Dear Reader, these papers were meant to be as an extremely quick review and ultra-short summary of the most

important information that I have encountered through my review of pharmacology, it may not be properly
updated, and may contain spelling and grammatical mistakes, but it was extremely valuable for Me to pass my
exam, it’s worth going through, thanks for reading.

Miscellaneous Diseases, Conditions and Syndromes :

Hypersensitivity Reactions :

Type One (Allergy) : is IgE mediated, which bind to histamine cells and activate it, it cause vasodilatation GIT and
respiratory constriction, these effects are mediated by leukotriene C,E,D (4), PGD2 and histamine. Examples
include : Atopy, Anaphylaxis, Asthma. It characterize by strong anaphylaxis.

The early phase is histamine mediated, late phase is complement mediated.

Type Two (Cytotoxicity) : is IgM and IgG mediated, it may take 7-10 day after 1st exposure to develop the 1st
response, and 3 days after the 2nd exposure, examples include Auto immune Hemolytic Anemia,
Thrombocytopnea, Goodpasture disease, Graft rejection, grave’s Disease and Mesthenia Gervais.

Type Three (Autoimmune Complex) : is IgG and IgA mediated, it characterize by persistant immune complex
(local or systemic) that is not removed after reaction induction. Examples include SLE and RA.

Type Four (Cell Mediated or delayed Type) : is TH1 antigen specific mediated, it characterize by inappropriate
prolonged response. Ex : Contact dermatitis, Granuloma, Mantoux test and multiple sclerosis.

Alcohol Withdrawal: is associated with auditory hallucinations.

1-Disulfiram (Antabuse) : Under normal metabolism, alcohol is broken down in the liver by the enzyme alcohol
dehydrogenase to acetaldehyde, which is then converted by the enzyme acetaldehyde dehydrogenase to the
harmless acetic acid. Disulfiram blocks this reaction at the intermediate stage by blocking the enzyme
acetaldehyde dehydrogenase. After alcohol intake under the influence of disulfiram, the concentration of
acetaldehyde in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of
alcohol alone. As acetaldehyde is one of the major causes of the symptoms of a "hangover" this produces
immediate and severe negative reaction to alcohol intake. Some 5–10 minutes after alcohol intake, the patient
may experience the effects of a severe hangover for a period of 30 minutes up to several hours. Symptoms
include flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache,
visual disturbance, mental confusion, postural fainting, and circulatory collapse.

Disulfiram should not be taken if alcohol has been consumed in the last 12 hours.There is no tolerance to
disulfiram: the longer it is taken, the stronger its effects. As disulfiram is absorbed slowly through the digestive
tract and eliminated slowly by the body the effects may last for up to two weeks after the initial intake.

2- Acamprosate (Campral): is thought to block NMDA receptors, NMDA receptors are up-regulated in alcoholism
due chronic blockade, abrupt alcohol withdrawal lead to hyperexcitability of those receptors that may lead to
delirium and excitotoxic death, Acamprosate block those Adverse effects.

3- Clonidine. 4- Naltrexone.

1-Bezodizepines: Chlordiazepoxide, Clorazepate, Diazepam.

Disulfiram like Effect:

1-Metronidazole, Several Cephalosporins, ex Cefotetan and Cefoperazone.

2-Sulfonylureas. Tolbutamide.

3-Griseofulvin. Plant Alkaloids.

Emergency Contraception (Plan B) :

A-One Step : 1.5 mg Levonorgestrel tablet PO.

B-Two Step : Mifepristone and Misoprostol use is a two-step method.

First, your doctor gives you a dose of mifepristone tablets by mouth.it causes the placenta to separate from
the endometrium. It also softens the cervix and increases uterine contractions to allow the uterine contents to
pass. For reference, see a picture of the reproductive organs camera.

Second, you take tablets of misoprostol by mouth or insert them vaginally, usually within 48 hours of
mifepristone. Depending on the dose and how it is given, this could be as soon as 6 hours after the mifepristone.

Bed Wetting (Nocturnal enuresis)

1- Imipramine, have been used in children older than 2 years, it act by contracting the bladder internal
sphincter.
2- Desmopressin an ADH analogue given PO (TAB), Intranasal and IV.

SIADH: the syndrome of antidiuretic hormone Hyper secretion, it may be caused by brain injury or a tumor, it may
be induced by drugs like: Carbamazepine, Clofibrate, Cyclophosphamide, Vincristine, Phenothiazine, SSRIs, it
presents as Hyponatremia and hypo-osmolarity of plasma, fluid over load with normal k levels and Acid-Base
balance, treatment:

1- Demeclocycline: it has 2-3 days onset, it has extensive SE profile, skin hypersensitivity and nephrotoxicity
2- Conivaptan:V1 and V2 Antagonist, it is available only as IV, and require hospitalization
3- Tolvaptan: is a selective V2 Antagonist ( DOC ).

Calcium Toxicity: can be treated by either, Citrate or EDTA.

Hyperkalemia:

1- Excess release: burns, hemolysis, tumor lysis syndrome.

2- Drugs: ACEIs, ARBs, NSAIDs,K sparing diuretics, BBs,Succinyl choline, Calcineurin Inhibitors and celecoxib.

Hyperkalemia Symptoms: Leg cramps, weakness, fatigue and nausea.

Hyperkalemia Emergency management:

1- Dialysis.
2- 50% hypertonic glucose IV fluid + Regular insulin.
3- Calcium Carbonate or Calcium chloride IV.
4- Sodium Bicarbonate.

Hyperkalemia long term management (non-acute):

1- Sodium polystyrene sulfate.

2- Loop or thiazide diuretics.

Hypokalemia Symptoms:

1- Dryness of the mouth and increase thirst.

2- Irregular heartbeats.
3- Muscle cramps.
 K-Dur, K-Tab, Micro-K and klotrix are Potassiun solid oral dosage forms, all cause Gi irritation, to avoid,
administer liquid or effervescent preparations like Kao Chlor.

Traveller’s Diarrhea: Bismuth subsalicylate.

Anaphylactic Drugs:
 1- Epinephrine is DOC in anaphylactic Shock.
2- Dopamine in Kidney compromised Anaphylactic Patients.
3- Dobutamine in Anaphylactic patients with CHF.

Diabetes Insipidus:

1- Chlorpropamide (sulfonyl ureas).

2- Desmopressin (not in nephrogenic DI).
3- Carbamazepine.
4- Thiazide Diuretics, K sparing Diuretics and indomethacin are useful in nephrogenic Diabetes Insipidus.
5- Amiloride is DOC in lithium induced diabetes.

Motion Sickness:

1- DOC is transdermal Scopolamine.

2- H1 receptor Blockers Meclizine, Cyclizine, Diphenhydramine.
3- Antipsychotic, prochlorperazine.
4- Acetazolamide, given 5 days at night before expected episode.

Hiccups: Dopamine blockers, chlorpromazine, metoclopramide and haloperidol.

Oliguria : is the production of abnormally small amount of urine.

Beriberi : is a disease in which the body does not have enough thiamine (vitamin B1), There are two major types
of beriberi:

1- Wet beriberi affects the cardiovascular system.

2- Dry beriberi and Wernicke-Korsakoff syndrome affect the nervous system.
- beriberi occurs mostly in patients who abuse alcohol. Drinking heavily can lead to poor nutrition, and
excess alcohol makes it harder for the body to absorb and store thiamine, People with genetic beriberi
lose the ability to absorb thiamine from foods. This can happen slowly over time and symptoms occur
when the person is an adult.
- Symptoms of dry beriberi include: Difficulty walking, Loss of feeling (sensation) in hands and feet, Loss of
muscle function or paralysis of the lower legs, Mental confusion/speech difficulties, Pain, Strange eye
movements (nystagmus), Tingling, Vomiting
- Symptoms of wet beriberi include: Awakening at night short of breath, Increased heart rate, Shortness of
breath with activity, Swelling of the lower legs

ADHD:

1- Dextroamphetamine, Methylphenidate.
2- Lisdexamphetamine, Atomoxitine.

Narcolepsy: is a chronic sleep disorder, or dyssomnia, characterized by excessive sleepiness and sleep attacks at
inappropriate times, such as while at work, it is a neurological sleep disorder. It is not caused by mental illness or
psychological problems. It is most likely affected by a number of genetic abnormalities that affect specific biologic
factors in the brain, combined with an environmental trigger during the brain's development, Symptoms include:
catalepsy, impaired vision, slurred speech with normal hearing and awareness.

1- Modafinil, Armodafinil.
2- Amphetamine, Methylphenidate.

Marasmus : is a severe form of malnutrition, characterized by severe energy deficiency, caused by a severe
deficiency of nearly all nutrients, especially protein and carbohydrates. It occur before the 1st year of age.

Kwashiorkor : is an acute form of childhood protein-energy malnutrition characterized by edema, irritability,

anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The presence of edema caused by
poor nutrition defines kwashiorkor. Kwashiorkor is thought to be caused by insufficient protein consumption but
with sufficient calorie intake, distinguishing it from marasmus. It usually occur after 18 months of age.
Pseudomembraneous colitis : is an infection of the colon, that is usually but not always caused by C. Difficile,
symptoms include offensive smelling diarrhea , fever and abdominal pain, it is usually caused by broad spectrum
antibiotics like Amoxicillin, Cephalosporins and clindamycin. The drug of choice is metronidazole, Vancomycin is a
second line due to toxicities.

