DoD Flashcards
Losartan drug class
Angiotensin II receptor antagonist
Losartan indications
Diabetic nephropathy in Type 2 Diabetes Mellitus
Chronic heart failure when ACEi are unsuitable
Hypertension
Losartan mechanism of action
Losartan binds to AT1 receptors blocking the binding of angiotensin II preventing the vasoconstrictor and aldosterone secreting effects of angiotensin II.
Losartan adverse drug reaction
Hypotension
Hyperkalaemia
Cause or worsen renal failure
Losartan drug interactions
NSAIDS
Drugs that increase K+ (ACEi and CCB)
Indapamide drug class
Thiazide - like diuretic
Indapamide indications
Essential hypertension
Indapamide mechanism of action
Indapaimde inhibits the Na+/K+ co-transporter in the DCT. This decreases sodium and water reabsorption.
Indapamide adverse drug reactions
Hypokalaemia
Hyponatraemia
Hyperuricemia - gout
Arrhythmias
Hyperglycaemia
Hypercholesterolaemia
Indapamide drug interactions
NSAIDs
Loop diuretics
Amlodipine drug class
Dihydropyridine calcium channel blocker
Amlodipine indications
Prophylaxis of angina
Hypertension
Amlodipine mechanism of action
Amlodipine is a peripheral arterial vasodilator that exerts its action directly on vascular smooth muscle to lead to a reduction in peripheral vascular resistance
Amlodipine adverse drug reactions
Ankle oedema
Flushing
Headaches
Palpitations
Amlodipine drug interactions
Simvastatin
Atorvastin drug class
Statin
Atorvastin indications
Primary hypercholesterolaemia
Familial hypercholesterolaemia
Atorvastatin mechanism of action
Atorvastatin competitively inhibits 3- hydroxy - 3 methylglutaryl coenzyme A ( HMG CoA) which is an enzyme involved in cholesterol synthesis.
Atorvastain adverse drug reactions
GI disruption, nausea and headaches
Myalgia - diffuse muscle pain
Rare - rhabdomyolysis
Atorvastatin drug interactions
amiodarone, diltiazem, macrolides and Amlodipine as there increase plasma statin concentration
Spironolactone drug class
Aldosterone antagonist
Spironolactone indications
Oedema
Ascites in liver cirrhosis
Nephrotic syndrome
Heart failure
Resistant hypertension
Primary hyperaldosteronism
Spironolactone mechanism of action
Spironolactone competitively inhibits aldosterone dependant Na+ K+ exchange
channels in the DCT. This action leads to increased sodium and water excretion, but more potassium retention
Spironolactone adverse drug reactions
Hyperkalaemia
Gynaecomastia
Spironolactone drug interactions
Drugs that increase K+ levels
Metformin drug class
Biguanides
Metformin indications
Type 2 diabetes mellutis
PCOS
Metformin mechanism of action
Metformin inhibits gluconeogenesis so hepatic glucose production decreases
Metformin adverse drug reactions
GI upset - nausea, vomiting and diarrhoea
Metformin drug interactions
ACEi
NSAIDs
Thiazide like diuretics
Loop diuretics
Salbutamol drug class
Short acting selective beta 2 agonist
Salbutamol Indications
Asthma
Salbutamol mechanism of action
Salbutamol binds to beta 2 receptors causing the increased production of cAMP. This decreases calcium in cells and therefore relaxes the smooth muscle causing bronchodilation.
Salbutamol advserse drug reactions
tachycardia palpitations, anxiety and tremor
Increased glycogenolysis and increased renin synthesis
Salbutamol drug interactions
Beta blockers
Sitagliptin drug class
Dipeptidyl peptidase-4 inhibitor ( gliptins )
Sitagliptin indications
Type 2 Diabetes Mellitus
Sitagliptin mechanism of action
Sitagliptin is released after eating and prevents incretin degradation. This increases the plasma concentration of incretin and therefore augments the release of insulin and controls it.
