Cardioresp PPT Flashcards

1
Q

name some thiazide diuretics

A

bendroflumethiazide, indapamide

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2
Q

indications of thiazide diuretics

A

hypertension, sometimes chronic heart failure

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3
Q

MOA of thiazide diuretics

A

inhibit the Na+/Cl- co-transporter on DCT, preventing reabsorption of Na+ and H2O

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4
Q

side effects of thiazide diuretics

A

Hyponatraemia
Hypokalaemia
Cardiac arrhythmias
gout

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5
Q

name some loop diuretics

A

furosemide (IV & oral), bumetanide (oral)

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6
Q

indications of loop diuretics

A

acute pulmonary oedema, chronic heart failure, resistant hypertension

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7
Q

MOA of loop diuretics

A

inhibit the Na+/K+/2Cl- pump in ascending loop which results in water retention. Also have a vasodilative effect

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8
Q

side effects of loop diuretics

A

Dehydration
Hypotension
Almost any low electrolyte state

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9
Q

name some potassium sparing diuretics and aldosterone antagonists

A

amiloride, spironolactone (AA), eplerenone (AA)

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10
Q

indications of potassium sparing diuretics and aldosterone antagonists

A

prevention of hypokalaemia with use of other diuretics, primary hyperaldosteronism, severe heart failure

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11
Q

MOA of potassium sparing diuretics

A

act at DCT to prevent reabsorbtion of Na+ and water, but spare K+

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12
Q

MOA of aldosterone antagonists

A

competitive inhibitors of aldosterone at collecting duct and prevent it causing Na+ reabsorption and K+ excretion

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13
Q

side effects of potassium sparing diuretics and aldosterone antagonists

A

GI upset
Hypotension
gynaecomastia (AA)
urinary symptoms

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14
Q

name some beta blockers

A

propranolol, bisoprolol, atenolol, metoprolol and carvedilol

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15
Q

indications of beta blockers

A

angina, MI, hypertension, arrhythmia, heart failure, anxiety

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16
Q

MOA of beta blockers

A

block beta-1 receptors on the heart and reduce force of contraction and speed of conduction. Non-cardioselective ones inhibit release of renin from kidneys.

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17
Q

side effects of beta blockers

A

Cold extremities
bronchospasm
fatigue

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18
Q

warnings of beta blockers

A

cause bronchospasm in asthmatics

contraindicated in heart block

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19
Q

name some calcium channel blockers

A

amlodipine, diltiazem, verapamil

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20
Q

indications of calcium channel blockers

A

hypertension, angina, arrhythmias

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21
Q

MOA of calcium channel blockers

A

decrease Ca2+ entry into vascular and cardiac cells. This causes relaxation and vasodilation in arterial smooth muscle. It suppresses cardiac conduction and slows heart rate

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22
Q

side effects of calcium channel blockers

A

amlodipine - oedema, headaches, palpitations
verapamil - constipation, heart block, gum hypertrophy
diltiazem - any of the above

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23
Q

warnings of calcium channel blockers

A

don’t use amlodipine in unstable angina

verapamil and diltiazem shouldn’t be used with beta blockers

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24
Q

name some ACEi’s

A

ramipril, enalapril, captopril

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25
Q

indications of ACEi’s

A

hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy

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26
Q

MOA of ACEi’s

A

blocks action of ACE, preventing conversion of angiotensin 1 to angiotensin 2. Angiotensin 2 is a vasoconstrictor and stimulates aldosterone production

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27
Q

side effects of ACEi’s

A

hypotension
hyperkalaemia
persistnet dry cough
renal failure

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28
Q

warnings of ACEi’s

A

avoid in renal artery stenosis, AKI
Don’t use antacids at same time
Alcohol amplifies its effects

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29
Q

name some ARBs

A

lorsartan, candesartan, valsartan

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30
Q

indications of ARBs

A

hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy

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31
Q

MOA of ARBs

A

block the action of angiotensin 2 on it’s receptor. Prevents it causing vasocontriction and stimulating aldosterone release

