King Saud University College of Medicine GIT BLOCK 2nd Year, 2nd Block
Revision
This work includes lectures from 3 to 10 and it is a summery of the important notes on each lecture + the uses and side effect for each drug +MCQs L3:antiamebic drugs Drugs Clinical Uses Adverse Effects Metronidazole -Giardiasis -Neurotoxicological effect= Notes &tinidazole -Trichomoniasis Peripheral neuropathy& 1-if the Pateint came with symptoms we -Broad spectrum of Encephalopathy use tissue amebicides while if he came anaerobic bacterial -Disulfiram-like effect with asymptoms we use luminal infections -Dysuria. amebicides -Neutropenia. Emetine -Amoebic liver abscess. Serious toxicities: cardiotoxicity, 2-if we have to start the treatment with &Dehydroemetine -Severe forms of Hypotension, cardiac tissue amebicides we have to follow with amebiasis acute amoebic arrhythmias, heart failure. dysentery luminal amebicides to get rid of the cycts Chloroquine In combination -pruritus 3-metronidazole is for amebic liver diseases. -Hemolysis in G6PD deficient the drug of choice in all tissue patients. Amebiasis And it is similar to tinidazole but tinidazole is better Diloxanide furoate -Drug of choice GIT disorder for asymptomatic intestinal 4-Emetine &Dehydroemetine both are infection toxic and have been replaced by metronidazole + they never given I.V Iodoquinol asymptomatic amebiasis -Peripheral neuropathy including optic neuritis. 5- luminal amebicides drugs should be -Enlargement of the thyroid gland. poorly absorbed to do the action which is -Iodine sensitivity. -interference with thyroid function eradicate cysts tests
6-Ciprofloxacin is the drug of choice in Paromomycin chronic amebiasis to -Gastrointestinal distress eliminate cysts bacillary dysentery. Ciprofloxacin Bacterial diarrhea -Arthropathy 7-In children and pregnancy, ceftriaxone (caused by shigella, -Phototoxicity. or cefixime is the choice salmonella and E coli). -Liver toxicity GIT -CNS -CVS disorder L3:antiamebic drugs
Q1: Old age patient who is live lonely come to you with extra luminal amoebiasis, he has lots of drugs to use for different diseases, which one of the following drugs is the best drug of choice in this case ? A) Metronidazole *Ans: B ( Because it has better toxicity profile and potency than B) Tinidazole metronidazole, so he will take small dose and may be once daily rather C) Diloxanide furoate than high dose and frequent time daily ) 1
- B
Q2: Alcoholic patient come to you with abdominal distress, nausea, vomiting, flushing, headache, *
tachycardia, hyperventilation ,after he take metronidazole for liver abscess . How you explain his
symptom ? 2
A) Disulfiram-like effect - B) Effects of high dose metronidazole A C) alcohol dehydrogenase deficiency
3 -
Q3: Which drug we should be avoid in case of patient with thyroid enlargement: A A) Iodoquinol
B) Diloxanide 4
C) Chloroquine - C Q4: Child present with bacillary dysentery which of the following should be given to treat him ?
