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mrcog part 1 > Revision notes 10: Pharmacology > Flashcards

Revision notes 10: Pharmacology Flashcards

(72 cards)

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1
Q

3 drugs that don’t cross placenta

A

Heparin
Insulin
Tubocurarine

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2
Q

Drugs that cause abortion

A

MET

Misoprostol
Ergotamine
Thrombolytic

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3
Q

Domperidone moa

A

dopamine antagonist

stimulates milk production

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4
Q

Drugs interfering with folate metabolism

A

Sulfonamide - inhibits conversion of benzoic acid to folate

Dihydrofolate reductase inhibitors

Trimethoprim
Methotrexate
Pyrimethamine

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5
Q

Aciclovir is an analogue of

A

guanine

it inhibits viral dna polymerase

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6
Q

Promethazine is an antagonist of what

A

H1 histamine antagonist

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7
Q

Ranitidine is an antagonist of what

A

H2 receptor antagonist

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8
Q

When are glucocorticoids given for fetal lung maturity

A

24h to 7 days before pre-term delivery

Up to 34+6 gestation
35+6 if SGA

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9
Q

finasteride mechanism of action

A

5a reductase inhibitor

prevents conversion of testosterone to dihydrotestosterone

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10
Q

Mifepristone

A

Binds to progesterone receptor but transcription inhibited

I.E anti-progestogenic

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11
Q

Mifepristone abortion rate on its own

A

60-80% effective

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12
Q

Contraindications to misoprostol

A 
Suspected ectopic pregnancy
Chronic adrenel insufficiency
Long-term corticosteroid therapy
Haemorrhagic disorders
Anti-coagulant therapy
Smokers over the age of 35 (avoid smoking / alcohol 2 days before and on the day of prostaglandin administration)
Hepatic / renal impairement
Avoid aspirin / NSAIDS for at least 8-12 days after mifepristone.
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13
Q

Ulipristal acetate (30 mg)

Contraceptive use?

A

Up to 5 days after intercourse

Selective progesterone receptor modulator

Once per cycle. If continuing with hormonal contraception, should use condoms until next period or withdrawal bleed

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14
Q

Absolute contraindications to COCP

A 
Smoker >15/day over 35 yrs old
<6 weeks post-partum
hypertension 160/100
History of VTE
IHD
CVA
Valvular heart disease
Migraine with focal neuro 
Current breast cancer
Diabetes with retinopathy
Cirrhosis
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15
Q

Clomiphene - when used

A

Non-steroidal antioestrogen with weak oestrogenic effects

Days 2-6 of cycle for ovulation induction

Used mainly in PCOS

Causes increase in GnRH, FSH, LH

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16
Q

Tamoxifen oestrogenic effects

A

Anti-oestrogen in breast

Anti-oestrogen on pre-menopausal uterus

Oestrogenic effects on post-menopausal uterus (inc risk endometrial carcinoma/hyperplasia

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17
Q

Bromocriptine & cabergoline & quinagolide

A

Dopamine agonists
Used to inhibit pituitary prolactin

Quinagolide - non-ergot pituitary selective dopamine-2 receptor agonist used when bromo dont work

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18
Q

PGE2 otherwise known as

A

Dinoprostone

Induction of labour

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19
Q

aspirin moa

A

IRREVERSIBLE inactivation of COX enzyme required for prostaglandin + thromboxane synthesis

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20
Q

furosemide site of action

A

ascending loop of henle

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21
Q

Aromatase inhibitors - two types

A

Irreversible - exemestane

Non-steroidal inhibitors - reversible
- Anastrozole, letrozole

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22
Q

Labetolol mechanism

A

Selective competitive alpha 1 adrenergic blocker
non-selective competitive beta adrenergic blocker
dose-related fall in BP without reflex tachy and without significant reduction in heart rate

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23
Q

Hydralazine moa

A

Vascular smooth muscle relaxation, decreased PVR
Causes reflex tachy + inc cardiac output

