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Drugs Flashcards

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1
Q

Name four common indications for tetracyclines.

A

Acne vulgaris, lower respiratory tract infections, chlamydial infections (including PID), typhoid/anthrax/malaria/Lyme disease.

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2
Q

How do tetracyclines work?

A

They inhibit bacterial protein synthesis.

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3
Q

Are tetracyclines bactericidal or bacteriostatic?

A

Bacteriostatic (they stop bacterial growth).

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4
Q

What are the common adverse effects of tetracyclines?

A

Nausea, vomiting, diarrhoea, hypersensitivity reactions (~1%), oesophageal irritation, photosensitivity, tooth discoloration/hypoplasia, and rare intracranial hypertension.

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5
Q

Why are tetracyclines low risk for Clostridium difficile infection?

A

They have a lower impact on gut flora compared to broad-spectrum antibiotics.

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6
Q

Why should tetracyclines not be given during pregnancy or to children under 12?

A

They bind to developing teeth and bones, causing permanent staining and enamel hypoplasia.

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7
Q

Why should tetracyclines be avoided in people with renal impairment?

A

They can raise plasma urea and increase the risk of toxicity due to reduced excretion.

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8
Q

What important interactions do tetracyclines have?

A

They bind divalent cations (calcium, antacids, iron), reducing absorption; they also enhance the anticoagulant effect of warfarin.

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9
Q

How should tetracyclines be taken to avoid oesophageal irritation?

A

Swallow whole with plenty of water while sitting or standing upright.

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10
Q

What is a practical tip for reducing nausea and vomiting with tetracyclines?

A

Take them with food (but not with dairy products).

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11
Q

Why shouldn’t tetracyclines be taken with dairy products?

A

Calcium binds to tetracyclines and prevents their absorption.

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12
Q

What is an example of tetracycline dosing for respiratory infection?

A

Doxycycline 100 mg orally daily for 5–7 days.

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13
Q

Name four common indications for metronidazole.

A

Antibiotic-associated colitis (C. difficile),oral infections/aspiration pneumonia (Gram-negative anaerobes), surgical and gynaecological infections (e.g., Bacteroides fragilis), protozoal infections (trichomoniasis, amoebiasis, giardiasis).

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14
Q

How does metronidazole kill bacteria?

A

Nitroimidazole antimicrobial metronidazole - stops bacteria growth by disrupting DNAs helical structure causing stands to break preventing DNA replication.

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15
Q

What are common adverse effects of metronidazole?

A

Gastrointestinal upset (nausea, vomiting), hypersensitivity reactions, and at high doses/prolonged use: neurological effects (peripheral/optic neuropathy, seizures, encephalopathy).

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16
Q

What serious neurological side effects can prolonged metronidazole use cause?

A

Peripheral neuropathy, optic neuropathy, seizures, and encephalopathy.

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17
Q

What warning should be given about alcohol while taking metronidazole?

A

Alcohol can cause a disulfiram-like reaction (flushing, nausea, vomiting, headache); avoid alcohol during and for 48 hours after treatment.

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18
Q

How should metronidazole dosing be adjusted in liver disease?

A

Reduce the dose in severe liver disease because metronidazole is metabolized by the liver.

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19
Q

Is metronidazole an inducer or inhibitor of CYP450?

A

Inhibitor.

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20
Q

What important drug interactions does metronidazole have?

A

Increases warfarin and phenytoin toxicity; plasma levels are reduced by cytochrome P450 inducers (e.g., rifampicin); increases lithium toxicity.

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21
Q

How is oral metronidazole usually prescribed for gastrointestinal infections?

A

400 mg orally every 8 hours.

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22
Q

What monitoring is needed if metronidazole treatment exceeds 10 days?

A

Full blood count and liver function tests.

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23
Q

Should metronidazole be routinely added when prescribing co-amoxiclav?

A

No; co-amoxiclav already provides good anaerobic cover unless advised otherwise by local guidelines or microbiology.

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24
Q

What is the main use of mebendazole?

A

Treatment of intestinal helminth infections like threadworm (Enterobius vermicularis), whipworm, roundworm, and hookworm.

