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Enalapril is an ethyl ester prodrug that is hydrolyzed in the liver to active enalaprilat, which inhibits ACE. Prodrug design improves oral bioavailability. Lisinopril and captopril are active as administered.

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Digoxin toxicity treated with Digoxin immune Fab fragments; Heparin reversed by Protamine sulfate; Warfarin reversed by Vitamin K; Iron overload treated with Deferoxamine chelation. Critical toxicology for pharmacists.

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Schedule C includes biological and special products like vaccines, sera, insulin which require strict quality control and specific storage conditions (cold chain). Schedule C1 covers similar products of animal origin.

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Omeprazole is a proton pump inhibitor (PPI) that covalently binds and irreversibly inhibits the H+/K+ ATPase enzyme in gastric parietal cells, profoundly suppressing acid secretion. Effect lasts until new pumps are synthesized.

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First-pass (presystemic) metabolism occurs when orally administered drugs are absorbed via portal vein and metabolized in liver before entering systemic circulation, reducing bioavailability. Sublingual and lower rectal routes partially bypass this.