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MVST 1B (Subject) / MoDA (Lesson)

MVST 1B - MoDA

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  • Vecuronium Use: neuromusculasr blockade for surgery, intermediate duration MoA: Non-depolarizing NMJ blocker SE: prolonged apnoea, muscle pain → pancuronium (long-lasting), atracurium
  • Latanoprost Use: open-angle glaucoma; occular hypertension MoA: PGF2α prostaglandin analogue SE: blood pressure changes, headache, occular discomfort →timolol, pilocarpine; misoprostol, iloprost
  • Timolol Use: Open-angle glaucoma MoA: β-arenergic antagonist SE: contra-indicated in asthma; systemic: cold peripheries, bradycardia →latanoprost
  • Fluphenazine Use: Schizophrenia, psychosis MoA: Typical antipsychotic: D2-antagonist SE: Extrapyramidal x4, hormonal x2, antimuscarinic → flupentixol, haloperidol, chlorpromazine; risperidone, quetiapine, clozapine, olanzapine
  • Methadone Use: Adjungt in opiod dependence; analgesic (severe pain); cough in terminally ill MoA: opiod receptor agonist SE: nause & vomiting (→ondansetron, cylizine, metoclopramide), constipation (→senna); respiratory depression; aythmias (torsade de points, long-QT) → morphine*, codeine, oxycodone, dihydrocodeine, fentanyl
  • Riboflavin = Vit B2 Use: Vit B2 deficiency (rare) →thiamine, pyridoxine, hydroxycobalamin
  • Iloprost Use: Raynaud's; systemic sclerosis; heart failure, hypertension, PAH MoA: prostacyclin PCI2 analogue → capillary vasodilation → misoprostol (PGE2), latanoprost (PGF2α)
  • Aminophylline →theophylline and ethylenediamine ⇒ greater solubility in water Use: Acute severe asthma MoA: non-selective PDE inhibitor, mast stell stabilizer SE: GI upset, palpitations, arrhythmias; headache, dizziness; loadig dose → theophylline, magnesium sulphate
  • Rituximab Use: Certain lymphomas, leukaemias; severe reumatoid arthritis, organ transplants MoA: Monoclonal α-CD20 atubody, targetting B-cells →alemtuzumab (CD52 - MS), ciclosporin/tacrolimus; cyclophosphamide, mycophenolate/azathioprine, prednisolone
  • Fomepizole Use: Methanol poisning →flumazenil, NAC, naloxone, charcoal, desferrioxamine, dimercaprol
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  • Ursodeoxycholic acid Use: Dissolution of gall stones, primary biliary cirrhosis (improves LFTs) MoA: Bile acid → colestyramine
  • G-CSF Use: pancytopaenia MoA: Granulocyte colony-stimulating factor →MESNA
  • Dutasteride Use: Prostate cancer MoA: 5α-reductase inhibitor (Testosterone → DHT) → Finasteride
  • Oxytocin Hormone secreted from the posterior pituitary gland (→ADH) → syntocinon, ergometrine, syntometrine
  • Ergometrine Use: PPH, active management of 3rd stage of labour; diagnosis of Prinzmetal's angina MoA:  Short-acting uterotonic acting on α-adreno, dopamine and serotonine receptors SE: GI upset; headache, dizziness, tinnitus; palpitations, bradycardia → oxytocin, syntocinon, syntometrine
  • Syntometrin Use: PPH, active management of 3rd stage of labour → Syntocinon + → ergometrine
  • Ulipristal acetate Use: Emergency contraception, up to 120h after fertilisation, only once per cycle fibroids MoA: Selectie progesterone receptor modulatorSE: nausea, irregular periods, may affect effectiveness of OCP/POP,CI: pregnancy, lactation, liver diseaseDose: 30mg PO → levonorgestrel, mifepristone
  • Levonogestrel Use:  Emergency contraception, up to 72h after conception; LevanElle Used in IUD / mirena MoA: Inhibits ovulation, fertilization, implantation C/I: More than 72h after earliest possible fertilization period overdue Advice: Return if vomiting within 3 hours Next period may be early / late No protection from STI → Urlistat
  • Misoprostol --
  • Propess / Prostin Use: Induction of labour (high vaginal pessary); termination of pregnancy MoA: prostaglandin analogue → PGE2 (dinoprostone, prostin) ⇒ relaxation of cervix → syntocinon; misoprostol, mifepristone
