PHARMA

●The mnemonic " A O DEVICES " can be used to memorize the commonly encountered cytochrome p450
enzyme inhibitors which also potentiate the effects of warfarin resulting in a raised INR.

Amiodarone

Omeprazole

Disulfiram

Erythromycin (and other macrolide antibiotics>> Clarithromycin…)

Valproate (sodium valproate)

Isoniazid

Ciprofloxacin

Ethanol (acute ingestion “alcohol”)

Sulphonamides

●The mnemonic "PC BRASS "can be used to memorize cytochrome p450 enzyme inducers inhibit the effects of
warfarin resulting in a reduced INR.

Phenytoin

Carbamazepine

Barbiturates

Rifampicin

Alcohol (chronic ingestion)

Sulphonylureas

Smoking

N.B.: Vancomycin monitoring is only recommended in patients with renal impairment, children and morbidly obese

patients (routinely carried out to minimize the risk toxicity and maximize the risk of efficacy)

Laxatives

Docusate is an example of a stool softener.

Lactulose is an example of a hyperosmotic agent.
Methylcellulose is an example of a bulking agent
Psyllium husk is an example of a bulking agent.
●The potency of adrenaline and noradrenaline at alpha and beta receptors is as follows:

Alpha1: Adrenaline > Noradrenaline

Alpha2: Adrenaline > Noradrenaline

Beta1: Adrenaline = Noradrenaline

Beta2: Adrenaline >> Noradrenaline

Beta3: Noradrenaline > Adrenaline

●Salicylate poisoning:- (A) Common features of salicylate poisoning include:

 Nausea and vomiting

 Tinnitus
 Lethargy
 Dizziness
 Restlessness
 Sweating
 Bounding pulses
 Warm extremities
 Hyperventilation

(B) Uncommon features of salicylate poisoning include:

 Hematemesis
 Hyperpyrexia
 Hypoglycemia
 Thrombocytopenia
 DIC
 Renal failure
 Non-cardiogenic pulmonary edema

Risk factors for death in severe poisoning include:

-Age < 10 or > 70 years

-CNS features
-Metabolic acidosis
-Hyperpyrexia
-Late presentation
-Pulmonary edema
-Salicylate concentration > 700 mg/L

●Drugs causing Gynecomas a: Digoxin, Cimetidine (resolve when substituted with ranitidine), omeprazole, spironolactone,
furosemide, finasteride, Marijuana” Cannabis”, and some anti-psychotics

●Ecstasy is a phenylethylamine compound with similari es to amphetamines and mescaline, Recognized side effects
includes: fulminant hyperthermia, convulsions, rhabdomyolysis, inappropriate ADH secretion, DIC, liver failure and
cerebrovascular accidents (CVA).
●Bactericidal an bio cs kill bacteria whilst bacteriostatic antibiotics slow their growth or reproduction.

Aminoglycosides are BACTERICIDAL "G-ve mainly "e.g. Gentamicin "not given orally", Examples of bactericidal antibiotics:
C/P FLU&CMV

 Cephalosporin
 Penicillin
 Fluoroquinolones
 Co-trimoxazole
 Metronidazole
 Vancomycin

NB:. Co-trimoxazole (2 components “Trimethoprim & Sulfamethoxazole “each one separately is Bacteriosta c but together
inhibit bacterial folic acid synthesis >>> Bactericidal )

●Bacteriosta c:

 Chloramphenicol
 Clindamycin
 Macrolides (Erythromycin)
 Sulfonamides
 Tetracycline
 Trimethoprim

●Methaemoglobinaemia:-Drugs that can cause methaemoglobinaemia include antibiotics such as “trimethoprim and
Sulfonamides”, local anaethesetics such as” prilocaine, metoclopramide and nitrates”.

-Is associated with pyruvate kinase deficiency, this is due to impaired production of NADH.

-There will be a significant degree of cyanosis with concentrations greater than 1.5 g/dl& Cyanosis > 2 g/dl.

-The genetic form is caused by a defect in NADH metabolism and is autosomal recessive.

