Second MBBS Buster Pharmacology Avishek Layek, Dyuti Deepta Rano
INDEX
A
Abciximab, mechanism of action of 113
Abdominal syndrome 63
Acarbose 86
mechanism of action of 86
Acetazolamide 49
Acetylcholine 183
high-dose of 190
Acidic drugs 48, 73
Acidosis 32
Acyclovir, mechanism of action of 117
Adenosine 33
Adipose tissue 85, 86
Adrenal medulla 190
Adrenaline 4, 6, 13, 46, 187
mechanism of action of 77
Adrenergic drugs 13, 14
Adverse drug reaction 6
Airways
hypersensitivity of 81
inflammation of 81
Ajmaline test 202
Albendazole 61, 137
mechanism of action of 124
Albuminemia 108
Alendronate 33
Alkalinization 144
Allergy 42
Alopecia 69
Alpha-1 acid glycoprotein 48
Alpha-adrenergic
agonists 49
receptor 4, 183, 190
Alpha-blocker 105, 187
administration of 187
Alpha-bungarotoxin 183
Alpha-calcidiol, mechanism of action of 107
Alprazolam, mechanism of action of 96
Alprostadil 209
Alteplase 114
mechanism of action of 114
Amebic dysentery, drug for 135
Amfebutamone 203
Amikacin 10, 67
Amiloride 208
Aminoglycoside 45, 119, 127
antibiotic 178, 179
transport of 119
Aminophylline 144
Amiodarone 39
Amitriptyline 39
Amlodipine 57
Ammonia, aromatic spirit of 157, 159
Amnesia 70
Amoxicillin 6, 44, 144, 173
antibacterial action of 173
capsules 138
Amphetamine 13, 209
Amphotericin B, mechanism of action of 127
Ampicillin 65
Anabolic steroids 51
Analgesics 29
Anaphylactic reaction, acute 77
Anemia
chronic renal failure-induced 107
megaloblastic 35, 111, 114
Anesthesia
dissociative 56
epidural 54
infiltration 54
spinal 54
surface 54
Angina 105
exacerbation of 55
pectoris 41, 146
acute attack of 138
worsening of 75
Angioedema 41
Angiotensin-converting enzyme 57
mechanism of action of 100
side effects of 41
Antacid 176
Antianginal drugs 22
Antiarrhythmics 39
Antibiotics 34
Anticancer drugs, classification of 28
Anticholinergic 70, 73, 83, 95
drugs 13
inhaled 83
Anticholinesterases 76
Anticoagulants 23
Anticonvulsants 45
Antidepressants 39, 98
Antidiabetic agent 150
Antidiuretics drugs 24
Antiemetics drugs 25
Antiepileptic drugs 20, 35, 54
Antihypertensive drugs 21, 22, 41, 55
classification of 41
Antileprotic drugs 26
Antimalarial drugs 27, 117
Antimicrobial drugs 117
Antineoplastic therapy 131
uses of 131
Antiobesity therapy 208
Antiparkinsonian drugs 20, 55
Antiparkinsonian therapy 93
Antiphlogistic action 156
Antiplatelet drugs 24
Antipsychotics, atypical 98
Antiretroviral agent 124
Antiretrovirus drugs 27
Antirheumatoid drugs 16
Antiseptic 9
Antisera 9
Antisnake venom 71
Antithrombotic drugs 24
Antithyroid drugs 34
Antitubercular drugs 10, 26
Antitubercular therapy, phase of 118
Antivenom sera 153
Antiviral agent 117
Anxiolytics 34
Apomorphine 209
Apraclonidine 49
Aripiprazole, mechanism of action of 98
Arrhythmia 102
cardiac 55, 91, 146
transient 70
Artesunate 151
Aspirin 6, 48, 50, 145, 146, 174
mechanism of action of 112
Astemizole 39
Asthma 32, 36
chronic 38
exacerbations 36
prophylaxis of 85
Atenolol 145
Atkins 208
Atonic seizures 96
Atracurium 106
Atrial fibrillation 102, 178
Atropine 6, 32, 39, 55, 70, 168
poisoning 32
side effects of 169
sources of 167
sulfate 50, 73, 148, 165
eye ointment, preparation of 165
uses of 168
Atropinic drugs 13
Attack, acute 37, 40, 145
Autacoids 7, 50, 79, 197
Autonomic nervous system 49, 74, 196
Azithromycin 63, 204
Azoles 64
mechanism of action of 121
B
Bacillary dysentery, drug for 134
Bacterial conjunctivitis, acute 136
Bacterial infections 119
Bacterial resistance 120
Bacterial vaginosis 32
Bactericidal antibiotic 10
Bactericidal antimicrobial agent 141
Baking soda 172
Bambuterol 36
Barbiturates 45
Beclomethasone 43, 143, 144
Bentonite 160162
Benzathine penicillin 138
Benzodiazepines 18, 45
poisoning 32
Benzonatate 207
Beta-adrenergic
blockers 14, 49
receptors 4
Beta-blocker 75, 105
mechanism of action of 102104
Beta-lactam aminopenicillin 173
Beta-lactamase 119
inhibitor 119
Beta-tubulin 61
Bethanechol 40
Bier's block 54
Biguanides 85
Bipolar disorder 54, 97
Bisacodyl tablets 139
Bisoprolol 44
Bleeding esophageal varices 33
Bleomycin 28
Blood
and blood formation 59, 108, 199
gas progression 7
glucose 85
Bone marrow suppression 69
Bradycardia 178
severe 46
Bradykinesia 153
Breast cancer 69, 88
Broad-spectrum bacteria 62
Bronchial asthma 7, 35, 73, 8184, 143
acute exacerbation of 144
asthma, drugs for 16
exacerbation of 81
Bronchial challenge test 202
Bronchial hyperactivity 35
Bronchial hypersensitivity 81
Bronchial smooth muscles 36, 83
Bronchoconstriction, ACH-mediated 83
Bronchodilators 144
Bronchogenic carcinoma 130
Brucellosis 63
Bupivacaine 6
Bupropion 32, 203, 209
Burkitt's lymphoma 69
Butyrophenones 55, 153
C
Caffeine 138
Calamine 160162
lotion, preparation of 160
Calcitriol, formation of 86
Calcium
absorption 86
channel blockers 22
Cancer cell cycles 131
Candida albicans 65
Capreomycin 10
Carbamate poisoning 32
Carbamazepine 6, 32, 44, 54
Carbidopa 93
Carbimazole 91
mechanism of action of 89
Carbohydrate 86
Carbonic anhydrase inhibitors 49
Cardamom 159
Cardiotoxicity 178
Cardiovascular drugs 99
Cardiovascular system 56
Carminative mixture
preparation of 157
