Drugs For Midsem Exam

Front 1

Codeine

Metabolised by?

Back 1

CYP2D6

Front 2

Codeine/morphine

agonist or antagonist
at what receptor?

Back 2

agnoist at mu receptor

Front 3

Codeine/morphine
Adverse effects?

Back 3

nausea and vomit
dyspepsia
drowsiness
dizziness
heaache
drymouth
constricted pupil
urinary retentioin
constipation

Front 4

Codeine/morphine

Antidote?

Back 4

Naloxone

Front 5

Naloxone

Agonist or antagonist at which receptor?

Back 5

antagonist at mu receptor

Front 6

Promethazine

What is it?

Back 6

sedating anti-histamine

Front 7

Promethazine

ago or antago?
At What receptor?

Back 7

antagonist at H1 and muscarinic receptors

Front 8

Promethazine

actions?

Back 8

antihistamine
decrease mucus secretion

Front 9

Promethazine

adverse reactions?

Back 9

oral health issues (reduced salivary flow)
Avoid alcohol since it is sedating drug

Front 10

Pseudoephedrine
actions?
receptor?
adverse effects?

Back 10

Relief of nasal congestion associated with acute and chronic rhinitis. It is sympathomimetic and acts (agonist) at the alpha adrenergic receptors (α1 and α2). It relieves nasal congestion by causing the nasal blood vessels to constrict. It can also dry salivary flow. Main adverse effect is increase in BP.

Front 11

Chlorpheniramine

Back 11

sedating anti-histamine. Antagonist at H1 receptor. ADR: drowsiness.

Front 12

Pilocarpine

include ADR

Back 12

primarily used to treat glaucoma but also is diluted and used to stimulate salivary flow. It is an agonist at the muscarinic receptor. Not to be used on asthmatics (since it causes bronchial constriction), and cardiac conditions (reduces HR)

Front 13

Paracetamol
what detoxifies paracetamol if overdosed?
how to treat overdose?

Back 13

analgesic. Works by inhibition of central prostaglandin synthesis. Works on CNS. Overdose can cause liver damage. Chronic liver disease pts at high risk. Prolonged fasting or malnutrition depletes glutathione stores. Glutathione is used to detoxify the toxic metabolite of overdosed paracetamol. If it is depleted liver damage occurs. Acetyl cysteine or charcoal are antidotes for paracetamol overdose

Front 14

Ibuprofen

Back 14

An NSAID analgesic. Non-selective. Inhibits synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX). ADR include nausea, dyspepsia, GI ulceration or bleeding, raised liver enzymes, diarrhoea, headache, dizziness, salt and fluid retention, hypertension. Ibuprofen can reduce the antiplatelet activity of low-dose aspirin and potentially reduce or negate its cardioprotective effect.

Front 15

Naproxen

Back 15

Nonselective NSAID

Front 16

Aspirin

Back 16

Aspirin has analgesic, antipyretic, anti-inflammatory and antiplatelet actions. It is a nonselective NSAID, preventing synthesis of prostaglandins by noncompetitively inhibiting both forms of cyclo-oxygenase (COX1 and 2).

Front 17

Diclofecnac

Back 17

Nonselective NSAID. (found in Voltaren)

Front 18

Precautions from NSAIDs:

Back 18

Allergic reactions to NSAIDs, including aspirin—contraindicated, see also Practice points.
Asthma —NSAIDs may increase risk of bronchospasm.
Coagulation disorders—nonselective NSAIDs increase risk of bleeding (antiplatelet effect); selective NSAIDs (COX-2 inhibitors) and possibly diclofenac increase risk of thrombosis.

Cardio- or cerebrovascular
NSAIDs increase risk of cardiovascular events
Heart failure and hypertension may worsen due to sodium and fluid retention from NSAID-induced reduction in glomerular filtration rate and renal blood flow.
Gastrointestinal
Contraindicated in active peptic ulcer disease or GI bleeding.
Renal
Pre-existing renal impairment increases the risk of NSAID-induced impairment; nonselective NSAIDs increase risk of bleeding.
Hepatic
Use with caution in severe impairment; nonselective NSAIDs increase risk of bleeding; selective NSAIDs (COX-2 inhibitors) are not recommended.

Excessive bleeding with warfarin

Front 19

Choline salicylate

include ADR

Back 19

: Found in Bonjella, the teething gel. Non-acetyl salicylate medicament that has anti-inflammatory properties but less analgesic and antiplatelet actions than aspirin. Not to be used for children under 16 since it has same effect as aspirin which is contraindicated for children. Risk of Reye’s syndrome (causes serious liver and brain damage). Alternatives include chewing on cold towel, carrot, ice, teething ring or give paracetamol/ibuprofen

Front 20

Clove oil/Eugenol

Back 20

Main constituent is eugenol which inhibits prostaglandin synthesis via COX1,2 and depresses the sensory receptros involved in pain perception. Adverse reactions include: allergic rashes, burning, loss of sensation, local tissue damage, dental pulp damage, lip sores, increased risk of cavities.

