Radiant Notes – Pharmacology –

Dr Hamza
https://www.youtube.com/watch?v→rZqM5BA2Kc4

https://www.youtube.com/watch?
v→agjIyjhj1Q0&list→PLhkR6GKDrsh1YDjjnbV7lR7Bhw99czvtt&index→78

Sicknesses
395. Mcq → Drug of choice for motion sickness is → Scopolamine


– Notes / HYPS
 Air sickness → Cyclizine
 Mn → Achi air me we go out for cycling

 Mountain sickness → Acetazolamide

 Mn → We went to mountain and found a seat to sit
 Morning sickness → Pyridoxine
 Mn → morning me pyari dost yad ati hia
 Motion Sickness → Scopolamine > Meclizine


DOC – Conditions + Infections

396. Mcq → DOC for diabetic patient with hypertension → Captopril


– Note

Condition Drug of Choice

Seizures
Mn → TMAP–SVEC – Terrorist MAP Sec Vulgar Edu College
Tonic Clonic Seizure / Myoclonic
 Sodium Valproate / Phenytoin
Seizures

Absence Seizures  Ethosuximide

Partial Seizures  Carbamazepine / Phenytoin

Partial Seizures in Neonates  Phenobarbital

 Mn → No Problem
Status Epilepticus  Benzodiazepines
 (Lorazepam > Diazepam)
 Mn → Jinka Status high hota hia unho
ne Merecedez Benz rakhi hoti hia
Tachycardia
Mn → SAVAd –
2nd me D is later
Supraventricular Tachycardia  Adenosine
 Mechanism → ↓ AV conduction
 Side Effect
 ↓ Conductions

Ventricular Tachycardia  Amiodarone

Adverse Effect
 Gray Man Syndrome
 Mn → Aam admi is grey

Others
Ventricular Fibrillation  Lidocaine / Lignocaine
 Mn ???
Hypertension  Captopril (ACEI)
 Mn → Captains usually have
Hypertension
 Adverse Affect
 Hyperkalemia
 Cough
Moderate to severe CHF  Captopril (ACEI)
 Mn → Army Captains are usually
Failure
Cardiogenic Shock  Dopamine / Dobutamine
 Mn → CD
Bradycardia  Atropine (to ↑ HR)
 Mn → Bread on trip is absurd.
Cardiac Arrest  Epinephrine
 Mn ???
Hypertrophic Obstructive Cardiomyopathy  β-blockers > Verapamil
 Mn → jab bhi cardiomyopathy hti hia
beta yaad ata hia – then Vera (faith)
yaad ati hia
 Vera = faith in hind
 Mechanism → ↓ AV delay
Ischemic Heart Diseases  IV Nitroglycerine > Sublingual NG
 NG converts to NO
 NO cause vasodilation
Infective Endocarditis  Injection Penicillin + Gentamycin

Pregnancy induced Hypertension  Labetalol > Methyldopa

 Mn → pregnancy pain → HTN
 Makes us think of why we got
pregnant – bcz of L
Eclampsia  MgSO4
Def – Seizures that occur in pregnant Mn → Shia hazrat ko Magnesium bht
people. pasand hia

Pregnant lady + thyrotoxicosis → 1st  PTU – Propylthiouracil

 Mn → 1st trimester vo cheez dein jo
trimester pro bhi ho – thigh par bhji act karey
urine par bhi act karey.
 Adverse Effect
 Hepatotoxic
 Cannot be administered in 2nd/3rd
trimester.
Pregnant lady + Thyrotoxicosis → 2nd/3rd  Methimazole
 Mn → 2 or 3 trimester me methi
nd rd
trimester
khani parti hia.
 Methimazole is actually Breaking
Bad wali methamphetamine
Adverse Effect
 Teratogenic → causes cancer
 Cannot be administered in 1
st

trimester.

Hypothyroidism  Levothyroxine
 Mn → hypothyroid me thyroxine hi
deinge.
Breast Carcinoma  Tamoxifen
Pre-menopausal  MOA → anti–Estrogen

Breast carcinoma  Anastrozole

Post-menopausal  MOA → Aromatase inhibitor
 Mn → For me time is 1 –
st

aroma/anus is 2 nd

Diabetic Gastric Paresis  Metoclopramide (Anti emetic drug)

(Complication of DM)  Mn → DM
MOA
 Block 5–HT3 receptors

Depression  Fluoxetine (SSRI)

Analgesic in Acute Pancreatitis (aka Acute  Pethidine (Opioid analgesic)

Cholelithiasis)  Note → Pethidine is DOC for
 Asthma
 Acute Pancreatitis
 Mn → Hakeem ki pakhi sarey

dard mita deti hia

 Side Effect
 Tachycardia
 Mn → Hakeem ki pakhi ↑ HR

GERD / PUD – Peptic Ulcer Disease  Acetaminophen (Paracetamol)

 Other NSAIDs aggravate ulcers

Pain management – Post Operative  Ketorolac > Pethidine

patient  Ketorolac → Classic NSAID
 Pethidine → Opioid analgesic

Pain management - Asthmatics  Paracetamol

 Ketorolac → Contraindicated in
 asthma patients
 Rx → bronchospasm + respiratory
depression.

Idiopathic Heavy Menstrual Bleeding  Mefenamic acid (Nonselective NSAID)

Mn → feminine & menstrual bleeding
in name.

Urinary Incontinence  Oxybutynin (Muscarinic Receptor

antagonist)
 Mn → Animal Ox have urinary
incontinence

Terminal Cancer Patient  Morphine

Mn → Cancer patient is near morgue

Ulcerative colitis – Acute  Corticosteroids

Ulcerative colitis – Chronic  Sulfasalazine (DMARD)

 Mn → If some one has persistent
Ulcerative colitis – take them to
Salazar Slytherin
Anaphylactic Shock  IM Epinephrine

Obsessive Compulsive Disorder (Aka  Clomipramine (TCA)

Obsessive compulsive neurosis)  Mn → Make a clone of OCD people.
 Mn 2 → OCD people are clingy
Schizophrenia  Risperidone (atypical antipsychotics)
 Mn → RS – in alphabetical order
Recurrent Migraines  Sumatriptan
 Mn → Summaiya has recurrent
migraine
Alzheimer’s Disease  Rivastigmine (ACh Esterase Inhibitor)
 Mn → Alzheimer patient go out for
swimming in River.

Nasal Decongestant  Phenylephrine (Selective α1 agonist)

 Mn → Naak band ho to phenyl dalein

Hypercalciuria  Thiazide diuretics

 Mn → Thigh has Hyper calcium
Infections
Bacterial Meningitis  Ceftriaxone (3rdgeneration
cephalosporin)
 Mn → Meningitis has i – 3 times – Tri
in ceftri

Hydatid Liver Disease  Albendazole → 400 mg

Pyogenic Liver Abscess  Ampicillin + Ciprofloxacin +

Metronidazole

Amoebic Liver Abscess  Metronidazole

Influenza Virus  Oseltamivir

  Mn → having a flu is like having a
new OS installed.

Pneumocytic jiroveci  TMP – SMX

 Is antibiotic resistant
 Combination is administered.

MRSA  Vancomycin > Linezolid > Fusidic acid

 Vancomycin Adverse Effect
 Red–Man Syndrome

Clostridium Species  All Clostridium species DOC →

Clostridium tetani Metronidazole
Clostridium botulinum  EXCEPT Clostridium perfringens
Clostridium difficile  Mn → Cluster is seen in Metro

Gas gangrene  Penicillin G

Caused by Clostridium perfringens  Penicillin G → DOC for
 Gas Gangrene

 Neisseria meningitides

 Neisseria Gonorrhoea

ⱺ Mn → Penicillin G is discussed
in GNN
 As per Double A mcq book →
Ceftriaxone > Penicillin G for
Gonorrhoea.

Pseudomembranous Colitis  Metronidazole OR Vancomycin

Clostridium difficile  Mn → Metro Sasti – Private Van
mehngi

st
1 -line therapy → Oral MZ for 10-14
days
If severe / NOT responding to
metronidazole → Oral Vancomycin
For life-threatening infections, a
combination of Oral Vancomycin + IV
Metronidazole
 If Vancomycin + Metronidazole in
option prefer that.

UTI  TMP – SMX (E.coli)

Most common cause → E.coli  Ceftazidime (Pseudomonas aeruginosa)
2nd most common →  Mn → Z in both Ceftazidime & Sabz
Pseudomonas aeruginosa Bagh

Enterococcus Fecalis  Ampicillin

Bacterial Vaginosis (fishy smell & vaginal  Metronidazole

discharge) Mn → Jab BV ki vagina se boo aae –
get her a metro
Travelers' Diarrhea  Norfloxacin > Diphenoxylate
 Mn → Noor Traveler’s (A Traveler
 company in Faisalabad)
 Mn 2 → After Floxy give Phenoxy

Anthrax (Bacillus anthrax)  Ciprofloxacin → mcq

 Mn → ABCF

Fungal sinusitis  Amphotericin B

Invasive Amoebiasis  Metronidazole

Metronidazole is DOC for both
bacterial & parasitic infections.

Tape worm  Praziquantel > Niclosamide

 Tapeworm includes  Mn → Agar meri Tape par razi ho to
 Taenia solium thek hia waena Niklo Sami
 Echinococcus granulosus
Diphyllobothrium latum
 Mn → TED

– Now let's solve some paper MCQs

– Conditions
 Q – Drug appropriate for endometriosis — Medroxy-progesterone ???
 Q – A known Chronic Liver Disease – CLD patient presents with upper GI bleed.
Management plan should be → IV Octreotide ???
 Q – GI bleed DOC → Injection Octreotide (remember Terlipressin > Octreotide) ???
 Q – A CLD patient presenting with hematemesis. Preferred immediate treatment is → Inj.
Octreotide ???
 Q – In a patient of asthma and Ischemic Heart Diseases – IHD, which drug should be
used to control B.P during an operation → IV Nitroglycerine > Sublingual Nitroglycerine
 MOA

 Nitroglycerine → converts to NO.

