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Therapeutics Flashcards

1
Q

What are the 3 features of opiate overdose?

A

Miosis
Respiratory depression
Coma

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2
Q

Nausea and vomitting,Tinnitus, Deafness, Sweating and

Hyperventilation are the 5 features of __________ overdose?

A

Salicylate (aspirin)

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3
Q

Mydriasis, Hyperthermia, Tachycardia, Arrhythmia

and Agiation are the 5 features of ___________ overdose?

A

Ecstacy/ cocaine

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4
Q

What is the drink driving limit for alcohol content (blood and breath tests)?

A

Blood- 80mg/ 100ml

Breath- 35mg/100ml

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5
Q

What is the recommended paracetamol doseage?

A

2 x 500mg tablet, every 4-6 hours.

1 tablet if <50kg

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6
Q

What is the recommended Ibuprofen doseage?

A

1 x 400mg tablet, 4 times per day

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7
Q

What is the recommended Diclofenac doseage?

A

1 x 50mg tablet, 3 times per day

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8
Q

What is “neuropathic” pain?

A

Pain generated ectopically, often in the absence of noxious events, by pathological processes in the nervous system

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9
Q

What is “psychogenic” pain?

A

Pain with no apparent organic basis

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10
Q

What is the recommended tramadol doseage?

A

50-100mg every 4 hours

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11
Q

Which drugs should be avoided in renal impairment? (MANPLN)

A

Metformin, Aminoglycosides (Gentamicin-nephrotoxic), Nitrofurantoin, Potassium sparing diuretics, Lithium, NSAIDs (exacerbate oedema)

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12
Q

Which drugs should be avoided in hepatic impairment? (NWSSD)

A

NSAIDS and steroids -> fluid overload
Sedatives and diuretics -> hepatic encepalopathy
Warfarin -> Reduced clotting

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13
Q

Which AEDs cause weight gain as a side effect?

A

Sodium valproate, Gabapentin

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14
Q

Which AEDs cause weight loss as a side effect?

A

Topiramate

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15
Q

Which AED causes behavioural changes as a side effect?

A

Leveteracitam

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16
Q

What drug is the antedote to paracetamol overdose?

A

N-acetylcysteine (NAC) which detoxifies NAPQUI

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17
Q

What is used for stimulant overdose?

A

Diazepam 10mg IV

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18
Q

What is used for sedative overdose?

A

Naloxone IV/IM (opiate receptor antagonist)

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19
Q

What drugs are examples of dopamine agonists?

A

Bromocryptine/ Cabergoline- used in prolactinoma

Pramipexole/ Rapinirole- used in Parkinsons

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20
Q

Which drugs should be avoided in children?

A

Chloramphenicol
Aspirin
Tetracyclines

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21
Q

Why should tetracyclines e g. Doxycyline be avoided in children?

A

Leads to discoloured teeth and bone issues

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22
Q

Which drugs should be avoided in the 1st Trimester of pregnancy? (ACLQRSTW)

A 
A- Androgens
C- Cytotoxics
L- Lithium
Q- Quinolones eg. Ciprofloxacin, Levofloxacin
R- Retinoids eg Vitamin A
S- Sodium valproate
T- Thalidomide
W- Warfarin
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23
Q

Which drugs should be avoided in the 2nd Trimester of pregnancy? (AABSTON)

A 
A- ACEIs/ ARBS
A- Aminoglycosides eg Gentamicin
B- Benzodiazepines
S- Sulfonamides 
T- Tetracyclines eg. Doxycycline
O- Opiates
N- NSAIDs
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24
Q

Which drugs should be avoided in breastfeeding? (AABSRRL)

A 
A- Antithyroid drugs
A- Amiodarone
B- Benzodiazepines
S- Sulfonamides
S- Statins
R- Radioactive iodine
L- Lithium
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25
Q

How are pharmacokinetics affected in pregnancy?

A

Increased IM and Inhaled absorption

Increased fat, increased plasma volume, increased volume of distribution = Maternal drug concentrations are often lower; doses may need to be increased

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26
Q

How should NAC be given for paracetamol overdose?

