‫السالم عليكم‬

‫ده حل لكل االسئله ‪ 2022‬من شهر‪ 1‬لشهر ‪ 5‬ومعها اسئله ملف يزيد وملف عباس‬
‫مع تصحيح االخطاء الموجودة ‪.‬‬
‫اسفل كل اجابة كاتبه المصدر‪ ،‬المصادر كلها مراجع في الصيدلة‬
‫اثناء دراستي كنت بذاكر الموضوع حول السؤال ‪ ،‬برضو بكون اسفل اجابة السؤال‬
‫عشان اغطي الموضوع كلو ‪.‬‬
‫انا باول شوفت ملف نوت ونون وقرايتهم مره واحدة وما رجعت ليهم تاني‪ ،‬بس‬
‫ركزت على االسئله دي حيث راتبتها حسب كل ‪ systems‬عشان تسهل حفظها‬
‫وذاكراتها في شهر‪.‬‬
‫الحمد هلل فادتني في االمتحان وجيبت درجه عاليه‬
‫فإن أحسنت فمن هللا‪ ،‬وإن أسأت أو أخطأت فمن نفسي‪ ،‬وما توفيقي اال باهلل عليه‬
‫توكلت واليه انيب‪.‬‬
‫دعواتك لي‬
‫د‪/‬الشيماء مجاهد‬
‫‪Chemotherapy:‬‬
Antiviral:
How to monitor hepatitis treatemnt ?
1-platelets
2-Hg
3-wbc
4-PCR
‫‪Drug for hep C‬‬

‫سؤال ايش اللي يعالج‪ Hept C‬هم كومباينيشن‬

‫‪Ledi+sofo‬احفظوها باالسم‬

‫‪- Zanamivir treatment for which‬‬

‫‪ -‬كيس طويل بس اخر شيء قال وش عالج ‪H1N1‬‬

 ‫ إنفلونزا الخنازير‬H1N1‫إنفلونزا‬

- Acyclovir or Oseltamivir

Drug used for Cytomegalovirus?

7 Foscarnet or Ganciclovir
Zidovudine in HIV pregnant

‫جاني وحده حامل وعندها هيبتانيس بي وولدت شنو نعطي البيبي‬

Zidovudine Duration of prophylaxis for baby?

4-6 week
Case about Respiratory synoptical virus (Palivizumab)
Nevirapine
For Hiv

Antiprotozoal:

Case pin worm: albendazole

Treatment of Tape worm ( Neclosamide ) no tap water

 ‫عالج االمبيا بواسطة فيه تينيدازول اخترته‬
Ttt of amebiasis in pregnant, in first trimester?

A. Tinidazole 2 gm once for 5 days

B. Nitazoxanide 500mg BID for 10days

C. Hydroxychloroquine 500mg for 7 days

D. Paromomycin 30mg/kg

How is Amoebiasis treated in pregnancy?

Metronidazole and the structurally similar tinidazole are the therapeutic agents used for
treatment of acute infection with E. histolytica. Metronidazole is the treatment of choice for
pregnant women but contraindication in first trimester. These results suggest that therapeutic
doses of quinine and chloroquine are safe to use in the first trimester of pregnancy.
Hydroxychloroquine is generally considered safe in pregnancy for the treatment,
First line treatment lice scalp (Pediculosis)

Ans : Permethrin
‫وش الهيستوري المهم عشان تتاكد من تشخيص مالريا ؟ تاريخ السفر‬
- Treatment of malaria?

Chloroquine

organ ?‫غالبا في اي‬- Side effect of chlorqunine

 ‫‪ -‬ايش عالج المالريا في السعوديه‬
‫رسمه لي ‪ plate‬فالسيبرم والسؤال ايش العالج الممكن نستخدمو‬
* Which antimalarial not given with G6PDH enzyme Quinine Primaquine
Tafenoquine
‫ ايش االدويه الي يتجنبها ؟‬G6PD ‫مريض عنده‬

A-hydroxychloroquine

B-primaquine

- Natural product for treatment of malaria ?Quinine

Antifungal:

Antifungal that requires dose adjustment in renal impairment

fluconazole
Which of the following can be used for primary diaper rash?
Nystatin cream may be
Corticosteroids
Amphotericin B hydroxylase?

-amphotericin b toxicity

amphotericin infusion
 ‫ماهو السبب‬.. chronic fungi infection ‫شخص ضهرت عنده الول مره عدوي فطري مزمنه‬

‫العمر‬.1

‫التاريخ العائلي‬.2

HIV ‫عدوي بال‬.3

‫بسبب المعالجه ب االميودارون‬.4

Fungal infections are difficult to treat, particularly in the immunocompromised or neutropenic

patient.

