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Y2 Practice Qs > CPT > Flashcards

CPT Flashcards

1
Q

How do you calculate NNT?

A

1/absolute risk reduction

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2
Q

What can you do within an hour of paracetamol overdose?

A

Give activated charcoal to prevent absorption

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3
Q

Name the CYP450 Inducers

A

PCBRAS - Phenytoin, Carbamazepine, Barbituates, Rifampicin, Alcohol (chronic use), Sulfonylureas

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4
Q

Name the CYP450 Inhibitors

A

GODEVICES - Grapefruit juice, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Cimetidine, Alcohol (acute use), Sulphonamides

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5
Q

Effect on CYP inducers on COCP?

A

Cause it to be metabolised too quickly - higher dose required

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6
Q

Give 4 drugs that increase plasma statin

A

CYP3A4 involved- amiodarone, diltiazem and macrolides increase plasma statin

Amlodipine also increases plasma statin

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7
Q

Why is lidocaine given IV?

A

Extensive 1st pass metabolism

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8
Q

Why is lidocaine affected by CYP inhibitors/ inducers?

A

active metabolites require CYP activity

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9
Q

Why are you careful w fenofibrate and warfarin being prescribed together?

A

Increased anticoagulation

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10
Q

Administration of benzos?

A

Administration: Intravenous Lorazepam, Diazepam rectally, Buccal or intranasal Midazolam

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11
Q

How does digoxin work in HF?

A

Digoxin binds to and inhibits the sodium/potassium-ATPase (sodium pump) within the plasma membrane of cardiac myocytes. This inhibition increases the intracellular sodium content which in turn increases the intracellular calcium content which leads to increased cardiac contractility.

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12
Q

Effect of hypokalaemia on digoxin?

A

Increases its activity

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13
Q

Common side effect of potent anti-diarrhoeals?

A

Paralytic ileus

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14
Q

Common side effect of PPIs?

A

Mask symptoms of gastro-oesophageal cancer

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15
Q

PPI DDIs?

A

Δ Omeprazole CYP inhibitor – reduced clopidogrel action

PPIs can increase effects of warfarin and phenytoin - monitor

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16
Q

Sided effects of SABA and LABA ?

A

adrenergic - tachycardia, palpitations, anxiety and tremor

SVT due to decreased refractory period at AVN

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17
Q

What is the difference between typical and atypical antipsychotics?

A

Typical:- Block D2 receptors in all CNS dopaminergic pathways
- Main action as antipsychotics is on mesolimbic and mesocortical pathways

Atypical:- Low affinity for D2 receptors

  • Milder side effects as dissociate rapidly from D2 receptor
  • mixture of mood stabilisers and D2 antagonist
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18
Q

Give 2 contraindications for COCP

A

Current breast cancer

Smoking in age 35+

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19
Q

What % must Q risk be greater than for a statin to be prescribed? What should be done before starting a statin?

A

> 10%

LFTs at 3 and 12 months

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20
Q

What tx is someone switched to if they experience myalgia on statins?

A

Ezetimibe

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21
Q

Why might a vasoconstricting agent be used in conjunction with a local anaesthetic?

A

Increase duration of anaesthesia , decrease minimum effective dose required

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22
Q

Primary site of action of tiotropium?

A

M3 receptors

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23
Q

Pt info needed to create an appropriate chemotherapy regimen

A

BMI
Liver and renal function
Performance status

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24
Q

What are selegiline and rasagline used for in Parkinson’s?

A

MAO B inhibitors

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25
Q

First line in idiopathic Parkinson’s?

A

Co-carledopa (levodopa + dopa-decarboxylase inhibitor)

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26
Q

4 types of generalised seizure

A

Absence
Myoclonic
Tonic-clonic
Atonic

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27
Q

Effect of valproate on lamotrigine?

A

Increases its plasma conc

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28
Q

Stepwise management of acute (dangerous) asthma?

A

Oh Shit I Hate My Asthma

Oxygen 
Salbutamol (nebulised)
Ipratropium bromide (nebulised)
Hydracortisone iV or Oral Prednisolone 
Magneisum sulphate IV
Aminophylline/ IV salbutamol
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29
Q

First line medical management for COPD?

