Clinical Pharmacology

Question 1

MOA of abciximab, tirofiban, eptifibatide

Answer 1

binds to the glycoprotein (GP) IIb/IIIa receptor of human platelets and inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive molecules

Question 2

MOA of clopidogrel, ticagrelor, prasugrel

Answer 2

ADP antagonism

Question 3

MOA of aspirin

Answer 3

cyclo-oxegnase inhibitor

Question 4

MOA of dipyramidole

Answer 4

phsophodiesterase inhibitor

Question 5

What drugs cause intracranial hypertension?

Answer 5

tetracycline, amiodarone, OCP and withdrawal of corticosteroids

Question 6

Pharmacokinetics vs pharmacodynamics

Answer 6

Pharmacokinetics is the study of what the body does to the drug, and Pharmacodynamics is the study of what the drug does to the body

Question 7

Which antibiotic increases risk of tendon rupture

Answer 7

Levofloxacin

Question 8

What side effect is noted with nitrofurantoin?

Answer 8

Acute pulmonary reaction

Question 9

CYP-2D6

Answer 9

TCA, Beta blockers, SSRI, Dihydrocodeine, Ecstacy

Question 10

CYP-2C8

Answer 10

Omeprazole, diazepam, barbiturates, dapsone(also 2C9)

Question 11

CYP-2C 18/19

Answer 11

omeprazole, diazepam, TCA, proguanil

Question 12

Carbimazole side effect

Answer 12

Agranulocytosis, Liver impairment

Question 13

Amiloride

Answer 13

potassium sparing diuretic

Question 14

Dihydropyrimidine vs non-dihydropyrimidine CCB

Answer 14

Dihydropyrimide (nifedipine and amlodipine) works on vessels while non-dihydropyridime works on hearts (diltiazem, verapamil)

Question 15

Why ACEi cause cough?

Answer 15

Accumulation of bradykinin in the lungs due to reduced formation of angiotensin II

Question 16

What antidepressant interacts with tyramine?

Answer 16

MAOI may cause hypertensive crisis due to increase sympathomimetic reactions of tyramine

Question 17

Side effect of ethambutol

Answer 17

Visual side effects- optic neuritis. All patients should have eye exams.

Question 18

Tb drugs and side effects

Answer 18

Isoniazid, Pyrazinamide, Rifampicin-drug-induced hepatitis
Streptomycin- renal dysfunction, vestibular disturbance

Question 19

What is sumatriptan?

Answer 19

5HT1 agonist used in migraines

Question 20

What is cisapride

Answer 20

5HT2 agonists which is prokinetic and used in gastroparesis. May cause QT prolongation

Question 21

What are the uses of 5HT3 antagonist?

Answer 21

Antiemetics such as ondansetron, gransietron

Question 22

What is clomethiazole?

Answer 22

GAABA mimetic used in alcohol withdrawal

Question 23

What is chlorpromazine?

Answer 23

Phenothiazines. D2 antagonists used in schizophrenia

Question 24

What is chlordiazepoxide?

Answer 24

benzodiazepine that may be used in alcohol withdrawal

Question 25

What cancer does BCG treat?

Answer 25

It is live attenuated vaccine. It is 70-80% protective against severe infection. Protection lasts for 10-15 years. Bladder carcinoma in situ

Question 26

What antihypertensive causes pericarditis?

Answer 26

Hydralazine

Question 27

Drugs that prolong QT interval?

Answer 27

floroquinolones, erythromycin, citalopram (SSRI)

Question 28

Complications of bisphosphonate?

Answer 28

Esophageal perforation, osteonecrosis of the jaw

Question 29

What anti-HTN causes glucose intolerance?

