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ICSM Finals > Pharmacology and Therapeutics > Flashcards

Pharmacology and Therapeutics Flashcards

1
Q

Metformin:

Drug class
Insulin sensitiser or secretagogue
MOA

A

Biguanide

Insulin sensitiser

Incompletely understood but:
Decreases gluconeogenesis
Increases peripheral glucose use
Decreases LDL and VLDL

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2
Q

Key side effects of metformin

A 
Lactic acidosis (care in renal failure and with contrast dye)
GI upset
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3
Q

Pioglitazone:

Drug class
Insulin sensitiser or secretagogue
MOA

A

Thiazolidinedione

Insulin sensitisation (peripheral)

PPAR gamma ligand. PPAR is involved in glucose and lipid homeostasis.

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4
Q

Gliclazide

Drug class
Insulin sensitiser or secretagogue
MOA

A

Sulphonylureas

Insulin secretagogue

Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

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5
Q

Repaglinide

Drug class
Insulin sensitiser or secretagogue
MOA

A

Meglitinides

Insulin Secretagogue

Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

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6
Q

Key side effects on sulphonylureas

A

Hypos (can be prolonged)
Weight gain
GI upset
Headache

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7
Q

Key side effect of pioglitazone

A

Weight gain
Deranged LFTs/ hepatotoxicity
Fluid retention
May exacerbate heart failure

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8
Q

Key side effects of repaglinide

A

Hypoglycaemia

also very short acting

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9
Q

Exenatide

Drug class
Insulin sensitiser or secretagogue
MOA

A

GLP-1 analogue/ Insulin secretagogues

Both

GLP-1 analogue
GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells
Increases insulin sensitivity

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10
Q

Key side effects of exenatide

A

Hypoglycaemia
GI upset

(also needs to be given by subcut injection)

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11
Q

Sitagliptin

A

DPP4 Inhibitor

Insulin secretagogue

Inhibits DPP4 which breaks down endogenous GLP-1.
GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells and increases insulin sensitivity

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12
Q

Key side effects of the DPP4 inhibitors

A

Hypoglycaemia

GI upset

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13
Q

For exenatide to be continued long term initially there must be clear metabolic benefit demonstrated by…

A

Weight fall of at least 3% and HbA1c fall of at least 11mmol (1%)

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14
Q

Which oral hypoglycaemic should not be used with insulin

A

Pioglitazone

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15
Q

Stepwise treatment of COPD (inhaled therapies)

A

For all patients:
Vaccinations, smoking cessation, pulmonary rehab if person is functionally limited by COPD.

1: PRN SABA (or SAMA)

2: If FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA
if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.
Stop any SAMA.

3: If FEV1 ≥ 50% predicted consider LABA+ICS in a combination inhaler
consider LAMA in addition to LABA where ICS is declined or not tolerated

4: Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.

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16
Q

Vaccinations to be offered to patients with COPD

A

Pneumococcal booster and annual influenza

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17
Q

When to use theophylline in COPD

A

Theophylline should only be used after a trial of short-acting bronchodilators and long-acting bronchodilators, or in patients who are unable to use inhaled therapy, as there is a need to monitor plasma levels and interactions

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18
Q

When to use carbocisteine in COPD

A

Mucolytic drug therapy should be considered in patients with a chronic cough productive of sputum.
They should not be used to prevent exacerbations.

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19
Q

When to start long term oxygen therapy in COPD

A

Non smokers!!! and any of the following:

Clinically stable with PaO2<7.3 (2 occasions >3/52 apart)
PaO2 7.3-8 with: PHT, cor pulmonale, polycythaemia, nocturnal hypoxaemia.
Terminally ill

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20
Q

MRSA eradication

A

Mupirocin (nasal) and chlorhexidine wash.

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21
Q

Acute management of non-self limiting seizures (if no IV access)

A

Rectal diazepam 10mg. Repeated if necessary after 10-15 minutes.

