Kristensmith

Broad-Spectrum Antibiotics Important Notes

1. Tetracyclines

• The first isolated tetracycline is chlortetracycline
• They are bacteriostatic
• Have a broad spectrum of action
• Effective against bacterial, rickettsial, and chlamydial infections
• Forms insoluble complexes by chelation with calcium. Magnesium and aluminum
• Widely used in the treatment of periodontal diseases
• It interferes with the bacteriocidal activity of penicillin
• Thus it is not given along with penicillin
• It potentiates the anticoagulant action of coumarin drugs
• Has enterohepatic circulation
• Excreted by kidneys except for chlortetracycline
• Tetracyclines Classification
  • Group I – tetracycline, Chlortetracycline, Oxytetracycline
  • Group II – Demeclocycline, methacycline
  • Group III – Doxycycline, Minocycline

Read And Learn More: Pharmacology Question and Answers

• Tetracyclines Adverse effects
  • Photosensitivity
  • Hepatotoxicity
  • Renal toxicity
  • Bone marrow suppression
  • Super infections
  • Hepatic dysfunction
  • Fanconi like syndrome
• Tetracyclines given to pregnant women cause
  • Discoloration of teeth in the fetus
  • Temporary suppression of bone growth
  • Hepatic necrosis in mother
  • Increased intracranial pressure in infants.

Broad-spectrum antibiotics examples

2. Chloramphenicol

• It inhibits the protein synthesis of bacteria
• In high concentrations, it inhibits the protein synthesis of the host
• It is the drug of choice for typhoid
• Chloramphenicol Adverse effects
  • Bone marrow depression
  • Gray baby syndrome in infants
  • Idiosyncrasy
  • Superinfection

3. Advantages of doxycycline over tetracyclines

• Has longer half-life
• Less propensity to cause GI disturbances
• Better GI absorption
• High lipid solubility

4. Local drug delivery systems of tetracyclines

• Activity – 25% tetracycline
• Atridox – 10% doxycycline

Broad Spectrum Antibiotics Long Essays

Question 1. Explain broad-spectrum antibiotics. Describe the mechanism of action, therapeutic uses, and toxic effects of tetracyclines.
Answer:

Broad-spectrum antibiotics:

• Broad-spectrum antibiotics are effective against a large number of microorganisms except for fungi and viruses.
• They are bacteriostatic and bacteriocides
• They are:

1. Tetracycline.
2. Chloramphenicol.

Tetracyclines:

• Obtained from soil actinomycetes.
• They are slightly water soluble.

Tetracyclines Anti-bacterial spectrum:

• Tetracyclines are broad-spectrum antibiotics.
• They are effective against gram-positive and gram-negative organisms.
• Also inhibit the growth of Rickettsiae, chlamydia, mycoplasma, and some protozoa.

Tetracyclines Classification:

1. Group-1 short-acting: Tetracycline, oxytetracycline.

2. Group- II – intermediate-acting: Demeclocycline, methacycline.

3. Group- III – long-acting: Doxycycline, minocycline.

Tetracyclines Mechanism of action:

Tetracyclines Therapeutic uses:

1. Orodental condition

• Tetracycline – 250 mg QID is used as an adjuvant for chronic periodontitis.
• Doxycycline – 0.1 – 0.2 g/day for 2 – 4 weeks controls gingival inflammation.
• Doxycycline polymer gel is placed in the periodontal pockets.
• Appropriate surgical treatment combined with 2 – 4 week tetracycline therapy stops the progression of juvenile periodontitis.

2. General uses

Used for initial treatment of mixed infections.

• First choice of drug for:
  • Chlamydial infections.
    • Lymphogranuloma venerum – given for 2 weeks.
    • Trachoma – given topically.
    • Inclusion conjunctivitis.
  • Rickettsial infections – typhus, Q. Fever.
  • Atypical pneumonia.
  • Cholera – reduces stool volume.
  • Brucellosis – combined with gentamicin.
  • Plague – combined with aminoglycoside.
  • Replacing fever.
  • Second choice of the drug too.
    • Penicillin for tetanus, anthrax.
    • Ciprofloxacin for gonorrhea
    • Ceftriaxone for syphilis.
    • Azithromycin for trachoma.

3. Other uses

• Urinary tract infections.
• Traveler’s diarrhea.
• Acne.
• Protozoal infections – amoebiasis, malaria.
• Chronic obstructive lung disease prophylactic use.
• Inappropriate secretion of ADH – demeclocycline is used.
• Topical use in scaling and root planning procedures.

Tetracyclines Adverse effects:

1. Irritative effects:

• GIT effects
  • Causes nausea, vomiting, epigastric pain, and diarrhea.
  • Esophageal ulceration occurs.
• Local effects   
  • Pain at the site of injection.
  • Thrombophlebitis on IV injection.

2. Dose-related toxicity

• Hepatotoxicity 
  • Resulting in jaundice.
  • Causes acute hepatic necrosis in pregnancy.
• Renal toxicity   
  • Tetracyclines accumulate and enhance renal failure.
  • Occurs due to the degradation of products which damages proximal renal tables.
• Phototoxicity

Skin reactions and dermatitis occur due to sun exposure.

• Effect of Teeth and Bones     

Tetracyclines have chelating properties.

• Antianabolic effect
• Reduces protein synthesis.
• Induces negative nitrogen balance and increases blood urea.
• Increases intracranial pressure
• Diabetes insipidus.
• Vestibular toxicity.

3. Hypersensitivity reactions

Skin rashes, urticaria, glossitis, pruritus, exfoliative dermatitis occurs.

4. Superinfections

Tetracyclines suppress normal flora and cause superinfections.

Question 2. How will you treat a case of superinfection due to tetracycline therapy?
Answer:

Tetracycline:

It is a broad-spectrum antibiotic.

Tetracycline Superinfection:

• It refers to the appearance of a new infection as a result of antimicrobial therapy.
• The use of tetracyclines alters the normal microbial flora of the body.
• Due to it, non-pathogenic components of the flora like Candida predominates and invades the flora.
• The mouth, skin, vagina, and intestinal are invaded by Candida albicans.
• It leads to pseudomembranous enterocolitis.

Superinfection Treatment:

• Tetracycline is discontinued.
• To treat superinfection antifungal agents like nystatin or clotrimazole are used.

Uses of broad-spectrum antibiotics

Question 3. List four tetracyclines. Explain pharmacokinetic differences among tetracyclines.
Answer:

Tetracyclines:

1. Group I – short-acting: Tetracycline, oxytetracycline.

2. Group II – intermediate-acting: Demeclocycline, methcycline.

3. Group III – long-acting: Doxycycline, minocycline.

Differences among tetracyclines:

Question 4. Explain the adverse effects of Tetracyclines. Add a note on Doxycycline.
Answer:

Adverse Effects Of Tetracyclines:

1. Irritative effects

• GIT effects
  • Nausea, vomiting, epigastric pain, diarrhea
• Local effects
  • Pain at the site of injection
  • Thrombophlebitis on IV injection

2. Dose-related toxicity

• Hepato toxicity
  • Results in jaundice
  • Causes acute hepatic necrosis in pregnancy
• Renal toxicity
  • Tetracyclines accumulate and enhance renal failure
  • Occurs due to degradation of products which damages proximal renal tubules
• Phototoxicity

Skin reactions and dermatitis occurs due to sun exposure

• Effect on teeth and bones

Tetracyclines have chelating property

• Antianabolk effect
• Reduces protein synthesis
• Increases blood urea
• Increases intracranial pressure
• Diabetes insipidus
• Vestibular toxicity

Broad-spectrum antibiotics classification

3. Hypersensitivity reactions

Skin rashes, urticaria, glossitis, pruritis, exfoliative dermatitis

4. Superinfection

Tetracyclines suppress normal flora and cause superinfection

Doxycycline:

• It is a semi-synthetic tetracycline
• When given orally it is 95% absorbed
• Food does not interfere with its absorption
• The plasma half-life is 18-24 hours
• So it is given once a day
• It is primarily excreted in feces as conjugate
• Phototoxicity, less renal toxicity occurs

Broad Spectrum Antibiotics Short Essays

Question 1. Give reasons for not prescribing tetracycline to a child of 5 – years.
Answer:

Tetracyclines have chelating properties

• It chelates calcium.
• Calcium-tetracycline chelate gets deposited in developing teeth and bone.
• The deformities depend on the time of tetracycline administration.

1. Mid-pregnancy up to 5 months of postnatal life

• Deciduous teeth are affected.
• Causes brownish discoloration.
• Teeth become ill-formed and more susceptible to caries.

2. 2 months – 5 years of age

• Effects permanent dentition.
• Causes discoloration of teeth.
• Permanent interiors are commonly affected.
• A repeated course is more damaging.

3. Pregnancy and childhood up to 8 years

• Causes temporary suppression of bone growth.
• Prolonged use of tetracyclines leads to bone deformities and height reduction.

Broad vs narrow-spectrum antibiotics

Question 2. Chloramphenicol.
Answer:

Chloramphenicol is a broad-spectrum antibiotic.

It is obtained from streptomyces venezuelae in 1947.

Chloramphenicol Mechanism of Action:

Chloramphenicol Uses:

1. Typhoid fever

• Given for 14 days.
  • Initially – 500 mg QID till the fever subsides.
  • Later – 250 mg QID up to the 14th day.

2. Meningitis

Used as an alternative to penicillin.

3. Anaerobic infections

Used in combination with penicillin and aminoglycosides.

4. Eye infections

Used for endophthalmitis.

5. Topical use

Used in conjunctivitis, external ear infections.

6. Second drug of choice to

• Tetracycline for brucellosis, and cholera.
• Erythromycin for whooping cough.
• Penicillin for meningococcal infections.
• Cotrimoxazole for dysentery.
• Fluoroquinolones for UTI.

Chloramphenicol Adverse Effects:

1. Bone marrow depression.

Occurs in 2 ways.

• Non-dose-related idiosyncratic reaction     
  • Rare but serious.
  • Manifested as aplastic anemia.
• Dose-dependent reaction 
  • Occurs due to the inhibition of mitochondrial enzyme synthesis.
  • Characterized by anemia, leukopenia, and thrombocytopenia.

2. Hypersensitivity reactions

Rashes, fever, atrophic glossitis, angioedema.

3. Irritative effects

• GIT disturbances – Nausea, Vomiting, diarrhea.
• Pain on injection.

4. Superinfection.

5. Grey baby syndrome

• Occurs when high doses are given.
• Baby develops vomiting, refusal of feeds, hypotonic, hypothermia, abdominal distension, irregular respiration, and ashen grey cyanosis.

