Pharm

Question 1

Rifampicin action

Answer 1

nhibits bacterial RNA synthesis by binding to the beta-subunit of bacterial DNA-dependent RNA polymerase (RNAP)
P450 enzyme inducer

Question 2

common cytochrome P450 (CYP450) inducers

Answer 2

C: arbamazepine
R: ifampin
A: lcohol (chronic use)
P: henytoin
G: riseofulvin
P: henobarbital
S: t. John’s Wort
S: moking

CRAP GPs

Question 3

ciprofloxacin mechanism of action

Answer 3

inhibiting bacterial DNA replication and cell division by targeting bacterial DNA gyrase and topoisomerase IV

Question 4

Drugs causing photosensitivity

Answer 4

P: soralens
C: iprofloxacin
S: ulfonamides
T: etracyclines
L: oop diuretics (e.g., furosemide)
A: miodarone
G: riseofulvin
(PC START LAG).

Question 5

Mechanism of Action: fomepizole

Answer 5

Competitive inhibitor of alcohol dehydrogenase

Question 6

indications for dialysis in salicylate poisoning

Answer 6

serum salicylate level greater than 700
metabolic acidosis
pulmonary edema

Question 7

Hyperbaric oxygen therapy (HBOT) is considered for carbon monoxide (CO) poisoning

Answer 7

COHb levels are high (>25%
Pregnancy
MI
LoC
Arrythmia
Neurological

Question 8

Trastuzumab, a monoclonal antibody

Answer 8

argeting and binding to the HER2 protein on cancer cells, inhibiting their growth and survival, and potentially triggering immune system responses to destroy these cells

Question 9

Lithium
1. theraputic range
2. precipitating
3. management

Answer 9

1. 0.4 - 1
2. dehydration, renal failure, drugs ( Diuretics, NSAIDs, Haloperidol, Carbamazepine, Dapagliflozin, ACE inhibitors , Antidepressants)
3. volume rescuitatiobn

Lithium Dosing Guide
B. Target Serum Levels
Acute mania: 0.8–1.2 mEq/L (monitor every 5–7 days until stable).
Maintenance: 0.6–0.8 mEq/L (lower for elderly).
Toxicity risk: >1.5 mEq/L (symptoms appear).
C. Titration & Monitoring
Check levels 5–7 days after dose changes (draw 12 hours post-dose).
Maintenance: Monitor every 3–6 months (levels + renal/thyroid function).

4. Key Considerations
   Renal function: Adjust dose if CrCl <60 mL/min.
   Drug interactions:
   Thiazides/NSAIDs/ACEIs ↑ levels (risk of toxicity).
   Theophylline/caffeine ↓ levels.
   Na+ intake: Low sodium → ↑ lithium retention (risk of toxicity).
5. Side Effects
   Level (mEq/L) Symptoms
   Therapeutic Fine tremor, polyuria, mild thirst.
   >1.5 Coarse tremor, confusion, vomiting.
   >2.5 Seizures, coma, arrhythmias.
   Chronic Risks:
   Nephrogenic DI (↓ urine concentrating ability).
   Hypothyroidism (check TSH every 6–12 months).

✅ Start low (300–600 mg/day), titrate to serum levels (0.6–1.2 mEq/L).
✅ Monitor renal/thyroid function regularly.
✅ Avoid NSAIDs/thiazides unless closely supervised.

Question 10

Caustic ingestion

Answer 10

if odinophagia present urgent endodcopy

Question 11

ECG changes in isolated hypomagnesaemia

Answer 11

Prolonged PR interval
Prolonged QT interval
Atrial and ventricular ectopy
Predisposition to ventricular tachycardia and torsades de pointes

Question 12

ECG features of hypokalaemia (K < 2.7 mmol/L)

Answer 12

Increased P wave amplitude
Prolongation of PR interval
Widespread ST depression and T wave flattening/inversion
Prominent U waves (best seen in the precordial leads V2-V3)
Apparent long QT interval due to fusion of T and U waves (= long QU interval)

