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โครงการเตรียมความพรอมสอบรวบยอด และ สอบใบประกอบวิชาชีพเภสัชกรรม โดย กศกษาเภส ชศาสตร นท 24 มหาวทยาล ยขอนแกน เฉลย ขอสอบ MCQ ใน MCQ and OSPE Examination Bank

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Page 1: Key MCQ Bank

โครงการเตรยมความพรอมสอบรวบยอด และ

สอบใบประกอบวชาชพเภสชกรรม

โดย นกศกษาเภสชศาสตร รนท 24

มหาวทยาลยขอนแกน

เฉลย ขอสอบ MCQ ในMCQ and OSPE Examination Bank

Page 2: Key MCQ Bank
Page 3: Key MCQ Bank

��������� MCQ ������ Infectious Disease

��� !�� "#�"�$%�& �#ก�ก� ($�ก!) *+, -�� �.* /+0 *-ก*!ก �&.�� ��� ,&*

Case HIV and OIs (307)

1.� Cyclophosphamide �������ก�� Hemorrhagic cystitis �ก�� �ก acrolein (Inactive metabolite) '()*ก+,-��.�/ hydration (~3 L/day x 72 hr) �78) Mesna .�/ Ifosfamide (IFEX) >?@.)ก�A�ก�� hemorrhagic cystitis ?�กกBC� Cyclophosphamide (CTX) �,8E)* �ก IFEX �F� dose �@EAG*กBC� CTX ?�ก ( CTX 750 mg , IFEX 1-3 g )

2. .�8E?,L��M�??�กN B+,O> 2-4 O�M7 �Q8E)�'R,ก�7 Hydration

3.ก SJS .�/ SJS (Stevens-Johnson Syndrome ) >QUM�?�/8E)UVMC�*N�FC, M� FC)*'�ก )B+/B>�QW �'R,M�,XO> >QUYO Nikolsky\s sign negative (Nikolsky\s sign test ]8)ก�7�G�XYO^�� �,8L)M���_L,?� >���YO positive �F�X/ก SJS ก+U TEN) 4. ก�7XQ�/� Fluconazole �78) Bactrim �,8E)* �ก/��+L*A)*M+B?@ก�7W_กc��,YG�'dB/ HIV QUBC�/��@E�F��,ก�77+กc�.7]XO�B�������ก��Y8E,XQ�/�F,�� Stevens -Johnson syndrome �@EQU�,ก�7W_กc�]7+L*,@L-��XกC Co-trimoxazole ( 7�)/O> 45.3 ) Fluconazole ( 7�)/O> 21.7 ) Nevirapine ( 7�)/O> 11.3 ) Ofloxacin ( 7�)/O> 10.4 ) XO> Rifampicin ( 7�)/O> 7.6 )

5. ].Enalapril �?8E)����-'�,7C�*ก�/XO�B _* >))กi�j�k PK: Enalapril �'R,/��@E)/GC�,7G' prodrug �@E,��?��F��'R,F,��X7ก��*]O�,�ก �?8E)���.�/ก�77+U'7>��, >A�?�7^�G�l_?-���@ )���7-?C?@YOO�ก�7�G�l_? /�^Gก�'O@E/,.�/ก7>UB,ก�7 deesterification �'R, A�7�@E�'R, dicarboxylic acid ]8) enalaprilat l_E*?@i�j�k��*�mA+FB��/���?8), enalapril XO>?@]C�]7_E*F@B�M�@E/�B,�,กBC� .�/ enalapril ?@]C�]7_E*F@B�M'7>?�n 1.3 F+EB.?* XMC enalaprilat ?@]C�]7_E*F@B�M 11 F+EB.?* �+L* Enalapril XO> enalaprilat A�?�7^�+U))ก��*-M-��

��) 6 M)U �Q7�> �]78E)* Atomic Absorption Spectrophotometer �F�A���7+Uก�7B��]7�>�pF,��XO>��'7�?�n�)*j�MV�,A�7M+B)/C�* .�/ก�7B+�]C�ก�7�G�กO8,]O8E,XA*�)*)>M)?)�A7>�)*j�MV �@E]B�?/�B]O8E,�qQ�> XO> fluconazole ?@B*X�B,�U,l�O l_E*A�?�7^�G�กO8,XA*�,FCB*�qQ�>-�� ��) 7 M)U ก �Q7�> ก�7B��]7�>�pM�,�V,-'7>A��j�YO (cost-effectiveness analysis) ��) 8 M)U �Q7�> Reg. No. 2A U)ก�7�BC�/�,@L�'R,/�A���7s 7G'XY,'t VU+,�@EYO�M�_L,m�/�,'7>��WXO>�'R,/�AGM7YA?�Q�E?�M�? Obimin AF '7>ก)U��B/ Vitamin A 6,000 USP units Vitamin D 400 USP units Vitamin C. 100 mg Vitamin B1 10 mg Vitamin B2 2.5 mg Vitamin B6 15 mg Vitamin B12. 4 mcg | Nicotinamide 20 mg | Calcium Pantothenate 7.5 mg | Folic Acid 0.25 mg | Ferrous Fumarate 90 mg | Calcium Lactate 250 mg | Copper (as Copper 0.1 mg | Iodine (as Potassium 0.1 mg | Dimethylpolysiloxane 20 mg | Fluoride (as Sodium Fluoride) 1 mg

Obimin -az

♣ ��)UC*�F�: '()*ก+,ก�7���B�M�?�,XO>X7Cj�MV�,7>�BC�*XO>�O+*ก�7M+L*]77mp

Page 4: Key MCQ Bank

♣ Obimin az 1 �?s� >'7>ก)U��B/: vit.A 5000 iu, vit.D 400 iu, vit.E 10 iu, vit.C 75 mg, vit B1 2 mg, vit.B2 3 mg, vit.B6 2.5 mg, vit.B12 3 mcg, nicotinamide 20 mg, folic acid 1 mg, Fe fumarate 200 mg, Ca lactate 250 mg, iodine(K iodate) 0.2 mg, Zn (Zn sulfate) 20 mg

B�j@�F�: 7+U'7>��,B+,O> 1 �?s�♣

�Q�E?�M�? �/� Obimin AZ tab XMกMC�* �ก/� Obimin AF tablet �,8E)* �ก?@'7�?�nA�7A��]+}?�กกBC� -��XกC Ferrous fumarate 200 mg ก+U Folic acid 1000 mcg XO> ?@�,���OsกกBC� ������A>�Bก�,ก�77+U'7>��, ��) 9 M)U ] �Q7�> ��������� ���������������������� (low-level disinfectants) ]8)A�7�]?@�@E-?CA�?�7^���O�/A')7p�)*XU]�@�7@/XO>-?CA�?�7^���O�/�F8L)B+n.7]XO>�F8L)-B7+A-�� A�7�]?@��OC�,@L�?8E)]B�?���?��,AG*�Q�E?AG*�_L,)� �'O@E/, �ก low-level disinfectants �'R, intermediate-level disinfectants -���FC, povidone-iodine �ก 75 ppm. ^_* 450 ppm. A�7�]?@U�*F,��X?�]B�?���?��? >�Q�E?�_L,�Q@/*��กs�'R, low-level disinfectants �FC, benzalkonium chloride( F8E)ก�7]�� Zephirol, Zephiran ) A�7�]?@กOVC?,@L��?�>A���7+UB+A�V�78)�]78E)*?8)�@E-?C ���'R,M�)*'O)��F8L)?�ก,+ก(non-critical item) ��) 10 M)U � �Q7�> prenisolone XO> cyclophosphamide �'R,/� ]BU]V?Q��Wc

�-.� CASE 3�4� 308-311

1. : )�ก�7�)* PCP : YG�'dB/?���B/)�ก�7-�� 1-2 A+'���p ?@-)X��*N��/� �)U�+� )� ?@�78)-?C?@ crepitation กs-�� U�*7�/?�]O��/)�ก�7�+B� B�/�78)m�B>��/� O�?��OB�q@/UQO+,

2.< /��O+ก PCP ]8) clotri-moxazole (trimetroprim 15 mg/kg/day) XUC*���B+,O>3-4]7+L* �'R,�BO� 21 B+,

ก7n@XQ� clotrimoxazole (Sulfonamides) ����F� dapsone100mg od + trimetroprim 5 mg/kg tid

3. = Clotrimoxazole ?@ ADR : hypersensitivity, SJS _*M�)*7>B+*Y8E,XQ� XO>)� XQ�/�

4. < -A�?X�ก : ������ก�,-��,�)/O* ,?>��?X�ก : �'R,/�7>U�/l_E*�+L*A)*)� ������,L���,+กO�-�� _*-?C��?�>ก+UYG�'dB/ HIV �Q7�>YG�'dB/ >?@,L���,+กO�O*)/GCXO�B, ก7>� @�/U ?@A77Q]Vn �8E?Xก�7�),�, ก7>��/,L�� U77���)�ก�7��)*�A@/ XO>FCB/'()*ก+,ก�7 +UM+B�)*-�?+,�,�A�,�O8)� กO@U�O@L/*XO>กO@U�)ก?@X]O�l@/? FCB/U��7V*ก7>�GกXO>�t,...-?C,C�?@YOก+UYG�'dB/,> �Q�E?�M�? A?V,-Q7�@E?@i�j�kM��,�F8L) HIV : OGก�M��U , �(��>O�/. 7 , ?>7>�@L,ก , �?�L,F+, , ��s��O�, 8)

5.@ YG��@E?@m�B>X�7กl�), �กก�7M���F8E) HIV ]8) ?@�78)�]/?@ก�7M���F8L)qB/.)ก�A �FC, B+n.7] �F8L)7� PCP .7]?>�7s*�@EA+?Q+,jpก+U�)�Ap (�FC, ?>�7s*MC)?,L����O8)*) XO>)8E,N ]B7-��7+U/�M��,-B7+A

6. < YG�'dB/ PCP A�?�7^�/V�/� prophylaxis -���?8E)?@ CD4>200 cell/mm3 M��MC)ก+,?�กกBC� 3 ��8),

7.ก YG�'dB/�@E-��AGM7 GPO vir : stavudine [D4T] , lamivudine [3TC] , nevirapine [NVP]]B7M��M�?)�ก�7XA�* )�ก�7XQ�/� .�/�qQ�>)/C�*/�E*Y8E,�@EY�B�,+*XO>M+U)+ก�AUl_E*�ก�� �กYO�)* nevirapine ,+L,�)* ---�Q�E?�M�?--- ��) ] : )�ก�7 N/V �ก�� �ก ritonavir ��) * : ritonavir �'R,�,_E*�,/�กOVC? PI l_E*กOVC?,@L?@ก�7�ก��'��ก�7�/��/)> �+L*YC�, p450 XO> ritonavir /+*�'R, CYP3A4 potent inhibitor ��B/ ��) : ritonavir ?@ S/E ]8) M+U)+ก�AU

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8.@ ก�7�AC lubricant �'R,X]CA�7FCB/�,ก�7YO�M ���-�O-���@�_L, -?C?@YOMC)ก�7�G�l_?

9. @. ����EF���G��3������=���������H� liquid extemporaneous preparation GO4�� ��@=�ก��:O��:@�EO����

ddI ���Q��RQSFF�:���O3� �.�.���������3�EF�EF������ '7>ก)U��B/ -���.,l�, (25, 50, 100 �78) 150 ?�OO�ก7+?) X)A'���? Crospovidone, -�-��7)กl@E)OG?��,@/? .l��@/?]�7pU)�,M X?ก,@�l@/?-��7)ก-l]p X?ก,@�l@/?A�M@/�7M -?.]7]O�AM�O�, �lOOG.OA l�O�]),-�))ก-l]p .l��@/?l��M7� ,L��M�O XMC*A�7���7A U77 V�B�O> 60 �?s�

ddI���QT@FEU�U��V (A���7+UO>O�/,L��7+U'7>��,) '7>ก)U��B/ -���.,l�, (100, 167, 250 �78) 375 ?�OO�ก7+?) ก7�A�? -��UA�] .l��@/?�O)A��M .l��@/?l��M7� ,L��M�O U77 Vl)*7+U'7>��,]7+L*��@/B

ddI ���QT@G�FEU�U��V (A���7+UO>O�/,L��7+U'7>��,) '7>ก)U��B/-���.,l�, �B�O> 2 ก7+? �78) 4 ก7+?

�?8E)7+U'7>��, /�-���.,l@, >^Gก���O�/-��)/C�*7B��7sB�,Am�B>ก7� A�7 Buffer �@E?@)/GC�,Y*/� _*FCB/O�ก�7�@E/� >^Gก���O�/�,ก7>�Q�>)���7XO>]B77+U'7>��,/��n>��)*BC�* �,8E)* �ก)���77UกB,ก�7�G�l_?�)*/� '7�?�n�)*/��@E Gก�G�l_?�Q8E)ก�7�)8L)'7>./F,p�,7C�*ก�/ ?@]C�'7>?�n 40% /� +Uก+UQO�A?�.'7M@,�Q@/* 5% YC�,����AGC,L��A?)*7CB?-�A+,�O+*XO>YC�,7ก-�� /�-���.,l@,?@]C�]7_E*F@B�M 1.5 F+EB.?* �,YG���}C XO> 0.8 F+EB.?*�,��sก ACB, ddATP ?@]C�]7_E*F@B�M�,�lO?�กกBC� 12 F+EB.?* '7>?�n 35-60% �)*/��@E7+U'7>��, >^Gก�+U))ก��*'tAA�B>�,7G'���?

10. zidovudine cotrimoxazole

ceftriaxone acyclovir

ciprofloxacin

11. <4����T�Q: � <4� ����E�.�.�������4��

�Y��Z:�@��4�@ ritonavir

:O��=��@S.4O�E�G�.�.�������.�

�ก Martindale : Practically insoluble in water; freely soluble in methyl alcohol and in dichloromethane

Page 6: Key MCQ Bank

12. :�ก��.�.�� 4:1 3���[\@��G� /� 4 ก7+? O>O�/-���?��,,L�� 1 mL M+B�O)ก]8)O>O�/,L�� 1 ก7+?

13.M)U �. �Q7�> T cell ���'R,A���7+Uก�7ก�� +��F8L)))ก �ก7C�*ก�/

11. ก. CD4 cellก�7M7B ��7>�+U�?s��O8)���B CD4 �@EO�O* ,+U�'R,�]78E)*F@L^_*]B�?7V,X7*�)*.7]�,YG�M���F8L)

12. @. BCG U@l@ @ �'R,B+]l@,'()*ก+,B+n.7] '7>ก)U��B/�F@L)B+n.7]Q+,jVpQ��Wc�@E/+*?@F@B�M)/GCXMC�?�i�j�k�,ก�7�������ก��.7] (attenuated strain of M. bovis ) XO>�,8E)* �ก)*]pก�7),�?+/.Oก-��Q� �7n�BC� ก�7q@�B+]l@, BCG �,YG�'dB/��sก�@EM���F8L) HIV �������ก��]B�?�A@E/*�)*ก�7XQ7Cก7> �/ (disseminate) �)*ก�7M���F8L) BCG

13. ��F <. Amphotericin B �,8E)* �ก cyptococosis �'R, OIs ?@S&S : fever , headach , neck stiffnessCSF : dark halo (India ink) /�7+กc� 1st choice : Amphotericin B 0.7-1 mg/kg qd 2 wk or )�ก�7�@ stable M�?��B/ Fluconazole 400 mg po qd ( ,�/?�,8E)* �ก����A?)*�@กBC�) �78) Itraconazole 200 mg bid 8-10 wk (�F��?8E)�,MC) SE �)* Fluconazole -?C-��) �78) ^���, SE �)* Amphotericin B -?C-�� ��� Fluconazole 400-800 mg 8-12 wks

14. 3. Ampicillin �,8E)* �กX/C*ก�7�+U))ก�)*/�กOVC? Penicillins �@E�C)-M

15.:. Cryptococcal meningitis )�ก�7��?8),��) 13 ��ก���@E�'R,O+กcn>�qQ�>�)*.7],@L -��XกC ?@-�� 'B�W@7c>7V,X7* )�� @/,?�ก XO>])X�s*(])X)C,-'���*�O+* XO>ก�?-?CO*) YG�'dB/ACB,?�ก >UC,'B��+EBW7@c> .�/�qQ�>)/C�*/�E*�BO�?@ก�7�]O8E),-�B�)*W@7c> (�FC, ก�?W7@c>) ?+ก >'B�M��MC)ก+,�O�/B+, XO>)� 7G�A_ก'B�]O��/W@7c> >7>�U�� ก�,/�Xก�'B�กs-?CFCB/����V�O�ACB,)�ก�7-�� )� ?@-��AG*MO)��BO��78)-��ME�� N

Case 3�4� 311

1. =�กbF�E�@����� ���:�QO�:cd���.��=��eO���H�Z�:��G� AIDS �,8E)* �กYG�'dB/-��7+U Antiretroviral agent ]8) AZT, DDI, EFV XO> /��@E�F�'()*ก+, OIs 2. �� �������H����3�c<�@Z�:b�<4� 1 GQ4Sก��G�F4�@ HIV virus, Pneumocystis carinii, Candida albican 3. ���F��[\@O@=���O��<�@�� �������H����3�c3.Eกb�<4� 2 -B7+AF,��,@L�'R, RNA virus l_E*?@�),-l?p reverse transcriptase (RNA dependent DNA polymerase) ����,���@E�,ก�7�'O@E/,X'O* RNA ����'R, DNA l_E*������-B7+AA�?�7^A7��* DNA -�� �?8E)-�� DNA XO�B viral DNA ,@L >���� incorporate ก+U host DNA -�� �provirus� �ก,+L, DNA ,@Lกs > transcription -��))ก?��'R, mRNA l_E*กs > translation ))ก?��'R, protein �@E ���'R,�)*-B7+AMC)-' l_E* protein �@EA7��*�_L,?�,@L >/+*-?CA�?�7^�F�ก�7-�� >M�)*^GกM+�XMC*กC),��B/�),-l?p protease XO�B _*-�� functional protein �@EA?UG7np �ก,+L,-B7+Aกs > assembly XO>))ก-' �ก�lOOpMC) 4. ���F��ก.Gกก����กh���i<�@����������[���.���� ��b�<4���� 3 ���E�@3�Q /�M��,-B7+A�)�Ap�@E?@�F���*]O�,�ก�,'t VU+, (Current Antiretroviral Drug in Clinical Use) �,'t VU+, /�M��,-B7+A�)�Ap�@E-��7+Uก�7 ��>�U@/,.�/ U.S.FDA ?@�+L*�?� 11 F,�� '7>ก)U��B//� 3 กOVC? ]8)

Nucleoside analogues reverse transcriptase inhibitors (NRTI) -��XกC AZT, ddC, ddI, d4T, 3TC Non-Nucleoside analogues reverse transcriptase inhibitors (NNRTI) -��XกC nevirapine, efaviren

Page 7: Key MCQ Bank

Protease inhibitors -��XกC saquinavir (hard capsule, soft gel capsule), indinavir, ritonavir XO> nelfinavir A���7+U�,'7>��W-�//�M��,-B7+A�)�Ap�@E�_L,�>�U@/,ก+U)*]pก�7)���7XO>/�?@ 10 F,�� -��XกC AZT, ddC, ddI, d4T, 3TC, nevirapin, efaviren, saquinavir, fortovase, indinavir, ritonavir XO> nelfinavir l_E*�'R,/��,U+}F@/��O+กX�C*F�M� 2 F,�� ]8) AZT XO> ddI 5. ��ก=�กก��b�4��S.4O b��j==cFE���ก��b�4OE:k��b�ก���l�@กE�:O���c�S�@<�@Z�: ���QbQF4�@ (F�ก������OE:k��)

OE:k����Q�V : ���Q<�@OE:k���l�@กE�Z�:��Q�V�����Yb���3O�@ก���Q.�@

B+]l@,�)�Ap�'R,W�AM7p��?C�)*.OกXO>�'R,YO�Mm+n�p��*F@Bm�Q�@EYO�M�_L,.�/�F�]B�?A�?�7^��*��].,.O/@F+L,AG* �+*,+L, _*YO�M.�/'7>��W�@EQ+�,�XO�B�'R,ACB,��}C �FC, A�7+�)�?7�ก� �7+E*�WA �'R,M�, )/C�*-7กsM�? �,FCB* 5 '��@EYC�,?�,@L'7>��W-�/-��7CB??8)ก+U'7>��WMC�* N �,ก�7]��]�,XO>YO�MB+]l@,�@E ]��BC� >��?�>A?ก+U'7>��W-�/�_L,XO�B �,'t VU+,�+EB.Oก?@ก�7��A)UB+]l@,�)�Ap��O)*F,��'()*ก+,�,], ��,B, 3 F,�� )+,-��XกC

Subunit protein vaccine

�+L* gp 120 XO> gp 160 �'R,.'7M@,ACB,�'O8)ก�)*�F8L) HIV -��^Gก�O8)ก�F��'R,ACB,'7>ก)U�,ก�7YO�MB+]l@, l_E*-��YC�,ก�7��A)U�,],XO�BQUBC�A�?�7^ก7>MV�,����ก��ก�7A7��*mG?�]V�?ก+,XO>?@]B�?'O)�m+/ �FC, synthetic peptide, gp120, gp160 �'R,M�, l_E*?@ก�7��A)U�,],-�/XO�B ��,B, 5 F,�� ,)ก �ก,@L U7�c+�-]7),XO>U7�c+�XBกlp� ,-��YO�MB+]l@,�@E�F�ACB,'7>ก)U �ก.'7M@,�'O8)ก,)ก�)*�F8L) HIV-1 sub type E l_E*QU�,'7>��W-�/ )+,-��XกC gp 120 B/E (U7�c+� Chiron) XO> gp120 B/E (AIDSVAX B/E �)*U7�c+� VaxGen) l_E*-��?@ก�7����,�,ก�7��A)U'7>A��j�YO AIDSVAX B/E �,กOVC?YG��F�/��AQM��F,��q@��,'7>��W-�/ XO>?@ก�7��A)U'7>A��j�YO�)* AIDSVAX B/B �,'7>��WA�7+�)�?7�ก��,กOVC?7+ก7CB?�QW ^_*X?�BC�YO�U8L)*M�, �กก�7��A)U'7>A��j�YO�)*B+]l@,F,��X7ก�,'7>��WA�7+�)�?7�ก�XO>�,'7>��W-�/�@E'7>ก�W�?8E)'��@EXO�BBC�-?C-��YOกsM�? XMCกs-��]B�?A�?�7^ XO>YO�MYO�)*ก�7A7��*A77]p ?@ก�7�7@/,7G��@EA�?�7^A7��*)*]p]B�?7G���?C �FC, ��)?GO�@E�ก@E/Bก+U7>UUmG?�]V�?ก+, (Humoral and Cellular Immunity) ]B�?XMกMC�*�)*A�/Q+,jVp�,mG?�m�]�)*.Oก (HIV-1 Genetic Variation) ]B�?A+?Q+,jp�)*YOก�7��A)U�,��)*'��U+M�ก�7 �,A+MBp XO>�,], (Correlates of Protective Immunity) ก�7B�B+�,�ก�7 (Evolution) XO>ก�7'7+U�'O@E/,X,B��*Q+�,�B+]l@,�)�Ap (Vaccine Concepts)

Live vector vaccine

�'R,B+]l@,�@E�F�ACB,�)*/@,�)*�F8L) HIV �AC����-'�,-B7+A/U+ก�M7@ �@E >�'R,Q��>�@E��?�>A? �,'t VU+,-��?@ก�7,��ACB,�)*/@,ACB,�'O8)ก�)*�F8L) HIV-1 sub type E �ก'7>��W-�/-'�AC�,-B7+A �FC, Canarypox/gp160 (ALVAC �)*U7�c+� Aventis Pasteur), rVaccinia-GagE XO>�,U+ก�M7@ �FC, rBCG-GagE �กก�7��A)U.�/���B+]l@, 2 F,�� ]8) Live vector vaccine XO> Subunit protein vaccine �,A+MBp��O)*QUBC�?@]B�?'O)�m+/XO>A�?�7^ก7>MV�,����ก��ก�7A7��*mG?�]V�?ก+,�+L*F,��Q_E*�lOOpXO>�,A�7,L�� (cell mediated and humoral immunity) A���7+UX,B��*ก�7�F�B+]l@, 2 F,��,@L)/GC�,7>�BC�*ก�7��A)U�,],�,'7>��WMC�* N 7B?�+L*�,'7>��W-�/l_E*ก��O+*��A)U�,7>/>�@E 3 l_E*�F�B+]l@, 2 F,���@E�F�ACB,'7>ก)U �ก.'7M@,�'O8)ก,)ก�)*�F8L) HIV-1 sub type E ]8) Live vector vaccine (ALVAC) XO> Subunit protein vaccine (AIDSVAX B/E, gp120) �,ก�7��A)U7>/>�@E 3 �,],-�/ ��,B, 16,000 ],

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�@E +*�B+�FOUV7@XO>7>/)* �n>,@L ก��O+*����,�,ก�7��A)U Live vector vaccine )@กF,���,_E*]8) MRK Adenovirus Serotype 5 HIV-1 gag l_E*�'R,.]7*ก�7�@EW_กc�]B�?'O)�m+/]B�?�,MC)B+]l@, �,���)*B+]l@, XO>]B�?A�?�7^�,ก�7ก7>MV�,7>UUmG?�]V�?ก+,�)*B+]l@, �)?�)�7p�] �)�@ 5 �)F-)B@ 1 Xกsก 3 ��s?�,YG���}C�@E?@AV�m�Q�@ �กmG?�m�]MC�* N �+EB.Oก .�/'7>��W-�/-������7CB?ก�7��A)U�?8E)'O�/'� 2546 ,@LA���7+U rBCG-GagE XO> rVaccinia- GagE,+L,YO�M.�/]B�?7CB??8)�)*,+กB��/�W�AM7p],-�/XO>}@E'Vd,XO>,��?���A)UM+L*XMC�,7>�+U��)*'��U+M�ก�7XO>�,A+MBp��O)* l_E*�n>,@LYOก�7��A)U�,�,GXO>�,O�*QUBC����YO�@XO>]��BC� >?@ก�7��A)U�,],MC)-' ,)ก �ก,@L /+*?@ก�7Q+�,� fowl pox live vector vaccine .�/]B�?7CB??8)�)*,+กB� +/-�/XO> ))A�M7�O@/ l_E*-���V,A,+UA,V, �ก US-NIH .�/ >�'R,ก�7W_กc�]GC�,�,7>�BC�*'7>��W-�/ก+U'7>��W ))A�M7�O@/ .�/-���7�E?���ก�7W_กc��,7>/>�@E 1 �,'7>��W))A�M7�O@/ l_E* >7G�YOm�/�,กO�*'� 2547 ,@L A���7+U'7>��W-�/)/GC�,7>�BC�*ก�7Q� �7n�.]7*ก�7 l_E*]��BC� >�7�E?���ก�7��A)U�,7>/>�@E 1 �,�7sB N ,@L

DNA vaccine

�'R,B+]l@,�@E�F�ACB,'7>ก)U�)*/@,�)*�F8L)HIV (DNA) YOก�7��A)U�,O�* QUBC�A�?�7^ก7>MV�,����ก��ก�7A7��*mG?�]V�?ก+,�+L*F,��Q_E*�lOOpXO>�,A�7,L��-�� 7B?�+L*-��?@ก�7��A)U�,7>/>�@E 1 �+L*�,YG��@EM���F8L)XO>-?CM���F8L)HIV QUBC�'O)�m+/XO>ก7>MV�,mG?�]V�?ก+,-���@ DNA vaccine ,+L,ACB,��}CYO�M�,'7>��WA�7+�)�?7�ก� XMC'7>��W-�/กs-���7�E?]��]�, DNA vaccine l_E*�F�ACB,'7>ก)U�)*/@,�)*�F8L) HIV-1 sub type E XO�B .�/]��BC� >A�?�7^,��?���A)U�,],-�/MC)-'

6. �j==cFE���ก��b�4��3������� V1 ���O�.Q:O���c�S�@<�@Z�:b�<4� 1 ��3�����O����: ���G� ��:cd��FE����H���G� V1?@)*]p'7>ก)U�'R,�กO8)?@ACB,�@E�7@/กBC� antigen X),M�� ,,@L >?@�,��M��78)F�L,ACB,]O��/�78)��?8),.'7M@,�78)F�L,ACB,�)*�F8L)-B7+AHIV ก�7M7B ก�7M���F8L)�)*YG�'dB/BC�M��HIV�78)-?C]8)ก�7M7B �� antibody X),M�U)�@L �@EA�?�7^���'��ก�7�/�ก+U X),M�� ,�@E?@)/GC�,,L��/��@E�F�M7B ��ก?@'��ก�7�/��ก���_L,�7��7@/กBC�?@YOpositive YOUBก XMC�,�?8E)�,�O8)�?@antigen�@E-�� �ก/�V1 ��,B,?�ก ,-'���'��ก�7�/�ก+Uantibody�,�O8)� ,�?��?8E)�7�,��?�M7B _*-?C?@7>�+Uantibody���'��ก�7�/�ก+UFV�M7B �78),L��/�M7B _*���YOOU'O)? �Q7�> 7�*N�,M+BYG�'dB/�)*/+*?@�F8L)HIV)/GC 7C�*ก�/�7�A7��*antibody�_L,?��Q8E)MC)M��,ก+U�F8L)XMC�F8L)M+B,@Lกs���O�/7>UUmG?�]V�?ก+,�)*�7��FC,ก+, �+*,+L,7C�*ก�/�78)j77?F�M� _*M�)*���7*-B�l_E*�YC�Q+,jVpMC)-' _* ���'R,M�)*ก�� +�YG�'dB/,+L,YG�'dB/ _*�7V�O*�78E)/NXO>��ก�7�A�?�7^�Q�E?QO+**�,�78))���7XO>ก��O+*� 7B?�+L*]B�?�B+*������-��ก�7�)�F,>MC).7],@L�'R,-'-�� �)�Q@/*�BO���C�,+L,�Q7�>7C�*ก�/�)*M�)*A7��*antibody�@E?@]B�? ���Q�>XO>X�OC*�@EA7��*'O)�m+/ �กก�77Vก7�, �ก�F8L)HIV 7. :cd���.�.�b34Uj@O� ��G<4��Q��กE��� 1 �Q ��S.4O F�@:�E�@����ก���OQp��q���ก [4����=���S.4O=�����ก��Q�<\�� �O@ 2 - 3 �Q �����T��������3�Eก�EO.Q.@�����d 5 kg ��ก=�ก����E@����ก���3@ ����ก���ก.�@: � :E�:�S.�G�F����ก=����G�GQ4 �����3����<��O��<�O��H�=���O���ก ���:�QO���ก=�กZ�:b�<4� 1 S.4O :cd���.��=���H�Z�:��G� �,ก7n@,@LYG�'dB/)� ?@ OEdZ�: 7CB?��B/ �,8E)* �ก�A?�>�7�E??@A@��O8)* ��@/B',�'R, ��,B,?�ก 7CB?ก+Uก�7-)MC)�,8E)*�'R,�BO�,�, ,L���,+กM+BO� XO>��*8E)))กM),กO�*]8,

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8. :cd���.�4�@ก����Sก4G� ���=�=����Sก4G����QbQ O���b�4��H����@G� S.����=�=�� codeine GQ43� �G� ���@G� ���],-�� =�F��Sก4G�3� ��������QSก4G�����c�:� �Q8E)FCB/���O��])�@EX��*XO>7>]�/)/GCFVC?F8L,XO>AU�/�_L, XO>b�4��

.�.�����3� �FC, GG, fluimucil �Q8E)FCB/����A?�>��OB�A�_L, XMC^���'R,ก�7-)XUUX��* N ]B7�F�/�7>*+U)�ก�7-) �FC, Dextromethorphan ก�7�GXO�U8L)*M�, : 1. �8E?,L��?�กN �Q8E)����A?�>��OBXO>�+U))ก*C�/XO>/+*FCB/O�)�ก�7-)-�� 2. G�:O�ก����กQ��ก��G� ��� ��Sก4����Q��������O�T��<�@stu� �����=����b34���3��ก:4�@��Yb���Q 3. �Vก]7+L*�@E�7� >-) ]B7'��'�ก 4. +��C�,), �FC,,),�,V,�+BAG* ��������/� A>�Bก�_L, 5. )�ก�W�,��)*Q+ก]B7^C�/��-��A>�Bก �O@ก�O@E/*�Vd, ]B+,UV�7@E 9. �ก�EO���@� �������b�4b�ก���Eกq�Z�:b�<4� 7 ��4��ก.Gกก����กh���i<�@���� 4 ���Q INH ^Gก,��?��F�M+L*XMC'� 1952 �'R,/��@E?@'7>A��j�m�Q?�ก�@EAV��,ก�77+กc�B+n.7] INH ?@�,��.?�OกVO�@E�Osก A�?�7^O>O�/�,,L��-���@ ?@AGM7.]7*A7��*]O��/ก+U pyridoxine INH A�?�7^YC�,�����lO�)*macrophage -�� _*A�?�7^�C��F8L) mycobacteria �@E)/GCm�/�,�lO�)* macrophage -����B/,)ก��,8) �กก�7�C��F8L)�@E)/GCm�/,)ก�lO macrophage (extracellular organism) กO-กก�7))กi�j�kXO>ก�7�8L)/� INH /+U/+L*ก�7A7��* mycolic acid l_E*�'R,ACB,'7>ก)U�@EA��]+}�)* Mycobacteria cell wall .�/ INH >M�)*^Gก activated .�/ catalase �78) peroxide กC), active metabolite �@E�ก���_L, >-'7UกB,ก�7���*�,�)* enzyme reductase (l_E*?@�,���@E reduce C=C bond �,ก7>UB,ก�7A7��* long chain fatty acid �)* cell wall) ก�7�8L)/�MC) INH �ก���_L,-��*C�/ .�/�qQ�>^��^Gก�F��,ก�77+กc��Q@/*M+B��@/B .�/?@กO-ก�+*,@L(1) �F8L) Mycobacteria O�ก�7 uptake /�����AGC�lO�)*�F8L) (2) �ก�� mutation �78) deletion �)* KatG gene �@E encode Mycobacteria catalase (3) �ก�� overproduction of the product of inh A gene �@E encode Mycobacteria reductase

.�/�+EB-' �7� >QU�F8L)�@E�8L)/� 1 M+B �ก�F8L)�+L*�?� 106 M+B XO>�,8E)* �กYG�'dB/B+n.7] >?@�F8L)?�กกBC� 108 M+B �Q7�>q>,+L, ก�7�F�/��Q@/*M+B��@/B �,ก�77+กc� _*�'R,-'-��AG*�@E >?@ก�7�8L)/��ก���_L, �+*,+L, ก�7�Q�E?/�M+B�@EA)* ����-' >�'R,ก�7FCB/�Q�E?'7>A��j�m�Q�,ก�77+กc� �,8E)* �ก.)ก�A�@E�F8L) >�8L)MC)/� �+L*A)*F,�� >��C�ก+U 1 �, 106 x 106 (1 �, 1012 )

Rifampin �'R,A�7ก_E*A+*�]7�>�p�@E�'R,),VQ+,jp�)* rifamycin (/�'��F@B,>�@EA7��*.�/�F8L)7� Streptomyces mediterranei) ?@กO-ก

ก�7))กi�j�k.�/ +Uก+U β subunit �)* bacterial DNA-dependent RNA polymerase (/+U/+L* RNA synthesis) ก�7�ก��ก�7�8L)/��ก�� �กก�7�@E�F8L)?@ก�7Q+�,�ก�7'()*ก+,ก�7 +U�)* rifampin MC) bacterial RNA polymerase ACB, Human RNA polymerase >-?C +Uก+U rifampin �+*,+L, _*-?C^Gก/+U/+L*-'��B/

Ethambutol ?@กO-กก�7))กi�j�k.�//+U/+L*ก�7A+*�]7�>�p arabinogalactam l_E*�'R,ACB,'7>ก)UA��]+}�)* Mycobacteria cell wall ACB,กO-กก�7�8L)/� -?C�7�UX,CF+���ก��G��\@����@:V �@EQUUC)/�@EAV� ]8) retrobulbar neuritis (loss of visual acuity XO> red/green color blindness) GI problem, confusion, headache กsQU-��

Page 10: Key MCQ Bank

Pyrazinamide �'R, synthetic analog �)* nicotinamide ?@กO-กก�7))กi�j�k�@E-?C�7�UX,CF+� /� >����-'�, macrophage l_E*?@ pH �'R,ก7� ('7>?�n 5.5) XO>))กi�j�k�C��F8L)�,,+L, ��ก��G��\@����@:V hepatotoxicity (1-5% �)*YG�'dB/�@E-��7+U/�,@L) , N/V, fever XO> hyperuricemia (l_E*)� ,��-'AGC acute gout attack) �กก�7/+U/+L*ก�7�+U))ก�)* uric acid

Streptomycin ?@กO-กก�7))กi�j�k.�//+U/+L*ก�7A+*�]7�>�p .'7M@, (.�/ +Uก+U 30S-subunit ribosomal proteins) ?@กO-กก�7�8L)/�]8) �'O@E/,X'O* ribosomal binding site ��ก��G��\@����@:V ototoxic (vertigo, hearing loss), nephrotoxic

10. ��ก=�ก����E@���� ��-O�Z�ก�����QbQF4�@ ��������[ก�Z�:b34Sก:cd���.GQ4

OI for AIDs patients

CD4 < 400 Thrush , candida esophagitis , TB , Herpes Zoster , Bacterial infection (S. pneumoniae , H. influenzae)

CD4 < 200 PCP , TB (extrapulminary)

* Primary prophylaxis PCP

CD4 < 100 Toxoplasmosis encephalitis cryptococcal meningitis , MAC

*Primary prophylaxis Toxoplasmosis

CD4 < 50 CMV retinitis , cryptosporidiosis

*Primary prophylaxis CMV , cryptococal prophylaxis ()� resistance -��/+*-?CA7V'BC�]B7����78)-?C)

��c�ก���Eกq� OIs

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CASE TB 3�4� 312

1. *) ก�,/��O+*)���7�+,�@ )���7?@YO������ก�7�G�l_?/�F��O* ������ peak level ME�� ]B77+U'7>��,�n>��)*BC�* �FC, 7+U'7>��,กC),,), �78)กC),/�O+*)���7 1 � 2 F+EB.?*

2. 1) /+U/+L*ก�7A7��* cell wall �)*�F8L)B+n.7] กO-กก�7))กi�j�k]8) /+U/+L*ก�7A+*�]7�>�p mycolic acid ������?@YO/+U/+L*ก�7A7��* cell wall

3. 2) hepatotoxicity, 5) leucopenia �Q7�> Rifampicin �ก�Q��ก��G��\@����@:V ������'tAA�B> ��*8E) ,L��M� �'R,A@A�?/X�* l_E*-?C�'R,)+,M7�/�� N )� �ก�� rash, thrombovytopenia, nephritis, cholestatic jaundice �78) hepatitis /+*)� �ก�� flu-like syndrome (fever, chill, anemia, thrombocytopenia)

4. 4) .7]�ก���p /��������ก�� hyperuricemia, ?@��)���?�F��,],�@E�'R, acute gout

5. 1) pyridoxine (B6) Peripheral neuropathy �ก�� �กก�7���vitamin B6

6. 4) pyridoxine (B6) Isoniazid �Q�E?ก�7�+U))ก�)* active Vitamin B6 �@E-M

�Q�E?�M�? Peripheral neuropathy �ก INH ?+กQU�,YG�'dB/�@E�'R, slow acetylator XO>YG�'dB/�@E?@'7>B+M��'R,.7]���A�7)���7 �8E?��O�� +� .7]�U��B�, AIDS ก�7�ก�� neuropathy ?@A���MV �กก�7��� pyridoxine ก�7�F�/� INH �'R,YO���?@ก�7�+U))ก�)* pyridoxine ?�ก�_L, ก�7��� pyridoxine �A7�? กsA�?�7^Xก�-� neuropathy �@E�ก���_L,-��.�/�+,�@ YO�@E�ก��ก+U7>UU CNS �FC, ก�7AG}�A@/]B�?�7* �� .7] �M XO>F+ก กs)� A�?�7^�F� pyridoxine Xก�-�-��

Case ����� 3�4� 312

1. ��F 5 Praziquantel ก.Gกก����กh���i /� Praziquantel �Q�E? permeability MC)X]O�l@/?������X]O�l@/?�����lOOp?�ก�_L,�ก��ก�7��M+B)/C�*?�ก�)*Q/�j� Q/�j��ก��)+?Q�MXO>�OV� �ก�@E�ก�>/_�XO>M�/M�??� /� Praziquantel ���YOก�� +��+L*Q/�j�M+B�Ms?B+/XO>M+B)C), <4�F@�����@:.���ก ���กO8,�+,�@E-?C�]@L/B�Q7�>�? >)�� @/,-�� ��ก)�� @/,)� >������Q/�j�)� ^Gก�/�),�_L,?���B/ ��)UC*F@L�@EA��]+}]8)�F�ก�� +�Q/�j��U-?�U�*F,�� (Schistosomiasis) XO>�@EA��]+}�F�7+กc�Taeniasis �O+*ก�7ก�,/� 2 F+EB.?*]B7-��7+Uก�77>U�/��B/�Q8E)ก�� +��)�M+B)C),XO>-�CQ/�j��@E)� >XMก))ก?� �ก'O�)*Q/�j�-�� �,8E)* �ก praziquantel -?CA�?�7^ก�� +�-�CQ/�j�-�� )� �������ก�� cysticercosis M�??�-�� A���7+U neurocysticercosis /� praziquantel +��'R,/�7)*�@E�F�7+กc�m�B>,@L�,8E)* �ก7>�+U/� >O�O*�?8E)���7CB?ก+U corticosteroid ��)���?�@EA��]+}-��XกC ocular cysticercosis �Q7�>'��ก�7�/�)+ก�AU�ก���_L, �กก�7���O�/Q/�j��,FC)*M�)� �������ก��ก�7AG}�A@/A�/M�M�??�-�� XQ�/pU�*�C�,)� ��s,BC�]B77>?+�7>B+*�,ก�7�F�7+กc� spinal neurocysticercosis ��B/

2.��F 2 Emetine & Dehydrpemetine ))กi�j�kก�� +�)>?@U��,�,8L)�/8E)XMC�,8E)* �ก?@YO���*�]@/*�@E7V,X7*�F�/�/�ก _*-?C�'R,�@E,�/? �Q7�>�?�.�7,���.lO���YO�@�FC,ก+,XMCYO���*�]@/*M�E� YO���*�]@/*�@EA�� ]+}-��XกCก�7�ก��Q�cMC)�+B� ��� ����ก���+B� �M�,Y�� +*�B> �+B� B�/ �A@/F@B�M-�� ?+ก�ก��ก+Uก7n@�@E�F�/��,��AG*�78)�F�/�,�,�ก�, 10 B+, /� Emetine XO> dehydroemetine ?@�F�

Page 12: Key MCQ Bank

�qQ�>U�*X�C*�,'7>��W-�/��C�,+L, B�j@�F�M�)*�F�q@����� subcutaneous �78)intramuscular XO>�n>���/�YG�'dB/ >M�)*^GกA+*�กM)�ก�7Y��'7กM�MC�*N)/C�*�กO�F��MO)� 3. ��F 1 Thiamphenical �'R,),VQ+,jp�)* Chloramphenical l_E*?@]VnA?U+M��,ก�7�C��F8L)�FC,��@/Bก+,XMC?@]B�?X7*กBC� 2.5-5��C� l_E*��)�@�@E��,8)กBC� Chloramphenical ]8)-?C�ก�� aplastic anemia

4. ��F 3 Rifampicin ?@กO-กก�7))กi�j�k.�/ +Uก+U β subunit �)* bacterial DNA-dependent RNA polymerase (/+U/+L* RNA synthesis)

5.��F 5.T.���ก. �ก7>�7B*A�j�7nAV�?@7�/*�,ก�7�F�A�7Aก+�YO?>�กO8)��B/X)Oก)�)Op�,�,�� 50 ?�OO�ก7+?/ก�.Oก7+? 7+กc�Q/�j�'�ก�) Q/�j�-A���8), Q/�j�XA�?�� .�/�'7@/U��@/Uก+U mebendazole �,�� 2.0 ?�OO�ก7+? �'R,�BO� 3 B+, QUBC�A�7Aก+����YO�@ก+UQ/�j�'�ก�) XMC���YO7+กc�-?C�@,+กก+UQ/�j�-A���8),XO>Q/�j�XA�?��

6. ��F 5 Sก���3�Q?@YOMC)Q/�j�M+BM8� ��?8), Niclosamide

7. ��F @ ���ก. � A�7Aก+� �ก?>�กO8)�@E�F�7+กc�],-�� A�?�7^�C�Q/�j�M+BM8� XO>Q/�j�-A���8),-���@ .�/A�7A��]+}]8)?@A�7 diospyrol diglucoside l_E*O>O�/,L��-���@ _*-?C^Gก�G�l_?YC�,O��-A� XMC^GกQ/�j�ก�,����-' _*������Q/�j�M�/

8. metronidazole Metronidazole A�?�7^�C� trophozoite �)* E. histolytica -��XMC-?C?@YOMC) cyst Metronidazole �'R,/��@E?@'7>A��j�m�Q�@�@EAV��,ก�77+กc� invasive amebiasis �+L*�@EO��-A��78)�@EM+U metronidazole -?C]C)/?@YO�C��F8L)�@E)/GC�, intestinal lumen กO-กก�7))กi�j�k ]��BC� metronidazole �������ก�� toxic oxygen products XO>�ก��ก�7���O�/ DNA �)* trophozoite _*�C� trophozoite -���mA+F O,W�AM7p�?8E)���.�/ก�77+U'7>��, metronidazole �G�l_?-���@XO>7B��7sB �ก��*���,)���7 metronidazole XQ7Cก7> �/����AGC tissue MC�*N-���@ 7B?�+L*����AGC CSF, breast milk, alveolar bone, liver abscess, vaginal secretion XO> seminal fluid Metronidazole ?@ peak plasma concentration �, 1-3 F+EB.?* ?@ protein binding ME�� (,�)/กBC� 20%) XO> half-life �)*/�'7>?�n 7 F+EB.?* /�^Gก metabolize �@EM+UU�*ACB, �+L*/�XO> metabolite �+U))ก��*'tAA�B> M+B)/C�*/��,'7>��W-�/-��XกC metrodinazole (Flagyl®) XO> Tinidazole (Fasigyn®)

CASE 2 3�4� 313

2.1) l+ก'7>B+M�YG�'dB/)/C�*-7 �F��)*�78)-?C ��sก�78)YG���}Cก�,* กC),�,��,@L-'ก�,)>-7?� _*]��BC�?@Q/�j� (��,�,8L)�?G*AVกN��UN) )V �7>?@M+BQ/�j��78)'O�)*Q/�j�',�78)-?C (��s,'O�)*Q/�j�M),^C�/)

2.2) ]��BC�YG�'dB/M��Q/�j�)>-7Q/�j�M+BM8��?G (Tenia solium) �,8E)* �กYG�'dB/U)กBC�ก�,ก�,�,8L)�?G��U N AVก N XO>QU'O�)*AVก',?�ก+U)V �7>

2.3) drug of choice �,ก�77+กc� Niclosamide

2.4) Regimen �@E�F��,ก�77+กc� Niclosamide tab 500 mg

��sก)�/VME��กBC� 2 '����7+U'7>��, 500 ?ก. (1 tab once) ��sก)�/V 2-6 '����7+U'7>��, 1,000 ?ก. (2 tab once) ��sก)�/V 6 '��_L,-'XO>YG���}C���7+U'7>��, 2,000 ?ก. ]7+L*��@/B (4 tab once)

Page 13: Key MCQ Bank

2.5) M�)*���)/C�*)8E,�Q�E?�78)-?C ��ก�'R,Q/�j�M8��?G ]B7���/�^C�/M�? .�/��� MgSO4 15-30 mL �O+*��� Niclosamid -'XO�B 2 F+EB.?*

2.6) �Q7�>��MV�� _*���/�7>U�/ ]B7���/�^C�/ก�� +�'O�)*))ก?� �Q8E)'()*ก+, Cysticercosis �Q7�>^��M+BXกCM�/)/GCm�/�,7C�*ก�/ 'O�)*�@E^Gก/C)/ 7CB?ก+Uก�7?@)�ก�7��)*YGก ��)*)8� �78)]O8E,-A�)�� @/, >������-�CQ/�j��@EXMก))ก?� �ก'O�)*^Gก/C)/XO>�/�),กO+U?��@EU7��BnO��-A��Osก-�CQ/�j�M+B)C),7>/> Oncospore กs >))ก?�Q7�)?ก+U-F�>OVO��-A�ก7> �/-'�t*M+BM�?�,8L)�/8E)ACB,MC�*N�+EB7C�*ก�/กO�/�'R,7>/> cysticercus �_L,?� �FC, Q/�j�M8��?G�@EA?)* (Neurocysticercosis)������YG�'dB/�ก��)�ก�7F+ก ]B�?�+,�,A?)*AG* Q/�j��@EM� (Ocular cysticercosis) )� QU^V*Q/�j�M8�M+B)C),�ก�>)/GC�M��7M�,� �������ก��)�ก�7UB? �O8)�))ก ������YG�'dB/?)*��s,?+B Q/�j��@EกO��?�,8L) (Muscular cysticercosis))� �������ก��กO��?�,8L))+ก�AU7V,X7*

2.7) X,>,��ก�7'��U+M�M+B -7+U'7>��,)���7�@E'7V*��B/�,8L)�?G�@EAVก �78)�,8L)�?G�@EYC�,ก�7���O�/M+B)C),XO�B �FC, ก�7q�/7+*A@ �78) �กsU�,8L)�?G -B��,MG��/s,�@E �20 0 C ,�, 12 F+EB.?* �^C�/)V �7>O*�,A�B?�@E GกAV�O+กcn> -),�?+/ACB,UV]]O O��*?8)���A>)��กC),7+U'7>��,)���7

*3����3�c: . �/p-?C-��U)กBC�],?��)l8L)�'R,��sก�78)BC�YG���}C...XMC����� BC�,C� >�'R,YG���}C�Q7�>�G �กdose /��@E���..../+*-*กs >�qO/-'����+L*��sกXO>YG���}CO>ก+,,>

; . �/pU)กBC�ก�,�,8L)B+BAVกN��UN?� ]��BC�,C� >�'R,M8�B+B XMC?@��) 2.6 �@E�qO/?�BC�'()*ก+, cysticerosis l_E* >�ก���qQ�>�,M8��?G...]��BC�Q@E]* ��. �/p?�Y�� *+L, >Xก�. �/p�)*�'R,ก�,�,8L)�?GO>ก+,,>

CASE MALARIA 1 ( 3�4� 314)

1. C. Plasmodium falciparum�,'7>��W-�/?@ก�77>U���)*/V*�@E�'R,Q��>�)*?�O��7@/)/GC 2 F,�� ]8) Plasmodium falciparum XO> Plasmodium vivax XMC�,. �/pU)กBC� >-'�@E ).X?CA>�7@/*XO>?@ก�77>U��?�ก�@EAV� l_E*M7*ก+U Plasmodium falciparum �Q7�> ).X?CA>�7@/* )/GC�, +*�B+�X?C�C)*A),�,m�]��,8) U7��BnF�/X�,l_E* Plasmodium falciparum �,'7>��W-�/,+L,QU-���+EB'7>��W.�/�qQ�>U7��BnF�/X�,XMC vivax >QU�,m�]�M�

2. A. �G)�ก�7-�� �,�BA+E,�,8E)* �ก)�ก�7�)*?�O��7@/ >?@)�ก�7-���ก���_L,กC),7>/>�BO�MC�ก+,-'�,XMCO>�F8L) XO>XUC*7>/>ก�7 +U-���'R,

7>/>�,�B (cold stage) �'R,�BO� 15-60 ,��@ YG�'dB/ >7G�A_ก�,�B?�ก ?@)�ก�7A+E,�ก7s*)Vn�mG?�7C�*ก�/ AG*�_L, F@Q 7�U��7sB ]B�?�+,�O8)��Q�E?�_L, )� ?@)�ก�7]O8E,-A� )�� @/,

7>/>7�), (hot stage) �F��BO�'7>?�n 2 F+EB.?* .�/YG�'dB/?@)�ก�77�), )Vn�mG?�7C�*ก�/AG*�_L, 39-40 )*W��lO�l@/A F@Q 7X7* 'B�ก7>U)กM� �,��X�* Y�B�,+*X�*XO>X��* ก7>��/,L�� ]O8E,-A� )�� @/, ก7>A+Uก7>AC�/XO>�Q�) U�*],-?C7G�AM�

7>/>��*8E)))ก ( sweating stage) 7>/>,@Lก�,�BO�7�B 1 F+EB.?* YG�'dB/�7�E??@��*8E)))กM�?�,�� U7��Bn�?+U XO>Y�B�,+*O��M+B MC) �ก,+L,)Vn�mG?�7C�*ก�/O�O*)/C�*7B��7sB YG�'dB/)C),�QO@/ �O+* �ก,+L, ����AGC7>/>Q+ก ]8) 7>/>�@EYG�'dB/-?C?@)�ก�7 +U-��YG�'dB/7G�A_กAU�/�@ ก�,�BO�'7>?�n 1-2 B+,XO�BXMCF,���)*�F8L) XO�B _* +U-��)@ก �+*,+L,7>/>Q+ก _*ก�,�BO�,�,��C�ก+U�BO��)*B* 7F@B�M-7��QW�,�?s�.O��MX�*

Page 14: Key MCQ Bank

3. C. Plasmodium falciparum�F8L)�tOl�'�7+? (P. falciparum) +U-���Vก 36-48 F+EB.?* XMC.�/ACB,?�ก +U-���VกB+,XO>)� ?@m�B>X�7กl�),7��/X7*�FC, ?�O��7@/�_L,A?)* m�B>,L��M�O�,�O8)�ME�� ��O8)*l@� 'tAA�B>��� -MO�?��OB ')�UB?,L�� l_E*m�B>��OC�,@LA�?�7^������YG�'dB/�A@/F@B�M-��

4. E. 7+U'7>��,/�'()*ก+,-��?�O��7@/ �FC, ]O).7]B�,�,'t VU+, _*-?CX,>,�����ก�,/�'()*ก+,OCB*�,�� กC)����ก��'t}���F8L)�8L)/�XMCX,>,��BC� ^��))ก �ก'd�XO�B?@)�ก�7-�� �78)?@)�ก�7A*A+/�'R,?�O��7@/ ���7@U���ก�7M7B 7+กc� �78)�,ก7n@�@EM�)*����-')/GC�,'d��@E�'R,^�E,�@E?@�F8L)?�O��7@/ �8L)MC)/��O�/F,�� �'R,�BO�,�,�ก�, 2 A+'���p (7>/>�tกM+B�)*.7]) กs]B7Qก/�7+กc�?�O��7@/ (-��XกC ]B�,�, �?.�O]B@,�78) )�7p�@lG�,M) -B�A��7)*�F��,/�?qVก�q�, �?8E)-?CA�?�7^M7B �O8)�-�� .�/�F��,�,���@E�F�7+กc�?�O��7@/

5. D. primaquine?@i�j�k�C��F8L)�@E)/GC�,�,8L)�/8E) (M+U)XO>�C� hypnozoite �@E)/GC�,M+U 6. �]��-?C7G�BC� >M)U)>-7)>�Q7�>�@E��?�-��?+,-?CM7*ก+U choice �O/ Q/�/�?���O�/X�OC*��@/Uก+,]��M)Uกs��?8),���?

