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MRCOG previous questions flashcards > treatments > Flashcards

treatments Flashcards

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1
Q

How does fluconazole work

A

selectively inhibits enzyme 14a-demethylase
this disrupts ergosterol synthesis in fungal cells
which in turn weakens the cell membranes of fungi

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2
Q

how does nystatin and amphotericin B work (POLYENE antifungals)

A

bind to ergosterol and form pores causing leakage of fungal cell contents

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3
Q

give 2 examples of second generation progestins (synthetic progesterones)

A

Levonorgestrel
Norgestrel

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4
Q

give 2 examples of third generation progestins (synthetic progesterones)

A

desogestrel
etonogestrel

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5
Q

give 2 examples of first generation progestins (synthetic progesterones)

A

medroxyprogesterone
norethindrone

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6
Q

what is the most antiandrogenic progestin?
What is its brand name?

A

cyproterone acetate - Diane

(if +ethinylestradiol you get the COCP Dianette)

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7
Q

what is the progestin with the highest glucocorticoid effect

A

medroxyprogesterone (i.e. DepoProvera!!!)

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8
Q

what percentage greater risk of venous thromboembolism (VTE) does Dianette (ethylestradiol + cyproterone acetate) give compared to COC pills containing levonorgestrel?

A

Dianette carries a 50-80% greater risk of venous thromboembolism (VTE) than COC pills containing levonorgestrel
But no higher than those containing gestodene, desogestrel, or drospirenone with 30-35 micrograms of ethinylestradiol

N.B. women who have severe acne or hirsutism may have an inherently increased cardiovascular risk

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9
Q

Dianette is not indicated for use solely as an oral contraceptive. When used for acne/hirsutism, how long can you use it for?

A

should be withdrawn 3-4 cycles after the treated condition has completely resolved
if it then relapses, consider Yasmin

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10
Q

drospirenone and ethinyl estradiol = ?brand name

A

Yasmin

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11
Q

which progestin has the highest antimineralocorticoid activity?

A

drospirenone
(the one in Yasmin)

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12
Q

give 2 examples of 4th generation progestins

A

drospirenone (in Yasmin)
timegestone
nomegestrol

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13
Q

Topical oestrogen helps with urinary symptoms. Where is the oestrogen acting to have this effect?

A

(answer unsure - the thought from ‘Jan 21 corrected’ was ‘bladder trigone’ but…)
After 12 weeks of estradiol treatment, the expression of ERβ in the bladder tissue was significantly higher than that in the tolterodine group (P < 0.05). Conclusion: Topical estrogen therapy ameliorates OAB in female patients, and this may be related to improved ERβ expression in the bladder mucosa.

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14
Q

What is the treatment for gonorrhoea when pregnant

A

1g ceftriaxone IM single dose
2nd line is spectinomycin 2g IM single dose

3rd line is azithromycin 2g PO single dose and only if the isolate is known to be susceptible

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15
Q

which B vitamin is thiamine

A

B1

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16
Q

what is a medical procedure that uses electrical currents to destroy atypical or abnormal cells (e.g. cervical dysplasia)

A

Fulguration

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17
Q

how does botox work to treat overactive bladder on the molecular level

A

inhibits the release of ACh in motor neurons at the NT junction

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18
Q

what is the treatment for syphilis

A

benzathine penicillin (in NZ at least!)

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19
Q

why should you consider admitting someone for syphilis treatment at 20/40 or more

A

Jarisch-Herxheimer reaction (40% of patients in first 24h of treatment) can trigger labour

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20
Q

mnemonic for generations of progestins

A

I was flying my DRONE
But it LEVitated out of sight
I am DESOlate
I had one drone, now I have NONE

1= norethinDRONE
2 = LEVonorgestrel (or norgestrel)
3 = DESOgestrel
4 = DrosperiNONE

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21
Q

what is cabergoline derived from?
and bromocriptine

A

ergot!
(so is ergometrine, obviously)

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22
Q

biggest association with fetal warfarin (according to the provided answer)

A

nasal hypoplasia

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23
Q

due to first-pass metabolism by CYP450, oral morphine is approximately ____ as potent as IM morphine
Also, the peak plasma level of morphine occurs ___ minutes after oral and ___ minutes after parenteral

A

half as potent orally
peak levels 30-90 mins post-oral dose
but 15-20 mins post-parenteral

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24
Q

what opioids are appropriate to give a postnatal mother

A

dihydrocodeine or tramadol (with caution). Or morphine in hospital.

N.B. ‘regular use of any opioid beyond 3 days should be under close medical supervision’.
All breastfeeding mothers should be informed of potential problems and advised to stop breastfeeding if opioid adverse effects develop and to seek medical advice.
This is regardless of ethnicity, although ultrarapid metabolisers of codeine are more prevalent e.g. in the Ethiopian community.

