Evaluating Exam Review Book

001 Canadian Pharmacy Review Content ver1
	Misbah Biabani, Ph.D
	Abbreviations
		Part 1. Biomedical Sciences 15%
		Part 2. Pharmaceutical Sciences 25%
		Part 3. Social/Behavioural/Administrative Sciences 10%
01 Chapter Human Anatomy
	Body Movements (Fig 1.1)
		 Extension: Lengthening or straightening of a flexed limb.
		 Flexion: Bending of a part of the body.
		Orthostatic: Standing upright and lying down supine.
		Weight bearing joints
	Muscles:
		Tips
			 Adduction ( (   )
	 Which one is a part of the shoulder? (   )
02 Chapter Gastrointestinal System
	This chapter review anatomy, physiology and pathophysiology of the gastrointestinal system, common disease that occurs in gastrointestinal tract.
	Mouth
	Esophagus
	Stomach
	G Cell
	*Deficiency of intrinsic factors causes a type megaloblastic anemia i.e. pernicious anemia.
	Gastric acid secretion mechanism. In the parietal cells CO2 and H2O are converted H+ and HCO3- catalyzed by carbonic anhydrase. The parietal cells secrete HCl into the lumen of the stomach and concurrently absorb HCO3- into the blood stream.
	Gastric acid stimulations. Gastric acid production is stimulated by three mechanisms.
	Gastrin: It is released in response to eating a meal (protein), thus stimulates parietal cells to secrete H+.
	Pathophysiology of gastric acid secretions causes gastric ulcer, duodenal ulcers and Zollinger-Ellison syndrome.
	Small intestine: Consist of duodenum, jejunum, and ileum.
	Duodenum: First part of the small intestine, C-shaped 10" (inch) long and curves around the head of pancreas and the entry of common bile duct.
	Large Intestines: It is also known as colon.
		Diseases of the gastrointestinal system
		Diseases of the Colon
		Digestion and Absorption
		Carbohydrates digestion: The most common site of carbohydrate absorption is small intestine. Only monosaccharides such as glucose, fructose, and galactose are absorbed.
	Disorder of carbohydrate absorption. Lactose intolerance results from absence of brush border lactase. Thus, non-absorbed lactose cause osmotic diarrhea.
	Milk intolerance can result from 2 reasons. 1) Lactose intolerance 2) milk protein allergies
	Lipid Absorption. Bile acids emulsify lipids in the small intestine, increase surface for digestion. Pancreatic lipases, hydrolyse, lipids to fatty acids, monoglycerides, cholesterol and lysolecithin.
	Lipid absorption disorders. Malabsorption of lipids thus causing fatty stools, this also referred as stethorrhea.  Stethorrhea can cause by
	Absorption of Proteins (small intestine): Trypsin and chymotrypsin are secreted by pancreas, which helps in digestion of proteins.
	Absorption of nucleic acid:
	Absorption of Vitamins and Nutrients: Fat soluble vitamins (ADEK) are absorbed in small intestine along with other lipids. Vitamin B12 is absorbed in the ileum and that requires intrinsic factor.
		Absorption of calcium: Mainly occurs in small intestine, which assisted by active form of vitamin D3, 1, 25-dihydroxycholecalciferol, which is produced in kidney. Chronic renal failure or vitamin D deficiency results in inadequate intestinal Ca2+ abso...
	(stomach)                                                 (small intestine)
	Absorption of Iron:  It is absorbed as heme iron (iron bound to hemoglobin or myoglobin) or as free Fe2+.  In intestinal cells, heme iron is degraded to Fe2+ and released. The free Fe2+ binds to apoferritin and is transported into the blood.
		Innervations of GI tract. Autonomic innervations.
			 A patient with chronic renal failure have deficiency of vitamin? (      )
		  Active Vitamin D is ( (        )
03 Chapter Nervous System
	3
	Nervous System
		Nervous system divided into central nervous system and peripheral nervous system. The central nervous system consists of brain and spine.
		Brain
		Meninges
	Pathology of neurological disorders
	Tips
	  Sciatica is ( (                 )
04 Chapter Cardiovascular System
	Conduction System of the Heart (fig 4.4)
	Blood flow sequence: Vena cava ( right atrium ( right ventricle ( left pulmonary artery( LUNGS ( left pulmonary vein ( left atrium ( left ventricle ( aorta ( systemic circulation
	Septal defect: Ventricular septal defect is a hole in the wall separating the two lower chambers of the heart.
	Types of pacemakers
		Decrease K+ efflux out to cell
			Myocardial action potential curve: Myocardial action potential curve reflects action potential, which describes electrical activity of five phases. This occurs in atrial and ventricular myocytes and purkinje fibers.
		Electrocardiograph Wave Forms: The electrical activity occurred during depolarization and repolarization transmitted through electrodes attached to the body and transformed by an electrocardiograph (ECG) in to series of waveforms.
			Laplace's Law: Laplace's law describes how tension in the vessel wall increases with Trans mural pressure. According to Laplace’s law, tension is proportional to the radius of a sphere.
	Depolarisation and repolarisation?
05 Chapter Endocrine System
	Oxytocin (formed in hypothalamus and stored in posterior pituitary gland).
	Calcitonin takes Ca from Blood ( Bones
	Insulin
	Pancreas
	Glucagon
	Epinephrine
	Testosterone
	Prepares for pregnancy
	Diabetic Patient
	What decreases insulin requirement?
	Pregnancy test: Human chorionic gonadotropin (hCG) hormone levels are elevated in first 3 months of pregnancy (first trimester). Progestin's in pregnancy is produced by ovaries, corpus luteum and placenta.
06 Chapter Renal System
	6
	Renal System
	Nephron.  A nephron is the basic unit of renal function. There are millions of nephron present in each kidney. Nephron has three major functions.
		Causes. Some of the most important causes of prerenal ARF are dehydration, heart failure, sepsis (severe infection), and severe blood loss.
	Intracellular
	Hypercalcemia
	Hypocalcemia
	Hyperphosphatemia
	 Occurs due to hypoparathyroidism (low PTH).
	Potassium regulated by.
	Hyperkalemia
	Hypokalemia
	Hyperchloremia (Cl- excess) and hypernatremia (Na+ excess in the blood)
	Hypochloremia
	Hyponatremia
		Metabolic alkalosis (pH >7.45): ↑ Bicarbonates (HCO3-) in blood and ↓ CO2 in blood.
	Respiratory Alkalosis
		 Pre-renal ARF is due to ( (      )
		 Normal serum potassium levels ( (       )
	 Summary of electrolytes action in kidney (True/ False)
07 Chapter Liver functions and chronic liver diseases
	7
	Liver and Chronic Liver Diseases
		Definitions
		 Necrosis cellular breakdown example: Acetaminophen
		 Steatosis: Hepatocytes filled with small droplet of lipid. Example: Tetracycline’s
			Drugs transportation into the bile from the liver
	Spontaneous Bacterial Peritonitis
	Wilsons Disease
	Viral Hepatitis: There are 5 types of hepatitis viral infection, hepatitis A, B, C, D, and E. However, the common infections are hepatitis A, B and C.
		Hepatitis A
		Hepatitis B and C
08 Chapter Respiratory System
	8
	Respiratory System
	Obstruction of airflow is irreversible
	Flu vaccine annually and Pneumococcal vaccine Q5-10y in high risk.
	Causes of COPD, smoking,   Alpha1-antitripsine deficiency, air pollution, secondary smoke.
09 Chapter Urinary System doc
10 Chapter The Eye and Ear doc
	Higher in number
	Cataract: When the eye lens becomes cloudy, decrease acuity, and no pain, and this obstruct the vision is referred as cataract.
	Dental anatomy and physiology
	 Blind spot is ( optic disc
	 Glaucoma occurs due to ( abnormal increase IOP in eyeball
11 Chapter Blood and Anemia
	45% Cells
	Vitamins
	Electrolytes: The Electrolytes present in blood are Na+, K+, Ca2+, Mg2+, Cl- and CO3
		Agranulocytes
	Rh factor: Agglutinogens in human RBCs are known as the Rh factor blood with this factor is described as Rh +ve (90% of population). Blood without this factor is described as Rh (-) negative. In Rh-negative mother, Rh-positive antigens may transfer fr...
	Qualities of Blood
	Megaloblastic Anemia (macrocytic anemia) Mean cell volume is increased. (MCV >100 fL)
	Filgrastim. It is glycoprotein produced through recombinant DNA technology.
	Hemolytic anemia: The sickle cell anemia disease is an inherited disorder caused by a defect in the gene for hemoglobin. Sickle cell anemia and thalassemia are hemolytic anemia associated with abnormal hemoglobins.  Due to poor solubility of such abno...
	Coombs test: The coombs test is used to distinguish immune mechanism or glucose 6-phospho dehydrogenase (G6PD) deficiency anemia. In autoimmune hemolytic anemia, coombs test is positive. Example of drugs that cause false positive coombs test penicilli...
12 Chapter Biochemistry
	Carbohydrates
	Classification
	Common questions in pharmacy exam is to ask!
	Carbohydrate metabolism. Glycogenesis, Glycogenolysis, Glycolysis, Gluconeogenesis.
		Gluconeogenesis
		Amino Acids: The amino acids from proteins are precursor of compounds and energy source like converted to acetyl CoA. Amino acids degradation eliminated -NH2- group and this converts to NH3 and this may be toxic. Ammonia eliminates through conversion ...
	Urea cycle
	Liver
	 Arginine ( Nitric oxide (NO)( vasodilator
	Glycine ( Porphyrine ring ( Hemoglobin
	Zwitter Ion: Amino acids are ionisable +ve ions as amines, -ve ions as acid. (no net charge)
		Proteins
	Fats and Lipids
13 Chapter Fluids Electrolytes and Nutrition
	This chapter review the important feature of the vitamins is that they generally cannot be synthesized by mammalian cells and, therefore, must be supplied in the diet.
		Canada's Food Guide, eating well with Canada Food Guide provides evidence base information on nutrient standards and the prevention of chronic diseases.
		Infants nutrition
			Folic Acid (vitamin B9)
	Vitamins
		Fat soluble
	Water soluble
14 Chapter Microbiology
	14
	Microbiology
	Bacterial Structure
	Fungal infections: Candidiasis (yeast), Athletes foot
	GRAM –ve and aerobic bacteria
	GRAM +ve and aerobic bacteria
	Gram –ve cocci
		Moraxella catarrhalis
			Salmonella
			Clostridium
				C. tetani
				C. botulinum
	Gram + ve cocci
		S. viridans (alpha hemolytic)
		S. aureus (Coagulase +ve)
		Cyanobacteria diphtheriae
	GRAM –VE and Anaerobic bacteria
		B. fragilis
	 
