Drug and Clinical Knowledge Flashcards
What is GOUT?
A chronic disease that involves the deposition of mono sodium urate crystals in the body.
Which drugs can inhibit the renal excretion of Uric acid?
Thiazide diuretics, loop diuretics, cyclosporine
What monitoring should be undertaken for people with GOUT?
Renal function, serum uric acid
What changes should be made to a patients urate lowering therapy when they are being treated for an acute gout attack?
No changes
What is the dosing regimen for prednisolone for an acute gout attack?
15 - 30mg daily until symptoms abate (typically 3-5 days)
What is the dosing regimen for colchicine for an acute gout attack?
1mg then 0.5mg 1 hour later (1.5mg total dose)
What is the first line drug and dosing regimen for long term management of GOUT?
Allopurinol (xanthine oxidase inhibitor). 50mg daily for 1-2 weeks then increase by 50mg daily every 2-4 weeks or 100mg every 4 weeks until the target serum urate concentration has been achieved. Max dose of 900mg daily
What is the serum urate target for non-tophaceous gout?
<0.36mmol/L
What is the serum urate target for tophaceous gout?
<0.3mmol/L
Which 2 drugs are contraindicated for use with Allopurinol and why?
Azathioprine and mercaptopurine. Allopurinol reduces the metabolism of these drugs resulting in increased risk of bone marrow toxicity.
Note: if this combination is unavoidable, decrease dose of azathioprine or mercaptopurine to 1/3 or 1/4 of original dose
Which drug can be added to Allopurinol if serum urate target cannot be achieved and what is its mechanism?
Probenecid. Blocks the renal tubular absorption of uric acid (uricosuric) and increases renal excretion of uric acid.
Which drug and what dose is recommend and prophylaxis for an acute gout attack when commencing on urate lowering therapy?
Colchicine 500mcg daily or bd
What are the four classes of drugs which are first line for hypertension?
ACE-I
ARBs
Non-dihydropyridine CCBs
Thiazide diuretics
Drug with the suffix (-gliptin) are found in which class?
DPP4-inhibitors (dipeptidyl peptidase)
What class of drugs have the suffix (-glutide)?
GLP-1 analogues (glucagon like peptide)
What is the mechanism of DPP-4 inhibitors?
Inhibit DPP-4 which results in:
- increase in glucose dependant insulin secretion
- reduced glucagon production
Can DPP-4 inhibitors be taken without food?
Yes
Biguanides, DPP-4 inhibitors and alpha 1 glucosidase inhibitors (acarbose) all have what in common?
They are weight neutral
Treatment with a sulfonylurea or insulin increases the risk of hypoglycaemia when combined with which class of drugs?
DPP-4 inhibitors
What is the dose of Linagliptin?
5mg daily
DPP-4 ADRs?
- hypoglycaemia
- GI disturbances
- headache
- muscle pain
- pancreatitis
- rash
What is the dose of Sitagliptin?
100mg daily
When should the dose of sitagliptin be reduced?
In renal impairment
What is the dose of Vildagliptin?
50mg bd
What monitoring is important for vildagliptin?
Liver enzymes
What is the MOA of GLP-1 analogues?
- increase glucose dependant insulin secretion
- suppress inappropriate glucagon secretion
- delay gastric emptying (slows glucose absorption and decreases appetite)
Which other drug class has a similar MOA to GLP-1 analogues and as such, the combination is generally avoided?
DPP-4 inhibitors
Which diabetes medication class commonly causes GI symptoms upon commencement but generally decreases over time?
GLP-1 analogues
Weight loss is an often desirable side effect of which classes of diabetes medications?
- GLP-1 analogues
- SGLT-2 inhibitors
What is the MOA for the SGLT2 - inhibitors?
Decrease glucose absorption in the kidneys
The -flozins belong to which class of diabetes drugs?
SGLT-2 inhibitors
WHat is the dose of empagliflozin?
10mg daily (25mg max)
What is the dose of dapagliflozin?
10mg daily
Which class of diabetes drugs would you NOT commence when a patient is acutely unwell?
SGLT-2 inhibitors (ketoacidosis)
WHich diabetes drug class is cardio and Reno protective?
