Commonly Prescribed Drugs Flashcards
What drugs/drug classes are prescribed for Analgesia according to the WHO pain ladder?
State the mechanism of action of each class.
Give an example of each class mentioned
Paracetamol: Unknown
NSAIDs: (Ibuprofen, Diclofenac, Naproxen) Inhibition of COX 1 and COX 2 enzymes
Opioids: (Codeine, Morphine) opioid receptor agonists
NSAIDs inhibit COX 1 and COX 2 enzymes. What is the significance of each?
State the side effects?
What are the contraindications to prescribing this medication?
COX 1 produces prostaglandins responsible for homeostatic function whereas COX 2 produces prostaglandins responsible for the expression of pain and inflammation
SE: GI disturbance, GI bleeding,
CI: Avoid in elderly patients and those with renal impairment (renaly excreted)
What is the mechanism of action of Buprenorphine?
Opioid receptor !partial agonists!
Is Aspirin an NSAID?
How does it differ from other NSAIDs?
Yes but Aspirin is also an antiplatelet => opposite to NSAIDs as NSAIDs would actually increase the risk of stroke, PE, CAD…
You are about to prescribe your patient Paracetamol. What is the main side effect of this drug?
What would prevent you from prescribing the drug? (contraindications)
SE: Hepatic Toxicity
CI: Hepatic impairment => Reduced LFTS/reduced synthetic function of the liver (SBR, Coag)
You are about to prescribe your elderly patient Morphine. How would this impact your prescribing?
What is the main side effect of this drug?
What would prevent you from prescribing the drug?
(contraindications). In that case, what other drug would you give instead?
When prescribing morphine or other opioids, what is good practice to prescribe alongside it?
Where would you prescribe the drug on the kardex?
This applies to all opioids unless specifically morphine:
It is important to reduce the dose in elderly patients to prevent precipitating delirium.
Morphine is a Opioid receptor agonist => sedation, respiratory depression, bradycardia, constipation, hypothermia, anhidrosis.
Avoid in renal impairment (renaly excreted => why reduced dose in elderly). Consider Fentanyl as an alternative in these cases.
Prescribing a laxative
Morphine is written normally like any other drug when prescribed in hospital but still needs to be documented as such. When discharging a patient or OPD prescribing, you would use the controlled drugs section
You are about to prescribe Morphine to an elderly patient. What dose will you prescribe and how will you administer it?
Your consultant asks you to give the patient oxycodone instead, How much will you administer?
This patient has an eGFR of 42. What do you decide to give alternatively + its dose.
Your consultant asks you to prescribe codeine to another patient with the equivalent dose. Give the dose. How about tramadol?
Normal dose = 5mg, for elderly 2.5mg PO. Half for SC injection.
Oxycodone (PO/SC): Divide by 2
Fentanyl (SC) : Divide by 50
Codeine/Tramadol (PO): Multiply by 10
Give the MOA of penicillins
Give 4 examples
Give the main SE to be aware about
MOA: Inhibit cell wall synthesis
Examples: Amoxicillin, flucloxacillin, co-amoxiclav, Pip-Taz
SE: Severe hypersensitivity reaction in some patients, Diarrhoea, risk of C.Deficile infection, Hepatic enzyme impairment
What is the MOA of Cephalosporins
Give 2 examples of 3rd generation Cephalosporins
Can you prescribe this class to a patient with a penicillin allergy? Why not?
Inhibit cells wall synthesis (same as penicillin)
Cefotaxime
Ceftriaxone
Cross-reactivity with penicillin in some cases (for allergy)
Note: Also like penicillin, risk of C. Deficile infection
Give 3 examples of Macrolides
Give the mechanism of action
Give the main side effects
What important interactions should you be aware about when prescribing a macrolide?
Clarithromycin, Erythromycin, Azithromycin
MOA: Inhibit Protein Synthesis
Qtc Prolongation, altered taste, hepatic enzyme derangement/impairment (like penicillin)
Statins: Increase risk of rhabdomyolysis
Warfarin: Inhibit its metabolism => increased INR
What antibiotics require drug monitoring?
Gentamicin and Vancomycin
Give 2 examples of Aminoglycosides.
Give the MOA
Give 2 main SE of Aminoglycosides.
Gentamicin, Streptomycin
Inhibit protein synthesis
Nephrotoxicity and Ototoxicity
What type of drug is Vancomycin?
Give the MOA
Give 2 main SEs of this drug?
What disease precipitated by antibiotic use is treated by this drug?
Glycopeptide
Inhibit cell wall synthesis (like cephalosporin and penicillin)
Ototoxicity and Nephrotoxicity
C. Deficile infection
Give the MOA of Trimethoprim
Give its SE
Inhibits bacterial folate metabolism
Teratogenic, depress hematopoesis (lower hmatocrit/anemia)
Give the MOA of Nitrofurantoin
Give the SE of nitrofurantoin
What is a contraindication to This drug?
Disrupts protein synthesis
SE: Pulmonary fibrosis (long-term), aplastic anemia, interstitial nephritis
CI: Renal impairment (GFR <45/3b) or renal replacement therapy.
