Pharmacology Flashcards

Question

Azathioprine Class: x2 others in the group: Fluorouracil, Methotrexate Use: x1immunosuppression – autoimmune conditions, suppress transplant rejection Conditions: x 5 ( in most common condition, how is azathiprone used (1st or 2nd line etc) Key info: S/E x 2

Answer 1

Class: DMARD (antimetabolite/immunosuppressant) - Fluorouracil, Methotrexate Use: immunosuppression – autoimmune conditions, suppress transplant rejection Conditions: * Crohn’s o 2nd line (combine with steroids ) to induce remission. o 1st line in maintaining remission * RA * prevent renal transplant rejection. * Severe eczema * Generalised myasthenia gravis Key info: S/E * immunosuppression: Bone marrow depression (dose-related); infection risk; leucopenia; thrombocytopenia * pancreatitis;

Answer 2

Class: corticosteroid [betamethasone, dexamethasone, fudrocortisone, fluticasone, hydrocortisone, methylprednisolone, prednisolone Use/Conditions - Inhalation o Asthma prophylaxis o Oral ulcer - Intranasal o Prophylaxis/Tx allergic / vasomotor rhinitis - Topical o Unresponsive eczema/psoriasis - Oral o Adjunct to aminosalicylates in mild-mod UC Key info: C/I – Live virus vaccines in those with immunosuppressive doses S/E * Inhaled: headache, oral candidiasis [avoid: use spacer device, rinse mouth with water], pneumonia ( in COPD Hx), alered taste/voice) * Intranasal: epistaxis, altered smell/taste, headache, irritated throat * Systemic steroid sx (inc cushings)

Answer 3

Class: Selective B-blocker (see atenolol) Use: HTN, angina, adjunct in HF Conditions: 4th line in HTN

Answer 4

4 steps 55 years 1. ACEi <55> CCB/ thiazide like diuretic 2. ACEi + CCB/ thiazide like diuretic 3. ACEi+CCB+ thiazide like diuretic 4. ACEi+CCB+thiazide like diuretic + A/B-blocker/other diuretic

Answer 5

Bendroflumethiazide Class: thiazide-like diuretic [Indapamide ] Mechanism of action: * Distal tubule: blocks thiazide sensitive NaCl cotransporter in the lumen of distal tubule --> Na (followed by H20 – also Cl) remain in the filtrate --> expelled in urine Use/ Conditions: Oedema, HTN Key info: S/E * (loss of solutes & water) o Dehydration --> AKI o Low chloride, sodium, potassium o Postural hypotension * (loss of water) o ↑ glucose (esp. in diabetics) o ↑ calcium o ↑ uric acid --> gout so Bendroflumathiazide= risk of AKI, postural hypotension, gout C/I: Addison’s disease, hypercalcaemia, hyponatraemia, refractory hypokalaemia, symptomatic hyperuricaemia

Answer 6

1 - sodium valproate 2 Lamtorigine/ carbamazepine

Answer 7

(reverse of generalised tonic-clonic) 1 Carbamazepine/ lamotrigine 2 Sodium valproate/ Keppra

Answer 8

Sodium valproate/ Ethosuximide

Answer 9

sodium valproate lamotrigine

Answer 10

sodium valproate lamotriogine, keppra, topiramate

Answer 11

infantile spasms prednisolone, Vigabatrin

Answer 12

Generalised tonic-clonic, Absence, Atonic, myoclonic 2nd - Focal seizures increases GABA activity --> relaxes brain S/E * teratogenic * liver damage & hepatitis * hair loss * tremor

Answer 13

AKA Carbagen/Tegretol 1st - focal 2nd - Gen tonic-clonic Agranulocytosis Aplastic anaemia Many drug interactions ( induces the P450 system) Trigeminal neuralgia

Answer 14

last line status epilepticus community: Buccal midazolam/ Rectal diazepam 1 - 4mg IV lorazepam 2 (10 mins later) - 4mg IV lorazepam 3 (10 mins later IV phenytoin Folate deficiency --> megaloblastic anaemia Vitamin D deficiency --> osteomalacia

Answer 15

Absence seizures ( along with sodium valproate) Night terrors rashes

Answer 16

1 - focal seizure 2- gen ton-clon, atonic, myoclonic Stevens-johnson/ DRESS syndrome Leucopenia

Answer 17

Carbimazole Mechanism of action: * Antithyroid: reduces uptake & concentration of iodine in thyroid & formation of T3 (di-iodotyrosine) and T4 (thyroxine ) Use/Conditions: Hyperthyroid Key info: Dose: 15-40mg daily Used until pt euthyroid: 4-8weeks

Answer 18

Cefuroxime Class: Second generation Cephalosporins (antibacterials) Common drug name/ others in the group: Mechanism of action: * Attach to penicillin-binding proteins  interrupt cell wall biosynthesis  cell lysis * Broad spec antibiotic Use: G+ve and G-ve bacterial infections (as broad-spec) Conditions: * lyme disease – 1st line in CNS Sx , otherwise Doxycycline for rash only (1st line) * UTI ( lower, catheter associated, acute pyelonephritis) – 1st line IV * Meningitis ( with vancomycin in 0-3m)

Answer 19

Certirizine Class: Non-sedating antihistamines Others in the group: loratadine Use: Sx relief of allergies ( hay fever idiopathic urticaria, atopic dermatitis)

Answer 20

Chloramphenicol NOT TO BE CONFUSED WITH THE SEDATING ANTIHISTAMINE CHLORAMPHENAMINE Class: Antibacterial, other others in the group: co-trimoxazole, fusidic acid, nitrofurantoin, trimethoprim Mechanism of action: * Broad-spec Use/ Conditions: * Superficial eye infection ( eye drop) * Otitis externa * Typhoid Key info: * Pregnancy o Avoid in 3rd trimester  grey baby syndrome (rare, life-threatening conditions following build up of chloramphenicol) * Breastfeeding – bone marrow toxicity

Answer 21

Chloroquine Class: Antimalarial Use: Conditions: * Malaria prophylaxis * Active RA - alternative to DMARD in mild RA/ in addition to DMARD if unresponsive, 1st line in pregnancy (safe where as methotrexate teratogenic) * Systemic/ discoid lupus erythematosus – 1st line mild SLE

Answer 22

Chlorphenamine NOT TO BE CONFUSED WITH THE ANTIBIOTIC CHLORAMPHENICOL Class: sedating antihistamine (Promethazine) Use: * Sx relief of allergy ( hayfever, urticaria, food allergy, drug reactions) * Itch relief (chickenpox) * Anaphylaxis

Answer 23

Chlorpromazine, Haloperidol, Zucpenthixol 1st gen = typical

Answer 24

Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone 2nd gen = atypical

Answer 25

weight gain, glucose intolerance, and hyperprolactinaemia.

