PART 2

Pharmacology

Self-study guide
for third year medical students

Student _________________________________________________

Group ____________ Faculty ________________________________

Teacher _________________________________________________

ЧАСТЬ 2

Методические указания
для самостоятельной работы студентов
3-го курса медицинских факультетов
при подготовке к практическим занятиям
по фармакологии

ХНМУ
2018
 МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ УКРАИНЫ
Харьковский национальный медицинский университет

PART 2
Pharmacology of the drugs acting on the function of organs and systems.
Vitamin, hormonal, anti-inflammatory, immunomodulating and enzymatic
agents. Pharmacology of antimicrobial, antiviral, anthelminthic,
antiprotozoal, antimycotic, anticancer agents. Preparations of acids, bases
and salts. Glucose.
Basic principles of acute poisoning treatment.

Self-study guide
for third year medical students

ЧАСТЬ 2
Фармакология средств, влияющих на функцию оганов и систем.
Витаминные, гормональные, противовоспалитеные,
противоаллергические, иммунотропные и ферментные лекарственные
средства. Фармакология противомикробных, противовирусных,
противопаразитарных, противопротозойных, противогрибковых,
противобластомных лекарственных средств. Препараты кислот,
щелочей и солей щелочно-земельных металлов. Глюкоза.
Принципы лечения острых отравлений.

Методические указания
для самостоятельной работы студентов
3-го курса медицинских факультетов
при подготовке к практическим занятиям
по фармакологии

Утверждено
ученым советом ХНМУ
Протокол № 1 от 22.01.2015

Харьков
ХНМУ
2018
 Part 2. Pharmacology of the drugs acting on the function of organs and
systems. Vitamin, hormonal, anti-inflammatory, immunomodulating and enzymatic
agents. Pharmacology of antimicrobial, antiviral, anthelminthic, antiprotozoal,
antimycotic, anticancer agents. Preparations of acids, bases and salts. Glucose. Basic
principles of acute poisoning treatment: self-study guide for third year medical
students / comp.: T.I. Iermolenko, E.V. Karnaukh, AV. Aleksandrova et al. –
Kharkov, KhNMU, 2015. – 142 p.

Compilers: Iermolenko T.I.

Karnaukh E.V
Aleksandrova A.V.
Gordiychuk D.A.

Часть 2. Фармакология средств, влияющих на функцию оганов и систем.

Витаминные, гормональные, противовоспалитеные, противоаллерги-ческие,
иммунотропные и ферментные лекарственные средства. Фармакология
противомикробных, противовирусных, противопаразитарных, противопрото-
зойных, противогрибковых, противобластомных лекарственных средств.
Препараты кислот, щелочей и солей щелочно-земельных металлов. Глюкоза.
Принципы лечения острых отравлений: метод. указ. для самост. работы
студентов 3-го курса мед. фак-тов при подготовке к практ. занятиям по
фармакологии / сост.: Т.И. Ермоленко, Э.В. Карнаух, А.В. Александрова и др. –
Харьков: ХНМУ, 2015. – 142 с.

Составители: Ермоленко Т. И.
Карнаух Э. В.
Александрова А. В.
Гордийчук Д. А.
 CONTENT
Part 2.
Pharmacology of the drugs acting on the function of organs and systems. Vitamin,
hormonal, anti-inflammatory, immunomodulating and enzymatic agents. Pharmacology of
antimicrobial, antiviral, anthelminthic, antiprotozoal, antimycotic, anticancer agents.
Preparations of acids, bases and salts. Glucose. Basic principles of acute poisoning
treatment……………………………………………………………………………………… 5

Unit I.
Pharmacology of the drugs acting on cardiovascular system. Diuretics and drugs
acting on myometrium………………………………………………………………………. 5

Topic 1. Inotropic drugs. Cardiac glycosides. Antiarrhythmic drugs ……………………... 5

Lesson 1. Inotropic drugs. Cardiac glycosides. Antiarrhythmic drugs......... 5

Topic 2. Antianginal drugs. Hypolipidemic agents…...………………………..…………... 15

Lesson 2. Antianginal drugs. Hypolipidemic agents…...………………… 15

Topic 3. Drugs acting on renal function and myometrium.

Drugs for treatment of gout, uricosuric agents………………………………….… 26
Lesson 3. Drugs acting on renal function & myometrium. Drugs for
treatment of gout, uricosuric agents …………………………… 26

Topic 4. Hypertensive and antihypertensive drugs ………………………………………… 34

Lesson 4. Hypertensive and antihypertensive drugs ……………………… 34

Unit II.
Pharmacology of the drugs acting on respiratory and digestive system ………………… 41

Topic 5. Drugs acting on respiratory system ………………………………………………. 41

Lesson 5. Drugs acting on respiratory system ……………………………. 41

Topic 6. Drugs acting on digestive system ………………………………………………… 49

Lesson 6. Drugs acting on digestive system: agents influencing on
appetite, salivary gland secretion, gastric secretory function and
gastric motility. Emetics and antiemetics…..…………………... 49

Lesson 7. Drugs acting on digestive system: agents influencing on

excretory function of the pancreas, intestinal motility,
cholagogue drugs, hepatoprotectors …………………………… 56

Unit III.
Pharmacology of the drugs acting on blood …………………..………................................ 62

Topic 7. Drugs acting on blood.

Плазмозаменитили………………………………………………………………. 62
Lesson 8. Drugs acting on erythropoiesis and leucopoiesis.
Plasma expanders ……………………………….…………….. 62

Lesson 9. Drugs acting on blood coagulation …………............................. 66

3
 Unit IV.
Vitamin, enzymatic and hormonal drugs.
Anti-inflammatory, antiallergic and immunomodulating drugs………..………………... 74

Topic 8. Vitamin and antivitamin drugs. Enzymatic and antienzymatic agents. Hormonal
preparations, their synthetic derivatives and antagonists ………………………… 74
Lesson 10. Hormonal agents of peptide nature …………………………… 74

Lesson 11. Hormonal drugs of steroidal structure and their synthetic

derivatives ……………………………………………………... 80

Topic 9. Anti-inflammatory, antiallergic and immunomodulating drugs …………………. 85

Lesson 12. Anti-inflammatory, antiallergic and immunomodulating drugs . 85

Unit V.
Antimicrobial, antibiotics, antiviral, antimycotic drugs…………………………………... 93
Topic10. Antiseptics and disinfectants ……………………………………………………... 93
Lesson 13. Antiseptics and disinfectants ………………………………….. 93

Topic11. Pharmacology of antibiotics ……………………………………………………... 99

Lesson 14. Pharmacology of β-lactam antibiotics ………………………… 99

Lesson 15. Pharmacology of aminoglycosides, tetracyclines,

chloramphenicol, macrolides, rifamycins …………………….. 104

Topic12. Sulfonamides and other synthetic chemotherapeutic drugs. Pharmacology of

atituberculous, antiviral, antispirochetous drugs. Antimycotic agents …………... 109
Lesson 16. Sulfonamides and other synthetic chemotherapeutic drugs.
………..…………………………………………………. 109

Lesson 17. Atituberculous, antispirochetous drugs ……………………….. 114

Lesson 18. Antimycotic, antiviral agents ………………………………….. 119

Unit VI.
Antiparasite drugs ………………………………………………………………………….. 122
Topic13. Antiprotozoal drugs. Antimalarial agents. Anthelminthic drugs…………………. 122
Lesson 19. Antiprotozoal drugs. Antimaiarial agents. Anthelminthic drugs. 122

Unit VII.
Anticancer drugs. Radioprotectors. Preparations of acids, bases and salts. Basic
principles of acute poisoning treatment. …………………………………………………... 129
Topic14. Pharmacology of anticancer drugs. Radioprotectors. Preparations of acids, bases
and salts. Glucose. Basic principles of acute poisoning treatment ……………… 129
Lesson 20. Anticancer drugs. Radioprotectors. Preparations of acids, bases
and salts.……………………………………………………….. 129

Lesson 21. Basic principles of acute poisoning treatment. Antidotes……... 134

The list of drugs for final lesson 2……..…............................................................................. 140

4
The list of drugs that are included in the license test items STEP-1…………………………… 142

Part 2
Pharmacology of the drugs acting on the function of organs and
systems. Vitamin, hormonal, anti-inflammatory,
immunomodulating and enzymatic agents. Pharmacology of
antimicrobial, antiviral, anthelminthic, antiprotozoal, antimycotic,
anticancer agents. Preparations of acids, bases and salts. Glucose.
Basic principles of acute poisoning treatment.

Unit I
DRUGS ACTING ON CARDIOVASCULAR SYSTEM.
DIURETICS AND DRUGS ACTING ON MYOMETRIUM

Topic 1
Inotropic drugs. Cardiac glycosides.
Antiarrhythmic drugs

Lesson 1 Inotropic drugs. Cardiac glycosides.

Antiarrhythmic drugs

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

DigoxinTab. 0,1 mg for children; for adults 0,125 & 0,25 mg; sol. 0,075% - 10 ml in vials for
internal use as a drops; amp. 0,025% sol. - 1 & 2 mlP.O. 0,25 mg 1-2 times a day in chronic
heart failure; for children dose is attained individually; I.V. 1-2ml of 0,025% sol. in 10 ml of
5%, 20%, or 40% sol of glucose; I.V. by drop 1-2ml of 0,025% sol. in 100 ml of glucose sol.
CorglyconumAmp.0,06% -1mlI.V. 0,5-1ml in 10-20ml of 20%, or 40% sol of glucose; for
children dependently on the age
DobutamineVials for injection 0,25 g or 0,1 g
Amp.5% - 5mlI.V. by drop 0,25-0,5-1,0 g/l.
IV slowly 5 ml of 5% solution

5
 AmiodaroneTab. по 0,2 g;
Amp 5% - 3 mlP.O. 1-3 tab. a day
I.V. drip 0,6-1,2 g in 250-500 ml 5% sol. of glucose

VerapamilTab. and dragee 0,04-0,08-0,12 g, tab. retard 0,2 & 0,4 g; caps. retard 0,12-0,18-024 g;
amp. 0,25% - 2mlP.O. 0,04-0,12 g per 24 hours in supraventricular arrhythmia; in acute cases
I.V. slowly 2ml of 0,25% sol in 100-150ml of isotonic sol. of NaCl or 5% sol. of glucose
Amlodipine

Tab. 0,005 g or 0,01 g

P.O. 5-10 mg 1 time a day

Write the prescriptions: Prescription № ______

Prescription "______"_________________
20_____.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Corglyconum. Patien's address and № of medical
recard_______________________________________
Doctor's
name____________________________________________________________

Rp.: ……………………………..……….
………..
2. Digoxin. ……………………….……………….
………..
………………………….…………….
………..
………………………….…………….
3. Amiodarone. ………..
............…………………………..
……………………..
Rp.: ....…………………..………….
4. Verapamil. ………………..
…………………..
……………………………..
…………………..……………………….
…….
6 ........................…………………..
……………………………..
Do the tasks:

1. Indicate the cardiotonic agents according to their mechanism of action

Inhibition of Na+ / K+ - Excitation of β1-adrenergic Inhibition of PDE → cAMP
ATPase activity → receptors of the heart → accumulation → increasing of
accumulation of increasing of excitability and Ca2+ in myocardiocytes →
mitochondrial Ca in
2+
conductivity of the heart. activation of contractile
myocardial cells → proteins.
stimulation of contractile
proteins.

2. Fill the table

Comparative characteristics of cardiac glycosides
Preparations Lipophilic Bind Routes of The onset Maxi- Elimina- Indications Cumu
(L) or with administ- of action mum of tion lation
hydrophilic blood ration (minutes / the action path- (+/–)
(H) proteins hours) (min / ways
(%) hours)
Corglyconum

Digoxin

Digitoxin

3. Fill the table (see note)

Comparative characteristics of antiarrhythmic agents
affecting on ion channels of cardiomyocytes
Options of comparison Groups of antiarrhythmic agents
IА IВ IС III IV
The blockade Sodium
of channels Potassium
Calcium
Impact on Phase 0
action potential Phase 3
(AP) of Фаза 4
Purkinje fibers
Duration of AP

Influence on The conductivity

parameters of The automatism
myocardium The duration of ERP

7
 Using for Supraventricular
arrhythmia Vemtricular
Adverse Decreasign of
effects myocardial
contractility
Violation of
atrioventricular
conduction
Arterial hypotension

Thyroid dysfunction

Fibrotic changes in
lungs

Note. When filling the table, use the following notation:

"+" - Presence of the effect; «↑» - increasing, «↓» - decrease.

4. Describe the cardiac effects of cardiac glycosides:

1) The positive inotropic action ____________________________________________________
2) The negative chronotropic action _________________________________________________
3) The positive bathmotropic action _________________________________________________
4) The negative dromotropic action _________________________________________________

5. Explain the mechanism of cardiotonic action of cardiac glycosides by placing the following
statements in a logical sequence:
1. Binding of Ca2+ with troponin C.
2. Increasing of sodium ions inside the cardiomyocytes.
3. Increasing of strength of heart contractions.
4. Decreasing in activity of Na+ / Ca2+ - pump.
5. Violation of calcium ions releasing from myocytes.
6. Inhibition of Na+ / K+ - ATPase of cardiomyocytes membranes.
7. The interaction of actin and myosin.
Answer:………………………………………………………………………………………………..

6. Solve situational tasks:

1) The patients taking digitoxin for chronic heart Answer:
failure has a sharp increase of the interval R-R1, the …………………………………………...
negative segment ST and single extrasystoles in ECG.
…………………………………………...
What kind of condition reflects the ECG?
What should you pay attention to during examination …………………………………………...
of the patient?
…………………………………………...
Which drugs can normalize the function of the heart?
…………………………………………....

2) Cardiac arrhythmia that occurred on the background Answer:

of the prolonged use of digitoxin, stopped by the drug, …………………………………………...
which improves the heart state, but causes the patient's
…………………………………………...
dry mouth, mydriasis and disturbance (paralysis) of
accommodation. …………………………………………...
What kind of an arrhythmia occurred in a patient?
8
Which drug was administered to the patient to relieve …………………………………………...
it? What is the reason of side effects appearing?
……………………………………………
7. Determine the drug:
1. It blocks potassium channels, increases 2. Cardiac glycoside, which derivates from
the effective refractory period. It is used digitalis, has significant cumulative
for ventricular and supraventricular properties, used only in chronic heart
tachyarrhythmia, angina pectoris. Side failure.
effects are bradycardia, disturbance of
atrioventricular conduction, impaired А. Corglyconum
thyroid function, bronchospasm. В. Digoxin
A. Verapamil С. Lidocaine
B. Amiodarone D. Digitoxin
C. Propranolol E. Strophanthin
D. Qunidine
E. Lidocaine

8. Choose correct answers:

1. Inotropics whith glycoside structure 2. Drugs for acute heart failure
1. Dobutamine 1. Digitoxin
2. Digoxin 2. Corglyconum
3. Adrenaline 3. Panangin
4. Strophanthin 4. Strophanthin
5. Corglyconum 5. Dobutamine
3. Drugs for cardiac glycoside intoxication 4. Sodium channels blockers from IA
subgroup
1. Digoxin 1. Qunidine
2. Asparkam 2. Procainamide
3. Calcium chloride 3. Propafenone
4. Unithiolum 4. Lidocaine
5. Sodium channels blockers from IB 6. Sodium channels blockers from IC
subgroup subgroup
1. Lidocaine 1. Propafenone
2. Propafenone 2. Propranolol
3. Ajimaline 3. Verapamil
4. Verapamil 4. Phenytoine
5. Phenytoine 5. Qunidine
7. Medicines for bradyarrhythmia 8. Medicines for tachyarrhythmia
1. Cardiac glycosides 1. Sodium channel blockers
2. M-cholinoblockers 2. Activators of potassium channels
3. β-adrenoblockers 3. Potassium channel blockers
4. β-adrenomimetics 4. β-adrenoblockers
5. Calcium channel blockers

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Epinephrine
9
 (Adrenaline hydrochloride)
Amiodarone

Amlodipine

Propranolol (Аnapriline)

Atropine sulfate

Hydrochlorothiazide

Digoxin

Dobutamine

Corglyconum

Lidocaine hydrochloride

Lisinopril

Losartan

Metoprolol

Nitroglycerine

Prednisolone

Spironolactone

Furosemide

Unithiolum

Typical license test tasks Step-1 For computer tests

1. The patient presented with pronounced 2. Due to long-term treatment the patient
symptoms of acute heart failure. Which of with heart defect developed refractory
these drugs can help him urgently? to cardiac glycosides. Which of the
following drugs should be selected to
continue treatment of this patient?
A. Digitoxin A. Celanidum
B. Aethazolum B. Dobutamine
C. Corglyconum C. Strophanthin
D. Physostigmine D. Cordigitum
E. Dithylinum E. Propranolol
3. The patient with chronic cardio-vascular 4. A men with chronic heart failure and
10
 insufficiency under the influence of paroxysmal atrial fibrillation used
digitoxin developed significant digoxin. To which pharmacological
bradycardia, arrhythmia, insomnia, group the drug belongs to?
headache, no appetite, nausea, diarrhea,
decreased urine output. Which drug should
be prescribed to the patient?
A. Unithiolum A. Coronarolitics
B. Clonidine B. Analeptics
C. Phenylephrine C. Nonglycoside inotropic drugs
D. Analginum D. Cardiac glycosides
E. GABA E. Calcium channel blockers
5. A 57-year-old woman with chronic heart 6. A patient suffering from chronic cardiac
failure has symptoms suggestive of insufficiency was recommended to
beginning toxic effects of cardiac undergo a prophylactic course of
glycosides during treatment with digitalis. treatment with a cardiological drug from
Which drug necessary to prescribe to the group of cardiac glycosides that is to
reduce the negative effects of cardiac be taken enterally. What drug was
glycosides? recommended?
A. Aethimizolum A. Digoxin
B. Potassium chloride B. Corglyconum
C. Caffeine C. Cordarone
D. Dipiroximum D. Nikethamide
E. Atropine sulfate E. Strophanthin
7. A patient who has been suffering from 8. The patient with chronic cardio-vascular
cardiac insufficiency for several months insufficiency headache, fatigue, nausea,
takes digoxin on an outpatient basis. At a impaired color vision (the surrounding
certain stage of treatment appeared objects are seen in green) appeared
symptoms of drug overdose. What during digitalization. ECG demonstrated
phenomenon underlies the development of sinus bradycardia and signs of impaired
this complication? atrioventricular conduction. What drug
can be used to reduce the symptoms of
intoxication?
A. Sensibilization A. Dipiroximum
B. Tolerance B. Naloxone
C. Material cumulation C. Bemegride
D. Functional cumulation D. Unithiolum
E. Tachyphylaxis E. Atropine sulfate
9. The patient presented with complaints of 10. The patient with pronounced signs of
swelling, rapid pulse, shortness of breath, acute cardiac insufficiency was admitted
cyanosis of the mucous membranes. to the hospital emergency department.
Diagnosis: chronic heart failure. What drug Which of these drugs urgently needed to
should be administered? introduce him?
A. Phenylephrine A. Corglyconum
B. Papaverine hydrochloride B. Aethazolum
C. Digoxin C. Dithylinum
D. Nikethamide D. Physostigmine
E. Nitroglycerine E. Digitoxin
11 A patient suffers from acute 12. A patient with cardiogenic shock,
cardio-vascular insufficiency accompanied hypotension, dyspnea and edema was
by pulmonary edema. Which drug from used nonglycoside inotropic agent.
cardiac glycosides should be prescribed? Which drug was administered to the

11
 patient?
A. Diacarb A. Caffeine
B. Spironolactone B. Dobutamine
C. Hypothiazide C. Nikethamide
D. Corglyconum D. Aethimizolum
E. Triamterene E. Bemegride
13 A 70-year-old man with heart failure, 14. A 50-year-old patient with chronic
which is a long time to take the digitalis cardiac insufficiency and
drug developed symptoms of intoxication, tachyarrythmia was prescribed
which quickly eliminated by use of cardiotonic drug. What drug was
sulfhydryl groups donator - Unithiolum. prescribed?
What is the mechanism of therapeutic
action of the drug?
A. Inhibition of potassium release from A. Dobutamine
cardiomyocytes B. Dopamine
B. Reducing the accumulation of ionized C. Digoxin
calcium D. Amiodarone
C. Reactivation of the Na+/ K+ - ATPase E. Mildronate
membranes of cardiomyocytes
D. Slowing inflox of sodium in
cardiomyocytes
E. Increasing energy of myocardium
15 A 63-year-old patient was admitted to the 16. A 67-year-old patient developed acute
cardiology department with complaints of cardiac insufficiency. What preparation
rapid pulse, shortness of breath, cyanosis of is necessary to enter the patient?
the mucous membranes. On examination:
swelling of the lower limbs, ascites.
Diagnosis: chronic heart failure. Which of
the following drugs should be prescribed to
the patient to feel better?
A. Digitoxin A. Corglyconum
B. Nikethamide B. Adrenaline hydrochloride
C. Adrenaline hydrochloride C. Atropine sulfate
D. Corglyconum D. Noradrenaline hydrotartrate
E. No-spa E. Caffeine
17 A 90-year-old patient developed acute 18. A 33-year-old patient with severe
myocardial infarction in removing the hypotension was administered inotropic
tooth. What preparation is necessary to drug which stimulates dopamine, alpha-
enter a patient for prevention of painful and beta-adrenergic receptors.
shock? Determine the drug
A. Morphine hydrochloride A. Dopamine
B. Pilocarpine B. Dobutamine
C. Propranolol C. Adrenaline hydrochloride
D. Calcium chloride D. Noradrenaline hydrotartrate
E. Acetylcysteine E. Phenylephrine
19 A 67-year-old patient with chronic heart 20. A 67-year-old patient suffers from acute
failure was admitted to the therapeutic heart failure. Which of the drugs is
department. What preparation should be advisable for intravenous drip use?
prescribed to patient?
A. Digoxin A. Corglyconum
B. Phenylephrine B. Magnesium sulfate

12
 C. Neostigmine C. Omeprazole
D. Chlorpromazine D. Digoxin
E. Dobutamine E. Asparkam
21 A 67-year-old patient with chronic heart 22. A patient takes digoxin for treatment of
failure and nitrogenemia was appointed cardiac insufficiency. What diuretic may
prolonged cardiac glycoside. Determine the increase digoxin toxicity due to the
drug intensified excretion of K+ ions?
A. Digitoxin A. Lisinopril
B. Digoxin B. Spironolactone
C. Celanidum C. Panangine
D. Infusion of herbs Adonis D. Siliborum
E. Strophanthin E. Hydrochlorothiazide
23 A patient with angina pectoris developed 24. A patient developed bronchial
ventricular tachyarrhythmia. The doctor obstruction (shortness of breath, cough)
prescribed amiodarone. Specify the during treatment of atrial fibrillation.
mechanism of action of this drug. Which of antiarrhythmic agents
contributes to this complication?
A. Blocks Na+ - channels A. Ajimaline
B. Blocks K+ - channels B. Propranolol
C. Blocks Ca2+ - channels C. Novocainamide
D. Blocks Mg2+ - channels D. Verapamil
E. Mostly blocks K+-, less Na+-, Ca2+ - E. Nifedipine
channels
25 A patient with myocardial infarction 26. A 64-year-old patient suffers from
occurred heart block. Which of the listed ventricular extrasystoles. Which of the
antiarrhythmic drugs must be used for following drugs should appoint him in
prevention of cardiac arrest? this type of arrhythmia?

A. Novocainamide A. Isoprenaline
B. Propranolol B. Lidocaine
C. Atropine sulfate C. Ajimaline
D. Qunidine D. Verapamil
E. Phenytoine E. Dobutamine
27 A 57-year-old man suffers from IHD 28. ECG of 45-year-old woman detected
accompanied by ventricular extrasystoles. atrial fibrillation, in the anamnesis
The doctor prescribed antiarrhythmic proved concomitant disease - asthma.
drugs, which is peculiar to coronarolytic Therapeutist prescribed antiarrhythmic
action. Which of the listed preparations is agent. What preparation of this group is
shown in this case? contraindicated in patient?
A. Qunidine A. Ajimaline
B. Novocainamide B. Propranolol
C. Disopyramide C. Nifedipine
D. Lidocaine D. Verapamil
E. Aetmozinum E. Novocainamide
28 A 56-year-old patient developed ventricular 29. A 45-year-old patient was diagnosed
fibrillation after myocardium infarction. atrial fibrillation, hypertension II
Heart rate returned to normal after the degree. What is the drug of choice
introduction of antiarrhythmic drug with should be prescribed to stop the attack?
local anesthetic activity. What preparation
is introduced?
A. Propranolol. A. Strophanthine
B. Benzocaine. B. Sustac forte
13
 C. Verapamil. C. Potassium chloride.
D. Panangine. D. Propranolol.
E. Lidocaine. E. Lidocaine.
30 The patient developed bronchial 31. A 67-year-old man with myocardial
obstruction (shortness of breath, cough) infarction and heart failure developed
during treatment of atrial fibrillation. ventricular arrhythmias. What is
Which of antiarrhythmic drugs can cause antiarrhythmic drug of choice in this
such complications? case?
A. Verapamil. A. Novocainamide.
B. Ajimaline. B. Qunidine.
C. Nifedipine. C. Nifedipine.
D. Propranolol. D. Lidocaine.
E. Novocainamide E. Ajimaline.

Date Student's name Teacher's signature

«____»_______ ____________________________ _____________

201__г.

14
 Topic 2
Antianginal drugs.
Hypolipidemic drugs.

Lesson 2
Antianginal drugs.
Hypolipidemic drugs.

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationAmlodipineTab.

0,005 g or 0,01 g P.O. 5-10 mg 1 time a dayNitroglycerine (Glyceril trinitrate, GTN)
Tab. 0,25mg, 0,5 & 1mg; alcohol sol. 1% - 10 & 20ml in vials for sublingual use; aerosol 1% -
300doses for sublingual use; amp. 0,1% sol. -1-5-10 & 25 mlSublingually, I.V. in physiologic NaCl
sol by drip in M.I. and insufficiency left ventricle under cardiovascular monitoringIsosorbide
mononitrateTab. 0,02g & 0,04g,
amp. 1% 1 ml.P.O. 1 tab. 2-3 times a day.
[Link]. 0,02gP.O., sublingually 1 tab. 2-3 times a day
AmiodaroneTab. по 0,2 g;
Amp 5% - 3 mlP.O. 1-3 tab. a day
I.V. drip 0,6-1,2 g in 250-500 ml 5% sol. of glucoseVerapamil

Tab. and dragee 0,04-0,08-0,12g, tab. retard 0,2 & 0,4g; caps. retard 0,12-0,18-024g; amp. 0,25% -
2mlP.O. 0,04-0,12g per 24 hours in supraventricular arrhythmia; in acute cases I.V. slowly 2ml of
0,25% sol in 100-150ml of isotonic sol. of NaCl or 5% sol. of glucoseLovastatinTab. 0,01g &
0,02gP.O. 0,01-0,04g per day before sleepAtorvastatineTab. 0,01, 0,02, 0,04, 0,08gP.O. 10-80 mg
1-2 times a dayFenofibrateCaps. 0,1g; caps. retard 0,2 & 0,25gP.O. 0,1g 3 times a day or 0,2 once a
day while mealPentoxyphyllineTab. 0,1g;
Amp. 2% 5 mlP.O. 1 tab. 2 times a day.
I.M. 5 ml 1 time a day.

15
 Prescription № ______
Prescription "______"_________________ 20____
Write the prescriptions: г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Nitroglycerine. Patien's address and № of medical
recard_______________________________________
Doctor's
name____________________________________________________________
Rp.: ……………………………..……….
………..
……………………….……………….
2. Niphedipine.
………..
………………………….…………….
………..
………………………….…………….
………..
3. Amiodarone.
............…………………………..
……………………..
Rp.: ....…………………..………….
………………..
4. Verapamil. …………………..
……………………………..
…………………..……………………….
…….
........................…………………..
……………………………..
5 Amlodipine. ........................…………………..
……………………………..
Rp. ……………………………………..…………
………………………………………….
6. Lovastatin. ……...
......................................................
………………………………………………
…
......................................................
7. Atorvastatine ………………………………………………
…
......................................................
………………………………………………
…
Rp.: ....…………………..………….
8. Pentoxyphylline.
………………..
…………………..
16 ……………………………..
…………………..……………………….
…….
Do the tasks:

1. Fill the table (see note).

Hypolipidemic effects of antisclerotic drugs
Hypolipidemic effects Lovastatin Fenofibrate Cholestyramine Nicotinic acid
Lowers cholesterol
Lowers TG
Reduces the amount of
LDL
Inhibits the absorption
of fat in the intestine
Inhibits the synthesis of
cholesterol in the liver
Accelerating the
elimination of fat from
the body
Note. The presence of the effect indicate by the symbol "+".

