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Mrcp > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What abx inhibit cell wall formation

A

Cephalosporins and penicillins

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2
Q

Which requires higher INR - mitral valves or aortic valves

A

mitral

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3
Q

how does Ivabradine work?

A

inhibits IF (funny) channels - mixed sodium and potassium channels…. so it delays depolarisation in the sinoatrial node and therefore selectively slows heart rate

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4
Q

Side effects of ivabradine

A

transient luminous phenomenon (reported by up to 15% of patients)

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5
Q

thiaze diuretics blood abnormalities

A

works by inhibiting sodium reabsorption… so hyponatraemia, hypokalaemia and hypercalcaemia (so also hypocalcuria so good for renal stones)!

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6
Q

SGLT2 inhibitors examples

A

-GIFLOZIN

canagliflozin, dapagliflozin and empagliflozin

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7
Q

SGLT2 inhibitor side effects

A

…secretes glucose in urine so:
genital infection (secondary to glycosuria)
diabetic ketoacidosis
WEIGHT LOSS
increased cholesterol - unclear if this affects mortality though

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8
Q

What is the mechanism of action of amphotericin B?

A

amphotericin b binds with ergosterol, a component in fungal cell membranes and forms pores that cause lysis of the cell wall and subsequent fungal cell death

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9
Q

mechanism of action of colchicine

A

bind to tubulins, thereby blocking the assembly and polymerization of microtubules

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10
Q

drugs that cause toxic epidermal necrolysis

A 
phenytoin 
allopurinol
sulphonamides 
penicillins
carbomazepine
NSAIDS

(lookslike scalded appearance over an extensive area,positive Nikolsky’s sign: the epidermis separates with mild lateral pressure)

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11
Q

most common cause of drug-induced angioedema

A

ACEi

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12
Q

TB meds side effects

A

rifamapacin - orange secretions, flu-like
Ethambutol - optic neuritis
Isonazid - peripheral neuropathy (prevent with pyridoxine (Vitamin B6)) and pellagra (b3 def)
Pyrazinamide - gout, arth/myalgia

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13
Q

What antibiotics exacerbate myasthenia gravis?

A

Gentamicin is worst, but also macrolides, tetracycline and metronidazole. Amoxicillin is ok

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14
Q

Sulphonylurea mechanism of action

A

Binds to and closes ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells…. Which simulates insulin release

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15
Q

Drugs that cause peripheral neuropathy

A

Nitrofurantoin, amiodarone, isoniazid, metronidazole, vincristine

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16
Q

How does Metformin work?

A

Increases insulin sensitivity, activates AMP-activated protein kinase

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17
Q

Mechanism of action of allopurinol

A

Inhibits xanthine oxidase, which creates 6-thiouric acid

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18
Q

Mechanism of action of bisphosphonates

A

Inhibits osteoclasts

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19
Q

Ando pain, frequency, haematuria, calcification on bladder….. Swimming in African lake. Antibiotic to treat schistosoma haematobium

A

Praziquantel

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20
Q

Mechanism of action of aspirin

A

Inhibits production of thromoxane a2

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21
Q

Mechanism of action of enoxaparin and fondaparinux

A

Activates antithrombin III, which potentiates the inhibition of coagulation factors Xa

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22
Q

Medication for old man with overactive bladder treatment or urge incontinence

A

Tolterodine or darifenacin (anti muscarinic). Anti muscarinics are contraindicated if history of retention though so use mirabegron (a beta-3 agonist)

  • oxybutynin can cause confusion
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23
Q

Reversal agent of beta blocker

A

Atropine or IV glucagon

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24
Q

Reversal of benzodiazepines

A

Mostly managed with best supportive care but Flumazenil if servere (risk of seizures)

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25
Q

Methanol poisoning reversal agent

A

Fomepizole or ethanol

Haemochromatosis

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26
Q

Mechanism of action of methotrexate

A

Inhibits dihydrofolate reductase and thymidylate synthesis

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27
Q

What is acetylator status

A

50% of UK population lack hepatic n-acetyltransferase

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28
Q

What drugs are affected by acetylator status

A 
Isoniazid,
Procanamide
Hydralazine
Dapasone
Sulfasalazine
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29
Q

Treatment for leprosy

A

rifampicin, dapsone and clofazimine for 12 month

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30
Q

Antibiotic to avoid in LQT

A

erythromycin

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31
Q

Antibiotic to avoid in LQT

A

erythromycin

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32
Q

Treatment for c diff in regular and in severe

A

Metronidazole PO 10-14 days

Severe then vanc and IV metronidazole

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33
Q

mecchanism of carbimazole

A

pro drug,,gets converted to methimazole, this prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4

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34
Q

side effects of sulphonylureas eg tolbutamide

A

hypos and weight gain

avoid in preg and breast

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35
Q

acne vulgaris treatement in pregnancy

A

Acne vulgaris in pregnancy - use oral erythromycin if treatment needed

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36
Q

Mechanism of zoladex (goserelin)

A

GnRH agonist

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37
Q

Treatment of Lyme’s

A

Oral doxy but use IV ceftriaxone if disseminated CNS involvement.
Amoxi if pregnant, as doxy contraindicated

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38
Q

features and causes of Oculogyric crisis…

A

agitation, involuntary upward deviation of the eyes… antipsychotics and metoclopramide

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39
Q

Drug causes of lithium toxicity

A

Thiazides, ACEi, metronidazole and nsaids

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40
Q

Causes of drug induced lupus

A

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

HIPP
Hydralazine
Isonoazid
Procainamide
Phenytoin
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41
Q

Drug causes of c diff

A

clindamycin: RR = 31.8
cephalosporins: RR = 14.9
ciprofloxacin: RR = 5.0

Second Gen cephalosporins like cefuroxime is more likely to cause c diff than cefalexin

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42
Q

Where does thiazides affect

A

Inhibit sodium reabsorption in beginning of the distal convoluted tubule by blocking Na-Cl symporter

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43
Q

Drug that is associated with an increased risk of atypical stress fractures

A

Bisphosphonates. because, due to reduced bone turnover, the bone ages.. more prone to fracture

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44
Q

Drugs that cause 6 month history of dry cough and shortness of breath on exertion…

A 
Pulmonary fibrosis is caused by
Amiodarone
Anti rheum drugs like methotrexate
Nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
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45
Q

Name live attenuated vaccines

A

Live attenuated vaccines

BCG

MMR

oral polio

yellow fever

oral typhoid

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46
Q

Mechanism of action of terbinafine

A

Terbinafine inhibits the fungal enzyme squalene epoxidase, causing cellular death

Turbines squaeel

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47
Q

Drug side effect of topiramate

A

drug-induced acute angle closure glaucoma, typically occurring within one month of treatment
P450 inducer too so worsening of contraceptive pill/implant
Foetal malformations

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48
Q

Drugs that affect levothyroxine

A

Iron, calcium carbonate, coffee

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49
Q

Drug that interacts with clopi

A

Omeprazole and esomeprazole

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50
Q

sulfasalazine cross reactivity

A

Patients who are allergic to aspirin may also react to sulfasalazine

SALA

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51
Q

p450 inducers

A

CRAP GPS induce rage

Carbamazepine 
Rifampicin  (Reduces INR)
bArbituates 
Phenytoin 
St Johns wort
Grisiofalvin
Phenobarbital
Sulphonylurea, st John's wort
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52
Q

p450 inhibitors

A

Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grrrrrrr

Sodium valporate 
Ciprofloxacin 
Sulphonamide 
Cimetidine/omeprazole 
Antifungals, amiodarone 
Isoniazid (Increases INR)
Erythromycin/clarithromycin 
Grapefruit juice
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53
Q

Side effects of isotretinoin

A 
Dry eyes
teratogenicity
Nosebleeds
Depression
Hair thinning
Raised triglycerides
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54
Q

Alcoholic comes in with persistent skin rash on his hands, arms, neck and face. The rash is red-brown in colour, symmetrical and scaly. He also complains of a poor appetite, nausea and diarrhoea…. What vitamin is he deficient in

A

Niacin (vit B3)

Pellagra is a caused by nicotinic acid (niacin) deficiency. The classical features are the 3 D’s -dermatitis, diarrhoea and dementia. Dermatits is brown scaly rash on sun-exposed sites (Casal’s necklace)

Isoniazid can trigger it

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55
Q

Patient with sore throat is treated then develops rash.

What antibiotic might he have been started on?

A

Amoxi.
Urti should be treated with treated with phenoxymethylpenicillin (pen V) because amoxi causes widespread erythematous rash in patients with infectious mononucleosis.

56
Q

Purpose of desmopressin in Von Willebrand’s

A

desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells

57
Q

Anti malarial prophylaxis

A

atovaquone + proguanil (Malarone)
Mefloquine (Lariam, contraindicated in epilepsy)
doxycycline
Chloroquine (contraindicated in epilepsy, resistance in South East Asia)

58
Q

Patient 75 NOF, what do you do to prevent further?

A

Treat with bisphosphonates…no need to wait for dexa

If not tolerated then strontium ranelate

59
Q

Transient rise in Cr following UTI treated with trimethoprim

A

Competitively inhibits tubular secretion causing a temporary rise in creatinine.

Also interacts with methotrexate because both inhibit dihydrofolate reductase

60
Q

What drugs are best for motion sickness

A

Hyoscine

Cyclizine (non sedating)

61
Q

drug management of Alzheimer’s

A

Start on acetylcholesterase inhibitor (denepozil, galantamine and rivastigmine)
Second line is Memantine… so moderate alz you can add it in, or can use on it’s own in severe

62
Q

Drugs to treat drug induced Parkinson’s

A

Anti muscarinic

Like procyclidine, benzotropine, trihexyphenidyl (benzhexol)

63
Q

SE of ciclosporin

A

Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose

64
Q

What can cycle does vincristine act on?

A

Metaphase

65
Q

What is the toxic metabolite of Paracetamol

A

NAPQI (N-acetyl-p-benzoquinoneimine)

66
Q

Bacterial static Vs ,-cidal

A

Core medical trainee (to) Specialist trainee.. mneumonic for bacteriostatic

Bacteriostatic:
CORe - ChlORamphenicol
Medical - Macro
TRAinee - TeTRAcycline
to
SPecialty - SulPhonamide
TRaInee - TRImethoprim
67
Q

Treatment for Chlamydia paittaci - psittacosis

A

Doxy

68
Q

Patient with IBD wants to pregnant, which meds are safe

A

Azathioprine, mesalazine and sulfasalazine (with folic acid) are safe to use in pregnancy and breastfeeding

69
Q

Most dangerous tricyclic antidepressants in overdose

A

amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose

70
Q

Patient with true confirmed IgE mediated pen allergy… What other drugs should you be cautious of

A

Cephalosporins i.e. cefalexin

And carbapenems I.e. mero, erta

71
Q

Convert oral morphine dose to subcut

A

Divide by 2

72
Q

Drug causes of intracranial hypertension

A

Lithium, tetracyclines, vitamin A, oral contraceptive pill

73
Q

What type of drug are exenatide and liraglutide

A

glucagon-like peptide-1 (GLP-1) mimetic, so increase insulin secretion and decrease glucagon,..

Weight loss!

74
Q

Treatment for homocystinuria

A

vitamin B6 (pyridoxine)supplements

75
Q

Half life of amiodarone

A

20-100 days!

Hence the loading dose

76
Q

Pancreatitis caused by antiretroviral

A

didanosine

77
Q

Mechanism of action: heparin

A

Activated antithrombin III

78
Q

Rivaroxiban mechanism

A

Direct X inhibitor

79
Q

how often should lithium levels be checked once a stable dose has been achieved?

A

Li-three-um

80
Q

What antibiotics are contraindicated in preg

A

doxy, metronidazole,

81
Q

management of complicated / severe falciparum malaria

A

IV artesunate

82
Q

what drug can cause pellagra?

A

Isoniazid - as it inhibits conversion of tryptophan to niacin

83
Q

do you treat B12 or folate deficiency first?

A

treat B12 def first to avoid precipitating subacute combined degeneration of the cord

84
Q

drug that can cause dilated cardiomyopathy

A

Doxorubicin

85
Q

which drugs can reactivate TB?

A

TNF-alpha inhibitors like etanercept

86
Q

Patient started on statin, three months later, what blood result would make you stop them?

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper NORMAL limit of the reference range.

87
Q

Terlipressin - method of action

A

constriction of the splanchnic vessels

88
Q

Drug interactions with levothyroxine

A

iron, calcium carbonate, caffeine all reduce absorption

89
Q

What increases absorption of iron?

A 
Vitamin C (ascorbic acid)
And gastric acid

Decreased by tea, PPI, tetracycline

90
Q

Do macrolides inhibit the subunit 50S or 30S of ribosomes

A

buy AT 30, ‘CCEL’ at 50

(Aminoglycosides, Tetracyclines bind to 30S, Clinda, Chloramphenicol and Erythromycin bind to 50S

91
Q

Common side effect of ticagrelor to remember

A

Dyspnoea in 15%

hypothesised that dyspnoea in is trigge ticagrelor inhibits adenosine clearance, thereby increasing its concentration

92
Q

What receptor does Trastuzaumab (herceptin) act on?

A

HER2

T-two(2)–Trastuzaumab

93
Q

What is side effect of cyclophosphamide and how do you prevent it

A

Haemorrhagic cystitis

Prevent it with hydration and Mesna

94
Q

Management of patient on warfarin before dental surgery

A

check INR 72 hours before procedure, proceed if INR < 4.0

95
Q

Patient with asthma has essential tremor. What is drug of choice?

A

Propranolol would be first line but given asthma, use primidone

96
Q

What is a common side effect of Trastuzumab (Herceptin)

A

Cardiotoxicity, so usually get echo beforehand

97
Q

Clopidogrel mechanism

A

Inhibits ADP binding to it’s platelet receptor

98
Q

What is filgrastim used for and MOA

A

Filgrastim is a granulocyte-colony stimulating factor used to treat neutropenia

99
Q

Contraindication of beta carotene

A

Can increase lung ca risk in smokers

100
Q

MOA of amiodarone

A

Blocks potassium channels, which inhibits repolarisation so prolongs action potential,,

101
Q

Diagnosis if taking anti malarials and then develop blood in urine, jaundice, bilirubinuria

Schistocytes and spherocytes on blood film

A

Haemolytic anaemia can be triggered by malaria prophylaxis in G6DP def

102
Q

Nicorandil MOA

A

Potassium channel activator, through activation of guanylyl cyclase increasing cGMP

103
Q

Patient in smoking cessation clinic. What are contraindications for bupropion?

A

norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Contra: seizures, preg, breast feeding

104
Q

Oral morphine to SC syringe driver?

A

Oral morphine dose /3 = diamorphine dose

105
Q

Which antibiotics inhibit 30S and 50S subunit of ribosomes, respectively?

A

Buy AT 30
CEL at 50

Aminoglycocydes (gentamicin, neomycin)
Tetracycline (doxy)

Clindamycin
Erythromycin
Linezolid

106
Q

Non sedating antihistamines

A

Loratidine (LORRYtidine, because youd give it to lorry driver)

Citirizine (but less so)

107
Q

First and second line for beta blocker OD

A

atropine

Glucagon if that fails
Can temporary pace

108
Q

Benefits of metoclopramide in treating migraines

A

It is anti emetic but also prokinetic.. this treats the delayed gastric emptying often found in migraines, so names analgesia more effective

109
Q

Which TCA has lowest toxicity in overdose?

A

Lofepramine

LOWfepramine

110
Q

Side effect of the anti epileptic Vigabatrin

A

V for visual field defect

In up to 40%! May be irreversible

111
Q

Patient of Thai decent has gout. What should you do

A

Screen for HLA-B*5801 before starting allopurinol due to high risk of severe cutaneous adverse reactions

112
Q

MOA pilocarpine

A

Pilocarpine is a muscarinic agonist… Pupillary constriction

113
Q

What drug may reduce effectiveness of adenosine

A

Adenosine Antagonised by Aminophylline

114
Q

Drug causes of urticaria

A

Aspirin
Penicillin
Opioids
NSAIDs

115
Q

When do you measure lithium levels

A

12 HR post

Please don’t check, Call just before, I have a Date at 6 so I’ll be Late at 12

Phenytoin .. No need to monitor
Cyclosporin .. Trough just b4 the dose
Digoxin .. 6 hrs after
Lithium .. 12 hrs after

116
Q

When do you measure digoxin levels

A

6hr post

Please don’t check, Call just before, I have a Date at 6 so I’ll be Late at 12

Phenytoin .. No need to monitor
Cyclosporin .. Trough just b4 the dose
Digoxin .. 6 hrs after
Lithium .. 12 hrs after

117
Q

When do you check different drug levels?

A

Trough levels immediately before dose

Please don’t check, Call just before, I have a Date at 6 so I’ll be Late at 12

Phenytoin .. No need to monitor (trough if suspected tox)
Cyclosporin .. Trough just b4 the dose
Digoxin .. 6 hrs after
Lithium .. 12 hrs after

118
Q

What electrolyte abnormality precipitates digoxin toxicity

A

Hypokalemia… It allows dig to bind to Na/K ATPase more easily so increased inhibitory effect

119
Q

MOA amiloride

A

Potassium soaring diuretic…

Blocks epithelial sodium channels in DCT

Spiro also acts on distal conv tub

120
Q

Drugs that can be cleared with haemodialysis -

A 
BLAST
Barbiturates
Lithium
Alcohol (inc methanol and ethylene glycol
Salicylates
Theophylline
121
Q

leukotriene receptor antagonist examples

A

Monteleukast

122
Q

Clearance

A

= urine conc X urine volume / plasma conc

123
Q

Treatment for cholera

A

PO doxy

124
Q

Test before starting azithro

A

ECG (Qt)

LFTs

125
Q

Hiccups in palliative care

A

chlorpromazine or haloperidol

126
Q

SE ACEi

A 
Cough
Angioedema
Hyperkalemic
First dose hypotension
- esp in AS, or diuretics

Avoid in preg/Bfeeding

127
Q

Patient just started ticagrelor. SE

A

Dyspnoea can occur in first week. Can last hours or days.

128
Q

MOA warfarin

A

Competitively inhibits vit k epoxide reductase

129
Q

5 HT 1, 2 and 3

A

5 HT 1 agonist Triptan
5 HT 2 antagonist Pizotifen
5 HT 3 antagonist Ondansetron

130
Q

Secondary prevention in stroke and Mi

A

Stroke: clopi long-term, statin if >3.5
MI: aspirin and 1yr ticagrelor, +ACEi, statin, BB
…continue ticagrelor if high risk

131
Q

Sulphasalazine side effect

A

Oligospermia (doesn’t happen w, mesalazine)

132
Q

Drugs that are zero order kinetics

A

Heparin
Ethanol
Aspirin
Phenytoin

….they’re saturated

133
Q

MOA tocilizumab and sarilumab

A

monoclonal antibodies against IL-6 receptor

134
Q

How long might it take for finasteride to improve BPH

A

Up to 6 months

135
Q

Where does spironolactone act

A

Cortical collecting ducts

136
Q

Tacrolimus SE

A

Tremor

Mrcp (21 decks)

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