50 Drugs

Question 1

Aspirin

Answer 1

Mechanism
- irreversible inactivation of COX enzyme
- reduces TXA2 production and endothelial prostaglandin (PGI2) production (reduces nociceptive sensitisation and inflammation)

GIVEN
after a thrombotic event
pain relief

SIDE EFFECTS:
bleeding
peptic ulceration
angioedema

Question 2

clopidogrel

Answer 2

MECHANISM
- Irreversibly blocks the ADP-receptor on platelet cell membranes
- Consequently inhibits formation of GPIIb/IIIa complex, required for platelet aggregation.

GIVEN
secondary prevention of thrombotic events

SIDE EFFECTS
Bleeding
abdo pain

Question 3

rtPA

Answer 3

Tenecteplase
Alteplase

MECHANISM
- Recombinant form of tissue plasminogen activator
- Catalyses conversion of plasminogen to plasmin
- Promotes fibrin clot lysis

GIVEN:
Ichaemic stoke LESS THAN 4.5 HOURS
MI within 12 hours
massive PE

SIDE EFFECTS
Bleeding
allergic reactions

Question 4

unfractionated heparin AND LMWH

Answer 4

MECHANISM
- Enhances activity of antithrombin III.
- Antithrombin III inhibits thrombin.
- Heparins also inhibit multiple other factors of the coagulation cascade.
- This produces its anticoagulant effect.

GIVEN:
treatment and prophylaxis of thromboembolic disease (with VIT K antagonists)
- renal dialysis
- acute coronary syndrome

SIDE EFFECTS
- Bleeding
- heparin induce thrombocytopenia
- osteoporosis

Question 5

Vit K antagonist - warfarin- give vitamin k to reverse the effects

Answer 5

Mechanism:
Inhibits vitamin K epoxide reductase.
Prevents recycling of vitamin K to reduced form after carboxylation of coagulation factors II, VII, IX and X.
Prevents thrombus formation.
GIVEN:
- treatment of venous thromboembolism
- Thromboprophylaxis in: AF / metallic heart valves / cardiomyopathy

SIDE EFFECTS:
- Bleeding
- warfarin necrosis
- osteoporosis

Question 6

dabigatran

Answer 6

Mechanism:

• Direct thrombin inhibitor; prevents conversion of fibrinogen to fibrin.
  This prevents thrombus formation.

GIVEN:
- prophylaxis of venothromboembolism

SIDE EFFECTS:
bleeding and dyspepsia

Question 7

Rivaroxaban and Apixaban

Answer 7

10 a antagonist

Inhibits conversion of prothrombin to thrombin, reducing concentrations of thrombin in the blood.

prevents formation of fibrin clots

GIVEN:
prophylaxis of VTE
and treatment

SIDE EFFECTS:
bleeding and nausea

Question 8

bisoprolol and atenolol

Answer 8

cardioselective beta blockers

Preferentially blocks beta-1 receptors in cardiac and renal tissue.
Inhibits sympathetic stimulation of the heart and renal vasculature.

GIVEN:
- Hypertension
- Angina
- Rate-control in atrial fibrillation

SIDE EFFECTS:
- Bradycardia
- hypotension
- bronchospasm
- cold extremities and sleep disturbances

Question 9

propanolol and carvedilol

Answer 9

non-cardioselective beta blockers

GIVEN
Hypertension
Angina
Anxiety
Migraine prophylaxis

SIDE EFFECTS:
- Bradycardia
- hypotension
- bronchospasm
- cold extremities and sleep disturbances

Question 10

Ramipril
Enalapril
Lisinopril
Perindopril

Answer 10

ACE INHIBITORS

Inhibits conversion of Angiotensin I to Angiotensin II (a more potent systemic vasoconstrictor)

GIVEN
Hypertension
Heart Failure
Nephropathy
Prevention of Cardiovascular events in high risk patients

SIDE EFFECTS
Dry cough (10% of Patients, causing cessation of treatment in 5%)
Hypotension
Hyperkalaemia
Renal Impairment
Angioedema

Question 11

nitrates

Answer 11

GTN and isosorbide

mechanism:
- converted to NO which is a potent vasodilator
- cardioselective and act predominantly on coronary blood vessels which enhance blood flow to the ischaemic areas of the myocardium and reduces preload and after load

GIVEN:
- angina
- severe hypertension

side effects:
- headache
- postural hypotension
- tachycardia

Question 12

verapamil and diltiazem

Answer 12

these are rate limiting calcium channel blocker drugs

mechanism:
- block the cellular entry of calcium by blocking l-type calcium channels
- decrease contraction of myocardial and smooth muscle
- prolong the AV node conduction which depresses the heart rate

GIVEN:
- supra ventricular arrthymias
- treatment of angina
- hypertension

side effects:
- constipation
ankle swelling in diltazem
- flushing

Question 13

amlodipine
nifedipine
felodipine

Answer 13

NON-rate limiting calcium channel blockers

mechanism:
- block the cellular entry of calcium by blocking l-type calcium channels
- decrease contraction of myocardial and smooth muscle

GIVEN:
- treatment of angina
- hypertension

side effects:
- ankle oedema
- abdo pain

Question 14

simvastatin
atorvastatin
pravastatin

Answer 14

HMG CoA reductase inhibitors
increases the amount of LDL-receptor expression on hepatocytes which increases the level of uptake of cholesterol

GIVEN:
- familial hypercholesterolaemia
- prevent of cardiovascular disease evens in high risk patients

side effects:
- myalgia
- GI disturbances

Question 15

simvastatin
atorvastatin
pravastatin

Answer 15

HMG CoA reductase inhibitors
increases the amount of LDL-receptor expression on hepatocytes which increases the level of uptake of cholesterol

