KSectives Inhibitor

reuptake

Deloxetine pain
fornuropathic
Psychiatric
Exagatoman
a aid't Kimm T.is NElsssg
jjdhyperpyrexia
osserotoninsyndromb
e
Depression: serotonin bReuptakeofserotonin
Depression + seizure:
7 8hpm
Antidepressants used in patient with epilepsy with/without HTN: Paroxetine (SSRIs)
Antidepressants should AVOID in seizure: Bupropion Tseizures I
Depression + weight:
Tseizures
DOC for epileptic patient who loss of appetite: Mirtazapine _I
DOC for depression patient who is obese: Bupropion, Venlafaxine
forobese
Tea lesssedation
# antidepressants act on which area in brain !: Postsynaptics
d # anxiolytics with least sedation and withdrawal symptoms: bupropion
in
• SSRI Examples:
CObese: Bupropionivanlafaxin
Thin: Mirtazapine
v citalopram (Cipramil)
v dapoxetine (Priligy)
Cardiac ❤: Sertraline orParoxetine SSRI
s anyone v escitalopram (Cipralex)
SII Anxiety #: SSRIs I
Seizure: Escitalopram
longest
fluoxetine (Prozac or Oxactin)
7
fluvoxamine (Faverin)
Insomnia $: Mirtazapine, Paroxetine paroxetine (Seroxat)
Pregnant %: Sertraline
Breastfeeding &: Sertraline, Paroxetinex
no
Iggy
sertraline (Lustral)
(Brintellix)
means
Cause cardiac anomalies v vortioxetine
I
CI inpregnancy
TCA: forbaby
Secondary: Protriptyline, Nortriptyline, Desipramine

utilities
Tertiary: Doxepin, Amitriptyline, Imipramine, Clomipramine, Trimipramine.
# Amitriptyline cause arrhythmia i i
C MOA-I: Monoamine oxidase inhibitors (MAOIs) # tyramine à cause hypertension crisis
A. Non selective (MAO-A, MAO-B inhibitors): Phenelzine, Tranylcypromine, isocratic #irreversible
B. Selective MAO-A inhibitors: Moclobemide # reversible
C. Selective MAO-B inhibitors: Rasgiline, Selegiline
# Tablet Selegilin for Parkinson disease (PD), Transdermal patch for depression TD

CDrug- switching:
3
Other anti-depressant à ßMAO-I: 2-weeks washout period Antidepeta
qbsbeia.si j
- # EXCEPT fluoxetine it is self-taper 4-5 weeks washout period ooiGa mIjIeMAOIS.E
ii
fluoxetine
Bupropion:
• Not use in seizure, Pregnant
• Used in case of Sexual dysfunction (SD) developed after SSRIs à DOC of SD caused by SSRIs
• Use in obese patient with depression (decrease weight) so
Bupropion Combinationbismia
 - benzodiazepines:
B D2
alprazolam lorzepam
chlordiazepoxide oxazepam
2am clorazepate prazepam
Anxiety: diazepam Clonazepam
halazepam
• SSRIs (1st line) Tineepa
•
•
Buspirone (2nd line)
TCA (2nd line)
# NOT use with MAO-I
y

L
• Propranolol (Beta-blocker) # to decrease symptoms, take it before 1 hour of event
• Benzodiazepine (BZDs)
www.nnnmym
lastchoice
# Bupropion à depression
# Buspirone à Anxiety

chlorpromazine Antiemeticforcancerpatient --------

fee
Antipsychotic:
child Ll

line Haloperidol, chlorpromazine

st
ofFirst Typical Antipsychotic (1 generation): # Extrapyramidal side effect (EPS), and worse -ve symptoms
E
I
vain # chlorpromazine causes Pigmentary
seem
em
m on retina and corneal
secimb
6,681A
cAtypical
nd
Antipsychotic (2 generation):
Clozapine, Aripiprazole, olanzapine, Quetiapine
schizophrenia ‫مث&ً يعني‬

T
# Metabolic side effect Metabolicdisease
excDiabetes
melletus
soiree # Clozapine cause agranulocytosis like PTU, monitor ANC, WBC ! low number of granulocytes

damn
(a type of white blood cell)
Propyitniouracid
fornypertngrodism

E E
Antipsychotic for Parkinson patient: Quetiapine, Primavanserin
I
2
my Patient with Tardive Dyskinesia (TD): Valbenazin # 1st FDA medication approved for TD
main
at
Medication for Extrapyramidal effect: Benztropine, Diphenhydramine, BZDs
7 is
onanist
Most effective in treating +ve symptoms in schizophrenia: 2nd generation E
Worsening -ve symptoms and developed EPS : 1st generation
Psychotic patient take olanzapine with high glucose what is alternative: Haloperidol (1st G, less
metabolic changes)
Toi DME g I DOST

I e
Smoking with Clozapine and Olanzapine ':
e
Increase metabolism decrease med. Conc. Increase CL of Med.
# Need higher dose of Olanzapine with smoking pt.
un w
in
--------
 Q
Bipolar:

Acute:
Fam A. Manic: Valproate or Lithium + Antipsychotic
MEE ist B. Bipolar: Lithium or lamotrigine Also Lurasidone, Olanzapine / fluoxetine
Maintenance: am atypical antipsychotics.
nd
A. Manic: Lithium +/- 2 generation of Antipsychotic (SGA)
B. Bipolar: Lamotrigine

Pregnant: Lurasidone, Lamotrigine, Levetiracetam

mm mm mm
nypothyroidism
c
Lithium: Mood-Stabilizer
Li
SE: Tremor, GI, edema, hypothyroidism
Cause: decrease Crcl, increase BUN à renal impairment
Toxicity: decreasing Na+ like (ACE-I, Diuretic) Bloodtnitrogen
IN a
Monitoring: 30 min before dose, drawn 8-12 hours post dose,
Tr every 6-12 months
# Monitor renal and thyroid

H NOTE:
mung
# Be hydrate, Limit sun exposure (
# Take it with food to decrease nausea
# Caution with driving and other heavy activities

I O e
Treatment of convulsion due to lithium toxicity: Phenobarbital, propofol, BZDs
Treatment of lithium toxicity (antidote): Sodium polystyrene sulfonate, NaHco3 sodiumbicarb
mung
µ--------
a polystyrene of
Dong
sulfonate
 i
anemones
gMetodopramide
is
Notuse
Because of extrapyramidalsideeffect
Neurologic:

Parkinson’s disease (PD) bDopamine

Treatment:
A. Levodopa/Carbidopa:
EW
# Dopa precursor of dopamine, dose depend on carbidopa unwmalevodopatt
# Carbidopa given with levodopa to prevent peripheral metabolism of levodopa
# MOA of l-dopa: inc. DA level in brain !, leading to stimulate DA receptor
ddd
9 # Take it on empty (morning)
or with food.tl
I
B. Dopamine receptor agonist: Pramipexole, Ropinirole, Apomorphine, Rotigotine

Ift
C. Catechol-O-Methyltransferase (COMT) inhibitors: Tolcapone # Hepatotoxic
D. Amantadine: Antiviral, Antiparkinsonian, DA agonist # cause Livedo reticularis “pigmentation” id
# MOA of Amantadine: interfere with viral M2 protein function, blocking uncoating of the virus particles activityof
Dopamine am
E. Anticholinergic: Trihexyphenidyl image
# cause mydriasis and CAG Coronary Angiogram (CAG)
ya

Parkinson patient with nausea ):

• if high dose of carbidopa decrease the dose
" • Domperidone
looks
Medication for Parkinson cause dizziness: Apomorphine, Pramipexole, Ropinirole, Retigabine
Psychosis in Parkinson patient: Quetiapine, Primavanserin
G
Sever mental disorder

--------
Alzheimer disease (AD) back
BlockofNMDA
Raptor
Treatment:
CHEF
A. Cholinesterase inhibitors: Donepezil, Rivastigmine, Glutamine
o Mild - moderate: Donepezil, Rivastigmine, Glutamine
o Advanced: ONLY Donepezil moderate or Sever
HAN GI o Dementia + Alzheimer disease (AD): ONLY Rivastigmine DonepezilMemantine
B. N-methyl-d-aspartate receptor antagonist: Memantine
# MOA of memantine: antagonist effect atserotonin
5HT3 receptor, NMDA receptor & block nicotine acetylcholine receptor

mim.si d
BZDs used in Alzheimer (DACL): Diazepam, Alprazolam, Clonazepam, Lorazepam,
Alzheimer patient with urinary urgency: Oxybutynin

All stages: Donepezil

In Urinary urgency: An immediate unstoppable urge to urinate, due to a
sudden involuntary contraction of the muscular wall of the bladder.

Moderate-sever: Memantine +/- Donepezil

Herbal for Alzheimer disease*: Gingko biloba, Caprylidene

cerepralBloodflow

about.IT
Pregnancywithtonicclonic
Topiramate causeof !
Joc is Valproicacid
follicacid Zonesemide oligohydrosis
GM W I
Anti-epileptics:

Antiepileptic for pregnant %: Levetiracetam, lamotrigine Rash

Antiepileptic for breastfeeding &: Levetiracetam
Antiepileptic need renal adjustment: Topiramate
Antiepileptic in absence seizures (petit): Ethosuximide younggirlor
Antiepileptic for older + (AOT): Alprazolam, Oxazepam, Triazolam
Boy

4315015 Status epilepsy (SE): BZDslorazepamIV DOIFirst dEa.am

1st BZD: IV Diazepam, Lorazepam, midazolam
2nd: phenytoin, valproic acid, levetiracetam

# Fastest Diazepam (D form Drive)

# Longest Lorazepam (longest from L) lastchoice
# Strongest Clonazepam
phenoparpital
Becauseof St M I
Hypertension
Treat neuropathic pain and depression: ⁉ HLAB15
IIe
d É
1st: duloxetine, pregabalin for
Others: Gabapentin, venlafaxine,highly
CBZs, ..
Stevens-Johnson Syndrome

stevensonnson
syndrome
oxecarbamazepine
J Phenytoin:
hypersensitivity
reaction fpiyjihf.in
phenotoin
Strong correlation between the plasma level and its effect
Dose: phenytoin sodium 100 mg = 92 mg of phenytoin base 8381asinine
m
_I
SE of phenytoin: Gingival hyperplasia, nystagmus, hirsutism, acne, Purple glove syndrome
Rapid involuntary

you
movement of the eye

# Topiramate: CI with alcohol, metallic acidosis, metformin

Cyclosporine
kidney
# Carbamazepine, Oxecarbamazapin, Phenytoin, Fosphenytoine: HLA-B 1502
d ve Anti cancer
pint y
u Sodium Channel Blockers (Na+):
- Phenytoin, Fosphenytoine B phenytoin
- Carbamazepine, Oxecarbamazapin JALA
it's
- Lamotrigine
Rash I p I does
v GABA enhancing agent (GABA): !
- Barbiturate. # withdrawal symptoms
ucrease - Benzodiazepine (BZDs)
ofGABA - Valproic acid

# Used in trigeminaltha
Carbamazepine
yOnecarbamazepine
neuroglia “‫"اﻟﺘﻬﺎب اﻟﻌﺼﺐ اﻟﺴﺎﺑﻊ‬: CBZs
 o
Attention-deficit/hyperactivity disorder (ADHD):

e
Medication of ADHD and non-stimulant: Atomixifin

ADHD: tamoxifen forbrestcancer

• Amphetamine soul Is
• Dextro-methamphetamine
• Dextro-methylphenidate
• Methylphenidate
i
asAutism:
Dimethyl glycine (DMG)
A
# Thimerosal (mercury) containing vaccines may cause: Autism

I t.AB.ph A

Dog
 Woman !
3
DIE Labor
Induce labor: Oxytocin 081503
Enix Uterine stimulates: ergot alkaloid
Chita (used in migraine)

Induce uterine contraction intravaginal: Dinoprostone

# Dilate cervix: oxytocin, dinoprostone, misoprostol palprostadil 260,44
Miami albrostadine prostaglandinanalog
mi aid D PDA goao.at
HIV med. giving during labor: Zidovudine im riku jawed
of 615dm I mid
Premature labor Indomethacinabpity
Eide
paa
jam Am
Itai
Stop premature labor !: Ritodrine
Lamia
Eclampsia Treatment of preterm labor are “Tocolytic”: MgSO4, Indomethacin, Nifedipine
RE

It.I www
im Mg sulfate
Eclampsia:

abortion:
446 blow
Gags Substance that induce abortion: Misoprostol, Mifepristone, Methotrexate
a
Antiestrogen cause abortion: Anastrozole

ppg
Antiprogesterone cause abortion: Mifepristone, Misoprostol
and't
Prostaglandin

BB and post abortion hemorrhage: Ergonovine

Prevention and treatment of postpartum Jina
—————
ergotamined

ppl
formigrain
 6 daddies levonorgestrel saws
baa nie I'm w.ua I6y.Mtb4
ovulationactivation.br
Oral birth control ":

Combination
ki ja
D
For mid age woman want oral birth control to give: Ethinyl estradiol / inestrenol 654Gt
pay
EXCEPT if she has one of the following will give her: LEVONORGESTREL 01404pA
§ > 35 + smoker or migraine headache or obese 136
§
§
> 50
Breastfeeding
bad Mi6 Is't b
THTN É
§ DM + Vascular disease Astron
§ Risk of DVT orhistory
Hx of now
§ Hx of uncontrolled HTN or heart problems I Mik
a cancer
§ Breast or endometrial gwwz.im w6M
§ Need to get pregnant

gonadotropin-releasing hormone, LH-RH, LHRH, and

Oral contraceptives suppress GnRH luteinizing hormone-releasing hormone.

Oral contraceptives work-on which phase: in ovulation phase

Oral contraceptive used to treat: endometriosis-associate pain “pain in menses and during
intercourses”
Hydroxyurea: Contraceptive require during and after treatment by
impacts § Female #: 6 months Contraceptive
I30
§ Male $: 12 months Candor
assist
obit Infertility in women who do not ovulate: Clomiphene citrate

Stop
—————

Hormones:

Ovulation phase hormone predominant: LH Ovulation É

Breast
cancerso
Inhibit estrogen synthesis: tamoxifen breastcancer
agogestrogens's
Monophase of estrogen: fixed amount of progesterone and estrogen ONLY
Sacred
Human chorionic gonadotropin is used to: induce ovulation and treatment of infertility
t
e j
Ea
Hormone cause male dysfunction in breastfeeding: androgen

Facial flushing and dry vaginal: estrogen

—————

JE
 Medications Should STOP or START with pregnancy:

Start before pregnancy:

§ 1 month: Folic acid (Vit B9):
# To decrease risk of neural tube defect

Stop before pregnancy:

§ 1 month: Isotretinoin (acne)
Gibson
§ 2 months: Neostigmine (myasthenia 11sclerosis)
gravis), Fingolimod (multiple
1 aww
§ 6 months: Ribavirin
third
# Ribavirin: can stay 6 months in body
swain 4 of
ECG aimed
§ 2 years: Leflunomide (RA treatment) im 54
§ Mycophenolate (immunosuppressant)
o 6 weeks in female
ga
Ide
M
o 12 weeks in male
3months
Medication in pregnancy:
§ Ciprofloxacin # Cause anemia of fetus if taken in the 1st trimester
§ Nicotine # Decrease blood flow to uterine
§ ACE-I
BB # Fetal growth
§ Warfarin # Nasal bone hypoplasia in neonate facialmalformation
teams
É
Ashok § Finasteride Randrogentiimone
aim
# Genital malformation in the infant
I
§ Progesterone # Fetal productive abnormalities
04k
4 Etat
—————

Cancer:

Breast cancer
§ Antiestrogen USE in breast cancer: tamoxifen
§ Treatment of breast cancer: Raloxifene, hydrochloride, tamoxifen
§ Prophylaxis of breast cancer: Raloxifene
g
# Early symptoms of breast cancer: Dimples or nipple discharge

Hysterectomy:
§ hysterectomy (Uterus + ovaries) removed: estrogen
d § Only ovaries removed: estrogen + progesterone # Add progesterone to remove risk

—————
 Pregnancy UTITGGPD Cefuroxime
Nitro wawadd
Ceftriaxone
Infection with pregnancy and lactation:
WWII's
Bacteria: it
Nitro
Pregnant with UTI: Nitrofurantoin
Pregnant with UTI + G6PD: cefuroxime 5in
Trimethoprim-sulfamethoxazole
retitionsPrevention recurrence of UTI: TMP/SMX
Prophylaxis UTI: Nitrofurantoin
Pregnant with E.coli and vaginal itching: Nitrofurantoin Utsa
4146 iwi WIG
Pregnant with pyelonephritis she is been treated with IV ceftriaxone what is the most
appropriate antibiotics: Amoxicillin/ Clavulanate or Cefuroxime
ammo
Pregnant with syphilis: Benzathine penicillin, Amox/Clavul
# PNC allergy: Doxycycline, erythromycin, ceftriaxone
contraindicated
PYeriyiynokbki tggpqgqangqtt.at
A
penicillin ai

F
Breastfeeding with mastitis%: dicloxacillin, Cephalexin, Amox / Clavu. # for 10-14 days
# PCN allergy: Clarithromycin
Yaaaan sporing _penicillin 4
Viral: imam B lactamliswm
Antiviral give pregnant: zidovudine
clarithromycing
HIV med. giving during labor: Zidovudine
HIV in pregnant ": NRTI + ritonavir or integrase inhibitors

Fungal: axmotd.my Nucleoside Reverse Transcriptase Inhibitors (NRTIs) inhibit reverse transcription by
causing chain termination after they have been incorporated into viral DNA.

