Year 2

Question 1

Azathioprine

Answer 1

• Disease: Used in autoimmune diseases like rheumatoid arthritis, inflammatory bowel disease, and in transplant medicine.
• Mechanism: Suppresses the immune system by inhibiting purine synthesis, leading to decreased proliferation of lymphocytes.
• Side Effects: Bone marrow suppression, increased risk of infections, gastrointestinal disturbances, hepatotoxicity.
• Contraindications: Hypersensitivity, severe bone marrow suppression.
• Pertinent Info: Requires monitoring of blood cell counts and liver function.

Question 2

Sulfasalazine

Answer 2

• Disease: Primarily used in inflammatory bowel disease (Crohn’s disease, ulcerative colitis), and also in rheumatoid arthritis.
• Mechanism: Combination of 5-aminosalicylic acid (anti-inflammatory) and sulfapyridine (antibacterial). Exact mechanism in IBD is not fully understood.
• Side Effects: Gastrointestinal upset, headache, rash, reversible oligospermia.
• Contraindications: Hypersensitivity to sulfonamides, porphyria.
• Pertinent Info: Requires monitoring for blood cell counts, liver function, and kidney function.

Question 3

Docetaxel

Answer 3

• Disease: Used in the treatment of various cancers, including breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, and head and neck cancer.
• Mechanism: Taxane class chemotherapeutic agent that promotes and stabilizes microtubule assembly, inhibiting their disassembly, which disrupts mitotic cell division and leads to cell death.
• Side Effects: Bone marrow suppression (neutropenia, anemia, thrombocytopenia), hypersensitivity reactions, fluid retention, peripheral neuropathy, alopecia, gastrointestinal disturbances (nausea, vomiting, diarrhea), mucositis, fatigue.
• Contraindications: Severe hypersensitivity to docetaxel or polysorbate 80, severe liver impairment, baseline neutrophil count < 1500 cells/mm³.

Question 4

Cyclophosphamide

Answer 4

• Disease: Used in the treatment of various cancers, including lymphomas, leukemias, breast cancer, ovarian cancer, and as an immunosuppressant in autoimmune diseases like lupus and vasculitis.
• Mechanism: Alkylating agent that cross-links DNA, leading to DNA damage and cell death, particularly in rapidly dividing cells.
• Side Effects: Bone marrow suppression (leading to anemia, leukopenia, thrombocytopenia), gastrointestinal disturbances (nausea, vomiting), hemorrhagic cystitis, alopecia, increased risk of infections, secondary malignancies.
• Contraindications: Hypersensitivity to cyclophosphamide, severe bone marrow suppression, active infections.
• Pertinent Info: Adequate hydration and mesna (a uroprotective agent) are used to prevent hemorrhagic cystitis. Regular monitoring of blood counts and renal function is necessary.

Question 5

Vincristine

Answer 5

• Disease: Used in the treatment of various cancers, including leukemia, lymphoma, and some solid tumors like neuroblastoma and Wilms’ tumor.
• Mechanism: Vinca alkaloid that inhibits microtubule formation, disrupting mitosis and leading to cell death.
• Side Effects: Neurotoxicity (peripheral neuropathy, constipation, neurogenic bladder), myelosuppression (less common compared to other chemotherapeutic agents), alopecia, gastrointestinal disturbances.
• Contraindications: Hypersensitivity to vincristine, Charcot-Marie-Tooth disease, intrathecal administration (which is fatal).
• Pertinent Info: Dosing is typically capped to minimize neurotoxic effects. Requires careful handling and administration.

Question 6

Nivolumab

Answer 6

• Disease: Used in the treatment of various cancers, including melanoma, non-small cell lung cancer, renal cell carcinoma, Hodgkin lymphoma, head and neck squamous cell carcinoma, and others.
• Mechanism: Immune checkpoint inhibitor that blocks PD-1 (programmed death-1) receptor, enhancing T-cell responses against cancer cells.
• Side Effects: Immune-related adverse events including colitis, hepatitis, pneumonitis, endocrinopathies (e.g., hypothyroidism, adrenal insufficiency), rash, and fatigue.
• Contraindications: Severe hypersensitivity to nivolumab.
• Pertinent Info: Requires close monitoring for signs of immune-related adverse events, which can often be severe and may require corticosteroids or other immunosuppressive therapies. Regular blood tests and assessments of liver, renal, and thyroid function are typically performed during treatment.

Question 7

Rituximab

Answer 7

• Disease: Used in the treatment of** non-Hodgkin’s lymphoma, chronic lymphocytic leukemia**, rheumatoid arthritis, and certain autoimmune diseases like granulomatosis with polyangiitis and microscopic polyangiitis.
• Mechanism: Monoclonal antibody that targets CD20, a protein expressed on the surface of B cells, leading to B cell lysis through antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and direct apoptosis.
• Side Effects: Infusion-related reactions (fever, chills, hypotension), infections, cytopenias, progressive multifocal leukoencephalopathy (PML), cardiovascular events.
• Contraindications: Hypersensitivity to rituximab or any component of the formulation, active severe infections.
• Pertinent Info: Requires premedication with antihistamines and antipyretics to reduce the risk of infusion reactions. Monitoring for infections and regular blood counts is essential.

Question 8

Cytarabine

Answer 8

• Disease: Used primarily in the treatment of acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), and non-Hodgkin’s lymphoma. It is also used intrathecally for the treatment and prophylaxis of meningeal leukemia and lymphoma.
• Mechanism: Cytarabine is a pyrimidine nucleoside analogue that inhibits DNA synthesis. It is converted into its active form, cytarabine triphosphate (ara-CTP), which incorporates into DNA and inhibits DNA polymerase, leading to impaired DNA replication and repair, resulting in cell death, particularly in rapidly dividing cells.
• Side Effects: Bone marrow suppression (leading to anemia, leukopenia, thrombocytopenia), gastrointestinal disturbances (nausea, vomiting, diarrhea, mucositis), hepatotoxicity, neurotoxicity (cerebellar toxicity, seizures), ocular toxicity (conjunctivitis, keratitis), and pulmonary toxicity. Other side effects include rash, fever, and flu-like symptoms.
• Contraindications: Hypersensitivity to cytarabine, severe bone marrow suppression (except when used in controlled conditions for treatment of leukemia), active infections.

Question 9

Methotrexate

Answer 9

• Disease: Used in the treatment of various conditions, including rheumatoid arthritis, psoriasis, and certain cancers such as acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, and osteosarcoma.
• Mechanism: Antimetabolite and antifolate agent that inhibits dihydrofolate reductase, leading to inhibition of DNA, RNA, and protein synthesis. This results in reduced cell proliferation and induces apoptosis, particularly in rapidly dividing cells.
• Side Effects: Bone marrow suppression (leading to anemia, leukopenia, thrombocytopenia), gastrointestinal disturbances (nausea, vomiting, mucositis), hepatotoxicity, nephrotoxicity, pulmonary toxicity, and risk of serious infections. Other side effects include alopecia, fatigue, and stomatitis.
• Contraindications: Severe renal or hepatic impairment, bone marrow suppression, active infections, known hypersensitivity to methotrexate, and pregnancy (due to teratogenic effects).

Question 10

Ipilimumab

Answer 10

• Disease: Used in the treatment of melanoma, renal cell carcinoma, and other cancers.
• Mechanism: Monoclonal antibody that blocks cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). This inhibition enhances T-cell activation and proliferation, boosting the immune system’s response against cancer cells.
• Side Effects: Immune-related adverse events including colitis, hepatitis, dermatitis, endocrinopathies (such as hypothyroidism or hypophysitis), and pneumonitis. Other common side effects include fatigue, diarrhea, rash, and pruritus.
• Contraindications: Severe hypersensitivity to ipilimumab or any component of the formulation.