uses of 159
Carvedilol, mechanism of action of 104
Catecholamines 13
blood volume 105
Catechol-O-methyltransferase 187
Cell
cycle 131
membrane 202
Central nervous system 54, 92, 198
Cerebellar signs 35
Ceruloplasmin 48
Cevimeline, mechanism of action of 78
Chancroid 63
Cheese reaction 32
Chemotherapy 1, 68, 130, 201
Chest syndrome, acute 63
Chlophedianol 207
Chloramphenicol 65, 118, 121
Chloroquine 32, 65, 66, 126, 151, 175
phosphate 73
resistant malaria, treatment of 151
Chlorpromazine 48, 70, 153
Chlorpropamide 87, 178
half-life of 178
mechanism of action of 87
renal clearance of 178
Cholera 32
Choline esters 12
Cholinergic
agonists, uses of 39, 40
drugs 12
Cholinomimetic drugs 39
classification of 40
Choroiditis 167
Chloroquine, mechanism of action of 123
Chromaffin cells 190
Chromosome, gene of 107
Ciliary body cox-2 enzyme 74
Cilostazol 208
Ciprofloxacin 62, 125, 134, 136, 174
inhibits 62
Cisapride 39
Cisplatin, mechanism of action of 130
Clavulanic acid 144, 173
Clindamycin 65
Clofazimine capsules 135
Clomiphene challenge test 202
Clomiphene citrate, mechanism of action of 89
Clonazepam 32
Clonidine 203
uses of 204
Clopidogrel, mechanism of action of 112
Codeine 6, 206
Colchicine 44, 137
actions of 80
Combined oral contraceptive pill 175
Complex partial seizures 54
Condyloma acuminata 70
Congestion, conjunctival 168
Congestive cardiac failure, management of 39
Corticosteroids 6, 18, 34, 42, 88
actions of 81
inhaled 37, 38, 84
Cotrimoxazole 128, 129
Crystalline penicillin 123
mechanism of action of 123
Cushing's syndrome 46, 64
Cutaneous T-cell lymphoma 70
Cycloplegia 167
Cytanaleine 28
Cytochrome 133
D
Dalteparin sodium 146
Danazol, mechanism of action of 90
Dantrolene 95
mechanism of action of 95
sodium 33
Dapsone 44, 135
Datura poisoning 39, 76
DEC provocation test 202
Deep vein thrombosis, prophylaxis of 59
Degradation inhibitor 206
Dehydration, severe 172
Delirium 169
Depression 95
treatment of 98
Dermal leishmaniasis 64
Dermatitis, acute exudative 162
Dermatophytosis 64
Desferrioxamine 133
Dextromethorphan 207
Dextrose-saline 144
Diabetes insipidus 106
drug for 208
Diabetes mellitus 42
gestational 141
type 1 41
type 2 85
Diarrhea 32, 65, 116, 171
mild 171
moderate 171
treatment solution 172
Diazepam 40, 46, 48
Dichloroisoproterenol 4
Dicoumarol 178
Diethylcarbamazine citrate 136
Digoxin 45, 144, 145, 177, 178
mechanism of action of 101, 102
toxicity, precipitation of 177
Dihydrotestosterone 75
Diloxanide furoate 127
Diltiazem 34
Dipivefrine 49
Directly observed treatment short-course 10
Discoid lupus erythematosus 66
Disease-modifying antirheumatic drugs 207
Disopyramide 39
Disposable sterile
blood transfusion set 195
intravenous fluid infusion set 195
Disulfiram 106
Diuretics 9
drugs 24
Dobutamine 13
Domperidone 71, 115, 141
mechanism of action of 115
Donovanosis 63
Donovans bacillus granulomatis 63
Dopamine 13, 146
mechanism of action of 101, 104
Dopaminergic pathways, significance of 205
Doxorubicin 28
Doxycycline 32, 48, 63
Drotaverine 32
Drug 1
administration 73
routes of 30
modifying dopaminergic transmission 205
potency 72
synergism 46
D-tubocurarine produce 84
Duodenal ulcer, drug for 134
Dysgeusia 41
Dyslipidemia, diabetic 32
Dysmenorrhea 32, 168
Dyspepsia 156
E
Ebastine 39
Eczema 162
Edema 42, 51
Emergency contraceptives 52, 209
Enalapril 180
mechanism of action of 107
Endocarditis
infective 63
subacute bacterial 68
Endothelial cells 88
Endothelium 88
Enoxaparin 32
Enterobacteriaceae 62
Enteroendocrine K cells 86
Enzyme 5-alpha-reductase, inhibitor of 75
Ephedrine 13, 74, 168
Epigastric pain 35
Epilepsy 8
Epileptic fit 32
Erectile dysfunction, drug for 209
Ergometrine 6, 90, 138
Ergotamine, actions of 90
Erythromycin 6
Erythropoiesis-stimulating agents 107
Erythropoietin, mechanism of action of 107
Estrogens 6, 91
Ethambutol tablets 139
Ethinyl estradiol 175
Ethosuximide 48
Ethyl alcohol 3, 173
mechanism of action of 94
Ethylestrenol 51
Etoposide 28
Euthyroid state 34
Exacerbations, treatment of 81
Expiratory airflow limitation 7
Extracellular fluid 184
Extracerebral decarboxylase inhibitor 93
Extraintestinal amebiasis 66
Extrapyramidal disorders 153
F
Falciparum malaria 122
Familial colonic polyposis 51
Fat cell 86
Fatty acid oxidation 85
Fatty tissues 184
Fenfluramine 206
Ferric oxide 162
Ferrous sulfate 152
Fetal
hydantoin syndrome 35
hypothyroidism 91
Fibrillar protein tubulin 81
Fibroblasts 88
Filariasis 61
drug for 136
Finasteride 75
Fingertip unit 10
Flozins 204
Flu syndrome 63
Flumazenil 32
Fluoroquinolone 10
first-generation 62
mechanism of action of 128
Fluoxetine, mechanism of action of 95
Focal seizures 54
Folic acid 111, 114, 142
deficiency 114
Folinic acid 130
Follicular lymphoma 70
Fomepizole 1, 33, 44
Formaldehyde 94
Formic acid production 94
Formoterol 36
Fosphenytoin 96
Fractures, spontaneous 42
Fragile skin 42
Frusemide 145
Fungal infections 42
Furosemide 58, 103
G
Gallamine 178
dose of 179
Galli's pot 166
Gamma aminobutyric acid, facilitation of 35
Gamma aminolevulinic synthetase, depression of 46
Gamma benzene hexachloride 163