GIVEN:
- familial hypercholesterolaemia
- prevent of cardiovascular disease evens in high risk patients

side effects:
- myalgia
- GI disturbances

Question 16

digoxin

Answer 16

cardiac glycosides

mechanism:
- Increases vagal parasympathetic activity and inhibits the Na+/K+ pump, causing a buildup of Na+ intracellularly.

in an effort to remove this build up of sodium, more calcium is brought into the cells by the exchangers

this build up means there is an increased force of contraction and reduced rate of conduction through the AV node

GIVEN:
- heart failure
- rate control in AF

side effects:
- nausea
- vomiting
- diarrhoea
- confusion

Question 17

amiodarone

Answer 17

anti-arhythmic drug which blocks cardiac potassium channels and therefore prolong repolarisation of the cardiac action potential

GIVEN:
- supraventrivular and ventricular arthymias

side effects:
- photosensitivity skin reactions
- hypersensitivity reactions

Question 18

Flucloxacillin
Amoxicillin
Benzylpenicillin
Penicillin V

Answer 18

beta-lactams

mechanism:
Attaches to penicillin-binding-proteins on forming bacterial cell walls.
This inhibits the transpeptidase enzyme which cross-links the bacterial cell wall.
Failure to cross-link induces bacterial cell autolysis.

indication:
fluclox use in skin infections
amox in non severe community acquired pneumonia

side effects:
- rash
- diarrhoea

Question 19

ceftriaxone
cephalexin

Answer 19

cephalosporins

GIVEN:
Serious infection: septicaemia / pneumonia / meningitis

side effects:
- hypersensitivity
- c.diff
- liver function impairment

Question 20

vancomycin

Answer 20

glycopeptides
bactericidal and inhibit cell-wall synthesis on gram positive bacteria

given:
- severe gram postiive infections
- MRSA
- severe c.diff

side effects:
- fever
- rash

Question 21

gentamicin

Answer 21

aminoglycoside

mechanism:
binds to 30s ribosomal subunit which inhibits protein synthesis which induces a prolonged post-antibiotic effect

GIVEN:
- severe gram -ve infections and some soft tissue infections if gram positive

side effects:
- nephrotoxicity
- ototoxicmy

Question 22

ciprofloxacin

Answer 22

quinolones

mechanism:
infers with bacterial DNA replication and repair
broad spectrum bactericidal antibiotics, provides both +ve and -ve cover

GIVEN:
Gram negative bacterial infection
Respiratory tract infection
Upper urinary tract infection
Peritoneal infection
Gonorrhoea
Prostatitis

SIDE EFFECTS:
GI toxicity
QT wave prolongation
C.diff
tendonitis

Question 23

clarithromycin and erthromycin

Answer 23

macrolides

binds to 50s ribosomal subunit and inhibits bacterial protein synthesis IS BACTERIOSTATIC AND BACTERIOCIDAL

GIVEN:
Atypical organisms causing pneumonia / Severe community acquired pneumonia
Severe campylobacter infection
Mild / moderate skin and soft-tissue infection
Otitis media
Lyme disease
Helicobacter pylori eradication therapy

SIDE EFFECTS:
diarrhoea
vomiting
QT wave prolongation
ototoxicity with long term use

Question 24

trimethoprim

Answer 24

inhibitor of folate synthesis
interferes with bacterial DNA replication

GIVEN:
First line antibiotic in uncomplicated UTI.
Acute / chronic bronchitis
Pneumocystis pneumonia (PCP)
Good range of action against gram negative and gram positive bacteria. Including some MRSA cover.

side effects:
elevated serum creatinine
hyperkalaemia
depressed haemotapoesis
rash and GI disturbances

Question 25

acyclovir

Answer 25

anti-viral
a guanosine derivative, converted to triphosphate by infected host cells and this then inhibits DNA polymerase, terminating the nucleotide chain nd inhabiting viral DNA replication

GIVEN:
Herpes simplex infection
Varicella zoster infection

side effects:
nausea
vomiting
local inflammation at the infusion site

Question 26

salbutamol

Answer 26

beta-adrenergic bronchodilator
short acting beta 2 adrenoceptor agonist which relaxes bronchial smooth muscle inducing bronchodilaton

inhibit pro-inflammatory cytokine release from mast cells and TNF alpha release from monocytes which reduces airway inflammation

increase mucus clearance

given:
COPD
asthma

side effects:
tremor
tachycardia
headache
sleep disturbances

Question 27

salmeterol

Answer 27

Beta-Adrenergic Bronchodilators
LONG ACTING

Question 28

beclomethasone

Answer 28

inhaled corticosteroid
- anti-inflammatory effect on the airways and decreases the formation of pro-inflammatory cytokines
- upregulates beta-2 adrenoreceptors in the airways

GIVEN:
- treatment of COPD and asthma

side effects:
oral candidiasis
adrenal suppression
osteoporosis

Question 29

Chlorpheniramine
Desloratidine
Fexofenadine
Hydroxyzine

Answer 29

anti-histamines H1 receptor antagonists
vasodilators bronchial smooth muscle

given:
Anaphylaxis
Hay fever
Urticaria
Sedation

side effects:
Drowsiness
Tinnitus

Question 30

levodopa

Answer 30

dopamine precursor
Pro-drug
Crosses the blood brain barrier and is converted to dopamine
Striatal dopaminergic neurotransmission increased

given
parkinsons

side effects
Dyskinesia
Compulsive disorders
Hallucinations
Nausea
GI upset