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CPT > Drug Of The Day > Flashcards

Drug Of The Day Flashcards

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1
Q

What is Ramipril?
What is it used for?
MoA?
Adverse effects?
Contraindications?
Drug Drug interactions?

A

ACEi

Antihypertensive, HFrEF

Prevents production of angiotensin II so vasodilation, reduced blood vol (low aldosterone and ADH)

Dry cough
Hypotension
Hyperkalaemia
Worsen renal failure

Renal artery stenosis
AKI
Pregnancy
CKD

K+ sparring drugs
NSAIDs
Other antihypertensives

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2
Q

What is Amlodipine?
What is it used for?
MoA?
Adverse effects?
Contraindications?
Drug Drug interactions?

A

Calcium channel blocker a dihydropyridine
Antihypertensive

Blocks L type calcium channels preventing flux of Ca2+ into cells in the peripheral vasculature

Ankle swelling
Flushing
Headaches (vasodilation)
Palpitations

Unstable angina
Serve aortic stenosis
Cardiogenic shock

Amlodipine + simvastatin increases effect of statin

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3
Q

What is Furosemide?
What is it used for?
MoA?
Adverse effects?
Contraindications?
Drug Drug interactions?

A

Loop diuretic

Acute pulmonary oedema, fluid overload in Heart Failure, adjunct in nephrotic syndrome

It blocks the NKCC channel in the ascending limb of the Loop Of Henle, this means lots of Na+, K+ and Cl- remain in filtrate increasing the Osmolality so water remains in the filtrate/gets drawn into it

Dehydration, hypotension, hypovolaemia, hyponatraemia, hypokalaemia, hypouricaemia, TINNITUS SINCE OTOTOXIC, inc cholesterol and TG

Hypokalemia, hyponatraemia, gout, hepatic encephalopathy

Aminoglycosides like gentamicin, digoxin and lithium since all Ototoxic

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4
Q

1.What is Atorvastatin?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1/2.Anti-hypercholesterolaemic drug

3.HMG-CoA REDUCTASE inhibitor preventing the conversion of HMG-CoA to mevalonate in the mevalonate pathway reducing the overall production of Cholesterol

4.Muscle pain, GI disruption, rhabdomyolysis

5.Renal or hepatic impairment
Pregancy
Breastfeeding

6.CYP3A4 metabolites like amlodipine, amiodarone, diltiazem, macrolides since they increase plasma statin conc

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5
Q

1.What is Spironolactone?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A
  1. Aldosterone (mineralocorticoid) receptor antagonist
  2. Resistant. hypertension (if BP not controlled after step 3 of treatment)
    Also used in PCOS due to antiandrogenic effects

3.) Blocks the aldosterone receptors preventing up regulation of ENAC so more Na+ lost at Collelcting Duct and less ROMK expressed enhancing water and Na+ loss

4.) Gynaeomastia (big problem in men since has anti androgenic effects)
Hyperkalaemia

5.) Hyperkalaemia, Addisons Disease (since works against the Mineralocorticoids)

6.) potassium sparing drugs, pregnancy (antiandrogenic)

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6
Q

What anti-hypertensive is given in pregnancy if theirs resisitnatn hypertension?

A

Can’t give Spironolactone so must give A or B blocker or if K+ high

Give centrally acting drug like Labetalol

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7
Q

1.What is Verapamil?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Non-dihydropyridine (Phenylaklyamine) Calcium Channel Blocker)

2.) Arrhythmias (Class IV), angina, hypertension

3.) Blocks the L-type Calcium channels mainly in the Heart (SAN and AVN) leading to negative Chronotropic and inotropic effects

4.) Bradycardia, Heart block, cardiac failure, constipation

5.) poor LV function, AVN conduction delay

6.) B blockers, other anti hypertensives and other antiarrhythmics

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8
Q

1.What is amiodarone?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Class III anti-arrhythmic
2.) Arrhythmias
3.) blocks voltage gated K+ channels leading to prolongation of repolarisation (Prolongs QT interval)
4.) can induce arrhythmia since prolongs the QT interval
Lung fibrosis
Hepatotoxic
Optic neuritis
Thyroid toxicity
Peripheral neuropathy

5.) Thyroid disease
Heart block at SAN

6.) anti-arrhythmics

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9
Q

Why is amiodarone conra-indicated if someone has thyroid dysfunction?

A

Amiodarone contains high amounts of iodine which the thyroid gland metabolises and converts to thyroid hormones

This initially leads to hyperthyroidism
Then inhibition occurs leading to hypothyroidism

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10
Q

1.What is semaglutide, exenatide and liraglutide?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?
7.Why is it administered in the way that it is?

