Pharmacotherapy

Question 1

Moclobemide

Answer 1

selective MAO A inhibitor

Question 2

What are the side effects of Varenicline?

Answer 2

Nausea
Insomnia
Suicidal and homocidal attempts
Close monitoring for psychiatric disorders

Question 3

Types of local anesthetics?

Answer 3

Ester type (short procaine, medium cocaine, long tetracaine) ->PABA

Amide type (Medium lidocaine, long Bupivacaine, Ropivacaine)

Question 4

Drug cause long QT interval ( Torsade be points)

Answer 4

Quinidine
Satolol
Class III antiarrhythmics
Terfinadine/ astemizole
Pimozide
Chlorpromazine
Ziprasidone
Macrolides (Clarithromycin, azithromycin, erythromycin)

Question 5

Explain the ECG wave

Answer 5

P wave= atrial depolarization
QRS = ventricular depolarization
T wave = phase 3 ventricular reploarization
PR = impulse from atria to purkinj fibers
ST segment = phase 2 Absolute refractory period
QT = mechanical contraction of ventricles

Question 6

Treatment of Alzheimer’s

Answer 6

Galanthamine
Rivastigmine
Donepezil
Memantine

Question 7

Bisphosphonate dosing

Answer 7

Alendronate  Daily (5mg, 10mg) Weekly (35mg, 70mg).
Residronate Daily (5mg), Weekly ( 35mg), 75 mg (2weeks), Monthly (150mg).
Pamidronate (30-60 mg) 3 months
Zoledronoic acid (5mg ) yearly

Question 8

Multiple Sclerosis Treatment

Answer 8

Interferon B, Glatiramer
Alemtuzumab, Natalizumab
Dimethyl fumerate
Fingolimod
Mitoxantrone
Teriflunomide
Fampridine

Question 9

Folic acid antagonists

Answer 9

Methotrexate
Sulpha drug
Trimethoprim

Question 10

Medications that cause weight loss

Answer 10

Ezetimibe 
Metformin
Topiramate
Xenical
CNS stimulants
Levothyroxine
Leflunamide
Dementia medications (Rivastigmine, Galantamine)

Question 11

Causes for hypokalemia?

Answer 11

Vomiting, Diarrhea 
Diabetic ketoacidosis
Laxative abuse
Thiazides/loop diuretics 
B agonist
Corticosteroids 
Insulin
Acute kidney failure
High aldosterone level
Amphotericin B
Cisplatin

Question 12

Conditions should not be treated if a symptomatic?

Answer 12

Increase in Uric acid.
UTI (if in pregnancy Must treat)
Trichomonalis in asymptomatic pregnant woman.

Question 13

Raynaud Disease.

Answer 13

Dihydropyridine CCB-Nifedipine, Felodipine
Alpha Blocker - Prazocin
IV  PGI2 analogue - iloprost
Endothelin 1 inhibitor- Bosentan
PDE 5 inhibitor

Question 14

What is psoriasis?

Answer 14

It is skin condition characterized red scaly patches

Chronic immunologically mediated skin condition

Question 15

Topical treatment for psoriasis include…..

Answer 15

Oil base products +/- Salicylic acid
Vit D (Calcitriol,Calcippotriol)
Calcinurin inhibitors (Tacrolimus,Pimecrolimus)
Topical CS ( betamethasone" Hydrocortisone)
TAT
Topical Vit A (Tazarotene)
Topical Anthralin
Topical Tar

Question 16

Treatment for severe and resistant psoriasis

Answer 16

Oral Acitretin + phytotherapy
Methotrexate
Cyclosporine 
Biological
Intralesion corticosteroid=psoriatic plaque

Question 17

What is meant by acute bronchitis.

Answer 17

Cough -/+ sputum less than 3 weeks

It is resolved without treatment in 10-14 days

Question 18

Causes of acute bronchitis?

