Drugs

Question 1

When should statins be taken? Why?

Answer 1

At night, when most of chol synthesis occurs

Question 2

How many mg of atorvastatin should be given in primary and secondary prevention?

Answer 2

Primary- 20mg.

Secondary/ known IHD etc- 80mg

Question 3

What is the MOA of aspirin?

Answer 3

Irreversibly acetylates cyclo-oxygenase preventing production of thromboxane A2, inhibiting platelet aggregation

Question 4

What is clopidogrel and what is its MOA?

Answer 4

ADP R antag to block platelet aggregation

Question 5

When is clopidogrel used?

Answer 5

Used after PCI (along with aspirin) , acute coronary syndrome, aspirin intolerance eg. after TIA, AF (if warfarin unsuitable), MI, peripheral arterial disease,

Question 6

What are the common SE of clopidogrel?

Answer 6

Abdo pain, bleeding disorders (GI, IC), diarrhoea, dyspepsia

Question 7

Name 2 rare SE of clopidogrel

Answer 7

Vertigo, acquired haemophilia

Question 8

What is the MOA of bisoprolol?

Answer 8

B1 selective- decrease pulse and SAN firing

Question 9

What is the MOA of furosemide? Where in the loop?

Answer 9

Inhibits Na/K/2Cl co-transporter. Ascending limb (loop)

Question 10

What is the MOA of thiazides? Where in the loop? Examples?

Answer 10

Inhibits Na/Cl co-transporter in DCT eg. metolazone, chlorthalidone

Question 11

SE of loop diuretic?

Answer 11

Dehydration, hypokalaemia, hypocalcaemia, ototoxic

Question 12

SE of thiazides?

Answer 12

Hypokalaemia, hypercalcaemia, decreased Mg, increased urate- gout, impotence

Question 13

SE of amiloride

Answer 13

Hyperkalaemia, GI upset

Question 14

What is the MOA of amiloride? Where in loop?

Answer 14

K+ sparing- inhibits Na/K exchange. DCT

Question 15

MOA of nitrates?

Answer 15

Venodilation and of large arteries preferentially, decrease pre load

Question 16

What is hydralazine?

Answer 16

Vasodilator- dilates resistance vessels to decrease BP (after load)

Question 17

What is prozasin?

Answer 17

Vasodilator- Alpha blocker- dilates arteries and veins

Question 18

MOA of Ca channel blockers? Target?

Answer 18

L-type Ca channels- decrease Ca entry into cell via voltage sensitive channels on SM cells promoting coronary and peripheral vasodilation, reducing myocardial O2 demand

Question 19

What are nifedipine and amlodipine?

Answer 19

Ca channel blockers- DHPs -> vasodilation

Question 20

Why are Ca channel blockers given with beta blockers?

Answer 20

Reduce reflex tachycardia

Question 21

What are verapamil and diltiazem? MOA? Use?

Answer 21

Non-DHPs- slow conduction at SAN and AVN. Antihypertensives, dysrrythmias, angina

Question 22

Why can’t you give verapamil with beta blocker?

Answer 22

Risk of severe bradycardia

Question 23

SE of Ca channel blockers? CI?

Answer 23

Flushes, headache, oedema, LV function decrease, gingival hypertrophy. CI- heart block

Question 24

MOA of digoxin? Use?

Answer 24

Blocks Na/K pump. Slows pulse in fast AF

Question 25

SE of digoxin?

Answer 25

Arrhythmia, nausea, decreased appetite, confusion, gynaecomastia

Question 26

MOA of statins? Example?

Answer 26

Inhibit HMG-CoA reductase in liver to prevent chol synthesis. Increases LDL R expression by hepatocytes decreasing circulating LDLs. e.g Simvastatin

Question 27

SE of statins?

Answer 27

Muscle aches, abdo discomfort, increased ALT and CK, myositis, rhabdomyolysis rare