Pharmacology

Question 1

Mechanism of action of furosemide

Answer 1

Loop Diuretic.

Inhibits the Na-K-Cl cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl.

Question 2

Furosemide side effects

Answer 2

Hypotension
Hypo K+, Mg, Na, ca
Ototoxicity
Hypochloraemic alkalosis
Gout

Question 3

Management of hiccups in palliative care

Answer 3

Chlorpromazine or haloperidol

Question 4

Drug class and MOA of amiloride

Answer 4

K+ sparing diuretic

Blocks the epithelial sodium channel in the distal convoluted tubule

Question 5

What does troponin T bind to?

Answer 5

Tropomyosin

Question 6

Which drugs are associated with gingival hyperplasia?

Answer 6

Phenytoin, ciclosporin, calcium channel blockers

Question 7

What is miller fischer syndrome?

Question 8

Antibodies in GBS?

Answer 8

Anti-GMI
Anti GQ1b (miller fisher syndrome)

Question 8

Metoclopramide

Answer 8

Anti-emetic

MOA: Dopamine antagonist in the chemoreceptor trigger zone of the CNS.

SE: extrapyramidal side-effects (acute dystonic reactions, akathisia, and parkinsonism). SE more common in young females.

Question 9

Ondansetron MOA

Answer 9

A selective serotonin 5-HT3 receptor antagonist - blocks these receptors both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone.

Can prolong QT

Question 10

Baclofen MOA

Answer 10

GABA agonist

Treats spasticity in MS, cerebral palsy and cord injuries.

inhibits release of excitatory neurotransmitters resulting in the blocking of mono- and polysynaptic reflex transmission. Clinically, this leads to reduced muscle spasticity, which can improve pain and mobility in patients.

Question 11

Codeine to morphine conversion

Answer 11

1/10th

Question 12

oral to subcut morphine conversion

Answer 12

1/2

Question 13

Role of timolol in open angle glaucoma

Answer 13

Reduces aqueous production

Question 14

Blue vision

Answer 14

Sildenafil

Question 15

Features of tricyclic overdose;

Example drugs
Clinical features
ECG features

Answer 15

Amitriptyline, dosulepin.

Dry mouth, dilated pupils (mydriasis).
Blurred vision

Sinus tachycardia
Broad QRS
Prolonged PR

Question 16

Management of TCA overdose

Answer 16

IV Bicarb
Lipid emulsion increasingly used - binds free drug

Question 17

Where is cyanide found?

What enzyme does it inhibit?

Answer 17

Insecticides,photograph development, factories (wool, rubber), metal

Cytochrome oxidase»_space; cessation of mitchondrial electron transport chain.

Question 18

Brick red skin, smell of bitter almonds

Answer 18

cyanide poisoning

Question 19

Management of cyanide poisoning

Answer 19

100% oxygen
hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

Question 20

What drugs can cause lung fibrosis?

Answer 20

Nitrofurantoin

Amiodarone

Cytotoxic drugs

Anti-rheumatoid drugs

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 21

Which drug can cause cataracts?

Answer 21

Steroids

Question 22

Which drugs cause corneal opacities?

Answer 22

Amiodarone
Indomethacin

Question 23

Which drug class is pilocarpine?

MOA?

Answer 23

Muscarinic agonist

Ciliary contraction > increase aqueous humour outflow, miosis, and accommodation.

Question 24

What causes AKI with gentamicin use? What medical condition is gent contra-indicated in?

Answer 24

Acute tubular necrosis Myasthenia

Question 25

What drugs should be avoided with SSRI?

Answer 25

Triptans MAOIs Increased risk of serotonin syndrome Warfarin Said - can be used with PPI Increased bleeding risk

Question 26

Which SSRI prolong QT interval?

Answer 26

Citalopram and escitalopram

Question 27

Can SSRI be used in pregnancy?

Answer 27

Weigh up risk and benefits. Use in 1st trimester - increased risk of congenital heartdefects Use in 3rd trimester - Pulmonary HTN of newborn

Question 28

Typical antipsychotics 1. Examples 2. MOA 3. Side effects

Answer 28

Haloperidol, Chlorpromazine Blocks D2 receptors EPSE & hyperprolactinaemia

Question 29

Atypical antipsychotics 1. Examples 2. .MOA 3. Side effects

Answer 29

Clozapine, risperidone, Olanzapine D2-D4 antagonists, 5HT3 Metabolic side effects - weight gain EPSE & prolactin less common

Question 30

Which TCA is generally avoided due to high risk in OD?