2. Specify antianginal drugs according to their mechanism of action

Decrease oxygen Decrease oxygen Increase oxygen Improve methabolic
demand of myocardium demand of supply processes in
and increase oxygen myocardium myocardium
supply

3. Mark by “+” the clinical goal of antianginal drugs

Preparations To relieve the angina attack For the treatment of angina
Nitroglycerine
Isosorbide mononitrate
Verapamil
Amiodarone
Propranolol
Metoprolol
Validol
Dipyridamole
Sodium ATP

4. Match the preparations with the mechanisms of their action

Preparations Mechanisms of action
1. Nitroglycerine A. Blocks β1 and β2-adrenergic receptors
2. Verapamil B. Inhibits adenosinedesaminase
3. Propranolol C. Blocks calcium channels of L-type
4. Metoprolol D. It forms nitric oxide after metabolic transformation
5. Dipyridamole E. Blocks β1-adrenergic receptors

17
Answer: 1.___2.___3.___4.___5.____.

5. Specify the groups and drugs used for acute myocardial infarction (see note)
Pharmacotherapy of acute myocardial infarction
The goal of pharmacotherapy Groups Preparations
Relief of pain
Relief of ventricular
arrhythmias
Prevention of thrombosis
Normalization of
hemodynamics (improving
coronary circulation)
Note. When completing the rubric “Groups” of drugs use the following pharmacological groups: organic nitrates,
blockers of Na+ channels subgroup IB, antiplatelet agents, opioid analgesics, fibrinolytics, anticoagulants
When completing the rubric “Prepapations” use the following drugs: morphine, heparin, lidocaine, nitroglycerin,
aspirin, alteplaza, streptokinase

6. Fill the table.

Drug’s name Mechanism of action
Cinnarizine
Piracetam
Pentoxiphylline
Preduktal
Acetylsalicylic acid
Heparin

7. Fill the table (see note).

Side effects of hypolipidemic drugs
Side effects Statins bile Fibrates Nicotinic acid Acid sequestrants
Nausea and vomiting
Constipation
Diarrhea
Malabsorption of the
drugs
The formation of
gallstones
(cholelithiasis)
Abnormal liver
function
Myopathy
Hyperemia and itchy
skin
Hyperglycemia
Note. The presence of the effect indicate by the symbol "+".

8. Explain the mechanism of action of hypolipidemic drugs, by placing the following statements
in a logical sequence.
Statins
1. Lower LDL in the blood plasma.
2. Inhibit 3G3MG-CoA reductase.
3. Disturb the synthesis of cholesterol in the liver at the stage of formation of mevalonic acid.
4. Increase the receptor-dependent endocytosis of LDL.
18
5. Increase the density of LDL receptors in the liver.
Answer::.............................................................................................................................................
Nicotinic acid
1. Reduces VLDL in the liver.
2. Inhibits triglyceride lipase of adipocytes.
3. Reduces fatty acids from triglycerides in adipocytes.
4. Reduces the intake of fatty acids in hepatocytes and the formation of triglycerides in the liver.
5. Decreases in plasma VLDL, LDL
Answer:..............................................................................................................................................

Fibrates
1. Reduces VLDL in plasma.
2. Activates lipoprotein lipase.
3. Increase the catabolism of VLDL.
Answer:..............................................................................................................................................

Bile acid sequestrants

1. Lower LDL in the blood plasma.
2. Increase the receptor-dependent endocytosis of LDL in the liver.
3. Increase the synthesis of bile acids from cholesterol and reduce its holdings in the liver.
4. Prevent the absorption of cholesterol and bile acids in the intestine.
5. Increase the density of LDL receptors in the liver.
6. Bind bile acids in the intestine.
Answer:..............................................................................................................................................

9. Explain the mechanism of vasodilatory action of organic nitrates, by placing the following
statements in a logical sequence:
1. The formation of nitric oxide after metabolic transformation.
2. The relaxation of vascular smooth muscle.
3. Decreasing the amount of ionized Ca2+ in vascular smooth muscle.
4. Activation of guanylate cyclase and increasing cyclic GMP synthesis.
Answer:..............................................................................................................................................

10. Solve situational tasks:

1) Drug with prolonged use was prescribed to the Answer:
patient from group of "risk" due to high content of …………………………………………...
cholesterol. The drug reduces the permeability of blood
…………………………………………...
vessels and prevents fatty infiltration of the vessels,
improves microcirculation, reduces platelet …………………………………………...
aggregation, has an antioxidant effect and promotes
…………………………………………...
regression of atheromatous plaques.
Which drug was prescribed to the patient? …………………………………………...
What is the name of effect?
…………………………………………...
In combination with which agent this one usually is
used?
2) Patient with ischemic heart disease after two weeks Answer:
of treatment by drug from the group of organic nitrates, …………………………………………...
had felt general weakness, headache, cyanosis of visible …………………………………………...
mucous membranes and nails. In view of these …………………………………………...
complaints and results of examination of the patient …………………………………………...
(blood pressure decreased, 73% methemoglobine in …………………………………………...

19
blood, increased and painful liver) were diagnosed - an …………………………………………...
overdose of nitrates.
Prescribe drug as specific antagonist?

11. Determine the drug:

1. It is derived from natural ray fungi, is a 2. It is a semisynthetic derivative alkaloid of
prodrug and its active metabolite - beta- vinca, selectively dilates the blood
hydroxy acid – that inhibits the synthesis vessels of the brain and improves blood
of endogenous cholesterol in the liver flow to ischemic areas of the brain,
and reduces its content in LDL. It is increases the resistance of neurons to
intended for long-term treatment of hypoxia reduces blood viscosity, used in
atherosclerosis, for once a day use at neurological and psychiatric disorders
dinner time; possible side effects muscle associated with disorders of cerebral
pain and in rare cases - myopathy. circulation, is not recommended for labile
blood pressure and low vascular tone.
A. Cholestyramine A. Cinnarizine
B. Simvastatin B. Cavinton
C. Probucol C. Piracetam
3. It blocks calcium channels mainly in the 4. The drug increases oxygen delivery to the
vessels of the brain. It is used to improve myocardium through the dialation of
circulation in the brain during ischemia small coronary vessels. It is used in
and to reduce neurological disorder after vasospastic angina. It can cause a
stroke. “stealing” syndrome.
A. Vinpocetine A. Nitroglycerine
B. Pentoxiphylline B. Propranolol
C. Cinnarizine C. Dipyridamole
D. Nicergoline D. Verapamil
E. Nicotinic acid E. Nifedipine
5. It refers to organic nitrates, causes a rapid 6. Synthetic drug has antianginal,
but transient expansion of the coronary antiarrhythmic, hypotensive and
vessels. It is the main for first aid for spasmolytic action on the basis of the
strokes blockade of Ca2+ flow into cells.
A. Sustac A. Validol
B. Amiodarone B. Verapamil
C. Nitroglycerine C. Propranolol
7. It is the similar to nitroglycerine by
chemical structure and pharmacological
properties but it has a longer effect. It is
used to treat coronary artery disease.
A. Propranolol
B. Sustac
C. Nifedipine

12. Choose correct answer:

1. Antiatherosclerotic action is rendered by 2. Hypolipidemic drugs
1. Holesteramin
1. Statins 2. Simvastatin
2. β-blockers 3. Parmidin
3. Fibrates 4. Lovastatin

20
 4. Antioxidants 5. Probucol
3. The agents, which mainly reduce blood 4. The agents that mainly reduce blood
levels of cholesterol levels of triglycerides
1. Atorvastatin 1. Nicotinic acid
2. Simvastatin 2. Bezafibrate
3. Holesteramin 3. Fenofibrate
4. Fenofibrate 4. Fluvastatin
5. Bezafibrate 5. Simvastatin
5. The agents that disturb intestinal 6. Myopathies, abnormal liver function may
absorption of drugs be caused by
1. Statins 1. Fibrates
2. Fibrates 2. Statins
3. Nicotinic acid 3. Nicotinic acid
4. Bile acid sequestrants 4. Bile acid sequestrants
7. Drugs used in case of violation of 8. Side effects of organic nitrates
cerebral circulation
1. Vinpocetine 1. Dizzeness
2. Atropine 2. Hypotension
3. Cinnarizine 3. Headache
4. Nicergoline 4. “Stealing” syndrome
5. Pentoxiphylline 5. Reflex tachycardia
9. Antianginal effect of verapamil is due to 10. Antianginal effect of propranolol is due
to
1. Dilation of small coronary vessels 1. Reduction in force and rate of the
heart
[Link] of force and rate of the 2. Reduction of preload on the heart
heart
3. Reduction of preload on the heart 3. Dilation of large coronary vessels
11. Drugs used to relief angina pectoris 12. Groups of drugs used for the treatment of
myocardial infarction
1. Sustac forte 1. Opioid analgesics
2. Nitroglycerine 2. Fibrinolytics
3. Validol 3. Antiplatelet agents
4. Amiodarone 4. Organic nitrates
5. Propranolol 5. Antiarrhythmic drugs
6. Adrenaline
13. The drug that causes both reducing 14. Antianginal action of nitroglycerine is
myocardial oxygen demand and caused by:
increasing oxygen delivery to the
myocardium
1. Dipyridamole 1. Reduction of preload on the heart
2. Nitroglycerine 2. Decreasing of afterload on the heart.
3. Verapamil 3. Dialation of large coronary vessels
4. Propranolol 4. Dilation of coronary vessels due to
5. Amiodarone reflex action
5. Improved collateral circulation
To give a pharmacological characteristics
for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks

STEP-1
21
Preparation Pharmacological group Indications
Propranolol (Anaprilinum)

Amiodarone

Amlodipine

Metoprolol

Nitroglycerine

Atorvastatine

Tocopherol acetate

Step-1
Typical license test tasks For computer tests

1. A 57-year-old man developed 2. A man suffers angina pectoris, began to

myocardial infarction of the left independently take dipyridamole.
ventricle back wall of the heart. Patient However, instead of improving, he felt
is disturbed by severe chest pain, more pain in the heart. Why dipyridamole
arrhythmia, shortness of breath. What caused a deterioration of the coronary
preparation is the most appropriate to circulation?
introduce in this case for first aid?

A. Amiodarone A. Redistribution of blood for the

B. Propranolol benefit of nonischemic regions
C. Sustac B. The occurrence of extrasystoles
D. Nitrong C. The occurrence of tachycardia
E. Nitroglycerine D. Insufficient vasodilator effect
E. Increase in myocardial oxygen
demand
3. A long time a 36-year-old patient 4. A woman suffers angina pectoris.
suffering from bronchial asthma. Bronchial asthma is in anamnesis. Which
Recently he developed angina attack. of the beta-blockers can be designate?
Which of the following drugs is
contraindicated appoint him?

A. Sustac A. Propranolol
B. Propranolol B. Atenolol
C. Dipyridamole C. Oxprenolol
D. Corinfar D. Pindolol
E. Nitroglycerine E. Nadolol

5. A patient developed angina attack. The 6. A 45-year-old patient with ischemic heart
doctor gave him nitroglycerine tablet, disease had myocardial infarction. To
pointing to the need to put it under the prevent angina attacks doctor prescribed
22
 tongue. Why the doctor chose antianginal agent, which is the main
sublingual route of administration of the nitrosorbide metabolite and has prolonged
drug? effect. What is the drug?
A. Is activated by saliva of the mouth
B. The action develops soon A. Nitroglycerine
C. Is destroyed by gastric juice B. Sustac
D. Has extremely harmful effects on C. Amiodarone
the liver D. Trinitrolong
E. Poorly absorbed from the intestine E. Isosorbide mononitrate

7. Which of the following drugs should be 8. A 49-year-old man developed angina

applied to stimulate leukopoiesis after attack. The doctor prescribed
radiation therapy if the patient has nitroglycerine tablet, pointing to the need
arisen myelodepressive reaction in the to put it under the tongue. Why the doctor
form of leukopenia? chose sublingual route of administration of
the drug?
A. Ferropleks A. Poorly absorbed from the intestine.
B. Haemostlmulinum B. Is destroyed by gastric juice.
C. Vitohepatum C. Sublingual action develops soon.
D. Nicotinic acid D. Is activated by saliva of the mouth.
E. Methyluracilum E. Has extremely harmful effects on the
liver.

9. Propranolol treatment positively 10. A 57-year-old patient with coronary heart

affected the dynamics of the disease of a disease not informed the doctor that she
44-year-old woman, who suffers angina. had bronchospasm attacks. The doctor
What is the mechanism of antianginal prescribed medication. After receiving of
action of this drug? drug angina attacks became less frequent,
but more frequent bronchospasm attacks.
What drug was administered?
A. Blockade of beta1-adrenergic A. Atenolol.
receptors and decrease myocardial B. Propranolol.
oxygen demand. C. Verapamil.
B. Reduction of oxidative metabolism D. Diltiazem.
in the myocardium E. Nitrosorbide.
C. Reduction of energy consumption
of the myocardium
D. Increasing oxygen supply to the
myocardium.
E. Reduction of oxygen demand and
increasing oxygen supply to the
myocardium

11. A 50-year-old man addressed to the 12. In the clinic in the wardrobe queue a 67 -
doctor complaining of chest pain that year-old patient suddenly developed chest
occurs on the street, on the way to work, pain. Which of the listed drugs would be
during physical exertion. He sicks for a the most effective in this case?
year. At first the pain disappeared after
taking validol, but in recent days usage
is ineffective. Which drug should be
appointed?
A. Potassium chloride. A. Nikethamide.
23
 B. Metoprolol. B. Validol.
C. Octadinum. C. Sustac.
D. Clonidine. D. Nitroglycerine.
E. Salbutamol. E. Analginum.

13. A 65-year-old patient with angina 14. What preparation is necessary to use a 33-
pectoris was appointed antianginal drug year-old patient to stop an attack of angina
in aerosol form. After using the drug pectoris?
chest pain disappeared, but the patient
complained of a headache and dizziness.
Which drug used by patient?
A. Propranolol. A. Dipyridamole
B. Metoprolol. B. Nitroglycerine
C. Validol. C. Heparin
D. Nitroglycerine. D. Furosemide
E. Verapamil. E. Calcium chloride

15. Medical intern diagnosed ischemic heart 16. During endoscopy a 33-year-old patient
disease and prescribed the patient long- developed acute angina attack. What
acting nitrates, which is fully absorbed preparation is necessary to prescribe to
in the GIT and is used to prevent angina relieve angina attack?
attacks. Determine this drug.
A. Isosorbide mononitrate A. Propranolol
B. Metoprolol B. Noradrenaline hydrotartrate
C. Validol C. Nitroglycerine
D. Nifedipine D. Diazepam
E. Amlodipine E. Insulin

17. Phenofibrate was prescribed for a 18. In a 33 years old patient doctor diagnosed
patient with a history of angina pectoris hyperlipidemia with atherosclerosis.
and high plasma cholesterol level. What Which of the drugs it is advisable to
is the mechanism of action of this drug? prescribe for long-term treatment?

A. Inhibition of fat absorption in the A. Fenofibrate

intestine B. Magnesium sulfate
B. Blockade of cholesterol C. Pancreatin
biosynthesis in the liver, inhibition D. Prednisolone
of it absorption and acceleration of E. Metronidazole
it excretion
C. Acceleration of cholesterol
catabolism and elimination
D. Inhibition of the release of fatty
. acids from adipose depo
E. Antiateromatous action in the
vascular wall

19. A 33 years old patient, suffering from

ischemic heart disease is defined
elevated triglycerides and very low
density lipoproteins in the blood plasma.
Which drug should be appointed?
24
 A. Fenofibrate
B. Famotidine
C. Amiodarone
D. Lisinopril
E. Dobutamine

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________ _____________

Topic 3
Drugs acting on renal function and myometrium. Drugs for treatment of
gout, uricosuric agents

25
 Lesson 3 Drugs acting on renal function and myometrium.
Drugs for treatment of gout, uricosuric agents

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of

administrationSpironolactoneTab. 25mg, 50mg, 100mg; amp. 0,2% sol. 10mlP.O. for adults
100-200mg a day (for 2-4 uses); children 1-3mg/kg per day(for 2-3 uses);
Hydrochlorothiazide

Tab. 25mg, 50mg, &100mgP.O. for adults 25-50mg once a day in the morning, dose may be
increased in severe cases up to 100mg or 200mg; for children 2mg/kg per day (in diabetus
insipidus);FurosemideTab. 5mg, 20mg, 40mg, 80mg & 500mg; amp. 1% sol.-1ml, 2ml, 5ml,
10ml 25ml, granules 0,1g in bags for childrenP.O. for adults 40mg once a day in the morning,
dose may be increased up to 160mg per day (for 2-3 uses); for children 1-2mg/kg per day;
I.M. or I.V. slowly 20-50 mg 1 or 2 times a day; for children 0,5-1,5mg/kg per
dayOxytocinAmp. 1ml (5&10 U); 2ml (2U)I.V. for initiation or stimulation of labor 1-3U in
300-500ml of 5% glucose sol. by dripping; I.M. or intranasally for stimulation of lactation

Fenoterol
Tab. 0,005g; Prescription № ______
Prescription
amp 0,005% 10 ml "______"_________________ 20____
г.
(50 mcg
(adult, children in amp.);that’s necessary)
– underline (date)

0,1%; 0,2%; 0,4% (metered aerosol)______________________________________________________________________

for inhalation P.O. 1 tab. each 3-6 hours; till 8 tab/day),
__
I.V.
Full(drip,
price 50 mcg/min),free of charge 50 % of price
inhalation 0,2 mg 1-3 times a day
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
Patien's address and № of medical
recard_______________________________________
Doctor's
name____________________________________________________________

Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
………..
………………………….…………….
………..
............…………………………..
……………………..

Write the prescriptions: Rp.: ....…………………..………….

………………..
26
…………………..
……………………………..
…………………..……………………….
…….
1. Hydrochlorothiazide.

2. Furosemide.

3. Fenoterol.

4. Oxytocin

Do the tasks:
1. Fill the table (see note).
Influence of diuretics on the excretion of uric acid and ions
Drugs Na+ K+ Ca2+ Mg2+ Cl- Uric
acid
Hydrochlorothiazide
Furosemide
Spironolactone
Triamterene
Note. When completing the table, use the following notation: "I" - increase "D" - decrease

2. Fill the table

Pharmacokinetic characteristics of diuretics
Drug Way of Onset of action Duration of action (min,
administration (min, hours, days) hours, days)
Hydrochlorothiazide
Chlorthalidone
Furosemide
Spironolactone

3. Fill the table.

The preferential localization, efficacy, indications for application of diuretics
Drugs Site of action Efficacy Clinical indications

27
 (high, moderate, low)
Thick segment of
ascending part of loop of
Henle
The initial section of the
distal tubules

The end section of the

distal tubule and cortical
part of collecting tubules
Proximal tubules, the
descending part of Henle's
loop, collecting ducts

4. Fill the table (see note).

Side effects of diuretics
Side effects Hydrochlorothiazide Furosemide Spironolactone Acetazolamide
Hypokalemia
Hyperkalemia
Hyperglycemia
Hyperuricemia
Metabolic acidosis
Hypochloremic
alkalosis
Ototoxicity
Gynecomastia
Note. The presence of the effect sign by "+".

5. Fill the table (see note).

Comparative characteristics of oxytocin and dinoprost
Parameters of comparison Oxytocin Dinoprost
Effective during the entire pregnancy and childbirth
Effective prior to delivery and during delivery
Lowers the tone of the cervix
Apply for induction of labor, acceleration of involution
of the uterus and stop bleeding in the sequence period
Used to induce abortion
Note. The presence of the effect sign by «+».

6. Match the preparations with the mechanisms of their action

Drug Effect on the uterus Clinical indications
1. Oxytocin A. Increases the tone of a. In order to prevent premature birth
the uterus and the
rhythmic contractions
2. Ergometrine B. Increases the tone of b. Oxytonic
the uterus
3. Dinoprostone C. Reduces the tone of c. For abortion
the uterus and the
rhythmic contractions
4. Fenoterol D. Reduced tone of the d. To stop the uterine bleeding associated with
cervix gynecological diseases
e. To reduce over-strong labor
28
 f. To accelerate the involution of the uterus in the
postpartum period and stop the bleeding during
sequence period
g. In order to prevent miscarriage
Answer: 1.– ;2– ; 3. – ; 4. –

7. Solve situational tasks:

1) In patient uncontrolled treated by furosemide, was Answer:
marked reduction of edema, increased diuresis, but …………………………………………...
there were muscle weakness, loss of appetite, pain in
…………………………………………...
the heart, arrhythmia.
What is the name of this complication? What should be …………………………………………...
used in this case?
…………………………………………...
…………………………………………...

2) The patient took a long time dichlorotiazide, which Answer:

led to improvement of patient’s condition, but there …………………………………………...
were tenderness and swelling in the ankle joint.
…………………………………………...
Name this complication and what is the cause of it?
…………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...
3) A pregnant woman was admitted to obstetric Answer:
department due to danger of premature labor. Despite …………………………………………...
the undertaken hospital treatment, uterine tone
…………………………………………...
remained high.
Which preparations must be applied to decrease the …………………………………………...
tone of the uterus and to safe of pregnancy in a woman?
…………………………………………...
…………………………………………...
…………………………………………...
4) Woman who has had interruption of pregnancy, Answer:
addressed the gynecologist with a complaint for …………………………………………...
persisiting bleeding. …………………………………………...
What may physician prescribe to stop uterine bleeding …………………………………………...
in this case? …………………………………………...
…………………………………………...
…………………………………………...

8. Determine the drug:

1. In a patient with heart failure, peripheral 2. It is strong and fast saluretiс agent that
edema is observed. Sequential use of inhibits reabsorption of sodium and
hydrochlorothiazide and furosemide did chloride in ascending part of loop of
29
 not cause a significant diuretic effect and Henle, proximal and distal convoluted
improvement. At blood test was revealed tubules, increases the excretion of
elevated level of aldosterone. Choose the potassium and calcium, improves renal
necessary drug. blood flow. It is equally effective in
conditions of acidosis and alkalosis, it is
used in urgent conditions for forced
A. Spironolactone diuresis and in hypertension.
B. Allopurinol A. Hydrochlorothiazide
C. Diakarb B. Furosemide
D. Mannitol C. Spironolactone
Е. Triamterene D. Diakarb
E. Mannitol
3. Antigout drug that reduces the formation 4. Ergot alkaloid was administered to stop
of uric acid was prescribed to the patient atonic uterine bleeding.
who complains on pain and limitation of
motion in joints.
A. Allopurinol A. Fenoterol
B. Etamid B. Atropine
C. Magurlit C. Oxytocin
D. Fitolizin D. Ergometrine
5. It increases tone and rhythmic 6. It increases the tone and rhythmic
contractions of myometrium, acts only on contractions of myometrium. Acts both
the pregnant uterus, maximally effective on pregnant and nonpregnant uterus,
during childbirth. It is used for induction reduces the tone of the uterine cervix. It is
of labor only in full opening of cervical used for medical abortion; it can be used
canal, or in combination with drugs to to induce labor, regardless of the degree
lower the tone of the uterine cervix. It can of cervical canal opening.
be used to accelerate the involution of the
uterus after delivery, postpartum bleeding,
and to enhance lactation.
A. Cotarnin A. Cotarnin
B. Oxytocin B. Oxytocin
C. Ergometrine C. Ergometrine
D. Dinoprostone D. Dinoprostone
E. Fenoterol E. Fenoterol
7. It has a bronchodilator and tocolytic 8. Diuretic for pulmonary edema:
properties. As a tocolytic agent it is used
orally. It is prescribed to maintain
pregnancy in threat of abortion, premature
birth and excessive uterine contraction in
labor .
A. Cotarnin A. Hydrochlorothiazide
B. Oxytocin B. Diakarb
C. Ergometrine C. Furosemide
D. Dinoprostone D. Spironolactone
E. Fenoterol E. Ethacrynic acid

9. Choose correct answer:

1. Diuretics thiazides and thiazide-like 2. "Loop" diuretics
agents
1. Hydrochlorothiazide 1. Ethacrynic acid

30
 2. Mannitol 2. Spironolactone
3. Indapamide 3. Indapamide
4. Chlorthalidone 4. Diakarb
5. Klopamid 5. Klopamid
6. Furosemide 6. Furosemide
3. Potassium-sparing diuretics 4. Diuretic for forced diuresis
1. Triamterene 1. Amiloride
2. Furosemide 2. Hydrochlorothiazide
3. Indapamide 3. Furosemide
4. Diakarb 4. Diakarb
5. Amiloride 5. Spironolactone
6. Spironolactone 6. Mannitol

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1

Preparation Pharmacological group Indications

Hydrochlorothiazide

Spironolactone

Furosemide

Magnesium sulfate

Oxytocin

Step-1
Typical license test tasks For computer tests
1. A 54-year-old man with chronic 2. A 76-year-old patient with acute heart
cardio-vascular insufficiency developed failure accompanied by general edema,
of pulmonary edema. What diuretic acidosis and hypokalemia needs to assign
should be prescribed to a patient for rapid a diuretic. Which of the following agents
treatment of this complication? can be recommended to a patient?
A. Diakarb A. Furosemide
B. Spironolactone B. Digoxin
C. Furosemide C. Mannit
D. Klopamid D. Spironolactone
E. Triamterene E. Ethacrynic acid
3. A 56-year-old woman with hypertension 4. The doctor prescribed drug for hydration
addressed to the doctor complaining of to the patient with pulmonary edema.
exacerbation of gout. It was found that Select most effective drug for this
for the treatment of hypertension in purpose.
recent years she is a regular taking
diuretics. Which of the following
diuretics can cause an aggravation of
31
 gout?
A. Triamterene A. Diakarb
B. Dichlorotiazide B. Triamterene
C. Oxodolinum C. Mannitol
D. Diakarb D. Dichlorotiazide
E. Hydrochlorothiazide E. Spironolactone
5. Which of the following diuretics is 6. The 35-year-old patient with significant
suitable for the patient which, along with peripheral edema alternate use of
other forms of treatment, forced diuresis dichlorotiazide, ethacrynic acid and
is prescribed? furosemide did not cause a significant
diuretic effect. Blood test showed
significant increase in the amount of
aldosterone. Specify the drug of choice:
A. Dichlorotiazide A. Amiloride
B. Amiloride B. Mannit
C. Diakarb C. Urea
D. Furosemide D. Klopamid
E. Ammonium chloride E. Spironolactone
7. The 50-year-old patient developed 8. The man has a brain injury. Threat of
pulmonary edema on the background of cerebral edema developed during the
atrial fibrillation. What diuretic should be postoperative period. Which drug
prescribed for output patient from severe necessary to assign to eliminate this
condition? complication?
A. Triamterene. A. Dichlorotiazide.
B. Furosemide. B. Papaverine hydrochloride.
C. Hydrochlorothiazide. C. Spironolactone.
D. Amiloride. D. Furosemide.
E. Euphylline. E. Digoxin.
9. The 63-year-old patient with chronic 10. After taking the drug a patient with heart
cardio-vascular insufficiency developed failure decreased heart rate, pulse became
pulmonary edema. What diuretic you better filling, reduced edema, increased
need to prescribe for the rapid elimination diuresis. Which drug was used?
of this condition?
A. Klopamid. A. Verapamil.
B. Spironolactone. B. Propronalol.
C. Furosemide. C. Digoxin.
D. Diakarb. D. Diltiazem.
E. Triamterene. E. Reserpine.
11. Patient with acute alcohol poisoning was 12. The 32-year-old patient with cirrhosis
admitted to emergency department. The developed ascites. What preparation is
doctor prescribed forced diuresis to necessary to enter the patient to remove
conduct to the patient. What diuretic fluid from the body?
should be prescribed?
A. Euphylline. A. Spironolactone
B. Spironolactone. B. Potassium chloride
C. Diakarb. C. Heparin
D. Furosemide. D. Atropine sulfate
E. Amiloride. E. Furosemide
13. The 32-year-old patient with pulmonary 14. A pregnant woman with weak labor
edema, which has long been taking contractions was admitted to the
diuretic, developed hypokalemia, maternity ward. On examination she was
32
 hypochloremia, metabolic alkalosis. diagnosed with high blood pressure.
Determine the drug. Which of the following drugs is
necessary to assign to enhance labor,
given the presence of hypertension?
A. Furosemide A. Pituitrin
B. Triamterene B. Progesterone
C. Spironolactone C. Oxytocin
D. Diakarb D. Dinoprost
E. Amiloride E. Estrone
15. Which of the following drugs prescribed 16. A 23-year-old women takes contraceptive
to stop postpartum uterine bleeding? Triquilar to plan pregnancy. Specify the
mechanism of drug action.
A. Progesterone A. Has spermicidal action
B. Inhibits the function of the
B. Oxytocin
hypothalamic-pituitary system
C. Ergometrine C. Enhances the progesterone phase
D. Neostigmine D. Violates the cell membrane
E. Quinine E. Enhances contractility of the
myometrium
17. A 5-months pregnant women complains 18. The doctor prescribed the 29-year-old
of a nagging pain in the lower abdomen. pregnant woman agent in aerosols to
The doctor prescribed an aerosol to relax myometrium and prevent preterm
prevent the threat of disruption of birth. What is the drug?
pregnancy. What is the drug?
A. Atropine sulfate A. Ephedrine
B. Pachycarpine B. Methacine
C. Fenoterol C. Plathyphilline
D. Dinoprost D. Papaverine hydrochloride
E. Isoverine E. Fenoterol
19. A pregnant woman introduced the drug 20. A pregnant woman with a weak labor
solution to prevent preterm birth. The activity was admitted to the maternity
drug is also known as anticonvulsant, ward. Which hormonal drug is necessary
hypotensive, choleretic and laxative. to assign to enhance labor?
Uterine contractions and pain ceased, was
manifested sedative effect. Which of the
following drugs doctor used?
A. Fenoterol. A. Oxytocin.
B. Oxytocin. B. Progesterone.
C. Magnesium sulfate. C. Methandrostenolone.
D. Ergometrine. D. Hydrocortisone.
E. Salbutamol E. Fercoven

The theme of individual student’s work:

Date Pharmacology
Student'sof drugs acting on myometrium
name Teacher's signature

«____»_______201__г. ___________________________ ____________

Topic 4
Hypertensive and antihypertensive drugs
33
 Lesson 4 Hypertensive and antihypertensive drugs

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationEnalapril

Tab. 2,5 - 5 – 10 - 20mg; amp. 0,125% - 1mlP.O. beginning from 5mg a day gradually increasing
dose up to 10-20 mg one or 2 times a day; I.V. slowly in hypertensive emergency 1ml per 6
hoursLisinoprilTab. 0,01g1 tab. 3 times a [Link]. 0,05g1 tab. 1 time a
[Link]. 0,005g or 0,01g P.O. 5-10 mg 1 time a dayNifedipine
Tab. 0,01g, 0,02g; caps.0,005 -0,01 - 0,02g ; tab. retard 0,01g, 0,02g; 0,03 -0,06gP.O.
0,005-0,01g 3 times a day regardless of mealDrotaverine (No-spa)Tab. 0,04g
Amp. 2% 2 ml1 tab. 2 times a day.
I.M. 2 ml.
DobutamineVials for injection 0,25 g or 0,1 g
Amp.5% - 5mlI.V. by drop 0,25-0,5-1,0 g/l.
IV slowly 5 ml of 5% solution

Write the prescriptions:

Prescription № ______
Rp.: ……………………………..……….
Prescription "______"_________________ 20____
г.
………..
(adult, children – underline that’s necessary) (date)

……………………….……………….
______________________________________________________________________
__
Full price ……….. free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. Lisinopril. ………………………….…………….
Patien's name __________________________________
_________________________
………..
Patien's address and № of medical
recard_______________________________________
Doctor's ………………………….…………….
………..
name____________________________________________________________

............…………………………..
Rp.: ……………………………..……….
2. Losartan. ……….. ……………………..
Rp.: ....…………………..………….
34
………………..
…………………..
……………………………..
3. Nifedipine.

