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notion 2 > PHARMACOLOGY > Flashcards

PHARMACOLOGY Flashcards

1
Q

nephrotic syndrome allows large protein mainly which one to appear in the urine

A

albumin

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2
Q

loop diuretics act where

A

thick ascending loop of henle

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3
Q

diuretics that work in the early distal convuluted tubule

A

thiazide and potassium sparing

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4
Q

where do carbonic anhydrase inhibitors work?

A

proximal coveted tubule and early distal convoluted tubule

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5
Q

potassium sparing drugs act where

A

collecting tubule and duct

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6
Q

na/cl

A

thiazides

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7
Q

site of action of most diuretics

A

apical membrane

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8
Q

thiazides and loops are transported by

A

organic anion transports as they are acidic drugs

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9
Q

main transporter in the basolateral membrane

A

OCT2

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10
Q

examples of loop

A

furosemide and bumetanide

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11
Q

loop diuretics bind to what site

A

Cl

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12
Q

what increases excretion of ca and mg and na

A

loops

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13
Q

loops have an additional good feature in pulmonary oedema caused by heart failure

A

indirect venodilator action

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14
Q

loops are absorbed from where

A

GI tract

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15
Q

what diuretics are preferred in hypertension

A

thiazides

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16
Q

what can reduce acute hypercalcaemia

A

loops

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17
Q

effects of loops

A

hypokalaemia, metabolic alkalosis, hypocalcaemia and hypomagnesium, hypotension

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18
Q

what diuretics can precipitate gout attack

A

loop as a complication is hyperuricaemia

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19
Q

example of thiazide

A

bendroflumethiazide

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20
Q

indapamide and metolazone are

A

thiazide like diuretic

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21
Q

what diuretic is used in nephrolithiasis

A

thiazide

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22
Q

diuretic that can be used in nephrogenic DI

A

thiazide

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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

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24
Q

activating what channel develops hypokalaemia

A

ROMK

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25
Q

aldosterone acts via what receptors

A

cytoplasmic

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26
Q

aldosterone increases synthesis of what

A

channel activating protease, epithelial Na channel, na/K ATPase

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26
Q

aldosterone increases synthesis of what

A

channel activating protease, epithelial Na channel, na/K ATPase

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27
Q

examples of K sparing diuretics

A

spironolactone and eplerenone

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28
Q

what drugs compete with aldosterone

A

potassium sparing

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29
Q

spironolactone is metabolised to what

A

canrenone

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30
Q

potassium sparing agents if given alone would cause what

A

hyperkalaemia

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31
Q

what potentiate the actions of thiazide

A

potassium sparing - (aldosterone receptor antagonists)

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32
Q

aldosterone antagonists( K sparing) used in

A

primary hyperaldosteronism (conns)

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33
Q

don’t give k sparing in

A

hyperkalaemia and Addisons

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34
Q

osmotic diuretic

A

mannitol

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35
Q

what are used in the prevention of acute hypovalamei renal failure to maintain urine flow

A

osmotic diureteic s

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36
Q

osmotic diuretics can also be used acutely

A

in raised intracranial or raised intraocular pressure

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37
Q

what oppose the absorption of water in parts of the nephron that are freely permeable to water

A

osmotic diuretics

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38
Q

major action of osmotic diuretic is

A

proximal tubule

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39
Q

where does most iso-osmotic reabsorption fo water occur

A

proximal tubule

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40
Q

adverse effects of osmotic diuretics

A

transient expansion of blood volume and hyponatraemia

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41
Q

osmotic diuresis can occur in

A

hyperglycaemia, radio contrast dyes in imaging that can cause hypotension

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42
Q

carbonic anhydrase inhibitor

A

acetozolamdide

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43
Q

carbonic anhydrase inhibitors increase excretion of what

A

bicarbonate, Na, K and H20 (alkaline diuresis) so can cause metabolic acidosis as a result