Question 11

Trastuzumab and Pertuzumab:

Answer 11

• Disease: Used in the treatment of HER2-positive breast cancer.
• Mechanism: Monoclonal antibodies that** target the HER2 receptor**, inhibiting cancer cell growth and survival.
• Side Effects: Infusion reactions, cardiotoxicity, diarrhea.
• Contraindications: Hypersensitivity, pre-existing heart failure.

Question 12

Timolol

Answer 12

• Disease: Used in the treatment of glaucoma and ocular hypertension.
• Mechanism: Non-selective beta-blocker that reduces intraocular pressure by decreasing aqueous humor production.
• Side Effects: Eye irritation, bradycardia, hypotension, bronchospasm.
• Contraindications: Asthma, severe COPD, bradycardia, heart block.

Question 13

Name some drugs that act on the M-phase of the cell cycle.

Answer 13

Colchicine ( prevents microtubule polymerization, leading to the arrest of cells in mitosis.)

Vinca alkaloids (inhibit microtubule polymerization by binding to tubulin subunits, leading to the formation of abnormal microtubules.)

Paclitaxel (microtubule polymerization and prevents depolymerization.)

Question 14

Colchicine

Answer 14

• Disease: Used primarily in the treatment of gout and familial Mediterranean fever (FMF).
• Mechanism: Inhibits microtubule polymerization, leading to disruption of cell division, migration of inflammatory cells, and phagocytosis.
• Side Effects: Gastrointestinal upset (nausea, vomiting, diarrhea), myopathy, peripheral neuropathy.
• Contraindications: Severe renal or hepatic impairment, gastrointestinal disorders.

Question 15

Vinca Alkaloids

Answer 15

• Disease: Used in various cancers, including leukemia, lymphoma, breast cancer, and lung cancer.
• Mechanism: Inhibit microtubule assembly, leading to disruption of mitotic spindle formation and cell division.
• Side Effects: Bone marrow suppression, peripheral neuropathy, gastrointestinal disturbances
• Contraindications: Hypersensitivity, severe bone marrow suppression, neuropathy.

Question 16

Paclitaxel

Answer 16

• Disease: Used in various cancers, including breast cancer, ovarian cancer, and lung cancer.
• Mechanism: Stabilizes microtubules, leading to inhibition of mitotic spindle function and cell division.
• Side Effects: Bone marrow suppression, peripheral neuropathy, hypersensitivity reactions.
• Contraindications: Hypersensitivity, severe bone marrow suppression.
• Pertinent Info: Requires premedication to prevent hypersensitivity reactions.

Question 17

Hydroxychloroquine

Answer 17

• Disease: Used in autoimmune diseases like rheumatoid arthritis, lupus erythematosus, and malaria.
• Mechanism: Exact mechanism in autoimmune diseases is not fully understood. May modulate immune response and interfere with lysosomal activity.
• Side Effects: Retinopathy, gastrointestinal disturbances, skin reactions.
• Contraindications: Pre-existing retinopathy, hypersensitivity to 4-aminoquinolines.
• Pertinent Info: Requires regular eye examinations due to risk of retinopathy.

Question 18

Certolizumab-pegol

Answer 18

• Disease: Used in autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, Crohn’s disease.
• Mechanism: Monoclonal antibody against tumor necrosis factor-alpha (TNF-α), inhibiting its inflammatory effects.
• Side Effects: Increased risk of infections, injection site reactions, infusion reactions, increased risk of malignancies.
• Contraindications: Active infections, hypersensitivity.
• Pertinent Info: Increased risk of reactivation of latent tuberculosis (TB).
• Pegylation increases the retention time, reduces the immunogenicity and increases the stability of the drug to be metabolized by enzymes.

Question 19

MAOI (Monoamine Oxidase Inhibitors)

Answer 19

• Diseases: Depression, particularly atypical depression and treatment-resistant depression.
• Mechanism: Inhibit monoamine oxidase enzyme, increasing levels of neurotransmitters (serotonin, norepinephrine, dopamine)
• Side Effects: Hypertensive crisis (with tyramine-rich foods), weight gain, insomnia, dizziness.
• Contraindications: Concurrent use with SSRIs, TCAs, certain pain medications, and other serotonergic drugs.

Question 20

SSRI (Selective Serotonin Reuptake Inhibitors)

Answer 20

• Diseases: Depression, anxiety disorders, PTSD, OCD
  .
• Mechanism: Inhibit reuptake of serotonin, increasing its availability in the synaptic cleft.
• Side Effects: Nausea, sexual dysfunction, insomnia, weight gain, serotonin syndrome (rare but serious).
• Contraindications: Concurrent use with MAOIs, certain other serotonergic drugs.

Question 21

TCA (Tricyclic Antidepressants)

Answer 21

• Diseases: Depression, neuropathic pain, migraine prophylaxis.
• Mechanism: Inhibit reuptake of norepinephrine and serotonin, also block acetylcholine and histamine receptors.
• Side Effects: Anticholinergic effects (dry mouth, constipation), sedation, weight gain, cardiotoxicity (in overdose).
• Contraindications: Recent myocardial infarction, concurrent use with MAOIs.

Question 22

Bupropion

Answer 22

• Diseases: Depression, smoking cessation.
• Mechanism: Inhibits reuptake of norepinephrine and dopamine.
• Side Effects: Insomnia, dry mouth, seizure risk (dose-dependent).
• Contraindications: Seizure disorders, eating disorders, concurrent use with MAOIs.

Question 23

Mianserin

Answer 23

• Diseases: Depression (primarily used in some countries).
• Mechanism: Noradrenergic and specific serotonergic antidepressant (NaSSA); blocks alpha-2 adrenergic receptors and serotonin receptors.
• Side Effects: Sedation, weight gain, agranulocytosis (rare but serious).
• Contraindications: Severe liver impairment, mania.

Question 24

Oestrogen

Answer 24

• Diseases: Hormone replacement therapy (HRT), certain cancers, contraceptive.
• Mechanism: Modulates gene expression by binding to estrogen receptors, influencing reproductive and other systems.
• Side Effects: Thromboembolic events, breast tenderness, headache, nausea.
• Contraindications: History of thromboembolic disorders, certain cancers, liver disease.

Question 25

Glutamatergic Agents

Answer 25

* **Diseases**: Alzheimer's disease (memantine), treatment-resistant depression (ketamine). * **Mechanism**: Modulate glutamate receptors (e.g., NMDA receptor antagonists). * **Side** **Effects**: Dizziness, headache, confusion (memantine); dissociation, elevated blood pressure (ketamine). * **Contraindications**: Severe renal impairment (memantine).

Question 26

Cannabidiol (CBD)

Answer 26

* **Diseases**: Epilepsy (e.g., Dravet syndrome, Lennox-Gastaut syndrome), anxiety, certain pain conditions. * **Mechanism**: Modulates endocannabinoid system, serotonin receptors, and other pathways. * **Side** **Effects**: Diarrhea, fatigue, changes in appetite. * **Contraindications**: Known hypersensitivity, caution in liver impairmen

Question 27

Barbiturates

Answer 27

* **Diseases**: Seizure disorders, anesthesia, anxiety (historical). * **Mechanism**: Enhance GABA-A receptor activity, increasing inhibitory neurotransmission. * **Side** **Effects**: Sedation, respiratory depression, tolerance, dependence. * **Contraindications**: Porphyria, severe respiratory or hepatic impairment.

Question 28

Benzodiazepines

Answer 28

* **Diseases**: Anxiety, insomnia, seizure disorders, muscle spasms. * **Mechanism**: Enhance GABA-A receptor activity, increasing inhibitory neurotransmission. * **Side** **Effects**: Sedation, dependence, respiratory depression (in overdose). * **Contraindications**: Severe respiratory insufficiency, sleep apnea, myasthenia gravis.

