Miscellaneous - 5 (SO MANY ERRORS)

KAPS Training Institute
KAPS Preparatory Tips by Dr Asad Mehmood

1- Do these recalls as much as you can. Do it on daily basis.
2- Do doses all the drugs (5-6 Questions come from doses).
3- Do all the notes which are attached with this email. This is very important because we have
summarized all the KAPS specific data in these files. You don’t need to consider any other book at all!
4- Studying CPR is MUST for Pharmacology and Therapeutics:
Specifically CPR Chapter number:

2,3,5,19,20,21,22,23,24,25,31,32,33,34,35,36,37,38,39,40,41,42,43,44,46,47,48,51
These chapters will cover pharmacology, therapeutics and pharmaceutics. These are more than enough to
pass the exam.
Note: Few chapters of AMH are attached. Preferably study those chapters from AMH and skip those
chapters from CPR which are mentioned above.
5- APEC Calculation book is attached. Practice calculations as much as you can.
6- For Medicinal Chemistry: Notes are attached which includes detailed SAR and all the important
structures of drugs. Along with this, super questions (Chapter 2) are attached. Solve those questions
(Answers are given at the end).
7- You need to cover, indications, drug interactions, drug-food interactions, doses, practice
points and adverse effects.
8- You should memorize the CYP enzymes either inhibited or stimulated by different drugs
(1-3 Questions always asked).
9- Pharmaceutics: Chapter 2 of CPR and these Recalls are enough. Questions could be asked from
Emulsions, Ointments, Suspensions, excipients (their role), tablets, capsules, bioavailability,
disintegration, dissolution and pharmacokinetics.
10- FAMOUS drugs for KAPS examiners.
Phenytoin, Warfarin, Digoxin, Paracetamol, Ibuprofen, LMWH, Thyroxine, HTN drugs, GIT drugs,
Methotrexate, Vancomycin, Rifampicin, Amoxicillin, Ampicillin, Fluoroquinolones, Epileptic drugs,
Dopamine, Dobutamine, Lidocaine, Atropine (its source), Hematocrit value, Aspirin, Loop diuretics,
thiazide diuretics, beta blockers, calcium channel blockers and anticancer drugs.
© All Rights Reserved 2019 by Asad Mehmood
By: Dr Asad Mehmood © Copyrights reserved

CHAPTER 1
RECALLS
1. The atom w is at plane in chair Equatorial

2. Structure of ampicillin
3. Ether
4. Phenothiazine

5. Zwitterion
6. Amix acid
7. Ester Carboxylic acid in w OH is replaced by alkoxy gp

8. All of ! following in alkylating agent except Cytrapine
9. Structure of oisplatinm 2 cl atoms are adjacent.
10. Acetyl choline Choline ester
11. Angiotensin 2 blocker Block type I receptor

12. Angiotensin 2 blocker Not used if urea is high.
13. DMARD ‘’ Disease modified Anti Rheumatic drugs’’ used if No relief with NSAID
14. Mode of Action of Allopurinol Inhibit xanthine oxidase enzyme
15. Not characteristic in gout In Women > Men
16. Used in anticholinesterase toxicity Atropine + Parlidoxime
17. The most causing vomiting Cisplatin
18. Not used in Mania Halloperidal
19. Not Choice in parkinsonism Jerky movement
20. Least acidity rise pka
21. Hematocrit value 45-50%
22. After centrifuging of blood Hematocrit value
23. Amount urine daily 1.5 - 2 Litres
24. Quinidine is D isomer of quinine
25. Difference between quetiapine and clozapine Anticholinergic activity
26. We reach CSS 4-5 half lifes
27. Pethidine doesn’t have Anti-cough action
28. Fentanyl Pain killer
29. Has active metabolite Morphine
30. Tamoxifen Antiestrogens is breast cancer
31. SIDE EFFECTS of Tamoxifen Hot Flushes
32. In case of hypophosphatemia Rise in Calcium Level
33. Not protease inhibitor lamivudine(Anti Cancer)
34. Completely re-absorbed in urine Glucose
35. Rifampicin and phenothiazine Enzyme inducer phenytoin
36. Fall in Amphetamine toxicity Acidify urine
37. Used for anaerobic bacteria Metronidazole
38. Not Absorbed in stomach Aminoglycosides + nitrofuran
39. SE of vancomycin Ototoxicity and Red Man syndrome
40. Antidote for methotrexate Folinic acid
41. Not used in Pregnancy Nitrofurantoin
42. In hypothyroidism Rise in THYROID STIMULATING HORMONE

43. Cretinism Low in infant
44. Conformation isomer is detected by NUCLEAR MAGNETIC RESONANCE
45. Shape of RBC Non nucleated biconcave
46. Drug contain Ketone Phenobarbitone
47. w is responsible for spermatogenesis FOLLICLE STIMULATING HORMONE
48. Increase Testosterone controlled by FOLLICLE STIMULATING HORMONE LH
49. Least important for physician in choosing anti-Cancer Age of patient
50. MAOI Selegiline
51. Limited use of acetazolamide Metabolic acidosis and alkaline urine
52. In case of hyperkalemia don’t use spironolactone
53. Chronic heart failure change morphology of left ventricle
54. Betaxolol is BETA BLOCKERS Fall in Aquous humor formation
55. Labetalol Alpha & Beta blocker
56. Dipyridamol Fall in platelet by Thromboxane A2
57. DRUG OF CHOICS in shock dopamine
58. Vit. Toxicity due to overdose in Fat Sol Vit(A,D,E,K)
59. Structure of Ketoprofen

60. Cyproheptadine antihistaminic and anti 5HT
61. PTH, Vit D Fall in excretion of Ca
62. Dobutamine B against
63. Filgrastum is Protein
64. Saponification Inorganic base + organic acid
65. Structure of Cloxacillin

66. Phenol not resist oxidation

67. Zalmitriptan and Sumatriptan SHTD against in Migraine
68. Cause of travellers diarrhea E-Coli
69. Loop diuretic ototoxicity
70. Metronidazole used for all except E-Coli
71. Spiranolactone and Eplerenone Aldosterone Antagonist
72. Coal tar used in psoriasis prior to cortisone level of cortisone increase in Absence
73. A verapamil used in angina arrhythmia, CHF
74. Estrogen, Diethy L. stilbostend are similar in 2 Groups on different side (Trans)
75. Calcitonin treatment hyper-calcemia
76. Vitamin D is steroid hormone
77. Acetazolamide Carbonic Anhydrase Inhibitors, Fall in Potassium level, metabolic
leads to acidosis but not metabolic alkalosis
78. Na+ level 135-147 mmol/L
79. Acid resistant amoxicillin
80. Post-pituitary gland secretes vasopressin and Oxytocin
81. Ketoconazole rise in warfarin level
82. Carbamazepine phenytoin, valproate HME inducer
83. Allopurinol take lots of H2O with it.
84. Dose of doxyrubicin 45 mg/m2/day

