MODULE 3 PRACTICE OF PHARMACY

DRUG CATEGORIES
NITROFURANS
Metronidazole, Nitrofurantoin
Nitrofurazone, Furazolidone
Metronidazole Flagyl -- nitimidazon der.

• Anti-infective (anti ____________and

protozoal Anti____________)
bacterial

Indications:
• Trichomoniasis-nTrichomonas Vaginalis
• Amoebiasis (NOT Ascariasis) Entamoeba histolytica
• Giardiasis Beaver Fever (Giardia lamblia
• Pseudomembranous colitis (caused by Clostridium difficile, an anaerobe)
Metabolites: A
• ________________
Nitroso

• Nitroxide
________________ inhibit DNA synthesis

• ________________
Hydroxylamine
Nitrofurazone burn infections
Nitrofurantoin Furazolidone-anti diarrheal
Urinary anti-infective or urinary ______________ antiseptic

ANTI-HYPERTENSIVE AGENTS BP CO = x PVR

Propranolol B-BBLOCKS
striction =
It inotropy : contraction
astm

1) chonotropy : heart rate

* C = BP -

• Non-selective beta blocker Beta

Biol
,
Selective B BLOCKCK
•
:

May aggravate ____________

Asthma give selective B Blockers
instead)

Metoprolol
Irbesartan -highest bioavailability ir Bestsartan Nebivolo Angiotensin I

•
⑧ACE

Angiotensin II receptor blocker Angiotensin - Angiotensint- vasodilation ↑BP

:

# = #

Vasoconstriction -
PPVR
=
↑CO :
↑BP

• Does not cause ___________ dry cough (alternative to ACE-inhibitors) ACEE-n vasodilating effect

• Bioavailability: ___________
60-80 %
& Budykinin-Kinin E

Bradykinin
•
↑

Others:
Losartan 33 %

Candesartan 15 %

Olmesartan 26 %

Sodium Nitroprusside
mins)
• Potent vasodilator
(in 2
- rapid onset of action

HTN urgency
% : ↑
18
120

• D DOC: Hypertensive ____________

CriSiS emergency organ
damage HIN :

• A ROA: Injectable IV infusion

-

• * Caution: drug is light sensitive (in amber colored)brown

side

Acetazolamide
• Carbonic anhydrase inhibitor diuretic - BV +C = BP
=

• Also used to treat _____________

glaucoma lip) (decrease aqueous humor production)
Mannitol
• Osmotic diuretic ↓ Co ↓ BV / BP = =

edema
pulmononary
• cerebral edema : Furosemide
Used in ____________
Spironolactone Aldactone & Amiloride
• K-sparing diuretic Spironolactone
pleninone Triamterene

• May cause _______________

hypokalemia (especially when taken with ACE-inhibitors)
 tombolytic to dissolve not

ANTI-THROMBOTIC -
D reduce Formation
clot

• Prevents clot formation

Platelet aggregation inhibitors ①
_____________
aspirin-acetylsalicylic acid

ADP receptor antagonist ① _____________

Clopidogrel Plavix &
-

Ticlopidine
Glycoprotein Platelet Inhibitors Abciximab, Eptifibatide, Tirofiban
Protease-activated receptor 1 antagonists Vorapaxar, Atopaxar

Nucleoside transport inhibitor Dipyridamole

&

PDE-3 inhibitor Cilostazol Pletaale

-

THROMBOLYTICS
• Dissolves blood clots
• Tissue Plasminogen Activators (TPA’s)
•
&
_______plase Actilyse Activate Plasminogen-plasmin
A
-

dissolves not
• _______plase
• _______plase
Tenect

• Streptokinase and Urokinase -naturally derived enzymes

PROTEASE INHIBITORS - HIV Reverse transcription

L anti retrovirals DA Helper
• _________navir
RitO
RNA
no
icels/CD y
"help" no
calls

antibodies
RAINS navir
=

• _________navir
Ampre

• _________navir
Indi

• _________navir
NelFi + Pl

• _________navir
Saqui + nNRTI
transcriptaseInn)
CocktailOF NRT1 inuclease revere
• Indication: retroviral infection

(+) INOTROPIC AGENTS Force contraction) Contractility - ; chronotropy-heart rate

Isoproterenol (_________________®)
Isuprel dromotropy-conduction
velocity
• Beta 1 and 2 agonist used asthma-has many SE
can be for

• Increases cardiac contractility: (+) Inotropy dose dependent -

• Increases heart rate: (+) chronotropy

• Increases conduction velocity: (+) dromotropy
• Indications: cardiac arrest and asthma
Digoxin (_________________®)
lanoxin Digitalis Ianata dromotropy
= Cardiac contraction ; 1) chronotropy &
• _________-_________
sodium Na K potassium ATPase pump inhibitor ⑧ NapCa

• Increases cardiac contractility: (+) Inotropy

• Indication: heart failure
narcotic analgesics

OPIOID RECEPTOR ANTAGONISTS opiates natural-

Opioids -
syntheti wl morphine-like effects
ex-morphine
ex .
Fentanyl
Opioid Toxicity Triad of Effects codeine
meperidine

• C________________
Oma Paparaine
Thebaine
• P________________
inpoint pupils
* Somniterm
From P
• R________________
.

espiratory depression imorphine

P bracteatrum
Agents * .

