Give examples of H2 receptor antagonists
What are the side effects of Ergometrine?
- Nausea and vomiting
- Arrhythmias including bradycardia
What are the contra-indications of Oxytocin?
- Hypertonic uterine contractions
- Severe pre-eclampsia toxaemia
- Severe cardiovascular disease
What are the Glycopeptide antibiotics used for?
Gram +ve bacteria (β-lactam resistant):
- Clostridium difficile
- Prophylaxis before prosthetic implants - heart valves
Name examples of the 3rd generation of cephalosporins
How does Metronidazole work?
It damages the DNA through reactive intermediates, therefore inhibiting DNA synthesis
How do the Macrolides work?
The bind to the 50S subunit of bacterial ribosomes and inhibit translocation
How do the Oxazolidinones work?
They bind to bacterial ribosomes and prevent the formation of 70S ribosome complex
Which compartment do colloids tend to stay in?
The intravascular space
What are the long acting β2 agonists (LABA) used in the treatment of COPD?
Give examples of gastric stimulants.
How does Trimethoprim work?
It inhibits the dihydrofolate reductase enzyme
How do NSAIDs cause GIT mucosal damage?
- They inhibit the prostaglandins
- They directly irritate the gastric and duodenal mucosa
What are the indications for giving paracetamol?
- Mild to moderate pain
What are the 2nd generation of cephalosporins used for?
Against certain Gram -ve such as Haemophilus influenzae
How do the statins work?
- They inhibit the HMG CoA-reductase, which is involved in the synthesis of cholesterol
- This leads to a decrease in the levels of LDL cholesterol
What is the antidote for an iron overdose?
What is the antidote for an opiate overdose?
What are the contra-indications of Aspirin use?
- Active peptic ulcer
- Bleeding disorders
What medications can Sucralfate interact with?
What is Metronidazole used for?
- Bacterial vaginosis
- Intra-abdominal infections/ abscesses
- Abscesses of brain, liver, oral cavity
- Aspiration pneumonia
- Clostridium difficile colitis
- Prophylaxis in GI surgery
What are the side effects of Rifampicin?
- Orange body secretions - stains contact lenses
- Altered liver function
What are the side effects of the penicillins?
- Cholestatic jaundice - Flucloxacillin
How do antacids work?
They neutralise the acid produced by the stomach
How do the glycopeptide antibiotics work?
The inhibit the release of the building block unit of the cell wall from the cell membrane
This prevents the addition of new units to the peptidoglycan cell wall
Give examples of the Aminoglycosides
What bacteria are the Marcolides useful against?
- Staphylococci spp
- Streptococci spp
- Haemophilus influenzae
- Legionella pneumophila
What is the treatment of aspiration pneumonia?
What are colloids made up of?
They are solutions of partially dissolved large molecular weight chemicals (>30, 000kDa) and dissolved low molecular weight chemicals such as electrolytes in water
How does Rifampicin work?
It inhibits RNA polymerase preventing transcription of mRNA
Give examples of proton pump inhibitors (PPIs)
What is the treatment of atypical pneumonia?
What are the side effects of Codeine?
What are the side effects of Tamsulosin?
- GI disturbances
- Erectile dysfunction
Which tissues do the Tetracyclines concentrate in?
Those undergoing calcification
What Dihydropyridine calcium channel blockers are used in the treatment of angina?
How does Sucralfate work?
It protects damaged mucosa.It stimulates local production of bicarbonates
What groups of are classified as beta-lactams?
When is Metformin contra-indicated?
- Lactic acidosis
What are the MI-5 drugs?
- ACE-inhibitor (Ramipril)
- β-blocker (Bisoprolol)
- Statin (Simvastatin or Atorvastatin)
Name examples of the 2nd generation of cephalosporins
What are the adverse effects possible with cephalosporins?
If a patient has a hypersensitive reaction to penicillins there is a 10% they will be allergic to cephalosporins
What are the side effects of Trimethoprim?
- Folate deficiency
- Rarely causes haematopoiesis depression
What bacteria are the Aminoglycosides used against?
- Only work on aerobes
- Pseudomonas and other Gram -ve bacilli
When should Misoprostol not be given?
- In pregnant women
- Women of child bearing age
What are the side effects of the Oxazolidinones?
- Haematopoietic disorders
- Cheese reaction - It is a MAOI
- Optic neuropathy
What are the 3 things found in Oral Rehydration Solution (ORS)?