 NO is a vasodilator.

 Note

 If Nitroglycerine is taken orally → inactivated in liver during 1st pass effect – mcq

 Q – Patient with Ventricular Tachycardia, ↑ Heart rate and abnormal QRS complex. Drug
of choice → Amiodarone
 Mn → SAVA–d

 Q – Drug of choice for Hypertrophic obstructive Cardiomyopathy → β blocker >

Verapamil
 MOA → ↓ AV delay

 Mn → jab bhi cardiomyopathy hti hia beta yaad ata hia – then Vera (Vera = faith) yaad

ati hia
 Q – Drug of choice for absence seizure → Ethosuximide
 Mn → Terrorist MAP – Secondary Vulgar Education College

 Q – Eclampsia patient on OT table, Drug of choice for HTN → Labetalol > Methyldopa
 Mn → pregnancy women have HTN – In HTN they think why they got pregnant – bcz of L

 Q – A 5-months pregnant lady with thyrotoxicosis. Drug of choice is → Methimazole

 5 months → 2nd trimester.

 Mn → 2nd / 3rd trimester me sada sabzi methi khani hti hia.

 Q – DOC for terminal cancer patient → Morphine
 Mn → Cancer patient is near morgue

 Q’ – A 21-years old boy presents with acute ulcerative colitis. treatment of choice
should be → IV Corticosteroids
 For Acute → Corticosteroids

 For Maintenance → Sulfasalazine

 Mn → if someone has persistent Ulcerative Colitis – take them to Salazar

 Q – Chronic Ulcerative colitis, DOC → Sulfasalazine

 Q – DOC for Bee sting, swollen face & periorbital edema → IM adrenaline
 Q – DOC for Hypothyroidism → Levothyroxine
 Mn → hypothyroid me thyroxine hi deinge.

 Q – DOC as analgesic in Acute pancreatitis → Pethidine.

 Mn → Hakeem ki pakhi sarey dard mita deti hia

 Side Effect

 Tachycardia

 Mn → Hakeem ki pakhi ↑ HR

 Remember Medroxy-progesterone > Danazol

 Mn → Madam Diana

 Pethidine → Opioid analgesic

 Short duration of action (2 – 3 hours)

 Q – A young male who is on antiepileptic drugs now develops depression. What drug
should be used to Tx depression → Fluoxetine (SSRI – anti depressant)
 Q – Urinary incontinence. Drug of choice is → Oxybutynin
 Mn → Animal Ox have urinary incontinence

 Q – Drug of choice in moderate to severe congestive heart failure – CHF → Captopril

(Angiotensin converting enzyme inhibitors)
 Mn → Army Captain likely to have Heart Failure.

 Q – Drug of choice in obsessive compulsive neurosis is → Clomipramine (TCA)

 Mn → Make a clone of OCD people.

 Mn2 → OCD people are clingy

 Q’ – The drug which has shown greatest efficiency in treatment of obsessive-compulsive

disorder is Clomipramine.
 Q – DOC for post MI ventricular fibrillation → Lignocaine
 Q – DOC for Hirsutism → Cyproterone acetate (anti-androgen)
 Note – Breast carcinoma

 Tamoxifen (MOA → anti-Estrogen) → DOC pre-menopausal women

ⱺ 1st line a/c Dr Hamza

 Anastrozole (MOA → aromatase inhibitor) → DOC in post-menopausal women

ⱺ Mn → For me time is 1st – aroma is 2nd

 Raloxifene → prevention of cancer in high-risk breast carcinoma women.

ⱺ MOA → inhibit estrogen receptors.

 Note 2 →

 Tamoxifen is also given selectively in post–menopausal women.

 Q – DOC for carcinoma of breast in pre-menopausal lady → Tamoxifen

 Q – DOC for carcinoma of breast in post-menopausal women → Anastrozole (aromatase
inhibitor)
 Mn → For me time is 1st – aroma / anus is 2nd
 Tamoxifen is an estrogen receptor AGONIST in uterus


 Raloxifene is an estrogen receptor ANTAGONIST in uterus

 Tamoxifen for pre–menopausal women with high risk for breast cancer

 Raloxifene for POST menopausal women with high risk for breast cancer

– Infections
 Q – DOC for Gonorrhoea → Ceftriaxone
 Recall Penicillin G → DOC for
 Gas Gangrene

 Neisseria meningitides

 Neisseria Gonorrhoea

ⱺ Mn → Penicillin G is discussed in GNN

 Recall 2 → For gonorrhoea as per Double A → Ceftriaxone > Penicillin G

 Q’ – DOC in Bacterial meningitis → Ceftriaxone

 Mn → Meningitis has i – 3 times – Tri in ceftri

 Q – Initial drug of choice for treatment of Influenza Virus is → Oseltamivir

 Mn → having a flu is like having a new OS installed.

 Q – Traveler’s diarrhea DOC → Norfloxacin > Diphenoxylate

 Mn → Noor Traveler’s (A Traveler company in Faisalabad)

 Mn 2 → After Floxy give phenoxy

 Q – DOC for Gas gangrene → Penicillin G

 Mn → Penicillin G is discussed in GNN
 Gas Gangrene

 Neisseria meningitides

 Neisseria gonorrhoea

 Q – A female with fishy smell vaginal discharge, clue cells seen on microscopy. Drug of
choice → Metronidazole
 Mn → Jab BV ki vagina se boo aae – get her a metro
 Q’ – Bacterial Vaginosis DOC → Metronidazole
 Q – Female has burning pain during urination. She is diagnosed with having UTI. Organism
on culture is identified as oxidase positive, non-lactose fermenting, greenish color, and
fruity smell. DOC for this organism → Ceftazidime
 Scenario of UTI caused by Pseudomonas aeruginosa

 Pseudomonas → Sabz bagh

 Mn → Z in both Ceftazidime & Sabz Bagh

 Q – DOC for Pseudomembranous colitis → Metronidazole > Vancomycin

 Mn → Metro sasti – private van mehngi
 1 line therapy → Oral MZ for 10-14 days
st

 If severe / NOT responding to metronidazole → Oral Vancomycin

 For life-threatening infections, a combination of Oral Vancomycin + IV Metronidazole

 If Vancomycin + Metronidazole in option prefer that.

 Q’ – drug of choice for severe Clostridium difficile infection is → Vancomycin (here word
severe indicates choice for Vancomycin
 Vancomycin > Metronidazole.

 Q – Drug of choice in MRSA is → Vancomycin > Linezolid > Fusidic Acid

 Q – DOC for Systemic Fungal infection → Amphotericin-B
 Amp–B DOC for

 Fungus causing Meningitis → Cryptococcus neoformans

 Systemic fungal infection.
 Q‘’– DOC for Fungal sinusitis → Amphotericin B
 Q’’ – Common drug used in nasal and sinuses fungal infection → Amphotericin B
 Q – DOC for Taenia Solium pork worm infestation → Praziquantel > Niclosamide
 Mn → Agar meri tape par razi ho to thek hia waena Niklo Sami

 Tapeworm includes
 Taenia solium

 Echinococcus granulosus

 Diphyllobothrium latum

Mn → TED
ⱺ

 Q’’ – A patient with Taenia Solium and Schistosoma infection. Drug of choice will be →
Praziquantel
 Q’’ – A 10-years old boy diagnosed with tapeworm infestation. Drug of choice will be →
Praziquantel
 Q’’ – DOC for Taenia Solium, pork worm infestation with Cysticercosis → Praziquantel
ⱺ

Pharmacokinetics & Dynamics

397. Mcq → Effect of drug on a body → Pharmacodynamics


– Notes / HYPs
 Pharmacodynamics → Drug action on body
 Mn → D in dynamics – What drug does to body

 Pharmacokinetics → action of body on drug.

 Mn → Kinetics – Body kia karti hia

 Includes → ABDE

 A → Absorption

 B → Bioavailability

 D → Distribution

 E → Excretion

 When asked Drug-drug interaction, select → Pharmacokinetics + Pharmacodynamics

option
 Tachyphylaxis → Rapid decrease in responsiveness to drug due to continued drug
administration.
 Tachyphylaxis is a protective mechanism.

 Acidic drug binds to → Albumin

 Basic drugs bind to → Glycoproteins
 Grand mn → Aa bhi ja sanam

 Zero order kinetics

 First order kinetics


– Know difference
 Q – An elderly Obese male was started on IV Gentamycin BD post Laparotomy. Which of
following will occur → Distribution
 In Obese patients → Distribution

 In Thin or lean patients → Excretion

 Mn → DONE
 ⱺ

– Now Let's practice some paper MCQs

 Q – Amount of drug which reaches systemic circulation after administration is called →
Bioavailability.
 Q – Fraction of active administered drug reaching systemic circulation unchanged is called
→ Bioavailability.
 Q – Effect of drug on a body → Pharmacodynamics
 Q – Regarding drug-drug interaction, correct is → Both pharmacokinetics &
pharmacodynamics
 Q – Regarding plasma albumin, more readily binds with → acidic drugs.
 Q – Tachyphylaxis → diminished response develops rapidly.
 Q – Regarding adverse effect of drug, Which is correct → Variable
 Q – Narcotic with lowest pKa is → Alfentanil > Remifentanil > Morphine > Sufentanyl >
Fentanyl > Meperidine)
 Mn → ARM Se FM

 Q – Drug with highest first pass metabolism is → Nitrates

 Mn → Nitrates have nitrous oxide – fast

Pharmacokinetics & Dynamics 2

398. Mcq → Therapeutic window = Therapeutic dose range


– Notes / HYPs
 Therapeutic index
 Def – It is ratio of dose that produces toxic effect to dose that produces desirable

clinical affects
TD 50

ED50
 Greater therapeutic index → Greater safety of drug
 Therapeutic Window
 Def – range between minimum clinical effect and maximum toxic effect

 Def 2 – Therapeutic window is therapeutic dose range.