Anti fungal treat esophageal candidiasis

Azole nystain Echinocandins or fungin

Esophageal candidiasis
 Vaginal candidiasis.. Clotrimazole

candida albicans treatment azole fluconazole

‫ اخترتها‬voriconazole ‫ وكان ف الخيارات‬Aspergillosis ttt

voriconazole is available for oral and intravenous use and has a wider spectrum
of fungal activity than itraconazole. It is a treatment of choice for invasive
aspergillosis; some studies report greater efficacy than amphotericin B.
Voriconazole is an alternative drug in candidemia with activity against some flu-
conazole-resistant organisms, and in AIDS patients has been used in the treatment
of candidal esophagitis and stomatitis
Itraconazole capsules require acidic pH optimal dissolution and absorption. Which
of the following is an appropriate advice to optimize the oral absorption of the
drug?
take it with food
TB:

tuberculosis patient in ICU treatment

Isolation
Treatment in icu then after stable treatment outpatient not sure
Treatment in home
Hospital treatment without isolation
1st line Tx for TB

TB active treatment (RIPE).

RIPE regimens for treating TB disease have an intensive phase of 2 months, followed by a continuation
phase of either 4 or 7 months (total of 6 to 9 months for treatment).

patient with active tuberculosis what drugs to give?

Screening antibiotics drug resistance before give to patient with disease

A. Tuberculosis

B. Brucella
-Toxicity of Isoniazid
31- rifampin for tb patient/tell them about urine coloration

aspirin -tramadol- preslodone‫ و كان الخيارات‬nicotine acid ‫ مع‬rash ‫عن ايش يسبب‬

pyrazinamide‫بعتقد‬

(Tuberculosis chemoprophylaxis is a therapeutic measure for the prevention of infection by

Mycobacterium tuberculosis or to avoid development of the disease in individuals already infected
with it. Isoniazid is the most commonly used therapy; however, the use of rifampicin and pyrazinamide
has recently been introduced).

Antibacterial:
‫ او شي كذا‬peritonitis ‫سوال واحد عنده‬
the infective organism is stap aures and entercocci fecalis
 what ab is best to start with
kanamycin
tigecycline
tm/sulfamethoxazole
another option

e coli treatment I choice septrin

E coli enteric infections require fluid replacement with solutions containing appropriate
electrolytes. Antimicrobials known to be useful in cases of traveler's diarrhea
include doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), fluoroquinolones,
rifaximin, and rifamycin

1) Patient with ESBL Klebsiella pneumonia what to give? 🡪 Meropenem

‫ وش كان المفروض‬c. Diff ‫ ايام كلهم فيهم‬٣ ‫ اشخاص ثم بعد‬١٠ ‫ مرتين مره يقول مريض حطيناه بغرفه مع‬C. Diff ‫ جاب عن ال‬-
soap and water ‫ ومره ثانيه جاب حق ال‬hand hygiene ‫نسوي لتقليل خطر االصابه والجواب‬
Q:Medical student enter patient room with C diff, he wipes his hand before and after the patient

What is your recommendation for him?

Antiseptic wipe acceptable

Soap and water wash

‫ عالجها و إيش نسوي لو لمسنا مريض عنده هاذي العدوى‬C.difficile ‫ سؤالين عن‬-

Drug cause colitis something? Can’t even remember answers but was a new question they were all
antibiotics except omeprazole

Ampicillin has been implicated in pseudomembranous colitis. TETRACYCLINES clindamycin

)clindamycin ( ‫ اجابته‬clostridum difficle ‫المضاد الي يسبب‬

To reduce transmission within health care facilities, patients with suspected or proven C difficile
infection should be placed on strict contact precautions and health care workers should apply careful
handwashing before and after contact.

Q:Brucella caused by

Unpasteurized milk mnemonic baby milk

Q: Treatment of brucella doxycycline rifampin

One drug from Fluoroquinolones and ask about

Mechanism of action

A. inhibiting bacterial DNA synthesis

B. Inhibit 50 s

C. Inhibit DNA gyrase

What’s the effect of fluoroquinolones in children?

Quinolone antibiotics are generally not recommended for use in children primarily
because cartilage abnormalities were noted in the weightbearing joints of juvenile animals
treated with fluoroquinolones

ciprofloxacin in adult cause *seizures*

Ciprofloxacin side effect to children? anthrax

Seizure

Drowsiness also

Pt developed arthritis problem after taking antibiotic(something like that) , what he was taken?

