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Drugs! Flashcards

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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
Common side effect of etanercept
Demyelination Reactivation of tuberculosis
26
Common side effect of: - infliximab - rituximab - adalimumab
infliximab & adalimumab: reactivation of TB rituximab: infusion reactions
27
Common side effect of NSAIDs
Bronchospasm in asthmatics Dyspepsia/peptic ulceration
28
Mechanism of action of alendronic acid
Reduce bone turnover - reduced amount of calcium in blood from bone stores.
29
Finasteride
5-alpha reductase inhibitor Stops conversion of testosterone to DHT therefore, reducing the size of prostate.
30
Tamsulosin
alpha 1 receptor blocker works at the bladder neck and prostate that causes relaxation of smooth muscles first line treatment for BPH
31
metformin ?contraindicated in chronic kidney disease
if eGFR<45, dose review if eGFR <30, stop tx
32
drugs causing thrombocytopaenia
quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin (probably immune related)
33
signs of salicylate poisoning
tinnitus is first sign hyperventilation (centrally stimulates respiration) lethargy sweating, pyrexia* nausea/vomiting hyperglycaemia and hypoglycaemia seizures coma
34
indications for haemodialysis for salicylate poisoning
serum concentration > 700mg/L metabolic acidosis resistant to treatment acute renal failure pulmonary oedema seizures coma
35
Drugs causing ototoxicity
loop diuretics aminoglycoside (gentamicin)
36
Contraindication to viagra (ie phosphodiesterase inhibitor) for erectile dysfunction
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
warning when using monoamine oxidase inhibitors!
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
amiodarone
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
side effect of beta-blockers (hint: i want sexual side effect)
impotence/erectile dysfunction
40
Nicorandil
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
what drugs causes gum hypertrophy?
phenytoin nifedipine
42
Cannabis - what are the effects?
euphoria drowsiness heightened images altered tactile sensations tachycardia hypertension ataxia visual and auditory hallucinations
43
what causes gout (or hyperuricaemia):
bendroflumethiazide loop diuretic alcohol salicylates pyrazinamide ethambutol nicotinic acid cytotoxic drugs
44
what abx causes tendon rupture
ciprofloxacin
45
which ulcerative colitis drug cannot be used for patients who has anaphylaxis to aspirin?
sulfasalazine (has structural similarities to salicylic acid)
46
side effect of benzodiazepine
drowsiness reduced muscle tone and reflexes hypoventilation hypotension coma confusion toxic psychosis convulsions
47
Side effect of these epileptic drugs: - levetiracetam - sodium valproate - phenytoin - carbamazepine - lamotrigine
- 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
which CYP450 system is involved with the metabolism of: - atorvastatin, simvastatin - clopidogrel activation - tamoxifen activation
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
these drugs affect the CYP450 system---how? - sodium valproate
sodium valproate is an inhibitor of CYPC29.
50
blindness, pulmonary oedema, metabolic acidosis, shock, hypoglycaemia ? toxicity of what & how to treat this
methanol Tx: fomepizole or ethanol. haemodialysis.
51
side effect of digoxin
hyperkalaemia
52
mechanism of action of sumatriptan
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
treatment of anticholinergic toxicity
physostigmine salicylate
54
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
DPP IV : -gliptins GLP-1 analogues: - tides SGLT2: -flozins (canglifozin cause lower limb amputation) thiazolidinediones: pioglitazone (cause bladder cancer) metformin cause b12 deficiency
55
Acute dystonia reactions - ?causes
metoclopramide
56
treatment of oculogyric crisis
procyclidine
57
what respiratory problem can you not use zanamivir for?
asthma as it can cause bronchospasm
58
which abx can cause photosensitivity?
doxycycline (ie risk of sunburn -> therefore particularly mentioned for those taking this for malarial prophylaxis)
59
what drug causes Reye disease in children?
aspirin
60
what drug causes gynaecomastia?
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
CKD stages and stopping some drugs
Stage 3b: nitrofurantoin Stage 4 : NSAIDs
62
examples of benzodiazepine and duration of action
diazepam - long half-life (up to 3 days in elderly) temazepam, oxazepam - short half-life
63
drugs causing thrombocytopenia
quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin
64
disulfiram causes nausea and vomiting when patient drinks alcohol. what other drug will also cause the same effect?
metronidazole
65
which drug causes? - glomerulonephritis - interstitial nephritis - acute tubular necrosis
GN: penicillamine, gold, captopril, phenytoin, penicillin, sulfonamides, rifampicin IN: penicillin, cephalosporin, sulfonamides, thiazide, furosemide, NSAIDs, rifampicin ATN: aminoglycosides, amphotericin, ciclosporin
66
which drug causes: - optic neuritis - corneal opacities - cataracts - retinopathy
ON: metronidazole, ethambutol, amiodarone CO: indomethacin, amiodarone, hydroxychloroquine Cataract: steroids Retinopathy: chloroquine, quinine, hydrocychloroquine (causing bulls eye macula)
67
what drug causes gingival hyperplasia?
phenytoin ciclosporin nifedipine
68
why can we not give a patient monoamine oxidase inhibitor and SSRI together?
increase risk of serotonin syndrome - triad of neuromuscular excitation, autonomic effects, altered mental status
69
what drug - when given with azathioprine causes myelosuppression (ie anaemia and leukipenia)?
ACEi
70
treatment of fungal nail
5% amorolfine nail lacquer 6 months (fingernail), 12 months (toenails) terbinafine for 12 weeks (fingernails), 6 months (toenails)
71
treatment of head lice
dimeticone 4% lotion wet combing with the BugBuster comb Permethrin is NO longer recommended due to not effective tx and resistance
72
drugs causing erectile dysfunction
thiazide beta-blockers spironolactone digoxin finasteride (5 alpha reductase inhibitors) bicalutamide (anti-androgens) TCA SSRI Benzodiazepine Phenytoin Famotidine (H2 antagonist) Opiates
73
ursodeoxycholic acid - mechanism of action
naturally occurring bile acid that is used dissolve cholesterol gall stones
74
drugs that causes oral ulcers
NSAIDs azathiopine methotrexate penicillamine gold captopril, enalapril losartan nicorandil fluoxetine lithium protease inhibitors
75
what does 1% of anaesthetic drug mean?
1ml in 10mg (ie 10mg/ml) So if it is 2%, this means 1ml for 20mg.
76
which drug should NOT be used for primary open angle glaucoma? beta-blocker sympathomimetic anti-muscarinic carbonic anhydrase inhibitor miotics
anti-muscarinic
77
which anti-HTN drugs worsen glycaemic control?
thiazide diuretic (also beta-blockers)
78
which drugs can cause lichenoid eruptions?
ACEi NSAIDs methyldopa chloroquine oral anti-diabetic drugs thiazide gold
79
how to treat scalp ringworm?
PO griseofulvin or TOP ketoconazole shampoo
80
what are the side effects of statins?
myositis/rhabdomyolysis deranged liver function interstitial lung disease pancreatitis NOT gallstones (but this is a side effect of fibrate)
81
causes of Horner syndrome?
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
Amantadine
NMDA antagonist - increase dopamine release and blocks dopamine reuptake treat parkinson's disease, post herpetic neuralgia and infleunza A

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