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2A Medicine Sam > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name three Bisphosphonate drugs

A

Alendronate, Pamidronate, Zoledronate

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2
Q

What are Bisphosphonates, calcitonin, SERM’s and denosumab useful in the treatment of?

A

Osteoporosis and Pagets

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3
Q

Mechanism of action of bisphosphonates

A

Inhibit bone resorption -> modest increase in bone mineral density and decreased fracture risk. Osteoclasts bind to bisphosphonates inhibiting their adherence to the bony surface. They decrease development and recruitment of osteoclast precursors and induce osteoclast apoptosis

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4
Q

What do bisphosphonates bind to in the bone?

A

Hydroxyapatite

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5
Q

Other indications for Alendronate

A

Useful in the treatment of hypercalcaemia

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6
Q

Side effects of bisphosphonates such as Alendronate

A

Upper GI side effects (E.g. acid reflux, Esophagitis and Esophageal uclers)
Osteonecrosis of the jaw
Hypocalcaemia

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7
Q

Explain the RANK-RANKL system

A

PTH stimulates osteoblasts to express RANKL and then RANKL binds to RANK on osteoclast to increase their activity

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8
Q

Class and Mechanism of action of denosumab

A

Monoclonal antibody against RANKL to inhibit osteoclast activity

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9
Q

Mechanism of action of calcitonin

A

Tones down calcium by inhibiting osteoclast activity to decrease bone resorption. It increases renal excretion of Calcium

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10
Q

Side effects of Calcitonin

A

Hypocalcaemia

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11
Q

What is atenolol indicated for?

A

Hypetension, Angina and Arrhythmias

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12
Q

What class of drugs does atenolol fall under?

A

Beta blocker

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13
Q

Name another drug in the same class as atenolol

A

Propanolol

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14
Q

Contraindications for atenolol (and all other beta blockers)

A

Asthma, hypotension, Bradycardia, metabolic acidosis, phaeochromocytoma, second and third degree AV block

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15
Q

Side effects of beta blockers

A

Abdominal discomfort, bradycardia, confusion, depression, diarrhoea, dizziness, nausea, fatigue, headache, syncope, sleep disturbance

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16
Q

Mechanism of action of beta blockers

A

Beta blockers, also called beta adrenergic blocking agents, block the release of the stress hormones adrenaline and noradrenaline in certain parts of the body. This results in a slowing of the heart rate and reduces the force at which blood is pumped around your body

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17
Q

Indications for Atracurium

A

Adjunct to general anaesthesia during surgery to relax skeletal muscle and to facilitate endotracheal intubation and mechanical ventilation

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18
Q

Atracurium mechanism of action

A

Atracurium antagonizes the neurotransmitter action of acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate

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19
Q

Indications for Bendroflumethiazide

A

It’s used to treat high blood pressure (hypertension) and the build-up of fluid in your body (oedema)

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20
Q

Bendroflumethiazide class

A

Thiazide diuretic

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21
Q

Bendroflumethiazide mechanism of action

A

As a diuretic, bendroflumethiazide inhibits active chloride reabsorption at the early distal tubule via the Na-Cl cotransporter, resulting in an increase in the excretion of sodium, chloride, and water. Thiazides like bendroflumethiazide also inhibit sodium ion transport across the renal tubular epithelium through binding to the thiazide sensitive sodium-chloride transporter. This results in an increase in potassium excretion via the sodium-potassium exchange mechanism. The antihypertensive mechanism of bendroflumethiazide is less well understood although it may be mediated through its action on carbonic anhydrases in the smooth muscle or through its action on the large-conductance calcium-activated potassium (KCa) channel, also found in the smooth muscle.