Broad Spectrum Antibiotics Short Question And Answers

Question 1. Adverse effects of broad-spectrum antibiotics.
Answer:

1. Toxicity

• Local irritancy
  • Broad-spectrum antibiotics act as irritants and causes.
    • GIT disturbances – nausea, vomiting.
    • Pain at the site of injection.
• Systemic toxicity 
  • They affect organs.
    • Tetracyclines cause phototoxicity, hepatotoxicity, and renal toxicity.
    • Chloramphenicol causes bone marrow suppression.

2. Superinfection

• The use of broad-spectrum antibiotics leads to the alteration of the normal microbial flora of the body.
• Due to it, even non-pathogenic organisms present invade the flora.
• As a result, a new infection occurs.

Antibiotic classification chart

Question 2. Doxycycline.
Answer:

Doxycycline is semi-synthetic tetracycline.

• When given orally, it is 95% absorbed.
• Food does not interfere with its absorption.
• The plasma half-life is 18 – 24 hours.
• So, it is given once in a day.
• It is primarily excreted in feces as conjugate.
• Phototoxicity, less renal toxicity occurs.

Question 3. Tetracyclines should not be given with antacids.
Answer:

Tetracyclines have chelating properties.

• They form insoluble and unabsorbable complexes with calcium and other metals.
• Milk, iron preparations, non-systemic antacids, and sucralfate reduces their absorption.
• Hence tetracyclines should not be given with antacids.

Beta Lactum Antibiotics Important Notes

1. Beta lactam antibiotics are

• Penicillins
• Cephalosporins
• Monbactem
• Carbepenems

2. Penicillin

• Has a wide therapeutic range
• Is the safest drug
• Penicillin Classification
  • Natural – penicillin G, procaine penicillin, Benzathine penicillin
  • Acid resistance penicillin – penicillin V, phenoxy ethyl penicillin
  • Penicillinase resistance penicillin
    • Acid labile – methicillin, cloxacillin, nafcillin
    • Acid resistant – fucloxacillin
  • Broad spectrum penicillin – ampicillin, amoxicillin, talampicillin
  • Extended-spectrum penicillin – carbenicillin, ticarcillin
  • Beta-lactamase inhibitors – augmentin, sulbactam

Read And Learn More: Pharmacology Question and Answers

• Penicillin Adverse effects
  • Anaphylaxis
  • Angioedema
  • Superinfection
  • JarischHerxheimer reaction
• Penicillin Uses
  • Syphilis
  • Actinomycosis
  • Gonorrhoea
  • Streptococcal infection
  • Abscess
  • Cellulitis

3. Carbenicillin

• It is neither Penicillinase resistance nor acid resistance
• It is inactive orally
• Rapidly excreted in urine
• It is active against Pseudomonas aeruginosa and indole-positive Proteus

Beta-lactam antibiotics examples

4. Benzathine penicillin

• It is a long-acting drug
• Given every 2-4 weeks
• Remains effective for prophylactic purposes for up to 4 weeks

5. Drugs and their route of administration

6. Cephalosporins

• They have a 7-amino cephalosporin acid nucleus, which bears a close resemblance to the 6-APA nucleus of penicillin.
• They are effective against both Gram-positive and Gram-negative organisms
• They inhibit bacterial cell wall synthesis
• Doesn’t undergo any metabolism in the body except for cefotaxime
• Excreted by the kidneys except for cefoperazone
• Generations:.

Beta Lactum Antibiotics Long Essays

Question 1. Define antibiotic. Classify penicillin. Explain their mechanism of action, toxicity, and uses of penicillin G or Benzylpenicillin.
Answer:

Antibiotics:

These are substances produced by micro-organisms that selectively suppress the growth or kill other micro-organisms at very low concentrations.

Penicillin:

Penicillin is a beta-lactam antibiotic.

Penicillin Classification:

1. Natural penicillin – penicillin G.

2. Semi-synthetic penicillin

• Acid resistant – penicillin V.
• Penicillinase-resistant penicillin.
  • Methicillin, cloxacillin.
• Extended-spectrum penicillin.
  1. Aminopenicillin – Ampicillin, Bacampicillin.
  2. Carboxypenicillin – Carbenicillin, Ticarcillin.
  3. Ureidopenicillin – peperacillin, mezlocillin.

Penicillin Mechanism of action:

• Bacterial cell walls consist of peptidoglycan chains.
• These require transpeptidase enzymes.

Penicillin Toxicity:

• Pain and sterile abscess at the site of injection.
• Thrombophlebitis on IV injections.
• Hypersensitivity reactions.
  • Frequently rashes, itching, urticaria, and fever occurs.
  • Rarely wheezing, angioneurotic edema, serum sickness, and exfoliative dermatitis occur.
• Topical use of penicillin causes contact dermatitis.
• CNS effects – include confusion, muscle twitchings, convulsions, and coma.
• Suprainfections – occur rarely due to the narrow spectrum of activity of penicillin.
• Jarisch – Herxheimer reaction.
• When penicillin is injected into a syphilitic patient; there is sudden destruction of spirochaetes and release of its toxic products known as the Jarisch herxcheimer reaction.
• It is characterized by fever, myalgia, shivering, exacerbation of syphilitic lesions, and vascular collapse.

Penicillin Uses:

1. Therapeutic uses

• CO Orodental infections – caused by aerobic and anaerobic micro-organisms.
• Pneumococcal infections – like pneumonia, meningitis, and osteomyelitis.
• Streptococcal infections – like pharyngitis, sinusitis, pneumonia, meningitis.
• Meningococcal infections.
• Staphylococcal infections.
• Syphilis.
• Diphtheria.
• Anaerobic infections, like pulmonary, periodontal, and brain abscesses.
• Actinomycosis.
• Tetanus, gas gangrene, anthrax, trench mouth, rat-bite fever.

2. Prophylactic uses

• To prevent the recurrence of rheumatic fever.
• Prevent sexually transmitted diseases like gonorrhea and syphilis.
• Surgical prophylaxis.
• To protect against agranulocytosis.

Beta-lactam antibiotics pharmacology

Question 2. Describe the antibacterial spectrum and therapeutic uses of ampicillin.
Answer:

Ampicillin:

It is semisynthetic aminopenicillin.

Antibacterial spectrum:

1. Cocci-strep viridians, enterococci, penumococci, gonococci, meningococci.
2. Gram negative bacilli – H.influenza, E.coli, proteus, salmonella, shigella.

Ampicillin Uses:

• Urinary tract infections.
• Respiratory tract infections like bronchitis, sinusitis, and otitis media.
• Meningitis.
• Gonorrhoea.
• Bacillary dysentery.
• Typhoid fever.
• Cholecystitis.
• Subacute bacterial endocarditis.
• Septicaemia.
• Orodental infections.

Question 3. Write the treatment of penicillin in anaphylactic shock.
Answer:

Treatment of Anaphylactic Shock:

• Penicillin causes anaphylactic reactions.
• It is more common following parenteral administration than oral.
• So the history of penicillin allergy must be elicited before injection.
• A scratch test or intradermal test with 2-10 units may be performed first
• Treatment of anaphylactic shock is as follows.
• Put the patient in a reclining position.
• Administer oxygen.
• Perform cardiopulmonary resuscitation.
• Inject adrenaline 0.5 mg IM, repeat every 5-10 min or adrenaline diluted 1:10000 or 1:1,00,000 IV.
• Administer chlorpheniramine 10 – 20 mg IM.
• IV hydrocortisone succinate 100 – 200 mg.

Question 4. Define chemotherapeutic agents. Describe newer penicillins.
Answer:

Chemotherapeutic agents:

A chemical of natural or synthetic origin used for its specific action against disease, usually against infection is called a chemotherapeutic agent.

Newer penicillins:

It includes:

1. Acid-resistant penicillin – phenoxymethyl penicillin – penicillin V.

2. Penicillinase-resistant penicillin – methicillin, cloxacillin.

3. Extended-spectrum penicillins

• Aminopenicillin – Ampicillm, Bicampicillin.
• Carboxypenidllm – carbenicillin, ticarcillin.
• UreidopenidlJin – piperacillin.

4. P-Lactamase inhibitors

Clavulanic acid, sulbactam.

Newer penicillins AIMS:

• To overcome the disadvantages of penicillin G like.
• Poor oral efficacy.
• Susceptibility to penidllanse
• Narrow spectrum
• Hypersensitivity reactions.
• p-lactamase inhibitors.

Question 5. Classify Penicillins. Write the spectrum of action, mechanism of action, therapeutic uses, and adverse effects of Amoxicillin.
Answer:

Penicillin Classification:

• Natural – penicillin G, procaine penicillin, Benzathine penicillin.
• Acid resistance penicillin – penicillin V, phenoxy ethyl penicillin
• Penicillinase resistance penicillin
  • Acid labile – methicillin, cloxacillin, nafcillin
  • Acid resistant – fucloxacillin
• Broad spectrum penicillin – ampicillin, amoxicillin, talampicillin
• Extended-spectrum penicillin – carbenicillin, ticarcillin
• Beta-lactamase inhibitors – augmentin, sulbactam

Amoxicillin:

It is aminopenicillin

Amoxicillin Spectrum Of Action:

• Cocci – streptococcus viridians, enterococci, pneumococci, gonococci, meningococci
• Gram negative bacteria – E.coli, proteus, salmonella

Amoxicillin Mechanism Of Action:

• The bacterial cell wall consists of peptidoglycan chains
• These require transpeptidase enzymes
• Penicillin inhibits transpeptidase → which inhibits the synthesis of peptidoglycan → results in the formation of cell wall deficient bacteria → causes lysis bacteriocidal

Amoxicillin Uses:

• Typhoid
• Respiratory infections
• Urinary tract infection
• Gonorrhoea
• Subacute bacterial endocarditis
• The most commonly used antibiotics for dental use
• Drug of choice for prophylaxis for endocarditis

Amoxicillin Adverse Effects:

• Adverse effects are rare
• Diarrhea – due to irritation of the lower part of the intestine and alteration of bacterial flora
• Skin rashes

Beta-lactam antibiotics classification

Beta Lactum Antibiotics Short Essays

Question 1. Adverse effects of penicillin.
Answer:

1. Penicillin Hypersensitivity reactions

• It is the more common adverse effect of penicillin.
• Frequent manifestations are – rashes, itching, urti- cariaand fever.
• Rarely wheezing, angioneurotic edema, serum sickness, and exfoliative dermatitis occur rarely.
• An anaphylactic reaction may rarely occur but may create a serious problem.
• Adrenaline injection is kept loaded to treat anaphylaxis.
• It is more common with parenteral administration than oral.
• To prevent it, a history of penicillin allergy is elicited.
• A scratch test or intradermal test with 2-10 units is done before the use of penicillin.