Question 29

Z Drugs (Non-Benzodiazepine Hypnotics)

Answer 29

* **Diseases**: Insomnia. * **Mechanism**: Enhance GABA-A receptor activity, similar to benzodiazepines but more selective for the alpha-1 subunit. * **Side** **Effects**: Sedation, dizziness, dependence (less than benzodiazepines). * **Contraindications**: Severe respiratory insufficiency, sleep apnea.

Question 30

5HT1A Antagonists

Answer 30

* **Diseases**: Depression, anxiety disorders (e.g., buspirone). * **Mechanism**: Partial agonists or antagonists at 5HT1A receptors, modulating serotonin activity. * **Side** **Effects**: Dizziness, headache, nausea. * **Contraindications**: Severe hepatic or renal impairment.

Question 31

Beta Noradrenergic Receptor Antagonists (Beta Blockers)

Answer 31

* **Diseases**: Hypertension, anxiety (situational), arrhythmias, heart failure. * **Mechanism**: Block beta-adrenergic receptors, reducing heart rate and contractility, and decreasing anxiety symptoms. * **Side** **Effects**: Bradycardia, fatigue, bronchospasm. * **Contraindications**: Asthma, severe bradycardia, certain heart block conditions.

Question 32

GABA Binding Agents

Answer 32

* **Diseases**: Epilepsy, anxiety, insomnia. * **Mechanism**: Enhance GABAergic activity by binding to GABA receptors, increasing inhibitory neurotransmission. * **Side** **Effects**: Sedation, dizziness, dependence (varies by specific agent). * **Contraindications**: Varies by specific agent; typically includes severe respiratory insufficiency and hypersensitivity.

Question 33

Hydrocortisone

Answer 33

**Disease**: Used in various conditions, including adrenal insufficiency, allergic reactions, asthma, and inflammatory disorders. **Mechanism**: Synthetic glucocorticoid that suppresses inflammation and immune responses by inhibiting cytokine production and leukocyte migration. **Side** **Effects**: Adrenal suppression, osteoporosis, hypertension, hyperglycemia, fluid retention. **Contraindications**: Systemic fungal infections, hypersensitivity.

Question 34

Prednisolone, Dexamethasone, Betamethasone

Answer 34

* **Disease**: Used in the treatment of various inflammatory and autoimmune conditions, including rheumatoid arthritis, asthma, and dermatitis. * **Mechanism**: Synthetic corticosteroid that suppresses inflammation and immune responses by inhibiting cytokine production and leukocyte migration. * **Side** **Effects**: Adrenal suppression, osteoporosis, hypertension, hyperglycemia, mood changes. * **Contraindications**: Systemic fungal infections, hypersensitivity.

Question 35

Nucleoside and Nucleotide Analog Polymerase Inhibitors:

Answer 35

**Disease**: Used primarily in the treatment of viral infections, including herpesviruses (e.g., herpes simplex virus, varicella-zoster virus) and HIV. **Mechanism**: These drugs interfere with viral RNA or DNA synthesis by acting as analogs of nucleosides or nucleotides. They are incorporated into the viral DNA or RNA chain during replication, leading to premature termination of the chain and inhibition of further synthesis. **Side** **Effects**: nausea, vomiting, diarrhea, headache, and fatigue. Long-term use may lead to renal toxicity (especially with tenofovir), bone marrow suppression, and peripheral neuropathy (particularly with older agents like stavudine). **Contraindications**: Hypersensitivity to the drug or its components. Renal impairment (dose adjustments may be necessary for certain agents).

Question 36

Protease Inhibitors:

Answer 36

**Disease**: Primarily used in the treatment of HIV infection, where they are part of combination antiretroviral therapy (cART) regimens. **Mechanism**: Protease inhibitors block the activity of viral proteases, enzymes essential for the cleavage of viral polyproteins into functional proteins required for viral replication. By inhibiting protease activity, these drugs prevent the production of infectious viral particles. **Side** **Effects**: gastrointestinal symptoms (nausea, diarrhea), metabolic disturbances (lipid abnormalities, insulin resistance), and drug interactions (due to inhibition of cytochrome P450 enzymes). **Contraindications** Hypersensitivity to the drug or its components. Concurrent use with medications metabolized by the cytochrome P450 system

Question 37

Neuraminidase Inhibitors:

Answer 37

**Disease**: Used primarily for the treatment and prevention of influenza virus infections, including seasonal flu and influenza outbreaks. **Mechanism**: Neuraminidase inhibitors target the neuraminidase enzyme, which is essential for the release of newly formed viral particles from infected cells. By inhibiting neuraminidase activity, these drugs prevent the spread of the virus to uninfected cells and reduce the severity and duration of symptoms. **Side** **Effects**: nausea, vomiting, headache, and dizziness.

Question 38

Fusion Inhibitors:

Answer 38

**Disease**: Primarily used in the treatment of HIV infection, particularly in patients who have developed resistance to other antiretroviral drugs. **Mechanism**: Fusion inhibitors prevent viral entry into host cells by blocking the fusion between the viral and cellular membranes. They specifically target viral proteins involved in membrane fusion, such as the gp41 protein of HIV. By inhibiting fusion, these drugs prevent viral entry and subsequent infection of host cells. **Side Effects:** injection site reactions (for enfuvirtide), hypersensitivity reactions, and gastrointestinal symptoms. Rare but serious side effects may include immune reconstitution syndrome and pneumonia.

Question 39

Amphotericin B:

Answer 39

**Disease**: Used in the treatment of severe fungal infections, including invasive candidiasis, aspergillosis, cryptococcosis, and mucormycosis. **Mechanism**: Binds to ergosterol in fungal cell membranes, disrupting membrane integrity and leading to leakage of cellular contents and fungal cell death. **Side** **Effects**: Infusion-related reactions (fever, chills, rigors), Nephrotoxicity (renal impairment, electrolyte disturbances), Hepatotoxicity, Hypokalemia, hypomagnesemia.. Anemia. **Contraindications**: Hypersensitivity to amphotericin B or any component of the formulation. Pre-existing renal impairment. Concomitant use with nephrotoxic drugs.

Question 40

Zidovudine (AZT):

Answer 40

**Disease**: Used in the treatment of HIV infection, both as monotherapy and in combination with other antiretroviral drugs. **Mechanism**: Nucleoside reverse transcriptase inhibitor (NRTI) that interferes with the reverse transcription process of HIV, leading to chain termination and inhibition of viral DNA synthesis. **Side** **Effects**: Bone marrow suppression (anemia, neutropenia). Gastrointestinal disturbances (nausea, vomiting, diarrhea). Lactic acidosis/hepatomegaly with steatosis (rare but serious). Peripheral neuropathy. Lipodystrophy.

Question 41

Dabigatran

Answer 41

**Disease**: Used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, and for the treatment and prevention of venous thromboembolism (VTE). **Mechanism**: Direct thrombin inhibitor that specifically targets thrombin, a key enzyme in the coagulation cascade, thereby preventing the formation of fibrin clots. **Side** **Effects**: Bleeding (major and minor). Gastrointestinal symptoms (dyspepsia, gastritis). Increased risk of myocardial infarction (MI) and other cardiovascular events in certain patient populations. **Contraindications**: Hypersensitivity to dabigatran or any component of the formulation. Active pathological bleeding. Severe renal impairment (CrCl < 30 mL/min).

