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Amba is having issues Drug of the day Flashcards

1
Q

What drug class is Amiodarone in?

A

Class III anti-arrhythmic - a potassium channel blocker.

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2
Q

What is Amiodarone prescribed for?

A

To reduce heart rate. It does this by extending PR interval, increasing QRS and increasing QT interval.

AF, atrial flutter, SVT, VT and refractory ventricular fibrillation (VF).

Used only when other therapeutic options (drugs or electrical cardioversion) are ineffective or inappropriate.

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3
Q

Describe Amiodarone’s mechanism of action

A

Blocks K+ channels responsible for hyper-polarisation of the heart (=extend refractory period)

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4
Q

What are ADRs associated to Amiodarone?

A
  • Pulmonary fibrosis.
  • Hepatic injury.
  • Increased LDL cholesterol
  • Thyroid disease
  • Photosensitivity.
  • Transient blindness.
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5
Q

What DDIs must you be aware of, when prescribing Amiodarone?

A

Other anti-arrhythmic drugs

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6
Q

What drug class is aspirin?

A

A cyclo-oxygenase inhibitor

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7
Q

What is aspirin used for?

A

To inhibit platelet aggregation

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8
Q

How does aspirin work? (mech of action)

A
  • Inhibits COX-1
  • So, can not produce TXA2 from arachidonic acid
  • Also can not produce prostaglandins
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9
Q

What are some ADRs of aspirin?

A
  • GI irritation
  • GI bleeding
  • haemorrhage
  • hypersensitivity
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10
Q

What are some contraindications, when prescribing aspirin?

A
  • Reye’s syndrome, so avoid <16yrs.
  • Hypersensitivity.
  • 3rd trimester of pregnancy. Can cause premature closure of the ductus arteriosus.
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11
Q

What are possible drug interactions when taking aspirin?

A

Other anti-platelet drugs and other anti-coagulant drugs. (Note: these can be taken together, but we need to be mindful!)

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12
Q

What are common indications for aspirin?

A
  • Atrial fibrillation
  • Secondary prevention of stroke and TIA
  • Secondary prevention of ACS
  • After primary percutaneous coronary intervention and stent, to reduce ischaemia
  • Co-prescribed with other anti-platelets
  • NSTEMI/STEMI (300mg)
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13
Q

How does the dosage of aspirin differ for analgesic use and non-analgesic use (anti-platelet)?

A

For analgesic use, the dosage is 300mg. For anti-platelet use, the dosage is 75mg.

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14
Q

What drug class is Verapamil?

A

Non-dihydropyridine CCB (class IV).

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15
Q

What is Verapamil used for?

A
  • Arrhythmia.
  • Angina.
  • Hypertension.
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16
Q

Describe the mechanism of action of Verapamil?

A

Prolongs the action potential

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17
Q

What are the ADRs of Verapamil?

A

Constipation, bradycardia (i.v.), heart block, cardiac failure

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18
Q

What are some contraindications of Verapamil?

A

Poor/weak LV function and AV nodal conduction delay

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19
Q

What are some DDIs of verapamil?

A

B-blockers, other anti-hypertensive agents, other anti-arrhythmic agents.

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20
Q

What drug class is flecainide in?

A

Anti-arrhythmic agent (class Ic)

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21
Q

What is flecainide used for?

A
  • Supra-ventricular arrhythmias including atrial fibrillation and flutter.
  • Premature ventricular contractions
  • WPW syndrome
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22
Q

Describe the mechanism of action of flecainide

A

Increases PR interval, QRS and QT by decreasing the entry of sodium in heart cells. This causes prolongation of the cardiac action potential.

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23
Q

What are ADRs of flecainide?

A
  • Pro-arrhythmia.
  • GI disturbances.
  • flecainide flutter

From BNF:
-dizziness.
-vision disorders
-fever
-oedema

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24
Q

What are DDIs for flecainide?

