Dear Reader, these papers were meant to be as an extremely quick review and ultra-short

summary of the most important notes that I have made through my review of pharmacology, it
may not be properly updated, and may contain spelling and grammatical mistakes, but it was
extremely valuable for Me to pass my exam, its worth going through, thanks for reading.
Bed Wetting (Nocturnal enuresis)
1- Imipramine, have been used in children older than 2 years, it act by contracting the
bladder internal sphincter.
2- Desmopressin an ADH analogue given PO (TAB), Intranasal and IV.
Hyperkalemia Symptoms: Leg cramps, weakness, fatigue and nausea.
Hyperkalemia Emergency management:
1- Dialysis.
2- 50% hypertonic glucose IV fluid + Regular insulin.
3- Calcium Carbonate or Calcium chloride IV.
4- Sodium Bicarbonate.
Hyperkalemia long term management (non-acute):
1- Sodium polystyrene sulfate.
2- Loop or thiazide diuretics.
Hypokalemia Symptoms:
1- Dryness of the mouth and increase thirst.
2- Irregular heartbeats.
3- Muscle cramps.
Drug Induced Hyperkalemia: Succinyl Choline, ACEIs, ARBs, K Sparing Diuretics, Beta2
Adrenergic.
Travellers Diarrhea: Bismuth subsalicylate.
Anaphylactic Drugs:
1- Epinephrine is DOC in anaphylactic Shock.
2- Dopamine in Kidney compromised Anaphylactic Patients.
3- Dobutamine in Anaphylactic patients with CHF.
Diabetes Insipidus:
1- Chlorpropamide (sulfonyl ureas).
2- Desmopressin (not in nephrogenic DI).
3- Carbamazepine.
4- Thiazide Diuretics, K sparing Diuretics and indomethacin are useful in nephrogenic
Diabetes Insipidus.
5- Amiloride is DOC in lithium induced diabetes.

Motion Sickness:
1- DOC is transdermal Scopolamine.
2- H1 receptor Blockers Meclizine, Cyclizine, Diphenhydramine.
3- Antipsychotic, prochlorperazine.
4- Acetazolamide, given 5 days at night before expected episode.
Hiccups: Dopamine blockers, chlorpromazine, metoclopramide and haloperidol.
ADHD:
1- Dextroamphetamine, Methylphenidate.
2- Lisdexamphetamine, Atomoxitine.
Narcolepsy:
1- Modafinil, Armodafinil.
2- Amphetamine, Methylphenidate.
Histaminic Effects:
- Some drugs can cause release of histamine from mast cells, which cause
Bronchoconstriction, sweating and Vasodilatation, its similar to cholinergic effect
except to miosis, and some of these drugs are Tubocurarine, Mivacurium, Atracurium,
and most Opioids.
Hyperprolactimic Effect: Cimetidine and morphine and all dopamine Antagonist.
BPH (Benign Prostatic Hyperplasia):
1- Alpha 1 blockers Tamsulosin and Alphazosin, they relax prostatic smooth muscles
improving urine flow.
2- Finesteride and dutasteride, they inhibit the conversion of testosterone to
dihyrdotestosterone.
3- CONTRAINDICATIONs: Antihistaminics, Anticholinergics and Alpha agonists.
4- GnRH Agonist like Flutamide, bicalutide and Nalitamide are used.
Alcohol Withdrawal:
1- Disulfiram. 2- Acamproste. 3- Clonidine. 4- Naltrexone.
5 _ Bezodizepines: Chlordiazepoxide, Clorazepate, Diazepam.
Disufiram like Effect:
1- Mteronidazole, Several cephalosporins, ex Cefotetan and Cefoperazone.
2- Sulfonyl Ureas.
3- Griseofulvin.
Prodrugs: All ACEIs, Fenofibrates, Lovastatine, simvastatine, Prednisone, All PPIs, INH,
Phenoxybenzamine, Oxacarbamazepine.

