drugs

Question 1

Drugs for GORD/ulcers

Answer 1

Antacids = aluminium hydroxide neutralises Hcl

H2 antagonists = Ranitidine

Proton pump inhibitors = Omeprazole

Question 2

Drugs for constipation

Answer 2

Osmotic laxatives = lactulose and macrogol draws water into stool

Stimulant laxatives = docusate sodium/senna/sodium picosulfate enhances gut motility

Bulk forming laxatives = methylcellulose stimulates through increased faecal bulk

Stool softeners = arachis oil and glycerol suppository lubricates and breaks down stool

Question 3

Drugs for nausea that acts on vestibular nuclei (antiemetics)

Answer 3

Hyoscine hydrobromide = muscarinic receptor antagonist

H1 antagonists eg. cyclizine

Question 4

Drugs for nausea that act on visceral afferents in the gut (antiemetics)

Answer 4

D2 antagonists eg. metoclopramide = also 5HT3 antagonists

5HT3 antagonist eg. ondansetron

Question 5

Drugs for nausea that act on chemoreceptor trigger zone (antiemetics)

Answer 5

Neurokinin-1 antagonists eg. aprepitant

Antipsychotics eg. haloperidol = D2 receptor antagonist

These drugs are good for chemo

Question 6

resp drugs x4

Answer 6

Beta adrenoceptor agonists eg. salbutamol

anti-muscarinics eg. tiotropium bromide, ipratropium bromide
= M3 receptor antagonists

Methylxanthines eg. aminophylline
= adenosine antagonist

corticosteroids eg. beclomethasone

Question 7

Diuretics x4

Answer 7

Thiazide eg. bendroflumethiazide = Na/Cl transporter inhibitor

Loop eg. furosemide = Na/K/2Cl transporter inhibitor

K+ sparing eg. amiloride = ENac transporter inhibitor

aldosterone antagonist eg. spironolactone = affects 3Na2KATPase on basolateral

Question 8

Diarrhoea drug

Answer 8

Loperamide is an intestinal opioid receptor antagonist so decreases colonic mass movement

Question 9

hypertension drugs

Answer 9

ACE inhibitors eg. ramipril = inhibits angiotensin converting enzyme

Angiotensin Receptor Blockers eg. Losartan = AT1 receptor antagonist

Calcium channel blockers eg. amlodipine, dilziatem, verapamil

Question 10

Anticoagulants

Answer 10

Vit K antagonists eg. warfarin = inhibits Vit K epoxide reductase

Unfractionated heparin eg. heparin = inhibits clotting factors XIIa, XIa, Xa, IXa, IIa (thrombin)

LMWH eg. dalteparin = inhibits Xa

Fondaparinux = inhibits Xa

Direct acting oral anticoagulants eg. apixiban = inhibits Xa

Direct thrombin inhibitors eg. argatroban, dabigatran = inhibits IIa

Question 11

What is heparin reversal and warfarin reversal

Answer 11

heparin reversal = protamine sulphate

warfarin reversal = Vit K1

Question 12

Fibrinolytic and antifibrinolytics

Answer 12

fibrinolytics = alteplase, reteplase
(activate plasmin to plasminogen)

antifibrinolytics = tranexamic acid
(inhibits plasmin to plasminogen)

Question 13

Lipid lowering drugs

Answer 13

Statin eg. atorvastatin, simvastatin
= HMG CoA reductase inhibitors

Fibrates eg. fenofibrate
= PPAR-a activator

Cholesterol absorption inhibitors eg. ezetimibe
= NPC1L1 transporter inhibition

Nicotinic acid eg. niacin
= inhibits diacylglycerol acetyltransferase-2

PCSK9 inhibitors eg. alirocumab
= monoclonal antibodies that inhibit PCSK9

Question 14

Anxiety medication?

Answer 14

• Selective Serotonin Reuptake inhibitors

- Anxiolytics eg. lorazepam, diazepam (increase GABA activity)

Question 15

Analgesics

Answer 15

Aspirin = prostaglandin production inhibition

Paracetamol = COX2 inhibition in spinal cord

Buprenorphine = partial opioid agonist

Codeine = converted to morphine via CYP2D6

Morphine = strong opioid receptor agonist

Naloxone = opioid receptor antagonist (low oral bioavailability as extensive first pass effect)

Question 16

Repro drugs eg. HRT, contraception etc

Answer 16

HRT eg. estradiol = oestrogen steroid hormone

Anti-oestrogens eg. tamoxifen (in breast cancer)

Emergency contraception eg. ulipristal acetate = progesterone receptor modulator

Emergency contraception eg. levonorgestrel = progesterone

Question 17

NSAIDS (dont undergo first pass elimination)

Answer 17

Ibuprofen = nonselective cyclooxygenase inhibitor (both COX1 and 2) to prevent arachidonic acid from being converted to prostaglandins to reduce inflammatory response

Naproxen = nonselective cox inhibitor

Celecoxib = selective COX2 inhibitor

Question 18

Paracetamol overdose?

Answer 18

paracetamol binds hepatic glutathione in the liver but this can run out, and NAPQI accumulates.

This causes hepatocellular damage. (nausea, vomiting, upper quadrant pain)

Fix with acetylcysteine

Question 19

Rheumatoid arthiritis drugs

Answer 19

methotrexate = reduces pyrimidines which inhibits synthesis of DNA/RNA

infliximab = TNF-a inhibitors which reduces inflammation

corticosteroids = prevent interleukin IL-1 and IL-6 production by macrophages

rituximab = depletes B cells by binding CD20 on B cells and causing apoptosis

Question 20

antiarrhythmics classes

Answer 20

Class 1 eg. flecainide, lidocaine
= Na+ channel blockers

Class 2 eg. bisoprolol
= beta blockers

Class 3 eg. amiodarone, sotalol
= K+ channel blockers

Class 4 eg. dilziatem, verapamil
= Ca2+ channel blockers

Question 21

Diuretic side effects

Answer 21

Loop = gout, alkalosis, calcium excretion increased

Thiazide = gout, hypokalaemia, calcium excretion decreased

K+ sparing eg. amiloride = hyperkalaemia

Aldosterone antagonist eg. spironolactone = hyperkalaemia, gynaecomastia