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Pharmacology Flashcards

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1
Q

Azathioprine

A

Class: anti-proliferative agent.
MOA: inhibits purine synthesis —> inhibiting DNA and RNA replication.
Indication: transplant immunosuppression, RA, IBD.
Side effects/contraindications: bone marrow suppression.

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2
Q

Cyclophosphamide

A

Class: anti-proliferative agent/bifunctional alkylating agent.
MOA: DNA cross linking —> inhibiting protein synthesis.
Indication: immune based renal disease, chemotherapy, autoimmune and CT disorders.
Side effects/contraindications: bone marrow suppression.

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3
Q

Ciclosporin

A

Class: calcineurin inhibitor.
MOA: inhibit pro-inflammatory cytokine synthesis, such as IL-2 —> suppressing T cell activation and differentiation.
Indication: transplant immunosuppression.
Side effects: everything is increased - fluid, BP, K+, hair, gums, glucose. Nephrotoxicity and hepatotoxicity.

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4
Q

Tacrolimus

A

Class: calcineurin inhibitor.
MOA: inhibit pro-inflammatory cytokine synthesis, such as IL-2 —> suppressing T cell activation and differentiation.
Indication: transplant immunosuppression.
Side effects/contraindications: increased risk of infection.

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5
Q

Trimethoprim

A

Class: antibiotic.
MOA: inhibits folate synthesis —> inhibiting nucleic acid synthesis.
Indication: UTI.
Side effects/contraindications: GI upset and skin rash. Avoid in first trimester and folate deficiency.

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6
Q

Nitrofurantoin

A

Class: antibiotic.
MOA: active metabolite damages bacterial DNA causing cell death.
Indication: UTI.
Side effects/contraindications: GI upset and hypersensitivity reactions. Avoid in pregnancy, babies < 3 months old and renal impairment.

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7
Q

Co-amoxiclav

A

Class: penicillins.
MOA: inhibit bacterial cell wall synthesis.
Indication: pyelonephritis.
Side effects/contraindications: D+V.

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8
Q

Ciprofloxacin

A

Class: fluoroquinolone.
MOA: inhibits DNA gyrase —> inhibiting DNA replication.
Indication: pyelonephritis.

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9
Q

Gentamicin

A

Class: aminoglycoside.
MOA: inhibits 30S ribosomal subunit —> inhibiting protein synthesis.
Indication: serious gram -ve infections e.g. pyelonephritis, sepsis and meningitis.
Side effects/contraindications: Ototoxicity and nephrotoxicity. Avoid in myasthenia gravis.

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10
Q

Cefalexin

A

Class: cephalosporins.
MOA: bind penicillin binding proteins —> inhibiting bacterial cell wall synthesis.
Indication: pyelonephritis.
Side effects/contraindications: GI upset. Use cautiously in people at risk of C.diff infection.

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11
Q

Ramipril, lisinopril, perindopril

A

Class: angiotensin-converting enzyme inhibitor (ACEi).
MOA: preventing the conversion of angiotensin 1 to angiotensin 2, this inhibits vasoconstriction and suppresses aldosterone secretion.
Indication: reduce proteinuria in glomerulonephritis and CKD. Anti-hypertensive, HF, IHD.
Side effects/contraindications: first dose hypotension, persistent dry cough and hyperkalaemia. Avoid in patients with renal artery stenosis and AKI, also in pregnancy.

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12
Q

Losartan, candesartan, irbesartan

A

Class: angiotensin receptor blockers (ARBs).
MOA: block action of angiotensin 2 on the angiotensin type 1 receptor, inhibiting vasoconstriction and suppressing aldosterone secretion.
Indication: reduce proteinuria in glomerulonephritis and CKD. Anti-hypertensive, HF, IHD.
Side effects/contraindications: first dose hypotension, hyperkalaemia and renal failure. Avoid in patients with renal artery stenosis and AKI, as well as pregnancy.

