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Yr 3 - Pharmacology > Pharmacology 1 > Flashcards

Pharmacology 1 Flashcards

1
Q

What does ADME stand for?

A

Absorption, distribution, metabolism, excretion

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2
Q

What are the two principle ways in which drugs are excreted from the body?

A

1) Renal system
2) Biliary system

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3
Q

Give the class of each drug;

  • Atenolol
  • Bendroflumethiazide
  • Bumetanide
  • Diltiazem
  • Lansoprazole
  • Prednisolone
  • Ramipril
  • Salbutamol
  • Simvastatin
  • Warfarin
A
  • Atenolol → beta blocker (b2 antagonist)
  • Bendroflumethiazide → thiazide diuretic
  • Bumetanide → loop diuretic
  • Diltiazem → calcium channel blocker
  • Lansoprazole → PPI
  • Prednisolone → catabolic steroid
  • Ramipril → ACE inhibitor
  • Salbutamol → B2 agonist
  • Simvastatin → HMG co-reductase inhibitor
  • Warfarin → vitamin K antagonist
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4
Q

Which drug is the most likely to cause harm from the following;

  • Atenolol
  • Bendroflumethiazide
  • Bumetanide
  • Diltiazem
  • Lansoprazole
  • Prednisolone
  • Ramipril
  • Salbutamol
  • Simvastatin
  • Warfarin
A

Warfarin

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5
Q

What harm can warfarin cause?

A
  • Can cause coumarin induced skin necrosis; skin and subcutaneous tissue necrosis occur due to acquired protein C deficiency following treatment with vitamin K anticoagulants
  • Nosebleeds, bleeding gums, heavy periods, bruising
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6
Q

Which 2 drugs counteract each other from the following;

  • Atenolol
  • Bendroflumethiazide
  • Bumetanide
  • Diltiazem
  • Lansoprazole
  • Prednisolone
  • Ramipril
  • Salbutamol
  • Simvastatin
  • Warfarin
A

Atenolol and salbutamol

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7
Q

Which drug is the most associated with long-term side effects from the following;

  • Atenolol
  • Bendroflumethiazide
  • Bumetanide
  • Diltiazem
  • Lansoprazole
  • Prednisolone
  • Ramipril
  • Salbutamol
  • Simvastatin
  • Warfarin
A

Prednisolone

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8
Q

What are potential long-term side effects from prednisolone?

A

Osteoporosis, poorly controlled diabetes due to high blood sugar, glaucoma, skin thinning, slower wound healing

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9
Q

Which 3 drugs act on enzymatic pathways?

  • Atenolol
  • Bendroflumethiazide
  • Bumetanide
  • Diltiazem
  • Lansoprazole
  • Prednisolone
  • Ramipril
  • Salbutamol
  • Simvastatin
  • Warfarin
A
  • Warfarin (acts on enzyme associated with vit K production)
  • Ramipril (ACE inhibitor)
  • Simvastatin (HMG co-reductase inhibitor)
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10
Q

Which class of drugs is most commonly prescribed in the UK?

A

Statins

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11
Q

What is the mechanism of action of atenolol?

A

Blocks the release of catecholamines (stress hormones) adrenaline and noradrenaline at B1 adrenergic receptors in certain parts of the body

This decreases sympathetic activity of the heart → decreases conduction through the AV node

Also reduces renin secretion which blocks formation of angiotensin II

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12
Q

What are the principle effects of beta blockers (beta-adrenergic blockers)?

A
  • Slow heart rate
  • Reduce blood pressure (by reducing force at which blood is pumped around the body)
  • Cardioprotective (protects against recurrent heart attacks)
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13
Q

Some beta blockers are cardio-selective. What does this mean?

A

That their effects are predominantly on the heart, and they have little effect on beta-adrenergic receptors elsewhere in the body.

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14
Q

Some beta-blockers are non-cardio-selective. What side effects can this cause?

A

These also have an effect on adrenergic receptors in the lungs and peripheral circulation.

  • Can cause bronchoconstriction (dangerous in asthma).
  • Can cause constriction of peripheral circulation (dangerous in peripheral vascular disease)
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15
Q

Indications for beta-blockers?

A
  • Angina (the reduction in HR reduces the oxygen requirements for the heart)
  • Tachyarrhythmias e.g. fast AF (to slow the HR)
  • Hypertension
  • Beneficial effects in patients with heart failure
  • Complications of MI e.g. LV systolic dysfunction
  • Supraventricular tachycardias
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16
Q

Contraindications for beta blockers?

