1 1. Define Suppositories and pessaries, Displacement value and evaluation. Define different extraction processes like infusion, Decoction, Maceration and Percolation 2. Pharmaceutical calculations, Define Surgical dressings, absorbable gelatin sponge, sutures, Classification of Incompatibilities DPH-102: Pharmaceutics 2 1. Discuss amino acid & nucleic acid derivatives 2. Explain LFT, KFT and Electrolytes in detail Med Biochem in eASY AND SHORT EXAMINATION

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DPH-102: PHARMACEUTICS

PAPER 1 - SECTION 1

1. Suppositories and Pessaries

Definition: Suppositories are solid dosage forms meant for insertion into body orifices other than the mouth (rectum, vagina, urethra). They melt, dissolve, or soften at body temperature to release the drug.

Types by route:

Rectal suppositories - torpedo/bullet shaped, ~2g (adults), ~1g (children)
Vaginal suppositories (pessaries) - ovoid/globular, ~5g
Urethral suppositories (bougies) - pencil-shaped, ~4g

Pessaries: Solid dosage forms specifically designed for vaginal administration. Used for local action (antifungals, antibiotics, contraceptives, estrogens).

Bases used:

Type	Example
Oleaginous (melting)	Cocoa butter (theobroma oil)
Water-soluble/miscible	PEG (polyethylene glycol)
Emulsifying	Glycerogelatin

2. Displacement Value (DV)

Definition: The number of parts by weight of a drug that displaces one part by weight of the base (usually cocoa butter).

Why it matters: Drugs are denser than the base. Adding drug without adjustment gives a suppository heavier than intended with incorrect dose.

Formula:

DV = Weight of drug / Weight of base displaced

Calculation example:

Mold capacity = 2g cocoa butter
DV of zinc oxide = 4.7
For 0.5g zinc oxide per suppository:
- Base displaced = 0.5 / 4.7 = 0.106g
- Cocoa butter required = 2 - 0.106 = 1.894g

3. Evaluation of Suppositories

Test	Purpose
Melting/Softening point	Should melt at 36-37°C (body temp); use melting point apparatus
Liquefaction time	Time to liquefy in water bath at 37°C; should be < 30 min
Dissolution test	For water-soluble bases
Breaking test	Mechanical strength; should withstand handling
Weight variation	Not more than ±5% deviation from mean
Drug content uniformity	Chemical assay for active ingredient
Leakage test	Wrapped in foil, placed at 37°C; no leakage allowed

4. Extraction Processes

a) Infusion

Definition: Prepared by pouring boiling (or cold) water over crude drug and allowing to stand.
Hot infusion: Drug + boiling water, steeped for 15 minutes, strained.
Cold infusion: Drug soaked in cold water for several hours.
Used for: Delicate plant parts - leaves, flowers, aromatic herbs.
Example: Ginger infusion, chamomile tea.
Shelf life: Short (prepared fresh daily).

b) Decoction

Definition: Prepared by boiling crude drug with water for a definite time (usually 15-20 minutes), then straining.
Used for: Hard, woody plant parts - bark, roots, rhizomes, seeds.
Example: Senna decoction, cinnamon decoction.
Difference from infusion: Heat is applied throughout (boiled, not just steeped).

c) Maceration

Definition: Drug is soaked in solvent (menstruum) at room temperature for a specified period (usually 2-7 days) with occasional agitation, then strained and marc pressed.
Solvent: Water, alcohol, or hydroalcoholic mixture.
Used for: Drugs whose constituents are soluble in cold solvent; drugs damaged by heat.
Example: Garlic maceration, belladonna tincture.
Advantage: Simple; suitable for thermo-labile drugs.
Disadvantage: Slow; incomplete extraction.

d) Percolation

Definition: Solvent (menstruum) is allowed to pass slowly downward through a column of powdered drug in a cone-shaped vessel (percolator). Fresh solvent continuously contacts drug, giving complete extraction.
Steps: Moistening drug → packing in percolator → allowing maceration → collecting percolate.
Used for: Large-scale preparation; most tinctures and fluid extracts.
Advantage: Complete, efficient extraction.
Example: Nux vomica tincture.

Method	Temperature	Time	Best For
Infusion	Hot/Cold	15 min	Delicate parts
Decoction	Boiling	15-20 min	Hard parts
Maceration	Room temp	2-7 days	Thermo-labile
Percolation	Room temp	Hours-days	Large scale/tinctures

PAPER 1 - SECTION 2

5. Pharmaceutical Calculations (Key Concepts)

Percentage calculations:

% w/w = grams of solute per 100g solution
% w/v = grams of solute per 100mL solution
% v/v = mL of solute per 100mL solution

Dilution formula: C1V1 = C2V2

Doses:

Child's dose (Young's formula): (Age / Age+12) × Adult dose
Clark's formula: (Weight in lbs / 150) × Adult dose

Proof spirit: 100 proof = 50% v/v ethanol

6. Surgical Dressings

Definition: Materials used to cover, protect, and aid healing of wounds, burns, and surgical incisions.

Ideal properties: Sterile, non-toxic, non-irritant, absorbent, non-adherent to wound, comfortable, permeable to air.

Types:

Type	Description
Absorbent cotton	Purified cellulose fiber; highly absorbent
Gauze	Loosely woven cotton fabric
Bandages	Roller bandages (cotton/elastic)
Adhesive plasters	Cotton/synthetic fabric with adhesive
Paraffin gauze	Gauze impregnated with soft paraffin (non-adherent)

7. Absorbable Gelatin Sponge

Definition: A sterile, absorbable, water-insoluble, off-white, non-elastic porous sponge made from purified gelatin solution.
Properties: Completely absorbed by body tissues in 4-6 weeks; can absorb 40 times its weight in blood.
Uses:
- Hemostasis during surgical procedures
- Control of capillary bleeding
- Packing dental sockets after extraction
- Neurosurgery and ENT surgery
Mechanism: Provides scaffold for clot formation; swells and mechanically stops bleeding.
Brand name: Gelfoam

8. Sutures

Definition: Sterile strands used to close wounds, ligate blood vessels, and approximate tissue layers.

Classification:

A. By Absorbability:

Absorbable	Non-absorbable
Catgut (plain/chromic)	Silk
Polyglycolic acid (Dexon)	Nylon (Prolene)
Polyglactin (Vicryl)	Polypropylene
Polyglecaprone (Monocryl)	Steel wire

B. By Origin:

Natural: Catgut, silk, cotton, linen
Synthetic: Nylon, Dacron, Vicryl, PDS

C. By Structure:

Monofilament: Single strand (Nylon, Prolene) - less bacterial adherence
Multifilament/Braided: Multiple strands twisted (Silk, Vicryl) - easier to handle

Needle types: Cutting (skin), Round-bodied (soft tissue), Taper-cut (tough tissue)

9. Classification of Incompatibilities

Definition: Incompatibility occurs when two or more substances in a prescription react together to produce an undesirable change in physical appearance, chemical nature, or therapeutic activity.

A. Physical Incompatibility

Physical change without chemical reaction.

Immiscibility: Mixing of two immiscible liquids (oil + water)
Liquefaction of solids: Eutectic mixtures (e.g., menthol + camphor)
Insolubility/precipitation: Adding alcohol-soluble drug to water
Color change: Physical adsorption

B. Chemical Incompatibility

New chemical compound formed.

Oxidation-reduction: e.g., potassium permanganate + glycerin (explosion risk)
Double decomposition/precipitation: e.g., lead acetate + sodium sulfate → lead sulfate (precipitate)
Hydrolysis: e.g., aspirin + water → salicylic acid + acetic acid
Complexation: Tetracycline + calcium/antacids → chelation

C. Therapeutic Incompatibility

Undesirable therapeutic outcome.

Synergism (adverse): Two CNS depressants → excess sedation
Antagonism: Heparin + protamine sulfate (desired antidote, but incompatible if overdosed)
Potentiation: e.g., sulfonamides + trimethoprim potentiation (desired but can cause toxicity)

MED BIOCHEMISTRY - PAPER 2

SECTION 1: Amino Acid & Nucleic Acid Derivatives

1. Amino Acid Derivatives

Amino acids are not just building blocks of proteins; they are precursors to many biologically active molecules.

Key Derivatives:

Amino Acid	Derivative	Function
Tyrosine	Dopamine, Norepinephrine, Epinephrine	Catecholamine neurotransmitters
Tyrosine	Thyroid hormones (T3, T4)	Metabolic regulation
Tyrosine	Melanin	Skin/hair pigment
Tryptophan	Serotonin (5-HT)	Mood, sleep, GI motility
Tryptophan	Melatonin	Circadian rhythm
Tryptophan	Niacin (Vit B3)	NAD+/NADP+ synthesis
Histidine	Histamine	Allergic response, gastric acid secretion
Glutamate	GABA	Inhibitory neurotransmitter
Glycine	Heme (with succinyl CoA)	Oxygen transport
Glycine	Creatine	Muscle energy (PCr)
Arginine	Nitric oxide (NO)	Vasodilation
Phenylalanine	Phenylethylamine; also → Tyrosine	Neuromodulator
Serine	Ethanolamine → Choline → Acetylcholine	Neurotransmitter
Cysteine	Glutathione (GSH)	Antioxidant

2. Nucleic Acid Derivatives

Nucleotides are derivatives of purine and pyrimidine bases + sugar + phosphate.

Purine bases: Adenine, Guanine

Pyrimidine bases: Cytosine, Thymine (DNA), Uracil (RNA)

Important Nucleotide Derivatives:

Derivative	Function
ATP (Adenosine triphosphate)	Universal energy currency
AMP/cAMP	Second messenger (protein kinase A activation)
cGMP	Second messenger (NO pathway)
NAD+/NADH	Electron carriers in cellular respiration
NADP+/NADPH	Reductive biosynthesis (fatty acid, steroid synthesis)
FAD/FADH2	Electron carriers (Complex II of ETC)
CoA (Coenzyme A)	Acyl group carrier; key in Krebs cycle
SAM (S-Adenosylmethionine)	Universal methyl group donor
GTP	Energy in protein synthesis, signal transduction

SECTION 2: LFT, KFT and Electrolytes

Liver Function Tests (LFT)

Tests used to assess hepatocellular damage, synthetic function, and biliary obstruction.

Test	Normal Range	Significance
Bilirubin (Total)	0.2-1.2 mg/dL	Elevated in jaundice
Direct (conjugated) bilirubin	0-0.3 mg/dL	Elevated in obstructive/hepatic jaundice
Indirect (unconjugated)	0.2-0.8 mg/dL	Elevated in hemolytic jaundice
AST (SGOT)	10-40 U/L	Hepatocellular damage, MI
ALT (SGPT)	7-56 U/L	More specific to liver
ALP (Alkaline phosphatase)	44-147 U/L	Biliary obstruction, bone disease
GGT	9-48 U/L	Alcohol liver disease, cholestasis
Total protein	6-8 g/dL	Synthetic function
Albumin	3.5-5 g/dL	Chronic liver disease if low
PT/INR	INR 0.9-1.1	Coagulation factor synthesis

Pattern recognition:

Hepatocellular: AST/ALT elevated predominantly
Cholestatic: ALP/GGT elevated predominantly
Synthetic failure: Low albumin, prolonged PT

Kidney Function Tests (KFT)

Test	Normal Range	Significance
Serum Creatinine	M: 0.7-1.3 mg/dL; F: 0.6-1.1 mg/dL	Best single marker of GFR
Blood Urea Nitrogen (BUN)	7-20 mg/dL	Affected by protein intake, dehydration
BUN:Creatinine ratio	10:1-20:1	>20: prerenal; <10: renal/postrenal
GFR (eGFR)	>90 mL/min/1.73m²	CKD stages by GFR
Uric acid	M: 3.5-7.2 mg/dL; F: 2.6-6 mg/dL	Elevated in gout, renal failure
24h urine creatinine	500-2000 mg/day	Creatinine clearance
Urine protein	< 150 mg/day	Proteinuria indicates renal damage

CKD Staging by eGFR:

Stage 1: ≥90 (with kidney damage markers)
Stage 2: 60-89
Stage 3a: 45-59
Stage 3b: 30-44
Stage 4: 15-29
Stage 5: <15 (Kidney failure)

Electrolytes

Sodium (Na+)

Normal: 135-145 mEq/L
Hyponatremia (<135): Confusion, seizures; causes: SIADH, heart failure, liver cirrhosis
Hypernatremia (>145): Thirst, dehydration, altered sensorium; causes: Diabetes insipidus, excess sodium intake

Potassium (K+)

Normal: 3.5-5.0 mEq/L
Hypokalemia (<3.5): Muscle weakness, U-wave on ECG, arrhythmias; causes: diuretics, vomiting, diarrhea
Hyperkalemia (>5.0): Peaked T-waves, fatal arrhythmias; causes: renal failure, ACE inhibitors, Addison's disease

Calcium (Ca2+)

Normal: 8.5-10.5 mg/dL (total); ionized: 4.5-5.5 mg/dL
Hypocalcemia: Tetany, Chvostek's/Trousseau's sign, prolonged QT
Hypercalcemia: "Bones, Stones, Groans, Moans" (hyperparathyroidism, malignancy)

Bicarbonate (HCO3-)

Normal: 22-26 mEq/L
Low: Metabolic acidosis
High: Metabolic alkalosis

Chloride (Cl-)

Normal: 98-106 mEq/L
Used in anion gap calculation: AG = Na - (Cl + HCO3); Normal = 8-12

Phosphate (PO4)

Normal: 2.5-4.5 mg/dL
Low in hyperparathyroidism, rickets
High in renal failure, hypoparathyroidism

Quick Exam Tips:

For LFT: Remember ALT is more liver-specific than AST

For KFT: Creatinine is the best GFR marker (BUN is unreliable alone)

Electrolytes: Always link to ECG changes for K+ and Ca2+

Displacement value: DV = Weight of drug / Weight of base displaced

Percolation = most efficient extraction; Infusion = quickest

Incompatibilities: Physical = appearance change; Chemical = new compound; Therapeutic = altered drug effect

MORE ABOUT LFT AND KFT WHAT AND HOW IT IS DONE IN EASY LANGUAGE

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🩺 LIVER FUNCTION TESTS (LFT) & KIDNEY FUNCTION TESTS (KFT)

In Easy Language - Full Detail

PART 1: LIVER FUNCTION TESTS (LFT)

What is LFT?

Think of your liver as a factory in your body. It:

Makes proteins (especially albumin)
Cleans toxins from blood
Produces bile (for fat digestion)
Helps blood clot

LFT is a blood test that checks if this factory is working properly. A doctor orders it when a patient has jaundice, fatigue, abdominal pain, or to monitor liver disease.

How is it done?

A blood sample is taken from a vein (usually in the arm)
Sent to the laboratory
Machine measures different chemicals in the blood serum
Results compared to normal values

Each LFT Test Explained Simply

1. BILIRUBIN (Total, Direct, Indirect)

What is it? When old red blood cells break down, they release a yellow pigment called bilirubin. The liver normally cleans it up and sends it into bile. If the liver fails or bile duct is blocked, bilirubin builds up in blood → skin/eyes turn yellow (jaundice).

Types:

Type	What It Means	Normal Value
Total bilirubin	Direct + Indirect combined	0.2-1.2 mg/dL
Direct (conjugated)	Bilirubin processed by liver, ready to leave via bile	0-0.3 mg/dL
Indirect (unconjugated)	Bilirubin not yet processed by liver	0.2-0.8 mg/dL

Easy trick to remember:

High indirect = problem BEFORE liver (e.g., too many RBCs breaking = hemolytic jaundice)
High direct = problem AFTER liver (bile duct blocked = obstructive jaundice)
Both high = liver itself is damaged (hepatitis, cirrhosis)

2. AST (Aspartate Aminotransferase) / SGOT

What is it? An enzyme found in liver cells. When liver cells get damaged, they burst open and release AST into the blood.

Normal: 10-40 U/L
High AST = liver cell damage
BUT: AST is also found in heart and muscle, so it's less specific for liver

Simple example: Like if you break an egg - the yolk (AST) spills out into the whites (blood).

3. ALT (Alanine Aminotransferase) / SGPT

What is it? Similar to AST, but ALT is found almost exclusively in liver cells. So it is a more specific marker for liver damage.

Normal: 7-56 U/L
High ALT = liver is specifically damaged
ALT is more important than AST for liver disease

"ALT is the liver's fingerprint" - if ALT is high, the liver is the culprit.

AST:ALT ratio:

If AST:ALT > 2:1 → think alcoholic liver disease
If ALT > AST → think viral hepatitis

4. ALP (Alkaline Phosphatase)

What is it? An enzyme on the surface of bile ducts. When bile cannot flow (blockage), ALP leaks into the blood.

Normal: 44-147 U/L
High ALP = bile duct blockage (e.g., gallstone, tumor blocking bile duct)
Also elevated in bone diseases (fractures, Paget's disease)

Think of it as: ALP is the "bile duct guard." When the duct is blocked, the guard panics and runs into the blood.

5. GGT (Gamma-Glutamyl Transferase)

What is it? Another liver enzyme, very sensitive to alcohol and bile duct problems.

Normal: 9-48 U/L
High GGT + High ALP = bile duct disease
High GGT alone (with normal ALP) = likely alcohol consumption or fatty liver

Trick: GGT is the "alcohol detector" of liver tests.

6. Total Protein and Albumin

What is it? The liver makes most of the body's proteins, especially albumin. Albumin keeps fluid inside blood vessels and transports drugs, hormones, and fatty acids.

Test	Normal	Meaning if Low
Total protein	6-8 g/dL	Liver can't make proteins
Albumin	3.5-5 g/dL	Chronic liver failure (cirrhosis)

Simple example: Albumin is like a sponge holding water in blood. If it's low (liver damaged), water leaks out → legs swell (edema), belly fills with fluid (ascites).

Important: Albumin only falls when 80% or more of liver tissue is destroyed - so it indicates severe, chronic damage.

7. Prothrombin Time (PT) / INR

What is it? The liver makes clotting factors (proteins that stop bleeding). If liver is damaged, it can't make these factors, and blood takes longer to clot.

Normal INR: 0.9-1.1
Prolonged PT/High INR = liver can't make clotting factors = bleeding risk

Think of it as: If the liver is the "clotting factory," a high INR means the factory is shut down.

LFT Pattern Recognition (Very Important for Exam!)

Pattern	Raised Tests	Likely Disease
Hepatocellular	AST, ALT very high	Hepatitis (viral/drug), liver necrosis
Cholestatic	ALP, GGT very high	Bile duct blockage (gallstone, tumor)
Synthetic failure	Low albumin, High PT	Cirrhosis, fulminant liver failure
Alcohol	GGT very high, AST:ALT >2	Alcoholic liver disease

PART 2: KIDNEY FUNCTION TESTS (KFT)

What is KFT?

Think of your kidneys as two filters that clean your blood 24/7. They:

Filter waste products (urea, creatinine) out into urine
Balance water and electrolytes
Control blood pressure

KFT checks how well this filtration is working.

How is it done?

Blood sample is taken (for serum tests)
Urine sample may also be needed (for urine tests)
Laboratory measures various waste products and compares them to normal

Each KFT Test Explained Simply

1. Serum Creatinine

What is it? Creatinine is a waste product from muscle metabolism (breakdown of creatine in muscles). It is filtered out by kidneys. If kidneys fail, creatinine builds up in blood.

Normal: Males 0.7-1.3 mg/dL | Females 0.6-1.1 mg/dL
Best single test for kidney function
High creatinine = kidneys not filtering properly

Important trap: Creatinine can double in blood even when 50% of kidney function is already lost (because of a curved relationship). So a "small rise" in creatinine actually means significant kidney damage.

2. Blood Urea Nitrogen (BUN)

What is it? Urea is the waste product of protein breakdown (from amino acids). Liver converts ammonia → urea, kidneys excrete it.