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22
Q

Side effects of sulfasalazine due to the sulphapyridine moiety

A

Rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia

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23
Q

2nd Line pharmacological treatment of IBS

A

Low dose tricyclic

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24
Q

Summarise the symptomatic treatment of MS

A

Fatigue: Modafanil
Depression: SSRI
Pain: Amitryptylline or gabapentin
Spasticity: Physio, baclofen (1st line drug), dantrolene, Botox
Urinary Urgency/frequency: Oxybutynin, tolterodine
ED: Sildenafil
Tremor: Clonazepam

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25
Q

Drugs that worsen mysasthenia gravis weakness

A 
B blockers
Gentamicin
Phenytoin
Macrolides 
Tetracyclines 
Opiates
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26
Q

Acute treatment of cluster headaches

A

Sumatriptan subcut or nasal (NOT ORAL)

100% oxygen

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27
Q

Prophylaxis of cluster headache

A

Verapamil or prednisolone

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28
Q

Side effects of sodium valproate

A 
Appetite increase (and weight)
Liver failure (monitor LFTs over first 6 months)
Pancreatitis
Reversible hair loss 
Oedema
Ataxia
Tertaogenicity, thrombocytopenia, tremor
Encephalopathy
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29
Q

Initial treatment of cryptococcal meninigitis

A

Amphotericin B and flucytosine
Follow up treatment with fluconazole

If HIV infeected also optimise ARVs

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30
Q

Treatment of toxoplasmosis

A

Pyrimethamine, sulfadiazine, folate

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31
Q

First line options for treatment of neuropathic pain

A

amitriptyline, duloxetine, gabapentin or pregabalin

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32
Q

First line for ‘rescue therapy’ in neuropathic pain

A

Tramadol

33
Q

Common side effects of triptans

A

Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

34
Q

Contraindications for use of triptans

A

Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

35
Q

Essential tremor is improved by…

A

Propranolol and alcohol

36
Q

Drug that shows survival benefit in motor neuron disease

A

Riluzole

prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months

37
Q

Management of motor neurone disease

A

Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months

Respiratory care
non-invasive ventilation (usually BIPAP) is used at night
studies have shown a survival benefit of around 7 months

50% of patients will die within 3 years.

38
Q

Enzyme inhibitors

A 
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking/Allopurinol 
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
39
Q

Enzyme inducers

A 
Carbamezapine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas
40
Q

Key side effects of thiazides

A

HYPER effects in serum:
HYPERuricemia (precipitate acute gouty arthritis)
HYPERcalcemia (renal calcium resorption, decrease calcium in urine)
HYPERglycemia
HYPERlipidemia (increase choleterol and LDL)

HYPO effects in serum:
HYPOkalemia
HYPOtension (decreases blood volume and peripheral vascular resistance)

41
Q

NICE fluid requirments recommendations for maintenance fluids

A

In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

42
Q

Drugs that preciptate gout

A

NSAIDs, diuretics (thiazides), cytotoxics, pyrazinamide.

43
Q

Treatment of acute gout

A

First line: NSAID (diclofenac or indomethacin)
Second line: Colchicone
In renal impairment: steroids (NSAID and colchicine CI)

44
Q

Common s/e of colchicine

A

Diarrhoea

45
Q

Prevention of gout (medications)

A

1st line: Xanthine oxidase inhibitors. Allopurinol first choice. Febuxostat is hypersensitivity.
2nd line: Uricosuric drugs. Probenicid, Losartan. These are rarely used.

Recombinant urate oxidase may be used before cytotoxic therapy.

46
Q

Side effects of xanthine oxidase inhibitors

A

Rash, fever, reduced WCC with azathioprine.

47
Q

Non ergot-derived dopamine agonists used in PD

A

Pramipexole, ropinirole, and rotigotine

48
Q

Treatment of pseudogout

A

Analgesia
NSAIDs
PO, IM or intra-articular steroids

49
Q

Treatment of psoriatic arthritis

A

NSAIDs

MTX, sulfasalazine, ciclosporin

50
Q

Treatment of reactive arthritis

A

NSAIDs
Local steroids
Relapse may require sulfasalazine or MTX

51
Q

Treatmement of polymyositis and dermatomyositis

A

Steroids

Cytotoxics: AZT, MTX

52
Q

Drugs that induce lupus

A

Procainamide
Phenytoin
Hydralazine
Isoniazid

53
Q

Treatment of anti-phsopholipid syndrome

A

Low dose aspirin

Warfarin if higher risk (e.g. recurrent thromboses) target INR 2-3

54
Q

SLE management

A

Severe flares (pericarditis, CNS disease, AIHA, nephritis): IV cyclophosphamide, High dose prednisolone.