BPH (Benign Prostatic Hyperplasia):

1- Alpha 1 blockers Tamsulosin and Alphazosin, they relax prostatic smooth muscles improving urine flow.
2- Finesteride and dutasteride, they inhibit the conversion of testosterone to dihyrdotestosterone.
3- CONTRAINDICATIONs: Antihistaminics, Anticholinergics and Alpha agonists.
4- GnRH Agonist like Flutamide, bicalutide and Nalitamide are used.

Serotonin Syndrome: it characterize by hyperthermia, sweating, myoclonus, muscle rigidity and change in mental
status, its cause by combination of serotonergic drugs, SSRIs, SNRIs, MAOIs, TCAs, Alkaloids, Meperidine and
Tramadol.

Cellulitis: Skin and soft tissue infection.

Acute Intermittent Porphyria:

a- Support Treatment. b- Dextrose Infusion. c- Increase CHO intake. d- Hematin infusion.

Mononucleosis: is a viral disease that is caused by Epstein-Barr virus (a form of herpes), it is also known as
Pfeiffer disease. Symptoms are Fever, fatigue, weight loss, loss of appetite, Hepatitis, splenomegaly, hemolysis
and lymphadenopathy. It is orally transmitted with incubation period of 4-7 weeks. Treatment is NSAIDs:
Ibuprofen, Corticosteroids oral and IV :dexamethasone and Hydrocortisone.

Pneumothorax : is the presence of gas in the cavity between the lungs and the chest wall, causing collapse of the
lungs, it may be caused by lung disease, smoking, hip fracture, surgery or may occur spontaneously.

Atelectasis : is collapse of parts or all the lung tissue(air sacs), preventing gas exchange.

Red Man Syndrome : is a pseudoallergic reaction to Vancomycin infusion, it is a non-specific, non IgE mediated
mast cell degranulation, it characterize by flushing, erythematous rash in the face, neck and upper torso.

Dog Bite : is associated with P. Muttocida, Anaerobes and S. Aureus. 3-4 PO amoxicillin is the prophylaxis of
choice, boost vaccination depend on immunization history of the patient, type and degree of contamination of
the wound (dog history).

Anastomosis : is a cross connection or communication between 2 adjacent channels, tubes or blood vessels, it can
occur spontaneously or made by surgery.

Gaucher's Disease : is a genetic disease in which a fatty substance (lipid) accumulates in cells and certain organs.
Gaucher's disease is the most common of the lysosomal storage diseases. It is caused by a hereditary deficiency of
the enzyme glucosylceramidase. The enzyme acts on the fatty acid glucosylceramide. When the enzyme is
defective, glucosylceramide accumulates, particularly in white blood cells, most often macrophages (mononuclear
leukocytes). glucosylceramidase can collect in the spleen, liver, kidneys, lungs, brain and bone marrow.

Symptoms may include enlarged spleen and liver, liver malfunction, skeletal disorders and bone lesions that may
be painful, severe neurologic complications, swelling of lymph nodes and (occasionally) adjacent joints, distended
abdomen, a brownish tint to the skin, anemia, low blood platelets and yellow fatty deposits on the white of the
eye (sclera). Persons affected most seriously may also be more susceptible to infection. Some forms of Gaucher's
disease may be treated with enzyme replacement therapy.

The disease is caused by a recessive mutation in a gene located on chromosome 1 and affects both males and
females.
Meniere’s disease: is a disorder of the inner ear that characterize by vertigo, tinnus and progressive loss of
hearing, usually in one ear, it’s associated with hypo or hyperthyroidism, and autoimmune diseases, treatment
include: 1- steroids, dexamethasone. 2- Surgical: removal of the inner ear which results in loss of hearing.

Ketoacidosis: is a complication of untreated diabetes, it’s manifested by accumulation of ketone bodies (

acetoaceticacid and betahydroxybutyrate), symptoms are deep rapid breathing, dry skin and mouth, flushed face,
fruity breath, N and V and frequent urination.

Treatment include: glucose, insulin and potassium IV administration, and electrolyte replacement.

Sweat Test: is used in cystic fibrosis diagnosis, the sweat contain higher than normal Cl ion.

Hepatic Encephalopathy : Hepatic encephalopathy is a worsening of brain function that occurs when the liver is
no longer able to remove toxic substances in the blood, Symptoms include : forgetfulness, mild confusion and
irritability. More severe encephalopathy is characterized by an inverted sleep-wake pattern (sleeping by day,
being awake at night), marked irritability, tremor, difficulties with coordination and trouble writing, other sign
may be related to liver failure like peripheral edema, Jaundice and exaggerated tendon reflexes.

Treatment include :

1- Decrease diet protein content. Specially Aromatic AA.

2- Lactulose, is thought to render the ammonia in absorbable by converting it to ammonium (NH4), and
increase transit of bowel content through the gut.
3- Antibiotics : Neomycin, Metronidazole and others, the rationale of their use was the fact that ammonia
and other waste products are generated and converted by intestinal bacteria, and killing of these bacteria
would reduce the generation of these waste products.
4- LOLA: A preparation of L-ornithine and L-aspartate (LOLA) is used to increase the generation of urea
through the urea cycle, a metabolic pathway that removes ammonia by turning it into the neutral
substance urea. It may be combined with lactulose and/or rifaximin if these alone are ineffective at
controlling symptoms.

ANTIHAEMORRAHGIC :

1- Apretonin : is a basic pancreatic trypsin inhibitor, it slows down fibrinolysis.

2- Aminocaproic Acid : it inhibits plasmin which lysis clots.
3- Tranexamic acid : it inhibit the conversion of plasminogen to plasmin, which degrade fibrin clots.
4- Microfibrillar Collagen :Topical.
5- Chitosan : Does not require body coagulation.
6- Antihemophilic Factor: Factor VIII is indicated in hemophilia A.

Metabolic Syndrome : is a combination of medical disorders that increase the risk of cardiovascular disease, 3 or
more factors qualify a patient for a metabolic syndrome diagnosis :

1- Abdominal Obesity: >40 For men, > 35 for women.

2- FBG >/= 110 mg/dl.
3- BP 130/85 .
4- TG >/= 150 mg/dl .
5- Low HDL < 40 men, < 50 women.

Phenyl Ketone Urea: is a disease caused by deficiency of phenyl alanine hydroxylase, which convert phenyl
alanine to tyrosine, it characterize by high serum phenylalanine and high urine phenyl pyruvic acid, it’s diagnosed
by GUTHRIE TEST, Acute Symptoms include musty urine smell, vomiting and rash, chronic symptoms are, mental
retardation, poor growth, poor develop. Treatment is diet control, with phenyl alanine serum level of 2-10 mg/dl.

Pulmonary Hypertension :

Treatment include :

1- Vasoactive Substances: Mostly for PAH

A- Endothelin Receptor Antagonist : Endothelin is vasoconstrictor protein secreted by the endothelium.
  Selective ETa receptor antagonists : Ambrisentan, Sitaxentan.
 Dual (ETa and ETb) blockers : bosentan.
B- Prostacyclin (prostacyclin I2 Analogues) : Treprostinil, Iloprost, Epoprostenol.
C- PDE 5 Inhibitors: Sildenafil (IV), Tadalafil (PO).
D- Nitric Oxide :
2- Since CHF is synonym with pulmonary Venous hypertension, Diuretics, BBs and ACEIs are indicated.

G6PD Hemolytic Anemia: (Non-immune mediated Hemolytic Anemia) : G6PD is necessary to maintain the level
of NADPH required to provide the supply the reduced GSH, which neutralize oxidative free radicals that can cause
hemolysis. It may be caused by:

1- Natural: Henna and fava beans.

2- Drug: primaquine, sulfonamide and methylene blue.
3- Infections: Hepatitis.

Treatment:

1- Blood transfusion: dialysis in acute renal failure.

2- Prevention: ex vaccination.
3- Selenium and Vitamin E as antioxidant but might not be so effective.

Otitis Externa: or swimmers’ ear, is caused primarily by P. Aerogenosa, and treated by Gentamycin or
Carbincillin.

Aortic Coarction: is narrowing part of the Aorta due to birth defects, if it is not corrected soon it may cause

Acute Intermittent porphyria Management:

1- Support treatment.
2- Dextrose Infusion
3- Increase CHO intake
4- Hematin infusion
- Barbiturates are contraindicated in porphyria.

Reliable Transdermal Absorption factors are :

1- Molecular weight less than 1000.

2- Drug do not cause histamine release.

3- The daily drug requirement is less 10 mg.

4- In a saturated aqueous solution with PH range of 5-9.

Burkitt Lymphoma: is a cancer of beta-Lymphocytes, it is a form of non-hodgkin disease, it is associated with

epstien-Barr virus, it characterize by RAPID and PAINLESS growth of lymph nodes in the neck, groin and under the
arms, treatment include: Prednisone, Cyclophosphamide, Ifosfamide, vincristine, Cytarabine, Doxorubicin,
Methotrexate and etoposide.

