Dispensing and ADR

1. DISPENSING AND ADR
Prepared by: Alexandra D.Atienza RPh

2. • the science and activities
relating to the detection,
assessment, understanding and
• prevention of adverse effects and
other medicine related problems

3. • One is noxious and unintended and
which occurs @ doses normally
• used in man for prophylaxis,
diagnosis, and therapy of disease @
normal doses.

4. Any adverse effect associated with use
of drugs in humans

5. Signal
Reported information on possible caused
relationship between AE & a medicine

6. Near Miss
• Potential Adverse Effect
Medication Error
• Any preventable event that may lead
to inappropriate drug use or patient
harm

7. Age
Concurrent
medicines
Duration and
therapy
Gender
Co-morbidities
Narrow
therapeutic index
Ethnicity and
Genetics

8. A. Mild: Bothersome but requires
no change intherapy.
B. Moderate : Change in therapy,
additional hospitalization.
C. Severe : Life threatening
D. Lethal: Directly/ Indirectly
causes death

9. TYPE A ( AUGMENTED )
Dose dependent
Predictable
Most Common ( 75% )
Avoidable

10. EXTENSION EFFECTS
a. Oral Hypoglycemic (Sulfonylureas) :
Hypoglycemia
b. CNS depressant : Sedation
c. Anticoagulants: Bleeding
d. Antihypertensive: Hypotension
e. Furosemide: Loss of Electrolyte

11. SIDE EFFECTS- unrelated to pharmacologic
Activity of the drug
a. Opiates: Constipation
b. NTG: Headache
c. ACE inhibitors: cough
d. Minoxidil: Hirsutism
e. NSAIDS: GI irritation
f. Anti Neoplastics: Alopecia

12. e. Antihistamine: Sedation
f .Statins: Rhabdomyolysis / Hepatotoxicity
g. Aminoglycosides:
Nephrotoxicity/Vestibulotoxicity/Ototoxicity
h. Atropine: Blurred Vision and Dry mouth

13. TYPE B ( Bizarre )
Uncommon
Not dose related
Non-predictable (Not
pharmacologically related)

14. 1. Idiosyncratic reaction
Genetically determined
Example:
a. Malignant hyperthermia
b. Hemolytic anemia (CI with G6PD
deficiency)

15. 2. Hypersensitivity Reaction
I- Anaphylactic/ Immediate ( IgE)
II- Cytotoxic ( IgG, IgM)
III- Immune Complex Mediated (IgG, IgM)
IV- Delated ( T-celled Mediated )

16. Type I - Anaphylaxis
Aka: Allergy
Immediate onset
Stimulants: {Pollens, Fungi, Animal fur,
Carpet Mites, Dairy Products, Shell fish,
Soybean Peanuts, Procaine,
Haptens (Penicillin, Vaccines Cephalosporins)}

17. Type I - Anaphylaxis
Pathogenesis: Involves the degranulation of
Mast cells (contains histamine)
Effect: Vasodilation, Bronchoconstriction

18. Type I - Anaphylaxis
Symptoms
Urticaria
Nasal congestion
Bronchoconstriction
Laryngeal edema
Vomiting and Diarrhea
Anaphylaxis

19. Type I - Anaphylaxis
Treatment
Antihistamines
Epinephrine
Cromolyn sodium (Mast cell stabilizers)
Steroids

20. Type II -Cytotoxic
Initiated by antibody (IgG, IgM) directed against antigens
found on cell membrane of a given target cells (
leukocytes and erythrocytes)
Example
Methyldopa: Hemolytic Anemia
Chloramphenicol: Aplastic anemia
ASA/Ibuprofen: Thrombocytopenia purpura

21. Type III - Immune Complex Hypersensitivity
Hypersensitivity
Causes
Self antigens ( Systemic Lupus Erythematosus )
Bacteria and viruses
Antiserum from animals
Spores

22. Type III - Immune Complex
Hypersensitivity
Clinical Symptoms
Lymphadenopathy
Splenomegaly
Glomerulonephritis
Arthralgia and Arthritis

23. Type III - Immune Complex
Hypersensitivity
Example
Drug induced SLE (H.I.P.S)

24. Type IV -Cell Mediated/ Delayed Type
Microbes (e.g. Mycobacterium tuberculosis - Mantoux
Reaction)
Uroshiol from Rhus species
Nickel and Chromates
Symptoms
Granulomas
Contact Dermatitis
Causes

