1. When we use only the clinical improvement and serum T4 (not TSH) to estimate the appropriate replacement dose of levothyroxine?

2. Your way to manage myxedema coma using 3 drugs? 3. Early goal-directed therapy (EGDT) to optimize oxygen delivery in septic

Shock??(4 interventions)4. Administration of bisphosphonate (prophylaxis, treatment) routes, doses5. Anti-emetics (best choice in elderly)6. Drugs for pain control, mention step approach and side effects7. Intra venous antiplatelets8. Drugs used in dementia mechanisms and generic names9. Different members and mechanisms antiaggregant?10.Famous Drug interactions of warfarin??

1. When we use only the clinical improvement and serum T4 (not TSH) to estimate the appropriate replacement dose of levothyroxine?

Central hypothyroidism (e.g. hypothalamic/pituitary disorders)

2. Your way to manage myxedema coma using 3 drugs? a. 300- 500 mcg LT4 levothyroxine intravenously initially, and is

followed by a daily intravenous dose of 50-100. b. hydrocortisone 50 to 100 mg every 6 hours, c. T3 Liothyronine 5-20 micrograms intravenously and to be continued

at a dosage of 2.5-10 micrograms every 8 hours.3. Early goal-directed therapy (EGDT) to optimize oxygen delivery in

septic Shock??(4 interventions)a. Fluids CVP of < 8 mm Hg Administer 30 mL/kg Crystalloid

persistent arterial hypotension despite volume resuscitation (septic shock) or lactate ≥ 36 mg/dL

b. Vasopressors CVP of at least 8 to 12 mm Hg Norepinephrine is recommended as first choice vasopressor

c. inotropic agents, a trial of dobutamine infusion up to 20 μg/kg/min added to vasopressor if myocardial dysfunction or ongoing signs of hypoperfusion, despite achieving adequate intravascular volume and adequate MAP

d. red blood cell transfusion occur only when hemoglobin concentration decreases to < 7 target a hemoglobin level of 7 to 9 g/dL

4. Administration of bisphosphonate (prophylaxis, treatment) routes, doses

Avoid when CrCl < 35 mL/min

a. Oral Take after an overnight fast with (180–240 mL) plain water

while sitting or standing upright at least 30 minutes prior to morning meal

Do not lie down for 30 minutes after administration. Do not take with other medications or fluids. Do not chew or suck on the tablet

i. Alendronate  Prevention of PM osteoporosis: 5 mg orally daily or 35 mg orally once weekly therapeutic: Osteoporosis (men and women): 10 mg orally once daily or 70 mg orally once weekly

ii. Ibandronate  Treatment or prevention of PM osteoporosis: 2.5 mg orally daily or 150 mg orally once monthly; 3 mg IV push over 15–30 seconds every 3 months

iii. Risedronate : PM osteoporosis: 5 mg orally daily, 35 mg orally once weekly, 75 mg on 2 consecutive days each month, or 150 mg once monthly

Iv therapeutic: Not to be administered with calcium infusions.

i. Zoledronate Dilute dose with 100mls of saline, or g5% and infuse over 15minutes Prevention of PM osteoporosis: 5 mg every 24 months Treatment 5 mg every 12 months

ii. Pamidronate IV90mg every 4 weeks , 90mg in 500mls saline, g5% at rate of 1mg/minute,

iv. Ibandronate 3 mg IV push over 15–30 seconds every 3 months5. Anti-emetics (best choice in elderly)

i. Anticholinergics, Antihistamines for vestibular mediated (badfor elderly)

ii. Phenothiazines sedating confusion, respiratory depression, extrapyramidal symptoms, and anticholinergic effects

iii. Domperidone Sedation, restlessness, diarrhea, agitation, CNS depressionneuroleptic syndrome, supraventricular tachycardia,QT prolongation, serotonin syndrome

iv. Metoclopramide causes acute extrapyramidal symptomsv. Serotonin Antagonists Granisetron, Ondansetron QT

prolongation considered potentially safe in elderlyvi. Corticosteroids as antiemetics in chemotherapy-induced emesis

6. Drugs for pain control, mention step approach and side effectsStep 1: Non opioid (+ or-) adjuvant.(VAS 2- 4). Step 2: Weak opioid (+) Non opioid (+ or-) adjuvant(VAS 4-6).

Step 3: Strong opioid (+) Non opioid (+ or- ) adjuvant(VAS>6/10).Step 4: Anesthetic/Neurosurgical Interventions.Adjuvant medications

Antidepressants. Anticonvulsants. Neuroleptic agents. Corticosteroids. Osteoclast inhibiting medications.

Analgesic: Paracetamol: risk of overdose, toxicity in hepatic NSAIDs:Increased risk of GI and renal complications in

elderly Selective COX-2 inhibitors: Similar nongastrointestinal

side effects to nonselective NSAIDs Opioid analgesics:

1. drowsiness2. nausea and vomiting3. constipation 4. Drug dependence is uncommon in elderly people

7. Intra venous antiplatelets:i. Glycoprotein IIB/IIIA inhibitors

Abciximab Eptifibatide Tirofiban

ii.  frequently used during percutaneous coronary intervention (angioplasty with or without intracoronary stent placement

8. Drugs used in dementia mechanisms and generic namesi. Choline esterase inhibitors Donepezil Galantamine

Rivastigmineii. Anti-NMDA blockers Memantine

iii. Antioxidants Vitamin E, Ginkgo bilobaiv. Anti-Inflammatory Drugs

9. Different members and mechanisms antiaggregant?

i. Irreversible cyclooxygenase inhibitors Aspirin

ii. Adenosine diphosphate (ADP) receptor inhibitors Clopidogrel,  Ticlopidine

iii. Phosphodiesterase inhibitors Cilostazol

iv. Glycoprotein IIB/IIIA inhibitors (intravenous use only)v. Adenosine reuptake inhibitors

Dipyridamole 10.Famous Drug interactions of warfarin??

i. Increase Anticoagulation Effecta. Acetaminophenb. Amiodaronec. Cephalosporinsd. Ciprofloxacine. Fenofibratef. Fluconazoleg. Influenza vaccineh. Lovastatini. Metronidazolej. Miconazolek. Omeprazole

ii. Decrease Anticoagulation Effect a. Carbamazepineb. Cholestyraminec. Phenytoind. Rifampine. Sucralfatef. Vitamin K

iii. Increase Bleeding Riska. Argatrobanb. Aspirinc. Clopidogreld. Dipyridamolee. LMWHsf. Nonsteroidal anti-inflammatory drugsg. UFH