Trimethobenzamide (Tigan):is an antihistaminic (Chemically), that act centrally as antiemetic, it is used in

gastroenteritis, Control of nausea after surgery, it has no ANTI, serotonergic/ Dopaminergic/ Histaminic effects, it
is emetic with least SE, it is available as Injection, Capsule and suppositories.

Light therapy or phototherapy (classically referred to as heliotherapy): consists of exposure to daylight or to

specific wavelengths of light using lasers, light-emitting diodes, fluorescent lamps, dichroic lamps or very bright,
full-spectrum light, usually controlled with various devices. The light is administered for a prescribed amount of
time and, in some cases, at a specific time of day.
Common use of the term is associated with the treatment of skin disorders (chiefly psoriasis), sleep disorder and
some psychiatric disorders. Light therapy directed at the skin is also used to treat acne vulgaris, eczema and
neonatal jaundice. Light therapy which strikes the retina of the eyes is used to treat circadian rhythm disorders
such as delayed sleep phase syndrome and can also be used to treat seasonal affective disorder, with some
support for its use also with non-seasonal psychiatric disorders.

Three percent of the population suffer from psoriasis, and UVB phototherapy has been shown to effectively treat
the disease, a feature of psoriasis is localized inflammation mediated by the immune system. Ultraviolet radiation
is known to suppress the immune system and reduce inflammatory responses.

Bursitis: is an inflammation of the bursa, which is tiny fluid sac that function as gliding surface to reduce friction
between tissue in the body.

Petechiae : is a small (1-2 mm) red to purpule spot on the body, caused by minor hemorrhage (typicaly a broken
blood vessel), they do not blench (become pale) on pressure.

Epistaxis : is nose bleed.

Akasia (Restless leg Syndrome) : is a syndrome of characterized by unpleasant sensation of inner restlessness that
manifest by the inability to sit still, there is an urge to move the leg to stop this sensation. It can be caused by
antidopaminergic drugs, parkinsonian disease and addiction withdrawal. First line treatment is propranolol,
others include benzodiazepines, clonazepam and anticholinergics.

Mycoplasma Pneumonia: is a lung infection with the bacteria M Pneumonia, Synptoms include chest pain, cough,
sweating and fever, treatment include: NSAIDs to control fever, cough medication may interfere with the body
mechanisms to expel the sputum, take a lot of water, antibiotics may not be required.

Asymptomatic Bactereuria : is the presence of bacteria in urine, without infection symptoms (fever, dysuria, etc),
treatment id indicated in pregnant women due to possibility of low birth weight and other SE, treatment is NOT
indicated in elderly due to possible emergence of resistance, cost and high adverse effects in elderly, treatment is
indicated if it progress into symptomatic Bactereuria.

Menier’s Disease: is a disorder of the inner ear that characterize by vertigo, tinnitus and progressive loss of
hearing, usually in one ear, treatment include: 1-Steroids, dexamethasone. 2-Surgical: removal of the inner ear
which cause loss of hearing. 3- chemical agents like gentamycin, Which retain hearing.

Myopia: is a disorder in which the person cannot see far objects clearly, but can see near objects perfectly, they
should wear a biconcave lenses (-ve) to correct it.

hypermetropia: is a disorder in which the person cannot see near objects, but can see far objects, they should use
convex (+ve) lenses to correct it.

Megacolon: is abnormal dilation of the colon, is often accompanied by paralysis of peristaltic movement,
treatment : 1- laxatives. 2- corticosteroids. 3-change eating habits. 4- Surgery.

Toxic Megacolon: is an acute form of chronic distension of the colon.

Pellagra : is a vitamin B3 (Niacin) deficiency, either due to low Niacin and tryptophan (niacin precursor) diet
content, or inability to endogenously synthesize it, and possibly by excessive intake of leucine, A deficiency of the
amino acid lysine can lead to a deficiency of niacin as well, symptoms include High sensitivity to sunlight,
Aggression, Dermatitis, alopecia, edema, Smooth, beefy red glossitis, Red skin lesions, Insomnia, Weakness,
Mental confusion, Ataxia, paralysis of extremities, peripheral neuritis, Diarrhea, Dilated cardiomyopathy,
Eventually dementia, Treatment is nicotinamide.
Cheilitis (Chapped lips) : is an inflammation of the lips, it can be caused by Vitamine D or iron deficiency, or by
trintoins therapy.

Xerophthalmia : is a condition in which the eye fails to produce tears.

Wilson Disease: is a genetic disease that impairs copper excretion by liver into the bile, Treatment include: d-
pencillamine and Trientine chelation, it might worsen neurological symptoms at first, due to copper mobilization,
zinc sulfate decrease copper absorption in the intestine.

Cachexia (wasting syndrome) : is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of
appetite in someone who is not actively trying to lose weight, Cachexia is seen in patients with cancer, AIDS,
chronic obstructive lung disease, Multiple Sclerosis, congestive heart failure, tuberculosis, familial amyloid
polyneuropathy, mercury poisoning (acrodynia) and hormonal deficiency, it might be treated with steroids and
corticosteroids and others.

Permethrin: is an insecticide and antifungal, it is a neurotoxin usually used to treat lice, it is available as liquid
and cream, direct contact with the hands should be avoided, it kill fungi eggs but it is poorly absorbed.

Meningitis: is an inflammation of the protective layers of the brain and spinal cord, it characterize by: 1- Intense
headache. 2- fever. 3-loss of appetite. 4- Intolerance of light and sound. 5- Muscle rigidity.

Parathesia: is an abnormal sensation of picking, tingling, or numbness of person skin with no apparent long term
physical effect.

Cushing syndrome :

1- Ketoconazol (Nizoral) (tablets) :

2- Aminoglutithemide (Cytadren) (tablets) :

3- Mitotane (Lysodren) (tablets) : alters steroid peripheral metabolism, directly suppresses the adrenal cortex
and alters cortisone metabolism leading to hypocortisolism.

4- Metyrapone (Metopirone)(Cap) :is used in both diagnosis and therapy, Metyrapone blocks cortisol synthesis
by inhibiting steroid 11β-hydroxylase (in zona Fasiculata).

Aplastic Anemia : is condition where bone marrow does not produce sufficient new cells, the patient has low low
WBCs, RBCs and Platelets (Pancytopnea). Causes include autoimmune disease, drugs like Chloramphenicol,
carbamazepine, phenytoin, Phenylbutazone and Quinine.

Hemolytic Anemia : is abnormal breakdown of RBCs, either intaravascularly or extravascularly, it may be aquire or
inherited, symptoms may include : fatigue, shortness of breath, jaundice and gallstones. Causes include
mycoplasma pneumonia, lead poisoning, Autoimmune disease, drugs like quinine, levodopa, methyl dopa,
penicillins, Cephalosporins and chloramphenicol, NSAIDs and sulfonamides.

Ideopathic Intracranial hypertention (Benign Intracranial hypertension) ( Pseudotumor Ceribri) : an unexplained

icrease in the intracranial pressure, it might be induced by Trintoins, tetracyclins and hormonal contrceptives,
Traetment is Acetazolamide, if not responding then surgery.

Scarlet Fever: is a disease caused by endotoxins released by streptococcus pyogens. Symptoms include: sore
throat, fever, rash, bright red tongue with strawberry appearance. Treatment is penicillin or clindamycin, and
erythromycin in penicillin allergic patients.

Epidural Anesthesia : is regional anesthesia resulting from injection of an anesthetic into the epidural space of the
spinal cord.
Drugs and effects :

Histaminic Effects:

-Some drugs can cause release of histamine from mast cells, which cause Bronchoconstriction, sweating and
Vasodilatation, it’s similar to cholinergic effect except to miosis, and some of these drugs are Tubocurarine,
Mivacurium, Atracurium, and most Opioids.

Hyperprolactinic Effect: Cimetidine and morphine and all dopamine Antagonist.

Drugs with Anticholinergic Effects:

Many drugs can cause Anticholinergic effects like dry mouth, mydriasis, some of these drugs are: Meperidine,
Quinidine, and disopyramide.

Cholinergic Effects:

1- Salivation, Sweating and bronchial secretion.

2- Nausea, Diarrhea and abdominal cramps.
3- Bronchoconstriction, Miosis and Bradycardia.

Pancrelipase: is an enzyme therapy, it’s a mixture of Amylase, trypsin, and lipase, which are usually produced by
pancreas, it’s used in the treatment of cystic fibrosis, chronic pancreatitis, it’s available as powders, capsules and
tablets, it should not be taken alone.

Neupogen: is a granulocyte colony stimulating factor, produced by DNA recombinant technology, it is useful in

NitroMist : is a nitroglycerin sublingual spray, it delivers 400 mg in each actuation, 1 or 2 sprays at the start of the
attack, and another spray every 5 minutes (only one), with maximum of 3 doses (15 minutes), if pain is not
relieved then medical attention should be requested.

Carbonic Anhydrase Inhibitors: Acetazolamide, Drazolamide, Brinzolamide, dorzolamide, and Topiramate, they
have a wide range of clinical uses, such as in glaucoma, diuretics, motion sickness, Antiepileptic and Osteoporosis,
Also Acetazoleamide is indicated in barbiturates and salicylates toxicity.