A

Use 3 bags IV over 21 hours

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27
Q

Which drugs are examples of stimulants?

A

Cocaine, MDMA, Amphetamines, Mephedrone

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28
Q

Which drugs are examples of hallucinogens?

A

LSD, Magic mushrooms, synthetic tryptamines

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29
Q

Which drugs are examples of sedatives?

A

Alcohol, opiates

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30
Q

What are the 4 main classes of drugs for depression? Give examples of drugs in each class.

A
  1. Tricyclic antidepressants- Amitryptaline, Imipramine
  2. Selective Serotonin Reuptake Inhibitors- Fluoxetine, Sertraline, Citalopram
  3. Serotonin and Norepinephrine Reuptake Inhibitors- Duloxetine, Venlaflaxine
  4. Monoamine Oxidase Inhibitors- Phenelzine
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31
Q

Give 4 examples of opiod drugs.

A 
Morphine
Codeine
Oxycodone
Fentanyl
Tramodol
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32
Q

What are the main classes of non-opiod analgesics?

A
  1. Paracetamol
  2. Non steroidal anti-inflammatory drugs- Aspirin, Ibuprofen, Naproxen
  3. Antidepressants: Amtryptaline (TCA) or Duloxetine (SNRI)
  4. Anticonvulsants- Gabapentin or pregabalin
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33
Q

How does the drug morphine work?

A

Binds to opiod receptor (Mu) which is a G protein coupled receptor:
- inhibits calcium entry
-inhibits release of neurotransmitters
-enhances outward potassium movement
-inhibits adenylate cyclase from converting ATP-> cAMP
THIS RESULTS IN HYPERPOLARISATION, so that downwards signalling of pain doesn’t happen.

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34
Q

Name some common side effects of morphine.

A 
Respiratory depression
Euphoria
Low blood pressure
Constipation
Hypogonadism
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35
Q

How does paracetamol work?

A

Inhibits production of prostaglandin by inhibiting the COX1-3 enzymes.

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36
Q

What are some of the common side effects of paracetamol?

A

Allergy

Overdose can lead to hepatotoxicity

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37
Q

Name some NSAIDs and give their mechanism of action.

A

Ibuprofen, Naproxen and Aspirin.

Inhibit production of prostaglandin by inhibiting the COX 1 and 2 enzymes. They also have anti-inflammatory and anti-platelet effects.

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38
Q

What are some common TCAs and their side effects?

A

Amitryptaline, Imipramine.

Side effects: Dry mouth, constipation, reduction in urine output, and cardiotoxicity.

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39
Q

What are some common SSRIs and their side effects?

A

Fluoxetine
Citalopram
Sertraline

Side effects: Dry mouth, bleeding risk

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40
Q

What are the main classes of drugs used in Parkinson’s?

A
  1. Levo-dopa
  2. Dopamine agonists: Pramipexole, Rapinirole
  3. Monoamine Oxidase B inhibitors: Selegiline, Rasagiline
  4. Catechol-o-methyl transferase inhibitors: Entacapone, Tolcapone
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41
Q

Name some side effects of Levo-dopa?

A

Hypotension
Dyskinesia
Nausea/ vomitting
Effectiveness decreases over time

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42
Q

Name some side effects of dopamine agonists?

A

Hypotension
Hallucinations
Addictive traits

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43
Q

Give examples of the two classes of anti-psychotic drugs.

A

Typical/ 1st generation: Chlorpromazine, Haloperidol

Atypical/ 2nd generation: Clozapine, Rispirodone

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44
Q

How do the first generation anti-psychotics work?

A

D2 receptor antagonists, so decrease the positive symptoms of schizophrenia. Side effects are related to reduction of dopamine in the nigro-striatal pathway= extra-pyramidal side effects

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45
Q

How do the second generation anti-psychotics work?

A

Act on serotonin, norepinephrine and dopamine. Avoids Parkinson’s like effects of typical anti-psychotics.

These have fewer neuromuscular and sexual side effects, but side effects do include weight gain, hyperprolactinaemia and blurred vision.