A

Inhaled salbutamol/ ipratropium

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30
Q

First line management for non-concerning dyspepsia?

A

Trial omeprazole and review in 4 weeks

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31
Q

What should be prescribed alongside aspirin for a pt with a history of GORD?

A

Lansoprazole

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32
Q

How do you eradicate H Pylori? How to check eradication?

A

PPI + 2 abx ( amoxicillin + clarithromycin OR metronidazole + clarithromycin)
Urea breath test

33
Q

Management for constipation?

A

Lifestyle - increase fibre and exercise
1st line - Isphagula husk
Then add or switch to macrogol
If macrogol ineffective then lactulose

34
Q

Mechanism of action of methadone?

A

Mu- receptor agonist

35
Q

Tx for infective exacerbation of COPD?

A

Amoxicillin or doxycycline if penicillin allergic

36
Q

Foods to avoid in excess on warfarin?

A

Broccoli, spinach , kale and sprouts - contain high levels of vit K

37
Q

What are sex steroids synthesised from? What receptors do they act at?

A

Cholesterol
Nuclear receptors that exert effects through gene transcription
Oestrogen has a membrane receptor

38
Q

Classes of drug resistance

A

Multi-drug resistant (MDR)
- Non-susceptibility to at least one agent in three or more
antimicrobial categories

Extensively-drug resistant (XDR)
- Non-susceptibility to at least one agent in all but two or
fewer antimicrobial categories

Pan-drug resistant (PDR)
- Non-susceptibility to all agents in all antimicrobial categories

39
Q

Betam lactam MOA and examples

A

Interfere with the synthesis of the bacterial cell wall peptidoglycan- Generally bactericidal

Penicillins
Cephalosporins
Carbapenems

40
Q

What is co-amoxiclav?

A

AMOXICILLIN + CLAVULANIC ACID

Beta-lactamase = enzyme used by certain bacteria to
break down Beta-lactam antibiotic molecular structure
Clavulanic acid = Beta-lactamase inhibitor

Clavulanic acid is commonly combined with amoxicillin
in order to overcome this issue = Co-amoxiclav

41
Q

How do tetracyclines work? Example?

A

Inhibit protein synthesis, bacteriostatic

Doxycycline
Tetracycline

42
Q

Who can’t have tetracyclines?

A

Shouldn’t be given to children <12 years, pregnant and breastfeeding women
(causes staining of developing teeth)

43
Q

Macrolide MOA? Examples?

A

Inhibit bacterial protein synthesis by an effect on ribosomal translocation- Bactericidal/bacteriostatic

Clarithromycin
Erythromycin
Azithromycin

44
Q

Nitrofurantoin MOA?

A

Works by being reduced to multiple reactive intermediates by nitrofuran reductase inside the bacterial cell
These intermediates then attack ribosomal and DNA proteins within the bacteria, as well as inhibit the Citric acid cycle

45
Q

Quinolones MOA and examples?

A

Inhibit topoisomerase II (a bacterial DNA gyrase), the
enzyme that produces a negative supercoil in DNA and
thus permits transcription or replication

Ciprofloxacin
Levofloxacin

46
Q

Side effect profile for quinolones?

A

Tendinitis +/- rupture
Aortic dissection
Central nervous system effects (inc. Convulsions)

47
Q

Give 2 agents that interfere with folate

A

Sulfonamides

Trimethoprim

48
Q

Trimethroprim MOA?

A

Folate antagonist:
Reversible inhibitor of dihydrofolate reductase, which is necessary for the biosynthesis of bacterial nucleic acids and proteins

49
Q

2 key examples of antivirals?

A

Aciclovir (DNA Polymerase Inhibitors)

Oseltamivir (Neuraminidase Inhibitors)

50
Q

BB ADRs?

A

Mask tachycardia – sign of insulin induced hypoglycaemia
Bradycardia, heart block, Raynaud’s (cold hands), lethargy, impotence
Bronchospasm bc act at respiratory B receptors too

51
Q

Valproate ADRs?

A

Liver failure
Pancreatitis
Lethargy

52
Q

Effect of calcineurin inhibitors on TH2?

