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🧠 MBBS 2nd Year Pharmacology - 10-Day Crash Plan

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📅 THE 10-DAY STUDY PLAN

• Paper 1: General Pharma + ANS + CVS + Haematology + GIT + Respiratory + AETCOM
• Paper 2: CNS + Endocrine + Chemotherapy + Autacoids + Miscellaneous (Toxicology, Ocular, Derma)

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📘 DAYS 1-2: General Pharmacology (Foundation - Do This First)

• Drug with highest first-pass metabolism: propranolol, lidocaine, morphine
• Largest Vd drug: chloroquine, digoxin
• Enzyme inducer: rifampicin (most potent), phenytoin, carbamazepine, alcohol (chronic)
• Enzyme inhibitor: ketoconazole (most potent), erythromycin, cimetidine, grapefruit juice
• t1/2 formula: 0.693 x Vd / Cl
• Drugs safe in pregnancy (category A/B): folic acid, iron, insulin, heparin, penicillin

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📘 DAY 3: Autonomic Nervous System (ANS) - MOST IMPORTANT

• Sympathetic (T1-L2, noradrenaline) vs Parasympathetic (craniosacral, ACh)
• Receptors: α1, α2, β1, β2, β3 / M1, M2, M3, Nicotinic (Nm, Nn)

• Adrenaline reversal (Dale's vasomotor reversal): alpha blocker + adrenaline → hypotension
• Drug of choice for anaphylaxis: adrenaline (epinephrine)
• Atropine dose for organophosphate poisoning: 2-4 mg IV repeated until secretions dry
• Physostigmine crosses BBB (tertiary amine), neostigmine does NOT (quaternary)
• Selective β1 blocker: atenolol, metoprolol, bisoprolol (cardioselective)
• Non-selective beta blocker with ISA: pindolol

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📘 DAY 4: Cardiovascular Pharmacology

• Nitrates: GTN (sublingual - fastest), ISMN (oral, prophylaxis) - mechanism: ↑NO → ↓preload
• Beta blockers: ↓O2 demand, good for stable angina
• CCBs: vasospastic angina (Prinzmetal) - use verapamil/diltiazem

• Class I (Na channel blockers): Ia - quinidine, procainamide; Ib - lidocaine; Ic - flecainide
• Class II (Beta blockers): propranolol, atenolol
• Class III (K channel blockers): amiodarone, sotalol - amiodarone = widest antiarrhythmic use
• Class IV (CCB): verapamil, diltiazem

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📘 DAY 5: CNS Pharmacology - Part 1

• Benzodiazepines: diazepam, lorazepam, midazolam - potentiate GABA-A → Cl- influx
• Barbiturates: phenobarbitone - older, enzyme inducers, higher overdose risk
• BZD antidote: flumazenil

• Typical (D2 blockers): chlorpromazine, haloperidol - EPS, tardive dyskinesia risk
• Atypical: clozapine (agranulocytosis - monitor CBC), olanzapine, risperidone
• Neuroleptic Malignant Syndrome: hyperthermia + rigidity + altered consciousness - Rx: dantrolene + bromocriptine

• SSRIs: fluoxetine, sertraline - 1st line for depression; SE: sexual dysfunction, serotonin syndrome
• TCAs: amitriptyline - cardiotoxic in OD; used for neuropathic pain, bed-wetting
• MAOIs: phenelzine - cheese reaction (tyramine), serotonin syndrome with meperidine
• SNRIs: venlafaxine, duloxetine

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📘 DAY 6: CNS Part 2 + Opioids + Anesthesia

• Morphine: strong mu agonist, constipation, miosis, respiratory depression
• Codeine: prodrug converted to morphine by CYP2D6
• Tramadol: weak opioid + SNRI - lower abuse potential
• Fentanyl: most potent, used in anesthesia/patches
• Antidote: naloxone (competitive mu antagonist)
• Methadone: long-acting, used in opioid dependence

• IV agents: thiopentone (induction), propofol (induction + TIVA), ketamine (dissociative - raises ICP, bronchodilator)
• Inhalational: halothane (hepatotoxicity), isoflurane, sevoflurane (safest for neuroanaesthesia), nitrous oxide (NO analgesia)
• MAC = minimum alveolar concentration (lower MAC = more potent)

• Mechanism: block Na channels (state-dependent)
• Lidocaine: most widely used; also Class Ib antiarrhythmic
• Bupivacaine: longest duration, most cardiotoxic
• Adrenaline added to LA: prolongs action, reduces bleeding (NEVER in digits, penis, nose, ear)

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📘 DAY 7: Endocrine Pharmacology

• Hypothyroidism: levothyroxine (T4)
• Hyperthyroidism: carbimazole/propylthiouracil (PTU preferred in pregnancy); PTU also blocks T4→T3 conversion
• Propranolol: controls symptoms (tachycardia) in thyrotoxicosis

• Anti-inflammatory: prednisolone, dexamethasone (most potent anti-inflammatory)
• No mineralocorticoid activity: dexamethasone
• Most mineralocorticoid activity: fludrocortisone
• Cushing's syndrome features from excess: buffalo hump, moon face, striae, osteoporosis

• Combined OCP: estrogen + progestin - inhibit LH surge
• Minipill (progestin only): thickens cervical mucus
• Emergency contraception: levonorgestrel (within 72h) or ulipristal (within 120h)

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📘 DAY 8: Chemotherapy - Antibiotics

• Penicillins (amoxicillin, ampicillin, cloxacillin), Cephalosporins (Ceph generations), Carbapenems (meropenem), Aztreonam
• Mechanism: inhibit transpeptidase → cell wall synthesis block
• Allergy: cross-reactivity between penicillin and cephalosporins (10%)

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📘 DAY 9: Autacoids + GIT + Respiratory + Haematinics

• Histamine: H1 (allergy, bronchospasm) via H1R; H2 (gastric acid) via H2R
• H1 antihistamines: 1st gen (sedating) - chlorpheniramine, promethazine; 2nd gen (non-sedating) - cetirizine, loratadine, fexofenadine
• H2 blockers: ranitidine, famotidine (gastric acid reduction)
• NSAIDs: aspirin (irreversible COX inhibitor, antiplatelet), ibuprofen, indomethacin; celecoxib (COX-2 selective)

• Antacids: Mg(OH)2, Al(OH)3 (constipation)
• PPIs: omeprazole, pantoprazole (block H+/K+ ATPase - most effective acid suppression)
• Metoclopramide: prokinetic + antiemetic (D2 blocker - causes EPS)
• Ondansetron: 5-HT3 blocker - best antiemetic for chemo-induced nausea
• Loperamide: antidiarrheal (opioid agonist, does not cross BBB)

• SABA: salbutamol (albuterol) - acute asthma
• LABA: salmeterol - maintenance
• ICS: beclomethasone, budesonide - most effective long-term asthma control
• Ipratropium (anticholinergic): COPD 1st line bronchodilator
• Theophylline: narrow therapeutic index, enzyme-induced levels affected
• Montelukast: leukotriene receptor antagonist, useful in aspirin-sensitive asthma

• Iron: ferrous sulphate orally; IV for malabsorption; antidote for overdose = desferrioxamine
• Vit B12: cyanocobalamin/hydroxocobalamin - IM for pernicious anemia
• Folic acid: 5 mg pre-conception to prevent NTDs
• Anticoagulants: Heparin (IV/SC, antidote = protamine sulfate), Warfarin (antidote = Vit K / FFP)
• Antiplatelets: Aspirin (COX inhibitor), Clopidogrel (ADP/P2Y12 blocker)
• Thrombolytics: streptokinase, alteplase (tPA) - for acute MI/stroke

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📘 DAY 10: Revision + MCQ Sprint

• Go through all your drug-of-choice tables
• Review all "antidotes" list
• Check all adverse effects charts

1. Single best answer questions on mechanism of action
2. Drug-side effect matching
3. DOC for conditions
4. Drug interactions

• Practice writing 2-3 long answers (10 marks each): e.g., "Write about beta blockers" or "Classify antihypertensives with mechanism and uses"

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⚡ HIGH-YIELD ANTIDOTES TABLE (must memorize)

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📝 DAILY TIME TABLE TEMPLATE

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📚 BOOKS TO USE

1. KD Tripathi (Essentials of Medical Pharmacology) - primary textbook for Indian universities
2. Lippincott's Pharmacology - great for mechanisms and diagrams (available in your medical library as referenced above)
3. Katzung's Basic & Clinical Pharmacology - comprehensive reference (full text in your medical library)
4. ROAMS / Gobind Rai Garg MCQ book - for MCQ practice

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💡 EXAM STRATEGY TIPS

1. Start answers with classification - examiners love drug classifications
2. Drug tables beat paragraphs - use columns: drug name / mechanism / uses / side effects / contraindications
3. Write DOC boldly - "Drug of choice for X is Y" gets marks
4. Mnemonics for side effects:
   • RIPE drugs (TB): Rash/Red urine, Isoniazid-neuropathy, Pyrazinamide-uricemia, Ethambutol-eyes
   • Atropine effects: "Hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter"
5. Every day revise antidotes and DOC tables - these are highest-yield MCQ material
6. 10 minutes before sleep: mentally rehearse classification of that day's drug class

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