A) Metronidazole 5 -
B) Ciprofloxacin A
C) Cefixime
Q5: which of the following has direct and indirect pathways to kill luminal forms of ameba ? A) Paromomycin Sulphate B) Metronidazole C) Cefixime L4:Drugs used in Drugs Clinical Uses Adverse Effects treating constipation 1-Dietary fibers: 1. Delayed onset of action (1-3 Indigestible parts of days). and IBS vegetables & fruits,Bran 2. Intestinal obstruction (should powder. Notes 2-Hydrophilic colloids: Acute & chronic be taken with enough water). 1- Osmotic Laxatives include lactulose, Saline Psyllium seed, Methyl constipation 3. Bloating, flatulence, distension. laxatives , Polyethylene glycol (PEG) cellulose, 4. Interfere with other drug Carboxymethyl absorption e.g. iron, cardiac 2-Saline laxatives include(Magnesium cellulose (CMC) glycosides sulphate or hydroxide Sodium or potassium phosphate) has a rapid effect and many 3-Fecal Softeners Treat constipation in Paraffin oil: adverese effects so it modified to (Docusate, Glycerin, patients with hard stool impairs absorption of fat soluble Polyethylene glycol (PEG) Paraffin oil) or specific conditions vitamins. and for people who -not palatable 3-Stimulant Laxatives is the most powerful should avoid straining group and it is not used in chronic ( as in after surgery or constipation because the patient won’t be acute perianal disease) able to pass stool without it 4-Stimulant Laxatives act via direct stimulation 1. Abdominal cramps may occur. (Bisacodyl, Castor oil, of enteric nervous 4-Castor Oil degraded into ricinoleic acid and 2. Prolonged use dependence senna, cascara, aloes) system →increased it is very irritating to mucosa & destruction of myenteric plexus peristalsis & purgation leading to atonic colon. 5-senna also degraded into emodin which has direct stimulant action 5-Osmotic Laxatives 1.Prevention of chronic 1. Delayed onset of action (2-3 (Lactulose) constipation. days) 6- Senna is contraindicated in lactation & 2.Hepatic 2. Abdominal cramps and Castor oil in pregnancy encephalopathy flatulence. (Hyperammonemia) as 3. Electrolyte disturbances. in liver cirhhosis. 7-for IBS we give Alosetron&Tegaserod both 3. Hemorrhoids . of them derivative from serotonin one is 4. opioid constipation agonist and the other is antagonist 6-Osmotic Laxatives Treatment of acute 1. Disturbance of fluid and (Saline laxatives) constipation . electrolyte balance 2. May have systemic effects. L4:Drugs used in treating constipation and IBS Drugs Clinical Adverse Uses Effects Q1: Patient suffering from constipation for 3 month then he develops Hemorrhoids after taking the history you found that he has liver cirrhosis, 7-Osmotic Used for No Adverse congestive heart failure and CNS depression . what is the drug of choice for Laxatives whole bowel Effects = constipation in this case ? (Polyethyle irrigation advantage A) lactulose ne glycol prior to B) Magnesium sulphate (PEG)) colonoscopy 1. Limited fluid C) Sodium phosphate or surgery or electrolyte imbalance 2. less Q2: Patient are going to do colonoscopy, which one of these drug should we flatulence and give him for bowel irrigation ? cramps A) Magnesium sulphate 8- Used in B) lactulose Alosetron severe IBS- D C) Balanced Polyethylene Glycol in women Constipation (5HT3 who have and ischemic Q3: Patient suffering from constipation and he decide to use senna to antagonist) not had colitis relieve it, he use it for long time until he become dependent . What do you success with expect to see as a complication of prolong use of senna ? any other treatment. A) atonic colon B) intestinal obstruction 9- Short term C) ischemic colitis Tegaserod treatment of IBS-C in
(5HT4 women <55 CVS side effects Q4: patient come to you suffering from constipation and she is agonist) years old breastfeeding which drug should we avoid ? with no A) castor oil history of B) senna heart C) Bisacodyl problems L4:Drugs used in treating constipation and IBS
Q5: Pregnant women come to you suffering from constipation which drug may cause abortion so we should avoid it ?
A) castor oil 1 - B) senna A
C) Bisacodyl 2
- C C Q6: patient with IBS was treated by a drug and after a while he developedischemic colitis .
What was the drug he took ? 3 -
A) Tegaserod A
B) Anthraquinone glycosides 4
C) Alosetron - B
Q7: Patient suffering from abdominal discomfort associated with constipation , he diagnosed 5 - that he have Irritable Bowel Syndrome with constipation . What is the drug of choice? A
A) Tegaserod 6
B) Anthraquinone glycosides - C C C) Alosetron
7 -
Q8: Patient undergo surgery, after that the doctor prescript one of the drugs that use for A
constipation becouse the patient should avoid straining to prevent any effort during 8
defecation . Which of drug from the following do you think the doctor prescript ? - C
A) luminal amebicides B) polyethylene glycol C) lubricants L5:Drugs used in Drugs Clinical Uses Adverse Effects inflammatory bowel 1-Sulfasalazine -Rheumatoid arthritis -Side effects of sulfasalazine: (Azulfidine) (Crystalluria, Bone marrow disease (IBD) depression, Megaloblastic anemia, Folic acid deficiency (should be Notes provided), Impairment of male 1-All aminosalicylates are used for fertility (Oligospermia)). -in ulcerative proctitis induction (acute) and maintenance Side effect of 5-ASA: Interstitial and proctosigmoiditis nephritis. (prophylaxis) of remission 2-Asacol ,Pentasa (oral) -well tolerated = have less side 2-there are different formulation because Canasa(suppositories) effects compared to sulfasalazine -we can give it to sulaf allergic we want to delay the absorption of Rowasa(enema) patients aminosalicylates from the small intestine to act on the site of inflammation . 3-prednisone(oral) -acute flares of -prednisolone(oral) disease (moderate & -Budesonide(oral) severe active 3-Glucocorticoids As enema or IBD) suppository have Less absorption rate 4-hydrocortisone(IV or -Asthma. than oral that means they have Minimal IM) -Rheumatoid arthritis. side effects & maximum tissue effects. -methyl -immunosuppressive drug for organ prednisolone(IV or IM) 4-Budesonide treat active mild to transplants. -Hydrocortisone(Rectal) -Antiemetic during moderate Crohn’s disease involving ileum cancer and proximal colon while,Hydrocortisone -chemotherapy. give to treat Crohn’s disease involving Induction and rectum or sigmoid colon 5-azathioprine & 6- -leucopenia+thrombocytopenia maintenance mercaptopurine -Hepatic dysfunction*Routine remission in IBD ,Complete blood count & liver 5- Immunomodulators function tests are required in all Are used to induce remission in IBD in patients* active or severe conditions or steroid dependent or steroid resistant patients= 6-Methotrexate IBD+Rheumatoid -Megaloblastic anemia because it arthritis+Cancer. is a folic acid antagonist if pt. not respond to Glucocorticoids - Bone marrow depression L5:Drugs used in inflammatory bowel disease (IBD)
Drugs Clinical Adverse Uses Effects Q1: which one of the following used for induction and 7-Infliximab (IV -rheumatoid -Severe hepatic as infusion) arthritis failure. maintenance of remission in IBD? -Psoriasis A) Budesonide -In moderate to -Rare risk of B) Olsalazine severe active lymphoma Crohn’s disease =Infection C) Alosetron and ulcerative complication colitis. Q2: Which one of the following Aminosalicylates is -Allergic reactions or anaphylaxis compose of 5-ASA+inert carrier? 8-Adalimumab -rheumatoid -well tolerated = A) Balsalazide (HUMIRA) arthritis have less side B) sulfasalazine -Psoriasis effects compared to C) olsalazine -In moderate to sulfasalazine severe active Crohn’s disease -we can give it to Q3: Patient diagnosed that he has ulcerative proctitis and and ulcerative sulaf allergic proctosigmoiditis and history of recent moderate IBD colitis. patients what is the first line of treatment : 9- -Given A) Rowasa subcutaneously Certolizumab B) sulfasalazine pegol (Cimzia) for the treatment of C) Budesonide Crohn's disease C) Budesonide - rheumatoid arthritis 1-B 2-A 3-A 4-C 5-A 6-B 7-A
disease involving involving disease
crohn’s as side effect ? effect side as
oligospermia
?
pegol
usedinflammatoryin boweldisease (IBD)
mercaptopurine mercaptopurine -
: which one of the following drug can causecan drug following the of one which : : Asthmatic patient come to you with active mild to moderate moderate to mild active with you to come patient Asthmatic : : patient suffering from prostate cancer and he is also having IBD which one of of the one which IBD having also is he and cancer prostate from suffering patient : : Which drug of the following use subcutaneously for the treatment of Crohn's disease? of Crohn's treatment the for subcutaneously use following of the drug Which : 6 canasa canasa
Certolizumab Rowasa
:Drugs 5
4 7
6
) Budesonide )
B)Infliximab B)Infliximab A)Methotrexate B) B) A) sulfasalazine A) Q