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25
What drug class is mebendazole?
Mebendazole is in a class of medications called anthelmintics
26
What are common side effects of mebendazole?
Abdominal pain, diarrhoea, and flatulence; rarely, rash and hypersensitivity reactions.
27
Why should mebendazole be avoided in pregnancy?
Potential risk of teratogenicity; safety has not been clearly established, especially in the first trimester.
28
How is mebendazole typically dosed for threadworm infection?
100 mg orally as a single dose, with a second dose repeated after 2 weeks if reinfection is suspected.
29
What advice should be given to families when treating threadworm infections?
Treat all household members simultaneously and maintain strict hygiene measures to prevent reinfection.
30
What important drug interactions does mebendazole have?
Metabolism may be increased by strong cytochrome P450 inducers (e.g., carbamazepine, phenytoin), reducing efficacy.
31
Name common nasal corticosteroids.
Mometasone, fluticasone, budesonide, beclometasone.
32
What are nasal corticosteroids used to treat?
Rhinitis, sinusitis, and upper airway cough syndrome (e.g., post-nasal drip).
33
How do nasal corticosteroids work?
They reduce inflammation in the nasal passages by suppressing the immune response.
34
What are common side effects of nasal corticosteroids?
Nasal dryness, irritation, sore throat, nosebleeds (epistaxis), headache.
35
How should nasal corticosteroids be administered?
With the head slightly tilted forward, directing the spray away from the nasal septum.
36
What contraindications are associated with intranasal corticosteroids?
Do not prescribe intranasal corticosteroids to people: With untreated fungal, bacterial, or viral nasal infections. After recent nasal surgery, or trauma, unless on specialist advice.
37
What are common indications for macrolide use?
Respiratory and skin/soft tissue infections (if penicillin allergy), severe pneumonia (added to penicillin for atypicals), and Helicobacter pylori eradication (with a PPI and amoxicillin/metronidazole).
38
What is the mechanism of action of macrolides?
They inhibit bacterial protein synthesis.
39
What are common gastrointestinal side effects of macrolides?
Nausea, vomiting, abdominal pain, and diarrhoea.
40
What are serious side effects of macrolides?
Cholestatic jaundice, QT prolongation, ototoxicity (at high doses), and antibiotic-associated colitis.
41
Why should macrolides be avoided in patients with hepatic impairment?
Because they are mainly eliminated via the liver.
42
Which macrolides inhibit cytochrome P450 enzymes?
Erythromycin and clarithromycin.
43
What are significant drug interactions with macrolides?
Increased risk of bleeding with warfarin and myopathy with statins; caution with QT-prolonging drugs (e.g., amiodarone, SSRIs).
44
What is the mechanism of action of penicillins?
They inhibit bacterial cell wall synthesis.
45
What are common adverse effects of penicillins?
Rash, anaphylaxis, GI upset, and CNS toxicity at high doses or with renal impairment.
46
What drug interaction should you be cautious of with penicillins?
They reduce renal excretion of methotrexate, increasing toxicity.
47
Why can't benzylpenicillin be taken orally?
It is inactivated by gastric acid.
48
How often must benzylpenicillin be dosed due to its short half-life?
Every 4–6 hours.
49
Why is tazobactam combined with piperacillin?
To inhibit β-lactamase and extend antibacterial spectrum.
50
What electrolyte consideration is important with Tazocin?
Each dose contains about 10 mmol of sodium.
51
What is a rare but serious side effect of co-amoxiclav?
Cholestatic jaundice.
52
What adjustment is needed in renal impairment?
Dose reduction.
53
Name antibiotics at high risk of C.diff.
Those most commonly implicated in C. difficile infection are clindamycin, cephalosporins (in particular second‑ and third‑generation cephalosporins), quinolones, co‑amoxiclav and aminopenicillins (for example, ampicillin and amoxicillin, which may be related to their volume of use rather than being 'high risk').
54
What is the mechanism of action of atovaquone-proguanil?
Atovaquone inhibits mitochondrial electron transport in the parasite, and proguanil acts as a dihydrofolate reductase inhibitor, both impairing the parasite’s ability to produce energy and replicate.
55
What are common side effects of atovaquone-proguanil?
Side effects may include abdominal pain, nausea, vomiting, diarrhoea, and headache. It should be used cautiously in those with liver or renal impairments.
56
How does chloroquine treat malaria?
Chloroquine works by interfering with the malaria parasite's ability to metabolize hemoglobin, which disrupts its ability to detoxify heme, leading to the parasite's death.
57
What are common side effects of chloroquine?
Common side effects include pruritus, headache, dizziness, and visual disturbances (including retinopathy with prolonged use).
