PHARMACOLOGY Flashcards
1
Q
nephrotic syndrome allows large protein mainly which one to appear in the urine
A
albumin
2
Q
loop diuretics act where
A
thick ascending loop of henle
3
Q
diuretics that work in the early distal convuluted tubule
A
thiazide and potassium sparing
4
Q
where do carbonic anhydrase inhibitors work?
A
proximal coveted tubule and early distal convoluted tubule
5
Q
potassium sparing drugs act where
A
collecting tubule and duct
6
Q
na/cl
A
thiazides
7
Q
site of action of most diuretics
A
apical membrane
8
Q
thiazides and loops are transported by
A
organic anion transports as they are acidic drugs
9
Q
main transporter in the basolateral membrane
A
OCT2
10
Q
examples of loop
A
furosemide and bumetanide
11
Q
loop diuretics bind to what site
A
Cl
12
Q
what increases excretion of ca and mg and na
A
loops
13
Q
loops have an additional good feature in pulmonary oedema caused by heart failure
A
indirect venodilator action
14
Q
loops are absorbed from where
A
GI tract
15
Q
what diuretics are preferred in hypertension
A
thiazides
16
Q
what can reduce acute hypercalcaemia
A
loops
17
Q
effects of loops
A
hypokalaemia, metabolic alkalosis, hypocalcaemia and hypomagnesium, hypotension
18
Q
what diuretics can precipitate gout attack
A
loop as a complication is hyperuricaemia
19
Q
example of thiazide
A
bendroflumethiazide
20
Q
indapamide and metolazone are
A
thiazide like diuretic
21
Q
what diuretic is used in nephrolithiasis
A
thiazide
22
Q
diuretic that can be used in nephrogenic DI
A
thiazide
23
Q
loop diuretics have similar side effects to thiazides but one that is different is
A
thiazides do not cause hypocalcaemia which is an advantage for elderly patients with osteoporosis
24
Q
activating what channel develops hypokalaemia
A
ROMK
25
aldosterone acts via what receptors
cytoplasmic
26
aldosterone increases synthesis of what
channel activating protease, epithelial Na channel, na/K ATPase
26
aldosterone increases synthesis of what
channel activating protease, epithelial Na channel, na/K ATPase
27
examples of K sparing diuretics
spironolactone and eplerenone
28
what drugs compete with aldosterone
potassium sparing
29
spironolactone is metabolised to what
canrenone
30
potassium sparing agents if given alone would cause what
hyperkalaemia
31
what potentiate the actions of thiazide
potassium sparing - (aldosterone receptor antagonists)
32
aldosterone antagonists( K sparing) used in
primary hyperaldosteronism (conns)
33
don't give k sparing in
hyperkalaemia and Addisons
34
osmotic diuretic
mannitol
35
what are used in the prevention of acute hypovalamei renal failure to maintain urine flow
osmotic diureteic s
36
osmotic diuretics can also be used acutely
in raised intracranial or raised intraocular pressure
37
what oppose the absorption of water in parts of the nephron that are freely permeable to water
osmotic diuretics
38
major action of osmotic diuretic is
proximal tubule
39
where does most iso-osmotic reabsorption fo water occur
proximal tubule
40
adverse effects of osmotic diuretics
transient expansion of blood volume and hyponatraemia
41
osmotic diuresis can occur in
hyperglycaemia, radio contrast dyes in imaging that can cause hypotension
42
carbonic anhydrase inhibitor
acetozolamdide
43
carbonic anhydrase inhibitors increase excretion of what
bicarbonate, Na, K and H20 (alkaline diuresis) so can cause metabolic acidosis as a result
44
carbonic anhydrase can be used
prophylaxis of altitude sickness, alkalinise the urine for relief in dysuria, glaucoma and after eye surgery as reduce pressure by suppressing formation of aqueous humour
45
aldosterone is secreted from where
adrenal cortex
46
aldosterone does what
enhance Na reabsorption and salt retention
47
vasopressin is an
anti -duretic hormone
48
vasopressin is secreted from where
posterior pituitary
49
vasopressin does what
enhance water reabsorption
50
difference between aldosterone and vasopressin actions
aldosterone enhances na reabsorption and vasopressin enhances water reabsorption
51
what are antaogonists of vasopressin
vaptans
52
tolvaptan is an antagonist of what
V2
53
V2 receptor causes what
excretion of what without accompanying sodium so there is a rise in Na
54
tolvaptan is used in
SIADH to to correct hyponatraemia and in PCKD
55
prostaglandin synthesised in the medulla
PGE2
56
prostaglandin synthesised in the gloemruli
PGI2
57
how do prostaglandins affects afferent arteriole
vasodilator
58
prostaglandins release renin that leads to angiontensin II that does what to efferent arteriole
vasoconstrictor
59
what stimulates prostaglandins
ischaemia, mechanical trauma, angiotensin II, ADH, bradykinin
60
what drugs are particularly detrimental to renal failure
ACEi/arb, diuretic, NSAID
61
uric acid is from
purines
62
what blocks reabsorption of urate in proximal tubule
Probenecid and sulfinpyrazole
63
what inhibits urate synthesis
allopurinol
64
common treatment for sepsis
gentamicin
65
what can cause cluster headaches
methysergide
66
what drug reaction are dose independent and unpredictable
B?
