 mg bd × 3 days for ascariasis
    200 mg bd × 3 days for tapeworms repeat after 2 weeks
    for hydatid cyst—30 mg/kg/day 8 hrly oral × 4 weeks
  4. Niclosamide—1 gm empty stomach followed by next dose after 1 hr
  5. Parziquntel—50 mg/kg/day 8 hrly oral × 10–14 days
  6. Pyrantel pamoate—11 mg/kg single dose
46
 
C. ANTIBIOTIC AND CHEMOTHERAPEUTIC AGENTS
  1. Aminoglycosides
    1. Amikacin*—7.5 mg/kg/dose IV/IM
    2. Gentamycin sulfate*—2.5 mg/kg/dose IM/IV
    3. Kanamycin sulfate*—2.5 mg/kg/dose IM/IV
    4. Neomycin sulfate—12.5 mg/kg/dose oral in diarrhea and 3 g/m2/day 6 hrly in hepatic coma
    5. Streptomycin—30–40 mg/kg/day 12 hrly.
      * every 12 hr for infants below 0–7 days and 8 hrly for infants > 7 days.
 
D. CEPHALOSPORINS
  1. Cefadroxil—15 mg/kg/dose 12 hr oral
  2. Cefazolin Na—20 mg/kg/dose IM IV
    IV should be given over 15–20 min
  3. Cefixime—8 mg/kg/dose oran once or twice
  4. Cefotaxime Na—50 mg/kg/dose
  5. Ceftazidime—50 mg/kg/dose IM IV
  6. Ceftriaxone Na—50–75 mg/kg/dose
  7. Cephlexin—7–12 mg/kg/dose 6 hr orally.
 
E. LINCOSAMIDES
  1. Clindamycin hydrochloride
    0–7 days—5 mg/kg/dose 8 hr oral IV
    > 7 days—5 mg/kg/dose 6 hrly
  2. Lincomycin hydrochloride
    5–10 mg/kg/dose 12 hrly IM IV
 
F. MACROLIDES
  1. Azithromycin dihydrate—10 mg/kg/day single dose empty stomach × 3 days
  2. Erythromycin—5–12.5 mg/kg/dose 6–8 hrly
    5 mg/kg/dose IV as infusion over 8 hr with normal saline or Ringer lactate
  3. Roxythromycin—2.5 mg/kg/dose 12 hrly.
 
G. PENICILLINS
  1. Amoxicillin—25–50 mg/kg/day 8 hr orally
    47
  2. Ampicillin with salbutam—150 mg/kg/day 8 hr IM or IV
    Cotanin 100 mg ampicillin/50 mg salbactum
  3. Cloxacillin*—12.5 mg/kg/dose oral or IV
  4. Methicillin Na*—25 mg/kg/dose
  5. Penicillin G (aquous)*—25,000 units/kg/dose IM IV.
    * Preterm infants = upto 70 mg—every 12 hrly
    Term upto 7 days—8 hrly
    and preterm infant > 2 days
    and term baby > 7 days—6 hrly
 
H. SULPHAS
  1. Sulphonamide—100–150 kg/day 8 hrs oral
  2. Timethoprim + Sulfamethoxazole (Cotrimoxazole)
    Neonates—2 mg/kg/days loading dose followed by 1.2 mg/kg/day 12 hrly
    Children—5–8 mg/kg or TMP or 25–50 mg/kg of SM2/day 12 hrly oral.
 
I. MISCELLANEOUS ANTIMICROBIALS
  1. Chloramphenicol—25 mg/kg/dose oral IM IV
  2. Ciprofloxacin—5–10 mg/kg/dose 12 hr
    avoide in children < 12 years because of cartilage toxicity
  3. Furazolidine—2 mg/kg/dose every 6–8 hr
  4. Nalidixic acid—50 mg/kg/day 6–8 hr oral
  5. Norfloxacin—7.5–10 mg/kg/day 12 hr oral
  6. Ofloxacin—7.5 mg/kg/day
    IV dose—5 mg/kg/dose 12 hrly
  7. Tetracycline hydrochloride—3–6 mg/kg/dose 6 hr oral + Avoid children < 8 years.
 
J. ANTICONVULSANTS
  1. Carbamazepine—10–20 mg/kg/day 8 hr oral
    less than 1 year 200 mg
    1–5 years—400 mg
    5–10 years—600 mg
    > 10 years 800–100 mg.
  2. Clonazepam—0.02 mg/kg/day 12 hrly oral
  3. Diazepam—0.2–0.3 mg/kg/dose
  4. Ethosuximide—20–70 mg/kg/day 12 hrly
    48
  5. Phenobarbitone Na—3–10 mg/kg/day or single dose at night 12 hours oral
  6. Phenytoin sodium—4–12 mg/kg/day 12 hrly or single oral dose
  7. Prednisolone—2 mg/kg/day 8 hrly for 2–6 hours
  8. Valproate Na—15 mg/kg/day 8–12 hrly orally.
 