4. Drotaverine.

Do the tasks:

1. Fill the table.

Pharmacological characteristic
Drug’s name Pharmacological group Mechanism of action
Sulfokamfokain
Caffeine-sodium benzoate
Phenylephrine
Dobutamine
Ephedrine hydrochloride
Noradrenaline
hydrotartrate
Clonidine
Prazosin
Metoprolol
Lisinopril
Losartan
Amlodipine
Dibazol
Drotaverine

2. Match the preparations with the mechanisms of their action

Drugs Mechanisms of action
1. Clonidine A. It reduces the release of norepinephrine in the synaptic cleft
2. Lisinopril B. Stimulates α2-adrenoceptors
3. Losartan B. Blocks calcium channels of L-type
4. Verapamil G. Blocks α1-adrenergic receptors
5. Metoprolol D. Blocks AT1-receptors

35
 6. Prazosin E. Inhibits ACE
7. Reserpine G Blocks β1-adrenergic receptors
Answer: 1.___2.___3.___4.___5.____6.____7.____.

3. Fill the table (see note)

Comparative characteristics of ACE inhibitors and blockers of angiotensin AT1-receptors
Parameters of comparison ACE inhibitors Blockers of
angiotensin AT1-
receptors
Content in the Angiotensin II
blood Aldosterone
Bradykinin
Application Systemic treatment of
hypertension
Treatment of chronic heart
failure
Side effects Dizziness
Dry Cough
Angioedema
Note. When completing the table, use the following notation:
«↑» - increase, «↓» - decrease, "+" - presence effect..

4. Explain the mechanism of antihypertensive action of clonidine, placing the following

statements in a logical sequence:
1. Decreasing of blood pressure.
2. Vasodilatation and a decrease of cardiac output.
3. Stimulation of central α2-adrenergic and imidazoline I1-receptors.
4. Inhibition of the vasomotor center and stimulation of the vagus nerve center.
Answer:..............................................................................................................................................

5. Choose correct answer:

1. Neurotropic antihypertensive agents 2. The agents, which suppress the renin-
angiotensin system
1. Prazosin 1. Losartan
2. Clonidine 2. Propranolol
3. Verapamil 3. Lisinopril
4. Moxonidine 4. Enalapril
5. Atenolol 5. Dibazol
3. Myotropic antihypertensive agents 4. The drugs used to increase blood pressure
1. Nifedipine 1. Captopril
2. Clonidine 2. Mezaton
3. Sodium nitroprusside 3. Metoprolol
4. Lisinopril 4. Angiotenzinamide
5. Amlodipin 5. Norepinephrine
5. A dry cough caused by
1. Angiotensin-converting enzyme
inhibitors
2. Angiotensin receptor blockers
3. Myotropic spasmolytics
6. Solve situational tasks:

36
1) To provide emergency aid to patient with acute Answer:
vascular failure occurred after traumatic brain injury, …………………………………………...
the doctor has caffeine, norepinephrine and cordiamine.
…………………………………………...
Which of the following drugs should be administered to
the patient at the first choice and why? …………………………………………...
…………………………………………...
…………………………………………...

7. Determine the drug:

1. Refers to the central neurotropic drugs. 2. It refers to the sympatholytic agents, has
Excites the alpha2-adrenoreceptors, has psychosedative action, side effects are
biphasic changes in blood pressure, bradycardia, salivation, dyspepsia.
should not be combined with the drugs
depressing the central nervous system.
A. Magnesium sulfate A. Reserpine
B. Clonidine B. Octadine
C. Benzohexonium C. Ephedrine
3. According to the classification it refers to 4. Name the drug of choice for acute
the agents influencing on the humoral vascular insufficiency to increase blood
regulation of vascular tone, is a prodrug, pressure.
reduces blood pressure by blocking the
activity of ACE is also indicated for
ischemic heart disease, after long using
causes dry cough
A. Andekalin A. Aminophylline
B. Enalapril B. Epinephrine
C. Losartan C. Prazosin

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Propranolol

Amlodipine

Dobutamine

Epinephrine
(Adrenaline hydrochloride)
Caffeine-sodium benzoate

Lisinopril

Losartan

Magnesium sulfate
37
Metoprolol

Furosemide

Typical license test tasks Step-1 For computer tests

1. A 65-year-old woman with diabetes 2. Which drug should be used for

mellitus addressed her doctor complaints therapeutic aid to the patient, who
of headache, fatigue and insomnia. On appeared spastic pain in the small
examination was found high level of BP intestine against the background of
(200/100 mm). Which drug is most weakening?
effectively used for the rapid
normalization of blood pressure?
A. Prazosin A. Carbocholine
B. Papaverine B. Dihydrocholic acid
C. Propranolol C. Drotaverine
D. Captopril D. Sodium sulfate
E. Reserpine E. Neostigmine
3. Which of these mechanisms provides 4. A 48-year-old man with kidney disease
antihypertensive effect of enalapril? and elevated levels of renin in the blood,
increased BP. Which of the following
drugs may provide a expressive
therapeutic effect in this clinical
situation?
A. Blocking calcium channel A. Phenihydin
B. Inhibition of adrenoreceptors B. Losartan
C. Angiotensin receptors blockade C. Phentolamine
D. Inhibition of ACE D. Tropaphenum
E. Activation of beta2-adrenoreceptors E. Talinolol
5. A 52-year-old woman addressed her 6. In occasion of hypertension at an early
doctor complaints of the pain in the heart, stage patient is scheduled sympatholytic.
shortness of breath, tachycardia, Which of the following drugs prescribed
increased blood pressure. Metoprolol by a doctor?
treatment improved the patient's
condition. What is the mechanism of
action of this drug?
A. Inhibition of alpha-adrenoreceptors A. Propranolol
B. Stimulation of beta-adrenergic B. Metoprolol
receptors
C. Blockade of beta1, beta2 C. Losartan
adrenoreceptors
D. Activation of alpha, beta- D. Reserpine
adrenoreceptors
E. Blockade of beta1-adrenoceptor E. Papazol
7. A 56 -year-old man, which a long time 8. A 62-year-old patient with complaints of
took reserpine and dichlorotiazide to pain in the heart, and tachycardia was
normalize blood pressure developed prescribed propranolol. What is the
exacerbation of gout. What is the reason mechanism of action of this drug?

38
 of complication?
A. Hypokalemia A. Blockade of alpha-receptors
B. Alkalosis B. M-cholinergic receptors blockade
C. Suppression urate release C. M-cholinergic receptors stimulation
D. Reduction of sodium reabsorption D. Alpha-receptors stimulation
E. Bicarbonate excretion E. Blockade of beta1, beta2
adrenoreceptors
9. A drug which mechanism of action is 10. Which of the following agents is
associated with the blocking of ACE is parenterally administered to relieve
assigned for hypertensive patient. What hypertensive crisis?
is the drug?
A. Magnesium sulfate A. Sodium sulfate
B. Clonidine B. Strophanthin
C. Lisinopril C. Nitroglycerine
D. Atenolol D. Magnesium sulfate
E. Prazosin E. Sustac
11. A 45 -year-old patient with hypertensic 12. The 57-year-old patient found
crisis was admitted to the emergency hypertension with elevated renin level in
department. Which drug should be the blood. Which antihypertensive drug
prescribed to normalize blood pressure? should be preferred in the treatment of
the patient?
A. Propranolol. A. Magnesium sulfate.
B. Reserpine. B. Clonidine.
C. Enalapril. C. Enalapril.
D. Atropine sulfate. D. Papaverine hydrochloride.
E. Magnesium sulfate E. Prazosin.
13. A patient with high blood pressure which 14. A doctor prescribed a woman, with
is caused by spasm of peripheral vessels hypertension losartan. What
was admitted to the therapeutic pharmacological property of the drug
department. Which antihypertensive drug provides therapeutic effect?
from alpha-blockers is most advisable to
appoint?
A. Prazosin. A. Inhibition of beta-adrenoreceptor.
B. Captopril. B. Inhibition of alpha-adrenoreceptors.
C. Chlorpromazine. C. Angiotensin receptors blockade.
D. Propranolol. D. Inhibition of ACE.
E. Clonidine. E. Antagonism with calcium ions.

15. The 56-year-old patient with 16. A 58 -year-old patient suffers chronic
hypertension takes enalapril. What is the heart failure and hypertension. The
mechanism of the antihypertensive doctor recommended to include in the
action? treatment regimen diuretic drug that does
not eliminate potassium, is an aldosterone
antagonist, but its therapeutic effect
develops slowly. Which of the drugs was
A. Inhibition of ACE recommended to the patient?
B. Antagonism with angiotensin A. Strophanthin.
receptors. B. Spironolactone.
C. Blockade of phosphodiestarase. C. Triamterene.
D. Blockade of cyclooxygenase. D. Furosemide.
E. Blockade of calcium channel. E. Amiodarone.

39
 17. Following the appointment of 18. What preparation should be administreted
antihypertensive drug to the patients with to the patient with pulmonary edema to
hypertension blood pressure returned to lower blood pressure in the pulmonary
normal, but there was a constant dry circulation and decrease in mass of
cough. Which of the following drugs has circulating blood?
such side effect?
A. Nifedipine. A. Furosemide
B. Propranolol. B. Unithiolum
C. Clonidine. C. Sulfacyle-sodium
D. Reserpine. D. Prazosin
E. Enalapril E. Acetylcysteine

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________ _____________

40
 Unit II
PHARMACOLOGY OF THE DRUGS ACTING ON RESPIRATORY
AND DIGESTIVE SYSTEM.

Topic 5
Drugs acting on respiratory system.

Lesson № 5 Drugs acting on respiratory system.

To know: properties of drugs, dose and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationGlaucin

hydrochloridTab. 0,05P.O. 0,05 g 2-3 t/day after [Link]. 0,03;
Syrup 0,3% in vials by 100 ml;
Sol. for inhalations 0,75% in vials by 100 ml;
Amp.0,5% - 2 ml.P.O. 0,03 g 3 t/day.
By inhalation 1-2 t/day.
I/M, I/V 0,03-0,045 g 2-3 t/[Link]. 0,2;
20% sol. for inhalation in amp. by 5 and 10 ml; 10% sol. in amp. by 2 ml; 5% sol. in amp. by 10
ml.P.O. 0,2 g 2-3 t/day;
By inhalation 2–5 ml 20% sol. 3–4 t/day (during 15–20 min); I/M 1-2 ml 10 % sol. 2-3 t/day;
I/V by 10 ml 5 % sol. 2 t/[Link];
Tab. 0,15;
Amp. 2,4% sol.– 10 ml and 24% sol.– 1 ml.P.O. 0,15 g 1-3 t/day;
I/V 2,4 % sol. – 5,10 ml, to dissolve in 10-20 ml of isotonic solution of sodium chloride,
I/M 24 % sol. – 1ml 1-3 t/day.

41
 Prescription № ______
Prescription "______"_________________
Write the prescriptions: 20____ .
(adult, children – underline that’s necessary) (date)

_______________________________________________________________________
_
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name __________________________________ ________________________

Patien's address and № of medical recard______________________________________
Doctor's name___________________________________________________________

1. Euphylline.
Rp.: ……………………………..……….………..
……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Ambroxol.
Rp.: …………………..………….………………..
…………………..……………………………..
…………………..……………………….…….
…………………..……………………………..
3. Acetylcysteine. …………………..……………………………..
Rp.: ……………………………………..
…………
………………………………………….……...
…………………………………………………
Do the tasks:

1. Fill in the table.

Pharmacological characteristics of drugs
Name of the Indications for use Side effects
preparation
Codeine phosphate
Acetylcysteine
Bemegride
Ambroxol
Ethimizol
Theophylline
Sulfokamfokaine
Salbutamol
Glaucine
Cromolyn sodium

42
 2. Fill in the table.
Comparative characteristics of drugs that are used for the treatment of bronchial asthma.
Properties Adrenaline Ephedrine Izadrin Salbutamol Atropine Ipratropium
bromide

Bronchodilative
activity
Type of adrenergic
receptors which
stimulates the drug
Type of the nicotinic
acetylcholine receptor
that blocks the drug
The presence of cardio
effect
The duration of action
Application:
-preventive
- urge

3. Fill in the table (see notice).

Indications for use of respiratory stimulants.
Cytitone Bemegride Camphor Aethimizolum CO2 Naloxone

Indications for use

Faint
Hypoxia of
newborns
Respiratory
depression in
infectious diseases
Respiratory
depression in
anesthesia
Hypnotic’s
poisoning
Morphine poisoning
Notice: Indicated by the symbol "+" - is used; "-" - not used.

43
4. Solve situational problems:
1) A child with chronic bronchitis, long taking a mixture, Answer:
which includes grass of thermopsis; appeared dyspepsia, …………………………………………
reduction of appetite and nausea. What is the reason of
…………………………………………
appeared complications? Measures to prevent it.
…………………………………………
…………………………………………
…………………………………………
…………………………………………
2) A 6 years child diagnosed with acute bronchitis. Answer:
Attacks of dry cough caused insomnia, loss of appetite. …………………………………………
In the lungs marked dry rale, the temperature is lowered -
…………………………………………
36,10C, pulse 87 per minute; respiratory rate - 36
movements per minute. Give your advice to the patient? …………………………………………
…………………………………………
…………………………………………
………………………………………...
3) The patient who is undergoing the treatment of Answer:
asthma, concomitant disease is glaucoma. Preparations of
…………………………………………
what the group is not recommended in the treatment of
asthma? …………………………………………
…………………………………………
…………………………………………
…………………………………………
5. Determine the drug:
1. The drug is used in bronchial asthma for 2. Patients with chronic bronchitis
inhalation to prevent bronchospasm. The appointed inhalation of the drug
therapeutic effect develops gradually. To containing a sulfhydryl group and causes
stop an attack of bronchospasm drug is depolymerization of the sputum protein
unsuitable. Active component of this components. What the drug has been
drug is: used?
A. Cromolyn sodium A. Acetylcysteine
B. Ipratropium bromide B. Trypsin-crystal
C. Ketotifen C. Ribonuclease
D. Salbutamol D. Sodium bicarbonate
E. Euphylline E. Salbutamol
3. To the pediatrician appealed a mother 4. Drugs act peripherally to relieve cough in
complaining of dry cough that causes acute bronchitis.
insomnia in an 11 months child. Which
of the drug should not be prescribed in
this case?
A. Codeine A. Codeine phosphate
B. Libeksin B. Glaucine hydrochloride
C. Tusupreks C. Oxeladin
D. Bromhexine D. Libexine
44
 E. Acetylcysteine E. Bromhexine
5. Centrally acting agents in a strong cough 6. Drugs for acute asthma attack
A. Codeine phosphate A. Salbutamol
B. Glaucine hydrochloride B. Ambroxol
C. Oxeladin C. Mukaltin
D. Libexine D. Euphylline
E. Bromhexine E. Fenoterol
7. Antifoaming agent for pulmonary edema
A. Corglikon
B. Furosemide
C. Antifomsilan
D. Ethyl alcohol
E. Lidocaine

6. Choose the correct answer:

1. Breathing stimulants 2. Antitussive agents

1. Codeine 1. Acetylcysteine
2. Cordiamin 2. Glaucine
3. Cytitone 3. Oxeladin
4. Ambroxol 4. Libexine
5. Caffeine-sodium benzoate 5. Codeine
6. Codeine 6. Ambroxol
3. Expectorant agents 4. Facilitates the separation of sputum by
breaking the disulfide bridges of
proteoglycans.
1. Glaucine 1. Ambroxol
2. Ambroxol 2. Glaucine
3. Salbutamol 3. Oxeladin
4. Acetylcysteine 4. Bromhexine
5. Bromhexine 5. Acetylcysteine
6. Infusion of herbs of Thermopsis
5. Facilitates the separation of sputum due 6. Bronchodilators:
to reflex increase secretion of bronchial
glands.
1. Acetylcysteine 1. Salbutamol
2. Infusion of herbs Thermopsis 2. Budesonide
3. Bromhexine 3. Fenoterol
4. Libexine 4. Libeksin
5. Mukaltin 5. Ipratropium
6. Ambroxol 6. Ketotifen
7. Dilates the bronchi due to stimulation of 8. Dilates the bronchi due to blockade of M-
β2-adrenergic receptors cholinergic receptors
1. Atropine 1. Ipratropium
2. Nedocromil 2. Atropine
3. Fenoterol 3. Salbutamol
4. Ketotifen 4. Ketotifen
5. Ipratropium 5. Fenoterol
6. Salbutamol 6. Bromhexine

45
 To give a pharmacological characteristics
for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Caffeine-sodium benzoate

Loratadine

Lidocaine hydrochloride

Prednisolone

Digoxin

Salbutamol

Dobutamine

Epinephrine
(Adrenaline hydrochloride)
Chlorpromazine (Aminazine)

Furosemide

Corglyconum

Ethyl alcohol

Morphine hydrochloride

Atropine sulfate

Fentanyl

Glaucine hydrochloride

Acetylcysteine

Ambroxol

46
 Typical license test tasks
STEP-1 for computer tests

1. Analeptic remedy of reflective type from 2. In complex therapy of bronchial asthma

the N-cholinomemetics group was given myotropic spasmolytic drug was added.
to the patient for restoration of breathing Soon after its usage, nervousness and
after poisoning with carbon monoxide. sleep disturbances occurred. Which of
What medicine was prescribed to the the following drugs can cause above-
patient? mentioned side effect?
A. Adrenalin hydrochloride A. Papaverine
B. Lobeline hydrochloride B. Platyphilline
C. Mesaton C. Aminophylline
D. Pentamin D. Drotaverine
E. Atropine sulfate. E. Ephedrine .
3. A 5 year-old –child was suffering from 4. Severe attack of bronchospasm and
bronchitis, accompanied with a cough occurred in a patient with
productive cough with thick sputum. In bronchial asthma. Choose the best drug
addition to antimicrobial treatment a for quick relief of the patient condition.
mucolytic drug was prescribed. This
drug was especially beneficial for the
child due to its ability to stimulate
production of surfactant. Point out this
drug
А. Codeine A. Ipratropium bromide
B. Ambroxolum B. Orciprenaline sulfate
C. Oxeladine C. Atropine
D. Ethylmorphine D. Adrenaline
E. Potassium iodide. E. Noradrenaline.
5. A patient with bronchial asthma had 6. A 13-year-old girl with history of
been taking tablets which caused asthma complained of cough, dyspnea
insomnia, headache, increased blood and wheezing. Her symptoms became so
pressure. What medecine can cause such severe that her parents brought her to the
complications? emergency room. Physical examination
revealed diaphoresis, dyspnea,
tachycardia and tachypnea. Her
respiratory rate was 42/min. pulse rate
was 110 beats per minute, and blood
pressure was l30/70 mm Hg. Choose
from the following list the most
appropriate drug to reverse the
bronchoconstriction rapidly:
A. Ephedrine A. Methylprednidsolone
B. Chromolin sodium B. Salbutamol
C. Euphyline C. Beclomethasone
D. Adrenaline D. Cromolyn
E. Izadrine. E. Ipratropium.
7. Apnoic newborn was resuscitated by 8. In complex treatment of patient with
administration of respiratory bronchial asthma cromolyn-sodium was
[Link] agent is the drug of first included as antiallergic agent. What is
choice in this case? the mechanism of this drug action?
A. Bemegridum A. Inhibition of histaminic H1
47
 receptors
B. Aethimisolum B. Inhibition of histaminic H2
receptors
C. Lobeline C. Prevention of mast cell
degranulation
D. Codeine D. Inhibition of antigen-antibody
interaction
E. Camphor E. Blockade of D2 receptors.
9. Severe attack of bronchospasm and 10. Patient with bronchial asthma was taking
cough occur in patient with bronchial tablets, which caused insomnia,
asthma. Choose the best drug for quick headache, increased blood pressure.
relieve of patient condition. What medicine can cause such
complications?
A. Ipratropium bromide A. Izadrine
B. Orciprenaline sulfate B. Adrenaline
C. Atropine C. Chromolin sodium
D. Adrenaline D. Euphyline
E. Noradrenaline. E. Ephedrine.
11. In complex therapy of bronchial asthma 12. A patient suffering from chronic
myotropic spasmolytic drug was bronchitis takes a synthetic mucolytic
included. Soon after its usage drug that facilitates the sputum thinning.
nervousness and sleep disturbances What drug is it?
occurred. Which of the following drugs
can cause above-mentioned side effect?
A. Papaverine A. Acetylcysteine
B. Platyphilline B. Diazepam
C. Aminophylline C. Heparin
D. Drotaverine D. Furosemide
E. Ephedrine. E. Enalapril.
13. A patient suffering from bronchial 14. A 70-year-old man, who suffered from
asthma didn't inform his doctor that he chronic bronchitis, was prescribed
had attacks of angina medicine for the cough - codeine. What
pectoris(stenocardia). Doctor is the mechanism of antitussive effect?
administered him a drug, which usage
resulted in less frequent attacks of
bronchial asthma, but stenocardia
(anginal) attacks became more frequent.
What medication was administered?
A. Isadrin (Isoprenalin) A. Central
B. Salbutamol B. Reflex
C. Aminophylline C. Competitive
D. Cromolyn sodium D. Local effect
E. Phenotherol. E. Peripheral effect.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

48
 Topic 6
Drugs acting on digestive system

Lesson 6 Drugs acting on digestive system: drugs acting on

appetite, function of the salivary glands,
secretory function and motility of the stomach.
Emetics and antiemetics.

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

Famotidine
Tab. 0,02 and 0,04 g.P.O. 0,02-0,04 g. once a day
Omeprazole
Тab. and caps. 0,02 g.P.O. по 0,02 g. once a day
AlmagelIn flasks 170 mlP.O. 1-2 tea spoon for 30 min. before meal, the evening before
bedtime
MetoclopramideТаb. 0,01;
in amp. 2 ml 0,5 % solutionP.O. 1-2 tab. 2-3 times a day before meal; I.M. or I.V. 2-6 ml
per day

OndansetronТаb. 0,004; 0,008;

solution for injection 2 and 4 ml
(1 ml contain 0,002 g)P.O. 8 mg 1–2 before anticancer therapy and then 8 mg after 8–12
hours
I.M. or I.V.

Write the prescriptions:

Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Famotidine. Patien's address and № of medical recard
______________________________________
Doctor's name___________________________________________________________

Rp.: ……………………………..……….
……….. 49
2. Metoclopramide. Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
3. Ondansetron. ………..
………………………….…………….
………..
............…………………………..

Do the tasks: ……………………..

1. Fill the table

Pharmacological characteristics of drugs
Preparations Indications Side effects
1. Metoclopromide
2. Omeprazole
3. Famotidine
4. Almagel
5. Ondansetron

2. Fill the table (see note).

Pharmacoterapy of gastric ulcer and duodenal ulcer
Magnesium oxide

Metoclopramide

Clarithromycin

Metronidazole
The pharmacological effects
Misoprostol
Famotidine

Omeprazol

Almagel
De-nol

Neutralizes HCl

Blocks of Н+-К+-АТP-ase

Protects the gastric mucosa

Antisecretory activity

Activity against H. pylori

Antiemetic effect

50
 Blocks Н2-histamine receptors

Note: The presence of the effect sign by «+».

3. Match the preparations with the mechanisms of their action

Drugs Mechanisms of action
1. Famotidine А. Blocks serotonin 5-НТ3-receptors
2. Metoclopromide Б. Blocks М1-cholinergic receptors
3. Omeprazole В. Blocks Н2-histamine receptors
4. Ondansetron Г. Blocks D2-dopamine receptors
5. Pirenzepin Д. Inhibts Н+-К+-АТPase
Answer: 1.___2.___3.___4.___5.____.

4. Choose correct answers:

1. Anorectics 2. In peptic ulcer are used
1. Dezopimon 1. Enzyme preparations
2. Tincture of wormwood 2. Antacids
3. Fenfluramin 3. Gastroprotectors
4. Mazindolum 4. Agents causing eradication of H.
5. Appetizing collection pylori
5. Antisecretory agents
3. Antacid action is rendered by 4. Blockers of Н2-histamine receptors
1. Aluminum hydroxide 1. Ranitidine
2. Magnesium hydroxide 2. Magnesium hydroxide
3. Famotidine 3. Famotidine
4. Pirenzepin 4. Omeprazole
5. Almagel 5. Almagel
6. Roksatidin

5. Inhibitors Н+,К+-АТP ase 6. М1-cholinobloker

1. Pirenzepin 1. Famotidine
2. Famotidine 2. Atropine
3. Omeprazole 3. Omeprazole
4. Almagel 4. Almagel
5. Lansoprazole 5. Pirenzepin

7. Drugs form a mechanical protection of 8. Drugs used for eradication of H. pylori

the mucous membrane of the stomach
and duodenum 1. Bismuth trikalium dicitrate
1. Bismuth trikalium dicitrate 2. Misoprostol
2. Misoprostol 3. Metronidazole
3. Omeprazole 4. Sucralfate
4. Sucralfate 5. Amoxicillin

9. Antiemetic action is rendered by 10. Agents that stimulates motility of the

stomach, promote the evacuation of
gastric contens
1. Metoclopramide 1. Metoclopramide
2. Aeron 2. Aeron
3. Misoprostol 3. Ondansetron
4. Domperidone 4. Domperidone
51
 5. Ondansetron 5. Cisapride

5. Solve situational tasks:

1) The patient went to a doctor for advice about the fact Answer:
that after taking the baking soda, which he used for …………………………………………...
heartburn, regurgitation with air and discomfort in the
…………………………………………...
stomach were observed. What is the cause of those
effects? What drugs can replace baking soda for …………………………………………...
heartburn? What are their advantages over sodium
…………………………………………...
bicarbonate?
…………………………………………...
…………………………………………...
2) Patient with gastric ulcer received antacid drug Answer:
Almagel Antibiotic metacyclin was prescribed for the …………………………………………...
treatment of acute bronchitis. However, within 5 days
…………………………………………...
the temperature was not decreased, cough and sputum
character were not changed. The doctor concluded …………………………………………...
incompatibility of drugs in their interaction. What kind
…………………………………………...
of incompatibility of drugs has occurred?
…………………………………………...
…………………………………………...
3) A patient who suffers from hyperacid gastritis used Answer:
remedy in a power several times a day to eliminate …………………………………………...
heartburn. A week later nausea, vomiting, abdominal
…………………………………………...
pain, atrial fibrillation and muscle spasm, shallow and
rare breathing, increased tendon reflexes and periosteal …………………………………………...
expressed fatigue, alkalosis were developed. Determine
…………………………………………...
the drug. Why these effects were arisen? First aid?
…………………………………………...
…………………………………………...
Answer:
4) A 42-year old man who suffers from duodenum …………………………………………...
ulcer. Doctor prescribed some agents: de-nol,
…………………………………………...
ampicillin, metronidazole. Therapy was appropriate
What is the main reason for the high efficiency of this …………………………………………...
complex drugs?
…………………………………………...
…………………………………………...
…………………………………………...
5) Patient with hyperacid gastritis, taking Н2-histamine Answer:
blockers, ranitidine, became ill with acute pneumonia. …………………………………………...
For treatment of pneumonia oral ampicillin was
…………………………………………...
prescribed. The effectivnes of antibiotics in the first
days of treatment was low. Only on the 2-nd day after …………………………………………...
discontinuation of ranitidine main symptoms of
…………………………………………...
52
pneumonia began to disappear. What is the reason for …………………………………………...
positive change in treatment?
…………………………………………...

