Misbah 2016-Tip Answers

Pharmacyprep.
com Human Anatomy
1
Human Anatomy
Tips
1. supination 2. flexion 3. abduction
4. extension 5. adduction 6. parasagittal plane
7. Sagittal plane 8. Midsagittal plane 9. kneecap
10. Biceps bronchi 11. Triceps bronchi 12. dysphagea
13. dysurea 14. etiology 15. dyspnea
16. extensor muscles 17. flexor muscles 18. pubis
19. ilium 20. ischium 21. transverse plane
22. Endocrine glands 23. arteries 24. skull bones
25. Moving away from 26. Moving closer to body 27. slicing vertically
body
28. slicing vertically from 29. slicing vertically from 30. slicing horizontal
middle line side lines
• (abduction) movement away from the midline of the body

• ( supination) act of turning the hand so that the palm is uppermost
• (flexion) bending part of the body
• ( adduction ) movement toward the midline of the body
• (extension) lengthening or straightening of the flexed limb
• (triceps bronchi) found in arms and thighs
• (biceps bronchi) found in arms only
• (parasagittal plane) separates the body into unequal right and left portions
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is 1-1
illegal to reproduce without permission. This manual is being used during review sessions conducted by
PharmacyPrep.
Pharmacyprep.com Human Anatomy
• ( midsagittal plan ) separates the body into equal right and left portions
• (sagittal plane ) separates the body into right and left portions
• (kneecap) it protects the front of the joint
• ( dyspnea ) difficulty in breathing
• (dysphagea ) difficulty in swallowing
• (dysurea ) difficulty in urination
• (etiology) causation
• (extensor muscles) found in limbs, foot, arms
• ( ischium, pubis, ilium ) hip joints have
• Adduction moving toward to the middle line
• Abduction moving away to middle line
• Flexor muscles found in joints
• Extensor muscles found in joints
• Sagittal plane  Separates the body into right and left portions
• Midsagittal plane (Median plane)  Separates the body/body part into equal right/left
portions
• Parasagittal plane  Separates the body into unequal right and left portions
• Pronation  act of turning the hand so that the palm faces downward
• Supination  act of turning the hand so that the palm is uppermost.
• Hip joints have ileum, ischium and pubis
• Knee cap is patella
• Etiology = causation
• biceps and triceps are found in --> arms
• Triceps and quadriceps are found in --> thighs
PharmacyPrep.
PharmacyPrep.com GI Anatomy, Physiology, and Pathophysiology
2
Gastrointestinal System
Tips
____________________________________________________________________________
1. diarrhea 2. constipation 3. bloating

4. cramps 5. proteins 6. nuclease
7. 2 glucose 8. colon 9. gluten present in
cereal
10. alpha glucosidase 11. 95-100% anaerobic 12. Fructose + glucose
bacteria
13. peptidase 14. enterokinase 15. chymotrypsin
16. trypsin 17. Vit D 3 18. Deficiency of intrinsic
factors
19. Parenteral vit B 12 20. Alcohol 21. wheat
dehydrogenase
22. rye 23. oats 24.
• most basic part of the GI tract( colon)

• irritable bowel symptoms(diarrhea, constipation, bloating, cramps)
• proteins are digested by(chymotrypsin, trypsin)
• converts nucleic acid into nucleotides(nuclease)
• pernicious anemia is caused by(deficiency of intrinsic factors )
• digest peptides into amino acids(peptidase )
• pernicious anemia is treated by( parenteral vit B 12 )
• converts inactive trypsinogen into trypsin( enterokinase)
• oxidizes alcohol to aldehyde and acids(alcohol dehydrogenase )
• what bacteria are present in colon(95-100% anaerobic bacteria)
• breakdown sucrose & starch to glucose( alpha glucosidase )
• gluten is present in(wheat, rye & oats)
• allergic component in milk( proteins )
• celiac is caused by( gluten present in cereal)
PharmacyPrep.
• soya milk allergies due to(proteins)

• Patient with chronic renal failure have deficiency of vitamin?
• Pernicious anemia is caused by 
• Pernicious anemia is treated by 
• Maltase breakdowns maltose to 
• Sucrase breakdowns sucrose to 
• Alcohol dehydrogenase  Ethanol  acetaldehyde  acetic acid
• Irritable bowel symptoms include 
• Alpha Glucosidase is 
• Active Vitamin D is 
• What is allergic component in milk?lactose or proteins
• Proteins are digested by by chymotrypsin and trypsin

• Nuclease are digested by  converts nucleic acid into nucleotides
• Peptidase are digested by  digest peptides into amino acids
• Enterokinase  converts inactive trypsinogen into trypsin
• Patient with chronic renal failure have deficiency of vitamin? D 3
• Pernicious anemia is caused by  deficiency of intrinsic factors
• Pernicious anemia is treated by  parenteral vitamin B 12
• Maltase breakdowns maltose to  2 glucose
• Sucrase breakdowns sucrose to  fructose + glucose
• Alcohol dehydrogenase  oxidize alcohols to aldehyde and acids
• Irritable bowel symptoms include  diarrhea, constipation, bloating and cramps,
• Most basic part of GI tract Colon (large intestine)
• What type of bacteria present in colon  95 to 100% anaerobic bacteria (C. difficle)
*********
• Alpha Glucosidase  breakdowns sucrose & starch to glucose
• What is allergic component in milk?Proteins
• Soya milk allergies due to Proteins
• Gluten is present in wheat, rye, and oat
PharmacyPrep.
• Celiac disease is caused by  gluten present in cereal

• What is NOT secreted in small intestine  Mucus (saliva)
• Saliva secretions are controlled by Parasympathetic & sympathetic
• Malabsorption of lipids cause  Steatorrhea
• Vitamin B 12 is absorbed in the ileum and requires intrinsic factors
• Calcium absorption in small intestine depends  1,25 dihydroxycholecalciferol
(vit.D 3 )
• Heartburn is symptom of GERD
• Entero = refers to intestine
• Enteral = through mouth into GI
• Stetorrhea  fatty stools
PharmacyPrep.
PharmacyPrep.com Nervous System
3
Nervous System
Tips
1. Sciatic nerve 2. Blood brain barrier 3. Adrenal medulla
4. Tardive dyskinesia 5. Protects brain from 6. bradykinesia
endogenous &
exogenous toxins
7. Nissl substance 8. Multiple sclerosis 9. cerebrum
10. it prevents escape of 11. lipid soluble drugs 12.
neurotransmitter from cross faster than H 2 O
CNS into blood soluble drugs
circulations
• it is the barrier between cerebral capillary blood and cerebrospinal fluid (CSF) the CSF fills
the ventricles & the subarachnoid space ( 2 )
• a CNS disease where the myelin sheath of motor neurons is degenerating or being
destroyed, which interferes with neuronal impulses (8 )
• the nerve that pass through buttocks, thighs down to foot ( 1 )
• controls voluntary and involuntary movements ( 9 )
• inappropriate posture of neck, face and limbs ( 4 )
• epinephrine is released from ( 3 )
• functions of blood brain barrier ( 5, 10, 11 )
• Slow movement ( 6 )
• the dark granular inside neuronal cell bodies ( 7 )
• GABA is  a major inhibitory neurotransmitter in brain
• Enkephalins are  peptide type of opioid neurotransmitters
• Serotonin consist of  indole ring
• Sciatica is  pain passing through buttocks, thigh down to foot
• Nor-epinephrine becomes epinephrine, this reaction is catalyzed by  phenylethanolamine
-N- methyl transferase
PharmacyPrep.
PharmacyPrep.com Nervous System
• Sciatica nerve pass through buttocks, thighs down to foot

• GABA is  inhibitory of neurotransmitter in CNS
• Enkephalins are  peptide type of opioids neurotransmitters act on delta receptors
• Endorphins are  Peptide type of opioids neurotransmitter act on mu receptors
• Serotonin consist of  Indole ring
• Epinephrine is secreted from  adrenal medulla
• Norepinephrine becomes epinephrine; this reaction is catalyzed by 
phenylethanolamine N-methyl transferase
• Tryptophan to serotonin formation is catalyzed by  tryptophan hydroxylase and
decarboxylation
PharmacyPrep.
www.PharmacyPrep.Com Cardiovascular System
4
Cardiovascular System
Tips
1. Absolute refractory 2. Repolarization 3. arrhythmia
period
4. Phase 0 5. Phase 1 to starting 6. Relative refractory
phase 3 period
7. Phase 3 8. +ve inotropic 9. –ve inotropic
10. Digoxin 11. ACE inhibitors 12. Dihydropyridine
CCBs
13. Beta blockers 14. stroke 15. brain attack
16. cerebral embolism
• absence of rhythm(arrhythmia)
• drugs that cause +ve inotropic effect( Digoxin, ACE inhibitors, dihydropyridine CCBs )
• a brain attack that occurs when a wandering clot (embolus) or some other particle forms in
a blood vessel away from the brain-usually in the heart( cerebral embolism )
• drugs that cause –ve chronotropic effect( Digoxin, beta blockers )
• rapid depolarization(Phase 0)
• increase in force of contraction(+ve inotropic)
• happens when brain cells die because of inadequate blood flow to the brain(stroke, brain
attack )
• the cell cannot respond to any stimuli(absolute refractory period, Phase 1 to starting phase
3)
• the cell ability to respond stimuli increases or cell can respond to strong stimuli(Phase 3,
relative refractory period)
• decrease in force of contraction( -ve inotropic effect )
• excessive negative charge in cell(Repolarization)
• Absolute refractor period or Effective refractory period  Phase 1 to starting phase 3 is 

the cell cannot respond to any stimuli
• Relative refractory period  During Phase 3 is  the cell ability to respond stimuli
increases or cell can respond to strong stimuli
PharmacyPrep.
www.PharmacyPrep.Com Cardiovascular System
• Internal carotid artery supply blood  from heart to brain

• Least blood pressure at rest is in  Vena cava
• Depolarization (Inward current): Brings +ve charge into cell
• Increase Na+ influx into cell
• Decrease K+ efflux out to cell
• Repolarization (outward current or hyper polarization), take +ve charge out of cell
• Increase K+ efflux out to cell
• Increase Cl- influx into cell
• Muscles that help in contraction  myosin and actin
PharmacyPrep.
www.PharmacyPrep.Com Endocrine System
5
Endocrine System
Tips
• Glycolysis---------GlucoseH 2 O+CO 2
• Glycogenesis------Glucose Glycogen
• Glycogenolysis---Glycogen Glucose
• Gluconeogenesis—Fats and proteins Glucose
• Epinephrine is released from? Adrenal medulla
• Aldosterone is released from? Outer adrenal cortex
• ACTH is secreted by Pituitary gland
 Oxytosin is secreted from Posterior pituitary gland
 ADH is secreted from  posterior pituitary gland
 Deficiency of ADH gives  diabetes insipidus
 Symptoms of diabetic insipidus is  excessive urination
• Diabetes mellitus symptoms? Polyphagia, Polyurea, and Polydipsea
• Hypoglycemia symptoms? Sweating, palpitation (heart racing), confusion, fatigue, blurred
vision.
• Symptoms of hyperthyroidism? Weight loss, tachycardia, diarrhea, and sensitive heat
• Symptoms of hypothyroidism? Weight gain, bradycardia, constipation, dry skin, and sensitivity
to cold.
• Symptoms of Cushing syndrome? Weight gain, moon face, and edema
• Addison disease is hypocortisole
• Cushing syndrome is hyper cortisole
Copyright © 2000 to 2011 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is 5-1
PharmacyPrep.
• Adrenal cortex secretes  aldosterone, androgen, and corticosteroids

• Adrenal medulla secretes  adrenaline (epinephrine)
• Corticosteroids secreted from adrenal cortex
• Androgens are secreted from adrenal cortex
• Thyroid gland secretes  thyroxin (T4), and liothyronin (T3) and calcitonin
• Hashimoto thyroiditis and myxedema is Hypothyroid
• Graves disease is Hyperthyroidism
• Pancreas secretes  insulin, glucagon, and somstatins
• Reabsorption of calcium is stimulated by parathyroid hormone (PTH)
• Insulin is secreted from  beta cells of islets of langerhans
• Glucagon is secreted from  alpha cells
• List the examples of extracelluar ions are?  Na, Cl, and Ca
• Hyperparathyroidism can cause?  Hypercalcemia and hypophosphetemia
 Thyroid is NOT a part of  lymphatic system
• Aldosterone secreted from  Adrenal cortex
• Cortisone is secreted form Middle layer adrenal cortex
• Hoshimoto disease Hypothyroidism
PharmacyPrep.
Hyperparathyroidism Excess production of PTH Increased serum calcium

Decrease serum phosphate.
Muscle weakness, atrophy.
Fatigue.
Hypoparathyroidism Decreased production Decrease serum calcium.
Increase serum phosphate.
Neuromuscular irritability.
Hypokalemia
Convulsions.
Myxedema Decrease secretion of thyroid Puffy face, dry skin, scanty
hormone hair, slow speech, Weight
gain. Slow BMR
Grave’s disease Increase secretion of thyroid Weight loss, fast heartbeat,
hormone anxious and sharp mind,
high BMR. Soft skin
Cushing syndrome Increase in glucocorticoids Obesity, hypertension,
horomone secretion, excess weakness, hirsutism, edema,
cortisol. osteoporosis, and weight
gain.
Addision disease Decrease in glucocoticoids Anorexia, nausea, vomiting,
hormone secretion weight loss, hypotension,
mucosal pigmentation.
Diabetes Insipidus Increase production of ADH Polyurea, polydipsea.
Conn,s syndrome Excessive production of Hypokalemia, muscle
aldosterone weakness, fatigue, polyurea,
polydipsea
1. adrenal medulla 2. pituitary gland 3. posterior pituitary

gland
4. diabetes insipidus 5. glucose 6. H2O + CO2
7. excessive urination 8. outer adrenal cortex 9. sensitivity to cold
10. bradycardia 11. Weight gain 12. Glycogen
13. constipation 14. dry skin 15. weight loss
16. tachycardia 17. diarrhea 18. sensitivity to heat
19. sweating 20. palpitation 21. fatigue
22. polyhagia 23. polyurea 24. Blurred vision
25. polydipsea 26. 27.
• Glycolysis ---------Glucose→(H2O + CO2)

• Glycogenesis----Glucose→(Glycogen)
• Glycogenolysis-------Glycogen→( Glucose)
• Gluconeogenesis------Fats& proteins→(Glucose)
• epinephrine is released from? (adrenal medulla)
• aldosterone is released from? (outer adrenal cortex)
PharmacyPrep.
• ACTH is secreted by? (pituitary gland)
• oxytocin is secreted from? (posterior pituitary gland)
• ADH is secreted from? (posterior pituitary gland)
• deficiency of ADH gives… (diabetes insipidus)
• symptom of diabetes insipidus (excessive urination)
• symptoms of diabetes mellitus (polyphagia, polyurea, polydipsea)
• symptoms of hypoglycemia (weight loss, tachycardia, diarrhea, sensitivity to heat)
PharmacyPrep.
www.PharmacyPrep.Com Renal System
6
Renal System
Tips
• BUN = Blood Urea Nitrogen
• GFR = Glomerular Filtration Rate
• Azotemia is?  Increase in blood urea nitrogen in blood
• Uremia is?  Symptoms of azotemia (Urea in blood)
• Early proximal convoluted tubule = Reabsorbs Na+, Cl-, Ca2+
• Early distal convoluted tubule = Reabsorbs Na+, Cl-, Ca2+
• Thin descending loop of Henle = Reabsorbs H 2 O
• Thick ascending loop of Henle = Reabsorbs: Na+, K+, Cl-, Mg2+,Ca2+
• Collecting tubule: Reabsorbs Na+ in exchange of K+ or H+ (regulated by aldosterone).
Reabsorbtion of H 2 O is regulated by ADH (vasopressin).
• Pre-renal Acute Renal failure is due to  renal perfusion
• Intrinsic Acute renal failure  in kidneys
• Post-renal Acute renal failure  can occur in ureter, bladder or prostate
• The most common extra cellular cation is sodium (Na+)
• The most common extra cellular anion is chloride (Cl-)
• GFR measures? Creatinin clearance
• Factors that effect on reabsorption  Flow rate, concentration ions, and tonicity
• Chronic renal disease may cause  hypokalemia
• Adrenal cancer may cause  hypokalemia
PharmacyPrep.
www.PharmacyPrep.Com Renal System
Reasoning and Problem solving

• Write the examples of drugs that cause metabolic acidosis? Acetazolamide, and K
sparing
• Write the examples of drugs that cause metabolic alkalosis? Thiazides and loop
diuretics
• What drug gives intracellular alkalosis  spiranolactones
• What is the abundant metal in body? Iron

• What happens in metabolic acidosis? ↓HCO 3 ↑CO 2
• What happens in metabolic alkalosis? ↑HCO 3 ↓CO 2
• A patient using captopril bid, may have the following lab results of potassium?
• Explain what active tubular secretion and reabsorption in the kidney mean?
1. hypokalemia 2. in kidneys 3. creatinin clearance

4. ↓HCO 3 ↑CO 2 5. ↑HCO 3 ↓ CO 2 6. Azotemia
7. renal perfusion 8. ureter 9. bladder or prostate
10. flow rate 11. pH 12. tonicity
13. metabolism 14. hypocalcemia 15. hypercalcemia
PharmacyPrep.
www.pharmacyprep.com Liver
7
Liver Function and
Pathophysiology
Tips
• Cholestasis = Bile cannot flow from the liver to the duodenum.
• Cholecystitis = Inflammation of gall bladder
• Lactulose is used in what type of chronic liver disorder  Hepatic encephalopathy
• Hepatitis A transmits by  Food and water or orofecal
• Hepatitis B and C transmits by  sexual contact, drug abuse, and blood transfusion.
• Hepatitis B and C are chronic infections
• What hepatitis have vaccine  A & B
• Hepatitis B vaccine protects  hep B and D
• Hepatitis B is  DNA type of virus
• Ascietes is caused by liver cirrhosis, infections, and cancer

• Interferon + ribavarin for  Hepatitis C
• Oral drug passage to liver by  mesenteric vein  portal veins  liver  hepatic
vein  heart  systemic circulation
• Drugs that cause hepatotoxicity
• Acetaminophen (> 4g daily)
• Tetracycline (>2g daily)
• Methotrexate (>25mg/wk)
• Vitamin A (chronic use over 40,000 U daily)
• Salicylates (chronic use >2g daily)
• Iron (single dose >1g)
• Cyclophosphamide
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and 7-1
it is illegal to reproduce without permission. This manual is being used during review sessions
conducted by PharmacyPrep.
• 6-Mercaptopurines
• Cholestatitis
• Retention of bile acids because of obstruction of bile ducts.
• Example: Penicillin’s (isoxazole type)
• Cholestatitis can lead to hyperbilirubinemia
Example: Rifampin
• Bacterial peritonitis: Chronic liver disease, history of fever, abdominal pain.
Reasoning and Problem Solving
• How are drugs transported into the bile from the liver? There are transporters for
anions, bile salts, cations, and neutral organic compounds.
• Explain what is meant by the term enterohepatic recirculation? This term refers to
drugs emptied via bile into the small intestine and then reabsorbed from the
intestinal lumen into the systemic circulation.
• What advantage does enterohepatic cycling have for the body? It can allow the
body to conserve endogenous substances such as bile acids, vitamins D and B 12 ,
estrogen etc. It may be responsible for some of the long half-lives of drugs.
• How does antibiotic therapy interfere with the process of enterohepatic
recirculation?
Oral drugs passage to liver = mesenteric veins  portal veins  liver  hepatic vein 
systemic circulation
• What is enterohepatic recirculation?
• What type of hepatitis is chronic  Hepatitis B and C
• What is treatment of hepatitis  Interferons
1. Penicillamine 2. ascites 3. Wilsons disease

4. cholestatitis 5. hepatic encephalopathy 6. Hepatitis B
7. Hepatitis C 8. Infections 9. TB
10. cancer 11. GI surgeries 12. Chronic liver disease
13. Sexual contact 14. water 15. orofecal
16. Interferon alfa 17. Portal hypertension 18. Spironolactone
• what type of hepatitis is chronic? (hepatitis B & C)

• what is the treatment of hepatitis? (Interferon alfa)
• Hepatitis A transmits by? (water, orofecal)
• Hepatitis B and C transmits by? (sexual contact)
• Ascitis is caused by? (infections, TB, cancer, GI surgeries, chronic liver disease)
• it is a DNA type of virus(Hepatitis B)
• accumulation of fluid in peritoneal cavity(ascites)
• it is caused by excessive copper(Wilsons disease)
• DOC for Wilsons disease(Penicillamine)
• retention of bile acids because of obstruction of bile ducts(cholestatitis)
• a type of Hepatitis that has no vaccine(Hepatitis C)
• DOC for ascites(spironolactone)
• lactulose is used in what type of chronic liver disorder? (hepatic encephalopathy)
www.pharmacyprep.com Respiratory System
8
Respiratory System
Tips
________________________________________________________________________
• Emphysema is a COPD, characterized as permanent enlargement of alveoli
• COPD symptoms: inflammation, cough, phlegm, excessive mucus, infections,

dyspnea
Bronchodilator
• Beta 2 agonist salbutamol, terbutalin, salmeterol, formeteral
• Beta 1 and Beta 2 agonist  isoproterenol and dobutamine
• Mixed alpha & Beta  epinephrine
• Alpha 1 agonist  Phenylephrine, methoxamine
• Muscarinic antagonists Ipratropium, and Tiotropium
LTRAs  Montelukast, zafirlukast
Bronchospasm (Branchoconstriction)
• Mixed Beta 1 and Beta 2 blockers--> Propranolol, Pindalol, Nadolol, Timolol,
• Partial agonist & antagonist  Pindolol
• Esmelol Metaprolol Acebutalol Atenolol (cardio selective)  do not give
bronchospasm
Tips format 02: Find answers from the table:
1. asthma 2. emphysema 3. dyspnea

4. COPD 5. rhinorrhea 6. sialorrhea
• difficulty in breathing(dyspnea)
• permanent enlargement of the alveoli(emphysema)
• emphysema is…(COPD)
• drooling (excessive saliva) (sialorrhea)
• runny nose(rhinorrhea)
• it occurs in the bronchus(asthma)
• it occurs in bronchioles & alveoli(COPD)
9
Urinary Systems
• Pyuria is  Abscess (pus) in urine
• Dysuria  painful urination
• Proteinuria  Protein in urea
• Cystitis  Bladder infections (UTI)
• Urinary tract infections symptoms Dysuria, Fever, Pyuria, frequent urination
• Urinary incontinence symptoms NO control on bladder or urination
• Drugs that are used for treatment of urinary incontinence Oxybutinin or
anticholinergic drugs
• Drugs that are avoided in patient with urinary incontinence Diuretics
• Enuresis (bed wetting) drug of choice  ADH (vasopressin) or imipramine
• Benign Prostatic Hyperplasia (BPH) is  enlargement of prostate
• Benign Prostatic Hyperplasia symptoms are --> dysuria, frequent urination, urine by
drop by drop, nocturia, and irritation (NOT a symptoms: Jet urination)
• Drug of choice for BPH  Finesteride
• Saw palmetto is used for --> BPH
10
The Eye and Ear
Tips
________________________________________________________________________
• The retina contains two types of photoreceptors, rods and cones.

• These rods are responsible for night vision, our most sensitive motion detection, and
our peripheral vision.
• The rods are more numerous, some 120 million, and are more sensitive than the
cones. However, they are NOT sensitive to color.
• The 6 to 7 million cones provide the eye's color sensitivity and they are much more
concentrated in the central yellow spot known as the macula.
• Cones are sensitive to color vision
• Blind spot is  optic disc
• Age related macular degeneration cause due to retinal detachment
• Glaucoma occurs due to  abnormal increase IOP in eyeball
• Drugs that are used to treat glaucoma are  sympathetic blockers (B-blockers),
Prostaglandin analogs (Latanoprost), diuretics (acetazolamide)
Pharmacyprep.com Blood composition and anemia
11
Blood and Anemia
Tips
______________________________________________________________________
• Anemia due to deficiency of iron  Microcytic
• Clinical laboratory measurements that determines the status of anemia The
hematocrit or packed red cells volume (PCV) per 100 ml, the blood hemoglobin
concentration per 100 ml and RBC counts per cubic millimetre.
• Megaloblastic anemia is due to  Vitamin B 12 + folic acids
• The clinical laboratory measurements in megaloblastic anemia  Increased volume of
RBCs with a MCHC proportionally increased
• Vitamin supplements recommended in elderly  vitamin B 12
• Intrinsic factor secreted from  Parietal cells in stomach
• Deficiency of intrinsic factor cause  Pernicious anemia
• Oprelvekin (Interleukins 11) is approved for  Thrombocytopenia
• Epoietin alpha (erythropoitins) are used to treat Anemia associated chronic renal
disease
• Deficiency of folic acid supplements in pregnancy can cause  Neuro Tubule Defect
• What is meaning of melanoma  Skin cell cancer
• Drugs that gives folic acid deficiency  Methotrexate, sulfa drugs, OCP and phenytoin
• Vitamin that decrease oxidative degradation  Vitamin C& E
• Anemia in pregnancy is mainly due to  iron deficiency
• The most abundant metal in the body is  iron
• Site of calcium reabsorption in nephron is at proximal convoluted tubules (PCT)
PharmacyPrep.
• Characteristic of both Vitamin B 12 and folic acid deficiency  Megaloblastic anemia

• Which component is required for vitamin B 12 absorption  intrinsic factor
• What is orthopnea breathlessness when lying down
• What iron salts have higher GI absorption Ferrous gluconate
• A patient G6PD deficiency, sulfa drug cause  hemolytic anemia
• Moon shape red blood cells are seen in  Sickle cell anemia
• Highest elemental iron present in  Ferrous fumarate
• A patient taking methotrexate for cancer treatment, to treat bucal ulcers give Folic
acid
• Abundant element in the interstitial fluid (extracelluar)  Na and Cl
• Intracellular means  Inside cells
• Interstitial means  between cells
• Aplasia  Total or partial failure of development in organ
• Blood dyskariosis  abnormal condition of cell.
• How do you take iron supplement empty stomach, or take with food if constipation
• What is common side effect of iron supplement  constipation
• Overdose symptoms of iron is  Diarrhea, vomiting and melena (dark stools)
• Iron supplement antidote is  Deferoxamine
• Liquid iron is taken by using  Straw (to prevent teeth discoloration)
• What is hemochromatosis (bronze disease)?  Excess absorption and storage of iron.
• The clinical laboratory measurements in megaloblastic anemia  Increased volume of
RBCs with MCHC
• What vitamin helps in RBC formation? B 12 , B 1 , Folic acid, vit E.
• Vit E helps in  RBC Cell wall integrity
• Hematocrit = The proportion of the blood that consists of packed RBC. The hematocrit is
expressed as a percentage by volume. The RBCs are packed by centrifugation.
• Ferritin: The major iron storage protein. The blood level of ferritin serves as an indicator of
the amount of iron stored in the body.
• Mean Corpuscular Hemoglobin Concentration (MCHC) =The MCHC is a measure of the
concentration of hemoglobin within a red blood cell.
PharmacyPrep.
• Reticulocytes  immature red blood cells that normally appear as a small percentage of
total RBCs. It is useful in diagnosis of anemia. A decrease in reticulocyte indicates a failure
in RBC production.
• Tips Format 02: Find answers from the table:
1. Vit C& E 2. Anemia associated 3. Parietal cells in stomach
chronic renal disease
4. Vit B12 5. Intrinsic factor 6. Skin cell cancer
7. Neurotubule defect 8. thrombocytopenia 9. pernicious anemia
10. megaloblastic anemia 11. iron 12. in nephron at proximal
convoluted tubule (PCT)
13. Methotrexate 14. Sulfa drugs 15. OCP
16. Phenytoin 17. Ferrous gluconate 18. Breathlessness when lying
down
19. Microcytic anemia 20. Sickle cell anemia 21. Folic acid
22. Empty stomach 23. constipation 24. ferrous gluconate
25. diarrhea 26. melena 27. vomiting
28. bronze disease, 29. Deferoxamine 30. Penicillins
excessive absorption
and storage of iron
31. Primaquin 32. Use straw 33.
anemia due to deficiency of iron (microcytic anemia)

vitamin supplements recommended in elderly (Vit B12)
intrinsic factors secreted from.. (parietal cells in stomach)
deficiency of intrinsic factors cause.. (Pernicious anemia)
megaloblastic anemia is due to (Vit B12 + folic acid)
Oprelvekin (interleukin 11) is approved for (thrombocytopenia)
Epoietin alpha are used to (Anemia associated chronic renal disease)
deficiency of folic acid supplements in pregnancy can cause (neuro tubule defect)
what is the meaning of melanoma? (skin cell cancer)
drug that gives folic acid deficiency (Methotrexate, sulfa drugs, OCP & Phenytoin)
vitamin that decrease oxidative degradation (Vit C & E)
anemia in pregnancy is due to (iron)
most abundant metal in the body (iron)
site of calcium reabsorption (in nephron at proximal convoluted tubules (PCT))
characteristic of both Vitamin B12 and folic acid (megaloblastic anemia)
which component is required for Vit B12 absorption (intrinsic factor)
what is orthopnea? (breathlessness when lying down)
what iron salts have higher GI absorption? (ferrous gluconate)
patient G6PD deficiency, sulfa drug can cause… (hemolytic anemia)
moon shaped platelets are seen in.. (sickle cell anemia)
highest elemental iron present in…(Ferrous fumarate)
patient taking Methotrexate for cancer treatment, to treat bucal ulcers give…(folic acid)
how do you take iron supplement? (empty stomach, or take with food if there is constipation)
PharmacyPrep.
common side effect of iron supplement (constipation)

overdose symptoms of iron (diarrhea, melena, vomiting)
iron supplement antidote (deferoxamine)
liquid iron is taken by using.. (straw(to prevent teeth discoloration)
what type of anemia can cause G6PD deficiency? (hemolytic anemia)
drugs that induce hemolytic anemia? (sulfa drugs, penicillins, primaquin)
What is hemochromatosis? (Bronze disease, excess absorption & storage of iron)
PharmacyPrep.
www.PharmacyPrep.Com Biochemistry
12
Biochemistry
Tips
• Glycolysis---------GlucoseCO 2 +H 2 O
• Glycogenesis------Glucose  Glycogen
• Glycogenolysis---Glycogen  Glucose
• Gluconeogenesis—Fats and Proteins  Glucose
• Glycolysis in anaerobic  Lactate
• Glycolysis in aerobic  Pyruvate
• The principle metabolic product is  glucose
• Glucose is stored as  Glycogen in liver  immediate source of energy
• Glycogen is stored in  Muscles  Reserved source of energy
• Maltose Gives two molecules of glucose
• Lactose  Gives galactose and glucose
• Sucrose  Fructose and glucose
• Starch  Gives amylose and amylopectins
• Alpha glucosidase  Breaks downs starch to glucose
• Cellulose  The polymer cellulose is also consumed but not digested
• Nitric oxide (NO) is derivative of what amino acid? arginin
• The serotonin is produced by? tryptophan
• Phenylketonuria (PKU) is? Excessive phenyl alanin
• Carbon monoxide binds to? Hemoglobin, myoglobin and cytochrome oxidase
• Carboxyhemoglobin is? Oxidized hemoglobin
PharmacyPrep.
• Methemoglobin is? Methylated hemoglobin

• Iron in hemoglobin is normally what state? Ferrous
• Cholesterol synthesis rate limiting step is catalyzed by HMG-CoA Reductase
• Antihyperlipidemic statins class drugs  HMG-CoA Reductase
• Essential fatty are? Linolic (omega 6), and linolenic (omega 3)
• Ecosanoids synthesis is dependent on? Prostaglandin or arachidonic acid
• What are the essential aminoacids  PVT TIM HALL (Phenyl alanin, valine,
tryptophan, isoleucin, methionin, histadine, arginin, leucin)
• What aminoacid is precursor of hemoglobin  glycine
• The most basic amino acid arginin
• Zwitter ion neutral ion
• All amino acids have two-titration curve  at isoelectric point
• Isoelectric point (pl) The pH of aminoacids, where it forms zwitter ion
• At pH>pl the structure has  net negative charge
• At pH<pl the structure has  net positive charge
• Energy storage form in body is? Glycogen
• Starch is composed of? Glucose
• Lecithins phosphatidyl choline
• Sphingolipids contain sphingenine
• End product of anaerobic Glycolysis  lactic acid or lactate

• End product of aerobic Glycolysis  pyruvic acid or pyruvate
• End product of amino acid (proteins)  Urea
• End product of purine cycle  uric acid
• Essential aminoacids  PVT TIM HALL (Isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan, and valine, histadine, and alanin)
• Krebs cycle occurs in  mitochondria
PharmacyPrep.
• Tryptophan is a precursor of the neurotransmitter serotonin.

• Glycine is a precursor of porphyrins such as heme.
• Arginine is a precursor of nitric oxide.
• Ornithine and S-adenosylmethionine are precursors of polyamines.
• Aspartate, glycine and glutamine are precursors of nucleotides.
• Chyme  The mixture of gastric secretions, saliva, and food, in the stomach
• α-amylase the pancreas secretes this enzyme and catalyzes the production of
disaccharides and trisaccharides and polysaccharides and these are converted to its
digestible constituents.
Tips Format 02: Find answers from the table:
1. linolenic 2. linoleic 3. arachidonic
4. arginin 5. oxidized hemoglobin 6. HMG Co-Reductase
7. Methylated 8. prostaglandin 9. ferrous
hemoglobin
10. hemoglobin 11. myoglobin 12. cytochrome oxidase
13. excessive 14. tryptophan 15.
phenylalanine in the
urne
• NO is a derivative of what amino acid? (arginin)

• the serotonin is produced by? (tryptophan)
• Phenyketonuria (PKU) is? (excessive phenylalanine in the urine)
• carbon monoxide is? (hemoglobin, myoglobin, cytochrome oxidase)
• carboxyhemoglobin is? (oxidized hemoglobin)
• methemoglobin is? (methylated hemoglobin)
• iron in hemoglobin is normally what state? (ferrous)
• cholesterol synthesis rate limiting step is catalyzed by… (HMG-Co Reductase)
• essential fatty acids (linolenic, linoleic, arachidonic)
• ecosanoids synthesis are dependent on? (prostaglandin)
• most basic amino acid (arginin)
PharmacyPrep.
www.PharmacyPrep.Com Clinical Biochemistry
13
Clinical Biochemistry
Tips
• Normal serum potassium levels?  3.5 to 5 mEq/L

• Osteoporosis can change calcium level by?  Does not change
• Calcitonin opposes action of?  Parathyroid Hormone (PTH)
• Replacement therapy in hypothyroidism can be monitored by?  Serum TSH (increase
TSH)
• What is monitored in hypothyroidism --> serum TSH
• What is the normal level of serum TSH --> 0.5 mU/L to 5 mU/L
• What is monitored in patients using warfarin --> INR and PT
• What is normal INR level in-patient taking warfarin?  2 to 3 if heart valve
replacement 2.5 to 3.5
• Increase INR indicated the risk of?  Bleeding
• If INR is more than 5  Stop warfarin, monitor INR and give oral vitamin K
• Normal levels of creatinin clearance?  80 to 120 ml/min
• Nitric oxide (NO) increases?  Relax smooth muscles
• What substance levels are increased in jaundice?  Bilirubin
• What enzyme ratio increases in chronic alcoholic hepatitis?  AST>ALT
• What is monitored for heparin  aPTT
• What is monitoring in Low Molecular Weight Heparins (LMWH) No monitoring
needed, it has predictable response
• Name the enzyme most likely to increase in levels suggesting a myocardial infarction.
 Creatin kinase (CK-MB).
PharmacyPrep.
www.PharmacyPrep.Com Clinical Biochemistry
• What cardiac enzyme exclusively elevated after MI  Troponin-I

• Name the enzyme that most likely to increase in levels suggesting a myopathy  CK-
MM
• Parenteral administered electrolytes are expressed in what types of units?  mEq
(millie equivalents).
• Most common liver enzyme that indicates liver function test  LDH, ALP, AST, and
ALT increases with liver dysfunction.
• Bilirubin is  a breakdown product of hemoglobin, it is predominant pigment in bile.
• What liver enzymes are elevated with overdose of Acetaminophen AST/ALT
• What are the examples of renal function tests  BUN, and CrCl.

1. 80-120 ml/min 2. bleeding 3. bilirubin
4. does not change 5. parathyroid hormone 6. 3.5 to 5 meq/L
PTH
7. 2 to 3 8. troponin 9. aPTT
10. AST>ALT 11. Creatinin kinase CK- 12. Stop Warfarin,
MB monitor INR and give
oral Vit K
13. No monitoring 14. 15.
required
• normal range of serum potassium levels? (3.5 to 5 meq/L)

• osteoporosis can change calcium level by? (does not change)
• calcitonin opposes action of? (parathyroid hormone PTH)
• hypothyroidism can be monitored by? (serum TSH)
• what is normal INR level in patient taking Warfarin? (2 to 3 )
• increase INR indicated the risk of? (bleeding)
• normal levels range of creatinin clearance(80-120ml/min)
• what substance levels are increased in jaundice? (bilirubin)
• what enzyme ration increases in alcoholic hepatitis? (AST>ALT)
• what is monitored in patient taking LMWH? (no monitoring required)
• If INR is more than 5(stop Warfarin, monitor INR and give oral Vit K)
• what is monitored by Heparin? (aPTT)
• name the enzyme most likely to increase in levels suggesting a myocardial infarction?
(Creatinin Kinase CK-MB)
• what cardiac enzyme exclusively elevated after MI? (troponin)
PharmacyPrep.
www.PharmacyPrep.Com Nutrition
14
Nutrition
Tips
• What vitamin found in only animal products?  Vitamin B 12
• People who do not eat from animal sources, have deficiency of vitamin B12
• Chron disease that causes deficiency of vitamin?  Vitamin B 12
• The most common vitamin deficiency in the United States and Canada?  Vitamin D
• Para Amino Benzoic Acid (PABA) is precursor of?  Folic acid
• Active form of vitamin D is?  1, 25 dihydroxy cholecalciferol-Vitamin D 3 (kidney)
• Storage form of vitamin D is?  25 hydroxy cholecalciferol-Vitamin D 2 (liver)
• Supplement of folic acid in early in pregnancy reduces?  Neurotubule defect (NTD)
• Sun exposed skin forms the type of vitamin D is?  Vitamin D 3
• Retin-A is used for wrinkles and acne is isomer of?  Trans 13-retinoic acid (Vitamin A)-
TTT
• Fat-soluble vitamins ADEK absorption takes place in what part of GI?  Ileum (small
intestine).
• What vitamin overdose causes toxicity? Vitamin A
• All B-complex vitamins washout from body except?  Vitamin B 12 (stored in liver)
• What vitamin is essential for the synthesis of nitrogenous bases in DNA and RNA?  Folic
acid.
• What chemical ring that binds with folate enzyme in folic acid?  Pteridine ring
• What vitamin is classified as hormone?  Vitamin D3
• Chronic alcoholism may cause deficiency of ? Vitamin B 1 (thiamine)
PharmacyPrep.
• Elderly have deficiency of  vitamin B12
• Infants on breast milk should receive  vitamin D
• Vegetarians have deficiency of  Vitamin B12
• A person is smokers should receive  Vitamin C
• Stethorrhia can cause deficiency of Fat soluble (ADEK)
• What type of food deficiency gives niacin deficiency  Protein diet deficiency
• Forms of vitamin A found in rods of retina  rodapsine
• What vitamins supplements are contraindicated in pregnancy  vitamin A
• Omega 3 fatty acid is  Linolenic acid
• Omega 6 fatty acid is  linoleic acid
• Alpha fatty acids are present in  Flax seeds, walnut etc.
• DHA  Docasahexanoic acid
• EPA  Eicosapentanoic acid
• What vitamins have steroidal structure  Vitamin D
• A patient using orlistat (xenical), what vitamin are recommended  ADEK
• A smokers, what vitamin is NOT recommended  beta carotene, because it give age
related macular degeneration
• Active Vitamin D is 1,25 dihydroxycholecalciferal
• Drugs that gives stethorrhia  Orlistat (xenical)
• Drugs that decrease vitamin ADEK absorption  Cholestyramine resins.
• Consuming over 10 times recommended dose of vitamin D for over several months can
cause Hypercalcemia
• For Vitamin D3 formation from sunlight, the precursor  7-dehydrocholesterol
• Foods that contain gluten  wheat, barley, oats, and rye
• Celiac disease is  intolerance to the gliadin fraction of ingested gluten
PharmacyPrep.
• ADEK = Vitamins A, D, E and K (fat soluble vitamins)

• ARMD = age related macular degeneration
• PABA = Para Amino Benzoic Acid
• NTD = Neurotubule defect
• What vitamin found only in animal products?