Drugs with Anticholinergic Effects:

Many drugs can cause Anticholinergic effects like dry mouth, mydriasis, some of these drugs
are: Meperidine, Quinidine, and disopyramide
Calcium Toxicity: can be treated by either, Citrate or EDTA.
Cholinergic Effects:
1- Salivation, Sweating and bronchial secretion.
2- Nausea, Diarrhea and abdominal cramps.
3- Bronchoconstriction, Miosis and Bradycardia.
Serotonin Syndrome: it characterize by hyperthermia, sweating, myoclonus, muscle rigidity and
change in mental status, its cause by combination of serotonergic drugs, SSRIs, SNRIs, MAOIs,
TCAs, Alkaloids, Meperidine and Tramadol.
Acute Intermittent Porphyria:
a- Support Treatment. b- Dextrose Infusion. c- Increase CHO intake. d- Hematin infusion.
Pancrelipase: is an enzyme therapy, its a mixture of Amylase, trypsin, and lipase, which are
usually produced by pancreas, its used in the treatment of cystic fibrosis, chronic pancreatitis,
its available as powders, capsules and tablets, it should not be taken alone.
Carbonic Anhydrase Inhibitors: Acetazolamide, Drazolamide, Brinzolamide, dorzolamide, and
Topiramate, they have a wide range of clinical uses, such as in glaucoma, diuretics, motion
sickness, Antiepileptic and Osteoporosis, Also Acetazoleamide is indicated in barbiturates and
salicylates toxicity.
Aromatase Inhibitors: are either selective like Anastrazole, Letrozole, or non-selective like
Glutithemide and Testolactone, non-selective block the conversion of cholesterol to
pregnolone( steroid precursor) and the conversion of testosterone to estrogen, and hence are
useful in cushing syndrome, selective ones block only the later, those drugs are important in
some malignancies and also, its used by athletic testosterone abusers to block some
undesirable side effect like gynecomastia.
To reduce Niacin induced flushing:
1- Titrate the dose to maximum.
2- Take with food.
3- Take Aspirin 30 minutes prior to niacin.

PhosphoDiesterase Inhibitors: it have wide clinical spectrum, it induce vasodilation,

bronchodilator, inotropic effect and anti-platelet effect.
1- Xanthines: ex Caffeine, Thoebromine and Theophylline. They are used as
bronchodilators in COPD and refractory Asthma.
2- PDE3 Inhibitors: Milrinone and Amrinone, it has a +ve chronotropic effects, they are
used in acute treatment of heart failure.
3- PDE5 Inhibitors: Sildenafil, Tardenafil and Varedenafil, they relax penis blood vessels
smooth muscles, enhancing erection.
4- PDE3 Inhibitors: Cilostazol, used in alleviation of symptoms of intermittent claudication,
in individual with peripheral vascular disease.
5- Dipyridamole: is TXA2inhibitor, and PDE3 inhibitor, both result in anti-platelet,
bronchodilation and vasodilatation.
Menieres disease: is a disorder of the inner ear that characterize by vertigo, tinnus and
progressive loss of hearing, usually in one ear, its associated with hypo or hyperthyroidism, and
autoimmune diseases, treatment include: 1- steroids, dexamethasone. 2- Surgical: removal of
the inner ear which results in loss of hearing.
Gaserelin: is a potent GnRH analogue, but it act as potent inhibitor of pituitary gonadotropin
secretion, its indicated for prostate, breast, and endometriosis carcinomas. NOTE that when
GnRH is normally secreted in a pulsatile manner it promote sex hormone production, but
chronic stable administration of the analogue produce down regulation of feedback and
decrease sex hormone production.
Ketoacidosis: is a complication of untreated diabetes, its manifested by accumulation of
ketone bodies ( acetoaceticacid and betahydroxybutyrate), symptoms are deep rapid breathing,
dry skin and mouth, flushed face, fruity breath, N and V and frequent urination.
Treatment include: glucose, insulin and potassium IV administration, and electrolyte
replacement.
Permethrin: is an insecticide and antifungal, its a neurotoxin that is usually used to treat lices,
its available as liquid or cream, direct contact with hands should be avoided, it kills both
mature and egg fungi, its generally poorly absorbed.
Sweat Test: is used in cystic fibrosis diagnosis, the sweat contain higher than normal Cl ion.
Lactulose: is a synthetic sugar used as
1- Laxative (osmotic laxative): its Brocken by intestinal bacteria into non-absorbable
carboxylic acids; they retain more water and soften the feces.
2- Antihyperammonemia: This can be either congenital or metabolic, ex liver or kidney
disease, increase protein catabolism, due to trauma or cancer.

Phenyl Ketone Urea: is a disease caused by deficiency of phenyl alanine hydroxylase, which
convert phenyl alanine to tyrosine, it characterize by high serum phenylalanine and high urine
phenyl pyruvic acid, its diagnosed by GUTHRIE TEST, Acute Symptoms include musty urine
smell, vomiting and rash, chronic symptoms are, mental retardation, poor growth, poor
develop. Treatment is diet control, with phenyl alanine serum level of 2-10 mg/dl.
Prostaglandin Analogues:
1- PGI2 analogue: Misoprostol is used in combination with aspirin and other non-steroidal
drugs, due to its cytoprotective properties, it increase mucous secretion in the stomach
preventing ulcer formation, its used rarely as emergency abortive agent, in combination
the new anti-progesterone Mifepristone.
2- PGF2alpha Analogues: its indicated for glaucoma, it increase the flow of aqueous
humor out of the eye, its used to control the progression of ocular hypertension
(glaucoma), but it does not cure it, ex Latanoprost, Travoprost, Bimatoprost.
3- PGE2 Analogues: are used in labor, they soften cervix and induce uterine contraction, ex
Dinoprostone.
Cyclobenzaprine: is a centrally acting Muscle relaxant, for treatment of fibromyalgia and
cerebral palsy.
Barium Sulfate: its a suspension used to examine the esophagus, stomach and intestine. Its
water insoluble, non-absorbable and toxic, it gives clear image of the damaged organ in both CT
and X-Ray. Its available as powder tablet, suspension and paste, it causes constipation.
G6PD Hemolytic Anemia: (Non-immune mediated Hemolytic Anemia)
G6PD is necessary to maintain the level of NADPH required to provide the supply the reduced
GSH, which neutralize oxidative free radicals that can cause hemolysis. It may be caused by:
1- Natural: Henna and fava beans.
2- Drug: primaquine, sulfonamide and methylene blue.
3- Infections: Hepatitis.
Treatment:
1- Blood transfusion: dialysis in acute renal failure.
2- Prevention: ex vaccination.
3- Selenium and Vitamin E as antioxidant but might not be so effective.
Phenazopyridine: is a chemical that when secreted in urine has a local analgesic activity; its
used in urinary infections, post-surgery and in examination.
Otitis Externa: or swimmers ear, is caused primarily by P. Aerogenosa, and treated by
Gentamycin or
Carbincillin.

D-pencillamine: (analogue of aa cysteine):

1- Used Rheumatoid Arthritis to slow bone destruction
2- Used as chelating Agent in heavy metal poisoning.
3- Treatment of cysteine urea.
Biologic Anti-rheumatoid drugs:
1- TNF-alpha Blockers, Etanercept, Infliximab, Adalimumab, Golimumab.
2- IL-1 Blockers, Anakinra.
3- Anti-B-cells antibody, Rituximab.
4- T-cell costimulation blockers, Abatacept.
5- It takes 2 weeks before response is evident.
6- Except Anakinra, all can be used in combination with others.
7- Should be used cautiously in heart failure.
DOCs:
1- Carbamazepine + Haloperidol, Treatment of Amphetamine overdose.
2- Leucovorin Ca or Na Salt (folinic acid), is used to treat folate antagonist toxicity, ex
methotrexate, pyrimethamine and trimethoprim, its used for megaloplastic anemia
secondary to folate deficiency but its CI in megaloplastic anemia secondary to Vitamin
b12.
3- Fluvoxamine in OCD.
4- Fluoxetine in Bulimia Nervosa.
5- Erythromycin in Legionnaires.
6- Tetracycline in Trachoma.
7- Beclomethsone in respiratory distress syndrome.
8- Parilidoxime is the DOC in thiophosphate toxicity in conjunction with Atropin.
9- Hydroxyurea is used in sickle cell anemia.

Unique Effects:
1- Pin pupil + depression, Opioids mainly Morphine.
2- Mydryasis, Anticholinergic, (Meperidine )
3- Mild Aspirin toxicity cause Bronchoconstriction, Hyperventilation and Roaring or Ringing
in the ear.
4- Strong Aspirin Toxicity cause respiratory depression.
5- Metallic Taste: ACEIs, Iodide, Teriparatide and Metranidazole.
6- Digoxin: changes in color perception and halos on dark objects.
7- Amiodarone: Blue skin discoloration.
8- Quinidine: Cinchonism.
9- Ticlodipine: TTP Thrombocytopenea Purpura.
10- Corticoids: Osteoporosis, Hirsutism.
11- ICS: candidiasis and Hoarseness.
12- Bisphosphonate: Osteonecrosis of the jaw.