Answer 26

Class: 1st gen (typical) antipsychotic others in the group: Haloperidol, Zuclopenthixol Mechanism of action: ?block dopamine-2 receptors Use/ Conditions: * Schizophrenia * Psychosis Key info: * NMS * EPS * QT-interval prolongation

Answer 27

Primaquine (an antimalarial) Ciprofloxacin Nitrofurantoin Trimethoprim Sulfonylureas (e.g gliclazide) Sulfasalazine and other sulphonamide drugs

Answer 28

Ciprofloxacin Class: Quinolone Mechanism of action: Use/ conditions: * Superficial bacterial eye infection * Close contact with confirmed bacterial meningitis * Otitis externa * Pyelonephritis * Key info: * 1 of the meds that triggers acute haemolysis in G6PD deficiency. * Prolong QT interval * Reduce seizure threshold

Answer 29

Class: Platinum compound (chemotherapy) Use/Conditions: Cancer: testicular, ovarian, lung, bladder, SCC head & neck, cervical Key info: S/E * peripheral neuropathy * sensorineural hearing loss (ototoxicity) * nephrotoxicity

Answer 30

A – Alcohol B – B12 deficiency C – Cancer and Chronic Kidney Disease D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin) E – Every vasculitis

Answer 31

Citalopram PSYCH Class: SSRI others in the group: Escitalopram, Fluoxetine, paroxetine, sertraline Mechanism of action: inhibits the reuptake of serotonin (5-HT) Use/Conditions: * depression * panic disorder Key info: dont use in: * epilepsy (porly controlled) * Mania S/E: * QT-interval prolongation * Sexual dysfunction ( even after Tx stopped)

Answer 32

Clopidogrel Class: anti-platelet Common drug name/ others in the group: aspirin, dipyridamole, ticagrelor Mechanism of action: Blocks glycoprotein GPIIb/IIIa complex pathway --> reduced platelet aggregation Use: * Post-MI triple therapy (Aspirin, clopidogrel, anticoagulant) * Prevention: MI/Stroke * Peripheral arterial disease * Preventing atherothrombotic events during PCI (if pt not already on clopidogrel) * Conditions: Key info: Typical dose: * 75mg * Loading dose 300mg Common S/E: * Diarrhoea, GI discomfort, haemorrhage

Answer 33

300mg initially, then 75mg (12/12)

Answer 34

300mg initially, then 75mg (4/52)

Answer 35

Co-amoxiclav Class: penecillins – amoxicillin and clavulanic acid Use: * beta-lactamase-producing strains, where amoxicillin alone not appropriate * broad spec Abx – esp for anaerobic bacteria – unlike simple penecillins (e.g. amoxicillin/ flucloxacillin)

Answer 36

NOT TO BE CONFUSED WITH ANTIFUNGAL CLOTRIMAZOLE Class: Sulfamethoxazole & trimethoprim = sulphonamide AKA Septrin Use: lots of infections Conditions: * Prophylaxis / Tx Pneumocystis jirovecii pnemonia Key info: N/A

Answer 37

Ciclosporin Class: calcineurin inhibitor (immunosuppressant) Common drug name/ others in the group: Pimecrolimus, tacrolimus Use: steroid sparing immunosuppressant - transplants/ severe -acute presentations of conditions Conditions: * Transplants (organ/bone marrow) * Ulcerative colitis * Rheumatoid arthritis * Atopic dermatitis * Psoriasis * SLE Key info: Can cause Hirsutism

Answer 38

Dalteparin Class: heparin Others in the group: Heparin, Enoxaparin, Tinzaparin Mechanism of action: Binds to antithrombin --> binds to Factor Xa --> prevents Factor Xa converting prothrombin to thrombin (factor IIa) --> prevents fibrinogen (factor I) to fibrin --> prevents clotting

Answer 39

Conditions: * DVT tx * PE prevention/ tx * VTE prophylaxis in pregnant women * Unstable coronary artery disease Key info: C/I * Acute bacterial endocarditis S/E * HIT – heparin induced thrombocytopenia. * Haemorrhage

Answer 40

Use in pregnant women * Very high risk – immediately * High risk – 28 weeks * Continue until 6ks postpartum * Stop temporarily during labour (and delivery in postpartum haemorrhage, spinal/epidural)

Answer 41

Acute = MOAN Morphine (10mg in 10ml, titrate for pain) O2 (if below ideal sats) Aspirin (300mg loading dose, then 75mg OD) Nitrites (GTN - in not hypotensive, then PRN) triple therapy 1 - antiplatelet: Aspirin 2 -Antiplatelet: Clopidogrel/ticagrelor 3 - Anticoagulant: Fundaparinoux/ Heparin long term: B-blocker/ ACE-i/Statin

Answer 42

Diamorphine Class: Opioids Mechanism of action: Opioid receptor agonist (binds to the Mu, kappa, delta opioid receptors) Use * Acute pain * Chronic pain * ACS: (MOAN) – Initial management in ACS Key info: S/E * Respiratory depression (OD) &sleep apnoea * Nausea * constipation Caution: * Benzos &opioids = risk of potentially fatal respiratory depression * dependence

Answer 43

Med given in dependence Methadone (tx dendence, also analgesic) Naloxone Signs and mx of OD o Pinpoint pupils (miosis) o Antidote – naloxone