 Potency
 Def – minimum concentration or dose of a drug required to produce 50 % of a drug’s

maximal effect.
 Efficacy
 Def – Maximal effect, a drug can produce irrespective of dose (ability of a drug to
accomplish a specified effect).
 Def 2 – It is E-max achieved by drug

 Note
 Rule → Potency & Efficacy are entirely unrelated.
 Mn to remember difference is → HELP

Height indicates efficacy

ⱺ

Leftward drug indicates potent drug

ⱺ

 Proband
 First person coming to doctor in affected family.


 – Now let's practice some paper MCQs
 Q – Doses at which a medication is effective without unacceptable adverse events →
Therapeutic Index.
 Q’’ – Safety margin of drug → Therapeutic Index.
 Q’’ – Therapeutic Index of drug indicates → Safety.
 Q – Minimum absorption of drug from its site of absorption, for its desirable effect occurs
if → Drug used for local action.
 Q – Therapeutic dose of a drug for a particular condition is determined by → Potency.
 Q’ – Therapeutic dose of drug in clinic is decided on → Potency
 Q – Steep curve in dose response shows → Potency
 Mn → HELP
 Height indicates efficacy

 Leftward drug indicates potent drug

 Q – Maximum effect (Emax) achieved by a drug is a measure of its → Efficacy

 Q – Better study of a drug can be done by knowing → Plasma half-life
 In options – bioavailability is also present which is wrong.

 Q – Max bioavailability of drug is via which route → Sublingual.

 xxx

 Q – Which of following types of drugs will have maximum oral bioavailability →

Largely hydrophobic, yet soluble in aqueous solutions.
 Q – Regarding Acetaminophen most likely is → its Therapeutic window is less than
Aspirin.
 Aspirin safer than Paracetamol (Acetaminophen)

 Mn → S in Aspirin – S for safe.

 Q – Plasma half-life depends on → Renal clearance

 Mn → PR

 Rx → most drugs are metabolized in Liver but excreted by Kidney.

 Note → in option – Volume of Distribution is also present & I confuse it with Renal

clearance.
 Q – Drugs with short plasma half life → Achieve steady plasma concentration quickly
 Rule → Shorter the half life → More rapid steady state.

Antidotes for Toxicity/Overdose

399. Mcq → Farmer organophosphate poisoning what should be given → Atropine > Pralidoxime


– Note / HYPs – Antidotes

– Painkillers
 Aspirin toxicity → Sodium bicarbonate
 Mn → in Aspirin → S for Sodium – inverted P for bicarbonate

 Acetaminophen (Paracetamol) →
 < 4 hours → Gastric lavage.

 > 4 hours → N-acetylcysteine (replenishes glutathione)

 Mn → mini mole & cyst in name.

 Opioids overdose → IV Naloxone

 Mn → doube oo in both drug & anti dote
  Naloxone has a stronger affinity for opioid receptors
 MOA Opioids → completely knocks off opioids attached to receptors in brain
– Anticoagulants
 Heparin overdose → IV Protamine Sulfate
 Note

 Side effect of Protamine Sulfate → Hypotension

 Warfarin overdose
 Immediate → Fresh Frozen plasma (Mn → Foran – Fresh)

 Delayed effect (24 hours) → Vitamin K

– Anxiolytics & Hypnotics

Benzodiazepines overdose → Flumazenil
 Recall → Barbiturates have NO antidote.

Barbiturates toxicity → Sodium bicarbonate

 Note

 Classically Barbiturates have NO antidote.

 Here Sodium bicarbonate is NOT an antidote but it only ↑ barbiturate excretion – (ref

Medicall + Google)
 Q – A drug taken in overdose. After few minutes, patient has pinpoint pupils, respiratory

depression, semi comatose. Its excretion is increased by giving NaHCO 3. Drug is most
likely → Phenobarbital.
– Antidepressants
Tricyclic Anti Depressants overdose – TCA → Sodium Bicarbonate
 Mn → anti of Tri is Bi

– Antimuscarinic
Atropine overdose → Physostigmine (Mn → Atropine is a stigma)
 For all other antimuscarinic overdose → Pralidoxime
– Others
Organophosphate overdose (ACh Esterase inhibitor) → Atropine > Pralidoxime
β blockers → Insulin + Glucagon
Carbon Monoxide poisoning → 100 % O2
Methotrexate (anti–cancer / DMARD) antidote → Leucovorin
Thallium → Persuasion blue ???


– Now let's practice some paper MCQs

 Q – An unconscious patient with respiratory depression, not responding to Naloxone. Most
likely cause → Phenobarbitone
 Rx → Only Sx of Opioids overdose is reversed by Naloxone

 Phenobarbitone → is barbiturate.

 Q – Antidote of Morphine → IV Naloxone

 Recall → Natural Opioids – Morphine + codeine (Mn → Morning coffee)
 Q – Flumazenil duration of action → 30-60 minutes
 Flumazenil antidote for Benzodiazepine overdose.

 Q – Antidote of Warfarin → FFP and Vit K

 Q – Which of following is best route to give immediate antidote to a drug overdose → IV
 Q’ – In drug overdose, best route to administer antidote is → IV
 Q – Leucovorin is an antidote for → Methotrexate (anti–cancer drug / DMARD)
  Q – Antidote of Paracetamol (Acetaminophen) → N-Acetylcysteine
 Mn → mini mol & cyst in name

 Q – Scenario of unconscious patient landing in ER due to ingestion of large bottle of

Aspirin. What will increase renal excretion of aspirin → Bicarbonate.
 Mn → in Aspirin → S for Sodium – inverted P for bicarbonate
 Q’’ – Patient came with Aspirin overdose having respiratory acidosis. Aspirin will be
removed from system by → NaHCO3
 Q’’ – Aspirin toxicity can be treated with → NaHCO3
 Q – Presurgical preparation of a pregnant woman with mild risk of DVT to have C section
in few hours. The most effective drug used in preventing DVT and have far fewer side
effects is → Low dose of Low molecular weight heparin.
 Recall → Heparin is safe in pregnancy

 Warfarin cause war on baby

 Q – TCA overdose results in → Seizures

 Affects are due to Na–channel blocking

 Seizure

 Convulsion

 Coma


– Notes 2
Potassium depletion may cause → Rise in plasma bicarbonate ??
In a person taking carbonic anhydrase inhibitors for 4 weeks now, what changes will
occur → Decrease HCO3 in blood ??
– One creepy question
Arsenic poisoning from where you will take soil of graveyard → Any side.


Classic NSAIDs
400. Mcq → Aspirin overdose causes → Alkalosis


– Intro / Background
 Drug toxicity vs drug overdose
 Toxicity → occurs over time

 Overdose → too much of a substance is consumed at once.

– Notes / HYPs – Aspirin – 1

 Aspirin MOA
 IRREVERISIBLY inhibits cyclooxygenase (both COX–1 and COX–2)

 Also inhibits production of Thromboxane A2.

 Aspirin inhibits platelet aggregation by inhibiting cyclooxygenase and inhibiting

thromboxane A2 production.
 Aspirin Toxicity
 Tinnitus + Respiratory alkalosis

 Aspirin Overdose
 Phase 1 → Respiratory alkalosis

 Note

Toxicity OR Overdose → dono me pehle alkalosis hi hga.

ⱺ
  Phase 2 → Metabolic acidosis
 Phase 3 → Hyperthermia + Tachycardia

 Then → Coma, then → Death

 Mn 1 → LCHCD – Low Cholesterol – High Cholesterol – Death

ⱺL → Respiratory Alkalosis – C → Metabolic Acidosis – H → Hyperthermia , C →

Coma – D → Death.
 Mn 2 → pehle alkalosis phir acidosis – patient loses mind & goes to coma.

 If both coma and alkalosis are in option prefer alkalosis as 1 to occur is alkalosis
st

occurs.
 Aspirin Adverse Effects
 Teratogenic in early pregnancy.

 Fatal in 3 trimester due to premature closure of vessels of heart.

rd

 Aspirin unique feature → have vasodilation properties – mcq

 Rx due to antiplatelet activity.

– Notes / HYPs – Other Classical NSAIDs – 2

 If asked both COX 1 and COX 2 irreversible inhibitor → Aspirin
 If asked both COX 1 and COX 2 reversible inhibitor → Diclofenac (and other NSAIDs)
 Ibuprofen → Most safe during lactation
 Mn → Brufen & boobs homophones.

 Mefenamic Acid → First line of drug to treat idiopathic heavy menstrual bleeding
 Mn → feminine & menstrual bleeding in name.

 Acetaminophen (Paracetamol) →
 Painkiller of choice in pregnant patients

 Acetaminophen (Paracetamol) therapeutic window less than Aspirin

 Therefore →

 Acetaminophen (Paracetamol) Overdose chances > than Aspirin. OR

 Aspirin Safer than Acetaminophen

– Now let's practice some paper MCQs

 Q – Aspirin decreases fever by decrease in → Prostaglandins
 Recall → Classic NSAIDs nonselective inhibitor of COX pathway

 COX pathway inhibition → PG inhibited → Formation of TXA2 inhibited.

 Q – Aspirin overdose side effect → Respiratory Alkalosis

 Recall in both toxicity / overdose → Respiratory alkalosis is 1 sign.
st

 If other overdose sign present → choose alkalosis ∵ it is 1st to occur.

 Q’’ – Regarding Aspirin → Thromboxane A2 inhibition.
 Q’’ – Genesis for long term Aspirin therapy → Inhibition of Thromboxane A2.
 Q’’ – Aspirin inhibit thrombus formation and inhibit platelet aggregation by inhibiting
which function → Thromboxane A2
 Thromboxane A2 full form → A2α

 Thromboxane A2α → Procoagulant

 Vasoconstrict

 Platelet aggregation

ⱺ Mn → in biochemistry, anything that has X or α in it cause vasoconstriction OR

bronchoconstriction.
 Q’’ – MOA of Aspirin in MI is → Inhibition of thromboxane synthesis.
 Q’’ – Low dose Salicylate / Aspirin is prophylactically given in Coronary artery disease –
CAD. MOA is → Thromboxane A2 inhibitor
 Q’’ – Aspirin decrease fever by which mechanism → Decrease in Prostaglandins – PG
 Q’’ – Which drug IRREVERSIBLY inhibits function of platelets → Aspirin
 Recall → Aspirin IRREVERSIBLE inhibition

 All other Classic NSAIDs → REVERSIBLE inhibition

 Q’’ – Diclofenac is → REVERSIBLE non–selective COX inhibitor.