A. Amoxicillin

B. Ciprofloxacin

C. Another antibiotic

digoxin ‫ بالخيارات فيه‬QT prolongation ‫ يزيد الريسك تبع‬cipro ‫ايش الدواء الي اذا استخدم مع ال‬
- Interaction cipro ? ‫جاء سؤالين‬

- levofloxacin ‫وش يغطي بكتيريا؟‬

- Interaction ampicillin?

- UTI ( more than 5 questions )

‫ اخترته بعدين يوم راجعت طلع خطا‬smx/tmb ‫ وش نسوي علشان نتجنب الهارم ؟ هنا بالخيارات كان موجود‬UTI‫ حامل وعندها‬-
‫ ناقص‬G6PD ‫ هذا السوال بيزيد دامه قال هارم يعني عندها الجين‬cephalexin ‫انتبهو مفروض‬

female not pregnant with UTI and CFU < 10, 000 what treatment?

Antibiotic safe for 3rd trimester?

nitrofurantoin

in the second and third trimester, trimethoprim/sulfamethoxazole and nitrofurantoin are well tolerated
and by some considered even first line agents, except in the last week before delivery, when they may
increase neonatal jaundice and predispose to kernicterus.

Q: Pregnant his child born with jaundice

Trimethoprim and sulfamethoxazole

Trimethoprim and sulfamethoxazole

urologist ‫ نعمل ليه ريفير ل اي دكتور اخترت‬Pt have uti and low back pain

Q: UTI female with penicillin allergy

‫ اخترتها‬accumulation of bilirubin ‫بيشن جا لون جسمو اصفر وعيونو كمان من الخيارات كان‬

Patient comes with dark urine, pale stool, yellow eyes why ?- elevated albumin - Elevated bilirubin -
Elevated triglycerides

Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the
eyes due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying
diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction.

- Side effect of nitrofurantoin?

Nitrofurantoin
Sulphamethoxazole
Chloramphenicol
All cause G6PDD (Hemolytic anemia) Favism
How to reduce UTI risk in female? Urinating after sexual intercourse

drug of choice for UTI in first trimester of pregnant women ?

Oral nitrofurantoin and cephalexin amoxicillin
 oral ‫احفظو الجينيريشنز كويس و كل جينيريشن ايش مميزاته و اي جينيريشن‬Cephalosporins

Oral cephalosporin ? cephalexin,,cefaclor/,,cefexime

MOA Of cefalexin
Which cephalosporins are not active against Pseudomonas species

- Cefazolin is firstgeneration

- cefepime

- Ceftobiprole

- Ceftazidime

‫ الباقي نسيتهم‬cefoxitin- ‫ بالخيارات‬prophylaxis before colorectal surgery ‫ايش االنتيبيوتيك الي يستخدم ك‬

Colorectal cancer screening at age 50?

 ‫ عالجها ايه مفتكرتهوش‬Endocarditis

Child first time media otitis what to give?

High dose amoxicillin I think

‫ لألطفال من‬otitis media ‫ في عالج ال‬amoxicillin ‫جرعة ال‬

80-90mg /kg/day
‫ودي جرعة عالية دايما بيسأل علي كدة العالج‬
Child <2 years or *sever case* ttt for *10days
‫ اخترته هو‬azithromycin ‫ بالخيارات ما كان فيه بنسلينز و فيه‬otitis media ‫حامل عندها‬
 ‫ سنوات ؟‬٣ ‫ لطفل عمره‬Otitis media ‫ مدة عالج ال‬-

Otitis media treatment duration in 3 years old boy

‫ أيام‬٧ -٢ ‫ أيام‬٥ -١ : ‫الخيارات‬

. ‫ أيام ما متأكد من اإلجابه‬٧ ‫ أنا أخترت‬. ‫ أيام‬١٠ -٣

Pt with fever , shills , another symptoms , brought to hospital and physician started empirical therapy
ceftriaxone and linezolid , after culture was taken , mecithillin sensitivite staph so? MSSA

A. Continue and add antifungal not sure

B. Discontinue and add meropenem

C. Discontinue and add piperacillin

Pt with fever , shills , another symptoms , brought to hospital and physician

started empirical therapy ceftriaxone and meropenem, after culture was taken ,
mecithillin sensitivite staph so? MSSA
A. Continue and add antifungal not sure
B. Discontinue and add linezolid
C. Discontinue and add piperacillin

Trimethoprim / Sulfamethoxazole

‫ ايش نعطيه غيره؟‬resistance ‫جتني اسئلة عليه و كان من ضمنها اذا بيشنت جته‬

amoxicillin ‫كان فيه ضمن الخيارات‬

Other alternative:
• nitrofur.
• Cipro..
• Amoxicillin.
• Doxycycline.
G6pd Trimethoprim-sulfamethoxazole

Bactrim cause hyperkalamia

*Drugs contraindicated in G6PD deficiency? Sulfa drugs ex. Bactrim

Dose depends on (Trimethoprim /Sulfamethoxazole)?

