Pharmacology Flashcards

Question

Childhood immunisations

Answer 1

Angiotensin receptor blockers ACE inhibitors Calcium and vitamin D

Answer 2

Antimuscarinic bronchodilators Beta 2 agonists Compound (beta 2 agonist-corticosteroid) inhalers Inhaled corticosteroids (glucocorticoids)

Answer 3

Colloids (plasma substitutes) Compound sodium lactate (Hartmann's solution) Sodium chloride

Answer 4

Metronidazole Vancomycin

Answer 5

Bulk-forming laxatives Osmotic laxatives Stimulant laxatives

Answer 6

Acetylcysteine (N-acetylcysteine)

Answer 7

Oestrogens and progestogens

Answer 8

Heparins and fondaparinux Warfarin

Answer 9

Metronidazole

Answer 10

SSRI antidepressants Tricyclics antidepressants Venlafaxine and mirtazepine

Answer 11

Insulin Metformin Sulphonylureas Thiazolidinediones

Answer 12

Angiotensin receptor blockers ACE inhibitors

Answer 13

Antimotility drugs Bulk-forming laxatives

Answer 14

Ocular lubricants (artificial tears)

Answer 15

Emollients

Answer 16

Alginates and antacids H2 receptor antagonists Proton pump inhibitors

Answer 17

Topical corticosteroids (glucocorticoids) Emollients

Answer 18

Aminoglycosides Penicillins Penicillinase-resistant penicillin Vancomycin

Answer 19

Carbamazepine Gabapentin and pregabalin Phenytoin Valproate

Answer 20

Phenytoin Valproate

Answer 21

Benzodiazepines Phenytoin

Answer 22

Phosphodiesterase (type 5) inhibitors

Answer 23

Bulk-forming laxatives Osmotic laxatives Stimulant laxatives

Answer 24

Aspirin Paracetamol

Answer 25

Colloids (plasma substitutes) Compound sodium lactate (Hartmann's solution) Glucose (dextrose) IV potassium Oral potassium Sodium chloride

Answer 26

Alginates and antacids H2 receptor antagonists Proton pump inhibitors

Answer 27

Venlafaxine and mirtazepine antidepressants Gabapentin and pregabalin

Answer 28

Prostaglandin analogue eye drops

Answer 29

Allopurinol Non-steroidal anti-inflammatory drugs

Answer 30

Antihistamines (H1-receptor antagonists)

Answer 31

Aldosterone antagonists Angiotensin receptor blockers ACE inhibitors Beta blockers Digoxin Loop diuretics

Answer 32

Macrolide Broad-spectrum penicillins Proton pump inhibitors

Answer 33

Osmotic laxatives

Answer 34

Oestrogens and progestogens

Answer 35

Aldosterone antagonists

Answer 36

Bisphosphonates

Answer 37

Beta 2 agonists Calcium and vitamin D Glucose (dextrose) Insulin

Answer 38

Alpha blockers Angiotensin receptor blockers ACE inhibitors Beta blockers Calcium channel blockers Thiazide and thiazide-like diuretics

Answer 39

Allopurinol

Answer 40

Calcium and vitamin D

Answer 41

Glucose (dextrose)

Answer 42

Potassium-sparing diuretics IV potassium Oral potassium

Answer 43

Systemic corticosteroids (glucocorticoids) Thyroid hormones

Answer 44

Thyroid hormones

Answer 45

Antimuscarinics

Answer 46

Cephalosporins and carbapenems Antipseudomonal penicillins

Answer 47

Antifungal drugs

Answer 48

Metronidazole

Answer 49

Corticosteroids (glucocorticoids) (systemic/inhaled/topical) NSAIDs

Answer 50

Benzodiazepines Z-drugs

Answer 51

Antimuscarinics

Answer 52

Angiotensin receptor blockers ACE inhibitors Aspirin Beta blockers Clopidogrel Fibrinolytic drugs Statins

Answer 53

Ocular lubricants (artificial tears)

Answer 54

Adrenaline (epinephrine) Lidocaine

Answer 55

Tetracyclines

Answer 56

Cephalosporins and carbapenems Penicillins

Answer 57

Gabapentin and pregabalin

Answer 58

Adrenaline (epinephrine)

Answer 59

Dipyridamole

Answer 60

Antiemetics - Dopamine D2-receptor antagonists - Histamine H1-receptor antagonists - Phenothiazines - Serotonin 5-HT3-receptor antagonists First-generation (typical) antipsychotics

Answer 61

SSRI antidepressants

Answer 62

Prostaglandin analogue eye drops

Answer 63

Loop diuretics

Answer 64

Penicillinase-resistant penicillins Vancomycin

Answer 65

Bisphosphonates Calcium and vitamin D

Answer 66

Acetylcysteine (N-acetylcysteine) Activated charcoal

Answer 67

Bisphosphonates

Answer 68

Aspirin NSAIDs Compound preparations opioids Strong opioids Weak opioids Paracetamol

Answer 69

Tricyclics and related drugs antidepressants Gabapentin and pregabalin

Answer 70

SSRI antidepressants

Answer 71

Colloids (plasma substitutes)

Answer 72

Dopaminergic drugs for Parkinson's disease

Answer 73

Dopaminergic drugs for Parkinson's disease

Answer 74

H2-receptor antagonists Proton pump inhibitors

Answer 75

Aspirin Clopidogrel

Answer 76

Cephalosporins and carbapenems Macrolides Metronidazole Penicillins Antipseudomonal penicillins Broad-spectrum penicillins Quinolones Tetracyclines

Answer 77

Trimethoprim (as co-trimoxazole)

