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Drugs List > Finals Drugs List > Flashcards

Finals Drugs List Flashcards

1
Q

Antacids:

Drugs

MOA

Indications

Side effects

A
  • Aluminium hydroxide and magnesium hydroxide
  • Calcium carbonate and magnesium carbonate

MOA: Buffer gastric acid to raise pH

Indications:

  • Dyspepsia/heartburn
  • Acid reflux

Side effects:

  • Nausea
  • Aluminium can cause constipation
  • Magnesium can cause diarrhoea
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2
Q

Antacids and alginates:

Drugs

MOA

Indications

Side effects

A
  • Sodium alginate with sodium bicarbonate

Anionic polysaccharides that form viscous gel upon binding with water which floats on top of stomach contents, reducing reflux symptoms & protecting oesophageal mucosa

Also increases viscosity of stomach contents to reduce acid reflux.

Indications:

  • Gastric reflux/ reflux oesophagitis

Side effects:

  • Abdominal distension
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3
Q

H2 receptor antagonists:

Drugs

MoA

Indications

Side effects

A
  • Ranitidine
  • Cimetidine
  • Famotidine
  • Nizatidine

Competitive inhibition of histamine actions at gastric H2 histamine receptors in parietal cells to decrease acid secretion by up to 90%

Indications:

  • Stomach ulcers
  • Reflux oesophagitis

Side effects:

  • Dizziness
  • Cimeditine inhibits many cytochrome P450 enzymes
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4
Q

Proton-pump inhibitors:

Drugs

MOA

Indications

Side effects/interactions

A
  • Lansoprazole
  • Omeprazole

Irreversible inhibition of H+/K+ ATPase pump in gastric parietal cells =decreased basal and stimulated acid secretion:

  • From the circulation, the pro-drug (lipophilic) traverses the parietal cell and enters the canaliculus.
  • In acidic canaliculus, drug is activated and trapped.
  • Drug binds to H+/K+-ATPase, irreversibly inactivating it.
  • For acid secretion to resume, new pump molecules have to be synthesized (2-3 days)

Indications:

  • Stomach and duodenal ulcers
  • GORD and reflux oesophagitis

Side effects:

  • Headache
  • Diarrhoea
  • Warfarin interaction
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5
Q

Pancreatic enzymes:

Drugs

MOA

Indication

Side effects

A
  • Pancreatin

Restoration of pancreatic enzymes in deficiency.

Indication:

  • Pancreatic insufficiency:
    • Cystic fibrosis
    • Pancreatitis

Side effects:

  • Abdominal distension
  • Constipation
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6
Q

Bulk laxatives:

Drugs

MOA

Indications

Side effects

A
  • Methylcellulose
  • Isphagula husk

Polysaccharide polymers not broken down by normal process of digestion. Retain water in the GI lumen, softening and increasing faecal bulk and promote increased motility. Act in 1-3 days.

Indications:

  • Constipation and IBS

Side effects:

  • Rare
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7
Q

What classes of drugs are used to treat disorders of acid secretion?

A
  • Antacids and alginates
  • Histamine H2-receptor antagonists
  • Proton pump inhibitors
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8
Q

Faecal Softeners:

Drugs

MOA

Indications

Side effects

A
  • Docusate
  • Arachis oil

Stimulates water & electrolyte secretion into intestinal lumen; lower surface tension at oil-water interface allowing water and fat to enter stool cause it to soften. Act 3-5 days

Indications:

  • Constipation
  • Fissures
  • Piles

Side effects:

  • Rare
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9
Q

Osmotic laxatives:

Drugs

A

Macrogol

​Lactulose

Magnesium sulphate and magnesium hydroxide

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10
Q

Lactulose

MOA

Indications

Side effects/interactions

A

Lactulose (osmotic laxative)

Semi-synthetic disaccharide of fructose and galactose- mimicks undigested lactose

Colonic bacteria convert it to its two component monosaccharides which are poorly absorbed. Fermentation yields lactic acid and acetic acid which function as osmotic laxatives.

Acts within 1-3 days

Indications:

  • Chronic constipation
  • Hepatic encephalopathy
  • Negating the constipating effects of opioids.

Side effects/interactions:

  • Stomach cramps
  • Interacts with antiepileptics
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11
Q

Macrogol

MOA

Indications

Side effects

A

Macrogol (osmotic laxative)

Inert polymers of ethylene glycol. Sequester fluid in the bowel

Uses:

  • Treatment of faecal impaction in children
  • Long-term management of chronic constipation

Side effects/interactions:

  • Stomach cramps
  • Interaction with anti-epileptics
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12
Q

Magnesium sulphate and magnesium hydroxide

MOA

Indications

Side effects/interactions

A

Magnesium sulphate and magnesium hydroxide (osmotic laxatives)

Potent, rapid action (1-2 Bowel prep prior to procedure)

Indications:

  • Bowel prep prior to procedure

Side effects

  • Stomach cramps
  • Interacts with antiepileptics
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13
Q

Stimulant laxatives

Drugs

MOA

Indications

Side effects

A

Bisacodyl

Stimulates rectal mucosa, resulting in mass movements and defaecation in 15-30 minutes Only short courses should be used

Indications:

  • Constipation
  • Opioid related constipation

Side effects:

  • Nausea

​Senna

Passes unchanged into colon, where bacterial action releases free anthracene derivatives. Anthracene derivatives are absorbed and have a direct on myenteric plexus to increase intestinal motility (stronger muscle contractions)

Indications:

  • Constipation

Side effects:

  • Nausea

Picosulfate

Same as Senna, used to relieve constipation and also as bowel prep for surgery.