	 
	BACTERIA
	 
	Gram +ve Cocci
	Found on the skin and in the nose
	Boils, and Septicemia
	Penicillin G and Penicillin V, cefalexin
	Food poisoning
	Staphylococcus aureus
	Wound infections, skin infections impetigo, and cellulitis.
	Catalase positive
	Toxic shock syndrome (TSS)
	Clarithromycin
	Tonsillitis, Cellulites, impetigo. Scarlet fever, Septicemia may cause immune-mediated disease (e.g. rheumatic fever).
	Beta-hemolytic streptococci e.g. Strep pyogenes (Group A Strep: GAS)
	Erythromycin
	Azithromycin
	Penicillin G, cloxacillin, cefalexin
	Amoxicillin
	Penicillin G
	Pneumonia (CAP), Otitis media, Meningitis, Sinusitis, Pharyngitis
	Alpha-hemolytic
	Clarithromycin
	Streptococcus pneumonia
	Azithromycin
	Amoxicillin, Penicillin G, Clindamycin
	Endocarditis,
	Alpha-hemolytic
	Dental caries
	Streptococci viridans
	Instrument contamination.  Catheter infections, UTI
	 
	S. epidermidis
	Gram +ve bacilli
	Erythromycin or penicillin's (to eliminate carrier state)
	Diphtheria (disease due to toxin production)
	Corynebacterium diphtheria
	Tetracycline
	Clostridia sp.
	Tetanus,
	Cl. tetani
	Metronidazole, or vancomycin
	Gas gangrene
	Cl. perfringens
	Botulism
	Cl. botulinum
	Pseudo membranous colitis
	Cl. difficile
	 
	 
	Gram-ve bacilli
	Uncomplicated UTI. Sulfa drugs (cotrimoxazole), nitrofurantoin, Trimethoprim, fluoroquinolones (cipro, norfloxacin, Ofloxacin)
	Urinary tract infections (90%),
	E. coli
	Traveler's diarrhea
	Proteus sp.
	E. coli (diarrhea). Ciprofloxacin, and Levofloxacin,
	Wound infection, sepsis.  Normal inhabitants of the gut.
	Klebsiella sp
	Enteric fever (typhoid), food poisoning
	Chloramphenicol (typhoid)
	Most sp. are animal pathogens (e.g. eggs etc). S. typhi infects man only, causes typhoid.
	S. typhi
	Salmonella sp
	Ciprofloxacin
	Dysentery (bloody diarrhea or shigellosis).
	Shigella sp.
	Carbapenems (imipenem, meropenem)
	Nosocomial (hospital acquired) and opportunist infections (most common S. aureus).
	Aminoglycosides +/-
	Pseudomonas aeruginosa
	Ampicillin,
	Ceftazidime (3rd)
	Clarithromycin,
	Azithromycin
	Pneumonia, meningitis, Otitis media
	Hemophilus influenza
	Ampicillin, amoxicillin
	Tetracycline
	 
	 
	Gram -ve cocci
	Penicillin G
	Meningococcal meningitis +/- shock commensal of upper respiratory tract
	Neisseria meningitides
	Cefixime
	Ceftriaxone im/iv
	Ciprofloxacin
	Gonorrhea (STIs). Always pathogenic.
	Neisseria gonorrhea
	Levofloxacin
	Ofloxacin
	Azithromycin 1g
	Chlamydia
	Chlamydia trachomatis
	 
	 
	Acid-fast bacilli
	Isoniazid
	Tuberculosis. (Weight loss, coughing, fever, sweating, chest pain)
	Rifampicin
	Streptomycin
	Mycobacterium tuberculosis
	Ethambutol
	The most common cause of infectious death world-wide.
	Pyrazinamide
	Dapsone
	Leprosy
	Mycobacterium leprae
	Rifampicin
	 
	 
	Spirochetes
	Syphilis (STIs) (genital ulcers or chancres), single large ulcer, and painless.
	Penicillin G im inj.
	Treponema pallidum
	Doxycycline
	 Have thick, ergosterol containing cell walls and grow in humans as budding yeast cells and slender tubes (hyphae).
	Fungi
	Nystatin
	Thrush, mucocutaneous infection, vulvovaginitis
	Candida albicans (yeast)
	Clotrimazole, miconazole
	Tolnaftate (topical)
	Athlete’s foot
	Tinea pedis
	Abscesses (puss)
	Sporotrichosis or granulomas
	Skin, nail and hair infections, sometimes acquired from animals.
	Ringworm
	Dermatophytes
	Ubiquitous airborne filamentous fungus
	Allergic reactions, opportunistic infections
	Aspergillus sp.
	Meningitis in immunocompromised
	Present in soil and pigeon droppings
	Cryptococcus neoformans
	 
	 
	Protozoa
	Malaria. Four sp. infect man via biting female anopheles mosquito.
	Chloroquine, Mefloquine
	Plasmodia sp
	Primaquine, Doxycycline
	Low grade gastrointestinal disease: giardiasis.
	 Metronidazole
	Giardia lamblia
	Amoebic dysentery (are infective when swallowed, traveler’s diarrhea). Severe, may invade and spread to the liver.
	Metronidazole
	Entamoeba histolytica
	Ciprofloxacin
	and Giardia lamblia (intestinal protozoa)
	Cotrimoxazole
	 