K. ANTIEMETICS
  1. Domperidone—0.2–0.4 mg/kg/dose 4–8 hrly
  2. Metochlorpromide HCl—0.1 mg/kg/day 6–8 hr oral or IM
  3. Ondansetron HCL dihydrate—5 mg/m2 IV prior to procedure followed by 4 mg oral × bd × 5 days
  4. Triflupromazine—0.5 mg/kg/day 8 hr oral.
 
L. ANTIHISTAMINES
  1. Astemizole—0.2–1 mg/kg/dose singl dose oral
  2. Cetrizine dihydrochloride
    5 mg for < 30kg
    10 mg > 30 kg oral od
  3. Chlorphenamine maleate—0.5 mg/kg/dose 8 hr oral.
 
M. ANTIHYPERTENSIVES
  1. Atenolol—1–2 mg/kg/dose single dose
  2. Captopril—3 mg/kg/dose 8 hrly
  3. Methyldopa—10–40 mg/kg/dose 8–12 hrly
  4. Nifedipine—0.5–1 mg/kg/dose 8 hrly oral
  5. Propranolol 2–4 mg/kg/dose 8 hrly oral
  6. Na nitroprusside—0.5 to 8 mcg/kg/mt
  7. Verapamil—2–4 mg/kg/dose 8 hrly oral.
 
N. ANTILEPROTIC
  1. Clofazime—1–2 mg/kg/daily and
    4–6 mg/kg once a month
  2. Diaminodiphenyl sulphone (DDS)—1–2 mg/kg/dose.
 
O. ANTIMALARIAL DRUGS
  1. Chloroquine PO4—10 mg of base/kg state
    followed 5 mg/kg 6 hr later and once a day oral × 2 hrly
  2. Mefloquine—15–25 mg/kg/single dose
  3. Quinine sulphate—25 mg/kg/day 8 hrly × 7 days.
    49
 
P. ANTITUBERCULAR (ANTI-TB)
  1. Isoniazid—5–10 mg/kg/day single dose
  2. Rifampicin—10 mg/kg/day single dose empty 8 hrly
  3. Pyrazinamide—20–35 mg/kg/day single dose
  4. Ethambutol—25 mg/kg/day single dose oral × 4 weeks then 15 mg/kg/hrly
    Streptomycin sulfate—20–40 mg/kg/day IM daily.
 
Q. MISCELLANEOUS DRUGS
  1. Adrenaline—0.01 ml/kg/dose of 1:1000 solution SC.
  2. Aminophyline—15–20 mg/kg/dose 8 hrly oral
    For status asthmatics—5–7 mg/kg loading dose IV followed by 0.09 mg/kg/hr.
  3. Metronidazole—15–20 mg/kg 8 hrly oral and 20 mg/kg/dose 8 hrly IV for anaerobic infant
  4. Human hepatitis B specific globulins—0.06–0.1 ml/kg IM at the time of exposure
  5. Tetanus antitoxins
    Prophylactic—3,000–5,000 units SC 1 hrly
    Therapeutics—10,000 units IM IV.
  6. Salbutamol—0.1–0.4 mg/kg/dose 8 hrly
  7. Digoxin—Digitalizing dose
    Premature—0.04 mg/kg/day
    Full term—0.06 mg/kg/day
    < 2 years children—0.06 mg/kg/day
    > 2 year children—0.04 mg/kg/day oral
    The daily maintenance digoxin is about 1/4 of initial digitalizing dose.
  8. Furosamide—2–4 mg/kg/day 12 hrly oral
    IV dose is 1.2 of oral dose
  9. Lithium carbonate—10–15 mg/kg/day 8 hrly oral to maintain blood 1 eml b/w—0.75 to 1 mEq/l.
  10. Ranitidine—2–4 mg/kg/day 12 hrly.
    50
 