7+กc�.�/��� Chloroquine (250) 4 �?s�ก�,�+,�@ M�?��B/ 2 �?s��O+* �กก�,]7+L*X7ก 6,24,48 F.?.MC)?� XO>�Q8E)'()*ก+,ก�7�ก��-��กO+UlL�� �ก�F8L)�@E�OU lC), (hypnozoite) M�)*��� Primaquine (15) 1 �?s� B+,O>]7+L* 7CB?��B/ ,�, 14 B+,

(Ref:CPG A'AF)

Page 15: Key MCQ Bank

��������� MCQ ������ Malaria

��� P����� , ��ก ! "����� ��� NoO_NaMe ^O^

Case Malaria 1

1. ��� c. Plasmodium falciparum ����� P.falciparum (80%) / P.vivax (20%) / P.malariae (1%) 2. ��� c. �� !"#$%�&'"($�� �)ก)�+,-.') /01'ก2"34'�)ก)�,�56)()"�7� 8�9 9)+69/)6)�:�$'�0'+�- !;5�$'�0'�- �.(0ก<)'8'9'�' 3. ��� c.Plasmodium falciparum 4. ��� e. �0�3�@A)'�)3B�5ก0'+,-6)"("�7� "#9' Chloroquine "'$1�5!)ก P.falciparum �$%��)"ก$��AGก#'H� ก)�&#-�)3B�5ก0'�)!!@!I)"34'&'�GJJ(A71+6967J )6�-)'A)'�9�6)()"�7� "�2ก .KH5�0%5J��LM 8(@A.)�A71",-)+3&'",�6)()"�7� 5. ��� d. Primaquine 6. ��� +6967,-�:Pก &#- Chloroquine 1500 mg. 8�95&.-L)�&' 3 0' �9 6ก0� Primaquine (R9)"#$%�&'�0� hypnozoitocide) 15 mg/day ')' 14 0' Case Malaria 2

1.��� !. Chloroqine injection /I).�0� Falciparum A71+69�$%��9��)!@&#- Chloroqine injection 2. ��� ก. ,. :Pก8(- 3. ���,. Chloroquine /)�A71��&'"3($�ก Cinchona "34'/)�&'ก(G96 quinoline alkaloids +�-8ก9 quinine, quinidine, cinchonine, cinchonidine

��������� MCQ ������ Case STD and UTI

��� P����� , ��ก ! "����� ��� NoO_NaMe ^O^

,-� 1 ')5ZB)� �)�G 45 3[ 6)��5��)�)(�- ��)ก)�:9)�3\//) @�9�� 8(@�P-/;ก3 �"�95"(2ก'-��".6$�':9)�+69.6�8A�AGกJ�0%5"6$1�:9)�"/�2! +�-3�@ 0�H"�H16"�H6 9) "�H'A)5+3A0]')!��9)5!05. 0�+69J9��+�-�$16'%I)8(@ก(0%'3\//) @.()�J�0%5 "'$1�5!)ก.-�5'%I)+69/@� ก

− A9)'JH� 9)8�A�M!@ 0ก,-�6P(�@+�"�H16"�H6�-)5 ���

1. 67�)ก)�3\//) @(I)�)ก 8/� ,0� .�$�+69 2. 3\//) @67"($��3'.�$�+69 3\//) @67/7�@+� 3\//) @,G9'.�$�+69 3. 67�)ก)��$1'�9 6�- � "#9' '%I).'0ก(� .H '%I)�9�� �9�'"�(7� +,- .') /01' .�$�+69 4. 67�)ก)�3 �.(05 3 �/7,-)5 .�$�+69 3 ��-) +3A71+.'.�$�+69 3 �8��+.' 3 �/�5,-)5.�$�,-)5"�7� 5. _P-3` �673\!!0�"/71�5�9�+3'7%.�$�+69 ("#9' "34'_P-/P5�)�G "�].KH5 ก)��0%5J��LM ก)�&#-"J�$1�56$�.�$�&/9/)�/ '3\//) @

67ก)��G�ก0%',�5A)5"�H'3\//) @ _P-3` �"�). )' _P-3` �A7167J )6_H�3ก�H�J�5/�-)5.�$�ก)�AI)5)',�5�@��,0�:9)� � 6:;5�@��3�@/)AA71J �JG6ก)�AI)5)'�- � .�$�ก)�67"�]/06�0'aM ���"b�)@A)5A )�.'0ก)

6. +�-�0��)�@+���P9.�$�+69 7. 673�@ 0�H"34''H1 &'A)5"�H'3\//) @ .�$�3�@ 0�H��J+� .�$�+69

Page 16: Key MCQ Bank

− 8�A�M/015�� !3\//) @ �� pyuria 8�A�M H'H!b0� 9)')5ZB)�"34' cystitis �)ก)�8/�5A71�95#7% 9) ')5ZB)�"34' cystitis J$��@+�

��� �� pyuria (WBC) &'3\//) @ �)ก)�:9)�3\//) @�9�� 8(@�P-/;ก3 �"�95"(2ก'-��".6$�':9)�+69.6�8A�AGกJ�0%5"6$1�:9)�"/�2! +3A0]')!��9)5!05. 0�+69J9��+�-�$16'%I)8(@ก(0%'3\//) @.()�J�0%5

− "#$%�ก9���JA71J)� 9)'9)!@"34'/)".�G6)กA71/G�J$��@+� ��� E.coli

− A9)'JH� 9)')5ZB)�J �+�-�0�ก)��0กg)�- ��)3hH#7 '@&� ��� Ofloxacin 200 mg q12hr x 3 days Ciprofloxacin 250 mg q12hr x 3 days

Norfloxacin 400mg q12hr x 3 days − ,-��7 ,-�"/7�&'ก)�"($�ก&#-�)8�9(@#'H�

��� − :-) 2 "�$�'�9�6)')5ZB)�ก(0�6)��8�A�M�- ��)ก)�"�H6 ก)��P8(_P-3` �J �AI)��9)5+�

��� _P-3` �67(0กgl@"34' Re-infection J �&#-�)')',;%'"34' 7-10 days 8'@'I)_P-3` �

1. �$16'%I)6)ก o 2. ��9)ก(0%'3\//) @ 3. .(05:9)��G!!)�@ J �AI)J )6/@�)�!)ก�-)'.'-)+3,-)5.(05 "�$1�3B�5ก0'+69&.-'I)"#$%�"#$%���J",-)/P9A9�3\//) @ 4. J �AI)J )6/@�)���H" l� 0� @"�]ก9�'A71!@67กH!ก��6A)5"�] 8(@.)ก�� 9)ก)�ก(0�6)"34' %I)�7กJ�0%5'0%'/06�0'aM

ก0�ก)�67"�]/06�0'aM J �8'@'I)&.-_P-3 �:9)�3\//) @A0'A7 8(@�0�3�@A)'�)J�0%5"�7� L)�.(05ก)�67"�]/06�0'aM Case './. '0��) �)�G 27 3[ 6)�-)'�)�- �"�$1�5�ก,) "34'ก-�'o /7,) o +6967p�5 67ก(H1'"3�7%� 8(@67�)ก)�J0'��H" l#9�5J(��6) 2 0' $%�6)A)!)ก�-)',)��)A71+6967"L/0#ก� �)ก)�+69�7,;%'!;56)A71�-)'�) − /H15A71"L/0#ก�J � 0ก:)6"�H16"�H6 J$��@+�

1. (0กgl@,�5�ก,) "34'��9)5+� "#9' "34'6Pก&/ ,-',) J(-)�83B5"3[�ก 2. /7,�5�ก,) "#9' /7,) /7",7� ".($�5 67p�5!I)' '6)ก /7"A) 3. �ก,) 67ก(H1'.�$�+69 "#9' ก(H1'".62'J) 3() 4. 3�H6)l�ก,) 5. J0'.�$�+69 J0'&'#9�5J(�� .�$�J0'L)�'�ก#9�5J(�� 6. 67�)ก)��$1' o�9 6�- �.�$�+69 "#9' +,- 3\//) @8/� 3\//) @,0� 3 �A-�5'-�� 7. ��P9&'#9 5&ก(-673�@!I)"�$�'.�$�+69 8. .KH5 0�.6�3�@!I)"�$�'.�$�+69

− A9)'J)� 9)�)ก)�,�5 './. '0��) "กH�!)ก�@+� �)ก)�'7%8�ก�9)5!)ก vaginitis 3�@"LA�$1'��9)5+�

��� �)ก)�,�5 './. '0��)"กH�!)ก"#$%��)&'#9�5J(�� (Vulvovaginal candidiasis) .)ก"34' Trichomoniasis !@"34' protozoa 67�ก,) ,G9',-'/7",7� 3'"A) 67ก(H1'".62' 67p�5 3\//) @8/�,0� J0'#9�5J(�� − A9)'!@�H!)�l)!9)��)�@+�&.- './. '0��) "��)@".�G&�

��� Clotrimazole 500 mg VT 1 tab hs single dose "�$1�"�H16 compliance ,�5_P-3 �"'$1�5!)ก/@� ก�9�ก)�&#-�)

Page 17: Key MCQ Bank

− "L/0#ก�J �8'@'I)ก)�&#-�)".'2�#9�5J(����9)5+� 1. (-)56$�&.-/@�)� 8ก@�)��ก!)กp��(M 2. !G96�)&''%I)&.-�)��#$%' 3. '�'.5)� #0'",9) ก)5,)"(2ก'-�� 4. /���)",-)#9�5J(��&.-(;ก"A9)A71!@AI)+�- 5. '�'&'A9)"�H6"34'" () 15 ')A7

�)!��ก_P-3` �"�H16"�H6 9) �)!67�)�)5/9 '��ก6)�H���H" lก)5"ก5&'�-)5 +�-�5ก05 (

��������� MCQ ������ Sexual

��� Ness , Nui "����� ��� NoO_NaMe ^O^

1. ��� 2. Oral !9)��)&'�P38�� oral "��)@_P-3` �67�)ก)�ก�@"�)@3\//) @�0ก"/� #9�5J(���0ก"/� ก)�&.- oral !@�0กg)+�-J���J(G6A0%5/�5�)ก)� 8(@ก)�&#- vaginal suppository, Transdermal ,IM +6967ก)�8'@'I)&.-&#-&'_P-3` �A7167�)ก)�ก�@"�)@3\//) @�0ก"/�

2. ��� 1.�@�@" ()&'ก)���กwAaHx')'ก 9) Pennicillin G 67 3 �P38�� J$� 1. short acting +�-8ก9 Pennicillin G Sodium 8(@ Potassium

2. medium acting +�-8ก9 Procaine Pennicillin G 3. long acting +�-8ก9 Benzathine Pennicillin G

3. ��� 5. procain penicillin G :Pก�P�+�-�7&'A)5"�H'�).)� Penicillin G "34'�)A71+69A'�9�ก��&'ก�@"�)@�).)� !;5'H�6��H.)����ก)�b7�6)กก 9) '�ก!)ก'7% Penicillin G �0567&'�P3,�5 Repository form A71&#-�9���7ก 2 �P3 J$� Procaine Penicillin G 8(@ Benzathine Penicillin G (Dibenzyl | Ethylenediamine Penicillin G) �)A0%5/�5�P3'7%(@()�'%I)+�-'-��8(@��H.)�+�-���b7� IM "A9)'0%'

4. ��� 1. Cotrimoxazole _P-3` �"6$1�+�-�0��) Cotrimoxazole ')' 3 0' 8�A�M+�-/015"3(71�'"34'�) Norfloxacin 8(@&.- Diphenhydramine (Antihistamine) ;15:$� 9)"34' tracer agent �05'0%' ADR A71"กH�,;%'!;5'9)!@"กH�!)ก Cotrimoxazole Alerting Order "34'(0กgl@,�5JI)/015&#-�),�58�A�MA718/�5 9)�)!67ก)�"กH��)ก)��0'+69�;53�@/5JM!)กก)�&#-�),;%' ���(0กgl@,�5JI)/015!@67(0กgl@�9)5o�05'7%

1) /015.�G�&#-�)A0'A7 2) (�,')��)8(@/.�$�/015�� !A)5.-�53hH�0�Hก)� 3) /015�)A71"34' antidote .�$� tracer agent ;15"34'ก(G96�)A71!@��&'ก)��0กg)ก)�"กH� ADR "#9' Antihistamine, Calamine

lotion, Dexamethasone inj., Adrenaline inj., Atropine inj. "�H16"�H6 Urispas �0 �)J$� flavoxate "34'�)"62�,')� 100 8(@ 200 6H((Hก�06 "34'�) antispasmodics #9 �(�ก)�.�"ก�25,�5ก(-)6"'$%�,�5ก�@"�)@3\//) @ 8(@#9 ����"A)�)ก)�3\//) @�)ก AI)&.-(�J )6"!2�3 �" ()3\//) @8(@+693\//) @ก@3�H�ก@3��� ,')��0�3�@A)'&'_P-&.K9: 100-200 6H((Hก�06 0'(@ 3-4 J�0%5 �)!�0�3�@A)'��-�6�).)�.�$���-�6'6"�$1�(�ก)��@J)�"J$�5ก�@"�)@�).)� SE : 59 5'�' 6;'55 .�$�".2'L)� -�'

Page 18: Key MCQ Bank

Imipramine "34'�)&'ก(G96 TCA ��กwAaHx(��)ก)� ;6"]�-)���ก)�+3"�H16�@�0�,�5 Norepinephrine (NE) 8(@ serotonin (5-HT) &'/6�5 &#-+�-_(�7&' Depression, Panic disorder 8(@ nocturnal enuresis SE : 67wAaHx anticholinergic

"กH�J )6_H�3ก�H&'ก)�".'71� 'I)J($1'.0 &! .0 &!"�-'_H�!05. @

67�)ก)�'�'+69.(0� /0�/'#01 J�) �)ก)� H�กก05 ("�H16

67�)ก)�A71��'-�� +�-8ก9 �0�AI)5)'+693ก�H +,-/P5 .P�$%� "�-)'6,�)� '%I)'6+.( _6�9 5 8(@67�)ก)�#0ก

ก)�.�G��)���ก@A0'.0' !@AI)&.-"กH��)ก)�J($1'+/-�)"!7�' 3 �]7�g@ 67�)ก)�A)53�@/)A H�กก05 ( 5. ��� 3.vestibular function Amikacin "34'�)&'ก(G96 Aminoglycoside 67 ADR J$� Nephrotoxicity ,Ototoxicity (Irreversible), NMJ Blokade !;5�-�567ก)��� !ก)�AI)5)',�5.P 6. ��� 4. !9)�+�- "��)@ Ganamycin !0�"34'�)�0'��)� 67ก)�/015!9)����8�A�M.�$�+�-�0�ก)�!9)�!)ก"L/0#ก�"A9)'0%' (�)6,-�6P(A)5 H#)ก)�,-�'7%:Pก) 5. +69!9)� "��)@�05+69A�)�,-�6P( 9)_P-3 �"34'�)�)� �-�5 0ก3�@ 0�H"�H16 (�)6!���)���l ,-�'7%:Pก) 7. ��� 3 .'�5&'8A- N.gonorrhea .'�5&'8A-60ก"กH�!)กก)��H�"#$%� N.gonorrhea .(05!)ก/06_0/"#$%�L)�&' 1-7 0' _P-3 �!@67�)ก)�8/�" ()3\//) @ 8(@67.'�5��ก!)กA9�3\//) @ �9�6'%I)".($�5A71,).'7��� 8. ��� 3,4 ofloxacin 8(@ ciprofloxacin ก)��0กg).'�5&'8A- 9. ��� 4 Diarrhea ADR of Fluoroquinolone A71��+�-�9�� J$�

− �@��A)5"�H'�).)� "#9' J($1'+/- �)"!7�' 3 �A-�5 A-�5"/7� − �@��3�@/)A8(@/6�5 "#9' 3 �]7�g@ 6;']7�g@ '�'+69.(0� − �@�� metabolism "#9' hyperglycemia, hypoglycemia

/9 ' prolong QT interval "34' ADR A71"กH�,;%''-��8�9�G'8�5

10. ��� 3 .)ก67"�]/06�0'aMJ �/ 6:G5�)5�')60� _P-3 �A71�H�"#$%�A)5"�]/06�0'aMJ �8'@'I)&.-_P-3 �5�67"�]/06�0'aM��9)5'-�� 2 /03�).M 11. ��� J doxycycline "'$1�5!)ก�)'7%67(0กgl@"34' time-dependent ก)�"��7�6&'�P38�� sustain release !@J5�@�0��)&'"($��A71�@�0�A71&.-_(ก)��0กg)+�-')'ก 9)�P38��a��6�)8(@+69�-�5A)'�9��"A9)�P38��a��6�)

12. ��� 2 disintegration �)67JGl/6�0�H sustained release !;5+69!I)"34'�-�5A�/��ก)�8�ก�0

13. ��� 3 Enteric coat tablet ก)�8�95�) enteric coat �)!AI)&.-JGl/6�0�H�) enteric coat "/7�+3 8(@8�ก�0 &'ก�@"�)@+�-

ก�l7�)A71"34' Monolithic /Matrix systems �0 �)!@ก�@!)���9)5A01 :;5ก0'A0%5"62� &'�P38��'7%[email protected]ก8�95+�- 8�9+69J ��� "J7%� "��)@�)!AI)&.-�P38��ก)�3(�3(9���0 �)A71กI).'�"3(71�'83(5+3

14. ��� 4. �)/I).�0�&#-"b�)@A71 15. ��� 1. Tetracycline Doxycycline "34'�)3hH#7 '@ (Antibiotics) ��P9&'ก(G96"�7� ก0� Tetracycline ���!)ก/P���J�5/�-)567(0กgl@"34' benzene ring 4 5 "�H16"�H6 Tetra กH'8(- 67_(,-)5"J7�5J9�',-)56)ก ("#9'กH'8(- !@p\'/7".($�5����) 3\!!G�0'!;5+69"34'A71'H�6

16. ��� Treponema pallidum

17. ��� 1.�0��0%5ก)�/�-)5 cell wall

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��������� MCQ ������ Infection disease

��� E v e V a - v a "�������� NoO_NaMe ^O^

1. ��� ก. ,0�, )5ก)�/�-)5_'05"^((M ��� Augmentin 3�@ก���- �

•••• Amoxicillin "34' Beta-lactam antibiotic ��กwAaHx����0��0%5ก)�/�-)5 Cell wall ���!0�ก0� penicillin-binding proteins (PBPs) �0��0%5ก)� transpeptidation ;15"34'ก�@� 'ก)�/G�A-)�,�5ก)�/�-)5 Peptidoglycans &' cell wall ,�5 bacteria

•••• Clavulanic acid "34' Beta-lactamase inhibitor "'$1�5!)ก Bacteria 67ก)�/�-)5 Lactamase enzyme A716)AI)()� Beta-lactam ring ,�5 penicillin !;5AI)&.-�)&'ก(G96 penicillin �)5�0 .6�wAaHx AI)&.-"#$%��$%��) �05'0%'!;5&.- Clavulanic acid "�$1�"34' Beta-lactamase inhibitor

2. ��� ก. Ciprofloxacin

Beta-Lactam ring "34'/9 ',�5�J�5/�-)5,�5 antibiotic drugs &'ก(G96 penicillins, cephalosporins, carbapenems 8(@ monobactams ���(0กgl@�J�5/�-)5,�5 Beta-lactam ring "34' heteroatomic ring structure A713�@ก���- � 3 carbon atoms 8(@ 1 nitrogen atom ��� lactam "34' cyclic amide.

!)ก�0 "($�ก Ciprofloxacin "34'�)&'ก(G96 Fluoroquinolone 67�J�5/�-)5 �05'7% 3. ��� J. "�$1�3B�5ก0'+69&.-:Pก AI)()��- � B-lactam Clavulanic acid "34' Beta-lactamase inhibitor Bacteria 67ก)�/�-)5 Lactamase enzyme A716)AI)()� Beta-lactam ring ,�5 penicillin !;5AI)&.-�)&'ก(G96 penicillin �)5�0 .6�wAaHx AI)&.-"#$%��$%��) �05'0%' Clavulanic acid "34' Beta-lactamase inhibitor ���"34' Compettitive inhibitor 8�95!0� lactamase enzyme 8A'�) 4. ��� ,. Diarrhea 5. ��� 5. !9)� Augmentin 375 mg 1*3 pc = 21 + Amoxicillin 250 mg pc = 21 Augmentin 1 "62� 3�@ก���- � Amoxicillin ,')��)8�ก�9)5ก0'+3

Clavulanic acid ,')��) 125 mg "A9)'0%' Augmentin ,')� 625 mg 3�@ก���- � Amoxicillin 500 mg + Clavulanic acid 125 mg Augmentin ,')� 375 mg 3�@ก���- � Amoxicillin 250 mg + Clavulanic acid 125 mg �05'0%'!;5"�H16 Amoxicillin 250 mg !;5!@+�-3�@6)l Amoxicillin �)6,')� Augmentin 625 mg A71�-�5ก)� 6. ��� J. �)�0'��)� Amoxicillin "34'�)�0'��)� 7. ��� 5. +�- "��)@+69+�-AI)&.-ก)���กwAaHx"3(71�'83(5+3

Page 20: Key MCQ Bank

Augmentin 67.()��P38�� +�-8ก9 Augmentin chewable #'H�"J7%� ก9�'ก($' Augmentin film-coated tablet Augmentin XR #'H���กwAaHx"'H1' �P38��'7%.-)6"J7%�

8. ��� !. 5 ;15"34'�I)8.'95,�5 beta lactam ring "6$1� beta-lactam ring :PกAI)()� AI)&.- ring 8�ก �)!;5.6�wAaHxAI)&.-"#$%�"กH�ก)��$%��)

�I)8.'95A71�)!:PกAI)()�

9. ��� ก. HPMC 4000 Hydroxypropylmethyl cellulose 4000 10. ��� , Clarithromycin, J Doxycycline Community-acquired pneumonia "#$%�/)".�GJ$� Streptococcus pneumoniae , H.influenza, M.catarrhalis Second-line .�$� penicillin-allergy ,�5ก)��0กg) CAP &#-�)&'ก(G96 macrolide ("#9' Clarithromycin) .�$� Doxycycline

��������� MCQ ������ Infect ("=�)

��� Mos "�������� NoO_NaMe ^O^

11. ��� 12 ��� J.Cefoxitin L) @ Hypoprothrombinemia "34'/L) @J )6_H�3ก�H,�5�@��"($��A71,)� prothrombin(Factor

II) "34'_(&.-"กH�J )6_H�3ก�H,�5ก)�8,25�0 ,�5"($�� AI)&.-"กH�"($����ก+�-59)� ;15"34'�)ก)�+69�;53�@/5JM,�5�)ก(G96 cephalosporins A7167 N-methyl thiotetrazole (NMTT) &'/P���J�5/�-)5 �0 ��9)5"#9' cefamandole cefotetan Cefotaxime cefmetaxole moxalactam 8(@ cefoperazone _P-3 �A7167J )6"/71�5/P5�9�ก)�"กH�L) @'7%8(@!I)"34'�-�5+�-�0��)"34'" ()')'!;5J �+�-�0� vitamin K "/�H6���ก)�b7�",-)&�-_H .'05 10 mg

�9�/03�).M 13 ��� , Amikacin ��� Amikacin 8(@ gentamicin "34'�)&'ก(G96 aminoglycosides A71673�@/HAaHL)��7�9�"#$%�8ก

�6(�� 6:;5 Pseudomonas aeruginosa �- � /I).�0� amikacin 60ก!@"($�ก&#-&'ก�l7A71"#$%�'0%'�$%� .�$�/5/0� 9)!@�$%��9� gentamicin ก)���H.)��)8�� 0'(@J�0%5"�7� ,�5 amikacin !@67,')�ก)�&.-�)��P9�@. 9)5 15-20 6ก./

กก./ 0' 14. "� Fanconi syndrome ;15"34'/L) @J )6_H�3ก�HA71"กH�,;%'A71+�/9 ' proximal tubule ;15!@AI)&.-(�ก)��P�

ก(0�,�5/)��).)�8(@ electrolytes

Page 21: Key MCQ Bank

15. "� 2. Ampicillin "��)@ �0 �$1'!@AI)&.-"กH�_("/7��9�A)�ก "#9' chloramphenical AI)&.-"กH� Gray baby

syndrome , Tetracycline !@67_(�9�ก�@�Pก8(@p\' 16. "� 5. Cefotaxime (�P,-� 28 '@)

17. ��� 1 PABA "��)@60'!@+3!0�ก0� enzyme dihydropteroate synthetase (DHPS) ;15���3ก�H8(- DHPS '7%!@"3(71�' PABA +3"34' dihydropteroic acid

18. "� 1 cell wall linking ��� penicillin !@�0��0%5 enzyme transpeptidase AI)&.-+69"กH�ก)� cross link ,�5 peptidoglycan

19. "� 4 Clindamycin 8(@ erythromycin "34' antibiotic /9 ' tretinoin "34'�'G�0'aM,�5 H�)6H' A

20. "� 1. Traveller diarrhea

��������� MCQ ������

��� PIm "�������� NoO_NaMe ^O^

21. ��� 1 Erythromycin ��� Pregnancy category ,�5

Erythromycin J$� Category B Gentamycin 8(@ Ciprofloxacin J$� Category C Sulfadiazine J$� Category B/D (at term)

22. ��� 1. �).)�+6967_(�9�ก)��P� ;6 Amoxycillin 23. ��� 1. Cefazolin "'$1�5!)ก Cefazolin "34'�)&'ก(G96 Cephalosporin (First generation) 8(@�J�5/�-)5,�5�)ก(G96

Cephalosporin J(-)�ก0��)ก(G96 penicillin !;5J ��@ 05ก)�&#-�)&'_P-3` �A718�- Penicillin "��)@�)!"กH�ก)�8�-,-)6ก(G96 24. ��� 5. (�ก)��P� ;6 "��)@'6+3 chelate ก0��)AI)&.-ก)�(@()�(�(5 '�ก!)ก'7%J ��@ 05� ก Fe2+ �)(�ก�� (Mg2+,

Al3+) 25. ��� 3. .�G� Amoxi clav 8(- &.- antihistamine 26. ��� 3. +6967�Hg�9�.P "'$1�5!)ก Vancomycin AI)&.-"กH� Ototoxicity /95_(&.-/PK"/7�ก)�+�-�H' 27. ��� 1, 3, 5. +69:Pก�-�5 Amoxicillin is a zwitterion at intermediate pH (3|6) and is mainly cationic at pH 2, and

anionic at pH 7.2 ��� Amoxicillin !@+367_(�0��0%5ก)�/�-)5 Cell wall 28. ��� 5. Cefotaxime �-�5 diagnosis �)6 criteria ISDA/ASCO guidelines • Neutropenia

– Severe: ANC < 200 (rising septicemia risk)

Page 22: Key MCQ Bank

– Moderate: 200-500 (rising serious infection risk) – Mild: 500-1000 – Duration: 7-day cut-off

29. ��� 1. Erythromycin 30. ��� 1-2 g IV q 6 hr

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���� MCQ ��� �� Infectious disease ������ !"� Peera

31. �� 5. �ก��ก���

��������ก ������������ �������� !ก����"�#$�� ������! 1. �&����� !��'$()&�"� �ก*�& 10- 14 & � 2. ��"�#$���ก��/0�� /"1�2��� �0) 3. /�"���4���5&ก !#���/2�6��#�)�� � 4. �&��"& �������1�&"/��ก7����)�����ก$��89� �(*� lung abscess

32. �� 2. Amoxicillin + Loratadine M�4���5&���� ! Cimetidine

��������ก 1. Ampicillin + CPM M��4���5&���� ! Antacid .4$� �2��" Antacid �ก�����78#��� Ampicillin 3. Erythromycin + Terfenadine M�4���5&���� ! ASA . 4$� �2��" Terfenadine #)4�*�� &M� 4. Roxithromycin + theophyline M�4���5&���� ! Antacid. 4$� �2��" ��ก��� ��#�ก ��#*�*� Theophyllene 33. �� ��� 2. Doxycycline �2��"Doxycycline � !��ก��� urine 23 % �8��#*������������� ! ����M�4���5&[���� Tetracycline � !��ก��� urine 60% Oxytetracycline 2!&*��"#) half life life ����89�M����)�#) renal impairment /" Meclocycline �#*#)���#�M� drug information 34. 35. ��1. Amoxicillin 80-90 mg/kg/day ��������ก���� drug of choice 0���� ! otitis media /" ก�"��� &�)ก&*� ������)������ &���ก 36. �� 5. NSS ���� � 9� Isotonic /" Iso osmotic

1. 4$��2��" colligative property ����0#! �$�)���)�������� &���"��#�����$#� & �ก"�����#*��89�ก !(�$����� &���"� ��"ก�!��&��e0#! �$ 1. �&�#� ��� 2. �������� 3. ������ก/�f� 4. �&�#� ���0[#�$ก

2. 4$��2��"ก���)� Hypertonic solution ���M���7 ��)�& 3. Phosphate /" Acetate M(��� ! Buffer �#*����� ! tonicity �ก�$M(� NaCl 4. �"!!����ก !�"!!���9�����/�ก�*��ก �

37. �� 2 . ��������ก ���j*� normal flora ���M���ก��& �8���)���������/!! �����2�"�)� M�� &���ก#)0��� &�)����� �����2�"�)� #) clindamycin /" benzyl benzoate [�#)�2)� clindamycin �)�M(�� กl�0$&��� 0*&� benzyl benzoate M(� j*� �$�j*����

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38. �� 1. �2��" �����(�9� gram m ��)�M(���� ciprofloxacin /" Norfloxacin /�* Ciprofloxacin /2�ก&*��8��#*��#�"0# 0*&� Erythromycin j*� �(�9� Gram + �8��#*���ก /" Chloramphenical �#*#)���/!!�ก$��8�M(��#*��� 39. �� 1. Erythromycin ��������ก �ก�$/�& �#��������/2�� ก�*# penicillin �"��)��#�M(�ก�*# macrolide �)�j*� gram + �����#��� penicillin/�� M�� &���ก #) Erythromycin /" Azitrhomycin ���ก Erythromycin �2��"#)M����/!! Oral suspension /"���� �กก&*� 40. �� 2 Ampicillin ��������ก ampicillin ���� drug of choice 0���� ! H Influenza /" gentamycin �#*M(�M���fก 0*&� Erythromycin ����������ก�#��������/2� penicillin 41. �� 2 Erythromycin ��������ก�����ก�*#macrolides #)o�p$q ! 9�ก��0 �����"�6[���)����/!��)��) ก�กก����กo�p$q��� �/��ก78#4*��4� ��76���/!��)��)/"� !ก ! 50S ribosome subunit 42. �� 1 Travelerrs diarrhea ������ ��ก� �ก���78#��� �8����4�)ก !ก��j*��(�9�M������$������ �)����M���ก$� diarrhea 43. �� 2. Kernicterus ��������กก���)��t$�#)���16M(��ก�*# Sulfa �"���M����fก#)��ก��4$��ก�$���0#��/"�utt��*����� ��)ก&*� Kernicterus 0*&���ก������ Gray syndrome �ก$���กM(�� Chloramphenical Fanconi Syndrome �ก$���ก ก��M(� Tetracycline �#���� 0*&� Beri Beri �ก$���ก��� Vitamin B1 44. �� 3. Antiarrhythmia ��������ก #)o�p$q � ectopic pacemaker (pacemaker �)�4$��ก�$�)����M���ก$�ก�� arrhythmia) [����กo�p$qM�ก��� !/" ! 9��)� activated Na+ channel 78��0*�4�2$�#ก���ก$� refractory period /"ก�ก���ก$� excitability /" conduction M� depolarized tissue �"��(*&��&�ก���ก$� action potential ��"ก�!ก !o�p$qM�ก���2$�#ก���ก$� effective refractory period 45. �� 1 M(�� กl�ก���$��(�9� 2�p$� &ก#���#�กก&*�(�$� pyrentel pamoate ��������กก�ก ��� mebendazole j*����� 0*&� Pyrentel pamoate � 9� ! 9� ก�� metabolism ���2�p$ 46. �� �ก��ก��� 47. �� 1 . �&�#����2$l0�� �(*� agranulocytosis 48. �� 2/3 pheripheral neuritis increase uric acid ( drug information) 49. �� 2 � ���กM(��/�&[��/0�#)��ก�� sun burn ��������กก���ก$� photosensitivy �"0 ��ก���ก!�$�&e�)� �ก/0� 50. �� 3 #)��ก���$��(�9�����*� �(*� �����& � ��f!�� �����0) ��������ก����� 4ก�"�!������#)!��! ��*��76�ก�$ ��� [�$��� �����0� 4#�*&� ��� 51 m 60 �#*#)��0*�#��8���������� 51. [��6 �#*��!

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52. �� 2 Cardiotoxicity ��������กก��M(�� �)9�����&����#�กก&*� 10 & � ����M(�M�����0���"#)[�ก�0���M���ก$� ������$� �&����� ����)� /�*�)�� ���� 8�()&$���� � &M�������f& ����� &M�4$��ก�$ Cardiomyophaty 53. �� 1. �&��"& �M��t$�� 9����16 ������*M��"�&*��� 9����16�2��"���M���ก$� teratogenicity ��������ก ���� is classified as FDA Pregnancy Category X 54. �� 3. ampicllin ��������ก � probenecid �"��/*�ก��[��� !��ก��� ampicillin ���M�� ก��� !��ก��� ampicillin �� 55. �� 2 ��������ก���� � Betablocker ���M����/��� ���M�� ���/����06 �$���/"�"������� 56. �� 2 � &��ก$� hydrolysis ��������ก[��6!�ก&*������/ก��&� /�& �กf!�$9��&�/�&��#f� �*��"���� ��*��"���� aspirin ��������ก �กhydrolysis ����*�/" #)ก$����#f��#���[�� hydrolysis 57. �� 1 nystatin suspension ��������ก M(�j*��(�9���M�(*����ก M(�ก 9&��ก 58. �� 2 ampicillin ��������ก � Chloramphenical ���M���ก$� Gray syndrome Cipofloxacin #)4�*�ก�"��ก tetracycline ���M��{u� /"ก����ก�*��4$��ก�$ Co-trimoxazole ���M���ก$� kernicterus

!�(�)"�*�+�

Case I 1. ��! �. Systemic infection �2��" 4���5&#)��ก�����&0 �� #)��� ��#)�0#�" �u00�&"/0!� � *���& {u�

���#)�0)� crepitation both lung 78���#� 8�4���5&#)ก���$��(�9��)��� organ 2. ��! �. Infection diarrhea �2��"ก�� *���&�#*������������ก$���กก���$��(�9������$������ ����"�ก$���ก

0������������ �(*� osmotic diarrhea 3. ��! �.��ก��� 2 �$�&*�ก�������0)��กก���$��(�9��������������)�0�� � �� 9�ก����&�������"�8�����0$��0*�

��&��������/!�)������������)�0�� 4. ��! ก Azithromycin ����drug of choice 5. ��! �.Ceftriaxone 6. ��! �. Ciprofloxacin �2��"ก���$��(�9� UTI drug of choice ��� ก�*#fluoroquinolone �)����ก ciprofloxacin

�2��"4���5&�$��(�9�M�������& 78��cipro���78#����)ก&*� norfloxacin 7. ��! ก. Erythromycin �2��" Erythro ����drug of choice M�4���5&URI �)�/2� penicillin

Case II

1.��!�. ��&�2! Anti HBS Ab M�ก�"/0���� ��������ก

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Anti HIV /�0 HIV antigen !*�!�ก23�0ก3��)"�*�+�HIV

2. ��! �. ��M���!������ ��������ก �#���2$���e���ก��� �# �# 8� กle"����$�$ก 78��กf��� symptom and sign � �� 9�� �� &���ก �. �$9��� 0*&��3ก3�567 /�0��8 (�������ก��0*&�M�t*�)�2!���M� lower RTI 0*&�ก��5�=>

��=?0����"@A�@BA�3ก3�6�� pulmonary tuberculosis � �� 9��3ก3�?� �?A� ���ก)"�3กก3��G) =/��HAก3�?3�H�

�A� ���3กHA23�0I> @�"�Jก�� �0IK3H?7IL�I3��")A�3ก3M�> /( �� �N��@BA�J�����กI> �ก> ��67��กJ !�(@�"�Jก��

=3กI> �O" 3.��! �. Streptococcus pneumoniae ��������ก �����ก�������������� !��"��#�$%�$&�ก��ก'(��"�

- S. pneumoniae 12-24 %

- C. pneumoniae 17-32 %

- M .pneumoniae 6-13 % 2&(

- Legenella spp. 6-10 %

- ก#7%8������ H. influenzae 9:!;��ก'(<�=�>?@�ABC� !� D7E����7���7�;<�F�@�@�C2&(F�G�ก8� 5%

4.��!E. pen G J � 7GB�ก�� erythromycin ก8�

5.��!E. ก#7C@��� acid fast stain <������ AFB

���!�;'#กก#7C@��� acid fast stain ������������ !ก#�ก��$%�%&'!( ) *�+,$��&-��.�*�&�*&/

01/023 )�4,$��5$�6-�

6. ��!'. STM/EMB �#� 24 ����� ��������ก����� #)��ก�� � !� ก�0! �8��&����� INH/RIF/Pyrazinamide

��������ก������)�#)[�ก�0���M���ก$� � !� ก�0! [��ก�$/�&�"����� �ก*�&� ��)/�&M�� 0���S/E /�&� กl�

HBsAg ����[���)�0*&���"ก�!�)�4$&����(�9��&� 0� !� ก�0!!) !*�!�ก1�&"ก���$��(�9���)!2 �/0��&*��e"� 9��*��ก�ก�� �=>ก3��)"�*�+�5��J��J �Jก�� >��QL ?����@BAG3?06���*�+�

Anti HBs ����1�#$���#ก ��*�0*&�4$&����(�9��&� 0� !� ก�0!!) �)��*��ก�0�����89�M��""/�ก���ก���$��(�9� !*�!�ก&*��L3�ก3�5"7��73�2Q=)(O7=กJA5��J��J �Jก�� >6N+A/�7� ?����(�5"7�J �J(R>A5��J��J �Jก�� >=3กL�A

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��ก�� � !� ก�0!/�&���*� AST ALT ��ก#)�*�����ก&*� 0����*�����*��ก�$ M��ก !#���$�#M(��[��*�~ ��$�#��ก�������� /�*��ก�����#)��ก�� � !� ก�0!���/�����/ก*#)��ก�� encephalopathy, ascites, coagulopathy M��M(��0��� S/E �*��� [����#M(� � I/R/Z � 7.��!ก. Isoniazid ��"�C#� !��กX�Y8Z%G������B�[D7E��;� !�C?G=��9&&\2&(��ก�9&&\ 2&(��"�C#�� CB� !=�@��"�C#

�]�;ก��ก#7%8������B�[D7E ��������ก

8.��!E. EB7=$@ก#77�ก^#B�[D7E�@BCC#�?%7 short course therapy �< C;�CG#;�� CBกG�� ���!��#ก#7�#;E&8�8ก��;>?@�ABC� �:�� $7��>&ก#7%7B'���$(� AFB��"�&�':;=$@C#�@#�FB7������\ D�CEB7=$@C#%@#�_#C=� 2 ����� ก#77�ก^#�@BCC#%@#�FB7������\=�ก&�G�>?@�ABC� !� B�[D7E7GB��@BC

. @# CD4 < 250 cells/cu.mm =$@��%6�(��>��$!?@�,ก4A� $&�;'#ก����_#C=� 2 a 4 ����#$\ =$@.%&��?���%6�(�

�>��5$�!0�A30B 5�4,$��A���ก$4� 2 �3CA� $7�� '�7�ก^#B�[D7EE7�กG���78!�C#%@#�FB7������\ �<7#(<�BG#��%7#ก#7%#C�?;

Case III

1. ��! �. Symptomatic HIV( CI) �2��"2$���e���ก��)�4���5&���� !��� cotrimazole /" clotrimazole lozenge (prophylaxis) �8�ก*�&���&*�4���5&��*M�� 9��$��(�9��&[�ก�0 �&#� 9��*� CD4+ ���4���5& �����ก&*� 200 cell/µl(140) /"�*� viral load ���4���5& �#�กก&*� 100000 copies/mm3( 110000)��& � �� 9�4���5&�8�� ���*M�� 9� symptomatic

HIV( CI) 2. ��! ก �2��" � GPO-vir ��"ก�!��& Nevirapine, Stavudine, lamivudine 4$�[����6ก���10 (ก��#

3. ตอบ � �2��" Efavirenz � ���*M�ก�*# NNRTI ��กo�p$q ! 9���f��7#6 reverse transcriptase /!!� ! �&� (Irreversible non-competitive inhibitor) � �� 9��M�ก�*#�)9�8�/��ก&*��M�ก�*# NRTI �)�#) กle"�)�/!! base ����(�9��&��0�"��กo�p$q

4.��! � �2��" ADR���������&� 0�)�2!!*���#[���ก��NAPHA �)�4$���� 3TC (lamivudine) �#*�ก$� CNS toxicity /"teratogenicity /�*4������)���� Lamivumine(3TC) ��� � !�*��� ก�0! �����0� ����)�/�*2!������#�ก (3TC > CAT C) 5.��! �. �ก��ก��� ��������ก 0$��0��� t�)��10 (�&�/���M��4���5&���!&*���ก#)��ก��� ��*����)9 (��ก���)�!*�&*��*��"���� Steven Johnson Syndrome (���ก) ���� Toxic Epidermal Necrolysis(��� �)) M������/"#�2!/2�6[��*&� �#*������& �� � ��ก��ก�)9���2!4����)�#) กle"��*#�9��M0 (Rash with blisters ��#��� �) /"M�0 ����6�)� 2 � �4���5&#��$���#ก��� กl�/"��&�ก����������!� ! ALT, AST ���� ��ก����ก����"� ���&� ALT �*����)& �� enzyme � !�2$�#�89� > 5 ��*���� baseline 4���5&�������� (��������#��� � �)�!�ก&*� SGPT< 5 ��*�) 6. ��! � miconazole oral gel �2��" �� ก�)�M(�� กl� oral candidiasis �)�M(�M��u���! �#)�2)�

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clotrimazole lozenge 10 mg & �" 4-5 �� 9�/& ������&� 10-14 & �Nystatin suspension 500,000 ��*& ��M���ก& �" 5 �� 9�Ketoconazole tablet /" fluconazole M(�M����)�����#�ก 7.��! ก ��#*�����������M�� fluconazole 0���� !����ก � cyptococal meningitis �2��"�"� ! CD4���4���5& �#�กก&*� 100 cell/mm3 ( 140) /"��ก#)�&�#������������ กl��&�M(� amphotericin B /����������ก fluconazole #) teratogenic effect (4���5&ก�� �� 9����16) 8.��! �. Nevirapine ��������ก��������� GPO- VIR 78��#) Nevirapine Stavudine /" Lamivudine [�� &�)��*��"���M���ก$� � !�0!��� Nevirapine 9. ��! � zidovudine, lamivudine, indinavir / ritonavir ��������ก/�&���ก��� กl�4���5&���06�)�� 9����16��#���4��M�t*� �&�� ��� NNRTI 2 � & /" PI 1 � & [���)����ก�"��&�0�p��e0��/�"���M��M(�0���� !4���5&�"�&*��� 9����16���/ก* zidovudine, nevirapine, lamivudine ��ก/2� nevirapine M����)������ nelfinavir 10.��!�. M��������&� 0�*&#ก !�� กl�& e[���2��" ก�e)��&�2!&*�����& e[���e"ก�� �ก$�������&� 0��* �#*��������������������&� 0 /�*M��2$���e�M�������& e[���*&#ก !������&� 0[�M�ก�e)�)9�����M(�������&� 0�����0����)���"ก�!��& unboosted PI M��2$���e���)������ EFV ����M(� boosted PI �(*� IDV/RTV (800/200) 11��! � ก��� กl�0#��/"�������#0#��� ก�0!��ก Cryptococcosis /�"���M��� กl���#�����!M���� � 12. ��! � ������&� 0���06������&!��#2$��l 0�#�� 7�9������2�"�)�[��2�!���*��� 9� ก�&��#)ก�������*��)� �������������6ก��10 (ก��# 13. ��! � #"�"�)9�ก (Momordica charantia) alpha-momorcharin #)o�p$q�����(�9� HIV /" ! 9� HIV-1 replication M� acutely HIV-1 infected T-lymphocytes /�*�#*#)4�*��""���9�� � /" #)�����&*�0�� Lectins �)�0ก ���ก#"�"�)9�ก (Momordica charantia) #)o�p$q��������7#6 reverse transcriptase ����&� 0 HIV-1 Case IV 1.��! � �2��"&*� ��ก��������)���กก��M(��M�ก�*# Non-nucleoside reverse transcriptase inh.(NNRTI) ���Rash /" Hepatotoxic

2.��! � �2��"���#�*��#�M�ก��� กl�[�ก��M��������&� 0/ก*����� ����ก��M���"� ! CD4#�กก&*� 200 cell/ mm3 ������$#�e�&� 0M�2�0#�����ก&*�( viral load) 50 copies/ml 3.��! ก ��)��$#M(��2���ก������ก �ก���$��(�9��&[�ก�0 Pneumocystis carinii pneumonia /!! primary prophylaxis M�4��M�t*�)��$��(�9� HIV ��� Cotrimoxazole(80 TMP/400 SMZ) 1 �#f� & �" 1 �� 9� 4.��! � #"�"�)9�ก (Momordica charantia) alpha-momorcharin #)o�p$q�����(�9� HIV /" ! 9� HIV-1 replication M� acutely HIV-1 infected T-lymphocytes /�*�#*#)4�*��""���9�� � /" #)�����&*�0�� Lectins �)�0ก ���ก#"�"�)9�ก (Momordica charantia) #)o�p$q��������7#6 reverse transcriptase ����&� 0 HIV-1

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Case I (�� 330)

�� 1. ��� – ����������ก� ������������ �� ��� 1.��������� �!�ก "�#$ก 2.��&���� ��'ก 3.)�!���)�*4. �����!�!���)�* (���������)�)

5. ก������ก*��!����� 6.0��1��2 � " 7.1��" �ก������� !����! � : !�กก��ก��5ก1��" � ��&�� �� #����

1. 6���17� : ��8, ����, �� �!�ก " 2. ��ก�� ���� 4 2�# 0#������2�ก 8��:�, 2�'ก, 1�ก, ��

2.1 8��:� : 1"#!" "����!���)�* 1"#������ �� " !��";����;!���)�* 2.2 2�'ก : �#2�'ก �� ��'ก)!�!���)�* (���)!�-���"*���ก/����) �� ��'ก����)� ��>��*� ��2�'ก 2��

!���)�* 2.3 1�ก : )�!���)�* (���)�*)�-���"*������!�!���)�* ����)� &>��ก��ก!����*�� !������)�-���"*�

)�ก���"�/ก������ ���)�ก������)�2����)�*)#���� )��17��#;��� )����"�!�����!�>��� �����!���� ���������)� &>��ก��ก!����*��)

2.4 �� : �2$>�� ���� ������� 3. �17���ก��"����" 4. ���)1!�!�� ก���������"!����� 5. ��0��1��2 � "/ ������?/6!���>� ���'*!���)�* 6. ����������)�>������ (������-���������"�17���*��)� ��������� �>>*����� ����������)�)

– �#$ก������*�2��17�0�� Common cold 0#���2��G�2�ก��ก����� ��)&� ���� ��'ก ���#� )�*��!��� �17��� 1"� – ��)�*2 ��17� ����>��1H��"�� ������2�ก0�� Common cold �ก�#2�กก�� �#����)"�� 5I����������>>*����� Rhinovirus

���0�����������!��)#�������6�10 "� #����ก���ก:�0�� Common cold 2I��17������ก���ก:� ����ก������"�6!�&������ �6�ก��1H�> � "��� 6!��กR*����ก;, #����� ���*���ก;

�� 2. ��� – R'�1S"��17�0�� Purulent rhinitis ������2�ก�����!������ ��'ก�&��"&�� 5I���ก�#2�กก�� �#�����>��������*"�ก�ก���17�

Common cold – ��2��G�2*����1H��"�� ������2�ก����ก����#����>*�>�ก"*���ก�� �#�����>������� )#��ก* �����!������ ��'ก�&��"&�� – ������� �����2��G�6�ก������ก6���1H��"�� ��� 1.1��" �ก�������!���0��1��2 � " 2.�������! ��*"�6!W* 3.