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32
Q

side effects of ARBs

A

hypotension
hyperkalaemia
renal failure

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33
Q

warnings of ARBs

A

avoid in renal artery stenosis and AKI

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34
Q

name some alpha 1 receptor antagonists

A

doxazosin, tamulosin

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35
Q

indications of alpha 1 receptor antagonists

A

resistant hypertension

benign prostatic hyperplasia

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36
Q

MOA of alpha 1 receptor antagonists

A

act on alpha-1 adrenoceptors which are present on smooth muscle of blood vessels and urinary tract. Blockage of these allows vasodilation and reduced resistance to bladder outflow

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37
Q

name some statins

A

simvastatin, atorvastatin

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38
Q

indication of statins

A

prevention of cardiovascular disease

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39
Q

MOA of statins

A

inhibit HMG coA reductase which is involved in making cholesterol. They decrease cholesterol production and increase LDL clearance

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40
Q

side effects of statins

A

myalgia
headaches
hepatitis
rhabdomyolysis

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41
Q

name some fibrates

A

fenofibrate, ciprofibrate

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42
Q

indications of fibrates

A

hypertriglyceridaemia

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43
Q

MOA of fibrates

A

activation of transcriptionfactors called PPARs which help regulate genes that control lipid metabolism. Increase HDL and reduce LDL

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44
Q

side effects of fibrates

A

GI upset
pruritis
headache

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45
Q

name a specific cholesterol absorption inhibitor

A

ezetimibe

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46
Q

indication of specific cholesterol absorption inhibitor

A

prevention of cardiovascular disease

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47
Q

MOA of specific cholesterol absorption inhibitors

A

Act on brush border of small intestine to reduce absorption of cholesterol

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48
Q

side effects of specific cholesterol absorbtion inhibitors

A

GI upset

unpalatability of drug

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49
Q

warnings of specific cholesterol absorption inhibitors

A

interact with absorption of acidic drugs e.g. warfarin, digoxin

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50
Q

name some heparins

A

unfractionated heparin, deltaparin (LMWH), fondaparinux (not a heparin but similar)

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51
Q

indications of heparins

A

thromboembolism, acute coronary syndrome (ACS)

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52
Q

MOA of heparins

A

activates antithrombin which inactivates thrombin and factor Xa, which are key in the common coagulation pathway.
unfractionated heparin inhibits both equally
LMWH inhibits factor Xa preferentially
Fondaparinux inhibits factor Xa only

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53
Q

side effects of heparins

A

bleeding
thrombocytopenia
reaction around injection site

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54
Q

name some DOACs

A

apixaban, rivaroxaban

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55
Q

indications of DOACs

A

thromboembolism treatment and prophylaxis

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56
Q

MOA of warfarin

A

Inhibits an enzyme that reactivates vitamin K. This prevents synthesis of vitamin K dependent coagulation factors

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57
Q

MOA of non-vitamin K dependent DOACs

A

they reversibly bind to factor Xa and inhibit it’s action. This causes quick onset anticoagulation

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58
Q

side effects of warfarin

A

haemorrhage
teratogenic effects on foetus
alopecia

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59
Q

warnings of warfarin

A

broad spectrum antibiotics can increase its anticoagulant effect. CYP450 inhibitors increase risk of bleeding e.g. NSAIDs, amiodarone, SSRIs

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60
Q

side effects of non-vitamin K dependent DOACs

A

haemorrhage

nausea

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61
Q

name some fibrinolytic drugs

A

alteplase, tenecteplase, streptokinase

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62
Q

indications of fibrinolytic drugs

A

acute stroke (alteplase can be given upto 4.5hrs after), STEMI, thrombolysis of thromboembolism

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63
Q

MOA of fibrinolytic drugs

A

catalyses conversion of plasminogen to plasmin which dissolves clots and re-canalises occluded vessels.

