Pharmacology K15 Compilation

Pharmacology K15 Compilation

1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• General principles of using NSAIDs:

• NSAIDs should be taken with or after meals.

• Contraindicated in patients with peptic ulcer disease.

• Do not use NSAIDs with vitamin K antagonists (Warfarin or Dicoumarol).

• Do not combine different NSAIDs.

• Side effects of Paracetamol: High and prolonged doses of Paracetamol can cause liver damage.

• NSAIDs indicated for chronic inflammation: Propionic acid (Ibuprofen, Naproxen).

• NSAIDs with strong analgesic effects, indicated for post-operative pain, acute pain: Diclofenac.

• NSAIDs that do not selectively inhibit COX-2: Tolmetin.

2. Cardiac Glycosides (Digitalis)

• Pharmacokinetic characteristics:

• Digitoxin and Digoxin are well absorbed from the gastrointestinal tract due to their fat solubility.

• When serum potassium is high, Glycosides bind less to the myocardium and vice versa.

• Uabain is not metabolized and is excreted very quickly.

• Digitoxin and Digoxin are excreted very slowly.

• Mechanism of action: Directly inhibit the (Na+, K+-ATPase) pump in the cell membrane, leading to an increase in intracellular Ca2+ concentration.

• Pharmacological effects:

• Increase myocardial contractility.

• Decrease heart rate.

• Decrease atrioventricular conduction.

• Indications:

• Acute heart failure: Beta-adrenergic enhancement and inhibition of Phosphodiesterase 3 (PDE3) enzyme.

3. Antibiotics

• Bactericidal antibiotics: Quinolone.

• Antibiotics that do not inhibit bacterial cell wall synthesis: Clindamycin.

• Penicillin resistant to Penicillinase: Methicillin.

• Penicillin well-indicated for patients with penicillinase-producing Staphylococcus infection (Staphylococcus aureus): Oxacillin.

• Drugs commonly used for patients allergic to Penicillin: Aztreonam.

• Second-generation Cephalosporins: Cefuroxime, cefamandol, cefuroxime acetyl.

• Cephalosporins active against methicillin-resistant Staphylococcus (MRSA), Enterococci: Ceftobiprol.

• General characteristics of Polymycin B and E:

• Mechanism of action: Inhibition of bacterial cell membrane synthesis.

• Spectrum of antibacterial activity: Gr (-) like Pseudomonas, Acinebacter, E.Coli.

• High toxicity on kidneys.

• Indications: multidrug-resistant infections.

• General characteristics of Aminosides:

• Almost no absorption through the gastrointestinal tract due to high Pm.

• Mechanism: inhibition of bacterial protein synthesis.

• Toxicity: kidneys and cranial nerve VIII.

• Broad spectrum of antibacterial activity: Gr(+) and Gr(-).

• Aminosides with the broadest spectrum of antibacterial activity: Amikacin.

• Common advantages of Chloramphenicol and its derivatives:

• Mechanism: inhibition of bacterial protein synthesis.

• Toxicity: bone marrow suppression.

• Distribution: cerebrospinal fluid, placenta.

• Indications: Salmonella infection, typhoid fever, paratyphoid fever, meningitis, spirochetes.

• Pseudomembranous colitis is the toxicity of antibiotics: Macrolide.

• Drugs belonging to the Macrolide group: Erythromycin.

• Incorrect indication of Macrolide and Lincosamide groups: Pseudomonas aeruginosa and MRSA infection.

• Third-generation Quinolones are called respiratory quinolones:

• Quinolones effective against both MRSA and anaerobic bacteria: Trovafloxacin, Gemifloxacin.

• Mechanism of action of Sulfonamide: Competition with PABA.

• Why drink plenty of water when using antibacterial Sulfonamides: The metabolites are poorly soluble and can irritate the gastrointestinal tract.

4. Adrenergic System

• The action of relaxing smooth muscles, skeletal muscles and stimulating the liver to break down glycogen, neoglucogenesis is due to the effect on adrenergic receptors: beta 2.

• Mechanism of action of adrenaline on the adrenergic system: Acts on both alpha 1, alpha 2, beta 1,2,3 adrenergic receptors.

• Incorrect statement about the effect of Adrenaline: Systolic blood pressure, mean arterial pressure increase strongly.