58
What is the role of permethrin in malaria prevention?
Permethrin is used as an insect repellent for malaria prevention, particularly on bed nets, clothing, and other textiles, as it kills or repels mosquitoes that transmit malaria.
59
What are the common indications for benzodiazepines?
First-line management of seizures and status epilepticus. First-line management of alcohol withdrawal reactions. Sedation for interventional procedures when general anesthesia is unnecessary. Short-term treatment of severe, disabling, or distressing anxiety. Short-term treatment of severe, disabling, or distressing insomnia.
60
How do benzodiazepines work at the GABAA receptor?
Benzodiazepines bind to the GABAA receptor, which is a chloride channel. They enhance GABA binding, increasing chloride influx into cells, making them more resistant to depolarization. This leads to a widespread depressant effect on synaptic transmission, causing sedation, reduced anxiety, and anticonvulsive effects.
61
What are the important adverse effects of benzodiazepines?
Dose-dependent drowsiness, sedation, and coma. Loss of airway reflexes, which can lead to airway obstruction and death in overdose. Dependence with long-term use, leading to withdrawal reactions upon cessation. The elderly are more sensitive to these effects and may require lower doses.
62
What are some key warnings when using benzodiazepines?
Elderly patients are more susceptible to benzodiazepine effects and should receive lower doses. Avoid in patients with significant respiratory impairment or neuromuscular diseases (e.g., myasthenia gravis). Avoid in liver failure as they may precipitate hepatic encephalopathy; if use is essential, lorazepam is preferred because it is less dependent on liver metabolism.
63
What are important drug interactions with benzodiazepines?
The sedative effects of benzodiazepines are additive with other sedating drugs, including alcohol and opioids. Benzodiazepines are metabolized by cytochrome P450 enzymes, so concurrent use with P450 inhibitors (e.g., amiodarone, diltiazem, fluconazole, macrolides, protease inhibitors) may increase benzodiazepine effects.
64
What is the preferred benzodiazepine for the management of seizures?
Lorazepam (4 mg IV) or diazepam (10 mg IV) are preferred for seizures and status epilepticus, with diazepam also available in a rectal solution for rapid absorption in seizure emergencies.
65
What benzodiazepine is commonly used in alcohol withdrawal?
Chlordiazepoxide (long-acting) is the traditional choice for alcohol withdrawal, although diazepam can be equally effective. Dosing is adjusted based on the patient’s symptoms and alcohol intake.
66
What is the best choice of benzodiazepine for sedation in interventional procedures?
Midazolam is the best choice for sedation in interventional procedures, as it is short-acting, allowing rapid recovery after the procedure.
67
What is the preferred duration and dosing for benzodiazepines in treating anxiety and insomnia?
For anxiety and insomnia, intermediate-acting drugs, such as temazepam (10 mg orally at bedtime), are generally preferred for short-term use, typically not exceeding 4 weeks.
68
What is the role of flumazenil in benzodiazepine overdose?
Flumazenil is a benzodiazepine antagonist, but its use in overdose is rarely indicated. It should not be used in mixed overdoses because it can precipitate seizures, especially in patients with chronic benzodiazepine use or polydrug toxicity.
69
What are the common side effects of Nicotine Replacement Therapy (NRT)?
Common side effects include local irritation (from patches, lozenges, nasal spray), gastrointestinal upset (with oral nicotine), and palpitations or abnormal dreams.
70
What are the key precautions when using Nicotine Replacement Therapy (NRT)?
NRT should be used with caution in patients who are haemodynamically unstable (e.g., after myocardial infarction) and in those with hepatic or renal impairment.
71
What is the mechanism of action of varenicline in smoking cessation?
Varenicline is a partial agonist at nicotinic receptors. It reduces withdrawal symptoms and the rewarding effects of smoking by preventing nicotine from binding to these receptors.
72
What are the common adverse effects of varenicline?
Common side effects include nausea, headache, insomnia, and abnormal dreams. Rarely, varenicline may lead to suicidal ideation. What is a key precaution when prescribing varenicline? Varenicline should be used with caution in patients with psychiatric conditions due to the potential risk of suicidal ideation.
73
How is varenicline typically administered for smoking cessation?
Varenicline treatment should start 1–2 weeks before the target quit date. It is titrated from a low starting dose to the optimal dose over the first week, continuing for 9–12 weeks.
74
