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PHRM4012 > Drug and Clinical Knowledge > Flashcards

Drug and Clinical Knowledge Flashcards

1
Q

What is GOUT?

A

A chronic disease that involves the deposition of mono sodium urate crystals in the body.

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2
Q

Which drugs can inhibit the renal excretion of Uric acid?

A

Thiazide diuretics, loop diuretics, cyclosporine

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3
Q

What monitoring should be undertaken for people with GOUT?

A

Renal function, serum uric acid

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4
Q

What changes should be made to a patients urate lowering therapy when they are being treated for an acute gout attack?

A

No changes

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5
Q

What is the dosing regimen for prednisolone for an acute gout attack?

A

15 - 30mg daily until symptoms abate (typically 3-5 days)

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6
Q

What is the dosing regimen for colchicine for an acute gout attack?

A

1mg then 0.5mg 1 hour later (1.5mg total dose)

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7
Q

What is the first line drug and dosing regimen for long term management of GOUT?

A

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

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8
Q

What is the serum urate target for non-tophaceous gout?

A

<0.36mmol/L

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9
Q

What is the serum urate target for tophaceous gout?

A

<0.3mmol/L

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10
Q

Which 2 drugs are contraindicated for use with Allopurinol and why?

A

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

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11
Q

Which drug can be added to Allopurinol if serum urate target cannot be achieved and what is its mechanism?

A

Probenecid. Blocks the renal tubular absorption of uric acid (uricosuric) and increases renal excretion of uric acid.

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12
Q

Which drug and what dose is recommend and prophylaxis for an acute gout attack when commencing on urate lowering therapy?

A

Colchicine 500mcg daily or bd

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13
Q

What are the four classes of drugs which are first line for hypertension?

A

ACE-I
ARBs
Non-dihydropyridine CCBs
Thiazide diuretics

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14
Q

Drug with the suffix (-gliptin) are found in which class?

A

DPP4-inhibitors (dipeptidyl peptidase)

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15
Q

What class of drugs have the suffix (-glutide)?

A

GLP-1 analogues (glucagon like peptide)

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16
Q

What is the mechanism of DPP-4 inhibitors?

A

Inhibit DPP-4 which results in:
- increase in glucose dependant insulin secretion
- reduced glucagon production

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17
Q

Can DPP-4 inhibitors be taken without food?

A

Yes

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18
Q

Biguanides, DPP-4 inhibitors and alpha 1 glucosidase inhibitors (acarbose) all have what in common?

A

They are weight neutral

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19
Q

Treatment with a sulfonylurea or insulin increases the risk of hypoglycaemia when combined with which class of drugs?

A

DPP-4 inhibitors

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20
Q

What is the dose of Linagliptin?

A

5mg daily

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21
Q

DPP-4 ADRs?

A
  • hypoglycaemia
  • GI disturbances
  • headache
  • muscle pain
  • pancreatitis
  • rash
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22
Q

What is the dose of Sitagliptin?

A

100mg daily

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23
Q

When should the dose of sitagliptin be reduced?

A

In renal impairment

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24
Q

What is the dose of Vildagliptin?

A

50mg bd

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25
Q

What monitoring is important for vildagliptin?

A

Liver enzymes

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26
Q

What is the MOA of GLP-1 analogues?

A
  • increase glucose dependant insulin secretion
  • suppress inappropriate glucagon secretion
  • delay gastric emptying (slows glucose absorption and decreases appetite)
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27
Q

Which other drug class has a similar MOA to GLP-1 analogues and as such, the combination is generally avoided?

A

DPP-4 inhibitors

28
Q

Which diabetes medication class commonly causes GI symptoms upon commencement but generally decreases over time?

A

GLP-1 analogues

29
Q

Weight loss is an often desirable side effect of which classes of diabetes medications?

A
  • GLP-1 analogues
  • SGLT-2 inhibitors
30
Q

What is the MOA for the SGLT2 - inhibitors?

A

Decrease glucose absorption in the kidneys

31
Q

The -flozins belong to which class of diabetes drugs?

A

SGLT-2 inhibitors

32
Q

WHat is the dose of empagliflozin?

A

10mg daily (25mg max)

33
Q

What is the dose of dapagliflozin?

A

10mg daily

34
Q

Which class of diabetes drugs would you NOT commence when a patient is acutely unwell?

A

SGLT-2 inhibitors (ketoacidosis)

35
Q

WHich diabetes drug class is cardio and Reno protective?

A

SGLT-2 inhibitors

36
Q

What are some of the common ADRs for SGLT-2 inhibitors?