	 
	DNA viruses
	 
	Conjunctivitis, Sore throat
	Adenoviruses
	HSV1 and HSV2 can cause oral and genital lesions. HSV1 causes cold sores and Keratoconjunctivitis.
	Acyclovir
	Famciclovir
	Herpes viruses
	Herpes simplex virus
	VZV can cause (Varicella: chickenpox, zoster: Shingles), glandular fever,
	Foscarnet
	Herpes zoster
	Ganciclovir
	Cytomegalovirus (CMV)
	Epstein-Bar (EB virus)
	Roseola infantum (sixth disease)
	Hepatitis B Transmitted via blood and body fluids and sexual contact.
	Interferon alpha
	Hepadnavirus. Hepatitis B
	Slapped cheek disease, (fifth disease, and erythema infectious).
	Can cause aplastic crises
	Parvovirus: parvovirus B
	HPV vaccine. Implicated in cancer of the cervix.
	Papovaviruses: papillomavirus,
	Warts, cervical cancer,
	Vaccine Gardasil. Quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine.
	Hemorrhagic cystitis.
	Polyomavirus
	Molluscum contagiosum, smallpox
	 
	Poxviruses
	 
	 
	RNA viruses
	Amantadine, Ribavirin, Rimantadine (influenza A).
	Orthomyxoviruses:
	Influenza (flu)
	Influenza A and B
	Yellow fever, chronic hepatitis
	Flaviviruses. Yellow fever, Hepatitis C
	 
	Paramyxoviruses: parainfluenza, RSV, Measles Mumps
	Respiratory infections: Croup
	May be severe in infants
	Measles, mumps
	Meningitis, Common cold (rhinoviruses)
	Picornaviruses: Enteroviruses (e.g. poliovirus), rhinoviruses, Hepatitis A
	 Rhino has runny nose
	Hepatitis
	 
	Gastroenteritis
	Reoviruses: rotavirus
	NRTI, NNRTI
	AIDS, T-cell leukemia,
	Retroviruses: HIV-1, 2
	Spastic paraparesis
	HTLV I, II
	Zoonotic infection
	Rabies
	Rhabdoviruses: rabies
	German measles (Rubella),
	Togaviruses: Rubella,
	 
