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INICET 2023 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

DOC for reversal of respiratory depression

A

Naloxone

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2
Q

How does Naloxone reverse effects of opioid toxicity?

A

Competitive antagonist at miu- opioid receptors

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3
Q

Opioid overdose symptoms

A

Triad- Respiratory depression, coma and pin point pupils (miosis)
Hypotension, bradycardia
Hypothermia
Shallow breathing

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4
Q

Naloxone reverses all effects except

A

sedation

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5
Q

Usage of Naloxone in neonates?

A

Used to reverse neonatal asphyxia d/t opioid usage

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6
Q

Meperidine (Pethidine)
a. Class
b. Uses
c. Advantage to Morphine
d. Effect on fetus
e. Excitatory syndrome

A

a. mu-opioid receptor agonist
b. Strong analgesic effect; also used in post-anesthetic shivering
c. Penetrates CNS better at lower systemic concentration than morphine so constipation, urinary retention and nausea is less frequent
d. Crosses placenta and cause respiratory depression in fetus
e. People who are tolerant to depressive effects of meperidine, large doses repeated at small intervals can cause Excitatory syndrome which includes- hallucinations, tremors, muscle twitches etc.

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7
Q

Atropine side effects

A
  1. Dry mouth, delirium, decreased bowel movements, dry warm skin
  2. Hypotension
  3. Accomodation paralysis, dilated pupils (blurring of vision)
  4. Tachycardia
  5. Urinary retention
  6. Respiratory depression
  7. Anhydrosis, Ataxia, Acute congestive glaucoma

Mnemonic: Dhatura

Also, convulsions and circulatory collapse d/t repiratory failure

Death occurs d/t respiratory paralysis

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8
Q

Atropine
a. class
b. MOA
c. Uses

A

a. Anticholinergic
b. Competitive, reversible inhibition of postsynaptic muscarinic acetycholine receptors
c. OP poisoning/ Muscarinic poisoning; bradycardia; to reduce salivary secretions; as mydriatic-cycloplegic

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9
Q

Buprenorphine
a. Class
b. Use

A

a. partial miu agonist and antagonist at kappa and delta receptors
b. As analgesic and in management of opioid dependence

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10
Q

Drug used for metastatic trastuzumab resistant Her 2 positive breast cancer

A

Lapatinib + Capecitabine

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11
Q

Lapatinib is an inhibitor of

A

EGFR
HER2 tyrosine kinases

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12
Q

Lapatinib is metabolised by

A

CYP3A4

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13
Q

Treatment of post-menopausal women with hormone receptor positive metastatic breast cancer that overexpresses HER2

A

Lapatinib + aromatase inhibitor Letrozole

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14
Q

Adverse effects of Lapatinib

A
  • Acneiform rash
  • Diarrhoea
  • Cramping
  • Exacerbation of GER
  • Cardiac toxicity (less than trastuzumab)
  • Dose dependent prolongation of QT interval
  • Hepatotoxicity
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15
Q

Transtuzumab
a. class
b. MOA
c. Use

A

a. monoclonal antibody
b. inhibits HER2 receptor
c. Treatment of HER2 positive breast cancer

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16
Q

Vismodegib
a. inhibits?
b. Used to treat?

A

a. Hedgehog pathway
b. Metastatic and locally advanced BCCs

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17
Q

Vemurafenib
a. Inhibits?
b. Used in?

A

a. BRAF
b. metastatic melanoma and thyroid cancers with BRAF V600E mutation

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18
Q

Erlotinib
a. class
b. First line treatment for

A

a. protein kinase antagonists
b. non small cell lung carcinoma with EGFR deletion of axon 19 or L858R mutation

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19
Q

Nomogram used for Vancomycin dosing is

A

Matzke nomogram

20
Q

Dosing intervals in Matzke nomogram

A

0.5 - 12 days on a continuum of CLcr (Creatinine clearance) values from 0 to 120ml/min

21
Q

Matzke nomogram was created to

A

determine initial empiric dose and interval of IV Vancomycin in hospitalised patients who are not receiving hemodialysis

22
Q

Nomogram doesnt apply to

A
  • critically ill
  • cystic fibrosis
  • liver failure/ ascites
  • acutely post transplant
  • burns > 20 percent
  • rapidly changing renal function
  • pregnant women
  • extremes of weight
23
Q

Nomogram used to asses potential hepatotoxicity after single acute ingestion of Acetaminophen

A

Rumack- Matthew nomogram

24
Q

Therapeutic range of lithium

A

0.8-1.2 mEq/L

25
Q

Difference between tremors in using lithium in therapeutic range and in toxicity

A

Normal- fine tremors, localised to arms, symmetric, non progressive

Toxicity- coarse, more disabling tremors, may involve legs also

26
Q

Teratogenicity of lithium

A

In early pregnancy- Ebstien anomaly

Otherwise- hypotonia (floppy baby syndrome), neonatal goitre, CNS depression, cardiac murmur

27
Q

Other adverse effects of lithium

A

hypothyroidism
nephrogenic Diabetes Insipidus
Mental confusion
edema

28
Q

Lithium toxicity treated with

A

hemodialysis

29
Q

Uses of lithium

A

Mood stabiliser
First line treatment- Bipolar disease
Also in Mania and has anti-suicidal properties

30
Q

Therapeutic drug monitoring of lithium is done by

A

measuring lithium levels 12 hrs after the last dose

31
Q

Prophylactic range of Lithium

A

0.5 to 08 mEq/L

32
Q

C/I of lithium

A
  • CKD
  • Hyponatremia or diuretic use
  • Heart disease
33
Q

Baseline studies for lithium intake

A

BUN, calcium, urine analysis, creatinine
TFT
ECG in patients with coronary risk factors

34
Q

Acute adverse effects of lithium

A

Vomiting, diarrhoea
Ataxia, weakness, tremors
Cognitive impairment
Polyuria, polydipsia

35
Q

Chronic adverse effects of lithium

A

Hyperparathyroidism
Thyroid dysfunction
Nephrogenic Diabetes insipidus

36
Q

Mirabegron
a. Class
b. Use

A

a. Beta 3 adrenergic receptor agonist
b. Bladder incontinence (it acts by relaxing detrussor muscle and increasing bladder capacity

37
Q

Indacaterol
a. Class
b. Use

A

a. very long acting Beta 2 agonists (V-LABA)
b. Once a day for COPD maintenance

38
Q

Betaxolol
a. Class

A

Beta 1 selective 3rd generation beta blocker with additional calcium entry blockade and membrane stabilizing property

39
Q

Isoproterenol
a. Class
b. Action
c. Use

A

a. Non selective Beta blocker with no alpha action
b. On b1- tachycardia and arrhythmias
On B2- fall in diastolic blood pressure (d/t decreased peripheral vascular resistance)
c. Cardiac stimulant in patients with bradycardia or heart block

40
Q

Cardioselective beta blockers

A

Mnemonic:
Cardioselective Beta blockers Act At Nothing But Myocardium Exclusively

Celiprolol (III)
Betaxolol (III)
Atenolol
Acebutolol
Nebivolol (III)
Bisoprolol
Metoprolol
Esmolol

41
Q

Therapeutic index is calculated by

A

LD50/ ED50
or
TD50/ ED50

42
Q

Median Lethal Dose vs Median Toxic Dose

A

Median Lethal dose (LD50)- dose of drug at which 50 % of experimental animals die

Median Toxic Dose (TD 50)- dose of drug at which 50 % of population is affected by adverse effects

In human trials, TD 50 is considered

43
Q

Larger the LD/TD is?

A

more safe the drug

44
Q

Therapeutic window

A

range of concentrations at which the likelihood of efficacy is high and probability of adr is low

45
Q

Drugs which need Therapeutic Drug Monitoring

A

Mnemonic- DATLAAT MC
Digoxin
Anti-arrhythmics
Theophylline
Lithium
Aminoglycosides
Anti-epileptics
Tricyclic antidepressants
Methotrexate
Calcineurin inhibitors

46
Q

DOC for intubation of child undergoing elective tonsillectomy

A

Rocuronium- in pediatrics
Faster onset, availability as an IM injection

47
Q

Indication for Succinylcholine in children for intubation

A

IV succinylcholine given in rapid sequence induction with a full stomach and laryngospasm

INICET 2023 (5 decks)

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