Answer 44

Diazepam Class: Benzo others in the group: Chlordiazepoxide, Clonazepam, Lorazepam, Midazolam Mechanism of action: binds to GABA receptors (GABA is an inhibitory neurotransmitter) --> inhibits transmission across neurones --> sedation. Use/Conditions: * Muscle spasms * Anxiety * Drug induced dystonic activity * Status epilepticus o Rectal diazepam as alternative to 4mg IV lorazepam Key info: - Risks when benzos+opioids = increased risk of sedation, respiratory depression, coma, death

Answer 45

Diclofenac Class: NSAID – aspirin, ibuprofen, mefenamic acid, naproxen Mechanism of action: Use: Analgesia - IV/IM post-op injection, collickey pain (ureteric colic) Eye surgery - Inhibit intra-op miosis - Post-op inflammation prophylaxis Key info: - IV diclofenac = analgesia in renal stone - Conditions it may be inappropriate/ C/I in o Asthma o Renal impairment o Heart disease o Stomach ulcers

Answer 46

Digoxin Class: Antiarrhytmic - cardiac glycoside Mechanism of action: positive ionotrope (increases force of myocardial contration) and reduces conductivity in the AVN Use / Conditions: SVT, Atrial flutter/ fibrillation, heart failure Key info: Common SE: arrhythmia

Answer 47

Class: CCB = amlodipine, nifedipine, verapamil Common drug name/ others in the group: Conditions: Angina, HTN

Answer 48

Dobutamine Class: cardiac stimulant Mechanism of action: acts of B1 receptors in cardiac muscle  increases contractility Use: inotropic support in: infarction, cardiac surgeries, cardiomyopathy, shock (septic/cardiogenic), PEEP

Answer 49

Domperidone Class: Dopamine receptor antagonist (anti-emetic), pro-kinetic Common drug name/ others in the group: metoclopramide (both are prokinetic  GI motility Use/Conditions: N&V/ GI pain in palliative care Key info: * Common S/E – dry mouth * Metoclopramide 1st line except in o Parkinson’s (domperidone has no EPSE) * Not to be combined with meds which slow motility (Ach inhibitors): hyoscine butylbromide, cyclizine, levomepromazine, ondansetron)

Answer 50

Donepezil Class: reversible AChesterase inhibitor (AChEi) others in the group: rivastigmine Use: mild-mod Alzheimer’s

Answer 51

Mild-mod: AChEi (donepezil, rivastigmine) Mod- sev: NMDA antagonist (memantine)

Answer 52

Doxazosin Class: alpha blocker Common drug name/ others in the group: Tamsulosin Mechanism of action: block alpha receptors  relaxation of smooth muscle Use: * HTN (last line addition) * BPH - relaxes muscle Key info: C/I in Hx micturition syncope

Answer 53

Alpha-blockers (doxasozin, tamsulosin) - relax smooth muscle 5-alpha reductase inhibitors (e.g., finasteride) (e.g., finasteride) - reduce size of the prostate

Answer 54

Doxycycline Class: tetracycline Use: infections: CAP/HAP, UTI, human/animal bites, acne vulgaris, STIs Key info: Acne vulgaris: doxyclyline( or lymecycline) – 6months Lyme disease: 21 days when suspected. Uncomplicated Chlamydia: 1st line doxycline 100mg BD 7/7 PID – part of triple therapy S/E – sun sensitivity C/I preggers/ breastfeeding

Answer 55

1. single dose IM ceftriaxone 1g (gonorrhoea) 2. Doxycycline 100mg BD 14/7 (chlamydia and Mycoplasma genitalium) 3.Metronidazole 400mg BD 14/7 (anaerobes e.g Gardnerella vaginalis) Ceftriaxone and doxycycline will cover many other bacteria, including H. influenzae and E. coli.

Answer 56

Ephedrine ANAESTHETICS Class: Sympathomimetic, vasoconstrictor ( CNS stimulant) Common drug name/ others in the group: adrenaline/ epinephrine, phenyephrine Mechanism of action: combined α&β-adrenergic agonist  vasoconstriction Key info: * Very potent! Only used in arrests/ITU/? Tx hypotension during surgery - when BP and HR are low

Answer 57

Epinephrine/adrenaline Class: Sympathomimetic (combined α&β-adrenergic agonist), vasoconstrictor Common drug name/ others in the group: Ephedrine, phenylephrine, metaraminol, noradrenaline, Mechanism of action: combined α&β-adrenergic agonist; Vasoconstriction (α effects), raised HR and contractility (β1 effects), peripheral vasodilation (β2 effects) Use: acute anaphylaxis

Answer 58

Erythromycin Class: macrolide Others in the group:Azithromycin, erythromicine, clarithromycin Mechanism of action: destroys bacterial ribosomes Use: Alternative in penicillin allergy: e.g. RTI

Answer 59

Ethinylestradiol Class: oestrogen combined with progestogens ( COCP) Mechanism of action: * Prevents ovulation (1ᴼ mechanism of action) * Progesterone  thickens cervical mucus, inhibits proliferation of endometrium Use: contraception Key info: S/E or risks * Unscheduled bleeding in 1st 3 months * Breast pain/ tenderness * Mood changes/depression * Headaches * HTN, VTE, MI, Stroke * Increased breast & cervical cancer risk * C/E uncontrolled HTN * Migraine with are (increased stroke risk) * Major surgery w/ prolonged immobility * >35 yo & >15 cigs/ day * VTE/ Vasc disease/ stroke/ IHD, Cardiomyopathy. AF Hx * Liver cirrhosis/tumour * SLE/ Antiphosp[holi[pid syndrome

Answer 60

Ferrous sulphate Class: iron, oral Use: iron deficiency anaemia Key info: - Dark stools - conume on empty stomach

Answer 61

Finasteride Class: 5α- reductase inhibitor Mechanism of action: 5α- reductase metabolises testosterone to dihydrotestosterone (more potent androgen). Finasteride inhibits that Use: BPH Key info: S/E sexual dysfunction Conception/contraception – finasteride is excreted in semen – so use condom if partner is pregnant/ likely to become pregnant.

