Pharmacology

Question 1

Give three examples of TNF blockers

Answer 1

Etanercept
Infliximab
Adalimumab

Question 2

adverse effects of TNF Blockers

Answer 2

Increased susceptibility to TB/activation of dormant TB through blunted TH1 response
Increased cancer incidence

Question 3

give three examples of ACE inhibitors

Answer 3

ramipril, lisinopril, perindopril

Question 4

mechanism of ACEI

Answer 4

block ACE - prevent conversion of angiotensin I to angiotensin II
ang II = vasoconstrictor and stimulates aldosterone secretion
blocking it reduces periph vasc resistance –> lowers BP
esp dilates efferent glomerular arteriole –> decreases glom P and slows progression of CKD
reduced aldosterone promotes Na and H2O excretion

Question 5

adverse effects of ACEIs

Answer 5

hypotension
persistent dry cough
hyperkalaemia (due to low aldosterone)
worsen renal failure

Question 6

aspirin - mechanism of action

Answer 6

aspirin irreversibly inhibits COX –> reduces production fo thromboxane from arachadonic acid –> reduced platelet aggregation

Question 7

adverse effects of aspirin

Answer 7

GI irritation/ulceration–>haemorrhage
bronchospasm
tinnitus

Question 8

aspirin overdose features

Answer 8

hyperventilation, hearing changes, metabolic acidosis, confusion
followed by convulsions, CV collapse and resp arrest

Question 9

give three examples of Beta blockers

Answer 9

propanolol, bisoprolol, atenolol, metoprolol

Question 10

mechanism of beta blockers

Answer 10

B1 adrenoceptors found mainly in hear, B2 adrenoceptors found mainly in SM of blood vessels and airways
B1 - BB reduce force of contraction and speed of conduction in heart
–> slow ventricular rate in AF by prolonging refractory period pf AV node
Also reduces renin secretion –> reduced vasoconstriction

Question 11

adverse effects of BBs

Answer 11

fatigue, cold extremities, headache and Gi disturbance (nausea)
sleep disturbance and impotence in men can also occur

Question 12

mechanism of clopidogrel

Answer 12

prevents platelet aggregation by binding irreversibly to ADP receptors on platelet surface
(independent of COX therefore actions are synergistic with aspirin)

Question 13

adverse effects of clopidogrel

Answer 13

BLEEDING, GI upset (dyspepsia, abdo pain, diarrhoea)

rarely - thrombocytopenia

Question 14

give two examples of fibrinolytic drugs

Answer 14

alteplase, streptokinase

Question 15

mechanism of fibrinolytic drugs

Answer 15

= thrombolytic drugs, catalyse conversion of plasminogen into plasmin, which acts to DISSOLVE FIBRINOUS CLOTS and re-canalise occluded vessels

Question 16

adverse effects of fibrinolytic drugs

Answer 16

N and V, bruising, hypotension
those requiring tx to be stopped = serious bleeding, allergic reaction, cardiac arrest
(transexamic acid is a antifibrinolytic drug)
cerebral oedema and arrhythmias due to reperfusion

Question 17

2 examples of nitrates

Answer 17

glyceryl trinitrate, isosorbide mononitrate

Question 18

mechanisms of nitrates

Answer 18

nitrates converted into NO which increases cGMP synth and reduces intracellular Ca in vascular SM cells–> relaxation –> venous (and arterial) dilation
therefore reducing cardiac preload and ventricular filling –> reduced cardiac work and 02 demand

Question 19

AEs of ntirates

Answer 19

flushing, headaches, light-headedness, hypotension

sustained use can lead to tolerance

Question 20

2 examples of strong opioids

Answer 20

morphine, oxycodone

Question 21

AEs of strong opioids

Answer 21

resp depression, neurological depression, N and V, pupillary constriction, constipation, itching
continued use leads to tolerance and dependence
can experience withdrawal reactions

Question 22

3 examples of statins

Answer 22

simvastatin, atorvastatin, pravastatin, rosuvastatin

Question 23

mechanism of statins

Answer 23

reduce serum cholesterol levels - inhibit 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) reductase
decrease cholesterol prod by liver and increase clearance of LDL-cholesterol from blood
indirectly reduce triglycerides and slightly increase HDL
slow/reverse atherosclerotic processes

Question 24

AEs of statins

Answer 24

headache and GI distrubance

aches and myopathy

Question 25

3 examples of corticosteroids

Answer 25

prednisolone, hydrocortisone, dexamethasone

Question 26

mechanism of corticosteroids

Answer 26

= MODIFY IMMUNE RESPONSE - upregulate anti-inflam genes and downregulate pro-inflam genes

Question 27

AEs of corticosteroids

Answer 27

IMMUNOSUPPRESSION, DM and osteoporosis, proximal muscle weakness, skin thinning, easy bruising and gastritis mood and behavioural changes LT --> adrenal atrophy --> decreased cortisol secretion --> acute Addisonian crisis --> CV collapse WITHDRAWAL = fatigue, WL and arthralgia

Question 28

give two examples of antiemetics

Answer 28

prochlorperazine, chlorpromazine

Question 29

list three benzodiazepines

Answer 29

diazepam, lorazepam, temazepam

Question 30

ferrous sulfate AEs

Answer 30

GI upset - nausea, epigastric pain, constipation and diarrhoea black bowel motions

Question 31

name 3 CCBs

Answer 31

amlodipine, nifedipine, verapamil, diltiazem

Question 32

mechanism of CCBs

Answer 32

decrease Ca entry into vascular and cardiac cells (decrease Ca intracellular conc) causing relaxation and vasodilation in arterial SM decreasing arterial P reduce myocardial contractility - suppress cardiac conduction and slow ventricular rate leading to reduced cardiac demand therefore preventing angina

Question 33

AEs of CCBs

Answer 33

ankle swelling, flushing, headache, palpitations | verapamil - constipation, bradycardia, heart block and HF

Question 34

SSRIs indications

Answer 34

= antidepressants, used in: moderate to severe depression panic disorder OCD

Question 35

mechanism of SSRIs

Answer 35

inhibit neuronal reuptake of seretonin (5-HT) from synaptic cleft, --> increases its availability for neurotransmission differ from anticyclics in that theyy dont inhibit noradrenaline uptake and cause less blockade of other receptors SSRIs preferred due to less AEs

Question 36

AEs of SSRIs

Answer 36

GI upset, appetite and weight disturbance hypersensitivity incl rash SUICIDAL THOUGHTS AND BEHAVIOUR lower seizure threshold and can predispose to arrhythmias Bleeding

Question 37

what is serotonin syndrome

Answer 37

triad of autonomic hyperactivity, altered mental state and neuromuscular excitation due to high dose SSRIs/overdose/in combo with other antidepressants

Question 38

SSRIs contraindicated in:

Answer 38

epilepsy, peptic ulcer disease, young people (assoc w poorer efficacy and increased thoughts about self harm and suicide risk)

Question 39

name 2 tricyclics

Answer 39

amitriptyline, lofepramine

Question 40

indications for tricyclics

Answer 40

moderate to severe depression | neuropathic pain

Question 41

mechanism of tricyclics

Answer 41

inhibit reuptake of serotonin (5-HT) and noradrenaline, increasing their ability for neurotransmission extensive adverse effects as they block a wide range of receptors

Question 42

AEs of tricyclics

Answer 42

``` block antimuscarinic -- dry mouth, constipation, urinary retention, blurred vision H1 and a1 - hypotension and sedation arrhythmias and ECG changes convulsions, hallucinations, mania breast changes and sexual dysfunction dangerous in overdose! ```