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Year 2 > Pharmo > Flashcards

Pharmo Flashcards

1
Q

What is the difference between Parkinsonism and parkinsons disease?

A
  • Parkinson’s disease- a degenerative disorder
  • Parkinsonism- due to other causes e.g. long term use of anti- psychotic drugs
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2
Q

What are the 4 mechanisms of action in Parkinson’s drugs?

A
  1. Direct dopamine agonists
  2. pre-cursor to dopamine
  3. reduce dopamine metabolism
  4. cause local release of dopam
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3
Q

Drugs used in Parkinsons?

A

Amantadine

Levodopa

MAO-B inhibitors

Dopamine agonists e.g. bromocriptine, ropinirole, pergolide

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4
Q

What is the function of amantiadine in parkinsons?

A

Amantadine - antiviral which increases CNS dopamine release.

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5
Q

What is the function of Levodopa in parkinsons?

A

can cross the BBB. Good response initially but usually declines with time

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6
Q

What is the function of Dopamine agonists in parkinsons?

A

e.g. bromocriptine, ropinirole, pergolide.

Monotherapy in early disease/ young patients. Given with levodopa in more advanced diseas

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7
Q

What is the function of MAO-B inhibitors in parkinsons?

A

eg selegiline.

Inhibits the metabolism of dopamine, NOT levodopa.

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8
Q

What is the function of Entacapone in parkinsons?

A
  • inhibits the metabolism of levodopa which happens peripherally
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9
Q

Side effects of Dopamine agonists in Parkinsons

A

Dopamine agonists- ropinirole (non ergot derivative), pergolide, cabergoline, lisuride, bromocriptine (ergot derivatives):

  • ergot derivatives- fibrotic reactions in the chest, abdo, heart
  • Non ergot derivative- leg oedema
  • Nausea, dizziness, vivid dreams, visual distrubances, postural hypotension
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10
Q

Side effects of Levodopa in Parkinson

A

levodopa is metabolised to dopamine- good thing in the brain but peripherally the dopamine results in adverse effects e.g. nausea and vomiting. To counteract this a decarboxylase inhibitor is given with levodopa e.g carbidopa. Carbidopa does not cross the BBB so only the peripheral dopamine is metabolised to reduce side effects.

  • dyskinesias- overactivity in the dopaminergic pathways, hypotension
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11
Q

Side effects of?

• Selegiline-

• Entacapone-

• Amantadine-

A
  • Selegiline- gastrointestinal upset, can induce confusion
  • Entacapone- gastrointestinal upset, can induce confusion
  • Amantadine- not frequently used, antiparkinsonian effects weak
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12
Q

2 Common drugs for depression

A

Tricyclic antidepressants - block presynaptic reuptake of noradrenaline and serotonin

Selective serotonin reuptake inhibitors (SSRIs)- inhibit serotonin reuptake by post-synaptic nerve terminals

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13
Q

Examples of SSRIs

A

• Fluoxetine- well absorbed from the gut, metabolite is equipotent, can build up in hepatic or renal failure

• Setraline- shorter elimination half-life

• Citalopram, paroxetine

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14
Q

Affects of SSRIs on Depression

A
  • Can take 6-8 weeks to start to work fully
  • No sedative effect with less of an affect on cardiac conduction too.
  • Better tolerated in overdose
  • Should not be given to under 18s as can cause suicidal behaviour and thoughts
  • Adverse effects: anorexia and weightloss, hyponatraemia, sexual dysfunction
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15
Q

Affects of Tricyclic antidepressants

A
  • E.g. amitriptyline – absorbed in gut but can slow down gut motility and make its absorption slower too. Slow half-life
  • Work quicker- 2 weeks
  • Some e.g. amitriptyline are sedative- can be useful side effect
  • Also used for treatment of neuralgia
  • May exacerbate epilepsy
  • Can cause weight gain
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16
Q

NOTE: tricyclic antidepressants also block muscarinic, histamine and alpha1-adrenoreceptors. The anticholinergic effects of this include constipation, urinary retention, tachyarrhythmias

TRUE OR FALSE

A

TRUE

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17
Q

tricyclic antidepressants are used in

  • epilepsy
  • prostatic hypertrophy
  • Immediately after MI
  • Glaucoma

TRUE OR FALSE

A

FALSE- its contraindicated in

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18
Q

Drugs in Asthma?

A

• Short acting beta agonist SABA - e.g. salbutamol, trade name; e.g Ventolin “the blue one” or terbutaline

• Inhaled steroid- beclomethasone, trade name: e.g. clenil modulate “the brown one”

• Long acting beta agonist LABA- e.g. salmeterol trade name: e.g. serevent, maybe “the green one” or formoterol

• Adjuncts- montelukast, theophylline, beta 2 agonist tablets • Oral steroids- prednisolone

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19
Q

What is Ventolin?

