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CR2 > CR2 Drugs > Flashcards

CR2 Drugs Flashcards

1
Q

Which drugs do you use to treat acute mountain sickness / & or HACE [3]

A

Oxygen
Acetazolamide: carbonic anhydrase inhibitors
Dexamethasone: 4mg qds, (four times daily) oral or iv (steroid): corticosteroid medication used to prevent brain swelling and inflammation.

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2
Q

Which drugs do you use to treat HAPE [6]

A

Oxygen
Acetazolamide: carbonic anhydrase inhibitors
Dexamethasone: 4mg qds, (four times daily) oral or iv (steroid): corticosteroid medication used to prevent brain swelling and inflammation.
Nifedipine: calcium channel blocker that relaxes vascular smooth muscle
Hyperbaric oxygen chamber
Sildenafil (Viagra): relaxes pulmonary vascular smooth muscle (it increases levels of cGMP & decreases intracellular calcium)

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3
Q

Nifedipine?

A

Calcium channel blocker that relaxes vascular smooth muscle

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4
Q

Sildenafil (Viagra):

A

relaxes pulmonary vascular smooth muscle (it increases levels of cGMP & decreases intracellular calcium)

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5
Q

Acetazolamide?

A

Carbonic anhydrase inhibitor; causes more HCO3- to be excreted in urine

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6
Q

Dexamethasone

A

corticosteroid medication used to prevent brain swelling and inflammation.

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7
Q

Which drugs would you use to manage IPF ? [3]

A

pirfenidone and nintedanib.

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8
Q

Which drugs would you treat dilated cardiomyopathy with? [4]

A

A
ACE I / ARBs: lower BP
Diuretics: reduce fluid built up
Anti-coagulants: reduce blood clot chances
Beta blockers: control HR

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9
Q

Q
What are the steps for treating PE? [7]

A

Administer oxygen: reduces arterial vascular resistance & treats hypoximia

Treat with subcut heparin: prevents the clot from getting bigger / propogation at clot source and at DVT. Does not dissolve the clot. Enables own body fibrinolytic system to kick in.

Warfarin: Vitamin K antagonist; reduces levels of factor II, VII, IX, X - reducing clotting ability. Delayed onset so treat with heparin first

Direct Oral Anticoagulants - DOACS - used instead of warfarin. E.g. Dabigatran: direct thrombin inhibitor; Rivaroxaban & Apixaban: Orally active factor Xa inhibitors – stop enzyme activating thrombin - prothrombin

If really serious clot:
Exogenous fibrinolytics (dissolves the clot) - streptokinase
Percutaneous catheter into pulmonary veins - suck out the clot
Pulmonary embolectomy

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10
Q

Explain mechanism of how heparin works to treat PE

A

Heparin binds to antithrombin and activates it; activated complex then inactivates factor Xa, preventing conversion of prothrombin to thrombin (thrombin converts fibrinogen into fibrin - integral step in clot formation)

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11
Q

Which drugs would you use to treat a Ptx who had acute sore throat with pharnygitis?

A

Start of treatment is determined by hospital’s microbiology protocol
But:

First choice: Phenoxymethylpenicillin

If allergic:

Clarithromycin
Erythromycin

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12
Q

What type of medication can you give for haemophilia? [3]

A

Factor VIII/ IX - recombinant or plasma (IV)
Desmopresssin / DDAVP (S/C) - causes the release of von Willebrand’s antigen from the platelets and the cells that line the blood vessels where it is stored. Von Willebrand’s antigen is the protein that carries factor VIII.
Tranexamic Acid (IV and Oral - Antifibrinolytic (stops fribrinlysis)

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13
Q

What type of medication can you give for VWD? [3]

A

Medication:
(Von Willebrand disease does not require day to day treatment. Management is required either in response to major bleeding or trauma (to stop bleeding) or in preparation for operations (to prevent bleeding):)

  • Wilate and Voncento- FVIII and vWF (IV)
  • DDAVP (S/C) Desmopressin (mimicking the actions of endogenous ADH)
  • Tranexamic Acid (IV and Oral) - stops heavy bleeding
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14
Q

Which drugs would you use to manage IPF ? [3]

How would you treat IPF via non-pharmacotherapy?

A

Pharmacotherapy:
- Pirfenidone: anti fibrotic agent, decreases pyhysiological deterioration
- Nintedanib : Tyrosine kinase inhibitor. ↓FVC decline
- Antiacid therapy:IPF with gastro-oesophageal reflux

Non-pharmacotherapy:
- Pulmonary rehab (MDT Team & QoL
- Oxygen therapy
- Lung treatment

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15
Q

Which drugs should you NOT combine to treat IPF?

A

A
Prednisone, Azathioprine & NAC = Harmful AEs

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16
Q

What pharmacological treatment consider for sarcoidosis?

A

Treat with corticosteroids (but has negative impact on immune system).

Remember than patients may have spontaneous resolution so have to weigh up options !!

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17
Q

Which drugs would you use to treat a Ptx who had acute sore throat with pharnygitis?

A

Start of treatment is determined by hospital’s microbiology protocol
But:

First choice: Phenoxymethylpenicillin

If allergic:

Clarithromycin
Erythromycin

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18
Q

What can

A

sepsis

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19
Q

Q
Which drugs would you use to manage pneumonia for:

CRB Score 0
CRB Score 1-2
CRB Score 3-4

A

Always follow yourlocal area guidelines. These are developed by looking at the bacteria in the local area for theirantibiotic resistanceso are specific to that population.

CRB Score 0: Amoxicillin or Doxycycline or Clathromycin

CRB Score 1-2: Amoxicillin AND Clathromycin
OR
Doxycycline

CRB Score 3-4: Benzylpenicillin

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20
Q

Which drug do you use to thrombolyse clots in a stroke?

A

Alteplase

BUT must be given 4.5 hours of onset!

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21
Q

What treatment do you use for resp. acidosis? [4]

A

Bronchodilator drugs to reverse some types of airway obstruction
Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or mechanical ventilation if needed
Opioid drug overdose reversal with naloxone
Oxygen if the blood oxygen level is low – BUT must be careful with oxygen

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22
Q

How should you treat hypoxaemia in Ptx with COPD and chronic hypercapnia? [2]
What is target Hb saturation for this? [1]

A

Controlled oxygen therapy with 24% or 28% O2
with target haemoglobin saturation of 88 – 92% as hypoxaemia is life threatening.
If CO2 does go up and pH falls may need to mechanically ventilate patient

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23
Q

First line treatment for TB? [4]

A

Standard treatment of TB disease is four-drug therapy - treatment with single drug can lead to development of a bacterial population resistant to that drug:

RIPE !

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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24
Q

What drug would you initially give to non-haem stroke? [1]

A

A
Aspirin !

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25
Q

How would you manange an acute TIA?

A

300mg aspirin

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26
Q

How do you treat PDA? [2]

A

Treatment: prostaglandin inhibitor, such as ibuprofen; surgery

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27
Q

Q
Which drugs would you use to manage pneumonia for:

CRB Score 0
CRB Score 1-2
CRB Score 3-4

A

Always follow yourlocal area guidelines. These are developed by looking at the bacteria in the local area for theirantibiotic resistanceso are specific to that population.

CRB Score 0: Amoxicillin or Doxycycline or Clathromycin

CRB Score 1-2: Amoxicillin AND Clathromycin
OR
Doxycycline

CRB Score 3-4: Benzylpenicillin

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28
Q

Which antihypertensives should not be used for pregnant / breastfeeding women? [2]

A

ACE inhibitors
AT II receptor antagonists

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29
Q

What is Step One Treatment for HTN?