C B) B) A) hydrocortisone A) ileum and proximal colon, what is the best drug in this case? this drugin best the is what colon, proximal and ileum Q
C) azathioprine C)
following is drug of of choice drug is following Q
C) B) A) A) Q
5
L L6:Cytochrome System Sorry but u have to CYT P450 “3A4” memorize all of them and Drug Metabolism Substrates Inhibitors Inducers Notes Immunosuppressants: Cyclosporine 1-CYT P450 “3A4” IS the most common ONE That related to drug metabolism Azole Antifungals: Fluconazole Antibiotics: Erythromycin, Clarithromycin 2-CYT P450 “3A4” can be induced or inhibited in presence drug that acts on Ca channel blockers: Amlodepine, Verapamil substrate “drugs” also Statins: Atorvastatin 3-there is Genetic Variation in some • Rifampicin Antiarrhythmic: • Protease CYT P450 like(CYP2D6+CYP2C19+CYP2C9) Inhibitors: Amidarone Ritonavir • Phenytoin 4-CYP2D6 when acts on drug or pro-drug Cancer Chemotherapy: • Carbamazepine • Barbiturates it becomes poor metabolized so toxicity Cyclophosphamide, • Cimetidine • Chloramphenicol will develop if it was a drug !! Or it Tamoxifen • Nefazadone • Dexamethazone not transformed into active forms if it Non-Sedating • Progestins was a pro-drug = no effect Antihistaminics: • Grape Fruits
Astamizole 5- CYP2C19 it increases & prolonge action of its Benzodiazipines: substrates as omeprazole = Midazolam, increased cure rates = good effect Clonazepam CYP2D6 6-CYP2C9 there is some drug metabolite with this enzyme and the drug it self has Drug=toxicity will develop pro-drug = no effect a narrow therapeutic index like (Warfarin neuroleptics, tricyclic antidepressants, codeine antianginals agent ( perihexiline), phenytoin, & tolbutamide) and Warfarin antiarrhythmics (propafenone & metoprolol) which will cause bleeding tramadole L6:Cytochrome System and Drug Metabolism
Q1: genetic polymorphism in CYTP2C19 gene will show what of the following ? A) increased & prolonged action of omeprazole B) increased & prolonged action of tolbutamide C) Metabolism of some drugs
Q2: Polymorphism in which of the following increase the rate of cure in H.Pylorus peptic ulcer? 1 -
A) CYP2D6 A B) CYP2C19
C) CYP2C9 2 -
B Q3: Patient has heart problem his doctor prescript Amidarone to him then he develop T.B and
take Rifampicin . Which one of the following is true 3
A) decrease in efficacy of Rifampicin , inducing CYT 3A4 ‘s activity by Amidarone - C C B) increase in efficacy of Amidarone , inhibiting CYT 3A4 ‘s activity by Rifampicin
C) decrease in efficacy of Amidarone , inducing CYT 3A4 ‘s activity by Rifampicin 4
- Q4: Which of the following drugs is metabolized by CYP2C9? C
A) Penicillin 5
B) Vancomycin -
C) Phenytoin B
Q5: Which one of the following is the transcription factor for the expression of the CYP P450 genes ? A) PXP B) PXR C) RXR L7: hepatotoxic drugs DRUG INDUCED LIVER INJURY Notes SYMPTOMATIC ASYMPTOMATIC 1-drug-induced hepatotoxic could be intrinsic hepatotoxin or idiosyncratic In hepatotoxin aminotransferases
2- intrinsic hepatotoxin could be in DRUGS LIKE HEPATIC
Supertherapeutic dose like INJURY Acetaminophen& Statins Acetaminophen Phenytoin
3- intrinsic hepatotoxin could be in +NSAIDs Cumulative Dose like Oral +Isoniazid Hepatitis* Statins contraceptives & Amiodarone +Amiodarone Sulfonamides 4-idiosyncratic Hepatotoxin in normal dose can cause Chlorpropamide Sulfonylureas toxic by immunoallergic reactions like +Erythromycin Cholestitis* Isoniazid+Phenytoin+Methyldopa cause +Rifamycin +Oral Viral hepatitis-like contraceptives Pattern or drugs like Chlorpromazine+Chlorpropamide+Erythr Phenytoin omycin which cause cholestasis +Carbamazepine Mixed +Sulfonamides +ACE 5- idiosyncratic Inhibitors Hepatotoxin in normal dose can cause toxic by Metabolic reactions like *Hepatitis Manifested by Flu-like, malaise& severe Erythromycin & Rifampicin which interfere with bilirubin metabolism or Anorexia& loss of drugs like Corticosteroids & tetracycline Appetite while Cholestitis Manifested by pruritus&stool may which interfere with protein metabolism be light&dark urine L7: hepatotoxic drugs
Case: Teenager patient come to ER with hepatotoxicity after she take Paracetamol trying to commit suicide as a result of failed love story. Q1: which type of hepatotoxin is it considered? A) indirect cumulative dose intrinsic hepatotoxin
B) direct super-therapeutic dose intrinsic hepatotoxin 1
C) direct super-therapeutic dose idiosyncratic hepatotoxin - B B Q2: Undergo which type of adverse effect ? A) Type A ADRs (dose-dependent hepatotoxicity)
B) Type B ADRs (dose-independent hepatotoxicity) 2 -
C) Type C ADRs A Q3: what is the toxic form of Paracetamol ?