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13
Q

Furosemide, bumetanide

A

Class: loop diuretic.
MOA: inhibits Na+/K+/2Cl- cotransporter on TAL —> decreasing Na+ and water reabsorption.
Indication: pulmonary oedema, fluid overload (HF, renal disease or liver failure).
Side effects/contraindications: dehydration and hypotension. Avoid in patients with dehydration and hypovolaemia.

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14
Q

Oxybutinin, tolterodine

A

Class: anti-muscarinic.
MOA: inhibits binding of ACh to M3 receptor —> stimulating bladder relaxation.
Indication: overactive bladder and urge incontinence.
Side effects/contraindications: dry mouth, tachycardia, constipation, blurred vision, urinary retention. Avoid in UTIs.

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15
Q

Mirabegron

A

Class: beta 3 adrenergic agonist.
MOA: activates beta 3 receptors relaxing detrusor smooth muscle.
Indication: overactive bladder and urge incontinence.
Side effects/contraindications: avoid in uncontrolled hypertension.

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16
Q

Doxazosin, tamsulosin, alfuzosin

A

Class: alpha blocker (alpha 1 adrenoceptor antagonist).
MOA: inhibit alpha 1 receptors —> SM relaxation in prostate —> reduced resistance to bladder outflow. Also causes vasodilation causing BP to fall.
Indication: BPH (1st line). Add-on in resistant hypertension.
Side effects/contraindications: postural hypotension, dizziness and syncope.

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17
Q

Dutasteride, finasteride

A

Class: 5 alpha reductase inhibitors.
MOA: inhibit 5 alpha reductase —> inhibiting conversion of testosterone to DHT —> reduces prostatic enlargement. Takes several months to work.
Indication: BPH (2nd line).
Side effects/contraindications: impotence, reduced libido, gynaecomastia. Pregnant women shouldn’t handle these drugs.

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18
Q

Sildenafil, tadalafil

A

Class: phosphodiesterase type 5 inhibitors.
MOA: inhibits PDE-5 —> prevention of cGMP breakdown, increasing its concentrations —> SM relaxation and vasodilation —> penile blood flow and erection (sexual stimulation required).
Indication: erectile dysfunction.
Side effects/contraindications: flushing, headaches, dizziness, nasal congestion. Serious = hypotension, tachycardia, palpitations, priapism.

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19
Q

Alprostadil

A

Class: synthetic prostaglandin E1 analogue.
MOA: induces vascular SM relaxation —> erection.
Indication: erectile dysfunction.

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20
Q

Cisplatin

A

Class: platinum based chemotherapy.
MOA: alkylating agent —> cross-linking —> DNA damage.
Indication: bladder cancer, metastatic testicular cancer and metastatic ovarian cancer.

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21
Q

Insulin aspart (rapid-acting), insulin glargine (long-acting), biphasic insulin (mixture of rapid- and intermediate-acting), soluble insulin (short-acting)

A

Class: insulin formulations.
MOA: stimulates glucose uptake into skeletal muscle and fat, stimulates glycogenesis and lipogenesis, inhibits gluconeogensis and ketogenesis. Drives K+ into cells.
Indication: insulin replacement for T1D, control of blood glucose in T2D, diabetic emergencies e.g. DKA and HHS, alongside glucose in hyperkalaemia.
Side effects/contraindications: hypoglycaemia, lipohypertrophy.

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22
Q

Gliclazide, glimepiride

A

Class: sulfonylurea.
MOA: stimulates pancreatic insulin secretion via blocking K+ channels in beta cell causing depolarisation and opening of voltage gated Ca2+ channels.
Indication: T2D.
Side effects/contraindications: GI upset, hypoglycaemia, weight gain.

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23
Q

Repaglinide

A

Class: meglitinides.
MOA: stimulates insulin secretion.
Indication: T2D.
Side effects/contraindications: GI upset, hypoglycaemia.

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24
Q

Metformin

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A

Class: biguanide.
MOA: reduces hepatic glucose output (glycogenolysis and gluconeogensis) and increases peripheral utilisation of glucose via activation of AMP kinase.
Indication: T2D.
Side effects/contraindications: GI upset, lactic acidosis, weight loss. Avoid in acute metabolic acidosis, AKI and use cautiously with renal impairment.

