'It is more blessed to give than to receive.

M iscellqnqqqs Stlbiqcts

1-Vitam ins.
H -A ntioxidants.
H l-chelating agents.
IV-lm m unopharm acology.

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1
 Freely you have received; freely give.

1-Vitam ins..
A -W ater soluble vitam ins.
.
1-l'
zï/tlza/zzB colnplex:
#
** *=/(Tllialninel:Used intreatment'ofBer-
p
tl
a.
qri(dry beriberi= peripheral
neuritis,andwetberiberi= heartfailureand edema).
Bktpvridoxinel:
U ses:
l-D ietary defciency ofvitam in B6.
z-Antiemeticin vomitingofpregnancy(seeG1T Phal-macology).
3-pre-m enstrualtension.
4-prophylaxis and treàtm entofperipheralneuropath),in patientstreated
withIsopiazid(seeAnti-tuberculous.drugs)orLlydralazine (seeAnti-
hypertensive#drugs)especially in slow acetylators.
N .B .:Pyridoxine is contraindicated in Parkinsonism treated by
L-dopa/carbidopaasitstimulatesperipheraldopadecarboxylase(see
Anti-parkinsonian drugs,CNS Pharmacology).
Bggkcvanocobalaminel: .
Used intreatmentofBI2deficiencyanemia(e.g.Perniciotlsanemia)
usually com binedwith Folicacid (seePllarm acology ofBlood).
Folic acid..
Causes ofdefciency:
1-D ietary deûciency.
z-pregnancy.
3-D ru:s:Folate antagonists as TrinnethoprilAn-cotl'ilnoxazole-
M ethotrexate,and A ntiepileptic drugs w ith potentI-IM E induction as
Phenytoin-carbam azepine-phenobarbitone.
U ses: .
l-M egaloblasticanemia(folicacid deficiencyanemia=megaloblastic
anemiawithoutneurologicalmanifestations).
z-pregnancy. '
3-W itl1antiepileptic drugs to preventm egaloblastic anem ia.

z-A scorbic acid = Vitalnin C.

.
U ses:
l--freatmentofScurvy(vitamin C deficiency).
z-Antioxidant.
3-prevention ofgom m on cold,çataract,gancer.
4-Acidification pfurine(treatmentofUT1s,andtreatmentofacute
toxicityby basicdrugsasEphedrineandAmphetamine).
WhiteKnightLove
'It is more blessed to give than to receive.

B -F atSoluble Vitw nins..

1-Vitanlin W .
*
Uses:l-treatmentofvitaminA deficiency (nightblindnessandskin
hyperkeratosis). z-treatmentofAcl)evulgaris(orally andtopically)
3-A ntioxidant.
Excessvitam in A leadsto adverse effectsknown as ''hypervitam inosisA ''
and itshould be stopped.Itm ay cause:teratogenicity.
2-Vitam in D .*
See Endocrine Pharm acology:Factors affecting calcium hom eostasis.
N .B .:H ypervitam inosis D istreated by Corticosteroids.
3-Vitalnin E .*
U ses:
l-sterility z-M usculardystrophy 3-H abitualabol-tion 4-A ntioxidant.
4-lv/tz/p/zlK : '
V itam in K is a system ic coagulant-Antidote oforalanticoagtllantsas
W arfain-fordetailssee Pharm acology ofB lood.
N .B .:H ypervitam inosisK leadsto hem olytic anem ia and
hypertlilirubinem ia. '
H -A ntioxidants:
l-v itam ins:A C E.
z-selenium (traceelement).
3-superoxidedismutase(enzyme).
4-phenolicacid (in Soya.beansl-polyphenols(in teal-lkiboflavinoids(in
citrusfruits).
s-M elatonin (ahormonesynthesized in thepinealglandfrom serotonin).

