HD2 Drugs Flashcards
What drug would you use to manage miscarriage? MoA? [2]
misoprostol: cause the uterus to contract to expel the products of conception that are still there
Pre-eclampsia:
What drugs do you use to stabilise mothers BP? [2]
Which anti-hypertensives & anticonvulsants would you use for acute [2] and chronic treatment? [2]
- Acute treatment:
Labetalol – alpha and beta blocker / antagonist
Hydralazine - Chronic management
Methyldopa – alpha 2 agonist (feeds back and stops noradrenaline being released)
Nifedipine - CCB
Treatment of congenital toxoplasmosis? [3]
Give prophylactic in mother:
- Pyrimethamine
- sulfadiazine
- folinic acid
Treatment for HSV-2? [1]
Acyclovir
Why does giving treatment for group B Strep not work throughout pregnancy? [1]
When can you give? [1] What drug is used to treat? [1]
If treat during pregnancy it just returns lol
Give benzylpenicillin in labour / from week 36
Treatment for UTIs? [3]
Treatment
* Penicillin’s
* Cephalosporins
* Nitrofurantoin
How can you treat BPE? [6]
α1-adrenergic blockers
* Relaxes smooth muscle in bladder neck and prostate improving urine flow rate
5-α-reductase inhibitors
* 2 isoforms type I and type II (type II predominant prostatic reductase) blocks the formation of DHT.
Dutasteride
Finasteride
Combinations
Surgery
* Open prostatectomy (for very large prostates, >75g)
* UroLift
Laser ablation
Transurehral microwave
High energy ultrasound therapy
Which drugs would you use to treat erectile dysfunction? [3]
Sildenafil (viagra) a PDE-5 inhibitor
Vardenafil (levitra), Tadalafil (cialis) also PDE-5 inhibitors
How do ED treatments work? [2]
- Sildenafil inhibits the action of phosphodiesterase (PDE) type 5,
- increasing the intracellular concentration of cGMP.
What is Peyronie’s disease? [1]
What is it caused by? [1]
What are treatment options? [2]
Peyronie’s disease = Bent Penis
Caused by: scar tissue forming in the shaft of the penis. Painful erections!
Treatment:
Surgical
Non-surgical:
* stretching
* topical verapamil (calcium channel blocker),
* Para-aminobenzoate (type of B vitamin: increase o2 to tissues to reduce scar tissue forming)
You have been asked to take a history from a patient in a breast clinic at the hospital. You clerk a 74-year-old woman, who had a left-sided mastectomy for invasive ductal carcinoma 2 years ago; she has now presented for follow-up. From your history, you elicit that she has had no symptoms of recurrence, and is still currently taking an aromatase inhibitor called letrozole, due to the findings of immunohistochemistry when the biopsy was taken.
What is the mechanism of action of this drug?
Inhibition of the conversion of testosterone to oestradiol
Modulation of the effect of oestrogen on the breast
Negative feedback on the HPO axis
Specific binding to HER2 receptors
Modulation of the effect of progestogen on the breast
You have been asked to take a history from a patient in a breast clinic at the hospital. You clerk a 74-year-old woman, who had a left-sided mastectomy for invasive ductal carcinoma 2 years ago; she has now presented for follow-up. From your history, you elicit that she has had no symptoms of recurrence, and is still currently taking an aromatase inhibitor called letrozole, due to the findings of immunohistochemistry when the biopsy was taken.
What is the mechanism of action of this drug?
Inhibition of the conversion of testosterone to oestradiol
Modulation of the effect of oestrogen on the breast
Negative feedback on the HPO axis
Specific binding to HER2 receptors
Modulation of the effect of progestogen on the breast
What are treatments for Chlamdydia trachomatis? [2]
Treatment
* Azithromycin
* Doxycycline
How do you treat Neisseria gonorrhoea? [1]
Ceftriaxone
What are the treatment options for genital warts / HPV? [3]
Topical podophyllotoxin
imiquimod
Cryotherapy
Which stages of HIV lifecycle to HAART target / what are the drug types? [5]
Protease Inhibitors (PIs)
Integrase Inhibitors (IIs)
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Entry Inhibitors (EIs; fusion inhibitors, CCR5 antagonist)
How can you treat blood coagulation protein / platelet defects causing repeated miscarriages? [1]
aspirin
Management of miscarriage?
- medical [1]
- surgical [1]
- for rhesus negative women [1]
Medical:
* misoprostol - cause the uterus to contract to expel the products of conception that are still there
Surgical:
* Surgical aspiration - gentle suction to remove the pregnancy
* Curettage (spoon-shaped instrument) to remove abnormal tissues.
Anti D to rhesus negative women
What drug class are given to mother of baby with placenta praevia? [1] Why? [1]
Corticosteroids are given between 34 and 35 + 6 weeks gestation to mature the fetal lungs, given the risk of preterm delivery.