Answer 62

Flucloxacillin Class: penicillin Use: infections, esp. staph. Aureus caused e.g., cellulitis, secondary bacterial infection of eczema, diabetic foot infection Key info: Most important S/E hypersensitivity (rashes and anaphylaxis)

Answer 63

Fluconazole Class: Triazole antifungal Use: - Candida infections ( vaginal, mucosal, candida balanitis, dermal e.g. tenea pedis, pityriasis vericolor) - Prophylaxis in immunocompromised

Answer 64

Fludrocortisone Class: mineralocorticoid Common drug name/ others in the group: beclomethasone, betamethasone, budesonide, hydrocortisone, prednisolone, dexamethasone, fluticasone(inhalers), methylprednisolone. Use: Neuropathic postural hypotension, adrenocortical insufficiency Key info: C/I – avoid live vaccines if receiving immunosuppressive doses (all steroids) S/E prolonged therapy  adrenal atrophy Increased risk of infections

Answer 65

Glucocorticoids: hydrocortisone mineralocorticoid: fludrocortisone (same in CAH)

Answer 66

Flumenazil Class: Benzodiazepine antagonist Use: reduce sedative effects of benzos ( peri-op/ICU) Key info: C/I life-threatening conditions controlled by benzos ( raised ICP, Status epilepticus)

Answer 67

Fluoxetine Class: SSRI Common drug name/ others in the group: Citalopram, escitalopram, sertraline NOT DULOXETINE – SNRI, LLIKE VENLAFAXINE Mechanism of action: inhibits the reuptake of serotonin (5-HT) Use: Major depression, bulimia nervosa, OCD, menopausal sx Key info: C/I - Poorly controlled epilepsy - Mania ( do not use SSRIs in manic phase) Serotonin syndronme ( rare S/E - marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop)

Answer 68

Folic acid Use: - Folate-deficient megaloblastic anaemia - Pregnancy – neural tube defect prophylaxis - Methotrexate use – prevention of S/E of methotrexate ( e.g. rheumatic disease, Crohn’s, psoriasis) - Deficiency prophylaxis in: chronic haemolytic states/ dialysis, PEN

Answer 69

Furosemide Class: loop-diuretic Common drug name/ others in the group: bumetanide Mechanism of action: inhibit reabsorption form the ascending loop of Henle Use: oedema Key info: Caution – can exacerbate, diabetes & gout S.E - hypokalaemia

Answer 70

Gabapentin Class: antiepileptic Common drug name/ others in the group: Pregabalin ,Carbamazepine, Ethosuximide, lamotrigine, phenytoin, sodium valproate, topiramate Mechanism of action: Use: - Peripheral neuropathic pain (e.g. diabetic neuropathy) - Anticonvulsant - Multiple sclerosis – oscillopsia / spasticity - MND – muscular symptoms

Answer 71

Gentamicin Class: Aminoglycoside G-ve bacteria Common drug name/ others in the group: streptomycin Use: broad spec antibiotic

Answer 72

Gliclazide Class: Sulfonylurea Mechanism of action: augment insulin secretion. Use: T2DM Key info: S/E - Hypoglycaemia - Weight gain

Answer 73

Glucagon Class: glycogenolytic hormone Mechanism of action: peptide hormone which raises glycaemic levels Use: - diabetic hypoglycaemia - severe: hypotension. Heart failure, cardiogenic shock

Answer 74

Glyceryl trinitrate Class: Nitrate Mechanism of action: organic nitrate  vasodilator Use: * Angina (prophylaxis/tx) * Anal fissure * IV infusion in – HTN/MI control during peri-cardiac op/ congestive HF/ unstable angina Key info: C/I – cardiac tamponade, constructive pericarditis, hypertrophic cardiomyopathy, hypotensive conditions Common S/E – headaches ,dizziness, flushing, hypotension

Answer 75

1) Take the GTN when the symptoms start 2)repeat after 5 mins in Sx remain 3) Repeat step 2 4) Call an ambulance after a further 5 minutes if the symptoms remain

Answer 76

Goserelin Class: Gonadotrophin releasing hormone Others: leuprorelin Mechanism of action: (GnRH agonist = gonadorelin analogues)  initial phase of stimulation  down-regulation of GnRH receptors  reduced release of gonadotrophins (FSH and LH)  inhibition of androgen and oestrogen production. Use: * Endometriosis – hormonal tx for symptomatic relief * IVF – suppression of the menstrual cycle in * Fibroids – reduce size of fibroids before surgery. * Prostate cancer – one of the hormones therapies used to reduce androgens (as this stimulates the cancer growth) * Breast cancer: alternative TX options in oestrogen-receptor positive breast cancer Key info: S/E – gynaecomastia, hot flush, sexual dysfunction C/I undiagnosed vaginal bleeding

Answer 77

Haloperidol Class: 1st gen (typical) antipsychotic Common drug name/ others in the group: chlorpromazine, flupentixol, prochlorperazine, zuclopenthixol Use: * Antiemetic (palliative care, post-op nausea& vom (tx/prophylaxis) * Psych: schizophrenia, mania, schizoaffective disorder * Delirium Key info: * C/I: Parkinsons, DwLB

Answer 78

gentamicin, neomycin aminoglycosides can be ototoxic, so may cause hearing loss if used topically in otitis externa here the tympanic membrane is perforated

Answer 79

Hydrocortisone Class: corticosteroid Common drug name/ others in the group: beclomethasone, betamethasone, dexamethasone, fludrocortisone, fluticasone, methylprednisolone, prednisolone Mechanism of action: glucocorticoid and mineralocorticoid activity Use: Thyrotoxic crisis ,adrenal insufficiency, adrenal crises, CAH adjunct to adrenalin in acute hypersensitivity reactions, asthma etc

Answer 80

Hydroxocobalamin Class: Vitamin B Common drug name/ others in the group: (Thiamine, Vitamin B) Use: * Prophylaxis macrocytic anaemia ass. w/ B12 vitamin deficiency * IM for Macrocytic anaemia Tx

Answer 81

Hyoscine butylbromide Class: Antimuscarinic others in the group: hyoscine butylbromide (Buscopan – IBS) Mechanism of action: binds to muscarinic receptors (M3 in GI System) preventing Ach from binding, so preventing activation. Use: * Sx relief of GI/GU disorders caused by smooth muscle spasm (IBS) * Palliative care: excess resp secretion * Palliative care: Bowel colic Key info: Not to be combined with prokinetics ( e.g. metoclopramide/ domperidone

Answer 82

Ibuprofen Class: NSAID Common drug name/ others in the group: aspirin, diclofenac, mefenamic acid, naproxen Mechanism of action: non-selective COX inhibitor (inhibits COX-1&2)  inhibits prostaglandin synthesis (which mediates inflammation, pain, fever and swelling) Use: * Pain, Fever, inflammation * Arthritis, 1st line for pain & fever Mx in infections e.g. tonsilitis, otisi media Key info: * S/E GI discomfort,GI ulceration, skin reactions * Pregnancy: no to be used. Inhibits Cox 2  inhibits prostaglandins (which keep ductus arteriosus patent) * C/I -IM in active bleeding (esp intracranial/gasto-intestinal, Hx hypersensitivity to other NSAID

Answer 83

Insulin Mechanism of action: bind to insulin receptor  signals Glut-4 receptor  opens and transports glucose into cell Use: * DM (1st line type 1, 4th line type 2) * DKA Key info: S/E oedema, lipodystrophy, hupoglycaemia (in OD)

Answer 84

Ipratropium bromide Class: antimuscarinic Common drug name(SAMA) others in the group: tiotropium, glycopyrronium Mechanism of action: antagonist of muscarinic Ach receptor  inhibits parasympathetic nervous system (generates bronchial secretion, & constriction)  bronchodilation and less secretions. Use: Reversible airway obstruction - COPD (inhaler) - Acute bronchospasm (nebuliser) - Severe/life-threatening asthma (nebuliser) Key info: Common S/E – GI motility disorder, throat complaints

Answer 85

Isofluorane Class: General (volatile liquid) anaesthetics Common drug name/ others in the group: Desflurane, Sevoflurane Use: general anaesthetic - hypnosis, sedation SLEEP ( the 3rd of the forms of anaesthetics) Key info: * cheapest of the inhaled anaesthetics that put patients to sleep. * Slower on & offset than desflurane/sevflurane

Answer 86

Isosorbide mononitrate Class: Nitrate Common drug name/ others in the group: GTN, isosorbide dinitrate Mechanism of action: long-acting nitrate Use: - Stable angina (prophylaxis)

Answer 87

Lactulose Class: Osmotic laxative others in the group: macrogol, Mechanism of action: increases gut motility & has osmotic effect ( softening stool) Use: - Constipation - Cirrhosis : To reduce ammonia, aim is 2-3 soft stools daily (increased clearance = less absorption of ammonia) Key info: - IBS: avoid, as it can cause bloating - May take 48 hrs to act - CI in GI obstruction/ perforation

Answer 88

Lamotrigine Class: antiepileptic Common drug name/ others in the group: carbamazepine, ethosuximide, Keppra, phenytoin, sodium valproate, topiramate Use: 1st line – focal seizures (or carbamazepine) 2nd line – gen tonic-clonic (or carbamazepine), atonic seizures, myoclonic

Answer 89

Lansoprazole Class: PPI Common drug name/ others in the group: Omeprazole, pantoprezole Mechanism of action: inhibits gastric acid secretion by blocking the proton pump’) (the ‘hydrogen-potassium adenosine triphosphatase enzyme system) of the gastric parietal cell. Use: * H. pylori (2 Abx & PPI – metronidazole, amoxicillin, PPI) * GORD * Gastric/ Duodenal ulcer * Prophylaxis NSAID/ steroid associated gastric ulcer * dyspepsia Key info: * fracture risk (particularly when used at high doses for over a year in the elderly) * GI infection risk (including C. diff)

Answer 90

Levodopa Class: synthetic dopamine Common drug name: typically prescribed as co-careldopa or co-beneldopa Mechanism of action: Use: parkinsons Key info: * Increases excessive daytime sleepiness, consider with driving * Overdose – dyskinesia ( chorea, dystonia, athetosis)

Answer 91

charcoal : <1hr of OD, function - reduces UNLES: staggered overdose

Answer 92

- plasma paracetaol concentration >= tx line ( joins points of 100mg/L at 4hrs and 15mg/L @ 15hrs - staggered overdose - 8-24hrs post OD >150mg/kg @( in plasma-para conc unavaiolable - present >24hrs later in jaundinced/hepatic tenderness/ ALT>normal

Answer 93

anaphylactoid (non-IgE mediated mast cell release) if it occurs: stop infusion, restart at slower rate geneeally: now infused over 1hr

Answer 94

Levonogestrel Class: Progestogens Common drug name/ others in the group: Desogestrel, progesterone Mechanism of action: 1. Inhibit ovulation by suppressing gonadotrophins 2. Thickens cervical mucus Use: contraception Key info: * Take same time each day, if >3hr indow, counts as a missed pill

Answer 95

Levothyroxine Class: thyroid hormone Mechanism of action: synthetic T4 ( hormone secreted by thyroid gland) Use: * primary hypothyroidism * blocking-replacement regimen in hyperthyroidism (combined with carbimazole) Key info: C/I thyrotoxicosis

Answer 96

Lignocaine Class: local anaesthetics Common drug name/ others in the group: Lignocaine aka Lidocaine Mechanism of action: inhibits conduction of impulses across nerves Use: local anaesthetic

Answer 97

Lithium Use: mood stabiliser – treatment and prophylaxis in * mania * bipolar * recurrent depression * aggressive/ self-harming behaviour Key info: can be used in pregnancy, but avoid where possible (esp. in 1st trimester) risks increased in pregnancy of: o Congenital anomalies (esp.Ebstein's anomaly) o miscarriage o Neurodevelopmental impairments

Answer 98

* Side effects (LITHIUM) – @ therapeutic dose o Leukocytosis (long term). o Insipidus (diabetes, nephrogenic). o Tremors (fine if side effect, coarse if toxicity). o Hydration (easily dehydrates, need to drink a lot as renally cleared). o Increased GI motility (nausea, vomiting, diarrhoea). o Underactive thyroid (hypothyroidism, long term) o Mums beware (teratogenic, Ebstein’s anomaly). Toxicity o Coarse tremor o CNS disturbance (seizure, impaired coordination, dysarthtia o Arrhythmias o Visual disturbance therapeutic : 0.4-1.0 Toxicity >1.5mmol/L

Answer 99

Interactions * NSAIDs, ACEi, ARBs + diuretics may increase lithium levels – * Diuretics beware of dehydration, NSAIDs beware of renal damage.