Allopurinol Xanthine oxidose enzyme inhibition
Acetazolamide carbonic anhydrase enzyme inhibition
Zidovudine lamivudine reverse transcriptive enzyme inhibition
Statins HMG Co reductase enzyme inhibition
85. Cytarabine Antimetabolite
86. Side effect of Danurubicin Cardiac toxicity
87. Used oral Nystatin Rise and Swallow
88. Definition of Conformational ixmer rotation around single band
89. Amoxicillin otitis media
90. Adrenaline Metabolized by COMT
91. Noradrenaline Metabolized by MAO
92. Isoprenaline B1, B2, Against
93. Aspirin may induce asthma shift axhidonic acid to leukotrienes
94. Zidovudine, lamivudine reverse transcriptase inhibitor
95. Curve of drug in presence of competitive antagonist will be shift to the right
96. Partial seizure may be conscious or non-conscious
97. Statins HMG Co reductase inhibitor
98. Ileum last part of small intestine
99. N2O Not analgesic
100. Nitroglycerin dilate coronary arteries
101. Methadone Not anti tussive aloo
102. ACEI + MI Not usual increase in creatine
103. Moclobemide Max dose 600 mg
104. Atropine 0.25-2 mg
105. Misoprostol 200 Mcg/q.i.d
106. Glyceryl trinitrate 0.3-1.2 mg
107. Na Phenobarbitone Basic
108. Side effect of Lithium Diabetes insipidus
109. Side effect of Fluoroquinolones Glidiness, dizziness
110. Amiodarone cause all except Hepatotoxicity
111. Sucralfate not taken food or antacid

112. Candesartan rise in K+
113. Cimetidine HME inhibitor, CONTRAINDICATED with digoxin
114. Needle gauge inversely proportional to Diameter.
115. Short-acting Benzodiazepine Oxazepam
116. A patient suffers from cough + runny nose Guaifenesin + Pseudoephedrine
117. Patient on Lithium shouldn’t restrict Na diet intake
118. Antifungal used topically or IV only Amphotericin-B
119. Drug formulated in micronized form To decrease the disintegration time
120. Crystal form Will effect solubility
121. Used for enteric coated Cellulose acetate phthalate
122. Vehicle for eye drops Polyvinyl alcohol
123. Binding of drug to plasma protein not affected by Molecular weight
124. TPN stored at 2-8 Degree
125. Cross sensitivity beta oxacillin and cephalosporin is 10%
126. Patient having rash often penicillin injection infectious mononucleosis
127. Best analgesic with METHOTREXATE Paracetamol
128. COX2 inhibitor Not inhibit thromboxane
129. Probenecid Rise in activity of Penicillin
130. Active transport Low conscious to high conscious
131. CONTRAINDICATED with Methenamine Tartrate (basic) any basic drug
132. Diabetes controlled by Glucose in blood
133. Side effect of Antipsychotic by Muscle rigidity
134. In Renal Failure increase in PO4, increase in K, increase in Uric acid,
decrease in Ca2, decrease in Na+
135. Penicillin hydrolysis B-lactam
136. Rickettes Vitamin D
137. Thiazide increase in Uric Acid, increase in Ca+, increase in Glucose and
Lipids
138. Sarcolemma found in striated muscle tissue
139. Patient on tea and toast diet Iron deficiency anemia, decrease in MCV.
140. USED IN METASTATIC PAIN FENTANYL

141. Penicillin differ In acyl side chain
142. Appetite modulating drug All except Orlistrate
143. In moderate exercise all happened except:
Increase in CO
Increase in TPR
Increase in blood to viscera
 Increase in diastolic pressure

144. Diabetic patient should perform effort To raise in Glucose uptake
145. Increase in HR without diastolic Sinus tachycardia
146. Parasympathetic action on urinary bladder M3
147. Tonocholic is a substance which Emulsify fats
148. Metoclopramide used In esophageal ulcer to hasten stomach content from
ulceration
149. In hypotension body act to increase in Blood Pressure
150. Acne caused by Propionic bacteria
151. Insulin garlino patient at injected site long acting
152. METHOTREXATE antidote Folinic acid
153. Malathion Organophosphorus Cpd
154. Tetracycline Amphoteric
155. Prostaglandin related to Fatty acid
156. Reaction beta methyl cellulose benzoic acid esterification
157. Petrolatum is not solution in ethyl alc.
158. Not solution Or miscible with Alcohol Acacia
159. Lignocaine has long action due to amide group in its structure
160. Substance produced in actively exercised human lactic acid
161. Calcium daily requirement in women 800-1000 mg 1000-1500 mg daily
162. Which cause hemorrhagic cystitis Cyclophosphamide
163. Receptors found in arterioles, eye
164. Renin release due to low in blood flow to hypotension kidney

165. MOA of nitroglycerin release NO
166. Can be used in both grand mal, petil mal epilepsy valproate
167. TCA affect neural uptake mech.
168. Cytochrome P450 needs O2 + NADPH
169. Cause meningitis Neisseria meningitis
170. Endocarditis caused by Staphylococcus bacterias
171. Noradrenaline act past and presynaptic
172. Partial against when it produces maximum effect less than other against on !
same receptor
173. Which metabolized to 5ASA Sulfasalazine
174. Decrease in Absorption of iron when taken as Ferric
175. Diabetes type-2 Inert normal B cell
176. Tubocurarine Skeletal muscle relaxant Contraindication e gentamycin
177. Clomiphene taken 0-5 days
178. Na cromoglycate Most cell stabilizer
179. Cortisone Decrease in prostaglandin synth
180. Sulfation in the body from Sulphate
181. Symptoms of Zn. Deficiency Poor wound healing
182. Storage of fats, formation of scar Anabolism
183. Pulse rate measured by radial artery
184. SE of oxycodone Intestinal inflammation
185. Css (Steady State Concentration) doesn’t depends on Dose
186. Arterial HTN patient Should take medicine even there is no symptoms
187. Increase in L. Dopa MAOIs
188. Alcoholism and phenytoin causes Anemia due to folic acid
189. Which is best for UV determination aromatic ring
190. Hunghtingoin chorea disease decrease in GABA level in Rheumatic fever
191. Present in gastric sec. small intestine Mucin
192. Action of neostigmine due to structural similarity
193. Least lipophilic BETA BLOCKERS Atenolol
194. Crystalline, zinc, insulin duration of action less than 12-Hour

195. Pregnant complain from HTN pregnancy induced HTN
196. EDTA used in EYE DROPS preservative chelating agents
197. Diuretics not used e sulfa allergy patient Furosemide, thiazide
198. Patient take lamotrigine + valproate induces except low in dose of
lamotrigine
199. When phenytoin blood level is 5 MCG/Ml patient not take it regularly
200. Therapeutic index lethal dose/effective dose
201. Not affect human or animal Dog round worm
202. SE of Raloxifene Leg cramp
203. Na Citrotartrate Alkalinize for urine
204. Aspirin IS NOT SOLUBLE IN wATER
205. Doesn’t have active metabolite Paracetamol
206. Phenytoin CONTRAINDICATION with Oral Contaceptives
207. Combined O.C. cause migraine and decrease in milk production
208. Cortisone not cause leukopenia
209. Metabolism is respiratory system not happen if taken intra-arterial or IV
210. First line treatment in open and close angle glaucoma decrease in BETA
BLOCKERS
211. Not orally Absorbed Nystatin
212. E-Coli Gram negative bacilli
213. Amiodarone long t1/2 ‘’7-Days upto 50-Day’’
214. ARBS used in CHF, HTN
215. Patient Renal failure need to adjust Vancomycin
216. Pethidine;
a. Doesn’t have anti cough act
b. Not taken in patient decrease in Ca, as it may cause convulsion
217. Infant immature enzyme system
218. IgG Pass Placenta
219. Salmeterol ;
a. Not used acute asthma
b. onset of action 1-2 Hours