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46
Q

What is the mechanism of action of sodium valproate?

A

Blocks sodium channels. It also increase levels of the inhibitory neurotransmitter GABA in the brain.

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47
Q

__________ is the ability of a drug receptor complex to produce a maximal functional response

A

Efficacy

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48
Q

What are the 2 types of adverse drug reactions?

A

Type A reactions: dose dependent, predictable based on the pharmacology of the drug

Type B reactions: idiosyncratic and not preditcable based on the pharmacology

49
Q

How is drug metabolism and distribution different in elderly patients?

A

Decreased 1st pass metabolism = Increased bioavailability
Increased fat so lipid soluble drugs accumulate
Decreased total body water
Decreased plasma protein conc

50
Q

What are the 3 steps of the WHO pain ladder?

A

Step 1: Non opiod eg Paracetamol
Step 2: Weak opiod eg. Codeine and non opiod
Step 3: Strong opiod eg. Morphine and non opiod

51
Q

Which are the older generation of AEDS?

A

Sodium valproate
Carbamazepine
Phenytoin
Phenobarbital

52
Q

Which are the newer generation of AEDs?

A

Topiramate
Levetiracetam
Lamotrigine
Gabapentin and pregabalin

53
Q

Which AEDs work by inhibiting Na channels?

A 
Sodium valproate
Carbamazepine
Phenytoin
Topiramate
Lamotrigine
54
Q

If a patient has a paracetamol concentration of __________mg/kg they are at risk of possible liver damage.

55
Q

Which drug is given in Thiamine (Vitamin B1) deficiency?

56
Q

What are the effects of alcohol on GABA amd NMDA?

A 
Increases GABA (inhibitory NT)
Antagonises NMDA (excitatory NT)
57
Q

What is used for Benzodiazepine overdoses?

A

Flumazenil

58
Q

Which drugs are 1st line for Hypertension in patients aged <55years?

A

ACEIs/ ARBS

59
Q

Which drugs are 1st line for Hypertension in patients aged >55years/ black afro Carribean?

60
Q

What are the main side effects of CCBs (dihydropyridines)?

A

Ankle swelling

Acid reflux

61
Q

What are the 2 main types of CCB?

A

Dihydropyridines eg. Amlodipine (cause vasodilation)

Non-dihydropyridines eg. Diltiazem (act on heart and blood vessles)

62
Q

Give an example of a Thiazide diuretic and its MOA.

A

Bendroflumethiazide

Acts in the DCT to block Na/Cl cotransport

63
Q

What are the main side effects of Bendroflumethiazide (thiazide diuretic)?

A

Gout
Erectile dysfunction
Electrolyte disturbance
Hyperglycaemia

64
Q

Give examples of a thiazide like diuretic.

A

Indipamide

65
Q

How do loop diuretics work? When are they used?

A

Inhibit the NKCC2 cotransporter in the Loop of Henle.

Not in hypertension, more for heart failure, renal failure, ascites and pulmonary oedema.

66
Q

What are common side effects of loop diuretics?

A

Hypokalaemia
Polyuria
Hypovolaemia

67
Q

Give an example of a potassium sparing (aldosterone antagonist) diuretic and its MOA?

A

Spironalactone

Antatonises aldosterone, so blocks sodium reabsorption and potassium excretion.

68
Q

What are common side effects of potassium sparing (aldosterone antagonist) diuretics?

A

Hyperkalaemia

Gynaecomastia

69
Q

What is the starting dose of Ramipril?

70
Q

Give an example of an alpha blocker used in 4th line hypertension treatment? What is a common side effect?

A

Doxazosin

Postural hypotension

71
Q

What is the effect of B1 receptor binding?

A

Increased cardiac rate and force

cardioselective

72
Q

What is the effect of B2 receptor binding?

A

Vasodilation, bronchodilation, muscle tremor

non-cardioselective

73
Q

Give examples of cardioselective Beta blockers?

A

Bisoprolol

Atenolol

74
Q

Give an example of a non-cardioselective Beta blocker?

A

Propanolol

75
Q

What are the side effects of Beta blockers?

