ca2 pharm Flashcards
Patient just had an acute gout attack. What should I prescribe to relieve her symptoms?
How does this drug help?
Colchicine
Binds to tubulin and prevents its polymerization into microtubules
Inhibits leukocyte migration and phagocytosis
Inhibits leukotriene and prostaglandin production
I just prescribed a drug to patient for her acute gout attack. What side effect should I warn her?
Diarrhoea!!
Nausea and vomiting, abdo pain, muscle weakness
If patient is unable to take colchicine for acute gouty attacks, what is my alternative?
NSAIDs or corticosteroids
Following a gouty attack, what drug can I prescribe for a patient to prevent recurrent gouty episodes?
How do they work?
- Allopurinol - xanthine oxidase inhibitor that reduces production of uric acid because xanthine oxidase is the enzyme that converts hypoxanthine to uric acid.
- Probenecid - increases uric acid excretion by inhibiting proximal tubule anion transport and inhibits its reabsorption
Before prescribing allopurinol, what are the 3 risk factors that I must check?
What is the adverse effect I am worried for?
- Renal impairment
- Thiazide treatment
- HLA-B*58:01 genotype
Allopurinol hypersensitivity syndrome -> severe cutaneous adverse reaction!
I prescribe probenecid to patient to reduce her uric acid levels and prevent recurrent gouty episodes.
What must I instruct/remind the patient to do when taking her probenecid medication?
Take with plenty of fluids!!
In order to minimize the risk of renal stone formation.
Patient has peripheral neuropathy. I prescribe her Vitamin B12 and B9 supplements for it.
What adverse effect of Vitamin B9 do I have to keep a lookout for?
Masking of B12 deficiency
Patient has a clot in her arteries (eg. stroke) and successfully recovered after surgery. What type of anticoagulant drug should I give to her to prevent clotting in ARTERIES?
What is the drug trying to reduce?
Anti platelets like aspirin or clopidogrel
Principle is to reduce primary haemostasis - formation of a temporary platelet plug at the site of vascular injury
Patient just recovered from deep vein thrombosis. Name 4 possible anti-coagulants I can prescribe
What are all these drugs trying to reduce?
Warfarin
Heparin
Dabigatran
Rivaroxaban
Reduce secondary haemostasis - coagulation factors and formation of fibrin mesh to trap blood cells and form the blood clot.
Patient has severe hypertension and some degree of renal and hepatic impairment. What anti-coagulant I die die also cannot give and how does this drug work?
Warfarin
Vitamin K reductase antagonist -> reduces the amount of Vitamin K which is crucial for synthesis of several clotting factors
I prescribed low molecular weight heparin to a patient who just recovered from DVT. How does it work and what should I warn the patient of, in terms of side effects?
Also, why LMWH over regular heparin?
Binds to antithrombin 3 to increase affinity for factor 2a, inhibiting common pathway in secondary haemostasis (ie. impeding the coagulation cascade)
LMWH has better oral bioavailability and longer half life than regular heparin.
Adverse effect: heparin induced thrombocytopenia
Patient just recovered from deep vein thrombosis. What are the 2 ORAL anticoagulants I can prescribe?
Briefly state their MOA
Dabigatran - factor 2a inhibitor
Rivaroxaban - factor 10a inhibitor
Patient has just been diagnosed with depression. What drug & its drug class am I likely to prescribe them?
What side effects should I warn patient about?
Selective serotonin reuptake inhibitor - fluoxetine
SSRIs: nausea, insomnia, sexual dysfunction and **SEROTONIN SYNDROME!!
I prescribed an SSRI to a patient with depression. What is the adverse effect I am most worried about?
Serotonin syndrome
Why is SSRIs preferred over MAOIs and TCA?
- Low affinity for alpha adrenoreceptors - lower risk for cardiac overstimulation - safer in an event of overdose
- Low affinity for muscarinic receptors - less cholinergic side effects (like dry mouth, constipation)
- Lack of effect at histamine receptor - less sedation
LESS SIDE EFFECTS = BETTER COMPLIANCE!!
I prescribed an SSRI to a patient with depression.
A few weeks later, patient’s symptoms do not appear to be getting better.
What is another drug + drug class I can prescribe and what are its side effects?