Question 13

ECG changes in Hypocalcaemia

Answer 13

Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment
The T wave is typically left unchanged
Dysrhythmias are uncommon
Torsades de pointes may occur, but is much less common than with hypokalaemia or hypomagnesaemia

Question 14

Ciclosporin
1. action
2. theraputic sampling

Answer 14

1. inhibiting T-cell activation through the calcineurin pathway, preventing the transcription of cytokines like IL-2
2. Before the next dose

Question 15

cyanide poisoning
1. action
2. effect
3. treatment

Answer 15

1. inhibits cellular respiration by binding to cytochrome C oxidase
2. Cellular Hypoxia, hypotension, Metabolic Acidosis
3. Oxygen, hydroxycobellamin

Question 16

CYP450 inhibitors

Answer 16

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

SICKFACES.COM

Question 17

zero-order elimination

Answer 17

salicylates, omeprazole, fluoxetine, phenytoin, and cisplatin
Ps and Wheats” :
Ps: Phenytoin, Phenylbutazone
W: Warfarin
H: Heparin
E: Ethanol
A: Aspirin
T: Theophylline, Tolbutamide
S: Salicylate

Question 18

tca excretion

Answer 18

not effectively removed by haemodialysis as high protien binding and large volume of destribution

Question 19

Drugs can be cleared through haemodyalysis

Answer 19

BLAST
barbiturate
lithium
Alcohol
salisilate
theophiline

Question 20

medications excerbating Heart F

Answer 20

pioglitazone
verapamil
NSAID
Plecanide

Question 21

DRESS syndrome
Drug Reaction with Eosinophilia and Systemic Symptoms
2. drugs

Answer 21

characterized by a rash, fever, lymphadenopathy, and organ involvement, often occurring 2-8 weeks after starting a medication

Rash: A widespread, often morbilliform (measles-like)
Lymphadenopathy:
High-grade fever
Atypical Lymphocytosis

2. Anticonvulsants (e.g., phenytoin, carbamazepine)
   Sulfonamides
   Antibiotics (e.g., minocycline)
   Allopurinol

Question 22

Cetuximab

Answer 22

a targeted cancer drug, specifically a monoclonal antibody, metastatic colorectal cancer,
inhibiting the epidermal growth factor receptor (EGFR)

Question 23

Finasteride
2. side effects

Answer 23

inhibiting the enzyme 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT)
1. erectile dysfunction, jaculatory dysfunction and loss of libido,

Question 24

Monoclonal Antibodies

Answer 24

laboratory-produced proteins designed to mimic the body’s natural antibodies
- Rituximab: Binds to a protein CD20 on B cells
- Blinatumomab: Binds to both CD19 (on leukemia cells) and CD3 (on T cells), bringing T cells

Question 25

Metformin activity

Answer 25

acts by activation of AMPK increase insulin sensitvity decrease hepatic gluco neogenesis decrease GI absorption of Carbo

Question 26

drugs undergo extensive 1st pass metabolism

Answer 26

aspirin ISDN GTN Lignocaine propanalol verapamil isoprenaline testestorone hydrocortisol

Question 27

zero order kinetics

Answer 27

high dose aspirin ethanol phenitoin heparin

Question 28

acetylator status drugs

Answer 28

sulfasalazine, hydralazine, isoniazid, procainamide, and penicillamine, dapsone **SHIPP D**

Question 29

zero-order kinetic drugs

Answer 29

**P's and WHEATS** P's: Phenytoin and Phenylbutazone W: Warfarin H: Heparin E: Ethanol A: Aspirin T's: Theophylline and Tolbutamide S: Salicylates

Question 30

drug-induced urinary retention

Answer 30

anticholinergic, alpha-agonist, opioid properties, as well as some antipsychotics and antidepressants

Question 31

king's college criteria for liver transplant

Answer 31

pH < 7.30 and all three of: INR > 6.5serum creatinine > 300 mcmol/Lthe presence of grade 3 or 4 encephalopathy