Answer 29

Thiazide diuretics and beta blockers

Question 30

Donepezil

Answer 30

cholinesterase inhibitor potentiates the action of cholinergic neurons

Question 31

Antiretroviral and side effects

Answer 31

Zidovudine- anaemia Lamivudine- skin rashes, peripheral neuropathy and arthralgia Abacavir- idiosyncratic hypersensitivity HLA-B5701 Indinavir(protease inhibitors)- renal stones, hyperlipidemia Tenofovir- renal impairment Efavirenz- nightmares Nevirapine, NNRTIs- hepatitis Stavudine- peripheral neuropathy

Question 32

Co-trimoxazole

Answer 32

SJS, anaemia, neutropenia

Question 33

Side effects of gliclazide (sulfonylurea)

Answer 33

weight gain and hypoglycemia

Question 34

Metformin class of drug

Answer 34

biguanide

Question 35

Side effects of pioglitazone

Answer 35

increased body mass, reduction in BMD, fluid retention

Question 36

Which diuretic interacts with lithium to cause increased concentrations?

Answer 36

Thiazide diuretic

Question 37

Where don each class of diuretic act in the nephron

Answer 37

COLT Pee Carbonic anhydrase inhibitor- proximal convoluted tubule (acetazolamide) Osmotic diuretics- loop of Henle Loop diuretics- loop of Henle (ascending)- inhibits sodium potassium chloride cotransporter Thiazide diuretics- at the early distal convoluted tubule Potassium sparing diuretics- distal portion of the distal convoluted tubule spironolactone (aldosterone antagonist)

Question 38

Signs and symptoms of amphetamine overdose

Answer 38

Hypertension, tachycardia, mydriasis, pallor, hyperexcitability, hypokalemia Severe toxicity may present with fever, rhabdomyolysis, AKI, liver failure Treatment: Benzos Labetalol if benzes does not reduce BP

Question 39

How does theophylline work?

Answer 39

Blocks adenosine receptors leading to relaxation of bronchial smooth muscles , constriction of cerebral blood vessels, stimulation of the cardiac pacemaker and stimulation of gastric secretions. It is highly protein bound and is extensively metabolized by the liver therefore a small amount (10%) is excreted unchanged in the urine. It has a narrow therapeutic window.

Question 40

How to work out drug clearance?

Answer 40

UxV/P (urine concentration x urine volume produced)/plasma concentration

Question 41

Side effects of simvastatin

Answer 41

Myositis

Question 42

Causes of hyperprolactinoma

Answer 42

Medications that can cause high prolactin Antipsychotics: Such as risperidone, haloperidol, chlorpromazine, and perphenazine Antidepressants: Such as imipramine, amitriptyline, paroxetine, and dothiepin High blood pressure medications: Such as methyldopa and verapamil Medications for heartburn and GERD: Such as H2 antihistamines Medications for menopause symptoms: Such as estrogen therapy Medications for nausea and vomiting: Such as antiemetics Pain relievers: Such as those containing opioids Medications that increase bowel motility: Such as certain gastrointestinal agents Other possible causes of high prolactin levels include herbal supplements like anise, fennel, or fenugreek seed, and opioid use.

Question 43

Entacapone

Answer 43

catechol-O-methyltransferase inhibitor which prolongs the effects of levodopa by inhibiting its peripheral degradation

Question 44

MOA of pioglitazone

Answer 44

to improve insulin sensitivity and decrease hepatic glucose output. It does this by stimulating the peroxisome proliferator-activated receptor gamma (PPARγ) nuclear receptor.

Question 45

Clopidogrel and omeprazole

Answer 45

Omeprazole is CYP2C19 inhibitor which leads to decreased effects of clopidogrel

Question 46

Drugs that theophylline interact with?

Answer 46

clarithromycin, ciprofloxacin, cimetdine, OCP, Allopurinol Rifampicin reduce these levels

Question 47

Ezetimibe

Answer 47

cholesterol lowering medication that works by blocking the Niemann-Pick C1-Like 1 (NPC1L1) protein, which is responsible for transporting cholesterol from the intestine to the liver

Question 48

Cholestyramine

Answer 48

anion exchange resins affects fat soluble vitamins and concentrations of drugs digoxin and thyroxine (fat-soluble)

Question 49

What drugs can worsen psoriasis

Answer 49

beta blockers, antimalarials and lithium. Strep may precipitate guttate psoriasis.