• Chron’s disease causes deficiency of vitamin?
• The most common vitamin deficiency in the United States and Canada?
• Para amino Benzoic Acid is precursor of?
• Active form of vitamin D is?
• Storage form of vitamin D is?
• Supplement of folic acid in early in pregnancy reduces?
• Sun exposed skin forms the type of vitamin D is?
• Retin A is used for wrinkles and acne is isomer of?
• Vitamin A, D, E, and K absorption takes place in what part of Gastrointestinal tract?
• All B-complex vitamin washouts from body except?
• What vitamin is essential for the synthesis of nitrogenous bases in DNA and RNA?
• What chemical ring that binds with folate enzyme in folic acid?
• Severe Vitamin B1 thiamine deficiency = Beriberi and Wernicke-Korsaskoff syndrome
• Chronic alcoholics have deficiency of = Riboflavin (Vitamin B2)
• Deficiencies in newborns treated for hyperbilirubinemia by photo therapy = Riboflavin
• Niacin = is not a true vitamin
• Niacin = derived from the amino acid tryptophan.
• Pellagra = Deficiency of vitamin B3 (Niacin)
• Pernicious anemia is = Vitamin B12 deficiency
• Pteridine ring structure is present in = Folic acid
• Scurvy = Deficiency in vitamin C
• β-carotenoids = Precursor of vitamin A
• Vitamin D deficiency = in children is rickets and in adults is osteomalacia
PharmacyPrep.
• Vitamin D supplements = are recommended in newborn that are on breast-feeding.

• Folic acid supplements are now recommended for pregnant women to prevent neural tube
defects (spina bifida) in their children
• Omega 6H = Lenoleic acid
• Omega 3 = Lenolenic acid  act like aspirin  Antiplatelet
• Lenolenic (Omega 3 ) acid mainly present in fish and walnut
• Chronic renal disease patient should receive vitamin  1, 25 dihydroxy vitamin D
• Vitamin E toxicity  More than 1100 units (average capsule is 400 units)  Prevent the
synthesis vitamin K coagulant factors (act as anticoagulant).
Diet
7-Dehydrocholesterol
Cholecalciferol Skin (ultraviolet)
↑ [ Ca2+] Liver
↑ PTH 25-OH-cholecalciferol-D2
↓ [ phosphate]
(+) Kidney
1, 25-(OH)2-cholecalciferol 24, 25-(OH)2-cholecalciferol

(Active)D3 (Inactive)
• What are the essential fatty acids  linolieic acid, linolinic acid
1. Vit D 2. Vit B12 3. Trans 1, 3 retinoic acid
(Vit A)
4. Vit D3 5. ileum 6. folic acid
7. neurotubule defect 8. Vit A 9. 1,25
dihydrocholecalciferol
Vit D3 in kidney
10. 25 11. 12.
hydroxycholecalciferol
Vit D2 in liver
• what vitamin is found only in animal products? ( )

• the most common vitamin deficiency in United States and Canada( )
• is precursor of? (folic acid) Para amino Benzoic Acid ( )
• active form of Vit D is? ( )
• storage form Vit D is? ( )
PharmacyPrep.
• supplement of folic acid in early pregnancy reduces? ( )

• sun exposed skin forms the type of Vitamin D is? ( )
• Retin A used for wrinkles and acne is isomer of? (trans 1,3 retinoic acid ( )
• Vitamin A, D, E, K absorption takes place in what part of gastrointestinal tract? ( )
• All B-complex vitamin washouts from body except? ( )
• what vitamin is essential for the synthesis of nitrogenous bases in DNA and RNA? ( )
• People who do not eat from animal sources have deficiency of? ( )
• what vitamin overdose causes toxicity? ( )
PharmacyPrep.
www.PharmacyPrep.com Microbiology
15
Microbiology
Tips
• E. coli is classified as?  Gram –ve bacilli
• Beta hemolytic bacteria example is?  Strep. pyogenes (Group A Strep)
• Toxic shock syndrome is caused by?  S. aureus (with use of tampons, and reservoir type
contraceptives such as contraceptive sponges, cervical caps, IUDs)
• Lyme disease is caused?  Borrelia burgdorferi, in summer, ticks bites (hosted in deer).
• Techoic acid is present in?  Gram +ve bacteria (gives blue stain)
• Encephalitis is?  Brain infection caused by alpha viruses.
• Chlamydia neonatrum (C. trachomatis) is?  Chlamydia infection in neonates (occurs in
new born)
• Non-gonococcal infections that cause UTI are? E. coli, chlamydia
• Diphtheria is caused by?  Corynebactereum diphtheria
• Syphilis is caused by?  Trepenoma pallidum
• Antrax is caused by?  Bacillus antracis (gram +ve)
• What bacteria catalase degrades H 2 O 2 ?  Super oxide dismutase  S. aureus (where as S.
epidermidis and S. saprophyticus do not.)
• Examples of live attenuated vaccines? MMR, Sabine, yellow fever, smallpox, VZV
(vericella zoaster)
• Viral diarrhea is caused by  Rota virus
• Traveller diarrhea (bacterial) is caused by  E. coli, Shigella, and Compylobacter jejuni
• Microorganism that is present in acne  Propionobacterium acne
• Example of alpha haemolytic bacteria  S. pneumoniae and S. viridans
• Chronic hepatitis is caused by  Hepatitis B, C,
• Hepatitis C is treated by  Interferon’s
• Hepatitis B is type of virus  DNA virus
• Endotoxins are produced by  gram –ve bacteria
• The most common type of UTI? Cystitis (bladder infection)
• Drug of choice for cystitis  Cotrimoxazole, Cephalosporins, and Cipro
• Complicated UTI is  due to anatomical and physiological abnormalities, cause infection
• Endocarditis prophylaxis is required for  dental surgeries, mitral valve surgeries, and
heart surgeries.
PharmacyPrep.
www.PharmacyPrep.com Microbiology
• Granulomatus is  Localized cell formation in response to infections or inflammation.

Examples: Tuberculosis or syphilis infections give granulomatus.
• Pyelonephritis is  Bacterial infection of kidney substance

1 S. pneumonia 2 Chlamydia trachomatis 3 Pseudomonas
aeruginosa
4 S. aureus 5 Treponema pallidum 6 Corynebacterium.
7 E. coli 8 H. pylori 9 Borrelia burgdorferi
10 Haemophilus influenza 11 M. catarhalis 15 Group B Strep
13 HSV 14 CMV 14a Rubella
16 herpes zoster 17 Influenza A and B 18 N. meningitis
19 Epsteinbar 20 Shigella 21 Compylobacter jejuni
• Is the most common cause of community acquired pneumonia( 1 )

• Is the most common cause of subacute endocarditis( 4 )
• Is the causative organism of SYPHILIS( 5 )
• Causative organism of lyme disease( 9 )
• Is tick born infection( 9 )
• Causative organism of bacterial diarrhea( 7, 20, 21 )
• Causative organisms of OTITIS EXTERNA( 3 )
• The most common pathogen isolated from middle ear (OTITIS MEDIA) infection when
aspiration of ear is performed. ( 1, 10, 11 )
• The most common cause of bacterial meningitis( 18, 10, 1 )
• The most common cause of encephalitis( 13, 14 )
• is a gram +ve bacilli( 6 )
• Is the causative organisms of SINUSITIS( 1, 10, 11)
• Causative organisms of nosocomial (hospital) infections (4, 3)
• is a type of herpes virus ( 13,14,16, 19 )
• Is a type of Epstein-Barr virus (EBV) (13)
• Causative organism of Shingles (16)
• Causative organism of Seasonal flu( 17)
PharmacyPrep.
www.PharmacyPrep.Com Cell and Molecular Biology
16
Cell and Molecular Biology
Tips
• DNA = Deoxyribonucleic acid

• RNA = Ribonucleic acid
• C= Cytosin
• U = Uracil
• T = Thymine
• G=Guanine
• A =Adenine
• DNA ligase = Coupling of DNA helicles
• DNA lyase = Splitting of DNA helicles
• Nucleoside = Base + Sugar
• Nucleotides = Base + sugar + phosphate
• Haploid is? Single set of unpaired chromosomes
• Diploid is  double set of unpaired chromosomes
Plasmid is ? Small circular, extra chromosomal DNA molecule called plasmid. Plasmid DNA
carries genetic information and undergoes replication. Plasmid may carry genes that convey
antibiotic resistance.
Vector is? A vector is molecule of DNA to which the fragment of DNA to be cloned is
attached. Essential requirements of vector include: It must capable of autonomous replication.
It must contain one specific nucleotide sequence. It must carry at least one gene. Commonly
used vectors are plasmids, bacteria and viruses.
• Genome (DNA library): Complete genetic information of one species.

• Transcription: Taking information from DNA template on m-RNA
PharmacyPrep.
• Translation: m-RNA tRNA  rRNA  Proteins

RNA Polymerase: Catalyses the synthesis of RNA
• Stop, nonsense or termination codons =
• Transduction is? Phage – mediated cell-to-cell DNA transfer.
• Conjugation is? Direct cell to cell DNA transfer
• Transformation is? Purified DNA taken up by a cell
• Transposition is? DNA transfers to it or another chromosomes or plasmid (piece of
DNA) within cell.
• Recombination: Exchange of genes between 2 chromosomes by crossing over within
regions of significant base sequence homology.
• Prokaryotes do not have mitochondria, but the function of energy production is found in
the plasma membrane
• Prokaryotes contains ribosome’s, that are smaller than eukaryotic
• Eukaryotes do not have murein within the cell wall
• Both eukaryotes and prokaryotes contain DNA within the chromosomes
• Mitochondria is the host of Krebs cycle
• Purine Bases = A, and G (Pure As Gold)
• Pyrimidine Bases = C, U, T (CUT the Py)
• Bases present in DNA = A, C, G, and Thimine,
• Bases present in RNA = A, C, G, and Uracil
• Uracil is not found in?  DNA
• Thiamine is NOT found in  RNA
• Complimentary bases  A—T and G—C or A – U and G – C
T CAG
| | | |
A GTC
• Prokaryotes = Have cell membrane
• Eukaryotic = Have no cell membrane
• The largest type of RNA? r-RNA (80%)
• The smallest type of RNA? m-RNA (5%)
PharmacyPrep.
• Single strand DNA is present in? Some virus

• RNA polymerase I catalyses formation of ? m-RNA
• DNA transferase catalyzes the transfer of various groups such as phosphate and
• amino groups.
• DNA hydrolase’s = hydrolyses various substances.
• DNA lyase = catalyzes the removal of various functional groups other than the process
of hydrolysis.
• DNA isomerase’s = catalyzes various isomerizations
• How many bases in codon  3 bases
• Haploid Single set of unpaired chromosomes
• Diploids  Double set of unpaired chromosomes
• Codons are present on  mRNA
• Anti codons are present in tRNA
• Protein synthesis sequence  transcription  translation  protein synthesis
• Transcription is  DNA to mRNA
• Translation is  mRNA to protein synthesis

• Mutagenic  The drugs cause changes or alterations to cancer cells but also to all cells.
• Carcinogenic  Some of these drugs may themselves cause cancer and these drugs use
vertical laminar airflow hood.
Write the correct sequence of protein synthesis? DNAmRNAtRNArRNA  Proteins
Or DNA  Transcription  Translation  Protein synthesis
Hemophilia: This is a genetic disease often associated with X chromosome only. Thus men
can hemophilic or no hemophilic, however there is no carrier in men. Hemophilia causes slow
blood clot formation.
• There are two types of hemophilia, that is type A and B
• Hemophilia type A is due to deficiency of factor VIII (antihemophilic factor).
Hemophilia type B is due to deficiency of Factor IX (Christmas factor)
Mutations:
• Transition is? Substituting purine for purine or pyrimidine for pyrimidine.
• Tranversion is? Substituting purine for pyrimidine
PharmacyPrep.
www.PharmacyPrep.Com Pharmacogenetics
17
Genetics and
Pharmacogenetics
Tips
• What is Pharmacogenetics  The study of pharmacogenomics allows designing and

developing drugs that are customized to each person’s genetic mark up.
• Pharmacogenetics  study of drug response to genetic variability’s.
• Herceptin is used for  breast cancer
• Trastuzumab --> use for breast cancer
• The study which allows to design and develop drugs that are customized to each person’s
genetic mark up(Pharmacogenomics)
1. Trastuzumab 2. use for breast cancer

3. Hirceptin 4. Used for breast cancer
References:
Made especially for you: pharmacogenomics and pharmacy practice, CPJ. Jan 2008 vol. 141,
No.1
PharmacyPrep.
www.Pharmacyprep.com Immunology
18
Immunology
Tips
• In organ transplant, the rejection is due to:  Infiltration of T-cells.
• The most common Ig is?  IgG (70%)
• What drugs attacks CD 4 + T cells?  Muromonab (OKT 3 ) and MABs.
• What Ig is produced first in response to antigen?  Ig M
• What Ig is activated with pollens in asthma patients?  IgE
• Acute graft rejection is what type of hypersensitive reaction?  Type IV
• Tuberculin reaction is what type of hypersensitive reaction?  Type IV
• Infliximab is indicated for? RA, Chron’s disease, UC
• Hapten is a low molecular weight compounds that act as immunogens after chemically
complexing to a larger molecule or cell surface.
• Infliximab is given as? i.v
• Hoshimoto thyroiditis is a type hypothyroidism of hypersensitive reaction? Type 2
• Acute graft rejection is a type of hypersensitive reaction? Type 4
• Tuberculin test is a type of hypersensitive reaction? Type 4
• IgE mediated anaphylactic reactions are a type of hypersensitive reaction? Type 1
• What type of hypersensitive reaction is caused by Cephalosporins? Type II
• What are the examples that cause type I hypersensitive reactions? Asthma, and allergic
Rhinitis
• Poison ivy is type of hypersensitivity reaction  type IV
• What cells responds to bacterial and fungal infectionNeutrophils
• What blood cells are the highest number of cellsErythrocytes
• What is the second highest number of blood cellsPlatelets
• Basophiles cannot be identified from  Mast cells
• Anaphylactic reaction caused by penicillin is  Type I
• Systemic Lupus Erythromatus  HIPP MCQ (Hydralazine, Isoniazid, Penicillamine,
Procainamide, Methyl dopa, Chlorpromazine, and quinidine
• SLE is  type III hypersensitive reaction
• Steven Johnson’s Syndrome symptoms  ? rash, skin lesions, fever, rashes resemble to 3rd
degree burns.
• Drugs that give SJS  SASPAN  sulphonamide, anticonvulsants, sulfaoxazole,
phenytoin, allopurinol, ans NSAIDs.
• Asthma is  type I hypersensitive reaction
PharmacyPrep.
www.Pharmacyprep.com Immunology
• Anaphalactoid reactions  It is similar in symptoms of anaphylaxis reaction, however it

produced due to direct release of inflammatory mediators from cells by pharmacologic or
physical effects.
• Red man syndrome  Vancomycin
• Drugs that are commonly causing allergic reactions  NSAIDs, ASA, Beta lactams,
insulin, radiocontrast media, and sulphonamides.
• Pharmaceutical exipient and additives causing allergic reaction  tartrazine (FD&C
yellow No.5), Sulfites (antioxidants), parabens (antifungal preservatives)
• Glutens are present in  wheat, rye,
PharmacyPrep.
www.pharmacyprep.com Immunizations or Vaccines
19
Immunizations or Vaccines
Tips
____________________________________________________________________________
• Examples of live attenuated vaccines MMR, Sabine, yellow fever, smallpox, VZV
(vericella zoaster)
• Examples of killed vaccines Rabies, influenza, Salk polio and Hep A vaccine (SalK =
Killed) (RIP Always)
• Flu season in Canada? October to April
• Immunization season? October to Mid to Nov
• How often flu shot is taken? Once a year (annually)
• Flu is caused by? Influenza A and B
• Hepatitis A spreads by? Food and water contamination
• Hepatitis B and C spreads by? Sexual contact, blood transfusion
• What hepatitis is chronic? Hep B and C
• Active immunity: A type of acquired immunity whereby resistance to a disease is built up
by either having the disease or receiving a vaccine to it.
• Flu vaccine should be taken? Annually
• Flu vaccine stored in? Refrigerator
• Flu vaccine is killed vaccine
• The most of vaccine should be stored at? 2 to 8 (cold), refrigerator
• Dukoral vaccine: Cholera and travellers diarrhea
• Gardasil vaccine: Cervical cancer caused certain strains of papilloma virus.

____________________________________________________________________________
• A patient bought flu vaccine. After 1 month took it to doctor for vaccination, when will
it be effective? 2 wks
• Who should not get live vaccines? In pregnancy, immunocompramized patient and
close contact.
• Egg protein based vaccines are? Flu, MMR, Yellow fever (FRY an egg)
PharmacyPrep.
www.pharmacyprep.com Immunizations or Vaccines
• Contraindications to flu vaccines? Allergic to egg, under 6 months age and a person flu
symptoms.
• Write example of organ specific of autoimmune diseases?
• Who should not get live vaccines? In pregnancy, and immunocompramized patient
• Egg protein based vaccines are? Flu, MMR, Yellow fever (FRY egg)
• Flu shot (vaccine) effective against, the type of viruses? Influenza A and B
• Who should NOT take flu vaccine? Egg allergies, flu symptoms, and under 6 months
age
• Who is high-risk group for flu? Seniors over >65, asthma, COPD, CVD, diabetes,
children from the age of 6 months to 2 years, pregnant, and persons working in health
care facilities,
1. In pregnancy 2. Immunocompramized 3. Egg allergies
patient
4. Influenza A& B 5. Seniors over >65 6. asthma
7. COPD 8. CVD 9. diabetes
10. children from the age 11. egg allergies 12. flu symptoms
of 6 months to 2
years
13. under 6 months of 14. active immunity 15.
age
• who is high-risk group for flu? (seniors over >65, asthma, COPD, CVD, diabetes,
children from the age of 6 months to 2 years, persons working in health care facilities)
• who should not take flu vaccine? (egg allergies, flu symptoms, under 6 months age)
• a type of acquired immunity whereby resistance to a disease is built by either having the
disease or receiving a vaccine to it. (active immunity)
• who should not get live vaccines? (in pregnancy, immunocompramized patient)
• effective against which type of viruses? (Influenza A and B) flu shot (vaccine)
PharmacyPrep.
www.pharmacyprep.com Biotechnology
20
Biotechnology
Tips
• Infliximab is?  Monoclonal Antibodies, indicated for Chron’s disease and RA

• Filgrastim indicated for?  Treatment of neutropenia associated to chemotherapy.
• Muromonab (OKT 3 ) indicated for?  Organ transplant rejection reversal.
• In HIV patient, CD 4 can be detected in?  Blood of patients. Macrophages and
monocytes act as reservoir for virus to protect it from body immune system and Tcells
are destroyed.
• Precursor of platelets?  Megakaryoblast
1. Infliximab 2. Etanercept 3. Megakaryoblast
4. Hemophilia A 5. Muromonab-CD3 6. Erythropoietins
Orthoclone OKT3
7. Filgastrim 8. Epoetin alpha 9.
• indicated for anemia, associated with cancer chemotherapy; also used for chronic renal
disease associated anemia(Erythropoietins)
• it is approved for anemia related to cancer chemotherapy, chronic dialysis and AZT
therapy(Epoetin alpha)
• treatment of neutropenia associated to chemotherapy(Filgastrim)
• precursor of platelets(megakaryoblast)
• binds with both TNF alpha and beta(Etanercept)
• acute graft rejection in renal, cardiac and hepatic transplant patients(Muromonab-CD3
Orthoclone OKT3)
• it is approved for Chron’s disease and the treatment of rheumatoid arthritis (RA)
(Infliximab)
• due to deficiency of clotting factor VIII (Hemophilia A)
PharmacyPrep.
www.Pharmacyprep.com Toxicology
21
Toxicology
Tips
____________________________________________________________________________
• Benzodiazepine antagonist is? Flumazenil
• Salicylates overdose may be treated by? Charcoal and NaHCO 3
• Salicylates toxicity symptoms  Metabolic acidosis
• Acetaminophen antagonist is? N-acetylcysteine
• Opioid antidote is  Nalaxone
• Iron overdose is treated by  Deferoxamine (by chelation)
• Heparin antidote  Protamine sulfate (by neutralization)
• Warfarin antidote  Vitamin K
• Insulin antidote is  Glucagon
• What is ASA antidote  None
1. Flumazenil 2. N-acetylcysteine 3. Glucagon
4. Latanoprost 5. NaHCO3 6. Amiodarone
7. myopathies 8. elevated CK MM 9. rhabdomyolysis
10. Hydrchloquine 11. 12.
• Insulin antagonist is? (Glucagon)

• Benzodiazepine antagonist is? (Flumazenil)
• Salicylates overdose may be treated by? (NaHCO 3)
• Acetaminophen antagonist is? (N-acetylcysteine)
• Which glaucoma medication causes iris pigmentation? (Latanoprost)
• Latanoprost side effect  (Lash lengthening)
• Which antiarrhythmic drug cause pulmonary toxicity? (Amiodarone)
PharmacyPrep.
www.Pharmacyprep.com Toxicology
• Amiodarone (cause 5Ps: Pulmonary toxicity, pneumonitis, photoxicity, pigmentation (blue

color skin), and photophobia
• Which antimalarial drug causes retinopathy side effect? (Hydroxychloroquine)
• Why repeat the use of 1% permethrin after 7 to10 days? (To prevent reoccurrence)
• Risk of HMG-Co A, reductase inhibitor is? ( Rhabdomyolysis)
• A patient using statins rarely may cause rhabdomyolysis, which can be noticed by?
• Myopathies and elevated CK-MM
PharmacyPrep.
www.pharmacyprep.com Pharmaceutical sciences
Part 2:
Pharmaceutical Sciences
PharmacyPrep.
PharmacyPrep.
22
Pharmacy Calculations
Dose Calculations
1-A prescription calls for 10 units of a drug to be taken 3 times a day. How much will the
patient have taken after 7 days?
A-21.0 units
B-0.21 units
C-2.10 units
D-210 units
Ans: D
10 units x 3 x 7 = 210 units
2-A physician orders Meprobamate 0.2 g. How much is to be administered if the dose on hand
is 400 mg. in each tablet?
A-do not dispense
B-give 2 tablets
C-give 1 tablet
D-give ½ tablet
Ans: D
200 mg = _1_ tab

400mg 2
3. Prednisolone each tablet containing 5mg. Start 35 mg and then taper by 5mg every other
day. How many tablets are needed?
A-20 tab
B-56 tab
C-14 tab
D-28 tab
E-8 tab
Ans:B
7+7+6+6+5+5+4+4+3+3+2+2+1+1 = 56 tabs
PharmacyPrep.
4- An inhaler contains 120 doses. How many days the patient will take to finish the entire
inhaler with this signature: “Use 2 inhalers in each nostril every morning and at bedtime”
a) 7 days
b) 10 days
c) 20 days
d) 15 days
e) 30 days
Ans- D “Two inhalers in each nostril every morning and at bedtime”

2 x 2 nostril x 2 (morning + night) = 8 doses daily
120 doses ÷ 8 doses daily = 15 days supply
Balance Sensitivity
1-What is the minimum quantity that can be weight on a balance with sensitivity requirements
of 15mg of a 5% error is permissible
a) 100mg
b) 200mg
c) 300mg
d) 400mg
e) 500mg
Ans-C
Sensitivity Requirement = Weight x Error
15 = weight x 5_ = 300 mg
100
2- What is the sensitivity of a balance that can weight 120 mg of a substance and has a
permissible error of 5%?
a) 6mg
b) 16mg
c) 66mg
d) 26mg
e) 1.6mg
Ans-A
SR = Weight x Error
SR = 120mg x 5_ = 6mg
100
PharmacyPrep.
Tips Practice Format 002: Dose Calculations

______________________________________________
Use the following formula to calculate answer the questions
1-The amount of solution needed can be determined by setting the two ratios equal:
active ingredient (available) = active ingredient (to be administered)

Solution (available) solution (needed)
2-
mEq = Molecular Weight
Valence
3-Converting between milligrams and milliequivalent
Number of mEq = Weight of substance in mg

mEq weight
4-
Q1 * C1 = Q2 * C2
Questions
1-You have a stock solution that contains 10 mg of active ingredient per 5 ml of solution. The
physician orders a dose of 4 mg. how many milliliters of the stock solution will have to be
administered?
2-The molecular weight of magnesium sulfate (Mg ++ SO 4 --) is 120 mg and its valence is 2.
How many milligrams does 1 meq of magnesium sulfate weigh?
3- You are to reconstitute 1 g of dry powder. The label states that you are to add 9.3 mL of
diluent to make a final solution of 100 mg/ml. What is the powder volume?
4-If a 600 ml of a 15% (v/v) solution of methyl salicylates in alcohol are diluted to 1500 ml
what will be the percentage strength.
5-1-How many mL of a 1:500 (w/v) stock solution should be used to make 4 liters of 1:2000
(w/v) solution?
PharmacyPrep.
Tips Practice Format 002: Dose Calculations Answers

______________________________________________
Use the following formula to calculate answer the questions
1-The amount of solution needed can be determined by setting the two ratios equal:
active ingredient (available) = active ingredient (to be administered)

Solution (available) solution (needed)
2-
mEq = Molecular Weight
Valence
3-Converting between milligrams (mg) and milliequivalent (mEq)
Number of mEq = Weight of substance in mg

mEq weight
4-
Q1 * C1 = Q2 * C2
Questions
1-You have a stock solution that contains 10 mg of active ingredient per 5 ml of solution. The
physician orders a dose of 4 mg. how many millilitres of the stock solution will have to be
administered?
Using the information provided, set up a proportion:
x mL = 5 mL
4 mg 10 mg
10x mL = 20 mL
x mL = 2 mL
Thus 2 ml of solution are needed to provide the dose.
PharmacyPrep.
2-The molecular weight of magnesium sulfate (Mg 2+ SO 4 2 -) is 120 mg and its valence is 2.
How many milligrams does 1 meq of magnesium sulfate weigh?
1 meq = 120 mg = 60 mg
2
3- You are to reconstitute 1 g of dry powder. The label states that you are to add 9.3 mL of
diluents to make a final solution of 100 mg/ml. What is the powder volume?
The final solution will have a strength of 100 mg/mL. Then, since you start with 1 g =
1,000 mg of powder, for a final volume x of the solution, it will have strength 1,000 mg/x mL.
x mL = 1 mL
1,000 mg 100 mg
x mL = (1,000 mg) x 1 mL
100 mg
x mL = 10 mL
10-9.3 = 0.7ml
C 2 = Q 2 /Q 1 *C 1
1500 mL = 15 % = 6%
600 mL X%
5-How many mL of a 1:500 (w/v) stock solution should be used to make 4 liters of 1:2000
(w/v) solution?
Working: 1:500 = 0.2%
4 liters = 4000 mL
1:2000 = 0.05%
0.2% = 4000 mL = 1000 mL
0.05% x mL
PharmacyPrep.
C 2 = Q 2 /Q 1 *C 1
1500 mL = 15 % = 6%
600 mL X%
PharmacyPrep.
23
Calculations
Ratios & Proportions
________________________________________________________________________
1-In dosing the drug gentamicin in pediatric patients, for every 1 mg/kg of gentamicin
administered, serum drug concentrations are expected to increase by 2.5 µg/ml. What
would be the expected serum drug concentration following an administration of a 2.5
mg/kg dose of gentamicin?
A-5 µg/ml
B-6.25 µg/ml
C-10 µg/ml
D-2.5 µg/ml
Ans: B
_1 mg/kg__ = 2.5 mg/kg

2.5 µg / ml X µg /ml
X = 6.25 µg /ml
2-An elixir is to contain 250 mg of an alkaloid in each teaspoonful dose. How many
grams of the alkaloid will be required to prepare 5 litres of the elixir?
A-0.25g
B-5g
C-250g
D-2.5g
Ans: C
= __Xg___ 0.25 g
5000 ml 5 ml
X= 250 g
3-A pediatric product contains 100mg of erythromycin ethylsuccinate in each dropper

(2.5ml) of the product. How many kilograms of erythromycin ethylsuccinate would
be required to prepare 5000 pint-size bottles?
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and
23-1
A-74.6 kg
B-84.6 kg
C-99.5 kg
D-94.6 kg
Ans: D
1 pint = 473 ml
480 ml x 5000 = 2, 365,000 ml
0.0001 kg = ____ X_____ X = 94.6 kg

2.5 ml 2, 365,000 ml
4-A physician places a patient on a daily dose of 48 units of U 80 insulin (80units/mL).

How many ml should the patient inject each day?
A-0.4
B-0.5
C-0.6
D-0.25
Ans: C
U- 80 INSULIN
80 U = 48 units
1ml X
X= 0.6 ml
5-A 20-ml vial of biologic solution is labelled “2.0 megaunits.” How many units of drug
are present in every ml of solution?
A-2000
B-1000
C-100,000
D-10,000
Ans: C
I Megaunit = 1000,000 U
20 ml --- 2000000 units

1 ml ---- ?
X= 2 x 1000 x 1000 = 100,000 units

20
1Megaunit = 1000KU
1KU = 1000 units
23-2
2.0 M units x 1000 KU_ x 1000 units = 1000,000 units
1M units 1KU
8-The usual initial dose of chlorambucil is 150 µg per kg of body weight once a day.
How many milligrams should be administered to a person weighing 154 lbs.?
A-10.5 mg
B-18 mg
C-15 mg
D-8 mg
Ans: A
154 lbs x_1 kg__ = 70 kg

2.2 lbs
150 µg_ = _ X_
1 kg 70 kg
X = 10, 500 µg
= 10.5 mg
9-An initial heparin dose of not less than 150 units/kg of body weight has been
recommended of open-heart surgery. How many ml of an injection containing 5000
heparin units per milliliter should be administered to a 300-pound patient?
A-5.1 µl
B-4.1 µl
C-5.1 ml
D-4.1 ml
Ans: D
300 lbs x _1kg_ = 136.36 kg
2.2 lbs
150 units = _ X___ = 20, 454.54 units
1 kg 136.36 kg
_5000 u_ = 20454.54 u
1 ml X
X= 4.1 ml
10-The pediatric dose of cefadroxil is 30 mg/kg/day. If a child is given a daily dose of 2

teaspoonful of a suspension containing 125 mg of cefadroxil per 5 ml, what is the
weight in lb. of the child?
A-19.5 lbs.
B-18.8 lbs.
C-18.3 lbs.
D-18.1 lbs.
Ans: C
_125 mg_ x 2 = 250 mg
5 ml 5 ml
23-3
_250 mg_ = _30mg_
X 1 kg
X = 8.33 kg
8.33 kg x 2.2 lbs = 18.33 lbs
1 kg
11-If the loading dose of Kanamycin is 7 mg/kg of body weight, how many grams should
be administered to a patient weighing 130 lbs.?
A-0.492 g
B-0.414 g
C-414 g
D-0.485 g
Ans: B
130 lbs x _1kg_ = 59.09 kg

2.2 lbs
7 mg = _ X__
1 kg 59.90 kg
X= 413.63 mg
= 0.414 g
12-The adult dose of a liquid medication is 0.1 ml/kg of body weight as single dose.
How many teaspoonfuls should be given to a patient weighing 220 lbs.?
A-2 tsp.
B-2.5 tsp.
C-2 tbsp.
D-2.5 tbsp.
Ans: A
220 lbs x 1 kg_ = 100 kg

2.2 lbs
0.1 mL = _X_
1 kg 100 kg
X = 10 ml
= 2 tsp
13-If a prescription order requires 25 g of concentrated HCI (density 1.18g/ml), what

volume should the pharmacist measure?
A-29.50 ml
B-0.0212 ml
C-23.0 ml
D-21.2 ml
23-4
Ans: D
W= 25 g
D= 1.18 g/ml
V= _M_ = _25_ = 21.2 ml
D 1.18
14-If the dose of a drug is 0.5mg/kg body weight/day, how many mg will a 35lb infant
receive per 24hours?
A-7.9 mg
B-7.1 mg
C-7.2 mg
D-7.4 mg
Ans: A
35 lbs x _1 kg_ = 15.9 kg
2.2 lbs
0.5 mg = __X__
1 kg 15.9 kg
X = 7.9 mg
15-What is the weight of 60 ml of oil whose density is 0.9624 g/ml?

A-5.770 g
B-57.7 g
C-6.0 g
D-0.577 g
Ans: B
V = 60 ml
D = 0.9624 g/ml
D = _M_
V
M=DxV
= 0.9624 x 60
= 57.7
16-A prescription calls for 0.3 g of phosphoric acid with a specific gravity of 1.71. How
many milliliters should be used in compounding the prescription?
A-0.5
B-0.7
C-0.18
D-0.3
Ans: C
D = _M_ = _g_
V ml
23-5
V = _M_ = _ 0.3 g_
D 1.71 g/ml
X = 0.18 ml
17-How many mL of a syrup having a specific gravity of 1.350 should be mixed with
3000 mL of a syrup having a specific gravity of 1.250 to obtain a product having a
specific gravity of 1.310?
A-3500 mL
B-4500 mL
C-4600 mL
D-5500 mL
Ans:
0.06 = _0.04_
X 3000 ml
X = 4500 ml
18-A patient is determined to have 0.8 mg of glucose in each milliliter of blood. Express
the concentration of glucose in the blood as mg%.
A-800 mg%
B-0.8 mg%
C-8 mg%
D-80 mg%
Ans:D
0.8 mg = __X__
1 ml 100 ml
X = 80 mg %
19-How many mL of a 1:400 (w/v) stock solution should be used to make 4 litres of a
1:2000 (w/v) solution?
A-1000mL
B-200 mL
C-800 mL
D-1600mL
Ans: C
_1 g_ = __X__ = 2 g
2000ml 4000mL
XmL = 400mL
2g 1g = 800 mL
20-If a patient is determined to have 100 mg % of blood glucose, what is the equivalent
concentration in terms of mg/dL?
A-1 mg/dL
23-6
B-10 mg/dL
C-40 mg/dL
D-100 mg/dL
1dL = 100mL
Ans: D
_mg_ = __mg__
dL 100 mL
=100mg /dL
21-Strong Iodine Solution USP contains 5% w/v iodine. How many mg of iodine are
consumed daily if the usual dose is 0.3 mL t.i.d.?
A-15 mg
B-90 mg
C-22.5 mg
D-45 mg
Ans: D
_5_ = _X_
100 0.9
X = 0.045 g x 1000
= 45 mg
22-Express in percentage the fluoride concentration in drinking given in 0.6 ppm.
A-0.06%
B-0.00006%
C-0.0006%
D-0.006%
Ans: B
___0.6g____ = _X_
1,000,000 100
X = 0.00006%
23-How many grams of dextrose are required to prepare 4 litres of a 5% solution?

A-0.2g
B-200g
C-2g
d-20g
Ans-B
x = 5g
4000mL 100mL
24-Change to percent the number 1/300.

A-3%
23-7
B-33%
C-3.3%
D-1/3%
Ans: D
_1_ = _X_
300 100
_1/3_ = 0.33%
100
23-How many grams of petrolatum should be added to 250g of a 25% sulphur ointment
to make a 5% ointment?
A-1000 g
B-1250 g
C-500 g
D-100 g
Ans:
Given: 250 g of 25 %
5 parts = 20 parts
250 mg X
X = 1000 g
26-How many grams of potassium citrate are needed to prepare 1 litre of 10%?
A-1000 g
B-50 g
C-100 g
D-10 g
Ans: C
_X_ = _10_
1000 100
X = 100
27-How many grams of a drug are required to make 120 mL of a 25% solution?
A-30 g
B-10 g
C-12.0 g
D-12 g
Ans: A
_X_ = _25_
120 100
X = 30
23-8
28-Calcium Hydroxide Topical Solution contains 170 mg of calcium hydroxide per 100
mL at 15º C. Express this concentration as ratio strength.
A-1: 688
B-1: 888
C-1: 588
D-1: 788
Ans: C
170 mg → 0.17 g = 1_
100 ml 100 ml X
X = 588 ≈ 1:588
29-How many mg of isofluorophate are contained in 15 g of a 1: 10,000 ophthalmic

solution of isoflurophate in peanut oil?
A-1.7 mg
B-1.9 mg
C-1.8 mg
D-1.5 mg
Ans: D
___1 g__ = _ X_
10,000 mg 15 g
X = 1.5 mg
30-Express 0.2 % in ratio strength.
A-1: 5000
B-1:50
C-1: 500
D-1:5
Ans: C
_0.2_ = _1_
100 15 g
0.2 X = 100
X = 500
31-How much of a substance is needed to prepare 1L of a 1: 10,000 solution?
A-0.1 g
B-10 g
C-0.01 g
D-1.0 g
Ans: A
_ 1_ = _ X _
10,000 1000
X = 0.1 g
23-9
32-A cupric chloride injection (0.4 mg Cu/mL) is used as an additive to IV solution for
TPN. What is the final ratio strength of copper in the TPN solution if 2.5 mL of the
injection is added to enough of the IV solution to prepare 500 mL?
A-1: 500
B-1:5000
C-1: 500,000
D-1: 50,000
Ans: C
_0.4 mg__ = X___ 0.001 g = _1_

1 ml 2.5 ml 500 ml X
X = 1 mg ≈0.001 g X = 500,000
1: 500,000
33-How many millilitres of a 23.5% (w/v) concentrate of Sodium Chloride solution

should be used in preparing 650 mL of a stock solution such that 30 mL diluted to
litre will yield a 1: 5000 solution?
A-0.2 mL
B-4.33 mL
C-18.44 mL
D-11.75 mL
Ans: C
_ 1_ = __X_ X = 0.2 g
100 5000
0.2 g_ = _ X _ X = 4.33 g
30 ml 650 ml
23.5 = 4.33 g X = 18.44 ml

100 X
34-You have a stock solution of 50% Sodium citrate and you were asked to prepare 300
mL of a 10% solution. How many mL is needed?
A-20
B-15
C-30
D-60
Ans: D
Q1C1 = Q2C2
X (50) = 300(10)
X = 60
23-10
35-How many millilitres of 1:16 solution of sodium hypochlorite should be used in
preparing 5,000 mL of a 5% solution of sodium hypochlorite for irrigation?
A-800 ml
B-2500 ml
C-4000 ml
D-300 ml
Ans: C
Q1C1 = Q2C2
(X) 6.25% = (5000)(5%)
X = 5% x 5000mL
6.25%
X = 4000 ml
36-Prepare 1000 ml of KMnO 4 1:12,000 compresses out of KMnO 4 1: 8,000.

A-Add 333.3 mL water to 1000 mL KMnO 4 1: 8,000
B-Add 666.6 mL water to 333.3 mL KMnO 4 1: 8,000
C-Add 333.3 mL KMnO 4 1: 8,000 and enough water to make final volume 1000 mL
D-Add 333.3 mL water to 666.6 mL KMnO 4 1: 8,000
Ans-D
C1V1 = C2V2
1000 x1/12000 = 1/8000 x V 2
V2 = 666.6 mL of KmnO4
37-How many milliliters of 24% (w/v) concentrate of saline solution should be used in
preparing 600 mL of a solution such that 10mL diluted to a litre will yield a 0.09%
solution?
A-300 ml
B-150 ml
C-50.0 ml
D-225 ml
Ans: D
_ 0.09_ = __X_ X = 0.9 g

100 1000
0.9 g_ = _ X _ X = 54 g
10 ml 600 ml
24 = 54_ X = 225 ml
23-11
100 X
38-The only source of Sodium Chloride is in the form of tablets, each containing 5.0 g.
How many tablets should be used in preparing 3000 litres of a solution of such
strength that 20 mL diluted to 100 mL with water will yield a 0.9% (w/v) solution?
A-60,000 tablets
B-27,000 tablets
C-12,000 tablets
D-9,000 tablets
Ans: B
_ 0.9_ = __X_ X = 0.9 g

100 100
0.9 g_ = _ X _ X = 135,000 g
20 ml 3,000,000 ml
135,000 g = 27,000 tabs

5g
39-How many grams of 10% (w/w) ammonia solution can be made from 1800 g of 28%
(w/w) strong ammonia solution?
A-6428.57 g
B-5040 g
C-50,400 g
D-642.86 g
Ans: B
Q1C1 = Q2C2
(10) X = (1800)(28)
X = 5040 g
17-How many ml of 0.9% (w/v) NaCl solution should be prepared from 250 ml of 25%
(w/v) solution?
A-3750 ml
B-2500 ml
C-6944.4 ml
D-9 ml
Ans: C
Q1C1 = Q2C2
(X)(0.9)= 250(25)
X = 6944.4 ml
25-A Pharmacy tech adds 75 mL of strong iodine solution USP (5.0% w/v) to 1 liter of
sterile water for irrigation. What is the % w/v of iodine present?
A-0.35%
B-0.475%
23-12
C-0.53%
D-0.60%
Ans: A
Q1C1 = Q2C2
75(5) = (1075)X
X = 0.35%
9-Determine the specific gravity of a mixture of 900 mL of syrup with a sp. Gr. of
1.1898, 700 mL of elixir with a sp. Gr. of 0.975 and 1150 mL of glycerin with a sp.
Gr. of 1.240.
1.1349
1.1486
1.1486
1.1561
Ans:
900 ml x 1.1898 = 1070.82
700 ml x 0.975 = 682.5
1150 ml x 1.240 = _1426_
3179.32
3179.32 = 1.1561
2750
10-What is the percentage alcohol in a mixture of 2000 mL of 50% (v/v) alcohol, 500 mL
of 70% (v/v) alcohol and 2.5 L of 95% (v/v) alcohol?
71.67%
73.25%
72.50%
74.5%
Ans:
2000 ml x 0.5 = 1000
500 ml x 0.7 = 350
2500 ml x 0.95 = 2375
5000 ml 3725
3725 = _X_
5000 100
X = 74.5
11-If 800 g of 5% coal tar ointment is mixed with 1200 g of a 10% coal tar ointment.
What is the concentration of coal tar in the finished product?
8.5 %
9.5%
8%
9%
Ans:
800 x 0.05 = 40
1200 x 0.1 = 120
23-13
160
_160_ = _X_
100
X = 8%
23-14
www.pharmacyprep.com Calculations
24
Calculations
Electrolytes solution
mEq = mg x valency
M.wt (mg)
mg = mEq x M.wt (mg)

valency
1-How many mEq of magnesium sulfate are represented in 1 g anhydrous magnesium sulfate?
(M.wt of MgSO 4 =120)
A-120mEq
B-166mEq
C-16.6mEq
D-33.2mEq
E-66.6mEq
Tips:
1 g = 1000mg
mEq = (weight) (valence)

Molecular weight
= (1000 mg)(2) = 16.6 mEq

120
2-A solution contain 10mg% of Ca2+, describe this concentration in mEq/L.

mEq/L = 100 mg/L
Valency = 2
Atomic weight = 40
mEq/L = (mg/L)(Valence)
atomic weight
(100 mg/L) (2) = 5 mEq/L

PharmacyPrep.
www.pharmacyprep.com Calculations
40 mg
3-What is the concentration in g per ml of a solution containing 4mEq of calcium chloride

(CaCl 2 x 2H2O) M. wt = 147
Mg /L = 4 x 147= 294 mg = 0.294g / L = 0.002 g/mL

2
PharmacyPrep.
Pharmacyprep.com Pharmacokinetics
25
Pharmacokinetics
Tips
Shelf life =
T 90% or T 10% = 0.105
k
st
1 order:
C = Co x 10 –kt/2.303
Log C = log Co –kt/2.303
C = Co x e-kt
ln C = ln Co –kt
Half life
t 1/2 = 0.693/k
t 1/2 = C o /2k
Shelf life
t 90 = 0.105/k
t 90 = 0.1C o
k
Clearance
Cl t = Amount absorbed/AUC
Cl t = FD/AUC
C ss = R o /KV d
C = Ro/KV d (1-e-kt)
Distribution
V d = A o /C o
PharmacyPrep.