	Encephalitis
	Alpha viruses
15 Chapter Cell and Molecular Biology
	Prokaryotic
		Animal: no cell wall but cell membrane
	Yes chloroplast
		Present in bacteria
	Cell organs compose of a number of tissues, and each tissue composes of cells of the same type. The individual cell is the minimal self-reproducing unit in all-living species. It performs two types of functions, such as performs chemical reactions nec...
		Centrosomes: Microtubule does cell division or formation spindle apparatus during cell division.
			Chromosome, Gene and Genome
	Gene Expression
		Nucleic acid (DNA and RNA).  Nucleotides are the building blocks of all nucleic acid molecules (such as DNA and RNA). These structural units consist of three essential components, i.e.
	DNA
	The DNA molecule consists of four bases Adenine (A), Cytosine (C), Guanine (G), Thymine (T)
	There are 3 types of types of RNA based on their functions:
		Codon
		DNA   ---------------------( mRNA      ( tRNA ( rRNA (  (  ( Protein synthesis
		Step 2. Translation ( mRNA ( tRNA.
	Introns and exons: The coding region of a eukaryote’s gene is different from that of a prokaryote. For Eukaryotes, each gene contains introns and exons. Intron is a segment of gene situated between exons. It is not responsible for the coding of protei...
		 DNA bases ( A, C, G and T  (True/False)
16 Chapter Pharmacogenetics
17 Chapter Immunology and Immunization
	THE ORGANS OF THE IMMUNE SYSTEM
	LYMPH NODE. Lymph nodes are small, bean-shaped structures that are laced throughout the body along the lymphatic routes. Lymph nodes contain specialized compartments where immune cells congregate, and where they can encounter antigens.
		B CELLS: B CELLS have thousands of identical antibodies in their membranes that allows them to bind chemically to a small group of chemically related antigen.
	Less than 1%, Functions not well understood.
	Ig E
		IgE mediated type I: Anaphylactic reactions. It is treated by epinephrine. (Penicillin's, bee stings, latex, pea nut).
	Structure of immunoglobulin's
	Ig A is secreted during memory response, this accounts for 10% of serum immunoglobulins.  It is secreted across mucosal surfaces into gastrointestinal, respiratory, lachrymal, mammary, and genitourinary secretions.  Where this protects mucosa from col...
		Natural Killer Cells
		Interferon: The interferons are the family of cytokines proteins, important in the immune response. Interferon Proteins that are secreted by cells when they become infected with virus. Bind to nearby infected cells and prevent viral infection. This in...
		Colony Stimulating factors:
	Ig A
	Cytotoxic/anti-body mediated hypersensitivity:
	Antigen-antibody (IgG/IgM) complex
		Active IMMUNITY
	How is HIV transmitted?
	Natural Immunity: Occurs when the person is exposed to a live pathogen, develops the disease, and becomes immune as a result of the primary immune response.
		Flu vaccine: Influenza A&B vaccine (seasonal flu).
			Hepatitis vaccine:
			 Hepatitis A is given anyone over 1 year age
18 Chapter Biotechnology
	Colony stimulating factors (CSF): Glycoprotein cytokines that promote proliferation, differentiation and activation of immune cells.
	Interferon’s
	Interleukins: synthesized by monocytes, macrophages, and lymphocytes. Interleukins are soluble messengers between leukocytes.
		Hybridoma technology (Biologics)
	Etanercept binds with both TNF alpha and beta: The greater risk of etanercept therapy is immuno suppression and subsequent serious infections.
	Clotting Factors: Recombinant antihemophilic factor (rAHF). Indicated for treatment of classical hemophilia A. The dry concentrate of rAHF should be stored between 2 to 8o C and protect from freezing.
	Human growth hormone (hGH)
		Tips
19 Chapter Clinical Toxicology
	GI Decontamination procedures
	Gastric lavage or gastric gabage: This procedure can be used:
	Syrup of Ipecac is administered within 60 min toxic dose ingestion (later has no benefit)
	Decontamination
	Diuresis: Promotes elimination acids and bases. This can be alkaline and acid diuresis.
	Acid Diuresis: Used to promote elimination of weak bases. Example amphetamines, phencyclidines, quinidine derivative, and alkaloid drugs.
	Methanol
		Acetylcysteine
			Q. Naloxone
	Acetaminophen Overdose
		Iron supplement overdose (Fe fumarate 33%, Fe sulfate 20%, Fe. gluconate 12%)
	 Antidote is deferoxamine (mechanism: it works by chelation)
	Benzodiazepine
	Amoxicillin
20 Chapter Pharmacokinetics
	Pharmacokinetics
		A  Absorption
		Distribution: Volume of distribution is a hypothetical volume of body fluid that would be required to contain the entire drug administered so that the concentration will be the same as that found in the blood.
	Factors affecting drug distribution
	Albumin
	K = elimination rate constant represents the fraction of drug eliminated per unit time.
		Factors that affect renal clearance: As clearance is decreased half-life increases, changes in Vd cause proportional changes in half-life.
	Plateau Principle
		Clearance
		t1/2 = 0.693 Vd/Clt
		Summaries from the above formula
		Formulas
21 Chapter Rates and Orders of Reactions
	Example. Photochemical degradations
	Zero order process application include administration of a drug as an intravenous infusion and controlled release dosage forms (SR, XL, MR) and Trans dermal patches.
	First order Kinetics:
	Slope –k/2.303
	Third order reaction. Rate of reaction is proportional to concentration of each of the three reactions
	Pseudo order. Rate of reaction is proportional to the concentration of only one reactant, in two-reactant reaction, if a reactant present in high concentrations.
		 Example: Photochemical degradations
	First order reactions
	Slope –k/2.303
22 Chapter Pharmacodynamics
	22
	Pharmacodynamics
	Competitive or non-competitive agonist and antagonist rates!
	Type of drug interactions; Mathematical model
	Therapeutic Window. The therapeutic window is the useful “opening” between the minimum therapeutic concentration and the minimum toxic concentration of a drug.
	Enzyme inhibition.  Chloramphenicol.
	First order
	Zero order
23 Chapter Medicinal Chemistry
	Basics of Organic Chemistry: Organic chemistry is the study of substances that contain carbon, hydrogen, oxygen, nitrogen, sulphur etc. However, carbon is the essential element in organic chemicals.
	Functional groups
	Diastereoisomers. Two asymmetric carbon atoms. They are super imposable and are not mirror images.
24 Chapter Medicinal Chemistry and Pharmacology of Autonamic drugs ver1
	Generally pharmacological receptors can be categorized into 4 types
		 Glutamic acid (glutamate) excitatory:  NMDA receptor. Example. Memantine
	Cholinergic
	Adrenergic
	Ion channels: There are two types of ion channels
	 Voltage gated: Na+ channel, Ca2+ channel, K+ channel
		Transcription regulators: There are over 150 receptors of this family, which acts as transcriptional receptors. This is second major class of receptors, which include steroid hormones including estrogens, androgens, and the glucocorticoids such as cor...
	Norepinephrine
		Dopamine
		Glycine
		Glutamate
	Reversible
	Reversible
	Dehydroxylation of pseudoephedrine gives methamphetamine
	Tertiary amines
25 Chapter Medicinal Chemistry and Pharmacology of Histamines, Serotonins, Leukotrienes, NSAIDs
	Histamines: The histamine is produced from mast cells. Histamines act on three receptors, of these H1, H2 receptors are excitatory and H3 receptors.
		Pharmacology H1-antihistamines
		H2 antagonist chemistry
	Has C-O-C, C-N bonds
	Ethanol amines:
	Diphenhydramine
		Piperizines
		2nd Generation (AM)
		Piperazine derivatives
	NO anticholinergic effect
	Less sedation due to less lipid soluble and do not penetrate the BBB.
	Non selective
	Ergotamine (DHE) are 5HT2 agonist.
	Antagonist of 5HT2a atypical antipsychotic olanzapine
		Agonist
	Triptans
	PGE analogs
		PGI analogs (prostacylcin) chemistry
		Thromboxanes (TxA2).
		Chemistry of Salicylates derivatives
			Onset: 5-30 min, duration 3-6 hours
			Analgesic action
	Epoprostenol
	Dinoprostone
	Dipyridamol inhibits platelet aggregation
	Latano"prost"
	Antipyretic action
	Antiplatelets action
	Irreversible platelet inhibition and inhibition of Cox-I & Cox-II action gives antiplatelets action. Antiplatelets action minimum dose is 60 to 80 mg.
	Problems associated with NSAID and acetyl salicylic acid.
	 Respiratory depression: Toxicity respiratory alkalosis and metabolic acidosis (increase CO2 and decrease pH).