Front 21

Salbutamol

Back 21

B2 agonist (but can also act as B1 agonist). Used in MDI to relieve acute asthma attack. Can also cause tremor and palpitations because it acts on B2 receptors in skeletal muscles. When it acts on B1 it can cause increase HR.

Front 22

Fluticasone

what does it do?
mechanism of action?
ADR?

Back 22

A corticosteroid which reduces airway inflammation and bronchial hyper-reactivity. This is to treat asthma. It doesn’t work straight away since it works by protein synthesis. Adverse reactions include dysphonia, oropharyngeal candidiasis, and bruising. Always use spacer with MDI and rinse out mouth with water after using it. Adrenal suppression can occur with high doses so only used for short courses (10 days or less). Long term use can cause adrenal insufficiency and Cushing’s syndrome.

Front 23

Prednisolone

Back 23

A corticosteroid which suppresses inflammation and immune response. Hence it is used for treating asthma. Long term use can cause adrenal insufficiency and Cushing’s syndrome.

Front 24

Fexofenadine

Back 24

Non sedating antihistamine (Selectively antagonise the action of histamine at H1 receptors).

Front 25

Terbutaline

Back 25

B2 agonist. Used for acute asthma. Tremor and palpitations.

Front 26

Salmeterol

Back 26

B2 agonist. For maintenance of asthma and not for acute asthma relief (slow onset) Symptom controller

Front 27

Ipratropium

Back 27

muscarinic antagonist. Prevent secretion of mucus. ADR: dry mouth, throat irritations

Front 28

Tiotropium

Back 28

muscarinic antagonist. Prevent secretion of mucus. ADR: dry mouth, throat irritations.

Front 29

Theophylline

Back 29

Acts on two sites. 1 inhibits PDE from metabolising cAMP into AMP leading to accumulation of cAMP which increases bronchodilation. 2 decreases bronchoconstriction. Hence very effective for acute asthma treatment or airway obstruction.

Front 30

Metaprolol

Back 30

Selective B1 blocker (antagonist). Used for treating hypertension, angina, MI, tachyarrythmia. This is safe for asthmatics since it B1 is only found in the heart.

Front 31

Propanolol

Cautions?

Back 31

non selective Beta blocker (blocks B1 and B2 receptors). Don’t give it to asthmatic since blocking B2 will prevent bronchodilation

Front 32

Budesonide

Back 32

Inhaled corticosteroid drug. Reduces airway inflammation and bronchial hyper-reactivity. ADR: adverse effects from corticosteroids

Front 33

Nystatin

Back 33

Antifungal for treating oral candidiasis.

Front 34

Miconazole

Back 34

An azole antifungal which works by inhibiting ergosterol synthesis. Azole antifungals may reduce warfarin metabolism hence increase risk of bleeding.

Front 35

Amphotericin

Back 35

Antifungal works by binding irreversibly to ergosterol in fungal cell membranes causing cell death by altering their permeability and allowing leakage of intracellular material.

Front 36

Aciclovir

Back 36

Antiviral for treating cold cores

Front 37

Terbinafine

Include drug interactions

Back 37

Inhibits ergosterol synthesis. Does not inhibit CYP450 unlike other azoles. It is both fungicidal (for fungal infections) and fungistatic (for yeast infections). Symptoms relieved very quickly (2 to 3 days).

It inhibits CYP206 codeine enzyme which breakes down morphine. So don’t give with codeine.

Front 38

Imidazole

Back 38

Group of antifungal drugs (includes metronidazole). All fungistatic and inhibits CYP450. Overdose can cause drug poisoning. Symptoms relieved within 7 days.

Front 39

Amoxicillin

Back 39

is a beta-lactam penicillin antibiotic. It contains beta-lactam ring. It is bactericidal and inhibits bacterial wall synthesis. But it can be deactivated by beta-lactamase enzyme which some bacteria resistant to amoxicillin have. Its adverse reactions include gastrointestinal symptoms such as nausea, vomiting, diarrhoea.

Front 40

Clavulanic acid

Include ADR

Back 40

Inhibits beta-lactamase in beta-lactam resistant bacteria. Often given along with amoxycillin for such bacterial infection. It can cause hepatotoxicity.

Front 41

Cephalexin

Back 41

It is a cephalosporin antibiotic. Beta lactam. Can cause diarrhoea.

