Drug

interactions and effects of common herbal products:

(There are questions that come about these)
I'll only write the ones I found in RQs, if you want the other ones let me know and i'll post
them.

-Ginseng:
*Adverse effects:
1.Inhibit platelet aggregation and blood coagulation.
*Drug interactions:
1.May increase effect of hypoglycemic drugs.
2.Increase resistance to loop diuretics.
3.May potentiate bleeding with Wafarin. <<< important
4.May cause mania with MAOI antidepressants.

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Garlic:
*Adverse effects:
1. Possible bleeding from inhibition of platelet aggregation.
*Drug interactions
1. Bleeding tendency with antiplatelet drugs (example: asprin) and aticoagulant drugs such
as Warfarin.
2. Could increase hypoglycemia with insulin intake.

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- Ginkgo Bilboa:
*Adverse effects:
1. Could cause bleeding from inhibition of platelet aggregation
*Drug interactions:
1. Possible bleeding with Asprin and Warfarin

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- Saw Palmetto:
*Adverse reactions:
1.May cause GI disturbances
*Drug interactions:
1. Could cause drug toxicity with sex steroids

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(important)
- St. John's Wort:
*Adverse reactions:
1. Causes photosensitivity at high doses
2. Increases Cytochrome enzymes CYP: 3A4-1A2 and all CYP2 enzymes (you dont have to
memorize these, just know that it induces Cytochrome P450)
* Drug interactions:
1. Increases phototoxicity with Tetracyclines, Sulfunamides, and proton pump inhibitors.
2. Could cause toxicity of Benzodiazepines, opoids and other CNS depressants.
3. Causes SEROTONIN CRISIS with MEPERIDINE.
4. Decreases effects of:
> Protease inhibitors
> Cyclosporine
> Digoxin
> Warfarin <<< there was an RQ on this.

PHARMACOLOGY—HIGH-YIELD CLINICAL VIGNETTES

These abstracted case vignettes are designed to demonstrate the thought processes
necessary to answer multistep clinical reasoning questions.
■ 28-year-old chemist presents with MPTP exposure → what neurotransmitter is depleted?
→ dopamine. Pharm.53
■ Woman taking tetracycline exhibits photosensitivity → what are the clinical
manifestations? → rash on sun-exposed regions of the body. Pharm.15
■ Young girl with congenital valve disease is given penicillin prophylactically. She develops
bacterial endocarditis → what do you give now? → beta-lactamase-resistant penicillin.
Pharm.44
■ Non diabetic patient presents with hypoglycemia but low levels of C peptide → what is
the diagnosis? → surreptitious insulin injection . Pharm.20
■ African-American man who goes to Africa develops anemia after taking prophylactic
medicine → what is the enzyme deficiency? → glucose-6-phosphate dehydrogenase.
■ 27-year-old female with a history of psychiatric illness now has urinary retention due to a
neuroleptic → what do you treat it with? → bethanechol.
■ Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping, and blurry vision →
what caused this? what is the mechanism of action? → insecticide poisoning; inhibition of
acetyl- cholinesterase.
■ 55-year-old man undergoing treatment for BPH has decreased levels of testosterone and
DHT as well as gynecomastia and edema → what is the drug? → estrogen (DES).
■ Patient with recent kidney transplant is on cyclosporine for immunosuppression.
Requires anti- fungal agent for candidiasis → what drug would result in cyclosporine
toxicity? → ketoconazole. Pharm.43
■ Man on several medications, including antidepressants and antihypertensives, has
mydriasis and becomes constipated → what is the cause of his symptoms? → tricyclic
antidepressant. Pharm.60
■ Patient presents with renal insufficiency → what alterations in doses of digoxin and
digitoxin, respectively? → decreased, same.
■ 55-year-old postmenopausal woman is on tamoxifen therapy → what is she at increased
risk of acquiring? → endometrial carcinoma.
■ Woman on MAO inhibitor has hypertensive crisis after a meal → what did she ingest? →
tyra- mine (wine or cheese). Pharm.6
■ After taking clindamycin, patient develops toxic megacolon and diarrhea → what is the
mech- anism of diarrhea? → C. difficile overgrowth.
■ Man starts a medication for hyperlipidemia. He then develops a rash, pruritus, and GI
upset → what drug was it? → niacin. Pharm.8
■ Patient is on carbamazepine → what routine workup should always be done? → LFTs.
Pharm.49
■ 23-year-old female who is on rifampin for TB prophylaxis and on birth control (estrogen)
gets pregnant → why? → rifampin affects estrogen metabolism in the liver. Pharm.45
■ Older female goes into OR for emergency surgery; after administration of
succinylcholine, she requires respiratory support for over 4 hours. Later it is determined
that she is receiving medica- tion for glaucoma → what is she on? → acetylcholinesterase
inhibitor.
■ Patient develops cough and must discontinue captopril → what is a good replacement
drug, and why doesn’t it have the same side effects? → losartan, an ATII receptor
antagonist, does not ↑ bradykinin as captopril does.

