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202 Core Drugs Flashcards

1
Q

Core Drug : Diazepam
What class of drug?
Indication?

A

It is an anxiolytic
Indication - GAD and PD
(not so effective in OCD and PTSD)

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2
Q

Core Drug : Chlorpromazine
What class of drug?
Indication?

A

It is a typical antipsychotic (first one discovered)

Indication - Schizophrenia (primarily + symptoms), also mania

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3
Q 
Core Drug : Haloperidol
What class of drug?
Indication?
A

It is a typical antipsychotic (more potent than chlorpromazine)
Indication - Schizophrenia (primarily + symptoms), also acute manic episodes

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4
Q

What drugs can cause extrapyramidal symptoms?

A

Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. (E.g. Haloperidol)

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5
Q

What are extrapyramidal symptoms?

A

→ Extrapyramidal symptoms - parkinsonian symptoms, dystonia, akithisia, tardive dyskinesia

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6
Q 
Core Drug : Risperidone
What class of drug?
Indication?
A

It is an atypical antipsychotic (Atypicals do not have same extra-pyramidal side effects -lower activity at D2 receptor)
Indication - Schizophrenia, also mania

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7
Q

Core Drug : Clozapine
What class of drug?
Indication?

A

It is an atypical antipsychotic (Atypicals do not have same extra-pyramidal side effects -lower activity at D2 receptor)
It’s activity mainly at D4 receptors (also binds D3, D1, D2, D5), 5HT receptors
Indication - Schizophrenia (+ and - symptoms), also mania

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8
Q

Side effects of Clozapine (atypical antipsychotic)

A

Not extrapyramidal but - weight gain, sedation, hypersalivation, tachycardia, hypotension, neutropenia (needs to be watched - blood tests)

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9
Q 
Core Drug : Lithium
What class of drug?
Indication?
Positive effects?
Side effects?
A

antimanic agent - Used for mania and bipolar disorder
Anti-suicidal effects - strong evidence for prevention of relapses of any polarity
Narrow therapeutic index
Blood tests every 3 months for the 1st year
Adverse long-effects on kidney function with excessive levels and risk of lithium toxicity

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10
Q

Core Drug : Amitriptyline
What class of drug?
Indication?

A

Amitriptyline is a type of drug called a tricyclic antidepressant. (1st generation antidepressants)

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11
Q

Side effects of tricyclic antidepressants

A

Constipation, orthostatic hypotension, dry mouth, drowsiness, cardiac toxicity in overdose

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12
Q

Core Drug : Fluoxetine
What class of drug?
Indication?

A

SSRI’s

Used for the treatment of Major depression, OCD, PTSD, Panic, GAD, social anxiety

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13
Q

Side effects of SSRIs

A

Gastro-intestinal symptoms (nausea, diarrhoea), headache, irritability, anxiety, reduction of libido and sexual dysfunction

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14
Q

Positive’s of SSRIs

A

Low toxicity and safe in overdose
Large spectrum of action
Efficacy equal to tricyclics in outpatients

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15
Q

SSRI initial treatment phase

A

most delicate - due to prevalence of side effects over benefit - slow titration

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16
Q 
Core Drug : Paracetamol
What class of drug?
Good effects?
Mechanism of action?
Dangerous in?
Indication?
A

Analgesic - Not classically a member of the NSAID group
Minimal anti-inflammatory effects, but good analgesic/ anti-pyretic
Very well-tolerated with almost no contraindications
Mechanism of action is controversial
- Doesn’t bind COX1 or 2; weak inhibitor of prostoglandin
- May inhibit COX3 (CNS only) but relevance controversial
Dangerous in overdose
Indication - mild to moderate pain

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17
Q 
Core Drug : Ibuprofen
What class of drug?
Good effects?
Mechanism of action?
Indication?
A

NSAID
Short-term management of pain (and fever)
As anti-inflammatories (?) - gout, inflammatory arthritis, rheumatoid arthritis
NSAID’s All inhibit cyclo-oxygenase

18
Q

NSAID mechanism of action

A

All inhibit cyclo-oxygenase
Three isoforms
COX-1 - Constitutive expression – all tissues
Stomach, Kidney, Platelets, Vascular endothelium
Inhibition → anti-platelet activity, also side effects
COX-2 – Induced in inflammation (IL-1)
Injury, infection, neoplasia
Inhibition → analgesia and anti-inflammatory actions
COX-3 – CNS only?
May be relevant to paracetamol

