ca2 pharm

Question 1

Patient just had an acute gout attack. What should I prescribe to relieve her symptoms?

How does this drug help?

Answer 1

Colchicine

Binds to tubulin and prevents its polymerization into microtubules
Inhibits leukocyte migration and phagocytosis
Inhibits leukotriene and prostaglandin production

Question 2

I just prescribed a drug to patient for her acute gout attack. What side effect should I warn her?

Answer 2

Diarrhoea!!

Nausea and vomiting, abdo pain, muscle weakness

Question 3

If patient is unable to take colchicine for acute gouty attacks, what is my alternative?

Answer 3

NSAIDs or corticosteroids

Question 4

Following a gouty attack, what drug can I prescribe for a patient to prevent recurrent gouty episodes?

How do they work?

Answer 4

1. Allopurinol - xanthine oxidase inhibitor that reduces production of uric acid because xanthine oxidase is the enzyme that converts hypoxanthine to uric acid.
2. Probenecid - increases uric acid excretion by inhibiting proximal tubule anion transport and inhibits its reabsorption

Question 5

Before prescribing allopurinol, what are the 3 risk factors that I must check?

What is the adverse effect I am worried for?

Answer 5

1. Renal impairment
2. Thiazide treatment
3. HLA-B*58:01 genotype

Allopurinol hypersensitivity syndrome -> severe cutaneous adverse reaction!

Question 6

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?

Answer 6

Take with plenty of fluids!!

In order to minimize the risk of renal stone formation.

Question 7

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?

Answer 7

Masking of B12 deficiency

Question 8

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?

Answer 8

Anti platelets like aspirin or clopidogrel

Principle is to reduce primary haemostasis - formation of a temporary platelet plug at the site of vascular injury

Question 9

Patient just recovered from deep vein thrombosis. Name 4 possible anti-coagulants I can prescribe

What are all these drugs trying to reduce?

Answer 9

Warfarin
Heparin
Dabigatran
Rivaroxaban

Reduce secondary haemostasis - coagulation factors and formation of fibrin mesh to trap blood cells and form the blood clot.

Question 10

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?

Answer 10

Warfarin

Vitamin K reductase antagonist -> reduces the amount of Vitamin K which is crucial for synthesis of several clotting factors

Question 11

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?

Answer 11

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

Question 12

Patient just recovered from deep vein thrombosis. What are the 2 ORAL anticoagulants I can prescribe?

Briefly state their MOA

Answer 12

Dabigatran - factor 2a inhibitor

Rivaroxaban - factor 10a inhibitor

Question 13

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?

Answer 13

Selective serotonin reuptake inhibitor - fluoxetine

SSRIs: nausea, insomnia, sexual dysfunction and **SEROTONIN SYNDROME!!

Question 14

I prescribed an SSRI to a patient with depression. What is the adverse effect I am most worried about?

Answer 14

Serotonin syndrome

Question 15

Why is SSRIs preferred over MAOIs and TCA?

Answer 15

1. Low affinity for alpha adrenoreceptors - lower risk for cardiac overstimulation - safer in an event of overdose
2. Low affinity for muscarinic receptors - less cholinergic side effects (like dry mouth, constipation)
3. Lack of effect at histamine receptor - less sedation

LESS SIDE EFFECTS = BETTER COMPLIANCE!!

Question 16

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?

Answer 16

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

Question 17

Side effect of SSRIs

Answer 17

Nausea, insomnia, sexual dysfunction, serotonin syndrome

Question 18

Side effect of NARIs

Answer 18

Tachycardia, insomnia, dry mouth, constipation

Question 19

Patient has just been diagnosed with anxiety. Name 2 possible benzodiazepines and non-benzodiazepines I can prescribe to them.

Answer 19

Benzodiazepines: diazepam, lorazepam, midazolam, triazolam

Non-benzodiazepines:
- phenobarbital
- buspirone
- zolpidem

Question 20

I prescribed diazepam to a patient with anxiety. What adverse effects I am concerned about?

Answer 20

1. Acute overdose -> severe respiratory depression
2. Drowsiness, confusion, amnesia
3. Withdrawal effects include sleep disorders, rebound anxiety, tremor and convulsions

Question 21

I prescribed propanolol to a patient with anxiety.

How does propanolol help with anxiety?

Answer 21

Reduces physical symptoms associated with anxiety due to adrenergic activation (tachycardia, palpitations)

**Contraindicated in patients with asthma and heart conditions

Question 22

Patient comes in for insomnia. What is a non-benzodiazepine drug that can be used to treat both insomnia and anxiety?

Answer 22

Zolpidem

Question 23

Patient has just been diagnosed with schizophrenia. What are the 2 main types of antipsychotics I can prescribe?

Answer 23

Typicals (1st gen): haloperidol, chlorpromazine

Atypicals (2nd gen): clozapine, olanzapine, risperidone, amisulpride

Question 24

Which type of receptor when antagonised, will result in postural hypotension and dizziness?

Answer 24

Alpha adrenoreceptors

Question 25

Which type of receptor when antagonised, will result in sedation and weight gain?

Answer 25

Histamine H1 receptors

Question 26

Which type of receptor when antagonised, will result in dry mouth, constipation and blurred vision?

Answer 26

Muscarinic

Question 27

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?

Answer 27

The term "extrapyramidal effects" describes involuntary movements that you cannot control, similar to the tremors in Parkinsonism. Extrapyramidal side effects include: 1. Acute dystonia - Parkinsonism-like syndrome (cogwheel rigidity, tremor at rest, bradykinesia) 2. Tardive (means slow development) dyskinesia (repetitive involuntary movements of the face, tongue and limbs) and akathisia (involuntary movements associated with restlessness, anxiety and agitation)

Question 28

Name 3 extrapyramidal side effects of taking anti psychotic drugs Which is reversible (stops when drug is stopped) and irreversible?

Answer 28

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

Question 29

Patient has just been diagnosed with schizophrenia. Differentiate between a typical and atypical anti psychotic drug. Explain the difference

Answer 29

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)

Question 30

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?

Answer 30

Agranulocytosis

Question 31

Patient has just been diagnosed with schizophrenia. What are side effects of either the typical or atypical anti psychotic I prescribe?

Answer 31

Alpha adrenoreceptors: postural hypotension and dizziness Histamine H1 receptors: sedation & weight gain Muscarinic: dry mouth, constipation, blurred vision

Question 32

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?

Answer 32

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.

Question 33

Patient has just been diagnosed with schizophrenia. If patient is also diabetic and overweight, what 3 atypical antipsychotic drugs should I not give?

Answer 33

Clozapine Olanzapine Risperidone

Question 34

Patient has just been diagnosed with schizophrenia. I prescribe him with amisulpride. What side effect am I worried about?

Answer 34

Gynaecomastia due to amisulpride causing increased prolactin secretion.