6. Determine the drugs:

1. It was prescribed to the patient who is 2. It was prescribed to the patient with
suffering from gastric ulcer with hyperacid severe pain caused by hypersecreion and
syndrome and tendency to constipation: high acidity of gastric juice:
A. Pirenzepin A. Pirenzepin
B. Almagel B. Almagel
C. Famotidine C. Famotidine
D. Almagel А D. Almagel А
E. Magnesium oxide E. Omeprazole
3. It was prescribed to the passenger with 4. It was prescribed to the patient with
airsick: chronic atrophic gastritis accompanied by
secretory insufficiency of the gastric
A. Ondansetron glands (ahilia):
B. Festal A. Allohol
C. Aeron B. Contrycal
D. Apomorphine hydrochloride C. Omeprazole
E. Bisacodyl D. Acidin-pepsin
E. De-nol
5. Emetic agent was injected:
A. Ondansetron
B. Festal
C. Aeron
D. Apomorphine hydrochloride
E. Bisacodyl

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Famotidine
Omeprazole

Atropine

Chloropramazine (Aminazine)

Droperidole

Insulin

Neostigmine (Proserinum)

Diphenhydramine
(Dimedrolum)

53
 Typical license test tasks Step-1 For computer tests

1. Agent increase pH when exposed to 2. A 37 year-old men has hyperacid

gastric juice in vitro, can be used for gastritis.У мужчины 37 лет,
treatment hyperacidity states. Find this гиперацидный гастрит. Specify the drug
drug? with the mechanism realized by blocking
of proton pump (H +-K +-ATPase) used
in the combined therapy?

A. Anaesthesinum A. Pirenzepin
B. Metacin B. Misoprostol
C. Omeprazole C. Omeprazole
D. Ranitidin D. Atropine
E. Almagel E. Almagel
3. Patient with cancer after surgery was 4. Patients with peptic ulcer of the
treated with a chemotherapeutic complex. duodenum uses famotidine. What is
At the very beginning of treatment the mechanism of of this drug action?
patient experienced much distressing
nausea and vomiting. Choose the best
agent to relieve patient’s condition?
A. Aeron A. Antacide action
B. Dimedrolum B. Inhibts Н+-К+-АТPase
C. Menthol C. Blockade of М – cholinoceptors in
D. Metoclopramide stomach
E. Validol D. Local anaesthetic action on mucous
of stomach
E. Blockade of Н2 - receptors
5. Patient with gastric ulcer received 6. A 43 year-old women has peptic ulcer
famotidine. Acidity of gastric juice was with incrised acidity of gastric juice, pain
decreased. What is mechanism of of this and dyspeptic syndrom. Choose correct
drug action? preparation for treatment?
A. Blockade of M1 - cholinoceptors A. Allocholum
B. Blockade of H1 histamine receptors B. Famotidine
C. Blockade of H2 histamine receptors C. Papaverine
D. Inhibition of Н+-К+-АТPase D. No-spa
E. Blockade of N - cholinoceptors E. Platyphylline
7. A 46 old-women complains of pain in the 8. For patients with peptic ulcer the drug
stomach, heartburn. On examination inhibiting the growth and reproduction of
increased acidity of gastric juice was [Link] was prescribed as a causal
diagnosed. What agent should be used to treatment. Name the drug?
neutralize the acidity of gastric juice?
A. Benzohexonium A. Proserinum
B. Atropine B. Atropine
C. Papaverine. C. Алмагель.
D. Proserinum D. Metronidazole
E. Almagel E. Furosemide

54
9. Patient about megaloblastic anemia 10. A 15-year old patient with peptic ulcer
resulting after gastrectomy, has been received drug, wich inhibits the growth
appointed a long course of treatment and reproduction of H. рylori. Name the
cyanocobalamin. The drug was drug?
administered I.M. What is the advantage A. Metronidazole
of parenteral routes of administration B. Omeprazole
compared with enteral? C. Prasosin
A. Rapidly excreted D. Famotidine
B.  Rapidly absorbd. E. Furosemide
C. For a long time circulates in
  blood
D. Not destroyed by the liver
E. Effective in the absence of
gastromukoprotein
11. A 67 year-old men with exacerbation of 12. A patient with exacerbation of duodenal
peptic ulcer has incrised acidity of gastric peptic ulcer was admitted to hospital The
juice, pain and dyspeptic syndrom. analysis showed an increased gastric
Which of the following drugs should be secretion and acid-forming function of
prescribed? the stomach. Choose a product that will
reduce the secretory function of the
stomach by blocking histamine H2-
receptor?

A. Famotidine A. Metronidazole
B. Allocholum B. Omeprazole
C. Spironolactone C. Isadrinum
D. Proserinum D. Famotidine
E. Promedol E. Allocholum
13. A 32 year-old patient was examined by 14. The patient went to the doctor
doctor. Hypoacid gastritis and pernicious complaining of epigastric discomfort,
megaloblastic anemia was diagnosed. nausea, loss of appetite. In the study of
Which of the following drugs should be duodenal contents revealed Giardia.
prescribed? Which drug should be appointed?
A. Sodium nukleinat A. Metronidazole
B. Gemostimulin B. Chloroquine
C. Molgramostin C. Rifampicin
D. Folic acid D. Isoniazid
E. Cyanocobalamine E. Aciclovir

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________

_____________

55
 Drugs acting on digestive system: drugs used in the
Lesson 7 disturbances of pancreatic secretory function,
intestinal motility, hepatobiliary system disorders,
hepatoprotectors

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of

administrationAllocholumTabulettae «Allocholum» obductae pro infantibusP.O. 2 таb. 3
times a day after meal
Holosas
300 ml in flasksP.O. 1 tea spoon 2-3 times a day
SiliborumTab. obductae pro infantibus 0,04 g.P.O. before meal 0,04-0,08 g. 3 times a
[Link] course of treatment 1-2 months.
BisacodilTаb. 0,005 g;
dragee 0,005 g.;
suppose. 0,01 g.P.O. 1-3 таb. once a day, per rectum
Pancreatin

Tab. 0,25 and 0,5 g.

P.O. 1 таb. 3 times a day Aprotinin
(Contrykal)Powder in vials 10000, З0000, 50000 Units. Amp. With solvent are added.I.V. in
300-500 ml of isotonic solution of NaCl slowly or by dripping 10000-20000 U; in acute
condition 40000-60000 U gradually decreasing dose

Write the prescriptions:

Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Allocholum Patien's address and № of medical recard
______________________________________
56 Doctor's name___________________________________________________________
Rp.: ……………………………..……….
………..
……………………….……………….
(Tabulettae «Allocholum).

2. Contrycal.
Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
3. Holosas. ………..
………………………….…………….
………..
............…………………………..
……………………..

Do the tasks:
1. Fill the table. Pharmacological characteristics of drugs
Drugs Clinical usages Side effects
1. Pancreatin
2. Contrycal
3. Holosas
4. Silibor
5. Bisacodyl

2. Fill the table

Drugs that affect liver function and biliary system
Groups of drugs Preparations Clinical usages
1. Choleretic drugs:  
– drugs, that contain bile acids;
– natural;
– synthetic
2. Cholekinetic drugs

3. Hepatoprotectors

4. Cholelytics

3. Fill the table

Preparations for the correction of the motor function of the intestine
Groups of drugs Preparations Way of
administration, dose
1. Spasmolytics to relieve intestinal    
57
 colic

2. Laxatives, which are indicated in

acute poisoning

3. Laxatives, which include

anthraglycosides
4. Antidiarrheal drugs

4. Solve situational tasks:

1) Patient with cholelithiasis used infusion of Answer:
corn stigmas by his own. Soon the pain in the …………………………………………...
right upper quadrant of abdomen increased
…………………………………………...
sharply, the skin and mucous membranes
became yellow. Mechanical jaundice was …………………………………………...
diagnosed. Could it cause this complications? By
…………………………………………...
what drug patient should be treated?
…………………………………………...
…………………………………………...
2) Patient was transported to hospital with severe Answer:
pain of abdomen. Blood test diastase confirmed …………………………………………...
the clinical diagnosis of acute pancreatitis.
…………………………………………...
Prescribe therapy and prove its use.
…………………………………………...
…………………………………………...
…………………………………………...

5. Determine the drug:

1. It was prescribed to the patient with acute 2. It was prescribed to the patient with
pancreatitis chronic constipation as a result of colon
hypotony
A. Allocholum A. Ondansetron
B. Contrycal B. Festal
C. Omeprazole C. Aeron
D. Acidin-pepsin D. Apomorphine hydrochloride
E. De-nol E. Bisacodyl
3. The drug stimulates µ-opioid receptors in
the gut and is used for acute and chronic
diarrhea
A. Atropine
B. Drotaverinum
C. Loperamide
D. Neostigmine
E. Bisacodyl
6. Choose correct answers:
1. Cholagogue drugs 2. Drugs stimulating bile production
1. Allochol 1. No-spa
58
 2. Holosas 2. Allochol
3. Essentsiale 3. Holosas
4. Магния сульфат 4. Magnesium sulfate
5. Drotaverine 5. Holenzim
6. Platiphyllin
3. Drugs stimulating bile excretion 4. Cholelytics
1. Drotaverine 1. Essentsiale
2. Allochol 2. Ursodeoxycholic acid
3. Holosas 3. Holosas
4. Magnesium sulfate 4. Xenodeoxycholic acid
5. Holenzim
6. Platiphyllin
5. Hepatoprotective drugs 6. Enzyme preparations for chronic
pancreatitis
1. Silibilin 1. Festal
2. Essentsiale 2. Essentsiale
3. Festal 3. Mezim forte
4. Heptral 4. Panzinorm
5. Loperamide 5. Pancreatin
6. Contrycal
7. Drug for acute pancreatitis 8. Antidiarrheal drugs
1. Festal 1. Neostigmine
2. Gordox 2. Smecta
3. Mezim forte 3. Loperamide
4. Allochol 4. Bisacodyl
5. Trasilol 5. Magnesium sulfate
6. Contrycal
9. Purgatives acting on the large intestine 10. Laxatives acting throughout the intestine
1. Senadeksin 1. Senadeksin
2. Castor oil 2. Castor oil
3. Magnesium sulfate 3. Magnesium sulfate
4. Bisacodyl 4. Bisacodyl
5. Guttalaks 5. Guttalaks
1 Drugs used in acute poisoning and 12. Drug used in chronic constipation
1. constipation
1. Bisacodyl 1. Senadeksin
2. Castor oil 2. Castor oil
3. Magnesium sulfate 3. Magnesium sulfate
4. Lactulose 4. Bisacodyl
5. Sodium sulfate 5. Sodium sulfate
6. Vaselin oil

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Atropine sulfate

Bisacodyl

59
 Loperamide

Pancreatin

Contrycal

Magnesium sulfate

Neostigmine

Typical license test tasks Step-1 For computer tests

1. A 37 year-old man was admitted to the 2. What is synthetic laxative should be

surgical department with symptoms of chosen for the treatment of elderly
acute pancreatitis: vomiting, diarrhea, patients with chronic constipation?
bradycardia, hypotention, weakness,
dehydration of the organism. What A. Pancreatin
medicine should be used first of all? B. Castor oil
A. Ephedrine C. Bisacodyl
B. Platyphylline D. Loperamide
C. Etaperazine E. Magnesium sulfate
D. Contrycal
E. No-spa
3. Patient addressed doctor complaining of 4. A 45 year-old women is suffering from
periodically occurring dyspepsia. chronic pancreatitis. Doctor prescribed
Laboratory tests did not reveal pathogens her complex preparation containing
that can be responsible for diarrhea. pancreatic enzymes and dry bile. Point
Choose the drug the most beneficial in out prescribed drug?
this case.
A. Atropine A. Contrycal
B. Platyphylline B. Pancreatin
C. Papaverine C. Natural gastric juice
D. Bisacodyl D. Trasilol
E. Holosas E. Festal
5. Patient with chronic hepatitis was 6. A 12 year-old child after hepatitis А
prescribed complex preparation with doctor prescribed cholagogue drug for
hepatoprotecting properties. Preparation stimulation bile secretion. Point out
contains essential phospholipids and choleretics, which prepared from rosehip
vitamins. Point out this preparation. and used in syrup.
A. Essentsiale A. Sorbit
B. Liv - 52 B. Allochol
C. Silibor C. Ksilit
D. Legalon D. Holagol
E. Papaverine E. Holosas
7. A 70 year-old patient suffering from 8. The patient with biliary dyskinesia and
chronic constipation, which are based constipation doctor prescribed
hypotension colon. Which of the cholagogue, which has a significant
following drugs is advisable to appoint? laxative effect. Which drug prescribed by

60
 a doctor?
A. Sodium sulfate A. Allochol
B. Magnesium sulfate B. Magnesium sulfate.
C. Castor oil C. Holosas
D. Neostigmine D. Colenzim
E. Bisacodyl E. Nikodin
9. A 12 year-old patient has У больного 12 10. Patient 43 years complained of a sharp
лет food poisoning. Choose the drug for pain in pancreatic area. Which of the
rapid bowel movements and accelerate following drugs should be selected to
the elimination of toxins from the body? provide him first aid?
A. Magnesium sulfate A. Contrycal
B. Calcium chloride B. Potassium chloride
C. Sodium hydrocarbonate C. Platyphylline
D. Potassium chloride D. Pancreatin
E. Magnesium oxide E. Dibazol
11. To improve the process of digestion in 12. The patient 52 years with hypoacid
patients with chronic pancreatitis and gastritis doctor prescribed enzyme
cholecystitis appointed combined preparation. Which of the following
preparation. Which of the following drugs improves digestion in the stomach?
drugs is advisable to appoint?
A. Pepsin A. Pancreatin
B. Festal B. Tripsin
C. Magnesium sulfate C. Pepsin
D. Pancreatin D. Contrycal
E. Natural gastric luice E. Natural gastric juice

The theme of individual student’s work:

Pharmacology of antidiarrheal drugs. Probiotics. Prokinetics.

Date Student's name Teacher's signature

«____»_______ 201__г.
____________________________ _____________

61
 Unit III
DRUGS ACTING ON BLOOD

Topic 7
Drugs affecting blood system. Plasma expanders.
Lesson 8 Drugs acting on erythropoiesis and leucopoiesis.
Plasma expanders.

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

Fercoven
Amp. 5 mlI.V. slowly: 1-st and 2-nd day — 2 ml, than 5 ml 10-15 days
CyanocobalaminAmp. 1 ml 0,003 %; 0,01%; 0,02 %;n0,05 % sol.I.M., I.V., S.C. In
megaloblastic anemia 0.1 – 0,2 mg. per day
MethyluracilumPowder; sup., tab. 0,5 g.;
Ointment 10 % - 25,0 g.P.O. 0,5 g. 4 times a day after meal; rectaly 1 sup.
2-4 times a day;
Locally on damaged skin.
Glucose
Flasks 200, 250, 400, 500 ml 5 % and 10% sol.Внутривенно капельно

Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

Write the prescriptions: ______________________________________________________________________

__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
Patien's address and № of medical recard
______________________________________
Doctor's name___________________________________________________________
1. Fercoven. Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
62
………..
………………………….…………….
………..
2. Glucose.

Do the tasks:
1. Fill the table. Pharmacological characteristics of drugs
Preparations Clinical usages Side effects
1. Fercoven

2. Cyanocobalamin

3. Methyluracilum

2. Solve situational tasks:

1) In a patient with anacidal gastritis general Answer:
weakness, dizziness, pale skin, headache, …………………………………………...
glossitis and funicular myelosis were marked. In
…………………………………………...
the peripheral blood a reduced number of red
blood cells, megaloblasts were detected. Indicate …………………………………………...
which drugs must be prescribed to the patient;
…………………………………………...
specify localization and mechanism of action.
…………………………………………...
…………………………………………...

2) Patient has iron deficiency anemia. For what Answer:

purpose iron containing drugs with vitamin C …………………………………………...
have been prescribed?
…………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...
3) Blood test revealed mild hypochromic anemia Answer:
in the patient. Doctor has prescribed antianemic …………………………………………...
preparation (tablets), but observing carious teeth,
…………………………………………...
he gave an additional set of recommendations
and prescribed it in another medicinal form. …………………………………………...
Which drug was prescribed by a doctor? What
…………………………………………...
was the recommendations given by a doctor?
…………………………………………...
4) Patient receiving radiation therapy once a Answer:
week has a blood leukocytes test. Once analysis …………………………………………...
showed a decreasing of leukocytes number.
…………………………………………...
Which medicines must be prescribed to the
patient to continue radiation therapy? …………………………………………...
63
 …………………………………………...
…………………………………………...

3. Fill the table.

Comparative characteristics of drugs for anemia
Drugs Used for anemias Route of Side
Iron defficiency megalloblastic macrocytic administration effects
Ferro-gradument
Ferropleks
Ferrum Lek
Folic acid
Cyanocobalamine
4. Choose correct answer:
1. Drugs used in iron-deficiency anemia 2. Drugs used for leucopenia
1. Folic acid 1. Ferropleks
2. Ferropleks 2. Methyluracil
3. Cyanocobalamin 3. Ferro-gradument
4. Ferrum Lek 4. Sodium nucleinate
5. Ferro-gradument 5. Pentoxil
6. Molgramostim
3. Drugs used for megalloblastic anemia 4. Drugs used for macrocytic anemia
1. Ferropleks 1. Ferro-gradument
2. Cyanocobalamin 2. Folic acid
3. Ferro-gradument 3. Ferropleks

5. Determine the drug:

1. On examination of 40 years man 2. Due to the large blood loss in woman
hypocromic anemia was diagnosed. Which after thyroidectomy hypochromic anemia
drug should be prescribed? was appeared. Which drug should be
prescribed to the patient?
A. Fercoven A. Ferrum Lek
B. Cyanocobalamin B. Pentoxil
C. Pentoxil C. Methotrexate
D. Heparin D. Sinkumar
E. Vikasol
3. To the patient with leukopenia, which
occurred as a result of uncontrolled taking
Metamizole, has been prescribed:
A. Methyluracil
B. Fercoven
C. Cyanocobalamin
D. Glucose
E. Trisamin

64
 To give a pharmacological characteristics
for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Cyanocobalamin (В12)

Methyluracil

Step-1 For computer tests

Typical license test tasks
1. Severe anemia occurred in patients after 2. Iron deficiency anemia is very common
gastric resection on account of ulceration. among pregnant women, complicating
What medicine has to be assigned along pregnancy, childbirth, adversely affects the
with improvement of nutrition? fetus and newborn. Propose for the
treatment such anemia preparation of
A. Ferotseron ferrous iron for oral administration:
B. Methyluracil
C. Iron sulfate A. Ferrum Lek
D. Koamidum B. Iron ferrous lactate
E. Cyanocobalamin C. Hemostimulin
D. Koamidum
E. Fercoven
3. On examination of 46 years women 4. Blood test of pregnant women showed
hypochromic anemia was diagnosed. megaloblasts and high color index.
Which drug should be prescribed? Diagnosed as megaloblastic anemia. Which
drug should be prescribed to the patient?
A. Cyanocobalamin. A. Nicotinic acid.
B. Fercoven B. Pyridoxine hydrochloride
C. Pentoxil. C. Ascorbic acid
D. Heparin. D. Cyanocobalamin
E. Vikasol. E. Koamidum

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________ _____________

65
 Lesson 9
Drugs acting on blood coagulation

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration
Vikasol Powder; tab. 0,015;
amp 1 ml of 1 % sol.P.O. 0,015 – 0,3 g/day (1 таb. 2-3 times a day); I.M. 0,01-0,015 g. (1–2
ml) 3-4 days with an interval of 4 days
Aminocaproic
acid
Powder; flasks 100 ml of 5 % sol; 60 g. in granules (for chidren)P.O. 0,1 g/kg per 4 hours,
daily dose – 10-15 g; I.V. 100 ml of 5 % sol. per 4 hours.
HeparinFlasks 5 ml – 5000, 10000 and 20000 U in 1 ml;
I.V., I.M., S.C. In acute MI heparin is injected I.V. in dose 15000-20000 U followed by
I.M. administration for 5-6 days in dose 40000U per 24 hours. In thrombosis of
pulmonary artery I.V. by dripping 40000-60000U during 6 hours, followed by IM
injection 40000U per 24 hours
FraxiparineSol for injection 2850U, 3800U,5700U, 7600U-0,8 ml and 1 mlS.C. 0,4-0,9 ml
(depends on weight)
DicumarolTab. 0,05 and 0, 1 g.P.O.: 1-st day –0,3 g. 2 times; 0,2 g 3 times a day; 2-nd
day –0,15 g. 3 times; then 0,2-1,1 g on day
WarfarinTab. 2,5 mgP.O. in dose 10 mg once a day for 1-2 days, then 5-7,5 mg per day

66
 Prescription № ______
Write the prescriptions:
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Heparin. Patien's address and № of medical recard
______________________________________
Doctor's name___________________________________________________________

Rp.: ……………………………..……….
………..
……………………….……………….
2. Fraxiparine. ………..
………………………….…………….
………..
………………………….…………….
………..
............…………………………..
3. Aminocaproic acid
. ……………………..
Rp.: ....…………………..………….
………………..
…………………..
4. Vikasol. ……………………………..
…………………..……………………….
…….
........................…………………..
……………………………..
5. Warfarin. ........................…………………..
……………………………..
Rp.: ……………………………………..
1. Fill the table (see note)
…………
………………………………………….
Indications for hemostatic and antifibrinolytic agents
Indications Hemostatic Vicasol Protamine Aminocaproic acid

67
 sponge sulfate
Topically for capillary
bleeding
Bleeding associated with
hypoprothrombinemia
Bleeding associated with
increased fibrinolysis
An overdose of anticoagulants
of direct action
An overdose of indirect
anticoagulants
Note: When filling the table use the «+» symbol.
Do the tasks:
2. Fill the scheme
The general pharmacological characteristics of drugs affecting clot
Process Platelet Blood clotting Fibrinolysis
agregation

Groups of
drugs

Clinical
usages

Main side
effects

3. Fill the table. Pharmacological characteristics of drugs

Preparation Mechanism of Pharmacological Indications Side effects
action effects

Тhrombin

Vicasol

Aminocaproic acid

Protamine sulfate

Heparin

Warfarin

68
 Streptokinase

Acetylsalicylic acid

Etamzilate

4. Fill the table (see note). Comparative characteristics of anticoagulants

Parameters of comparison Heparin Fraxiparine Warfarine
Mechanism of Inhibit the clotting factors in
action plasma (in combination of
antithrombin III)
Inhibit the clotting factors in
plasma (independently of
antithrombin III)
Inhibits the synthesis of clotting
factors in liver
Route of Parenteral (I.M., S.C.)
administration Per os
The rate of development of the effect
(minutes, hours, days)
Antagonist in overdose
Note: When filling the table use the «+» symbol.

5. Match the preparations with the mechanisms of action

Antipletelet Mechanisms of action
1. Acetilcalicylic acid А. Inhibition of phosphodiesterase
2. Dipyridamole Б. Noncompetitive blockade of glycoprotein IIb/IIIа
3. Ticlopidin В. The irreversible inhibition of cyclooxygenase
4. Abciximab Г. Blockade of Р2Y-receptors

Answer: 1.___2.___3.___4.___
6. Fill the table (see note). Comparative characteristics of fibrinolytics
Parameters of comparison Sterptokinase Urokinase Alteplase
Site of In the blood cliot and
action blood plasma
Mainly in the blood
clot
Pyrogenic and allergic reactions
Note: When filling the table use the «+» symbol.

7. Solve situational tasks:

1) The patient with suspected thrombosis of the Answer:

69
pulmonary artery was injected i/v heparin during …………………………………………...
7 days every 4 hours; the condition was
…………………………………………...
improved, and therefore the introduction of
anticoagulation was discontinued. However, one …………………………………………...
day after at the patient signs of massive
…………………………………………...
thrombosis was developed?
…………………………………………...
…………………………………………...
2) To the patient with acute myocardial Answer:
infarction anticoagulant was administered …………………………………………...
intravenously every 6 hours. On the 4th day
…………………………………………...
capillary bleeding from the gums and nose was
developed, bruises was appeared on the skin, …………………………………………...
fresh red blood cells in urine. Which drug was
…………………………………………...
administered to the patient, explain the
mechanism of complications occurrence? Which …………………………………………...
indices of coagulation doctor has to pay attention
…………………………………………...
when using this drug to prevent overdose?
Which aid is needed in overdose?
3) Intense uterine bleeding occurred in a women Answer:
after childbirth. The level of fibrinogen in …………………………………………...
peripheral blood was dramatically reduced. What
…………………………………………...
the medicines you need to apply in this situation,
what their mechanism of action, route of …………………………………………...
administration, dosage?
…………………………………………...
…………………………………………...

4) The patient with thrombophlebitis for two Answer:

weeks taking warfarine that resulted in reduction …………………………………………...
of prothrombin detected by blood test and
…………………………………………...
microhematuria revealed in urine analyses. What
the remedy must be applied as an antagonist of …………………………………………...
warfarine?
…………………………………………...
…………………………………………...

5) A 64 year-old patient was operated for acute Answer:

calculous cholecystitis. 12 hours after the …………………………………………...
operation shortness of breath, hypotension,
…………………………………………...
cyanosis of the skin appeared. Pulmonary
embolism was suspected. Specify drugs to treat …………………………………………...
this complication?
…………………………………………...
…………………………………………...

8. Determine the drugs:

1. Medication was prescribed to the patient 2. A massive uterine fibrinolytic
with venous thromboembolism of lower hemorrhage occurred in woman during
70
 limb. After 2 days hemorrhage was labor, complicated by premature
appeared on the skin. Which of the detachment of placenta, began. Which
following drugs can cause such drug should be prescribed for inhibition
complications? of fibrinolysis?
A. Heparin A. Aminocaproic acid
B. Dipyridamole B. Vicasol
C. Acetylsalicylic acid C. Fibrinogen
D. Warfarine D. Calsium chloride
E. Fenilin Е. Hemostatic sponge
3. Having the property to slow down platelet 4. Anticoagulants of direct action:
aggregation:
A. Heparin A. Warfarine
B. Alteplase B. Fraxiparine
C. Dipyridamole C. Heparin
D. Aminocaproic acid D. Dicumarol
E. Acetylsalicylic acid E. Contrycal
5. Agent used to stop the gastrointestinal 6. Drug increase fibrinolysis and acted only
bleeding: in the blood clot
A. Calsium chloride A. Streptokinase
B. Aminocaproic acid B. Clopidogrel
C. Acetylsalicylic acid C. Etamzilate
D. Thrombin D. Abciximab
E. Hemostatic sponge E. Alteplase
9. Choose correct answers:
1. Drugs increases blood clotting and used 2. Drugs inhibits fibrinolysis and used for
for bleeding bleeding
1. Vikasol 1. Heparin
2. Heparin 2. Gordox
3. Calsium chloride 3. Kontrikal
4. Hemostatic sponge 4. Streptokinase
5. Warfarine 5. Aminocaproic acid
6. Streptokinase
3. Drugs reduces blood clotting 4. Drugs reduces platelet agregation
1. Heparin 1. Heparin
2. Vikasol 2. Clopidogrel
3. Streptokinase 3. Streptokinase
4. Etamzilate 4. Etamzilate
5. Fraxiparine 5. Abciximab
6. Abciximab 6. Acetylsalicylic acid

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Menadione (Vikasol)
Calsium chloride
Hydrogen peroxyde

71
Acetylsalicylic acid (Аspirin)

Step-1 For computer tests

Typical license test tasks
1. For the prevention of myocardial 2. In acute thrombosis intravenous heparin
infarction doctor prescribed nonsteroidal relieves the patient's condition. Which of
anti inflammatory drug with antiplatelet these mechanisms is responsible for
effect - aspirin. Choose the dose and effect of heparin?
regimen at which the drug will exert A. Inhibition of the synthesis of
antiplatelet effect. prothrombin in the liver
B. Inhibition of the transformation of
A. 0.25 three times a day prothrombin to thrombin in the blood
B. 1.0 three or four times a day C. Reduction of the number of calcium
C. 0.1-0.2 once a day for a long time ions in the blood
D. 0.5 three times a day D. Influence on the retraction of the
E. 0.1 three times a day clot
E. Dissolution of fresh thrombus
3. 8 year-old child is preparing for 4. Massive uterine bleeding in woman was
tonsillectomy. Blood analysis showed stopped by introducing aminocaproic
clotting time increased to 7 minutes. acid. Which of listed mechanisms
What medication should be included in a contributed to hemostatic effect of this
complex of drugs for preparation period drug?
of 5 days before surgery in the first
place?
A. Fibrinogen A. Activation of fibrinolysis
B. Vikasol B. Increased prothrombin in the blood
C. Calsium chloride C. Increased synthesis of prothrombin
D. Etamzilate in the liver
E. Aminocaproic acid D. Inhibition of fibrinolysis
E. Increasing calcium in the blood
5. Anticoagulant therapy with heparin was 6. Patients suffering from angina and
performed in patient with myocardial receiving isosorbide mononitrate, was
infarction. What preparation should be appointed an additional drug with
used to continue treatment after antiplatelet effect. Identify the drug:
withdrawal of heparin to prevent
recurrence of thrombosis?