drugs and their antidotes
1. acetaminophen - acetylcycteine
2. benzodiazepine - flumazenil
3. coumadin - vitamin k
4. curare - tensilon
5. cyanide poisoning - methylene blue
6. digitalis - digibind
7. ethylene poisoning - antizol
8. heparin - protamine sulfate
9. iron - desferal
10. lead - edetate disodium (edta), dimercaprol (bal), succimer (chemet)
11. lovenox - protamin sulfate
12. magnesium sulfate - calcium gluconate
13. morphine sulfate - naloxone hydrochloride
14. methotrexate - leucovorine
15. mestinon - atropine sulfate
16. neostigmine - pralidoxime chloride (pam)
17. penicillin - epinephrine
18. vincristine (oncovin) - hyaluronidase,also apply moderate heat to disperse drug and
minimize sloughing. (oncovin - iv administration only)

poison antidotes
arsenic ------------------------------------------------------ dimercaprol, succimer
barbiturates (phenobarbital)------------------------ urine alkalinization, dialysis, activated
charcoal
beta-blockers--------------------------------------------- glucagon
caffeine, metaproterenol, theophylline------------- esmolol
carbon monoxide -------------------------------------- 100% oxygen, hyperbaric o2
cholinesterase inhibitors---------------------------- atropine
cyanide-------------------------------------------------------- nitrite, sodium thiosulfate
ethylene glycol --------------------------------------------ethanol
gold ------------------------------------------------------------dimercaprol
heparin --------------------------------------------------------protamine sulfate
iron salts -----------------------------------------------------deferoxamine
isoniazid------------------------------------------------------- vitamin b6

lead ----------------------------------------------------------- caedta, dimecaprol, succimer
methanol ------------------------------------------------------ ethanol, fomepizole, dialysis
methemoglobin/cyanide poisoning----------------- methylene blue
muscarinic receptor blockers ------------------------ physostigmine
opioids ---------------------------------------------------------- naloxone
organophosphate cholinesterase inhibitors --------- pralidoxime
phencyclidine hydrochloride (pcp) ------------------ ng suction
quinidine, tca's ----------------------------------------------- sodium bicarbonate
salicylates ------------------------------------------------------ urine alkalinization,dialysis, activated
charcoal
snake bites ------------------------------------------------------ antivenin
tissue plasmogen activator (tpa), streptokinase------ aminocaproic acid
warfarin ---------------------------------------------------vitamin k, ffp
do you have some additional info????? pls share it! thanks! :typing

god bless!!!