67
what drug reaction are dose independent and unpredictable
B
68
drug rashes are what type of drug reaction
B
69
Cushing disease from steroid and diabetes from beta blockers
type C - chronic effect from prolonged therapy
70
woman taking isotetinoin can cause
craniofacial abnormaliteis in chidlren
71
type e reactions are
end of treatment, withdrawl effects
72
allopurinol hypersensitivity with
HLA B5801
73
what changes dose of medications
cytochrome P450 metabolisation rates
74
report adverse drug reactions
yellow card scheme- even if you suspect it was the drug still meed to report
75
wax solvents
sodium bicarbonate, olive and almond oil
76
what is a side effect of ear drops
dizziness if drop is not close to body temperate- lateral semicircular canal is stimulated bu temperature difference
77
risk of ototoxicity with what antibiotics in patients with perforated tympanic membrane
amino glycoside
78
outer corneal layer is
epithelium
79
inner corneal layer is
stroma
80
epithelium likes
fat
81
what drug has both lipophilic and hydrophilic properties
chloramphenicol
82
what can reduced the hydrophobic epithelium
ocular inflammation
83
alcohol or acetate makes steriod
like fat
84
phosphate make steriod like
water
85
what is good for inflamed cornea
prednisone phosphate
86
what can increase corneal permeability
benzalkonium chloride
87
what can reduce nasty taste in back of throat
punctual occlusion
88
what is a common contaminant for ear drop bottles
pseudomonas
89
many intravitreal drugs are toxic to what
retina
90
when is intra virtual drugs used
antibiotics in endophthalmittis, intra-ocular steroids, anti- VEGF
91
what is an injection in to the anterior chamber fo the eye
intracameral
92
what inhibits peptide transferase
chloramphenicol
93
what is chloramphenicol bacteriostatic for
staph
94
when to not give chloramphenicol
aplastic anaemia or newborns - grey baby syndrome
95
what are beta lactase
penicillins and cephalosporins
96
ofloxacin is an
quinolone
97
quinolones does what
inhibits DNA gyrase
98
DNa gyrase does what
compresses bacteria into supercoils
99
what is used for dendritic ulcers of the cornea
gangliclovir
100
ganglicovr does what
inhibits viral DNA synthesis
101
steriod eye drops are used
post op cataract
uveitis
prevent corneal graft rejection
102
when to not use steriod eye drops
dendritic ulcer as can cause corneal melt
103
eye effects of steroids if sued prolonged
cataract, glaucoma
104
what can cause gastric ulcer
steriods
105
prostanoid do what
open up drainage for aqueous humor
106
prostonoid example
latanoprost
107
beta blocker for eyes
timolol
108
alpha agonist for glaucoma
brimonidine
109
brimonidine is contraindicated when
children
110
parasympathetic that results in miosis
pilocarpine
111
side effect of pilocarpine
night blindness
112
what measures IOP pressure
tonometry
113
what blocks sodium channels
anaesthetic
114
what can diagnose nasoplacrimal duct obstruction
dyes
115
mydratic drugs
tropicamide and cyclopentolate
116
what is applied before fundoscopy to aid examination
mydriatics
117
mydriatics can precipitate what
AACG
118
sympathetics that can also dilate the pupil
atropine- causes cyceopegia and phenylephrine which does not
119
alcohol and ethambutol can cause what
optic atrophy
120
what can cause red tears
rifampicin - can stain contacts
121
what drug can change colour appreciation
digoxin
122
chloroquine can cause
maculpoathy
123
amiodarone can cause
corneal verticillata
124
when is short acting insulin taken
before each meal
125
why are analogue insulin better
have a longer duration of action with less peak activity
126
when is metformin contraindicated
renal, cardiac and hepatic failure
127
if renal function fails what should you do to metformin
decrease it
128
alternative first line treatment where cost is a major issue
sulphonylureas ?
