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Module 204 > Drugs > Flashcards

Drugs Flashcards

1
Q

Nasal decongestants

E.g. oxymetazoline

A

Alpha 1 adrenoceptor agonist
Causes vasoconstriction
Short term use only
Topical and systemic use

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2
Q

Salbutamol

A

Beta 2 agonist

Causes smooth muscle relaxation via lung beta 2 adrenoceptors

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3
Q

Adrenaline

A

0.5mg intramuscular administration for anaphylactic shock

Causes bronchodilation, vasoconstriction to increase peripheral resistance and increases cardiac output

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4
Q

Leukotriene receptor antagonist

A

E.g. montelukast
Reduces early allergic responses by inhibiting leukotriene actions
Used for chronic asthma

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5
Q

H1 antihistamines

A

E.g. cirizine, loratidine, desloratidine, fexofenadine (2nd gen.)
Inverse agonist at H1 histamine receptor
Non-drowsy and administered 1x/day

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6
Q

Mast cell stabilisers

A

E.g. Sodium cromoglycate

Reduce mast cell degranulation

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7
Q

Corticosteroids

A

Alter gene expression to reduce immune activation (T/B/innate cells affected)
Delayed onset of action - effects appear within 2 weeks
E.g. beclamethasone, fluticasone
Other RoA = ophthalmic drops, oral, IV

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8
Q

Nasal corticosteroid

A

Mometasone

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9
Q

Topical corticosteroid

A

Hydrocortisone

May cause local or systemic side effects

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10
Q

Omalizumab

A

Monoclonal antibodies against IgE for atopic asthma
Binds to alternate part of Fc region of IgE to limit IgE binding to IgE receptor on mast cells and basophils
Result: limits the degree of mediator release of typical allergic response

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11
Q

Allergovit vaccine

still in trials

A

Used for pollen allergy
Long-term protection by inducing Treg responses, reducing Th2 response, IgG antibodies, mast cell response, and IgE levels

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12
Q

Name NSAIDs

A

Aspirin
Paracetamol
Propionic acid derivatives e.g. ibuprofen, naproxen
Arylalkanoic acids e.g. indometacin, diclofenac
Fenamic acids e.g. mefanamic acid
Coxibs (COX-2 inhibitors) e.g. celecoxib

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13
Q

Side effects of NSAIDs

A

Only seen in 1-2% of users
Bruising due to thromboxane production
GI toxicity - stomach irritation/ulcers/bleed
Tinnitus
Nephrotoxicity - hypernatraemia, hyperkalaemia, decreased GFR
Hepatic failure in children

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14
Q

Mechanism of action of NSAIDs

A

Antagonise COX enzymes

Inhibition of COX-1 causes side effects relating to gastric mucosa and renal tubules

Inhibition of COX-2 causes analgesic and anti-inflammatory effects

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15
Q

Paracetamol

A

Inhibits COX-3 (thought to only be located in CNS)
First drug offered for chronic pain
No significant anti-inflammatory or GI toxic effects
Doesn’t bind COX 1 or 2
Produces mild analgesic effects and antipyretic effects

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16
Q

Implications for NSAIDS

A

Short term pain and fever management
Mild analgesic
Potent analgesic (following operation, or ureteric colic pain)
Anti-inflammatory effects e.g. gout, inflammatory arthritis
Anti-platelet effect e.g. after MI

17
Q

Non-NSAID anti-platelet drugs

A

Clopidogrel

Dipyrimidole

18
Q

Paracetamol metabolism

A

Conjugated in liver with glucuronide and sulphate

When overwhelmed with paracetamol, the liver produces larger quantities of NAPQI causing fatal hepatic necrosis

19
Q

Rx for paracetamol overdose

A

N-acetylcysteine(NAC)
Methionine
Replenishes glutathione to prevent liver damage

20
Q

Aspirin and Asthma

A

Arachidonic acid forms more leukotrienes due to NSAID blocking COX enzymes
Results in bronchospasm in 10% of asthmatics

21
Q

Voltarol (trade name)

A

Diclofenac used for severe short term analgesic

22
Q

Indomethacin

A

Used for more potent pain e.g. gout

23
Q

Rx for GI toxicity

A

Misoprostil (prostaglandin E1 analogue)

PPI e.g. omeprazole, lansoprazole

24
Q

Selective COX-2 inhibitors

A

Celecoxib
Etoricoxib
Rofecoxib
Valdecoxib

25
Q

Side effects of COXIB

A

No activity as anti-thrombotics, found to increase risk of MIs
GI bleeds
BNF recommends use only in pts with increased ulceration risk

26
Q

Effects of corticosteroid drugs

A 
Carbohydrate and protein metabolism
Fluid and electrolyte balance
Lipid metabolism
Bone metabolism
Profound immune modulator
27
Q

Uses of corticosteroids

A

Inflammation suppression: asthma, crohn’s, ulcerative colitis, eczema, MS, sarcoid, allergy, rheumatoid arthritis, SLE
Specific immunity: Graft rejection
Replacement therapy in hypoadrenalism

28
Q

Drugs to limit T cell activation in acute rejection

2 or 3 drugs used

A

Cyclosporin A - T cell inhibition via cytokine synthesis inhibition (IL-2, IFN-g)
Azathioprine - anti-proliferation to inhibit clonal expansion of immune cells
Corticosteroids - anti-inflammatory
Antibody to T cell to reduce number and activation of T cells

29
Q

IV C1 inhibitor concentrate

A

Used for attacks in hereditary angioedema or C1 inhibitor deficiency

30
Q

Ecallantide

A

Kallikrein inhibitor to prevent bradykinin production in C1INH deficiency/HAE
SC injection 3x
Used for acute attacks in US only

31
Q

Icatibant

A

Bradykinin B2 antagonist

SC injection for acute attacks in C1INH deficiency/HAE

32
Q

Prophylaxis for HAE

A

Tranexamic acid - prevents activation of kinin system
Attenuated androgens e.g. danazol/stanozolol to stimulate hepatic C1 inhibitor production
C1INH injections 2x/wk

33
Q

Lanadelumab

A

Monoclonal antibodies against Kallikrein to prevent bradykinin production for HAE
Administered SC monthly
95% reduction seen in attacks during phase 3 trials
Not licensed yet

34
Q

HAEGARDA

A

SC prophylaxis for HAE
2x/wk with 95% reduction in attacks, licensed in US, currently awaiting approval in Europe
£300,000/yr

35
Q

Immunomodulators

A

Systemic corticosteroids
Small molecule immunosuppressive drugs (eg methotrexate, azathioprine, ciclosporin)
High dose IV immunoglobulin

36
Q

Neostigmine

A

AChE inhibitor
Increases ACh activity at NMJ
Used for myasthenia gravis

37
Q

Edrophonium

A

short lived ACE inhibitor for diagnosis (temp. symptoms improvement)

Module 204 (5 decks)

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