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MRCP > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Celecoxib MOA

Indications

A

Cox-2 inhibitor

less UGI SE compared to Naproxen (inhibits Cox-1 and 2)

OA, RA, AS

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2
Q

How does Celecoxib differ from other NSAIDs?

A

Celecoxib = Cox-2 inhibitor

NSAIDs e.g. Naproxen inhibit Cox-1 and 2

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3
Q

Cox -1 inhibition affects

A

COX-1 affects platelet aggregation -> beneficial cardiovascular effects.

However platelet aggregation not affected by COX-2

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4
Q

Ivabradine

MOA?

Use?

A

Blocks If channel in SAN -> reduced HR

Novel anti-anginal
second line to CCBs e.g. diltiazem and verapamil

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5
Q

Flecainide MOA

Indication

A

Sodium channel blocker

Anti-arrhythmic used for tachyarrhythmias e.g. AF

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6
Q

Doxazocin

MOA

Uses

A

Alpha blocker

Tx HTN, also used for LUTs Sx

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7
Q

Spironolactone SE

A

Gynaecomastia

Inhibits enzymes in testosterone synthesis pathway, and blocks receptor binding of testosterone. Also displaces oestradiol from SHBG so increases free oestrogen levels

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8
Q

SE bisphosphonates

pamidronate /zolendronic acid

A

Jaw osteonecrosis.

Due to anti-resorptive action of the nitrogen containing bisphosphonates.

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9
Q

SE Lithium

A

Diabetes insipidus

Hypercalcaemia

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10
Q

Clarithromycin increases concentration/ AUC and risk of toxicity of which COPD drug

A

theophylline

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11
Q

Clarithromycin + statin risk of

A

rhabdomyolysis

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12
Q

AntiHTN CI in pregnancy

A

ACEi

ARB

BB

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13
Q

AntiHTN used in pregnancy

A

labetolol

methyldopa

2nd line = nifedipine

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14
Q

Selegine

MOA

Indication?

A

MAO -inhibitor

Selegine used with levodopa in PD

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15
Q

Analgesic that increases lithium concentration (by decreasing renal clearance)

A

Diclofenac

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16
Q 
St John's wort
Carbamazepine
Phenobarbitone
Rifampicin
Phenytoin

effect on warfarin

A

decreases warfarin conc

as both are CYP450 inducer

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17
Q

ABx causing achilles tendon rupture

A

Fluoroquinolones

  • floxacins
    e. g ciprofloxacins
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18
Q

Adalimumab MOA

A

TNF-a inhibitor

Binds human TNFa and stops it binding to receptors -> reduces inflammation
in e.g. psoriasis

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19
Q

Why use metformin in PCOS

A

Increases insulin sensitivity / PERIPHERAL GLUCOSE UPTAKE
(insulin resistance in PCOS)

this -> ovulation in increased chances of CONCEPTION

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20
Q

Drug that can improve outcomes in severe sepsis

A

LOW DOSE steroids (hydrocortisone)

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21
Q

Ertolinib for e.g. pancreatic Ca

MOA

mechanism of resistance

A

MOA - targets epidermal growth factor (EGFR) tyrosine kinase + ATP binding -> cell signalling

Resistance after 1 year as mutation in ATP binding site

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22
Q

Causes QT shortening

Electrolytes
Endocrine
Drugs

A

High Ca, High Mg

Thyrotoxicosis

DIGOXIN

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23
Q

Dopamine effect on prolactin

A

inhibits prolactin from anterior pituitary

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24
Q

Drugs that increase prolactin levels

A

Antipsychotics e.g. Risperidone

APs = DA receptor antagonists therefore less DA therefore higher prolactin

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25
Q

Hyperprolactinaemia Sx

A 
amenorrhoea
galactorrhoea
infertility 
loss libido
erectile dysfunction
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26
Q

Exanatide MOA

more associated with

A

GLP-1 analague

GLP-1 increases insulin secretion

more associated with

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27
Q

Rare complication of Exanatide

A

pancreatitis

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28
Q

Drug increasing risk of mortality after acute MI

A

Nifedipine (Ca antagonist)

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29
Q

Criteria transferring to liver unit after paracetamol poisoning

A 
pH <7.3
systolic BP <80
creatinine >200 
INR >2 at 48h or ?3.5 at 72h
encephalopathy
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30
Q

Macrolides e.g. Clarithromycin
Fluoxetine / other SSRIs
Cimetidine
Omeprazole

effects on CYP450

Effect on warfarin

A

CYP450 INHIBITOR

So INCREASES conc of warfarin

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31
Q

Drug that induces G6PD

A

NSAIDs

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32
Q

Woman on azathioprine wants to start a family

What do you do?

A

Continue azathioprine

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33
Q

Drugs safe for use in acute intermittent porphyria

A

Ibuprofen
Amoxocillin
Opiates

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34
Q

Antiepileptic associated with constricted visual fields

A

Vigabatrin

should be stopped when vision deterioration

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35
Q

Analgesic effect of adding partial opioid agonist e.g. Buprenorphine to morphine

A

Reduces analgesic effect

As blocks mu receptors from binding morphine

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36
Q

Recreational drugs causing CK in 1000’s

A

Ecstasy (MDMA)

Phencyclidine (PVP)

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37
Q

Drugs used in opioid addiction

MOA

A

Buprenorphine + naloxone

Buprenorphine partia mu agonist - so binds receptor but don’t get full effects

Naloxone blocks mu receptors -> stops heroin binding and stops the high

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38
Q

RX alcohol withdrawal

1st line =

then give…

A

1st line = Benzo e.g. chlordiazepoxide (or PO lorazepam if hepatic impairment) to reduce seizure risk

Also give thiamine to prevent risk of irreversible Korsakoff’s psychosis

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39
Q

When to give ABx for otitis media in children

A

if fever or systemic Sx

otherwise if just pain then give analgesia

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40
Q

Pioglitazone

MOA

Indication

SEs

CI in …

A

MOA - PPAR gamma agonist, lowers blood glucose, improve insulin sensitivity

Indication - DM

SEs - fluid retention, decreased bone mineral density

CI in pts with Hx of HF

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41
Q

Clopidogrel MOA

A

ADP receptor antagonist

Prevents platelet aggregation

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42
Q

Equivalent glucocorticoid,
Hydrocortisone : Prednisolone

How much Pred would you give if taking 20mg Hydrocortisone?

A

Pred : Hydrocort
4: 1

20mg Hydrocortisone -> 5mg Pred

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43
Q

Cisplatin chemotherapy MOA

A

causes cross linking of DNA

inhibits DNA replication

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44
Q

BB overdose (get low HR and BP)

1st line

2nd line

A

1st = IV atropine

2nd = IV glucagon

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45
Q

Rx methanol poisoning

A

ethanol

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46
Q

Common SE of cisplatin

A

Ototoxicity
BM toxicity
Peripheral neuropathy
Nephrotoxicity

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47
Q

Quinine OD effects

A

blindness (spasm retinal artery)
tinnitus/deafness
arrhythmias

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48
Q

AED associated with

weight gain
PCOS
tremor
hair loss

A

Sodium valproate

49
Q

AED associated with

gingival hypertrophy
hypocalcaemia

50
Q

AED associated with

skin rash
Steven -Johnson syndrome

A

Lamotrigine

51
Q

Tamoxifen and Raloxifene MOA

A

Selective oestrogen receptor modulator

52
Q

SE of Tamoxifen

A 
endometrial hyperplasia 
(as SERM acts on endometrial receptors)
53
Q

Cyclosporin

MOA

Indication

A

T cell suppression

Atopic dermatitis, psoriasis

54
Q

Myasthenia Gravis MOA

A

ACh - R ABs

Reduced ACh receptors available, but same amount of ACh

55
Q

Myasthenia Gravis Ix

A

EMG (abnormal jitter response)

56
Q

Drug that interacts with cranberry juice

57
Q

Drug that interacts with grapefruit

A

Simvastatin

58
Q

Recurrent PEs despite being on warfarin

Next steps?

A

Switch warfarin to DOAC, or IVC filter

59
Q

Exanatide MOA

A

GLP-1 analogue

suppresses appetite, stops liver glucose secretion, slows gastric emptying, stimulates insulin release

60
Q

Epileptic

Tremor, seizure, confusion
nystagmus, hyperreflexia

Which drug OD

A

Lithium toxicity

61
Q

Rigidity, fever, autonomic instability, delirium, high creatinine phosphokinase

Which OD?

A

Neuroleptic malignant syndrome

62
Q

Metformin MOA

A

Biguanide

improves insulin sensitivity and increases hepatic gluconeogenesis

63
Q

Diabetic drugs CI immediately after MI

A

Metformin

increased risk of lactic acidosis due to tissue hypoxia

64
Q

Pt with depression
muscle cramps / lethargy

Hyponatraeia
Low serum osmolality
High Urine osmolality

Causative drug? Why?

A

SSRI e.g. Fluoxetine

SSRIs can cause SIADH

65
Q

Disulfiram MOA

Indication

A

Inhibits acetaldehyde breakdown (which is EtOH metabolite). High acetaldehyde -> N+V when drink EtOH

Indication - EtOH withdrawal

NB can get serious reaction when use alcohol-based perfumes

66
Q

CYP450 Inducers

effect on warfarin

A 
St John's wort
Carbamazepine
Phenobarbitone
Rifampicin
Phenytoin

decreases warfarin

67
Q

CYP450 inhibitors

effects on warfarin

A

Macrolides e.g. Clarithromycin
Fluoxetine/ SSRIs
Fluconazoles

Increases warfarin

68
Q

Antiemetics

Ondansetron MOA

A

5HT3 antagonist

69
Q

Antiemetic

Hyoscine MOA

A

Hyoscine - anticholinerginc/histaminergic

70
Q

Antiemetic

Domperidone MOA

A

Domperidone - antiDopaminergic

71
Q

Antiemetic

Aprepitant MOA

indication

A

neurokinin receptor blocker

used for chemotherapy nausea

72
Q

Drug causing angioedema, bronchospasm, urticaria

in hypersensitive patients

73
Q

Pioglitazone increases risk of which cancer?

A

Bladder cancer

74
Q

Rx acromegaly and carcinoid tumours

MOA

A

Octreotide

Somatostatin analogue (stops GH secretion)

75
Q

OD in farmer

Miosis and hypersalivation

A

ACh overactivity

e.g. insecticide

76
Q

Rx delirium tremens

hallucinations, confusion, agitation 2-3 days after stopping

A

Oral lorazepam

77
Q

Rx restless leg syndrome

A

Ropinirole and rotigotine

78
Q

AED that can cause severe hepatotoxicity

A

Sodium valproate

79
Q

Sildenafil (for erectile dysfunction) SE

A

Blue rings

80
Q

Furosemide MOA

A

Loop diuretic

Blocks Na reabsorption in loop of Henle

81
Q

Thiazide MOA

A

Block Na and Cl reabsorption in DCT

82
Q

Imatinib MOA

used in which Ca

A

tyrosine kinase inhibitor

stops cell proliferation as signal transduction inhibition

Used in CML

83
Q

Rx cyanide poisoning

A

dicobalt EDTA (Kelocyanor)

84
Q

Change in antiHTN

has anaphylaxis

Likely causative drugs?

85
Q

Pioglitazone CI in

A

Heart failure

86
Q

Sodiuim valproate risk in pregnancy

A

neural tube defect

so give folate supplements

87
Q

Rx for remission of membranous glomerulonephritis

A

Cyclophosphamide + Methylprednisolone

88
Q

Rx eclampsia / eclamptic fit

89
Q

SE of erythropoeitin in ESRF

A

HTN and seizures

90
Q

Metformin can reduce absorption of what?

91
Q

Sildenafil CI with which drugs

A

nitrates

including nitrate derivatives e.g. nicroandil

92
Q

Erythema nodosum drug causes

A

OCP
Aspirin (salicylates)
Sulphonamides

Sarcoid
TB

93
Q

Delirium drug Mx

Avoid which drugs

A

Haloperidol or Olanzapine

Avoid BDZs (over-sedation + inc delirium risk)

94
Q

Ezetimibe

MOA

Indication

A

prevents gut cholesterol absorption

used to lower LDL cholesterol

95
Q

Levetiracetam (Keppra)

PO or IV

what to do in renal failure

A

Good oral absorption

Does not affect hepatic enzymes

Reduce dose in renal failure

96
Q

LMWH MOA

A

inhibits antithrombin

97
Q

Progesterone missed pill must be taken within

98
Q

COCP missed pill must be taken within

99
Q

Inhibitor of gastric acid secretion

A

prostaglandin

100
Q

51M

4m pale stools and diarrhoea and wt loss

Ca 1.8
ALP 300

Cause?

A

pancreatic carcinoma

lack pancreatic enzymes ->
increase SI fat absorption ->
Ca not absorbed

101
Q

Rash + coeliac disease

A

dermatitis herpetiformis

102
Q

Dermatitis herpetiformis

Which Ig seen at dermo-epidermal junction

103
Q

Somatostatin

Released from?

Role?

A

pancreas

inhibits insulin and glucagon secretion

104
Q

dysphagia and regurgitation/
gurgling in throat

hallitosis

+/- palpable lump in the neck on examination

A

Pharygeal pouch

herniation between the thyropharyngeus and cricopharyngeus muscles (Killian’s dehiscence, in the inferior constrictor of the pharynx), resulting in a diverticulum where food and other debris can collect

105
Q

Pharyngeal pouch Ix

A

barium swallow

106
Q

GORD Sx

Endoscopy - Barrett’s + low grade dysplasia

Rx?

107
Q

loss of the APC gene on the long arm of chromosome 5

condition?

A

Familial adenomatous polyposis (FAP)

108
Q

intestinal hamartomatous polyps,

peri-oral pigmentation

A

Peutz-Jeghers syndrome (PJS) is an autosomal dominant

109
Q

How to differentiate

Peutz-Jeghers syndrome

familial adenomatous polyposis

Hereditary nonpolyposis colon cancer

A

Peutz-Jeghers syndrome - lots polyps + perioral pigmentation

FAP - polyps + no pignmentation

HNPCC - no pigmentation

110
Q

Ascites on diuretic

Na drops to 118

Mx?

A

If Na <120

Stop diuretic

Give fluids

111
Q

25M
diabetes mellitus
recurrent chest infections
referred to the gastro w/ chronic diarrhoea

3m abnormal liver function tests +
Abdo USS - fatty liver and gallstones

A

Cystic fibrosis

112
Q

Stop smoking

effect on UC

A

increases risk UC

113
Q

Smoking effect on women w/ CD

A

earlier disease onset

114
Q

drug causing pancreatitis

A

azathioprine

115
Q

Ix
pharyngeal pouch
achalasia

A

PP - barium swallow

achalasia - oesophageal manometry

116
Q

40F
3m dysphagia + wt loss + vomiting

predominantly solid food + reports she has had trouble with liquids too

CXR - fluid level behind the right heart border

A

Achalasia

Barium swallow may show a classical bird beak appearance

117
Q

Achalasia Rx

A

oesophageal dilatation or surgical myotomy

118
Q

perifollicular haemorrhages and bleeding gums

which deficiency?

119
Q

B1 deficiency -

B12/cyanocobalamin deficiency -

A

B1 - Wernicke’s

B12 - subacute combined degeneration of SC

MRCP (12 decks)

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