220. Dose of Cortisone 250 mg 4 Times
221. Indapamide Eat banana, Orange Juices
222. Pyuria Pus in urine
223. Style pencil used in minor cut WTF is this so many errors! STYPTIC PENCIL!
224. Probenecid CONTRAINDICATION Aspirin, in low dose
225. Enalapril first dose hypotension
226. Vd definition volume of the drug distributed in the body
227. Hypersensitivity patient need CBC TEST
228. Used as depot Risperidone
229. Thiazide action on Li increase in Li reabsorption and decrease in Na+
reabsorption
230. Dose of theophylline should be deceased in all except liver cirrhosis
231. Rate det. Step in skin pass epidermis
232. All of the following attribute to tolerance except rate of Absorption
233. May cause hypotension on loading dose Methyl Dopa
234. Phenytoin loading dose 15-20 mg /kg This is for status epilepticus!
235. Dangerous in Pregnancy trimethoprim
236. Doesn’t appropriate for adult Perindopril 24 mg
237. W of following causing Tinnitus in anti-inflammatory dose Aspirin
238. Ascorbic acid unsaturated lactone ring
239. Sulfonamide contains acidic ‘H’ in Sulfonamide group
240. Lime H2O CaCO3
241. EEG in epilepsy measure cortical neuron activity discharge
242. Methadone is Ketone
243. Cannot measured by u-v Glucose
244. Main type of blood cell erythrocyte
245. DRUG OF CHOICS in non gonococcal urethritis Doxycycline
246. Leukocytosis increase in WBCs
247. Vaccine given at 18-Months DPT
248. Women > Men; rheumatoid arthritis and Migraine
249. Men > Women; In gout osteoarthritis

250. Glomerular filtration Due to hydrostatic pressure of blood
251. If 2 solution put on 2-sides of a permeable membrane after equilibrium
Number of solute in both sides are equal
252. Cortisone Decrease in phospholipase
253. BETA BLOCKERS no vasodilation in Angina
254. Tolbutamide + Metformin Rena toxicity
255. Least anti inflammatory effect Celecoxib
256. Aspirin in infants Reyes syndrome in viral infection
257. Shingles disease Zoster affect ganglion
258. Salmeterol Not used in acute asthma
259. Atenolol Selective B1 blocker
260. Physostigmine Enzyme inhibitor
261. Muscle fatigue Accumulation of Lactic Acid
262. Suxamethonium Short acting depolarizing skeletal muscle relaxant
263. Ca+ Increase in digitalis toxicity
264. 1st enzyme in MI CK-MB
265. Pancreatic disease Increase in amylase
266. GABA Inhibitory in CNS
267. Benzodiazepine (BZD) valproate and Haloperidol do potentiate GABA
268. Finasteride 5x-reductase inhibitory of DHT in Benign Prostate Hypertrophy
269. Prolactin Maintain milk secretion.
270. Dose of thyroxin 150 mcg/day
271. 1st line in HTN 12.5 mg Hydrochlorothiazide
272. Dose of chloroquine 500-600 mg/week
273. Kcl slow release Matrix wax
274. Langeat duration Fentanyl patch
275. W isn’t effect of hydromorphone Dysphonia
276. W doesn’t need dose adjustment in Renal failure Allopurinol anti
anflammotry affect
277. Celecoxib Not used in patient sensitive to sulfa
278. Heparins SE Thrombocytopenia and increase the risk of osteoporosis

279. Gentamycin should not exceed 10 Mcg/ml
280. Tocopherol Antioxidant
281. SE of Indomethacin Frontal headache
282. Nitrazepam Accumulation, once daily
283. Chlorpromazine IM longer duration of action
284. Ampicillin t1/2 =1/2 hr when taken every 6 hour No accumulation
285. Carbamazepine Increase in ADH cause hypothermia and Hyponatremia
286. Phenytoin and alcohol Decrease in ADH
287. Indapamide not Carbonic Anhydrase Inhibitors
288. Taken as prophylaxis Cefazolin 1gm every 8 hour for 2-days
289. Ampicillin as prophylaxis Before dental operation
290. To reach CSS depends on We need 5 half lives
291. Rate limiting step in lipid solution drug Dissolution AND decrease in
disintegrate time
292. Micronization Increase in dissolution rate
293. Fall in P.S. Increase in bioavailability
294. Tinidazole + Alc Disulfiram like reacts metronidazole
295. Salbutamol + Ipratropium In acute asthma
296. Phenothiazine SE Photosensitivity
297. Furosemide Decrease in K so increase in digoxin toxicity
298. Thiazide cause Glucose intolerance
299. MAOIs + Tyra mine Increase in NE release
300. Release of atoms from crystal lattice Exothermic reaction release energy
301. Antibodies Igm, A, G, E,D
302. Saliva Contains amylase + slight acidic pH.
303. Anaphylactic reaction Within minutes
304. Diphenoxylate doesn’t cause Bronchospasm
305. Hyoscine CONTRAINDICATED in Glaucoma
306. IV preferred over oral dose in all except Increase in spectrum activity
307. Sup. Base immiscible e body fluid Cocoa butter
308. Brady kinin Patent vasodilator

309. SSRIs advice over TCA
 Few SE
 Safe even in high dose
 Very low incidence of addiction
310. MESNA treat Hemorrhagic cystitis caused by cystic fibrosis
311. Digoxin MOA Inhibit Na/K ATPase
312. Theophylline toxicity N,V,D tremors tachycardia
313. Triptans Mimic serotonin
314. Triazolam Cause amnesia ‘’short term memory loss’’
315. Aspirin Increase in toxicity of METHOTREXATE
316. Piroxicam Taken at bed time to avoid morning stiffness
317. Jacob disease Caused by prion
318. Prion is Infectious disease
319. Shelf life when drug is not acceptable c=0.85 Co
320. Patient on METHOTREXATE Increase in fluid intake to inhibit dehydration
321. IV of dextrose 5% By central vein to avoid irritation
322. Parkinsonism Decrease in dopamine in basal ganglia
323. Gentamycin active against Pseudomonas
324. Thromboxane Deactivated by Indomethacin
325. Clomiphene Stimulate ovulation with Follicular development
326. Treatment of travellers disease Ciprofloxacin
327. Thyroxin given in Cretinism till 5-years
328. Causes thyrotoxicosis Amiodarone t1/2 7-days In codeine and stimulant
laxative
329. In codeine constipation Use stool softener (Sodium Docusate) and stimulant
laxative (Senna).
330. Caloric measured by Joule
331. Death of codeine due to Respiratory depression
332. 2nd line depression clozapine
333. Penicillin measured by kidney
334. Mech. Of action of Glyceryl trinitrate increase in cGMP

335. MOA of Ca.ch blocker influx of Ca
336. Clomiphen partial against estrogen
337. Leukocytosis increase in WBCs
338. Pain killer in cancer Morphine
339. Left ventricular HF dysnea
340. Which part of heart doesn’t involve in conductance Valves
341. DRUG OF CHOICS in non gonorrheal urethritis doxycycline
342. Which type of reaction in liver metabolism oxidation
343. Antihistaminic drug causing drowsiness azatadine
344. Amitryptalline used in neurologic pain
345. When drug has 1st pass effect less system effect
346. Streptokinase CONTRAINDICATED in peptic ulcer
347. Should be refigerated Pilocarpine EYE DROPS
348. Methicillin resistant Vancomycin
349. Diazepam longer duration than temazepam
350. Cetrimide o/w
351. Guaifenesin Anti cough and ACEIs as it doesn’t affect HTN
352. Not CONTRAINDICATED with Amitriptyline Chlorothiazide
353. Anionic surfactant camp ichthammol
354. SLE Common in young women
355. Side effect Hydrochlorothiazide Rash
356. Leflunomide increase in t1/2 so need loading dose
357. Cause Na, H2O retention verapamil, methyldopa
358. Patient come ask about effervescent Metamucil indicates something about her
Compliance
359. Which may cause major SE if used chronically in child oral prednisolone
360. Hormone responsible for initiating and maintenance of lactation prolactin
361. Self-care of diabetic patient include all except remove corn furuncles
362. Blood dyscriasis symptoms fever, sore throat for 4-6 weeks after initiating
therapy
363. Least interaction of CYP450 is with famotidine