Pregnant with candida albicans: Clotrimazole

Anti-fungal CI in pregnancy ! " :

my Griseofulvin, Ketoconazole, Voriconazole, Flutyisine, Potassium
head
Anti-fungal SAFE in pregnancy ✅ " :
Amphotericin B, Topical imidazole, Nystatin MetabolismofAmphotericinis

at Anti-fungal CI in lactation ! %:
Antifungalstructure
Ketoconazole, Itraconazole, Voriconazole

Anti-fungal SAFE in lactation ✅%:

Fluconazole

—————
 Psychiatric with pregnancy and lactation:

Pregnant with tonic-clonic seizure": Valproic acid + folic acid

Safest anti-convulsant in pregnancy: Levetiracetam, lamotrigine Rash
Pregnant with mania: levetiracetam, lamotrigine
Pregnant with schizophrenia: Olanzapine, Risperidone, Quetiapine

Antiepileptic in breastfeeding %:
AT topiramate, pregabalin, vigabatrin,
Gabapentin, lamotrigine, OCBZs, Levetiracetam,

f I e
Antiepileptic CI in breastfeeding %: Ethosuximide, clonazepam, diazepam

Young girl with rash of Oxcarbamazepine ':

§ Sexual inactive: Ethoxsumide.
uo.ms
§ Sexually active and inconsistent contraceptive use: Topiramate

—————
Patienthavethntilwinwithosteoporosis
Pregnancy with conditions:
Ca carbonateantacid
GI with pregnancy:
§ Laxative CI in pregnant: senna and castor oil
iamdardd
§ Pregnant with constipation: Psyllium (Bulk forming laxative) or lactulose
glycerin
§ Nausea with / without vomiting in pregnant: Vit B6 +/- Doxylamine suppository
§ GERD: Ca++ carbonate antacid
zit y
§ Flatulence: Simethicone
Cacard Pireddy
Pain: Acetaminophen
Anticoagulant: LMWH Heparin Celeran
Asthma: Albuterol, Cromolyn
I b b
Shortt longertin
Pregnant with glaucoma ( : Brimonidine or Timolol b t
0pm HA
b
Thyroid:
t.wa.fm h
§ Hypothyroidism: increase dose by 30% - 50%
ft
§ Hyperthyroidism:
ad A
!

t.CI
o 1st: PTU agranulocytosis clozapine
a
g g
o 2nd & 3rd: Methimazole monitorANC.ws p me
Pregnant with DM:
1st: Insulin
2nd: Metformin, Glyburide

Pregnant with HTN: Methyldopa, Labetalol , Nifedipine

# Hydralazine: for emergency and urgency HNT " XR
a Eclampsia: Mg sulfate
Ta —————
 pasteurization
Prolactin ):

Responsible for milk production): lactobacillus i m

at.im
1st baby milk named *: Colostrum T.tw toga
# High concentrated with IgA
I
colostrum
gypsy
WHY Medication and prolactin level:
§ Increase Prolactin: Decrease Dopamine (DA)
o Metoclopramide
o Methyldopa Tansitipressionisicauses
Dopamine
o Estradiol
o Serotonin
o GABA
levodopatDopaning him

o Opioid

§ Decrease Prolactin: Increase Dopamine (DA)

o Bromocriptine
9 44 o Cabergoline
I
a

plasentary
IgG
IgM largest one
AsthmaAllergy Hypersensitivity
IgE Anaphylaxis

IgM Infection
disease
eaten
 Respiratory & Hepatic & Renal:

Respiratory:

Asthma:
A. Quick relief (acute cases)
1. SABA: (Salbutamol or albuterol)
# All asthmatic patient should have SABA for quick relief in acute attack
SE of beta agonist: Tremor, Tachycardia, hypokalemia
2. Systematic Corticosteroid: (Prednisone, Prednisolone, Methylprednisolone)
# Not use for long time

Tk SAMI 3. Anticholinergics: (Ipratropium) à Short acting

# Approved for COPD, and off-label use for ONLY acute asthma statusasthmatic Emergency
ascarinic B. Long term control:
1. Inhaled Corticosteroid: (Beclomethasone, Fluticasone, Mometasone, Budesonide)
# 1st line and DOC in chronic asthma, Consider Ca++ & Vit D supplements
y

I t.ge
# SE: oropharyngeal candidiasis à Wash mouth after each use

it
2. LABA: (Formoterol, salmeterol)
# NOT monotherapy in asthma, combined with Corticosteroid
t riskofmortality
boats Egg
twin LAMA 3. Anticholinergic: (Tiotropium) à long acting.Muscarinic # NOT use in acute cases
d 4. Methylxanthines: (Theophylline)
m my my men
my
Monoclonal antibody: Omalizumab t am.mu me
amythmia
# Omalizumab for allergic asthma, it is anti-IgE

E # Medication CI in Asthmatic patient: Beta-blockers, Aspirin, LABA alone

ariskofmortality fterol44463J
Corticosteroids MustgivenwithCSI
Mineral corticosteroids: Fludrocortisone, Deoxy-corticosteroid, Aldosterone
imdb Most potent: dexamethasone
OG
Least potent: hydrocortisone
Max prednisone dose in asthma:2560 mg/kg
o
Function of alpha-1-antitrypsin in lung:
widen
# Protect the lungs from neutrophils elastase & enhance alveolar exchange

name
ntidiuretic Indapamide used in: Pulmonary Edema, Essential hypertension

Cromolyn for preventing allergic rhinitis:

for the Max. effect take before 1-2 wks before contact with allergen
# MOA of Cromolyn: Mast cell stabilizer
# Cromolyn can be used in chronic asthma in pregnant 19 24 1m46 It
ow bi
Inflamatory
i 2
is is mid mastcell mediator
Immediate relive allergy after cleaning: Chlorpheniramine masted bys
stabilizer
gym
Patient with respiratory depression from anesthesia, what is drug for post anesthesia respiratory

j.y.gg
depression: Picrotoxin
is.SN
aqetpkswubiWsbhbM
Important # Used as central nervous system stimulate, antidote,
Misia
 ---------

Hepatic:

Hepatotoxicity of paracetamol due to: glutathione depletion tamed

Lactulose in Hepatic Encephalopathy (HE): to decrease ammonia level in blood 6 14 16.83
hemoglobin 1 Hb1 genotype hepatic pt. (HCV) ttt: Interferon, Ribavirin treatmentofHebatitis A t xD
Fat soluble Vit. Important for liver: Vit (A.D.E.K) lactulose AK
iswww.bing.q
am Precursor of bile: cholesterol
risen
f'd Vitamins involved in fatty acid synthesis: B5, B3, B2 this
# and oxidation reaction PantothenicNiacin b
Riboflavin
acid
NEVER related on ultrasound if its pancreatic patient
# Pancreatic lipase more specific than amylase
aww.ae
II
so
Neuromuscular blocker used in renal or hepatic failure: Atracurim anesthesia
I
Liver enzyme:
Tlipase
• High amylase: pancreatitis
• High liver enzymes + normal bilirubin(BUN): cirrhosis own e Ida Important

I
• High liver enzymes + high bilirubin (BUN): stenosis Bilirubin G
bile see • Flow of bile Decreased or Blocked: Cholestasis ABilirubin
bflowori
Blockage
# Chloramphenicol liver inhibitor: decrease metabolism & increase response

# Hepatotoxic drug should be DC: if LFT > 3 folds than the upper limit

Nucleoside/Reverse transcriptase inhibitors (NRTIs)

# (NRTIs) à Prior to use test ALL patient for HIV zidovudine
# Boxed warning for ALL NRTIS:
mid 4
Lactic acidosis, Sever hepatomegaly with stenosis, HBV Exacerbation
It
Direct antiviral agents (DAA)
# Boxed warning to all (DAA) testing ALL patient for HBV before starting DAA à because
there is a probability to reactivate HBV
# All DAA increase concentration of statin à will increase the risk of rhabdomyolysis

statins
---------
 Urine12J Filter It 11.44
feses I Is Bile 12511.411

Renal:

Glomerulus filter:
• Substate wt. < 40,000 can pass the filter
# Mwt > 500 will excreted in biliary an www.easwaiib sbsACEI
• In healthy kidney protein binding and albumin should not pass the filter

Estimating renal function: albuminurea Renalfailure

• BUN, Scr, Crcl thin I 464881
livers
www.ask.f
# we measure creatinine because it is bound to protein that ONLU excreted by kidney
neyIsiw
5 indication for dialysis:
• High Potassium level (K)
• Overload not response
• Acidosis guy's
• Uremia
Uricacid
increase in blood

Kidney failure diuretic DOC: loop diuretic ! Because it isdecrease

Kidney failure + hyperkalemia: Ca gluconate or carbonate
B thiazideT K
8158 Anticoagulant with dialysis: Heparin
F any
stew Neuromuscular blocker used in renal or hepatic failure: Atracurim atesthesia
CI in Kidney failure⛔: Aminoglycosides, Potassium sparing diuretics, Metformin, ACE-I
Cause
n ephrotoxicity

Vit D that we used in CKD: 1,25-dihydroxycholecalciferol

and TDI for
Urea
albumin
treatment

shaking
Anemia with CKD: epoetin
252 Adds Renalimpairmentwas
actively
Anemia in CKD with iron deficiency: Darbepoetin
Y aner Ist hydroxy
b
QePatientwithdialysis wegivehimEpoeitn
renal 2ndhydroxy
to treatanemia
MustHemoglobinlessthan11
If inincreasemorethanin cause Cardiovasculardisease

IS EI
Attracurim
Propofol
Cetamine
 Vitamins & Minerals:

Vitamins:
Lipid soluble Vitamins (A.D.E.K):
# Lipid vitamins are important for liver
A: Retinol (Deficiency à Night Blindness)
# High dose of Vit A is contraindication in pregnant
D: Cholecalciferol (Deficiency à Rickets, Osteomalacia)
E: Tocopherol (Deficiency à Thalassemia, infertility)
K: Phylloquinone (Deficiency à Bleeding)
# Warfarin Vit K antagonist

Water soluble Vitamins (B.C):

B1: Thiamin (Deficiency à Beri-Beri)
B2: Riboflavin (Deficiency à Ariboflavinosis)
B3: Niacin (Deficiency à Pellagra)
# Niacin (Vit B3) can be used as Antihyperlipidemic agent
B5: Pantothenic (Deficiency à Paresthesia)
B6: Pyridoxin (Deficiency à Neurological symptoms)
# Give Pyridoxin (Vit B6) with Isoniazid (INH), antidote
B7: Biotin (Deficiency à Alopecia, Dermatitis)
B9: Folic acid (Deficiency à Megaloblastic anemia, Neural tube defect)
# Methotrexate is a folic acid antagonist; we should supply folic acid with methotrexate
# Give 1 month before pregnancy à decrease risk of neural tube defect
# Give with Vit b12 in megaloblastic anemia
B12: Cobalamin (Deficiency à Precious anemia, Megaloblastic anemia)
# Higher dose will cause Cyanide toxicity -> we give Hydroxocobalamin
# Schilling test is used to detect Vitamin B12 amount
# Absorbed by intrinsic factor
* if there is a lack of intrinsic factor à lead to decrease Vit B12 absorption à Cause Precious anemia
# Metformin and PPIs and H2RA cause decrease in Vit B12
C: Ascorbic acid (Deficiency à Scurvy, Gingivitis)
# Vit C increase iron absorption
# Vit C use in preparation as preservative agent
# Vit C use in cold ”flu” to reduce the duration

Minerals:

Ca++: (Deficiency à Children: Stunted growth, Adult: OP)

++
# medication should be separate from Ca and Ca containing products “milk, ..etc”
* Tetracycline, Bisphosphonate, Bisacodyl, iron, levothyroxine, quinolone
# Also, Ca++ supplement should be supply to:
* patient with colitis and taking cortisone, Osteoporosis (OP), with SERM
Iodine: (Deficiency à Goiter) # Hyperthyroidism
Iron: (Deficiency à Anemia, weakness)
# Copper is essential for iron absorption in gut
Mg: (Deficiency à Weakness, muscle twitches)
K+: (Deficiency à Muscular weakness, Paralysis, Confusion)
 Dosages:

ADULT PREGNANT BREASTFEEDING GERIATRIC

++
CA 1000 mg 1200 mg --- 1200 mg
VIT D 600 IU 600 IU 600 IU < 70 y: 600 IU
> 70 y: 800 IU
VIT C Men: 90 mg --- --- ---
Women: 75 mg
VIT A Men: 900-1000 mcg 900 mcg 1200 mcg ---
Women: 600-800 mcg
FOLIC ACID Men: 400 mcg 600 mcg 500 mcg ---
(VIT B9) Women: 400 - 800 mcg
IRON 1200 mg/ day --- --- ---
or
325 mg TID
# elemental iron: 65 mg

EndofFirst day
Heparin 081W
Wasa
dik Gim
Its Anticoagulant & Antiplatelet:

Anticoagulant:

A. Indirect thrombin Inhibitors: (Heparin)

Hebarin - UFH: Shorter t1/2, More to cause Heparin inducing thrombocytopenia an Edible
(HIT)
Enoxaparin - LMWH: dose 1 mg/kg/day BID, 1.5 mg/kg/day OD
# Monitor aPTT, Antidote is protamine sulfate
# pregnant we use LMWH, but if she going to labor we use UFH due to shorter ½
raft # Heparin use in Dialysis patient

B. Direct thrombin inhibitors: DÉÉpsia

- Oral: dabigatran # GI side effect (take it with food), antidote idarucizumab
- Parenteral: Argatroban # use in case of Heparin inducing thrombocytopenia (HIT)

Heparin'd 21 Id
C. Direct factor Xa inhibitors:
- Oral: Rivaroxaban, Apixaban
- Parenteral: Fondaparinux
# Direct factor Xa inhibitors NOT use in sitting lumber puncture (LP) or spinal surgery

14 4 D. Vit K antagonist: (Warfarin). # SE: Hemorrhage, Purple toe syndrome !

# Cross BBB, Category X à cause Nasal bone hypoplasia
# Avoid: Tamoxifen, SERM/estrogen à increase bleedingphenytoin Purple glovessyndrome
# Antidote: Vit K
Gibbon # Vit b12 can be taking with warfarin, warfarin with AL complex in GI & poorly absorption
eeding A
MOAas Aluminum
Antiplatelet: Antiintanatory acetylation
ofConConInhibition
A. Inhibit prostaglandin synthesis: (Aspirin)
# Inhibits synthesis of thromboxane A2 by irreversibly acetylation of COX enzyme
# NOT give in children and teenagers (< 20 years) à Reyes syndrome “innitus of ear”

ÉÉÉIiuofear
# Not use in asthmatic patient, and it is CI with methotrexate

B. P12Y12 receptor inhibitors: (Clopidogrel, Ticlopidine, Ticagrelor)

# Clopidogrel is CYP 2C19, and can NOT take it with omeprazole, use Pantoprazole Prasugrel

Dpi
d
bbygreentea
!
INRIabyginsing
Ideal is INR 2.5g
thenormalrange
 wish.EE
A.fib + mechanical valve: warfarin, dabigatran, Rivaroxaban
dime Valve replacement: warfarin
Anticoagulant with dialysis: Heparin
Emergency ED + HTN + PE: Argatropan, Dabigatran

HIN Pulmonary Embolism (PE):

in
MaryEmpolism - LMWH (Enoxaparin, Daltaparin)
- UFH (Fondapanux)

Anticoagulant take with meal !: Rivaroxaban

Anticoagulant CI in TIA: Prasugrel
Trasitischemic
Attack Iwasawa
Oral anticoagulant ": ask.is
Warfarin, Dabigatran, Rivaroxaban, Apixaban

Anticoagulant
Hi and dyspnea
Dabigatran: dyspepsia
Rivaroxaban: dyspnea
im
Anti-platelet:
Ticagrelor, elinogrel and Clopidogrel: dyspnea

Ifosfamide: hemorrhagic
TH
HIT: Argotrabem
PCI: Bivalirudin
arininducethrombocytopenia
Argatroban
Him
ima varmint
cab
ask.snorttuzm.IE
# Clopidogrel STOP before surgery #: 5 days
# STOP UFH before surgery: 4-6 hours before surgery
an # Oral anticoagulant with high risk of GI bleeding: Dabigatran
DOC Dabigatran
# DOAC need parental anticoagulant for 5-10 days before starting oral: Apixaban
IIimie
II
DOAC: Direct oral anticoagulants.
Parentral495 1001Dabigatran tote Bigamy
Natural products and INR
⁃ Incr INR: cranberry, Chinese angelica, ginger, grapefruit $ , garlic , anise Coenzyme
Qu
has ⁃
1,1
Dec INR: soya, st johns wort, co-enzyme Q10, green tea %, vitamin E

Drug and INR:

⁃ Incr. INR: NSAID‘s, Omeprazole, cimetidine, ciprofloxacin
Important
Macrolides, isoniazid, trimethoprim, amiodarone, verapamil, retroviral, flu/Ketoconazole.
⁃
C
Dec. INR: Alcohol, CBZs, phenytoin, Rifampin, oral contraceptives, griseofulvin

of OC
 Antidote and Vaccines

Antidote
Activated charcoal give within 4 hours of ingestion

Acetaminophen: Acetylcysteine
Crotaline snake ! and window spider ": antivenin
Organophosphate, nerve gases: Atropine, pralidoxime

