MasterPass 2 PHARMA 7

80%.

Lithium should be discontinued 72 hours prior to surgery, except for minor surgery under local anaesthesia.

Imidazolbenzodiazepine.

Tonic-clonic seizures, status epilepticus, anxiolysis, alcohol withdrawal, muscle spasm, sedation, and premedication.

Within 1–2 minutes.

Tablets (100/200/500 mg), syrup (40 mg/mL), and powder (400 mg ampoules for dissolution in water).

100 μg boluses, titrated to effect, with a maximum of 1 mg.

A chronic disease resulting from paroxysmal, episodic, abnormal and spontaneous discharge of electrical activity in the brain.

To reverse the effects of benzodiazepines, especially in cases of overdose.

It may cause histamine release.

It is classified into generalized and partial (focal) seizures.

They increase the duration of opening of the GABA-A chloride channel when stimulated.

A synthetic α1 agonist.

Methylxanthine derivative.

It lasts between 15 minutes to 2 hours.

10–20 mg/L.

A potentially life-threatening adverse drug reaction resulting from increased levels of serotonin in the brain stem and spinal cord.

10 mg/mL.

An anaesthetic machine, although it may be administered through in-line devices in certain critical care ventilators.

β-blockers and NSAIDs.

100 mg every 8 hours.

Tablets (100/200/400 mg), suppositories (125/250 mg), and syrup (20 mg/mL).

20 mg.

Reversible airway obstruction secondary to bronchoconstriction.

Severe symptoms may occur within 1 hour due to a narrow therapeutic index.

ECG monitoring due to the risk of various cardiovascular abnormalities.

Consciousness is impaired, confined to one brain region, and may involve automatisms.

Continuous monitoring of blood pressure, ECG, CNS, and arterial pH, with ventilatory support if needed.

Anticonvulsant and Class 1b antiarrhythmic.

Treatment of epilepsy, especially generalized seizures and infantile spasms.

BDZ1 causes anxiolysis and is found in the spinal cord and cerebellum; BDZ2 causes sedation and has an anticonvulsant effect, found in the spinal cord, hippocampus, and cerebral cortex.

Oral, nasal, PR, IM, IV, intrathecally, and epidural.

5–20 mg, titrated to effect.

Neuromuscular monitoring due to prolonged neuromuscular blockade.

50–500 μg/mL.

It occurs at plasma levels greater than 35 μg/kg.

To increase SVR and as a nasal decongestant.

First published in 2009 and updated in 2014.

Hypertension, serotonin syndrome, orthostatic hypotension, psychosis, headaches, insomnia, sexual dysfunction, weight gain.

Benzodiazepine.

Treatment should be gradually discontinued, and if continued, benzodiazepine premedication should be used.

It can cause noradrenaline release.

Gas analysis and scavenging.

They facilitate the binding of GABA to its respective receptor and increase the frequency of opening of GABA-A channels.

Tablets (100/225/350 mg), suppositories (180/360 mg), and clear colourless solution (25 mg/mL).

By altering the balance of central neurotransmitters.

Seizures that involve both cerebral hemispheres and impair consciousness.

100–1600 mg/day.

It works within 1 minute.

Changes in behavior, increased motor activity, autonomic instability, seizures, rhabdomyolysis, renal failure, arrhythmias, coma, and death.

It causes histamine release.

Metformin for overweight and non-overweight patients, sulphonylurea for non-overweight patients or those who cannot take metformin, rapid-acting secretagogues (meglitinides) for people with erratic lifestyles, and acarbose if the above are not tolerated.

It reversibly inhibits GABA transaminase, the enzyme that breaks down GABA.

Up to 100% due to its high lipid solubility.

Antiepileptic effects, headache, diplopia, ataxia, and sedation.

40%.

It decreases uterine blood flow and increases uterine contractions.

Increases heart rate (HR), cardiac output (CO), and can be arrhythmogenic at higher doses.

