Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oscestop Revision > Commonly Prescribed Drugs In Community > Flashcards

Commonly Prescribed Drugs In Community Flashcards

1
Q

Describe the antihypertensives ladder

A

<55y/ diabetic= ACEi
>55y / afrocarribean= Calcium channel blocker

Step 2= use both
Step 3= add thiazide like diuretic
Step 4= add spironolactone or alpha/beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the oral hypoglycaemic ladder

A

Step 1= diet control
Step 2= metformin (sulfonylurea if thin)
Step 3= sulfonylurea, pioglitazone, GLP agonist
Step 4= triple therapy/ insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What class of drug is metformin?

A

Biguanide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does metformin work?

A

Increased insulin sensitivity and suppress gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the side effects of metformin?

A

GI disturbance
Weight loss
Lactic acidosis
Metallic taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the contraindications to metformin?

A

Low BMI
Creatinine >150
GFR <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give an example of a sulfonylurea

A

Gliclazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do sulfonylureas work?

A

Increased B cell insulin secretion (must be at mealtimes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the side effects of sulfonylureas?

A

Hypos

Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the contraindications to using sulfonylureas?

A

Patients at risk of hypos

Severe hepatic/ renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an example of a thiazolidinedione?

A

Glitazones eg pioglitazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does pioglitazone work?

A

PPARy agonist—> increases fat and muscle glucose uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the side effects of pioglitazone?

A

Fluid retention
Fractures
Hepatotoxic
Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications to using pioglitazone?

A

Heart failure

History of bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an example of a DPP4 inhibitor?

A

Sitagliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mechanism of action of gliptins?

A

Inhibit DPP4 which breaks down GLP 1 which is a hormone released by the gut to increase insulin after food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the side effects of gliptin?

A

Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give an example of a GLP agonist

A

Exenatide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the mechanism of action of exenatide?

A

Mimics GLP 1 which is a hormone released by the gut to increase insulin after food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the side effects of exenatide?

A

GI disturbance and indigestion
Pancreatitis
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the contraindications of exenatide?

A

GFR<50
History of pancreatitis
Severe GI disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give an example of an SGLT 2 inhibitor

A

Dapaglifozin, canaglifozin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Increase urinary glucose excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the side effects of SGLT 2 inhibitors?

A

UTIs, ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the contraindications of SGLT2 inhibitors?

A

GFR<30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which hypoglycaemics are safe in pregnancy?

A

Metformin and insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What HbA1c do we aim for with the patient on oral hypoglycaemics?

A

48-58mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe the asthma ladder

A

Step 1- SABA + inhaled steroid
Step 2- SABA+ ICS+ LABA
Step 3- trial of increasing ICS, LAMA, LTRA, SR theophylline
Step 4- daily steroid tablet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the COPD ladder

A

Step 1: SABA(salbutamol)+ SAMA(ipratropium)

FEV1>50%- LABA— add ICS
Or
LAMA

FEV1<50%- LAMA
Or LABA+ICS

Step 3: LABA+LAMA+ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does seretide consist of?

A

Salmeterol+ fluticasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does symbicort consist of?

A

Formeterol+ budesonide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does fostair consist of?

A

Formoterol+ beclometasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How can HRT be given?

A

Systemic
Oral
Transdermal
Vaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which HRT do you give to a lady without a uterus?

A

Oestrogen only HRT (oral or transdermal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which type of HRT do you give to a woman with a uterus?

A

Perimenopausal—> cyclical HRT (oestrogen everyday but progesterone given also for 12-14 days at end of every menstrual cycle if still having regular periods, or every 13 weeks if having irregular periods

Post menopausal (no periods for >1 yr or cyclical HRT for > 1 yr)—> give continuous HRT (continious oestrogen and progesterone, no bleed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the contraindications to HRT?

A 
Undiagnosed PV bleeding
Pregnancy/ breastfeeding
Oestrogen dependent cancer
Active liver disease
Uncontrolled hypertension
History of breast cancer
History of VTE
Recent stroke/ MI/ angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the side effects of HRT?

A

Vaginal bleeding, premenstrual syndrome, breast tenderness, leg cramps, nausea/bloating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the long term risks of HRT?

A 
Increased VTE risk
Increased stroke risk
Increased breast cancer risk with time
Increased ovarian cancer risk >5y
Increased endometrial cancer risk if unopposed oestrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is an example of an SSRI?

A

Fluoxetine
Citalopram
Paroxetine
Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How do SSRIs work?

A

Increased extracellular serotonin by limiting its reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the side effects of SSRIs?

A

Sexual dysfunction
Withdrawal
Insomnia
Hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What do you need to be careful about with SSRIs?

A

May increase suicide risk

Safe in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is an example of an SNRI?

A

Duloxetine, venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How do SNRIs work?

A

Increased extracellular serotonin and noradrenaline by limiting their reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the side effects of SNRIs?

A 
Hypertension
Sexual dysfunction
Insomnia
Withdrawal
Hyponatraemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is an example of a tricyclic antidepressant?

