CPT

Question 1

What effect will the i.v. rate of infusion have on plasma steady state?

Answer 1

It doesn’t effect it
(it will always take 4-5 half lives to reach state)

Question 2

How do you work out the apparent volume of distribution?

Answer 2

Vd = dose/[drug in plasma]
Vd/ patient’s weight = apparent Vd

Question 3

Which reactions take place in phase I and phase II drug metabolism?

Answer 3

Phase I - Oxidation/Reduction
Phase II - Glucuronidation & Sulfation (conjugation)

Question 4

What is a reaction of both B Blockers and thiazide like diuretics?

Answer 4

Hypergylycaemia
Hyperlipidaemia

Question 5

Which anti-hypertensive can be used to treat gestational hypertension?

Answer 5

Labetalol

Question 6

A deficiency in CYP2D6 will have what effect on codeine?

Answer 6

Decreased therapeutic effect, an increased dose may be needed
(codeine is a pro drug - it’s metabolised to morphine by CYP2D6)

Question 7

Does HRT increase the risk of VTE?

Answer 7

Yes

Question 8

Which ion governs depolarisation (phase 0) in the SA node?

Answer 8

Calcium influx
(Na is ventricular AP not myocytes AP)

Question 9

What are some of the ways amiodarone work?

Answer 9

K channel blocker (primary)

Ca channel blocker
B blocker (non-competitive)
Na channel blocker

Question 10

What effect does flecainide have?

Answer 10

Increases the P-R interval
Increases the AP duration
Slows the tissue conduction during phase 0

Question 11

How does digoxin work as an anti-arrhythmic?

Answer 11

via parasympathetic vagal tone
(blocks NA/K ATPase when used in HF)

Question 12

Loperamide’s mechanism of action?

Answer 12

Decreases peristalsis but increases segmental contractions
Increases transit time to allow more fluid to be removed from the faeces

Question 13

Lactulose MOA?

Answer 13

Draws fluid into the bowel (osmotic laxative)

Question 14

Macrogols MOA?

Answer 14

Limit loss of fluid into the bowel (osmotic laxative)

Question 15

Hyoscine hydrobromide MOA for motion sickness?

Answer 15

Blocks muscarinic ACh receptors
Blocks ACh at Central Trigger Zone via CN VIII
ADR is sedation which contributes to use of motion sickness

Question 16

Cisplatin MOA?

Answer 16

Neurokinin 1 receptor antagonist
Prevents the action of substance P
Increases the effect of 5HT3 receptor antagonists
[CHEMO DRUG]

Question 17

What effect do PPI have on warfarin and phenytoin?

Answer 17

PPIs inhibit CYP2C decreasing the metabolism of warfarin and phenytoin

Question 18

PPI MOA?

Answer 18

Irreversibly inhibit the H/K ATPase pump
Inhibit 90% of acid secretion
Could mask gastro-oesophageal cancer

Question 19

Which antihypertensive will exacerbate hyperkalaemia in patients taking heparin?

Answer 19

Spironolactone & Ramipril
(both inhibit aldosterone)

Question 20

Factors needed for a chemo regimen?

Answer 20

BMI
Liver function
Renal function
Performance status

Question 21

Warfarin MOA?

Answer 21

Competitively inhibits the oxidation of vit K by VKOR
(Limits the activation of factors II,VII,IX & X)

Question 22

A high Minimum Alveolar Concentration (MAC) indicates what?

Answer 22

Volatile anaesthetic is less potent
(MAC is 50% who fail to respond to surgical stimulus)

Question 23

Anaesthetic MOA?

Answer 23

Inhibition of NDMA glutamate receptors
Potentiate GABAa receptors

Question 24

Why would use a vasoconstricting agent with a local anaesthetic?

Answer 24

Decrease peak plasma conc of local anaesthetic
Decrease the minimum effective dose
Increase duration of anaesthesia

Question 25

Which ADP receptor antagonist binds reversibly to the P2Y12 receptor?

Answer 25

Ticagrelor (binds to a different site than Clopidogrel/Prasugrel)

Question 26

Aspirin MOA?

Answer 26

Irreversibly inhibits COX-1 and decreases TXA2
(limits platelet aggregation)

Question 27

GLP-1 agonist (exenatide) MOA?

Answer 27

Increase insulin secretion
Decrease glucagon secretion
Decrease gastric emptying (promote weight loss)

Question 28

Caution when prescribing glicazide for diabetes?

Answer 28

Can cause weight gain

Question 29

Disease modifying antirheumatic drugs should…

Answer 29

Be considered in combination in severe rheumatoid disease

Question 30

What should you be cautious of when prescribing a TNF inhibitor (e.g. adalimumab)?

Answer 30

Reactivation of TB
(TNF is essential in granuloma formation)

Question 31

Which prostanoids contribute to platelet aggregation?

Answer 31

PGI2 Inhibits platelet aggregation (I-I)
TXA2 Assists platelet aggregation (A-A)

Question 32

What happens if inhaled particles are too small or too large?

Answer 32

Too big - deposit in the mouth/oropharynx
Too small - inhaled into alveoli and exhaled

Question 33

What effect would grapefruit juice have on simvastatin?

Answer 33

Increase plasma conc of simvastatin

CYP3A4 is inhibited by grapefruit juice
CYP3A4 metabolises statins

Question 34

Will liphophillic drugs cross the cell membrane and why?

Answer 34

Lipophillic drugs dissolve in the lipid membrane and penetrate the cell surface to cross membrane

Question 35

What drug is given if a patient is unable to cope with a statin?

Answer 35

Ezetimibe (NPC1l1 inhibitor)

Question 36

Flecainide MOA?

Answer 36

Increases action potential duration
Slows tissue conduction during phase 0
Increases PR interval

Question 37

Why are insulins made as soluble preperations?

Answer 37

To delay absorption from injection site

Question 38

Loperamide MoA?

Answer 38

Decreases peristalsis but increases segmental contractions

(more fluid can be removed)

Question 39

Which anti-emetic is particularly useful in chemo induced N+V?

Answer 39

Neurokinin 1 receptor antagonist (aprepitant)

Question 40

How do selegiline/rasagaline help in the management of parkinson’s?

Answer 40

Inhibit MAO B metabolism of dopamine
(prolongs action of L-dopa)

Question 41

What are the 4 types of generalised seizure?

Answer 41

Tonic-clonic
Myoclonic
Absense
Atonic