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Pharmacology Flashcards

1
Q

What is the role of ACE inhibitors?

A

Reduce the blood volume and cause vasodilation, therefore decreasing peripheral vascular resistance

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2
Q

Examples of ACEi

A 
Ramipril
Perindopril
Enalapril
Lisinopril
Catopril
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3
Q

When are ACEi indicated?

A

(1st line) Hypertension
(1st line) Heart failure
Early renal failure with proteinuria
Secondary prevention after MI

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4
Q

What is the mechanism of ACEi?

A

Competitively inhibit ACE and reduce the generation of ATII, and consequently aldosterone. This reduces Na and H2O retention.

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5
Q

What are the additional effects ACEi?

A

Reduced ATII in tissue also leads to arterial and venous dilation. No reflex tachycardia, inhibits bradykinin breakdown (a vasodilator so further increases vasodilation) and ATII is associated with arterial and ventricular hypertrophy in hypertension, which is now prevented.

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6
Q

Pharmacokinetics of ACEi?

A

Usually a prodrug, active forms are water soluble so poor absorption in the gut. Converted to active form in the liver and most forms are excreted unchanged by the kidneys with generally short half lives.

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7
Q

ACEi side effects?

A 
Persistent dry cough
Postural HTN
Renal impairment
Disturbances to taste, nausea, vomiting, dyspepsia and bowels
Angioedema
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8
Q

ACEi cautions

A

Careful in conjunction with drugs that raise potassium, at risk of hyperkalaemia
Never prescribe with NSAIDS and thiazides diuretics altogether

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9
Q

What are the two main types of analgesics?

A

NSAIDs and opioids

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10
Q

What are less frequent forms of analgesics?

A

Tricyclic antidepressants (amitriptyline)
Anticonvulsants (carbamazepine)
Diazepam

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11
Q

Examples of NSAIDs

A 
Paracetamol
Ibruprofen
Diclofenac
Naproxen
Celecoxib
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12
Q

Examples of opioids

A 
Codeine
Morphine
Fentanyl
Diamorphine
Tramadol
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13
Q

What are NSAIDs indicated for?

A

Mild to moderate pain, particularly MSK
Fevers
Arthritis
Ankylosis spondylitis

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14
Q

What are opioids indicated for?

A

Moderate to severe pain such as childbirth, peri operative pain and cancer

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15
Q

How do NSAIDs work?

A

Prostaglandins are cell signalling molecules involved in the inflammatory and pain responses, synthesised by arachidonic acid from COX enzymes. NSAIDs inhibit COX enzymes to reduces inflammatory and pain responses

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16
Q

How do opioids work?

A

Opioids act of 3 receptors of the CNS - μ, κ & δ. There are 2 subtypes of μ receptor. Type 1 reduces sensation of pain by inhibiting the transmission of pain signals ascending the spinal cord. Type 2 produces the unpleasant side effects of opioids.

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17
Q

What are the side effects of NSAIDs?

A

Gastric ulcers
Reduced renal perfusion (if have prior liver, kidney or cardio problems)
Hypersensitivity
Increased bruising and bleeding

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18
Q

What are the side effects of opioids?

A 
Constipation
Drowsiness
Nausea
Vomiting
Respiratory arrest
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19
Q

Cautions for NSAIDs?

A

Can cause bronchospasm in asthmatics

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20
Q

Cautions of opioids?

A

Elderly
Asthmatics
Mental illness
CVD

Can be addictive

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21
Q

What type of drug is amiodarone?

A

Anti-arrhythmic

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22
Q

What is amiodarone indicated for?

A 
Paroxysmal supraventricular tachycardia
Nodal and ventricular tachycardia
AF + flutter
Ventricular fibrillation
Tachyarrhythmias associated with WPW syndrome
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23
Q

What is the mechanism for amiodarone?

A

Amiodarone blocks K+ channels prolonging the refractory period, blocks Na+ with a high affinity for inactivated channels, non-competitively blocks α and β receptors resulting in anti-adrenergic effects, weakly blocks Ca2+, slows down sinus rate and AV conduction, slightly prolongs QT intervals and can cause peripheral vasodilation

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24
Q

Is the half life of amiodarone long or short?