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44
Q

carbonic anhydrase can be used

A

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

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45
Q

aldosterone is secreted from where

A

adrenal cortex

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46
Q

aldosterone does what

A

enhance Na reabsorption and salt retention

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47
Q

vasopressin is an

A

anti -duretic hormone

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48
Q

vasopressin is secreted from where

A

posterior pituitary

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49
Q

vasopressin does what

A

enhance water reabsorption

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50
Q

difference between aldosterone and vasopressin actions

A

aldosterone enhances na reabsorption and vasopressin enhances water reabsorption

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51
Q

what are antaogonists of vasopressin

A

vaptans

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52
Q

tolvaptan is an antagonist of what

A

V2

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53
Q

V2 receptor causes what

A

excretion of what without accompanying sodium so there is a rise in Na

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54
Q

tolvaptan is used in

A

SIADH to to correct hyponatraemia and in PCKD

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55
Q

prostaglandin synthesised in the medulla

A

PGE2

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56
Q

prostaglandin synthesised in the gloemruli

A

PGI2

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57
Q

how do prostaglandins affects afferent arteriole

A

vasodilator

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58
Q

prostaglandins release renin that leads to angiontensin II that does what to efferent arteriole

A

vasoconstrictor

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59
Q

what stimulates prostaglandins

A

ischaemia, mechanical trauma, angiotensin II, ADH, bradykinin

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60
Q

what drugs are particularly detrimental to renal failure

A

ACEi/arb, diuretic, NSAID

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61
Q

uric acid is from

A

purines

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62
Q

what blocks reabsorption of urate in proximal tubule

A

Probenecid and sulfinpyrazole

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63
Q

what inhibits urate synthesis

A

allopurinol

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64
Q

common treatment for sepsis

A

gentamicin

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65
Q

what can cause cluster headaches

A

methysergide

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66
Q

what drug reaction are dose independent and unpredictable

A

B?

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67
Q

what drug reaction are dose independent and unpredictable

A

B

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68
Q

drug rashes are what type of drug reaction

A

B

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69
Q

Cushing disease from steroid and diabetes from beta blockers

A

type C - chronic effect from prolonged therapy

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70
Q

woman taking isotetinoin can cause

A

craniofacial abnormaliteis in chidlren

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71
Q

type e reactions are

A

end of treatment, withdrawl effects

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72
Q

allopurinol hypersensitivity with

A

HLA B5801

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73
Q

what changes dose of medications

A

cytochrome P450 metabolisation rates

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74
Q

report adverse drug reactions

A

yellow card scheme- even if you suspect it was the drug still meed to report

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75
Q

wax solvents

A

sodium bicarbonate, olive and almond oil

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76
Q

what is a side effect of ear drops

A

dizziness if drop is not close to body temperate- lateral semicircular canal is stimulated bu temperature difference

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77
Q

risk of ototoxicity with what antibiotics in patients with perforated tympanic membrane