A) N-acetylcysteine 3
B) Ursodiol - C C C) NABQI
Q4: what is the treatment in this case? 4
A) N-acetylcysteine - B) Cholestyramine A
C) Ursodeoxycholic acid 5
Q5: A patient took an cumulative dose of a drug A after tow months he developed Flu-like, malaise, m.aches - weakness,loss of appetite, GIT symptoms, diarrhea,jaundice, urine discolored what is drug A ? C A) Paracetamol
B) Erythromycin 6 -
C) Amiodarone A Q6: from previous question under which type of hepatotoxin is drug A considered?
A) indirect cumulative dose intrinsic hepatotoxin 7
B) direct super-therapeutic dose intrinsic hepatotoxin - C) direct super-therapeutic dose idiosyncratic hepatotoxin B Q7: what is the treatment for pruritus ? A) N-acetylcysteine B) Cholestyramine C) Ursodeoxycholic acid
L8: Anti-coagulants Parenteral Anticoagulant Oral (Used in acute ‘emergency’ Cases) Anticoagulants
Notes Unfractionated LMW Direct Factor Xa Vitamin K 1-heparin and LMW heparin has same heparin Heparin Thrombin Inhibitor antagonist indication but LMW heparin works mainly on inhibitors factor 10 + has less tendency to have bleeding + decrease monitoring needs + we XIIa, XIa, IXa, Xa, IIa And don’t need to give antidot thrombin Thrombin Factor Xa Factors II, VII, IX
Acts on (1000 more potent than 2a &X 2-heparin and LMW both can be given to Anti thrombin3) pregnant woman while warfarin is LMWH: Works more on Xa contraindicated to her
3- only give heparin at hospital setting while LMW heparin can be used at home Indirect: -Bivaluridin Fondaparinux 4- heparin and LMW heparin are rescue Enoxaparin -Argatroban -Warfarin > 40 therapy and VKA give to follow the therapy Drugs Heparin Lovenox -Dabigatran Direct: times potency Dalteparin -Lepirudin Rivaroxaban than: 5-rivaroxaban & dabigatran have oral (Orally) Dicumarol preparation so can be given at home also
6- if we developed heparin induced Pharma • Rapid -Slow thrombocytopenia as a side effect of using co • Variable (unpredictable) -Latency heparin !! we treat this situation by giving kinetics -Variable any drug from Direct Thrombin inhibitors group
7-VKA inhibit Vit K epoxide reductase • aPTT (1.5 - 2.5 times normal [30sec]) -PT (2 times) Monitor enzyme + warfarin has genetic • CT (2-3 times normal [5-7 min]) -INR (2.5) polymorphisms so some patients can get -Vitamin K1 bleeding without any increasing in dose • Protamine Sulphate IV for heparin Antidote infusion • Fresh blood -Fresh blood L8: Anti-coagulants Q1: which one of the following have -ve of fibrin-bound IIa ? A) UF Heparin B) Low molecular weight heparin C) Direct thrombin inhibitors
Q2: Patent taking heparin as anticoagulant for 2days, after that he developed one of the side effect of heparin which one of
the following do you expect ? 1
A) Heparin induced thrombocytopenia - B) Re-thrombosis C C) Both
2 -
Q3: Patent taking heparin as anticoagulant for 7days, after that he developed one of the side effect of heparin which one of B the following do you expect ?
A) Heparin induced thrombocytopenia 3
B) Re-thrombosis - A A C) Both
4
Q4: what is the treatment in case of Heparin induced thrombocytopenia ? -
A) Low molecular weight heparin B B)Direct thrombin inhibitors
C) Vitamin A antagonist 5 -
A Q5: Which drug is contraindicated for pregnant lady with Venous thrombosis?
