Drug of the day Flashcards
Losartan
Common indications: Hypertension, Diabetic nephropathy, Chronic HF
Class: Angiotensin II receptor antagonist
MOA: Directly target AT1 receptors, inhibit vasoconstriction and aldosterone stimulation
Adverse reactions: Anaemia, Hypoglycaemia, Hypotentsion
DDIs: K sparing drugs, NSAIDs
Amlodipine
Common indications: HTN, Stable angina
Class: CCB: Dihydropyridine
MOA: Acts on peripheral vasculature, blocks CA entry into cells, preventing Ca initiated smooth muscle contraction
Adverse reactions: Ankle swelling, Headaches, Flushing, Syncope, Palpitations
DDIs: Anti-hypertensives, Simvastatin, Unstable angina/severe aortic stenosis
Indapamide
Common indications: HTN, HF, Oedma
Class: Thiazide-like diuretic
MOA: Inhibit Na/Cl transporter in the DCT - decreased Na & H2O absorption
Adverse reactions: Hypo- kalaemia & natraemia, Arrhythmia, Increased LDL, Hyper - calcaemia, glycaemia, uricaemia (gout)
DDIs: NSAIDs, K lowering drugs, Alcohol, Amlodipine
Atorvastatin
Common indications: Hypercholesterolaemia (inc familial), Hyperlipidaemia, Prevention of cardiovasuclar events
Class: Statin
MOA: Competitive inhibtion of HMG-CoA reductase, Upregulation of hepatic LDL receptors, Increased clearance of circulating LDL
Adverse reactions: GI disruption, Nausea, Headache, Myalgia, Rhabdomyolosis (rare), Increased liver enzymes
DDIs: CYP3A4 inhibitors- amiodarone, diltiazem, macrolides. Amlodipine
Spironalactone
Common indications: HTN, HF, Oedema, Nephrotic syndrome
Class: Aldosterone antagonist
MOA: Increased ENAC and Na/K/ATPase expression in CD, reduced Na absorption and K excretion (K sparing drug)
Adverse reactions: Gynaecomastia, Hyperkalaemia, Severe Cuatneous Adverse Reactions (SCARs)
DDIs: Alcohol, ACEi, Amiloride, ARBs, Preganancy, monitor K sparing drugs
Verapamil
Common indications: Arrhythmias (tachycardia), Angina, HTN
Class: CCB- non-dihydropyridine, Class IV anti-arrhythmic
MOA: Acts centrally, prolonging the action potential/refactory period, Negative chronotropic and ionotropic effects
Adverse reactions: Constipation, Bradycardia, Heart block, Cardiac failure
DDIs: B-blockers, anti-hypertensives/arrhythmics
Amiodarone
Common indications: Arrhythmias, Ventricular fibrilation
Class: Class III anti-arrhythmic
MOA: Rhythm controlling, Blocks K channels, Increases refractory period
Adverse reactions: Thyroid disease, Pulmonary fibrosis, Hepatic injury, Increased LDL cholestrol, Photosensitivity, Optic neuritis
DDIs: Digoxin, Warfarin
Ezetimibe
Common indications: Familial hypercholesterolaemia
Class: Cholesterol absorption inhibitor
MOA: Inhibits NPC1L1 transporter at brush border in SI, Increases hepatic LDL receptor expression - reduces cholesterol and LDL
Adverse reactions: Abdominal pain, GI upset, angioedema
DDIs: Cautions w/ statins (rhabdo risk)
Dapagliflozins
Common indications: T2DM, Symptomatic chronic HFrEF. CKD
Class: SGLT2 inhibitor (gliflozins)
MOA: Reversible inhibition of SGLT2 in PCT - decreased glucose absorption, increased urinary glucose excretion
Adverse reactions: UTI/genital infection, Polydipsia, Polyuria, Pancreatitis?
