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Metabolic > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Azathioprine

A

Class: anti-proliferative agent.
MOA: inhibits purine synthesis —> inhibiting DNA and RNA replication.
Indication: transplant immunosuppression, RA, IBD.
Side effects/contraindications: bone marrow suppression.

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2
Q

Cyclophosphamide

A

Class: anti-proliferative agent/bifunctional alkylating agent.
MOA: DNA cross linking —> inhibiting protein synthesis.
Indication: immune based renal disease, chemotherapy, autoimmune and CT disorders.
Side effects/contraindications: bone marrow suppression.

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3
Q

Ciclosporin

A

Class: calcineurin inhibitor.
MOA: inhibit pro-inflammatory cytokine synthesis, such as IL-2 —> suppressing T cell activation and differentiation.
Indication: transplant immunosuppression.
Side effects: everything is increased - fluid, BP, K+, hair, gums, glucose.

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4
Q

Tacrolimus

A

Class: calcineurin inhibitor.
MOA: inhibit pro-inflammatory cytokine synthesis, such as IL-2 —> suppressing T cell activation and differentiation.
Indication: transplant immunosuppression.
Side effects/contraindications: increased risk of infection.

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5
Q

Trimethoprim

A

Class: antibiotic.
MOA: inhibits folate synthesis —> inhibiting nucleic acid synthesis.
Indication: UTI.
Side effects/contraindications: GI upset and skin rash. Avoid in first trimester and folate deficiency.

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6
Q

Nitrofurantoin

A

Class: antibiotic.
MOA: active metabolite damages bacterial DNA causing cell death.
Indication: UTI.
Side effects/contraindications: GI upset and hypersensitivity reactions. Avoid in pregnancy, babies < 3 months old and renal impairment.

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7
Q

Co-amoxiclav

A

Class: penicillins.
MOA: inhibit bacterial cell wall synthesis.
Indication: pyelonephritis.
Side effects/contraindications: D+V.

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8
Q

Ciprofloxacin

A

Class: fluoroquinolone.
MOA: inhibits DNA gyrase —> inhibiting DNA replication.
Indication: pyelonephritis.

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9
Q

Gentamicin

A

Class: aminoglycoside.
MOA: inhibits 30S ribosomal subunit —> inhibiting protein synthesis.
Indication: serious gram -ve infections e.g. pyelonephritis, sepsis and meningitis.
Side effects/contraindications: Ototoxicity and nephrotoxicity. Avoid in myasthenia gravis.

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10
Q

Cefalexin

A

Class: cephalosporins.
MOA: bind penicillin binding proteins —> inhibiting bacterial cell wall synthesis.
Indication: pyelonephritis.
Side effects/contraindications: GI upset. Use cautiously in people at risk of C.diff infection.

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11
Q

Ramipril, lisinopril, perindopril

A

Class: angiotensin-converting enzyme inhibitor (ACEi).
MOA: preventing the conversion of angiotensin 1 to angiotensin 2, this inhibits vasoconstriction and suppresses aldosterone secretion.
Indication: reduce proteinuria in glomerulonephritis and CKD. Anti-hypertensive, HF, IHD.
Side effects/contraindications: first dose hypotension, persistent dry cough and hyperkalaemia. Avoid in patients with renal artery stenosis and AKI, also in pregnancy.

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12
Q

Losartan, candesartan, irbesartan

A

Class: angiotensin receptor blockers (ARBs).
MOA: block action of angiotensin 2 on the angiotensin type 1 receptor, inhibiting vasoconstriction and suppressing aldosterone secretion.
Indication: reduce proteinuria in glomerulonephritis and CKD. Anti-hypertensive, HF, IHD.
Side effects/contraindications: first dose hypotension, hyperkalaemia and renal failure. Avoid in patients with renal artery stenosis and AKI, as well as pregnancy.

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13
Q

Furosemide, bumetanide

A

Class: loop diuretic.
MOA: inhibits Na+/K+/2Cl- cotransporter on TAL —> decreasing Na+ and water reabsorption.
Indication: pulmonary oedema, fluid overload (HF, renal disease or liver failure).
Side effects/contraindications: dehydration and hypotension. Avoid in patients with dehydration and hypovolaemia.