10. IMPORTANT POINTS
  • Potency of the drug refers to the amount of drug needed to produce a given response.
  • Efficacy of the drug refers o the maximal response that can be produced by the drug.
  • ED50 is the dose of drug required to produce 50% of the maximum response. It is a measure of potency of drug.
  • Zero order kinetics = rate of elimination = constant, CL ↓ with ↑ in concentration of drug.
    • Ethyl alcohol
    • Tolbutamide
    • Theophylline
    • Propanolol
    • Phenytoin
    • Warfarin
    • Aspirin
    Follow the zero order kinetics
  • First order kinetics = Rate of elimination is directly proportional to concentration of the drug.
    CL remains constant.
  • Uses of microsomal enzyme induction:
    1. Cong. Nonhemolytic jaundice (phenobarbitone)
    2. Cushing's syndrome = Phenytoin may reduce the manifestation.
    3. Chronic poisonings
    4. Liver disease
  • Bioavailability is a measure of fraction of administered dose of a drug that reactes the systemic circulation in the unchanged form (100% of drug injected IV)
  • Steroid hormones act on cytoplasmic receptor → nucleus, thyroid hormones act on nuclear reception while others act on cell membrane receptors.
  • National essential drug list (1996) = 279 drugs included.
  • P-450 enzyme inhibitors:
    • Ciprofloxacin
    • Omeprazole
    • Metronidazole
    • Erythromycin
    • Ketoconazole
    • Cimetidine
    51
  • Autonomic drugs =
    • = produce actions similar to Acetylcholine
  • Anticholinesterases (Anti Ches) = (-) Che thus protects the Acetylcholine from hydrolysis = produce cholinergic effects and potentiates Acetylcholine
    • Physostigmine
    • Edrophonium
    • Neostigmine
    • Tacrine
    Reversible
    • Melathion
    • Parathione
    • Tabun
    • Carbaryl
    • Propoxur
    Irreversible
    zoom view
  • Anticholinergic drugs = block actions of Ach on ANS and act via muscarinic receptors in CNS.
    • Atropine
    • Hyosine
    • Homatropine
    • Ipratropium bromide
    • Cyclopentolate
    • Tropicamide
    • Glycopyrolate
    • Pirenzepine
    • Telenzepine
    • Benzhexol (trihexy phenidyl).
  • Pralidoxime (2-PAM) = in Anti-cholinesterase poisoning (organophosphorus poisoning) (also atropins) 2 mg IV till pupil dialates at an interval of 10 min. upto 200 mg in one day)
  • First line antitubercular drugs are tuberculocidal except ethambutol
    52
  • 2nd line drugs are tuberculostatic
  • Other uses of rifampin
    1. Leprosy
    2. Systemic fungal infection with amphotericin B)
    3. Prophylaxis of meningococcal meningitis
    4. Legionella infection
    5. Brucellosis (with doxycyclins).
  • Side effect of various ATT drugs.
    1. Arthralgia = INH and pyrazinamide
    2. Hyperuricemia = ethambutol, pyrazinamide
    3. Optic neuritis = isoniazid, Ethambutol
    4. Hepatitis = Inn, rifampicin, pyrazinamide
    5. Peripheral neuropathy = Streptomycin INH, Ethambutol, ethionamide
    6. Ototoxicity and renal toxicity = Streptomycin (CI in pregnancy)
    7. Pigmentation = Rifampicin
    8. Cataract, red green colour blindness ethambutol
    9. Neutrosychiatric manifestation = Cycloserine
    Thiazetaxone is CI in AIDS patients.
  • Treatment of TB in pregnanacy
    • INH + Rifampicin = 9 months
      Add E if resistance to INH suspected
    • Pyridoxine 50 mg daily
    • It should cover delivery and perpeuriam
    • In case of active lesion T should continuous 6 months following delivery or until the disease is amsted
  • Effective ATT reduces infectively upto 90% in 48 hours.
  • Drug and their mechanism of action.
    1. Inhibition of cell wall synthesis ← inhibition of mycolic acid synthesis → Isoniazid (INH)
      = Penicillins, cephalosporins
      Cycloserine, vancomycin, bacitracin
      53
    2. Inhibition of protein synthesis
      • Tetra-cycline
      • Clinda-mycin
      • Aminoglycoside → Misreading of m RNA code
      • Streptomycin
      • Chloram-phenicol
      • Mupirocin
      • Erythro-mycin
      • Griseofulvin
    3. Interfere with intermediatory metabolism
      = Sulfonamides, trimethoprim, ethambutol, PAS
    4. Inhibition of nucleic acid synthesis
      = Quinolines, flucyosine, rifampin
    5. Inhibition of HMG GA reductase
      = Lovastatin, merastatin, simvastatin.
  • Drugs causing gynaecomastia:
    • Calcium channel blockers
    • Digitalis
    • Ketoconazole
    • Griseofulvin
    • INH
    • Ethionamide
    • Estrogen
    • Testosterone
    • Methyldopa
    • Phenytoin
    • Reserpine
    • Cimetidine
    • Amiodarone
    • Clomiphine.
  • Agents inducing theophylline metabolism (↓ its plasma level, toxicity)
    • Rifampicin
    • Phenytoin
    • Phenobarbitone
    • Smoking
    54
  • ➩ Agents which inhibit theophyline metabolism (enhance toxicity)
    • Erythromycin
    • Ciprofloxacin
    • Oral contraceptives
    • Cimetidine
    • Allopurinol.
  • PCM produces highly reactive toxic minor metabolite = N-acetyl benzoquinone amine Antidote = N-acetyl cystine.
  • Lipid insoluble alpha blockers (do not cross BBB)
    Atenolol
    Nadolol
    Sotalol = Excreted in urine so should not be used in renal failure.
  • Septran (TMP-SMI) is Doc for:
    • Moraxella catarrhalis
    • Haemophilus
    • Nocardia
    • Enterobacter
    • Wipple's disease = T. septran 1 bd (DS) × 1yr
  • Penicillin G is Metabolized by kidney (mainly)
    zoom view
  • DOC for PSVT = Adenosine (2nd verapamil)
  • Red man Syndrome = Pruritis, flushing, erythema of head and upper toxo = Caused by vancomycin
  • Drug raising intracranial pressure:
    Steroids, hypervitaminosis A, oral contraceptive, tetracyclines amiodarone, quinolones.
  • Oral anticoagulants act by interfering with prothrombin, factor VII, IX, X
  • Non-selective α blockers = Ergotamine, Dihydroxyergotamine (DHE) chlorpromazine phentolamine, ergotamine
  • Non-selective β blockers = (β1 + β2) = Propranolol, sotalol, Timolol, oxprenolol
    Labetalol and Carvedilol = with α blocking property = (α + β blocker)
  • β1 blocker (cardioselective)
    Atenolol, Metoprolol, Esmolol, Betaxolol, Bisoprolol
  • Bone marrow suppression is the most serious toxicity of anticancer drugs with often limits the dose. Infections and bleeding are usual complications.
    55
    Anticancer drug
    Prominant side effects
    1. Actinomycin D
    2. Bleomycin
    3. Busulphan
    4. Cyclophosphamide
    5. Doxorubicin
    6. Methotrexate
    7. Vincristine
    8. Melphalan
    Alopecia, BMS
    Pulmonary fibrosis
    Pulmonary fibrosis, hyperuricemia
    Alopecia, hemorrhagic cystitis
    Cardiotoxicity
    BMS, acute renal failure, Histotoxicity
    Alopecia, Peripheral neuropathy
    Pulmonary fibrosis
  • ACE inhibitors and angiotensin antagonists (Losartan) are contraindicated in pregnancy.
  • T3 & T4
    1. Thyroid secretes more T4 than T3
    2. T4 = More tightly bound to plasma protein (15 times) = major circulatory hormone
    3. T3 = 5 times more potent than T4
    4. 1/3rd of T4 is converted T3 is in peripheral tissues
    5. T3 is more avidely bound to nuclear receptors than T4
  • Diabetic ketoacidosis treatment =
    • Insulin
    • IV fluid = to combat dehydration
    • KCl = to prevent hypokalemia as K+ is driven intracellularlly with insulins therapy)
    • Sodium bicarbonate = if pH < 7.1
    • Antibiotics
    • Phosphate
  • Indications of purer/human insulins:
    1. Insulin resistance
    2. Allergy to conventional preparations
    3. Injection site lipodystrophy
    4. Short-term of insulin (Diabetic)
    5. Pregnancy
  • Uterine
    56
  • Edrophonium 2 mg IV
  • 1.5 mg neostigmine (IM) = improve = “Myasthenia gravis”
  • Side effects of phenytoin = Megaloblastic Anaemia, osteomalacia, Pancytopenias and H5 = Hypertrophy of gums, Hirsutism, hyperglycemia, hypersensitivity hydantoin Syndrome.
  • Side effect of cisplatin = vomiting
  • Side effect of cisapride = Diarrhoeas
  • Tamsulosin = α1 A antagonist (DYNAPRESS)
  • +ve intopic action = ↑ in force of contraction (↑ myocardial contractibility)
  • Erythromycin:
    Treatment of choice in:
    • Pertusis
    • Mycoplasma pneumonia infection
    • Legionnaire's disease (Azithromycin)
    • Diphtheria carriers → erythrasma
    • Chancroid
  • Treatment of choice of cholera
    1. Adults: Doxycycline 300 mg single dose = DOC
      (or tetracycline 500 mg tid × 3d)
    2. Children: Septran (Sulfamethoxazole + Trimethoprim)
    3. Pregnant women: Furazolidine 100 mg q id × 3d
  • 5HT receptor
    • 5HT1:
    • 5HT2: 5HT2A = Ketanserine, cyproheptadine (Antagonists)
    • 5HT3 : Ondensetron (Antagonist)
    • 5HT4 : Cisapride (Agonist)