2. Penicillin Local effects

• Pain – at the site of injection
• Nausea – on oral ingestion.
• Thrombophlebitis – on IV injection occurs.

3. Penicillin CNS effects

• Large doses cause mental confusion, muscular twitching convulsions, and coma, especially in patients with renal insufficiency IV infections.

4. Penicillin Jarlsch – Herxheimer miction

• It occurs when penicillin is injected into a syphilitic patient
• It is due to the release of endotoxins from dead organisms.
• It is due to the release of endotoxins from dead organisms.
• It is characterized by shivering, fever, myalgia, exacerbation of lesions, and vascular collapse.
• It lasts for 12 – 72 hours.
• Aspirin and corticosteroids provide symptomatic relief.

5. Penicillin Superinfections

It occurs rarely due to a narrow spectrum of activity.

Question 2. Uses of benzylpenicillin (PnG).
Answer:

1. Orodental infections

• Parenteral penicillin is more effective.
• It is given at ordinary doses of 0.5 – 2 MU IM-6 hourly in cases of periodontal abscess, periapical abscess, pericoronitis, ANUG, oral cellulitis, etc.

2. Streptococcal infections

• 0.5 – 5 MU IV 8 hourly for 7-10 days given for pharyngitis, otitis media, scarlet fever, and rheumatic fever.
• High doses of 10 – 20 MU IV daily for 2 – 6 weeks are used in subacute bacterial endocarditis.

3. Pneumococcal infections

If the organism is sensitive, PnG 3-6 MU IV every 6 hours is used.

4. Meningococcal infections

High doses are needed.

5. Gonorrhoea

6. Penicillin

• Early and latent syphilis – 1.2 MU of procaine penicillin daily for 10 days.
• Late syphilis – 2.4 MU of benzathine penicillin weekly for 4 weeks.

7. Diphtheria – 1 – 2 MU procaine penicillin daily for 10 days

8. Tetanus and gas gangrene – 6 – 12 MU dialy.

9. Anthrax – 4 MU 6 hourly for 2 weeks.

10. Actinomycosis – 2 – 4 MU IV 6 hourly for 4 weeks.

Benzylpenicillin Prophylactic use:

• Penicillin G is used «s prophylactic In.
  • Rheumatic fever
  • Gonorrhoea and syphilis
  • Valvular heart disease
  • Surgical procedures.
  • Agranulocytosis.

Question 3. Extended-spectrum penicillin.
Answer:

1. Amlnopenicillin – Amptclllln, Bacamplclllln, Amoxicillin
2. Carboxypenicillin – Carbenicillin, Ticarcillin
3. Ureidopenicillin -Piperacillin, Mezlocillin.

Extended-spectrum penicillin Uses:

Amlnopenicillin – Urinary tract Infection

• Respiratory tract infection
• Dental infections > Meningitis
• Typhoid
• Septicaemia
• Gonorrhoea
• Bacillary dysentery
• Cholecystitis
  • Carboxypenicillin – Used as sodium salt.
  • In serious infections like burns, septicemia
  • Ureidopenicillin – In gram-negative infections
  • caused in immunocompromised patients

Extended-spectrum penicillin Adverse effects:

• Aminopenicillin – Diarrhoea, skin rashes
• Carboxypenicillin – Edema, CLF, bleeding
• Ureidopenicillin – Relatively safe.

Mechanism of action of beta-lactam antibiotics

Question 4. Penicillins act as bacteriocidal agent.
Answer:

Penicillin inhibits the synthesis of bacterial cell walls.

It is more lethal in the phase of rapid multiplication when cell wall synthesis takes place.

Penicillins act as bacteriocidal agent Mechanism:

Penicillin also depresses bacterial autolysins which usually function during bacterial cell division.

Question 5. Cloxacillin and staphylococcal infections.
Answer:

Cloxacillin is penicillinase-resistant penicillin.

• It is resistant to hydrolysis by penicillinase produced by bacteria.
• It is also acid resistant
• It is more active against penicillinase-producing staphylococci.
• It is incompletely absorbed from the oral route especially when taken on an empty stomach.
• It is more than 90% plasma bound.
• The plasma half-life is 1 hour.
• It is given in doses of 0.25 – 0.5 g orally 6 hourly.

Question 6. Cephalosporins.
Answer:

Cephalosporins are semisynthetic antibiotics with a beta-lactam ring.

They have a wider spectrum of activity.

Cephalosporins Classification:

1. Cephalosporins First generation

• Parenteral – cephalothin, cefazolin.
• Oral – cephalexin, cefadroxil.
  • They are very effective against gram-positive organisms and less against gram-negative.

2. Cephalosporins Second generation

• Parenteral – cefamandole, cefuroxime.
• Oral-cefachlor.
  • They are more active against gram-negative or, paganism and some are active against anaerobes

3. Cephalosporins Third generation

• Parenteral – cefotaxime, ceftriaxone.
• Oral – cefixime.
  • They are highly resistant to beta-lactamase.
  • Have good activity against gram-negative organisms.
  • They are rarely used in dentistry.

4. Cephalosporins Fourth generation

• Parenteral – cefepime, cefpriome.
• Active against gram-positive and gram-negative organisms.
• More resistant to b-lactamases.
• Used in septicemia, nosocomial, and in infections in immune-compromised patients.

Cephalosporins  Adverse reactions

• Pain at the site of injection.
• Hypersensitivity reactions.
• Nephrotoxicity.
• Bleeding diarrhoea
• Neutropenia – low WBC count
• Disulfiram-like reaction with alcohol.

Cephalosporins Uses:

• Dental infections.
• Used as an alternative to penicillin.
• Urinary, respiratory, and soft tissue infections.
• Surgical prophylaxis.
• Gonorrhoea
• Meningitis
• Septicaemia.
• Typhoid.
• Mixed aerobic – anaerobic infections.
• Nosocomial or hospital-acquired infections
• Prophylaxis and treatment of infections in neutropenic patients.

Beta-lactamase inhibitors

Question 7. Semi-synthetic penicillin.
Answer:

Semi-synthetic penicillin Classification:

1. Acid-resistant penicillin – Penicillin V

2. Penicillinase-resistant penicillin – methicillin, clock- oxacillin.

3. Extended-spectrum penicillin.

• Aminopenicillin – ampicillin, amoxicillin.
• Carboxypenicillin – carbenicillin, ticarcillin.
• Ureidopenicillin – peracillin.

4. p-lactamase inhibitors.

• Clavulanic acid, sulbactam.

Semi-synthetic penicillin Advantages over natural penicillin:

• Effective orally.
• Have a wider spectrum of activity
• Resistance to b-lactamases
• Hypersensitivity reactions are less.

Question 8. Compare amoxicillin and ampicillin.
Answer:

Question 9. 3r^d generation cephalosporins.
Answer:

• They are highly resistant to beta-lactamase
• Active against Gram-negative and pseudomonas
• Less active against Gram-positive and anaerobes

3r^d generation cephalosporins Example

Question 10. Amoxicillin.
Answer:

It is aminopenicillin

Amoxicillin Spectrum of Action:

• Cocci – streptococcus viridians, enterococci, pneumococci, gonococci, meningococci
• Gram negative bacteria – E.coli, proteus, salmonella

Amoxicillin Mechanism of Action:

• The bacterial cell wall consists of peptidoglycan chains
• These require transpeptidase enzymes
• Penicillin inhibits transpeptidase → which inhibits the synthesis of peptidoglycan → results in the formation of cell wall deficient bacteria → causes lysis → bacteriocidal

Amoxicillin Uses:

• Typhoid
• Respiratory infections
• Urinary tract infection
• Gonorrhoea
• Subacute bacterial endocarditis
• The most commonly used antibiotics for dental use
• Drug of choice for prophylaxis for endocarditis

Amoxicillin Adverse Effects:

• Adverse effects are rare
• Diarrhea – due to irritation of the lower part of the intestine and alteration of bacterial flora
• Skin rashes

Side effects of beta-lactam antibiotics

Beta Lactum Antibiotics Short Question And Answers

Question 1. Probenecid and penicillin are used in chemotherapy.
Answer:

Probenecid is combined with penicillin because.

• Probenecid competes with penicillin for active tubular secretion.
• Retards their excretion.
• Increases plasma concentration of penicillin.
• Increases duration of action of penicillin. Thus, this combination is used in.
  • Treatment of bacterial endocarditis.
  • Gonococcal infections.

Question 2. Uses of benzylpenicillin or Penicillin G.
Answer:

1. Therapeutic uses:

• Orodental infections.
• Pneumococcal infections.
• Streptococcal infections.
• Meningococcal infections
• Staphylococcal infections
• Syphilis
• Diptheria
• Anaerobic infection
• Actinomycosis.
• Tetanus and gas gangrene.

2. Prophylactic uses.

• Rheumatic fever.
• Agranulocytosis
• Sexually transmitted diseases like syphilis and gonorrhea
• Surgical prophylaxis.

Question 3. The rationale for combining amoxicillin and clavulanic acid. Write one indication of this combination.
Answer:

Ciavulanic acid has a beta-lactam ring but no antibacterial activity.

• The combination of amoxicillin and clavulanic acid causes:
• Extension of the antibacterial spectrum.
• Inhibits beta-lactamase-producing organisms.
• After binding to the b-lactamase enzyme, clavulanic add itself gets inactivated, hence it is called a sudden inhibitor.

Amoxicillin and clavulanic acid Indications:

• Skin and soft tissue infections.
• Urinary tract infections.
• Respiratory tract infections.
• Orodental infections.
• Nosocomial infections.
• Gonorrhoea.

Question 4. D-penicillamine.
Answer:

D-penicillamine is a copper-chelating agent

D-penicillamine Uses:

• As chelating agent
• Use in rheumatoid arthritis.

D-penicillamine Adverse effects:

• Loss of taste.
• Systemic lupus erythematosus.
• Myasthenia gravis.

Question 5. Amoxicillin.
Answer:

Amoxicillin is a semi-synthetic penicillin.

Advantages over ampicillin:

• Good oral absorption.
• Food does not interfere with absorption.
• Diarrhea and skin rashes are less.

Amoxicillin Uses:

• Typhoid
• Respiratory tract infections.
• Urinary tract infections.
• Gonorrhoea.
• Subacute bacterial endocarditis.

