MEDICINE-QUESTIONS FOR ORAL EXAM

ENDOCRINOLOGY
1. Diabetes mellitus type 2 – oral hypoglycemics.
2. Diabetes mellitus type 2 – oral antihyperglycemics.
3. Incretin system drugs in the treatment of diabetes.
4. Drugs in the treatment of diabetes complications.
5. Drugs in the treatment of exocrine pancreas disorders.
6. Diabetes mellitus type 1 – insulins (types).
7. Osteoporosis-prophylaxis.
8. Osteoporosis – therapy.
9. Hyperthyroidism – drugs in the treatment of thyroid gland hyperfunction.
10. Hypothyroidism – drugs in the treatment of thyroid gland hypofunction.
11. Thyroid gland malfunctions as a result of use of drugs.
12. Pharmacotherapeutic use of corticosteroids.
13. Pharmacotherapeutic use of hormones of hypothalamus and pituitary gland posterior lobe.
14. Drugs in the treatment of diabetes insipidus.
15. Drugs in the induction of labor and in the treatment of postpartum hemorrhage and
galactostasis.
16. The role of female sex hormones in pharmacotherapy.
17. The role of male sex hormones and anabolic steroids in pharmacotherapy.
CARDIOLOGY AND BLOOD DISORDER
18. Antiarrhythmics – drugs for the treatment of atrial arrhythmias.
19. Antiarrhythmics – drugs for the treatment of ventricular arrhythmias.
20. Antiarrhythmics – arrhythmia as a result of interactions and adverse effects of drugs.
21. Hypertension – drugs of first choice in the treatment of hypertension
22. Hypertension – drugs of second choice in the treatment of hypertension
23. Hypertension and Diabetes
24. Hypertension and bronchial asthma.
25. Hypertension and hyperlipoproteinemia.
26. Hypertension and arrhythmias.
27. Angina pectoris – drugs for the treatment and prophylaxis of stable angina pectoris.
28. Angina pectoris – drugs for the treatment and prophylaxis of unstable angina
29. Angina pectoris – drugs for the treatment and prophylaxis of vasospasmatic angina pectoris.
30. Drugs in the treatment of acute myocardial infarction
31. Drugs in the secondary prevention of acute myocardial infarction
32. General principles (goals) in the treatment of heart failure
33. Treatment of overdose with cardiotonics.
34. Drugs in the treatment of acute pulmonary edema
35. The treatment of hypercoagulable condition – oral anticoagulants.
36. Treatment of hypercoagulable states – parenteral anticoagulants.
37. Antiplatelet drugs.
38. Drugs in the treatment of hyperlipoproteinemia.
39. Drugs in the treatment microcytic, sideropenic anemia.
40. Drugs in the treatment megaloblastic anemia.
CNS
41. Opioids in the treatment of pain.
42. Opioids – indications other than pain
43. Drugs in the treatment of mild and moderate pain.
44. Drugs in the treatment of neuropathic pain.
45. Treatment of colic pain.
46. Clinically significant interactions between NSAID and other drugs.
47. Drugs in the treatment of epilepsy.
48. Clinically significant interactions of antiepileptic drugs.
49. Local anesthetics.
50. Principles of general anesthesia.
51. Treatment of anaphylactic shock.
VNS
52.Treatment of acute rhinitis.
53. Therapeutic use of parasympathomimetics.
54. Therapeutic use of parasympatholytics.
55. The treatment of overdose with scopolamine and atropine.
56. The treatment of poisoning with cholinesterase inhibitors.
57. The treatment of involuntary urine passing (incontinentio).
58. The therapeutic use of botulinum toxin.
ANTIMICROBIAL AGENTS
59. Antimicrobial agents for the treatment of streptococcal pharyngitis
60. Antimicrobial agents for the treatment of skin and soft tissue infections
61. Noncomplicated lower urinary tract infections: causes and treatment
