CA1: Gavin Dawe + Inthrani

Question 1

NSAIDs for Rheumatoid Disorders

Answer 1

Aspirin, Naproxen, Indomethacin, Diclofenac

Question 2

COX-2 Selective Inhibitors Rheumatoid Disorders

Answer 2

Celecoxib, Parecoxib, Etoricoxib

Question 3

Analgesic for OA

Answer 3

Parecetamol

Question 4

Uric acid synthesis inhibitors for Gout

Answer 4

Allopurinol (purine), Febuxostat (non-purine)

Question 5

Uricosuric Agents for Gout

Answer 5

Probenecid

Question 6

NSAIDs/Coxibs for Gout

Answer 6

Indomethacin/Naproxen & ibruprofen/Coxibs

Question 7

Leucocyte mobility inhibitor for Gout

Answer 7

Colchicine

Question 8

Pain relief for OA

Answer 8

Paracetamol, NSAIDs, Coxibs, Glucocorticoids

Question 9

Polysaccharide Supplementation for OA

Answer 9

Intra-articular hyaluronic acid

Question 10

Symptomatic slow acting drugs for OA

Answer 10

Chondroitin sulphate, glucosamine

Question 11

csDMARDs for RA (increase adenosine levels, decrease pyrimidines)

Answer 11

Methotrexate

Question 12

csDMARDs for RA (gut microflora)

Answer 12

Sulfasalazine

Question 13

csDMARDs for RA (increase pH of vesicles, interfere with antigen presentation)

Answer 13

Hydroxychloroquine

Question 14

csDMARDs for RA (decrease pyrimidines, antiproliferative T cells, inhibit NF-kappaB)

Answer 14

Leflunomide

*colestyramine wash-out for toxicitiy

Question 15

tsDMARDs for RA (JAK pathway inhibitor, blocks cytokine production)

Answer 15

Tofacitinib

Question 16

bDMARDs (TNF-alpha blockers)

Answer 16

Infliximab, Adalimumab

Question 17

bDMARDs (IL-1 blockers)

Answer 17

Anakinra

Question 18

bDMARDs (IL-6 blockers)

Answer 18

Tocilizumab

Question 19

csDMARDs for SLE

Answer 19

Azathioprine (inhibit de novo purine synthesis)
Cyclophosphamide (DNA alkylation)
Hydroxychloroquine

Question 20

Anti-anginal drugs (first line for acute)

Answer 20

Nitroglycerin

• convert GTP to cGMP with guanylyl cyclase –> vasodilation
• endothelial dysfunction (peroxynitrite)
• DDI: PDE5 inhibitors

Question 21

Anti-anginal drugs (first line for prophylaxis but not in vasospastic angina) –> BB

Answer 21

Beta-1 selective: Metoprolol
Non-selective (Carvedilol)
Beta-1 antagonist & beta-3 agonist (Nebivolol)

Question 22

Anti-anginal drugs (prophylaxis) –> CCB

Answer 22

Non-DHP: Verapamil, Diltiazem
DHP: Short acting: Nifedipine (+ BB)
Longer acting: Amlodipine

Question 23

Anti-anginal (prophylaxis) –> Novel antianginals (inhibit inward funny current in SA node)

Answer 23

Ivabradine

Question 24

Anti-anginal (prophylaxis) –> Novel antianginals (inhibit slow inward Na current)

Answer 24

Ranolazine

Question 25

Anti-anginal (prophylaxis) --> Novel antianginals (inhibit FFA oxidation)

Answer 25

Trimetazidine

Question 26

Anti-arrhythmic (Class 1: Na blocking) 1A | local anaesthetic action

Answer 26

Procainamide, Quinidine (DNV), Disopyramide (anticholinergic) (for ventricular arrhythmias)

Question 27

Anti-arrhythmic (Class 1: Na blocking) 1B | local anaesthetic action

Answer 27

Lidocaine, Mexiletine (for ventricular arrhythmias)