A

amino glycoside

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78
Q

outer corneal layer is

A

epithelium

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79
Q

inner corneal layer is

A

stroma

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80
Q

epithelium likes

A

fat

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81
Q

what drug has both lipophilic and hydrophilic properties

A

chloramphenicol

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82
Q

what can reduced the hydrophobic epithelium

A

ocular inflammation

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83
Q

alcohol or acetate makes steriod

A

like fat

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84
Q

phosphate make steriod like

A

water

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85
Q

what is good for inflamed cornea

A

prednisone phosphate

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86
Q

what can increase corneal permeability

A

benzalkonium chloride

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87
Q

what can reduce nasty taste in back of throat

A

punctual occlusion

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88
Q

what is a common contaminant for ear drop bottles

A

pseudomonas

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89
Q

many intravitreal drugs are toxic to what

A

retina

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90
Q

when is intra virtual drugs used

A

antibiotics in endophthalmittis, intra-ocular steroids, anti- VEGF

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91
Q

what is an injection in to the anterior chamber fo the eye

A

intracameral

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92
Q

what inhibits peptide transferase

A

chloramphenicol

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93
Q

what is chloramphenicol bacteriostatic for

A

staph

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94
Q

when to not give chloramphenicol

A

aplastic anaemia or newborns - grey baby syndrome

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95
Q

what are beta lactase

A

penicillins and cephalosporins

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96
Q

ofloxacin is an

A

quinolone

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97
Q

quinolones does what

A

inhibits DNA gyrase

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98
Q

DNa gyrase does what

A

compresses bacteria into supercoils

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99
Q

what is used for dendritic ulcers of the cornea

A

gangliclovir

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100
Q

ganglicovr does what

A

inhibits viral DNA synthesis

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101
Q

steriod eye drops are used

A

post op cataract
uveitis
prevent corneal graft rejection

102
Q

when to not use steriod eye drops

A

dendritic ulcer as can cause corneal melt

103
Q

eye effects of steroids if sued prolonged

A

cataract, glaucoma

104
Q

what can cause gastric ulcer

A

steriods

105
Q

prostanoid do what

A

open up drainage for aqueous humor

106
Q

prostonoid example

A

latanoprost

107
Q

beta blocker for eyes

A

timolol

108
Q

alpha agonist for glaucoma

A

brimonidine

109
Q

brimonidine is contraindicated when

A

children

110
Q

parasympathetic that results in miosis

A

pilocarpine

111
Q

side effect of pilocarpine

A

night blindness

112
Q

what measures IOP pressure

A

tonometry

113
Q

what blocks sodium channels

A

anaesthetic

114
Q

what can diagnose nasoplacrimal duct obstruction

A

dyes

115
Q

mydratic drugs

A

tropicamide and cyclopentolate

116
Q

what is applied before fundoscopy to aid examination

A

mydriatics

117
Q

mydriatics can precipitate what

A

AACG

118
Q

sympathetics that can also dilate the pupil

A

atropine- causes cyceopegia and phenylephrine which does not

119
Q

alcohol and ethambutol can cause what

A

optic atrophy

120
Q

what can cause red tears

A

rifampicin - can stain contacts

121
Q

what drug can change colour appreciation

A

digoxin

122
Q

chloroquine can cause

A

maculpoathy

123
Q

amiodarone can cause

A

corneal verticillata

124
Q

when is short acting insulin taken

A

before each meal

125
Q

why are analogue insulin better

A

have a longer duration of action with less peak activity

126
Q

when is metformin contraindicated

A

renal, cardiac and hepatic failure

127
Q

if renal function fails what should you do to metformin

A

decrease it

128
Q

alternative first line treatment where cost is a major issue

A

sulphonylureas ?