62. Complicated lower urinary tract infections: causes and treatment
63. Antimicrobial agents for the treatment of sinusitis
64. Antimicrobial agents for the treatment of pneumonias
65. Antimicrobial agents for the treatment of intraabdomianl infections
66. Antimicrobial agents for the treatment of osteomyelitis
67. Drug treatment of benign prostatic hyperplasia: classification, mechanism of action and
principles of application
68. Drugs used for the treatment of Benign Prostatic Hyperplasia: adverse reactions,
interactions
69. Drugs for the treatment of erectile dysfunction: mode of action, indications
70. Drugs for the treatment of erectile dysfunction: adverse reactions, interactions
71 Drugs for the treatment of chlamydial infections
72. Prophylactic use of antibacterial agents.
73. Agents in the treatment of viral infections.
74. Agents in the treatment of HIV infection.
75. Agents in the treatment of protozoal and helminth infections.
76. Aminoglycosides: mechanism of action, adverse effects and interaction with other
medicines.
77. Aminoglycosides: therapeutic use, contraindication and special warnings and precautions
for use.
78. Tetracyclines: mechanism of action, adverse effects and interaction with other medicines.
79. Tetracyclines: therapeutic use, contraindication and special warnings and precautions for
use.
80. Quinolones: division and mechanism of action.
81. Quinolones: pharmacokinetics, antibacterial spectrum, adverse effects and interaction with
other medicines.
82. Quinolones: therapeutic use and contraindications.
83. Nitroimidazoles: mechanism of action, pharmacokinetics, side effects and interactions.
84. Nitroimidazoles: therapeutic use, contraindications.
85. Sulfonamides: division, mechanism of action and side effets.
86. Sulfonamides: therapeutic use.
87. Co-trimoxazole: pharmacokinetics, therapeutic use.
88. Antufungal medicines: division and mechanism of action.
89. Antufungal agents for systemic administration.
90. Antifungal agents for topical administration.
91. Medicines for the treatment of tuberculosis.
PSYCHOPHARMACOLOGY
92. Anxiolytics
93. Sedatives and hypnotics
94. Antidepressants
95. Mood stabilizers
96. Antipsychotics
97. Drugs in the treatment of Parkinson’s disease
98. Drugs in the treatment of Alzheimer’s disease
99. Drugs in the treatment of peptic ulcer disease
100. Spasmolytics
101. Drugs in the treatment of nausea and vomiting
102. Treatment of diarrhea
103. Treatment of constipation
104. Treatment of ulcerative colitis
105. Drugs in prophylaxis of bronchial asthma and COPD
106. Drugs for treatment of asthma attacks and worsening of COPD
107. Basic principles of COPD treatment
108. Antitussives
109. Expectorants
GENERAL PHARMACOLOGY
110. Drug interactions – importance and classification according to the place where they
happens.
111. Clinically significant pharmacokinetic interactions.
112. Clinically significant pharmadynamic interactions.
113. Drug interactions: how to reduce the risk of drug interactions and make the therapy to be
safe.
114. Adverse drug reactions: definitions, division.
115. Adverse drug reactions: types of adverse drug reactions.
116. Adverse drug reactions: reporting and monitoring.
117. Drug abuse and drug dependence (types of drug dependence).
118. Specifics of pharmacotherapy in elderly patients.
119. Adverse drug reactions in geriatric population.
120. Specifics of pharmacotherapy in certain pathological conditions.
121. Specifics of drug use in pregnancy.
122. Specifics of drug use in breastfeeding.
123. The influence of gender on drug use.
 Endokrina