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22
Q

Cefuroxime indications

A

Susceptible gram postitive and gram negative bacteria, acute diverticulitis, prophylaxis sometimes, LUT infection, acute pyelonephritis

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23
Q

Cefuroxime drug class

A

Cephalosporin antibiotic

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24
Q

Cefuroxime mechanism of action

A

Attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death

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25
Q

Side effects of cephalosporins

A

Abdo pain, diarrhoea, dizziness, eosinophilia, leucopenia, neutropenia, thrombocytopenia, vomiting, vulvovaginal candidiasis

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26
Q

Celecoxib indications

A

Pain and inflammation in osteoarthritis, pain and inflammation in RA, ankylosing spondylitis

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27
Q

Contra-indications for Celecoxib

A

GI bleeding, ulceration, IBD, IHD

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28
Q

Celecoxib drug class

A

COX-2 inhibitor NSAID

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29
Q

Mechanism of action of Celecoxib

A

The mechanism of action of celecoxib is due to selective inhibition of cyclooxygenase-2 (COX-2), which is responsible for prostaglandin synthesis, an integral part of the pain and inflammation pathway. This pharmacologic activity gives celecoxib its analgesic, anti-inflammatory, and antipyretic effects.

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30
Q

Chloramphenicol indications

A

Superifical eye infections, Bacterial infection in otitis externa, HiB infections

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31
Q

Chloramphenicol drug class and action

A

Chloramphenicol is an antibiotic and is in the class of antimicrobials that inhibits protein synthesis.

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32
Q

Ciclosporin indications

A

Severe acute UC refractory to corticosteroid treatment, severe active RA, Nephrotic syndrome

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33
Q

Ciclosporin drug class

A

Disease-modifying anti-rheumatic drug or DMARD

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34
Q

Ciclosporin mechanism of action

A

Cyclosporine is a calcineurin inhibitor that inhibits T cell activation.

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35
Q

Other examples of DMARDs

A

Methotrexate, sulfasalazine, hydroxychloroquine and leflunomide

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36
Q

DMARD side effects

A

loss of appetite, nausea, diarrhoea, abdo pain, liver problems, increased infection risk

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37
Q

Ciprofloxacin indications

A

Bacterial eye infection, otitis externa, diabetic foot, acute diverticulitis (with metronidazole), resp infections, UTI, prostatitis, uncomplicated gonorrhoea, pyelonephritis

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38
Q

Ciprofloxacin drug class

A

Fluoroquinolone antibiotic

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39
Q

Side effects of quinolone antibiotics

A

Decreased appetite, arthralgia, constipation, diarrhoea, dizziness, dyspnoea, fever, fungal infection, GI discomfort, myalgia, headache, QT interval prolongation

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40
Q

Co-amoxiclav indications

A

Infections due to beta-lactamase-producing strains where amoxicillin is inappropriate, acute diverticulitis, diabetic foot, surgical prophylaxis, community-acquired pneumonia, hospital-acquired pneumonia, otitis media, pyelonephritis, UTI from catheter, osteomyelitis

Exacerbation of: bronchiectasis, COPD, sinusitis

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41
Q

Co-amoxiclav class

A

Penicillin

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42
Q

General mechanism of action for penicillins

A

Penicillin kills bacteria through binding of the beta-lactam ring to DD-transpeptidase, inhibiting its cross-linking activity and preventing new cell wall formation. Without a cell wall, a bacterial cell is vulnerable to outside water and molecular pressures, which causes the cell to quickly die.

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43
Q

Diamorphine indications

A

severe surgery related pain, MI, Palliative pain, relief of dyspnoea in acute pulmonary oedema

44
Q

Diamorphine drug class

A

Opioid analgesic

45
Q

Dalteparin drug class

A

LMWH anticoagulant

46
Q

Dalteparin indications

A

Treatment of DVT, PE, unstable coronary artery disease

Acute conditions e.g. cancer, bed rest, heart failure, severe lung disease

47
Q

Dobutamine drug class

A

Beta-1 agonist (inotropic agent)

48
Q

Indications for dobutamine

A

inotropic support (increase force of muscle contraction) in infarction, cardiac surgery, cardiomyopathies, septic shock, cardiogenic shock

cardiac stress testing

49
Q

Side effects of dobutamine

A

Arrhythmias, bronchospasm, chest pain, dyspnoea, eosinophilia, fever, headache, IHD, nausea, palpitations, urinary urgency, vasoconstriction

