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Drug of the day > Amba is having issues Drug of the day > Flashcards

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
Q

What class is salbutamol in?

A

ß2 agonist

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26
Q

What is salbutamol used for?

A

Symptom relief (reliever), can be used before, increase mucus clearance

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27
Q

What is salbutamol’s mechanism of action?

A

Reverses bronchoconstriction. This mainly occurs on the smooth muscle of airways

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28
Q

What ADRs are associated to salbutamol?

A
  • Adrenergic - fight or flight effects. These include tachycardia, palpitations, anxiety, tremors.
  • increase glycogenolysis and increase renin
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29
Q

What are DDIs for salbutamol?

A

ß-blockers - these can reduce the effect of the ß2 agonist.

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30
Q

What class of drugs does morphine belong to?

A

Opioid receptor agonist, specifically a strong agonist opioid.

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31
Q

What are common indications for morphine?

A

Analgesia and euphoria

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32
Q

Describe morphine’s mechanism of action

A
  • 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
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33
Q

What are side effects of morphine?

A

Emesis, respiratory depression, GI effects, miosis, increased histamine release (caution with asthmatics), CVS (arrhythmias).

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34
Q

What are DDIs for morphine?

A

Other opioids, alcohol, drugs which cause CNS depressive effects (from BNF)

35
Q

What drug class does fluticasone belong to?

A

Inhaled corticosteriods

36
Q

What is fluticasone used for?

A
  • 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
Q

What is fluticasone’s mechanism of action?

A

Activates cytoplasmic receptors, which pass into the nucleus to modify transcription. Result: turn on anti-inflammatory genes, and turn off genes for inflammation.

38
Q

What are ADRs of fluticasone?

A

Cause local immunosuppressive action: candidiasis and hoarse voice

39
Q

What are contraindications of ICS such as fluticasone in patients with COPD?

A

Risk of pneumonia at high doses

40
Q

What drugs are part of the proton pump inhibitor (PPIs) class?

A

Omeprazole, Lansoprazole

41
Q

What is omeprazole used for?

A

To reduce acid secretion in conditions such as GORD or peptic ulcers

42
Q

How does omeprazole work?

A

Irreversibly inhibits H+/K+ ATPase in gastric parietal cells. This reduces acid secretion.

43
Q

What are ADRs of omeprazole?

A

GI upset, diarrhoea, constipation, abdominal pain, heartaches, dizziness, drowsiness, confusion

44
Q

What DDIs are associated to omeprazole?

A

Clopidogrel - omeprazole is a CYP inhibitor so will reduce the action of clopidogrel

45
Q

What drug class does cyclizine belong to?

A

H1 receptor antagonist

46
Q

What is cyclizine used for?

A

nausea/ motion sickness

47
Q

How does cyclizine work?

A

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
Q

What are ADRs of cyclizine?

A

Sedation, excitation, anti-muscarinic action - such as dry mouth, constipation and urinary retention, cardiac toxicity - because it causes long QT interval

49
Q

What drug class does metoclopramide belong to?

A

D2 receptor antagonists

50
Q

What is metoclopramide used for?

A

To promote gastric emptying and increase peristalsis. This will hopefully relieve GORD and ileus

51
Q

How does metoclopramide work?

A

Increases acetylcholine at muscarinic receptors in the gut.

52
Q

How does metoclopramide promote gastric emptying?

A

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
Q

What are ADRs of metoclopramide?

A

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
Q

What are DDIs of metoclopramide?

A

L-Dopa for patients with Parkinsons

55
Q

What class is low weight heparin (LWH) part of?

A

Heparins !!!!

56
Q

What is LWH used for?

A

PE, DVT, VTE - to slop people having blood clots

57
Q

How does LWH work?

A

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
Q

What are ADRs associated to LWH?

A

Bleeding, bruising

59
Q

What DDIs should we be aware of when prescribing LWH?

A

Other anti-thrombin drugs. Warfarin, aspirin, NSAIDs, SSRIs

60
Q

What class does apixaban belong to?

A

DOAC - Direct Oral Anti-Coagulant

61
Q

What is apixaban used for?

A

VTE< PE, DVT, especially when clots have ben reccuring. May be prescribed when patent has AF

62
Q

What is the mechanism of action of apixaban?

A

Directly inhibits free Xa and bound Xa

63
Q

What ADRs are associated to apixaban?

A

Bleeding etc

64
Q

What DDIs should we be aware of when prescribing apixaban?

A

Other anti-coagulants

65
Q

What drug class is co-amoxiclav part of?

A

Betalactam antibiotics

66
Q

What is co-amoxiclav used for?

A

Gram positive infections, but does have a broad range

67
Q

How does co-amoxiclav work?

A

Interferes with cell wall synthesis. Clavaunic acid is a beta-lactamase inhibitor, so prevents bacterial enzyme beta lactase breaking down the antibiotic

68
Q

When prescribing co-amoxiclav, what ADRs would you make the patient aware of?

A

GI upset, diarrhoea, skin reactions such as rashes, vomiting

69
Q

What are DDIs for co-amoxiclav?

A

warafarin, as co-amoxiclav increases anticoagulant effects of warfarin.

70
Q

what class is carbamazepine in ?

A

Na+ channel blocker (AED)

71
Q

What is carbamazepine used for?

A

Epilepsy, neurological chronic pain, bipolar

72
Q

What is the mechanism of action of carbamazepine?

A

Na+ channel blocker. Prevent channel going from inactive to closed. Therefore, can not be activated again. As a result, this reduces neuronal transmission.

73
Q

What are ADRs of carbamazepine?

A

Suicidal thoughts, joint pain, BM fails, Steven Johnson syndrome, nausea, vomiting

74
Q

What are DDIs of carbamazepine?

A

Therapeutic effect reduces with COCP, reduces with antibiotics, induces CYP - so affects warfarin (CYP3A4). Also need to be careful with statins and CCBs.

75
Q

What class is co-careldopa part of?

A

Mix of L-Dopa and Carbidopa - DOPA decarboxylase inhibitor

76
Q

What is co-careldopa used for?

A

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
Q

How does co-careldopa work?

A

Inhibits DOPA decarboxylase - D2 receptor involved

78
Q

What are ADRs of co-careldopa?

A

Involuntary movements, psychosis, difficulty sleeping, hallucinations, seizures, nausea, drowsiness, hypotension, mania (anything related to increasing dopamine) “wearing off affect”

79
Q

What are DDIs of co-careldopa?

A

anti-psychotics, anti-emetics (metoclopramide)

80
Q

What drug class does sodium valproate belong to?

A

Anti-epileptic (AED)

81
Q

What is sodium valproate used for?

A

Epilepsy, bipolar, migranes

82
Q

How does sodium valproate work?

A

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
Q

What are ADRs of sodium valproate?

A

Liver failure, pancreatitis, lethargy, abdomen pain, weight gain

84
Q

What are DDIs of sodium valproate?

A

Carbopenems (penicillins) - these reduce sodium valproate; other anti-epileptics

Drug of the day (2 decks)

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