A. Calsium chloride A. Acetylsalicylic acid

B. Neodikumarinum B. Validolum
C. Furosemide C. Anaprilinum
D. Fibrinolysin D. Nifedipine
E. Sodium hydrocitrate E. Nitroglycerine

7. In the laboratory experimental studies in 8. A 59 year-old patient after myocardial

72
 vitro and in vivo antagonist of direct infarction doctor prescribed aspirin for 3-
anticoagulant was selected for the clinical 4 months 0.25 1 time in 2-3 days. On
use. What could be the preparation of what action expected a doctor?
these?

A. Neodikumarinum A. Antiplatelet
B. Dipyridamole. B. Antiinflammatory.
C. Acetylsalicylic acid. C. Antipyretic.
D. Heparin. D. Analgesic.
E. Protamine sulfate E. Ulcerogenic
9. On examination of 42 year old patient 10. Wich drug should be prescribed to the
was diagnosed prothrombin deficiency in patient with myocardial infarction for
the blood. Which drug should be prevention of thromboembolism?
prescribed to reduce blood loss? A. Heparin
A. Fenilin B. Cloroquine
B. Thrombin C. Calcitonin
C. Aminocaproic acid. D. Biseptol
D. Vikasol E. Dimedrol
E. Contrycal
11. The patient with overdose of 12. On examination a 33 year-old patient
anticoagulant was appointed antidote – was diagnosed bleeding from the gums,
protamine sulfate. Name the drug caused bruises on the skin, fresh red blood in the
the overdose: urine. What medication can cause such
complications?
A. Heparin A. Alteplase
B. Cyanocobalamine B. Vikasol
C. Fercoven C. Fercoven
D. Vikasol D. Pentoxil
E. Methyluracil E. Heparin
13. A patient 65 year-old during long time 14. A 34 year-old patient with liver disease
used indirect anticoagulant for prevention before surgery was appointed synthetic
of [Link] must be water-soluble analogue of vitamin K.
appointed if develops bleeding from What is a drug??
nose?
A. Blood transfution A. Fraxiparin
B. Thrombin B. Vikasol
C. Vikasol C. Heparin
D. Calsium chloride D. Neodikumarinum
E. Аdrenaline E. Dipyridamole

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________ _____________

73
 Unit IV
Vitamin, enzyme and hormonal drugs. Antiinflammatory and
antiallergic drugs. Immunodepressants.

Topic 8
Vitamin and antivitamin drugs. Enzyme and antienzyme drugs.
Hormonal preparations, their synthetic derivatives and antagonists.

Lesson 10 Hormonal agents of peptic nature

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

CorticotropinPowder 10, 20, 30, 40 Units in flasksI.M., I.V. by dripping 10-20 Units for adults
and chidren
.
OxytocinAmp. 1 ml (5 and 10 U) and 2 ml (2 U)For induction of labor 1-3 Units in 300-500
ml of 5% glucose solution I.V. by dripping; I.M. 0,5-1 Units with an interval 30-60 мinutes.

LevothyroxineTab. 0,025; 0,05; 0,15; 0,1; and 0,2 g.P.O in the morning on an empty stomach
begin from 0,0125 mg, then increase to support dose (for adults and children).
Regular insulinVials 10 ml (1 ml – 40 U);
Vials 10 ml (1 ml – 80 and 100 U)S.C., I.M. for adults and children.
GlibenclamideTab. 0,005 g.P.O. 2,5 mg – 10 mg 1-2 times a day 30 min before meal
MetforminТаb. 0,25; 0,5 and 0,85 g.P.O. 0,5 g. per day (2 times a day while meal).

74
Write the prescriptions : Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Corticotropin. Patien's address and № of medical recard
______________________________________
Doctor's name___________________________________________________________

Rp.: ……………………………..……….
………..
……………………….……………….
2. Oxytocin.
………..
………………………….…………….
………..
………………………….…………….
………..
3. Levothyroxine. ............…………………………..
……………………..
Rp.: ....…………………..………….
………………..
4. Regular insulin. …………………..
……………………………..
…………………..……………………….
…….
........................…………………..
Do the tasks: ……………………………..
1. Fill the table. Hormones medications of the hypothalamus and pituitary gland
Hormones Preparations Indications
Тiroliberin
Gonadorelin Whith the «pulsating administration»:

Whith the continuous administration:

Follicle-stimulating hormone
Luteinizing hormone
Adrenocorticotropic hormone
Growth hormone
Somatostatin

75
 Oxytocin
Posterior pituitary antidiuretic
hormone
Note. When filling column «Indications» use the following indications:
А. To stop bleeding from esophageal varices
B. Whith the dwarfism
C. For the stimulation of labor and stopping bleeding in the postpartum period
D. In acromegaly
E. For hypogonadism and infertility
F. For malignancy of ovarian and prostate cancer
G. In atrophy of the adrenal cortex,caused by long-term use of glucocorticoids
H. In diabetes insipidus
И. For the diagnosis and treatment of hypothyroidism.

2. Choose and write down preparation on these indications.

1) To stimulate the adrenal cortex.....................................................................................................
2) To induce labor..............................................................................................................................
3) The agent for relief diabetic coma.................................................................................................
4) Synthetic oral hypoglycemic agent – a derivative of sulfonylurea...............................................
5) Agent for hyperthyroidism............................................................................................................
6) Agent for myxedema.....................................................................................................................

3. Fill the table (see note). Calcitonin and parathyroid hormone preparations
Hormones
Parathyroid hormone Calcitonin
Endocrinic gland
Preparations
Absorption of Са2+ in the
intestine
Са2+ reabsorption in the
Effects kidney
Са2+ content in the bones
The level of Са2+ in the
blood
Indications
Note. When filling table, use the symbols «↑» – increase, «↓» – decrease.

4. Fill the table (see note).

Side effects of thyroid and antithyroid agents
Side effects L-thyroxine Tiamazol (merkazolil) Ways of correction
(group of drugs)
Goitergenic action
Toxic effects on the
heart
Inhibition of
hematopoiesis
Anxiety, insomnia
Note. When filling table, use the «+» symbol.

5. Fill the table (see note).

Mechanisms and side effects of oral hypoglycemic agents
Glibenclamide Мetformin Acarbose
76
 Mechanism Reduction of
of action gluconeogenesis
Enhancing of endogenous
insulin incretion
Decreasing of glucose
absorption in the intestine
Increasing of glucose
utilization by tissues
Side Hypoglycemia
effects Increasing of appetite
Loss of appetite and body
weight
Lactic acidosis
Flatulence
Note. When filling table, use the «+» symbol.

6. Fill the table. Comparative characteristics of insulin dgugs

Preparations Onset of action Maximum of action The total duration of action

7. Solve a situational task:

1) The patient has diagnosis diabetes type II. Answer:
Endocrinologist prescribed glibenclamide. What …………………………………………...
is the mechanism of action of this drug?
…………………………………………...
…………………………………………...
2) The patient who received multiple fractures as Answer:
a result of road accidents, has delayed fusion of …………………………………………...
the bones. Specify a hormonal drug that
…………………………………………...
promotes splicing of fractures?
…………………………………………...
…………………………………………...
8. Choose correct answers:
1. Drug for stimulation delivery 2. Drug for diabetes insipidus is used
1. Octreotide 1. Kaltsitrin
2. Oxytocin 2. Desmopressin
3. Metformin 3. Merkazolil
4. Desmopressin 4. Vasopressin
5. Merkazolil
3. It is used in osteoporosis 4. При гипотиреозе применяют
1. Miacalcic 1. Merkazolil
2. Merkazolil 2. Potassium iodide
3. Kaltsitrin 3. Levothyroxine
4. Insulin 4. Parathyroidin
5. Parathyroidin 5. Triiodothyronine
77
 5. It is used in hyperthyroidism 6. It is used in diabetes mellitus type I
1. Merkazolil 1. Insulin
2. Potassium iodide 2. Glimepiride
3. Levothyroxine 3. Desmopressin
4. Parathyroidin 4. Metformin
5. Triiodothyronine 5. Acarbose
7. It is used in diabetes mellitus type II 8. Incretion endogenous insulin is increased
1. Insulin 1. Acarbose
2. Glimepiride 2. Glimepiride
3. Glibenclamide 3. Glibenclamide
4. Metformin 4. Metformin
5. Acarbose 5. Gliclazide
9. It decreases gluconeogenesis and 10. It is used in acromegaly
increases glucose uptake of muscle tissue
1. Acarbose 1. Glibenclamide
2. Glimepiride 2. Oxytocin
3. Glibenclamide 3. Bromocriptine
4. Metformin 4. Desmopressin
5. Gliclazide 5. Оctreotide
11. It is used for dwarfism
1. Oxytocin
2. Bromocriptine
3. Somatropin
4. Оctreotide
5. Insulin

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Glibenclamide

Insulin

Oxytocin

Levothyroxine

Step-1 For computer tests

Typical license test tasks
1. A little boy of 7 years old was 2. A patient ill with collagenosis has been
complaining of thirst and frequent taking prednisolone for a long time.
urination. On examination Hypokaliemia development caused
hyperglycaemia was revealed and spastic pain of skeletal muscles. What
diabetes mellitus was diagnosed. Which medication should be used in order to
of antidiabetic drugs most probably was correct potassium exchange?
used for treatment of this patient?
A. Panangin
78
 A. Acarbose B. Thyrocalcitonin
B. Chlorpropamide C. Dithylinum
C. Insulin D. Diazepam
D. Metformin E. No-spa
E. Glibenclamide
3. A patient in unconscious state was 4. Somatostatin is beneficial in the
admitted to the emergency room. treatment of acromegaly, but its synthetic
Diabetic coma was diagnosed. analog octreotide is more preferable.
Intravenous administration of regular What is the reason?
insulin was performed. Which of the
listed agents in addition to insulin is A. Lower toxicity
commonly used intravenously to B. Quick onset of action
normalize patient's condition? C. Higher potency
D. Lack of drug interaction
A. Acarbose E. Positive action on CNS
B. Tolbutamide
C. Glibenclamide
D. Metformin
E. Sodium bicarbonate

5. A patient whith hypothyroidism L- 6. A 47-year-old female obesity patient was

thyroxine was prescribed. As a diagnosed type II diabetes mellitus.
complications can be thachycardia, Choose the most beneficial antidiabetic
tremor of the limbs. Which of the drug for this patient?
following drug can exert such action?

A. Retabolil. A. Insulin.
B. Metformin. B. Metformin.
C. Mercazolil. C. Tolbutamide.
D. Levothyroxine. D. Glipizide.
E. Prednisolone. E. Chlorpropamide.

7. A 52 year patient with diabetes mellitus 8. A yong man with hypogonadism was
controls his sugar level by regular treated with hormonal drug. It results in
administration of glibenclamide. What is onset of spermatogenesis. Which drug
the main mechanism of its action? was used?

A. Inhibition of intestinal absorption A. Somatotropin.

of glucose.
B. Stimulation of gluconeogenesis in B. Human menopausal gonadotropin.
liver
C. Increase in insulin secretion by beta C. Pituitrin.
cells.
D. Promotion of glucose penetration D. Oxytocin.
into the cells.
E. Inhibition of alpha glucosidase E. Corticotropin.

79
 Date Student's name Teacher's signature

«____»_______ 201__г.
____________________________ _____________

Hormonal drugs of steroidal structure and their

Lesson 11
synthetic derivatives

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

PrednisoloneТаb. 0,005; 0,001 g.,
oinment 10 g. and 20 g.; suspension in amp. and flasks 1 ml; 0,3% and 0,5% eye dropsP.O., I.V.,
topicaly for adults and [Link] deconate
(Retabolil)Amp. 5% oily sol - 1 mlI.M. 25-50 mg once per 2-3 weeks 8-10 injections; for
children in weight relating dose once per 3-4 weeks
Progesterone1% oily sol in amp. 1 ml; caps. 0,1 I.M., P.O. for adults

Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

Write the prescriptions: ______________________________________________________________________

__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
Patien's address and № of medical recard
______________________________________
Doctor's
name____________________________________________________________

1. Prednisolone. Rp.: ……………………………..……….

………..
……………………….……………….
………..
2. Retabolil.
………………………….…………….
………..
………………………….…………….
………..
............…………………………..
80
……………………..
Rp.: ....…………………..………….
3. Progesterone.

Do the tasks:
1. Fill the table (see note). The pharmacological effects of glucocorticoids
Effect of glucocorticoids on: Effect
Metabolism Protein
Carbohydrate
Adipose
Water and electrolyte Na+
metabolism H2O
K+
Ca2+
Cardiovascular system BP
Heart rate
Periferal blood lymphocytes
eosinophils
neutrophils
erythrocytes
platelets
Hypothalamic-pituitary Releasing of
system ACTH
Note. When filling table, use the symbols «↑» – increase, «↓» – decrease.

2. Indicate the main pharmacological effects of glucocorticoids (see note).

Glucocorticoids cause:
Inhibition of the enzyme The induction of synthesis of Repression of gene synthesis of
phospholipase А2 gene of lipokortine-1. interleukin-1,-2,-4.
Reduced infiltration in Decreasing of leukotriene Reduction of proliferation and
inflammatory focus synthesis С4, D4, E4 differentiation of Т- and В-
Decrease production COX2 Stabilize the membranes of lymphocytes
Reduction of prostsglandin mast cells
synthesis
effect effect effect

Note: When filling column «Effect» use the following effects: antiallergic, immunosuppressive, antiinflammatory

3. Fill the table (see note).

Comparative characteristics of estrogens and progestogens
The parameter of comparison Estrogenic drugs Progestin drugs
Indications Amenorrhea
Delayed puberty
Infertility
81
 Risk of miscarriage
Prevention of osteoporosis
For replacement therapy in
postmenopause period
Prostate cancer
For contraception
Increased blood clotting
Renal failure
Nausea and vomiting
Side effects
Insomnia, depression
Edema
Hirsutism
Note. When filling table use the «+» symbol.

4. Fill the table (see note).

Pharmacological characteristics of androgens and anabolic steroids
Androgens Anabolic steroids
Preparations Testosterone propionate
Теstosterone enanthate
Retabolil
Nandrolone
Indications Slow formation of callus
Delayed puberty
Breast cancer in women under 60
years
Muscular dystrophy
Osteoporosis
Note: When filling table use the «+» symbol.

5. Solve situational task:

1) Signs of climacteric syndrome were found at Answer:
the man 58 years old. In addition, osteoporosis …………………………………………...
was revealed. Which drug must be prescribed to
…………………………………………...
the patient? Prove the answer.
…………………………………………...
…………………………………………...

2) Two patients with bronchial asthma were Answer:

treated with prednisolone administered in …………………………………………...
different regimens: one used 3 times a day,
…………………………………………...
another – the daily dose in the morning. After 15
days administration of preparation was …………………………………………...
discontinued by gradually reducing the dose.
…………………………………………...
How both patients will carry the abolition of the
drug?
3) The drugs have anti-inflammatory, Answer:
antiallergic, antishock and immunosuppressive …………………………………………...
effects; they reduce the number of lymphocytes
…………………………………………...
and eosinophils in the blood, increasing the
number of circulating neutrophils, erythrocytes, …………………………………………...
reticulocytes. The mechanism of anti-
82
inflammatory effect is associated with inhibiton …………………………………………...
of phospholipase A2, that is necessary for the
…………………………………………...
synthesis of arachidonic acid.
А) Determine the group. …………………………………………...
В) For which disease they are used?
…………………………………………...
4) The drug stimulates protein synthesis that Answer:
leads to increase in weight of skeletal muscle …………………………………………...
and parenchymal organs. It is accompanied by
…………………………………………...
delaying of the output from the body of nitrogen,
phosphorus and calcium. Used for cachexia, …………………………………………...
fatigue, osteoporosis, to stimulate regeneratory
…………………………………………...
processes after radiation therapy, myocardial
infarction, severe illness, prolonged use of …………………………………………...
glucocorticoids, with non-medical purpose in
…………………………………………...
athletes.
А) Determine the group of drugs; …………………………………………...
В) Indicate the side effects.
6. Choose correct answers:
1. Influencing on metabolism of 2. Therapeutically valuable effects of
glucocorticoids causes glucocorticiods
1. Hyperglycemia 1. Allergy
2. Redistribution of body fat 2. The anti-inflammatory
3. Increase protein synthesis 3. Immunosuppressant
4. Swelling 4. Hypotensive
5. Оsteoporosis 5. Antishock

3. Indications for use of glucocorticoids 4. It is used for amenorrhea

1. Peptic ulcer 1. Ethinyl estradiol
2. Bronchial asthma 2. Prednisolone
3. The reaction of graft rejection 3. Progesterone
4. Collagen 4. Methyltestosterone
5. Anaphylactic shock 5. Triamcinolone
6. Diabetes mellitus

5. It is used for male infertility 6. Contraceptives are

1. Methyltestosterone 1. Маrvelon
2. Retabolil 2. Аnteovin
3. Progesterone 3. Trikvilar
4. Prednisolone 4. Progesterone
5. Triamcinolone 5. Postinor

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Prednisolone

83
 Step-1 For computer testing
Typical license test tasks

1. Patient 28 years, after long-term use of 2. A 70 year-old patient with numerous

one of the therapeutic agents developed fractures of lower limbs was
hypersensitivity to colds. Which of the immobilized for a long period. As a
following drugs may help reduce result osteoporosis was developed.
immunity? Choose the beneficial long acting drug
for this patient.

A Prednisolone
A Sustac-forte B Insulin
B Prednisolone C Retabolil
C Reserpine D Danasol
D Folic acid E Тhyroxine
E Clonidine
3. The patient with arthritis was treated with 4. A 14 – year-old girl was raped. Which
prednisolone for a long period, then type of contraceptive agent has to be
suddenly stop taking it. Which used for prevention of undesirable
complications can develops in this case? pregnancy?

A Hyperglycemia. A Combined monophasic.

B Increase of blood presure. B Combined biphasic.
C Withdrawal syndrome. C Combined triphasic.
D Exacerbation of chronic infectious D Postcoital pills.
processes. E Spermatocidal.
E Ulceration of the stomach and
duodenum.
5. A patient had been taking glucocorticoids 6. Patient with severe burns was admitted
for a long time/ When the preparation was to transplantology department, where
withdrawn he developed the symptoms of skin allograft was performed. Point out
disease aggravation, decrease blood the drug that most probably was used to
pressure and weakness. What is the reason prevent reaction of rejection?
of the condition?
A Hyperproduction of ACTH. A Cromolin-sodium.
B Appearance of adrenal insufficiency. B Prednisolone.
C Sensibilization. C Ketotifen.
D Habituation. D Loratadine.
E Cumulation. E Diclofenac.

Date Student's name Teacher's signature

84
 «____»_______ 201__г.
____________________________ _____________

Тopic 9
Anti-inflammatory, antiallergic and immunotropic drugs.

Lesson 12 Anti-inflammatory, antiallergic and immunotropic

drugs.

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administration

Prednisolone
Таb. 0,001; 0,005; 0,02 g.;
oinment 0,5% 10,0 g;
Powder in amp. 25 mg
P.O. for adults 20-40 mg/ 24 hours; for children 1-2 mg gradually decreasing dose; in shock I.V.
50-100 mg
Diphenhydramine (Dimedrolum)
Таb. 0,02 for children
0,03, 0,05 and 0,1 for adults; amp. 1 % – 1 ml;
Sup. 0,005; 0,01; 0,015 and 0,02 [Link] adults 0,025—0,05 g. 1–3 times a day, I.M and I.V. –
1 – 5 ml 1 % sol.; suppositories 1–2 times a day
For children up to 3 y.o. – 0,005g.; from 3 to 4 y.o. –0,01; from 5 to 7 y.o. –0,015; 8–14 y.o. –
0,02g.

LoratadinТаb. 10 mg,
0,1% sirup and [Link] flasks 100–120 mlP.O. 10 mg once a day;
sirup, susp. 1 tea spoon once a day
Chloropyramine
(Suprastinum)Таb. 0,025
Amp. 2% sol 1 ml.P.O. while eating 25-50 mg (1-2 tab.)
3-4 times a day; I.M. and I.V. 1-2 ml 2% sol.

Prescription № ______
Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Write the prescriptions: Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
Patien's address and № of medical recard
______________________________________ 85
Doctor's
name____________________________________________________________
Rp.: ……………………………..……….
………..
1. Diphenhydramine.

2. Loratadin.
Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
3. Chloropyramine. ………..
………………………….…………….
………..
............…………………………..
……………………..
Do the tasks:
1. Fill the table (see note).
Comparative characteristics of non-steroidal and steroidal anti-inflammatory
Parameters of comparison NSAID SAID
Antiinflammatory
Analgesic
Effects Immunosuppresive
Antiallergic
Antipyretic
Inflammatory diseases (arthritis, myositis)
Fever
Bronchial asthma
Indications
The reaction of graft rejection
Аutoimmune diseases.
Eczema, atopic dermatitis, psoriasis
Reduced resistance to infection
Ulcerogenic action
Atrophy of the adrenal cortex for prolonged use
Side effects Redistribution of body fat
Bronchospasm
Renal failure
Azoospermia, decreased contractility of the myometrium
Note: When filling table use the symbols «+».

2. Solve situational tasks:

1) Patient, who suffers from arthritis, taken Answer:
nonsteroidal anti-inflammatory preparation by 1 …………………………………………...
g per day for 2 weeks. The joint pan has passed,
…………………………………………...
but there was pain in the epigastric region.
Patient was admitted to hospital where gastric …………………………………………...
bleeding was diagnosed. What drug was
…………………………………………...
prescribed to the patient?
…………………………………………...
86
 …………………………………………...

2) After the administration of penicillin Answer:

angioedema appeared in the patient. Prescribe to …………………………………………...
the patient antiallergic preparation and specify
…………………………………………...
the route of administration.
…………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...
3) To the patient suffering from gout, was Answer:
prescribed preparation from group of …………………………………………...
pyrazolone, wich increased the excretion of uric
…………………………………………...
acid. Which drug was prescribed to the patient?
…………………………………………...
…………………………………………...
…………………………………………...

3. Choose correct answers:

1. Nonsteroidal anti-inflammatory drugs 2. Steroidal anti-inflammatory drugs

1. Prednisolone 1. Prednisolone
2. Celecoxib 2. Celecoxib
3. Diclofenac sodium 3. Ketotifen
4. Тriamcinolone 4. Тriamcinolone
5. Мeloxicam 5. Hydrocortisone
6. Indometacin 6. Dexamethasone
3. Nonsteroidal anti-inflammatory drugs – 4. Nonsteroidal anti-inflammatory drugs are
selective inhibitors of COX2 inhibitors of enzyme

1. Acetylsalicylic acid 1. Cyclooxygenase (COX)

2. Celecoxib 2. Phospholipase А2
3. Piroxicam 3. 3, 5-lipoxygenase
4. Diclofenac sodium 4. Hyaluronidase
5. Мeloxicam 5. Phosphodiesterase
5. NSAID prevent formation of 6. Steroidal anti-inflammatory drugs
prevent formation of

1. Arachidonic acid 1. Arachidonic acid

2. Postaglandins 2. Postaglandins
3. Leukotrienes 3. Leukotrienes
7. Nonsteroidal anti-inflammatory agents 8. Steroidal anti-inflammatory agents have
have effects effects

1. The anti-inflammatory 1. The anti-inflammatory

2. Antipyretic 2. Antipyretic
3. Immunosuppressant 3. Immunosuppressant
87
 4. Antiallergic 4. Antiallergic
5. Analgesic 5. Analgesic
9. Indications for use of nonsteroidal anti- 10. Indications for use of steroidal anti-
inflammatory drugs inflammatory drugs
1. A fever 1. A fever
2. The reactions of graft rejection 2. The reactions of graft rejection
3. Inflammatory diseases of the 3. Inflammatory diseases of the
musculoskeletal nature musculoskeletal nature
4. Eczema 4. Eczema
5. Bronchial asthma 5. Bronchial asthma
6. Autoimmune disease
11. Groups of drugs used in allergic reactions 12. Blockers of Н1-histamine receptors
of immediate type

1. Immunostimulants 1. Diphenhydramine
2. Blockers of Н1-histamine receptors 2. Celecoxib
3. Mast cell stabilizers 3. Diazolin
4. Glucocorticoids 4. Nedocromil
5. Immunosuppressants 5. Loratadine
6, Tavegil
13. Blockers of Н1-histamine receptors with 14. Mast cell stabilizers
minimal marked psyhosedative effect
1. Ketotifen
1. Fexofenadine 2. Cyclosporine
2. Loratadine 3. Intal
3. Diphenhydramine 4. Nedocromil
4. Nedocromil 5. Loratadine
5. Cetirizine 6. Celecoxib
6. Celecoxib
15. Immunostimulants 16. Immunosuppressants
1. Levamisole 1. Interferon
2. Interferon 2. Cyclosporine
3. Cyclosporine 3. Prodigiozan
4. Timalin 4. Azathioprine
5. Prednisolone 5. Т-activin
6. Аscorbic acid 6. Prednisolone

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Prednisolone
Acetylsalicylic acid
(Аспирин)

Acetaminophen (Paracetamol,
Panadol)

88
Diclofenac sodium (Voltaren,
Ortofen)
Celecoxib

Chloroquine (Delagil)

Diphenhydramine
(Dimedrolum)

Loratadine (Claritin, Loridin)

Epinephrine (Adrenaline
hydrochloride)
Phenylephrine (Mezaton)

Atropine

Salbutamol

Calcium chloride

Interferon

Methyluracil

Ascorbic acid
(vitamin С)
Retinoli acetas
(vitamin А)

Step-1 For computer tests

Typical license test tasks
1. A young woman was diagnosed atopic 2. For treatment of patient with allergic
dermatitis. She asked her doctor to dermatitis doctor prescribed prednisolon.
prescribe the drug, which does not What is the mechanism of antiallergic
interfere with driving her car. The action of this drug?
doctor prescribed the drug that belongs
to 2nd generation of antihistaminics. A Inhibition of COX
Point out this drug B Inhibition of phospholipase A2
C Stimulation of M1 –cholinoceptors
A Cromolin-sodium D Inhibition of H1 histamine receptors
B Diphenhydramine (Dimedrolum) E Inhibition of H2 histamine receptors
C Loratadine
D Famotidine
E Prednisolone

3. A patient suffering from polyarthritis was 4. Which an important advantage has

treated with antiinflammatory drug. After loratidine in comparison with astemizole?
3 weeks patient addressed doctor with A selective blocking Н1- receptors
complaints on abdominal pain. On B Long-term exposure
89
 examination ulceration of gastric mucous C Lack of sedation
membrane was revealed. In addition to D The rapid development of effect
this x-rays examination proved the E Easy penetration through the blood
existence of osteoporosis. Which of brain barrier
antiinflammatory drug was used?

A Cromolin-sodium
B Prednisolon
C Ketotifen
D Paracetamole
E Diclofenac-sodium
5. What preparation should be prescribed to 6. The treatment of patient with chronic
the patient to accelerate the regeneration rheumatoid arthritis with quick acting
of infected wounds? anti-inflammatory drugs was not
A Oxolinic ointment effective. Which drugs can be used in
B Indomethacin ointment such case?
C Yellow mercury ointment
D Hydrocortisone ointment A Cloroquine
E Methyluracyl ointment B Diclofenac-sodium
C Celecoxib
D Aspirin
E Paracetamol

7. A patient with continious 8. A patient suffering from rheumatism was

bronchopneumonia was admitted to the treated with prednisolone for two
therapeutic department. Antibiotic therapy months. After the abrupt discontinuation
didn't give much effect. What medication of the drug administration patient’s blood
for improvement of immune state should pressure dropped dramatically, there was
be added to the complex treatment of this a severe weakness, tachycardia,
patient? reappeared joint pain. Which condition
was developed in patient due to
A. Sulfocamphocaine prednisolone discontinuation?
B Dimedrolum
C Paracetamol A Orthostatic collapse
D Timaline B Withdrawal
E Analgin C Allergic reaction
D Anaphylactic shock
E Hyperglycemic coma.
9. Anaphylactic shock developed in patient 10. To the patient of 33 years old was
after administration of lidocaine. Which of diagnosed AIDS. Which drug should be
the following medications must choose a prescribed ib this case?
doctor to bring the patient out of shock?
A Ethoxide
B Sulfalen
A Acetylsalicylic acid C Cycloserine.
B Corticotropin D Ethionamide.
C Azathioprine E Zidovudine.
D Adrenaline
E Aminopyrine
11. A female patient consulted a doctor about 12. Immune stimulant of animal origin was

90
 pain and limited movements in the knee included in the complex treatment of
joints. Which of the following nonsteroid patients with severe bronchopneumonia.
anti-inflammatory drugs should be Which of these drugs belong to this
administered taking into consideration that group of drugs?
the patient has a history of chronic
gastroduodenitis? A Timalin
[Link]
A Celecoxib [Link]
B Diclofenac sodium [Link]
C Promedol [Link] nucleinat.
D Acetylsalicilic acid
E Butadiounum
13. A 45-year-old woman suffers from 14. Patient with allergic dermatitis addressed
seasonal allergic rhinitis caused by the doctor complaining of disturbances of
ambrosia blossoming. What medicine sleep. Point out the most beneficial drug
from the stabilizer of the adipose cells for this patient.
group can be used for prevention of this
disease?
A Diazoline A Astemizole
B Tavegyl B Diphenhydramine (Dimedrolum)
C Phencarol C Levamisol
D Dimedrol D Ketotifen
E Kromolin sodium E Cromolyn sodium
15. What pharmacological property of 16. Assign a drug that belongs to the group
dimedrolum (diphenhydramine) is used in of nonsteroidal anti-inflammatory agents
the hives treatment? affects predominantly COX-2 and has
no irritant effect on the mucous
membrane of the digestive tract.
A Interference with formation of the
antigen-antibody complex A Indomethacin
B Elimination of histamine action on the B Celecoxib.
cell* C Diclofenac sodium
C Sedative effect on the central nervous D Aspirin
system E Ibuprofen
D Violation of antibody synthesis
E Inhibition of biologically active
substances release by mast cell.
17. Determine a second generation 18. The 12-year-old child has intolerance of
antihistamine, a derivative of piperidine. some food stuffs. Their use causes an
Apply 1 time per day. Whithout allergic reaction in the form of itchy skin
anticholinergic and adrenoblocking effect. rash. What antihistamines should be
Has antiallergic, antiexudative, antipruritic appointed, not to interfere with school
effect. activities of the child (not cause
drowsiness)?