A

A
Offer ACE inhibitor or Angiotensin receptor blockers (ARBs) if have:

type 2 diabetes
under 55 but not black African / African-Caribbean
OR

Offer calcium-channel blocker (CCB) who:

aged 55 or over AND no type 2 diabetes
black African / African-Caribbean

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30
Q

What is Step Two Treatment for HTN?

If already on ACE inhibitor? [2]
If already on CCB? [3]

A

If on ACE inhibitor:
- Add CCB or thiazide-like diuretic [2]

If on CCB:
- Add ACE inhibitor or ARB or thiazide-like diuretic

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31
Q

Which drug is used as a diagnostic tool in cardiac stress test?

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

A

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

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32
Q

What is the MoA of Dobutamine? [1]

A

Sympathomimetic β1 agonist which is used in cardiac stress test and imaging

Increases contractility not rate

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33
Q

Which radioactive tracer is used in SPECT imaging of the myocardim to see perfusion? [1]

A

99m-technetium

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34
Q

Name a longer acting alternative to GTN [1]

A

Isosorbide mono/dinitrate

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35
Q

Which of the following acts as a nitrate and also opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels so net effect is vasodilation.

Nicorandil
Amlodipine
Nifedipine
Verapamil
Diltiazem

A

Which of the following acts as a nitrate and also opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels so net effect is vasodilation.

Nicorandil
Amlodipine
Nifedipine
Verapamil
Diltiazem

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36
Q

Name two betablockers that reduce HR and LV wall tension [2]

A

Atenolol
Propranolol

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37
Q

How does beta blocker act alongside acting as an anti-sympathomimetic? [1]

A

Beta blocker causes down regulation of RAAS as well as acting as a anti-sympathomimetic

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38
Q

Which of the following calcium channel blockers are selective for voltage gated calcium channels in myocardium to reduce HR and O2 demand

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

A

Which of the following calcium channel blockers are selective for voltage gated calcium channels in myocardium to reduce HR and O2 demand

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

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39
Q

Which of the following calcium channel blockers act on both myocardium and vessels for dual effect

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

A

Which of the following calcium channel blockers act on both myocardium and vessels for dual effect

Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel

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40
Q

Which of the following calcium channel blockers are selective for voltage gated calcium channels in blood vessels to cause vasodilation and decrease TPR.

Dobutamine
Verapamil
Diltiazem
Amlodipine
Nifedipine

A

Which of the following calcium channel blockers are selective for voltage gated calcium channels in blood vessels to cause vasodilation and decrease TPR.

Dobutamine
Verapamil
Diltiazem
Amlodipine
Nifedipine

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41
Q

Which drug acts by COX-2 inhibition in platelets for thromboxane A2(TXA2) synthesis [1]

A

Aspirin

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42
Q

Which drug acts by blocking P2Y12, an adenosine diphosphate (ADP) on platelet cell membranes? [1]

A

Clopidogrel

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43
Q

Name 4 things that cause acute haemolysis in G6PD deficiency

A

Fava beans, primaquine, cotrimoxazole, dapsone

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44
Q

Warfarin is what class of drug? [1]

What is warfarin an antagonist to? [1]

What does warfarin act agasint? [6]

A

Anticoagulant

Vit K antagonist

Acts agaisnt factors II, VII, IX, X AND protein C &/ S

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45
Q

Which of the following is used in treatment of VTE / DVT and PE and is a heparin antagonist

Fondaparinux
Warfarin
Protamine
Folate

A

Which of the following an heparin antagonist

Fondaparinux
Warfarin
Protamine
Folate

Binds heparin to inactivate it. Does not work as well on LMWH

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46
Q

Which of the following is used in treatment of VTE / DVT and PE and is a has high selectivity for just anti-Xa activity and little antithrombin activity.

Fondaparinux
Warfarin
Protamine
Folate

A

Which of the following is used in treatment of VTE / DVT and PE and is a has high selectivity for just anti-Xa activity and little antithrombin activity.

Fondaparinux
Warfarin
Protamine
Folate

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47
Q

What is the first choice treatment for VTE / DVT / PE? [1]

What is specific mechanism? [1]

A

LMWH

Anti-Xa effect

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48
Q

What is a risk of heparin use for treatment of VTE / DVT / PE? [2]

A

Heparin induced thrombocytopaenia(HIT) 5-14 days after start(rare)

bleeding

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49
Q

Which of the following blocks the Na/K/2Cl symporter in the ascending loop of Henle?

Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone

A

Which of the following blocks the Na/K/2Cl symporter in the ascending loop of Henle?

Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone

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50
Q

AE of furosemide? [1]

A

Hypokalaemia

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51
Q

Which of the following blocks the Na/Cl symporter in the distal convoluted tubule to prevent sodium reabsorption?

Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone

A

Which of the following blocks the Na/Cl symporter in the distal convoluted tubule to prevent sodium reabsorption?

Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone

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52
Q

Name two drugs that block ACE, resulting in lower SVR [2]

A

Captopril, lisinopril

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53
Q

Whoch of the following blocks angiotensin II receptor preventing its vasoconstrictive effects?

lisinopril
Captopril
Spironolactone
Losartan
Amiloride

A

Whoch of the following blocks angiotensin II receptor preventing its vasoconstrictive effects?

lisinopril
Captopril
Spironolactone
Losartan
Amiloride

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54
Q

Whoch of the following blocks aldosterone transporter?

lisinopril
Captopril
Spironolactone
Losartan
Amiloride

A

Whoch of the following blocks aldosterone transporter?

lisinopril
Captopril
Spironolactone
Losartan
Amiloride

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55
Q

Which of the following may you prescribe alongside spironlactone to normalise potassium levels?

lisinopril
Captopril
Furosemide
Losartan
Amiloride

A

Which of the following may you prescribe alongside spironlactone to normalise potassium levels?

lisinopril
Captopril
Furosemide
Losartan
Amiloride

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56
Q

Which of the following epithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there

lisinopril
Captopril
Furosemide
Losartan
Amiloride

A

Which of the following pithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there

lisinopril
Captopril
Furosemide
Losartan
Amiloride

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56
Q

Which of the following epithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there

lisinopril
Captopril
Furosemide
Losartan
Amiloride

A

Which of the following blocks epithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there

lisinopril
Captopril
Furosemide
Losartan
Amiloride

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57
Q

Which of the following is an alpha 2 agonist that causes a decrease in CO and vascular tone?

Clonidine
Carvedilol
Propranolol
atenolol
doxazosin

A

Which of the following is an antihypertensive alpha 2 agonist that causes a decrease in CO and vascular tone?

Clonidine
Carvedilol
Propranolol
atenolol
doxazosin

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58
Q

Which of the following is an alpha 1 antagonist that causes a decrease in CO and vascular tone?

Clonidine
Carvedilol
Propranolol
atenolol
doxazosin

Name one more

A

Which of the following is an alpha 1 antagonist that causes a decrease in CO and vascular tone?

Clonidine
Carvedilol
Propranolol
atenolol
doxazosin and prazosin

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59
Q

Propranolol is what type of arrythmia drug class?