- Sodium chloride
When are PPIs indicated for use?
- Treatment of GU and DUs
- Prevention and treatment of NSAID induced ulceration
- H. pylori erdatication
- Severe GORD
- Zollinger-Ellison syndrome
- Stress ulceration
Give some examples of alginates.
- Sodium alginate
What is the antidote for cyanide poisoning?
- 100% O2
- Skin decontamination
- Dicobalt edetate (Kelocyanor)
- Nitrites (Amyl nitrite) / Sodium thiosulphate
What is Carboprost used for?
Severe post-partum haemorrhage due to uterine atony in patients unresponsive to Ergometrine and Oxytocin
What is the mechanism of action of Ramipril?
- It inhibits angiotensin converting enzyme (ACE) stopping the conversion of angiotensin I to angiotensin II
- This prevents vasoconstriction and release of aldosterone
How do Domperidone and Metoclopramide work?
They increase peristalsis in the jejunum and duodenum, thought to be through activation of muscarinic receptors in the GIT
What is the method of action of Aspirin?
- Irreversibly inhibits COX-1 and COX-2
- This inhibits thromboxane A2 production
- Leads to inhibition of platelet aggregation
What can occur if Macrolides are given IV?
Can cause phlebitis
What are the side-effects of Tetracyclines?
- Irritation of gastric mucosa
- Growth stunting due to incorporation into growing bones
What are the side effects of Vancomycin?
- Red man syndrome if given too quickly
- Phlebitis if not diluted enough
- Ototoxicity in the elderly
What are the side effects of the H2 receptor antagonists?
Name examples of the 1st generation of cephalosporins
What does activation of the β2 receptor on bronchial smooth muscle cause?
What are the side effects of Misoprostol?
- Abdominal pain
When would Losartan be given?
If a patient had an intolerance to ACE inhibitors due to the dry cough or other side effects
Which of the penicillin antibiotics are penicillinase resistant, including those used in combination with other drugs?
- Amoxicillin if given with clavulanic acid - Co-amoxiclav
- Piperacillin if given with Tazobactam
How does Sulphonamide work as an antibiotic?
It inhibits the dihydrofolate synthetase enzyme needed for folate synthesis in bacteria
What beta-blockers are used for the treatment of angina?
What class of drug are Bisoprolol, Atenolol and Carvedilol?
What is the antidote for a digoxin overdose?
Digoxin specific antibodies
Give an example of a glycopeptide antibiotic.
What is Co-trimoxazole and when is it used?
It is both Trimethoprim and Sulfamethoxazole
Where it confers benefits over other treatments, such as Pneumocystis jiroveci pneumonia in AIDs and other immunocompromised people
What is the antidote for a β-blocker overdose?
What are the side effects of Aspirin?
- GI irritation
- GI haemorrhage
What are crystalloid solutions made up of?
They are solutions of dissolved low molecular weight chemicals such as glucose, or electrolytes in water
What are the 1st generation of Cephalosporins used for?
- Skin infection
- Soft tissue infections
The activation of which receptor causes bronchoconstriction?
Muscarinic receptor in bronchial smooth muscle
What are the muscarinic antagonists used in the treatment of COPD?
What are the bacteria that Tetracyclines are used against?
Gram -ve bacteria
Certain strains of MRSA
Community acquired pneumonia
What effects do non-dihydropyridines have on the heart?
- They prevent the influx of calcium in coronary artery smooth muscle, leading to vasodilatation
- They also slow conduction through the AV node - rate limiting
What is the osmolality of UK ORS, and how does this help with rehydration?
Osmolality = 240mOsm/L
This is lower than the osmolality found in the body, so water will passively move from the lumen of the intestine into the body to rehydrate
How long do the SABA last for?
4-6 hours after inhalation
What are the side effects of Quinolones?
- Reduction in seizure threshold
- Tendon damage and/or rupture
- Confusion and drowsiness
- Arthropathy - not advised in under 18's
What is Varenicline used for?
It is used as an aid to quit smoking
How are the Aminoglycosides administered?
Only by IV
What is the method of action of Clopidogrel?
It irreversibly binds to P2Y12 components of adenosine receptor on platelet surface
When is Orlistat contraindicated?
- Malabsorption disorders
- Reduced gallbladder function
- Pregnancy and breast feeding
What is the antidote for a benzodiazepine overdose?
What medical conditions should loperamide not be given with?
