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Y3 hist and exam > Drugs > Flashcards

Drugs Flashcards

1
Q

What do you give for secondary prevention of MI?

A 
Aspirin
Clopidogrel
Beta blocker
ACEi
Statin
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2
Q

4 anticipatory medications given by syringe driver at end of life

A

Pain- diamorphine
Agitation- midazolam
N+V- haloperidol
Secretions- hyoscine butylbromide

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3
Q

Side effect of omeprazole?

A

Hypomagnesaemia–> tetany and ventricular arrythmia

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4
Q

What is loperamide?

A

Anti-diarrhoeal

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5
Q

What is the generic name for loperamide?

A

Codeine phosphate

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6
Q

Does loperamide have analgesic effects?

A

No

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7
Q

How do opioids prevent diarrhoea/cause constipation?

A

Agonists of opioid u-receptors in GI tract, increases non-propulsive contractions and decreases propulsive (peristaltic) contractions. Transit is slowed and anal sphincter tone is increased. More time for water absorption so stool hardens.

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8
Q

Contraindications of loperamide?

A

Acute UC, C.diff and dysentry- as risk of megacolon and perforation.

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9
Q

Other name for senna?

A

Docusate

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10
Q

How does senna work?

A

Stimulant. Increase water and electrolyte secretion from colonic mucosa so colonic volume is increased and peristalsis increases. Also direct pro-peristaltic action

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11
Q

Contraindications of senna

A

Bowel obstruction

Avoid rectal route in haemorrhoids/anal fissure

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12
Q

What drug class is mesalazine/sulfasalazine?

A

Aminosalicylate

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13
Q

What is the indication for mesalazine?

A

Ulcerative colitis

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14
Q

What is the indication for sulfasalazine?

A

Rheumatoid arthritis

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15
Q

How does mesalazine work?

A

Topically on the gut. Releases 5-aminosalicylic acid- anti-inflammatory and immunosuppresant.

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16
Q

Why isn’t sulfasalazine used in UC?

A

broken down to sulfapyridine which treats RA but has side effects in UC.

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17
Q

Side effects of aminosalicylates

A

Leucopenia, thrombocytopenia, renal impairment, oligospermia

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18
Q

What is the route of mesalazine?

A

Rectal

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19
Q

What does metoclopramide do?

A

Anti-emitic

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20
Q

What class of drug are metoclopramide and domperidone?

A

Dopamine D2-receptor antagonists

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21
Q

How does metoclopramide/domperidone work?

A

D2 is the main receptor in the chemoreceptor trigger zone (area responsible for sensing emetogenic substances in the blood.) Dopamine is the neurotransmitter.
Also a neurotransmitter in the gut so increased gut motility (decreased gut motility may cause nausea)

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22
Q

Contraindications of metoclopramide/domperidone?

A

GI obstruction

Perforation

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23
Q

Side effect of metoclopramide/domperidone?

A

Extrapyramidal syndromes- acute dystonic reaction e.g. oculogyric crisis

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24
Q

Possible interactions of metoclopramide/domperidone?

A

Antipsychotics (increased risk of side effects)

Dopaminergic agents used in parkinsons (antagonises these)

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25
Q

What type of diuretic is furosemide?

A

Loop

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26
Q

How does furosemide work?

A

Inhibits Na/K/Cl co-transporters in the ascending loop of Henle so water doesn’t follow these ions into the cell. i.e. prevents water reabsorption.
Also vasodilation so reduces preload of heart and increased contractility of overstretched heart muscle.

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27
Q

Indications for furosemide?

A

Pulmonary oedema

Fluid overload e.g. CHF, liver failure, renal disease

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28
Q

Contraindications of furosemide

A

Hypovolaemia

Dehydration

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29
Q

Unexpected side effect of furosemide?

A

Hearing loss and tinnitus

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30
Q

Possible interactions of furosemide?

A

May effect drugs excreted by the kidneys e.g. increased risk of digoxin toxicity, of oto+nephrotoxicity of aminoglycosides

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31
Q

Name 2 thiazide like diuretics

A

Bendroflumethiazide

Indapamide

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32
Q

Where do thiazide like diuretics act

A

DCT

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33
Q

Contraindication of thiazide like diuretic

A

Hypokalaemia

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34
Q

Unexpected side effect of thiazide like diuretic

A

Impotence

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35
Q

Efficacy of thiazide like diuretics is reduced by what?