Sitagliptin adverse drug reactions
GI upset
Small risk of pancreatitis
Sitagliptin drug interactions
other hypoglycaemic drugs
Thiazide like diuretics
Loop diuretics
Gliclazide drug class
Sulfonylureas
Gliclazide indications
Type 2 diabetes mellitus
Gliclazide mechanism of action
Gliclazide stimulates insulin secretion through beta cell sulfonylurea receptors augmenting the release of insulin. It also causes ATP-dependant K+ channels to become blocked.
Gliclazide adverse drug reactions
mild GI upset ( nausea, diarrhoea, hypoglycaemia
Gliclazide drug interactions
other hypoglycaemic drugs
Loop diuretics
Thiazide like diuretics
Clopidogrel drug class
ADP receptor antagonist
Clopidogrel indications
TIA
Acute ischaemic stroke
Clopidogrel adverse drug reactions
Bleeding
GI upset - dyspepsia and diarrhoea
Rarely - thrombocytopenia
Clopidogrel drug interactions
CYP inhibitors
Other anti platelet and anticoagulants
Amiodarone drug class
Class III anti-arrhythmic
Amiodarone indications
Ventricular fibrillation
Atrial fibrillation
Tachycardia
Wolff-Parkinson-White syndrome
Amiodarone mechanism of action
Amiodarone increases the refractory period and action potential duration so this increases the sodium conduction and therefore the threshold increases. The next depolarisation cant occur so AV conduction is extended.
Amiodarone adverse drug reactions
Pulmonary fibrosis
Hepatic injury
increase in LDL cholesterol
Thyroid disease
Photosensitivity
optic neuritis - transient blindness
Amiodarone drug interactions
Digoxin
Warfarin
Verapamil drug class
Calcium Channel Blocker ( phenylalkylamine )
Verapamil indications
Supraventricular tachycardia
Angina
Hypertension
Aspirin drug class
Cyclo-oxygenase inhibitor
Aspirin indications
Unstable angina
TIA
Acute ischaemic stroke
Secondary prevention for CVD and DVT
Aspirin mechanism of action
Aspirin inhibits COX-1 mediated production of TXA2 and reduces platelet aggregation
Aspirin adverse drug reactions
GI irritation
GI bleeding
Haemorrhage
Aspirin drug interactions
Anti-platelet drugs
Anti-coagulant drugs
Flecainide drug class
Class Ic anti-arrhythmics
Flecainide indications
Supraventricular tachycardia
Ventricular tachycardia
Wolff-Parkinson-white syndrome
Flecainide adverse drug reactions
Pro-arrhythmia an sudden death with chronic use
Flecainide flutter - increase ventricular response to Supraventricular arrhythmias
CNS and GI effects
Flecainide drug interactions
beta blockers,
Amiodarone
Some antibiotics
Celecoxib drug class
NSAID ( selective COX-2 inhibitor )
Celecoxib indications
Pain and inflammation in : OA and RA
Inflammatory conditions such as ankylosing spondylitis
Celecoxib adverse drug reactions
Increase risk of MI
Decrease in GFR and renal blood flow
Increased BP due to increased sodium reabsorption
Celecoxib Drug Interactions
ACEi
ARBs
Diuretics
Azathioprine drug class
Immunosuppressant
Azathioprine indications
IBD
RA
SLE
Autoimmune conditions
Suppression of transplant rejection T
Azathioprine mechanism of action
Azathioprine inhibits purine synthesis. This results from Azathioprine being cleaved to form 6-MP which is an anti-metabolite that decreases DNA and RNA synthesis. This decreases white blood cell production.
Azathioprine adverse drug reactions
Bone marrow suppression
Increased risk of malignancy
increased risk of infection
Hepatitis
Azathioprine drug interactions
Other immunosuppressants
Morphine drug class
Opiod
Morphine indications
Pain ( acute, chronic , in palliative care )
MI
Acute pulmonary oedema
Morphine mechanism of action
Morphine binds to the μ receptor. This decreases cAMP production causing an efflux of potassium. This hyperpolarises the cell membrane. There is then a decrease in substance P and GABA release and an increase in dopamine release causing a euphoric effect.