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14
Q

Which 4 classes of drugs are purgatives?

A
  • Bulk laxatives
  • Osmotic laxatives
  • Faecal softeners
  • Stimulant purgatives
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15
Q

Opioid anti-motility agents

Drugs

MOA

Side effects

Indications

A
  • Loperamide
  • Codeine

Agonist for μ-opioid receptors in myenteric plexus; increases tone and rhythmic (haustral) contractions of the colon but diminishes propulsive activity. Blocks intestinal muscarinic receptors.

Indications:

  • Diarrhoea (acute, uncomplicated, used in adults)

Side effects:

  • Constipation
  • Flatulence
  • Abdo cramps
  • Dizziness
  • Paralytic ileus can occur
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16
Q

Paracetamol antidote

MoA

Indication

Side effects

A
  • N-Acetylcysteine (Or Acetylcysteine)

MoA: Restores and maintains hepatic intracellular glutathione required for paracetamol detoxification.

Indication: Paracetamol overdose

Side effects:

  • Oral inflammation
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17
Q

Benzodiazepine for alcohol withdrawal

MoA

Indications

Side effects

A

Chlordiazepoxide (Librium)

MoA: Potentiation of GABAA receptors

Indications: severe alcohol misuse and withdrawal

Side effects:

  • Drowsiness
  • Dizziness
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18
Q

Non-benzodiazepine hypnotic (for alcohol withdrawal)

MoA

Indications

Side effects

A
  • Clomethiazole

MoA: GABA mimetic- GABAA receptor agonist

Indications: alcohol withdrawal and severe alcohol misuse

Side effects:

  • Nasal congestion
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19
Q

Substance abuse treatment for alcohol rehabilitation

MoA

Indications

Side effects

A
  • Acamprosate

MoA:GABA mimetic- GABAA receptor agonist, possible NMDA receptor antagonist.

Indications: severe alcohol misuse

Side effects: diarrhoea, nausea

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20
Q

Loop diuretics

Drugs

MOA

Indications

Side effects/interactions

A
  • Furosemide
  1. Inhibits Na+/K+/2Cl- transporter (competes with Cl- binding) reducing NaCl reabsorption in the thick ascending LoH therefore decreased water absorption.
  2. Causes decreased osmotic concentration in the medulla therefore decreased ADH mediated H20 absorption.
  3. Increased delivery of NaCl to the DCT causes increased Na+ uptake by principal cells, causing loss of K+ and H+.
  4. Reduce calcium and magnesium absorption

Bind to plasma proteins, not filtered, but secreted directly into PCT so effective in renal impairment.

Indications:

  • Peripheral oedema
  • Acute pulmonary oedema
  • Resistant HTN
  • Left ventricular heart failure

Side effects/interactions:

  • Nausea
  • Hypotension
  • Dizziness
  • Hypovolaemia
  • Hyponatraemia/hypokalaemia
  • Ototoxicity (high doses)
  • Interacts with NSAIDs and ACE-inhibitors
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21
Q

Thiazide and thiazide-like diuretics

Drugs

MOA

Indications

Side effects/interactions

A
  • Indapamide
  • Bendroflumethiazide
  • Chlortalidone
  • Hydrochlorothiazide

Inhibits Na+/Cl- co-transporter in early DCT (compete with Cl- binding) so increasing Na+ in lumen therefore water. Decreased sodium and chloride reabsorption.

Vasodilate by potassium channel activation

Filtered and secreted so not useful in renal impairment

Indications:

  • Hypertension
  • Peripheral oedema
  • Congestive HF

Side effects/interactions:

  • Weak/moderate diuresis,
  • Hyponatraemia/hypokalaemia
  • Increased plasma uric acid (gout)
  • Erectile dysfunction
  • Hyperglycaemia
  • Raised cholesterol
  • Interacts with digoxin and NSAIDs
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22
Q

Potassium sparing diuretics: aldosterone antagonists

Drugs

MOA

Indications

Side effects/interactions

A
  • Spironolactone
  • Eplenerone

Aldosterone antagonist binds to mineralocorticoid receptor in the late DCT/cortical collecting tubule. Prevents synthesis of ENaC and Na+/K+ATPase activation therefore reduced K+ secretion into the lumen (K+ retained) and reduced Na+ reabsorption and accompanying water.

Indications:

  • Oedema
  • Congestive heart failure
  • Ascites caused by liver cirrhosis
  • Hyperaldosteronism (Conn’s syndrome)
  • Resistant HTN, in combination with loop/thiazide diuretics to prevent K+ loss.

