Year 2 Pharm Flashcards
(89 cards)
1
Q
Salbutamol
A
SABA
B-2 agonist
tachycardia (β-1), muscle tremor (β-2), development of reliance/tolerance, mask inflammation/no effect on remodelling
2
Q
Fluticasone
A
ICS
Modifies gene transcription to increase anti-inflammatory proteins
SE: oral candida
3
Q
Salmeterol
A
LABA
Only for prophylaxis and in combination with ICS.
SE: masks symptoms of inflammation -> increased mortality
4
Q
montelukast
A
Cysteinyl leukotriene receptor antagonist
Aspirin and exercise induced asthma
5
Q
Omalizumab
A
IgE antibodies for severe allergic asthma
6
Q
Ipratropium
A
SAMA (short acting muscarinic antagonist) for COPD (SAMA/SABA -> LAMA/LABA -> ICS) Tiotropium (LAMA)
7
Q
Asthma treatment?
A
SABA Add ICS (low dose) Add LABA (low dose) ONLY IN CONJUNCTION WITH ICS Increase ICS/LABA dose \+- montelukast
8
Q
Ranitidine
A
H2 receptor antagonist for GORD
9
Q
Esomepraze
A
Irreversibly inactivates H+/K+ ATPase pump in caniculi of parietal cell. most effective peptic ulcer drug
10
Q
Sucralfate
A
adheres to surface of ulcers
11
Q
Misoprostol
A
PGE-1 analogue
Increases secretion of mucus in the stomach
used in NSAID using patients with high risk of ulcers
CONTRA- pregnancy (contractions)
12
Q
Treatment of H. pylori
A
Triple therapy (first line): PPI (esomeprazole) + amoxicillin + clarithromycin Quadruple therapy: Esomeprazole + bismuth (disrupt cell wall) + metronidazole + tetracycline
13
Q
Metamucil
A
bulk laxative
14
Q
Lactulose
A
osmotic laxative
can cause dehydration long term
15
Q
Docusate sodium (coloxyl)
A
faecal softener (reduces surface tension of water)
16
Q
Senna
A
Stimulant purgatives
stimulates secretion by mucosa
SE- use dependance
17
Q
Metoclopramide
A
Anti-emetic
D2 receptor antagonists in the CTZ
also enhance gastric emptying, increase colon motility
SE: Poor crossing of BBB, however can cause parkinsonian effects, dystonia
Used in migraine management
18
Q
Loperamide
A
Opioid for diarrhoea
doesn’t cross BBB, selective for GIT
19
Q
Hyoscine
A
anti-emetic, anti-muscarinic
competitively antagonise M3 receptors at the CTZ
used in ‘crampy’ abdo pain (alcohol withdrawal)
20
Q
Promethazine
A
Antihistamines - H1 receptor antagonists
motion/morning sickness. crosses BBB - sedative effects
21
Q
Ondansetron
A
Central and peripheral 5HT3 blockade - CTZ main site of action. also antagonises 5HT3 in the GIT
good for chemo nausea. Now first line for post-op nausea
22
Q
Amoebiasisinfection treatment
A
Paramomycin (related to gentamicin)-asymptomatic
Metronidazole - symptomatic (also for giardiasis)
23
Q
Helminth infection treatment
A
Albendazole- Benzimidazoles(paralyses worm) (also treats cestodes/tapeworms
Pyrantel and Ivermectin inhibit worn energy production
24
Q
Iodine
A
high doses inhibit thyroid in hyperthyroidism
25
Carbimazole
inhibit iodination of tyrosine on thyroglobulin → reduced T3/4 synthesis
use Propylthiouracil in pregnancy
26
radio active iodine
destroys thyroid
27
thyroxine
T4 for hypothyroidism
| SE- hyperthyroid, risk of osteoporosis
28
Glucagon
increases blood glucose
| used for hypoglycaemia (insulin OD of T1-DM)
29
Insulin
Decreases blood glucose for T1-DM or late stage T2-DM or hyperglycaemic emergency
30
Metformin
Insulin sensitiser
1st line unless renal impairment (stop 48hr before contrast)
SE: May cause weight loss, lactic acidosis, metallic taste in mouth
31
Glicazide
Sulfonylurea
Second line
Increases insulin secretion in pancreatic cells by depolarising them
SE- hypo, weight gain
32
Acarbose
Carbohydrate digestion inhibitors. not used often due to SE
| SE- flatulence, bloating
33
Exenatide
Incretin mimetics
Incretins are insulin secretagogues
(glial monster)
34
(Sita)gliptin
Incretin enhancer
| Prevents the degradation of incretin, increasing levels of insulin
35
Cyclosporin
Calcineurin inhibitor - Immunosuppressant
Calcineurin causes transcription of IL-2 in T cells.
