Pharmacology Flashcards
Orlistat class
pancreatic lipase inhibitor
Asprin in breast feeding risk of?
Reyes syndrome
bleeding problems
Quinolones (-floxacin) mechanism ?
Inhibit DNA Gyrase
aminoglycosides, and tetracyclines mechanism (gent / cyclines)
inhibit bacterial ribosomal protein synthesis
Penicillins action
binds to proteins -> impairs osmotic balance -> cell lysis
Cell wall synthesis
Cephalosporins action
bactericidal
Inhibit cell wall synthesis
How does metronidazole work
free radical production within anaerobic organisms
Aspirin overdose -> what blood gas initially? then? Pathophysiology of each
Respiratory alkalosis
[salicylates stimulate the respiratory drive ]
Followed by metabolic acidosis if severe
[due to disruption of ATP production -> anaerobic respiration and build-up of lactic acid ]
Why sub lingual drugs needed in lower doses
Avoid first pass metabolism
Carbamazepine’s key side effects
Cerebellar toxitiy
C for C in the brain
Hyponatraemia
Need co amox but amox allergy? What if preg?
Doxy + metro
Preg = Azithro + metro
Normal metabolism of paracetamol ? In OD?
conjugation to glucuronic acid
[NOT GLUTATHIONE]
in OD - pathway saturated so non specific P450 oxidation which produces toxic metabolite (NAPQI)
->NAPQI is conjugated by gluathione
If excess of NAPQI (glutathione saturated) then it binds to hepatocytes and causes cell death
Cardiac history - pt comes in complaining things have a weird colour or halo’s around. + nausea + anorexia + brady =?
Digoxin toxicity
Seen on ECG of therapeutic digoxin
Prolonged PR + scooped ST
Rx of digoxin toxicity? Key marker of mortality?
Fab fragments [digoxin specific antibody]
Potassium level >5
CP450 pneumonic
Bare minimum - remeber both mnemonics and the C in CRAPGPS is carbamazepine and s is sulphonylureas
Inducers - Reduces concentration of drugs) CRAP GPs
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
Inhibitors (Increases concentration of drugs) SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
On multiple agents which increase QT why do die?
Torsade du pointes
Epilepsy with side effects:
Hair loss, liver damage, pancreatitis, weight gain?
Sodium valproate
Discoloured teeth in infants - what drug in preg?
Tetracyclines
TEETHracycline
Where do thiazide diruetics work on
The proximal segment of the distal convoluted tubule
Where do loop diuretics work?
Ascending loop of henle
Where do aldosterone antagonists work eg spironolactone
collecting duct
Where does amiloride work?
distal segment of distal convoluted tubule eNAC channels
Epilepsy and vision problems =
vigabatrin
V for vision
(loss of peripheral vision and retinal atrophy)
May also get alopecia and aggression
What happens in mdma toxiticy?
SIADH -> hypoNa
Key types of drug contra indicated with sildenafil?
Nitrates + nicroandil
Statins are HMG-CoA-reductase inhibitors? What does this mean? How does ezetimibe work?
Statins reduce cholesterol synthesis
Ezetimibe - reduces intestinal cholesterol absorption
How is lithium cleared
95% renal clearance
[none in liver]
How do PPIs work
inhibit H+/K+ATPase
Which antieileptic key for hypoNa
carbamazepine
Need to check before starting azathioprine therapy
TPMT
Drug of choice in hyperthyroid pregnancy
Propylthiouracil in first 2 trimesters
Often switched to Carbimazole before delivery
Vit D replacement levels in OP
400-800 units daily
[+1500mg Ca]
Who gets drug-induced lupus
White people
How does enox work?
