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FUNDAMENTAL

MSK

CVS

Solid Dosage Form

Succinylcholine

ACEI
- captopril
- enalapril
- Lisinopril

Classification of Neuromuscular Blocking


Agent (NMBA) :
1. Non depolarizing NMBA :
- d-tubocurarine
- pancuronium
2. Depolarizing NMBA :
- succinylcholine = suxamethonium
- decamethonium
Suppositories
insertion into body orifices where they
melt, soften or dissolve and exert local
and systemic effects.
rectally, vaginally and occasionally
urethrally .
Advantages :
Easily administered to children, old
persons, unconscious, mentally unstable
Convenient mode of admission for drugs
which irritate GIT, causing vomiting &
destroyed in acidic pH of stomach
Faster onset of action as compared to oral
adm because absorption of drug tru rectal
mucosa directly reaches blood
Disadvantages :
Irritant to mucous membrane (rectum)

MOA :
Phase 1 : depolarizing
depolarize motor end plate
Phase 2 : block (desensitization)
membrane cant be depolarized
Non competitive NMBA

IOP
Intra-gastric pressure
Initial fasiculation followed by
skeletal muscle relaxation
K+ release
Bradycardia

C/U :
1. Provide ms relaxn anesthesia,
endotracheal intubation, surgery, scopic
examn, reduction of fracture and
dislocation, ICU

Problematic in alrge scale prod

2. Carbamazepine + NMBA = NMBA eff

Leaking problem of material tru cavities

3. Quinidine (anti arrhythmic) + NMBA =

Inflammation of anus and lining rectum

4. curare + suc = suc doses req

Urethral / bougies : pencil shape


Anti bacterial, local anaesthetic
Prescription
R : Recipe (Latin take) : after R

S/E :
- hyperkalemia
- 1st dose hypotension
RESPIRATORY
Inhalation Route

Stringent storage conditions

Vaginal / pessaries : cone-shape


Local effect contraceptives, antiseptics
Female hygiene wash

C/U :
HT, HF

A/E :

D/I :
1. Aminoglycoside + NMBA = potentiate
NMB

Classification :
Rectal suppositories : bullet shape
Local action constipation, irritation,
itching
Glycerin, Diclofenac sodium (NSAID)

MOA :
- prevents conversion Ang I to Ang II
(vasoconstrictor)
- blocks rls of aldosterone

Advantages:
Rapid absorption
Rapid onset of action
Maximise drug delivery to site of action
(lungs)
Minimum side effects
No first pass effect observed
Ease of admn
Low dose required
Disadvantages:
Expensive
Respiratory tract irritation may be present
Patient cooperation required
Airway must be maintained
Inhaler devices:
1. Metered-dose inhaler (MDIs)
2. Dry-powder inhaler (DPI)
3. Nebulizers
Drugs:
Short-acting bronchodilators : Provide
immediate relief of asthma symptoms.
E.g. albuterol /salbutamol.
Long-acting bronchodilators : Relieve
asthma symptoms for longer periods of
time. E.g. salmeterol and formoterol .
Corticosteroids : long term prevention of
asthma attacks. E.g. budesonide
Types of Inhalers :

RENAL

REPRODUCTIVE
CNS
Clomiphene citrate
Phenytoin
Estrogen antagonist
Clomiphene citrate, tamoxifen, faloxifene
Non steroidal selective estrogen receptor
modulator (SERM)
MOA :
- partial agonist at estrogen R
- I estradiols feedback on gonadotropins
- sec of estrogen
A/E :
- stim. Ovulation in women with
amenorrhea due to ovulatory dysfunction
- polycystic ovary syndrome ;
- ovarian hyperandrogenism
- infertility
Multiple pregnancy
Ovarian enlargement
Abdominal distension
Hot flushes
Visual symptoms
Nausea and Vomiting
Headache

Furosemide
Loop diuretics
Sulphonamide derivatives : furosemide,
bumetanide, torsemide
MOA :
Inhibits Na+- K+ -2Cl- symport mechanism
15-25% Na+ lost in urine with a large
volume of water
A/E :
- dehydration
- hyponatremia
- hypokalemia
- metabolic alkalosis
- electrolyte imbalance
C/I :

C/U :
- DO of ovulation in pt who wants to
pregnant
- gynecomastia
Oral Contraceptive Pills
Ingredients :
1. Progestin only (mini pill)
- norethindrone
- norgestrel
2. Morning after pill (emergency, high
dose estrogen)
- ethinyloestradiol
- diethylstilbestrol
3. Parenteral Contraceptives
- medroxyprogesterone
- Hydroxyprogesterone
4. Progestin implant
- levonorgesterol
Contraindication :
- pre existing CV disease
- severe obesity
- liver tumors
- liver cirrhosis
- breast cancer
Drug Interaction