364. t1/2 of Nitrazepam = 24 hour, if taken once it will accumulate in body
365. w of following contraindicated for child less than 12 years ciprofloxacin
366. NaCl saline used for irritating tissue antiseptic affect
367. Morphine or codeine toxicity contraction of airway pathway
368. Best to indicate drug accumulation in tissue Vd > 1L/kg
369. Dose of phenytoin 3-divided dose or once daily
370. Better take on empty stomach Azithromycin, penicillin
371. Glucuronidation may give less toxic or more toxic than patient drug
372. Side effect of doxorubicin Cardio toxicity
373. Used KCL as Sustained release Tablet decrease irritation to Gastric mucus
by drug
374. Patient take cephalosporin and experienced fever, rash Type-3 allergy
375. Aspirin taken with Metoclopramide Metoclopramide fasten its Absorption
376. BETA BLOCKERS increase hypoglycemic acts of insulin by mask
hypoglycemic symptoms.
377. Side effect of Aminogycoside Ototoxicity and Nephrotoxicity
378. TCA may cause heat stroke due to decrease in sweating due to
Anticholinergic effect and its effect on thermoregulatory zone
379. CONTRAINDICATED is pregnancy 1st trimester Quinolones
380. 1st line treatment of penicillinase produced gonorrhea Cefactor +
cefatriaxone
381. Side effect of Levodopa Postural hypotension
382. Acetazolamide Decrease formation of ag humor
383. One has allergy to sulfa shouldn’t use Celecoxib
384. Laxative cause dependence Stimulant
385. Patient taken tobramycin recently take FeSO4 lead to loss of hearing
386. Benzatropine Side effect Constipation
387. Used for treatment of Obsessive compulsive disorder (OCD) Clomipramine
or fluoxetine
388. Particle size, matrix polymer are important when the drug is Sparingly
soluble in H2O

389. Probenecid Advice patient not to take Aspirin
390. Minocycline SE Vestibular disorder Vibramycin
391. Indapamide Contraindication WITH ALL OF THE FOLLOWING
a. Thiazides (not Carbonic Anhydrase Inhibitors )
b. NSAIDS
c. Banana and Orange Juice
d. Alcohol
392. Furosemide affected by Renal clearance allopurinol
393. NaHCO3 Increase in excretion of Aspirin
394. On steady state Rate of elimination = rate of Absence
395. Nystatin Thermolabile, treatment candida, not Absorbed orally
396. Xanthine, uric acid, adenine Purine base
397. Immunoassay used in all except
a. Ab
b. Enzyme
c. Drug level
d. Receptor distance
e. Electrolyte (Answer)
398. Substitution on C6 at Penicillin Increase in stability to B-lactamase
399. Substitution on C6 at Penicillin Increase in steric hindrance to B-lactamase
400. CHO fats are alike Both release energy
401. Samaritan Has no role in migraine prophylaxis, treatment only.
402. Symptoms of left sided failure of heart Pulmonary orthopnea, Dyspnea,
proximal nocturnal dyspnea
403. In epilepsy Decrease in GABA level
404. Cystic fibrosis Chirac by Impaired Na, cl transport and change sweat content
405. Lecithin Phosphorous + lipid + choline Act as source of choline
406. Gentile dysfunction Inability to obtain an adequate erection sufficient for
sexual intercourse
407. Major consequences for diabetes Erectile dysfunction
408. Aortic and pulmonary valve Prevent back flow of blood to ventricles

409. + Symptoms nerve Contraction of vascular smooth muscles.
410. Slow IV adrenaline Increase in Cardiac Output and decrease in diastolic
vasodilation
411. Tranxemic, AminoCaproic, Aprotinin Antifibrinolytic
412. In Rheumatoid Arthritis DMARD used as 2nd line after NSAID
413. B-estradiol Steroid structure
414. I2 uptake by thyroid inhibit by High dose of I2 & Digoxin
415. Cretinism Decrease in I2 in childhood
416. Restriction endonuclease Cleave DNA at specific sites
417. Dimercaprol can be characterized by all except Ready metabolized complex
418. Hypotonic sol. Half conc. Of normal saline
419. Omeprazole Could be Swallowed NOT crushed.
420. Diameter of dispersed particle Should exceed 0.5 Mcg
421. Content of iron in;
a. + Ferric glucomate 12%
b. + Ferric Sulfate 20%
c. + Ferric Fumerate 33%
422. Interferon B. used in Multiple Sclerosis
423. Multiple Sclerosis Destruction of Myelin Sheath
424. Diethyl ether Add antioxidant to prevent toxic camp formation w is peroxide
425. Overdose of linotile No anticholinergic side effects
426. UTI antibiotics should be characterized by Short t1/2, Low plasma binding
427. Ribosomes attached to endoplasmic reticulum
428. Tinidazole used in treatment Giardiasis
429. Inner ear responsible for Balance
430. Diclofenac Phenyl Acetic Acid
431. To cause hepatotoxicity Penicillin, Paracetamol, Methotrexate
432. Goal of therapy of Hydrocortisone in Rheumatoid arthritis Decrease in
edema and decrease in inflammation and immunity.
433. Zaminivir Not used in pregnancy
434. Erythromycin + warfarin Increase level of warfarin

435. Ketoconazole SE N, V, Rash, Hepatitis, menstrual irregularities
436. Piroxicam syrup Used at night to decrease morning stiffness
437. Thiazide SE Decrease in k, Na, Mg and increase in Ca, TG, Uric acid
glucose level and metabolic alkalosis
438. Diagoxin + Ca Ca displace K+ from myocardium and increase in digoxin
toxicity
439. Hemodialysis is used for Polar drug and very small particles
440. Tranyl cypramine CONTRAINDICATED with Cheese
441. In non-linear pharmacokinetics Increase in t1/2 and Dose
442. Coal tar is mixed polysorbate Assist its dispersion
443. Levodopa doesn’t cause Hypertension
444. Chlorpromazine doesn’t cause Vomiting
445. Measure asthma by Expiration
446. ACEIs Side effect Cough, Angiodema
447. Timolol CONTRAINDICATED in Asthma
448. Liquid in Liquid Emulsion
449. Intensity Drug reach site of action
450. Terbutaline SE Tremors
451. Erythromycin dose 400 Mg/4-Times
452. Salbutamol SE Decrease in potassium
453. Not used in Bipolar treatment
a. Li
b. Carbama Zepire
c. Valproate
d. SSRIs
e. Haloperidol (Answer)
454. Nifedipine SE Ankle edema, constipation,
455. Cortisone SE Manaliasis fungal infection
456. in Fick’s law Diffusion * 1/Thickness
457. Penicillin allergy patient shouldn’t take Imipenem
458. booster dose of tetany toxoid Every 10-Years