>���"G��� �#�������>���"G�������กX�Y�Z 4.D rug profile (PK, PD) 5.&���"���"������ก��&�������� �� 3. ��� ��2��G�2*���� Amoxycillin ก�G��#$ก���� < 3 �#��� 6!���&��# 20-30 mg/kg/day 0#��>*�6!���ก 12 �"0��

��������� MCQ ����� Upper Respiratory Tract Infection (URI)

-.� /0�ก 2 �3��4�0� /��� & ��67���-.� Lady_1st

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ก�G��#$ก���� > 3 �#��� ����� �!�ก < 40 kg 6!���&��# 20-50 mg/kg/day 0#��>*�6!���ก 8-12 �"0�� 2*���� 3 "� �����ก��#�&I��ก$2*���� *���ก 7 "� (�"��>1�������6!���> 10 "� �����1h��ก�ก���ก�#��ก�����ก5��� ���� �*� )&��'�� �ก) ก�G�����"�2*���17��'1�>>���� � ���Powder for oral suspension �����6!��*�� *�ก���>1����� !��2�ก���� ���R���� ����"�������ก$>��)"������G!�'��!���)#� 7 "� !����ก$>��)"�6� '���$�5I��2��ก$>)#���� 14 "� �� 4. ��� !�ก�����ก��*� Penicillin 6!�6���ก��*� Macrolide ��� �*� Erythromycin 30-50 mg/kg/day �>*�6!�"��� 2-4 ���� &��#�'���#���6!�)#���� 2 g/day �'1�>>����������"��ก��6!��17��!���� Amoxycilliin �� 5. ��� Erysil (Erythromycin estolate) Ilosone(Erythromycin estolate)

� Erythromycin estolate �17��'1�ก������������ ��ก�#6�ก������)#�#� ���� ก " (dissociate) >���"G� �)����$ก�*"� ��)#��17� inactive propanoate ester ���"#'#5I�����'ก hydrolyzed 6�����#)#��17� free erythromycin

Servitrocin (Erythromycin Ethylsuccinate) � Erythromycin ethylsuccinate �17��'1������ 2�#'#5I���� hydrolyzed 6�����#���")#� free erythromycin � ���ก��

6��'1���>1����� �����!�*"�ก���ก�# gastric inactivation ���*"�� �6!� oral bioavailability #�&I��

• ��6��'1&���ก��� estolate ��� Ethylsuccinate �"��>1������������!��!���!����!������������#ก������������ก��������!��

• ��6��'1&�� base !��� stearate �"��>1�����ก*����!�� 1 �"0��!����"������"*���������)�*�� *�ก�#6�ก��������!�� �� 6. ���

�>1������� *�������2���!�# ��*�!��#�����"*���ก��2�#�&I�����"�����1h��ก�����#�����

�� 7. ��� ������2�ก��2�����������������'ก�"�������������##

�� 8. ��� �*�2���6�!�������>���������ก)�*��

�� 9. ���AB�C�D�ก0��6กE��F���B��E� 3 �B��E� (RX1-RX3)

�� 10. ���

0�������� Penicillin �17� unstable structure � �6!���)�*�� *�ก�# *** ��� R �17� e-withdrawing 2�� �6!�����ก�#)#� ���"� A, B � ก��ก ��2ก*�6!��ก�#ก��ก�� ����'������ก� � �6!�����ก�����)#�

A : Thiazolidine ring

B : Beta-lactam ring

C : Site of action of penicillinase

D : Site of action of Amidase

AB

C

D

***

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RX1 (Ampicillin 250/1tsp)

�� 1.1 ��� 5 ก�� �! �R�: 6� ��> ����� ampicillin 250/1 tsp 5I��2�ก02��?ก �!�#6!����� 100 ml

2�ก 1 ���� = 5 ml 5 ml �� ampicillin 250 mg

#���� 100 ml ����� ampicillin = (100x250)/5 = 5,000 mg (5 g) �� 1.2 ��� e. Glycerin �! �R�: Glycerin � �!�������17� wetting agent ��� dispersing agent �� 1.3 ��� c. Sodium CMC �! �R�: Sodium CMC � �!�������17� suspending agent �� 1.4 ��� c. suspensions �� 1.5 ��� pH &�� �!�>���1����G 3.45

2�ก�' � pH = pKa + log[salt/acid] ����*� pH = 3.06 + log[0.125/0.051] 2�)#� pH = 3.45

�� 1.6 ���

�� 1.7 ��� "�Y�� ���� ��� 1) ># ampicillin 6�0ก�*� � �� glycerin ���>#R��6!� "���1x�ก2�)#� smooth paste 2) � ���� sodium carboxymethylcellulose 6�0ก�*�2�)#� mucilage 2�ก���� �����R��6�&�� 1) ��)1>#R��6!��&��ก� 3) �*��;� �����1��ก�>����;6�&"#��� tare ���"

�� 1.8 ��� �>1�������ก*����!�� (1����G 30-60 ����) R'�6!W*�>1����������� 1 tbsp, �#$ก�>1����������� 1 tsp ��ก 6 hr. �"��>1���������� �# *�ก�2�!�# �� 1.9 ��� 2-8 ��8��5��5��� �� 1.10 ��� ก��1������ �!�>���� ��&"� �ก�� ���1������6�#���

• �ก:G������ก (�� ก���� ��)

• �"��!�����*�&����� ����

• ��G��> �ก��)!�����"��!��#

• pH

• 1����G "��� ��W

• � ����$"&��ก�� ก �ก��

• &��#���ก��ก��2��&��&��#������R���

• �"��������6�ก��ก��2�� "������&�*�

• � ��ก�������/1�#1�*�� "��ก2�กR���

• Microbial limit test �� 1.11 ��� a. ≤ 38 ��8� �! �R�: �*� angle of response �������*����� �"��������6�ก��)!�&��R�������#�

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�� 1.12 ��� b. Solutions �! �R�: �� 1.13 ��� b. Buffer (pH 5-8) �! �R�: ������2�ก0������������"��"*��)" *�1H�ก�����&��"� β-lactam � �6!��ก�#ก������ "6����"� *�� ; )#��*��&����*�����6����"�����17��>�����17�ก�# ก���ก$> β-lactam 6���������>y�y��?2�*"�1h��ก�ก������ ")#� �� 1.14 ��� ��)&�>���� ���6� augmentin (amoxicillin+clavulanic acid) ��� amoxicillin ������������ �#���������������� β-lactamase ��� ����"� β-lactam ring &�� amoxicillin )#� � �6!�ก���ก:�)�*)#�R� �17��! �6!���)&� ���)#��>�� amoxicillin ��� plus ก>�� ก��*� β-lactamase inhibitor 5I��ก$��� clavulanic #�"� �� 1.15 ��� ��> augmentin oral suspension 1��ก�>#�"����� ��W ���

• Amoxicillin trihydrate

• Clavulanate potassium

• Colloidal silicon dioxide (glidant)

• Xanthan gum (flocculating agent)

• Aspartame (sweetening agent)

• Sodium carboxymethylcellulose (suspending agent)

• Silicon dioxide (���#'#�"�����) RX2 (Erythromycin 250/1 tsp)

�� 1.1 ��� a. Erythromycin estolate �! �R�: ������2�ก6�ก�� �� ��>�� dry syrup �ก6����'1�>>��� �� 1.2 ��� 5 g �! �R�: 2�ก 1 ���� = 5 mL

5 mL ���� 0.25 g #���� 100 mL ���� = (100 x 0.25)/5 = 5 g

�� 1.3 ��� c. Sodium alginate �! �R�: Sodium alginate �17� cosolvent �� 1.4 ��� e. glycerine �! �R�: ������2�ก glycerine �17����� *���!"�� �� 1.5 ��� d. sucrose �! �R�: ������2�ก sucrose �17����� *���!"�� �� 1.6 ��� &�#���1���� *����1����" �! �R�: ������2�ก���1����" �*� citric acid ������ก�>��!"��)#�� �6!� ��>���"���*�6���ก&I�� �� 1.7 ��� e. 31 �.�.2004 �! �R�: !�ก|��ก)�*��>�"�!�#���� 6!��>"���#����&���#��������>��17�"�!�#���� �� 1.8 ��� c. ≤ 10% activity �! �R�: ��!�#���� !����I� �������1����G������!�����'*����� 90% &��1����G���������'*6���$#�� �� 1.9 ��� �ก$>��6!������� �� 1.10 ��� ��>�����)#���2����!"����ก ������2�ก)�*��ก��� *�������; ����*�2����"���� "#�

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��������� MCQ ������ Upper Respiratory Tract Disorder (2)

$%� &'�()*( +,-.�/0 +,-.(��� 1�� 234� �ก*� �/�67 8�01��$%� +9

Rx 3 (2(�/ 333-334)

Master Formular Working Formular

Use

Trimethoprim 40 mg/ 1 tsp Methylcellulose 1500 1% Methyl paraben 0.2% Propyl paraben 0.02% Syrup USP 5% Propylene glycol 2% Purified water to 100% M.Q. 60 mL

(40x60) / 5 = 480 mg (1x60) / 100 = 0.6 g (0.2x60) / 100 = 0.12 g (0.02x60) / 100 = 0.012 g (5x60) / 100 = 3 mL (2x60) / 100 = 1.2 mL qs to 60 mL

Active ingredient Suspending agent

Preservative Preservative

Sweetening agent Solvent Vehicle

1.1 ./0 c. Suspensions 1.2 ./0 04K'ก/��8�'�.8L/�M - 2.3456 Methylcellulose 7889:;ก=/8 >?@AB;6;3C7DE89:;25F8GHG;5IJE KJ52.34567804ก2ก/3L 7MEIJEB;3GHG;5M8NJ7B - 0JOA5; Trimethoprim 78Kก3=A PGEQ2.R6B;3GHG;5 MC [email protected]/ 1 GAIV 0JOB6กW878Kก3=A - P5กGHG;5 Methyl paraben PGH Propyl paraben T4@DW@A6; 78 PG Y/GHG;5M6JZ=/58:;6;OB6กW8 - 8:;B;3GHG;5T4@IJE78UE/ 3 2.R6GA78UE/ 2 Z=/5[ 0JOB6กW878Kก3=A - 2.R6 syrup 3 mL GAIV0JOB6กW878Kก3=A PGEQ2.R689:;\8Z30 60 mL 1.3 ./0 c. Trituration ZN/ก;3GJU8;J5;KJ5ก;30JOB6JEQ5Kก3=A 1.4 ./0 b. IV CE;C;62^Y;H3_VP008H 2Y3;H Suspension 7MET;A IV I6=IJE P.=CE;C;6TW9A.:;3W0 UE/849\H`34 2Y3;H64B=Q8V3Hก/02Va8 syrup I6=ZQ32/;6;7MEQRb4/N@8[ .;6.WQ2GN/กT4@7ME6; 8/ก\;กก;3กR8 1.5 ./0 Benzyl alcohol >[email protected]:;GHG;5U/A5; Trimethoprim (REF: ก;3YWi8;B_.3.:;3W05;89:;B;3GHG;5 Sulfadiazine

PGH Trimethoprim j;ZQRD;2jBWD/k.B;Mก336 ZlH2jBWDm;B.3L \kn;GAก3lL6M;QRT5;GW5)

1.6 ./0 e. Thixotropy [email protected]/Aก;378 Suspensions >?@AV3Hก/0JEQ5/8kj;ZT4@64\kJBW6OWBกW8MG;5\kJ\82กRJ.;U=;5B;66R.R6;V3HB;8กW8 (three dimensional network) /5=;AMGQ6[ 26N@/I6=64P3A6;ก3HT:;KZ3AB3E;A\H\W0

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กW8M8;P8=8 26N@/7DEP3A2U5=;\HIVT:;G;5\kJT4@BW6OWBกW83H00\H2VG4@58\;ก2\G2Va8K>G (gel to sol) ZQ;6M8NJGJGA 26N@/M5kJ2U5=;KZ3AB3E;A\HกGW06;\W0กW8 2Va83_V2JR6/4ก ��)+ ZN/ 26N@/23;2U5=; suspension \HT:;7MEZQ;6M8NJGJGA Y/M5kJ2U5=; กF5WAI6=กGW06;2Va8.Hก/8TW8T4 OA5;5WAก3H\;5/5_= 7ME23;5WA2TกR8IJE \;ก8W98OA5;\HZ=/5[ กGW0B_=Bj;QH2JR62M6N/8./85WAI6=2U5=; (REF: http://pharm.kku.ac.th/thaiv/depart/techno/basicpharm/downloads/Lesson4.pdf)

1.7 ./0 a. Zero order VrRกR3R5; zero order 78T;A2jBWDก336 IJEPก= ก;3BG;5.WQU/A5;89:;PUQ8.Hก/8>?@A\H64.WQ5;0;AB=Q8GHG;52Va8B;3GHG;5/[email protected]:;ก3HB;55; 78ก3l48495;B=Q8T4@/5_=783_VB;3GHG;52T=;8W98T4@\HB;6;3C2กRJVrRกR3R5;BG;5.WQIJE 26N@/5;78B;3GHG;5BG;5.WQIV [email protected]ก/8กF\HGHG;52UE;6;TJPT82B6/ T:;7MEZQ;62UE6UE8U/A5;B=Q8T4@GHG;564Z=;[email protected]/J2QG; 1.8 ./0 28N@/A\;ก2Z3N@/ADW@A5;64U4JZQ;6B;6;3C\:;กWJ78ก;3DW@A5; 2D=8 2Z3N@/A torsion balance B;6;3CDW@A89:;M8WกIJE8E/5T4@BkJ 120 mg KJ564ZQ;6C_ก.E/AU/Aก;3DW@A.;6ก:;M8J CE;.E/Aก;3DW@A89:;M8WกT4@8E/5กQ=; 120 mg กF/;\T:;IJEP.=ZQ;6C_ก.E/A78ก;3DW@A\HGJGAPGHI6=2Va8T4@2DN@/CN/ 64/4กQRb4T4@\HIJE6;>[email protected];T4@64V3R6;l8E/5[ I6=Q=;\H2Va8ก;3DW@AM3N/.QA KJ52.34562Va8 Trituration M3N/ Stock solution 26N@/.E/Aก;35;\:;8Q82T=;7J7MEZ:;8QlP0=A//ก6; B=Q8T4@P0=A//ก6;2345กQ=; Aliquot part QRb4ก;3T4@กG=;Q6;TW9AM6J2345กQ=; Aliquot method QRb4ก;3Z:;8Ql \;กK\T5L Propyl paraben 12 mg I6=B;6;3CDW@AIJE JWA8W98 1. 2/O0/.���.��(��� Tirturation .E/AZ_l 12 JEQ5 10 = 120 mg (2YN@/7MEOGZ_l64Z=;/5=;A8E/5 120 mg) 7MEZQ;62UE6UE8U/A Trituration 2T=;กW0 1 : 10 2. 2/+�4./P Diluent

1/10 = 120/x x = 1200 mg 2Y3;H^H8W98 Trituration TW9AM6J2T=;กW0 1200 mg

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QRb42.3456 Trituration ZN/DW@A Propyl paraben 120 mg OB6กW0 PG 1200 mg 3. 2/+�4./P Aliquot part

1/10 = 12/y y = 120 mg

2Y3;H^H8W98P0=A Trituration //ก6; 120 mg (.3A849ZN/ Aliquot part) >?@A\H64.WQ5; Propyl paraben 12 mg (ZN/2/;B;3GHG;56;PZ= 120 mg \;ก[email protected] 1200 mg)

Case 2 (2(�/ 335) 1. ./0 j_6RPYET;A\6_ก (Allergic rhinitis) 2. ./0 A. 28N@/A\;กK3Zj_6RPYET;A\6_ก2Va8 hypersensitivity type 1 2กRJ\;กT4@O_EVtQ5IJE3W0 allergens 6;ก=/8 PGEQ2กRJก;3 sensitization KJ564ก;3ก3H.kE87ME3=;Aก;52กRJก;3B3E;A IgE IV\W0กW0 mast cell T4@03R2QlT;A2JR8M;57\ 2กRJก;3MGW@A mediators .=;A[ //ก6; (Histamine, 5-HT, PGD2, PAF, LT, proteolytic enzyme PGHeosinophill,neutrophill chemotactic factor) T:;7ME2กRJ vasodilate, edema PGH2กRJ inflammation 78KY3A\6_ก 3../0 \. 2Y3;HBR@Aก3H.kE864MG;5/5=;A IJEPก= B;3ก=/j_6RPYE (Allergens) 2D=8 I3xkt8(mite) U8BW.QL P6GAB;0 2DN9/3; (mold) 54B.L GH//A2กB3 BV/3L xkt8 (dust) 2Va8.E8 ก;3.RJ2DN9/T4@T;A2JR8M;57\ (KJ52^Y;HYQก virus 2D=8 Mycoplasma, Influenza) BR@Aก3H.kE8\;ก/;D4YT4@T:; (D=;AT;B4, B;32Z64.=;A[) 6Gj;QHT;A/;ก;m 5;PGH/;M;3 (ASA, NSAIDs, beta-blockers) 4../0 ก. 28N@/A\;ก nasal decongestant 2Va85;กGk=6 Sympathomimetics //กzTbR{KJ5ก;3\W0กW0 Adrenergic receptor T:;7ME2กRJก;3MJ.WQU/AMG/J2GN/J (vasoconstriction) 7825N@/0kKY3A\6_ก GJ/;ก;3ZWJP8=8\6_กIJE

2(�/ 336 5. ./0 U. 2Y3;H 5; Brompheniramine 2Va8 Antihistamine Gen1 >?@A64 Sedating effect 3/AGA6;ZN/ Cetirizine 2Va8 Antihistamine Gen3 A=QA8E/5BkJZN/ Loratadine 2Va8 Antihistamines Gen2 (2B3R6>>Gen3 C_กYWi8;U?986;KJ564ZklB60W.R2M6N/83k=8T4@ 2 P.=MG4ก2G4@5AV}~M;2ก4@5QกW0ก;326.;K0GR>[email protected]) 6. ./0 A. 28N@/A\;กO_EVtQ564/;ก;3ZWJ\6_ก6;กU?98MGWA\;ก7DE nasal decongestant (Oxymetazoline 0.05%) .RJ.=/กW88;82กR8 5-7 QW8>?@AกFZN/j;QH rebound congestion B:;M3W0ก;33Wก�;j;QH849T:;IJEKJ5ก;3M5kJ5;0332T;/;ก;3ZWJ\6_กT4@7DE2^Y;HT4@ ก;3M5kJ\HM5kJUE;A7JUE;AM8?@Aก=/8 PGEQ3/7MEUE;AT4@M5kJ/;ก;3J4U?98 (V3H6;l 1-2 BWVJ;ML) PGEQ\?AM5kJ5;/4กUE;A (2B3R6 >>>/;\7DE5;0332T;/;ก;3ZWJ\6_กD8RJ3W0V3HT;82UE;6;D=Q5j;5MGWA\;กM5kJ5;849234503E/5PGEQIJE) (REF: 2/กB;3Z:;B/8 QRD;2jBWD0:;0WJ 1 23N@/A K3ZT;A.; M_ Z/ \6_ก PGH5;T4@7DE2^Y;HT4@.; M_ Z/ \6_ก KJ5 /;\;35LQ33lQRIG 2G;GWZ8; ZlH2jBWDm;B.3L 6M;QRT5;GW5U/8Pก=8) 7. ./0 04K'ก/�ST��/&*(1.9ก

1. CE;6489:;6_ก7MEO_EVtQ5BW@A89:;6_ก20;[ PGH2DFJ89:;6_ก7MEM6J

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2. [email protected]�HU?982GFก8E/5 2U5=;UQJ5;Y=820;[ (P8H8:;7MEPกQ=AUQJ5;20;[ \HIJEI6=2กRJ`/A CE;64`/A6;กกJ5;\H6489:;5;//ก8E/52Y3;H\H64P.=G6)

3. 2V�Jx;UQJ//ก B/JVG;5T4@Y=85;2UE;3_\6_ก 7DE8R9Q6N//4กUE;AV�J3_\6_กUE;AT4@2MGN/ 4. กE6m43�HGA B_JM;57\2UE;DE;[ Y3E/6กW0กJT4@Y=85;2UE;\6_ก ก;3Y=85;8W98.E/A7MEVG;5MG/JY=8D49IVT4@O8WA

JE;8UE;AU/A\6_ก ME;6Y=85;2UE;T4@O8WAกW98D=/A\6_ก (2Y3;H03R2QlO8WAกW98D=/A\6_ก0;A\H/Wก2B0A=;5) 5. กGW98M;57\ 2-3 QR8;T4 6. Y=85;783_\6_ก/4กUE;AJEQ5QRb42J45QกW8 KJ5Y=8UE;AGH 1 Z3W9A7MEZ30 2 UE;A 7. 2DFJT:;ZQ;6BH/;JT4@VG;5Y=8 V�Jx;2กF07ME234503E/5 8. 0EQ8V;กกGW9QZ/7MEBH/;J M3N/PV3A`}8PV3AGR987MEBH/;J (MGWA\;กY=85;T4@2Va8 steroid) Z:;P8H8:;PGHZ:;D49P\[email protected] - 78ก3l4T4@2Va85;Y=80332T;/;ก;3ZWJ\6_ก 7ME7DEIJE2Va8Z3W9AZ3;Q26N@/\:;2Va8I6=ZQ37DE .RJ.=/กW8 8;8MG;5QW8

2Y3;H\H7DE5;I6=IJEOG P.=CE;2Va85;Y=8 steroid .E/A7DETkกQW8B6@:;2B6/ 2Y3;H5;849I6=B;6;3C0332T;/;ก;3IJETW8T4 PGHMGWA\;กY=85;T4@2Va8 steroid ZQ30EQ8V;ก กGW9QZ/TkกZ3W9A 2YN@/V�/AกW8OGUE;A2Z45A\;กก;37DE5; 2D=8 2Va8x�;U;Q78D=/AV;ก M3N/ 2B45APM0

- 78ก3l4T4@O_EVtQ5.E/A7DE5;B6@:;2B6/ CE;GN6Y=85;7MEY=8TW8T4@T4@8?กIJE P.=CE;8?กIJE782QG;7กGE2Z45AกW02QG;T4@\HY=8Z3W9A.=/IV7MEY=85;Z3W9AT4@.=/IV2G5KJ5I6=.E/A2YR@65;2Va8 2 2T=;

- I6=ZQ3M5kJ5; GJU8;J5; M3N/2YR@6U8;J5;2/A KJ5T4@I6=V3?ก�;PYT5L - ก;37DE5;Y=8\6_ก/;\T:;7ME3_EB?กU6Z/IJE 2Y3;HD=/A\6_กกW0D=/AZ/64T;A.RJ.=/C?AกW8 - QRb4ก;37DE5;Y=8\6_ก[email protected]�WT.=;A[ /;\64ZQ;6P.ก.=;AกW8 7MEJ_3;5GH2/45J U/AOGR.jWl�LP.=GHD8RJ

JEQ5 8. ./0 A. M8;65/ก2/;M8;60=A 2Y3;Hก;33Wก�;KJ57DE/R66_80:;0WJ ZN/ก;33Wก�;K3Zj_6RPYET;A\6_กKJ5ก;3^4JB;3ก=/j_6RPYET4@IJE3W0ก;3TJB/0PGEQQ=;O_EVtQ52กRJก;3PYE 23R@6JEQ5V3R6;l.@:;[TkกBWVJ;ML PGEQ2YR@6V3R6;lT4@^4J7ME6;กU?98 >?@AOGT4@IJE\H64ก;32VG4@58PVGAU/A3H00j_6RZkE6กW8 (Immune modulation) T:;7ME/;ก;3U/AO_EVtQ5J4U?98 9. ./0 ก. 2Y3;HB:;ZW~ZN/23;Y5;5;6MG4ก2G4@5ABR@AT4@23;PYE \H2Va8ก;3V�/AกW8PGH3Wก�;T4@J4T4@BkJ 10. ./0 ก. Allergen Avoidance .;[email protected];PGEQ78UE;A.E8 ZN/23;Y5;5;6MG4ก2G4@5ABR@AT4@23;PYE \H2Va8ก;3V�/AกW8PGH3Wก�;T4@J4T4@BkJ U.Antihistamine 2Va8ก;33Wก�;T4@VG;52M.k ZN/PYEPGEQZ=/53Wก�; CE;O_EVtQ5PYE3k8P3A/;\\HC?AD4QR.IJE Z.Cromolyn Sodium 2Va85;กGk=6 Cell membrane stabilizer (Cromolyn sodium PGH Nedocromil sodium) 2Va85;T4@5/63W07ME7DE78M~RA64Z33jLIJE 28N@/A\;ก5WAI6=Y0/;ก;3UE;A2Z45AT4@3k8P3A B;6;3C7DE782JFก/;5k.@:;กQ=; 4 V�IJE 64V3HK5D8L78กGk=6T4@/;ก;3I6=3k8P3A cromolyn sodium 2Va85;T4@64V3HBRTbRj;YJE/5กQ=; inhaled steroid 78ก;3.E;8ก;3/Wก2B0U/AMG/JG6 3_VP005;64TW9AP003W0V3HT;8PGHY=8B_J

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A.Immunotherapy 2Va8ก;3^4JB;3j_6RPYET4@O_EVtQ5PYE 23R@6\;กV3R6;l8E/5[ PGHZ=/5[2YR@6U?98 2Va83H5H2QG;.RJ.=/กW8 2 2JN/82Va8/5=;A8E/5\8ก3HTW@A3=;Aก;5O_EVtQ5B;6;3CB3E;Aj_6RZkE6กW82/AIJE \. Exercise + Good nutrition //กก:;GWAก;5 PGH IJE3W0B;3/;M;3T4@J4 78B=Q8849 ก;3//กก:;GWAก;5D=Q57ME3=;Aก;5PUFAP3A PGHก;3IJE3W0B;3/;M;30;A/5=;AD=Q52B3R6j_64ZkE6กW8 2D=8YQก89:;G_ก5/ 2Va8.E8 P.=ก;33Wก�;P008492M6;HT4@\H2Va8ก;33Wก�;2B3R62T=;8W98 11. ./0 A. CE;89:;6_ก7BPBJAQ=;2Va8j_6RPYE

Case 3 (2(�/ 337) 1. ./0 3.Sinusitis /;ก;3B:;ZW~ZN/ \;6 6489:;6_ก ZWJ\6_ก VQJ.;670M8E; M8E;O;ก MWQ PGHกJ2\F0T4@KM8กPกE6 2. ./0 2.1 S.pneumoniae, H.influenzae, M.catarrhalis (2B3R6 >> .RJ2DN9/ bact \H2Va88;8 5-7 QW8 M3N/I6=J4U?98j;578 10 QW8) 2.2 Rhino virus, Influenza virus 3. ./0 Amoxycillin(500) 1X3 2week M3N/ Bactrim (400:80) 2x2 pc 2 week (MGWกก;3ZN/7ME5;6;กกQ=; 10 QW8 PGHI6=8R567MEกGk=6 Macrolide 8H2Y3;H2DN9/I6=Z=/5\H sense) 4. ./0 I6=ZQ3 28N@/A\;กBR982VGN/A PGH.RJ2DN9/ bacteria PGEQ 8/ก\;ก849ก;37DE 1st Gen antihistamine \HT:;7ME2B6MH78I>8WBUE82M845Q IMG//ก5;ก 5. ./0 I6=ZQ3\=;52Y3;HO_EVtQ53;58498=;\H2Va8P00 Chronic IVPGEQ ก;33Wก�;T4@J4ZN/7ME5;�=;2DN9/PGH7DE89:;2กGN/BQ8GE;A\6_ก\HJ4กQ=; B=Q878 nasal decongestant 8W98.E/A3HQWA78O_EVtQ5K3ZMWQ7\ ZQ;6JW8KGMR.B_A 20;MQ;8 PGHZ8IUEK3Z\R. YQก849CE;\H7DE\HP8H8:;7ME7DEP00 short acting PT8 6. ./0 I6=3_EQ=;T4@YR6YL6;ZN/5;/HI3 P.=2J;Q=;8=;\H2Va8 nasal decongestant spray B:;M3W0O_EVtQ53;5849กFI6=ZQ37DE 2M.kOG2J45QกW8กW0UE/UE;A08

Case 4 (2(�/ 337) 1. ./0 c Erythromycin and Terfenadine I6=ZQ37DE3=Q6กW8 2Y3;H\HT:;7ME64OG.=/ก;32.E8U/AMWQ7\ Terfenadine I6=ZQ37DEกW05;กGk=6 Macrolide PGH Ketoconazole PGHV}\\k0W8 Terfenadine KJ8C/8PGEQ8H 2. ./0 b Ipratropium Ipratropium (MDI) 2Va85;T4@7DE3Wก�; K3Z COPD 78กGk=6 anticholinergic agent 2Va85;Y=8//กzTbR{BW98( short acting) >?@AOGUE;A2Z45A ZN/ V;กPMEA 7\BW@8 (ZQ;[email protected] Cardiac asthma is a term used to describe asthma-like symptoms in the presence of severe pulmonary congestion and acute heart failure. The primary characteristics of cardiac asthma are a combination of high pitched inspiratory and/or expiratory wheezing, marked dyspnea, and pronounce inspiratory crackles. Cardiac asthma can also be identified by its response to diuretic therapy and by being refractory to standard treatment of

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bronchial asthma. Stridor is a harsh, high-pitched wheeze that is characterized as inspiratory, expiratory, or biphasic.) (REF: http://www.rcjournal.com/abstracts/1999/?id=A00000680) 3. ./0 c 30กQ8ก;3T:;A;8U/AMWQ7\ 4. ./0 c 8=;\H2Va8 Leukotriene receptor antagonist 6;กกQ=;

2(�/ 338 5. ./0 d Loratadine 2Va8 2 nd generation antihistamine >?@A2Va8กGk=67M6=U/A antihistamine (non-sedative) x;กPกE8H (a) ZN/ Cyclizin c ZN/ Astemizole >?@ATW9AZ_=2Va8 antihistamine T4@T:;7ME2กRJ sedative IJE 78V}\\k0W8./8849 Astemizole C_กC/8PGEQ8H B=Q8UE/ b PกE2Va8 Tripelennamine (6Wก3_E\WกกW878DN@/ Pyribenzamine) 2Va8 first generation antihistamine >?@A64zTbR{ sedative 2D=8กW8 6. ./0 e block fibrinogen receptor 2Va85;กGk=6 antiplatelet T4@7DE78Z8T4@7DE Aspirin I6=IJEM3N/PYE Aspirin >?@A\H block ADP Receptor P00 irreversible 7. ./0 a 7DE783_V5;Y=82Va8 bronchodilator 2Y3;H2Va85;U5;5MG/JG6 78กGk=6 inhale anticholinergic short acting 8H 8. ./0 b Dextromethorphan 2Va85;PกEI/กGk=6 non-narcotic I6=64zTbR{2BY.RJ 9. ./0 a Tetracycline 28N@/A\;ก UE/ c. Erythromycin (Macrolide) I6=B;6;3C3Wก�;2DN9/ E.coli IJE /4ก/5=;A TW9A b,d 2Va85;78 Chloramphenicol group >?@A ADR U/A6W8ZN/ กJIUก3HJ_กPGH anemia 2Y3;H^H8W98\?A2GN/กUE/ a Tetracycline 10. ./0 a Nystatin suspension \H7DE2^Y;Hj;58/กKJ5T;T4@ORQM8WAPGH 2Va8 oral suspension 78 Candidiasis 78D=/AV;กIJE key B:;ZW~ ZN/ Pseudohyphae 0=AD492G5Q=; 2Va82DN9/ Candida 8H B=Q8 Griseofulvin I6=B;6;3C3Wก�; 2DN9/ candida IJE 11. ./0 e organ tissue transplant O_EVtQ5T4@VG_กC=;5/QW5QH .E/A7DE5;กJj_6RZkE6กW82YN@/V�/AกW83=;Aก;5 reject graft 12. ./0 d. 3Wก�; reversible airflow obstruction KJ57DE5;U5;5MG/JG6PGH5; corticosteroid T4@C_กZQ3\H2Va8 3Wก�; reversible airflow obstruction KJ57DE5;U5;5MG/JG6 2Y45A/5=;A2J45Q B=Q8 steroid \H2Va85;ZQ0Zk6/;ก;3 **I6=3_EQ=; PSF ZN//HI3 M;I6=2\/\3RA[ 13. ./0 e. steroid 2Va8 drug of choice .WQ2GN/กI6=2ZG453L .E/A0/กQ=; inhale corticosteroid 2Va85;กGk=6ZQ0Zk6/;ก;3T4@O_EVtQ5K3ZMNJTkกZ8ZQ3IJE3W0TkกQW878U8;J.@:;[

8*� Case 4 (2(�/ 339) 14. ./0 a. Guaifenesin 2Va85;UW02B6MH (Expectorant) B;6;3C7DEIJEVG/JjW5782JFก2GFก (2B3R6 >>I6=ZQ3\=;55;กJm_85Lก;3I/782JFก/;5k.@:;กQ=; 5 V�)

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15. ./0 e. Loratadine 2Va85; antihistamine 2nd gen (non-sedative) T4@//กzTbR{8;8 24 DW@QK6APGHT:;7MEA=QA8/88E/56;ก 16. B_.3.:;3W0 Brown mixture 100 mL V3Hก/0JEQ5 Glycyrrhiza 12 ml Camphorate opium 12 ml Antimony Potassium Tartrate 24 mg Alcohol (95 %) 3 mL Glycerin 12 mL Purified water add to 100 ml (REF:http://www.fda.moph.go.th/edl/joke/ed_c06.htm) 17. ./0 c 2Y3;H 1 DE/8K.�H (15 ml) 64 camphorate opium 12/100x15 =1.8 ml 18. ./0 c. moderate persistent \;ก GINA guideline update 2008

19. ./0 b. 10-20 mcg/mL (REF : Survival guide for pharmacy student book 1 p.328) 20../0 a. Ciprofloxacin, b. Erythromycin, c. Cimetidine B;6.WQ849\H2YR@6 serum theophylline level (REF:Drug information p.1772)

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21. ./0 b. Beta 2 agonist \H7ME2Va8 inhaled rapid-acting beta 2-agonists 2-4 B_J Tkก 20 8;T478DW@QK6AP3ก M;ก/;ก;3J4U?982Va8 mild exacerbation 7ME 2-4 B_J Tkก 3-4 DW@QK6A M;ก5WA64/;ก;3 moderate exacerbation 7ME 6-10 B_JTkก 1-2 DW@QK6A PGH\H7ME oxygen 78U8;JT4@2M6;HB6 (REF : 2/กB;3Z:;B/8QRD; 611 314 2jBWD0:;0WJ 1 Lower Respiratory disorder p.13-14) 22. ./0 c. Acetylcysteine 200 mg GHG;589:; 1 PกEQ JN@6 tid 28N@/A\;กO_EVtQ564/;ก;3I/ 642B6MH2M845QUE8B4U;Q >?@A2กRJ\;กก;3.RJ2DN9/IQ3WB ZQ37MEJN@689:;/k=86;ก[PGHME;6JN@689:;25F8 PGH/;\7ME5;78กGk=6 Expectorant M3N/ Mucolytics (acetylcysteine) 3=Q6JEQ5 B=Q85;VrRD4Q8HI6=\:;2Va8.E/A7ME5ก2QE8783;5T4@BABW5Q=;.RJ2DN9/P0ZT42345 (REF : Survival guide for pharmacy student book 1 p.292)

Case 5 (2(�/ 340-341) 1. ./0 Z. Fexofenadine 2Y3;H2Va8 2nd generation antihistamines 2. ./0 ก. IJE 2Y3;H I6=64ก;32กRJVrRกR3R5;3HMQ=;A5;.=/กW8T4@3k8P3A P6EQ=;3HJW05;\H2YR@6U?98กF.;6 PGH2Va8 DI P00 minor (REF:www.drugs.com) 3. ./0 Z. Hyperthyroidism, ZQ3PกE2Va8 Hypertension, Arrhythmia Pseudoephedrine \WJ2Va8Alpha/Beta Agonist P.=กFZQ33HQWA7820;MQ;8JEQ5 4. ./0 A. //กzTbR{5W05W9Aก;3B3E;A COX \?A64zTbR{.E;8ก;3/Wก2B0 Rhinocort 64.WQ5;B:;ZW~ZN/ Budesonide >?@A2Va85;B2.453/5JL IVJ_U;T4@6W85W05W9AJ4[ 8H78BIGJL asthma T4@2YN@/8.RQ 5. ./0 Z. 5;64OG78ก;3V�/AกW8ก;32กRJj;QHM/0MNJ IJEI6=P.ก.=;AกW8กW05;6;.3�;8 95%CI = 0.2-2 6W8Z3=/6 1 \?AI6=sig 6. ./0 ก. Alkaloid 7. ./0 \. 6HPQEA2Z3N/ V}\\k0W86HPQEAIJE3W0ก;3YWi8;\;ก/AZLก;32jBWDก336 OGR.PGH\:;M8=;52Va85;/66HPQEA 6HPQEAI>3WV B33YZklD=Q5PกEI/PGHDk=6Z/ 8. ./0 ก. YWi8;B_.3KZ3AB3E;A7MEB;6;3CO=;8 BBB IJEJ4U?98 ORJ2Y3;HO=;8 BBB กF5R@AT:;7MEA=QA 9. Z. Terfenadine 10. Z. 64OG.=/3H00MWQ7\PGHMG/J2GN/J T:;7MEMWQ7\2.E8ORJ\WAMQH (Torsade de pointes)

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��������� MCQ ������ Asthma&COPD

��� �� � ��ก� "#$% � # ��� &'() (*ก +�,������ -%�.(

'"�% 342-343 (��� 1-12) 1.��� �.ก� �� �����ก �������ก��������������ก� � � caffeine �� ���� ������������ 1,3,7-trimethylxanthine !����"���#$��%&���'��'�'�(�)(� theophylline �*���+�: http://siamclassview.edu.chula.ac.th/cud46_warit/blog/view.php?Bid=1234516593604657&msite=c

ud46_warit)

2. ��� ก. ��,�� �� �����ก���$�#-ก*���� )�'�'�(�)(� ��.�%+/ก���#*����0�(��(�)(� 0�*��ก1�2��� )(�2��3�*���) 3.�. ��4�'ก�������( ������'������2�*�5������2(ก 4.��� �.colloidal dispersion �� �����ก Aerosol ��"�'�����'��� liquid-in-gas dispersion � ����ก��)*�'���'������"� liquid particle ���)�(6ก��ก7 ���(�'��"� colloid ก����'����'8�0� gas 5. ��� �.ก���#*� B2-adrenergic receptor

6. ��� �.Tachycardia 7. ��� �.Oral candidiasis 8. ���ก. 3��3)* �$������'���9��"�'�����#�$+�41 �� �����ก prednisolone 5 mg ��"�'�����#�$+�41�����'3)*�� ����0�����$�'&������9� 9. ����.�� ��5 �3��3)* ��ก���)����'������*�'�ก+�3� �� �����ก0����ก�-� ����+��'���$���� P>0.05 ��9�7 ���0�������"���+�(*� '� A (� B 0�*:((�$%&0�ก����ก1�����ก����ก�� ��ก��4!ก1��� �����+��'�+9���9�3��$������ก������9 !����ก���������#����กก��0�* sample size ���)�*�'�ก+�3�(�*���+�: ��ก������ก���������+�� new drug �� ���ก���(:(ก���)�������5+�+���$����'0�����+��'�����+�:(ก����ก1� ��*� 2 ���2)' �.�#<�=�-& (+���>�����& ) 10. ��� �. �ก5��������+ก��0�*'���ก1����� )���:8*�@�'��' 11.����. �(��$�� Budesonide (*���������0�*:8*�@�'�*����ก �$�������ก+)�� 9���������ก3)* �� �����ก�(��$��'����6� ����*����ก�$ ��()��ก����ก���*� ���'()ก���ก+)�� 9���0�������ก (�ก���ก+)���'��� 2)'�A$����กก��0�*'�����'��')&(�*���+�: �8�� ���ก1�����ก-B&�����8*���������5����+����$C $4. 2550 12.��� ก. ����(�ก�(��'��D���'����'����ก��0�*�ก+)��ก������ ) ���� E#@� ��ก�4�'6� ����������+) �� �����ก ��������*� � :8*�@�'����(�ก�(��'� beta-block )*�' (�*���+�: ��ก������ก���������=��������) 1 �� ��� Lower respiratory disorder ���2)' �.�#-� �(+4�+��#)�)

Case 2 ('"�% 343-344)

1. ��� a) Beta-agonist ��+)$����ก.�%+/��9�0�*��"����9����� �� �����ก0��#ก��9����ก����ก1�:8*�@�'���3)*���'���������ก�� �$ ����������ก������A�'�$(���� ������ก�� 2. ��� d) 0�* 2 ����ก+�ก�� beclomethasone ����� ��� �� �����ก��������*� a) (� b) Beta-agonist ��+)$����ก.�%+/��9���3��0�*����� ��� �$���3����.�%+/()ก����ก�������ก+)�!9�0��(�)(� (�ก��0�*��"����9�����ก63�������5����#���ก��(�()ก��ก����+����2��3)* �����*� c) Beta-agonist ��+)$����ก.�%+/'����3��0�*��"�'��)��'� ���0�*����ก�� corticosteroid �����*�

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e) steroid (� beclomethasone ก6� � steroid ��� ��ก���!�3��0�* ����0��*� d) 2 ����� �ก+� !���������"� Beta-agonist �$ ����������ก����� (�0�*����ก�� beclomethasone �$ ��()��ก����ก�������ก+)�!9�0��(�)(� 3. ��� a) ก���#*�ก����*�� adenylate cyclase �$+��ก����*�� cyclic AMP

4. ��� c) Salmeterol

5. ��� Free �� �����ก���3)*�(�'�*� side effect ��� beta agonist � � ����9�� ����� 0����� ��)4��1� 6. ��� Free �� �����ก 2��'&3����(�'�& 3���8*���5����3� 7. ��� Free �� �����ก Microalbumin ����ก��'�ก�� asthma )*�'���? 8. ��� c) N-acetylcysteine 9. ��� Free �� �����ก3���8*�9�����ก���:8*�@�' �('���3��3)* �� dose '�� � 1 mg/kg QID 5*�:8*�@�'���ก�����- 60 kg ก6���*��3)*���'� 60 mg QID ก6� � 60 mg/dose !��'�(�(�'������������9���������*��*� 0.5% w/v ����� � 0.5 g/100 ml

�� � 5 mg/ml :8*�@�'�!��*��3)*���'����9�(� 60/5 = 12 ml � � �����- 1 �*��2�F�

Case 3('"�% 343-345) 1. ��� �.10-20 mcg/ml 2. ��� �. �( ��3�*�����'� ��)4��1� 0����� ��ก 3. ��� �. 1 ciprofloxacin,2 Erythromycin ,3 cimedtidine 4. ��� �. Prolong high cAMP level 0� mast cell 2)'ก��'��'�9� phosphodiesterase !����(��'�cAMP ��"�

AMP 5. ��� �������ก�����0�*0�ก������'� theophylline syrup (non-alcoholic, sugar free)

Slo-Phyllin 80 mg Syrup (theophylline, anhydrous) is a nonalcoholic, sugar-free solution containing per 15 ml theophylline, anhydrous, USP 80 mg with sodium benzoate, NF, 18 mg and methylparaben, NF 3 mg added as preservatives. Syrup inactive ingredients are citric acid, flavors, glycerine, methylparaben, propylene glycol, saccharin sodium sodium benzoate, sorbitol, purified water. (http://www.rxlist.com/cgi/generic/theosr.htm)

6. ��� �.��ก��6)'���"���)�������������� (*�ก( �$�*���9�� �� �����กtheophylline �� matrix + disintegration ก�������!����6)'��!�3�����0�* matrix �8����'�#-�����+ ��ก���)'���"�:� �� ����9'������0�* matrix �8����'�#-�����+3� ก�� release '���3����"� SR ��ก���3�

7. ��� - ��ก���*�����'� terbutaline � � 5��'�D�����3���ก�+ ��ก�*� (�����'�� �� ��� ����ก �����'�0��8 �ก+)��ก�����0���*�3�����������, palpitations, ��)��*��ก ��)���0� ��'0�(����ก��ก�!9� �����'���u) 0�*$�$�'&����� - ��ก���*�����'� beclomethasone � � ��ก���*�����'� beclomethasone

Case 4 ('"�% 345-348)

1. ��� �. 58ก�#ก�*� �D���'���ก���#*�0�*�ก+)ก������ ) 3)*ก� �����'6� �����#���� ก����กก��(��ก�' ก���$��%#&

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2. ��� ก. ��'0������'����), ��'0���), 3� �� �����ก��"�(�ก1-��A$������)����)0�:8*�@�'���� ) 3. ��� �. ����ก����ก����� 9��������(�)(� ���0�*5#�(�3�����+��ก���#*���กก����ก�+ !����"��� reversible 4. ��� �. Allergen ���ก�� IgE �� mast cell���0�*�ก+)ก���(��� mediator ���3��8� early phaser allergic reaction

5. ��� �. ��)�� 3 Moderate Persistent��9�32��� )��)���#������ก(��Moderate

6. ��� ก. �(��$��'�����*����ก�#ก���9� �$��� Beclotide inhaler � �'� Beclomethasone ��"�'����0�*����#�2��� )�*��0�*����� ���ก�� �!��������5����#���ก��3)* ก(3กก����ก.�%+/� � ��)����(�ก)ก����������� inflamatory cell (�()ก�����(�ก����*���9���� �ก0��(�)(�:(�*�����'����'�� � ���'��� �� 9���0���ก �� �����ก��"�'�ก(#�� steroid ����*����กก(�9����#ก���9��(��ก���8)$�� (�ก��0�* spacer �����'():(�*�����'� 7. ��� ก. �� 9���0�������ก ���'��� )8���#:(�*� 6 8. ��� �. Nedocromyl, Glucocorticoid, Leukotriene antagonist �$���'�0�ก(#�� controller � � Inhaled

glucocorticoid(ICS), Long acting Beta2 agonist(LABA), Leukotriene modifiers, Sustained-release theophylline, Cromine(Nedocromyl)

9. ��� �. 3�����''� �������0�*:8*�@�'ก(��3�$�$�'& �� �����ก Prednisolone ��"�'�����#�$+�41 �=���ก������'3)*�� ����0�����$�'&������9� 10. >ก���?�. �%ก&"ก�@ ?%�ก �-A" &"ก�@ "%� ก

��� ก. ��������������*���� 11. ��� �. ��"�'�����#�$+�41 �=���ก����''�3)*�� ����0�����$�'&������9� 12. ��� �. MDI ����#'������"� solution 0�*�+%�ก)(*���'0���*��*�7 turbuhaler ����#���'������"� powder 0�*�+%��8)��7 13. ��� �. ���'0�*'�3���ก�*�������ก(�(���� �$����*�)����ก��0�* spacer � �

- :8*�@�'�����5�8)'���ก spacer 3)*2)'���2)'3���*����4�'������)�(*���������ก��ก)��� ��� MDI ก��ก���8)��'0���*�

- ()ก���ก�*����� aerosol particle ���)0���0� oropharynx ���0�*():(�*�����'�0�(����(� - Aerosol particle !��58ก$����ก��0� spacer ������'�������)�(6ก(�ก���������8)��'0���*�3����

0�* particle ��(����9ก����'3��ก�*������(�)(������(�'3)*��ก�!9� - ���'()��ก��3�����ก+)��ก aerosol particles ก����ก����+��-�$)�����������ก

14. ��� �. 58ก�#ก�*� 15. ��� �. 100-400 mcg/day �)6ก��'# 6-12 �} - ���)0�*��+���*� : 200-400 mcg ������ 2)'���0�*���(� 2 ���9� ���9�(� 100-200 mcg

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- ���)'���ก1������ ��� : 100-200 mcg ������ ���(� 2 ���9�

16. ,BC ก%�&D��%�)" MDI()80� OSPE ��) 17. F()( ���GHก

:8*�@�' COPD ��$'�%+�=�$���3��ก(��� � ������ secretion (� mucus ��ก�#)ก�9� :����(�)(�����6� ���0�*58ก' )�'�'3)*���' :���5#�(�58ก���(�' �� radial traction �����'���) airway ���)�(6ก ก6()�*�'(�5���'��58ก:��� 5*�:����(�)(���� ���0�* airway ���)�(6ก��2�ก����������' 5*�58กก)��ก)*����ก !��ก6� ���ก intrapleural pressure �����"���ก ก��0�* bronchodilator ���0�*:8*�@�'�8*�!ก���'�!9� ����)+���'0����)�'�'��ก�!9� 5*���� forced expiration $'�%+�=�$���'�����'8� ���0�*�������:+)�ก�+��� intrapleural pressure �����"���ก���� )����9��ก+)ก��������'8�)� 5!��*��3)* bronchodilator �$���3��3)*���0�*$'�%+�=�$����ก+)��ก�(�)(�(�5#�(� ��'3� 'ก��*� ก(*���� 9����'��(�)(��(�'��� )����9��!��ก+) ก��������������)+���'0��'8�)� :(��"� irreversible obstructive pattern 0�:8*�@�' COPD ����ก��:8*�@�' asthma ����� airway smooth muscle contraction �ก��'��*�� ��5#�(�'���ก�+)��'8� :��� airway �������� ����3)* ก(3ก�(�ก��� airway obstruction 0� asthma � � bronchospasm ���� )����9� �� ��3)* bronchodilator �!�3���(��'� phenotype 3)* �ก+) reversible obstructive pattern 0�:8*�@�' asthma

Case 5 ('"�% 348-349) 1.��� �.���0���*��*�(bradycardia) �� �����ก acute asthma attack ������ก�� acute asthma attack :8*�@�'������ก��3����ก(��� � ��'0������'���)7 �� ������� ��' ��6���*��ก 2.��� �.salbutamol �� �����ก '����������������ก�� acute asthma attack ���ก��)*�' ก(#�� -short acting beta2agonist : salbutamol, terbutaline -anticholinergics : Ipratopium -systemic corticosteroid : prednosolone -methylxanthines ��+)��ก.�%+/��9� : aminophylline 3. ��� �.���� ) Theophylline ���0�*�ก+)��ก�� �( ��3�* �����'���)�*�� ��"�����+�����*�� �� ������� ���3���(�� 0�������'0���6� ��3�*���� ��� ����ก ก����'�9�� 4. ��� �. HPLC �� �����ก�����5��)3)*��9���+���+��- (��#-=�$ 5. ��� ก. '�:+)������� '����:(+��!9�3��58ก�*������������5!����)�����+��-�� ���������������ก.�%+/��)�� ��ก+�ก����*�'(�'���+���ก�ก-B&�����#)�� ��8��#) 6. ��� � . :8*�@�'�ก+)(+9���"�E����� ���'��� �(����ก0�*'���"���(� 3 �) �� �� �����ก ��ก��)��ก(��������5����ก��3)* 2)'0�*��������:8*�@�' 0�*�*����ก(������������)������ก�(��$��'� steroid

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7. ��� ก.�$+����������� �0�ก��0�*'�:8*�@�' �� �����ก ����( �ก�*�� ����"�ก���$+����������� �0�ก��0�*'����:8*�@�' 8. ��� �. Budesonide inhaler, beclomethasone inhaler �� �����ก��"�'�0�ก(#������#�$+�41 �����5 9�����*����''�3)*�� ����0�����$�'&������9� 9. ��� 10. ��� ก. ��#=��:�'�����(6กก��� 0.5 mcg ��58ก�����ก���ก����'0� ���0�*3���ก+).�%+/0�ก����ก1� �� �����ก :�'������#=���(6กก��� 2 mcg �����5�ก(�3)*5!� alveolar ,alveoli �����558ก)8) !�3)*

Case 6 ('"�% 349-350)

1. ��� b. ��) 9�)*�'�+%�$+�413�����ก�)����+� �� �����ก���ก�4ก������ 2. ��� a. randomize double blind controlled trial. 3. ��� e. ����(�'2�� 4. ��� a. ����� �� �����ก 0� 0�*���������ก��3� ก*��6��� 5. ��� 2��'&:+)�!��(�� �$���choice 3����'���6)�(' 5*��������� a. ก������'�'� solution ���3)*2)'ก��0�*������(�(�'���������"� organic solvent �� �����ก organic solvent ��"���������"�$+1 6. ��� �)� 3���*� d ก6 e 7. ��� c. amoxicillin 8. ��� a. '��'�9�ก����*��cell wall��� bacteria 9. ��� d. :8*�@�'���$* penicillin �����50�* Cefazolin 3)* �� �����ก'��'8�0�ก(#�� beta lactam ring ������0�*�ก+)ก��$*�*��ก(#��3)*

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� 43 �

���� MCQ ��� CVS

��� ����� ��� �

1. �. Pseudoephredine

��������ก angina pectoris ������ !"#�ก$%�&���'�() *�+�,�$��,-.���ก/,��กก�0"#�($�,�$��,�ก/, vasospasm 3$! Pseudoephredine "4�*(%�ก/,vasoconstriction ,)��)'�5�6) �#'�.�"4�*(%�ก/, ��ก�0+�� angina pectoris 7,%

2. �. 90�(�, �:0�!7&;&#+%�(%�&*<%ก)=>?%�@ 590�(�, 36;&#+%�(%�&*<%*�90��ก�"A 76 �5 �=�( �� 3$!>?%"#�3:%5� sulfonamide (http://www.umm.edu/altmed/drugs/hydrochlorothiazide-062500.htm)

3. �. ก/���P& �:0�!�Q��)5�R#�5�6;�ก�0�ก/,90�($�,�$��,() *��)'�&#($�5�5;��0 &S.� 90��=�( �� R?==T(0#� ��5T"#�&�ก+.'� HDL 6�4� (http://www.americanheart.org/presenter.jhtml?identifier=4726)

4. +. β-block �:0�!ก�0*<% β-block �)'� 5��!7�block "#� β1-β2 receptor &#>$"4�*(%($�,$&(,6) ����ก/, exacerbate asthma 7,%(http://www.thaihp.org/adr/index2.php?option=showfile&tbl=home&id=113)

5. �. Prozozin 90� ?= (Syncope) ��� ��ก�0����$&(&,R6/������ !"#�:=7,%=;�5 R��(6T+��ก�0����$&(&,R6/ &#6)'�36;����$&b00&,� ��S.�����$&��������ก� �&>/,�ก6/+)'�0T�30�+��() *� >?%�@ 5"#�&#�0!R=ก�0cAก)=6����0 &S.���*ก$%</,>?%�@ 5 �!�ก/,� �& /6กก)� $R?d�R#5� �&&)��*� ��������ก7&;3�;*� ;�6����(0����*ก$%</,�!����$& (&,R6/�#ก�&���70 S%��ก/,+c!+)=0S +%�&S�� (0��+c!�$;�ก#e� �!"4��5;��70 Prazozin ����!"4�*(%�ก/, syncope 7,% /b#ก�0��� *(%�0/�&��กdose 6�4�fก;��3$% �.��;�5f�:/�& dose +.'� (http://www.medsafe.govt.nz/Profs/datasheet/a/Apo-Prazotab.htm)

6. ก. α block 5��!+5�5ก$%�&���'�+��($�,�$��,3$!+��6;�&$?ก(&�ก"4�*(%� �&,)�9$(/6$,$�3$!"4�*(%�QRR� !�$;��+.'� 3$!>$��กก�0+5�5($�,�$��กกP"4�*(% BP $,$�,% 5 5ก6) �5;��5� ��� doxazosin, prazosin, terazosin

7. �. ก/�5� anticoagulant

��ก Meta-analysis := ;� UFH R�&�0S$,�)60�ก�0�ก/, acute myocardial infarction 3$!ก�06�5*�>?%�@ 5 UA/NSTEMI �&���*(%0; &ก)= Aspirin �0!&�c0%�5$! 33

8. +. 30 �&P, &�60� 13 R�&�0S�4�5�6/6) �+%�&�*�0�<��c��)ก09,57&;6%��+���Td�67,%7&;�ก/� 30 )� 9. ก. Tyramine MAOI �!7�5)=5)'�ก�0 metabolism +�� Tyramine "4�*(%0;��ก�5&# catecholamine &�ก �.�"4�*(%�ก/,

acute hypertension 10. ก. 6)=96 6)=3+P�

6)=�)ก�R= ��ก�0�($;��#'����>$+%����#5���กก�0*<%5�

11. +. 0=ก �ก�0"4����+��0!=="���,/���(�0

�:0�! ;�R; �*(d;&)��!7�"4�*(%ก�0,?,-.&7+&)�0. ;�ก�05;�57+&)�$,$�,)��)'�กP����!"4�*(%�ก/,"%����,0. ;�"%���R#57,%

12. �. Nifedipine �:0�!����5�ก$T;& calcium channel blocker -.��S�� ;����� first choice R4�(0)= ก�00)กt� variant angina -.��5�"#�&)ก�!*<%6) ����fกP7,%3ก; Organic nitrates, Beta-blockers (www.med.cmu.ac.th/dept/.../07FM%20Antianginal%20drugs.pdfc)

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� 44 �

13. �. ก/�5� aspirin - 1. +.