129
Q

alternative first line treatment where cost is a major issue

A

sulphonylureas

130
Q

is insulin anabolic or catabolic

A

anabolic- as it promotes synthesis of glycogen

131
Q

insulin stimulates what

A

appetite

132
Q

are sulphonylureas dependent on glucose

A

no

133
Q

tzds are particularly potent in who

A

obese women

134
Q

tzds are generally avoided in patients over what age due to side effects

A

65

135
Q

ppar- gamma is a what receptor

A

nuclear

136
Q

TZDs reduces insulin…

A

resistance

137
Q

net results of TZDs

A

increase insulin sensitivity

138
Q

tzds increase what which acts on liver to increase insulin sensitivity

A

adiponectin

139
Q

tzds does what to weight

A

weight gain

140
Q

fracture risk doubles with what diabetic drug

A

tzd

141
Q

can get mild anaemia in

A

TZDs

142
Q

what kind of CVD do you give GLP-1

A

atherosclerotic eg previous MI

143
Q

GLP-1 agonist or antagonist

A

agonist

144
Q

what drug reduced blood pressure en diabetes

A

GLP-1

145
Q

when are gLP angonsits contraindicated

A

history of pancreatitis

146
Q

are GLP-1 glusose dependent

A

yes - incretin pathway is hence why there is no risk of hypoglycaemia

147
Q

Gi effects also seen in what d drug

A

GLP-1

148
Q

how do you take a GLP -1

A

SC

149
Q

what can be used as a mono therapy when metformin is not tolerated

A

DDP4i

150
Q

DDPI4 like glp 1 can also

A

lower blood pressure

151
Q

nausea and pancreatitis are effect of what

A

dpp4i

152
Q

what is first line if heart failure or chronic kidney disease

A

metformin and sglt2i

153
Q

action of sglt2i on afferent arteriole

A

decrease dilation

154
Q

what can be a mild diuresis

A

sglt2i

155
Q

what drug increases urate excretion so good in gout

A

sglt2i

156
Q

what increases na delivery to distal convoluted tubule

A

sglt2i

157
Q

na does what to renal afferent

A

reduces vasodialtion

158
Q

what are fuel to cardiac mycoyetes

A

FFA and ketones from sglt2i

159
Q

sglt2i can cause hypovaalemia and DKA so should be omitted when

A

prolonged fasting or acute illness

160
Q

levothyroxine is T

A

4

161
Q

what medications can impair absorption of levothyroxine

A

PPIs, iron and calcium tablets

162
Q

why does dose requirements increase in pregnancy of levothyroxine

A

increase TBG

163
Q

first line for hyperthyroidism

A

carbimazole

164
Q

carbimazole inhibits what

A

TPO- thyroid peroxidase

165
Q

what is the risk of carbimazole in early pregnancy

A

aplasia cutis

166
Q

when is propyluracil used in pregnancy

A

first trimester

167
Q

can you use antithyroid drug again after agranulocytosis

A

no

168
Q

when to suspect angranulocytosis

A

fever, oral ulcer or oropharyngeal infection

169
Q

what is the action of propylthiouracil

A

inhibits DIO1 which decreases conversion of T4 to T3

170
Q

what should you monitor when on propyluracil

A

LFTs as small risk of fulminant hepatic failure

171
Q

why is propanol the drug of choice for symoptamtic relief of thyrotoxic

A

addition benefit of inhibition DIO1

172
Q

what should be used instead to control thyrotoxisos symptoms if eg got asthma so can’t use beta blockers

A

CCB eg diltiazem

173
Q

when should testosterone contraindicated

A

hormonal cancer eg prostate. severe sleep apnoea or heart failure

174
Q

why is testosterone cause risk of stroke/MI

A

can cause polycythaemia so monitor FBC

175
Q

why is testosterone not given in prostate cancer ?

A

it does not cause it but may cause it to grow

176
Q

what is the thing with somatostatin analogues for pituitary adenoma

A

shrinks tumour by tumour re-expamds after stopping treatment

177
Q

what can be used before surgery in agromagealy to relieve symptoms

A

somatostatin analogues

178
Q

local stinging and long term gallstones are adverse effects of

A

somatostatin analogues

179
Q

somatostatin analogues

A

sandostain, lanreotide, pasireotide

180
Q

dopamine agonist example

A

cabergolien

181
Q

what drug shrinks prolactinoma tumour in most cases so no need for surgery

A

dopamine agonists

182
Q

dopamine agonists acts on what receptors

A

D2

183
Q

what can cause fibrosis of heart valves

A

dopamine agonists

184
Q

gh antagonist

A

pegvisoman

185
Q

what is last lien as very expensive

A

pegvisomant

186
Q

diclofenac is a

A

NSAID

187
Q

are most NSAIDs selective or non selective of COX

A

non selective

188
Q

when are NSAIDs contraindicated

A

peptic ulcer disease

189
Q

effect of NSAIDs

A

dyspepsia - indigestion

190
Q

wheeze can be caused in asthma if on

A

NSAIDs

191
Q

what other arthritis is methotrexate used

A

psoriatic

192
Q

what is a folate ANTAGONSIST

A

methotrexate

193
Q

what is a contraindication of methotrexate

A

it is teratogenic so must be stopped in females at least 3 months before conception

194
Q

why is leukopenia/ thrombocytopenia side effects of methtotrexate

A

it suppresses bone marrow

195
Q

why must alcohol intake must be limited if on methotrexate

A

risk of hepatitis/ cirrhosis

196
Q

methotrexate can cause what lung effect

A

pneumonitis

197
Q

methotrexate can be co prescribed with what

A

folic acid

198
Q

leflunomide is a

A

DMARD

199
Q

what is a pyrimidine synthesis inhibitor - inhibits the mitochondrial enzyme dihyroorotate dehydrogenase