Question 6. Adverse effects of penicillin.
Answer:

• Hypersensitivity reaction.
• Pain at the site of injection.
• Superinfection.
• CNS effects – hallucination, coma.
• Jewish Herxheimer reactions.

Question 7. β-lactamase inhibitors.
Answer:

Beta-lactamase inhibitors are the drugs that bind to inactive β-lactamases preventing the destruction of the β-lactam antibiotics.

Beta-lactamase inhibitors:

1. Clavulanic acid

• Competitively and irreversibly inhibits b-lactamases.
• It is a progressive inhibitor.
• It is combined with amoxicillin and ticarcillin.

2. Sulbactam

• It is combined with ampicillin.
• It is given parenterally for mixed aerobic-anaerobic infections.

3. Tazobactum

It is combined with piperacillin for parenteral administration.

Beta-lactam ring function

Question 8. Why penicillin is not combined with sulphonamide?
Answer:

Penicillin is bacteriocidal while sulphonamide is bacteriostatic.

• Sulphonamide retards the multiplication of bacteria.
• Penicillin acts on actively multiplying bacteria.
• Thus combining penicillin and sulphonamide causes antagonism instead of synergism of both drugs.
• Hence, penicillin is not combined with sulphonamides.

Question 9. Amoxicillin.
Answer:

It is aminopenicillin

Cefixime Mechanism of Action:

• The bacterial cell wall consists of peptidoglycan chains
• These require transpeptidase enzymes
• Penicillin inhibits transpeptidase → which inhibits the synthesis of peptidoglycan → results in the formation of cell wall deficient bacteria → causes lysis → bacteriocidal

Cefixime Uses:

• Typhoid
• Respiratory infections
• Urinary tract infection
• Gonorrhoea
• Subacute bacterial endocarditis
• The most commonly used antibiotics for dental use
• Drug of choice for prophylaxis of endocarditis

Cefixime Adverse Effects:

• Adverse effects are rare
• Diarrhea – due to irritation of the lower part of the intestine and alteration of bacterial flora
• Skin rashes

Penicillin group antibiotics

Question 10. Cefixime.
Answer:

• It is a third-generation cephalosporin
• Highly resistant to beta-lactamase
• Have good activity against gram-negative organisms
• Less active against Gram-positive and anaerobes
• Rarely used in dentistry
• Given orally.
• Dose: 200-400 mg BD
• Plasma half-life – 3 hours

Cefixime Uses:

• Respiratory infections
• Biliary infections
• Urinary infections
• Adverse effects
• Stool changes
• Diarrhea

Aminoglycosides Important Notes

1. Aminoglycosides

• They contain amino carbohydrate complexes with glycoside bonding
• Drug of choice for gram-negative infection
• Acts by blocking mRNA
• Aminoglycosides Examples
  • Streptomycin
  • Kanamycin
  • Amikacin
  • Gentamycin
  • Netilmycin
• Aminoglycosides Adverse effects
  • Ototoxicity
  • Nephrotoxicity
  • Neuromuscular blockade
  • Topically used aminoglycosides
  • Neomycin
  • Gentamycin

Read And Learn More: Pharmacology Question and Answers

Aminoglycosides Long Essays

Question 1. Enumerate aminoglycoside antibiotics. Write antibacterial spectrum mechanism of action uses and adverse effects of gentamicin.
Answer:

Aminoglycosides:

Aminoglycosides are a group of natural and semisynthetic antibiotics having polybasic amino groups linked glycosidically to two or more.

Aminoglycosides Classification:

1. Systemic aminoglycosides

Streptomycin, gentamicin, kanamycin, tobramycin, amikacin, netilmicin.

2. Topical aminoglycosides

Neomycin, framycetin.

Gentamicin:

• It is obtained from micromonospora purpurea.
• It is a commonly used aminoglycoside.
• It is more potent

Gentamicin Anti-bacteial spectrum:

• It has a broader spectrum of activity.
• Effective against P.aeruginosa and most strains of proteus, E-coli, klebsiella, enterobacter, and Serratia.
• Inhibits strep. Faecalis and some staph. Aureus.

Aminoglycosides pharmacology

Anti-bacterial spectrum Mechanism of action:

1. Blocking initiation of protein synthesis by
2. Terminating protein synthesis.

Gentamicin Uses:

1. In dentistry

Gentamicin 2 mg/kg IM/IV single dose is given to supplement amoxicillin or vancomycin for prophylaxis of bacterial endocarditis.

2. General medical uses

• Urinary tract infections.
• Pneumonia – used along with penicillin.
• Used in preventing and treating. Respiratory infections in critically ill patients.
• Osteomyelitis, peritonitis, septicaemia.
• Bacterial endocarditis – used in place of streptomycin.
• Topical uses.
  • As cream – in bums and infected wounds.
  • As eye drops – in conjunctivitis.

Gentamicin Adverse effects:

1. Ototoxicity

• The vestibular or cochlear part may be primarily affected.
• Sensory cells present undergo destructive changes.
• Tinnitus appears first, followed by deafness.
• Vestibular dysfunction is characterized by headache, nausea, vomiting, dizziness, vertigo, nystagmus and ataxia.

2. Nephrotoxicity

• Manifests as tubular damage resulting in loss of urinary concentrating power, low GFR, nitrogen retention, and albuminuria.
• Effects are reversible.

3. Neuromuscular blockade

Aminoglycosides reduce acetylcholine release from motor nerve endings.

Aminoglycosides Short Essays

Question 1. Neomycin.
Answer:

It is a topical aminoglycoside.

It is a wide-spectrum aminoglycoside.

Neomycin Uses:

1. Topical use

Used for infected wounds, ulcers, burns, external ear infections, and conjunctivitis.

2. Oral use

• Preparation of bowel before surgery.
• Hepatic coma.

Neomycin Adverse effects:

• Highly ototoxic.
• Oral use causes diarrhoea, steatorrhea and malabsorption syndrome.
• Skin rashes on topical use.

Aminoglycosides side effects

Aminoglycosides Short Question And Answers

Question 1. Aminoglycoside.
Answer:

Aminoglycoside Classification:

1. Systemic aminoglycosides

Streptomycin, gentamicin, konamydn, amikacin.

2. Topical aminoglycosides

Neomycin, framycetin.

Aminoglycoside Properties:

• They are not absorbed orally.
• All are sulphate salts.
• Highly water soluble.
• Distribute only extracellularly.
• Do not penetrate CSF.
• Excreted unchanged by the kidneys.
• All are bacteriocidal.
• Act by inhibiting bacterial protein synthesis.
• They are more active at alkaline pH.
• All are active primarily against aerobic gram-negative bacilli.
• There is partial cross-resistance among them.
• Have a narrow margin of safety.
• Exhibit nephrotoxicity and ototoxicity.

Question 2. Streptomycin.
Answer:

Streptomycin is the oldest aminoglycoside.

• It is obtained from streptomyces griseus.
• It is not metabolized, so excreted unchanged in the urine.
• Plasma t½ -2-4hours.

Streptomycin Uses:

• Tuberculosis.
• Subacute bacterial endocarditis.
• Plague, tularaemia, brucellosis.

Streptomycin Adverse effects:

• Less nephrotoxic.
• Less ototoxic.
• Hypersensitivity reactions – rashes, eosinophilia, fever and exfoliative dermatitis.
• Pain at the site of injection.
• Rarely paresthesia occurs.

Aminoglycosides mechanism of action

Question 3. Gentamicin.
Answer:

Gentamicin Uses:

1. In dentistry

Gentamicin 2 mg/kg IM/IV single dose is given to supplement amoxicillin or vancomycin for prophylaxis of bacterial endocarditis.

2. General medical uses

• Urinary tract infections.
• Pneumonia – used along with penicillin.
• Used in preventing and treating. Respiratory infections in critically ill patients.
• Osteomyelitis, peritonitis, septicaemia.
• Bacterial endocarditis – used in place of streptomycin.
• Topical uses
  • As cream – in burns and infected wounds.
  • As eye drops – in conjunctivitis.

Gentamicin Adverse effects:

1. Ototoxicity

• The vestibular or cochlear part may be primarily affected.
• Sensory cells present undergo destructive changes.
• Tinnitus appears first, followed by deafness.
• Vestibular dysfunction is characterized by headache, nausea, vomiting, dizziness, vertigo, nystagmus and ataxia.

2. Nephrotoxicity

• Manifests as tubular damage resulting in loss of urinary concentrating power, low GFR, nitrogen retention, and albuminuria.
• Effects are reversible.

3. Neuromuscular blockade

Aminoglycosides reduce acetylcholine release from motor nerve endings

Aminoglycosides antibiotics

Question 4. Adverse effects of Aminoglycosides.
Answer:

1. Ototoxicity

• The vestibular or cochlear part may be primarily affected
• Sensory cells present undergo destructive changes
• Tinnitus appears first followed by deafness
• Vestibular dysfunction Is characterized by headaches. nausea, vomiting, dizziness, vertigo, nystagmus and ataxia

2. Nephrotoxicity

• Manifests as tubular damage resulting in loss of urinary concentrating power, low GFR, nitrogen retention, albuminuria
• Effects are reversible

3. Neuromuscular blockade

Aminoglycosides reduce acetylcholine release from motor nerve endings

Macrolides Important Notes

1. Macrolide Antibiotics

• They have large lactone ring
• They are used as an alternative to penicillin

Macrolides Classification:

Macrolide antibiotics questions and answers

2. Macrolides Erythromycin

• Given in patients allergic to penicillin
• Effective against all penicillin-sensitive organisms and penicillin-resistant streptococci
• Inactivated by gastric acid
• Thus available in enteric-coated tablets
• It is bacteriostatic at low concentrations and bacteriocidal at high concentrations

Read And Learn More: Pharmacology Question and Answers

Macrolide Antibiotics

Macrolides Long Essays

Question 1. Enumerate macrolide antibiotics. Describe the antimicrobial spectrum and therapeutic uses of erythromycin.
Answer:

Macrolide antibiotics:

• These are antibiotics having a macrocyclic lactone ring with attached sugars.
• They are

1. Erythromycin.
2. Roxithromycin.
3. Clarithromycin.
4. Azithromycin.

Erythromycin:

It is isolated from streptomyces erythroid.

Macrolide Antibiotics

Erythromycin Antibacterial spectrum:

• Erythromycin has a narrow spectrum.
• It is effective against aerobic gram-positive bacteria and a few gram-negative organisms.
• Streptococci, pneumococci, staphylococci, gonococci, C.diptheria, B. Pertussis, and some atypical mycobacteria.