A

NSAIDs

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36
Q

Name 3 potassium sparing diuretucs

A

Amiloride
Co-amilofruse
Spironolactone

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37
Q

Where do potassium sparing diuretics act?

A

DCT

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38
Q

Indication for potassium sparing diuretic

A

Hypokalaemia from loop or thiazide diuretics- is used in combination as quite a weak diuretic alone.

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39
Q

Contraindications of potassium sparing diuretic

A

Renal impairment
Hyperkalaemia
Don’t start in hypokalaemia is unpredictable effects on K+

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40
Q

Name 2 alpha blockers

A

Doxazosin

Tamulosin

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41
Q

How do alpha blockers work

A

Block alpha 1 adrenoreceptors in smooth muscle (blood vessels, urinary tract) and cause vasodilation (lowers BP) and reduced resistance to bladder outflow

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42
Q

Indications for alpha blockers

A

BPH

Resistant HTN

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43
Q

Contraindications for alpha blockers

A

Postural hypotension

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44
Q

What should you do in terms of interactions on the first day of alpha blocker administration?

A

Stop beta blockers as block reflex tachycardia in response to vasodilation which could = syncope

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45
Q

When should alpha blockers be taken?

A

Bed time

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46
Q

Name a xanthine oxidase inhibitor

A

Allopurinol

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47
Q

How does allopurinol work?

A

Prevents the conversion of purine to xanthine (via inhibition of the enzyme xanthine oxidase), xanthine would normally go on to become uric acid. So plasma uric acid conc is lowered.

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48
Q

Indications for allopurinol

A

Prevents:

  • gout
  • uric acid/calcium oxalate renal stones
  • hyperuricaemia
  • tumour lysis syndrome
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49
Q

Contraindication of allopurinol

A

Acute gout attack (but continue if already take it)

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50
Q

Side effects of allopurinol

A 
Skin rash (can=SJS/TEN)
Trigger or worsen gout when start
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51
Q

Interactions of allopurinol

A

Inhibit mercaptopurine and azathioprine as they require xanthine oxidase for metabolism
Increased risk of rash to amoxicillin
Increased risk of hypersensitivity reactions to ACEi and thiazides.

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52
Q

Name 2 tricyclic antidepressants

A

Amitryptiline

Lofepramine

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53
Q

How do tricyclic antidepressants work?

A

Inhibit the reuptake of serotonin and noradrenaline

also block many receptors: muscarinic, histamine, alpha adrenergic and dopamine which lead to adverse effects!

54
Q

Indications for tricyclic antidepressants

A

2nd line for depression

Neuropathic pain off licence

55
Q

Side effects of tricyclic antidepressants

A 
Dry mouth
Constipation
Urinary retention
Blurred vision
Sedation
Hypotension
Arrythmias/ECG changes
Convulsions
Hallucinations
Mania
Breast changes
Sexual dysfunction
Tremor/dyskinesia
56
Q

Interactions of tricyclic antidepressants

A

Monoamine oxidase inhibitors (have same action so lead to HTN, hyperthermia, serotonin syndrome)

57
Q

How long should antidepressants be taken for after remission?

A

6 months after start to feel better

58
Q

Which platelet receptors does clopidogrel bind to? What does this do?

A

ADP receptors, prevents aggregation

59
Q

Aspirin and clopidogrel act on the same/different pathway

A

Different

60
Q

Indications for clopidogrel

A

ACS
Prevent stent occlusion
Long term secondary prevention of thrombotic arterial events
AF where warfarin or NOVACs c/i

61
Q

Contraindications of clopidogrel

A

Bleeding

Stop 7 days before elective surgery

62
Q

Side effects of clopidogrel

A

Bleeding
GI upset
Thrombocytopenia

63
Q

Aspirin mechanism of action

A

COX inhibition (stops arachidonic acid turning into throboxane which is pro-aggregatory)

64
Q

Is aspirin COX inhibition reversible?

