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1MRCPCH FOP and TAS > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is an irreversible side effect of tetracyclines?

A

Teeth staining

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2
Q

How does montelukast work?

A

Blocks action of leukotriene D4 in the lungs which decreases inflammation and relaxes smooth muscle

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3
Q

How does rituximab work and what conditions is it used for?

A

Binds to CD20 on B cells
Used in Hodgkins lymphoma and some vasculitides

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4
Q

How does vigabatrin work?

A

Analogue of GABA which inhibits GABA aminotransferase (inhibits GABA breakdown)
Has a seizure suppression effect

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5
Q

How does cyclophosphamide work?

A

Chemotherapeutic agent which causes cell apoptosis when it breaks down to its metabolite phosphoralide mustard

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5
Q

Which chemotherapy agent has the side effect of haemorrhagic cyctitis?

A

Cyclophosphamide

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6
Q

How does vincristine work?

A

Vinca alkaloid chemotherapeutic agent which acts through inhibiting microtubule activity

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7
Q

Which chemotherapy drug causes peripheral neuropathy?

A

Vincristine

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7
Q

How does doxorubicin work?

A

Anthracycline chemotherapy drug which acts through inhibition of topoisomerase II (allows uncoiling of DNA in preparation for transcription)

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8
Q

Which chemotherapy agent is known to be cardiotoxic?

A

Doxorubicin

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9
Q

How does blinatumomab work and what is it used for?

A

Targets the CD19 antigen on B-cells
Used in treatment of refractory B cell leukaemia

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9
Q

Which biological agent works by inhibiting IgE?

A

Omalizumab

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9
Q

How does inflixamab work?

A

Inhibits TNF-alpha

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9
Q

Which type of antibiotic is known for its QTc prolongation?

A

Macrolides

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10
Q

How do PPIs work?

A

Inhibit the H+-K+-ATP pump in the gastric parietal cells

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11
Q

How does lamotrigine prevent seizures?

A

Prolongs sodium channel inactivation to prevent membrane depolarisation and subsequent seizure activity

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12
Q

How does metformin work to lower blood sugars?

A

Decreased gluconeogenesis and increase peripheral utilisation of glucose

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13
Q

How does insulin function to reduce blood sugar levels?

A

Enhances glucose uptake and cell metabolism

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13
Q

How does gliclazide work to lower blood sugar levels?

A

Augments insulin secretion from functioning B pancreatic cells

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13
Q

How does risperidone work?

A

It is a D2, 5-HT, alpha-1, histamine-1 antagonist

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14
Q

How does a n oculogyric crisis present?

A

Involuntary deviation upward of both eyes

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14
Q

Which type of drugs most commonly cause oculogyric crises?

A

Neuroleptic drugs

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14
Q

What is the mechanism of action of trimethoprim?

A

Inhibits an essential step in synthesis of bacterial nucleic acid synthesis
Is an antifolate antibiotic

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14
Q

What is the mechanism of action of gentamicin?

A

Inhibits bacterial synthesis by binding to 30s subunit of bacterial ribosomes

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14
Q

What is the mechanism of action of clarithromycin?

A

Inhibits bacterial synthesis by binding to 50s ribosomal subunit

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14
Q

What is the mechanism of action of cyclopentolate?

A

Muscarinic acetylcholine M1 receptor antagonist

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15
Q

What is the mechanism of action of azithromycin?

A

Binds to recombinant 23S rRNA of bacterial 50S ribosomal unit to inhibit bacterial synthesis

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16
Q

What is the mechanism of action of metronidazole?

A

Inhibits bacterial synthesis by causing loss of helical DNA structure and strand breakage

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17
Q

What is the mechanism of action of vancomycin?

A

Inhibits synthesis of bacterial cell wall via prevention of peptide incorporation into the peptidoglycan matrix

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18
Q

What is the mechanism of action of allopurinol?

A

Inhibits xanthine oxidase and its active metabolite

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19
Q

What is allopurinol used for in oncology patients?

A

Used to avoid TLS

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20
Q

What is the mechanism of action of amlodipine?

A

Inhibits calcium ion reflux at L-type calcium channels

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21
Q

What is the mechanism of action of hyoscine?

A

Antimuscarinic agent which competitively inhibits acetylcholine muscarinic receptors

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22
Q

What is the mechanism of action of isoprenaline?

A

Positive inotropic and chronotropic effects via B1 adrenergic stimulation

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23
Q

What is the mechanism of action of adrenaline?

A

Alpha and beta receptor agonist
B1 receptors - increases HR and myocardial contractility
A-adrenergic receptors - inhibits vasodilation

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24
Q

What is the mechanism of action of atenolol?

A

Selective B1 receptor antagonist - antagonist to sympathetic innervation

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25
Q

What is the mechanism of action of NAC?

A

Generates glutathione which in turn conjugates the NAPQI (paracetamol metabolite) into a harmless metabolite
Reduces the circulation of toxic metabolites

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26
Q

What is the mechanism of action of mycophenolate mofetil?

A

Prevents DNA synthesis and proliferation by inhibiting inosine monophosphate

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27
Q

What is the mechanism of action of flecainide?

A

Blocks sodium channels which reduce the rate of depolarisation of phase 0 without changing the overall AP duration.

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28
Q

What class of anti-arrythmic is flecainide?

A

Class Ic

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29
Q

Give an example of a class III antiarrhythmic drug?

A

Amiodarone

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30
Q

What is the mechanism of action of amiodarone?

A

Block potassium channels that increase the action potential duration by increasing length of repolarisation in phase 3.

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31
Q

What is an example of a class Ia anti-arrhythmic drug?

A

Disopyramide

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32
Q

What is the mechanism of action of disopyramide?

A

Block sodium channels that increase AP duration by increasing length of depolarisation during phase 0

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33
Q

What is the mechanism of action of Ivabradine?

A

Blocks the If channel in the SAN, reducing rate of pacemaker potential depolarisation, increasing refractory period and slowing the heart rate

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34
Q

What is an example of a class Ib anti-arrhythmic drug?

A

Mexiletine

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35
Q

What is the mechanism of action of melixetine?

A

Block sodium channels that shorten the AP duration by reducing the length of plateau in phase 2.

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36
Q

What is the most common side effect of IV quinine?

A

Tinnitus

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37
Q

What are the major side effects of ciclosporin?

A

Chronic interstitial nephritis
Hypertrichosis
Periodontal destruction

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38
Q

Which commonly used drug in TB management can reduce the effectiveness of warfarin?

A

Rifampicin - potent enzyme inducer

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39
Q

Which antibiotic can cause cholestatic jaundice?

A

Co-amoxiclav

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40
Q

Which chemotherapy agent can cause haemorrhagic cystitis?

A

Cyclophosphamide

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41
Q

What is the mechanism of action of fexofenadine?

A

H1 antagonist

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42
Q

What is the mechanism of action of fomepizole?

A

Competitive inhibitor of alcohol dehydrogenase

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43
Q

What is the mechanism of action of milrinone?

A

Positive inotrope - competitive phosphodiesterase-3-inhibitor that inhibits degradation of cAMP.

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44
Q

What is the mechanism of action of domperidone?

A

Dopamine-receptor antagonist

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45
Q

Which antiepileptic medication is associated with visual field defects?

A

Vigabatrin

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46
Q

What is the mechanism of action of aminophylline?

A

Inhibits phosphodiesterase type III and IV which breakdown cAMP in smooth muscle cells. Allows bronchodilation.

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47
Q

What is the mechanism of action of chloramphenicol?

A

Inhibits intracellular protein production
Binds to 50S subunit of 70S ribosome inhibiting action of peptidyl transferase

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48
Q

What is the mechanism of action for ondansetron?

A

Selective serotonin 5-HT3 receptor antagonist

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49
Q

What is the mechanism of action of verapamil?

A

Non-dihydropyridine CCB

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50
Q

What is the most common side effect of verapamil?

A

Constipation

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51
Q

What is the mechanism of action of infliximab?

A

IgG monoclonal ab which binds to TNF-alpha with high affinity

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52
Q

Which chemotherapeutic agent causes peripheral neuropathy?

A

Vincristine

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53
Q

Which drug causes “grey baby syndrome”?

A

Chloramphenicol

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54
Q

What is “grey baby syndrome”?

A

Cardiovascular collapse in infants due to immature hepatic glucuronidation meaning they are unable to excrete the drug.

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55
Q

Which corticosteroid has the highest mineralocorticoid activity?

A

Fludrocortisone

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56
Q

What is the mechanism of action of levetiracetam?

A

Binds to SV2A which regulates release of neurotransmitters into vesicles

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57
Q

What is a type A drug reaction?

A

“Augmented”
Exaggeration of a drugs normal pharmacological actions
Normally dose dependent

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58
Q

What is a type B drug reaction?

A

“Bizarre”
Novel response not expected from the known pharmacological actions of teh drug

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59
Q

What is a type C drug reaction?

A

“Continuing”
Persist for a very long time

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60
Q

What is a type D drug reaction?

A

“Delayed”
Become apparent sometime after the use of a medicine

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61
Q

What is a type E drug reaction?

A

“End-of-use”
Associated with medication withdrawal.

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62
Q

What is the mechanism of action of ondansteron?

A

Serotonin receptor antagonist - selectively blocks 5-HT3 serotonin receptor

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63
Q

What are the common side effects of ondansetron?

A

Dry mouth
Drowsiness
Constipation

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64
Q

Which antibiotic can cause red man syndrome if it is infused too quickly?

A

Vancomycin

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65
Q

How does red man syndrome present?

A

Pruritic erythematous rash over face, neck and upper torso

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66
Q

What is one of the main significant side effects of ethambutol?

A

Visual disturbances

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67
Q

What is the antidote for benzodiazepine overdose?

A

Flumazenil

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68
Q

What is the mechanism of action of prednisolone?

A

Inhibits migration of neutrophils

69
Q

What is the mechanism of action of cyclizine?

A

Sedating antihistamine with antimuscarinic properties.
Acts on medulla oblongata

70
Q

What is the mechanism of action of phenylephrine?

A

Pure alpha-adrenoreceptor agonis which elevates vascular resistance and increases BP

71
Q

What is the mechanism of action of sildenafil?

A

Phosphodiesterase V inhibitor

72
Q

What is the mechanism of action of insulin?

A

Translocation of pre-formed GLUT4 to the cell surface

73
Q

What is nitric oxide often derived from?

A

L-arginine

74
Q

What is the mechanism of action of nitric oxide?

A

Modulation of vascular tone via vasodilation

75
Q

What is the mechanism of action of ursodeoxycholic acid?

A

Protects hepatocytes against bile-acid-induced apoptosis

76
Q

What class of HIV drugs tend to cause lipoatrophy?

A

NRTIs (nucleoside reverse transcriptase inhibitors) e.g. zidovudine

76
Q

What is the mechanism of action of indomethacin?

A

Inhibits prostaglandin E2 synthesis therefore closing the ductus arteriosus

77
Q

What effects does adrenaline have in the treatment of anaphylaxis?

A

A1 receptor agonist - vasoconstriction
B1 agonist - increased contractility and HR
B2 agonist - bronchodilation

77
Q

Which TB drug most commonly causes peripheral neuropathy?

A

Isoniazid

77
Q

What is the preferred opioid used in syringe drivers?

A

Diamorphine - larger doses with smaller volumes compared to morphine

77
Q

What is the mechanism of action of adenosine?

A

Blocks the AV node to allow normal heart rhythm to restart
Causes reversible bronchospasm
A1 adenosine-receptor agonist

77
Q

What is the reason that ACEIs can cause cough as a side effect?

A

Bradykinin accumulates causing cough through bronchoconstriction

77
Q

What is the conversion ration from oral morphine to subcutaneous diamorphine?

A

3mg PO morphine is roughly equivalent to 1mg S/cut diamorphine

77
Q

What is the mechanism of action of ranitidine?

A

H2-receptor blocker

78
Q

What is the antidote to unfractionated heparin?

A

Protamine

78
Q

What renal complication can beta-lactam antibiotics sometimes cause?

A

Acute tubule-interstitial nephritis

78
Q

What is the mechanism of action of sodium valproate?

A

Reduction of catabolism of GABA

79
Q

What is the mechanism of action of isoniazid?

A

Inhibition of mycolic acid synthesis

79
Q

What is the mechanism of action of lorazepam?

A

Activates chloride channels by binding in post-synaptic GABA-A ligand-gated chloride channels and increases flow of chloride ions into the cell

79
Q

What is the ratio for converting IV to oral morphine?

A

1mg Iv morphine is roughly equivalent to 2mg PO morphine.

79
Q

What is the mechanism of action of lidocaine?

A

Prolongs inactivation of voltage-gated sodium channels, which prevents action potentials from firing

79
Q

What is the mechanism of action of morphine?

A

Adenylyl cyclase inhibitor

79
Q

What treatment is used for malignant hyperthermia?

A

Dantrolene

79
Q

What is the mechanism of action of sildenafil?

A

Phosphodiesterase V inhibitor - causes pulmonary-specific vasodilation and reduction of pressure

79
Q

What antibiotics are more commonly known to cause erythema multiforme?

A

Sulphonamides (co-trimox) and penicillin

79
Q

What is the mechanism of action of ipratropium?

A

Cholinergic receptor blocker - decreases smooth muscle contraction in the airways

79
Q

What is the mechanism of action of furosemide?

A

Blocks sodium and chloride reabsorption in the loop of Henle

79
Q

Which antibiotics can cause ototoxicity?

A

Gentamicin
Vancomycin

80
Q

What is the mechanism of action of acetazolamide?

A

Reversible inhibitor of carbonic anhydrase

80
Q

What is the mechanism of action of folic acid?

A

Activated by dihydrofolate reductase as it itself is biochemically inactive

80
Q

What blood test should be closely monitored in ganciclovir treatment and why?

A

FBC as drug can cause leukopenia, neutropenia and thrombocytopenia

80
Q

What is the mechanism of action of atomoxetine?

A

Activation of adrenergic alpha and beta receptors
Selective norepinephrine reuptake inhibitor

80
Q

What is the main renal complication of acetazolamide therapy?

A

Acute interstitial nephritis

80
Q

What is the mechanism of action of midazolam?

A

GABA-A receptor agonist

80
Q

What is the first line treatment for CMV?

A

Ganciclovir

80
Q

What is the mechanism of action of phenylephrine?

A

Alpha adrenergic effects - increases systemic vascular resistance via vasoconstriction with no effect on HR

80
Q

What is the mechanism of action of chlorphenamine?

A

H1-receptor blocker

80
Q

What is the mechanism of action of dornase alpha?

A

Endonucleic cleavage of extracellular DNA

80
Q

What is the mechanism of action of LMWH?

A

Accelerates antithrombin-dependent inactivation of factor Xa

81
Q

Which diuretic can cause a metabolic acidosis?

A

Acetazolamide

81
Q

Why are statins and macrolides contraindicated to be taken at the same time?

A

Macrolides are potent CYP450 3A4 inhibitors and as statins are metabolised this way - may cause statin toxicity.

81
Q

What is the mechanism of action of Ezetimibe?

A

Blocks the Niemann-Pick C1-like protein and therefore inhibits dietary cholesterol absorption

81
Q

What is the drug metabolism pathway for carbamazepine?

A

CYP3A4

82
Q

What is the mechanism of action of phenobarbital?

A

Increases opening time of chloride channels by binding to GABA-A receptors

82
Q

What is the drug metabolism pathway for diazepam?

A

CYP3A4

82
Q

What is the drug metabolism pathway for erythromycin?

A

CYP3A4

82
Q

What is the drug metabolism pathway for fentanyl?

A

CYP3A4

82
Q

What is the drug metabolism pathway for midazolam?

A

CYP3A4

82
Q

What is the drug metabolism pathway for nifedipine?

A

CYP3A4

82
Q

What is the drug metabolism pathway for ondansetron?

A

CYP3A4

83
Q

What is the drug metabolism pathway for rifampicin?

A

CYP3A4

83
Q

What is the drug metabolism pathway for caffeine?

A

CYP1A2

84
Q

What is the drug metabolism pathway for theophylline?

A

CYP1A2

84
Q

What is the drug metabolism pathway for phenytoin?

A

CYP2C9

84
Q

What is the drug metabolism pathway for ibuprofen?

A

CYP2C9

84
Q

What is the drug metabolism pathway for amitriptyline?

A

CYP2D6

84
Q

What is the drug metabolism pathway for codeine?

A

CYP2D6

85
Q

What is the drug metabolism pathway for SSRIs?

A

CYP2D6

85
Q

What is the drug metabolism pathway for paracetamol?

A

Glucuronidation

86
Q

What is the mechanism of action of mannitol?

A

Osmosis in the proximal renal tubule

87
Q

Why should methotrexate and NSAIDs be avoided concurrently?

A

NSAIDs inhibit renal excretion of methotrexate

88
Q

Which renal side effect is most common with topiramate?

A

Nephrolithiasis

89
Q

How can trimethoprim affect U&Es?

A

As trimethoprim competes with creatinine for secretion into the renal tubule, it can cause asymptomatic elevation in creatinine with no change in urea. It is transient and resolves on cessation

90
Q

What is the mechanism of action of atropine?

A

Blocks the vagal impulse

91
Q

What is the mechanism of action of clindamycin?

A

Inhibits protein synthesis preventing elongation along peptide chain at the 50S ribosome

92
Q

What respiratory complication occurs in upto 10% of patients taking long term amiodarone therapy?

A

Pulmonary fibrosis

93
Q

What is the mechanism of action of caffeine?

A

Blocks adenosine receptors causing increased sensitivity to CO2 concentrations, resp centre stimulation and wakefulness

93
Q

What is the mechanism of action of spironolactone in PCOS?

A

Antagonism of androgen receptors

94
Q

Which antibiotic interacts with the OCP to decrease its effectiveness?

A

Rifampicin

95
Q

Which receptors does low dose adrenaline primarily act upon?

A

Beta 1 ++
Beta 2 ++

96
Q

What is the mechanism of action of desmopressin?

A

Water reabsorption activator - it is a synthetic analogue of ADH
Increases cellular permeability of collecting ducts resulting in water reabsorption

96
Q

What is the mechanism of action of sulfasalazine?

A

Inhibits leukotrienes to reduce inflammation

97
Q

What is the mechanism of action of alendronic acid?

A

Inhibits osteoclastic activity thereby increasing bone mass

98
Q

Which fluid must amiodarone be administered in?

A

Glucose 5%

99
Q

What is the mechanism of action of sumatriptan?

A

5HT-1D and 5HT-1B receptor agonist resulting in vasoconstriction of cranial blood vessels and inhibits release of pro-inflammatory neuropeptides

99
Q

What is the mechanism of action of oxybutynin?

A

Muscarinic receptor antagonist - competitive antagonist of acetylcholine at postganglionic muscarinic receptors

100
Q

Which receptors does high dose adrenaline primarily act upon?

A

Alpha 1 +++
Alpha 2 +++
Beta 1 +++

100
Q

Which receptors does noradrenaline primarily act upon?

A

Alpha 1 ++++
Alpha 2 +++
Beta 1 +++

101
Q

Which receptors does low dose dopamine primarily act upon?

A

Beta 1 ++

102
Q

Which receptors does high dose dopamine primarily act upon?

A

Alpha 1 +++
Beta 1 +

103
Q

Which receptors does dobutamine primarily act upon?

A

Beta 1 ++

104
Q

What does low-dose adrenaline do to heart rate?

A

Increases

105
Q

What does high-dose adrenaline do to heart rate?

A

Increases

106
Q

What does noradrenaline do to heart rate?

A

Increases

106
Q

What does low-dose dopamine do to heart rate?

A

Increases

106
Q

What does high-dose dopamine do to heart rate?

A

Increases

107
Q

What does low-dose dopamine do to Contractility?

A

Increases

107
Q

What does dobutamine do to heart rate?

A

Increases

108
Q

What does low-dose adrenaline do to Contractility?

A

Increases

108
Q

What does high-dose adrenaline do to Contractility?

A

Increases

109
Q

What does high-dose adrenaline do to SVR?

A

Increases

109
Q

What does low-dose adrenaline do to Cardiac output?

A

Increases

109
Q

What does low-dose dobutamine do to Contractility?

A

Increases

109
Q

What does noradrenaline do to Contractility?

A

Increases

109
Q

What does low-dose dopamine do to SVR?

A

Nil effect

110
Q

What does low-dose dopamine do to Contractility?

A

Increases

110
Q

What does low-dose adrenaline do to SVR?

A

Decreases

110
Q

What does noradrenaline do to SVR?

A

Increases

110
Q

What does high-dose adrenaline do to Cardiac output?

A

Nil effect

111
Q

What does high-dose dopamine do to SVR?

A

Increases

111
Q

What does dobutamine do to SVR?

A

Nil effect

111
Q

What does noradrenaline do to Cardiac output?

A

Decreases

111
Q

What does high-dose dopamine do to Cardiac output?

A

Decreases

111
Q

What does low-dose dopamine do to Cardiac output?

A

Increases

111
Q

What does dobutamine do to Cardiac output?

A

Increases

112
Q

What are the side effects of prostaglandin E1?

A

Apnoea (most common)
Respiratory depression
Fever
Seizures
Tissue oedema
Cortical hyperostosis

112
Q

What is the mechanism of action of terlipressin?

A

Vasopressin analogue

113
Q

What can cimetidine do to U&Es?

A

Causes elevation of creatinine without changing GFR - potent inhibitor of tubular creatinine secretion

114
Q

What is the mechanism of action of flucloxacillin?

A

Inhibits bacterial cell wall synthesis

115
Q

What is the mechanism of action of methotrexate?

A

Dihydrofolate reductase antagonist

115
Q

What is the mechanism of action of propranolol?

A

B1 and B2 receptor antagonist

115
Q

What is the mechanism of action of adalimumab?

A

TNF-alpha inhibitor

116
Q

How does a conjugate vaccine work?

A

Combines a weak polysaccharide antigen with a string protein antigen as a carrier so that a T cell response can be induced

117
Q

Where is the site of action of furosemide?

A

Ascending loop of Henle

118
Q

What is the starting dose (first bag) of NAC in a child >40kg?

A

150mg/kg in 200ml 5% glucose over 1 hour

119
Q

What are the side effects of protease inhibitors?

A

Dyslipidaemia
Insulin resistance and diabetes
Fat accumulation
Lipodystrophy

120
Q
A

1MRCPCH FOP and TAS (23 decks)

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