DDIs: Antihypertensives, hypoglycaemic drugs
Clopidogrel
Common indications: Ischaemic stroke/ TIA, (N)STEMI, Risk of CVS events
Class: Anti-platelet (ADP receptor antagonist)
MOA: Irreversible inhibition of P2Y 12 - inhibits activation of GPIIb/IIIa receptors
Adverse reactions: Bleeding, GI upset - dyspepsia, diarrhoea, Thrombocytopenia (rare)
DDIs: PPIs, CYP inhibitors - omperazole, erhthromycin, SSRIs
Semaglutide
Common indications: Diabetes -uneffective triple therapy, Weight loss
Class: Incretin mimetic
MOA: GLP-1 receptor agonist, increases glucose dependant synthesis of insulin secretion
Adverse reactions: Gi upset, Decreaesd appetitie w/ weight loss
DDIs: Hypoglycaemic agents
Flecainide
Common indications: SVT (AF and flutter), Wolff-Parkinson-White syndrome, Pre-ventricular contractions
Class: Class Ic anti-arrhythmic
MOA: Na channel blocker, Increase APD and refractory period
Adverse reactions: Pro-arrhythmic, GI upset, CNS - drowsiness, dizziness, Sudden death in IHD
DDIs: Anti-arrhythmic drugs w/ negative chronotropy or prolong QT
Aspirin
Common indications: (N)STEMI, 2* prevention of CVS event, Some AF patients, Post PCI/stent
Class: Anti-platelet - COX-1 inhibitor
MOA: Irreversibly inhbits COX-1 mediated production of thromboxane A2 and decreases platelet aggregation
Adverse effects: GI irritation and bleeding, Haemorrhage (stroke), Hypersensitivity
DDIs: Caution- other anti-platelets and anti-coagulants
Celecoxib
Common indications: OA, RA, Ankylosing spondylitis
Class: NSAID- COX-2 inhibitor
MOA: Selective COX-2 inhibition, Inhibits platelet aggregration
Adverse effects: Dyspepsia, Nausea, Peptic ulcerations, Bleeding and ulcerations, IBD exacerbation, Nephrotoxic
DDIs: Aspirin, Glucocorticoids, Anti-coagulants
Azathioprine
Common indications: CD, UC, SLE, Vasculitis
Class: Immunosupressannt - DMARDs
MOA: Cleaves to 6-MP, Anti-metabolite decreases DNA and RNA synthesis, Inflammatory cell inhibition
Adverse effects: Bone marrow suppression, Hepatitis, Pancreatitis, Increased infection and malignancy risk
DDIs: Immunosuppressants
Measure TPMT levels before treatment
Fentanyl
Common indications: Chronic pain, Palliation
Class: Opiod
MOA: Acts at u-opiod receptor
Adverse effects: Respiratory depression, Miosis, Constipation, Drowsiness, Dysphoria, Itching, Urinary retention, Flushing, Hyperhyrosis
DDIs: CNS depressants- AEDs, benzos, Opiod containing drugs, decreased gut motility - Clarithromycin
Salbutamol
Common indications: Asthma, COPD, Allergy prophylaxis
Class: B2 agonist
MOA: Acts on airway smooth muscle to reverse bronchoconstriction, Short-acting
Adverse effects: Tachycardia, Palpitations, Anxiety, Tremor, Increased glycogenolysis and renin
DDIs: B-blockers
Theophylline
Common indications: Asthma
Class: Xanthines
MOA: Adenosine receptor antagonist, decreases bronchoconstriction, PDE inhibitor, Long acting
Adverse effects: GI disturbance, - dicomfort, diarrhoea, GORD, Anxiety, Dizziness, Nausea/vomiting, Arrhythmias
Narrow therapeutic index
DDIs: CYP450 inhibitors (increase drug conc)
Metoclopramide
Common indications: Nausea & vomiting - post op and chemo, Acute migraine
Class: Anti-emetic: dopemaine receptor agonist
MOA: D2 receptor antagonist, central dopamine, peripheral cholinergic agonist
Adverse effects: Depression, Diarrhoea, Drowsiness, Hypotension, Galactorrhoea, Dystonia, Parkinsonism
DDIs: Anti-psychotics, caution dopamine agonists
Omeprazole
Common indications: Gastro/duodenal ulcers, H. pylori infection, G.O.R.D.
Class: Proton pump inhibitor
MOA: Irreversibly inhibits H+/K+ ATPase in gastric parietal cells - decrease acid secretion
Adverse effects: GI disturbance - abdo pain, constipation, diarrhoea, Headaches, Dizziness, Drowsiness, Confusion
DDIs: Omeprazole CYP inhibitor - decreased Clopidogrel action
Monitior warfarin & phenytoin
Ondansetron
Common indications: Nausea & Vomiting associated w/chemo/radiotherapy and post-op
Class: 5-HT3 (Serotonin) antagonist
MOA: Blocks the action of serotinin in the gut. reduced GI motility and secretions, Centrally acts to inhibit CTZ (chemo centre)
Adverse effects: Conatipation, Headache, Dystonia, Parkinsonism, Increased liver enzymes, Long QT syndrome
DDIs: Liver disease, QT interval lengthening drugs - amiodarone
Apixaban
Common indications: VTE - DVT/PE, prophylaxis of cardiac events
Class: DOAC
MOA: Inhibit both free Xa and that bound w/ ATIII - preventing thrombus formation and growth
Adverse effects: Bleeding, Skin reactions
DDIs: CYP inhibitors
Carbamazepine, phenytoin, barbituates - Decrease [plasma]
Macrolides - Increase [plasma]
Caution- AF and GI bleed risk group
Dalteparin
Common indications: VTE = DVT/PE treatment and prophylaxis, Unstable coronary artery disease
Class: low Molecular Weight Heparin
MOA: Inhibition of Xa by enhancing ATIII activity
Adverse effects: Bleeding/Bruising - intracranial, infection site, GI, epistaxis, Hyperkalaemia, Osteoporosis, Heparin induced thrombocytopenia
DDIs: Anti-thrombotic agents, ACEi/ARB, K+ sparing drugs
Warfarin
Common indications: VTE- DVT/PE, AF - DOACs not suitable
Class: Vit K antagonist
MOA: Inhibit activation of Vit K dependant clotting factors
Adverse effects: Bleeding- Epistaxis, Retroperitoneal
DDIs: CYP2C9 - amiodrarone, clopidogrel, intoxicating alcohol dose
Cephalosporin Abx
NDSAIDs - decreasing GI absorption of Vit K
Barbituates, phenytoin, rifampicin, St John’s Wort