CCB’s: CaCL, Glucagon

Hydrofluoric acid CCB: Calcium gluconate
BB : Glucagon
Na channel blockers: Sodium bicarbonate
Iron: Deferoxamine

Heavy metal: Dimercaprol, DMSA

Lead: Calcium disodium “EDTA”, penicillamine

Digoxin: Digoxin Immune FAB “Digi”

Lipophilic cardiotoxic drugs: IV fat emulsion “Intralipid”
Lithium: Sodium bicarbonate, Polystyrene Sulfonate

Methanol: Folic acid, Fomepizole

Ethylene glycol: Fomepizole, thiamine, pyridoxine
Opioids toxicity: Naloxone
Opioid treatment: Methadone
Cocaine: Amyl nitrate
# take by inhalation
Cyanide poisoning such as Cocaine and MDMA: amyl nitrate*
Cyanide: Cyanide Kit, Hydroxocobalamin, sodium Bicarbonate

CSerotonin syndrome: Cyproheptadine, BZDs

Benzodiazepines: Flumazenil
TCA: Alpha agonist
Valproic acid: L-Carnitine

Methotrexate: leucovorin
Methemoglobinemia: methylene blue
Sulfonylureas: octreotide

Warfarin, anticoagulant: phytonadione “Vit K1”

# other names: naphthol, (k2) Menadione,
Heparin: protamine sulfate
Dabigatran: Idarcuizumab
Apixaban, Rivaroxaban, edoxaban: Andexanet alfa (a)
Thrombolytics agent: Aminocaproic Acid, Tranexamic Acid

Neuroleptic malignant syndrome, stimulant induce hyperthermia: Dantrolene

# MOA of dantrolene: postsynaptic muscle relaxant inhibitors Ca ions release

Vaso-excitation: phentolamine
Vasopressin extravasation: phentolamine, methylene blue, nitroglycerin

Ach: Atropine
Anticholinergic: physostigmine
Pilocarpine: atropine

Vinca alkaloid: Hyaluronidase

Bleach toxicity: water or milk

Vaccines
MOH Schedule:
At birth: ONLY Hep B
2-4 mon: DR BHIP
6 mon: DO BHIP, BCG
9 mon: MeasM
12 mon (1 year): MMR MOP
18 mon (year and half): MMR DOV AH
24 mon (2 years): A
School (4-6 years): MMR DOV
11 years: Tdap, HPV
12 years: HPV
18 years: MCV 4

#
Hepatitis B vaccine: 3 doses per a year
Hepatitis A vaccine: 2 doses
# Hep A is the most recommended for travel

DTaP : < 7 years

DT : < 7 who had allergy from pertussis
Recommend age to switch from DTaP to Tdap: 7 years

Influenza vaccine taken Oct - Mar

Emergency staff: should take meningitis vaccine

Routs:
Oral vaccine: OPV, RV
Vaccines can be given IM or SC: IPV, PPSV23

Vaccines with conditions:

DM:
DM pt.: Pneumococcal, HBV, Influenza
Diabetic foot: TD only

Pregnancy:
Pregnancy vaccine: HBV, Tdap, influenza
# one Tdap in third trimester every pregnancy between 27- and 36-weeks gestation
Pregnant with +ve Hep B: baby should receive Hep B vaccine and Immunoglobulin
Vaccination prevents pregnant: Depo-Provera (DMPA)
Prevention of cervical cancer and reduce the incidence of infertility: HPV
 Older pt:
⁃ > 50: shingle
⁃ > 60: pneumococcal disease vaccine
⁃ All pts. > 65: PCV13 then after 1 year give PPSV23 5 years from last dose

Hajj “Pilgrims”: Influenza, meningococcal vaccine (MCV)

Vaccine with Influenza antiviral drugs (IAD)

Influenza vaccine with IAD
⁃ Inactive vaccine can be taken with IAD
live vaccine
• IAD —> wait 48 h —> LAIV
• LAIV —> wait 2 weeks —> IAD

Live vaccine with Corticosteroid:

Pt receiving high dose of corticosteroids less than 14 days: live vaccine gives immediate
Pt receiving high dose of corticosteroids for more than 14 days: delayed at least 1 month
after DC the steroid

Live vaccines:
yellow ROME lu Best
place
MMR, BCG , Varicella, RV, LAIV, ZVL, Yellow fever, Plague, Oral Piolo vaccine, Oral Typhoid
# Don’t give live vaccines to pt who have CD4 < 200

CI of Live attenuated Influenza Vaccine (LAIV):

⁃ 0-6 months
⁃ allergy and egg allergy
⁃ 2-17 years taking aspirin
⁃ 2-4 years with asthma or wheezing past 12 mon
⁃ immune compressed

When to take 2 vaccines:

compromised
⁃ 2 inactive vaccines: can be taken at same time
⁃ Live and inactive: same time
⁃
o
2 Live vaccines: either same time or 28 days apart

Allergy:
CEgg: MMR, Yellow fever, Influenza
Gelatin: varicella, MMR, Yellow fever, Zoster
 Latex: HPV, RV
Storage:
Majority in refrigerator (2-8 C)
Zostravax, OPV: freezer (- 15 C)

“Vaccine should be kept in button shelf of refrigerator“

Wound:
Deep wound + Unknown Vaccination history = Td + TIG
Deep wound + Patient has vaccinated within 5 years = No need today
# BUT if 10 years we need
Deep wound + Patient hasn’t vaccinated within 5 years = Only Td

Minor wound + Unknown vaccination history = only Td

Minor wound + Patient has vaccinated within 10 years = No vaccine needed
Minor wound + Patient hasn’t vaccinated within 10 years = only Td

Info:

Thimerosal (mercury) containing vaccines may cause: Autism

Aydt
Vaccine with a Max. age: Pneumococcal Reta 8 months
patient65or more
Zoster cause: shingles Pneumococcal Pneumosaccride
Varicella cause: chicken box # $ 2M
tuman sat
JapilomaeHPV: it causes syncope à let the pt. set for 15 min
Vaccine
LYMErix vaccine use to prevent Lyme disease
# Lyme disease caused by bacterium Borrelia
__

Airborne virus need vaccine or cause Endemic: MMR

Vaccination prevent immunocompromise: MMR, MMRV

FluMist: inhaled influenza vaccine from (2-49 years)

Bacteria that cause Diphtheria : Corynebacterium

 CVD:

Arrhythmia:

P wave: Atrium depolarization show

Important
QRS complex: Ventricular depolarization
T wave: Ventricular Repolarization
imam
Him
Phase 0: Rapid Ventricular depolarization due to influx of Na
Phase 1: Early rapid repolarization due to Na channel close
LAKSA thaw
W'Naoko's t.weisa
n.am.am
Phase 2: Plateau phase due to a Ca influxTea
FÉ Plateau.im biw
Phase 3: Rapid Ventricular repolarization due to efflux of K RI tEimIb.w
zbkIscdxcas
Phase 4: RMP, Atrial depolarization kI24a
Aida.sk
Arrhythmia with heart block: phenytoin
# CCBs is CI in arrhythmia with heart block
Ventricular arrhythmia: procainamide
Digitalis arrhythmia:
1st: lidocaine
2nd: phenytoin
3rd: procainamide
4th: propranolol
Reflex tachycardia (RT): propranolol
amok A.Fib: Verapamil

Classes:
Gai A. Class I: Na+ Channel blockersphase I
say stay(blurred vision, tinnitus, ..)
Intermediate - Ia: Quinidine, Procainamide. #SE of Quinidine: Cinchonism/Quinism

Fast -- Ib: Lidocaine, Mexiletine

Ic: Flecainide, Propafenone
Slow
B. Class II: Beta-blockers.phaseIV # AVOID: with intrinsic sympathetic activity e.g (Pindolol, acebutolol)
C. Class III: K+ channel blockers
phasein likeEpeNorEpeactivit Penbutold
- Amiodaron, Dronedarone, Sotalol, Doftilide
# Amiodaron SE: thyroid abnormalities, Blue-gray man syndrome, photosensitive
# Sotalol is the ONLY one who have Beta blocker activity with K+ channel activity
3B I D. Class IV: CCBs. # verapamil inhibits metabolism of digoxin
CCB -
phased
Verapamil, Diltiazem
ja
Other classes:
• Digoxin, Adenosine, Mg sulfate
+ +
If ## Digoxin toxicity will be increased by: decrease K , decrease Mg , Renal failure
Adenosine will not give effect if the patient was taking theophylline or coffee Na RATPaseInhibitor
23034 # Digoxin antidote: Digoxin immune fab (Digifab) WR toxicityofDigoxin
Renal
Ing Failure
 MK
t
Rate control: BBs, CCBs, Digoxingamiodarone
Rhythm control: Amiodarone, Propafenone, Sotalol, Flecainide

NBRatesd
-ve inotropic: decrease contractility, dec cardiac workload “BB’s”
+ve inotropic: increase contractility “Digoxin”

---------------

Heart Failure (HF):

ACE-I and Beta blocker should be given to ALL heart failure patient unless if there is
contraindications to decrease mortality. ex
AsthmaCIusingotBB
Beta blocker in Heart failure (MBC): Metoprolol, Bisoprolol, Carvedilol
# Diuretic in HF patient: Loop Diuretics

HF with EF < 40 which med. AVOID: CCBs

A.Fib + HF: amiodarone

Drug Decrease mortality with HF: BBs, ACE-I, Spironolactone Rsparing

TyDrug Increase mortality wit HF: Metformin, CCBs, Pioglitazone, gabapentin bNuropathic
pain
Med, cause edema: amlodipine, NSAIDs, Corticosteroids, Pioglitazone
Edema !

--------------- the 4Prephraledema CCB

Angina: Minty'm t
Constrictionotchoronaryantery disease Angioedema ACEI
name Alteplase
Nitroglycerin, Isosorbide mononitrate Cause: orthostatic hypotension
# Drug interaction: PDE-5-I
or syncope
CI in angina: Vasopressin vasoconstriction
Prinzmental angina: nitroglycerin & CCBs you.am Vasopressin: have antidiuretic action
# Schedule doses of nitroglycerin cause tolerance oxytosinesE4moa on the collecting ducts of the kidney.
loopof
Posterior
sever headache I
Increase in case of blessing: Reticulocytes-WBC Pitutarygland
# so will produce when there is blood loss
Responsible for fibrin lysis: plasma

Minoxidil: Dilate ONLY artery

# Minoxidil cause water and Sodium & water retention

MI Nitroprusside sodium: Potent vasodilator

Potent
 ---------------

Stroke:

Lysis clots: streptokinase

Acute Ischemia: Alteplase
y
3
# Alteplase can cause Angioedema Dhaka
CI of Fibrinolytic: stroke within 2 months, Uncontrolled HTN astroked
tagging.gg
Med. may cause hemorrhagic cystitis: ifosamide
4566sec'm
Antiplatelet CI in Hx of TIA: Prasugrel g cyclophosphamide
CI in IHD: Celecoxib

Acute ischemic stroke treat it with: hydralazine

# Hydralazine NOT use monotherapy in HTN
Nitropreside
Hydralazine: Vasodilation (Artery > Vein)
# metabolism in intestine

E as
Hemorrhagic stroke:
# Anticoagulant should NOT use while patient bleeding
# Use hypertonic slain (Mannitol) esmotitic
saltine ---------------

Shock:

Cardiac shock: Dopamine or Dobutamine

shore
anaphylactic
Penicillin
Anaphylactic shock: Epinephrine
Cephalosporin
aim
2
Septic shock: fluid à 1st NE à DA à Epi 5 44 5
# if we give NE without sufficient amount of fluid will cause necrosis a
Septic shock with kidney injury: DOC DA
o
Dopamine
---------------
artery
coronary disease

t.AM
Pain in CAD: Nitrate, morphine
Preventing cardiomyopathy AFTER bariatric surgery: selenium
Urgent Cardiac surgery of PCI required: Bivalirudin o cardiacprotective

an
 Dermatology:

Skin conditions:
§ Chronic skin disease:
o Eczema
o Psoriasis
o Scabies
3
§ NOT chronic skin disease:
o Chicken pox !
mr
Psoriasis
A § Coal tar
OH § Calcipotriol (Vit D)

Acne:
§ Topical:
o Benzyl peroxide (Keratolytic)
o Azelaic acid

§ Systemic:
o Erythromycin, doxycycline
o Isotretinoin
# Isotretinoin should be STOP 1 month before getting pregnant
i
Sun protective factor (SPF):

Amount of light that induce redness in sunscreen protected skin

SPF = ----------------------------------------------------------------------------------------
Amount of light that induce redness in unprotected skin

Simply:

Minutes after SPF (with sunscreen)

SPF = ------------------------------------------------------
Minutes before SPF (without sunscreen)

Inflammation:
§ Diaper inflammation: Petrolatum
 Cancer:

Alkylating anti-cancer agent: Cyclophosphamide

Decrease immunity: cyclophosphamide
Immunosuppressant cause hirsutism: cyclosporine !
in d phenotoin
Methotrexate increase liver enzyme: Give folic acid or decrease dose or STOP !
# Avoid with methotrexate: Aspirin
# Penicillin increase methotrexate level
# Dose of methotrexate: 7.5 - 15 mg once weekly

Treatment ofFIL swim

peritoneal carcinoma: Bevacizumab

Common gene in cancer: P53, TP53

Tumor suppression protein: P53

Human papilloma vaccine (HPV) for ": Cervical cancer

HEY
# Prevention of cervical cancer and reduce the incidence of infertility em
Breast cancer: Hey
g letrezole
Treatment of breast cancer: Raloxifene, hydrochloride, tamoxifen
Prophylaxis of breast cancer: Raloxifene My
# Supplement decrease the risk of breast cancer: Vit D
YimEing
Medication to mange N&V from anticancer:
§ Serotonin (5HT3) antagonist (Granisetron, Ondansetron, Dolostone)
I 1 I
Plant sources of anticancer:
§ Vinca Alkaloid: Vinblastine, Vincristine, Vindesine, Vinorelbine
# Vincristine Fatal if given intrathecal ONLY IV infusion Eminences
I § Texans: Paclitaxel, Docetaxel Igibivinfusiontig nib
§
shot
Plant origin (epipodophyllotoxin): Etoposide
b

ideas wid ski

NOTE: Edi
Methotrexate, cytarabine, hydrocortisone and dexamethasone are commonly given by the intrathecal route.
Occasionally rituximab and thiotepa may be given by this route.
0651346 Vincristine'm
IVinfusion

ask.IE
 I
Dyslipidemia:

Statin: HMG-CoA reductase inhibitors (rate-limiting step)

omitgat
# Not use: in pregnant and lactating woman (Category X)
team
# SE: Muscle pain (rhabdomyolysis, myopathy), Elevate liver enzyme, exaggerated glucose level
Is
6ham tf
# Monitor: Creatin Kinase, liver enzyme (if increase X 3 fold from upper limit à Hepatotoxic à DC)
# Decrease myopathy with statin co-administration with Co-enzyme Q10
# Statin + Gemfibrozil or Valproic acid à severe Rhabdomyolysis
04111 !

tech
aAdministration d
of Statin:

SRP statins need dose adjustment: Simvastatin, Rosuvastatin, Pravastatin

AF statin NOT need adjustment: Atorvastatin, Fluvastatin

i 9516 FAR is statin ☀ / ": Fluvastatin, Atorvastatin, Rosuvastatin

SPFL is statin # : Simvastatin, Pravastatin, Fluvastatin, Lovastatin
d d
FPRP are statin safe when taken with grape fruit juice $ : Fluvastatin, Pitovastatin,
wisp Rosuvastatin, Pravastatin

Equivalent doses of Statin:

Pharmacist Rock At Saving Lives & Preventing Flu.