Side effects/interactions:

  • Interacts with NSAIDs and ACE-inhibitors
  • Hyperkalaemia
  • Gynaecomastia (more with spironolactone than eplerenone)
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23
Q

Potassium sparing diuretics: ENaC antagonists

Drugs

MOA

Indications

Side effects/interactions

A
  • Amiloride

Blockade of sodium reabsorption via ENaC channel (competes for Na binding site) therefore decreases luminal permeability to Na+. Causes reduced K+ secretion into the lumen, therefore K+ retained.

Used in combination to prevent K+ loss from use of loop/thiazide diuretics

Indications:

  • Oedema
  • Congestive HF

Side Effects:

  • Hyperkalaemia
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24
Q

Osmotic diuretics

Drugs

MOA

Indications

Side effects/interactions

A
  • Mannitol

Increases osmolality of glomerular filtrate preventing water reabsorption in the PCT and descending LoH

Indications:

  • Raised intraocular pressure
  • Cerebral oedema

Side effects:

  • Hypotension
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25
Q

Why do loop and thiazide diuretics cause hypokalaemia?

Why may alkalosis also occur alongside this?

A

They increase delivery of NaCl to the distal nephron and decrease blood volume.

This increases K+ secretion by:

  • Increasing tubular flow rate (K+ washes away creating high concentration gradient)
  • Increases activity of Na+/K+ATPase via increased Na+ therefore more K+ is secreted out of the cells
  • Activation of RAAS from decreased blood volume = increased aldosterone therefore more Na+ reabsorption in kidneys = more K+ secreted.

May also cause alkalosis as it can stimulate intercalated cells to secrete H+ so more acid is lost in urine.

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26
Q

Carbonic anhydrase inhibitors

Drugs

MOA

Indications

Side effects/interactions

A
  • Acetazolamide

Reduces aqueous humour volume by preventing renal absorption of bicarbonate:

Inhibit carbonic anhydrase in the PCT, preventing it from converting carbonic acid to water and CO2, therefore blocking the absorption of HCO3- and the accompanying sodium and water.

Indications:

  • Raised intra ocular pressure: open and closed angle glaucoma

Side effects/interactions:

  • Paraesthesias
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27
Q

ACE-Inhibitors

Drugs

MOA

Indications

Side effects/interactions

A
  • Ramipril
  • Captopril
  • Perindopril
  • Lisinopril

Inhibits angiotensin converting enzyme, preventing it from converting angiotensin I to angiotensin II. This prevents it from inducing contraction in vascular smooth muscle and increasing BP.

Indications:

  • Hypertension
  • T1 Diabetic nephropathy
  • Congestive heart failure
  • Post MI
  • Secondary stroke prevention

Side effects/interactions:

  • Cough (through inhibited breakdown of bradykinin in the lungs)
  • Hyperkalaemia (potassium retained by blocking RAAS)
  • Hypotension
  • Angioedema
  • Decreased GFR as angiotensin normally constricts efferent arterioles
  • Caution in renal artery stenosis- can precipitate kidney failure
  • Interacts with NSAIDs and Lithium
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28
Q

Angiotensin II receptor blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Losartan
  • Valsartan
  • Irbesartan
  • Candesartan

Blockade of cell signalling induced by angiotensin II. Binds to type 1 angiotensin II receptors preventing the direct vasoconstriction effects of ATII and its action in the RAAS system (release of aldosterone)

Indications:

  • Hypertension
  • T2 diabetic nephropathy
  • CHF
  • LV hypertrophy
  • ACE-i intolerance

Side effects/interactions:

  • Hypotension
  • Fatigue
  • Hyperkalaemia
  • Myalgia
  • Raised CPK
  • Other diuretics- avoid
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29
Q

Direct Renin Inhibitor

MoA

Indications

Side Effects

A
  • Aliskiren

MoA: Direct inhibition renin enzymatic function and of angiotensin I generation

Indications: Hypertension

Side effects: diarrhoea, cough

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30
Q

Neprilysin inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Sacubitril (in combination with Valsartan)

Inhibits the breakdown of natriuretic peptide

Indications:

  • Heart failure with reduced ejection fraction

Side effects/interactions:

  • Hypotension
  • Hypoglycaemia
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31
Q

Beta adrenergic receptor antagonists (B-blockers)

Drugs

MoA

Indications

Side effects/interactions

A
  • Bisoprolol (B1 selective)
  • Atenolol (B1 selective)
  • Metoprolol (B1 selective)
  • Labetalol (B1, B2 and A1 selective)
  • Propranolol (B1 and B2)

Competitive inhibitors of adrenaline and noradrenaline at beta-adrenergic receptors, inhibit sympathetic stimulation of heart muscle.(B1 antagonists selective for cardiomyocytes and contractility) by inhibiting cAMP cascade (PKA etc) which in cardiomyocytes drives contraction (opposite to bronchiolar smooth muscle)

  • Negative inotropes and chronotropes.
  • Reduce workload of the heart relieving oxygen demand. (reduced heart rate = reduced cardiomyocyte contractility)

Indications:

  • Hypertension
  • Stable angina

Side effects/interactions:

  • Bradycardia
  • Bronchospasm
  • Dizziness (hypotension)
  • Constipation
  • Fatigue
  • Interacts with NSAIDs and digoxin

Contraindicated in asthmatic patients

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32
Q

Alpha 1 adrenergic receptor blockers (A-blockers)

Drugs

MoA

Indications

Side effects/interactions

A
  • Doxazosin

Selective alpha1 adrenergic receptor blocker in the bladder neck, urethra and prostate. Prevents sympathetic neurons from initiating smooth muscle contraction, causing relaxation which allows urinary flow.