25. TYPE C - CONTINUOUS
Uncommon
Dose and Time Related
Cumulative dose of the drug

26. A. Tolerance
Lost of response to the drugs
e.g. Nicotine
B. Addiction
Person takes the drug compulsively despite potential
harm and desire to stop
e.g. Marijuana , Cocaine, Amphetamines, L.S.D

27. C. Dependence
Without the drug, the patient experience withdrawal
effects
Example: Benzodiazepines and Caffeine
2 Types:
1. Physical dependence : body cannot function well
2. Psychological dependence: mind cannot function
well

28. Other Examples:
Ethambutol: Optic neuritis
Steroid: Cushing syndrome
Morphine
Drug tolerance : ↑dose , same response
Tachyphylaxis: Repeated
administration ↓effectiveness because of down
regulation of receptors

29. Other Examples:
Isoniazid: Peripheral Neuritis
NSAIDs: Ulcer
Ethambutol: Optic neuritis
Thioridazine: Pigmentary retinopathy

30. TYPE D - DELAYED
Manifested long after
exposure
A . Carcinogenicity
Ability to cause cancer or carcinoma
Example:
HC
Aflatoxin
Benzene
Asbestos

31. TYPE D - DELAYED
B. Teratogenicity
Ability to cause fetal malformations

32. Carbamazepine and Valproic acid: Neural
tube defects
Diethylstilbestrol : Vaginal adenocarcinoma
Phenytoin: Fetal Hydantoin syndrome

33. Streptomycin: Ototoxicity
Thalidomide: Phocomelia
Captopril: Renal tubular dysplasia
Phenylephrine: Growth Retardation

34. Benzodiazepines: Cleft palate
Vitamin A: Heart and Brain abnormalities
Lithium: Ebstein anomaly ( abnormal
tricuspid valve)

35. Methimazole: Aplasia cutis
Warfarin: Fetal warfarin syndrome ;subs: Heparin
Antineoplastics: embryo toxic
Alcohol: Fetal alcohol syndrome

36. Diethylstilbestrol: Breast Cancer
Tretinoin :blisters/crusting or swelling
of skin, darkening or lightening of skin
color, Erythema

37. TYPE E - END OF USE
Withdrawal Symptoms
Example
Opiates: irritability ; withdrawal syndrome
Benzodiazepines: Rebound insomnia and
excitation

38. Example
Clonidine: Rebound HTN
Rebound congestion: Nasal decongestants
Steroids: Adrenal crisis (Addisons disease)

39. Drug-drug reactions
Use of counterfeit
drugs
TYPE F
FAILURE OF
EFFICACY
Drug instability
Patient non
compliance
Wrong route of
administration
Drug resistance

40. Category A
Adequate and well-controlled studies have failed to
demonstrate a risk to the fetus in the first trimester
of pregnancy (and there is no evidence of risk in
later trimesters.
Example drugs or substances: levothyroxine, folic
acid, magnesium sulfate, liothyronine

41. Category B
Animal reproduction studies have failed to
demonstrate a risk to the fetus and there are no
adequate and well-controlled studies in pregnant
women.
Example: metformin, hydrochlorothiazide, amox
icillin, pantoprazole

42. Category C
Animal reproduction studies have shown an
adverse effect on the fetus and there are no
adequate and well-controlled studies in humans,
but potential benefits may warrant use of the drug
in pregnant women despite potential risks.
Example: tramadol, gabapentin, amlodipine
trazodone, prednisone

43. Category D
There is positive evidence of human fetal risk based
on adverse reaction data from investigational or
marketing experience or studies in humans, but
potential benefits may warrant use of the drug in
pregnant women despite potential risks.
Example: lisinopril,alprazolam, losartan,clonaze
pam, lorazepam

44. Category X
Studies in animals or humans have demonstrated
fetal abnormalities and/or there is positive evidence
of human fetal risk based on adverse reaction data
from investigational or marketing experience, and
the risks involved in use of the drug in pregnant
women clearly outweigh potential benefits.
Example: atorvastatin, simvastatin, warfarin,
methotrexate, finasteride

45. It refers to problems which arise during the
compounding and dispensing of
prescriptions or during drug administration.
It is a result of prescribing together
substances that adversely affect the
appearance or elegance, safety or
therapeutic efficacy of the product.

46. Importance:
Develop good formulation
Dispense quality, safe and effective
medicines
Save time, material and money

47. Physical Incompatibility
A condition arising in the prescription due to conflicting
physical properties of drugs.
Chemical Incompatibility
A condition arising in the prescription due to chemical
reactions that change the original composition of the
substance.