Answer 78

Acetylcysteine (N-acetylcysteine) Activated charcoal Benzodiazepines Naloxone Oxygen Vitamins

Answer 79

Antihistamines (H1-receptor antagonists)

Answer 80

Emollients Methotrexate

Answer 81

Fibrinolytic drugs Heparins and fondaparinux Warfarin

Answer 82

Phosphodiesterase (type 5) inhibitors

Answer 83

Loop diuretics Nitrates Strong opioids

Answer 84

Aminoglycosides

Answer 85

Glucose (dextrose) Sodium chloride

Answer 86

Acetylcysteine (N-acetylcysteine) Cardiovascular and GI uses antimuscarinics

Answer 87

Aminosalicylates Methotrexate

Answer 88

First-generation (typical) antipsychotics Second-generation (atypical) antipsychotics

Answer 89

Benzodiazepines

Answer 90

Aminoglycosides Cephalosporins and carbapenems Penicillins Antipseudomonal penicillins Vancomycin

Answer 91

Aminoglycosides Metronidazole Antipseudomonal penicillins Broad-spectrum penicillins

Answer 92

Penicillinase-resistant penicillins

Answer 93

Colloids (plasma substitutes) Compound sodium lactate (Hartmann's solution) Sodium chloride

Answer 94

Macrolides Penicillins Antipseudomonal penicillins Penicillinase-resistant penicillins

Answer 95

Ocular lubricants (artificial tears)

Answer 96

Nicotine replacement and related drugs

Answer 97

Aspirin Clopidogrel Dipyridamole Fibrinolytic drugs

Answer 98

Adenosine Amiodarone Beta blockers Calcium channel blockers

Answer 99

Penicillins

Answer 100

Penicillins

Answer 101

Carbamazepine

Answer 102

Allopurinol

Answer 103

Aminosalicylates

Answer 104

Cephalosporins and carbapenems Nitrofurantoin Antipseudomonal penicillins Broad-spectrum penicillins Quinolones Trimethoprim

Answer 105

Antihistamines (H1-receptor antagonists)

Answer 106

Heparins and fondaparinux

Answer 107

Fibrinolytic drugs Heparins and fondaparinux Warfarin

Answer 108

Adrenaline (epinephrine) Amiodarone Lidocaine

Answer 109

Adrenaline (epinephrine) Amiodarone Lidocaine

Answer 110

Calcium and vitamin D

Answer 111

Antidote for paracetamol poisoning To prevent renal injury due to radiographic contrast material (contrast nephropathy) To reduce viscosity of respiratory secretions (acting as a mucolytic)

Answer 112

Paracetamol is metabolised by conjugation with glucuronic acid and sulfate and a small amount is converted to NAPQI (hepatotoxic). This is detoxified by conjugation with glutathione, which is overwhelmed in paracetamol poisoning. Acetylcysteine replenishes the body's supply of glutathione.

Answer 113

Reduce absorption of certain poisons (including some drugs in overdose) from the gut Increase the elimination of certain poisons

Answer 114

Supraventricular tachycardia

Answer 115

Hypotension Coronary ischaemia Decompensated heart failure Asthma COPD

Answer 116

Dipyridamole

Answer 117

Cardiac arrest Anaphylaxis Local vasoconstriction, e.g. during endoscopy to control mucosal bleeding or mixed with local anaesthetic drugs to prolong local anaesthesia

Answer 118

Potent agonist of the alpha 1, alpha 2, beta 1 and beta 2 adrenoceptors, and so has many sympathetic effects. * Vasoconstriction of vessels supplying skin, mucosa and abdominal viscera (mainly alpha 1) * Increases in heart rate, force of contraction and myocardial excitability (beta 1) * Vasodilatation of vessels supplying the heart and muscles (beta 2) * Bronchodilatation (beta 2) * Suppression of inflammatory mediator release from mast cells (beta 2)

Answer 119

Beta blocker Alpha 1 mediated vasoconstricting effect is not opposed by beta 2 mediated vasodilatation

Answer 120

Cardiac arrest: 1mg IV after the third shock (or ASAP if not shockable) and repeated every 3-5 minutes thereafter Anaphylaxis: 500ug IM, repeated after 5 minutes if necessary

Answer 121

Ascites and oedema due to liver cirrhosis (spironolactone) Chronic heart failure Primary hyperaldosteronism

Answer 122

Inhibit the effect of aldosterone by competitively binding to the aldosterone receptor. This increases sodium and water excretion and potassium retention.

Answer 123

Hyperkalaemia, which can lead to muscle weakness, arrhythmias and cardiac arrest Spironolactone causes gynaecomastia

Answer 124

Severe renal impairment Hyperkalaemia Addison's disease (who are aldosterone deficient)

Answer 125

Gastro-oesophageal reflux disease Dyspepsia

Answer 126

Alginates increase the viscosity of the stomach contents, which reduces the reflux of stomach acid into the oesophagus Antacids buffer stomach acids

Answer 127

Divalent cations in compound alginates can bind to other drugs, reducing their absorption. Antacids can reduce serum concentrations of other drugs, so the doses should be taken at different times, e.g. ACE inhibitors, some antibiotics, bisphosphonates, digoxin, levothyroxine and proton pump inhibitors. They can also increase the excretion of aspirin and lithium.

Answer 128

Following meals, before bedtime and/or when symptoms occur

Answer 129

Prevent acute attacks of gout Prevent uric acid and calcium oxalate renal stones Prevent hyperuricaemia and tumour lysis syndrome associated with chemotherapy

Answer 130

Xanthine oxidase inhibitor Xanthine oxidase metabolises xanthine (produced from purines) to uric acid. Inhibition of xanthine oxidase lowers plasma uric acid concentrations and reduces precipitation of uric acid in the joints or kidneys.