ointment, preparation of 163
Gastric
acid secretion 60
hypermotility 168
Gastroesophageal reflux disease 40, 115
Gastrointestinal drugs 114
Gastrokinetic action 60, 116
Gentamicin 178
inhibits acetylcholine 178
Giardia lamblia 66
Glaucoma 40, 42, 74, 76, 78
acute congestive 149
drug treatment of 49
provocative test for 202
water drinking test for 202
Glimepiride 52
Global Strategy for Asthma Management and Prevention 2016 Update 36
Glomerulopathy, index of 108
Glucagon-like peptide-1, plasma level of 86
Glucocorticoid 18, 73
receptor antagonist 43
stabilize 88
therapy
contraindications of 42
side effects of 42
Gluconeogenesis, hepatic 85
Glucose tablets 203
Glutamate, inhibition of 35
Glycerin 160162
actions of 162
Glyceryl trinitrate 145, 146
Glycogen storage 85
Glycopyrrolate 70
Glycoside, cardiac 178
Gonadotropins, suppression of 90
Gonorrhea, drug for 138
Gout
acute 137
drugs for 16
Gram-negative aerobic infections 119
Granulocytopenia 41
Growth retardation 42
Gums, hyperplasia of 35
Gynecomastia 64
H
Haemophilus influenzae 63
Hair, graying of 66
Hallucinations 40
Haloperidol 70
Halothane 95
Head injury 98
Headache, simple 32
Hearing, loss of 66
Heart
block, partial 168
disease, ischemic 102
failure 101, 104, 144
causes of 145
congestive 23, 104, 144
rate 187
Heavy metal complex 130
Helicobacter pylori infection 114
Hematinics 9
Hemolysis 63
Hemolytic reaction 108
Hemorrhage, postpartum 90
Hemosiderin 133
Henderson-Hasselbalch equation 73
Heparin 109
mechanism of action of 113
Hepatic microsomal enzyme 175
Hepatitis, chronic 70
Herpes simplex keratitis 42
High-dose methotrexate therapy 130
Highly active antiretroviral therapy 119
Hirsutism 35, 42
Histamine 4, 83
Hookworm 61
Hormone 51, 85, 197
replacement therapy 91
Hydatid disease 61
Hydrochlorothiazide 91, 177, 178
chronic use of 91
Hydrocodone 207
Hydrocortisone 34, 48
hemisuccinate 35
prednisolone 43
sodium succinate 144
Hyoscine 39, 70
Hyperaldosteronism, secondary 32
Hyperemesis gravidarum 60
Hyperglycemia 35, 36
Hyperkalemia 41, 57
Hyperlipidemia 59
Hypersensitivity 35, 59
Hypertension 32, 33, 75, 99
chronic 91
moderate 147
Hypertensive emergency 8, 102, 147
management of 41
Hyperthermia, malignant 33, 95
Hyperthyroidism 32, 89
Hyperuricemia 59
Hypocalcemia 59
Hypoglycemia 59, 179
potentiation of 179
severe 151
Hypoglycemic coma 41, 150
management of 41
Hypokalemia 36
Hypokalemic metabolic alkalosis 59
Hypolipidemic drugs 22, 112
Hypomagnesemia 59
Hyponatremia 59
Hypoproteinemia 48
Hypotension 57, 70
Hypothyroidism 32
Hypoxemia 107
Hypoxia, diffusion 8
I
Ibuprofen 32
Indomethacin 208
actions of 80
Infantile spasms 32
Infective diarrhea 171
causes of 171
Inflammation, pain of 156
Inflammatory bowel disease 69
Inositol monophosphatase 56
Insulin 17, 179
therapy, indications of 41
Intensive care unit 37
Intestinal amebiasis 127
Intracranial tension, raised 156
Intraocular tension 41, 167
Intrauterine contraceptive device 209
Intravenous fluids 31
therapy set, component of 195
Intravenous rehydration, indications of 172
Intubation 36
Ionization 73
Iopanoic acid 34
Ipratropium 143, 144
bromide 36, 82
Iridocyclitis, treatment of 167
Iritis, acute 167
Iron 142
Irritable bowel syndrome 168
drug for 208
Isoniazid 118, 139
mechanism of action of 129
Isosorbide mononitrate 145
Isotretinoin 6
Isoxsuprine 208
Ivermectin 165
mechanism of action of 126
J
Jaundice, congenital nonhemolytic 46
K
Kala-azar 64
Kanamycin 10
Kaposi's sarcoma 70
Ketamine 18, 56
Ketoacidosis, diabetic 41, 149
Ketoconazole 64
Ketolide antibiotics 204
Kidney 106
cells 107
peritubular interstitial cells of 107
L
Labor, induction of 89
Largactil 153
Laser iridotomy 149
Latanoprost, mechanism of action of 74
Legionellosis 63
Lepra reaction 66
Leucovorin 130
Leukotriene 83
Levocetrizine 50
Levodopa 55, 93
Levonorgestrel intrauterine system 209
Libido, loss of 64
Light reflex, loss of 167
Lignocaine 40, 53, 142
mechanism of action of 102
Linezolid 33
Lipodystrophy 42
Liposomal amphotericin B 1, 120
Lithium 45, 48, 55, 179
inhibits hydrolysis 56
mechanism of action of 97
Liver disease 46
Log dose-response curves 181
Lorazepam 6
Lorcaserin 209
Losartan 56
Lotion calamine, actions of 162
Low dose aspirin 141
Low molecular weight 32, 59
heparin 59, 109
Lower uterine segment 90
Lysosomal membrane 88
M
Macrolide antibiotics 125
mechanism of action of 125
Magnesium sulfate 32, 156
actions of 156
contraindications of 156
purgative, preparation of 154
solubility of 155
Malaria 32, 63
chloroquine-resistant 151
endemic area of 151
treatment 126
Malleable intravenous catheter 194
Mannitol, mechanism of action of 108
Mean arterial blood pressure 186, 188, 189
Mebendazole 137
Mecamylamine 203
Medical termination of pregnancy, 2nd trimester of 91
Mefloquine 151
Meningitis 118
Meningococcal meningitis, prophylaxis of 63
Mental disturbances 66
Meropenem 64
Mesocortical pathway 205
Mesolimbic pathway 205
Metered dose inhaler 193
Metformin 85, 204
actions of 85
mechanism of action of 85
Methacoline 40
Methadone 32, 92
Methemoglobinemia 54
Methenamine therapy 121
Methicillin-resistant Staphylococcus aureus 33