A

salbutamol, a short acting beta agonist

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20
Q

WHat is Clenil modulate?

A

beclomethasone, inhaled corticosteroid

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21
Q

WHat is serevent?

A

salmeterol, long acting beta agonist

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22
Q

WHat is seretide?

A

salmeterol (LABA) and fluticasone (steroid

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23
Q

Asthma – acute management- know your severities!

  • Oxygen- ____ high flow non-rebreather mask
  • Salbutamol- inhaled through a______
  • High doses of systemic steroids e.g. oral prednisolone or IV hydrocortisone

• Ipratropium bromide (add to salbutamol nebuliser in those with acute severe or life threatening asthma or those who have little response to b2 agonists)

• ________ _______- a single IV dose ( in those with acute severe asthma or who have not had a response to intial bronchodilator therapy

A
  • Oxygen- 100% high flow non-rebreather mask
  • Salbutamol- inhaled through a nebuliser
  • High doses of systemic steroids e.g. oral prednisolone or IV hydrocortisone

• Ipratropium bromide (add to salbutamol nebuliser in those with acute severe or life threatening asthma or those who have little response to b2 agonists)

• Magnesium sulphate- a single IV dose ( in those with acute severe asthma or who have not had a response to intial bronchodilator therapy

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24
Q

COPD: general medication for breathlessness and exercise?

A

Short acting beta 2 agonist as required

Short acting muscarinic antagonist as required

25
Q

COPD: if the patient has exacerbation or peristent breathlessness with

FEV >50%

What drugs would you give?

A

Long acting beta 2 agonist

Long acting musariniv antagonist (discontinue SAMA)

26
Q

COPD: if the patient has exacerbation or peristent breathlessness with

FEV < 50%

What drugs would you give?

A

Long acting beta 2 agonist plus inhaled corticosteroids

Long acting muscarininc antagonist (discontinue SAMA)

27
Q

COPD: if the patient has persistent exacerbation or breathlessness with

What drugs would you give?

A

Long acting muscarinic antagonists plus long acting beta 2 agonist plus inhaled corticosteroid

28
Q

Medication used for Tuberculosis?

Think of RIPE

A
  • Rifampicin- Top 2 for 4 months
  • Isoniazid- Top 2 for 4 months
  • Pyrazinamide
  • Ethambutol

All for 2 months

29
Q

Drugs used for hypetension?

A

ACE inhibitors (ramipril)

Calcium- channel blcokers

thiazide type diuretics

beta blockers

30
Q

Hypertension drugs- side effects

• ACE inhibitors –

• Calcium channel blockers –

• Thiazide diuretics-

• Beta-blockers-

A

• ACE inhibitors – dry cough (bradykinin production), severe hypotension- in RAS, first dose, heart failure, hyperkalaemia

• Calcium channel blockers –cause smooth muscle to relax so result in facial flushing, ankle swelling, headaches and dizziness

• Thiazide diuretics- dehydration, hypokalaemia/hyponatraemia/hypocalcaemia, impaired glucose tolerance/diabetes

• Beta-blockers- bradycardia/heart block, bronchospasm (do not give to asthmatics), peripheral vasoconstriction

31
Q

3 main management for heart failure?

A

ACE inhibitors

Diuretics

Nitrates

32
Q

What does ACE inhibitors for heart failure?

A
  • blocks RAAS activity
  • vasodilator so reduces afterload Can use an ARB if ACE inhibitor not tolerated though not as effective

• Falling Cardiac output • Falling blood pressure • Increased RAAS activity

33
Q

What does diuretics for heart failure?

A

For reducing fluid retention e.g. furosemide e.g. bendoflumethiazide e.g. spironalactone

• Increased preload • Restores cardiac output in the short term

34
Q

What does NITRATEs for heart failure?

A

Venodilators – reduce the preload on the heart. Effective in acute heart failure e.g. IV isosorbide dinitrate

• Raises BP • Increases afterload

35
Q

What does loop diuretics do?

A

inhibit the resorption of chloride in the ascending limb of the LOH. Chloride loss also leads to loss of sodium and thus water too

Used in moderate to severe heart failure

36
Q

What does Thiazide diuretics do?

A

inhibit sodium absorption at the DCT and water is lost with the sodium. However the major effects is from vasodilation not diuresis

Used alone in mild heart failure

37
Q

What does Potassium-sparing diuretics do?

A

act in DCT at sodium/potassium exchange- spironolactone is an aldosterone antagonist and causes potassium retention and sodium loss. Amiloride actually interferes with sodium/potassium exchange

Used in severe congestive heart failure (usually with ACE inhibitors and loop diuretics)

38
Q

Management for ischaemic heart disease (ACUTE)
think MONA

A
  • M-morphine (+anti-emetic)
  • O- oxygen
  • N- nitrates (sub-lingual glyceryl trinitrate)
  • A- aspirin (oral and providing no contraindication)
39
Q

Ischaemic heart disease

• Everyone who has had an MI should go home on 4 medications

What are they?