111-C helatin -4 ents:

Chelatin a ent Therapeutic'z/xc:
l-Desjkrrioxam ine lron chelating agentused in treatm entof
acute iron toxicit , iven oraland 1V .
z-D i-sodium Edetate C alcium chelating agentused in
h ercalcem ia as in di italis toxicit .
3-calcium Di-sodium Edetate Lead toxicity(lead replacesCa +forming
non-toxicEDTA-lead complex).
4-D-penicillam ine Chelates:Coppel--M ercury-Lead-cobalt.
U sed in W ilson'sdiseaseto chelateCopper
(in W ilson'sdiseasecopperdepositsinthe
liver and basal an lia causin Parkinsonism .
s-Dimerca ro1(BAL) Acutetoxicit ofArsenic-M ercury-Antimony
6-D eferipone: N ew iron chelatine auent used in treatm ent
'
. ofacute iron toxici .
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3
 Freely you have received; freely give.

Iv-lm m unopltarm acolozv..

A -hnm unosu ressive :/rz/ s.
.
CommonIndications Examples Ctp??k???taFcAdj,el-seEffecj -.

l-Topreventrqjection ' Col-ticostel-oidsa-tn

-ycltlsporille- l-lncreased riskofinfkctions.
afterorgan Tacrolimus-M uram onab- z-lncreased risk ofm alignant
transplantation. D açlixim ab- neoplasm s and lym phom as .

z-Treatm entofA uto- Cytotoxic drugs as: 3-cytotoxic drugs only:

im m une diseases asR A , M ethotrexate, A zathiopl-ine, Bone m arrow depression .

H em olytic anem ia, Cyclophospham itle,

N ephrotic syndrom e. M ycofenolate m ofetil.

3-Erythroblastosis fetalis Rh 0 D im m unoglobulin.

(Rh incom atibilit .
B -h nm ultostim ulantn
Thera eutic uses Exam /cx
l-lm m une deficiency conditions Thylrosila-llaxlnlulnoglobulins-
(congenitaloracquired asAIDS). NaturalsubstancesasNigellasativa
z-chronicinfectionsasl-lepatitisB Honey -Garlic. (Rf..
p:21Qs
.x)
and C .
3-cancer.

M onoclonalA ntibodies:
l-o m alizum akb:anti-lg E m onoclonalantibody in severe persistent
asthm a notresponding to al1m edications,given S.C .
z-A bcixim ab:anti-f)p llb/llla plateletreceptors used asantiplatelets in
eardiac catheterization and cardiac surgery,given by IV infusion.
3-lnfliximab-Etanercelt anti--f'
N F a usedinRheumatoid arthritis(RA).
Rituximab:anti-cD 20antigen,used in 1tA (ilAhibitsdamageofjoints).
4-M urarnonab-c b 3:apt-CD 3 used as im m unosuppl-essantin acute
graftrejection.
Allm onoclonalantibodiesare ineffectiveorally and shotlld be given
parenterally (by injection).
WhiteKnightLove
'It is more blessed to give than to receive.

LM RAS
CN S p/zqrzacc/k/r

AN AL GM W S;
O pioid A nalzesics:
* M etabolism ofm orphine is deficientin extrem ities ofage
supelrsensitivity.
* M orphine is contraindicated afterEye operations.
* W ithdraw alsym ptom s ofm orphine in addicts occurifm orphine is
suddenlystopped orby theuseofmom hineantagonists(asNaloxone)or
m ixed agonist-antagonists(asPentazocine).
* M ethadone is used forG radualsubstitution in m ol-phine addiction.
* C om arison betw een M or hine and Codeine' .
M or hine Co#e(
#e ..

l-chem istry; M om hine. M ethylm orphine.

2-% ofO pitlm : 10$$. 1% . .

3-Ora1bioavailability'
. 25-30% . 50% .
4-D uration: 6-8 hours. 2-4 hours.
s-A ntitussive: Potent. Potent.
6-A nalgesia: Potent. W eaker.
7-c onstipation: Potent. W eaker.
8-Addiction: Highly. W eaker.
g-taargedose: IRC,tVM C,Coma. tRC,JVI
M C,Excitation.
10-U se: Severe visceral ain. M ild visceral ain-A ntitussive.