Pitavastatin 2 mg = Rosuvastatin 5 mg = Atorvastatin 10 mg = Simvastatin 20 mg =

Lovastatin 40 mg = Pravastatin 40 mg = Fluvastatin 80 mg
# Atorva 40mg = Rovista 20mg
HDL e
TG
Bile Acid Sequestrants: medicines that help statin
lower your LDL (bad) cholesterol.
Cholesterol VLDL
pBile acid Sequestrants: (Resins)
Ies Cholestyramine obstructionin
djkW4d Bowel
g
# Not use in pregnant and CI in Hypertriglyceridemia (increase TG)

Cholestyramine: indicated as adjunctive therapy to diet for the reduction of elevated serum cholesterol in
Fibric acid derivative: (Fibrates) patients with primary hypercholesterolemia (elevated low density lipoprotein [LDL] cholesterol)

Fenofibrate, gemfibrozil
28 6 # Not use with statin à severe Rhabdomyolysis
statin Act on triglycerides and cholesterols: Simvastatin
Acts on triglycerides: gemfibrozil
TGonly
Pliverenzyme
Others:
- Niacin (Vit B3) If increaseofdose cause
Flint Aspirin325mg
- Cholesterol absorption inhibitors (Ezetimibe). # Can use it with statin
- Omega – 3 – fatty acid
24340366
statins
 Details (Enzy. & CYP & Hormones & Cell)

Enzyme:

O
Abacavir: HLA-B*5701
# Class: Nucleoside reverse transcriptase inhibitors (NRTIs)
Allopurinol: HLA-B*5801
u
CBZ&OCBZ – Phenytoin & Fosphenytoin: HLA-B*1502
O
Enzy. inducer:
inducer
Phenobarbital, Rifampin, Phenytoin, Ethanol, CBZs Auto
# Phenytoin potent enzy. Inducer

Enzy. Inhibitor: Anti Hz

Allopurinol, Chloramphenicol, Corticosteroids, Cimetidine, MOA-I, Erythromycin,
Ciprofloxacin

Trastuzumab & Pertuzumab (breast cancer ♋): HER2 (+ve) use

Cetuximab & Panitumumab (colorectal cancer ♋): KRAS (-ve) use

cAzathioprine: Thiopurine Methyltransferase (TPMT)

D
Capecitabine & fluorouracil: Dihydropyrimidine dehydrogenases (DPD)
Enzy. Effected by anticancer: aromatase
2 7
CYP:

Clopidogrel: CYP2C19
Warfarin: CYP2C9, VKORC1
# also 2C9 amiodarone
Codeine: CYP2D6
# tamoxifen, tramadol, Risperidone
Irinotecan: UGU1A1
Rituximab: CD 20 "
Fluorouracil: DPYD

I
Inc. risk of rhabdomyolysis with statin: SLCO1B*1*5
SLCO2B L g
IT
Paracetamol: CYP2E1
Atazanavir: CYP3A4

CYP1A2: caffeine, Clozapine, Theophylline

CYP2C9: Carvedilol, Celecoxib, Glipizide, Warfarin Aniodarone
CYP2C19: Omeprazole, Clopidogrel, phenytoin, Phenobarbital
cCYP2D6: Codeine, Amitriptyline, Carvedilol, Donepezil, Haloperidol, Paroxetine
cCYP3A4&5:
Verapamil
Alprazolam, Amlodipine, Atrovastatin, Cyclosporine, Diazepam, Sildenafil,
 f
Metabolism:

Phase 1:
⁃ oxidation
⁃ ReductionIvitamined
Brotocinine
⁃ Hydrolysis Amphotericin
B
# Med. undergo phase 1 metabolism: Diazepam

Phase 2:
⁃ Conjugation
# Conjugation reaction excretion will lead to inactive substance swag
I
Phase which acid secretion decrease: intestinal phase pH Basic
Phase which acid secretion increase: Cephalic phase and Gastric phase

Metabolism in intestine: hydrolysis

# Amphotericin B eliminated by hydrolysis

0
Process require CYP450: Oxidation

73.444
CAN 22After 94 become: Polar
med. metabolism
Hot Drug store in body as: Fat and protein Ionised
if Most common diffusion of med. entry the cell: Aqueous diffusion Toxic metabolite of paracetamol:
N-acetyl-p-benzoquinone imine (NAPQI)

M 94A conjugates
Metabolism of paracetamol: Glucuronides detoxifyMetabolite0143 GI 449
Glucose from glucose: Glycogenesis
i w.ms
Tyrosine to tyrosinase esterase: tyrosine hydroxylase
t tonic iv new
L-glutamine to D-glutamine: Glutamate synthesis
Codeine to morphine = dealkylation, demethylation, oxidation
Important
morphinetocodeine alkylationMethylationReduction
Enzy. Metabolize starch: a-amylas
Polysaccharides: starch
Enzy. kinetic law: Michaelis-Menten law
I ÉÉreatinineclearance
foradultandpediatric
d WIN
K
Aspirin bond: covalent bond pi'd
# aspirin reduce the flushing of nitrate
Acetaminophen: Hydrogen bond (H)
Niacin
3
paracetamol
 7
1st order: linear
# rate direct proportional of the conc., CL NOT change
mm
0 order: Non-linear
# rate is independent of the conc.
WAATTP warfarin

too mm j
# WAATTP, non-linear
Warfarin, Alcohol, Aspirin, Theophylline, Tolbutaminde, Phenytoin

Largest capsule #: 3cm (000)

Ifbb
Med. can be crushed: immediate release tablet #
68m6156.9

Sustain release depend on:

•
SR
interaction with body fluid
• Medium PH
• Enzy. activity

Absorption in stomach:
• non-ionized
excretion
Ionized
I Tj ionized
5 Ty
• non-polar
• Lipid soluble Polar
Cross BBB $: watersoluble
• Unionized
• Thou
Lipophilic
Cross the placenta %: W
• Mwt < 500 ASolubility I
•
•
Lipophilic
Non-ionized
64811M bondtoproteinmore
UM.Wt IT
ÉÉÉg
I OR
# Protein bound NOT cross PlacentaONLY the free unbound

Vd of distribution: solubility, protein binding, Mwt I

WATTIE
Effect of volume
want
Obese pt. The effect of lipid soluble drug: will be on volume 610
of distribution
Controlled med. in body depend on: Body fluid interaction
pud
Mwt > 500 will excreted in: biliarythenmetabolisminfeces
Contributes for two compartments of drug distribution: Adipose

ACE-I to ARBs: No time is needed

ARBs to ACE-I: No time is needed
idk ACE-I to ARNI: 36 hours &
3
ARBs to ARNI: No time is needed
9

TT-lymph: intercellular
see 7
B-lymphocytes: extracellular
so T
 Hormones:
brain
Posterior pituitary gland:
NOT produce any hormones by its own, store and secrete 2 hormones from hypothalamus
(Oxytocin & ADH)
Anti
diureticitorinomsine
Vasopressin
Anterior pituitary gland: Hi
Produce and release many hormones
(GH, Prolactin, TSH, ACTH, FSH, LH)
Adrenal
Es
Hormone release from adrenal cortex adrenocorticotropic: progesterone

Essential Amino acid (a.a)

# Try This VIP MALL
Tryptophan Valine leucine
Try: tryptophan Isoleucine histidine
lysine
T: threonine
phenylalanine
methionine threonine
His: Histidine
V: Valine
I: isoleucine
P: phenylalanine arginine
M: methionine
A: Arganine
L: leucine
L: lysine
CS GA Non
Histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan

Non-essential a.a:
Alanine, Asparagine, Aspartic acid, Glutamic acid

A.A conjugate in liver: Glycine, taurine

A.A present in hair and nails: Cysteine, Arginine, Lysine, Methiein (CALM)
On DNA: A, G M m
Component of purine nitrogen: Adenine, Guanine
6 s

Stating code: AUG

T
Stopping code ': UUA UGA UAA 9 UPA
U A E A
it
G Is U e Ab 61 I
 Monosaccharide:
• Glucose
• Fructose
• Galactose

Disaccharides:
• Maltose
• Lactose
3
• Sucrose

•
•
7
Polysaccharides:
• Starches
Fibers
Glycogen A is 1 01 190 if
Dextran MIMA wt ii a.m
Cell:

Mitochondrial
• ATP -> energy Axis Energy

• Q10 with selenium

at
EW.tk
i t
DNA is: Deoxyribonucleic acid
Epitope: “Antigenic determinant”
WE Part of an antigen that is recognized by the immune system. Specially by antibodies, B cell, T
ji cell.

Golgi apparatus:
54 # Membrane bound organelle found in mast cell.
É # Responsible for packing proteins into vesicles to secretion and therefor plays a key role in
o
th the secretory pathway

Plasmid:
# Small, extrachromosomal DNA molecule within a cell that is physically separated from

Eff chromosomal DNA and can replicate independently.

# Found as small circular, double standard

Plasmin: responsible for fibrin lysis Na

I
sw Doubleheled
It Philadelphia chromosome:
Imatinib 9:22

if
# Nilotinib used to treat Philadelphia chromosome CML

Active enzy. PEPSIN Stomach II

t.am
Pepsinogen
inactive

j
 Discoloration and Syndromes
* Discoloration in urine, feces, taste
* Pigmentation
* Syndromes
* Eyes and Ears problems

Urine

Red / orange urine:

§ Phenazopyridine
§ Senna laxative
acuttreatconstip
at II.ie necathareticlaxative
§ Rifampin EnzymeInducer Anti TB
686251 § Doxorubicin
Anticarcinogen cardio toxicity
mi ON It § phenytoin Antiepeliptic
bone marrow suppression

depression
Brown / Dark urine:
§ Metronidazole
§ Nitrofurantoin anemiabecauseGod
pregnant Utfpaspinggytic
§ Carbidopa / levodopa

Green / blue urine:

ofotherdrug
4 § Cimetidine enzymeinhibitor toxicity Hepaticenzyme
404
Mri § Amitriptyline Antidepressant Because I
§ Doxorubicin Anticancer SE
§ Indomethacin Potent analgesic
§ Propofol Anathesia
§ Sildenafil Hf Malesexualdisease
§ B vitamins

Feces:

Discoloration of feces !:
§ Phenytoin
§ Iron
§ Rifampine

Dark stool:
A § Iron
§ Bismuth subgallate
feces
 0
find
die
Other pigmentation: Bf no so
s

them Doc in PE
Chlorpromazine, Thioridazine: Pigmentary on retina and corneal " T
psychiatry Asthmatic
Prostaglandin Analogue: (Latanoprost, ..etc) Darkening of the iris "temolol latanoprost
came Red-green color blindness: Ethambutol
yy.gg
ME
A
missus
X
glucoma
die we
Amantadine: Livedo Reticularis “Pattern of reddish-blue skin discoloration”
Hydroxychloroquine “anti-malaria”: Chronic use will cause skin pigmentation
nitorof Ka
eye Rifampin: Red urine, tears, sweat

did
sik Taste:

Metallic taste:
§ Metformin
§ Metronidazole
Captopril
Fits Loss of taste: Captopril
Black tongue # : bismuth subgallate

E E
within
 Syndromes:

Toxidrome: The syndrome caused by toxin I'm am

Prodrome: the signs and symptoms of toxicity syndrome É 651
Gray baby syndrome $: Chloramphenicol Ee E
Gray man syndrome: Amiodarone
Red man syndrome: vancomycin
pimp d
binfusionrate
am me.jo
Blue-Gray skin discoloration: amiodarone Red
syne
Brown-pink skin discoloration: Clofazimineinfusions it
E j G j
Purple gloves syndrome %: phenytoin
Hand-foot syndrome &: capecitabine
Purple toe syndrome ': warfarin
Yellow one
nail syndrome (: Sodium aurothiomalate
w
Lupus like syndrome: hydralazine & procainamide & isoniazid

Monday syndrome: Isosorbide sublingual at 5mi u

Angina toleranceod
Pitsea isa
Red-green color blindness: Ethambutol schedulingof
tolerance
Dosetoavoid
Reye syndrome: aspirin (children and teenagers)
ji isn # Not use bismuth in children and teenagers who recovering from flu, chickenpox, viral infection -> risk of Reye’s
20 syndrome
t

TCB
Treatment of Raye syndrome:
§ CCBs: Nipedifine
§ VD: Sildenafil
Nif e di pie
 i

Eye problems !

Retinopathy:
§ Quinine
canst § Hydroxychloroquine Ts
a
Not § Ethambutol

treat
§ Indomethacin
th
Eye pigmentation:
§ Latanoprost
7 # Pigmentation + blurred vision
§ Deferoxamine AntidoteofIron
I
§ Chlorpromazine, Thioridazine

Loss of vision (Myopia):I 1

b'she !
§ Topiramate s.eoligfiytiitjsis
§ Hydrochlorothiazide
rostglandinanaloge I
epilepsy
Diuretic
§ Latanoprost (Blurred vision)
yjygg.iq
ucomaz.ae § Itraconazole (vision distribution)
Antifungal § Antimuscarinic (Blurred vision)
§ PDE-5 inhibitors (abnormal vision)

Glaucoma ( inc. IOP) increaseinIntraocularpressure

§ topiramate
Glaucoma
ft mop
§ Corticosteroids
§ Tetracycline

my Chloramphenicol: cause optic neuritis

Class
MA Hydroxychloroquine: Ocular toxicity
enemas
WIT
Tamsulosin: Floppy iris syndrome (during cataract surgery)
Heroin and morphine: miosis “pointed pupil”
benign prostatic hyperplasia BPH

# Pupillary construction
mminhibit
5reductase
BPH e
Cocaine: mydriasis
Important g blocker
Ear problems "

Ototoxicity:
§ Aminoglycoside (Irreversible)
§ Vancomycin
§ Macrolides
furosemide
Quinine: Deafness
act
iii Cisplatin: Hearing loss
Aspirin in children: tinnitus of the ear
# For tinnitus treatment: Betahistine
g
aim
 MIX- NOTE

Medication should stop before IV contrast

§ NSAID: Don’t take then for 2 days before and after the test
at
§
§ Diuretics: Avoid for 24h before test I
Metformin: Don’t take it the fay of the test and 2 days after.

§ ACE-I & ARBs: Stop at least 48 hours

# IV Radiological substance: May cause acute renal failure
w
-----

Travel ✈: IG Vaccinee
osmium
vaccine
eonly Is I
Hep A: the most recommended for travel
C
I
s IT
Travel diarrhea prophylactic ✈ : hygiene and bismuth, rifaximin
Travel diarrhea caused by: E.coli
Travel diarrhea treatment:
T
§ Ciprofloxacin, azithromycin, Quinolones
§ loperamide (opioid with anti-diarrhea effect)I
an desists mid
sioidderivativeTravel insomnia: Melatonin (Ramelteon)
sedintreatment His
y
Midd
hecogh Jet lag ": Valeriu
§ Melatonin
§ Zolpidem

Zolpidem
twain § MOA of Zolpidem: BZDs like action
§ Uses: Jet lag, insomnia & geriatric “hypo hypnotic”
t
# NOT cause addiction & withdrawal

ds'm § The patient who using zolpidem will be: drowsiness, Dizziness, Weakness,
lightheadedness
He
§ Dose:
o Man: 3.5 mg Max.: 10 mg
o Woman: 1.75 mg
7 Max.: 5 mg

-----
3
 Glucose-6-phosphate dehydrogenase
G6PD
# G6P Enzy. Activate when there is high insulin level
is G6PD deficiency will cause which type of anemia: hemolytic anemia
Medication CI in G6PD deficiency:
§ Hydroxychloroquine (RA treatment) Nitrofurantoin
I
0 96 § Sulfasalazine (RA treatment)
GGPD § SMX/TMP I (Antibiotic) t.BE
Kate § Primaquine (Anti-malaria)
Gp y
Caution in pt. ē G6PD deficiency: Nitrofurantoin
2141301
Pregnant with UTI + G6PD: cefuroxime
b E
INE 2346 61 m
-----
Itani
UTItGGPDists
1661
jaggySmoking:
THepaticenzyme
shat ask 404314
Smoking associated with CYP induction #
! LIMIT A of
stMFanulocytosis II metabolisms s
i Geshe edged
§ Clozapine and Olanzapine with smoking #:
thiouracil
Propyl Streat
ofpsychosis
o Smoking
t.TT
will Increase metabolism à which lead to decrease Conc. & Increase
Gtreatnyperthirodism
Clearance
# Need higher dose of Olanzapine with smoking pt.

§ Theophylline + smoking # : decrease theophylline plasma level

# Require higher dose Metepatic
Enzyme
Antidepressants used in stop smoking #: Bupropion
Anti
depressants
-----
Gance'd
Diet:
§ Plate diet: DM
Important
§ Dash diet: HTN
GIT
CHEN § Gluten free diet: Celiac disease
§ BRAT diet: Diarrhea
§ Ketogenic diet: epilepsy

-----
 Sulfa allergy

§ Celecoxib K

geeky §
§ Captopril
TX
Sulfasalazine
IX wa # The ONLY ACE-I containing sulfa
Sfa 1455 I
Sulfonamide allergy CI: Thiazide, Loop diuretics
Manitol EsmoticDiuretic
bwater
especially ifwasedemainbrain
 Genitourinary (Men)

Isotta
Erectile dysfunction (ED):
GH Decrease blood flow to penis
ni's
Treatment:
A. Non-pharmacological:
§ Lifestyle (decrease weight, stop smoking & alcohol)
§ Manage the underline causes (HTN, Atherosclerosis)
B. Pharmacological:
MOA
§ Phosphodiesterase – 5 inhibitors (PED-5): (1st line)
{Sildenafil, Tadalafil, Vardenafil, Avanafil}. Essay
# Tadalafil if the ONLY approved for BPH
# MOA: local release of nitric oxide which will inhibit Phosphodiesterase enzyme à increase cGMP à smooth
gkwsorbidel.ci muscle relaxes à increase blood flow à erection

Iii
# SE: Hypotension, Nasal congestion, headache, dizziness, abnormal vision (STOP once this happen)
a # CI: nitrate (will cause sever hypotension)
Issa
oronary I
I'd d artery ex isosorbidemononitrate

mothmusclerelax yy.gg yup Nitroglycerin

Benning Prostate Hyperplasia (BPH):

WITH for development and maintained the

Pathophysiology: Prostate depend on testosterone
size and function

Testosterone 5 -a reductase
so
iwjowbcqd.im
> Dihydrotestosterone (DHT) # responsible for normal & hyper growth
# too many conversion it will lead to enlargement of the prostate
# So 5-a reductases inhibitors will ONLY be used in case of prostate enlargement > 40 g Tamsolusin
time 3040 combination
BPH worse by: Anticholinergic (atropine, benztropine, ..etc.) 40 surgery offReductase
BPH induce by: Chloramphenicol
awww Eta
Treatment: gray babysyndrome

4
1. a1- receptor antagonist: {Prazosin, Terazosin, Tamsulosin}
# SE: orthostatic hypotension, nasal congestion, headache, floppy iris syndrome (with tamsulosin) Important

