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Medicine Phase 2A (OWN) > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Aspirin

A

Action: Irreversibly inhibits COX-2 causing reduced thromboxane production and therefore platelet activation
+ reduced prostaglandin production, reducing inflammation

Indications: Anti-inflammatory- fever/ pain/ headache
Anti-platelet- MI/ stroke

Contras: decrease in gastric mucin production- GI bleed/ ulceration/ H.pylori

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2
Q

Warfarin

A

Action: Vitamin K antagonist, reduces production of clotting factors, therefore reducing thrombosis
Delayed effect, bleeding risk if high so do INR

Indications: treatment for venous thrombosis and PE
Prophylaxis of embolism in AF, rheumatic HD, prosthetic valve, TIA, post DVT

Contras: bleeding risk, dietary vitamin K (pomegranate)

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3
Q

Heparin

A

Heparin/ enoxaparin/ daltteparin/ riveparin

Action: glycoaminoglycan, binds to antithrombin and increases it’s activity
Unfractioned- IV Fractioned/ LMW-SC

Indications: treatment of PE/ DVT/ unstable angina/ claudication
Thromboprophylaxis: post DVT/ post surgery/ pregnancy

Contras: bleeding/ thrombocytopoenia + hyperkalaemia

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4
Q

DOACs (direct oral anti-coagulants)
Apixaban
Rivaroxaban
Endoxaban

A

Inhibits factors 2 and 10
Benefit over warfarin as less monitoring and short dose- response time

Indications: treatment of DVT/ PE
Prophylaxis- post op, post DVT/ PE, second line in prophylaxis with AF

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5
Q

P2Y12 inhibitors

A

Clopidogrel/ tricagrelor

Inhibits ADP reception on platelets thus reducing activation

Indications: MI gold standard, dual anti-platelet therapy- Aspirin + P2Y12 inhibitor

Contras: bleeding

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6
Q

Beta blockers

A

Propanolol/ bisoprolol/ atenolol (B1 selective)

B1- vasolation
B2- bronchoconstriction
Negatively ionotropic and chronotropic

Indications: HTN, angina, arrhythmia, post MI/ stable HF (if sinus rhythm)

Contras: severe HF, bronchospasm, asthma, COPD, bradycardia, cold peripheries

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7
Q

Statins

A

Atorvostatim, simvastatin

Action: reduce cholesterol synthesis

Indications: hypercholesterolaemia, primary/ secondary prevention of CAD

Contras: toxicity to liver/ muscles

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8
Q

ACE inhibitors

A

Ramipril, enalapril

Action: Inhibit angiotensin converting enzyme at lungs, reducing affect of RAAS, causing systemic vasodilation and a drop in BP

Indications: HTN, HF, secondary to MI

Contras: hypotension, renal as reduces GFR, hyperkalaemia
Causes increased bradykinin- cough, rash, anaphylaxis

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9
Q

Angiotensin receptor blocker

A

Candesartan/ losartan/ valsartan

Action: antagonise angiotensin II receptors

Indications: when ACE-inhibitors are not tolerated (cough/ rash)
HTN

Contraindications: work poorly in afro-caribbean
Renal artery stenosis as contracts further

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10
Q

Calcium channel blockers

A

Dihydropyridines: Amlodopine, peripheral vasodilator and coronary artery vasodilator- increases BP and myocardial supply
Indicated: HTN/ angina
Contras: flushing, dizziness, hypotension, oedema

Non-DHPs: verapamil, slows conduction from SAN to AVN
Indicated: angina, HTN, supraventricular tachycardia
Contras: oedema/ bradycardia

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11
Q

Thiazides

A

Bendroflumethazide

Action: inhibits Na+ absorption at beginning of DCT so less water is absorbed
Downstream epithelial cells try to compensate by reabsorbing Na+ using Na+/K+ antiporters, may lead to hypokalaemia

Indications: oedema/ HTN/ HF

Contras: hypotension/ reduces uric acid secretion so can cause gout/ may worsen diabetes

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12
Q

Loop diuretics

A

Furosemide

Action: inhibits the N/K/Cl co-transporter in the loop of Henle thus increasing osmolarity of filtrate retaining water
Potential hypokalaemia

Indications: oedema/ secondary for HTN when resistant

Contras: hyponatraemia/ hypokalaemia

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13
Q

K sparing diuretic (aldosterone antagonists)

A

Spironolactone

Action: alsosterone stimules Na uptake and K excretion, antagonising this reduces water reabsorption and K+ excretion

Indication: oedema/ ascites/ HF/ HTN/ hyperaldosteronism

Contras: addisons (adrenal insufficiency)/ hyperkalaemia/ avoid in kidney damage

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14
Q

Nitrates

A

GTN spray (glyceryl tri-nitrates)