potentiates action of anti-thrombin III
Diuretics class and where they act
MALT K
Mannitol (Osmotic Diuretics): water reabsorption in the proximal tubule
Acetazolamide (Carbonic Anhydrase Inhibitors): proximal tubule
Loop Diuretics: thick ascending loop of Henle, =/=> Na+/K+/2Cl- transporter (furosemide, ethacrynic acid)
Thiazides: distal tubule, =/=> Na+/Cl- symporter (hydrochlorothiazide, indapamide)
K+ sparing agents: distal nephron (late distal tubule + collecting ducts). Aldosterone receptor antagonist (spironolactone) Na+/K+ e
xchange by of Na+ channels (amiloride, triamterene)
Tricyclic OD key thing to give? 3 things worried about
IV Sodium Bicarbonate
Acidosis
Seizures
Arrhythmias
[50% chance of ventricular arrythmias with QRS >160ms)
Tricyclic OD key thing to give? 3 things worried about
IV Sodium Bicarbonate
Acidosis
Seizures
Arrhythmias
[50% chance of ventricular arrhythmias with QRS >160ms)
Oliguric crisis Rx
Procyclidine
Methanol poisoning rx mainstay if gubbed?drug? Mechanism?
RRT
Fomepizole - inhibitor of alcohol dehydrogenase
if mild and conscious -> try soda bic first
Where is methanol metabolised? Which is the metabolite which causes acidosis, blindness and end-organ damage?
Why could you give ethanol if no fomepizole?
Liver -> toxic metabolites
Formic acid [similar name to FORMepizole]
Ethanol competes with methanol (prevents toxic metabolite formation)
Drugs which cause lung fibrosis
Blah NeverMind
Bleomycin Nitrofurantoin MTX
Rifampicin action
RNA polymerase disruption
Diabetes and HGV licence
Need to discuss with DVLA if insulin dependent.
Need regular blood sugar checks when driving and before driving
When dialysis for methanol level?
Serum methanol >50mg/dl
Red urine and tears which drug
Rifampicin
Red Rif
HBA1C target? If on gliclazide or other drug which causes Hypos?
48mmol/mol
53
1st line for dual therapy T2DM if patient is obese?
DPP4 inhibitor
-gliptin
Or GLP-1
-Glutide
Which classes diabetic meds cause hypos (excluding insulin smart arse)
Sulphonyureas
-gliflozin (SGLT2 inhibitos)
Which antiepileptic - gum hypertrophy
Phenytoin
How does theophylline work?
Adenosine receptor blocker ->relaxation of smooth muscle
Key SE of bosentan (used for pulm HTN)
liver toxicity
What does finasteride do?
Prevents conversion of testosterone to dihydrotestosterone by inhibiting 5a-reductase
Drug for reducing prolactin in pituitary adenomas
Bromocriptine (dopamine agonist)
How does clomifene work
Stimulates pituitary release of GnRH
Green / blue urine from which infection? Which most common drug also causes it?
Pseudomonas
Amitriptyline
Long-term key risk of TNFa inhibitors
Lymphoma
How does amiodarone affect sight?
Corneal deposits
eg of aromatase inhibitor? Mechanism?
Letrozole, Anastrozole
Aromatase inhibitor
Blocks conversion of androgens -> oestrogens
Which antihypertensives bad with ciclosporin? Antibiotic?
Verapamil, diltiazem
Macrolides
[also imidazole based antifungals - good luck]
Who gets phenytoin toxicity even when drug in the normal range on bloods?
Uraemia
HypoAlbumin
Hyperbilirubin
[Get decreased phenytoin protein binding - drug appears to be in normal range but actually has more free non bound active bits in blood]
Who gets phenytoin toxicity even when drug in the normal range on bloods?
Uraemia
HypoAlbumin
Hyperbilirubin
[Get decreased phenytoin protein binding - drug appears to be in the normal range but actually has more free non bound active bits in blood]
Key side effect of donepezil
Cholinesterase inhibitor
->Brady most important
[Urine incontinence, hepatitis, GI upset]
Which NSAID most likely to cause convulsions in OD? What are symptoms of NSAID OD due to?
Mefanamic acid
Inhibition of cyclo-oxygenase
Why do you often get a little bit of hyperthyroid with reduced TSH pregnancy
B-HCG stimulates thyroid hormone production
how does carbimazole work
Converted to active metabolite - methimazole
-Inhibits iodination of tyrosine
how does carbimazole work
Converted to active metabolite - methimazole
-Inhibits iodination of tyrosine
First line antihypertensive if on lithium
Amlodipine
(ACEi can increase lithium levels)
How is propythiouracil different from carbimazole
Blocks peripheral conversion of thyroxine -> t3
Parkinsons drug which can be given S/C if no oral route
Apomorphine
Multiple fungal nails Rx
Oral Terbinafine
(topical only if 1 nail affected)
anti-emetics -setron’s are which class? Where do they work?