Vasodilator, decreases total peripheral resistance by inhibiting the postsynaptic alpha-1 receptors on vascular smooth muscle.

Indications:

  • Hypertension
  • BPH
  • Urinary retention

Side effects/interactions:

  • Dizziness
  • Headache
  • Nausea
  • Dry mouth
  • Constipation
  • Anxiety
  • Back pain
  • Coughing
  • Dyspnoea
  • Fatigue
  • Myalgia
  • Paraesthesia
  • Vertigo
  • Not to be given with hypotensive drugs
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33
Q

Alpha 2 adrenergic agonist

MoA

Indications

Side Effects

A
  • Clonidine

MoA: Stimulation of alpha-2 receptors, driving vasodilation

Indications: acute hypertension

Side effects: Constipation, dry mouth

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34
Q

Calcium channel blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Amlodipine
  • Nifedipine
  • Diltiazem
  • Verapamil

Prevent opening of L-type voltage-gated calcium channels reducing influx of Ca2+ into cells.

Reduced intracellular calcium has vasodilator effect on resistance vessels = reduced afterload. Causes dilation of coronary arteries increasing blood flow.

Do not act on veins.

Indications:

  • Hypertension
  • Stable angina

Side effects/interactions:

  • Oedema
  • Ankle swelling
  • Palpitations
  • Not to be given with beta blockers or digoxin
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35
Q

Calcium channel blockers: Verapamil

MoA

Indications

Side effects

A

Mostly works on cardiac muscle. Slows Ca entry during phases 2 and 3 of cardiac action potential.

  • Moderate reduction in SVR by peripheral vasodilation
  • Moderate coronary vasodilation
  • Moderate decrease in cardiac contractility
  • Large reduction in heart rate
  • Mild reduction in stroke volume

(Mild decrease in BP)

Indications: HTN, tachyarrhythmias (esp re-entry and atrial origin)

Side effects:

  • Heart failure
  • Heart block (esp when used with a B blocker)
  • Peripheral oedema
  • Constipation
  • Facial flushing
  • Headaches
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36
Q

Calcium channel blockers: Diltiazem

MoA

Indications

Side effects

A

Affects cardiac smooth muscle

  • Mild reduction in SVR through peripheral vasodilation
  • Moderate coronary vasodilation (useful for angina)
  • Moderate slowing of AV node- antiarrhythmic
  • Mild reduction in HR and stroke volume

Mild decrease in BP

Indications: HTN, arrhythmia, angina

Side effects:

  • Facial flushing
  • Headaches
  • Peripheral oedema
  • Heart failure
  • Heart block
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37
Q

Calcium channel blockers: dihydropyridines

Drugs

MoA

Indications

Side effects

A

Amlodipine and Nifedipine

  • Large reduction in SVR by peripheral vasodilation
  • Moderat cardiac vasodilation
  • Mild decreased cardiac contractility
  • Moderate reflex increase in sympathetic tone
  • Mild slowing of AV node conduction
  • High increase in HR (compensatory from drop in BP)
  • Moderate natriuresis and diuresis

Indications: HTN

Side effects:

  • Marked facial flushing
  • Headaches
  • Peripheral oedema
  • Polyuria (exacerbate prostatism)
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38
Q

Selective I (f) Current inhibitors

MoA

Indications

Side Effects

A
  • Ivabradine

MoA: Inhibition of cardiac I(f) current in the sinoatrial node

Indications:

  • Angina with normal sinus rhythm
  • Heart failure

Side effects: bradycardia

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39
Q

Nitrates

Drugs

MoA

Indications

Side effects/interactions

A
  • Glyceryl trinitrate
  • Isosorbide mononitrate

Metabolised to release NO which diffuses into cell and stimulates soluble guanylate cyclase.

Increases cGMP in vascular smooth muscle cells:

  • Drives dephosphorylation of myosin light chains via activation of MLC phosphatase.
  • Inhibits influx of Ca2+ into smooth muscle cytoplasm causing relaxation.

Works on vascular smooth muscle of arteries and veins:

  • Venodilation: reduces cardiac preload (capacitance)
  • Arteriodilation: coronary artery vasodilation increases blood flow to myocardium
  • Moderate arteriolar dilation: reduces cardiac afterload

Indications:

  • Acute angina pectoris
  • Heart failure

Side effects/interactions:

  • Hypotension
  • Headache
  • Caution with other antihypertensives
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40
Q

Sympathomimetics

Drugs

MoA

Indications

Side effects/interactions

A
  • Adrenaline (alpha and beta)
  • Noradrenaline (alpha)
  • Dobutamine (beta)

Adrenergic stimulation increases inotropy.