A

Cold extremities
Bradycardia
Erectile dysfunction
Hypoglycaemia

76
Q

Which drug is used for orthostatic hypotension?

A

Fludrocortisone

77
Q

Which drugs can be used for heart failure with reduced ejection fraction (systolic)?

A
  1. Diuretics eg. Potassium sparing- Spironalactone
  2. ACEI/ ARB
  3. B blockers eg. Bisoprolol, Carvedilol (but can worsen heart failure initially)
  4. Other diuretics…. loop, thiazide. Digoxin- increases force of contraction. Hydralyzine and nitrates.
78
Q

What are the 4 classes of anti-arrhythmic drugs?

A

Class 1- Block Na channels- eg. Flecainide, Phenytoin

Class 2- Beta blockers

Class 3-Prolong the action potential eg. Amiodarone

Class 4- CCBs

79
Q

Which drug is used in SVT?

A

Adenosine IV via a large bore cannula if vagal manouevres are unsuccessful
Briefly blocks transmission through the AV node, resulting in restoration of normal sinus rhythm

80
Q

How is AF normally treated (which drug classes)?

A

Anticoagulants

AND

Rate control (B blockers, CCBs, Digoxin) OR Rhythm control (Amiodarone, Flecainide)

81
Q

What is CHADS VASc?

A 
Used in patients with AF to consider their risk of stroke:
C- CCF
H- Hypertension
A- Age > 75
D- Diabetes
S- Previous stroke/ TIA

V-Vascular disease
A- Age >65
Sc- Female

82
Q

What is the HAS BLED score?

A

Used to estimate the risk of a major bleed for patients on anticoagulation:

H- Hypertension
A- Abnormal liver or renal function
S- Stroke

B- Bleeding
L- Labile (changing) INRs
E- Elderly >65 years
D- Drugs/ alcohol

83
Q

What is Flecainide used for?

84
Q

Which drugs INHIBIT warfarin breakdown (so Increase INR)?

A

Cranberry Juice
Clarithromyin
Ciprofloxacin
Metronidazole

85
Q

Which drugs INCREASE warfarin breakdown (so DECREASE INR)?

A

Vitamin K
St Johns Wort
Rifampicin
Carbamazepine

86
Q

How do Apixaban and Rivoroxaban work?

A

Direct inhibition of Factor Xa

87
Q

How does Dabigatran work?

A

Direct inhibition of thrombin

88
Q

__________ can NOT be given for anticoagulating patients with metalic heart valves.

89
Q

Which drugs can be used for smoking cessation?

A

Buproprion- licenced for depression and anxiety. Contraindicated in seizures.

Varenicline- nicotine receptor partial agonist

90
Q

What is the role of Orlistat?

A

Reduces fat absorption from diet, used in Obesity.

Side effects are steathorrhoea and faecal urgency

91
Q

How do statins work?

A

They are HMG CoA Reductase inhibitors- reduce LDL cholesterol

92
Q

What is a key side effect of statins?

A

Increased risk of developing diabetes

93
Q

Ezetimibe is an alternative to ___________ and blocks NPC1L1 transport in the duodenum.

94
Q

What drug classes can be used as alternatives to statins?

A

Ezetimibe
PCSK9 Inhibitors
Fibrates

95
Q

Which drugs can be used in STABLE angina?

A
  1. Rate limiting drugs: Beta blockers, CCBs, Ivabradine
  2. Nitrates eg. Isosorbide mononitrate
  3. Nicorandil
96
Q

Which drugs are used for ACS?

A

(MONA)
1. Morphine IV 5-10mg and Anti-emetic IV Metoclopramide 10mg IV

  1. Oxygen to maintain sats
  2. GTN sublingual spray
  3. Aspirin 300mg loading. Clopidogrel loading dose. LMWH eg. Enoxaparin 2mg/kg BD
97
Q

Which drugs are used for thrombolysis?

A

Alteplase (a tissue plasminogen activator)

98
Q

Clopidogrel is a prodrug, and requires conversion by which enzymes?

