mechanisms

Question 1

mechanism of denosumab

Answer 1

monoclonal antibody which inhibits RANKL receptors, which, when activated, inhibits the maturation of osteoclasts

acts as a competetive inhibitor which prevents activation of osteoclasts from resorbing bone

Question 2

what is denosumab used to treat

Answer 2

osteoporosis - second line

tumours or other diseases which result in bone loss

Question 3

side effects of denosumab

Answer 3

fever
chills
muscle and joint pains
dysuria
skin conditions - dermatitis, eczema
couhging and SoB
UTIs
hypocalcaemia
osteonecrosis of jaw or fractures

Question 4

administration of denosumab

Answer 4

injection under skin every 6 months by HCP

subcutaneous

Question 5

contraindications of denosumab

Answer 5

not given orally, IV, IM, or intradermally
not given to pregnant women
correct pre-existing hypocalcaemia before administrating denosumab
not given with immunosuppressants

Question 6

mechanism of methotrextate

Answer 6

inhibits the enzyme dihydrofolate reductase
essential for the synthesis of purines and pyrimides

Question 7

mechanism of leflunomide

Answer 7

inhibits the enzyme dihydroorotate dehydrogenase
stops pyrimidine synthesis
pyrimidine important component of RNA and DNA

Question 8

mechanism of sulfasalazine

Answer 8

not completely known
thought to be suppression of IL1 and TNF alpha

Question 9

mechanism of hydroxychloroquine

Answer 9

induces apoptosis of inflammatory cells
decreases chemotaxis
targets TNF alpha
interferes with toll like receptors, disrupting antien presentation and increasing pH of lysosomes

Question 10

mechanism of adalimumab

Answer 10

inhibits TNF alpha and inhibits its reaction with p55 and p75 cell surface receptors

Question 11

mechanism of rituximab

Answer 11

acts against CD20 protein on B-cell surface, triggering cell death
it is an IgG

Question 12

side effects of methotrexate

Answer 12

pulmonary fibrosis
mouth ulcers and mucositis
liver toxicity
bone marrow suppression
leukopenia
harmful to pregnancy
atrial fibrilation when paired with etanercept (anti TNF biologic)

Question 13

side effects of leflunomide

Answer 13

mouth ulcers and mucositis
liver toxicity
bone marrow suppression
leukopenia
rashes
peripheral neuropathy
harmful to pregnancy

Question 14

side effects of sulfasalazine

Answer 14

temporary male infertility - reduced sperm count
bone marrow suppression

Question 15

side effects of hydroxychloroquine

Answer 15

nightmares
reduces visual activity
liver toxicity
skin pigmentation

Question 16

side effects of Anti TNF drugs

Answer 16

vulnerable to severe infections and sepsis
reactivation of TB and Hep B

Question 17

side effects of rituximab

Answer 17

vulnerable to severe infections and sepsis
night sweats
thrombocytopenia
peripheral neuropathy
liver and lung toxicity

Question 18

mechanism of colchicine

Answer 18

not fully established
likely to be inhibition of tubulins
- antimitotic, stops metaphase
stops production of IL-1

Question 19

mechanism of allopurinol

Answer 19

xanthine oxidase inhibitor
- stops conversion of xanthine to uric acid (de novo synthesis)

Question 20

mechanism of febuxostat

Answer 20

non-purine xanthine oxidase inhibitor

Question 21

mechanism of prednisolone and dexamethasone (glucocorticoids)

Answer 21

inhibits neutrophil apoptosis
inhibit phospholipase A2
promotes IL-10

Question 22

mechanism of ibuprofen

Answer 22

non selective COX inhibitor
- COX 1 inhibition causes GI problems(?)

Question 23

mechanism of aspirin

Answer 23

non selective COX inhibitor

Question 24

mechanism of naproxen

Answer 24

non selective COX inhibitor

Question 25

mechanism of diclofenac

Answer 25

non selective COX inhibitor

Question 26

mechanism of aciclovir (herpes, chickenpox, shingles)

Answer 26

nucleoside analog that inhibits action of viral DNA polymerase and DNA replication of different herpesviruses

Question 27

mechanism of alendronic acid

Answer 27

binds to bone hydroxyapetite bone resorption releases alendronic acid which is taken into osteoclasts by endocytosis causes apoptosis of osteoclasts

Question 28

mechanism of amitryptiline (tricyclic antidepressant)

Answer 28

suggested inhibits membrane pump mechanism responsible for re-uptake of transmitter amines (norepinephrine and serotonin)

Question 29

mechanism of amlodipine

Answer 29

dihydropyridine calcium antagonist causes influx of calcium ions to smooth and cardiac muscle

Question 30

mechanism of amoxicillin (gram +ve - strep)

Answer 30

inhibits penicillin binding protein-1 leading to upregulation of autolytic enzymes and inhibition of cell wall synthesis

Question 31

mechanism of buprenorphine

Answer 31

partial agonist against Mu-receptor antagonist at kappa receptor

Question 32

mechanism of carbimazole (hyperthyroidism)

Answer 32

decreases uptake of iodine by thyroid reduces formation of di-iodotyrosine and thyroxine prevents coupling of peroxidase and iodinating the tyrosine residues on thyroglobulin - stop production of T3 and T4 thyroid hormones

Question 33

mechanism of codeine

Answer 33

selective agonist for Mu-receptor

Question 34

mechanism of doxycycline (tetracyclines)

Answer 34

inhibits bacterial protein synthesis by allosterically binding to 30S (ribosomes)

Question 35

mechanism of flucloxacillin (gram positive except for staph A)

Answer 35

inhibits 3rd and last stage of bacterial cell wall synthesis by binding to penicillin binding proteins

Question 36

mechanism of furosemide (diuretic)

Answer 36

blocks tubular resorption of sodium and chloride through competitive inhibition of NKCC2 decreases excretion of uric acid

Question 37

mechanism of gabapentin

Answer 37

unclear inhibits calcium ion channels?

Question 38

mechanism of methadone

Answer 38

full agonist against u-receptors, k-recetpros, and o-receptors strong inhibition of seritonin and norepinephrine uptake - likely contributes to anti-nociceptive pain

Question 39

mechanism of morphine

Answer 39

agonist of mu and kappa receptors

Question 40

mechanism of naloxone

Answer 40

opioid receptor antaognist competitive inhibitor of u-receptor

Question 41

mechanism of omeprazole (eradication of h-pylori!)

Answer 41

proton pump inhibitor inhibits ATPase

Question 42

mechanism of pregabalin

Answer 42

suggested binding to voltage gated calcium channels anticonvulsant

Question 43

mechanism of tramadol

Answer 43

agonist for u-receptor