Macrolides pharmacology MCQs

Erythromycin Uses:

1. Orodental infections

• Used in the prevention and treatment of oriental infections including post-extraction infections, periapical abscesses, and other periodontal lesions.
• Used in patients who are allergic to penicillin.

2. Medical use

• Atypical pneumonia.
  • Erythromycin – 500 mg 6 hourly oral or IV is used.
• Legionnaire’s pneumonia.
  • Treated for 10 – 14 days with erythromycin.
• Whooping cough.
• Streptococcal infections like pharyngitis tonsillitis and scarlet fever.
• Staphylococcal infections.
• Diptheria.
• Syphilis and gonorrhea.
• Tetanus, anthrax.

3. Topical use

• Ointment – for skin infections and boils.
• Lotions – for acne vulgaris.

4. Prophylactic use

• In valvular heart disease patients.
• For rheumatic fever.

Erythromycin Adverse effects:

1. Gastrointestinal disturbances

• Erythromycin induces gastric contractions, hastens gastric emptying, and promotes intestinal motility.
• Causes epigastric pain.
• Rarely diarrhea occurs.

Macrolide Antibiotics

2. Hepatitis with cholestatic jaundice

• Starts after 2-3 weeks of treatment
• Symptoms are Nausea, vomiting, abdominal cramps, and mimic acute cholecystitis.

3. Hypersensitivity reactions

Fever, skin rashes.

4. Cardiac arrhythmias in patients with cardiac disease.

5. Reversible hearing impairment

Macrolides Short Essays

Question 1. Difference between amoxicillin and gentamicin.
Answer:

Macrolides uses and side effects

Macrolides Short Question And Answers

Question 1. Compare penicillin and erythromycin.
Answer:

Question 2. Macrolide antibiotics.
Answer:

Macrolides are antibiotics with a macrocyclic lactone ring to which sugars are attached.

Macrolide Antibiotics

They are:

1. Erythromycin.
2. Roxithromycin.
3. Clarithromycin.
4. Azithromycin.

They are bacteriostatic at low concentrations and bacteriocidal at high concentrations.

Macrolide antibiotics Mechanism:

Erythromycin pharmacology questions

Macrolides Short Question And Answer

Question 1. Azithromycin
Answer:

• It is a derivative of erythromycin
• It is acid stable
• Rapidly absorbed, absorption is decreased by food
• Has better tissue permeability
• Longer-acting
• Better tolerated
• Plasma half-life – 3 days
• Free of drug interactions
• Azithromycin Uses
• • Prophylactic use
  • Treatment of atypical mycobacterial infections in AIDS patients
  • Respiratory infections
  • Genital and skin infections
  • Pneumonias
  • Orodental infection instead of erythromycin
  • Acute exacerbation of chronic bronchitis
• Azithromycin Adverse effects
• Mild gastric upset
• Abdominal pain
• Headache
• Dizziness

Drugs Used In Psychiatric Disorders Important Notes

1. Classical antipsychotic drills – block dopamine D2 receptors

• Chlorpromazine
• Halo peridot
• Zudopenthixol
• Thioridazine

2. Atypical antipsychotic drugs – block 5-HT2 and D4 receptors

• Clozapine
• Olanzapine
• Risperidone

Read And Learn More: Pharmacology Question and Answers

3. Disorders Adverse effects of antipsychotic drugs

Psychiatric drugs questions and answers

4. Anti-anxiety drugs

5. Oxazepam

• It is preferred in elders and in patients with liver disease
• Duration of action is short
• Used mainly in short-lasting anxiety

6. Migraine

• Drugs used for its treatment
  • Mild – simple analgesics + antiemetic
  • Moderate – NSAIDs combination
  • Severe – ergot alkaloids + antiemetic + prophylaxis
• Drugs used for prophylaxis
  • Propranolol
  • Amitriptyline
  • Flunarizine
  • Valproate
  • Methysergide

7. Chlorpromazine

• It belongs to the phenothiazine
• Exhibit antipsychotic action by blocking dopaminergic receptors in CNS
• They are also potent antiemetics

8. Antidepressants

• Act by inhibiting the uptake of biogenic amines like noradrenaline, serotonin, and dopamine
• They are
• Tricyclic compounds – Imipramine, Amitriptyline
• MOA inhibitor – Isocarboxazid, Phenelzine

Antipsychotic drugs pharmacology questions

Drugs Used In Psychiatric Disorders Short Essays

Question 1. Chlorpromazine.
Answer:

Chlorpromazine is phenothiazine with an aliphatic side chain.

Chlorpromazine Mechanism of action:

• Chlorpromazine has potent dopamine D2 receptor-blocking action.
• It also blocks Dl, D3, and D4 receptors.

Chlorpromazine Actions:

1. Chlorpromazine CNS effects.

• In normal individuals.
  • Reduces motor activity.
  • Produces drowsiness.
  • Reduces initiative.
• In psychotic individuals.
  • Reduces irritational behavior, agitation, and aggressiveness.
  • Normalises sleep.
• Other actions.
  • Cortex – lowers the seizure threshold.
  • Hypothalamus – decreases gonadotropin secretion.
  • Basal ganglia – Acts as a dopamine antagonist
  • Brain stem- depresses vasomotor reflexes.
  • CTZ – Act as antiemetic.

2. Chlorpromazine Autonomic nervous system.

Chlorpromazine has anticholinergic properties.

3. Chlorpromazine CVS

Has a myocardial depressant effect

4. Chlorpromazine Local anesthesia – Has local anesthetic effect.

5. Chlorpromazine Kidney – depresses ADH secretion.

Chlorpromazine Uses:

• Schizophrenia.
• Mania.
• Organic brain syndrome.
• As antiemetic.
• Hiccough.
• Anxiety.

Drugs used in psychiatric disorders PDF

Chlorpromazine Adverse Effects:

1. Chlorpromazine Dose-related.

• CNS effects – drowsiness, lethargy, mental confusion.
• CVS effects – postural hypotension, palpitation.
• Anticholinergic – dry mouth, blurring of vision constipation.
• Endocrine – amenorrhoea, infertility.
• Extrapyramidal disturbances – parkinsonism, acute muscle dystonia, akathisia, malignant neuroleptic syndrome, tardive dyskinesia.
• Others – weight gain, blue pigmentation of skin, corneal ulceration, retinal degeneration, cardiac arrhythmia.

2. Chlorpromazine Hypersensitivity reactions.

• Cholestatic jaundice.
• Skin rashes, urticaria, contact dermatitis
• Agranulocytosis.

Question 2. Classification of antipsychotic drugs.
Answer:

Anti-psychotic drugs/neuroleptics:

These drugs have a therapeutic effect on psychosis.

1. Anti-psychotic drugs Phenothiazines

• Aliphatic side chain – chlorpromazine, trifluoro- magazine.
• Piperidine side chain – thioridazine.
• Piperazine side chain. Trifluoperazine, fluphenazine.

2. Anti-psychotic drugs Butyrophenones

Haloperidol, trifluperiodol, penfluridol.

3. Anti-psychotic drugs Thioxanthenes

Flupenthixol.

4. Anti-psychotic drugs Other heterocyclics

Pimozide, loxapine.

5. Anti-psychotic drugs Atypical antipsychotics

Clozapine, risperidone, olanzapine, quetiapine.

Question 3. Neuroleptoanalgesia.
Answer:

Neuroleptanalgesia is a state of analgesia characterized by quiescence, psychic indifference, and intense analgesia without loss of consciousness.

It is obtained by a combination of.

1. Fentanyl – 0.05 mg – short-acting drug.

2. Droperidol – 2.5 mg/ml – rapidly acting drug.

4 – 6 ml of it is infused IV for 10 min.

Neuroleptoanalgesia Advantages:

The patient is drowsy but cooperative.

Neuroleptoanalgesia Adverse Effects:

• Respiratory depression.
• Slight fall in BP and heart rate.
• Extrapyramidal symptoms may be present.

Neuroleptoanalgesia Uses:

• Endoscopies.
• Burn dressing.
• Angiography.
• Diagnostic procedures.
• Minor surgical procedures.

Classification of psychiatric drugs

Drugs Used In Psychiatric Disorders Short Question And Answers

Question 1. Four drugs are used in mental depression.
(or)
Anti-depressants.
Answer:

Anti-depressants Classification:

1. Reversible inhibitors of MAO-A.

Moclobemide, clorgyline.

2. Tricyclic antidepressant

• Na + 5 HT reuptake inhibitors.
• Imipramine, Trimipramine, Amitriptyline.
• Predominantly NA reuptake inhibitors
• Desipramine, nortriptyline.

3. Selective serotonin reuptake inhibitors.

Fluoextine, fluvoxamine, paroxetine.

4. Atypical antidepressants.

Trazodone, minaserin, mirtazapine, venlafaxine.

Drug therapy for psychiatric disorders

Question 2. Analeptic drugs.
Answer:

Analeptic drugs are drugs that stimulate respiration and have resuscitative effects in fainting or coma.

Analeptic drugs Uses:

• Hypnotic drug poisoning.
• Suffocation on drowning.
• Respiratory failure due to removal of the hypoxic drive.
• Apnea in premature infants.

Analeptic drugs Adverse Effects:

• Convulsion.
• Postictal depression.

