drugs

Question 1

parkinson drugs for old people (>10 years left)

Answer 1

madopar (benserazide + L-dopa)
sinemet (carbidopa + L-dopa)

ben and carb are L-dopa decarboxylase inhibitor

Question 2

parkinson drug for young people

Answer 2

dopamine agonist (ropinirole)

Question 3

treat tremors refractory to L dopa

Answer 3

anticholinergics (benzhexol, benzatropine)

Question 4

treat rigidity refractory to L dopa

Answer 4

MAO-B inhibitor (selegiline)
risk of seratonin syndrome

Question 5

prolong beneficial effects of L dopa by reducing methylation of L dopa and dopamine

Answer 5

COMT inhibitor (etacapone, tolcapone)

Question 6

side effect of L dopa

Answer 6

Peak-dose dyskinesia: Stereotypic head movements, choreiform truncal movement, ballistic limb movement

Off-period dystonia: Freezing at the end of day

Diphasic dyskinesia

Postural hypotension

Hallucinations

Dry mouth, n/v, dizziness

*shld take L-DOPA 30-60 mins before meals

Question 7

4 drugs causing secondary parkinson

Answer 7

anti-psychotics (haloperidol, risperidone), anti-emetics, valproate, CCB

Question 8

RA drug, which is safe for pregnancy?

Answer 8

NSAIDS, corticosteroids

csDMARDS
- methothrexate + folic acid (TERATOGENIC)
- sulfasalazine (SAFE)
- hydroxychloroquine (SAFE)

tsDMARD (JAK inhibitor)
- tofacitinib

bsDMARDS
- TNF-a inhibtitor (infliximab)
- IL-1 Receptor Antagonist (Anakinra)
- IL-6 Receptor Antagonist (Tocilizumab)

Question 9

aortic dissection acute management

Answer 9

Rapid BP control
- IV nitroprusside
- IV Labetalol

Question 10

AAA management

Question 11

UC management

Answer 11

acute
1. corticosteroids (rectal or oral or IV methylprednisolone)
2. 5-ASA (mesalamine), rectal or oral

chronic
1. 5-ASA
2. azathioprine (check thiopurine methyltransferase levels first to prevent leukopenia)
3. biologics (anti-TNFa)

surgical: panproctocolectomy with ieal pouch anal anastamosis (toxic megacolon, 4Bs, refractory to medical mx)

Question 12

Crohn’s management

Answer 12

acute
1.corticosteroids (oral or IV methylprednisolone)
2. exclusive enteral nutrition 6-8 weeks

chronic
1. methothrexate
2. azathioprine (check thiopurine methyltransferase levels first to prevent leukopenia)
3. biologics (anti-TNFa)

Question 13

stroke mx

Question 13

seizure mx (acute)

Answer 13

Stage 1
- If there is IV access: IV lorazepam 4mg or IV diazepam 10m g
- If no IV access: PR diazepam 10mg or IM midazolam 10mg

Stage 2 (5 min later, seizure not aborted)
- Repeat Stage 1 medications

Stage 3 (seizure still not aborted)
- call anesthesia => rapid sequence intubation => induce coma (IV phenobarbital or IV propofol infusion or IV sodium valproate)

Question 14

seizure mx (long term)

Answer 14

focal
- carbomezapine
- phenytoin

both (safe for pregnancy)
- levertiracetam (keppra)
- lamotrigine

generalised
- sodium valproate (give folate in preg)

sodium valproate - hepatotoxicity, pancreatitis
the rest - SJS
carbamezapine - check HLAB 1502, can also cause angranulocytosis

Question 15

breast CA

Answer 15

hormone receptors - 5 years
1. SERM - tamoxifen (increase risk of endometrial CA => yearly TVUS)
2. Aromatase inhibitor - anastrozole (peripheral estrogen pdtn, only in menopausal women; do yearly BMD, HLD checks)

HER-2 receptor inhibitor - 1 year
1. Herceptin - trastuzumab (IV 3/52) (cardiomyopathy, pulmonary toxicity, neutropenic fever, HS reactions)

Question 16

thalssemia mx

Answer 16

minor
- folic acid supplements when needed e.g. during pregnancy or illness

major
- PCT transfusion (lifelong or PRN)
- start iron chelating agents when ferritin > 1000 ng/mL or after 10-20 transfusion (SC deferoxamine / oral deferiprone)