459. Doses:
a. maximum dose of Gentamycin 10 mcg/level
b. maximum dose of Paracetamol 4gm/day
c. maximum dose of Aspirin 6gm/day
460. Withdrawl symptoms of Alcohol Increase in BP, Pulse, Respiratory rate,
Temperature, tremors, flushing, seizure and sleep disorder
461. Cough receptor found in Medulla oblongata
462. Satiety, appetite, thirst centers Hypothalamus
463. Codeine Partially 10% metabolized
464. Bolus IV Sodium nitroprusside
465. IV bolus Diazoxide
466. Titanium dioxide Sun blocking agent
467. MOA GABA cl entrance
468. Decrease in GABA Convulsion in children
469. Diastolic Heart relaxation
470. Speed of blood in artery higher than that in arterioles.
471. Use central vein for infusion When poor access to peripheral vein.
472. Antifungal not used topically Griseofulvin
473. Prepare patient to take chemotherapy follow special technique
474. Surface Active Agents add to tablet to To improve dissolution
475. Lipophilic drug Dissolution is Rate limiting step
476. Enzyme inducer drugs act by either increase in production of enzyme or
inhibit enzyme degradation
477. Propranolol cause all except Tremors
478. Amoxicillin and Clavualnic Acid hepatotoxicity & Cholestatic Jaundice
479. Cispride + Ketoconazole prolongation of Q-T period of Heart
480. Most rapid method for diagnosis of MI ECG
481. Not logical combination for treatment of asthma Salbutamol and Terbutalin
482. Ephedrine is Cpd contains 2-chiral carbon atoms
483. Indomethacin decrease in anti-hypertensive effect of BETA BLOCKERS
484. NSAID decrease the effect of ACEIs, Thiazide and Loop diuretics

485. Mianserin SE Blood dyscriasis
486. No need loading dose Morphine
487. Least addiction Nicotine
488. Long use of glucocorticoids osteoporosis
489. Agranulocytosis Decrease in polymorph nuclear leukocyte due to bone
marrow depression
490. Agranulocytosis is is SE of clozapine, PTU
491. Blood glucose Level Normal
492. Hypoglycemia signs all except Odor of Acetone in mouth
493. Immunity is related to Thymus gland
494. Should be taken after meal isotretinoin
495. Glucocorticoid level is controlled by ACTH
496. Direct regulation of insulin secretion Blood Glucose Level
497. OTC used for ocular pain but FOR blepharitis prescription is required
498. What is the cause of lesion in psoriasis infiltration of T-lymphocyte cells
499. What is least important for physician in choosing Anti-Cancer agent Age of
Patient
500. Dose of theophylline should be decreased in all of the following cases except
Hepatic Failure
501. Cellulose polystyrene used for K+ toxicity
502. CaCO3 used in renal failure to increase in Ca concentration
503. Vd volume drug distribute in the body after distribution of equilibrium
504. Boric acid isn’t used for children severe rash
505. A substance is contain both aldehyde and Ketone Sucrose
506. Ketoprofen is propionic acid
507. Substance completely Absorbed from kidney Glucose
508. Acetyl choline choline ester 4 amine
509. Drug used for anaerobic peritonitis Metronidazole
510. Baroreceptors regulate body pressure
511. Band beta amino Peptide
512. Band bet, DNA, base pairs Glycosidic bond

513. Bilirubin is fat Emulsifier
514. Bradykinin is vasodilator
515. Increase in heart beat and out changing rhythm Sinus Tachycardia
516. Anorexia + blue extremities cyanosis
517. Frusemide acts on Ascending Loop of Henle
518. Type 1 allergy is Hypersensitivity to a specific protein
519. Al3+ in Renal failure Phosphate binders
520. Receptors of ear in inner ear
521. Which type of reaction involved in hepatic metabolism oxidation
522. Altered chemistry in cartilage in osteoarthritis
523. Young women suffer from SLE
524. Glibenclamide and metformin increase the risk of Renal Failure
525. A dose of salicylic acid is equivalent to Ibuprofen
526. If sensitivity to TCA not take Carbamazipine
527. In renal failure, dose adjustment depends creatinine clearance
528. Not need adjustment for dose in Renal failure Allopurinol
529. HbA1C ‘’GLYCOSELYTED HEMOGLOBIN’’ detect hyperglycemia after
3-6 Months
530. Energy released when solute is added to solvent break of crystal lattice
531. Cell mediated immunity T4 Cell-marker of AIDS
532. In case of hypotension, the body acts t enhance sympathetic action
533. Chondroitin used in Osteoarthritis
534. Organism doesn’t respond to clindamycin Clostridium deficile
535. Clostridium deficile is treated metronidazole
536. ACEIs are CI in Pregnancy and Renal artery stenosis
537. Talc is used in aromatic H2O to prevent volatilization during prep.
538. Method not used for extraction crushing
539. Drug which do not antagonize Warfarin phenytoin, Grape fruit and thyroxin
540. Antibiotic used only parenterally Cephalothin
541. Drug doesn’t cause hyperghycemia mefloquin
542. Emulsifying agent used in parentral sol Egg, Lecithin

543. To increase dissolution put 6 drug in polar salt form
544. Drug used IV for treatment of glucoma mannitol and acetazolamide
545. Which cause megaloblastic anemia phenytoin-alcohol
546. Acetaminophen prevent metabolism of Zidovudine
547. Deficiency of bradykinin causes antihistamine like action
548. Bentonite + rifampin Inhibits rifampin Absorption
549. Combination of treatment in T.B.
a. Delay resistance
b. Increase in tuberculastics effect
c. Decrease in duration of therapy
Drugs which cause hyperglycemia

1. Thiazides
2. Diazoxide
3. Cortisome
4. Sympathomimetics
5. Thyroxin
6. LiCO3
7. Phenytoin
8. Chlorpromazine
9. Oral Contraceptives
10. Isoniazid

Chapter 2
Recalls from specific Topics
1. Glucoma
1. Normal IOP = 10-20 mmHg
2. Drug w used to decrease production of Aqueous humor
a. Acetazolarnide; + limit use due to
 Metabolic acidosis and Alkaline urine
 Decrease in K+
 Renal stone formation
 NH4 excretion so CONTRAINDICATION in liver disease
b. BETA BLOCKERS levobunolol, timolol, betoxolol, metoprolol
 Another expression increasein Aquousuous Humor flow from ciliary body
 Advice over pilocarpine with no effect on pupil size
 No effect on flow from eye
 SIDE EFFECTS of B.B; if non selective may Absorbed systematically and cause
bronchospasm
 Decrease in K+ so caused hypokalemia
3. Drug which are used to increase in Aqueous Humor outflow
a. Pilocarpine, Carbachol causes:
 Direct miosis
 Cholinergic effect
 Rapid action in 15-30 Mins
b. Isoflurophate, neostigmine Anti Cholinesterase action
c. Latanaprost prostaglandin analogue
4. Drug used to increase Aqueous Humor flow and decrease un Aqueous Humor formation

 Adreraline
 Called dipivefrin
 Duration of action 1-2 Hour
5. Drugs CONTRAINDICATED in Glucoma;
 Homatropine (narrow angle glaucoma)
 Cyclopentolate + Hyoscine
 TCA + phenothiazine
 Narrow angle glaucoma present in 10% of total glaucoma patient
2. Potassium (K+)
 Normal level 3.5 to 5.5 mmol-L
 It is main intracellular ion
 Play an important role in glucose utilization
 Decreased by insulin
 Transmission of nerve impulse
Drugs w to increase K+ level (Hyperkalemia)
1. ACEIs :
 So not used with spironolactone
 Also cause Angioedema
 CONTRAINDICATED in Renal Artery stenosis and pregnancy.
2. Spironolactone:
 Antialdosterone
 Act on 1 last part of distal tube ‘’Collecting duct’’
3. Triameterene:
 Act on collecting tubule
4. In acute Renal Failure
5. ARBs (Angiotensin receptor blockers ):

Drugs which decrease K+ level (Hypokalemia)
1. Corticosteroids: due to action of aldosterone

2. Thiazides, loop diuretics
3. Acetazolamides
4. B2 agonist
 In hypokalemia: Digoxin toxicity can happen so always used with banana

juice and Orange juice and drugs which causes hypokalemia.
Treatment of Hyperkalemia:
a. If there is no change in ECG: Use Rectal Na polystyrene sulfonate

b. Change in ECG;
 IV calcium to displace K+ action on heart
 Na polysterene sulfurate Chelate K+
 Insulin + Glucose Decrease in K+ level