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64
Q

side effects of fibrinolytic drugs

A

bleeding
hypotension
cardiac arrest
N&V

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65
Q

name vitamin K as a drug

A

phytomenadione

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66
Q

indications of phytomeandione (vit K)

A

reverse the anticoagulant effect of warfarin,

used in newborns

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67
Q

MOA of phytomenadione (vit K)

A

supplies vitamin K for the synthesis of vitamin K dependent clotting factors

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68
Q

side effects of phytomenadione(vit K)

A

occasionally anaphylaxis

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69
Q

name a prothrombin complex concentrate

A

beriplex

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70
Q

indications of prothrombin complex concentrate

A

reverse the anticoagulant effect of warfarin and vit K antagonists

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71
Q

what drug causes reversal of anticoagulation from DOACs

A

idarucizamab

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72
Q

name some nitrates

A

isosorbide mononitrate, glyceryl trinitrate

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73
Q

indications of nitrates

A

acute angina, ACS (both use glyceryl trinitrate), prophylaxis of angina (isosorbide), pulmonary oedema

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74
Q

MOA of nitrates

A

converted to NO which helps reduce intracellular Ca2+ in vascular smooth muscle, helping them relax. This reduces cardiac work and myocardial oxygen demand

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75
Q

side effects of nitrates

A

frequent headaches
postural hypotension
dizziness
tolerance

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76
Q

name a potassium channel opener

A

nicorandil

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77
Q

indications of potassium channel openers

A

angina

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78
Q

MOA of potassium channel openers

A

they open ATP-inhibited potassium channels, allowing outflow of K+ and hyperpolarisation (-ve potential). Also activates guanylyl cyclase which increases cGMP to further decrease Ca2+. This results in vasodilation which helps reduce myocardial oxygen demand

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79
Q

side effects of potassium channel openers

A

skin, eye and GI ulcers
flushing
headaches

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80
Q

side effects of sinus node inhibitors

A

blurred vision & ocular symptoms
ventricular ectopics
heart block

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81
Q

name a sinus node inhibitor

A

ivabradine

82
Q

indications of sinus node inhibitors

A

angina, chronic heart failure

83
Q

MOA of sinus node inhibitors

A

Inhibit current from pacemaker cells so slows rate of firing of sinus node

84
Q

name a late sodium current inhibitor

A

ranolazine

85
Q

indications of late sodium current inhibitors

A

angina

86
Q

MOA of late sodium current inhibitors

A

they weaken the late Na+ current in ischaemic myocardial cells which goes on to reduce Ca2+ in the cell. This reduces compression of vessels and increases perfusion

87
Q

side effects of late sodium current inhibitors

A

dyspepsia
constipation
elongation of QT interval

88
Q

name a COX inhibitor used in cardiovascular disease

A

Aspirin

89
Q

indications of Aspirin

A

ACS and stroke, secondary prevention of cardiovascular disease, prevention of stent occlusion, treat pain

90
Q

MOA of aspirin

A

irreversibly binds to COX to help prevent formation of thromboxane, reducing platelet aggregation. cox 1 &2 inhibitor

91
Q

side effects of aspirin

A

GI upset
GI ulcers
tinnitus

92
Q

warnings of aspirin

A

Don’t prescribe in under 16s due to risk of Reyes syndrome

acts synergistically with other anti-platelets

93
Q

name a phosphodiesterase (PDE) inhibitor involved in treating CV events

A

dipyridamole

94
Q

CV indications of PDE inhibitor

A

secondary prevention of cardiovascular events, prevention of stent occlusion

95
Q

MOA of PDE inhibitors

A

inhibits reuptake of adenosine, the increased plasma conc of adenosine inhibits platelet aggregation. Also inhibits PDE which leads to reduced platelet activation

96
Q

side effects of PDE inhibitors

A

GI upset
myalgia
angina

97
Q

name some adenosine diphosphate receptor antagonists

A

clopidogrel, ticagrelor

98
Q

indications of ADP receptor antagonists

A

ACS, secondary prevention of CV event, prevention of stent occlusion, prevent thromboembolism

99
Q

MOA of ADP receptor antagonists

A

irreversibly binds to ADP receptor (P2Y12) on surface of platelet, this inhibits platelet aggregation.