A

No, lasts for lifetime of platelet

65
Q

Indications of aspirin

A 
ACS
Ischaemic stroke
Long term prevention of thrombotic events
AF where warfarin/novac c/i
Pain and fecer
66
Q

Aspirin c/is

A

<16yo Reye’s syndrome risk

3rd trimester of pregnancy (ductus arteriosus)

67
Q

Is propanolol a particularly selective or non selective beta blocker?

A

Non selective for B1

68
Q

Which beta blocker has a particularly short half life?

A

Metoprolol

69
Q

How do beta blockers work?

A

Act on B1 receptors in the heart, reduce force and speed of contraction. Less cardiac work and oxygen demand, increased myocardial perfusion.
Prolong the refractory period of the AV node
Reduce renin secretion from kidneys (mediated by b1 receptors)

70
Q

Indications for beta blockers

A 
Ischaemic heart disease
CHF
AF
SVT
HTN
71
Q

Contraindications for beta blockers

A

Asthma
Heart block
Haemodynamic instability

72
Q

Side effects of beta blockers

A 
Fatigue
Cold extremities
Headache
GI upset
Sleep disturbance and nightmares
Impotence
73
Q

Interactions of beta blockers

A

Non dihydropyridine calcium channel blockers e.g. verapamil, dilitiazem as the combination can cause HF, bradycardia and even asystole

74
Q

What are the two types of calcium channel blocker and what are they each selective for?

A

Non-dihydropyridines (heart)
Dihydropyridines (vasculature)
Dilitiazem is MIXED

75
Q

Name 3 calcium channel blockers

A

Dilitiazem
Amlodipine
Verapamil

76
Q

How do calcium channel blockers work

A

Decrease entry of calcium into vascular and cardiac cells so intracellular calcium conc is decreased. This = relaxation and vasodilation of arterial smooth muscle and decreases arterial pressure.
In heart reduces contractility and suppresses cardiac electrical conduction (esp AVN) so ventricular rate decreased so reduced O2 demand of heart.

77
Q

Indications for Ca Ch bs

A

HTN
Stable angina
SVT

78
Q

Contraindications of non-dihyd ca ch bs

A

AV node conduction delay

Caution if poor LV function

79
Q

C/is of dihyd ca ch bs

A

unstable angina

severe aortic stenosis

80
Q

Side effects of ca ch bs

A

Dihydro- Ankle swelling, flushing, headache, palpitations

Verapamil- constipation, bradycardia, heart block, CF

81
Q

Possible interactions of calcium channel bl

A

Non dihydro with beta blockers. As both negatively inotropic and chronotropic

82
Q

Name an ACEi

A

Ramipril

83
Q

What does angiotensin II do?

A

Vasoconstriction and stimulates aldosterone

84
Q

Contraindications of ACEi

A

Renal artery stenosis
AKI and caution in CKD
Pregnant

85
Q

Side effects ACEi

A

Hypotension
Dry cough (increased bradykinin)
Hyperkalaemia

86
Q

What type of drug is losartan

A

Angiotensin II type 1 receptor antagonist

87
Q

How does losartan work

A
  • Competes with angiotensin II to bind to the type 1 receptor.
  • Decreased PVR
  • Decreased aldosterone secretion means increased sodium and water excretion which reduces venous return
  • Dilates efferent glom. arteriole so decreased intraglom pressure and slows progress of CKD
88
Q

Indication for losartan

A

Generally when ACE not tolerated due to cough

  • HTN
  • CHF
  • Ischaemic HD
  • Diabetic nephropathy and CKD with proteinuria
89
Q

Contraindications for losartan

A

Same as ACEi.

Renal artery stenosis, AKI and caution in CKD, pregnant

90
Q

Possible interactions of losartan and ACEi

A

Other potassium elevating drugs

91
Q

L dopa is always given with ?

A

Peripheral decarboxylase inhibitor

92
Q

Name an L dopa (and PDI)

A

Sinemet, madopar

93
Q

Side effects of L dopa

A 
nausea
drowsiness
confusion
hallucinations
hypotension
Wearing off effect and on-off effect
94
Q

Possible interactions of L dopa/PDI

A

Antipschotics

Metoclopramide

95
Q

What is phenytoin?

