PHARMACOLOGY 2008/2009 PART I 1.

Ocular complication of (pg 138) a) Corticosteroids : y flare of infection y cataracts with long term use of topical corticosteroid b) Parasympathomimetics : y blurred vision y ache over the eye due to ciliary muscle spasm 2. Advantages and disadvantages of clozapine (pg 78) a) Advantages : y effective in the treatment of -ve symptoms of schizophrenia y low incidence of extrapyramidal symptoms and tardive dyskinesia y better tolerated and more effective than classical agents for resistant schizophrenia b) Disadvantages : y seems to cause weight gain y tends to lower individual seizure threshold y more expensive y has the risk of inducing agranulocytosis 3. Drugs used in treatment of (pg 135) a) Bacterial conjuctivitis : y antimicrobial agents (neomycin) y astringent eye drops (zinc sulphate) y hot foments y eye lotions (Bland eye lotions or Boric acid lotion) b) Allergic conjunctivitis : y anti-histamine eye drops (levocabastine) y glucocorticoids eye drop (dexamethasone) y mast cell stabilizers (Na cromoglycate) 4. Name of the opiod used a) b) c) d) as anti-diarrhea agent : loperamide & diphenoxylate (pg 66) in neuroleptanalgesia : fentanyl (pg 65) as substitution therapy for morphine addiction : methadone (pg 63) to reverse the CNS depression cause by morphine overdose : naloxone & naltrexone (pg 66)

5. Mechanism of action and therapeut ic uses of terbinafine (pg 156) a) MOA : y inhibition of the enzyme squalene epoxidase leading to inhibition of fungal ergosterol biosynthesis y accumulation of squalene, which is toxic to the organism b) Therapeutic uses : treatment of dermatophytoses especially onychomycosis 6. Mechanism of action and therapeutic uses of TCA s (pg 79-80) a) MOA : y inhibit neuronal reuptake of NE and 5-HT leading to increase their concentration in synaptic cleft y block -adrenergic, histamine (H1) and muscarinic (M1) receptors b) Therapeutic uses : y treatment major depression and some panic disorders y obsessive compulsive disorder (OCD) PART II - Compare 1. Morphine and pethidine (pg 65) MORPHINE depress cough depress respiration cause constipation cause pin point pupil (PPP) PETHIDINE does not depress cough does not depress respiration in therapeutic dose does not cause constipation pupil is dilated

y y y y

y y y y

2. Carbamazepine & ethosuximide (pg 92 -93 & 96) CARBAMAZEPINE use-dependent blockade of Na channels drug of choice for partial seizure worsens absence seizure use in neuropathic pain & mood stabilizer ETHOSUXIMIDE inhibit T-type Ca channels ineffective for other type of epilepsy drug of choice for absence seizure no other therapeutic uses

y y y y

y y y y

PART III A. 24 years old man, unresponsive, pin -point pupil, unresponsive to light, RR is 7 per min. 1. Most likely cause is - morphine overdose (pg 64) 2. The majority of pharmacological effects of opioid drugs are mediated by - mu receptor (pg 61) 3. Tolerence develops to the following effects of the drugs EXCEPT - miosis (61) 4. Contraindication for the drugs (pg 62) y bronchial asthma y head injuries y during delivery y constipation B. 35 years old man, scheduled for surgical operation, he said that his mother developed severe liver problems from general anesthesia 2 years earlier. He asks whether nitrous oxide might be used because he has heard that it was a safe agent. 1. The probable general an aesthetic agent used is - halothane (pg 102) 2. An inhalational agent with a low MAC value, has which of the following a high potency (pg 102) 3. Advantages of nitrous oxide include all of the following EXCEPT - high potency (pg 102) 4. To alleviate patients fear about the operation, the doctor can prescribe which of the following drugs the night before day of surgery - diazepam (pg 100) 5. Which one of the following will be most effective in alleviating the post operative pain of this patient morphine (pg 61)