19
Q

Indications for NSAID therapy

A

Short-term management of pain (and fever)
- As mild analgesics (orally and topically)
mechanical pain of all types
minor trauma
headaches, dental pain
dysmenorrhoea
- As potent analgesics (orally, parenterally, rectally)
peri-operative pain
ureteric colic
- As anti-inflammatories (?)
gout
Inflammatory arthritis eg ankylosing spondylitis, rheumatoid arthritis

20
Q

NSAID GI toxicity

A 
In the GI tract prostaglandins E2 and I2 
- Decrease acid production
- Increase mucus production
- Increase blood supply
NSAID inhibition in stomach and duodenum
- Irritation
- Ulcers (gastric 15-30%, duodenal 10%)
- Bleeding
Similar effect in the colon
- Colitis – esp with local preps e.g. rectal diclofenac
Upper GI bleeding
- Relative Risk 4.7 all users
- Azapropazone = 23.4
- Piroxicam = 18.0
- Small differences between others…
Biggest risk factor for GI bleed = previous GI bleed
Also
- Age
- Chronic disease (e.g.rheumatoid disease)
- Steroids
21
Q

NSAID nephrotoxicity

A 
Primarily related to changes in glomerular blood flow
Decreased glomerular filtration rate
Sodium retention
Hyperkalaemia
Papillary necrosis
Acute renal failure 0.5-1%
Avoid or dose adjust in renal failure
Avoid in patients likely to develop renal failure
22
Q

Core Drug : Codeine phosphate
What class of drug?
Indication?

A

Opioid analgesic

Mild to moderate pain

23
Q

Core Drug : Morphine
What class of drug?
Indication?
Side effects?

A

Opioid analgesic
Severe pain
Side effects - respiratory depression/airway loss, nausea/vomiting, constipation/pruritis, miosis

24
Q

Core Drug : Pizotifen
Indication?
Side effects?