• Why Adrenaline is not used to treat asthma: Loss of bronchodilator effect in subsequent uses.

• Mechanism of action of Norepinephrine on the adrenergic system: Strong effect on alpha 1, 2 receptors.

• Clinical indications of Noradrenaline: Prolonging the duration of anesthesia, sudden cardiac arrest, raising blood pressure in shock: poisoning, infection, allergy…

• Mechanism of action of Dopamine: Acts on D1 dopaminergic and beta 1 adrenergic receptors.

• Incorrect statement about the pharmacological effects of beta-adrenergic receptor agonists: Vasoconstriction.

• Isoproterenol is a drug that acts on adrenergic receptors: beta 1 and beta 2.

• Incorrect statement about dobutamine: More potent effect than Isoproterenol.

• Indications of Terbutaline: Asthma.

• Incorrect indication of adrenergic system blockers: Hypothyroidism.

• The main mechanism of action of alpha methyldopa adrenergic system blocker: Inhibition of Catecholamine synthesis.

• Main indications of alpha-adrenergic blockers: Hypertensive episodes, diagnosis of pheochromocytoma, treatment of Raynaud’s disease.

• Incorrect main indication of beta-adrenergic blockers: Asthma.

• Do not use beta-adrenergic blockers with Insulin and hypoglycemic Sulfonamides because: Inhibition of glycogenolysis and lipolysis.

5. Treatment of Angina Pectoris

• Which angina pectoris treatment drug is used for anti-crisis: Nitric, Nitrate derivatives.

• Mechanism of action of nitrate, nitrite derivatives: Release of nitric oxide (NO).

• Which drug is not indicated for treatment of angina pectoris: Sodium nitroprusside.

• Indications of propranolol, atenolol in treatment of angina pectoris: Anginal pain due to unstable angina.

• The main mechanism of action of anti-anginal calcium channel blockers: Reduce myocardial contractility.

6. Pharmacokinetics

• Drug absorption in the stomach: Well absorbed for drugs with weak acid and weak base properties.

• Drug bound to protein does not have the following characteristic: Difficult for the drug to be absorbed into the bloodstream.

• Drugs transported well through the placenta: Fat-soluble drugs and less bound to maternal blood plasma proteins.

• The meaning of the volume of distribution Vd: It can be used to calculate the dose to achieve the desired plasma concentration when Vd is known.

• Phenobarbital, meprobamat, Chlorpromazine, phenylbutazol,… are drugs that easily cause drug tolerance due to: Induction of metabolic enzymes.

• Prolonged use of thiazide, causing gout that occurs during excretion due to: Competition for carriers in the renal tubule.

• Incorrect statement about the dosing interval of the drug with t1/2: 6h < T1/2 < 12h: use the drug with a dosing interval equal to t1/2.

• Correct statement about sleep: Sleep consists of 2 phases: REM (Rapid Eyes Movement) and NREM (Non Rapid Eyes Movement).

• Mechanism of central nervous system stimulation: Reduced Cl- entry into the post-synaptic neuron.

7. Sedative, hypnotic drugs

• Incorrect statement about the hypnotic effect of Barbiturates: Reduce the proportion of NREM sleep.

• Which Barbiturate derivative hypnotic drug has a strong anticonvulsant effect: Phenobarbital (Gardenal).

• Base blood plasma to increase excretion when dealing with acute barbiturate poisoning: Intravenous infusion of 0.14% NaHCO3 solution (0.5-1L).

• Incorrect statement about Barbiturate hypnotics: Strong enzyme inhibition.

• Mechanism of action of alcohol on central nervous system inhibition: Inhibition on NMDA receptors of glutamate.

• Chronic alcohol poisoning, which drug is used to detoxify: Disulfiram.

8. Drug effects

• Which effect does not go through the drug receptor: Mannitol increases osmotic pressure in the plasma, causing diuresis.

• Incorrect statement about pregnant women: Plasma protein increases.

• Which mechanism is not of rapid drug tolerance (Tachyphylaxis): Drug-induced induction of drug metabolizing enzymes.

9. Anticholinergic drugs

• When poisoning with Amanita muscarin mushrooms, which symptom is incorrect: Urinary retention.

• Drugs are not usually indicated for patients with constipation, urinary retention after surgery: Pilocarpine.

