Sunday, July 7, 2013

52 - Drugs causing Fatty liver

1. Antiarrythmics - Amiodarone

2. Antibiotic - Tetracycline ( high-dose, intravenous )

3. Anticonvulsant - Valproic acid

4. Antiviral - Dideoxynucleosides ( eg: Zidovudine ), protease inhibitors ( indinavir, ritonavir )

5. Oncotherapeutics - Asparginase, Methotrexate .


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57 - Anti-arrhythmic agents classification

Ia
QuinidineProcainamideDisopyramideIb
LidocainePhenytoinMexiletineIc
FlecainidePropafenoneMoricizineII
PropranololEsmololTimololMetoprololAtenololIII
AmiodaroneSotalolIbutilideDofetilideE-4031

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Saturday, July 6, 2013

62 - Adverse effects, Precautions and Contraindications of Chloroquine

Toxicity and Side Effects: 

Taken in proper doses, chloroquine is an extraordinarily safe drug; however, its safety margin is narrow, and a single dose of 30 mg/kg may be fatal (Taylor and White, 2004). Acute chloroquine toxicity is encountered most frequently when therapeutic or high doses are administered too rapidly by parenteral routes. Toxic manifestations relate primarily to the cardiovascular system and the CNS. Cardiovascular effects include hypotension, vasodilation, suppressed myocardial function, cardiac arrhythmias, and eventual cardiac arrest. Confusion, convulsions, and coma indicate CNS dysfunction. Chloroquine doses of more than 5 g given parenterally usually are fatal. Prompt treatment with mechanical ventilation, epinephrine, and diazepam may be lifesaving.

Doses of chloroquine used for oral therapy of the acute malarial attack may cause GI upset, headache, visual disturbances, and urticaria. Pruritus also occurs, most commonly among dark-skinned persons. Prolonged medication with suppressive doses occasionally causes side effects such as headache, blurring of vision, diplopia, confusion, convulsions, lichenoid skin eruptions, bleaching of hair, widening of the QRS interval, and T-wave abnormalities. These complications usually disappear soon after the drug is withheld. Rare instances of hemolysis and blood dyscrasias have been reported. Chloroquine may cause discoloration of nail beds and mucous membranes. Chloroquine can interfere with the immunogenicity of certain vaccines (Horowitz and Carbonaro, 1992; Pappaioanou et al., 1986).

Irreversible retinopathy and ototoxicity can result from high daily doses (>250 mg) of chloroquine or hydroxychloroquine that lead to cumulative total doses of more than 1 g of base per kilogram body weight, such as those used for treatment of diseases other than malaria. Retinopathy presumably is related to drug accumulation in melanin-rich tissues and can be avoided if the daily dose is 250 mg or less (see Rennie, 1993). Prolonged therapy with high doses of 4-aminoquinoline also can cause toxic myopathy, cardiopathy, and peripheral neuropathy; these reactions improve if the drug is withdrawn promptly (Estes et al., 1987). Rarely, neuropsychiatric disturbances, including suicide, may be related to overdose.

Precautions and Contraindications :

This topic has been reviewed by Taylor and White (2004). Chloroquine is not recommended for treating individuals with epilepsy or myasthenia gravis. The drug should be used cautiously if at all in the presence of hepatic disease or severe gastrointestinal, neurological, or blood disorders. The dose must be adjusted in renal failure. In rare cases, chloroquine can cause hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency (see Primaquine below). Concomitant use of gold or phenylbutazone (no longer available in the United States) with chloroquine should be avoided because of the tendency of all three agents to produce dermatitis. Chloroquine should not be prescribed for patients with psoriasis or other exfoliative skin conditions because it causes severe reactions. It should not be used for malaria in patients with porphyria cutanea tarda but is used in smaller doses for treatment of the underlying disease . Chloroquine is an inhibitor of CYP2D6 and interacts with a variety of different agents. It should not be given with mefloquine because of increased risk of seizures. Most important, this antimalarial opposes the action of anticonvulsants and increases the risk of ventricular arrhythmias from coadministration with amiodarone or halofantrine. By increasing plasma levels of digoxin and cyclosporine, chloroquine also can increase the risk of toxicity from these agents. For patients receiving long-term, high-dose therapy, ophthalmological and neurological evaluations are recommended every 3 to 6 months.


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50 - Antimicrobial chemotherapy - Protein biosynthesis inhibitors

Pharmacology Mcqs Postgraduation entrance preparation: 50 - Antimicrobial chemotherapy - Protein biosynthesis inhibitorsPharmacology Mcqs Postgraduation entrance preparation

Friday, September 11, 2009 50 - Antimicrobial chemotherapy - Protein biosynthesis inhibitorsStreptomycin     30S ribosomal subunitBactericidalGentamicin     30S ribosomal subunit               
BactericidalTetracycline     30S ribosomal subunitBacteriostaticSpectinomycin     30S ribosomal subunitBacteriostaticChloramphenicol     50S ribosomal subunitBacteriostaticErythromycin     50S ribosomal subunitBacteriostaticClindamycin     50S ribosomal subunitBacteriostaticGriseofulvin     Microtubule functionFungistatic


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61 - Drugs potentially harmful in Porphyria

1. BARBITURATES : The effect of barbiturates on ALA synthetase can cause dangerous disease exacerbations in persons with intermittent porphyria.Because barbiturates enhance porphyrin synthesis, they are absolutely contraindicated in patients with acute intermittent porphyria or porphyria variegata.
2. ETHCHLORVYNOL: Ethchlorvynol may enhance the hepatic metabolism of other drugs such as oral anticoagulants, and it is contraindicated in patients with intermittent porphyria.
3. CHLOROQUINE : It should not be used for malaria in patients with porphyria cutanea tarda but is used in smaller doses for treatment of the underlying disease.