Indic - prophylactic transplant rejection, RA, skin conditions
Use in conjunction with steroids to avoid SE (nepro/hepatotoxicity, HNT, hyperlipidaemia, gum hypertrophy)
36
Sirolimus
m-TOR inhibitor - immunosuppressant
Inhibits signal transduction of IL-2 in T cells
Indic- prophylactic transplant rejection, coronary stent coating
SE- lung toxicity, thrombocytopenia, ↑TAG, ↑glycemia
37
Mycophenolate
Anti-metabolite drug - immunosuppressant
inhibits purine synthesis of B and T cells
Indic- prophylactic transplant rejection, RA
SE- leukopenia, lymphomas
38
Infliximab
MAB against TNF-Alpha
Prevents binding of TNF on inflammatory cells, no cytokines produced
Same indic as other immunsuppressants
39
Thalidomide/IFNs
Immunostimulants
increased T cell cytokines
Enhanced macrophage phagocytic activity, increased T cell proliferation
40
Clopidogrel
Anti-platelet
| Blocks ADP receptor on platelet irreversibly
41
Abixcimab
Anti-platelet
| Blocks glycoprotein IIb/IIIa, preventing fibrinogen binding to platelets
42
Heparin
Anti-coagulant
Binds to antithrombin III and facilities it in inhibiting clotting
Unfractionated heparin (IV): Intrinsic pathway affecting F2, 7, 9, 10, 11, 12. Protamine to reverse
LMWH (IM) - Safer no need for monitoring. Selective for F10. Used as a bridge for warfarin. Irreversible
43
Warfarin
Anti-coagulant
Vit-K antagonist, Vit K is a cofactor in lots of the factor
SE: bleeding, nose bleeds, dark urine/faeces
Contra: alcoholism, pregnancy
Needs dose monitoring, INR ( international normalised ratio)
44
Dabigatran
Anti-coagulant
| Direct thrombin inhibitor
45
Alteplase
Fibrinolytic drugs - plasminogen activators
Indic: MI, PE, stroke
SE: GIT bleeding, stroke
46
Levadopa//Carbidopa/Entacapone
Parkingsons
Dopa is dopamine precursor, given as DA doesn't cross BBB.
SE- nausea, dyskinesia, joint stiffness, hypotension, psychotic symptoms
Carbidopa to inhibit peripheral conversion to DA
Entacapone to inhibit COMT
47
Bromocriptine
```
Dopamine agonist (pramipexole similar actions)
Used when Levadopa looses effect/intolerable
SE- hypotention, nausea/vomiting (enhanced peripheral effects, less dyskinesia), problems with impulse control?, fibrosis
```
48
Selegiline
MAO-B inhibitor (treatment of parkingson's)
no restrictions, alone or in combination
minor SE- insomnia, headache
49
Benzotropine (atropine??)