1 the baine)
• NAL_______________
oxone Narcana
-

competitive antagonist
• NAL_______________
trexone Trexan
-
 ester

MODULE 3 PRACTICE OF PHARMACY local anasthetics amide

: amnesiaofconscious
so

GENERAL ANESTHETICS -Can cause eNs Depression

3) reversible muscle paralysis
Inhalational Anesthetics
Gas Volatile Liquids ↓ temp : vaporize

Nitrous Oxide claughing gas) DHalothane most hepatotoxic

-

DEnflurance -patients with asthma

&
Cyclopropane Isoflurane
Fluorinated Desflurane
Sevoflurane
Methoxyflurane for labor pain -

Intravenous Anesthetics
SLOWER ACTING -maintenance anesthesia

Dissociative Anesthesia Opioids ↓ CNS Benzodiazepines CNS

Ketamine Fentanyl Diazepam

Meperidine Lorazepam
Midazolam

Inducing Agents - Fast onset of action

Thiopental
Methohexitone TEMP

Propofol
Etomidate

PENICILLINS
INH
O
B lactamase opens the Blactam ring produced by
-

s .

aureus =
making it ineffective

NATURAL PENICILLINS AMINO PENICILLINS extended

spectrum
G(t) & GC # :

Beta Lactamase Resistance: no staphylococcal not for infections

Beta Lactamase Resistance: no
(syphilis)
Effectiveness agains G(-): no+ used to treat G(t)
Effectiveness agains G(-): Yes producing - as long as not Blactamase

Examples: Nim sensitive poor oral absorption

Examples: bioavailability
- Better oral

Pen G Benzylpenicilline -
; acd ;

AmOxicillin + clavulanic acid--staph infections Amoclav Augmentin VG(t

- unasyni
Better Parenteral bioavailability
*
-

Pen V Phenoxymethylpenicillin "penvivig" acid Stable PO

AmPicillin + sulbactam
- -

ANTI-STAPHYLOCOCCAL PENICILLINS ANTI-PSEUDOMONAL PENICILLINS

Beta Lactamase Resistance: yes Beta Lactamase Resistance: no

Effectiveness agains G(-): no (For staph infections) Effectiveness agains G(-): Yes
Examples: Examples:
Methicillin, Nafcillin, Oxacillin "MON" Carbenicillin, Ticarcillin "CTMAP"
Mezlocillin, Azlocillin
In 1st to be discovered Lobiliary excreted Derivatives :
Cloxacillin
Interstitial nephritis Didoxacillin
Flucloxacillin
Piperacillin + Tazobactam Piptaz& Tazo Cin, PiperTazo
potent
-n most

=
,

CEPHALOSPORINS
First G(t) - Ceph , CeFa Cephalexin, Cephradine, Cefadroxil, Cefazolin
Second Cefuroxime, Cefoxitin, Cefotetan, Cefprozil, Loracarbef,
Gt-
i
CeFU Let
,

Cefaclor, Cefamandole
Third G(- "para" Ceftriaxone, Cefdinir, Cefixime, Cefpodoxime
Cefditoren, Ceftibuten, Ceftazidime, Cefotaxime,
Cefoperazone Moxalactam mX3
Fourth Broad Spectrum Both 6()8 act
"Pime/prime at four
"
Cefepime, Cefpirome, Cefiderocol -new

Fifth Ceftaroline, Ceftobiprole

Reserved agents
Taro the 5th / rol"
-
 TOPIC QUIZ
QUESTIONS

1. The following are 3rd generation Cephalosporin EXCEPT________.

A. Cefixime
B. Cefotaxime
C. Ceftriaxone
D. Cefazolin
2. A patient has allergies to beta-lactam antibiotics. Without skin testing, which of the
following is not a beta-lactam antibiotic to which the patient may not be allergic to?
Ceph A. Cefalexin penicillin
cephalosporin
penicillin B. Nafcillin carbapenem
carbapenem C. Meropenem monobactam

D. Doxycycline
3. Amoxicillin and Ampicillin are aminopenicillins. Which of the following comparisons is/are
true?
~
I. They both have similar spectrum G(t)9G()
II. Hypersensitivity reaction may occur for both. ~
III. Ampicillin is better absorbed orally compared to Amoxicillin. X
parenterally
A. II and IIIX

B. I and II
C. I, II and III
X

D. I and III X

4. The sputum sample of a 55-year old patient with pneumonia is positive for a
staphylococcal strain that is beta-lactamase positive. Which is the BEST choice of penicillin
therapy in this patient?
A. Ampicillin X amino
B. Piperacillin X anti pseudo
C. Penicillin G X natural
D. Oxacillin ~ anti staph
5. A cardiologist called up the pharmacy to as regarding availability of antiplatelet agents on
stock. Which of the following items would the cardiologist be referring to?
I. Cilostazol / PDE3
II. Aspirin -
~
III. Clopidogrel
A. I and II
B. I, II and III
C. II and III
D. I and III
6. Which of the following is TRUE? anti thrombotic
A. Thrombolytics dissolve clots, example is Aspirin. Antithrombotic reduces thrombus
formation, example is Reteplase ~
Lytics dissolve B. Thrombolytics dissolve clots, example is Reteplase. Antithrombotic reduces thrombus
=

clot -
formation, example is Aspirin.
dissolve
antithrombotics reduce
:

C. Thrombolytics reduces thrombus formation, example is Aspirin. X Antithrombotic dissolves

clot
clots, example is Reteplase.
D. Thrombolytics reduces thrombus formation, example is Reteplase. Antithrombotic
-

dissolves clots, example is Aspirin

7. The patient was given a general anesthetic prior to surgery. It was administered via
inhalation. Which of the following general anesthetic was administered?
A. Succinylcholine
B. Propofol
C. Sevoflurane
D. Ketamine
MODULE 3 PRACTICE OF PHARMACY

8. Which of the following is/are non-opioids IV preparation that can be used to produce
general anesthesia?
I. Meperidine X opioid
II. Thiopental
III. Midazolam X BID
A. I and II
B. II
C. I
D. II and III ~
antidote opioid toxicity For

9. The nurse administered Naloxone for a patient at the ER. Which of the following physical
assessment data is important to indicate the effectiveness of the drug?
A. Reduction of body temperature
B. Seizure has stopped
C. Respiratory rate has normalized IP HiN crisis

D. (-) chest pain

-

& Altiplase Thrombolytic

-

(t) ino , chromo ,

dromo Idose dependent)
④ antithrombotic
cropidogrel
-

-finotropy

DRUG INTERACTIONS

OBJECT DRUG PRECIPITANT DRUG

(obj
Drug
dmg)
that
(precipitant
is ________________
amg)
affected by the interaction Drug that ________________the
causes interaction
Penicillin + Probeneciavicosurcagent an me active tubular secretion of penicillins -
n retained , perfectivenes ,

PHARMACOKINETIC INTERACTIONS -inside (after administration bodysdmg : ADME

occur when a drug alters the ___________ (absorption, distribution, elimination) of a co-
administered agent.