5HT-3 receptor antagonists
Medulla oblongata
Which parkinsons drug makes urine dark
L-dopa
Ciprofloxacin and a sore ankle whats happened
Ciprofloxacin induced achilles tendonitis
more likely if >60, on steroids, renal impairment or prev transplant/tendon rupture
How does NAC work in Paracetamol OD
Conjugates NAPQI as an exogenous glutathione source
3 main choices of Antihypertensive in pregnancy
Labetalol
Nifedipine
Methydopa
-Should also be prescribed aspirin
B Blocker OD Rx hypotension/brady? Hypoglycaemic?
Widened QRS?
IV glucagon - for symptomatic brady
-+/- Atropine, +/-isoprenaline
IV dextrose - if hypoglycaemic
Sodium bicarb for wide QRS or hypotension not fluid responsive
OD -> Hypo. Not diabetic drug
B blockers
Half life of adenosine? What drug increases this? When is it CI’d?
5s
Dipyridamole
May cause complete heart block in…
2/3rd degree heart block
Sick sinus syndrome
Verapamil
Which anti-epileptic is associated with osteomalacia? What on bloods would make you suspicious
Phenytoin
HypoCa, HypoVitD, HypoPO4
Raised ALP
Sulfonylureas mechanism and key side effects
stimulate insulin secretion by acting on the K+ ATP channel on the surface of the pancreatic β-cell
weight gain and risk of hypoglycemia
PPAR-γ agonists (thiazolidinediones)
Eg?
Mechanism?
Key side effects?
Pioglitazone
Act on adipose tissue to increase adipogenesis and lipogenesis in peripheral adipose depots.
Fluid retention -> Oedema / heart failure
risk of fractures
2 types of incretin class? EG?
Effect?
Side effects?
Oral (DPP-4) inhibitors (gliptins)
Injectable glucagon-like peptide-1 receptor agonists (GLP-1) -glutide
Stimulate glucose-induced insulin secretion
suppress glucagon production
Weight loss - mostly GLP-1 (good)
Risk of pancreatitis
SGLT2 inhibitors eg?
Mechanism?
Good for?
Key risks
-Gliflozin
Glycosuric suppress reabsorption of glucose from the proximal tubule
beneficial effects on major adverse cardiac even
UTIs / genital infections
Which diabetic drug may caused reduced gastric emptying
Gliptins
How do SLG2- inhibitors improve bp?
Osmotic diuresis
Which antidiabetic cause eDKA
SLG-2 inhibitors
Which class antidiabtics worst for fluid retention
-glitazones
(thiazolidinediones)
Medications causing erythema nodosum
Omeprazole
HepB vaccine
Isotrenatoin
drugs metabolised by CYP-2D6
Antidepressants - Tricyclic / SSRI
B blockers
c
Dihydrocodeine (converted to morphine)
Ecstasy
Dihydrocodeine but no analgesic effect?
Reduced CYP-2D6 action
[usually concerted to morphine]
Why take statins at night
HMG-CoA-reductase most active when fasting (and liver blood flow increased lying flat)
Which pain killer has actions on serotonin and may contribute to serotonin syndrome
Tramadol
What class is Phenelzine? what do you need to avoid
MAOi
SSRIs as risk of serotonin syndrome
Sumatriptan mechanis
5HT-1 agonist
hypertensive crisis and collapse Rx
IV Sodium nitroprusside
Hypokalaemic on furosemide - long term plan?
Add a potassium-sparing diruetic eg amiloride / spironolactone
What is aminophylline - how is it different in potency to theophylline
Theophylline + [ethylenediamine]
makes it 20x more potent
Key side effects of theophylline? in excess
Insomnia + agitation
[metabolic acidosis + hypoK]
OD -> profound hypoK and supraventricular arrythmias
Option for Rx of Kallman’s other than testosterone
Human Chorionic Gonadotrophin
How does trimethoprim work
Inhibits dihydrofolate reductase
What happens if you use allopurinol during an acute gout attack?
Prolongs and exacerbates episode