A Retinoli acetas A Loratadine

B Dimedrolum B Mezaton
C Diazolin C Diclofenac sodium
D Tavegil D Aminophylline
E Loratadine E Diphenhydramine

91
 19. Patient 32 years old to reduce the possible 20. A 28 years old woman with complains
negative impact on the gastric mucosa was of nasal congestion, lacrimation,
prescribed selective inhibitor COX2. Point dizziness, which occur during flowering
out this drug. poplar. What antihistamine agent should
be prescribed in this case?
A Celecoxib A Loratadine
B Аnalginum B Penicillinum
C Acetylsalicylic acid C Adrenaline
D Butadione D Metoprolol
E Ibuprofen E Bisacodyl

21. Patient of 32 years old with atopic 22. In patient 33 years old angioedema was
dermatitis during several weeks took an developed. Which drug for emergency
antiallergic drug, after which developed treatment must be entered to the patient?
severe drowsiness. Name drug. A Prednisolone
A Loratadine B Ascorbic acid
B Ibuprofen C Suprastinum
C Dimedrolum D Sulfacil sodium
D Adrenaline E Adrenaline
E Cromolin sodium

The theme of individual student’s work:

Immunostimulants

Date Student's name Teacher's signature

«____»_______ 201__г. ____________________________ _____________

92
 Unit V
Antimicrobial, antibiotics, antiviral, antifungal agents.
Тopic 10
Antiseptics and disinfectants

Lesson 13 Antiseptics and disinfectants

To know: preparations, their properties, doses and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationAlcoholic
solution of iodine (Sol. Iodi spirituosae)Amp. 5 % 1 ml;
10 ml, 15 ml and 25 ml in flasksDisinfecting of wounds and operative field

IoddicerinSol. 25 and 50 ml in flasksExternally in applications applied 2 – 3 times a day, 20 —

30 min. 5 – 15 ml

Chlorhexidine20% water sol. In flasks 500 ml

Externally – sol.
(flushing, soaking)
Hydrogen peroxydeOficinal 3% sol. In flasks 25 ml, 40 ml, 50 ml, 100 [Link]. Sol.
(flushing, soaking)

Ethyl alcochol
20% – 40% – 70% – 96% sol.
20 – 30 % [Link]. I.V. Potassium permanganate
Kalii permanganasPowder in flasks (3-5 g); 0,1% - 5% [Link]: externlly (flushing, soaking);
P.O. (flushing).Brilliamt Green (Sol. Viride nitentis spirituosae)1% and 2% sol spirituosae in
amp.
1 ml and flasks 10 ml and 20 mlExternally
Sol.
Aethonium
0,02% – 1% sol;
0,5% – 2 % oinment;
7 % pastaExternally. Sol., drops.
Furacilinumтаb. 0,1 for internal usage;
таb. 0,02 for solution; 0,2% oinmentP.O. 0,1 g. 3 times a day;
Sol., drops, oinment - externally
Unithiolum
5% sol in amp. 5 ml
I.M. or i.V. 5-10 ml (based on 0,05 g. Of the drug, or 1 ml of 5% sol. per 10 kg patient weight)

93
 Prescription № ______
Write the prescriptions: Prescription "______"_________________ 20____
г.
(adult, children – underline that’s necessary) (date)

______________________________________________________________________
__
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name
___________________________________________________________
1. Chlorhexidine. Patien's address and № of medical recard
______________________________________
Doctor's
name____________________________________________________________

Rp.: ……………………………..……….
………..
……………………….……………….
[Link] peroxide.
………..
……………………….…………….………..
………………………….…………….
………..
............…………………………..
3. Brilliant Green.
……………………..
Rp.: ....…………………..………….
………………..
…………………..
4. Ioddicerin. ……………………………..
…………………..……………………….
…….
........................…………………..
……………………………..
5. Aethonium. ........................…………………..
……………………………..
Rp.: ……………………………………..
Do the tasks:
1. Fill the table. The farmacological characteristics of the drugs
Preparations Indications for use Side effects
Zinci sulfas

Potassium permanganate

Ethacridine lactate

Miramistin

Salicylic acid

94
 Methylene blue

Hydrogen peroxide

Furacilinum

Alcoholic solution of iodine

2. Solve the situational tasks:

1) A group of students were traveling by Answer:
countryside collecting medicinal plants. It was a …………………………………………...
hot day and the students spent the entire drinking
…………………………………………...
water. The team leader offered the water of the
pond, using the pill for its disinfection. Name the …………………………………………...
drug, its group identity, and active component.
…………………………………………...
…………………………………………...
2) The patient appealed to the trawma center Answer:
with the festering cut wounds. Doctor washed it …………………………………………...
by 3% hydrogen peroxide solution to clean the
…………………………………………...
wounds of purulent discharge. In this case foam
is not formed. What is the cause the absence of …………………………………………...
the drug's effect?
…………………………………………...
…………………………………………...

3) For the treatment of burn skin of forearm Answer:

antiseptic solution was applied; this agent is also …………………………………………...
administrated parenterally in poisoning with
…………………………………………...
methemoglobin-forming agents – cyanides.
Point out the drug. …………………………………………...
…………………………………………...
…………………………………………...

3. Determine the drug

1. It is antiseptic of the halogen group used to 2. It is preparation of a group of dyes for the
handle the surgical field and the wound treatment of pyodermia.
edges.
A. Alcoholic solution of iodine A. Alcoholic solution of iodine
B. Cerigelum B. Cerigelum
C. Solution of brilliant green C. Solution of brilliant green
D. Aethonium D. Aethonium
E. Solution of potassium permanganate Е. Solution of potassium permanganate
3. Antiseptic agent of oxidizing group used 4. Preparation of nitrofurans used for throat
for washing festering wounds. gargling in tonsillitis.
A. Solution of hydrogen peroxide A. Solution of hydrogen peroxide
B. Solution furacilinum B. Solution furacilinum
C. Solution of silver nitrate C. Solution of silver nitrate
95
 D. Cerigelum D. Cerigelum

4. Choose the correct answer:

1. Halogenated compounds 2. Antiseptics agent of oxidizing group
1. Chlorhexidine 1. Brilliant green
2. Potassium permanganate 2. Ethacridine lactate
3. Chloramine B 3. Potassium permanganate
4. Alcoholic solution of iodine 4. Boric acid
5. Lugol's solution 5. Methilene blue
3. Agent that cause denaturation of proteins 4. Agent that blocks the SH-groups of the
of the bacterial cell enzyme systems of microorganisms
1. Potassium permanganate 1. Boric acid
2. Ethyl alcohol 2. Mercury dichloride
3. Chloramine B 3. Chlorhexidine
4. Mercury dichloride 4. Silver nitrate
5. Formaldehyde 5. Ethyl alcohol
6. Zinci sulfas
5. Drugs used to rinse the mouth and throat 6. Antiseptic drug used to handle the
in stomatitis and sore throat surgeon's hands

1. Chlorhexidine 1. The ammonia solution

2. Cerigelum 2. Cerigelum
3. Furacilin 3. Chlorhexidine
4. Solution of hydrogen peroxide 4. Silver nitrate
5. Chloramine B 5. Chloramine B
7. Drugs used for degerming of wounds, 8. Agents used for disinfection of premises
skin and mucous membranes and items of care are
1. Potassium permanganate 1. Solution of hydrogen peroxide
2. Alcoholic solution of iodine 2. Chlorhexidine
3. The ammonia solution 3. Carbolic acid (phenol)
4. Chloramine B 4. Chloramine B
5. Solution of hydrogen peroxide 5. Solution of formaldehyde

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Chlorhexidine

Hydrogen peroxide

Alcoholic solution of iodine

Ethyl alcohol

96
 Step-1 For computer tests
Typical license test tasks
1. A patient has purulent wound with 2. The patient was admitted to the
necrotic content. What medication should infectious disease clinic with complaints
be used to cleanse the wound? of vomiting, diarrhea, fever, after errors
in diet. What antiseptic should be used
for gastric lavage (washing out)?
A Chlorhexidine A Hydrogen peroxide
B Hydrogen peroxide B Potassium permanganate
C Alcohol solution of iodine C Methilene blue
D Potassium permanganate D Activated charcoal
E Sulfacyl sodium E Ethyl alcohol
3. After pneumonia the woman had irritating 4. Nitrofurane antiseptic was prescribed for
therapy with antiseptic solution. What mouth wash to patient with stomatitis.
antiseptic was used? Point out this agent

A Magnesium sulfate A Hexamethylen tetraminum

B Aethonium. B Aethonium
C Brilliant green C Furacilinum
D Alcohol solution of iodine D Boric acid
E Boric acid. E Aethacridini lactates
5. For disinfecting of metallic instruments in 6. To prevent pyodermia in 4-year-old girl
the surgical department the formaldehyde with chickenpox mother was
solution is used. What is the chemical recommended to apply a preparation of
group of this antiseptic preparation? a group of dyes. Point out this
preparation.
A Halogenated compounds A Chlorhexidine
B Aromatic substance B Alcoholic solution of iodine
C Detergents C Furacilinum
D Aliphatic agent D Brilliant Green
E Alcohols. E Chloramine.
7. Which drug has antimicrobial and 8. Name the drug from antiseptic group
antimycotic action, can be used externally that besides the antibacterial effect can
as an antiseptic, inside with urinary tract be used for treatment pediculosis?
infections, intravenously with nitrite A Iodopironum
poisoning and aniline: B Hydrogen peroxide
A Furacilinum C Boric acid
B Brilliant Green D Resorcinol
C Chloramine. E Mercury dichloride
D Methilene blue
E Aethacridini lactates
9. Patient of surgical department has purulent 10. The patient, the worker of chemical
wound with necrotic content. What industry was admitted to toxicological
preparation for cleansing wounds should department with mercury poisoning.
be used? Which drug should be used in this
situational?
A Hydrogen peroxide A Boric acid
B Furacilinum. B Deferoxamine

97
 C Sulfacyl sodium C Activated charcoal
D Alcohol solution of iodine D Unitiol
E Boric acid E Naloxone
11. In the patient with syphilis treated by, 12. For disinfecting of hand before
bismuth preparations gray patches on the operation surgeon used chlorine
mucous membrane of the mouth and containing antiseptic, that also widely
symptoms of kidney disturbances used in dentistry. Point out this agent.
appeared. Which agent is advisable for the
treatment of bismuth poisoning?
A Naloxone A Potassium permanganate
B Unitiol B Boric acid
C Methylene blue C Alcoholic solution of iodine
D Nalorphine D Chlorhexidine
E Bemegride. E Ethanol.
13. The preparation antiseptic properties of 14. Gastric lavage with a solution of
which are provided by free of oxygen potassium permanganate was performed
release in the presence of organic matter in patient due to food poisoning. Which
was used for treatment of burn skin? group of antiseptics does this drug
belong to?
A Furacilinum. A Aromatic substances.
B Potassium permanganate. B Halogens.
C Chlorhexidine. C Acid.
D Boric acid. D Oxidizing agents.
E Sodium bicarbonate. E Detergents.
15. Dentist handled herpetic lesions of 7 years 16. Teenager addressed dermatologist
old child with halogen antiseptic that has complaining of acne. Doctor prescribed
antimicrobial, antifungal and antiviral him an antiseptic agent that gradually
properties. Name the drug. releases oxygen and is traditionally used
locally for treatment of acne. Point out
prescribed drug.
A Alcohol solution of iodine A Hydrogen peroxide.
B Potassium permanganate. B Potassium permanganate.
C Formaldehyde. C Benzoyl peroxide.
D Silver nitrate. D Boric acid.
E Brilliant Green. E Methylenum coeruleum.

Individual independent work of students:

Farmacology of detergents.

Date Student's name Teacher's signature

«____»_______ 201__г.
____________________________ _____________

98
 Topic 11
Рharmacology of antibiotics

Lesson № 14 Pharmacology of β-lactam antibiotics

To know: properties of drugs, dose and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationBenzylpenicillin
sodium
Powder in vial 250000, 500000, 1000000 U.I/M by 500000-1000000 U each 4 hours, the
content of vial dissolve in 2 ml 0,5 % sol. of [Link]-5
Vial 1500000 U.I/M 1500000 U 1 time per 4 weeks, the content of vial dissolve in 2 ml 0,5 %
sol. of [Link]
Tab. 0,125; 0,25, 0,5; 0,75; 1,0
Caps. 0,25, 0,5.
Flask 60 ml with the powder for preparation of 2,5%, 5% and 8% suspension.P.O. adults by
0,5g–1,0g
3 times per day
children 0,125g–0,25g 3 times
per day,
before 2 years - 20mg/kg Amoxicillin /
Clavulanate

(Amoxiclav, Augmentin)
Tab. 0,375 (0,25+0,125), 0,625 (0,5+0,125) and
1,0 (0,875+0,125).
Syrup in vials with measuring spoon.
Dry substance for suspension per os and drops (children before 1 year).
Vials by 0,6 and 1,2 for [Link] and children older than 12 years: by 1-2 tab. 3 t/d,
Children less than 1 year: 0,75-1,25 ml in drops,
I/V not more than 30 mg/kg 1-2 t/d.
Children less than 12 years: by 2,5-5-10 ml. syrup/suspension 3 t/d.
I/V by 1, 2, 3-4 t/d. Carbenicillin
Vial by 1,0 for solution [Link]: I/V 4-8 g/day, I/V (streamly, by dripping) 20-30
g/day.
Children: I/M 50-100 mg/kg/day
I/V 250-400 mg/kg/day, 4-6 t/dayCeftriaxon
Vials 0,25, 0,5, 1,0.I/M or I/V by 1-2 g 1 t/day, the content of vial dissolve in 2-3,5 ml 0,5 %
sol. of lidocaine;
Children - 20-100 mg/kg per [Link]
Tab. 0,125, 0,5.
Caps. 0,25.
Vials by 0,1 and 0,2 g for preparation of 2% and 4% suspension and syrup.P.O., for the 1-st use
– 0,5 g, for next 2-5 days – by 0,25 g per day 1 hour or 2 hours before meal;
Children on 1-st day – 10 mg/kg, on last 4 days by 5 mg/kg per day.

99
Выписать в рецептах:
Write the prescriptions: Prescription № ______
Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________

1. Benzylpenicillin sodium
Rp.: ……………………………..……….………..
……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Ceftriaxon. Rp.: …………………..………….………………..
. …………………..……………………………..
…………………..……………………….…….
…………………..……………………………..
…………………..……………………………..

Do the tasks:
1. Fill in the table
Preparation Group Spectrum Characteristic side
effects
1. Bicillin-5

2. Amoxicillin / Clavulanate
(Amoxiclav, Augmentin)
3. Carbenicillin

4. Ceftriaxon.

5. Imipinem, Tienam,
Meropenem
6. Aztreonam
2. Fill in the table (See note). Comparatine characteristics of penicillins
Parameters of comparison Benzylpenicillin Bicillin-5 Oxacillin Ampicillin Carbenicillin
sodium
Predominantly
Gram-positive
The bacteria
spectrum
Wide
of the
action Effects on
Pseudomonas
aeruginosa
Resistance to penicillinase
100
 Routes of administration
(orally/parenterally)
Duration of action
Note: When completing the table, use the «+» symbol.
3. Fill in the table (See note). Comparative characteristics of cephalosporins.
Parameters of Cephalexin Cefuroxime Cefotaxime Ceftriaxone Cefepime
comparison
Generation
Routes of
administration
(orally/parenterally)
Effects on
Pseudomonas
aeruginosa
Nephrotoxic effects
Note: When completing the table, use the «+» symbol.
4. Choose the correct answers:
1. β-lactam antibiotics: 2. Long-acting biosynthetic penicillins:
1. Tienam 1. Benzylpenicillin sodium
2. Azithromycin 2. Аmpicillin
3. Aztreonam 3. Bicillin
4. Benzylpenicillin sodium 4. Benzylpenicillin procaine
5. Ceftriaxone 5. Amoxicillin
6. Doxycycline hydrochloride
3. Penicillinase resistant penicillins: 4. Peptidoglycan synthesis of the bacterial cell
wall breakers:
1. Аmpicillin 1. Penicillins
2. Benzylpenicillin sodium 2. Cephalosporins
3. Amoxicillin 3. Monobactams
4. Oxacillin 4. Carbapenems
5. Benzylpenicillin procaine 5. Macrolids, azalids

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Benzylpenicillin sodium
Amoxicillin / Clavulanate
(Amoxiclav, Augmentin)
Ceftriaxone

Step-1 For computer tests

Typical license test tasks
1. A 60-year-old patient was admitted to the 2. The patient of 42 years old for the
surgical department because of infection treatment of bacterial pneumonia was
caused by blue pus bacillus (Pseudomonas appointed ampicillin. Specify the
aeruginosa) which is sensitive to penicillin mechanism of bactericidal action of the
antibiotics. Indicate which of the given drug
penicillins has marked activity to the

101
 Pseudomonas aeruginosa?
A Methicillin A Inhibition of the synthesis of the cell
B Phenoxymethylpenicillin wall of the microorganism
C Carbenicillin disodium B Violation of the permeability of the
D Oxacillin cytoplasmic membrane
E Benzylpeniciilin. C Inhibition of SH - groups of
enzymes of microorganisms
D Inhibition of intracellular protein
synthesis
E Antagonism with paraaminobenzoic
acid.
3. A 6 year child was admitted to the 4. A patient diagnosed with purulent
hospital with diagnosis of candidiasis pleurisy caused by penicillin resistant
caused by Candida albicans, the mucous staphylococcus. What preparation of
membrane of cheeks, palate and tongue penicillin resistant to beta-lactamase
was cowered by fur of white and yellow may be used for the treatment of this
color. Which of the drugs can be used to patient?
treat the child?
A Gentamicin A Ampicillin
B Ketoconazole B Benzylpenicillin
C Tetracycline C Phenoxymethylpenicillin
D Cefran D Augmentin
E Penicillin. E Carbenicillin.
5. Patient with staphylococcal sepsis was 6. A 20 years old man with gonorrhea was
treated with benzylpenicillin. Therapy was treated with penicillin G in combination
ineffective. What preparation of penicillin with probenecid. His state was
group should be prescribed for the patient improved, but 1 week later the patient
to continue treatment? was still complaining of a persistent
urethral discharge and pain on urination.
Laboratory test reveals chlamidia in
discharge. Which of the listed drugs
effective both in gonorrhea and
chlamidial infection must be used for
further treatment
A Oxacillin A Amoxicillin
B Polymyxin B Doxycycline
C Erythromycin C Oxacillincin
D Phtalazol D Gentamycin
E Aztreonam. E Streptomycin.
7. Child of 5 years with a staphylococcus 8. Patient, with severe pneumonia was
infection was assigned penicillin antibiotic treated with the III generation
without testing pathogen susceptibility to cephalosporin. Doctor warned him about
drugs of this group. Which drug of the danger of alcohol usage while
penicillin group is resistant to beta- treatment. What the drug was used for
lactamase and effectively influences on the treatment of patient?
penicillin-resistant staphylococci?
A Carbenicillin A Carbenicilin
B Ampicillin B Cefotaxim
C Bicillin-5 C Cefalexin
D Phenoxymethylpenicillin D Gentamycin
E Oxacillin. E Doxycycline.
9. Patient with pneumonia, prone to use 10. Patient condition after long term
102
 alcohol, was treated with antibiotic of wide atimicrobial treatment was complicated
spectrum. On the third day of treatment by pseudomembranous enterocolitis. For
after alcohol usage severe antabus-like it treatment vancomycin was prescribed.
reaction occurs. What was the group of What is the mechanism of its
antibiotic used for treatment of patient? antimicrobial effect?
A Biosynthetic penicillin A Disturbances of structure and
B Aminoglycoside function of cell membrane
C 3rd generation cephalosporin B Inhibition of cell wall synthesis
D Penicilinse resistant penicillin C Inhibition of protein synthesis
E Tetracycline. D Inhibition of nucleic acid synthesis
E Inhibition of folic acid metabolism.
11. A 19 year old woman suffers from primary 12. Patient was admitted to the infection
syphilis. Doctor administered her complex unit with diagnosis of bacterial
therapy that includes benzylpenicillin dysentery. On laboratory studies it was
sodium salt. What is the mechanism of revealed that causative element is
action of this drug? sensitive to the many antimicrobial
medicines, but patient has anemia. What
antibiotic can be recommended for this
patient?
A It blocks RNA synthesis А Levomycetin
B It blocks synthesis of cytoplasm В Amoxicillin
proteins С Erythromycin
C It blocks thiol enzymes D Cotrimoxazol
D It blocks synthesis of peptidoglycan of Е Oxacillin.
microbal wall
E It blocks DNA synthesis
13. A patient with bacterial pneumonia was 14. Patient has primary syphilis. What is the
prescribed benzylpenicillin. What is the most effective antibiotic in this case?
mechanism of its antibacterial effect?
A Abnormal permeability of cytoplasmic A Penicillin
membrane B Nystatin
B Inhibition of intracellular protein C Amphotericin
synthesis D Streptomycin
C Inhibition of synthesis of microbial cell E Kanamycin.
wall
D Inhibition of SH-groups of
microorganism enzymes
E Antagonism with p-amino-benzoic acid.

Date Student's name Teacher's signature

«____»_______ 201__г.
____________________________ _____________

103
 Lesson № 15 Pharmacology of aminoglycosides, tetracyclines,
chloramphenicols, macrolides, rifampicins
antibiotics.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration

ClarithromycinTab. 0,25 and 0,5.
Vial 0,125-0,25 for suspension preparation.
Vial 0,5 for solution preparationP.O. 0,25-0,5 2 t/day
I/V by dripping (during 60 min.) by 0,5g 2 t/day.

Doxycycline hydrochloridCaps. 0,05; 0,1 and 0,2; tab.0,1 and 0,2;

Powder in amp. 0,1 and 0,2 g, 2% sol. for injections in vials by 5 ml.P.O., on 1-st day 0,2 g in 1
or 2 use. Next days –0,1 g per day after meal; I/V by dripping during 1-2 [Link]
sulfateVial powder 250 mg, 500 mgI/M, I/V (streamly or by dripping) in the dose 10 mg/kg 2–3
t/day.

Выписать в рецептах:

Write the prescriptions:

Prescription № ______
Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________

1. Amikacin sulfate Rp.: ……………………………..……….………..

……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..

Do the tasks:
1. Fill in the table

104
 Preparation Group Spectrum Characteristic side effects
1. Erythromycin,
     Clarithromycin
     Azithromycin
2. Telithromycin,
     Quinupristin,
     Virginiamycin
3. Clindamycin
4. Doxycycline
     hydrochloride
5. Laevomicetin
6. Gentamicin,
     Netilmicin,
     Amikacin
7. Vancomycin,
     Teicoplanin
8. Polymyxin B (M),
     Gramicidin
9. Fuzidin - sodium
10. Rifampicin

2. Fill in the table (See note).

Comparatine characteristics of antibiotics with the wide spectrum of action
Parameters of comparison Amikacin Doxycycline Laevomicetin
sulfate
Group of Tetracyclines
antibiotics Chloramphenicols
Aminoglycosides
Type of action Bacteriostatic
Bactericidal
Routs of Orally
administration Parenterally
Side effects 1. 1. 1.
2. 2.
3.
Note. When completing the heading, "Side Effects" letter indices using the following side effects:
А. Ototoxic and vestibulotoxic actions D. Violation of neuromuscular transmission
B. Violation of hematopoiesis E. Hepatotoxicity
C. Nephrotoxicity F. Violation of the skeleton

3. Determine the drug:

1. For the treatment of atypical pneumonia in a child……………………………………………
2. For the treatment of brucellosis………………………………………………………………..
3. The beta-lactam antibiotic for the treatment of meningitis…………………………………….
4. For the treatment of rickettsiosis……………………………………………………………….
5. For seasonal prophylaxis of rheumatic fever…………………………………………………..
6. For the treatment of Pseudomonas infections………………………………………………….
7. The drug of choice for treatment of syphilis……………………………………………………
4. Choose the correct answer:
1. Macrolides: 2. Aminoglycosides:
1. Erythromycin 1. Metacyclin
2. Clarithromycin 2. Amikacin
105
 3. Azithromycin 3. Gentamicin
4. Amoxicillin 4. Azithromycin
5. Doxycycline 5. Streptomycin
6. Laevomicetin
3. Tetracyclines: 4. Side effects of aminoglycosides:
1. Metacyclin 1. Violation of hematopoiesis
2. Amikacin 2. Ototoxic and vestibulotoxic action
3. Violation of neuromuscular
3. Gentamicin
transmission
4. Doxycycline 4. Hepatotoxicity
5. Tetracycline 5. Dysbacteriosis
5. Side effects of tetracyclines: 6. Side effects of levomicetin:
1. Violation of hematopoiesis 1. Violation of hematopoiesis
2. Ototoxic and vestibulotoxic action 2. Ototoxic and vestibulotoxic action
3. Violation of neuromuscular 3. Violation of neuromuscular
transmission transmission
4. Hepatotoxicity 4. Hepatotoxicity
5. Dysbacteriosis 5. Dysbacteriosis

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Azithromycin

Doxycycline hydrochloride

Laevomicetin

Rifampicin

Step-1 For computer tests

Typical license test tasks
1. In the patient, who has long used 2. A 50-year-old patient with typhoid fever
tetracycline, there was mucosal was treated with Levomycetin, next day
candidiasis. What medication should be his condition became worse, temperature
appointed to treat it? rose to 39,6°C. What caused the
complication?
A Nystatin A The effect of endotoxin agent
B Nizoral B Reinfection
C Griseofulvin C Secondary infection addition
D Furadonin D Irresponsiveness of an agent to the
E Nitrofungin levomycetin
. E Allergic reaction.
3. A patient suffers from severe postoperative 4. Car driver has got into accident and was
pseudomonadous infection. What of the admited to emergancy department.
following antibiotics should be Surgical invasion in abdominal cavity
administered in this case? was successfuly performed, but
106
 postoperative period was complicated by
A Erythromycin peritonitis. Bacterial analysis revealed
B Doxycycline Pseudomonas aeruginosa. For treatment
C Cephazolin of patient you may propose any
D Benzylpenicillin antibiotic leasted below with axception
E Amicacin sulfate. A Azlocillin
B Genamycine
C Cefotaxim
D Imipenem (Tienam)
E Tetracycline.
5. A 6-year boy was admitted to hospital with 6. Mother of 2 years old child addressed
pneumonia. Treatment with amoxycycline dentist with tooth abnormality in her
was not effective. Bacterial analysis child. On child examination the
revealed Micoplasma pneumoniae. Choose destruction of the incisors, yellow
the most suitable drug for treatment of this enamel, the brown rim on the necks of
child. the teeth ware revealed. Mother
informed doctor that she had infection
and used antibiotics. Which of the drugs
has a strong teratogenic effect,
disrupting the development of teeth?
A Tetracycline A Polymyxin
B Azithromycine B Erythromycin
C Bicillin 5 C Tetracycline
D Nystatin D Cefrenol
E Oxacillin. E Ampiox.
7. Patient with tuberculosis was on the 8. A 20 years old man with gonorrhea was
complex treatment including antibiotics. treated with penicillin G in combination
At the end of first course doctor noticed with probenecid. His state was
significant decrease in patient hearing. improved, but 1 week later the patient
Which of the following drugs can cause was still complaining of a persistent
such side effect? urethral discharge and pain on urination.
Laboratory test reveals chlamidia in
discharge. Which of the listed drugs
effective both in gonorrhea and
chlamidial infection must be used for
further treatment
A Isoniazid A Amoxicillin
B Rifampicin B Doxycycline
C Streptomycin C Oxacillincin
D Paraaminosalicylic acid D Gentamycin
E Pirazinamide . E Streptomycin.
9. Patient was admitted to the infection unit 10. Infectious patient is sensitized to
with diagnosis of bacterial dysentery. On benzylpenicillin. Which of the following
laboratory studies it was revealed that antibiotics would be the safest in this
causative element is sensitive to the many case?
antimicrobial medicines, but patient has
anemia. What medicine is contra-indicated
to the patient?
A Levomycetin A Amoxicillin
B Phthalazol B Ampicillin
C Enteroseptol C Erythromycin
D Furazolidone D Oxacillin
107
 E Ampicillin. E Bicillin 1.
11. A 6 year child was admitted to the 12. A patient with impaired hearing has
hospital with diagnosis of candidiasis severe bacillary infection. Which group
caused by Candida albicans, the mucous of antibiotics is contraindicated in this
membrane of cheeks, palate and tongue case?
was cowered by fur of white and yellow
color. Which of the drugs can be used to
treat the child?
A Gentamicin A Aminoglycosides
B Ketoconazole B Penicillins
C Tetracycline C Cephalosporins
D Cefran D Tetracyclines
E Penicillin. E Rifamycins.
13. A 5-year-old child has been diagnosed 14. Use of which broad-spectrum antibiotic
with acute right distal pneumonia. Sputum is contraindicated in liver disease?
inoculation revealed that the causative
agent is resistant to penicillin, but it is
senstive to macrolides. What drug should
be prescribed?
A Azithromycin A Polymyxin
B Tetracycline B Lincomycin
C Gentamycin C Tetracycline
D Streptomycin D Oxacillin
E Ampicillin. E Penicillin G.
15. A patient underwent appendectomy. In the 16. Why tetracycline is not recommended in
postoperative period he has been taking an pregnant women?
antibiotic. The patient complains about
hearing impairment and vestibular
disorders. What group of antibiotics has
such side-effects?
A Cephalosporins A Due to ototoxicity
B Penicillins B Due to the depressing effect on the
C Tetracyclines respiration of the fruit
D Macrolides C Due to the ability of the drug to
E Aminoglycosides. increase uterine tone
D Due to the teratogenic effect of the
drug
E Due to the ability to cause anemia in
pregnant.
17. A patient with gastric peptic ulcer was on 18. Antibiotic used for the treatment of
complex treatment that includes antibiotic typhoid fever is:
of macrolide group. Point out this
antibiotic.
A Clarithromycin A Oxacillin
B Tetracycline B Erythromycin
C Gentamycin C Cephalexin
D Streptomycin D Benzylpenicillin
E Ampicillin . E Levomicetin.