Noradrenaline reuptake inhibitors (NARIs)
Reboxetine
More noradrenaline = more stimulation of CNS/SNS = less PNS
Anticholinergic effects - dry mouth, constipation
Stimulation of CNS = insomnia
Stimulation of SNS = tachycardia
Side effect of SSRIs
Nausea, insomnia, sexual dysfunction, serotonin syndrome
Side effect of NARIs
Tachycardia, insomnia, dry mouth, constipation
Patient has just been diagnosed with anxiety. Name 2 possible benzodiazepines and non-benzodiazepines I can prescribe to them.
Benzodiazepines: diazepam, lorazepam, midazolam, triazolam
Non-benzodiazepines:
- phenobarbital
- buspirone
- zolpidem
I prescribed diazepam to a patient with anxiety. What adverse effects I am concerned about?
- Acute overdose -> severe respiratory depression
- Drowsiness, confusion, amnesia
- Withdrawal effects include sleep disorders, rebound anxiety, tremor and convulsions
I prescribed propanolol to a patient with anxiety.
How does propanolol help with anxiety?
Reduces physical symptoms associated with anxiety due to adrenergic activation (tachycardia, palpitations)
**Contraindicated in patients with asthma and heart conditions
Patient comes in for insomnia. What is a non-benzodiazepine drug that can be used to treat both insomnia and anxiety?
Zolpidem
Patient has just been diagnosed with schizophrenia. What are the 2 main types of antipsychotics I can prescribe?
Typicals (1st gen): haloperidol, chlorpromazine
Atypicals (2nd gen): clozapine, olanzapine, risperidone, amisulpride
Which type of receptor when antagonised, will result in postural hypotension and dizziness?
Alpha adrenoreceptors
Which type of receptor when antagonised, will result in sedation and weight gain?
Histamine H1 receptors
Which type of receptor when antagonised, will result in dry mouth, constipation and blurred vision?
Muscarinic
Patient has just been diagnosed with schizophrenia. I prescribe haloperidol to them.
What are the 2 extrapyramidal side effect of it? And what does extrapyramidal mean?
The term “extrapyramidal effects” describes involuntary movements that you cannot control, similar to the tremors in Parkinsonism.
Extrapyramidal side effects include:
- Acute dystonia - Parkinsonism-like syndrome (cogwheel rigidity, tremor at rest, bradykinesia)
- Tardive (means slow development) dyskinesia (repetitive involuntary movements of the face, tongue and limbs) and akathisia (involuntary movements associated with restlessness, anxiety and agitation)
Name 3 extrapyramidal side effects of taking anti psychotic drugs
Which is reversible (stops when drug is stopped) and irreversible?
REVERSIBLE:
Acute dystonia - Parkinsonism-like syndrome (cogwheel rigidity, tremor at rest, bradykinesia)
IRREVERSIBLE:
1. Tardive dyskinesia (repetitive involuntary movements of the face, tongue and limbs)
2. Tardive akathisia (involuntary movements associated with restlessness, anxiety and agitation)
Tardive means slow development
Patient has just been diagnosed with schizophrenia.
Differentiate between a typical and atypical anti psychotic drug. Explain the difference
Atypical (eg. clozapine, olanzapine, risperidone) has LESS SEVERE extrapyramidal side effects (dystonia, dyskinesia, akathisia).
Atypicals have greater affinity for 5-HT2 and D4 receptors than typicals (haloperidol, chlorpromazine)
Patient has just been diagnosed with schizophrenia and I prescribed an atypical anti psychotic, clozapine.
A few days after the drug is started, patient develops sore throat and runny nose.
What am I worried for?
Agranulocytosis
Patient has just been diagnosed with schizophrenia.
What are side effects of either the typical or atypical anti psychotic I prescribe?
Alpha adrenoreceptors: postural hypotension and dizziness
Histamine H1 receptors: sedation & weight gain
Muscarinic: dry mouth, constipation, blurred vision
Patient has just been diagnosed with schizophrenia. I prescribe him an anti psychotic.
A few weeks later, patient returns to the clinic complaining that his chest feel abnormally fuller.
What drug have I prescribed and what happen?
Amisulpride - the only antipsychotic drug without the typical side effects of an antipsychotic
Instead, it causes an increase in PROLACTIN secretion -> causes gynaecomastia in males and breast swelling in females.
Patient has just been diagnosed with schizophrenia. If patient is also diabetic and overweight, what 3 atypical antipsychotic drugs should I not give?
Clozapine
Olanzapine
Risperidone
Patient has just been diagnosed with schizophrenia. I prescribe him with amisulpride.
What side effect am I worried about?
Gynaecomastia due to amisulpride causing increased prolactin secretion.