- Active colitis
- Infective cause of diarrhoea
- Antibiotic associated colitis
What are the contra-indications of Clopidogrel?
What drug is given to induce labour?
What are the side effects of Sucralfate?
- It can cause constipation
- Bezoar formation with enteral feeds
How is 1 L of Hartmann's solution distributed amongst intravascular and interstitial compartments?
250ml in intravascular
750ml in interstitial fluid
What is the treatment of cavitation pneumonia?
How do the Quinolones exert an antibiotic effect?
They inhibit the DNA gyrase enzyme in the bacteria preventing the supercoiling of their DNA
What are the concentrations of Sodium and glucose in UK ORS?
- Na - 60mmol/L
- Glucose - 90mmol/L
What are the side effects of Ibuprofen?
- GIT ulceration and/or bleeding
- Diarrhoea or constipation
What is loperamide used for?
- Acute diarrhoea - symptomatic treatment used with rehydration
- Chronic diarrhoea
Give examples of the Quinolones
What is the antidote for a paraquat overdose?
What tissues are Quinolones good at penetrating?
What are the side effects of PPIs?
What is the treatment of complicated pneumonia?
Cefuroxime + Clarithromycin
Augmentin + Clarithromycin
How does Tamsulosin work?
It is a α1-selective alpha blocker that causes relaxation of the smooth muscle in benign prostatic hyperplasia
How do the beta-lactam antibiotics work?
They covalently bind to penicillin-binding proteins to inhibit the final formation of cross links in the bacterial cell wall
What are the indications for H2 receptor antagonist use?
- Treatment of GUs or DUs
- GORD symptoms
- High dose in Zollinger-Ellison syndrome
What are some of the side effects of Ipratropium?
- Dry mouth
- Blurred vision
- GI disturbances
- Glaucoma in susceptible people
How does Choloramphenicol work?
It inhibits transpeptidation on the ribsome
What are the side effects of Ramipril?
- Dry cough
- Renal impairment
- Hepatic impairment
How do the Dihydropyridine calcium channel blockers exert their effect in angina?
They cause smooth muscle relaxation by inhibiting influx of Ca ions
This leads to relaxation of the coronary arteries and peripheral arteries
What is the antidote for paracetamol overdose?
What Macrolide is destroyed in the stomach, so must the tablets must be enteric coated?
What is Misoprostol used with?
NSAIDs - Arthrotec
What disease should Ramipril not be given with?
- Renal artery stenosis
- Severe aortic stenosis
How does Metformin work?
It decreases gluconeogenesis and increases peripheral utilisation of glucose
It can only work if there is endogenous insulin present
What is the effect of food on penicillins?
It delays their absorption
What are the 3rd generation of cephalosporins used for?
- Lots of Gram -ve infections
- Meningitis - Ceftriaxone
- Ceftazidime - Pseudomonas
How do the Tetracycline antibiotics work?
The bind to the 30S subunit of the bacterial ribosome, and actively compete with tRNA for the A site
This competition inhibits tRNA from binding and therefore protein synthesis
How does food interact with the absorption of the Macrolides?
It decreases the absorption of Erythromycin and Azithromycin
It increases the absorption of Clarithromycin
What are the short acting β2 agonists (SABA) used in the treatment of COPD?
How loperamide exert its effect on the GIT?
It is a GI μ opioid receptor agonist causing decreased motility of the bowel and increased anal sphincter tone
What is the treatment of uncomplicated pneumonia?
Amoxycillin + Clarithromycin or Cephalosporin
What is Rifampicin used for?
- Mycobacteria (TB) - always given with a 2nd (Isoniazid, Vancomycin)
- Nasal carriage of Neisseria meningiditis
- Staphylococci such as MRSA
What is Sucralfate used to treat?
- Gastric and duodenal ulcers
- Prophylaxis for stress ulcers
What is Tamsulosin used for?
Difficulty urinating due to benign prostatic hyperplasia
How long does the effect of LABAs last?
12 hours after inhalation
When are Oxazolidinones used?
Gram +ve bacteria:
- Other serious infections where other antibiotics have failed
What is Metformin used for?
It is mainly used for type II diabetes
When are Calcium channel blockers used for angina?
They are used as a 2nd line to beta blockers, or when beta blockers are contra-indicated
How do Aminoglycosides work?