Methotrexate 68, 130
Methyl alcohol poisoning 33, 94
Methyl xanthene alkaloid 82
Metoclopramide 55, 71, 115, 137, 146
mechanism of action of 115
Metoprolol 48, 146
Metronidazole 106, 135, 173
Miconazole ointment 136
Microsomal enzyme protein, synthesis of 45
Microtubule polymerization 61
Mifepristone 43, 209
Migraine 79
drugs for 15, 137
Miltefosine 44
Mineralocorticoids 18
Minimum bactericidal concentration 10
Minimum inhibitory concentration 10
Miotics 40, 49
Misoprostol 53
mechanism of action of 79
Mitochondrial respiratory chain 85
Mitomycine 28
Mixed worm infestation, drug for 137
Mononucleosis, infectious 66
Monosulfiram 165
Monotherapy 93
Montelukast 85
Morning sickness 32
Morphine 6, 48, 70
mechanism of action of 101, 103
sulfate 146
withdrawal 32, 92
Motion sickness 32, 168
Moxifloxacin 39
Mucosal edema 35
Multibacillary leprosy, drug for 135
Multidrug resistant tuberculosis 10, 68
Multidrug therapy 121
Multiple myeloma 70
Muscarinic antagonists 13
Muscarinic blockers 168
Muscle cramps 91
Myasthenia gravis 76
ameliorative test for 202
provocative test for 202
Mycobacterial infections 175
Mycobacterium leprae 119
Mycobacterium tuberculosis 129
Mydriasis 167
Myeloid leukemia, chronic 70
Myelosuppression 70
Myocardial infarction, acute 146
Myoclonic seizures 96
N
N-acetyl cysteine, mechanism of action of 81
Naltrexone 209
Nandrolone 51
Narcotic antitussive 206
Natriuretics 9
Natural alkaloids 13
Nausea and vomiting
drug for 137
postoperative 60
Neisseria meningitidis 63
Neoplastic diseases 130
Neostigmine 76
Nephritis, interstitial 63
Nephropathy, diabetic 107
Nerve block anesthesia 54
Neurocysticercosis 61
Neurogenic theory 79
Neuroleptics 70
Neuromuscular junction 178
Neuronal degeneration 206
Neurotoxicity 70
Nicotine
chewing gum 203
transdermal patch 32, 203
Nifedipine 145, 208
Nigrostriatal pathway 205
Nitrate 101
actions of 41
Nitroglycerin 48, 99
Nonobstructive urinary retention 40
Nonselective beta-blockers 34
Non-steroidal anti-inflammatory drugs 15
Non-steroidal inhibitor of renal epithelial sodium 91
Noradrenaline 13, 46, 183, 187
Norethindrone acetate 175
Norfloxacin 134, 136
Noscapine 207
Nucleic acid synthesis 131
O
Octreotide 33
Omeprazole 60
Ondansetron 32, 59, 71, 115
blocks 60, 116
Open-angle glaucoma 49, 74
Opioid 70
analgesic 18, 21
antagonists 21
Oral anticoagulants 23
Oral contraceptive pill 175
Oral hypoglycemic
agent 178
sulfonylureas group of 52
Oral rehydration salt
powder, preparation of 169
solution 172
Organ
protective role 108
transplantations 69
Organophosphate 169
poisoning 32
Organophosphorus insecticide 148
Orlistat 209
Orphan drugs 1, 44
Osteoarthritis 50
Osteomalacia 35
Osteomyelitis 63
Osteoporosis 42, 85
postmenopausal 33
Ototoxicity 59, 68
Ovarian function 90
Oxandrolone 51
Oximes 76
Oxycodone 207
Oxygen inhalation 144
P
Paclitaxel 28
Pancreatic beta-cell level 87
Pantoprazole 71
Paracetamol 6, 32, 153
poisoning 32, 81
toxicity, acute 46
Parasympatholytics 13
Parenteral anticoagulants 23
Parkinsonism like syndrome 153
Paroxysmal supraventricular tachycardia 33
termination of 40
Penicillin 6, 26, 118, 129
binding proteins 208
blocks tubular secretion of 129
Penile erection, papaverin induced 209
Pentoxiphylline 208
Peptic ulcer 6, 42, 116, 117, 168
drugs for 25
Peripheral nervous system 53, 92, 198
Peripheral vascular disease 78
drug for 208
Permethrin 165
Persistent codeine resistant cough 41
Pharmacodynamics 1
Pharmacokinetics 1
Pharmacology 1
charts 181
general 44, 196
Pharmacovigilance 7, 47
Pharmacy 154
Phenobarbitone 45, 48
Phenothiazine 55, 153
Phenoxybenzamine 183, 208
Phentermine 209
Phentolamine 32, 209
Phenylbutazone 48
Phenylephrine 168
response of 187
Phenylpropionate 51
Phenytoin 3, 6, 32, 35, 48, 96
mechanism of action of 35
sodium 135
water soluble prodrug of 96
Pheochromocytoma 105
Phocomelia 6
Photo allergy 66
Photogenic reactions 66
Photophobia 169
Physostigmine 32, 40, 76
actions of 76
Pilocarpine 40, 41, 76
Pimozide 39
Pin worm 61
Pindolol 46
Pioglitazone 86
mechanism of action of 86
Piperacillin 33, 119
antibacterial action of 119
destruction of 119
preparation of 119
Plasma
concentration versus time curves 183, 184
half-life 3, 48
protein binding 48
Plasmodium ovale malaria 117
Plasmodium vivax 117
Pneumonia, atypical 63
Poisoning, severe 169
Potassium
chloride 170
supplement 144
Pralidoxime chloride 148
Prazosine 33, 208
Preanesthetic medication 70
drugs 20
Prednisolone 43
Pregnancy
2nd trimester 152
anemia in 152
Primaquine 117
Probiotics, uses of 65
Procainamide 39
Progestins 91
Promethazine 32
Propafenone 39
Propofol 54, 96
Propoxyphene 207
Propranolol 34, 48, 78, 177, 179
Propylthiouracil 34, 89, 91
Prostaglandin 91
analogs 49
Prostate, benign hypertrophy of 75
Prostatic hypertrophy, benign 33
Protein Bindings Act 48
Proteinuria 41
Proton pump inhibitor 134, 141
Pseudomembranous colitis 65
Pseudomonas 62, 68
Psoriasis 69
Psychiatric disturbances 42
Psychiatric illness, chronic 153
Psychosis 42
Pulmonary edema, acute 103
Pure anti-inflammatory action 35
Pylorospasm 168
Pyrazinamide 118, 139