3. Migraine
 Mechanism Of Headache Inflammation or vascular or contraction
 Common type without eura 85%
 Un common type with Eura 15%
 Vascular changes due to Serotonin
Eura means there are symptoms after them you can suspect migraine.
 Occur in female > Male
 Drugs used for prophylaxis :
1. BETA BLOCKERS
2. TCA-Calcium Channel Blockers (VERAPAMIL)
3. Anticonvulsive clonidine
4. Aspirin
5. Metocloprmaide
 Drugs used for treatment of acute migraine:
1. Triptans; 5HT1D agonist (Can be taken Subcutaneously, Intranasally and orally)
2. Dihydroergotamine ‘’DRUG OF CHOICE’’ in Migraine.
 Sumatriptan not used if:

1. Ergotamine taken during last 24-Hour
2. Sibutramine
3. MAOIs
4. Angina pectoris
5. Methyl sergide (anti 5HT in brain )
 Oral contraceptive increases the migraine.
 Focal neurological symptoms of Migraine Vasoconstriction of intracranial arteries.
Most Important Drugs

1. Hydralazine:
 Vasodilator
 Decrease afterload
 Act on arteries
 Most appropriate for patient with Renal failure as it doesn’t affect renal function
 DRUG OF CHOICE for patient who are depressed.
 Cause reflex tachycardia so used with BETA BLOCKERS.
 Cause angina attack due to coronary steal phenomena
 Side effects include systemic lupus erythromatosis
 Cause nasal congestion
2. ARBs (Angiotensin receptor blockers)
 Act on AT1 type receptor
 CONTRAINDICATED in pregnancy and Renal artery stenosis
 Increase in K+ level
 Used in the treatment of Hypertension and Congestive Heart Failure (CHF).
 Used instead of ACEIs because they induced cough in patients.
 Not used if CrCl is high
 Ibresartan used once daily means it is more patient compliant drug.
3. Allopurinol
 Xanthine Oxidase Inhibitor..

 Decrease in formation of Uric Acid
 Not Uricusoric (Drug which increases excretion of Uric acid)
 Taken with lot of H20 as it helps to decrease Uric Acid
 May initially happen gout attack due to migration of uric acid to affected area
 Take with food to avoid irritation
 Not taken e Aspirin as Aspirin increases Uric Acid level.
 It Increases the effect of some anticancer e-g Mercaptopurine because Allopurinol
inhibits its metabolism of anticancer by inhibiting Xanthine oxidase
 Does not bind to plasma protein so not replace warfarin
 Monitored by uric acid in serum
4. Probenecid
 CONTRAINDICATED with Aspirin
 It is Uricosuric as it inhibits tubular reabsorption of uric acid
Note: Uricosuric drugs:
Probenecid, Sulfinpyrazone, Phenyl-butazone, Aspirin in high dose-
 Increase the blood level of penicillin

5. Paracetamol
 Most safest drug for elderly people, pregnant women and infants
 Safe in gout and ulcer patients
 Has no anti-inflammatory effect
 Doesn’t have active metabolite
 Antidote by N-acetyl cysteine in case of toxicity within 12 hour
 Inhibit glucoronidation of zidovudine so increase its level
 DRUG OF CHOICE in patient on METHOTREXATE
 Metabolized by glucoronidation
 Cause hepatotoxicity
 Safe in Renal failure patient
 No tendency for bleeding

 Maximum Dose 4gm/day
6. Clonidine
 Alpha 2 against
 Cause Na and Water retention so used with diuretic
 Not used in alcoholic patient
 Used as transdermal patches
 Used for prophylaxis of migraine
 Used to decrease Benzodiazepine withdrawal symptoms
 Side effects: Bradycardia, Dry mouth, Sedation
7. Digoxin
 Inhibit Na/K Atpase enzyme
 Has positive inotropic effect negative chronotropic effect
 Has vagomimetic effect
 Similar to amrinone
 Decrease O2 consumption
 Digitoxin is completely Absorbed orally and is suitable for patient with Renal failure
as it is metabolized by liver.
 Lanoxicap 20 % more active than tablet
 Toxicity symptoms: Nausea, Vomiting, Diarrhea, Blurred vision, Ventricular
tachycardia, Bradycardia
 Decrease in potassium in the body while taking digoxin lead to toxicity
 Treatment of digoxin toxicity;
a. Stop drug
b. EDTA to chelate Ca2+
c. Lidocaine or phenytoin IV to counteract arrhythmia
d. Atropine to counteract bradycardia
e. Metabolism: conjugate to serum albumin in liver to excreted unchanged via
kidney
8. Pencillamine:
 Chelating agent in treatment of Rheumatoid Arthritis

 Treatment of heavy metals poisoning
 Treatment of Wilsons disease because it increases Copper level
Antibiotics
a. Inhibitors of cell wall synthesis:

Penicillin Cephalosporins Natural Others
Excreted in 1st general and Penicillin G-benzyl 1. Bicatracin;

kidney: Renal 2nd : Penicillin V  Topical only
tabular Cefaclor Extended  Nephrotoxic
secretion. Cefotaxime Spectrum:
Cefuroxime Ampicillin
rd
3 generation Amoxicillin
Cefi or Cefti Antistaphylococcal
Amoxicillin is 4th Generation Penicillinase 2. Vancomycin;

the only one Cefepine Resistant:  Slow IV
Absorbed Methicillin (not Infusin
totally after oral oral)  Ototoxic
route Naficillin Side effects:
Cloxacillin  Fever Chills
Dicloracillin  Red man syndrome
Floxacillin
Oxacillin

Side-effect: All
Cefoperazone Antipseudomonals: When taken with
given before Ceftriaxone Carbencillin aminoglycoside, ototoxicity
meals except All others renal Mezlocillin occurs and nephrotoxic
Amxocillin so safe in Renal Azlocillin
Hypersensitivity failure Piperacillin
and Cross react Ticarcillin
Although Side effects: Polypeptide A.B: disrupting

ticracillin and 1. cytoplasmic membrane
carbencillin are Hypersensitivity
both disodium 2. Disulfiram- Polymyxin B and Colistin (both
Salt ticarcillin- like effect are nephrotoxic)
is prepared in
CHF
Safe in
pregnancy
b.Inhibitors of Protein Synthesis

Tetracyclines Aminoglycosides Macrolides
Metabolized in Liver, execute in kidney Amikacin; Azithromycin, clathromycin,

 G- Negative bacilli erythromycin.
 Most stable  Orally taken
Kanamycin  1,3 inbile
Centamycin  2 in urine
Neomycin  Enteric tablet destroyed
Streptomycin in stomach
Tobramycin  Side effect: Ototoxicity
Tetracyclin, minocycline Execrted renally unchanged Chloramphenicol
 IV or oral
 Excreted in kidney
 CONTRAINDICATED in
pregnancy
 Grey baby syndrome due to
its accumulation

Doxycycline; excrete in feces, Renal Vancomycin and streptomycin; Clindymycin
patients  Related in structure  Same as erythromycin
 Both have Anti TB  Excreted by liver
 SIDE EFFECTS
 Diarrhea
 Accumulate in patients with
hepatic disease.
Actinomycin; ineffective in UTI S.E: Neuromuscular paralysis;
Tubocurorine
Contraindication in Myasthenia Gravis
SIDE EFFECT Ototoxicity
 Phototoxicity Nephrotoxicity
 Ototoxicity
 Nephro
 Deposit in bone and teeth

