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Medicine Phase 2A (OWN) > Pharmacology > Flashcards

Pharmacology Flashcards

(45 cards)

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1
Q

Aspirin

A

Action: Irreversibly inhibits COX-2 causing reduced thromboxane production and therefore platelet activation
+ reduced prostaglandin production, reducing inflammation

Indications: Anti-inflammatory- fever/ pain/ headache
Anti-platelet- MI/ stroke

Contras: decrease in gastric mucin production- GI bleed/ ulceration/ H.pylori

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2
Q

Warfarin

A

Action: Vitamin K antagonist, reduces production of clotting factors, therefore reducing thrombosis
Delayed effect, bleeding risk if high so do INR

Indications: treatment for venous thrombosis and PE
Prophylaxis of embolism in AF, rheumatic HD, prosthetic valve, TIA, post DVT

Contras: bleeding risk, dietary vitamin K (pomegranate)

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3
Q

Heparin

A

Heparin/ enoxaparin/ daltteparin/ riveparin

Action: glycoaminoglycan, binds to antithrombin and increases it’s activity
Unfractioned- IV Fractioned/ LMW-SC

Indications: treatment of PE/ DVT/ unstable angina/ claudication
Thromboprophylaxis: post DVT/ post surgery/ pregnancy

Contras: bleeding/ thrombocytopoenia + hyperkalaemia

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4
Q

DOACs (direct oral anti-coagulants)
Apixaban
Rivaroxaban
Endoxaban

A

Inhibits factors 2 and 10
Benefit over warfarin as less monitoring and short dose- response time

Indications: treatment of DVT/ PE
Prophylaxis- post op, post DVT/ PE, second line in prophylaxis with AF

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5
Q

P2Y12 inhibitors

A

Clopidogrel/ tricagrelor

Inhibits ADP reception on platelets thus reducing activation

Indications: MI gold standard, dual anti-platelet therapy- Aspirin + P2Y12 inhibitor

Contras: bleeding

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6
Q

Beta blockers

A

Propanolol/ bisoprolol/ atenolol (B1 selective)

B1- vasolation
B2- bronchoconstriction
Negatively ionotropic and chronotropic

Indications: HTN, angina, arrhythmia, post MI/ stable HF (if sinus rhythm)

Contras: severe HF, bronchospasm, asthma, COPD, bradycardia, cold peripheries

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7
Q

Statins

A

Atorvostatim, simvastatin

Action: reduce cholesterol synthesis

Indications: hypercholesterolaemia, primary/ secondary prevention of CAD

Contras: toxicity to liver/ muscles

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8
Q

ACE inhibitors

A

Ramipril, enalapril

Action: Inhibit angiotensin converting enzyme at lungs, reducing affect of RAAS, causing systemic vasodilation and a drop in BP

Indications: HTN, HF, secondary to MI

Contras: hypotension, renal as reduces GFR, hyperkalaemia
Causes increased bradykinin- cough, rash, anaphylaxis

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9
Q

Angiotensin receptor blocker

A

Candesartan/ losartan/ valsartan

Action: antagonise angiotensin II receptors

Indications: when ACE-inhibitors are not tolerated (cough/ rash)
HTN

Contraindications: work poorly in afro-caribbean
Renal artery stenosis as contracts further

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10
Q

Calcium channel blockers

A

Dihydropyridines: Amlodopine, peripheral vasodilator and coronary artery vasodilator- increases BP and myocardial supply
Indicated: HTN/ angina
Contras: flushing, dizziness, hypotension, oedema

Non-DHPs: verapamil, slows conduction from SAN to AVN
Indicated: angina, HTN, supraventricular tachycardia
Contras: oedema/ bradycardia

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11
Q

Thiazides

A

Bendroflumethazide

Action: inhibits Na+ absorption at beginning of DCT so less water is absorbed
Downstream epithelial cells try to compensate by reabsorbing Na+ using Na+/K+ antiporters, may lead to hypokalaemia

Indications: oedema/ HTN/ HF

Contras: hypotension/ reduces uric acid secretion so can cause gout/ may worsen diabetes

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12
Q

Loop diuretics

A

Furosemide

Action: inhibits the N/K/Cl co-transporter in the loop of Henle thus increasing osmolarity of filtrate retaining water
Potential hypokalaemia

Indications: oedema/ secondary for HTN when resistant

Contras: hyponatraemia/ hypokalaemia

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13
Q

K sparing diuretic (aldosterone antagonists)

A

Spironolactone

Action: alsosterone stimules Na uptake and K excretion, antagonising this reduces water reabsorption and K+ excretion