48. Therapeutic Incompatibility
A condition arising in the prescription due to conflicting
activities of drugs.
In-vitro Incompatibility
Includes physical and chemical incompatibilities.
What happens to bottles drugs that are compounded and
dispensed?
In-vivo Incompatibility
Includes therapeutic incompatibilities.
What happens when as drug is already administered?

49. 1. Insolubility
Usually happens between solids and liquids.
It is the inability of a solid material to dissolve in a
particular solvent system.
Examples:
Camphor and water (Camphor is soluble is
alcohol)
Gum and alcohol (Gum is soluble in water)

50. 2. Immiscibility
Usually happens between two liquids.
It is a condition wherein two or more
liquids fail to dissolve or mix with one
another.
Example:
Oil and water (can be mixed using an
emulsifying agent such as acacia, tragacanth)

51. 3. Precipitation
Separation of a solid.
It involves the separation of a solid by physical
causes but no new product is being formed.
Causes:
Salting-out (usually happens in aromatic waters)
Change in temperature
Change in pH

52. 4. Liquefaction
It is the transformation of a solid into liquid.
Causes:
Deliquescence - absorption of water; example NaCl
Efflorescence - release of water; examples Alum,
FeSO4, Citric acid, Atropine sulfate
Eutexia - reduction/ lowering of melting point;
examples Camphor, Methol, Thymol, Phenol, Ibuprofen
and Acetophetidine.

53. 5. Polymorphism
It refers to the ability of a substance to exist
in different crystalline or physical states.

54. 6. Loss of Water
“Dehydration” - will cause an increase in its
potency/concentration
A significant manifestation with liquid preparation
Examples:
O/W Emulsion
Solutions
Suspensions

55. Precipitation
It involves the separation of a solid and
accompanied by the formation of a new
substance.
Example:
Calcium hydroxide (Syn. Lime Water)

56. Vaporization
Liberation of the active ingredient
Example:
Nitroglycerin: Monday Disease

57. Oxidation
“Dehydrogenation reaction”
A reaction involving the loss of electrons.
It is triggered by the presence of light and oxygen.
It is usually manifested by a change in color
Examples:
Ascorbic acid (white→ yellow [when oxidized])
Epinephrine ([syn. Adrenaline] yellow → pink [when
oxidized]

58. Reduction
“Hydrogenation reaction”
It involves the gain of electrons.
It usually occurs with metallic salts.
Example:
Silver nitrate → Ag0 (Metallic silver)

59. Hydrolysis
Involves the decomposition or the
breakdown of a substance in the presence of
water.
Example:
Aspirin

60. Photolysis
It refers to the decomposition of a substance
upon exposure to sunlight.
Examples:
Cisplatin
Amphotericin
Adriamycin

61. Racemization
It involves the conversion of an optically
active drug to an optically inactive drug.

62. Explosive Combination
It usually occurs when mixing oxidizing
and reducing agents with the aid of friction.
Examples:
Potassium permanganate (Mineral
chameleon) and sugar
Potassium permanganate and glycerin

63. Gelatinization
Involves the formation of gels.
Examples:
Acacia with Ferric salts
Collodion (Pyroxillin = cotton + H2SO4 +
HNO3) with phenol

64. Cementation
Involves the formation of cakes or
cements at the bottom of the container.
Example:
Acacia with Bismuth salts

65. Polymerization
Involves the formation of “Polymers”
(Large molecules).
Examples:
Dextrose
Formaldehyde

66. Rx
Sodium Phenobarbital
Syrup of Ipecac
Purified Water
M.ft.sol.
Manifestation: Precipitation
(Chemical)
Ingredients: Sodium Phenobarbital
and Syrup of Ipecac
(Because Syrup of Ipecac has HCl
Sodium Phenobarbital will be
precipitated)
Type: Chemical
Correction: Change in the kind of
Ingredient
(Syrup of Ipecac → Simple
Syrup)

67. Rx3
Cod Liver Oil
Purified Water
M.ft.sol
Manifestation: Immiscibility
Ingredients: Cod liver oil and
Water
Type: Physical
Correction: Addition of a
therapeutically inactive ingredient
Such as an emulsifying agent
(Acacia and Tragacanth

68. Rx
Potassium Bromide
2g
Camphor Water
qs.ad. 60mL
M.ft.sol.
Manifestation:
Precipitation (Salting out)
Ingredients: Potassium
Bromide and Camphor
water
Type: Physical
Correction: Adjustment of
the volume of the
prescription

69. Pharmacokinetic Interactions
What the body does to the drug?
Interactions in which the precipitant alters
the ADME of the object.
Accompanies by a change in plasma
concentration of the object.