Aromatase Inhibitors: are either selective like Anastrazole, Letrozole, or non-selective like Glutithemide and
Testolactone, non-selective block the conversion of cholesterol to pregnolone( steroid precursor) and the
conversion of testosterone to estrogen, and hence are useful in cushing syndrome, selective ones block only the
later, those drugs are important in some malignancies and also, it’s used by athletic testosterone abusers to block
some undesirable side effect like gynecomastia.

To reduce Niacin induced flushing:

1- Titrate the dose to maximum.

2- Take with food.
3- Take Aspirin 30 minutes prior to niacin.

Autocoids : include:

1- Kallidin : is similar to bradykinin and can be converted to bradykinin.

2- Bradykinin : is a vasodilator that is metabolized by ACE, this is the basis for the angioedema in ACEIs.
3- Histamine :
a- H1 Blockers :
1- Pyrilamine
2- Bromophniramine :
3- Chlorpheniramine:
4- Diphenhydramine :
5- Clemastine :
 6- Hydroxizine
7- Cetrizine :
8- Promethazine :
9- Cyprohepatidine :
10- Azelastine :
11- Azatadine :
12- Loratidine :
13- Desloratidine :
14- Fexofenadine :
b- H2 Blockers :
1- Cimetidine
2- Ranitidine
3- Fomatidine
4- Nizatidine

4- Serotonin :

a- Agonists :
1- Sumatriptan :
2- Rizatriptan :
3- Eletriptan :
4- Fravotriptan :
5- Tegaserod is indicated in constipation dominant IBS.
b- Ergot Alkaloids :
1- Ergotamine :
2- Ergonovine :
3- Methysergide : is used in Diarrhea dominant IBS.
4- Bromocriptine :
c- Antagonists :
1- Dolasetron :
2- Palonosetron :
3- Alosetron :

5- Prostaglandins :

a- PGE2 analogue:
1- Misoprostol : is used in combination with aspirin and other non-steroidal drugs, due to its
cytoprotective properties, it increase mucous secretion in the stomach preventing ulcer formation, it
is dosed at 200mcg qid, its main side effect is diarrhea. it’s used rarely as emergency abortive agent,
in combination the new anti-progesterone Mifepristone.
2- Alprostadil : is used in erectile dysfunction.
3- Dinoprostone : is indicated in labor induction, it soften the cervix and induce uterine contraction.
4- Lubiprostone(Permax) : is a bicyclic fatty acid derived from prostaglandin E1 that acts by specifically
activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a
chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote
spontaneous bowel movements (SBM), Lubiprostone is used for the treatment of chronic constipation
of unknown cause and irritable bowel syndrome associated with constipation.
b- PGF2alpha Analogues: it’s indicated for glaucoma, it increase the flow of aqueous humor out of the eye,
it’s used to control the progression of ocular hypertension (glaucoma), but it does not cure it, ex
Latanoprost, Travoprost, Bimatoprost.
c- PGI2 Analogues: are IV administered, they are vasodilators and antiplatelets aggregation agents, they are
indicated in Raynaud’s Syndrome, limb ischemia and PAH.
1- Epoprostenol :
2- Treprostinil :
3- Iloprost :
 6- Leukotriens

PhosphoDiesterase Inhibitors: it have wide clinical spectrum, it induce vasodilation, bronchodilator, inotropic
effect and anti-platelet effect.

1- Xanthines: ex Caffeine, Thoebromine and Theophylline. They are used as bronchodilators in COPD and
refractory Asthma.
2- PDE3 Inhibitors: Milrinone and Amrinone, it has a +ve chronotropic effects, they are used in acute
treatment of heart failure.
3- PDE5 Inhibitors: Sildenafil, Tardenafil and Varedenafil, they relax penis blood vessels’ smooth muscles,
enhancing erection.
4- PDE3 Inhibitors: Cilostazol, used in alleviation of symptoms of intermittent claudication, in individual with
peripheral vascular disease, it is used in caution in patient with CHF.
5- Dipyridamole: is TXA2inhibitor, and PDE3 inhibitor, both result in anti-platelet, bronchodilation and
vasodilatation.

Mifepristone : is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist

used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive.

Prodrugs: All ACEIs, Fenofibrates, Lovastatin, simvastatin, Prednisone, All PPIs, INH,

Phenoxybenzamine, Oxacarbazepine.

Gaserelin: is a potent GnRH analogue, but it act as potent inhibitor of pituitary gonadotropin secretion, it’s
indicated for prostate, breast, and endometriosis carcinomas. NOTE that when GnRH is normally secreted in a
pulsatile manner it promote sex hormone production, but chronic stable administration of the analogue produce
down regulation of feedback and decrease sex hormone production.

Permethrin: is an insecticide and antifungal, it’s a neurotoxin that is usually used to treat lices, it’s available as
liquid or cream, direct contact with hands should be avoided, it kills both mature and egg fungi, its generally
poorly absorbed.

Phenazopyridine: is a chemical that when secreted in urine has a local analgesic activity; it’s used in urinary.

Lactulose: is a synthetic sugar used as

1- Laxative (osmotic laxative): it’s Brocken by intestinal bacteria into non-absorbable carboxylic acids; they
retain more water and soften the feces.
2- Antihyperammonemia: This can be either congenital or metabolic, ex liver or kidney disease, increase
protein catabolism, due to trauma or cancer.

Barium Sulfate: it’s a suspension used to examine the esophagus, stomach and intestine. It’s water insoluble,
non-absorbable and toxic, it gives clear image of the damaged organ in both CT and X-Ray. It’s available as powder
tablet, suspension and paste, it causes constipation.

Pylera : is a combination of tetracycline, Metronidazole and Bismuth subsalicylate, that is used to treat peptic or
duodenal ulcers, it is administered 4 times a day for 10 days, it usually used in combination with Prilosec
(Omeprazole), notice that pylera should not be given with antacids.

Zolidronic Acid (Reclast) :

1- Indicated in bone metastasis.

2- Single dose for 2 years for prevention of osteoporosis in post-menopausal women.
3- Jaw necrosis specially with IV administration.

D-pencillamine: (analogue of aa cysteine):

1- Used Rheumatoid Arthritis to slow bone destruction

2- Used as chelating Agent in heavy metal poisoning.
 3- Treatment of cysteine urea.

Opioid Tolerance :

1- Give Fentora (Fentanyl Buccal Tablets), it is indicated ONLY in opioid tolerant patient, it CI in post-
operative opioid naive patients, due to serious hypoventilation, it is available as 100, 200, 300, 400, 600,
800 mcg.
2- .Patients considered opioid tolerant are those who are taking around-the-clock medicine consisting of at
least
a- 60 mg of oral morphine daily.
b- at least 25 mcg/hour of transdermal fentanyl.
c- 30 mg of oral oxycodone daily.
d- 8 mg of oral hydromorphone daily.
e- 25 mg oral oxymorphone daily
or an equianalgesic dose of another opioid daily for a week or longer.

MUSCLE RELAXANT :