Pharmacokinetic interactions may result in the increase or the decrease of plasma drug
concentrations.

Examples:
1. MAO inhibitors and Tyramine rich food
§ Non-metabolism of Tyramine
Moclobemide

Pucntidid § Accumulation of pressor amines

Tranylcypromine
Selegeline § Increase in blood pressure

2. Carbidopa inhibits the peripheral metabolism of Levodopa

Sinemet SR po levodopa a Dopamine -- cannot coss the BBB

levodopaGperipheralconvmioneasion

3. Carbamazepine, Phenytoin and cigarette smoke induce the metabolism of certain drugs
PRC
Enzyme inducer CyP450 MFO
smoke
arbamazepine Cigarette
function oxidases)
Eifampica ital
St soun (mixed
,

metabolism of drugs by oxidation

,
Phenytoin Edegrdation ,
scrum
st Jonn's worth
warfarin + carbamazepine conc.

Canti wagulant) (inducer)

4. Grapefruit Juice inhibits the metabolism of certain drugs

Enzyme Metronidazole Amiodaron ex ·
Warrarin + GFJ
: acid linhibitor)
inhibitor Erythromycin Valproic lanticoagulant)
isulfiram Grapermit juice
Psoniazident = scrum conc .
OD + inducer
+ inhibitor
=
↑ scrum conc
op
(Chelating agents)
5. Absorption of Tetracyclines is decreased when taken with Aluminum, Magnesium and
Iron containing drugs Chelating agents I absorption + metalions :
chelates

easily excreted

etracycline w) calcium
 Fluoroquinolone ; chelating agent Ciprofloxacin + In
- chelating agent
6. Absorption of Ciprofloxacin is decreased when taken together with Fe, Zn, Al and Mg
containing drugs
7 .

Guscofulvin + Fatty meal

:
Tang absorption
ex full milk
ice cream

Xenical
ADER Har soluble
8 .
Orlistat & Vitamins
Fats
inhibit absorption of
lipase inhibitor
:

+x of obesity ; All : Statoned ,

Vit ADER deficiency

PHARMACODYNAMIC INTERACTIONS drug > body ; directly affects the effect of the drug
interactions in which drugs influence each other's ___________directly.
effect

pK .

It summ conc.

ADDITIVE 1 1 2 + =

Occurs when two or more drugs combine to produce an effect greater than effect of either
drug taken alone.

Examples: spironolacton(

ACE-inhibitors and Aldactone ② =

cardiac arrest

In AlE Hyperkalemia K- sparing :

hyperkalemia

↓ glucose * glucose

Ampalaya and Anti-diabetic medications Hypoglycemia =

POTENTIATION 8 2 + =

a drug with no effect is combined with another drug to cause a toxic effect.

Example:
Amoclav, Augmentin Amox +
↑ effect
clavulanic acid
Blactamase inn

Digoxin + Thiazide Diuretics

NaR ATPase hypokalemia
inhibitor

ANTAGONISTIC 1+ 1 0 Copposite effect =

one drug weakens or cancels out the effect of another drug

Example:
Green Leafy Vegetable + Warfarin
Vit K :
Formation of banti coagulant
10 , 9 , 7 2
clotting Factors ,

SYNERGISTIC OR HYPERADDITIVE 1+1 3 1 1 8 =

or + =

when a mixture of two or more drugs produces a greater response than expected
Rifampicin - inh RNA synthesis
and synthesis
radicals to inn mycolic
Isoniazid-generates the

Example: -

acd linterferes wh energy production

Pyrazinamide-pyrazinoic
Anti-TB drugs Ethambutol
-
inn arabinosyl transferase
=
cell wall sunthesis

(protein sunthesis)
Streptomycin-binds to 30s

PHARMACEUTICAL INTERACTIONS -
outside the patient's body
AKA Pharmaceutical Incompatibilities

When two or more than two substances are combined together, a physical or chemical
change takes place and an unacceptable product is formed.
Example:
1. certain additives may affect the inherent characteristics of the drug present ( Acacia +
Ironà Gelatinization )
Acacia gum+Bismuth
= cementation (ABC)
insolve
a
Acacia Alcohol USP 195 % ethanol
= Turbidity (acaciais
gum +

precipitationone
2. metal ions may cause precipitation of Quinolones and Tetracyclines Doxycycline
La
+

cal ,
cast

Manifestations of Chemical Incompatibility:

1. Evolution of gas NaHCOz Acid HeO bubbles (eFFervescence + + :

2. Precipitation and Gel Formation Tetracycline precipitation Acacia : Fe ge Formation

=
+ metal + FQ : +

crddish brown)
3. Change in color (Photolysis or Photodegradation) Na nitroprusside
"
D cyanide (blue)
4. Release of heat and light H NAyOH-Releas (neutralizat a +