Adrenaline: Binds and stimulates cardiomyocyte B1-adrenergic receptors. Used in cardiac arrest to drive cardiac muscle contraction and restore heart function. Positive inotrope and chronotrope.

Indications:

  • Cardiac arrest
  • Cardiogenic shock

Side effects/indications:

  • Arrhythmia
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41
Q

Anti-platelet drugs

Drugs

MoA

Indications

Side effects/interactions

A

Aspirin

Blocks the enzyme action of platelet COX enzyme which is required for the synthesis of thromboxane A2 (TXA2).

Reduced TXA2 synthesis results in inhibition of platelet activation and thrombus formation.

Indications:

  • NSTEMI
  • Stable angina
  • Acute ischaemic stroke

Side effects: GI bleeding, caution with other anticoagulants

Clopidogrel, Prasugrel, Ticagrelor

ADP receptor blocker: binds to and block the function of ADP receptors on platelet surfaces, inhibiting platelet activation and subsequent thrombus formation.

Indications:

  • Secondary prevention for CVD

Side effects/interactions:

  • Gastrointestinal irritation and bleeding
  • Not to be given with anticoagulants
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42
Q

Anticoagulants: coumarin

Drugs

MoA

Indications

Side effects/interactions

A
  • Warfarin

Inhibition of epoxide reductase which results in inhibition of vitamin K pathway and vitamin K-dependent coagulation factors (VII, IX, X and prothrombin/FII) (1972)

Indications:

  • Prophylaxis and treatment of VTE
  • Prophylaxis of stroke from AF

Side effects/interactions

  • Abnormal bleeding
  • Drug interactions: NSAIDs, diuretics and others
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43
Q

Anticoagulants: direct thrombin inhibitors

Drugs

MoA

Indications

A
  • Dabigatran

Competitive, reversible direct inhibition of thrombin proteolytic function

Indications:

  • Prophylaxis of VTE post surgery

Side effects:

  • Bleeding
  • Abnormal bruising
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44
Q

Anticoagulants: FXa inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Apixaban
  • Edoxaban
  • Rivaroxaban

Inhibition of factor Xa in the coagulation cascade

Indications:

  • Prophylaxis of stroke from AF
  • VTE

Side effects/interactions:

  • Abnormal bleeding
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45
Q

Anticoagulants: heparins

Drugs

MoA

Indications

Side effects/interactions

A
  • Dalteparin (LMWH)
  • Tinzaparin (LMWH)
  • Enoxaparin (LMWH)
  • Unfractionated heparins

Inactivation of thrombin and factor Xa by reversibly binding to and increasing activation of anti-thrombin III.

Indications:

  • Prophylaxis of VTE and P.E
  • Treatment of existing clots (higher dose)

Side effects/interactions:

  • Abnormal bleeding
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46
Q

Thrombolytics/fibrinolytics

Drugs

MoA

Indications

Side effects/interactions

A
  • Alteplase
  • Urokinase
  • Streptokinase

Activates plasminogen to plasmin for proteolytic breakdown of fibrin and fibrinogen to restore blood flow

Indications:

  • Myocardial infarction
  • Ischaemic stroke

Side effects:

  • Arrhythmias
  • Bleeding
  • Ecchysmosis
  • Hypotension
  • Streptokinase can only be used once as an immune response is generated, memory B cells produce anti-streptokinase ABs.
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47
Q

HMG-CoA reductase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Simvastatin
  • Atorvastatin

Inhibiton of malevolate pathway needed for cholesterol synthesis.

Inhibit HMG-CoA Reductase (HMGCR) enzyme which reduces circulating cholesterol by:

  • Reducing intrinsic production of cholesterol
  • Promoting uptake of excess cholesterol by liver.

Indications:

  • Treatment of HF without affecting BP
  • Hypercholesterolaemia
  • Risk of CVD and stroke

Side effects/interactions:

  • Myalgia
  • Interacts with verapamil and macrolides
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48
Q

Class I antiarrhythmics: Sodium Channel Blockers

Drugs

MoA

Indications

Side effects/interactions

A

Class 1a:

  • Disopyramide
  • Quinidine

Class 1b:

  • Lidocaine

Class 1c:

  • Flecainide
  • Propafenone

Voltage-sensitive sodium channel blockade. Prolongs QT interval and increases QRS duration.

Indications:

  • Class 1a: Ventricular and supraventricular arrhythmias
  • Class 1b: CPR (given IV)
  • Class 1c: Paroxysmal atrial fibrillation and ventricular ectopic beats “pill in pocket”

Side effects/interactions:

  • Oedema
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49
Q

Class II anti-arrythmics: beta blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Sotalol

Beta-adrenergic receptor blockade reducing adrenergic effects on inotropy and chronotropy.