____________________________________________________________________________
• What is meant by the maintenance of a
drug?
• The amount of drug required maintaining a clinically effective concentration.
• How is the maintenance dose of a drug calculated?
• Maintenance dose= dosing rate X dosing interval/bioavailability.
• What does loading dose of a drug mean?
• This is the priming dose or initial dose used to initiate therapy so as to yield therapeutic
concentrations that will result in clinical effectiveness.
• How is the loading dose calculated?
• LD=Vd (Css-Ci) where Css and Ci refer to the steady state and initial concentrations.
• Which plasma proteins do drugs bind to?
• Albumin, glycoprotein, and alpha and beta lipoprotein.
• What is the significance of drug-protein binding?
• It affects the concentration of the free drug available. It also can lead to potential drug-
drug interactions due to displacement of one drug bound to albumin by another drug.
• What is the blood-brain barrier and what is its pharmacological significance?
• The blood-brain barrier refers to the row of capillary epithelial cells that regulates
transfer of drugs to the brain. Only drugs having a high lipid-water partition coefficient
will diffuse into the brain.
• What is meant by AUC (area under the blood concentration –time curve) and what does
it measure?
• It is the integral of the drug level over time from zero to infinity. It reflects absorption,
distribution, metabolism, and excretion. It is the most reliable and popular method of
evaluating bioavailability.
• How many doses of a drug are required for the plasma concentration of a drug to reach
a steady state if a drug is repeatedly administered at dosing intervals equal to its
elimination half-life?
• 4-5.
PharmacyPrep.
• What are the consequences of liver disease on drug elimination?

• There may be a decreased rate of drug metabolism and decreased amount of metabolites
being excreted in the feces.
• What are the major pathways of drug excretion?
• Renal, fecal, pulmonary, breast milk and skin.
• What types of drugs are excreted through the lungs?
• Volatile substances that enter the body, e.g. inhalation anesthetics and alcohol.
• What types of drugs are excreted by way of the sweat and saliva?
• Nonionized lipid forms of drugs and more hydrophilic compounds and drugs.
• What are the pharmacokinetic consequences of drug interactions?
• They may result in alterations in absorption, alterations in distribution, alterations in
metabolism and alterations in excretion.
1. albumin 2. glycoprotein 3. alpha & beta
lipoprotein
4. loading dose 5. AUC 6. Nonionized lipid
forms of drugs
7. More hydrophilic 8. 9.
compounds and drugs
• the initial dose used to initiate so as to yield therapeutic concentrations that will result
in clinical effectiveness. (loading dose)
• which plasma proteins do drugs bind to? (albumin, glycoprotein, alpha and beta
lipoprotein)
• area under the curve; it is the integral of the drug level over time from zero to
infinity(AUC)
• What types of drugs are excreted by way of the sweat and saliva? (nonionized lipid
forms of drugs and more hydrophilic compounds and drugs
PharmacyPrep.
www.Pharmacyprep.com Rates and orders of Reactions
26
Rates and Orders of Reactions
What is the plasma t ½ of a drug?
• The time it takes for the plasma drug concentration to fall to half its initial value.
What is the difference between first order and zero order rate of elimination of a drug?
• With zero order elimination the rate of elimination is constant and independent of drug
concentration. The t ½ depends on the amount of drug given and is longer when more of
the drug has been administered. With first order elimination the t ½ is constant and the rate
of elimination depends upon how much drug is present, being higher at higher plasma drug
concentration. A constant fraction of the drug is being eliminated in unit time. Most drugs
are eliminated with first-order kinetics.
Zero order reactions

• Independent of concentration
• Time dependent
• -dc/dt = Ko
• Slope -ko
• Example: Photochemical degradations
Zero order constant expressed in units of concentration eg. milligrams per millilitre per hour.
Or gram/L/ hour
• Linear equation = C = -K o t +C o
• K o is slope of the line = zero order constant (conc./time)
• C o is initial concentration
• T = time
• C = drug concentration
Slope of the line is not equal to the rate constant because it includes minus sign.
The negative indicates that slope is decreasing.
PharmacyPrep.
www.Pharmacyprep.com Rates and orders of Reactions
Rate of elimination is independent of the amount of drug to be eliminated.
The zero order elimination rate constant is K o and has the units of amount/time
A constant amount of drug is eliminated per unit of time
First order reactions
Rate of reaction is proportional to the first power of concentration.

Concentration and time dependent
Log C o /C = K t /2.303
Where
C o = concentration at t o
K = rate constant
A plot of log of concentration against time produces a straight line with a slope:
Slope –k/2.303
Half-life 0.693/k
C = C o e-kt
ln C = -kt + ln C o
log C = - kt/2.303 +log C o
Half-life t 1/2
Blood or plasma considered in equilibrium with total volume of distribution.

t 1/2 = ( 0.693 X V d ) / CL
First order reaction

0.693
t1/2 =
k
PharmacyPrep.
www.Pharmacyprep.com Pharmacodynamics
27
Pharmacodynamics
• Explain the differences between additive and synergistic effects of drugs? Synergistic
effects are effects that are greater than additive.
• What is the name of the effect whereby two drugs acting on the same tissue or organ
through independent receptors may result in opposite effects?This is referred to as
physiological antagonism.
• What is the therapeutic index of a drug? Therapeutic index (T.I.) =LD50/ED50 (ratio of
toxic dose to therapeutic dose). The higher the T.I. the safer the drug.
• What is a dose-response curve? A graphic representation of a quantitative response
between the amount of drug given and the response of the drug.
• What equation defines the dose-response curve? KA =[R] [A]/[AR]; [R] = concentration
of free receptor; [A] =concentration of agonist.
• How is a dose response curve plotted?  The response or effect vs the agonist
concentration.
• What type of curve is defined by this equation? A hyperbolic curve.
• What is meant by the potency of a drug? The amount of drug necessary to produce an
effect. The concentration or dose of the drug required producing 50% of the drugs
maximum effect.
• What is the efficacy of a drug? The maximal response produced by a drug. Efficacy is
often used to compare drugs.
• What is the EC50? The drug concentration required producing 50% of the maximum
response.
• When the agonist concentration is equal to the Ka the effect is what percentage of the
maximum? 50%. (Ka = Micheles Menten constant)
PharmacyPrep.
• What is an antagonist? A drug which inhibits the effects of an agonist.

• What is a partial agonist? An agonist, which at even higher concentrations, gives less
than 100% response. Partial agonists produce a lower response, at full receptor occupancy
than do full agonists.
• What is a competitive inhibitor?  A drug which compete reversibly with agonists for the
same receptor site and produces no response.
• What is a non-competitive inhibitor?  It is also called an irreversible antagonist that binds
to the receptor site or another site which inhibits the response to the agonist. It reduces the
maximal effect without changing the potency.
• Define receptor up-regulation, down regulation and super sensitivity? Up-sensitivity is an
increase in the number or density of receptor binding sites.
• Tips Format 02: Find answers from the table:

1. physiological 2. potency of drug 3. efficacy of drug
antagonism
4. dose-response curve 5. synergistic effects 6. non-competitive
inhibitor
7. competitive 8. partial agonist 9. EC50
inhibitor
• effects that are greater than additive(synergistic effects)

• the effect whereby two drugs acting on the same tissue or organ through independent
receptors may result in opposite effects? (physiological antagonism)
• a graphic representation of a quantitative response between the amount of drug given and
the response of the drug(dose-response curve)
• the amount of drug necessary to produce an effect. The concentration or dose of the drug
required producing 50% of the drugs maximum effect. (potency of drug)
• the maximal response produced by a drug(efficacy of drug)
• the drug concentration required producing 50% of the maximum response(EC50)
• an agonist, which at even higher concentrations, gives less than 100% response(partial
agonist)
• a drug which compete reversibly with agonists for the same receptor site and produces no
response(competitive inhibitor)
PharmacyPrep.
• it is called an irreversible antagonist that binds to the receptor site or another site which
inhibits the response to the agonist(non-competitive inhibitor)
PharmacyPrep.
www.Pharmacyprep.com Medicinal Chemistry
28
Medicinal Chemistry
Tips
• Isomers Same molecular formula with different structures
•
Example of geometrical (cis & trans) isomers  2-butene
• Examples of epimers  tetracycline and epitetracyclin
• Formula to calculate optical isomers  2n (n = number of chiral centres)
• If there is 3 chiral centres in a drugs, how many optical isomers are possible  8
• Pyridine ring  Nicotinic acid, nicotinamide, nicotine, and isoniazid
• Dihydropyridine ring Nifedipine (calcium channel blockers)
• Piperidine Atropine, ipratropium, bromotropin and scopolamine (muscarinic blockers),
morphine, codeine, heroin, meperidine.
• PyrrolidineAtropine, ipratropium, bromotropin, scopolamine (muscarinic blockers)
• Imidazoline  Clonidine
• Isoxazole  Sulphonamide
• Beta lactams Penicillin’s (6-amino penicillinic acid) and cephalosporins (7-amino
penicillinic acid)
• Amino penicillin’s  amoxicillin and ampicillin
• Pyrazole ring is  Cox II inhibitor
• Steroids skeleton have 3 rings of cyclohexane and 1 ring cyclopentane ring
• (phenanthrene and cyclopentane rings)
• Estrogens have  aromatic phenyl ring (benzene ring)
• Folic acid  Pteridyl ring
• Imidazole Ranitidine,
• Imidazole ring  Histamine, histadine, and azole antifungals, ARBs
• Serotonin  Indole ring
• Quasi ring (combination of piperidine and pyrrolidine) atropine
• Vitamin K  quinolone ring
• Ciprofloxacin  quinolones ring
• Quinidine and quinine  quinoline ring
• Carbamate group  Carbachol and bethanechol
• Dihydropyridine ring is present in  DHP type calcium channel blockers (nifedipine,
amlodipine, nicaradipine, and felodipine)
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is 28-1
being used during review sessions conducted by PharmacyPrep.
• Captopril have functional group of  sulfhydril group

• Difference between penicillin’s and cephalosporins  Penicillin have β-lactams +
5membered thiazolidine ring, where as cephalosporins have β-lactams + 6membered
dihydrothiazine.
• Tetracyclin conversion to epitetracyclin is  epimerization
1-If a structure has 3 chiral or asymmetric centres, how many optical isomers are possible 2n
23 (2 x 2 x 2 = 8)
2-How many chiral centres are in fexofenadine?

O
H3C
H3C
OH
CH3 CH3
CH3
HO N
HO N
OH
OH
Terfinadine Fexofenadine

1. Amlodipine,Felodipine, 2. Muscarinic 3. nicotinic acid,
Nifedipine, Nicardipine blockers, nicotinamide,
Atropine, nicotine, Isoniazid
Ipratropium,
Bromotropine,
Scopolamine
4. Penicillins, Cephaloshorin 5. Pteridyl ring 6. Morphine, Codeine,
Heroin,
Meperidine,Thioridaz
ine, Haloperidol,
risperidone
7. Clonidine 8. Ranitidine 9. Sulfonamide
10. histamine, histadine & 11. Indole ring 12. quinolone ring
azole antifungals, ARB’s
13. combination of piperidine 14. 3 rings of 15. COX II inhibitors
& pyrrolidine cyclohexane and 1
ring cyclopentane
• Pyridine ring ( )
• Dihydropyridine ring ( )
• Piperidine ring( )
• Pyrrolidine ring( )
• Imidazoline ring( )
• Isoxazole( )
• Beta Lactam( )
• Amino Penicillins( )
• Pyrazole( )
• steroids( )
• folic acid( )
• Imidazole( )
• Imidazole ring( )
• serotonin( )
• Quasi ring( )
• Vitamin K( )
• Ciprofloxacin( )
• Quinidine & Quinine( )
• Isomers( )
• (2-butene) example of geometrical ( )
29
Medicinal Chemistry and
Pharmacology of Autonomic
Nervous System
Tips
Summary of adrenergic drugs (Sympathetic drugs)

Adrenergic
agonists
Alpha agonist Alpha 1 agonist Increase BP
Phenylephrine Increase TPR
Pseudoephridine Vasoconstriction
Mydriasis
Alpha 2 agonist Decrease NE
Clonidine Decrease lipolysis
Methyl dopa Decrease insulin secretions
Sexual dysfunction
Beta agonist Beta1 agonist
Beta 2 agonist Branchodilatation
Tremors
Palpitations
Hyperglycemia
Tachycardia
Mixed alpha and beta agonist
Adrenergic
antagonists
Alpha Alpha1 antagonists (α 1 -blockers) First dose effects (syncope)

antagonists Doxazosin Orthostatic hypotension
(α-blockers) Prazosin Tachycardia (No reflex
Terazosin tachycardia)
Tamsulosin Vertigo
Sexual dysfunction
Alpha 2 antagonists (α2- Hypotension
blockers)
Alpha 1 and 2 antagonist Orthostatic hypotension
Reflex tachycardia
Beta Non selective β-blockers CNS insomnia, fatigue,
antagonists Propranolol hallucinations, impotency (libido)
(β-blockers) Pindolol CVSDecrease HDL and
Nadolol increase TG, bradycardia
Levobutalol
Timolol
Cardioselective β-blockers
(EMAA)
Esmolol
Metaprolol
Atenolol
Acebutalol
Partial alpha and beta blockers
Carvedilol
Labetelol
Partial agonist and antagonist
Acebutalol
Pindolol
Oxyprenolol
Examples of Bronchodilator:
• Beta 2 agonist and Beta 1 agonist
• Mixed alpha & Beta  epinephrine and norepinephrine
• Alpha 1 agonist  Phenylephrine, methoxamine
• Muscarinic antagonists Ipratropium, tiotropium
• Salbutamol is? Beta 2 agonist (sympathomimetics)
• Epinephrine act on? Alpha1, alpha2, beta1 and beta 2
• Norepinephrine act on? alpha 1 , alpha 2 and beta 1
Bronchospasm
• Mixed Beta1 and Beta 2 blockers
• Partial agonist & antagonist  Pindolol
1. Amlodipine,Felodipine, 2. Muscarinic 3. nicotinic acid,

Nifedipine, Nicardipine blockers, nicotinamide,
Atropine, nicotine, Isoniazid
Ipratropium,
Bromotropine,
Scopolamine
4. Penicillins, Cephaloshorin 5. Pteridyl ring 6. Morphine, Codeine,
Heroin,
Meperidine,Thioridaz
ine, Haloperidol,
risperidone
7. Clonidine 8. Ranitidine 9. Sulfonamide
10. histamine, histadine & 11. Indole ring 12. quinolone ring
azole antifungals, ARB’s
13. combination of piperidine 14. 3 rings of 15. COX II inhibitors
& pyrrolidine cyclohexane and 1
ring cyclopentane
• Pyridine ring (nicotinic acid, nicotinamide, nicotine, Isoniazid)

• Dihydropyridine ring (Amlodipine,Felodipine, Nifedipine, Nicardipine)
• Piperidine ring (Morphine, Codeine, Heroin, Meperidine,Thioridazine, Haloperidol,
risperidone)
• Pyrrolidine ring (Muscarinic blockers, Atropine, Ipratropium, Bromotropine,
Scopolamine)
• Imidazoline ring (Clonidine)
• Isoxazole (Sulfonamide)
• Beta Lactam (Penicillins, Cephaloshorin)
• Amino Penicillins (Amoxicillin, Ampicillin)
• Pyrazole (COX II inhibitors)
• steroids (3 rings of cyclohexane and 1 ring cyclopentane)
• folic acid (Pteridyl ring)
• Imidazole (Ranitidine)
• Imidazole ring (histamine, histadine & azole antifungals, ARB’s)
• serotonin (Indole ring)
• Quasi ring(combination of piperidine & pyrrolidine)
• Vitamin K(quinolone ring)
• Ciprofloxacin(quinolone ring)
• Quinidine & Quinine(quinolone ring)
• Isomers(same molecular formula with different structures)
• (2-butene) example of geometrical (cis&trans)
30
Medicinal Chemistry and Pharmacology of
Histamines, Serotonin, Prostaglandin and Non-
Steroidal Anti-inflammatory Drugs
Tips
• Histamine precursor is? Histadine

• Serotonin precursor is? Tryptophan
• Serotonin contains  indole ring
• Leukotriene synthesis from arachidonic acid is catalyzed by? Lipoxygenase
• Misoprostol is? Ecosanide (PGE 1 analog)
• 1st generation antihistamines often cause sedation, this due to? Tertiary amine, lipid
soluble, crosses BBB.
• Ondansetron is classified as? 5HT 3 antagonist
• Triptans is classified as  5HT 1b/1d agonist
• Latanoprost is classified as? PGF 2α analog
• Montelukast and Zafirlukast act on? LTC 4 and LTD 4
• Endorphins are? Peptide opioids neurotransmitter
• Acetaminophen hepatotoxicity is due to? N-acetyl-p-benzoquinoneimine
• Glutathione conjugation produce? Mercapturic acid
• The most common side effects associated with NSAIDs? GI bleeding, and Renal
diseases.
• What NSAID has highest GI bleeding? Pyroxicams

• Drug of choice to treat NSAID induced GI ulcer? Proton pump inhibitor
• Drug of choice to prevent NSAID induced GI ulcer? Misoprostol
• Ibuprofen, indomethacin, mefenamic acid are  Type 1 PG analog.
• Morphine overdose symptoms  pinpoint pupil, respiratory depression, and
constipation.
• Glutathione consist of  cysteine+ glycine + glutaric acid
• Antihistamines taken prophylactically and then continuously through allergy season it is
more effective if taken before allergen exposure.
• Leukotriene antagonist are also referred as  steroid sparing agents
• 1st generation antihistamines not for  Elderly, Narrow angle glaucoma, Benign
Prostate Hyperplasia (BPH), kidney and liver disease
• Opioids can be used as  analgesics, antidiarrheal, and antitussive action
• Heroin structure? Diacetyl morphine
• Morphine diacetylation gives  heroin
• Morphine active metabolite is  6-glucuronide morphine
• Active metabolite of codeine is  morphine
• What enzyme catalyzes codeine to morphine  CYP2D6
• ASA have 4 actions such as  analgesic, antipyretics, antiplatelet and antiinflammatory
• ASA analgesic action is due to  ↓ PGE 2 synthesis
• ASA antiplatelet action dose  60 to 81 mg
• ASA antipyretic action is due to ↓ PGE 2 synthesis
• ASA anti-inflammatory action is due to PG synthesis and COX1 and Cox 2 inhibitors
• Acetaminophen have 2 actions  antipyretic and analgesic
• Structure activity of antihistamines, identify essential functional groups for
antihistamine action?
CH3
O CH2CH2 N CH N N CH3
CH3
Biosynthesis of serotonin: identify precursors and catalyzing enzymes?
NH2
NH2
HO HO CH2CH2NH2
COOH COOH
N
H N N
Hydroxylase H Decarboxylase H
Tryptophan Hydroxy tryptophan Serotonin (5HT)
HO CH2CH2NH2 Niacin
N Tryptophan Serotonin
Indole ring H
Serotonin (5HT) Melatonin
Structure activity relationship of opioids?

CH3 CH3
CH3
N N
N
O O
CH3O O OH O
HO O OH H3C C O O C CH3
Morphine Codeine Heroin
CH3 CH3
N
N
HO
HO O O CH3O O O
Hydromorphone Oxycodone (percodan)
31
Pharmacology of
Cardiovascular Drugs
Tips
____________________________________________________________________________
Diuretics
Create a negative sodium balance, reduce blood volume, and decrease vasoconstriction.
Type of Ca Mg Na K Uric Blood Lipids Metabolic Disturbances

diuretic acid sugar
Thiazide ↑ ↓ ↓ ↓ ↑ ↑ ↑ Hypokalemic metabolic
alkalosis
Loop ↓ ↓ ↓ ↓ ↑ ↑ _ Hypokalemic metabolic
alkalosis
K- _ ↑ ↓ ↑ ↑ _ _ Hyperchloremic
sparing metabolic acidosis
(↑CO2)
Intracellular alkalosis
CAI _ _ _ ↓ ↑ ↑ _ Heperchloremic metabolic
acidosis
Osmotic ↑
Spiranolactons  Act on distal collecting tubules, intracellular alkalosis.
Hydrochlorthiazide, essential functional group? Sulphonamide and halogen at position 6 & 7.
Thiazide diuretics side effects are  Hyper GLUC
Loop diuretics side effects are  OH DANG
Structure activity of thiazide diuretics; identify essential functional groups in
hydrochlorthiazide?
Essential functional group that are present in thiazide diuretics? Sulphonamide at position 7
What diuretics cause intracellular alkalosis? Potassium sparing
H No Doble bond
Cl N on position 3 - 4 Cl N
NH NH
Essential NH2SO2 S NH2SO2 S
O2 O2
Hydrochlorothiazide Chlorothiazide
Cl
O N CH3
NH2SO2 NH
Cl S
N CH3 O2
Indapamide (Lozol) Diazoxide (Hyperstat)
Diuretics that have sulfa allergy Hydrochlorthiazide, Chlothiazide, Furosemide,

Acetazolamide, Spiranolactone, Amiloride, Metalazone, Chlothalidone, Indopamide
Except: Ethacrinic acid
ACE inhibitors
Decrease Sodium retention by blocking the conversion of inactive Angiotensin I to Angiotensin
II.
Identify functional groups of captopril? Captopril  Contain Sulfhydryl group
O
HS - H2C
N
CH3
CO2H
Captopril
Angiotensin II-receptor antagonist

Produced vasodilatation and causes loss of salt and water thus decreasing the plasma volume,
and myogenic activity.
Analogs of imidiazole ring group
N
C
Imidazole ring N
(essential)
Tetrazole ring OH
N N
N
N
H
Losartan
Calcium channel blockers

Block voltage-gated calcium channels causes lower vascular resistance and blood pressure.
Vascular = nifedipine > diltiazem > verapamil
Myocardial = verapamil > diltiazem>nifedipine
Comparison of dihydropyridines (DHP) and nondihydropyridine (NDHP):

DHP NDHP (Verapamil, Diltiazem)
Reflex tachycardia Bradycardia
No heart blockade Heart blockade
Peripheral vasodilatation Myocardial vasodilatation
Amlodipine long half-life -ve inotropic effect
(Only amlodipine does not cause
reflex tachycardia)
Can be used in asthma
Structure activity of dihydropyridine calcium channel blockers? Identify essential functional

groups of
Write the differences in dihydropyridine and non-dihydropyridine calcium channel blockers?
DHP gives reflex tachycardia and NDHP gives bradycardia.
Dihydropyridines are used for the treatment of ? Angina, MI and CHF
Dihydropyridine oxidized to pyridine by enzyme  CYP3A4
R1
CO2R2 4 3 CO2R2
5 2
CH3 6 N 1 CH3
H
General structure of 1,4 dihydropyridines
1,4-dihydropyridine ring Pyridine ring
H H3C N CH3
H3C N CH3
CYP3A4 H3CO2C CO2CH3

H3CO2C CO2CH3
NO2
NO2
Oxidized analog
Nifedipine
(inactive)
(active)
Inotropic = Force of contraction in heart muscles. inotropic (+ ve) = Increase in force of

contraction. The -ve inotropic = Decrease in force of contraction. non-dihydropyridine
(verapamil)
Drugs that cause +ve inotropic effect: Digoxin, ACE inhibitors, and dihydropyridine CCBs
What is structure of niacin?

COOH
N
Nicotinic acid (niacin)
Structure of statins: Identify essential functional groups in HMG CoA reductase inhibitors?
Lactone ring
O
CH3
O
CH3CH2CH-C-O
OH
CH3
H3C
Lovastatin
What functional groups make digoxin more polar than digitoxin?
DIGOXIN O O
OH
CH3
CH3H
CH3 OH H3C H OH
OH O O O
O O O H
OH OH OH
O O
CH3
CH3H
CH3 OH H3C
O O H OH
OH O
O O O H
OH CH3 OH
DIGITOXIN
A negative (-ve) chronotropic effect decreases heart rate by decreasing firing rate of SA node
Contractility and SV decreased by: Beta-blockers, CCBs, and diseases such as CHF,
A positive (+ ve) chronotropic effect increases heart rate by increasing firing rate of SA node
Dromotropic = Conduction velocity
Dromotropic effect produce changes in conduction velocity, primarily in the AV node
A negative dromotropic effects decreased by slow AV node conduction action potential from
atria to ventricles and increases PR intervals
A positive dromotropic effects increased by speeding AV node conduction potential from atrial
to ventricles and decreasing PR interval.
Write the examples of drug those effects on systolic and diastolic blood pressure?
Norepinephrine  ↑ SBP & ↑ DBP

Epinephrine  ↑ SBP & ↓ DBP
Dopamine  ↑ SBP & ↑ DBP
Dobutamine, isoproterenol  ↑SBP & ↓ DBP
Reserpine  ↓SBP & ↑ DBP
Phenylephrine↑ SBP & slightly ↑ DBP
Non selective Beta blockers ↑ SBP & ↓ DBP
Alpha1 agonist  ↑ DBP
Chronotropic = Heart rate
A failing heart has decreased SV
Increase SV = Increase Contractility
Increase SV when Increase preload, decrease after load, or increase contractility.
Stroke volume affected by Contractility, after load, and Preload.
SV increased in anxiety, exercise, and pregnancy.
Drugs that cause –ve chronotropic: Digoxin, Beta-blockers.
Autonomic effects on force of contraction, heart rate and conduction velocity
Nitric oxide (NO) is a neurotransmitter, this act as? Vasodilator

Drugs that cause venous pooling? Nitroglycerin
Nitroglycerin is classified as? Nitrates
Vasodilators
Relaxes arterioles and veins, membrane hyper polarization, decrease atrial resistance.
• Tips practice format 002

O
N
HS - H2C C
N
Imidazole ring N
CH3
(essential)
Sulfanil Group
CO2H
Tetrazole ring OH
N N
N
N
H
1 2
Lactone ring
O
CH3
O
COOH
CH3CH2CH-C-O
OH
CH3
H3C
N
3 4
R1 H No Doble bond
Cl N
on position 3 - 4
CO2R2 4 3 CO2R2 NH
S
Essential NH2SO2
O2
5 2
CH3 6 N 1 CH3
H
5 6
( 2 ) Class of drugs are analog of imidazole group

( 1 ) Drug that has sulfanil group
( 5 ) I-4 dihyropyridine ring is present in?

( 5 ) Drugs that cause reflex tachycardia?
( 3, 4 ) Cholesterol lowering drugs?
(3 ) Prodrugs
(6 ) Hydrocholorothiazide
( 4 ) Nicotinic acids also known as niacin
( 2 ) Structure of losartan an ARBs
(4, 6 ) Drugs that cause hyper glycemia?
(1, 2, ) Drugs that cause hyperkalemia?
Tips practice Format 02:

1. PGF2a analog 2. Ecosonide PGE1 3. Tryptophan
analog
4. histadine 5. LTC4 and LTD4 6. N-acetyl-p-
benzoquinoneimine
7. Mercapturic acid 8. proton pump inhibitor 9. Pyroxicam
10. Misoprostol 11. Tertiary amine 12. Lipid soluble
13. Crosses BBB 14. GI bleeding 15. Renal diseases
16. 5HT3 antagonist 17. 5HT1B/1D agonist 18. peptide opioid
neurotransmitter
19. Diacetyl morphine 20. cysteine 21. glycine
22. glutamic acid 23. pinpoint pupil 24. respiratory depression
25. constipation 26. Type 1 PG analog 27. steroid sparing agents
28. analgesic 29. antidiarrheal 30. antitussive
• histamine precursor is? ( )

• serotonin precursor of? ( )
• Misoprostol is? (Ecosonide PGE1 analog)
1st generation antihistamines often cause sedation, this is due to? (tertiary amine, lipid
soluble, crosses BBB
• Ondansetron is classified as? (5HT3 antagonist)
• triptans is classified as? (5HT1B/1D agonist)
• Latanoprost is classified as? (PGF2a analog)
• Montelukast and Zafirlukast act on? (LTC4 and LTD4)
• endorphins are? (peptide opioid neurotransmitter)
• Acetaminophen hepatotoxicity is due to? (N-acetyl-p-benzoquinoneimine)
• Glutathione conjugation produce? (Mercapturic acid)
• the most common side effects associated with NSAIDs(GI bleeding, renal diseases)
• what NSAID has highest GI bleeding? (Pyroxicam)
• DOC to treat NSAID induced GI ulcer(proton pump inhibitor)
• DOC to prevent NSAID induced GI ulcer? (Misoprostol)

• Glutathione consist of? (Cysteine, glycine, glutamic acid)
• Ibuprofen, indomethacin, mefenamic acid are? (Type 1 PG analog)
• Leukotriene antagonist also referred as? (steroid sparing agents)
• opioids can be used as? (analgesics, antidiarrheal, antitussive action)
• Heroin structure(Diacetyl morphine)
• Morphine overdose symptoms(pinpoint pupil, respiratory depression, constipation)
www.pharmacyprep.com Medicinal Chemistry
32
Medicinal Chemistry and Pharmacology of Psychiatric
and Neurological disorder agent
Tips
• What are the SSRIs  Paroxetine, Fluoxetine, fluvoxamine, Citalopram, escitalopram, and
sertraline
• SSRI onset of action is  3 to 4 weeks or more
• Fluoxetine washout period  5 weeks
• What SSRI has least drug interactions  Citalopram, and sertraline
• Depression with sexual dysfunction  Bupropion
• To treat depression in insomnia patient  Trazodone, and TCA
• Depression with diabetes  SSRI
• Venlafaxine is  Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
• Venlafaxine at higher dose act on  5HT, NE and Dopamine
• Higher dose of venlafaxine (225mg/day) have effect on  Hypertension
• A patient on antidepressants and shows with dilated pupil, may be due to Anticholinergic
side effect
• TCA onset of action is  2 to 3 weeks
• A substance found commonly in fermented foods, which can be toxic when MAO
inhibitors are, used Tyramine
• MAO is classified as  Enzyme
• Avoid cheese with  MAO Inhibitors (Phenelzine, Tranylcypramine etc)
• Milk + MAOI  Can be used during MAO Inhibitor treatment
• St. John wart is  Natural product, it is used as antidepressant
• Clorgyline is  specific for MAO type A inhibitor
Copyright protected by Tips Inc 2000-2011 Protect copyright and prevent piracy 32-1
• Selegiline and resegline is  MAO B selective inhibitor

• DOC in bipolar disorders and manic depression  Lithium
• Lithium + Diuretics  Increase lithium toxicity
• Lithium concentration varies with Na+ ions: Li+ conc. increases with decrease Na+ and Li+
conc. decreases with increase in Na+
• ACEI decrease Na+  Increase Li+
• NSAID decrease Na+ renal perfusion is less
• Thiazides deplete Na+
• Fluoxetine (SSRI) increase Li+ toxicity
• Renal dysfunction  Li+ increase
• Dehydration Li+ increases
• Lithium toxicity symptoms  CNS: seizures, cerebrovascular, confusion, drowsiness,
dizziness, CVS: change in heart rate, fluid retention
• Thiopental  shortest acting (acts within second)
• Lithium normal serum levels in adults  0.8 to 1.5 mEq/L (over >2 mEq/L toxic)
• Drugs that cause serotonergic syndrome  SSRI+TCA, SSRIs+MAOI, SSRI+SSRI
• Fast or quick acting benzodiazepine is  midazolam, triazolam and estazolam.
• Long acting benzodiazepine diazepam, flurazepam, clonazepam, and diazepoxide
• GABA analogs are  Gabapentin, pregabalin and vigabatrin
• What is active product of Diazepam and chlordiazepoxide  Oxazepam
• Antiepilectic drug that cause weight loss  Topiramate
• Antiepilectic drugs that cause Steven Johnson Syndrome  Phenytoin, CBZ, and Valproice
acid
• What benzodiazepine are considered in elderly or hepatic disease  oxazepam (rapidly
metabolite to inactive)
Structure activity relationship of antipsychotic drugs phenothiazines? Phenothiazines

• Chlorpromazine (aliphatic)
• Thioridazine, mesoridazine (piperidine ring)
• Fluphenazine, perphernazine, Prochloperazine,
• Trifluoperazine (piperazine rings)
Side chain
N X
R
R = CH2CH2CH2N(CH3)2
Phenothiazine skeleton
Structure activity of benzodiazepines; identify essential functional groups of benzodiazepine?
Long acting benzodiazepines include: Diazepam (longest half life), flurazepam, clonazepam,
chlordiazepoxide
Intermediate acting: Alprazolam, lorazepam, oxazepam, temazepam and nitrazepam
Short acting: Triazolam, midazolam (shortest half life). Short acing benzodiazepine have no
phase I metabolism, or extra hepatic metabolism
R1
R2 R3 = OH
N
R3 Lorazepam
R4 NH
Oxazepam
Temazepam
O CH3
O CH2CH3
HN
HN NH
O
O
Phenytoin (Dilantin) Ethosuximide (Zarontin)
H2N COOH
N
CONH2
GABA
Carbamazepine (Tegretol) Gabapentin (Primary amine)
33
Medicinal Chemistry and Pharmacology of
Endocrine Drugs
Tips
• What drug shows it action by acting on cell surface?  Insulin

• Insulin has pharmacodynamic effect on  cell surface
• Insulin is stored at --> refrigerator (can be stored at room temperature for 28 days)
• Insulin antagonist  glucagons
• Glucogon cause hyperglycemia
• DKA mainly occurs in  Type I diabetes
• *oral antidiabetic drugs
• Sulfonylureas – Chlorpropamide, Gliclazide (Diamicron), gliclazide long-acting
(Diamicron MR) glimepiride (Amaryl),glyburide (Diabeta),tobutamide
• Chlorpropamide + alcohol can cause  Disulfuram reaction
• Meglitinides – Nateglinide (Starlix), repaglinide (GlucoNorm)
• Biguanides - metformin (Glucophage)
• Dose adjustment in renal impairment, SE: lactic acidosis, diarrhea (most), VB 12 ↓
• ONLY oral, NO Wt↑ → good for obese Pt, NO hypoglycaemia on its own
• DI: alcohol (potentiates hypoglycemic effect)
• CI: hepatic impairment, renal impairment, CHF, hypoxemic states Pts
• Metformin + glyburide may cause Hypoglycemia

• Thiazolidinediones (TZDs) - pioglitazone (Actos), rosiglitazone (Avandia)
• rosiglitazone / glimepiride (Avandaryl), metformin (Avandamet)
• SE : Wt↑(most), fluid retention, ↑ HDL, NO hypoglycaemia on its own
• DI : gemifibrozil (↑repaglinide conc. - avoid) , CI : CHF pts, can use renal impairment
pts
• Alpha-glucosidase Inhibitors - acarbose (Glucobay)
• With meal, NO use as monotherapy, SE: flatulence, diarrhea
• Incretin hormone (Dipeptidyl peptidase-4) Inhibitors (DPP-4s) - Sitagliptin (Januvia)
• SE: Nasopharyngitis, DI : low potential (NO inhibit CYP P450),
• Take with metformin, with or without food, NO potentiates hypoglycaemia
• Intestinal Lipase Inhibitors - orlistat (Xenical)
SE: Diarrhea, steatorrhea, abdominal discomfort, and oily leakage.
• Take with food; impair absorption of fat-soluble vitamins (A, D, E, K)
• Thyroid Hormones-levothyroxine (Eltroxin, Euthyrox, Synthroid): T4
• Dosage: 1.6 µg/kg/day (adults), 12.5-25 µg/day (pts with coronary artery disease or
elderly)
• Example of antithyroid drugs  Thioamides, Methimazole, and PTU
• Myxedema is malfunction of Thyroid hormone
• Antithyroid Agents - methimazole: MMI (Tapazole), propylthiouracil: PTU (Propyl-
Thyracil).
• SE: agranulocytosis, monitor WBC or CBC
• Stop about 5days prior to a thyroid scan, RAIU or treatment with 131I
• Increase in cortisone cause (Hypercorticoids) Cushing syndrome
• Decrease in cortisone cause (Hypocorticoids)  Addison Disease
• Glutathione is  metabolic enzyme
• During ovulation increase of  LH and FSH
• Corpus luteum is stimulated by  Progesterone
• What steroidal hormone structure have phenolic ring  Estrogen
• Finaseride is 5-alpha reductase inhibitor
• Vitamin D 3 acts as  Hormone

• The effect of vasopressin on kidney  Water retention
• Deficiency (absence) of ADH cause  0
• Glutathione protects Cell integrity
• The endocrine gland plays important rule in calcium metabolism  Parathyroid
hormone
• The major factor that controls Na excretion in kidney Aldosterones (ADH)
• The effect of the antidiuretic hormone is to  (increase rate of reabsorption Na/H 2 O)
• In postmenopausal therapy, which drugs have, risk of endometrial cancer  conjugated
estrogen
• Oral contraceptives completely contraindicated in Pregnancy, DVT, vaginal bleeding
• Oxytosin is used  induce labor
• Calcium reabsorption of distal convoluted tubule due to PTH
• Testosterone to 5-hydroxy testosterone is catalyzed by? 5-alpha reductase (Finesteride,
Dutasteride)
• Example of antiandrogenic drug  Finasteride, and Dutasteride
• Finasteride mechanism of action  5-Alpha reductase inhibitor
• Steroid structures are common in hormones, such estrogen, progesterone, and
testosterones. Steroid contain how many cyclohexane and cyclopentane respectively in
it skeleton.
17
11
1 C D
16
A B 7
3
4 6
Steroid Skeleton
What steroidal hormone structure have phenolic ring
O
OH OH
C CH
Phenolic ring
HO O O
Estrogen Progesterone Testosterone
Structure activity relationship of corticosteroids

O O
OH OH
OH OH
O HO
Cortisone Hydrocortisone
O O
O O
OAc OAc
OH
HO HO
Desoxycorticosterone F Fludrocortisone
O O
CH3
Tips Practice Format 02: Find answer from the table:

1. Water retention 2. progesterone 3. 5 alpha reductase
inhibitor
4. Addisons disease 5. Cushing syndrome 6. Metabolic enzyme
7. LH 8. FSH 9. estrogen
10. hormone 11. induce labor 12. pregnancy
13. DVT 14. Vaginal bleeding 15. Aldosterone
16. cell integrity 17. 18.
• increase in cortisone cause? (Cushing syndrome)

• decrease in cortisone cause? (Addisons disease)
• Glutathione is? (metabolic enzyme)
• durng ovulation increase of? (LH & FSH)