A

Class II

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60
Q

Which of the following is a β2 agonist that causes short acting smooth muscle relaxation in the bronchioles

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following is a β2 agonist that causes short acting smooth muscle relaxation in the bronchioles

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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61
Q

Which of the following is an asthma drugs that is a β2 agonist that causes long acting smooth muscle relaxation (LABA) in the bronchioles [2]

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following is a β2 agonist that causes long acting smooth muscle relaxation (LABA) in the bronchioles [2]

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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62
Q

Which of the following acts on steroid receptor to modify nuclear expression, in this case it prevents inflammatory expression for asthma treatment?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following acts on steroid receptor to modify nuclear expression, in this case it prevents inflammatory expression for asthma / COPD treatment?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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63
Q

Asthma treatments is a corticosteroid? [2]

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Asthma treatments is a corticosteroid?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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64
Q

Which of the following is associated with Cushings syndrome in long term use?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following is associated with Cushings syndrome in long term use?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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65
Q

Which of the following is associated with Cushings syndrome in long term use?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following is associated with Cushings syndrome in long term use?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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66
Q

Which of the following is a corticosteroid used to treat asthma but acts locally upon inhalation?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

A

Which of the following is a corticosteroid used to treat asthma but acts locally upon inhalation?

Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol

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67
Q

Which of the following is a leukotriene antagonist used in asthma / COPD control?

Tiotropium
Ipratropium
Montelukast
Theophylline
Beclomethasone

A

Which of the following is a leukotriene antagonist?

Tiotropium
Ipratropium
Montelukast
Theophylline
Beclomethasone

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67
Q

Which of the following is a LAMA used in asthma / COPD control? [2]

Tiotropium
Ipratropium
Montelukast
Theophylline
Beclomethasone

A

Which of the following is a SAMA used in asthma / COPD control?

Tiotropium
Ipratropium
Montelukast
Theophylline
Beclomethasone

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68
Q

Which of the following treatments for TB blocks causes mycoloic acid synthesis [2]

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following treatments for TB blocks causes mycoloic acid synthesis

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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69
Q

Which of the following stains bodily secretions orange

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following stains bodily secretions orange

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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70
Q

Which of the following blocks bacterial RNA polymerase for the treatment of TB

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following blocks bacterial RNA polymerase for the treatment of TB

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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71
Q

Which of the following is a
prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following is a
prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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72
Q

You are attending a cardiology clinic one afternoon. A 56-year-old man presents for a medication review. He is currently taking a beta-blocker but is still frequently symptomatic. From his medication history, it is evident that he does not tolerate calcium channel blockers.

The consultant considers the option of starting him on a new drug called nicorandil. Strangely enough, the patient feels that nicorandil is a calcium channel blocker and is not keen to try it out. You have been asked to explain the mechanism of the new drug to this patient.

What is the mechanism through which the new drug exerts its effect?

Causes vasoconstriction by activating guanylyl cyclase which causes an increase in cGMP
Causes vasodilation by inactivating ATP-sensitive potassium channels
Causes vasodilation by increasing intracellular calcium load
Causes vasodilation by activating guanylyl cyclase which causes an increase in cGMP
Causes vasodilation by inhibiting guanylyl cyclase which causes an increase in cGMP

A

You are attending a cardiology clinic one afternoon. A 56-year-old man presents for a medication review. He is currently taking a beta-blocker but is still frequently symptomatic. From his medication history, it is evident that he does not tolerate calcium channel blockers.

The consultant considers the option of starting him on a new drug called nicorandil. Strangely enough, the patient feels that nicorandil is a calcium channel blocker and is not keen to try it out. You have been asked to explain the mechanism of the new drug to this patient.

What is the mechanism through which the new drug exerts its effect?

Causes vasoconstriction by activating guanylyl cyclase which causes an increase in cGMP
Causes vasodilation by inactivating ATP-sensitive potassium channels
Causes vasodilation by increasing intracellular calcium load
Causes vasodilation by activating guanylyl cyclase which causes an increase in cGMP
Causes vasodilation by inhibiting guanylyl cyclase which causes an increase in cGMP

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73
Q

A 65-year-old lady attends the GP surgery for a routine hypertension review. She has been taking amlodipine for a year and although her blood pressure is well controlled her ankles often become swollen. The ankle swelling is worse at the end of the day since starting amlodipine. The GP decides to prescribe a diuretic instead of amlodipine. Which of the following diuretics acts on the sodium-chloride transporter of the distal tubule?

Acetazolamide (carbonic anhydrase inhibitor)
Bendroflumethiazide (thiazide diuretic)
Furosemide (loop diuretic)
Spironolactone (potassium-sparing diuretic)
Mannitol (osmotic diuretic)

A

A 65-year-old lady attends the GP surgery for a routine hypertension review. She has been taking amlodipine for a year and although her blood pressure is well controlled her ankles often become swollen. The ankle swelling is worse at the end of the day since starting amlodipine. The GP decides to prescribe a diuretic instead of amlodipine. Which of the following diuretics acts on the sodium-chloride transporter of the distal tubule?

Acetazolamide (carbonic anhydrase inhibitor)
Bendroflumethiazide (thiazide diuretic)
Furosemide (loop diuretic)
Spironolactone (potassium-sparing diuretic)
Mannitol (osmotic diuretic)

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74
Q

A 71-year-old gentleman is admitted to the renal ward with acute kidney injury after having diarrhoea and vomiting for 4 days. Blood tests show that his potassium is below normal limits. You note that this is likely due to his gastrointestinal symptoms. You check his medications to ensure nothing is making the situation worse. You find that he is on diuretic therapy for the treatment of heart failure. Which of the following diuretics is associated with hypokalaemia?

Triamterene

Bumetanide

Amiloride

Spironolactone

Eplerenone

A

A 71-year-old gentleman is admitted to the renal ward with acute kidney injury after having diarrhoea and vomiting for 4 days. Blood tests show that his potassium is below normal limits. You note that this is likely due to his gastrointestinal symptoms. You check his medications to ensure nothing is making the situation worse. You find that he is on diuretic therapy for the treatment of heart failure. Which of the following diuretics is associated with hypokalaemia?

Triamterene

Bumetanide

Amiloride

Spironolactone

Eplerenone

Loop diuretics may cause hypokalaemia

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75
Q

A 55-year-old man is admitted to the emergency department with sudden onset chest pain. His ECG shows ST depression in leads II, III, & aVF. His troponin is also found to be raised. He is treated for an NSTEMI (non-ST-elevation myocardial infarction), and as part of this treatment regime, he is given ticagrelor.

What is the mechanism of action of this drug?

Activates antithrombin III which mainly inhibits factors Xa and IIa
Inhibits ADP binding to platelet receptors
Inhibits prothrombinase complex-bound and clot-associated factor Xa
Inhibits the production of prostaglandins
Inhibits vitamin K epoxide reductase complex 1

A

A 55-year-old man is admitted to the emergency department with sudden onset chest pain. His ECG shows ST depression in leads II, III, & aVF. His troponin is also found to be raised. He is treated for an NSTEMI (non-ST-elevation myocardial infarction), and as part of this treatment regime, he is given ticagrelor.

What is the mechanism of action of this drug?

Activates antithrombin III which mainly inhibits factors Xa and IIa
Inhibits ADP binding to platelet receptors
Inhibits prothrombinase complex-bound and clot-associated factor Xa
Inhibits the production of prostaglandins
Inhibits vitamin K epoxide reductase complex 1

Ticagrelor has a similar mechanism of action to clopidogrel - inhibits ADP binding to platelet receptors

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76
Q

A 45-year-old female is found to have a blood pressure of 185/102mmHg following ambulatory blood pressure monitoring. She is started on the ACE inhibitor Ramipril. What is the most common side effect of this drug?