2. 5 - a - reductase inhibitors: {Finasteride, Dutasteride}

synthetase

# used ONLY in sensetasest

prostate enlargement > 40 g
730g
3. Combination therapy: {tamsulosin + Finasteride or Dutasteride}
# Symptoms of BPH with enlargement prostate > 40 g
730g
4. Phosphodiesterase – 5 inhibitors (PED-5): {ONLY tadalafil approved for BPH}
5. Antimuscarinic: {Oxybutynin}
Adam
a BPI
Plant used in BP: Saw palmetto 1311241
g
whichofthe followingcausefate
fpatienthaveBPH you choose
infetus aims
Finasteride geneticalanomelas
Dutasteride t.IM
Horman Androgen exam
Oxybutynin Idi a
SEAnticolinergicI Drug Finasteride 1 061
 methotrexateifinastnde 6 m.w.cm

mango
Is vimeo.kz
Urinary incontinence (UI):

Treatment: b Is It
a
s
§ Anticholinergic: {Oxybutynin, Tolterodine, Darifenacin}.
§ Anti-diuretic (ADH): desmopressin
# most common used

# Desmopressin also used in: Diabetic insipidus, nocturnal enuresis, UI Incontinence

Urinary
412A
y
NOTE:

ED: PDE-5 (Sildenafil) ED: Erectile dysfunction

wise BPH: a1- receptor antagonist (Tamsulosin, Prazosin)

th BPH with prostate enlargement score > 40: Combination therapy {tamsulosin + Finasteride
E
or Dutasteride} 30
740 surgery
BPH + ED: ONLY Tadalafil ED: Erectile dysfunction

É
Prostate cancer: Flutamide, Androcur
Prostatitis: Finasteride
neuropathy

# Inflammation of prostate gland ofNeuropathy

treatment
for reuptake
Inhibitor
Premature ejaculation: duloxetine SiNepdepression
# Terazosin treatment of BPH by relaxationAnti
of bladder neck
11am.is W
TWC
Treatment of Urine incontinence (urgency and frequency): darifenacin
Treatment of Urine retention: Neostigmine, Carbachol, Pilocarpine
int
WI Dad's
Tai Isi
Med. induce impotence: Thiazide, Cimetidine, Propranolol, Azoles Oxybutynin
t
Rs's g
II
 Naproxen Not take with end the

Ionized polar Urine

GIT:

Antacid: Aspirin Nattcos

aciddrug Antacid
NaHco3 antacid makes an out elimination: Pka = 1.2 -> weak acid EliminationofAntacid
PH stomach gastric: 1.5-3.5

Antacid used in heartburn: Neutralize acidity

Neutralize acidity and treat gastritis: PPIs
Neutralize stomach acidity and prevent PU: Antacid PepticUlcer omeprazole
When use Omeprazole as a single therapy: gastritis 20 4 6
Esomeprazole for esophageal injury: 30 days geneticinteraction
PPIs used in GI bleeding: Pantoprazole Pantoprazolen
PPIs used in case with Clopidogrel: Pantoprazole
Medication make complex with antacid: Fluoroquinolone, Tetracycline, Doxycycline
Complement ajay him
a Mesalazine treat and maintenance of: Ulcerative colitis
a It Fistulas ulcerative colitis: infliximab
ntia E
Sulfasalazine used for: IBW (Ulcerative colitis, crohn’s disease)
# Colitis & cortisone: better ca + vit b12, Ca
Interensifactorhylnflamatory
# Only Colitis: vit B12 Boweldisease
Melena treatment: Sulfasalazine

whim
G# it is a dark black, bloody faces
feces
É
I Antacids give Cathartic effect as SE: Mg hydroxideHerrus Constipation
I d B Glycoside of senna cathartic effect: anthraquinone
etabolismot Catharticlaxative
Pt with catheter jitter should take: ciprofloxacin stimulant
aged Inflamationwygg
receptor
Antagonist
H2RA SE: decrease Vit B12 sustain
c # H2RA in GERD NOT use in casestay
with erosive Cite an.at
in
anitidine PPIs SE: decrease Vit b12 and mg and decrease Ca absorption which lead to bone fracture
++
I
famotidine # PPIs is block H/K irreversibly
ga FLEW Win
t.sk # Urea Breath test to detect Pylori infection: we should STOP antibiotics, PPIs, Bismuth and antacid
before 2 weeks serology

IID fecessample PresenceofAntegin

# 20 mg of Omeprazole = 300 mg of Cimetidine

t
enzymeinhibitor
# Clove oil USED in dark box !
# Med. incr. absorption with ranitidine: Naproxengynecomastia

-------------

ok
Stivengonson
 Lactulose Psynium Glycerin Supp
pregnant Swiss
Constipation:

Classification:
A. Stimulant laxative:
Senna, Bisacodyl, Sodium Picosulfate, Castor oil
ima # Anthraquinone Glycoside of senna responsible for catheter effect
et
Esta # Castor oil CI in pregnant
B. Bulk forming laxative:

IIIT
ight
Psyllium, Methylcellulose, Polycarbophile, wheat bran, inulin
# Safe in pregnancy and old patients
C. Osmatic laxative: É
chronicle Glycerin, Lactulose HepaticIncepndalopathgtamonia befurroglobin
# Glycerin use in pediatric " assets
# Lactulose use in Hepatic Encephalopathy (HE) to decrease ammonia level
D. Stool Softener: (emollient)
Docusate
# Require water intake, NOT take it with mineral oil
E. Lubricant laxative:
Mineral oil
# Take it in upright position to avoid aspiration & potential sever lipid pneumonitis

-------------

Diarrhea:

Adsorbent antidiarrheal med.:

• •Kaolin
in.sk
# Bind to bacteria toxin
Lisa
Antimotility to Control diarrhea:
• •Diphenoxylate
• •Loperamide
# Opioids and have antidiarrheal effect
opioidsource
# Avoid in case of infection and bloody stool
ÉtÉis
aka
Waco DOC of giardiasis: metronidazole

waif I
# infection cause diarrhea

Travel diarrhea:
• Hyg_
Prophylaxis: SMT/TMP, Doxycycline, Bismuth Rifaximin
• Treatment: Ciprofloxacin, Levofloxacin
# Pregnant and Pediatric: Azithromycin
IL be
Colitis caused diarrhea: Vancomycin
GoClostredium
Defficile
indie
Vanycinw
rugsof
Parkinsondisease

VomitingNausea b

Eskimo s
dopamine
-------------
D Parkinson
amines.im Nausea & Vomiting:
itings.w.ae
nausea

EPS
stays
Dopamine (D2) antagonist:
Notgiven
ExtraPyramidtigepeys
2
Metoclopramide.
Domperidone
Xifptake
drug
t parkinson# Cross BBB & cause EPS
seizures # Not cross BBB butit cause QT prolongation
Qt 9 Becauselipophilic
crossBBB Causearrythmia
Pregnant with N&V:
- Meclizine + Pyridoxine (Vit B6) inrarecases
- Cyclizine + Pyridoxine (Vit B6)
RT 8 - Doxylamine + Pyridoxine (Vit B6)
Kai

Induce vomiting !:
• Ipecac
• Emetic

Emesis NOT use in toxicity of: 818th toxic w Iya

• Pt. Ingested caustic substance 986
Id swzy
E
• Pt. Ingested volatile hydrocarbon WE
• Pt. Has CNS depression
shag
spit 544 use
Antiemetic e in ER ": that chlorpromazine
ink Promethazine, Dimenhydrinate
Vomiting Metoclopramide, Chlorpromazine, It iAntipsychotic
anddiaren 2 Antiemetic
Antipsycoticai
# Metoclopramide work in: Chemo-trigger-zone 3Antihistamine
EPSwhy BBB brain seizure
Potentwhy chemotriggerzone-------------
Administration:
GIG
- Mineral oil (for constipation) à Upright position

HE - Bisphosphonate (for OP) à Upright position + empty stomach (morning)

- Levothyroxine (for hypothyroidism) à on empty stomach (morning)
ga - Levodopa/Carbidopa (for PD) à on empty stomach (morning)
meow
PILI
Medications make complex with antacid:
Iron, Bisacodyl, tetracycline, Fluroquinolone, Bisphosphonate Doxycycline
wittedwithaiantacid
# Digoxin decreases
# Warfarin with AL poorly absorbed becausepresenceofBibalentmetal b absorptionof
Calcium carbonate drugs
15
am
magnesium carbonate ex
Digoxin
Aluminum
Hydroxide
SIG Heartburnes 464
ABB Cacarbonate
th sHeartburne osteoporosis

I CaCarbonate woo
 Heath
muscle
pTContractionofHeart ma Digoxin
Medications with Ca++ and products contacting Ca++ (milk, ..etc):
• Dec absorption:
diag
Iron, Bisacodyl, tetracycline, Fluroquinolone, Bisphosphonate Digoxin 15
• Change effect:
Increase effect of digoxin effects
g Decrease effect of CCBs
effects't
ppigsphenterT
snobs Relaxation
# Decrease gastric emptying rate: Atropine & hypothyroidism
# Complex with dietary products: Ciprofloxacin Caffiene
PandaExtra
F.pt ia paracetamy
# Ibuprofen can take it with milk y
# Increase acetaminophen absorption with coffee I caffeine Tabsorptionof
Mmg # Increase iron absorption with Vit C Paracetamol
# Metformin & lithium takes it with meal to decrease GI side effect
# PPIs take it 30 mins before the meal
 Migraine & Glaucoma:

Migraine

A. Acute attack:
§ Triptan (Sumatriptan):

Iii
o Can combine with NSAIDs PreventPostpartumHemorrage
o Max. 2 doses/day, 2-3 day/wk. or Postlaborhemorrage
11 migraines
o Not take Ergot za in the same day
Alkaloids
o CI: CAD, Stroke, uncontrolled HTN, pregnancy W iwd a.at
EMI o Warning: serotonin syndrome
depressions es e p
§ Ergot Alkaloids: (Ergotamine, Dihydroergotamine): The same CI with triptan, Category X

§ Analgesic:
o NSAIDs, Paracetamol:
# ONLY moderate attach without vomiting or sever nausea, either NSAID alone or in combination with paracetamol
a
§ Antiemetic:
o IV metoclopramide, IV/IM chlorpromazine, Prochlorperazine:
# Can be use as Monotherapy
o Oral antiemetic:
# Can’t use as monotherapy, should be combined with metoclopramide and NSAIDs

B. Migraine prophylaxis:

1. Antihypertensive:
§ BBs: (Propranolol, Timolol)
§ CCBs: (Verapamil, Flunarizine)
2. Antiepileptics: Valproate, topiramate, Lamotrigine
3. Antidepressants:
§ TCAs: (Amitriptyline, Nortriptyline, Protriptyline, Doxepin)
4. Serotonin antagonist: Methysergide, Pizotifen, Cyproheptadine
# Cyproheptadine have a antihistaminic activity and 5- hydroxy-tryptamine (5-HT) antagonist “Serotonin antagonist”
5. Botulinum Toxin: Clostridium botulinum toxin type A (Botox)
6. Devices: TENS (Transcutaneous Electrical Nerve Stimulation) device

NOTE:
Migraine:
§ Mild - moderate: acetaminophen, Ibuprofen
§ Sever: triptans (Sumatriptan) +/- NSAID

ulcer
I

8 i
Glaucoma:
Most common cause is increase Interocular pressure (IOP) due to increase fluid

Treatment:

A. Decrease fluid production: (beta-blockers)

Patent ductus arteriosus (PDA)
§ Selective B1-blocker: Betaxolol also IHI
§ Non-selective B-blocker: Timolol CI inasthmatic
# Non-selective do NOT used in asthmatic patient
pt ✅
those
alprostadines
B. Increase fluid outflow: (Prostaglandin analogue)
§ Latanoprost, Travoprost Us Iggy PDA Sid
withasthma what
# warning: it causes darkling of the iris 6611W
# SE: Blurred vision, increase pigmentation Mitosis.mn
timmy a
C. Decrease fluid production & Increase fluid outflow: (Adrenergic a-2 agonist) betspecific
§ Brimonidine thus
# warning: Caution with heavy activity (e.g driving) until you know the effect on your body owe
# SE (adrenergic SE): sedation, burning, itching eye, dry mouth
___ are If pregnantwithglucom
NOTE: 1stlineBrimonidine
2ndlineTimolol
§ Glaucoma in pregnant: Brimonidine or Timolol
IN 634183
§ Glaucoma in asthmatic patient: Betaxolol or Latanoprost winded
# Non-selective do NOT used in asthmatic patient as ship
that's
c§ Open angle glaucoma (OAG): PilocarpineAntidote Atropine
# Pilocarpine is a cholinergic agonist used to reduce pressure inside the eye Brimonidinera
 Dashdiet
lowsodiumintake HTN: IN
dbkyoa aw.im a Uk
Diuretics:
A. Thiazide: Hydrochlorothiazide, Chlorthalidone
ask.br n

# SE: hypo K, Mg, Na/ Hyper Ca, glucose, uric acid. “Bone protective” 1xw4s
# CI: DM, gout, renal failure Fam
# Indapamide which is used in essential HTN & Pulmonary edema “thiazide like diuretic”

btwn www.ewi
B. Loop Diuretics: Furosemide, torsemide, ethacrynic acid # diuretic in kidney failure

whimWIT
# SE: hypo K, Mg, Na, Ca/ Hyper glucose, uric acid / Ototoxicity
duetosecototoxicity !
# CI: DM, gout, Aminoglycoside
# Furosemide infusion rate: 4 mg/min
R my
C. K-sparing diuretics: Spironolactone, Eplerenone, amiloride
Beas's

j
i 54 ws
YbReyfwew
# SE: Hyper K, Gynecomastia, impotence
# CI: BBs, ACE-I, K supplements, Renal failure
hyperbp c
WITI Furosemide

most
# Spironolactone with cimetidine have anti-androgenic effect
Furosemide : Spironolactone (40 : 100)
d 6 11
If amination
G
artilyCCBs: Augusta
A. Nifedipine: (can use in pregnant)
B. Verapamil / Diltiazem:

phenytoin
jig
CCDs
Manas
# SE: Gingival hyperplasia,orprephraledemy
Ej
Ankle edema, constipation, 1st degree atrioventricular block (verapamil)
# Avoid: with digoxin, beta-blockers, Heart block
!

Renin-Angiotensin-Aldosterone-System-Inhibitors (RAAs-I) :
A. ACE-I: PBradykinine
# SE: Hyper K, cough, Angioedema, hypotension
# Cause of cough: increase the of bradykinin
# CI: in kidney failure and pregnant woman (fetal growth)
# ACE-I it is used: to convert Macroalbuminuria to Microalbuminuria
albumine 6451641
of # ACE-I should be taken to ALL patient with HF to decrease mortality except if there is CI RenalFailureD I
by B. ARBs & Renin-I (aliskiren):
lesscough # aliskiren CI in kidney and pregnant
# Both are less cough and angioedema
conduction
CEIL Beta-Blockers:
thosestorm,
Propranolol it is used in: Thyroid
b HTN, Anxiety, Migraine
Labetalol: use in pregnant with HTN t
I
ethyldopa # ALL beta blockers are CI in: asthma, DM
swims a
Masking
Hypoglycemic
symptoms
effect
 Centrally Acting Sympathetic Inhibitors:
eyes
- Clonidine: cause hypertension crisis if withdraw suddenly
8643.6 - Methyldopa: use in pregnant woman
At t
i3 II Vasodilator:
- Hydralazine: NOT use monotherapy in HTN
in Combination
artery 1AM
HTN in pregnant:
1st: Methyldopa HI Asthma is
2nd: labetalol or Nifedipine dopa
# Hydralazine can be use in HTN crisis in pregnancy et Methyl
e Dittiazimut
HTN Urgency:
BP > 180/120 without organ dysfunction
ithOrgandamages
HTN emergency:
BP > 180/120 with organ dysfunction

Black people: CCBs, Thiazide

dupamide
Albuminuria (regardless to race and CKD): ACE-I or ARBs
Cause hypotension due to blocking efferent limb: Beryllium
imma
Indomethacin use in: essential Hypertension
# Also used in Pulmonary edema
!
Indapayden t
GFor EssentialHypertension

Pulmonaryedema
 Hematology:

Anemia:

Types of anemia:
A. Iron deficiency anemia: (Decrease iron)
Seine § Oral iron: {ferrous sulfate, ferrous fumarate}.
# SE: GI, constipation, dark stool.325mg TID
# Copper: essential for iron absorption in gut.
# DI: decrees levothyroxine, levodopa, methyldopa / PPIs: decrease iron / Vit C: increase absorption
Drug
Interation# Dose: 325 mg TID {elemental iron = 65 mg}.
complexwithit
# Antidote: deferoxamine {non-receptor
me IN
mechanism, because it is bind to free iron}
µ 66 § Parenteral iron: {iron dextran, iron sucrose} anaphylaxis t 4
it in w
# Black box warning: anaphylactic shock
t
antidote 41 # Parenteral iron is restricted to: unable to tolerate oral iron, extensive CKD
# test the dose before
ABowel
a
hole
rrigation
n
# Iron store in the body: Hemosiderin FFerriten
and.gg B. Megaloblastic anemia, Macrocytic anemia: {Decrease both Folic acid (Vit B9), Vit B12}
§ Vitamin B12: Cyanocobalamine
16folic
# High dose will cause cyanide toxicity à give Hydroxocobalamin
Biz
angle
I
§ Folic acid (Vit B9): l
BEEN Normal
obalamine # Give it before 1 month of pregnancy à decrease risk of neural tube defect
My
C. Pernicious anemia: {Decrease Vit B12} relieved iarettatiostervaccine
# Using Schilling test to detect amount of Vit B12 Shinglesdisease with
# Absorbed by intrinsic factor {* if there is a lack of intrinsic factor à lead to decrease Vit B12 absorption à
Cause Precious anemia}
# Common medication decreases Vit B12 {Metformin, PPIs, H2RA}