• Corpus luteum is stimulated by? (Progesterone)
• what steroidal hormone structure have phenolic ring? (estrogen)
• Finasteride is? (5 alpha reductase inhibitor)
• Vitamin D 3 acts as? (hormone)
• the effect of vasopressin on kidney? (water retention)
• Glutathione protects? (cell integrity)
• the major factor that controls Na excretion in kidney? (aldosterone)
• oral contraceptives completely contraindicated in ? (pregnancy, DVT, vaginal bleeding)
• Oxytosin is used to? (induce labor)
34
Pharmacology of
Respiratory Drugs
Tips
Asthma COPD
Emphysema Bronchitis
Esinophilic Neutrophilic Neutrophilic
Wheezing SOB (dyspnea) SOB (dyspnea)
• Emphysema is  permanent enlargement of alveoli
• COPD is  emphysema and chronic bronchitis
• Asthma symptoms wheezing, cough, sputum, dyspnea
• Asthma triggers include,  emotional stress, cold air, dust, pollen, ASA, animal
dander, mold, humid >50% and exercise (not a trigger is warm air)
Tips Practice Format 02: Find answer from the table:
1. B 2 receptor 2. cough 3. wheezing
4. permanent 5. Salbutamol 6. Emphysema
enlargement of
alveoli
7. chronic bronchitis 8. emotional stress 9. cold air
10. dust pollen 11. ASA 12. Animal dander
13. mold 14. humid>50% 15. exercise
• emphysema is? (permanent enlargement of alveoli)
• COPD is? (emphysema & chronic bronchitis)
• asthma symptoms(cough, wheezing)
• asthma triggers include? (emotional stress, cold air, dust pollen, ASA, animal dander,
mold, humid .50%, exercise)
• DOC in allergy induced bronchospasm(Salbutamol)
34-1
• what action of adrenergic agonist action is selected treatment of asthma? (B 2
receptor)
34-2
35
Pharmacology of
Musculoskeletal Drugs
• Drink plenty of fluids, while taking  allopurinol, sulfinpyrazone and probenecid
• Colchicines side effects  GI irritation
• Colchicines is contraindicated in  renal failure
• What analgesic is NOT used in gout arthritis  acetaminophen
• Example of drug that decrease uric acid production  Allopurinol
• Example of drug that increase uric acid secretion  sulfinpyrazone, and probenecid
• What drug is NOT used for acute gout attack? Anti hyperuricemia drugs
• Drug decrease uric acid production or inhibit formation of uric acid.? Allopurinol
• Drugs increase uric acid excretion  Probenecid and sulfinpyrazones
Tips Practice Format 02: Find answers from the table:
1. Anti hyperuricemia 2. GI irritation 3. Allopurinol
drugs
4. Sulfinpyrazone 5. Probenecid 6. Alloxanthine or
oxypurinol
7. Acetaminophen 8. Renal failure 9.
• Drink plenty of fluids while taking…(Allopurinol, Sulfinpyrazone, Probenecid)

• side effect of Colchicine(GI irritation)
• Colchicine is contraindicated in? (renal failure)
• what analgesic is not used in gout arthritis? (Acetaminophen)
35-1
• example of drug that decrease uric acid production(Allopurinol)
• example of drug that increase uric acid secretion(Sulfinpyrazone & Probenecid)
• what drug is not used for acute gout attack? (anti hyperuricemia drugs)
• the major metabolite of Allopurinol(Alloxanthine or oxypurinol)
35-2
36
Medicinal Chemistry of
Antimicrobial
Tips
H
R N H
S R N S
O
N O
N
O
O R
COOH
COOR
Penicillins Cephalosporins
36-1
Penicillin have β-lactams + 5membered thiazolidine ring, where as cephalosporins have
β-lactams + 6membered dihydrothiazine.
6-Aminopenicillanic acid
D
β-lactam ring
H
R N
S
Thiazolidine ring
O
N
O
COOH
C
Penicillin backbone
C = Bond cleavage by beta-lactamases

D=Susceptible to hydrolysis
Epimerisation of tetracycline give 4-epitetracyclin

H N(CH3)2
N(CH3)2 H N(CH3)2
OH
OH OH
Base H+
NH2
H+ NH2 Base NH2
OH
O O OH OH
O O O O
Tetracycline 4 - Tetracycline
Epimerization of Tetracyclines
36-2
1 Amoxicillin 3 Penicillin G and V 5 Tetracyclin
2 Cephalexin 4 Cefuroxime 6 Ceftriaxone
7 Erythromycin 8 Clarithromycin 9 Azithromycin
10 Ciprofloxacin 11 Ofloxacin 12 Clindamycin
13 Trimethoprim- 14 Metronidazole 15 Vancomycin
sulfamethoxazole
• is commonly causes dose-related GI tract disturbances, including nausea, vomiting,
and diarrhea( 7 )
• raises blood levels of theophylline and potentiates terfenadine in producing
ventricular arrhythmias. ( 7 )
• have enhanced activity against Haemophilus influenza( 9 )
• Inhibit the activity of DNA gyrase( 10, 11 )
• are effective in bacterial prostatitis and bacterial diarrhea except that caused by C.
difficile( 1,2,3,4,6, 13 )
• as competitive inhibitors of p-aminobenzoic acid in the folic acid metabolism cycle(
13)
• It is used primarily for the treatment of Trichomoniasis, Amebiasis, Giardiasis (14)
• and P.colitis (GET A METRO)
• Stevens-Johnson Syndrome is a severe form of erythema multiforme (erythema
multiforme major) characterized by bullae on the oral mucosa, pharynx, anogenital
region, and conjunctiva; target-like lesions; and fever
• Antacids containing Mg or aluminum interfere with absorption if taken within 4 h (5,
10 )
Tips practice format 02: Find answers from the table:
1. Folate antagonist 2. Nalidixic acid 3. Thiazolidine
4. epimerization 5. DNA gyrase & 6. Antacids
topoisomerase II
7. Ca (bi and trivalent ) 8. 9. Dihydrothiazine
10. Tetrahydrfolic acid 11. 12.
• the chemical ring present in penicillins(Thiazolidine)

• the chemical ring present in cephalosporins(Dihydrothiazine)
• tetracyclines at 4 position undergoes…(epimerization)
• Tetracyclins chelate with.. (antacids, Ca (bi and trivalent)
• Sulfa drugs act on? (folate antagonist)
• sulfa drugs action prevent formation of? (tetrahydrofolic acid)
• Quinolone antibiotic are bactericidal act by inhibiting…(DNA gyrase &
topoisomerase II)
• what is an example of urinary tract disinfectant? (Nalidixic acid)
36-3
www.pharmacyprep.com Metabolism
37
Metabolism
Tips
• What is a pro-drug?  A compound that enters the body in an inactive form and is
subsequently converted to the active form.
• What happens to drugs when they are metabolized?  They are metabolized to more polar
products than the parent compound.
• Is a drug always inactivated when metabolized? Usually, but sometimes an active drug
that is more potent is formed and sometimes it is first converted to a reactive intermediate.
• Where does the majority of drug metabolism take place? In the liver.
• What are the other sites of drug metabolism?  The plasma, lung, kidney, intestinal
mucosa, adrenals, skin and placenta.
• What is the primary enzyme system involved in drug metabolism?  CYP 450
• What is meant by the term induction of drug metabolism? Drugs that induce or increase
CYP 450
• What is the significance of induction of drug metabolism? Increased metabolism of drugs
• What is meant by inhibition of drug metabolism and what is its significance? Inhibit
metabolism and increase concentration
• What happens during drug conjugation? Reactive metabolite conjugates with acids, alcohol,
amines etc.
• What happens to the drug after conjugation? It becomes more inactive, more polar, larger
and more easily excreted in the bile or urine.
• What enzyme catalyzes the most conjugation reactions? UDP-glucoronyltranferase.
• How does age effect drug metabolism? Decreased in elderly
• What type of nutritional factors effect drug metabolism? Drug metabolism is impaired by
protein deficiency.
• How does genetics affect drug metabolism? Levels of some CYP450 will vary between
individuals. (pharmacogenetics)
• The most common metabolic reaction in GI  Hydrolysis
• The most common phase I metabolic reaction is  Oxidation
• The most common metabolic reaction in human  Glucuronidation
• The most common cytochrome subtype enzyme is metabolize drugs CYP3A4

• Benzodiazepine are metabolized by  CYP3A4
• Cytochrome is commonly located at Endoplasmic reticulum
• Glucuronidation reaction is catalyzed by UDPGT
• What are enzyme responsible for drug metabolism CYP 1, 2, 3 and 4
• Acetaminophen detoxification mechanism involves, what type of metabolic reaction 
Glutathione conjugation
• Azoreduction occurs in  Sulfasalazine
• Primary amine undergo what type of metabolism  Acetylation
• Glucuronidation reactions are the most common metabolic reactions. (T/F)
• Write the most common CYP3A4 inhibitors? Ery, Clari, GFJ, ketoconazole, cimetidine,
Protease Inh, sequinavir, etc
• Write the most common CYP3A4 Substrates? BZD, statins (ALS), DHP-CCBs, digoxin,
sildenafil, tadalafil, and verdenafil
• Write the most common CYP3A4 inducer --> Phenobarbital, phenytoin, carbamazepine,
rifampin, St JW, tolglitazone.
• Write the most common CYP 2D6 Substrate and inhibitors? Codeine x Fluoxetine
• What is NOT a drug metabolizing enzyme  alcohol dehydrogenase
• Methanol toxicity can lead to blindness due to  formic acid
• Penicillin G is metabolized by  A-renal B-hepatic C- Biliary

• Valproic acid conjugation withA-glucuronidation B-glutathione conjugation C-
acetylation D- methylation
• Ethanol oxidizes to acetic acid by enzyme called  alcohol dehydrogenase
• Antifreeze is  ethylene glycol
• Ethylene glycol oxidized product is  oxalic acid
• Glutathione conjugation end product is  mercapturic acid
• Glutathione structure have  cysteine, glycine and glutamic acid
• Prednisolone metabolizes to  prednisone
• Examples of prodrugs Enalapril, Methyldopa, Cefuroxime axetil, Valacyclovir ,
Primedone, levodopa
Concepts
1- What type of metabolic reaction?
O
H3C
H3C
OH
CH3 CH3
CH3
HO N
HO N
OH
OH
Terfinadine Fexofenadine
What are the metabolic products acetaminophen that may contribute to hepatotoxicity?
Acetaminophen Metabolism
O
CH3 C NH OH
e Acetaminophen
fe r as UDP-GT
o tr ans
ul f
S
Glucoronidation
Sulfate conjugation
Cytochrome CYP 450
N-benzoquinoneimine
Glutathione conjugation
Mercaptopurine

UDP-gluconyltransferase CYP3A4 UDPGT
formic acid alcohol dehydrogenase oxidation
inhibit metabolism and in the liver drug metabolism is impaired
increase concentration by protein deficiency
levels of some cytochrome Phenobarbital, Phenytoin, Codeine & Fluoxetine
P450 isoenzymes will vary Carbamazepine, Rifampin, St.
between individuals John’s wort
CYP 450 increased metabolism of it becomes more inactive,
drugs more polar, larger and more
easily excreted in the bile &
urine)
Benzodiazepines, statins Erythromycin, Acetylation
(ALS), Digoxin, Sildenafil Clarithromycin, grapefruit
juice, Ketoconazole,
Cimetidine, Protease INH
Sulfasalazine Glutathione conjugation CYP 1,2,3 and 4
endoplasmic reticulum decreased in elderly Glucoronidation

hydrolysis
• where does the majority of drug metabolism take place? (in the liver)
• what is the primary enzyme system involved in drug metabolism? (CYP 450)
• what is the significance of induction of drug metabolism(increased metabolism of drugs)
• what is meant by inhibition of drug metabolism and what is its significance? (inhibit metabolism
and increase concentration)
• what happens to the drug after conjugation? (it becomes more inactive, more polar, larger and more
easily excreted in the bile & urine)
• what enzyme catalyzes most conjugation reactions? (UDP-gluconyltransferase)
• how does age affect drug metabolism? (decreased in elderly)
• what type of nutritional factors affect drug metabolism? (drug metabolism is impaired by protein
deficiency)
• How does genetics affect drug metabolism? (levels of some cytochrome P450 isoenzymes will vary
between individuals)
• the most common metabolic reaction in the GI(hydrolysis)
• the most common Phase I metabolic reaction is? (oxidation)
• the most metabolic reaction in human (Glucoronidation)
• the most common cytochrome subtype enzyme is? (CYP3A4)
• Benzodiazepine are metabolized by? (CYP3A4)
• Glucoronidation reaction is catalyzed by? (UDPGT)
• cytochrome is commonly located at? (endoplasmic reticulum)
• What enzyme is responsible for drug metabolism? (CYP 1,2,3 and 4)
• Acetaminophen detoxification mechanism involves, what type of metabolic reaction? (Glutathione
conjugation)
• Azo reduction occurs in? (Sulfasalazine)
• Primary amine undergoes what type of metabolism? (Acetylation)
• What are the most common CYP 3A4 inhibitors? (Erythromycin, Clarithromycin, grapefruit juice,
Ketoconazole, Cimetidine, Protease INH)
• What are the most common CYP 3A4 substrates? (Benzodiazepines, statins (ALS), Digoxin,
Sildenafil)
• What are the most common CYP 2D6 substrate and inhibitor? (Codeine & Fluoxetine)
• What are the most common CYP 3A4 inducer? (Phenobarbital, Phenytoin, Carbamazepine,
Rifampin, St. John’s wort)
• What is not a drug metabolizing enzyme? (alcohol dehydrogenase)
• methanol toxicity can lead to blindness due to? (formic acid)
www.Pharmacyprep.com Biopharmaceutics
38
Biopharmaceutics
Tips
• Ranking of various oral dosage (fastest → lowest)
• Solutions (ready for absorption)
• Suspensions (wetted and ready for dissolution)
• Powder [(dispersed + GI fluid → wet) absorbed]
• Capsules (dissolve gelatine cap first → then powder)
• Tablets (disintegrate from tab. to smaller granulate then → powder)
• Sustained release tab (barrier of coating materials)
• Sequence of absorption of dosage forms; Sublingual > inhalation > liquid > topical >
tablet>enteric coated
• The Henderson-Hasselbach equation?  pKa –pH =Log (protonated)/(unprotonated)
•
Hasselbach-Handerson = % ionization = 100/1+10 charge (pH-pKa)
• pH (acidity or alkalinity of the substance)
• Most drugs are weak acid or weak bases
• Dissociation of weak acids or bases is directly affected by pH therefore absorption is
directly affected by pH
• As pH rises (H+ decreases), the amount of weakly acidic drug in the non-ionized state
decreases
• As pH falls (H+ increases) the amount of weakly acidic drug in the non-ionized state
increases; i.e. diffusion pressure increases
• For weak bases the effect is opposite
• NOTE: one changes the pH by 1unit, the ratio of non-ionized to ionized changes by factor
of 10. The direction of change and ration can be calculated in one’s head when the pH
changes are 1 full unit
• Henderson-Hasselbalch Equation: Helps to determine pH effect on absorption.
(Determining the drug absorption by pKa)
• If the pKa of drug and pH of the medium are known, the fraction the molecules in the
ionized state can be predicted by means of the Henderson-Hasselbalch equation.
How much of drug is found on either side of membrane.
For an acid:
pH = pKa + log (Salt)
(Acid)
pKa = pH – log (Salt)

(Acid)
For base:
pH = pKa + log (Acid)
(Salt)
You may also see the above as:
pH = pKw – pKb + log (base)

(salt)
• Since pKw = pKa + pKb
• Weak acid RCOOH (Cross membrane)  RCOO + H+
• Weak Base R-NH 3  RNH 2 + H+ (cross membrane)
Percent ionized (To calculate percent of a weak acid or base that is ionized)
Where charge = -1 if acid drug or 1 if basic drug

• Ionized drugs = are water soluble and poor absorption through stomach, BBB, and placenta,
no reabsorption across membrane and excrete faster.
• Non-ionized (unionized) = are lipid soluble = and absorbed well in membrane (cell
membranes are composed of lipids), have higher reabsorption.
• An acid in an acid solution will not ionize. (acid + acid = non ionized)
• An acid in a basic solution will ionize (acid + base = ionized)
• A base in a basic solution will not ionize (base + base = non-ionized)
• A base in an acid solution will ionize (base + acid = ionized)
• pKa = pH drug exists as 50% ionized and 50% unionized.
• If pH- pKa = 0, then 50% of drug is ionized and 50% is unionized.
• If the acid/base ratio is 1:1, then the log of that number will be zero, and pH = pK a
• If pH- pKa = 0.5, then the solution is 75% ionized/ 25% unionized or 75% unionized / 25%
ionized.
• If pH- pKa > 1 then the solution is 99 - 100% ionized or 99 - 100% unionized.
• If pH- pKa >2 then the solution is 100% ionized or unionized
• What is drug absorption? The transport of drugs from the site of administration into the
blood.
• What factors affect the bioavailability of a drug?
• The same factors that affect absorption plus any first pass metabolism that may occur.
• What is responsible for the different phases of a two-compartment model of drug
elimination?
• The rapid decline is caused mainly by the prompt redistribution of drug from the small
central compartment. The second slope is caused predominantly by the elimination of the
drug from the body.
• What is meant by first pass metabolism?

• The metabolism of the drug before the drug reaches the general circulation.
• Where does the first pass metabolism usually occur?
• In the stomach and the intestine but mainly in the liver.
• Which route(s) of administration is most likely to subject a drug to a first-pass effect?
• Oral and rectal administration.
• What sites of absorption have low first pass metabolism?
• Sublingual, lungs, nasal mucosa, intramuscularly, intravenous and transdermal.
• What factors affect the bioavailability of a drug?
• The same factors that affect absorption plus any first pass metabolism that may occur.
• What is responsible for the different phases of a two-compartment model of drug
elimination?
• The rapid decline is caused mainly by the prompt redistribution of drug from the small
central compartment. The second slope is caused predominantly by the elimination of the
drug from the body.
• What is meant by first pass metabolism?
• The metabolism of the drug before the drug reaches the general circulation.
• Where does the first pass metabolism usually occur?
• In the stomach and the intestine but mainly in the liver.
• Which route(s) of administration is most likely to subject a drug to a first-pass effect?
• Oral and rectal administration. Drugs that are administered orally and rectally enter the
portal circulation of the liver and can biotransformed by this organ prior to reaching the
systemic circulation.
• What sites of absorption have low first pass metabolism?
• Sublingual, lungs, nasal mucosa, Intramuscular, intravenous and transdermal.
1. Oral 2. rectal 3. in the stomach and
intestine but mainly in
the liver
4. first pass metabolism 5. sublingual 6. lungs
7. nasal mucosa 8. intramuscularly 9. intravenous

10. transdermal 11. 12.
• the metabolism of the drug before the drug reaches the general circulation(first pass
metabolism)
• Where does the first pass metabolism occur? (in the stomach and the intestine but mainly in
the liver)
• which route of administration is most likely to subject a drug to a first-pass effect? (oral and
rectal)
• What sites of absorption have low first pass metabolism? (sublingual, lungs, nasal mucosa,
intramuscularly, intravenous and transdermal)
www.Pharmacyprep.com Pharmaceutics
39
Physical Pharmacy
Tips
• Arrhenious equation is used for? Effect of temperature on drug degradation
• Water-soluble antioxidants? Vitamin C (ascorbic acid)
• Fat-soluble antioxidants? Vitamin E (tocopherol)
• Theobroma oil and cocoa butter are? Polymorphs
• Polymorphs have  Same substances, with crystal structures; also they differ in density,
physical properties.
• Arrhenious equation is used for? Temperature effect on drug stability
• Water soluble antioxidants? Ascorbic acid
• Polymorphs are different in crystalline forms of the same drug, will differ in  melting
point, X-diffraction, solubility, and density, dissolution, and stability.
• USP official temperature is  25oC
• Protect from light indicates storage in light resistant container that reduces light
transmission in the range of  290 to 450 nanometers
• Pycnometer is used for  measure weight of liquid with same volume
• Hydrometer is used for measure specific gravity by means of floating in liquid.
• Boric acid is  mild antiseptic used in the eye, topically and vaginally
• Tannic acid is  used in treatment of burns and bed sores
• Acetic acid is  used as bladder irrigate
• Freon is  used as propellant
USP (United States Pharmacopea):

• Alcohol USP 94.9% ethanol V/V
92.3% ethanol W/V
• Diluted alcohol 49% ethanol V/V
• Rubbing alcohol 70% V/V absolute alcohol (denatured)
PharmacyPrep.
40
Pharmaceutical Exipient
Tips
• Filler/Diluents  Increase the bulk volume so that the final product has the proper
volume for patient handling. Fillers: Lactose, Sucrose, Glucose, Mannitol, Sorbitol,
Calcium phosphate, Calcium carbonate, and Cellulose
• Binder: to cause the adhesion of the powdered drug and inactive ingredients
• Disintegrant To ensure that when tablets are in contact with water, they are rapidly
breaking into smaller fragments, facilitating their dissolution
• Disintegrants: Starch, Cellulose, Cross linked polyvinyl pyrrolidone (PVP), Sodium
Starch Glycolate, Sodium carboxy methyl cellulose.
• Lubricant  To reduce the adhesion between the powder (granules) and the punch
faces and thus prevent tablet sticking to the punches. Ex: talc, and starch
• Anti-Adherent To ensure that tablet formation and injection can occur with low
friction between the solid and the die wall.
• Example: Polyethylene Glycols, Stearic acid
• Stearic acid salts (calcium stearate).
• Glidant  To improve the flow ability of the powder or granules or both.
• Example: Corn starch, Silica derivatives (silicon dioxide colloidal), and Talc
• Triethanol amine is  Alkalizing agent
• Prevent sticking in die wall and facilitating ejection is referred as  Lubricant (stearic
acid)
• Glidants is Improve flow ability of granules
• Example of water soluble antioxidant is  Ascorbic acid, Sodium bi sulfate
• Sodium lauryl sulphate is  anionic surfactant
• Magnesium stearate is  anti adherent
• The type of water used parenteral preparation manufacturing  water for injection USP
• In aerosol propellant action is given by  Hydrofluroalkenes (HFA)
• Tween is Polysorbate
• Span is Sorbic acid ester
• Example of synthetic emulsifying agents
Types of water”
Water for injection USP

o Prepared by distillation, or reverse osmosis
o Free from pyrogen
o Used as solvent for parenteral solutions
Bacteriostatic water for injection USP

 not >30 ml
• Contain 1 or more antimicrobial agent
• Packed in single or multiple dose containers
Sterile water for injection USP

 not > 1 liter
• Sterilized and packed in single dose container of type I and II glass
• Limitation of total solids depends on size of the container
Sterile water for irrigation USP

 > 1 liter
 Sterilized and suitably packed
 It contain no antimicrobial agents or other added substance
Purified water USP

 Prepared by distillation, reverse osmosis, or ion exchange
 Should not contain 10 ppm solid particle
 Should have pH between 5 and 7
 Used in prescription and finished manufactured product
 Not used in parenteral and ophthalmic products
Sterile purified water USP

 It is purified water sterilized and packed
 It does not contain antimicrobial agents
 It is NOT intended for parenteral preparations
Excipient Use
Acacia Emulsifying agent; stabilizing agent; suspending agent; tablet
binder; viscosity-increasing agent
Alginate Binder
Alginic Acid Stabilizing agent;
suspending agent;
tablet binder,
tablet disintegrant;
viscosity-increasing agent.
Aluminum Acetate Antiseptic
Benzyl Alcohol Antimicrobial preservative; disinfectant; solvent
Butyl Paraben Antimicrobial preservative
Butylated Hydroxy Toluene Antioxidant.
Citric acid Disintegrant
Calcium carbonate Tablet and capsule diluent; therapeutic agent

Candelilla wax Binder
Croscarmellose sodium Tablet and capsule disintegrant
Confectioner sugar Sugar coating adjunct; sweetening agent; tablet and capsule
diluents
Colloidal silicone dioxide Adsorbent; anticaking agent; emulsion stabilizer; glidant;
suspending agent; tablet disintegrant; thermal stabilizer;
Cellulose Adsorbent; suspending agent; tablet and capsule diluent;
tablet disintegrant.(cellulose microcrystaline) Adsorbent;
glidant; suspending agent;
tablet and capsule diluent; tablet disintegrant (cellulose
powdered) Tablet and capsule diluent.(cellulose Silicified)
Plain or anhydrous calcium Diluent
phosphate
Carnuba wax Binder
Corn starch Binder
Carboxymethylcellulose Stabilizing agent; suspending agent;
calcium tablet and capsule disintegrant;
viscosity-increasing agent; water-absorbing agent
Calcium stearate Tablet and capsule lubricant
Calcium disodium EDTA Chelation
Copolyvidone Film-former; granulating agent; tablet binder
Castor oil hydrogenated Extended release agent; stiffening agent; tablet and
capsule lubricant
Calcium hydrogen Diluent
phosphate dihydrate
Cetylpyridine chloride Antimicrobial preservative; antiseptic;
cationic surfactant; disinfectant;
solubilizing agent; wetting agent
Cysteine HCL Reducing Agent
Crosspovidone Tablet disintegrant
calcium phosphate di or tri Tablet and capsule diluent Anticaking agent; buffer, nutrient;
basic dietary supplement;
glidant; tablet
and capsule diluent and
clouding agent( for calium phosphage tribasic)
Dibasic Calcium Phosphate Diluent
Disodium hydrogen Buffering agent
phosphate
Dimethicone Antifoaming agent;
Emollient
Erythrosine Sodium Color
Ethyl Cellulose Coating agent;

flavoring fixative;
tablet binder;
tablet filler;
Gelatin Coating agent;
film-former;
gelling agent;
suspending agent;
tablet binder;
viscosity-increasing agent
Glyceryl monooleate Nonionic surfactant
Glycerin Antimicrobial preservative;
emollient;
humectant;
plasticizer;
solvent;
sweetening agent;
tonicity agent
Glycine Tonicity
Glyceryl monostearate Emollient; emulsifying agent;
solubilizing agent;
stabilizing agent;
sustained-release ingredient;
tablet and capsule lubricant
Glyceryl behenate Coating agent; tablet binder; tablet and capsule lubricant
Hydroxy propyl cellulose Coating agent; emulsifying agent;

stabilizing agent; suspending agent;
tablet binder; thickening agent;
Hydroxyl propyl methyl Coating agent; film-former;
cellulose rate-controlling polymer for sustained release;
stabilizing agent; suspending agent; tablet binder; viscosity-
increasing agent.
Hypromellose Coating agent; film-former;
rate-controlling polymer for sustained release; stabilizing
agent;
suspending agent; tablet binder; viscosity-increasing agent.
HPMC Pthalate Coating agent.
Iron oxides or ferric oxide Color

Iron oxide yellow Color
Iron oxide red or ferric oxide Color
Lactose hydrous or Binding agent; diluent for dry-powder inhalers;

anhydrous or monohydrate lyophilization aid;
or spray dried tablet binder; tablet and capsule diluent.( lactose anhydrous)
Binding agent; diluent for dry-powder inhalers; tablet binder;
tablet and capsule diluent(lactose monhydrate) Binding
agent; diluent for dry-powder inhalations; tablet and capsule
diluent;
tablet and capsule filler.(lactose spray dried)
Magnesium stearate Tablet and capsule lubricant
Microcrystalline cellulose Adsorbent; suspending agent; tablet and capsule diluent;
tablet disintegrant same as cellulose see above it is just that
mcc is usp
Mannitol Sweetening agent; tablet and capsule diluent; tonicity agent;
vehicle (bulking agent) for lyophilized preparations
Methyl cellulose Coating agent; emulsifying agent; suspending agent;
tablet and capsule disintegrant; tablet binder; viscosity-
increasing agent
Magnesium carbonate Tablet and capsule diluent
Mineral oil Emollient; lubricant; oleaginous vehicle; solvent
Methacrylic acid copolymer Coating
Magnesium oxide Tablet and capsule diluent
Methyl paraben Antimicrobial preservative
Povidone or PVP Disintegrant; dissolution aid; suspending agent; tablet binder.
PEG Ointment base; plasticizer; solvent; suppository base;
tablet and capsule lubricant
Polysorbate 80 solubilizer
Propylene glycol Antimicrobial preservative; disinfectant; humectant;
plasticizer;
solvent; stabilizer for vitamins; water-miscible cosolvent.
Polyethylene oxide Mucoadhesive; tablet binder; thickening agent.
Propylene paraben Antimicrobial preservative
Polaxamer 407 or 188 or Dispersing agent; emulsifying and coemulsifying agent;

plain solubilizing agent; tablet lubricant; wetting agent.
Potassium bicarbonate Alkalizing agent; therapeutic agent
Potassium sorbate Antimicrobial preservative
Potato starch Binder
Phosphoric acid Acidifying agent
Polyoxy140 stearate Emulsifying agent; solubilizing agent; wetting agent
Sodium starch glycolate Tablet and capsule disintegrant
Starch pregelatinized Tablet and capsule diluent; tablet and capsule disintegrant;
tablet binder (starch pregelatinized Glidant; tablet and
capsule diluent; tablet and capsule disintegrant;
tablet binder.( starch , potato, corn , wheat, rice) so check the
above and make the changes
Sodium crossmellose Disintegrant

Sodium lauryl sulfate Anionic surfactant; detergent; emulsifying agent;
skin penetrant; tablet and capsule lubricant; wetting agent
Starch Glidant; tablet and capsule diluent; tablet and capsule
disintegrant;
tablet binder.( starch , potato, corn , wheat, rice) combine all
the starches
Silicon dioxide Same as colloidal silicon dioxide
Sodium benzoate Antimicrobial preservative; tablet and capsule lubricant
Stearic acid Emulsifying agent; solubilizing agent; tablet and capsule
lubricant.
Sucrose Base for medicated confectionery; granulating agent;
sugar coating adjunct; suspending agent; sweetening agent;
tablet and capsule diluent; viscosity-increasing agent.
Sorbic acid Antimicrobial preservative
Sodium carbonate Carbonating agent
Saccharin sodium Sweetening agent
Sodium alginate Stabilizing agent; suspending agent; tablet and capsule
disintegrant;
tablet binder; viscosity-increasing agent.
Silica gel Adsorbant
Sorbiton monooleate Solubilizer
Sodium stearyl fumarate Tablet and capsule lubricant.
Sodium chloride Tablet and capsule diluent; tonicity agent
Sodium metabisulfite Antioxidant.
Sodium citrate dihydrate Alkalizing agent; buffering agent; emulsifier; sequestering
agent.
Sodium starch Binder
Sodium carboxy methyl Coating agent; tablet and capsule disintegrant; tablet binder;
cellulose stabilizing agent; suspending agent;
viscosity-increasing agent; water-absorbing agent.
Succinic acid Acidity
Sodium propionate Antimicrobial preservative
Titanium dioxide Coating agent; opacifier; pigment
Talc Anticaking agent; glidant; tablet and capsule diluent; tablet
and capsule lubricant.
Triacetin Humectant; plasticizer; solvent
Triethyl citrate Plasticizer
Tips Practice format 02: Find answers from the table:
1. Anti-adherent 2. polysorbate 3. alkalizing agent

4. lubricant stearic acid 5. Water for injection 6. anionic surfactant
USP
7. improve flow ability 8. ascorbic acid 9. sodium bisulfate
of granules
10. sorbic acid ester 11. hydrofluoroalkenes 12.
HFA
• triethanol amine is? (alkalizing agent)

• prevent sticking in die wall is referred as? (lubricant(stearic acid)
• glidant is? (improve flow ability of granules)
• example of water soluble antioxidants are? (ascorbic acid, sodium bisulfate)
• sodium lauryl sulfate is? (anionic surfactant)
• the type of sterile water used in parenteral preparation in manufacturing? (Water for
injection USP)
• in aerosol propellant action is given by? (hydrofluoroalkenes HFA)
• magnesium stearate is? (anti-adherent)
• tween is? (polysorbate)
• span is? (sorbic acid ester)
www.Pharmacyprep.com Rheology
41
Rheology
Tips
• Term that referred to non Newtonian flow, increase force will increase difficulty in
suspension flow  dilatants flow
• Pseudoplastic flow  Increase flow, and decrease viscosity
• Thixotropy Gel to solution
• Thixotropy  Thixotropy increases flow and decrease viscosity
• Antithixotropy  Solution to gel
• Dilatants flow  Decrease flow
• Rheopexy is  Antithixotropy
• Agents to prepare dilatants flow  Bentonite at high concentration
• Shear thickening is  Increase viscosity with increase shear stress

1. bentonite at high conc 2. is increase viscosity 3. dilatants flow
with increase shear
stress
4. increase flow 5. decrease viscosity 6. antithixotropy
7. decrease flow 8. thixotropy increases 9. gel to solution
flow and decrease
viscosity
10. solution to gel 11. 12.
• term that referred to non Newtonian flow, increase force will increase difficulty in
suspension flow? (dilatants flow)
• Pseudoplastic flow(increase flow, and decrease viscosity)
• Thixotropy(gel to solution)
• thixotropy(thixotropy increases flow and decrease viscosity)
• anti-thixotropy(solution to gel)
• dilatants flow(decrease flow)
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is 41`-1
www.Pharmacyprep.com Rheology
• rheopexy is? (antithixotropy)

• agents to prepare dilatants flow(bentonite at high conc.)
• shear thickening is? (is increase viscosity with increase shear stress)
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is 41`-2
Pharmacyprep.com Pharmaceutical Dosage Forms
42
Pharmaceutical Dosage Forms
• What type of products cannot be used by wet granulation method of tablet manufacturing--
>ASA
• Hard gelatin capsules, should not contain --> liquid preps cannot be used
• What is plasticizer used gelatin capsule shells --> sorbital, glycerine
• levigating agent --> mineral oil, paraffin oil
• What type of powder release CO2 --> effervescent
• Definition of tincture?  Alcoholic and hydro alcoholic liquid mixtures
• Sodium lauryl sulfate is?  Anionic surfactant
• High HLB values associated with? O/W emulsions
• HLB for O/W --> 8- 18 and tWeen
• HLB for W/O --> 4 to 6 and span
• Cold cream is -- > W/O
• Vanishing cream --> O/W
• What problem does not occur in suspension?  Crystallization
• Ficks law describes? Rate of diffusion
• Rate limiting step in ophthalmic drops (eye)?  Cornea
• Partition coefficient is described as?  Pc = octanol/water (o/w)
• Drug with low volume of distribution: Has low accumulation.
• The most commonly used humectants? Glycerin
• Aluminum acetate is? Astringent (Burrow solution)
• Dose dumping is?Sustain release (SR) tablets, release drugs abruptly, that can lead to
dose dumping.
• Eutectic mixture is?  Mixing of two substance leads to lowering in melting point,
example includes camphor and menthol.
• Oils used for parenteral preparations?  All oils except mineral oil
• Write the sequence of surface area in gastrointestinal tract (GIT)?  Small intestine>oral
mucus membrane> stomach
• Largest capsule size is?  Capsule size 000
• Rate limiting step in skin?  Stratum corneum
• Mineral oil is used as?  Laxative to treat constipation
• Water used in parenteral preparation is?  Sterile water for injection USP.
• What is avoided in transdermal patch?  First pass effect
• Example of anionic surfactant?  Sodium lauryl sulfate

• Tablets are disintegrated by?  disintegrating agents
• Relation of sedimentation and particle size is can be explained by?  Stokes equation
• What type of tocoferal has the strongest antioxidant properties?  Tocoferal alpha
• Complexation can modify which two properties in a drug? Stability and solubility.
• Example of biphasic include  suspension, emulsions, aerosol,
• Suppository bases used in both the oil and water soluble drugs PEG
• What alcohol is used in internal formulation Ethanol
• A surfactant with HLB value of 14 to 18 is used as solubilizing agent (O/W)
• Emulsion can make creaming due to increase droplet size
• The rate of settling (creaming) of dispersed phase in the dispersion medium is function of
 Particle size, dispersion phase viscosity, difference of density of disperse phase and
media
• A paste of karaya gum powder is utilized in astomy patients toto protect skin from stomal
effluent
• In some preps egg yolk is used due to emulsifying agent

1. has low accumulation 2. rate of diffusion 3. Burrow solution
4. disintegrating agents 5. Pc=octanol water o/w 6. first pass effect
7. Stokes equation 8. stability & solubility 9. all oils except mineral
oil
10. alcoholic and 11. Tocoferol alpha 12. anionic surfactant
hydroalcoholic liquid
mixtures
13. disintegrating agents 14. sodium lauryl sulfate 15. Sterile Water for
injection USP
16. small 17. stratum corneum 18. capsule size 000
intestine>oral>mucus
membrane>stomach
19. mixing of 2 subs. 20. glycerin 21. crystallization
Leads to lowering in
melting point,
example includes
camphor and menthol
22. o/w emulsion 23. 24.
• the definition of tincture is? (alcoholic and hydroalcoholic liquid mixtures)

• sodium lauryl sulfate is? (anionic surfactant)
• high HLB values associated with? (o/w emulsion)
• what problem does not occur in suspension? (crystallization)
• Ficks law describes? (rate of diffusion)
• (cornea) the rate limiting step in ophthalmic drops(eye)?
• (Pc=octanol water o/w) partition coefficient is described as?
• (has low accumulation) drug with low volume of distribution?
• (glycerin) the most commonly used humectants is?

