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MFSRH Part 1 CM > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Carbimazole side effects

A

Agranulocytosis, neutropenia, cholesteric jaundice, alopecia

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2
Q

Pregnancy effects of warfarin

A

Central nervous system damage trimester 2&3

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3
Q

Is methyldopa safe in pregnancy

A

Safe in all trimesters

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4
Q

Effects of thiazide diuretics on pregnancy

A

Reduced placental perfusion

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5
Q

Trimephoprim method of action

A

Folate antagonist

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6
Q

UTI self help options

A

Water
Cranberry pills
Methenamine salts
Mannose receptors

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7
Q

Long term side effects of nitrofurantoin

A

Pulmonary fibrosis
Hepatitis

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8
Q

Is cefalexin safe in pregnancy

A

Yes

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9
Q

Mechanism of action of cirpofloxacin

A

(fluroquinolone) Interferes with DNA synthesis by disrupting the function of DNA gyrase.

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10
Q

What is misoprostol

A

synthetic prostaglandin E1 analogue

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11
Q

Example dosing of misoprostol

A

800mcg PV STOP for cervical priming
800mcg PV 24-48 hours after mifepristone for MTOP

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12
Q

how does misoprostol work

A

increases smooth muscle contraction
relaxes cervix

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13
Q

effect of prostaglandins on increasing gestation

A

increasing effect with increasing gestation

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14
Q

success of misoprostol when used combined with mifepristone in EMTOP

A

> 95%

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15
Q

which route is most effective for misoprostol

A

PV

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16
Q

where is misoprostol metabilised

A

liver

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17
Q

side effects of misoprostol

A

headache, fever, nausea, D&V, constipation, bleeding + excessive bleeding.

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18
Q

teratogenic effects of misoprostol?

A

moeibios syndrome, amniotic band syndrome, CNS deformity

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19
Q

contraindications to misoprostol

A

high risk of uterine rupture
placenta preavia

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20
Q

effects of misoprostol on pain?

A

increases pai sensitivity due to blockage of K+ channels

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21
Q

what is pharmacokinetics

A

what the body does to the drug
(absorbtion, distribution, elimination)

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22
Q

how do water soluble drugs cross cell membranes

A

active transport

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23
Q

how do lipid solouble drugs cross cell membranes

A

diffuse easily, usually from stomach or duodenum

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24
Q

what is bioavailabilty

A

the amount of drug that reaches circulation unchanged

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25
Q

what happens in phase 1 hepatic metabolism

A

drugs are reduced/oxilated/hydrolised into water solouble comounds

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26
Q

what sort of compounds do phase 1 metabolised drugs become

A

active, inactive, toxic

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27
Q

what is the phase 1 pathway in hepatic metabolism

A

cytochrome P450

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28
Q

what happens in phase 2 hepatic metabolism

A

drugs are conjugated usually to:
glucorunate (basic drugs)
acetate (acids)
sulphate (oral contraceptives)

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29
Q

what is enterhepatic circulation

A

feacaly-excreted drug can be reaborbed from the GI tract prior to excretion (eg COC)

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30
Q

how are soluble drusg excreted

A

renally (from blood flow from the liver)
bile (if molecular weight >300Da)

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31
Q

which part of the kidneys does the excretion

A

Proximal convoluted tubule
loop of Henle

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32
Q

what drugs are not renally excreted?

A

very large molecular drugs as cannot filter through kidneys (eg heparin)

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33
Q

what happens to insulin levels in pregnancy

A

pregnancy creates increasing insulin resistance, so insulin needs to go up

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34
Q

what is pharmacodynamics

A

what the drug does to the body (the drug effect)

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35
Q

What does phenytoin do

A

potent cytochrome P450 inducer (will reduce drug levels)

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36
Q

How does aciclovir work

A

inhibits HSV specific thymidine kinase

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37
Q

how does warfarin work

A

vitamin K epoxade reductase inhibitor

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38
Q

how does methotrexate work

A

dihydrofolate reductase inhibitor

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39
Q

how does gentamicin work

A

inhibition of ribosome synthesis

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40
Q

how does erythromycin work

A

inhibition of protein translocation

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41
Q

how does doxyxycline work

A

inhibition of protein translation

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42
Q

how might ampicillin effect COC

A

alters gut bacteria leading to reduced enetro-hepatic uptake

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43
Q

what is background incidence of congenital abnormality

A

2-3%

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44
Q

does heparin cross the placenta

A

no

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45
Q

how long is methotrexate present for

A

3 months

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46
Q

how long can retinoids affect a pregnancy for

A

up to 2 years

47
Q

What are the main teratogen classes?