13- Rifampin: Red-Brown discoloration of the urine, feces, and other secretions.
14- Rifabutin: Skin hyper pigmentation.
15- Ethambutol: Optic Neuritis and loss of color discrimination.
16- Dapsone: Erythemea Nodosum Leprosum.
17- Atropine: Sandy eyes.
18- Nalutamide: Delayed Adaptation to light.
19- Sildenafil may cause loss of blue red discrimination due to PDE6 inhibition in retina.
20- Clozapine is indicated for refractory Schizophrenia, it cause serious agranulocytosis,
though it has strong Antimuscarinic effects it increase salivation.
Used Specifically In:
1- Fentanyl in Cardiovascular surgery because it has minimal effect on the heart.
2- Meperidine in Obstetrics because it does not cross the placenta.
3- Clonidine and Alpha Methyldopa, in hypertension complicated with renal Disease,
because it act centrally.
4- Aspirin in Niacin Induced cutaneous flushing.
5- Metyrapone in Pregnant women with Cushing syndrome.
6- Fenoldopam in hypertensive renal compromised patients.
7- Fosinopril is the only ACEI excreted in bile.
8- Doxazosin is the only Alpha blocker excreted in bile.
9- Oxytocin is administered IV to promote labor and intranasally to promote milk let
down.
10- Edrophonium In diagnosis of Myasthenia Gravais.
11- Succinyl Choline is indicated for preventive treatment Electroconvulsive Shock therapy.
12- Carbamazepine is indicated I trigeminal neuralgia.
13- Na Metabisulfate is used in sickle cell anemia diagnosis.
14- Povidone reduce iodide volatility and irritation.
15- Lactulose reduce serum ammonia concentration.
16- Pilocarpine in emergency lowering of ocular pressure in both open and closed angel
glaucoma.
17- Physostigmine is indicated for atropine toxicity because it crosses the BBB.
18- Salmetrol and Formetrol in nocturnal Asthma Attacks.
19- Pindolol and Acebutolol Hypertensive patient with bradycardia.

General Notes:
1- IV Morphine can dramatically relief pulmonary edema associated with left ventricular
Failure.
2- Albumin has high affinity to bind Acidic Hydrophobic drugs.
3- Weak basic drugs toxicity can be treated by urine acidification using NH4Cl.
4- E50 is a measurement of potency which correlates with receptor affinity.
5- Emax is measurement of efficacy which correlates with the drugs intrinsic activity, and
its more therapeutically important than potency.
6- Thiazides > Creatinine CL 50 ml/sec > loop diuretics.
7- Antipsychotic drugs can alter thermoregulatory mechanisms and can produce
PIOKILOTHERMIA, a condition in which body temperature can vary with the
environment.
8- Nitroprusside is converted to cyanide when PO administered.
9- Thiazides lower pressure by both diuretic and vasodilatory effects.
10- Minoxidil is only Arterioodilator, hydralazine is primarily a Arterioodilator. Nitrates are
Vasodilators.
11- Isoproterenol is stable to MAO.
12- Barbiturates increase porphyrine synthesis causing Acute Intermittent porphorya .
13- All Zocins May Cause first doe effect ( first dose syncope, postural hypotension.
14- Galantamine is the only competitive AchEI used in Alzheimer disease.
15- Hydroxyzine: is an Antihistaminic, Anticholinergic its use as anxiolytics and in drug
abuse.
16- Barbiturates: has a poor analgesic property.
17- Zolipidem: Its not a BZ, it has no anticonvulsive and no muscle relaxants, has few
withdrawal effects and little or no tolerance.
18- Atomoxitine: is only NE reuptake inhibitor, its not habit forming and its a controlled
substance.
19- Paroxetine and Fluvoxamine: are more sedating and hence more used in depressed
patient with insomnia.
20- Fluoxetine and Sertraline: Are more activating and hence its used in patient with
sleepiness.
21- Bupropion and Mirtazapine: are used to avoid sexual dysfunction.
22- Buspirone: is anxiolytic that lack both muscle relaxant and anticonvulsive properties, its
a psychoactive agonistic at dopamine and 5HT receptors, it cause hypothermia, it
increase prolactin and GnRH, and take 2 weeks to work.
23- Local Anesthetics tend to accumulate in the fetus, due to ion trapping.
24- Dantrolene: is a muscle relaxant, poorly water soluble, its used in the treatment of
Malignant Hyperthermia, General Anesthesia, Cerebral Palsy, Paraplegia, Serotonin
Syndrome and Ecstasy poising.
25- Parasympathetic is the predominant innervation at the salivary gland.
26- Amlodipine: has the least possibility of first dose effect.
27- Nimodipine: is indicated for cerebral spasm, due to high lipophilicity.

