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Drugs Lists 2021 > Block 4 > Flashcards

Block 4 Flashcards

1
Q

IMPORTANT

Biphosphonates

A
  • First line treatment
  • Used to treat disorders of bone and calcium homeostasis, osteoporosis, Paget’s, hypercalcaemia of malignancy.
  • Administered orally
  • Generic Drug Names: alendronate (alendronic acid), pamidronate, risedronate
  • Mechanism of Action: Promotion of osteoclast apoptosis/ inhibition. Reduction of calcium release from bone- they are absorbed onto the hydroxyapatite crystals which s then taken up by osteoclasts and interferes with their function or attachment to bone via the ruffled borders thus slowing down rate of bone remodelling
  • Side effects: asymptomatic hypocalcaemia, general GI disturbance, oesophageal reactions, osteonecrosis of jaw and EAM, atypical femoral fractures
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1
Q

Synthetic hormone, Animal-derived hormone (for osteoporosis and calcium balance)

A
  • Used to treat disorders of bone and calcium homeostasis
  • Generic Drug Names: parathyroid hormone (recombinant) and calcitonin (derived from salmon)
  • Mechanism of Action: Modulation of calcium metabolism and bone resorption
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2
Q

Essential nutrients (for calcium and bone deficiency)

A
  • Used to treat disorders of bone and calcium homeostasis
  • Vitamin D (cholecalciferol), also calcetriol (1, 25-dihydroxyvitamin D), IV calcium gluconate
  • Mechanism of action: restoration of active Vitamin D or plasma calcium levels
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3
Q

IMPORTANT

Selective Oestrogen Receptor Modulator (SERM)

A
  • Used to treat disorders of calcium and bone metabolism, osteoporosis
  • Generic Drug Name: Raloxifene - usually prescribed for postmenopausal osteoporosis if bisphosphonates are not tolerated
  • Administration: Oral
  • Mechanism of action: Activates the oestrogen receptor (ER) in the bone to retain bone mineralisation. These are anticatabolic and act by reducing cytokines that cause osteoclast activation and function
  • Side Effects: hot flushes, leg cramps, increased risk of DVT and stroke
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4
Q

IMPORTANT

Biologic (monoclonal antibody) for osteoporosis treatment

A
  • Used to treat disorders of bone and calcium homeostasis, osteoporosis and malignancy involving bones
  • Generic Drug Name: Denosumab - recombinant human monoclonal antibody that inhibits RANKL so inhibits osteoclast formation and function
  • Mechanism of Action: Inhibition of release of calcium from bone, inhibition of osteoclast activity
  • Administration: subcutaneous injections twice yearly
  • Side effects hypocalcaemia, hypophosphataemia, altered bowel habit, dyspnoea, osteonecrosis of the jaw
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5
Q

Anti-proliferative agents

A
  • Used as disease modifying anti-rheumatic drugs (DMARDS)
  • Generic Drug Name: methotrexate, azathioprine
  • Mechanism of Action: Reduces lymphocyte proliferation
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6
Q

Immunosuppressive agents

A
  • Used as disease modifying anti-rheumatic drug
  • Generic Drug Name: sulphasalazine, penicillamine
  • Mechanism of action: immunosuppressive (precise mechanism is unclear)
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7
Q

Biologics (monoclonal antibodies for treating inflammation)

A
  • Used as a disease-modifying anti-rheumatic drugs
  • Generic Drug Names: infliximab, rituximab
  • Mechanism of Action: binds and blocks pro-inflammatory function of TNF-alpha (infliximab)/ depletion of B cells via CD20 binding (rituximab)
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8
Q

Beta lactams - penicillin

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: Flucloxacillin, benzylpenicillin, amoxicillin, co-amoxiclav
  • Mechanism of Action:: Bactericidal - cell lysis by blocking cell wall synthesis
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9
Q

Beta lactase - cabapenems

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: meropenem
  • Mechanism of Action: bactericidal - cell lysis by blocking cell wall synthesis
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10
Q

Cephalosporins

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: ceftriaxone
  • Mechanism of Action: bactericidal - cell lysis by blocking cell wall synthesis
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11
Q

Fluoroquinolones

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: ciprofloxacin
  • Mechanism of Action: bacteriostatic - inhibition of bacterial DNA coiling
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12
Q

Lincosamides

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: clindamycin
  • Mechanism of Action: bacteriostatic - inhibition of bacterial protein synthesis
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13
Q

Macrolides

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: erythromycin
  • Mechanism of Action: bacteriostatic - inhibition of bacterial protein synthesis
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14
Q

Anti-folate antibiotic

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: trimethoprim
  • Mechanism of Action: bacteriostatic - inhibition of bacterial folic acid synthesis, affecting bacterial DNA synthesis
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15
Q

Tetracycline

A
  • Antibiotic and antimicrobial drugs
  • Generic Drug Name: tetracycline, doxycycline
  • Mechanism of Action: Bacteriostatic - inhibition of bacterial protein synthesis
16
Q

IMPORTANT

Parathyroid Hormones

A
  • Used to stimulate bone formation - anabolic drug
  • Drug name: Teriparatide - the peptide fragment of recombinant PTH
  • Use: Osteoporosis
  • Mechanism of Action: Continuous PTH causes bone loss however its been found that PTH given in doses paradoxically stimulate osteoblast activity and enhance bone formation. It increases bone mass, structural integrity and bone strength by increasing osteoblasts and by activating the osteoblasts. It can reduce osteoblast apoptosis
  • Adminstration: subcutaneous injection once daily
  • Side effects: Mild hypercalcaemia, transient orthostatic hypotension, muscle cramp, nausea and vomitting
17
Q

What are the consequences of falling?

A

Biological consequences:

  • Fractures - femur, wrist, humerus, vertebrae, pelvis
  • Head Injury - subdural haematoma
  • Soft tissue injuries - carpet burns, bruising
  • Burns - fall onto fire or radiator
  • Long lies on floor (more than 1 hour) - pressure sores, rhabdomyolysis - breakdown of muscle tissue, hypothermia, pneumonia

Psychological consequences:

  • Fear of further falls leading to loss of confidence
  • Depression due to reduced independence and reduced social interaction
  • Anxiety disorders such as panic disorder, agoraphobia and social anxiety disorder
  • Anxiety in carers can lead to elder abuse, and movement from a familiar home to an unfamiliar residential home.

Social consequences:

  • Loss of independence due to hobbies, social interaction and dependence on others
  • Impact on others- if patient is unable to care for others, family tension and stress
  • Need to move to safer surroundings - residential/ nursing homes, financial impact, restriction to one room
18
Q

When do falls more often occur?

A

Afternoon, as there is a dip in alertness in the afternoon - night times are also a risk

19
Q

What are the major intrinsic causes of falls in the older adult?

A
20
Q

What are the major extrinsic causes of falls in the older adult?

A
21
Q

How are falls assessed?

A
22
Q

How are falls managed?

A
23
Q

What are the mechanisms of antibiotics?

A
24
Q

What factors affect antibiotic choice?

A
25
Q

What are adverse drug reactions?

A
26
Q

What are dose-related adverse drug reactions?

A
27
Q

What are time-course related adverse drug reactions?

A
28
Q

What are patient susceptibility adverse drug reactions?

A
29
Q

What can cause adverse drug reactions?

A
30
Q

What are the changes of ageing in pharmacokinetics?

A
31
Q

What are the changes of ageing in pharmacodynamics?

A
32
Q

What are the changes of ageing in homeostasis?

A
33
Q

What is polypharmacy?

A
34
Q

What are the issues associated with prescribing for older adults?

A
35
Q

How can concordance be improved?

A
36
Q

What are medication reviews?

A
37
Q

What strategies can minimise adverse drug reactions?

A

Drugs Lists 2021 (4 decks)

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