Action: arterio and venous dilators to reduce BP
Relax CA to increase supply to myocardium

Indications: prophylaxis of angina/ HF and unstable angina

Contras: aortic stenosis/ tamponade/ hypotension

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15
Q

Reslizumab

A

Monoclonal AB
Interferes with binding of IL-5, reducing eosinophil activity

Indication: severe eosinophilic asthma

Contra: concurrent helminth infection (treat this first)
May cause anaphylaxis

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16
Q

Beta-2 adrenergic agonists

A

Salbutamol/ salmeterol/ formeterol

Action: B adrenergic receptors relax airway smooth muscle and inhibit histamine release

Indications: asthma/ COPD/ can be SABA or LABA

Contras: tachy/ arrhythmia, hyperkalaemia/ acidosis

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17
Q

Anticholinergics

A

Atropine, ipratropium, tiotropium

Action: blocking parasympathetic receptors results in bronchodilation

Indication: asthma, COPD,

Cautions: potential glaucoma, paradoxical bronchospasm, prostatic hyperplasia

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18
Q

Inhaled corticosteroids

A

Beclometasone, budenoside

Action: Reduce oedema, inflammation and immune activation
Increases B2 receptor expression so increase effect of salbutamol

Indication: Asthma, (COPD generally unresponsive)

Cautions: Prolonged high doses can lead to adrenal insufficiency and loss of bone density
Behavioural change
Candidiasis

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19
Q

Leukotriene receptor antagonist

A

Monteleukast

Action: leukotrienes are inflammatory mediators causing inflammation and WBC activation

Indication: asthmatic prophylaxis, treatment of allergy

Caution: thirst, abdo pain, headache

20
Q

Proton pump inhibitors

A

Omeprazole, lanzoprazole

Action: block the H/K ATPase at parietal cells thus less H+ into the lumen

Indication: GORD/ gastric ulcer prophylaxis and treatment/ H. pylori eradication (+ amoxicillin and clarithromycin)

Cautions: Osteoporosis, may trigger SLE rash, abdo pain, headache/ nausea

21
Q

Histamine 2 receptor antagonists

A

Ranitidine, cimetidine

Action: Block parietal cell stimulation by histamine thus reducing H+ into lumen

Indication: Gastric ulceration/ GORD

Caution: may mask gastric cancer
SE: Diarrhoea, dizziness, headache

22
Q

Steroids: prednisolone

A

Action: mimic effects of adrenal hormones to reduce inflammation and immune response

Indication: reversible obstructive resp disease, allergy, inflammatory conditions: UC, chron’s/ autoimmune: rheymatoid/ joint infections

Cautions: related to hypoadrenalism, HTN, water retention, diabetes, osteoporosis
Try to avoid long-term therapy

23
Q

Hyoscine butylbromide (buscopan)

A

Action: antispasmodic agent acting directly on GI tract smooth muscle

Indications: Symptomatic relief for cramps/ spasms in IBS
Used in bowel imaging to reduce spasms

Cautions: may reduce bowel movement too much
Tachycardia/ constipation/ dry mouth/ dry skin

24
Q

Loperamide

A

Action: an opioid receptor agonist, acts at peripheral not central receptors thus different to opiate analgaesics, acts at mesenteric plexus on smooth muscle to reduce tone and activity

Indication: acute or chronic diarrhoea

Contras: UC/ Chron’s
SE: Dizziness, headach, flatulance

25
Q

Movicol/ macrogol

A

Osmotic laxative (polyethylene glycol)

Action: cannot be absorbed but is osmotically active, thus draws water into lumen relieving diarrhoea

Indication: constipation

Contras: chrons/ UC + arrhythmia
Caution: may cause abdo pain, nausea and flatulence

26
Q

NSAIDs: apirin, celecoxib, ibuprofen, naproxen, diclofenac

A

Inhibition of COX enzymes involved in prostaglandin production
GI effects- increased acid production
Less prostaglandins causes pre-glomerular constriction and therefore reduced GFR: nephrotic

Indication: mild-moderate analgesia/ pyrexia/ symptom relief for inflammation

Contras: gastric ulceration/ renal impairment

27
Q

Paracetamol

A

Mild analgesic

Indication: pyrexia, analgesic

Caution: high dose is heptotoxic
Give N-acetyl-cysteine in OD

28
Q

Bisphosphonates

A

Alendronate, risedronate

Action: reduce bone metabolism thus used in osteoporosis
Have a high affinity for calcium, ingested by and cause death of osteoclasts

Indications: osteoporosis- general/ post-menopausal

Contra: hypocalcaemia

Caution/SE: abdo distention and pain/diarrhoea or constipation/ dyspepsia

29
Q

Chloramphenicol

A

Action: abx that inhibits protein synthesis, so is bacteroatatic

Indications: eye and ear infections/ haemophilus influenzae/ typhoid/ meningitis/ cholera

Caution: marrow suppression, diarrhoea, dry mouth, headache, nausea

30
Q

Ciclosporin

A

Action: immunosuppressant, acting to suppress T cells and IL2 communication

Indication: rheumatoid arthritis, UC, psoriasis, post transplant

Caution: nephrotoxic, infection risk

SE: abdo pain, fatigue, leukopoenia, HTN

31
Q

Rifampicin

A

Action: abx stopping DNA transcription

Indication: TB, serious staph, legionnaires, endocarditis + H. Influenzae

Caution: liver toxic
Orange/ red secretion in urine
Renal damage/ adrenal insufficiency/ flu like symptoms

32
Q

Opiates

A

Codeine, morphine, fentanyl, oxycodone
Analgesic acting on central mu receptors
Antagonist = naloxone (in OD and addiction)

Indication: moderate- severe analgesia+ some sedation/ trauma/ MI/ chronic pain

Cautions: addiction and dependance
Respiration depression
Nausea/ constipation/ hypotention/ bradycardia

33
Q

Atracurium

A

Neuromuscular blockade by blocking Ach on muscle

Indication: for stillness in surgery/ intubation

SE:anaphylactoid, myopathy, bronchospasm, hypotension

34
Q

B-lactams

A

Penicillin/ amoxicillin/ flucloxicillin

Cephalosporins: more resistant to B lactamases
Carbapenems: more resistant

Action: inhibit cell wall production and are therefore bacterocidal
More effective against gram positive

Indication: gram positive infection

Contras: penicillin allergy

35
Q

Mesalazine

A

Action: strong anti-inflammatory

Indication: achieving and maintaining remission in UC, often given PR (and given in acute attack)
Less used in Chrons

Caution in elderly
SE: abdo pain, headache, dizziness

36
Q

Ciclosporin

A

Action: Immunosuppressant, acting to suppress T cells and IL-2 communication

Indication: RA, UC, psoriasis, post transplant to prevent rejection

Caution: Nephrotoxic and hepatotoxic, immunosuppressant so infection risk

SE: abdo pain, fatigue, leukopenia, HTN

37
Q

Dobutamine

A

Beta-1 adrenergic agonist is therefore sympathomimetic

Indication: Acute/ reversible HF i.e. in surgery, septic shock and congestive HF

Contra: IHD, HD (as increases oxygen requirement)

SE: HTN, angina, arrhythmia

38
Q

Sulfasalazine

A

Action: 5 amino salicylic acid, strong anti-inflammatory with some immuno-modulatory effects

Indication: RA = DMARD, UC, Chrons

Contra: Renal disease, blood disorder
SE: liver/ kidney toxic, marrow suppression

39
Q

Oxybutynin

A

Action: anticholinergic, antagonises muscarinic Ach receptors, reducing tone and spasm at the bladder, reducing ureteric peristalsis

Indication: Urge incontinence, LUTS, kidney stones

Contra: BPH, UC, GI obstruction

40
Q

Tamulosin/ Doxasozin

A

Action: Alpha blocker thus relaxes smooth muscle and vasodilates

Indication: BPH

SE: hypotension

41
Q

Hormone replacement therapy

A

Oestrogen and progesterone

Action: Relieves symptoms from androgen withdrawal and menopause such as hot flush, night sweats, mood swings, vaginal dryness

Contra: Hx of breast/ ovarian cancer, liver disease, HTN

SE: Increased breast cancer risk, increased clot risk, headache, nausea

42
Q

Metformin

A

Action: reduces amount of hepatic gluconeogenesis, lowering blood sugar

Indication: T2DM, polycystic ovary syndrome

Contra: kidney/ liver disease

SE: Diarrhoea, nausea, risk of hypoglycaemia

43
Q

Sildenafil (viagra)

A

Action: Inhibits cyclic GMP specific phosphodiesterase 5 (this enzyme degrades cGMP which, when present, relaxes smooth muscle= vasodilation= erection)

Indication: ED, pulmonary artery HTN

SE: Headache, heartburn, flushed skin

Contra: CVD

44
Q

Lidocaine

A

Action: Blocks fast Na channels on neurone thus preventing axonal transmission

Indication: SC, local anaesthesia, acute arrhythmia

SE: Sleepiness, twitching, tingling

45
Q

Cyclophosphamide

A

Action: Causes apoptosis as it’s metabolite causes DNA cross-linking (only produced in cells with low aldehyde dehydrogenase so less SE)

Indication: Chemo: leukaemia, myeloma, lymphoma, breast, ovarian, immunosuppression

SE: Low WCC, hair loss, pulmonary fibrosis, GU bleed

Medicine Phase 2A (OWN) (10 decks)

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