Pharmacology

Question 1

Mechanism of action: ACE Inhibitor

Answer 1

block conversion of AT1 to AT2 > reduced AT2 mediated vasoconstriction, sodium retention and aldosterone release > reduced blood pressure

Question 2

Non pharmacological management of HTN

Answer 2

smoking cessation
improve diet
reduce alcohol consumption
regular physical exercise
weight reduction

Question 3

Pharmacological management of HTN: first line (drug + class + dose)

Answer 3

Ramipril 2.5-10mg PO daily (ACEI)
Amlodipine 5-10mg PO daily (CCB)
Hydrochlorothiazide 12.5-50mg PO daily (Thiazide diuretic)
Losartan 50-100mg PO daily (ARBs)

Question 4

Pharmacological management of HTN: second line

Answer 4

Beta blocker
Spironolactone
Alpha blockers

Question 5

Non pharmacological management of dyslipidaemia

Answer 5

Dietary modification
Regular exercise
Smoking cessation
Healthy weight range

Question 6

Pharmacological management of dyslipidaemia: first line (drug + class + dose)

Answer 6

Rosuvastatin 5-10mg PO daily

more potent and fewer drug interaction

Question 7

Pharmacological management of dyslipidaemia: second line

Answer 7

Bile acid biding resins (cholestyramine)
Fibrates (fenofibrate, gemfibrozil)
Ezetimibe
Nicotinic Acid

Question 8

Mechanism of action of statins

Answer 8

Competitively inhibit HMG-CoA reductase (enzyme in cholesterol synthesis) > reduced hepatic cholesterol synthesis > increased hepatic cholesterol uptake from blood > reduced total cholesterol, LDL, (modest) TG & small increase in HDL

Question 9

Non pharmacological management of depression in adolescents

Answer 9

CBT
Psychoeducation and supportive counselling
Drug and alcohol councelling
Nutrition
Complementary and lifestyle interventions (exercise, relaxation techniques, sleep hygiene etc.)

Question 10

Pharmacological management of depression in adolescents

Answer 10

Fluoxetine (SSRI)

10mg for first week, then 20mg (normal therapeutic dose)

Question 11

Pharmacological management of HF

Answer 11

ACEI - Ramipril 2.5mg PO daily
Beta Blocker - metoprolol MR 23.75mg PO daily
Spironolactone - 25mg PO daily
Frusemide - 20/40mg PO daily

Question 12

Pharmacological management of H. pylori infection

Answer 12

Triple therapy:
esomeprazole 20mg BD for 7 days
amoxicillin 1g daily PO for 7 days
clarithromycin 500mg BD for 7 days

Question 13

Pharmacological management of APO

Answer 13

Frusemide IV 20-80mg stat (daily dose in IV)
Morphine IV 1-2.5mg stat
GTN subling

Question 14

Long term pharmacological management of ACS

Answer 14

Aspirin 100mg daily
Clopidogrel 75mg daily
Consider: Beta Blocker (metoprolol 25mg BD)
Consider: ACE (ramipril 1.25mg daily)

Question 15

Pharmacological management of acute ACS

Answer 15

Morphine 5mg IV
Oxygen (to be above 94%)
Nitrates 400-800 microg/5 mins
Aspirin 300mg stat

Question 16

Pharmacological management of T2DM

Answer 16

Metformin SR 500mg-2g daily
+ sulfonylureas (e.g. gliclazide, glipizide)
+ SGLT2 inhibitors (e.g. empaglifozin, dapaglifozin)

Question 17

Mechanism of action of metformin

Answer 17

reduced gluconeogenesis and glycogenolysis > decreased hepatic glucose production

increased muscle insulin sensitivity and uptake of glucose

> > reduced BSL

Question 18

Mechanism of action of sulfonylureas

Answer 18

Bind to SUR receptors on pancreatic beta cells

• blocks K+ channel
• reduced K+ outflow
• depolarisation
• calcium influx
• insulin secretion

simple: increase pancreatic insulin secretion from beta cells

Question 19

Mechanism of action of SGLT2 inhibitors

Answer 19

selectively and reversibly inhibit sodium-glucose transporter protein in proximal renal tubule > decreased reabsorption of filtered glucose > increased urinary excretion of glucose

Question 20

Pharmacological management of acute mania (bipolar)

Answer 20

Lithium 500mg BD

Olanzapine 5-10mg PO nocte

Question 21

Pharmacological prevention of VTE

Answer 21

enoxaparin 40mg once daily subcut

if ortho: consider dabigatran, apixaban etc.

Question 22

Pharmacological management of pneumonia

Answer 22

Mild: amoxicillin PO 1g TDS 5-7 days
Moderate: benzylpenicillin IV 1.2g TDS
Severe: ceftriaxone IV 1g mane + azithromycin IV 500mg mane

Question 23

Pharmacological management of depression in adults

Answer 23

SSRI 
- escitalopram 10mg PO mane
- fluoxetine 20mg PO mane
- sertraline increase to 100mg mane over a week
SNRI
- desvenlafaxine
- duloxetine
- venlafaxine
TCA
- amitriptyline, nortriptyline, imipramine

Question 24

Pharmacological management of seizures

Answer 24

1. give supportive care
2. treat status
   - benzo after 5 mins continuous convulsions
   - midazolam IV 10mg over 2 mins
   - sodium valproate
3. transfer to ICU if seizure continues

Question 25

Pharmacological management of sepsis (unknown origin)

Answer 25

flucloxacillin 2g IV 6 hourly

+ gentamicin 5mg/kg IV first dose