A. Sulfamethoxazole

B. Trimethoprim

C. Both Trimethoprim and Sulfamethoxazole

Dose of ceftriaxone in ttt meningitis? 2g BID

4 g/*day* IV divided every 12 to 24 hour ; _MAX_ 4g/day

pt with meningitis treated by vancomycin and other antibiotic, what should be use with the
antibiotic

24- Brudzinski sign

one of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness
causes a patient's hips and knees to flex when the neck is flexed.

‫ بس ماذكر الخيارات اتذكر في خيار كان انو حاليا نوت ركمندد‬close contact meningitis prophylaxis ‫ سؤال عن‬-
‫ خيار ثاني كان ريفامبن‬.‫البروفالكسس‬

Mother bring her daughter with high fever …..etc

Finally the baby diagnosed with meningitis
How we can protect the mother ?
‫ وفيه دواء بس نسيت اسمه وهللا واخر خيار ان الركومنديشنز حاليا‬MCV‫وكانت الخيارات كلها تطعيمات مو حقت ال‬
‫ماتنصح ومارح نعطيها شي‬
.‫ كوقايه يعني‬TB‫ وبعدين قال المفروض االم وش نعطيها وحالة مشابهه لـ‬،‫ وعطوه دواء‬miningitis ‫ قال كيس ام جابت طفلها معه‬-

mother brought his sun and he diagnosed with meningitis how can we protect his
mother and people contacting him ?
pneumococcal vaccine Frist choice
Rifampin Frist choice
Meningitis vaccination is no longer recommended for such cases
Chemoprophylaxis should be offered to all persons having close contact with an IMD case
during the infectious period (the 7 days before onset of symptoms in the case to 24 hours after
onset of effective treatment), regardless of their immunization status (see section 10.0
Recommendations for Chemoprophylaxis)

mother brought his sun and he diagnosed with meningitis how can we protect his
mother and people contacting him ?
• pneumococcal vaccine
• Meningitis vaccination is no longer recommended for such cases
Infection can be prevented using antimicrobial agents (chemoprophylaxis) or
vaccines (immunization), remembering that prevention is better than cure

‫ايش تضيف له؟‬Drug for meningitis,

‫كورتيزون‬
- The dose and duration of ceftriaxone for treatment of osteomyelitis

Osteomyelitis duration?

- 1-2 weeks

- 4-6 weeks

- 7 days

The duration of therapy for acute osteomyelitis is 4-8 weeks

Case about osteomyelitis treatment regimens ciprofloxacin 500 mg BID for 6 weeks-
wrong dose

-wrong duration ‫ا‬

-wrong frequency

-no wrong

-wrong dose
 ‫ ما اسم البكتريا المسببة للمرض؟؟؟‬Osteomyelitis ‫ سنوات عنده‬٩ ‫جالي سؤال اليوم طفل عنده‬

Streptococcus a.
E. Coli
Pneumococcal
S aureus
9-year-old boy had nail piercing few days ago, now he has osteomyelitis,
which organism?
A. E.coli
B. pseudomonas aeruginosa
C. Streptococcus pyrogens
D. Candida albicans
outpatient ttt of pseudomonas
Cipro may choice
Cefuroxime
Cefalexin
vanco
patient with reduced kidney function (CrCl 23) and multiple disease, has
urinary tract infection, what is the best antibiotic regimen "
B) Ciprofloxacin400mgq24

1st line CAP inpatient = ceftriaxone + azithromycin

community acquired pneumonia and need hospitalization ‫جاب برضو ال‬

patient with pneumonia received IV ceftriaxone and azithromycin, after 3 days he became afebrile
with normal WBC level, what to do "

A) Continue treatment 10-14 days in high severe

B) stop the antibiotics

C) Switch to oral

D) Stop azithromycin and continue ceftriaxone

Chlamydia ttt ? Azithromycin macrolide or tetracyclines

Ttt chlamydia in children erythromycin

Frist doxycycline alternative azithromycin
pertussis treatment ?
Azithromycin
Several antibiotics are available to treat pertussis. The most popular are azithromycin,
clarithromycin and erythromycin. If you have had pertussis for three weeks or more,
antibiotics will not be prescribed because the bacteria are already gone from your bod