A

Amitryptylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How do TCAs work?

A

Block serotonin and NA transporters resulting in elevation in their synaptic concentrations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the side effects of TCAs?

A

Antimuscarinic effects:
Dry mouth, constipation, blurred vision, urinary retention

Hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What must you be cautious of in prescribing amytrptylline>

A

Dangerous in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is an example of a monoamine oxidase inhibitor?

A

Selegiline, phenelzine

51
Q

How do MAOIs work?

A

Inhibits monoamine oxidase (an enzyme that oxidises monoamines to inactivate them)

52
Q

What are the side effects of monoamines?

A

Hypertension
Hepatocellular jaundice
Hyperthermia

53
Q

What must you warn the patient about if prescribing MAOIs?

A

Do not eat tyramine containing foods eg cheeses and cured meats as they may trigger a hypertensive crisis.

54
Q

What is the first line drug for lowering cholesterol?

A

Statins

55
Q

What are some examples of statins?

A

Atorvastatin
Fluvastatin
Pravastatin
Simvastatin

56
Q

How do statins work?

A

Inhibit HMG CoA reductase which is an enzyme involved in hepatic cholesterol synthesis

57
Q

What are the indications for statin use?

A 
Any vascular disease
Any lipid disorder
QRISK >10%
T1 diabetic if >40y/ had diabetes >10 years? Nephropathy/ CVS risk factors
CKD
Ratio of total cholesterol: HDL >6
58
Q

What are the side effects of statins?

A

Maylgia and rhabdo myolysis

Hepatotoxicity and increased liver enzymes

59
Q

What is the 2nd line management for high cholesterol?

A

Ezetimibe

60
Q

How does ezetimibe work?

A

Decreases cholesterol absorption in small intestine

61
Q

What are the indications for ezetimibe use?

A

Primary hypercholesterolaemia if statin not tolerated or contraindicated

In conjunction with statin if statin fails to control total cholesterol o LDL cholesterol alone

62
Q

What are the side effects of ezetimibe?

A

Headache

Diarrhoea (steattorhoea)

63
Q

What is the 3rd line medication for statins?

A

Fibrates

64
Q

How do fibrates work?

A

Act in liver to reduce cholesterol synthesis

Reduce VlDL secretion and increase their removal from the blood

Increases plasma HDL

65
Q

What are the indications for fibrate use?

A 
Isolated triglyceridaemia (>10mmol/L)
Hypercholesterolaemia if statin not tolerated
66
Q

What are the side effects of fibrates?

A

GI disturbance

Myalgia and rhabdomyolysis

67
Q

What are the cautions in prescribing fibrates?

A

Do not use with statins

68
Q

What medications are first line for heart failure?

A

ACEi, beta blocker, diuretic

69
Q

What medications are second line for heart failure?

A

Aldosterone antagonist eg spironolactone

70
Q

What medication is 3rd line for heart failure?

A

Digoxin

71
Q

How does haemostasis work?

A

3 factors:
Vascular spasm
Platelet plug formation
Coagulation

Intrinsic pathway: damaged surface—> factor 7,11,9,8–> factor 10 converts prothrombin to thrombin, thrombin converts fibrinogen to fibrin

Extrinsic pathway: tissue damage—> thromboplastin—> factor 7–> factor 10, converts prothrombin to thrombin, converts fibrinogen to fibrin.

72
Q

How does clot dissolution work?

A

Plasminogen—-> plasmin,

Also protein C&S, heparin and antithrombin

73
Q

What are the vitamin K dependent clotting factors?

A

2,7,9,10 (and protein C&S)

74
Q

What pathway does PT and INR measure?

A

Extrinsic pathway

75
Q

What pathway does APTT measure?

A

intrinsic

76
Q

How does warfarin work?

A

Reduces the synthesis of vitamin K dependent clotting factors

77
Q

How is warfarin action monitored?

A

INR

78
Q

What is warfarin used for?

A

AF
VTE
Metallic heart valves

79
Q

What are the advantages and disadvantages of warfarin?

A

Easily reversible

Regular INRs required
Under/over coagulation

CYP450 interactions

80
Q

Give an example of a direct thrombin inhibitor

A

Dabigatran

81
Q

How does dabigatran work?

A

Inhibits thrombin

82
Q

How is dabigatran reversed?

A

Praxbind

83
Q

What is dabigatran used for?

A

AF, VTE, post op VTE prophylaxis

84
Q

What are the advantages and disadvantages of dabigatran

A

Quick onset/offset, no monitoring required

Irreversible, renally cleared

85
Q

Give an example of a direct oral anticoagulant

A

Rivaroxaban

Apixaban

86
Q

How do DOACs work?

A

Inhibits factor Xa

87
Q

What monitoring is required for DOACs?

A

None

88
Q

Can DOACs be reversed?

A

No

89
Q

what are the indications for DOACs?

A

AF

VTE, post op VTE prophylaxis

90
Q

What are the advantages and disadvantages of DOACs?

