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MSRA > Drugs! > Flashcards

Drugs! Flashcards

1
Q

Varenicline

A

Nicotinic receptor partial agonist

Binds selectively to alpha4 beta 2 nicotinic acetylcholine receptors of the brain - reducing pleasure and satisfaction associated with smoking. Helps decrease nicotinic cravings and withdrawal symptoms.

Use in caution for patients with depression or self harm. Contraindicated in pregnancy and breastfeeding.

Side effect: abnormal dreams! nausea. Other problems: headache, insomnia, abnormal dreams

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2
Q

Roflumilast

A

Oral phospodiesterase-4 inhibitors (PDE-4)

Reduce risk of COPD in patients with severe COPD (FEV1 <50% after bronchodilator & has 2 or more exacerbations per year despite triple therapy) and history of frequent exacerbations.

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3
Q

Terbutaline

A

SABA
(like salbutamol)

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4
Q

Tiotropium

A

LAMA

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5
Q

Beclomethasone (&budesonide) VS fluticasone

A

Both are inhaled steroids

Fluticasone is more potent

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6
Q

Bupropion

A

Norepinephrine and dopamine reuptake inhibitor & nicotinic antagonist

Used as smoking cessation.

Small risk of seizures
Contraindicated in epilepsy, pregnancy and breastfeeding. Having eating disorder is a relative contraindication.

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7
Q

Pirfenidone

A

Anti-fibrotic

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8
Q

Nintedanib

A

Cancer drug

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9
Q

Memantine

A

NMDA antagonist
Serotonin antagonist
Dopamine agonist

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10
Q

Donepezil

Contraindication for using donepezil

A

Acetylcholinesterase and butyrylcholinesterase inhibitor

(Another example is rivastigmine)

Donepezil should not be used for patients with bradycardia/sick sinus syndrome/AVN block. Adverse effect include insomnia

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11
Q

Phenytoin - mechanism of action

A

Binds to sodium channels and increase their refractory period

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12
Q

Side effect of phenytoin

A

Induced CYP450
Teratogenic- cleft palate, congenital heart problems
Acute- dizziness, diplopia, nystagmus, slurred speech, ataxia -> confusion, seizures
Chronic - gingival hyperplasia (due to increased PDGF), hirsutism, course facial features, drowsiness, peripheral neuropathy
Idiosyncratic- fevers, rashes, hepatitis, Dupuytren’s contracture, aplastic anaemia

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13
Q

Methylphenidate

A

CNS stimulant

Dopamine/norepinephrine reuptake inhibitor

Side-effects include abdominal pain, nausea and dyspepsia

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14
Q

Example of xanthine oxidase inhibitor

A

allopurinol
febuxostat

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15
Q

Colchicine

A

inhibits microtubule polymerization by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity
has a slower onset of action
may be used with caution in renal impairment: the BNF advises to reduce the dose if eGFR is 10-50 ml/min and to avoid if eGFR < 10 ml/min
the main side-effect is diarrhoea

Dont use when taking p-glycoprotein inhibitors ( as it can increase colchicine concentration) - eg clarithromycin, erythromycin, ritonavir, verapamil.

Dont use when taking strong CYP3A4 inhibitors - clarithromycin, telithromycin, nefazodone, itraconazole, ketoconazole, atazanivir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir.

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16
Q

Hydroxychloroquine

A

Used for RA and SLE/discoid SLE
Pharmacologically similar to chloroquine
Can be used in pregnancy

Adverse effect: bull’s eye retinopathy - may result in severe and permanent visual loss. RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula
baseline ophthalmological examination and annual screening is generally recommened

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17
Q

Methotrexate

A

Not to be used for pregnancy

Don’t use with trimethoprim or co-trimoxazole (increases risk of marrow aplasia).

Aspirin increases risk of methotrexate toxicity due to reduced secretion.

Tx of toxicity: folinic acid.

