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Therapeutics > Exam questions > Flashcards

Exam questions Flashcards

1
Q

What is Splanchnic Blood Flow

A

blood flow to the abdominal gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine.

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2
Q

What is a beta lactam drug

A

creates an enzymatic defense system in the body`

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3
Q

what is an example of a beta lactam drug

A

penicillins

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4
Q

what is chadsvasc score

A

most commonly utilized method to predict thromboembolic risk in atrial fibrillation

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5
Q

what does cha2ds2vasc score stand for

A 
Congestive heart failure
Hypertension
Age>75 (2)
Diabetes melitus
Stroke/Thromboembolism (2)
Vascular disease
Age 65-74
Sex
C
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6
Q

what does the c of chadsvasc score stand for

A

congestive heart failure

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7
Q

what does the h of chadsvasc score stand for

A

hypertension

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8
Q

what does the a2 stand for in chadsvasc

A

age >75 (counts for 2 points)

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9
Q

what does the d stand for in chadsvasc

A

diabetes melitus

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10
Q

what does the s2 stand for in chadsvasc

A

stroke (counts for 2 points)

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11
Q

what does the v stand for in chadsvasc

A

vascular disease

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12
Q

what the the a stand for in chadsvasc

A

65 - 74 year old

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13
Q

what does the Sc stand for in chadsvasc

A

sex catagory i.e. male or female at birth

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14
Q

what does a score of 0 call for in chadsvasc

A

Nothing

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15
Q

what does a score of 1 call for in chadsvasc

A

consideration of DOAC

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16
Q

what is a DOAC

A

‘Direct Oral AntiCoagulant’

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17
Q

what is an example of a direct oral anticoagulanty

A

apixaban

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18
Q

what does a score of 2 indicate for in chadsvasc

A

use of direct oral anticoagulant

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19
Q

what type of drug is lasartan

A

angiotensin II receptor blocker

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20
Q

give another type of angiotensin 2 receptor blocker other than lasartan

A

volsartan

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21
Q

what type of drug is atropine

A

anticholnergic

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22
Q

what do anticholinergic drugs do

A

inhibit the transmission of parasympathetic nerve impulses

reducing spasms of smooth muscle reducing bradycardia

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23
Q

What is fluticasone

A

steroidal nasal spray

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24
Q

What is bioavailability

A

the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect.

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25
Q

What is EC50

A

Half maximal effective concentration

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26
Q

What is Emax

A

the maximum response achievable

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27
Q

What is Ki

A

The inhibitor constant, Ki,

is an indication of how potent an inhibitor is

it is the concentration required to produce half maximum inhibition.

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28
Q

What is IC50

A

indicates how much of a particular inhibitory substance (e.g. drug) is needed to inhibit, in vitro, a given biological process or biological component by 50%

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29
Q

What is LD50

A

the amount of a material, given all at once, which causes the death of 50%

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30
Q

What is Kd

A

measure of the affinity of a drug for a receptor. More simply, the strength of the ligand–receptor interaction.

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31
Q

What is Bmax

A

is the total density (concentration) of receptors in a sample of tissue.

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32
Q

what is pA2

A

a measure of the potency of an antagonist

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33
Q

what is Citalopram

A

selective serotonin reuptake inhibitors

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34
Q

what is tamoxifen

A

antiestrogens

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35
Q

what does tamoxifen target

A

oestrogen

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36
Q

what is COMT

A

Catechol-O-methyltransferase

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37
Q

What is adrenaline in reference to COMT

A

a substrate

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38
Q

what is the key feature of adrenaline for the comparisson to the structure of salbutamol

A

Catechol ring

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39
Q

why is the catechol ring important in the comparisson between adrenaline and salbutamol

A

it is important as salbutamol does not have a catechol ring so has a longer duration.

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40
Q

is adrenaline selective

A

no

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41
Q

is salbutamol selective

A

yes it is a selective beta 2 agonist that helps to relax bronchial muscle

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42
Q

what other receptors beside b2 receptor does adrenaline target

A

alpha 2 receptors in the smooth muscle and arteries leading to vasoconstriction

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43
Q

what causes paracetamol poisoining

A

a build of the toxic metabolite NAPQI

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44
Q

how do you treat paracetamol poisoining

A

activated charcoal administered within one hour of paracetamol being taken

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45
Q

what is pancuronium

A

neuromuscular blocker

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46
Q

what is pancuronium used for

A

to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation.

47
Q

what is the key molecular target for pancuronium

A

nicotinic acetylcholine receptors

48
Q

what is donepazil

A

reversible inhibitor of acetylcholinesterase

49
Q

what is donepazil indicated for

A

indicated for the treatment of mild to moderate alzeheimers disease

50
Q

what is alzheimers characterised by

A

loss in cholinergic activity

51
Q

How does adrenaline work at the beta 1 receptor

A

beta 1 adrenergic receptor = gpcr due to g alpha subunit (gas)

it signals g causing adenylyl cyclase to convert atp to camp leading to increased levels of activity at PKA.

leading to an increase in receptor activity

52
Q

how is the cAMP dependent pathway initiatied for adrenaline working at a beta 1 receptor

A

it is initiated through adenylyl cyclase

53
Q

what effect does the initation of the cAMP dependent pathway have on the receptors function

A

potentiation

54
Q

what is a pro drug

A

a drug which is broken down in the body into its active components

55
Q

what is timolol

A

beta blocker

56
Q

what is timolol used for

A

open angle glaucoma

57
Q

what is open angle glaucoma

A

Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.