129
alternative first line treatment where cost is a major issue
sulphonylureas
130
is insulin anabolic or catabolic
anabolic- as it promotes synthesis of glycogen
131
insulin stimulates what
appetite
132
are sulphonylureas dependent on glucose
no
133
tzds are particularly potent in who
obese women
134
tzds are generally avoided in patients over what age due to side effects
65
135
ppar- gamma is a what receptor
nuclear
136
TZDs reduces insulin...
resistance
137
net results of TZDs
increase insulin sensitivity
138
tzds increase what which acts on liver to increase insulin sensitivity
adiponectin
139
tzds does what to weight
weight gain
140
fracture risk doubles with what diabetic drug
tzd
141
can get mild anaemia in
TZDs
142
what kind of CVD do you give GLP-1
atherosclerotic eg previous MI
143
GLP-1 agonist or antagonist
agonist
144
what drug reduced blood pressure en diabetes
GLP-1
145
when are gLP angonsits contraindicated
history of pancreatitis
146
are GLP-1 glusose dependent
yes - incretin pathway is hence why there is no risk of hypoglycaemia
147
Gi effects also seen in what d drug
GLP-1
148
how do you take a GLP -1
SC
149
what can be used as a mono therapy when metformin is not tolerated
DDP4i
150
DDPI4 like glp 1 can also
lower blood pressure
151
nausea and pancreatitis are effect of what
dpp4i
152
what is first line if heart failure or chronic kidney disease
metformin and sglt2i
153
action of sglt2i on afferent arteriole
decrease dilation
154
what can be a mild diuresis
sglt2i
155
what drug increases urate excretion so good in gout
sglt2i
156
what increases na delivery to distal convoluted tubule
sglt2i
157
na does what to renal afferent
reduces vasodialtion
158
what are fuel to cardiac mycoyetes
FFA and ketones from sglt2i
159
sglt2i can cause hypovaalemia and DKA so should be omitted when
prolonged fasting or acute illness
160
levothyroxine is T
4
161
what medications can impair absorption of levothyroxine
PPIs, iron and calcium tablets
162
why does dose requirements increase in pregnancy of levothyroxine
increase TBG
163
first line for hyperthyroidism
carbimazole
164
carbimazole inhibits what
TPO- thyroid peroxidase
165
what is the risk of carbimazole in early pregnancy
aplasia cutis
166
when is propyluracil used in pregnancy
first trimester
167
can you use antithyroid drug again after agranulocytosis
no
168
when to suspect angranulocytosis
fever, oral ulcer or oropharyngeal infection
169
what is the action of propylthiouracil
inhibits DIO1 which decreases conversion of T4 to T3
170
what should you monitor when on propyluracil
LFTs as small risk of fulminant hepatic failure
171
why is propanol the drug of choice for symoptamtic relief of thyrotoxic
addition benefit of inhibition DIO1
172
what should be used instead to control thyrotoxisos symptoms if eg got asthma so can't use beta blockers
CCB eg diltiazem
173
when should testosterone contraindicated
hormonal cancer eg prostate. severe sleep apnoea or heart failure
174
why is testosterone cause risk of stroke/MI
can cause polycythaemia so monitor FBC
175
why is testosterone not given in prostate cancer ?