Dental Pharmacology Important Notes

1. Drugs causing dry mouth

• Anticholinergic
• Ganglion blocking agents
• Antihistamines

2. Drugs causing gingival hyperplasia

• Phenytoin
• Nifedipine
• Cyclosporines

Dental pharmacology important questions and answers

Read And Learn More: Pharmacology Question and Answers

Dental Pharmacology Short Essays

Question 1. Mummifying agents.
Answer:

• Mummifying denotes the hardening of dead tissue and rendering it resistant to microbial attack and degradation
• Mummifying agents were used earlier before the use of root canal-filling materials
• They were used to kill tissues in the tooth pulp, make it hard and dry so it does not get infected later
• Mummifying agents are

1. Formaldehyde or paraformaldehyde

• It is mixed with zinc oxide or zinc sulfate + creosote
• A paste is made by it to fill the root canal
• Paraformaldehyde releases formaldehyde slowly which
  • Destroys all living tissues of the pulp
  • Hardens it
  • Makes it more resistant to future infection
• To prevent pain caused by filling, lidocaine may be added to the paste

2. Iodoform + phenol

• The paste is made of it glycerine
• Eugenol or cinnamon oil may be added to add frag- nance
• Liberated iodine or phenol helps to keep the pulp uninfected

3. Tannic acid

• Mixed with an additive to get a paste form

Question 2. Drugs used in Halitosis.
Answer:

• Halitosis is an unpleasant odor exhaled in breathing
• Treatment of halitosis depends on the cause

1. Mouthwashes – containing antibacterial agents including

• Cetylpyridium chloride
• Chlorhexidine
• Zinc gluconate
• Essential oils
• Hydrogen peroxide
• Chlorine dioxide
  • Mouthwashes can temporarily stain teeth
  • Chlorhexidine is a chemical antiseptic
  • It kills volatile sulfur compounds producing bacteria
  • Cetylpyridium chloride has bacteriocidal action which kills the bacteria and microbes present in the mouth causing halitosis
  • Chlorine dioxide effectively reduces plaque, tongue coating accumulation, and Fusobacterium nucleatum count in saliva

2. Cimetidine

• When the gastric acid in the stomach flows bade up into the food pipe due to indigestion it causes heartburn and bad breath
• Cimetidine is H2 receptor antagonist
• It is used to treat the heartburn

3. Ranitidine

• It is an antacid
• Inhibits gastric add secretion

Dental drugs classification and uses

Question 3. Dentrifrice.
Answer:

• It is a substance used with a toothbrush for the purpose of cleaning the accessible surfaces of teeth
• Used in the form of powder, paste, or gel

Dentrifrice Functions:

• Minimize plaque build-up
• Anticaries action
• Removal of stains
• Mouth freshener

Dentrifrice Composition:

• Abrasive
• Calcium carbonate
• Calcium phosphate
• Humectants
• Maintains moisture
• Glycerine, sorbitol
• Preservatives
• Benzoic acid
• Thickening agents
• Methylcellulose
• Foaming agents
• Sodium lauryl sulfate
• Flavoring agents
• Mint
• Sweetening agents
• Mannitol saccharine
• Desensitizing agents
• Sodium fluoride
• Anticalculus agent
• Pyrophosphates

Question 4. Disclosing agents.
Answer:

• They are prepared in liquid, tablet, or lozenge form that contains a dye or other coloring agent
• It is used to identify bacterial plaque for instruction, evaluation, and research

Disclosing agents Purpose:

• Patient’s education
• Evaluate the effectiveness of the treatment
• Evaluate plaque indices
• Self-evaluation

Disclosing agents Requirements:

• Color should contrast with the normal color of the oral cavity
• It should not rinse off immediately
• It should not have bad taste
• It should not cause any irritation
• It should be thin enough

Disclosing agents Agents:

• Iodine containing preparation
• Bismarck brown
• Merbromin
• Erythrosine
• Fast green
• Two-tone

Dental pharmacology MCQs with answers

Dental Pharmacology Short Question And Answers

Question 1. Use of fluorides in caries.
Answer:

• Fluorides make the tooth more resistant to caries
• It has weak antibacterial action
• It can be administered either systemically or locally to the teeth
  • Topical fluoride
  • Placed directly on the teeth
  • It includes

1. Fluoride toothpaste

• A most common and effective method
• Salts used in it are sodium fluoride, sodium mon- fluorophosphate or stannous fluoride
• It should not be swallowed to avoid systemic toxicity

2. Fluoride mouth rinses

• Sodium fluoride and stannous fluoride are used as daily mouth rinses
• The rinse solution is held in the mouth for 1-3 minutes and swished around and then discarded

3. Professionally applied fluoride

• It includes – APF gel and fluoride varnishes
  • Systemic fluoride
    • Circulate through the bloodstream and are incorporated into developing teeth
    • It includes

Water fluoridation

• It is the upward adjustment of the concentration of fluoride ions in a public water supply in such a way that the concentration of fluoride ion in the water may be consistently maintained at one part per million by weight to prevent dental caries with minimum possibility of causing dental fluorosis

Salt fluoridation

• Fluoride is added to salt by spraying concentrated solutions of sodium fluoride and potassium fluoride on salt on a conveyor belt

Milk fluoridation

• Milk is an excellent source of calcium and phosphorous
• It contains all essentials for the development of bone and teeth

Dental pharmacology viva questions

Question 2. Sweetening agents.
Answer:

• They are substances used to impart a sweet taste to a pharmaceutical preparation
• They are used in centrifuges to
  • Mask their blandness
  • Improve their taste
  • Make them acceptable
• Agents used are

1. Saccharin

• It is an artificial sweetener
• 500 times more sweet than sugar
• It is no cariogenic
• Used as a dilute solution
• Excreted unchanged within 24 hours
• It is stable and nontoxic
• Enhances palatability

2. Sorbitol

3. Glycerol

Dental pharmacology previous year questions

Question 3. Obtundents.
Answer:

• Obtundents are agents that diminish dentin sensitivity
• When applied to the teeth and gums it produces numbness that could dampen toothache
• They penetrate poorly and do not relieve deep pain

Obtundents Disadvantages:

• Pulp may shrink
• Irritants may stimulate the formation of secondary dentin

Obtundents Agents:

Histamines And Antihistamines Important Notes

1. Antihistamines

• Antihistamines Uses
• • Common cold
  • Anti-allergic
  • Insect bite
  • Idiopathic pruritis
  • Motion sickness
  • Vertigo

Pharmacology of antihistamines questions

Read And Learn More: Pharmacology Question and Answers

Histamines And Antihistamines Short Essays

Question 1. Mention four newer antihistamines with their advantages.
Answer:

• Newer Antihistamines are:
  • Fexofenadine
  • Loratadine
  • Cetrizine
  • Azelastine
  • Mizolastine
  • Terfenadine

Newer Antihistamines Advantages:

• Donot impair psychomotor performance
• Produce no subjective effects
• No sedation as they poorly cross the blood-brain barrier
• No anticholinergic side effects

Question 2. Mention four therapeutic uses of HI blockers.
Answer:

Uses of H1 Blockers:

1. Allergic reactions

• • Block the effects of released histamine
  • Control Immediate types of allergies like Itching, urticaria, angioedema
  • Cetrizine has an adjuvant role In seasonal asthma

2. Prurltldes

• • Older H1 blockers are used In Idiopathic pruritus

3. Common cold

• • Provide symptomatic relief by anticholinergic and sedative actions

4. Motion sickness

• • Promethazine and diphenhydramine are used prophylactically in motion sickness
  • It should be taken one hour before the journey

5. Vertigo

• • Inhibits vestibular sensory nuclei in the inner ear

6. Preanasethetic medication

• • Promethazine is used for it
• It includes the following groups

Pharmacology of antihistamines questions

7. Cough

• • Provide symptomatic relief

8. Parklsonism

• • Provide symptomatic relief

9. Acute muscle dystonia

• • Due to Its central anticholinergic action

10. As sedative, hypnotic, and anxiolytic

Question 3. Autocoids
Answer:

• Autocoids are substances formed in various tissues, have complex physiological and pathological actions, and act locally at the site of synthesis
• They are called local hormones
• They serve as transmitters or moderators in the nervous system
• They have brief action and are destroyed locally

Question 4. Antihistamines
Answer:

• Antihistamines are the drugs that competitively antagonize the action of histamine at H1 receptors

Antihistamines Classification

Antihistamines Uses:

• Allergic disorders
• Priorities
• Common cold
• Cough
• Motion sickness
• Preanasethetic medication
• Vertigo
• Parkinsonism
• Acute muscle dystonia
• As sedative, hypnotic, anxiolytic
• To control mild blood transfusion and saline infusion reactions

Question 5. Enumerate two nonsedative Antihistamines and mention four uses of them.
Answer:

Non Sedative Antihistamines:

• Fexofenadine
• Loratadine
• Cetrizine
• Azelastine
• Mizolastine
• Terfenadine

Non Sedative Antihistamines Uses:

• Allergic rhinitis, conjunctivitis, hay fever
• Control sneezing and runny nose, red watering eyes
• Urticaria, dermographism, atopic eczema
• Acute allergic reactions to drugs and food

Classification of antihistamines questions

Histamines And Antihistamines Short Question And Answers

Question 1. Cyproheptadine
Answer:

Cyproheptadine is a serotonin antagonist

Cyproheptadine Actions:

• Blocks 5-HT₂
• Blocks H1 receptors
• Blocks cholinergic receptors
• Increases appetite

Cyproheptadine Uses:

• Promote weight gain in children and poor eaters
• To control intestinal manifestations of carcinoid tumors

Question 2. Non sedative Antihistamines
Answer:

Non Sedative Antihistamines:

• Fexofenadine
• Loratadine
• Cetrizine
• Azelastine
• Mizolastine
• Terfenadine

Non Sedative Antihistamines Uses:

• Allergic rhinitis, conjunctivitis, hay fever
• Control sneezing and runny nose, red watering eyes
• Urticaria, dermographism, atopic eczema
• Acute allergic reactions to drugs and food

Non-Sedative Antihistamines Advantages:

• Donot impair psychomotor performance
• Produce no subjective effects
• No sedation as they poorly cross the blood-brain barrier
• No anticholinergic side effects

Question 3. Cetrizine
Answer:

• Cetrizine is non sedative Antihistamines
• It can metabolite of hydroxyzine with a marked affinity for peripheral H1 receptors
• It is well absorbed orally
• It attains high and long-lasting concentration in the skin

Cetrizine Actions:

• Inhibits the release of histamine and cytotoxic mediators from platelets
• Inhibits Eosinophil chemotaxis during the secondary phase of the allergic response

Cetrizine Uses:

• Upper respiratory allergies, pollinosis, Urticaria, atopic dermatitis
• Adjuvant to seasonal asthma

Uses and side effects of antihistamines questions

Question 4. Ergometrine
Answer:

• Ergometrine is an amine ergot alkaloid
• It is a very weak Agonist
• It has no antagonist action on alpha-adrenergic receptors
• The emetic potential is low
• They are rapidly and completely absorbed
• The plasma half-life is 1-2 hours
• Onset of action

Ergometrine Uses:

• To control and prevent postpartum hemorrhage
• To prevent uterine atony
• To ensure normal involution

Question 5. Promethazine
Answer:

• Promethazine is a highly sedative H1 antagonist

Promethazine Uses:

• Allergic disorders
• Pruritis
• Common cold
• Preanasethetic medication
• Parkinsonism

Question 6. Prostaglandins
Answer:

• Prostaglandins are biologically active derivatives of 200-carbon atom polyunsaturated fatty acids
• They are major lipid-derived autocoids

Prostaglandins Actions:

First and second-generation antihistamines MCQs

Question 7. Uses of ergot alkaloids
Answer:

Blood Important Notes

1. Heparin

• It is a powerful anticoagulant
• Effective both in vivo and vitro
• Present in all tissues containing mast cells
• In high doses, inhibits platelet aggregation and prolongs bleeding time
• Activates plasma antithrombin III
• This inactivates dotting factors of common and intrinsic pathways
• It does not cross the blood-brain barrier or placenta
• Thus it is safer during pregnancy

