CR2 Drugs Flashcards
Which drugs do you use to treat acute mountain sickness / & or HACE [3]
Oxygen
Acetazolamide: carbonic anhydrase inhibitors
Dexamethasone: 4mg qds, (four times daily) oral or iv (steroid): corticosteroid medication used to prevent brain swelling and inflammation.
Which drugs do you use to treat HAPE [6]
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)
Nifedipine?
Calcium channel blocker that relaxes vascular smooth muscle
Sildenafil (Viagra):
relaxes pulmonary vascular smooth muscle (it increases levels of cGMP & decreases intracellular calcium)
Acetazolamide?
Carbonic anhydrase inhibitor; causes more HCO3- to be excreted in urine
Dexamethasone
corticosteroid medication used to prevent brain swelling and inflammation.
Which drugs would you use to manage IPF ? [3]
Which drugs would you treat dilated cardiomyopathy with? [4]
A
ACE I / ARBs: lower BP
Diuretics: reduce fluid built up
Anti-coagulants: reduce blood clot chances
Beta blockers: control HR
Q
What are the steps for treating PE? [7]
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
Explain mechanism of how heparin works to treat PE
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)
Which drugs would you use to treat a Ptx who had acute sore throat with pharnygitis?
Start of treatment is determined by hospital’s microbiology protocol
But:
First choice: Phenoxymethylpenicillin
If allergic:
Clarithromycin
Erythromycin
What type of medication can you give for haemophilia? [3]
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)
What type of medication can you give for VWD? [3]
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
Which drugs would you use to manage IPF ? [3]
How would you treat IPF via non-pharmacotherapy?
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
Which drugs should you NOT combine to treat IPF?
A
Prednisone, Azathioprine & NAC = Harmful AEs
What pharmacological treatment consider for sarcoidosis?
Treat with corticosteroids (but has negative impact on immune system).
Remember than patients may have spontaneous resolution so have to weigh up options !!
Which drugs would you use to treat a Ptx who had acute sore throat with pharnygitis?
Start of treatment is determined by hospital’s microbiology protocol
But:
First choice: Phenoxymethylpenicillin
If allergic:
Clarithromycin
Erythromycin
What can
sepsis
Q
Which drugs would you use to manage pneumonia for:
CRB Score 0
CRB Score 1-2
CRB Score 3-4
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
Which drug do you use to thrombolyse clots in a stroke?
Alteplase
BUT must be given 4.5 hours of onset!
What treatment do you use for resp. acidosis? [4]
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
How should you treat hypoxaemia in Ptx with COPD and chronic hypercapnia? [2]
What is target Hb saturation for this? [1]
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
First line treatment for TB? [4]
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
What drug would you initially give to non-haem stroke? [1]
A
Aspirin !
How would you manange an acute TIA?
300mg aspirin
How do you treat PDA? [2]
Treatment: prostaglandin inhibitor, such as ibuprofen; surgery
Q
Which drugs would you use to manage pneumonia for:
CRB Score 0
CRB Score 1-2
CRB Score 3-4
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
Which antihypertensives should not be used for pregnant / breastfeeding women? [2]
ACE inhibitors
AT II receptor antagonists
What is Step One Treatment for HTN?
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
What is Step Two Treatment for HTN?
If already on ACE inhibitor? [2]
If already on CCB? [3]
If on ACE inhibitor:
- Add CCB or thiazide-like diuretic [2]
If on CCB:
- Add ACE inhibitor or ARB or thiazide-like diuretic
Which drug is used as a diagnostic tool in cardiac stress test?
Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel
Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel
What is the MoA of Dobutamine? [1]
Sympathomimetic β1 agonist which is used in cardiac stress test and imaging
Increases contractility not rate
Which radioactive tracer is used in SPECT imaging of the myocardim to see perfusion? [1]
99m-technetium
Name a longer acting alternative to GTN [1]
Isosorbide mono/dinitrate
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
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
Name two betablockers that reduce HR and LV wall tension [2]
Atenolol
Propranolol
How does beta blocker act alongside acting as an anti-sympathomimetic? [1]
Beta blocker causes down regulation of RAAS as well as acting as a anti-sympathomimetic
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
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
Which of the following calcium channel blockers act on both myocardium and vessels for dual effect
Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel
Which of the following calcium channel blockers act on both myocardium and vessels for dual effect
Dobutamine
Verapamil
Diltiazem
Amlodipine
Clopidogrel
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
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
Which drug acts by COX-2 inhibition in platelets for thromboxane A2(TXA2) synthesis [1]
Aspirin
Which drug acts by blocking P2Y12, an adenosine diphosphate (ADP) on platelet cell membranes? [1]
Clopidogrel
Name 4 things that cause acute haemolysis in G6PD deficiency
Fava beans, primaquine, cotrimoxazole, dapsone
Warfarin is what class of drug? [1]
What is warfarin an antagonist to? [1]
What does warfarin act agasint? [6]
Anticoagulant
Vit K antagonist
Acts agaisnt factors II, VII, IX, X AND protein C &/ S
Which of the following is used in treatment of VTE / DVT and PE and is a heparin antagonist
Fondaparinux
Warfarin
Protamine
Folate
Which of the following an heparin antagonist
Fondaparinux
Warfarin
Protamine
Folate
Binds heparin to inactivate it. Does not work as well on LMWH
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
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
What is the first choice treatment for VTE / DVT / PE? [1]
What is specific mechanism? [1]
LMWH
Anti-Xa effect
What is a risk of heparin use for treatment of VTE / DVT / PE? [2]
Heparin induced thrombocytopaenia(HIT) 5-14 days after start(rare)
bleeding
Which of the following blocks the Na/K/2Cl symporter in the ascending loop of Henle?
Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone
Which of the following blocks the Na/K/2Cl symporter in the ascending loop of Henle?
Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone
AE of furosemide? [1]
Hypokalaemia
Which of the following blocks the Na/Cl symporter in the distal convoluted tubule to prevent sodium reabsorption?
Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone
Which of the following blocks the Na/Cl symporter in the distal convoluted tubule to prevent sodium reabsorption?
Chlorthalidone
Bendroflumethiazide
Furosemide
Spironolactone
Name two drugs that block ACE, resulting in lower SVR [2]
Captopril, lisinopril
Whoch of the following blocks angiotensin II receptor preventing its vasoconstrictive effects?
lisinopril
Captopril
Spironolactone
Losartan
Amiloride
Whoch of the following blocks angiotensin II receptor preventing its vasoconstrictive effects?
lisinopril
Captopril
Spironolactone
Losartan
Amiloride
Whoch of the following blocks aldosterone transporter?
lisinopril
Captopril
Spironolactone
Losartan
Amiloride
Whoch of the following blocks aldosterone transporter?
lisinopril
Captopril
Spironolactone
Losartan
Amiloride
Which of the following may you prescribe alongside spironlactone to normalise potassium levels?
lisinopril
Captopril
Furosemide
Losartan
Amiloride
Which of the following may you prescribe alongside spironlactone to normalise potassium levels?
lisinopril
Captopril
Furosemide
Losartan
Amiloride
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
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
Which of the following is an alpha 2 agonist that causes a decrease in CO and vascular tone?
Clonidine
Carvedilol
Propranolol
atenolol
doxazosin
Which of the following is an antihypertensive alpha 2 agonist that causes a decrease in CO and vascular tone?
Clonidine
Carvedilol
Propranolol
atenolol
doxazosin
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
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
Propranolol is what type of arrythmia drug class?
Class II
Which of the following is a β2 agonist that causes short acting smooth muscle relaxation in the bronchioles
Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol
Which of the following is a β2 agonist that causes short acting smooth muscle relaxation in the bronchioles
Salmeterol
Beclomethasone
Salbutamol
Prednisolone
Indaceterol
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
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