MoDA

Question 1

Ketamine

Accepted Answer

Use: Anesthesia MoA: Intravenous; NMDA glutamate receptor antagonist; open channel blocker.; some anti-depressant properties → propofol, thiopental, etomidate

Question 2

Baclofen

Accepted Answer

Use: Spasticity in spinal cord lesions, multiple sclerosis MoA: GABAB receptor agonist SE: GI upset + many more → gabapentin/pregabalin; oxybutynin, interferon-β, steroids; alemtuzumab

Question 3

Ramelteon

Accepted Answer

Use: insomnia MoA: Melatonin receptor agonist →temazepam, diazeoam

Question 4

Phenobarbital

Accepted Answer

Use: Status epilepticus, epilepsy except absence seizures (→ethosuximide) MoA: Long-lasting barbiturate, half-life 2-7 days. Positive modulator of GABA_A reeptor beyond physiological limit SE: many → sodium valproate, lamotrigine, carbamazepine, ethosuximide, levetiracetam, phenytoin; diazepam, lorazepam

Question 5

Reboxetine

Accepted Answer

Use: major depression (biological symptoms) MoA: NA-selective NET inhibitor

Question 6

Benserazide

Accepted Answer

Use: Parkinson's MoA: Peripheral DCC inhibitor ~ carbidopa; → co-beneldopa

Question 7

Apomorphine

Accepted Answer

Use: refractory motor fluctations in Parkinson's disease MoA: non-selective dopamine receptor agonist SE: GI upset, impuls control disorders, sleepiness → ropinirole, pramipexole; bromocriptine, cabergoline

Question 8

Pramipexole

Accepted Answer

Use: Parkinson's disease ± co-careldopa; restless legs MoA: Selective D2-like dopamine receptor agonist SE: GI upset, impulse control, hypotension, dizziness, dayytime sleepiness (→driving) →ropinirole, apomorphine; bromocriptine, cabergoline

Question 9

Ropinirole

Accepted Answer

Use: 1st line for Parkinson's, restless legs MoA: Selective D2-like dopamine receptor agonist SE: GI upsets, psychosis, daytime sommnolence (→implications for driving) →pramipexole, apomoprhine; bromocriptine cabergoline, L-DOPA, entacapone/tolcapone; procyclidine/benzatropine

Question 10

Domperidone

Accepted Answer

Use: Reduce peripheral side effects of Parkinson treatment (nausea), anti-emetic MoA: D2-receptor antagonist, gastroprokinetic SE: Dry mouth, galactorrheoa, psychosis ~metoclopramide; → cyclizine; ondansetron

Question 11

Metoclopramide

Accepted Answer

Use: nausea + vomiting, inclduing migraine, delayed chemo, opiate-induced MoA: D2-receptor antagonist; prokinetic SE: extrapyramidal, galactorrhoea, gynacomastia ~domperidone; →cyclizine; ondansetron

Question 12

Cabergoline

Accepted Answer

Selective D2-receptor agonist; ergot-derivative Use: Hyperprolactinaemia, prolactinoma Not Parkinson's b/c of side effects: fibrosis ~ pramipexole, ropinirole, L-DOPA, etc.

Question 13

Antiemetics

Accepted Answer

Indications: Morphine*, chemotherapy, motion sickness, co-careldopa Antagonists 5-HT-3 - ondansetron D2 - metoclopramide, promethazine, domperidone mACh - scopolamine ~ hyoscine hydrobromide H1 - mepyramine, cyclizine*

Question 14

Tramiprosate

Accepted Answer

Future Alzheimer's treatment; block aggregation of amyloid plaques ~ cyclohexanehexols

Question 15

Diphenhydramine

Accepted Answer

Use: Allergy, pruritus MoA: Topical H1-antagonist →colestyramine

Question 16

Cetirizine

Accepted Answer

Use: symptomatic relief of allergy such as hay fever, chronic idiopathic urticaria MoA: 2nd generating non-sedating anti-histamine; selective H1-inverse agonist SE: drowsiness rare; GI upset; agitation → mepyramine, diphenhydramine, cyclizine, chlorphenamine, promethazine;→loratidine, fexofenadine

