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1MRCP Part 1 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

DMARDs that can be used in pregnancy

A

Azathioprine
Sulfasalazine

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2
Q

B-blocker association

A

Myasethenia Gravis
- They act on the neuromuscular junction

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3
Q

Progesterone in HRT
Associated Risks

A

Breast cancer
Increased risk of VTE

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4
Q

Risk of Methadone

A

QT prolongation and sudden cardiac death

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5
Q

What type of receptors do steroids act on?

A

Nuclear receptors

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6
Q

What type of receptors do hormones (largely) act on?

A

Nuclear receptors

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7
Q

Why do you need a loading dose of amiodarone?
When should it be avoided?

A

Slow metabolism - long half life and very lipophillic
Because very lipid soluble, storied in body tissues
Avoid in breast feeding

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8
Q

Levothyroxine absorption
- what medications affect absorption?
- how managed?

A

Iron/calcium
Take at least 4 hours apart

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9
Q

Mechanism of action of baclofen

A

GABA agonist

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10
Q

TB medication associated with gout
- why?

A

Pyrazinamide
- Causes hyperuricaemia = gout

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11
Q

Class I anti-arrhythmics
- examples
- phase of cardiac action potential

A

1b = lidocaine, phenytoin
1c = fleccanide
Phase = 0 (block sodium channels)

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12
Q

Class II anti-arrhythmics
- examples
- phase of cardiac action potential

A

Beta blockers
Phase = 4 - acts on K+ rectifier current

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13
Q

Class III anti-arrhythmics
- examples
- phase of cardiac action potential

A

Amiodarone, sotalol
Phase = 3 - K+ channel blocker

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14
Q

Class IV anti-arrhythmics
- examples
- phase of cardiac action potential

A

Verapamil, diltiazem
Phase = 2, calcium channel blockers

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15
Q

What not to use with PDE5 inhibitors?

A

Nitrates
Can cause severe hypotension

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16
Q

Zero order kinetics =

A

= amount of drug excreted is constant, regardless of plasma concentration

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17
Q

Which part of hyperkalaemia treatment encourages excretion of K+ out of the body?

A

Calcium resonium

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18
Q

Side effect of nicorandil?

A

GI ulceration - can be ++ severe

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19
Q

Best non-sedating anti-histamine

A

Loratadine
Safe for LORRY drivers

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20
Q

Side effect of trimethoprim

A

Pancytopaenia

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21
Q

Mechanism of action of cyclophosphamide

A

Promotes cross linking in DNA

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22
Q

What is the mechanism of carvedilol?

A

Non selective B blocker/alpha adrenoceptor antagonist

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23
Q

TCA overdose - is dialysis involved in management?

A

Not usual part of management - large volume of distribution

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24
Q

Threshold for LFTs + statin and stopping the statin

A

If transaminases rise and persist @ 3x upper limit of normal

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25
Q

INR + dental work

A

Check 72 hours before
If <4 then can proceed

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26
Q

Mechanism of action of sulphonylureas

A

Close K+/ATP channel on B cells in the pancrease
= depolarisation then calcium exocytosis = release of insulin

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27
Q

What precipitates the effects of digoxin? (5)

A

Hypokalaemia - binds to the ATPase pump/competes with K+
Less K+ = more of an effect

Increasing age
Renal failure
Hypercalcaemia
Hypomagnesaemia

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28
Q

Give a sulphonylurea
Give an effect

A

Chlorpropramide
SIADH

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29
Q

Effect of MDMA

A

Hyponatraemia

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30
Q

Contraindication to triptan use

A

Ischaemic heart disease
- can cause coronary artery vasospasm

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31
Q

Management of early presentation salicylate toxicity

A

Charcol can be given if within 1 hour of ingestion

32
Q

How can a steady state be reached quicker?

A

Loading dose
Increased frequency of dosing

33
Q

Examples of medications metabolised on first pass metabolism (5)

A

(liver)
Propranolol
Oestrogens
Verapamil

(intestinal mucosa)
Levodopa
Ethanol

34
Q

Examples of drugs that exhibit zero order kinetics (3, exception)

A

Phenytoin
Heparin
Ethanol
Salicylates - at high doses

35
Q

Drugs which decrease absorption (3)

A

Iron
Cholestyramine
Anti-cholinergics

36
Q

What occurs in phase I reactions?

A

Oxidation/reduction/hydrolysis

37
Q

What occurs in phase II reactions?

A

Conjugation

38
Q

Drugs dependent on acetylator status (4)

A

Dapsone
Hydralazine
Isoniazid
Sulfalazine

39
Q

What are CYP450? What are they involved with?

A

= group of enzymes involved in drug reactions: specifically phase I metabolism

40
Q

What does a CYP450 inducer do?

A

= increased CYP450 expression
= increases metabolism of the drug
= reduced therapeutic concentrations

Inducer - reduce the effectiveness of the drug e.g. reduce contraceptive efficacy

41
Q

What does a CYP450 inhibitor do?

A

= decreased CYP450 expression
= decreased metabolism of the drug
= elevated therapeutic concentrations: TOXICITY

42
Q

Examples of CYP450 inhibitors

A

3A 2S RIF
3A - antibiotics (cipro/erythromycin), allopurinol, amiodarone

2S - SSRIs, sodium valproate

R - ritonavir
I - isoniazid
F - fluconazole

43
Q

Which antibiotics are CYP450 inhibitors?

A

Ciprofloxacin
Erythromycin

44
Q

Examples of CYP450 inducers

A

RAS
R - rifampicin

A - anti-convulsants
Phenytoin, carbamazepine, phenobarbitone

S - steroids
Dexamethasone, prednisolone

45
Q

Which antibiotics are CYP450 inducers?

A

Rifampicin

46
Q

What is the effect of alcohol on the CYP450 enzyme system?

A

Acute alcohol intake = enzyme inhibitor (decreased metabolism, more toxic effects)

Chronic alcohol intake = enzyme inducer
(increased metabolism, reduced therapeutic concentrations)

47
Q

Metabolism of alcohol

A

Ethanol to acetaldehyde (requires alcohol dehydrogenase)

48
Q

Effect of verapamil
Side effects
Compared to diltiazem

A

= negative inotrope
(contra-indicated in HF, not to use in conjunction with BB)
S/E: constipation, bradycardia
Diltiazem less negatively inotropic

49
Q

Adverse effect of dihydropyridine CCBs

A

Reflex tachycardia
(relax vascular smooth muscle, increased HR to maintain CO)

50
Q

Medications to avoid in G6PD deficiency (4)

A

Sulphonamides
Nitrofurantoin
Ciprofloxacin
Primaquine

51
Q

Amiodarone is a…

A

CYP450 inhibitor
= increased risk of toxicity e.g. digoxin or warfarin toxicity

52
Q

What medication is good for lowering triglycerides?

A

Fibrates

53
Q

Interactions with levodopa (4)
Effect

A

MAO-I
Methyldopa
Haloperidol
Metoclopramide

= decreased levodopa effect

54
Q

Side effects of isoniazid (3)

A

Peripheral neuropathy
Pellagra
Agranulocytosis

55
Q

Side effects of Ethambutol (2)

A

Colour vision defects
Retrobulbar neuritis

55
Q

Side effect of Rifampicin (3)

A

Nephritis
Thrombocytopaenia
Urine colour changes

56
Q

Side effect of Pryazinamide

A

Hyperuricaemia

57
Q

Management of heparin overdose/heparin reversal

A

Protamine

58
Q

Drugs to avoid in breast feeding (5)

A

Aminoglycosides
Tetracyclines
Isoniazid
Phenytoin
Carbimazole

59
Q

Management of methanol poisoining

A

Fomepizole
(previously was ethanol)
Severe - haemodialysis

60
Q

Management of salicylate poisoning

A

Activated charcoal if <1 hour since ingestion
IV bicarbonate
HD in severe cases

61
Q

Management of ethylene glycol poisoning
- mechanism

A

Fomepizole
= competitive inhibition of alcohol dehydrogenase

62
Q

What to avoid in arrhythmia in TCA overdose

A

Class Ia/c - prolong depolarisation
Class III - prolong QT

63
Q

Management of mild/moderate lithium poisoning

A

Volume resuscitation

64
Q

Management of iron poisoning

A

Desferrioxamine

65
Q

Management of cyanide poisoning

A

Hydroxycobalamin

66
Q

Action of alpha-1 receptor
- mechanism
- agonist
- antagonist

A

= vasoconstrictor, GI smooth muscle relaxation, salivary secretion

Activates phospholipase C

Agonist = phenylnephrine
Antagonist = doxazosin, tamsulosin

67
Q

Action of alpha-2 receptor
- mechanism
- agonist

A

= inhibits neurotransmitter (pre-synaptic)

Acts to inhibit adenyl cyclase

Agonist = clonidine, brimonidine

68
Q

Action of beta-1 receptor
- mechanism
- agonist
- antagonist

A

= positive inotrope and chronotrope: acts on cardiac tissue

Stimulates adenyl cyclase

Agonist = dobutamine
Antagonist = atenolol

69
Q

Action of beta-2 receptor
- mechanism of action
- agonist
- antagonist

A

= vasodilation and bronchoconstriction, relaxation of GI smooth muscle

Stimulates adenyl cyclase

Agonist = salbutamol

70
Q

Mechanism of action of ketamine

A

NMDA antagonist

71
Q

Ethylene glycol poisoning
- biochemical finding
- management

A

Raised anion gap metabolic acidosis
Mx: fomepizole

72
Q

What is nabilone?

A

Synthetic cannabinoid

73
Q

Side effect from ACE-I initiation

A

First dose hypotension

74
Q

Electrolyte abnormality associated with loop diuretics

A

Hypomagnesaemia
(think hypokalaemia, magnesium and potassium are friends)

75
Q

Glargine insulin VS isophane insulin advantage

A

Better at avoiding nocturnal hypoglycaemia

76
Q

Mechanism of action of gabapentin

A

Binds to A2 subunit of calcium channel

1MRCP Part 1 (20 decks)

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