 Recall only Aspirin is IRREVERSIBLE.

 Q’’ – Which of following NSAIDs are contraindicated in chronic liver disease → Aspirin
 Rx → NSAIDs are metabolized in Liver.

 High doses of any Classic NSAID lead to liver toxicity

 Liver toxicity ultimately progress → Liver failure.

 NSAIDs are safe in patients with chronic liver disease but a reduced dose of 2-3 g/d is

recommended for long-term use.

 Non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided because of risk of

renal impairment, Hepatorenal syndrome, and gastrointestinal hemorrhage.

 Q – A patient developed moderate pain after limb surgery, DOC for this patient →
Ketorolac
 Note → DOC for post–operative treatment of moderate to severe pain → Ketorolac >

Pethidine
 Ketorolac → Short duration of action.

ⱺ Mn → Lac rupay patient k lag jate hian letne k liye.

 But Ketorolac contraindicated in asthma patients

 Pethidine → short duration of action opioid

 Q’’ – Female having asthma, hysterectomy done. Which drug is contraindicated →

Ketorolac
 Ketorolac

 Contraindicated in asthma patients

 Rx → bronchospasm + respiratory depression.

 Pethidine → aggravates asthma.

 Paracetamol → Safe analgesic in asthmatics

 Q – Female having asthma, hysterectomy done. Which drug can be given as safe post op
analgesic → Paracetamol
 Q – A patient with history of peptic ulcer came with complaint of lower molar pain.
Analgesia of choice → Acetaminophen (Paracetamol)
 DOC for GERD / PUD – Peptic ulcer disease → Acetaminophen
  Other NSAIDs aggravate ulcers.
 Q – Which of the following is a centrally weak acting mu–opioid receptor agonist →
Tramadol.
 Mn → Tramadol rhymes trembling.

Drug discontinuation Before Surgery

401. Mcq → Aspirin should be stopped before surgery / or How many days effect of Aspirin remains
7-9 days


– For drugs when to be stopped before surgery.



Drug When to Stop Mnemonic

Aspirin Stop 1 week before surgery

Lithium (Anti depressant) Stop 2 weeks before surgery Mn → 'L' is formed by 2

Straight lines
MAO-Inhibitors Stop 3 weeks before surgery Remember 'MAO' has 3 letters

Estrogen pills Stop 4 weeks before surgery Remember 'E' is formed by 4

straight lines
Mn → ALME – 1 2 3 4


 Q – Aspirin stopped → 7-9 days before surgery.



Non-selective NSAIDs
402. Mcq → More selective for COX 2 than for COX 1 → Meloxicam / Celecoxib


– Notes / HYPs
 If asked more selective COX 2 → Celecoxib
 Mn → Cele in name
 If asked most potent COX 2 → Meloxicam
 Mn → Camera is very potent nowadays


Half Lives
403. Mcq → half-life on kanamycin in perilymph is 12 hours (Range 10-15 hours)


– Note / HYPs
 Half-life of Propofol in anesthesia, is → 4 – 7 hrs
 Half-life of Kanamycin → 10 – 5 hours
 Half-life of Cobalt is → 5 year
 Mn → Co education in MBBS 5 years

 Half-life of Caesium137 → is 33 year

 Mn → Lamba naam 33 years


 Diuretics
404. Thiazide diuretics acts on → DCT


– Note – Target Location of Diuretics

 Carbonic anhydrase inhibitors act on → early PCT
 Loop diuretics acts on → Thick ascending limb of loop of Henle
 Osmotic diuretic act on → PCT
 Thiazide diuretics → early DCT (act on Na–Cl cotransport)
 K+ sparing diuretics acts on → Collecting ducts
 Mn 1 → Car Leak Over The King

 Mn 2 → PT PDC (Physical training – Pakistan Dental Council)

Diuretics Continued
405. Mcq → Thiazide diuretic cause → Hypokalemia


– Notes / HYPs
 Loop diuretics Side Effect
 Low blood Volume

 Thrombocytopenia – mcq

 Hypocalcaemia & hypomagnesemia

 Inhibition of Mg / Cl paracellular transport.

 Hypokalemia

 Hyponatremia

 Inhibition of Na-K-2Cl cotransporter

Mn 1 → LT–CM–KN – Light CM say K & N

ⱺ

Mn 2 → Everything will be Low – L for Loop L for Low

ⱺ

 Thiazide diuretics Side effect

 Hypokalemia > Hyperglycaemia > Hyperlipidaemia > Hyperuricemia > Hypercalcemia

 Mn → Tk.GLUC

 K-Sparing diuretics Side Effect

 Hyperkalemia

 Mn → in name

 Note
 Side effect NOT COMMON at all


– MCQs
 Q – Diuretic used in pulmonary edema, Action on smooth muscle → Furosemide
 Furosemide → Loop diuretic

 Q – Spironolactone side effect → Hyperkalemia.

 Spironolactone → K sparing diuretic

Contraindications
406. Mcq → Drug contraindicated in Hypertrophic Obstructive Cardiomyopathy → Digoxin
 

– Notes / HYPs
 Contraindicated in Hypertrophic Obstructive Cardiomyopathy – HOCM → Digoxin
 Other drugs that are contraindicated in HOCM are

 Nitrates

 ACEIs

 Inotropes

 Contraindicated in asthmatics → Ketorolac

 Rx → Cause bronchospasm + respiratory depression.

 Contraindicated in Bronchial asthma → Propranolol

 Rx → β blocker

– MCQs
 Q – In Hypertrophic cardiomyopathy, which of following is present → Myocytes disarray
???


Conditions in Pregnancy
407. Mcq → Safest drug in 3rd trimester Cefadroxil.


– Other questions related to Pregnancy

 Q – Pregnant patient developed vesicles on abdomen which later developed into bullae.
She had similar lesions in previous pregnancies. Diagnosis → Pemphigus gestationalis.
???
 Q – A pregnant lady develops some skin changes just like her uncle who is HCV positive.
Which changes are most likely to occur → Spider telangiectasia and palmer erythema ???
 Q – Secretion of following is NOT increased during pregnancy → GH
 Q’ – Which does not change during pregnancy → GH
 Note

 In 1 half of pregnancy GH rises

st

 In 2 half of pregnancy GH decreases

nd

  overall remains same.

 Q’’ – Decreased GH in pregnancy is due to → Human chorionic Somatotropin

 Q – A female with bleeding and coagulation defects. Intrauterine death has occurred.
Management → Evacuation of uterus


Anti Emetics
408. Mcq → Anti-emetic with highest bioavailability → Metoclopramide


– Background – Antiemetics
 Antiemetics include
 Ondansetron

 Metoclopramide

– Notes / HYPs
  Ondansetron → Antiemetic DOC in patients of chemotherapy prior to surgery.
 Mn → OCP

 O → Ondansetron

 C → Chemotherapy

 P → Prior to surgery

 Metoclopramide
 Antiemetic DOC in Diabetic gastroparesis

 Increases stomach emptying in patients with diabetes.

 Mn → Metro people have gastric problems – metro = meto

 Actions

 Increases LES tone + stimulates Gastric contractions (gastric emptying)

– Now Lets solve some paper MCQs

 Q – Ondansetron mechanism of action → 5–HT3 antagonist
 Mn → tron = 3

 Q’ – One surgeon preparing patient for Laparotomy. But prior to surgery, patient was
complaining of nausea and vomiting. Which will be best premedication in this case →
Ondansetron
 Mn → Ondansetron Mn → OCP

 O → Ondansetron

 C → Chemotherapy

 P → Prior to surgery

 Q – Diabetic gastroparesis, drug to be given → Metoclopramide

 Mn → Metro people have gastric problems – Metro = meto

 Q’’ – Drug which increases competency of gastroesophageal junction → Metoclopramide

 Q’’ – Chronic diabetic patient having complaints of bloating etc. Doctor diagnosed as
diabetic gastroparesis. Which drug would be useful for her → Metoclopramide.
 Q’’ – Drug which inhibits Dopamine D2 + Serotonin Type 3 receptors – 5-HT3 in
chemoreceptor trigger zone (CTZ) located in area postrema of brain → Metoclopramide –
fav mcq
 Metoclopramide inhibits both D2 + 5HT3

 D2 >> 5 HT3

 For this mcq See following diagram

409. Dexamethasone as compared to hydrocortisone → Immunosuppression > Hyperglycaemia
 Dexamethasone is a long acting, causes immunosuppression much more than
hydrocortisone, although it does causes hyperglycaemia, but immunosuppression effect
is more, so if both in options prefer immunosuppression. ???


MOA Of Drugs
410. Mode of action of Cephalosporin → Inhibit transpeptidase.


– Background
 Sympatholytic Agents
 Classification

 Centrally acting

 α blockers

 β blockers

 α + β blockers

 Centrally acting Drugs

 Levodopa + clonidine

– Remember all questions that came in previous papers related to Mechanism Of

Action
– Diuretics
 Acetazolamide (Carbonic anhydrase inhibitor) MOA → H+ secretion
– Anti Emetic
 Ondansetron MOA → Serotonin Type 3 receptor antagonist / blocker – 5-HT3
 Metoclopramide MOA → Blocks both – D2 + 5HT3 receptors
 D2 >> 5 HT3

– Painkillers
 Aspirin (Classic NSAID) MOA → Non–specific inhibition of cyclooxygenase enzyme (COX 1
+ COX 2)
– Anti Thyroid Drugs
 Propylthiouracil MOA → Inhibit release of iodine.
– HTN
 Captopril (RAAS Inhibitor) MOA → Inhibit Angiotensin Converting enzyme
 Verapamil (Calcium Channel Blocker) on heart MOA → Increases AV nodal delay
– AChE Inhibitors
 Neostigmine (Acetyl choline Inhibitor) MOA → Inhibit enzyme Acetyl cholinesterase
– Sedatives & Hypnotics
 Benzodiazepine MOA → Potentiate GABA mimetic
– Cardiac Drugs
 Digoxin MOA → ↑ intracellular calcium
 Adenosine → Decreases AV conduction
– Gastric Ulcer Drugs
 PPI MOA → Direct inhibition of H+– K+ ATPase pump in gastric parietal cells.
 Cimetidine / Ranitidine (H2 receptor antagonists) MOA → H2-receptor antagonist on
parietal cell
 Ranitidine (better) > Cimetidine

 Rx → Less CNS toxicity.