A

Cytochrome p450

99
Q

How is asthma treated?

A

(Use SABA eg. Salbutamol, Terbutaline as required)
Step 1: Low dose ICS eg. Beclometasone, Fluticasone
Step 2: Add LABA eg. Salmeterol
Step 3: Increase the ICS dose and add SR theophyline, or Leukotriene receptor antagonist eg. Monteleukast
Step 4: Oral steroids

100
Q

Give examples of SABAs and their MOA and side effects.

A

SABA- Salbutamol. Terbutaline
Treat bronchospasms, to be used as necessary

Side effects: Tremor, tachycardia, HYPOkalaemia

101
Q

Give examples of ICS and their MOA and side effects.

A

ICS: Beclometasone, Fluticasone, Budesonide
Preventatory; anti inflammatory, decrease oedema and inhibit leukocyte infiltration, used 2x daily (eg. 800mg beclometasone, 2 puffs twice per day)

Side effects: Oral thrush, oesteoporosis, growth suppression in children

102
Q

Give examples of LABAs

A

Salmeterol, Formoterol

Should always be used with ICS

103
Q

Give an example of a Leukotriene Receptor Antagonist and its side effects.

A

Monteleukast (oral)

Antiinflammatory and bronchodilation

Side effects: GI upset, hypersensitivity

104
Q

Give an example of a Xanthene Derivative and reasons why its use is limited.

A

Slow Release oral theophylline

HAS A NARROW THERAPEUTIC INDEX SO USE IS LIMITED, stopping smoking alters drug levels, used by specialists only.

105
Q

What are the differential diagnoses for asthma?

A

COPD
GORD
Bronchiectasis

106
Q

What is acute severe asthma?

A
  1. Unable to complete sentence in one breath
  2. Hr >110bpm
  3. RR > 25
  4. PEFR <50% predicted
107
Q

How is acute severe asthma treated?

A
  1. Oxygen
  2. Salbutamol Nebuliser driven via oxygen
  3. Prednisolone PO or Hydrocortisone IV
  4. Ipratropium bromide (SAMA) neb if poor response
108
Q

How is COPD managed?

A

Initially SABA/SAMA (ipatropium)

If no improvement:
If FEV1 >50% predicted: Add on LABA or LAMA
If FEV1 <50% predicted: Add on LABA and ICS or LAMA

109
Q

What size should inhaler particles be?

110
Q

What are the side effects of alpha blockers used for BPH?

A 
Drowsiness
Depression
Hypotension
Dry mouth
Extra pyramidal signs
Ejaculatory failure
111
Q

Which drugs can be used in BPH?

A
  1. Alpha blockers eg. Doxazosin, Tamsulosin- decrease smooth muscle tone
  2. 5aplha reductase inhibitors eg. Finasteride- decrease conversion of testosterone to Dihydrotestosterone
112
Q

Which diuretics work on the DCT?

A

Thiazide diuretics eg. Bendroflumethiazide

Thiazide like diuretics eg. Indapamide

113
Q

Which diuretics work on the collecting duct?

A

Potassium sparing eg. Spironalactone

114
Q

Which diuretics work on the PCT?

A

Osmotic diuretics eg. Mannitol

Carbonic anhydrase inhibitors eg. Acetazolamide

115
Q

Which class of Parkinso’s medications interact with sinus medications?

A

MAOB inhibitors (Rasagiline, Selegiline)

116
Q

Which antibiotics are used for bacterial pneumonia?

A
  1. Coamoxiclav/ Amoxicyclin
  2. Macrolides (Clarithromycin/ Erythromycin)
  3. Tetracyclines (Doxycycline)
117
Q

Which antibiotics are used for Strep pharyngitis?

A

Phenoxymethylpenicillin

If allergic to penicillin:
Clarithromycin/ Erythromycin

118
Q

Which antibiotics are used for pyelonephritis?

A

Cephalosporins (Cefalexin)
Amoxicillin/ Coamoxiclav
Trimethoprim

119
Q

Which antibiotics are used for gonorrhoea?

A

Ceftriaxone

Year 3 (22 decks)

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