Anti epileptic
1. Carboxamides (enzyme inductors) :
Carbamazepine
Oxcarbazepine
2. Hydantoins:
Phenytoin (enzyme inductor), used in
digitalis
intoxication too
3. Barbiturates (Phenobarbital enzyme
inductors) and their
analogues (Primidone prodrug)
4. Succinimides: Ethosuximide
5. Valproates (enzyme inhibitors):
Sodium valproate
6. Benzodiazepines:
Clonazepam
Diazepam
Lorazepam
7. GABA analogues:
Gabapentin
Tiagabine
8. Hetereogenic anticonvulsants:
Lamotrigine, Levetiracetam,
Pregabalin (partial seizures, peripheral
neuropathic pain),
Topiramate, Vigabatrin
MOA :
Membrane stabilization by blocking Na &
Ca influx into the neuronal axon.
or inhibits the release of excitatory amino
acids via inhibition of Ca influx
A/E :
Dose Related:

G.I.T upset

Neurological like headache,


vertigo, ataxia, diplopia,
nystagmus

Sedation
Non-dose related:

Gingival hyperplasia

Hirsutism

Megaloblastic anaemia

Hypersensitivity reactions
(mainly skin rashes and lesions,
mouth ulcer)

Hepatitis rare

ENDOCRINE
A. Antithyroid Drugs
1. Thiourea derivatives
-carbimazole
-methimazole
- PTU
2. Iodides
- K iodide
- Lugols iodine
3. Radioiodine
- Sodium iodide
4. Ionic inhibitors
- Potassium perchlorate
- Potassium thiocyanate
5. Inhibitors of peripheral T3 production
- propylthiouracil
- sodium ipodate, iopanic acid
- glucocorticoids
B. Drugs for symptomatic control of
hyperthyroidism
1. adrenergic blockers : propranolol
2. CCB : diltiazem

Propylthiouracil also inhibits the peripheral


conversion of T4 to T3
C/U
- Hyperthyroidism, DTG
- PO prep thyroidectomy
- With radioiodine therapy
- PTU : throid crisis rapid action
A/E
Common : pruritus, mild rash
freq : joint pain, headache, N
Rare, serious : granulocytopenia
myasthenia gravis, megacolon, glaucoma
or obstructive prostatic hypertrophy
Treatment of thyroid storn :
- Dexamethasone large dose /
Hydrocortisone IV
- PTU large dose
- Lugols iodine
- Treatment of congestive HF
- Treatment of fever anti pyretic
- Sedation, rehydration
** PTU + spironolactone,
hydrocholorthiazide (K sparring
diuretics ?)
Ondansetrone, Dexamethasone (anti
emetics)
GIT
Anti amoebic
1. Lumen amoebicide (asymptomatic)
- Diloxanide furoate
- Iodoquinol
- AB : paromomycin, tetracyclines,
erythromycin

Thiourea derivatives : Methimazole, PTU


MOA
Inhibits thyroid hormone synthesis by
inhibiting oxidation, organification,
coupling (sites 2, 3 & 4)

2. Tissue amoebicides (systemic)


Intestinal wall infecn, liver abscess
- Emetine
- Dehydroemetine
- Chloroquine (liver only)
3. Mixed amoebicides
- Metronidazole
- Tinidazole
- Ornidazole

H. pylori infection
AB :
- Amoxycillin
- Tetracycline
- Clarithromycin
- Metronidazole
Triple therapy (1st line)
-PPI (omeprazole, lansoprazole,
rebeprazole, pantoprazole, esomeprazole)
- Clarithromycin
- Amoxicillin / Metronidazole
BD, 14 days
4 drugs regimen (2nd line)
- PPI BD
- 3 capsules of combination ;
- bismuth subcitrate
- metronidazole
- tetracycline
QD, 10 days
Anti emetic
Motion sickness : hyoscine
Cytotoxic drugs : Ondansetron 5HT3 R
antagonist
Severe V : ondansetron +
dexamethasone +/- lorazepam (all IV)
After GA : metoclopramide, O
Pregnancy : promethazine
Vertigo : chlorpromazine
Minieres : Diphenhydramine
Chemotherapy : Ondansetron
Hyoscine :
Anticholinergic
MOA
block central muscarinic receptor on VC &
gut (relaxation of GIT)
C/I
myasthenia gravis, megacolon, glaucoma
or obstructive prostatic hypertrophy
A/E
- Dry mouth
- Dry skin, sweating
- Itchiy skin rash