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FINALS > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Ramipril - class and mechanism

A
  • ACEi = enalapril, lisinopril, captopril
  • Competitive inhibitor
  • Inhibits synthesis of AG2 which is a vasoconstrictor
  • Therefore = vascular smooth muscle relaxation and vasodilation
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2
Q

ACEi - dose

A
  • initially 1.25 - 2.5mg once daily for HTN
  • Can be increased to 10mg a day
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3
Q

ACEi SE and contraindications

A
  • SE = persistent dry cough, hyperkalaemia, renal failure
  • CI = caution if on diuretics or renal impairment, pregnancy
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4
Q

ACEI monitoring

A
  • renal function and electrolytes before starting and during treatment
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5
Q

BB - examples and mechanism

A
  • Bisoprolol, atenolol, metoprolol
  • target beta adrenoreceptors in heart, peripheral vasculature, bronchi
  • Competitive antagonist
  • Inhibits binding of normal ligand noradrenaline released from sympathetic adrenergic neurons –> inhibits activation of adenylyl cyclase enzymes –> reduced CAMP
    –> reduced intracellular Ca
  • Reduced contractility, reduced heart rate
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6
Q

BB dose

A
  • Angina = 5mg OD up to 10
  • HF = 1.25 and increase
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7
Q

BB SE + contraindications + monitoring

A
  • SE = dizziness, fatigue, impotence
  • CI = COPD, asthma, DM, heart block
  • Probably not in preg and BF
  • Monitor lung function in COPD
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8
Q

CCB examples and mechanism

A
  • amlodipine, felodipine, lercanidipine, nidefipine
  • Antagonist
  • Inhibits influx of ca into vascular smooth muscle cells through L type Ca channels
  • Therefore decreased arterial smooth muscle contractility –> vasodilation
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9
Q

CCB dose

A
  • Initially 5mg OD and increase to 10mg
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10
Q

CCB SE and contraindications

A
  • CI = cardiogenic shock, aortic stenosis, unstable angina
  • SE = abdo pain, dizzy
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11
Q

ARB examples and mechanism

A
  • Candesartan, losartan, valsartan
  • Competitive antagonist
  • Selective inhibition of potent vasoconstrictor peptide angiotensin 2
  • Vascular smooth muscle and vasodilation
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12
Q

ARB dose

A

Candesartan = start 4mg, maintenance 8-32mg
Losartan = 50mg OD

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13
Q

ARB SE and CI

A
  • Hypotension
  • CI = aortic of mitral stenosis
  • No in pregnancy or BF
  • Monitor renal function
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14
Q

Aspirin mechanism of action

A
  • Targets cyclooxygenase enzymes
  • Irreversible inhibitor
  • Impairs synthesis of thromboxane A2 and prostacyclin within platelets
  • Therefore reduces platelet aggregation
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15
Q

Aspirin dose

A

75mg for secondary prevention

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16
Q

Aspirin SE and CI

A
  • CI = peptic ulcer, bleeding disorders, under 16s, haemophilia, asthma
  • SE = GI irritation, ulceration and bleeding, bronchospasm
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17
Q

Clopidogrel mechanism of action

A
  • ADP receptor pathway inhibitors
  • Irreversible inhibitor of ADP receptor
  • Inhibits binding of ADP to platelet receptor –> inhibits platelet aggregation
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18
Q

Clopidogrel dose

A

75mg for prevention
ACS = 300-600mg loading dose

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19
Q

Clopidogrel SE and CI

A
  • CI = active bleeding, caution in hepatic and renal impairment
  • Avoid in pregnancy
  • SE = GI discomfort
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20
Q

Statin mechanism of action

A
  • HMG co-enzyme A reductase inhibitors
  • Competitive inhibitor
  • inhibition if HMG co-enzyme A reductase reduces hepatic cholesterol synthesis through mevalonate pathway
  • Upregulation of LDL receptor and increased hepatic removal of LDL from circulation
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21
Q

Statins dose

A

10mg OD and can increase to 80

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22
Q

Statins monitoring, SE and CI

A
  • CI = caution if myositis/rhabdomyolysis or liver disease
  • No in pregnancy
  • SE = arthralgia, GI
  • Monitoring = lipid profiles, LFTs, CK
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23
Q

LMWH examples and mechanism of action

A
  • Enoxaparin, dalteparin, tinzaparin
  • Inhibit factor Xa which is needed to convert prothrombin to thrombin, therefore coagulation inhibited
  • DOAC = anticoagulant
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24
Q

LMWH dose

A
  • VTE pregnancy = 40-100mg 2X
  • DVT prophylaxis = 20mg - 40mg
  • DVT/PE tx = 1.5mg/kg every 24hrs
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25
Q

LMWH SE and CI

A
  • CI = endocarditis, trauma, renal impairement, haemorrhagic disorders
  • SE = haemorrhage, thrombocytopenia
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26
Q

What can happen when restarthing levothyroxine after a cessation?

