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CPT Drug of the day Flashcards

1
Q

what is Jenny’s fav drug

A

white wine

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2
Q

What class of drug is Amlodopine?

A

Amlodopine is a dihydropyridine calcium- channel blocker

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3
Q

What are the common indications for Amlodopine?

A
  • Prophylaxis of Angina
  • Hypertension
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4
Q

What is the mechanism of action for Amlodopine?

A

Ca channel blockers stop inward movement of Ca ions through slow channels of cell membranes.

Act on: myocardial cells, cells of the conducting system in the heart, cells of vascular smooth muscle Effect: myocardial contractility is reduced, depressed propagation of action potentials in the heart, coronary / systemic vascular tone can be diminished.

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5
Q

What are some adverse drug reactions to Amlodopine?

A
  • Abdominal pain
  • Dizziness
  • Headache
  • Nausea
  • Flushing
  • Tacchycardia
  • Peripheral oedema
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6
Q

What are the possible drug interactions when taking Amlodopine?

A
    • Bisoprolol = risk of hypotension
    • GTN = risk of hypotension (LOTS with risk of hypotension)
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7
Q

What is type of drug is losartan?

A

Antihypertensive

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8
Q

How does losartan work?

A

Angiotensin 2 receptor antagonist.It lowers BP by decreasing vasoconstrictor tone

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9
Q

When would we give losartan over ACEi?

A

When patients have low renin or when they are unable to tolerate the cough with ACEi.

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10
Q

How do you deliver losartan?

A

Orally

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11
Q

What are the clinical uses of losartan?

A

hypertension, congestive heart failure, nephropathy

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12
Q

What are the adverse affects of losartan?

A
  • Hypotension
  • Hyperkalaemia
  • Can worsen renal failure
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13
Q

What conditions are contraindicated with losartan?

A

Renal artery stenosis, AKD, pregnancy

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14
Q

Are there any drug interactions with losartan you need to be aware of?

A

Drugs that increase potassium and NSAIDS

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15
Q

What type of drug is Indapamide

A

Thiazide-like diuretic

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16
Q

What is the mechanism of action for Indapamide

A
  • Indapamide (Thiazide like diuretic) acts at the DCT where it inhibits the Na+/Cl- cotransporter.
  • Sodium and water are retained in the lumen of the nephron for urinary excretion.
  • At lower doses vasoldilation is prominent, higher doses diureses is the biggest effect.
  • Reduced plasma volume, reduced venous return, lower cardiac output, and ultimately decreased blood pressure.
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17
Q

What are the side effects of Indapamide?

A
  • Postural hypotension
  • Constipation
  • Diarrhoea
  • Dizziness
  • Dry Mouth
  • Electrolyte imbalance
  • Hyperuricaemia
  • Hyperglycaemia (esp with beta blocker)
  • Hypokalaemia
  • Small increase in cholesterol and triglycerides
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18
Q

What the contraindications of Indapamide?

A

In patients with hypokalaemia, hyponatraemia and gout

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19
Q

Are there any DDIs you need to be aware of when prescribing Indapamide?

A

NSAIDs, drugs that cause K loss (loop diuretics)

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20
Q

How do statins work?

A

Competitive inhibition of HMG- CoA reductase, contributes to the up regulation of hepatic LDL receptors

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21
Q

What are some additional benefits of statin therapy?

A

Improved vascular endothelial function Stabilisation of athersclerotic plaque Improved haemostasis Anti-inflammatory Antioxidant All contributes to the reduction in CVD risk

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22
Q

What is the half life of Atorvastatin and how is it metabolised?

A

first pass metabolism and the t1/2 is 24hrs

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23
Q

What are some adverse side effects of Atorvastatin?

A

GI disruption, nausea and headache, myalgia (dose related), rhabdomyolsis

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24
Q

What are some contraindications you should be aware of when prescribing Atorvastatin?