70. Pharmacodynamic Interactions
What the drug does to the body?
Interactions in which the sensitivity or
responsiveness of the tissues to the object is
altered by the precipitant.
Not accompanied by a change in plasma
concentration of the object but by a change in the
object’s effect.

71. Alteration of Gastric pH
A drug to be absorbed must be non-ionized and
lipophilic.
An acidic drug is best absorbed in the stomach.
A basic drug is best absorbed in the small intestine.
Complexation
Involves the formation of complexes which are
insoluble and large compounds that are difficult to
absorb.

72. Adsorption
Adsorbents usually bind with substances concurrently
administered with them.
Leads to the formation of large compounds that are difficult to
absorb.
Alteration of Gastric Emptying time (GET)
GET refers to the time for the stomach contents to be
transported into the intestines.
High GET →Decreased motility : ↑Absorption
Low GET →Increased motility : ↓Absorption

73. Distribution is the process by which a drug is
delivered to body tissues and fluids.
The distribution of an absorbed drug within the
body depends on several factors.
Blood flow
Solubility
Protein binding
↑Protein binding : ↓Efficacy
↓Protein binding : ↑Efficacy

74. The main mechanism involved is
“Displacement”.
Competitive - binds at the same site
Non-competitive -binds at different site
This results to an increase in the concentration
of object leading to increase effects -
Therapeutic and Toxic.

75. Alteration of Gastrointestinal Flora
Changes in the microbial flora of the
gastrointestinal tract may affect the
metabolism of some drugs.
↑ GI Flora : ↑Metabolism : ↓Absorption
↓ GI Flora : ↓Metabolism : ↑Absorption

76. Absorption
decreased by
Food
Alendronate
Captopril (Side effect:
release Bradykinin
→coughing)
Erythromycin (Side
effect: gastric pains)
Penicillamine
Penicillin
Tetracycline
Isoniazid
Quinolones

77. Absorption increased by Food
Acarbose
Griseofulvin (best absorbed with fats)
Itraconazole
Metoprolol
Theophylline

78. Alteration of Gastrointestinal Metabolism
Metabolism may happen in the Gastrointestinal
tract.
Enzyme Induction
Characterized by high levels of enzymes leading to
enhanced metabolism. : ↓Absorption
Enzyme Inhibition
Characterized by low levels of enzymes leading to
reduce the metabolism. ↑Absorption

79. Enzyme
Inducers
Pyridoxine
Rifampicin
Phenytoin
Phenobarbital
Carbamazepine
Chronic alcoholism
Smoking

80. Enzyme
Inhibitors
Cimetidine
Ketoconzole
Itraconzaole
 Valproic Acid
Miconazole
Macrolides except
Azithromycin
Grapefruit juice
Allopurinol
Disulfiram
Fluoriquinolones

81. Excretion refers to the elimination of drugs
from the body.
Combining one drug with another drug or
with food can cause interactions that increased
or decreased drug interaction.

82. Alteration of Urinary pH
A drug to be excreted must be ionized and
hydrophilic.
An acidic drug is best excreted in basic urine.
A basic drug is best excreted in acidic urine.

83. 2. Alteration of Active Transport
A drug bound for active transport may have
two fates.
If drug is already in the ionized form, it will be
actively secreted and excreted.
If drug is still in the non-ionized from, it will be
reabsorbed.

84. 1. Antagonism
An antagonistic effect occurs when the
combined responses of two drugs is less
than the response produced by either drug.
Mathematically expressed as “1+1 = 0”.

85. 2. Additive
Additive effects can occur when two drugs with
similar actions administered to a patient.
The effects are equivalent to the sum of either
drug’s effects if it were administered alone in
higher doses.
Mathematically expressed as “1+1 = 2”.

86. 3. Synergism
A synergistic effect occurs when two drugs
producing the same effect are given
together. This produces greater effects that
when each drug is taken alone.
Mathematically expressed as “1+1 = 3”.

87. 4. Potentiation
Potentiation occurs when one drug
enhances the effect of the other drug.
Mathematically expressed as
“1+0 = 2”.