Answer 100

Monitoring * Baseline measurements – * FBC, U+Es, eGFR, TFTs (free T4, TSH), weight + height + ECG if indicated. Regular monitoring – * Weekly serum lithium after initiation + after each dose change until concentrations stable then every 3m for a year then every 6m. * Sample taken 12h after dose. * 6/12 – free T4, TSH, U+Es + eGFR. * Annual – height + weight (BMI).

Answer 101

Loperamide Long-acting antidiarrheal Use: - Sx tx for acute/ chronic diarhoea (in IBD/ gastroenteritis - Bowel colic pain in palliative care

Answer 102

Losartan Class: ARB (Angiotensin II receptor antagonist) others in the group: candesartan, Mechanism of action: Competitively binds to angiotensin II receptors > vascular smooth muscle relaxation > lowered BP Use: - HTN - chronic HF ( where ACEi unsuitable/ CI) - Diabetic nephropathy Key info: - Switched tofrom ACEi pts w/ cough

Answer 103

Medroxyprogesterone Class: progestogens Common drug name/ others in the group: desogestrel, levonorgestrel, progesterone Mechanism of action: inhibits gonadotropin (LH, FSH) production  1) inhibits follicular maturation & ovulation 2) thins endometrium. Use: - contraception - abnormal uterine bleeding - mild-mod endometriosis Key info: Contraindications - thromboembolism Hx (if taken orally) - undiagnosed vag bleed

Answer 104

Metformin Class: biguanide Mechanism of action: - decreases blood glucose by: - decreases gluconeogenesis. - decreases intestinal absorption of glucose. - While increasing peripheral uptake and use of glucose (increasing insulin sensitivity) Use: 1st line medical mx in T2DM , PCOS` Key info: SE - GI disturbance, nausea, decreased appetite, B12 deficiency

Answer 105

Methadone Class: opioids Use: - palliative care: severe pain, cough - adjunct in opioid dependency tx

Answer 106

Methotrexate Class: DMARD others in the group: azathioprine, daunorubicin, fluorouracil, Use: - crohn’s – maintenance of remission ( 2nd line – 1st line is azathiprineq/ mercaptopurine) - rheumatoid arthritis ( 1st line, other 1st line alternatives: leflunomide or sulfasalazine) - medical management in ToP in <35mm, 1000-1500 b-hCG - Key info: Interferes with which vitamin? – folate, so give Folic acid 5mg once/ week on different days Common SE - Mouth ulcers & mucositis - Liver toxicity - Bone marrow suppression & leukopenia - Teratogenic ( avoid in men AND women pre conception )

Answer 107

Metoclopramide Class: Dopamine receptor antagonists (prokinetic antiemetic) Common drug name/ others in the group: Domperidone Mechanism of action: inhibit D2 (dopamine) and 5-HT3 (serotonin) receptors in the chemoreceptor trigger zone in the brain. Prokinetic effects ( on D2 antagonism, 5-HT4 agonism & muscarinic receptor antagonism)  release of ACh  increased LES & gastric tone  accelerated gastric emptying Use: - 1st line in Nausea and vomiting in gastric stasis in palliative care - N&V in migraine) - prevention of post-op nausea Key info: - Do not co-prescribe with cyclizine, hyoscine butylbromide, levomepromazine, ondansetron – s they slow gut motility

Answer 108

aspirin sulfasalazine and aspirin are structurally similar so potential of cross-sensitivity

Answer 109

GI - gastritis, peptic ulcers --> Upper GI bleed Renal --> AKI/ CKD CV - HTN ( blocks prostaglandins, which cause vasodilation), HF, MI, Stroke

Answer 110

Metronidazole targets anaerobes Use: * Anaerobic infections: Gastroenteritis by Giardiasis, 1st line in bacteria vaginosis, Tx in trichomoniasis ( STI caused by protozoa t. vaginalis ) * Mod- severe diabetic foot infection * H. Pylori – triple therapy * PID – triple therapy * Breast abscess ( Co-amox OR erythromycin/clarithromycin + metronidazole ( for anaerobes) Key info: * Triple therapy in H. Pylori 2x Ab + PPI = metronidazole + amoxicillin + omeprazole * Triple therapy in PID – 1g IM Ceftriaxone stat, Doxycylcine 100mg BD 14days, Metronidazole 400mg BD 14days ( gonorrhoea, Chlamydia + mycoplasma genitalium, anaerobes e.g. G. Vaginalis) * Avoid in chronic alcohol use * Do not consume alcohol during the duration of treatment: Alcohol + Metronidazole = disulfiram-like reaction ( N&V, flushing, + sometimes severe Sx shock & angioedema)

Answer 111

Mirtazapine Class: TCA – atypical antidepressant Use: severe depression (1st line depression – SSRI, 2nd line – SSRI, 3rd line can use mirtazapine or other drug) Key info: S/E – fatigue, increased appetite & weight gain (may be used e.g. in anxiety for this side effect profile)

Answer 112

- depressed w/ pain - FLUOXETINE - depressed/ anxious and not eating - MIRTAZAPINE extra: - depressed but pregnant/ breastfeeding - PAROXETINE

Answer 113

N-acetylcysteine Use: IV N-acetylcysteine used in paracetamol poisoning * >1hr OD <4 hrs:: Wait until 4 hrs > take serum paracetamol level > Tx based on level * 4-8 hours & dose >150mg/kg: Start N-acetylcysteine immediately if there is going to be a delay of ≥8 hours in obtaining the paracetamol level * Ingestion within 8-24 hours + dose >150mg/kg: Start N-acetylcysteine immediately * Ingestion >24 hours: Start N-acetylcysteine immediately in liver damage signs (jaundice, RUQ tenderness, elevated ALT, INR >1.3) or paracetamol conc. is detectable * Staggered overdose: Start N-acetylcysteine immediately * Pt at increased risk of toxicity following paracetamol OD (e.g., DHx long-term enzyme inducers, regular alcohol excess, pre-existing liver disease, glutathione-deplete states: eating disorders, malnutrition and HIV): N-acetylcysteine should also be administered immediately Key info: Acetyl cysteine can be used without finding the treatment line if: * Lab cannot provide measurement within 8 hours of OD * Hx suggests hepatic damage risk (e.g. jaundice, raised ALT) * Pregnancy * given via a two-bag regimen over 12 hours/ three bag regimen over 21 hours, according to local protocols.

Answer 114

Naloxone Class: opioid receptor antagonist others in the group: Naltrexone Mechanism of action: competitive inhibitor of µ-opioid receptor, and antagonises the opioid action, reversing their effects Key info: - does not have significant effects on person who has not taken opioids

Answer 115

Nefopam Class: analgesic Mechanism of action: Use: non-opioid analgesic used for mod - severe pain ( post-surgical pain, dental ache) – used when simple analgesia doesn’t help Key info: To be used in caution in: * Angle-closure glaucoma * Elderly * urinary retention

Answer 116

Nicorandil Class: Potassium-channel openers ( vasodilator) Use: 2nd line in long-term Sx Mx in stable angina ( 2nd to B-blocker +/ CCB)

Answer 117

Nitrofurantoin Class: antibacterials (other- Use: LOWER UTIs 1st line or trimethoprim (in kids other options are: cefalexin/ amoxicillin) - catheter- associated. - severe/ recurrent - prophylaxis ( e.g. recurrent/ GU surgery) Key info: - CI – acute porphyrias, G6PD, <3m old - Pregnancy – 3rd trimester, risk of neonatal haemolysis NiTRIofurantoin - Breastfeeding – avoid (haemolysis in G6PD infants) - Avoid in eGFR <45 - Trigger haemolysis so should be avoided in G6PD. - Can cause pulmonary fibrosis. Nitrofurantoin Class: antibacterials Use: LOWER UTIs 1st line or trimethoprim (in kids other options are: cefalexin/ amoxicillin) - catheter- associated. - severe/ recurrent - prophylaxis ( e.g. recurrent/ GU surgery) - pregnancy Key info: - CI – acute porphyrias, G6PD, <3m old - Pregnancy – 3rd trimester, risk of neonatal haemolysis NiTRIofurantoin - Breastfeeding – avoid (haemolysis in G6PD infants) - Avoid in eGFR <45 - Trigger haemolysis so should be avoided in G6PD. - Can cause pulmonary fibrosis.

Answer 118

Nitrous oxide Class: volatile liquid anaesthetics Common drug name/ others in the group: desflurane, isoflurane, sevoflurane Use: - maintenance of anaesthesia (in conjunction w/ other anaesthetic agents) - analgesia Key info: - Gas and air (e.g., Entonox) – 50% nitrous oxide, 50% oxygen - Use during delivery – may depress neonatal respiration. - S/E – light-headedness, nausea, sleepiness

Answer 119

Nystatin Class: antifungal Use: particularly Candida infections - Oral candida - - oral/ perioral infections - Candida of the nipple Key info: Commonly either Miconazole or nystatin in candida infections

Answer 120

Ondansetron Class: serotonin (5HT3) receptor antagonist Mechanism of action: serotonin ( 5-HT3) receptor antagonist - 5-HT3 is release by chemo/radiotherapy --> stimulation of the 5HT3 receptors --> vomiting reflex Use: antiemetic in chemotherapy & post-op Antiemetic * prophylactic/ rescue antiemetic peri-operatively * Hyperemisis gravidum ( 3rd line – prochlorperazine, cyclizine, ondansetron, metoclopramide Key info: CI: Pt with prolonged QT interval

Answer 121

Oxybutynin Class: antimuscarinic Mechanism of action: antimuscarinic (inhibits muscarinic action of Ach on smooth muscle) reduces detrusor muscle activity bladder relaxation  inhibiting urge to void. Use: Urinary frequency/ urgency/ incontinence, nocturnal enuresis associated with overactive bladder Key info: common side-effects diarrhoea (oxybutynin), (for all antimuscarinics: ) Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting

Answer 122

nasal cannula: 24-44% oxygen (1, 2 or4 l/min) simple face mask: 40-60% oxygen (5 or 8 l/min) Venturi mask: 24-60% oxygen (2,4,6,8,10,15 l/min) Non-rebreather mask: 80-95% ( 8 or 95 l/min)

Answer 123

Oxytocin Common names: Use: - induction of labour ( induces & improves uterine contractions) - prevention of PPH after delivery of the placenta - tx of PPH Key info: - CI o where spontaneous labour/ vaginal delivery are no advisable ( e.g. major uterine scar) o foetal distress

Answer 124

Paracetamol Use: - mild-mod pain - post-immunisation pyrexia in infants Key info: * OD o <1hr – activated charcoal (reduces absorption) o 8-24 hrs, and substantial OD (150mg/kg), N-acetylcysteine (plasma-paracetamol conc. not needed)

Answer 125

Levetiracetam, lamotrigine and carbamazepine

Answer 126

neural tube defect developmental delay

Answer 127

cleft lip and palate

Answer 128

Phenytoin Class: antiepileptic Common drug name/ others in the group: carbamazepine, ethosuximide, gabapentin, lamotrigine, Keppra, pregabalin, sodium valproate, topiramate, vigabatrin Use: - Status epilepticus - Tonic clonic/ focal seizures Key info: S/E – may cause gingival hyperplasia, hirsutism, folate/ vit D deficiency. CI – pregnancy: causes cleft lip and palate