PHARMACOLOGY 2009/2010 PART I 1. Mechanism of action and therapeutic uses of fluoxetine (pg 81) a) MOA : block serotonin reuptake into presynaptic nerve terminals, leading to enhance serotonergic neurotransmission b) Therapeutic uses : y depression and panic disorder y obsessive compulsive disorder (OCD) y premature ejaculation y aneroxia nervosa 2. Mechanism of action and advantages of buspirone (pg 71) a) MOA : suppresses 5-HT neurotransmission through a selective activation of the inhibitory presynaptic 5-HT1A receptors, producing negative feedback inhibition of 5 -HT release. b) Advantages : y no hypnotic, anticonvulsant, or muscle relaxant properties y minimal abuse liability y less psychomotor impairment than BZs and does not affect driving skills 3. Drug that induces dissociative anaesthesia, and disadvantages for it (pg 101) a) Ketamine b) Disadvantages : y increase sympathetic outflow ( cardiac stimulation and increase BP) y increase cerebral blood flow ( nightmare & post-operative hallucination) 4. Drug interactions with L-dopa (pg 91) y L-dopa with Vit. B 6 reduce its parkinsonian effect because it elevates dopa decarboxylase activity y L-dopa with anti-cholinergic drugs cause synergism y L-dopa with MAO A inhibitors cause hypertensive crisis

5. Drug used for a) Diagnosis of corneal ulcer : Fluorescein 1% (pg 130) b) Allergic conjunctivitis y anti-histamine eye drops (levocabastine) y glucocorticoids eye drop (dexamethasone) y mast cell stabilizers (Na cromoglycate) 6. Mechanisms of action of timolol and acetazolamide in the treatment of open angle glaucoma (pg 137) a) Timolol : blocks -receptors on the ciliary processes resulting in decrease aqueous production b) Acetazolamide : inhibits carbonic anhydrase in the ciliary body, which prevents bicarbonate synthesis resulting in a fall in Na transport and aqueous formation 7. Drug used in the treatment of Acne vulgaris and its mechanism(s) of action (pg 148) a) Erythromycin b) MOA : inhibitory effect on Propionibacterium acnes PART II - Compare 1. Typical and atypical antipsychotics (handout Dr. Manal) TYPICAL control +ve & -ve symptoms cheap high risk of extrapyramidal side effects ATYPICAL more effective in treating -ve symptoms expensive low/no risk of extrapyramidal side effects

y y y

y y y

2. Itraconazole and fluconazole (pg 154 -155) ITRACONAZOLE wide spectrum low CSF penetration (not drug of choice for meningitis) less tolerated FLUCONAZOLE not for Aspergillosis high CSF penetration (drug of choice for meningitis) wide therapeutic margin (prophylaxis)

y y y

y y y

PART III A. 24 years old man, undergo frontal craniotomy for resection of a meningioma. Prior to surgery, he was maintained on carbamazepine for his generalized seizures with good results. After surgery, upon admission to ICU, he had three generalized tonic -clonic seizures over 30 minutes without regaining consciousness in between. 1. Treatment options for this patient (pg 98) y Intravenous lorazepam or diazepam or; y Slow IV injection of phenytoin or more rapid injection of fosphenytoin or phenobarbital or; y Full anaesthesia using thiopental or propofol with assisted respiration 2. Does carbamazepine have possibility of drug -drug interaction, give reason (pg 93) a) Yes b) It is hepatic P 450 inducer, the most common interaction is wi th oral contraceptive pill, warfarin and cyclosporin (accelerate their metabolism) 3. Mechanisms of action of carbamazepine (pg 92) y Use-dependent blockade of Na channels y Attenuates action and release of glutamate (excitatory neurotransmitter) y Suppresses repetitive neuronal firing y Reduces propagation of abnormal impulses in brain B. A male patient, had been receiving morphine for a considerable period. One day, he received an injection of 40 mg of morphine HCl subcutaneously. After the injection, the typical symptoms and signs of morphine poisoning were found. 1. Diagnostic signs and symptoms of morphine overdosage (pg 64) y coma y respiration is depressed and slow y PPP y Cyanosis 2. Drug of choice for treatment of morphine overdosage (pg 64) y naloxone y naltrexone

3. Contraindications for the uses of morphine (pg 62) y bronchial asthma y head injuries y during delivery y constipation 4. Differences between morphine and pethidine (pg 65) MORPHINE depress cough depress respiration cause constipation cause pin point pupil (PPP) PETHIDINE does not depress cough does not depress respiration in therapeutic dose does not cause constipation pupil is dilated

y y y y

y y y y