88. 1. Drug Herb
2. Drug Lab Test
3. Drug Food
4. Drug Drug

89. 1. Drug - Herb
a. Licorice + Anti- HTN
b. Digoxin + St. John’s Wort
c. Warfarin/Heparin + Garlic
d. Sedatives + Valerian

90. 2. Drug-Lab
a. Rifampicin and Urinalysis
b. Ascorbic acid and Glucose Test

91. 3. Drug - Food
1. Quinolones/TCN + Ca rich diet
2. Warfarin+ Green Leafy vegetable
3. INH + Histamine-Rich Foods
4. MAOI + Tyramine rich food

92. 4. Drug - Food
5. CNS Depressant + caffeine
6. Griseofulvin + Fatty foods
7. Bisacodyl + Milk
8. ASA + Caffeine

93. 4. Drug - Drug
1. Addition
1 + 1 = 2
e.g.
a. Benzodiazepines + Antihistamine
b. Beta blockers + CCBs

94. 4. Drug - Drug
2. Synergism
1 +1 = 3
e.g.
a. Trimethoprim + Sulfamethoxazole

95. 3. Antagonism
1 +1 = 0
e.g.
Phenoxybenzamine + Catecholamines
Warfarin + Vitamin K
Heparin + Protamine SO4

96. 4. Drug - Drug
4. Potentiation
1 + 0 = 2
E.g.
a. Amoxicillin+ Clavulanic acid
b. Aminoglycosides + Loop Diuretics

97. 5. Drug - Electrolyte
concentration
1. Diuretic + Digoxin
2. Low sodium + Lithium drug
3. ACEI’s + Potassium sparing
diuretics

98. 1. Absorption
a. Alteration of pH
i. Ketoconazole + Antacid
ii. Bisacodyl + Antacid

99. 2. Complexation and
Adsorption
i. Tetracycline/ Quinolones + Metals
ii. Cholestyramine/Colestipol + Drug

100. 3. Alteration of Motility/ GER
a. Laxatives/Cathartics:↑ motility
b. Anticholinergics: ↓motility

101. 4. Alteration of G.I. Flora
a. Digoxin + Antibiotic

102. 5. Metabolism
Enzyme Induction
Characterized by high levels of enzymes
leading to enhanced metabolism. :
↓Absorption
Enzyme Inhibition
Characterized by low levels of enzymes
leading to reduce the metabolism.
↑Absorption

104. 1.) Drugs bound to plasma proteins are
considered:
A. Pharmacologically active
B. Pharmacologically inactive
C. Free drugs
D. Bioavailable drugs

105. It is recognized that the protein-bound
fraction of a drug in the body is not
pharmacologically active.

106. 2.) In metabolizing a standard dose of
INH, Filipinos are considered:
A. Fast acetylators
B. Slow acetylators
C. Neither slow or fast
D. Same as the caucasians

107. Eskimos and Orientals are rapid
acetylators. Egyptians and
Mediterranean Jews are mainly slow
acetylators.

108. 3.) The following are guidelines for
reducing drug interactions except:
A. Employ combination therapy
B. Identify patient risk factors
C. Educate the patient
D. Know properties of drugs

109. Guidelines for reducing drug interactions:
- Identify the patient risk factors
- Take a thorough drug history
- Be knowledgeable about the drug being used
- Consider therapeutic alternatives
- Avoid complex therapeutic regimes where
possible
- Educate the patient
- Monitor therapy
- Individualize the therapy

110. 4.) The following are true about the
incompatibilities except:
A. Problems arising during compounding,
dispensing and drug administration.
B. Easier to correct than to prevent
C. May be intentional or unintentional
D. Must be recognized by pharmacist

111. Incompatibilities are easier to prevent
than to correct

112. 5.) Oxidizing agents are incompatible with
reducing agents. This is a:
A. Physical incompatibility
B. Therapeutic incompatibility
C. Chemical incompatibility
D. Both a and b

113. Chemical incompatibility- a result of oxidation
reaction, acid-base, hydrolysis or combination
reaction
Physical incompatibility- a result of insolubility,
liquification, or physical complexation
Therapeutic incompatibility- exists when the
response of one or more drugs administered is
different in nature or intensity than that intended

114. 6.) A mathematical model for potentiating
drug effect:
A. 1 + 1 = 2
B. 1 + 1 = 3
C. 0 + 1 = 2
D. 1 + 1 = 0

115. Mathematical representations:
- Potentiation as 0 + 1 = 2
- Synergism as 1 + 1 => 2
- Antagonism as 1 + 1 = 0

116. 7.) A drug induced hypersensitivity
reaction caused by sulfonamides:
A. Parkinson’s disease
B. Steven-Johnson’s syndrome
C. Hypertension
D. Contact dermatitis

117. SJS is a blistering disorder that is
usually more severe than erythema
multiforme. Initial presentation is often a
sore throat, malaise, and fever. W/in a
few days, small blisters or purpuric
macules or atypical target lesions
characterize this eruption.