The bind to the 30S subunit of bacterial ribosomes and cause a misreading of the codon on the mRNA
This results in a non-functional protein being produced
When is Ergometrine given in labour, and what does it do?
It is used in the 3rd stage of labour to help control post-partum haemorrhage
How does Orlistat work in the treatment of obesity?
It is an intestinal lipase inhibitor that prevents the digestion and absorption of dietary lipids
What are the side effects of the β2 agonists?
What is an example of an Oxazolidinone?
Give examples of the Tetracyclines
Give some examples of antacids.
- Sodium bicarbonate
- Magnesium & Aluminium salts (Gaviscon)
What are the side effects of Dinoprostone?
- Nausea and vomiting
- Uterine hypertonus
- Pulmonary embolus
- Low Apgar score
What bacteria are Pencillin V and Benzylpenicillin used for?
- Cocci - Neisseria
- Bacilli - Listeria monocytogenes
- Cocci - Streptococcus pneumoniae
- Spirochetes - syphilis
What are the side effects of Metoformin?
- Nausea and vomiting
- Abdominal pain
How do the H2 receptor antagonist work?
They reversibly and competitively bind to the H2 receptor which suppresses gastric acid secretion
They also inhibit gastrin and ACh mediated acid secretion
What is the antidote for a methanol overdose?
What is the first line treatment of angina?
- Glyceryl Trinitrate (GTN)
Give examples of the Macrolides
Which metal ions can interfere with the absorption of the Quinolones?
What are the side effects of the Macrolides?
- Nausea, vomiting and diarrhoea - increased gastric motility
- Liver dysfunction
- Prolong QT interval
- Statin-induced myopathy
Which of the pencillins is effective against Pseudomonas?
What is Oxytocin (Syntocinon) used for?
- To augment labour - stronger uterine contraction
- Help control post-partum haemorrhage if given with Ergometrine
How do alginates work?
They increase the viscosity of the stomach content, and may produce a "raft" to reduce symptoms of GORD
How does Varenicline work?
It is a selective nicotine partial agonist
What are the contra-indications of Ibuprofen?
- Active GU or DU
- Gastrointestinal bleeding
What happens to water in the cells when colloids are given?
It moves out of the cells into the intravascular space
What bacteria is Flucloxacillin used for?
What are the side effects of loperamide?
- Abdominal cramps
- Skin reactions - urticaria
When is Codeine given?
Mild to moderate pain
What non-dihydropyridine calcium channel blockers are used for angina?
What can be a side effect of giving 0.9% NaCl?
It can lead to hyperchloraemic metabolic acidosis, which causes hyperkalaemia and multi-system pathology
What are the indications for giving Ibuprofen?
What are the main side effects of the antacids and alginates?
- Constipation (aluminium)
- Diarrhoea (magnesium)
- Interact with other medications (antibiotics, enteric coated drugs etc).
Give examples of a statin?
What class of drug is Ibuprofen?
It is a NSAID
What are the side effects of Clopidogrel?
- GI irritation
- GI haemorrhage
What muscarinic receptors that are blocked and cause bronchodilation?
M1 and M3
What are the 3rd line treatments for angina?
- Potassium channel activators
What class of drug are Losartan, Candesartan and Valsartan?
Angiotensin II receptor blockers
How do NSAIDs work?
The inhibit the activity of both COX-1 and COX-2, thereby inhibiting the production of prostaglandins and thromboxanes
What are the side effects of Orlistat?
- Feacal incontinence
- Abdominal discomfort and pain
What are the side effects of the Aminoglycosides?
- Ototoxicity - damage to CN VIII
What are the side effects of Metronidazole?
- Metallic taste
- Extreme reaction if taken with alcohol
Which of the Macrolides has a similar spectrum to the Penicillin V?
What bacteria are the Quinolones useful against?
- E. coli
What is Trimethoprim used for?
- UTI's - treatment in high doses and prophylactic in lower doses
- Certain Gram -ve bacteria
When should dinoprostone not be given to induce labour?
- Active cardiac or pulmonary disease
- Placenta praevia
- Ruptured membranes
- Multiple pregnancies
What class of drug is Codeine?
What is the antidote for carbon monoxide poisoning?
- Removal from CO environment
- 100% O2
- Hyperbaric chamber
What are the side effects of statin?
- Altered liver function
How does Misoprostol work?
It is a prostaglandin analogue
What is the maximum length of time an Oxazolidinone should be given for?
What are the contra-indications for Ergometrine?