Question 42

Immune Checkpoint Inhibitor:

Answer 42

**Disease**: Used in the treatment of various cancers, including melanoma, non-small cell lung cancer, renal cell carcinoma, and others. **Mechanism**: Blocks inhibitory checkpoint proteins such as PD-1 (programmed cell death protein 1) or CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), thereby enhancing the activity of T cells against cancer cells. **Side** **Effects**: Immune-related adverse events (irAEs) including dermatitis, colitis, hepatitis, pneumonitis, and endocrinopathies (e.g., hypothyroidism, hypophysitis). Fatigue. Rash. Infusion reactions. **Contraindications**: Hypersensitivity to the immune checkpoint inhibitor or any component of the formulation. Active autoimmune disease requiring systemic immunosuppressive therapy. Severe or uncontrolled concurrent infections.

Question 43

Disease Modifying Antirheumatic Drugs (DMARDs): Entanercept

Answer 43

**Disease**: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis. **Mechanism**: Tumor necrosis factor (TNF) inhibitor, reducing inflammation and joint damage. **Side** **Effects**: Injection site reactions, increased risk of infections, headache, gastrointestinal symptoms. **Contraindications**: Active infections, heart failure. Pertinent Information: Requires regular monitoring for infections and signs of heart failure.

Question 44

Disease Modifying Antirheumatic Drugs (DMARDs): Cyclosporin

Answer 44

**Disease**: Rheumatoid arthritis, psoriatic arthritis. **Mechanism**: Calcineurin inhibitor, suppresses T-cell activation and inflammatory response. **Side** **Effects**: Nephrotoxicity, hypertension, tremor, gingival hyperplasia. **Contraindications**: Hypersensitivity to cyclosporin, uncontrolled hypertension, renal impairment. Pertinent Information: Requires regular monitoring of renal function and blood pressure.

Question 45

Dopamine Agonists: | Bromocriptine Ropinirole Pramipexole

Answer 45

**Disease**: Parkinson's disease, restless legs syndrome, hyperprolactinemia. **Mechanism**: Stimulate dopamine receptors, restoring dopaminergic function in the brain. **Side** **Effects**: Nausea, dizziness, hallucinations, hypotension. **Contraindications**: Hypersensitivity to the drug, uncontrolled psychiatric disorders. Pertinent Information: Start with low doses and titrate gradually to minimize side effects.

Question 46

Antiestrogens: | Tamoxifen

Answer 46

**Disease**: Breast cancer (estrogen receptor-positive). **Mechanism**: Selective estrogen receptor modulator (SERM), blocks estrogen binding to breast cancer cells. **Side** **Effects**: Hot flashes, vaginal discharge, increased risk of endometrial cancer, thromboembolic events. **Contraindications**: History of thromboembolic events, pregnancy, concurrent use with strong CYP2D6 inhibitors. Pertinent Information: Long-term use may increase the risk of uterine cancer; regular monitoring is required.

Question 47

Cholinesterase Inhibitors: | Donepezil, Rivastigmine

Answer 47

**Disease**: Alzheimer's disease, dementia. **Mechanism**: Inhibit acetylcholinesterase, increasing acetylcholine levels in the brain, improving cognitive function. **Side** **Effects**: Nausea, vomiting, diarrhea, bradycardia (rivastigmine). **Contraindications**: Hypersensitivity to the drug, severe bradycardia, concurrent use with anticholinergic drugs. Pertinent Information: Start with low doses and titrate gradually to minimize gastrointestinal side effects.

Question 48

NMDA Receptor Antagonists: | Memantine

Answer 48

**Disease**: Alzheimer's disease. **Mechanism**: NMDA receptor antagonist, regulates glutamate activity, reducing excitotoxicity. **Side** **Effects**: Dizziness, headache, confusion. **Contraindications**: Hypersensitivity to the drug, severe renal impairment. **Pertinent** **Information**: May be used in combination with cholinesterase inhibitors for moderate to severe Alzheimer's disease.

Question 49

Monoclonal Antibodies: Rosuzumab | Lecanemab

Answer 49

**Disease**: Osteoporosis. **Mechanism**: Monoclonal antibody targeting sclerostin, increasing bone formation. **Side** **Effects**: Injection site reactions, hypercalcemia, hypophosphatemia. **Contraindications**: Hypersensitivity to the drug, hypercalcemia. **Pertinent** **Information**: Administered subcutaneously once monthly; requires monitoring of serum calcium and phosphorus levels.

Question 50

Antidiabetic Drugs: Metformin

Answer 50

**Disease**: Type 2 diabetes mellitus. **Mechanism**: Biguanide, decreases hepatic glucose production, improves insulin sensitivity. **Side** **Effects**: Gastrointestinal upset, lactic acidosis (rare). **Contraindications**: Renal impairment (eGFR < 30 mL/min/1.73 m²), acute or chronic metabolic acidosis. **Pertinent** **Information**: Considered first-line therapy for type 2 diabetes; monitor renal function regularly.

Question 51

Anticonvulsants | Gabapentin

Answer 51

**Disease**: Epilepsy, neuropathic pain, restless legs syndrome. **Mechanism**: Binds to voltage-gated calcium channels, reducing excitatory neurotransmitter release. **Side** **Effects**: Dizziness, somnolence, peripheral edema. **Contraindications**: Hypersensitivity to the drug. **Pertinent** **Information**: Titrate dose gradually to minimize side effects; avoid abrupt discontinuation.

Question 52

Antidiabetic Drugs: Gliclazide

Answer 52

**Disease**: Type 2 diabetes mellitus. **Mechanism**: Sulfonylurea, stimulates insulin release from pancreatic beta cells. **Side Effects:** Hypoglycemia, weight gain, gastrointestinal upset. **Contraindications**: Hypersensitivity to the drug, type 1 diabetes mellitus, diabetic ketoacidosis. **Pertinent** **Information**: May require dose adjustment in renal impairment; monitor blood glucose regularly.

Question 53

Antihyperlipidemics: Atorvastatin

Answer 53

**Disease**: Hypercholesterolemia, prevention of cardiovascular events. **Mechanism**: HMG-CoA reductase inhibitor, reduces cholesterol synthesis, increases LDL receptor expression. **Side Effects**: Myopathy, elevated liver enzymes, gastrointestinal upset. **Contraindications**: Active liver disease, pregnancy, breastfeeding. **Pertinent Information**: Monitor liver function tests periodically; may interact with other medications metabolized by CYP3A4.

Question 54

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

Answer 54

* **Disease**: Pain, inflammation, fever, arthritis. * **Mechanism**: Inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. * **Side** **Effects**: Gastrointestinal ulcers, bleeding, renal impairment, cardiovascular risks. * **Contraindications**: Peptic ulcer disease, renal impairment, cardiovascular disease, hypersensitivity to NSAIDs.

Question 55

Capsaicin

Answer 55

* **Disease**: Neuropathic pain, osteoarthritis. * **Mechanism**: Activates TRPV1 receptors, leading to the depletion of substance P and reduced pain sensation. * **Side** **Effects**: Local burning, stinging, erythema. * **Contraindications**: Hypersensitivity to capsaicin.

Question 56

COX-2 Inhibitors

Answer 56

* **Disease**: Pain, inflammation, arthritis. * **Mechanism**: Selectively inhibits COX-2 enzyme, reducing prostaglandin synthesis with less gastrointestinal side effects. * **Side** **Effects**: Cardiovascular risks, renal impairment, gastrointestinal issues (less than non-selective NSAIDs). * **Contraindications**: Cardiovascular disease, renal impairment, hypersensitivity to COX-2 inhibitors. *

Question 57

Corticosteroids

Answer 57

* **Disease**: Inflammatory and autoimmune conditions, allergies, asthma. * **Mechanism**: Inhibits multiple inflammatory cytokines, suppressing immune response. * **Side** **Effects**: Weight gain, osteoporosis, hyperglycemia, hypertension, adrenal suppression. * **Contraindications**: Systemic infections, hypersensitivity to corticosteroids.