Answer 129

Prednisolone Class: steroid - glucocorticoid Use: - Severe croup - Adrenocortical insufficiency - Bells palsy (within 72hrs of Sx – high dose e.g. 50mg for 10 days) - Ramsay hunt syndrome (prednisolone & acyclovir) - 2nd line prevention for cluster headaches ( 1st – verapamil, 2nd – occipital nerve block, prednisolone, lithium) - GCA – high dose (prednisolone, 60mg) - Tx inn autoimmune hepatitis ( high dose) - Acute exacerbation of COPD - Anti-inflammatory/ allergic ( vasculitis, UC, Crohns acute Mx, polymyalgia rheumatica) - Myasthenia gravis Key info: CI – do not give pts on immunosuppressants live vaccines

Answer 130

amitryptyline ( TCA) Duloxetine ( SNRI) Gabapentin (anticonvulsants) pregabalin (anticonvulsants)

Answer 131

Pregabalin Class: antiepileptic Use: - Neuropathic pain - Adjunct in focal seizures - GAD

Answer 132

Antimuscarinic effects * Mouth o Dry mouth o Thirst o Difficulty swallowing * Eyes: o Dilation o Difficulty accommodating o Sensitivity to light o Increased intraocular pressure. * Skin o Dry o Hot o Flushed * Cardiac o Arrhythmias ( Bradycardia followed by tachycardia & palpitations) * Bladder and bowel o Urinary retention o Constipation

Answer 133

Prochlorperazine Class: 1st gen antipsychotic Common drug name/ others in the group: Haloperidol, Zuclopenthixol Use: - Schizophrenia - Psychosis - Mania - Vertigo (used short term – 3days) - Anti-emetic (palliative care) Key info: S/E: * EPSE * Drowsiness * Anti-muscarinic effects * Postural hypotension * QT-prolongation

Answer 134

Class: Intravenous anaesthetic – hypnotic agent Use: - Induction of anaesthesia - Maintenance of anaesthesia/ sedation Key info: - Log-term sedative - Quick onset - Common side effects: o Apnoea, arrhythmias, headache, hypotension, localised pain, N&V

Answer 135

Oncology - chemotherapy - Rituxumab ( autoimmune/ cancer) - inflixamab ( autoimmune) Psych - schizophrenia - clozapine MSK - RA - Hydroxychloroquine - Sulfasalazine - Methotrexate Endo - hyperthryroidism - Carbimazole Infectious disease - Malaria - Quinine

Answer 136

trimethoprim + methotrexate = increased risk of bone marrow suppression.

Answer 137

Quinine Class: antimalarials others in the group: Artemether, chloroquine, primaquine, proguanil Use: * non-falciparum malaria (10mg/kg TD – max 700mg/dose) * Nocturnal leg cramps (low dose 200-300mg ON) Key info: CI – haemoglobinuria, MG, optic neuritis, tinnitus SE – agranulocytosis Order of prescription in malaria Uncomplicated malaria * 1st line – Oral Artemether w/ lumefantrine * 2nd line Oral Quinine + doxycycline/ clindamycin Complicated malaria (HDU/ICU – IV Tx) * Artesunate * Quinine dihydrochloride

Answer 138

Ramipril Class: ACEi Mechanism of action: * inhibits the RAAS system by: inhibiting ACE thereby preventing the conversion of angiotensin I to angiotensin II Use: * 1st line HTN in <55/non-afrocaribbean * Adjunct in Sx HF * Prophylaxis after MI * Prophylaxis of CV events in atherosclerosis / DM Key info: S/E dry cough (as ACE normally breaks down bradykinin)  so give ARB

Answer 139

Rifampicin Use: TB – 6months ( RIPE regime ) Acute osteomyelitis ( 6Wks fluclox w/ rifampicin/fusidic acid for 2wks) Key info: - Causes red secretions - Activates cytochrome P45O pathway  reduced drug metabolism ( e.g. COCP)

Answer 140

Mechanism of action: factor Xa inhibitor Use: Suspected DVT/PE: 1st line interim anticoag in DVT (Apixaban/ rivaroxaban/LMWH for at least 5 days) Confirmed DVT: maintenance treatment with an oral anticoagulant (warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban) for at least 3 months. VTE prophylaxis (e.g. post joint replacement surgery) Key info: CI: antiphospholipid syndrome (risk of recurrent thrombotic events), pregnancy, renal impairment (CR clearance <15ml/min) other causes of high-risk bleed (e.g. malignant neoplasms, oesophageal varices) Difference between DOAC and warfarin: frequent monitoring and dose adjustment are not required. DOACs Stopped 24-72 hours post surgery In uncontrolled bleed, DOACs ( Xa inhibitors) are reversible by Andexanet alfa

Answer 141

mode of action bocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production S/E agranulocytosis others: acute pancreatitis, bone marrow supression, teratogenic

Answer 142

both propylthyouracil (2nd line) and carbimazole cause agranulocytosis propylthyouracil can cause liver reactions and death

Answer 143

AKI - STOP ( nephrotoxic) CKD - continue ( protective)

Answer 144

Age >50 Initial dose 25mcg OD, slowly titrate Age <50: initial dose 50-100mcg OD Pregnancy - increase dose by 25-50mcg Check TFT 8-12wks following change of dose S/E Hyperthyroidism Reduced BMD Cardiac: AF, worsened angina Interaction Iron, calcium carbonate - reduce absorpton of L-thyroxine, so give 4 hr apart

Answer 145

propylthiouracil - 1st trimester ONLY ( as carbimazole teratogenic, and propythiouracil causes severe hepatic injury) carbimazole - from 2nd trimester ( HCG highest in 1st trimester, activating TSH recptor)

Answer 146

cetirizine, loratadine, and fexofenadine

Answer 147

cephalosporins carbapenems