Date Student's name Teacher's signature

108
 «____»_______ 201__г.
____________________________ _____________

Topic 12
Sulfa drugs. Antimicrobial agents with different chemical structure.
Pharmacology of antitubercular, antiviral and antispirochetal agens.
Antimycotic drugs.

Lesson № 16 Sulfa drugs. Antimicrobial agens with different

chemical structure.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration Co-

trimoxazole, Bactrim, Biseptol-480, 120, 240, 960Tab. № 20P.O. 2 tab. 2 t/day after meal
CiprofloxacinTab. 0,25; 0,5; 0,75
amp. 10 ml 1% sol.
(for dissolving)
Sol. for infusion
0,2% - 50, 100 mlDosage and routes of administration depend on severity of the disease.
Indicate 2 times per day, 10-15 days.

Prescription № ______
Write the prescriptions: Prescription Prescription № ______
"______"_________________ 20____ г.
Prescription
(adult, children – underline that’s necessary) "______"_________________
(date)
20____
________________________________________________________________________
г.
Full price
(adult, free of
children – underline charge
that’s necessary) (date)
50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________
Patien's name ___________________________________________________________
_Patien's address and № of medical recard ______________________________________
Full price free of charge 50 % of price
Doctor's name____________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name __________________________________

Patien's address and № of medicinal card_________
Doctor's name______________________________________________

1. Co-trimoxazole Rp.: ……………………………..……….………..

……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Ciprofloxacin Rp.: …………………..………….………………..
…………………..
…………………..……………………………..
……………………………. ……………..
…………………..……………………….…….
……………………………………
…………………..……………………………..
………………………………………..…………
…………………..……………………………..

109
Do the tasks:

1. Fill in the table.

The mechanism of action of sulfonamides and synthetic antibacterial agens.
Preparations

The mechanisms of Sulfa- Bactrim Nitro- Nalidixic Ciprofloxacin Fura-

action dimezine xoline acid zolidone

Competitive antagonism
with PABA
Oppression
dehydropteroat
synthetase
Inhibition of
dihydrofolatereductase
The formation of the
compounds with metal
ions of enzyme systems
of microbial cells
The Inhibition of DNA
synthesis
Inhibition of DNA
gyrase
Violation of the activity
of NADPH in microbial
cells
Note: When completing the table, use the «+» symbol.
2. Solve situational problems:
1) In the surgical department addressed patient Answer:
with purulent wound shank, which began to be …………………………………………...
treated locally by powdering sulfonamide. Over
…………………………………………...
3 days of treatment there was no improvement.
In this regard, the doctor has changed the way of …………………………………………...
treatment: topical irrigation of hypertonic
…………………………………………...
solution of sodium chloride and sinthomycin
emulsion was scheduled, and P.O. - two times a …………………………………………...
day tablets of sulfadimethoxine that soon led to
…………………………………………...
the healing of wounds. What does account for
the different outcomes of local and resorptive
action of sulfonamides in this patient?
2) The patient with acute tonsillitis treated with Answer:
antimicrobial agent addressed doctor …………………………………………...
complaining of back pain, decrease in the daily
…………………………………………...
amount of urine. On examination doctor

110
revealed a positive Pasternatsky symptom and …………………………………………...
clinical analysis of urine showed the presence of
…………………………………………...
crystals. Identify the group of used drugs. What
is the reason of a complication? What are the …………………………………………...
measures to prevent it?
…………………………………………...
3. Determine the drug:
1. Combined drug for the treatment of 2. For the treatment of urinary tract
infectious diseases of the genitourinary infections used:
system, upper respiratory tract, lungs:
A. Ftalazol A. Ftalazol
B. Ciprofloxacin B. Ciprofloxacin
C. Co-trimoxazole C. Co-trimoxazole
D. Nitroxoline D. Nitroxoline
E. Furazolidone E. Furazolidone
3. For treatment of meningococcal sepsis: 4. For the treatment of gonorrhea:
A. Ftalazol A. Ftalazol
B. Ciprofloxacin B. Ciprofloxacin
C. Co-trimoxazole C. Co-trimoxazole
D. Nitroxoline D. Nitroxoline
E. Furazolidone E. Furazolidone
5. Synthetic antibacterials with the wide 6. Synthetic antibacterial sulfa agent with
spectrum. They are antagonists of PABA bactericidal action. Violates the exchange
and inhibitors of dehydropteroatsyntheta- of folic acid. Causes skin and allergic
se. Indicate in toxopolasmosis, bacterial reactions, disorders of the blood system,
conjunctivitis, infections of the intestine, crystalluria.
respiratory and urinary tract infections.
Cause crystalluria, disorders of the blood
system. A. Trimethoprim
A. Fluoroquinolones B. Biseptol
B. Nitrofurans C. Sulfadimetoxine
C. Sulfonamides D. Sulfalen
D. Oxazolidone E. Sulfadimezin
7. Violates organism’s DNA replication.
Active against protozoal and certain
normal body bacteria. Indicated in
protozoal infections (amebiasis,
trichomoniasis, giardiasis), peritonitis,
eradication of H. pylori in peptic ulcer
disease. Side effects: nausea, vomiting,
metal taste in the oral cavity, blood
system disorders, teturam-like reaction
while drinking alcohol.
A. Furazolidone
B. Metronidazole
C. Ciprofloxacin
D. Biseptol
E. Nitroxoline

111
 To give a pharmacological characteristics
for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Ciprofloxacin

Typical license test tasks Step-1 for computer tests

1. A 7 year old child is ill with bronchitis. It 2. Patient with pneumonia has intolerance
is necessary to administer him an to antibiotics. Which of the combined
antibacterial drug. What drug of sulfanilamide medicines should be
fluoroquinolone group is CONTRA- prescribed to the patient?
INDICATED at this age?

A. Cyprofloxacin A. Sulfacyl sodium

B. Sulfadimethoxine B. Aethazol
C. Ampiox C. Biseptol
D. Ampicillin D. Streptocid
E. Amoxicillin. E. Sulfadimethoxine.
3. A patient consulted a stomatologist about 4. A patient with pneumonia had a
purulent inflammation of his gums. What complex treatment that included
drug will be the most effective if it is sulfonamide preparation. What should
suspected that a causative agent is an doctor recommend to prevent
anaerobe? cristaluria?

A. Co-trimoxazole A. Decrease the dose of sulfonamide

B. Gentamicin B. Drinking of alkaline solution
C. Oxacillin sodium C. Administration of drugs before
D. Metronidazole meal
E. Nitroxoline . D. Drinking of acidic solution
E. Use of vitamins.
5. Gonorrhoea was revealed in the patient on 6. Patient with pneumonia has intolerance
bacterioscopy of the smear from urethra. to antibiotics. Which of the combined
Taking into account that medicines for sulfanilamide medicine should be
gonorrhea are fluorquinolones, patient prescribed to the patient?
should be prescribed:
A. Ciprofloxacin A. Trimethoprim
B. Furazolidone B. Aethazol
C. Fluorouracil C. Natrium sulfacyl
D. Urosulfan D. Streptocid
E. Cefazoline. E. Biseptol.
7. A 30-year-old patient complains about 8. What is the mechanism of antimicrobial
having abdominal pain and diarrhea for 5 effect of sulfonamide?
days body temperature rise up to 37,5o C
along with chills. The day before patient A. Inhibition of protein synthesis
had been in forest and drunk from open B. Inhibition of bacterial cell wall
water reservoir. Laboratory analysis synthesis
enabled to make the diagnosis of amebic C. Competitive antagonism with
112
 dysentery. What is the drug of choice for para-aminobensoic acid
its treatment? D. Inhibition of cell membrane
A. Phthalazol synthesis
B. Furazolidonum E. Inhibition of nucleic acid
C. Emetine hydrochloride synthesis.
D. Metronidazole
E. Levomycetin.
9. Combined sulfonamide preparation with 10. A HIV patient has bacterial dysentery.
bactericidal effect was prescribed for On the result of antimicrobial sensitivity
treatment of sore throat in 13 years old test doctor prescribed him cotrimoxazol
child. Point out this drug. (bactrim,biseptol). What type of
antibacterial action has this drug?
A. Biseptol A. Virostatic
B. Eneroceptol B. Bacteriostatic
C. Sulfalen C. Fungicidal
D. Aethasolum D. Fungistatic
E. Urosulfanum. E. Bactericidal.
11. A Bactrim was prescribed for 35-years old 12. For treatment of typhoid fever
patient with bronchitis. What is the ciprofloxacin was prescribed. What is
mechanism of action of this drug? mechanism of this drug action?

A. Sequential block of two stages of A. Inhibition of bacterial cell wall

bacterial folate metabolism synthesis
B. Inhibition of bacterial cell wall B. Inhibition of DNA gyrase
synthesis
C. Inhibition of protein synthesis C. Inhibition of protein synthesis
D. Inhibition of cell membrane synthesis D. Competitive antagonism with
paraaminobenzoic acid
E. Inhibition of nucleic acid synthesis. E. Inhibition of nucleic acid
synthesis.
13. Due to which side effect ciprofloxacin is 14. A doctor prescribed sulfonamide drug to
contraindicated in children? patient with acute bronchitis. After
urinalyses he changed it for antibiotic of
penicillin group. The possibility of
which side effect of sulfonamide was
the base for changing it by other drug?
A. Hepatotoxicity A. Mental confusion
B. Glucosuria B. Hyperglycemia
C. Cartilage damage C. Allergic reaction
D. Nausea D. Crystalurea
E. Insomnia. E. Glucosurea.

The theme of individual student’s work:

Pharmacology of sulfa drugs.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

113
 Lesson № 17 Antitubercular, antispirochete drugs.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration IsoniazidTab.

0,1 и 0,3.
1 tab. 1-2 t/dayRifampicinCaps. 0,15. 1 caps. 1-2 t/day 30-60 min before
mealPyrazinamideTab. 0,25 and 0,5.1 tab. 1-2 t/dayAmikacin sulfateVial, powder
250 mg, 500 mg.I/M, I/V (streamly or by dripping) in the dose 10 mg/kg 2–3 t/day.

Write the prescriptions:

Prescription № ______
Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________

1. Amikacin sulfate Rp.: ……………………………..……….………..

……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Isoniazid
Rp.: …………………..…………………………….
………………………………………….……...
…………………………………………………
…………………………………………………
…………………………………………………

Do the tasks:

1. Fill in the table.

Comparative characteristics of some anti-TB drugs
Comparative parameters Preparations

Isoniazid Rifampicin Amikacin Ethambutol

Tuberculocidal or
tuberculostatic action

114
 The mechanism of action
The spectrum of action
The route of administration
(I/M, P.O.)
Typical side effects
Note: When filling out the heading "mechanism of action" letter indices using the following mechanisms:
A. Inhibition of bacterial RNA synthesis. B. Violate synthesis of mycolic acids of the cell wall of mycobacteria.
C. Inhibition of bacterial protein [Link] filling out the heading "Specific side effects" letter indices of the
following effects: A. Hearing loss, vestibular disorders. B. Violation of the liver. C. Neuritis. D. Mental disorders. E.
Violation of view. F. Dysbacteriosis.

2. Solve situational problems:

1) A patient diagnosed with focal tuberculosis of Answer:
the upper lobe of the right lung in a combination …………………………………………...
therapy received isoniazid. After some time, the
…………………………………………...
patient complained of muscle weakness,
decreased skin sensitivity, impaired vision and …………………………………………...
coordination.
…………………………………………...
What is a vitamin preparation is advisable to
apply for the removal of these phenomena? …………………………………………...
…………………………………………...
2) Patient 60 years with tuberculosis Answer:
systematically have been receiving specific …………………………………………...
treatment, decreased hearing acuity. What a drug
…………………………………………...
should be excluded from this set of prescribed
therapy? …………………………………………...
…………………………………………...
…………………………………………...

3. Determine the drug:

1. Optic neuritis, memory impairment, 2. What antibiotic can cause redness of
convulsions appeared in women after urine, sputum and mucous fluid?
treatment with highly effective anti-TB
drugs. What a drug have taken patient?
A. Rifampicin A. Gentamicin
B. PASA B. Amikacin
C. Isoniazid C. Rifampicin
D. Canamycin D. Erythromycin
3. Synthetic anti-TB drug acts selectively
on the mycobacterium tuberculosis.
Violates the synthesis of mycolic acid in
the cell wall. The applying of drug may
cause peripheral neuritis, and psychotic
reactions:
A. Pyrazinamide
B. Rifampicin
C. Isoniazid
D. Ethambutol

115
4. Choose the correct answer:
1. As anti-TB drugs used: 2. Used in syphilis
1. Streptomycin 1. Benzylpenicillin sodium
2. Doxycycline 2. Azithromycin
3. Rifampicin 3. Biseptol
4. Isoniazid 4. Doxycycline
5. Ciprofloxacin 5. Ceftriaxone
6. Pyrazinamide

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Isoniazid

Rifampicin

Typical license test tasks

STEP-1 for computer tests

1. A 35-year-old man under the treatment for 2. A patient was diagnosed with active
pulmonary tuberculosis has acute-onset of focal pulmonary tuberculosis. What
right big toe pain, swelling, and low-grade drug should be prescribed in the first
fever. The gouty arthritis was diagnosed place?
and high serum uric acid level was found.
Which of the following antituberculosis
drugs are known for causing high uric acid
levels?
A. Rifampicin A. Ethionamide
B. Aminosalicylic acid B. Isoniazid
C. Thiacetazone C. Ethoxide
D. Pyrazinamide D. Sulfalen
E. Cycloserine. E. Cyclocerine.
3. A patient suffers from pulmonary 4. Patient suffering from tuberculosis was
tuberculosis. During treatment neuritis of treated with isoniazid. In the course of
visual nerve occurred. What drug has treatment peripheral neuritis was
caused this side effect? developed. What is the mechanism of
this side effect?
A. Isoniazid A. Direct toxic effect of drug on
B. Ethambutol peripheral nerves
C. Kanamycin B. Inhibition of myoneural junctions
D. Rifampicin C. Interference with pyridoxine
E. Streptomycin. metabolism
D. Interference with folic acid
synthesis
E. Inhibition of sodium channels.
5. Patient with tuberculosis was on the 6. One of the problems in the treatment of
complex treatment including antibiotics. tuberculosis is caused by existence of
116
 At the end of first course doctor noticed metabolically dormant forms of
significant decrease in patient hearing. mycobacterium (persister). Which of
Which of the following drugs can cause the drugs is effective against all
such side effect? subpopulations of Mycobacteria
tuberculosis and causes sterilizing
effect?
A. Isoniazid A. Streptomycin
B. Rifampicin B. Isoniazid
C. Streptomycin C. Kanamycin
D. Paraaminosalicylic acid D. Rifampicin
E. Pirazinamide . E. Paraaminosalicylic acid.
7. The patient suffering from tuberculosis 8 A patient with lung tuberculosis is
was treated with combination of treated with a drug that has a wide
antituberculous drugs, including isoniazid. antimicrobial spectrum; mycobacteria
Which drug should be added to prevent of tuberculosis are highly sensitive to it.
neurological side effects of isoniazid? Its effect is realized by depression of
bacterial RNA synthesis. Drug is
staining body liquids (urine, sputum,
tears) in red color. What the drug is
used?
A. Streptomycin A. Streptomycin
B. PASA B. Isoniazid
C. Rifampicin C. Ethambutol
D. Pyridoxine D. Rifampicin
E. Ascorbic acid. E. Paraaminosalicylic acid.
9. Treatment of tuberculosis is realized by 10. The patient went to a doctor
means of combination chemotherapy, complaining of red staining of urine and
including agents with different tear. From his case history it is known
mechanisms of action. Which of the that he is treated on pulmonary
antituberculosis drugs inhibit the tuberculosis. Which of anti-TB drugs is
transcription of DNA into RNA of responsible for this phenomenon?
mycobacteria?
A. Rifampicin A. Isoniazid
B. Isoniazid B. Ethionamide
C. Streptomycin C. Ethambutol
D. Ethionamide D. Rifampicin
E. PASA. E. Streptomycin.
11. How do you explain the fact that the in 12. TB patient after prolonged treatment
treatment of tuberculosis with isoniazid with effective anti-TB drug called
dose is adjusted individually, with attention to breast enlargement. On this
mandatory measurement of its occasion he went to a doctor, who
concentration in the urine after the first confirmed gynecomastia. Identify the
drug? drug, which he used.

A. Genetically determined differences A. Cycloserine

in rate of drug acetylating B. Ethambutol
B. Occurrence of hyperglycemia as a C. Isoniazid
side effect D. Rifampicin
C. The development of renal failure E. Streptomycin sulfate.
D. Irritant action of the drug
E. Development of hemolytic anemia.

117
 13. As a result of prolonged use of broad 14. A 20 years old patient with primary
spectrum antibiotics intestinal syphilis is receiving combined therapy,
candidamycosis was developed. What which includes the sodium salt of
should be prescribed to treat it? benzylpenicillin. What is the
mechanism of action of this drug?
A. Interferon A. Blockade of DNA synthesis
B. Remantadin B. RNA synthesis blockade
C. Itraconazole C. Blockade of the SH- groups of
D. Rifampicin enzymes
E. Gramicidin. D. Blockade of the synthesis murein
of cell wall of microorganisms
E. Blockade of protein synthesis in
cytoplasm.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

118
 Lesson № 18 Antiviral, antifungal drugs.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration Laferon

Vial 100000 U; 1000000 U;
5000000 U.I/M 1000000 U - 1 t/dayAcyclovir
Tab. 0,2;
Eye ointment 3%;
Cream 5% - 5,0.P.O. 0,2 – 5,0
1 t/day
Lay behind the eyelid or ointment applied to the damaged area 5 times a [Link]
Caps. 0,1.P.O. 0,2 g - 2 t/dayAzidothymidineCaps. 0,1 and 0,25
Vial 2% -20 ml.
P.O. 0,2 g - 6 t/day.
I/V 1-2 mg/kg - 6 t/day.

Write the prescriptions: Prescription № ______

Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________

1. Laferon Rp.: ……………………………..……….………..

……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
Rp.: …………………..…………………………….
……………..…………………………………
2. Acyclovir
………………………………………..………
………………………………………….……..
1. To combine: ………………………………………………
Preparation Mechanisms of action
1. Rimantadine А. Inhibits neuraminidase
2. Oseltamivir B. Inhibits viral DNA polymerase
3. Acyclovir C. Inhibits HIV reverse transcriptase
4. Azidothymidine D. Inhibits HIV protease
5. Saquinavir E. Inhibits viral M2 protein

119
Answer: 1.___2.___3.___4.___5.____.
2. Fill in the table (see note).
Comparative characteristics of antifungal agents
Comparison parameters amphotericin nystatin terbinafine ketoconazole fluconazole

Dermatomycoses
(trichophytosis)

Systemic
mycosis
Indications
(cryptococcosis)
Superficial
candidiasis
Systemic
candidiasis
Intravenously
Route of
administration Orally
Locally
Side effects Nephrotoxicity
Neurotoxicity
Hepatotoxicity
Gynecomastia
Note: When completing the table, use the "+" symbol.
3. Determine the drug:
1. Antiviral agent from the adamantane 2. Which of the following drugs is most
group for influenza prevention. expedient to appoint a child for instillation
into the nasal passages to prevent a flu?
A. Acyclovir A. Remantadine
B. Zidovudine B. Interferon
C. Rimantadine C. Acyclovir
D. Cycloferon D. Midantan
3. Antifungal agent, a triazole derivative,
which is effective in oftalmomycozis:
A. Nystatin
B. Levorine
C. Itraconazole
D. Fluconazole
4. Choose the correct answers:
1. Antiviral agents used in a flu: 2. Antiviral agents used in herpes:
1. Acyclovir 1. Acyclovir
2. Zidovudine 2. Zidovudine
3. Oseltamivir 3. Oseltamivir
4. Arbidol 4. Arbidol
5. Rimantadine 5. Rimantadine
3. Antiviral agents used in HIV infection: 4. Antifungal antibiotics:
1. Acyclovir 1. Rifampicin
2. Zidovudine 2. Amphotericin B
3. Oseltamivir 3. Griseofulvin
4. Arbidol 4. Nystatin
5. Rimantadine 5. Rimantadine

120
 To give a pharmacological characteristics
for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Fluconazole

Acyclovir
(Zovirax, Gerpevir)
Interferon

Typical license test tasks Step-1 for computer tests

1. A patient has herpetic rash. What 2. Point out the antiviral agent used in
medication should be administered? influenza.
A. Acyclovir A. Oseltamivir.
B. Gentamycin B. Streptomycine
C. Clotrimazole C. Gentamycin
D. Benzylpenicillin sodium salt D. Clotrimazole
E. Biseptol. E. Pyridoxine.
3. As a result of prolonged use of broad 4. A patient with a diagnosis of AIDS was
spectrum antibiotics intestinal admitted to the infectious disease
candidamycosis was developed. What hospital. To improve the immune status
should be prescribed to treat it? of patient, stabilizing body weight and
improwement of his condition, antiviral
agent - an antagonist of thymidine,
which blocks the DNA polymerase of
HIV was prescribed. Select the
designated agent.
A. Interferon A. Azidothymidine
B. Remantadin B. Acyclovir
C. Itraconazole C. Interferon
D. Rifampicin D. Rimantadine
E. Gramicidin. E. Midantan.
5. Patients with herpes doctor prescribed an 6. A patient addressed doctor with
antiviral drug, which the main complaints on the damage of skin
mechanism of action is inhibition of viral between the fingers of foot, exudation
DNA polymerase, and the ability to be and itching. Doctor prescribed paste
integrated instead of deoxyguanosine into containing antifungal agent of wide
viral DNA. Name the drug. spectrum. Point out this drug
A. Interferon A. Nystatin
B. Azidothymidine B. Clotrimazole
C. Acyclovir C. Streptomycin
D. Midantan D. Co-trimoxazol
E. Ethambutol. E. Levorin.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________

_____________
121
 Unit VI
Antiparasitic agents.
Topic 13
Antiprotosoals drugs. Antimalarial and antihelminthics agents.

Lesson № 19 Anti protozoals drugs. Antimalarials and

antihelminthic agents.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration

Chloroquine (Chingamin)Tab. 0,1; 0,15; 0,25; sol. 4,5,6%.P.O. 0,25 1-2 t/day;
I/M, I/V 10-20 [Link]. 0,25;
vial 0,5% -100 ml, vaginal suppositories 0,125; 0,25; 0,5 g.P.O. 0,25 – 2 t/day during 7-10 days;
I/V 100 ml – 0,5% sol. slowly during 20-30 min. (repeat each 8 hours);
Intravaginally 0,25 g - 2 t/day or 0,5 g - 1 t/day during 10 [Link]
Tab. 0,1; 0,5; susp. per os 20 mg/ml; sir. 0,1 g/ml.P.O. in ascaridosis and entherobiosis 2.5
mg/kg per day for 3 days;
strongyloidiasis and trichuriasis at the same dose for 3-5 days;
trichinosis at 0.3-0.6 per day (3 doses) during 10-14 days;
ehinococcosis at 0.5-2 per day for the first 3 days and three times per day for the next 3 days,
later by 25-30 mg/kg per day (3-4 times).

Write the prescriptions: Prescription № ______

Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Rp.: ……………………………..……….
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

………..
Patien's address and № of medical recard ______________________________________
……………………….……………….
Doctor's name____________________________________________________________
1. Chingamin Rp.: ………..
……………………………..……….………..
………………………….…………….
……………………….……………….………..
………..
………………………….…………….………..
………………………….…………….
………………………….…………….………..
2. Metronidazole
………..
…………………………..……………………..
............…………………………..
Rp.: …………………..…………………………….
……………………..
……………..……………………………………
122 ……………..……………………………………
Rp.: ……………………………………..
………………………………………..…………
………………………………………….……...
Do the tasks:
1. Fill in the table (see note).
Pharmacological characteristics of drugs
Preparations Indications Side effects
Quinine

Chingamin

Chloridin

Mebendazole

Piperazine adipate

Levamisole

Metronidazole

Primaquine

2. Fill in the table (see note).

Medicines that are used in:
Intestinal nematodoses Intestinal cestodosis Extraintestinal helminthiasis

3. Fill in the table (see note).

Agents acting on the various stages of the malarial plasmodium development
Drugs that affect the schizogony (shizontotropic) Drugs affecting
Preparations sporogonia
Histoscizontotropic Hematoscizontotropic (gamontotropic)
Quinine
Chingamin
Chloridin
Primaquine
Note: When completing the table, use the "+" symbol.

4. Fill in the table (see note).

Indications for antimalarial agents
Indications Chloroquine Quinine Pyrimethamine Primaquine
Treatment
123
 Individual
prevention
Prevention of
relapse
Social prevention
Note: When completing the table, use the "+" symbol.

5. Fill in the table (see note).

Comparative characteristics of anthelminthics agents
Comparative parameters Mebendaz Pyrantel Piperazine Levamisol Praziquante
ole e l
Mechanis Paralysis of the
ms of neuromuscular
action system of
helminths
The destruction
of covering tissue
of helminths
Violation of
helminths energy
processes
Applicati Ascariasis
on Enterobiasis
Teniarinchiasis
Trichuriasis
Hookworm
disease
Note: When completing the table, use the "+" symbol.
6. Solve situational tasks:
1) Patient with malaria assigned a drug that is Answer:
available in 0.1 yellow tablets. Patient taking this …………………………………………...
drug: 1 tablet 3 times a day for 4 days, but the
…………………………………………...
malaria attacks did not stop. The preparation has
been replaced with another antimalarial agent …………………………………………...
also as 0.009 yellow tablets. However, the patient
…………………………………………...
felt even worse: there were nausea, headache,
cyanosis of the lips and nails, fever, urine …………………………………………...
acquired a reddish tint. What drugs were assigned
…………………………………………...
to the patient? What accounts for this
phenomenon? Make the correction in the …………………………………………...
treatment.
…………………………………………...
…………………………………………...
2) Before going abroad in a country with a high Answer:
incidence of malaria, it was proposed for …………………………………………...
specialists who travel to use as prevention an
…………………………………………...
antimalarial agent. What preparations must be
applied for the purpose of personal prevention of …………………………………………...
malaria? Give reasons for their preventive action.
…………………………………………...
…………………………………………...

124
3) At a reception at female consultation, woman Answer:
27 years with a 4-week pregnancy with …………………………………………...
complaints that her first pregnancy ended in
…………………………………………...
stillbirth, the second - miscarriage. What a
protozoan infection can lead to marked effects of …………………………………………...
pregnancy? What is the preventive drug of this
…………………………………………...
disease?
…………………………………………...