A

Renal or hepatic impairment, pregnancy and breastfeeding

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25
What are some DDIs you need to be aware of when prescribing Atorvastatin?
Amiodarone, diltiazem, macrolides- CYP 3A4- they increase plasma statin conc and amlodipine increases plasma statin conc too
26
When would you prescribe Atorvastatin?
Primary prevention- 20mg once daily if someone has a CVD risk of \> 10% Secondary prevention- 80mg once daily if someone has had a major cardiac event
27
What type of drug is Spironolactone?
An aldosterone receptor antagonist
28
Why might we prescribe Spironolactone?
As an antihypertensive. Might be prescribed for a patient needing to manage heart failure. It is added as an adjunct to ACEi/ARB + diuretic.
29
How does Spironolactone work?
1. Spironolactone competes with aldosterone. 2. It competitively binds to the aldosterone receptor, at the aldosterone-dependent sodium-potassium (NA+K+ATPase) exchange site in the distal convoluted renal tubule. 3. Kidneys excrete more water and NA+. This reduces the circulating volume, reducing preload and after load (workload of the heart).
30
What are some ADRs of Spironolactone?
Hyperkalaemia, gynaecomastia
31
What are the contraindications/warnings of Spironolactone?
Hyperkalaemia, Addison's
32
What interactions should you be aware of, when prescribing spironolactone?
1. Drugs affecting K+, or limit excretion of K+. 2. Pregnancy
33
What drug is in the class Biguanides?
Metformin
34
What is Metformin used for?
T2 DM
35
What is Metformin's mechanism of action?
Inhibits gluconeogenesis. As a result, this reduces hepatic glucose production and reduces insulin resistance
36
How does Metformin limit weight gain?
Suppresses appetite
37
For someone with T2DM, what is a benefit of prescribing Metformin?
It can be taken alongside other hypoglycaemic agents
38
What are ADRs associated to Metformin?
GI upset - nausea, vomiting, diarrhoea
39
What are contraindications of Metformin?
Metformin is not metabolised, so is excreted unchanged in the kidneys. Because of this, it needs to be stopped if: 1. eGFR\<30mL/min 2. have alcohol intoxication
40
Why is the risk of hypoglycaemia when taking Metformin reduced?
Metformin does not completely inhibit gluconeogenesis, so some can still occur
41
What are some DDIs to be aware of when prescribing Metformin?
1. Drugs that impair renal function - ACEi, diuretics, NSAIDs 2. Drugs that reduce metformin action/effects (i.e. oppose action) - loop and thiazide like diuretics (as they increase glucose)
42
What type of drug is Sitagliptin?
Gliptins aka DPP-4 inhibitor (Dipeptidyl peptidase-4 inhibitor)
43
What is Sitagliptin prescribed for?
T2 DM
44
How does Sitagliptin work?
Prevents incretin degradation so increase plasma incretin concentration levels. (Note: incretin = stimulate insulin secretion)
45
How does Sitagliptin affect appetite and weight?
Suppress appetite, but patients remain weight neutral
46
What are ADRs of Sitagliptin?
* GI upset * Headaches * Risk of pancreatitis (in 1%)
47
What DDIs should you be aware of when prescribing Sitagliptin?
Other hypoglycaemic agents Drugs that increase glucose can oppose gliptins (thiazide like and loop diuretics)
48
What class does gliclazide belong to?
Sulfonylureas
49
What Is gliclazide prescribed for?
T2 DM
50
How does gliclazide work?
Stimulates B-cell pancreatic insulin secretion by blocking ATP dependent K+ channels. (To help understanding: If K+ channels are blocked, this reduces K+ conductance, so membrane depolarisation can occur. Depolarisation causes Ca2+ influx. Ca2+ influx allows insulin to be secreted from insulin vesicles.)
51
What are side effects of gliclazide?
GI upset - nausea, vomiting, diarrhoea, hypoglycaemia
52
What contraindications should you be cautious of if prescribing gliclazide?
Patients at risk of hypoglycaemia. Patients with hepatic or renal disease
53
What are some DDIs to think about when prescribing gliclazide?
Hypoglycaemic agents
54
What class of drug is Clopidogrel?
Antiplatelet drug - will thin the blood
55
What are the common indications for Clopidogrel?
* Prevent atherothrombotic events in PCI (percutaenous coronary intervention) used + aspirin. * TIA for patients with severe aspirin hypersensitivity * Post MI with ST elevation + aspirin * To prevent Acute Coronary syndromes w/o ST elevation * Pt w/ Atrial Fib + 1 risk factor for vasucalr event + aspirin * Prevent atherthrombotic event in peripheral arterial disease, or within 35 days of MI, or within 6 months of a stroke.
56
What is the mechanism of action for Clopidogrel?
* The active metabolite of **clopidogrel** selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor. * The stops the subsequent ADP- mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. * This action is irreversible
57
What are some adverse drug reactions of Clopidogrel?
* Diarrhoea * GI discomfort * haemorrhage * skin reactions
58
What are some DDIs to be aware of with Clopidogrel?
* + Omeprazole (PPI) reduce efficacy * Any other drug that increaeses bleeding e.g. heparin, aspirin * Fluoextine (SSRI) reduced the efficacy of Clopidogrel * Fluconazole (anti fungal) reduce efficacy * Naproxen (NSAID) GI Bleeding, malena, Gi upset, abdo pain
59
What is the problem with prescribing NSAIDS alongside aspirin, an antiplatelet?
* Low-dose aspirin irreversibly inhibits platelet cyclooxygenase-1 (COX-1) and suppresses platelet aggregation. * Aspirin is effective for secondary prevention of cardiovascular events. * Because nonsteroidal anti-inflammatory drugs (NSAIDs) reversibly bind with COX-1, the antiplatelet effects of aspirin may be suppressed when NSAIDs are co-administered. * This interaction could be avoided by avoiding simultaneous administration * https://jphcs.biomedcentral.com/articles/10.1186/s40780-017-0078-7
60
What cautions are there for the use of Indapamide?
* Diabetes * Gout * Risk of Hypokalaemia * Systemic Lupus Erythematosus

Drug of the day (2 decks)

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