50
Q

Doxazosin drug class

A

Alpha blocker

51
Q

Doxazosin indications

A

HTN, benign prostatic hyperplasia

52
Q

Side effects of Doxazosin

A

Arrhythmias, chest pain, cough, dizziness

53
Q

Ephedrine indications

A

Reversal of hypotension from spinal or epidural anaesthesia, revesible airwya obstruction, Neuropathic oedema, nasal congestion, sinusitis

54
Q

Erythromycin drug class

A

Macrolide antibiotic

55
Q

Erythromycin indications

A

Susceptible infections in patients with penicillin hypersensitivity, gram positive and atypical bacteria, community acquired pneumonia, sore throat, otitis media, uncomplicated chlamydia, chronic prostatitis

56
Q

Furosemide drug class

A

Loop diuretic

57
Q

Furosemide indications

A

Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome, in adults and pediatric patients, resistant HTN

58
Q

Furosemide mechanism of active

A

Furosemide, like other loop diuretics, acts by inhibiting the luminal Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle, by binding to the chloride transport channel, thus causing more sodium, chloride, and potassium to be excreted in the urine.

59
Q

Ipratropium Indications

A

anticholinergic drug used in the control of symptoms related to bronchospasm in chronic obstructive pulmonary disease (COPD), asthma exacerbation, severe or life-threatening acute asthma

60
Q

Ipratropium class

A

antimuscarinic

61
Q

Ipratropium mechanism of action

A

Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blocking cholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). This decrease in the lung airways will lead to decreased contraction of the smooth muscles.

62
Q

Loperamide indications

A

Acute diarrhoea, chronic diarrhoea, faecal incontinence

63
Q

Loperamide mechanism of action

A

Loperamide binds to the opiate receptor in the gut wall. Consequently, it inhibits the release of acetylcholine and prostaglandins, thereby reducing propulsive peristalsis, and increasing intestinal transit time. Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency.

64
Q

Metformin drug class

A

Biguanide

65
Q

Metformin mechanism of action

A

Metformin exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells.

66
Q

Metformin indications

A

T2DM, PCOS

67
Q

Methotrexate drug class

A

DMARD

68
Q

Methotraxate mechanism of action

A

Methotrexate inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines.

69
Q

Indications for methotrexate

A

Severe Crohns, Maintenance of remission of Chrons, Moderate to severe RA, severe active RA, Neoplastic disease

70
Q

Oxybutinin indications

A

Overactive bladder or symptoms of detrusor overactivity, including urinary frequency and urgency

71
Q

Ramipril class

A

ACE inhibitor

72
Q

Ramipril indications

A

HTN, Symptomatic heart failure, Prophylaxis following MI, prevention of cardiovascular events in patients at high risk, nephropathy

73
Q

Ramipril mechanism of action

A

Ramipril inhibits angiotensin-converting enzyme and decreases angiotensin II formation. As a result, sympathetic activity goes down, sodium and water reabsorption from the kidneys reduces, smooth muscles in the arterioles also relax. As a result, blood pressure decreases

74
Q

Rifampicin indications

A

Brucellosis, Legionnaires, serious staph infections, endocarditis in combination, TB in combination, Gram positive cocci (staph and strep), C.diff and select Gram negative pathogens e.g. Neiserria meningitides, N.gonorrhoeae and HiB

75
Q

Rivaroxaban class

A

DOAC, Factor Xa inhibitor, anticoagulant

76
Q

Rivaroxaban indications

A

Prophylaxis of venous thromboembolism, treatment of DVT or PE, Stroke Prophylaxis

77
Q

DOAC mechanism of action

A

The mechanism of action of rivaroxaban and all other factor Xa inhibitors is the inhibition of prothrombinase complex-bound and clot-associated factor Xa, resulting in a reduction of the thrombin burst during the propagation phase of the coagulation cascade.

