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Drug of the day > CPT Drug of the day > Flashcards

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
Q

What are some DDIs you need to be aware of when prescribing Atorvastatin?

A

Amiodarone, diltiazem, macrolides- CYP 3A4- they increase plasma statin conc and amlodipine increases plasma statin conc too

26
Q

When would you prescribe Atorvastatin?

A

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
Q

What type of drug is Spironolactone?

A

An aldosterone receptor antagonist

28
Q

Why might we prescribe Spironolactone?

A

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
Q

How does Spironolactone work?

A
  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
Q

What are some ADRs of Spironolactone?

A

Hyperkalaemia, gynaecomastia

31
Q

What are the contraindications/warnings of Spironolactone?

A

Hyperkalaemia, Addison’s

32
Q

What interactions should you be aware of, when prescribing spironolactone?

A
  1. Drugs affecting K+, or limit excretion of K+. 2. Pregnancy
33
Q

What drug is in the class Biguanides?

A

Metformin

34
Q

What is Metformin used for?

A

T2 DM

35
Q

What is Metformin’s mechanism of action?

A

Inhibits gluconeogenesis. As a result, this reduces hepatic glucose production and reduces insulin resistance

36
Q

How does Metformin limit weight gain?

A

Suppresses appetite

37
Q

For someone with T2DM, what is a benefit of prescribing Metformin?

A

It can be taken alongside other hypoglycaemic agents

38
Q

What are ADRs associated to Metformin?

A

GI upset - nausea, vomiting, diarrhoea

39
Q

What are contraindications of Metformin?

A

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
Q

Why is the risk of hypoglycaemia when taking Metformin reduced?

A

Metformin does not completely inhibit gluconeogenesis, so some can still occur

41
Q

What are some DDIs to be aware of when prescribing Metformin?

A
  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
Q

What type of drug is Sitagliptin?

A

Gliptins aka DPP-4 inhibitor (Dipeptidyl peptidase-4 inhibitor)

43
Q

What is Sitagliptin prescribed for?

A

T2 DM

44
Q

How does Sitagliptin work?

A

Prevents incretin degradation so increase plasma incretin concentration levels. (Note: incretin = stimulate insulin secretion)

45
Q

How does Sitagliptin affect appetite and weight?

A

Suppress appetite, but patients remain weight neutral

46
Q

What are ADRs of Sitagliptin?

A
  • GI upset
  • Headaches
  • Risk of pancreatitis (in 1%)
47
Q

What DDIs should you be aware of when prescribing Sitagliptin?

A

Other hypoglycaemic agents Drugs that increase glucose can oppose gliptins (thiazide like and loop diuretics)

48
Q

What class does gliclazide belong to?

A

Sulfonylureas

49
Q

What Is gliclazide prescribed for?

A

T2 DM

50
Q

How does gliclazide work?

A

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
Q

What are side effects of gliclazide?

A

GI upset - nausea, vomiting, diarrhoea, hypoglycaemia

52
Q

What contraindications should you be cautious of if prescribing gliclazide?

A

Patients at risk of hypoglycaemia. Patients with hepatic or renal disease

53
Q

What are some DDIs to think about when prescribing gliclazide?

A

Hypoglycaemic agents

54
Q

What class of drug is Clopidogrel?

A

Antiplatelet drug - will thin the blood

55
Q

What are the common indications for Clopidogrel?

A
  • 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
Q

What is the mechanism of action for Clopidogrel?

A
  • 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
Q

What are some adverse drug reactions of Clopidogrel?

A
  • Diarrhoea
  • GI discomfort
  • haemorrhage
  • skin reactions
58
Q

What are some DDIs to be aware of with Clopidogrel?

A
    • 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
Q

What is the problem with prescribing NSAIDS alongside aspirin, an antiplatelet?

A
  • 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
Q

What cautions are there for the use of Indapamide?

A
  • Diabetes
  • Gout
  • Risk of Hypokalaemia
  • Systemic Lupus Erythematosus

Drug of the day (2 decks)

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