Muscarinic antagonist
Elevates early parkingson symptoms since DA usually inhibits cholinergic neurons
SE- anti SLUDGE
50
Valproate
Anti-epileptic
GABA-transaminase inhibitor (also blocks high frequency firing through Na channels)
Indic: first line for all types of epilepsy
SE: weight gain, birth defects, raised liver enzymes, tremor, drowsiness, thinning hair, acute pancreatitis (rare)
51
Phenytoin
Anti-epileptic
Use-dependant blockade of Na channels
Indic: second line for partial and generalised seizures
SE: drowsiness, weight gain + many others (small therapeutic window). Cerebella syndrome (ataxia, nystagmus, intention tremor), acne, hirsutism, gum hypertrophy. Folate deficiency anaemia. Vit D deficiency
52
Carbamazepine
Anti-epileptic
Use-dependant blockade of Na channels
Indic: first line for partial seizures, second line for generalised
SE: drowsiness, rash nausea
53
Lamotrigine
Anti-epileptic
Use-dependant blockade of Na channels (also interferes with glutamate release and activation of excitatory receptors)
Indic: first line for general, second for others
SE: rash/flu symptoms (skin pathologies)
54
Ethosuximide
Anti-epileptic
Blocks T-type Ca channels in the thalamus for PETIT MAL/absence
SE: drowsiness
55
Midazolam
| Oxazepam/Lorazepam (safe for use in liver failure)
Benzodiazepine - IV GA
Short acting used to produce strong sedation (anxiolysis and amnesia) prior to anaesthesia with another agent or if full anaesthesia not required (endoscopy).
Cannot produce general anaesthesia, little respiratory risk
SE: resp arrest, seizures (withdrawal), alcohol interaction, "hangover" effect, addiction, hepatotoxic
Flumazenil for OD
56
Thiopental/thiopentone
Barbiturate - IV GA
| Short acting for induction (intubation)
57
Propofol
IV anaesthetic
Rapid induction- very similar to thiopentone
Half-life approx. 30-60 min- useful for day-case surgery
58
Ketamine
IV anaesthetic
Blocks glutamate receptors, prevents excitation
Rapid induction, short duration of action (approx 40min)
Used for induction or very short painful procedures (changing wound/burn dressings)
Treatment in children
59
Desfluorane/ isoflurane/ sevoflurane
Inhaled anaesthetic
Activates TREK-1 potassium receptor
Fast induction/removal, lower solubility/potency
SE: laryngeal spasms/breath holding
60
Methoxyflurane
Inhaled anaesthetic
Activates TREK-1 potassium receptor
Slow induction/removal, higher solubility/potency
61
Desipramine/amytriptyline
Tricyclic Antidepressant
Inhibits reuptake of NA (more) and 5-HT. Takes 4-6 weeks
SE- blockade of muscarinic (Dry mouth, blurred vision, urinary retention, constipation), H1 (sedation) and a1-adrenoceptors (Orthostatic hypotension). creates toxicity in alcohol, some antiHNT, general anaesthetics
Precautions- cardiac arrhythmia (block muscarinic while promoting NA) causes REGULAR BROAD COMPLEX TACHY
Contra: SSRIs,
Sodium Bicarbonate in OD
62
Fluoxetine (kids, most SE)
Sertraline (used in pts with ^CVD Rx)
Escitalopram (first line anxiety, Rx long QT)
Fluvoxamine (go to for MDD, sedating)
SSRI (selective seratonin reuptake inhibitor)
Results in decrease 5-HT2A receptors
Initial SE of increased anxiety/agitation, GI upset, insomnia, sexual dysfunction. no long-term effects
Do not use with other SSRI (St John's Wort), SNRIs, MAOi, triptans = serotonin syndrome
63
Tranylcypromine
| Iproniazid
Irreversible MAOI
Indic: antidepressant
SE- insomnia, postural hypotension, anti-muscarinic, sexual dysfunction, cheese reaction
64
Moclobamide
RIMA (reversible monoamine oxidase inhibitor)
Targets MOA-A, no cheese reaction
SE- nausea, insomnia, NO OH or anti-muscarinic
65
Lithium
Used in bipolar disorder during the manic phase, not as effective in depressive phase
66
Chlorpromazide
Classic anti-psychotic
Blocks D2 receptors in the nucleus accumbens to reduce POSITIVE effects of schizophrenia
SE: sedation (H1), postural hypotension (alpha-1), dry mouth/blurred vision/constipation (M), weight gain and metabolic effects
MOST sedating/OH/potent anti-cholinergic (less EPS)
67
Haloperidol
Classic anti-psychotic
Blocks D2 receptors in the nucleus accumbens to reduce POSITIVE effects of schizophrenia
SE: parkinsonism effects (EPS), however least likely to cause OH/sedating, most potent anti-psychotic
68
Risperidone/Olanzepine/Clozapine
Atypical/2nd generation anti-psychotics
Both blocks D2 receptors in the nucleus accumbens and blocks 5HT2-A which inhibits DA release in pre-frontal cortex, increasing D1 in that area treating both negative and positive symptoms
SE: also have sedative, OH and anti-cholinergic effects
69
oral iron
Iron deficiency anaemia
take vitamin c (helps absorption)
SE: nausea, GI upset, dark stool
70
Calcium/Vit D
Used for osteoporosis
Calcitriol has also been used, can ↓rate of BMD loss in postmenopausal women. used for prevention. limited evidence
SE: hypercalcaemia
71
HRT (raloxifene)
Osteoporosis for post-menopausal women
SE: increase risk of cancers and CVD effects
SERMs retain eostrogen effects on bone but also CVS however not other effects
72
Alendronate (Bisphosphonates)
Osteoporosis treatment for those with previous fractures.