1- Meprobamate : cause altered pain perception, its use as anxiolytic, antiepileptic has decreased due to
availability of better agents, it is centrally acting and may be abused.
2- Carisoprodol : is a centrally-acting skeletal muscle relaxant. Carisoprodol is slightly soluble in water and
freely soluble in alcohol, chloroform and acetone. It has rapid (30 minutes) onset of action and 2-6 hours
lasting effect, The drug's solubility is practically independent of pH, Carisoprodol made on the basis of
Meprobamate, and some of it is metabolized to Meprobamate in liver, it has potential for abuse, it is not
a controlled substance but it is prescription only.
3- Dantrolene: is a muscle relaxant that acts by abolishing excitation-contraction coupling in muscle cells,
probably by action on the ryanodine receptor. It is the only specific and effective treatment for malignant
hyperthermia, a rare, life-threatening disorder triggered by general anesthesia. It is also used in the
management of neuroleptic malignant syndrome, Cerebral Palsy,paralgia, muscle spasticity (e.g. after
strokes, in paraplegia, cerebral palsy, or patients with multiple sclerosis), ecstasy intoxication, serotonin
syndrome it is poorly soluble in water
4- Ketamine: cause dissociative anesthesia, it is related to phencyclidine, it blocks NMDA receptors, it cause
increased blood pressure and bronchodilation, Indications for use as an anesthetic :
A- Pediatric anesthesia (as the sole anesthetic for minor procedures or as an induction agent followed by
muscle relaxant and endotracheal intubation)
B- Asthmatics or patients with chronic obstructive airway disease
C- As part of a cream, gel, or liquid for topical application for nerve pain—the most common mixture is
10% ketoprofen, 5% Lidocaine, and 10% ketamine.
D- Emergency surgery.
E- To supplement spinal / epidural anesthesia / analgesia utilizing low doses.
 The effect of ketamine on the respiratory and circulatory systems is different from that of other
anesthetics. When used at anesthetic doses, it will usually stimulate rather than depress the
circulatory system.[20] It is sometimes possible to perform ketamine anesthesia without
protective measures to the airways. Ketamine is also a potent analgesic and can be used in sub-
anesthetic doses to relieve acute pain.
 It is used not as first line, as an Antidepressant , Abuse Therapy, and post-operative pain.
5- Propofol: is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and
maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation,
Propofol is not considered an analgesic, so opioids such as fentanyl may be combined with Propofol to
alleviate pain, it is associated with painful IV administration. Advantages include faster recovery, Less cost
and less respiratory depression.
 6- Cyclobenzaprine (Flexeril) : is a centrally acting Muscle relaxant, it is structurally related to TCAs, used to
relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions, It decreases pain
in the first two weeks, therapy should not be continued long-term, peaking in the first few days, but has
no proven benefit after two weeks, It is not useful for spasticity due to neurologic conditions such as
cerebral palsy.
7- Baclofene : is a derivative of gamma-aminobutyric acid (GABA). It is primarily used to treat spasticity, A
very beneficial property of baclofen is that tolerance does not seem to occur to any significant degree —
baclofen retains its therapeutic anti-spasmodic effects even after many years of continued use.
8- Metaxalone : is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and
other musculoskeletal conditions. Its exact mechanism of action is not known, Possible side effects
include nausea, vomiting, drowsiness and CNS side effects such as dizziness, headache, and irritability,
Because of potential for side effects, this drug is on the list for High Risk Medications in the elderly.
9- Barbiturates : May cause laryngospasm.
10- Clonidine :
11- Tizanidine : is a drug that is used as a muscle relaxant. It is a centrally acting α2 adrenergic agonist. It is
used to treat the spasms, cramping, and tightness of muscles caused by medical problems such as
multiple sclerosis, spastic diplegia, back pain, it is main SE is hepatotoxicity.
12- Orphenadrine : is an anticholinergic drug of the ethanolamine antihistamine class with prominent CNS
and peripheral actions used to treat painful muscle spasms, other similar conditions, as well as the
treatment of some aspects of Parkinson's Disease. It is closely related to diphenhydramine. Therefore, it is
related to other drugs used for Parkinson's like benztropine and trihexyphenidyl, The orphenadrine salt
used for Parkinsonism is the hydrochloride, whereas the muscle relaxant tablet are the citrate, salts are
not interchangeable, The combination of anticholinergic effects and CNS penetration make orphenadrine
useful for pain of all etiologies, orphenadrine can also cause excitement and insomnia, particularly in
children and the elderly. It is Muscarinic, Histaminic, NMDA and Potassium and sodium channel blocker,
and it is NE reuptake inhibitor.

Non-Benzodiazepines Sedatives ( Z Group ): are a newer classification of hypnotic medications indicated for mild
to moderate insomnia. They work on the benzodiazepine site on the GABAA receptor complex similarly to the
benzodiazepine class of drugs. Some but not all of the nonbenzodiazepines are selective for the α1 subunit on
GABAA receptors, which is responsible for inducing sleep and may therefore have a cleaner side-effect profile
than the older benzodiazepines, they include :

1- Zolpidem(Ambien) : is a short acting for short treatment of insomnia, it is good for induction but not
maintenance of sleep, long term use of zolpidem is associated with drug tolerance, drug dependence,
rebound insomnia and CNS related adverse effects. It was recommended that zolpidem be used for short
periods of time using the lowest effective dose, Alcohol have cross tolerance with zolpidem, Flumazenil
can also reverse zolpidem's sedative/hypnotic and memory impairing effects, Zolpidem should be
avoided in those with a history of Alcoholism, drug misuse, physical dependency, or psychological
dependency on sedative-hypnotic drugs. Zolpidem has rarely been associated with drug-seeking behavior.
2- Zaleplon : is effective in the treatment of insomnia where difficulty in falling asleep is the primary
complaint, unlike many other hypnotic drugs, does not interfere with sleep architecture and can be
administered for up to long term without the risk of dependence or addiction upon discontinuation,
Zaleplon is not addictive, and does not cause addiction and drug dependence is unlikely. Stopping this
medication suddenly after prolonged or frequent use usually does not cause withdrawal effects such as
mood changes, anxiety, restlessness, or rebound insomnia unlike other drugs such as Ambien, In terms of
adverse effects zaleplon appears to offer little improvement compared to both benzodiazepines and
other non-benzodiazepine Z-drugs, except it has less residual effect upon awakening.
3- Zopiclone : is indicated for the short term treatment of insomnia where sleep initiation or sleep
maintenance are prominent symptoms. zopiclone may have an even greater addictive potential than
 benzodiazepines, Long term use is not recommended as tolerance, dependence, addiction can occur with
prolonged use, it has a cross tolerance with alcohol.
4- Eszopiclone: is the active dextrorotatory stereoisomer of zopiclone, it has the same mechanism, effects
and side effects as Zopiclone.

Iodoxamide: usually it is 0.1% sterile ophthalmic solution, it is a mast cell stabilizer. It is used for seasonal allergy
and redness.

Doxapram : is an IV respiratory stimulant, it stimulate chemoreceptors in the carotid arteries which stimulate
brain stem, it is used in opiate induced respiratory depression.

Ritodrine : is a Beta Agonist and a tocolytic drug, used to stop premature labor, it is a beta-2 selective Agonist, It
has been removed from the market.

Tocolytics (anti-contraction medications or labour repressants) : are medications used to suppress premature
labor, Agents include :

1- BBs : Terbultaline, Ritodrine, Salbutamol.

2- Nifedipine:
3- Atosiban : an Oxytoxin antagonist.
4- NSAIDs :Indomethcin and Sulindac.
5- MgSulfate : May be used in torsades de pointes , as adjuncts to Beta Agonists in severe asthma, Eclampsia
, topical application in genital herpes.

Vesamicol: inhibit transport of choline into cholinergic vesicles.

Clostridium Toxin: inhibit vesicular acetyl choline release.

Anisindione (Miradon): is a synthetic anticoagulant, It prevents the formation of active procoagulation factors II,
VII, IX, and X, as well as the anticoagulant proteins C and S, in the liver by inhibiting the vitamin K–mediated
gamma-carboxylation of precursor proteins.

DIP : Di Isopropyl Phosphate.

Ketorolac: is given IV, IM and PO. For no more than 5 days.

Biologic Anti-rheumatoid drugs:

1- TNF-alpha Blockers, Etanercept, Infliximab, Adalimumab, Golimumab.

2- IL-1 Blockers, Anakinra.
3- Anti-B-cells antibody, Rituximab.
4- T-cell costimulation blockers, Abatacept.
5- It takes 2 weeks before response is evident.
6- Except Anakinra, all can be used in combination with others.
7- Should be used cautiously in heart failure.

Pancrelipase: is an enzyme therapy, a mixture of Amylase, trypsin and lipase, that are normally produced by the
pancreas. It is used in cystic fibrosis, chronic pancreatitis and pancreatectomy. It is available as powder capsule
and tablets, it should not be taken alone, powders and capsules should be dissolved in liquid, tablets should be
taken with soft food.
Deferroxamine Mesylate: is an iron Chelating agent, it can be given IV, IM and SC, it is water soluble and readily
excreted by urine.

Antabuse (Disulfiram): is contraindicated with elixir.

Papverine : is an opium poppy product , it is used as vasodilator in visceral spasm and vasospasm, especially in the
heart and the brain, it may inhibit PDE, it is not an analgesic but may be habit forming.

Pitavastatin: reduce LDL and increase HDL, so it might be indicated in metabolic syndrome, it has NO CYP3A4
interactions, which is important in elderly patient who need to take multiple medicines.

Dronase Alpha (polyzyme): is highly purified solution of deoxy ribo nuclease, that hydrolyse DNA in the sputum, it
is used in cystic fibrosis.

Mesalamine: is 5- Amino salicylic acid, it is an anti-inflammatory that is used ONLY in ulcerative colitis, and mild
to moderate Crohn disease, it is available as tablet, capsule and suspension.

Sulfasalazine : is indicated in IBD, Rheumatoid Arthritis and Psoriasis, Sulfasalazine, and its metabolite 5-ASA, are
poorly absorbed from the gut, The precise reasons why sulfasalazine are effective in various forms of arthritis is
not clearly understood, because sulfasalazine and its metabolite 5-ASA are poorly absorbed into the bloodstream,
it is surprising that the drug is effective against symptoms outside of the intestine. The metabolite sulfapyridine
which gives rise to side-effects such as agranulocytosis and hypospermia.

Compound W: is a topical liquid solution of salicylic acid, it is used to remove warts.

Loteprednol: is a corticosteroid that is used in ophthalmology, it is used in eye allergies, keratitis and
conjunctivitis, it has little effect on ocular pressure.

Azelastin: is a potent, selective 2nd generation histamine antagonist, it is available as nasal spray and eye drops, it
is used in allergic rhinitis, pruritus and allergic conjunctivitis.

Astemazole: is an antihistaminic that was drawn from the market due to some serious side effects.

patient with myelosuppression, bone marrow transplantation and sever chronic neutropenia.

Cefdinir: is a broad spectrum 3rd generation cephalosporin, it is indicated in ear, sinus, throat and skin infection, it
might bind to iron (causing red discoloration of the stool) or Al or Mg, which decrease absorption, probenecid
inhibit renal excretion of cefdinir and increase it is concentration.