		Oxicams derivatives side effects
	Glutathione is consisting of glutamic acid, cysteine, and glycine
	Phenyl piperidine Derivatives
	Morphinan Derivatives
	Natural opium alkaloids
26 Chapter Medicinal Chemistry and Pharmacology of Cardiovascular Drugs
	Thiazide diuretics chemistry: Benzene ring with sulfonamide in position 7, and halogen or trifluoro methyl group in position 6. The electron withdrawing group at position 6 is necessary.  Saturation of 3, 4 double bonds (increases potency with hydroch...
	Thiazide diuretics pharmacology
	Thiazide diuretics therapeutic uses
	Thiazides diuretics side effects  (Hyper GLUC)
	Loop diuretics pharmacology
		Loop diuretics side effects: [OH DANG] Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), except ethacrynic acid, Nephritis (intestinal), and Gout arthritis.
		Carbonic anhydrase inhibitor chemistry: Acetazolamide.  Aromatic or heterocyclic sulfonamides with a thiadiazole ring.
	Carbonic anhydrase inhibitor therapeutics: Used in treatment of glaucoma (not chronically). Acute mountain sickness (respiratory alkalosis) also high altitude sickness (mountain sickness). Because of the alkaline diuresis it produces, acetazolamide ha...
		Carbonic anhydrase side effects
		Osmotic diuretics pharmacology
	Osmotic diuretics therapeutic use
		Potassium sparing diuretics: Spironolactone, eplerenone, amiloride, and triamterene
	Potassium sparing diuretics chemistry
		Potassium sparing diuretics pharmacology
		Potassium sparing diuretics therapeutic use
		Potassium sparing diuretics side effects
			Vasodilators
	ACE Inhibitors therapeutic use
	ACE Inhibitors side effects
	Antihyperlipidemic Drugs
		Antihyperlipidemic drug chemistry. Categorized into non-absorbable agents and absorbable agents.
	Cholestyramine chloride
	Colestipol hydrochloride
		Absorbable agents
		Administered orally, it converted in body to nicotinamide, NAD+ and NADP+.  The later two are coenzymes essential for biochemical oxidation, reduction reactions. Participation in tissue respiration oxidation, reduction reactions, which decreases hepat...
	Statins
		HMG-CoA reductase ( Mevalonic acid(cholesterol
		Antianginal agents
	Statins structure activity?
	Pharmacology of nitrates
		Nitrates therapeutic use: Relieve acute anginal attacks, as prophylaxis, for long-term management of recurrent angina pectoris.
		Nitrates side effects
	Calcium blockers pharmacology: These agents are used to treat hypertension and are effective in treating angina as well. All muscles, including the smooth muscle of the blood vessels, require calcium inorder to contract. If the CCB block the entrance ...
		Dihydropyridine
		Non-dihydropyridine side effects
		Anticoagulants classification
	Anticoagulants chemistry
		Anticoagulant side effects
	Thrombolytic chemistry
		Thrombolytic pharmacology
		Thrombolytic side effects
		Antiplatelet drugs pharmacology
		Antiplatelet drugs therapeutic use
		Antiplatelet drugs side effects
		 Dobutamine, isoproterenol ( ↑SBP & ↓ DBP
27 Chapter Medicinal Chemistry and Pharmacology of CNS drugs
	Irreversible MAOi
	Non-selective
		5HT only
	Dual action
	SNRI
	NDRI
	Antidepressants
		Tricyclic antidepressants (TCA) pharmacology
	Tricyclic antidepressants (TCA) therapeutic use
		Tricyclic antidepressants (TCA) side effects
	Selective Serotonin Reuptake Inhibitors therapeutic use
		Antipsychotic drugs pharmacology
	CNS stimulants: Methylphenidate, amphetamines
		Benzodiazepine pharmacokinetics
	Methamphetamine have one C-methyl and one N-methyl
	Benzodiazepine pharmacology
	Benzodiazepine therapeutic use
	Barbiturates chemistry
	Barbiturates Therapeutic Use
		Drugs to treat Parkinson’s disease
		Anti-Parkinson’s drugs chemistry
	Thiopental
	Anti-epileptics chemistry
	GABA analogs: Gabapentin, vigabatrin, pregabalin and baclofen (a muscle relaxant).
	Local anesthetics pharmacology
		General anesthetics pharmacology
			 Venlafaxine at higher dose act on (
28 Chapter Medicinal Chemistry and Pharmacology of drugs that act on hormones
	Antidiabetic drugs pharmacology
		First generation: Tolbutamide, Chlorpropamide,
	Third generation: Glimepiride
		Antidiabetic drug Therapeutic uses
	Orlistat (Xenical). Reduces fats stores and produce weight loss. It is an intestinal lipase inhibitor.
	Antidiabetic drugs Side effects
	Thyroid disorders
	Medicinal chemistry of thyroid disorders
		Thyroid hormones drug interactions
	Thyroid hormones monitoring
		Antithyroid drugs Pharmacology
		Antithyroid drug mechanism:
	Mechanism of antithyroid drugs
	Therapeutic uses
	Antithyroid drugs Contraindications / Precautions
	Antithyroid drugs Pharmacokinetics
		Propylthiouracil
		Estrogen chemistry: Ovaries produce 17 estradiol and estrone. These hormones have 18 carbons for four rings. Three 6 membered rings and one 5-member ring. Estrogen exist as estradiol in body in equilibrium with oxidized form of estrone and further bi...
		Estrogen Pharmacology
		Estrogen therapeutic uses
	Testosterone
	Progesterone
	Estrogen
	Testosterone
	Estrogen antagonist
	Progesterone antagonist
	Two types of progesterone
		Progesterone therapeutic use
		Progesterone side effects
	Anti Progesterone pharmacology
	Androgen pharmacology
	Androgen side effects
	Anti-androgens pharmacology:  Inhibit the synthesis of androgen.
	Anti-androgen side effects
29 Chapter Medicinal Chemistry and Pharmacology of Respiratory Drugs
	Asthma
	Long acting beta2 agonist (LABA) (Maintenance or daily): In asthma LABA combined with ICS.
	 Therapeutic use. Maintenance therapy and EIA.  Used in patients already taking corticosteroids. Formoterol can be used for acute and maintenance.
	Corticosteroids
	Oral corticosteroids (Po CST): Prednisone and prednisolone.
	Drug used for the treatment of COPD: Anticholinergics. Ipratropium and tiotropium are muscarinic blocker and act as bronchodilator. Beta adrenergic agonists, Corticosteroids and theophylline.
30 Chapter Medicinal Chemistry and Pharmacology of Musculoskeletal drugs
	Rheumatoid arthritis
		Gout Arthritis
	Acute gout arthritis
		Tips
31 Chapter Medicinal Chemistry and Pharmacology of Antimicrobials
	R = Substitution of R effects in solubility's salts are given orally, R = benzyl penicillin = Pen G. R = Phenoxymethyl = Pen V
	Macrolides: Erythromycin, clarithromycin and azithromycin.
		Inhibition of DNA gyrase (topoisomerase II) and topoisomerase IV makes cell inaccessible and leads to cell death. Different quinolones inhibit different extent of topoisomerase II and IV. DNA gyrase seems more important in gram –ve. Topoisomerase IV i...
		Nitrofurantoin
	Chloramphenicol
	Lincosamides
	Macrolides
		Erythromycin
	Tetracycline's
	Macrolides Tips
		Tetracyclin Tips
		Clindamycin Tips
		Quinolone and fluroquinolone Tips
		Metronidazole Tips
		Sulfadrugs Tips
32 Chapter Drug Metabolism
	Oxidative metabolism
	Alcohol oxidations
		Hydrolysis
		Deamination: Examples of deamination include amphetamine and dopamine.
	Dehalogenation. (Halothane, Chloramphenicol)
	Factors affecting Drug Metabolism
	Enzymes
		Glucuronidation (addition of glucuronic acid)
			Nefazodone
			Phenobarbital
			Grapefruit
			Carbamazepine
	PHASE 2 REACTION
	Genetic factors:  Acetylation rate by N-acetyltransferase, which may result in fast acetylators or slow acetylators (pharmacogenetics).
		Tips
33 Chapter Biopharmaceutics
	Bioavailability and Bioequivalence
	A drug is hydrophobic if partition coefficient is >1
		Mechanism of drug absorption.
		Transport process across membrane
			 Powder [(dispersed + GI fluid → wet) absorbed]
	Degree of ionization: Drugs will pass thru a membrane at a faster rate if they are unionized. The size of an ion increases due to dipole-to-dipole attraction especially water. Ionized portion of drug is less soluble in lipid but more in water.
	Solubility
		Surface area (Ficks law of diffusion)
	Supersaturated Solution: Contains more dissolve solute then it normally would contain at a specific temperature if there were undissolved solute present.  If upon cooling, the excess solute fails to crystallize from the lower temperature, the solution...
	Types of Solvents
	Polar solvents
	Semi polar solvents
	Factor Affecting solubility and Rate of Solution
	Effect of Temperature
	Effect of electrolytes on the solubility of non electrolytes
	Action potential across cell membrane:  Neuronal excitability depends on the influx of ions through specific channels in membranes.
	Membrane depolarization: Excitation = increase Na entry (influx), decrease K exit (efflux)