Incorporated into the bone, when taken up by osteoclasts causes apoptosis.
Use in mets bone disease to lower hypercalcemia
SE: rare osteonecrosis of jaw and fractures, GI upset and specific intake requirements (standing up, before eating etc)
73
Denosumab (Prolia)
Osteoporosis
| monoclonal antibody that mimics OPG and inhibits RANKL
74
Pneumonia ABX
CURB65 score
outpatient (mild 0-1): amoxicillin OR doxy
inpatient (moderate 2-3): penicillin (+ve streps) + doxy (atypicals) or clarithro/azithro
ICU (severe 4-5): ceftriaxone (strep + -ve) + azithromycin (legionella)
75
Meningitis empirical ABX
IV dexamethasone before or same time as ceftriaxone infusion
+benpen if >50yo (listeria) or rash (meningococcal)
+vanc if recent sinis/otitis infection (strep)
76
Teriparatide
Anabolic osteoporosis treatment
PTH analogue. Only treatment that CREATES bone
Daily injections.
SE: Osteosarcoma risk so only 18 month treatment limit then back to anti-resorptive therapy, nausea, headache
Contra: malignancy, Pagets disease, children, hyperparathyroidism
77
(Suma)triptan
Serotonin 5HT agonist
Migraine analgesia when conventional treatment fails
Contra: CAD, MI or uncontrolled HTN, ergotamine use within last 24hr
78
Naltrexone
Opioid antagonist used in alcohol abuse
Decreases craving of alcohol, used in every patient
Contra: opioid users
79
Disulfiram
causes acute sensitivity to ethanol and makes patient feel sick
80
Varenicline
Partial nicotine agonist
| reduces both craving and pleasurable effect
81
Burprenorphine
Partial opioid antagonist
| used with naloxone as Suboxone in opioid abuse
82
Methadone
Full opioid agonist
| used in opioid abuse
83
Venlafaxine
Desvenlafaxine
Duloxetine
SNRIs
SE: same as SSRI + HNT, rash common
Indic: severe MDD, anxiety
84
Bupropion
NA + DA reuptake inhibitor
Reduced efficacy compared to other antidepressants
Indic: pro sexual function (sometimes used w SSRI for anorgasmia), helps quit smoking
85
Mirtazapine
Direct NA and serotonin receptor inhibitor
Indic: insomnia + anxiety (sedating from H2)
SE: weight gain
86
Bupropion
NA + DA reuptake inhibitor
Reduced efficacy compared to other antidepressants
Indic: pro sexual function (sometimes used w SSRI for anorgasmia), helps quit smoking
87
Mirtazapine
Direct NA and serotonin receptor inhibitor
Indic: insomnia + anxiety (sedating from H2)
SE: weight gain
88
Pilocarpine
Parasympathetic mimetic
| Used in glaucoma to constrict the pupil
89
Acetazolamide
carbonic anhydrase inhibitor
| Decreased aqueous secretions, used in glaucoma