Diabetes:
I. Oralni hipoglikemici

1. Derivati sulfonilureje
 tolbutamin
 glibenklamid
 glipizid
 glimepirid

2. Meglitinidi
 repaglinid
 nateglinid

II. Antihiperglikemici

1. Bigvanidi
 metformin

2. Tiazolidindioni
 pioglitazone
 rosiglitazone

3. Inhibitori alfa glukozidaze

 akarboza
 miglitol

III. Incretin sistem

1. Analozi inkretina
 eksanatid
 2. Inhibitor dipeptidil – peptidaze DPP
 sitagliptin
 vildagliptin

IV. Insulin – podela prema jacini, stepenu cistoce, vreme trajanja

1. Brzo i kratko dejstvo (5h, dimeri)

 insulin lispro
 insulin aspart
 insulin glulisine

2. Kratko dejstvo (8h, heksamer)

 standardni insulin

3. Srednje dugo dejstvo (24h)

 izofan insulin (insulin + protamin)
 insulin tipa lente (krista)

4. Dugo dejstvo (24h – bez dnevnog max effekta)

 insulin detemir
 insulin glargin

Osteoporosis:

I. Calcium – 1000 mg + vitamin D za profilaksu

 Calcium karbonat PO
 Calcium citrat PO
 II. Calcitonin – Padzet, osteoporoza, hiper Ca
 humani
 sintetski (lososov), samo PE

III. PTH
 teriparatide – analog
intermitentne doze – povecana aktivnost osteoblasta

IV. Vitamin D
profilaksa 400ij
terapija 4000ij
toksicnost 50000ij
 kalcitriol – kod HBI
 doksekalciferol – noviji, manje hiper Ca
 ergokalciferol D2
 holekalciferol D3

V. Hormonalna supstituciona terapija

 estrogen + progesteron – za menopauzu
 Raloxifen – selektivni modulator estrogenskih r
oba dobra za prevenciju

VI. Bifosfati – 1st line za osteoporozu, Padgets

 Etidronat
 Pamidronat

Hipertireoza: (Graves d, toksicna struma, amijodaron)

I. Thionamidi
 Propiltiouracil (PTU)
 Metilmazol
 II. Jodidi
 Kalijum jodid

III. Radioaktivni jod

 Sodium Iodide I 131

IV. Beta blokatori

 Propranolol

Hipotireoza: (low jod, Hashimoto, zracenje, litijum)

 Levotiroksin – T4
 Liothyronin – T3, retko, manji t ½, vise ND

Kortikosteroidi: ujutru, doziranje u odnosu na hidrokortizon, ND!!

1. Kratkodelujuci
 Hidrokortizon
 Kortizon - Kortizol
 Prednizon – Prednizolon
 Metilprednizolon

2. Srednje delujuci
 Fluprednizolon
 Fluokortolon
 Triamcinolon

3. Dugodelujuci
 Betanetazon
 Deksametazon

4. Mineralokortikoidi
  Fludrokortizon – glukokortikoidno i mineralokortikoidno
dejstvo, za Addison kao nadoknada
 Aldosteron

Hipotalamus i hipofiza

I. Nadbubreg
 Cosyntropin – ACTH, dijagnoza adrenalne insuf.
 Corticorelin – CRH, uzrok Kushinga

II. Hormon rasta

 Somatrem – analog GH
 Sermorelin – GHRH, insuf. hipofize ili hipotalamusa?
 Octreotide – analog somatostatin, akromegalija
 Pegvisomant – antagonista na GH r

III. Gonadotropni hormone

1. GnRH agonisti – pulsativna i kontinuirana administracija

 Gonadorelin
 Goserelin
 Buserelin
 Nafarelin
 Leuprolide

2. GnRH antagonisti
 Abirelix – kancer prostate
 Ganirelix – infertilitet

IV. Dopamine
 Bromokriptine
  Kabergoline

V. Neurohipofiza
 Oxytocin
 Vasopresin – V1, V2
 Desmopresin – only V2

Dijabetes insipidus:
Centralni – Desmopresin, Vasopresin
Nefrogeni – Hidrohlortiazid

Indukcija porodjaja:
 Oxytocin IV
 Dinoprostone – prostaglandin E2
 Misoprostol – prostaglandin E1, also za abortus

Zenski hormoni

I. Estrogeni – estrogen alfa i beta r

1. Prirodni – samo IM
 Estradiol
 Estriol
 Estron
2. Sintetski
 Etinil estradiol
 Mestranol
  Estradiol valerate – long acting IM

II. Progesteron

1. Prirodni
 Hidroksiprogesteron
 Medroksiprogesteron

2. Sintetski – derivati testosterona sa gestagenskim dejstvom

 Levonogestrel
 Norgestrel

III. Antiestrogeni
 Klomifen – infertilitet
 Tamoksifen – estrogen-zavisni tumori dojke
 Raloksifen – selektivni modulator estrogenskih r,
osteoporoza

IV. Antiprogestins
 Mifepriston - abortus
 Danazol

V. Inhibitori aromataze – androgen u estradiol

 Anastrozole – estrogen zavisan tumor dojke

Muski hormoni
dihidroepiandosteron – 5 Alfa reduktaza – dihidrotestosteron
testosterone u estradiol by aromataza
I. Androgeni

1. Prirodni testosteron – samo IV, first pass effect

2. Polu-sintetski estri – PO
 3. Sintetski – dodatni anabolicki efekat, gel, flaster, buccal – avoid
liver
4. Anabolicki steroidi
 Stanozolol, ND!