Question 58

Calcineurin Inhibitors (Tacrolimus)

Answer 58

* **Disease**: Organ transplantation, atopic dermatitis. * **Mechanism**: Inhibits calcineurin, reducing T-cell activation and cytokine production. * **Side** **Effects**: Nephrotoxicity, hypertension, hyperglycemia, neurotoxicity. * **Contraindications**: Hypersensitivity to tacrolimus.

Question 59

Antihistamines

Answer 59

**Disease**: Allergies, allergic rhinitis, urticaria. **Mechanism**: Blocks H1 histamine receptors, reducing allergic symptoms. **Side** **Effects**: Sedation, dry mouth, dizziness (more in first-generation antihistamines). **Contraindications**: Hypersensitivity to antihistamines.

Question 60

Azathioprine

Answer 60

* **Disease**: Autoimmune diseases, organ transplantation. * **Mechanism**: Inhibits purine synthesis, reducing lymphocyte proliferation. * **Side** **Effects**: Bone marrow suppression, gastrointestinal disturbances, hepatotoxicity. * **Contraindications**: Hypersensitivity to azathioprine, pregnancy.

Question 61

Methotrexate

Answer 61

* **Disease**: Rheumatoid arthritis, psoriasis, cancer. * **Mechanism**: Inhibits dihydrofolate reductase, reducing DNA synthesis. * **Side** **Effects**: Bone marrow suppression, hepatotoxicity, pulmonary toxicity. * **Contraindications**: Pregnancy, liver disease, renal impairment.

Question 62

Ciclosporin

Answer 62

* **Disease**: Organ transplantation, autoimmune diseases. * **Mechanism**: Inhibits calcineurin, reducing T-cell activation. * **Side** **Effects**: Nephrotoxicity, hypertension, hyperlipidemia, gingival hyperplasia. * **Contraindications**: Hypersensitivity to ciclosporin.

Question 63

Dupilumab

Answer 63

**Disease**: Atopic dermatitis, asthma. **Mechanism**: IL-4 receptor alpha antagonist, reducing IL-4 and IL-13 signaling. **Side** **Effects**: Injection site reactions, conjunctivitis, eosinophilia. **Contraindications**: Hypersensitivity to dupilumab.

Question 64

Alitretinoin

Answer 64

* **Disease**: Chronic hand eczema. * **Mechanism**: Binds to retinoid receptors, modulating cell proliferation and differentiation. * **Side** **Effects**: Headache, dryness of skin and mucous membranes, teratogenicity. * **Contraindications**: Pregnancy, hypersensitivity to retinoids. MUST BE ON BIRTH CONTROL

Question 65

Dithranol

Answer 65

**Disease**: Psoriasis. **Mechanism**: Inhibits DNA synthesis, reducing keratinocyte proliferation. **Side** **Effects**: Skin irritation, staining of skin and clothing. **Contraindications**: Acute or pustular psoriasis, hypersensitivity to dithranol.

Question 66

Doxycycline

Answer 66

* **Disease**: Bacterial infections, acne, Lyme disease. * **Mechanism**: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. * **Side** **Effects**: Gastrointestinal upset, photosensitivity, esophagitis. * **Contraindications**: Pregnancy, children under 8 years, hypersensitivity to tetracyclines.

Question 67

Duloxetine

Answer 67

* **Disease**: Depression, anxiety, neuropathic pain. * **Mechanism**: Serotonin and norepinephrine reuptake inhibitor. * **Side** **Effects**: Nausea, dry mouth, dizziness, insomnia. * **Contraindications**: MAOI use, uncontrolled glaucoma, hypersensitivity to duloxetine.

Question 68

Amitriptyline

Answer 68

* **Disease**: Depression, neuropathic pain. * **Mechanism**: Tricyclic antidepressant, inhibits reuptake of serotonin and norepinephrine. * **Side** **Effects**: Sedation, dry mouth, weight gain, cardiac toxicity. * **Contraindications**: MAOI use, recent myocardial infarction, hypersensitivity to amitriptyline.

Question 69

Teriparatide

Answer 69

**Disease**: Osteoporosis. **Mechanism**: Recombinant PTH, stimulates bone formation. **Side** **Effects**: Hypercalcemia, dizziness, leg cramps. **Contraindications**: Hypercalcemia, bone metastases, skeletal malignancies.

Question 70

Romosozumab

Answer 70

* **Disease**: Osteoporosis. * **Mechanism**: Sclerostin inhibitor, increases bone formation and decreases bone resorption. * **Side** **Effects**: Arthralgia, headache, injection site reactions. * **Contraindications**: Hypersensitivity to romosozumab.

Question 71

Bisphosphonates

Answer 71

* **Disease**: Osteoporosis, Paget’s disease. * **Mechanism**: Inhibits osteoclast-mediated bone resorption. * **Side** **Effects**: Gastrointestinal issues, osteonecrosis of the jaw, atypical femoral fractures. * **Contraindications**: Esophageal abnormalities, inability to stand or sit upright for 30 minutes, hypocalcemia.

Question 72

Non-Bisphosphonates (e.g., Raloxifene)

Answer 72

* **Disease**: Osteoporosis. * **Mechanism**: Selective estrogen receptor modulator, reduces bone resorption. * **Side** **Effects**: Hot flashes, leg cramps, thromboembolism. * **Contraindications**: History of venous thromboembolism, pregnancy.

Question 73

Denosumab

Answer 73

* **Disease**: Osteoporosis, bone metastases. * **Mechanism**: RANKL inhibitor, reduces osteoclast activity. * **Side** **Effects**: Hypocalcemia, infections, osteonecrosis of the jaw. * **Contraindications**: Hypocalcemia, hypersensitivity to denosumab.

Question 74

NGF mAb (Nerve Growth Factor monoclonal antibodies)

Answer 74

**Disease**: Chronic pain. **Mechanism**: Inhibits nerve growth factor, reducing pain signaling. **Side** **Effects**: Arthralgia, headache, potential for joint destruction. **Contraindications**: History of significant orthopedic conditions.

Question 75

Furosemide

Answer 75

* **Disease**: Oedema, hypertension. * **Mechanism**: Loop diuretic, inhibits Na-K-2Cl transporter in the loop of Henle. * **Side** **Effects**: Electrolyte imbalances, dehydration, hypotension. * **Contraindications**: Anuria, severe electrolyte depletion, hypersensitivity to furosemide.

Question 76

Pamidronate

Answer 76

* **Disease**: Hypercalcemia of malignancy, Paget's disease, bone metastases. * **Mechanism**: Bisphosphonate, inhibits osteoclast-mediated bone resorption. * **Side** **Effects**: Hypocalcemia, osteonecrosis of the jaw, flu-like symptoms. * **Contraindications**: Hypocalcemia, severe renal impairment.

Question 77

Calcitonin

Answer 77

* **Disease**: Osteoporosis, hypercalcemia, Paget's disease. * **Mechanism**: Inhibits osteoclast activity, lowers blood calcium levels. * **Side** **Effects**: Nausea, facial flushing, injection site reactions. * **Contraindications**: Hypersensitivity to calcitonin.

Question 78

Prednisolone

Answer 78

* **Disease**: Inflammatory and autoimmune conditions. * **Mechanism**: Glucocorticoid, reduces inflammation and suppresses immune response. * **Side** **Effects**: Weight gain, osteoporosis, hyperglycemia, adrenal suppression. * **Contraindications**: Systemic infections, hypersensitivity to corticosteroids.

Question 79

Calcimimetics (e.g., Cinacalcet)

Answer 79

* **Disease**: Secondary hyperparathyroidism, parathyroid carcinoma. * **Mechanism**: Activates calcium-sensing receptors, reducing PTH secretion. * **Side** **Effects**: Hypocalcemia, nausea, vomiting. * **Contraindications**: Hypocalcemia.