100
Q

side effects of ADP receptor antagonsists

A

SOB (ticagrelor)
bleeding
thrombocytopenia

101
Q

warnings of clopidogrel

A

generally prescribed with aspirin because clopidogrel doesn’t affect COX pathway so they act synergistically.
CYP450 inhibitors can reduce efficacy e.g. omeprazole, ciprofloxacin, erythromycin, some SSRIs

102
Q

name a glycoprotein IIb/IIIa antagonists

A

tirofiban

103
Q

indications of glycoprotein IIb/IIIa antagonists

A

secondary prevention of CV event, prevention of occlusion of a stent

104
Q

MOA of glycogen IIb/IIIa antagonists

A

tirofiban reversibly binds to GP IIb/IIIa receptors, preventing binding of fibrinogen which reduces platelet aggregation

105
Q

side effects of glycogen IIb/IIIa antagonists

A

bleeding

thrombocytopenia

106
Q

indications of adrenaline

A

cardiac arrest, iontropic support in ICU, anaphylaxis, local vasocontriction

107
Q

MOA of adrenaline

A

potent agonist of alpha 1&2 and beta 1&2 adrenoceptors resulting in a multitude of effects. specific ones include vasodilation of vessels supplying heart, increased HR and strength of contractions

108
Q

side effects of adrenaline

A

hypertension
MI
angina
arrhythmia

109
Q

name an antimuscarinic agent with CV use

A

atropine

110
Q

indications of antimuscaranic agents (CV)

A

treat symptomatic bradycardia

111
Q

MOA of antimuscarinic agents

A

bind to muscarinic receptors where they are competitive antagonists of Ach. Ach should cause parasympathetic effects, but as it’s blocked the opposite occurs and heart rate and conduction increases

112
Q

side effects of antimuscarinic agents

A

tachycardia
dry mouth & blurred vision
urinary retention
hypohydrosis

113
Q

name a class III antiarrhythmic drug

A

amiodarone, sotalol

114
Q

indication of amiodarone

A

any tachyarrhythmia

115
Q

MOA of amiodarone

A

blockade of sodium, potassium and calcium channels as well as antagonism of alpha and beta receptors. This helps slow conduction through the heart and increase resistance to depolarisation

116
Q

side effects of amiodarone

A
hypotension
pneumonitis/pulmonary fibrosis
AV block
grey skin discolouration
hepatitis
thyroid dysfunction
corneal deposits
peripheral neuropathy
ventricular arrhythmias (with erythromycin)
rhabdomyolysis (with statins)
117
Q

name a class 1b antiarrhythmic drug

A

lidocaine

118
Q

indication of any classified antiarrhythmic drug

A

treat atrial and ventral arrhythmia

119
Q

MOA of class 1b antiarrhythmics

A

provide a weak Na+ channel blockade in abnormal heart tissue, causing slowed impulse conduction

120
Q

side effects of class 1b antiarrhythmics

A

CNS toxicity - seizures, respiratory depression

bradycardia

121
Q

name a class 1c antiarrhythmic

A

flecainide

122
Q

MOA of class 1c antiarrhythmics

A

marked blockade of Na+ channels and slight blockade on both Ca2+ and K+ channels. This slows the rate of impulse conduction

123
Q

side effects of class 1c antiarrhythmics

A

CNS toxicity - dizziness, visual problems
oedema
dyspnoea

124
Q

name a class 4 antiarrhythmic

A

verapamil

125
Q

MOA of class 4 antiarrhythmics

A

selectively block specific calcium channels in heart which leads to slowed impulse conduction in AV node

126
Q

name some unclassified antiarrhythmics

A

adenosine, digoxin

127
Q

indications of unclassified antiarrhythmics

A

atrial tachyarrhytmias

128
Q

MOA of adenosine

A

agonist of adenosine receptors which helps slow sinus rate and conduction, and increase AV refractoriness by breaking the re-entry circuit

129
Q

side effects of adenosine

A

bradycardia

asystole - chest symptoms and breathlessness

130
Q

MOA of digoxin

A

it’s negatively chronotropic and positively ionotropic. It inhibits Na+/K+ pump which increases intracellular Na+, this means Ca2+ can’t be secreted out so there’s increased intracellular Ca2+ which increases force of contractions