Physical penonpolar, pan

. * Polyethylene glycol + mineral oil
immissibility ex ,

acacia + alcohol
2 insolubility
MODULE 3 PRACTICE OF PHARMACY

TOPIC QUIZ
Questions
When a certain additive alters the inherent characteristic of an IV drug, this is
_____________________.
A. Pharmacodynamic incompatibility
B. Pharmaceutical incompatibility
C. Pharmacokinetic incompatibility ADME
D. Therapeutic incompatibility
The following are manifestations of chemical incompatibility EXCEPT________.
A. Evolution of gas
B. Photolysis
C. Gel formation
D. immiscibility
Anti-TB drugs are usually administered in combination. This is to achieve _______________
among the agents.
A. Antagonism X
B. Synergism
C. Potentiation X
D. Enhancement of bioavailability
When a drug which has no effect or has a different effect enhances the effect of a second drug,
this is
A. Antagonistic interaction
B. Potentiation interaction
C. Synergistic reaction
D. Addition interaction
The following are pharmacokinetic interactions involving food EXCEPT______.
A. Fats decreasing gastric emptying time
B. Grapefruit juice interfering with the metabolism of certain drugs.
C. Green leafy vegetables antagonizing the effect of warfarin. -pharmacodynamic
D. Probenecid competes with the active tubular secretion of Penicillins
A student pharmacist was reviewing a new order of Aldactone for a patient who is receiving an
ACE inhibitor. Which of the following significant interaction should be noted by the student
pharmacist? Hyperkalemia
A. Aldactone may antagonize the action of the ACE inhibitor.
B. Both drugs may interact to cause an elevation in blood potassium levels
C. Both drugs may interact to cause an elevation in uric acid levels
D. Both drugs may interact to cause a decrease blood sugar levels
If a patient takes Griseofulvin with high fat meal, this will most likely result to ____________.
A. Increase in the absorption of griseofulvin
B. Decrease the elimination of griseofulvin
C. Potentiates the side effects of griseofulvin
D. Decrease the absorption of griseofulvin
Miconazole is a potent inhibitor of CYP2C9. What would be the resulting effect when a topical
preparation (cream) of miconazole interacts with another drug that will metabolized by
CYP2C9?
A. No interaction is likely to happen since systemic absorption of miconazole from the cream
is so low
B. Concentration of the drug that will interact with miconazole will increase
C. A pharmacodynamics interaction will be expected
D. Concentration of the drug that will interact with miconazole will decrease
Melissa is taking ampalaya supplements. This may potentially have an additive
pharmacodynamic effect with what medication she is taking?
A. Antihypertensive agent
B. Antiasthma drugs
C. Antidiabetic agents
D. Antidepressants
Digoxin toxicity due to the depletion of electrolytes brought by intake of diuretics, such as
thiazides, is an example of _____. Hypokalemia 10 2 potentiation = = =

A. Pharmacokinetic interaction
B. Pharmaceutical interaction
C. Both pharmacological and pharmaceutical interaction
D. Pharmacodynamic interaction
Which of the following factors will directly lead to a drug interaction?
-I. Multiple pharmacologic effect of drugs
-II. Pharmacokinetic variability of a patient diFF ADME
III. Pharmacoeconomics evaluation of drugs
cost
A. II and III
B. I, II and III
C. I and II
D. I
What is the significant interaction involving Orlistat and a fat-soluble vitamin, such as Vitamin
D? no FaCorption vit ADER (Fat soluble
of

A. Decrease in the absorption of the fat-soluble vitamins

B. ↑ Decrease in the absorption of orlistat
C. Increase in the absorption of orlistat
D. Increase in the absorption of the fat-soluble vitamins
Tyramine rich food taken together with MAO inhibitors lead to
I. Accumulation of pressor amines vaso constriction :

II. Non-metabolism of Tyramine ~

III. Increase in blood pressure ~
A. I, II, III
B. I, II
C. I, IIII
D. II and III
In drug interactions, the “drug affected by the interaction” is the
A. Inactive Drug
B. Precipitant Drug
C. Active Drug
D. Object Drug
Which of the following is/are TRUE?
I. Levodopa inhibits the peripheral metabolism of Carbidopa Carbidopa + Levidopa
II. ~ Carbidopa inhibits the peripheral metabolism of Levodopa
III. Immediate release tablets can be crushed for NGT administration
IV.↑Immediate release tablets cannot be crushed for NGT administration
A. I and IV
B. II and III
C. II and IV
D. I and II ADME
When a drug alters the absorption of another drug, this is
A. Pharmacokinetic interaction
B. Physico-chemical interaction
C. Pharmacodynamic interaction
D. Pharmaceutical interaction
Which of the following is rational?
bleeding bleeding
I. Aspirin given with Warfarin to enhance anticoagulation
II. Multiple anti-hypertensives to control hypertension = Co + PVR BP

III. Giving Levofloxacin with antacids to decrease GI distress

FQ

A. I and II
metal ions =
chelate

B. I, II and III
C. II
D. I
What is the interaction between Warfarin and Vitamin K?
A. Antagonistic
B. Additive 1) 2
= =
acc spironolactone
+
MODULE 3 PRACTICE OF PHARMACY

C. Potentiation Amoclar 110 =

2

D. Synergistic antiTB
objamg
1+ 1
level
=
3
Blood

If Drug A inhibits the excretion of Drug B, then there will be a/an

A. Decrease in blood levels of Drug A
B. Decrease in blood levels of Drug B
C. Increase in blood levels of Drug A
D. Increase in blood levels of Drug B
Which of the following can increase the clearance of another drug?
I. Grapefruit Juice /
X
↑ metabolism enzyme =
inducer

II. Phenytoin
III. Cigarette Smoke St .

Jonn

IV. Carbamazepine
A. III
B. XI, II and III
C. II and III
D. XI enzyme
↓ inducer
:
OD semm come .
PD
If Drug A induces the metabolism of Drug B, then there will be a/an
A. Decrease in blood levels of Drug A
B. Decrease in blood levels of Drug B
C. Increase in blood levels of Drug A
D. Increase in blood levels of Drug B
Which of the following medications may affect the absorption of Doxycycline?
ions chelates
I. Warfarin
= metal =

II. ~ Aluminum and Magnesium Hydroxide

III. ~ Ferrous Sulfate
IV. Vitamin C
A. I, II, III and IV
B. I and IV
C. II and III
D. II, III and IV
Which of the following drugs may cause a decrease in the effectiveness of Ciprofloxacin?
A. Ferrous sulfate tablets
B. Levocetirizine
C. Vitamin B complex
D. Levetiracetam

ADVERSE DRUG REACTIONS

“a response to a medicine which is _____________

noxious and_____________,
unintended and which occurs at doses
(patient discomfort

normally used in man

Examples:
Propranolol Inderal (non-selective longon a

Forastmas-moder
(intended effect)
§ Blocks Beta 1 receptors: normalize ____________ Blood pressure CO = BP

§ Blocks Beta 2 receptors: broncho____________ constriction reaction) (noxious Nebivolo

Morphine narcotic analgesic ; opiate (From P somniterum) Opioid (synthetic Fentanyl)

. vs ex .

