Medications Flashcards
1
Q
True or False: NSAIDs primarily inhibit the production of prostaglandins.
A
True
2
Q
Which enzyme do NSAIDs inhibit to reduce inflammation?
A
Cyclooxygenase (COX)
3
Q
What are two common side effects of NSAIDs?
A
Gastrointestinal issues and increased risk of bleeding
4
Q
What are the two main types of cyclooxygenase enzymes that NSAIDs inhibit?
A
COX-1 and COX-2
5
Q
Short Answer: What is a serious risk associated with long-term use of NSAIDs?
A
Kidney damage
6
Q
3 examples of an endogenous opioids?
A
Endorphins, Enkephalins and Dynorphins.
7
Q
What are common side effects of opioid use?
A
Common side effects include bradycardia, constipation, sedation, nausea, and respiratory depression.
8
Q
Fill in the blank: The withdrawal symptoms of opioids can include ______.
A
anxiety, muscle aches, insomnia, tachycardia and diarrhea.
9
Q
What is the role of naloxone in opioid treatment?
A
Naloxone is an opioid antagonist used to reverse opioid overdoses.
10
Q
Name one synthetic opioid.
A
Oxycodone is a synthetic opioid.
11
Q
True or False: Codeine is a prodrug that is metabolized to morphine.
A
True
12
Q
What are the potential consequences of long-term opioid use?
A
Long-term opioid use can lead to tolerance, physical dependence, and addiction.
13
Q
Which opioid is commonly prescribed for chronic pain and is available in extended-release formulations?
A
Oxycodone is commonly prescribed for chronic pain.
14
Q
Which opioid is derived from the opium poppy and is often used in palliative care?
A
Morphine is derived from the opium poppy and used in palliative care.
15
Q
Fill in the blank: The primary receptor types that opioids bind to are ______ receptors.
A
mu, delta, and kappa
16
Q
What is the primary risk associated with opioid overdose? What what is the stage of general anaesthia caused by overdose
A
The primary risk is respiratory depression, which can lead to death.
Medullary depression
17
Q
What do does the binding of opioids to its receptors do specifically that influences dopamine and where
A
Opioids decreases GABA which increases dopamine production in the nucleus accumbens leading to addiction
18
Q
What do endogenous opioids do (enkephalins, endorphins and Synoptics)
A
Block Ca influx in pre-synaptic neurons which decreases glutamate,
Works on K channels on post-synaptic neuron to increase K efflux leading to hyper polarization and decreased action potential signal
19
Q
True or false: endogenous and exogenous opioids have the same MoA
A
True
20
Q
What is the primary purpose of anaesthesia?
A
To induce a state of controlled, temporary loss of sensation or awareness for surgical or medical procedures.
21
Q
What are the two main types of anaesthesia?
A
Local anaesthesia and general anaesthesia.
22
Q
Give an example of a local anaesthetic.
A
Lidocaine.
23
Q
What is the mechanism of action (MOA) of local anaesthetics like lidocaine?
A
They block sodium channels, preventing the propagation of nerve impulses.
24
Q
What is a common intravenous (IV) anesthetic agent?
A
Propofol.
25
What is the MOA of propofol?
It enhances the activity of GABA at the GABA-A receptor, leading to sedation.
26
List 3 inhaled anesthetic agents.
Isoflurane, Nitrous Oxide and Halothane
27
What is the primary effect of inhaled anesthetics?
They depress the central nervous system, leading to loss of consciousness and sensation.
28
Fill in the blank: The use of __________ is essential for maintaining anaesthesia during surgery.
monitoring equipment.
29
True or False: Local anaesthetics can be used for both surgical and diagnostic procedures.
True.
30
What does MAC stand for in the context of anaesthesia?
Minimum Alveolar Concentration.
31
What does MAC indicate?
The concentration of inhaled anesthetic at which 50% of patients do not respond to surgical stimulation.
32
Why is MAC important
Shows how potent a anaesthetic is
33
How does ketamine work
Blocks NMDA receptors (which is what glutamate binds to)
34
What is sodium valproate and what does it do
Antiepileptic, blocks Na and T-type calcium channels
And
Inhibits GABA-T which breaks down GABA
35
What is the drug used for generalized tonic-clonic seizures and its mechanism of action?
Phenytoin; it stabilizes neuronal membranes and decreases excitability by blocking sodium channels.
36
Which medication is used for absence seizures and what is its mechanism of action?
Ethosuximide; it inhibits T-type calcium channels in the thalamus.
37
What is the drug used for partial seizures and its mechanism of action?
Carbamazepine; it stabilizes the inactive state of sodium channels, decreasing neuronal firing.
38
True or False: Valproate is used for both generalized and partial seizures.