A
  • CO suddenly increases
  • Angina, palpitations, SOB, HF
  • So should be reinitiated at a low dose and gradually increased
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27
Q

NSAID examples and mechanism

A
  • ibuprofen, naproxen, diclofenac
  • Target cox-2 enzymes and cox-1 isoform also affected
  • Inhibit cix-mediated conversion of arachidonic acid to prostaglandins and thromboxanes = vasodilation, oedema, pain
28
Q

NSAID dose

A
  • Ibuprofen = 300-400mg 3-4 times a day
  • Naproxen = 0.5-1g daily in rheumatic
29
Q

NSAID SE and CI

A
  • Gastric irritation, ulceration and bleeding
  • Compromised renal blood flow
  • Caution in asthma
30
Q

Paracetamol mechanism of action

A

inhibits synthesis of prostaglandins from arachidonic acid = cox3 enzyme
- peripherally blocks generation of pain impulses, reduced central pain signalling

31
Q

paracetamol dose

A

0.5-1g every 4-6 hours, max 4g daily

32
Q

PPI examples and mechanism of action

A
  • lansoprazole, pantoprazole, omeprazole
  • target H K ATPase pump at the secretory surface of gastric parietal cells
  • Irreversible inhibitor = inhibits final transport of hydrogen ions into gastric lumen
33
Q

PPI dose

A
  • 20-40mg
34
Q

PPI SE and CI

A
  • GI disturbance
  • rebound acid hypersecretion
  • if red flags rule out GI malignancy before prescribing
35
Q

Antiplatelet examples and mechanism of action

A
  • Clopidogrel, prasugrel
  • inhibits binding of adp to platelet receptor therefore prevents platelet aggregation
36
Q

Antiplatelet dose

A
  • secomdary prevention 75mg
  • loading dose for MI 300mg
37
Q

Antiplatelet SE and CI

A
  • GI disturbance
  • not in pregnancy
  • caution in hepatic and renal impairment
38
Q

Loop diuretics examples and mechanism of action

A
  • furosemide, bumetanide
  • competitive inhibitor at the chloride binding site of the symporter
  • prevents transport of sodium from the lumen of loop of henle = diuresis
39
Q

Loop diuretic dose

A
  • 20-40mg for oedema
  • 80mg for resistant htn
40
Q

Loop diuretic se and ci

A
  • postural hypotension, electrolyte disturbances = hypok
  • caution in hypovolaemia
  • avoid in anuria, hypona/k
41
Q

K sparing diuretics and mechanism of action

A
  • spironalacton and epleronone
  • competitive antagonist targets intracellular aldosterone receptors in renal tubules
42
Q

K sparing dose

A
  • HF = 25-50mg
  • ascites = 50BD - 200BD
43
Q

K sparing SE and CI

A
  • GI upset, hyperk
  • avoid in addisons
44
Q

Thiazide diuretic SE and CI

A
  • hypokalaemia
  • hyponatraemia
  • hypercalcaemia and glycaemia
  • gout
  • avoid in addisons
45
Q

thiazide diuretics examples and MoA

A
  • bendroflumethiazide, indapamide
  • inhibitor, targets Na Cl symporter in DCT, inhibits NaCl reabsorption therefore reduce BV and rpessure
46
Q

thiazide diuretic dose

A
  • Bendro = 5-10mg for oedema, 2.5 for HTN
47
Q

aminosalicylates examples and MoA

A
  • mesalazine, sulfasalazine
  • inhibits prostaglandin production = reduces colonic inflammation
48
Q

SE and dose for mesalazine

A
  • GI upset
  • 1.2 - 4.8g until remission then 2.4g
49
Q

SSRI exmaples and MoA

A
  • fluoxetine, sertraline, citalopram
  • prevents re-uptake of serotonin from cleft = prolonged serotonin = prolonged neuronal activity
50
Q

SSRI SE and CI

A
  • GI upset
  • anorexia
  • Bleeding
  • NMS
  • CI = epilepsy, DM, pregnancy, mania
51
Q

Sertraline dose

A
  • 50mg OD then increase in 50mg to max 200
52
Q

TCA examples and MoA

A
  • amitryptilline, nortryptilline
  • increased presence of serotonin and noradrenaline in cleft
53
Q

amitriptyline dose

A
  • 75mg daily starting dose
  • 150-200mg
54
Q

amitryptilline SE and CI

A
  • antimuscarinic, weight gain, abdo pain
  • cardiotoxic in overdose
  • CI = hepatic, elderly, suicude risk, epilepsy
55
Q

dopamine antagonist anti-emetics

A
  • domperidone
  • mecoclopramide 10mg up to 3Xd
  • prokinetic effect on GI tract
  • extrapyramidal sx
56
Q

antihistamine anti-emetics

A
  • cyclizine 50mg up to 3xd
  • antimuscarinic
57
Q

5 hydroxytryptamine anti-emetics

A

ondansetron = for emetogenic chemotherapy = 8mg 1hr prior
- consitpation, flushing

58
Q

benzodiazepines examples and MoA

A
  • diazepam, lorazepam
  • hyperpolarization = further excitation
59
Q

SE and Ci diazepam dose

A
  • amnesia, ataxia, confusion
  • psychomotor impairement
  • rep depression
  • 2mg increased to 15-30mg if needed
60
Q

salbutamol MoA

A
  • bronchial smooth muscle relaxation and bronchodilation
61
Q

salbuamol SE and CI

A
  • fin tremor, headaches, cramps
  • hypokalaemia
62
Q

salbutamol doses

A
  • ingaler = 100-200mcg 4xd
  • nebs = 2.5 - 5mg 4xd
  • powder 200-400mcg 4xd
63
Q

alendronic acid moa, dose, se

A
  • bisphosphonate
  • prevents further reduction in bone mass
  • 10mg daily
  • SE = gi, oesophagitis, necrosis jaw
  • empty stomach, 30mins pre breakgast
64
Q

corticosteroids moa

A
  • upregulation of gene transcription
65
Q
A

FINALS (31 decks)

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