Drugs

Question 1

What are calcimimetics?

Answer 1

Calcimimetics are a class of drugs that mimic the action of calcium on tissues. They are primarily used to treat conditions like hyperparathyroidism, which involves overactive parathyroid glands.

Question 2

How do calcimimetics work?

Answer 2

Calcimimetics work by increasing the sensitivity of the calcium-sensing receptors on the parathyroid glands to extracellular calcium. This helps to lower the levels of parathyroid hormone (PTH), calcium, and phosphorus in the body.

Question 3

What conditions are treated with calcimimetics?

Answer 3

> Primary hyperparathyroidism.

> Secondary hyperparathyroidism, often seen in patients with chronic kidney disease.

> Parathyroid carcinoma (a rare cancer of the parathyroid glands).

Question 4

What are the common side effects of calcimimetics?

Answer 4

Nausea
Vomiting
Diarrhoea
Muscle pain
Abdominal pain

Question 5

What are the names of some calcimimetic drugs?

Answer 5

Cinacalcet (Sensipar®): An oral medication
Etelcalcetide (Parsabiv®): An intravenous medication

Question 6

Bone disease that can arise as a complication of bisphosphonate use.

Answer 6

Osteonecrosis of the jaw.

Question 7

Doxorubicin trade name.

Answer 7

Adriamycin

Question 8

What effect may doxorubicin have on urine?

Answer 8

Red discolouration.

Question 9

Pembrolizumab mechanism of action.

Answer 9

PD-1 inhibition. Pembrolizumab is a humanised monoclonal antibody.

Question 10

What is benzydamine (Difflam) used for in chemotherapy patients?

Answer 10

Management of chemotherapy-induced mucositis.

Question 11

What is a TIVAD?

Answer 11

A Totally Implanted Venous Access Device, also known as a Port-A-Cath is a small medical device used for patients who require frequent access to their bloodstream for treatments like chemotherapy, intravenous fluids, or parenteral nutrition.

Question 12

Opiate versus opioid.

Answer 12

Opiates are natural.
Opioids are synthetic.

Question 13

Colour of Heroin

Answer 13

White Heroin:

Highly purified heroin, often in powder form.
Common in Southeast Asia and some parts of the U.S.

Typically mixed with other white powders like sugar, starch, or quinine.

Brown Heroin:

Less refined and usually appears as a coarse powder.
Found more commonly in parts of Europe and Asia.

Brown colour comes from impurities or incomplete refining processes.

Black Tar Heroin:

Dark brown to black, sticky, or hard tar-like substance.

Predominantly produced in Mexico and distributed in the U.S.
Contains impurities, giving it a distinctive texture and colour.

Grey or Off-White Variants:

May appear depending on the cutting agents used or regional manufacturing differences.

Question 14

ACE inhibitor-induced angioedema pathophysiology.

Answer 14

ACE inhibits bradykinin. Bradykinin increases vascular permeability. Therefore, inhibiting ACE increases bradykinin.

Question 16

What is the mechanism of action of lidocaine?

Answer 16

Lidocaine is a local anesthetic and antiarrhythmic drug. Its mechanism of action involves blocking sodium ion channels in the neuronal cell membrane. By inhibiting these channels, lidocaine prevents the generation and conduction of nerve impulses, which effectively numbs the area where it is applied or injected.

Question 17

Name two drugs or drug classes that are used to manage lidocaine toxicity.

Answer 17

Intravenous lipid emulsion (to sequester the lidocaine).

Benzodiazepines (to control seizures).

Question 18

What are the stages of lidocaine toxicity? What are the symptoms/signs?

Answer 18

CNS excitation: circumoral tongling, tongue numbness, metallic taste, lightheadedness, dizziness, visual disturbances, tinnitus, restlessness, muscular twitching, tremors, and anxiety.

CNS depression: seizures, confusion, agitation, and disorientation.

Question 19

Mechanism of action of bicalutamide (Casodex).

Answer 19

Bicalutamide is a non-steroidal antiandrogen that works by blocking the action of androgens (male hormones) like testosterone.

Question 20

What drug is used prophylactically to reduce the risk of haemorrhagic cystitis in patients receiving alkylating agent chemotherapy?

Answer 20

Sodium-2-mercaptoethanesulfonate (Mesna).

Question 21

What is the mechanism of action of tizanidine?

Answer 21

Tizanidine is a muscle relaxant that works by acting as an alpha-2 adrenergic agonist. This means it binds to alpha-2 adrenergic receptors in the central nervous system, which leads to presynaptic inhibition of motor neurons. By doing so, it reduces the release of excitatory neurotransmitters that cause muscle spasms.

Question 22

What are the SSRIs of choice for treatment initiated in breastfeeding women?

Answer 22

Paroxetine and sertraline.

Question 23

Where can you seek advice regarding the use of medication while breastfeeding?

Answer 23

UK Drugs in Lactation Advisory Service (UKDILAS)