Correcting hypoxaemia and reducing airways resistance through bronchodilation.

Agonist at benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of GABA’s Cl- ion channel.

Thrombocytopenia and impaired clotting.

Disease control defined by absence of symptoms, no activity limitations, and normal lung function.

156 L/kg.

Minimal respiratory suppression and blunts response to pCO2 at high doses.

Increased risks of heart failure, hepatic enzyme derangement, limb fractures, and bladder cancer.

Mainly α1 receptors with some β activity.

Agonist at the benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of the Cl- ion channel.

Treatment of epilepsy, especially generalized seizures and infantile spasms.

They can cause dependence syndromes, particularly drug withdrawal.

Hypotension and treatment of priapism (off-license use).

600–2500 mg/day in 2 divided doses.

Hirsutism, gum hyperplasia, and megaloblastic anemia.

Dose-dependent hypertension and common GI and CNS side effects similar to SSRIs.

Allergens, tobacco smoke, cold air, exercise, viral infections, and certain drugs.

A seizure where consciousness is preserved and symptoms depend on the origin.

8–20 hours.

Drugs enhancing GABA-mediated inhibition and drugs modulating sodium flux in nerves.

Liver function tests (LFTs).

Type 1 respiratory failure due to ventilation–perfusion mismatching.

Hypnosis, sedation, anxiolysis, anterograde amnesia, and decreased cerebral metabolic oxygen requirements.

In urine (main route) and faeces.

To assess response and improve asthma control.

76%.

Hypersensitivity reactions including anaphylaxis, angioedema, and Stevens-Johnson syndrome.

It acts as a competitive antagonist at benzodiazepine receptors.

15 mg/kg.

An imbalance in neurotransmitters such as serotonin, norepinephrine, and dopamine.

30–60 μg/min, titrated to response.

Increased risk of GI and post-operative bleeding due to inhibition of cytochrome P450, potentiating effects of warfarin and impairing platelet function.

It can precipitate seizures and reduce post-operative shivering.

By hepatic metabolism through monoamine oxidase.

Hepatic metabolism to an active compound; induces liver enzymes with chronic use.

It undergoes hepatic metabolism and is excreted in urine, with no significant active metabolites.

They block the bronchoconstricting effects of leukotrienes on the airways and act synergistically with inhaled steroids.

GABA (gamma amino-butyric acid).

Morphine, fentanyl, alfentanil, and remifentanil.

99%.

Maintain SaO2 > 92%.

Decreases blood pressure (β2) and can increase heart rate and contractility (β1).

Decreases uterine tone, causes hypokalaemia, increases blood glucose and fatty acids, and can cause anxiety and sweating.

Serotonin syndrome.

Withdrawal symptoms or discontinuation syndrome, especially with paroxetine.

Congestive cardiac failure and patients at increased risk of fractures.

Drugs that do not fit into standard categories and have varied uses.

It is a good bronchodilator and may be used in resistant bronchospasm.

10 mg/mL.

50–100 μg, repeated as necessary.

0.5 mg, titrated to effect.

900 mg in 2–3 divided doses.

By binding to inactivated fast Na+ channels, reducing sodium influx and stabilizing the membrane.

Sulphonylurea to first-line metformin, metformin to first-line sulphonylurea, meglitinides to first-line metformin, and DPP-4 inhibitors or TZDs to first-line metformin or sulphonylurea.

History of epileptic activity, underlying pathology, type and frequency of seizures, occupation, driving status, and drug history.

They prevent the breakdown of monoamine neurotransmitters by inhibiting the monoamine oxidase enzyme.

A beneficial metabolic response, specifically a decrease in HbA1c.

Asthma, COPD, hyperkalaemia, and uncomplicated pre-term labour.

By the parasympathetic nervous system through acetylcholine release.

It decreases renal blood flow.

Sedation and weight gain due to blockade of various postsynaptic 5-HT2 receptors.