§ Therapeutic dose 15-30 mg q4h: ____________, rashes _____________

constipation
§ More than the therapeutic dose:
• Signs and symptoms of toxicity
C___________

(miotic
Omatose
antidote : Naloxone
Narcan
• P___________
-

inpoint pupils i
Naltrexone Trexan -

• R___________
espiratory depression

A augmented
B Bizarre
Continuous
Delayed
End of use

Failure of efficacy
 AUGMENTED ADR
§ Most common (___) 75%
#long use of...

§ Related to the _________Pharmalogic action of the drug

① Recommend lose
can lead to ....

§ Pre_________
dictable ex· Sulfonylureas (Insulin Secretagogues)
§ Pre_________
ventable & insulin normal blood sugar
=

- blood sugar (hypoglycemia

§ Dose-dependent ↑ dose I severity :

§ AVOID: Reco _______the

decrease dose
2 TYPES: anti HiN Hypotension =

- sugar hypoglycemia
Extension Effects
:

Fluoxetine (SSRI)
• Serotonin Syndrome caused by _________________ Rhinitis Medicamentosa

• F__________
ever

• A__________
gitation
• S__________
weating (perfusion
• T__________
remors
Zaleplon Zoplicone Cantipsychotic 1st gen antihistamine , = non polar-sedating
• Patient Fall caused by ________________ INS depressant (dicines, ess)
(Zolpidem, Olanzapine, Diphenhydramine) and gen : non sedating

Side Effects Propranolol - "SIE constriction ; main effect : BP

ex
·
:
CNs deppressant
Broncho

• Dry cough: ACE inhibitors due to accumulation of ___________ bradykinin

ALTERNATIVE: ARB’s (Angiotensin Receptor Blockers) -_______________ no dry cough (-sartan)
• Endocrine side effects- _____________ Cimetidine gynecomastia main effect PuD-giveRanitidine ; : For

lleak bilirubin

• Kernicterus-_______________
neonates) on
permanent brain damage
sulfonamides Lactic acidosis
* Metformin
can cause Kernicterus on neonates ? Sulfonamides -

9 acid = H Lactic

• Cholestatic Hepatitis- _______________ Erythromycin estolate

BIZARRE ADR
§ Least common/_______ rare

§ ___related
NOt to the PCOL action
§ ____Preventable
not

§ ____Predictable
not

§ ____Dose
Not Dependent small dose ADR = =

2 TYPES: Hypersensitivity Reactions

Idiosyncratic Reactions -
- immediate (within

TYPC LgEmediatexis
mins)

(Idiosyncratic: rare but very severe genetically determined ADR)

Type Itxi-autoimmune hemolytic anemic

Stevens Johnson Syndrome caused by: Fever

complex
-SLE due to Hydralazine

blisterForT
- immune Isoniazid

TYPC antibody complex Procainamide

__________________
-
antigen
Carbamazepine phenytoin sulfonamide NSAIDs
,

Sulfasalazine (sulfonamide)
, mediated
,
Immunoglobulin (19)
, -

Gene: HLA-B 15:02 - Southeast asians

- cell mediated (T-cell)

Type V Delayed type

-

contact dermatitis curoshiol)

- Mantoux test (Tuberculin test)

Hypersensitivity/ ______________reactions
allergic exaggerated response to a normal dose of a drug
Penicillins and Cephalosporins: ______________________
not immunogenic

hapten cause anaphylaxis : Doc Epinephrine

(type 1)

CONTINUOUS ADR -Dose and time dependent

§ Addiction aware pero

-Patient takes the drug ________________despite potential harm

-

compulsively continuous

Example:
(MDMA) THC Marijuana
Methamphetamine/_______ Shabu Ecstasy 3 4-methylenedioxymethamphetamine -

,
,

§ Dependence physicalgical
-abrupt d/c of the drug may lead to _____________ withdrawal Example:
Diazepam (BID) ① taper dose

insomnia omeaswitching
tentation
-abrupt d/c may lead to _____________
§ Tolerance
-_____________effects
diminished

-Normal dose
Example: = Failure X
continuous supply-reFFeCt

Nitroglycerin-patches must be removed after 12 hours

reset the body
Drug holiday
-
MODULE 3 PRACTICE OF PHARMACY

DELAYED ADR -Time dependent (mos , years)

§ Teratogenicity Fetal harm Thalidomide hyperemesis gravidarum phocomelia

- =
-
morning severe sickness

Example: leprosy now : For

lanticonvulsant)
Carbamazepine/Valproic Acid SAFe Lamotrigine Levetiracetam
Gabapentin : ,
,

(affect the metabolism of ___________)

Folic acid
Leads to Neural Tube Defects (Spina Bifida) ,
encephalocele , anencephaly
§ Carcinogenicity - can cause cancer

Examples: Asbestos , Benzopyrene , Benzene Cigarette smoke-lung leukemia

My silicate lung cancer cancer acute myeloid

END OF USE ADR

______________ Effects
withdrawal

Abrupt discontinuation of steroids: adrenal insufficiency

Abrupt discontinuation of clonidine: Rebound HTN

ADR
Augmented
Abrupt discontinuation of nasal decongestants: Rebound ______________(Rhinitis
congestion medicamentosa) Extension effect
In prolonged use of decongestant

REMEDY: _____________dose
tapering the , switch med ,
med augmentation

FAILURE OF EFFICACY ADR

Fails to elicit its supposed pharmacologic effect
Wrong ROA
• Example: Potassium supplements: must not be administered by: _____________ pid N push IV bolus
Antagonistic Drug Interactions Warfarin green leafy veg (it) - +

Patient non-compliance
methicillin vancomycin
URSA linezolid
Anti-Microbial Resistance staph aureus a penicillin .