A

Anti-arrhythmic drugs

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25
What class is salbutamol in?
ß2 agonist
26
What is salbutamol used for?
Symptom relief (reliever), can be used before, increase mucus clearance
27
What is salbutamol's mechanism of action?
Reverses bronchoconstriction. This mainly occurs on the smooth muscle of airways
28
What ADRs are associated to salbutamol?
- Adrenergic - fight or flight effects. These include tachycardia, palpitations, anxiety, tremors. - increase glycogenolysis and increase renin
29
What are DDIs for salbutamol?
ß-blockers - these can reduce the effect of the ß2 agonist.
30
What class of drugs does morphine belong to?
Opioid receptor agonist, specifically a strong agonist opioid.
31
What are common indications for morphine?
Analgesia and euphoria
32
Describe morphine's mechanism of action
- Binds to a µ MOP opioid receptor. - Morphine reacts with glucoronic acid. - This metabolises and forms M6G and M3G. - M6G allows for a therapeutic effect = analgesia
33
What are side effects of morphine?
Emesis, respiratory depression, GI effects, miosis, increased histamine release (caution with asthmatics), CVS (arrhythmias).
34
What are DDIs for morphine?
Other opioids, alcohol, drugs which cause CNS depressive effects (from BNF)
35
What drug class does fluticasone belong to?
Inhaled corticosteriods
36
What is fluticasone used for?
- To be used along reliever as a regular preventer, when the reliever is not enough. -To reduce mucosal inflammation and reduce mucus - To widen airways - To reduce symptoms and exacerbations - Prevent death
37
What is fluticasone's mechanism of action?
Activates cytoplasmic receptors, which pass into the nucleus to modify transcription. Result: turn on anti-inflammatory genes, and turn off genes for inflammation.
38
What are ADRs of fluticasone?
Cause local immunosuppressive action: candidiasis and hoarse voice
39
What are contraindications of ICS such as fluticasone in patients with COPD?
Risk of pneumonia at high doses
40
What drugs are part of the proton pump inhibitor (PPIs) class?
Omeprazole, Lansoprazole
41
What is omeprazole used for?
To reduce acid secretion in conditions such as GORD or peptic ulcers
42
How does omeprazole work?
Irreversibly inhibits H+/K+ ATPase in gastric parietal cells. This reduces acid secretion.
43
What are ADRs of omeprazole?
GI upset, diarrhoea, constipation, abdominal pain, heartaches, dizziness, drowsiness, confusion
44
What DDIs are associated to omeprazole?
Clopidogrel - omeprazole is a CYP inhibitor so will reduce the action of clopidogrel
45
What drug class does cyclizine belong to?
H1 receptor antagonist
46
What is cyclizine used for?
nausea/ motion sickness
47
How does cyclizine work?
Blocks H1 receptor on the central vestibular nuclei, so inhibits histaminergic signals from the vestibular system to the CTZ (chemoreceptor trigger zone) in the medulla
48
What are ADRs of cyclizine?
Sedation, excitation, anti-muscarinic action - such as dry mouth, constipation and urinary retention, cardiac toxicity - because it causes long QT interval
49
What drug class does metoclopramide belong to?
D2 receptor antagonists
50
What is metoclopramide used for?
To promote gastric emptying and increase peristalsis. This will hopefully relieve GORD and ileus
51
How does metoclopramide work?
Increases acetylcholine at muscarinic receptors in the gut.
52
How does metoclopramide promote gastric emptying?
Increased acetylcholine causes increased tone at the LOS as it closes, increased tone and amplitude of gastric contractions and reduces tone of the pylorus, so the pylorus opens.
53
What are ADRs of metoclopramide?
Galactorrhea (dopamine is usually inhibits prolactin, but bc we are inhibiting dopamine, we no longer have inhibition on prolactin, so it is released, causing galactorrhea). Extra-pyramidal effects such as Parkinsonism, dystonia
54
What are DDIs of metoclopramide?
L-Dopa for patients with Parkinsons
55
What class is low weight heparin (LWH) part of?
Heparins !!!!
56
What is LWH used for?
PE, DVT, VTE - to slop people having blood clots
57
How does LWH work?
LWH binds to AT III and changes the shape of it. This inhibits Xa, which then prevents the conversion of prothrombin to thrombin. If you can't form thrombin, you can't convert fibrinogen to fibrin. So clots can't be made
58
What are ADRs associated to LWH?
Bleeding, bruising
59
What DDIs should we be aware of when prescribing LWH?
Other anti-thrombin drugs. Warfarin, aspirin, NSAIDs, SSRIs
60
What class does apixaban belong to?
DOAC - Direct Oral Anti-Coagulant
61
What is apixaban used for?
VTE< PE, DVT, especially when clots have ben reccuring. May be prescribed when patent has AF
62
What is the mechanism of action of apixaban?
Directly inhibits free Xa and bound Xa
63
What ADRs are associated to apixaban?
Bleeding etc
64
What DDIs should we be aware of when prescribing apixaban?
Other anti-coagulants
65
What drug class is co-amoxiclav part of?
Betalactam antibiotics
66
What is co-amoxiclav used for?
Gram positive infections, but does have a broad range
67
How does co-amoxiclav work?
Interferes with cell wall synthesis. Clavaunic acid is a beta-lactamase inhibitor, so prevents bacterial enzyme beta lactase breaking down the antibiotic
68
When prescribing co-amoxiclav, what ADRs would you make the patient aware of?
GI upset, diarrhoea, skin reactions such as rashes, vomiting
69
What are DDIs for co-amoxiclav?
warafarin, as co-amoxiclav increases anticoagulant effects of warfarin.
70
what class is carbamazepine in ?
Na+ channel blocker (AED)
71
What is carbamazepine used for?
Epilepsy, neurological chronic pain, bipolar
72
What is the mechanism of action of carbamazepine?
Na+ channel blocker. Prevent channel going from inactive to closed. Therefore, can not be activated again. As a result, this reduces neuronal transmission.
73
What are ADRs of carbamazepine?
Suicidal thoughts, joint pain, BM fails, Steven Johnson syndrome, nausea, vomiting
74
What are DDIs of carbamazepine?
Therapeutic effect reduces with COCP, reduces with antibiotics, induces CYP - so affects warfarin (CYP3A4). Also need to be careful with statins and CCBs.
75
What class is co-careldopa part of?
Mix of L-Dopa and Carbidopa - DOPA decarboxylase inhibitor
76
What is co-careldopa used for?
Used in combination with L-dopa to increase the amount of L-DOPA reaching the brain. So, reduces the dose needed and side effects
77
How does co-careldopa work?
Inhibits DOPA decarboxylase - D2 receptor involved
78
What are ADRs of co-careldopa?
Involuntary movements, psychosis, difficulty sleeping, hallucinations, seizures, nausea, drowsiness, hypotension, mania (anything related to increasing dopamine) "wearing off affect"
79
What are DDIs of co-careldopa?
anti-psychotics, anti-emetics (metoclopramide)
80
What drug class does sodium valproate belong to?
Anti-epileptic (AED)
81
What is sodium valproate used for?
Epilepsy, bipolar, migranes
82
How does sodium valproate work?
Na+ channel blocker, GABAa (inhibits an enzyme that results in increase GABA. Increased GABA s an inhibitory NT, so reduces neuronal transmission), and CCB
83
What are ADRs of sodium valproate?
Liver failure, pancreatitis, lethargy, abdomen pain, weight gain
84
What are DDIs of sodium valproate?
Carbopenems (penicillins) - these reduce sodium valproate; other anti-epileptics

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