Nitroglycerine ��������ก>?%�@ 5&#�� ! HTN 0; &ก)= Proteinuria 2+ �),���� severe preeclampsia 3$!��5T�00�A 7 �,��� (0!( ;�� 22-32 R)�,�(A) 6�& Pre-eclampsia Seminar, Sibai.S, et.al., 2005 �!*(% treat >?%�@ 5,% 5 antihypertensives �:���$,� �&�R#�5�*�ก�0�ก/, cerebral hemorrhage 3$% 6�&,?��ก�0�5;��*ก$%</, �&�����5T�00�A�0= 34 wks �.��!"4�ก�0>;�6),����,Pก��ก&� 36;S%�(�ก��ก�0 severe &�ก WHO 2006(managing eclampsia) *(%>;�6),����,Pก��ก��5*� 24 <&.($)�:= ;����� severe preeclampsia 3$!��5*� 12 <&. ($)���ก"#�&�0,��0/�&<)ก "#��$��ก5� Nitroglycerine �:0�! 5��#'����6) �,#5 *� choice "#�R�&�0S*<%7,% ��ก�)'��),����5�"#�(%�&*<%*� case �#'")'�R/'� S.�3&%�!$,� �&,)�7,%7&;,#�";�7(0; 36;*�ก�0x.กt�+��,�$Pก7&;:= ;�&#ก�00�5���ก�0�ก/,>$+%����#5�*,f +.'��$5 3$!��ก��ก�#'5)�:= ;�ก�0�4�ก),R�0�'4�3$!�ก$���)'� 7&;&#>$<; 5*(%��ก�0+��>?%�@ 5,#+.'�

2. �. Methyldopa ���� first line antihypertensives *�ก�00)กt� pre-eclampsia ��กก�0x.กt� Sibai B.,1996 := ;�ก�0*<%5��#'*� long term �$�,�)56;�"�0ก*��00�A

3. ก. ACEI &#0�5����0���� malformations 3$! adverse events *� ACE inhibitors 3$! ARBs ,)��#' - Oligohydramnious - IUGR - joint contractures - pulmonary hypoplasia - hypocalvaria (incomplete ossification of the fetal skull) - fetal renal tubular dysplasia and neonatal renal failure.

(Pre-eclampsia Seminar, Sibai.S, et.al., 2005.) 4. ก. 7&;�4�����6%��

*(%5� *(%� =�T&��(�0

��������ก cholesterol +��>?%�@ 5 5)�S�� ;�7&;R?�&�ก �5?;*�0!,)= normal 7,% (normal cholesterol level < 200 mg/dl) � 03�!�4�*(%� =�T&��(�0,#ก ;� ก�0 prevent >?%�@ 5,% 55� �:0�! 5�6) ����f *� choice �)'�7&;�;�5�$�,�)5*���"%��

5. �. ก;����� ��������ก 1. 5�6) �#'&# half life R)'� (7&;7,%0!=T7 %) 2. simvastatin ����5�*�ก$T;& HMG-CoA reductase inhibitor -.�� enzyme HMG CoA reductase �!&#�0/&�cR?�*�� $�ก$�����

6. ก. Cyclophosphamide

cyclophosphamide (CPA) ���� prodrug -.���&����+%�0;��ก�5 �!S?ก��$#�5����� active metabolite ��� 4-hydroycyclophosphamide (4-OH-CPA) (Clinical Pharmacology of Cyclophosphamide and Ifosfamide by Zhang J.,et.al,2006)

7. ก. 1

carboxyl gr. 8. ก. IR -

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� 45 �

9. +. 0!5;�&�%�5 - 10. �. CaCO3 ��������ก AAS ������0����R4�(0)= /��0�!(Ab�6T9$(!(�)ก*�0!,)=�0/&�c6�4�f 9,5��x)5($)กก�0 ),ก�0

,?,ก$��3R� +���!6�&�/R0!+��b�6T"#�6%��ก�060 � ),"#S?ก"4�*(%0%����ก Flame (http://www.sci.cmru.ac.th/knowledge.php?idknowledge=25)

1. �. 90�76��ก�� !�=�( ��3$!� �&,)�"#� �����5?;

��������ก>?%�@ 5&#5)�7&;&#�0! )6/*�ก�0����90�76�0�ก� �#ก")'���ก guideline AHA/ACC 0!=TS.��Q��)5�R#�5�*�ก�0�ก/, MI 7,%3ก; �=�( �� � �&,)�R?� 7+&)�R?� ก�0R?==T(0#� (Risk Factors for Myocardial Infarction in Women and Men: Insights From the INTERHEART Study ��กhttp://www.medscape.com , AHA/ACC guideline)

2. ก. Aspent gr.V

��������ก����5�"#�&#>$ก�0x.กt� ;�R�&�0S$,�)60��R#�5�6;�ก�0�R#5<# /6 (0��ก$%�&���'�() *�6�5��#5=:$)� (MI) 7,% �Q��T=)��.�3�!�4�*(%*<% aspirin 3ก;>?%�@ 5")�"#�7,%0)= /�/�)5 ;�����90��ก#�5 ก)= Acute coronary syndrome 3$!*(%ก/�7�6$�,<# /6 9,5�0)'�30ก"#�&�,% 5��ก�0 Attack 3$!7,%0)=ก�0 /�/��)5 ;����� �!*(%��#'5 3$% ก$��")�"# �:���( )�>$ก�0,?,-.&3$!��ก�"b/��0P ��ก��ก�)'� Aspent 5)�&#0?�0;��$)กtc!�����&P,ก$&R#<&:?=���5P�60�6�&+%�&?$"#�*(%&� (survival Guideline for pharmacist book 1, AHA/ACC guideline)

3. �. Enteric coat tablet

�Q��T=)�5� Aspent gr.V &#36;0?�3== Enteric coat �:�������ก)��Qd(��0����0!��5�����ก0!�:�!��(�0 (MIMS Thailand 2008)

4. �. simvastatin ��ก AHA/ACC 0!=T7 % ;� ก�0*(%5�$,7+&)�ก$T;& statin *�>?%�@ 5 MI *(%>$*�ก�0$,7+&)�3$!*(%�0!95<�A3ก;>?%�@ 5&�ก ;�5�ก$T;&$,7+&)�����f 3$!�;��+%���$�,�)5 R; �ก$T;& Nicotinic acid �)'� 7&;� 0*<%*�>?%�@ 5�=�( �� ��������ก7�&#>$0=ก �6;�5�0)กt��=�( �� R; �5�ก$T;& Fibra(gemfibrosil) R�&�0S<; 5$,�)60�ก�0����90�() *�+�,�$��,$�7,% 36;:= ;�&#�)60�ก�06�50 &�:/�&+.'� 5�ก$T;&�#'�.��/5&*<%�%�5$� (AHA/ACC guideline 2007, survival Guideline for pharmacist book 1)

5. +. Enalapril ����5�ก$T;& ACEI 3$!&#ก$7กก�0����ก)� Nephropathy 9,5�!7�+5�5($�,�$��, Efferent arteriole "#�76 "4�*(%$,� �&,)�+�� glomerular 7,% ,)��)'��.�<; 5$,� �&�R#�5�*�ก�0,4���/�+��90� kidney dysfunction *�>?%�@ 5�=�( ��7,% �#ก")'�5)�:= ;�����5�"#� AHA/ACC 3�!�4�*(%*<%*�>?%�@ 5"#�����(0��&#� �&�R#�5�6;�ก�0�ก/,90�() *�$%&�($ ��������ก&#ก$7ก"#�7�<; 5$, pre load & after load "4�*(%��0!*�ก�0"4����+��() *��%�5$� 3$!<; 5ก�0$,ก�0�)��+���'4�3$!�ก$�� 0 &S.�ก�0x.กt�"���$/�/ก5)�:= ;� 5�ก$T;& ACEI 5)�<; 5$,�)60�ก�06�5��ก90�() *�3$!($�,�$��,7,% (AHA/ACC guideline 2007, survival Guideline for pharmacist book 1)

1 � 6�& JNC 7 guideline (stage 2 ��� Sys ≥ 160 , Dias ≥ 100) 2 � Enarapril ����5�*�ก$T;& Angiotensin converting enzyme Inhibitor 3 � ��������ก&#($)ก���5��5)� ;�ก�0*<%5� 2 <�/,0; &ก)�ก;�*(%�ก/,�Qd(� kidney failure, heart failure,

stroke 4 + � 0�0)=��$#�5� /S#ก�0,4���/�<# /6 ��������ก>?%�@ 55)�R?==T(0#� )�$! 10 & �3$!,��&RT0������0)'��0�

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� 46 �

5 � �:0�!&#ก�0��0#5=�"#5=&�กก ;� 2 ก$T;& 6 + ��������ก5� HCTZ �&���*<%����� $����>?%�@ 5�!R�&�0S"�5�7,%"4�*(%��ก�0�QRR� !=;�5$,�%�5$� �.�

� 0$,+��,5�$�3$% �;�5f�:/�&+��,5�*���5($)� 7 � ��������ก nifedipine &#�T=)6/ก�0c"4�*(%�ก/, angioedema 7,% < 1% 8 � ก�06)'�64�0)=5��&P,7&;�4�����6%��x.กt� viscosity (� �&(��,)+��5� 9 ก ��������ก /b#ก�06�ก9,560� &#+%�,#"#�RT,��� �0!(5),��0����&��3$!�;�*<%�;�5*�ก�0>$/66�4� 10 Ionize form ��������ก5�&#�TcR&=)6/����ก0,�;��3$!&# pka 2 �;� �&����5?;*�R�� ! pH = 8 �!"4�*(%5��ก/,ก�036ก

6) �5?;*�0?� ionize form 3$!S?ก+)=��ก*�0?��#' 11 + 5�ก$T;& beta-block "#����� B1 selective 7,%3ก; atenolol , bisoprolol , metoprolol , acebutolol ,

betaxolol 12 � ��������ก ���7-&A�#'�!:=�0/&�c&�ก+.'��&���&#�� !ก$%�&���'�() *�6�5 13 ก flunarizine ����5�"#�&#+%��=;�*<%*�ก�0����ก)�90�� ,() 7&�ก0�(")'�"#�&# aura 3$!7&;&# aura) 3$!0)กt�

90� vertigo ��������ก&#� �&R�&�0S*�ก�0+5�5($�,�$��,*�R&��7,%,# 14 + Verapamil ����5�$,� �&,)�9$(/6*�ก$T;& calcium channel block 15 ก &# side effect "%��>?ก 12-42 % ,�(���ก= & 19% , Bradycardia 1.2-4% 16 ก Simvastatin &#� �&R�&�0S*�ก�0$, LDL,TG 3$!�:/�& HDL -.��+.'��5?;ก)= dose "#�*<%*�ก�00)กt� 17 + 5�ก$T;& nitrate �!*<%*�ก�0<; 5$,��ก�0��P=3�;�(�%��ก9,5ก�0+5�5($�,�$��, (=00�"���ก�0) R; �

5�ก$T;& Beta-block $,9�ก�R�ก/, MI 3$!$,�0/&�cก$%�&���'�() *�+�,�$��,7,% 18 � >?%�@ 5"#�&#�� !7+&)�*��$��,R?�7&;� 00)=�0!"��7+&)��/�&6) ��������ก�!"4�*(%�:/�&ก�0�T,6)�+��7+&)�*�

�R%��$��, 19 � ��������ก /6�&/��# R�&�0S�:/�& serum level +�� warfarin 7,% 20 � ��������ก clopidogrel &#�"b/�5)=5)'� ADP receptor "4�*(%5)=5)'�ก�0�ก�!ก$T;&ก)�+���ก$P,�$��, �.�7&;� 0

*<%0; &ก)= Aspirin ��������ก5�")'� 2 &#�"bA*�ก�05)=5)'�ก�0�ก�!ก$T;&ก)�+���ก$P,�$��, 21 + ��กก�0x.กt�:= ;�ก�0*<% ASA R�&�0S$,�)60�ก�0�R#5<# /63$!$,�)60�ก�0�ก/, MI 7,% �<;��,#5 ก)=

5�ก$T;& Beta-block 22 ก OR �%�5ก ;� 1 3R,� ;���"#�ก/� ASA &#9�ก�R�ก/, CAD �%�5ก ;���"#�7&;ก/� 17 % �4�� c9,5��� 1-

0.83 = 0.17 (17%) 23 � ��������ก5�0?�3==�&*6%$/'��&���&#ก�0�$,�$;�5 6) 5��!S?ก,?,-.&�+%�R?;ก0!3R�$��,7,%")�"# �.�"4�*(%��ก

�"b/�0 ,�0P "#�RT,�&����"#5=ก)=5�0?�3==���� 24 � ��������ก0?�3==�#',?,-.&�+%�R?;ก0!3R�$��,7,%�$59,560�9,57&;>;�� first pass metabolism "4�*(%��ก

�"b/�7,%0 ,�0P �.�R�&�0S0)กt��&����ก/,��ก�0ก4��0/=7,%")�"; �"# 25 � ��������ก0?�3==5� sustained release ����0?�3==5�"#���ก3==&��:���"4�*(%ก�0��ก�"b/�+��5�����7�

7,%5� ���+.'���������ก&#ก�0� =�T&ก�0�$,�$;�5*(%5��;�5f release ��ก&�6�&�)60�3$!� $�"#�ก4�(�,+.'� -.���!&#� �&(&�5ก %��ก ;� controlled release (0�� delay release

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47

��������� MCQ ������ DM (PAGE 359 - 366)

��� � !"#$ %�&��'( )��*& %�( �� ��� �$�*

��� 1 ��� �. Type 2 ������������������������ �!"��#�ก���#ก%�"���ก���#����&���� ��'(��)�ก DM type2 -#ก�ก."/��������������� ��������0��/120-#ก)����� ��� 2 ��� �. ����3�/1��� 4(��������ก �0-�'(�&4(!-0&3�/1�1���-'"

��� 3 ��� ). 6���ก��7 6�����1��� -48����&�ก9����0������0��: !"��ก0 retinopathy, nephropathy, 8����&�ก9����0����������&�0��� ��, artherosclerosis, 1 �"� '�"�-��, ก���."�E'F� �������

��� 4 ��� �. metformin ก��/E� Metformin ��-��J " incidence ��� microvascular � �macrovascular complications /�������� type 2 DM &4(����!"�

��� 5 ��� �. �� 4(�� rosiglitazone ���� 70/30 Insulin BID ��'(��)�ก�� gliclazide J�กก3�)#"�0��!�/���� Inactive metabolite )W�!-0�����X21�/���������X21�"���!� �3�1�#��-����! 97��� rosiglitazone )�J�ก�#���ก&#F�&���X������ ���))��� � �!-0����3�/1�/E���ก �0-�4F/��������6���#� ��0��-��J/E�ก#��������6��!�6"�!-0)3�����������#����"��� �!-0���0���&3�/1�ก��&3�������!���0 � ��0��!�กY��-ก��/1���ก �0-�4F/��������!����กY������#� ��'(��)�ก��ก �0-�4F&3�/1��ก."8����F3��#(�9W(�!-0����� "4�0��������!���� )W�!-0����3�/1�/E� rosiglitazone )W��� 4(��!�/E� Insulin �&� 6"���-��J/1� mixtard !"�

��� 6 ��� �. Sulfonylurea compounds �� glipizide )#"���0/�ก �0- sulfonylurea second generation

��� 7 ��� �. /1��� � ��!"�"4/�ก������ ��'(��)�ก�������� extended release tablet �����3��#���&4(���4�-��'(�/1�����-��J��ก]&^._!"�����WF� !-0!"�&3�/1��� � ��!"�"4/�ก������

��� 8 ��� �. Glipizide -4����6��������� ���ก#� Metformin �." ����� glipizide -41-�0 sulfonamide ��0 metformin

!-0-4

Metformin glipizide

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��� 9 ��� ). ������b#� insulin /�ก����ก]&^._ ก !ก����� rosiglitazone �#F��'�)���.(-���-!��0� insulin &4(�#�

ก ��-��'F� � ���'(���'(�!�-#� 9W(�กY�'�������b#� insulin /�ก����ก]&^._�#(���� "#��#F�)W�!-0��-��J/E�!"� ��'(��)�ก

���1���E�."&4(1 �#F� ����8���&4( �#��0�� (Pancreas) � .� �.�9� .� (Insulin) !"�����1�'�� .�!-0!"�� �

��� 10 ��� ). Cardiotoxicity ���4F&3�/1��ก."�.%�0��#�� �&3�/1��ก." congestive heart failure � � peripheral

edema ��0�.(�&4(�0�)��de����#������.�b%-�กก�0��0�)����� congestive heart failure

��� 11 ��� ). ��'(�1 4ก� 4(��ก��J�ก&3� ��/�&���".���1�� ��'(��)�ก�.�9� .�����6���4� 1�ก�#����&��กY)�J�ก&3� ��/�&���".���1��!"�

��� 12 ��� �. Protamine /� NPH &3�/1���ก]&^._��Y�

��� 13 �. ���1��� ��/�ก �0- alpha-glucosidase inhibitors (AGIs) E0�� "ก��"�"9W-���76�!i�"��&3�/1���"#��F3��� /�� '�" " � ��� � � � � �." ����� ���1��-/E���� acarbose �'� 1��-/E�/��������!���'(�- � �6���#���Y�

Reference - 1�#��'��.� ��ก������ก��ก�������)���7���4�7

-��ก������ก��ก���.�/����ก���.E�E4���� )�j� �ก�k7-1��.&�� #�

- Metformin and The United Kingdom Prospective Diabetes Study: A Commentary

http://www.scielo.br/scielo.php?pid=S0004-27302000000200003&script=sci_arttext

��� 14 ��� �. Chloporpamide ��'(��)�ก������ "��"#��F3��� /�� '�" )W�-4� &3�/1��ก." hypoglycemia � ���-4� �0�ก��1 #(� i��76-� ADH &3�/1��ก."8��� hyponatremia

��� 15 ��� �. DM type 11�'� 2 &4(�F3��� ���ก �� ��'(��)�ก�3��������'(����� ���1��-/E������ Glibenclamide �'� ��&4(-48��� ketoacidosis pregnancy �������&4(-4 severe renal � � liver dysfunction � ���&4(��� Glibenclamide

��� 16 ��� �. semilente insulin ���� amorphous precipitate insulin 9W(����4�-)�ก insulin ก#� Zinc ion /� acetate*(6)&�7�0�)��.-�7�.") buffer (���� rapid-acting insulin &4(���ก��"��� porcine insulin � ���.(- zinc chloride 6"�&3�/1����0/������� suspension ��� amorphous insulin) �0����� ก. Regular insulin ���� crystalline insulin ��� �. Ultralente insulin ���� crystalline zinc-insulin suspension !-0��-��J/1�6"�ก��y4" IV !"� (�."�0�6)&�7�0�)� '-�.-�7 IV) ��� �. Isophane insulin ���� NPH insulin J'��0����� immediate acting insulin �1-'�� NPH ��� ). Preproinsulin �#�!-0-4]&^._

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��� 17 ��� ��� �. ���������'(��������^.�8����� DM &#F�1-" (6)&�7�0�)�J�-�0����/"!-0/E0���^.�8����� DM)

��� 18 ��� ��� �.Glucose ��'(��)�ก��ก��1���-'")����� - -4���1��-�)�กy4"�.�9� .�� ��!-0!"��#����&����1��&3�/1�-48����F3��� /�� '�"�(3�)W����/1� Glucose !�&"�&�ก0�� )�ก�#F�)W�y4"�.�9� .��-�ก�.� ��#����&����1��/1������ �

��� 19 ��� ��� �. intermediate acting insulin

��� 20 ��� ��� ).site of action

��� 21 ��� ). ADR(Adverse drug reaction) ��'(��)�ก ADR 1-��JW� ก����������0���&4(�����#������ �!-0!"�)�/)/1��ก."�WF� 9W(��ก."�WF�/�ก��/E�����-�ก�. 6"�!-0��-JW�ก��!"��#����ก.����"1�'�ก��)�/)/E���/�&���." ADR �#���-JW�ก������� (Drug allergy) � ���ก��������4��)�กก��/E��� (Slide effect) ��!"�&#F�&�� skin � � non-skin ��'(��)�ก��ก�� hypoglycemia ����� ������4��)�ก��&4(�ก."�WF�!"� )W�)#"�0����� ADR

��� 22 ��� �. chest pain

��� 23 ��� �. ��ก��!-0�W�������7��� metformin �.� hypoglycemia hypoglycemia &4(-4���1��)�ก metformin �ก."!"�����-�ก ��'(��)�ก-#�!-0!"���ก]&^._ก������ก��1 #(� insulin -#����� insulin sensitizer

��� 24 ��� ก alpha-glucosidase inhibitors

��� 25 ��� ก. ก������ก��1 #(� glucagon

E�� 26 ��� �. Down-regulation of sulfonylureas receptor

Case 1��� 363 -365

��� 27 ��� . Myalgia Myalgia ��� ��ก�����ก��������� �� !�"#$"��ก����%�����&��� '"����ก��('���)*��+�,���&���!��(ก" �-''��.�"�, (Polyuria) ,ก�.&�,��6� (Polydipsia),��6�&�:ก��%�,!�";���'��&�< ��ก=�ก�:��)*��+�,,:�>��ก��&?��"�,(Polyphagia) ,���&A�B�C�:�,���ก�.=ก,�>��ก��$�������,������,�;��,�ก?�ก���?��$���!��"�, %�,��� ��ก?�()�#��"�ก�,=.�:กD�#&�&�,,�กก�"��ก�?

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��� 28 ��� �. (���"���ก��('���)*��+�,������=.('�F���ก����)*��+�,���&��� (�"ก��C?=��G�ก��#&�,� (�.ก��(�" stage ��%�����&���=.����ก:��"� FPG (�. HA1C =����(�.�6�#&�)*��+�,C�(C;,P�C� ����=�:��.�:���6�����C? ���?�

��� 29 ��� �.�������#�����

��� 30 ��� ก. ก�!กก����กS;T?U��,�%�,ก��ก�.�<��#&��:��"��&�: �?��*�?� ��V�ก�!ก��,�ก�<"� sulfonylurea (�. non sulfonylurea (�"ก�!ก��,� Metformin �� ��V�,�#�ก�<"� Biguanide ��� ��ก��'���ก�*%�'=�ก�:� �C? �ก���:�'���"��?��*�?�;> �:�(�.������,� �'"�����, %�,�C? � insulin-stimulated uptake ก��<��#&��ก?�ก���6�ก�*%�'!�#$�

��� 31 ��� .

��� 32 ��� �. Metformin ��� �=�ก,�;6�#&��ก?� lactic acidosis !�� =�;6�#&� serum lactic acid '*(�.anion gap '* ���,

��� 38 ��� . Lactic acidosis

��� 39 ��� . Metformin ��V�,�#�ก�<"� Biguanide

��� 40 ��� . 1�ก '-�#����&���� �-'(�JW���-'F��0�!�กY��.(-�������������&0� 9W(�J'��0��." &�ก����:���.;��,������:�� ������������:��!�!�"����C? �����,���V� 2 �;"�

��� 41 ��� ก.�1-�� ��'(��#ก%���"#��F3��� /�� '�"/1�-(3���-�� �"�� �* ����4F!-0��0/)

Case 1��� 365 - 366

��� 42. ���

1. ก��/E��� ���-�0�--'�/�ก��/E���

2. �]�.ก��-ก���#����&����1��

3. ��� ��-��!��&4(/E��0�-

��� 43. ��� HbA1c < 7% ��- ADA guideline1

��� 44. ��� ���������-��J���)!"� 2 ��� �'�

� Fasting blood sugar �������)������"�F3�� ���1��-������� � 8 E#(�6-� ก0��ก���)��� '�"���)��"#��F3��� 9W(���e�1-��������0/�E0�� 80-120 (mg%)

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� Post pandrial blood sugar ���������-��J���)�F3��� !"�6"�!-0�����"�F3�� ���1�� 9W(���-��J�)��� '�"���)��"#��F3��� !"�1 #��#����&����1��-�� �� 2 E#(�6-� 9W(���e�1-��������0/�E0�� 80-140 mg%2,3

��� 45. ���

- �.^4/E� metformin : �#����&�� metformin 500 mg ��#F� � 1 �-Y" �#� � 2 ��#F� 1 #���1���E��-��Y� 1�ก�ก." � ������4���0�����&���".���1���'�&3�/1��ก."��ก����'(���1�� � '(�!�� ���)4�� ���d����/���ก ����Wก!-0����&��� &�����4� &����'" ����3�/1��#����&������-��1��4,5

- � lab &4(�����."��- fasting blood glucose and glycosylated hemoglobin levels ���0/���"#��ก�., vitamin B12 and folate J���ก." anemia, hematologic parameter �E0� hemoglobin/hematocrit and red blood cell indices, � � renal function �E0� serum creatinine4,5

��� 46. ��� �����.(- insulin 6"���.(-&4( 0.5 unit/kg/day ��0�/1����� 2/3 �E�� � � 1/3 ��Y� )�!"�"#��4F

Dose : 0.5 x 65 kg = 32.5 unit/day

� �E�� : 21.5 unit ac � ��Y� : 11 unit ac

��0/1��0��ก�0������ 4(������ �E�� : 20 unit ac � � ��Y� : 10 unit ac 9W(����0/�E0��&4(����ก��

������ : Average daily insulin requirements /�������� DM type 2 ����"#��4F

Initial dose 0.2-0.6 U/kg/day (Actual Body Weight)

Split- dose therapy 0.5-1.2 U/kg/day (Actual Body Weight)

with insulin resistance 0.7-2.5 U/kg/day (Actual Body Weight)4

�#���0��ก��/1� insulin therapy regimen method : ��0�/1����� 2/3 ��� total dose insulin /�����E�� � � 1/3 ��� total dose insulin /������Y�4

��� 47. ��� 6�-�����-��!��&4(-4]&^._ "�F3��� /�� '�" "#��#F�!-0���/E��0�-ก#�ก#�ก��/E��� "��"#� �F3��� /�� '�" �������)�ก." hypoglycemia !"�9W(������#������ก0E4�.� ��ก)�ก�4Fก0��&4()�/E� �-��!��1�'���/"�����Wก%���&�71�'��8�#Eก�ก0��&�ก��#F�6

��� 48. ��� �.Metformin � � glipizide )����.-]&^._ก#�/�ก�������-��"#��F3��� 6"� metformin !�ก������ก����ก�� glycolysis ���ก ��-��'F�� ���#����0��:

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������ : ��-ก !กก����ก]&^._��� metformin &4(E0�� "ก�������ก �6��)�ก�#� ��.(-ก���������0��.��� .�&4(�#�� ���'F���'(��0��� �� 6"���.(- insulin-stimulated uptake �3�ก �6��!�/E� ��0��ก �0-�4F!-0-4]&^._/�ก��ก������ก��1 #(� insulin �0�� glipizide ������/�ก �0- sulfonylureas ��ก]&^._ก������ก��1 #(� insulin )�ก�#��0��4,6

��� 49. ��� �. Rosiglitazone4,6

������ : ����� Metformin � � Rosiglitazone )#"���� Insulin sensitizer &#F���0 E0��/1��0��ก����������0� Insulin /��0��ก��!"�"4�WF� : ก ��-��'F���-��J /E��F3��� !"�-�ก�WF� � ��#�)� "ก�� � .��F3��� �

��� 50. ��� �. Insulin ��-��1�0�� Regular insulin ก#� NPH insulin /��#����0�� 3:74

������ : Premixed insulin ����ก����-��1�0�� short acting insulin ก#� intermediate acting insulin 9W(� Regular insulin )#"���� short acting insulin �0�� NPH insulin )#"���� intermediate acting insulin

��� 51. ��� ). J�ก&�ก���4 ������ : �������ก��������4��&4(��/�ก��/E� insulin -4"#��4F

- Endocrine & metabolic : Hypoglycemic

- Ocular : Blurred vision

- Dermatologic : Urticaria

- Local : Lipoatrophy

- �'(�:

Reference

1. ADA guideline

2. diabetes2 [Internet]. [cited 2009 Jun 17] Available from:

http://www.student.chula.ac.th/~50370442/diabetes2.htm

3. Pharmacotherapy handbook

4. Drug information handbook

5. Fortamet (Metformin Hcl) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at

RxList [Internet]. [cited 2009 Jun 18] Available from: http://www.rxlist.com/fortamet-drug.htm

6. >?@ABC DEAFBGEHIJKLB MNO>JO. DEกQCHกCHRSTUVWHOกEVTSXCXAYDZQ[XกHHG (Pharmacy guide). >JO

DZQ[X\CQRH] I_CN`กHJ]GaCTSLBCN[B:กHI`DLYb,2549.

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ก�����ก��� 1

������������ ���� levothyroxine ferrous ���� ���� 4 "#$%& '�(#� )�ก+,ก�,-,./&0� ���� levothyroxine 1�$��� carbamazepine '�8��� 9#&9:;<1&�=>'�8� enz. Inducer )/ &9B++,�,��� levothyroxine )/ =�� �&,�$ �+�:��1 'ก=��ก�0� %: ��))��'�8�=�� 'C>#&�>&�<�� levothyroxine :��������'C>#&'=>&�(#�D

- :$��� ������'$+�',9�$ก����=�+�$� %,���)��������� ��ก�������'"�� ���� ���� 30 �� 9 - B-��H$�=�� �ก�กI�J�=+�,"9$>= ���&��;,���(�'�+9#����'� %,�J&�J,��/กI��C �K - ��)&9B+0�� ':9� )�ก�� '"�� '� (#���ก �$,L9I� �(� �� '19� - ��ก� hypothyroidism )����J��+ J,����'�8�'$+� 2 N 3 ',(�� - ��กB-��H$�&9��ก�' )O������ก �)1#� �(�"9C)'=��'O$0/P� :$�)� ����C �K �� � 9 ก�����ก��� 2

B-��H$��Q> &9 �� "9P$��B-��H$�'�8� hyperthyroidism ./# &9 TSH =#�� �+� Thyroxine 1- ./# �1, ��ก�0� %:, ก+��$, =��J��9P'"�� Goiter, Loose bowels, Insomnia, Irritability ก�����ก��� 3 3.1 =�� ก.

1. ����� ก. :(� ��ก��� 9#&9:$�&)��'�8� 1����1Z��C����+ ;ก�,� 2. ����� � :(� ��ก��� 9#��))��'�8� =�� �"���1Z��C����+�� �,� �(�)��ก, 0���� �"�1���� ��ก�

�(�%:�� "�>, 9#�"������Q"9ก. J&�J,� �(�J&�J,�B+ �(�'�8��� 9#�"�� ��� ���Q"9 ก. "#$ :�$��ก<9 9#),�������Q"9 ก. �P�J&�J,�

3. ����� � . :(� ��ก��� 9#=�� �"�%,�B-� '"9#�$"�Q 9#J,��&���&��)�กB-�����$�ก�0� 1Z��C����+�P�D '�(#� )�ก '�8��� 9#&9��=�� Z���"� J&�Z-ก=�� ��)'ก>,C>I�(�'�8���=�� =��B-��H$��(�'�8� 1�'�=;���'ก>,'"(P�,(P� ��J,� ���

4. ����� �. :(� ��ก��� 9#��)&9:$�&)��'�8�=�� �"�1����"�$�"9$>=B-��H$��� �� �=���) �����'ก>,��=��=�� B-��H$� �(�ก���[Q��'"(P�,(P��� 9#���� �+�/�(�&9�:��C &�ก ก�1# �"���./# =�� ���1&'�=;B+ 'ก>,:$�&:;�&:��1&��%�"�K)�=�� ��L�ก�=$)$>�>)]��+�C>)�<�%,�B-�'"9#�$"�Q 9#J,��ก� ^_ก��& ]��P� �����Q"9, ก+��$)�1# �"�J,�%,�B-�'"9#�$"�Q']C��%: 9#J,��ก�^_ก��&�� 1�0�$>"� 9#'ก9#�$0�� )�ก1Z��^_ก��& �(�J,��$;`>�=�(��� 1(���;&=>)�ก�C �1a��(� �=�C �1a�

']+�0��1�� MCQ '(#� thyroid disorder ���� 366-371

%,� ก>gก.9#, '�&9�$ C9#$>"� ��+ =$)%,� �� :K

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' ���P� �+�% C����+)�=�� &9���ก�ก��ก���'&>� �+�=$)1��ก��"��� (��� Drug Utilization Evaluation) %,�&9ก�'กO�0��&-+ก��"�'C(#� =$)1����a���+ J,�

5. ����� �. :(� ��ก���1�����"�']C��%: ก�C>'LI0� ก� $ �$ ก& �(�' 9��' �� 9#J,�� :$�&'�O�"��)�ก:<���;ก&ก�C`���Q"9���+ก��� "�=>

3.2 0.����������"���'�&(��',>& '�(#� )�ก1-=%: 1�� �� A :(� ��-� ก.(C>&CKB>, )�ก ก0: '�+9#��'�8� ABC ) �� A '�8�1-=%: 1�� 0� PTU 1�$��� B :(� ��-� 0. '�8�0� MMI 9#����������"���'�&(��',>&'�(#� )�ก:�J0���-���"�$ =P :aK ./# PTU �+# B��� placenta J,�����ก$�� MMI(PTU B����P���&����ก$��,�$�) �"�J,��+�,a�&�กก$�� P ��:� 9#=P :aK�+�����&�;= �+���'&(#���ก�,90/P� )�J&���0��,+ กO'�(#� )�ก)�ก$��)�'0��1-� Euthyroidal stage กO:(�: =�� �����'�&(��',>&)�ก$��)�'0��1-� a�$��9PZ/ )���+,0��,��J,� (PTU cat.D �"���:�=P :aKก<9 life-threatening �+�&9��%�"�K&�กก$��B+'19�) 3.3 ก. Agranulocytosis

'�8�B+0�� ':9� 9#;�� 0� �� P 1� =$ )�'ก>,�� PTU > MTZ ก�����ก��� 4

4.1 '�(#� )�ก:�� lab 9#��ก$�� FT4 =#�� �+� TSH &9:��1- : Hypothyroidism

4.2 ก� 9#กI�J&�=��'�(#� '�8�'$+�����(�J&�J,��ก�กI� �����'ก>,a�$� Myxedema Coma 4.3 %:�9P'ก9#�$0�� ก�=��&J ��,K 9#1�� u�K%&�J,�����ก$���ก=> 1�'�=;1�$���Q�)�'ก>,&�)�กก�0�,J�%�,9� �(�=���&J ��,KB>,�ก=>�(�)�กก�0�, TSH &�ก�=;�� ������� ก��'"(#� "�� '�(#� )�กu�K%&�J ��,K ������ 9#'ก9#�$ก�'&=���+>./&0� �� ก�� 4.4 Levotyroxine (T4 N Eltroxin®) 4.5 I ��-���=������ 9# 3w �+� 5w 0� tyrosine �+���-���-� L-form 4.6 Triiodothyronine 4.7 ก�กI�%: hypothyroid )�'0��1-�a�$� euthyroid =�� �"�'$+� 2-3 ',(�� ก�$>�>)]�1�$���Q�)�=$)�,� TSH ��ก<9 primary hypothyroid �=�:� 9#'�8� secondary �+� tertiary ./# 'ก>,)�กก�1�� TSH �+� TRH B>,�ก=>=�&+��,�)�J&�1�&�Z�,��"� TSH =$)1��J,�

ก�����ก��� 5

5.1 =�� ). Methimazole ���&�"����Q> 9#=P :aK ����&�;= :� 9#�C��� �+�&9 DI ก��� warfrin %,�)�J�'C>#&y z>{0� warfarin

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55

5.2 =��0�� ก 0���9P:���0�� ก��ก$& 0�� 0 : ) '�8�1># 9#:$�������=�0�� ก B>,= 9#�����;,�� � 9�+���ก$����ก�')O�:�&�'ก>,)�ก�� �=� 9#)> &�'ก>,)�ก��ก�0�� ':9� 0� �� 9# �����'&O,'+(�,0�$=#��)/ =>,'"(P�J,� ��� 1�$�0�� ) methimazole ������$,0�� �+�,9.���J,� �=�J&�Z/ 0���ก'1�

5.3 '�+9#��%) �K'�8�0���,J&�Z-ก=�� 'C��0�� ) B>,0��',9�$ 0���(#�DZ-ก 5.4 =�� ก lugolws solution J&��"�ก&&�= 19 5.5 =�� ก. %:=� 0���(#�D'ก9#�$�&, L-thyroxine J&�:$�"���:�J0�%:�$�) '���$�� �+�&9DI ก�

anticoagulant(warfarin) �+� cholestyramine 5.6 =�� . liotrix '�8�1�1ก,)�ก=��J ��,K �[Q��0� 1�1ก,J ��,K��-� 9#J&�1�&�Zก����,�>&�<:$�&

'0�&0��0� =$����กy z>{J,� )/ J&��>�&�"����[));��'�(#� )�ก��1> z>B+J&��������+�&9�[Q��ก�'�+9#����+ 0� ������ ก��

5.7 =�� ก. T4 active ����ก$�� T3 5.8.=�� 0. PTU '�8� 2-thiouracil derivative 1�&�Z'ก>, tautomerization )�ก keto form J�'�8� thioenol

form 1�$�0���(#�D'0�=P &��+�ก ก�����ก� 7 (J&�&9ก<9 9# 6) 7.1-7.4 .P��0��ก��������9P 7.5 =�� B>, ;ก0�� Z��0�� ก. =�� '�8� thiouracil 7.6 =�� ). Carbimazole )�Z-ก=, ester bond ��%: 1�� J,�'�8� MMI 7.7 =�� 0.

7.8 =�� ). Perchlorate ��กy z>{�ก$�ก� uptake 0� J�%�,9� �&��'�=; 1� ก��% ')�(goitrogens)�(� Goitrin '�8�1����P ก�1 ':���KJ ��,Ku�K%&� %,����P ก�1� B��� J�%�,9� J,��ก�1�C$ก J %�-�.>+(throuraci) �+�J %�J.��'� (thiocyanate) ./# C���ก��+#���+9,�$Bกก�, &1=�, �+� ��กI�%:J ��,K '"�� 'C�%:' (perchlorate) - Lithium 1�&�Z'��9#�$������'ก>, hypothyroid J,�)�กก+JกJ�0,0$� ก��+# u�K%&� 7.9 =�� ก. 7.10 =�� ก. Ref : micromedex, wiki, drug infor, google �����ก��ก���

cabimazole

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��������� MCQ ������ Bone and joint Dosorder ���................ !�"#�� ��� saonoi_neo

(������������ � ����������������������������� ����������� �)

Case %&�'(��&�) 55 +, (./�& 372-373 ��� 1-10)

1. ��� � ��� �ก� uric ��� �������ก������ �� ��ก�!�����!���ก"� #� $%&�' . 2. ��� ! 3. ��� ! 4. ��� � select �$� cox2 1� s/e �3���ก���� 5. ��� $ �� 5� $ � choices 6. ��� ! 8� $9�ก�5���ก���� 7. ��� ; �<=�ก�>�����'�!�����8����?����5��13�ก 8. ��� � $ ��$��<�ก��!�� ก$ �;3����� 8��A5ก��� � N ��� (� � purine ���8�?�) 9. ��� # 10.��� ก A B E �<=�8��5����, C 8��� 5N<�#������, D 8�;��;? ��PQ

Case (./�& 373-375) (7&'8�+9/������'!�: ���;�+/8& <�����

1. ��� 5. <&กQ�9�8R�3���8?� antacid %��#�ก�� antacid ก$������ก��8���ก�5��$��ก5� 2 hr 2. ��� 1. ;��1�ก�1��8��;3������5��R U;� ���8�R;��1�ก�1��8�������� �ก�8��ก����'$� <Vก ก$ 8��A5ก ��$� � 91�

�;3������5��R 3. ��� 4. �<1��8��<=��5�1� 1 ;5W� Piroxicam 5�<���� 10-20 mg/day �5�1�;5W� (�$�9�$ AR �� choice1 ;3� ��??

