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