A) Warfarin 6
B) Heparin - A A C) LMWH
7
Q6: one of the advantages in Low molecular weight heparin that it has much better tolerability and can given subcutaneous . -
A)True B B)Fouls
Q7: Carbamazepine is giving to a patient who is taking VKI, what is the predictable result of this combination ? A) Toxicity that leads to bleeding B) Decrease the efficacy leading to thrombosis C) Increase the INR L9:anti-malaria Drugs Clinical Uses Adverse Effects
Notes -blood -Transient heart block 1-Artemisinin *4hrs* Schizontocide=Affect all -Decrease neutrophil count 1-we use artemisinin & forms including multi- -Brief episodes of fever
chloroquine&quinine to treat attack and drug resistant P. -Neuro, hepato and bone artenusate *45 minns* primaquine to prevent relapse + it is not falciparum marrow toxicity nephritis.
use alone Artemether*4-11hrs*
2-we give Artesunate IV or IM in severe -Eradicate blood -Retinopathy complicated cases as cerebral malaria schizonts of Plasmodium -Lichenoid skin eruption, (24h) followed by complete course of 2-Chloroquine and vivax bleaching of hair Artemisin-based combination therapies -hypotension (ACTs) Amodiaquine -used also in rheumatoid - dysrrhythmias artheritis, SLE 3-Chloroquine and Amodiaquine very -Cinchonism effective on vivax + can be given to - Blood dyscarasis pregnant lady 3-QUININE -Potent blood IV = neurotoxicity Schizontocide & weak -Blackwater fever 4-QUININE can raise plasma levels of Gametoside. -Mild oxytoxic warfarin and digoxin+ it is -Slight neuromuscular blocking contraindicated to pt. has Prolonged QT action
Interval orGlucose-6-Phosphate Dehydrogenase -Radical cure of G-6-PD deficiency =hemolytic Deficiency P. ovale & anemia. 4-PRIMAQUINE P. Vivax=liver orMyasthenia Gravis hypnozoites -Granulocytopenia & Or Optic Neuritis, auditory problems agranulocytosis -Prevent spread of all 5- we prefer to give QUININE rather than forms=gametocytocides Chloroquine L9:anti-malaria
Q1: Patient suffering from Malaria come to ER with confusion and she diagnosed that she has falciparum cerebral malaria, what is the management in this case ? A) IV Artisunate for 24 hrs followed by Artemether+Clindamycin B) IV Chloroquine followed by primaquine for 14 days C) Artemether+Clindamycin for 7days followed by primaquine for 14 days
Q2: Patient has history of Malaria tow month ago come to you suffering from progressive visual loss the doctor notice 1
macular pigmentation, lichenoid skin and bleaching of hair. After investigation what do you expect to see in his blood ? - A) Falciparum A B) Chloroquine
C) Artisunate 2 -
B Q3: which one of the following drug act on heme polymerase by block it to prevent heme from convert to hemozine ?
A) Chloroquine 3
B) Quinine - C) Both C
Q4: Patient has malaria and he taking drug for it, he come to you suffering from cinchonism which is tinnitus he feel like 4 -
ringing of the ear, headache, nausea and visual disturbance also he has thrombocytopenic purpura and blackwater fever . B Which one of antimalaria drugs can cause such side effect?
A) Chloroquine 5 -
B) Quinine A C) Artisunate
6
Q5: Patients with G-6-PD deficiency develop hemolytic anemia . Which one of the following cause this side effect ? - C C A) Primaquine
B) Chloroquine
C) Artisunate
Q6: Pregnant women in first months of pregnancy suffering from falciparum Malaria, what is safest drug for her case ? A) IV Artisunate for 24 hrs followed by Artemether+Clindamycin B) Primaquine for 14 days C) Quinine+Clindamycin for 7days L10: Anti-platelets drugs Drugs Clinical Uses Adverse Effects 1-Aspirin - Prophylaxis of thromboembolism. - Peptic Ulcer. Notes (orally) - Prevention of ischemic events in - GIT bleeding. 1-all antiplatelets drugs used as prophylaxis and unstable angina pectoris. all of them can cause bleeding as a side effects 2-Ticlopidine Secondary prevention of ischemic -Sever neutropenia (less
(orally) complications after MI, ischemic in Clopidogrel). 2-Aspirin inhibite COX-1 (cyclooxygenase stroke and unstable angina. - Bleeding. enzyme) and we give it in small dose (pediatric - Allergic reactions. dose) to inhibit thromboxane not prostaglandin 3- Clopidogrel - Recent MI, Recent Stroke or
(orally) Established Peripheral Arterial 3-If the patient not tolerated aspirin here we Disease. can give any drug from the other groups - Acute Coronary Syndrome .
