Pharmacology

Question 1

How are ACEi renal protective?

Answer 1

Reducing angiotensin II production (normally constricts efferent) leading to dilation of efferent arteriole

Question 2

SE’s of ACEi?

Answer 2

Cough
Angioedema up to one year
HyperK

Question 3

Threshold for monitoring ACEi initiation?

Answer 3

Creatinine up to 30% from baseline
K up to 5.5

Question 4

How does dabigatran work?

Answer 4

Direct thrombin inhibitor

Question 5

Contraindications X2 of dabigatran?

Answer 5

CrCl <30
Valvular disease

Question 6

Reversal agent of Dabigatran?

Answer 6

Idarucizumab

Question 7

Mechanism of action of digoxin?

Answer 7

Na/K ATPase inhibitor and parasympathetic on SAN

Question 8

Actions of digoxin?

Answer 8

Positively Inotropic
Negatively Chronotropic

Question 9

Describe the action of Ivabradine?

Answer 9

Slows cardiac pacemaker activity by binding to If ion channels to work as anti anginal

Question 10

SE of Ivabradine?

Answer 10

Visual phosphenes and luminesces

Question 11

Mechanism of action of statins?

Answer 11

HMG-co reductase inhibitors

Question 12

Adverse effects of statins?

Answer 12

Myopathy
Liver impairment stop if transaminases X3 ULN

Question 13

Contraindications to statins?

Answer 13

X Intracerebral haemorrhage
X Macrolides: erythromycin/ clarithromycin
X pregnancy

Question 14

Use statins in?

Answer 14

primary prevention QRISK >10
secondary prevention
T1DM diagnosed >10 years ago or >40 or nephropathy

Question 15

Mechanism of action of thiazide diureitcs?

Answer 15

Inhibits Na reabsorption in proximal DCT by blocking Na/Cl symporter

Question 16

Why are thiazide diuretics used in renal stones?

Answer 16

Causes hypocalcinuria (and internal hypercalciumia) reducing incidence of renal stones

Question 17

Other adverse features of thiazide diuretics?

Answer 17

Dehydration
HypoK
HyperCa
HypoNa
Postural hypotension
Gout
Photosensitive rash

Question 18

Mechanism of action of warfarin?

Answer 18

Inhibits epoxide reductase reducing Vit K dependant clotting factors II, VII, IX, X (1972) and protein C

Question 19

Which pathway does warfarin affect?

Answer 19

Extrinsic and PT

Question 20

INR for mitral mechanical valve?

Answer 20

3.5

Question 21

INR for aortic mechanical valve?

Answer 21

3

Question 22

INR for VTE?

Answer 22

2.5

Question 23

INR for recurrent VTE?

Answer 23

3.5

Question 24

Warfarin and breastfeeding?

Answer 24

Fine

Question 25

Warfarin in pregnancy?

Answer 25

No tertatogenic

Question 26

Management of major bleeding on warfarin?

Answer 26

Stop warfarin IV vit K 5mg Prothrombin complex (if not FFP)

Question 27

Management of INR >8 and minor bleeding?

Answer 27

Stop warfarin IV Vit K 1-3 mg Repeat if INR still high 24 hours Restart warfarin when INR <5

Question 28

INR >8 and no bleeding?

Answer 28

Stop warfarin Vit K IV liquid PO 1-5mg Repeat if still high 24 hours Restart when INR <5

Question 29

INR 5-8 minor bleeding?

Answer 29

Stop warfarin IV Vit K 1-3mg Restart INR <5

Question 30

INR 5-8 no bleeding?

Answer 30

Withold 1-2 doses reduce subsequent maintenance dose

Question 31

Warfarin in dentistry?

Answer 31

Check INR 24h prior <4 proceed

Question 32

Mechanism of action of adenosine?

Answer 32

A1 receptor agonist in AVN reducing cAMP and hyperpolarisation causing transient heart block

Question 33

Adenosine contraindicated in?

Answer 33

Asthma Decompensated HF Long QT syndrome

Question 34

Mechanism of action of amiodarone?

Answer 34

Class III antiarrhythmic agent blocking K channels inhibiting repolarisation and prolongs the action potential

Question 35

SE's of amiodarone 4 H's and 4 P's

Answer 35

* Prolonged QT interval * Pulmonary Fibrosis * Peripheral Neuropathy * Photosensitivity * Hyperthyroidism * Hypothyroidism * Hyperpigmentation - slate grey skin * Hepatotoxicity

Question 36

Amiodarone and P450 enzymes

Answer 36

Amiodarone inhibits P450 enzymes

Question 37

Mechanism of action of flecainide?

Answer 37

Class 1c antiarrhythmic agent blocking sodium channels (Nav 1.5) slows conduction of the action potential.

Question 38

Contraindications to flecainide?

Answer 38

Post MI Structural heart disease Sinus node dysfunction Atrial flutter

Question 39

Flecainide does what to the ECG?

Answer 39

Widens QRS Prolongs PR interval

Question 40

Mechanism of action of carbimazole?

Answer 40

Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin reducing thyroid hormone production.

Question 41

Important adverse effect of carbimazole?

Answer 41

Agranulocytosis

Question 42

Mechanism of propylthiouracil?

Answer 42

Inhibits enzyme peripherally reducing conversion of T4 to T3.

Question 43

When to taper steroids?

Answer 43

40mg or more 1 week + More than 3 weeks of treatment Repeated courses