A

All the A’s
Anti-convulsants
Antibiotics
anti-coagulants
antimetabolites
antipsychotics
androgens
Acne drugs (A-vitamins)
alcohol

48
Q

what drugs may cause miscarriage

A

ergotamine
misoprostol
mifepristone
thrombolytics

49
Q

% patients with epilepsy who do not have a normal pregnancy

A

10%

50
Q

risk of teratogenicty with sodium valproate

A

6%

51
Q

valproate teratogenicty risks

A

dose related effect on verbal IQ
neural tube defects

52
Q

safest anti-epiliptic drug in pregnacy

A

lamotrageine (3% approx baseline)

53
Q

phenytoin teratogenic effects

A

cleft lip
microcephaly
cardiac abnormalities
mental retardation

54
Q

carbemazipine teratogenic effects

A

cleft lip
microcephaly
cardiac abnormalities
mental retardation
neural tube defects

55
Q

teratogenic risk reduction in epilepsy?

A

5mg folic acid 3 months
lowest effective dose
avoid polypharmacy

56
Q

teratogenic abx classes

A

tetracyclines
sulphonamides
aminoglycosides
quinolones
nitrofuatoin
chloramphenicol

57
Q

abx safe in pregnancy

A

penicillins
cephalosporins
macrolides

58
Q

when is warfarin most teratogenic

A

weeks 6-12

59
Q

in what situation would you keep someone on warfarin

A

metallic heart valve

60
Q
A
61
Q

Can misoprostol be used in breast feeding

A

No

62
Q

Tamoxifene indications

A

BC treatment
BC prevention
Primary anovulatory infertility

63
Q

MoA clomiphene

A

Blocks negative estrogen feedback at hypothalamus, causing FSH surge

64
Q

Raloxifene indication

A

Prevention of osteoperotic vertebral factors

65
Q

CV effects of tamoxifene

A

Decreased cholesterol decreased LDL

66
Q

Major side effects SERMs

A

Increased VTE risk
Endometrial hyperplasia and polyps (tamoxifen)
Fluid retention, headaches, nausea, rash, fatigue, hot flushes, menstrual irregs
Cataracts (T)
Visual changes (C)

67
Q

SERM C/I

A

Pregnancy, VTE (unless BC tx), ovarian cyst (C) liver diseaee

68
Q

MoA heparin

A

Acts on Antithrombin III, causing inhibition of clotting factors IX, X (Xa+++), XI, XIII and thrombin

69
Q

Rates of heparin induced thrombocytopenia?

A

5%

70
Q

Affect of UA on period timing

A

7% early
18% late by 7 days
4% late by 20+ days

71
Q

What is the decrease in BMD in 6 months tx with GNRH analogouges

A

4-6%
Most recovers within 18-24 months of tx completion

72
Q

What is triptorelin

A

Decapeptyl SR, a GnRH analogue

73
Q

Initial response to GNrH analogues

A

“Flare up” - first two weeks see increase in LH, FSH + estrogen, resulting in worsening of symptoms.
Settles by day 20.

74
Q

Side effects of mefenamic acid

A

Peptic ulcers, diarrhoea, glucose intolerance in diabetes, heamolytic anaemia (reversible on stopping)

75
Q

MoA of mefenamic acid

A

NSAID, prostaglandin production inhibitor.
Inhibits action of cyclo-oxygenase

76
Q

MoA mifepristone

A

Antagonises the endometrial and myometrial effects of progesterone
Sensitises the myometrium to cramps produced by prostaglandins

77
Q

Mifepristone C/I

A

Severe uncontrolled asthma
Chronic adrenal failure
Inherited porphyria

78
Q

MoA TXA

A

Anti fibrinolytic.
Potent competitive inhibitor of activation of plasminogen to plasmin

79
Q

MoA Doxycycline

A

Bacteriostatic - inhibition of protein synthesis

80
Q

What are potential interactions with doxycycline

A

Penicillin.
Can worsen MG and SLE

81
Q

Doxycycline C/I

A

Pregnancy, breastfeeding, retinoids, renal impairment (severe)

82
Q

C/I TXA

A

Hx convulsions
DIC
Active/prev. VTE

83
Q

What class is ceftriaxone

A

Cephalosporins
(Beta lactam)

84
Q

How does ceftriaxone work

A

Inhibitionnof bacterial cell wall synthesis.
Interrupts peptodoglican biosynthesis (due to binding to penicillin binding protein) leading to cell wall lysis and cell death

85
Q

Ceftriaxone cross reactivity

A

10% cross reactivity with those with a penicillin allergy, as with all beta-lactams

86
Q

Side effects of ceftriaxone

A

Abdo pain, diarrhoea, dizzy, eosophillia, headache, nausea, pseudomembranous enterocolitis, skin reactions

87
Q

Name cephalosporins

A

Ceftriaxone, cefotaxime, cefalexin
(CEFs)

88
Q

What does ceftriaxone not work against

A

CT, MGen, e coli

89
Q

Contraindications to Benzathine benzylpenicillin

A

Peanut and soy allergies
Other penicillin allergies

90
Q

MoA benzylpenicillin

A

Beta lactam - bacteriocidal, inhibiting cell wall synthesis

91
Q

Metronidazole MoA

A

Treats anaerobic bacteria.
Reduced by intracellular proteins to a form that is cytotoxic to host cell DNA, resulting in strand breakage

92
Q

Metronidazole side effects

A

Disulfiram reaction (beware oral drug solutions, may contain alcohol)
Dark urine

93
Q

Contra indications to metronidazole

A

Cockayne syndrome
Hypersensitivity
Ciclosporin co administration can cause toxicity

94
Q

What are macrolides

A

Azithromycin, erythromycin, clarithromycin

95
Q

Side effect of prolonged mentronidazole therapy

A

Peripheral neuropathy

96
Q

How does Viagra work

A

Inhibits phosphodiesterase 5

97
Q

What does phosphodiesterase do

A

Degrades cGMP in smooth muscle cells

98
Q

What does the inferior mesenteric ganglion release to act upon the cholinergic receptors on the epidymis

A

Norepinephrine

99
Q

What does the somatic (pudendal nerve) release onto the bulbospongiosus

A

Acetylcholine

100
Q

Which anti emetic is seritonergic

A

Ondansetron

101
Q

Which anti emetic is dopaminergic

A

Metaclopromide

102
Q

MoA clomiphene

A

Estrogen antagonist in the hypothalamus
(Increasing LH and FSH production)

103
Q

Name HIV integrase inhibitors

A

Raltegravir, elvitegravir, dolutegravir

104
Q

Name NNRTIs

A

Efavirenz, etravirine, delavirdine, nevirapine

105
Q

Teratogenic NNRTIs

A

Efavirenz, delavirdine* ask simon

106
Q

Which nnrti easily crosses the placenta?

A

Nevirapine

107
Q

Where are NNRTIs metabolised

A

Via cytochrome P450

108
Q

Name the NRTIs

A

Zidovudine, stavudine, lamivudine, didanosine, abacavir, tenofovir

109
Q

Name protease inhibitors

A

Navirs.
Ritonavir, atazanavir, darunavir, indinavir, lopinavir, nelfinavir, saquinavir, tipranavir

110
Q

What are protease inhibitors metabolised by

A

Cyp450.
Also inhibits this

111
Q

What is solifenacin

A

Competitive muscarinic M3 receptor antagonist

112
Q

MoA oxybutanin?

A

Non-selective muscarinic receptor antagonist

113
Q

MoA mirabegron

A

Selective B3 adrenergic antagonist

MFSRH Part 1 CM (15 decks)

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