• aluminum acetate is? (Burrow solution)
• eutectic mixture is? (mixing of 2 subs. Leads to lowering in melting point, example
includes camphor and menthol)
• oils used for parenteral preparations? (all oils except mineral oil)
• write the sequence of surface area in GIT(small intestine>oral>mucus membrane>stomach)
• the largest size of capsule is? (capsule size 000)
• the rate limiting step for the topical drugs(stratum corneum)
• water used in parenteral preparation is? (Sterile Water for injection USP)
• what is avoided in transdermal patch? (first pass effect)
• an example of anionic surfactant(sodium lauryl sulfate)
• the tablets are disintegrated by? (disintegrating agents)
• relation of sedimentation and particle size can be explained by? (Stokes equation)
• what type of tocoferol has the strongest antioxidant properties? (Tocoferol alpha)
• complexation can modify which two properties in a drug? (stability & solubility)
• example of biphasic include(suspension, emulsion & aerosol)
www.pharmacyprep.com Drug delivery Systems
43
Drug Delivery Systems
• What are the advantages of oral administration? It is most convenient to both the patient
and the physician.
• What dosage forms are requiring sterile? Ophthalmic and parenteral
• Intraarticular injections  Injection in joints
• What propellant used in meter dose inhaler  hydrofluroalkane (HFA)
• Nitroglycerine patch require nitrate free period for  8 to 12 hours
• Meter dose inhalers that require shaking  Salbutamol, Fluticasone, Budesonide,
• Salmeterol
• What type of inhalation devices are used in children under 5 year age --> MDI +
aerochamber
• Nitroglycerine spray requires  no shaking but prime
• What are the disadvantages of oral administration? The taste and/or smell, and possible first
pass metabolism and slow onset
• What is the advantage of IV drug administration? It is fastest acting method.
• What are the advantages of sublingual administration of a drug? it is a rapid onset and no
first pass metabolism.
• What is meant by the intrathecal administration of a drug? into the spinal column.
• Drug distribution into different tissues depends on which factors? the tissue mass, and the
extent of ionization
• What is the most direct route of drug administration? IV
• What factors must be considered in choosing a specific route of administration?
• The physical and chemical characteristics of the drug.
• Which provides a more rapid absorption, IM or SC administration? IM
• What are the advantages of transdermal patches? They provide continuous drug
administration and no first pass metabolism.
• What type of drugs can be given by inhalation? Drugs that act directly on the
• bronchi and inhalation anaesthetics.
• What are the advantages of rectal administration of drugs? For drugs that cause
• GI irritation and N&V and uncooperative or unconscious patients.
• Tablet disintegration in body by  A-swelling B-water uptake C-hydrolysis
Ophthalmic drops:
• Voltaren ophthalmic drops: Cause stinging and burning, blurred vision.
• Ketorolac: Cause stinging and burning
• Trifluridine: Store in refrigerator

• Pilocarpine: cause miosis
• Latanoprost: cause pigmentation, enlargement of eyelashes.
• What types of delayed release preparations are available for drugs?
• There are delayed release tablets, depot I.M. injections, transdermal patches, & pumps.
1. it is rapid onset & no 2. 8-12 hrs 3. drugs that act directly
first pass metabolism on the bronchi &
inhalation anesthetics
4. for drugs that cause gi 5. no shaking but prime 6. it is the most
irritation and n&v and convenient to both the
uncooperative or patient and physician
unconscious patient
7. hydrofluoroalkane hfa 8. iv 9. the physical and
chemical
characteristics of the
drug
10. the tissue mass, extent 11. it is the fastest acting 12. they provide
of ionization method continuous drug
administration and no
first pass metabolism
13. im 14. ophthalmic and 15. injection in joints
parenteral
16. salbutamol, 17. the taste and or smell 18. into the spinal column
fluticasone, and possible first pass
budesonide, salmeterol metabolism and slow
• what are the advantages of oral administration? (it is the most convenient to both the patient
and physician)
• what dosage forms require sterile? (ophthalmic and parenteral)
• intraarticular injections(injection in joints)
• what propellant used in meter dose inhaler? (hydrofluoroalkane HFA)
• nitroglycerine patch require nitrate free period for? (8 to 12 hrs)
• meterdose inhalers that require shaking(Salbutamol, Fluticasone, Budesonide, Salmeterol)
• Nitroglycerine spray require(no shaking but prime)
• what are the disadvantages of oral administration? (the taste and or smell and possible first
pass metabolism and slow onset)
• what is the advantage of IV drug administration? (it is the fastest acting method)
• what are the advantages of sublingual administration of a drug? (it is rapid onset & no first
pass metabolism)
• what is meant by the intrathecal administration of a drug? (into the spinal column
• drug distribution into different tissues depends on which factors? (the tissue mass, extent of
ionization)
• what is the most direct route of drug administration? (IV)
• what factors must be considered in choosing a specific route of administration? (the

physical and chemical characteristics of the drug)
• which provides a more rapid absorption, IM or SC administration? (IM)
• what are the advantages of first pass metabolism? (they provide continuous drug
administration and no first pass metabolism)
• what type of drugs can be given by inhalation? (drugs that act directly on the bronchi &
inhalation anesthetics)
• what are the advantages of rectal administration of drugs? (for drugs that cause GI irritation
and N&V and uncooperative or unconscious patient)
www.Pharmacyprep.com Sterile Preparations
44
Sterile Preparations
Tips
Methods of sterilizations:
o Steam (moist) sterilization 
• Autoclave is used
• 120 oC for 15 min to 30 min
• Parenteral solutions preparations
• Ophthalmic solutions
Dry Heat sterilization 

• Oven is used
• 150 oC for 1 hour
• Glass apparatus
• Powders
• Mineral oil sterilization
Gas sterilizations 
• Ethylene oxide gas is used
• Surgical tubing
Radiation sterilizations
• Heat sensitive substances
• Hormones, proteins etc
• Filtration sterilizations For microbial filtration 0.22 mm in sterile water

• Dry heat sterilization Oven, 240 to 250 oC for 2 hour
• Steam (wet) sterilization Autoclave, 121oC at least 30 min
• Filtration: Size of filter for small volume of parenteral solution is 0.22mm
• Gas sterilization  Ethylene oxide is gas
• Radiation methods  Heat sensitive product
• Pyrogen test  Rabbit test and LAL test
• Hormones are sterilized by Filtration, and radiation
• Tubing’s are sterilized by Gas sterilization methods (ethylene oxide)
• Proteins sterilized by  Filtration or radiation
• Petrolatum, waxes are sterilized by Dry heat

• Glass apparatus sterilized by Steam sterilizations
• Parenteral solutions should be  Pyrogen free, sterile, particulate free, and isotonic.
• Sterility is  Absolute term and free from bacteria
• Cytototoxic drug (anticancer drugs) preparations should be done in? Vertical laminar air
flow
• Doxorubicin is an anticancer antibiotic prepared in? Vertical laminar air flow hood
• The size of HEPA filter that is used in laminar airflow hood? 0.33 mm (milli micron)
• The size of filters that is used in water filtration? 0.22 mm
• Parenteral preparation should be free from? Microorganism, pyrogen, and particulate
• Pyrogens are eliminated by? Distillation
• Types of water used in parenteral preparations  Sterile water for injection USP
• Water for injection USP Parenteral manufacturing
• Water for irrigation  Wound cleaning, GI and surgical irrigations
• Purified water  Reconstitution of oral suspension
• How do you prepare type II glass, from type III glass  Dealkalinizing by sulphur dioxide
• What part of syringe should not be touched  Needle

1. filtration and radiation 2. dry heat 3. Vertical laminar air
flow hood
4. ethylene oxide 5. dealkalinizing by 6. for microbial filtration
sulfur dioxide 0.22mm in sterile
H2O
7. Distillation 8. microorganism, 9. absolute form
pyrogen & particulate
10. free from bacteria 11. autoclave, 121oC 12. heat sensitive
atleast 30 min. products
13. Rabbit test and LAL 14. pyrogen free, sterile, 15. 0.22mm
test particulate free, and
isotonic
16. needle
• How do you prepare type II glass, from Type III glass? (dealkalinizing by sulfur dioxide)
• filtration sterilizations (for microbial filtration 0.22mm in sterile H 2 O)
• steam (wet) sterilization (autoclave, 121oC atleast 30 min.)
• Gas sterilization (ethylene oxide)
• Radiation methods (heat sensitive products)
• pyrogen test (Rabbit test and LAL test)
• Hormones (filtration and radiation)
• Tubing’s (gas sterilization methods :ethylene oxide)
• Proteins (filtration or radiation)
• Petrolatum, waxes (dry heat)
• Parenteral solutions should be: (pyrogen free, sterile, particulate free, and isotonic)
• Sterility (absolute form)

• Sterility is? (free from bacteria)
• Cytotoxic drug preparations should be done in? (Vertical laminar flow hood)
• Doxorubicin is an anticancer antibiotic prepared in? (Vertical laminar air flow hood)
• The size of HEPA filter that is used in Laminar airflow hood? (0.22mm)
• parenteral preparations should be free from? (microorganism, pyrogen & particulate)
• Pyrogens are eliminated by? (Distillation)
• what part of the syringe that should not be touched? (needle)
www.Pharmacyprep.com Extemporaneous Pharmaceutical Prep
45
Extemporaneous
Pharmaceutical Preparations
• What antibiotic available chewable dosage form? Amoxicillin
• Suspensions that should be stored at room temperature? Azithromycin, clarithromycin,
cotrimoxazole and clindamycin.
• What temperature is fridge? 2 to 8 oC (also known as cold)
• What is room temperature in Canada? 15 to 25 oC
• What is cool temperature? 8 to 15 oC
• What is freezer temperature? 0 to 4oC
• Lanoline is? Lipid-soluble ointment base incorporate water (hydrous)
• White petrolatum is? Lipid soluble ointment base
• What is levigating agent? White petrolatum
• What type of container should be used for ointments? Wide mouth jar or tube
• Amoxicillin suspension7 days at RT or 14 days in refrigerator.
• Azithromycin 10 days at RT (should NOT be stored in refrige)
• Clarithromycin14 days at RT (must be stored in RT)
• Cotrimoxazole (Septra) store at RT for until expiry in amber color bottle.
• Clindamycin  store at RT
• Cefachlor (cephalosporin)  store in refrigerator (room temperature for 7 days)

1. lipid soluble ointment 2. 0 to 4oC 3. white petrolatum
base incorporate water
(hydrous)
4. lipid soluble ointment 5. 8 to 15 oC 6. 15 to 25 oC
base
7. 2 to 8 oC also known 8. Amoxicillin 9. Azithromycin
as cold
10. Clarithromycin 11. Cotrimoxazole 12. Clindamycin
www.Pharmacyprep.com Extemporaneous Pharmaceutical Prep
• What antibiotic available chewable dosage form? (Amoxicillin)

• suspensions that should be stored at room temperature(Azithromycin, Clarithromycin,
Cotrimoxazole & Clindamycin)
• Lanolin is? (lipid soluble ointment base incorporate water (hydrous)
• white petrolatum is? (lipid soluble ointment base)
• What is levigating agent? (white petrolatum)
www.Pharmacyprep.com Pharmaceutical Analysis
46
Pharmaceutical Analysis
• High performance liquid chromatography (HPLC) is used for  Purification and analysis
of pharmaceuticals
• Pump is present in what type of chromatography? HPLC
• Types of detectors used in HPLC? UV, DAD, fluorescent, and refractive index (RI)
• Gas chromatography (GC) is used for  Analysis of volatile pharmaceuticals
• Drugs present in blood samples can be detected by? Gas chromatography and Mass
spectroscopy (GC-MS)
• Salting in is? Increase in solubility by addition of salt.
• Salting out is? Decrease in solubility by addition of salt.
• Mechanism of thin layer chromatography (TLC) is based on? Capillary action
• Ninhydrin is a spray agent used to detect? Amine, amino sugars, and proteins.
• What are the factors that does not effect on resolution in HPLC? Detectors, printers etc.
• GC-MS is? Analysis and detection of volatile chemical in samples.
• Lyophylization is used for? To dry wet powders, which are heat sensitive drugs.
Lyophylization function based on sublimation method.
• Electron impact (EI) ionization mass spectroscopy is? The methods of ionization of MS
which results in well-established fragmentation pattern that are useful in identification of
unknown chemicals.
• ELISA Enzyme Linked Immunosorbent Assay
• ELISA is used for the  Detection of HIV infections
• Western blot test for  Detecting monoclonal antibody
• Gel electrophoresis separates  Protein separation
• Polymer chain reaction (PCR) devices are used --> To magnify DNA

1. to dry wet powders, 2. the method of 3. purification and
which are heat ionization of MS w/c analysis of
sensitive drugs results in well- pharmaceuticals
established
fragmentation pattern
that are useful in
identification of
unknown
www.Pharmacyprep.com Pharmaceutical Analysis
4. Analysis and detection 5. protein separation 6. protein isolation

of volatile chemical in
samples
7. Enzyme linked 8. HPLC 9. UV, DAD,
immunosorbent assay Fluorescent & RI
10. Gas Chromatography 11. capillary action 12. amine, amino sugars
and proteins
13. increase in solubility 14. decrease in solubility 15. detectors, printers
by addition of salt by addition of salt
16. detection of HIV 17. Mass Spectroscopy
infection
• Pump is present in what type of chromatography? (HPLC)

• types of detectors used in HPLC? (UV, DAD, Fluorescent & RI)
• Drugs present in blood samples can be detected by? (Gas Chromatography & Mass
Spectroscopy)
• Salting in is? (increase in solubility by addition of salt)
• Salting out is? (decrease in solubility by addition of salt)
• Mechanism of TLC is based on? (capillary action)
• Ninhydrin is used to detect? (amine, amino sugars and proteins)
• What are the factors that does not affect resolution in HPLC? (detectors, printers)
• GC-MS is? (Analysis and detection of volatile chemical in samples)
• ) Lyophilization is used for? (to dry wet powders, which are heat sensitive drugs
• Electron impact (EI) ionization Mass spectroscopy is? (the method of ionization of MS
w/c results in well-established fragmentation pattern that are useful in identification of
unknown)
• HPLC is used for? (purification and analysis of pharmaceuticals)
• ELISA is? (Enzyme linked immunosorbent assay)
• ELISA is used for? (detection of HIV infection)
• Western blot test for? (protein isolation)
• Gel electrophoresis separates? (protein separation)
www.Pharmacyprep.Com Social/Behavioral and Administrative Sources
Part III:
Social / Behavioral and
Administrative Sciences
47
Ethical Principles
• Beneficence  Doing good
• Non maleficence  Preventing harm
• Autonomy  Right of determination
• Veracity  Honesty without deception
• Justice  Equality with everyone or first come first serve or fairness
• Fidelity  Best interest of patient
• Paternalism  violating autonomy
1. Violating autonomy 2. Tell the truth 3. Right of determination
4. beneficence 5. ethics 6. equality with everyone
7. preventing harm 8. best interest of patient 9. honesty without
deception
• doing good(Beneficence)
• Non Maleficence(preventing harm)
• Autonomy(right of determination)
• Honesty(tell the truth)
• Veracity(honesty without deception)
• Justice(equality with everyone)
• Fidelity(best interest of patient)
• Paternalism(violating autonomy)
• code of conducts or morals(Ethics)
www.Pharmacyprep.com Social /Behavioral / Administrative Sciences
48
The Canadian HealthCare
System
• Canadian health care system is  Universal
• Canadian Health Act (CHA) approved in  1984
• What are the five Canadian Health Act principles? CAPPU = Comprehensiveness,
Accessibility, Universality, Portability and Public administration
• What is included in provincial drug benefit program --> over 65 year age, person social
assistance,
• Federal drug benefit program offers help --> Non-Insured Health Benefits (NIHB),
veterans, inmates (prisoners), aborginals, refugees, and RCMP
• The healthcare system in Canada is public administration in which provincial and federal
government owns, operate and provide all essential health care services to its citizens.
• Health Canada is a federal agency; it is responsible for drug quality, safety and efficacy
• The health protection branch (HPB) or The Health protection Food Branch Inspectorate
(HPFBI) of Health Canada regulates drugs imported into and manufactured for sale in
Canada.
1. pharmaceuticals 2. non essential services 3. federal
4. provincial 5. comprehensiveness 6. universality
7. portability 8. public administration 9. accesibility
10. natives or aboriginals 11. inmates 12. refugees
13. veterans 14. RCMP 15.
• What are the five Canadian Health Act principles? (Comprehensiveness, Universality,
Portability, Public Administration & Accesibility)
• Federal Drug Benefit Program covers: (Natives or aboriginals, inmates, refugees, veterans,
Royal Canadian Mounted Police RCMP)
• What is not covered in CHA? (pharmaceuticals & non essential services)
• Funding for healthcare system is paid by? (federal & provincial)
www.pharmacyprep.com Pharmacy practice and Management
49
Pharmacy Regulations and
Administration
• NAPRA; National Association of Pharmacy Regulatory Authority
• Who regulates pharmacy profession in Canada  NAPRA
• Examples of pharmacy associations, where pharmacist can be a member? CPhA and CSHP
and professional college of pharmacies such as Ontario college of pharmacy, Alberta
college of pharmacy and British Columbia college of pharmacy, Saskatchewan college of
pharmacy.
• Who sets prescription drug prices in Canada  Patented Medicine Price Review Board
(PMPRB)
• Who sets over the counter drug prices  Pharmacy manager/owner
• What are the NAPRA schedules --> there are 3 schedules and 1 unscheduled.
• What drugs are require prescription only --> Schedule 1
• Who approves drug sales in Canada --> health Canada
Institute of Safe Medication NAPRA CPhA
Practices Canada ISMP
• National Association of Pharmacy Regulatory Authority(NAPRA)

• Examples of pharmacy associations, where pharmacist can be a member? (CPhA)
• examples of medication incident reporting systems in Canada? (Institute of Safe
Medication Practices Canada ISMP)
www.Pharmacyprep.com Social, Behavioral and Administrative Sciences
50
Social, Behavioral,
Economics Aspects of
Pharmacy Profession
Pharmaceutical Care Delivery System
• The major pharmaceutical care activities takes place in the following systems
A. Community pharmacy
B. Hospital pharmacy
C. Long term care facilities
D. Specialty hospital units
• What is the most expensive in health care system --> hospitalization
• What is the second most expensive in health care system --> doctor salaries
• Tips Practice format 02: Find answers from the table:
1. ick-role behavior 2. Illness behavior 3. Professionalism
4. practice ethics 5. reflection and self 6. responsibility/accountability of
and high moral awareness actions
standards
7. Health behavior 8. 9.
• it is defined as any activity undertaken by an individual who believes himself or herself to

be healthy, for the purpose of preventing illness. (Health behavior)
• It is defined as any activity undertaken by an individual who believes he/she maybe ill.
(Illness behavior)
• It is defined as an activity undertaken by an individual who considers them to be ill or who
have been diagnosed by a health professional as being ill. (Sick-role behavior)
• is described as the competence and skill expected and required of a professional.
(Professionalism)
• personal attributes of professionals(practice ethics and high moral standards, reflection and
self awareness, responsibility/accountability of actions)
PharmacyPrep.Com Pharmacy Management
51
Pharmacy Management
• What are forms of business structure in Canada? Corporation, sole proprietor, partnership,
and Franchise (Lease is not business structure)
• What is banner pharmacy ownership? A type of franchise
• What is the most important in business location analysis? Market area analysis
• What financial statement includes sales of prescription drugs? Income statement
• What financial statements include assets and liabilities? Balance sheet
• Examples of currents assets include? Cash, Account receivable
• Examples of fixed assets include? Furniture, Building etc
• What is the most expensive in pharmacy business? Salaries
• Business efficiency  Net sales/Net worth
• Turnover rate  Cost of good sold/average inventory capital
• What is average turnover rate for a pharmacy  4 to 6
• Staffing need is described as? Job analysis
• Position description includes? Nature and scope of position
• Delegation include Authority, responsibilities and accountability
• Coinsurance is  customer and insurance share payment
• Co-payment is patient has to pay fix amount each time
• Deductible is specific amount is paid for initial use
• Liquidity is  indicator of efficiency
• Solvency is  indicator of efficiency, which is also known as bankruptcy
• DIN is  Drug identification number
• POS is  Point of sale
• Income statement indicates sales, cost of good sold, gross margin and net profit
• Balance sheets include  assets and liabilities
• Gross margin is  total sales – cost of goods sold
• Net profit or net income is  gross margin – expenses
• Average inventory means  opening inventory +closing inventory
2
• Net profit ratios indicates business profitability
• Turn over rate indicates  business efficiency
PharmacyPrep.Com Pharmacy Management

1. POS 2. salaries 3. income statement
4. balance sheet 5. turnover rate 6. 4 to 6
7. Nature and scope of 8. Market area analysis 9. Corporation
position
10. sole proprietor 11. partnership 12. franchise
13. cash 14. account receivable 15. furniture
16. building 17. 18.
• what are the forms of business structure in Canada? (corporation, sole proprietor,
partnership, franchise)
• what is banner pharmacy ownership? ( a tyoe of franchise)
• what is the most important in business location analysis? (market area analysis)
• what financial statement includes sales of prescription drugs? (income statement)
• what financial statements include assets and liabilities? (balance sheet)
• examples of current assets include? (cash, account receivable)
• examples of fixed assets include? (furniture, building)
• what is the most expensive in pharmacy business? (salaries)
• cost of good sold/average inventory capital(turn over rate)
• the average turnover rate for a pharmacy(4 to 6)
• staffing need is described as? (job analysis)
• position description includes(nature and scope of position)
• (POS) point of sale
www.PharmacyPrep.com Social / Behavioral / Administrative Sciences
52
Pharmacoeconomics
Tips
• Pharmacoeconomics studies aimed at Society

• What are the methods of pharmacoeconomic analysis:
• Cost effective analysis (CEA)
• Cost utility analysis (CUA)
• Cost minimization analysis (CMA)
• Cost Benefit analysis (CBA)
• What is QALY? Quality Adjusted Life Year (QALY)
• QUALY is outcome of  Cost utility analysis (CUA)
• Cost–effectiveness analysis Which attempts to define exactly how much good is achieved
for each dollar spent, is playing a greater role in shaping our health care system. One form
of cost–effectiveness analysis
• What is SF-36 means  short form 36, is used for conducting survey.
• CUA allows comparison across different health programs and policies by using a common
unit of measure
1. Units 2. Society 3. Short Form 36

4. Cost Minimization 5. Quality Adjusted Life 6. Dollars
Analysis Year
7. cost utility analysis 8. 9.
• What is QALY(Quality Adjusted Life Year)?

• Pharmacoeconomics is centered for? (Society)
www.PharmacyPrep.com Social / Behavioral / Administrative Sciences
• Cost minimization analysis outcome is measured in? (Dollars)

• Cost effectiveness analysis outcome is measured in? (Units)
• QALY is outcome of? (cost utility analysis)
• What is SF 36? (Short Form 36)
• To compare cheaper intervention, what methodology is used? (Cost Minimization
Analysis)
www.Pharmacyprep.com Drug Information Resources
53
Drug information Resources
• CPS  Compendium of Pharmaceutical Specialties
• What is found in CPS  drug monographs, generic to brand or brand to generic names,
immunization schedule, dental prophylaxis, endocarditis treatment, drugs in pregnancy and
lactation, drugs for elderly, drugs that contain alcohol, peanut oil, gluten, tartrazine, DI of
grapefruit juice, and food
• What is found in patient self-care (PSC)patient self-care recommendation about simple
conditions such GI, skin, foot, ear, eyes, sport injuries etc.
• What is NOT present in patient self-care  antibiotic recommendations or clinical practice
trial recommendations.
• What is found in therapeutic choices  clinical practice recommendations for diseases
such as cardio, neuro, psycho, respiratory, and GI etc.
• Children immunization schedule in Canada is found in  CPS or immunization guide of
health
• Dental prophylaxis clinical practice guidelines can be found in  CPS
• Initial treatment can be recommended by using  therapeutic choices
• Off label indication is  Second use of drug or unapproved use of drug
• Off label indication are found in --> USP - DI vol.1, Martindale
• What is NOT found in CPS  self care recommendation
• What reference is used to find foreign drugs --> Martindale
• Off label indication are found in  Medline or USP-DI vo1.1
• Compendium of patient self-care product (CPSP)  has over the counter product brands
available in Canada.
• Foreign drugs are found in  Martindale
• US equivalent drugs in Canada  USP-DI vol.1
• Compounding reference  Remington
• Medline or Pubmed: Online source of indexes and abstracts.
• Red book: Pharmaceutical prices are described in this book.
• SOP = Standard Operating Procedures used in preparation and formulation of
pharmaceuticals
• GMP = Good Manufacturing Practices or Procedure, the guidelines that determined by
FDA for pharmaceutical preparations.
• GLP = Good Laboratory Practice
www.Pharmacyprep.com Drug Information Resources
Tips practice format 02: find answers from the table:

1. second use of drug or 2. CPS 3. Therapeutic Choices
unapproved use of
drug
4. drug monographs, 5. CPS or Immunization 6. patient self care.
Guide of Health
Canada
7. clinical practice 8. Remington 9. antibiotic
recommendations for recommendations or
diseases such as clinical practice trial
cardio, neuro, psycho, recommendations
respiratory, GI etc.
• Children immunization schedule is found in? (CPS or Immunization Guide of Health

Canada)
• Dental prophylaxis clinical practice guidelines can be found in? (CPS)
• Initial treatment can be recommended by using? (Therapeutic Choices)
• Off label indication is? (second use of drug or unapproved use of drug)
• Compendium of Pharmaceutical Specialties (CPS)
• What is found in CPS? (drug monographs, generic to brand or brand to generic names,
immunization schedule, dental prophylaxis, endocarditis treatment, drugs in pregnancy and
lactation, drugs for elderly, drugs that contain alcohol,peanut oil, gluten, tartrazine, DI of
grapefruit juice)
• What is found in Patient Self Care? (patient self care recommendation about simple
conditions such as GI, skin, foot,ear, eyes, sport injuries etc.)
• What is not present in patient self care? (antibiotic recommendations or clinical practice
trial recommendations)
• (Remington) Compounding Reference
• (clinical practice recommendations for diseases such as cardio, neuro, psycho, respiratory,
GI etc.)
www.Pharmacyprep.com New Drugs Developments and Approval process
54
New Drug Development
Process
• Who approves and authorizes the sale of medications in Canada? Health Canada
• Government regulates drug prices. Who sets the prices of prescription drugs in Canada?
Patented Medicine Price Review Board (PMPRB)
• Who sets the prices of over the counter drugs in Canada? Pharmacy Manager/owner
• What is NOC? Notice of Compliance
• Pre-clinical studies is conducted in  animals
• Phase I clinical studies is conducted in healthy volunteers, pharmacokinetics and safety
• Phase II clinical studies disease patient and small number
• Phase III clinical studies disease patient, large number of patient, and it is decisive phase
• Phase IV clinical studies is post marketing, inspection of safety and regulatory
compliance
1. Notice of Compliance 2. Phase III 3. disease patient, large

number of patient, it is
decisive phase
4. animals 5. Post marketing, 6. Health Canada
inspection of safety
and regulatory
compliance
7. Patented Medicine 8. Pharmacy 9. healthy volunteers,
Price Review Board Manager/Owner pharmacokinetics &
PMPRB safety
10. disease patient and
smaller number
• Who approves and authorizes the sale of medications in Canada? (Health Canada)
www.Pharmacyprep.com New Drugs Developments and Approval process
• Who sets the prices of prescription drugs in Canada? (Patented Medicine Price Review
Board PMPRB)
• Who sets the prices of over the counter drugs in Canada? (Pharmacy Manager/Owner)
• Pre-clinical studies is done in? (animals)
• Phase I clinical studies is done in? (healthy volunteers, pharmacokinetics & safety)
• Phase II clinical studies is done in? (disease patient and smaller number)
• Phase III clinical studies is done in? (disease patient, large number of patient, it is decisive
phase)
• Phase IV clinical studies is done in? (Post marketing, inspection of safety and regulatory
compliance)
• What is NOC? (Notice of Compliance)
• Decisive Phase (Phase III)
• approves the prescription & OTC medications (Health Canada)
www.PharmacyPrep.com Epidemiology
55
Epidemiology
• Meta analysis  analysis of combination of clinical trials

• Most credible studies is that utilizes  double blind randomized clinical trials
• What is a placebo  an inert compound identical in appearance with the drug being tested.
It may or may not be known to the physician and/or patient.
• Case report  reporting a drug related problem
• Case series  a group of case reports
• Case control study design is retrospective studies (comparing previous records of patient)
• Cross sectional study design is current studies
• Cohort of follow up study design prospective studies
• Cohort  a group with a common characteristics
• Randomization no selection criteria is used
• Single blind  only subjects are blinded
• Double blind  Both subjects and investigator are blinded
• Parallel study design one group will get control and other group treatment
• Crossover study design one group will get control and treatment
• N of 1 model  one subject gets drug and the same gets placebo
• Odd ratio is used for retrospective studies
Tips format 002: Epidemiology

1 case-control 2 cross-sectional 3 prospective
4 cohort 5 single-blind studies 6 double-blind
7 randomization of the 8 parellel Studies 9 crossover studies

sample
10 Dependent variable 11 Meta analysis 15 prevalence
13 Case report 14 Blood pressure 14
16 17 18
• Factors reduces best bias( 5, 6, 7)
• the odds ratio associated with( 1)
• A study designed to determine the relationship between emotional stress and ulcers
used the records of patients diagnosed with peptic ulcer disease versus controls over the
period from May 2009-May 2010. This is an example of what kind of study? ( 1)
• Twelve patients are given a drug or a placebo to determine the effect of medication on
blood pressure. The dependent variable in this study is ( 14 )
• A study was undertaken to determine if prenatal exposure to marijuana is a cause of
low-birth weight. Mothers of 50 infants weighing less than 5 lbs (low-birth weight) and
50 infants weighing more than 7 lbs (high-birth weight) were questioned about their use
of marijuana during pregnancy. The study found that 20 mothers of low-birth weight
infants and only 2 mothers of high birth weight infants used the drug during pregnancy.
This is an example of what kind of study? ( 1 )
• In this study, the odds ratio associated with smoking marijuana during pregnancy is ( 1)
The odds ratio is 16 and is calculated as follows:
Mother smoked marijuana Mother did not smoke marijuana
Low-birth weight babies A = 20 B = 30
High-birth weight babies C=2 D = 48
Odds ratio = (A)(D) or (20)(48) = 960 = 16
(B)(C) or (30)(2) = 60
• Combining data form several studies (often via a literature search) to achieve greater
statistical power. ( 11 )
• is the number of people who have an illness at a specific point of time( 15 )
• prevalence is used in( 2)
www.Pharmacyprep.com Biostatistics
56
Biostatistics
• The mean, median and mode are equal. (Normal = Gaussian = Bell shaped).
• P = Probability of making type I error, also referred level significance.
• Example: A statistical data mean is 100, Median is 100, and Mode 100, the statistical
distribution is? Indicates symmetrical distribution
• A statistical data mean is 200, median is 150, and mode 100, the statistical distribution
is?
• Indicates positive skew
• Chi-square test: --> The degree of freedom is defined as (R-1) x (C-1)
• Type I error occurs due to  chance
• Type I error also known as  false positive alpha error
• Type II error occurs due to  sample size
• P = probability of error
• The absolute risk (AR) = A/(A+B) A = Drug, B = Placebo
• What is ARR ARR = (placebo events) – (treatment events)
• What is RRR  RRR = [EER-CER]/CER or [CER-EER]/CER
• RRR=ARR ÷ placebo events.
• RRR = 1 x CER
 NNT
• What is NNT NNT = 1/ARR
• What are the examples of parametric tests are mean, standard deviation, and T-test
• What are the examples of non-parametric tests are median, mode, and chi-square test
• False +ve test is  type 1 error or alpha error
• Type I error can occur by chance
• Type II error can occur by  sample size
• Probability of error is presented as  type I error
• What is precision reproducibility
• What is specificity  Specificity measures how well a test identifies truly
• What is accuracy close to true value
• What is validity measuring accurately
Tips format 002: Biostatistics

1 (SD/mean) x100 2 3
4 Parametric tests 5 Non parametric tests 6 t-tests
7 f-tests 8 Type I (α-error) 9 Type II (β-error)
10 A/(A+B) 11 EER – CER 12 1/ARR
A = Drug, B = Placebo
13 (1 x CER)/ NNT 14 [EER-CER]/EER 15 a / (a+b)/c(c+d)
16 17 18
• to calculate of % of variance coefficient( 1 )

• example of mean and standard deviation and t-test( 4)
• example of chi square, median, and mode( 5 )
• Used for comparing the means of 2 treatment, even if they have different number of
replicates(6 )
• False + ve( 8 )
• Rejecting null hypothesis when null hypothesis (Ho) is true( 8 )
• Accepting null hypothesis when it is false. ( 9 )
• Absolute risk reduction (ARR) ( 11 )

• Number of patient needed (NNT) to be treated to prevent one bad outcome( 12)
• Relative risk( 15)
• Relative risk reduction (RRR) (13 and14 )
57
Managing Drug Distribution
Tips
• Pharmacist functions in hospital pharmacy Procurement (purchasing), Preparation and

dispensing
• Pharmacist role in P&T committee preparing formulary, purchase order, receive and
store.
• Therapeutic equivalent drugs in hospital are exchangeable
• What is least likely pharmacist functions in hospital pharmacy  Indications,

administration.
• Who is the last person to check medications in hospital ward 
• A patient in hospital is using different brand of drug, then hospital formulary. Patient
wants same drug? Get a prescription
• Hospital funding --> Provincial government

www.pharmacyprep.com Pharmacy Practice, Therapeutics, and OTC drugs
Part 4:
Pharmacy Practice /
Therapeutics/ OTC drugs
59
Prescription Processing
Abbreviations
Abbreviation Meaning Latin Phrase Abbreviation Meaning Latin Phrase
a Before Ante OD Right eye D= dexter
a.c. Before meals Ante cibum OS Left eye S=sinister
Ad lib As desired Ad libitum OU Both eyes
pc After meal Post cibum AD Right ear D= dexter
p.o. By mouth Per os AS Left ear S=sinister
pr Per rectum AU Both ear
b.i.d. Twice a day bis in die
p.r.n. As needed Pro re nata
c with cum q every quaque
cc With food q.a.m. Every
morning
dr Dram q.d Everyday Quaque die
dx Diagnosis q.o.d. Every other
day
pt Pint q.i.d. Four times a Quarter in
day die
g Gram Q2h, q3h, etc Every two
hours… etc
gr Grain qt quart
gtt Drop rx, Rx prescription
h Hour s without sine
hr Hour ss One half
h.s. At bed time Hora somni stat immediately
hx History supp suppository
ID Intradermal sx symptoms
IM Intramuscular T, Tbsp or tbs tablespoon
IU International t, tsp teaspoon
unit
IV Intravenous t.i.d. 3X a day ter in die
IVPB IV piggyback T.O. Telephone

order
kg Kilogram tr tincture
L Liter tx treatment
lb Pound ung ointment
mcg Microgram VO Verbal order
mEq Milliequivalent
mg Milligram
ml Milliliter
oz Ounce
p post post
• caps ii tid pc Take two capsules three times a day after meals (after food)
• suppos I pr q6h prn  Unwrap and insert 1 suppository into the rectum every 6 hours
as needed.
• tabs iss stat; tabs I q6h cc Take one &one half tablets to start (at once): then take 1
tablet every 6 hours with food.
• fl. I tid cc Take two tablespoonful three times a day with food
• gtts ii ou qid for 7 daysInstil 2 drops into both eyes 4 times a day for 7 days
• For a child: 10 mL stat, then 5mL tid for 10 daysgive 2 teaspoonful at start: then 1
teaspoonful three times a day for 10 days
• gtts iv au qid for 7 days Instil 4 drops in both ears, 4 times a day for 7 days
• tabs ii qam, ss at noon & tabs ii qhsTake 2 tablets every morning, half tablet at noon
and two tablets at bed time.
• fl. iv stat; fl. ii q4h udTake teacupful (120 mL) at start: four tablespoonful every
4hours as directed.
• app ung sp aa tid Apply ointment sparingly to affected area three times a day
• gtts x po q12h udGive 10 drops orally every 12 hours as directed
Interpret the following examples of abbreviations used in prescriptions and orders:
• ii tabs pc: Take 2 tablets after meals

• Ibuprofen 200 mg q4h prn temp > 101oF: Take tabs every 4 hours as need when temp
is higher 101 F
• i cap hs prn for sleep: Take 1 cap at bed time as needed for sleep
• Cefazolin 1g IVPB q8h: Infuse 1g iv piggy bag every 8 hours
• Mix 2 tbs in 4 oz of water and take po qid: Mix 2 tablespoon in 1 cup of water and take
orally four times a day
• Heparin 5000 units SC q12h: Inject 5000 units of heparins sc every 12 hours
• iii gtt OD bid: Instil 3 drops in right eye two times a day
• Rocephin 250 mg IM Stat: Inject rocephin 250 mg intra muscular at start
• i tab ac & hs: Take 1 tablets before meal and bed time
• Acetaminophen 10 mg/kg prn pain: Give acetaminophen 10mg/kg as needed for pain
• Prescription is  a direction of therapy written by prescriber to pharmacist.
Abbreviation Meaning Abbreviation Meaning

aa Of each a before
a.c. Before meals
Ad lib As desired
cc With food
pc After meal
AD Right ear
AS Left ear
AU Both ear
OD Right eye
OS Left eye
OU Both eyes
p.o. By mouth
pr Per rectum
q.o.d. Every other day
iii gtt OD bid Instil 3 drops in right eye twice

daily
i tab ac & hs Take 1 tab before meals at Ex aqua In water

bedtime
ii tabs pc Take 2 tabs after meals SPO Structure process outcome
POS Point of sale

SF-36 Short form 36
DIN Drug identification number
QALY Quality
PharmacyPrep.Com Pharmaceutical Care
60
Pharmaceutical Care
Tips
• Pharmaceutical care should be focus to  patient care
• Write examples of drug related problem 
• A patient is receiving fluticasone inhaler, what is appropriate to counsel  rinse mouth

after each use
• A patient using analgesic and allergic to ASA may take acetaminophen
• A patient is using ramipril, experiencing dry cough, recommend  ARBs
• A child have milk allergies, the allergy may be due to  proteins and lactose
• Gluten is present in  wheat, and rye

• A 50-year-old patient currently using enalapril for hypertension. Experiencing dry cough.
What is alternate preferably therapy is recommended Recommend drug from other class
of antihypertensive
• A customer searching for OTC antidiarrheal medications. If you realized diarrhea is
associated with clindamycin, what is appropriate action?  Refer patient to doctor
• Drugs
• causing discoloration of feces:
Discoloration - Omeprazole, risperidone
Whitish speckling - Aluminum antacids
Black - Bismuth, Charcoal, Ferrous salts
Pink, red/black - Anticoagulants, Heparin, Phenylbutazone, Salicylates, NSAIDs,
Red - Pyrvinium
PharmacyPrep.Com Pharmaceutical Care
Orange-red - Phenazopyridine, Rifampin

Yellow - Senna
Green - Indomethacin Cholophyll
Greenish gray - Antibiotics
• Pharmaceutical care should be focus to  improving patient quality of life
• Write examples of drug related problem (DRP) 
• A 50-year-old patient currently using enalapril for hypertension. Experiencing dry cough.
What is alternative preferably therapy is recommended? ARBs
associated with clindamycin, what is appropriate action? Refer to doctor
• Find the DRPs
• Alendronate-->
• Statins --> stomach upset
• Metformin --> stomach upset
• Insulin --> hypoglycemia
• salbutamol --> tremor, shaking, palpiatation
• steroid inhalers --> fungal infection
• Anticholinergic drugs (ipratropium) --> dry mouth, constipation, urinary retention
• contraceptive pills --> n & v, weight gain, pigmentation, and acne
1. ARBs 2. Refer to doctor 3. Pharmaceutical care

4. FARM 5. SOAP 6. improving patient
quality of life
• is the services offered by the pharmacist to improve patient quality of life within
reasonable economic expenditure (Pharmaceutical care)
• Finding, Assessment, Resolution, Monitoring (FARM)
• Subjective data, Objective data, Assessment, Plan (SOAP)
• Pharmaceutical care should be focus to? (improving patient quality of life)
• A 50 year old patient currently using enalapril for hypertension. Experiencing dry
cough. What alternative therapy should you recommend? (ARBs)
associated with Clindamycin, what is appropriate action? (Refer to doctor)
www.pharmacyprep.com Adverse Drug Reactions
61
Adverse Drug Reactions
Tips
• Malignant hyperthermia is caused by  Halothane
• Pre-renal failure may cause due to  Decrease renal perfusion
• Syncope or first dose effect is caused by  α blockers
• MAO Inhibitors with pseudoephridine (sympathomimetics) gives  Hypertensive
crisis
• Neuroleptic malignant syndrome is caused by  Abrupt discontinuation of
antipsychotic
• Nitroglycerin gives  Severe headache
• Graybaby syndrome caused by  Chloramphenical
• Red man syndrome caused in  Rapid infusion of vancomycin
• Reye syndrome is caused by  ASA
• Pseudomembranous colitis is mainly caused  Clindamycin
• Agranulocytosis is caused by  Clozapine and methimazole, and PTU
• Hypokalemia + digoxin gives  Digitalis toxicity
• Levodopa + pyridoxine gives  Nausea and vomiting
• Levodopa + tolcapone  Inhibit levodopa conversion to catecholamine in brain
• Gingival hyperplasia caused by  Phenytoin, cyclosporin and CCBs
• Pulmonary fibrosis is caused by  Amiodarone, bromocriptine, and bleomycin
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 59-1
manual is being used during review sessions conducted by PharmacyPrep.
• Headache is the side effect of  Nitroglycerine, hydralazine, CCB (amlodipine), and

ACEI
• What drugs do venous pooling Nitroprussides, nitroglycerine and vasodilators
• What antiplatelet drug gives neutropenia SE? Ticlopidine
• Constipation is side effect of  Anticholinergic, opioids, antihistamine, Al OH, Ca,
iron, TCAs, antinauseating, and verapamil.
• Diarrhea is the side effect of  Clindamycin, Mg antacids, statins, metformin, and
orlistat.
• Glaucoma is the side effects of  Sympathomimetics (pseudoephridine)
• Spironolactone side effects  Gynecomastia
• Choose a beta-blockers with vasodilators actions  Carvedilol and labetelol
• Risk of torsade de pointes (QT interval prolongation)  Amiodarone, disopyramide,
procainamide, propafenone, quinidine, sotalol, Antihistamines (terfenadine)
• Bradycardia SE associated with  Beta-blockers (including eye drops), H 2 -receptor
antagonists, carbamazepine, clonidine, digoxin, diltiazem, and verapamil.
• AV node arrhythmias SE associated with  TCAs
• Agranulocytosis (profound reduction of granulocytes with neutrophils count less than
0.5 x 109/L is associated with  Antipsychotic (chlorpromazine, thioridazine,
clozapine), antithyroid drugs (methimazole, propylthiouracil), captopril,
procainamide, and ticlopidine.
• Neuroleptic malignant syndrome is caused by  Dopamine antagonists
(antipsychotics, most common are phenothiazines and butyrophenones).
• Serotonergic syndrome is caused by  combination of SSRI+MAOI, TCA+MAOI,
MAOI+MAOI.
• Headache is SE of  nitrates, CCBs (amlodipine)
• Reduction of convulsion threshold and increasing the risk of seizures is caused by 
Bupropion, 1st generation antihistamines, and antipsychotics,
• Extrapyramidal symptoms and Parkinson’s disease is SE of  1st generation
antipsychotics such as haloperidol (also following withdrawal). Antiemetics and
(metoclopramide, prochlorperazine).
• Tinnitus is associated with  NSAIDs, including ASA, antimalarials

• Cough is most common SE of  ACE inhibitors
• Chronic use of topical nasal decongestants (ephedrine, xylometazoline,
oxymetazoline) can cause  Nasal congestion
• Pulmonary fibrosis is associated with  Anticancer agents (Bleomycin) Amiodarone,
gold, sulfasalazine, nitrofurantoin, bromocriptine and pergolide.
• Pulmonary edema is SE of  hydrochlorothiazide, mannitol, and urea,
• Respiratory failure (neuromuscular) Opioids depress the rate and depth of
respiratory centre in the brain to increases blood CO 2
• Pulmonary and thromboembolism is SE of  Combined oral contraceptives
• Hyperprolactinemia or galactorrhea is caused by  Methadone, morphine,
antidepressants, antipsychotics, anti ulcer drugs (e.g. cimetidine, ranitidine),
benzodiazepines, estrogens, methyldopa, and verapamil.
• Myalgia (muscle pain), cramps or myopathy is associated with  Statins, fibrates,
nicotinic acid, and amiodarone,
• Increase serum creatine phosphokinase (CPK) (10 x normal level may indicate
myopathy) is an indicator of  muscle damage
• Metabolic bone disease: osteomalacia (rickets, abnormal bone softening) 
Corticosteroids, heparin, thyroid hormones
• Arthralgia: acute gout  Thiazide diuretics, Low-dose salicylates, and cyclosporin
• Arthropathy (erosion of articular cartilage)  Quinolone antibiotics
• Systemic lupus erythematosus (SLE)  Hydralazine, procainamide, beta-blockers,
carbamazepine, chlorpromazine, disopyramide, isoniazid, methyldopa, nitrofurantoin,
penicillamine, phenytoin, quinidine, sulfasalazine, sulphonamides, tetracycline’s
(minocycline, particularly young patients) thiazides, and thiouracil
• Systemic lupus erythematosus (SLE) symptoms  arthralgias, myalgias, malaise,
fever, pleurisy and pericarditis
• Taste disturbance  ACE inhibitors, CCB, Etidronate, Griseofulvin, isotretinoin,
Levodopa, Losartan, Penicillamine, and terbinafine
• Metallic taste  Captopril, allopurinol, gold, lithium, metformin, metronidazole,

penicillamine, and zopiclone
• Gingival overgrowth  Phenytoin, Dihydropyridine CCBs, and cyclosporin
• Dental coloration  Tetracycline’s
• Dry mouth (xerostomia)  Anticholinergic effects (e.g. antihistamine, TCAs,
anticholinergics, CNS stimulants, and Phenothiazines
• Saliva secretion (Ptyalism)  Cholinergic agonist (e.g. pilocarpine, clozapine).
• Clindamycin-induce diarrhea may be the result of  Pseudomembranous colitis.