A

Very long - gives rise to potentially serious drug interactions

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25
Side effects of amiodarone
``` Corneal micro deposits Thyroid function Hepatotoxicity Pulmonary toxicity Peripheral neuropathy ```
26
Cautions of amiodarone?
In pregnancy can possibly cause neonatal goitre Avoid in breastfeeding CI in cardiac issues and iodine sensitivities
27
Examples of ARBs
Candesartan Irbesartan Valsartan (-sartan suffix)
28
What are ARBs indicated for?
Second line treatment for: Hypertension, heart failure and post-MI Diabetic nephropathy
29
Mechanism of ARBs?
Selectively inhibits ATII at AT1 receptors. ATII binding causes vasoconstriction, aldosterone release, sympathetic activation, potentially harmful CV effects. Antagonists cause vasodilation and blocking of aldosterone release
30
Cautions of ARBs?
``` May not be as beneficial in Afro-Caribbean Aortic/mitral stenosis Elderly Hypertrophic cardiomyopathy History of angioedema 1ο aldosteronism Renal artery stenosis ``` CI with aliskirin Potentially serious interactions with many drugs Avoid in pregnancy and breast feeding, caution in renally impaired.
31
How do hanging histamines work?
They are an antagonist to the histamine H1 receptor
32
When are anti-histamines effective?
Against mast cell activated inflammatory reactions
33
What type of antibiotic Trimethoprim?
Folic acid inhibitor
34
What is Trimethoprim indicated for?
Pneumonia (often in conjunction with sulphonamide - coxtrimoxazole) RTI UTI
35
What are the side effects of Trimethoprim?
N+V, rashes, meh oblast is anaemia (folate deficiency)
37
Is Trimethoprim broad spectrum? What is it effective against?
Yes it is a broad spectrum antibiotic | It is effective against gram positive and gram negative bacteria
38
What type of antibiotic is Penicillin?
β-lactam
39
Give examples of penicillin antibiotics
Penicillin, amoxicillin, flucoxicillin, benzylpenicillin
40
What are the side effects of penicillin?
Not many, hypersensitivity and n+v
41
Is Penicillin broad spectrum? What is it effective against?
Very much broad spectrum | Effective against gram positive and negative bacteria
42
Which antibiotics are modified β-lactams?
Cephalosporins, Monobactum, Carbapenams
43
Give examples of Cephalosporins
Cefuroxime, Cephalexin, Cefotaxime
44
Give examples of Monobactums
Atrezonam
45
Give examples of Carbapenems
Imipenem
46
What are cephalosporins indicated for?
Infections
47
Are cephalosporins broad spectrum? What are they effective against?
Yes they are broad spectrum anti-biotics | They are effective against gram positive and gram negative bacteria
48
What are the side effects of Cephalosporins?
Hypersensitivity, nephrotoxicity, diarrhoea, skin rashes, headaches
49
What are monobactums indicated for?
Gram negative bacteria in penicillin allergies. Must be administered IV or IM
50
Are Monobactum broad spectrum? What are they effective against?
No they’re not broad spectrum. They are only effective against gram negative bacteria
51
What are Carbapenems indicated for?
Infections - they’re very wide spectrum
52
What are the side effects of Carbapenems?
Hypersensitivity, n+v, nephrotoxicity in high concs
53
Are Carbapenems broad spectrum? What are they effective against?
Very broad spectrum. Effective against gram positive and negative bacteria as well as anaerobic bacteria.
54
What type of antibiotic are Tetracyclines?
t-RNA inhibitor
55
Give examples of tetracycline antibiotics
Tetracycline, doxycycline
56
What are tetracyclines indicated for?
An alternative to β-lactams in renal impairment | Malaria prophylaxis
57
What are the side effects of tetracyclines?
Photosensitivity, upset GI if not taken with sufficient water
58
Are tetracyclines broad spectrum? What are they effective against?
Yes they are broad spectrum. They are effective against gram negative and positive bacteria
59
Which type of antibiotics are cell wall synthesis inhibitors?
Aminoglycosides, Glycopeptides
60
Give examples of aminoglycosides
Gentamycin, streptomycin, ancomycin
61
Give examples of glycopeptides
Vancomycin, teicoplanin
62
What are aminoglycosides indicated for?
Serious gram positive infections (used with penicillin / vancomycin to overcome resistance)
63
What are glycopeptides indicated for?
Serious staph infections and infective endocarditis. Sometimes C. difficile.
64