25
Pioglitazone
Class: thiazolidinedione. MOA: reduces peripheral insulin resistance, increasing glucose utilisation. Indication: T2D. Side effects/contraindications: weight gain, pins & needles, respiratory tract infections.
26
Linagliptin, sitagliptin, saxagliptin
Class: DPP-4 inhibitor. MOA: inhibit incretin degradation —> promote insulin secretion and inhibit glucagon release. Glucose dependent (decrease risk of hypoglycaemia). Indication: T2D. Side effects/contraindications: GI upset, acute pancreatitis. Avoid in pregnancy.
27
Acarbose
Class: alpha-glucosidase inhibitors. MOA: delays digestion and absorption of starch and sucrose. Indication: T2D. Side effects/contraindications: GI upset.
28
Canagliflozin, empagliflozin
Class: SGLT2 inhibitors. MOA: inhibits SGLT2 in PCT, reducing glucose reabsorption and increasing glucose urinary excretion. Indication: T2D. Side effects/contraindications: glucose urine, UTIs, weight loss.
29
Liraglutide, dulaglutide, semaglutide
Class: GLP-1 mimetic. MOA: increases insulin secretion, inhibits glucagon secretion and slows gastric emptying. Indication: T2D and obesity. Side effects/contraindications: GI upset, weight loss.
30
Glucagon
MOA: raises blood glucose via stimulating glycogenolysis and stimulates gluconeogensis. Indication: diabetic hypoglycaemia. Side effects/contraindications: nausea. Avoid in phaeochromocytoma.
31
IV glucose
MOA: increases blood glucose levels. Indication: hypoglycaemia, OGTT.
32
Carbimazole
Class: thionamides. MOA: decreases uptake of inorganic iodine by the thyroid, reducing formation of thyroid hormones. Indication: hyperthyroidism. Side effects/contraindications: avoid in severe blood disorders.
33
Propylthiouracil
Class: thionamides. MOA: inhibits thyroid peroxidase, inhibiting the formation of thyroid hormones. Indication: hyperthyroidism.
34
Radioiodine (I-131)
MOA: destruction of thyroid tissue. Indication: hyperthyroidism and thyroid cancer.
35
Levothyroxine
Class: synthetic T4. MOA: converted into T3 in target tissues, regulating growth and metabolism. Indication: hypothyroidism. Side effects/contraindications: GI disturbance, cardiac and neurological manifestations. Interacts with antacids, calcium/iron salts - should be taken 4 hours apart.
36
Hydrocortisone, prednisolone, dexamethasone
Class: glucocorticoids. MOA: bone glucocorticoid receptors —> translocate to nucleus and bind glucocorticoid-response elements —> gene expression. Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes. Also increase gluconeogensis and have mineralocorticoid effects. Indication: allergic/inflammatory conditions, autoimmune diseases, cancers, adrenal insufficiency and hypopituitarism. Side effects/contraindications: immunosuppression, risk of developing diabetes and osteoporosis, proximal muscle weakness, skin thinning, mood and behaviour changes. Prolonged treatment - suppression of ACTH —> adrenal atrophy. Suddenly withdrawn —> addisonian crisis.
37
Fludrocortisone
Class: mineralocorticoid. MOA: increases Na+ and water reabsorption and K+ excretion. Increasing BP. Indication: neuropathic postural hypotension, adrenal insufficiency (primary). Side effects/contraindications: hypertension, hypokalaemia and oedema.
38
Somatropin
Class: synthetic human growth hormone. MOA: stimulates linear bone growth, increases bone mass, increasing muscle mass. Indication: Turner syndrome, GH deficiency. Side effects/contraindications: carpal tunnel syndrome, headache, oedema, joint disorders.
39
Tetracosactide
Class: synthetic ACTH. MOA: stimulates synthesis of adrenal steroids from cholesterol (in normal patients). Doesn’t increase cortisol in patients with adrenocortical insufficiency. Indication: diagnosis of adrenocortical insufficiency.
40
Cabergoline, quinagolide
