Drugs

Question 1

What is the MoA of Metformin?

Answer 1

Suppresses hepatic gluconeogenesis, reducing glucose output form the liver. Increases peripheral insulin sensitivity, increasing glucose uptake and utilisation. It increases AMPk increasing glucose uptake in skeletal muscles and adipose. Inhibits G6Pase and PEPCK

SE - LACTIC ACIDOSIS, GI upset

Question 2

What is the MoA of Sulphonylureas?

Answer 2

Closes the ATP sensitive K channels on beta cells, Ca influx, Stored insulin release. Increased cellular glucose uptake. Glimepride, glibenclamide, glipizide

SE - abdominal pain, GI upset, risk of hypoglycaemia

Question 3

What is the MoA of Glitazones?

Answer 3

PPAR gamma-receptor agonist
Increases the transcription of insulin sensitising genes. increased GLUT 4 expression. Increased sensitivity of adipose, muscles and liver to insulin
e.g. Pioglitazone

Question 4

What is the MoA of DPP-4 inhibitors?

Answer 4

Inhibit DPP-4 enhancing the activity of endogenous incretins. Increases glucose mediated insulin secretion and suppresses glucagon release.
Improves HbA1c
E.g. Sitagliptin, saxagliptin, alogliptin

SE- hypoglycaemia, acute pancreatitis

Question 5

What is the MoA of SGLT2 inhibitors?

Answer 5

Inhibits SGLT2 on PCT to reduce renal reabsorption of glucose.
SGLT2 on PCT usually reabsorbs 90% of glucose
Canagliflozin, dapagliflozin, empagliflozin
Improves HbA1c

SE - GU infections

Question 6

Name some types of insulin.

Answer 6

Rapid - Novorapid (insulin aspart), Humalog (insulin lispro)
Short acting - Actrapid, Humulin S
Intermediate - Insulatard, Humulin I
Long - Lantus (insulin determir), levier (insulin glargine)
Pre-mixed - Humulin M3

Question 7

First line in focal seizures is lamotrigine or carbamazepine what is their MoA?

Answer 7

Blocks the pre-synaptic Na channels preventing influx and so reducing excitability and AP
SE- headache, irritable, blurred vision, drowsy

Question 8

First line for generalised seizures is sodium valproate, what is its MoA?

Answer 8

Inhibits the degradation of GABA (the inhibitory transmitter)
Weak inhibitor of Na channels
SE - tremor, ataxia, behavioural disturbances, thrombocytopenia, hair loss

Question 9

How does levetiracetam work?

Answer 9

Inhibits SV2A, which is required for release of NT

Question 10

How do benzodiazepines work?

Answer 10

Enhances and facilitates the binding of GABA to GABAa receptors - this has a widespread depressant effect on synaptic transmission
SE- drowsy, sedation, coma

Question 11

What is the MoA of gabapentin and pregbalin in epilepsy?

Answer 11

Block the presynpatic voltage gated Ca channels, inhibiting the release of excitatory NT, reducing neuronal excitability
SE- ataxia, drowsy, dizzy

Question 12

What is an adverse drug reaction?

Answer 12

A drug related event that is a noxious, unintended event that occurs at doses used in humans for prophylaxis, diagnosis or therapy of diseases.
Overdose, therapeutic failure, drug interactions, drug withdrawal

Question 13

What is a Type A adverse reaction?

Answer 13

Augmented, predictable, pharmacological -
An exaggerates but otherwise normal pharamcological action that is dose dependent and readily reversible when the dose is reduced or withdrawn

Question 14

What are type B adverse reactions?

Answer 14

Bizarre, unpredictable or aberrant, unrelated to pharamcology of the drug.

Question 15

What are the types of ADRs?

Answer 15

Type A - Augmented/ predictable
Type B - Bizzare/ unpredicaable
Type C - Chronic or continuous
Type D - Delayed
Type E - End of use reactions

Question 16

What are some drugs that induce CYP450?

These drugs reduce the level/ conc of drugs that are metabolised by CYP450

Answer 16

CRAPS
Cabamazepine/ chronic alcohol use
Rifampicin
bArbiturates
Phenytoin
St Johns wart

Question 17

What are some drugs that inhibit CYP450?

Answer 17

'Some Certain Silly Compounds Annoyingly Inhibit Enzymes Grr'
Sodium valproate 
Ciprofloxacin
Sulphonamide 
Cimetidine/ omeprazole (PPIs)
Antifungals/ amiodarone 
Isoniazid
Erythromycin/clarithromycin
Grafefruit juice

Question 18

What drugs interact with CYP inducers or inhibitors?

Answer 18

Warfarin, OCOP, theophylline, corticosteroids, statins

Question 19

Give a specific side effect of the immunosuppressant Methotrexate.

Answer 19

Pneumonitis and fibrosis, teratogenic

Dihydrofolate reductase inhibitor

Question 20

Give a specific side effect of the immunosuppressant Sulphasalazine,

Answer 20

Reversibel hypospermia

Question 21

Give a specific side effect of the immunosuppressant hydroxychloroquine.

Answer 21

ECG changes, skin changes, visual changes

Question 22

How does paracetamol work?

Answer 22

Weak inhibitor or cycloxygenase (cox) enzyme specifically brain COX. No peripheral effects. It increases the nociceptive threshold by inhibits PG synthesis
SE - rash

Question 23

What are some side effects of anti-TNF agents such as etanercept, infliximab?

Answer 23

Flu like - headache, runny nose, fever
Immunodeficiency - Legionella or listeria infections
Reactivation of TB

Question 24

Before giving Azathioprine or mercaptopurine, what should you check?

Answer 24

TPMT levels (thiopurine methyltransferase) (xanthine oxidase also used it its metabolism)
Lower levels are more prone to bone marrow suppression

Question 25

What are some SE of H2 receptor antagonists?

Answer 25

B12 absorption reduced, headache, gynaecosmatsia, Cytochrome P450 inhibitor

Question 26

What triad may be seen in serotonin syndrome (SSRI overdose?)

Answer 26

Autonomic hyperexcitability (sweating, fever)
Neuromuscular excitation (tremor, clonus)
AMS