• Molecular mechanism of depolarizing blockade at the motor end plate causing muscle contraction is related to which ion: Ca2+.

• Atropine poisoning will be treated with which of the following drugs: Physostigmine.

• Which clinical application is not of Atropine: Eye drops to lower intraocular pressure.

10. Ganglion Blocking Drugs

• Mechanism of action of ganglion blocking drugs: Competition with Acetylcholine at nicotinic neuron (Nn) receptors.

• Clinical indications of ganglion blocking drugs: Hypotension during surgery, hypertensive episodes, acute pulmonary edema.

11. Muscle Relaxant Drugs

• Mechanism of action of Cura type drugs: Blockade of the Nicotinic system of skeletal muscles.

• Which type of cura does not belong to the mechanism of competing with acetylcholine at the motor end plate, making the motor end plate non-depolarized (antidespolarisant or curarimimetic or pakicura): Succinylcholine.

• Poisoning with which type of cura can be detoxified with cholinesterase inhibitors and atropine: Type competing with acetylcholine at the motor end plate (curarimimetic).

• Incorrect indication of Cura type drugs: Urinary retention after surgery, benign prostatic hyperplasia.

12. Anticholinesterase Drugs

• Common indications of reversible anticholinesterase drugs: Myasthenia gravis, detoxification of Cura type competing with acetylcholine, treatment of glaucoma.

• Which anticholinesterase drug is the first-line drug to detoxify Cura type competing with acetylcholine: Edrophonium chloride.

• The mechanism of acute poisoning of irreversible anticholinesterase inhibitors is due to: Stimulation of all 3 systems (M, N, central nervous system).

• Treatment of poisoning with irreversible anticholinesterase inhibitors, except: Edrophonium chloride.

13. Calcium Channel Blockers

• Which of the following drugs are commonly used to treat arrhythmias: Diltiazem and Verapamil.

• Which group of calcium channel blockers belongs to dihydropyridine (DHP) derivatives: Phelodipine.

• Which calcium channel blocker has prolonged action: Nimodipine.

• Which of the following drugs are often used for patients with cerebrovascular accidents: Nimodipine.

14. Antihypertensive Drugs

• Which antihypertensive drug has common side effects of dry cough, angioedema: Angiotensin-converting enzyme inhibitors (ACEIs).

• The US Food and Drug Administration (FDA) advises against using Renin inhibitors together with ACEIs and Angiotensin II receptor blockers (ARBs) because: It causes dry cough, angioedema.

• Which of the following antihypertensive drugs does not have an effect on the Renin-Angiotensin system (RAS): Reserpine.

• Which group of antihypertensive drugs can be applied well for all types of hypertension (elderly, diabetes, kidney disease): Angiotensin Converting Enzyme Inhibitors (ACEIs).

• Antihypertensive drug due to the mechanism of stimulating alpha 2 adrenergic receptors: Clonidine.

15. Drug Interactions

• Sulfamethoxazole + Trimethoprim is a type of interaction: Synergistic increase in level.

• Taking medication on an empty stomach, how long does the medication stay in the stomach: 10 – 30 minutes.

• Which drug interaction affects the drug metabolism in the body: Phenobarbital is an enzyme inducer, so it reduces the effect of drugs used together.

• Drugs should be taken on an empty stomach (1/2 to 1 hour before meals): Drugs that irritate the stomach (NSAIDS, quinine).

16. Psychotropic Drugs

• Mechanism of typical neuroleptics (Typical antipsychotics): Inhibition of both D2 receptors of Dopamine and 5HT2A of Serotonin in the brain.

• Which drug belongs to the typical neuroleptics (Typical antipsychotics): Haloperidol.

• Extrapyramidal effects (EPS) are due to which mechanism: Inhibition of D2 dopaminergic in the substantia nigra, striatum in the brain.

• When treating with neuroleptics and there are signs of extrapyramidal effects (EPS), which drug should be used together: Anticholinergic drugs.

• The main mechanism of action of Benzodiazepines (BZD): Binds to its receptor, thereby increasing the frequency of Cl- channel opening by GABA binding to GABA receptors.

Note: This article is just a compilation of basic knowledge about Pharmacology K15, not a substitute for studying and consulting professional resources.