• Many drugs cause constipation but most common are  anticholinergics, opioids
(codeine, morphine etc), iron slats, verapamil, TCAs, and antihistamines,
• Dark stools causative agent  Iron slats, bismuth salts, aminosalicylates, and ACE
• Chronic renal failure is associated with  chronic use of NSAIDs especially
salicylates
• Nephrogenic diabetes insipidus  Lithium
• Discoloration of urine  Rifampicin, dopaminergic antiparkinson drugs
1. rapid infusion of Vancomycin 2. Clindamycin 3. ASA

4. Clozapine 5. Methimazole 6. PTU
7. CK-MM 8. Halothane 9. abrupt discontinuation of
antipsychotic
10. hypertensive crisis 11. decrease renal 12. alpha blockers
perfusion
13. Carvedilol 14. Labetalol 15. Ticlopidine
16. Sympathomimetics/Pseudoeph 17. Clindamycin 18. Mg antacids
ridine
19. statins 20. Metformin 21. Orlistat
22. anticholinergics 23. opioids 24. antihistamine
25. AlOH 26. Verapamil 27. Ca
28. Iron 29. TCA 30. Nitroprussides
31. Nitrogylerine 32. vasodilators 33. Hydralazine

34. CCB 35. Amiodarone 36. Bromocriptine
37. Bleomycin 38. Phenytoin 39. inhibit levodopa
conversion to
catecholamine in brain
40. nausea & vomiting 41. digitalis toxicity 42.
• Malignant hyperthermia is caused by? (Halothane)

• Pre-renal failure may cause due to? (decrease renal perfusion)
• Syncope is caused by? (alpha blockers)
• MAO inhibitors with pseudoephridine (sympathomimetics) gives? (hypertensive
crisis)
• Neuroleptic malignant syndrome is caused? (abrupt discontinuation of antipsychotic)
• Nitroglycerine gives? (severe headache)
• What creatinin kinase indicates myopathy? (CK-MM)
• Gray baby syndrome caused by? (Chloramphenicol)
• Red man syndrome caused by? (rapid infusion of Vancomycin)
• Reye syndrome is caused by? (ASA)
• Pseudomembranous colitis is mainly caused? (Clindamycin)
• Agranulocytosis is caused by? (Clozapine, Methimazole & PTU)
• Hypokalemia + digoxin gives? (digitalis toxicity)
• Levodopa + Pyridoxin gives? (nausea & vomiting)
• Levodopa + Tolcapone (inhibit levodopa conversion to catecholamine in brain)
• Gingival hyperplasia caused by? (Phenytoin & CCBs)
• Pulmonary fibrosis is caused by? (Amiodarone, Bromocriptine & Bleomycin)
• Headache is side effect of? (Nitroglycerine, Hydralazine, CCB Amlodipine) and ACE
I)
• What drugs do venous pooling? (Nitroprussides, Nitroglycerine & Vasodilators)
• What antiplatelet drug gives neutropenia side effect? (Ticlopidine)
• (constipation is a side effect of? anticholinergic, opioids, antihistamine, AlOH, Ca,
iron, TCAs & Verapamil)
• Diarrhea is side effect of? (Clindamycin, Mg antacids, statins, Metformin & Orlistat)
• Glaucoma is a side effect of? (Sympathomimetics/Pseudoephridine)
• Spironolactone side effect? (gynecomastia)
• Choose a beta blocker w/ vasodilator action (Carvedilol & Labetalol)
www.pharmacyprep.com Drug Interactions
62
Drug Interactions
• MAOI (Phenelzine, tranylcypromine + Tyramine gives  Hypertension crisis
• Serotonergic syndrome is caused by  MAOI+TCA, MAOI+SSRIs, MAOI+MAOI
• Which vitamin is essential for iron absorption? Vitamin C
• Which vitamin is essential for calcium absorption? Vitamin D 3
• Iron supplements are preferably taken? Empty stomach
• A 60 year old women taking calcium supplement bid. Recently doctor prescribed
alendronate 70 mg/wk. What is appropriate recommendation?
• A 60-year-old women-taking calcium supplement 500 mg tid. Recently doctor prescribed
ciprofloxacin 500 mg bid for 3 days. What is appropriate recommendation?
• A patient using sildenafil should avoid  Nitrates (nitroglycerin) and alpha blockers
• Sildenafil + nitroglycerin can cause  Severe hypotension
• What statins should be avoid taking with grapefruit juice  Atorvastatin, lovastatin and
simvastatin (ALS)
• What antidepressants can be used with MAO I  Bupropione and venlafaxine
• What statins should be taken with food  Fluvastatin and lovastatin
• Warfarin + carbamazepine  Carbamazepine increase clearance of warfarin
• Metronidazole + alcohol gives  Disulfiram like reaction
• Chlorpropamide + alcohol gives  Disulfiram like reaction
List of drug that should be taken empty stomach;

• Tetracyclin
• Ampicillin
• Zafirleukast
• Alendronate, etidronate, and residronate
• Cloxacillin
www.pharmacyprep.com Drug Interactions
• Penicillin V
• PPIs
1. Bupropion 2. Venlafaxine 3. Fluvastatin
4. Lovastatin 5. Simvastatin 6. Atorvastatin
7. Carmazepine increase 8. gives disulfiram 9. severe orthostatic
clearance of Warfarin reaction hypotension
10. hypertension crisis 11. MAOI + TCA 12. MAOI + SSRI
13. MAOI + MAOI 14. 15.
• Sildenafil cannot be combined with Prazosin because it cause? (severe orthostatic

hypotension)
• MAOI Phenelzine, tranycypromine & Tyramine gives? (hypertension crisis)
• serotonergic syndrome is caused by? (MAOI + TCA, MAOI + SSRI, MAOI + MAOI)
• A patient using Sildenafil should avoid? (Nitrates(Nitroglycerine)
• Sildenafil + Nitroglycerin can cause? (severe hypotension)
• What statins should be avoided taking w/ grapefruit juice? (Atorvastatin, Lovastatin, &
Simvastatin ALS)
• What antidepressant can be used with MAOI? (Bupropion & Venlafaxine)
• What statins should be taken with food? (Fluvastatin, Lovastatin)
• Warfarin + Carbamazepine (Carmazepine increase clearance of Warfarin)
• Metronidazole + alcohol (gives disulfiram reaction)
List of drug that should be taken empty stomach

Tetracyclin
Ampicillin
Zafirleukast
Alendronate, Etidronate, and residronate
Cloxacillin
Penicillin V
PPIs
www.Pharmacyprep.com Therapeutic Drug Monitoring
63
Therapeutic Drug Monitoring
Tips
• Lithium serum levels  0.8 to 1.5 mEq/L
• Lithium overdose symptoms 
• Warfarin monitoring PT and INR
• Statin monitoring  LFT and CK
• Clozapine mechanism and monitoring WBC or CBC
• Serum levels of phenytoin  10 to 20 mcg/ml
• Factors that effects on theophylline clearance  increase CL = smoking, age 1 to 9,
• HbA1C test monitoring  shows BSL for past 3 months
• Symptoms of renal disease  oliguria, CrCl < 50 ml/min, increase BUN
• Monitoring hypothyroidism  serum TSH
• What laboratory tests indicates myopathy CK-MM
• What supplements recommended with phenytoin therapy folic acid
• Amino glycosides have  post dose antibiotics effect, require low dose for UTI, and have
NO oral dosage forms.
• Metformin is contraindicated in CHF, liver and renal diseases, lactic acidosis
• What is true about erythropoeitins Treatment of anemia in chronic renal failure
• Propylthiauracil and methimazole should monitored for  WBC
• Vancomycin is monitored for  Blood work, renal function
Digoxin toxicity is caused by
Quinidine
Amiodarone
Verapamil
Tetracyclin
Erythromycin
Thiazides and Loop diuretics
Erythropoietins
• Produced from kidney
• Helps in formation of RBCs
• Used in treatment of anemia caused by chemotherapy and chronic renal
disease
Fibrates (Gemfibrosil, fenofibrate, clofibrates and benzafibrate)

• Indicated for lowering TG
• DOC for diabetes + high cholesterol treatment
• Fibrates + statins may cause myopathies
Heparin
• Binds with 2a, 9a, 10a, 11a, 12 and 13
• Monitored by aPTT
LMWH (EDTA)
• Inactivates primarily 10a (no 2a)
• No monitoring is required, predictable response
Statins
• HMG CoA reductase inhibitors
• CK-mm elevation indicated myopaties
• Monitor: LFT, and CK
• Avoid grapefruit juice with ALS
Insulin
• Monitor: HbA1C, and FBSL
• iv insulin is regular and lispro
• Fastest insulin lispro
• Longest insulin glargine
• Cloudy insulin NPH
• Do NOT mix glargine with others
• DOC for diabetes in preg & gestational DM
Lithium
• Overdose symptoms if >1.5 mEq/L
• DOC for manic depression (bipolar)
Methotrexate
• Dose for RA 25mg/wk
• Oral ulcers are treated for folic acid
• Used for RA, psoriasis, & cancer
Phenytoin
• Long-term use of phenytoin may require folic acid supplement (inc. meta. of FA)
• Gingival hyperplasia
Thyroid hormones (Synthroid, eltroxin)
• Monitor: Serum TSH (0.2 to 5.4 microU/mL)
• If 0.2, symptoms may be: Diarrhea, weight loss, tachycardia, sensitive to heat.
Warfarin
• Monitor: PT and INR (normal 2 to 3)
• If INR is > 5  stop warfarin, monitor INR and may require oral vitamin K.
Heparin
• Monitor: aPTT
LMWH;
• Monitor: may not need, due to predictable response.

• A patient using digoxin 200 mcg daily for the treatment of congestive heart failure. Doctor
prescribed furosemide 40 mg daily for edema. What laboratory test should be monitored?
Potassium levels
• A patient is using insulin for type II DM, what is normal fasting blood sugar levels 
A patient is using clozapine for resistance schizophrenia, what lab test should be monitored?
A patient is using risperidone for resistance schizophrenia, all lab test should be monitored,
except?
1. LFT & CK 2. shows BSL for past 3 3. serum TSH

months
4. CHF 5. liver and renal 6. lactic acidosis
diseases
7. blood work 8. renal function 9. WBC
10. CBC 11. 0.8 to 1.5 meq/L 12. PT & INR
13. 10 to 20 mcg/ml 14. increase CL=smoking 15. oliguria, CrCl<50
age 1 to 9 ml/min, increase BUN
16. post dose antibiotic 17. require low dose for 18. have no oral dosage
effect UTI form

19. treatment of anemia in 20. folic acid 21. CK-MM
chronic renal failure
• Lithium serum levels (0.8 to 1.5 meq/L)

• Warfarin monitoring (PT & INR)
• statin monitoring (LFT & CK)
• serum levels of phenytoin (10 to 20 mcg/ml)
• factors that affect theophylline clearance (increase CL=smoking age 1 to 9)
• HbA1C test monitoring (shows BSL for past 3 months)
• symptoms of renal disease (oliguria, CrCl<50 ml/min, increase BUN)
• monitoring hypothyroidism (serum TSH)
• what laboratory tests indicates myopathies? (CK-MM)
• What supplements recommended with phenytoin therapy? (folic acid)
• Aminoglycosides have? (post dose antibiotic effect, require low dose for UTI, have no oral
dosage form)
• Metformin is contraindicated in? (CHF, liver and renal diseases, lactic acidosis)
• What is true about erythropeitins? treatment of anemia in chronic renal failure)
• Clozapine mechanism & monitoring (WBC or CBC)
• PTU and Methimazole should be monitored for? (WBC)
• Vancomycin is monitored for? (blood work, renal function)
www.Pharmacyprep.com Safety of Medications in Special Populations
64
Safety of Medications in Special
Populations
Seniors
• In seniors what physiological changes increase  adipose tissues
• In senior what physiological changes decrease  creatinin clearance, renal function,
muscle mass, and total body water
• What vitamins decrease in elderly  Vitamin B 12
• Pharmacokinetics factors that increase with age? Body fat/lean muscle mass ratio
• Calcium supplements that are preferably given to seniors? Calcium citrate
• What vitamin supplements are recommended to seniors? Vitamin B 12
• What therapy recommended for constipation in seniors? Fiber diet, stool softeners and
lactulose
• How do pharmacokinetic characteristics in the very young differ from that of an adult?
There is decreased plasma protein, decreased renal clearance, changes in receptor
populations, changes in end organ responsiveness, decreased drug metabolism and
decreased body fat.
• What pharmacokinetic characteristics change in the elderly? There is a decreased rate
absorption as well as changes in drug distribution.
Pregnancy
• The most critical period in pregnancy associated with drug toxicities? 1st trimester
• Drugs that should be discontinued in pregnancy? Category X
• Supplements that should be recommended in pregnancy? Folic acid and multivitamins
• Folic acid supplements in pregnancy prevents  Neurotubular defects

• Nausea and vomiting in pregnancy also referred as Morning sickness
• Drug of choice therapy for N&V in pregnancy is Diclectin (doxylamine + vit B)
• OTC drug therapy in pregnancy N&V include  Dimenhydrinate
• Self care for N&V in pregnancy --> Eat in small and frequent meals, avoid fatty, oily,
spices. Avoid heavy meals
• Herbal products that is recommended for nausea and vomiting in pregnancy  ginger root
• Cranberry juice is used for  Urinary tract infection
• What is the placental barrier? The fetus and the mother are separated by a number of
tissue layers that collectively constitute the placental barrier.
• What is the significance of the placental barrier?  Drugs must be able to diffuse across
lipid barriers to enter the fetus.
1. Eat in small & 2. Urinary tract 3. Diclectin

frequent meals, infection
avoid fat, oily and
spicy food, avoid
heavy meals
4. decreased renal 5. Dimenhydrinate 6. body fat/lean muscle
clearance, mass ratio
7. fiber diet 8. stool softeners 9. lactulose
10. Calcium citrate 11. Vit B 12 12. Drugs must be able
to diffuse across
lipid barriers to
enter the fetus
13. ginger root 14. There is decreased 15. Neurotubular defect
rate of absorption as
well as change in
drug distribution
16. Category X 17. folic acid & 18. morning sickness
multivitamins
• Pharmacokinetics factors that increase with age? (body fat/lean muscle mass ratio)
• Calcium supplements that are preferably given to seniors? (Calcium citrate)
• What vitamin supplements are recommended to seniors? (Vit B12)
• What therapy recommended for constipation in seniors? (fiber diet, stool softeners and
lactulose)
• Drugs that should be discontinued in pregnancy? (Category X)

• Supplements that should be recommended in pregnancy? (folic acid & multivitamins)
• Folic acid supplements in pregnancy prevents? (Neurotubular defect)
• Nausea and vomiting in pregnancy also referred as? (morning sickness)
• DOC therapy for nausea and vomiting in pregnancy is? (Diclectin)
• OTC drug therapy in pregnancy include? (Dimenhydrinate)
• Self care that is recommended for nausea and vomiting in pregnancy? (Eat in small &
frequent meals, avoid fat, oily and spicy food, avoid heavy meals)
• Cranberry juice is used for? (Urinary tract infection)
• How do pharmacokinetic characteristics in the very young differ from that of an adult?
(There is decreased plasma protein, decreased renal clearance, changes in receptor
populations, changes in end organ responsiveness, decreased drug metabolism and
decreased body fat)
• What pharmacokinetic characteristics change in elderly? (There is decreased rate of
absorption as well as change in drug distribution)
• What is the significance of the placental barrier? ( Drugs must be able to diffuse across
lipid barriers to enter the fetus and the mother are separated by a number of tissue layers
that collectively constitute the placental barrier)
• Herbal products that is recommended for nausea & vomiting in pregnancy? (ginger root)
www.Pharmacyprep.com Identification and Prevention of Drug Toxicity
65
Prevention and intervention
in Medication Overdose
• Iron overdose should NOT be treated by  charcoal
• Benzodiazepine Antidote  flumazenil
• ASA overdose is treated by NaHCO 3 diuresis
• What is ASA antidote? None
• What is acetaminophen antidote? N-acetylcystein
• N-acetylcystein should be administered within  8 hours of overdose of acetaminophen
• Benzodiazepine overdose treatment  Removal of benzodiazepines with lavage, treatment
with charcoal and treatment with flumazenil
• Opioid antidote is  Nalaxone
• Pinpoint pupil (miosis) is overdose symptoms of  opioids
• Mydriasis is overdose symptom of  TCAs and anticholinergic
• What drugs overdose can cause proarrhythmias  TCAs
• What is true about charcoal  Increase surface area increase adsorption, decrease
impurities on surface of charcoal increase adsorption. However, increase temperature on
surface of charcoal increase adsorption.
• Deferoxamine is an antidote for iron overdose, which act by  chelation
• Tricyclic antidepressant overdose symptom s Mydriasis and anti cholinergic symptoms,
and severe arrhythmias.
• Opioids overdose symptoms  Lethargy, sedation, coma, bradycardia, hypotension,
hypoventilation, pinpoint pupils (miosis), cool skin, decreased bowel sounds, and flaccid
muscles
www.Pharmacyprep.com Identification and Prevention of Drug Toxicity
• Acetyl salicylates Overdose Overdose: more than 4 g/day can cause toxicity  Symptoms
of overdose = Mild à rapid, deep breathing, nausea, vomiting, vertigo, tinnitus, flushing,
sweating, thirst, and tachycardia.
1. opioids 2. TCA’s 3. Deferoxamine

4. lethargy 5. sedation 6. coma
7. bradycardia 8. hypotension 9. hypoventilation
10. pinpoint pupils 11. cool skin 12. decreased bowel
(miosis) sounds
13. flaccid muscles 14. mydriasis 15. anticholinergic
symptoms
16. severe arrhythmias 17. charcoal 18. NaHCO 3 diuresis
19. Naloxone 20. Removal of 21. increase surface area,
benzodiazepines with increase adsorption,
lavage, treatment with decrease impurities on
charcoal & treatment surface of charcoal
with Flumazenil increase adsorption.
However, increase
temp on surface of
charcoal increase
adsorption
22. Flumazenil 23. 8 hrs of overdose of 24.
acetaminophen
• Iron overdose should not be treated by? (charcoal)

• What is ASA antidote? (NaHCO 3 diuresis)
• What is the acetaminophen antidote? (N-acetylcysteine)
• N-acetylcysteine should be administered within? (8 hrs of overdose of acetaminophen)
• Benzodiazepine antidote is? (Flumazenil)
• Benzodiazepine overdose treatment? (Removal of benzodiazepines with lavage, treatment
with charcoal & treatment with Flumazenil)
• Opioid antidote (Naloxone)
• Pinpoint pupil is overdose symptoms of? (opioids)
• What drugs overdose can cause proarrhythmias? (TCA’s)
• What is true about charcoal? (increase surface area, increase adsorption, decrease impurities
on surface of charcoal increase adsorption. However, increase temp on surface of charcoal
increase adsorption)
• Iron overdose is treated by? (Deferoxamine)
• TCA overdose symptoms (mydriasis & anticholinergic symptoms and severe arrhythmias)
• , cool skin, decreased bowel sounds & flaccid muscles)n Opioid overdose symptoms
(lethargy, sedation, coma, bradycardia, hypotension, hypoventilation, pinpoint pupils
(miosis)
www.Pharmacyprep.com Professional Communication Skills
66
Professional Communication
Skills
• The best communication skills are  Verbal and Written
• Examples of communication barrier include all? Distraction and language
• Examples of communication distractions include all? Tel. phone rings, loud noise, and
music
Reasoning and Problem solving

• A customer to your pharmacist does not speak English and you do not understand her
language? How do you serve?
• A women patient have some sensitive questions about personal hygiene, however, she is
shy to talk to a male pharmacist, what is appropriate action?
• A union negotiating the wages, working hours, and conditions on behalf of pharmacist with
company?
• If there is recall of product, pharmacist do all except?
1. Low self-confidence 2. distractions 3. language

4. promotion sales 5. telephone 6. noise
7. verbal 8. written 9. cultural differences
10. discomfort to sensitive 11. conflicting values to 12. shyness
situations therapy
• the best communication skills are? (verbal & written)

• examples of communication barriers includes? (distractions & language)
• examples of communication distractions includes? (promotion sales, telephone, noise)
• examples of personal barriers includes? (low self-confidence, cultural differences,
discomfort to sensitive situations, conflicting values to therapy, shyness)
www.Pharmacyprep.com Pharmacy Practice and Management
67
Safe and effective use of
medications/Strategies to
prevent Dispensing Errors
Examples of medication error that could occur if auxiliary labels are not used or used
inappropriately:
• Codeine containing medication auxiliary label: dizziness may occur be careful when
operating machinery, A car accident may occur if the patient is not aware that this
medication may cause dizziness.
• Fosamax auxiliary labels: drink with plenty of water, remain upright for about ½ hour
after taking the dose, take on an empty stomach, If the patient is to take the medication and
lie down right after taking it then the patient may experience oesophageal adverse
experiences
• Ventolin auxiliary labels: shake well; don’t take too much of the medication
• If the patient is to take too much of the medication then the patient may experience adverse
drug reactions such as palpitations, tachycardia, tremors, nervousness, hypokalemia.
• Flovent auxiliary labels: shake well, rinse mouth after using this inhaler. If you don’t
wash your month a pharyngeal candidacies fungal infection in the mouth may occur in the
mouth.
• Atorvastatin auxiliary label: avoid grapefruit juice. Grapefruit juice may have the
potential to increase plasma levels of HMG CoA reductase inhibitors metabolized by this
isoenzyme causing increased potential for adverse effects such as muscle weakness and
pain.
Medications that should be taken with plenty of water:

• Sulphonamides: Recommended for sulphonamides to decrease likelihood of crystalluria.
• Expectorants: Expectorants to enhance viscosity reduction of bronchial secretions
• Bulk laxatives: Bulk laxatives to increase stool bulk and decrease the likelihood of
compaction
• Irritating drugs: Such as potassium supplements, Chloral hydrate, theophylline
and some antibiotics.
• Antihyperuricemic drugs: Allopurinol, Probenecid, and sulfinpyrazone
www.Pharmacyprep.com Pharmacy Practice and Management
Take with food or milk: Recommended for the drugs that cause stomach upset when this
effect may be decreased by taking medication with food.
Medication examples include:

• NSAIDs,
• ASA
• Erythromycin
• Nitrofurantoin
• Valproic acid
www.Pharmacyprep.com Pharmacy practice, Therapeutics and OTC
68
Pharmaceutical Preparation
Storage Conditions
Tips
• Amoxicillin  Suspensions, store in refrigerator. Discard after 14 days.
• Combination Amoxicillin + clavulunate  use within 200 and 400 mg 7 days. 125 to 250
mg use within 10 days
• Clavulin suspension  Store in refrigerator for 7 days
• Ampicillin  Refrigerate, if unused for 14 days discard it.
• Streptomycin  Reconstituted solution does not shake. Use immediately. Discard after 8
hours
• Erythromycin refrigerate
• Store cipro otic suspension at room temp (15 to 25oC).
• Clarithromycin  Shake well before use and do not store in refrigerator. Discard unused
portion after 14 days.
• Clotrimoxazole  Store until expiry date
• Metronidazole  Refrigerate for 60 days
• Insulin’s  Store in refrigerator, do not freeze and Can be stored at room temperature for a
month
• Vaccine  All vaccine should be stored in refrigerator
• Xalatan (Latanoprost)  Store unopened bottles in refrigerator. Opened bottles may be
stored at room temperature up to 25 oC for up to 6 weeks
• Xalacom (Latanoprost + Timolol)  Opened bottles may be stored at room temperature up
to 25 oC for up to 10 weeks
• Extemporaneous Azithromycin suspension = Stored at room temperature
• Extemporaneous clarithromycin suspension = Stored at room temperature
• Clindamycin suspension = Stored at room temperature
• Cotrimoxazole suspension = stored at room temperature
1. Streptomycin 2. Xalatan 3. Amoxicillin
4. Insulin 5. Ampicillin 6. Clarithromycin
7. Combination 8. Azithromycin 9. Clindamycin
www.Pharmacyprep.com Pharmacy practice, Therapeutics and OTC
Amoxicillin +
clavulanate
10. Cotrimoxazole 11. 15 to 25 oC 12. 8 to 15 oC
13. 2 to 8 oC also known 14. 0 to 4oC 15.
as cold)
• What temperature is fridge? (2 to 8 oC also known as cold)

• What is room temperature in Canada? (15 to 25 oC)
• What is cool temperature? (8 to 15 oC)
• What is freezer temperature? (0 to 4oC)
• suspensions, store in refrigerator. Discard after 14 days. (Amoxicillin)
• Reconstituted solution does not shake. Use immediately. Discard after 8 hours.
(Streptomycin)
• store in refrigerator, do not freeze and can be stored at room temperature for a
month(Insulin)
• store unopened bottles in refrigerator. Opened bottles may be stored at room temperature up
to 25 oC for up to 6 weeks(Xalatan (Latanoprost)
• use within 200 and 400 mg 7 days. 125 to 250mg use within 10 days(Combination
Amoxicillin + clavulanate)
• Refrigerate, if unused for 14 days discard it. (Ampicillin)
• Shake well before use and do not store in refrigerator. Discard unused portion after 14 days.
(Clarithromycin)
• stored at room temperature(Azithromycin, Clarithromycin, Clindamycin, Cotrimoxazole)
• Extemporaneous azithromycin suspension  Stored at RT
• Extemporaneous clarithromycin suspension  Stored at RT
• Clindamycin suspension  Stored at RT
• Cotrimoxazole suspension  Stored at RT
• Insulin stored at  Refrigerator
PharmacyPrep.com OTC and Prescription drugs for Dermatological Conditions
69
OTC and Prescription Drugs
for Dermatological
Conditions
Head lice
• What is correct self care measure for head lice treatment? Avoid sharing combs,
brushes, hats and pillows.
• How does head lice transmits  Head lice do NOT fly, it transmit by head to head
contact or common shared items.
• What is INCORRECT about head lice  Hygiene is a criterion, long hair often gets
head lice, and shaving head, and head lice can fly
• The drug of choice for head lice? Permethrin 1%
• How often head lice treatment should be applied? Second application after 7 to 10
days of 1st application
Scabies
• In scabies treatment permethrin 5% is applied  All body (from neck down to toes)
• Scabies is caused by  Human mites
Acne
• What bacteria can cause acne? Propioni bacterium acne
• What gland secretions can cause acne? Sebaceous gland
• What is pharmacological therapy for acne in pregnancy? Erythromycin or

clindamycin
• What oral contraceptives can be used for acne treatment? Dian and Alesse
• What is the self-care measure should be recommended for dermatitis? Cool

humidifiers, moisturizer cream, and reducing frequent hot water showers.
Diaper rash
• Diaper rash self care 
• What is the treatment for uncomplicated diaper rash? Petroleum jelly, and ZnO
• What is pharmacotherapy for complicated diaper rash? Anti fungal + ZnO
• What self care measures is NOT recommended for diaper rash? Cleaning with alcohol
wipes
Psoriasis
• Psoriasis is  Red scaly silvery patch
• What is pharmacotherapy for psoriasis? Coal tar, UV light, salicylic acid, anthralin
and corticosteroids and methotrexate
Dandruff
• What is the treatment of dandruff and seborrhea Antiseptics (benzalkonium
chloride, chlorhexidine, povidone iodine), coal tar, ketoconazole, salicylic acid (2 to
3%), selenium sulfide, sulfur (3 to 5%), and zinc pyrithione
• What is NOT recommended for dandruff treatment  Hydrocortisone and antibiotics
• What topical dermatological agents give stains? Coal tar, anthralin,
• What topical dermatological agents gives odor? Coal tar, and sulfur
• What dandruff shampoo over use can give stain? Selenium sulfide
• What is the treatment of dandruff? Ketoconazole, selenium sulfide, zinc pyrithione,

and coal tar.
Athlete’s foot
• Athlete’s foot is caused by? Tinea pedis
• Athlete’s foot self care measure? Keep dry feet, change socks and shoes daily.
• Treatment for athletes foot include?  Clotrimazole, miconazole, oxiconazole and
tioconazole, naftifine and butenafine, tolnaftate and undecylenic acid
Burns
• 1st degree burn --> Superficial, sunburn

• 2nd degree burn --> Gives blisters, hot water, flame, and oil
• 3rd degree burn --> Full thickness, painless leathery, flame, and hot metal
Sunburn
• UVA --> Phototoxicity, photoaging, immunosuppression and skin cancer
• UVB --> Sunburn, immunosuppression, and skin cancer
• SPF--> Sun protection factor (SPF 15, 30 or 50)
General information
peak time 10:00 am to 4:00 pm
Cloud, snow, beach and high altitude have high sunburn
1. sebaceous gland 2. Diane & Alesse 3. Erythromycin or

Clindamycin
4. cool humidifiers, 5. petroleum jelly, 6. cleaning w/ alcohol
moisturizer cream ZnO wipes
7. it transmits by head 8. Permethrin 1%) 9. avoid sharing
to head contact on combs,brushes,hats
common shared & pillows
items
10. gives blisters, hot 11. full thickness, 12. superficial, sunburn
H2O, flame oil painless leathery,
flame & hot metal
13. UVB 14. SPF 15. UVA
16. coal tar 17. sulfur 18. anthralin
19. UV light 20. salicylic acid 21. corticosteroids
22. Methotrexate 23. antifungal + ZnO 24. petroleum jelly, ZnO
25. Propioni bacterium 26. second application
acne after 7 to 10 days of
1st application
• How do head lice transmit? (it transmits by head to head contact on common shared
items)
• What is correct self care measure for head lice? (avoid sharing combs,brushes,hats &
pillows)
• DOC for head lice? (Permethrin 1%)
• How often head lice treatment should be applied? (second application after 7 to 10
days of 1st application)
• What bacteria cause acne? (Propioni bacterium acne)
• What gland secretions can cause acne? (sebaceous gland)

• What is pharmacological therapy for acne in pregnancy? (Erythromycin or
Clindamycin)
• What oral contraceptives can be used for acne treatment? (Diane & Alesse)
• What is self care measure should be recommended for dermatitis? (cool humidifiers,
moisturizer cream)
• What is the treatment for uncomplicated diaper rash? (petroleum jelly, ZnO)
• What is pharmacotherapy for complicated diaper rash? (antifungal + ZnO)
• What self care measure is not recommended for diaper rash? (cleaning w/ alcohol
wipes)
• What is pharmacotherapy for psoriasis? (Coal tar, UV light, salicylic acid, anthralin
& corticosteroids & Methotrexate)
• What topical dermatological agent that gives stains? (coal tar, anthralin)
• What topical dermatological agent gives odor? (coal tar, sulfur)
• 1st degree burn(superficial, sunburn)
• 2nd degree burn(gives blisters, hot H2O, flame oil)
• 3rd degree burn (full thickness, painless leathery, flame & hot metal)
• phototoxicity, photoaging, immunosuppression & skin cancer(UVA)
• sunburn, immunosuppression & skin cancer(UVB)
• sun protection factor 15, 30 or 50 (SPF)
www.Pharmacyprep.com OTC / Therapeutics
70
Ophthalmic, Otic and Mouth
Conditions
• What ophthalmic conditions require referral to doctor? Pain in eye, blurred vision,
blepharitis, and dry eye + diabetes.
• What is added in ophthalmic preparation to increase eye contact  Polyvinyl alcohol,
hydroxyl propyl methyl cellulose (HPMC).
• The most allergic ophthalmic preservative  Thimerasol
• Abreva is used for  Cold sore
• Benzalkonium chloride concentration as preservative in ophthalmic drops  0.01%
• Ophthalmic preparation should be  Sterile, and isotonic
• What eye drops that are used in eye exams  Tropicamide
• Cold sores are caused by  HSV 1
• Acyclovir is effective against  HSV 1 and HSV 2 , CMV, Epstein bar virus and VZV
• What is the treatment of cold sores  Emollients, anesthetics, astringents and
acyclovir
• What is active drug of valacyclovir  Acyclovir
• What is NOT a treatment of cold sores  Antibiotics and corticosteroids
• Ear wax glands are also known as  Cerumenous gland
• Mineral oil in ear is used as  Wax removal
• 1 gtt OS means Instill 1 drop in left eye
• Instill 1 drop in both eyes is directed as  1 gtt OU
• Instill 1 drop in both ear is directed as  1gtt AU
• Earwax removal is  Carbamide peroxide

• Swimmers ear is  Otitis externa
• Blepharitis is  Inflammation of the eyelid margin
• Hordeolum (stye) is  acute inflammation in the eyelash follicle or eyelid gland
(Crusting and scaling around eyelashes may be present)
• Conjunctivitis is  diffuse redness in eyes
• Sjogren’s syndrome (Sicca syndrome) is  an autoimmune disease characterized by
destruction of the lacrimal and salivary glands resulting in the inability to produce
saliva and tears.
• Endocarditis prophylaxis  amoxicillin or azithromycin or clindamycin
1. 1 gtt OU 2. 1 gtt AU 3. Carbamide
peroxide
4. otitis externa 5. cold sores 6. wax removal
7. antibiotics & 8. inflammation of the eyelid margin 9. HSV1
corticosteroids
10. HSV2 11. CMV 12. Epstein barr
virus
13. VZV 14. pain in eye 15. blurred vision
16. blepharitis 17. dry eye 18. diabetes
19. polyvinyl 20. hydroxypropylmethylcellulose 21. Thimerosal
alcohol HPMC
22. 0.01% 23. sterile & isotonic 24. Tropicamide
25. emollients, 26. Acyclovir 27. cerumenous
anesthetics, gland
astringents
and Acyclovir
• What ophthalmic conditions require referral to doctor? (pain in eye, blurred vision,
blepharitis, dry eye & diabetes)
• What is added in ophthalmic preparation to increase eye contact? (polyvinyl alcohol,
hydroxypropylmethylcellulose HPMC)
• the most allergic ophthalmic preservative? (Thimerosal)
• Benzalkonium chloride concentration as preservative in ophthalmic drops? (0.01%)
• Ophthalmic preparation should be? (sterile & isotonic)
• What eye drops that are used in eye exams? (Tropicamide)
• Cold sores are caused by? (HSV1)
• What is treatment of cold sores? (emollients, anesthetics, astringents and Acyclovir)
• What is not a treatment cold sores? (antibiotics & corticosteroids)
• Both eyes is directed as? (1 gtt OU)
• Both ear is directed as? (1 gtt AU)
• Earwax removal is? (Carbamide peroxide)

• Swimmer’s ear is? (otitis externa)
• Abreva is used for? (cold sores)
• What is active drug of Valacyclovir? (Acyclovir)
• Ear wax glands are also known as? (cerumenous gland)
• mineral oil in ear is used as? (wax removal)
• Acyclovir is effective against? (HSV1, HSV2, CMV, Epstein barr virus VZV)
• Blepharitis is? (inflammation of the eyelid margin)
• an autoimmune disease characterized by destruction of the lacrimal and salivary
glands resulting in the inability to produce saliva and tears. (Sjogren’s syndrome
(Sicca syndrome)
www.Pharmacyprep.com OTC Drugs
71
OTC Drugs, Antihistamine,
Decongestants, Antitussive,
and Expectorant
• Common cold is caused by  Self limiting viral infection of rhinovirus (30 to 50%)
and corona virus (10 to 20%)
• Common cold infection is transmitted by  Hand to hand (virus contact nasal
mucosa) and via aerosol particle.
• Common cold symptoms  Runny nose, sore throat, watery eyes, sneezing, low-
grade fever and malaise. Duration; 1 to 2 weeks
• Echinacea purpurea probably can be effective in the prevention and treatment of
common colds in adults.
• Expectorants: Guaifenesin (SE: drowsiness nausea, vomiting), ammonium chloride
and Ipecac
• Topical antihistamine levocabastine (levostin) available as  Ophthalmic drops and
nasal spray
• Contraindications or precaution of antihistamines Driving or operating machines
• Contraindications of decongestants Glaucoma, uncontrolled BP, diabetes and BPH
• MAOI + sympathomimetics (pseudoephridine) gives  hypertension crisis
Copyright protected by Tips Inc Protect copyright and prevent piracy 69-1
www.Pharmacyprep.com OTC Drugs
1. glaucoma 2. hypertension crisis 3. runny nose

4. uncontrolled BP 5. diabetes 6. sore throat
7. BPH 8. watery eyes 9. sneezing
10. low grade fever 11. self-limiting viral 12. malaise
infections of
rhinovirus (30-50%)
& corona virus (10-
20%
• common cold is caused by? (self-limiting viral infections of rhinovirus (30-50%) &
corona virus (10-20%)
• common cold symptoms(runny nose, sore throat, watery eyes, sneezing, low grade
fever & malaise)
• contraindications of decongestants(glaucoma, uncontrolled BP, diabetes & BPH)
• MAOI + sympathomimetics (Pseudoephridine) (hypertension crisis)
• Echinacea purpurea probably can be effective in the prevention and treatment of

common colds in adults.
• Expectorants: Guaifenesin (SE: drowsiness nausea, vomiting), ammonium chloride
and Ipecac
• Topical antihistamine = Levocobastine (levostin) available as ophthalmic drops and
nasal spray
• High risk groups for flu vaccine 
• Who should NOT take flue vaccine e
• Flu vaccine is taken every 
• When is the Flu season in Canada 
• Flu immunization season 
• Contraindications of antihistamines 
• Contraindications of decongestants 
Copyright protected by Tips Inc Protect copyright and prevent piracy 69-2
72
OTC drugs for Nausea,
Vomiting, Constipation,
Diarrhea, and Hemorrhoids
Tips
1. Psyllium 2. Diclectin Vit B6 + 3. Docusate sodium +

Doxylamine senna or bisacodyl
4. Dexamethasone 5. Ciprofloxacin 6. Benzodiazepines
7. Bismuth 8. uncooked food 9. contaminated water
subsalicylate
10. ice cubes 11. fresh salads 12. dry mouth
13. sunken eyes 14. less frequent urine 15. loss of skin turger
16. crying without tears 17. 18.
• DOC for pregnancy induced nausea and vomiting(Diclectin Vit B6 + Doxylamine)
• DOC for low emitogenic chemotherapy induced N& V(Dexamethasone)
• DOC for delayed chemotherapy induced N&V(Dexamethasone)
• DOC for anticipated nausea and vomiting(Benzodiazepines)
• symptoms of dehydration(dry mouth, sunken eyes, less frequent urine, loss of skin
turger & crying without tears)
• traveler’s diarrhea mainly caused by? (uncooked food, contaminated water, ice cubes
& fresh salads)
• black stools and tongue is side effect of? (Bismuth subsalicylate)
• DOC for traveler’s diarrhea(Ciprofloxacin)
• DOC in pregnancy for constipation(Psyllium)
• DOC for opioids induced constipation(Docusate sodium + senna or bisacodyl)
• What is the drug of choice for pregnancy induced nausea and vomiting 
• What are the self care measures recommended for N&V associated with PCNV
• DOC for low emitogenic chemotherapy induced N&V 
• DOC for delayed chemotherapy induced N&V 
• DOC for anticipated nausea and vomiting 
• Symptoms of dehydration
• Traveler’s diarrhea mainly caused by 
• Black stools and tongue is side effect of 
• What type of food should be avoided by travelers to prevent infectious diarrhea 
• Drug of choice for travelers diarrhea 
• What are the most important self care measure is recommended relieve constipation?
• Drug of choice in pregnancy for constipation?
• Drug of choice for opioids induced constipation
• What are the self care measures to relieve hemorrhoids
• Drug of choice for pregnancy induced nausea and vomiting  Diclectin
(Vit.B6+doxylamine)
• What are the self care measures recommended for N&V associated with post
Chemotherapy nausea and vomiting (PCNV) Take small and frequent meals, avoid
fatty and spicy foods and take salty crackers.
• The DOC for low emitogenic chemotherapy induced N&V  Dexamethasone
• The DOC for delayed chemotherapy induced N&V Dexamethasone
• The DOC for anticipated nausea and vomiting  Benzodiazepines
• Symptoms of dehydration Dry mouth, sunken eyes, less frequent urine, and loss of
skin turger, and crying without tears.
• Traveler’s diarrhea mainly caused by  Uncooked food, contaminated water, ice
cubes and fresh salads
• Black stools and tongue is side effect of  Bismuth subsalicylate
• The drug of choice for traveler’s diarrhea  Ciprofloxacin
• The drug of choice in pregnancy for constipation? Psyllium
• The drug of choice for opioids induced constipation Docusate sodium + senna or
bisacodyl
www.pharmacyprep.com OTC drugs
73
Analgesics and OTC Pain Relievers
Tips
1. Propranolol 2. NSAIDS or 3. triptans,
Acetaminophen alternatively ergot
alkaloids
4. avoid prolong bed 5. throbbing pain; 6. unilateral headache
rest feels hitting w/ a
hammer
7. nausea& vomiting 8. 5HT1b/1d agonist 9. R-I-C-E
10. Amitriptyline 11. Valproic acid 12. Verapamil
• What are the symptoms of migraine headache