7. Determine the drug:

1 Few days ago patient was in the wood, where 2. In the patient’s feces found eggs of
. he had drinking water from open sources. ascarids. Which of the following drugs
Bacteriologically confirmed diagnosis: you have to assign:
amoebic dysentery. Specify the drug for the
treatment.
A. Furazolidone A. Nystatin
B. Metronidazole B. Chloramphenicol
C. Chloramphenicol C. Piperazine adipate
D. Ftalazol D. Tetracycline
E. Emetine hydrochloride Е. Furazolidone
3 A healthy man stays at risk for malaria area. 4. In intestinal cestodiasis apply:
. What preparation is necessary in order to
assign for personal chemoprophylaxis of
malaria:
A. Chloridin A. Mebendazole
B. Sulfalen B. Levamisole
C. Tetracycline C. Pyrantel
D. Metronidazole D. Piperazine
Е. Enteroseptol Е. Praziquantel

8. Choose the correct answer:

1. Antimalarials: 2. Pre-erythrocytic forms of malaria
parasites suppress:
1. Chloroquine 1. Sulfalen
2. Primaquine 2. Pyrimethamine
3. Metronidazole 3. Primaquine
4. Pyrimethamine 4. Quinine
5. Quinine 5. Chloroquine
3. Erythrocytic forms of malaria parasites 4. Paraerythrocytic forms of malaria
suppress: parasites suppress:
1. Sulfalen 1. Sulfalen
2. Pyrimethamine 2. Pyrimethamine
3. Primaquine 3. Primaquine
4. Quinine 4. Quinine
5. Chloroquine 5. Chloroquine
5. Used to treat malaria: 6. For individual prevention of malaria
apply:
1. Sulfalen 1. Sulfalen
2. Pyrimethamine 2. Pyrimethamine
3. Primaquine 3. Primaquine

125
 4. Quinine 4. Quinine
5. Chloroquine 5. Chloroquine
7. To prevent a recurrence of malaria apply: 8. For social prevention of malaria apply:
1. Sulfalen 1. Sulfalen
2. Pyrimethamine 2. Pyrimethamine
3. Primaquine 3. Primaquine
4. Quinine 4. Quinine
5. Chloroquine 5. Chloroquine
9. In intestinal amebiasis apply: 10. In extraintestinal amebiasis apply:
1. Metronidazole 1. Metronidazole
2. Chiniofon 2. Chiniofon
3. Chloroquine 3. Chloroquine
4. Emetine 4. Emetine
5. Doxycycline 5. Doxycycline
11. In giardiasis used: 12. In trichomoniasis used:
1. Metronidazole 1. Metronidazole
2. Quinacrine 2. Quinacrine
3. Pyrimethamine 3. Pyrimethamine
4. Sulfalen 4. Sulfalen
5. Furazolidone 5. Furazolidone
13. In toxoplasmosis apply: 14. In cutaneous leishmaniasis are used:
1. Metronidazole 1. Sodium stibogluconate
2. Thinidazole 2. Metronidazole
3. Pyrimethamine 3. Quinacrine
4. Sulfalen 4. Sulfalen
5. Furazolidone 5. Furazolidone
15. In visceral leishmaniasis used: 16. In intestinal nematodes used:
1. Metronidazole 1. Mebendazole
2. Quinacrin акрихин 2. Levamisole
3. Sulfalen 3. Pyrantel
4. Sodium stibogluconate 4. Piperazine
5. Praziquantel

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Mebendazole (Vermox)

Chloroquine (Chingamin)

Metronidazole (Trikhopol)

126
Typical license test tasks
Step-1 for computer tests

1. To prevent of 4-day malaria a 42-year-old 2. A 52-year-old patient has the following

patient was prescribed primaquine. On the diagnosis: systemic amebiasis with
3-rd day from the begin of treatment there involvement of intestines, liver, lungs.
appeared stomach and heart pains, What drug should be prescribed?
dyspepsia, general cyanosis,
hemoglobinuria. What is the cause of side
effects of the preparation?
Drug potentiation by other A. Enteroseptol
A. preparations B. Tetracycline
B. Cumulation of the preparation C. Quiniofone
C. Delayed urinary excretion of the D. Quingamine
preparation E. Metronidasol.
D. Decreased activity of microsomal
liver enzymes
E. Genetic insufficiency of glucose 6-
phosphate dehydrogenase.
3. A patient consulted a doctor about bowels 4. A patient consulted a stomatologist
disfunction. The doctor established about purulent inflammation of his
symptoms of duodenitis and enteritis. gums. What drug will be the most
Laboratory examination helped to make effective if it is suspected that a
the following diagnosis: lambliosis. What causative agent is an anaerobe?
medication should be administered?
A Tetracycline A Oxacillin sodium
B Monomycin B Gentamicin
C Metronidazole C Nitroxoline
D Erythromycin D Co-trimoxazole
E Chingamin. E Metronidazole.
5. A patient ill with amebiasis was 6. Before the doctor’s business trip to
prescribed a certain drug. The use of foreign country he was proposed
alcohol together with this drug is contra- histoschizontocidal antimalarial drug for
indicated because the drug inhibits the personal prevention of malaria.
metabolism of ethyl alcohol. What drug is Which drug has got a specialist?
it?
A Clonidine A Mefloquine
B Metronidazole B Chloroquine
C Reserpine C Quinine
D Diazepam D Doxycycline
E Aminazine. E Primaquine.
7. The patient with lovered immunity was 8. The patient addresed her gynecologist
examined concerning helminthiasis. complaining of heavy vaginal discharge
Laboratory studies have found ascariasis. with an unpleasant odor. After the
Which drug should be prescribed? smears bacterioscopy trichomoniasis
was diagnosed. What the drug is
indicated in this case?
A Niclosamide A Sulfadimezin
B Piperazine B Chloroquine
127
 C Furazolidone C Pyrimethamine
D Gentamicin D Metronidazole
E Levamisole. E Monomecinum.
9. The patient has a mixed helminthic 10. The drug has a devastating effect on the
invasion: intestinal ascariasis and liver erythrocytic forms of malaria parasites,
trematodes. What anthelminthic drugis the dysenteric amoeba. It is used to treat and
most advisable for the treatment of this prevent malaria, the treatment of
patient? amoebiasis and connective tissue
diseases. Identify the drug.
A Mebendazole A Emetine hydrochloride
B Pyrantel B. B Chloroquine
C Chloxylum C Tetracycline
D Piperazine adipate D Erythromycin
E Levamisole. E Quinine.
11. The patient addressed doctor complaining 12. Antiprotozoal agent of wide spectrum
of epigastric discomfort, nausea, loss of was included in complex treatment of
appetite. The study of duodenal content patient with gastric peptic ulcer. Doctor
revealed Giardia resistant to warned patient about prohibition of
metronidazole. Which drug should be alcohol usage during treatment with this
appointed? drug. What the drug was used?
A Rifampicin A Chloramphenicol
B Chloroquine B Metronidazole
C Metronidazole C Cotrimoxazole
D Isoniazid D Chloroquine
E Acyclovir . E Praziquantel.
13. Patient suffering from severe malaria 14. Point out the drug of first choice for
caused by plasmodium falciparum treatment of patient suffering from kala-
resistant to chloroquine was treated with azar (visceral leishmaniasis)
the oldest antimalarial drug, obtained from
the bark of cinchona tree. Point out this
drug.
A Primaquine A Nystatin.
B Proguanil B Metronidazole
C Pyrimethamine C Sodium stibogluconate
D Quinine D Tetracycline
E Emetine. E Pyrimethamine
15. For treatment of neck phlegmon caused by 16. The drug with histoschizontocydal and
anaerobic infection antimicrobial drug of gametocydal action was used for causal
imidasole group was included. Point out prophylaxis of malaria. Point out this
this drug drug.

A Norfloxacin A Metronidasole
B Clindamycin B Primaquine
C Metronidazole C Chloroquine
D Tetracycline D Tetracycline
E Ampicillin. E Emetine hydrochloride .

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

128
 Unit VII
Antiсancer drugs. Radioprotectors. Preparations of acids,
alkalis and salts of alkaline earth metals. Principles of
treatment of acute poisoning.

Topic 14
Pharmacology of anticancer drugs. Radioprotectors. Preparations of
acids, alkalis and salts of alkaline earth metals. Glucose. Principles of
treatment of acute poisoning.

Lesson № 20 Anticancer drugs. Radioprotectors.

Preparations of acids, alkalis and salts of earth
alkaline metals.

To know: properties of drugs, dose and dosage forms.

Name of preparationDosage formsRoutes and regimens of administrationSodium

bicarbonateAmp. 3 and 5% sol. 20-50 ml.I/VSodium chlorideAmp. 0,9% by 5; 10; 20 ml.
Amp. 10% -10 ml.
Vial 10% - 400 ml.S/C, I/M, I/V.
Intravenously and locally,
Intravenously by [Link] chlorideTab. 1,0;
Amp. 4% - 20 mlP/O.
I/[Link]
(Asparcam)Tab;
Dragee;
Amp. 10 mlP/O 1-2 tab. (dragee) 3 t/day.
I/V 20-30 ml isotonic sol. of NaCl or glucose in 500 ml for intravenous [Link]
sulfatePowder;
Amp. 25%
by 5-10-20 mlP/O by 15-30,0 in ½ glass of water.
I/[Link] chlorideAmp. 10%
by 5 and 10 mlI/V.
Calcium gluconateTab. 0,5 g;
amp. 10% sol.
by 10 mlP/O, 1-1,5 hours after meal or 1-3 g before meal 2-3 t/day;
I/M, I/V slowly or by dripping – 5-10 ml.

129
Write the prescriptions: Prescription № ______
Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________

1. Isotonic sol. of Sodium

chloride
Rp.: ……………………………..……….………..
……………………….……………….………..
………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Calcium chloride.
Rp.: …………………..………….………………..
…………………..……………………………..
…………………..……………………….…….
…………………..……………………………..
3. Calcium gluconate. …………………..……………………………..
Rp.: ……………………………………..…………
………………………………………….……...
…………………………………………………
…………………………………………………
4. Sodium bicarbonate. Rp.: …………………..………….………………..
…………………..……………………………..
…………………..……………………….…….
…………………..……………………………..
…………………..……………………………..
5. Magnesia sulfate.
…………………………………………………
Rp.: …………………..………….………………..
…………………..……………………………..
…………………..……………………….…….
…………………..……………………………..
…………………..……………………………..

Do the tasks:
1. Specify the group of anticancer agents with the following mechanisms:
The mechanism of For what group (s) of drugs is characteristic
action
Antimitotic
Antihormonal
Antimetabolite

130
2. Fill in the table. Concentration (%) of osmotically active substances
Preparation Isotonic Hypertonic
Sodium chloride
Sodium bicarbonate
Potassium chloride
Calcium chloride
Glucose

3. Solve situational tasks:

1) During medical examination of patient with Answer:
the esophagus tumor in the history of blood was …………………………………………...
leukocytes 4 ∙ 109 / l and platelets 180 ∙ 109 / l.
…………………………………………...
Subsequent blood tests carried out in the course
of sarcolysine chemotherapy revealed a gradual …………………………………………...
decrease in the number of these blood cells.
…………………………………………...
Could it have been appointed sarcolysine? When
it should be canceled? What can be done to …………………………………………...
restore the cellular composition of the blood?
…………………………………………...
2) Patients with hyperacid gastritis during Answer:
heartburn takes sodium carbonate, which has a …………………………………………...
short antacid effect.
…………………………………………...
What is the reason for the short action of sodium
carbonate? What adverse effects are possible …………………………………………...
with its use? What preparation in this case is
…………………………………………...
more effective and less dangerous?
…………………………………………...
…………………………………………...

4. Determine the drug:

1. Antifolate, inhibit dehydrofolate reductase 2. Identify a group of substances and
and DNA synthesis and cause the cytotoxic indicate preparations: widely used in
effect. Excreted by the kidneys in prostate cancer by suppressing the
unchanged form, is used in acute leukosis, production of natural male sex hormones.
especially in children, and in combination Side effects: nausea, vomiting, itching,
therapy of cancer. Administered hemorrhage, feminization.
intravenously, is available in vials in the
2.5-5% solution form:
A. Mielosan A. Antiestrogens
B. Fluorouracil B. Antigestagens
C. Vincristine C. Antiandrogens
D. Methotrexate D. Anabolic steroid
3. Specify an intracellular ion, slows heart 4. The enzyme is effective in tumor
rate, an antagonist of calcium ions and diseases:
cardiac glycosides. It is indicated for use of
diuretics.
A. Sodium A. L-asparginaze
B. Potassium B. Flutamide
C. Calcium C. Tamoxifen
D. Magnesium D. Fosfestrol
131
 Е. Chlorine E. Pancreatin

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Indications
Calcium chloride
Sodium valproate
Magnesia sulfate
Sodium bicarbonate

Typical license test tasks Step-1 for computer tests

1. A patient who was previously ill with 2. In order to accelerate healing of a

mastectomy as a result of breast cancer radiation ulcer a vitamin drug was
was prescribed radiation therapy. What administered. What drug is it?
vitamin preparation has marked
radioprotective action caused by
antioxidant activity?
A. Ergocalciferol A. Methyluracil
B. Tocopherol acetate B. Retinol acetate
C. Thiamine chloride C. Levamisole
D. Ribof1avin D. Prednisolone
E. Folic acid. E. Retabolil.
3. An oncological patient was prescribed Patient after surgery for breast cancer
methotrexate. With the lapse of time chemotherapy with antiestrogen agent
target cells of the tumour lost was prescribed. Which of the following
susceptibility to this drug. There is change drugs belongs to antiestrogen with
of gene expression of the folowing anticancer activity?
enzyme:

A. Thiaminase A. Tamoxifen
B. Deaminase B. Cyclophosphamide
C. Dehydrofolate reductase C. Chlorbutin
D. Folate decarboxylase D. Cisplatin
E. Folate oxidase. E. Fosfestrol.
5. What is the basic mechanism of 6. In the intensive care unit a child was
anticancer action of ethyleneimine enrolled with pronounced signs of
derivative? acidosis, to relieve his condition
immediate drip of infusion was started.
Which of the following drugs should be
used in acidosis?
A. Alkylation of RNA and DNA of A. Potassium Chloride
tumor cells B. Sodium Chloride
B. Inhibition of cell division in C. Sodium bicarbonate
metaphase D. Glucose

132
 C. Formation of stable complexes with E. Magnesium sulfate.
DNA of tumor cells
D. Competitive inhibition of nucleic
E. Cytorecptors blockade on the cell
membrane.
7. Patient suffering from cancer of skin is 8. Radio protector was given to a worker of
treated with anticancer antibiotic. Point a nuclear power station. What
out this drug mechanism is considered to be
responsible for radioprotection?
A. Neomycin A. Increasing of respiration
B. Danazol B. Inhibiton of free radicals formation
C. Mercaptopurine C. Activation of oxidation reactions
D. Phtoruracil D. Prevention of tissue's hypoxia
E. Bleomycin. E. Increasing of tissue blood supply.
9. Patient suffering from acute leucosis was 10. Patient with gastric cancer is treated
treated with agent that is competitive with drug that interferes with synthesis
antagonist of folic acid. Point out this of nucleic acids due to its resemblance
agent with pirimidine. Point out this drug
A. Phtoruracil A. Mercaptopurine
B. Methotrexate B. Methotrexate
C. Mercaptopurine C. Phluorouracil (Phtoruracil)
D. Phtorafur D. Neomycin
E. Cytarabine. E. Bleomycin.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

133
 Lesson № 21 Principles of treatment of acute poisoning.
Antidotes.

To know: properties of drugs, dose and dosage forms.

Name of preparation Dosage forms Routes and regimens of administration UnithiolAmp.
sol. 5% - 5 ml.S/C, I/M, I/V 1 ml 5% sol. by each 10 kg of patient’s [Link] calciumAmp.
10% - 10 and 20 ml.10 or 20 ml I/[Link] sulfate
Powder20,0-30,0 in ¼ glass of [Link] – 0,04% sol., amp. 1 ml, 2 ml sol. for
injection 400 mcg/1 ml.I/V slowly (during 2–3 min), I/M or S/C 0,4-2 [Link]
Powder0,5% water sol. for gastric [Link]. 0,075 (lyophilized powder) with a 1
ml solvent.1 ml I/[Link]
Amp. sol. 1% -2 ml.
Tab. 0,04 g.1-2 ml I/[Link] charcoalPowder
Tab. 0,25 and 0,5 g.20,0-30,0 P/O as a suspension in [Link] Powder;
Tab. 0,0005;
Amp. 0,1% - 1 ml;
Eye drops 1%;
Eye ointment 1%.P/O 0,0005-0,001 g
S/C, I/M, I/V 0,00025-0,0005 g (0,25-0,5 ml); 1-2 drops 0.5-1% solution in conjunctive sac 1-2
times a [Link]
Tab. 0,015,
Amp. 0,05% 1 mlP/O 0.015 g 2-3 times a day, 1-2 drops in conjunctive sac 2-4 times a day in the
form of 0.05% solution; 0.0005 S/C (1 ml) 1-2 times a day.

Write the prescriptions:

Prescription № ______
Prescription "______"_________________ 20____ г.
(adult, children – underline that’s necessary) (date)

________________________________________________________________________
Full price free of charge 50 % of price
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Patien's name ___________________________________________________________

Patien's address and № of medical recard ______________________________________
Doctor's name____________________________________________________________
1. Unithiol
Rp.: ……………………………..……….………..
……………………….……………….………..
134 ………………………….…………….………..
………………………….…………….………..
…………………………..……………………..
2. Tetacin. Rp.: ……………………………..……….
………..
……………………….……………….
………..
………………………….…………….
………..
3. Activated charcoal. ………………………….…………….
………..
............…………………………..
……………………..
4. Magnesia sulfate. Rp.: ....…………………..………….
………………..
…………………..
……………………………..
…………………..……………………….
5. Furosemide. …….
........................…………………..
……………………………..
........................…………………..
……………………………..
6. Tannin.
Rp.: ……………………………………..
…………
………………………………………….
……...
......................................................
7. Atropine sulfate.
………………………………………………
…
......................................................
………………………………………………
…
8. Alloxim. ......................................................
………………………………………………
…
Rp.: ……………………………………..
…………
9. Neostigmine. ………………………………………….
……...
......................................................
………………………………………………
…
10. Naloxone.
......................................................
……………………………………………… 135
…
......................................................
Do the tasks:

1. Solve situational problems:

1) During thiopental intravenous narcosis Answer:
cardiac arrhythmia and respiratory failure …………………………………………...
appeared in patient. What analeptic drug have to
…………………………………………...
choose for non-inhalation anesthetic overdose
prevention (barbituric acid derivatives)? …………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...
2) In methyl alcohol poisoning, together with Answer:
common methods of providing emergency …………………………………………...
assistance (gastric lavage, activated charcoal,
…………………………………………...
emetics, laxatives, diuretics), administered
ethanol. What is the base of ethanol reduces …………………………………………...
toxic activity of methanol?
…………………………………………...
…………………………………………....
3) Patient with myocardial infarction getting Answer:
intensive heparin therapy for the prevention of …………………………………………...
thrombosis, which complicated with a
…………………………………………...
hemorrhage and hematuria. What mean this
symptoms and how they can be canceled? …………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...
4) During the lungs surgery, which was Answer:
conducted with the use of tubocurarine and …………………………………………...
artificial respiration it is appeared apnea.
…………………………………………...
What the drug can recover breath in this case?
…………………………………………...
…………………………………………...
…………………………………………...
…………………………………………...

136
5) In the hospital delivered a child with Answer:
abdominal pain, vomiting, shortness of breath. …………………………………………...
OBJECTIVE: pupils contracted, bradycardia,
…………………………………………...
wheezing. From the survey was find that
children were playing with antiinsect spray …………………………………………...
balloons.
…………………………………………...
What group is the substance that caused the
poisoning? What is the emergency drug in this …………………………………………...
case?
…………………………………………...
6) A child during the game swallowed the seeds Answer:
of unknown plants. After some time, it is …………………………………………...
appeared agitation, disorientation, meaningless
…………………………………………...
phrases, playing with nonexistent toy.
OBJECTIVE: hyperemia of "gaping pupil", …………………………………………...
tachycardia, increased blood pressure, fever,
…………………………………………...
swollen belly, but painless.
What is the plant and what the substances …………………………………………...
contained in this plant caused the poisoning?
…………………………………………...
What additional symptoms can confirm the
diagnosis? Emergency measures.
7) Patient delivered in a hospital in the comatose Answer:
state. In objective examination, the doctor noted …………………………………………...
cyanosis of the skin and mucous membranes,
…………………………………………...
pale face, cold limbs, sharply narrowed pupils
not reacting to light, Cheyne-Stokes breathing, …………………………………………...
muffled heart sounds, pulse 50 beats per minute,
…………………………………………...
B/P 100/40 mm Hg. Skin and tendon reflexes
saved. …………………………………………...
What caused the coma? Specify the diagnostic
…………………………………………...
features. What are the measures of assistance?
8) To facilitate the reduction of the shoulder Answer:
joint dislocation in order to relax skeletal …………………………………………...
muscles administered myorelaxants. At the same
…………………………………………...
time appeared apnea, after 1 minute breathing is
not restored. It have been injected Neostigmine, …………………………………………...
but breathing is not restored.
…………………………………………...
What is a muscle relaxant was used? Why
neostigmine administration is not contributed to …………………………………………...
the restoration of breathing? What are the
…………………………………………...
measures of assistance?

2. Determine the drug as a specific antidote:

1. In mercuric chloride poisoning: 2. In phosorganic substances poisoning:
A. Naloxone A. Unithiol
B. Unithiol B. Dipyroxim
C. Atropine C. Methylene blue
3. In case of direct anticoagulants overdose: 4. In hypoglycemic coma:
A. Atropine A. Insulin
B. Alloxim B. Unithiol
C. Protamine sulfate C. Glucose
137
 5. In belladonna poisoning: 6. In tramadol poisoning:
A. Atropine A. Fentanyl
B. Neostigmine B. Nalorphine
C. Aceclidine C. Naloxone

To give a pharmacological characteristics

for the basic drugs from the practical lesson topic,
that are included in the typical license test tasks
STEP-1
Preparation Pharmacological group Preparation
Atropine sulfate

Unithiol

Naloxone hydrochloride

Neostigmine (Proserine)

Furosemide

Menadione (Vikasol)

Protamine sulfate

Ethyl alcohol

Typical license test tasks Step-1 for computer tests

1. A patient with acute poisoning was 2. Choose the most beneficial agent for
admitted to emergency department. It was stomach wash in patient poisoned with
established that poisonous substance was alkaloid
excreted by kidney. Choose the best
diuretic for forced diuresis.
A. Acetazolamide A. Physiological solution
B. Amiloride B. Chlorhexidine
C. Spironolactone C. Sodium bicarbonate
D. Furosemide D. Potassium permanganate
E. Hydrochlorothiazide. E. 5% solution of glucose.
3. Point out the antidote used in poisoning 4. A patient in comatose state was admitted to
with salts of heavy metals emergency department. His respiration was
abnormal (Cheyn-Stoke’s respiration).
Poisoning with opioid analgesic was
diagnosed. After intravenous
administration of antidote respiration was
restored. What agent was used as antidote?
138
 A. Penicillamine A. Pralidoxime
B. Unithiolum B. Naloxone
C. Acetylcysteine C. Ethanol
D. Magnesium sulfate D. Acetazolamide
E. Atropine. E. Unithiolum.

5. A patient with myocardium infarction was 6. A patient working at a chemical plant was
treated with heparin. On 6th day of admitted to the toxicological department
treatment nasal bleeding occurred. with mercury poisoning. What medicine
Overdose of heparin was diagnosed. Point should be used?
out the antidote of heparin

A. Acetylcysteine A. Isonitrozin
B. Protamine sulfate B. Naloxone
C. Magnesium sulfate C. Enterosorbent
D. Unithiolum D. Unithiol
E. Deferoxamine. E. Activated carbon.

Date Student’s name Teacher’s signature

«____»_______ 201__. ____________________________ _____________

139
 The list of basic drugs
for the total control - 2
Drugs affecting the function of the cardiovascular system
Epinephrine (adrenaline Nitroglycerine Nifedipine
hydrochloride) Clonidine Panangin (Asparkam)
Amiodarone (Cordarone) Corglycone Papaverine hydrochloride
Amlodipine Caffeine-sodium benzoate Prazosin
Propranolol (Anaprilin) Lidocaine hydrochloride Reserpine
Verapamil Lisinopril Strophanthin
Dgoxin Lovastatin Sustak forte
Dobutamine Atorvastatin Talinolol (Kordanum)
Isosorbide mononitrate Fenofibrate Tocopherol acetate
Potassium chloride Magnesium sulfate Eufillin
Ascorbic acid Phenylephrine (Mezaton) Losartan
Metoprolol
Drugs affecting renal function
Allopurinol Hydrochlorothiazide Furosemide
Spironolactone
Uterine drugs
Magnesium sulfate Oxytocin Tocopherol acetate
Drugs affecting the function of the respiratory system
Epinephrine Izadrin Morphine hydrochloride
(adrenaline hydrochloride) Caffeine-sodium benzoate Prednisolone
Atropine sulfate Loratadine Salbutamol
Ambroxol (Lasolvan) Lobeline hydrochloride Furosemide
Drugs affecting the function of the digestive system
Almagelum Magnesium sulfate Neostigmine (Neostigmine)
Bisacodyl Metoclopramide Omeprazole (Omez)
Aprotinin (Contrycal) Metronidazole Famotidine
Pancreatin Loperamide hydrochloride
Drugs affecting blood system
Menadione (Vikasol) Calcium chloride Metyluracil
Heparin Aminocaproic acid Protamine sulfate
Glucose Acetylsalicylic acid Streptokinase
Iron ferrous sulfate Neodikumarin (pelentan) Cyanocobalamin (B12)
Deferoxamine (Desferal) Warfarin Hydrogen peroxide
Vitamin agents
Menadione (Vikasol) Retinol acetate Cyanocobalamin
Ascorbic acid Thiamine chloride Ergocalciferol
Pyridoxine hydrochloride Tocopherol acetate
Hormonal drugs
Glibenclamide Oxytocin L-thyroxine
Insulin Prednisolone

140
 Antiallergic and anti-inflammatory drugs, immunomodulators
Diclofenac sodium Ketotifen Prednisolone
(Voltaren, Ortofen) Acetylsalicylic acid Thymalin
Diphenhydramine Loratadine Interferon
(Dimedrol) Acetaminophen (Paracetamol) Metyluracil
Indomethacin Celecoxib
Calcium chloride
Antiseptics and disinfectants medications
Chlorhexidine Iodine solution Ethyl alcohol
Hydrogen peroxide
Antibiotics
Azithromycin Amikacin Levomycetin
Benzylpenicillin sodium salt Doxycycline hydrochloride Metatsiklin
Amoxicillin / clavulanate Carbenicillin disodium Rifampicin
(Amoxiclav, Augmentin) Clarithromycin
Lincomycin hydrochloride
Synthetic chemotherapeutic drugs
Ciprofloxacin
Antituberculosis, antiviral, anti spirochetal, antimycotic agents
Benzylpenicillin sodium salt Azidothymidine Isoniazid
Fluconazole Pyrazinamide
Acyclovir (Zovirax, Gerpevir) Rifampicin
Antiparasitic drugs:
antiprotozoal and anthelmintics
Mebendazole Primaquine Chloridin (Pirametamin)
Metronidazole Chingamin (Plaquenil)

Anticancer agents
Methotrexate
Preparations of acid, alkalis and salts
Glucose Magnesium sulfate Sodium bicarbonate
Potassium permanganate Sodium bromide Sodium chloride
Potassium chloride Panangin
Calcium chloride
Antidotes
Atropine sulfate Neostigmine (Neostigmine) Unithiol
Dipiroxim Protamine sulfate Furosemide
Naloxone hydrochloride Menadione (Vikasol) Ethyl alcohol
(Naloxone) Deferoxamine (Desferal)

141
 List of drugs
 that are included in the license tests STEP-1
Azithromycin Magnesium sulfate
Ambroxol (Lasolvan) Mebendazole (Vermoxum)
Amiodarone (Cordarone) Menadione (Vikasol)
Amitriptyline Methyluracil
Amlodipine Metoprolol
Aprotinin (Contrycal) Metronidazole (trykhopol)
Articaine hydrochloride + Epinephrine (Ultrakain) Morphine hydrochloride
Atorvastatin Naloxone hydrochloride (Naloxone)
Atropine sulfate Sodium valproate
Acetaminophen (Paracetamol) Neostigmine (proserine)
Acyclovir (Zovirax, Gerpevir) Nitrazepam
Benzilpenitsilina sodium salt Nitroglycerine
Bisacodyl Oxytocin
Warfarin Omeprazole (omez)
Heparin Pancreatin
Hydrochlorothiazide Hydrogen peroxide
Glibenclamide Pilocarpine hydrochloride
Digoxin Piracetam
Diclofenac sodium (Voltaren, Ortofen) Pyridoxine hydrochloride
Diphenhydramine hydrochloride (Dimedrol) Prednisolone
Diazepam Propranolol (anaprilin)
Dobutamine Retinol acetate
Doxycycline hydrochloride Rifampicin
Droperidol Salbutamol
Isoniazid Ethyl alcohol
Insulin Spironolactone
Interferon Suxamethonium iodide (Ditilin)
Iodine solution Trimeperidine (promedol)
Calcium chloride Unithiol
Ketamine hydrochloride (Ketamine) Famotidine
Ascorbic acid Phenylephrine (mezaton)
Acetylsalicylic acid Fentanyl
Corglycone Fluconazole
Caffeine-sodium benzoate Furosemide
Levodopa Chlorpromazine (chlorpromazine)
Levotrixin sodium (L-thyroxine) Chingamin (plaquenil)

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Lidocaine hydrochloride Chlorhexidine
Lisinopril Celecoxib
Lincomycin hydrochloride Ciprofloxacin
Losartan Cyanocobalamin
Loperamide hydrochloride Epinephrine (adrenaline hydrochloride)
Loratadine

Учебное издание

Для студентов медицинских факультетов

Составители: Ермоленко Тамара Ивановна

Карнаух Элла Владимировна
Александрова Алина Вячеславовна
Гордийчук Дарья Александровна

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