‫ تنعطى للرضع ليش؟ لعالج اي بكتيريا‬erythromycin ‫ سوال يقول القطرات‬-

erythromycin to prevent conjunctivitis ……gonococcal

gonococcal ophthalmia neonatorum (GON) is a severe infection of the eye that can occur in
babies born to women with gonorrhea. If left untreated, the condition can cause serious eye
problems, including corneal scarring, ocular perforation and blindness, as early as 24 hours
after birth. And without ocular prophylaxis, it's estimated that up to half of babies born to
mothers with gonorrhea could develop GON. The only FDA-approved medication for this is
erythromycin.

- medication treatment pseudomonas aeruginosa?

piperacillin/tazobactam), ceftazidime cefepime Ceftolozane/Tazobactam and Ceftazidime/Avibactam

AZTREONAM AMINOGLYCOSIDES(amikacin) QUINOLONES(Ciprofloxacin, levofloxacin) POLYMYXINS

Q: Case about Gram negative bacteria coverage

Linezolid

Vancomycin

Daptomycin

Piperacillin tazobactam
1 year child suffering from dermatitis and has penicllin allergy?
Doxycycline
Daptomycin
vancomycin, linezolid ‫ والخيارات ما فيها‬MRSA

MRSA infection ( vancomycin)

vancomycin dose depends on ? Trough test

- book interaction between vancomycin and gentamicin

‫ بأيش نعالج والخيارات كانت‬c.difficle ‫وفيه سؤال جاء كمان‬

Iv vancomycin
Oral metronidazol
Oral antifungul
Vancomycin Class:
Non B-lactam acting on cell wall(inhibit cell wall synthesis)
Side effect
Nephrotoxicity
Ototoxicity
Phlebitis (irritation to the vien)
Myelo suppression (result in neutropenia & thrombocytopenia)
If taken orally used for pseudomembranous colitis
، every 12 hours ‫ وياخذ ڤانكومايسن‬MRSA ‫فيه كيس بعد شخص عنده‬
: ‫ والخيارات‬،٥ ‫ولما قاسوا الليڤل حقه صار‬
- Stop vancomycin and start linezolid
- Increase the frequency of vancomycin to every 8 hours
time dependent‫اخترت نزيد فريكونسي ألن ڤانكومايسن‬
Case necrotizing pneumonia treated with vancomycin and meropenem
Vancomycin troup level is checked
‫كانوا جايبين هي كام و الرانج المهم انهن في الرانج‬
What to do next
Continue treatment
Request meropenem drug level
Increase vancomycin dose
Decrease vancomycin dose
time ‫ بردة مش فكراه اوي بس كان اقل من الرانج و بيقول نعمل ايه و انه‬vancomycin ‫و في سؤال عن‬
dependent antibiotic

increase frequency
Decrease frequency
Increase dose
Decrease dose
Time dependent antibiotic (decrease infusion rate = increase infusion time)
Blood CONC above MIC
Mic =minimum inhibitory CONC
Infusion rate
‫ أرقام متباعدة وغير مترابطة بس وجب زكزها‬٣ ‫فية‬
5mg/ml
1ml/min
10mg/min
No Need for renal adjustment
Peripheral iv infusion should not exceed 5mg/ml
Vancomycin cause if iv bouls or rapid infusion rate... Red man syndrome
During or soon after rapid infusion of vancomycin, patients may develop anaphylactoid
reactions, including hypotension, wheezing, dyspnea, urticaria, or pruritus. Rapid
infusion may also cause flushing of the upper body (“red neck”) or pain and muscle
spasm of the chest and bac
Patient with Methicillin resistant Staphylococcus aureus infection?

A- vancomycin
B- cefepime

C- Aztreonam

Antibiotic has low bioavailability vancomycin

Treatment of central line-associated bloodstream infections (CLABSIs) ?

- Gentamicin

- Vancomycin MRSA

- Cefotaxime

- avibactam
4-antibiotic interact with pulmonary surfactant:

b-dapromycin

dipalmitoylphosphatidylcholine (DPPC)
Pulmonary surfactant is composed of approximately 90% lipids and 10% proteins. The main
phospholipid in surfactant is dipalmitoylphosphatidylcholine (DPPC), also known as lecithin. It is
surface active because of its hydrophilic head and hydrophobic tails
- medication cause hearing loss ?