A

Prevents them producing IL2

53
Q

calcineurin inhibitors ADRs?

A

renal toxicity ( check BP and eGFR regularly), gum hypertrophy

54
Q

Digoxin contraindication?

A

X Heart block, renal failure, hypokalaemia (increased digoxin activity)

Diuretics that can cause hypokalaemia, amiodarone

55
Q

Gliclazide drug class? How do they act?

A

Sulfonylureas

Block ATP dependent K+ channels to stimulate B-cell pancreatic insulin secretion

56
Q

exenatide and liraglutide drug class?

A

GLP-1 receptor agonists (incretin mimetics)

57
Q

Verapamil contraindications?

A

X Poor LV function (caution), AV nodal conduction delay

58
Q

Other name for gliptins?

A

Dipeptidyl peptidase-4 (DPP-4) inhibitors

59
Q

MOA of glitazones?

A

Insulin sensitisation in muscle and adipose, ↓hepatic glucose output by activation of PPAR-γ → gene transcription

60
Q

Which diabetes drug has the mad side effects?

A

Glitazones - GI upset, fluid retention, fracture risk, bladder cancer AND weight gain because of fat call differentiation

61
Q

How does fenofibrate help with hyperlipidaemia?

A

Activation of nuclear transcription factor – PPARα- which regulates expression of genes that control lipoprotein metabolism = increase production of lipoprotein lipase
↑triglycerides removal from lipoprotein in plasma ↑fatty acid uptake by the liver

62
Q

Ezetimibe MOA?

A

Inhibit NPC1L1 transporter at brush border in small intestines

63
Q

dipyridamole drug class? MOA?

A

Phosphodiesterase inhibitor

inhibits cellular reuptake of adenosine → increased [adenosine] → inhibits platelet aggregation via adenosine (A2) receptors

Also acts as phosphodiesterase inhibitor which prevents cAMP degradation → inhibit expression of GPIIb/IIIa

64
Q

Corticosteroids for N&V?

A

Dexamethasone and Methylprednisolone

65
Q

Examples of LMWH?

A

dalteparin, enoxaparin and fondaparinux

66
Q

ADRs of LMWH?

A

Bruising and bleeding- Intracranial, at site of injection, GI, epistaxis
HIT
Hyperkalaemia- aldosterone inhibition
Osteoporosis- more in pregnancy

67
Q

Give examples of DOACs

A

apixaban edoxaban and rivaroxaban-Inhibit both free Xa and that bound with ATIII

68
Q

What is amiloride?

A

potassium sparing diuretic

69
Q

Why is warfarin avoided in pregnancy?

A

It crosses the placenta – avoided at least in 1st (teratogenic) and 3rd (haemorrhage) trimesters

70
Q

Main contraindication for metformin?

A

excreted unchanged by kidneys – stop if eGFR < 30 mL/min, alcohol intoxication

71
Q

Levetiracetam MOA?

A

Synaptic vesicle glycoprotein binder. Stops the release of neurotransmitters into synapse and reduces neuronal activity

72
Q

What increases peripheral breakdown of levodopa?

A

Pyridoxine (vitamin B6)

73
Q

Atropine MOA?

A

Antimuscarinic – blocks M2 receptors (vagal activity) increasing firing of SA node and conduction through AV node

74
Q

Dihydropyridine CCB contraindications?

A

X Unstable angina, severe aortic stenosis

75
Q

Special Dihydropyridine CCBs?

A

amoldipine has a longer half life than the others, nimodipine is selective from cerebral vasculature so can be used in subarachnoid haemorrhage

76
Q

Adenosine MOA?

A

A1 receptor agonist – activate K+ channels enhancing flow out of cells causing hyperpolarisation

Slows conduction through AVN

77
Q

Rituximab use in RA?

A

Binds to CD20 found on a subset of B cells, causes B cell apoptosis

78
Q

Methotrexate MOA? Side effects?

A

Competitively inhibits DHFR ( needed for purine and thymidine synthesis), inhibits DNA and RNA synthesis, cytotoxic ( however mechanism in non malignant disease is uncertain)

ALL the itis things

Y2 Practice Qs (8 decks)

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