28- Tazorotene: is a topical retinoid (gel or cream), its indicated for Acne, Psoriasis, its SE
are dryness, cracking and redness of skin.
29- Erythromycin can increase digoxin concentration by inhibiting Normal flora, which
usually deactivate digoxin.
30- Sumatriptan has a sulfonamide structure.
31- Leuprolide, Gaserelin, Naferelin, Histerlin are GnRH synthetic analogues, used in
prostatic cancer, endometriosis and precocious puberty.
32- Octreotide: is a somatostatin analogue, it suppresses the secretion of glucagon and
growth hormone, used in the treatment of acromegaly and diarrhea associated with
vasoactive intestinal peptides secreting tumors.
33- Chlorpromazine, Clozapine, olanzapine and thioridazine have strong Antimuscarinic
effects and thus have less EPSE.
34- Opioids occur in Medial thalamus, Hypothalamus, Pituitary, immune cells, urinary
bladder and GIT.
35- SNRIs are used in depressed patient refractory to SSRAs, Neuropathic pain.
36- Lithium has low therapeutic effects; its not sedative, not euphoriant and not
depressant.
37- Ramelteon: Act on MT1 and MT2.
38- Food increases Sertraline absorption, only Sertraline undergo 1st pass Metabolism.
39- Labetalol and CCBs are most effective in Blacks and elderly.
40- Tolcapone cross the BBB.
41- Pancuronium has a vagolytic effect, it increase heart rate.
42- All Ergot Alkaloids: like ergotamine, cabergoline and bromocriptine may cause
pulmonary and retroperitoneal fibrosis.
43- Trazodone: causes priapism.
44- Cisatracurium is the only NMJB that do not need dose reduction in renal failure,
because its spontaneously hydrolyzed in the plasma.
45- Aminoglycoside inhibit acetylcholine release.
46- Non Catechole Adrenergic Agonists, Ephedrine, Amphetamine, Metaproterenol and
phenylephrine.
47- Isoproterenol is stable to MAO hydrolysis.
48- Bethanechol is used in postoperative urinary retention, neurologic atony, and
Megacolon.
49- Since Chloramphenicol toxicity is potentiated by Na depletion, a bolus dose before and
after administration is used to reduce chloramphenicol.
50- Allopurinol can produce allergic reaction (rash) after months.
51- Progestin only pills (mini pills) are used in: smoker, lactating or estrogen intolerant
women.
52- LH stimulate steriodogenesis, FSH stimulate Spermatogenesis.
53- Testosterone is active in liver and muscles; DHT is active at liver, brain and adipose
tissue.
54- Beta2 Agonists are not metabolized by COMT.
55- Liquid ICS should be inhaled slowly and deeply.
56- Powder ICS should be inhaled quickly and deeply.

57- Cromylin is recommended in asthma prophylaxis children and pregnant women.

58- Urea Breathe Test is used to diagnose H. Pylori complicated ulcer.
59- Drugs that may cause sexual dysfunction, Beta-Blockers, Alpha Agonists, SSRIs.
60- Procainamide and Hydralazine cause reversible Lupus Erythematous like Syndrome.
61- Dopamine is metabolized to Homovanillic Acid.
62- Reserpine blocks Amine uptake (not reuptake) system.
63- Guanthidine blocks NE release.
64- Beta: Iso > Epi > NE
65- Beta1: Epi=NE
66- Beta2: Lung Epi > NE
67- Beta3: Lipolysis
68- Epi > NE > Iso
69- Fluorodopa: A dopamine Analogue used in PET (Positron Emission Tomography) in
parkinsonian Diagnosis.
70- Nicotinic receptors at autonomic ganglia differ from receptor of NMJ.
71- Hemicholinium is a choline uptake inhibitor, indirect acting anticholinergic.
72- Botilinium toxin blocks Acetylcholine release.
73- Black widow spider venum empties all acetylcholine stores.
74- MEGESTROL ACETATE
75-