A

Anti-convulsant

96
Q

How does phenytoin work?

A

Binds to inactive neuronal Na channels, prolonging the period of inactivity, so neuronal excitability decreased

97
Q

Indication of phenytoin

A
  • Stop status epilepticus of benzos not working

- Decrease frequency of epileptic seizures

98
Q

What could phenytoin cause if taken in pregnancy?

A

Foetal hydantoin syndrome

99
Q

Side effects of phenytoin

A 
Skin coarsening
Acne
Hirsutism
Gum hypertrophy
Cerebellar toxicity
Haem disorders
Osteomalacia
100
Q

Which drugs decrease the efficacy of phenytoin (not to do with P450)

A

Drugs that lower the seizure threshold e.g. SSRIs, tricyclics, antipsychotics, tramadol

101
Q

What must patients taking phenytoin be cautious with?

A

Contraception

102
Q

Which anticonvulsant can be used for trigeminal neuralgia

A

Carbamezapine

103
Q

Which anticonvulsant is the worst teratogen

A

Sodium valproate

104
Q

Which anticonvulsant interacts with oestrogen containing contraceptives

A

Lamotrigine

105
Q

Which anticonvulsant can have psychiatric side effects including suicidal thoughts

A

Levetiracetam

106
Q

How do cardiac nitrates work?

A

Decrease intracellular calcium so relaxation of smooth muscle

107
Q

Interaction of nitrates

A

Slidenafil

108
Q

Contraindications of nitrates

A

Severe aortic stenosis
Haemodynamic instability
Hypotension

109
Q

Side effect of digoxin given its narrow therapeutic index

A

Digoxin toxicity

110
Q

Digoxin contraindications

A

Heart block (2nd and 3rd degree) and ventricular arrhythmias

111
Q

Digoxin interactions

A

Risk of digoxin toxicity increased by- diuretics, amiodarone, calcium channel blockers and quinine

112
Q

Amiodarone indication

A

Treatment of tachyarrhythmias (life support)

113
Q

Amiodarone contraindications

A

Hypotension, heart block, thyroid disease

114
Q

How do heparins work

A

Inhibit thrombin and factor Xa

115
Q

What type of anticoagulant is enoxaparin?

A

Heparin

116
Q

How do statins work

A

Inhibit HMGCoA reductase (enzyme involved in making cholesterol)

117
Q

What type of drug is tiotropium?

A

Antimuscarinic/anticholinergic

118
Q

When are antimuscarinics contraindicated?

A

Angle closure glaucoma

119
Q

What are acetylcholinesterase inhibitors used for?

A

Myasthenia gravis
Glaucoma
Alzheimers/dementia/parkinsons

120
Q

What do antimuscarinics do?

A

Inhibit acetylcholine

121
Q

How do 5-alpha reductase inhibs work?

A

inhibiting the intracellular enzyme 5α-reductase, which converts testosterone to its more active metabolite dihydrotestosterone. As dihydrotestosterone stimulates prostatic growth, inhibition of its production by 5α-reductase inhibitors reduces prostatic enlargement and improves urinary flow.

122
Q

How long do 5-alpha reductase inhibs take to work?

A

Months

123
Q

Side effects of 5-ARI

A

Impotence, reduced libido
Gynaecomastia
Hair growth
Breast cancer

124
Q

Men taking 5-ARI must be careful not to……?

A

Have unprotected sex with a pregnant woman

125
Q

How does gliclazide work

A

stimulates pancreatic insulin secretion

126
Q

Side effect of gliclazide

A

Weight gain

127
Q

Name a biguanide

A

Metformin

128
Q

How does metformin work

A

increases the response (sensitivity) to insulin. It suppresses hepatic glucose production (glycogenolysis and gluconeogenesis), increases glucose uptake and utilisation by skeletal muscle and suppresses intestinal glucose absorption

129
Q

Do metformin and gliclazide carry a risk of hypoglycaemia?

A

Metformin no, gliclazide yes

130
Q

Contraindication of metformin

A

Severe renal impairment

Y3 hist and exam (17 decks)

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