58
Q

how does timolol help treat open angle glaucoma

A

it reduces the intraocular pressure, responsible for causing glaucoma, by reducing the amount of fluid entering the eye.

59
Q

what type of drug is lasartan

A

angiotensin II receptor antagonists

60
Q

what is lasartan mechanism of action

A

prevents angiotensin 2 binding to at1 receptors

preventing mediated vasoconstriciton and aldosterone secreting effects

61
Q

what is lasartan useful for

A

reducing blood pressure

62
Q

what do you experience a cough in ACE inhibitors

A

blocks the degradation of bradykinin leading to accumulation in the system

the bradykinin stimulates the vagal afferent nerve fibres in the smooth muscle of the airways

resulting in constriction then a cough

63
Q

what do both acei and arb mechanism of action have in common

A

both affect the raas

64
Q

what are the differences in the acei and arb mechanism of action

A

acei

blocks conversion ag1 to ag2 leading to vasodilation,

reduced sodium retention and reduced anti diuretic hormone reducing the amount of sodium and water retrieved from the collecting duct.

arb

blocks the Angiotensin II receptor, which results in vasodilation,

reduced sodium retention (Aldosterone secretion reduced)

reduced release of anti diuretic hormone from the pituitary gland which reduces the amount of sodium and water retrieved from the collecting ducts of the kidney

65
Q

One advantage of sublingual route

A

drugs administed can bypass first pass metabolism optimising its bioavailability

they have a fast onset of action owing to the fact they are not influenced by tansit through the gi tract

66
Q

one disadvantage of sublingual route

A

need to have small molecular weight to be able to cross the epithelium meaning only a small number of drugs can take advantage of the route

67
Q

What is fast

A

fast
arm weakness
speach diffuculties
time to call 999

68
Q

what is fast used for

A

stroke

69
Q

what is the assessment criteria used for face and speech

A

can the person smile, has their mouth or eye dropped

speech is the individual able to speak normally

70
Q

how does low dose aspirin protect patients from CKD

A

blocks thromboxane A2 Production

71
Q

what beta blocker should be used in pregnent people

A

lebetalol

72
Q

give 4 examples of lipid lowering agents

A

simvastatin
ezetimibe
bezafibrate
nictotinic acid/vitamin b3

73
Q

how does simvastatin reduce lipid

A

inhibits the synthesis of cholesterol by inhibiting the hmg coA reductase inhbitor

74
Q

how does ezetimibe lower lipid

A

blocks the absorption of cholesterol from food and bile

75
Q

how do fibrates lower lipid

A

angonist that induce hepatic uptake and oxidation of cholesterol and tryglycerides

76
Q

how does vitamin b3 lower lipids

A

inhibits lipolysis in adipocyrtes and thus reduce lipid synthesis in the liver

77
Q

how does the activation of b1 receptors in the heart increase heart rate

A

beta 1 adrenergic receptor is a g protein coupled receptor (gas)

signalling Gas ATP -> cAMP via adenylyl cyclase -> increased activity at PKA

78
Q

where are beta 1 receptor located

A

heart

79
Q

if a patient has asthma what drugs can you give for the treatment of coronary events

A

nitrate
beta blocker or CCB
low dose aspirin
statin

80
Q

what is spironolactone

A

potassium sparing thiazide diuretic

81
Q

how does spironolactone work

A

cleaves small amounts of sodium from the distal convoluted tubule

leading to a lack of water being reabsorbed increasing the amount of urine passed.

82
Q

how does atenolol lower cardiac output

A

reduces heart rate by reducing sympathetic activity

reduces the cardiac force of contraction by reducing sympathetic activity

83
Q

what is first line management of a patient presenting with stroke <4 hours after the eventq

A

alteplase is a thrombolytic agent used to rescue the blood supply and reduce the impacts due ischaemia

84
Q

what are three surgical interventions to help with plaque in carotid artery

A

bypass
baloon angioplasty
stent

85
Q

what are two pharmacological interventions which could help reduce the risk of future stroke

A

anti coagulant

statins

86
Q

what three major interventions may help rehabilitate from stroke

A

speach
physi
occupational

87
Q

what are four non pharmacological interventions which could help reduce the risk of future stroke

A

moderate exercise
diet
stop smoking
moderate alcohol

88
Q

what are the similarities between COPD and Asthma

A 
Coughing
Shortness of breath
Chest tightness
exercise intolerance
wheezing
anxiety with increased heart rate may occur in both diseases
89
Q

what are the differences between asthma and COPD

A

asthma is reversible whereas copd is progressive

asthma can occur at any age wheras copd is usually >40

copd produces more mucus and phlegm compared to asthma

chronic cough common in copd

copd often have chronic blueness to fingernail bed and or lips

90
Q

what does mart stand for

A

maintenance and reliever therapy

91
Q

what is maintenance and reliever therapy

A

2 drugs given together in one inhaler

including a corticosteroid and fast acting or long acting beta 2 agonist

92
Q

what is an example of a inhaler that has 2 drugs within used for mart therapy

A

forstair contains beclometasone and or formoterol

93
Q

why would you use a ICS + LABA in asthama

A

benefit of using an ics and laba in combination without any increased side effects. Due to their complementary and synergistic effects.