A

leflunomide

200
Q

bad things about leflunomide

A

teratogenic and very long half life so requires wash out

201
Q

what DMARD should be used with caution in acute porphyrias

A

sulfasalazine

202
Q

what DMARD can cause reversible oligozoospermia

A

Sulfasalazine

203
Q

what DMARD has no effect on joint damage

A

hydroxychloroquine

204
Q

why do hydroxychloroquine need every year

A

optometry check ups

205
Q

penclliamine and sodium aurothiomalate(gold) are

A

DMARDs

206
Q

when are anti- TNF given in ankylosing spondylitis

A

after 2 NSAIDs

207
Q

the only anti-TNF licensed in pregnancy/ breastfeeding

A

certolizumab

208
Q

what trimester is antiTNF normally advised to stop

A

third

209
Q

what are adverse effects of anti-TNF

A

risk of infection (especially tb) and may increase risk of malignancy especially skin cancer

210
Q

what is a monoclonal antibody again CD20 lymphocytes

A

rituximab

211
Q

tocilizumab is a

A

inhibits IL-6

212
Q

weight gain from steroids is

A

centripetal

213
Q

when is allopurinol contraindicated

A

renal impairment

214
Q

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

A

NSAIDs

215
Q

allopurinol interacts with what other drug

A

azathioprine

216
Q

if allopurinol not tolerated

A

febuxostat

217
Q

when can you consider biphosphonates if T score is under 1.5? as opposed to 2.5

A

steriod treatment of greater than 7.5mg pednisolone for 3 months or if there is a vertebrae fracture

218
Q

what drugs are ingested by osteoclasts

A

biphosphonates

219
Q

biphosphonates are analogues of what

A

pyrophosphate

220
Q

long term side effects of biphosphonates are

A

osteonecrosis of jaw
oesophageal cancer
atypical fractures

221
Q

second line for osteoporosis

A

zoledronic acid

222
Q

zoeldronic acid is delivered by

A

IV

223
Q

how to manage acute reaction from zoledronic acid

A

paracetamol

224
Q

denosumab

A

another second line for osteoporosis
is a monoclonal antibody that binds to RANKL

225
Q

RANK does what

A

increase osteoclast activity to denosumab binds and inhibits it

226
Q

densoumab can cause

A

hypocalcaemia

227
Q

what is recommended to reduce risk of vertebrae and non vertebral fractures in post menopausal woman with severe osteoporosis

A

Teriparatide

228
Q

when to give teriparatide. over biphosphonate to post menopausal woman

A

if got at least 2 moderate vertebrae fracture or 1 severe

229
Q

what is a recombinant parathyroid hormone that stimulates bone growth rather than reduce bone loss

A

teriparatide

230
Q

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

A

Romosozunab

231
Q

romosozunab inhibits what

A

sclerotostin

232
Q

stratum corneum consists of

A

corneocytes and lipids

233
Q

corticosteroids are soluble to what

A

lipid

234
Q

topical drug delivery involves

A

diffusion

235
Q

an advantage of topical drug

A

avoid first pass metabolism

236
Q

what is the best drug, base combo for topically getting into skin

A

lipophilic drug in a hydrophobic base

237
Q

subcutaneous is inserted into

A

adipose tissue

238
Q

what has high lipid content bu too preservatives

A

ointment

239
Q

lotions suspended in what cause stinging

A

alcohol

240
Q

what are generally sued to treat hair bearing areas such as scalp

A

lotions

241
Q

gels used for

A

face and hear bearing areas

242
Q

zinc oxide

A

paste

243
Q

avoid emollients containing

A

SLS

244
Q

clobetasol propinate is a very potent

A

steriod

245
Q

steroids in psoriasis can trigger

A

pustular psoriasis

246
Q

what 2 things can increase penetration of steriod

A

urea and salicylic acid

247
Q

steroids can cause

A

steriod rosacea
may mask infections eg Tina incogneto
pustular psoriasis if steroids stopped

248
Q

permanent effects fo steroids

A

glaucoma and cataract, hirsutism, stretch marks, easy bruising (thinned epidermis) and telangiectasia

249
Q

calcineurin inhibitors can be used in what kind of eczema

A

atopic

250
Q

menthol can

A

reduce itch

251
Q

capsaicin can also reduced itch by

A

deplete substance P

252
Q

what can be used for Bowens disease

A

5-flurouracil

253
Q

imiquid can be sued for

A

superficial basal cell carcinoma

notion 2 (9 decks)

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