II. Antiandrogeni
 Ciproterone – antagonista na testosteronske r, karcinom
prostate
 Finasterid – inhibitor 5-alfa reduktaze, hiperplazija prostate

Kardiovaskularni sistem

Hipertenzija: 1st choice

I. Beta Blokatori

B1 – srce (-), bubrezi (RAA)

B2 – vazokonstrikcija, bronhokonstrikcija, jetra – hipoglikemija

1. Kardioselektivni B1 – AMEBA
 Atenolol
 Metoprolol
 Esmolol
 Bismolol
 Acebutolol

2. Neselektivni B1, B2 – PNP

 Propranolol
 Nadolol
 Pindolol
 3. Hidrofilni
 Atenolol
 Soltalol

4. Lipofilni
 Metoprolol
 Propranolol

5. ISA – intrinsic simpatomimmetic activity

 Pindolol
 Acebutalol

6. Mixed – alfa 1, B1, B2

 Carvedilol
 Labetalol

II. Diuretici

1. Diuretici Henleove petlje – NaKCl simporter, ushodni krak hp

 Furosemid
 Etakrinska kiselina

2. Tiazidni diuretici – distalni tubul, resporpcija Na, Cl

 Hidrohlortiazid
 Indapamid

3. K sparing diuretici – razmena Na i K u zavrsnim tubulima

 Amilorid
 Triamteren

4. Spironolakton – antagonista aldosteronskih r, androgena

struktura (ND)

III. Ca Blokatori
 1. Nedihidropiridini – srce (L tip) i krvni sudovi (T tip)
 Verapamil
 Diltiazem

2. Dehidropiridini – samo krvni sudovi

 Amlodipin
 Felodipin
 Nifeldipin – fenomem koronarne kradje

IV. ACE inhibitori

 Enalapril – prolek
 Catopril – aktivni lek

V. Antagonisti angiotenzinskih receptora

 Losartan
 Valsartan

Hipertenzija: 2nd choice

I. Centralni simpatolitici – presinapticki alfa 2 agonist

 Clonidine
 Alfa-metildopa – za trudnice!! NE tokom laktacije

II. Alfa antagonisti

1. Selektivni – Alfa 1(hipertenzija i hiperplazija prostate)

 Prazosin
 Terazosin
 Doxazosin
ND: hipotenzija, bez refleksna tahikardija, poremecaj
ejakulacije
 2. Neselektivni
 Fentolamin – feohromocitom
ND:hipotenzija, refleksna tahikardija

III. Vazodilatatori – nagla vazodilatacija = cesta refleksna

tahikardija i moguca angina
 Hidralazin (NO, arterije)
 Na nitroprusid (arterije i vene)

Angina pectoris:

Prevencija – Beta blokatori, Ca blokatori, dugo delujuci organski nitrati

+ apirin 75-100 mg, statini, ACEi (ako je prisutan dijabetes)
Zaustavljanje napada – sublingvalni nitroglicerin

I. Beta blokatori – negativno inotropno i hronotropno, smanjuju

potrebe miokarda za O2, produzavaju dijastolu i povecavaju
prokrvljenost

II. Ca blokatori – negativno inotropno i hronotropno, periferna

vazodilatacija

III. Organski nitrati – donor SH grupe→NO→ ↑cGMP

→vazodilatacija

1. Dugo delujuci
 Izosorbid mononitrat (hidrosolubilan – jednake
koncentracije)
 Izosorbid dinitrat (liposolubilan – nejednake
koncentracije)
 Nitroglicerin – transdermalni flaster
  Penta eritriol – tetranitrat (manje glavobolja)

2. Kratko delujuci
 Nitroglicerin – sublingvalno, sprej, injekcija, PO (first pass effect)
ND – glavobolja, crvenilo lica, razmak izmedju doza

Vazospasticna angina – Ca blokatori, organski nitrati

Acute myocardial infarction:

Terapija – (MONA)
Morfin, O2, nitroglicerin, aspirin 300mg or klopidogrel, heparin IV, mogu BB
+ reperfuziona terapija – fibrinolitici (streptokinaza, urokinaza, plasminogen
aktivator) OR PCI percutaneous coronary intervention