* Fentanyl:high lipid' solubility:IV e lkapid onset+ shortduration

(Redistribution).
* U ses ofFentanyl:IV anesthesia:
A lone b'
ut.-+ V om iting.
Fentanyl+ Droperidol-->N eurolept-A nalgesia.
Fentanyl+ D roperidol+ N itrous oxide .-+ N eurolept-A nesthesia.
.

* A lfentanyl- 1/3-1/4 < Fentanyl.

* Sufentanyl- 10 tim es> Fentanyl.
e M ethadone:L.A .action.
* N aloxone and N altrexone:pure antagonists,m ore selective on m u
receptors,butN altrexone:stronger,longer,and effective orally.
WhiteKnightLove
 Freely you have received; freely give.

SA ID s..
* Salicylic acid:Keratolytic in colmsan4qwarts-l7ungistatic in Tineéof
skin-/kntisept,ic in H yperhiderosis.
--

* Salicylatesin Rheumaticfever'
am poteffective in Carditis,Clnorea,
and SC nodules.
.

* Pyrazolone derivatives. .A lltipyrine..A iralal-opazone-

M etam izole'
.w ithdraw n because itcausesagranulocytosis-
Dipyrone' .selective COX 3 inhibitor.
* M eloxicam ' .prefel-entially inhibits CO X 2 > CO X 1.

o COXIBS (selectiveCOX 2 inhibitors:

asCelecoxib)arecontraindicated
in patients w ith history ofm yocardialinfàrction .

G out
z.
(:
3AllopurinolJ both seruln and urine levelsofuric acid-probenecid and
Benzbromaronet serum uricacidand 'rurineuricacid (uricosuricsl-
C olchicine does notchange serum orurine uric aeid.
SSR Isu.
* Themostcommonly prescrihed antîdepressants.
o Fluoxetine isaHM E inhibitor(M CQ book).
A tvpicalW a//f/cprc-
îwz/a/u
A tom oxetine:selective N oradrenaline reuptake inhibitor-used in
treatm entofpsychic depression and is recently introduced in A D H D and
isaseffective asM ethylphenidate.
CN S Stim ulants..M ethvlxanthines..
@ Tea.--ytannic acid -,+ precipitates:
a-G IT surface protein =A stringçnt--+ constipation.
b-lron -.+ H ypochrom ic m icrocytic anem ia.

GlT phqm qçqlozv

' cplk
=
-t-
.U lcer..
* A ntaclds are used in addition to othel. drugsforreliefofpain in;
l-peptic ulcer--+ rapid pain relietl Z-G ERD . 3-G astritis.
* ain D ruzs affectinz GIT m otilitv..
l-prokinetics:IGIT motilitywithoutevacuation.Used inGERD.
z-purgatives:IGIT luotility with evacuation.Used inconstipation.
3-AntimotilityAntidiarl-heal:tGIT motility:LoperalAaide-Diplaenoxylate.
U sed in diarrhea.
4-Antispasmodics:JGIT motility.Used in colics:
- parasym patholytics:Atropine and itssubstitutes.
- D irectspasm olytics:Papaverine-M ebeverine.
WhiteKnightLove
'It is more blessed to give than to receive.

E m etics and A ntiem etics.

.
* A pom orphine is a ce
'ntralem etic by stim ulation ofD areceptors in C TZ
* A ntiem eticsare used in prevention and treatm entofnausea and
vom iting.
* H yoscine isgiven orally and astransderm alpatch.
* M etoclopram ide isgiven:orally-rectally-lM -lv .
* M etoclopram ideand ltopride:prokineticsby stim ulation of5-l-lTyin
.

enteric ganglia.