Nicotinic acid/meclozine/hydroxyzine

Medroxyprogesterone + estrogenTestosterone, transdermal patch
Phenylpropanolamine + cinnarizinePseudoephedrine + dexbrompheniramine

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53 - Benzodiazepine interactions with other drugs

Benzodiazepine interactions with other drugs.

Decreased absorption of benzodiazepines
Increased half-life of diazepam and 
triazolam
Increased levels of diazepam and 
triazolam
Alprazolam and diazepam raise 
digoxin level
Increased duration of action of sedatives
Inhibition of antiparkinsonism effect
Impaired clearance of diazepam

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64 - AIPGME 2005 Pharmacology Mcqs with answers

1q: A highly ionized drug
a. Is excreted mainly by the kidney
b. Can cross the placental barrier easily
c. Is well absorbed from the intestine
d. Accumulates in the cellular lipids answera. Is excreted mainly by the kidney
2q: All of the following hormones have cell surface receptors except
a. Adrenaline
b. GH
c. Insulin
d. Thyroxine
3q: Which one of the following is true of adrenal suppression due to steroid therapy?
a. It is not associated with atrophy of adrenal glands
b. It does not occur in patients receiving inhaled steroids
c. It should be expected in anyone receiving greater than 5mg of prednisolone daily
d. Following cessation, the stress response normalizes after 8 weeks answerc. It should be expected .....
4q: With which of the following theophylline has an antagonistic interaction?
a. Histamine receptors
b. Bradykinin receptors
c. Adenosine receptors
d. Imidazoline receptors
5q: Which one of the following drugs increases gastrointestinal motility?
a. Glycopyrrolate
b. Atropine
c. Neostigmine
d. Fentanyl
6q: Which one of the following drugs has been shown to offer protection from gastric aspiration syndrome in a patient with symptoms of flux?
a. Ondansetron
b. Metaclopramide
c. Sodium citrate
d. Atropine
7q: The following drugss have significant drug interactions with digoxin except :
a. Cholestyramine
b. Thiazide diuretics
c. Quinine
d. Amlodipine
8q: One of the following is not true about nesiritide
a. It is a brain natriuretic peptide analogue
b. It is used in acutely decompensated heart failure
c. It has significant oral absorption
d. It has a short half life answerc. It has significant oral absorption.
9q: Dry mouth during antidepressant therapy is caused by blockade of
a. Muscarinic acetylcholine receptors
b. Serotonergic receptors
c. Dopaminergic receptors
d. GABA receptors answera. Muscarinic acetylcholine receptors.
10q: The major difference between typical and atypical antipsychotics is that
a. The latter cause minimal or no increase in prolactin
b. The former cause tardive dyskinesia
c. The former are available as parenteral preparations
d. The latter cause substantial sedation answerb. The former cause tardive dyskinesia.
11q: Antipsychotic drug induced parkinsonism is treated by
a. Anticholinergics
b. Levodopa
c. Selegilline
d. Amantadine
12q: Oculogyric crisis is known to be produced by all of the following drugs except
a. Trifluoperazine
b. Atropine
c. Perchlorperazine
d. Perphenazine
13q: Inverse agonist of benzodiazepine receptor is
a. Phenobarbitone
b. Flumazenil
c. Beta-carboline
d. Gabapentin
14q: All of the following are hallucinogens except
a. LSD
b. Phencyclidine
c. Mescaline
d. Methylphenidate
15q: All of the following are topically used sulphonamides except
a. Sulphacetamide
b. Sulphadiazine
c. Silver sulphadiazine
d. Mafenide
16q: One of the following is not pencillinase susceptible
a. Amoxicillin
b. Pencillin G
c. Piperacillin
d. Cloxacillin
17q: The group of antibiotics which possess additional anti-inflammatory and immunomodulatory activities is
a. Tetracyclines
b. Polypeptide antibiotics
c. Fluoroquinolones
d. Macrolides
18q: Which one of the following is best associated with Lumefantrine?
a. Antimycobacterial
b. Antifungal
c. Antimalarial
d. Antiamoebic
19q: Which one of the following is used in therapy of Toxoplasmosis?
a. Artensunate
b. Thiacetazone
c. Ciprofloxacin
d. Pyrimethamine
20q: Nevirapine is a
a. Protease inhibitor
b. Nucleoside reverse transcriptase inhibitor
c. NNRTI
d. Fusion inhibitor
21q: Which one of the following drugs is "Topoisomerase I" inhibitor?
a. Doxorubicin
b. Irinotecan
c. Etoposide
d. Vincristine
22q: Etanercept acts by one of the following mechanisms
a. By blocking Tumor necrosis factor
b. By blocking bradykinin synthesis
c. By inhibiting COX-2
d. By blocking lipoxygenase

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