*Drugs that cause erythema multiforme include: Sulphonamides, barbiturates, carbemazepine, phenytoin, antiobiotics
including penicillins and cephalosporins, antituberculous drugs including isoniazid, NSAIDs, paracetamol and many others

●Cocaine can cause numerous adverse effects upon the cardiovascular system including:

 Hypertension
 Cardiac arrhythmias
 Coronary vasoconstriction
 Coronary thrombosis
 Myocardial ischemia
 Aortic aneurysm
 Cardiomyopathy

●Drugs that require rou ne monitoring include: Gentamicin, digoxin, theophylline, phenytoin, lithium, cyclosporine
&carbamazepine.

●Drugs that undergo first pass metabolism include: Verapamil, salbutamol, GTN, amitriptyline, Naloxone, propranolol and
pethidine.
● The BTS guidelines for the management of acute severe asthma are:

-High flow O2.

-Short ac ng beta2 agonist via large-volume spacer or nebulizer.

-PO Prednisolone or IV hydrocortisone.

*Monitor response for 15-30 minutes and if response poor:

-Inhaled ipratropium bromide via nebulizer (500 mcg of ipratropium bromide via an oxygen-driven nebulizer).

-Refer those who fail to respond and require ventilator support to intensive care / HDU and consider:

•IV beta2 agonist or;

•IV aminophylline or;

•IV magnesium sulphate (If required the dose of IV magnesium sulphate is 1.2-2 g IV given over 20-30 minutes).

-The loading dose of aminophylline is 5 mg/kg over 20 minutes.

●The typical, or first generation, neuroleptics include "chlorpromazine, pipotiazine, prochlorperazine and haloperidol" They
tend to block dopamine pathways in the brain and have prominent extrapyramidal side effects including Parkinsonism,
dystonia, akinesia, akathisia and tardive dyskinesia.

-Neuroleptic malignant syndrome is an adverse reaction to neuroleptic drugs, the syndrome consists of muscle rigidity,

Pyrexia, autonomic instability and cognitive changes, there is usually also an elevated plasma creatine kinase level.

●Drugs which cause cholestatic jaundice include: Nitrofurantoin, erythromycin, cephalosporin, NSAIDs, ACE inhibitors,
TCAs, phenytoin, azathioprine, carbamazepine, oral contraceptive pills, diazepam and ketoconazole amongst others.

●Plasma levels of carbamazepine should be measured every 6 months to exclude toxicity, because therapeutic levels and
toxic levels are close, Liver func on tests and a full blood count should be checked a er 6 months of treatment with
carbamazepine, and weight should be monitored in patients who gain weight rapidly, Urea and electrolytes should also be
measured every 6 months a er star ng treatment with carbamazepine to check for hyponatremia.

●Cefalexin, cefradine and cefadroxil are all ‘first-generation’ cephalosporin.

●Cefuroxime is a ‘second-generation’ cephalosporin that is less susceptible than the ‘first-generation’ cephalosporin to

Inactivation by beta-lactamases, it is therefore, active against certain bacteria which are resistant to the other drugs and has

Greater activity against Haemophilus influenza.

●Cefotaxime, ce azidime and ce riaxone are all ‘third-generation’ cephalosporin, they have greater activity than the
‘second generation’ cephalosporin against certain Gram-negative bacteria, and however they are less active than
cefuroxime against Gram-positive bacteria, such as Staphylococcus aureus, Pseudomonas.
●Rela ve to hydrocor sone:

-Dexamethasone is 25 mes more potent

-Methylprednisolone is 5 times more potent

-Triamcinolone is 5 mes more potent

-Prednisolone is 4 mes more potent

*Dexamethasone is 6 mes more potent than Prednisolone

●Pericardi s is inflamma on of the pericardium and has a variety of underlying causes:

 -Infections (usually viral e.g. coxsackie virus)

 -Drugs e.g. isoniazid, cyclosporine
 -Traumatic
 -Autoimmune e.g. SLE
 -Paraneoplastic
 -Uremia
 -Post MI (Dressler’s syndrome)
 -Post radiotherapy
 -Post cardiac surgery

Mu receptors are responsible for:

Mu1: Analgesia, physical dependence = DELTA
Mu2: reduced GI tract motility, Miosis, Physical dependence, Respiratory depression, Euphoria. “GMPRE”
Mu3: Vasodilatation

Kappa receptors are responsible for: SADM " ‫"ﻛـﺄﺑﺔ‬

Sedation, Analgesia, Dysphoria, and Miosis.

Delta receptors are responsible for:

-Physical dependence -Analgesia