Can cause a syndrome similar to Lupus

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24
Q

idarucizumab is antidote for what

A

Dabigatran

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25
Alkylating agent moa
Form covalent bonds with DNA side chains, causing depurination, strand breaks and cross-linking.
26
This drug decomposes within cells to form phosphoramine mustard and acrolein
Cyclophosphamide
27
Paclitaxel mechanism
Binds to micro-tubules to disrupt mitosis
28
First line treatment choriocarcinoma
methotrexate
29
methotrexate mechanism
inhibits dihydrofolate reductase
30
azathioprine is converted to which active forms
6-mercaptopurine | 6-thioinosinic acid
31
This chemo drug binds to tubulin preventing polymerisation and disrupting mitosis
Vincristine/vinblastine
32
warfarin works by
inhibiting vit k epoxide reductase (recycles oxidised vitk to its reduced form
33
warfarin metabolism
hepatic microsomal mixed function oxidases
34
Why is aspirin contraindicated in neonates and children
risk of rye syndrome
35
MFO inducers
``` Carbamazepine Ethanol Groseofulvin Phenobarbitone Phenytoin Rifampicin ``` They INCREASE metabolism of glucocorticoids, contraceptives, theophylline, warfarin - need higher dose
36
Inhibitors of hepatic enzymes
1) Phenelzine 2) Cimetidine 3) Isoniazide 4) Sodium valproate 5) Sulphonamides 6) Erythromycin 7) Theophylline
37
safest ssri during pregnancy
fluoxetine
38
SSRI taken after 20 weeks - risk of
persistent pulmonary hypertension
39
when does the neural tube close?
day 28
40
clozapine risk to fetus
agranulocytosis
41
folic acid dose if on valproate
5mg/day
42
lithium risks to fetus
increase risk of fetal heart defects: 60-1000 from 8-1000 Inc risk Ebstein's anomaly - 1 in 20,000 to 10 in 20,000
43
Lamotrigine in breast feeding women - significance
avoid can cause Stevens-Johnson syndrome in the infant
44
methotrexate - toxicity increased by:
antifolates e.g. trimethoprim, pyimethamine sulphonamides penicillin probenecid
45
Suxamethonium is a
nicotinic agonist
46
tubocurarine, pancuronium, atracurium are examples of
competitive nicotinic antagonists
47
Examples of muscarinic antagonists
``` Atropine Hyoscine Ipratropium bromide Imipramine Quinidine ``` All competitive antagonists
48
examples of competitive cholinesterase inhibitors
neostigmine | Physostigmine
49
Doxazosin mechanism of action
alpha-adrenergic antagonist that inhibits a1 receptors Anti-hypertensive High affinity for alpha-1c adrenoceptor --> used in BPH
50
benzo antagonist
flumazenil
51
Anti-cholinergics for detrusor overactivity
oxybutynin, tolterodine
52
mirabegron mechanism
b3-receptor agonist Detrusor relaxation Treat OAB
53
First-line tocolytic if contraindicated?
Nifedipine - calcium channel antagonist Atosiban if contra (competitive oxytocin receptor antagonist)
54
maximum contraction rate when using oxytocin for induction of labour
no more than 4-5 every 10 minutes
55
Treatment of uterine hyperstimulation
terbutaline
56
what is carboprost
PGF2a analogue (synthetic prostaglandin)
57
what is misoprostol
synthetic prostaglandin E1 analogue
58
misoprostol important side effects
Severe diarrhoea requiring withdrawal associated with magnesium containing antacids
59
medical treatment of stress urinary incontinence
duloxetine
60
Why is nitrofurantoin avoided at term
risk of neonatal haemolysis
61
plasma half life of oxytocin
1-6 minutes
62
Following IV admin of oxytocin, effects subside within
1 hour
63
embryopathic effect of warfarin occurs when
6-9 weeks
64
firstline suppression of lactation
cabergoline
65
properties of acidic drugs
higher oral bioavailability poorer hepatic clearance higher protein binding smaller volumes of distribution
66
anti-epileptic that increases risk of pcos
valproate
67
uti drug in late pregnancy
trimethoprim
68
indomethacin mechanism of action
cycloxygenase inhibitor
69
molecular structure of heparin
polysaccharide
70
main adrenergic receptor mediating detrusor relaxation
beta 3
71
adrenergic receptors present in urinary bladder
beta 1, beta 2, beta 3
72
Drug class that increases haematological toxicity of methotrexate
corticosteroids

mrcog part 1 (14 decks)

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