Answer 30

Dosulepin

Question 31

What is the risk of antipsychotic use in elderly?

Answer 31

Increased risk of stroke Increased risk of VTE

Question 32

What is MOA of benzodiazepines?

Answer 32

Bind to GABA receptors increasing affinity for GABA molecules to bind. This binding causes influx of Cl- ions into cell, lowering risk of action potential and preventing excitation of cell... e.g more calm Increase Cl- ion channel opening frequency.

Question 33

What is MOA of barbiturates?

Answer 33

Bind to GABA a receptor (alpha or beta subunit). Increase Cl- ion opening duration. Low therapeutic index - high risk of toxicity. e.gg phenobarbitol

Question 34

What is MOA of non-benzo hypnotics?

Answer 34

Selectively bind to alpha 1 subunit of GABA a receptor. No anti-anxiety effect e.g Zolpiden, zopiclone

Question 35

Management of bulimia?

Answer 35

Self help guide > CBT > High dose fluoxetine if no improvement after 4 weeks

Question 36

Which psych drugs cause hyponatraemia?

Answer 36

SSRI

Question 37

What is the component in food products that can interact with MAOIs? What are the foods to avoid?

Answer 37

Tyramine Cheese, broad beans, bovril, oxo, marmite

Question 38

SNRIs 1. Examples 2. MOA

Answer 38

Duloxetine, venlafaxine Inhibit reuptake of serotonin and noradrenaline increasing concentrations in the synaptic cleft

Question 39

Management of PTSD

Answer 39

Trauma focussed CBT or EMDR > Venlafaxine or SSRI > Risperidone in severe cases may be used

Question 40

What is lithium excreted by? Side effects

Answer 40

Kidneys N&V, diarrhoea, goitre, nephrotoxicity, weight gain, IIH, hyper PTH & hyperCa

Question 41

How often should lithium levels be checked?

Answer 41

3 monthly if stable. Weekly after dose change.

Question 42

Quinolones - Examples - MOA - Adverse effects - Contraindications

Answer 42

Cipro/levofloxacin Inhibit topoisomerase II (DNA gyrase) and topoisomerase IV AE: Lowers seizure threshold, tendonitis, prolongs QT, suicidal thoughts, AAA/dissection CI: Avoid in pregnancy/breastfeeding G6PD deficiency

Question 43

First line pharmacological support in smoking cessasion?

Answer 43

NRT, bupropion, varenicline, cytisincline

Question 44

MOA of bupropion? Reason for starting? Contraindications?

Answer 44

A norepinephrine–dopamine reuptake inhibitor and nicotinic antagonist. Minimal effect on serotonin compared with many antidepressants. Smoking cessation - should be started 1 to 2 weeks before the target stop date. Small risk of seizures (approximately 1 in 1,000) contraindicated in epilepsy, ED, pregnancy and breastfeeding

Question 45

Can you use NRT in pregnancy?

Answer 45

Yes but bupropion, varenicline and cytisincline are contraindicated

Question 46

Varenicline and cytisincline MOA

Answer 46

Nicotinic acetylcholine partial agonist Varenicline is more effective than bupropion

Question 47

What toxic metabolite is produced in paracetamol OD?

Answer 47

N-acetyl-B-benzoquinone imine During an overdose the conjugation system becomes saturated leading to oxidation by P450 mixed function oxidases >>> lower threshold for commencing NAC on pts taking p450 inducers

Question 48

MOA of allopurinol Adverse reactions? Interactions

Answer 48

Inhibits xanthine oxidase Severe skin reactions - SCAR/DRESS/SJS - Patients should stop taking immediately - Higher risk in chinese, korean, thai - should have allele testing HLA - B5801 Azathioprine, cyclophosphamide, theophylline

Question 49

Infliximab drug class?

Answer 49

Anti TNF monoclonal antibody

Question 50

Example of EGFR inhibitor?

Answer 50

Cetuximab

Question 51

Rituximab drug class?

Answer 51

Anti CD-20 antibody

Question 52

Bisphosphonates MOA?

Answer 52

Inhibit osteoclasts

Question 53

Dobutamine drug class

Answer 53

Beta 1 agonist