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25
when should prophylactic LMWH stop before regional anaesthesia
12 hours (24h for treatment dose)
26
when to stop aspirin in pregnancy
36 weeks
27
structure of heparin
Polysaccharide: Glycosaminoglycans (GAGs) or mucopolysaccharides are long, linear polysaccharides
28
Why ramifentanyl used in patient controlled analgesia?
Short acting easily metabolized by serum esterase
29
how to reduce local thermal tissue damage in monopolar diathermy (cutting)
Pulsed waves can reduce local thermal tissue damage.
30
what is DMPA A.K.A?
medroxyprogesterone acetate (i.e. the depot)
31
what to pick if asked about depot side effect
irregular bleeding
32
aspirin MOA
irreversible inactivation of the cyclooxygenase (COX) enzyme. Cyclooxygenase is required for prostaglandin and thromboxane synthesis
33
clindamycin mode of action
Bacterial protein synthesis inhibitor, by binding to the rRNA of the bacterial 50S ribosome subunit **although it is a -mycin, it is NOT a macrolide. It is a lincosamide (but there is some overlap in activity**
34
Raltegravir MOA
an integrase inhibitor (antiretroviral)
35
shelf life of whole blood
21 - 35 days (3 - 5 weeks)
36
what is sacrospinous fixation? what is it used to treat?
Sacrospinous fixation is a surgical procedure designed to treat pelvic organ prolapse, specifically to support the vaginal vault or uterus. The operation involves placing stitches through the vagina to attach the vaginal vault to the sacrospinous ligament, a strong ligament in the pelvis.
37
Levonorgestrel IUS secretion in 24 hrs
20 micrograms / 24h
38
IV oxytocin half life and time to steady state concentration with infusion
3 minutes half life 40 minutes to steady state
39
why isn't oxytocin given orally?
While it was originally assumed that Oxytocin administered orally would be destroyed in the gastrointestinal tract, studies have shown that Oxytocin is transported by the immunoglobulin RAGE (receptor for advanced glycation end products) across the intestinal epithelium and into the blood. Orally-administered Oxytocin has been shown to increase putamen responses to facial emotions in humans.[53] Oxytocin administered orally produces different effects on human behaviour and brain function than when given intranasally, possibly due to variations in the molecular transport and binding mechanisms.
40
t with cervical ca What Rx for radiotherapy
brachytherapy
41
Remifentanil is an ideal controlled analgesia for management of labour pain because
It is rapidly metabolized by tissue esterases (according to the answer I was given). It has short onset and offset so it's good in labour :)
42
Name Desogestrel-only POP brand names
Cerazette Aizea Cerelle Nacrez
43
doxylamine is...
antihistamine medication used to treat morning sickness in pregnant women
44
why does suxamethonium not cross the placenta
high ionisation (according to answers given)
45
hydralazine MOA
smooth muscle relaxant
46
Quinolones are CI'd in pregnancy. What is the concern that they will cause in the foetus? How do they work?
musculoskeletal malformations DNA gyrase inhibitor
47
Sulphonamides are CI'd in pregnancy. What is the concern that they will cause in the foetus?
KERNICTERUS! thought to displace bilirubin from its albumin-binding sites in plasma leading to an elevation of plasma bilirubin, which crosses the blood-brain barrier cleft palate and other bony abnormalities
48
what drug competitively inhibits the action of acetylcholine (ACh) at the muscarinic cholinergic receptors.
Atropine (e.g. to treat bradycardia)
49
How do they work? Sulphonamides
Sulphonamides -competitive inhibitors of dihydropteroate synthetase, disrupting folate synthesis in bacteria, which is essential for DNA and RNA production
50
CI to using oxybutynin
narrow angle glaucoma
51
paroxetine teratogenicity
heart defect
52
letrozole MOA
aromatase inhibitor
53
TXA MOA
antifibrinolytic 'plasminogen-activator inhibitor' Tranexamic acid is a synthetic analog of the amino acid lysine.
54
azathioprine MOA
It works via 6-thioguanine to disrupt the making of RNA and DNA by cells.
55
BASHH recommendations for treating chlamydia in pregnancy
Azithromycin 1g orally as a single dose, FOLLOWED BY 500mg once daily for two days or Erythromycin 500mg four times daily for seven days or Erythromycin 500mg twice daily for 14 days or Amoxicillin 500mg three times a day for seven days
56
non-ergot dopamine agonist
quinagolide
57
metronidazole MOA
It is a prodrug that inhibits nucleic acid synthesis by forming nitroso radicals, which disrupt the DNA of microbial cells
58
mnemonic for bugs which Cephalosporins don't work against - those bugs are LAME
Listera Atypicals (Mycoplasma, Chlamydia) MRSA Enterococci
59
labetalol mechanism of action
alpha 1 blocker beta 1 and 2 blocker
60
Raltegravir MOA
inhibits HIV-1 integrase
61
Terbinafine (and amorolfine) act by...
inhibiting squalene epoxidase. Squalene epoxidase is an enzyme that catalyses the conversion of squalene to lanosterol, a precursor for Ergosterol (a vital component in fungal cell walls).
62
How many times more potent than morphine is fentanyl?
Fentanyl is approximately 80 to 100 times more potent than morphine
63
which one is penicillin G?
benzaTHINE

MRCOG previous questions flashcards (24 decks)

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