Question 32

Aminoglicocide side effect

Answer 32

tubular necrosis urine test muddy brown cast

Question 33

drug causing lung fibrosis

Answer 33

nitrofurentoin ameaderon brom0ocriptin cabagolin pergolide methotrexate sulphursalasine busulphan bliomicin

Question 34

Aminoglicocide Nephro toxicity

Answer 34

ATN

Question 35

AIN toxic drugs

Answer 35

with rash & eosinophila NSAIDS, Antibiotics - Betalactoms,

Question 36

Cortical

Question 37

Metformin Side Effects

Answer 37

Metformin is a first-line oral antidiabetic (biguanide class) used for Type 2 Diabetes Mellitus (T2DM) and PCOS. While generally safe, it has notable side effects: Common Side Effects (≥10%) Gastrointestinal (GI): Diarrhea (most common, often transient). Nausea/vomiting. Abdominal discomfort, bloating, metallic taste. Anorexia (mild weight loss benefit). Serious but Rare Side Effects A. Lactic Acidosis (FDA Black Box Warning) Risk factors: Renal impairment (eGFR <30 mL/min). Severe liver disease, alcoholism, hypoxia (e.g., COPD, sepsis). Contrast dye exposure (temporary hold advised). Symptoms: Fatigue, muscle pain, hyperventilation, hypotension. Lab findings: ↑ Lactate (>5 mmol/L), metabolic acidosis (low pH, low HCO₃⁻). Management: Discontinue metformin, hospitalize, IV bicarbonate if severe. B. Vitamin B12 Deficiency Mechanism: Interferes with B12 absorption in ileum. Risk: Long-term use (>4 years), elderly, vegans. Effects: Megaloblastic anemia (fatigue, pallor). Peripheral neuropathy (numbness, tingling). Prevention: Monitor B12 levels annually (supplement if deficient). 3. Other Side Effects Hypoglycemia (rare alone, but risk increases with insulin/sulfonylureas). Reduced thyroid function (interference with TSH/levothyroxine absorption). Contraindications Absolute: eGFR <30 mL/min (or <45 with risk factors for acidosis). Acute/chronic metabolic acidosis. Relative: Heart failure (if unstable), alcoholism, liver disease. Key Takeaways ✅ GI upset (diarrhea/nausea) is most common → take with food or use ER form. ✅ Lactic acidosis is rare but life-threatening (avoid in renal impairment/hypoxia). ✅ Long-term use → B12 deficiency → monitor levels.

Question 38

Lithium

Answer 38

A. Neurotransmitter Modulation Serotonin & Dopamine Regulation: Enhances serotonin release, improving mood stability. Modulates dopamine hyperactivity, reducing manic symptoms. Glutamate & GABA Balance: Reduces excessive glutamate (excitatory) activity. May enhance GABA (inhibitory) neurotransmission. B. Second Messenger Systems Inhibition of GSK-3 (Glycogen Synthase Kinase-3): Lithium blocks GSK-3, which regulates neuroplasticity and apoptosis. Contributes to neuroprotective effects. Reduction of Inositol Monophosphate (IMP): Disrupts the phosphatidylinositol (PI) cycle, affecting intracellular signaling. Leads to decreased hyperactivity in manic states. C. Neuroprotective & Neurotrophic Effects Increases BDNF (Brain-Derived Neurotrophic Factor): Promotes neuronal growth and synaptic plasticity. Reduces Oxidative Stress & Apoptosis: Protects against neurodegeneration. Lithium modulates serotonin and acetylcholine, neurotransmitters involved in gut motility. Excessive lithium may reduce acetylcholine activity, slowing digestion mild diuretic effect Lithium affects dopaminergic and serotoninergic pathways, leading to fine motor tremors, typically in the hands ("pill-rolling" tremor) 47. Postural tremor (worsens with movement) is most common, resembling essential tremor but often more rapid