– Adrenergic Receptor antagonist

 Labetalol → inhibit both α and β receptors
– Anticholinergic drug
 Dicyclomine → Act on M3 receptor ???
 Mn → 3 letters after letter M → acts on M3 receptor.

– Gout
 Allopurinol → Xanthine oxidase inhibitor
– Anti Bacterial
 Penicillin MOA → Inhibition of cell wall synthesis
 Vancomycin MOA → Inhibition of cell wall synthesis
 Cephalosporin MOA → inhibits enzyme transpeptidase
 Mn → Cephalosporin is drug of transgender

 Cyclosporine MOA in transplant patients → anti–tumor effect, inhibit T cell differentiation

– Fungal Drugs
 Itraconazole (Azole) MOA → Inhibit ergosterol synthesis
 Mn → Engro – ergo – fungal.

– Others
 Methyl DOPA MOA → binds adrenergic receptors in CNS.
 Drug decreases TG levels most → Gemfibrozil
 MOA of Local anaesthetic is → Block Na+ channel
 Antipsychotic action of Phenothiazine → Blocking dopamine receptors in limbic system.
 Phosphodiesterase inhibitor → Inhibit conversion of cAMP to 5 AMP. ???
 MOA of nitroprusside → Direct on vessels
 MOA of clomiphene citrate → Ovulation induction
 Clomiphene citrate Induces ovulation by working on → Hypothalamus


– Now Lets solve some past papers MCQs

 Q – Which lipid mobilizing drug in liver cause decrease in plasma triglyceride levels &
increase plasma levels → Gemfibrozil.
 Q – Which drug decreases Triglyceride levels most → Gemfibrozil
 Mn → Gemfibrozil Jams (traffic Jam) TCA
 Q – Patient have unilateral pulsating headache with photophobia, nausea and
vomiting. You gave a drug which have following MOA → 5 HT agonist
 5–HT receptor agonist → vasoconstriction of painfully dilated cerebral blood vessels.

 Q – MOA of Acetazolamide (Diuretic – Carbonic anhydrase inhibitor) → Decreases H+

secretion and ↑ Na+ and K+ excretion.
 Q’ – MOA of Loop diuretic → Inhibits co transport system (Na–K–2CI) of thick ascending
limb of loop of Henle.
 Q – Patient with severe gastroenteritis, develops Hypokalemia. To treat hypokalemia,
IV potassium infusion is advised. MOA of IV potassium infusion in this patient is through →
Na–K pump
 Q – Mechanism of action of Captopril (RAAS inhibitor) → Decrease TPR
 Q’ – Captopril → Inhibit synthesis of angiotensin 2
 Mn → to in Captopril

 Q – Mechanism of action of Allopurinol (Chronic Gout) → Xanthine oxidase inhibitor

 Q – Propylthiouracil (Anti–Thyroid) MOA → Inhibits thyroid hormone synthesis
 Q’ – Propylthiouracil MOA → inhibiting oxidation of iodide + release of iodine.
 Remember → PTU → Block thyroid peroxidase, inhibiting oxidation of iodide and

organification and coupling of iodine → inhibition of thyroid hormone synthesis

 Q – Clavulanic acid in Penicillin → β lactamase inhibitor
 Q’ – Clavulanic acid is mixed with Ampicillin because → Inhibit β lactamase
 Q – Citrate (Vitamin D3) is given to patient with renal calcium stones. What is mechanism
of citrate in this case → increases PTH
 Q – α methyldopa MOA → inhibits norepinephrine for post ganglionic neuron to act in
CNS
 Q – Verapamil (Anti–HTN – Ca channel blocker) MOA → ↑ AV nodal delay
 Q – A patient taking Dicumarol can expect to have which of following symptoms →
Delayed blood clotting.
 Dicumarol (Vitamin K depleter like Warfarin)

 Side Effect → ↑ clotting time (↑ PT time) / ↑ bleeding tendency

 Mn → Die kyun ??

 Dimercaprol

 Side Effect → ↑ Bleeding time.

 Mn → English me bhi die – urdu me bhi maro

 Q – Labetalol → Acts on both α and β receptors

 Q – Patient presented with upper abdominal spasmodic pain after fatty food intake,
relieved by Dicyclomine(Anticholinergic), what is MOA of Dicyclomine → Act on M3
receptor
 Q’ – A lady has severe colicky pain relieved by giving Dicyclomine. This drug acts on →
Muscarinic receptor.
 Q – MOA of Vancomycin → Causes change in bacterial component (cell wall synthesis)
 Q – Thioridazine (Typical Antiphsychotic) MOA → Blocks Dopamine receptors.
 Q – Drug inhibit H+/K+ ATPase pump → Omeprazole (PPI)
 Q – A drug which blocks adenylyl cyclase and inhibits cAMP can be used in treatment of
which disease → Vibrio cholera.
 Q – Patient was given a drug which caused increased calcium. Which drug was given →
Thiazide
 Thiazide diuretics side effects Mn → Tk. GLUC
 Hypokalemia > Hyperglycaemia > Hyperlipidaemia > Hyperuricemia >


Hypercalcemia
 Q’ – Thiazide drug side effect → Hypercalcemia
 if Hypokalemia in options → prefer that – follow order.

 Q – Patient with gum bleed given ascorbic acid (Vitamin C). MOA of ascorbic acid →
Hydroxylation of proline and lysine.
– Also note these mcqs
 Reduces size of prostate → 5 α reductase ???
 Q – Adrenaline causes vasoconstriction through → α 1 adrenergic receptor
 Q – Naturally occurring alkaloids (opioids are alkaloids) are → Morphine and Codeine
 Mn → Morning coffee

 Q’ – Both Morphine & Codeine can → cross BBB.

 Q – Regular Insulin is → Short acting chain mechanism
 Q – Potent venodilator → IV Nitroglycerine
 Q – The duration in which a tricyclic antidepressant shows its analgesic effect when
given to a patient with post–herpetic neuralgia is → 1–2 weeks
 TCA analgesic effect → 1 – 2 weeks

 TCA antidepressant effect → 3 – 4 weeks

 Mn → Pehle dard ka ilaaj phir marz ka ilaaj.

 Q – Sodium bicarbonate given in aspirin poisoning – MOA → increase GFR.



Anesthesia
411. Mcq → What increases potency of Local anesthesia when added to it → epinephrine in ratio
1:200,000


– Intro / Background
Def of Local Anesthesia → Drugs which can provide regional anesthesia – Kaplan
MOA of Local anaesthetic → Block Na+ channel
– Notes / HYPs
Anaesthesia which decreases Hepatic blood flow → Halothane
 Mn → H for Halothane – H for Hepatic

Anesthetic which dissociates in light → Halothane

 Mn → Heat in light – light dissociates halothane
All Inhalational General anaesthetic agent increases Cerebral blood flow
 Halothane > Desflurane > Isoflurane > Sevoflurane
 Mn 1 → Halothane ↓ blood flow to liver to↑ blood flow to CNS

 Mn 2 → HDI–S – Human Development Index Savory

Sevoflurane has sweet smell – mcq.

 Mn → Sevoflurane Savory

Local anaesthetic agent for OPD use → Desflurane

 Mn → We must have a D in OPD

– Duration of Action
Shortest acting Local anesthesia → Procaine (+ Chloroprocaine) & Esmolol
 Mn → Procaine is pro

Intermediate acting local anesthesia → Prilocaine, Mepivacaine, Lignocaine / Lidocaine

 Mn 2 → has 2 I in name
  Longest acting Local anesthesia → Bupivacaine Ropivacaine, Tetracaine
 Mn → BRT

 Most widely used Local anesthesia are → Intermediate & Long-acting local anesthetics.
 Anaesthetic for breast (chest or ribs injury) → Bupivacaine
 Mn → B for breast – B for Bupivacaine

– Toxic Traits
 Local anaesthetic decreases plasma esterase level → Procaine
 Mn → Pro Kane ( β Kane wrestler) has ↓ plasma esterase levels.

 Local anesthetic cause methemoglobinemia / hemoglobinemia → Prilocaine

 Mn → Pretty people are pink

 Most toxic Local anaesthetic → Bupivacaine

 Important feature Bupivacaine → Cardiotoxic (+ CNS toxic)
 Signs of Bupivacaine toxicity

 Early → Perioral paresthesia + Tinnitus (ringing in ears)

 Mid → Hypotension

 Late → Arrhythmias (cardiotoxic)

 Ropivacaine preferred over Bupivacaine → Less CNS toxic.

 Mn Roop wala is less CNS toxic

 Anaesthetic causing Malignant hyperthermia → Halothane + Succinyl choline

 Mn → HSc is a malignant hyperthermia institute

– Useful Features
 Combination used in general anesthesia → Halothane & NO
 Potent anesthetic but weak analgesic → Propofol / Halothane
 Local anesthetic decreases risk of nausea and vomiting → Propofol

 Mn → Propofol fools vomiting center.

 Potent Analgesic but weak anesthetic → NO (Nitrous Oxide)

 Mn → Nitrous oxide says NO to pain.