Paricalcitol: is a d2 analouge, used in treatment of secondary hypothyroidism, or renal failure.

Rifapentine: is indicated in tuberculosis, it inhibit DNA dependent RNA polymerase.

Buspirone: is anxiolytic that lack both muscle relaxant and anticonvulsive properties, it’s a psychoactive agonistic
at dopamine and 5HT receptors, it cause hypothermia, it increase prolactin and GnRH, and take 2 weeks to work,
it is indicated in patient with substance abuse history (Because it is not habit forming).

Advantages over BZD are less sedation and little to psychomotor cognitive impairment, 2nd is NO withdrawal,
abuse or physical dependence.

Leflunomide: is a pyrimidine synthesis inhibitor, it belongs to a group of medications called DMARD (Disease
Modifying Anti Rheumatic drugs), it is indicated in moderate to severe RA and Psoriatic Arthritis, it inhibit
dihydrooroate dehydrogenase, it may cause fatal hepatitis and fever when co administered with methotrexate, it
may cause serious infections.

Cyproterone Acetate: is indicated as antiandrogen, it acts by blocking testosterone receptors and suppressing LH,
it may be used in hot flashes, and contraceptives.

Drospirenone : is an anti-androgenic synthetic progestin that is used in birth control an HRT. it has anti-
mineralocorticoid properties, counteracts the estrogen-stimulated activity of the renin-angiotensin-aldosterone
system, and is not androgenic. The anti-aldosterone properties exhibited by drospirenone promote sodium
excretion and prevent water retention.

Danazol : is an androgen agonist, that was used for endometriosis,it might be used for breast pain, menorrhagia
and Acne, Unlike GnRH agonists, danazol does not induce osteoporosis. Also, symptoms of hot flushes tend to be
less common or severe.

To reduce Niacin Induced flushing:

1- Take with food.

2- Initiate at low dose.
3- Take aspirin 30 minutes prior to niacin.

Imidazolines: Naphazoline, Oxymetazoline, Xylometazoline, tetrahydrozoline, are Alpha agonist, Available as OTC
eye drops and nasal sprays.

Monoclonal Antibodies Nomenclature:

1- 1st part is product specific.

2- 2nd part is product specific, li = inflammation, tu = cancer, Ci = cardio.
3- 3rd part indicate the type of the agent, mo = Murine, xi = Chimeric, zu = humanized.

DOCs:

1- Carbamazepine + Haloperidol, Treatment of Amphetamine overdose.

2- Leucovorin Ca or Na Salt (folinic acid), is used to treat folate antagonist toxicity, ex methotrexate,
pyrimethamine and trimethoprim, its used for megaloplastic anemia secondary to folate deficiency but its
CI in megaloplastic anemia secondary to Vitamin b12.
3- Fluvoxamine in OCD.
4- Fluoxetine in Bulimia Nervosa.
5- Erythromycin in Legionnaires.
6- Tetracycline in Trachoma.
7- Beclomethsone in respiratory distress syndrome.
8- Parilidoxime is the DOC in thiophosphate toxicity in conjunction with Atropin.
9- Hydroxyurea : decrease DNA production by inhibition of ribonucleotide reductase, without affecting
protein synthesis, it is used in myeloproliferative disease like Polycythemia Veraand essential
thrombocytosis, it also indicated in sickle cell anemia, it works by inhibiting the adult defected
hemoglobin S, and promoting the healthy fetal Hemoglobin, thereby decrease the number and the
severity of the attacks and pain associated.
10- Vancomycin, MRSA.
11- Erythromycin is indicated for 1- Legionare diease. 2- Mycoplasma Pneumopnia. 3- Campylobacterial
Infections.
12- Nystatin, Clotrimazole in oral candidiasis.
13- Tazorotene (TazoRac) cream in Psoriasis and Acne.
14- Quinapristin-Dalfopristin in Vancomycin Resistant Enterococcus Faecium (VREF).
15- IV methylprednisolone in Status Asmaticus.
Unique Effects:

1- Pin pupil + depression, Opioids mainly Morphine.

2- Mydryasis, Anticholinergic, (Meperidine )
3- Mild Aspirin toxicity cause Bronchoconstriction, Hyperventilation and Roaring or Ringing in the ear.
4- Strong Aspirin Toxicity cause respiratory depression.
5- Metallic Taste: ACEIs, Iodide, Teriparatide and Metranidazole.
6- Digoxin: changes in color perception and halos on dark objects.
7- Amiodarone: Blue skin discoloration.
8- Quinidine: Cinchonism.
9- Ticlodipine: TTP Thrombocytopenea Purpura.
10- Corticoids: Osteoporosis, Hirsutism.
11- ICS: candidiasis and Hoarseness.
12- Bisphosphonate: Osteonecrosis of the jaw.
13- Rifampin: Red-Brown discoloration of the urine, feces, and other secretions.
14- Rifabutin: Skin hyper pigmentation.
15- Ethambutol: Optic Neuritis and loss of color discrimination.
16- Dapsone: Erythemea Nodosum Leprosum.
17- Atropine: Sandy eyes.
18- Nalutamide: Delayed Adaptation to light.
19- Sildenafil may cause loss of blue red discrimination due to PDE6 inhibition in retina.
20- Clozapine is indicated for refractory Schizophrenia, it cause serious agranulocytosis, though it has strong
Antimuscarinic effects it increase salivation, dispensing require weekly WBC test, the pharmacist should
check that WBC level is more than 3500, the pharmacist should not dispense more than 1 week supply.

Used Specifically In:

1- Fentanyl in Cardiovascular surgery because it has minimal effect on the heart.

2- Meperidine in Obstetrics because it does not cross the placenta.
3- Clonidine and Alpha Methyldopa, in hypertension complicated with renal Disease, because it act
centrally.
4- Aspirin in Niacin Induced cutaneous flushing.
5- Metyrapone in Pregnant women with Cushing syndrome.
6- Fenoldopam in hypertensive renal compromised patients.
7- Fosinopril is the only ACEI excreted in bile.
8- Doxazosin is the only Alpha blocker excreted in bile.
9- Oxytocin is administered IV to promote labor and intranasally to promote milk let down.
10- Edrophonium In diagnosis of Myasthenia Gravais.
11- Succinyl Choline is indicated for preventive treatment Electroconvulsive Shock therapy.
12- Carbamazepine is indicated I trigeminal neuralgia.
13- Na Metabisulfate is used in sickle cell anemia diagnosis.
14- Povidone reduce iodide volatility and irritation.
15- Pilocarpine in emergency lowering of ocular pressure in both open and closed angel glaucoma.
16- Physostigmine is indicated for atropine toxicity because it crosses the BBB.
17- Salmetrol and Formetrol in nocturnal Asthma Attacks.
18- Pindolol and Acebutolol Hypertensive patient with bradycardia.
19- Palifermin: is a human recombinant keratinocyte growth Factor (KFG), KFG stimulate the growth of cells
that line the mouth and the intestinal tract, it is indicated for chemotherapy induced mucositis.
20- Pegfilgrastim is pegylated recombinant keratinocyte colony stimulating factor analogue, it stimulate the
level of WBCs.
21- Sargramostin: a Recombinant Granulocyte Macrophage Colony Stimulating Factor.
22- Brimonidine (Alphagan) is relatively selective Alpa 2 agonist, it is used as ocular solution in open angle
glaucoma and in ocular hypertension.
23- Foscarnet is indicated in HIV +ve, VZ and Herpes Simplex resistant to acyclovir, it does not require kinase
activation.
General Notes:

1- IV Morphine can dramatically relief pulmonary edema associated with left ventricular Failure.
2- Albumin has high affinity to bind Acidic Hydrophobic drugs.
3- Weak basic drug’s toxicity can be treated by urine acidification using NH4Cl.
4- E50 is a measurement of potency which correlates with receptor affinity.
5- Emax is measurement of efficacy which correlates with the drug’s intrinsic activity, and it’s more
therapeutically important than potency.
6- Thiazides > Creatinine CL 50 ml/sec > loop diuretics.
7- Antipsychotic drugs can alter thermoregulatory mechanisms and can produce PIOKILOTHERMIA, a
condition in which body temperature can vary with the environment.
8- Polyacrylic Aromatic Hydrocarbons in cigarette induce CYP 1A2, which decrease warfarin and
amitriptyline.
9- PH = PKa + Non Protonated / Protonated.
10- Nitroprusside is converted to cyanide when PO administered.
11- Thiazides lower pressure by both diuretic and vasodilatory effects.
12- Minoxidil is only Arterioodilator, hydralazine is primarily a Arterioodilator. Nitrates are Vasodilators.
13- Isoproterenol is stable to MAO.
14- Barbiturates increase porphyrine synthesis causing Acute Intermittent porphorya .
15- All Zocins May Cause first doe effect ( first dose syncope, postural hypotension).
16- Galantamine is the only competitive AchEI used in Alzheimer disease.
17- Hydroxyzine: is an Antihistaminic, Anticholinergic its use as anxiolytics and in drug abuse.
18- Barbiturates: has a poor analgesic property.
19- Zolpidem: It’s not a BZ, it has no anticonvulsive and no muscle relaxants, has few withdrawal effects and
little or no tolerance.
20- Atomoxitine: is only NE reuptake inhibitor, it’s not habit forming and it’s a controlled substance.
21- Paroxetine and Fluvoxamine: are more sedating and hence more used in depressed patient with
insomnia.
22- Fluoxetine and Sertraline: Are more activating and hence it’s used in patient with sleepiness.
23- Bupropion and Mirtazapine: are used to avoid sexual dysfunction.
24- Parasympathetic is the predominant innervation at the salivary gland.
25- Amlodipine: has the least possibility of first dose effect.
26- Nimodipine: is indicated for cerebral spasm, due to high lipophilicity.
27- Tazorotene: is a topical retinoid (gel or cream), it’s indicated for Acne, Psoriasis, its SE are dryness,
cracking and redness of skin.
28- Erythromycin can increase digoxin concentration by inhibiting Normal flora, which usually deactivate
digoxin.
29- Sumatriptan has a sulfonamide structure.
30- Leuprolide, Gaserelin, Naferelin, Histerlin are GnRH synthetic analogues, used in prostatic cancer,
endometriosis and precocious puberty.
31- Octreotide: is a somatostatin analogue, it suppresses the secretion of glucagon and growth hormone,
used in the treatment of acromegaly and diarrhea associated with vasoactive intestinal peptides secreting
tumors.
32- Chlorpromazine, Clozapine, olanzapine and thioridazine have strong Antimuscarinic effects and thus
have less EPSE.
33- Opioids’ occur in Medial thalamus, Hypothalamus, Pituitary, immune cells, urinary bladder and GIT.
34- SNRIs are used in depressed patient refractory to SSRAs, Neuropathic pain.
35- Lithium has low therapeutic index; it’s not sedative, not euphoriant and not depressant.
36- Ramelteon: Act on MT1 and MT2.
37- Food increases Sertraline absorption, only Sertraline undergo 1st pass Metabolism.
38- Labetalol and CCBs are most effective in Blacks and elderly.
39- Tolcapone cross the BBB.
40- Pancuronium has a vagolytic effect, it increase heart rate.
41- Cisatracurium is the only NMJB that do not need dose reduction in renal failure, because it’s
spontaneously hydrolyzed in the plasma ( No metabolism), while Mivacuronium is metabolized by blood
esterases.
42- All Ergot Alkaloids: like ergotamine, cabergoline and bromocriptine may cause pulmonary and
retroperitoneal fibrosis.
43- Trazodone: causes priapism.
44- Non Catechole Adrenergic Agonists, Ephedrine, Amphetamine, Metaproterenol and phenylephrine.
45- Isoproterenol is stable to MAO hydrolysis.
46- Bethanechol is used in postoperative urinary retention, neurologic atony, and Megacolon.
47- Since Chloramphenicol toxicity is potentiated by Na depletion, a bolus dose before and after
administration is used to reduce chloramphenicol.
48- Allopurinol can produce allergic reaction (rash) after months.
49- Local Anesthetics tend to accumulate in the fetus, due to ion trapping.
50- Progestin only pills (mini pills) are used in: smoker, lactating or estrogen intolerant women.
51- LH stimulate steriodogenesis, FSH stimulate Spermatogenesis.
52- Testosterone is active in liver and muscles; DHT is active at liver, brain and adipose tissue.
53- Beta2 Agonists are not metabolized by COMT.
54- Liquid ICS should be inhaled slowly and deeply.
55- Powder ICS should be inhaled quickly and deeply.
56- Cromylin is recommended in asthma prophylaxis children and pregnant women.
57- Urea Breathe Test is used to diagnose H. Pylori complicated ulcer.
58- Drugs that may cause sexual dysfunction, Beta-Blockers, Alpha Agonists, SSRIs.
59- Procainamide and Hydralazine cause reversible Lupus Erythematous like Syndrome.
60- Dopamine is metabolized to Homovanillic Acid.
61- Reserpine blocks Amine uptake (not reuptake) system.
62- Guanthidine blocks NE release.
63- Beta: Iso > Epi > NE
64- Beta1: Epi=NE
65- Beta2: Lung Epi > NE
66- Beta3: Lipolysis
67- Epi > NE > Iso
68- Fluorodopa: A dopamine Analogue used in PET (Positron Emission Tomography) in parkinsonian Diagnosis.
69- Nicotinic receptors at autonomic ganglia differ from receptor of NMJ.
70- Hemicholinium is a choline uptake inhibitor, indirect acting anticholinergic.
71- Botilinium toxin blocks Acetylcholine release.
72- Black widow spider venum empties all acetylcholine stores.
73- MEGESTROL ACETATE
74- Benedict Roth Apparatus is used to calculate oxygen consumption.
75- Kinpp Respiratory Apparatus is used to measure respiratory quotient.
76- Essential AminoAcids: Leucine, Isoleucine, Valine, Histidin, Tryptophan, Threonine, Methionine.
77- Bupropion is indicated in Smoking cessation but contraindicated in alcohol withdrwal.
78- Alpha receptors in the eye mediate mydriasis.
79- Muscarinic receptors in the vasculature mediate vasodilation.
80- Methacholine is a synthetic choline ester that act as non-selective muscarinic receptor Agonist, in the
parasympathetic nervous system.
81- Thoracolumbar means sympathetic.
82- Skeletal muscle hypersensitivity is usually due to receptor proliferation.
83- M2 receptor present in the heart.
84- Ascorbic acid is cofactor in dopamine beta hydroxylase.
85- Passive tubular reabsorption is most sensitive to drug ionization.
86- AST should be regularly checked when using acarbose.
87- Human topoisomerase inhibitors are etoposide, teniposide, doxorubicin while bacterial, flouroquinolone.
88- Normal PT time is 12-15 sec, PTT is 35-45 sec.
89- NSAIDs should not be used for fever more than 3 days and 7 days for pain.
90- Combination of methotrexate and gold increase the risk of nephrotoxicity.
91- PGD2 or IgE is a potent mediator in asthma attacks.
92- PTU is preferred in pregnant women with hyperthyroidism.
93- Ketone urea can be caused by, DM, Starvation and vomiting.
94- Thioridazine, tetracycline and hyrdrochlorthizide may cause photosensitivity.
95- Warfarin is the only Anticoagulant that is classified as Enzyme Inhibitor blood thinner.
96- Cetirizine, Fexofenadine and Astemazole are non-sedative Antihistaminic.
97- IV lorazepam is indicated as antiemetic.

General Notes:

1- Carbamazepine and cyclobenzaprine are structurally related to TCAs.