Question 80

Calcium Gluconate

Answer 80

* **Disease**: Hypocalcemia, hyperkalemia, hypermagnesemia, calcium channel blocker overdose. * **Mechanism**: Provides calcium ions necessary for physiological functions, including muscle contraction, nerve function, and blood clotting. * **Side** **Effects**: Nausea, vomiting, constipation, hypercalcemia (with excessive use), hypotension (if administered too quickly intravenously). * **Contraindications**: Hypercalcemia, renal calculi, ventricular fibrillation, hypersensitivity to calcium gluconate.

Question 81

Leflunomide

Answer 81

* **Disease**: Rheumatoid arthritis. * **Mechanism**: Inhibits dihydroorotate dehydrogenase, leading to a reduction in pyrimidine synthesis and decreased lymphocyte proliferation. * **Side** **Effects**: Hepatotoxicity, gastrointestinal disturbances, hypertension, alopecia. * **Contraindications**: Pregnancy, severe hepatic impairment, hypersensitivity to leflunomide. * **Pertinent** **Information**: Teratogenic; requires effective contraception during and after treatment until drug levels are sufficiently low.

Question 82

Etanercept

Answer 82

* **Disease**: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis. * **Mechanism**: TNF-alpha inhibitor, reduces inflammation and immune response. * **Side** **Effects**: Increased risk of infections, injection site reactions, malignancies. * **Contraindications**: Active infections, hypersensitivity to etanercept. * **Pertinent** **Information**: Screen for latent tuberculosis before starting treatment.

Question 83

Bromocriptine

Answer 83

* **Disease**: Parkinson's disease, hyperprolactinemia. * **Mechanism**: Dopamine agonist, stimulates dopamine receptors. * **Side** **Effects**: Nausea, vomiting, orthostatic hypotension, hallucinations. * **Contraindications**: Uncontrolled hypertension, hypersensitivity to ergot derivatives. * **Pertinent** **Information**: May be used to treat symptoms of Parkinson's disease and disorders related to high prolactin levels.

Question 84

Ropinirole

Answer 84

* **Disease**: Parkinson's disease, restless legs syndrome. * **Mechanism**: Dopamine agonist, stimulates dopamine receptors in the brain. * **Side** **Effects**: Nausea, dizziness, somnolence, orthostatic hypotension. * **Contraindications**: Hypersensitivity to ropinirole. * **Pertinent** **Information**: Gradually increase dosage to reduce the risk of side effects. *

Question 85

Pramipexole

Answer 85

* **Disease**: Parkinson's disease, restless legs syndrome. * **Mechanism**: Dopamine agonist, stimulates dopamine receptors in the brain. * **Side** **Effects**: Nausea, dizziness, somnolence, orthostatic hypotension. * **Contraindications**: Hypersensitivity to pramipexole. * **Pertinent** **Information**: Monitor for signs of compulsive behaviors and sudden onset of sleep. *

Question 86

Amantadine

Answer 86

* **Disease**: Parkinson's disease, drug-induced extrapyramidal symptoms. * **Mechanism**: Increases dopamine release, blocks NMDA receptors. * **Side** **Effects**: Dizziness, insomnia, livedo reticularis. * **Contraindications**: Renal impairment, history of seizures. * **Pertinent** **Information**: May also have antiviral activity against influenza A. ## Footnote This sounds like cimetidine. The rule is Ti Dine not Ta Dine

Question 87

Selegiline

Answer 87

* **Disease**: Parkinson's disease. * **Mechanism**: MAO-B inhibitor, prevents breakdown of dopamine. * **Side** **Effects**: Nausea, dizziness, headache, insomnia. * **Contraindications**: Concurrent use of meperidine, hypersensitivity to selegiline. * **Pertinent** **Information**: Can be used as an adjunct to levodopa therapy. *

Question 88

Entacapone

Answer 88

* **Disease**: Parkinson's disease (as adjunct to levodopa/carbidopa). * **Mechanism**: COMT inhibitor, prolongs the action of levodopa by inhibiting its breakdown. * **Side** **Effects**: Diarrhea, dyskinesia, urine discoloration (brownish-orange). * **Contraindications**: Hypersensitivity to entacapone. * **Pertinent** **Information**: Only effective when used with levodopa/carbidopa.

Question 89

Benztropine

Answer 89

* **Disease**: Parkinson's disease, drug-induced extrapyramidal symptoms. * **Mechanism**: Anticholinergic, reduces acetylcholine activity to balance dopamine and acetylcholine levels. * **Side** **Effects**: Dry mouth, blurred vision, constipation, urinary retention. * **Contraindications**: Narrow-angle glaucoma, gastrointestinal obstruction, hypersensitivity to benztropine. * **Pertinent** **Information**: Use with caution in elderly patients due to increased risk of cognitive impairment.

Question 90

Procyclidine

Answer 90

* **Disease**: Parkinson's disease, drug-induced extrapyramidal symptoms. * **Mechanism**: Anticholinergic, blocks acetylcholine receptors to balance dopamine and acetylcholine levels. * **Side** **Effects**: Dry mouth, blurred vision, constipation, urinary retention, confusion. * **Contraindications**: Narrow-angle glaucoma, gastrointestinal obstruction, hypersensitivity to procyclidine. * **Pertinent** **Information**: Use cautiously in elderly patients due to potential cognitive side effects.

Question 91

Sumatriptan

Answer 91

* **Disease**: Migraine headaches. * **Mechanism**: Selective 5-HT1 receptor agonist, causes vasoconstriction of cranial blood vessels. * **Side** **Effects**: Tingling, dizziness, chest discomfort, flushing. * **Contraindications**: History of ischemic heart disease, uncontrolled hypertension, hemiplegic or basilar migraine, hypersensitivity to sumatriptan. * **Pertinent** **Information**: Available in various forms (oral, nasal spray, injection); should be used at the onset of migraine symptoms.

Question 92

Prochlorperazine

Answer 92

* **Disease**: Nausea, vomiting, schizophrenia. * **Mechanism**: Dopamine D2 receptor antagonist, antipsychotic, antiemetic. * **Side** **Effects**: Drowsiness, dizziness, extrapyramidal symptoms, hypotension. * **Contraindications**: Coma or severe CNS depression, bone marrow depression, hypersensitivity to prochlorperazine. * **Pertinent** **Information**: Used for acute nausea/vomiting and psychiatric disorders; monitor for signs of tardive dyskinesia with long-term use.a

Question 93

Oxycodone

Answer 93

* **Disease**: Moderate to severe pain. * **Mechanism**: Opioid receptor agonist, alters perception of pain. * **Side** **Effects**: Constipation, nausea, drowsiness, respiratory depression. * **Contraindications**: Severe respiratory depression, acute or severe bronchial asthma, hypersensitivity to oxycodone. * **Pertinent** **Information**: Risk of addiction, abuse, and misuse; use with caution in patients with a history of substance abuse.

Question 94

Gabapentin

Answer 94

* **Disease**: Neuropathic pain, epilepsy, restless legs syndrome. * **Mechanism**: Modulates calcium channels, reduces excitatory neurotransmitter release. * **Side** **Effects**: Dizziness, somnolence, peripheral edema, weight gain. * **Contraindications**: Hypersensitivity to gabapentin. * **Pertinent** **Information**: Dose adjustment required in renal impairment; monitor for signs of depression or suicidal thoughts.

Question 95

Fexofenadine

Answer 95

* **Disease**: Allergic rhinitis, chronic idiopathic urticaria. * **Mechanism**: Second-generation antihistamine, blocks H1 histamine receptors. * **Side** **Effects**: Headache, drowsiness (less than first-generation antihistamines), dry mouth. * **Contraindications**: Hypersensitivity to fexofenadine. * **Pertinent** **Information**: Non-sedating antihistamine, suitable for use where alertness is required.