 Potent anesthetic + potent analgesic → Ketamine

 Intrinsic activity of bronchodilation → Ketamine (used in asthma)

 Anesthetic drug causes cardiac stimulation, ↑ HR & B.P → Ketamine

 Anesthesia in asthmatic, hemodynamically stable patient → Propofol
 Anesthesia in asthmatic hemodynamically unstable patient → Ketamine
 I think → broncho dilatory affect of Ketamine are potent & only utilized when needed.

 After spinal anesthesia, hypotension occurs. Cause is → loss of vasomotor tone

– Regions
 More local anesthetic concentration in blood by → Intercostal block ???
 Type of regional anesthesia associated with greatest serum concentration of local
anesthetic is → Intercostal ???
 Succinylcholine caused apnea due to → Absence of Psuedocholine-esterase ???
– Others
 Pancuronium → causes respiratory depression (respiratory paralysis)
 Pancuronium is a muscle relaxant

 Administered during anesthesia to facilitate anesthetic.

 If Pancuronium administered IV → cause respiratory paralysis within 2 to 4 minutes.

– Now Let's Solve some paper MCQs

 Q – Dose of Local anesthesia required per segment → 0.5 ml to 1 ml.
 Q – Most widely used Local anesthesia are → Intermediate & Long-acting local
anesthetics.
 Q – Local anesthesia crosses placenta through → Simple diffusion
 Antibody which crosses placenta → IgG
 Mn → EFG – Erythroblastosis Fetalis IgG

 Q – Mechanism of action of Local anesthesia → Blockade of Na+ channels

 Q – Lignocaine → prevents Na+ influx across membrane
 Recall local anesthetics block Na+ channel.

 Q – 1st sign of Lidocaine toxicity → Light headedness

 Q – Inhalational anesthetics act on → Reticular activating system – fav mcq
 Q – Good analgesic but week anaesthetic → Nitric oxide
 Mn → Nitrous oxide says NO to pain.

 Q – IV local anaesthetic with rapid metabolism and hence less side effects that can be
used in regional blocks → Mepivacaine.
 Recall → Mepivacaine is a Local anesthetic

 Def of Local anesthetic → Drugs which can provide regional anesthesia.

 Q – Esmolol is preferred in anesthesia because → Short duration of action.

 Short acting local anesthetics → Procaine (+ Chloroprocaine) + Esmolol

 Q – Which short acting local anesthetic is given epidural in vaginal hysterectomy →

Procaine
 Q – In a RTA, a patient had chest injury resulting in 3 rd and 4th ribs fractured. For
prevention of pain which local anesthetic with long duration of action shall be advised
→ Bupivacaine
 Long acting – Mn → BRT

 Bupivacaine – Ropivacaine – Tetracaine.

 Q – Which one is strongest anaesthetic but weak analgesic → Propofol / Halothane

 Q – Paramedian approach in spinal anaesthesia must pierce which of following →
Ligamentum flavum ???
 Q – A patient on benzodiazepines is planned for cholecystectomy. What possible
complications can occur during surgery because of benzodiazepines → Increased
timing/dose for anaesthesia induction ???
 Q – Metabolism of Tetracaine, a local anaesthetic, given in spinal anaesthesia is by →
Hydrolysis by cholinesterase ???
 Q – Decrease heat production during general anaesthesia is due to → Reduced skeletal
muscle tone.
 Q – An asthmatic female had her hysterectomy done. Which post–op analgesic is
preferred for her → Paracetamol
 Paracetamol → Safe analgesic in asthmatics

 Pethidine → aggravates asthma.

 Ketorolac

 Contraindicated in asthma patients

 Rx → bronchospasm + respiratory depression.

 Q – Following local anesthetic cause Methemoglobinemia → Prilocaine

 Mn → Pretty people are pink.
 Q – Bradycardia is side effect of which anesthetic agent → Halothane
 Mn → Halo movie dekhte huwe we are relaxed → Bradycardia
  Q – Halothane causes Malignant hyperthermia. Mechanism → Continuous skeletal
muscle contractions.
 Mn → HSc is a malignant hyperthermia institute – Halothane + Succinyl choline

 Q – A 28–years old man presents for shoulder surgery. Patient had a documented
episode of malignant hyperthermia in a previous surgery under general anesthesia.
Which of following neuromuscular blockers is contraindicated in this patient →
Succinylcholine ???
 Q – In anesthetized patient, EEG shows → Low frequency waves – fav mcq
 Deep anesthesia shows Low frequency waves.

 Q – Which inhalation anaesthetic agent increases cerebral blood flow → Halothane

 Sequence for ↑ in cerebral blood flow → Halothane > Desflurane > Isoflurane >

Sevoflurane
 Mn → Human Development Index Savory

 Q – Patient during inguinal hernia surgery developed respiratory depression and

cyanosis. Which anaesthetic drug is responsible → Pancuronium
 Recall → Pancuronium is a muscle relaxant – causes respiratory paralysis.

 Q – Ketamine is preferred as an anaesthetic agent for repeat burn dressing because →

It produces profound analgesia.
 Recall → Ketamine is both strongly analgesic + strongly anesthetic.

 Q – A 30 years old man presents for open reduction and internal fixation of a left radius
fracture as an outpatient. He has smoked 1 pack of cigarettes per day for 12 years. Plan
is general anesthesia with endotracheal intubation. Which one of following agents is most
appropriate for him → Sevoflurane ???
 Q – A 60 kg 17 years old man presents for open reduction and internal fixation of an ankle
fracture. You discuss a general anesthetic for intraoperative management with a
sciatic block via popliteal approach. You decide to use 20 ml of 0.5 % Bupivacaine with
1:200,000 of epinephrine. How many ml of 1:1000 epinephrine should you add to your
Bupivacaine to reach appropriate concentrations → 0.1 ml
 Q – Which drug may be useful in management of neuroleptic malignant syndrome,
although it can worsen symptoms of Schizophrenia → Bromocriptine ???


Random MCQs
412. Mcq → Rivastigmine Acetylcholinesterase Inhibitor


– Note all important Pharmacology related MCQs

 Q – Characteristic sign of Penicillin allergy → Bronchospasm
 Recall Penicillin allergy induces → Type 1 HS reaction.

 Q – Drug which cause increase effect of anti–seizure drugs → Valproate

 Mn ???

 Q – Epinephrine release from adrenal medulla dilates blood vessels through → β 2 agonist
receptors.
 Recall Mn → ABCD

 α 1 → constriction

 β 2 → dilation

 Bupivacaine
 Locks sodium channel as ionized form
  Bupivacaine safe dose → 150 mg
 Q – All antipsychotic same in → Antiemetic effect
 It also comes as with different options
 Q – Antipsychotic are same in → Efficacy

 Q – Morphine is given to a patient; what effect will occur → Constipation + Bradycardia

 Mn → MCB bank

413. Benzodiazepines causes → Dependence



Important Adverse Effects

– Intro / Background – Adverse Effects vs Variable Effects
 Side Effects → unintended affects of drugs which may be positive or negative &
discontinued after drug is removed from body.
 Example → hypotension is side effect of β blockers & can be used in HTN patient.

 Adverse Affects → unintended affects of drug which are always negative & dangerous
for body & cannot be utilized to treat a condition
 Example → Valproic acid causes severe pancreatitis & continues even after drug is

removed from body.



– Notes / HYPs


Drug reaction Causing drugs Mnemonic

Nephrotoxicity /  Aminoglycosides  Mn → Amino – Mice Create

Ototoxicity  (Gentamycin / Vancomycin) Amp–B in Loop of Kidney
 Cisplatin (anti neoplastic) Mice → Mycin
 Amphotericin B Create → Cisplatin
 Loop Diuretics Amp B → Amp B
Loop → Loop diuretics
Photosensitivity  Sulfonamides  Mn → Photo of Nomi Amid 5th
 Amiodarone (Anti– arrhythmic) Fluoro Tetra pack
 5-Flurouracil
 Tetracyclines
Hyperuricemia (Gout)  Niacin (Vitamin B3)  Mn → Gutsy Niacin has Pyari
Note → Gout patient  Pyrazinamide (Anti TB) Thigh Furry Cycle
presents with pain in big  Thiazide diuretics
toe.  Furosemide (Loop Diuretic)
 Cyclosporin
Osteoporosis  Corticosteroids  Mn → All Steroids
 Depot medroxyprogesterone
acetate
 GnRH agonists
 Aromatase inhibitors.
Hemolysis in G6PD  Analgesics  Mn → AAAA Sulfa
Deficiency  Aspirin / Ibuprofen  A → Antimalarials
 Only if dose > 3 g / day.  A → Anti – TB
  Antimalarials  A → Analgesics
 Primaquine  A → Antibiotics
 Anti – TB  Mn 2 → AI – PINSS
 Isoniazid
 Antibiotics
 Nitrofurantoin
 Sulfonamides (Dapsone)
 Sulfamethoxazole
Thrombocytopenia  Heparin  Mn → Happy Queen
 Quinidine (Anti–arrhythmic) Thrombocytopenia Furry Rauf
 Furosemide (Loop Diuretics)  Happy → Heparin
 Heparin > Quinidine >  Queen → Quinidine
Furosemide  Thrombocytopenia
 Rifampicin (ATT)  Furosemide → only Loop
Diuretic.