Morphine adverse drug reactions
Respiratory Depression
Emesis
GI tract Cardiovascular
Miosis
Histamine release ( asthmatics )
Morphine drug interactions
Other pain medications
Omeprazole drug class
Proton pump inhibitor
Omeprazole indications
Helicobacter Pylori eradication
Benign gastric ulceration
GORD
Severe oesophagitis
Omeprazole mechanism of action
Omeprazole irreversibly inhibits the hydrogen potassium ATPase in gastric parietal cells. This significantly reduces gastric acid secretion.
Omeprazole adverse drug reaction
GI disturbance ( abdominal pain , constipation , diarrhoea )
Headache , dizziness
Drowsiness / confusion
Omeprazole drug interactions
Clopidogrel ( as omeprazole is a CYP inhibitor )
Warfarin ( increases effects )
Phenytoin ( anti - epileptic )
Cyclizine drug class
Histamine 1 receptor antagonist
Cyclizine indications
Nausea
Vomiting
Vertigo
Motion Sickness
Cyclizine mechanism of action
Cyclizine acts on the vestibular nuclei. It inhibits the histaminergic signals from the vestibular system to the chemoreceptor trigger zone in the medulla.
Cyclizine adverse drug reactions
Sedation
Excitation
Anti-Muscarinic - dry mouth, constipation, urinary retention
Cardiac toxicity - long QT intervals
Metoclopramide drug class
Dopamine 2 receptor antagonist
Metoclopramide indications
Nausea
Vomiting
Metoclopramide mechanism of action
Metoclopramide increases acetylcholine at Muscarinic receptors in the gut. This promotes gastric emptying as it increases the tone of the lower oesophageal sphincter and decreases tone of the pylorus. It also increases the tone and amplitude of the gastric contractions. This increases peristalsis.
Metoclopramide adverse drug reactions
Galactorrhoea
Extra-pyramidal effects - dystopia and parkinsonism
Formoterol drug class
Long acting selective beta - 2 - agonist
Formoterol indications
Asthma
COPD
Formoterol mechanism of action
Formoterol binds to beta 2 receptors causing dilation of bronchial smooth muscle and relaxation of airways
Formoterol adverse drug reactions
tachycardia, palpitations, anxiety and tremor
Increased glycogenolysis
Increased renin synthesis
Formoterol drug interactions
beta blockers may reduce the effects of a beta agonist
Apixaban drug class
Direct factor Xa acting oral anticoagulants
Apixaban indications
DVT
PE
Apixaban mechanism of action
Apixaban inhibits both free Xa and that bound with ATIII, do not directly effect thrombin (IIa) - hepatic metabolism and excreted partly by kidneys
Apixaban adverse drug reaction
Bleeding
Apixaban drug interactions
Less frequent interactions than warfarin but affected by CYP inhibitors and inducers
[plasma] reduced by carbamazepine, phenytoin and barbiturates
[plasma] increased by macrolides
Co-amoxiclav drug class
Penicillin
Co-amoxiclav indications
Infections where amoxicllin cant be given alone
Co-amoxiclav mechanism of action
Amoxicillin alongside clavulanic acid is used as some bacteria have an enzyme beta lactamase which breaks down Beta-lactam’s molecular structure and clavulanic acid is a beta-lactamase inhibitor. Therefore this issue is removed.
Co-amoxiclav adverse drug reactions
Diarrhoea
Nausea
Vomiting
Dalteparin drug class
Low molecular weight heparin
Dalteparin indications
DVT
PE
Acute coronary syndromes
Dalteparin mechanism of action
Dalteparin inhibits factor Xa due to it increasing activity of anti thrombin III.
Dalteparin adverse drug reactions
bruising and bleeding
Heparin induced thrombocytopenia
Hyperkalaemia
Osteoporosis
Dalteparin drug interactions
other anti thrombotic drugs
ACEi and ARBs
Amiloride
Spironolactone