True; it increases GABA levels and inhibits sodium channels.
39
What is the drug used for myoclonic seizures and its mechanism of action?
Levetiracetam; it modulates synaptic neurotransmitter release through binding to SV2A.
40
First line treatment for status epilepticus.
Benzodiazepines (e.g., Lorazepam or Diazepam); they enhance GABA-A receptor activity.
41
What is the mechanism of action of Lamotrigine? And what type of drug is it
It inhibits sodium channels and decreases glutamate release.
Anti-epileptic
42
Which anti-epileptic drug is known for causing weight gain?
Valproate; it also increases GABA levels.
43
True or False: Topiramate is used for migraine prevention as well as for seizures.
True; it blocks sodium channels and enhances GABA activity.
44
What type of drug is gabapentin and what is the mechanism of action of Gabapentin? And what can it also be used for
Anti-epileptic
It inhibits high-voltage activated calcium channels and modulates GABA release.
Neuropathic pain
45
Fill in the blank: __________ is a broad-spectrum anti-epileptic drug.
Valproate; it is effective against multiple seizure types.
46
Which medication is used for seizures in pregnant women and its mechanism of action?
Lamotrigine; it stabilizes sodium channels and inhibits glutamate release.
47
Which anti-epileptic drug is associated with hypersensitivity reactions?
Carbamazepine; it can cause Stevens-Johnson syndrome.
48
What is the drug used for seizure control in patients with hepatic impairment?
Levetiracetam; it is renally cleared and has minimal liver metabolism.
49
Second line drug used for status epilepticus and can cause gingival hyperplasia
Phenytoin
50
Treatment for ambylopia
Encourage use of affected eye via occlusion therapy and if refractive ambylopia use a corrective lens, if strabismic ambylopia u can use surgery to align eyes
51
Treatment for exacerbation of MS
Methylprednisolone (corticosteroid to reduce inflammation)
52
Treatment for relapsing-remitting MS that mimics/resembles myelin basic protein
Glatiramer acetate
53
Interferon beta and what condition it’s used for
Drug for MS which is a cytokine that helps produce inflammatory cytokines
54
The two biologics (monoclonal antibodies) used to treat MS
Natalizumab and Ocrelizumab
55
What receptors do first generation antipsychotics target (typical)
D2 receptor antagonist and anti HAM (histamine-1, alpha-1 and muscarinic-1 receptor antagonists)
56
Haloperidol
First gen antipsychotic and high potency
57
Prochlorperazine
High potency first gen antipsychotic
58
Fluphenazine
First gen high potency antipsychotic
59
Trifluoperazine
First gen high potency anti psychotic
60
Chloropromazine
First gen low potency antipsychotic
61
Thioridazine
First gen antipsychotic low potency
62
Side effects of first gen antipsychotics
Weigh gain and sedation (histamine), orthostatic hypotension (alpha), dry mouth, blurry vision and constipation and difficulty urinating (muscarinic) and can cause extrapyramidal symptoms
63
How do second gen antipsychotics work and why are they better
Blocks D2 receptor and serotonin 2a (5HT-2a) receptor which brings back some dopamine leading it to cause less extrapyramidal symptoms and HAM receptors
64
What’s the suffix for first gen antipsychotic except for haloperidol
-azine
65
What’s special about the binding of second gen antipsychotics
They have transient binding meaning they bind then dissociate quickly
66
Clozapine and its major side effect and what it’s used to treat
Clozapine is a 2nd gen antipsychotic that’s used to treat resistant schizophrenia but can cause agranulocytosis (potentially life threatening drop of white blood cell)
67
What does the blocking of serotonin 2c by 1st gen antipsychotics do
Can lead to metabolic side effects such as increased weight, hyperglycemia, dyslipidaemia (problem for MI and stroke patients)
68
Risperidone
2nd gen antipsychotic
69
Olanzapine
2nd gen antipsychotic
70
Aripiprazole
2nd gen anti psychotic
71
Quetiapine
2nd gen anti psychotic
72
Treatment for dystonia and Parkinsonism
Anticholinergic medication, it does this by restoring balance between dopamine and acetylcholine in basal ganglia
73
Treatment for mania and hypomania
Antipsychotics like Haloperidol etc
Lithium, (mood stabilizer)
And antiepileptics like valproate, carbamazepine.