A dry cough
Oedema
Shortness of breath
Excessive urine output
Headaches

A

A 45-year-old female is found to have a blood pressure of 185/102mmHg following ambulatory blood pressure monitoring. She is started on the ACE inhibitor Ramipril. What is the most common side effect of this drug?

A dry cough
Oedema
Shortness of breath
Excessive urine output
Headaches

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77
Q

You are a medical student in general practice. A 67-year-old female attends for an annual checkup of her blood pressure. She has GTN spray at home. How does nitric oxide result in vasodilation?

Directly opens K+ channels

Directly opens Ca2+ channels

Activates guanylate cyclase

Inhibits the release of Bradykinin

Activates cAMP

A

You are a medical student in general practice. A 67-year-old female attends for an annual checkup of her blood pressure. She has GTN spray at home. How does nitric oxide result in vasodilation?

Directly opens K+ channels

Directly opens Ca2+ channels

Activates guanylate cyclase

Inhibits the release of Bradykinin

Activates cAMP

78
Q

A baby is born at 36 weeks via an emergency cesarean section. His mother lives in a cottage up in the mountains.

The baby looks healthy and is administered a dose of Vitamin K soon after birth. She is discharged the next day with a happy, healthy baby.

Six weeks later, she presents to the hospital with the baby after she noticed increased work of breathing and difficulty while feeding. On auscultation of her heart, a continuous ‘machinery’ murmur is heard and is loudest at the left sternal edge. The cardiologist arrives at the scene and instructs that the child is given a dose of indomethacin.

What is the mode of action of indomethacin?

Endothelin receptor antagonist

Phosphodiesterase inhibitor

Prostaglandin synthase inhibitor

Endothelin receptor agonist

Adenosine receptor antagonist

A

A baby is born at 36 weeks via an emergency cesarean section. His mother lives in a cottage up in the mountains.

The baby looks healthy and is administered a dose of Vitamin K soon after birth. She is discharged the next day with a happy, healthy baby.

Six weeks later, she presents to the hospital with the baby after she noticed increased work of breathing and difficulty while feeding. On auscultation of her heart, a continuous ‘machinery’ murmur is heard and is loudest at the left sternal edge. The cardiologist arrives at the scene and instructs that the child is given a dose of indomethacin.

What is the mode of action of indomethacin?

Endothelin receptor antagonist

Phosphodiesterase inhibitor

Prostaglandin synthase inhibitor

Endothelin receptor agonist

Adenosine receptor antagonist

Indomethacin inhibits prostaglandin synthesis in infants with patent ductus arteriosus

79
Q

A 74-year-old female was with urinary incontinence presents to the urogynaecology clinic. She was diagnosed with overactive bladder incontinence, and was started on pharmacological treatment which antagonises the parasympathetic pathway.

Which of the following have a similar mechanism of action with the drug she was prescribed?

Alfuzosin

Meropenem

Mirabegron

Atropine

Adenosine

A

A 74-year-old female was with urinary incontinence presents to the urogynaecology clinic. She was diagnosed with overactive bladder incontinence, and was started on pharmacological treatment which antagonises the parasympathetic pathway.

Which of the following have a similar mechanism of action with the drug she was prescribed?

Alfuzosin

Meropenem

Mirabegron

Atropine

Adenosine

Atropine is an antimuscarinic

80
Q

Whilst in general practice, you review Susan a 48-year-old patient with hypertension. Despite taking ramipril, her blood pressure remains clinically elevated. Based on current guidelines you consider add-on therapy with a thiazide-like diuretic.

Which of the following electrolyte disturbances may occur with this new treatment?

Hypercalciuria
Hyperkalaemia
Hypermagnesemia
Hypokalaemia
Hypolipidaemia

A

Whilst in general practice, you review Susan a 48-year-old patient with hypertension. Despite taking ramipril, her blood pressure remains clinically elevated. Based on current guidelines you consider add-on therapy with a thiazide-like diuretic.

Which of the following electrolyte disturbances may occur with this new treatment?

Hypercalciuria
Hyperkalaemia
Hypermagnesemia
Hypokalaemia
Hypolipidaemia

81
Q

A 65-year-old patient with chronic kidney disease is found to have a deficiency of antithrombin III after he presented to emergency department with left leg pain and swelling.

A doppler-ultrasound scan of the leg confirms deep venous thrombosis (DVT). The patient is started on dabigatran.

What is the mechanism of action of dabigatran?

Activates anti-thrombin III
P2Y12 inhibitor
Glycoprotein IIb/IIIa inhibitor
Direct thrombin inhibitor
Direct factor X activator

A

A 65-year-old patient with chronic kidney disease is found to have a deficiency of antithrombin III after he presented to emergency department with left leg pain and swelling.

A doppler-ultrasound scan of the leg confirms deep venous thrombosis (DVT). The patient is started on dabigatran.

What is the mechanism of action of dabigatran?

Activates anti-thrombin III
P2Y12 inhibitor
Glycoprotein IIb/IIIa inhibitor
Direct thrombin inhibitor
Direct factor X activator

82
Q

Question 103 of 203
An 82-year-old lady with a history of heart failure presents to the general practice with a 5-day history of constipation. On further questioning, she tells you that she has been feeling weaker this week, and has been getting muscle cramps regularly On examination, there is reduced tone and hyporeflexia bilaterally in both the upper and lower limbs. You think this lady’s presentation may be due to hypokalaemia. The patient takes a number of diuretics to control her heart failure. Which of the following diuretics is associated with hypokalaemia?

Triamterene

Furosemide

Spironolactone

Eplerenone

Amiloride

A

Question 103 of 203
An 82-year-old lady with a history of heart failure presents to the general practice with a 5-day history of constipation. On further questioning, she tells you that she has been feeling weaker this week, and has been getting muscle cramps regularly On examination, there is reduced tone and hyporeflexia bilaterally in both the upper and lower limbs. You think this lady’s presentation may be due to hypokalaemia. The patient takes a number of diuretics to control her heart failure. Which of the following diuretics is associated with hypokalaemia?

Triamterene

Furosemide

Spironolactone

Eplerenone

Amiloride

83
Q

A patient with a history of peripheral vascular disease presents to his GP with essential hypertension. Which of the following drugs may exacerbate his peripheral vascular symptoms?

Ramipril

Atenolol

Spironolactone

Hydrochlorothiazide

Furosemide

A

A patient with a history of peripheral vascular disease presents to his GP with essential hypertension. Which of the following drugs may exacerbate his peripheral vascular symptoms?

Ramipril

Atenolol

Spironolactone

Hydrochlorothiazide

Furosemide

84
Q

A 60-year-old man presents to the emergency department complaining of sudden numbness of his right arm and right leg. On examination, he has decreased sensation and 3 out of 5 power throughout his right arm and right leg. A head CT reveals ischaemia along the area of the left middle cerebral artery. After initial management, he is deemed to be unfit to be prescribed clopidogrel and instead is prescribed aspirin and another antiplatelet that works by inhibiting phosphodiesterase.

What medication was this patient likely prescribed in addition to the aspirin?

Dipyridamole

Heparin

Ticagrelor

Prasugrel

Apixaban

A

A 60-year-old man presents to the emergency department complaining of sudden numbness of his right arm and right leg. On examination, he has decreased sensation and 3 out of 5 power throughout his right arm and right leg. A head CT reveals ischaemia along the area of the left middle cerebral artery. After initial management, he is deemed to be unfit to be prescribed clopidogrel and instead is prescribed aspirin and another antiplatelet that works by inhibiting phosphodiesterase.

What medication was this patient likely prescribed in addition to the aspirin?