A

Statin

  • Aspirin
  • Ramipril
  • Bisoprolol
  • +/- clopidogrel
40
Q

What is APFEL score?

A

-Female -History of travel sickness -Non-smoker -Opioids scheduled in the post-op period

The Apfel simplified score includes female gender, history of PONV and/or motion sickness, non-smoking status, and postoperative use of opioids. When 0, 1, 2, 3, or 4 factors are present, the risk of PONV is 10%, 20%, 40%, 60%, or 80%, respectively (ROC-AUC=0.69

41
Q

Name the drugs used for nausea and vomiting?

A
  • Anticholinergics
  • Antihistamines-
  • Phenothiazines-
  • Dopamine receptors antagonists
  • Domperidone
  • 5-HT antagonist
42
Q

Functions of Anticholinergics and Antihistamines

A
  • Anticholinergics- act on the vomiting centre but also affect the gastrointestinal tract directly e.g. hyoscine. Have anticholinergics side-effects e.g. dry mouth
  • Antihistamines- act on H1 receptors in the vomiting centre but also have some anticholinergic power and can cause drowsiness. Newer non-sedating antihistamines have been found to not be as effective but can be useful in treating motion sickness or vestibular disease e.g. promethazine
43
Q

Diabetes type 2 management

A
44
Q

Describe monotherapy, dual therapy, triple therapy for type 2 Diabetes

A
45
Q

Antibiotics 1- Cell wall- CCP

___________ and ____________ act on the cell wall of the bacteria – the contain a b_________ _______ and can inhibit the formation of _____________ cross-links in bacterial cell walls. Once the cell wall has been weakened water enters and the cell ______

A

• Penicillins and cephalosporins act on the cell wall of the bacteria – the contain a beta-lactam ring and can inhibit the formation of peptidoglycan cross-links in bacterial cell walls. Once the cell wall has been weakened water enters and the cell bursts

46
Q

Examples of Cephalosporins and Penicillins

A
  • Cephalosporins • Different generations e.g. cefotaxime, cefuroxime, cephalexin
  • Penicillins • E.g. amoxicillin, flucloxacillin, benzyl penicillin, penicillin V, piperacillin • Allergies
47
Q

What is amoxicilin used for?

A

chest infections, sinusitis, avoid in tonsillitis

48
Q

What is Flucloxacillin used for?

A
  • skin and soft tissues infections e.g. cellulitis, osteomyelitis, infected eczema
49
Q

What is Benzyl Penicillin used for?

A
  • IM emergency treatment in suspected bacterial meningitis
50
Q

What are the common uses for cephalosporins?

A

HAP- Hospital-acquired pneumonia

Biliary tree sepsis

Peritonitis

Meningitis

Septicaemia

10% sensitivity cross over with penicillins

51
Q

WHat is PMAT and what does it do?

A

Plasma Membrane Monoamine Transporter

• Inhibit protein synthesis by binding to and interfering with ribosome

52
Q

Examples of PMAT, common uses and side effects

A
  • Macrolides- alternative to penicillins in patients with allergies e.g. for pneumonias and first line for atypical pneumonias
  • enzyme inhibitors
  • Gentamicin- gram negative anaerobes
  • Nephrotoxic and ototoxic
  • Doxycycline- malaria prophylaxis, acne, chlamydia
  • Do not give to children- yellow teeth and bones
53
Q

Examples of DNA replication blockers?

A

Metronidazole

Trimethoprim

Quinolones

54
Q

WHat does Metronidazole and Trimethoprim do?

A

Metronidazole • Active against anaerobic organisms, often used in abdominal surgery, against protozoa, H pylori, dental infections

Trimethoprim - Inhibits the enzyme in bacteria which activates folate- therefore it cannot be given in pregnancy as folate is needed for neural tube formation- used for UTIs/ respiratory infections in non-pregnant adults

55
Q

Examples of anticoagulants?

A

Warfarin - a vitamin K antagonist - affects factors 2, 7, 9 and 10

Heparin - binds to anti thrombin III and enhances its natural anticoagulant effect

56
Q

Examples of enzyme inhibitors

think of O DEVICES

A

O- omeprazole

D- disulfiram

E- erythromycin

V- valproate

I- isoniazid

C- cimetidine + ciprofloxacin

E- ethanol (acute)

S- sulphonamides

57
Q

Examples of enzyme inducers

think of PC BARS

A

P- phenytoin

C- carbamazepine

B- barbiturates

R- rifampicin

A- alcohol (chronic)

S- sulphonylureas

58
Q
A

Year 2 (33 decks)

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