Class: dopamine D2 agonists MOA: stimulates dopamine receptors, inhibiting release of prolactin. Indication: suppress lactation, hyperprolactinaemic disorders.
41
Sustanon (IM), testogel (transdermal)
Class: testosterone. MOA: testosterone-receptor complex transported to nucleus where it bind transcription factors —> gene expression —> male sex organs and secondary sexual characteristics. Indication: androgen deficiency, hypogonadism. Side effects/contraindications: avoid in breast cancer in men and prostate cancer.
42
Alendronic acid, residronate, zoledronic acid, pamidronate
Class: bisphosphonates. MOA: inhibit osteoclasts —> reducing bone resorption —> improved bone mass. Indication: osteoporotic fragility fractures (alendronic acid), Paget’s disease, severe hypercalcaemia of malignancy (pamidronate and zoledronic acid), myeloma and breast cancer with bone metastases (pamidronate and zoledronic acid). Side effects/contraindications: oesophagitis and hypophosphataemia (common), osteonecrosis of jaw (rare but serious), atypical femoral fracture. Avoid in severe renal impairment and hypocalcaemia.
43
Alfacalcidol, calcitriol, ergocalciferol
Class: vitamin D compounds. MOA: active form of vitamin D —> increases calcium absorption, decreases renal excretion of calcium. Indication: severe renal impairment (bone disease), hypocalcaemia due to hypoparathyroidism, osteoporosis, vitamin D deficiency (rickets and osteomalacia). Side effects/contraindications: avoid in hypercalcaemia.
44
Calcichew (oral), calcium gluconate (IV), calcium chloride (IV)
Class: calcium salts. MOA: oral calcium supplements bind phosphate in the gut. In hyperkalaemia , calcium raises myocardial threshold potential, reducing excitability and risk of arrhythmias. Indication: dietary deficiency (calcichew), prevention/treatment of osteoporosis, CKD (renal bone disease), hypocalcaemia, severe hyperkalaemia (calcium gluconate/chloride). Side effects/contraindications: oral calcium - dyspepsia, constipation. Avoid in hypercalcaemia.
45
Desmopressin, terlipressin
Class: vasopressin (ADH) analogues. MOA: insertion of aquaporins —> water reabsorption. Indication: cranial diabetes insipidus (desmopressin), oesophageal bleeding (terlipressin), bleeding reduction in mild/moderate haemophilia (desmopressin), primary nocturnal enuresis. Side effects/contraindications: avoid with diuretics, cardiac insufficiency and Hx of hyponatraemia.
46
Tolvaptan
Class: selective vasopressin receptor 2 antagonist. MOA: prevention of water reabsorption —> increase in urine volume —> decrease in urine osmolality. Indication: hyponatraemia secondary to SIADH, autosomal dominant polycystic kidney disease. Side effects/contraindications: avoid in anuria, hypernatraemia.
47
Paracetamol, co-codamol
Class: analgesic and antipyretic (weak anti-inflammatory). Co-codamol (paracetamol + codeine). MOA: weak inhibitor of COX-2 —> inhibits prostaglandin synthesis. Also causes peripheral vasodilation due to effect on hypothalamus. Indication: analgesia and palliative care. Acute and chronic pain (mild-moderate). Fever. Side effects/contraindications: overdose —> liver failure.
48
Ibuprofen, naproxen, etoricoxib (selective COX-2 inhibitor)
Class: NSAIDs. MOA: inhibits COX —> inhibits prostaglandin synthesis. COX-1 (constitutive form) involved in integrity of gastric mucosa, dilates afferent glomerular arterioles and inhibits thrombus formation. COX-2 (inducible form) involved pain and inflammation. Indication: acute, chronic and neuropathic pain (mild-moderate). Pain related to inflammation. Side effects/contraindications: GI toxicity (gastric ulcer), renal impairment and increased risk of CV events. Avoid in severe renal impairment, HF, liver failure, peptic ulcer disease, GI bleeding.
49
Codeine phosphate, morphine sulfate, diamorphine, tramadol