94
Q

what is chiral switching

A

chiral switch occurs in the pharmaceutical market when a drug made up of 2 enantiomer forms is replaced with a purified single-enantiomer version

95
Q

how does salbutamol benefit from chiral switching

A

salbutamol is a beta 2 adrenergic receptor antagonist causing bronchial dilation

bronchodilator effect delivered by r abuterol which is 60x more potent than the pharmacodynamic effect.

96
Q

what are the advantages of chiral switching

A

An improved (less complex, more selective) pharmacodynamic profile

A higher therapeutic index (improved safety margin)

Less complex drug interactions and relationship between plasma concentration and effect

More rational therapeutic drug monitoring

Expose the patient to less body load and thus reduce metabolic/renal/hepatic drug loa

97
Q

explain the advantages of routine use of salbutamol for the managment of asthma vs adrenaline in relation to chemical structure

A

Adrenaline is not selective to beta2 receptor

the tertiary butyl (c-ch3-ch3-ch3) of salbutamol makes it selective for beta receptor compared to alpha

that means that adrenaline would lead to side-effects

Furthermore adrenaline has a short half-life

salbutamol has longer half-life because the change from catechol to primary alcohol

means it is no longer substrate for COMT and also increase selectivity for beta2

98
Q

Salbutamol is available as tablets, however it is commonly used as Metered-Dose Inhaler (MDI). Explain why.

A

o A Lower dose
o A faster onset of action
o Less side effects
o When compared to administering the same drug orally.

99
Q

Outline FOUR factors that need to be considered when discussing and deciding on a suitable nicotine replacement therapy (NRT) product

A

The decision should be patient centric
Considering the patients needs, tolerability and cost

If the patient has early morning cravings for a cigarette
A lozenge could be helpful

If the patient is pregnant
A 24 hour patch may be supportive

If the patient is willing to stop smoking immediately
A quick mist mouth spray may be helpful.

100
Q

what is a common side effect of salbutamol

A

can influence the b2 receptors found in skeletal muscle which leads to tremor

101
Q

what are two common side effect of ICS inhaled treatment (short term)

A

Oral thrush, if the patient does not wash their mouth out after each inhalation, this can lead to accumulation of the drug in the mouth which can make the patient susceptible to oral thrush.

Hoarse voice

102
Q

what are 3 longer term side effects of ics inhaled treatment

A

hypertension
osteoporosis
cushing syndrome

103
Q

how can we measuere airway inflamation

A

quantifying the fractional exhaled nitric oxide in the breath

as if there is an increase it may reflect the induction of nitric oxide synthase 2

that is found to be increased in airway epithelial cells of asthmatic patients with the presence of inflammation

104
Q

how can we test the function of the lungs

A

peak expiratory flow

105
Q

explain how we use peak expiratory flow

A

measure peak flow variability is typical of asthma

106
Q

why is lumacaftor given to cystic fibrosis patiients

A

improves symptoms and underlying disease pathology by aiding the conformational stability of F508 delta mutated CFTR proteins

preventing misfolding and resulting in increased processing and trafficking of mature protein to the cell surfarce

107
Q

If the patient is on ibuprofen and lanzoprazol, what would the recommendation be if he is dx with AKI

A

• Stop ibuprofen as it is nephrotoxic

108
Q

Which drugs would you use to manage hyperkalaemia

A

Insulin

salbutamol

109
Q

why would we use insulin in the treatment of hyperkalaemia

A

insulin shifts potassium into cells by stimulating the na+-h+ antiporter on cell membrane

promoting the entry of sodium into cells which leads to activation of the Na+ K+ atapase causing electrogenic influx of potassium

110
Q

why would we use salbutamol in the treatment of hyperkalaemia

A

rapidly reduces potassium levels by shifting potassium into smooth skeletal muscle cells

mediated by the beta 2 receptors and require the intervention of cAMP

joined at the cell membrane and the subsequent stimulation of the Na K ATPase

which bring the potassium into the striated muscle cells

111
Q

what are the four types or kidney stone

A

calcium oxolate stone

uric acid

cystine

infection stone

112
Q

what are the 4 non invasive treatment options to deal with a kidney stone

A

increase fluid intake
alpha adrenergic receptors
penicillamine
extracorporeal shock wave lithotripsy

113
Q

what is ureteroscope

A

small viewing telescope inserted into urethra and through the bladder to remove small stones in the lower part of the ureter

114
Q

what is percutaneous nephrolithotomy

A

small incision into the back and a probe is inserted through the nephroscope to break the stone into small pieces

Therapeutics (50 decks)

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