MAIN POINTS----PHARMACOLOGY PAST PAPERS 1973-2000

ADMINISTRATION of single 1gm dose of asprin instead of usuall 650mg will increase anti
inflammatory response to the drug.
Cocaine produced powerful stimulation of cerebral cortex.
Most systemic side effect of LA toxicity is post convulsion CNS depression.
Primary action of therapeutic dose of digitalis on cardiac muscle is increase in contraction.
Digitalis is used in the treatment of 1.A fibrillation 2.CHF 3. Proximal A.trachycardia
Pathogenomic symptoms of NARCOTIC overdose is 1.meiosis 2.respiratory depression 3.
COMA
Sulfonylurea -------------------increase stimulation of pancreatic secretion of insulin
Pretreatment with reserpine prevents a response to amphetamine
Drugs which decrease potassium level increases toxicity to digitalis
Methyl testosterone---- 1. Premature closure of epiphysis of long bone 2.hirshhuitsm in
women
Erythromycin estolate----allergic cholestatic hepatitis
Prominent toxic effects of mercury are 1.gingivitis 2.speach difficulties 3. Visual disturbance
Amphetamine abuse causes extreme violence and paranoid psychotic behavior.
Scopolamine antidote-phsiostigmene
Severe hypertension---gunathidiene and ganglionic blockers
Patient allergic to amide and ester type of LA—we will go for diphenhydramine
Disulfiram reaction are caused by accumulation of acetaldehyde
Most resistant part of CNS is medulla oblongata
Effective antidote for mercury poisning is dimecarpol b/c it form stable complex with
mercury and allows it to be excreted in inactive compound.
Babrbiturates and morphine causes respiratory depression and rendering respiratory
centers less sensitive to CO2 changes.
C.I to use oral contraceptive are 1. History of breast cancer 2.hypertension 3.undiagnosed
genital bleeding 4. Thromboembolic diseases.
Digitalis toxicity 1.inc PR interval 2.AV conduction block 3.yellow green vision 4.nausea and
vominting 5.extrasystole.
Most important therapeutic measure to be taken in case of barbiturates poisning is to
assure adequate respiration.
Most frequent cause of faiting associated with LA is pshycic factor.
Outstanding advantage of phenytoin rather than Phenobarbital in the drug therapy of
epilepsy is less sedative effect for a given degree of suppression of seizure activity.
Most likely sign of and symptoms of over dosage with atropine are CNS excitation and
tracycardia.
High plasma level of LA may causes depression of inhibitory neuron in CNS .
Salicyclates-------anti pyretic action---vasodilatation------increase heat loss.
Pre operative medication------promethazine
Tolbutamide-------maturity onset DM
Phenybutazine--------bone marrow depression
Phenacetin and acetaminophen posses similar properties
LA induced convulsion by effects on 1.limbic system 2.cerebral cortex.
Reserpine 1. Prevents reuptake of NE by storage granules 2.depletes NE from adrenergic
neuron.
Delayed menifestaion of anaphylaxis ----------------cortecosteroids
Immediate menifestaion of anaphylaxis------epinephrine.
Relative contraindication of morphine are 1.asthama 2. Head injury 3. Chronic pain from
cancer
Drugs causing meiosis 1.morphine 2. Pilocarpine 3. Phsiostigmene 4. Reserpine
5.phenoxybenzamine
Methicillin and penicillin G are inactivated by stomach acids.
Ether-----fire hazards.
Grand mal epilepsy----phenytoin
Epinephrine+halothane-------serious cardain irregularities
Mixture of sulfonamides have an advantage over single sulfonamides in that mixture
reduces renal toxicity.
Anti anxiety drugs-------skeletal muscle relaxation by depressing polysynaptic pathway in
spinal cord and higher center.
Dental patient on clonidine therapy most often complains of xerostomia.
LA acts on nerve membrane to displace ca++.
Phenothizenes-1. Sedation 2.anti emetic 3.anti histamine 4.narcotics.
Oral contraceptive side effects…thrombophlebitis, headache, nausea,vomiting, liver
function disturbance and abnormal pattern of skin pigmentation.
Scopolamine tends to obscure eye sign.
Dry mouth, dec in secretory and motor activity of GIT tract, mydriasis and difficulty in
accommodation are caused by 1.anti histamine 2.ganglionic blocking agent
Methoxylation of morphine-----------codeine
Barbiturates with drawl-------changes in ECG and convulsion.
Ephedrine causes mydriasis but no cycloplagia.
Propranol contraindications 1.hypoglycemia 2.asthama 3.CHF 4. P existing AV block.
Factors common to drug abuse---------psycological disturbance.
Quinidine--------supraventricular trachyaruthymias.
Glucocortecosteriods in anaphylaxis----b/c suppress the inflammatory response to cell
injury.
Pressor dose of NE----------bradycardia due to baroreceptor reflex.
Ototxicity is caused by----loop diuretics and aminoglycosides.
Hepatotoxic------tetracycline
All have long duration of action due to liver generated active metabolites 1.dizepam
2.flurazepam 3.chlordizeperoxide.
Tetracycline have low tendency for sensitization but high therapeutic index.
Narrow angel glaucoma contraindication---------meperdine, scopolamine and diazepam.
Bacitracin----------topical antibiotics.
CNS depressant------1. Alcohal 2.phenothizenes 3.barbiturates 4.MAO inhibitor
5.tranquilizers
Following drugs causes adverse reaction when taken in the presence of MAO inhibitor 1.
Epinephrine 2.amphetamine 3. Tyramine
Controlled drugs--------CMOP (codeine, meprobamate oxycodeiene and Phenobarbital)
Side effects of reserpine-----nasal stiffness, postural hypotension and potentition of barb
and narcotic agents.
Acute asthamatic attack due to praponol-----DOC IS AMINOPHILLINE.
1ST clinical useful and systemic antiinfective was sulfonamides.
H2O2------------hypertrophy of filliform papilla of toungue.
Germicidal action of Benzallkonium chloride is rapidly reduced in the presence of soap.
Principle central action of caffeine is in cerebral cortex.
Cardain arrythymias are more commonly seen during administration of halothane.
Use of vasoconstrictor in combination with LA is contraindicated in the dental patient with
parkinsons disease who is on levadopa therapy.
CHF shows digitalis toxicity-------------DOC is triamterene.
Adverse effects of sympatholytics are 1 GIT disturbance 2. Postural hypotension 3.nasal
congestion 4.Meiosis
Side effects of phenytoin are 1. Ataxia 2.nystagmus 3.photophobia 4.B.dyscrasias.
Theoretical uses of scopolamine are 1. Peptic ulcer 2.euphoria and amenesia b/f surgery
3.releiving bronchoconstriction 4.parkinsons diseases 5.visulization of retina.
Vasoconstrictor are 1.epinephrine 2.levonordefin 3.phenylpherine.
GOOD LUCK