A

Quick onset/offset
No monitoring required

Irreversible
Renally cleared

91
Q

How does unfractionated heparin work?

A

Natural anticoagulant that potentiates antithrombin (inactivates factors 2,9,10,11,12) and inactivates thrombin

92
Q

How is unfractionated heparin reversed?

A

Stop infusion

Protamine sulfate

93
Q

What is unfractionated heparin used for?

A

Peri-op in patients requiring full anticoagulation for a high risk indication eg metallic heart valve

94
Q

What are the advantages and disadvantages of unfractionated heparin?

A

Very fast onset, very fast reversal by stopping infusion.
SC unfractionated heparin maay be used in patients with renal impairment instead of LMWH

Regular APTRs required

95
Q

How does LMWH work?

A

Consists of short chain heparins so binds to a specific part of antithrombin which results in inhibition of Xa only

96
Q

How is heparin reversed?

A

Protamine sulfate

97
Q

What is LMWH used for?

A

VTE

VTE prophylaxis

98
Q

What are the advantages and disadvantages of LMWH?

A

Predictable effect
Doesnt need routine monitoring
Safe in pregnancy

Renally cleared

99
Q

What INR target do we aim for in DVT/PE?

A

2-3

100
Q

What INR target do we aim for in AF?

A

2-3

101
Q

What INR target do we aim for in patients with a mechanical heart valve?

A

2.5-3.5

102
Q

What INR target do we aim for in patients with a mitral metallic heart valve?

A

3-4

103
Q

How do we reverse warfarin when there is a major bleed?

A

Stop warfarin

Prothrombin complex concentrate, 5-10mg IV vitamin K

104
Q

How do we reverse warfarin with the following INRs?
INR>8
INR6-8
INR3-6

A

INR>8 stop warfarin, 0.5-2.5mg PO vitamin K if no other risk factors for bleeding
INR 6-8 stop warfarin
INR 3-6 reduce/ stop warfarin

105
Q

What are the contraindications for the COCP?

A

Absolute: smoker>35 years, <6 weeks postpartum, breast feeding, hypertensive, current or past VTE, migraine with aura, CVD, current breast ca, liver cirrhosis.

Relative: adequately controlled hypertension, migraine >35, BMI >35, enzyme inducing medications

106
Q

How does the COCP work?

A

Stops ovulation
Increased cervical mucus
Thins endothelium

107
Q

How are the COCP and other variants given?

A

Pill: take daily 3 weeks on, 1 week off
Patch: change weekly. One free week per month
Ring: leave in for 3 weeks then one ring free week

108
Q

What are the side effects of COCP?

A 
Hormonal SEs
Blood clots
Increased risk of breast/ cervical cancer
Periods may become lighter
Local irritation from patch
109
Q

What are the missed pill rules?

A

Take ASAP even with the next one. If next one on time its fine

If miss two, take one pill immediately and use a condom for 7 days.

If in 1st week of packet will need emergency contraception if had sex in pill free interval or 1st week of pill packet.

2nd week: no action

3rd week: omit the pill free week.

110
Q

What are some contraindications to Progesterone only pill?

A

Forgetfulness
Breast cancer
Undiagnosed PV bleeding
Liver disease

111
Q

How does the progesterone only pill work?

A

Increased cervical mucus

Thins endothelium

112
Q

When do you take the POP?

A

Take daily at same time each day with no breaks

113
Q

What are the side effects of the POP?

A

Hormonal SEs

Periods either stop, irregular, light, more frequent

114
Q

What are the missed pill rules for POP?

A

Take ASAP even if with next one.
If > 3 hours late use condom for 2 days and consider emergency contraception if had sex in 2-3 days before missed pull or had sex since missed pill

115
Q

What are the contraindications for the copper coil or the mirena coil?

A 
Pelvic infection/ PID < 3 months ago
Gynae cancer
Small uterine cavity
Undiagnosed PV bleeding
Copper allergy
116
Q

How does the copper coil work?

A

Copper acts as a spermicide and also causes intrauterine inflammation

117
Q

How long do the copper coil and mirena coil last for?

A

5 years

118
Q

What are the side effects of the copper coil?

A

Coil insertion risks, periods may be heavier

119
Q

What are the important things to know about the coils?

A

Check for string monthly
STI check before inserting
Put in anytime if not had sex since period, or within first 5 days since start of period

If fitted >40y can stay in place until menopause

120
Q

What are the contraindications for progesterone implant?

A

Liver/genital/ breast cancer
Liver disease
Undiagnosed PV bleeding

121
Q

What is the mechanism of action of progesterone implants?

A

Stops ovulation
Thickened cervical mucus
Thins endothelium

122
Q

How long does the progesterone implant work for?

A

3 years

123
Q

How long does the progesterone injection work for/

A

3 months

124
Q

What are the side effects of progesterone implants/ depot?

A

Irregular periods
Hormonal SEs

Bruising/infection after insertion

Oscestop Revision (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions