Semper Pharmacy

28/01/2026

💊 What is vitamin E?
A fat-soluble vitamin
Main form: α-tocopherol
Powerful antioxidant
⚙️ Mechanism / Function
Prevents lipid peroxidation of cell membranes
Protects RBCs, nerves, muscles, and retina
Works with selenium as an antioxidant system
✅ Functions in the body
Maintains cell membrane integrity
Protects against oxidative stress
Supports immune function
Important for neuromuscular function
🩺 Uses
Treatment of vitamin E deficiency
Malabsorption states:
Fat malabsorption
Cystic fibrosis
Abetalipoproteinemia
Premature infants (prevention of hemolytic anemia)
⚠️ Not routinely used to treat heart disease, cancer, or gout
❌ Deficiency features
Hemolytic anemia
Peripheral neuropathy
Ataxia
Muscle weakness
Retinopathy (rare)
⚠️ Excess / toxicity
Rare, but high doses may cause:
Increased bleeding risk (interferes with vitamin K)
GI upset
Fatigue
🍎 Dietary sources
Vegetable oils
Nuts & seeds
Green leafy vegetables
Whole grains

28/01/2026

💊 What is Paracetamol?
A non-opioid analgesic and antipyretic
Used for pain relief and fever reduction
Not anti-inflammatory
⚙️ Mechanism of action
Inhibits prostaglandin synthesis in the CNS
Acts on COX enzymes centrally
Minimal effect on peripheral COX → no anti-inflammatory action
✅ Uses
Mild to moderate pain (headache, toothache, myalgia)
Fever (pyrexia)
Safe alternative when NSAIDs are contraindicated
Peptic ulcer disease
Asthma
Children
Pregnancy (at therapeutic doses)
🚫 What it does NOT do
No significant anti-inflammatory effect
No platelet inhibition
No gastric irritation at normal doses
⚠️ Adverse effects
Hepatotoxicity in overdose or chronic high doses
Usually well tolerated at therapeutic doses
☠️ Overdose
Metabolized to NAPQI (toxic metabolite)
Normally detoxified by glutathione
Overdose → glutathione depletion → liver failure
🧪 Antidote
N-acetylcysteine (NAC)
💡 Key exam points
Drug of choice for fever in children
Safe in peptic ulcer disease
No anti-platelet effect
Overdose → liver toxicity

27/01/2026

Laxatives used with opioids
1. Stimulant laxatives (first-line)
Senna
Bisacodyl
👉 Increase bowel motility (important because opioids ↓ gut movement)
2. Osmotic laxatives
Lactulose
Polyethylene glycol (PEG / macrogol)
Magnesium hydroxide
👉 Draw water into stool
3. Stool softeners (adjunct)
Docusate sodium
👉 Often combined with stimulants (e.g., docusate + senna)
4. Peripherally acting μ-opioid receptor antagonists (for refractory cases)
Methylnaltrexone
Naloxegol
Naldemedine
👉 Reverse opioid effects in the gut without affecting analgesia

Bulk-forming laxatives (psyllium)

27/01/2026

27/01/2026

Vitamin D —
What it is
A fat-soluble vitamin that acts like a hormone in the body.
Forms
Vitamin D₂ (ergocalciferol) – from plants
Vitamin D₃ (cholecalciferol) – from skin (sunlight) & animal sources → more effective
Sources
☀️ Sunlight (UVB on skin)
🥚 Egg yolk
🐟 Fatty fish (salmon, mackerel)
🥛 Fortified milk/cereals
💊 Supplements
Activation (important for exams)
Skin → Vitamin D₃
Liver → 25-hydroxyvitamin D (calcidiol)
Kidney → 1,25-dihydroxyvitamin D (calcitriol) → active form
Functions
↑ Calcium & phosphate absorption from gut
Bone mineralization & growth
Supports muscle and immune function
Deficiency
Children: Rickets
Adults: Osteomalacia
Symptoms: bone pain, muscle weakness
Excess (toxicity)
Hypercalcemia → nausea, vomiting, kidney stones

23/01/2026

Ni****ne Replacement Therapy (NRT)

helps people stop smoking by giving ni****ne without the harmful chemicals in to***co. It eases withdrawal symptoms and cravings, so quitting feels more manageable.
🔹 How NRT works
Ni****ne from ci******es causes dependence. When you stop suddenly, you get:
Cravings
Irritability
Anxiety
Poor concentration
NRT provides controlled, lower doses of ni****ne to reduce these symptoms while you break the smoking habit.
🔹 Types of NRT
🟢 Short-acting (for sudden cravings)
Ni****ne gum
Ni****ne lozenges
Ni****ne nasal spray
Ni****ne inhaler
🔵 Long-acting (baseline control)
Ni****ne transdermal patch
👉 Best results often come from combining:
A patch (steady ni****ne)
PLUS gum or lozenge (breakthrough cravings)
🔹 Dosing basics
Patch:
Heavy smoker → start with 21 mg/day
Then taper over weeks
Gum/lozenge:
2 mg or 4 mg depending on how soon you crave after waking
🔹 Advantages
✔ Reduces withdrawal symptoms
✔ Doubles quit success rates
✔ Safer than smoking
✔ Over-the-counter (most forms)
🔹 Side effects
Patch: skin irritation, vivid dreams
Gum/lozenge: jaw pain, hiccups, nausea
Nasal spray: nasal irritation
🔹 Contraindications / cautions
Recent myocardial infarction
Severe arrhythmias
Unstable angina
(Still much safer than smoking, even in most cardiac patients)
🔹 NRT vs other quit-smoking drugs
Drug
Mechanism
NRT
Replaces ni****ne
Bupropion
↓ craving via NE & DA

22/01/2026

Dementia is a syndrome (not a single disease) marked by a progressive decline in cognitive function severe enough to interfere with daily life and independence.
🧠 What’s affected?
Memory (especially recent memory)
Thinking & reasoning
Language
Visuospatial skills
Judgment & problem-solving
Behavior & personality
Consciousness is usually clear (unlike delirium).
🔍 Common causes (important for exams)
Alzheimer’s disease – most common
Gradual onset, progressive
Early memory loss
Pathology: β-amyloid plaques & neurofibrillary tangles (tau)
Vascular dementia
Stepwise deterioration
History of strokes, hypertension
Executive dysfunction early
Lewy body dementia
Fluctuating cognition
Visual hallucinations
Parkinsonism
Sensitive to antipsychotics ⚠️
Frontotemporal dementia (Pick’s disease)
Early personality & behavior changes
Disinhibition, apathy
Language problems
Reversible causes (don’t miss!)
Vitamin B12 deficiency
Hypothyroidism
Depression (pseudodementia)
Normal pressure hydrocephalus (wet, wobbly, wacky)
Drugs (anticholinergics, sedatives)
🧪 Diagnosis
Clinical assessment + cognitive tests (MMSE, MoCA)
Labs: B12, TSH, electrolytes
Brain imaging (CT/MRI) to rule out structural causes
💊 Management (not curative, but symptomatic)
Cholinesterase inhibitors:
Donepezil, Rivastigmine, Galantamine
NMDA antagonist:
Memantine (moderate–severe dementia)

21/01/2026

Psychosis is a mental state in which a person has loss of contact with reality, leading to abnormal thoughts, perceptions, and behavior.
Core features of psychosis (high-yield)
At least one of the following is present:
Delusions – fixed false beliefs
Persecutory (being harmed)
Grandiose (special powers)
Referential (TV/radio talking about them)
Hallucinations – perception without stimulus
Auditory (most common): voices commenting or commanding
Visual, tactile, olfactory (more common in medical causes)
Disorganized thinking/speech
Loose associations
Tangentiality
Word salad
Grossly disorganized or abnormal behavior
Agitation, bizarre behavior
Catatonia can occur here
Common causes
Psychiatric
Schizophrenia
Schizoaffective disorder
Bipolar disorder (mania with psychosis)
Major depressive disorder with psychotic features
Medical / organic
Delirium
CNS infections, tumors
Thyroid disorders
Vitamin B12 deficiency
Substance-induced
Amphetamines, co***ne
Cannabis (high doses)
Steroids
Alcohol withdrawal
Management (overview)
Antipsychotics → mainstay
Typical: Haloperidol
Atypical: Risperidone, Olanzapine
Treat underlying cause
If severe agitation → antipsychotic ± benzodiazepine
If psychosis with catatonia → benzodiazepines first, not antipsychotics
Feature
Psychosis
Neurosis
Insight
Absent
Present
Reality testing
Impaired
Intact
Delusions/hallucinations
Present
Absent

21/01/2026

Just a little reminder that we are active and available

21/01/2026

Visit us today and grab yours!!!

21/01/2026

Niacin (Nicotinic acid, Vitamin B₃)
Niacin is a lipid-lowering drug and a vitamin used mainly to improve cholesterol levels.
Mechanism of action
Inhibits lipolysis in adipose tissue
→ ↓ free fatty acids to liver
→ ↓ VLDL synthesis
↓ VLDL → ↓ LDL
Increases HDL by decreasing hepatic uptake of Apo-A1
👉 Niacin is the most effective drug for raising HDL
Effects on lipid profile
Lipid
Effect
HDL
↑↑ (major effect)
LDL
↓
Triglycerides
↓
Uses
Dyslipidemia (especially low HDL)
Hypertriglyceridemia
Prevention of cardiovascular disease (less used now due to side effects)
Adverse effects (very important for exams)
Flushing & itching (prostaglandin-mediated) 🔥
Hyperglycemia
Hyperuricemia → gout
Hepatotoxicity
GI upset
📌 Flushing can be reduced by aspirin taken before niacin.
Contraindications / caution
Liver disease
Gout
Diabetes mellitus
Peptic ulcer disease
Key exam pearls
Vitamin B₃ deficiency → Pellagra
Dermatitis, Diarrhea, Dementia
IR vs SR:
Immediate-release → more flushing
Sustained-release → more hepatotoxicity
One-line summary
Niacin lowers LDL & triglycerides and raises HDL but causes flushing and metabolic side effects.