131
Q

side effects of digoxin

A

bradycardia
GI upset
digoxin toxicity - cause of arrhythmias

132
Q

name some drugs used in ALS algorithm that treat electrolyte and metabolic abnormalities

A

sodium bicarbonate
calcium gluconate
magnesium sulfate

133
Q

name some penecillins

A

amoxicillin, flucloxacillin, co-amoxiclav, benzylpenecillin

134
Q

indications of penecillins

A

streptococcal infection - tonsillitis, pneumonia, endocarditis, skin infection
clostridial infection - tetanus
meningococcal infection - meningitis, septicaemia

135
Q

MOA of penecillins

A

inhibit the enzymes that cross link peptidoglycans in cell walls. This weakens the cell wall, causing swelling, lysis and death

136
Q

side effects of penecillins

A

resistance of bacteria to beta lactam ring
allergy
anaphylaxis
CNS toxicity

137
Q

name some cephalosporins

A

cefalaxin, cefotaxime, cefuroxime

138
Q

indications of cephalosporins

A

community acquired pneumonia, serious antibiotic resistant infection

139
Q

MOA of cephalosporins

A

broad spectrum. Inhibit enzymes responsible for crosslinking peptidoglycans in cell walls. This weakens cell wall causing swelling, lysis and death

140
Q

side effects of cephalosporins

A

resistance - contains a beta lactam ring (less resitance than to penecillins)
GI upset
colitis
CNS toxicity - seizures

141
Q

name some macrolides

A

erythromycin, clarithromycin, azithromycin

142
Q

indications of macrolides

A

community acquired pneumonia, atypical pneumonia, respiratory and skin infection, H.pylori

143
Q

MOA of mcrolides

A

bacteriostatic and broad spectrum. Inhibit protein syntesis by binding to ribosomes and preventing translocation

144
Q

side effects of macrolides

A
GI upset
thrombophelbitis (when IV)
cholestatic jaundice
prolonged QT
ototoxicity
145
Q

name some aminoglycosides

A

gentamycin, streptomycin, amikacin

146
Q

indications of aminoglycosides

A

endocarditis, pyelonephritis, sepsis,

147
Q

MOA of aminoglycosides

A

act on gram -ve, are bacteriostatic. bind irreversibly to ribosomes to inhibit protein synthesis

148
Q

side effects of aminoglycosides

A

nephrotoxicity

ototoxicity

149
Q

name some tetracyclines

A

doxycycline, lymecycline, minocycline

150
Q

indications of tetracyclines

A

community acquired pneumonia, atypical pneumonia, chlamydia, acne

151
Q

MOA of tetracyclines

A

broad spectrum and bacteriostatic. Bind to ribosomes to inhibit protein synthesis

152
Q

side effects of tetracyclines

A

oesophogeal irritation
photosensitivity
intracranial hypertension
GI upset

153
Q

name some quinolones

A

ciprofloxacin, moxifloxacin

154
Q

indications of quinolones

A

UTI, LRTI, GI infection, community acquired and atypical pneumonia

155
Q

MOA of quinolones

A

mainly bacteriocidal against gram +ve and gram -ve. They inhibit DNA synthesis.
resistance is rapidly developed

156
Q

side effects of quinolones

A

GI upset
ruptured muscle tendons
neurological effects e.g. low seizure threshold

157
Q

name some rifamycins

A

rifampicin, rifabutin

158
Q

indications of rifamycins

A

TB, endocarditis

159
Q

MOA of rifamycins

A

broad spectrum bactericidal action. Inhibit RNA synthesis through binding to DNA dependant RNA polymerase

160
Q

side effects of rifamycins

A

resistance buils quickly
GI upset
leucopenia, thrombocytopenia and anaemia
orange discolouration of sweat and urine

161
Q

indication of isoniazid

A

TB

162
Q

MOA of isoniazid

A

narrow spectrum, bactericidal with dividing bacteria but bacteriostatic with resting bacteria. It’s a cell wall synthesis inhibitor