10–40 mg at night.

Inhibits succinic semialdehyde dehydrogenase, increasing brain levels of GABA, and may stabilize sodium channels.

40 mg prednisolone orally or 200 mg hydrocortisone intravenously followed by 50–100 mg hydrocortisone every 6 hours.

Increases hepatic sensitivity to insulin, promoting glucose clearance.

It is an excellent bronchodilator and should be considered in resistant bronchospasm.

Binds to inactivated fast Na+ channels, reducing sodium influx and stabilizing the membrane.

53 minutes.

It may cause histamine release.

A β2 agonist with some small β1 activity.

50%.

It causes a rapid increase in SVR lasting 5–10 minutes.

Neuroleptic malignant syndrome.

Direct stimulation of β2 receptors with less pronounced action at β1 receptors.

Inhibits insulin release, causes hyperglycemia, increases lipolysis, and raises basal metabolic rate and temperature.

It causes increased flux of chloride or potassium ions into the cell, leading to hyperpolarization of the membrane and stabilizing the synapse.

Weakly diuretic, inhibits tubular Na+ reabsorption.

Propofol, etomidate, benzodiazepines, and inhalation agents.

Hepatic metabolism with a small amount excreted unchanged in urine.

Imipramine, amitriptyline, doxepin, and dosulepin.

Increased anaesthetic requirement and potential cardiac depressant effects.

NSAIDs, loop and thiazide diuretics, and ACE inhibitors.

It is a potent α adrenoreceptor agonist with no effect on β receptors.

Second-generation antidepressants that include venlafaxine and duloxetine.

Agonist at the benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of GABA’s Cl- ion channel.

Seizures that occur in one region of the brain.

Anticholinergic effects, cardio- and neurotoxicity, pulmonary hypoventilation, and metabolic acidosis.

MAO-A and MAO-B.

Churg–Strauss syndrome (eosinophilia, vasculitic rash, pulmonary infiltrates).

Asthma, COPD, hyperkalaemia, and uncomplicated pre-term labour.

Increased airways resistance and reduced expiratory gas flow.

Decreases systemic vascular resistance (SVR) by one-third and increases heart rate (HR).

Apnoea.

Inhaled short-acting β2 agonist (e.g., salbutamol) as required.

Continue peri-operatively and be aware of drug interactions that may precipitate serotonin syndrome.

It blocks phosphodiesterase, increasing intracellular cyclic AMP, leading to bronchodilation.

Increase insulin secretion and lower glucagon secretion by inhibiting DPP-4.

It inhibits the release of brainstem neurotransmitters, reducing the requirement for anaesthetic agents and prolonging neuromuscular blockade.

Tonic-clonic (Grand mal), Tonic, Myoclonic, Absence (Petit mal), Akinetic.

Tachyarrhythmias, tremor, seizures, nausea and vomiting, rhabdomyolysis.

4: ring closed (non-ionised, lipid soluble); < 4: ring open (ionised, less lipid soluble).

100 μg, 2 puffs as needed (prn).

Almost 100%.

Increased SVR and blood pressure, may cause reflex bradycardia.

GABA-A, a ligand-gated chloride ion channel, and GABA-B, a G-protein-coupled receptor.

Tramadol, pethidine, and linezolid.

Hepatic metabolism with metabolites and unchanged drug excreted in urine.

A mood stabilizer used in the management of bipolar disorder.

5–11 hours.

CNS: sedation, confusion, tremors; CVS: sinus bradycardia, AV block, hypotension.

Severe tachycardia and lactic acidosis.

Indirect-acting sympathomimetics and certain direct-acting sympathomimetics should be used in lower doses.

Direct stimulation of β2 receptors with less pronounced action at β1 receptors.

The first class of antidepressants developed, used infrequently now due to lethal interactions.

Increases systemic vascular resistance (SVR), blood pressure (BP), and coronary artery blood flow.