74
Clopidogrel
Antiplaletlet
75
Apixaban
Anticoagulant (Xa inhibitor)
76
What drug is used for a-fib patients as secondary prevention of a stroke
Warfarin
77
Alteplase and how it works
Binds to fibrin in clot then activates plasminogen which forms plasmin which breaks down fibrin, breaking the clot
78
Contraindications for thrombolysis
Convulsion accompanying stroke, hyperglycemia, hypoglycemia, stroke within last 3 months, heart infections (pericarditis or bacterial endocarditis) recent surgery or trauma, severe hypertension, acute pancreatis and onset after 4.5 hours
79
Thrombolysis side effects
Anaphylactic shock, angina pectoris, cardiac arrest, cardiogenic shock, CNS harmorrhaging, fever, heart failure, hypotension
80
Thrombectomy types
Catheter aspiration or mechanical
81
Two ways to deal with popped aneurysm
Aneurysm-clipping
Endovascular coiling
82
What is usually given with local anaesthecis and why
Noradrenaline because it causes vasoconstriction of nearby blood vessels keeping the local drug in its place
83
What do SSRI’s block? And why
SERT (serotonin transporter) to prevent the reuptake of serotonin in the synaptic cleft
84
What anti depressive are better tolerated and are safer in overdose
SSRIs
85
Sertraline
Anti depressant (SSRI)
86
Citalopram
Anti depressant (SSRI)
87
Escitalopram
Anti depressant (SSRI)
88
Fluoxetine
Anti depressant (SSRI)
89
Paroxetine
Anti depressant (SSRI)
90
What antidepressant has a helpful anti-anxiety effect and one of the safest for people with heart disease
Sertraline
91
What antidepressant can prolong QT interval and what condition can it lead to
Citalopram can lead to torsades de pointes
92
First-line antidepressant for children and adolescents
Fluoxetine
93
Side effects of SSRI
GI symptoms, headaches, sexual dysfunction, hyponatraemia (all antidepressant usually), increased risk of bleeding, insomnia, anxiety and agitation
94
How does SNRIs work
Block SERT and NAT (serotonin and noradrenaline transporter)
95
Venlafaxine
Antidepressant (SNRI)
96
Duloxetine
Anti depressant (SNRI)
97
What SNRI can also be used to treat neuropathic pain particularly diabetic neuropathy
Duloxetine
98
What SNRI has increased risk of death when overdosed and often used if there inadequate response to other antidepressants
Venlafaxine
99
What is serotonin synthesized from
Tryptophan
100
What is noradrenaline synthesized from
Tyrosine
101
What do tricyclics do
Block both SERT and NAT but also work on HAM receptors unlike SSRIs and SNRIs
102
Amitriptyline
Tricyclic antidepressant
103
Nortriptyline
Tricyclic antidepressants
104
Imipramine
Tricyclic antidepressants
105
Lofepramine
Tricyclic antidepressants
106
What tricyclics are used to treat neuropathic pain and in what dose
Amitriptyline and nortriptyline in low doses for neuropathic pain and higher doses for mood disorders
107
Side effects of tricyclic antidepressants
Causes HAM side effects but also heart problems like arrhythmias, tachycardia, prolonged qt interval and bundle branch block (they block Na channels in the heart)
108
How do monoamine oxidase inhibitors work (MAOi)
Monoamine oxidase (MAO) breaks down monoamine like serotonin, noradrenaline and dopamine, MAOi irreversibly blocks MAO
109
Main side effect of monoamine oxidase inhibitors and why
MAO is also found in the gut where it breaks down tyramine in the food, tyramine stimulates release of adrenaline so if MAO is blocked in stomach you have increased dopamine it can lead to a hypertensive crisis
110
Isocarboxazid
MAOi antidepressant
111
Moclobemide
MAOi antidepressant
112
Phenelzine
MAOi antidepressant
113
What foods are high in tyramine
Cheese, yeast, alcohol and avocado etc
114
What antidepressant must not be cross tapered and has to have a washout period and what is its washout period
MAOi antidepressant (7-14 days)
115
Main example of atypical antidepressant
Mirtazapine
116
Mirtazapine
Atypical antidepressant
117
How does Mirtazapine work
Blocks presynapyic alpha 2 receptors which leads to NA and SE release no longer being inhibited so increased NA and SE
118
Side effects of Mirtazapine and who is it given to usually
Can cause sedation and increased appetite, usually given to elderly patient and patients that can benefit from sedation and increased appetite
119
How long do you wait before switching antidepressant
4 weeks (6 for elderly)
120
What do you do to antidepressants after symptoms stop
Continue for 6 months (12 for elderly or GAD patients)
121
What to do at the start when first giving antidepressants
Review and monitor patient for first 1-2 weeks as symptoms might initially feel worse