Prevencija – nefarmakoloske mere, statini, aspirin / klopidogrel, BB kod

svih pacijenata!, ACEi kod hipertenzije ili dijabetes

Srcana insuficijencija:
Nemogucnost miokarda da istisne dovoljno krvi u jedinici vremena
Desno vs levo srce

Lekovi prvog izbora:

 Diuretici – odstranjuju visak vode, rasterecuje srce
 ACE inhibitori / ARB – smanjuju zadrzavanje vode i izazivaju
vazodilataciju
  Beta blokator – smanjuju dejstvo simpatikusa, ne kod kardijalno
dekompezovanih

Lekovi drugog izbora:

 Kardiotonicni glikozidi – ne produzavaju zivot ali na neko
vreme pomazu sa simptomima, mala terapijska sirina

I. Kardiotonicni glikozidi
 Digoxin
 Digitoxin – kumulacija, predoziranje, vise se NE koristi
 Medigoxin

Mehanizam dejstva:
1. Blokada K-Na-ATPazu, blokirana razmena izmedju K i Na, otvaraju
se alternativni kanali za izlazak Na, ulazi Ca = jace kontrakcije
miokarda!
2. Stimulacija vagusa (parasimpatikus) = negativno hronotropno,
usporen srcani rad i bolje punjenje
3. Indirektno – veci protok krvi kroz bubrege, diureticki efekat

ND: extrakardijalna (vagus i CNS) – mucnina, povracanje, gubitak

apetita, povecanja salivacija, poremecaj vida
Kardijalna – prvo bradikardija, pa tahiaritmija i srcani zastoj

Predoziranje: use PO Kalijum, kod teskih stanja antitela digoxina!

Interakcije:
Diltiazem, Verapamil – smanjuje clearance digoxina
Diuretics – low K, precipitate digoxin toxicity, ako ima aritmije daju se BB
Akutni plucni edem – O2, morfin, IV furosemide, vazodilatatori (IV
nitroglicerin, nitroprussin ako je TA veci od 100mm Hg)

Antikoagulanti

1. Oralni antikoagulanti

 Warfarin – 36h t 1/2

 Acenokumarol – 10h
Inhibicija enzima vitamin K epoksid reduktaze – no
sinteza protrombina, faktora koagulacije VII, IX, X
Produzeno protrombinsko vreme
ND – alopecija, krvarenje (INR manje od 4), osteoporoza,
NO u trudnoci, hirurgiji, bakterijski endocarditis, DIK
Interakcije – NSAILs i hipoglikemici (protein plazme), CYP
3A4, antibakterijski lekovi sirokog spectra (low K u GIT)

 Apiksaban – noviji, antagonizam a faktora X

 Ribaroksaban

2. Parenteralni antikoagulanti

 Visokomolekularni heparin, sporo IV or supkutano

Direktno se veze za antitrombin III, inhibise pretvaranje

fibrinogena u fibrin, antagonizan faktora X,
antiagregacijski i antizapaljenski efekat
 Brzo deluje! t1/2 1-2h, kontrolisati APTT
ND: trombocitopenija izazvana heparinom!
ANTIDOT – Protamin sulfat!

 Niskomolekularni heparin - enoksaparin

Veci afinitet za X factor, manje za antitrombin

Duze t1/2, supkutano, redje krvarenje

Antiagregacijska terapija
1. Acetilsalicilna kiselina – blokada tromboxan A2

2. Antagonizam Adenozin Difosfata (ADP)

 Klopidogrel – dvojna terapija sa aspirinom
 Tiklopidin
ND: depresija kostane srzi (tiklopidin), ne inhibisu
prostaglandine u GIT ali su skuplji

3. Glikoproteinski IIb/IIIa receptorski antagonisti

 Abciksimab, IV
Inhibicija vezivanje fibrogen za receptore i
stvaranje
Akutni antiagregacijski efekat – akutni IM,
kardiohirurgija

4. Dipiridamol – prvo angina pectoris ali fenomen

pogresne preraspodele krvi, sada + aspirin
Hiperlipoproteinemija
Hipoproteinemija
Ako je HDL h nizak – fibrate
Povisek ukupan holesterol i trigliceridi – statini

I. Statini
 Lovastatin
 Pravastatin
 Fluvastatin

II. Fibrati
 Fenofibrat
 Ciprofibrat

III. Ostali lekovi

 Nikotinska kiselina
 Ezetimib