118. 8.) Phenobarbital and griseofulvin are
____ of coumarin:
A. Enzyme inducers
B. Enzyme inhibitor
C. Antagonists
D. Agonists

119. These drugs are well known hepatic
enzyme inducers.

120. 9.) Type F ADR can occur as a result of
the following except:
A. Antimicrobial drug resistance
B. Patient compliance
C. Counterfeit drugs
D. Drug instability

121. Type F (failure of therapy) ADR may
result from non-compliance

122. 10.) Chloramephenicol can lead to this
untoward drug reaction:
A. granulocytosis
B. Gray syndrome
C. Both a & b
D. None of the above

123. Chloramephenicol in neonates may
cause Gray baby syndrome, a fatal
cyanosis with symptoms of vomiting,
abdominal distention and loose green
stools, owing to the inability of the infant
to metabolize drug

124. 11.) Camphor, menthol, acetophenetidine,
phenol will form:
A. Eutectic combination
B. Liquefication
C. Explosive combination
D. Botha a & b

125. Eutectic mixture is an example of a
physical incompatibility manifested by
lowering melting point.

126. 12.) The most important protein to which
drugs can bind in the plasma:
A. Lipoprotein
B. Albumin
C. Glycoprotein
D. None of the above

127. Albumin binds to acidic drugs while
glycoprotein and lipoprotein binds to
basic and other drugs, respectively.

128. 13.) Side effect of streptomycin:
A. Headache
B. Dryness of the mouth
C. Ontotoxicity
D. None of the above

129. The common side effects of all
aminoglycosides are ototoxicity and
nephrotoxicity.

130. 14.) The transport of a substance by
means of blood:
A. Absorption
B. Distribution
C. Metabolism
D. Excretion

131. - Absorption- a process by w/ch drug is
transferred from its administration site to
systematic circulation.
- Distribution- a process by w/ch drug
leaves the systemic circulation & enters
the cells.
- Metabolism- a process by w/ch drug is
chemically altered in the body.
- Excretion- a process by w/ch a drug or
metabolite is removed from the body

132. 15.) The conversion of an optically active
form to an optically inactive form is
called:
A. Polymorphism
B. Racemization
C. Polymerization
D. Enantiomorphism

133. - Polymorphism- existence of a
substance in more than one
crystalline form.
- Polymerization- combination of 2 or
more identical molecules forming a
larger molecule.

134. 16.) These are functions of pharmacist
except:
A. Drug information
B. Diagnosis
C. Counseling on medications
D. Monitor drug respone

135. Diagnosis is the function of the doctors.

136. 17.) The following is/are characteristics of
side effects:
A. Dose-dependent
B. Predictable
C. Associated pharmacological effect
D. All of the above

137. Side effects are predictable, dose
dependent, and manifestation of the
main pharmacological effect but
occurring at some other time.

138. 18.) Oral antihistamines exhibit the ff.
side effect:
A. Drowsiness
B. Sleepiness
C. Both a & b
D. Anemia

139. Antihistamines can depress depress the
CNS.

140. 19.) W/ch of these drug products require a
physician’s prescription:
A. Aspirin 325 mg tab
B. Paracetamol 500mg tab
C. Nubain 10 mg tab
D. Both b & c

141. Nubain nees a physician’s prescription
and in triplicate form.

142. 20.) Characterizes the first exposure of
the fraction of the drug:
A. First pass effect
B. Drug-receptor interaction
C. Biotransformation
D. Pharmacokinetics

143. - Pharmacokinetics- study of the time
course of drug movement in the body
during the absorption, distribution,
metabolism and excretion of drug.
- Biotransformation- also known as
metabolism.
- Drug should bind to a receptor to
initiate response

144. 21.) Tetracycline tends to form complexes
with:
A. Calcium ions
B. Magnesium ions
C. Aluminum ions
D. Iron ions
E. All of the above

145. Do not give concurrently as this will
result to complexation.

146. 22.) A suspension with the ff. ingredients
(FeCl3, Fe(OH)3, acacia, FD&C # 5 (orange
color) and methyl paraben will reveal this
manifestation:
A. polymerization
B. gelatinization
C. cementation
D. precipitation

147. Acacia + ferric salts = gelatinization
Acacia + Bismuth = cementation

148. 23.) Identify the odd-man-out:
A. Complex formation
B. Insolubility
C. Liquefication of solid ingredients
D. Polymorphism

149. Complex formation is a type of chemical
incompatibility. The rest are physical
incompatibilities.

150. 24.) The ff. are true about dimercaprol
except:
A. British anti-Lewisite
B. Indicated for Fe poisoning
C. Indicated for As poisioning
D. Chemical antagonist