Dipyridamole

Heparin

Ticagrelor

Prasugrel

Apixaban

85
Q

A 63-year-old male presents to GP with mild chest pain and dyspnoea. The patient is normally fit and well with no significant medical history. He has a family history of heart disease with his dad passing away following a heart attack last year. The GP decides to do an ECG to confirm the diagnosis and suspects atrial flutter. Given the diagnosis, which of the following findings would you expect to see on an ECG?

Broad complex tachycardia

Narrow complex tachycardia

Heart rate of 175/min

Heart rate of 58/min

Prolonged QT interval

A

A 63-year-old male presents to GP with mild chest pain and dyspnoea. The patient is normally fit and well with no significant medical history. He has a family history of heart disease with his dad passing away following a heart attack last year. The GP decides to do an ECG to confirm the diagnosis and suspects atrial flutter. Given the diagnosis, which of the following findings would you expect to see on an ECG?

Broad complex tachycardia

Narrow complex tachycardia

Heart rate of 175/min

Heart rate of 58/min

Prolonged QT interval

86
Q

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being ‘really annoying’ and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications?

Reassure her that the majority of ACE related coughs resolve within three months
Switch her to an angiotensin II receptor blocker

Switch her to bendroflumethiazide

Switch her to amlodipine

Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

A

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being ‘really annoying’ and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications?

Reassure her that the majority of ACE related coughs resolve within three months
Switch her to an angiotensin II receptor blocker

Switch her to bendroflumethiazide

Switch her to amlodipine

Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

87
Q

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being ‘really annoying’ and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications?

Reassure her that the majority of ACE related coughs resolve within three months
Switch her to an angiotensin II receptor blocker

Switch her to bendroflumethiazide

Switch her to amlodipine

Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

A

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being ‘really annoying’ and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications?

Reassure her that the majority of ACE related coughs resolve within three months
Switch her to an angiotensin II receptor blocker

Switch her to bendroflumethiazide

Switch her to amlodipine

Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

88
Q

A 68-year-old man has recently been discharged from hospital following a non-ST-elevation myocardial infarction (NSTEMI).

He has a history of angina, hypertension and hypercholesterolaemia and was already taking aspirin, atorvastatin, bisoprolol and ramipril prior to his NSTEMI.

Following his hospital discharge, he has been instructed to also take ticagrelor for the next 12 months.

What is the mechanism of action of this newly-started drug?

Activated factor X (Xa) inhibitor

Cyclooxygenase inhibitor

Direct thrombin inhibitor

Glycoprotein IIb/IIIa receptor antagonist

P2Y12 receptor antagonist

A

A 68-year-old man has recently been discharged from hospital following a non-ST-elevation myocardial infarction (NSTEMI).

He has a history of angina, hypertension and hypercholesterolaemia and was already taking aspirin, atorvastatin, bisoprolol and ramipril prior to his NSTEMI.

Following his hospital discharge, he has been instructed to also take ticagrelor for the next 12 months.

What is the mechanism of action of this newly-started drug?

Activated factor X (Xa) inhibitor

Cyclooxygenase inhibitor

Direct thrombin inhibitor

Glycoprotein IIb/IIIa receptor antagonist

P2Y12 receptor antagonist

89
Q

Q
How would you treat someone with acute failure?
a) immediately? [2]
b) after stabilisation? [3]
c) ongoing management? [2]

A

Immediately:
Pharmalogical: O2 & duiretic
Non Pharmalogical: ventilation; ultrafiltration

After stabalisation: ACE-I/ARB, beta-blocker, aldosterone inhibitor

Ongoing management: Valve surgery; revasc; transplant

90
Q

Drug used to treat IPF? [1]

A

Pirfenidone

91
Q

How do you treat a/b thalassemia? [1]

A

Thalassaemia major (a+b) treatment:

Regular blood transfusion

BUT: can get Iron overload from constant blood transfusion: this happens because excess haemolysis can lead to excess free iron in blood (usually bound to ferritin in the spleen), which is oxidising

92
Q

How would you treat arrhythmias caused by dilated cardiomyopathy? [3]

What is another treatment possibility? [1]

A

Medication to treat blood clots (anti coagulants)
Pacemaker: control rhythm of heart
ICD: shock heart if need to go into normal rhythm

Surgery: remove areas of heart muscle / whole heart transport

93
Q

Anti-hypertensives:

Which of the following class of drug does indapamide fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

A

Which of the following class of drug does indapamide fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics thiazide-like diuretic
Beta-blockers

94
Q

Which of the following class of drug does metoprolol fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

A

Which of the following class of drug does metoprolol fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

95
Q

Which of the following class of drug does amlodipine fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

A

Which of the following class of drug does amlodipine fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

96
Q

Which of the following class of drug does enalapril fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

A

Which of the following class of drug does enalapril fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

97
Q

Which of the following class of drug does losartan fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

A

Which of the following class of drug does losartan fall into?

ACE inhibitors:
Angiotensin-II receptor antagonists
Calcium-channel blocker
Diuretics
Beta-blockers

98
Q

Which of the following prevents the conversion of arachidonic acid to thromboxane A2

Heparin
Warfarin
Aspirin
Dabigatran
Edoxaban

A

Which of the following prevents the conversion of arachidonic acid to thromboxane A2

Heparin
Warfarin
Aspirin
Dabigatran
Edoxaban

99
Q

Explain the mechanism of action of aspirin [3]

A

Non-selective for COX-1 and COX 2 enzymes (prevent aggregation)

COX 2 inhibition prevents arachidonic acid conversion to Thromboxane A2

Thus preventing Thromboxane A2 formation, preventing platelet aggregation.

100
Q

Which of the following can cause thrombocytopenia

Heparin
Warfarin
Aspirin
Dabigatran
Dipyridamole

A

Which of the following can cause thrombocytopenia

Heparin
Warfarin
Aspirin
Dabigatran
Dipyridamole

101
Q

Which of the following should not be used in pregnancy

Heparin
Warfarin
Aspirin
Dabigatran
Dipyridamole

A

Which of the following should not be used in pregnancy

Heparin
Warfarin: teratogenic
Aspirin
Dabigatran
Dipyridamole

102
Q

Name a drug that is a synthetic Factor Xa inhbitor [1]

A

Fondaprinux

103
Q

Which of the following is a non-specific phosphodiesterase inhibitor

Heparin
Warfarin
Aspirin
Dabigatran
Dipyridamole

A

Which of the following is a non-specific phosphodiesterase inhibitor

Dipyridamole

Inhibits both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, an inhibitor of platelet function

104
Q

Name four DOACs [4]

A

Dabigatran
Rivaroxaban
Apixaban
Edoxaban

105
Q

Describe MoA of the DOACs:

Rivaroxaban
Apixaban
Edoxaban

A

Direct factor Xa inhibitor (more modern version of heparin)

106
Q

Explain mechanism of action of Dabigatran [1]

A

Direct thrombin inhibitor

107
Q

Which of the following is not a direct factor Xa inhibitor

Rivaroxaban
Apixaban
Edoxaban
Dabigatran

A

Which of the following is not a direct factor Xa inhibitor

Rivaroxaban
Apixaban
Edoxaban
Dabigatran: direct thrombin inhibitor

108
Q

Name two thrombolytic drugs [2]

A

Streptokinase
Alteplase (tPA)

109
Q

Describe the MoA of: [2]

Streptokinase
Alteplase (tPA)

A

Streptokinase: Clot buster; Activates fibrinolytic pathway

Alteplase (tPA): Increase clot; breakdown by increasing Plasmin formation

110
Q

Which of the following inhibits L type calcium channel [2]

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following inhibits L type calcium channel

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

111
Q

Which of the following drug is for voltage gated calcium channels in myocardium to reduce HR and O2 demand?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following drug is for voltage gated calcium channels in myocardium to reduce HR and O2 demand?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil - CCB

112
Q

Which of the following is a CCB that acts on both myocardium and vessels for dual effect?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following is a CCB that acts on both myocardium and vessels for dual effect?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

113
Q

Which of the following is a vasodilator that opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels and causes release of NO?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following is a vasodilator that opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels and causes release of NO?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

114
Q

Which of the following that particularly reduces peripheral vascular resistance / lowers peripheral BP?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following that particularly reduces peripheral vascular resistance / lowers peripheral BP?