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18
Q

Common side effects of: methotrexate

A

Myelosuppression
Liver cirrhosis
Pneumonitis

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19
Q

Common side effects of: sulfasalazine

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

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20
Q

Common side effects of: leflunomide

A

Liver impairment
Interstitial lung disease
Hypertension

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21
Q

Common side effects of: hydroxychloroquine

A

Retinopathy
Corneal deposits

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22
Q

Common side effects of: prednisolone

A

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

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23
Q

Common side effect of gold

A

Proteinuria

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24
Q

Common side effect of penicillamine

A

Proteinuria
Exacerbation of myasthenia gravis

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25
Q

Common side effect of etanercept

A

Demyelination
Reactivation of tuberculosis

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26
Q

Common side effect of:
- infliximab
- rituximab
- adalimumab

A

infliximab & adalimumab: reactivation of TB
rituximab: infusion reactions

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27
Q

Common side effect of NSAIDs

A

Bronchospasm in asthmatics
Dyspepsia/peptic ulceration

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28
Q

Mechanism of action of alendronic acid

A

Reduce bone turnover - reduced amount of calcium in blood from bone stores.

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29
Q

Finasteride

A

5-alpha reductase inhibitor

Stops conversion of testosterone to DHT therefore, reducing the size of prostate.

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30
Q

Tamsulosin

A

alpha 1 receptor blocker
works at the bladder neck and prostate that causes relaxation of smooth muscles
first line treatment for BPH

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31
Q

metformin ?contraindicated in chronic kidney disease

A

if eGFR<45, dose review
if eGFR <30, stop tx

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32
Q

drugs causing thrombocytopaenia

A

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

(probably immune related)

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33
Q

signs of salicylate poisoning

A

tinnitus is first sign
hyperventilation (centrally stimulates respiration)
lethargy
sweating, pyrexia*
nausea/vomiting
hyperglycaemia and hypoglycaemia
seizures
coma

34
Q

indications for haemodialysis for salicylate poisoning

A

serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma

35
Q

Drugs causing ototoxicity

A

loop diuretics
aminoglycoside (gentamicin)

36
Q

Contraindication to viagra (ie phosphodiesterase inhibitor) for erectile dysfunction

A

Recent MI/stroke
Unstable angina
Patients in whom vasodilation or sexual activity is not advisable
Patients receiving nitrates
Previous history of non-arteritic anterior ischaemic optic neuropathy
Hypotension (esp if SBP<90)

37
Q

warning when using monoamine oxidase inhibitors!

A

when patient eats cheese (strong or aged) or smoked/aged meats, alcohol beverages, some fermented food, yeast extract spreads and various sources -they are HIGH in tyramine.

Tyramine has direct and indirect sympathomimetic actions.

MAOi inhibit breakdown of tyramine.

causes hypertensive reaction & can lead to death.

Eg MAOi: Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), Tranylcypromine (Parnate)

38
Q

amiodarone

A

AKA - photosensitiser (ie sunburn)

causes:
grey discolouration of skin
pulmonary fibrosis
hypo/hyperthyroidism
corneal deposits
liver hepatitis/fibrosis
peripheral neuropathy
bradycardia
prolonged QT syndrome

39
Q

side effect of beta-blockers
(hint: i want sexual side effect)

A

impotence/erectile dysfunction

40
Q

Nicorandil

A

used for angina
activate ATP-dependent potassium channels -> relaxation of vascular smooth muscles (esp venous) -> reduced ventricular filling pressure and myocardial workload.

side effect: headache (most common), oral ulcer, stomatitis

Should NOT use sildenafil as it can worsen the hypotension effect of nicorandil .

41
Q

what drugs causes gum hypertrophy?

A

phenytoin
nifedipine

42
Q

Cannabis - what are the effects?

A

euphoria
drowsiness
heightened images
altered tactile sensations
tachycardia
hypertension
ataxia
visual and auditory hallucinations

43
Q

what causes gout (or hyperuricaemia):

A

bendroflumethiazide
loop diuretic
alcohol
salicylates
pyrazinamide
ethambutol
nicotinic acid
cytotoxic drugs

44
Q

what abx causes tendon rupture

A

ciprofloxacin

45
Q

which ulcerative colitis drug cannot be used for patients who has anaphylaxis to aspirin?