A nt
'ibiotics f'
C jiezp//hercpp) ,1

B -L actam A ntibiotics;
* Penicillin m olecule m ay be broken by m icroorgalnism s by:
a)Amidaseenzyme.
b)B-laactamase(penicillinase).
* Resistanceto Penicillins'
.l-production ofj-lactalnases z-decreased
perm eability to penicillins 3-occurrence ofm oditied PB P 4-lack of
peptidoglycanstructure(asM ycoplasma).
* M ostofpenicillins are incoldpletely absorbed afteroraladm inistration.
e A bsorption ofa1lpenicillinase-resistantpenicillins is decl-eased by
food in s'tom ach.
e Procainepenicillin G '.Procaine+ benzylpenicillin.
* B enzathine penicillin is depotfonu.
* M ethicillin isused for diagnosis ofM R SA infections.
* Beta-lactam ase inhibitors'.Piperacillin + Tazobactam .
* B leeding induced by Cephalosporins is due to:anti-vitalxin '
K action
(warfarin-likeon theliver)andplatele'
tdysfunction.ltmay occurwith
Cefam andolesCefoperazone-M oxalactaln.
@ lmipenem-cilastatin'
.itresistsp-lactamase-itaffectsgrowingandnon-
grow ing bacteria.
* I,
l*krdrk'rtine..
,

l-New tdracyclinederivative(glycyclinegroup)relatedtoldinocycline.
z-u sed i1aresistantinfections as M R SA and enterococci.
3-Takenby injection and hashighvolumeofdistribution.
A nti=-Tuberculous D ruzs:
. 2nd'
Lineorugs:cthionam ide-pA sA-cyclosel-ineare Bacteriostatic.

0 Tm O n eS
@ Corticosteroid antagonists.
.
Ketoconazole(inhibitscortisoland androgen synthesis-Antifungal-llM E
inhibitor).M epra-pone-Aminoglutethimide.
'inhibitcortisolsynthesis.
M ifepristonelblockscortisoland progesterone receptors.
WhiteKnightLove
 Freely you have received; freely give.

R evision on B lood
G ive an A ccounton:
l-unfractionated heparin(lJFH):mechanism ofaction-adverse,effects-
contrailadications.
.''
2-Theadvantagesof1ow molecularweightheparins(1-M W H)over
unfractionated heparins(high molecularheparins).
3-Oralanticoagulants(warfarin O icuomarol)asregards:mechanism of
action-adverse effects- contraindications- drug interactionq .

zl-W hatisthe m echanism ofaction of:

-
streptokinase(fibrinolytics= thrombolytics).
-D ipyridam ole.
-
sim vastatin.
-
cholestyram ine.
5-lron preparationsand treatm entofacute iron toxicity.
Comp are betweenheparin andwarfarin asregards'
.mechanism of
action-phanmacokinetics- onsetand duration ofaction -controlofthe
dose-reversalofaction.
G ive Reason:
l-l-leparin actsas an anticoagulant'both in vivo and in vitro.
z-W arfarin acts only in vivo and notin vitro.
3-In prophylaxis againstdeep venousthrom bosis both heparin and
w arfarin are co-adm inistered atthe start,then heparin is stopped and
warfarin therapy iscontinued.
4-Alteplase(r-tPA)ispreferréd to streptokinase.
s-Folinic acid isnotused alonein treatm entofpenliciousanem ia.

Answnr the following M CQ ..'(Only oneanswerisrct/kzïrctp

l-Absorptioû ot-oraliron isfacilitated by thefollowing Except:
A -A ntacids containing m agnesium and /oralum unium salts.
B-Tetracyclines.
C -phosphates.
D -A scorbic acid.

2-1ron sorbitolcitric acid differs from iron dextran in that:

A-ltcannotbeinjected 1V.
B-ltisnotexcreted in tlrine.
C-ltis notbound to transfel-ring in plasm a.
D-ltcausesfeweradverse effects.
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l
'It is more blessed to give than to receive.