  • BCG Use: Tuberculosis immunisation, Bladder CIS, Ta - T1 grade 3 MoA: Unknown → Mitomycin
  • HRT Physiology: Oestrogen to treat symptoms (hot flushes, vagina dryness); progestogen to protect from endometrial cancer Types: Oestrogen only: post-hysterectomy Cyclical/sequential: if still having periods: oestrogens every day, progestogen either monthly at end of period or 3-monthly, for 12-14 days Continuous: post-menopausal (≥ 1y since last period) Contraindication (as for COCP) Family / history of breast, ovarian or endometrial cancer History of DVT / PE Heart disease Contraception: Need for two years after last period Barrier method - condom or diaphragm Hormonal - IUS
  • OCP Use: contraception, 3+1 weeks, withdrawal bleeding, start d1 or cover for 7d, window period (late + missed pills?); dysmenorrhea, menorrhagia, endometriosis, DUB MoA: oestrogen + progesterone, e.g. → microgynon 30 (ethinylestradiol + → levonorgestrel); suppress ovulation /endometrial proliferation, thicken mucous SE: mood swings, weight gain, breast tenderness, acne CI: pregnancy, cancer (breast, cervix, ovaries); smoking + >35y, Hx of thrombotic events, breast feeding → POP, IUD (copper), IUS (mirena, Jaydess); implant, depot injections
  • POP --
  • Mefanemic acid Use: Endometriosis
  • Mefanemic acid Use: Endometriosis, dysmenorrhoea MoA: NSAID SI: GI bleeding, vomiting, headache, kidney damage → Tranexamic acid, ibuprofen
  • Mirena coil Use: Hormonal IUS, Contraception, menorrhagia, dysmenorrhea; effectiveness: immediate if inserted within first 7d, else cover with condoms for 7 days, up to 5 years MoA: Progesterone --> thickened mucous, thin endometrial lining SE: irregular bleeding, mood swings, breast tenderness, acne CI: pregnancy, cancer (breast, liver, cervix), I/M or P/C bleeding, STI, PID → Jaydess, copper coil (IUD), OCP, POP, implants, depot injections
  • Bicalutamide Use: Prostate cancer MoA: Androgen receptor antagonist SE: increased teststerone + oestrogren levels ⇒ reduced libido, ED, weight gain, gynaecomastia; osteoporosis → tamsulosin, prazosin, doxazosin; finasteride, dutasteride
  • Syntocinon Use: Induction / augmentation of labour, PPH, active management of 3rd stage of labour; termination of pregnancy MoA: Synthetic oxytocin → uterotonic Dose: IV drip during labour, IM for PPH; measured in units SE: → ergometrine, syntometrine
  • Betahistine Use: Prevent attacks of merniere's disease MoA: H3 antagonist, H1 agonist S/E: headache, insomia, GI upset Cautions: Asthma, peptis ulcer disease
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  • Prochlorperazine --
  • Cinnarizine --
  • Demeclocycline Use: SIADH (dilutional euvolaemic hyponatraemia; infections MoA: Vasopression antagonist, tetracycline antibiotic S/E: GI upset, thrush etc C/I: pregnancy, renal impairment, SLE, porphyria → tetracycline
  • Dronedarone Anti-arrhythmic --> amiodarone
  • Alphaderm --
  • Eumovate --
  • Betnovate --
  • Dermovate --
  • Raloxifene Use: Osteoporosis MoA: Selective oestrogen receptor modulator → alendronate, bisphosphonates
  • Pinaverium Use: reduce the pain duration in irritable bowel syndrome (IBS)
  • Nebivolol Use: Hypertension, heart failure MoA: Selective β1 antagonist →carvedilol; frusomide, ACE-I's; spironolactone, digoxin
  • Terbinafine Use: fungal toe infection, several toes MoA: antifungal Covers both dermatophytes and candida species → fluconazole, ketoconazole
  • Methylphenidate aka ritaline Use: ADHD MoA: stimulant S/E: headache, insomnia, anorexia Monitor: weight, growth, BP, HR → atomoxetine; antipsychotics
  • Amoxetine MoA: Stimulant Use: ADHD S/E: less likely to exacerbate ticks and epilepsy → methylphenidate
  • Rifamixin Antibiotic, no GI absorption; for hepatic encephelopathy
  • Bupropion Atypical antidepressant, smoking cessation C/I: epilepsy
  • Enoxaparin --
  • Dalteparin --
  • Pabrinex --

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