DOC For MRSA

: vancomycin

TOPIC QUIZ
QUESTIONS
1. Which of the following drug may aggravate asthma?
A. Protease inhibitor
B. Non-selective beta blocker Propranolol
C. Calcium channel blocker
D. ACE inhibitor
2. A reversible cholestatic hepatitis with fever and jaundice has been observed as an adverse
reaction in patients taking Erythromycin ________________.
A. Estolate
B. Base
C. Ethylsuccinate
D. Stearate
3. Which of the following medications is most likely to cause drug interaction and endocrine
side effects?
A. Ranitidine
B. Omeprazole
C. Cimetidine
D. Lansoprazole
4. Which of the following medications can increase the likelihood of patient fall?
I. Zolpidem
II. Loratadine
X and gen

III. Olanzapine
A. I, II and III
B. I and III
C. II and III
D. I and II
 5. What type of adverse reaction is exemplified by Serotonin Syndrome due to the
administration of an SSRI? (Fluoxetine) extension effect
-p

A. Therapeutic Failure X
B. Augmented
C. Teratogenic X
D. Bizarre
6. What adverse effect may result from the intake of HMG-CoA Reductase Inhibitors? (= statins
A. Bleeding
B. Hypoglycemia myalgia-muscle pain
C. Rhabdomyolysis myasthenia-muscle
weakness

D. Hypertensive Crisis
7. Which of the following may cause drug-induced kernicterus in neonates?
A. Doxycycline X
B. Chloramphenicol X
C. Isoniazid *
D. Sulfisoxazole sulfonamide
8. Which of the following is NOT an advisable mode of administration for potassium
supplements?
A. Modified release tablet, po
B. Oral Solution
C. IV bolus Rapid IV push
D. D. IV infusion
9. Which of the following is a side effect of Digoxin?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Isoniazid
Transaminase
SGPT -
scrum glutamine + pyruvic
Oxaloacetic Transaminase
glutamine +
MONITORING PARAMETERS
scrum
36OT-
SGPT ALT-alanine amino transferase

transferase
-

amino
(LABORATORY TESTS) SGO1 AST aspartate
"Astig Sgot"

FALSE POSITIVE FALSE NEGATIVE

A test which incorrectly indicates that a A test which incorrectly indicates that a particular
particular condition or attribute is present condition or attribute is absent

Example: X Wrong site

Red urine is interpreted as blood in urine in Example:
a patient taking Rifampicin. sle : The test indicates a normal blood sugar level in
Ded-oransectionis patients with untreated Diabetes Mellitus.
The test does not detect the virus from an infected
person

TESTS AND PROCEDURES

TEST OR DESCRIPTION
PROCE-
DURE
PT INR •* Prothrombin Time- International Normalized Ratio 11-13 5 normal prothrombin.
secs
time

• Screens the ____trinsic Coagulation Pathway

PTPX(IS) 0 9-73-normaldoe
EX
(
time to clot
o
=
-NR
.
:

• Monitoring Parameter for WARFARIN Therapy

aPTT •A Activated Partial Thromboplastin Time normal APTT
25-35 secs -

&Pour pa • Screens the ____trinsic

In Coagulation Pathway heparIn
As

• Monitoring Parameter for HEPARIN Therapy 35dose

Creatine • Muscle damage such as in acute myocardial infarction CK MM skeletal muscles -

Kinase MB CK BB -Brain CKMB-heart

,
blood organ damagesimvastain-RhabdomyoykMCB
:
Myocardial Infarction
-
CMB

Troponin I • Muscle damage such as in acute myocardial infarction

Troponin C-skeletal muscles + ex-myocardial infarction Troponin IP CKMB
:

I heart

-" Skeletal musele +

MODULE 3 PRACTICE OF PHARMACY

Creatinine • Volume of ______________cleared

blood of ___________per
creatinine minute * CrCl = Renal Failure
Clearance • Unit: ___________
mc min D
A- Age- years
B- Body Weight- kilograms (kg) (140 A) (B) -

10 .
85)
C- Serum Creatinine (mg/dL) (2 x 72)

Sample Problem:
The serum creatinine of a 55-year old female patient, weighing 150 lb was 1.5
mg/dL. What is her creatinine clearance?
CoCl 100-120 malmin (MALE) =

A. 52.65 mL/min
min (FEMALE)
= ML
B. 45.61 mL/min CrCl 90 -110

C. 40.2 mL/min
D. 27.3 mL/min

Computation: 15016 199

:

(140 55x)(68 18ky)

2 216
.

-
.
=

10 .
85)
(1 5 mg(d( x 72)
.

