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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
INR + dental work
Check 72 hours before If <4 then can proceed
26
Mechanism of action of sulphonylureas
Close K+/ATP channel on B cells in the pancrease = depolarisation then calcium exocytosis = release of insulin
27
What precipitates the effects of digoxin? (5)
Hypokalaemia - binds to the ATPase pump/competes with K+ Less K+ = more of an effect Increasing age Renal failure Hypercalcaemia Hypomagnesaemia
28
Give a sulphonylurea Give an effect
Chlorpropramide SIADH
29
Effect of MDMA
Hyponatraemia
30
Contraindication to triptan use
Ischaemic heart disease - can cause coronary artery vasospasm
31
Management of early presentation salicylate toxicity
Charcol can be given if within 1 hour of ingestion
32
How can a steady state be reached quicker?
Loading dose Increased frequency of dosing
33
Examples of medications metabolised on first pass metabolism (5)
(liver) Propranolol Oestrogens Verapamil (intestinal mucosa) Levodopa Ethanol
34
Examples of drugs that exhibit zero order kinetics (3, exception)
Phenytoin Heparin Ethanol Salicylates - at high doses
35
Drugs which decrease absorption (3)
Iron Cholestyramine Anti-cholinergics
36
What occurs in phase I reactions?
Oxidation/reduction/hydrolysis
37
What occurs in phase II reactions?
Conjugation
38
Drugs dependent on acetylator status (4)
Dapsone Hydralazine Isoniazid Sulfalazine
39
What are CYP450? What are they involved with?
= group of enzymes involved in drug reactions: specifically phase I metabolism
40
What does a CYP450 inducer do?
= increased CYP450 expression = increases metabolism of the drug = reduced therapeutic concentrations Inducer - reduce the effectiveness of the drug e.g. reduce contraceptive efficacy
41
What does a CYP450 inhibitor do?
= decreased CYP450 expression = decreased metabolism of the drug = elevated therapeutic concentrations: TOXICITY
42
Examples of CYP450 inhibitors
3A 2S RIF 3A - antibiotics (cipro/erythromycin), allopurinol, amiodarone 2S - SSRIs, sodium valproate R - ritonavir I - isoniazid F - fluconazole
43
Which antibiotics are CYP450 inhibitors?
Ciprofloxacin Erythromycin
44
Examples of CYP450 inducers
RAS R - rifampicin A - anti-convulsants Phenytoin, carbamazepine, phenobarbitone S - steroids Dexamethasone, prednisolone
45
Which antibiotics are CYP450 inducers?
Rifampicin
46
What is the effect of alcohol on the CYP450 enzyme system?
Acute alcohol intake = enzyme inhibitor (decreased metabolism, more toxic effects) Chronic alcohol intake = enzyme inducer (increased metabolism, reduced therapeutic concentrations)
47
Metabolism of alcohol
Ethanol to acetaldehyde (requires alcohol dehydrogenase)
48
Effect of verapamil Side effects Compared to diltiazem
= negative inotrope (contra-indicated in HF, not to use in conjunction with BB) S/E: constipation, bradycardia Diltiazem less negatively inotropic
49
Adverse effect of dihydropyridine CCBs
Reflex tachycardia (relax vascular smooth muscle, increased HR to maintain CO)
50
Medications to avoid in G6PD deficiency (4)
Sulphonamides Nitrofurantoin Ciprofloxacin Primaquine
51
Amiodarone is a...
CYP450 inhibitor = increased risk of toxicity e.g. digoxin or warfarin toxicity
52
What medication is good for lowering triglycerides?
Fibrates
53
Interactions with levodopa (4) Effect
MAO-I Methyldopa Haloperidol Metoclopramide = decreased levodopa effect
54
Side effects of isoniazid (3)
Peripheral neuropathy Pellagra Agranulocytosis
55
Side effects of Ethambutol (2)
Colour vision defects Retrobulbar neuritis
55
Side effect of Rifampicin (3)
Nephritis Thrombocytopaenia Urine colour changes
56
Side effect of Pryazinamide
Hyperuricaemia
57
Management of heparin overdose/heparin reversal
Protamine
58
Drugs to avoid in breast feeding (5)
Aminoglycosides Tetracyclines Isoniazid Phenytoin Carbimazole
59
Management of methanol poisoining
Fomepizole (previously was ethanol) Severe - haemodialysis
60
Management of salicylate poisoning
Activated charcoal if <1 hour since ingestion IV bicarbonate HD in severe cases
61
Management of ethylene glycol poisoning - mechanism
Fomepizole = competitive inhibition of alcohol dehydrogenase
62
What to avoid in arrhythmia in TCA overdose
Class Ia/c - prolong depolarisation Class III - prolong QT
63
Management of mild/moderate lithium poisoning
Volume resuscitation
64
Management of iron poisoning
Desferrioxamine
65
Management of cyanide poisoning
Hydroxycobalamin
66
Action of alpha-1 receptor - mechanism - agonist - antagonist
= vasoconstrictor, GI smooth muscle relaxation, salivary secretion Activates phospholipase C Agonist = phenylnephrine Antagonist = doxazosin, tamsulosin
67
Action of alpha-2 receptor - mechanism - agonist
= inhibits neurotransmitter (pre-synaptic) Acts to inhibit adenyl cyclase Agonist = clonidine, brimonidine
68
Action of beta-1 receptor - mechanism - agonist - antagonist
= positive inotrope and chronotrope: acts on cardiac tissue Stimulates adenyl cyclase Agonist = dobutamine Antagonist = atenolol
69
Action of beta-2 receptor - mechanism of action - agonist - antagonist
= vasodilation and bronchoconstriction, relaxation of GI smooth muscle Stimulates adenyl cyclase Agonist = salbutamol
70
Mechanism of action of ketamine
NMDA antagonist
71
Ethylene glycol poisoning - biochemical finding - management
Raised anion gap metabolic acidosis Mx: fomepizole
72
What is nabilone?
Synthetic cannabinoid
73
Side effect from ACE-I initiation
First dose hypotension
74
Electrolyte abnormality associated with loop diuretics
Hypomagnesaemia (think hypokalaemia, magnesium and potassium are friends)
75
Glargine insulin VS isophane insulin advantage
Better at avoiding nocturnal hypoglycaemia
76
Mechanism of action of gabapentin
Binds to A2 subunit of calcium channel

1MRCP Part 1 (20 decks)

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