Question 28

Anti-arrhythmic (Class 1: Na blocking) 1C | local anaesthetic action

Answer 28

Flecainide, Propafenone (for supraventricular arrhythmias, AF)

Question 29

Anti-arrhythmic (Class 2: BB) control rate

Answer 29

Metoprolol (depress AV node) | for Sinus tachycardia, AF, PSVT, WPW syndrome, CHF)

Question 30

Anti-arrhythmic (Class 3: K channel blockers)

Answer 30

Amiodarone --> bradycardia, blue-grey discolouration, corneal microdeposits, hypo/hyperthyroidism, pulmonary fibrosis Dronedarone (lack iodine atoms, no thyroid SE)

Question 31

Anti-arrhythmic (Class 4: CCB)

Answer 31

Non-DHP: verapamil/diltiazem | CI: digitalis toxicity, beta-blockade, AV block

Question 32

Anti-arrhythmic (Class 5) for CHF, AF

Answer 32

Digoxin (lower speed of conduction) | Toxicity: cardiac exacerbation, GIT, CNS

Question 33

Anti-arrhythmic (Class 5) for supraventricular tachycardias

Answer 33

Adenosine (IV)

Question 34

Anti-arrhythmic (Class 5) for torsades de pointes

Answer 34

Magnesium

Question 35

Anti-Thrombotic (normal)

Answer 35

Aspirin

Question 36

Anti-Thrombotic (ADP receptor - Thienopyridine-derivatives)

Answer 36

``` Ticlopidine Clopidogrel (CYP2C19) Prasugrel (overcome shortcomings) ```

Question 37

Anti-Thrombotic (ADP receptor - Non-Thienopyridine-derivatives)

Answer 37

Ticagrelor (inhibit G protein activation, DDI with CYP3A4 inhibitors) *higher risk of bleeding events

Question 38

Anti-Thrombotic (GP IIb/IIIa inhibitors) reversible

Answer 38

Abciximab against complex(oral) Eptifibatide (receptor antagonist competes with fibrinogen) (oral) Tirofiban (non-peptide antagonist) IV

Question 39

Oral anti-coagulants (vit K antagnoist)

Answer 39

Warfarin

Question 40

Oral anti-coagulants (NOACs)

Answer 40

Dabigatran (block F2a), antidote: idarucizumab Rivaroxaban & Apixaban (block F10a)

Question 41

Parenteral anti-coagulants

Answer 41

Heparin (HIT) & LMWH | Lepirudin (treat HIT)

Question 42

``` Fibrinolytic drugs (r-tPA, bind to fibrin-bound plasminogen) CI: prior hemorrhage Antidote: tranexamic acid ```

Answer 42

Alteplase, Reteplase, Tenecteplase (longer half life)

Question 43

``` Fibrinolytic drugs (uPA/streptokinase) CI: prior hemorrhage Antidote: tranexamic acid ```

Answer 43

Urokinase, Streptokinase (form complex with PLG) | bind to both free & fibrin-bound PLG

Question 44

Hypothyroidism drugs

Answer 44

Levothyroxine (longer half life) DDI: estrogen hormone therapy -subclinical hypothyroidism, elderly, pregnant, IHD Liothyronine --> short half life, more CV effects

Question 45

``` Hyperthyroidism drugs (thioamides - inhibit TPO) **SE: agranulocytosis ```

Answer 45

Carbimazole (Thiamazole) Propylthiouracil (PTU) --> additional inhibit deiodination of T4 to T3, for thyroid storm

Question 46

Hyperthyroidism (high conc of iodine) | for pre-operative/thyrotoxic crisis/endemic goitre

Answer 46

Lugol's solution/KI + BB

Question 47

Hyperthyroidism (radioactive iodine)

Answer 47

131 I for thyroid destruction, 123 I (beta & gamma) for diagnostic