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MRCP part 1 > Clinical pharmacology > Flashcards

Clinical pharmacology Flashcards

1
Q

ADP receptor inhibitors

A

Clopidogrel
Ticagrelor
PrasugrelA

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2
Q

ADP receptor inhibitor mechanism

A

prevents ADP-mediated pltelet activation and aggregation
adenosine concentration in circulation can increase and give rise to dyspnoea

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3
Q

Aspirin mechanism

A

block prostaglandin synthesis
non-selective for COX1 and COX2 enzymes

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4
Q

ARB mechanism

A

block angiotensin II at the AT1 receptor

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5
Q

Liver enzyme inducers

A

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic excess)
St Johns Wort

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6
Q

Drugs whose effectiveness is reduced by induction…

A

hydrocortisone
oral contraceptive
phenytoin
warfarin

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6
Q

Liver enzyme induction…

A

increases metabolism and therefore reduces effectiveness of some drugs

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7
Q

Liver enzyme inhibitors

A

Allopurinol
Omepazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Cimetidine
Ethanol (acute intoxication)
Sulfonamide

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8
Q

Liver enzyme inhibition…

A

slows metabolism of drugs thereby increasing plasma concentration and risk of adverse effects

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9
Q

Drugs whose effects increased by liver inhibition

A

Carbamazepine
Ciclosporin
Phenytoin
Statins
Theophyline
Warfarin

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10
Q

Drugs to be avoided in pregnancy

A

ACEI and ARB
Lithium
Phenytoin
Sodium valproate
Warfarin
Antibiotics - tetracycline, aminoglycosides, trimethoprim, quinolones

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11
Q

Drugs to be avoided in breast feeding

A

Amiodarone
Cytotoxics
Chloramphenicol
Gold
Indometacin
Iodides
Lithium
Oestrogens

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12
Q

Quinolones

A

Bactericidal
Inhibits DNA synthesis
Avoid in G6PD, pregnancy breastfeeding
Prolong QT
Lower seizure threshold

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13
Q

Trastuzumab

A

(Herceptin)
Acts on the HER2/neu receptor
i.e. for HER-2 positive breast Ca

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14
Q

Metabolic acidosis with a high anion gap and high osmolar gap

A

Ethylene glycol poisoning

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15
Q

Paracetamol liver failure transplant criteriA

A

Arterial pH < 7.3, 24 hours after ingestion
OR all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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16
Q

Anion gap cal

A

(Na + K) - (Cl +Bic)
Normal 4-12

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17
Q

Causes of normal anion gap MA

A

Addison’s
Bicarbonate loss: GI (e.g. diarrhoea) or renal (e.g. renal tubular acidosis)
Chloride excess
Diuretics (e.g. acetazolamide)

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18
Q

Causes of high anion gap MA

A

Lactate
Toxins (e.g. methanol, paracetamol, propylene glycol)
Ketones
Renal failure

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19
Q

Anion gap high

A

blood too acidic

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20
Q

Anion gap low

A

blood too alkali

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21
Q

Drug act on nuclear receptor

A

Levothyroxine
Prednisolone
(must be lipid soluble to cross into cell)

22
Q

Drug act on G coupled protein receptor

A

Adrenaline

23
Q

Drug act Guanylate cyclase receptor

A

BNP

24
Q

Drug act on Ion channel receptors

A

Zolpidem
(these receptors mediate fast actions i.e. GABA)

25
Q

Drugs act on Tyrosine kinase receptor

A

insulin like growth factor
IL-2

26
Q

Direct thrombin inhibitor

A

Dabigatran

27
Q

LMWH mechanism

A

activation of antithrombin III to inhibit Xa

28
Q

Anthracycline example and adverse effects

A

Doxorubicin, epirubicin
Cardiac dysfunction (myopathy)

29
Q

Vinca alkaloids example and adverse effects

A

Vincristine, vinblastine
Peripheral neuropathy

30
Q

Platinum-based compounds example and adverse effects

A

Cisplatin, carboplatin
Nephrotoxicity, ototoxicity

31
Q

Taxanes example and adverse effects

A

paclitaxel, docetaxel
peripheral neuropathy

32
Q

Topoisomerase I inhibitors example and adverse effects

A

Irinotecan, topotecan
Diarrhoea, myelosuppression

33
Q

Tricyclic OD management

A

IV bicarb if:
pH <7.1
QRS >160 ms
Arrhythmias
Hypotension

34
Q

Tricyclic OD toxidrome

A

anticholinergic: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.
severe poisoning :
arrhythmias
seizures
metabolic acidosis
coma
ECG:
sinus tachycardia
widening of QRS
prolongation of QT interval

35
Q

Rifampicin mechanism

A

Inhibits RNA synthesis

36
Q

Clarithromycin mechanism

A

reversible inhibition of 50s ribosome subunit

37
Q

Tacrolimus mechanism

A

Decreases IL-2 release by inhibiting calcineurin

38
Q

Digoxin mechanism

A

Inhibition of the Na+/K+ ATPase pump

39
Q

Organophosphate poisoning

A

Bradycardia
hypotension
miosis
urination, defecation

40
Q

Amiloride mechanism

A

potassium sparing diuretic
acts on epithelial sodium channels

41
Q

Antibiotic contraindicated in G6PD

A

Ciprofloxacin (quinolones)
(fava beans infection also precipitate haemolytic crises)

42
Q

Dopamine receptor agonist example and indications

A

Bromocriptine, cabergoline, ropinirole
Parkinsons, prolactinoma, cyclical breast disease, acromegaly

43
Q

Adrenaline induced ischaemia

A

local phentolamine

44
Q

Drugs commonly causing urticaria

A

penicillins
aspirin
NSAIDs
Opiates

45
Q

Metformin mechanism

A

Activation of the AMP-activated protein kinase (AMPK)
Increases insulin sensitivity
Decreases hepatic gluconeogenesis
May also reduce gastrointestinal absorption of carbohydrates

46
Q

Allopurinol mechanism

A

inhibits xanthine oxidase

47
Q

rituximab mechanism

A

monoclonal antibody against CD20

48
Q

Factors predisposing to lithium toxicity

A

Dehydration
Renal failure
Drugs - Diuretics, ACEI, ARB, metronidazole, NSAIDs

49
Q

Drugs that can be cleared by a blast of haemodialysis

A

Barbiturate
Lithium
Alcohol
Salicylates
Theophylline

50
Q

Drugs which cannot be cleared by haemodialysis

A

Dig
Benzos
Tricyclics
Bblockers

51
Q

Nicotinic acid in diabetics

A

May increase insulin resistance

52
Q
A

MRCP part 1 (15 decks)

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