Serum • produced during skeletal muscle ______________

contraction

Creatinine • excreted by the kidneys mgld

Sur
↑Scr Kidney Failure :

• its level in the blood INCREASES when the renal function diminishes
ECG • Electro________gram
cardio

To record ________’s
heart electrical signals

EEG • Electro ________gram

encephalo
To record ________’s
brain electrical signals
lung funcionit
PEFR • Peak Expiratory Flow Rate ↓ vol
g impaired =

• A process to assess _________function and diagnose pulmonary diseases

lung
Vol of air expelled by the lungs in one quick exhalation uses spirometer
-

Endoscopy • A procedure in which an instrument is introduced into the GI tract to diagnose

diseases like ________
colon cancer

BIOLOGICAL MARKERS
_____________,_____________produced
proteins peptides by abnormal cells (Objective indications of medical states)
Cystatin C Renal Function

PSA prostate specific Antigen BPH trauma prostate cancer

,
,

CEA Carcinoembryonic Antigen colon cancer

AFP Alfa Feto Protein Liver cancer

TOPIC QUIZ
QUESTIONS
1. Which of the following is important in monitoring the effects of Warfarin?
A. INR
B. Hemoglobin A1C blood glucose control
C. Platelet count thrombocytopenia (dengue Fever
D. AST:ALT ratio
2. Which of the following are cardiac biomarkers released when muscle cells are damaged
during acute myocardial infarction?
A. Creatine Kinase-MB
B. Lactate Dehydrogenase
C. Creatinine
D. Neutrophil
3. A new test for HIV does not detect the presence of the virus in someone who is infected. This
is known as a ________________.
 A. False negative result
B. True negative result
C. False positive result
D. True positive result
4. Cystatin C is a biomarker in ______________ disease.
A. Pulmonary
B. Renal
C. Hepatic
D. Cardiac
5. Which of the following statements are true regarding creatinine? scr
I. It is produced during skeletal muscle contraction
II. It is excreted by the kidneys
III. Its level in the blood decreases if the renal function diminishes
X g Scr =
Annal Function

A. I and III
B. I and II
C. I, II and III
D. II and III

EQUIVALENTS AND ALTERNATIVES

PHARMACEUTICAL EQUIVALENTS PHARMACEUTICAL ALTERNATIVES

Same _______________(s)
active ingredient Same _________________
active ingredient

same _______
ester or _______
salt

Same __________of
route administration May differ in:
Same __________and
dosage Form salt or ester form,
Same __________
strength and concentration ROA
dosage forms
May differ in: S___________,
izs strength or concentration
Release mechanism,
L__________,
abeling Example:
I
S__________,
coring -Erythromycin Lactobionate 500mg
E__________
xcipients Erythromycin stearate
, 250mg Tab X

- 1 x - X

~ x

(Temprae) soomgan Paracetamol (Biogesic &) 500 mg

a
a

Example: Paracetamol ,

THERAPEUTIC EQUIVALENTS THERAPEUTIC ALTERNATIVES

Same _______________(s)
Active ingredient may have chemically different contents but
same _______
salt or _______
ester are purported to have the same __________
CFFeCt as
Same __________of
route administration other drugs for treating a condition.
Same __________and
dosage form

Same __________
strength and concentration Example:
SAME CLINICAL ____________ eFFeCt AND _______________
safety

PROFILE as the innovator drug the bioequivalence test -

Mefenamic acid , Ibuprofen

Adequate scientific evidence establishing NSAID

through in vivo and/or in vitro studies the
bioequivalence of the product to a selected
reference drug.

May differ in: shape, release mechanism,

labeling, scoring, excipients

ORANGE BOOK:
Approved Drug Products with Therapeutic
Equivalence Evaluations

(Lithromax) Azithromycin (Acin

innovator drug
EX -

Azithromycin
j ,
500 my po
~
~
 MODULE 3 PRACTICE OF PHARMACY

TOPIC QUIZ
QUESTIONS
1. Quinidine Sulfate 200 mg capsule and Quinidine 200 mg tablet are:
A. Therapeutic alternatives
B. Therapeutic equivalents
C. Pharmaceutical alternatives
D. Pharmaceutical equivalents
2. Which of the following products are considered “Pharmaceutical alternatives”?
A. Paracetamol 500 mg tablet (Biogesic) and Paracetamol 500 mg tablet (Tempra) PE
B. Mefenamic acid tablet and Ibuprofen tablet TA
C. Paracetamol 500 mg tablet x 50’s and Paracetamol 500 mg tablet x 100’s same drugs
D. Verapamil SR tablet and Verapamil sugar-coated tablet PA =

diFF DF dIFF DF
2 groups : Staff : Smed
Investigational
Single-blinded " subj
Double blinded-staff-
is
New
not aware

subj
Dmgs
(IND

are not
or

aware
; Placebo
Placebo)

(IND placebo)
>
-
to please
dosaac Form who AP1
CLINICAL TRIALS AND STUDY DESIGNS subjectmarm individuals

PHASE 1 adults & children w/ consent

Subjects Healthy individuals/Healthy volunteers safety
Importance Test for __________,
safe determine the dosage and side effects

PHASE 2
Subjects __________
patients (affected individuals)
Importance Test for efficacy and side effects effectiveness

PHASE 3
Subjects Patients (wider demographics) 7000 safety & effectiveness
Importance Test for long term effectiveness and comparisons with other medications
(__________ studies)
Bioequivalence T he efficacy safety
IND has the same with the reference and

FDA Treatment determined effective and safe for public use

APPROVAL

PHASE 4
Subjects Patients (wider demographics)
Importance Post marketing surveillance ADR :

MomI in
continue testing for effectiveness and safety still
drug can be taken off the market if necessary
under investigation

STUDY DESIGNS:
1. Cross-sectional Study
• both the __________
Outcome and the __________
exposure are determined simultaneously
• __________
prevalence of the disease or condition is determined
2. Cohort or Prospective Study
• the researcher selects a group of exposed and another group of unexposed individuals
and _________________
Follows Up time to determine whether a particular outcome of interest will
occur.
3. Retrospective Study case control
exposure is determined
• the outcome of interest ____________________ at the time the study is initiated.
-

is
already determined
4. Randomized Controlled Trials
• Randomized: The researchers decide randomly as to which participants in the trial
receive the new treatment and which receive a placebo, or fake treatment.
• Controlled: The trial uses a control group for comparison or reference. In the control
group, the participants do not receive the new treatment but instead receive a placebo
or reference treatment
• RCTs are the gold standard for clinically testing treatments and drugs.
5. Meta-analysis
• a statistical analysis that ____________________
summarizes of multiple scientific studies.
ex
Ginkgo biloba
Memory enhancing
- =