78
Q

Salmeterol drug class

A

Long-acting beta-agonists (LABA)

79
Q

LABA mechanism of action

A

LABAs activate pre-junctional β2-adrenoceptors and reduce acetylcholine release thereby prevent any functional competition by acetylcholine at post-junctional muscarinic receptors in the airways occupied by LAMAs

80
Q

Salmeterol indications

A

Reversible airways obstruction in patients requiring long-term regular bronchodilator therapy,
Nocturnal asthma in patients requiring long-term regular bronchodilator therapy,
Prevention of exercise-induced bronchospasm in patients requiring long-term regular bronchodilator therapy,
Chronic asthma only in patients who regularly use an inhaled corticosteroid (not for immediate relief of acute asthma)

COPD

81
Q

Side effects of LABA

A

Arrhythmias, headache, palpitation, tremor

82
Q

Sildenafil indications

A

Pulmonary arterial hypertension, ED

83
Q

Suxamethonium drug class

A

Neuromuscular blocker

84
Q

Suxamethonium indications

A

Neuromuscular blockade during surgery

85
Q

Tamsulosin indication

A

Benign prostatic hyperplasia

86
Q

Tamsulosin class

A

alpha blocker

87
Q

Tamsulosin mechanism of action

A

Tamsulosin is in a class of medications called alpha blockers. It works by relaxing the muscles in the prostate and bladder so that urine can flow easily

88
Q

Tramadol class

A

Opiate analgesics

89
Q

Tramadol indications

A

Moderate to severe pain, chronic pain, postoperative pain

90
Q

Metyrapone indications

A

Cushings syndrome/disease - it reduces the production of cortisol by the adrenals

91
Q

Propylthiouracil and Methimazole indications

A

PTU - Used in hyperthyroidism to reduce thryoid hormones

92
Q

Clopidogrel class and indications

A

Anti-platelet medication

Indications: Prevent atherothrombotic events: in PCI (with aspirin), TIA, Peripheral arterial disease, Acute coronary syndrome without ST elevation, acute STEMI, A.fib with at least one rf for vascular event

93
Q

Ticagrelor drug action/class

A

P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependant platelet activation and aggregation

94
Q

Ticagrelor indications

A

Preventing artherothrombotic events in patients with: acute coronary syndrome, history of MI

95
Q

Name two fibrinolytic agent used in the management of STEMI

A

Streptokinase, Alteplase and Tenecteplase

96
Q

Fondaparinux class and indications

A

Antithrombin therapy, used for the management of NSTEMI unless the patient has a high bleeding risk

97
Q

What are the 6 A’s of secondary prevention of an Acute Coronary syndrome?

A

Aspirin
Another anti-platelet e.g. ticagrelor or clopidogrel
Atorvastatin
ACE inhibitor e.g. ramipril
Atenolol or another beta-blocker
Aldosterone antagonist for those with clinical heart failure (eplerenone)

98
Q

Risks of using ACE inhibitor and aldosterone antagonists

A

Hyperkalaemia

99
Q

Ticagrelor mechanism of action

A

Inhibits ADP binding to platelet receptors. Prevents activation of glycoprotein IIb/IIIA complex so ADP cannot bind which limits platelet aggregation

100
Q

Aspirin mechanism of action

A

irreversibly binding to COX, an enzyme that converts arachidonic acid to prostaglandin – one of these is Thromboxane A2 which facilitate platelet aggregation

101
Q

DOAC mechanism of action

A

Directly inhibit clotting factor Xa

102
Q

Warfarin mechanism of action

A

Inhibits production of Vit K dependant clotting factors (2,7,9,10)

103
Q

Dabigatran Mechanism of action

A

Thrombin inhibitor

104
Q

Why can beta blockers worsen peripheral artery disease

A

Beta-blockers should be avoided in peripheral artery disease as they can restrict blood flow to peripheral blood vessels, by blocking beta-adrenergic receptors, hence worsening oxygen delivery

105
Q

Mechanism of action of thiazide like diuretics

A

Thiazides/thiazide-like drugs (e.g. indapamide) - inhibits sodium reabsorption by blocking the Na+-Cl− symporter at the beginning of the distal convoluted tubule

106
Q

Hydroxycarbamide indications and action

A

Sickle cell anaemia

Stimulated production of HbF which has a protective effect against sickle cell crises and acute chest syndrome

107
Q

Hydroxyurea indications and action

A

Prophylaxis for painful episodes in sickle cell anaemia, causes increased HbF

2A Medicine Sam (12 decks)

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