A

1.) GLP1 receptor agonists (incretin mimetics)
2.) Diabetes
3.) increases glucose dependant synthesis of insulin secretion from B cells by ACTIVATING the GLP1 receptors
Promotes satiety and weight loss

4.) GI Upset, decreased appetite with weight loss
5.). Renal impairment
6.) other hypoglycaemic agents
7.) subcutaneous injection since the its a protein hormone, so will get digested in the stomach

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11
Q

1.What is clopidogrel ?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) ADP receptor antagonist
2.) Antiplatetl dual therapy, ischamic stroke (TIA), clopidogrel long term mono therapy where aspirin is contraindicated, NSTEMI

3.) IRREVERSIBLY binds to P2Y12 inhibiting the binding of ADP to P2Y12 receptor, this inhibits activation of GPIIb/IIIa receptors

4.) bleeding, GI upset, dyspepsia and diarrhoea, rarely thrombocytopenia

5.) caution in high bleeding risk patients with renal or hepatic impairment

6.) anything that inhibits CYP (2C19) since clopidogrel gets activated by CYPs so: omeprazole,, ciprofloxacin, erythromycin, some SSRIs

Caution with anti platelet and anticoagulant or NSAIDs = bleeding risk

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12
Q

1.What is dapagliflozin?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) SGLT2 inhibitor
2.) T2DM, HFrEF and HFpEF (reduces cardiovascular risk)

3.) inhibits the SGLT2 transporters in the PCT decreasing reabsorption from the filtrate leading to increased urinary excretion competitive reversible inhibitor)
Weight loss

4.) UTIs and genital infections(more glucose in. Urine), thirst, polyuria and pancreatitis

5.) hypovolaemia and possible hypotension

6.) antihypertenisves and other. Hypoglycaemics

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13
Q

1.What is aspirin?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) prevents platelet aggregation (anti-platelet)
2.) Atrial fibrillation post stroke, secondary prevention of stroke and TIA, secondary prevention of acute coronary syndromes and post primary percutaneous coronary intervention . 300mg loading dose for NSTEMI/STEMI, for acute iscaemic stroke 300mg daily for 2 weeks

3.) COX inhibitor (Cyclo-oxygenase inhibitor), this prevents the production of Thromboxane A2 IRREVERSIBLY reducing platelet aggregation
(75mg low non analgesic dose, 300mg loading dose used in acute coronary syndromes)

4.) GI irritation (need to prescribe PPI inhibitor with aspirin), GI bleeding, haemorrhage (stroke), aspirin hypersensitivity

5.) Reye’s syndrome (Kids causing organ failiure)
Hypersensitivity
3rd trimester (it closes the ductus arteriosus)

6.)other anti-platelets and anticoagulants

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14
Q

1.What is tranexamic acid?
2.What is it used for?
3.MoA?

A

1.) Coagulant (Stops bleeding)
2.) Epistaxis, Menorrhagia
3.) Inhibits Plasmingoen preventing the conversion to plasmin

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15
Q

1.What is celecoxib?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) selective COX2 inhibitor (Type of NSAID)
2.). Anti-inflammatory, analgesic
3.) inhibits COX2 enzymes reducing prostaglandin production , LESS prostacyclin (PGI2) (Less inhibition on platelet aggregation) is made but same amount of Thromboxane A2 is made (platelet aggregation effect )

4.) Increased risk of MI (low PGI2), may reduce GFR, may exacerbabte IBD

5.) elderly, prolonged used, CKD,

6.) Asprin, glucocorticoid steroids, anticoagulant (consider PPIs), ACEi, ARBs, diuretics

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16
Q

1.What is Azathioprine?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Non-biologic DMARD (Disease Modifying Anti-rheumatic drugs)

2.) Systemi Lupus Eythamatous
Maintenance
IBD
Transplants

3.) Azathioprine converted to 6-MP and then converted to TIMP which ten decreases DNA and RNA sysntehsis

4.) bone marrow suppression
Inc risk of malignancy
Inc risk of infection
Hepatitis

5.)

17
Q

1.What is Fentanyl?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Therapeutic opioid
2.) Analgesia, antitussive (cough suppression), anaesthetic
3.) highly lipid soluble extremely potent opioid (more potent than morphine)
Binds to Mu opioid receptors.
Binds to presynaptic membrane preventing Ca2+ influx reducing amount of (excitatory NT)
Binds to postsynaptic membrane preventing K+ effluent prenting membrane repolarisation

4.) Constipation, drowsiness, Dysphoria, Euphoria, flushing, headache, hyperhidrosis, miosis, nausea, respiratory depression, itching, urinary

5.) comatose patients, head injury or raised ICP, resp depression, paralytic ileus, asthmatics, caution in pregnancy

6.) CNS depressant many anti-epileptic drugs and benzodiazepines, opioids, drugs causing reduced gut motility , CYP450

18
Q

1.What is formoterol?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Long Acting B2 agonist (LABA)
2.) Add on therapy with inhaled corticosteroids for asthma

3.) acts on B2 receptors leading bronchodiation

4.) Adrenergic effects
Tachycardia, palpitations, anxiety and tremor
Inc glycogenolysis , inc renin

5.) LABA should only ever be prescribed with ICS. (Can mask fatal asthma attacks)

6.) B blockers (may reduce effects of B2 agonists)

19
Q

1.What is Naloxone?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) competitive Mu opioid receptor antagonist
2.) also called Narcan, given with opioid overdose
3.) blocks Mu opioid receptors preventing opioids binding and causing repsoiiraoty depression