Front 42

Clindamycin
all about it including ADR

Back 42

: Lincosamide antibiotic. Bacteriostatic; inhibit protein synthesis by binding to the 50S ribosomal subunit. Alternative in patients with severe allergy to penicillins and cephalosporins. A serious adverse effect of it is pseudomembranous colitis which is characterised by explosive diarrhoea.

Front 43

Glycopeptides

Back 43

Include teicoplanin and vancomycin. These are not broad spectrum which are active only against gram +ve organisms. Adverse reactions include, nausea, vomiting, diarrhoea, chills and fever. All administered via IV. Poor renal function pts in risk of ototoxicity, nephrotoxicity

Front 44

Red man syndrome
when does it occur? what are the symptoms?

Back 44

Occurs when vancomycin is infused too quickly. Pt turns red showing fever, chill, erythema, uppor torso rash

Front 45

Macrolides

Back 45

Group of antibiotics. Has similar spectrum of antibiotic activity as penicillin. Includes, azithromycin, clarithromycin, erythromycin, roxithromycin

Front 46

Clarithromycin

type?
durg interactions?

Back 46

: a macrolide antibiotic. Inhibits CYP 450 3A4 which breaks down midazolam. Don’t prescribe with midazolam

Front 47

Midazolam

Back 47

sedative. Clarithromycin prevents midazolam metabolim.

Front 48

Metronidazole

include drug interactions

Back 48

Antibiotic. Fast absorbing. Can be given rectally or intravenously. ADR: nausea, diarrhea, and/or metallic taste in the mouth. Avoid alcohol due to disulfram-like reaction. Metronidazole inhibits warfarin metabolism, increasing its concentration and risk of bleeding.

Front 49

Doxycycline

Back 49

: A tetracycline. Bacteriostatic; inhibit bacterial protein synthesis by reversibly binding to 30S subunit of the ribosome. Avoid antacids since it can chelate with Fe3+. Must be taken with water – if sticks to throat, it may cause a hole in the throat. Becomes photosensitive and easily sunburnt. Avoid sun. Avoid in growing children. Causes tooth discolouration and bone defect.

Front 50

Oxymetazoline

Back 50

: Agonist at α1 and α2 receptor. Produce vasoconstriction in nasal mucosa; decrease nasal blood flow and congestion. Used in nasal sprays. ADR: increase in BP but small since it is in topical form. Avoid using it long term (restrict to 5 days) since it develops rebound congestion (desensitisation).

Front 51

Pholcodine

include ADR

Back 51

Opioid derivative. Agonist at mu receptor. Used in cough syrups for dry irritating cough.

ADR: constipation, sedation. Increase effects of alcohol.

Front 52

Guaifenesin

include ADR

Back 52

Expectorant (loosens and expels mucus). Cough symptom relief. ADR: laxative effect, diarrhoea. Take with water and don’t use if hypersensitive

Front 53

Pethidine

Back 53

Opioid analgesics. It has active metabolite – norpethidine. The effect of the drug is prolonged.

Front 54

Diazepam

Back 54

A benzodiazepam psychotic drug. Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and antiepileptic effects

Front 55

Example of selective NSAID?

Back 55

Celecoxib
Rofecoxib

Front 56

ADR of Celecoxib?

Back 56

Increased risk of CVS

Front 57

ADR of Sedating Antihistamines?

Back 57

Dry mouth
Dry eyes
Blurred vision
Hot
Flushed

Front 58

What drugs have the following ADRs?

Dry mouth
Dry eyes
Blurred vision
Hot
Flushed

Back 58

sedating antihistamine
Tricyclic Antidepressants
Anticholinergics (atropine)
Benzodiazepines (diazepam)

Front 59

Relationship between OC and grapefruit?

Back 59

grapefruit will inhibit enzyme that metabolises OC. OC levels will be high.

Front 60

Relationship between OC and rifampicin?

Back 60

rifampicin will induce enzymes that metabolises OC. OC levels will be low.

Front 61

Relationship between OC and St Johns Worts?

Back 61

St John's Worts will induce enzymes that metabolises OC. OC levels will be low.

Front 62

Serotonin Syndrome?

Back 62

– Nausea, vomiting, diarrhoea
– Tachycardia
– Agitation, anxiety, headache
– Tremor
– Sweating

Front 63

What are Phase I and Phase II reactions?

Back 63

Phase I reactions:
Transform the drug to a more hydrophilic (more polar) metabolite by adding -OH -NH2 -SH

Phase II reactions:
Metabolites are made more hydrophilic (more polar) to
enable them to be excreted by the kidneys by adding liver conjugates e.g. acetyl, glycine, methyl, glutathione. Thus it makes the molecule a lot heavier, more polar and less activity(toxicity).