Pyridoxine 93, 118, 176
hydrochloride tablets 139
Q
Quantal curve example 182
Quaternary compounds 13
Quinidine 39
R
Radiopaque dyes 202
Ranitidine 71, 134
Reflex bradycardia 187
Refraction test 78
Relapsing malaria, radical cure of 117
Renal artery stenosis, bilateral 41
Renal failure 42
acute 41, 63
chronic 107
Reserpine, mechanism of action of 98
Respiratory depressions 169
Respiratory system 51
drugs 81
Retinal damage 66
Rheumatic fever, acute 50
Rheumatoid arthritis 50, 69
Rifampicin 10, 45, 62, 63, 135, 139, 175
Rimonabant 203, 209
Ringer lactate solution 172
Ritonavir boosted therapy 125
Ritonavir, mechanism of action of 124
Roland's epilepsy 54
Rosiglitazone 86
Round worm 61
S
Salbutamol 13, 36, 48, 144, 202
actions of 83, 84
dose of 144
inhalation of 143, 144
Salmeterol 36
Salmonella 63
Scabies 164
Scopolamine 32
Selective phosphodiesterase inhibition-4 82
Semisynthetic derivatives 13
Serotonergic system 206
Shock, cardiogenic 104
Sialoglycoprotein hormone 107
Sibutramine 209
Sigmoid curve 182
Sildenafil 101
Single antibiotic therapy 114
Sinus bradycardia 168
Skeletal muscle 85
relaxants 17
Snakebite, management of 152
Sodium
benzyl penicillin 123
bicarbonate 144, 157, 159
chloride 169, 170
chromoglycate 84
citrate 160, 161, 170
function of 162
cromoglicate 36, 51
glucose cotransporter 2 141
nitrite 1, 44
phenobarbitone 73
sulfadiazine 73
Somatropin 44
Sparfloxacin 39
Spasmogenic drugs 190
Spastic colitis 156
Spastic constipation 168
Spirit 159
Spironolactone 32, 180
Stable angina 145
management of 41
Stanozolol 51
Staphylococcus aureus, vancomycin-resistant 33
Staphylococcus infections 63
Statins, mechanism of action of 112
Status asthmaticus 7, 37
Status epilepticus 8
Streptogramins 33
Streptokinase 114, 146
Streptomyces avermitilis 126
Streptomyces clavuligerus 173
Streptomyces nodosus 127
Succinylcholine 92
mechanism of action of 92
Sucralfate 176
Sudden cardiac death 75
Sulfadoxine 151
Sulfamethoxazole 129
Sulfonamide therapy 121
Sulfonamide, mechanism of action of 126
Sulfonylureas 204
Sumatriptan 79, 137
actions of 79
Sunburn 162
Super saturated solution 156
Syntocin 89
Syphilis, drug for 138
Systemic lupus erythematosus 66
T
Tachycardia 36, 187
Tachyphylaxis 6, 74
Taeniasis
drug for 136
types of 136
Tamoxifen, mechanism of action of 88
Tamsulosin 75
mechanism of action of 75
Tazobactam 33, 119
pharmacokinetics of 119
preparation of 119
Telengiectasia 42
Tendon rupture 62
Tenosynovitis 62
Terbutaline 36, 144
Terfenadine 39
Teriparatide, mechanism of action of 85
Tetracycline 65, 127
actions of 122
Thalassemia 133
Thalidomide 209
Theophylline 3, 36, 48, 82, 83, 174
mechanism of action of 82
Therapeutic drug monitoring 72
indications of 202
Therapeutic index 45
Therapeutic window phenomenon 7
Thiabendazole 165
Thiazide 21, 91, 179
diuretics, mechanism of action of 99
mechanism of action of 106
Thiazolidinedione 86
Thioamide 34
Thiopentone 6, 96
sodium 45, 184
Thioridazine 39
Thrombolytic agents 114
Thymoxamine 209
Thyroid
dysfunction 70
hormone 88
inhibitors 17
peroxidases, activation of 34
stimulation 88
surgery 88
Thyrotoxicosis 78
acute 34
Timolol 78
Tincture 159
composition of 159
Tocolytics 19
Tolbutamide 3, 48, 150
Tolvaptan, mechanism of action of 106
Tonic-clonic seizures
drug for 135
generalized 32
Topical beta-blocker 50
advantages of 40
Topiramate 203, 209
Topotecan 28
Torsades de pointes 39
Toxoid 9
Toxoplasma gondii 63
Trabeculectomy 149
Trachoma 63
Tramadol 32, 153
Tranylcypromine 206
Trazodone 209
mechanism of action of 98
Triamcinolone acetonide fluticasone 43
Triamterene 91
Tricyclic antidepressants, mechanism of action of 93
Trihexyphenidyl hydrochloride 153
Trimethoprim 129
Trisodium citrate dehydrate 170
Tropicamide 78
Tryptophan 206
Tuberculosis 42
monoresistance 10
polydrug resistance 10
uncomplicated pulmonary 139
Tuberoinfundibular pathway 205
Tubular necrosis, acute 63
Tumor, removal of 106
Typhoid fever, drug for 134
Tyramine 13
U
Unstable angina 59
Ureidopenicillin 119
Urinary tract infection 32
drug for 136
Urine 121
Urticaria 162
Uterine relaxants 19
Uveoscleral outflow 74
V
Vagomimetic action 39
Valproate 6, 32
mechanism of action of 95
Valproic acid 95
Vancomycin 33
Varenicline 32, 203
Variant angina, pathogenesis of 105
Vascular theory 79
Ventilation-perfusion mismatch 144
Verapamil 48, 177
Vigabatrin 32
Vinblastine 28
Vincristine 28
Vinorelbine 28
Vision, blurring of 40, 148
Vitamin B12 114
deficiency 114
Vitamin K metabolism 96
Vomiting
chemotherapy induced 115
cisplatin-induced 33
W
Warfarin, mechanism of action of 113
Weight
gain 42, 204
loss 204
Whip worm 61
X
Xanthinol nicotinate 208
Xerostomia 78
Y
Yellow soft paraffin 165
Z
Zero free water clearance 9
Zinc oxide 160, 161
actions of 162
Ziprasidone 39
Zollinger-Ellison syndrome 61
×
Chapter Notes

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Definitions in PharmacologyCHAPTER 1

Avishek Layek
  • Drug: Drug is any substance or product that is used or is intended to be used to modify or explore physiological systems or pathological states for the benefit of the recipient.