		Tips
		 Write sequence of absorption for oral dosage, from higher to lower:  solution > suspension > liquid gel caps > powder>
34 Chapter Pharmaceutics
	State of the matter
	Sublimation is?
	Interfacial Phenomena
	Wetting Phenomena:  A solid is said to be wetted by a liquid if the liquid spontaneously spreads over the solid.  A solid is not wetted by a liquid if the latter cannot spread over the former spontaneously. The contact angle is an important parameter ...
	Methyl alcohol (methanol) and isopropyl alcohol, ethylene glycol is toxic, and butyl and amyl alcohol are irritating. Volatile ethers paralyse the central nervous system, and are irritating to mucous membrane increases. Ketones are mildly irritating a...
		London forces in molecules are weak intermolecular forces in liquid hydrocarbon are not true chemical bonds.
	Critical solution temperature: It is the maximum temperature above which homogenous liquid is formed regardless to any concentration of phenol.
	Wetting Phenomenon?
	Chemical kinetic & Drug stability
	Change pH effect on degradation of drugs. The magnitude of the rate of hydrolytic reaction catalyzed by acid (H+) and base (OH-) can change with pH. Acid (H+) catalysis predominates at lower pH, whereas base (OH-) catalysis operates at higher pH.
		Modes of pharmaceutical degradation:
	Buffers and Buffer Calculations: A buffer is a compound or a mixture of compounds that has the ability to resist changes in pH when limited amounts of acid or base are added to the solution of the buffer or when the solution is diluted with solvent.
	1) Examples of colligative properties?
	 Hypotonic. The clinical significance of all this is to insure that isotonic or iso-osmotic solutions do not damage tissue or produce pain when administered.
35 Chapter Pharmaceutical Exipients
	Sterile water for injection USP
		Bacteriostatic water for injection USP
	Packed in single or multiple use dose containers.
		Sterile purified water USP
	Triethnolamine
	Ethyl paraben
	Sodium benzoate
	Benzalkonium chloride
		Benzyl alcohol
		Phenol
	Thimerosal
	Antioxidant
	Ascorbic acid
	Ferric oxide gives red color
	Sodium lauryl sulfate
	Gelatin
	Humectants
		Surfactant
	Filler/
	diluents
	Binder
	Disintegrant
	Glidants
	Lubricant
36 Chapter Rheology
	Non-Newtonian flow is characterized into three types: plastic, pseudo plastic and dilatants.
	Plastic Flow
	Dilatants flow
	Anti-thixotropy systems (RHEOPEXY): Products that exhibit opposite action of thixotropy are referred to as anti-thixotropy.  Anti-thixotropy occurs when solutions to gel transformation. Example dilatants flow.
		Tips
37 Chapter Pharmaceutical dosage forms
	Suppository
	Capsules
	Lozenges
	External Use
	Inhalants
	Miscellaneous
	Emulsions
	Solid Dosage
	Friability
	Question Alerts!
	Trituration
	Levigation
	Spatulation
		Eutectic mixtures
			Suppository Bases
	Physical and chemical properties of suspension
	Purpose. Sustaining effect it necessitates drug dissolution prior to absorption.
		Sedimentation:  The Stoke’s law can express the relationship of the rate of sedimentation with various parameters.
	LARGE PARTICLE SIZE
	( SEDIMENTATION
	HIGH VEHICLE DENSITY
	( SEDIMETATION
	Clays. Bentonite, veegum
		Liquid Dosage Form
	Water and lipid soluble base. Poly ethylene glycol (PEG)
	Examples
		Mechanism
	Spirits
38 Chapter Drug Delivery Systems
	Intravenous
	IM
		Intraarticular
	Parenteral preparations
	Vaginal products
	Controlled/targeted delivery:
	Controlled delivery systems
	Technological methods
	Liposomes for drug delivery systems
39 Chapter Pharmaceutical Analysis
	Gas
	Column
		Planar
		GSC
		GLC
		HPLC
		Paper
	Parameter that affects resolution.
		GLC (Gas Liquid Chromatography)
		 Stationary phase is liquid surface on solid
		GSC (gas solid chromatography)
	TLC Spray Reagent
	Paper Chromatography
	 Stationary phase. The stationary phase is cellulose paper (paper is made from cotton fibres and highly purified about 90% alpha cellulose).
	Question Alerts!
	Ultra Violet/Visible light spectrophotometer:
		 Ultraviolet radiation <400 nm
		 Welding arcs (UV, visible, and IR
	Infrared spectrophotometer
	Atomic-absorption spectroscopy
	The Beer-Lambert law
	Non-aqueous solvents. Acid base titration in non-aqueous solvents. Three types of solvents: Amphiprotic, non-ionisable, and aprotic or inert.
	Criteria for successful determinations
		 Mixture of two volatile liquids can be separated using fractional distillation techniques
		 Example: Ethanol in water, Hexanes in Chloroform
40 Chapter Health Care system in Canada
	 Universality
		The CHA covers
	CHA does not cover
	Federal Drug Benefit Programs covers
		 Natives or aboriginals (covered by NIHB)
		 Inmates
41 Chapter Pharmacy Regulations
	 Schedule III ( Pharmacist intervention ( over the counter, self-selection or 5 to 10 m rule. Lock and leave.
		 Schedule U ( Unscheduled Drugs ( can be sold from any corner store.
	Schedule II
	Pharmacy related professional associations in Canada
42 Chapter Scope of Pharmacy Practice In Canada
	Regulated health professions in Canada
	 Respiratory therapist
	Prescription scope of practice of some healthcare professions
	 Doctor, Dentist, veterinarians, midwife, podiatrist, and nurse practitioner.
43 Chapter Pharmacy Management
	Starting and managing a pharmacy business
		Sole proprietorship
		Partnership
			Retained Earnings Statement.
		Described three commonly used steps in human resources. Job analysis, position description and job description.
			Job Analysis
	Delegation
	Risk Management; Strategic Planning
		 UPC: universal Product Code.
	ABC analysis (Pareto’s law): (20:80 LAW)
		Third Party Insurance. The payment system can be classified into two different categories. Retrospective payment and Prospective payment.
		Ratio indicating financial position
	Ratio indicating efficiency
	Solvency measures a pharmacy’s ability to meet current liabilities with moderate change in the composition of current assets.
	Marketing in pharmacy “4 Ps “of marketing management. These activities, which are under the direct control of the business, were known as the “4 Ps” of marketing product, place, price, and promotion.
	Management use of Structure-Process-Outcome component (SPO)
	Measure of SPO
44 Chapter Pharmacoeconomics
	Pharmacoeconomic Methodologies: There are some scientific methods are used to evaluate pharmacoeconomics.
	Outcome unit
	Cost-effective analysis (CEA)  (dollars ( clinical effects
	Cost-minimization analysis (CMA) (dollars ( equal in both groups
		Cost of illness analysis (COI or CIA) ( does not address both cost and consequences.
	Healthcare Outcome Research
45 Chapter Drug Development Process
	Pre-clinical research (in animals)
		Trial review and approval
46 Chapter Epidemiology
	Descriptive studies
	Cohort Studies
	Randomization: Participants are selected by computer codes, randomization improves the validity of a trial’s results.
		Multi-Centre Trials
	Pros and Cons
	 (-) “Grouping” results from trials with different designs, statistical analyses, and patient populations may be problematic.
47 Chapter Statistics
	Mean:
		Median:
			Mode:
			Range:
				Standard deviation: The standard deviation is another way to calculate dispersion. This is the most common and useful measure because it is the average distance of each score from the mean. The formula for sample standard deviation is as follows.
		Statistical Significance: It’s important to determine whether a treatment effect is really caused by the study intervention or whether it is merely due to chance. A result is said to be statistically significant when it is reasonably unlikely to be du...
			Alternate hypothesis (HA) (relationship hypothesis). The alternate hypothesis states that there is difference between smokers and non-smokers with respect to the risk of developing lung cancer.
		Tips
	Chance
	P or LOS
	 What are the examples of parametric tests are (
	 What are the examples of non-parametric tests are (
	 False +ve test is (
	 Type I error can occur by (
	 Type II error can occur by (
	 Probability of error is presented as (
48 Chapter Hospital Pharmacy
	B) Administering medications to patients
	C)  Eternal tube feeding nutrition calculations
	E) Calculating flow rates for IV infusions
49 Chapter Basic Calculations
	A patient weight 180 lbs has admitted to emergence for congestive heart failure and severe edema. Patient was give furosemide iv infusion for the past 24 hours. After discharge the patient weight was 173 lbs. How many kg patient weight is lost?