�'$ RA �??) 4. ��� 5. Prednisolone (8�;��;? ��PQ) Celecoxib, Mefenemic acid, Naproxen, MTX #5��<=�8��5���8 5. ��� 3. Chronic renal failure �� ��8� CRF ;3� � CrCl < 60 9�$%�� ESRD ���� CrCl < 15 6. ��� 3. Sodium polystyrene sulfonate g��� hyperkalemia �� �%9ก� !U�8������ sodium polystyrene sulfonate

�3� calcium polystyrene sulfonate ��ก�#5�ก5� K+ ��� A� ก5��W���� �W�� ���� �3��W��A1 ���� � K+ ���k ���8� 5�#� <#5�ก5� K+ ���W��A1 ���1$��5W�� �

7. ��� 3. Furosemide Furosemide #� �A1�$� potassium ion ���8 ( � SE !��8��<=� hypo K) 8. ��� 4. $ �A1�ก��� �?1 ก�-�$�� !��$��ก�8 Furosemide �<=�8�ก1?$ Loop diuretic ก1 ก85�85W�ก�!��$�

$� !�� Na+ - K+ -2Cl 91� Prednisolone 9. ��� 2. 3amp ;3� MW HCO3 = 61, NaHCO3 = 84 ����ก� HCO3 2.8 mmol/l �� SWF 100 �5��5W�#&�����ก�

HCO3 0.28 mmol 9����$�����ก� HCO3 0.28 x 61 = 17.08 mg . � NaHCO3 ;�� �!� !�� 2 mg/ml q&�� Vial �&� �!��� 5 mL �5��5W� 1 vial �;�� �!� !�� 10 mg ���$��� 10 mg ����888 � HCO3 ��$� �$ กt 61/84 x 10 = 7.26 mg �5��5W� ������� � 17.08/7.26 = 2.35 �5��;3� 3 amp

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10.��� 4. clean room class 10,000 ( $'5�����)

����u CLASS

1. ����5กg�'������5� �#?ก$���$��!������1��� 100,000 -200,000

2. ����1���g�'������5��#? (Washing area) ����5W� Prefilter 91� HEPA-filter

10,000

3. �������8 8� (Perparation room) ����5W� Prefilter 91� HEPA - filter 10,000

4. �����#?8� (Filling room) 10,000

5. �����<1��8�'?�<�P#�ก�'3W� (Gowning room) 10,000

6. �%������#? (Filling station) g�8��� Laminar Air Flow 100

(�������: http://wwwapp1.fda.moph.go.th/drug/zone_service/files/ser008_04.asp)

11.��� 5. 12.��� e. #5�q3W����8��{�กu���PQ#�ก��;Rก��g�5'ก $#��ก5������� 13.��� 5. �N������9 � | �ก���5�'5��9ก�U;A����5�}, - ! �W�'5�9ก������3��~��, -��ก<V�5กQ�U;����3�, -

�!� <�� 9ก�ก���8�W�� 9ก� � (�������: http://www.samunpri.com)

���� MCQ (./�& 375-378) ��� 14-30 14.��� 1 ��3���#�ก glucosamine sulfate �!���$��'���ก�5กQ�U;!����3�� ��ก#�ก��W85�'$�8��� ก������W���1�W8�

!�� '$�8q$� 9q !!��91�ก���ก�$�� 15.��� 4 �1�ก�1��8�ก����8��!����!��91��������$�ก5� ��3���#�ก8��������5W�;3� Hyaluronic Acid �3� HA�<=�

�$��<�ก�����;5N!���W����!�� 91���A��<��8!���!$���3�� ��$��W����!�� �;�� ��3�1�1� ��3���#�ก Hyaluronic Acid (HA) g�8��!�� �<� �u1�1� �5��5W� ก����8� Hyaluronic Acid (HA) �!$�!��#�'$�8��� ;�� ��3�!���W����!�� ��� �;�� �1$�13�� �ก!&W� 91� 8�����!��!��85� �<�U8'�R'$�8ก��?���q11RA��!������ก��ก�A1���W���1$��1�W8�!����ก���8 ��ก#�ก��W 8���� Hyaluronic Acid (HA) 85� �;?u� �5��'$�81���ก�<��!�� ��

16.U���� ceutic ��� $ ������ 17.��� 4 ;� 1 ��3���#�ก 1�5W� �;?u� �5�� ��$������W�� 5��ก5������$��5W�������A11���ก��� �?���������

ก�P&กQ���3W��������;1���ก��$����A1��ก�5กQ���ก�<��ก1�� ��3W� <��!��91��;1t��$��k U�8�� (E)-1-(3,4-dimethoxyphenyl) butadiene (DMPBD) ����ก5���ก � ���5W� ���{��85�85W���ก��� !�������!������ก��#�ก dethyl phenylpropiolate 91� arachidonic acid (AA) #�กก���1����{��!�� DMPBD �$�ก�85�85W�ก��5ก�����$� DMPBD ���{������ก��5ก��� U�8 ���{��85�85W���� q R cyclooxygenase 91� lipoxygenase !��ก����ก�� ����1�� !�� arachidonic acid ����������ก��ก��5ก���

18.��� 2. ��3���#�ก 1. ;��'� NSAID, 3. NSAID ������� U������, 4. SE = ����A�ก, 5. COX1 �A1 �กก�$� 19.��� 5 ��� ��� q R cyclooxygenase � 2 isoforms ;3� cyclooxygenase-1 (COX-1) 91� cyclooxygenase-2

(COX-2) U�8 COX-1 #� �������ก��8�ก5�ก�A1�� cytoprotective prostaglandin ���������������� %�� COX-1 %�ก85�85W�กt#��������ก��9A1�������������� �� �$�� COX-2 #��<=���� q R���'5ก�������ก��ก�

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�5ก��� <�� �� �5��5W�8� NSAIDs �������ก��5ก��� ��U�8 $�������ก��8�{��g��$���������������;�#��<=� NSAIDs ���85�85W����� COX-2 (COX-2 selective inhibitor)

�5��5W� 8����#������$� COX-2 �ก#���ก��{���$� COX-1 ���8 ���<�N��;�� �ก�ก�!��U �1ก?1����!�� <85� COX-1 $ �� 9�$���ก5� side pocket !�� COX-2 �$��8����#������$� COX-1 �ก#�85�85W� COX-2 ���8 ���!�������1tก�ก�� <������8�����5�{� �����ก5� COX-1 91� $�� �% ��$�����83��1� <����5�{� �����ก5� COX-2 �� side pocket #&�85� ����5W�����1?�1���!�� < �� #�ก9��;����W���#&���� <5���8����#������$� COX-2 �3��1���ก�!����;�8�

20. �'�� ก� Handerson 21.��� 3 ��3���#�ก methadone �<=�8���������U�Q 2 22.��� 4 ��3���#�ก �� �%#$�8 �� ��3���#�ก�<=�8�'������8�ก5� 9�$������5��3����5�� ���8?��$��5W���� 23. ��� 1 colchicine ��3���#�ก 8���W �!���$��'���8� gouty arthitis 24.��� 1 ��3���#�ก Aspirin �'��<=� antithrombotic drug q&�� ���{��85�85W�ก�#5�ก1?$ ก5�!���ก1t��13��1.1 �3��<���ก5�

ก��ก�� thrombosis U�8�����8$��8��� arterial thrombosis 19.1.3 q&���<=������?��ก��ก�� cardiovascular disease U�8ก1 กก���ก��{��;3� 85�85W�ก�������!�� cyclooxygenase ���ก1t��13���8$��%��19.1.1 U�8��{� Acetylation ������ arachidonic acid $�� �%�<1��8� <�<=� thromboxane A2 (TXA2) �� �������ก1t��13��� �5�ก5� $ �� q&����{���5�ก1$��#��ก��!&W��5����15����8� 91�#��8�$ <#��1����8?!���ก1t��13���5W� (4-7 �5�)

25.��� 1 ��3���#�ก �������ก1t��13�� 5� $�ก��ก1?$ ก5� 26.��� 2 ��3���#�ก 9 ��$�ก1 กก���ก��{�����9��#��!�� NSAIDs ��ก�1� !�85� $���9�$'5�9�$�'3���$���#�ก��8�!���

ก5� ก�85�85W�ก�����U<���9ก1���������<�����$��ก1�� (��#�<=���� �U<��1� 5�) ��3���#�ก�'3���$�U<���9ก1�����<=��3����ก�9�����{��!�� U�#���$��ก�891�������;�� � �?1 ��ก�����91�ก�ก��#5�;�� ������ �U<��1� 5����8 < �������?u�g� �!��$��ก�8��� !&W� ���8���?��W� 3�� NSAIDs 85�85W�ก�����U<���9ก1�������� �� ��#&� ���{��1� !� ��

27.��� 5 ��3���#�ก Mefenemic acid � duration of action ���8ก�$� 6 hr. 28.��� 5 29.��� 1 30.��� a

MCQ ./�& 378 ��� 1-7

./�& 379 ��� 1-9 1. �. Calcitonin �/����#&กก��'����U��#�#���� <�##58����8���ก��ก�� thromboembolism, endometrial cancer,

breast cancer q&���� �%1�<�##58����8���ก��ก�� endometrial cancer #�ก���U��#����N����� $ ��A$��5���� �1�ก��ก U�8ก����$� ก5� progestin 9�$กt#���������� ;�� ����8���ก��ก�� breast cancer, coronary artery disease, stroke, biliary disease

2. ก. Misoprostol �/����#&ก��กD(EFG!��(H� Prostaglandins ��� 3. ก. Edrophonium test (Tensilon test) �� MG #� �A1������A��<��8��ก���!&W� 4. ก. Colchicine �� Acute Attack

Page 62: Key MCQ Bank

- 5�<���� 0.5|1.2 mg 91���� ���8 0.5|0.6 mg �?ก' . �3� 1-1.2 mg �?ก 2 ' . #�ก��5����ก���!&W� �3�#�ก�$�A��<��8#� ���ก�;13�� �� ���#�8� �3��������8 ��� 5�<�����ก���5�1� 8mg/�5�

- ����!���1���13����� ��� ���!��� 2mg g�8�� 2-5 ���� �� ���8 0.5mg �?ก 6 ' . #�ก�$���ก�#���!&W� ��ก��ก� $�?�1������� ��;5W�1� 1mg �?ก 6-12 ' . � �5W���W� $�ก�� 4mg �$� 1;5W�ก�5กQ� 5. !. Rheumatoid arthritis (RA) ;3�U;��� �ก��5ก���!��!��'��� synovial joint �ก3���?ก!���5��$��ก�8����$�ก5��<=���1�����<=���3�� k �3��1�8<V �������ก��ก����1�8U;�����!��!�� #��ก��!��A���<91��ก� <������?� ก��5ก���#��ก��!&W�����83���?!������?�8�$��!���<=��$����N$ 9�$A��<��8����8#� �ก��5ก���!��������t� 5�A3� ก1�� ��3W�91���58������3�� k $� ���8 �'$� �83���?� �5��# �83���?� <�� �83���?1�ก�� 91��1���13��9������$�� k �<=���� 6. !.Colchicine 7. ;. ������ก�<��ก1�� ��3W� 8. �. � $����!8�8 9. !. A��<��8�$�#� ���ก�!�� �ก� ��� ���ก���� ���� MCQ (./�& 380-381) ��� 1-5

1.��18!�� 1 ��3���#�ก Raloxifene $�'$ pure estrogen antagonist 9�$�<=� selective estrogen receptor modulator (SERM) ��� ���{�� estrogenic effect ���ก���ก, lipid metabolism 91� blood clotting ��ก#�ก��W85� ���{�� antiestrogenic effect �������� 91��83���?U� �1�ก #&����8���W ��'���A���N����� �;�� ����8���ก��ก�� breast cancer !���$��'���� FDA approved ;3� ก�5กQ�91�<���ก5�ก��ก��ก���ก?����N���58� �<�#����3��

2.��18!�� 3 ��3���#�ก ก1 กก���ก��{��!�� raloxifene �5�����{���8��!�� 3 �5W� �<=�ก1 กก���ก��{��!�� alendronate 91� first generation bisphosphanates (ก1?$ ��� � Nitrogen �<=��$��<�ก��) �$��!���3��k �<=�ก1 กก���ก��{��!�� raloxifene ���%�ก����

3.��18!�� 2 ��3���#�ก ��ก�!����;�8������$�8!�� raloxifene ��9ก$ hot flashes, leg cramps, pain in chest, fever, burning, difficult or painful urination, frequent urination,vaginal itching �$���3��กt ����A���5���W!�� 1 raloxifene กt85� $�� �%�'� ����A��<��8 thromboembolism !�� 3 A�� ��� raloxifene $ �!���$��'���A��<��8��� � corticosteroid-induced osteoporosis !�� 4 A�� ��� raloxifene ������ ��กt �� ���� $ �A1�$�ก����q& !�� 5 A�� ��� raloxifene '$�81��?�5��ก�uRก��ก�� vertebral fracture �� 30-50% 9�$1�ก��ก�� hip fracture �8$�� $ ��58���;5N����%���

4.��18!�� 4 ��3���#�ก �� �%��� alendronate $� ก5� calcium � t� �� 9�$�������;�1���1� ��3���#�กก���� alendronate �� ก5� calcium #��ก��ก����q& !�� alendronate ��ก�5W� alendronate กt���q& ���8�8�$91�����8 (���q& ���8ก�$� 10%) �'$� ��� alendronate ����'��ก$������ 91����� calcium �� ����ก1���5�

5.��18!�� 1,3 ��3���#�ก alendronate �<=�8�ก1?$ third generation bisphosphanate �'$����8�ก5� risedronate U�8 alendronate �'�!��� 70 mg once weekly 91� risedronate �'�!��� 35 mg once weekly q&����$� alendronate ��� bone mass density ��� hip �� �กก�$� risedronate

�$��!�� 3 �����ก�$�A�� ;���$��$�#��<=��3���!�� �1��� update !&W��� q&��<�##?�5� (July, 2008) 8�ก1?$ Bisphosphonates FDA-Approved for Prevention and Treatment of Osteoporosis 91�� ��5W�� � 5 �5� ��9ก$ alendronate, alendronate plus D, ibandronate, risedronate 91� zoledronic acid

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���� MCQ ��� Dermatology

1. �. Retinoid

� ������������� Isotretinoin

Isotretinoin ����������� ���Retinoid (Vit.A) %�ก���'()�*'()ก��+,�-��(ก��.�ก

� �/�0������������� Retinol

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�:>�%=� �,��(��V��90� , 9.=SG� retin A �=>.ก�)���V_���r����*'_.' alcohol ����,T:>+,/%��.�ก�mn� , �(=�S%�����<� �(V_�<���>��+��ก��)90� , (�9><=�/00 �-�(<�>��v> *r�S%�T:> sensitive , -��*�*'_*���/�� %-��S)% 0 >=�/��9%.

4. �:�:<h�.>=�+,SG�(��'n�=>.ก�) panoxyl 90�%�V�9.= *=��+,/�,�r��(=��9� � 9.=�>� +,�,��(��V�� %���-�ก90��%.V��ก�� h��+,SG��=>.ก��S%�SG� panoxyl <���G�� Retin A ก=�����

5. ก-9กก����กC*�:D��� Retin A /-, Panoxyl /<ก<=��ก���(=��9� � Panoxyl ( Benzoyl peroxide 2.5% 5% 10% *r�S%�T:>�,��(��V�� i=��GVn��-(�0(��กC*�:D *r�S%��ก:0 oxidation S%� hydrogen peroxide �=>� Retin A +,��:_.ก��%-�0-�ก��� cell 9.=.'C*�:Di=��GVn�

6. h��*=��90���).�)%.�(S%��<�'(.<r���)(�*'_.'<�>(��r���;����G�:0�0'(>ก�) Panoxyl ����>��,>��*'_*=��<����r��m�hm��V��,9� � Panoxyl (Benzoyl peroxide) +,�,�):0*'_ ��q%l .:�ก:� 60 ��F� /-,<:09�h���( =Sก-� reducing agent %��.h=�(l�G�, %��.�*�V� S�=�>0/ก�>9.=90� ( S�=�-��<:ก/*� ) �-%,*r�-�(�0(SG� 10% NaOH

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1. *=��+,?�กh�.���. -S0)��� & 2. *=���:0>=������������,9� +,+=�((��,9� � �/))S0 & 3. *=��+,/�,�r��,9���:_.�<:.)��� � h������<�=.��)��>ก���ก� S%�h�.>=���-'_(�ก���ก�S�S%.=�m��-=� ( ��ก��/��(��

(V0 ) S%� anti histamine ก:� ��+��:_. steroid *� %�ก�0:�*��.� � ��%�')/0� �ก:0+�กก����'(0�' inflame S%� steroid *� �ก:0����>��0'(> �(�(S%;=�mn� �%v���)G�0�+� � �GVn��� �ก:0+�ก�>�.��)GVn� Candida %�V� Tinea กv90� S%� broad spectrum antifungal /<=h����ก��).�กuS%� combination ��� steroid+ antifungal กv90� (� topical .' 1. whitefield ointment bid 3-4 wk *�<=��'ก 1 wk 2. Clotrimoxazole 3. Ketoclonazole 4. Terbinafin

ก�����ก��7�1 7 G�(��(� 40 �� �r�<�>�(=��(� Dermovate .���?Vn�+�ก*=�� ( Dermovate ���� high potency ) 1. *=��+,?�กh�.���. -S0��:_.�<:.)��� � steroid �������*'_%-�_��( =S��=��ก�(��� +m�9.=�=�+,/�� /<=��+/�� preservative %�V�

anti histamine กv90� 2. ���)�ก>=�+,���9�*�/ก�(��ก�0S%�ก�))�<�G�(��(� 1 �>) /-, 4 �>) *=��+,+=�((�<�.*'_���<���ก��%�V�9.= ����,�%<�S0

h��9.=+=�( *=��+,+=�((�G�:0S0 � 9.=+r�����<���SG� steroid SG�/�= calamine %�V� /?.)��กv�� 3. ���/�,�r�S�ก��SG�(�ก-�=.�'n .'%-�กก���(=��9� � *�)��u)�:�>q*'_���� %��.*�)�:�>q/T-���0 *����u��+ systemic 4. +,?Vn�(�/ก�/��9�*��0�>(+,90�%�V�9.=� 90� cpm กv90� /<=h������<�=.�:0u9.=<���+=�(กv90� 5. h��+,/�,�r��.��9�� �>�SG��.��9��G�:0S0 � �;�(� �t�*,-�(�+� ( 2 <�>�'n.'C*�:D anti histamine ) <r�-m�*r�S%��(v�

��G����i�< 9�*)*>��.��9��9-=(��0�>( !! ก�����ก��7�1 8 .��0�.���?Vn�(�/ก��%�S%�)�<���>��(� 7 �>)

1. *=��+,?�กh�.���. -S0��:_.�<:.)���� ����.����(�� /��(�9%. SG�(��,9�.�ก=�� 2. *=��+,+=�((�S0 /�,�r�>:�'SG�0�>( � lindane ( *�ก-���V� 12 hr <:0<=�ก�� 3 >�� �'ก 1 wk ?nr��'ก 1 ���n� 3. h��+,SG�(� anti histamine �=>.0�>(+,90�%�V���-=� *=���:0>=��>��-V�กSG�(�G�:0S0 � CPM 4. �.��9��G�:0S0��.��hSG���ก^��%� /-,.'>:�'SG��(=��9�� ���(%�=�T�.�nr�.���VG

ก�����ก��7�1 9 �:�:<�q,�l��GF��<� 9��กv)<�>�(=��<��9.�S��>�����q, �0(<�>)��� .'TV_�/��/-,���.�ก >:_�.�*'_���hF�-���?Vn�(�ก�)*=��

1. *=��+,/�,�r��,9�)��� /-,+=�((�S0� anti histamine 2. �.��9��*'_��+SG�S�ก�q'.'�,9�)���� ��-0������ �.:n�G�� �;�(�<�>�.'( �- ( /ก�-.�:^ ) 3. h��.�:�:<T ��'n.'��ก��.�กhm���n��nr��%-V��9%- *=��+,S%�<r�/�,�r��(=��9� /-,+=�((��,9�� �)/�*( *'_���)�-

��++=�(���� antibiotic �G=� cloxacillin 4. �'ก 4 >��h�0.� ���ก-�).�%�*=�� )�ก>=�(�*'_S%�9�9.=G=>(S%���ก��0'�mn� *=��+,/�,�r��(=��9� ����,�%<�S0 5. ก-9กก����กC*�:D<�����ก��/�����(�ก-�=. anti histamine /-,ก-�=. steroid /<ก<=��ก���(=��9�

anti histamine %��.ก��%-�_� mediator �G=� histamine ก-�=. steroid %��.ก���ก:0 arachidonic acid *r�S%� %��. ก������� leucotriene ?m_��������*'_*r�S%��ก:0��ก��/��90�

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��� ����� ��� � 1 �. Calcium carbonate ก��� !�"#�$ calcium carbonate %$�$�&'() (+�กก,-� 1 ก� +) /"#��%��ก0& acid

rebound 2&�$�$3�"��$3�) $45�)/�ก ca2+ '�+��8ก�"���$ก���� 5) 3ก'�0$3�"ก�&2&�

2 ). +9 �ก&�"!�"'�#'-,$ก��)

- Bisacodyl / &�>(-%$ pregnancy category C /A)2+-�,�%B�%$�C0)+9���DE - Bisacodyl +9�(!3>� !F$3 Enteric coated tablet ���)ก��%��3�ก� ,%$���2'�#-�$ H$ & )$ H$/ )2+-�,�ก0$>�$9H�-,+ก >��&ก�& I��"/"#��%�� pH %$ก�"I�"'()�AH$ 3��,/��#��%��>�3�ก� ,ก-�$8A) Target organ - >�$9H2+-+9������+�"�8A)ก�����+%B�%$��9>+ (�!L,>ก-�$ -�� &ก-�$M�>� )'9 - Bisacodyl !F$>�%$ก��-+ Diphenylmethane PA5)��กQ#R0ST&>I05+ก��'"'+��)��,%$���2'� &�,>ก�2�#952+-ก95>,���)ก '+�)'-,$%&U �>

3 ). Enema - Unison-enema +9 onset !�"+�X 2 Y15 $�#9 ก�2ก�4�&(&$H��/�ก 0,��)���2'�%�C-'-,$ colon ���'(-B-�)��)���2'� (lumen) #��%����//��"+9$H�� $05+ 3�"I05+3�)& $%$ lumen - >��"�>+"��+3�ก : B-$ Sennokot !F$'+�$2I�#95+9Q#REก�"���$���2'�%��9� , onset !�"+�X 6 8A) 10 B 5,T+) - >��$ Bisacodyl +9 onset !�"+�X 15 $�#9 8A) 1 B 5,T+) ก�2ก�4�I05+ก��9� ,��)���2'�%�C- 8��!F$>�ก0$+9 onset !�"+�X 6-10 B 5,T+) - P0��9>+ (Psyllium) B$0& ) (��9>+/�ก+�&I4B#95B45�,-� "#9>$ก�&��>" ��4� Plantago) / &�>(-%$ก��-+ Bulk forming laxative ก����กQ#R0S�`+#95 ��/���)ก0$�0&�-�ก $�>-�)$��> 3 , $

4 ก. Mg(OH)2 Mgnesium hydroxide / &�>(-%$>��"�>ก��-+ Osmotic/Saline laxatives � ,�>-�)>�#95+9 '��B$0&$9H '+�>(-B-$>��"�> milk of magnesia (MOM)

Case: �$�� 392 ��� 1

ก.+ ก+98-�>��//��"!F$�4�&'9��H��&��

(�!L,>'-,$+�ก/"+9��ก���4�&��ก#�)#,���$ ก !F$�4�&'93&)'& 8��+98-�>��//��"!F$'9��H��&�� %��$Aก8A)ก��+9�4�&��ก%$ก�"I�"��4����2'�

��� ����� ��� � Case: �$�� 392 ��� 2

�.Bactroban !F$>�k-�B4H��0,X 0,�$ )

Case: �$�� 392 ��� 3

�.I05+ก��&(&PA+%$#�)&0$�����

ก��#��!F$ micronized form !F$ก��I05+�-�ก���"��>3ก-���� #��%��I05+ก��&(&PA+

Case: �$�� 392 ��� 4

�.6 tabs daily for 4 days followed by 4 tabs daily for 3

��� � ��+�ก'��ก��ก >�

���� MCQ ��� GI ��������� P�BirD

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days Case: �$�� 393 ��� 1

�.0&+9� , /��!F$���)%B�>�!n0B9,$"

' )ก�/�ก�$2��2+-+92�� ��ก� &2#o�>&E 0&2+-+9� , 3��,#9$9H��ก&(#95�$2��2+-+9��45$2'���/9>$ � &�����!F$I0p 3�"��0,��E2&�

Case: �$�� 393 ��� 2

�.�,�%��&45+$+#95B)��+��$ก,-�!ก�0I45�B&B>$H��#95'(C'9>2!

$45�)/�ก$+#95��+��$�AH$'�+��8&A)$H����ก+��>(-#95���2'���/ก0& osmosis laxative 2&�

Case: �$�� 393 ��� 3

ก.&(&P '��I0p Kaolin-pectin '�+��8&(&P '��I0p2&�

Case: �$�� 393 ��� 4

�.#��%��ก0&�,�+ 0&!ก�0%$ก��/�0C�0T���)���ก�"&(ก

$45�)/�กNorfloxacin ก&2�ก�"&(ก

��� 5 ).3.44 ก� + '+ก���+9$ก-�$ #��!F$ mol ก-�$$" Citric 1/210 = 4.76x10-3 mol �-�2! citric 1 '-,$%B� Sod 3 '-,$ /"2&� 3x4.76x10-3 = 0.0142 mol #��!F$ gram $" 0.0142x84=1.2 g for Sod. '+ก���-�)#���+4�$ก $$" 1/150= 6.67x10-3 mol �-�2! Tar 1 '-,$%B� sod 2 '-,$ /"2&� 2x6.67x10-3 = 0.013 mol #��!F$ gram 0.013x84= 1.12 g #95$9H���%B� citric:Tar 1:2 /"2&� 1.2+(1.12x2) = 3.44 g

��� 6 �.�,�+B4H$/"#��%��ก0&o�)o(Lก-�$ก��$��2!%B�/�0)

��� 7 /.88.89 mOms= wt/LxNx1000/MW = 2.6x2x1000/38.5 = 88.89

��� 8 ก.Carbohydrate Pectin !F$ glycopolysacaride

��� ����� ��� � ��� 9 �.%x� 5)>-�)2o%��ก�� 10-

15% ��+&45+$H�� 1 3ก�, &45+�-�)$H��

2+-3$-%/ 3�-8��!F$%x� 5) ��4� �&0 B-,>��#���ก��#��)'9>2&�

��� 10 �.Diphenoxylate 2+-+9 �#�� Diphenoxylate +9Q#R0S'I�0& /A)formulate ก atropine sulfate I45�%�� (�%B�>�#$Q#R0S

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%��'I�0& B-$&9>,ก Loperamide

��) atropine 2+-2&�/"2&�2+-�0&>�

Case �$�� 395 ��� 1

�. �& ����)�9>)PA5)ก $3�"ก $ $45�)/�ก AlOH3 #��%��ก0&��ก��#��) (ก

$45�)/�ก Al #��%��#��) (ก, Mg #��%��#��)'9> �>%���-,+ก $I45��& ����)�9>)PA5)ก $3�"ก $

Case �$�� 395 ��� 2

�. Peptic ulcer Peptic Ulcer �-,+ก ก���0&B4H� H.Pyroli +45�&(/�ก>�#952&�� !F$B$0& Triple therapy (2 Antibiotic + 1 PPI)

Case �$�� 395 ��� 3

�. Helicobacter Pylori !|//� $I,-� ก���0&B4H� H.Pyroli PA5)!F$B4H� anaerob !F$'����'��� C��)ก��ก0& peptic ulcer

Case �$�� 395 ��� 4

�. Suspending agent

Case �$�� 395 ��� 5

�. ��45�)#��$H��&45+ , ��45�)ก��)$H�� DI

Reverse osmosis %B�#�� Water for injection /A)� &� ,�4�ก& )ก�-�,��ก2! (!�.�$M�>ก"�$��,/ ก2+-3$-%/)

Case �$�� 395 ��� 6

). Furan

+9 Furan 3#$#95�+(- Imidazole ring

Case �$�� 395 ��� 7

/. !���$��> - planotol plaunotol +9��X'+ �0!F$ potent antiulcer agent (Ogiso et al., 1978) T&>'�� plaunotol '��I��X� กp�T��ก�"I�"��กQ#R0ST&>ก��k-�B4H�#95ก-�%��ก0&T��ก�"I�"%$#�)&0$����� #95+9B45�,-� Helicobacter pyroli ก�"���$ก���� 5) endogeneous secretin 3�" ก�"���$ก��' )���"�E gastric-mucosal prostaglandin (PGE

2& PGI

2) (Koga et al, 1996) 3�" !F$,��ก,-�10 !�3��,#95�0p # P )ก9>, /��ก &

��)!�"#�C95!�L$ 2&� �0�� ,>� plaunotol !F$>�3 $!|//� $ ��ก/���$-�> I45�#�)ก�����D�>%��B45� Kelnac®

Case �$�� 395 ��� 8

2+-'�+��8��2&� #�ก� ,'�+��8+9��>%$���$>�%$���$>�2&�

Case �$�� 395 ��� 9

�. ��>ก��>�#95���)%B�%$T��MI�"#�) T&> (�B95>,B�C ��4� (�#952&�� +��+�>/�ก

����� ก �+�>8A) ��>ก��>�'���� '8�$I>���#�ก�"& !F$��>ก��>�+�����$#95%B�%$ก��!��)ก $3�"3ก�2�!|C��'��D�I#95I-�> +9�� ก��$B &/$ ����� � �+�>8A) ��>ก��>�#95%B�'���� ���-)%B���4�T���)B$0&#95%B�>�%$ CB9 ก.

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(����$,>ก����)'8�$I>���$ H$U

2+-2&� ��4�2+-2&� � ��4�%B�!F$>�3#$>�%$ CB9 ก. ��+�,�+/��!F$ ����� �+�>8A) ��>ก��>�#95���)%B�%$T��MI�"#�) T&> (�B��$�C ��4� (�#952&�� +��+�>/�ก (����$,>ก����)'8�$I>��� ����� �+�>8A) ��>ก��>�#95+9���>���-)%B� 3�-+9�,�+�+�"'+#95/"%B�I9>)�)���-)%B� ��4�+93$,T$�+/"+9ก��' 5)%B�>�2+-8(ก���) ��4� !F$��>ก��>�#95+9����3I)

Case �$�� 395 ��� 10

�. ก�",�$ ��� ����� : Clove Tree ก�����

��� : Myrtaceae ������ : ���� ก��� - 3ก�!,&#��) 3ก��+ ��+R��� � - 3ก�!,&+,$ ! ก�"� - � !�"#�$� �+ %B�3�-)ก�05$ &�กก�$I�(3��) #95> )2+-2&�'ก &��$H��+ $��ก 3�"+9ก�05$��+/ & +9$H��+ $��+�"�>+�ก �' `& B-,>� �+ 3ก���ก��#��)�4& #��)o�� !,&#��) 3�"3$-$/�ก'9>&

Case �$�� 395 ��� 11

�. ����A) �#��$ % B-,>>-�>�����/��I,ก3!�) ���)ก0$'&��4�2+-%B��,�+���$'() I��"!F$�$2P+E�+0�' (amylase) PA5)'��>� ,+45�8(ก�,�+���$

Case �$�� 395 ��� 12

�. ,��,) ��� ����� : Lotus ���%��

��� : Nelumbonaceae ������ : �%��&�����'! - �'�,�$ >$ + $�ก$��> ����)ก��� ) 3ก����$%$ก�"��>$H��

Case �$�� 395 ��� 13 ���3�ก(���PH��)

ก.3+)� ก ��� ����� : Hairy Basil &���ก ��� : Apiaceae ( Labiatae ) ������ : ���'! - ��กQ#R0S!F$>��"�> T&>ก��I05+!�0+�����)ก�ก�����ก�"���$ก��9� ,��)���2'�

Case �$�� 395 ��� 13 (���'�))

�. �0) ��� ����� : Ginger �(

��� : Zingiberaceae ������ : �%��&ก)�! %B�!F$>� >�3ก���/9>$

Case �$�� 395 ��� 14

+ )��& ��� ����� : Mangosteen ���!

��� : Guttiferae

������ : 1. � กp�T��#��)'9>�4H�� ) 3�"T�����2'� 2. >�3ก�#��)�-,) #��)&0$

Case �$�� 395 ��� 15

�. ก��,> ก���*�+#�%��� ������� ก��,>B$0&�45$U #95ก0$2+-2&� + ก/"!�(ก2,�#��>�ก��,>$H���,�� %B�ก0$ �'�ก, $�" 2-3 �(ก B-,>%������)ก��� )/�0C����� B-,>�"� 8-�> 3ก�#��) (ก 3ก�T��ก�"I�" ���2'�!F$3 � 3�"!F$>�����)ก��� ) ����)R��� #��%��ก�"I�"3�"���2'�2+-���)ก�ก�����ก-�U

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Case �$�� 400

'05)#95D' Bก��,�8�+I05+�0+�4��"2�?

• %$ case > )2+-#���45�)� กpX"��)��//��" B-$ '9 ก�05$ ��ก���45$U��)�$2�� B-$ ��/9>$ �����#95� !�"#�$ >�#95� !�"#�$ T��!�"/��� ,(# H)$9H�,�P ก���+(�I4H$��$B-$ก��3I�>�&�,>) /A)�,�8�+I05+�0+

��ก����) (�!L,>/ &�>(-%$ก��-+%& ก0&/�ก'����%&?

• #��)'9>3�0&B4H� #952+-+9ก��� ก' (non-inflammation) ��/ก0&/�ก�����!F$I0p/�กB4H� Streptococcus ��4� �0&B4H� Vibrio parahaemolyticus (I+�ก%$�����#"�)

�,�/-�>>���4�2+-I��"���%&?

• 2+-�,� I��"��ก��#95ก0&/�กB4H�# H)'�)'�+��8��>2&��) 3�"2+-/��!F$���)%B�>�antibiotic 3�"2+-/��!F$���)%��>��>�&8-�>$45�)/�ก!F$#��)'9>3�0&B4H� ��//-�> ORS I45�!��)ก $ก��'(C'9>ก�4�3�-

8��/-�> /"/-�>�"2�?

• /-�> ORS T&>%�� (�!L,> '+/03#$$H�� /$ก,-���ก��#��)'9>/"��> ,0R9 '+ T&>%B�$H����+'�ก#95>$3��, �"��>$H�����ก�4�3�-/0-�>U �� ) '+�,�&45+%���+&D�>%$ 24 B+.

�,�3$"$���45�)ก��� !�"#�$�"2���)?

• )&������'/ &#�ก!�"D#(2+-MI�" `&$" �`+/ & !�9H>,/ &ก���+)

• � !�"#�$�����>-�>)-�>B-$ ���,��+

• &45+ORS'� ก $H��!�-�($H����+'�ก)

• )&��)/�ก/0ก �2+-#�กB$0& ��ก��#��)'9>#95�,�3$"$��%�� (�!L,>2!I3I#>E

• +92��>38�)��/��/9>$��$3�)/8-�>!F$+(ก�4�&

• !,&#��)��$3�)

• +9��ก����&$H��!�$ก��)(��T!$ 0,3��) +4�#��>$ B9I/���$�,)

• #��)'9>�4H�� )$�$ก0$ 2 wk

• $$.�&>5%

• &`ก�5��ก,-� 3 �, �$3ก-+�กก,-� 60 %B�>����>� ,

• (�!L,>T���4H�� ) � ,%/ ���4& ��,�$

!ก�0,���$2��+�&�,>��ก��#��)'9>�,�P ก8�+& )$9H

• ��>���) (�!L,>

• � กpX"��)��//��" �,�+895 3�"��ก���45$UB-$!,&ก�`)#��) ��/9>$

• �">",��#95!F$$�$#-�2��-

• +92����4�2+-

• 8�+�45�)�����#95� !�"#�$+�($+ ������'/ & �����#"�)

• >�#95� !�"#�$+9�"2���) T��!�"/��� ,

$45�)/�ก (�!L,>+92�� I���+ก ��ก��#��)'9> 3�-2+-+9+(ก�4�&!$ 3�"ก0&�� )/�ก� !�"#�$�����#"�

กX�E%$ก��/-�>>� antibiotic %��3ก-�$2��#��)'9>

• +45�#��)'9>+�กก,-� 48 B 5,T+)3��,2+-&9�AH$

• 8-�>+�กก,-� 6 �� H)%$ 24 B+.

• #��)'9>3+92���-,+ก +(ก�4�&

• %B�'���� �0&B4H� Cholera, shigella, campylobacter/traveller�s diarrhea, &`ก<12wk, �$2����&immune 3�-/"2+-%B�ก ก���0&B4H�2,� '

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Case ������ %��� 400

#��)'9>8-�>!F$+(ก�4�&!F$T��%&��)?

• Inflammatory diarrhea

• ��/ก0&/�กB4H� Salmonella, Shigella, E. histolytica, Giardia lambia,

• T���,�+ 0&!ก�0�45$U��)���2'� B-$ +"�`)���2'� B4H�'���� ��ก��3'&) 3�">�#95 (�!L,>�,�2&�

• Salmonella spp. Y +92���$�,' 5$ !,&0& 8-�>!F$$H�� 2+-+�ก ��45$2'���/9>$ �)�� H)+9+(ก�4�&!$ ��ก��/"��>�)%$ 2-5 , $ 2+-�,�%�� antibiotic

• Shigella spp. (0&2+-+9� ,)��$3�ก/"!,&0&+�ก �-�+�/"+92���AH$ 8-�>!F$$H�� +9+(ก��4��4�&!$ !,&-)�+4�$��//��"2+-'�& ��45$2'� ��/9>$ �-�$I�9>I��"'9>$H�� !,&��9p" �,�%�� quinolone ��4� bactrim DS q 12 hr 3-5 , $

E. histolytica, Giardia lambia (0&+9� ,) ��$3�ก/"8-�>��//��"��, !,&#��) !,&-)#95ก�$ 2+-+92�� �-�+�/"8-�>!F$+(ก�4�&#9�"$��> 2+-+9$4H���//��"!$ 3�-+9ก�05$�+`$�+4�$� ,ก��)$-�8-�>ก�"!�0ก�"!�>, $�"���>�� H)(20-50) 3�-/"2+-�-�$I�9> '�+��8#��)�$2&� �,�2&� Tinidazole 4 tab * 500 mg (2g single dose '���� G. lambia '-,$ E. histo %��, $�" 2g �+4�$ก $3�-%��ก0$�0&�-�ก $ 3 , $)

��� 1 �� ��� ). , �8���กQ#R0S�-�/0�!�"'�#!�"D# 4 >�'I�0&%��T#p ( Narcotic Drugs ) '���+9��4�, �8�B$0&%&U PA5)+45�'I���'(-�-�)ก�>2+-,-�/"T&>� !�"#�$ &+ '( M9& ��4�&�,>!�"ก��%&U 3��,#��%��ก0& ��-��-�)ก�>3�"/0�%/%$� กp"'��� C B-$���)I05+�$�&ก��'I�AH$!F$���& +9��ก��8�$>�+45���&>� +9�,�+���)ก��'I# H)#�)�-�)ก�>3�"/0�%/�>-�)��$3�)���&,�� 3�"'��D�IT&># 5,2!/"#��&T#�+�) ����233�� 1 >�'I�0&%��T#pB$0&���>3�)B-$ �T��9$ ����233�� 2 >�'I�0&%��T#p# 5,2! B-$ +��Eo�$ T��$ x��$>� T�&�9$ ����233�� 3 >�'I�0&%��T#p#95+9>�'I�0&%��T#p!�"D# 2 !F$'-,$ '+�>(-&�,> ��+#952&��AH$#"9>$���� 2,� B-$>�3ก�2� '+T�&�9$ ����233�� 4 '���+9#95%B�%$ก�� �0�>�'I�0&!�"D# 1 ��4�!�"D# 2 B-$ ��P�0�3�$2�2&�&E (Acetic Anhydride) ��P�0����2�&E (Acetyl Chloride) ����233�� 5 >�'I�0&%��T#p#95+02&�����>(-%$!�"D##95 1 8A)!�"D##95 4 B-$ก CB� I4Bก�"#-�+ 3�"�`&�9H�,�> , �8���กQ#R0S (Psychotropic Substances) , �8���กQ#R0S (Psychotropic Substances) �+�>8A), �8�#95!F$>� ��4�2+-%B->�#95��กQ#R0S/�"/)�-��"/0�3�"!�"'�# '�+��8!�95>$'D�I���+XE 3�"/0�%/��) (�#952&�� '����-�$9H2&� ����23 1 '��#95+9� ก>D�I%$ก��ก-�%��ก0&ก��%B�>�%$#�)#95 0&(Abuse) +9�,�+'95>)� $���>�-�'��D�I'()3�"2+-+9ก��%B�%$#�)ก��3I#>E >�'-,$%�C-+9Q#R0S���$!�"'�#� ,�>-�) B-$ +'���9$(Mescaline) 2PT�2P9$ (Psilocybin)

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73

����23 2 >�#95+9� ก>D�I%$ก��ก-�%��ก0&ก��%B�%$#�)#95 0&'() +9� $���>�-�'��D�I+�ก +9ก��%B�%$#�)ก��3I#>E�>(-%$,)/��ก & � ,�>-�)B-$ o�(2$���P93I+(Flunitrazepam) o$���E+9$(Phentermine) ���+9$(Ketamine) ����23 3 >�#95+9� ก>D�I%$ก��ก-�%��ก0&ก��%B�%$#�)#95 0&!�$ก��) +9� $���>�-�'��D�I!�$ก��) 3�-+9%B�%$#�)ก��3I#>E+�ก � ,�>-�) B-$ �"T+��E0��� (Amobarbital) +T!��+# (Meprobamate) ����23 4 >�#95+9� ก>D�I%$ก��ก-�%��ก0&ก��%B�%$#�)#95 0&�5�� +9�,�+'95>)� $���>�-�'��D�I$��> +9ก��%B�%$#�)ก��3I#>E+�ก � ,�>-�)B-$ B-$ � �I��TP3�+ (Alprazolam) 2&��P93I+ (Diazepam) ��� 2 �� �. Loperamide $45�)/�ก�$2��+9��ก��#��)'9>3�0&B4H�/A)2+-�,�2&�� >�#95/"2!> > H)ก��� 8-�> $45�)/�&B4H�/"2+-8(ก� ��ก3�"/"/�0C�0T�3#$ Loperamide ��4� Imodium® !F$�$�I $RE��)x��$#952+-#��%��'I�0& ��กQ#R0ST&>ก��2!/ ก opioid receptor #95 myenteric plexus 3�-2+-��กQ#R0S#95�"!�"'�#'-,$ก��) Furazolidine !F$>�k-�B4H�I,กT!�T�P , 3�"3�#9�9> %B�%$ก���0&B4H�#95#�)&0$����� ��� 3 �� /. 2+-���)%��>����$/��B9I $45�)/�ก (�!L,>!F$�$!ก�0 3�"!F$ (�%�C- PA5)T&>!ก�03��,ก���0&B4H�B$0&$9H/"��>2&��)%$ 2-5, $ /A)2+-/��!F$���)%�� antibiotic Case ��� 1 �� �. Muscarinic receptor , !�ก3��) ��I�-� #��) (ก Hyoscine %B���#���ก��!,&ก�`)%$B-�)#��) T&>��กQ#R0S!F$ muscarinic antagonist ��4� !F$anticholinergic drug$ 5$�) #��%���&ก���� 5)��) acetylcholine �&ก���&ก�`)��)ก���+$4H��9>%$B-�)#��)2&� �"cholinergic /"3-)!F$ muscarinic 3�" nicotinic 3�->�ก��-+anticholinergic + ก!F$3 antimuscarinics !F$'-,$%�C- ��� 2 �� �. 450 g D-5-S �4� 5%dextrose and 0.9% Nacl PA5)%$ 1 �,& +9 1000 ml 100 �,& +9 100000 ml & )$ H$ 0.9%NaCl %$100000 ml /A)#-�ก 900 !�0+�����)��)3�`)#-�ก ��A5)$A)��)$$. ☺ /A)#-�ก 450 g ��� 3 �� �. Autoclave 121 �)�� $�$ 20-30 $�#9 Autoclave �4� ก��%B�2�$H��I45�#��%��!���/�กB4H� !ก�0ก��autoclave/"%B���X�D(+0 121 �)�� $�$ 15 $�#9 ��4� 134 �)��$�$ 3 $�#9 8��$�$ก,-�$9Hก>05)&9 3�-ก��#��hot air oven (160�)�� 2 B+.) 2+-�+�"'+ก ,0R9$9HI��"2+-'�+��8%B�ก , �8�#95!F$��)��,��4�#$�,�+���$'()2+-2&� PA5)%$#95$9H!F$$H��ก�4� ��� 4 �� ก.LAL test Limulus amebocyte lysate (LAL) !F$ก��testI45���bacterial endotoxin ��4� pyrogen$ 5$�) PA5)LAL!F$'��#95I%$�4�&��)horseshoe crab PA5)/"#��!n0ก0�0>�ก endotoxinT&>#��%��ก0&ก��clot PA5)%B�!F$�-�positive result %$���&#&��)

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��������� MCQ ������ EENT (���� 402-413) P.402

1. ก. Dexamethasone �������ก���������ก ! "#$%�&�'()*�)!ก+(,��-*./0 Because 4��56'7,+8�$ ��9�/,+(&'���'7 !&+":-ก��"+กก+(,��-*./08;���-(�7 ก+(( ก<+"#$�'()*�7+5=�*�'!: 8,&Dexamethasone -5>!7+ก?�&� steroid ก���������ก ! �C+)D�0+ก+(,��-*./0-5>!�+ก9#/!

2. 9. Chloramphenical Because ก+(( ก<+ 4��56'7�'(%��( ;7+5=�*�'!:

3. �. -กI;7+)!J+�),�*&0$8*&89I$90$,��-7I! Because Chloramphenical -5>!7+��K,�0$-กI;)!,��-7I! (2-8 °C) %�&)*&*&0$8*&89I$

4. �. ก+(�0$�+Q-DI!�+QR�0! Because 0+"��5STD+-ก�K7'ก ;(:;;-U�!5(:U+�

5. 9. Ciprofloxacin injection Because ,�0$-,(�7�)!(�57+5(+Y"+ก-*./0 R#K$7+Z����ก+(-,(�7��+07&+$ sterile

P.403 6. ก. Ionic strength

Because D? กก+(-,(�7�7+D70�,+ �.0 1. Sterility 2. Clarity 3. pH and buffer 4. Isotonicity 5. Preservative

7. ก. Benzalkonium chloride Because Preservative��K)*�07&+$ก'�+$9'+$)!7+,+ �.0 Benzalkonium chloride

8. 9. Water for injection Because 7+,+,�0$-,(�7�)!(�55(+Y"+ก-*./0 (Sterile technique)

9. 9. Aseptic technique Because -5>!-��!����K5j0$ก !%�&)D�-*./0"�?�!�(�7k5!-5lm0!?$%5)!7+��KกC+? $-,(�7�07�&

10. ". Stability test Because ,�0$U&$7+%5n($Q7+;+?*��*! R#K$0+",�0$)*�-'?+!+! 8?:4&+!U�K$8'�?�0�D?+7U�+':ก&0!":J#$-5j+D�+7

11. 2. )D�4��56'7D70�,+ก&0! "+ก! /!0�ก5(:�+o 5 !+�� "#$5j+7��'77+5j+7,+ Because )D�4��56'7D70�,+ก&0! "+ก! /!0�ก5(:�+o 5-10 !+�� "#$5j+7��'77+5j+7,+ 8,&J�+-5>!7+D70�,+ 2 *!�� กI)D�-'�!(:7:-'?+5(:�+o 1-5 !+��

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P.404 1. ก. Amoxicillin

Because Amoxycillin -5>! first choice )!ก+(( ก<+ Otitis media (D�* /!ก?+$0 ก-U;) D+ก�./0 amoxicillin �&07-5?�K7!%5)*� erythromycin

2. $. Steroid Because 7+ก?�&� steroid �C+)D�-ก��ก+(-5?�K7!85?$90$ mucopolysaccharide ��K;(�-'o trabecular meshwork

*&0$(:;+7!/C+)!?�ก,+ (intertrabecular space) 8�;-9�+

U+(!/C+)!?�ก,+ (aqueous humour) (:;+700ก%�&%��

�'+�� !)!?�ก,+U�$9#/!

,�0D�! (glaucoma)

7+ก?�&� steroid �C+)D�-ก��ก+(-Q�K��'+�� !)!D?0�-?.0��C+;(�-'o-7.K0;�4! $?�ก,+ (episcleral venous pressure)

ก+(%D?-'�7!90$!/C+)!?�ก,+ (aqueous outflow) ?�?$

�'+�� !)!?�ก,+U�$9#/!

,�0D�! (glaucoma) 3. $. 4&+, �-5?�K7!-?!Uk,+

Because ก+(( ก<+,�0D�! �.0 ?�ก+(U(�+$ aqueous humour 8?:-Q�K�ก+((:;+700ก90$ aqueous humour -Q.K0)D��'+�� !)!?�ก,+?�?$ R#K$��ก�C+,0; 7ก-'�!9�0 $. -5>!'���ก+(( ก<+ 8,&D+ก,�0$ก+(4&+, �( ก<+,�0D�! กI":-5>!ก+(4&+, �-5r��+$-��!!/C+-?�/7$,+ %�&)*&ก+(-5?�K7!-?!Uk,+ (-?!Uk,+4��5ก,�%�&)*&U+-D,�90$,�0D�!...":-5?�K7!%5�C+%�)

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4. $. !'���K-5?.0ก,+ 2-3 !+�� 5. �. Miotic

Because Pilocarpine -5>!7+ก?�&� miotic 00ก�����n�7-Q�K�ก+((:;+790$ aqueous humour -!.K0$"+กก+(D�, '90$ ciliary muscle %5�#$ trabecular meshwork �C+)D�?�8($,�+!,&0ก+(%D?90$U+(!/C+)!?�ก,+ �'+�� !)!?�ก,+"#$?�?$

6. B. Timolol Because ก+(( ก<+8;;-(&$�&'! -Q.K0?��'+�� !)!?�ก,+)D�,KC+?$n�7-(I'��KU��ก&0! � $!�/ 1.)D�7+ก?�&� beta blocker -*&! 0.5% timolol 1 drop 2.)D�7+ก?�&� carbonic anhydrase inhibitor -*&! acetazolamide 2 tab. 3.)D�7+ก?�&� osmotic -*&! 50%glycerine 2ml/wt.1kg 4.D? $"+ก! /! 30!+�� -�.K0�'+�� !)!?�ก,+-(�K�?�?$ )D�7+ก?�&� miotic -*&! 4%pilocarpine D70�,+��กw 15!+�� -5>!-'?+2 �( /$ 5.ก(o���K4��56'7%�&U+�+(J( ;5(:�+!%��D(.00+-"�7! )D� 20%mannitol 5ml/wt.1kg IV drip30-45!+��

7. $. Metamphetamine

Ephedrine

Metamphetamine P.405

1. ก. 0+7� Because ��)�(-5>!;�+$>>>J�+,���+"+ก�!0.K! กI!&+":-ก��"+ก-*./0%'( U

ก�!7+0:%(�+;�+$>>>":%��%�&"&+77+R/C+R�0! 8Q�7+0:%(>>>7 $%$กI,�0$J+�0&:

��0+ก+(0.K!w0�กD(.0%�&>>>J�+-ก����9�/,+(&'���'7 กI!&+":-ก��"+ก8;���-(�7 J�+��0+ก+(� ! กI!&+":-ก��"+กก+(8Q� 2. ก. %'( U

Because -*./0��K-5>!U+-D,�%��8ก& adenovirus � ก":(:;+�)!*��*! n($-(�7! ��K�C+$+! ก+(,��,&0� ก":,��,&0n�7ก+(U �4 U�+$�.0 -�(.K0$�.0 U(:'&+7!/C+ 0+ก+(��KUC+� T�.0,+8�$-Z�7;Q? ! !/C+,+%D? -7.K0;�,+;'� ,&0�!/C+-D?.0$D!�+D�n, -�.0$,+-?Iก!�07

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;+$(+70+"":��-?.0�00ก��K,+9+' 0+"":-5>!9�+$)�9�+$D!#K$ก&0!8?�'�&07?+��+0�ก9�+$D!#K$ 8?: ,+%�&��D!0$ 8U�$'&+%�&)*&8;���-(�7

3. ก. Decadron (Dexametasone) eye drop Because -!.K0$"+กn(�!�/,��,&0n�7ก+(U �4 U"#$8!:!C+)D�D?�ก-?�K7$U �4 Uก ;�!0.K!-5>!-'?+ 7 ' !! ;, /$8,&-ก��0+ก+( ก+(( ก<+-5>!-Q�7$5(:� ;5(:�0$n�7ก+(5(:�;-7I! 7+D70�,+ %�&���'+�"C+-5>!,�0$)*�7+5=�*�'!: 8?: %�&�'()*�7+��K��U&'!4U�90$ steroid -Q(+:":�C+)D�D+7*�+

4. 9. 7+��K-5r�)*�8?�' ":-กI;%'�%�� 4 U 5�+Dk Because 7+D70�,+ !/C+7+?�+$,+ ��K-5r�9'�8?�' �'(-กI;)!,��-7I!*&0$�((��+(2-8°C) U+�+(J-กI;%��%�&-ก�! 1 -�.0!

5. ก. ?�+$,+;&07w Because �C+8!:!C+��K�� �.0 %�&)D�-ก��ก+(,��,&0%57 $4��0.K!%��0�ก R#K$�C+,0;��ก9�0-5>!ก+(?�ก+(,��,&090$n(�%5U�&�!0.K!%�� 7ก-'�!9�0 ก. 8?:ก+(?�+$,+;&07w":�C+)D�,+8D�$

6. ". -"I;�0 Because -"I;�0-5>!0+ก+(��K-ก��9#/!%��D+ก-5>!n(�,+8�$��K-ก��"+ก%'( U D+ก��0+ก+(,&0%5!�/ )D�(�;Q;8Q�7k

• ,+� '?$ • 5'�,+�+ก9#/! • ก(0ก,+8?�'5'� • %9� • )D�7+%58?�' 48 * K'n�$%�&��9#/! • !/C+,+7 $%D?07�&8��'&+":%��7+�(;8?�'

7. 9. S.aureus Because -5>!ก+(,��-*./0 staphylococus 90$,&0�-5?.0ก,+ "!5(+ก=-5>!? ก<o:,�&�D!0$ n�7J�+-5>! external hordeolum ":-5>!ก+(,��-*./0��K gland of Zeis D(.0 gland of Moll 8,&J�+-5>! Internal hordeolum ":-5>!ก+(,��-*./090$ meibomian glands 4��56'7":��0+ก+( -5>!ก�0!5'� ;'� 8�$ (�0! ��K;(�-'o-5?.0ก,+ n�70+"":-5>!D?+7ก�0!กI%�� 0+"":�0$-DI!* ���+!)!D(.0��+!!0ก-5?.0ก,+9#/!ก ;*!��90$ก��$7�$ )!ก(o���Kก�0!8,ก00ก":��9�/,+ ก+(( ก<+�C+%��$&+7wn�7ก+( 5(:�;0�&! ' !?: 3-4 �( /$ )*�7+5|�*�'!:D70�,+ -*&! poly-oph, chloramphenicol D(.0)!ก(o���Kก�0!n,กI-"+:-0+D!0$00ก n�7J�+-5>!��+!!0ก":ก(��(0784?9!+!ก ;-5?.0ก,+ 8,&J�+-5>!��+!)!":ก(��, /$Z+กก ;-5?.0ก,+

8. 9. Sulfacetamide eye drop Because 9 /!,0!ก+(( ก<+ �.0

1. )*�7+5j+7,+5=�*�'!: D(.07+D70�,+5=�*�'!:��K�(0;�?��-*./0 Staphylococcus R#K$ Sulfacetamide %',&0-*./0 Staphylococcus aureus, Escherichia coli,Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.

2. D+ก0+ก+(%�&��-?+ "#$)*�7+ก�!ก?�&� Penicillin -*&! Cloxacillin

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P.406 9. �(� 10. c. Miotic

Because : Miotic = contraction of the pupil. Pharmacologic category: cholinergic agonist, antiglaucoma, miotic 11. c. Decongestant

Because Decongestant -*&! Phenylephrine �C+)D�-ก��ก+(D�, '90$D?0�-?.0�)!-7.K0;�"��ก "#$?�0+ก+(� �8!&!"��ก 8?:�C+)D��'+�� !)!?�ก,+U�$%��8?:7 $00ก�����-5>! Mydriatic R#K$00ก�����,($9�+�ก ; Miotic ��K( ก<+,�0D�!

12. b. 7+!�/)*�8?�'�'+�� !?�ก,+-Q�K�9#/! �C+)D�,+;0�%�� Because Glucocorticoid induced increase in IOP. Glucorcorticoid reduce the facility of aqueous humor outflow through the trabecular meshwork. The decreased of facility of outflow appears the result from the accumulation of extracellular material blocking the tabecular chanels.