163
Q

side effects of isoniazid

A

GI upset
peripheral neuropathy
systemic lupus erythematosus

164
Q

indication of pyrazinamide

A

TB

165
Q

MOA of pyrazinamide

A

selectively bactericidal. unclear, but may inactivate a key enzyme in fatty acid synthesis

166
Q

side effects of pyrazinamide

A

hepatotoxicity
arthralgia
sideroblastic anaemia

167
Q

indication of ethambutol

A

TB

168
Q

MOA of ethambutol

A

bacteriostatic. Cell wall synthesis inhibitor

169
Q

side effects of ethambutol

A

peripheral neuritis
gout
visual disturbances

170
Q

name some beta 2 agonists

A

salbutamol, salmeterol, formoterol

171
Q

indications of beta 2 agonists

A

asthma, COPD

172
Q

MOA of beta 2 agonists

A

Beta 2 receptors are located in smooth muscle of bronchi and other locations. When they are stimulated they cause smooth muscle relaxation resulting in bronchodilation

173
Q

side effects of beta 2 agonists

A

tachycardia
anxiety
muscle cramps

174
Q

name some antimuscarinic bronchodilators

A

tiotropium, ipratropium, glucopyrronium

175
Q

indications of antimuscarinic bronchodilators

A

asthma, COPD

176
Q

MOA of antimuscarinic bronchodilators

A

Ach acts at muscarinic receptors causing rest and digest. These drugs are competitive inhibitors of Ach and so cause opposing effects resulting in reduced smooth muscle tone and reduced secretions from glands

177
Q

side effects of antimuscarinic bronchodilators

A

dry mouth

178
Q

name some theophyllines

A

theophylline, aminophylline

179
Q

indications of theophyllines

A

asthma, COPD

180
Q

MOA of theophyllines

A

inhibit phosphodiesterase which leads to vasodilation, bronchodilation and anti-inflammatory effects

181
Q

side effects of theophyllines

A

GI upset
CNS stimulation - insomnia, irritability, seizures
hypokalaemia

182
Q

name some inhaled corticosteroids (glucocorticoid )

A

beclometasone, budesonide, fluticasone

183
Q

indications of ICS

A

asthma, COPD

184
Q

MOA of ICS

A

Corticosteroids pass through plasma membrane and activate receptors in the cytoplasm. These receptors then travel to the nucleus to alter transcription of some genes, downregulating inflammatory cytokines and upregulating inflammatory proteins. This results in reduced mucosal inflammation, bronchodilation and reduced secretions

185
Q

side effects of ICS

A

oral candidiasis
pneumonia
adrenal suppression (rare)

186
Q

name some oral/parenteral corticosteroids

A

prednisolone, hydrocortisone

187
Q

indications of oral/parenteral corticosteroids

A

asthma, COPD, autoimmune disease, cancers, adrenal insufficiency, hypopituitarism

188
Q

MOA of oral/parenteral corticosteroids

A

same as for ICS, but effects are systemic.

189
Q

side effects of oral/parenteral corticosteroids

A

immunosuppression
diabetes
mood changes
hypertension

190
Q

name a cromone

A

sodium cromoglicate

191
Q

indications of cromones

A

prophylaxis in mild to moderate asthma

192
Q

MOA of cromones

A

cause mast cell stabilisation, protection against eosinophil accumulation and decreased bronchoconstriction

193
Q

side effects of cromones

A

GI upset
headache
cough after inhalation

194
Q

name some leukotriene receptor antagonists (LTRA)

A

montelukast, zafirlucast

195
Q

indications of LTRAs

A

asthma

196
Q

MOA of LRTAs

A

inhibit bronchoconstriction by blocking receptors on bronchial smooth muscle

197
Q

side effects of LTRAs

A

GI upset

headaches

198
Q

side effects of alpha 1 receptor antagonists

A

postural hypotension
headache
dizziness

199
Q

important side effect of niacin

A

increases insulin resistance

200
Q

what drug class is dabigitran

A

direct thrombin inhibitor