Indication: oedema/ ascites/ HF/ HTN/ hyperaldosteronism

Contras: addisons (adrenal insufficiency)/ hyperkalaemia/ avoid in kidney damage

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14
Q

Nitrates

A

GTN spray (glyceryl tri-nitrates)

Action: arterio and venous dilators to reduce BP
Relax CA to increase supply to myocardium

Indications: prophylaxis of angina/ HF and unstable angina

Contras: aortic stenosis/ tamponade/ hypotension

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15
Q

Reslizumab

A

Monoclonal AB
Interferes with binding of IL-5, reducing eosinophil activity

Indication: severe eosinophilic asthma

Contra: concurrent helminth infection (treat this first)
May cause anaphylaxis

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16
Q

Beta-2 adrenergic agonists

A

Salbutamol/ salmeterol/ formeterol

Action: B adrenergic receptors relax airway smooth muscle and inhibit histamine release

Indications: asthma/ COPD/ can be SABA or LABA

Contras: tachy/ arrhythmia, hyperkalaemia/ acidosis

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17
Q

Anticholinergics

A

Atropine, ipratropium, tiotropium

Action: blocking parasympathetic receptors results in bronchodilation

Indication: asthma, COPD,

Cautions: potential glaucoma, paradoxical bronchospasm, prostatic hyperplasia

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18
Q

Inhaled corticosteroids

A

Beclometasone, budenoside

Action: Reduce oedema, inflammation and immune activation
Increases B2 receptor expression so increase effect of salbutamol

Indication: Asthma, (COPD generally unresponsive)

Cautions: Prolonged high doses can lead to adrenal insufficiency and loss of bone density
Behavioural change
Candidiasis

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19
Q

Leukotriene receptor antagonist

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A

Monteleukast

Action: leukotrienes are inflammatory mediators causing inflammation and WBC activation

Indication: asthmatic prophylaxis, treatment of allergy

Caution: thirst, abdo pain, headache

20
Q

Proton pump inhibitors

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A

Omeprazole, lanzoprazole

Action: block the H/K ATPase at parietal cells thus less H+ into the lumen

Indication: GORD/ gastric ulcer prophylaxis and treatment/ H. pylori eradication (+ amoxicillin and clarithromycin)

Cautions: Osteoporosis, may trigger SLE rash, abdo pain, headache/ nausea

21
Q

Histamine 2 receptor antagonists

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A

Ranitidine, cimetidine

Action: Block parietal cell stimulation by histamine thus reducing H+ into lumen

Indication: Gastric ulceration/ GORD

Caution: may mask gastric cancer
SE: Diarrhoea, dizziness, headache

22
Q

Steroids: prednisolone

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A

Action: mimic effects of adrenal hormones to reduce inflammation and immune response

Indication: reversible obstructive resp disease, allergy, inflammatory conditions: UC, chron’s/ autoimmune: rheymatoid/ joint infections

Cautions: related to hypoadrenalism, HTN, water retention, diabetes, osteoporosis
Try to avoid long-term therapy

23
Q

Hyoscine butylbromide (buscopan)

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A

Action: antispasmodic agent acting directly on GI tract smooth muscle

Indications: Symptomatic relief for cramps/ spasms in IBS
Used in bowel imaging to reduce spasms

Cautions: may reduce bowel movement too much
Tachycardia/ constipation/ dry mouth/ dry skin

24
Q

Loperamide

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A

Action: an opioid receptor agonist, acts at peripheral not central receptors thus different to opiate analgaesics, acts at mesenteric plexus on smooth muscle to reduce tone and activity