A

Genital infection, GI disturbanaces, ketoacidosis, dehydration, dizziness, weight loss

37
Q

What are some of the beneficial ADRs of GLP-1 analogues?

A
  • weight loss
  • low risk of hypoglycaemia
  • BP lowering
38
Q

ADRs of GLP-1 analogues

A
  • weight loss
  • N & V
  • injection site reaction
  • increased HR
39
Q

What are the three common GLP-1 analogues?

A
  • Duloglutide
  • Semaglutide
  • Liraglutide
40
Q

What drugs are first line for Parkinson’s disease? And what is the dose?

A
  1. Levodopa/benserazide (50/12.5mg tds ➡️ 100/25mg tds)
  2. Levodopa/carbidopa (50/12.5mg tds ➡️ 100/25mg tds)
41
Q

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?

A

Domperidone 10mg tds for 1 week

42
Q

What are the second line treatment options for Parkinson’s disease?

A
  1. Pramipexole (dopamine agonist)
  2. Rotigotine (dopamine agonist - patch, suitable for patients who are nil by mouth)
43
Q

If a patient has a penicillin allergy. What is another appropriate drug therapy for H.pylori?

A

Metronidazole 400mg bd

44
Q

What is the common first line treatment for eradication of H.pylori?

A
  • esomeprazole 20mg bd
  • amoxicillin 1g bd
  • clarythromycin 500mg bd
    (For 7-14 days)
45
Q

Donepezil, Rivastigmine (oral and transdermal), galantamine and memantine are used for cognitive impairment in which condition?

A

Dementia

46
Q

Donepezil dose for cognitive impairment

A

5mg d nocte for 4 weeks, increasing to a max of 10mg nocte

47
Q

Acetylcholinesterase inhibitors are the drug of choice in dementia. What are their effects in the short term?

A

Modestly improve or stabilise cognition, alertness and function

48
Q

What are some of the ADRs for acetylcholinesterase inhibitors? Think (DUCTBVG)

A

Dizziness, drowsiness, urinary incontinence, cramps, tremor, bradycardia, vivid dreams, GI Sx

49
Q

In which situation would you choose rivastigmine over other anticholinesterase inhibitors?

A

If the patient can’t swallow (this medication comes in patches!)

50
Q

What is the dose of memantine?

A

5mg initially, titrating up to 20mg

51
Q

What is the dose of Galantamine MR? (DIMENTIA)

A

8mg (max 24 mg daily)

52
Q

Which acetylcholinesterase inhibitor should not be used in dementia with Lewy bodies?

A

Galantamine

53
Q

Which 2 antipsychotic therapies are used for the management of aggression, agitation or psychoses of dimentia? (NOT LEWY BODY THO)

A

Risperidone - 0.25mg bd
Olanzapine - 2.5mg d

54
Q

What is an appropriate antipsychotic choice for dementia with Lewy body’s and which is also accepted for neuropsychiatric symptoms in Parkinson’s disease?

A

Quetiapine 12.5 - 25mg d or bd

55
Q

Which class of antidepressants may be used in dimentia (however limited evidence)

A

SSRIs (citalopram, escitalopram, sertraline)

56
Q

Outline the stepwise approach for drug therapy in COPD.

A
  1. PRN SABA therapy
  2. Regular LAMA or LABA
  3. Dual therapy: LABA + LAMA
  4. Triple therapy: LAMA + LABA + ICS
57
Q

What is the first line treatment option for a COPD exacerbation?

A

Salbutamol 100mcg up to 8 times

58
Q

What is the one thing that can slow the progression of COPD?

A

Smoking cessation

59
Q

Pramipexole and rotigotine are second line anti-Parkinson’s agents. What is their class/Moa?

A

Dopamine agonists

60
Q

Rasagiline, safinamide and selegiline belong to which class of drugs and MAY be used for treatment of Parkinson’s disease?

A

Monoamine oxidase inhibtiors

61
Q

When would you consider using Pramipexole over first line agents (levodopa) in Parkinson’s?

A

If a patient strongly prefers/wants once daily dosing

62
Q

When would you use rotigitine in parksions disease?

A

If a patient can’t swallow (transdermal formulation)

63
Q

Which two antipsychotics may be trialled for neuropsychiatric symptoms of Parkinson’s disease?

A

Clozapine
Quetiapine

64
Q

Which drugs may be trialled for DIMENTIA in Parkinson’s disease?

A

Acetylcholinesterase inhibitors
- Donepezil
- rivastigmine oral or transdermal

65
Q

MOA of sulfonylureas

A

Increase pancreatic insulin secretion

PHRM4012 (6 decks)

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