SGLT-2 inhibitors
What are some of the common ADRs for SGLT-2 inhibitors?
Genital infection, GI disturbanaces, ketoacidosis, dehydration, dizziness, weight loss
What are some of the beneficial ADRs of GLP-1 analogues?
- weight loss
- low risk of hypoglycaemia
- BP lowering
ADRs of GLP-1 analogues
- weight loss
- N & V
- injection site reaction
- increased HR
What are the three common GLP-1 analogues?
- Duloglutide
- Semaglutide
- Liraglutide
What drugs are first line for Parkinson’s disease? And what is the dose?
- Levodopa/benserazide (50/12.5mg tds ➡️ 100/25mg tds)
- Levodopa/carbidopa (50/12.5mg tds ➡️ 100/25mg tds)
Nausea is a common side effect of anti Parkinson’s medications. Which drug would be an appropriate treatment option if a a patient experiences nausea and what is it’s dosing regimen?
Domperidone 10mg tds for 1 week
What are the second line treatment options for Parkinson’s disease?
- Pramipexole (dopamine agonist)
- Rotigotine (dopamine agonist - patch, suitable for patients who are nil by mouth)
If a patient has a penicillin allergy. What is another appropriate drug therapy for H.pylori?
Metronidazole 400mg bd
What is the common first line treatment for eradication of H.pylori?
- esomeprazole 20mg bd
- amoxicillin 1g bd
- clarythromycin 500mg bd
(For 7-14 days)
Donepezil, Rivastigmine (oral and transdermal), galantamine and memantine are used for cognitive impairment in which condition?
Dementia
Donepezil dose for cognitive impairment
5mg d nocte for 4 weeks, increasing to a max of 10mg nocte
Acetylcholinesterase inhibitors are the drug of choice in dementia. What are their effects in the short term?
Modestly improve or stabilise cognition, alertness and function
What are some of the ADRs for acetylcholinesterase inhibitors? Think (DUCTBVG)
Dizziness, drowsiness, urinary incontinence, cramps, tremor, bradycardia, vivid dreams, GI Sx
In which situation would you choose rivastigmine over other anticholinesterase inhibitors?
If the patient can’t swallow (this medication comes in patches!)
What is the dose of memantine?
5mg initially, titrating up to 20mg
What is the dose of Galantamine MR? (DIMENTIA)
8mg (max 24 mg daily)
Which acetylcholinesterase inhibitor should not be used in dementia with Lewy bodies?
Galantamine
Which 2 antipsychotic therapies are used for the management of aggression, agitation or psychoses of dimentia? (NOT LEWY BODY THO)
Risperidone - 0.25mg bd
Olanzapine - 2.5mg d
What is an appropriate antipsychotic choice for dementia with Lewy body’s and which is also accepted for neuropsychiatric symptoms in Parkinson’s disease?
Quetiapine 12.5 - 25mg d or bd
Which class of antidepressants may be used in dimentia (however limited evidence)
SSRIs (citalopram, escitalopram, sertraline)
Outline the stepwise approach for drug therapy in COPD.
- PRN SABA therapy
- Regular LAMA or LABA
- Dual therapy: LABA + LAMA
- Triple therapy: LAMA + LABA + ICS
What is the first line treatment option for a COPD exacerbation?
Salbutamol 100mcg up to 8 times
What is the one thing that can slow the progression of COPD?
Smoking cessation
Pramipexole and rotigotine are second line anti-Parkinson’s agents. What is their class/Moa?
Dopamine agonists
Rasagiline, safinamide and selegiline belong to which class of drugs and MAY be used for treatment of Parkinson’s disease?
Monoamine oxidase inhibtiors
When would you consider using Pramipexole over first line agents (levodopa) in Parkinson’s?
If a patient strongly prefers/wants once daily dosing
When would you use rotigitine in parksions disease?
If a patient can’t swallow (transdermal formulation)
Which two antipsychotics may be trialled for neuropsychiatric symptoms of Parkinson’s disease?
Clozapine
Quetiapine
Which drugs may be trialled for DIMENTIA in Parkinson’s disease?
Acetylcholinesterase inhibitors
- Donepezil
- rivastigmine oral or transdermal
MOA of sulfonylureas
Increase pancreatic insulin secretion