Normal: 7-20 mg/dL
High BUN = kidneys failing OR too much protein, OR dehydration

Why BUN alone is unreliable:

BUN rises if you eat a high-protein diet (nothing to do with kidneys)
BUN rises in dehydration (concentrated blood)
BUN rises after surgery (muscle breakdown)

So BUN is never used alone - always check BUN:Creatinine ratio.

3. BUN:Creatinine Ratio

Normal: 10:1 to 20:1

Ratio	Meaning
>20:1	Pre-renal (kidneys are fine but blood flow is reduced - dehydration, heart failure)
10-20:1	Normal / intrinsic kidney disease
<10:1	Post-renal OR severe kidney damage OR low protein intake

4. eGFR (Estimated Glomerular Filtration Rate)

What is it? GFR tells you exactly how many mL of blood the kidneys filter per minute. It's the gold standard for kidney function.

Normal eGFR: >90 mL/min/1.73m²
Calculated using a formula (MDRD or CKD-EPI) using:
- Serum creatinine
- Age
- Sex
- Race

CKD (Chronic Kidney Disease) Staging by eGFR:

Stage	eGFR (mL/min)	Severity
1	≥90	Normal (with other damage markers)
2	60-89	Mildly decreased
3a	45-59	Mild-moderate
3b	30-44	Moderate-severe
4	15-29	Severely decreased
5	<15	Kidney failure (dialysis needed)

5. Serum Uric Acid

What is it? A waste product from breakdown of purines (from DNA/RNA). Kidneys excrete it.

Normal: Males 3.5-7.2 mg/dL | Females 2.6-6 mg/dL
High uric acid = gout, kidney failure, or excess cell breakdown (chemotherapy)

6. Urinalysis (Urine Test)

This is the simplest and cheapest kidney test. Done with a dipstick dipped into urine.

Urine Test	Normal	Abnormal Means
Protein	Negative (< 150 mg/day)	Kidney filter leaking (glomerular damage)
Blood (RBCs)	Absent (0-2/HPF)	Kidney stone, infection, glomerulonephritis
WBCs	Absent	Kidney/urinary infection
Glucose	Negative	Diabetes OR kidney tubule damage
Specific gravity	1.001-1.035	<1.010 = kidney can't concentrate urine
Casts	Absent	Present in glomerulonephritis, AKI
Color	Pale to amber	Dark = dehydration or liver disease (bilirubin)

7. Urine Protein:Creatinine Ratio (UPCR)

Used to check how much protein is leaking into urine. Important for diagnosing nephrotic syndrome.

Normal: <0.2
Nephrotic range: >3.5

How to Differentiate Pre-renal vs Renal vs Post-renal

Feature	Pre-renal (reduced blood flow)	Renal (kidney damaged)	Post-renal (blocked outflow)
Cause	Dehydration, heart failure	Glomerulonephritis, drugs	Kidney stone, enlarged prostate
BUN:Cr ratio	>20	<20	Variable
Urine Na	<20 mEq/L	>40 mEq/L	Variable
Urine specific gravity	High (>1.020)	Low (isosthenuric ~1.010)	Variable
Response to fluids	Improves	No improvement	Improves if obstruction relieved

Simple Summary Table: LFT vs KFT

Feature	LFT (Liver)	KFT (Kidney)
Sample needed	Blood	Blood + Urine
Key enzyme markers	AST, ALT, ALP, GGT	-
Key waste products	Bilirubin	Creatinine, Urea
Synthetic function	Albumin, PT/INR	-
Filtration rate	-	eGFR
Best single marker	ALT (liver damage)	Creatinine (kidney function)

Key Mnemonics

LFT - "BAG PT"

Bilirubin
AST / ALT
GGT / ALP
Protein / Albumin
Time (Prothrombin Time)

KFT - "BUC"

BUN
Urine analysis
Creatinine + eGFR

Remember: LFT tells you how well the liver is processing and making things. KFT tells you how well the kidneys are filtering and excreting waste. Both are blood (and urine) tests done in a standard hospital lab - the patient just needs a blood draw and/or urine sample.

Harper's Illustrated Biochemistry, 32nd Ed
Henry's Clinical Diagnosis and Management by Laboratory Methods
Barash Clinical Anesthesia, 9e

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