Mj
Fbp'd'd
D. 1q(EPO)}Metformin
Normocytic anemia: {Decrease Erythropoietin
ETA § Erythropoiesis stimulating agent (ESA): Epoetin alfa, Epoetin beta, Darbepoetin
E # iron is important for ESA to be effective
ESA: Erythropoiesis Stimulating Agents
To.at E

it
Éj
Irondeficiency
E. Aplastic anemia: {bone marrow fail to make RBCs}
anemia § Immunosuppressant, blood transfusion, bone marrow transplantation

F. Hemolytic anemia: {RBCs destroyed and removed before their lifespan} I Epoetina
Nitrofurantoin 906,1692g
331 Iron
Bacteria WMTMS SWT deficieng
Bromenoid
Hemolyticom
Amend
 Acute lymphoid anemia:
•
•
Doxorubicin, vincristine
6-mercaptupurine methotrexate
TEAM
• Etoposide L-asparaginase Chemotherapy

Non lymphocytic anemia:

Anti
cancer
• Thioguanine
• Cytarabine Anti Cancer
NOTE:

Iron deficiency anemia: iron

Megaloblastic anemia: folicBa
Ba
acid & Vit b12
terinsic Pernicious anemia: Vit b12
# Lack of intrinsic factor
Hemolytic anemia: Cortisone
# Decrease 661
G6D cause hemolytic anemia im Isis
Mi
k Anemia of chronic renal failure: epoetin
# If there is a iron deficiency: darbepoetin

Medication Cause anemia: Nitrous oxide Metheglopenimia Nitricon'd ed'd

Medication cause aplastic anemia: Chloramphenicol
eyg.fr
Medication cause megaloblastic anemia: Trimethoprim nent intystad
Nitrates
Gmcu A
I Methyleneblue Antidote
----------

Sickle Cell disease (SCD): Decrease fatsoluble

invitee tochoferole
Treatment:
A. Non-pharmacological:

space
§ Blood transfusion

d B. Pharmacological:
Tak
# The ONLY cure for SCD if bone marrow transplantation

§ Immunization
§ Analgesics: acetaminophen, NSAIDs, Opioid (sever cases)
§ Hydroxyurea:
# Black box warning: myelosuppression Thine
# Avoid: live vaccines 11ft
# warning: Embryo-fetal toxicity
# NOTE: contraceptive required during and after DC of therapy by 6 months in women and 12
months in men

SCA with pain crisis: hydroxyurea

Few opioidAnalgesic
 Musculoskeletal:
ta
4
Osteoporosis (OP): Lower bone density
E6A
Gold Slandered test: Dual energy X-ray absorptiometry (DEXA)

I
I diagnosis WII
Treatment: T
• Non-pharmacological:
- Supplement (Ca++, Vit D)
___
- Lifestyle modification (Exercise, avoid smoking and alcohol, fall prevention)
• Pharmacological:
- Bisphosphonate. (1st line in OP)
- Selective estrogen receptor modulator (SERM)
É
# High risk of VTEYenufthmigrisbiism
§ Raloxifen. # Need Ca++ & Vit D supplement

Bisphosphonate:
!
Oral
• Alendronate: daily, weekly RGIgpti.ve
• Ibandronate: daily, monthly
Breast
• Risedronate: daily, weekly, monthly prophylaxis of
IV tamoxifen
• Ibandronate: 4 times per a year
• Zoledronic acid: once per a year
Cancer by
Alendronate OP dose:
§ Prevention: 5 mg/day or 35 mg/wk
§ Treatment: 10 mg/day or 70 mg/day
at WR

Bisphosphonate associated with gastric ulcer: oral alendronate and risedronate

Need renal adjustment: Zoledronic acid

Side effect of Bisphosphonate:

§ Esophageal irritation (upright position)
§ Osteonecrosis of the jaw (ONJ) -> Avoid with dental procedure
maid
§ Atypical femoral fracture
e sid § Hypophosphatemia bph

NOTE of bisphosphonate:
§ Should evaluate Ca++ & vit D before start therapy
§ Take it on empty stomach (morning)
Etawah
§ Remain upright position for 30-60 minutes
§ NOT use in active upper GI disease
§ Delay therapy if the patient will undergo any dental procedure
# because it may cause Osteonecrosis of the jaw (ONJ)
§ Separate Ca++, antacid, Iron, Mg at least 2 hours

pal 610 Nam

take Antacid papaya
take bisphosphonates
aim
 M

MA of
Remove cartilage
uflamation

Immunity I y
Osteoarthritis (OA): Most common joint disease
Breakdown of cartilage, bony changes, deterioration of tendons & ligament
Iwata
disease pkg
Treatment:
A. Pain management: Topical, paracetamol, NSAIDs, opioid (Not responded)
B. Other treatment
G
o Glucosamine & Chondroitin
way
# NOT recommended
o Hydronic acid, Hydronated sodium (tissue lubricant). # lip pigmentation
wait L Moreeffective
GAY
Q: what Glucosamine and chondroitin used for: OA

Rheumatoid Arthritis (RA): to autoimmune disease

inflammation
inthejoint
Treatment:
Disease modifying antirheumatic drugs (DMARDs)
A. Non-biologic DMARDs:
Sulfasalazine# Folic aww im.cm
1. Methotrexate: ( 1st line) acid antagonist
Uses: Cancer, RA, abortion (category X)
d E AVOID: aspirin with methotrexate s Gday other day
# the patient should have a folic acid supplement even if it decreases the methotrexate effect but to reduce
the adverse effect
2. Leflunomide: gym
# female should DC 2 years before getting pregnant or administered cholestyramine
B. Biological DMARDs:
Fife
1. TNF-a inhibitors: Etanercept, infliximab, adalimumab
2. T-cell activation blockade: Abatacept
3. B-cell depletion: Rituximab
4. IL-6 inhibitors: Tocilizumab
Interleukin
# Most medication increase the risk of TB infection
# Live vaccine should be avoided to avoid the risk of infection
live K
accing Metal use in treatment of RA: Gold !

--------

D
Osteoporosis (OP): Alendronate (Bisphosphonate)
Osteoporosis + Methotrexate: Leflunomide (Non-biological DMARDs)
missis Baek
Osteoarthritis (OA): Etanercept (Biological DMARDs)
Osteoarthritis + Methotrexate:
1st choice Etanercept
2nd choice Leflunomide Hee
stop
 Uricacid III
enzyme
burinbase
purine
wj
4,21dg metabolism46 4 4
Urine JUG day

C Gout

Treatment:
TUricacid
HyperUricemia
XOIGADXA.bgouts 45
Imp Uricacid414.103
HE
A. Acute gout attack:
§ 1st line in acute is NSAIDs:
o Indomethacin (DOC)
o Naproxen, Sulindac I
§ 2nd line:
Has
Antiinflammatory o Colchicine: Plant Alkaloid
I
# Also used in Bechet’s disease
effect § 3rd line:
o
o Corticosteroids

B. Chronic gout:

e
§ Allopurinol { Xanthine oxidase inhibitors (XOI) }
§ Probenecid MOA Increase excretion
# When Allopurinol is CI or NOT tolerated
the
§ Lesinurad

D
# Combination with XOI, NOT use alone

hickofthe
Mowing is
HAI said 4dg
Uricosuric:

mAt
ricosuric Increase uric acid excretion which lead to decrease the uric acid Conc. In blood.
urinalsEx.: Probenecid
op
Allopurinol:
581
Decrease uric acid synthesis Xanthine oxidase inhibitors (XOI)
# Cause sever cutaneous ( red skin rash ).

Allopurinol dose depend on Crcl:

o Crcl 3-9: 100 mg /day
o Crcl 10-20: 200 mg / day

S CI (hyperuricemia)
loop thiazide PE
T
§ Diuretics (Thiazide, Loop diuretics)AUricAcid
§ Pyrazinamide, Ethambutol (TB antibiotics) TUricAcid
# Both of them increasing the uric acid level
ex
CIndomethacin: Cause water retention
# Also minoxidil
is t CNS risk
--------
Izzi III a
Multiple Sclerosis (MS):

Monitoring

ECAC
Gam
Multiple sclerosis: Fingolimod st
(1 line oral)
# DC 2 months before getting pregnant & during pregnancy
# CI: MI, unstable angina, stroke, TIA , HF with block

Relapsing form of Multiple sclerosis: natalizumab

X
Refractory MS: Teriflunomide, natalizumab

Symptomatic therapy: TCA, Anticonvulsant

Walking impairment: Dalfampridine # ONLY approved for improve walking in MS patient

Routs of MS medications:
Injections (S.c) ": interferons, Glatiramer acetate
oral #: Fingolimod, Dimethyl fumarate, Teriflunomide
IV ": Natalizumab, Alemtuzumab, Ocrelizumab

--------

Myasthenia Gravies: OP‫اﻟﻮﻫﻦ اﻟﻌﻀ‬ bath

Treatment:
§ Cholinergic: Neostigmine, Physostigmine
# MOA: block the action of Acetylcholinesterase à increasing Acetylcholine level
 Natural products:
Use of cranberry juice: UTI
Saw palmetto: BPH

Enzyme
#Saw palmetto SE: dizziness, headache, N/V/C/D.
Painful menstruation: Black cohosh

Grapefruit NOT: with amiodarone

inhibitor Herbal safe with warfare: fish oil !

a si
Dry cough: Thyme"
Erygiant
IT
Plant used for cough relief ":
Oil form eucalyptus tree #

coughStress: Chamomile, lavender, lemon $

Herbal for mental disease%: Gingko biloba
# use in Alzheimer

F
Herbal for sedative: Valerian
Plant used to increase physical activity ⛹: Ginger emetic
Anti
Gndansetron
same
Flavor used in: fruits '
29
I
BE Fra a oil * , vinegar
Natural products of burning (: cool water, Aloe over, honey ), coconut
# Sliver sulfadiazine FDA approved for wound infection and burn EG
Plant used to treat vomiting +:
ginger
Citrus lemon $, berberis vulgaris, malus domestica, mentha piperita, valeriana officinalis,
zingiber officinalis
Natural products for hyperlipidemia:
Garlic , red yeast rice ,, Fish oil -
Alipid
D hyperlipidenia
Redyeast rice
Plant with adaptogenic effect:

WI
Ginger, Chinese Schisandra

ress
Plant source use for acute gout.: colchicine
Derived of belladonna /: Atropine

2 0
Anti-malaria from natural source: Cinchona “quinine”
 Plant sources of anticancer:

F
go
Vinca Alkaloid: Vinblastine, Vincristine, Vindesine, Vinorelbine
# Vincristine Fatal if given intrathecal ONLY IV infusion

Texans: Paclitaxel, Docetaxel

Plant origin (epipodophyllotoxin): Etoposide

Natural estrogen:
Estrone, Estriol, Estradiol

Sources of insulin:
⁃ Human insulin ——> E.coli by DNA technology
⁃ Cows 0
⁃ Pigs 1
⁃ Human

O Decoction
Natural emulsifying agent: Acacia
ta
python
I
idk
O
Decoction: Extraction active material from plant by boiling ( 2
C
E k
bindingagent imam
MY GO
 Pediatric & Children !

Ages:
§ Premature neonate: birth before < 37 week of pregnancy
§ Term neonate: birth after > 37 week of pregnancy
§ Neonate: 0 – 28 day (< 1 month)
§ Infant: 1 – 12 months (1 year)
§ Toddler: 1 -3 years
§ Children: 4 – 12 years
§ Adolescent (teenagers): 13 – 18 years

Medication Contraindication (CI):

§ 1 - 28 days: Ceftriaxone. bactrian # Cause hyperbilirubin
§ 0 - 6 months: Live attenuated Influenza Vaccine (LAIV)
§ Neonate: SMX / TMP Abilirubin
§ < 6 months: Ibuprofen
i II
§ < 2 years: Promethazine # Cause fetal respiratory depression
§ < 4 years: Dextromethorphan I
E
§ < 12 years: Codeine & Tramadol #Consider lethal dose
s
§ Pediatric: Tetracycline (tooth discoloration), Fluroquinolone (QT prolongation)
§ Pediatric: Antihistamine # Cause liver toxicity
§ Children & Teenagers: Bismuth
# Who recovering from flu chickenpox, viral infection because there is a risk of Reye’s syndrome
§ Children & Teenagers: Aspirin
To
mi
# Cause Reye’s syndrome 20 q
Conditions:
Teething gel for children ! : Antiseptic
Gonococcal conjunctivitis in newborn " !: Oral erythromycin # Topical alone NOT effective
im
Neonate with bronchiolitis: Ventilation + supportive IV nutrition
just
Neonate with ductus arteries: Indomethacin www
Respiratory syncytial virus (RSV) in neonate: Palivizumab
ioo aaimiIag
onlyIftvenotgiven
Pediatric with diabetic mellitus: Metformin prophylaxis
amnesia
go.tk Constipation in neonate & infant: Glycerin suppository
Diaper inflammation: Petrolatum
__
Kernicterus:
HIT a
Type of brain # damage that can result from high levels of bilirubin in baby’s ! body.
j'd
park
# Treatment of kernicterus is sulfonamide
NN

in
bloodexchange in
Destroy'd
Route:
Hsing
go Morphine in neonate: IV
ai
Vit K in neonate: IM
Asian
Put IV in coagulopathy
µ get twins
im
a
# Theophylline in children: increase metabolism à we need higher dose
I 5
else
at 4 Enzyme
a
Mj Indian
 Medication increase K level (Hyperkalemia):
Onon
Potassium (K)

§ ACE-I
§ K-Sparing diureticspironolactone

aYe § Trimethoprim
T
TMPsty
§ Aldosterone Antagonist
g § Long use of heparin
spironolactone Epherenone
a and lactic acidosis
§ Ringer lactate
§ NSAIDs
nE # CI in hyperkalemia
TRAI
§ Beta Blockers (BB) # Potentially cause hyperkalemia
§ Isoniazid
aI
# Hyperkalemia one of manifest of isoniazid toxicity

4
1E 9 Antidote
Brid Monitoring
Medication decrease K level (Hypokalemia):
§ Thiazide diuretic Ldk
§ Loop diuretic µ
§ Insulin LIK tr
K §
§
Beta-agonist
CorticosteroidSalbutamol
Huna
§
Cs
Amphotericin B, Itraconazole ،Posaconazole
§ Na HCO3
§ Dialysis
§ Laxative
§ Salicylates t.RS
# Salicylates cause respiratory alkalosis à and one of the important results in respiratory alkalosis is
hypokalemia
Taidosisofood

Digoxin:
§ Digoxin side effect (SE): hyperkalemia

t § Digoxin toxicity: Hypokalemia

# If there is hypokalemia à will induce the toxicity of digoxin (which the effect of digoxin increase) à then will
lead to increase the K level as a side effect

idk
 Preparation

É
emulsyfingagent
of
Prepare emulsion: continental, dry gum method, wet gum method
gum
Preparation can be use externally as optic waxes remover !:
Glycerin + 5% sodium bicarbonate
vertical chemotherapy
NOT prepared in horizontal laminar flow: large volume fluid
NonChemotherapy
Not consider formation of suspension:
F use chelating agent

Boric acid in preparation: puffer

I
I A E pH I
preparation
ophthalmic
it 11organ
Agents:
da
SAE

ÉI
Gums used in tableting as: Binding agent
IN Aspartame added to preparation as: sweeting agent
Bentonite used as: suspending agent and Rheological agent
Vit C in preparation: preservative
B indigent
Used to prepare suppository: Cocoa butter
liquidsolid

if Fine
Oleaginous base: white petroleum
Which preparation have more moisture: ointment uspensio
5655
igegy
fe
y.gg
Water:

Which type of water use in cold cream: Distilled water

Which type of water use in large amount of parental: sterile water for injection wFI
Normal water used for preparation of: External preparation

O
# Pka for normal water in room temp: 14
O of NL H2o
pKa M

Sterilization:

Method sterilization our society: Autoclave

Method used in sterilization: moist heat, dry heat

Oph 15min

filter of
microfiltration
 Infusion ausby
Mercation enemy
be ayy
Methods:
awl 11 1 plant by boiling " #
gDecoction:
C Extraction active material from
Liquid dissolved in liquid: Miscibility
Levigation: or I ysize
grinding an insoluble substance to fine powder (dec. size) with
2g wetting
Tablet to powder: Disintegration
Freeze drying is done by: Sublimation
a
E
Big fragments into small fragments: Reduction s
I
From more lipid to less lipid: Biotransformation
0min's
Grinding powder before adding it: Trituration

5 to
The most common disintegrator in compressed tablet is: Starch
Parameter describing dissociation in solution: Pka
to
I
atebe
ok
ate
separation
Ophthalmic preparation should have $ : Sterile, Purified, Isotonic
E
PH of eye preparation $: 6-8
a É
I
as

Ind Surfaceactiveagent

841 to
Surfactant use orally: Tween & Span
Surfactant NOT use orally: Na lauryl sulphate
GIT
6 66116.6
NLS
 Pain management and anesthetics:

e
Pain management:

A. Non-opioid: NSIDS II idiot

1. Acetaminophen: {analgesic & antipyretic} Antiinflammatory
# Caffeine increase absorption & enhance effect
not
Tabsorptionofparacetamol
# CI in sever hepatic impairment
T
damage
te agent)
# Antidote: N-acetylcysteine (mucolytic
Ce 7
# Hepatotoxicity of acetaminophen is due to: Decrease glutathione “NAPQI” à lead to direct livercell
toxicmetabolite
fromparacetamol
liver

2. NSAIDs: {analgesic & antipyretic & anti-inflammatory}.

chemo
E
§ COX-1: in gastric mucosa, platelets, kidney
§ COX-2: Macrophages, Monocytes —> inflammation I
§
as
By blocking COX-1 {Selective COX-1 inhibitors}: High GI risk, CV protective, Decrease renal blood flow
By blocking COX-2 {Selective COX-2 inhibitors}: Less GI risk, CV risk Less effect on renal

• Aspirin: The ONLY NSAIDs Irreversibly block

C # CI: in asthmatic patient, with methotrexate, patient less than < 20 years (Reye’s syndrome)
# SE: tinnitus, bleeding
g
big II www.PDts n
• Indomethacin: {one of the most NSAIDs potent}
I
É
# Uses: acute gout, Rheumatoid arthritis (RA), Closing patent ducts arteriosus
# High GI risk & CNS risk PDA
§ Ketorolac: {MOST potent}. # NOT use > 5 days
i § Piroxicam: High GI risk

I
• Celecoxib: Selective COX-2 inhibitors, CYP2C9, CI: sulfa allergy
notusewithHeartdisease 2
⚠:
Risk
aw
• GI risk: 1
o Lowest risk: Ibuprofen, Celecoxib
A
Gawain o High risk: Indomethacin, Piroxicam, Ketorolac Aspirin
• CV risk ♥:
o Lowest risk: Naproxen
MU Iwm o High risk: Diclofenac
• CNS risk # : Indomethacin
• Nephrotoxic risk:
o Lowest risk: Aspirin, ibuprofen
Uses:
§ Gout: Indomethacin
amuse
§ Ductus arteries: ibuprofen, Indomethacin
§ Pain with renal stone: Diclofenac
§ Primary dysmenorrhea: Mefenamic acid
§ Menstrual migraines prophylaxis: Naproxen
§ Migraine and severe headache $: Tolfenamic acid

prostaglandin soul
Isaws
§ Patient with GI risk: ibuprofen or Celecoxib + Misoprostol or PPIs
§ Pediatric: ibuprofen icytoprotectives
an
I.SEEnum age
Paracetamol

y.g.jo
cytoprotectivew
“Use NSAIDS with LOWEST effective dose for SHORTEST possible duration”
s

II É
ME im
 B. Opioids:

Heroin and morphine: miosis “pointed pupil”

Cocaine: mydriasis

T
Narcotic addiction: methadone (treatment)

TOE Narcotic toxicity or overdose: naloxone (antidote)

TRedution
p 1 I I
Codeine to morphine (CYP2D6) = dealkylation or demethylation or oxidation That
ibid
Analgesic and consider narcotic but dispense normally: methadone, Ketorolac

Enkephalins are small peptides: similar to morphine action

i
O
Morphine in neonate%: IV &
s
Fentanyl:
É IV: adjunct to anesthetic whichofthefollowing isimportantfor
the
Patch: chronic pain exigout
m.it
T
# AVOID heat
a
FentanylorPatch
Meltingpointlow
CYP of analgesic:
mom
via
§ Paracetamol: CYP2E1 1
§ Codeine, Tramadol: CYP2D6
1 13 iaEm im.we
selfentanyldotiated
s
meningpointer
 Anesthetics:

Inhaled anesthesia:
§ Halothane
at gas)
§ Nitrous oxide (laughing
t.am
§ isoflurane, desflurane (pungent odor)

cInterventions anesthesia:
st
§ Propofol (1 choice). axa.M # Milk like appearance
# CI: in patient with allergy of egg & soy products
§ Ketamine: # Benefit in hypovolemic patient

E m
3
# increase Bp, CO, CSF pressure, bronchodilator

Local anesthesia:
I
Ifluid In't
§ Lidocaine # Systematic: antiarrhythmic / Locally: anesthetic
§ Articaine (Best choice)
ius y
§ Ropivacaine (Popular choice)
ji
DOC of Neuromuscular block in Spinal Anesthesia: Tetracaine
Which place produce spinal fluid: choroid plexus
1 11061 spinal fluid
Neuromuscular blocker used in renal or hepatic failure: Atracurim
Neuromuscular blocker has the lowest half-life: Succinylcholine
7 timid
ex
Age related muscular degeneration: Bevacizumab (anti-cancer)
# Bevacizumab used for peritoneal carcinoma
Medication used in age related muscular degeneration: Pegaptanib
END
a It I
Malignant hypothermia complication of: General anesthesia

Patient with respiratory depression from anesthesia, what is drug for post anesthesia respiratory
depression: Picrotoxin
Imus
# Used as central nervous system stimulate, antidote

Intrathecal: spinal cord

Intraosseous: bone marrow
toe
ate
I to (LP): CI in seizure and intercranial pressure (ICP)
Lumber puncher

Wait d
meningitis si E
 Endocrania: insulin
I it
DM:
test in TBD 4444111
go C peptide
P sTÉ
Type 1:
Destruction of B-cell in pancreases that produce insulin
# C-peptide test to determine if there still insulin production or not www.t.tt
# if there is no sufficient amount of insulin to take glucose inside the cell to produce energy à the body will break the fat to
produce ketone body as an alternative source of energy
HE Type 2:
cInsulin resistant and deficiency, decrease insulin sensitivity in body cells i'It
Willem
C
Diagnosed of DM:
5.7 6.4 prediabetes
• A1C > 6.5
a
Tasting
Blood
• FBG > 126
y 765T
f BG 126
diabetes
Glucose Medication:
i
A. Oral:

L I
1. Biguanide (metformin):
# SE: lactic acidosis, Metallic taste, decrease Vit B2, GI upset (take it with food)

t.IE
# Avoid: with Iodinated contrast 48 hours.

L
# Drug interaction: topiramate
# off label use: gestational DM, decrease weight, Poly cystic ovarian syndrome (PCOS)
# CI: lactic acidosis, renal failure. T
> 80 y: metformin consider CI, bc. Kidney function will decrease
2. Meglitinides: (repaglinide, Nateglinide). 3
heteretoaadosis a
a# CI: T1DM, DKA, cause hypoglycemia
Nap 3. Sulfonylurea: (Glipizide, Glimepiride, Glyburide) # CI: T1DM, DKA, Sulfa allergy, cause hypoglycemia
a o
4. Thiazolidinediones: (pioglitazone, Rosiglitazone) # CI: HF, Hepatic failure, edema
11
É
of
Glucose
is 11
6. DPP-4I: (Sitagliptin, Sexagliptin, Linagliptin) 11
c
5. SGLT-2I: (canagliflozin, Dapagliflozin, Empagliflozin) # Monitor: renal
11 dungfor Hf
# Cause: Pancreatitis
Renalexcretion e okay
B. Injection:

Ee
1. GLP-1: (Exenatide, Liraglutide) # Have adverse effect on thyroid
# Liraglutide it an FDA approved to decrease weight
2. Insulin
HAM # High risk medication see.se
- Rapid (lispro, Aspart)
glusodin use
- Short (regular) # use IV in DKA regular
- Intermediate (NPH) IV incasediabetic # cloudy and can be mix with other insulin
- Long (detemir, Glargine) ketoacidosis
b NPH T
severehypoglycemia degludec
Insulin dose:
T1DM: 0.3-0.6 U/kg/day
0 100mL
2g
T2DM: 0.1-0.2 U/kg/day

0.3 O.br ngldayXg

l 0.2U 5oon 0
kg day 800
Too
89
50150prandial
 tetanus vaccine Because Diabeticpatient ask III a
DiabeticNephropathy Ab Iggy
5 Infection
4455
Vaccination with Diabetic patient:
GM
poi Vaccine in diabetic foot: TD ONLY
g
Vaccine in DM: Pneumonia, HBV, influenza
Fremont
C
Diabetic insipidus:
• Vasopressin
ok Loeb
met if
DiabetesMellitus
idea
• Desmopressin
# desmopressin also used in nocturnal enuresis and urine incontinence (UI)

By
E
E
DM in pregnant:
1st: insulin
2nd: metformin I
# NOT cross placenta
Not hypoglycemia in baby
3rd: Glyburide
a # NOT cross placenta

O
DM & weight:
Approved medication: liraglutide
Off-label use: Metformin
Obesity: Orlistat J
je 3
NOTE on DM:

FITIn je
# Medication can exaggerate blood glucose and cause hyperglycemia: Thiazide diuretic & statin

E
# Medication can exaggerate insulin effect and cause hypoglycemia: linezolid
# Medication masking the symptoms of hypoglycemic: Beta-Blockers
Giant
Oral hypoglycemic agent used in T1DM: empagliflozin
I 56272i
Oral hypoglycemic agent CI in HF: Sulfonylurea, glitazone (ex: pioglitazone)

I
Diabetes medication need renal adjustment: Sitagliptin
Oral hypoglycemic cause acute pancreatitis: DPP-4 (sitagliptin)
Metformin and sitagliptin: monitoring kidney Is pancreatitis
Pioglitazone and glipalamide: monitor liver

T
Meta needed for insulin production: Zinc, Copper, Chromium
# Chromium help to regulate glucose

forfunction
Hypoglycemia: glucose or dextrose Emine
Dextrose: NOT in DM and ICP

Intensive
care -----------------
Patient

inside
 O
Thyroid:
blood

c
Hypothyroidism:

Diagnosis:
a
Primary Hypothyroidism: low T4, High TSH
me
Secondary Hypothyroidism: low T4, Low TSH
Subclinical Hypothyroidism: Normal T4, High TSH

S/sx: Cold intolerance, fatigue, decrease weight

Causes: Hashimotos’s disease, drugs (lithium), conditions
THR
Treatment: Levothyroxine groidgland
# t1/2: 7 days
3 Ty
# take on empty stomach (morning)
m.am
3
# Safe for pregnant but we should increase dose by 30%-50% in pregnancy
# you will see the effect on patient energy & lab

cod
Crisis case of hypothyroidism: Myxedema # Life-threating condition
Meaning
# Treatment: levothyroxine

Hyperthyroidism:

Diagnosis: High T4, Low TSH

LTSH 9Th AHAagranulocytosis
S/sx: Heat intolerance, decrease weight, Goiter, Exophthalmos
Causes: Grave’s disease, Thyroiditis, drugs
pyu
I
Treatment:
A. Antithyroid agents: Methimazole, Propylthiouracil (PTU)
# in pregnancy {1st trimester PTU, 2nd & 3rd trimesters use methimazole}
# SE: Agranulocytosis,aPTU à Hepatotoxic

3
B. Iodides: Potassium iodide (KI), Saturated Solution of Potassium iodide (SSKI)
iwi skirmish M
my
Crisis case of hyperthyroidism: Thyroid storm # Life-threating condition
# Treatment: PTU + SSKI + Dexamethasone + Propranlol (for symptoms) + Acetaminophen (for fever)
a a a z
to
THR
J
Adrenal hormones:

Hyper Cortisone secretion: Cushing syndrome cortisone

AAA
Hypo Cortisone secretion: Addison’s disease
Hyper Aldosterone secretion: Conn’s syndromeddtcortisone
 Extra info:

Off-label
SAMA
Anticholinergic (Ipratropium): Acute asthma

E Syndrome (PCOS), Decrease weight wt

Biguanide – (Metformin): Polycyclic Ovarian I

-----------

f
Anticholinesterase:
J ch EI
6hamgravis: Pyridostigmine, Neostigmine
MGMyasthenia Iif
Alzheimer disease (AD): Rivastigmine Donipezil Memantin
Te Te
O
Antiandrogens:
I AndrogenHorman
ee
Spironolactone, cimetidine, Finasteride

gynecomastia 4064231410 -----------

tenderness
ofbreast MOA: 0
istabder
MOA Cromolyn: prophylactic anti-inflammatory that inhibit mast cell degranulation and release
histamine
per MOA Phentolamine: reversible alpha antagonist & vasodilation
w
lipident MOA Cholestyramine: bile acid sequestrants
MOA Pancratium: skeletal muscle relaxant
I
É
MOA Ribavirin: antiviral decrease RNA
# Rimantadine inhibit viral RNA uncoating
tamantadine
SERM 1 USE
É
MOA Clomiphene: non-steroidal estrogenic and selective estrogen receptor modulator (SERM)
MOA of Clopidogrel: inhibit ADP -> platelets aggression
Antiplatelet
MOA TCA: increaseLorepenifren
NE & serotonin
MOA CBZ: Na channel block NE
9 s 95HT
WAFA
MOA BZDS:
rip
II
enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA
receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety),
anticonvulsant.
 -----------

Resistance to penicillinase allergy:

allergy from
Flucloxacillin, Oxacillin, Cloxacillin, Methicillin penicillin
----------- ID 43

CAdministration:
7
- Mineral oil (for constipation) à Upright position
ft - Bisphosphonate (for OP) à Upright position + empty stomach (morning)
- Levothyroxine (for hypothyroidism) à on empty stomach (morning)
- Levodopa/Carbidopa (for PD) à on empty stomach (morning)

-----------

Photosensitive: TCA
Lithium, tetracycline, Quinolones, Amiodarone t tricyclic Antidepressant
Pii Sensitive to light: Ed 1114 Hi 11
Amphotericin SAU GU 41 D
3 sensitiveforlight
um g II
 Worm !:
I
0
Infections:

a xPin worm !" : mebendazole, pyrantelpamote, elbendazole

T # “Tinea”
Ringworm JFantifungal
im • Clotrimazole, Miconazole, Terbinafine, Ketoconazole (OTC)
Antifungal
• Griseoflulvin, Terbinafine, Itraconazole, Fluconazole

É Tape worm: Praziquantel, Neclosamide

IT PraziQvantel
HEI Malaria:
neonate
If
# transmission by female anopheles’ mosquito
me
Treatment of malaria: chloroquine
# chloroquine is a 4-aminoquinolines
ca
Anti-malaria cause anemia: primaquine GGPD
Anti-malaria used in KSA: D hemolytic anemia
a ki
•
•
e
C
1st line: combination of pyrimthamine/sulfadoxine/artesunate
ne
2nd line: lumefantrine/artemether s pyri sulfa AS
Anti-malaria AVOIDED in G6PD: primaquine
Anti-malaria from
7
annatural source: Cinchona “quinine”
4
L # eliminated by hydrolysis
K
Grisofulvin: Antifungal act ONLY orally %
e
Amphotricin: Antifungal act ONLY parentally $

s
Micronazole: Antifungal act locally and systemic
we

UTI:

NON pregnant with UTI: TMP/SMX Hemolyticanend

Pregnant with UTI &: Nitrofurantoin
Pregnant with UTI + G6PD: cefuroxime i Aims a is
Prevention recurrence of UTI: Nitrofurantoin GID
Prophylaxis UTI: TMP/SMX W
I fME
Bactria
is a O
Use of cranberry juice: UTI

quin
UT I
 Microorganism:
6 63
o
M.O for dental caries: streptococcus mutants
M.O cause Diphtheria infection: Corynebacterium
M.O causerow cnn.cm staphylococcus auras
Osteomyelitis:
ruin staphylococcus aureus on
M.O for food poisoning:
M.O Obligate anaerobic: bacteria’s fragilis
Lyme: bacterium Borrelia
A Plague: Yersinia Pestis lyne Borrelia
G # transmitted by flea
That n't

o
Cell wall in fungi: N-acetylglucosamine polymers chitin
Membrane wall of fungus: chitin, glucans, glycoproteins
Makeup of cell wall fungi: ergosterol

0
Most imp. structure in viral: Nucleic acid

I Probiotics: live yeast a bacterium

Tiaret
swim 32
Obligated aerobe: Need O2
Obligated anaerobe: NO need O2
It Facultative anaerobe: with or without O2

FEI T
Chemotaxis: movement of an organism in response to chemical stimulus.