Question 96

Enfuvirtide

Answer 96

* **Disease**: HIV/AIDS. * **Mechanism**: Fusion inhibitor, prevents HIV from entering CD4+ cells. * **Side** **Effects**: Injection site reactions, pneumonia, hypersensitivity reactions. * **Contraindications**: Hypersensitivity to enfuvirtide. * **Pertinent** **Information**: Subcutaneous injection; used in combination with other antiretrovirals for treatment-experienced patients.

Question 97

Maraviroc

Answer 97

* **Disease**: HIV/AIDS. * **Mechanism**: CCR5 antagonist, blocks HIV from entering cells via the CCR5 receptor. * **Side** **Effects**: Hepatotoxicity, cough, fever, upper respiratory tract infections. * **Contraindications**: Severe renal impairment, hypersensitivity to maraviroc. * **Pertinent** **Information**: Requires tropism testing to confirm CCR5-tropic HIV before use.

Question 98

Scopolamine

Answer 98

* **Disease**: Motion sickness, postoperative nausea and vomiting. * **Mechanism**: Anticholinergic, blocks muscarinic receptors in the vestibular system. * **Side** **Effects**: Dry mouth, blurred vision, drowsiness, urinary retention. * **Contraindications**: Narrow-angle glaucoma, hypersensitivity to scopolamine. * **Pertinent** **Information**: Available as a transdermal patch; apply several hours before needed for motion sickness prevention.

Question 99

Ramipril

Answer 99

* **Disease**: Hypertension, heart failure, post-myocardial infarction. * **Mechanism**: ACE inhibitor, reduces angiotensin II production, lowering blood pressure and decreasing cardiac workload. * **Side** **Effects**: Cough, hyperkalemia, hypotension, angioedema. * **Contraindications**: Pregnancy, history of angioedema related to previous ACE inhibitor therapy, hypersensitivity to ramipril. * **Pertinent** **Information**: Monitor blood pressure, renal function, and electrolytes regularly. *

Question 100

Trimbow

Answer 100

* **Disease**: Asthma, COPD. * **Mechanism**: Short-acting beta-2 agonist, relaxes bronchial smooth muscle. * **Side** **Effects**: Tremor, palpitations, tachycardia, headache. * **Contraindications**: Hypersensitivity to salbutamol. * **Pertinent** **Information**: Used for acute relief of bronchospasm; overuse can lead to decreased effectiveness and increased side effects.

Question 101

Allopurinol

Answer 101

* **Disease**: Gout, hyperuricemia. * **Mechanism**: Xanthine oxidase inhibitor, reduces uric acid production. * **Side** **Effects**: Rash, gastrointestinal disturbances, hepatotoxicity, Stevens-Johnson syndrome (rare). * **Contraindications**: Hypersensitivity to allopurinol. * **Pertinent** **Information**: Start at a low dose to minimize the risk of gout flares; monitor renal function and uric acid levels regularly.

Question 102

Beta-Blockers

Answer 102

* **Mechanism of Action:** Block β-adrenergic receptors, inhibiting the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine). * **Subtypes**: * Selective β1-blockers primarily affect the heart. * Non-selective β-blockers affect both the heart and other tissues like bronchial smooth muscle and blood vessels. * **Indications**: * Hypertension, Angina pectoris, Arrhythmias, Heart failure, Glaucoma (non-selective β-blockers), Essential tremor (primarily propranolol) * **Side Effects:** Bradycardia (slow heart rate), Hypotension (low blood pressure), Fatigue, Dizziness, Bronchoconstriction (non-selective β-blockers) * **Contraindications**: * Severe bradycardia, Heart block, Decompensated heart failure, Hypotension, Asthma (non-selective β-blockers) * **Pertinent Information**: * Non-selective β-blockers should be used with caution in patients with asthma or chronic obstructive pulmonary disease (COPD). * Abrupt withdrawal of β-blockers can lead to rebound hypertension or angina.

Question 103

# PAEDS Corticosteroids

Answer 103

* **Disease**: Inflammatory conditions, asthma, autoimmune diseases. * **Mechanism**: Anti-inflammatory and immunosuppressive effects by inhibiting cytokine production and reducing immune cell activity. * **Side** **Effects**: Growth suppression, weight gain, increased infection risk, osteoporosis. * **Contraindications**: Untreated systemic infections, hypersensitivity to corticosteroids. * **Pertinent** **Information**: Monitor growth regularly in children; use the lowest effective dose for the shortest duration.

Question 104

# PAEDS Sulphonamide | Kernicterus

Answer 104

* **Disease**: Bacterial infections. * **Mechanism**: Inhibit folic acid synthesis in bacteria by blocking dihydropteroate synthase. * **Side** **Effects**: Allergic reactions, rash, Stevens-Johnson syndrome, kernicterus in neonates. * **Contraindications**: Infants less than 2 months old, pregnant women at term, hypersensitivity to sulfonamides. * **Pertinent** **Information**: Avoid use in neonates and late pregnancy to prevent kernicterus.

Question 105

# PAEDS Ceftriaxone + Calcium Solutions

Answer 105

* Calcium Precipitation in Lungs * **Disease**: Bacterial infections. * **Mechanism**: Third-generation cephalosporin antibiotic, inhibits cell wall synthesis. * **Side** **Effects**: Diarrhea, rash, calcium precipitation leading to lung and kidney damage. * **Contraindications**: Concurrent use with calcium-containing IV solutions in neonates. * **Pertinent** **Information**: Avoid co-administration with calcium-containing solutions in neonates; flush IV lines between medications.

Question 106

# PAEDS IV Chloraphenicol

Answer 106

* **Disease**: Severe bacterial infections. * **Mechanism**: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. * **Side** **Effects**: Bone marrow suppression, aplastic anemia,*Grey baby syndrome* in neonates. * **Contraindications**: Neonates, hypersensitivity to chloramphenicol. * **Pertinent** **Information**: Use with caution in neonates due to risk of Grey baby syndrome; monitor blood levels and function.

Question 107

# PAEDS Gentamycin

Answer 107

* **Disease**: Severe bacterial infections (e.g., sepsis, pneumonia, urinary tract infections) * **Mechanism**: Aminoglycoside antibiotic that binds to the 30S ribosomal subunit, inhibiting bacterial protein synthesis. * **Side** **Effects**: Nephrotoxicity (kidney damage) Ototoxicity (hearing loss) Neuromuscular blockade * **Contraindications**: Hypersensitivity to gentamycin or other aminoglycosides, Caution in patients with pre-existing renal or hearing impairment * **Pertinent** **Information**: Requires careful dosing and monitoring of blood levels, particularly in neonates and infants, to avoid toxicity. Regularly monitor renal function and hearing during treatment.Dosage adjustments needed in renal impairment. | Higher volume of distribution of water-soluble drugs

Question 108

# PAEDS Diazepam

Answer 108

Used in paediatrics for acute seizure management and anxiety; caution with long-term use due to potential for dependence and withdrawal. Similar or lower for fat-soluble drugs

Question 109

Synometrine

Answer 109

* **Disease**: Postpartum hemorrhage, uterine atony. * **Mechanism**: Combination of oxytocin and ergometrine, stimulates uterine contractions. * **Side** **Effects**: Hypertension, nausea, vomiting, headache. * **Contraindications**: Hypertension, pre-eclampsia, severe cardiac disease. * **Pertinent** **Information**: Used to prevent or control postpartum hemorrhage; monitor blood pressure and uterine tone.