2- Amlodipine has the least possibility of causing Sympathetic response (tachycardia).
3- Erythromycin increase digoxin concentration by decreasing normal for a that deactivate digoxin.
4- Cholestipol decrease digoxin because it binds to the acidic moiety of digoxin.
5- Troches means Lozenges.
6- Sumatriptan has a sulfonamide Structure.
7- Most common SE of sucralphate is constipation.
8- Arthrotec is a diclofenac and misoprostol combination.
9- Meclophenamate have higher risk of GI cramping and diarrhea.
10- Indomethcin have higher risk of CNS side effects.
11- Piroxicam have higher incidence of GI ulceration.
12- TAH: Total Abdominal Hysterectomy.
13- WDWN: Well Developed Well Nourished.
14- PSH: Past Surgical History.
15- ROS: Review Of Systems.
16- BSA is the best measure for dosing drugs with narrow therapeutic index, CrCl is the best measure for
renally impaired patients.
17- Cytokines include: Interferon, Interleukin, CSF.
18- Diclonine is used in throat lozenges and sprays.
19- Pramoxeine is used in Antihemorrhoidal preparations.
20- Mirtazapine have alpha blocking properties, it is used in anorexic depressed patients.
21- Digitalis may cause bradycardia and it is Contraindicated in combination with CCBs, BBs and
Procainamide or quinidine.
22- Adenosine slows Av nodal conduction and interrupt reentry.
23- Triamterene is contraindicated in patient with renal stones.
24- Nebivelol have some vasodilator effects possibly through NO release.
25- Alph Blocker SE include: 1st does syncope, edema, priapism, diarrhea and constipation.
26- Methyl Dopa has inhibitory effect on heart rate and contractility, Positive Coombs test, Hemolytic
anemia and lactation in either gender.
27- Reserpine is CI in depression and peptic ulcer.
28- ACEIs are indicated in prehypertesives with risk factors.
29- ACEIs SE include Neutropenia, Proteinuria, dry cough, Angioedema.
30- ARBs cause less hyperkalemia and no dry cough.
31- CCBs are most effective in elderly, Blacks and Low renin individual.
32- Use sustained release Nifedipine to avoid edema, flushing, headache.
33- Slow acetylators have increased risk of SLE with hydralazine.
34- Minoxidil is stronger vasodilator than Hydralazine.
35- DIAZOXIDE is mainly an arteriodilator, it has a similar structure to thiazides and may cause transit
hyperglycemia.
36- BB and Succcinyl choline may cause hyperkalemia by shifting intracellular potassium.
37- SSRIs are the 1st line in OCD, SNRIs are not indicated, Clomipramine is a second line.
38- Clonazepam might have some anticholinergic and serotonergic activity, serotonergic activity might
make it helpful in OCD, but both fluoxetine and fluvoxamine decrease clonazepam level, it should be
used cautiously in BPH and glaucoma, clonazepam is metabolized by nitro reduction.
39- Therapeutic doses of aspirin might increase the level of Valproic acid, possibly through protein
binding replacement.
40- Amantadine has been effective in treating tremor.
41- TCAs have alpha blockers activity, causing hypotension and syncope.
42- Desipramine one week dose can be fatal.
43- Nefazodone is a potent P450 inhibitor.
44- Ferrous may decrease levo-dopa absorption.
45- Diazepines are effective ONLY in acute phase of PTSD, SSRIs are the drug of choice, neuroleptic are
not effective.
46- Felbamate increase carbamazepine metabolite ( 10- 11 Carabamezepine epoxide), Which increase it’s
toxicity, on the other hand CMZ increase felbamate levels.
47- ACEIs and BBs have been associated with lower risk of macrovascular and microvascular DM
complications.
48- ACEIs in DM decrease the risk of MI, Stroke, Cardiovascular Death, Revascularization, but NOT
Unstable Angina.
49- The PRIMARY mechanism of thiazide is the inhibition of NaCl channels in the Distal Convoluted tubule,
it also inhibit NaCl channels in the PCT and renal cortex.
50- Gabapentin is indicated in diabetic neuropathy, titrate dose from 900mg to maximum of 3600
mg/day.
51- Acetohydroxamic acid (also known as AHA or Lithostat) is a drug that is a potent and irreversible
inhibitor of bacterial and plant urease usually used for urinary tract infections. The molecule is similar
to urea but is not hydrolyzable by the urease enzyme.
52- Acitretin is the oral retinoid of choice in resistant psoriasis, women should avoid getting pregnant for
the next 3 years after discontinuation, because it can be metabolized to its parent compound
(Etretinate), Which has long t1/2, so it is not recommended for women in child bearing age.
53- Tolnaftate (Tinacitin) is a synthetic over-the-counter anti-fungal agent. It may come as a cream,
powder, spray, or liquid aerosol, and is used to treat jock itch, athlete's foot and ringworm, Although
the exact mechanism of action is not entirely known, it is believed to inhibit the squalene epoxidase.
54- Phytonadione (vitamin K1) is used to prevent bleeding in people with blood clotting problems or too
little vitamin K in the body.
55- Certolizumab Pegol (Cimzia) : is a pegylated monoclonal antibody, since PEG do not cross the
placenta it can be used in women want to get pregnant.
56- Ecallantide is a plasma kallikrein inhibitor, it is given SC to treat hereditary angioedema. Plasma
kallikrein liberates kinins (bradykinin and kallidin), peptides responsible for the regulation of blood
pressure and activation of inflammation. It is also capable of generating plasmin from plasminogen.
57- Injectable Poly-L-Lactic Acid (Sculptra) : is a thermoplastic aliphatic polyester derived from renewable
resources, such as corn starch, It can biodegrade under certain conditions, such as the presence of
oxygen, and is difficult to recycle, it is used in nasolabial fold contour and other facial wrinkles.
PLA is currently used in a number of biomedical applications, such as sutures, stents, dialysis media
and drug delivery devices. The total degradation time of PLA is a few years.[8] It is also being
evaluated as a material for tissue engineering, Because it is biodegradable, it can also be employed in
the preparation of bioplastic.
58- Bepotastine (Talion) is an antihistamine. It was approved in Japan for use in the treatment of allergic
rhinitis and urticaria/pruritus.
59- Coartem (Artemether-Lumefantrine) : Artemether is an antimalarial for the treatment of multi-drug
resistant strains of falciparum malaria, it has some anthelmintic and anticancer properties, it is
available as injection, Lumefantrine is an antimalarial drug. It is only used in combination with
artemether, combination therapy (ACT) indicated for the treatment of acute uncomplicated
plasmodium falciparum malaria.
60- Quinine is a natural white crystalline alkaloid having antipyretic (fever-reducing), antimalarial,
analgesic (painkilling), anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine
which, unlike quinine, is an anti-arrhythmic. Quinine[2] is an effective muscle relaxant.
Despite popular belief, quinine is not an effective abortifacient (abortion pill) (in the US, quinine is
listed as Pregnancy category D [23]). Pregnant women who take toxic doses of quinine will suffer from
renal failure before experiencing any kind of quinine-induced abortion.[24] Indeed, quinine is the only
drug recommended by the WHO as firstline treatment for uncomplicated malaria in pregnancy.
Quinine can cause cinchonism, hearing impairment, TTP, Hemolysis in G6PD deficiency, Atrial
fibrillation and heart block.
 61- Chronic alcohol use, Large doses of vitamin E, low vitamin K diet and Disulfiram all potentiate
Warfarin .
62- Acute alcohol ingestion inhibit warfarin effects.
63- LMWH indications may vary by manufacturer.
64- Platelet count should be monitored in both LMWH and UFH.
65- Fondaparinux should not be used in patient <50 kg, it is contraindicated in bacterial endocarditis and
renal impairment, it is pregnancy category B and should be cautiously used in lactating women.
66- LMWH have less hemorrhage , less to no effect on platelets, less protein binding, and less binding to
endothelial cells.
67- Amrinone and Milrenone are PDE5 inhibitors, they are indicated for short term treatment of resistant
CHF, it is indicated in BBs toxicity, they have high long term mortality rate.
68- Corgard (Nadolol) is indicated in Angina complicated with HTN, 40-80 mg/day.
69- Clonidine TTS (Catapres TTS), is available as 0.1, 0.2 and 0.3 mg /day. For a week.
70- Ketorolac have higher oral bioavailability than Parenteral.
71- Adalimumab is a sterile preservative free solution for subcateneous administration.
72- Piroxicam is a long acting NSAID, it is given twice a day.
73- Diflunisal (Dolobid) is a prodrug.
74- Phenytoin therapeutic serum concentration is 10-20 mg/ml.
75- Travatan Z is a new combination that contain SofZia instead of Bezykconium chloride as a
preservative. SofZia is robust ionic buffered preservative system, that is gentle on the ocular system.
76- Anaprox DS is 550 mg of Naproxen, it is prescription ONLY.
77- Maalox contain Al and Mg Hydroxide, Maalox Plus contain Also simethicone .
78- Talwin NX (Pentazocine + naloxone) : is an analgesic, indicated for mild to moderate pain, it given
orally only, naloxone concentration is minimal and cause Antagonism only in opioid dependent
patients.
79- Brovana (Arformeterol for Inhalation) is long acting BB, it is indicated in COPD, it is for nebulization
ONLY.
80- Riserperidone (oral disintegrating tablets) is approved for irritability associated with Autism.
81- Bromo-Seltzer is effervescent Granules of acetaminophen .
82- Ziana is Clindamycin 1.2% + trentoin 0.025 % .
83- Nebupent is Pentamidine for inhalation .
84- Paregoric is camphorated opium tincture (or elixir), it is used as antidiarrheal.
85- Prednisone is associated with triggering or exacerbating Acne.
86- Parabin and benzyl alcohol are preservatives, that can NOT be contained in epidural preparation.
87- Lorazepam, Oxezepam and Temazepam are metabolized by conjugation, Clonazepam is metabolized
by nitroreduction, ALL the rest benzodiazepines are metabolized by oxidation.

NON PHARMACOLOGICAL:

Metered-Dose Inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of
a short burst of aerosolized medicine that is inhaled by the patient. It is the most commonly used delivery system
for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases. The
medication in a metered dose inhaler is most commonly a bronchodilator, corticosteroid or a combination of both
for the treatment of asthma and COPD. Other medications less commonly used but also administered by MDI are
mast cell stabilizers, such as cromoglicate or nedocromil.

Epidemiology : is the study of health and illness, it is a cornerstone method of public health.

Laminar: arrange or consist of thin layers, sheets or plates.

Laminar Flow : non turbulent flow of fluid or gas.

Skim the cream : is a pricing mechanism that involve selling at high price to those who are willing to pay before
aiming at more price-sensitive consumers.

Psychometry : is a branch of psychology that deals with the design , administration and interpretation of
quantitative test for psychological variables, ex : intelligence.

Positioning strategy : is the process by which marketers try to create an image or identity in the minds of their
target markets for its product brand.

Benidict Apparatus : is used to measure O2 consumption per minute.

Kinpp Respiratory Apparatus : Respiratory Quotient.

Intracellular Organisms include: chlamydia, legiomnella, Moraxella, Ureaplasma,

Spirometry : is the most common pulmonary function test, measuring lung function, specifically the volume and
the speed of the air the air that can be inhaled or exhaled, it is used in Asthma, COPD and Cystic fibrosis.

Pulvule : is gelatin based capsule.

Symbicort should be primed when :

1- First used. 2- Dropped. 3- NOT used for a week.

Indications for IV to PO :

1- Improved sign and symptoms

2- Normal WBCs and vital signs.
3- Afebrile for 12-24 hours.
4- Functioning GIT.