Indication: acute or chronic diarrhoea

Contras: UC/ Chron’s
SE: Dizziness, headach, flatulance

25
Movicol/ macrogol
Osmotic laxative (polyethylene glycol) Action: cannot be absorbed but is osmotically active, thus draws water into lumen relieving diarrhoea Indication: constipation Contras: chrons/ UC + arrhythmia Caution: may cause abdo pain, nausea and flatulence
26
NSAIDs: apirin, celecoxib, ibuprofen, naproxen, diclofenac
Inhibition of COX enzymes involved in prostaglandin production GI effects- increased acid production Less prostaglandins causes pre-glomerular constriction and therefore reduced GFR: nephrotic Indication: mild-moderate analgesia/ pyrexia/ symptom relief for inflammation Contras: gastric ulceration/ renal impairment
27
Paracetamol
Mild analgesic Indication: pyrexia, analgesic Caution: high dose is heptotoxic Give N-acetyl-cysteine in OD
28
Bisphosphonates
Alendronate, risedronate Action: reduce bone metabolism thus used in osteoporosis Have a high affinity for calcium, ingested by and cause death of osteoclasts Indications: osteoporosis- general/ post-menopausal Contra: hypocalcaemia Caution/SE: abdo distention and pain/diarrhoea or constipation/ dyspepsia
29
Chloramphenicol
Action: abx that inhibits protein synthesis, so is bacteroatatic Indications: eye and ear infections/ haemophilus influenzae/ typhoid/ meningitis/ cholera Caution: marrow suppression, diarrhoea, dry mouth, headache, nausea
30
Ciclosporin
Action: immunosuppressant, acting to suppress T cells and IL2 communication Indication: rheumatoid arthritis, UC, psoriasis, post transplant Caution: nephrotoxic, infection risk SE: abdo pain, fatigue, leukopoenia, HTN
31
Rifampicin
Action: abx stopping DNA transcription Indication: TB, serious staph, legionnaires, endocarditis + H. Influenzae Caution: liver toxic Orange/ red secretion in urine Renal damage/ adrenal insufficiency/ flu like symptoms
32
Opiates
Codeine, morphine, fentanyl, oxycodone Analgesic acting on central mu receptors Antagonist = naloxone (in OD and addiction) Indication: moderate- severe analgesia+ some sedation/ trauma/ MI/ chronic pain Cautions: addiction and dependance Respiration depression Nausea/ constipation/ hypotention/ bradycardia
33
Atracurium
Neuromuscular blockade by blocking Ach on muscle Indication: for stillness in surgery/ intubation SE:anaphylactoid, myopathy, bronchospasm, hypotension
34
B-lactams
Penicillin/ amoxicillin/ flucloxicillin Cephalosporins: more resistant to B lactamases Carbapenems: more resistant Action: inhibit cell wall production and are therefore bacterocidal More effective against gram positive Indication: gram positive infection Contras: penicillin allergy
35
Mesalazine
Action: strong anti-inflammatory Indication: achieving and maintaining remission in UC, often given PR (and given in acute attack) Less used in Chrons Caution in elderly SE: abdo pain, headache, dizziness
36
Ciclosporin
Action: Immunosuppressant, acting to suppress T cells and IL-2 communication Indication: RA, UC, psoriasis, post transplant to prevent rejection Caution: Nephrotoxic and hepatotoxic, immunosuppressant so infection risk SE: abdo pain, fatigue, leukopenia, HTN
37
Dobutamine
Beta-1 adrenergic agonist is therefore sympathomimetic Indication: Acute/ reversible HF i.e. in surgery, septic shock and congestive HF Contra: IHD, HD (as increases oxygen requirement) SE: HTN, angina, arrhythmia
38
Sulfasalazine
Action: 5 amino salicylic acid, strong anti-inflammatory with some immuno-modulatory effects Indication: RA = DMARD, UC, Chrons Contra: Renal disease, blood disorder SE: liver/ kidney toxic, marrow suppression
39
Oxybutynin
Action: anticholinergic, antagonises muscarinic Ach receptors, reducing tone and spasm at the bladder, reducing ureteric peristalsis Indication: Urge incontinence, LUTS, kidney stones Contra: BPH, UC, GI obstruction
40
Tamulosin/ Doxasozin
Action: Alpha blocker thus relaxes smooth muscle and vasodilates Indication: BPH SE: hypotension
41
Hormone replacement therapy
Oestrogen and progesterone Action: Relieves symptoms from androgen withdrawal and menopause such as hot flush, night sweats, mood swings, vaginal dryness Contra: Hx of breast/ ovarian cancer, liver disease, HTN SE: Increased breast cancer risk, increased clot risk, headache, nausea
42
Metformin
Action: reduces amount of hepatic gluconeogenesis, lowering blood sugar Indication: T2DM, polycystic ovary syndrome Contra: kidney/ liver disease SE: Diarrhoea, nausea, risk of hypoglycaemia
43
Sildenafil (viagra)
Action: Inhibits cyclic GMP specific phosphodiesterase 5 (this enzyme degrades cGMP which, when present, relaxes smooth muscle= vasodilation= erection) Indication: ED, pulmonary artery HTN SE: Headache, heartburn, flushed skin Contra: CVD
44
Lidocaine
Action: Blocks fast Na channels on neurone thus preventing axonal transmission Indication: SC, local anaesthesia, acute arrhythmia SE: Sleepiness, twitching, tingling
45
Cyclophosphamide
Action: Causes apoptosis as it's metabolite causes DNA cross-linking (only produced in cells with low aldehyde dehydrogenase so less SE) Indication: Chemo: leukaemia, myeloma, lymphoma, breast, ovarian, immunosuppression SE: Low WCC, hair loss, pulmonary fibrosis, GU bleed

Medicine Phase 2A (OWN) (10 decks)

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