Aminoglycoside or amikacin

‫ و دوائين ثانيين و بعد فتره جا يشكي ان سمعه صار ضعيف اي ذي االدويه يسبب‬-amikacin - moxifloxacin ‫مريض ياخذ‬
tinnitus ‫ النه يسبب‬amikacin ‫ اخترت‬hearing loss
- enzyme of B-lactam resistance?

plasmid ‫ما اذكر االختيارات اال‬

Purpose of bacterial Transpeptidase enzyme!??

Transpeptidase is the bacterial enzyme, which catalyses the cross-linking of peptidoglycan

layers during the cell wall synthesis. It is the main target of antibiotics such as penicillin.
Penicillin inhibits the transpeptidase enzyme by binding at its active site leading to inhibition of
bacterial cell wall synthesis.
 ‫ وين بيكون المونترنغ‬septarin ‫كيس لمريض اخذ‬

🌑prophylaxis of traveler diarrhea ? (With dose)

TD is the sudden onset of abnormally loose or liquid, frequent stools. If blood is

mixed in with the stool, it is classified as dysentery, which is often accompanied
by more severe systemic symptoms such as fever. Severity is assessed by
the patient as mild, moderate or severe, and this determines initial treatment.
symptoms usually begin within 6 - 72 hours if caused by a bacterial or viral
pathogen. More than 80% of TD cases are bacterial. The primary pathogen
is E. coli, followed by Campylobacter jejuni, Shigella species and Salmonella
species. Untreated bacterial diarrhea can last 3 - 7 days, and some pathogens
can cause invasive infections outside of the GI tract. Persistent TD, defined
as diarrhea lasting ≥14 days, is more likely to occur with certain bacterial and
protozoa! pathogens and requires additional testing.
Prophylaxis for Travelers' diarrhea A. Ciprofloxacin B. Bismuth C. Hygiene and eat in clean places
What cause dysentery: Entamoeba histolytica

prophylaxis traveler diarrhea

Cipro
Azithro
‫‪- Virus associated diarrhea‬‬

‫‪Viral prophylaxis? Probiotic‬‬

‫? ‪* probiotics mean‬‬
‫جاء في الخيارات يجي على شكل مكمالت غذائية او طبيعية وهل هو يعزز نمو البكتريا او البكتيريا‬
‫والفطريات ‪.‬‬
‫‪Patient with Rota infection, what to do‬‬
‫كان جايب من ضمن الخيارات البكتيريا الموجوده ف الزبادي ‪ ،‬الكزيتيف ‪ ،‬انتي بيوتك وخيار ثالث استبعدته‬
‫‪9/child mild dehydration fluids‬‬
-Treatment of mild dehydration in children
Apple juice
Normal saline
Oral dehydration solution
6- patient has diarrhea what is cornerstone treatment?

A) fluids and electrolytes

B) anti motility

- what given for patient have diarrhea? - Loperamide MOA

Antimotility

Lopermide > “abused” answer (don’t chose opioid agonist because it’s not)
 If diarrhea and want to save fluids.. Yoghurt
* High dose Amikican affect which organ (kidney)
‫ وش الدواء اللي ما ينعطى للرضع؟‬-Ceftriaxone

* inhibit protein synthesis by 30 S: *initiation

Drug need renal monitoring.. Imipenem

* Baby with high bilirubin what the possible antibiotic that his mother take in
last 2 weeks of pregnancy:
Pregnancy and the neonate-Antimicrobial therapy during pregnancy and the
neonatal period requires special consideration. Aminoglycosides (eg, gentamicin)
may cause neonatal neurologic damage. Tetracyclines cause tooth enamel
dysplasia and inhibition of bone growth. Sulfonamides, by displacing bilirubin
from serum albumin, may cause kernicterus in the neonate. Chloramphenicol
may cause gray baby syndrome. Other drugs that should be used with extreme
caution during pregnancy include most antiviral and antifungal agents. The
fluoroquinolones are not recommended for use in pregnancy or in small
children because of possible effects on growing cartilage.
Mechanism of chloramphenicol responsible for grey baby syndrome
 h post third dose3 ‫ بس اإلجابات كانت غريبه‬sample of trough. Of gentamicin ‫سؤال اخذ ال‬

4 hr post 4th dose

Trogh of mild of vsnco.. 10_15

- Vancomycin and gentamicin monitoring

Gentamicin trough level ?