4-Prasugrel, Prophylactic: reduce the rate of - increase bleeding risk. 4-Clopidogrel&Ticlopidine inhibit ADP receptor Ticagrelor thrombotic cardiovascular events in - Ticagrelor causes P2Y12 irreversibly both are pro drug and have patients with acute coronary dyspnea. slow onset syndrome who are to be managed by
PCI. 5-Clopidogrel has replaced ticlopidine which means clopidogrel is the best in the group 5-Dipyridamole - prophylaxis of thromboembolism in -Headache. (orally) cardiac valve replacement with - Postural hypotension. 6-the new generation of ADP inhibitors including warfarin. (Prasugrel, Ticagrelor) have rapid onset and the - Secondary prevention of stroke and don’t require hepatic activation transient ischemic attack with aspirin. 7-the glycoprotein 2B\3A receptor inhibitors is the only group that we can give them as IV 6-Abciximab -Prevention of ischemic cardiac ------infusion and can be used during PCI or even I.V complications in patients undergoing after PCI. -Can be used in combination with 8-Dipyridamole inhibit phosphodiestrase thus aspirin and heparin. increase cAMP + it is not giving alone should be 7-Tirofiban, reduction of incidence of thrombotic ------combined with aspirin or warfarin for better Eptifibatide complications during PCI result (I.V) L10: Anti-platelets drugs
Q1what is the mechanism of action of Aspirin as anti-platelet drug? A) small dose, Irreversible inhibition of cyclooxygenase enzyme ( COX-1 ) B) small dose, irreversible inhibition of cyclooxygenase enzyme ( COX-2 ) C) large dose, reversible inhibition of cyclooxygenase enzyme ( COX-1 )
Q2: patient has peptic ulcer and history of recent myocardial infarction what is the best drug to use as 1
secondary prevention of ischemic complication after MI ? - A) Aspirin A B) Clopidogrel
C) Ticlopidine 2 -
Q3: what the different between new ADP inhibitor pathway( Prasugrel,Ticagrelor) and clopidogrel ? B A) Both have rapid onset of action than Clopidogrel
B) Both have slow onset of action than Clopidogrel 3
C) Both taken by I.V while Clopidogrel taken orally - A A Q4: patient come to ER undergoing percutaneous coronary intervention (PCI) what is the best drug used to
prevent ischemic cardiac complications in this patient? 4
A) Clopidogrel - B) Tirafiban C
C) Abciximab 5
Q5: what is the mechanism of action of Tirafiban as anti-platelet drug ? - A A A) act as fibrinogen mimicry agents B) Block all the receptors P2Y12
C) inhibition of cyclooxygenase enzyme ( COX-1 ) 6 - Q6: which one of the following using as Prophylaxis with warfarin of thromboembolism in cardiac valve A replacementpatients ?
A) Dipyridamole 7 -
B) Eptifibatide C
C) Ticagrelor Q7: which one of the following given as I.V. infusion ? A) Abciximab B) Tirafiban & Eptifibatide C) both A,B # Alosetron use in case of IBS associated with diarrhea كأنها looseٌعنً لٌن و بالتالً اربطوها انه ٌستخدم فً الحاالت اللً فٌها اسهال < A(lose)tron : lose #Tegaserod use in case of IBS associated with constipation كأنها )قاسً( و بالتالً اربطوها انه ٌستخدم فً الحاالت اللً فٌها امساك < Te(gase)rod : gase # Systemic amebiasis: Chloroquine, Metronidazole, Emetine, Dehydroemetine. بما أنها Systemicمعناها مو فً مكان واحد فتحتاج مٌترو علشان تتنقل بٌن أجهزة الجسم :Metro)nidazole) لما ٌكون الواحد متٌن )سمٌن( تصٌر له مشاكل فً :(E(metine), Dehydroe(metine (systemic and invasive( كثٌر من أجهزة الجسم < و أي نظام systemالزم ٌكون له ملكة > (Chloro(quine From @Med_433 و مكان ملكتنا هنا الكبد خامل Balsalazide: 5-ASA + inert carrier# تذكروا بلٌد ٌعنً خامل و كسول بالتالً اإلضافة هنا عنصر خامل > Bal)salazide) #Olsalazine: 5-ASA + 5-ASA (Ol)salazine
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