Answer 18

Viral.. RSV, parainfluenza, influenza

Non infectious: Mycoplasma pneumonia, Bordetella, Clamydophilia pneumonia

Chemicals or fumes

Question 19

Pharmacological treatment of Acute bronchitis?

Answer 19

Analgesic (Acetaminophen,Ibuprofen)
Antitussive (Codeine, dextromethorphan, hydrocodone)
B2 agonist ( Salbutamol, Terbutaline)
Herbal (Pelargonium root , Ginseng)

Not recommended: Antibiotics, Corticosteroids, mucolytic, expectorants

Question 20

What is the main treatment for different Anxiety disorders?
Panic disorder/ Social Anxiety Disorder/Specific phobia/ Obsessive Compulsive Disorder/ Post Traumatic Stress Disorder (PTSD)/ General Anexity Disoder

Answer 20

SSRI and SNRI

Question 21

What is the use of propranolol in different anxiety disorders?

Answer 21

For stage fear and public speaking fear

PrevenT PTSD if given few hrs before traumatic event

Question 22

Drugs used for treatment of General Anxiety Disorders?

Answer 22

DOC- Escitalopram
1st line - SSRI & SNRI
2nd line - Imipramine
Buspirone, pregabalin, Quatipine, hydroxyzine

Question 23

Attention deficit hyperactivity disorder?

Answer 23

1st- Stimulants (>6yrs)
2nd - Atomoxetine
Bupropion- Venlafaxine- Clonidine

Question 24

Alzheimer’s Dementia

Answer 24

Mild- Donepezil, Rivastigmine, Galantamine
Moderate/ severe - Memantine
Vit E

Question 25

Levy body dementia, dementia with Parkinson's

Answer 25

Rivastigmine | Quetiapine

Question 26

Examples of Irreversible MAO inhibitors used in depression?

Answer 26

Phenelzine | Tranylcypromine

Question 27

What is the discontinuation symptoms of antidepressants?

Answer 27

``` FINISH Flu Insomnia Nausea Imbalance Sensory changes Hyperactivity ```

Question 28

Used for Bipolar maniac disorder?

Answer 28

1st - Lithium, Divalproex, QOR (Quetiapine, Olanzapine, Risperidone) 2nd- Carbamazepine

Question 29

What cause Neuroleptic Malignant Syndrome

Answer 29

Antipsychotics

Question 30

Management of neuroleptic Malignant syndrome?

Answer 30

Stop antipsychotics Hydration + cooling Bromocriptine Dantrolene

Question 31

What is Akathisia? Management

Answer 31

Akathesia is restless leg syndrome Reduce antipsychotics Propranolol BDZ

Question 32

What is acute dystonia?

Answer 32

Sustained muscle contraction Treatment Benzotropine Diphenhydramine

Question 33

Which antipsychotics has maximum weight gain, maxiumum glucose abnormalities, maximum dyslipidemia?

Answer 33

Clozapine | Olanzapine

Question 34

How to switch from one antipsychotic to another?

Answer 34

Crossover technique over (2 weeks - 3 months)

Question 35

What medication used for mild insomnia and jet lag?

Answer 35

Melatonin

Question 36

Smoking cessation?

Answer 36

1st line: NRT, Bupropion, Varenicline 2nd line: Nortryptyline , Clonidine

Question 37

Management of Anorexia Nervosa? DeME More

Answer 37

Domperidone Metoclopramide Erythromycin

Question 38

Managment of Bulimia Nervousa

Answer 38

SSRI (Fluoxetine) | SNRI (Venlafaxine, Trazodone)

Question 39

Examples of neuraminidase inhibitors

Answer 39

Oseltamivir | Zanamivir

Question 40

When does the post vaccination protection from influenza vaccine start?

Answer 40

2 weeks post vaccination and extend for 6 to 8 months

Question 41

Treatment of chronic Spasticity?

Answer 41

``` Baclofen ( GABA b agonist) Tizanidine (a-2 agonist) Diazepam & Clonazepam Gabapentin Dantrolene (insufficient evidence) Sativex (cannabis extract) Phenol injection Botulism toxin II ```