4.) causes severe withdrawal effects inn individuals with opioid addiction, arrhythmias, have to give multiple times since

6.) opioids

20
Q

1.What is Metoclopramide?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) D2 antagonist (central dopamine antagonist)
2.) GORD, Ileus and iatrogenic causes of emesis
3.) central dopamine antagonist and peripheral CHOLINERGIC agonist:
-so increases ACh at Muscarinic receptors in the gut
-promotes gastric emptying
-inc tone at lower oesophageal sphincter
-inc tone and amplitude of gastric contractions
-dec tone of pyloric. Sphincter
-inc peristalsis

4.) depression, diarrhoea, drowsiness, hypotension, galctorrhoea,e xtra pyramidal effects, distonia and Parkinsonism

5.) post GI surgery, GI obstruction, GI perforation, GI haemorrhage

6.) anything that interacts with dopamine

21
Q

1.What is omeprazole?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Proton pump inhibitor
2.) antacid used in GORD
3.) irreversibly inhibits the H+/K+ ATPase in gastric parietal cells so inhibts the final stage of the pathway so great reduction in gastric acid production

4.) GI disturbance (abdominal pain, constipation, diarrhoea)
Headache , dizziness
Drowsiness/coofusion

5.) masks symtoms of Gastro-oesophageal cancer
Osteoporosis (fracture risk))

6.) Omeprazole is a CYP inhibitor so reduces the action of CLOPIDOGREL
PPIs increase effects of warfarin and phenytoin

Often prescribed with NSAIDs or steroids
Prescribe Lansoprazole with Clarithromycin and amoxicillin or metronidazole (if allergic to penicillin) for Helicobacter pylori infection

22
Q

1.What is codeine?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) Mu opioid receptor angonist
2.) analgesia, sometimes as an anti diarrhoeal since an advertise effect of it is constipation, antitussive, anaesthetic
3.) a prod drug which is metabolised by liver to CYP2D6 which blocks Mu opioid receptors most importantly at the pain gate where the Pirmary sensory neurone synapses to the 2ndary sensory neurone on the Ipsilateral side of the cord in the spinothalamic tract

4.) Respiratory depression, constipation, drowsiness, dysphoria, euphoria, miosis, hyperhidrosis, nausea, itching, urinary retention

5.) comatose patients, head injury or raised ICP, resp depression, paralytic ileus, asthmatics (due to histamine release),, pregancy

6.) CNS depressants, anti epileptics, benzodiazepines, opioids, drugs reducing gut motility, CYP450 improtnatn

23
Q

1.What is dalteparin?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) low molecular weight heparin (LMWH)
2.) inhibit coagulation, preventing thrombus formation and growth.
VTE, Acute Coronary Syndromes , NSTEMI

3.) inhibits factor Xa by enhancing anti-thrombin III activity

4.) bruising, bleeding, intracranially or at site of injection, GI bleeds, epistaxis
Heparin induced thrombocytopenia autoimmune repsonse
Osteoporosis (high risk with unfractioned heparin)
Hyperkalaemia (inhibits aldosterone secretion)

5.) clotting disorders, GI ulcers, renal impairment

6.) antithrombotics , ACEi, ARBs, K+ sparing drugs

24
Q

1.What is Apixaban?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) DOAC (direct oral anticoagulant)
2.) can be used in most cases where warfarin is indicated (VTE, PE, DVT, AF, Heart valve replacemtn , precarioversion)
3.) directly. Inhibts free Xa and Xa bound with Antithrombin III (DOESNT directly effect Thrombin (IIa))

4.) bleeding, skin reactions, risk in GI bleed risk groups) NEED TO CARRY A DOAC CARD

5.) low creatinine clearance
Avoid in pregnant and breastfeeding

6.) affected by CYP inducers and inhibitors
Plasma conc reduced by carbamazepine, phenytoin, barbiturates
Plasma conc increased by macrolides

25
Q

1.What is warfarin?
2.What is it used for?
3.MoA?
4.Adverse effects?
5.Contraindications?
6.Drug Drug interactions?

A

1.) vitamin K anatagonist
2.) VTE, PE, DVT, AF, Heart valve replacement, pre cardio version
3.) inhibits Vitamin K epoxide reductase which is what’s responsible for recycling and allowing Vit K to be reused so lose Vit K dependant clotting factors (II, VII, IX and X)
4.) bleeding, epistaxis, spontaneous Retroperitoneal bleeding (TREAT THESE side effects by giving Vit K and stopping warfarin)
5.) pregnancy (crosses placenta) early post partum period, haemorrhagic stroke

6.) vitamin K intake, alcohol, CYP2C9 inducers/inhbitors andpolymorphisms,
CYP2C9 inhbitors = amiodarone, clopidogrel, metronidazole, intoxicating dose of alcohol
Cephalosporins reduce Vit K by eliminating Vit K producing bacteria

Warfarin may be displaced from albumin
NSAIDs and drugs decreasing GI absorption of VIt K

Drugs accelerating warfarin metabolism:
Phenytoin, Rifampicin, barbiturates, St John’s wort

CPT (30 decks)

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