• What is drug of choice for acute migraine attack
• What is prophylaxis is recommended for migraine in-patient experiencing 3 to 4
migraine attacks every month and having constipation 
• What is mechanism of action of triptans 
• What are the symptoms of migraine headache? (unilateral headache, nausea&
vomiting)
• What is the DOC for acute migraine attack? (triptans, alternatively ergot alkaloids)
• What is the mechanism of action of triptans? (5HT1b/1d agonist)
• What prophylaxis is recommended for migraine patient experiencing 3 to 4 migraine
attacks every month and having constipation? (Propranolol)
• General approach for sports injuries(R-I-C-E)
• What drugs are used for migraine prophylaxis? (Amitriptyline, Propranolol, Valproic
acid & Verapamil)
• What are recommended self measures for back pain? (avoid prolong bed rest)
• What is the treatment for back pain? (NSAIDS or Acetaminophen)
• Migraine pain is? (throbbing pain; feels hitting w/ a hammer)
• Pressure ulcers also known as  Decubitus ulcer or rectal ulcers
• Mechanism of muscle relaxants  Act on nicotinic receptors in ion channels
• Drugs used in multiple sclerosis  Beclofen, dantrolene,
www.PharmacyPrep.Com Pharmacology
74
Asthma
Tips
• Asthma is  chronic inflammatory disorder of the airways, ↑ airways responsiveness,

causes reversible obstruction.
• Emphysema is  permanent enlargement of alveoli
• What are asthma triggers? Emotional stress, exercise, allergens, animal dandur,
pollens, cockroaches, cold air and mold
• What is NOT a trigger? Hot air
• Indications of short acting beta 2 agonists include  relieve branchoconstriction, the
acute symptoms of cough, wheezing and chest tightness, asthma emergencies and
EIA
• Indications of long acting beta 2 agonist include  Maintenance therapy and EIA
NOT for acute. Used in patients already taking corticosteroids
• Sequence of treatment: SABA prn  ICS  LABA ↑ICS or LTRA po CTS 
iv CTS
• When LABA are initiated in asthma patient?
• Indications of LTRA include  Asthma maintenance (steroid sparing agents), and
ASA induced asthma
• What are the vaccines in-patient of COPD  flu vaccine (annually) and
Pneumococcal vaccine
• Tiotropium is  long acting anticholinergic drug
Tips format 002:
1 Excercise 2 Stress 3 Cold air
4 Salbutamol 5 Formeterol 6 Salmeterol
7 Ipratropium 8 Tiotropium 9 Epinephrine
10 Budesonide + 11 Fluticasone + 12 Montelukast

Formoterol Salmeterol (Singulair)
(symbicort) (Advair)
13 Zafirlukast (Accolate) 14 Omalizumab 15 Theophylline
16 Meter dose inhaler 17 Diskus 18 Turbuhaler
19 Aerochamber 20 Ketotifen 21 emphysema
• are triggers of asthma ( 1,2,3 )

• are rescue medications or treatment of acute exacerbations & prevention of exercise-
induced asthma( 4 )
• is emergency therapy of acute shortness of breath( 9 )
• have steroid-sparing properties and the drug of choice ASA induced asthma ( 12, 13
)
• Maintenance therapy and EIA NOT for acute( 5,6,10,11 )
• devices used for children <5 yr age( 16, 19 )
• adjunctive therapy in acute sever asthma excerbation( 7 )
• ↑IgE level for up to 1year after ending the treatment( 14 )
• long acting anticholinergic drug, used single daily( 8 )
• administered by device called handihaler( 8 )
• antihistamine inhaler( 20 )
• permanent of enlargement of alveoli( 21 )
• what drugs combination have synergistic action( 10, 11, 4,7 )
• what drug require higher at the age between 1 to 9 yr old( 15 )
• What inhalers do not requiring shaking( 17,18 )
• what drugs require to rinse mouth after inhalations(10, 11 )
1 Salbutamol 2 short acting beta2 agonist 3 Terbutaline

4 Corticosteroids 5 Prednisone/ 6 Zafirlukast
Prednisolone
7 Theophylline 8 Diphenhydramine 9 Codeine
10 Ephedrine 11 Cromolyn sodium 12 Ipratropium bromide
13 exercise 14 stress 15 cold air
• Triggers of asthma (exercise, stress, cold air)

• (Salbutamol ) are rescue medications or treatment of acute exacerbations and
prevention of exercise-induced asthma
• It relieves the symptoms of asthma, chronic bronchitis and emphysema( )
• It may interact with MAOIs and cause a dangerous rise in blood pressure( )
• Rinsing mouth and using spacer can minimize the side effect of this drug( )
• It is use for the treatment of skin diseases, rheumatic disorders and certain blood
disorders( )
• It is the drug of choice for Aspirin induced asthma( )

• This drug should be use with caution in patients with peptic ulcer and seizure diseases
( )
• It is a non narcotic antitussive( )
• It is a narcotic antitussive that causes addiction and tolerance( )
• It causes slight increase in blood pressure and has both alpha and beta effects( )
• It is use for prophylactic treatment and not used for acute asthma attack( )
• It is the drug of choice for chronic obstructive pulmonary disease (COPD) ( )
• Indications of short acting beta2 agonists include 
• Indications of long acting beta2 agonist include 
• Sequence of treatment: SABA prn  ICS  LABA  LTRA PO CTS  iv CTS
• When LABA are initiated in asthma patient?
• What are asthma triggers? Emotional stress, dust
• What is NOT a trigger? Hot air
• Leukotrienea are Stored and released by leukocyte granules and formed from
arachidonic acid LTC4 and LTD4 receptors may cause branchoconstriction effect
• Theophylline clearance in 3 year old ? Increase in enzymatic clearance rate
• A patient is suffering from COPD and asthma. He is on theophylline, ranitidine and
now doctor prescribed ciprofloxacin which of the following is correct?
• Omalizumab is? IgE neutralizing antibody, indicated for allergic asthma
www.pharmacyprep.com Smoking cessation
75
Smoking Cessation
• Nicotine withdrawal symptoms  severe craving, anxiety or irritability, restless,

nervousness, difficulty with concentration, sleep disturbance, headaches, increases appetite
or eating behavior. (no anorexia)
• Nicotine overdose symptoms  Palpitation (heart racing), difficulty in breathing, Nausea,
vomiting, and diarrhea
• What drugs are used for smoking cessationNicotine based treatment: Nicotine patch or
gum and Non-nicotine baseBupropione (Zyban), and vernaclin (Champix).
• Vernaclin is  Nicotine receptor agonist
• Pharmacotherapy
• Nicotine Replacement: first-line medication
• Immediate release – nicotine inhaler (Nicorette Inhaler), nicotine polacrilex gum (Nicorette
Gum)
• Inhaler – SE: mild local irritation (stomatitis, cough etc.), absorbed buccally (NOT a true
inhaler)
• Gum – SE: jaw pain
• Sustained release – nicotine transdermal patch (Habitrol, Nicoderm)
• SE: skin sensitivity, insomnia
• Start on the quit date
• Advice not to smoke

• Habitol – late onset, NOT use while exercising
• Dose: >20 cigarettes/day →start 21mg 3-4wk or ≤20→start 14mg 3-4wk →tapering (i.e.
21mg- 14mg- 7mg every 3-4w)
• Nicoderm – rapid onset, CAN use while exercising & cut
• Dose: 21mg 6W→ 14mg2wk → 7mg2wk
• Exception – Start 14mg 6wk →7mg 2wk (CV disease, Wt≤45kg, <1/2pack cigarette /day)
• Unmanageable cravings & smoke cigarettes → add nicotine gum or inhaler as a
breakthrough medication
Partial agonists – varenicline (Champix)

• Alpha4 beta2 – nicotinic receptor partial agonist
• SE: nausea
• NOT combine with nicotine replacement therapy
• NO DI
• Should quit smoking 1-2wk after starting carenicline (still smoking 4wk after starting –
need additional 12wk)
• NO tapering necessary
• first-line medication
• Antidepressants – bupropion (Zyban), nortriptyline
• Bupropion
• Begin 1-2wk before the selected quit date
• SE: insomnia, ↑risk of seizures at HD
• CI: seizure Pts (history, predisposing), current eating disorder, severe hepatic impairment
• Nortriptyline
• Quit day is usually set between 1 and 4wk
• SE: dry mouth, blurred vision, constipation, sedation
• Caution: CVD or arrhythmias Pts
• Alpha2- adrenergic Receptor Agonists – clonidine (Catapres, Dixarit)
• Duration: 3 to 10wk
• MO: BP
• Taper off gradually to avoid rebound hypertension when stopping treatment
• Good to HT Pts
1. severe craving 2. anxiety or irritability 3. dry mouth
4. insomnia 5. restlessness 6. nervousness
7. difficulty with 8. sleep disturbance 9. headaches
concentration
10. nicotine gum 11. nicorette 12. nicorette plus
13. nicotine patch 14. nicoderm or habitrol 15. Champix
16. increase appetite or 17. Bupropion 18. Room temperature
eating behavior
• What drugs are used for smoking cessation?

• How nicotine patches are stored?
• What is incorrect about nicotine patch? While taking nicotine patches may smoke 1 to 8
cigarettes a day
• The types of nicotine dosage forms, except? Inhaler, nasal spray, transdermal, and gums
• (nicotine gum,nicorette, nicorette plus, nicotine patch, nicoderm or habitrol) Nicotine
Replacement Therapy
• (Champix) use in combination with quit smoking education
• (severe craving, anxiety or irritability, restlessness, nervousness, difficulty with
concentration, sleep disturbance, headaches, increase appetite or eating behavior) Nicotine
withdrawal symptoms
• (Bupropion) this could be used with or without NRT
• (dry mouth, insomnia) more common side effect of Bupropion
www.pharmacyprep.com Insomnia
76
Insomnia
Non Pharmacological
Sleep hygiene
• Keep regular sleep-wake schedule for 7 days/wk
• Restrict sleep time to average sleep time
• Avoid extensive horizontal rest or daytime napping
• Get regular exercise every day
• Avoid heavy meals just before bedtime
• Do something which is boring before bed time
• Avoid exercise before bedtime
1. Temazepam 2. short acting 3. Lorazepam

4. Midazolam 5. Zopiclone 6. Oxazepam
7. Diazepam 8. Triazolam 9. Exercise before bed
• short acting benzodiazepines(Triazolam, Midazolam)

• long acting benzodiazepines(Diazepam)
• intermediate benzodiazepines(Oxazepam, Temazepam, Lorazepam)
• least hang over effect(short acting)
• What benzodiazepine is indicated for initiating sleep? (Triazolam)
• What drug may cause less rebound on withdrawal? (Zopiclone)
• What is inappropriate self care measure
• a non-benzodiazepine act on BZ 1 receptors (Zopiclone)
• Benzodiazepine act on BZ 1 and BZ 2 receptors
• Benzodiazepine act on GABA-A receptors
• Short acting benzodiazepines  triazolam, midazolam,
• Long acting benzodiazepine  diazepam
• Intermediate benzodiazepine  oxazepam, temazepam, lorazepam.
• Least hangover effect  short acting
74-1
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is
www.pharmacyprep.com Insomnia
• What is benzodiazepine are indicated for initiating sleep  triazolam

• What drug may cause less rebound on withdrawal  zopiclone
74-2
Copyright © 2000-2011 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is
www.pharmacyprep.com Eating Disorders
77
Eating Disorders
• Anorexia Nervosa is  It is characterized by deliberate loss of weight (to <85% of
expected weight), refusal to maintain normal body weight, fear of weight gain and
amenorrhea.
• Bulimia Nervosa is  It is characterized by repeated episodes of binge eating followed by

inappropriate compensatory behavior such as self-induced vomiting, misuse of laxatives,
diuretics, emetics, other medication, long time fasting, or excessive exercise.
• Purging is = induced using laxatives, or emetics

• Non purging is = excessive exercise or fasting
• Examples of appetite suppressants  Diethyl propion (Tenuate), and Buprapion

(Wellbutrin)
• Examples of Satiety enhancers  Sibutramine (Meridia)
• Sibutramine (Meridia) is  serotonin and norepinephrine reuptake inhibitor (SNRI)
• Examples of Lipase inhibitor  Orlistat (Xenical)
• Orlistat (Xenical)  Gastric lipase inhibitor reduces 30% fat absorption
• Examples of Cannabinoid type 1 receptor antagonist  Rimonabant
• Rimonabant act by  Blocks the central and peripheral effects of the endocannabinoid
system mediated by cannabinoid (CB)-1 receptors
• Drugs that are used for weight loss therapy include:
• Orlistat
• Sibutramine
• Buprapione
• Topiramate
www.pharmacyprep.com Eating Disorders
• Drug that gives anorexia (loss of appetite)

• Metformin
• Amiodarone
• Drug that increase appetite
• TCAs
• Corticosteroids
• Oral contraceptives
• Sulfonyl ureas
• Drugs that cause weight gain
• Insulin
• TCAs
• MAOI
• Antipsychotics
• Sulfonyl ureas
• Meglitinides
1. Domperidone 2. Metoclopramide 3. Orlistat

4. anorexia nervosa 5. bulimia nervosa 6. purging
7. anorexia nervosa 8. 9.
• it is characterized by deliberate loss of weight(anorexia nervosa)

• excessive exercise or fasting(non purging)
• reduce the feeling of fullness(Domperidone, Metoclopramide)
• it is characterized by repeated episodes of binge eating(bulimia nervosa)
• intestinal lipase inhibitor(Orlistat)
• using laxatives, or emetics(purging)
www.PharmacyPrep.Com GERD, Ulcers, IBD, and IBS
78
GERD, GI Ulcers,
Inflammatory Bowel
Disease, Irritable Bowel
Syndrome
Tips format 002:
1 High-fat meal, 2 Pregnancy 3 Increase age

carbonated drinks
4 Obesity 5 Al antacids 6 Mg antacids
7 Ca antacids 8 Alginic acid 9 Sucralfate
10 Famotidine 11 Cimetidine 12 omeprazole,
13 esomeprazole 14 lansoprazole 15 pantoprazole, rabeprazole
16 Misoprostol 17 GERD 18 IBD
19 H. pylori 20 Ulcerative colitis 21 Chrons
22 5-ASA 23 prednisone 24 Infliximab
25 Ulcers 26 Colon 27 Simethicone
• are triggers of heartburn or GERD( 1,2,3,4 )

• is symptoms as heartburn, epigastric pain ( 17,25 )
• is defined as is abdominal discomfort associated with altered bowel habits. It is
characterized by symptoms of abdominal discomfort, bloating, cramping,
constipation or diarrhea. ( 18 )
• symptom are relapsing inflammatory condition in the colon with signs of
bleeding, urgency, diarrhea and tenesmus(20 )
• symptoms of inflammation is present from the esophagus to the anus but
predominantly in the small bowel or colon. Obstruction of the bowel abscess
formation( 21 )
www.PharmacyPrep.Com GERD, Ulcers, IBD, and IBS
• take ½ hour before meals: the most effective acid suppression, once daily
( 12,13,14,15 )
• gram –ve bacteria that cause gastric ulcer( 19 )
• active metabolite of sulfasalazine ( 22 )
• is antiflatulance agent( 27 )
• gives the side effect of diarrhea (Mg = Must go) ( 6 )
• gives the side effect of constipation( 5,7 )
• isomer of omeprazole( 13 )
• gives rare side effects as gynecomastia, impotence( 11 )
• do not take with ciprofloxacin, tetracyclin, bisphosphonates and thyroxine
( 5,6,7,9,8 )
• has rapid onset proton pump inhibitors( 15 )
• ↓efficacy of drugs requiring an acid medium for absorption( 5,6,7 )
• usually effective in mild GERD, BID( 10,11 )
• Step-down therapy: ____ are instituted after symptomatic relief has been achieved
with PPIs( 10,11 )
• Potent H 2 RA( 10 )
PharmacyPrep.com Diabetes
79
Insulin and Antidiabetic
Drugs
• Normal glycosylated hemoglobin  (HbA1c) < 6.5%
• When a person is diabetic  Fasting blood glucose (FBG) >7.1 mmol/L, a casual
(random) blood glucose >11.1 mmol, and two hours after 75g of glucose is 11.1
mmol/L
• A person diabetic if  casual blood glucose is >11.1 mmol and symptoms of
polyurea, polydipsia, polyphagea and unexplained weight loss
• Risk factor for type I DM  ketoacidosis, family history, juvenile, (obesity is NOT),
absence of pancrease beta cells
• Risk factors for type II DM  1st degree relative with DM, impaired fasting glucose,
or glucose tolerance, vascular disease, hypertension, overweight, schizophrenia, and
polycystic ovary syndrome
• Insulin works on cell wall

• What antidiabetic drug of choice in pregnancy insulin
• If patient has admitted in surgical ward and her blood glucose levels high, what is
drug of choice insulin
• Which of the available forms of insulin should be used iv dose to correct excessive
preprandial glucose concentrations? Homolog, and regular
What types of insulins are clear solutions  Lispro, regular and glargine
• The antidiabetic drug side effect of anorexia  metformin

• Anticholesterol DOC in diabetic patient fibrates
• Metformin monitoring renal (CrCl) and liver functions, HbAIC
• Which antidiabetic drugs are not used in type I DM  sulfonyl ureas
• Body Mass Index (BMI)  weight in Kg/(height in m)2
• Waiste line circumference for men  >102 cm and women >87 cm is risk factor
diabetes and heart disease
• The most common cause of glaucoma (blindness) is associated with  Diabetes
Mellitus
• Sulfonyl ureas (glicalizide, glimepride, glyburide, chlorpropamide, and
tolbutamide) Stimulate insulin secretions
• Meglitimides (Repaglinide, nateglinide) Stimulate insulin secretions
• Biguanides (metformin) Inhibit gluconeogenesis in liver, increase glucose
uptake in cell.
• Thiozolidinediones (Rosiglitazone, pioglitazone) Increase insulin sensitivity
(decrease resistance) increase glucose uptake in cell.
• Alpha glucosidase inhibitors (acarbose, miglitol)Inhibit glucosidase in GI tract.
• Intestinal lipase inhibitors  Orlistat
• What antidiabetic drug decrease mortality metformin
• Contraindications of metformin include CHF, renal and liver diseases
• What antihypelipidemic drug may increase blood sugar levels  Niacin
• Gliclazide  Long acting and once daily dose
• Sitagliptin (januvia)  Inhibitor of dipeptidyl peptidase enzyme (DPP-4) that
enhances the incretin hormone
• Diabetes related complications Retinopathy (blindness), nephropathy (kidney
disease), Neuropathic pains, vascular diseases, foot infections however there is no
liver cirrhosis.
• α-glucosidase inhibitor MOA Inhibit alpha glycosidase intestinal enzymes
Decrease absorption of starch and sucrose (does not stop absorption of glucose).
• Glargine  Longest acting Single daily dose
• Meglitinides  It can be taken in sulfa allergy (It does not contain a sulfa group)
• Metformin CIs  CHF, renal disease and liver disease and pregnancy
• Difference between glyburide and glicalize glicalizide is long half life, taken
daily single dose
• Antidiabetic drugs taken before or after meals glitazone
Tips format 002:
1 FBG >7.1 mmol/L 2 HbA1c > 7.0% 3 Random >11.0

4 Polyurea 5 Polydipsea 6 weight in Kg/(height in m)2
7 Weight loss 8 Sweating 9 Palpitation
10 Rapid acting Insulin 11 Insulin regular 12 Intermediate
13 Long acting insulin 14 Premixed insulin 15 Sulfonyl ureas 1st gen
16 Sulfonyl ureas 2nd gen 17 Meglitinides 18 Metformin
19 Thiozolidinediones 20 Acarbose 21 Incretin inhibitors
22 Diabetic complications 23 Insulin 24 Intestinal lipase inhibitors
25 Waist line >102 cm 26 Waist line >87 cm
• act on cell wall receptors to increase glucose uptake ( 23 )

• blood sugar levels if a person is diabetic ( 1,2,3 )
• symptoms of hyperglycemia ( 4,5,7 )
• symptoms of hypoglycemia ( 8, 9)
• insulins are clear solutions, except ( 12 )
• are sitagliptine ( 21 )
• give lactic acidosis if taken with alcohol and renal diseases ( 18 )
• are retinopathy, nephropathy, cardiovascular diseases, and foot amputation,
except: hepatic cirrhosis ( 22 )
• waist line in men ( 25 )
• waist line in women ( 26 )
• drugs increase glucose uptake ( 18,19,21 )
• drugs increase insulin secretion ( 15,16,17 )
• drugs that should be taken with first bite of meals ( 17, 20 )
• drugs that are withdrawn due to heart failure side effects ( 19 )
• used for weight loss therapy ( 24 )
• Acarbose mechanism
• Orlistat mechanism
• Difference between glyburide and glicalize
• Antidiabetic drugs taken before or after meals 
• Insulin works on cell wall
• The antidiabetic drug side effect of anorexia 
• Anticholesterol DOC in diabetic patient 
• Metformin monitoring
• Which antidiabetic drugs are not used in type I DM 
• What is the antidiabetic drug of choice in pregnancy 
• If patient has admitted in surgical ward and her blood glucose levels high, what is
drug of choice
• Which of the available forms of insulin should be used iv dose to correct

excessive preprandial glucose concentrations?
• BMI = weight in Kg/ (height in m)2
• The most common cause of glaucoma (blindness) is associated with  Diabetes

Mellitus
• Sulfonyl ureas
• Meglitimides
• Biguanides
• Thiozolidinediones
• Alpha glucosidase inhibitors
• Intestinal lipase inhibitors 
• What antidiabetic drug decrease mortality 
• Contraindications of metformin include 
• What antihypelipidemic drug may increase blood sugar levels 
Pharmacyprep.com Thyroid disorders
80
Thyroid disorders
Tips
• TRH is secreted from  hypothalamus
• TSH is secreted from  anterior pituitary gland
• Normal TSH levels are 0.3 to 6.0 mU/L
• The hypersecretion of the thyroid hormone may cause thyrotoxicosis or Grave’s
disease and plummer’s.
• Calcitonin is stimulated by Hypercalcemia
• In treatment of hypothyroidism with T 4 have effect on 
• Hypothyroidism is monitored by  serum TSH
• DOC in pregnancy for hyperthyroidism  propylthiouracil
• Hypothyroidism symptoms Cold intolerance
• Hyperthyroidism is  thyrotoxicosis, graves disease, and plummers,
• Hypothyroidism is  hoshimoto and myxedema
• T 4 metabolized to T 3 by deiodinase enzyme
• Discontinue antithyroid if patient notice even a single rash
• Sweating is symptom of  hyperthyroidism
• Lugol solution is? KI + I
• Lugol solution is oral drops and can cause  stain.
• Why is it beneficial to add propranolol to a drug regimen of a patient diagnosed
with hyperthyroidism? Decrease sweating, tachycardia, palpitation associated
with hyperthyroidism
• Thyroxine absorption is decreased by  calcium, high fiber diet, iron, high soya
diet, cholestyramine (separate 6 hours)
• TSH levels changes after  6 to 8 weeks
• A Patient using levothyroxine should be monitored for  serum TSH

• May decrease absorption of levothyroxine by Iron salts, Clacium and Sucralfate
separate 30 min; resins separate 6 hours resins. Do not take aluminium
compounds with thyroid preparations.
• Lugol solution is  oral drops, may cause stains
• Propylthiouracil SE  agranulocytosis
• Myxedema  In this disease, the patient may have slow speech, a puffy face,
slow pulse, low BMR and scanty hair.
• Cretinism: The growth and height of the child is stunted. The patient has low
BMR and a bloated face. The patient is also mentally retarded.
• Goitre: It is also known as simple or non-toxic goiter. A dietary deficiency of
iodine may be responsible for this. The neck of the patient is swollen.
• Toxic nodular goiter: It is due to benign neoplasm or adenoma or may be
because of long standing normal goiter.
• Hashimoto disease is primary hypothyroidism  it is an autoimmune disease
resulting from cell and antibody mediated thyroid injury.
Tips format 002: Thyroidism

1 Bradycardia 2 Hypotension 3 Constipation
4 Diarrhea 5 Dry skin 6 Sensitive to heat
7 Weight loss 8 Weight gain 9 Sensitive to cold
10 TSH < 0.5 11 TSH > 5.5 12 Graves disease
13 Hashimoto disease 14 Thyroxin 15 Methimazole
16 Propylthiouracil 17 Lugol solution 18
19 20 21
22 23 24
25
• symptoms of hypothyroidism ( 1, 3, 5,8,9 )

• symptoms of hyperthyroidism( 2,4,6,7 )
• hyperthyroidism( 10, 12 )
• hypothyroidism( 11, 13 )
• is the drug of choice for hypothyroidism( 14 )
• is the drug of choice for hyperthyroidism( 15,16,17 )

• is the drug of choice for hyperthyroidism in pregnancy( 16 )
• drug that are taken empty stomach( 14 )
• absorption is decreased if taken with calcium supp or dairy products( 14 )
• drugs that stain ( 17 )
• severe fever, sore throat and agranulocytosis are the side effects of( 15, 16 )
PharmacyPrep.Com Contraception
81
Contraception
Tips format 002: Contraception
1 Ovral 2 Plan B 3 Condoms
4 nonoxynol-9 5 pregnancy 6 breast cancer,
7 Deep vein thrombosis 8 bleeding 9 Alesse
10 Dian 25 11 Nausea and vomiting 12 Dimehydrinate
13 Chloasma 14 Breast tenderness 15 Chest pain
16 Headache 17 Eye problems 18 Severe leg pain
19 Tampons 20 Evra patch 21 Nuva ring
22 IUDs 23 Depo provera 24 Abdominal pain
25
• Emergency contraceptive methods( 1, 2 )

• Spermicidal: Vaginal contraceptive film ( 4 )
• contraception method may protect STDs and HIV ( 3 )
• are contraindications of oral contraceptive pills ( 5, 6, 7, 8 )
• oral contraceptives used for acne ( 9, 10 )
• is the common side effect of plan B ( 11 )
• used as treatment for nausea and vomiting for contraceptives ( 12 )
• what contraceptive methods can cause TSS ( 19, 22, 21 )
• applied for once a week ( 20 )
• the side effects of oral contraceptive pills ( )
• the danger signals of oral contraceptive pills (ACHES)
• Natural contraceptive method  Coital timing= rhythm or calendar method Symptom

thermal method = basal temperature; cervical mucus
• Mechanical methods  Male condoms, female condoms, diaphragm, cervical cap, and
intrauterine devices
• Emergency contraception  also known as post coital/morning after pill.
• Emergency contraception Plan B side effects  nausea and vomiting
• Plan B is CI’s  pregnancy
PharmacyPrep.Com Contraception
• If missed 1pills then take as soon as you remember and next pill as per schedule (no need
for extra contraception method)
• If missed 2 pills in first 2 weeks Then take double pill for next two days
• What contraception may protect STDs and HIV  Condoms
• What contraception methods may NOT cause Toxic shock syndrome (TSS)  condoms
www.pharmacyprep.com Gynaecological and genitourinary conditions
82
Gynaecological and
Genitourinary conditions
•
• Symptoms of dysmenorrhea painful menstruation, starts 1 to 2 days before periods
• Symptoms of endometriosis pelvic pain, dysmenorrhea and infertility
• What microorganism cause toxic shock syndrome S. aureus
• What contraceptive methods can cause TSS  cervical caps, contraceptive sponges,
tampons and IUDs. Except condoms
• What drugs are inhibitors of PDE 5 enzyme seldenafil, verdanafil, and tadalafil
• Nitrates or alpha blockers + Sildenafil should not take together because  give
hypotension
• Menopause symptoms hot flushes, vaginal dryness, mood swings, and dysprunea (pain
intercourse)
• Benign prostatic hyperplasia (BPH) symptoms include all except jet stream urination
• What phase of menstrual cycle PMS symptoms occur Luteal phase
• What drugs should be avoided in urinary incontinence diuretics
• Enuresis in children (bed wetting) Drug of choice is  Antidiuretic hormone derivatives

desmopressin (DDAVP)
• Drug of choice is urinary incontinence oxybutynin (Ditropan)

• Drug that should avoided in urinary incontinence  diuretics
• PMS symptoms occur 1 to 2 days before periods: may be due ↓ progesterone, or Estrogen
www.pharmacyprep.com Gynaecological and genitourinary conditions
Tips format 002: Gynaecological and genitourinary conditions

1 Mood changes (swing) 2 Flushing 3 Night sweat
4 Vagina dryness 5 PDE5 inhibitors 6 oxybutinin
7 Luteal phase 8 Urinary incontinance 9 Benign prostatic
hyperplasia (BPH)
10 Premenstrual 11 dysmenorrhea 12 Jet urination
syndrome (PMS)
13 Difficulty in urination 14 Finesteride 15 Dutasteride
16 Prazosin 17 tamsulosin 18 irritation
19 Saw palmetto 20 21
22 23 24
25
• symptoms of menopause ( 1,2,3,4 )

• are sildenafil, taldalafil, verdanafil ( 5 )
• the drug of choice of urinary incontinence
• occurs in premenstrual syndrome (PMS) ( 7 )
• symptoms of benign prostatic hyperplasia (BPH) ( 13, 18 )
• the drug of choice for BPH( 14 )
• the drugs that used to relieve the symptoms of BPH ( 16, 17 )
• what is not symptoms of BPH( 12 )
• is the anticholinergic drug that acts on M3 receptors( 6 )
• herbal product that is used for prostatic hyperplasia( 19 )
PharmacyPrep.Com Osteoarthritis, Rheumatoid arthritis and Gout arthritis
83
Osteoarthritis, Rheumatoid
Arthritis and Gout Arthritis
Osteoarthritis, Rheumatoid Arthritis & Gout Arthritis
1 Acetaminophen 2 Methotrexate 3 Minocycline
4 Hydroxychloroquine 5 Infliximab 6 Allopurinol
7 Sulfinpyrazone 8 Colchicine 9 Indomethacin
10:weight bearing joints 11: non weight bearing 12: obesity
joints
13: family history 14: inadequate Ca & vit D 15: deficiency of estrogen
16: hyluronic acid 17:intraarticular 18:probenicid
( 2 ) this may cause renal damage or bone marrow depression

(1 ) the drug of choice for osteoarthritis
( 2 ) an anticancer drug used for the treatment of rheumatoid arthritis
( 4 ) use to treat rheumatoid arthritis and malaria
( 3 ) a broad spectrum antibiotic for the treatment of rheumatoid arthritis
(5 ) use for rheumatoid arthritis and Chron’s disease
( 6 ) a suicide inhibitor of xanthine oxidase (XO)
( 7, 18 ) it promotes uric acid excretion in urine
( 8, 9 ) it is use for acute gout attacks
1. Acetaminophen 2. Methotrexate 3. Minocycline

4. Hydroxychloroquine 5. Infliximab 6. Allopurinol
7. Sulfinpyrazone 8. Colchicine 9. Indomethacin
10. Weight bearing joints 11. Non weight 12. Obesity
bearing joints
13. family history 14. inadequate Ca & 15. deficiency of
Vit. D estrogen
16. hyaluronic acid 17. intraarticular 18. Probenecid
19. RA 20. Osteoarthritis 21. Gout
22. 23. 24.
PharmacyPrep.Com Osteoarthritis, Rheumatoid arthritis and Gout arthritis
• Morning stiffness is symptoms of 
• Rheumatoid arthritis can occur on 

• Examples of DMARDs  Methotrexate, hydroxychloroquine, Sulfasalazine, gold
salts, leflunomide, azathioprine, cyclosporine, and D-penicillamine
• Biological response modifiers  It block tumor necrosis factor – alpha and
interleukin-1 (IL-1)
• TNF-Alpha blockers  infliximab, Etanercept, Adalimunab,
• Biological modifier that blocker IL-1  anakinra
• Methotrexate initial dose for RA treatment is 
• Infliximab is 
• Acetaminophen have least activity as 
• Probenecid, sulfinpyrazone and allopurinol should be taken with 
• this may cause renal damage or bone marrow depression ( )
• the DOC for osteoarthritis ( )
• an anticancer drug used for the treatment of rheumatoid arthritis( )
• use to treat rheumatoid arthritis and malaria( )
• a broad spectrum antibiotic for the treatment of rheumatoid arthritis ( )
• use for rheumatoid arthritis and Chron’s disease( )
• a suicide inhibitor of xanthine oxidase (XO) ( )
• it promotes uric acid excretion in urine( )
• it is use for acute gout attacks( )
84
Osteoporosis
Osteoporosis
1 Alendronate 2 Calcium carbonate

3 Risedronate 4 Raloxifene
5 Calcium citrate 6 Calcitonin salmon
7: family history 8: inadequate Ca & vit D 9: deficiency of estrogen
• risk factors of osteoporosis( 7,8,9 )

• approved for prevention and treatment of postmenopausal bone loss, treatment of
established osteoporosis and glucocorticoid-induced osteoporosis( 1, 3 )
• 40% elemental calcium; provides the most calcium( 2 )
• selective estrogen receptor modulator (SERM), estrogen like action on bone and
lipid metabolism( 4 )
• a hormone secreted from thyroid gland( 6 )
• calcium supplement recommended in elderly( 5 )
• this drug should be taken first thing in the morning on an empty stomach( 1, 3 )
• Bone remodeling occurs, when which is presentosteoblast
• Osteoporosis is caused by reduction bone mass
• Risk factors of osteoporosisAge >65 yr, gender, race, and family history.
• What exercise are recommended for osteoporosis  weight bearing
• What exercise are least effective for osteoporosis  swimming
• Androgen deficiency cause  hypogonadism
• What is NOT risk factor of osteroporosis  over weight or obese
• Recommended daily allowance of vitamin D is  800 IU/day
• Elderly may absorb calcium carbonate poorly due to  decrease acidity in
stomach
• Daily Calcium dose for over 50 yr old  1500 mg daily
• Calcium supplement in elderly  calcium citrate
• Paget Disease Softened bones

• Calcium carbonate (40% Elemental calcium) Provides most calcium, usually
require requires an acidic environment for absorption.
• O-Calcium contain  CaCO3 obtained from oyster shells
Bisphosphonates  Etidronate, (alendronate, and residronate are
aminobisphonates)
Alendronate  70 mg once week dose
Selective estrogen receptor modulator (SERM)  raloxifene (Evista) 60 mg/day
What partial antiestrogen cause hot flushes  raloxefine
Calcitonin peptides  calcitonin salmon, intranasal (Miacalcin NS) and
calcitonin salmon, subcutaneous Calcimar, Caltine (not approved for osteoporosis)
Anabolic Agents  teriparatide (Forteo) 20 mcg sc/day for 18 months
• Drugs that cause osteoporosis: Corticosteroid  Prednisone, Levothyroxide,
Phenytoin, Heparin (long term use), and Al-antacid
• Calcium carbonate (40% Elemental calcium) Provides most calcium.
www.pharmacyprep.com Hypertension
85
Hypertension
Maintain BP below Targeted BP should be 
• 140/90 uncomplicated hypertension
• 140/90 with target organ damage or CV disease
• Isolate systolic hypertension >140 / <90
• Diabetic or renal impairment <130/<80
• <125/75 with proteinuria >1g/24 hrs
• Hypertension with diabetes drug of choice (DOC) is  ACE I
• Hypertension with renal disease DOC is ACE I
• Isolated systolic hypertension, which drugs should not use Beta blockers
• Hypertension
 1 Propranolol  2 Thiazide diuretics  3 Clonidine

 4 Hydrochlorothiazide  5 Methyldopa  6 Triamterene
 7 Captopril  8 Furosemide  9 Enalapril
 10 Minoxidil  11 Sodium Nitroprusside  12 Hydralazine
 13 Felodipine  14 Terazocin  15 Losartan
• it is an antihypertensive drug which is also used prophylaxis migraine( 1 )

• the drug of choice for hypertension in pregnancy( 5 )
• use in non complicated hypertension and also indicated in opiods and benzodiazepine
withdrawal symptoms( 3 )
• decrease BP in both supine & standing position, especially in elderly( 4 )
• this causes ototoxicity, hypokalemia, dehydration, allergy, nephritis and gout( 8 )
• this drug turns urine into blue color( 6 )
• this should be taken 1 hour before meals( 7 )
• it is 3x more potent , used once daily and no sulfonil group( 9 )
www.pharmacyprep.com Hypertension
• it is use for hypertension and alopecia treatment( 10 )

• the drug of choice for hypertensive crisis( 11 )
• it causes salt and water retention which may lead to CHF( 12 )
• the drug of choice for Raynaud phenomenon( 13 )
• this drug may cause a sudden drop in blood pressure that can result in loss of
consciousness( 14 )
• it may increase the effects of potassium supplements, potassium sparing diuretics,
cyclosporine, leading to raise of potassium in the blood( 7, 9,15 )
86
Coronary Artery Diseases
• Examples of ischemic heart diseases  Angina, MI

• Normal Cholesterol = Total < 200 (5.2mmol), HDL > 40 (>1mmol), LDL < 100 (2.5
mmol), TG < 150 (3.9 mmol)
• Symptoms of stable angina  pain above sternum, radiating to neck, back, and arms,
shortness of breath.
• Drug of choice for stable angina  Beta blockers (BBs)
• Prinzmetal (vasospastic) angina  Caused by spasm, do not increase MVO 2 and Mainly
due to atherosclerosis
• Prinzmetal angina symptoms  Pain usually occurs at rest awakens from sleep
• Prinzmetal angina is due to vascular spasm
• Drug of choice for Prinzmetal angina is Calcium channel blockers (CCBs)
• Unstable angina/NSTEMI Caused by  Disruption of an atherosclerosis plaque or
formation of platelet aggregation thrombus.
• Unstable angina/NSTEMI symptoms Crushing chest pain that can radiate to neck, back,
shoulders, arms and jaw. Pain is similar to angina but more severe. May occur at rest and
may be caused by less exertions.
• Unstable angina/NSTEMI drug of choice nitrate  anticoagulants
• Acute MI or STEMI  Most common type MI (85%) is due to thrombus formation caused
by precipitated by atherosclerosis plaque rupture. This propagated thrombus leads to
occlusive thrombus.
• ST segment elevated Myocardial infarction (STEMI) treatment Nitrates 
Thrombolytics  BBs
• Neutropenia is side effect of Ticlopidine
• A patient is intolerant or allergic ASA, should get alternate drug of prophylaxis for vascular
diseases clopidogrel
• Nitroglycerin act as smooth muscle vascular dilator due to produce NO
• Venous pooling effect is caused by nitroglycerin or Nitropruside
• Nitroglycerine storage conditions prevent from light, moisture and high temperature
• Drug of choice for STEMI  thrombolytics (fibrinolytics)
• What are the examples of LMWH  enoxaparin, dalteparin, tinzaparin, and alteparin
(EDTA)
• Mechanism action of LMWH Inhibitor of factor Xa
• What laboratory test is used for monitoring LMWH  Not monitored
• Headache is side effect of  Amlodipine, and nitroglycerin
• Protamine sulphate is antagonist of heparin, which react by  neutralization
Ischemic Heart Disease
Heparin LMWH
MOA Increase rate of thrombin and LMWH preps are insufficient length to
antithrombin reaction at least a catalytic inhibition of thrombin produce
1000 fold by serving as catalytic an anticoagulation effect mainly through
template to which both inhibitor + inhibition of Xa by antithrombin. (anti
protease bind Xa activity)
PK t 1/2 depends on amount. Heparin Longer t 1/2 than heparin
has immediate action when iv Once or twice daily SC
Q 8 to 12 h dosage Absorbed more uniformly
Monitoring aPTT No monitoring
Antidote Protamine sulphate
Pregnancy yes yes
1 Nitroglycerine 2 Amlodipine 3 Ca channel blockers
4 Nitrates 5 Nitrites 6 ASA
7 Heparin 8 Dihydropyridine 9 Clopidogrel
10 LDL > 2.2 11 Beta blockers 12: Thrombolytics
13: Diltiazem 14: verapamil
• Risk factor for ischemic heart disease( 10 )

• this may cause hypotension with Sildenafil( 1, 4, 5 )
• the drug of choice for hypertensive crisis( 5 )
• this can be safely used by asthmatic and non-insulin dependent diabetics( 2 )
• is effective for acute and chronic angina( 1, 4, 6, 9 )
• these are the treatment of choice in patients with coronary arterial spasm (prinzmetal
angina) ( 2,3,8)
• is the drug of choice of stable angina( 11 )
• it is use for STEMI treatment (ST-segment elevation MI) ( 6, 12 )
• it is use for NSTEMI treatment (Non ST-segement elevation MI) ( 6, 7 )
• it acts on peripheral vascular system that causes reflex tachycardia( 8,2 )
• it is appropriate drug for those who cannot take ASA( 9 )
• can cause bradycardia like beta blocker( 13, 14 )
87
Stroke
Stroke symptoms
Headache, Dizziness, blurred vision, confusion, incoherent speech

Anti-platelets – ASA, Clopidogrel, Ticlopidine, Dipyridamole/ASA
DOC : 2nd prevention of Noncardioembolic ischemic strokes
ASA – initial therapy (50 – 325mg/day for prevention)

Clopidogrel – 75mg/daily, alternative agent, somewhat more effective < ASA alone
Avoid grapefruit juice
ASA + Clopidogrel – should NOT be used for long-term secondary prevention of
ischemic events (↑bleeding)
Ticlopidine – 250mg bid , SE: diarrhea, skin rash, neutropenia(need monitoring) Not
routine use
Dipyridamole SR/ASA – 200/25g bid, ↓risk of stroke(mostly for ischemic stroke)
Anticoagulants –Warfarin, nicoumalone
DOC : 2nd prevention of Cardioembolic ischemic strokes
prevent cerebral and systemic emboli in patients with acute MI, valvular and nonvalvular
AF and prosthetic cardiac valves
nonvalvular AF and prior TIA/stroke → require INR of 3.0 instead of 2.5
WF – INR2-3 (cerebrovascular indications), 2.5-3.5 (with mechanical heart valves)
INR3-5 & NO significant bleeding : lower dose or omit dose and monitor
INR>5 to <9 & NO bleeding : skip dose
INR>5 to <9 & bleeding : skip dose & give VK orally (<5mg)
INR>9 & NO bleeding : hold WF & give high dose of VK orally
INR>9 & bleeding : hold WF & give VK infusion
Combination therapy
Low-dose ASA (81 mg/day) + oral anticoagulant
DOC: not respond to an anticoagulant alone
Pts have a risk for a cardio embolic stroke
use superior to anticoagulant alone in Pts with prosthetic heart valves
MO: hemorrhagic complications
Intolerant of ASA → Dipyridamole (400 mg/day)
Tips format 002: Stroke