Sotalol also has K+ channel blocker activity

Indications:

  • Prophylaxis of paroxysmal atrial tachycardia or fibrillation

Side effects/interactions:

  • Hypotension
  • Bradycardia
  • Bronchospasm
  • Not to be given with NSAIDs or digoxin
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50
Q

Class III anti-arrhythmics: potassium channel blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Amiodarone
  • Dronedarone
  • Sotalol (also has some beta blocker activity)

Potassium channel blockade, also evidence of beta blocker and calcium channel blocker properties – prolong QT interval.

Indications:

  • Supraventricular, nodal and ventricular tachyarrhythmias, atrial fibrillation
  • CPR (given IV)

Side effects/interactions:

  • Nausea
  • Vomiting
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51
Q

Class IV antiarrhythmics: calcium channel blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Verapamil
  • Diltiazem

Cardiac calcium channel blockade- reduction of action potential and cardiac output.

Indications:

  • Supraventricular tachycardia (esp paroxysmal SVT)

Side effects/interactions:

  • Constipation (diltiazem)
  • Hypotension (verapamil)
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52
Q

Cardiac glycosides

Drugs

MoA

Indications

Side effects/indications

A
  • Digoxin

Reduces contractility of AV node.

Indications:

  • Atrial fibrillation
  • Congestive heart failure

Side effects/interactions:

  • Fatigue
  • Nausea
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53
Q

Adenosine

MoA

Indications

Side effects/interactions

A
  • Adenosine

Activates adenosine receptors which cause hyperpolarisation.

Slows conduction through AV node.

Indications:

  • Supraventricular tachycardia

Side effects/interactions:

  • Nausea
  • Contraindicated in obstructive airway disease
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54
Q

Anti-cholinergic (emergency)

Drugs

MoA

Indications

Side effects/interactions

A
  • Atropine

Blockade of vagal (parasympathetic) muscarinic acetylcholine receptors in the SA and AV nodes.

Indications:

  • Bradycardia (emergency)

Side effects/interactions:

  • Urinary retention
  • Dry mouth
  • Dilated pupils
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55
Q

Magnesium sulfate

MoA

Indications

Side effects/interactions

A
  • IV Mg sulfate

Unclear – possible alteration of Na+, K+ and Ca2+ ion balance via ion channels and transporters.

Indications:

  • Emergency arrhythmia
  • Emergency asthma

Side effects/interactions:

  • Electrolyte irregularities
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56
Q

Beta2 adrenergic agonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Salbutamol (short acting)
  • Terbutaline (short acting)
  • Salmeterol (long acting)
  • Formoterol (long acting)

Cellular target: Bronchiolar smooth muscle cells

Molecular target: Stimulation of B2-adrenergic receptors

  • Activation of B2AR activates G-protein
  • Increases activation of adenylate cyclase
  • Adenylate cyclase converts ATP to cAMP
  • Increased cAMP activates protein kinase A which:
  • Drives Ca2+ into intracellular storage vesicles away from cytoplasm.
  • Reduces activity of myosin light chain kinase = reduced muscle contraction
  • Dephosphorylation of myosin light chain = reduced muscle contraction
  • Reduced cytoplasmic Ca2+ levels reduce smooth muscle contraction resulting in bronchodilation.

Indications:

  • Asthma
  • Reversible airway obstruction

Side effects/interactions:

  • Tachycardia
  • Tremor
  • Cardiac arrhythmias
  • Interacts with diuretics
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57
Q

Anti-muscarinics (anti-cholinergics)

Drugs

MoA

Indications

Side effects/interactions

A
  • Ipratropium (short acting)
  • Tiotropium (long acting)
  • Aclidinium (long acting)

Blocks M3 muscarinic acetylcholine receptors preventing stimulating effects of ACh:

  • Inhibits activation of G-protein therefore inhibits activation of phospholipase C enzyme (PLC)
  • PLC therefore cannot release calcium from intracellular stores
  • Cytoplasmic Ca2+ levels do not rise therefore bronchiolar smooth muscle contraction does not increase (inhibits bronchoconstriction)
  • =Bronchiolar relaxation

Indications:

  • Acute asthma
  • Bronchospasm in COPD

Side effects/interactions:

  • Dry mouth
  • Constipation
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58
Q

Methylxanthines

Drugs

MoA

Indications

Side effects/interactions

A
  • Aminophylline
  • Theophylline

Inhibit phosphodiesterase enzymes (PDE) preventing it from inhibiting CAMP.

CAMP levels maintained therefore protein kinase A enzyme activated which stores intracellular Ca2+ into storage vesicles.

Reduced cytoplasmic Ca2+ results in less smooth muscle contraction so less bronchoconstriction

Indications:

  • Acute asthma
  • Reversible airways obstruction

Side effects/interactions:

  • Headache
  • Nausea
  • Cardiac arrhythmias
  • Seizures
  • Interacts with antidepressants and salbutamol
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59
Q

Glucocorticoids

Drugs

MoA

Indications

Side effects/interactions

A
  • Beclomethasone
  • Prednisolone
  • Hydrocortisone
  • Fluticasone

Targets immune cells of the lungs: macrophages, T-lymphocytes, eosinophils.