13. a. 7+0 !,(+7 Because 7+"C+Q'ก�0(k,�n�U-,0(07�k( Corticosteroids )��K%��"+ก�((�*+,� D(.0��K%��"+ก ก+(U $-�(+:DkUC+D( ;)*�-ZQ+:��K " �-5>!7+0 !,(+7

14. a. -�U *ก( Because 7+0 !,(+7U+�+(J"C+D!&+7%��� K'%5)!(�+!9+77+ (97. 1) n�7%�&"C+-5>!,�0$��);U K$8Q�7k 8,&-�U *ก(,�0$�';���ก+(9+78?:ก+("&+77+

15. b. Physostigmine Because Physostigmine -5>!7+( ก<+,�0D�!��K00ก�����-D�.0! Pilocarpine

16. e. !'���-5?.0ก,+ 2 -3 !+�� 17. d. Chloramphenicol 18. �(�

D!�+ 407 1. a. Otitis Media

because -�Iก�� discharge 00ก�+"+กD� J�+ -5>! Otitis externa ":��0+ก+(� !(&'���'7 8?:J�+-5>! Tinnitus D(.0 D�0./0 ":-ก��ก ; D�* /!)! %�&�� discharge U&'! influenza !&+":-ก��"+ก virus R#K$ discharge ":)U 8,&-�Iก�!!�/ �� discharge U�9+'9�&! Sinusitis � %R! U0 ก-U; %�&!&+�� discharge 00ก�+"+กD� 8?: tonsillitis กI!&+":-"I;�0 �08�$ %�&!&+":-ก�K7'ก ;D�

2. d. Straphylococcus saprophylicus because Straphylococcus saprophylicus -5>!-*.K0��KQ;)! UTI -5>! coagulase-negative species of Staphylococcus bacteria R#K$%�&!&+":�C+)D�-ก�� Otitis media U&'! Streptococcus pyrogenes -5>! -9.K0)! Strep. Gr. A. (wikipedia) R#K$-5>! common bacteria ��K�C+)D�-ก��D' �8?:��%9� )!-�Iก R#K$-*.K0� ! relate 8?:4&+! Eustachian tube %57 $ D�%�� -!.K0$"+ก Eustachian tube 7 $%�&* !Q0 �C+)D�-ก�� Otitis media %�� U&'! Strep. Pneunomiae (found in children > 6 years) 8?: H. influenza (found in children < 6 years) -5>! causative agent D? ก ��K�C+)D�-ก�� Otitis media 8?: Staphylococcus aureus Q;%��"+กก+(87ก-*./0�+ culture "+ก otitis media patient

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3. c. amoxicillin -Q(+:'&+� !�(0;�?��-*./0 Q'ก strep. staph. 8?:-5>! first line drug for otitis media U&'!9�00.K! ?�'!-5>!7+��K%�&U��'()*�

)!-�Iก0+7�-�&+!�/07�&8?�' Norfloxacin -> ��4?,&0ก+(-"(�T90$ก(:��ก tetracycline �C+)D�-ก�� bone discoloration chloramphenicol -ก�� Grey�s syndrome )!-�Iก8?: Sulfamethoxazole �C+)D�-ก�� Kernicterus

4. a. �������-5>! bacteriostatic -Q(+: Amoxicillin -5>! bacteriocidal

5. b. ( ;5(:�+!7+�( /$?: ½ *�0!*+ ' !?: 3 �( /$ -Q(+: "+ก dose 5ก,�90$7+-5>! 20 mg/kg/day -�Iก�!!�/D! ก 9 kg ���-5>! 20*9=180 mg/d J�+)D� ¼ *�0!*+ ' !?: 4 �( /$ ":%��7+-5>! 125 mg/day %�&J#$dose��K,�0$ก+( J�+%�� ¾ *�0!*+ ' !?: 3 �( /$ ":%��7+-5>! 270 ก'&+w dose -ก�! 8?:!0ก! /!กIdose-ก�! 6. b. 2 9'�

-Q(+: 4��56'7,�0$%��( ;7+ 14 ' ! )! 1 ' ! )*�7+%5 7.5 ml ":%�� 7.5*14 = 105 ml �.04��56'7,�0$%��( ;7+07&+$!�07 105 ml R#K$)! 1 9'� �� 60 ml � $! /!4��56'7(+7!�/ �'(%��( ;7+07&+$!�07 2 9'� (120 ml)

P.408 7. b. )*� 25% NaHCO3 6 ml 8?:5( ;5(��+,()D�%�� 30 ml

25% NaHCO3 D�+7�'+�'&+ �� NaHCO3 25 g. in solution 100 mL. )*� aliquot method -��7;-5>! 25% 5 = )*� 25% NaHCO3 5 U&'! "+ก 25 U&'! 5% 0% 20 = )*� 0% NaHCO3 5 20U&'! "+ก 25 U&'! � $! /! 5 U&'! 90$ 25% NaHCO3 �.0 30 x 5 = 6 ml. 25

8. a. Antioxidant -Q(+: ก+(-,(�7�7+)*�)!*&0$D� �'(D?�ก-?�K7$ก+()*�!/C+ก(:U+77+��K��!/C+-5>!U&'!5(:ก0; -Q(+:!/C+0+"J�ก5!-5lm0!"+ก-*./0 8?:-Q�K��'+�-U�K7$��K�C+)D�-ก��ก+(,��-*./0)!*&0$D� "#$%�&"C+-5>!,�0$)*� antioxidant )!,C+( ; 9. d. 5( ;�&+�'+�-5>!ก(�-�&+$ 90$,C+( ;)D����&+�+กก'&+�&+ pKa -Q(+: �C+)D� pH > pKa of solution 10. d. Tonicity test

-Q(+: 7+,+,�0$�C+!#$J#$ tonicity U&'!90$7+D� %�&�&07R�-(�7U-(.K0$!�/ "#$�C+)D�U+�+(J !C+7+,+�+)*�ก ;7+D�%�� 8,&-0+7+D��+)*�ก ;7+,+%�&%��

Case study D!�+ 408 (0 !!�/-��+-Z?7-0$!: -Q(+:-Q.K0!%�&U&$�+)D�) 1. e. n(�,�0D�! 2. d. ก+(( ก<+U+�+(J)*�7+D70�,+ atropine -Q.K0�';���0+ก+(%��

Total = 25 U&'! �.0 30 mL.

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3. a. Timolol 4. a. 0.1% Diclofenac ED 5. b. hypertonic solution 6. c.��ก+(ก(0$U+(?:?+7��'7 filter 0.45 micron 7. d.creams 8. a.dexa+chloram 9. a. 10. a. Diclofenac ED

Case #$� 2 ���� 411

1. c. 7+D70�,+ chloramphenicol + 7+ก�! cloxacillin -Q(+: 0+ก+(��Kก?&+'�+9�+$,�!-5>!0+ก+(90$,+ก��$7�$�.0��ก�0!;(�-'o-5?.ก,+ 5'� ;'� -"I;8?:(:�+7-�.0$

2. Ans - Tonicity ,�0$�C+!#$-Q(+:;(�-'o,+��-U�!-?.0��0707�& J�+tonicity%�&-D�+:U�กI":�C+)D�-U�!-?.0�8?:-�I�-?.0�-,&$8?:-D�K7'%�� -0!��+�85?ก5?0� -Preservative -Sterility -Buffer 3. Ans -Tonicity - pH 4. Ans -กI;)!,��-7I!*&0$�((��+ 0�oD���� 2-8°c -กI;%��!+! 1 -�.0!-�&+! /! J�+)*�%�&D��กI,�0$��/$ 5. Ans U&'!5(:ก0;90$7+,+ 5(:ก0;��'7 1., '7+UC+� T 2.Vehicle )*�5( ; pH 3.Preservative -)*�5j0$ก !-*./0,&+$w -*&! pseudomonas aeruginosa R#K$�C+)D�,+;0�%�� -,�0$-,��preservative -!.K0$"+ก��ก+()*�7+D?+7�( /$8,&J�+":%�&-,��กI,�0$ �C+)!(�58;;��K)*��( /$-��7' )!7+,+!�7�)*� Benzalkonium chloride

4.Stabilizer 5.Surfactant 6.Thickening agent �C+)D�7+07�&)!,+%��!+!9#/! ?�ก+(กC+" �7+00ก Bioavailability ��9#/! 6. Ans !/C+,+-��7�5(:ก0;��'7U+(��KU+�+(J)D��'+�*�&�*./!,+ ���'+�9�!D!.��C+)D�U+�+(J07�&)!,+%��!+! -*&! methycellulose D(.0 polyvinyl alcohol ;(("�07�&)!9'� R#K$U+�+(J)*�!+!D?+7' ! R#K$"C+-5>!,�0$ก+()*�U+(ก+(-U�7 (preservatives) -Q.K0)D�U+�+(J-กI;7+9'�!�/%��!+! w n�7U+�+(J5j0$ก !ก+(5ก-5lm0!90$-*./0n(� ��K0+"-9�+%5)!9'�9o:D70�%�� R#K$U+(ก !-U�7!�/กI0+"�C+)D���ก+((:�+7-�.0$D(.0ก+(8Q�,&0-7.K0;�,+ -(+0+" U+�+(J8;&$*!��90$!/C+,+-��7�,+�ก+()*�U+(ก !-U�7-5>!5(:-��,&+$ w ก ! %��8ก&

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1.!/C+,+-��7���K��U+(ก !-U�7 ก?�&� Benzalkonium chloride -5>!!/C+,+-��7���K;(("�)!9'�5(:�+o 10-15 �?. U+�+(J)*�D70�,+,&0-!.K0$%��5(:�+o 1 -�.0!D? $"+ก-5r�9'� 8,&��9�0-U�7�.0 U+(ก !-U�70+"�C+)D�-ก��ก+(8Q�(:�+7-�.0$,&0-7.K0;�,+-U�7-0$ D(.0ก+(5!-5lm0!)!ก(o���K-กI;%'�!+! w

2.!/C+,+-��7� *!����K%�&��U+(ก !-U�707�&-?7 %��8ก& !/C+,+-��7���K;(("�)!ก(:-5+:-?Iก w )*�D��' !,&0' ! 9�0���.04��56'7":%�&��0+ก+(8Q�-?7 8,&��9�0-U�7-�.K0-5r�)*�8?�'":,�0$)*�)D�D�� )!D!#K$' ! 8?:��(+�+U�$ก'&+*!��0.K!

5S""�; !��ก+(Q �!+!/C+,+-��7�n�7ก+()*�U+(ก !-U�7��KU+�+(JU?+7, '-0$ %��-�.K0J�ก8U$8�� -5>!ก?�&� Nonperoxide Purite R#K$��5(:n7*!k)!��+!90$�'+�5(:D7 �8?:ก+(8Q�U+(ก !-U�7%�� n�7U+(*!��!�/":U?+7, '-�.K0J�ก8U$ 8?�'ก?+7-5>!-ก?.0��K%�&��4?9�+$-��7$,&0-7.K0;�,+ 7. Ans ��oU�; ,�90$7+D70�"��ก -0!��+�7+-?Iก -pH 8?: partition coefficient -Solubility of drug -Morphology ,�0$ก?�w-?Iกw":%��'�K$%5%ก?w ก+(-Q�K�5(:U�����+Q7+"��ก -0+")U&Q'กpolymer -Q.K0)D�D!.�":%��-ก+:,��"��ก%��!+!w-*&! methycellulose, hydroxypropylcellulose -5>!,�! -)U&U+(*&'7)!ก+(���R#�-*&! polymer ;+$, ' ,0!��K00ก������ !0+"%5�C+)D� cell 97+7�C+)D����R#��� 5S"" 7-ก�K7'ก ;ก+(00ก�����8?:,C+8D!&$ก+(00ก�����)!"��ก -�'+�D!.�, 8($,#$4�', design pump )D�-D�+:U�, 9!+�0!��+�, 5(��+o��K)*� 8. Ans 7+D70�D��?�+77+,+8,&%�&serious)!-(.K0$tonicity-�&+%D(& 7+,+;+$, 'U+�+(J)*�D70�D�%��8,&-0+7+D��+D70�,+%�&%��

7+D���U&'75(:ก0;��K�?�+7wก ;7+,+8,&,&+$ก !,($7+D��� -Cerumem preparation -5>!7+?:?+79�/D� 7+":%��-9�+%5%�� -Cerumenolytic agent -5>! carbamine peroxide

7+D���� $!�/ -7+?�+$D�(irrigation solution) -7+D70�D�UC+D( ;กC+" �9�/D�(cerumen removing preparation) -7+5( ;U�+Q�'+�-5>!ก(�(re-aciditying agent) -!/C+7+�&+-*./0(antiseptic) 9. Ans propylene glycol ����oU�; ,�-5>! hygroscopic (����'+�*./!) 8?:7 $U+�+(J-Q�K��'+�D!.�)D�ก ;,C+( ;8?:�������)!ก+(�&+-*./0��'7 10. Ans Vehicle 11. Ans b. )D�4��56'7D70�,+ก&0! "+ก! /!0�ก5(:�+o 5 !+�� "#$5j+7,+ 12. Ans d. hyperglycemia �.0U K! ก(:'!ก(:'+7 !0!%�&D? ; -Q(+: Adverse effects

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o Cardiovascular effects include hypotension and arrhythmias (eg, sinus tachycardia, premature ventricular complexes, atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation).

o Gastrointestinal effects include nausea, vomiting, diarrhea, and abdominal pain or cramping. o Metabolic effects include hypokalemia, hyperglycemia, hypercalcemia, rhabdomyolysis, and acidosis. o Neurologic effects include headaches, restlessness, tremors, disorientation, hallucinations, insomnia, and seizures.

13. Ans 4. a,b,c -Q(+: Its toxicity is increased by erythromycin, cimetidine, and fluoroquinolones, such as "cipro" (ciprofloxacin). It can reach toxic levels when taken with fatty meals, an effect called dose dumping.

P.412

14. Ans c. Prolong high cAMP level )! mast cell n�7ก+(7 ;7 /$ phosphate diesterase R#K$-5?�K7! AMP -5>! 5�AMP -Q(+: Pharmacology Several mechanisms have been proposed which include the inhibition of phosphodiesterase to increase intracellular cAMP levels. However, the concentrations of theophylline required to produce measurable increases in cAMP are far outside the levels at which there is a clinical effect. Theophylline is an antagonist of adenosine at pharmacological doses, but a theophylline analogue, enprofylline, does not antagonise adenosine yet still retains potent bronchodilator activity. Recently, theophylline has also been shown to have some anti-inflammatory activity, inhibiting the activity of CD4 lymphocytes in vitro and mediator release from mast cells, and can inhibit bronchoconstriction produced by exercise and challenge testing.

15. ก+(, /$,C+( ;7+ theophyllin syrup ��'���-,(�7�7+!/C+-*.K0�)U07&+$%( 16. Ans c. D ก-�I�7+-5>!U �U&'!��K-D�+:U� 8?�'ก?.!Q(�0�!/C+

-Q(+: 7+TheophyllineU+�+(JD ก8;&$D(.08ก:8�5R�?00ก%��8,&D�+�;� -��/7'D(.0�C+)D�-�I�7+�+7)!8,ก

Case D!�+ 412

1. Ans b. ,�0D�! -Q(+: 0+ก+(90$,�0D�! �.0 ��0+ก+(�0$-DI!%�&* � -�.K0�0$8U$%�":-DI!(��$ก�!!/C+-5>!'$w 5'�,+ 5'�Y�(<:

2. Ans n(�,�0D�!�� 2 5(:-�� �.0 1. Open angle glaucoma

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-5>!*!����KQ;;&07��KU��90$,�0D�! -ก��"+กก+(%D?-'�7!90$!/C+D?&0-?�/7$,+0��, ! �C+)D��'+�� !)!?�ก,+U�$ (intraocular pressure IOP) 4��56'7":%�&��0+ก+( %�&��U TT+o-,.0!D+ก%�&Q;กI":��ก+(-U.K0�90$U+7,+ ,�0D�!*!��!�/,0;U!0$��,&0ก+(( ก<+��'77+

2. Angle closure glaucoma

Q;%�&;&07 -ก��-�.K0���(:D'&+$ iris 8?: cornea8�; ,�0D�!*!��!�/":-ก��0+ก+(07&+$-Z�7;Q? !-!.K0$"+ก��ก+(0��90$(:;;�&0(:;+7�C+)D��'+�� !)!?�ก,+-Q�K�9#/!07&+$('�-(I' 7+;+$*!��D(.0ก+(��K07�&)!��K�.�":�C+)D�(��&+!,+97+7กI":�C+)D�-ก��,�0D�!*!��!�/%�� 0+ก+(��KUC+� T�.05'�Y�(<: 5'�,+ �?.K!%U�0+-"�7! -DI!8U$-5>!U+7(��$(0;�'$%�8?:,+� '?$ D+ก��0+ก+(!�/,�0$(�;Q;8Q�7k-Q(+:D+ก*�+":�C+)D�-ก��ก+(�C+?+75(:U+�,+ ก+(( ก<+� ก":,�0$4&+, �

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3. Ans a. Beta blocker ED

4. Ans b. ?�ก+(U(�+$ aqueous humer "+ก ciliary body

5. Ans e. J�ก��ก9�0 -Q(+: ก+()*�BB �C+)D�-ก�� stinging , dry eye , corneal anesthesia , blurred vision

P.413

6. Ans 7+D70�,+)!ก?�&� BB ��9�0�'((:' $)!4��56'7 CHF , asthma , COPD

7. Ans n(�,�0D�!*!�����-5r� -ก��"+กก+(0��ก? /!90$5+ก�+$-9�+ Canal of schlemn �C+)D�U+(!/C+)!?�ก,+%D?-'�7!%�&U:�'ก �C+)D���0+ก+( ก+(�0$-DI!?�?$, ?+!U+7,+4��5ก,� , �'+�� !)!?�ก,+U�$ >21 mmHg , 5'�,+ , 5'�D ' , �0$-DI!(��$(0;�'$%�

8. Ans a.-Q�K�ก+((:;+7 aqueous humer �+$ trabecular outflow

9. ;0ก0+ก+(

,�0ก(:"ก ��0+ก+(,+� '�+ก9#/!-(.K07w � '-D�.0!��D�0กD(.0�j+9+' ;+$(+7,+� '-�.K007�&)!��K8U$"�+w (:7:U����+7-?!Uk,+��U�9+'9�&!

,�0D�! ��0+ก+(-DI!%�&* � -�.K0�0$8U$%�":-DI!(��$ก�!!/C+-5>!'$w 5'�,+ 5'�Y�(<:

,�0-!./0 -ก��-7.K0U�9+'w;+$w-ก��9#/!��K9�+$w,+�C+ -5>!84&!"+กD ',+D(.0D+$,+?+�-9�+%5)!8ก�',+ �C+)D��0$%�&-DI!

10. Ans

Case ���� 413

1. Ans Otitis Media

2. Ans 4) J�ก��ก9�0

%��8ก& ก+(R ก5(:' ,� 4��56'7��!/C+D!0$%D?00ก�+"+กD�D(.0%�& , ก&0!D!�+!�/-5>!n(�07&+$0.K!�+ก&0!D(.0%�& -*&! D' � , 8Q�7+0:%(D(.0%�& , %��%5Q;8Q�7k�+ก&0!D(.0%�& , �+!7+0:%(�+8?�'

3. Ans b) 6-12 5�

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4. Risk factor 90$ Otitis Media �.0 -5>!%9�D' �?$�0 U K$!/C+��ก8($

1. 0+7� : -!.K0$"+ก-�Iก-?Iก":��n0ก+U-ก��ก+(0��, !90$�&07�U-,-*�K7!%���+กก'&+-�Iกn, 2. -QY : Q;)!-QY*+7%���+กก'&+-QYDT�$ 3. ก((�Q !��k : D+ก��Q&0 8�& Q�K !�0$ ��K-5>!D�0 ก-U;;&07w � กQ;'&+-�Iก":��n0ก+U�+ก

9#/!��K":-5>!D�0 ก-U;R/C+R�0! 4. D' �8?:����8Q� : � /$ 2 �+':":�C+)D�-ก��ก+(0��, !90$�&07�U-,-*�K7! 8?:!C+%5U�&

�+':,��-*./0%��;&07w 5. ;�D(�K : Q;'&+ก+(U�;;�D(�K90$;���?)!;�+!-��7'ก ! D(.0)!7+!Q+D!:��K-�Iก-��!�+$ �C+)D�-�Iก��5STD+U�9�+Q%��

D?+75(:ก+( ('�� /$ก+(,��-*./090$D�* /!ก?+$��'7 6. ก+(���9'�!� : n�7-ZQ+:ก+(!0!���!�":�C+)D�D�0 ก-U;%��;&07ก'&+-�Iก��K���!�

8�& D+ก"C+-5>!,�0$)D�!�9'��'()D�)!�&+��KY�(<:-�Iก07�&U�$ก'&+ก(:-Q+: -Q.K0?�ก+(UC+? ก8?:0��, !90$�&07�U-,-*�K7!

5. -*./0��K-5>!U+-D,�D? ก

• Streptococcus pneumoniae • H. influenzae • Moraxella catarrhalis

6. 7+��K)*�)!ก+(( ก<+

• First line : Amoxicillin 40-90 mg/kg/day 8;&$)D� 2 �( /$ • Second line : Agmentin , cefaclor • ก(o�4��56'78Q� penicillin : )*� roxithomycin , clarithomycin , azithromycin

8. Ans d. Azithromycin 10 mg/kg )!' !��K 1 8?: 5 mg/kg )!' !��K 2-5

9. -97&+4$7+)D�(&'! 8?�'-,��!/C+,��U�ก��K-7I!8?�')D�%��5(:�+o�(#K$90$9����KกC+D!� 8?�'-97&+)D�4$7+?:?+7 8?:-,��!/C+)D�Q0��9����KกC+D!� 8?�'-97&+0�ก�( /$

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86 ���� MCQ ���� Neurology and Psychiatry

��� ������, ������, ���, ��, ���� , �������� ����������� ����� ��� ��!�

���� 414

"# $� 1 Carbidopa .�#����ก� Levodoopa ��$��� ����� Dopamine ������ก Levodopa 67ก metabolize $� peripheral tissue �����>?�@ L-AAAD (L-Aromatic Amino Acid Decarboxylase) ��H� dopamine ?I� J�.�#������" Levodopa $���67ก���$�����H� dopamine $������ �I�$ก��.�# Levodopa ����ก� L-AAAD inhibitor ?I�>�#�ก� benserazide ��� carbidopa ��������������� Levodopa $���67ก���$�����H� dopamine .��� "# 2� methadone .�#ก��ก��6��� (withdrawal symptom) $��ก����กก���#���M��ก heroin ��� opioid .�#��กM��ก��6��� (withdrawal symptom) "N7#�O�� $�>�#�� ��.�ก�P�� Opioid ���� ���ก#��� Tramadol, Morphine ��� ��กM�N7#�O�� $������������� ���� Heroine ������ก���������$V��>�ก���P#� Mu-opioid receptors ���>��� ��Vก���J���$�ก�� " NE and 5-HT $���������� ����ก���ก������� ��ก>��>�#�� �����ก���ก�� ก����ก����� ��>����� ����ก #��$� ����� ��� ���.���!�"IV� �I��$�ก��� �ก��6��� �I.�# Methadone ?I���H���� opioid $���������@"IV�กZ [�\���( long-acting opioid agonist ) �� Mu-receptor ���$�ก������#�ก�����ก Short-acting "# 3 � �. MI N�" morphine .�ก�� ��� ��ก�����������������$�� $�.�#.�b��� acute MI ��V��ก����กก�� $� morphine >�ก� brainstem center ?I��� �P� sympathetic efferent activity J�.�#ก�� J���"�� ����� sympathetic ��� ��N�.�#��������J��� #����������"���ก��"�������ก! ����>�# J�.�#����>��ก�� �"#����.���� (�� preload) J�.�#���.� J�����������ก��.�# oxygen �I J�.�#�����6��� ���.�N7#�O�� MI >�#����#.�#.�"��� $��7ก��� $�.�#.�ก����� ����ก�� ������$ active metabolite �����6.�#��.��7�� ก���� ��� ��.�ก����� ก�� "# 4 � ". Mild anxiety ก���ก���������กก��� �$�����P��ก�����e���� ?I��e������I��� ������$.����ก��ก�� imbalance �����V��� Neurotransmitter ?I���H������������ $��� �P���� J�.�#�ก��ก�� ��ก����� �ก������P#�Iก���f6#���ก�ก������>�����P�"���������$V �� J�.�#������ก���ก�����กก������?I��g�#�>�# ����������� 2 ��� $��$N��������7#�Iก�Iก���"�� �� serotonin, NE, GABA���dopamine ����V�Imipramine ��H���.�ก�P�� TCA(Tri-cyclic antidepressant) กZ [�\�� ��Vก�� reuptake " neurotransmitter >�#�ก� NE, non selective 5-HT �I����.�#��กM����� ����������� .�#�7�.�b������P�>�# "# 5 � ก. ��>��� $� mu receptor �� J�.�#�ก���ก�� euphoria (�ก������V��P") ?I�6#�����H� mu receptor agonist ก!����H�ก�������Z [�\ euphoria �� J�.�#���>�# - 6#����� $� delta receptor $� J�.�#�ก�� spinal analgesia ���6#�����H� delta antagonist ก!�������6��Z [�\�ก#����$V>�# "# 6 � . ��, >"������, ��#������ ��� cell ��l����� "# 7 � ". Cell ����� ��� cell �VJ��P� "# 8 � �. ��H�ก������oo�� $��g��������$��H�����J���oo������� "# 9 � �. Threshold potential ก��������� �#6I threshold ก���I���ก�� EPSP ��� IPSP ����� "# 10 � ". Inhibitory control system 67ก�� ��V6#��$ก���� ��V����� ��V �� J�.�#ก����ก��������� J�>�#��ก"IV� "# 11 � ก. Glutamate "# 12 � ". GABA

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"# 13 � . Triglyceride TG ��H� >"��� ��� Second messenger ��H���� $��$��������.�ก��.�ก��� ���������N�������� "��������� Postsynaptic ?I�>�#�ก� cyclic AMP,cyclic GMP, inositol trisphosphate (IP3) and diacylglycerol (DAG) "# 14 � . >���$"#67ก ����� Pก"#�ก$���"#��� "# 15 � ก. Endothelium cell $�������� �?��@ PN���������s� (Endothelial cell) b��.������������ก��������������H� tight junction ������$��V�" lipid $���$�ก��� basement membrane $��7�� �ก ?I��$�����J���o.�ก���J�ก��.�#����กP��J���H� ������ ����V� $������6����N������� matrix >�# �V�$V�� $���N���>�#�$��������>�#�$.�>"��� �ก��ก��กM�����gM"���������#� �������6� "�"�?��@�ก�$����� Astrocyte �#��#��������b��.��� ?I��$�����J���o.�ก���J�ก��ก��N���"������f�"#��7���$ก�#�� "# 16 � . 67ก Pก"# �����N�������� $�67ก����ก���7�������������� ��67ก�Iก�� �"#��7���������� ���

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"# 17 � �. �� ��Vก����������@����������� .���������� "# 18 � �. Neurological disorder "# 19 � ? �����������"IV�ก� ��� $���H� "# 20 � ". Halothane ก. Ether >��.�#��#� ������ก��ก������������ก �. Chloroform >������.�# �����>�>v ����$��M���� ������.� . Cyclopropane ��H����ก���� �� ���ก�ก�����.� "# 21 �. ก��ก������#�ก�� (redistribution) �7������ก����������!��� thiopental ��H����7���ก�P�� barbiturates ?I������H���ก��� ����� ����ก�� �e��P ��� �����H��� $�����$�����J���o�����ก.� ������ก .�ก��.�# J�.�#�7o��$������7#�Iก ����������� !" �����ก�$����"#���������J� �������6 J�.�#N7#�O��������������oo�>�#b��.��������������� 20 ���� $ ����$Z [�\��7�>�#��� 5-10 �� $ ก�� $����$V�����6ก [�\>�#��!� ������ก�$�P��� ��������>�#�$.�>"����IN��� blood-brain barrier >�#��������!�

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ก������.�����">"��� ก��vxy�ก�� ��กก���7o��$������7#�Iก���ก��b��.����������� 5 �� $ ������ก���ก������#��7���H������������ ก��.�#��?VJ��� J�.�#��������ก���7o��$������7#�Iก������"IV�>�# ������กก������"��.����ก��

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"# 30 �. N7#�O���������ก $���H��o�����.�#���#������ก��������V���b@ �����lก����M"���� ��ก 31. �. Dopaminergic neurons .������� nigrostriatal pathway������@ก������ก����ก����N���ก��" nigrostriatal dopamine system ?I���H�������I�" extrapyramidal system

"# ก. ". . N�� (������$�� �V����7�.������ $���ก��� J� ���� 2 P.203 35. . 67ก Pก"# 67ก Pก"#��� (������$�� �V����7�.������ $���ก��� J� ���� 2 P.204) 36. . �� ��Vก�����$������ levodopa ��H� dopamine $����V�����ก�� "# . 67ก�# ����� carbidopa ��H������ ��V AAD 37. ก. �lก��ก���ก�� free radical ?I��$��M�����H�N����>�#��กก�� J���� dopamine Selegiline �$Z [�\�� ��V��>?�@ MAO-B $���H���� J���� dopamine .��� ������$Z [�\���P�7�������กก�� J���� dopamine �#�� 38. ". ���V���$ neurofibrillary tangles and senile plaque ��กก����ก�� ก. N�� (��.�o�>���ก$���) �. N�� (acetylcholine esterase ��กก����ก��� ����V���) . N�� ( Alzheimer}s disease ��H���� $��ก����ก Ach .������) 39. ". �ก�� ���� ����@����Z��ก��� ���� .����� ����ก��ก ��ก��# ������ ก. >�������������[@ก� Ach .��� $���� �. ��H� cholinergic effect

32. . 67ก Pก"#�ก�����ก"������@ก�����1). �ก������ Tremor �ก������"N7#�O�����@ก��������$��กM��������� ���$ก������>���>"��V��������������V���������� 3 ���V������ $ �� $�������ก� ก�ก�����������ก� ��กJ����ey���!��� pill rolling �����ก�ก�������ก���ก�� $��� ���ก!�$N7#�O��������I��ก�� $�� #� ���ก��� �ก����������H�"����ก ����H���ก�����ก���ก�����$�� �ก�����������>�������������� ����������กJ���.�#�� �ก����������H�"#���I�ก�� ���������H���ก�I����H� �V��� 2). �ก���ก�! Rigidity ���ก����������������>�����$ก�#�����V $����ก�! ���ก�#�����V�#����"#�����$ก��������� ������@ก�����ก�#�����V>���$ก����������I J�.�#ก��������>����H�>��#�������J� �ก ��ก����� ��N7#�O��������>�����$���#����H����������ก� �$����� cogwheel rigidity 3). �ก��������>���#� Bradykinesia N7#�O����������>���#�����J� �ก ������J� $������6 J��>�#����#.�#������ก 4). �7o��$�ก�� ���� Postural instability N7#�O����������#�6���� ��������������ก#����!ก?�6$�f J�.�#�ก�#�>�#��� 33. ". ��H� immediate precursor "dopamine levodopa An amino acid precursor of dopamine with antiparkinsonian properties. Levodopa is a prodrug that is converted to dopamine by DOPA decarboxylase and can cross the blood-brain barrier. When in the brain, levodopa is decarboxylated to dopamine and stimulates the dopaminergic receptors. 34. �. Levodopa ����.�o����$��������H� dopamine $����V�������f�ก�� "# �. 67ก�#������ �����.����V�����$��>?�@ AAD $���H���� ���$������ Levodopa ��H� dopamine $����V�������f�ก�� ���� Levodopa �"#������f��$���� 1%

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(�ก������.�#����� ��V acetylcholine esterase) 40. cholinergic antagonists ���� atropine Alzheimer}s disease ��H���� $��ก����ก Ach .������ �L��6�7�7? ���� 419-421 6�7 1-10 1) �. ?�ก�����������������������J�.�#>�� �� �@ N7#�O���$�ก����ก�ก�!������ ?I����$���������� �I���>�� �� �@����.�#�� �@?�ก6���ก��������$�����.�#ก����กM� $�67ก�# 2) d. 90 ���?7� 1*3 hs 30 ��� = 3*30= 90 3) �. ���ก"# A ������ก��H����$��#��$��ก�� �����6����� �ก��>�# ����#���$�����[$�� ��� ������H�ก�����V�� 2 ��!� ����� 3 ���V�� Phenytoin ��� brand ก�����$��� ก������� ������ bioavailability $����ก�� J�.�#�$N���ก����กM� $����ก������V��I������ก�� brand ���� ���������ก Dilantin 100 mg ��H� Sustained released ��� Dilantin 50 mg ��H� � Prompt released �I�#���$�����[$ก�� ���������H� �� ��� �����V�� 2 ��!� ����� 3 ���V 4) ก. Block PTP (Potential Tetanic Potentiation ) 5) �.ก�����$V�����ก����H�����J� Pก��� ��ก����ก�#ก�������ก�� Pก��� �#����� ��"������ 6) ก.�����I��$���" Phenytoin ��� ����������I��$���" Phenytoin 7) . �����"#�"#�"��.�ก�������� $������"IV�>����H�������������ก� "���"�� 8) ก. Gingival hyperplasia 9) �. N7#�O�������P�.�#�� Phenytoin �����7�ก�� �ก�� nystagmus ��H��ก��" Phenytoin overdose (��ก Serum conc. > 20 mg/L : nystagmus, > 30 mg/L: Ataxia, > 40/L: lethargy, confusion, coma) ����V� �I����$ก������� ���"#���f ��������6.�#��ก�P�� Benzodiazepines ��กM��ก�� nystagmus >�# ���>�������P��� ������ก�� J�.�#�ก���ก����กกJ���� >�# 10) �. ���$��.��7�� Phenytoin suspension .�#N��� ������ ก��.�#N��������.�ก��$ $��#ก��.�#��กZ [�\��!� $��P����.�#.��7� Phenytoin suspension ������ก�$��� salt factor =1 ?I���#� $�����������67ก�7�?I���� Case ���� 421

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��������� MCQ ������ Neuro & Psychi ��� ��!"� Black_cat

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1. �. Gingival hyperplasia ����� �ก �ก�����"�#$%"� "%� Carbamazepine *+�,-��ก./ Skin: Stevens-Johnson syndrome Nervous System: Transient diplopia, Abnormal involuntary movements(Ataxia) 2. �. Gingival hyperplasia ����� �ก �ก�����"�#$%"� "%� Carbamazepine 400 PO bid *+�,-��ก./ Skin: Stevens-Johnson syndrome Nervous System: Transient diplopia, Abnormal involuntary movements(Ataxia) Hemopoietic System: Agranulocytosis 3. #. Enzyme inducer Phenobarbital has been shown to induce a number of hepatic enzymes, including UGT. 4. . ,H�I./IJ กKL�MNL�OP�L�L � *+�,-�/QR %�S/� 5. ก. Cost effectiveness 6. ก. Phenytoin T$ half life %�O Half life T$#O�TUIกIJ�"T�กUP��VRLกKW dose � "ก���KWM��*�L%� X/%T$#J��YP$Z% half life � "��/KW%�*$Z#"*$Z,L�PQ /,H��OP� 22 HKZOXT" �LQZ " �ก%� Phenytoin �%KW%KR"ก���MP$Z%LUMP"IKO� " /K"LKRL��/KW%�,L�PQ /#"*$ZL�L-P�% �*.I%[ 7. #. Mental retardation 8. . NSAIDs Consider taking non-steroidal anti-inflammatory drugs (NSAIDs) like celecoxib, ibuprofen, or indomethacin. Statin drugs (eg. Vytorin), used to treat high cholesterol, may help lower your risk of Alzheimeras Disease. 9. #. IKR"#��c[ d��-Ie� "X�#PTHKก X�#PTHKก�ก./S/� �ก-P�% f d��-Ie M��T�g 70 % �-�d��-IeSTJ�W UP� $ก 30 % � �ก./ �กd��-IeIJ�" f /K"IJ SML$R 1. UiP�MNL,LdT " �HJL �กก��I./�HQR � "dT " eWKI.�-IeIJ dT " HKก�g�S��dj",LOK%�/kก 2. X�#*�"ก�% �HJL c�O��กPQ Xl�/$%T,L�J�"ก�%dj"-�Q IZ+� LR+�I�P,L�PQ /dj"-�Q IZ+� X�#IKW X�#SI 3. ก��/QZT�-P�� ก.L%�W�"HL./ -�Q S/��KWd���.m 4. c�O�T$ก� L,LdT " �HJL �LQR " ก,LdT " �%�n.,LdT " -�Q -P /�PQ /dT "IKL -�Q UIก 5. X�#*�"ก��T�KLne[ 10. #. Complex HKกUWW*+� �S�X/%STJ�j�dVกIKO (complex partial seizure -�Q CPS) �MNL �ก��HKก*$Z�WWJ %*$Zde/ UIJWJ %#�KR" �����, i./OJ�T.,HJ �ก��HKก �ก��#Q ij�MoO% �djp�d$%ก���KW�j�d.Z"� WIKOSM*KL*$ I� � " -�Q �-TJ P % � L.Z"#��",L*J��/.T-�Q � *+�"�LIJ SMX/%STJ�j�dVกIKO W�"��% � T$ก���#PQZ LS-O*$ZSTJT$ e/M��d"#[X/% KIXLTKI. �HJL �#$R%O-�Q /j/�.TqrM�ก sjTQ #P+�-�d.Z"� " �j/#+�lR+� f -�Q �/.LSMT� �MNLI�L ��-OJ�"�MNLij�MoO%W�"��% � � �j�dVกIKO�-TQ L#�VZ"-PKW#�VZ"IQZL UIJI WdL "IJ #L� W���"STJS/� s�� KW-�Q TK/ � T$ก��IJ dj�/.RL�L �ก��TKก�ก./L�L 2-4 L�*$ -�%UP�O � dKWdLUP� +��-Ieก��g[*$Z�ก./�VRLSTJS/� 11. #. ��%�ก���Kกm� ก��,H�%�

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12. ". STJI��LกKWU�" �กก��HKก STJ#O�ijกTK/-�Q IJ dj�กKW#LS�� �ก��HKก�TQZ �ก./�VRLUP�O �-%e/SMS/�� " ก��ijกTK/-�Q �K/�O�"ก��HKก � �MNLd��-Ie*+�,-�ij�MoO%W�/� kW 13. #. Colchicine 14. �.��.ZT dopaminergic neurotransmission ,Lij�MoO%parkinsonas �T$ก��djp�d$%pigmented neurons ,LdT "dJOL pars compacta � " Substantia nigra lVZ"�lPP[M��d�*dJOLL$R K/�MNL�lPP[�Oก dopaminergic V"I� "*+�ก���Kกm�X/%ก����.ZT dopaminergic neurotransmittion 15. #. Levodopa Levodopa is considered the "gold standard" of treatment for Parkinson's disease. But levodopa can have negative effects when used long-term. Because of this, dopamine agonists such as pramipexole and ropinirole often are used first. Other non-dopamine drugs may be used early in the course of the disease. These include amantadine, monoamine oxidase inhibitors (such as selegiline), and anticholinergics (such as trihexyphenidyl). As the disease progresses, levodopa will likely need to be added. 16. �. Levodopa dJOL,-pJ�MP$Z%LUMP"�MNL dopamine *$Z�LQR �%QZ IJ�"fL กdT " 17. �. J L��P$% STJT$U�" ��/dT�n. ADR of levodopa - #PQZLSd� �� $%L �WQZ �-�� - ก���I�L� "-KO, i./MกI. - Orthostatic hypotension - Dyskinesia - confusion, delusions, hallucinations (ref: http://www.pharm.chula.ac.th/surachai/academic/CNS-Drgs/Cns-

drg6.pdf) 18. #. IKO�KW dopamine receptor ,LdT " �ก./ down regulation P/ +�LOLP" ก., �., ". T$#+�I W,L-LK"dQ �cdKHO.*%�2 %�T$Z กz*n.{IJ .IM��d�*dJOLกP�" . a slowly progressive neurological condition, causes three main motor disorders: tremor at rest, stiffness and akinesia (diminished and slowed movements). It is due to the degeneration of neurons that produce and release dopamine in the substantia nigra. 19. �. %KW%KR"ก���MP$Z%LUMP" Levodopa �MNL dopamine *$Z�LQR �%QZ L กdT " Carbidopa is added to the levodopa to prevent the breakdown of levodopa before it crosses into the brain. The addition of carbidopa allows lower doses of levodopa to be used. This reduces the risk of side effects from levodopa such as nausea and vomiting. (http://www.medicinenet.com/levodopa-carbidopa/article.htm) 20 ก. Pyeidoxine �MP$Z%L�MNL pyridoxical phosphate lVZ"�MNL cofactor � " � LSlT[ dapa decarboxylase ��J"ก���MP$Z%L levodopa �MNL dopamine *$Zc�%L กdT " *+�,-��-PQ ����dT "L� %P" 1) Pyridoxine when coadministered with levodopa to parkinsonian patients may negate levodopa's therapeutic effect. Since pyridoxal 5-phosphate is a cofactor for transaminase and dopa-decarboxylase, it may accelerate levodopa metabolism. 2) levodopa and pyridoxine (Moderate Drug-Drug) GENERALLY AVOID: Pyridoxine doses of 5 mg/day or more antagonise the effects of levodopa. In the presence of pyridoxine, the peripheral metabolism of levodopa to dopamine is increased, resulting in less levodopa available to

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enter the CNS. The dopa-decarboxylase inhibitors carbidopa and benserazide reduce the peripheral metabolism of levodopa, even in the presence of high concentrations of pyridoxine, allowing more levodpa to enter the CNS. 21. M} "กKLก���ก./ LeTjP .d�� lVZ"T$�.mUP��MNLiP�P %S/� �กก�� กl.S/l[ dopamine X/% MAO-B (selegiline) Monoamine oxidase B (MAOB) is an enzyme involved in the metabolism of dopamine. It converts

dopamine to its corresponding carboxylic acid via an aldehyde intermediate. MAOB regulates both the free

intraneuronal concentration of dopamine and the releasable stores. MAOB inhibitors, such as selegiline, bind to and inhibit MAOB, preventing dopamine degradation. This results in greater stores of dopamine available for release. (ref:

http://www.cnsforum.com/imagebank/item/MAOB_inhib/default.aspx)

22. " 23 �. 47 -� dielectric constant S/� �กdTก�� εmixt = (%A)( εA) + (%B)( εB) + ��. �กdTก�� U*L#J� εmixt= (60/100)(25)+(40/100)(80) εmixt=47 24 ". 31 Tก��#T 2548

OKL-T/ �%e ��$%L�MNLc�m� K"กzmS/�-P�%UWW �HJL Exp.date, Expiring, Use by -�Q Use before IKO %J�"�HJL Exp.date 20/02/05 -T�%#O�TOJ�%� �-T/ �%e,LOKL*$Z 20 กeTc��KLn[ 2005 UIJ-�กWLYP�กSTJS/�ก+�-L/OKL*$ZOKL-T/ �%e กk,-�-T�%sV"OKLde/*��%� "�/Q LLKRLf �HJL Exp.date 03/05 -T�%#O�TOJ�%� �-T/ �%e,LOKL*$Z 31 T$L�#T 2005 ,Lก�g$*$Z%�STJS/�ก+�-L/OKL-T/ �%e � dK"�กIS/� �กOKL*$ZiP.I (Manufacturing date -�Q Mfg.date) lVZ"X/%*KZOSM -�ก%�LKRLiP.IT��ก.L 5 Mr กkSTJ#O�L+�T�,H�*KR"L$R%�UIJP�HL./ �T$ �%eSTJ�*J�กKL UP�ก���กkW�Kกm�กkT$M� K%-P�% %J�"*$ZT$iPก��*W �HJL Ud" #O�T�� L ,LW�.�Og*$Z�กkW *+�,-�W�"#�KR"%�*$Z%K"STJsV"OKL-T/ �%e UIJT$ก���MP$Z%LUMP"PKกmg�*�"ก�%c��SMUP�O กkSTJ#O�L+�%�LKRLT�,H� 25. ก 26.

ก�;<=>ก?@A<� 1 !�CD>E�=��@ (GH�@428-433) ���1. �� �� 5 �MNLiPSTJ�V"M��d"#[� "%� Fluoxetine *$ZT$z*n.{ก��Ie�L �ก��L LSTJ-PKW �ก��*$Z � �WS/�,LกPeJT �ก��L$RS/�UกJ �ก��ก��dKWก��dJ�% ก��OLก��O�%, UP�ก��L L*$Zi./MกI. UIJ�MNL �ก��*$Z �#J %f /$�VRL� "-PK" �ก,-�%��MNL��%��OP�-LVZ" ก����.ZT%�*$Z�L�/IZ+� �HJO%P/ �ก��O.IกกK"OP*$Z � �ก./�VRL dJOL �ก��L LSTJ-PKW � ,-�ก���Kกm�I�T �ก��X/%ก��,-�%�,LกPeJT Benzodiazepine �HJL Diazepam, Chlordiazepoxide, Lorazepam �MNLI�L ��� 2. �� �� 2 UL�L+�,-�iJ L#P�% .I *+�dT�n. UP�/QZTLT eJLfกJ LL L �����OJ� �ก��� "ij�MoO%�ก./ �ก��*$Zij�MoO%�ก./c�O��#�$%/ UP�O.IกกK"OP� " /K"LKRL#O�Uก�S�*$ZI�L�-IeT�กกOJ�MP�%�-Ie ��� 3. �� �� 3 ������MNL%�*$Z�-T��กKWij�MoO%*$Z-PKW%�ก UP�%�d�T��s กz*n.{��kO ��� 4. �� �� 4 ����� s��#LS��T$ �ก�� hip fracture cotting T$iPIJ -KO, Death ��� 5.�� �� 1 ����� ij�MoO%��/KW Mild STJ +��MNLI� ",H�%� dJOLij�MoOL��/KW Moderate, Server sV" ��PQ ก,H�%�,Lก���Kกm�

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�� 6.I W �� 3 �����%�กPeJT SSR T$#egdTWKI.�MNLIKO%KW%KR"� LSlT[ CYP450 �*.�HJL CYP142, CYP2C9, CYP2C19, CYP2D6 UP� CYP3A4 ��� 7.�� �� 1 *� "ijกM�dd�O�STJ ก �LQZ "T� �ก%�,LกPeJT SSRIs *+�,-�T$ก��ก��Ie�LIKO�KW serotonin *$Z*�"�/.L �-�� UP�*$ZdT " iP*$Z�W#Q T$ �ก��#PQZLSd� *� "�d$%-�Q *� "ijก L LSTJ-PKW dKZL �O$%L�$�m�UP�MO/��$m� ��� 8. �� �� 2 �MNL Pharmacodynamic ��-OJ�" Fluoxetine กKW Sumatriptan �����OJ�%�*KR"d "IKO �U%J"กKL KW*$Z recepter ��� 9. �� �� 2 ����� ก�g$*$Z#LS��T$ �ก���% � I� ",-�#LS��-%e/%�กJ L UP�-�d��-Ie �� 10.I W �� 4 ����� %� Fluoxzetine �TQZ ,H��JOTกKW%�,LIKO�PQ ก QZL f �*+�,-�T$X ก�d�ก./ serotonin syndrome S/� �HJL ก���MP$Z%LUMP"ก����$%L�j� PKกmg�*�"�KLneก��T iPIJ ก��*+�"�L� "��WWM��d�* KIXLOKI. ,Lij�MoO%*$ZT$ �ก���eLU�" ��W �ก��U�k"�ก�k" #O�Ti./MกI.� " .�PkกX*�PK%*[ UP�X#TJ� ��� 11.�� �� 4 �����OJ�%�HL./L$R �H�P ก��MP/MPJ %IKO%�djJก��Ud�PQ / ��� 12. �� �� 2 St.Johnass wort ����� T$z*n.{HJO%,Lก���Kกm� �ก�� O.IกกK"OP �#�$%/ UP� �ก��lVT����� ���13. �� �� 5 ����� #O�TU�"� "%� �VRLกKW �ก��� "ij�MoO%UIJP�#L ��� 14.�� �� 2 �������#�%�T$#O�Td+�#KpL� %กOJ�ก��,-�#+�M�Vกm� QZL f �*.�HJL ก��,H�%� %J�"IJ �LQZ " #O�Td+�#Kp,Lก���Kกm���%�%�O #O�Td+�#Kp�."ก��� # %iTก���Kกm� UP�ก��d���"#O�TTKZL, ,-�UกJij�MoO% ��� 15. �� �� 4 ����� response � "ij�MoO%UIJP�#LSTJ�*J�กKL C�@E�P�กกQ���R�ST@�SH�HUEVG�Q-L�� 432-434 1.�� /j �กdc���J�"ก�% ,W-L��-T "#PR+� UP�T$#O�TO.IกกK"OP 2.�� i./ ����� diazepam I� " J�%I�T,WdKZ"U�*%[%�L$R K/ �MNLOKIse กz*n.{,LM���c**$Z4 I�T �.�.W.OKIse*$Z กz*n.{IJ .IUP�M��d�* �.�.2518 ก����%I� "T$,WdKZ"U�*%[ X/%T$�cdKHก�#OW#eTก�� +�-LJ�% ก@� Q"AW@�@��@H ij��KW Lep�I I� " K/,-�T$ก��*+�WKpH$�KW- J�%OKIse กz*n.{ UP��dL ��%"�L,-��P��n.ก��*��W�MNL��%�/Q LUP���%Mr WKpH$/K"กPJ�OI� "�กkW�Kกm�SO�UP���� T*$Z �Ud/"IJ �LKก"�L� ��-L��*$ZS/� *eก�OP��g��M�//+��L.Lก�� 3.�� s���MNL�cdKHก� �STJ��%%� diazepam ,-� UP� �UL�L+�,-�P/�L�/%�*$Z�#%,H�P"��QZ %fUP�OUก�S�X/%ก���MP$Z%L�zI.ก��T 4.�� Melatonin -�Q *$Z � ��j� Kก,LHQZ *�"�#T$#Q N-acetyl-5-methoxytryptamine -�Q N-[2-(5-Methoxy-1H-indol-3-yl) ethyl] acetamide �MNL� �[XTLn��TH�I.HL./-LVZ"lVZ"sjกd���"X/% Pineal gland *$ZdT " ก��-PKZ"� "� �[XTLHL./L$R �sjกก��Ie�LX/%#O�TTQ/UP�sjก%KW%KR"X/%Ud" �TQZ ก��-PKZ"� " Melatonin ��.ZT�VRL#L��� �T$#O�T�j�dVกIQZLIKOP/P"-�Q �YQZ %H�P"LKZL� " �OTsV" eg-cjT.� "�J�"ก�%กk��.ZTP/IZ+�P" *+�,-��-T��d+�-�KWก��L LT�ก�VRL UP���/KW Melatonin �P/P" %J�"�O/��kO,LHJO"�H��TQ/� "OKL,-TJ/�O%�-Ie*$Z��/KW� " Melatonin �VRLP"I�T O" �� "#O�TTQ/-#O�TdOJ�" (light-dark cycle) *+�,-�*KR"TLem%[-�Q UT�ก��*KZ"�QHlVZ"กkT$� �[XTLL$R�HJLกKLT$#O�TIQZLIKO,L��-OJ�"OKL X/%*$Z��/KW� " Melatonin ���.ZT�VRLdj"de/�TQZ �OP� 2.00 L. ,L�/kก*$ZT$de�c��/$*KZOSM UP� ���.ZT�VRLdj"*$Zde/�TQZ �OP� 3.00 L. ,Lij�*$Zdj" �%e L ก �กL$RUP�OM�.T�gก��iP.I Melatonin X/%�J�"ก�%%K"P/P"�TQZ �%eT�ก�VRL �HQZ กKLOJ�*+�,-�ij�dj" �%eI� "�WกKWM�p-�,Lก��L LSTJ-PKWT�กกOJ�ij�*$Z �%e%K"L� % 5.�� Melatonin �MNLd��*$Z*+�,-�-PKW"J�%�VRL �-T��กKW#L*$ZL LSTJ�MNL�OP� -�Q �/.L*�"���TM���*� s��,H���%�dKRL I�TM�.T�g*$Zก+�-L/กkSTJT$ KLI��% �S� UIJ � *+�,-�T$ �ก��"JO"lVTW��" ,LI L�H�� UP�s��-�กI� "*+�"�LกKW�#�QZ " Kก�-�Q I� "�KW�s#O�-P$ก�P$Z%"ก��,H�%��TP�X*L.L 6.�� �TP�X*L.L%K"#"T$ก���Vกm���$%"�PkกL� %,L��QZ "#O�TMP /cK% iP���"�#$%" ก���ก./M�.ก.�.%�กKW ก��,H��JOTกKW%� QZL UP�iP,L��%�%�O� " Melatonin �LQZ " �กIKO Melatonin � "STJsjก K/OJ��MNL %�,LM���*�d-�K� �T�.ก� V"STJ +��MNL*$Z �I� "*+�ก��*/P "�Vกm�,LdKIO[UP�,LTLem%[ %J�" �." K"