1 Headache 2 Dizziness 3 Blurred vision
4 Confusion 5 Incoherent speech 6 Warfarin
7 ASA 8 Clopidogrel 9 Ticlopidine
10 Alteplase 11 BP > 140/90 12 LDL > 2.6 mmol/L
13 seizure
• symptoms of stroke ( 1,2, 3, 4, 5 )

• is the initial symptoms of stroke( 1 )
• are the drugs of choice for long term prevention of atherothrombotic events( 7,8
)
• Risk factors for stroke( 11, 12 )
• is the drug of choice for transient ischemic attack (TIA) ( 7 )
• is the initial therapy for stroke prevention( 7 )
• combination of drugs increases the risk of bleeding( 6,7,8,9 )
• gives neutropenia infrequently but is potentially serious and require monitoring
of CBC (every 1 to 2 wks) ( 9 )
• is not recommended routine protection of stroke. ( 9 )
• prevents cerebral and systemic emboli in patient with acute MI( 6 )
• Drugs that are used in within 3 hrs of acute ischemic stroke( 10 )
• is not a stroke symptoms. ( 13 )
88
Congestive Heart Failure
• Symptoms of CHF  The primary manifestation of heart failure are dyspnea, fluid
retention and fatigue that may limit exercise tolerance.
• Causes of CHF  In 65% of patient’s coronary artery disease is the cause of heart failure.
• Left ventricular ejection fraction <40% is indicates  systolic dysfunction
• ACE Inhibitors  reduce mortality 20 to30%,
• Beta-blockers  Negative inotropic effect is disadvantage.
• Bisoprolol and metaprolol β 1 selective and carvedilol a β 1 , β 2 and α 1 receptor inhibitor are
effective in CHF
• Digoxin acts as  +ve inotropic, -ve chronotropic, and vegomimetic effect
• Digoxin  Do not improve mortality only produce symptomatic relief.
• CCBs  Verapamil and diltiazem are not used because –ve inotropic effect
Congestive Heart Failure (CHF)
1 Digoxin 2 Digifab 3 Loop diuretics

4 Captopril 5 Verapamil 6 Thiazides
7: dyspnea, fatigue 8: impaired left ventricular (LV) 9: Fluid retention
function and reduce LV reserve
10: systolic HF
• symptoms of CHF (7, 9 )

• characterized as CHF( 8 )
• is the common type CHF characterized by decreased pump function, dilatation of LV,
and decreased LV ejection fraction( 10 )
• is the most widely used cardiac glycoside( 1 )
• this drug should be avoided in ventricular arrhythmias( 1 )
• it is the antidote for digoxin toxicity( 2 )
• a drug that increase digoxin levels( 3, 5,6 )
• decrease Na/H2O retention by inhibiting reabsorption of Na in loop of henle( 3 )
• the most common side effect of this drug is cough( 4 )
• drugs that decrease K levels( 3,6 )
89
Arrhythmias
Tips:
• Class 1a drugs are Na+ channel blocker Slows phase 1 depolarization
• Class 1b drugs are Na+ channel blocker Shortens phase 3 repolarization
• Class 1c Na+ channel blocker Significantly slow phase 0 depolarization
• Class II Beta blockers Decrease phase 4 depolarization
• Class III K+ channel blockers prolong phase 3 repolarization
• Class IV Ca2+ channel Shortens action potential
• What phases of action potential curve have no effect of stimuli (absolute refractory
period)  phase 1 to 3
• Relative refractory period is  phase 3
• Phase I action potential is 40 (+ve) due to Na+ entry
• What drug causes QT prolongation (torse des pointes) quinidine, procainamide,
diispyramide, amiodarone, sotalole and bretylium.
• Digoxin is contraindicated in what type of arrhthmiasVentricular arrhythmias
• A patient taking digoxin, the prescription is expired what will you do?
• Amiodorone side effects are: Photosensitive reactions, skin pigmentation, blurred
vision. Pulmonary toxicity, and pneumonitis.
• Class Ia drugs act on  slow phase 0, and prolong repolarization
• Proarrhythmic drugs are Amitriptyline
1 Quinidine 2 Amiodarone
3 Propranolol 4 Lidocaine
5 Procainamide 6: K Channel blockers
7: phase 1 to 3
• slows phase 0 depolarization( 1, 5 )
• it prolong phase 3 repolarization (increase refractory period) ( 2, 6 )

• use to treat cardioversion related arrhythmias( 4 )
• competitively block catecholamine induced stimulation of beta receptor thereby
suppress phase IV depolarization( 3 )
• chronic use of this drug may cause lupus like syndrome( 1,5 )
• when taking this medication grapefruit juice should be avoided( 2 )
• drug that cause QT prolongation (torse des pointes) ( 1, 2, 5, 6 )
• is absolute refractory period( 7 )
www.PharmacyPrep.Com Cardiovascular Disorders
90
Peripheral Vascular Disorders
Tips: Format 01: Write answers:
• Arterial Thromboembolism Acute therapy  Heparinized (80 u/kg) followed by

thromboembolectomy (thrombolytics treatment in all patients)
• Raynaud’s phenomenon Therapy peripheral vasodilator may relieve this condition.
• Raynaud’s phenomenon CI: Avoid prescribing medications with vasoconstrictive
potential: ergot derivatives, methylsergide and beta-blockers.
• Examples of vascular diseases angina, MI, and stroke
• Symptoms of deep vein thrombosis leg pain, swollen legs and tenderness
• What is pharmacotherapy for deep vein thrombosis warfarin, heparin and LMWH
• Intermittent claudication symptoms  cold feet, pulses are absent, and exercise induced
cramping pain.
• Raynaud’s phenomenon symptoms fingers spasm, extremities turn to pale, or blue.
• What is the drug of choice in Raynaud’s phenomenon CCBs
• What drugs should be avoided in Raynaud’s phenomenon Vasoconstrictors ergot
alkaloids, methesergide and beta blockers.
• Examples of vascular diseases 
• Symptoms of deep vein thrombosis 
• What is the pharmacotherapy for deep vein thrombosis 
PharmacyPrep.
www.PharmacyPrep.Com Cardiovascular Disorders
• Intermittent claudication symptoms 

• Raynaud’s phenomenon symptoms .
• What is the drug of choice in Raynaud’s phenomenon 
• What drugs should be avoided in Raynaud’s phenomenon 
• Symptoms of stroke 
• Drug of choice for transient ischemic stroke 
Tips format 002: Find answer from the table:
1 Smoking 2 Obesity 3 Increase age
4 Immobility 5 Severe pain in legs 6 Pale finger tips
7 Effects extremities 8 plaques 9 iv heparin
10 sc LMWH 11 Warfarin 12 fondaparinux
13 Embolism 14 Pulmonary embolism 15
16 17 18
19 20 21
22 23 24
25
• risk factors of venous thrombosis( 1,2,3,4 )

• symptoms of deep vein thrombosis( 5 )
• symptoms of Raynauds phenomenon( 6,7 )
• is not a cause of Raynauds phenomenon( 8 )
• is the initial treatment of established DVT/or PE( 9, 10, 11 )
• are enoxaparin, dalteparin, tinzaparin, and nadroparin are approved for both prophylaxis
and treatment of VTE( 10 )
• is the first of a new class of antithrombotic agents, the specific factor Xa inhibitors. ( 12 )
PharmacyPrep.
91
Anticoagulants
Tips
• Heparin antidote  Protamine Sulfate, act by neutralization

• A patient taking heparin monitored for aPTT
• Heparin site of actions include in vitro and in vivo
• What anticoagulant can be used in pregnancy Heparin
• What are the factors heparin inhibits 2a, 9a, 10a, 11a, 12a, 13a
• Monitor warfarin through PT and INR
• What do you monitor in LMWH No monitoring
• Vitamin K supplements and green vegetable effect on INR by increase clotting risk
• Increase in INR can increase risk of bleeding
• Heparin antidote action with protamine sulfate is due to neutralizing
• If patient taking warfarin and INR is 4 to 5, what is appropriate recommendation
Dose adjustment
• ASA interact with warfarin by  antiplatelet action
• Warfarin act on what factors  2,7, 9, 10
• A patient after 2 days, air flight, reports pain on his legs. His medical history
includes, DVT and currently using warfarin  INR possibly less than 2 to 3
• Recurrence of heparin induced thrombocytopenia syndrome can be prevented by
using heparinoids (danaparoid)
• What free flowing clotting factor in blood  prothrombin
• Normal levels of aPTT is  25 to 30 seconds
• Examples of LMWH  EDTA
Tips: Format 02: Find answers from the table:

1 Heparin 2 iv & sc
3 Protamine Sulfate 4 Warfarin
5 LMWH 6 Vit K
7 Enoxaparin 8 ASA
9: Alteplase
• this drug interacts with warfarin because of its antiplatelet action ( 8 )
• it is the major thrombolytic drug for DVT and pulmonary embolism ( 9 )
• it catalyzes the factor (thrombin activation factor) 2a, 9a, 10a, 11a, 12a,&13a (1 )
• it is use in the prevention of DVT or PE, NSTEMI and unstable angina ( 4, 8 )
• it acts longer and do not require close blood monitoring ( 5, 7 )
• it is an anticoagulant used to prevent blood clots, mainly in areas where blood flow is
( 4 slowest, particularly in the leg and pelvic pains
• PT & INR should be monitored when taking this drug ( 4 )
• it is the antidote for warfarin(6 )
• it is the safest anticoagulant used in pregnancy( 1 )
• it is the antidote for heparin and it act by neutralization( 3 )
www.Pharmacyprep.com Anxiety Disorders
92
Anxiety Disorders
Tips Exercise Format 01: Write answers
________________________________________________________________________
• Panic attack and panic attack with or without agoraphobia example  with phobic of
snake may panic when encounter with snake.
• Social anxiety disorder (SAD) and (or) social phobia example  social or
performance situations and Intolerance of embarrassment or scrutiny by others
• Specific phobia example  an animal, blood, injections, heights, storms, driving,
flying, or enclosed places).
• Excessive or unreasonable fear of a circumscribed object or situation usually
associated with avoidance of the feared object.
• Obsessive compulsive disorder (OCD)  obsessions; recurrent, thoughts, images, or
urges, thoughts about contamination, doubts about actions, distressing religious,
aggressive, or sexual thoughts
• Compulsions; repetitive behaviors or mental acts example, checking, washing,
counting, or repeating)
• Generalized anxiety disorder (GAD) example excessive worry headaches or upset
stomach)
• Posttraumatic stress disorder (PTSD) example  intense fear, helplessness, or horror.
• Obsession is repetitive thoughts
• Compulsion is repetitive actions
• Paroxetine indicated for  PD, SAD, OCD, GAD, and PTSD
• Propranolol is used in anxiety of  stage fear

1 Benzodiazepines 2 Flumazenil 3 Fluoxetine
4 Sertraline 5 Paroxetine (Paxil) 6 Fluvoxamine
7 Venlafaxine 8 Paroxetine (Paxil CR) 9 Buspirone
• are minor tranquilizers used to treat insomnia and anxiety ( 1 )
• it is the antidote for benzodiazepine ( 2 )
• drugs that are use for Obsessive-Compulsive Disorder (OCD) ( 3,4,5,6 )
• drugs that are use for Post Traumatic Stress Disorder (PTSD) ( 3,4,5,6 )
• drugs that are use for Generalized Anxiety Disorder (GAD) ( 3,4,5,6 )
• drugs that are use for Social Anxiety Disorder (SAD) & social phobia ( 3,4,5,6 )
• Paroxetine is indicated for  depression, anxiety, and bipolar depression
• Obsession is repetitive thoughts
• Compulsion is repetitive action
www.PharmacyPrep.Com Depression
93
Depression
Tips Excercise Format 02: Write answers
• SSRI onset of action is  2 to 4 wks and optimal effects 4 to 6 wks

• Fluoxetine washout period  5 weeks
• Buprapion, trazadone and mirtazepine have least sexual dysfunction
• Drug of choice in depression with sexual dysfunction  Use Buprapion
• Depression with insomnia  use trazadone
• Depression with diabetes  avoid TCA and MAO due to its weight gain
• Take SSRI in the morning
• Take TCAs in evening or bedtime
• Higher dose of venlafaxine (225mg/day) have effect on  5HT and NE
• Patient on antidepressants and shows with dilated pupil, may be due to TCA
intoxication
• TCA onset of action is  4 to 6 weeks
• A substance found commonly in fermented foods which can be toxic when MAO
inhibitors are used Tyramine
• MAO is classified as  enzyme
• SSRI inhibit cytochrome  CYP2D6
• Mirtazepine may cause SE weight gain
• Avoid cheese with  Phenelzine (MAOI)
• Milk + MAOI  Safe
• St. John wort have  antidepressant effect
• Serotonergic symptoms vomiting, hypotension, palpitation, fever, agitation (not
sleep), coma, death
• DOC in Bipolar disorders and manic depression  Lithium carbonate
• Normal blood levels of lithium in adult is 1.5 mEq/L
• Lithium concentration varies with Na+ ions
• Li+ conc. increases with decrease Na+
• Li+ conc. decreases with Increase in Na+
• ACEI decrease Na+  Increase Li+
• NSAID decrease Na+ renal perfusion is less
• Thiazides deplete Na+ and increase Li+ concentration
• Fluoxetine (SSRI) increase Li+ toxicity
www.PharmacyPrep.Com Depression
• Renal dysfunction  Li+ increase

• Dehydration and diarrhea Li+ increases
• Lithium toxicity symptoms 
• CNSseizures, cerebrovascular, confusion, drowsiness, dizziness
• CVS change in heart rate, fluid retention
• Examples of SNRIs  venlafaxine, duloxetine and sibutramine
Tips Excercise Format 01: Find answers from the table:

1 Phenelzine 2 Moclobemide
3 Mirtazepine 4 Venlafaxine
5 Bupropion 6 Lithium
7 Trazodone 8 Fluoxetine
9 Amitriptyline 10 SSRI
11 TCAs MAO Inh.
• selectively blocks the prejunctional neuronal reuptake pumps in the CNS ( 8,10 )
• it is the most anticholinergic and sedative TCA(9 )
• it is use in depression with insomnia(7 )
• it requires 5 weeks washout period( 8 )
• it is also used for smoking cessation( 5 )
• it is use in depression with sexual dysfunction( 3,4,5 )
• it is an irreversible non selective MAO( 1 )
• it is the only reversible & selective inhibitor of MAO that is currently available(2)
• it acts directly on noradrenergic system & has low rate of GI and sexual side
effects but is associated with sedation and weight gain( 3 )
• it is also use for Generalized Anxiety Disorder (GAD) ( 8,10 )
• it is use in prophilactically in treating manic-depressive patient, treat manic
episodes & bipolar depression( 6 )
• serum level should not exceed 1.5 mEq/L( 6 )
Pharmacyprep.com Antipsychotic Drugs
94
Anti Psychotic Drugs
Tips Excercise 2: Write answers
• 1st gen (haloperidol, loxapine, chlorpromazine, thioridazine) is effective in positive
schizophrenic symptoms. However, 2nd gen (clozapine, risperidone, olanzapine,
quetiapine) covers negative schizophrenic symptoms. Olanzapine, not effective for
the treatment of resistance, and resperidon works for negative and positive symptoms.
• Orthostatic hypotension is SE of  2nd generation antipsychotics (can cause additive
effects with other antihypertensive drugs)
• Mechanism of clozapine  D 2 , D 4 , 5HT, H 1 , M and α 1 blockers
• Drug of choice for acute agitation in seniors Quetiapine
• 1st generation 4 to 8 weeks no response, change to 2nd generation.
• Severe case of psychosis (schizophrenia) or bipolar disorder  For 2 episode,
continue for 2 to 5 yrs
• 2nd gen (clozapine, olanzapine) increase risk of lipids and diabetes, EXCEPT:
Respiridone
• Least extra pyramidal symptoms  2nd generation risperidone and quetiapine.
• Highest EPS  1st generation haloperidol
• Patient experiencing hallucination  haloperidol (1st gen for +ve symptoms)
• Patient experiencing social withdrawal  2nd generation for –ve symptoms
• 2nd generation covers -ve symptoms like social withdrawal, lack of interest and
isolation
• Schizophrenia is characterized by 
• Metoclopramide  antinauseating drug
• Chlorpromazine 1st gen antipsychotics
• Tardive dyskinesia is caused by  antipsychotics
• For resistance schizophrenia DOC  clozapinea
• For hiccups  Thioridazine may be used
1 Zuclopenthixol 2 Haloperidol
3 Chlorpromazine 4 Risperidone
5 Clozapine 6 Olanzapine
• it is not use in antipsychotic- naive patients( 1, 5 )
Pharmacyprep.com Antipsychotic Drugs
• it is the only antipsychotic with proven efficacy in treatment-resistant

Schizophrenia( 5 )
• the most widely used treatment for psychotic agitation( 2 )
• it is use in patients experiencing social withdrawal( 4,6 )
• this can cause lupus like syndrome( 3 )
• this should not combine with parenteral benzodiazepines( 1 )
• the highest extra pyramidal symptoms( 2 )
• WBC should monitored, because have high agranulocytosis( 5 )
• act on dopamine and serotonin receptors almost equally( 4,5,6 )
www.PharmacyPrep.Com Dementia
95
Dementia
Dementia
1 Donepezil 2 Rivastigmine
3 Galanthamine 4 Memantine
5 Tacrine 6: Mild dementia
7: moderate dementia 8: decrease ACh
• Alzheimers occurs due to  ↓ Ach

• DOC for Alzheimers is Donepezil
• it is non selective & limited use because of its hepatotoxicity( 5 )
• causes Alzheimer’ dementia( 9 )
• the drug of choice of Alzheimer’ dementia( 1 )
• effective in Alzheimer’s & vascular dementia( 2 )
• effective in Lewy body dementia( 2 )
• the drug of choice for Alzheimer’s disease( 1 )
• drug that has anorexia side effect( 1 )
• it is effective for patients with dementia associated with Parkinson’s disease
• N-methyl D-aspartate (NMDA) blocker( 4 )
• forgeting instrumental activities of daily living (phone #s, keys, driving direction,
finance) ( 6)
• forgeting daily activities (bating, feeding, dressing), recalls upon reminders. ( 7 )
• Donepezil and rivastigmine and galatamine all have anorexia SE.
• Delirium is  acute agitation, lack of judgement and thinking.
• Amnesia is short loss of memory
• What are risk factors for Alzheimers disease  Age, gender, and family history
• Levy body dementia  dementia with hallucination
• Galantamine is classified as  anticholinesterase inhibitor
• Tacrine: Oldest drug, it is non selective and limited used because of its
hepatotoxicity.
• Donepezil: Centrally active reversible, non competitive. It selective and have greater
affinity for AchEI in brain than periphery. Little or no hepatotoxicity.
• Rivastigmine: is centrally selective arylcarbamate AchEI, it has short half-life of 2
hours, but able to inhibit AchEI upto 10 hours. Because of slow dissociation of
carbamate enzyme it is referred as pseudo-irreversible AchEI.
• Memantin (Ebixa) NMDA inhibitor
www.PharmacyPrep.Com Epilepsy
96
Epilepsy
Tips Format
Find answers from the table:
1 Carbamazepine 2 iv Diazepam
3 Phenytoin 4 Gabapentin
5 Topiramate 6 Valproic acid
7 clobazam 8 phenobarbital
9 gingerval hyperplasia 10 steven jhonson syndrome
11 simple partial seizures 12 Generalised seizure
13 petit mal (absence) seizures 14 tonic clonic
15 Status epilepticus
• it has the least drug interaction with oral contraceptives( )

• the drug of choice for status epilepticus( )
• it is use for partial seizures and tonic clonic seizures( )
• it causes Steven Johnson syndrome side effect( )
• it is not effective in absence (petit mal ) seizures( )
• the drug of choice for trigeminal neuralgia( )
• it enhances GABA activity; antagonizes amino acid( )
• the drug of choice for generalized seizure( )
• it decrease the efficacy of oral contraceptives( )
• What type of seizure in-patient is NOT unconscious? Simple partial
• Carbamazepine interferes with thyroid function test
• Phenobarbital and phenytoin stimulates  Hepatic microsomal enzymes (HME)
• Carbamazepine is DOC for  trigeminal neuralgia and partial seizures
• DOC for status epilepticus is  iv diazepam
• Avoid phenytoin in  petit-mal (absence seizures)
• Phenytoin overdose have  zero order (saturated) kinetics
• Gingival hyperplacia associated with phenytoin is treated by mouth hygiene and
chlorohexidine mouth wash.
• Chlorhexidine is mouth rinse used for the treatment  gingivitis, stomatitis
(mucositis)
• Carbamazepine, phenytoin, clonazepam  decrease efficacy of oral contraceptives
• Gabapentin and valproic acid, lamotrigine have no interaction with oral
contraceptives
• Topiramate cause  weight loss, and kidney stones
www.PharmacyPrep.Com Epilepsy
• Gabapentin has least  drug interactions with oral contraceptives

• Phenytoin available as  suspension, iv, chewable tablets and capsule.
• Carbamazepine available as  chewable tablets, liquid
• Clobazam has high  tolerance
• Gabapentin indicated for  diabetic neuropathy, post herpetic neuralgia and
trigeminal neurologia
• Pregabalin indicated for  diabetic neuropathy and post herpetic neuralgia
• Lamotrigine  have low teratogenic (alternate drug of choice in pregnancy)
• Symptoms of Steven Jhonsons Syndrome  Rash skin peeling, sores on mucus
membrane, blistering mucus membrane, typically mouth, eyes and vagina. Patchy
areas rashes. (SASPAN)
• Xerostomia  dryness of mouth
• Sialorrhea  excessive saliva
• Vigabatrin + carbamazepine  worsen absence seizures
• A patient is on phenytoin but now dose is increased, when is the appropriate time to
measure steady state 5 to 30 days
• Phenytoin blood levels monitored for  10 to 20 mcg/mL
• Chlorhexidine is  antiseptic, and disinfectant mouth rinse
• List the monitoring parameters for phenytoin. Plasma phenytoin levels, liver
function tests, CBC, blood pressure, vital signs (with iv use).
• GABA analogs include  Gabapentin, vigabatrin and pregabalin
• Fabrile seizure occurs to  children from 3 months to 5 years due to high fever
www.PharmacyPrep.Com Anti-Parkinson's Drugs
97
Anti-Parkinson’s Drugs
Anti-Parkinson’s Drugs
1 deficiency of dopamine 2 Amantadine

3 Entracapone 4 Levodopa
5 Selegiline 6 Tolcapone
7 levodopa/carbidopa 8 Bromocriptine
9 does not cross blood brain barrier 10 tardive dyskinesia
11 MAO- type B inhibitor 12
• PD is due to decrease in  (1)

• it is a non selective dopamine agonist ( )
• it is converted to dopamine within presynaptic dopaminergic neurons( )
• it is indicated in Parkinson’s disease and also for prevention and treatment of
Influenza A viral infections( )
• it a selective MAO type B inhibitor( )
• it help prevent peripheral metabolism of levodopa, which increase its availability
• to the brain( )
• Levodopa does penetrate into brain (crosses the blood-brain barrier)
• Dopamine does not penetrate into brain (does not cross the blood-brain barrier)
• Carbidopa does not penetrate into brain (crosses the blood-brain barrier)
• Parkinson’s disease is due to decrease in Dopamine

• Levodopa does penetrate into brain
• Dopamine does not penetrate into brain
• Carbidopa does not penetrate into brain
• Dyskinesia involuntary movement
www.PharmacyPrep.Com Anti-Parkinson's Drugs
• Deficiency of dopamine gives  Parkinsons disease

• Parkinsons disease symptoms are  TRAP (Tremor, Rigidity, Akenesia, and postural
unstability)
• Tardive dyskinesia  inappropriate posture of neck, limbs and face
• Metochlopramide an antinauseating drug should be avoided in PD patient
• All antipsychotic required caution in PD
• Levodopa/carbidopa is DOC in PD
• Selegline is a selective MAO- type B inhibitor
• Tolcapone and entacapone are  COMT inhibitor
• Akinesia  Characterized by difficulty in initiating movement
• Bradykinesia  slowness in performing common voluntary movement, including,
standing, walking, eating, writing, and talking.
• Over treatment of Parkinsonism drugs can result into Psychotic symptoms
• Sciatic nerve  are found in all foot branches
• Why do we add entracapone to levodopa treatment in parkinson’s entacapone
prevents levodopa degradation
• Metochlopramide an antiemetic drug should be avoided in PD patient
• All antipsychotics require caution in PD
• Levodopa/carbidopa is DOC in PD
• Selegline is a selective MAO- type B inhibitor
• Akinesia  Characterized by difficulty in initiating movement
• Bradykinesia --> slowness in performing common voluntary movement, including,
standing, walking, eating, writing, and talking.
• Over treatment of Parkinsonism drugs can result into Psychotic symptoms
98
Antimicrobials
Summary of Cell wall synthesis inhibitors
• Methicillin is only IV and IM

• Penicillin G benzathine has long half life  24 to 60 hours
• Naficillin is mainly hepatic elimination
• Beta lactamase sensitive drugs  Pen G, Amoxi, Pen V and ampicillin
• Endocarditis prophylaxis is  Amoxicillin
• Drug of choice for otitis media  Amoxicillin +/-clavulanate
• A child less than 2 yrs allergic penicillin, what is the drug choice for otitis media
treatment Clindmycin (if above 3 years, macrolides can be used)
• A patient has heart diseases and underwent prostatic valve surgery. Dentist plans to
tooth extraction, what antibiotic is suitable for endocarditis prophylaxis
Amoxicillin, or macrolides, or clindamycin
• Chewable antibiotics Amoxicillin (indicated strep throat treatment)
• Beta lactams that should be taken empty stomach  Ampicillins, Penicillin v and
cloxacillin
• Aminopenicillins are  Amoxicillin and ampicillin
• Penicillin allergic patient, alternate drug of choice is?  Macrolides (erythromycin)
• Penicillins are ineffective in treatment of bacterial infections associated with 
Mycoplasma
• MRSA infections are treated by Vancomycin

• P.colitis associated diarrhea is treated by  Oral Vancomycin
• Bacteria is inhabitant in GI, what location of GI tract is commonly found  Colon
• Type of bacteria mainly present in colon is  90-95% anaerobic bacteria
• On which part of penicillin molecule, oxidase act beta lactams ring and the side
chain
• On which part of penicillin molecule, penicillinase act  beta lactams ring
• Penicillin is metabolized by penicillinase to  penicilloic acid
• Penicilloyl polylysin is used as skin test for penicillin allergy test
• Which antibiotic is both penicillinase and acid resistant cloxacillin
• Cephalosporin 2nd generations available as i.v  cefuroxime sodium
• Cephalosporin 3rd generation available as oral  cefexime
Macrolides
• Erythromycin, clarithromycin and azithromycin, telethromycin
• Erythromycin side effect  GI upset (ketal cause GI upset)
• Azithromycin suspension stored at  Room temp
• Clarithromycin suspension stored at  Room temp
• Which macrolide suspension have to refrigerate after reconstitution  Erythromycin
• What antibiotics should caution and require monitoring in patient receiving warfarin -
 Clarithromycin
• What antibiotic potentiate the effect of digoxin and can cause digitalis toxicity 
Erythromycin and clarithromycin, tetracycline
• Azithromycin is the drug of choice in traveler diarrhea for person traveling to 
Thailand
• Erythromycin is effective against  gram +ve cocci
• Erythromycin estolate side effects  reversible cholestatic hepatitis, jaundice, and
fever
Tetracyclin
• Tetracyclin are contraindicated are contraindicated in  pregnancy and children.
• Tetracyclin can stain teeth and discoloration.
• Oral or topical tetracycline are drug of choice for acne treatment
• Tetracyclin MUST BE taken empty stomach.
• Tetracyclin binds Bi and tri valent (Calcium or Aluminum)
• GI distress (abdominal discomfort, diarrhea) most common SE. This can be resolved
by taking with food or decreasing dose.
• Expired tetracycline can lead Renal tubular necrosis or renal toxicity
• Doxycyclin is the DOC Prophylaxis in traveler diarrhea
• Doxycyclin should be taken with or after food
• Minocyclin may take with or without food.
• Phototoxic reactions (sever skin lesions) can develop with exposure to sunlight.
Photoxicity is the most common with doxycyclin or demeclocyclin.
• Epimerization is a  optical isomerism
• Mycoplasma pneumonia is treated by  marolide or tetracyclin
Clindamycin
• Most common complication of clindamycin is  P.colitis (diarrhea)
• Clindamycin active against  gram +ve, -ve and anaerobic bacteria.
• Pseudomembranous colitis symptoms include  fever, abdominal pain, and bloody
stools.
• Clindamycin can cause  Blood dyscariasis (esonophilia, thrombocytopenia,
leukopenia).
• Clindamycin drug associated diarrhea is treated by Vancomycin oral or
metronidazole. Over the counter antidiarrheal have NO benefit.
• Clindamycin suspension stored at  Room temperature
• Clindamycin should taken  With or without food
• Clindamycin is available  i.v, oral and suspension
Quinolone and fluroquinolone

• Mechanism of action of quinolone is  DNA gyrase inhibitors and topoisomeraze II
• Cipro, levo and moxi available as  po and iv

• Fluroquinolones are indicated for  UTI, Infectious diarrhea (travellers diarrhea), re
lower respiratory tract infections, bone and joint infections (osteomylitis).
• Gatifloxacin, Moxifloxacin SE are  QT prolongation
• Contraindicated in children, less than 18 year, pregnant women due to its Cartilage
erosion.
• Antacids, bivalent and trivalent ions significantly decrease absorption of 
fluroquinolones and tetracyclin
• Fluroquinolone increase INR in patient receiving warfarin, therefore monitor 
prothrombin time (PT)
• Fluroquinolones can cause hypo or hyperglycemia, therefore monitor blood sugar
levels in diabetic patient.
• Fluroquinolones at higher alkaline pH can cause crystalluria
• Cipro is the drug of choice in  travelers diarrhea
• The only Quinolone that is taken empty stomach is  norfloxacin
Metronidazole
Indications are  GET a Metro
• Alcohol with metronidazole can cause  disulfiran like reaction
• Metronidazole is classified asAntiprotozoal drug and antibiotic
• Metronidazole is effective against  C. difficle, B. fragilis, amebia, C. vaginalis
(bacterial vaginitis), Giardiasis, trichomonas, H. pylori, and P.colitis
• Metronidazole discolor urine
• Metronidazole caution in pregnancy
Sulfadrugs
• Mechanism of sulfa drug antibiotis inhibit synthesis of dihydropteroic acid
• Sulfamethoxazole + trimethoprim have  Synergistic.

• A 22-year-old patient currently using cotrimoxazole for UTI, reported sever blisters
on mucus membrane, and eyes. What are the possible reactionsStevens Johnson
Syndrome, it is a hypersensitive reaction of sulfadrugs.
• What are the folic acid synthesis inhibitorsSulfadrugs, methotrexate, trimethoprin,
5FU, pyremethamine, and dapsone.
• Patient with G6PD deficiency, takes sulfadrugs can cause  Hemolytic anemia
• Hypersensitive reactions of sulfadrugs most commonly involve Skin and mucous
membrane: manifestation include skin rash, exofoliative dermatitis, and
photosensitive. Drug fever and serum sickness also may occur.
• Life threatening hepatitis caused by sulfadrug toxicity or sensitization rare SE, the
signs and symptoms include Headache, nausea vomiting, and jaundice
• Sulfamethoxazole have high frequency of skin hypersensitive reaction in patient with
 AIDS
• If used in last trimester of pregnancy, can cause kernecterus in new born.
• Cotrimoxazole suspension stored at room temperature in amber color glass bottle.
• P. carinii pneumonia (PCP) drug of choice is cotrimoxazole.
Four antibiotic suspension that should be stored at room temeperature are:

Azithromycin
Clarithromycin
Cotrimoxazole
Clindamycin
Antibiotics that should be taken empty stomach
Ampicilin
Penicilin V
Tetracyclin
Naficillin
Azithromycin
Norfloxacin
Antimicrobials
1 Vancomycin 2 Penicillins 3 Tetracycline
4 Clarithromycin 5 Streptomycin 6 Azithromycin
7 Minocycline 8 Clindamycin 9 Metronidazole
10 Doxycyclin 11 Ciprofloxacin 12 Cotrimoxazole
• use in gram +ve anaerobic bacteria Bacteroid fragilis (abdominal infection) ( )

• it should be stored at room temperature( )
• it is not effective for Mycoplasma bacteria( )
• it increase Warfarin INR, increase Digoxin & theophylline levels( )
• it is effective for H. pylori (used along with PPIs in triple therapy) ( )
• it is use in treatment of acne( )
• drug for treating methicillin-resistant Staphylococcus aureus infections( )
• it has the highest ototoxicity( )
• it is more active against gram-ve H. influenza than Erythromycin( )
• it is use for acne and rheumatoid arthritis( )
• must avoid alcohol while on this drug because it cause disulfiram like reactions(
)
• it is use as prophylaxis in traveller’s diarrhea( )
• the drug of choice for UTI 7 traveller’s diarrhea( )
• it is use in chronic treatment of UTI( )
www.PharmacyPrep.Com Anticancer Drugs and Chemotherapy
99
Anticancer Drugs and
Chemotherapy
Tips Format 1
Find the answers from the table:
1. alopecia 2. neutropenia 3. chemotherapy

4. Doxorubicin 5. Daunorubicin 6. Cyclophosphamide
7. Vincristine 8. Paclitaxel 9. Tamoxifen
10. Bleomycin 11. Methotrexate 12. Vinblastine
13. xerostomia 14. 5-fluorouracil 15. Cytarabine,
16. Mercaptopurine, 17. Thioguanine 18. Methotrexate
19. Skin cancer 20. 21.
• the treatment of cancer with drugs is called? (chemotherapy)

• it is the loss of hair ( )
• Drugs that cause alopecia( )
• is one of the most common complications associated with radiation therapy ( )
• treated by colony stimulating factor(neutropenia)
• lowest emetic anticancer drugs(Tamoxifen, Bleomycin, Methotrexate, Vincristine,
Vinblastine)
Tips Format 02
• Goal of therapy in chemotherapy in terminally ill patient is? Pain relief, mimizing
side effect, follow up, (may not be cost effectiveness)
• Examples antimetabolites include methotrexate, 5 FU, mercaptopurine, citarabine
and theoguanine
• Examples of alkylating anticancer drugs Cisplatin, cyclophophamide, streptozocin
• Non pharmacological measures to prevent nausea and vomiting associated with

caneer chemotherapy avoid large meals, take small and frequently, avoid fat and
spicy
• Melonoma is  skin cancer
• Metoclopramide and dexamethasone are more effective nausea related to acute
nausea and vomiting
• Methotrexate is used for RA, cancer and psoriasis
• Which anticancer drugs cause pulmonary fibrosis bleomycin
• Hypertropy is  enlargement of cells
• Hyperplasia is  increase number of cells
• Least emetic anticancer drug is tamoxefine
• Cancer patient on cancer chemotherapy, reports shortness of breath, non productive
cough, she may be using drug Bleomycin
• DOC for delayed Nausea and vomiting  dexamethasone
• Mesna is uroprotective agent
• Doxorubicin preparation should be performed in  vertical laminar airflow hood
• Melatonin  regulates sleep
• Peclitaxel and docetaxel act on  Cell cycle phase M
• Cancer estimated deaths in men: Lung cancer 31% and Prostate cancer 11%
• Cancer estimated deaths in women: Lung cancer 25% and Breast cancer 15%
• Examples antimetabolites include -->
• Examples of alkylating anticancer drugs -->
• Non pharmacological measures to prevent nausea and vomiting associated with
caneer chemotherapy.
• Melonoma is 
• Metoclopramide and dexamethasone are more effective against nausea related to 
• Methotrexate is used for 
• Which anticancer drugs cause pulmonary fibrosis
• Hypertrophy is 
• Hyperplasia is 
• Least emetic anticancer drug is 

• Cancer patient on cancer chemotherapy, reports shortness of breath, non productive
cough, she may be using drug 
• DOC for delayed Nausea and vomiting  dexamethasone
• Mesna is 
• Doxorubicin preparation should be performed in 
• Hypertropy is 
• Hyperplasia is 
• Melatonin 
• Peclitaxel and docetaxel act on 
• Cancer estimated deaths in men: Lung cancer 31% and Prostate cancer 11%
• Cancer estimated deaths in women: Lung cancer 25% and Breast cancer 15%
100
Pharmacognosy and Natural
Products
Tips
• Echinacea Common cold

• Saw palmetto Prostate (BPH-Benign Prostate Hyperplacia)
• Garlic  lipid levels
• Feverfew  Migrane
• Gincgo Increase memory
• St. Johns wart  antidepressant
• Bitter melon anti-diabetic
• Prime rose oil  PMS (premenstrual syndrome)
• Atropine anticholinergic
• Vincristine and vinblastinanti-cancer
• Taxol (pecli-taxol)Yew plants (himalayas)
• several types of cancers

Misbah 2016-Tip Answers

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Misbah 2016-Tip Answers

Uploaded by

Copyright:

Available Formats

Pharmacyprep.

com Human Anatomy

1. supination 2. flexion 3. abduction

4. extension 5. adduction 6. parasagittal plane

7. Sagittal plane 8. Midsagittal plane 9. kneecap

10. Biceps bronchi 11. Triceps bronchi 12. dysphagea

13. dysurea 14. etiology 15. dyspnea

16. extensor muscles 17. flexor muscles 18. pubis

19. ilium 20. ischium 21. transverse plane

22. Endocrine glands 23. arteries 24. skull bones

• (abduction) movement away from the midline of the body

1. diarrhea 2. constipation 3. bloating

• most basic part of the GI tract( colon)

• soya milk allergies due to(proteins)

• Proteins are digested by by chymotrypsin and trypsin

• Celiac disease is caused by  gluten present in cereal

• Sciatica nerve pass through buttocks, thighs down to foot

• Absolute refractor period or Effective refractory period  Phase 1 to starting phase 3 is 

• Internal carotid artery supply blood  from heart to brain

• Adrenal cortex secretes  aldosterone, androgen, and corticosteroids

Hyperparathyroidism Excess production of PTH Increased serum calcium

1. adrenal medulla 2. pituitary gland 3. posterior pituitary

• Glycolysis ---------Glucose→(H2O + CO2)

Reasoning and Problem solving

• What is the abundant metal in body? Iron

1. hypokalemia 2. in kidneys 3. creatinin clearance

• Ascietes is caused by liver cirrhosis, infections, and cancer

Reasoning and Problem Solving

• What is enterohepatic recirculation?

• What type of hepatitis is chronic  Hepatitis B and C

• What is treatment of hepatitis  Interferons

1. Penicillamine 2. ascites 3. Wilsons disease

• what type of hepatitis is chronic? (hepatitis B & C)

• COPD symptoms: inflammation, cough, phlegm, excessive mucus, infections,

Tips format 02: Find answers from the table:

1. asthma 2. emphysema 3. dyspnea

• The retina contains two types of photoreceptors, rods and cones.

• Characteristic of both Vitamin B 12 and folic acid deficiency  Megaloblastic anemia

anemia due to deficiency of iron (microcytic anemia)

common side effect of iron supplement (constipation)

• Methemoglobin is? Methylated hemoglobin

• End product of anaerobic Glycolysis  lactic acid or lactate

• Tryptophan is a precursor of the neurotransmitter serotonin.

• NO is a derivative of what amino acid? (arginin)

• Normal serum potassium levels?  3.5 to 5 mEq/L

• What cardiac enzyme exclusively elevated after MI  Troponin-I

• Bilirubin is  a breakdown product of hemoglobin, it is predominant pigment in bile.

• What liver enzymes are elevated with overdose of Acetaminophen AST/ALT

Tips Format 02: Find answers from the table:

• normal range of serum potassium levels? (3.5 to 5 meq/L)

• Elderly have deficiency of  vitamin B12

• Infants on breast milk should receive  vitamin D

• Vegetarians have deficiency of  Vitamin B12

• A person is smokers should receive  Vitamin C

• Stethorrhia can cause deficiency of Fat soluble (ADEK)

• Forms of vitamin A found in rods of retina  rodapsine

• What vitamins supplements are contraindicated in pregnancy  vitamin A

• Omega 3 fatty acid is  Linolenic acid

• Omega 6 fatty acid is  linoleic acid

• Alpha fatty acids are present in  Flax seeds, walnut etc.

• DHA  Docasahexanoic acid

• EPA  Eicosapentanoic acid

• What vitamins have steroidal structure  Vitamin D

• A patient using orlistat (xenical), what vitamin are recommended  ADEK

0.0001 kg = X_ X = 94.6 kg

_0.4 mg = X_ 0.001 g = _1_