Question 17

Anti-arrhythmics

Accepted Answer

Vaughan-Williams Classes I - IV Na+ channel blockers - a) lidocaine, b), c) flecainide β-blockers: sotalol, metropolol amiodarone, sotalol Ca2+ blockers - diltiazem, verapamil Other adenosine cardiac glycosides - digoxin, ouabain

Question 18

Voltage-gated Na+ cannel

Accepted Answer

4x6 transmembrane domains voltage sensor in S4 loop selectivity filter in S5-6

Question 19

Caspofungin

Accepted Answer

Use: Invasive aspergillosis, invasive candidiasis; empirical treatment of systemic viral infections in neutropaenia MoA: β-1,3-glucan synthesis inhibitor → fluconazole, itraconazole; amphotericin B, nystatin, griseofulvin

Question 20

Griseofulvin

Accepted Answer

Use: Dermatophyte infections of the skin, scalp, hair and nails where topical therapy has failed or is inappropriate; taenia pedis caputisque MoA: systemic atifungal; targets microtubules → fluconazole, ketoconazole, miconazole; amphotericin B, nystatin

Question 21

Enfurvitide

Accepted Answer

HIV fusion inhibitor

Question 22

Lamivudine

Accepted Answer

Use: HIV, Hep B MoA: Nucleoside Reverse Transcriptase Inhibitor → zidovudine; nevirapine; saquinavir; enfuvirtide

Question 23

Raltegravir

Accepted Answer

Use: HIV infection + other drugs MoA: integrase inhibitor → zidovudine, nevirapine, saquinavir, enfuvirtide

Question 24

Na+ channels

Accepted Answer

Structure: 4x6 TM regions; voltage sensor, sensitivity pore; inactivation cycle LA's and anti-dysrhymthics, anti-epileptics

Question 25

K+ channels

Accepted Answer

Structure: twin-pore, 4x6 TM etc Examples HGIRK HCN Leak ATP-gated voltage-gated

Question 26

Ca2+ channels

Accepted Answer

Structure: 4x6 TM Types: L, T, N Modes: 0<1<2 → Ca2+ channel blockers

Question 27

Milrinone

Accepted Answer

Inodilator → PDE-III inhibitor; heart failure May precipitate dysrhythmias

Question 28

Bendroflumethiazide

Accepted Answer

Use: HTN ('D') MoA: Inhibits Na+ reabsorption in distal convoluted tubule SE: Electrolytes: ↓K+, ↓Na+, ↑Ca2+, ↑uric acid, ↓Mg2+ Oligospermia, impaired glycaemic control → hydrocholorothiazide, chlortalidone

Question 29

long QT syndromes

Accepted Answer

Mutation in K+ or Na+ channels off-target interactions of drug with hERG channels, e.g. terfenadine K+ channel blockers: amiodarone etc

Question 30

Ziconotide

Accepted Answer

Use: Chronic severe pain; non-steroid, non-NSAID analgesic administered by intrathecal infusion MoA: N-type voltage-gated Ca2+ channel, inhibits release of pro-nociceptive neurotransmitters in the CNS → opiates, NSAIDs, paracetamol

Question 31

Icatibant

Accepted Answer

Use: acute attacks of hereditary angioedema in patients with C1-esterase inhibitor deficiency MoA: Bradykinin B2-receptor antagonist; prevents sensitisation of TRPV1 via Gq → PKC; anti-inflammatory SE: nausea, dizziness, headache, pyrexia, injection-site reactions, rash, pruritus, erythema → ecallantide

Question 32

Diclofenac*

Accepted Answer

Use: Analgesic mild to moderate pain: rheumatic, gout, migraine Antipyretic: Fever in ENT infection in children MoA: COX-1/2 inhibitor SE: NSAIDs → GI events (bleeding, ausea, vomiting, diarrhoea) → misopriostol, PPI; asthma Dose: 50-150mg daily in 2-3 divided doses → ibuprofen, aspirin; paracetamol

Question 33

Nitrosoureas

Accepted Answer

Alkylating / carbamoylating anti-cancer agents Examples: Lomustine, carmustine

Question 34

Actinomycins

Accepted Answer

Class of intercalating anthracyclines → chromophores → Dactinomycin; mitomycin, daunomycin, doxorubicin/mitoxantrone