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14
Q

Oxybutinin, tolterodine

A

Class: anti-muscarinic.
MOA: inhibits binding of ACh to M3 receptor —> stimulating bladder relaxation.
Indication: overactive bladder and urge incontinence.
Side effects/contraindications: dry mouth, tachycardia, constipation, blurred vision, urinary retention. Avoid in UTIs.

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15
Q

Mirabegron

A

Class: beta 3 adrenergic agonist.
MOA: activates beta 3 receptors relaxing detrusor smooth muscle.
Indication: overactive bladder and urge incontinence.
Side effects/contraindications: avoid in uncontrolled hypertension.

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16
Q

Doxazosin, tamsulosin, alfuzosin

A

Class: alpha blocker (alpha 1 adrenoceptor antagonist).
MOA: inhibit alpha 1 receptors —> SM relaxation in prostate —> reduced resistance to bladder outflow. Also causes vasodilation causing BP to fall.
Indication: BPH (1st line). Add-on in resistant hypertension.
Side effects/contraindications: postural hypotension, dizziness and syncope.

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17
Q

Dutasteride, finasteride

A

Class: 5 alpha reductase inhibitors.
MOA: inhibit 5 alpha reductase —> inhibiting conversion of testosterone to DHT —> reduces prostatic enlargement. Takes several months to work.
Indication: BPH (2nd line).
Side effects/contraindications: impotence, reduced libido, gynaecomastia. Pregnant women shouldn’t handle these drugs.

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18
Q

Sildenafil, tadalafil

A

Class: phosphodiesterase type 5 inhibitors.
MOA: inhibits PDE-5 —> prevention of cGMP breakdown, increasing its concentrations —> SM relaxation and vasodilation —> penile blood flow and erection (sexual stimulation required).
Indication: erectile dysfunction.
Side effects/contraindications: flushing, headaches, dizziness, nasal congestion. Serious = hypotension, tachycardia, palpitations, priapism.

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19
Q

Alprostadil

A

Class: synthetic prostaglandin E1 analogue.
MOA: induces vascular SM relaxation —> erection.
Indication: erectile dysfunction.

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20
Q

Cisplatin

A

Class: platinum based chemotherapy.
MOA: alkylating agent —> cross-linking —> DNA damage.
Indication: bladder cancer, metastatic testicular cancer and metastatic ovarian cancer.

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21
Q

Insulin aspart (rapid-acting), insulin glargine (long-acting), biphasic insulin (mixture of rapid- and intermediate-acting), soluble insulin (short-acting)

A

Class: insulin formulations.
MOA: stimulates glucose uptake into skeletal muscle and fat, stimulates glycogenesis and lipogenesis, inhibits gluconeogensis and ketogenesis. Drives K+ into cells.
Indication: insulin replacement for T1D, control of blood glucose in T2D, diabetic emergencies e.g. DKA and HHS, alongside glucose in hyperkalaemia.
Side effects/contraindications: hypoglycaemia, lipohypertrophy.

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22
Q

Gliclazide, glimepiride

A

Class: sulfonylurea.
MOA: stimulates pancreatic insulin secretion via blocking K+ channels in beta cell causing depolarisation and opening of voltage gated Ca2+ channels.
Indication: T2D.
Side effects/contraindications: GI upset, hypoglycaemia, weight gain.

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23
Q

Repaglinide

A

Class: meglitinides.
MOA: stimulates insulin secretion.
Indication: T2D.
Side effects/contraindications: GI upset, hypoglycaemia.

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24
Q

Metformin

A

Class: biguanide.
MOA: reduces hepatic glucose output (glycogenolysis and gluconeogensis) and increases peripheral utilisation of glucose via activation of AMP kinase.
Indication: T2D.
Side effects/contraindications: GI upset, lactic acidosis, weight loss. Avoid in acute metabolic acidosis, AKI and use cautiously with renal impairment.

25
Q

Pioglitazone

A

Class: thiazolidinedione.
MOA: reduces peripheral insulin resistance, increasing glucose utilisation.
Indication: T2D.
Side effects/contraindications: weight gain, pins & needles, respiratory tract infections.

26
Q

Linagliptin, sitagliptin, saxagliptin

A

Class: DPP-4 inhibitor.
MOA: inhibit incretin degradation —> promote insulin secretion and inhibit glucagon release. Glucose dependent (decrease risk of hypoglycaemia).
Indication: T2D.
Side effects/contraindications: GI upset, acute pancreatitis. Avoid in pregnancy.

27
Q

Acarbose

A

Class: alpha-glucosidase inhibitors.
MOA: delays digestion and absorption of starch and sucrose.
Indication: T2D.
Side effects/contraindications: GI upset.

28
Q

Canagliflozin, empagliflozin

A

Class: SGLT2 inhibitors.
MOA: inhibits SGLT2 in PCT, reducing glucose reabsorption and increasing glucose urinary excretion.
Indication: T2D.
Side effects/contraindications: glucose urine, UTIs, weight loss.

29
Q

Liraglutide, dulaglutide, semaglutide

A

Class: GLP-1 mimetic.
MOA: increases insulin secretion, inhibits glucagon secretion and slows gastric emptying.
Indication: T2D and obesity.
Side effects/contraindications: GI upset, weight loss.

30
Q

Glucagon

A

MOA: raises blood glucose via stimulating glycogenolysis and stimulates gluconeogensis.
Indication: diabetic hypoglycaemia.
Side effects/contraindications: nausea. Avoid in phaeochromocytoma.

31
Q

IV glucose

A

MOA: increases blood glucose levels.
Indication: hypoglycaemia, OGTT.

32
Q

Carbimazole

A

Class: thionamides.
MOA: decreases uptake of inorganic iodine by the thyroid, reducing formation of thyroid hormones.
Indication: hyperthyroidism.
Side effects/contraindications: avoid in severe blood disorders.

33
Q

Propylthiouracil

A

Class: thionamides.
MOA: inhibits thyroid peroxidase, inhibiting the formation of thyroid hormones.
Indication: hyperthyroidism.

34
Q

Radioiodine (I-131)

A

MOA: destruction of thyroid tissue.
Indication: hyperthyroidism and thyroid cancer.

35
Q

Levothyroxine

A

Class: synthetic T4.
MOA: converted into T3 in target tissues, regulating growth and metabolism.
Indication: hypothyroidism.
Side effects/contraindications: GI disturbance, cardiac and neurological manifestations. Interacts with antacids, calcium/iron salts - should be taken 4 hours apart.

36
Q

Hydrocortisone, prednisolone, dexamethasone

A

Class: glucocorticoids.
MOA: bone glucocorticoid receptors —> translocate to nucleus and bind glucocorticoid-response elements —> gene expression. Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes. Also increase gluconeogensis and have mineralocorticoid effects.
Indication: allergic/inflammatory conditions, autoimmune diseases, cancers, adrenal insufficiency and hypopituitarism.
Side effects/contraindications: immunosuppression, risk of developing diabetes and osteoporosis, proximal muscle weakness, skin thinning, mood and behaviour changes. Prolonged treatment - suppression of ACTH —> adrenal atrophy. Suddenly withdrawn —> addisonian crisis.

37
Q

Fludrocortisone

A

Class: mineralocorticoid.
MOA: increases Na+ and water reabsorption and K+ excretion. Increasing BP.
Indication: neuropathic postural hypotension, adrenal insufficiency (primary).
Side effects/contraindications: hypertension, hypokalaemia and oedema.

38
Q

Somatropin

A

Class: synthetic human growth hormone.
MOA: stimulates linear bone growth, increases bone mass, increasing muscle mass.
Indication: Turner syndrome, GH deficiency.
Side effects/contraindications: carpal tunnel syndrome, headache, oedema, joint disorders.

39
Q

Tetracosactide

A

Class: synthetic ACTH.
MOA: stimulates synthesis of adrenal steroids from cholesterol (in normal patients). Doesn’t increase cortisol in patients with adrenocortical insufficiency.
Indication: diagnosis of adrenocortical insufficiency.

40
Q

Cabergoline, quinagolide

A

Class: dopamine D2 agonists
MOA: stimulates dopamine receptors, inhibiting release of prolactin.
Indication: suppress lactation, hyperprolactinaemic disorders.

41
Q

Sustanon (IM), testogel (transdermal)

A

Class: testosterone.
MOA: testosterone-receptor complex transported to nucleus where it bind transcription factors —> gene expression —> male sex organs and secondary sexual characteristics.
Indication: androgen deficiency, hypogonadism.
Side effects/contraindications: avoid in breast cancer in men and prostate cancer.

42
Q

Alendronic acid, residronate, zoledronic acid, pamidronate

A

Class: bisphosphonates.
MOA: inhibit osteoclasts —> reducing bone resorption —> improved bone mass.
Indication: osteoporotic fragility fractures (alendronic acid), Paget’s disease, severe hypercalcaemia of malignancy (pamidronate and zoledronic acid), myeloma and breast cancer with bone metastases (pamidronate and zoledronic acid).
Side effects/contraindications: oesophagitis and hypophosphataemia (common), osteonecrosis of jaw (rare but serious), atypical femoral fracture. Avoid in severe renal impairment and hypocalcaemia.

43
Q

Alfacalcidol, calcitriol, ergocalciferol

A

Class: vitamin D compounds.
MOA: active form of vitamin D —> increases calcium absorption, decreases renal excretion of calcium.
Indication: severe renal impairment (bone disease), hypocalcaemia due to hypoparathyroidism, osteoporosis, vitamin D deficiency (rickets and osteomalacia).
Side effects/contraindications: avoid in hypercalcaemia.

44
Q

Calcichew (oral), calcium gluconate (IV), calcium chloride (IV)

A

Class: calcium salts.
MOA: oral calcium supplements bind phosphate in the gut. In hyperkalaemia , calcium raises myocardial threshold potential, reducing excitability and risk of arrhythmias.
Indication: dietary deficiency (calcichew), prevention/treatment of osteoporosis, CKD (renal bone disease), hypocalcaemia, severe hyperkalaemia (calcium gluconate/chloride).
Side effects/contraindications: oral calcium - dyspepsia, constipation. Avoid in hypercalcaemia.

45
Q

Desmopressin, terlipressin

A

Class: vasopressin (ADH) analogues.
MOA: insertion of aquaporins —> water reabsorption.
Indication: cranial diabetes insipidus (desmopressin), oesophageal bleeding (terlipressin), bleeding reduction in mild/moderate haemophilia (desmopressin), primary nocturnal enuresis.
Side effects/contraindications: avoid with diuretics, cardiac insufficiency and Hx of hyponatraemia.

46
Q

Tolvaptan

A

Class: selective vasopressin receptor 2 antagonist.
MOA: prevention of water reabsorption —> increase in urine volume —> decrease in urine osmolality.
Indication: hyponatraemia secondary to SIADH, autosomal dominant polycystic kidney disease.
Side effects/contraindications: avoid in anuria, hypernatraemia.

47
Q

Paracetamol, co-codamol

A

Class: analgesic and antipyretic (weak anti-inflammatory). Co-codamol (paracetamol + codeine).
MOA: weak inhibitor of COX-2 —> inhibits prostaglandin synthesis. Also causes peripheral vasodilation due to effect on hypothalamus.
Indication: analgesia and palliative care. Acute and chronic pain (mild-moderate). Fever.
Side effects/contraindications: overdose —> liver failure.

48
Q

Ibuprofen, naproxen, etoricoxib (selective COX-2 inhibitor)

A

Class: NSAIDs.
MOA: inhibits COX —> inhibits prostaglandin synthesis. COX-1 (constitutive form) involved in integrity of gastric mucosa, dilates afferent glomerular arterioles and inhibits thrombus formation. COX-2 (inducible form) involved pain and inflammation.
Indication: acute, chronic and neuropathic pain (mild-moderate). Pain related to inflammation.
Side effects/contraindications: GI toxicity (gastric ulcer), renal impairment and increased risk of CV events. Avoid in severe renal impairment, HF, liver failure, peptic ulcer disease, GI bleeding.

