Pharmacology

Question 1

What do NSAIDs do?

Answer 1

block COX-1 or 2 which are enzymes that form prostaglandins. prostaglandins are pro-inflammatory lipids that can lead to clotting, fever and pain

Question 2

What is the difference between COX 1 and 2?

Answer 2

COX2 is just inflammatory but COX1 has a role in stomach lining, platelet formation and kidney function

Question 3

How does aspirin stop clotting?

Answer 3

stops production of a prostaglandin called thromboxane A2 which activates platelets to initiate blood clotting

Question 4

How does aspirin cause gastric bleeds?

Answer 4

it decreases production of protective mucus in the stomach so the acid can burn through stomach causing ulcers and bleeds

Question 5

How can aspirin affect asthma?

Answer 5

when cyclooxygenase is blocked there are more fatty acids available to the leukotriene pathway which cause narrowing airways and increased mucus

Question 6

What can aspirin cause in babies and children?

Answer 6

Reye’s syndrome

Question 7

What does an agonist do?

Answer 7

binds to the receptor and produces an effect within a cell

Question 8

What does an antagonist do?

Answer 8

binds to receptor to block the effect of the natural agonist that binds to it

Question 9

What is the difference between noradrenaline and adrenaline?

Answer 9

noradrenaline is the major neurotransmitter used by the sympathetic nervous system

adrenaline is a hormone released by the adrenal glands in response to metabolic changes

Question 10

How do general anaesthetics work?

Answer 10

they enhance GABA A receptor activity through a site distinct from the benzodiazepine binding sites

Question 11

What is the choice of IV GA?

Answer 11

propofol

Question 12

What is the choice of inhaled GA?

Answer 12

sevoflurane

Question 13

How do local anaesthetics work?

Answer 13

they prevent action potential propagation in neurones so that painful impulses are not conducted to higher centres

Question 14

What can systemic deliverance of local anaesthetic cause?

Answer 14

cardiovascular collapse

Question 15

What is the prototypical local anaesthetic?

Answer 15

lidocaine

Question 16

What are benzodiazepines used for?

Answer 16

sedation and anxiolysis

Question 17

How do benzodiazepines work?

Answer 17

bind to and enhance the activity of GABA A receptors which open Cl- channels causing hyperpolarisation which makes it less likely for the neurone to fire an AP

Question 18

What reverses the action of benzodiazepines? what is it?

Answer 18

flumazenil: competitive antagonist

Question 19

Which benzodiazepine is mainly used for anxiolysis?

Answer 19

temazepam

Question 20

Which benzodiazepine is mainly used for sedation and amnesia?

Answer 20

midazolam

Question 21

How does morphine work?

Answer 21

it binds to the mu opiod receptor and stimulates dopamine release in the reward pathway

Question 22

What reverses the action of morphine? what is it?

Answer 22

naloxone

competitive antagonist

Question 23

How can morphine cause nausea and vomiting?

Answer 23

causes mast cell degranulation leading to histamine release

Question 24

How does the anti-emetic 
a) cyclizine
b) ondansetron
c) dexamethazone
d) metoclopramide
work?

Answer 24

a) H1 receptor antagonist
b) 5HT3 receptor antagonist
c) steroid
d) D2 receptor antagonist

Question 25

What are the two types of muscle relaxants?

Answer 25

non-depolarising | depolarising

Question 26

How do non-depolarising muscle relaxants work?

Answer 26

they are competitive antagonists of ACh at the neuromuscular junction

Question 27

Give an example of a non-depolarising muscle relaxant

Answer 27

rocuronium

Question 28

How can non-depolarising muscle relaxants' action be reversed?

Answer 28

anticholinesterases eg. neostigmine

Question 29

How do depolarising muscle relaxants work?

Answer 29

partial agonist for ACh causing an inital fasciculation the paralysis

Question 30

Name the depolarising muscle relaxant

Answer 30

suxamethonium

Question 31

Why would suxamethonium be used over rocuronium?

Answer 31

it has a rapid onset which can be used for rapid sequence induction

Question 32

What gastric acid inhibitors are used before surgery?

Answer 32

ranitidine which is a H2 receptor antagonist | proton pump inhibitors eg. omeprazole, lansoprazole

Question 33

What is warfarin?

Answer 33

a synthetic coumarin derivative which inhibits the synthesis of the vitamin K dependent clotting factors in the liver

Question 34

What are the vitamin K dependent clotting factors?

Answer 34

II VII IX X

Question 35

How can warfarin be reversed?

Answer 35

immediately: fresh frozen plasma | 12 hours: vitamin K

Question 36

What a) potentiates b) inhibits warfarin activity?

Answer 36

a) antibiotics | b) barbituates, oral contraceptives, carbamazepine

Question 37

How do ACEi work?

Answer 37

they inhibit the conversion of angiotensin I to angiotensin II by angiotensin converting enzyme

Question 38

What are ACEi used for?

Answer 38

treatment of hypertension all grades of heart failure prophylaxis after MI

Question 39

What needs to be checked before using ACEi?

Answer 39

renal function | may cause increase in potassium

Question 40

What should not be used with ACEi?

Answer 40

potassium sparing diuretics

Question 41

What is salbutamol?

Answer 41

a relatively selective beta adrenoceptor agonist which is used as a bronchodilator in reversible obstructive airway disease

Question 42

Which beta adrenoceptor does salbutamol have more of a pronounced effect on?

Answer 42

beta-2

Question 43

What are the side effects of salbutamol?

Answer 43

tachycardia tremor anxiety hypokalaemia

Question 44

What is atenolol?

Answer 44

a relatively cardioselective beta 1 receptor antagonist

Question 45

What are beta 1 receptor antagonists used for?

Answer 45

treating angina, MI, arrhythmia, heart failure

Question 46

What happens if a non-selective beta blocker is used in an asthmatic patient?

Answer 46

bronchoconstriction

Question 47

Why should beta 2 adrenoceptors be used with cause in insulin-dependent diabetics?

Answer 47

beta 2 adrenoceptors stimulate hepatic glycogen breakdown and pancreatic release of glucagon increasing plasma glucose so, blocking them lowers plasma glucose

Question 48

What effect do beta blockers have on the heart?

Answer 48

negative chronotropic and inotropic effect on the heart

Question 49

What is a negative chronotropic effect?

Answer 49

reduce heart rate

Question 50

What is a negative inotropic effect?

Answer 50

reduce myocardial contractility

Question 51

How does insulin work?

Answer 51

it binds to and activates a membrane bound tyrosine kinase receptor and increases the rate of glucose uptake in to cells

Question 52

What is metformin?

Answer 52

a biguanide oral hypoglycaemic