151. It is an antidote for Fe poisoning.

152. 25.) How many mL will you dispense for a
prescription calling for a 100 g of a liquid
substance with a sp. Gr. of 1.25:
A. 75 mL
B. 80 mL
C. 85 mL
D. 90 mL

153. SG = M/V
V = M/SG
V = 100g/1.25 = 80 mL

154. 26.) Pharmacists should caution patients
who are taking niacin that this drug:
A. Stains the urine bright red
B. Causes ringing in the ears
C. Causes muscular weakness
D. Should be taken with meals

155. Rifampicin = colored urine

156. 27.) Emulsions made with tweens are
usually:
A. unstable
B. w/o
C. o/w
D. clear
E. reversible

157. Spans = w/o

158. 28.) W/ch of the ff. is not used as a vehicle
for injections:
A. Peanut oil
B. Cottonseed oil
C. Theobroma oil
D. Sesame oil

159. Theobroma oil is not used as a vehicle
for injection, simply because it is in solid
state. The four official oils that re used
as solvents for injections are: peanut oil,
cottonseed oil, sesame oil, and corn oil/

160. 29.) Lidocaine HCl is not administered
orally because it is:
A. Ineffective by this route
B. Too acidic
C. Too toxic by this route
D. A cause of arrhythmias
E. unstable

161. Because of its very extensive firs-pass
hepatic metabolism only 3% of orally
administered lidocaine appears in the
plasma. Thus, lidocaine must be given
parenterally.

162. 30.) The dose of a drug is 5mg/kg of body
weight. What dose should be given to a
100-lb female patient:
A. 2500 mg
B. 250 mg
C. 25 mg
D. 44 mg

163. Given:
dose of the drug = 5g/kg of body weight
weight of the patient: 100 lb
1kg = 2.2 lbs
100lb (1kg/2.2lbs) = 45.4545 kg (5mg/kg) = 227.27
mg
*Among the choices, the nearest is 250 mg

164. 31.) Prednisone is converted to w/ch of
the ff. by the liver:
A. Cortisone
B. Hydrocortisone
C. Prednisolone
D. Methylprednisolone
E. Dexamethasone

165. Prednisone is a pro-drug. It is rapidly
converted to the active product,
prednisolone in the body.

166. 32.) Clindamycin is closely related to w/ch
of the ff. in effective spectrum:
A. chloramphenicol
B. hydrocortisone
C. kanamycin
D. lincomycin
E. dexamethasone

167. Clindamycin is a chlorine substituted
derivative of lincomycin, an antibiotic
that is elaborated by Streptomyces
lincolnensis. It is effective against
Streptococcal and Staphylococcal
infections.

168. 34.) Activated charcoal is used insome
antidotes because of w/ch of its
properties:
A. Neutralizing
B. Emetic
C. Absorptive
D. Adsorptive
E. Stabilizing

169. It is an example of a chemical antidote,
where its mechanism of action is
adsorption of the toxicant.

170. 35.) The major use of titanium dioxide in
pharmacy is in:
A. Sunscreens
B. Antacid capsules
C. Capsules as a diluent
D. Effervescent salts
E. Emulsions

171. Titanium dioxide is used as white
pigment in creams and paints. The
refractive characteristic makes it useful
to ward off light rays and it is for this
purpose in sun-tan preparations.

172. 36.) The principal use of magnesium
stearate in pharmaceutics is as a/an:
A. lubricant
B. antacid
C. source of magnesium ions
D. disintegrator
E. binder

173. Magnesium stearate is used as the
lubricant, the water-proofing
characteristics of this insoluble material
can retard penetration by the
gastrointestinal fluids and delay drug
dissolution and absorption.

174. 37.) What is the proof strength of a 50%
(v/v) solution of alcohol:
A. 25 proof
B. 50 proof
C. 100 proof
D. 75 proof
E. 150 proof

175. Proof strength = 2 x (%v/v) so 50% x 2
= 100 proof

176. 38.) Increase serum levels and prolongs
the activity of penicillin derivatives by
blocking the latter’s tubular excretion:
A. probenecid
B. indomethacin
C. propranolol
D. methyldopa

177. It is well recognized that probenecidcan
increase serum concentrations and
prolong activity of penicillin derivatives
by blocking their tubular secretion.