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7.�� 5 8.******�� L$RX *%[STJ#�W �#���/�OJ�LJ� �s�TsV"����ก���H V"#./OJ� I W�� 4 ����� Alprazolam T$ active metabolite U#Jz*n.{L� %กOJ�Alprazolam is readily absorbed from the gastrointestinal tract with a bioavailability of 80�100%. The peak plasma concentration is achieved in 1�2 hours. Most of the drug is bound to plasma protein, mainly serum albumin. Alprazolam is hydroxylated in the liver to α-hydroxyalprazolam, which is also pharmacologically active but much less so than the parent compound. This and other metabolites are later excreted in urine as glucuronides. Some of the drug is also excreted in unchanged form. The elderly clear alprazolam more slowly than younger adults 9.= 1 10. = 2 11. = 4 ����� Buspirone STJS/�T$z*n.{*$Z�ก$Z%O�� "กKWก��%KW%KR" benzodiazepine-GABA receptor lVZ"IJ�" �กกPeJT Benzodiazepine 12 = 4 13. = 2 14.= 1 15 = 3 RYZกGQ"AA�HC�@E�[� (435-437) 1. I W 3 Ach d+�#Kp,L Alzhimers 2. I W 5 *+�,-��ก./ Amyloid plaques #Q dystrophic axons, microglia, astrocytes with β-amyloid core lVZ"�HQZ OJ� �*+�,-��ก./ toxic 3.I W 2 Neurofibrillary tangles #Q masses of abnormal tau protein lVZ"�W %jJ,L neuron �HQZ OJ�d�T��s*+�P�%ก��*+�"�L� "�lPP[S/� 4. I W 1 5. I W 2. Tacrine (Cognex ®) 6. I W 1 X�#���[ก.LdKL K/�MNL#O�Ti./MกI.� "��WWM��d�**$ZT$ก���dQZ T� "�lPP[UWW��QR �K" �ก./ �ก#O�Ti./MกI.� " nigrostrital dopamine system 7. I W 5 �ก��� " PD #Q T$ �ก��dKZL�TQZ -%e/L.Z"(resting tremor) �MNLT�ก*$ZTQ �dKZLUWWก��M��LPjกกP L(pill rolling) T$ �ก���#PQZ LS-OH��P"(bradykinesia) T$PKกmg�� " mask-like face , monotonous speech djp�d$%ก��*�"IKOUP� reflex H��P" T$ �ก���ก�k"IKO� "กP��T�LQR (rigidity) T$ก����.ZT� " muscle tone *+�,-�ก���#PQZ LS-OP+�W�กT$PKกmg� �ก�� cogwheel rigidity T$ก��*�"IKOSTJdT/eP(posture instability)T$PKกmg�ก��*�"IKO*$ZSTJ/$ P�T"J�% 8. I W 2 I� "��.ZT DA P/ Ach 9.I W 3. 10. I W 2. levodopa �sjก�MP$Z%LUMP"L ก��WWM��d�*กP�"X/%� LSOT[ aromatic L-amino acid decarboxylase (AAD) S/��MNL dopamine T$��$%" 1 % *$Z����djJ��WWM��d�*กP�" 11.I W 2 12. I W 3 13. I W 5 ,-� levodopa �JOTกKWd��*$Z%KW%KR" AAD �HJL carbidopa UP� benseraside lVZ"d��*KR"d "IKOSTJiJ�L blood brain barrier V"STJ�WกOLก��*+�"�L� " levodopa 14.I W 1 Vitamin B6 (pyridoxine): co-factor for decarboxylase enzyme decrease DA level in the CNS 15.I W 1 MAO-B �MNL� kLSlT[*$ZT$-L��*$Zd+�#Kp,Lก��*+�P�% dopamine ,LdT " %� selegilineT$z*n.{%KW%KR"� LSlT[ MAO-B S/� LJ� �T$M��X%HL[,Lij�MoO%���[ก.LdKL L ก �ก%� selegiline �P/ก��*+�P�% dopamine UP�O%K"P/ LeTjP .d��*$Z�ก./ �กก���MP$Z%LUMP" dopamine *+�,-�P/ก��*+�P�%�lPP[ $ก/�O%

Case Senario 1. ��� 2 2.��� 4 3.��� 1 4.��� 4 5.��� 2 6.��� 1 7.��� 1 8.��� 5 9.��� 5

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Case 1 p.441 1.1 ��� ก Norfloaxacin ��������ก��������� � UTI $%��&�'()*+�,*� ����-.���ก/+)( fluoroquinolone

1.2 ��� 4 levofloaxacin ��������ก,6� penicillin ,/8 �� ���-�ก/+)( Fluoroquinolone *&ก:�UTI

1.3 ��� �. Co-trimoxazole (BCD�)�.���6C(�CD�8 clotrimazole �� ���E)��.�F�*�) �H�+�/

��$%��C�(-.�B�� TMP-SMX, TMP, nirofurantoin H*�� fluoroquinolone .�CD*&��*8$���� ���/� 3 �&� 2 ��� hypersense Cross reaction ก&� penicillin 3 Q�$�R(&�,�/กS '()���ก�D� �C�C Q$D$% 4 ��� 4. ��U�(&V�*8�W�������U�(&V�*8�W�����,��Q�*�X �*8ก��D����W�*&���,��Q�*�X ,/8��,��Q�*�X����(%.���

U)���*8ก�� �CY%$W� U**6B+X 4��D*&��*8$�� BW������ ,/84��D�**�+ 5 ��� 4. /&ก:X84�� flocculation B�����ก�8ก&���)��H/�(S �� �ก���-HV)S �8�ก�8ก����)��*�D�*[� ,/8�*C(�X�8ก���8

U�� �(����4�)��8U�(�*\ redisperse 'D��)�� 6 ��� .���'() complete �&DUC�-�'()'D�

- sedimentation volume H*�� sedimentation ratio (B)� F) �� �D&.�%F.%F�&Dก�*�ก�8ก�� H�'D���ก �&�*�U)��4���*C(��*U+D$���4��ก�*�ก�8ก�� U)��D��� �� ������� ������������������ก�� (��� � � !" ��) B)� F (%B)�����ก�)� 1 H*��(�กก�)� 1 ก['D� �ก�C(%B)�����ก�)� 1 \��B)� F �$)�ก&� 1 ,UD��)� �/C�_&X R���)-�U_�64��ก�*�กCD floccule ��)��U(��*XR a%���� �$%���(*&�$���_U&.ก**(

7 cloxacillin Na �� ��W�*&� dry syrup �����U(ก)��กC� �U(,/���ก[�-������[�'D� 14 �&� ,/8 3 �&�$%��+XH_�(CH���

Case 3 $��� 444

3.1. ��� %. Chronic renal failure �6*�8�กX Rก�*�&DB�� Scr>3 �� ���/����ก�)�3�D��� �&D4�� �.��ก�6*�8�กX R4��End-stage renal failure B�� CrCl < 10 �&D 4.ก&� � ��ก�6*�8'()-.)���),/�� 3.2. ��� %. Sodium polystyrene sulfonate (Kayexalate)-.�*&ก:� Hyperkalemia QD�$W�H���$%��� � cation exchange resink $%��8,/ก��/%��� Na D��� K �6C�(��C(: ก�*4�&DQ�,�U�a%�(��ก��ก*)��ก���)��$���+���*8D��� potassiumkexchangek�.)� sodium polystyrene sulfate(Kayexalate)kH*��kcalciumkpolystyreneksulfatek(Kalimate) ��m&�ก�*,/ก��/%���*8H�)��Qa�D%�(kH*�� ,B/�a%�(ก&�Q�,�U�a%�(�*C��X/W�'U�-HV) �6���4&�Q�,�U�a%�(��ก(�ก&��+���*8k 3.3. ��� %. Furosemide ��������ก�� ���$%�/D��('D�D% (potent diuretic) ,/8 SE 4�� Furosemide B�� Hypokalemia an���8.)����ก�* Hyperkalemia 4��B�'4� 3.4. ��*�ก��U(D+/ก*D-��U -�*)��ก���6*�8$W�-H��กCDB��(�CD�ก�C4�� electrolyte QD��o6�8K, Cl (��ก��ก*)��ก��(�ก�กC�'�) 3.5. ��� �. Mmol = �FW�H�&ก4��U�*�� �mg/Mw 4��U�*�&F� NaHCO3(%(�/Q(�/ก+/ 84

�o/�4��U�� MCQ �*���� Nephrology QD� &'ก (�� �()ก �*��U��QD� *+�

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2.8mmol(% 235.2 mg/L an���$)�ก&� 0.235 mg/mL -.�U��* C1V1 = C2V2 �(��� C1= 2 mg/mL C2=0.235 mg/mL V2= 100 mL ,$�B)�-�U(ก�*�8'D� V1=12 mL Amp./8 5 mL D&��&F��8����-.� 3 amp. 3.6. ��� �. GMP กW�H�D�*C��X��o%D�� � Clean room class 100 3.7. ��� +. ��������ก�� �ก�*��*%�($%�-.�$&�$%�n�'()����-U) preservative 3.8. ��� +. �&Da�F�D����CY%ก*X%6C�m:��ก��BRก�*�_U&.ก**( '()�W�ก&D����C� �6*�8Q�$�R�� �ก�*a�F���$%���BRก�*�_U&.ก**(�/C�(�4��4)���*8�_$$%�54���/)�� �6C�(��C( �*8�_$4��ก�*�&Da�F��*8�_$4��ก�*�&Da�F� 1.�CY%�ก/�*�B� 'D�,ก)ก�*a�F�-���� '()�กC� 100,000 ��$ 2.�CY%U��*�B� 'D�,ก)ก�*a�F�-���� B*&F�H�n��*�B��กC� 100,000 ,�)'()�กC� 2,000,000 ��$ 3.�CY%�*8ก�D*�B� 'D�,ก)ก�*a�F� z ���� B*&F�H�n��(%*�B��กC� 2,000,000 ��$ 4.�CY%6C�m: 'D�,ก)ก�*a�F�-���� B*&F�H�n��(%*�B��กC� 100,000 ��$ 5.�CY%ก*X%6C�m: '()กW�H�D����C� (&ก�� �ก�*a�F�����ก��BRก�*�_U&.ก**( '()B�*�กC� 2,000,000 ��$ 6.�CY%�*8(�/D���*8���C�/[ก$*��CกUR (e-Auction) 3.9. ��� �. Cohort �6*�8�� �ก�*mnก:�$%�������*%���$%����U���&�,���ก[�4��(�/'�4���H��� ,'()�/��กcase cotrol �6*�8'()(%�&�B��B+((�.)� 'D���ก&�'()'D���) 3.10 ��� + HV��H��D,(�(%Q6,$U�a%�(�n�.)��-�ก�*4&��|UU��8

Case 5 $��� 446 5.1 *&��*8$����H/&���H�*$&�$% D��(�FW���((�กS �*8(�X 1 ,ก�� 5.2 �\��&/�R��*%�� U**6B+X .)��,ก���D�(���� ��D��� �U���n� ,ก�ก:&� 5.3 NSAIDs , ���&��*����(ก~H(�� 5.4 5.5 5.6 Q�$�R'()�B/%�*R 5.7 phosphase U��-.� CaCO3, Al(OH)3, C4H6CaO4 5.8 -�B�Q*B'�'()U�(�*\4&� calcium,/8 phosphorus'D��ก�C �n�(%U���กC�'� ,/8�8�&�ก&��� � calcium- phosphate �n�$W�-H��กCD�C�� 7. ��� + �&������� �,�/�� agonist an���8$W�-H�H/�D�/��D4����&� ,�) Tolterodine �� � anticholinergic $W�-H�ก/��(���F��*%��HD�&� $W�-H��กCD urine retention-�������� Prostate Cancer 8. ��� � HV��H��D,(�-.�*&ก:��C��'D�$&F��C��D)��an���กCD��ก,B/�a%�( (HC����) ,/8-.�*&ก:��C��ก*Dan���กCD��กก*D��*Cก �(���*&��*8$��HV��H��D,(� an��(%Q�,�U�a%�(U�� �8$W�-H�-�ก*D(%�$YC��� �D)�� $W�-H�ก*D��*Cก ,/8�ก/�����*� (urate) '()�&��&��� �ก��� .)������ก&�'()-H�,B/�a%�(�กB���-�'� .)��4���$)�'�-H�ก����4nF� �n�.)���**�$���ก�*��D HV��H��D,(�'()(%�$YC�/8/���C�� D&F��&F��C��ก���-HV)�8'()'D��/ -.�'D�D%ก&��C��ก����/[กS �$YC�4&��|UU��84��HV��H��D,(��8.)��D&��([D�C���/[กS -H�H/+D��ก(� (�&�D% ก�:X6&�YR .2539 : 162) 9. ��� �. U(+�'6*'$�����&�$%���BRก�*���(&�Q*B H*�� WHO ,�8�W�-H�-.�'D� �.)� HV��H��D,(� ก*8��%���,D� 4nF�o)�� -����H�(

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10. ��� % ก*8��%���,D� 11. ��. Afferent Arteriole (4��4��) /D PG D&��&F��n� vasoconstrict �6C�(��C(: ACEI (%�/ vasoconstrict $%� efferent arteriole

Case 1 p. 447 1.1 ��� �. ก����� sodium bicarbonate(Sodamint) ������� ก��������ก��/����ก��������� !ก��-�#��$%�&'��ก '$%�

��%(ก�#� metabolic acidosis )*����ก�+%$%��#� �,�����ก��-� Sodamint ,..��.���$�� �����/�%0(�����ก!��(�ก��� , #��ก� �,��ก�1��-�(�2%�

1.2 ��� � calcium gluconate �&D calcium lactate ��ก�6*�8 �������(% �H lactic acidosis ���),/��'()B�*-H��ก/�� lactate

Case 2 2.1 ��� � ��������ก Eprex !$��4�56�� IV �(� SC

2.2 ��� ก ��������ก ก/��� U�( ,��Q( (% Q6�&U�a%�(U��Q6,$U�a%�(�&F��8'�$W�-H�'�����$W����H�&กD���ก�*4&�Q6,$U�a%�(,/8Qa�D%�(��ก(� an���8�� ��&��*���)�'� 2.3 ��� �. �������Q*B'� (%B)� clearatinine clearance 10 ml/min QD����)-�_��8U+D$���4��Q*B'� ( end stage renal disease ; ESRD) ก�*-.� M.O.M. �n��U%����)�ก�*�ก6*)��4��ก�*4&���ก4�� magnesium $��'� ��������ก'�(%ก�*$W����/D/� �n�B�*H/%ก�/%���ก�*-.���*8���$%�(% magnesium �� �U)���*8ก�� QD������/%���'�-.���*8��� Senokot H*�� Bisacodyl ,$�

Case 3 p 448 3.1 ��� �. N1V1 =N2V2 V2 = 20*120/70 = 34.29 mL

3.2 ��� %. �FW�,��Q( �6*�8Q6,$U�a%�(�&F��8'�$W�-H�'�����$W����H�&กD���ก�*4&�Q6,$U�a%�(,/8Qa�D%�(��ก(� an���8�� ��&��*���)�'� D&��&F� �&ก,/8�/'(�$%�6�*&��*8$��'D� ,�)�*C(�X'()(�ก'D�,ก) \&��6� \&���&ก��� (8�4����� H�)�'(��*� �&กB8��� \&��/&���� (8*8 H&��&กก�D4�� (8()�� (8/8ก� ��+)� ,��Q( ,�����/ .(6�)

3.3 ��� �. Enalapril (% adverse reaction B�� Dizziness, headache: fatigue, coughing, hyperkalemia 3.4 ��� �. Leucovorin is antidote for folic acid antagonists 3.5 ��� � $W�-H�D�Dan(D%4nF� Microemulsion �� �*8��$%�U�(�*\��*%�('D��)��QD�'()����-.�B��(*���U�(�*\/8/���&����4��

'�'D��)�� ,/8(%U�*�6C�(ก�*D�Dan(�)��������+$���DC���H�*���)-�*8�� �.)�ก�*�W�U)��� cyclosporine .�CD*&��*8$��-�*��,�� microemulsion (Neoral®)

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Case ��� 449-450

1. ��� �. ������� Ranitidine. ������ก ก �ก ����� �ก���ก��������ก���������ก��������� !����"#$�%��%�%&� X " ��!() �*!���+,�� $ �ก ����� " �-!(.ก����*���"���-$� Electrolytes ("���ก-��9� � �:!�� �ก��) $�� �ก���"��<��.�� %���=���ก���ก��>��� Hyperkalemia � �ก ก������,�E�%��� � : &F���G�!(.�&--#��H��-���$�� (-��"�������-��"�� (Oxidants) ��ก$FE�" �-!(.�ก��ก���G�-��"�������-��"�� (Oxidants) � � : �, � H2O2 �����N���O� ��&--#!�� �ก��%���=����&--#��H��-���9� �ก �������N�������G���H��-���9���9�ก �� �.����ก http://th.wikipedia.org/wiki 2. ��� �.� !�"#��$%!&�'��ก�"%)"��� ��ก��$�%��กH��� Acute hemolytic anemia (>���&���กก�������H��-���9�9�ก�� �=�*�-��) %��!���Hก���ก��*� �����ก����& ���������������ก�� " ��!���.!() ��E���*� � �W""�����"��G� ���W""����.������G�<�"� >���<�����=��*�-�� (Acute renal failure) <�. ��ก�ก��E ��" �-!(.ก����*���"���-$� Electrolytes ("���ก-��9� � �:!�� �ก��) $�� �ก���"��<��.�� %���=���ก���ก��>��� Hyperkalemia (%�9�"�&���!��-���"�) $.�����:��N���ก��9"�$���.�Y��G6PD �, � �(����� � ����-�� � �9-H*����ก�� �.����ก http://th.wikipedia.org/wiki 3. ��� � �กก�*�%���+�, G-6-P-D 123�� Reduced glutathione %)$:�*;<� =�ก�>�ก*�?%�@�%=A��>�? �������.����� >����� ����<&�# Glucose-6-phosphate dehydrogenase (G6PD deficiency) ��� ��.���$�����<&�# NADPH methemoglobin reductase (��� GSH peroxidase %�����<&�#��E 2 ,�����(�.����!�ก����-���� glutathione <���N� glutathione peroxidase &F� glutathione peroxidase ��E����(�.����กG��� peroxide ��ก�ก��H��-���9� ����E�!���.�����>����� ����<&�# G6PD �<� "��� กG�����ก-� � oxiadtive drug <�. �G�!(.��"���� oxidize " �� sulfhydryl group $� hemoglobin F��N�"��(��$� hemolysis �.����ก http://woooootw.googlepages.com/news11 4 .��� * Primaquine �.����ก http://rxbanglamung.wikidot.com/g6pd http://drug.pharmacy.psu.ac.th/Question.asp?ID=4627&gid=2 5.��� ก.3��%=A�� ����� ก����กO���N�ก����กO������ก��9**�����*����� �, � ก��!(.�-���, ก��!(.�EG�!������n���������������o�ก��<���� " ��ก��9�ก$���H��-���9��(���<�.�� %����E<� ��ก����กO����(��$��!�$n���E

%E=�*��F�� MCQ %�A:�? Hematology Disorder

'�� >�@� F�� �=$# >�G� ��#�F��'�� '�H

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�.����ก http://thaiherbclinic.com/node/424 " �� Ferrous sulfate is used to treat iron deficiency anemia �.����ก http://www.drugs.com/mtm/ferrous-sulfate.html " �� Folic acid ��N�����������-�-���EG� กG�����ก��<� ��$.�* !,.��� ��กO�>��� megaloblastic anemia 9-� macrocytic anemia �����"��(�����กก��$�� folate 9-�!,.�"�����(��������o�ก�� neural tube defect(NTDs) �.����ก http://www.pha.nu.ac.th/dis/forum_posts.asp?TID=10 6. ��� ?.��I�3J�� Ranitidine %)�"%!&�F%��I*�?%�@�%=A��>�?>�ก "��(��� ����N� co-trimoxazole ��กก� �&F���N������(.��!,.!���.�Y�� G6PD deficiency �.����ก http://thaiherbclinic.com/node/424 7. ���.? Sickle cell anemia ��N�>�����������ก����E9� กG�����$� hemoglobin ��N�"��(��!(.�&--#��H��-���9� ก-����N� C-shaped �.����ก http://drug.pharmacy.psu.ac.th/Question.asp?ID=10792&gid=9 ก.Autoimmune induced hemolysis �, � Penicillin http://en.wikipedia.org/wiki/Drug-induced_autoimmune_hemolytic_anemia $.Bone marrow suppression �, � chemotherapy and certain drugs affecting the immune system such as azathioprin http://en.wikipedia.org/wiki/Myelosuppression �.Methemoglobinemia �, � "������G�!(.�ก�� methemoglobinemia ����*����xy��ก�*��(��* �� <�.9ก %&�����<�<���# 9-�<����� http://epsilon707.multiply.com/reviews/item/2 .�, � arsine �.����ก http://www.microscopy.ahs.chula.ac.th/newmicros/lecture/images/clinhema/ha.pdf 8.��� �.Ferrous sulfate http://yaandyou.net/search2_web.php?nsetid=1585&tradename=Ferrous%20sulfate%20300%20mg&dosageform=0&gen_name=g 9.���.*.weight variation ������ก����H���-��*�EG���-��E� <�.��ก��,�����ก �������G�ก����-��*9-.� ������กก����-��*�EG���-�.���-��*(����ก(�ก�G����G�weight variation ��ก�� error ��ก9-�!� BP กH*�ก� �<� G���N��.��G� 10.��* $.���E<� 9� ! 9� <�������.������ก����ก!" ��<� <�.��*�� ���N���������� (�������*������+O ������� �� ����N������������

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Hemato 11-20

11. � 12. 13.� 14.� 15.$ 16. 17.$ 18. 19. 20. Case (�.� 453-456 Scene 1

1. ��� ? .Enlarged spleen “%��%-(���,���%|%�&��ก�"�*�.���-�"&����� ��%-(�����ก����*|�%�%ก-*����(� � 3-6 ก���� ���&�-��� ��ก���������ก��&����E9� $�*�}9�ก (�ก<� <�.��*ก����กO���� ��* �.��%� ก����ก$���ก�.��G�!(.���!*(�.���-����9**��-�"&����� � �ก�����)���*%�,.� G���N��.�!(.�-��� 9-������ F����� �9-������.!() ��ก��>���9��ก&.���ก�����(-Hก�ก��<�.9ก ��*9$H �*�(��� 9-�(��!-.��(-��

!���.�Y����-�"&���������.��!() ����9�ก�.�� �, ��!�ก��"�.���H��-��� 9� �.����(�.�����G�-����H��-���9ก : ��������.��!���.�Y����-�"&����� ��H��-���9�����ก���9�ก�����H� �.���.��G�(�.������ก �.��F%�$FE� : ������.��%����G�!(.�.��Y��F���� 9-�ก-�*�����ก���G�-����H��-�����ก$FE� ��.�Y��*�����.��%���ก���H��.� �G�!(.�.�!(.�-��� ����ก$FE�: ��ก�����(�����ก 2-3 "����(# * ��������*��* 2. ��� �.T=�F+ %� �%!&�'��1?)��TIก��� 1 :%�@�%=A��>�?� '��?F��?U$�!ก�$�=���V!%F <�#���1�, 123��>�ก���?W� “%��%-(�����-�"&����� ��N�%��%-(��������ก��������������ก��������ก��$�ก��"�.�|�%�%ก-*�� �G�!(."�.��.��-9-�(���"�.�|�%�%ก-*������ก�� ��N��-!(.��H��-���9���-�กOn�����ก�� 9-�������"�E��

�.����ก http://www.thalassemia.or.th/(��-����%��%-(�����"&�����9( �����+<��) Scene 2 ������ก$.���-�ก Case ��� ��$.��.�� 9-�%��(���กH��(-������>�!�ก�n���E "����� ���.�Y����N�%��(��� ��-�"&����� 3.��� ?. ��W�#����!�"1� %�A:�?�ก� FW#�UF�*�?T�I%�=@ก ������ก>���$�%������� Iron overload ��� 9-.�F<� ���<�.��*�(-Hก����� �� Hemovit® ��" �����ก�*$� Ferrous sulphate 150 mg *" �����ก�*$���Hemovit®[Thiamine HCl (Vitamin B1):2mg, Riboflavin (Vitamin B2):2mg, Nicotinamide:10mg, Ferrous Sulphate:150mg, Folic Acid:0.5mg, Ascorbic Acid:50mg, Pyridoxine:1mg] 4. ��� ก.FBC ��������ก FBC �� ก������ Ferrous fumarate 200 mg (���������ก�� ��������ก 65 mg) F<� �����*�������(���-�-.��$.� 3 "�����G���N�����.�<�.��*��� Folic acid ������<�., ��!�ก��"�.���H��-���9������$FE�

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5.��� �. UV�!Z#��#������� erythropoietin %�W?ก�F��? RBC erythropoietin (EPO) &F���N�|��#%��"G���)"G�(��*�� ก��"�.���H��-���9� (proliferation, maturation, differentiation) Scene 3

6. ��� �. 3��3��V!>���%�@�3�*�� 1-5 mg/day Folic acid ��N�����������-�-���EG� กG�����ก��<� ��$.�* !,.��� ��กO�>��� megaloblastic anemia 9-� macrocytic anemia �����"��(�����กก��$�� folate 9-�!,.�"�����(��������o�ก�� neural tube defect (NTDs) Dosage : Anemia; Children › 4 years and adults : 0.4 mg/day (�.����ก Drug Information Handbook 17 th) 9� $���$� ��#ก���>"�,ก���(���*��O�� !�<�� ��N� 5 mg ��$.���-� �"���� !(.<�.!�$��� 1-5 mg/day * 7. ��� ?.#$��$� E 3�!�$�^1 :)�%��" %�A:�?�ก� �I F����$�����I�V=�$F�" �;?JW#�=�U=*�?%� �?�ก!_$ก$�$���ก+$%�J�:�

%�A:�?�ก`#"'�� 8.��� ?. Folic %ก :�#ก��ก�F�?%��"�, thymidylate <� ��$.���-� �folic �ก����ก�*ก��"������(# thymidylate 9.��� ?. ��2�I?%=A�� %!&��F��a *����������� ��W���?� 3���Ia� ��"���)���G�*.�� ��N�������-��>�����"��������,�,�����<�"���� !,.*�������ก���H*�Y���-Hก : �.�� : <�.��&F���� ���ก�+ก�����"����n"�$�������"���)���G�*.�� =*�*-������ 24 ��-��� 2538 ��E� ��� F ����H�*G���%-(�� (Ferrous Sulfate Tablets) 10. ��� �. ������������ �����<� !, ���������(�������*������+O 11. ��� ?. >�"�23��UV�!Z#��!�).1��1 ������ก��ก���W""���"�E�-EG�����ก�����<� <�.��"��(���ก��(��(��������<�.��* ��� ���N���ก������������ ���<�.��*ก������=���ก9���#%��� ��

12.��� *. Hemolytic anemia Glucose-6-phosphate dehydrogenase ��N����<&�#�������� !��&--#����<�$�� �ก�� �����E��H��-���9� .�$�����<&�#,�����E ��G�!(.��H��-���9�9�ก 9-�����ก��&�� ����ก� � Hemolytic anemia 13.��� �. Packed red cell ������ก��.�Y����>����W""���"��-EG�� ���.�� &F���ก���W""���"��-EG��ก���ก"�$�"����%�*�-�%��� (urobilinogen) &F�$�*��ก�����W""�����กก� ����ก�� ��N� �-������ก��ก���G�-����H��-�����กก� ��ก��!���.�Y�� 9-� .�!(.���� folic acid ��ก��&����(��,.� 9-� platelet <� !,.!�ก����กO���ก��&�� 14. ��� ก. Aspirin ������ก��.�Y���������������ก��&��(-��ก<��*����9���# 9-� .���.�Y����>����� ����<&�# G-6-PD 9� <�.��*�� aspirin � ����G�!(.��H��-���9�9�ก ����ก��&��<�. 15. 16. <� ��$.�"�*!�(��"�� 17. 18.

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� !4"#�W4��2P4�X8>%&'��(�#1���6!�+�*"�8$"01��(�#1���6%&'��4"�# !�+� estrogen dependent tumor �+'�

� !4"#�W4��89>�3$�%&' Epiphysial closure >96,#$5#�P�OS , *�%4�6

� ,#$*8��W4��2P4%&'#& vaginal bleeding B��,#$%�"�5"�!�3

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3. ��� 0. *�%&'��(�B�*,�#9� *8"#�9�BR!��5P6

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- 5��&%&'��(��54��R+�����

- 2P4%&'#&��189�� thrombosis

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5. ��� ก. �@:�f$"> ,�@:�f$"> ก��,��"�^$�E�)%'%, 50% (www.panyathai.or.th,wikipedia.org), �98!R86 ->"�C"�36�R+��

R# !98�0 !4"#�R+��, ก�1�%&># � �Y�6ก9�!R���R+���3��9� R����#"O*��R5�����R# �&:�!R�ก � W$8>�!4!R9�5�">, >"

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6. ��� 6 ethinylestradiol 35 ug + cyproterone acetate 2 ug 5$8� Primalute- N *+� Norethisterone 5 mg (1 st gen

progestrogen) ��+'�60"ก2P4�X8>#&5�8 2�8#9� ���ก 0@6�$"01�!4 estrogen 0.035 ug �R1 cyproterone 01#&5�8 2�8#9� ��

�ก�4�>ก8$" gestodene, desogestrel

7. ��� ก. >�#�!4*8"#W+:��R1�"ก"�2$"� ��(��4��4�>��6ก"��W4]R"5��ก

8. ��� ��R&'>���(� Dian 7@'6 Dian ��1ก���48> Ethinyl estradiol 0.035 ug Cyproterone acetate 2 mg(3 rd

progestogen)

ก�� �ก��B�* 3 ���� 463

1. ��� f. GnRH agonists are pregnancy category X drugs

2. ��� �. Clomiphene citrate >"!�+�5"�%&'%C"!�4"%&'ก�1�34�,�$R9W9ก�C"�!4,�$�ก ,�4�ก$ >" Clomiphene citrate, ���SB#�

0"ก HYPOTHALAMUS (GnRH) �R1 BROMOCRIPTINE

3. ��� �. �>+'��3#�RPก�0�� 2��%&' ก"��9กA" endometriosis ,�4�ก$

- Progesterone %C"�!4�>+'��3B]�6#�RPก~X�

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- Gonadotropin releasing hormone %C"�!4R����SB#�#"ก�1�34��96,�$

- ก"�2$"�9�

4. ��� 6. Levodopa 7@'6#&r%[�s>96>9:6ก"�!R9'6 prolactin 0"ก pituitary Galactorrhea !#">a@6 ก"�#&5"�*9�!R9'6��ก%"6!98�#��(�R9กAO1�:C"�#%&',#$,�4 relate ก9�ก"��!4�#�3�� #9ก]�%9:6 2 �4"6 B�>�>ก��(�

- physiologic galactorrhea �W$� ��\"81 post lactational, mechanical stimulation, stress, puberty - secondary galactorrhea �W$� 0"ก>"�"6W��� ( phenothiazine, butyrophenone (haloperidol), reserpine, domperidone, estrogen, opiate) !�+�0"ก*8"#2���ก��%&'%C"�!4#& circulating prolactin level �]�'##"ก2���ก�� �W$� pituitary adenoma, pituitary microadenoma, bronchogenic carcinoma, Hypothyroidism, Chronic renal failure 5.��� ��(�~Y"5"�!�3 �ก��0"ก���#"O estrogen %&'5P6�ก��,�ก�Dก�=# *8���R&'>�#"ก��>"�#��*3#กC"����%&'#&���SB#� estrogen �'C" �R1!R&ก�R&'>6ก"�aPก�56��� !�+�%C"6"�กR"6�046 �R1*8��W42R��\9O�Sก9����%&'#&*$" SPF �>$"6�4�> 15 �$8#�48>

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5P��3!�&'#"กก8$" 15 #8��$�89�, 5��&�!4�#�3��, 2P4�X8>B�*��"!8"��R1�4�6ก"�*3#กC"������(��8R"�"�, �>P$�1!8$"6�W4 �R1#&�4�

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ก�� �ก��B�* 4 ���� 464

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#�RPก�4� �]+'�W$8>*9��R+�ก�530� %&'01��4"25#ก9�,�$ �!4��4",�4>"ก�@:��48> 5$8� estrogen 01%C"�!4#Pก%&'�"ก#�RPก#"ก�R1

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2. ��� 2. ��$*8��1896��+'�60"ก #& EE 5P6

3. ��� Cypoterone acetate �]�"1 .��"K'�E"ก����)' %&'5"#"�a�9กA"5�8,�4 01#&5$8�25#��6 Cyproterone acetate 7@'6

#&r%[�s�$��4"����SB#��]�W"> B�>��4",�R����#"Oก"�5�4"6 Sebum R���"���6�$�#5�4"6,�#9� (Sebaceous Gland)

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5$8�25#��6 Drospirenone 7@'6#&�"*"�]6#"กก8$"��1#"O 2-3 �%$"

4. ��� drospirenone ��(� spironolactone derivative 5P��B*�65�4"601#&*8"#*R4">*R@6ก9� spironolactone

5. ��� ก8"8�*�+��"8ก9�a9'8�!R+�6 �]�"1 ก8"8�*�+���6 = Butea superba Roxb. �#+'�aPก51ก��%&'��R+�ก!98 01#&>"65&��6

*R4">�R+��,!R��ก#"��ก ��ก5&��6-54# Phytoandrogen : #&B*�65�4"6 �R1%C"!�4"%&'*R4"> Hormone �]�W">

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acid (143) 5"� veracylglucan B �R1 C

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9. ��� 2P4�X8>B�*!��!+� Contraindication #$,ก�&��.��E"ก����)'

- ��189���]4>" levonorgestrel �R1 estradiol valerate

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erythematosus (SLE) B�*�9� ��'8�:C"�& (gallstone) !�+�B�*��"!8"� �"ก"�*9� �&7$"� !�+��"ก"�2���ก��

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(transient ischemic attack) #&�1�9�,%�กR&�7�,��S���R+��5P6 #&�1�9� prolactin 5P6 B�* hemolytic

uremic syndrome (*8"#2���ก����6�R+��) B�*��6�#���R+����6�P��*&>8 (sickle cell disease) B�*RC",54

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progestin (Postinor, Madonna 7@'6��1ก���48> Levonorgestrel 750 ug/tab 1 �26#& 2 �#��) B�>8�[&�9���1%"� *+�

- �9���1%"��#����ก%9�%&!R96#&�]�59#]9�[S B�>,#$�ก�� 72 W9'8B#6!R96#&�]�59#]9�[S 0"ก�9:��&ก 12 W9'8B#6�&ก 1

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- ก"����03W����26 (strip) ��(�8�[&%&'�W4ก9�#"�"�ก8$"W��� Blister >"%&'#&R9กAO1 ��(���6���65$8�

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- Blister Packaging �9:� ก�1�8�ก"����03�R1895�3%&'�C" #"�W4��ก"����03ก�*R4">ก9� Strip packaging ��(�8�[&ก"�%&']9��"�@:�%&'!R96�R1��(�%&'��>#ก9��>$"6�8����8�R1�]�$!R"> �26 Blister 01��1ก���48>5$8�%&'��(��4"�!�4"!�+��4"���7@'6��(�895�3]8ก Transparent Thermoformable Plastic Material ก9��4"�!R967@'6��(�]8กHeat-sealable Lacquered Backing Material

- ���03���7�6 (Sachets) ���03\9O�S5C"!�9��W4*�9:6��&>8 (single dose) B�>�"0�W4�2$�ก�1�"A �2$��RP#���&># !�+��2$�]R"5��ก �R48��$*8"#�4�6ก"��]+'�01�Y�6ก9�>"%&'�>P$\">��

- 5$8� laminate *+�ก"��1%"�7@'6%C"�]+'��Y�6ก9�*8"#W+:� ��ก7��0� !�+�W$8>�!4ก"� seal %C",�4�&�@:� 16. ��� 5 biodegradable polymer �]�"1 polymer 015R">�98,�4���$"6ก">B�>,#$�4�6*�>��"��ก#" 7@'6�1>1�8R"ก"�

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2. ��� ก. Androgen ��10C"��+����(��R+��%&'�ก��0"กก"�!R3�R�ก��6�>+'��3B]�6#�RPก aPก*8�*3#ก"�5�4"6�R1!R3�R�กB�>���SB#�5�6W���*+� Estrogen �R1 Progesterone 7@'6�1�9����SB#�%9:65�601#&*8"#59#]9�[Sก9�ก"��ก,�$0"ก�96,�$ B�>��$R1�����+��01#&W$86�8R"��1#"O 26-30 89� �@:��>P$ก9���$R1�3**R %C"�!4��10C"��+�� �ก���@:��fR&'>��+��R1 1 *�9:6 B�>�1�9���6���SB#���(��96�&:

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• ��W$8689�%&' 14-28 ��6��+��01#&ก"�5�4"6���SB#� Luteinizing hormone(LH)7@'601��(����SB#�%&'ก�1�34��!4�96,�$5�4"6���SB#� progesterone �R1�1�9� ���SB#� LH 01#&���#"O5P6�@:�ก$��89�%&'#&ก"��ก,�$�]�"1���SB#� LH 01ก�1�34��!4,�$�ก 5$8� ���SB#� progesterone 01*8�*3#ก"�!�"�98��6�>+'��3#�RPก�]+'���6�9�,�$%&'aPก

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5. ��� ก. �# ��4"!P4 �R",54�9� ��+'�60"ก��(��!R$6��6�*R�7&># �R1����4"!P4>96#&5"� phytoestrogens 6. ��� *. !4�6%&'���&>#�4�6��(� negative pressure �]+'��Y�6ก9�ก"�����������6���SB#���ก,���ก!4�6���&>#>"

ก"��R+�ก�W4�1�9�*8"#51�"���ก"�2R��>"��"�0"ก�W+:� B�>%9'8,�ก"�2R��>"��"�0"ก�W+:� ��$6��(� 2 8�[&�! $ ^ �96�&: ก. ก"�2R��>"��"�0"ก�W+:�B�>8�[& asptic technique %3ก�9:����!�+��"6�9:���� 8�[&�&:�!#"1 %&'01�W4ก9�>"%&'�5+'�#6$">�#+'�aPก*8"#�4�� �W$� >"��1�\%8��"#�� !�+�>"�o�W&8�1�"6W��� �. ก"�2R��>"��"�0"ก�W+:� ���9:����53�%4"> B�>�W4 autoclave 7@'6�!#"15#5C"!�9�>"��"�0"ก�W+:�%3กW���%&'%��$�*8"#�4�� �W$� >"f&� >"�" >"W1R4"6 ( irrigating soltion) }R} ก"�2R�� ก"����03>"�96กR$"8�4"6�4� 01�4�6%C"��!4�6!�+�����8O %&'#&�1�9�*8"#51�"� ��ก�$"6ก9���ก,��96�&: 1. ก"�2R��>"��"�0"ก�W+:�B�>8�[& aseptic technique 01�4�6%C"\">��4 laminar air flow 7@'6��4"#"���"��1�9�*8"#51�"� class 100 (3.5) B�>#&0C"�8�03R��%�&>S ,#$�ก�� 1 / h / 55 cm2 TSA Plate !�+� ,#$�ก�� 1 / m3 air samplar ���O1�o��9��6"� �R1�9:6�>P$\">��!4�6 %&'#&�1�9�*8"#51�"� class 10,000 2. ก"�2R��>"%&'�4�6%C"�!4��"�0"ก�W+:� ���9:����53�%4">�48> autoclave 01�4�62R�� ��!4�6 51�"� class 10,000 (350) B�>#&0C"�8�03R��%�&>S ,#$�ก�� 10 / h / 55 cm2 TSA plate !�+� ,#$�ก�� 100/m air sampler

7. ��� *. ���&>#B�>8�[& wet granulation B�>ก"����# magnesium stearate ��+'�60"ก*$" angle of repose ��(�*$"%&'��ก

a@6*3O5#�9��ก"�,!R��65"� 7@'60"กB0%>S]�8$" 5"�#&ก"�,!R%&',#$�& 0@6*8�%C" wet granulation �!4�ก����(��ก��PR ก"�

,!R01�&�R15#'C"�5#�#"ก�@:� �R1���# Magnesium stearate �]+'�W$8>!R$�R+'�

Table 1 Scale of flowability

Flow Property Angle of Repose (degree) Excellent 25-30

Good 31-35 Fair l aid not need 36-40

Possible l may hang up 41-45 Poor l must agitate, vibrate 46-55

Very Poor 56-65 Very, very poor > 66

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114 Table 2: The relationship between Compressibility Index/Hausner ratio and flowability

Compressibility Index (%) Flow Character Hausner ratio <10 Excellent 1-1.11

11-15 Good 1.12-1.18 16-20 Fair 1.19-1.25 21-25 Passable 1.26-1.34 26-31 Poor 1.35-1.45 32-37 Very poor 1.46-1.59 >38 Very, very poor >1.60

8. ��� 6. 5"�%&'�W4%C" adhesive layer Adhesive layer #&!�4"%&'��(��98>@���� �!4 patch 5"#"�a>@����ก9�2�8!�96 �R1��(�5$8�%&'01�4�659#295ก9�2�8!�96B�>��6 �96�9:� adhesive *8�#&R9กAO1�96�$�,��&:

a. biocompatibility ก9�2�8!�96 ,#$�1*">�*+�62�8!�96 b. ��4"ก9�,�4ก9��98>" �R1�6*S��1ก���+'� ^ ��6�C"�9� c. �4�6#&��15�%[�\"]�& a@6�#401�ก��!R">�{ (shelf stability) �R1%&'5C"*9 *+��#+'�5�:�53�ก"����!"�>"01�4�6��"

��ก6$"> ,#$ก$��!4�ก���9���">!�+�*8"#�0���8��ก$2P4�X8> adhesive materials %&'��>#�W4�� Transdermal patch ,�4�ก$ silicone based, isobutylene based�R1 acrylate

based 9. ��� 7. a9'8�!R+�6 Phytoestrogen �"0��(�5"���กR3$# flavonoids, isoflavonoids, lignans, coumestans !�+�

chalcones 7@'65"��!R$"�&:#&R9กAO1�$8#ก9�*+� #&B*�65�4"65$8�%&'��(� diphenolic 5$8�#"ก�R48

phytoestrogen 01#&�"65$8���65P��B*�65�4"6*R4">*R@6!�+��%&>�,�4ก9� steroid nucleus ��6 estradiol �9���(���5B��

�0�%&']���[��#W"�� 5"�กR3$# flavonoid ��]+W ,�4�ก$ quercetin �R1 apigenin ��(�5"�%&']�,�4%9'8,���]+W ��W" ก"�|

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phytoestrogen ��]+W�!R$"�&:5$8��! $01#&B#�Rก3R��6�:C"�"R�$��>P$��5P��B*�65�4"6�48> %C"�!4��(�R9กAO1��6กR9>B*

,7�S7@'6 polar �R1R1R">�:C",�4 ��$B�>�%40��6�R48 r%[�s��R9กAO1��6��5B���0�!�+� anti-estrogen ,�40"ก5$8���6

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5"���กR3$#�+'� ,�4�ก$ กR3$# coumestan �R1 lignan ก�]�

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2. ก��E"ก����)'��*-��- ��(�8�[&�Y�6ก9�ก"��9:6*��\S���W9'8*�"8�#+'�>96,#$]�4�#%&'01#&�3�� !�+��4�6ก"��84��1>1ก"�#&�3�� �#+'��R�ก�W4ก�5"#"�aกR9�#"#&�3��,�4�&ก �W$� ก"��9���1%"�>"�#��*3#กC"���� ก"�f&�>"*3#กC"���� ก"��5$!$86��"#9> ก"��W4a36>"6��"#9> ก"�58�R4"6W$�6*R��\">!R96ก"��$8#�]� ก"�~�6>"��42�8!�96 ��(��4�

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3. Estrogen %&'��>#�W4 �� OCs *+� EE �R1 Progestin %&'#&2R�'C" (�$"01!#">a@6 androgenic effect) *+� Progestin 596�*�"1!S �3$�%&' 2 �R1 3 u$?/"��$�/+��� (estrogen) ���SB#���5B���0�596�*�"1!S%&'�W4��>"�#��*3#กC"���� #& 2 W��� *+� ethinyl estradiol �R1 mestranol (ethinyl

estradiol-3-methyl ether) B�> ethinyl estradiol 01#&r%[�s��6ก8$" mestranol ��1#"O 1.2 - 2 �%$" �R1 mestranol �#+'���4"5P$�$"6ก">�R48�4�6��R&'>���(� ethinyl estradiol ก$��0@6015"#"�a��กr%[�s,�4 �]�"1 mestranol ,#$,�409�ก9��98�9���6��5B���0� (estrogen receptor) �R1���#"Oก"���R&'>�0"ก mestranol ��(� ethinyl estradiol >96��ก�$"6ก9�����$R1�3**R�48>

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Mestranol Ethinyl estradiol

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1. Derivatives of 17-α-hydroxyprogesterone ,�4�ก$ medroxy progesterone acetate 7@'6��>#�W4��(�>"*3#กC"����W���f&�#"กก8$">"**3#กC"����W����#���9���1%"�

2. Derivatives of 19-nortestosterone !�+� 19-norprogestins ,�4�ก$ norethynodrel, norethindrone (norethisterone) , norethindrone acetate (norethisterone acetate), levonorgestrel, lynestrenol, norgestrel, ethynodiol diacetate

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117

�P� �5�6B*�65�4"6��6���SB#�B���05���B��596�*�"1!S%&'�W4��>"�#��*3#กC"���� B*�65�4"6��6���SB#�กR3$#�&:*R4"> testosterone #"ก 0@6#&r%[�s androgenic property �R1 anabolic effect �>P$�4"6

�R1#&r%[�s�169�ก"��ก,�$,�4�&ก8$"กR3$# 17-α-hydroxyprogesterone ก"���กr%[�s��6���SB#�กR3$#�&:��&>6RC"�9�0"ก#"ก,��4�> �96�&: anabolic effect : norgestrel, norethindrone (norethisterone), ethynodiol diacetate, lynestrenol androgenic effect : norgestrel, norethindrone (norethisterone), ethynodiol diacetate anti-estrogenic effect : norgestrel progestational effect : norgestrel

��+'�60"ก���SB#�B���05���B��#9ก01#&*3O5#�9����6���SB#��]�W"> (androgenic) 7@'6%C"�!4�ก���"ก"��9�,#$]@6��156*S ,�4�ก$ !�4"#9� 2##9� 5�8 2#�$86 #&���@:��"#�98 ��(��4� ����003�9�0@6#&5"�596�*�"1!S%&'��กr%[�s�!#+�� progesterone 7@'6��(��98�!#$%&'��>#�C"#"�W4��(�>"�#��*3#กC"���� ��(����SB#���กR3$# 19-nortestosterone %&'#&B*�65�4"6�$"6ก9� levonorgestrel ,�4�ก$ norgestimate, desogestrel �R1 gestodene 7@'6���SB#��!R$"�&:�Y�6ก9�ก"���กr%[�s��6���SB#��]�W">,�4 !�+�,#$#&*3O5#�9����6���SB#��]�W">�~6�>P$ 0@6��(�ก"�R��"ก"��9�,#$]@6��156*S�96กR$"8 B�>�f]"1�#+'��W4����$�ก9���(��8R"�"�

�P� �5�6B*�65�4"6��6���SB#�กR3$# 19-nortesterone %&'�W4��>"�#��*3#กC"����

17αααα-

hydroxyprogester

Norgestimate

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118

MCQ ���� ONCOLOGY

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�ก1; �ก!2�-.��#()����,/8 $�0����

• �-.��#()���� White blood cell • )!���4����-.��#()���� Differential blood count (Diff)

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• �3�����ก�.��#()� Platelet count

2. �. )�ก���+�%��1 %�)% Cyclophosphamide ,#0 Doxorubicin

)�ก���5�(;) 5)2����)�ก��81;�กO���กก��ก�ก��83�%���)%*�ก�0�9ก�)% ���-123�2!� 83�'5+ red blood cell #��+) #% �:%�กO� anemia 83�'5+ oxygen *��#1P %�"##$�;3� �กO�)�ก���5�(;) 5)2 �+)%�)�5-)�49% ":;%8!P% � Cyclophosphamide ,#0 Doxorubicin -17#�+�%��1 %83�'5+�กO� Myelosuppression(ก��ก�ก��83�%���)%*�ก�0�9ก)

3. �. �#(;�*4+)���1 �

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3. �. Antiestrogen

4. �. Neutral Solution

Aseptic �8��O��#)��R(P) Sterility ก��83�'5+���s��ก�R(P) 4)%�8��O��1P�����8��O�81;'R+���1 - �S1� Isotonic �()4��#0#� 81;-1 osmoloarity �8��ก!2���%ก� Bacterial endotoxin �() 4��81;83�'5+�กO�*�+ ":;%5+�--1'� �S1� �!%�!P� Neutral Solution )��,�#��� 4��#0#� 81;����ก#�% 5�()4��81;83�'5+4��)(;�����ก#�% �:%*-��3�����81;�0-1'�ก�����1 - �S1�ก.*�+ ���� 472 �+) 1�)2 ก. Cisplatin, cisplatinum, or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers Cisplatin is administered intravenously as short-term infusion in physiological saline for treatment of solid malignacies. 81;-� : available : en.wikipedia.org/wiki/cisplatin �+) 2

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���� 473 �+) 1�)2 ก Erythromycin ) 9�'� cat B ,��-1ก��s:กq�5�:;%2)ก��� Erythromycin has been considered a nonteratogenic medication that can be used orally in pregnancy, but some published data have suggested that prenatal use increases the risk for cardiovascular abnormalities in the child. 81;-� : Erythromycin May Be Teratogenic : Available : http://dermatology.jwatch.org/cgi/content/full/2005/823/2 �+) 2�)2 ก. cefazolin () 9�'�ก#h�- cephalosporin) Penicillins are the most common cause of drug-induced, IgE-mediated hypersensitivity. Cephalosporin, which is a beta-lactam antibiotic like penicillin, can cause a similar reaction. 81;-� : Use of Cephalosporin with penicillin hypersensitivity : available : http://www.aafp.org/afp/20050501/tips/10.html �+) 3�)2 %. Muscle hypertrophy 81;-� : std.kku.ac.th/4930702013/NLME%20RS.doc �+) 4 �)2 �. 81;-� : Drug information handbook 15 edition �+) 5�)2 %. Overdosage : tinnitus,headache,dizziness 81;-� : Drug information handbook 15 edition �+) 6 �)2 %. 81;-� : Drug information handbook 15 edition(2)ก���5+�-'R+'�'��2+�%) Available : en.wikipedia.org/wiki/Myocardial_infarction (2)ก���'R+ �!กq� acute myocardial infarction ) �+) 7 �)2 ����0 s phase )!��1P��+�5�*-�*�+ �9+,����� �,��#0ก#h�-�0))กn8oOp81; phase ���%&ก!���+��O��������0����)!��1P�/��0 S phase �����0 081;-1ก��4!%����05$ DNA �+) 8�)2 ก.MTX �/��0 MTX inh. Metabolism of folic acid 81;-� : R14 Pharmacotherapeutics oncology �+) 9 �)2 %. Cytarabine 81;-� : Clinical Pharmacokinetics of Cytarabine Formulation Authors : Hamada A. ; Kawaguchi T. ; Nakano M . �+) 10 �)2 �. 81;-� : R14 Pharmacotherapeutics oncology �+) 11 �)2 ก. 4!%����05$��ก�+� Periwinkle 81;-� : R14 Pharmacotherapeutics oncology �+) 12 �)2 � ??????? �+))(;�����ก#h�- �81;����� ��1 ��F� hormone กGH(��(��IJ�K���+"� An introduction to human disease �� Leonard V. Crowley ��� prostate tumors 4�-��gg9ก !2 !P%�� estrogens *�+ ,��ก.-1ก��s:กq���� "High levels of Vitamin D help the body produce proteins with anti-tumor activity� #)%*��94Ohttp://www.medicalnewstoday.com/articles/146695.php ���� MCQ cancer ��'(� 13-23 ���� 474-475 13. ( % ) Leucovorin '5+���-ก!2 High-dose Methotrexate