49
Q

Codeine phosphate, morphine sulfate, diamorphine, tramadol

A

Class: opioids.
MOA: activation of mu opioid receptors in the CNS —> reduce neuronal excitability and pain transmission. Reduce sympathetic NS activity.
Indication: acute and chronic moderate-severe pain. End of life care.
Side effects/contraindications: respiratory depression, neurological depression, N+V, pupillary constriction, constipation, itching, tolerance & dependence. Avoid in respiratory failure (except in palliative care) and biliary colic. Codeine should never be given IV (severe reaction). Avoid tramadol in epilepsy (lowers seizure threshold).

50
Q

Amitriptyline, duloxetine, gabapentin, carbamazepine, capsaicin

A

Class: non-opioid non-NSAID analgesics.
Indication: chronic and neuropathic pain.

51
Q

Cyclizine, hyoscine, metoclopramide, prochlorperazine, ondansetron, aprepitant, nabilone

A

Class: antiemetics.
MOA: cyclizine (antihistamine), hyoscine (antimuscarinic), metoclopramide (dopamine receptor antagonist), prochlorperazine (dopamine receptor antagonist), ondansetron (5-HT3 receptor antagonist), aprepitant (neurokinin 1 receptor antagonist), nabilone (cannabinoid).
Indication: motion sickness, postoperative vomiting, drug-induced vomiting, cytotoxic drug-induced vomiting, pregnancy-induced vomiting.

52
Q

Doxorubicin

A

Class: cytotoxic anthracycline.
MOA: inhibits topoisomerase 2, preventing religation and DNA replication.
Indication: cancer chemotherapy e.g. acute leukaemia, lymphoma, bladder cancer, Kaposi’s sarcoma.
Side effects/contraindications: hair loss, anaemia, bone marrow suppression etc.

53
Q

Methotrexate

A

Class: antimetabolite.
MOA: inhibits dihydrofolate reductase, which prevents DNA/RNA synthesis and cellular replication. Also has anti-inflammatory and immunosuppressive effects via inhibition of inflammatory mediators.
Indication: RA, cancer chemotherapy e.g. leukaemia, lymphoma, some solid tumours, psoriasis.
Side effects/contraindications: mucosal damage and bone marrow suppression. Hepatic cirrhosis or pulmonary fibrosis (long term use). Avoid in pregnancy (teratogenic), severe renal impairment (renally excreted) and abnormal liver function.

54
Q

Tamoxifen, anastrazole

A

Class: anti-oestrogens.
MOA: oestrogen receptor antagonist (tamoxifen). Inhibits aromatase enzyme (anastrazole).
Indication: breast cancer.

55
Q

Ferrous sulfate, ferrous fumarate

A

Class: oral iron supplement.
MOA: iron is best absorbed in ferrous state (Fe2+) in duodenum and jejunum. Once absorbed iron is bound by transferrin, which transports it to be used in bone marrow for erythropoiesis, or stored as ferritin.
Indication: iron deficiency anaemia.
Side effects/contraindications: GI upset (nausea, epigastric pain, constipation, diarrhoea), black stools.

56
Q

Iron sucrose (IV)

A

Class: parenteral iron preparations.
Indication: iron deficiency anaemia.
Side effects/contraindications: risk of anaphylaxis in susceptible individuals.

57
Q

Hydroxocobalamin

A

Class: vitamin B12 injection.
Indication: megaloblastic anaemia, subacute combined degeneration of the cord.
Side effects/contraindications: in patients with co-existing vitamin B12 deficiency and folate deficiency, replace both vitamins simultaneously to prevent subacute combined degeneration of the cord.

58
Q

Folic acid

A

Class: folic acid (synthetic vitamin B9/folate).
MOA: folic acid reduces the risk of neural tube defects via facilitating cell proliferation.
Indication: megaloblastic anaemia and first trimester of pregnancy.

59
Q

Darbepoetin

A

Class: recombinant erythropoietin.
MOA: stimulates erythropoiesis and rbc production.
Indication: renal anaemia.
Side effects/contraindications: embolism and thrombosis, headaches. Avoid in uncontrolled hypertension, patients who are unable to receive thromboprophylaxis.

Metabolic (6 decks)

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