Amlodipine

Bind to L-Type calcium channel

Peripheral arterial vasodilator

Reduce peripheral vascular resistance – lower BP

Calcium channel antagonist (smooth + cardiac muscle)

115
Q

Which of the following reduce heart rates by prolonging refractory period of AVN?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Verapamil - CCB

Inhibit L-Type calcium channel

Reduce contractility and peripheral resistance

Reduce heart rate by prolonging refractory period of AVN.

116
Q

Which of the following can cause severe hypotension as an AE?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

A

Which of the following can cause severe hypotension as an AE?

Amlodipine
Nicorandil
Diatelzem
Lisinopril
Verapamil

117
Q

Name a statin [1]

A

Rosuvostatin

118
Q

State the MoA of Rosuvostatin [3]

A

Competitive inhibitor of HMG-CoA Reductase

Reduction of the mevalonate pathway

Inhibit cholesterol synthesis
Inhibit LDL uptake, VLDL synthesis.

119
Q

What is an AE of statin use like Rosuvostatin? [1]

A

rhabdomyolysis

120
Q

Name three ACE-inhibitors [3]

A

Ramipril
Lisinopril
Captopril

121
Q

Explain MoA of Ramipril [3]

A

Converted to ramiprilat
Inhibits ACE, stop ACE-1 –> ACE-II conversion

Reduce sodium and H2O reabsorption

Reduces peripheral vascular resistance.

122
Q

State an a common side effect of ACE-Inhibitor [1]

A

ACE breaks down bradykinin: causes Dry COUGH

123
Q

Explain effect of ACE-Inhibitor like Ramipril on K levels [1]

A

Hyperkalaemia (Less Angiotensin II, NO aldosterone, less K secreted, less Na reabsorbed)

124
Q

Name two ARBs

A

Valsartan
Losartan

125
Q

Which of the following would you prescribe if a patient has ACE-I intolerance?

Losartan
Captopril
lisinopril
Digoxin
Ivabradine

A

Which of the following would you prescribe if a patient has ACE-I intolerance?

Losartan - ARB
Captopril
lisinopril
Digoxin
Ivabradine

126
Q

Which of the following is an inotrope?

Losartan
Captopril
lisinopril
Digoxin
Ivabradine

A

Which of the following is an inotrope?

Losartan
Captopril
lisinopril
Digoxin increases the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node.
Ivabradine

127
Q

Describe the MoA of Digoxin [2]

A

increases the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node

Stimulate Vagus Nerve, reduce circulating noradrenaline = lower heart rate

128
Q

Name a common AE of digoxin

A

Gynaecomastia

129
Q

Which of the following has a risk of gynaecomastia?

Losartan
Captopril
lisinopril
Digoxin
Ivabradine

A

Which of the following has a risk of gynaecomastia?

Losartan
Captopril
lisinopril
Digoxin
Ivabradine

130
Q

Name the diuretic that works by blocking epithelial sodium channels in in the late DCT, collecting tubules and collecting ducts

Amiloride
Spironolactone
Atenolol
Propranolol
Carvedilol

A

Name the diuretic that works by blocking epithelial sodium channels in in the late DCT, collecting tubules and collecting ducts

Amiloride
Spironolactone
Atenolol
Propranolol
Carvedilol

131
Q

Describe the difference between Propranolol & atenolol [2]

A

Both decrease HR and RAAS.

Propranolol is non-selective
Atenolol is β1 selective

132
Q

Which of the following is an α2-agonist that causes a decrease in CO and vascular
tone

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

A

Which of the following is an α2-agonist that causes a decrease in CO and vascular
tone

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

133
Q

Which of the following is an α2-agonist that causes a decrease in CO and vascular
tone

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

A

Which of the following is an α2-agonist that causes a decrease in CO and vascular
tone

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

134
Q

Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate [2]

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

A

Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate

Clonidine
Propranolol
Atenolol
Prazosin
Doxazosin

135
Q

Name a drug that Inhibits collagen synthesis, down-regulates profibrotic cytokines and decreases fibroblast proliferation? [1]

A

Pirfenidone: used to treat IPF

136
Q

Name a drug that may given for patients contraindicated for beta blocker use [1]

Explain MoA [2]

A

Ivabradine

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers

Slows heart rate

137
Q

What is the first line treatment for Asthma?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

What is the first line treatment for Asthma?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Ipratropium

138
Q

Name 4 AEs of salbutamol [5]

A

trembling, particularly in the hands
nervous tension
headaches
suddenly noticeable heartbeats (palpitations)
muscle cramps

139
Q

Which of the following is a Long-Acting Beta-2 Agonist (LABA)

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a Long-Acting Beta-2 Agonist (LABA)

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Ipratropiuma

140
Q

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Ipratropiuma

141
Q

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

142
Q

Which of the following is a corticosteroid used to treat asthma and acts more globally

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a corticosteroid used to treat asthma and acts more globally

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

143
Q

Which of the following is a corticosteroid used to treat asthma and acts more locally

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a corticosteroid used to treat asthma and acts more locally

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

144
Q

Which of the following is associated with Cushings disease if long term use occurs

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is associated with Cushings disease if long term use occurs

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

145
Q

Which of the following treatment for asthma can be associated with oral thrush?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following treatment for asthma can be associated with oral thrush?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

146
Q

Which of the following is a leukotriene antagonist to treat asthma?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

A

Which of the following is a leukotriene antagonist to treat asthma?

Salbutamol
Salmeterol
Beclomethasone (Becotide)
Montelukast
Prednisolone

147
Q

What are the 4 drugs used to treat TB? [4]

A

What are the 4 drugs used to treat TB? [4]

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

148
Q

Which of the following treats TB by blocking mycolic acid synthesis required for mycobacterial cell wall synthesis?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following treats TB by blocking mycolic acid synthesis required for mycobacterial cell wall synthesis?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

149
Q

Which of the following is a prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following is a prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

150
Q

Which of the following blocks mycolic acid synthesis?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following blocks mycolic acid synthesis?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

151
Q

Which of the following blocks bacterial RNA polymerase to treat TB?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

A

Which of the following blocks bacterial RNA polymerase to treat TB?

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

152
Q

Alongside prescribing oxygen, which other drug would you give someone with acute heart failure?

diuretic
ACE-I/ARB
beta-blocker
aldosterone inhibitor

A

Alongside prescribing oxygen, which other drug would you give someone with acute heart failure?

diuretic
ACE-I/ARB
beta-blocker
aldosterone inhibitor

153
Q

Which of the following medications works by relaxing vascular smooth muscle that leads to increased coronary blood flow?

A Glyceryl trinitrate
B Ivabradine
C Amlodipine
D Ranolazine
E Bisoprolol

A

GTN

154
Q

Describe the MoA of Nicorandil [1]

A

Nicorandil: potassium channel agonist, which inhibits voltage-gated calcium channels leading to muscle relaxation

155
Q

Describe the MoA of Ivabradin [1]

A

Ivabradine: lowers heart rate through inhibition of cardiac ‘funny channels’

156
Q

Describe the MoA of Amlodopine [1]

A

CCB:
Blocks the action of L-type calcium channels - works at cardiac and vascular tissue

157
Q

Describe the MoA of apixaban

A

Apixaban is a type of medicine known as an anticoagulant

is a direct inhibitor of activated factor X (factor Xa)

158
Q

On examination, she has an irregular pulse at 130 bpm. An ECG is performed, which reveals an irregularly irregular rhythm and an absence of P waves. Her CHA2DS2-VASc score is 3.

What is the most appropriate initial treatment option from the choices below?

A

In patients with persistent AF the recommended management is rate control drugs (e.g. beta-blockers, calcium channel blockers) and anti-coagulation according to risk stratification.

159
Q

Describe the MoA of clonidine [1]

A

Stimulate presynaptic α2-adrenergic receptors in the CNS → dilates peripheral blood vessels → lowers peripheral resistance → reduces blood pressure

160
Q

Describe the difference in action and therapeutic effect of the following types of CCBs:

Dihydropyridine:
Non-dihydropyridine

A

Dihydropyridine: predominantly anti-hypertensive effects; block the action of L-type calcium channels, which are found in vascular and cardiac tissue; but primarily act on vascualr tissue

Non-dihydropyridine: predominantly anti-arrhythmic effects

161
Q

State two examples of the folllowing types of CCBS

Dihydropyridine:
Non-dihydropyridine

A
162
Q

Which of the following medications is considered a type IV antiarrhythmic on the Vaughan-Williams classification?

A Amiodarone
B Propranolol
C Flecainide
D Verapamil
E Lidocaine

A

Which of the following medications is considered a type IV antiarrhythmic on the Vaughan-Williams classification?

A Amiodarone
B Propranolol
C Flecainide
D Verapamil
E Lidocaine

163
Q

What are the drug classes for Vaughan-Williams classification groups for antiarrhtmatic drugs? [4]

A

Class I - block sodium channels
Class II - beta-blockers
Class III - block potassium channels
Class IV - block calcium channels

This can be remembered by the mnemonic ‘Some Block Potassium Channels’.

164
Q

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia?

A Atenolol
B Amiodarone
C Flecainide
D Verapamil
E Adenosine

A

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia?

A Atenolol
B Amiodarone
C Flecainide
D Verapamil
E Adenosine

165
Q

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia?

A Atenolol
B Amiodarone
C Flecainide
D Verapamil
E Adenosine

A

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia?

A Atenolol
B Amiodarone
C Flecainide
D Verapamil
E Adenosine

166
Q

What are the appropriate target saturations in a patient not at risk of type 2 respiratory failure?

A 90-100%
B 94-98%
C 88-92%
D 96-100%
E >94%

A

What are the appropriate target saturations in a patient not at risk of type 2 respiratory failure?

A 90-100%
B 94-98%
C 88-92%
D 96-100%
E >94%

167
Q

Question 8.
What percentage of oxygen can venturi masks deliver?

A 20-24%
B 24-60%
C 30-80%
D 24-32%
E 20-100%

A

Question 8.
What percentage of oxygen can venturi masks deliver?

A 20-24%
B 24-60%
C 30-80%
D 24-32%
E 20-100%

168
Q

Statins are generally considered contraindicated in which condition?

A Stroke
B Myocardial infarction
C Chronic kidney disease
D Decompensated cirrhosis
E Peripheral vascular disease

A

Statins are generally considered contraindicated in which condition?

D Decompensated cirrhosis

Statins are contraindicated in patients with decompensated cirrhosis or acute liver failure (i.e. advanced liver disease).

169
Q

Which of the following best describes the mechanism of action of a statin?

A Inhibition of cholesterol absorption
B Bile acid sequestrant
C Stimulate beta-oxidation of fatty acids
D HMG-CoA reductase inhibitor
E Reduces breakdown of adipose tissue

A

Which of the following best describes the mechanism of action of a statin?

A Inhibition of cholesterol absorption
B Bile acid sequestrant
C Stimulate beta-oxidation of fatty acids
D HMG-CoA reductase inhibitor
E Reduces breakdown of adipose tissue

170
Q

Which of the following management options is the only effective way to halt the natural history of chronic obstructive pulmonary disease (COPD)?

A Inhaled beta-2 agonists
B Smoking cessation
C Inhaled muscarinic antagonists
D Exercise
E Pulmonary rehabilitation

A

Which of the following management options is the only effective way to halt the natural history of chronic obstructive pulmonary disease (COPD)?

A Inhaled beta-2 agonists
B Smoking cessation
C Inhaled muscarinic antagonists
D Exercise
E Pulmonary rehabilitation

171
Q

Which cells are important for the secretion of the incretin GLP-1?

A K cells
B M cells
C L cells
D D cells
E S cells

A

Which cells are important for the secretion of the incretin GLP-1?

A K cells
B M cells
C L cells
D D cells
E S cells

172
Q

Which cells are important for the secretion of gastric inhibitory peptide (GIP)?

A K cells
B M cells
C L cells
D D cells
E S cells

A

Which cells are important for the secretion of gastric inhibitory peptide (GIP)?

A K cells
B M cells
C L cells
D D cells
E S cells

173
Q

Which cells are important for the secretion of secretin?

A K cells
B M cells
C L cells
D D cells
E S cells

A

Which cells are important for the secretion of secretin?

A K cells
B M cells
C L cells
D D cells
E S cells

174
Q

What is the mechanism of action of atropine?

A Non-selective beta-adrenoreceptor agonist
B Beta-adrenergic receptor antagonist
C Reversible muscarinic acetylcholine receptor antagonist
D Calcium channel receptor antagonist
E Relaxation of smooth muscle

A

C Reversible muscarinic acetylcholine receptor antagonist

Atropine transiently blocks the action of the vagus nerve (i.e. parasympathetic nervous system) leading to increased SAN electrical activity and increased conduction through the AVN. This results in an increase in heart rate.

175
Q

On the Vaughan-Williams classification, amiodarone is which predominant class?

A Class I
B Class II
C Class III
D Class IV
E Class V

A

On the Vaughan-Williams classification, amiodarone is which predominant class?

C Class III

Amiodarone is thought to have wide-ranging effects on cardiomyocytes. However, its predominant mechanism is on potassium channels.
This means amiodarone is categorised as a class III antiarrhythmic agent. By blocking potassium channels, these drugs prolong the action potential.

176
Q

Which of the following beta-blockers is the least cardioselective?

A Propranolol
B Nebivolol
C Metoprolol
D Bisoprolol
E Atenolol

A

Which of the following beta-blockers is the least cardioselective?

A Propranolol
B Nebivolol
C Metoprolol
D Bisoprolol
E Atenolol

177
Q

Hypertension: Afro-carribean patients and those [younger / older] than 55 years old should be started on a calcium-channel blocker?

A

Afro-carribean patients and those older than 55 years old should be started on a calcium-channel blocker.

(e.g. young afrocarribean would be on a ACE-i)

178
Q

Which of the following medications should be used with caution in asthma?

A Paracetamol
B Aspirin
C Salbutamol
D Prednisolone
E Levothyroxine

A

Which of the following medications should be used with caution in asthma?

A Paracetamol
B Aspirin: This is because of the risk of bronchospasm with these agents. I
C Salbutamol
D Prednisolone
E Levothyroxine

179
Q

What is the pharmacological mechanism for type II antiarrhythmic agents?

A Inhibition of sodium channels
B Inhibition of potassium channels
C Inhibition of adrenergic receptors
D Inhibition of calcium channels
E Inhibition of chloride channels

A

What is the pharmacological mechanism for type II antiarrhythmic agents?

A Inhibition of sodium channels
B Inhibition of potassium channels
C Inhibition of adrenergic receptors
D Inhibition of calcium channels
E Inhibition of chloride channels

180
Q

Which of the following organs is the predominant site of cholesterol synthesis?

A Cerebral cortex
B Lungs
C Spleen
D Liver
E Ovaries

A

Which of the following organs is the predominant site of cholesterol synthesis?

A Cerebral cortex
B Lungs
C Spleen
D Liver
E Ovaries

181
Q

Which of the following organs is the predominant site of cholesterol synthesis?

A Cerebral cortex
B Lungs
C Spleen
D Liver
E Ovaries

A

Which of the following organs is the predominant site of cholesterol synthesis?

A Cerebral cortex
B Lungs
C Spleen
D Liver
E Ovaries

182
Q

Which of the following best describes the hepatic effects of metformin?

A Enhances glycolysis
B Suppression of gluconeogenesis
C Increased utilisation of glucose
D Enhances GLP-1 release
E Increased tubular reabsorption of glucose

A

Which of the following best describes the hepatic effects of metformin?

A Enhances glycolysis
B Suppression of gluconeogenesis
C Increased utilisation of glucose
D Enhances GLP-1 release
E Increased tubular reabsorption of glucose

183
Q

What type of drug is metformin
A GLP-1 agonist
B Sulphonylurea
C Biguanide
D Long-acting insulin
E Sodium-glucose co-transporter 2 inhibitor

A

What type of drug is metformin
A GLP-1 agonist
B Sulphonylurea
C Biguanide
D Long-acting insulin
E Sodium-glucose co-transporter 2 inhibitor

184
Q

Aside from diabetes mellitus, metformin can be prescribed in which other condition?
A Migraine
B Chronic obstructive pulmonary disease
C Hypertension
D Polycystic ovarian syndrome (PCOS)
E Alcoholic liver disease

A

Aside from diabetes mellitus, metformin can be prescribed in which other condition?
A Migraine
B Chronic obstructive pulmonary disease
C Hypertension
D Polycystic ovarian syndrome (PCOS)
E Alcoholic liver disease

185
Q

Which muscarinic receptor subtype is thought to be most important in the treatment of chronic airway disease?

A M1
B M2
C M3
D M4
E M5

A

Which muscarinic receptor subtype is thought to be most important in the treatment of chronic airway disease?

A M1
B M2
C M3
D M4
E M5

186
Q

Which of the following statements best describes the mechanism of ACE-inhibitors?

A Inhibit the the release of angiotensin-converting enzyme

B Inhibit the conversion of angiotensinogen into angiotensin I

C Directly inhibit the release of renin

D Inhibit the conversion of angiotensin I into angiotensin II

E Directly antagonise the angiotensin II receptor

A

D Inhibit the conversion of angiotensin I into angiotensin II

187
Q

Which of the following side-effects is commonly associated with metformin?
A Headache
B Gastrointestinal upset
C Reduced vision
D Hearing loss
E Nail changes

A

Which of the following side-effects is commonly associated with metformin?
A Headache
BGastrointestinal upset
C Reduced vision
D Hearing loss
E Nail changes

187
Q

Which of the following side-effects is commonly associated with metformin?
A Headache
B Gastrointestinal upset
C Reduced vision
D Hearing loss
E Nail changes

A

Which of the following side-effects is commonly associated with metformin?
A Headache
BGastrointestinal upset
C Reduced vision
D Hearing loss
E Nail changes

188
Q

Which of the following is not a recognised side-effect of thiazide diuretics?

A Hyperkalaemia
B Pancreatitis
C Hypomagnesaemia
D Hyperglycaemia
E Hyperuricaemia

A

Which of the following is not a recognised side-effect of thiazide diuretics?

A Hyperkalaemia
B Pancreatitis
C Hypomagnesaemia
D Hyperglycaemia
E Hyperuricaemia

189
Q

29-year-old is admitted with an acute exacerbation of asthma. Their saturations are currently 97% on 2L of oxygen via nasal cannulae.

Approximately, what percentage of oxygen is being delivered to the patient?

A 20%
B 24%
C 28%
D 36%
E 60%

A

29-year-old is admitted with an acute exacerbation of asthma. Their saturations are currently 97% on 2L of oxygen via nasal cannulae.

Approximately, what percentage of oxygen is being delivered to the patient?

A 20%
B 24%
C 28%
D 36%
E 60%

As a general rule, each litre of oxygen via nasal cannulae provides an additional 4% of oxygen.

190
Q

Which electrolyte abnormality would you expect with the use of high doses of salbutamol?

A Hypernatraemia
B Hypokalaemia
C Hyperkalaemia
D Hyponatraemia
E Hyperphosphataemia

A

Which electrolyte abnormality would you expect with the use of high doses of salbutamol?

B Hypokalaemia

This results from activation of beta-2 adrenoreceptors linked Na/K-ATPase channels leading to increased cellular uptake of potassium. Salbutamol may be used to help treat hyperkalaemia. At high doses salbutamol may also lead to tachycardia, hypomagnesaemia and hyperglycaemia.

191
Q

Which statement best describes the cause of a dry cough with ACE-inhibitor use?

A Angiotensin converting enzyme blockade causes decreased degradation of bradykinin

B Inhibition of angiotensin converting enzyme leads to increased levels of angiotensin I

C Inhibition of angiotensin converting enzyme causes massive histamine release

D Angiotensin converting enzyme blockade increases levels of kininogen

E Inhibition of angiotensin converting enzyme leads to increased synthesis of bradykinin

A

Which statement best describes the cause of a dry cough with ACE-inhibitor use?

A Angiotensin converting enzyme blockade causes decreased degradation of bradykinin

192
Q

Which of the following is not a typical side-effect of ACE-inhibitors?

A Angio-oedema
B Hyperkalaemia
C Ankle swelling
D Postural hypotension
E Dry cough

A

Which of the following is not a typical side-effect of ACE-inhibitors?

A Angio-oedema
B Hyperkalaemia
C Ankle swelling: clasic AE of CCBs
D Postural hypotension
E Dry cough

193
Q

Which of the following statements is not a recognised effect of corticosteroids in asthma?

A Suppression of goblet cells
B Decreased IgE synthesis
C Reduced synthesis of inflammatory mediators
D Beta-2 adrenoreceptor downregulation
E Reduced mucosal oedema

A

Which of the following statements is not a recognised effect of corticosteroids in asthma?

A Suppression of goblet cells
B Decreased IgE synthesis
C Reduced synthesis of inflammatory mediators
D Beta-2 adrenoreceptor downregulation

Corticosteroids lead to the upregulation of beta-2 adrenoreceptors, a synergistic activity that leads to increased bronchodilation in response to beta-2 agonists.

194
Q

Which of the following is not considered a mechanism of GLP-1

A Inhibition of gastrointestinal motility
B Inhibition of gastrointestinal secretion
C Enhances the secretion of insulin
D Increases gastric emptying
E Promotes fullness and satiety

A

D Increases gastric emptying

CR2 (59 decks)

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