Blood MCQ questions and answers

Read And Learn More: Pharmacology Question and Answers

2. Styptics:

• They are local hemostatic agents
• Particularly effective on oozing surfaces
• Examples: thrombin, fibrin, gelatin foam, astringents like tannic add, vasoconstrictors like adrenaline

3. Drugs and anticoagulant action

4. Contraindications of vasoconstrictors

• Hypertension
• Hyperthyroidism
• Angina
• Patients receiving beta-blockers
• During anesthesia with halothane

3. Antiplatelet drugs

• Uses
  • Coronary artery disease
  • Cerebrovascular disease
  • Coronary angioplasty, bypass implants
  • Prosthetic heart valves
  • Venous thromboembolism
  • Peripheral vascular diseases
• Examples
  • Aspirin
  • Dipyridamole
  • Ticlopidine
  • Clopidogrel
  • Abcbdmab
  • Glycoprotein receptor antagonist

4. Vitamin K

5. Anticoagulants

• In vitro – Citrate, oxalate, EDTA
• In vivo – Coumarin, warfarin
• Both Vivo and vitro – heparin

6. Antifibrinolytics

• Epsilon amino Caproic acid
• Tranexamic acid

7. Iron preparation

8. Blood substitutes

• Blood products
  • Whole blood
  • Plasma
  • Plasma proteins
• colloidal plasma substitutes
  • Dextran
  • Gelatin
• Fluid plasma substitutes
  • 0.9% saline
  • 5% dextrose

9. Daily dose of iron

• Adult male – 0.5-1 mg
• Adult female – 1-2 mg
• Pregnancy – 3-5 mg in the last two trimesters

10. Megaloblastic anemia

• Occurs due to deficiency of vitamin B12 or folic acid
• Treatment includes vitamin B12 + folic acid
• Folic acid given alone may worsen the neurological deficit

Blood short notes for nursing students

Blood Long Essays

Question 1. Explain the mechanism of iron absorption in the body. Add a note on different iron preparations
Answer:

Iron Absorption:

• Dietary iron is in the ferric form bound to proteins or organic acids
• The acidic medium of gastric juice releases this ferric ion
• Later it is converted to ferrous form by reducing substances like ascorbic acid and cysteine
• The ferrous form is soluble and is readily absorbed by mucosal cells
• It is oxidized to ferric form by ferroxidase
• This ferric form then combines with apoferritin and forms ferritin
• Iron from the mucosal cells may enter the bloodstream
• The ferric form is- Fe3+
• The ferrous form is Fe2+
• Gastric acid, reducing substances, and amino acids facilitate iron absorption
• Antacids, tetracyclines, phosphates, and phytates decrease iron absorption

Iron Preparations:

1. Oral iron preparations

It is the preferred route of administration

Oral iron Preparations:

• Ferrous sulfate -200 mg tab
  • Contains 20% hydrated salt and 32% dried salt
  • It is inexpensive
  • Produces a metallic taste in the mouth
• Ferrous gluconate -300 mg tab
  • Contains 12% of iron
  • Causes less gastric irritation
• Ferrous fumarate -200 mg tab
  • Contains 33% iron
  • It is less water soluble and tasteless
• Ferrous succinate -100 mg tab, 35% iron
  • Better absorbed and expensive
• Iron calcium complex -5% iron
  • Better absorbed and expensive
• Ferric ammonium citrate -45 mg tab
  • Better absorbed and expensive

Iron Dose:

• Total -200 mg given daily in 3 divided doses
• Prophylactic dose -30 mg daily

Iron Indications:

• Iron deficiency anemia

Iron Preparations Adverse Effects:

• Nausea, vomiting, epigastric pain
• Heartburn
• Staining of teeth
• Metallic taste
• Constipation

2. Parenteral iron preparations

• Intramuscular injection of iron is given deep in the gluteal region using the Z technique
• Intravenous is given slowly over 5-10 minutes

Blood long essay questions and answers

Parenteral Preparations:

• Iron dextran
  • It is a colloidal solution containing 50 mg of elemental iron
  • It is given intravenously and Intramuscularly
• Iron sorbitol citric acid complex
  • Contains 50 mg of elemental iron
  • Can be given only IM
  • If given IV it quickly saturates transferrin stores
  • Due to it free iron levels in the plasma rise and cause toxicity

Parenteral Dose:

• It is calculated using the formula:
• Iron requirement (in mg] = 4.4 * body weight (in kg) * Hb deficit (in g/dl)

Parenteral Indications:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Parenteral Adverse Effects:

• Pain at the site of injection
• Pigmentation of skin
• Sterile abscess
• Fever
• Headache
• Joint pain, flushing, palpitation
• Chest pain, dyspnoea
• Anaphylactic reaction

2. Systemic agents

Question 2. Enumerate the agents used to control bleeding. Discuss their actions and uses.
Answer:

• Agents that help in controlling bleeding and are used in preventing or treating hemorrhagic conditions are known as coagulants

Control bleeding Classification:

1. Local agents or styptics

Control bleeding Actions:

• These materials provide a meshwork
• This activates the clotting mechanism and checks bleeding.

Question 3. Classify Anticoagulants. Discuss the mechanism of action, uses, and adverse effects of the coumarin derivatives.
Answer:

Anticoagulants:

• Anticoagulants are drugs used to reduce the coagulability of blood

Anticoagulants Classification:

• Used in vivo

1. Parenteral Anticoagulant

• • Heparin, low molecular weight heparin, heparan sulfate

2. Oral Anticoagulants .

• • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione
• Used in vitro

1. Heparin

2. Calcium complexing agents

• • Sodium citrate, sodium oxalate, sodium edetate.

Anticoagulants Coumarin Derivatives:

• Coumarin derivatives are
• Bishydroxycoumarin- Dicoumarol
• Warfarin
• Acenocoumarol- nicoumalone
• Ethylbiscoumacetate

Anticoagulants Mechanism of Action:

• They act only in vivo
• They interfere with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro, quinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation

Anticoagulants Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction
• Unstable angina,
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Blood components questions and answers

Anticoagulants Adverse Effects:

• Bleeding- ecchymosis, epistaxis, hematuria, bleeding in the GIT, intracranial bleeding
• Gastrointestinal disturbances
• Teratogenicity
• Skin necrosis

Question 4. Classify styptics. Describe the role of vitamin K when bleeding is due to oral anticoagulant therapy.
Answer:

Styptics:

• Styptics are local hemostatic substances used to stop bleeding from a local approachable site
• Commonly used styptics are
  • Thrombin
  • Fibrin
  • Oxidized cellulose
  • Gelatin foam
  • Adrenaline
  • Astringents

Role of Vitamin K

• Oral Anticoagulants interfere with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydroquinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X ‘
• This gamma-carboxylation is essential for the ability of the clotting factors to bind Ca ions and to get the bound phospholipid surface necessary for the coagulation sequence to proceed
• Vitamin K acts as an antidote for Warfarin
• Administration of vitamin K by competitive antagonism with oral Anticoagulants reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence to proceed.
• Hence vitamin K is used for bleeding due to oral Anticoagulants

Physiology of blood questions

Question 5. Describe how heparin and dicumarol act as Anticoagulants. Indicate their route of administration, duration of action and name their antagonists.
Answer:

• Heparin
  • It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Mechanism of Action:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Route of Administration:

• Heparin is given IV or SC

Heparin Duration of Action:

Heparin Antagonists:

• • Protamine sulfate is an antagonist of heparin
  • It is a low molecular-weight protein
  • When given IV it neutralizes heparin
  • It is used when heparin action needs to be terminated rapidly
• Dicoumarol:
  • Dicoumarol is a Coumarin derivative

Dicoumarol Mechanism of Action:

• It interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation

Dicoumarol Route of Administration:

• It is given orally

Dicoumarol Duration of Action:

• Duration of action -4-7 day

Dicoumarol Antagonists:

• Vitamin K acts as an antagonist for Dicoumarol
• Administration of vitamin K by competitive antagonism reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence to proceed

Important questions on blood for BSc Nursing

Question 6. Explain in detail about pharmacological action, pharmacodynamics, therapeutic uses, and toxicity of heparin.
Answer:

Anticoagulants:

• Anticoagulants are drugs used to reduce the coagulability of blood

Heparin

• It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Pharmacological Actions:

1. Anticoagulants

• Heparin is a powerful anticoagulant
• It is effective in vivo and in vitro
• At low concentrations, it prolongs activated partial thromboplastin time
• At high concentrations, it prolongs prothrombin time as well as partial thromboplastin time

2. Antiplatelet action

• Heparin inhibits platelet aggregation
• this prolongs the bleeding time

3. Lipaemia clearing

• Heparin activates lipoprotein lipase
• This hydrolyses triglycerides present in the plasma and thus clears the plasma of lipids

Heparin Pharmacodynamics:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Uses:

Heparin Low molecular weight heparin is used in:

• Prophylaxis of deep vein thrombosis and pulmonary embolism
• Treatment of established deep vein thrombosis
• Unstable angina
• To maintain patency of cannula and shunts in dialysis patients

Heparin Toxicity:

• Bleeding
• Thrombocytopenia
• Osteoporosis
• Alopecia
• Hypersensitivity reactions
• Hypoaldosteronism

Blood Short Essays

Question 1. Cyanocobalamin
Answer:

Coenzyme Forms:

• 5′- Deoxyadenosyl cobalamin
• Methylcobalamin

Functions:

1. Synthesis of methionine from homocysteine

• Vitamin B12 is used as Methylcobalamin in this reaction

2. Isomerization of methyl malonyl CoA to succinyl CoA

• It occurs in the presence of vitamin B12 Coenzyme, deoxy adenosylcobalamin

Cyanocobalamin Dietary Requirements:

• Adults- 3 micrograms/day
• Children-0.5-1.5 microgram/day
• During pregnancy and lactation- 4 micrograms/day

Cyanocobalamin Uses:

• Prevention and treatment of B12 deficiency
• Mega doses used in neuropathies, psychiatric disorders, cutaneous sarcoid

Blood question bank with answers

Question 3. List two Anticoagulants acting by different mechanisms. Mention any two uses of them.
Answer:

• Heparin
  • It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Mechanism of Action:

• Heparin activates plasma antithrombin III
• Anti-thrombin III binds and inhibits activated Thrombin and coagulation factors Xa and IXa
• Heparin antithrombin III complex inhibits activated factor X and thrombin
• Low molecular weight heparin inhibits only factor X and not thrombin

Heparin Uses:

Heparin Low molecular weight heparin is used in:

• • Prophylaxis of deep vein thrombosis and pulmonary embolism
  • Treatment of established deep vein thrombosis
  • Unstable angina
  • To maintain patency of cannula and shunts in dialysis patients
• Dicoumarol
  • Dicoumarol is a Coumarin derivative

Dicoumarol Mechanism of Action:

• It interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K.
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X
• This gamma-carboxylation is needed by these factors for coagulation.