40–100 mg/L.

Slight, transient decrease in blood pressure and increased coronary artery vasodilation.

Sedation, especially for insomnia.

1–4 hours.

It requires blood glucose and HbA1c monitoring, and caters for individual indications, contraindications, lifestyles, and circumstances.

Bronchodilation and increased diaphragmatic contractility.

0.8–1.4 L/kg.

Second-generation antidepressants that increase serotonin levels by selectively inhibiting its re-uptake.

GI effects, CNS effects, sexual dysfunction, and increased risk of bone fractures.

100%.

Increase inhaled steroid dose or consider other therapies like leukotriene receptor antagonists or slow-release theophylline.

Inhibition of intestinal alpha glucosidase, delaying absorption and digestion of sucrose and starch.

Hepatic metabolism to active compounds such as Desmethyldiazepam, Oxazepam, and Temazepam.

They selectively block serotonin (SERT) and norepinephrine transporters (NET) at the presynaptic membrane, increasing levels of serotonin and norepinephrine in the postsynaptic membrane.

Approximately three deaths per day.

Severe hypertension, nausea and vomiting, tissue necrosis with extravasation.

Agranulocytosis, mild neutropenia, and aplastic anemia.

90%.

To adsorb TCA in the stomach if administered within 2 hours of ingestion.

Sedation, anxiolysis, and induction of anaesthesia in unstable patients.

It reverses metabolic acidosis, increasing protein binding and reducing bioavailability of TCAs.

It is used for oxygen-driven nebulisation to deliver bronchodilation.

It prevents the repetitive opening and closing of fast Na+ channels, reducing action potentials.

Inhaled steroid 200–800 μg/day.

A mixture of helium and oxygen that may improve gas flow by reducing work of breathing, though not recommended by the British Thoracic Society.

Insulin to metformin and sulphonylurea, exenatide to metformin and sulphonylurea, and DPP-4 inhibitors or TZDs to metformin and sulphonylurea.

Ketamine and etomidate, as they can lower the seizure threshold.

Craniofacial abnormalities, limb abnormalities, and growth retardation.

Continue peri-operatively; may potentiate effects of warfarin; avoid drug interactions that could cause serotonin syndrome.

Mainly supportive care, usually requiring intensive care.

Antidepressants such as mianserin and mirtazapine that promote noradrenergic and serotonergic neurotransmission via α2 antagonism.

Drowsiness, hepatic dysfunction, pancreatitis, nausea, vomiting, hair loss, weight gain, and edema.

They reduce the metabolism of barbiturates, requiring lower doses.

They should be used with caution.

They may precipitate potentially fatal hypertensive crises.

It is an excellent smooth muscle dilator and is administered intravenously.

Used in combination with metformin or sulphonylureas, or as monotherapy.

High chance of gastrointestinal adverse effects, particularly flatulence and diarrhea.

Significant weight loss, appropriate for patients with BMI > 35 kg/m².

Anticonvulsant effects, hypnosis, sedation, anxiolysis, anterograde amnesia, drowsiness, and ataxia.

It is teratogenic.

Heart block, ventricular fibrillation, and asystole.

Benzodiazepines, barbiturates, sodium valproate, and vigabatrin.

500 μg every 6 hours.

They act primarily as serotonin-norepinephrine re-uptake inhibitors.

Anticholinergic effects, changes in appetite, CNS effects, and cardiovascular issues.

0.8 L/kg.

They bind to inactivated fast Na+ channels, reducing sodium influx and stabilizing membranes.

GI issues (nausea, vomiting, diarrhea), CNS effects (headache, sedation, tremors), hypothyroidism, and risk of lithium toxicity.

Pioglitazone.

Hypnosis, sedation, and anxiolysis.

It is an NMDA receptor antagonist with bronchodilating properties, used for sedation and treatment of bronchoconstriction.

Acts as an incretin-mimetic and is given by subcutaneous injection before meals.