statistically summarized from diff papers

 TOPIC QUIZ
Questions
Which of the following study designs would be most appropriate in determining the efficacy of
the drug?
A. Cross-sectional study
B. Randomized controlled study
C. Cohort study
D. Case-control study
Which of the following is/are TRUE when conducting clinical trials?
I. Serious Adverse Drug Reaction can happen.
II. Children can be test subjects.
III. Placebo can be used for comparison.
A. I and III
B. II and III
C. I, II and III
D. I
Which of the following phases of clinical trials would usually involve healthy human subject?
A. Phase 4 post marketing
B. Phase 2 efficacy
C. Phase 1 safety
D. Phase 3 & E
The hospital pharmacist has reviewed several clinical papers concerning the benefits of a new
formulary drug and is preparing summary comparing the findings for publication. Which term
is used to describe this type of review?
A. Meta-analysis
B. Double blind study
C. Peer review
D. Dimensional analysis
A study was approved that aims to determine the relationship between a newly approved
formulary drug and ulcer. Record of patients diagnosed with peptic ulcer disease versus
controls over the period from July 2009- July 2019 was used. This is an example of a _______
study?
A. Cross-sectional
B. Cohort
C. Retrospective
D. Prospective

HOSPITAL PHARMACY
QUESTIONS
1. The following are functions of a hospital, except: Wellness
A. Provides rooms and services for outpatients Education
B. Medical Research ~ Research
C. Patient Care ~ Patient care
~
D. Promotes wellness of the community
2. ASHP means
A. American Society of Health Pharmacists
B. American Society of Health-System Pharmacists
C. American Society of Hospital Pharmacists
D. American Society of Health Care Pharmacists
3. Retired Medical Practitioners fall under:
A. Honorary Staff
B. Attending Staff completed residency
>
-

hospital
admit patients in a

C. Courtesy Staff -physicians wh privilege to occasionally

a

medical training
D. Residents completed medical school & completing
>
-
 PrP
main
*
= P
p

PrP
MODULE 3 PRACTICE OF PHARMACY main
* P
P

4. Which of the following refers to the drug distribution system in which each peripheral
facility determine the drug quantities to be requisitioned from the procurement unit or
warehouse?
A. Unit dose distribution system
B. Pull System
C. Direct purchase from suppliers
D. Push System

PHARMACOECONOMICS
QUESTIONS
1. Which of the following refers to the science that evaluates the value of a pharmaceutical
product or drug therapy compared to its effects?
E. Pharmacogenetics
F. Pharmacoeconomics
G. Pharmapreneurship
H. Pharmacogenomics
2. When choosing medicines for inclusion in the formulary, evaluation would involve looking at
the complete cost of using the drug. What type of cost would quality of life belong?
E. Indirect cost
F. Intangible cost
G. Direct cost
H. Direct, Indirect and Intangible cost

EMERGENCY DRUGS
Code carts/Crash Carts- availability of critical medications and supplies to respond to
emergencies

List of Emergency Drugs

DRUG USE
Adenosine + x of tachycardia (THR)
Atropine Bradycardia
Calcium gluconate cardiac arrest , cardiotoxicity 20 hyperkalemia , hypermagnesemia
Dextrose (10%) Hypoglycemia
Dopamine Hypotension ,
cardiac arrest

Epinephrine Adrenaline Anaphylaxis

Fentanyl Opioid-anesthesia : analgesic
Hydralazine Hypertensive emergency

Lorazepam Anticonvulsant

Morphine Narcotic analgesic

Naloxone antidote For Opioid toxicity

Phenobarbital alcohol withdrawal syndrome

Sodium bicarbonate metabolic acidosis

Vecuronium muscle relaxant

Volume Expanders (RBC’s and Hypotension 20 to

hypovolemia : BV
Normal Saline)

QUESTIONS
1. Code carts located at nursing units and clinics are used primarily for what purpose?
A. Availability of critical medications and supplies to respond to emergencies
B. Securing all controlled substances available at the units
C. Securing PRN medications available for patients
D. Availability of unit dose for 24-hour medications for individual patients
 TOTAL PARENTERAL NUTRITION - Horizontal Laminar Flow hood
HEPA High Efficiency Particulate Air Filter
•Administered via: Subclavian Vein (14)
•Prepared under a Laminar Flow Hood vertical laminar Flow
hood
cytotoxic - for

•Must be administered within 24 hours after reconstitution

MACRONUTRIENTS
Sources of calories or kiloCalories 1009 CHO tins
Carbohydrates (Dextrose) , Proteins, Fats (Triglycerides) ? Fats
1g =
4kcal Camino acids) * 19 akcal *
:
1500
19 4kcal
=

MICRONUTRIENTS
Add-ons
Electrolytes , Trace Minerals , Vitamins Vit Ba ,
Vit B12

(Na +, (at) Fe Cu In
-

k (1 Megaloblastic anemia
-

,
, , ex -

ex microcytic anemia (Fe)

TOPIC QUIZ
QUESTIONS
1. Which of the following are macronutrients found in Total Parenteral nutrition?
A. Fats, Vitamins, Carbohydrates, Trace Elements
B. Carbohydrates, Proteins and Fats
C. Carbohydrates, Proteins, Vitamins
D. Proteins, Fats and Electrolytes
2. Which of the following components of parenteral nutrition is/are micronutrients?
I. Electrolytes
II. Dextrose
Fatekins
III. Triglycerides
A. III
B. I, II and III
C. II and III
D. I
3. The IV fluid D5W means?
A. 0.5% Dextrose in water
B. 0.05% Dextrose in water
C. 50% Dextrose in water
D. 5% Dextrose in water
4. Which of the following deficiencies is/are the most common cause/s of megaloblastic
anemia?
I. Iron Deficiency
II. Vitamin B12 Deficiency B12
III. Folic acid Deficiency Bq
A. I
B. I, II and III
C. III
D. II and III

END.