Question 35

Spectrum of antibiotics

Accepted Answer

Narrow -- Gram (+)-ve or (-)-ve, e.g. polymixin broad -- wide range limited -- single organism extended -- chemically enginered

Question 36

Tamoxifen

Accepted Answer

Use: certain hormone-dependent breast cancer MoA: Oestrogen receptor modulator; antagonist in breast cancer → cancer treatment; agonist in other tissues (bone) → no osteoporotic effects SE: legion, caution: endometrial cancer →taromifene

Question 37

Melphalan

Accepted Answer

Use: Certain cancers, incl melanome MoA: Alkylating nitrogen mustard

Question 38

Linezolid

Accepted Answer

Use: MRSA or VRSA MoA: Oxazolidinone antibiotic against Gram-(+), binds 50S subunit; Lipophilic, anti-protein, e.g. staph. aureus PVL toxin; no Gm- cover → clindamycin

Question 39

Lincomycin

Accepted Answer

Lincosamide antibiotic targetting protein synthesis Peptidyltransferase inhibitor at 50S subunit ∼ linezolid

Question 40

DNA-covalent anti-cancer agents

Accepted Answer

Nitrogen mustards: melphalan, cyclophosphamide (prodrug) → alkylating guanine; G-C → A-T Nitrosourea: lomustine, carmustine: chloroethyl side chains → alkylation / carbamaylation at guanosine aziridines: mitomycin C: alkylation / crosslinking platinum compounds: cisplatin

Question 41

Levetiracetam

Accepted Answer

epilepsy; mechanisms unknown == Keppra

Question 42

Oxybutynin

Accepted Answer

Use: urinary frequency, urgency, incontinence, e.g. in MS; neurogenic bladder instability, nocturnal enuresis MoA: M3 anticholinergic SE: antimuscarinic: constipation, urinary retention, dry mouth, blurry vision, confusion → darifenacin

Question 43

Lamotrigine

Accepted Answer

Use: Epilepsy, may be safer i pregnancy than → sodium valproate, also → carbamazepine MoA: Na+ channel blocker SE: dry mouth, GI upset → Sodium valproate, carbamzepine, phenytoin, levetiracetam

Question 44

Carbimazole

Accepted Answer

Use: hyperthyroidism, thyrotoxicosis MoA: Antithyroid drug SE: GI disturbance, agranulocytosis; hypothyroidism (safety net!) →levothyroxine, propylthiouracil

Question 45

Propylthiouracil

Accepted Answer

Use: Hyperthyroidism, thyrotoxicosis MoA: Antihtyroid drug SE: as carbimazole: GI upset, agranulocytosis (warn!); hypothyroidism → carbimazole; levothyroxine

Question 46

Co-amilofruse

Accepted Answer

Use: oedema MoA: →Amiloride + →furosemide

Question 47

Lansoprazole

Accepted Answer

Use: Gastro-Oesophageal Reflux Disease, heartburn, w/ NSAIDs, gastric & duodenal ulcers, ZE-syndrome MoA: Proton Pump Inhibitor SE: diarrhoea, glossitis, pancreatitis →omeprazole; ranitidine/cimetidine, gaviscon

Question 48

Tinzaparin Sodium

Accepted Answer

Use: VTE prophylaxis MoA: Low Molecular Weight Heparin, injection, anticoagulant / antithrombotic SE: Bleeding, thrombocytopaenia →dalteparin, unfractionated heparin

Question 49

Levothyroxine

Accepted Answer

Use: Hypo- and hyperthyroidism (block & replace) MoA: Thryroid hormone SE: Agitation, palpitation, heat intolerance, diarrhoea, insomnia, arrhytmias, anginal pain Dose: initially 50-100mcg PO OD up to maintenance 100-200mcg PO OD; before breakfast → carbimazole, propylthiouracil

Question 50

Insulin*

Accepted Answer

Basal-bolus short / medium / long acting Sliding scale Human vs non-human ??

MVST 1B (Subject) / MoDA (Lesson)