Cutaneous: topical steroids to treat, sun cream for prevention

Maintenance for joints and skin: NSAIDs, hydroxychloroquine, low dose steroids (option)

Lupus nephritis: ACEi for proteinuria. Immunosupression if aggressive GN

55
Q

Treatment of GCA

A

High dose steroids (e.g. pred 40-60mg oral) and taper slowly.
PPI and alendronate cover

56
Q

Treatment of polymyalgia rheumatica

A

15mg/day oral prednisolone and then taper according to ESR and symptoms
PPI and alendronate cover

57
Q

Treatment of granulomatosis with polyangiitis

A

Immunosuppression:
Cyclophsphamide, Rituximab, MTX

Azathioprine, Rituximab or MTX for maintenance.

58
Q

Treatment of Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

A

Prednisolone
Cyclophosphamide is severe multi-organ
Azathioprine or MTX for maintenance

59
Q

Women should avoid pregnancy for at least… months after stopping MTX

A

3 months (men should use contraception for the same duration)

60
Q

Treatment of warm AIHA

A

Immunosuppression

Splenectomy

61
Q

Drugs that trigger haemolysis in G6PD deficiency

A

Antimalarials, henna, dapsone, sulphonamides

62
Q

Management of sickle cell anaemia (chronic)

A

Pen V 250mg BD
Folate 5mg OD
Hydroxycarbamide if frequent crises

63
Q

Treatment of Hodgkin’s lymphoma

A

A – doxorubicin (Adriamycin ®)
B – bleomycin
V – vinblastine (Velbe ®)
D – dacarbazine (DTIC).

Possibly add radiotherapy.

64
Q

Immunisations post splenectomy

A

Pneumovax (repeat every 5 years)
Hib if not done in childhood
Men C if not done in childhood
Yearly flu

65
Q

Contraindications for thrombolysis (STEMI)

A

AGAINST

Aortic dissection 
GI bleeding 
Allergic reaction previously 
Iatrogenic (recent surgery)
Neuro: cerebral neoplasm of CVA Hx 
Severe HTN (200/120)
Trauma (including CPR)
66
Q

Clopidogrel post MI: How long to continue post..
STEMI
NSTEMI

A

STEMI with stenting: 12 months
STEMI with medical management: 1 month
NSTEMI: 12 months

67
Q

1st line treatments of stable angina (in addition to GTN)

A

CCB or B blocker

68
Q

2nd line treatments of stable angina

A

a long-acting nitrate or
ivabradine or
nicorandil or
ranolazine.

69
Q

Drugs causing lung fibrosis

A

BANS ME

Bleomycin/busulfan
Amiodarone 
Nitrofurantoin 
Sulfasalazine 
MEthotrexate
70
Q

Prednisolone dose following:
Asthma exacerbation
COPD exacerbation

A

40mg OD for at least 5 days

30mg OD for 7-14 days

71
Q

Duration of treatment for Scarlet fever

A

10 days

72
Q

Treatment of CMV retinitis

A

Oral valganciclovir

if sight threatened add intravitreal injections of ganciclovir or foscarnet

73
Q

Drug used for CMV prophylaxis in renal transplant

A

Valgancyclovir

74
Q

Treatment of chronic hepatitis B

A

Nucleoside analogue (e.g. tenofovir) or interferon

75
Q

Clinical features of cholera

A

Rice water stools

Shock, acidosis, renal failure

76
Q

Antibiotics most likely to cause C.diff

A

Clindamycin
Ciprofloxacin
Cephalosporins

77
Q

Treatment of giardiasis

A

Tinidazole, metronidazole, or nitazoxanide

78
Q

Treatment of amoebic dysentery

A

Metronidazole (800mg TDS) 5 days or 10 days if liver abscess

Tinidazole

79
Q

Midodrine is used to treat

A

Orthostatic hypotension

ICSM Finals (7 decks)

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