Contraindicated in pregnancy
 Hypoplasia of neonatal teeth
 Hepatotoxicity to mother
c. Inhibitors of Folate Synthesis

 Mafenide cream for burns
 All sulfa drugs
 All Absorbed orally except sulfasalazine which is used in Crohn’s disease and ulcerative
colitis
 Acetylated in liver Urine Crystallurea.
Taken with large amount of H2O NOT taken with orange or lemon juice.

d.Urinary tract antiseptics
Methenamine basic
 Mandelic acid Decrease in Ph of Urine

 Ascorbic acid Excretion and Decomposition
Methenamine Formaldihyde
CONTRAINDICATED
1. In liver insufficiency due to increase in NH4

2. In kidney insufficiency due to mandelic acid precipitation
3. Sulfonamides due to reaction with formaldehyde
Nitrofurantoin:
 Used in UTI
 Side effect: Pneumonitis (pulmonary toxicity)
9. Sulfa Drugs:
Contain acidic H in its sulfonamide structure
 Inhibit conversion of PABA to folic acid w is main process in growth
 It is highly bounded to plasma protein so it can displace warfarin, coumarin, tolbutamide,
chlorpropamid SO increase in their actions.
 Aspirin and Methyl salicylic acid CONTRAINDICATED Sulphanilamide action
Examples of Sulfa drugs and their uses:
1. Maferide Topically for burns
2. Phthalyl sulfathiazole decrease in intestinal bacterial flora
 Sulfamethoxypyridine Long acting due to highly protein binding
 Sulfamethizole short acting so safest drug for allergic patient

 Sulfasalazine treatment of ulcerative colitis and regional enteritis, Poor Absorbed
from G.I.T and if sensitivity occur then shift to olsalazine and mesalamine.
 Sulfacetamide treatment of chlamydia
 Sulfa isoxazole treatment of UTI in patient with Renal Disease
 CONTRAINDICATED is G6PD deficiency.
 Prepared as acetyl sulfaisoxazole salt to improve its unpleasant taste
 Sulfa bramophthalin assist liver function
 Phenol sulphonphthalin assist kidney function
Side Effect: Steven-Johnson Syndrome
 Sulfa is not decomposed by heat;

 Cross sensitivity with Diazoxide, Dorsemide, frusemide, thiazide, Acetazolamide,
Dapsone, sulfonyl urea, celecoxib as all of these contains sulfonamide group.
 Combined and trimethoprim as they both block sequential steps in folic acid
synthesis and very active against E-Coli which is main cause of UTI and
Traveller’s diarrhea.
NOTE: E-Coli is negative rod Bacilli and not affected by metronidazole
 Metabolized by acetylation
 To prevent Crystalluria we should alkalinize urine to increase excretion of
sulfa drugs, acidic.
 CONTRAINDICATED with Methenamine.

T.B.
Drug Action S.E. Interact
isoniazid INH Cidal peripheral neuritis e Vi + B, deficiency gynaecomastic inhibit met. Of phenytoi
Rifampin cidal red-orange urine, faeces tears food
Pyrezinamide Cidal increase in guot due to ureate retents
Ethambutol static all 3 cause hepatitis, optic neuritis
10. Vitamin D
 It is steroid in nature
 Used in treatment of Ricketasia and osteomalacia
 It helps in deposition of Ca 2+ on bone
 Cholecalciferol Vit D3 found naturally in rod liver oil
 Vitamin D is synthesis in body from dehydrocholesterol by the effect of U.V. under the
skin
 Vitamin D doesn’t decompose by sunlight
 Not used in hyperthyroidism
 Toxic dose cause convulsion due to decrease in Ca 2+ blood level
10. Diuretics
 Carbonic Anhydrase inhibitors: Acetazolamide, dorsolamide, brinzolamide.

 Alkaline urine
 Metabolic acidosis
 K- Depletion
 Renal stone formation
 Increase in NH4 blood level so contraindicated in liver disease
 Acts on the proximal convulated tubules
 Decrease in Aqueous Humor formation

Loop Diuretics:
Frusemide, Torsemide, Bumetanide, Ehtacrynic acid.
 Act on ascending loop of henle

 Used in pulmonary oedema as action occur within 30-Minutes
 It decreases K+ , Mg2+ , Na+ , Ca2+
 It increases uric acid
 Cause hypovolemia and used in hypercalcemia
 Cause metabolic alkalosis, ototoxicity so CONTRAINDICATED with Aminoglycoside
 When used Renal function should be checked as its excretion depends on it
 CONTRAINDICATED is Renal Failure Patient
 CONTRAINDICATED with NSAID
 CONTRAINDICATED with sulpha allergic patients except Ethacrynic Acid
Thiazide Diuretics:
Drugs: Hydrchlorothizide, Chlorothiazide, metalozone, Indapamide, chlorothalidone.

 Dose of CTZ = 50-1000 mg
 Dose of HCTZ = 1205-500 mg
 Chlorothalidone = 12.5-100 mg
 Cause HYPO = volumia, Natremia Na, Kalemia, Magnesemia’’
 Cause HYPER =Calcemia, Glycemia, lipidemia, uricemia’’
 Cause Metabolic alkalosis
 Increase digoxin toxicity due to decrease in K+
 Increase in Li+ toxicity due to decrease in Na+
 Act on distal tubules by inhibit Na/cl transport
 CONTRAINDICATED with NSAID
 CONTRAINDICATED with Sulpha allergic patients
K+ Sparing diuretic:

Drugs: Spironolactone, Triamterene and Amiloride
 Spironolactone is anti-aldosterone/ aldosterone antagonist so it inhibit action of
aldosterone Decrease in Na+ retention
 Used in hepatic ascites
 Side effects due to its similarity in structure to same of sex hormones it causes
Gynecomastia in males and menstrual irregularities in females
 Can cause peptic ulcer
 CONTRAINDICATED with NSAID inhibit PG
 CONTRAINDICATED with ACEIs.
Osmotic diuretics
Drug: Mannitol
 Extracellular H20 expansion

 Dehydration if H20 not replaced
 Used IV in Glucoma
Note: Thiazides, loop diuretics, spironolactone, ACEIs their action depends on
renal prostaglandin synth. So NSAID decrease their effect !
 We use diuretic with Minoxidil and hydralazine, Clonidine and methyldopa to
decrease Na+/H20 retention
 Mannitol used as sweetner in chewable Tablet and is bulking agent in lyophilized
preparations.
11. Protamine:
 Protamine SO4 treatment bleeding caused by heparin but should be used with caution
as it is also anti-coagulant.
 Protamine Zn insulin 24-36 Hour duration of action

 When mix with regular insulin duration of action = that of protamine Zn because
excess protamine will bind regular one.
12. Phenyl Butazone: (NSAIDs )
 It decreases prostaglandin synthesis So have analgesic, anti-inflammatory and antipyretic

actions.
 It is Uricosuric.
 Highly bound to plsma proteins so displace other drugs such as warfarin, sulfanyl urea
 T1/2 = 75-100 Hours
 Prolong use cause Blood Dyscriasis
 SIDE EFFECT: Peptic ulcer
 Metabolized to Oxyphenbutazone which is also very active compound.
13.Drugs Effecting Uric Acid

(a) Increase Uric Acid Levels:
 Aspirin in low dose
 Diuretics except spironolactone.
 Nicotinic acid
 L-Dopa
 Ethumbatol
 Pyrazinamide
 Cyclosporin
 Cytotoxic
 Ethanol increase production and decrease excretion of Uric Acid.
14. Drugs which causes Photosensitivity

 Azathioprine, chloropromazine, dantroline, clofozamine, 5 Fluorouracil
 Sulfonyl urea , sulfa drugs, thiazide
 Griseofulvin, tetracycline, hydroxyl chloroquine
 Etritinate, Retin A, Isotretinoin
 Amiodarone and Nalidixic acid, Ethambutol
 Trimethadone ‘’Tridon’’ – lantanoprost
 Nitrofurantoin, coal tar.
15. Vitamin B6 Pyridoxine
 Used as anti-emetic in pregnancy

 Decrease depression associated with Oral Contraceptives
 Contraindicated with Levodopa, alcohol and phenytoin
 Isoniazid cause Vitamin B6 deficiency which cause peripheral neuritis.
16. Monoamine Oxidase Inhibitors (MAOI):
 Phenelzine, tranyl cypramine, isocarboxazide, selegline are MAOIb only.