A 
Prevention of vascular headache, 
Prevention of classical migraine, 
Prevention of common migraine, 
Prevention of cluster headache
Side effects - Appetite increased; dizziness; drowsiness; dry mouth; fatigue; nausea; weight increase
25
``` Core Drug : Carbamazepine What class of drug? Mechanism? Indication? Side effects? ```
Anticonvulsant Inactivates sodium channels, raises AP threshold and lowers excitability Used for seizure disorders and neuropathic pain Side effects - Nausea, vomiting, dizziness, drowsiness, constipation, dry mouth, or unsteadiness may occur.
26
``` Core Drug : Sodium valproate What class of drug? Mechanism? Indication? Side effects? ```
anticonvulsant (or anti-epileptic) Sodium valproate is an anticonvulsant which elevates GABA levels in the brain. Used for primary generalized epilepsy Side effects: Sedation, Tremor long term: Hair thinning, Weight gain, Menstrual irregularities, Encephalopathy, Parkinsonism
27
``` Core Drug : Phenobarbitone What class of drug? Mechanism? Indication? Side effects? ```
Barbiturate All forms of epilepsy except typical absence seizures, also anaesthesia The primary action of phenobarbital is to enhance the inhibitory actions of gamma-aminobutyric acid (GABA) on neurons
28
Barbiturates are an indirect agonist of what?
GABA(A) - increase the duration of channel openings (anaesthesia, epilepsy treatment)
29
``` Core Drug : Phenytoin What class of drug? Mechanism? Indication? Side effects? ```
``` anticonvulsants Used for Tonic-clonic seizures (grand mal seizure) , Focal seizures Side effects - problems with walking and coordination slurred speech confusion dizziness trouble sleeping nervousness tremors headache nausea or vomiting constipation skin rash irregular movement of the eye ```
30
some anti-epileptic drugs make myoclonic jerks and absences worse - which drugs?
phenytoin*, carbamazepine, gabapentin, pregabalin | *although phenytoin treats tonic clonic seizures so safe to use in status epilepticus
31
``` Core Drug : Ropinirole What class of drug? Mechanism? Indication? Side effects? Do not give this drug to people who have history of... ```
Dopamine agonists. Ropinirole is used alone or with other medications to treat the symptoms of Parkinson's disease (non-ergot - They have not been associated with a risk of heart damage and can be prescribed) Side effects: Confusion; dizziness; drowsiness; fatigue; gastrointestinal discomfort; hallucination; movement disorders; nausea; nervousness; peripheral oedema; sleep disorders; syncope; vertigo; vomiting Do not give this drug to people who have history of gambling due to Dopamine dysregulation syndrome - people complain of impulsive disorders - gambling, online shopping etc
32
What is Dopamine dysregulation syndrome (DDS)?
Dopamine dysregulation syndrome (DDS) is a dysfunction of the reward system observed in some individuals taking dopaminergic medications for an extended length of time. It typically occurs in people with Parkinson's disease (PD) who have taken dopamine agonist medications for an extended period of time.
33
``` Core Drug : Levodopa What class of drug? Mechanism? Indication? Side effects? ```
Levodopa is a dopamine precursor used in the management of Parkinson's disease. Side effects - nausea, dizziness, headache, insomnia, abnormal dreams, dry mouth, dyskinesia, anxiety, constipation, vomiting, and orthostatic hypotension
34
``` Core Drug : Selegiline What class of drug? Mechanism? Indication? Side effects? ```
``` Selegiline is a monoamine oxidase inhibitor used to treat major depressive disorder and Parkinson's. Side effects - dizziness. lightheadedness. fainting. dry mouth. nausea. vomiting. stomach pain. difficulty swallowing. ```
35
Levodopa-induced ... (LID) is commonly seen in Parkinson's disease patients treated with levodopa.
Levodopa-induced dyskinesia (LID) is commonly seen in Parkinson's disease patients treated with levodopa.
36
``` Core Drug : Entacapone What class of drug? Mechanism? Indication? Side effects? ```
COMT inhibitors Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase, allowing more levodopa to reach the brain. Entacapone is used in the treatment of Parkinson's disease as an adjunct to levodopa/carbidopa therapy Side effects - Nausea, vomiting, diarrhea, unwanted/uncontrolled movements, increased sweating, drowsiness, tiredness, dry mouth, gas, and abdominal pain may occur.
37
``` Core Drug : Donepezil What class of drug? Mechanism? Indication? Side effects? ```
Cholinesterase inhibitors Treatment of mild to moderately severe Alzheimer's dementia (a drug used to improve cognition and behaviour of people with Alzheimer's, but which does not slow the progression of or cure the disease.) Side effects - diarrhoea, headache and feeling sick (nausea)
38
``` Core Drug : Lidocaine What class of drug? Mechanism? Indication? Side effects? (injection) ```
``` Lidocaine is a local anaesthetic of the amide group (also an antiarrhythmic) Apply topically Lidocaine specifically blocks Na+ channels in the inactivated state - raises the threshold, lowers excitability, stopping AP locally Used for pain relief - topically, dentistry etc - It is also used to treat ventricular tachycardia. Side effects of injection = Low blood pressure (hypotension) Swelling (edema) Redness at injection site. Small red or purple spots on skin. Skin irritation. Constipation. Nausea. Vomiting. ```
39
``` Core Drug : Propofol What class of drug? Mechanism? Indication? Side effects? ```
Anaesthetic Side effects - Apnoea; arrhythmias; headache; hypotension; localised pain; nausea; vomiting The GABAA receptor is a target of many general anesthetics, such as propofol
40
``` Core Drug : Naloxone What class of drug? Mechanism? Indication? Side effects? ```
Opioid antagonist - A medication used to block the effects of opioids. (note - not the same as naltrexone, an opioid antagonist used to help with cravings and prevent drug relapse) Used for opiate overdose Side effects - Arrhythmias; dizziness; headache; hypertension; hypotension; nausea; vomiting
41
Naltrexone is used for what?
Opiate antagonist (note - not the same as naloxone) - used as a treatment to reduce alcohol consumption and craving in alcoholics, also smoking cessation
42
``` Core Drug : Suxamethonium What class of drug? Mechanism? Indication? Side effects? ```
A muscle relaxant used in modern anaesthesia to facilitate rapid sequence endotracheal intubation by providing skeletal muscle relaxation. It is known as a non-depolarising neuromuscular inhibitor. They are dangerous drugs - muscle paralysis - only administered by experienced people Side effects - Arrhythmias; bradycardia (may occur with repeated doses); flushing; muscle contractions involuntary; myoglobinaemia; myoglobinuria; post procedural muscle pain; rash

Core Drug Lists (12 decks)

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