Activates glucocorticoid receptors which interact with selected nuclear DNA sequences and influences the expression of genes:

  • Repression of pro-inflammatory mediators: IL-3, IL-5, Th​2 cytokines
  • Expression of anti-inflammatory products: secreted leukocyte peptidase inhibitor (SLPI), Lipcortin-1 and upregulation of B2 adrenoceptors.

Indications:

  • Asthma
  • Allergic rhinitis
  • Suppression of inflammatory diseases (RA, SLE, Crohn’s, UC)

Side effects/interactions:

  • Cough
  • Hyperglycaemia
  • Muscle wasting
  • Thinning skin
  • Osteoporosis
  • Increased risk of infection, esp throat infection with inhalers
  • Moon face (facial swelling)
  • Interacts with aspirin
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60
Q

Leukotriene antagonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Montekulast
  • Zafirlukast

Blockade of leukotriene receptors.

Leukotrienes released from mast cell upon activation, normally binds to CysLT1 leukotriene receptor to:

  • Stimulate bronchiolar smooth muscle constriction
  • Bind to and recruit immune cells such as eosinophils by guiding eosinophil chemotaxis.

Leukotriene receptor antagonists block CysLT1 receptors on smooth muscle and eosinophils blocking the above effects.

Indications:

  • Asthma
  • Allergic rhinitis
  • (used as a preventor)

Side effects/interactions:

  • Abdominal pain
  • Interacts with phenobarbital
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61
Q

Mucolytic drugs

MoA

Indications

Side effects/interactions

A
  • Dornase alfa

Synthetic DNAse 1 – breakdown Cystic fibrosis of extracellular DNA to reduce sputum viscosity.

Indications:

  • Cystic fibrosis

Side effects: GI bleeding

  • Carbocisteine

MoA: Cleavage of mucus glycoproteinsto reduce sputum viscosity

Indications: cystic fibrosis

Side effects: GI bleeding

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62
Q

Synthetic Dopamine Agonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Pramipexole
  • Ropinirole
  • Rotigotine

Synthetic dopamine, act on dopamine receptors (primarily D2) to replace lost dopamine

Less overall improvement than levodopa, more psychiatric side effects.

Indications:

  • Parkinson’s disease
    • Esp younger patients to delay the need for levodopa
    • First line for initial treatment
    • Can be used with levodopa in later stages

Side effects/interactions:

  • Psychiatric symptoms (due to action on mesocortical and mesolimbic pathways)
    • Confusion, agitation
  • Nausea and vomiting
  • Sudden onset sleep/ drowsiness
  • On-off effects
  • Hypotension
  • Tachycardia
  • Interacts with MAOIs
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63
Q

Levodopa

MoA

Indications

Side effects/interactions

A

Dopamine precursor: crosses blood brain barrier and is metabolised into dopamine to replace that lost. Works on dopamine receptors to restore activity in the nigrostriatal pathway.

Indications:

  • Parkinson’s disease (use as late as possible)

Side effects/interactions:

  • Psychiatric symptoms (due to action on mesocortical and mesolimbic pathways)
    • Confusion, agitation
  • Nausea and vomiting
  • Sudden onset sleep/ drowsiness
  • On-off effects
  • Hypotension
  • Interacts with MAOIs
  • Tachycardia
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64
Q

Monoamineoxidase-B (MAOI-B) inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Selegiline
  • Rasagiline

Inhibition of levodopa breakdown in the CNS by monoamineoxidase-B meaning more is available to be converted into dopamine.

Indications:

  • Parkinson’s disease
    • Use alongside levodopa

Side effects: arrhythmias

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65
Q

Dopa-decarboxylase inhibitors

Drugs

MoA

Indications

A
  • Carbidopa
  • Benserazide

Prevents the breakdown of levodopa in the periphery by dopa-decarboxylase enzyme allowing more to cross the blood brain barrier and be converted into dopamine.

Indications:

  • Parkinson’s disease
    • Use in conjunction with levodopa

Side effects:

  • Confusion
  • Agitation
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66
Q

Catechol-o-methyl transferase (COM-T) inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Entacapone
  • Tolcapone

Prevents breakdown of levodopa in the CNS by Catechol-O-methyltransferase (COM-T) so more is available to be converted to dopamine.

Indications:

  • Parkinson’s disease
    • Use alongside levodopa

Side effects/interactions:

  • Nausea
  • Vomiting
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67
Q

Anticholinergics

Drugs

MoA

Indications

Side effects/interactions

A
  • Orphenadrine
  • Procyclidine
  • Trihexphenadyl

Inhibits cholinergic fibres from the striatum to the globus pallidus that moderate GABAergic cells and prevents them from inhibiting the direct pathway and increase effects of the indirect pathway.

Indications:

  • Parkinson’s disease (iatrogenic)
  • Muscle rigidity
  • Negate the side effects of anti-psychotics

Side effects/interactions:

  • Can reduce the absorption of levodopa
  • Dry mouth
  • Constipation
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68
Q

Dopamine depleting drugs

MoA

Indications

Side effects/interactions

A
  • Tetrabenazine

Inhibits VMAT2 (vesicular monoamine transporter) within basal ganglia, preventing transport of dopamine into presynaptic vesicles therefore less released into the synaptic cleft.