A

sulfasalazine
(has structural similarities to salicylic acid)

46
Q

side effect of benzodiazepine

A

drowsiness
reduced muscle tone and reflexes
hypoventilation
hypotension
coma
confusion
toxic psychosis
convulsions

47
Q

Side effect of these epileptic drugs:
- levetiracetam
- sodium valproate
- phenytoin
- carbamazepine
- lamotrigine

A
  • Levetiracetam: abdominal pains, nausea, diarrhoea, anxiety, weight changes, aggression, tremor, anorexia,
  • SV: hair loss, aggression, tremor, abdo pain, pancreatitis, jaundice, anorexia? weight gain? thrombocytopenia
  • P: tremor, gingival hypertrophy, acne, hirsuitism, coarse facial features, peripheral neuropathy, stevens-johnson syndrome, aplastic anaemia, megaloblastic anaemia
  • C: aggression, dry mouth, hyponatraemia, aplastic anaemia, thrombocytopenia, leukopenia, haemolytic anaemia, eosinophilia, gynaecomastia, male infertility, hepatitis, restlessness
  • Lamotrigine: aggression, tremor, skin rash, hypersensitivity, blurred vision, dizzyness, sleep disturbance, joint pains
48
Q

which CYP450 system is involved with the metabolism of:
- atorvastatin, simvastatin
- clopidogrel activation
- tamoxifen activation

A

CYP3A4 (don’t take with grapefruit, amlodipine - inhibitors)

CYPC19 (therefore, by taking omeprazole, this inhibit this process and reduces efficacy of clopidogrel)

CYP2D6 (therefore, taking SSRI - inhibitors - cause reduce plasma concentration and efficacy of tamoxifen)

49
Q

these drugs affect the CYP450 system—how?
- sodium valproate

A

sodium valproate is an inhibitor of CYPC29.

50
Q

blindness, pulmonary oedema, metabolic acidosis, shock, hypoglycaemia
? toxicity of what
& how to treat this

A

methanol
Tx: fomepizole or ethanol. haemodialysis.

51
Q

side effect of digoxin

A

hyperkalaemia

52
Q

mechanism of action of sumatriptan

A

used for migraine and cluster headache
structurally similar to 5-HT
it is a 5-HT agonist
activated at the cranial and basilar arteries - causes vasoconstriction

for cluster headache: reduce activity of trigeminal nerve

53
Q

treatment of anticholinergic toxicity

A

physostigmine salicylate

54
Q

DPP IV inhibitors
GLP-1 analogues
SGLT2 inhibitors
thiazolidinediones

give names of drugs

WHICH drug causes these side-effect?
- limb amputation
- vit b12 deficiency
- bladder cancer

A

DPP IV : -gliptins
GLP-1 analogues: - tides
SGLT2: -flozins (canglifozin cause lower limb amputation)
thiazolidinediones: pioglitazone (cause bladder cancer)

metformin cause b12 deficiency

55
Q

Acute dystonia reactions - ?causes

A

metoclopramide

56
Q

treatment of oculogyric crisis

A

procyclidine

57
Q

what respiratory problem can you not use zanamivir for?

A

asthma as it can cause bronchospasm

58
Q

which abx can cause photosensitivity?

A

doxycycline (ie risk of sunburn -> therefore particularly mentioned for those taking this for malarial prophylaxis)

59
Q

what drug causes Reye disease in children?

A

aspirin

60
Q

what drug causes gynaecomastia?

A

inhibit testosterone: spironolactone, finasteride/dutasteride, metronidazole, alkylating agents

anabolic steroids abuse

flutamine - blocks androgen receptors

others:
digoxin
amiodarone
isoniazid
cimetidine
methyldopa
TCA
diazepam
heroin
heroin
ketoconazole
goserelin
oestrogen in gender reassignment surgery or treatment of prostate cancer

61
Q

CKD stages and stopping some drugs

A

Stage 3b: nitrofurantoin
Stage 4 : NSAIDs

62
Q

examples of benzodiazepine and duration of action

A

diazepam - long half-life (up to 3 days in elderly)

temazepam, oxazepam - short half-life

63
Q

drugs causing thrombocytopenia

A

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

64
Q

disulfiram causes nausea and vomiting when patient drinks alcohol.
what other drug will also cause the same effect?

