Pharmacology

Question 1

Side effect of thiazides

Answer 1

Altered lipid concentration, high Uris acid, glucose, calcium
Hypokalaemia, hyponatraemia, gout

Question 2

Warfarin interactions

Answer 2

Metabolised by the Cytochrome P450 system in liver.

Inhibitors (decrease the effect): NSAIDs, abx (erythromycin and ciprofloxacin), amiodarone, SSRIs.

Enhancers (increase effect): phenytoin, carbamazepine, rifampicin

Question 3

Clotting factors affected by warfarin

Answer 3

2, 7, 9, 10. (1972)

Question 4

Calcium antagonist 2 types and use

Answer 4

Dihydropyridines (nifedipine, amlodipine, ramipril) are mainly peripheral vasodilator and are used in conjunction with b blockers to prevent reflex tachycardia. Hypertension and angina

Non-dihydropyridines (verapamil, diltiazem). Also slows conduction at AV/SA node so DONT give with BBlocker

Question 5

ACE inhibitors action

Answer 5

Dilation of efferent and afferent arteriole reducing renal filtration fraction.

Side effects include renal failure, first use hypotension, cough, angioedema

Question 6

Action of digoxin

Answer 6

Control heart rate and contractililty in HF and AF. Blocks Na/K+ pump.

Question 7

Actions to take if TG>20 mmol/L

Answer 7

Refer to lipid clinic if not alcoholic nor DM

Question 8

Action of penicillins

Answer 8

inhibit cell wall formation through binding of beta lactam ring to cell membrane.

Question 9

Benefits of cephalosporins and action

Answer 9

work similarly to penicillins by binding penicillin-binding protein and inhibiting its action. They do not get inactivated by staphylococcal penicillinases. Works well in gram + and gram - organisms, except for enterococci and gram - anaerobic bacteria.

Question 10

Monobactam abx what bacteria use

Answer 10

aerobic gram - bacilli

Question 11

Carbapenems what type of bacteria they cover

Answer 11

Broadest spectrum - covers gram +, gram - and anaerobic (not MRSA).

Question 12

Macrolide side effect and drug interactions.

Answer 12

QT prolongation potentially leading to torsade de pointe. Interactions with carbamazepine, digoxin, theophyllines

Question 13

Examples of macrolide and common uses and MOA

Answer 13

Erythromycin, clarithromycin… Usually used for gram - ad atypical bacteria (mycoplasma, legionella, chlamydia) upper resp tract infection. Also good for penicillin replacement in allergy. interfers with 50s ribosome binding.

Question 14

Tetracycline abx MOA and common uses.

Answer 14

Bacteriostatic and inhibition of tRNA. Used for gram + and - bacteria, especially complicated skin and soft tissue infections and intra-abdo sepsis.

Question 15

Common side effect of tetracyclines

Answer 15

brown discolouration of teeth, N&V.

Question 16

Common use of trimethoprim and co-trimoxazole

Answer 16

Trimethoprim: frequently used in UTI. Co-trimoxazole (sulfamethoxazole and trimethoprim) is used mainly in pneumocystis jirovecci.

Question 17

MOA and side effects of co-trimoxazole

Answer 17

MOA: inhibit folic acid synthesis. Side effects include skin eruptions, Steven-johnson’s syndrome and thrombocytopenia. TERATOGENIC

Question 18

Steven-johnson’s syndrome what it is and 4 drug causes

Answer 18

Severe skin reaction. Caused by co-trimoxazole, lamotrigine, carbamazepine, allopurinol. amongst others

Question 19

ciprofloxacin class and uses

Answer 19

quinolones. Ciprofloxacin is used against gram - bacteria in most areas of body.

Question 20

Quinolones MOA. issue with them

Answer 20

inhibits DNA gyrase, so unwounds DNA. Can cause higher rates of MRSA and c.dif

Question 21

Gentamicin drug class and common use

Answer 21

Aminoglycoside abx (30s ribosome inhibition). Used for gram - bacteria, esp in staph aureus in synergy with penicillins.

Question 22

Glycopeptide common use and side effect

Answer 22

Includes vancomycin and teicoplanin. can cause ototoxicity and nephrotoxicity. Used mainly for gram + bacteria, especially MRSA.

Question 23

Examples of cephalosporins

Answer 23

cefazolin, cefalexin, cefuroxime.

Question 24

Abx treatment for MRSA

Answer 24

Linezolid, vancomycin, co-trimoxazole.

Question 25

Methotrexate side effects

Answer 25

Agranulocytosis/ pancytopenia (if more than granulocytes - neutrophils, eosinophils and basophils also present)

Question 26

Spironolactone MOA

Answer 26

Inhibits mineralocorticoid receptors in cortical collecting ducts. Aldosterone antagonist

Question 27

Ibesartan

Answer 27

Angiotensin II antagonist. Usually used in patients who can’t tolerate ACE. Can cause hypotension and hyperkalaemia

Question 28

Effect of prostaglandin on glaucoma

Answer 28

Turn iris brown, increase uveoscleral outflow

Question 29

Effect of b blockers on glaucoma

Answer 29

Decreases aqueous humour production

Question 30

Médications to avoid in constipation

Answer 30

Calcium channel blockers, opioids, TCA, antimuscarinics

Question 31

SSRIs avoid if

Answer 31

Hyponatraemia

Question 32

Drugs to avoid in parkinsonsim

Answer 32

Antipsychotics, metoclopramide, prochlorperazine

Question 33

Drugs to avoid in falls

Answer 33

Benzodiazepines, antipsychotics, first gen antihistamines, b blockers or vasodilatory drugs, long term opiates, antimuscarinics (dizziness and impaired balance)

Question 34

First mine management of osteoporosis with DXA >2.5 or fragility fracture

Answer 34

Alendronic acid