pharm-d 3rd year previous papers

Take a glance on antibiotics

 Five Basic Mechanisms of Antibiotic Action against Bacterial Cells:

1. Inhibition of Cell Wall Synthesis (most common mechanism)
2. Inhibition of Protein Synthesis (Translation) (second largest class)
3. Alteration of Cell Membranes
4. Inhibition of Nucleic Acid Synthesis
5. Antimetabolite Activity

 Inhibition of Cell Wall Synthesis

Beta-Lactams ---> Inhibition of peptidoglycan synthesis (bactericidal)

Resistance --->

(1) fails to cross membrane (gram negatives)
(2) fails to bind to altered PBP’s
(3) hydrolysis by beta-lactamases

Vancomycin ---> Disrupts peptidoglycan cross-linkage

Resistance --->

(1) fails to cross gram negative outer membrane (too large)
(2) some intrinsically resistant (pentapeptide terminus)

Bacitracin ---> Disrupts movement of peptidoglycan precursors (topical use)

Resistance ---> fails to penetrate into cell

Antimycobacterial agents ---> Disrupt mycolic acid or arabinoglycan synthesis (bactericidal)

Resistance --->

(1) reduced uptake
(2) alteration of target sites

 Inhibition of Protein Synthesis (Translation)

 30S Ribosome site

Aminoglycosides ---> Irreversibly bind 30S ribosomal proteins (bactericidal)

Resistance --->

(1) mutation of ribosomal binding site
(2) decreased uptake
(3) enzymatic modification of antibiotic

Tetracyclines ---> Block tRNA binding to 30S ribosome-mRNA complex (b-static)

Resistance --->

(1) decreased penetration
(2) active efflux of antibiotic out of cell
(3) protection of 30S ribosome

 50S Ribosome site

Chloramphenicol ---> Binds peptidyl transferase component of 50S ribosome, blocking peptide elongation (bacteriostatic)

Resistance --->

(1) plasmid-encoded chloramphenicol transferase
(2) altered outer membrane (chromosomal mutations)

Macrolides ---> Reversibly bind 50S ribosome, block peptide elongation (b-static)

Resistance --->

(1) methylation of 23S ribosomal RNA subunit
(2) enzymatic cleavage (erythromycin esterase)
(3) active efflux

Clindamycin ---> Binds 50S ribosome, blocks peptide elongation; Inhibits peptidyl transferase by interfering with binding of amino acid-acyl-tRNA complex

Resistance ---> methylation of 23S ribosomal RNA subunit

 Alteration of Cell Membranes

Polymyxins (topical) ---> Cationic detergent-like activity (topical use)

Resistance ---> inability to penetrate outer membrane

Bacitracin (topical) ---> Disrupt cytoplasmic membranes

Resistance ---> inability to penetrate outer membrane

 Inhibition of Nucleic Acid Synthesis

 DNA Effects

Quinolones ---> Inhibit DNA gyrases or topoisomerases required for supercoiling of DNA; bind to alpha subunit

Resistance --->

(1) alteration of alpha subunit of DNA gyrase (chromosomal)
(2) decreased uptake by alteration of porins (chromosomal)

Metronidazole ---> Metabolic cytotoxic byproducts disrupt DNA

Resistance --->

(1) decreased uptake
(2) elimination of toxic compounds before they interact

 RNA Effects (Transcription)

Rifampin ---> Binds to DNA-dependent RNA polymerase inhibiting initiation & Rifabutin of RNA synthesis

Resistance --->

(1) altered of beta subunit of RNA polymerase (chromosomal)
(2) intrinsic resistance in gram negatives (decreased uptake)

Bacitracin (topical) ---> Inhibits RNA transcription

Resistance ---> inability to penetrate outer membrane

 Antimetabolite Activity

https://www.youtube.com/watch?v=NGwP471sehI

Sulfonamides & Dapsone ---> Compete with p-aminobenzoic acid (PABA) preventing synthesis of folic acid

Resistance ---> permeability barriers (e.g., Pseudomonas)

Trimethoprim ---> Inhibit dihydrofolate reductase preventing synthesis of folic acid

Resistance --->

(1) decreased affinity of dihydrofolate reductase
(2) intrinsic resistance if use exogenous thymidine

Trimethoprim-Sulfamethoxazole synergism

community pharmacy 2nd year

CODE OF ETHICS OF COMMUNITY PHARMACIST

I. A pharmacist respects the covenantal relationship
between the patient and pharmacist.
Interpretation: Considering the patient-pharmacist
relationship as a covenant means that a pharmacist
has moral obligations in response to the gift of
trust received from society. In return for this gift, a
pharmacist promises to help individuals achieve optimum
benefit from their medications, to be committed
to their welfare, and to maintain their trust.

II. A pharmacist promotes the good of every patient in
a caring, compassionate, and confidential manner.
Interpretation: A pharmacist places concern for the
well-being of the patient at the center of professional
practice. In doing so, a pharmacist considers needs
stated by the patient as well as those defined by health
science. A pharmacist is dedicated to protecting the
dignity of the patient. With a caring attitude and a
compassionate spirit, a pharmacist focuses on serving
the patient in a private and confidential manner.

III. A pharmacist respects the autonomy and dignity of
each patient.
Interpretation: A pharmacist promotes the right of
self-determination and recognizes individual selfworth
by encouraging patients to participate in decisions
about their health. A pharmacist communicates
with patients in terms that are understandable. In all
cases, a pharmacist respects personal and cultural
differences among patients.

IV. A pharmacist acts with honesty and integrity in
professional relationships.
Interpretation: A pharmacist has a duty to tell the truth
and to act with conviction of conscience. A pharmacist
avoids discriminatory practices, behavior or work conditions
that impair professional judgment, and actions
that compromise dedication to the best interests of
patients.

V. A pharmacist maintains professional competence.
Interpretation: A pharmacist has a duty to maintain
knowledge and abilities as new medications, devices,
and technologies become available and as health information
advances.

VI. A pharmacist respects the values and abilities of
colleagues and other health professionals.
Interpretation: When appropriate, a pharmacist asks
for the consultation of colleagues or other health
professionals or refers the patient. A pharmacist
acknowledges that colleagues and other health professionals
may differ in the beliefs and values they
apply to the care of the patient.

VII. A pharmacist serves individual, community, and
societal needs.
Interpretation: The primary obligation of a pharmacist
is to individual patients. However, the obligations
of a pharmacist may at times extend beyond
the individual to the community and society. In these
situations, the pharmacist recognizes the responsibilities
that accompany these obligations and acts
accordingly.

VIII. A pharmacist seeks justice in the distribution of
health resources.
Interpretation: When health resources are allocated,
a pharmacist is fair and equitable, balancing the
needs of patients and society.

PATHOPHYSIOLOGY

HYPERSENSITIVITY REACTION MECHANISMS

USEFUL WEBSITES FOR PHARM-D

1)PHARMACOLOGY
http://howmed.net/pharmacology          ( Its a very useful website for pharmacology and has a good way of representation.)

pharm-d 2nd year previous question papers 2010,2011,2012,2013,2014(new)