Question 110

Anabolic Steroids | Stanozolol, Nandrolone

Answer 110

* **Disease**: Anemia, muscle wasting diseases, delayed puberty. * **Mechanism**: Synthetic derivatives of testosterone, promote muscle and bone growth. * **Side** **Effects**: Liver damage, cardiovascular disease, hormonal imbalances, aggressive behavior. * **Contraindications**: Prostate cancer, breast cancer in males, hypersensitivity to anabolic steroids. * **Pertinent** **Information**: Potential for abuse and serious side effects; used under medical supervision for specific conditions.

Question 111

GnRH Agonist

Answer 111

* **Disease**: Prostate cancer, endometriosis, precocious puberty. * **Mechanism**: Initially stimulate and then desensitize GnRH receptors, leading to a decrease in gonadotropin release and sex hormone production. * **Side** **Effects**: Hot flashes, decreased libido, osteoporosis, injection site reactions. * **Contraindications**: Pregnancy, breastfeeding, hypersensitivity to GnRH analogs. * **Pertinent** **Information**: Used to suppress hormone-dependent conditions; monitor bone density and hormone levels. *

Question 112

GnRH Antagonist

Answer 112

* **Disease**: Prostate cancer, endometriosis, infertility treatments. * **Mechanism**: Directly inhibit GnRH receptors, leading to an immediate decrease in gonadotropin release and sex hormone production. * **Side** **Effects**: Hot flashes, decreased libido, osteoporosis, injection site reactions. * **Contraindications**: Pregnancy, breastfeeding, hypersensitivity to GnRH analogs. * **Pertinent** **Information**: Used to suppress hormone-dependent conditions and in assisted reproductive technology; monitor bone density and hormone levels.

Question 113

Androgen Antangonists

Answer 113

* **Disease**: Prostate cancer, hirsutism. * **Mechanism**: Block androgen receptors, inhibiting the effects of male sex hormones. * **Side** **Effects**: Gynecomastia, hot flashes, gastrointestinal disturbances, liver toxicity. * **Contraindications**: Severe liver disease, hypersensitivity to androgen antagonists. * **Pertinent** **Information**: Used primarily in prostate cancer treatment; monitor liver function and hormone levels.

Question 114

Copper Coil/IUD

Answer 114

* **Disease**: Contraception. * **Mechanism**: Copper ions released create a hostile environment for sperm, preventing fertilization. * **Side** **Effects**: Heavy menstrual bleeding, cramping, risk of pelvic inflammatory disease. * **Contraindications**: Active pelvic infection, uterine abnormalities, copper allergy. * **Pertinent** **Information**: Long-term contraceptive method; regular check-ups recommended to ensure proper placement.

Question 115

Levonorgestrel (Levonelle)

Answer 115

* **Disease**: Emergency contraception. * **Mechanism**: Progestin, inhibits ovulation and fertilization. * **Side** **Effects**: Nausea, fatigue, headache, menstrual changes. * **Contraindications**: Hypersensitivity to levonorgestrel. * **Pertinent** Information: Most effective within 72 hours of unprotected intercourse; available over-the-counter.

Question 116

Ulipristal Acetate (EllaOne)

Answer 116

* **Disease**: Emergency contraception. * **Mechanism**: Selective progesterone receptor modulator, delays ovulation. * **Side** **Effects**: Headache, abdominal pain, menstrual changes, nausea. * **Contraindications**: Hypersensitivity to ulipristal acetate, existing pregnancy. * **Pertinent** **Information**: Effective within 120 hours (5 days) of unprotected intercourse; requires prescription in some regions.

Question 117

Montelukast

Answer 117

* **Disease**: Asthma, allergic rhinitis. * **Mechanism**: Leukotriene receptor antagonist that blocks leukotrienes, reducing bronchoconstriction, inflammation, and mucus production. * **Side** **Effects**: Headache, abdominal pain, cough, dizziness, mood changes (e.g., depression, anxiety, suicidal thoughts). * **Contraindications**: Hypersensitivity to montelukast or any of its components. * **Pertinent** **Information**: * Used as a maintenance treatment for asthma and to relieve symptoms of allergic rhinitis; not intended for the relief of acute asthma attacks. * Monitor for changes in mood or behavior. * Typically taken once daily in the evening for asthma; dosing may vary for allergic rhinitis.

Question 118

Prednisolone

Answer 118

* **Mechanism**: Glucocorticoid that reduces inflammation by inhibiting multiple inflammatory cytokines and mediators. * **Side** **Effects**: Weight gain, increased infection risk, hypertension, osteoporosis, mood changes, hyperglycemia. * **Contraindications**: Systemic fungal infections, hypersensitivity to prednisolone. * **Pertinent** **Information**: * Long-term use requires monitoring for side effects such as osteoporosis and adrenal suppression. * Dosage should be tapered gradually to avoid adrenal insufficiency.

Question 119

Dexamethasone

Answer 119

* **Disease**: Inflammatory conditions, autoimmune diseases, severe allergies, cerebral edema, croup, adjunct in cancer therapy, COVID-19 * **Mechanism**: Potent glucocorticoid that reduces inflammation by inhibiting multiple inflammatory cytokines and mediators. * **Side** **Effects**: Weight gain, increased infection risk, hypertension, osteoporosis, mood changes, hyperglycemia, insomnia. * **Contraindications**: Systemic fungal infections, hypersensitivity to dexamethasone. * **Pertinent** **Information**: * More potent and longer-acting than prednisolone; used in conditions requiring strong anti-inflammatory effects. * Monitor for side effects, especially in long-term use or high doses. *

Question 120

Betamethasone

Answer 120

* **Disease**: Inflammatory conditions, autoimmune diseases, severe allergies, preterm labor to enhance fetal lung maturity. * **Mechanism**: Glucocorticoid that reduces inflammation by inhibiting multiple inflammatory cytokines and mediators. * **Side** **Effects**: Weight gain, increased infection risk, hypertension, osteoporosis, mood changes, hyperglycemia. * **Contraindications**: Systemic fungal infections, hypersensitivity to betamethasone. * **Pertinent** **Information**: * Highly potent with strong anti-inflammatory effects. * Commonly used in obstetrics to promote fetal lung development in preterm labor. * Monitor for side effects, particularly with prolonged use.

Question 121

Aspirin

Answer 121

* **Disease**: Pain, fever, inflammation, cardiovascular disease (prevention of heart attacks and strokes). * **Mechanism**: Non-selective irreversible inhibitor of cyclooxygenase (COX-1 and COX-2), reducing the production of prostaglandins and thromboxanes, which mediate inflammation, pain, fever, and platelet aggregation. * **Side** **Effects**: Gastrointestinal ulcers and bleeding, tinnitus (ringing in the ears), allergic reactions, Reye's syndrome (in children with viral infections). * **Contraindications**: Active peptic ulcer disease, bleeding disorders, hypersensitivity to aspirin or other NSAIDs, children and teenagers with viral infections (due to the risk of Reye's syndrome). * **Pertinent Information:** * Low doses (81-325 mg daily) are commonly used for cardiovascular protection. * Higher doses are used for anti-inflammatory and analgesic effects but increase the risk of side effects. * Should be taken with food or a full glass of water to minimize gastrointestinal irritation.

Question 122

Naproxen

Answer 122

* **Disease**: Pain, inflammation, arthritis (osteoarthritis, rheumatoid arthritis), menstrual cramps, ankylosing spondylitis, gout. * **Mechanism**: Non-selective reversible inhibitor of cyclooxygenase (COX-1 and COX-2), reducing the production of prostaglandins which mediate inflammation, pain, and fever. * **Side** **Effects**: Gastrointestinal irritation, ulcers and bleeding, renal impairment, cardiovascular events (e.g., heart attack, stroke), dizziness. * **Contraindications**: Active peptic ulcer disease, recent gastrointestinal bleeding, severe renal impairment, hypersensitivity to naproxen or other NSAIDs, perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. **Pertinent**: GI bleeding