A

metronidazole

65
Q

which drug causes?
- glomerulonephritis
- interstitial nephritis
- acute tubular necrosis

A

GN: penicillamine, gold, captopril, phenytoin, penicillin, sulfonamides, rifampicin

IN: penicillin, cephalosporin, sulfonamides, thiazide, furosemide, NSAIDs, rifampicin

ATN: aminoglycosides, amphotericin, ciclosporin

66
Q

which drug causes:
- optic neuritis
- corneal opacities
- cataracts
- retinopathy

A

ON: metronidazole, ethambutol, amiodarone

CO: indomethacin, amiodarone, hydroxychloroquine

Cataract: steroids

Retinopathy: chloroquine, quinine, hydrocychloroquine (causing bulls eye macula)

67
Q

what drug causes gingival hyperplasia?

A

phenytoin
ciclosporin
nifedipine

68
Q

why can we not give a patient monoamine oxidase inhibitor and SSRI together?

A

increase risk of serotonin syndrome
- triad of neuromuscular excitation, autonomic effects, altered mental status

69
Q

what drug - when given with azathioprine causes myelosuppression (ie anaemia and leukipenia)?

A

ACEi

70
Q

treatment of fungal nail

A

5% amorolfine nail lacquer 6 months (fingernail), 12 months (toenails)

terbinafine for 12 weeks (fingernails), 6 months (toenails)

71
Q

treatment of head lice

A

dimeticone 4% lotion

wet combing with the BugBuster comb

Permethrin is NO longer recommended due to not effective tx and resistance

72
Q

drugs causing erectile dysfunction

A

thiazide
beta-blockers
spironolactone
digoxin
finasteride (5 alpha reductase inhibitors)
bicalutamide (anti-androgens)
TCA
SSRI
Benzodiazepine
Phenytoin
Famotidine (H2 antagonist)
Opiates

73
Q

ursodeoxycholic acid - mechanism of action

A

naturally occurring bile acid that is used dissolve cholesterol gall stones

74
Q

drugs that causes oral ulcers

A

NSAIDs
azathiopine
methotrexate
penicillamine
gold
captopril, enalapril
losartan
nicorandil
fluoxetine
lithium
protease inhibitors

75
Q

what does 1% of anaesthetic drug mean?

A

1ml in 10mg (ie 10mg/ml)

So if it is 2%, this means 1ml for 20mg.

76
Q

which drug should NOT be used for primary open angle glaucoma?
beta-blocker
sympathomimetic
anti-muscarinic
carbonic anhydrase inhibitor
miotics

A

anti-muscarinic

77
Q

which anti-HTN drugs worsen glycaemic control?

A

thiazide diuretic
(also beta-blockers)

78
Q

which drugs can cause lichenoid eruptions?

A

ACEi
NSAIDs
methyldopa
chloroquine
oral anti-diabetic drugs
thiazide
gold

79
Q

how to treat scalp ringworm?

A

PO griseofulvin
or TOP ketoconazole shampoo

80
Q

what are the side effects of statins?

A

myositis/rhabdomyolysis
deranged liver function
interstitial lung disease
pancreatitis

NOT gallstones (but this is a side effect of fibrate)

81
Q

causes of Horner syndrome?

A

central lesions: stroke/demyelinating disease

preganglionic lesions: pancoast tumour, mediastinal/thyroid mass, cervical ribs, neck trauma or surgery

postganglionic lesions: carotid artery dissection, cavernous sinus lesion, otitis media, head & neck trauma

82
Q

Amantadine

A

NMDA antagonist - increase dopamine release and blocks dopamine reuptake

treat parkinson’s disease, post herpetic neuralgia and infleunza A

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