178. 39.) The common adverse effect related to
the use of aluminum antacids:
A. nausea
B. vomiting
C. constipations
D. all of the above

179. Aluminum compounds are vomitting.

180. 40.) Tetracycline tends to form complexes
with:
A. Iron salts
B. Magnesium salts
C. Calcium salts
D. All of the above

181. Tetracycline can combine with metal
ions in the GI tract to form complexes
that are poorly absorbed.

182. 41.) W/ch of the ff. factors may make it
necessary to give lower doses of drugs to
geriatric patients:
A. Reduced enzyme activity
B. Reduced kidney function
C. Enhanced absorption
D. A and B

183. These type of disease more experienced by the
elderly patients (ex. renal disorder) may contribute
to an altered drug response, and there appears to
be an increased sensitivity to the action of certain
drugs with advancing age. In addition, there may be
aging –related changes in the absorption,
distribution, metabolism, and excretion of certain
drugs, w/ch increase the possibility of adverse drug
reactions.

184. 42.) Allergic reactions that are due to a
patients immune response:
A. hypersensitivity
B. idiosyncracy
C. synergy
D. potentiation

185. Hypersensitivity denotes an allergic
response of a person to a drug/allergen.

186. 43.) The most serious drug-induced blood
disorder:
A. Aplastic anemia
B. Leukemia
C. Agranulocytosis
D. Thrombocytopenia

187. Blood dyscrasias:
- Aplastic anemia- characterized by acellular or
hypocellular bone marrow
- Agranulocytosis- characterized by marked
reduction or disappearance of neutrophilic
granulocytes in the peripheral blood
- Thrombocytopenia- characterized by platelet
count below 100,000/mm^3

188. 44.) The ingestion of alcoholic drinks
while on analgesic or sedative therapy
represents a commonly encountered drug
interaction that may result in:
A. tolerance
B. antagonism
C. Excessive CNS stimulation
D. Excessive CNS depression

189. The increased CNS depressant effect
that is experienced by individuals being
treated with depressant drugs when
they consume alcoholic beverages is
among the best-known interaction.

190. 45.) Sodium benzoate is effective as a
preservative if the pH of the preparation
is:
A. Above 4
B. Above 7
C. Below 4
D. Below 7

191. Sodium benzoate is used as preservative in
acidic liquid preparations in w/ch benzoic
acid (pKa=4.2) is released. Using the
Henderson-Hasselbalch equation for weak
acids, at pH<4.2, benzoate concentration is
less than the benzoic acid concentration.
Meaning, the acid form predominates w/ch is
the form responsible for its preservative
action.

192. 46.) Upon exposure to air, aminophylline
solution may develop:
A. A gas
B. A precipitate of theophylline
C. Crystals of theophylline
D. A straw color

193. Aminophylline, upon exposure to air,
gradually loses ethylenediamine and
absorbs CO2, w/ liberation of free
theophylline (white crystalline powder).

194. 47.) The action between sodium
bicarbonate and aspirin would result to:
A. Formation of precipitate
B. Evolution of gas
C. Hydrolytic changes
D. Invisible changes

195. The gas produces is carbon dioxide.

196. 48.) The objective of the Generic Law is
to:
A. Provide the patient the choice of drugs at
the lowest cost
B. Provide regulated drugs
C. Provide prohibited drugs
D. Use habit forming drugs

197. One of the declared policies of the State
in the Generic Act of 1988 is to “ensure
the adequate supply of drugs with
generic names at the lowest price
possible cost and endeavor to make
them available for free to indigent
patients.

198. 49.) Valium and Tagamet combination will
not result to one from the following:
A. Tagamet delay elimination of anti-anxiety
agent
B. Increased sedation and dizziness
C. Blood levels of anti-anxiety drug increased
D. Valium increases the metabolism of
theophylline

199. H2 antagonists such as Cimetidine (Tagamet) may
increase plasma concentrations of some
benzodiazepines and enhance sedation. The
mechanism may be related to inhibition of the liver
cytochrome P450 enzymes responsible for
metabolism of certain benzodiazepines. Clinical
monitoring of patient response and tolerance is
recommended and benzodiazepine dosage
reductions may be indicated.

200. 50.) W/ch statement is incorrect regarding interaction
involving tyramine containing substance and MAO
inhibitor:
A. Inhibition of MAO result in accumulation of large amounts
of norepinephrine.
B. Decrease ion the rate of intracellular metabolism
C. Large amount of norepinephrine can cause severe
headache and hypertension
D. Large amount of stored norepinephrine can cause
hypotensive crisis

201. Tyramine is metabolized by MAO-1 (Monoamine
Oxidase Inhibitors) following ingestion of certain
foods with a high content of pressor substances,
such as tyramine. Examples of food rich in tyramine
are aged cheese, Chianti wine, pickled fish,
concentrated yeast extract and broad bean pods.