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��(;)%��ก4�-��g#�/Oq81;�กO���กก��*�+�!2 � Methotrexate *�+ ":;% Methotrexate ���� �81;-17# !2 !P%ก��4�+�% folate �)%���%ก� 83�'5+���%ก� ��� folate *�+ ()���กO�T��0�#()���%R�O� Macrocytic, Megaloblastic anemia) 4��� Leucovorin ���� folic acid derivative -1ก#*กก��#�/Oq�� �����!�8�,8� folate '����%ก� *�+ 14. ( � )79+�k� *�+�!2 � Cisplatin '�R��%�!�81; 1-5 '���!P%,�ก81;�!2 � �!%�!P�)�ก��*-�/:%��04%�$81;�กO��:P��:%-���ก ��1P ":;%-1 Serious Adverse effect 81;/22�) �() - Nausea, Vomiting - Myelosuppression - Nephrotoxicity ":;%)�ก��81;�0�กO�*�+�!P%,��'��!�,�ก&5#!%��กก��*�+�!2 ��1P �() Nausea, Vomiting �!%�!P�79+�k� �� �1P�:%���*�+�!2 ��X)%ก!�5�()2���8�)�ก�� N/V �/O;-��O--�ก81;4h� *�+-1ก��s:กq���04O8oOT�/�)% �'�ก���X)%ก!�5�()2���8�)�ก�� N/V ��กก��*�+�!2 � Cisplatin (81;-�: BMJ 1984 ) /2��� ก��*�+�!2 � Metoclopramide '�����49% *-�����0*�+�!2���-ก!2 Dexamethasone 5�()*-� '5+7#'�ก���X)%ก!�,#02���8�)�ก��*�+�1 ,��ก��'5+ � Dexamethasone �/1 %) ��%��1 � ��2�h-)�ก��*�+*-��1�!ก 15. (� )��กก��s:กq�/2��� -1ก��,2�% Anti-emetic drug ���� 2 ก#h�-�() High therapeutic index ,#0 Low therapeutic index ":;% � Ondansetron (��-g:% �'�ก#h�-��1 �ก!��1P�+� �() Granisetron, Dolasetron, Tropisetron, Palonosetron) ���� �81;) 9�'�ก#h�- High therapeutic index ":;%4�-��g��2�h-)�ก��*�+�1ก��� ��!�)(;�&( �'��!��#()ก)(;��!�) 9�'�ก#h�- Low therapeutic index) � Ordansetron 4�-��g�X)%ก!�,#02���8�)�ก�� N/V 81;�กO���ก Chemotherapy �0�!2 moderate-high emetic *�+8!P%R�O� acute ,#0 delayed type (,��'�ก�j181;���� � Cisplatin )���0��2�h-)�ก��*�+'��0�!2���ก#�% ��(;)%-���ก���� �81;4�-��gก�0�h+�'5+�กO�)�ก�� N/V *�+��)��+�%49%) (Reference; Chemotherapy-Induced Nausea and Vomiting, NEJM 2008.) 16. ( � )�5�h7#��1 �ก!2�+)81; 14 4��� �)1ก 2 �!� �() Vinblastin ,#0 Etoposide )�ก��*-�/:%��04%�$�ก1; �ก!2 N/V �0�!2�;3� ,���0-1)�ก��*-�/:%��04%�$)(;�&":;%�+)%'R+��#��0 05�:;%":;%-�กก��� 1-2 �!� *�+,ก� Etoposide (SE: myelosuppression), Visblastin (SE: Hypertension) 17. ( -!�-1�!��#()ก*-���2)�0 ��+�ก.�# '4�R(;) �81;'R+�!กq�8!P%-0��.%,#0ก�T9-O�h+-ก!�) - Cyclophosphamide: 'R+�!กq�-0��.%5#� R�O�,#0-1�+)2�%'R+'�ก��ก�T9-O�h+-ก!�'�79+�k� 81;-1T��0 autoimmune diseases *�+,ก� Rheumatoid arthritis �� ��1P���� �'�ก#h�-disease-modifying antirheumatic drugs (DMARDs) ,#0Systemic lupus erythematosus (SLE) with severe lupus nephritis - Vincristine:'R+�!กq�-0��.%5#� R�O�,#0-1�+)2�%'R+'�ก��ก�T9-O�h+-ก!�'���� thrombotic thrombocytopenic purpura (TTP) 5�() chronic idiopathic thrombocytopenic purpura (ITP) - Etoposide: 'R+�!กq�-0��.%5#� R�O�,#0-1�+)2�%'R+'�ก��ก�T9-O�h+-ก!�'�2�%ก�j1 �R�� bone marrow 5�()blood stem cell transplant - Methotrexate: 'R+�!กq�-0��.%5#� R�O�,#0-1�+)2�%'R+'�ก��ก�T9-O�h+-ก!�'� Autoimmune disease *�+,ก� rheumatoid arthritis, Crohn's disease, psoriasis 18. ( � )Mercaptopurine - Allopurinol /2������� � Major Drug-Drug Interaction � : Allopurinol )���0*�ก�0�h+�n8oOp8�%�T4!R�O8 ��)% �ก#h�- thiopurines (mercaptopurine (6-MP) 5�() azathioprine) 83�'5+�กO�T��0ก�*�ก�0�9ก (bone marrow suppression) R�O��h�,�%*�+ �� -1ก#*ก�() Allopurinol !2 !P%�)�*"-$ xanthine

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oxidase '�ก�02��ก�� first-pass metabolism �)% 8!P%81;2�O��j�!2,#0#3�*4+ ":;%�)�*"-$�1P�����!���#1; � 6-MP'5+ก#� ���� inactivation of 6-MP MANAGEMENT: 5�ก�+)%-1ก��'R+ ����-ก!��05���% Allopurinol ก!2 �ก#h�- thiopurines R�O��!2��08�� ,�0�3�'5+#����� �ก#h�- thiopurines �5#()�/1 % 1/3 V 1/4 �)%���� ��ก�O ,#0���81;ก���O���-79+�k� ) ��%'ก#+RO��/(;)�9 hematologic ,#0/Oq)(;�& )�ก��/Oq81;)��/2*�+,ก� fever, chills, sore throat, fatigue, lethargy, pallor, anorexia, jaundice, dark urine, nausea, vomiting, signs of local infection, and unusual bleeding or bruising. 19. ( ก )Ondansetron ; ���� ��+��ก��)���1 �(antiemetic) '�ก#h�- Serotonin (5-HT3) receptor antagonists ))กn8oOp�� ก�� !2 !P% Serotonin receptor �!%�1P

(1) Peripheral antagonism of receptors in GI tract (2) Central antagonism of receptors in Medulla - Side effect: headache, constipation - Dosage regimen: �!2��08������ 8 mg ก�)�*�+�!2 ���-1��0-�j 30 ��81 ,#0'5+"P3�T� '� 8 R-. ��ก�!P�'5+)1ก

8 mg 8hก& 12 R-. 43�5�!2 1-2 �!�5#!%*�+�!2 ���-1 20. ( % ) ��!กq����-0��.%8hก�!�4�-��gก�)'5+�กO�)�ก��*-�/:%��04%�$*�+ -1 �2�%�!��8���!P�81;ก�)'5+�กO� N/V '��0�!2�h�,�%(Level 4; high risk > 90%) �:%*-�'R� �4���'56�81;4�%7#'5+�กO�)�ก��*-�/:%��04%�$�!%ก#��� ��!กq����-0��.%81;) 9�'� Level 4 *�+,ก� Cisplatin, Cyclophosphamide(>15 g/m2), Carmustine, Dacarbazine, Mechlorethamine ,#0 Streptozocin 21. ( ก ) Doxorubicin ���� �'�ก#h�- DNA replication inh. ":;%))กn8oOp���� Topoisomerase II inh. ,#0 DNA intercalation ":;%���%4�+�%'�2�O��j81;���� Anthracycline ring (planar aromatic chromophore portion) -!��0 intercalate ��+��05���%�9��24�)%4� DNA 4�%7#83�'5+*-��4�-��g�กO� DNA replication *�+

22. ( � ) 5-� �5�h ; Dosage regimen �)% Cisplatin /2���-1���-,�ก���%ก!�'���(;)%���� �81;'5+ ":;%�:P�ก!2R�O��)%-0��.%,#0����! )(;�& ,���0 0��#�'�ก��'5+ �'�,��#0 cycle �()'R+��#� 5 �!� ,#0'��3�g�-�+)�1Pg�-g:%�!�81; 4 �)% cycle 2 Stability of Doxorubicin ; Solution 81;2���h'� vials �+)%�ก.2�!กq�'��9+� .�)hj5T9-O�05���% 2-8 C ,#0�ก.2'5+/+���ก,4% (Drug information handbook) ,��43�5�!2�3���� cool temperature (81;� .�) 5-� g:%81;)hj5T9-O 8-15 )%s� ,��) ��%*�ก.��-)���ก.2*�+'��9+� .�*�+(2-8 )%s�) (�9�-()8!กq0��-�กj�$ 4T��T4!Rก��-) 23. ( � )��O;-'5+ � Cisplatin �!�81; 3 -O. . ":;%g()�������ก���!2 �'� cycle ,�ก�)%79+�k� ��ก�!P��!2*�)1ก 28 �!� (��(;)%��ก��8 $ก3�5����� 79+�k� �+)%-��!2 � cycle #0 28 �!�) 79+�k� ก.�0�+)%-��!2 ��!�,�ก�)% cycle 2 '��!�81; 1 ก.�. ��ก��8 $g�-g:%�!�81; 4 �)% cycle 2 ":;%ก.�() �!�81; 4 ก.�.

Anthracycline ring

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��������� MCQ ������ Nutrition ��� P��ก� �� � !�"#�� ��� $" %�&�'(�" ^O^

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Item BMI a (kg/m2)

Obesity Class

Disease Risk Relative to Normal Weight and Waist Circumference

Men ≤102 cm (≤40 in), Women ≤88 cm (≤ 35 in)

Men >102 cm (>40 in), Women >88 cm (>35 in) Item

Underweight <18.5 ... ... ... Normal 18.5-24.9 ... ... ... Overweight 25.0-29.9 ... Increased High Obese 30.0-34.9

35.0-39.9 I II

High Very high

Very high Very high

Extremely obese 40 III Extremely high Extremely high 5. ��� -)#'ก���#��%& Ceutics

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6. ��� 1. Solubility � )4� 7. ��� 3.Capsaisin Capsaicin is the active component of cayenne pepper or commonly known as chili or red

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5. ! ��# )6&"���1�����ก.�/�0�4����(�)����)�� �� 2 z ��ก��������1������%���'�%#��� $�� &�� $�� (�4���ก�ก "�&ก����"��/��21$��+��'�-#�������������กก����"��/��21$ #��&�k&ก��ก�������#!"����"&ก14�#��ก4�"���X#� ��&�ก��&!2�ก���ก�������(��� ก����"��/��21$�� )6&�'�&����������2�5�� ����')��ก�4��)�� �@ $����%&)�� �@-��(�4 �����'� #��" (�"4��4�-)���X�������(�!�&�ก�4��y ���!��$�z+k�$��I@�&�Jก�"=5 5'K�"5ก��6z ���� )6&�'������2�����4����#!"����"&(ก4�'�)*"�$���& ���������&$�������-#����%��&1E��(�&){��1��&(�" (��� ���ก���'4)?�����ก����# "����ก�������$����%��&1E��$��"���1��ก.�/�0)�� �� 3 (� 4 -#� (�4��������&4��"���1��ก.�/�0)�� �� 1 (� 2 X#� #�#$�# ก��$������$��%���'���%������$��(���5 ��&�(���5 (���"(���5 X#��4�����%������-#� ����!��k� #��" ����4��zk����zk��-#�-�4 ก�& 3 !��k� (�4�!��k��4��-#�-�4 ก�& 30 "�& (�%����(�4�%�%��-#�-�4 ก�& 90 "�&&��(�4"�&�����ก http://www.fda.moph.go.th/fda-net/html/product/addict/obesity.html 6. ก ��ก.�/�0ก���1�&����)����4"&ก��(�����z���� /��! X#���ก.�/�0�4�& catecholamine pathways http://www.fda.moph.go.th/fda-net/html/product/addict/obesity.html 7. ����%��%&�'�)*"���� )6& arteriosclerosis , cardiovascular disease, moderate to severe hypertension, pulmonary hypertension, hyperthyroidism, glaucoma, �'����ก����%�� ��+���'4%&�4"� 14 "�&���ก��%����%&ก14� MOA inhibitor (Drug Information Handbook 17th Edition) 8. !�����-�4�'�"4������2�5���ก4�"� �!+���-� ���-�4-#� 9. ก %������ (Dietary Fiber) ��"4�ก�����)����&%������%&$&�#��� ������4"�#!� ���� (���#��&k����%& +�#-#� #!"�� ����%&ก�� ก�# heart disease -!X�z�& �4"�#!� ���� (�-$��&%& �& +�# X#����ก��!� ���� ���%���4��ก��-�4�����#'#z �-)%����+�#'#z �-#�&���� 10. -�4 $��%�!"������$����" +�ก�4� (�4Nicotinic acid ���%�� ก�# Dyspnea -#� 11. $�� 2 Heme-iron ��%&���������"ก &+k���"5 "�����& C ����ก��#'#z �/��1 ��ก-#�)����2 30 % (� ��ก%&�+���-#�%&�"ก ��#���"�4�� y ��ก%� $��" �� Phytate )6&�����$�#$"��ก��#'#z �/��1 ��ก &+�����ก ��&�k������ก%&$��" ��+� ��#�+� ��}�}�� )6&4"&)��ก��(�4�4��ก��-�4�����&��-)%��-#� &+�����ก��'4%&�') Phytate z ����&�k�����ก�� Fe Zn ���%���4��ก��#'#z �-)%��-�4-#�� � ก�#ก��$�#/��1 ��ก 12. $�� 2!"� ��� L�@���'% (Fluorine) %& #�ก���)���ก�&}{&�1 X#���%&�����4"& 1 �4� ��&

13. $�� 4 (reduced form) (oxidized form) (http://en.wikipedia.org/wiki/File:Ascorbic_acid_structure.png)

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���� MCQ ���� PK BY �ก� ���� �������� Rx’24

1. � �� narrow ก��������� �����ก

2. � � ��!�..�#�!�$%�&#���%�# ก��ก��!���'(�ก�&#����&�ก��!�)��(&�ก �

3. ก������#%��*���� !����������# �&� ก�������ก��(&����$ �+��$�)�$ ',!! �(%�$%-�)& dissolution

Surface area of drug :

Geometric shape

1. Amorphous form ���������%ก#&� 2. Crystalline form

Aqueous solubility

1. ��������01���ก � ���$������ 2. ����� '�ก�� !��+��$ก������� �+��$ก��� ���$

pH partition theory

4. �&� disintegration time )�1� �$&�&�!��ก%��#ก �ก��(1� bioequi

�+��$�)�$ �ก23�ก��+�!��2�)1�� ���(%��#�(1�ก��4�ก5��%#�$$ � 1.)1�� ���(%�-��)6��- �-��))&�ก � +�#&����-�ก��� ก5��)ก)&�ก � 2.��(%�$%�&#���-���ก��� ก5���� ก�������)�����#�$��$ ���# ��ก��ก1����*����� 3.��(%����� ก5����'8ก �6�������� 9����(%��1�$�������'����(:�;�+- �'<#��!�ก�� �)���!�ก6�� 4.) #��$%��2�$� )�(���$%���ก��;�+(%��!�'>���)����$%',?�������%#'��6���� ��&� ��2�$� )���ก��������01� )��ก������� *���-�����+�0�(%�-�# � ก52�*-��ก(%��1�$���� �'>�)�� 5. ) #���1�� ?$%'��$�2����$���(%��ก ��&#�'��ก������)1�� � ~4-5 �(&� ���$%-�)&ก��� ���$*) #���1�� ? 6. )1�� ���$%�&#�'��ก������)1�� �(%�$%-�ก��(�)&ก��� ���$) #�� �������+��# )9�'�������ก���+��$ก��� ���$*) #���1�� ? 7. ��$%ก��� ���$��+��(%�����#2������#2����������(��������� 8. ��� ���$������ (�&��%#'��6����� $� �2� )�1�) �$�#&�!�� &��� '��������ก�� � ���$������ 9. ��(%�$% Fist Pass Effect 6��-� (������������6��) � 10. ��(%�$%�&������%#�)���&�ก��� 0� (1������)���������# ���� ���$���# ก��� ก5�!�!����-� 11 ��$%��2�$� )��$&�) #���9 ก(1�������&��������(��������� 12. ��(%��'>� Nonlinear Pharmacokinetic Drug ���&#����ก����%�ก ��&#(%����-�ก��� ก5� ��� )�����'��$�2ก��� ���$$%�#�$�1�� ?)&�%#�$$ �

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5. ! *��%0�� )� ! !�� �+����1�)�$ �I,� &��J��� 555 �&.. 9��$!�ก choice -&��J *� ก ก �*� $ ���$��!���)-���%�#ก � �� $ �����+��� 0� 9���'�%����'�!��ก�� �)��� �+��� 0�)� ! !�� �)& $�%J $ ��'�#&���#� .. index �� 'ก)� $ ��$&�+��$��� &���# $ ��(%� �&#�*� ! !��J�+��� compliance ก���� (���� ���;��+����ก$�) �+��� 0� ���*���'#&�..9�� . !��J���#�1�)�$ ��#��*%��#&� ��� ���������9���'�%����'������&� ก�!��ก�� �)������(TI ���) ���!�)� ! !�� �)&JJ 9��6!(��$ �)�$� 0� ���ก�)� ! !�� � �K���.. ($� ���� ) ��)�-�(%�)�$%ก��(1� TDM

1. Narrow therapeutic range

2. serious toxicity

3. Inter-individual variation of PK, PK depend on renal function

4. �$&��$��9)�#!# � clinical endpoints (%�� ��!���� 5. Poor relationship between dose and serum drug concentrations (SDC)

6. Non-linear pharmacokinetics

7. Good relationship between serum SDC and therapeutic/toxic effects

6. � Absorption ) # �% �'>�ก��� ���$ 9�� adsorption � �� ��ก��*�0�(%�-�#������*# ���� �� � 9�� Elimination $ ��� ก���#$ก �* Met+Exc ��

7. * Hepatic extraction ratio (EH) �� '����(:�;�+*) ���ก��ก1�! ���ก!�ก plasma

���#&�.. ��$ ��$&!1��'>�)��'>� HEPATIC ก�����+��� first pass metabolism ��$��9�ก�����(%�) � ���ก�(%��1���������#�

8. ! �& �� �!��������$� �� �&.. 6!(��9�$�$��9�*�$ �* bioequivalent ���'�&�#�? �(&�(%����#&��� �+��� Bioavailability �%#'����(:�-� $ ��#�$��$��9��ก��� ���$*�� �1��#26�����AUC and DOSE

�$&����!��ก%��#ก ��ก����� ���'�&�???

BA = )�����#���'��$�2*) #���1�� ?(%�9 ก� ���$!�ก-��); 23����*��� &ก����6���) ���ก��!���'9�����#2(%���กL(:�M �)&9���'>� bioequivalent = �%#�$$ � �#�$�(&��(%�$ก �����$&$%�#�$�)ก)&��&�$%� ��1�� ?**�$ �(��%#'����(:�-�*-��); 23���(%�$%�;� �ก��$�$$ �ก � 6��4�ก5�;���)��;�#�ก��(��(%���$��ก � $ �ก�!����*�$ �+#ก� '��$�2 ก��� ���$�� ��� ��� �#$9��ก����� '� �+��$�)�$ ��(%��$&)�(1� �%#�$$ � Ø���%��*����������1� Ø ���1��� ����;���ก Ø ��(%����6���$&�# -�ก��� ���$�*��� &�&�ก�� ��&� ����ก�� ��9&��+��:� N�N

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Ø ���1��� ����� ��$ Ø���01�� �'��(��(%��'>�����������

9. ! �+���#&� digoxin = TI ��� ����'>� � �$+��( 9 ก ���#ก���� ���������� $+ �:�ก �L(:�MHOW?

10. ! 9 ก(�ก*� �)& *� C �� �!��'>�� )� CL = Ke x Vd �� �$&���

11. ���#&� ก��ก1�! ��� 40% �$��9� ER = 40% (extraction ratio)

�+��� 0� ������ = 60% = 120*60/100 = 72 mg

T1/2 = 10 = 0.693/Ke

So Ke = 0.0693 h-1

!�ก C = Co(e-kt

)

72 = 120(e-0.00693*t)

t= 7.37 hr Ansss!!!

12. ก ก �ก&9 ก*���%�# �+��� B �$&��&�! ������#&�$ ��$��9���� ���(%� steady state ���9�������#���������� $ ��&�!�)�1�� �+���ก�$%ก��ก1�! ���#�� ก���� ��JJJ C �ก!�ก�%0 $ �� *�0�ก � T1/2,time interval and DOSE ! :l

13. ��'<#�(%��'>� CHF $ ก���� � digoxin ���$% S/E �� +#ก N/V ���#ก�!�$%��&�J�� $�����%�'�%��� �&#�*����J �$&�&�!��'>�����)�*�ก��� ก�&�# &� HCTZ �%��$&��&�! �)&���#&� �ก��*����%��$&�&�!���&+#ก�������� digoxin $ ���&�ก#&�&�

14. �+���#&� $ ��'>� Acute toxicity of DIGOXIN = VOMIT, hyperK, sinus bradycardia, S-A arrest and AV Block

/ for chronic tox = visual disturbance, weakness, AF blah blah blah

- hypoK (1�����ก��+�5!�ก digoxin )�$ก��ก*$ �

- renal impairment (1����ก1�! ���ก!�ก�&�ก��������� 15. WHAT ????? 16. ! )�$� 0� 17. * *� A ��� C �1���9�-�*ก��� ก5����ก��)���)&��*- �'<#����! ��'>� Pharmacodynamics 18. ก �&..

9�� ���'>�ก��&� ก�!�! �ก � Albumin ���# ER )�1� .. !�ก ER = (Ca-Cv)/Ca

ER =1 �� ��9 กก1�! �����$� ER = 0 � ���$&9 กก1�! �6��) ���� 9�� ER )�1� ���#&� ���$&�&�9 กก1�! �6��) �.. �&… ���#���#�%0 ..�*�9�$#&� ก��ก1�! �*��) #�%0-&��) �!��'8�� � !�กก��(%�$ �ก1�! �-&��) ���� �+��� 0�) #�'��1�� ?���ก���..�#�$��$��9ก��! �ก �6'�)%� ��� �#�$��$��9* enzyme 9�����(�'�ก ��) #�%0ก�$% first pass )�1�

���#ก� !�+��1�$�(1��$#� !! �+��� 0���JJJ

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Enzyme $%-���&6�)�J �&#� Serum albumin ก�ก��! �ก � ���# *� ��� �� �#&�!��$��9�9�� ���� ���ก��&���$��ก �%ก) #(�+���! � �� $����$��ก �)(%�$%binding � ��$��ก � $ �ก�!�$%-���$��&� �+���!�$���&ก �ก1�! �%Tก )��%0ก����� hep blood flow ก � ���0��)� ��� hep blood flow !��Jก�$%�#�$�1�� ?��� �+���$ �!��1�� ?$�กJJJก �+#ก ก��ก1�! ���� ratio � � �)&ก��� $ �ก�� $�กก#&� ���0��)� 555555555 ���' +��1�$�) 0��� ��!��ก#&� ���0��)�&� 6����������#$ �ก��&�!��$&�&��ก%��#�� !�..

19. ก ก�)�$� 0�

20. � )� bioavailability= [AUC]A*dose B / [AUC]B*dose A

=[68.8]*200 / [72.5]*250 =75.8

21. ?? �*%���&�ก&��&�ก �... T1/2 = 6 hr

Vd = 20/100 x 75 = 15 L

TI = 5-15 mcg/mL

Tinterval = 8 hr

S,F = iv = 1 � )��� ��ก&�.. Cpss = SFD/kVTin = Css/ln(Cp/Ct) = Dose/CL*T

Cpss = SFD/kVTin � )��%0��$��!������� wow

=(15-5)/ln(15/5) 6.21 mcg/mL ... no choice ToT

�$$)���� DOSE �� ���#&� SFD/kVTin = 6.21 mcg/mL ��$��&� 1x1xD = 6.21 x 0.1155 x15 x 8 = 86 mg ~ 100 mg

�$$)� $%6�����# 555 ��$���& (!�(1��'$�(1��$I�) 1x1x100/0.1155x8x15 =Cpss avè 7.2 mcg/mL ก�� �$&$%�1�)� ���' �1�)�$ �ก� 6-7 �%��&�#� ����$&$% choiceeeee ���#����#���%����������������� !!! ���'�� ���#&� �*���$�*%�� DOSE ����&��� 9���$&� � DOSE !��� Css ����#� !!!@#$%

22.

291.06 �*%���&�ก&���$�����$ (������$&����&�#&�ก � 55)

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mg/h Vd= 70 L

T1/2 = 2 hr

K = 0.3465 h-1

CL = Ke*Vd

Therapeutic conc =12 mg/L

Dose è 150mg * 5 * 14 = 10500 mg drug ^_^ for what??

Ko = R =Rate of infusion = Css x CL = Css*Ke*Vd = SFD/Tint

Rate = 12 mg/L * 0.3465 h-1* 70 L

= 291.06 mg/h Ans... YEAH

23. ! �*%��� )�ก&� ��&���� T1/2

= 6 hr

Ke = 0.693/6 = 0.1155 h-1

Dose = 200 mg

Time = 24 hr

Drug in blood = Cp = Co(e-kt)

So.. ��(%�9 กก1�! �ก�)��(&�ก �.. = Co-Cp = Co- Co(e-kt) = Co(1-e-kt)

Cก1�! � = Co(1-e-kt)

� ��&#� Cก1�! �/Co = (1-e-kt) = (1-e(-0.1155*24)) = 1-0.0625 = 0.9375

ก��� 93.75 % � ��� Ans.. 24. Same as no. 11 25. 8.576 �*%���&�ก&��

F= 0.8 Vd = 0.6 L/Kg * 45 = 27L

T1/2 = 10 hr � � 0� Ke = 0.693/10 = 0.0693 h-1

Tint = 6 hr

Css ���ก��)�ก��* �&� MIC 25-30 ���ก 27 mcg/mL

CL = Ke*Vd = 0.0693 * 27 = 1.87 L/hr

From Css*CL = SFD/T

D (MD) = Css*CL*T/SF

= 27 mcg/mL * 1.87 L/h * 6 hr / 1 x 0.8 = 378.675 mg (�'�%�����&#����#��) �+��� 0�ก���� 378.675 ก�'��$�2 380 mg or 400mg (�ก 6 �$. ANS!!

����!���# ���JJJJJJ ������ -*-

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132

���� MCQ ���� ��� �� ��� ��������� P’bomb and ������

���� 487-502

1 ��� 5 ���� alcohol �������� 2 ��� 4 O/W emulsion base 3 ��� %&%'()*+�,-���� 4 ��� 2 PG )�0� lubricant 5 ��� 2 ก-�4�'5�6�7��)8' 6 ��� 2 Enteric coating tablet 7 ��� 2 Coloring agent 8 ��� 2 �-� ephedrine 1.0% 2.5 ml )DE�D�7'(F� NSS D�,�� 5 ml 9 ��� %&%'()*+�,-���� 10 ��� 4 mottling 11 ��� 4 neutral acid test 12 ��� 2 4 tbsp 13 ��� %&%'()*+�,-���� + choice %&,�� 14 ��� 5 Erythromycin stearate 200 mg/ml 15 ��� 5 5���L)�5��4+&�+E����6MN����ก&���-�Oก��P+%'( 16 ��� 4 enteric coated tablet 17 ��� 2 ����5�����)ก'D�กก��5+���MF6�75��Q5-�,MR 18 ��� 3 direct compression 19 ��� 2 D-�)�0��(�7�5��S&F��T')ก�Q (binder) 20 ��� 3 �P()�8�S&�7W��'� 21 ��� 2 LPก�-�+������7)'���4��)�8F�ก 22 ��� 5 102.8 23 ��� 6.�P��&�7,7)'4+M7),+E�� 24 ��� D.��D)X�����5���T')ก�Q)XE���4(Oก��P+DM�กM�%'('� 25 ��� 7.��*�')6(���(YF4�M7O�� matrix 26 ��� 7.Corn starch 27 ��� ก.Tapioca starch 28 ��� ,.+' stearyl alcohol

29 ��� D.���D\�� ampule 4�E� vial 30 ��� 6.2.4 g. 31 7. �S( alcohol +Q+�� ferrous sulfate ก&�� 32 6.4 S(��_�`Q 337. Potency

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133

34 ,. single-unit containers O+Q D. tamper-resistant containers &��O�&D��)X��Q)*+� 2 6(�)+��&�^^ 35 7. )�+����)�0�FM�+Q 1 ,�MN7 36 6. wet gum method 37 ,.4�ก)6�&�6F'��ก,�MN7��DQ5���Lก+M��)�0�)4E��)' 38 ก. )�0��-��M�O���S(%'(�M��� (ready to use) 39 6(���N&���)*+��&� 40 6. sedimentation ratio %'(D�กก��,-��F��M���5&F�6�7�Qก���Q�Q)F+�4�T�7O+Q������Qก��)���(� 41 6.100 42 6(���Nก8&���)*+��&� dE� dE� 43 ก. )� electrolyte ������QD\�Fก )+E�ก suspending agent ������QD\+� 44 ,. Plastic flow 45 D. %&���4(�N-��&����ก�Q)X�Q��4��O��กeTY&�� O�&���4(�N-��&����+-�%5()+8กO��กeTY&�� 46 D biological safety harzard 47 ก 48 D 49 ก 50 7 51 7 52 ก 53 ก 54 6 55 D 56 7

57 , 58 ก 59 g 60 ก 61 , 62 7 63 ก 64 , 65 D 66 ,

67 7 68 6 69 7 70 ก 71 6 72 6 73 ก 74 6 75 6

76. ก. Ointment )X��Q Cetomacrogols )�0���XEN�6�NYTN7 (Ointment)S�'+Q+���N-�%'( 77. ก. Phenobarbital Na (ก�') )X��Qก�'กM�'&�7)ก'�hก����Q4F&�7กM� �-��4()ก'ก���ก�Qก��%'( 78. ก. ��M��4(%'( Isotonic 79. 6. M.W. KBrO3 4�� 1 80. ,. ��FD5��,F�LPก�(�7 81. 6. Phenolthalein 82. ,. �Qก�� AgCl ��M�5'\+�4&%'(�Qก������ KCl Y5��P&'(F� 83. 7. Polychromatic radiation, 5��+Q+���,F�)6(6(�D�7%� 84. ก. Chromophore 85.

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134

86. 7.�,&�4Mก)4S&F7 1.429-1.430 87. ,.,F�D\5P75\' 30 g +Q)���' 1 mg 88. ก. Top loading electronic balance +Q)���'�o�� 3 �-�O4�&7 89. 6. %recovery 90. 7. 1.4*10 91. 7. %relative standard deviation 92. 6. 2.4 93. - 94. ,. 26.00 95. ก. �&�� upper 4�E� lower menicus ก8%'( 96. 6. 0.2% W/V 97. D.LPก�\ก6(� 98. 7. 4�����,F�)6(6(�%'(D�ก primary standard 99. ก. %&�4()ก'r�7��ก�o�� pump O+Q detector 100. D. Selective factor 101 6 102 7 103 , 104 6

105 , 106 ก 107 ก 108 6

109 g 110 7 111 6 112 6

6(� 113 ��� 6.alcohol ���ก���� ��ก������%'(Oก& sodium alginate, tragacanth, gelatin, pectin

sodium alginate ���QD\- +Q+��%'(���N-� O�&%&+Q+���� alcohol tragacanth ���QD\-%&+Q+���� alcohol O+Q�MF�-�+Q+��������s (��)� glycerin, alcohol )XE��)�0�5��S&F�ก�QD���MF

กM�5��ก&�)D+DM��MF)�0�ก(�� 114 ��� sustain release ก��)�+����)�0� sustained-release form ��DS&F�)X� compliance 6�7YP(�tF��4('�6TN�%'( O�&L(�,F�,\��ก��SMก%'('�O+(F O5'7F&� compliance 6�7YP(�tF��&�DQ'���P&O+(F4�E�%& 5�7����(�7�QFM7��ก��&�74�T�7 ,E� bioavailability 6�7�����P� sustained-release ��D��-�กF&��P� immediate-release %'( ��&�7)S&� valproic acid �P� SR � bioavailability +'+7 10-20% 4�E� Tegretol Controlled-release � bioavailability ��-�กF&��P���)8'S�'W��'� 15% )�0��(� 'M7�MN�ก��)�+����)�0��P� SR form �(�7,-��T7LT7 bioavailability �����D+'+7'(F�,�M� ��Q)'8�����S(�M'5��D�&�DQ��P&��� compliance )�0�4+Mก,�M�

115. 6 suspension _'�'PD�ก,&�ก��+Q+��

116. ,. alc O�&7ก��+Q+�� O+Q 7.

117. 6. O7'��Q)+ FW�ก����FD5��ก����)�vw��6�75��%X_�)D�����*�'��)x5MS�-��M��M�F%�ก-�4�'%F( 2 FW� ,E� FW�ก�Q�&�� (Rabbit Pyrogen Test) eT�7)�0�FW�����S(กM��ก���กF&� 50 �y _'�ก��*�'5������(�7ก���'5��)6(�)5(�)+E�'���4P6�7ก�Q�&�� O+(F

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�M��Tก�\�4xP���)�+����O�+7 5&F���กFW�4�T�7,E� FW� Bacterial endotoxin Test 4�E� LAL Test eT�7)�0�FW�ก���'5����4+�'�'+�7 (in vitro) _'���oM�4+Mกก���-��hก����Q4F&�75��5กM'6�7)+E�'O7'��Q)+กM�5�� Bacterial endotoxin O+(F'PY+���)ก'6TN�

118.,&� dielectric constant _'�,&� dielectric constant (E) )�0�,&�����S(��ก,F��6MNF (polar) 6�75�� _'�O�&7��ก)�0�'M7��N non-polar �,&� E ��S&F7 1-20 semi-polar �,&� E ��S&F7 20-50 polar �,&� E �กกF&� 50 ,�M� _'�,&���N)�&���������S(5���L��ก,F�5���L6�7ก��+Q+��%'(

119.6. polar 5����Qก��%����กDQ+Q+�����N-�O�&%&+Q+����)��e��4�E��MF�-�+Q+��������s �N-�O+Q�MF�-�+Q+��S�'�6MNF�E�� { DQ�,&� dielectric constant 5P7 eT�7DQ�-��4(O�7'T7'P'%rr|����'T7'P'�Q4F&�7%�����&��+7 �-��4(%����O�กD�กกM� ก����Q�QกM� (interaction) �Q4F&�7%����O+Q_)+ก\+����6MNF (Polar nature) DT7S&F���6�F�ก�� dissociation (disssociation )�0�6�F�ก�����5��O�ก�MF��ก)�0�%����)E��+Q+�����N-� �MF�-�+Q+��������s � dielectric constant ��-�O+QMก)�0�5����Qก�����%&�6MNF 5����Qก��%����ก_'��M�F { %�DQ%&+Q+�����MF�-�+Q+�����%&�6MNF

120. ��� 10-8 D�ก Henderson-Hasselbalch

121. 7. ,\�5�M� )4E�� Purify )X��QF&� water Water for Injection (WFI): )�0�ก�Q5����*�'����S(�ก���5\' �(�7���oD�ก pyrogen

-total amount of dissolved solid %&)ก� 10 ppm

-������ก)ก8��� closed stainless steel tank

-������(��)ก8��� sterile pyrogen free glass container �(�7�S(x���� 24 hr

-)ก8��4(���6TN�_'� steriled )�0� SWFI

)ก8���� <5 °C 4�E� >80°C ()SEN�%&6TN�)

5&F� Purify water %& sterile

122.6. � sucrose �ก)ก�%� Syrups 5&F��4R&��Qก��%�'(F�5���&�7{'M7�&�%���N

1) ������ �� !"��#$%&�'(#�������#$%&�')*���*��(�+)*���� , �N-���+���� (Sucrose) )�0�5������S(กM��ก��ก��)X�,F�4F��6�7 syrups ��D�S(�N-���+S�'�E��O�� sucrose )S&� dextrose

4�E��S(5���E�����%&�S&�N-���+ )S&� sorbitol, glycerin O+Q propylene glycol 5-�4�M�,�%6(����(�7ก��,F�,\�N-���+4�E��N-�4�Mก��D�S(5��)X�,F�4F���E�����%&�4(X+M77��O�� )S&� saccharin 4�E� artificial sweetener �E�� O+(FO�&7�4( syrups 'P6(�4�E'_'�ก���S(5��)X�,F�4�E' )S&� hydroxyethylcellulose 4�E� methylcellulose Syrups 5&F��4R&����,F�)6(6(�6�7 sucrose ��Q�� 60-80% DQ�4(,F�4F��O+Q,F�4�E'���(�7ก�� ��กD�ก�MN��M7�,F�,7�MF'�กF&�5��+Q+�� sucreose )DE�D�7'(F�

2) "��./!0ก1�ก��2��32456!02� �! (Antimicrobial preservatives) ����S(กM�OX�&4+���� syrups %'(Oก& ♦ Benzoic acid (0.1-0.2%) ♦ Sodium benzoate (0.1-0.2%)

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♦ 5&F�Y56�7 Methyl paraben O+Q propyl paraben (,F�)6(6(��F 0.1%) ♦ Alcohol (15-20%) MกDQ�S( alcohol )�0�5��S&F�+Q+�����-��M� _'����L(������ alcohol 5P7ก8DQ�Y+��ก��)�0�5���(��)SEN�

'(F� 3) "��(?0ก�%��" (Flavorants)

5&F��4R&�S(5��O�&7ก+���55M7),��Q4s 4�E�5��W��S�� )S&� volatile oils ()S&� orange oil) , vanillin O+Q�E��{ 5��)4+&���N,F�DQ�ก��+Q+�����N-�%'('� 4�E���D�S( alcohol ����)+8ก�(��)XE��)X�ก��+Q+��6�75��)4+&���N'(F�

4) "��(?0"$ (Colorants) ,F��S(5��4(5�',+(�7กM�ก+�� )S&� 5�)6��FกM�ก+�� mint, 5��N-���+กM�ก+�� chocolates )�0��(� 5�����S(,F�)�0�5�����+Q+���N-�'� %&

�-��hก���กM�5���E�� O+Q�,F�,7�MF��S&F7 pH กF(�7O+Qx����(O575F&�75P7{

123. D. KOH )ก'�hก���กM� cresol

124. ก. Wet method

125. 7. cracking

126, PKa 7 (PKa of weak acid should be close (+/- 1pH unit) to desired pH) ��ก��)����5��+Q+�� buffer )XE���4(%'( buffer pH ����(�7ก��DQ�(�7�S(�ก��,-��F�F&�DQ�(�7�S(ก�'�&��/)ก+E�6�7ก�'�&����&�7+Q)�&�%� (Henderson-HasselbalchEquation) pH=pKa+log[salt]/[acid] pH= pKa+log[conjugatedbase]/[acid] pH ,E� ,&� pH 6�7 buffer ����(�7ก�� pKa ,E�,&�6�7 pKa 6�7ก�'�&�� O+Q [salt],[acid] ,E�,F�)6(6(�6�7 )ก+E�6�7ก�'�&��O+Qก�'�&����4�&F�_+�&�+�� (Molar,M) http://www.medsci.nu.ac.th/Thai/DeptBiochem/powerpoint%20lecture%20biochemistry/Foundation_Gen.pdf 1276 ,�� Cetomacrogol 1000 (Polyethylene glycol 1000 monocetyl ether) )�0� non-ionic emulsifier �MF4�T�7�����P&��ก+\& Macrogol ethers 5M7),��Q4s%'(D�กก�� condensation of cetyl alcohol or cetostearyl alcohol กM� ethylene oxide �5P��_'��M�F%�,E� CH3(CH2)m (OCH2CH2)n OH _'���� n 4��LT7 D-��F�6�7 oxyethylene group ��S&F7 20-24 O+Q m = 15 4�E� 17 Cetomacrogol 1000 �+Mก��Q)�0�6�7O687 5�6�F-,�� 4+�����\�4xP�กกF&� 38 �7o�)e+)e��5 )�E��7D�ก cetomacrogol 1000 )�0�5���-��M+SM�S�'%&���QD\ DT7)6(�กM��MF��������QD\+�4�E���QD\�Fก 4�E�%&���QD\ ,7�MF'��� pH S&F7กF(�7 )�ก5���(�7�7 Carter, SJ (editor). Cooper and Gunn's Dispensing for Pharmaceutical Students. 12th ed. p. 130. 128_D��s%&5��P�s 129ก PEG base S�'6�7��XEN� 1. S�')�0�M� (Fatty/Oleaginous/Hydrophobic base) n Cocoa butter 4�E� Theobroma oil

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n Semisynthesis glycerides 2. S�'+Q+���N-� (Hydrophilic base) n Glycero-gelatin base n Polyethylene glycol polymer (PEG

)�ก5���(�7�7 �o. '�. W��Q ��W��' PPT ��)4�8� 1306 ,&� hydrophilic-lipophilic balance (HLB) http://pharm.kku.ac.th/thaiv/depart/techno/basicpharm/downloads/Lesson3.pdf131ก cetrimide "��#�� emulsion ��,.�+�F4*ก

_D��s )6��� cetosterol eT�7%&���)�E��7 �M+SM� �O�& agent O+Q� paper �The self-bodying action of the mixed emulsifier Cetrimonium bromide ((C16H33)N(CH3)3Br) is one of the components of the an effective antiseptic agent against bacteria and fungiextraction of DNA. It has been widely used iused in hair conditioning products.

As any surfactant, it forms micelles in aqueous solutions. At 303 K (30 °C) it forms (depending on method of determination, usually avg. ~95) and degree of ionization high concentration).Standard constant of Br-selective electrode measurements and conductometrycritical micelle concentration is K° ≈ 400 (it varies with total concentration of micelles is zero).The closely related compounds topic antiseptics, and may be found in many household products such as

http://www.ncbi.nlm.nih.gov/pubmed/5471435132D chromophore ,E� _)+ก\+6�75����Qก������5�phore �D�กx���ก��ก phoros 4��LT7 carry) ��P&)��Q{ O�&XM�WQ,P&)4+&��MN��(�7��P&�ก+(กM� X����DQ%��4�5P&กM�%'(�Q,�M�5+M�กM�XM�WQ)'���F4�T�7XM�WQ �MF��&�7)S&� )��(�O,_��������5�5( �5P��_,�75�(�7�����)48�'(��+&�7

The removal of colour strength was achieved by using reduction reaction to change the chromophore structure of each dyestuff by destroying the conjugate double bonding system forming non chromophore structure.Thesis (M.Eng.)--Chulalongkorn University, 2003physical and chemical methods),http://www.vcharkarn.com/include/vcafe/showkratoo.php?Pid=28199133 6 I2 + KI KI3 [Iodine Io 134 6 (��)� glycerin, alcohol )XE��)�0�5��S&F�ก�QD���MFกM�5��ก&�)D+DM��MF)�0�ก(��

PEG, Macrogols, Carbowax) ��)4�8� (Suppositories)

(HLB) ���5P7 5���L�S()�0��MFS&F��4(�MF��+Q+�����N-� http://pharm.kku.ac.th/thaiv/depart/techno/basicpharm/downloads/Lesson3.pdf

��,.�+�F4*ก eT�7%&���)�E��7 �M+SM� �O�& Cetostearyl alcohol, cetearyl alcohol or cetylstearyl alcohol

bodying action of the mixed emulsifier cetrimide-cetostearyl alcohol� 5&F� Br) is one of the components of the topical antiseptic cetrimide

antiseptic agent against bacteria and fungi.It is a cationic surfactant. Its uses include providing a buffer solution for the . It has been widely used in synthesis of gold nanoparticles (e.g., spheres, rods, bipyramids). It is also widely

in aqueous solutions. At 303 K (30 °C) it forms micelles with aggregatio(depending on method of determination, usually avg. ~95) and degree of ionization α (fractional charge) 0.2

- counterion binding to the micelle at 303 K (30 °C), calculated from Brconductometry data by using literature data for micelle size (r = ~3400 (it varies with total surfactant concentration so it is extrapolated to the point at which the

is zero).The closely related compounds cetrimonium chloride and cetrimonium stearatetopic antiseptics, and may be found in many household products such as shampoos and cosmetics.

5471435,http://en.wikipedia.org/wiki/Hexadecyltrimethylammonium_br,E� _)+ก\+6�75����Qก������5�(XD����D�ก,-�oMX�s chrome O�+F&� 5� )S&� monochrome

carry) ����7),�������s )F+�XP'LT7 chromophore MกDQ�TกLT7_)+ก\+6�75������XM�WQ,P&XM�WQ,P&)4+&��MN��(�7��P&�ก+(กM� X����DQ%��4�5P&กM�%'(�Q,�M� LT7DQ�-��4()ก'5�%'( ��4+Mกก8,E�XM�WQ,P&4�T�7XM�WQ

�MF��&�7)S&� )��(�O,_��������5�5( �5P��_,�75�(�7�����)48�'(��+&�7

strength was achieved by using reduction reaction to change the chromophore structure of each dyestuff by

destroying the conjugate double bonding system forming non chromophore structure. Chulalongkorn University, 2003 (On removal of residual dyestuff in effluent from yarn dyeing process by

),http://www.vcharkarn.com/include/vcafe/showkratoo.php?Pid=28199[Iodine Iodide (Tri-iodide) Complex]

)XE��)�0�5��S&F�ก�QD���MFกM�5��ก&�)D+DM��MF)�0�ก(��)

137

cetylstearyl alcohol ���)�0� stiffening 5&F� cetrimide 4�E�

cetrimide. The cetrimonium cation is Its uses include providing a buffer solution for the

(e.g., spheres, rods, bipyramids). It is also widely

with aggregation number 75-120 (fractional charge) 0.2 - 0.1 (from low to

at 303 K (30 °C), calculated from Br- and CTA+ ion data by using literature data for micelle size (r = ~3 nm), extrapolated to the

concentration so it is extrapolated to the point at which the cetrimonium stearate are also used as

http://en.wikipedia.org/wiki/Hexadecyltrimethylammonium_bromide monochrome 4��LT7 5�)'��F

MกDQ�TกLT7_)+ก\+6�75������XM�WQ,P&LT7DQ�-��4()ก'5�%'( ��4+Mกก8,E�XM�WQ,P&4�T�7XM�WQ

strength was achieved by using reduction reaction to change the chromophore structure of each dyestuff by

On removal of residual dyestuff in effluent from yarn dyeing process by ),http://www.vcharkarn.com/include/vcafe/showkratoo.php?Pid=28199

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135_D��s%&5�P��s 136 ,. ��)�0�ก�'(pKa 4) DQ+Q+��%'('���� pH �กกF&� pKa DT7+Q+��%'(��+-�%5( (pH 6.8) %'(�กกF&���ก�Q)X�Q��4�� (pH 1-2) 137 ก. _�77���\�5�4ก���S(ก����'Y�TกO�XP+'(F�),�E��7�M�_�M� _'�FW� pull seal eT�7�-�_'� �S()�+F%rD�N 5&F������-�กF&� �+��4+�' +7���Q�� 18-20 mm )XE���4()4+E���ก4+�'5&F��� %&LPก4+�%F(5-�4�M��S(��ก,��DM� )E��Oก(FLPก4+��&���MFO+(F DT7�S(��ก,��DM�5&F���6�7��ก4+�'�4(O�&� 'T76TN�)�8F{ X�(�กM�4\�4+�'�-���กD�ก)�+F%r DQ%'(O�XP+�����'5�� 138 ,. 6(� ก. O+Q 6. )�0�ก��)�+����O�+7��7ก��x�X 5&F� 6(� ,. )�0�ก��)�+����O�+7���_,�75�(�76�75�� DT7)�0�ก��)5E����7),� 1396. pseudo+thixotropy )X��Q5��ก&��M+SM��)�0�5��XFก_X+)��s �ก��%4+O�� pseudoplastic ,E� )E���4(O�7�(��{ X�+)��sDQ)���7�MF�4&���o��7)'��FกM�O�7����4()6(�%�O+QL(��4(O�7�ก{ DQ)ก'ก��%4+6TN� ,F�4�E'+'+7 O+Q)E��+'O�7����S(��ก��),+E������ DQ%4+O�� thixotropy �M���)�8F����S(��ก��),+E������+'+7��&�7S(�{ _'�%&)�0�%���,F�_,(76�7ก��r)5(�6�6TN� �M+SM�����'� DQ�(�7�,F�4�E'�ก)E���5&6F'�MN7�N7%F( ,F�4�E�DQX�\7��\x�,6�7Y7��O6F��MF+����P& %&�ก�Qก�����ก(� 4�E�)ก'ก��O�กSMN�O+Q)E���(�7ก���S(�-��)6�&� �-��M�,F�DQ)4+F )���กD�กx�S�Q���D\%'(7&�� )E������YF4�M7DQก�QD���MF'� O+Q5���Lก+M��,F�4�E'��&�7S(�{)E���MN7�N7%F( 140ก. Tween )�0� non-ionic surfactant Peppermint spirit )�0� volatile substance / aromatic substance (oil) Tween DQ)ก' Micelle formation กM� Peppermint spirit _'�4\()�� Oil (peppermint spirit) %F('(���� 4\('(F�5��+'O�7�T7YF �-��4()ก')�0�_,�75�(�7%)e++s 141 7. Cmax , AUC 142 6. glycerin (humectant+vehicle) 6(���N %&O�&�D�&Q Silicone , isopropyl myristate , mineral oil ก8)4E��DQ%'( S&F�4�&��,M� !!! 143 ก. �N-�M� )X��Q�-��M������N-�DQ'P'eT'� 5&F��-��M����� alc DQ�Q)4�7&�� 'M7�MN� DT7,F�)+E�ก�-��M������N-�M� )X��Qก�QD���MF'� ��P&�MF��� 'P'eTX��S(%'( 144 6. Phenobarbital sodium )�0�)ก+E�6�7ก�'�&�� DQ�ก�Qก��+7���5��+Q+������ pH ��-� (pKa 7.41) 145 ก. Benzoic acid �,\�5�M�)�0�ก�'�&�� , pKa 4.2 ก��)�+����O�+7,&� pH �Y+�&�ก��O�ก�MF6�75��L������,\�5�M�)�0�ก�'�&�� ก�')��_e�กDQ���Q5�Wx�X'�)E����P&�� pH ���)�0�ก�' (%&O�ก�MF) O�&L(� pH )ก� 4 ก�')��_e�,DQ���Q5�Wx�X+'+7��ก��)�0�5��L�� 146 ก. PEG 400 147 )4E��6(� 15 148 )4E��6(� 16 149 )4E��6(� 18 150 )4E��6(� 19