Class: opioids. MOA: activation of mu opioid receptors in the CNS —> reduce neuronal excitability and pain transmission. Reduce sympathetic NS activity. Indication: acute and chronic moderate-severe pain. End of life care. Side effects/contraindications: respiratory depression, neurological depression, N+V, pupillary constriction, constipation, itching, tolerance & dependence. Avoid in respiratory failure (except in palliative care) and biliary colic. Codeine should never be given IV (severe reaction). Avoid tramadol in epilepsy (lowers seizure threshold).
50
Amitriptyline, duloxetine, gabapentin, carbamazepine, capsaicin
Class: non-opioid non-NSAID analgesics. Indication: chronic and neuropathic pain.
51
Cyclizine, hyoscine, metoclopramide, prochlorperazine, ondansetron, aprepitant, nabilone
Class: antiemetics. MOA: cyclizine (antihistamine), hyoscine (antimuscarinic), metoclopramide (dopamine receptor antagonist), prochlorperazine (dopamine receptor antagonist), ondansetron (5-HT3 receptor antagonist), aprepitant (neurokinin 1 receptor antagonist), nabilone (cannabinoid). Indication: motion sickness, postoperative vomiting, drug-induced vomiting, cytotoxic drug-induced vomiting, pregnancy-induced vomiting.
52
Doxorubicin
Class: cytotoxic anthracycline. MOA: inhibits topoisomerase 2, preventing religation and DNA replication. Indication: cancer chemotherapy e.g. acute leukaemia, lymphoma, bladder cancer, Kaposi’s sarcoma. Side effects/contraindications: hair loss, anaemia, bone marrow suppression etc.
53
Methotrexate
Class: antimetabolite. MOA: inhibits dihydrofolate reductase, which prevents DNA/RNA synthesis and cellular replication. Also has anti-inflammatory and immunosuppressive effects via inhibition of inflammatory mediators. Indication: RA, cancer chemotherapy e.g. leukaemia, lymphoma, some solid tumours, psoriasis. Side effects/contraindications: mucosal damage and bone marrow suppression. Hepatic cirrhosis or pulmonary fibrosis (long term use). Avoid in pregnancy (teratogenic), severe renal impairment (renally excreted) and abnormal liver function.
54
Tamoxifen, anastrazole
Class: anti-oestrogens. MOA: oestrogen receptor antagonist (tamoxifen). Inhibits aromatase enzyme (anastrazole). Indication: breast cancer.
55
Ferrous sulfate, ferrous fumarate
Class: oral iron supplement. MOA: iron is best absorbed in ferrous state (Fe2+) in duodenum and jejunum. Once absorbed iron is bound by transferrin, which transports it to be used in bone marrow for erythropoiesis, or stored as ferritin. Indication: iron deficiency anaemia. Side effects/contraindications: GI upset (nausea, epigastric pain, constipation, diarrhoea), black stools.
56
Iron sucrose (IV)
Class: parenteral iron preparations. Indication: iron deficiency anaemia. Side effects/contraindications: risk of anaphylaxis in susceptible individuals.
57
Hydroxocobalamin
Class: vitamin B12 injection. Indication: megaloblastic anaemia, subacute combined degeneration of the cord. Side effects/contraindications: in patients with co-existing vitamin B12 deficiency and folate deficiency, replace both vitamins simultaneously to prevent subacute combined degeneration of the cord.
58
Folic acid
Class: folic acid (synthetic vitamin B9/folate). MOA: folic acid reduces the risk of neural tube defects via facilitating cell proliferation. Indication: megaloblastic anaemia and first trimester of pregnancy.
59
Darbepoetin
Class: recombinant erythropoietin. MOA: stimulates erythropoiesis and rbc production. Indication: renal anaemia. Side effects/contraindications: embolism and thrombosis, headaches. Avoid in uncontrolled hypertension, patients who are unable to receive thromboprophylaxis.

Metabolic (6 decks)

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