Gentamicin peak?
A-one hour after dose
B-two hour before dose
C-one hour before dose
‫ امتي نقدر‬gentamicin ‫مش دا السؤال نصا لكن نفس الكالم واحده كانت مريضه بمرض مش فاكره اسمه والدكتوره كتبلها‬
after one hour ‫ واالجابه‬peak ‫نرسمله‬
Traditional dosing: draw a trough level right before (or 30 minutes
before) the 4 th dose; draw a peak level 30 minutes after the end of
the 30-minute infusion for the 4 th dose (see table on the following
page for target peaks and troughs).
Trough of vancomycin (goal trough 15-20 mcg/ml
Other infections (e.g., UTI, skin infections): goal trough 10-15 mcg/ml)
30 min before 4 dose
- What is the physiological changes in the child that affect dose of Gentamicin? Incomplete liver
enzyme/ immature kidney function/ low fat..

gentamicin‫ وامورة كلها بخير وماخد ادوية الضغظ والمدررات بما فيهم‬dialysis‫برضو في سؤال لو شخص في ال‬
‫ تعدل دوز‬، ‫انتيبيوتك‬٢‫ تغير دوز ال‬.‫ كلها زايده‬renal profile‫الخيارات اش تعمل قراءات ال‬,, antibiotic ‫واثنين‬
‫ ماراح يستفيد من التغير‬dialysis‫ النه اصال في ال‬gentamicin‫ وخيار ماتغير ال‬gentamicin‫ال‬

Red man syndrome ? Vancomycin

Anticancer:

INDEX FOR ALL ANTICANCER

ANTINEOPLASTI DAUNOrubicin sorafenib
CS hydrochloride SUNItinib
1-ANTIMETA- DOXOrubicin lapatinib
BOLITES: DOXOrubicin, gefitinib
nucleoside liposomal, acalabrutinib
metabolic inhibitors: Idarubicin afatinib
hydroxyurea epiRUBicin alectinib
Folic acid analogs: valrubicin binimetinib
Methotrexate 4- ANTITUMOR brigatinib
PEMEtrexed ANTIBIOTIC: ceritinib
PRALAtrexate Dactinomycin cobimetinib
Purine analogs: Daunomycin crizotinib
6-mercaptopurine mitoXANTRONE dabrafenib
Thioguanine bleomycin encorafenib
Fludarabine mitoMYcin lenvatinib
cladribine 5- VINCA ALKALOIDS neratinib
pentostatin vinBLAStine PAZOPanib
pyrimidine analog: vinCRIStine regorafenib
fluorouracil vinorelbine vandetanib
capecitabine 6- TAXOIDS: vemurafenib
floxuridine DOCEtaxel trametinib
trifluridine PACLitaxel protein- cabozantinib
cytidine analogs: bound particles bosutinib
cytarabine (albumin-bound ponatinib
azacitidine cabazitaxel axitinib
gemcitabine 7- epothilone B ruxolitinib
2- ALKYLATING analogues: osimertinib, also epidermal
AGENTS: ixabepilone growth factor receptor
Nitrogen mustard: 8- (EGFR) inhibitors.
Mechlorethamine PODOPHYLLOTOXI alpelisib
cyclophosphamide N DERIVATIVES: abemaciclib
ifosfamide Etoposide palbociclib
chlorambucil Teniposide ribociclib
melphalan 9- ENZYME temsirolimus
bendamustine INHIBITORS everolimus
nitrosoureas: abiraterone histone deacetylases
carmustine nucleoside metabolic inhibitors:
lomustine inhibi- romiDEPsin
streptozocin tors, thymidine vorinostat
alkyl sulfonates: phosphorylase inhibitors belinostat
busulfan trifluridine/tipiracil. poly (ADP-ribose)
triazenes: Inhibits topoisomerase: polymerase (PARP)
procarbazine topotecan inhibitor:
dacarbazine irinotecan niraparib
temozolamide Inhibits kinase: olaparib
platinum: imatinib rucaparib
CARBOplatin, nilotinib 10- ENZYMES
CISplatin dasatinib Deplete asparagine:
oxaliplatin erlotinib Asparaginase
3- pegaspargase
ANTHRACYCLIN
ES:
11- HORMONAL buserelin ramucirumab
AGENTS: 12- PROTEASOME inotuzumab,ozogamicin.
Estrogens INHIBITORS: Gemtuzumab,ozogamicin.
estramustine bortezomib olaratumab
Estrogen antagonist: carfilzomib ofatumumab
Fulvestrant ixazomib necitumumab
tamoxifen 13- PROTEIN daratumumab
aromatase inhibitor: SYNTHESIS ipilimumab
aminoglutethimide INHIBITOR: ibritumomab
anastrozole Omacetaxine blinatumomab
letrozole 14- BCL-2 inhibitors: nivolumab
exemestane venetoclax durvalumab
progestins: 15- IMMUNE avelumab
megestrol MODULATORS: OTHERS:
medroxyPROGEST Aldesleukin interferon
ERone, Denileukin diftitox aflibercept
anti androgen: Pomalidomide vismodegib
enzalutamide lenalidomide bexarotene
apalutamide MONOCLONAL
flutamide ANTIBODIES:
nilutamide riTUXimab,
bicalutamide cetuximab,
cyproterone brentuximab,
gonadotropin-re- bevacizumab,
leasing hormones: trastuzumab,
leuprolide pertuzumab,
goserelin elotuzumab
triptorelin pembrolizumab,
GnRH antagonist: obinutuzumab
degarelix, alemuzumab
luteinizing ado-trastuzumab,
hormone-releasing ado-trastuzumab
hormone (LHRH) emtansine.
analogues: atezolizumab,
panitumumab
Anti-cancer medication what work on mitotic phase 🡪 Vincristine –
Doxorubicin
 ‫الدواء الذي يستخدم لسرطان البروستات‬