Dicoumarol Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction.
• Unstable angina.
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Question 4. Iron-sorbitol-citric acid
Answer:

• Iron sorbitol citric acid complex is parenteral iron preparation.
• Contains 50 mg of elemental iron
• Can be given only IM
• If given IV it quickly saturates transferrin stores
• Due to it free iron levels in the plasma rise and cause toxicity

Iron-sorbitol-citric acid Dose:

• It is calculated using the formula:
• Iron requirement ( in mg) = 4.4 * body weight (in kg) * Hb deficit (in g/dl)

Iron-sorbitol-citric acid Indications:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Iron-sorbitol-citric acid Adverse Effects:

• Pain at the site of injection
• Pigmentation of  skin
• Sterile abscess
• Fever
• Headache
• Joint pain, flushing, palpitation
• Chest pain, dyspnoea
• Anaphylactic reaction

Composition of blood short answer

Question 5. Anticoagulants
Answer:

• Anticoagulants are drugs used to reduce the coagulability of blood

Anticoagulants Classification:

• Used in vivo

1. Parenteral Anticoagulant

• • Heparin, low molecular weight heparin, heparan sulfate

2. Oral Anticoagulants

• • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione
• Used in vitro

1. heparin

2. Calcium complexing agents

• • Sodium citrate, sodium oxalate, sodium edetate.

Question 6. Compare heparin and oral anticoagulants.
(or)
Compare heparin and dicumarol
Answer:

Question 7. Explain the mechanism of action of streptokinase and mention one use of it.
Answer:

Streptokinase:

• Streptokinase is a fibrinolytic drug

Streptokinase Mechanism of Action:

• Streptokinase is antigenic
• It combines with plasminogen to form tissue plasminogen activator complex
• This complex then causes limited proteolysis of other plasminogen molecules to plasmin
• Plasmin degrades fibrin thereby dissolving the clot

Streptokinase Uses:

• Acute Myocardial infarction
• Deep vein thrombosis
• Pulmonary embolism

Blood diseases questions for nursing

Question 8. Name two oral anticoagulants. Mention one drug treating toxicity of oral anticoagulants.
(or)
Dicumoral poisoning
Answer:

Oral Anticoagulants:

1. Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate

2. Indandione derivative- Phenindione

Drug Used to Treat Toxicity of Oral Anticoagulants:

• Vitamin K is used to treat toxicity of oral anticoagulant
• Administration of vitamin K by competitive antagonism with oral Anticoagulants reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for coagulation sequence to proceed

Question 9. Heparin and Warfarin.
Answer:

Blood Short Question And Answers

Question 1. Drugs for anemia.
Answer.

Question 2. Ferrous sulfate.
Answer:

Ferrous sulfate is oral iron preparation

Ferrous sulfate Dose:

• 200 mg tab, 3-4 tablets daily

Ferrous sulfate Indication:

• Prophylactic use in iron deficiency Anemia

Ferrous sulfate Adverse Effects:

• Nausea, vomiting, epigastric pain
• Heartburn
• Staining of teeth
• Metallic taste
• Constipation

Question 3. Folic acid
Answer:

Folic acid is important in one-carbon metabolism

Folic acid Sources:

• Green vegetables, liver, yeast, egg, milk, and some fruits

Folic acid Functions:

• The Coenzyme of it, tetrahydrofolate( THF], serves as an acceptor or donor of one carbon units
• It is involved in the synthesis of important compounds like
• Purines- Incorporated into DNA and RNA
• Pyrimidine nucleotide- deoxythymidylic acid- Involved in the synthesis of DNA
• Aminoacids- Glycine, serine, ethanolamine, and choline
• N-Formylmethionine- Initiator of protein biosynthesis

Folic acid Deficiency Manifestations:

• Megaloblastic anemia
• Glossitis
• Diarrhea
• Weakness

Blood group compatibility questions

Question 4. Drugs used in microcytic anemia.
Answer.

1. Oral iron preparation

• Ferrous sulfate-200 mg tab
• Ferrous fumarate -200 mg tab

2. Parenteral iron preparation

• Iron dextran containing 50 mg of elemental iron
• Iron sorbitol citric acid complex containing 50 mg of elemental iron

Question 5. Drugs used for pernicious anemia.
Answer:

1. Vitamin B12 supplements
2. 1-5 mg of folic acid and iron preparation

Question 8. Indications for parenteral use of iron.
Answer:

• When oral iron is not tolerated
• Failure of absorption of oral iron
• Noncompliance
• In the presence of severe deficiency with chronic bleeding
• Along with erythropoietin

Question 6. Mention two oral and parenteral preparations.
Answer:

Oral Preparations:

• Ferrous sulfate
• ferrous gluconate
• Ferrous fumarate
• Colloidal ferric hydroxide

Parenteral Preparations:

• Iron dextran
• Iron sorbitol citric acid complex

Question 7. Vitamin C is given with iron in the treatment of anemia.
Answer:

• Vitamin C Improves Absorption Of Iron In The Intestine
• It maintains ferrous salts in a reduced state
• So vitamin C is used in the treatment of anemia along with iron,

Question 8. Vitamin K deficiency.
Answer:

Causes of Vitamin K Deficiency:

• Liver diseases
• Obstructive jaundice
• Malabsorption
• Long-term antimicrobial therapy altering intestinal flora

Vitamin K Deficiency Manifestations:

• Bleeding tendencies- hematuria, GIT bleeding, epistaxis, ecchymosis

Question 9. Heparin
Answer:

• It is a mucopolysaccharide found in the mast cells of the liver, lungs, and intestinal mucosa

Heparin Uses:

• Low molecular weight heparin is used in:
• Prophylaxis of deep vein thrombosis and pulmonary embolism
• Treatment of established deep vein thrombosis
• Unstable angina
• To maintain patency of cannula and shunts in dialysis patients

Heparin Toxicity:

• Bleeding
• Thrombocytopenia
• Osteoporosis
• Alopecia
• Hypersensitivity reactions
• Hypoaldosteronism

Mechanism of blood clotting questions

Question 10. Vitamin K
Answer:

• It is a fat-soluble vitamin

Vitamin K Sources:

Vitamin K

1. Animals sources

• Egg yolk, meat, liver, cheese and dairy products

2. Plant sources

• Cabbage, cauliflower, tomatoes, alfa, spinach

Vitamin K Functions:

• It helps in blood coagulation

Vitamin K Daily Requirements:

• 70-140 micrograms/day

Question 11. Fibrinolytic
Answer:

• Fibrinolytic are drugs that lose the clot or thrombus by activating the natural fibrinolytic system
• Fibrinolytic agents are:
  • Streptokinase
  • Urokinase
  • Alteplase
  • Replace
  • Tenecteplase

Fibrinolytic Uses:

• Acute Myocardial infarction
• Deep vein thrombosis
• Pulmonary embolism

Fibrinolytic Adverse Effects:

• Bleeding
• Hypotension
• Fever
• Anaphylactic reactions

Fibrinolytic Contraindications:

• In recent surgeries
• Injury
• GIT bleeding
• Stroke
• Severe hypertension
• Bleeding disorders

Question 12. Hemostasis
Answer:

• Hemostasis is the process of stopping bleeding postsurgically or from a site of injury
• It can be achieved by
  • Applying pressure at the bleeding site
  • Suturing
  • Use of styptics
• It occurs by
  • Contraction of the injured vessel wall
  • Adhesion and aggregation of platelets to form a plug
  • Formation of a blood clot
  • Dissolution of the clot by fibrinolysis

Question 13. Warfarin sodium
Answer:

• It is a Coumarin derivative

Warfarin sodium Uses:

• Deep vein thrombosis and pulmonary embolism
• Myocardial infarction
• Unstable angina
• Rheumatic heart disease, atrial fibrillation
• Vascular surgery, prosthetic heart valves, retinal vessel thrombosis, extracorporeal circulation, hemodialysis

Warfarin sodium Adverse Effects:

• Bleeding- ecchymosis, epistaxis, hematuria, bleeding in the git, intracranial bleeding
• Gastrointestinal disturbances
• Teratogenicity
• Skin necrosis

Blood clotting cascade steps questions

Question 14. Oral anticoagulants
Answer:

• Oral anticoagulants are:
  • Coumarin derivatives- Dicoumarol, warfarin, acenocoumarol, ethylbiscoumacetate
  • Indandione derivative- Phenindione

Question 15. Uses of vitamin K
Answer:

• Act as a cofactor for the synthesis of coagulation proteins- Ffrothrombin, factor VII, IX, and X
• Required for carboxylation of glutamic acid residues of osteocalcin
• Participates in the coagulation cascade

Question 16. Vitamin K used in the overdosage of Warfarin
Answer:

• Warfarin interferes with the synthesis of vitamin K-dependent clotting factors in liver
• Act as a competitive antagonist of vitamin K
• Reduces plasma levels of clotting factors
• Interferes with the regeneration of the active hydro-quinone form of vitamin K
• Blocks the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X v
• This gamma-carboxylation is essential for the ability of the clotting factors to bind Ca ions and to get the bound phospholipid surface necessary for the coagulation sequence to proceed
• Vitamin K acts as an antidote for Warfarin
• Administration of vitamin K by competitive antagonism with Warfarin reduces the anticoagulant action and brings about carboxylation of glutamate residues of prothrombin and factor VII, IX, and X necessary for the coagulation sequence ta proceed

Pulmonary and systemic circulation questions

Question 17. Adverse effects of vitamin B12.
Answer:

• Vitamin B12 is used
• In the treatment of vitamin B12 deficiency
• Cyanacobalamine -100 ml in. daily
• Hydroxocobalamin -100-500,1000 mg daily
• Multivitamins for oral use
• B12 deficiency – Prophylaxis 3-10 mg daily
• Treatment of megaloblastic anemia
  • B12 neuropathies, psychiatric disorders, cutaneous sarcoid, and as a general tonic to allay fatigue and improve growth

vitamin B12 Adverse Effects:

• Anaphylactoid reaction on IV injection occurs due to sulfite contained in the formulation

Question 18. Name two oral anticoagulants. Mention two adverse effects.
Answer: