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Bpt > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Type A Drug RXN

A

Related to pharmacodynamics of a drug

  • dose dependent and predictable
  • Known SE of meds
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2
Q

Type B Drug RXN

A

Unrelated to pharmacodynamics of drug

  • Unpredictable and mostly immunological
  • E.g. drug rash
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3
Q

Clearance units

A

L/min

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4
Q

1st order kinetics

A

same AMOUNT of drug eliminated per unit of time

Dependent on cencentration

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5
Q

Zero order kinetics

A

same PROPORTION of drug eliminated per unit of time

Independent of concentration

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6
Q

Dopamine MOA

A

D1 - Low doses - vasodilation
Beta 1 - Intermediate doses - Increase chronotropy (HR) and inotropy (SV)
alpha 1 - High doses - Vasoconstriction

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7
Q

Adrenaline/Noradrenaline MOA

A

Mostly Alpha 1 - vasoconstriction

Some Beta 1 and 2

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8
Q

Dobutamine MOA

A

Mostly Beta1 and Beta2

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9
Q

Neprolysin inhibitor MOA

A

• Inhibition of neprilysin (a neutral endopeptidase) raises levels of several endogenous vasoactive peptides, including natriuretic peptides, bradykinin, and adrenomedullin, and may thus have beneficial effects in patients with HF.

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10
Q

MOA Tranexamic acid

A

Inhibits breakdown of clots by blocking binding of plasminogen and plasmin to fibrin.

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11
Q

Elimination definition

A

Elimination refers to the irreversible removal of drug from the body by all routes of elimination

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12
Q

Clearance definition

A

Clearance may be defined as the volume of fluid cleared of drug from the body per unit of time

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13
Q

PTU MOA

A

Propythiouracil inhibits the synthesis of thyroxine and inhibits the peripheral conversion of throxine to tri-iodothyronine.

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14
Q

Carbimazole MOA

A

Carbimazole is a pro-drug as after absorption it is converted to the active form,methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4

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15
Q

Potassium iodine MOA in Thyroid

A

iodine acutely inhibits hormonal secretion within hours [1], but the responsible mechanisms are uncertain.

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16
Q

MMF MOA

A

selectively suppresses lymphocyte proliferation and antibody formation by inhibiting inosine monophosphate dehydrogenase.

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17
Q

Which drug of abuse causes increased risk of seizures

A

Cocaine

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18
Q

Which OTC supp can cause hepatotoxicity

A

Valerian

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19
Q

achievement of steady state concentration is significantly delayed because this drug induces its own metabolism

A

CArbamazepine

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20
Q

Phase 0 Trial

A

To determine if drug engages its expected target

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21
Q

Phase 1 Trial

A

Initial safety check:

  • Determine safe dosage range
  • Identify SE and study toxicity profile
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22
Q

Phase 2 Trial

A

Explore efficacy while maintaining safety usually against placebo

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23
Q

Phase 3 Trial

A

Multiple dose trials and ascending dose trials

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24
Q

Phase 4 Trial

A

Trials after FDA approval

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25
Q

Drugs that have zero order kinetics

A

ethanol, phenytoin and salicylates

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26
Q

why is morphine half life prolonged in renal failure

A

Impaired elimination of morphine-6-glucoronide

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27
Q

Alpha 1

A

Vasoconstriction

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28
Q

Beta 1

A

Increase in contractility of heart and HR

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29
Q

Beta 2

A

Vasodilation, bronchodilation

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30
Q

Dopaminergic

A

Vasodilation

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31
Q

MOA Red Man Syndrome with Vanc

A

NOT IgE mediated – is due to vancomycin directly activating mast cells resulting in release of vasoactive mediators (eg histamine)

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32
Q

Gold standard testing for allergic contact dermatitis

A

PAtch testing - as type 4 hypersensitivity reaction

Not prick or scratch testing - these are IgE mediated tests

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33
Q

PO Morphine to SC morphine

PO Hydromorphone to SC Hydromorphone

A

2:1 or 3:1

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34
Q

PO Morphine to PO Codeine

A

1:10

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35
Q

PO Morphine to PO Hydromorphone

A

5:1

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36
Q

PO Morphine to PO Oxycodone

A

1.5:1

37
Q

SC morphine to SC fentanyl

A

100:1

38
Q

Phase 1 metabolism

A

introduction of a functional grouop (e.g. reduction, oxidation) – CYP450 has its place here

39
Q

Phase 2 metabolism

A

conjugation of drug with large polar group to make it more hydrophilic (e.g. glucuronidation, sulphate conjugation)

40
Q

Bioavailability

A

Defined as the fraction of unchanged drug reaching the systemic circulation following administration by any route

41
Q

Bactrim side effects

A

o Hyperkalemia
o Megaloblastic anaemia
o Methaemoglobinemia

42
Q

Mx of Tardive dyskinesia

A

Mild: Benzos
Severe local: Botox injection
Severe generalised: IV/ IM Benztropine 1-2 mg

43
Q

Tx of Paracetamol overdose

A
  1. Activated charcoal if presenting <4 hours
  2. NAC if
    - Level above normogram after 4 hours
    - Unknown time of ingestion and level > 66 micromol/L
    - Any hepatotoxicity
44
Q

What level of paracetamol level is there no risk of toxicity

A

if the paracetamol level is <120 μmol/L or 22 mg/L

45
Q

Warfarin MOA

A

• The mechanism of warfarin is it INHIBITS the VKOR enzyme (thus inhibiting the reaction which makes oxidised vitamin K to reduced vitamin K, and therefore there is no vitamin K to act as a co-factor for the carboxylation of the coagulation factors to their active form)

46
Q

WArfarin anticoagulant effect

A

Anticoagulants increase the time it takes for blood to clot

Blocking factors VII, IX and X is technically anticoagulation

The ultimate anticoagulant effect of warfarin is delayed until the normal coagulation factors, especially prothrombin, are cleared from the circulation (plasma half life of prothrombin is ~3 days)

This is why parental anticoagulants (LMWH, UFH) should overlap with warfarin for at least 4-5 days

47
Q

Warfarin antithrombotic effect

A

Antithrombotics reduce thrombus formation

blocking factor II (thrombin) is antithrombotic

48
Q

BEst benzos for elderly and cirrhotics and why

A

Lorazepam, oxazepam and temazepam (“LOT”)

metabolized by the liver through glucuronidation (Phase II not Phase I), which means
§ There are no active metabolites
§ These drugs are rarely susceptible to drug-drug interactions

49
Q

When to give PJP prophylaxis with pred

A

PJP prophylaxis if >20mg prednisolone daily for >4wks

50
Q

Features of Aspirin OD

A
  • Tachypnea (Direct stimulation of resp centre)
  • Usually Resp Alkalosis or mixed acidosis
  • Hypovolemia
  • LFT derrangement (increased lactate)
51
Q

Mx of Aspirin OD

A
  • Serum levels every 2 hours till peak (>7.2 = haemodialysis)
  • Avoid intubation
  • Fluid resus
  • MAINSTAY: Alkalinsation of serum and urine with HCO3 or HSAL
52
Q

Features of NMS

A

Decreased GCS, Rigidity, dysautonomia, fever

Elevated CK

Occurs over days to weeks

53
Q

Mx of NMS

A 
Ventilation and fluids
Cooling
Antihypertensives
Benzos for agitation
CAse reports: Bromocriptine, amantadine, dantroline
54
Q

Features of SS

A

Decreased GCS, MYOCONUS, HYPERREFLEXIA, dysautonomia, Fever

Occurs over 24 hours

55
Q

Mx of SS

A

Supportive care
Sedation with benzos if needed
Cyproheptadine (H1 antagonist)

56
Q

Methadone SE

A

Orthostatic hypotension
Long QTc
Increased ICP

57
Q

Dihydropyridines MOA

A

Peripheral CCBs

Bind to L type Ca channels on cells and prevent influx leading to vasodilation

58
Q

Non-Dihydropyridines MOA

A

Central CCBs

Dialtes coronary arteries and decreases cardiac contractility and conduction

59
Q

Clozapine MOA

A

• Antagonist at alpha, H1, cholinergic and other dopaminergic and serotonergic receptors

60
Q

SE of Clozapine

A

○ Agranulocytosis, seizures, myocarditis, increased mortality in elderly, other CV effects (eg. Orthostatic hypotension)

Risk of SEs is usually highest in early treatment course

61
Q

Worst drug to cause lithium toxicity

A

Thiazides

62
Q

LEvel at which Lithium Toxicity is seen

A

> 1.5-2 mmol/L

63
Q

SE of lithium

A 
GIT
Neurologic - Ataxia, dysarthria, tremors
-Hypothyroid/Goitre
-Sick sinus
-QTc prolongation
-Nephrogenic DI
64
Q

Lithium Toxicity Treatment

A

Acute: Nil treatment usually needed, usually need chronic for uptake in brain

Chronic: IV, possible dialysis

65
Q

SSRI MOA

A

• SSRIs block the action of presynaptic serotonin reuptake pump 🡪 increases the amount of serotonin available in the synapse, increasing postsynaptic serotonin receptor occupancy.

66
Q

SSRI SE

A

Sexual dysfunction
Drowsiness
Weight gain
Anxiety/insomnia

67
Q

Varenicline (Champix)

A

Partial agonist of nicotinic receptor

		§ Concerns with psychiatric effects (eg. Risk of suicide in existing psych disease) and CV effects (small increased risk all CV events)
68
Q

Bupropion (Zyban)

A

Enhances central NA and dopamine release

		§ Also neuropsych concerns (also increased risk of suicide/self harm but possibly smaller risk than Champix)
69
Q

Sympathomimetic Toxidrome

A

Tachycardia, hypertension, agitation, diaphoresis, hyperthermia (warm, wet skin)

Cause:
-Amphetamines, MAOIs, methylphenidate

70
Q

Opioid toxidrome

A

Miosis, sedation, respiratory depression

Tx: Naloxone

71
Q

Cyanide poisoning Tx

A

Hydroxycobalamin

72
Q

Benzo OD Tx

A

Flumazenil

-CI in seizures, benzo dependence

73
Q

Iron OD Tx

A

Desferrioxamine

Whole bowel irrigation if lots of PO tablets on AXR

74
Q

Organophosphate OD Tx

A

Atropine, Oximes

75
Q

When is gastric lavage performed in OD

A

Only within one hour of ingestion of a life threatening OD

-E.g. >20 mg/Kg TCAs

76
Q

When to consider whole bowel irrigation in OD

A

For iron, lithium, lead, and SR CCBs

77
Q

Role for MDAC (Multi dose activated charcoal) in OD

A

Enhances elimination
“GI Dialysis for drugs with entero hepatic recirculation”

Carbamazepine, dapsone, colchicine

78
Q

Toxic dose of paracetamol

A

200mg/kg or 10g, whichever is less

79
Q

NAC SE and MX

A

Anaphylactoid reaction

-Stop infusion, antihistamine, and restart at half rate

80
Q

When to continue NAC in paracetamol OD

A

ALT >50, INR >1.3, Paracetamol concentration >10mg/L, unwell patient

81
Q

Quetiapine OD Features

A

CNS Depression
Antcholingeric toxidrome
Hypotension

82
Q

Mx of Quetiapine OD

A

Supportive
Alpha blocker - vasodilation
IVF and Norad

83
Q

SSRI Complications in OD

A

Hyperthermia is life threatening - Cyproheptadine is the antidote

Citalopram/Escitalopram - QT prolongation/TdP

84
Q

TCA OD Features

A

•
Coma and tachycardia most common clinical features –present with 60-90 mins
•
Hypotension, seizures, ventricular arrhythmias
•
QRS prolongation, right axis deviation, upright R wave in AVR, PR prolongation

85
Q

TCA OD MX

A

•
Rx is IV Na bicarbonate 1-2 mmol/kg, repeated to pH 7.5—7.55
•
Hyperventilate to maintain pH

86
Q

Iron OD Features

A

haemorrhagic gastroenteritis: nausea, vomiting, haematemesis, metabolic acidosis, hypotension

87
Q

Anticholinergic toxidrome Features

A

red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask

flushing, dry skin and mucous membranes, mydriasis with loss of accommodation, altered mental status (AMS), fever, and urinary retention, respectively

88
Q

Anticholinergic OD Tx

A

Activated charcoal
IVF
Physostigmine (reversible cholinesterase inhibitor)

Bpt (15 decks)

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