Patient present with neutropenia after her chemotherapy regimen, what test is
indicated for neutropenia?
A- ANC
B- Hemoglobin And 2 others
Philadelphia is issue in which chromosome 9 & 22
The Philadelphia chromosome is a reciprocal translocation involving chromosomes 9 and 22
that is commonly identified in chronic myelogenous leukemia (CML). The break points of the
translocation create a fusion of two genes: ABL1 on chromosome 9 and BCR on chromosome 2

recombinant DNA technology ‫مين اللي بيتعمل ب‬

Filgrastim

Filgrastim is produced by bacteria through the use of genetic engineering and

recombinant DNA technology. Filgrastim belongs to a class of drugs called colony-
stimulating factors because of their ability to stimulate cells in the bone marrow to
multiply and form colonies of new cell
-Doxorubcin classfication ‫سوالين وع شنو يشتغل‬

S. E doxorubicin
-Vincristine ‫سؤالين‬

-Vinblastine

●Vincristine dispense (piggy bag - syringe - ..).

The solution may be injected either directly into a vein or into the tubing of a running
intravenous infusion.Gravity drip using an IV minibag.
-Venca labling -> avoid intrathecal iv use only

cancer patient will be started in vinca alkaloids what should we monitor first? echocardiogram, renal ,
liver

Cancer patient will be start in vinka alkaloid why should we monitor first?
A) Echocardiogram
B) renal
C) hepatic
bleomycin toxicity is *pulmonary fibrosis*
iofosfamide and cyclophosphamide are *alkylating anget* cause *hemolytic
cystitis*

٨٥‫ شهور‬٦ ‫ قبل‬٥٥ ‫مريضة عندها كانسر وزنها االن‬

‫شنو تعتبر؟‬
Malnourished

Chronic disease associated

Well nourished
 Anti cancer for solid tumer
Capecitabine
Enrectinib
Pembrolizumab
solid tumor‫هو االشهر كمان اللي يعطى ب‬

Keytruda (pembrolizumab) is indicated for the treatment of adult and pediatric patients with
unresectable or metastatic solid tumors that have been identified as having a biomarker
referred to as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR
‫ايش افضل شي تعطيه ؟‬solid tumor ‫كيس طويلة لواحد اتشخص ب‬

Paclitaxel

anti cancer needs DVT monitoring

granisetron ‫اللي بيستخدم في الترجيع ل كانسر انا اخترت‬

●Antimetabolite drug cause bleeding ( capecitabine -

Mechanism of doxorubicin A. inhibits topoisomerase II
topoisomerase I inhibitors include irinotecan, topotecan, and camptothecin, and
topoisomerase II inhibitors include etoposide, doxorubicin and epirubicin.
 ECG, ‫ ووش افضل شي اسويه قبل م ابدا العالجات؟‬anthracyclin and cyclophosphamide ‫ جاب كيس ومريضه تاخذ‬-
ovarian ‫ اخر خيار شي ال‬,acidification of Urine, alkali action of urine

● Monitor intake and output ratios, and report occurrence of significant discrepancies. Encourage
fluid intake of 2000–3000 mL/day. Allopurinol and alkalinization of the urine may be used to decrease
serum uric acid levels and to help prevent urate stone formation .