    Drugs thus can be classified according to this definition into four basic types:
    1. Modify physiological system, e.g. vaccines modifying immune system
    2. Explore physiological system, e.g. radioiodine dyes to exclude pathology
    3. Modify pathological system, e.g. diuretic to reverse edema
    4. Explore pathological system, e.g. radioactive dyes to confirm pathology.
  • Pharmacokinetics: It is defined as movement of the drug in and alteration of the drug by the body; including absorption, binding/localization/storage, biotransformation and excretion of the drug.
  • Pharmacodynamics: It is defined as the study of the biochemical and physiological effects of drugs and their mechanisms of action at organ system/subcellular/macromolecular levels.
  • Chemotherapy: It is defined as the treatment of systemic infections or malignancy with specific drugs that have selective toxicity for the infecting organism or malignant cell respectively, with no or minimal effects on the host cell.
    Another classification of drugs may be:
    • Pharmacodynamics agents—designed to have pharmacodynamics effects in the recipient
    • Chemotherapeutic agents—inhibit or kill parasite/malignant cell with minimal pharmacodynamics effect to the recipient (however, there is no drug that has zero systemic effect).
  • Essential medicines: They are defined as those drugs that satisfy the priority healthcare needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety and comparative cost effectiveness.
    No. of essential drugs in National List of Essential Medicines of India:
    • 2011 : 348
    • 2015 : 376 (106 drugs added and 70 deleted from 2011 list)
  • Orphan drugs: These are drugs or biological products for diagnosis or treatment or prevention of a rare disease or condition, or a more common disease (endemic only in resource poor countries) for which there is reasonable expectation that the cost of developing and marketing it will be recovered from the sales of that drug, e.g.:
    • Sodium nitrite—used with sodium thiosulfate to treat cyanide poisoning
    • Fomepizole—treat methanol and ethylene glycol poisoning
    • Liposomal amphotericin B—used in morbid systemic fungal infections2
  • Bioavailability: Defined as the rate and extent of absorption of a drug from a dosage form which is measure of the fraction of administered dose of the drug that reaches the systemic circulation in unchanged form.
    • 100% bioavailability is attained in intravenous route.
      Exception: Chloramphenicol succinate; about 70% because renal excretion of ester before hydrolysis.
    • Nearly 100% oral bioavailability is attained in levofloxacin.
      zoom view
      Fig. 1.1: Concentration-time graph showing bioavailability for IV and oral routes
  • Apparent volume of distribution: Presuming that the body behaves as a single homogeneous compartment, the apparent volume of distribution is defined as the volume that would accommodate all the drug in the body; if the concentration throughout was the same as plasma.
    zoom view
    Fig. 1.2: The concept of apparent volume of distribution in one compartment model
    3
  • Biotransformation: Defined as the chemical alteration of blood in the body.
    Isoniazid undergoes phase II followed by phase I reaction.
  • Clearance: It is defined as the theoretical volume of plasma from which the drug is completely removed in unit time.
    • Phenytoin/tolbutamide/theophylline/warfarin initially show zero order but then follow 1st order kinetics
    • Ethyl alcohol follows zero order kinetics.
      zoom view
      Fig. 1.3: The concept of clearance of a drug's
  • Half-life:
    • Plasma half-life: It is the time taken for the plasma concentration of the drug to be reduced to half from its original value
    • Biological effect of peak effect half-life: The time in which pharmacological effect of a drug or its active metabolites is reduced to half
    • Elimination half-life: The time in which the total amount of the drug in the body after equilibrium is attained (in plasma, fat, muscle, etc.) is reduced to half
    • Hit and run drugs: Drugs whose peak effect half-life > elimination half-life, e.g. proton pump inhibitors, monoamine oxidase inhibitors.
  • Loading dose: This is a single or few quickly repeated doses given in the beginning to attain target concentration rapidly.
  • Maintenance dose: This dose is one that is to be repeated at specific intervals after the attainment of target steady state plasma concentration so as to maintain the same by balancing elimination.4
    zoom view
    Fig. 1.4: Concept of achieving steady state plasma concentration with and without loading dose
  • Receptor: It is defined as a macromolecule or binding site located on the surface or inside the effector cell that serves to recognize the signal molecule or drug and initiate the response to it, but itself has no other functions.
    Silent receptor: These bind to drugs but show no pharmacological response, e.g. plasma proteins.
  • Agonist: An agent which activates a receptor to produce an effect similar to that of the physiological signal molecule. (Affinity is present and intrinsic activity = +1) (e.g. adrenaline at alpha adrenergic receptor, histamine at H1 receptor, etc.).
  • Antagonist: An agent which prevents the action of an agonist on a receptor or the subsequent response, but does not have any effect of its own (affinity is present and intrinsic activity = 0) (propranolol at beta-adrenergic receptors).
  • Inverse agonist: An agent which activates a receptor to produce an effect in the opposite direction to that of the agonist (affinity present and intrinsic activity = –1 to 0) (DMCM on BZD receptor).
  • Partial agonist: An agent which activates a receptor to produce submaximal effect, but antagonizes the action of a full agonist (affinity present and intrinsic activity = 0 to +1) (Dichloroisoproterenol on beta-adrenergic receptors).
  • Ligand: Any molecule which attaches selectively to particular receptors or sites.
  • Antagonism:
    • Competitive or equilibrium type: Increased kM but Vmax is unchanged, e.g. Methotrexate on dihydrofolate reductase
    • Noncompetitive type: kM remains unchanged but Vmax is reduced, e.g. aspirin on COX.5
    zoom view
    Fig. 1.5: Competitive antagonism
    zoom view
    Fig. 1.6: Noncompetitive antagonism
  • Fixed dose combination: A single formulation containing 2 or more drugs in a fixed dose ratio. NLEM India 2011 approves only 12 FDCs where as WHO approves 23 of them. Most widely used FDC is ORS.
  • Placebo: This is an inert substance given in the garb of medicine which works by psychodynamics rather than pharmacodynamics means.
    Naloxone suppresses endorphins in brain and can antagonize psychodynamics effect too.