Treatment of placenta accreta / increta / percreta? [3]
Treatment:
* Emergency Caesarean plus hysterectomy
* Methotrexate
* Close pelvic vessels
Expain MoA of Methotrexate [1]
Methotrexate is highly teratogenic (harmful to pregnancy). It is given as an intramuscular injection into a buttock. This halts the progress of the pregnancy and results in spontaneous termination.
Name and explain the MoA of the anti-emetics you would use to treat hyperemesis gravidarum [4]
Prochlorperazine (stemetil)
Cyclizine: histamine H1 receptor antagonist
Ondansetron: Blocks 5HT-3 in chemical trigger zone/vomiting centre
Metoclopramide: Blocks D2 in chemical trigger zone/vomiting centre
Vitamin B6
Diagnosis [2] and treatment of congenital toxoplasmosis? [3]
Diagnosis: PCR of amniotic fluid / maternal serology
Give prophylactic in mother:
- Pyrimethamine
- sulfadiazine
- folinic acid
Treatment for HSV-2? [1]
Prognosis if left untreated in baby? [1]
Acyclovir
65% chance of mortality if left untreated !
Why does giving treatment for group B Strep not work throughout pregnancy? [1]
When can you give? [1] What drug is used to treat? [1]
If treat during pregnancy it just returns lol
Give benzylpenicillin in labour / from week 36
Treatment for UTIs? [3]
Which drug do you use for active managment of 3rd stage of labour? [1]
Oxytocin [1]
How do you manage failure to progress:
- Initially? [1]
- If continued? [4]
- If still continued? [2]
How do you manage failure to progress:
- Initially: relax and wait
- If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
- If still not delivered: membrane sweep or c section
Q
20% of deliveries need induction. Which drugs can you use to do this? [4]
Oxytocin
misoprostal
mifepristone
oestrogen pessary
A 44-year-old woman who has just discovered that she is pregnant comes to see you about her hypertension. She reports that she has suffered from chronic hypertension for the past year and is currently taking ramipril. She does not suffer from any other medical problems. Her blood pressure today is 160/90mmHg. She would like your advice of hypertensive treatment in pregnancy.
Which one of the following should you advise?
Continue ramipril and start propranolol
Discontinue ramipril and start labetalol
Discontinue ramipril and start methyldopa
Continue ramipril
Continue ramipril and start labetalol
A 44-year-old woman who has just discovered that she is pregnant comes to see you about her hypertension. She reports that she has suffered from chronic hypertension for the past year and is currently taking ramipril. She does not suffer from any other medical problems. Her blood pressure today is 160/90mmHg. She would like your advice of hypertensive treatment in pregnancy.
Which one of the following should you advise?
Continue ramipril and start propranolol
Discontinue ramipril and start labetalol
Discontinue ramipril and start methyldopa
Continue ramipril
Continue ramipril and start labetalol
Name the drugs used for Tocolysis (a temporary stoppage of contractions that can delay preterm labour) [5]
nifedipine (calcium antagonist)
atosiban: oxytocin receptor antagonists
indomethacine NSAID: inhibitors of prostaglandin synthesis
nitroglycerine: NO donors, Betamimetics (sympathetic beta agonsists)
magnesium sulphate
[] is used first-line to stimulate uterine contractions during labour [1]
The aim is for [] contractions per 10 minutes.[1]
Oxytocin is used first-line to stimulate uterine contractions during labour [1]
The aim is for 4 – 5 contractions per 10 minutes.
Which drugs are used to treat PPH? [5]
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
The treatment/management of secondary PPH is usually []? [1]
The treatment/management of secondary PPH is usually broad spectrum IV antibiotics, and 90% of cases will improve within 48-72 hours of the antibiotics.
Q
Treatment of Primary PPH?
- Massage? [1]
- Drugs? [2]
- Surgery? [4]
Massage:
* Bimanual uterine massage and compression (one hand in vagina, pushing agaisnt the body of the uterus & the other hand compresses fundus from abdomen. Causes the uterus to contract)
Drugs: causes myometrium to contract – normal functioning
* Oxytocin agents
* prostaglandins
Surgery:
* suture tears:
Bakri balloon: takes up 300ml of saline and is placed in the uterus, completely clear of the internal cervical os. Assisted by uterotonics, the balloon in the uterus will be hugged by the contracting uterus and drain blood out.
B-lynch:hold uterus tight via stitching from anterior - posterior surface. Maintains compression
uterine artery embolisation:: femoral artery –> internal iliac -> uterine artery: close artery
Future treatment for Secondary PPM? [1]
Tranexamic acid
Explain MoA of Tranexamic acid for PPH
Analogue of lysine
Binds to plasminogen and stops conversion of plasmin: causes bigger clots to form
Treatment for thromboembolic disease in post-partum mother? [1]
Heparin (does not cross into breast milk)
What drug class are the first line of pharmalogical therapy for post natal depression? [1]
Give two examples
Selective serotonin reuptake inhibitors (SSRIs): sertraline, citalopram