Megaloblastic anemia  Hydroxyurea,  Megablast with PMS

 Phenytoin
 Methotrexate
 Sulfa drugs
Hepatitis  3 Anti TB drugs  Mn → RIP Liver
 Rifampicin
 Isoniazid
 Pyrazinamide
Hepatic Necrosis  Valproic acid  Mn → Well Hello Ace
 Halothane (Anesthetic)
 Acetaminophen (Paracetamol)
Pancreatitis  Azathioprine  Mn → Azaad Dye Cared about
 Diadenosine (anti HIV drug) Veela Alcohol & Diuresis.
 Corticosteroids
 Valproic acid
 Alcohol
 Diuretics (Furosemide,
Hydrochlorothiazide)
Pseudomembranous  Clindamycin  Mn → CAM TCF
Colitis  Ampicillin + Amoxicillin First 3 →  lactams
(Penicillin)
 Monobactam (Only drug in
Aztreonam)
 Tetracycline
 Carbapenems
 Fluroquinolones
Diabetes Insipidus  Lithium  Mn → LID
 Demeclocycline
Torsades de pointes  Anti–Arrhythmic (Class IA, III),  ABCDE
(Tachycardia)  Antibiotics (e.g. Macrolides),
 Anti"C"ychotics (e.g.
 Haloperidol),
 Antidepressants (e.g., TCAs),
 Anti–Emetics (e.g.,
Ondansetron)


Pulmonary Fibrosis  Carmustine (Chemotherapy)  Mn → Car Nitro Blew Bus Amid

 Nitrofurantoin Methi
 Bleomycin
 Busulfan
 Amiodarone
 Methotrexate (Anti-cancer /
DMARD)
Gynecomastia  Digoxin  DISCO GK
 Isoniazid
 Spironolactone
 Cimetidine
 Oestrogen (only minimal)
 Griseofulvin
 Ketoconazole
Dilated Cardiomyopathy  Anthracyclines (e.g.,  Mn → D
doxorubicin daunorubicin)
 Prevent with dexrazoxane
Teeth Discoloration  Tetracyclines  –
 (Dentin > Enamel)
Gray Man Syndrome  Amiodarone (Anti– arrhythmic)  Mn → Aam aadmi is gray
DOC in Ventricular 

Tachycardia (Mn → SAVA–

D)
Gray Baby Syndrome +  Chloramphenicol (Anti-  Mn → Charcol
Aplastic anemia bacterial)

Red Man Syndrome  Vancomycin 

RMS = Anaphylactic Shock

Hepatic Encephalopathy  Paracetamol  Note

 Hepatic Encephalopathy is
worsen by diuretic
Inhibit Cartilage Growth  Fluroquinolones 

Hyperkalemia + Dry  ACE inhibitors (Captopril) 

Cough
Neuroleptic Malignant  Haloperidol (Antipsychotics)
Syndrome
Lymphocytopenia  Corticosteroids

B6 Deficiency  Isoniazid

↑ Bilirubin  Methyldopa  Mn → if we eat methi →

Bilurubin ↑
Also Remember these  Chloroquinine
 Corneal opacities / deposits – fav mcq
 Mn → queen has no shortage of anaaj – corn – cornea
 Jaundice & Dark urine
 Mn → color ko change karne wali queen → Chloroquinine
 Chlorpromazine
 Lens opacities / lens deposits
 Mn → promax has good lens

 Thioridazine
 reTinal opacities / retinal deposits
 Mn → rida has retinal opacities.
 Theophylline
 Angina worsens
 Cardiotoxicity and Neurotoxicity
 Aspirin
 Teratogenic in early pregnancy
 Fatal in 3rd trimester due to premature closure of vessels of
heart.
 Captopril
 Fetal kidney damage
 Edrophonium
 Nausea
 BZs
 Dependence
 Protamine Sulfate
 Hypotension
 Opioids
 Vomiting
 Pethidine
 Fatal Tachycardia


– Now let's solve some paper MCQs

 Q – Regarding adverse effect of drug. Which is correct → Variable
 Q – Man develops hypoglycemia which will correct it → Glucagon
 Q – Edrophonium (ACh Esterase Inhibitor) most common adverse effect → Nausea
 Q – Benzodiazepines causes → Dependence
 Q – Corneal opacity is caused by → Chloroquine
 Mn → Corneal opacity is caused by a queen → Chloroquine.

 Q – Scenario of patient with raised urea creatinine. Drug contraindicated would be →

Gentamicin
 Nephrotoxicity / ototoxicity is caused by → Mn → Amino – Mice Create Amp–B in Loop of
Kidney
 Q – Neuroleptic Malignant syndrome by → Haloperidol
 Q – Before giving Sodium Valproate to patient check → LFTs
 Drugs which cause Hepatic Necrosis → Valproic Acid / Halothane / Acetaminophen
  Mn → Well Hello Ace
 Q – Drug that causes Pseudomembranous colitis → Clindamycin
 Q – Adverse effect of Protamine Sulfate is → Hypotension
 Recall → Protamine Sulfate antidote for Heparin .

 Q’ – Angina worsens by which drug → Theophylline

 Q – Drug causing peripheral neuropathy and pancreatitis → Diadenosine
 Q’ – Anti-HIV drug causing pancreatitis → Diadenosine
 Q – Side effects of recombinant human growth hormone therapy include → Benign
Intracranial hypertension.
 Q – Which drug causes fetal kidney damage in utero → Captopril
 Q – Which drug cause fatal excitation when given with MAO inhibitors → Pethidine
 Mn → Hakeem ki pakhi ↑ HR

 Q – Serotonin syndrome can be frequently encountered when a person is receiving →

Fluoxetine and Tricyclic antidepressant.
 Q – Thrombocytopenia is an adverse effect of → Loop Diuretic
 Mn → Happy Queen Thrombocytopenia Furry Rauf

 Heparin > Quinine > Furosemide (Loop diuretic) + Rifampicin

 Q – Cimetidine common adverse effect which causes it to be stopped → Gynecomastia.

 Q – Opioids given in poisoning cause vomiting by → Stimulating chemoreceptors trigger
zone
 Q – A patient on psychiatric medications develops agitation and visual impairment.
Drug most likely causing it is → Thioridazine
 Chlorpromazine → Corneal deposits

 Thioridazine → reTinal deposits

Drug–Drug Interactions
414. Mcq → A known CRF patient presented in OPD with fever, pain and discharge from ear. Which
antibiotic should be given in low dose or with caution → Gentamycin


– Some More MCQS about drugs

 Q – Which of following drug will increase effect of Diazepam → Fentanyl
 Mn → Fanta ↑ Digestion

 Q – Which drug is most commonly distributed in ECF is → Mannitol

 Q – The shortest acting anti-hyperglycaemic agent is → Tolbutamide
 Mn → Toll plaza is for less time.

 Q – Epinephrine cause decrease in → Cutaneous blood flow

 Q – A 42 years para +3 reported with heavy cyclic vaginal bleeding for last 6 months. Her
clinical examination was unremarkable. She had recent D&C and histopathology showed
early secretory phase endometrium. What is best standard first line of treatment →
Mefenamic acid ???
 Q – Bromocriptine causes decreased prolactin levels by acting on → Dopamine receptors
 Q – An Epileptic drug which increases effect of other Antiepileptic's when given together
is → Valproic acid
 Q – Which drug has properties similar to Atropine → Scopolamine
 Q – Metabolism of Candesartan can decrease when combined with → Metronidazole
 Q – Effect of Warfarin is increased by → Cimetidine
  MOA of Cimetidine increasing Warfarin effect → ↓ hepatic clearance
 Q – The dose of Warfarin will have to be modified if patient is receiving any of following
drugs → Cimetidine


Anti Depressants
415. Mcq → Thiazides often reduce excretion of → Lithium ion


– Also remember these

– Atypical Anti–Depressants
Q – A father brought his 41 years old son with some personality changes &
aggressiveness which usually normalizes between episodes and afterwards apologizes
for his act. Drug of choice → Lithium.
 Lithium – Atypical Anti Depressant.

Q – Daily dose of Lithium should be started from → 400 mg

 Lithium dose

 Starts from → 400 mg

 Ends at → 1200 mg.

Q – Which of following is an indication to stop Lithium immediately in a patient already

using it → When Lithium blood levels are more than 1.5 mmol/L
 Lithium toxicity occurs if concentrations > 1.5 mmol/L.

 Features of Toxicity

 Coarse tremor (a fine tremor is seen in therapeutic levels)

 Acute confusion, coma

 Rhabdomyolysis.

 Seizure

Mn → CARS
ⱺ

– Anti–convulsant
Q – An epileptic lady who is currently on Phenytoin has become pregnant. She is
concerned about her medication in pregnancy. Which of following is correct → Replace
with Barbiturate ???
•

Cardiac Drugs
416. Mcq → Which drug acts on Na+/K+ ATPase and its inhibitors → Digoxin


– Also remember
 Digoxin act as → Inotropic
 Digoxin side effect → Hyperkalemia
 Digoxin toxicity increases with Hypokalemia. ???
 Note that (it reduces rate of Na+/K+ ATPase pump turnover and exacerbates pump

inhibition due to digitalis)

 It also comes as

 Most commonly digitalis toxicity is due to → Concurrent use of potassium removing

diuretic


– MCQs
  Q – Which of the following given as oral medicine having aqueous absorption → Digoxin
 Digoxin completely absorbed in oral solutions.

Side Effects of Drugs

417. Dangerous side effect Belladonna alkaloid on children → Hyperthermia


– Note side effects of drugs that came in previous papers

– Anti TB Drugs
 Rifampicin → Orange-red body fluids secretions – Example urine
 Mn → R for Red – R for Rifampicin

 Isoniazid → Peripheral neuropathy (needle sensation)

 Mn → needle is pointed like letter I

 Pyrazinamide → Hyperuricemia + Gout (Gout presents with pain in big toe)

 Mn → P for pain in per – P for Pyrazinamide.

 Ethambutol → Optic neuritis (red – green color blindness)

 Mn → E for Eye – E for Ethambutol

 ATT – Anti tuberculous therapy side effect → Moderately ↑ ESR

 ATT lowers immune function – make body susceptible to other infections

 Infection in body → ↑ ESR

 Most Hepatotoxic ATT drug → Pyrazinamide

 Mn → Pyrazinamide is pagal

– Anti Seizure Drug

 Phenytoin Side effect → Granulocytopenia , Gingival hyperplasia, Facial hirsutism.
– Cardiac Drug
 Digoxin Side effect → Hyperkalemia
 Mn → DK

 Nitroglycerine Side effect → Headache.