  • Tolerance: It refers to the requirement of higher doses of a drug to produce a given response, e. g. sulfonylureas in type 2 DM.
  • Cross tolerance: It is a development of tolerance to pharmacologically related drugs, e. g. alcoholics are relatively resistant to barbiturates and general anesthetics.
  • Intolerance: It is the appearance of characteristic toxic effects of a drug in an individual at therapeutic doses. For example, carbamazepine producing ataxia in some people.6
  • Tachyphylaxis: It refers to rapid development of tolerance when doses of a drug repeated in quick succession result in marked reduction in response. For example, tyramine, ephedrine.
  • Drug resistance: It refers to tolerance of microorganisms to inhibitory actions of anti-microbials, e.g. Staphylococcus to penicillin.
  • Shelf life/life period of a drug: The period between date of manufacture and date of expiry.
  • Expiry date: It is a date stamped on all medicines beyond which medicine actually does not lose its potency or become toxic but simply the quality of the medicine is not assured beyond it; and the manufacturer is not liable if any harm arises from the use of it.
    The degradation product of only one drug is toxic in man: tetracycline
  • Adverse drug reaction: It is any noxious change which is suspected to be due to a drug, occurs at doses normally used in man, requires treatment or decrease in dose or indicated caution in the future use of the same drug.
    • Type A: Augmented pharmacological effects—dose dependent and predictable, e.g. hypoglycemia caused by anti-diabetics like SUs.
    • Type B: Bizarre or idiosyncratic—dose independent and unpredictable, e.g. allergic reaction to penicillins
    • Type C: Chronic effects, e.g. peptic ulcer due to NSAIDs
    • Type D: Delayed effects, e.g. phocomelia due to thalidomide
    • Type E: End of treatment effect, e.g. morphine withdrawal
    • Type F: Failure of therapy.
  • Idiosyncrasy: It is genetically determined abnormal reactivity to a chemical, e. g. dose unrelated serious aplastic anemia in some individuals.
  • Drug dependence: It is a state in which use of drugs for personal satisfaction is accorded a higher priority than other basic needs, often in the face of known risks to health. Types— psychological dependence, physical dependence, drug abuse, drug addiction and drug habituation.
  • Teratogenicity: It refers to the capacity of a drug to cause fetal abnormalities when administered to the pregnant mother.
  • Iatrogenicity: Induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.
Risk category of drugs during pregnancy
Category
Examples
A
Adequate studies in pregnant women have failed to demonstrate a risk to the fetus
Inj. Mag. sulfate, thyroxine
B
Adequate human studies are lacking, but animal studies have failed to demonstrate a risk to the fetus
or
Adequate studies in pregnant women have failed to demonstrate a risk to the fetus, but animal studies have shown an adverse effect on the fetus
Penicillin V, amoxicillin, cefaclor, erythromycin, paracetamol, lignocaine
C
No adequate studies in pregnant women and animal studies are lacking or have shown and adverse effect on fetus, but potential benefit may warrant use of the drug in pregnant women despite potential risk
Morphine, codeine, atropine, corticosteroids, adrenaline, thiopentone, bupivacaine
D
There is evidence of human fetal risk, but the potential benefits from use of the drug may be acceptable despite the potential risk
Aspirin, phenytoin, carbamazepine, valproate, lorazepam
X
Studies in animals or humans have demonstrated fetal abnormalities, and potential risk clearly outweigh possible benefit
Estrogens, isotretinoin, ergometrine
7
  • Pharmacovigilance: Defined by WHO in 2002 as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems.
  • Therapeutic window phenomenon: Some drugs show sub-optimal efficacy below a certain concentration and also beyond a certain concentration. Classical example is clonidine which shows optimum BP lowering between blood levels of 0.2 to 2.0 ng/mL.
  • Clinical trial: According to WHO, clinical trial is any research study that prospectively assigns human participants or groups of humans to one or more health related interventions to evaluate the effects on health outcomes. Summary of clinical trials:
Phase
Name
Conducted on
Blinding and control
Purpose
I
Human pharmacology and safety
Healthy volunteers (20–100)
Open Label (No binding)
  • To know maximum tolerable dose (MTD)
  • Safety and tolerability
II
Therapeutic exploratory
100–150 patients (homogeneous population)
Single blind controlled
  • To establish therapeutic efficacy
  • Dose ranging and ceiling effect
III
Therapeutic confirmatory
Up to 5000 patients from several centers (heterogeneous population)
Double blind randomized controlled
  • To confirm therapeutic efficacy
  • To establish the value of drug in relation to existing therapy
IV
Post-marketing surveillance
Large number of patients being treated by practicing physicians
  • To know rare and long-term adverse effects
  • Special groups like children, pregnancy, etc. can be tested
0 (Zero)
Microdosing studies
Healthy volunteers (small number)
Very low dose 1/100 of human dose; max 100 mg of drug is administered to know pharmacokinetics. This could avoid costly phase I studies for candidate drugs with unsuitable pharmacokinetics
  • Autacoids: These are diverse substances produced by a wide variety of cells in the body, having intense biological activities but generally act locally (e.g. within inflammatory pockets) at the site of synthesis and release. The classical autacoids are: amine autacoids (histamine, 5-HT), lipid derived autacoids (PGs, leukotrienes, PAFs) and peptide autacoids (bradykinin, angiotensin).
  • Bronchial asthma: It is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation (GINA).
  • Status asthmaticus: It is a life threatening acute exacerbation of bronchial asthma wherein bronchospasm is not relieved with aggressive therapy within 30–60 minutes and attacks follow without any pause.
    Blood gas progression in status asthmaticus:
    • Stage 1: Hyperventilation (low PCO2) with a normal (PO2).8
    • Stage 2: Hyperventilation with hypoxia.
    • Stage 3: A false-normal PCO2 which is an extremely serious sign of respiratory muscle fatigue.
    • Stage 4: Hypoxemia and a high PCO2, which occurs with respiratory failure and needs ventilatory support.
  • Minimal alveolar concentration: The lowest concentration of the anesthetic in pulmonary alveoli needed to produce immobility in response to a painful stimulus in 50% individuals.