	Body Surface Area (BSA):
		 BMI = normal 18.9 to 24.9 (healthy weight)
	Milligrams and Grains
	Millilitres and Ounces
		Percentage: To convert percent to fractions
		Ratio percent:  W/W%
			Proportion and Percent Calculations
		Ratio strength:  5:1,000,000 = 1:200,000
		3) Express 0.0001% in how many ppm? 1ppm
		A) 0.25g B) 5g  C) 250 g   D) 2.5 g
	PHARMACY PREP: RATIO STRENGTH PRACTICE EXERCISE
50 Chapter Pharmacy Dosage Calculations
	Dosage Calculations
51 Chapter Dilutions and Allegations
	51
	Dilution, Concentrations
		Q1 (quantity) X C1 (concentration) = Q2 (quantity) X C2 (concentration)
	Calculations involving dilution and concentration of Stock solutions
		Calculation involving electrolyte solutions
	Molarity
	One mole of HCl = 36 g
	Millimole
	Normality
	Converting weight to milliequivalents
	Milliosmole: The unit of osmotic activity. It is the unit of measuring the osmotic concentration.  Osmotic pressure is directly proportional to the number of particles in the solution.
		For Solutes which do not dissociate, the milliosmole = millimole
		ISOTONIC SOLUTION PREPARATIONS
			Rx
	Dissociation factors: The dissociation factor is the measure of the number of particles resulted in when a substance is placed in aqueous solution.
	Calculations involving Balance sensitivity
		Weight = sensitivity requirement/error
52 Chapter Generic and Brand Names Index ver1
	52
	Generic and Brand Names
53 Chapter Prescription Processing and dispensing
	Synthroid 112 mcg
	Interpreting Directions (SIG) of prescriptions
	Direction of administration of prescription order
	Clarify with patient
	Suspicious prescription of forged narcotic prescription.
54 Chapter Special Population
	Increase with age
	Decrease with age
	Decreased hepatic clearance in the older adults
55 Chapter Promoting Medication Adherence
56 Chapter Professional communication skills
	56
	Professional Communication Skills
	Verbal communication
		Personal barriers
57 Chapter Bioethics and Professional ethics
	57
	Bioethics/Professional Ethics
	Beneficence
	Beneficence: to do good or doing well or doing the very best to patient.
		Harm reduction services such dispensing syringes to drug addicts. Receiving narcotics to destroy from customers.
	Autonomy: Whether like to take or not like to take?
		Autonomy opposite is Paternalism.
		Paternalism: When one fails to respect another’s autonomy, and acts with disregard to the individual rights.  Substitute their own beliefs, opinions and judgment to that of another. Claim they acted in the person’s best interest.
		Honesty and Veracity: Act with honesty without deception.
		Obecalp
			Fidelity (loyal)
			Informed Consent (permission) and decision making
				Confidentiality
			Tips
58 Chapter Drug Information Resoureces
	Literature: It is defined as an extensive, heterogeneous collection of resources, which provide information about drugs. Drug information sources can be categorized into primary literature, secondary literature and tertiary literature.
	Primary Sources: Consist of original information about clinical trials or research. Examples Scientific Journals containing clinical trial information.
	Secondary Sources: Examples Indexes, bibliography and abstracts.
	Tertiary Sources: Examples text books and compendia
		Side Effects
		Drug-Drug Interactions
	Drug-Lab Test Interactions
		Drug-Food Interactions
	Drug-Herb Interactions
		Compounding or Extemporaneous prep
	Formulas For Compounding
	Characteristic Of Specific Chemicals/Drugs
	Compatibility and Stability Of Parenteral Drugs
		Pharmacokinetic Monographs
			Patient Counseling
	Pregnancy and Lactation
		Pediatrics
	Poisoning and Toxicology
		Veterinary Medicine
		Doses And Drug Administration
			Intravenous and Intramuscularly Compatibilities
			Teratogenicity
	USP DI Volume II
		United States and international drug names
	The Medical Letter
	Remington. The Science and Practice Of Pharmacy
		Tips
59 Chapter Medication Errors
	0.9% Sodium Chloride Injection, 1000 mL (2017-05-10)
		Affected products
			Cefazolin for Injection
				DIN, NPN, DIN-HIM
				Dosage form
				Strength
				Lot or serial number
				Companies
	Preventing dispensing errors: In order to prevent dispensing errors, pharmacy should have policy and procedures in place.
	Resolving dispensing errors. Pharmacy should have policies and protocol about resolving dispensing error.  Follow the guidelines provided by the provincial college of pharmacists. However, this is a general discussion to help you get started understan...
	Handling Returned Products
		High alert drug: The drug errors that can cause serious harm to patient.
60 Chapter Health Promotion and Disease Prevention
61 Chapter Collaboration and Team work
	Pharmaceutical Care Delivery System
62 Chapter Sterile Preparations
	Sterile Preparations
	Dry heat sterilization
	 Ethylene oxide gas require 4 to 16 hours
		Sterile Preparations
63 Chapter Drug Storage Conditions
	 Cotrimoxazole suspension (
64 Chapter Patient Care and Drug Related Problems
65 Chapter Adverse Drug Reactions
	ADRs leading to psychotic problem
	"PATD"
	ADRs affecting Respiratory system
66 Chapter Drug Interactions
	Drug Interactions
	Pharmacokinetics, pharmacodynamics and pharmaceutical interactions.
	Pharmacokinetic interactions (Absorption, Distribution, Metabolism and Excretion).
	Alteration of GI flora
		Alteration of motility/Rate of gastric emptying time and absorption
	Stimulation of metabolism
	Metabolism inhibitors:
	Theophylline and macrolide. Macrolides such as erythromycin, clarithromycin inhibit CYP3A4.
	Pharmacodynamic interaction: Drugs having opposing pharmacological effects.
	Lithium and diuretics: Diuretics gives side effect of hyponatremia (↓Na), thus this increase lithium levels, and it can lead to lithium toxicity.
		TCA + SSRI combination can give serotonin syndrome
		Drug that can lead to complication if combined with alcohol.
		Food drug interactions
67 Chapter Clinical Biochemistry and Therapeutic Drug Monitoring
	Clinical Biochemistry and
	Therapeutic Drug Monitoring
	Creatinine Clearance (eGFR): The rate at which creatinine is removed from the blood by the kidney, roughly equal to GFR. Normal values for men range from 80 mL/min to 120 mL/min If it is less than <50 ml/min, it is categorised as renal disease. Creati...
		Serum Protein (blood proteins):
	Hypoalbuminemia
	Hyperalbuminemia
		Serum Enzymes:
		Creatine kinase (CK), previously known as creatine phosphokinase (CPK). It is primarily found in heart muscle, skeletal muscle and brain tissue.
	Renal failure
	Pregnancy
	Urinalysis: Provides basic information regarding renal function, urinary tract disease, and presence of certain systemic diseases.
		 pH: Urine pH is around 5 to 9.
		 Specific gravity (SG). Normal SG is 1.003 to 1.035
	2) Bacterial infections increase?
	Increase in PT (INR)
	Decrease in PT (INR)
	Decrease in INR (<2). Indicate blood thickening
	Normal lipoproteins levels
	 High density (HDL) cholesterol (serum)>0.9 mmol/L >35 mg/dL.
	Therapeutic Drug Monitoring
68 Chapter Quality Assurance in Pharmacy Practice
	Quality Assurance in Pharmacy Practice
69 Chapter OTC and Prescription Drugs for Dermatological Disorders ver1
	69
	OTC and Prescription Drugs for Dermatological Conditions
		Head lice
	Non-pharmacological
		Scabies
	Treatment
	Acne
	Tetracycline
	Tetracycline
	Erythromycin
	Hormonal Therapy
		Rosacea or Acne rosacea
		Dermatitis
	Signs and symptoms
	Differential diagnosis
	Nonpharmacological treatment
	Pharmaceutical agents
		Allergic Contact Dermatitis
	Urticaria
		Dry, Scaly Skin
			Signs and symptoms
			Differential diagnosis
			Nonpharmacological treatment
			Pharmacological treatment
			Pharmaceutical agents
			How to prevent dry skin
			How to treat dry skin
				Reduce bathing
	Psoriasis
		Dandruff and Seborrhea
			Signs and symptoms:
			Nonpharmacological treatment
			Pharmacological treatment
			Pharmaceutical agents
		Foot Conditions
		Fig 69.1
		Athlete’s Foot
			Signs and symptoms
			Differential diagnosis
			Nonpharmacological treatment
			Pharmacological Treatment
			Pharmaceutical agents
			How to prevent athlete’s foot
	Tips
70 Chapter OTC and Prescription Drugs for Ophthalmic, Ear and Mouth Disorders
	Pharmacological treatment
	Conjunctivitis (red or pink eye). Inflammatory condition of the membrane that lines the inside of the eyelids and covers the exposed surface of the sclera. Conjunctivitis can be allergic, bacterial, and viral.