What is the mechanism of action of bupropion in smoking cessation?
Bupropion increases levels of norepinephrine and dopamine by inhibiting their reuptake, which helps reduce cravings and withdrawal symptoms during smoking cessation.
75
What are common side effects of bupropion (type of antidepressant but only licensed for smoking cessation)?
Common side effects of bupropion include dry mouth, gastrointestinal upset, headache, dizziness, impaired concentration, and psychiatric effects such as insomnia, depression, and agitation.
76
What are the key precautions when prescribing bupropion for smoking cessation?
Bupropion should be used with caution in people at risk of seizures, those with psychiatric conditions, and in patients with hepatic or renal impairment. It should also be avoided in people with a history of alcohol abuse or head injury.
77
What drug interactions are important to consider with bupropion?
Bupropion is metabolized by cytochrome P450 enzymes. Its plasma levels can be increased by P450 inhibitors (e.g., valproate) and decreased by inducers (e.g., phenytoin, carbamazepine). It should not be used with monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs).
78
How does methadone work in the treatment of opioid dependence?
Methadone is a long-acting opioid agonist that binds to the same receptors as other opioids (e.g., heroin) but with a slower onset and longer duration. This helps to prevent withdrawal symptoms and cravings without producing a "high."
79
What are the common adverse effects of methadone?
Common side effects include drowsiness, constipation, nausea, sweating, and respiratory depression. Long-term use can lead to physical dependence and potential overdose if not dosed correctly.
80
How does buprenorphine work in opioid dependence treatment?
Buprenorphine is a partial opioid agonist that binds to opioid receptors, providing enough activation to relieve withdrawal symptoms and cravings without producing a significant "high." It has a ceiling effect, reducing the risk of overdose compared to full agonists like methadone.
81
What is the difference between methadone and buprenorphine in terms of overdose risk?
Methadone has a higher risk of overdose due to its long-acting nature and lack of a ceiling effect, while buprenorphine has a ceiling effect that reduces the risk of respiratory depression and overdose.
82
What is the primary clinical use of thiamine?
Thiamine is primarily used in the treatment and prevention of thiamine deficiency, which can lead to conditions such as beriberi and Wernicke-Korsakoff syndrome, particularly in patients with chronic alcohol use or malnutrition.
83
What are the clinical considerations when prescribing thiamine to alcohol-dependent patients?
In alcohol-dependent patients, thiamine should be administered before glucose administration to prevent precipitating Wernicke's encephalopathy, as glucose administration without thiamine can worsen symptoms.
84
What is the primary use of acamprosate in clinical practice?
Acamprosate is primarily used in the management of alcohol dependence to help maintain abstinence in individuals who are recovering from alcohol addiction.
85
How is acamprosate administered?
Acamprosate is administered orally in the form of tablets. The usual dosing regimen is 666 mg three times daily (a total of 2 grams per day). It should be taken with food to improve absorption.
86
What are the contraindications for acamprosate use?
Acamprosate is contraindicated in patients with severe renal impairment (creatinine clearance less than 30 mL/min) as it is excreted unchanged by the kidneys. It should also be used with caution in patients with a history of severe depression.
87
What is the primary use of naloxone in clinical practice?
Naloxone is primarily used as an opioid antagonist for the emergency reversal of opioid overdose, including respiratory depression, sedation, and hypotension caused by opioid toxicity.
88
How is naloxone administered in emergency situations?
Naloxone can be administered intravenously (IV), intramuscularly (IM), or subcutaneously (SC). It is often available as an intranasal spray for easier use by non-medical personnel (e.g., family members or bystanders during an opioid overdose).
89
What is the duration of action of naloxone and its implications in overdose situations?
The duration of action of naloxone is typically around 30-90 minutes, which may be shorter than the duration of action of some opioids (e.g., heroin or fentanyl). Therefore, patients may need further doses or monitoring, as opioid effects may reemerge after naloxone wears off.
90
What is the primary use of naltrexone in clinical practice?
Naltrexone is primarily used in the management of opioid dependence and alcohol dependence. It works to help prevent relapse by reducing cravings and the rewarding effects of alcohol and opioids.

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