3-M egaloblastic anem ia occurs in:

A -v itam in B j2butnotfolic acid deficiency.
B -Folic acid butnotV itam in B ladeficiency.
,

C-Either folic acid orV itam in B jadebiciency.

D -o nly com bined V itam in B 1aand folic acid deficiency.

4-M egalobla.stic anem ia '

due to folate det-iciency m ay occurby:
A -phenytoin therapy.
B -Trim ethoprim therapy.
C -pyrim etham ine orProguaniltherapy.
D -A llofthe above.

s-vitam in K injection isindicatedin treatmentofbleeding occurring in

patients:
A -B eing treated w ith heparin.
B -B eing treated w ith streptokinase.
C-Ofobstructivejaundice.
D -O fpeptic ulcer.

6-l-leparin iscontraindicated in the follow ing conditions Except:

A -pulm onary T.B .
B -Threatened abortion.
C-subacute bacterialendocarditis.
D -D issem inated intravascularcoagulopathy.

7-The follow ing statem entaboutoralanticoagulants is lncorrect:

A -rrhey interfere w ith an early step in synthesis ofcoagulation factors
B -They'have a latency ofonsetofabout3 days.
C--fheirdoseisadjusted by repeatedmeasurementofprothrombin time
and internationalnormulized ratio(1NR).
D --fhey are contraindicated in pregnancy and lactation.

8-W hen using W arfarin in prophylaxis ofdeep venousthrom bosis you

attem ptto m ake 1N R :
A - 1.3- 1.5
B- 1.j- 1.8
C-2-3
D - 3-5

9-The following drug reducesthe effectofw arfarin'

.
A -A m picillin.
B -cim etidin'e.
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C-A spirin.
D-Estrogen(asoralcontraceptive).
10-The follow ing drug prolongsprothrom bin tim e w hen given to a
patienttreated w ith oralanticoagulaùts:
A -Frusem ide.
B-Rifam picin.
C-v itam in K .
D -o 1-alcontraceptives.

1l-W hich .f1brinolytic selectively activates plasm inogen bound to fibrin

ratherthan circulating plasm inogen:
A -u rokinase.
B -streptokinase.
C-Alteplase(r-tPA).
D -N one ofthe above.

12-The m ostim portantcom plication ofstreptokirlase is:

A -Bleeding. '
B-l-lypotension.
C-Fever.
D -A V block.

13-A patienthas'an attack ofhem atem esis follow ing streptokinase

therapy,w hich ofthe follow ing drugs is m osteffective in controlling this
bleeding:
A -v itam in K .
B -A m inocaproic acid.
C -protam ine sulphate.
D -Rutin.

l4-Tranexam ic acid is the specific antidote of;

A -H eparin.
B -D ictlom arol.
C-lron.
D -A lteplase.

ls-pediatricaspirin prolongsbleeding tim eby inhibiting synthesisof:

A -coagulation factors ilzthe liver.
B-prostacyclin(PGIa)invascularendothelium.
C -TX A ; in platelets.
D -C-A M P in platelets.
WhiteKnightLove
'It is more blessed to give than to receive.

l6-W hich ofthe follow ing drugs inhibitplateletaggregation by

increasing plateletC-A M P:
A -sulphinpyrazone.
B -D ipyridam ole.
C -A spirin.
D -Ticlopidine.

N4atch :

l7-B locks G Pl1b /l1a plateletreceptors.

l8-preventsA D p-dependentplateletaggregation.
lg-lnhibits cholesterolsynthesis by inhibition ofIIM G -COA reductase

zo-synthetic pentasaccharide used in prophylaxis ofD V T during

orthopedic leg surgery.

A -sim vastatin.
B-A bcixim ab.
C-Ticlopoidine.
D -lfondaparinux.

Answersto M CQ:
1-D 2-A 3-C 4-D
5-C 6-D 7-A 8-C
9-D 10-A 11-C 12-A
13-B 14-D 15-C 16-B
17-B 18-C 19-A 20-D

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