 Linezolid is used for treatment of G+ve bacterial infection as vancomycin resistant
bacteria
 Procarbazine Treatment Hodgkin’s disease
 Maximum dose of Meclobemide 600 mg
 Not used with cheese, wine, beer as they contain tyramine NE release HTN
crisis which is treated by Phentolamine.
17. Methotrexate:

 Antagonize folic acid synthesis
 Immunosuppressant
 Antimetabolite
 Clinically used for psoriasis, Rhematoid arthritis, leukemia
 Antidote by Folinic acid leucoverin
 Available as 2.5 mg tablet or sol for injection
 Aspirin increases its toxicity so use paracetamol
 Patient should drink much fluid to avoid Dehydration
 Allopurinol increase its level metabolism
 On long term use cause hepatotoxicity
 Dose 15 mg per WEEK
18. Isoniazid
 Most potent Anti T.B.
 Slow metabolism by acetylation slow metabolism but normal therapeutic action
 Cause Vitamin B6 depetion Peripheral neuritis and Gynaceomastia.
19. Raloxifine
 Used to prevent osteoporosis SERM

 SIDE EFFECTS Leg Cramps
20. Albumin:
 Generally bind acidic drug

 Not specific for any group
 3.5-5 % of blood
 Used as substituent for plasma
 Not used for any treatment

21. Procainamide:
 Antiarrythmic similar to quinidine

 Cause SLE like hydralazine
 Not block nerve terminal
 Metabolism by hydrolysis then acetylation
22. Fluorouracil:
 Antimetabolite
 Its chemical structure is modified pyrimidine
 Similar to uracil and idoruridne
 Interfere with synthesis Of RNA
 Side effect: Aneorexia, vomiting, nausea
 Leukopenia is major clinical toxic effect
 Used typically or IV
 When used topically don’t put occulusive dressing
23. Atropine:
 Selective muscarinic blocker.
 Used in the Treatment of organophosphorus poisoning.
 Ester group is liable to destruction.
 L-isomer is more active than D-isomer.
 Used to treat Sinus tachycardia.
 Dose: 0.2-2 mg
 Contraindicated in Hypertensive patient and glaucoma.
 Cause Mydriais means Increase Intraocular pressure.
 Side effects: Constipation, Xerstomia, Blurred vision, Sedation and tachycardia.
24. Levodopa:

 It is dopamine precursor.
 Best combined with MAOIs.
 It can cross Blood Brain Barrier
 Antacids fasten its absorption
 If taken with Vitamin B6, the effect of Levodopa get reduced.
 Side effect: Diplopia (Double vision), discoloration of saliva and urine,
Hypotension.
Important Short Notes on Drugs (Came as True/False in

previous exams)
 Acetazolamide Carbonic Anhydrase Inhibitors

 Indapamide thiazide diuretic
 Pyrivinium pamate treatment pinworm
 Pyridium Analgesic in UTI used not more than 2-Days
 Lefenalac Dairy product for phenyl ketonurea
 Lefulanimide DMARD and always given as loading dose first
 Azathioprine immunosuppressant
 Azatadine H1 blocker cause sedation
 Astimazole Contraindicated with Ketoconazole
 Aprotinin Antifibrinolytic
 Cyclopentolate + Mydriatic and cycloplegic used for refraction work and
contraindicated in glaucoma.
 Cycloserine 2nd line Anti T.B and inhibit cell wall synthesis. Its side effect is
peripheral neuropathy and CNS disturbances.
 Cyclobenzaprine analogue of amitryptyline. Treatment of acute voluntary muscle
spasm muscle relaxant.

 Cyclophosphamide Alkylating agent. Cause hemorrhagic cystitis. Treatment by IV
MESNA.
 Cyclosparin immunosuppressive in Graft rejection. Used in Psoriasis, Rheumatoid
arthritis as methotrexate. Side effect includes nephrotoxicity, neurotoxicity,
hepatotoxicity and hypertension.
 Tyramine in cheese Contraindicated with MAOI.
 Tyrosine precursor of catecholamine, thyroxine,
 Natamycin antibacterial treatment of fungal blepharitis
 Natatriptan 5HT10 against Used in acute migraine attack
 Cispride Prokinetic against contraindicated with Ketaconazole
 Cisplatin alkylating agent SIDE EFFECTS nephrotoxicity
 Misoprostol prostaglandin analogine. Contraindicated in pregnancy.

Dose 200 mg/6hr. It is used in the Treatment of ulcer.
 Mifepristone Antiprogesteron
 Schick test For Diphtheria
 Schilling test for pernicious anemia
 Mantoux test for T.B.
 Tamoxifen Antiestrogen- used in breast cancer. May cause uterine cancer.
 Clomiphen Antiestrogen e partial against effect. Used in infertility In women
Cause ovulation e follicular development.
 Phenalzine and Pargyline MAOI
 Phentolamine is alpha blocker
 Amiloride K+ spairing diuretic
 Amiodarane Anti arrhythmic drug
 Amrinane similar to digoxin
 Diazoxide not diuretic. It reduces Hypertension and taken as IV bolus

 Chlorodiazepoxide Drug of Choice in alcoholic patient to counter withdrawl
symptoms.
THE END

Miscellaneous - 5 (SO MANY ERRORS)

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KAPS Training Institute

KAPS Preparatory Tips by Dr Asad Mehmood

2- Do doses all the drugs (5-6 Questions come from doses).

4- Studying CPR is MUST for Pharmacology and Therapeutics:

Specifically CPR Chapter number:

5- APEC Calculation book is attached. Practice calculations as much as you can.

points and adverse effects.

(1-3 Questions always asked).

10- FAMOUS drugs for KAPS examiners.

© All Rights Reserved 2019 by Asad Mehmood

By: Dr Asad Mehmood © Copyrights reserved

1. The atom w is at plane in chair Equatorial

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7. Ester Carboxylic acid in w OH is replaced by alkoxy gp

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59. Structure of Ketoprofen

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66. Phenol not resist oxidation

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Increase in blood to viscera

 Increase in diastolic pressure

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Drugs which cause hyperglycemia

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Recalls from specific Topics

By: Dr Asad Mehmood © Copyrights reserved

By: Dr Asad Mehmood © Copyrights reserved

1. Corticosteroids: due to action of aldosterone

 In hypokalemia: Digoxin toxicity can happen so always used with banana

a. If there is no change in ECG: Use Rectal Na polystyrene sulfonate

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Most Important Drugs

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Note: Uricosuric drugs:

Probenecid, Sulfinpyrazone, Phenyl-butazone, Aspirin in high dose-

 Increase the blood level of penicillin

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By: Dr Asad Mehmood © Copyrights reserved

a. Inhibitors of cell wall synthesis:

Excreted in 1st general and Penicillin G-benzyl 1. Bicatracin;

Amoxicillin is 4th Generation Penicillinase 2. Vancomycin;