Shape & Type:

G +ve: enterococcus (staph, strep, bacillus, listeria, closeted)

Types of clostridium: +ve, rodes, anaerobic

in
Skin normal flora: staphylococcus aureus
Actinomyces shape: Rod
my Bacterial genome consists of: single circular DNA
Bacteria take cluster shape: staphylococcus
a Bacteria cause plague: yersinia pastis
I
Cryptococcus neoformans: encapsulated yeast
Cause croup: Parainfluenza virus
e I

e o
Release by cell wall of bacteria:
t's
j
•
• During phagocytosis: Endotoxins I
During infection or growth: Exotoxins

ight
aim t
i
 u
t 6 idk E
Treatment of endocarditis: WI I i
40 3 • Penicillin G at
enicillin Gi • Ampicillin / sulbactam + aminoglycoside
aquired
munity
heumonia y CAP: Ceftriaxone + Macrolides Ceftarffinesursan
thacillin MSSA: ceftriaxone, daptomycin, oxacillin
aured MRSA: Vancomycin, lineside
ynsetive
apu # Ceftaroline is the ONLY beta-lactams against MRSA 4548 i.NL b
Masks
Tinct a she.owÉÉ
Meningitis: ceftriaxone, cefuroxime 5Igeneration
as Meningitis in neonate: Ampicillin, Gentamicin, cefotaxime

Clostridium: metronidazole
Chlamydia: Doxycycline, Azithromycin
!
# Neonate chlamydia infection: erythromycin eye ointment infection
I gonoreal
µ E
Leprosy: Dapsone, Rifampin, Clofazinine

Travel diarrhea treatment: Quinolones, ciprofloxacin

F It
Antibiotics cause diarrhea as SE: Amoxil / Clavi, Clindamycin AugmentinV
Treatment of Giardiasis “diarrhea disease”: Metronidazole, Tinidazole, Nitazoxanide
Antibiotics associated with colitis: clindamycin
F
Ttt clinda
Used to treat Amoeba:
1. Metronidazole
2. Diloxanide
# if the symptoms still present
3. Tetracycline

D
GI Amebiasis:

II
• Nitroimidazole (Metronidazole, Tinidazole)

Ascaris infection ":

• Piperazine
• Mebendazole
• Pyrantel
• Levamisole

a Head lice ( " : Pyrethrin’s, Permethrin lotion

Mum
Athletic foot: Terbinafine topical
e
Others: Clotrimazole, Miconazole, Ciclopirox, Tolnaftate
I # analgesic for foot and leg pain Diclofenac or Ketorolac
Ear tinnitus ): betahistine
Fused by
EMA
Fluids
Betahistine
GINA
GATE
 # Also used to treat the symptoms of Ménière's disease
Child with nail injure !+:
⁃ Bacteria: paronychia
⁃ Fungal: onychomycosis
Acute Otitis Media (AOM):
T
1st: high dose of Amoxicillin
C 2nd: Azithromycin
C Antibiotics CI in pediatric:

Gmt
# tooth discoloration L
Tetracycline, Doxycycline, Minocycline, Tigecycline

Quinolones:
QT
# QT prolongation a
f Daptomycin:
# Musculoskeletal, Neuromuscular

Rotavirus: supportive therapy

as
Respiratory synoptical virus (RSV): Palivizumab
prophylaxis
sportive To prevent RSV: Palivizumab
crapy if Flu #: oseltamivir
giveas Zanamivir: Treat and prevent influenza A & B
vention

Antiviral for HIV which nucleotide reverse Transcriptase

$
I
Antiviral can be combined with all genotypes: Sofosbuvir, velpatasvir
NRTI
inhibitors: Zidovudine
any ya
e
# Same as Diazocine
EAT
If
# prevent passing the HIV virus to the unborn baby .
at

Pt. exposed to COW and had symptoms % “Brucellosis”:

O AAA
L
• Doxycycline, tetracycline
• Streptomycin
Ixacin
• Cipro / oflo
• Rifampine
• SMX/TMP Fact
• Azithromycin
rim
to
# Treatment for 6 weeks
C % by direct inoculation, consumption of non-pasteurized dairy,
# Brucellosis transmitted
airborne transmission. I
a
%%%
a Anthrax transmitted to human by: Cattle &'
J I
# Ebola virus highly transmitted by direct contact with infected blood, secretion, tissues,
organs and other body fluid. I
a
Ebola Blood
 Azole
Fluconazole: need renal adjustment
Gaspofungin & Voriconazole: need hepatic adjustment

I
CI in HF: Itraconazole
Penetrate BBB ! to treat meningitis: Fluconazole, Voriconazole
Treatment for Aspergillus: Voriconazole, Amphotericin
e
cmv
Cytomegalovirus:
In
Ganciclovir, Valganciclovir, foscarnet
# also Foscarnet use for cytomegalovirus
I
prazik
DOC for treatment of all forms of Schistosomiasis: Praziquantel
# Snail fever & bilharziasis
I Same as tapeworm
Use as topical ointment: Gentamycin, Tobramycin
É Erythromycin also used for: acne
Use
————————
NOTE:
Nasogastric
QQ
# Ciprofloxacin oral suspension NOT give by NG tube or other tube
# Cause anemia of fetus if taken in the 1st trimester: ciprofloxacin
# Pt with catheter jitter should take: ciprofloxacin 3G fQ is Ci in pregnant

# Penicillin NOT give IV: Cardiorespiratory arrest

# Sensitivity test of penicillin done after 30 days or more

If
⚠
Jst
# Linezolid caution with insulin because it causes hypoglycemia
# Vancomycin use as an IV route EXCEPT C.difficile and enterocolitis
s giveitoral
6 # Max. infusion 10 mg/min = 2 ml/min ( vial 500 mg/100 ml)
☀
$
c## Doxycycline3 need sunscreen
Lithium limit sunlight T
because it is a photosensitive drug
tea
a Injection can be use for inhalation
% É
is a # Colistin
# Argument CI in patient with jaundice
nm
_t PcN
# Tetracycline it is decrease Penicillin
& WHILE Penicillin increase Methotrexate
# Cilastatin give with imipenem to protect imipenem from hydrolyzed by dehydropeptidase
# Metronidazole NOT with alcohol
inactivaedpoliovaccine i guess
IPV allergy: neomycin

Spike fever: will be with viral “high reading then low”

Bacterial: high for long time
GINA
y A I
I
 O
Ibuprofen:
SAIF ALGHAMDI
• Max dose OTC: 1200 mg !‫توكلت على ا‬
• Max dose Prescription: 3200 mg Last update 11/8/2020

• Good for: CV Risk

ibuprofen
• CV Risk: Celecoxib
• GIT Risk: Piroxicam - Ketoprofen - Indomethacin
• Low GIT Risk: Ibuprofen - Sulindac - Fenoprofen - Aspirin - Diclofenac
• Least SE: Ibuprofen
• More Safe: Naproxen

Typical antipsychotics FGA: Atypical antipsychotics SGA:

Haloperidol - Chlorpromazine Olanzapine - Clozapine - Quetiapine
• D2 Antagonism Aripiprazole - Risperidone
• Treat +ve Symptoms
• EPS • 5HT2 Antagonism >> D2 Antagonism
• Hyperprolactinemia • Treat -ve Symptoms
• Metabolic side effect

Clozapine SE: Agranulocytosis

 Increase Dopamine = Decrease Prolactin

Decrease Dopamine = Increase Prolactin

NL GENS should be gill

in Central
5%D in 0.225% solutions
line

05W
 Forelderly LOAT
COAT
8

A
C L
In O

E z Notgiven in
elderly

Er
C SGA Non Essential
#SPLE
Phenytoin : Na CBP
• use in generalized tonic clonic and partial seizure

• Use in Status epilepticus as IV et after w lorazepam

• Drug-induced gingival hyperplasia

• Potent enzyme inducer.

• Pregnancy: category D

• it is Sodium channel inhibitor

• Phenytoin follows non-linear kinetics

zero
order
‫علومات اعرفها زي اسمك مهمة جدًا‬:‫ا‬ kinetic

#SPLE
Anti-hyperglycemic
#No renal adjustment
2
• DPP 4 inhibitor: Linagliptin
Tradgenta
#Required renal adjustment
• Biguanide: Metformin

• SGLT2 inhibitor: Dapagliflozin - Canagliflozin - Empagliflozin - Ertugliflozin

• GLP-1AGONIST: Exenatide

• Second generation sulfonylureas: Glyburide - Glibenclamide

• DPP -4 inhibitor: Sitagliptin , saxagliptin , alogliptin

 phenytoin
0.240 c

glutide we
g

GLP la H
7 56512 l

l p
antipseudomonal

Ceftazidine
2 Cefoperazone v
3 Cefepine
antipseudomonal
You have to know how to prevente When two different eye drop
medication error
0
preparations are used at the same time
ME
In order of day, wait for at least five minutes
before putting the second drop into an
eye. This stops the first drop from being
diluted or washed away
effetIin
Yip so
checklist
DS f
RIP
Kffective
Elf IN
becareful

#SPLE Components of
!
Maslow hierarchy of needs in order
Study Design

-‫كيف تقدر تعرف نوع الدراسة من اول سطر في‬

!
‫السؤال ؟‬ !

‫ اشياء‬3 ‫ عن طريق‬.

How patient identified ?

O
• cross sectional: By location (Jeddah).
no
• Case control: By disease (Lung cancer).
c
• Cohort: By Risk factor (Smoking) .

I
Outcome of the study ?
• cross sectional: Prevalence
C
"
oddsRatio
o
• Case control: OR
7g
peuyi.fi
• Cohort: Incidence - RR

Time period ?
• cross sectional : Not follow up

• Prospective : Look forward

• Retrospective : Look backward

 NCB CCB
y UCB

BB

Depolarization contraction
anythingq
anything I
repolarization ion
relax

pietingDuringstress
igsAlways
very difficult

Fronaderoe
Ibutilide

TPNU
g
HAM
T

TPD

SUFI
• Planning: most critical elements

• Strategic planning:
provides a framework for more detailed planning
and day to day decisions.

• Operational planning:
Prepared perform the immediate tasks
od's
• Business Planning:
To determine the feasibility e
• Resources planning:
The resources necessary to achieve the goals
e e
and strategy of the organization. r
• Organizational planning:
Challenging of the futures
F
• Contingency planning:
To provide a fallback option
Tmnt

IGs responsablity Is Id
e C
IgE: Hypersensitivity
c
IgG: Infection
c %

IgA: Mucosal membrane (GI) I

C if I j
I
IgM: B-cells activation on
c &
 I i e i
EI
worse g
A 79 lose

II
cyp2C9
J
INR
sulface

gi j
Hr
Y
j g
tetra

go

Nasalhypoplasia

ACET

we
c c
RCT

I
i
Rase
l K

G I

c
s
j
 s
I
s fo
g e
StG I
I

check next 1
slide a
• ICS: Beclomethasone – Budesonide – Fluticasone

• LAMA Inhalation antocholenargic: Tiotropium

• SAMA Inhalation antocholenargic: Ipratropium

• Leukotriene modifiers LTRA: Montelukast -

Zileuton

• Theophylline – Aminophylline

• Omalizumab Allergic - IgE

Low
dose • (IL-5) antagonist: Mepolizumab and Reslizumab
Ics
doseus
withSABA
 o

PRNSABA

ssfkcaii.de
 Flecainide — To control tachycardia in Pioglitazone - NSAID - Doxorubicin - Bupivacaine
! Wolff-Parkinson-White syndrome. !
*Cardiotoxicity*
Postural hypotension chemo anthra localAnesthetic
cycrine
‫هبوط الضغط بشكل مفاجئ عند الوقف‬ Aminoglycosides - Loop diuretics ( furosemide )
‫دوية إلي تسببه‬a‫اهم ا‬ *Ototoxicity*
!
Alpha blocker: Prazosin
TCA tricyclic antidepressant Quinidine —— *Cinchonism + Lupus *
Nitroglycerin —> vasodilator !
AUG *start code*
Abortifacients: substance that induces abortion. UUA UGA UAA *stop code*
Misoprostol - Mifepristone - Methotrexate. au
withA
Antipsychotic ( renal dysfunction ) Clozapine need test CBC
!
Tricyclic antidepressant ( hepatic dysfunction ) *‫ شهور بشكل *اسبوعي‬٦ ‫اول‬
*‫ شهور بشكل *شهري‬٦ ‫ثاني‬
3
Plate diet ——— Diabetic TCA 3
Dash diet ——— HTN form MAOi to SSRI
!
From SSRI to MAOi
C to avoid Serotoni
Isoniazid - Hydralazine - Procainamide ( 2 week )
!
Quinidine - Methyldopa - Chlorpromazine - !
Except - *Fluoxetine* to MAOi a syndrome
Minocycline ( *Lupus* like syndrome ) ( 5-6 week ) a
Clozapine - Propylthiouracil ( hyperthyroidism ) Hypothyroidism monitoring
*Agranulocytosis* ( 6-8 week )

!
y 8 weeks
!

! • HTN O

fight preserved
edecution
fraction
!

! !

spironolactone
Aldosterone Antagonist

0
IV inhalation
rectal

! ! C
C i
C
 DTI in HIT

Te

PA
Bs
Bz

e
T

as

Ifa
Fhm
as
#SPLE
‫زم تعرف عنه كل معلومه‬a‫دواء مهم و‬

0
Vancomycin:

I
use in MRSA

it cause Red Man Syndrome , Nephrotoxicity

BD
Dose of pediatrics: Initial dose 15 mg/kg followed by 10 mg/kg/dose every 12 hours
!

Trough Level is: 10-12

use as Iv route except in C. difficile use as oral

!

Vancomycin trough levels should ideally be drawn immediately

before administration of the 4th dose (within 30 minutes of the dose is acceptable),
O
!
*SRP* statins NEED dose adjustment: *AF* statin NOT NEED adjustment:

• S = simvastatin • Atrovastatin
!
• R = rosuvastatin
• P = pravastatin Eva • Fluvastatin

Rosner
!
prava

!
WA ATT P
 d Na TNA Lk 9k
Pok
w
E mga I
Poglucoseletectrolyees

wk

apo apo Sevelaner sea orca

Acetate
T

Naito's
dug omg
Nang D
Cac
Cagle
DUA Yushin

rouchodilating
7 agents

7 BB
important information about Azole antifungal
! !

T
Only Azole that requires renal adjustments: FLUCONAZOLE

Only Azole is C.I for pt. With heart failure: ITRACONAZOLE pkeee.tn
Adoustment
!
Only Azole that penetrate BBB To treat maningitis: FLUCONAZOLE AND VORICONAZOLE
a
Azole that DOC for Aspergillus: VORICONAZOLE t Ct Aspergillus
!

important information about Anti-fungal

! Anti-fungal contraindications in pregnancy:

• Grisofluvin - Ketoconazole - Voriconazole - Fluctyisine - Potassium iodide

I
!
Anti-fungal SAFE in pregnant:

I
• Amphotercin B - Topical imadazole - Nystatin

• Ketoconazole - Itraconazole
O
Anti-fungal contraindications in lactation:
! !

Anti-fungal SAFE in lactation:

!

• Fluconazole

! Decrease Death = Prevalence Increases

 Must-Know Drug-Induced Syndromes!
☑
Red man syndrome - vancomycin

Purple glove syndrome - phenytoin

*
Purple toe syndrome - warfarin

Gray baby syndrome - chloramphenicol

+
Yellow nail syndrome - sodium aurothiomalate

*
Which antiarrythemia is contraindicated in patient with Atrial fibrillation + MI ?
Flecainide - Propafenone IC
class 1C CI in Afi bi MI
Which anti arrhythmia can be used in patient with Atrial fibrillation + HF?
Amiodarone - Dofetilide
class 3 Afib HF Aniodarone
Dronedarone is contraindications
Feticide
Do

E
Enoxaparin + UH cause = hyperkalemia

Fondaparinux + Idarucizumab cause = hypokalemia

I
O
amphotericin b elimination outside the body by ? Hydrolysis

What vitamin to give with isoniazid? Pyridoxine

2836
Atenolol class? Bb 1 Selective selective B Blocher

Duloxetin class ? SNRI

O
Diphtheria caused by which bacteria? Corynebacterium

Which drug masking hypoglycemia ? BB

um
hypotonic example ? 0.45 nacl
Ers
Abbreviation means (OU)? Both eye

Gene abacavir ? HLA-B 5701

O
Gene Allopurinol ? HAL-B 5801
0
Gene of codeine ? Cyp2d6
O
What is Casualty score ? Narnjo
mm
Which antiplatelet causes dyspnea ? Ticagrelor + Clopidogrel

Which antihyperglycemia that doesn’t pass placenta ? Insulin - Glyburide

a
I
Pregnant women with DM ? Insulin if not give Metformin if not give Glyburide
Lice treatment ? Permethrin lotion

If alleles identical it call ? Homozygous

If different alleles ? Heterozygous

a

Drug-induced gingival hyperplasia ? Phenytoin

What is ISO7 ? Clean room (buffer area)

s
Leucovorin is antidote for ?? Methotrexate

Calcium dosa
eefor pregnant women ? 1200

BPH Score 16: Tamsulosin

z
BPH Score less than 30: Tamsulosin alone
added to reduce
BPH Score more than 30: Tamsulosin + fenasteride size of prostate

J
Patient take Flouconazole monitor for ? Renal

Antihypertensive produce tackycardia ? Hydralazine

i
a
First line to treatment sepatic shock ? Fluids THEN NE Fluids NE DA E
First line to treatment cardiac shock ? Dopamine or Dobutamine

Which of the following contraindicated in breastfeeding ? Variconazole

The cerebrospinal fluid (CSF) is produced from ?

arterial blood by the choroid plexuses of the lateral

Virus types are ? DNA or RNA

The most common bacteria that cause Endocarditis ? Staphylococus auerus

Name of bacteria that cause Sore throat ? streptococcus

Osteomyelitis name of bacteria ? Staphylococus auerus

 More pathogenic and virulent
bacteria cause disease in 10:1000 persons and the other bacteria cause 10:10000
Which one is more pathogenic or more virulent ?
pathogenic = ‫رض أكثر‬:‫ إيش إلي يسبب ا‬cause more disease
virulent = ‫ إيش إلي يكون مميت وقاتل أكثر‬cause kill

I
the first bacteria more pathogenic than the 2nd one

Anthrax transmitted to human by ? Cattle

o
Exercise induced asthma treated by?
SABA: 5-15 minutes before exercise
LABA But NOT alone: 30 minutes before exercise
Montelukast: 2 hours before exercise
er
Digoxin toxicity: Hypokalemia
Digoxin SE: Hyperkalemia

Fungi are characterized by ? cell wall consist of chitin eucaryotic

3
Time dependent: Ttrrequent
E e
Penicillin - Cephalosporins - Macrolide - Clindamycin - Carbapenem - Vancomycin

Concentration dependent: T dose

T
Quinolone - Aminoglycoside - Azithromycin - Ketolides - Daptomycin

to