What are the side effects of aminoglycosides?
Sensory-neuro deafness, balance
65
What are the side effects of glycopeptides?
Nephrotoxicity, rashes, blood disorders, nausea
66
Are aminoglycosides broad spectrum? What are they effective against?
Yes they are broad spectrum | They are effective against gram positive and gram negative bacteria
67
Are glycopeptides broad spectrum? What are they effective against?
No, only effective against gram positive bacteria
68
What type of antibiotic are Macrolides?
They are an inhibitor of protein translocation
69
Give examples of macrolides
Erythromycin and clarithromycin
70
What are macrolides indicated for?
Generally gram positive bacteria | No gram negative bacteria except H influenzae and legionella
71
What are the side effects of Macrolides?
GI disturbance, skin rashes, hypersensitivity
72
What is penicillin indicated for?
Infections - usually those not yet identified. Should be IV but can be oral
73
Are Macrolides broad spectrum? What are they effective against?
Yes they are broad spectrum against gram positive bacteria. Only effective against those two gram negative bacteria
74
What type of antibiotic is fusidic acid?
Protein synthesis inhibitor
75
What are the side effects of fusidic acid?
GI disturbance, skin eruptions, jaundice
76
Is fusidic acid broad spectrum? What are they effective against?
No they are not broad spectrum | They are effective against gram positive bacteria
77
What type of antibiotic are quinolones?
DNA transcription inhibitor
78
Give examples of quinolones
Ciprofloxacin Levofloxacin Ofloxacin
79
What are quinolones indicated for?
Penicillin resistant gram positive bacteria, gram negative cocci
80
What are the side effects of quinolones?
GI disorders, skin rashes, dizziness, headaches
81
Are quinolones broad spectrum? What are they effective against?
Yes they are broad spectrum | They are effective against both gram positive and gram negative bacteria
82
What type of antibiotic are metronidazole?
DNA synthesis inhibitors that break down DNA
83
Give examples of metronidazole
Metronidazole and tindazole
84
What is metronidazole indicated for?
C. difficile, dividing and non-dividing cells
85
What are the side effects of metronidazole?
n+v, metallic taste, alcohol intolerance, rashes
86
Is metronidazole broad spectrum? What are they effective against?
They are effective against gram positive bacteria and anaerobic bacteria. They are not effective against aerobic bacteria or gram negative bacteria.
87
What type of antibiotic is nitrofurantoin?
It disrupts DNA
88
What is nitrofurantoin indicated for?
Most gram positive cocci E.coli (gram negative) LUTIs
89
What are the side effects of nitrofurantoin?
Peripheral neuropathy, GI upset, lung fibrosis
90
Is nitrofurantoin broad spectrum? What is it effective against?
No, it is effective against mainly gram positive bacteria.
91
Which antibiotics are protein synthesis inhibitors?
Tetra-cyclines Chloramphenicol Lyncosamides
92
Give examples of tetra-cyclines
Doxycycline Minocycline Oxytetracycline
93
Give examples of lyncosamides
Clint Amy in
94
What are tetra-cyclines indicated for?
Very broad spectrum | Acne, chlamydia, cholera, mycoplasma
95
What is chloramphenicol indicated for?
Very toxic so only in life threatening conditions or topically for conjunctivitis
96
What are lyncosamides indicated for?
Prophylaxis for IE in penicillin allergy | Strep or bone infection
97
What are the side effects for tetra-cyclines?
n+v, diarrhoea, teeth discolouration in children, intracranial hypertension
98
What are the side effects of chloramphenicol?
Bone marrow toxicity, neuritis, headache, rashes
99
What are the side effects of lyncosamides?
n+v, jaundice, rash, neutropaenia, thrombocytopenia
100
Are tetra-cyclines broad spectrum? What are they effective against?
Yes very broad spectrum. Effective against gram positive and negative bacteria
101
Is chloramphenicol broad spectrum? What is it effective against?
Yes it is broad spectrum, effective against gram positive and gram negative bacteria but highly toxic so rarely used
102
Are lyncosamides broad spectrum? What are they effective against?
Unsure but they are used in both gram negative and positive bacteria
103
What is fusidic acid indicated for?
Staph infections, | lesions and conjunctivitis (topically)

Phase 2 Revision (6 decks)

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