Pharmacology

Question 1

ACE inh

Answer 1

rami”pril”
Dilate arteries and veins by blocking angiotensin II formation and inhibiting bradykinin metabolism. This vasodilation reduces arterial pressure, preload and afterload on the heart.
Down regulate sympathetic adrenergic activity by blocking the facilitating effects of angiotensin II on sympathetic nerve release and reuptake of norepinephrine.
Promote renal excretion of sodium and water (natriuretic and diuretic effects) by blocking the effects of angiotensin II in the kidney and by blocking angiotensin II stimulation of aldosterone secretion. This reduces blood volume, venous pressure and arterial pressure.
Inhibit cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

Question 2

Calcium channel blocker

Answer 2

amlodi”pine” acts on the smooth muscle of the vascular smooth muscle (arterial not venous) to reduce contraction.

Question 3

nitrates

Answer 3

isosorbide mononitrate promotes NO mediated dilation of the venous system.

Question 4

A blockers

Answer 4

used fro benign prostate hyperplasia

doxasin negative ionotrope, and cause vasoconstriction of the veins especially when the patient stands.

Question 5

medication given in alcohol withdrawal

Answer 5

chlordiazepoxide

Question 6

drugs that can contribute to dysphagia

Answer 6

oesophageal tone: ca channel blockers and nitrates

PUD: NSAIDS, asprin, steriods, and bisphosphonates

Question 7

mechanism of action of asprin

Answer 7

irreversible inhibitor of the enzyme cyclooxygenase which synthesises inflammatory mediators including platelet aggregator A2. Platelets have no nuclei so cannot reverse this action by procudcing more COX. Aspirin’s action is reversed by platelet production

Question 8

mechanism of action of clopidogrel

Answer 8

irreversibly blocks the ADP receptor on pletlet cell membranes that prevents binding to fibrogen and inh platelet aggregation.

Question 9

Abcixmab mechanism of action

Answer 9

also tirofiban works the same way to reversibly block fibrogen binding to the glycoproteins r IIB/IIIa on the platelet cell membranes that mediate platelet aggregation,

Question 10

bivalirudin mechanism of action

Answer 10

is a direct thrombin inh and used as an alternative to heparin

Question 11

what are the indications for an exercise stress test?

Answer 11

possibility of coronary artery disease and the benefit of angioplasty. patients ECG and bp are measured along with symptoms ST depression greater than 2 mm exertional angina, ST elevation greater than 1 mm
30% of positive results are false positives

Question 12

what are you looking for in a stress echogram

Answer 12

give dobutamine looking for hypokinetic movement in ischemia
hyperkinetic movement is normal
this is used for patients who are not fit for traditional stress test or immobile

Question 13

salbutamol

Answer 13

selective B agonist
acts on the G protien coupled receptor activating adenylate cyclise and increasing the formation of camp leading the relaxation of smooth muscle cells

Question 14

ipratropium

Answer 14

antimuscarinic/ anticolinergic antagonizes muscarinic receptors in the airways preventing parasympathetic muscular contraction. often used in COPD but less often in asthma

Question 15

combivent

Answer 15

mixture of salbutamol and ipratropium bromide

Question 16

inhaled corticosteroids mechanism of action

Answer 16

affecting the intracellular production of various proteins to reduce inflammation response in the airways

Question 17

cycline mechanism of action and use

Answer 17

antihistamine and antimuscarinic that blocks actylcholine rectors in the vestibular and vomiting centres
use in post op nausea, bowel obstruction nausea *ANTIKINETIC
and also raised ICP

Question 18

metoclopramide MOA and use

Answer 18

agonist properties at the 5HT4 receptor and antagonist properties at D2 receptors
PROKINETIC DO NOT use in bowel obstruction and use with caution in parkinson’s patients
used in causes of delayed gastric emptying.

Question 19

odansetron MOA and use

Answer 19

5HT3 receptor antagonist acts on receptors of the gut and chemoreceptors trigger zone useful for chemo induced and post op vomiting

Question 20

haloperidol MOA and use

Answer 20

antagonist of dopamine (D2) receptors found in the chemoreceptor trigger zone and myenteric plexus of GIT
drug induced and metabolic causes of vomiting and also raised ICP

Question 21

what are the cautions and contraindications for NSAIDs

Answer 21

contraindicated in asthma
history of anaphylaxis with NSAIDS
previous or active peptic ulcers
severe heart failure
COX2 SHOuld not be used in ischeamic heart disease, cerebralvascular disease or PAD increased risk of thromboembolic events
caution in:
cogulation defects
renal cardiac and hepatic impairment
during pregnancy or breastfeeding- in utero can cause closure of the ductus arteriosus
elderly patients have risk of bleeding and renal failure

Question 22

indications for AAA surgery repair

Answer 22

symptomatic
greater than 5.5 cm
if it is growing greater than 1 cm per year

Question 23

indapamide

Answer 23

thiazide like diuretic used for HTN or decompensative heart failure

Question 24

alendronate

Answer 24

bisphosphanate drug used for bone disease

Question 25

what three medications predispose a patient to peptic ulcers?

Answer 25

NSAIDS
bisphosphonates
steriods

Question 26

what medications should you put on hold in a patient with oligouria or a worsening kidney function

Answer 26

NSAIDS ACE inh diuretics and abx (gent, vanc,)

Question 27

MOA of biguanides

Answer 27

decrease hepatic uptake and increase peripheral glucose uptake

Question 28

MOA of glitazones

Answer 28

activate peroxisome proliferator activated receptor gamma
nuclear transcription factor increasing LPL and fatty acid transporter protein 1 transcription involved in lipid metabolism
increasing perpheral insulin sensitivity

Question 29

MOA of sulphonylureas and meglitinides

Answer 29

increased insulin secretion by blocking the K ATP channel in the pancreatic B cells causeing deploratization and ca entry leading to increased insulin production.

Question 30

MOA of gliptins

Answer 30

competively inhibit the DPP4 enzyme that normally inactivates glucagon like peptide and incretin that stimulates insulin secretion and inhibits glucagon release.

Question 31

a- glucosidase inh. MOA

Answer 31

decrease glucose reabsorption in the intestine.

Question 32

Warfarin side effects

Answer 32

heamorrhage 
nausea and vomiting 
purple toes and skin necrosis
hepatic dysfunction 
pancreatitis

Question 33

What is the INR target range for patients with proven DVT?

Answer 33

2-3