122
Should you stop antidepressants suddenly
No, dose must be reduced slowly over atleast 4 weeks
123
Treatment for GAD
Usually SSRI and/or CBT, can also give tricyclic AD, Mirtazapine (atypical AD) and benzodiazepines like diazepam
124
How many sessions of CBT over how long is recommended by NICE for GAD
12-15 one hour long sessions over 4 months
125
Levadopa
Precursor to dopamine given for Parkinson’s
126
Why can’t you give just dopamine for Parkinson’s
Dopamine doesn’t cross blood brain barrier
127
What breaks down levadopa peripherally
Dopa decarboxylase
128
Carbidopa
Dopa decarboxylase inhibitor
129
Why is carbidopa given with levadopa
Levodopa is a precursor to dopamine that can cross the blood brain barrier but levodopa gets broken down peripherally by dopa decarboxylase however carbidopa inhibits that action meaning levadopa can safely cross into the brain
130
Pramipexole
Dopamine agonist used for Parkinson’s
131
Ropinirole
Dopamine agonist used for Parkinson’s
132
What do MAOB and COMT proteins do
They break down dopamine into other substances (like 3-OMD, 3-MT, HVA and L-DOPAC), we don’t want this
133
Selegiline
MAO-B inhibitor for Parkinson’s
134
Apomorphine
Dopamine agonist for Parkinson’s
135
Rasagiline
MAO-B inhibitor for Parkinson’s
136
What do COMT inhibitors remind you of
Al “Capone” they end with “-Capone” and they destroy dopamine, Al Capone destroyed lives with cocaine which messes with dopamine
137
Entacapone
COMT inhibitor for Parkinson’s (works outside BBB
Entacapone sound like “you’re Capone” in Arabic
138
Opicapone
COMT inhibitor for Parkinson’s (works outside BBB)
139
Tolcapone
COMT inhibitor for Parkinson’s (works inside brain) (past BBB)
140
What side effect can dopamine agonists cause
Impulse control disorders
141
None pharmacological treatment for Parkinson’s
Deep brain stimulation
142
How does huntington disease affect GABA, Acetylcholine and dopamine
Decreased GABA and Ach but increased dopamine
143
What can be gives for huntington disease patients to help with anxiety and muscle spasms
Benzodiazepines (especially since HD causes decreased GABA)
144
What drug can be given for memory and attention problems in Alzheimer’s
Cholinesterase inhibitors
145
Donepezil
Cholinesterase inhibitor for Alzheimer’s and Lewy body dementia
146
Rivastigmine
Cholinesterase inhibitor for Alzheimer’s, Parkinson’s dementia and Lewy body dementia
147
Galantamine
Cholinesterase inhibitor for Alzheimer’s and Lewy body dementia
148
Treatment for lewy-body dementia
- Levadopa
- Cholinesterase inhibitor
- Antidepressants like SSRIs
- Antipsychotics (eh)
149
Is glycine an inhibitory or excitatory neurotransmitter
Inhibitory
150
What’s used to treat rheumatoid arthritis
DMARDs (disease modifying anti-rheumatic medications), biologics
And
For flare ups: NSAIDs and short term glucocorticoids like methylprednisolone
151
Methotrexate
DMARD used for rheumatoid arthritis
152
Leflunomid
DMARD used for rheumatoid arthritis
153
Sulfasalazine
DMARD for rheumatoid arthritis
154
How do DMARDS work
They suppress inflammation by decreasing amount of inflammatory cytokines like TNF-alpha, IL-1 beta and IL-6 as well as having anti-inflammatory effects in joints
155
Abatacept
Biologic used for rheumatoid arthritis to suppress T-cells
156
Rituximab
Biologic used in Rheumatoid arthritis to suppress B-cells
157
Tell me more about methotrexate, it’s MoA and what it’s main contraindication
It’s a DMARD used to treat rheumatoid arthritis, it’s specifically an antimetabolite that inhibits dihydrofolate reductase which is an enzyme essential for synthesis of purines and pyramidines and so messes with DNA and RNA synthesis. This is useful because immune cells need these process to proliferate so it ultimately leads to immunosuppression. Its main contraindication is pregnancy, it’s teratogenic (harmful to pregnancy)
158
Non-pharmacological treatment for Rheumatoid arthritis
- Physiotherapy - (moving joints make it feel better)
- Occupational therapy - aids, splints, long-handled spoons etc to help with daily living
159
Lithium cause kidney problems?
Yes
160
Flumazenil
Benzodiazepines antagonist
161
Infliximab
A DMARD that inhibits TNF-alpha
162
Baricitinib
Inhibits Janus kinase (JAK) enzyme which blocks pro-inflammatory cytokine signaling but has increased risk of thromobosis and infections
163
What medications can cause neural tube defects
Valproic acid (Depakote)
Carbamazepine
Phenytoin
Phenobarbital
Methotrexate
Trimethoprim
Lithium
Isotretinoin (Retinoic acid derivatives)