  • Second gas effect: During induction of general anesthesia, when a large volume of a gas (e.g. nitrous oxide) is taken up from alveoli into pulmonary capillary blood, the concentration of gases remaining in the alveoli is increased. This results in effects known as the “concentration effect” and the second gas effect where the gas mixture will be sucked in independent of ventilatory exchange; thus gas flow will be higher than tidal volume.
    zoom view
    Fig. 1.7: The concept of second gas effectSource: Congnecker DE, Brown DL, Newman MF, Zapol WM. Anesthesiology, 2nd edn. www.accessanesthesiology.com
  • Diffusion hypoxia: During discontinuation of N2O after prolonged anesthesia the reverse of second gas effect occurs leading to dilution of the alveolar air and finally PP of oxygen is reduced, this resulting hypoxia is called diffusion hypoxia.
  • Epilepsy: The term ‘epilepsy’ denotes any disorder characterized by recurrent unprovoked seizures (CMDT 2017). Seizure is defined as a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain.
  • Status epilepticus: It refers to continuous seizures or repetitive, discrete seizures with impaired consciousness in the inter-ictal period. The duration of seizure activity sufficient to meet the definition of status epilepticus has traditionally been specified as 15–30.
  • Hypertensive urgency: SBP>220 mm Hg or DBP>120 mm Hg without overt signs of end organ damage.
  • Hypertensive emergency: SBP>220 mm Hg or DBP>120 mm Hg with active evidence of end organ damage.9
  • Diuretics (Natriuretics): These are drugs which cause a net loss of Na+ and water in urine.
  • Free water clearance: It is defined as the volume of urine excreted per unit time in excess of that required to excrete the contained solute isosmotically with plasma.
    • Positive free water clearance: Urine is dilute wrt plasma.
    • Negative free water clearance: Urine is concentrated wrt plasma.
    • Zero free water clearance: Isosmotic with plasma.
  • Hematinics: These are substances required in the formation of blood and are used for the treatment of anemias, e.g. iron, folic acid, etc.
    Unconventional hematinics: Erythropoietin, lithium, thyroxine.
  • Laxatives and purgatives: Chemical agents that promote evacuation of bowel and are primarily used to treat constipation or when loose stools are desirable. Based on their intensity of action they are classified as:
    • Laxatives or aperients: Milder action and thus lead to elimination of soft but formed stools.
    • Purgatives or cathartics: Stronger action resulting in fluid evacuation.
  • Chelating agents: These are drugs that can form ring structures within their molecule with metallic ions thus producing stable, non-toxic and easily excretable complexes.
    Orally active iron chelator- deferiprone, deferasirox.
  • Vaccine/sera: These are biological products which act by reinforcing the immunological defence of the body against foreign agents mostly infective organisms or their toxins.
  • Toxoid: A toxoid is a bacterial toxin (usually an exotoxin) whose toxicity has been inactivated or suppressed, while other properties, typically immunogenicity, are maintained. Thus, when used during vaccination, an immune response is mounted and immunological memory is formed against the molecular markers of the toxoid without resulting in toxin-induced illness.
  • Antisera: These are purified and concentrated preparations of serum of horses actively immunized against a specific antigen.
  • Antiseptic and disinfectant: These two terms connote an agent which inhibits or kills microbes on contact. Conventionally, agents used on living surfaces are called antiseptics while those used on inanimate objects are called disinfectants.
  • Irritant: These are drugs that stimulate sensory nerve endings and induce inflammation at the site of application.
  • Counter irritant: Certain irritants also produce a remote effect which tends to relieve pain and inflammation in deeper organs, e. g. clove oil, methyl salicylate.
  • Vesicant: Stronger irritants which in addition increase capillary permeability and cause collection of fluid under the epidermis forming vesicles, e. g. vancomycin.
  • Rubefacient: Irritants which cause local hyperemia with little sensory competent, e. g. capsaicin.
  • Emollient: These are bland oily substances which soothe and soften skin, e.g. olive oil.
  • Demulcent: Inert substances which soothe inflamed or denuded mucosa or skin by preventing contact with air/irritants in the surroundings, e. g. glycyrrhiza, methylcellulose
  • Astringent: These are substances that precipitate proteins, but do not penetrate cells thus affecting the superficial layer only, e. g. tannic acid.10
  • Adsorbents and protectives: These are finely powdered, inert and insoluble solids capable of binding to their surface (adsorbing) noxious and irritant substances, e. g. talc, aloe vera.
  • Ointment: It is a semisolid preparation containing medicinal ingredients for external use only on skin/mucous membranes.
    zoom view
    Fig. 1.8: Venn diagram showing different types of topical applications and their composition
  • FTU (Fingertip unit): It is the unit of application of ointments. 1 FTU ~ 0.5 g/area of 2 palms. 20 FTU ~ whole body.
  • Antibiotic: These are substances produced by microorganisms, which selectively suppress the growth of or kill other microorganisms at very low concentrations.
  • Antimicrobial agent (AMA): This is a common term to designate both synthetic and naturally derived drugs that attenuate microorganisms.
    Thus, all antibiotics are also antimicrobials but the reverse is not true. For example, silver
  • Anticancer: These are drugs that either kill cancer cells or modify their growth.
  • DOTS: Directly observed treatment short-course (DOTS) is a domiciliary treatment strategy to ensure cure of TB by providing most effective regimen of medicines and also confirming that medicines are taken.
  • Monoresistance TB: Resistance to one 1st line anti-TB drug only.
  • Polydrug resistance TB: Resistance to more than one 1st line anti-TB drug (other than INH and rifampicin).
  • Multidrug resistance TB: Resistance to at least both INH and rifampicin (i.e. may have resistance of other 1st line drugs).
  • Extensive drug resistance TB: Resistance to any fluoroquinolone and at least one of the 2nd line injectable drugs (capreomycin, amikacin, kanamycin); in addition to multidrug resistance.
  • MIC: Minimum inhibitory concentration (MIC) is the lowest concentration of an antibiotic which prevents visible growth of a bacterium after 24 hrs incubation in micro-well culture plates using serial dilutions of the antibiotic.
  • MBC: Minimum bactericidal concentration (MBC) of an antibiotic is determined by subculturing from tubes with no visible growth denotes killing of the organism.
    • Bactericidal antibiotic: Small difference between MIC and MBC.
    • Bacteriostatic antibiotic: Large difference between MIC and MBC.11
  • Post-antibiotic effect: The lag period in growth resumption when after a brief exposure to an antibiotic, the organism is placed in an antibiotic free medium; it starts multiplying again, is called post-antibiotic effect. It depends on the antibiotic as well as the organism.
    zoom view
    Fig. 1.9: The concept of minimum inhibitory concentration, minimum bactericidal concentration and post-antibiotic effect
  • Break point concentration: It is defined as the concentration of antibiotic that demarcates between sensitive and resistant bacteria.