it does not cause it but may cause it to grow
176
what is the thing with somatostatin analogues for pituitary adenoma
shrinks tumour by tumour re-expamds after stopping treatment
177
what can be used before surgery in agromagealy to relieve symptoms
somatostatin analogues
178
local stinging and long term gallstones are adverse effects of
somatostatin analogues
179
somatostatin analogues
sandostain, lanreotide, pasireotide
180
dopamine agonist example
cabergolien
181
what drug shrinks prolactinoma tumour in most cases so no need for surgery
dopamine agonists
182
dopamine agonists acts on what receptors
D2
183
what can cause fibrosis of heart valves
dopamine agonists
184
gh antagonist
pegvisoman
185
what is last lien as very expensive
pegvisomant
186
diclofenac is a
NSAID
187
are most NSAIDs selective or non selective of COX
non selective
188
when are NSAIDs contraindicated
peptic ulcer disease
189
effect of NSAIDs
dyspepsia - indigestion
190
wheeze can be caused in asthma if on
NSAIDs
191
what other arthritis is methotrexate used
psoriatic
192
what is a folate ANTAGONSIST
methotrexate
193
what is a contraindication of methotrexate
it is teratogenic so must be stopped in females at least 3 months before conception
194
why is leukopenia/ thrombocytopenia side effects of methtotrexate
it suppresses bone marrow
195
why must alcohol intake must be limited if on methotrexate
risk of hepatitis/ cirrhosis
196
methotrexate can cause what lung effect
pneumonitis
197
methotrexate can be co prescribed with what
folic acid
198
leflunomide is a
DMARD
199
what is a pyrimidine synthesis inhibitor - inhibits the mitochondrial enzyme dihyroorotate dehydrogenase
leflunomide
200
bad things about leflunomide
teratogenic and very long half life so requires wash out
201
what DMARD should be used with caution in acute porphyrias
sulfasalazine
202
what DMARD can cause reversible oligozoospermia
Sulfasalazine
203
what DMARD has no effect on joint damage
hydroxychloroquine
204
why do hydroxychloroquine need every year
optometry check ups
205
penclliamine and sodium aurothiomalate(gold) are
DMARDs
206
when are anti- TNF given in ankylosing spondylitis
after 2 NSAIDs
207
the only anti-TNF licensed in pregnancy/ breastfeeding
certolizumab
208
what trimester is antiTNF normally advised to stop
third
209
what are adverse effects of anti-TNF
risk of infection (especially tb) and may increase risk of malignancy especially skin cancer
210
what is a monoclonal antibody again CD20 lymphocytes
rituximab
211
tocilizumab is a
inhibits IL-6
212
weight gain from steroids is
centripetal
213
when is allopurinol contraindicated
renal impairment
214
allopurinol can be started 4-6 weeks after attack but what should also be prescribed for first 6 months so there issnt too much of a rapid reduction in uric acid that can result in further exacerbation of gout
NSAIDs
215
allopurinol interacts with what other drug
azathioprine
216
if allopurinol not tolerated
febuxostat
217
when can you consider biphosphonates if T score is under 1.5? as opposed to 2.5
steriod treatment of greater than 7.5mg pednisolone for 3 months or if there is a vertebrae fracture
218
what drugs are ingested by osteoclasts
biphosphonates
219
biphosphonates are analogues of what
pyrophosphate
220
long term side effects of biphosphonates are
osteonecrosis of jaw
oesophageal cancer
atypical fractures
221
second line for osteoporosis
zoledronic acid
222
zoeldronic acid is delivered by
IV
223
how to manage acute reaction from zoledronic acid
paracetamol
224
denosumab
another second line for osteoporosis
is a monoclonal antibody that binds to RANKL
225
RANK does what
increase osteoclast activity to denosumab binds and inhibits it
226
densoumab can cause
hypocalcaemia
227
what is recommended to reduce risk of vertebrae and non vertebral fractures in post menopausal woman with severe osteoporosis
Teriparatide
228
when to give teriparatide. over biphosphonate to post menopausal woman
if got at least 2 moderate vertebrae fracture or 1 severe
229
what is a recombinant parathyroid hormone that stimulates bone growth rather than reduce bone loss
teriparatide
230
drug for postmeonpausual woman with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture within the next 2 years
Romosozunab
231
romosozunab inhibits what
sclerotostin
232
stratum corneum consists of
corneocytes and lipids
233
corticosteroids are soluble to what
lipid
234
topical drug delivery involves
diffusion
235
an advantage of topical drug
avoid first pass metabolism
236
what is the best drug, base combo for topically getting into skin
lipophilic drug in a hydrophobic base
237
subcutaneous is inserted into
adipose tissue
238
what has high lipid content bu too preservatives
ointment
239
lotions suspended in what cause stinging
alcohol
240
what are generally sued to treat hair bearing areas such as scalp
lotions
241
gels used for
face and hear bearing areas
242
zinc oxide
paste
243
avoid emollients containing
SLS
244
clobetasol propinate is a very potent
steriod
245
steroids in psoriasis can trigger
pustular psoriasis
246
what 2 things can increase penetration of steriod
urea and salicylic acid
247
steroids can cause
steriod rosacea
may mask infections eg Tina incogneto
pustular psoriasis if steroids stopped
248
permanent effects fo steroids
glaucoma and cataract, hirsutism, stretch marks, easy bruising (thinned epidermis) and telangiectasia
249
calcineurin inhibitors can be used in what kind of eczema
atopic
250
menthol can
reduce itch
251
capsaicin can also reduced itch by
deplete substance P
252
what can be used for Bowens disease
5-flurouracil
253
imiquid can be sued for
superficial basal cell carcinoma