Question 42

Treatment of NSTEMI: Partial block of coronary artery

Answer 42

``` Morphine Oxygen Nitroglycerin Asprine B Blockers /CC blockers Heparin, LMWH, fondaparinaux ```

Question 43

Patient wth STEMI occluded coronary artery

Answer 43

Asprin Nitroglycerin PCI ( available, >75 years, cardiogenic shock, ) Thrombolytics B blocker Asprin / Clopidogrel Heparin, enoxaparin, fondaparinaux (min 48 hrs)

Question 44

Precaution when administrating floroquinolones

Answer 44

Separate dose of floroquinolones about 8 hours when administering sucralfate or metallic cations . It is better to avoid these agents when administrating floroquinolones

Question 45

Patient fentanyl patch fall in bath tub🛁what to do

Answer 45

Contact dr..if not available..patch for patch policy...patient return old patch to get the new patch

Question 46

Medications used for Alzheimer's dementia?

Answer 46

``` Donepezil = DOC Rivastigmine = levy body dementia Galantamine = Vascular dementia ``` Memantine: NMDA antagonist

Question 47

Cause of Alzheimer dementia and diagnosis?

Answer 47

Decrease in Acetyl choline and Beta amyloid plaque Test: Mini- Mental Scale Exam. MMSE

Question 48

Stages of dementia

Answer 48

Preclinical: mild objective cognitive decline🤔 Mild: Impaired instrumental activity of daily life (IADL)💊🚗📞📱💸💵 Moderate: impaired IADL and Personal activity daily life (PADL)🛁👖👔🍛🚽🚰 Severe: PADL cannot be done even if reminded Terminal: patient must be fed as that are immobile and mute

Question 49

Risk factors for Alzheimer?

Answer 49

``` Family history👨‍👩‍👧‍👦 Age 👴🏽 CVD💔 Diabetes🍭 Sedentary life style🚶🏻‍♀️ Head trauma🤕🤕 ```

Question 50

Patient with levy body dementia and hallucination, early Parkinsonism . What to avoid??

Answer 50

Avoid Antipsychotics

Question 51

Diagnosis of Diabetes?

Answer 51

Fasting plasma glucose >7mmol/L Random plasma glucose> 11.1 mmol/liter Plasma glucose level> 11.1 mmol/liter 2hrs 75 mg glucose He Alc >6.5%

Question 52

Diabetic ketoacidosis symptoms

Answer 52

``` > 14mmol/liter Hyperglycemia Ketone urine and blood Volume depletion ( prerenal failure due to dehydration) Acidosis Decrease consciousness ```

Question 53

Management of diabetic ketoacidosis

Answer 53

Fluids KCl IV insulin ( regular rapid insulin) Bicarbonate

Question 54

Management of hyperkalemia

Answer 54

``` Calcium gluconate - stabilize heart Insulin/dextrose - move K inside cell B agonist - move K inside cell NaHCO3 Diuretic Furosamide Resins Sodium polystyrene sulphonate ```

Question 55

Glaucoma Medications

Answer 55

B blocker :Timolol, Betaxolol, Levobunolol a2 Agonist: Apraclonidine, Brimonidine Prostaglandin: Bimatoprost, Travoprost, Latanoprost Carbonic anhydrase inhibitors : acetazolamide, dorzolamide

Question 56

Some one has cataract 👁👁surgery..what are the post operative medications?

Answer 56

Antibiotics (4th floroquinolones, AG, combined products with dexamethasone) Dilators/Cycloplegics Cyclopentolate, phenylephrine, Tropicamide Anti inflammatory agents NSAIDs / Corticosteroids

Question 57

What are medications that cause Cycloplegia?

Answer 57

Ciliary muscle paralysis cause loss of accommodation - Atropine - Cyclopentolate - Homatropine - Scopolamine - Tropicamide