Answer 131

Acute attacks of gout Recurrent skin rash Signs of more severe hypersensitivity

Answer 132

Benign prostatic hyperplasia Resistant hypertension

Answer 133

Most drugs in this class are selective for the alpha 1-adrenoceptor, which is found mainly in smooth muscle, including in blood vessels and the urinary tract (the bladder neck and prostate in particular). Blockage induces relaxation, and so vasodilatation and a fall in BP and reduced resistance to bladder outflow.

Answer 134

Postural hypotension Dizziness Syncope

Answer 135

At bedtime (to reduce BP lowering effect)

Answer 136

Severe infections, particularly those caused by Gram-negative aerobes (including Pseudomonas aeruginosa) * Severe sepsis, including where the source is unidentified * Pyelonephritis and complicated UTI * Biliary and other intra-abdominal sepsis * Endocarditis

Answer 137

Bind irreversibly to bacterial ribosomes (30S subunit) and inhibit protein synthesis. They are bactericidal (kill bacteria). Their spectrum of action includes Gram-negative aerobic bacteria, staphylococci and mycobacteria.

Answer 138

Enter bacterial cells via an oxygen-dependent transport system. Streptococci and anaerobic bacteria don't have this transport system, so have innate aminoglycoside resistance. Other bacteria acquire resistance through reduced cell membrane permeability to aminoglycosides or acquisition of enzymes that modify aminoglycosides to prevent them from reaching the ribosomes. As penicillins weaken bacterial cell walls, they may enhance aminoglycoside activity by increasing bacterial uptake.

Answer 139

Nephrotoxicity and ototoxicity They accumulate in renal tubular epithelial cells and cochlear and vestibular hair cells where they trigger apoptosis andcell death. Nephrotoxicity presents as reduced urine output and rising serum creatinine and urea. Ototoxicity may present with hearing loss, tinnitus (cochlear damage) and/or vertigo (vestibular damage).

Answer 140

Neonates, elderly and those with renal impairment Myasthenia gravis

Answer 141

Ulcerative colitis (mesalazine) Rheumatoid arthritis (sulfasalazine)

Answer 142

Release 5-aminosalicylic acid (5-ASA), which has anti-inflammatory and immunosuppressive effects

Answer 143

GI upset and headache Serious blood abnormalities (e.g. leucopenia, thrombocytopenia) Renal impairment Sulfasalazine can cause decrrease in number of sperm

Answer 144

Aspirin hypersensitivity (aspirin is a salicylate, too)

Answer 145

Spironolactone Epleronone

Answer 146

Gaviscon Peptac

Answer 147

Doxazosin Tamsulosin Alfuzosin

Answer 148

Gentamicin Amikacin

Answer 149

Mesalazine Sulfasalazine

Answer 150

Enema or suppository Oral

Answer 151

Tachyarrhythmias, including AF, atrial flutter, supraventricular tachycardia, ventricular tachycardia and refractory ventricular fibrillation

Answer 152

Many effects on myocardial cells, including blockade of sodium, calcium and potassium channels, and antagonism of alpha- and beta-adrenergic receptors. This reduces spontaneous depolarisation, slows conduction velocity and increases resistace to depolarisation, including in the AV node. By interfering with the AV node conduction, amiodarone reduces the ventricular rate in AF and atrial flutter. It may also increase the chance of conversion to, and maintenanec of, sinus rhythm.

Answer 153

Pneumonitis Bradycardia and AV block Hepatitis Photosensitivity and grey discolouration Thyroid abnormalities

Answer 154

Severe hypotension Heart block Active thyroid disease

Answer 155

Digoxin Diltiazem Verapamil

Answer 156

For VF or pulseless VT immediately after the 3rd shock, 300mg IV followed by 20mL of 0.9% sodium chloride or 5% glucose as a flush

Answer 157

Hypertension Chronic heart failure Ischaemic heart disease Diabetic nephropathy and chronic kidney disease with proteinuria

Answer 158

Block the action of ACE, to prevent the conversion of angiotensin 1 to angiotensin 2. Angiotensin 2 is a vasoconstrictor and stimulates aldosterone secretion. Blocking its action reduces peripheral vascular resistance, which lowers BP. It particularly dilates the efferent glomerular arteriole, which reduces intraglomerular pressure and slows the progression of CKD. Reducing the aldosterone level promotes water and sodium excretion, which helps to reduce venous return, which is beneficial in heart failure.

Answer 159

Hypotension Persistent dry cough (*!ACE inhibitors only!* increased levels of bradykinin) Hyperkalaemia (lower aldosterone level promotes K+ retention) Renal failure

Answer 160

Renal artery stenosis or AKI Pregnancy or breastfeeding

Answer 161

Ramipril Lisinopril Perindopril

Answer 162

When ACE inhibitors are not tolerated due to cough (same indications): * Hypertension * Chronic heart failure * Ischaemic heart disease * Diabetic nephropathy and chronic kidney disease with proteinuria

Answer 163

Block the action of angiotensin 2 on the AT1 receptor. Angiotensin 2 is a vasoconstrictor and stimulates aldosterone secretion. Blocking its action reduces peripheral vascular resistance, which lowers BP. It particularly dilates the efferent glomerular arteriole, which reduces intraglomerular pressure and slows the progression of CKD. Reducing aldosterone level promotes water and sodium excretion, which helps to reduce venous return, which is beneficial in heart failure.

Answer 164

Losartan Candesartan Irbesartan

Answer 165

Moderate-to-severe depression and mild depression if psychological treatments fail Panic disorder Obsessive compulsive disorder

Answer 166

Inhibit neuronal reuptake of serotonin (5-HT) from the synaptic cleft, increasing its availability for neurotransmission

Answer 167

GI upset, appetite and weight disturbance Hypersensitivity reactions, including skin rash Hyponatraemia (confusion and reduced consciousness) Suicidal thoughts and behaviour Lower the seizure threshold, prolong the QT interval and can predispose to arrhythmias Increase risk of bleeding Serotonin syndrome - autonomic hyperactivity, altered mental state and neuromuscular excitation

Answer 168

Epilepsy Peptic ulcer disease

Answer 169

Citalopram Fluoxetine Sertraline Escitalopram

Answer 170

Symptoms should improve over a few weeks, particularly sleep and appetite Carry on with drug treatment for at least 6 months after they feel better to stop the depression from coming back Don't stop treatment suddenly, as it may cause tummy upset, flu-like symptoms and sleeplessness; instead reduce the dose slowly over 4 weeks

Answer 171

Moderate-to-severe depression (where SSRIs are ineffective) Neuropathic pain (not licensed)

Answer 172

Inhibit neuronal reuptake of serotonin (5-HT) and noradrenaline from the synaptic cleft, increasing their availability for neurotransmission. Also has extensive adverse effects due to blocking a wide array of receptors, including muscarinic, histamine (H1), alpha-adrenergic and dopamine (D2) receptors.

Answer 173

Antimuscarinic: dry mouth, constipation, urinary retention and blurred vision H1 and alpha 1 receptors: sedation and hypotension Arrhythmias and ECG changes (prolongation of QT and QRS durations) Convulsions, hallucinations and mania Dopamine receptors: breast changes and sexual dysfunction, and rarely extrapyramidal symptoms (tremor and dyskinesia)

Answer 174

**Elderly** **Cardiovascular** **disease** **Epilepsy** Constipation Prostatic hypertrophy Raised intraocular pressure

Answer 175

Amitriptyline Lofepramine

Answer 176

Major depression where SSRIs are ineffective Generalised anxiety disorder (venlafaxine)

Answer 177

Serotonin and noradrenaline reuptake inhibitor (SNRI), which interferes with uptake of these neurotransmitters from the synaptic cleft. Increase availability of monoamines for neurotransmission. Weak antagonist of muscarinic and histamine (H1) receptors.

Answer 178

Antagonist of inhibitory pre-synaptic alpha 2-adrenoceptors. Increase availability of monoamines for neurotransmission. Potent antagonist of histamine (H1) but not muscarinic receptors.

Answer 179

GI upset (dry mouth, nausea, change in weight, diarrhoea or constipation) CNS effects (headache, abnormal dreams, insomnia, confusion, convulsions) Hyponatraemia Serotonin syndrome Suicidal thoughts and behaviour

Answer 180

At night (sedative)

Answer 181

Prophylaxis and treatment of nausea and vomiting, particulary in the context of reduced gut motility

Answer 182

Dopamine, acting via D2 receptors, is: * The main receptor in the chemoreceptor trigger zone, which is responsible for sensing emetogenic substances in the blood (e.g. drugs) * An important neurotransmitter in the gut, where it promotes relaxation of the stomach and lower oesophageal sphincter and inhibits gastroduodenal coordination. Blocking D2 receptors has a prokinetic effect, promoting gastric emptying (e.g. opioids, diabetic gastroparesis)

Answer 183

Diarrhoea Extrapyramidal symptoms (metoclopramide) - acute dystonic reaction, e.g. oculogyric crisis

Answer 184

GI obstruction GI perforation Antipsychotics (metoclopramide) Dopaminergic agents for Parkinson's disease (metoclopramide)

Answer 185

Metoclopramide Domperidone

Answer 186

Prophylaxis and treatment of nausea and vomiting, particularly in the context of motion sickness or vertigo

Answer 187

Histamine (H1) and acetylcholine (muscarinic) receptors predominate in the vomiting centre and in its communication with the vestibular system.

Answer 188

Hepatic encephalopathy Prostatic hypertrophy

Answer 189

Cyclizine Cinnarizine Promethazine

Answer 190

Prophylaxis and treatment of nausea and vomiting in a wide range of conditions, particularly when due to vertigo Psychotic disorders, e.g. schizophrenia

Answer 191

Blockade of various receptors, including dopamine (D2) receptors in the chemoreceptor trigger zone and gut and, to a lesser extent, histamine (H1) and acetylcholine (muscarinic) receptors in the vomiting centre and vestibular system

Answer 192

Drowsiness Postural hypotension Extrapyramidal syndromes (D2 receptor blockade) - acute dystonic reaction (e.g. oculogyric crisis), tardive dyskinesia QT interval prolongation

Answer 193

Severe liver disease Prostatic hypertrophy

Answer 194

Prochlorperazine Chlorpromazine

Answer 195

Prophylaxis and treatment of nausea and vomiting, particularly in the context of general anaesthesia and chemotherapy

Answer 196

High density of 5-HT3 receptors in chemoreceptor trigger zone Serotonin is the key neurotransmitter released by the gut in response to emetogenic stimuli. Acting on 5-HT3 receptors, it stimulates the vagus nerve, which activates the vomiting centre via the solitary tract nucleus.

Answer 197

Ondansetron Granisetron

Answer 198

Treatment of local fungal infections, including of the oropharynx, vagina or skin Systemic treatment of invasive or disseminated fungal infections

Answer 199

Polyene antifungals (nystatin) bind to ergosterol in fungal cell membranes, creating a polar pore which allows intracellular ions to leak out of the cell, which kills or slows the growth of the fungi. Imidazole (clotrimazole) and triazole (fluconazole) antifungals inhibit ergosterol synthesis, impairing cell membrane synthesis, cell growth and replication.

Answer 200

GI upset (nausea, vomiting, diarrhoea, abdominal pain) Headache Hepatitis Hypersensitivity (skin rash, cutaneous reactions, anaphylaxis) Severe hepatic toxicity Prolonged QT interval (arrhythmias)

Answer 201

Allergies, particularly hay fever Aid relief of itchiness (pruritis) and hives (urticaria) due, for example, to insect bites, infections (chickenpox) and drug allergies Adjunctive treatment in anaphylaxis, after administratno of adrenaline and other life-saving measures

Answer 202

Nystatin Clotrimazole Fluconazole

Answer 203

Histamine is released from storage granules in mast cells as a result of antigen binding to IgE on the cell surfaces. Mainly via H1 receptors, histamine induces features of immediate type 1 hypersensitivity: increased capillary permeability casing oedema formation, vasodilatation causing erythema and itch due to sensory nerve stimulation. When histamine is released in the nasopharynx, as in hay fever, it causes nasal irritation, sneezing, rhinorrhoea, congestion, conjunctivitis and tich. In the skin, it cause urticaria. Widespread histamine release, as in anaphylaxis, produces generalised vasodilatation and vascular leakage, with consequent hypotension. Antihistamine blocks the H1 receptor.

Answer 204

Cetirizine Loratadine Fexofenadine Chlorphenamine

Answer 205

Diarrhoea, usually in the context of irritable bowel syndrome or viral gastroenteritis

Answer 206

Agonist of opioid u-receptors in the GI tract, which increases non-propulsive contractions of the gut smooth muscle, but reduces propulsive (peristaltic) contractions. As a result, transit of bowel contents is slowed and anal sphincter tone is increased. Slower gut transit allows more time for water absorption, which hardens the stool.

Answer 207

Acute ulcerative colitis (inhibition of peristalsis increases risk of megacolon and perforation) Clostridium difficile colitis Acute bloody diarrhoea

Answer 208

Loperamide Codeine phosphate

Answer 209

Chronic obstructive pulmonary disease Asthma

Answer 210

Bind to muscarinic receptor, where they act as a competitive inhibitor of acetylcholine. Blocking the receptor reduces smooth muscle tone (including in the respiratoy tract) and reduces secretions from glands in the respiratory and GI tract.

Answer 211

Angle-closure glaucoma Arrhythmias

Answer 212

Ipratropium Tiotropium Glycopyrronium

Answer 213

Severe or symptomatic bradycardia (atropine) Irritiable bowel syndrome (hyoscine butylbromide) Reducing copious respiratory secretions (hyoscine butylbromide)

Answer 214

Bind to muscarinic receptors, where they act as competitive inhibitor of acetylcholine. Blocking the receptor results in increased heart rate and conduction, reduced smooth muscle tone and peristaltic contraction (including in the gut and urinary tract) and reduce secretions from glands in the respiratory tract and gut.

Answer 215

Tachycardia Dry mouth Constipation Urinary retention in those with BPH Blurred vision

Answer 216

Atropine Hyoscine butylbromide Glycopyrronium

Answer 217

Reduce urinary frequency, urgency and urinary incontinence in overactive bladder

Answer 218

Bind to muscarinic receptors, where they act as competitive inhibitor of acetylcholine. Contraction of the smooth muscle of the bladder is under parasympathetic control. Blocking muscarinic receptors promotes bladder relaxation, increasing bladder capacity. Relatively selective for the M3 receptor.

Answer 219

Oxybutynin Tolterodine Solifenacin

Answer 220

Urgent treatment of severe psychomotor agitation that is causing dangerous or violent behaviour, or to calm patient to permit assessment Schizophrenia Bipolar disorder, particularly in acute episodes of mania or hypomania Nause and vomiting, particularly in palliative care setting

Answer 221

Block the post-synaptic dopamine D2 receptors. D2 blockade of the mesolimbic/mesocortical pathway between the midbrain and limbic system/frontal cortex. D2 receptors also found in chemoreceptor trigger zone, where blockade accounts for their use in nausea and vomiting.

Answer 222

Extrapyramidal effects (D2 blockade in nigrostriatal pathway) - acute dystonic reactions (involuntary parkinsonian movements or muscle spasms), akathisia (state of internal restlessness) and neuroleptic malinancy syndrome (rigidity, confusion, autonomic dysregulation, pyrexia), tardive dyskinesia Drowsiness Hypotension QT prolongation (arrhythmias) Erectile dysfunction Hyperprolactinaemia (tuberohypophyseal D1 blockade) - menstrual disturbance, galactorrhoea, breast pain

Answer 223

Haloperidol Chlorpromazine Prochlorperazine

Answer 224

Orally (tablet and liquid) Slow-release IM ('depot') injection Rapid-acting IM injection (haloperidol) IV (haloperidol)

Answer 225

Elderly Dementia Parkinson's disease

Answer 226

Urgent treatment of severe psychomotor agitation that is causing dangerous or violent behaviour, or to calm patient to permit assessment Schizophrenia, particularly when extrapyramidal SEs have complicated the use of typical antipsychotics or negative symptoms are prominent Bipolar disorder, particularly in acute episodes of mania or hypomania

Answer 227

Improved efficacy in 'treatment-resistant' schizophrenia and against negative symptoms (higher affinity for other receptors, particularly 5-HT2A receptors) Lower risk of extrapyramidal symptoms (looser binding to the D2 receptors)

Answer 228

Metabolic disturbance - weight gain, DM, lipid changes

Answer 229

Agranulocytosis (severe deficiency of neutrophils) Myocarditis

Answer 230

Severe heart disease History of neutropenia

Answer 231

Quetiapine Olanzapine Risperidone Clozapine

Answer 232

Acute coronary syndrome and acute ischaemic stroke Long-term secondary prevention of thrombotic arterial events in those with cardiovascular, cerebrovascular and peripheral arterial disease Reduce the risk of intracardiac thrombus and embolic stroke in AF where warfarin and novel oral anticoagulants are contraindicated Mild-to-moderate pain and fever

Answer 233

Irreversibly inhibits cyclooxygenase (COX) to reduce production of the pro-aggregatory factor thromboxane from arachidonic acid, reducing platelet aggregation and the risk of arterial occlusion

Answer 234

GI irritation GI ulceration and haemorrhage Hypersensitivity reactions (bronchospasm)

Answer 235

Children under 16 (Reye's syndrome) Aspirin hypersensitivity Third trimester of pregnancy (premature closure of ductus arteriosus)

Answer 236

ACS: once-only loading dose of 300mg followed by a regular dose of 75mg daily Acute ischaemic stroke: aspirin 300mg daily for 2 weeks before switching to 75mg daily Prevention of thrombosis: low-dose aspirin 75mg daily

Answer 237

Proton pump inhibitor, e.g. omeprazole 20mg daily

Answer 238

After food

Answer 239

Seizures and status epilepticus Alcohol withdrawal reactions Sedation for interventional procedures Short-term treatment of severe, disabling or distressing anxiety or insomnia

Answer 240

Facilitate and enhance binding of GABA to GABAA receptor. Depressant effect on synaptic transmission, resulting in reduced anxiety, sleepiness, sedation and anticonxulsive effects.

Answer 241

Respiratory impairment Neuromuscular disease, e.g. myasthenia gravis Liver failure (hepatic encephalopathy)

Answer 242

Diazepam Temazepam Lorazepam Chlordiazepoxide Midazolam

Answer 243

Lorazepam (initial dose 4mg IV) or diazepam (10mg IV or rectally) Long-acting

Answer 244

Asthma: short-acting to relieve breathlessness and long-acting as step 3 treatment for chronic asthma COPD: short-acting to relieve breathlessness and long-acting as an option for second-line therapy Hyperkalaemia (nebulised)

Answer 245

Beta2 receptors are found in smooth muscle of the bronchi, GI tract, uterus and blood vessels. Stimulation of this G protein-coupled receptor activates a signalling cascade that leads to smooth muscle relaxation. This improves airflow in constricted airways, reducing the symptoms of breathlessness. Also stimulate Na+/K+-ATPase pumps on cell surface membranes, causing a shift of K+ from extracellular to intracellular compartment.

Answer 246

Salbutamol Terbutaline

Answer 247

Salmeterol Formoterol

Answer 248

Fight or flight * Tachycardia * Palpitations * Anxiety * Tremor Promote glycogenolysis > increased serum glucose Muscle cramps

Answer 249

Spacer with metered dose inhalers

Answer 250

Ischaemic heart disease (angina and acute coronary syndrome) Chronic heart failure AF Supraventricular tachycardia Hypertension

Answer 251

Beta1-adrenoreceptors are located mainly in the heart and beta2-adrenoreceptors are found mainly in smooth muscle of blood vessels and the airways. Beta blockers reduce force of contraction and speed of conduction in the heart, relieving myocardial ischaemia by reducing cardiac work and oxygen demand and increasing myocardial perfusion. Slow the ventricular rate in AF by prolonging the refractory period of the AV node. Lower BP in a variety of ways, including reducing renin secretion from the kidney.

Answer 252

Fatigue Cold extremities Headache GI disturbance, e.g. nausea Sleep disturbance and nightmares Impotence

Answer 253

Asthma Non-dihydropyridine calcium channel blockers, e.g. verapamil, diltiazem Haemodynamic instability Heart block

Answer 254

Bisoprolol Atenolol Propranolol Metoprolol

Answer 255

Osteoporotic fragility fractures (alendronic acid) Severe hypercalcaemia of malignancy (pamidronate and zoledronic acid) Myeloma and breast cancer with bone metastases (pamidronate and zoledronic acid) Metabolically-active Paget's disease

Answer 256

Reduce bone turnover by inhibiting the action of osteoclasts, the cells responsible for bone resorption. As bone is resorbed, bisphosphonates accumulate in osteoclasts, where they inhibit activity and promote apoptosis, resulting in reduction in bone loss and improvement in bone mass.

Answer 257

Oesophagitis (when taken orally) Hypophosphataemia Osteonecrosis of the jaw Atypical femoral fracture

Answer 258

Severe renal impairment Hypocalcaemia Upper GI disorders (oral administration only)

Answer 259

Alendronic acid Disodium pamidronate Zoledronic acid

Answer 260

Swallowed whole At least 30 minutes before breakfast or other medications With plenty of water Remain upright for 30 minutes after taking (reduce oesophageal irritation)

Answer 261

Osteoporosis (Ca + vit D) Chronic kidney disease (secondary hyperparathyroidism and renal osteodystrophy) (Ca + vit D) Severe hyperkalaemia to prevent life-threatening arrhythmias (Ca) Hypocalcaemia that is symptomatic (e.g. paraesthesia, tetany, seizures) or severe (Ca) Vitamin D deficiency, including for rickets and osteomalacia (vit D)

Answer 262

Calcium carbonate Calcium gluconate Colecalciferol Alfacalcidol

Answer 263

Hypertension (amlodipine, nifedipine) Stable angina Supraventricular arrhythmais (diltiazem, verapamil)

Answer 264

Decrease Ca entry into vascular and cardiac cells, reducing intracellular calcium concentration. This causes relaxation and vasodilation in arterial smooth muscle, lowering arterial pressure. Reduce myocardial contractility. Suppress cardiac conduction, particularly across the AV node, slowing ventricular rate.

Answer 265

Dihydropyridines (amlodipine, nifedipine): relatively selective for vasculature Non-dihydropyridines: more cardioselective

Answer 266

Ankle swelling Flushing Headache Palpitations

Answer 267

Constipation Bradycardia Heart block Cardiac failure

Answer 268

Amlodipine Nifedipine Diltiazem Verapamil

Answer 269

Epilepsy, for focal seizures and primary generalised seizures Trigeminal neuralgia Bipolar disorder, as an option for prophylaxis in those resistant or intolerant of other medication

Answer 270

GI upset (nausea and vomiting) Neurological effects (dizziness and ataxia) Oedema Hyponatraemia Hypersensitvity (mild maculopapular skin rash) Antiepileptic hypersensitivity syndrome (severe skin reactions, fever, lymphadenopathy, systemic involvement and 10% mortality)

Answer 271

Antiepileptic hypersensitivity syndrome Pregnancy

Answer 272

Urinary and respiratory tract infections (oral cephalosporins) Treatment of infections that are very severe or complicated, or caused by antibiotic-resistant organisms (IV cephalosporins and carbapenems)

Answer 273

Beta-lactam ring. During bacterial cell growth, they inhibit enzymes responsible for cross-linking peptidoglycans in bacterial cell walls, which weakens cell walls, preventing them from maintaining an osmotic gradient, resulting in bacterial cell swelling, lysis and death.

Answer 274

Cephalosporins and carbapenems due to fusion of the beta-lactam ring with a dihydrothiazine ring (cephalosporins) or hydroxyethyl side chain (carbapenems)

Answer 275

GI upset (nausea and diarrhoea) Antibiotic-associated colitis Hypersensitivity CNS toxicity (seizures)

Answer 276

Cefalexin Cefotaxime

Answer 277

Meropenem Ertapenem

Answer 278

Cephalosporins: orally (tablets, capsules, suspension), injection (IV, bolus injection, infusion), IM Carbapenems: IV injection or infusion

Answer 279

Generally prescribed with aspirin * Acute coronary syndrome * Prevent occlusion of coronary artery stents * Long-term secondary prevention of thrombotic arterial events in those with cardiovascular, cerebrovascular and peripheral arterial disease * Reduce the risk of intracardiac thrombus and embolic stroke in AF where warfarin and novel oral anticoagulants are contraindicated

Answer 280

Prevents platelet aggregation and reduces the risk of arterial occlusion by binding irreversibly to adenosine diphosphate (ADP) receptors (P2Y12 subtype) on the surface of platelets

Answer 281

Bleeding GI upset (dyspepsia, abdominal pain, diarrhoea) Thrombocytopenia

Answer 282

Active bleeding 7 days before elective surgery and other procedures

Answer 283

Asthma: control of symptoms and prevention of exacerbations COPD: control of symptoms and prevention of exacerbations

Answer 284

Inhaled corticosteroid suppresses airway inflammation Long-acting beta2-agonist (LABA) stimulates bronchodilation

Answer 285

Seretide Symbicort

Answer 286

Rinse mouth and gargle after taking inhaler

Answer 287

Allergic or inflammatory disorders, e.g. anaphylaxis and asthma Suppression of autoimmune disease, e.g. inflammatory bowel disease and inflammatory arthritis Treatment of some cancers as part of chemotherapy or to reduce tumour-associated swelling Hormone replacement in adrenal insufficiency or hypopituitarism

Answer 288

Mainly glucocorticoid effects. Bind to cytosolic glucocorticoid receptors, which then translocate to the nucleus and bind to glucocorticoid-response elements, which regulate gene suppression. Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes (cytokines, tumour necrosis factor alpha). Direct actions on inflammatory cells: suppression of circulating monocytes and eosinophils. Metabolic effects: increase gluconeogenesis from increased circulating amino and fatty acids, released by catabolism of muscle and fat. Mineralocorticoid effects: Na+ and water retention and L+ excretion in the renal tubule.

Answer 289

Infection DM Osteoporosis Proximal muscle weakness Skin thinning with easy bruising Gastritis Mood and behavioural changes: insomnia, confusion, psychosis and suicidal ideas Addisonian crisis (If withdrawn suddenly) Mineralocorticoid actions: HTN, hypokalaemia and oedema

Answer 290

Prednisolone Hydrocortisone Dexamethasone

Answer 291

Asthma COPD

Answer 292

Pass through the plasma membrane and interact with receptors in the cytopmas. Activated receptor passes into the nucleus to modify the transciption of a large number of genes. Pro-inflammatory interleukins, cytokines and chemokines are downregulated, while anti-inflammatory proteins are upregulated. In the airways, this reduces mucosal inflammation, widens the airways and reduces mucus secretion.

Answer 293

Oral candidiasis Hoarse voice

Answer 294

Beclometasone Budesonide Fluticasone

Answer 295

Inflammatory skin conditions, e.g. eczema

Answer 296

Hydrocortisone Betamethasone

Answer 297

AF and atrial flutter Severe heart failure

Answer 298

Negatively chronotropic (reduces heart rate) and positively inotropic (increases force of contraction). Indirect pathway increases vagal (parasympathetic) tone, reducing conduction at the AV node, preventing some impulses from being transmitted to the ventricles, thereby reducing the ventricular rate. Direct effect on myocytes through inhibition of Na+/K+-ATPase pumps, causing Na+ to accumulate in the cell. As cellular extrusion of Ca requires low intracellular Na concentrations, elevation of intracellular Na causes Ca to accumulate in the cell, increasin contractile force.

Answer 299

Bradycardia GI disturbance Rash Dizziness Visual disturbance (blurred or yellow vision)

Answer 300

Second-degree heart blok and intermittent complete heart block Ventricular arrhythmias

Answer 301

Cerebrovascular disease (TIA or ischaemic stroke), for secondary prevention of stroke Induce tachycardia during a myocardial perfusion scan in the diagnosis of ischaemic heart disease

Answer 302

Antiplatelet and vasodilatory effects. Inrease in intra-platelet cyclic adenosine monophosphate (cAMP) that inhibits platelet aggregation, reducing the risk of artieral occlusion. Blocks cellular uptake of adenosine, prolonging its effect on blood vessels to produce vasodilation.

Answer 303

Relief of breathlessness in acute pulmonary oedema Symptomatic treatment of fluid overload in chronic heart failure Symptomatic treatment of fluid overload in other oedematous states, e.g. due to renal disease or liver failure

Answer 304

Act principally on the ascending limb of the loop of Henle, where they inhibit the Na/K/2Cl co-transporter, which is responsible for transporting Na, K and Cl ions from the tubular lumen into the epithelial cell, and so water then follows by osmosis. Inhibiting this has a potent diuretic effect. Direct effect on blood vessels, causing dilatation of capacitance veins.

Answer 305

Dehydration Hypotension Low electrolyte state

Answer 306

Hypovolaemia Dehydration

Answer 307

Furosemide Bumetanide

Answer 308

Hypokalaemia arising from loop- or thiazide-diuretic therapy

Answer 309

Weak diuretics. Counteract potassium loss and enhance diuresis when combined with another diuretic. Acts on distal convoluted tubules in the kidney. Inhibits the reabsorption of Na and therefore water by epithelial sodium channels, leading to sodium and water excretion and retention of potassium.

Answer 310

Severe renal impairment Hyperkalaemia K supplements Aldosterone antagonists

Answer 311

Hypertension

Answer 312

Inhibit the Na/Cl co-transporter in the distal convoluted tubule of the nephron. This prevents reabsorption of sodium and its osmotically associated water. The resulting diuresis causes an initial fall in extracellular fluid volume. Vasodilatation.

Answer 313

Hyponatraemia Hypokalaemia (arrhythmias)

Answer 314

Bendroflumethiazide Indapamide Chlortalidone

Answer 315

Early Parkinson's disease Later Parkinson's disease Secondary parkinsonism

Answer 316

Precursor of dopamine that can enter the brain via a membrane transporter

Answer 317

Nausea Drowsiness Confusion Hallucinations Hypotension Dyskinesia (excessive and involuntary movement)

Answer 318

Levodopa Ropinirole Pramipexol

Answer 319

Taken at the right time, to produce the best symptom control

Answer 320

Topical treatment for all dry or scaling skin disorders

Answer 321

Replace water content in dry skin. Contain oils or paraffin-based products that help to soften the skin and can reduce water loss by protecting against evaporation from the skin surface.

Answer 322

Aqueous cream Liquid paraffin

Answer 323

Acute ischaemic stroke (alteplase) Acute STEMI (alteplase, streptokinase) Massive PE with haemodynamc instability

Answer 324

Catalyse the conversion of plasminogen to plasma, which acts to dissolve fibrinous clots and re-canalise occluded vessels. This allows reperfusion of affected tissue, preventing or limiting tissue infarction and cell death.

Answer 325

Nause and vomiting Bruising Hypotension Serious bleeding Allergic reaction Cardiogenic shock Cardiac arrest Cerebral oedema (brain infarction) Arrhythmia (heart infarction)

Answer 326

Bleeding: recent haemorrhage, recent trauma or surgery Bleeding disorders Severe hypertension Peptic ulcers Previous streptokinase treatment

Answer 327

Alteplase Streptokinase

Answer 328

Focal epilepsies Neuropathic pain (pregabalin) Migraine prophylaxis (gabapentin) Generalised anxiety disorder (pregabalin)

Answer 329

Binds with voltage-sensitive Ca channels, where it prevents the inflow of Ca and inhibits neurotransmitter release. This interferes with synaptic transmission and reduces neuronal excitability.

Answer 330

Peptic ulcer disease GORD and dyspepsia

Answer 331

Reduce gastric acid secretion. Histamine is released by local pararine cells and binds to H2-receptors on the gastric parietal cell. Via a second-messenger system, this activates the proton pump. Blocking the H2-receptors therefore reduces acid secretion.

Answer 332

Ranitidine

Answer 333

Venous thromboembolism: DVT and PE Acute coronary syndrome

Answer 334

Thrombin and factor Xa are key components of the final common coagulation pathway that leads to formation of a fibrin clot. By inhibiting their function, they prevent the formation and propagation of blood clots. Unfractionated heparin activates antithrombin, which inactivates clotting factor Xa and thrombin. LMWH preferentially inhibit factor Xa. Fondaparinux inhibits factor Xa only.

Answer 335

Clotting disorders Severe uncontrolled hypertension Recent surgery or trauma Invasive procedures (lumbar puncture, spinal anaesthesia)

Answer 336

Enoxaparin Dalteparin Unfractionated heparin

Answer 337

Type 1 and 2 DM Diabetic emergencies (DKA, hyperglycaemia hyperosmolar syndrome) (IV) Perioperative glycaemic control in selected DM patients Hyperkalaemia