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
Tocolysis drugs:
which of the following is an inhibitor of prostaglandin synthesis?
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Tocolysis drugs:
which of the following is an inhibitor of prostaglandin synthesis?
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Tocolysis drugs:
which of the following is an oxytocin inhibitor?
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Tocolysis drugs:
which of the following is an oxytocin inhibitor?
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Tocolytic drugs:
which of the following is a myosin light chain inhibitor
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Tocolytic drugs:
which of the following is a myosin light chain inhibitor
nifedipine
atosiban
indomethacine
nitroglycerine NO donor
Betamimetics (sympathetic beta agonsists)
magnesium sulphate
Name a prostaglandin analogue that stimulates uterine contraction for the treatment of PPH [1]
Carboprost
Name a drug that stimulates smooth muscle contraction but is contraindicated in hypertension, for the treatment of PPH [1]
Ergometrine
Name a drug for PPH that is an antifibrinolytic that reduces bleeding [1]
Tranexamic acid (intravenous)
Which anxiolytics may be recommended as an adjunctive treatment for PPD? [2]
Explain MoA [1]
Lorazepam and clonazepam
GABA benzodiazepines (enhances GABA activity)
A
allopregnanlone (a progesterone metabolite)
Modulates synaptic GABA-receptors and extrasynaptic GABA-A receptors: (GABA is an inhibitory receptor)
Allows GABA that binds to receptor to have a bigger effect on the GABA receptor Makes patients feel open and feeling of relaxtion
Which type of antidepressant drugs are useful in women with sleep disturbance? [1]
Tricyclic antidepressants (TCAs)
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which type of antidepressant drugs are useful in women with sleep disturbance?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an SNRI?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an TCA?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following is an TCA?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following does not cause nausea in mother?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following does not cause nausea in mother?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
How do you treat postnatal psychosis? [3]
Mood stabilizer: (lithium, valproic acid and carbamazepine)
In combination with antipsychotic medications and benzodiazepines
electroconvulsive therapy is well tolerated and rapidly effective
Which mood stabilisers would give for postnatal psychosis? [3]
- lithium
- valproic acid
- carbamazepine
Which drugs prescribed should women avoid breastfeeding (and why) [3]
valproic acid and carbamazepine should avoid breastfeeding
Linked to hepatotoxicity in the infant
Why should you monitor affect of mood stabiliser lithium? [2]
Can be toxic and if breastfeed monitor levels of lithium and thyroid function
Explain how anti-psyc. drugs can lead to hyperprolactinemia
Anti-psychotic drugs work by inhibiting dopamine release
Dopamine inhibits prolactin release: reduced dopamine causes hyperprolactinemia (increased breast milk - can cause pain)
How do SSRIs influence ALLO levels? [1]
SSRIs may enhance sensitivity of GABAA or promote formation of more ALLO
Why does giving cortiosteroids to neonate decrease impact of respiratory distress syndrome? [1]
Stimulates type 2 pneumocytes to develop quicker and produce surfactant
Treatment of necrotising enterocolitis? [3]
A
Stop oral feeding
Broad spectrum antibiotics covering both aerobic and anaerobic species
Surgery to remove perforated sections
What is the first line treatment for osteoporosis? [1]
Bisphosphonates are the first-line treatment for osteoporosis. They work by interfering with osteoclasts and reducing their activity, preventing the reabsorption of bone. There are a few key side effects to remember:
What type of drug is Tamsulosin? [1]
Describe the MoA for aiding micturition [1]
Tamsulosin:
* α1a blocker
* prevent sympathetic drive to internal urethral sphincter (maintains tonic contractions of the internal urethral muscle): therefore causes it to relax and urine to escape
What type of drug is Oxybutynin? [1]
Describe the MoA [1]
Oxybutynin:
* Muscarinic antagonist / anti-cholinergic drug
* Blocks M3 muscarinic receptors to prevent over excitation of the bladder
What type of drug is Bethanecol? [1]
Describe the MoA [1]
Bethanecol:
* Muscarinic agonist /
* Agonises M3 muscarinic receptors to cause over excitation of the bladder - causes it to leave
Which of the following is anti-cholinergic?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Which of the following is anti-cholinergic?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Which of the following is pro-cholinergic?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Which of the following is pro-cholinergic?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Which of the following are α-adrenergic antagonists?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Which of the following are α-adrenergic antagonists?
Oxybutynin
Tamsulosin
Prazosin
Bethanecol
Name an anti-manic drug [1]
Lithium
Name two drugs that Increase 5HT concentration by blocking serotonin reuptake [2]
Fluoxetine (Prozac), Sertraline, Paroxetine
Citalopram
Describe MoA of Ergometrine [1]
What does this treat? [1]
Causes massive vasoconstriction to reduce heavy bleeding of the placenta
Stops PPH
[] is a 5α-reductase inhibitor to prevent testosterone turning into dihydrotestosterone which is much more potent
Finasteride is a 5α-reductase inhibitor to prevent testosterone turning into dihydrotestosterone which is much more potent
Which is the most common approach for surgical treatment of BPE? [1]
TURP (Transurethral resection of the prostate) is most used or transanal approach
Which drug used to treat most herpes & CMV? [1]
Acyclovir
Prostate treatment:
[] is an anti-androgen drug to prevent androgenic growth
Cyproterone acetate is an anti-androgen drug to prevent androgenic growth
Name two drugs prescribed for ADHD [2]
Methylphenidate
Lisdexamfetamine
Name a prostaglandin E2 analog that induces contraction of the myometrium [1]
Carboprost
Which drug induces uterine contraction? [1]
oxytocin
Which of the following drug induces labour by causing the cervix to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Which of the following drug induces labour by causing the cervix to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Name a prostaglandin E1 analog that Increase force of cervical contractions [1]
Misoprostol
How does ergometrine stop PPH? [1]
causes vasoconstriction
Which of the following drug induces labour by causing the myometrium to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Which of the following drug induces labour by causing the myometrium to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Which of the following drug induces labour by causing the uterus to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Which of the following drug induces labour by causing the uterus to contract?
Oxytocin
Misoprostol
Carboprost
Mifepristone
Name a drug used after surgery to treat a complete molar pregnancy [1]
Methotrexate
Which treatment for genital warts inhibits topoisomerase II
Podophyllotoxin
Which antibiotic inhibits bacterial wall synthesis, which prevents peptidoglycan cross linking?
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic inhibits bacterial wall synthesis, which prevents peptidoglycan cross linking?
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin (type of beta lactam drug)
Which antibiotic inhibits inhibit cell wall formation, D-ala bond formation & thus transglycosylation which prevents peptidoglycan cross linking to treat chlamydia
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic inhibits inhibit cell wall formation, D-ala bond formation & thus transglycosylation which prevents peptidoglycan cross linking to treat chlamydia
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic inhibits bacterial growth to treat chlamydia
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic inhibits bacterial growth to treat chlamydia
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic can be used to treat malaria?
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic can be used to treat malaria?
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic can be used to treat N. Gonnorrhoea
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antibiotic can be used to treat N. Gonnorrhoea
Azithromycin
Doxycycline
Ceftriaxone
Benzylpenicillin
Which antivirals can be used to treat CMV? [2]
Ganciclovir
Valganciclovir
What is the first line treatment for HSV? [1]
Acyclovir
