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Pharmacology Flashcards

1
Q

What pain killer has a dangerous interaction with lithium, in terms of it’s excretion?

A

NSAIDs- competes for active transport out the kidneys so less lithium excreted

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2
Q

What type of laxative should be given for those on morphine?

A

Stimulant laxative- ie senna

As opioids reduce motility

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3
Q

What is the danger of giving SSRIs (like citalopram) with antiplatelet drugs?

A

Seratonin is a mild antiplatelet, slightly increases risk of bleed

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4
Q

What needs to be on a controlled drug prescription?

A

On all prescriptions: Name + address, Dr name + address, signed

Drug name + strength + preparation
Dose + frequency
Total number of tablets/volume given
Written in numbers and words

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5
Q

Why is tramadol different in mechanism to other opioids?

A

Acts on seratonin and noradrenergic receptors unlike other opioids so can lower seizure thresholds (avoid in epileptic patients) and puts at risk of seratonin syndrome

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6
Q

Drugs causing urinary retention:

A 
Anticholinergics (antipsychotics, antidepressants, respiratory gents)
Anaesthetic agents
Analgesia- morphine
Alpha-adrenoreceptor agonists (hypertension)
Anti-inflammatories
Anxiolytics (benzodiazepines)
Antihistamines
Alcohol
Antihypertensive- Ca channel blockers
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7
Q

Which antibiotics may have cross-reactions with penicillins, causing anaphylactic reactions is pen-allergic?

A

Carbopenems (meropenem)

Cephalosporin

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8
Q

Which antibiotic causes tendontis?

A

Ciprofloxacin

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9
Q

What antibiotics put patients at higher risk of C Diff infections?

A

Ciprofloxacin

Cephalosporin

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10
Q

What is the problem with giving nitrofurantoin in a patient with a low GFR <30?

A

Doesn’t get excreted enough into the urine to become concentrated and give a therapeutic dose, so patient gets subtherapeutic dose if clearance is poor

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11
Q

What’s the difference between spironolactone, eplerenone compared to amiloride?

A

All work as aldosterone pathway antagonists, but spironolactone acts on the receptor and amiloride acts on the ENaC channel directly.

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12
Q

Which UTI antibiotic causes high potassium?

A

Trimethoprim- blocks ENaC channels.

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13
Q

Side effects of steroids

A

Diabietes, Hypertension
Cushing’s, Addisonian crisis

Osteonecrosis, osteoporosis
Proximal myopathy
Pancreatitis, infection

Cataracts, glaucoma
Buffalo hump, acne, striae

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14
Q

Which receptors does tamulosin act on?

A

Alpha 1 antagonist
Benign prostatic hyperplasia

Prevent smooth muscle constriction

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15
Q

What are beta 1 + beta 2 agonists used for?

A

Dobutamine- beta 1 agonism (raise BP in very sick patients)

Salbutamol- beta 2 agonism (asthma)

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16
Q

Which drugs can cause constipation:

A 
Opiates
Ca-channel antagonists
Antidepressants, antiepileptics 
Iron/calcium supplements
Diuretics
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17
Q

Causes of gynaecomastia

A 
D - Digoxin
I - Isoniazid
S - Spironolactone
C - Cimetidine
O - Omeprazole/Oestrogens
M - Methyldopa
T - Tricyclic antidepressants
V - Verapamil
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18
Q

What features on the U+Es/FBC indicate there is a CKD rather than AKI?

A

Anaemia

Low calcium, high phosphate (no vit D, so low calcium absorption and lack of phosphate excretion)

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19
Q

Signs of Digoxin toxicity:

A

Fatigue + confusion
N+V
Yellow vision

Bradycardia or tachycardia, AV block every kind of dysarrhythmia

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20
Q

Drug causes of lung fibrosis:

A 
BAN MS
Bleomycin- chemo
Amiodarone
Nitrofurantoin long term- chronic UTI
Methotrexate
Sulfasalazine, rarely statins
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21
Q

What happens in Gilbert’s disease?

A

Bilirubin normally conjugated by liver, so it is water sluble and can be secreted into bile and the duodenum.

Gilbert’s reduced activity of gluconryltransferase- less conjugation of bilirubin so it isn’t excreted into urine (unconjugated bilirubin is insoluble), can get jaundice from high bilirubin

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22
Q

Vincristine SE (chemo)

A

Peripheral neuropathy

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23
Q

How does Isoniazid cause peripheral neuropathy?

A

Vit B6 deficiency

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24
Q

Which immunosuppressant causes ulcerative stomatitis (inflammation of gum linings)

A

Methotrexate

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25
Drug causes of long QT syndrome
SHAME AT ``` SSRIs HAloperidol Methadone Erythromicin Amiodarone Tricyclic antidepressants ```
26
Which beta blocker prolongs QT interval?
Sotolol
27
Name the mechanism of the following Parkinson's drugs: 1. Ropinirole 2. Rasagiline 3. Entacapone 4. Benzhexol
1. Dopamine agonist (also pramipexole) 2. MAO-B inhibitor, reduces DA breakdown at presynaptic terminal (also selegiline) 3. COMT inhibitor, reduces DA breakdown in synapse and on postsynaptic terminal 4. Anticholinergic, reduces tremor by decreasing muscle activation by nAChR
28
How does N-acetylcysteine help prevent damage in a paracetamol overdose?
The body runs out of glutathione to be conjugated with a toxic paracetamol metabolite, so the metabolite builds up. However NAC provides more glutathione so the metabolite may be neutralised before it can cause any toxic damage
29
Summarise the renin angiotensin system effects
Renin (juxtaglomerular cells-kidney) converts Angiotensinogen (from liver) into Angiotensin I Which is converted into Angiotensin II by ACE (lungs) AT-II vasoconstricts arterioles, increases ADH and prompts aldosterone secretion (from adrenals) Aldosterone increases ENaC expression (more Na+, less K+)
30
What effect would thiazide diuretics have on calcium levels?
Thiazides raise Ca+ levels By blocking Na/Cl cotransporter there's less Na in tubular cells. On the side of the cell near capillaries (not the luminal side) there's a transporter that swaps 3Na into the tubular cell for every Ca it moves out of the cell and into the interstitium. Less Na in the cell, more active transporter, more Ca moved into capillaries
31
How does Clopidogrel and Dipyridamole prevent platelet aggregation?
The resting state of platelets in maintained by a cAMP-activated calcium channel that causes efflux of Ca+ from the platelet keeping intracellular levels low, preventing activation. Dipyridamole inhibits phosphodiesterase to maintain cAMP levels and keep Ca+ inside low Clopidogrel inhibits the ADP receptor, this receptor would otherwise inhibit adenyl cyclase and break down cAMP
32
How does N-acetylcysteine help prevent damage in a paracetamol overdose?
The body runs out of glutathione to be conjugated with a toxic paracetamol metabolite, so the metabolite builds up. However NAC provides more glutathione so the metabolite may be neutralised before it can cause any toxic damage
33
Summarise the renin angiotensin system effects
Renin (juxtaglomerular cells-kidney) converts Angiotensinogen (from liver) into Angiotensin I Which is converted into Angiotensin II by ACE (lungs) AT-II vasoconstricts arterioles, increases ADH and prompts aldosterone secretion (from adrenals) Aldosterone increases ENaC expression (more Na+, less K+)
34
What effect would thiazide diuretics have on calcium levels?
Thiazides raise Ca+ levels By blocking Na/Cl cotransporter there's less Na in tubular cells. On the side of the cell near capillaries (not the luminal side) there's a transporter that swaps 3Na into the tubular cell for every Ca it moves out of the cell and into the interstitium. Less Na in the cell, more active transporter, more Ca moved into capillaries
35
How does Clopidogrel and Dipyridamole prevent platelet aggregation?
The resting state of platelets in maintained by a cAMP-activated calcium channel that causes efflux of Ca+ from the platelet keeping intracellular levels low, preventing activation. Dipyridamole inhibits phosphodiesterase to maintain cAMP levels and keep Ca+ inside low Clopidogrel inhibits the ADP receptor, this receptor would otherwise inhibit adenyl cyclase and break down cAMP
36
Main side effect issue that needs to be monitored with ciclosporin?
Nephrotoxicity Check creatinine every two weeks for first 3 months of treatment
37
Receptors that tramadol exerts an effect on?
``` Mu-opioid R agonist SSRI + 5-HT R antagonist Noradrenaline reuptake inhibitor NMDA R antagonist NACh R antagonist Muscarinic ACh R antagonist ```
38
Which opioids can precipitate serotonin syndrome?
Fentanyl and Tramadol
39
1st line antiemetic in pregnancy?
Antihistamine like cyclizine antiemetic | More experience, no evidence or teratogenicity
40
Preferred anti-emetic for chemo?
Visceral and chemoreceptor trigger zone nausea is mediated by serotonin and dopamine. 5-HT strongly involved in chemo-nausea so Metoclopramide
41
What situation is metoclopramide less useful for?
Post-op nausea, for some reason despite it being a anti-dopaminergic agent it works less well? Good for chemo-induced nausea though
42
Which antiemetics can cause 1. Prolonged QT 2. Parkinsonian side effects 3. Worsening of bowel obstruction
1. 5-HT antagonists and DA antagonists like ondansetron (5-HT) and metoclopramide (DA) 2. DA antagonists (prochlorperazine, metoclopramide, NB domperidone doesn't cross BBB, less likely to cause) 3. DA antagonists (increases gut motility)
43
Hierarchy of Rx in type 2 diabetes?
Diet Metformin Add sulfonylura (gliclazide) or DPP-4 inhibitor (sitagliptin) or glitazone Triple therapy or insulin (No glitazone if LVF)
44
How does Rx of COPD differ depending on whether they have an FEV >50% or below 50%?
All get a short acting b-agonist or anti-muscarinic Mild/moderate >50% = LABA or LAMA, then add steroid, then all 3 (stepwise approach) Sever <50% = LAMA or LABA + steroid, then all 3 (jumps a step)
45
When would you give HRT via the vaginal route rather than transdermally?
For urogenital atrophy associated with the menopause
46
What is the benefit of giving HRT cyclically, continuously or without progesterone?
No progesterone- increased risk of endometrial cancer only indicated for hysterectomy patients Cyclical HRT- still have periods (given if patient is still having periods) Continuous HRT- no periods (only appropriate if post-menopausal + no periods in 1 year)
47
Name some common SSRIs, SNRIs and TCAs:
Depression Rx 1st: SSRIs- Fluoxetine, Citalopram, Sertraline, Paroxetine 2nd: SNRIs- Venlafaxine, Duloxetine 3rd: TCAs- Amitriptyline
48
1st line drug for high triglycerides in isolation (no raised cholesterol/LDLs)?
Fibrates- gemofibrozil, ciprofibrate, fenofibrate Act in liver to reduce cholesterol synthesis, reducing vLDL secretion and increasing uptake from blood, increasing HDL plasma levels Not to be used with statins
49
Drug causes of hypocalcaemia:
HypO: Someone has CALled, loop over to the phone, pick up the phen Loop diuretics Bisphosphonates Phenytoin
50
Drugs affected by cyp450:
COWEST ``` Ciclosporin Oral contraceptives Warfarin Epileptics Statins Theophylline ```
51
Causes of hyperkalaemia:
N SAID:Tri have Tact in the Cycles of Parin UREA NSAID, Trimethoprim, Tacrolimus, Ciclosporin, Heparin, Sulphonylurea ACEi, K+ sparing
52
Causes of agranulocytosis:
Carbamazepine Colchicine Carbimazole Clozapine
53
Causes of liver fibrosis:
MAMI Methotraxate Amiodarone Methyldopa Isoniazid
54
Causes of gynaecomastia
DISCO MTV: ``` Digoxin Isoniazid Spironolactone Cimetidine Oestrogen ``` Methotrexate TCAs Verapamil
55
Causes of Long QT:
``` Macrolide Antipsychotic TCAs Histamine SSRI ```
56
SIADH:
Carbamazepine | SSRIs
57
Causes of neuropathy
MICE NAP ``` Methotrexate Isoniazid Ciclosporin Ethanol Nitrofurantoin Amiodarone Phenytoin/Penicillamine ```
58
Indications for anti-digoxin antibody:
Dangerous arrhythmias: VT, VF, 3rd degree heart block K+ above 6 Digoxin above 7.8ng/mL 6 hours later
59
Antidote for arsenic?
Dimercaprol
60
Drug causes of diarrhoea:
COT (babies poo): Colchicine Orlistat Theophylline
61
Antidepressant that particularly may cause constipation?
Tricyclics- anticholinergic effects | Also watch out for oxybutinin, given for urge incontinence
62
Drug causes of lupus?
HIP Hydralazine Isoniazid Procainamide (sodium channel blocker antiarrhythmic)
63
How does suxamethonium work?
Partial agonist of acetylcholine receptors, depolarises the post-synaptic membrane Rapidly inactivated using plasma cholinesterases SEs: high K+, muscle pains post-op
64
What are the two mechanisms of neuromuscular blockers used in surgery and how are they reversed?
Partial ACh receptor agonists- depolarise post-synaptic membrane (suxamethonium) Competitive antagonists of AChR- compete with ACh at the neuromuscular junction (Rocuronium, sugammadex, vecuronim, atracurium)
65
Which antibiotics are safe to prescribe to patients with porphyrias?
Penicillins only pretty much.
66
Which drugs can displace sodium valproate and digoxin from protein-carriers in the blood?
NSAIDs | Aspirin
67
Which drugs cause oesophageal irritation, and what are the two mechanisms by which they do this?
Direct inflammation: alendronic acid, tetracycline, sando-K Lowering oesophageal tone: nitrates, Ca channel blockers
68
Which immunomodulator drugs are associated with the following side effects: A. Pancreatitis B. Oligozoospermia
A. Azathioprine or mercaptopurine (it's prodrug) | B. Sulfasalazine
69
Rx of Whipple's disease? | PAs + macrophages
``` Gram positive bacteria, trophyerma whipplei Causes 1. Malabsorption 2. Arthropathy 3. CNS disease + cerebellar signs ``` Rx: ceftriaxone- crosses BBB Long term- trimethoprim or doxycycline
70
Rx of constipation and order of medication trials:
1. Lifestyle and drug reconciliation 2. Stimulant laxative- senna 3. + Osmotic- movicol or lactulose 4. + Glycerine suppository 5. Phosphate enema 6. Manual evacuation

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