	Bacterial conjunctivitis: Common causes are S. aureus, S. pneumonia (most common in children), H. influenza (most common in children).
	Viral conjunctivitis
	Allergic conjunctivitis
		Dry eye
	Nonpharmacologic treatment
	Drugs that cause dry eye
	Treatment
	Pharmaceutical agents
		How to administer eye drops
		Eye care products
			Contact Lenses
			Mouth Ulcers (aphthous ulcer):
			Dental Abscess: accumulation of puss in dental cavities.
	Cold Sores
		Cold sores also known as recurrent herpes labialis.
		Nonprescription medications
	CANKER SORES
	Oral thrush
		Teething pain
		Treatment of eruption cysts
			Dental Caries: Destruction of calcified tissue resulting from an infection. Dental caries most commonly caused by Streptococcus mutans.  This bacterium produces acids that demineralized the enamel.
		Gingivitis/periodontitis
			Endocarditis
				OTIC disorders
		Excessive/impacted earwax
		Otitis Externa (swimmer ear)
		Otitis Media (OM)
71 Chapter OTC Drugs antihistamine, decongestants, antitussives, Expectorants
	Pharmaceutical Agents
	The Common cold
		Signs And Symptoms
		Prevention:
		Treating the common cold
			Pharmacological Treatment
			Recognizing A Common Cold
	Fever
		Signs and symptoms.
		Differential diagnosis: Hyperthermia, increase in body temperature without an increase in the thermoregulatory set point.
		Nonpharmacological treatment
			Pharmacological treatment
			Pharmaceutical agents
				 Adults with chronic condition such as asthma, COPD, diabetes mellitus, cancer, immunodeficiency or immunosuppression, renal disease, anemia or hemoglobinopathy.
				Sinusitis
	Pharyngitis
		Bacterial pharyngitis: Beta hemolytic streptococcus (Group A Strep-GAS) (15-30%)-during winter or early spring.
	Cough
		Narcotic Antitussive: Codeine and hydrocodone
	Expectorants
	Decongestant
72 Chapter OTC Drugs for Nausea, Vomiting, Constipation, Diarrhea, Hemorrhoids
	OTC drugs for Nausea, Vomiting, Diarrhea Constipation, and Hemorrhoids
		NAUSEA & VOMITING
		Non-prescription anti emetic drugs
		Motion sickness
			DIARRHEA
		Prescription
		CONSTIPATION
			Pharmacological treatment: laxatives
		Intestinal worms. (Pinworm, ascariasis, and whipworm)
73 Chapter OTC Medications for Pain and Musculoskeletal disorders
	Sports Injuries
74 Chapter Asthma and COPD
	Long acting beta2 agonist (LABA)
	 Therapeutic use Maintenance therapy and exercise induced asthma NOT for acute. Used in patients already taking corticosteroids
	Corticosteroids
	Oral corticosteroids (Po CST)
	Recommend: flu vaccine (annually) and Pneumococcal vaccine
	Tips
75 Chapter Smoking cessation
	 NICOTINE BASED: Nicotine patch or gun; Stop smoking completely.
	 NON-NICOTINE BASE: Bupropion (Zyban); Can smoke for first two weeks of treatment.
	Nicotine replacement therapy
	Nicotine Patch
	Nicotine Gum
	Nicotine Nasal Spray
	Nicotine lozenges: available
	Contraindicated in:
	Tips
76 Chapter Sleep Disorders
	76
	Sleep Related Disorders
	Tips
77 Chapter Eating Disorders
	77
	Eating Disorders
		Anorexia Nervosa: It is characterized by deliberate loss of weight (to <85% of expected weight), refusal to maintain normal body weight, fear of weight gain and amenorrhea.
		Bulimia Nervosa:  It is characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior such as self-induced vomiting, misuse of laxatives, diuretics, emetics, other medication, long time fasting, or excessive exercise.
78 Chapter Gastrointestinal Drugs
	This chapter review the symptoms and therapy of gastroesophageal reflux disease (GERD), ulcers, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD).
	Gastroesophageal Reflux Disease: It is defined as (heart burn, regurgitation) chronic symptoms or mucosal damage produced by the abnormal reflux of gastric content into the esophagus.
	Gastroesophageal reflux disease (GERD) is categorized into mild and severe.
	 Special populations: Pediatric. Non-prescription H2 RA are CI. in children (12 yrs old.
		Ulcers are categorized as
		Treatment of peptic ulcers
	Irritable Bowel Syndrome (IBS): It is defined as abdominal discomfort associated with altered bowel habits. It is characterized by symptoms of abdominal discomfort, bloating, cramping, constipation or diarrhea.  (NO BLEEDING SYMPTOM)
79 Chapter Diabetes
	Glargine
	Insulin storage conditions
80 Chapter Thyroids disorders
	HYPERTHYROIDISM
	HYPOTHYRODISM
	The drug of choice ANTITHYROID METHIMAZOLE AND PTU
	The drug of choice LEVOTHYROXINE, (SYNTHROID, ELTOXIN)
	TREATMENT IF serum TSH >10 Mu/l
	Hoshimoto
	Hypothyroidism. Symptoms that are caused by deficient thyroid hormone production, thus resulting into slowing down of all body metabolic functions.
	Tips
81 Chapter contraception
	Contraception
82 Chapter gynecological and genitourinary conditions
	82
	Gynaecological and Genitourinary Conditions
	Dysmenorrhea
	Endometriosis
	Male sexual dysfunction
	Menopause
	Vaginitis or vaginosis or vaginal infection
	Urinary incontinence in adults
	Drug of choice is oxybutynin (Ditropan) and is an anticholinergic drug act M3 receptors.
	Tips
83 Chapter Osteoarthritis, rheumatoid and gout arthritis
	Acute gout attack
	Asymptomatic hyperuricemia
	Tips
84 Chapter Osteoporosis
85 Chapter Hypertension
	Hypertension
		Hypertension is defined as a systolic blood pressure >140 mm Hg, a diastolic blood pressure >90 mm Hg. Diagnosis criteria from joint national committee (JNC8) report recommendations for follow up in adults.
		Calcium channel blockers (CCBs)
86 Chapter Ischemic Heart Disease
	NSTEMI
	STEMI
	Tips
87 Chapter Stroke
	Stroke
88 Chapter Congestive Heart Failure
	Causes of CHF. In 65% of patient’s coronary artery disease is the cause of heart failure, other causes include nonischemic cardiomyopathy example hypertension, thyroid disease or valvular disease. These patients usually have reduced left ventricular d...
	Diagnostic tests
	ACE Inhibitors (captopril, enalapril, lisinopril, ramipril, and trandopril)
	Beta blockers (Bisoprolol and carvedilol, labetalol, Metoprolol)
	Digoxin
	Tips
89 Chapter Anti Arrhythmic Drugs
	Supraventricular (atrial) SVA                                    Ventricular arrhythmias (VA)
		praventricular (atrial) SVA treatment. Rate control drugs
		 Cardiac glycoside (digoxin), Beta blockers (Propranalol, atenolol, metoprolol, nadolol), CCBs (verapamil and diltiazem), Antiarrhythmic class 1C: flecainide, propafenone; Antiarrhythmic Class III: Sotalol, Amiodarone, and dofetilide
		Ventricular tachycardia treatment
		 Class 1A (quinidine, procainamide); Class 1B (mexiletine); Class 1C (flecainide, propafenone);  Class III (sotalol, Amiodarone); Beta blockers (metoprolol)
		Antiarrhythmic Drugs Classification
	Class III
	Class I
	Quinidine
	Procainamide
		Disopyramide
	Ib: Lidocaine
	Class IV
	Verapamil
	Diltiazem
90 Chapter Peripheral Vascular Diseases
91 Chapter Chronic Pain Conditions
	91
	Chronic Pain Conditions
92 Chapter Anxiety Disorders
	SSRIs
	Azapirones
	5HT1a agonist
93 Chapter depression
	 Caution: when starting other antidepressants after fluoxetine discontinuation.
	Tips
94 Chapter psychosis and schizophrenia
	94
	Anti Psychotic Drugs
		High potency
		 First line treatment
		Risperidone:
	Negative Symptoms
	Disorganizations. Disorganized speech
	Disorganized behavior: Agitation, Hostility
95 Chapter Dementia ver1
	Mechanism
96 Chapter Antiseizure or epileptic drugs
	96
	Epilepsy
		Generalized seizures
97 Chapter Parkinson’s Disease ver2
98 Chapter Antimicrobial drugs
	S. aureus
	Bacterial Conjunctivitis
	Canaliculitis
	Skin and Soft Tissue Infections
	Impetigo
	Cellulitis
		Strep. pyogenes and/or Staphylococcus aureus
	Impetigo
	Follculitis, boil (furuncles) and carbuncles
		S. aureus
	Erysipelas
	Necrotising fasciitis
		Neisseria meningitis
		Bacterial infection of kidney substances.
			Pseudomembranous colitis
	Infection of Skin by fungi
	Infection of the CNS
	Infections of the joint and bones
		LOWER RESPIRATORY TRACT INFECTIONS
		Tetracyclins = Take empty stomach
			SKIN INFECTIONS
			CNS INFECTIONS
			URINARY TRACT INFECTIONS
			SEXUALLY TRANSMITTED INFECTIONS
	Osteomyelitis
99 Chapter Anticancer Drugs and Chemotherapy
	Chemotherapy
	GI toxicity
		Hepatotoxicity
	Hemorrhagic cystitis
999 Chapter Pharmacognosy and Natural Products ver1
	Cranberry
	Dong Quai
	Echinacea
	Evening Primrose
	Garlic
	Licorice
	Ginger
	Ginkgo Biloba
	Ginseng
9999 Abbreviations et al
	Abbreviations
	Dys-
	Above; excess