A
  • Patients with bradycardia
  • Patients with hypotension
  • Patients with diabetes (can mask hypoglycaemia signs)

In addition, non cardio-selective beta blockers are contraindicated in:

  • Patients with peripheral vascular disease → cause constriction of peripheral circulation
  • Patients with asthma → cause bronchial constriction
17
Q

Common side effects of atenolol?

A
  • GI upset: N&V, constipation, diarrhoea, abdominal pain
  • Dizziness, syncope, fatigue (bradycardia)
  • Cold fingers and toes
  • Rash → concern
18
Q

How often should atenolol be taken?

A

Daily

19
Q

Which side effects should cause a patient to call 999/seek medical help when taking atenolol?

A
  • Signs of allergic reaction: rash, wheezing, swelling of face/tongue etc
  • Signs of cardiac issues: SOB, chest pain, irregular heart beat, swollen ankles or legs
  • Signs of respiratory disease
20
Q

Describe appropriate treatment cessation of atenolol. Why is it important to not stop taking it suddenly?

A
  • Avoid abrupt withdrawal, especially in heart disease patients as may cause rebound worsening of myocardial ischaemia
  • Encourage gradual reduction
21
Q

What are the 3 major classes of diuretic medications?

A
  1. Loop
  2. Thiazide
  3. Potassium-sparing
22
Q

When would combination diuretic therapy be considered?

A

May be effective in patients with oedema resistant to treatment with one diuretics.

23
Q

Describe the mechanism of action of thiazide diuretics (e.g. bendroflumethiazide)

A

Inhibits the sodium/chloride cotransporter located in the distal convoluted tubule of a nephron. This inhibits sodium uptake so increases the excretion of sodium and water.

24
Q

What is the primary effect of diuretics?

A

Increase fluid excretion, ‘water tablets’

25
Q

What are the 2 major indications for thiazide diuretics?

A
  1. Oedema
  2. Hypertension
26
Q

Give some contraindications for thiazide diuretics

A
  • Addison’s disease (underactive adrenal glands)
  • Hyponatraemia, hypokalaemia
  • Hypercalcaemia
  • Symptomatic hyperuricaemia
  • Previous allergic reaction to drug
  • Liver problems
27
Q

What time of day is it ideal to take diuretics?

A

In the morning (taking in evening can cause needing to wee in night)

28
Q

Potential side effects of thiazide diuretics?

A
  • Needing to urinate more often
  • Dehydration (feeling thirsty with a dry mouth)
  • Mild stomach upset: pain, constipation, diarrhoea, N&V
  • Deranged electrolytes levels (hypokalaemia)
  • Hypovolaemia
  • Allergic reaction
29
Q

How are thiazide diuretics excreted?

A

Renally (be careful in renal failure patients)

30
Q

What type of diuretic is bumetanide?

A

Loop diuretic (think… furosemide)

31
Q

What are the 2 major indications for loop diuretics?

A
  1. Pulmonary oedema due to LVF and chronic heart failure (or CKD)
  2. Hypertension
32
Q

Which type of diuretic would be used to treat a pulmonary oedema 2ary to LVF and chronic heart failure?

A

Loop diuretics

33
Q

What is the mechanism of action of loop diuretics?

A
  • Inhibit the Na+/K+/2Cl co-transporter in the loop of Henle (in the kidney) which reduces the Na, Cl & K reabsorption
  • This leads to increased loss in the urine (water follows this so excess water is lost)
  • Less fluid remains in bloodstream (eases symptoms of oedema)
34
Q

Contraindications for loop diuretics (e.g. bumetanide)?

A
  • Anuria
  • Hypokalaemia/hyponatraemia
  • Hypotension
  • Allergic reaction to drug
  • Liver disease
35
Q

Common side effects of loop diuretics?

A
  • Urinating more frequently
  • Symptoms of dehydration: feeling thirsty and dry mouth
  • Weight loss (as body loses water)
  • Headaches
  • Confusion/dizziness
  • Muscle cramps/weakness
  • Electrolyte imbalance
  • Hypotension
36
Q

Serious side effects of loop diuretics?

A
  • Ringing in ears (tinnitus) or loss of hearing
  • Unexplained bruising or bleeding
37
Q

What time of day should patients take loop diuretics?

A

In morning (not after 4pm)

Yr 3 - Pharmacology (18 decks)

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