– Anesthesia
 Halothane Side effect → Bradycardia.
 Mn → Halo movie dekhte huwe we are relaxed → HR ↓

 Epidural anesthesia Side Effect → Hypotension

 Xylocaine Side effect → Syncope
 Isoflurane Side Effect → Vasodilation
 Mn → soft Vaseline

 Side effect of Clonidine when used in ICU anesthesia → Hypotension

– Antipsychotic
 Clozapine (Atypical Anti Psychotic) Side Effect → Leukopenia
– Pain Killer Side Effect
 Aspirin Side effect → ↑ bleeding time
 Ketorolac Side effect → bronchospasm + respiratory depression.
 Contraindicated in asthma patients

 Morphine Side Effect → Bradypnea / Bradycardia and miosis

– Autonomic Nervous System
 Cholinergic drugs Side effect Most common → Bradycardia
 β blocker Side Effect → Hypoglycemia
– Anti-Depressants
  Side effect of TCA → General tonic clonic seizures
– Diuretics
 Loop diuretics Side Effect
 Hypocalcaemia

 Low blood volume

 Thrombocytopenia

 Mn → Low calcium thrombus Loop

 Thiazide Diuretics Side effect

 Hypokalemia > Hyperglycaemia > Hyperlipidaemia > Hyperuricemia > Hypercalcemia

 Mn → Tk.GLUC

 K-Sparing Diuretics Side Effect

 Hyperkalemia

 Mn → in name

 Note
 Side effect NOT COMMON at all.

– Antibiotics
 Streptomycin Side Effect → Vestibular (8th) nerve damage.
 Cyclosporin Side Effect → Dose related nephrotoxicity.
– Anti-Psychotic
 Chlorpromazine (Typical antipsychotic) Side effect → Dystonic movement.
 Chlorpromazine Adverse effect → Lens opacities.

– Others
Angiotensin Converting Enzyme Inhibitors → Hyperkalemia (+ Dry Cough)
∵ ↓ Aldosterone


 Theophylline Side Effect x 1 → Tachycardia

 Theophylline Side Effect x 2 → CNS Excitation (presents as Seizure)
 H1 Antagonist Side Effect → Sedation
 H1 → Histamine Antagonist

 Cytochrome P450 enzyme Inhibitors

 Mn → SICK FACES.COM Group

 S → Sodium Valproate

 I → Isoniazid

 C → Cimetidine / Ciprofloxacin,

 K → Ketoconazole

 F → Fluconazole

 A → Amiodarone / Alcohol (acute)

 C → Chloramphenicol

 E → Erythromycin (macrolides EXCEPT azithromycin)

 S → Sulfonamides, ,

 C → Cranberry juice

 O → Omeprazole

 M → Metronidazole

 Group → Grapefruit juice.

 Cytochrome P450 enzyme Inducers

 Mn → St John Wort - Car Bar GPRS Chori

 Car → Carbamazepine

 Bar → Barbiturates
  G → Griseofulvin
 P → Phenytoin / Phenobarbital

 R → Rifampicin (aka → Rifampin)

 S → Sulfonylureas / Smoking

 Chori → Chronic Alcoholic

 Note

 P450 inhibitors → ↑ INR

 P450 inducers → ↓ INR ratio

 ↑ INR → ↑ risk of bleeding.

 Warfarin metabolized by Cytochrome P 450 enzyme

 Any drug which inhibits Cytochrome P 450 enzyme → ↑ duration of action of warfarin

( decrease metabolism of warfarin) → patient will have ↑ risk of bleeding – dose

needs to be adjusted.
 Danazol Side Effect → Hirsutism
 Protamine Sulfate Side effect → Hypotension
 Protamine Sulfate antidote of → Heparin

 Anti-Lipidemic drugs Side effect → GI disturbances

 Biguanides Side effects → Diarrhea and flatulence ???
 Prolong use of Hormone replacement therapy – HRT Side Effect → Thromboembolism


– MCQs
 Q – Isoflurane NOT given in patient of hypotension due to danger of → Vasodilation.
 Mn → Soft Vaseline

 Q – Patient post general anesthesia – GA in recovery room stops breathing and is

cyanosed. What drug caused this → Pancuronium
 Q – Doctor prescribed anti hypertensive due to which blood glucose level reaches 40
mg/l & patient unconscious. Drugs was → β blocker
 β blocker Side Effect → Hypoglycemia

 Q – A patient has multiple drug allergies, now he has been given Xylocaine what will
occur → Mild Syncope
 Q – Which of following is a complication of Epidural anesthesia given for narcotic
administration → Hypotension.
 Q – Side effect of giving first-generation Histamine H1 antagonists is → Sedation
 Q – Histamine, NG, Isoprenaline, dopamine & theophylline have same side effect which is
→ Tachycardia.
 Q – Side effect of Morphine → Bradypnea / Bradycardia and Miosis
 Q’ – Side effect of Morphine → Diarrhea.
 Q – Patient receiving antipsychotic therapy develop sore throat, fever, Leukopenia.
Most likely drug is → Clozapine (Atypical Anti Psychotic)
 Q – Which drug at therapeutic dose causes Tachycardia → Isosorbide Dinitrate ???
 Q – Cimetidine Side effect → Inhibition of Cytochrome P450 enzyme Inhibitors
 Mn → jab bhi cement lagta hia – Liver me ana jana band

 Q’ – Cimetidine interaction with Warfarin → Decrease hepatic clearance of Warfarin.

 Q’’ – Person on oral anticoagulant for long time and INR well controlled between 2 and
2.5. Now he developed bilateral wheeze. His INR is now 5. Which drug was given along
with anticoagulant to bring about this effect in INR → Ciprofloxacin
 One of the drug which inhibit Cytochrome P450 enzyme
  Q’’’ – Patient with chest infection on drug, come with deranged INR which drug is
responsible → Clarithromycin
 One of the drug which inhibit Cytochrome P450 enzyme

 Q – Terminal cancer to reduce side effects Morphine is given along with Paracetamol
(decreases morphine consumption and decreases its adverse effects) Morphine side
effect → Meiosis, bradycardia
 Q – Case of Endometriosis. Patient took Danazol 3 months back, Side effect of drug →
Hirsutism
 Q – Common cause of increase bleeding time → Aspirin toxicity
 Q – Analgesics causing tachycardia in therapeutic dose → Pethidine
 Mn → hakeem ki pakhi ↑ HR – Pethidine

 Q – Cyclosporin side effect → Dose related nephrotoxicity.

 Q – Common side effect Theophylline and nitrates → Tachycardia
 Q’ – Common side effect of Theophylline → Seizures
 Q – A DM patient was started on a new oral antidiabetic medication for last 10 days.
Now he complaints of GI distress & Metallic taste. Most probable medication it is →
Metformin
 2 drugs cause metallic taste

 Metronidazole (antibiotic)

 Metformin (anti–diabetic)

 Q – Most common risk of giving systemic steroid to diabetic patients is → Deranged

diabetic control ???
 Q – Which drug reduces metabolism of Theophylline → Cimetidine
 Rx → Cimetidine is Cytochrome P450 enzyme inhibitor.

 It also comes as

 Q – Metabolism of Theophylline is slowed by concomitant use of → Cimetidine



Gastric Ulcer Drug – Cimetidine

418. Regarding Cimetidine-sucralfate interaction → Sucralfate doesn't let cimetidine get absorbed


– Remember these highly repeated questions about cimetidine

– H2 receptor antagonists
 Q – H2 blocker / Cimetidine are given before C section because → Decrease Volume +
acidity of gastric content
 Mn → CAVE

 Q – The main difference between Cimetidine and Ranitidine → Ranitidine Is less likely to
produce CNS toxicity.
 It also comes as

 Q – Ranitidine is different from Cimetidine as → It has less CNS toxicity

 Q – Ranitidine is superior to Cimetidine – Rx → has less CNS side effects
 It also comes as →

 Q – Cimetidine significantly prolongs prothrombin time and cause bleeding in patients on

Warfarin by → Decreasing hepatic clearance of Warfarin
 Q – H2 blocker (Cimetidine) ineffective in → Zollinger Ellison Carcinoma.
 Rx → Zollinger Ellison is Gastrinoma.


Others (Not in Rafiullah)
– Calculations
 2 % mean
 2 gm in 100 ml OR

 2000 mg in 100 ml

 If a vial contains 2 % of 4ml lidocaine, how much in mg lidocaine is →

 100 ml = 2 g

 100 ml = 2000 mg

 1 ml = 2000/100 = 20 mg

 4 ml = 20 x 4 = 80 mg

 Q – Concentration of physiological saline is 0.85 % or 850 milligrams per 100 ml.



MCQs from Past Papers

 Q – Chlorpromazine exhibits antipsychotic effects via → act on dopamine receptors.
 Q – Which one is classified as a prodrug → Enalapril (ACE inhibitor)
 Q – Diazepam relaxes muscle by acting on → Interneurons
 Q – Oxazepam is active metabolite of → Diazepam
 Mn → OD – once daily

 Q – IV infusion effects which organs 1st → Heart.

 Q – Patient addicted to cocaine & heroin → Euphoric
 In option → Depressed ALSO given.

 Depression occurs with chronic use OR when drug NOT available.

 Q – Dopamine half life → 2 minutes

 Q – Shortest Half life of which substance needs continuous IV supply is following →
Dopamine
 Q – Characteristic sign of Penicillin allergy is → Bronchospasm.
 Q – MAC – Minimum anesthetic concentration is related to → Oil / gas solubility
coefficient.
 Volatile substance is inversely proportional to its lipid solubility.

 Q – Sample for ABGs prepared in → Heparinised arterial blood.

 Q – Shortest acting benzodiazepines → Midazolam
 Note

 Alprazolam + Triazolam + Oxazepam + Midazolam → short acting BZs (1.5 to 2.5

hours – First AID)

ⱺ Mn → ATOM
 Triazolam is shortest acting BZs – Google

 Q – A woman who was taking cyclosporine and has a baby. Which part of tooth of baby
will be affected → no effect at all.
 Penicillin and cephalosporin safe in pregnancy.

 Q – Earliest sign of local anesthetic toxicity is → Dizziness & light headedness