Indications:

  • Huntington’s chorea

Side effects/interactions:

  • Affects all monoamines: 5-HT and NA
    • Can cause depression
  • Parkinsonism
  • Anxiety
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69
Q

Selective Serotonin Re-uptake Inhibitors (SSRIs)

Drugs

MoA

Indications

Side effects/interactions

A
  • Sertraline
  • Citalopram
  • Fluoxetine
  • Paroxetine

Inhibition of 5-HT reuptake pump in synaptic cleft.

Indications:

  • Depression
  • Generalised anxiety disorder

Side effects/interactions:

  • Slow onset, can increase depressive symptoms initially
  • Nausea
  • Insomnia, early waking, vivid dreams
  • Sexual dysfunction
  • Increased bleeding
  • Serotonin syndrome (increased 5-HT levels)- Emergency
  • Interacts with NSAIDs and lithium
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70
Q

Reversible inhibitors of monoamine oxidase type A (RIMA)

Drugs

MoA

Indications

Side effects/interactions

A
  • Moclobemide

Increases 5-HT and noradrenaline levels by reversibly inhibiting enzymatic breakdown by monoamine oxidase A.

Indications:

  • Depression

Side effects/interactions:

  • Tachycardia
  • Also affects dopamine levels
  • DO NOT USE WITH TCAs/SSRIs
  • Interacts with cheese (contains tyramine)
  • Postural hypotension
  • Restlessness
  • Convulsions
  • Sleep disorders
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71
Q

Tricyclic antidepressants (TCAs)

Drugs

MoA

Indications

Side effects/interactions

A
  • Amitryptiline
  • Nortryptiline
  • Dosulepin

5 main actions:

  • Therapeutic effects:
    • 5HT reuptake inhibitor
    • Noradrenaline reuptake inhibitor
  • Side effect causing:
    • A1 adrenoceptor antagonist
      • Postural hypotension
    • H1 receptor antagonist:
      • Sedation
    • M1 receptor antagonist
      • Cardiac dysrhythmia
      • Prolonged QT interval

Indications:

  • Depression

Other side effects:

  • Confusion
  • Mania
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72
Q

Atypical antidepressants: Serotonin Noradrenaline Reuptake Inhibitors

Drugs

MoA

Indications

A
  • Venlafaxine

Inhibits the reuptake pumps of both 5-HT and noradrenaline

Indications:

  • Depression
73
Q

Atypical antidepressants: Noradrenaline reuptake inhibitors

Drugs

MoA

Indications

A
  • Raboxetine

Inhibition of the noradrenaline reuptake pump.

Indications:

  • Depression
74
Q

Atypical antidepressants: Melatonin Agonist

Drugs

MoA

Indications

A
  • Agomelatine

Increases slow wave sleep to prolong sleep duration and reset sleep patterns.

Indications:

  • Depression
75
Q

Atypical antidepressants: Noradrenaline dopamine reuptake inhibitors

Drugs

MoA

Indications

A
  • Bupropion

Inhibition of the noradrenaline and dopamine reuptake pumps in the synaptic cleft.

Indications:

  • Depression
76
Q

Atypical antidepressants: a2-adrenoceptor antagonist

MoA

Indications

Side Effects/interactions

A
  • Mirtazipine

Increase neurotransmitter release by inhibiting a2 receptors which normally slow transmitter release.

Indications:

  • Depression

Side effects/interactions:

  • Decreased vascular flow in extremities
  • Postural hypotension
  • Fatigue
  • Bronchoconstriction
  • Cardiac failure
  • Bradycardia
  • Sleep disorders
  • Impotence
77
Q

First generation antipsychotics

Drugs

MoA

Indications

Side effects/interactions

A
  • Haloperidol
  • Chlorpromazine

Selective dopamine D2 receptor antagonists. Also affect M1, H1, alpha1 receptors.

Low efficacy (30% non-responders)

Indications:

  • Schizophrenia
  • Haloperidol: used for short term treatment of extreme or aggressive behaviour, rapid tranquilisation
  • Haloperidol: huntington’s

Side effects/interactions:

  • Blurred vision
  • Tremor
  • Extrapyramidal symptoms (result of altering activity of nigrostriatal pathways):
    • Dystonias
    • Akathisia
    • Parkinsonism
    • Sedation
    • Seizures
    • Hypotension
    • Hypothermia
    • Hypersensitivity
  • Chlorpromazine: agranulocytosis
  • Tardive dyskinesia from prolonged use (choreiform movements, grimacing, tongue protruding)
78
Q

Second generation (atypical) antipsychotics

Drugs

MoA

Indications

Side effects/interactions

A
  • Olanzapine

Antagonism of D1, D2, D3 and D4 receptors in the brain, 5HT2A, 5HT2C, 5HT3 and 5HT6 receptors, alpha-1 adrenergic receptor, histamine receptor H1 and multiple muscarinic receptors.

  • Risperidone

​5HT2A and Dopamine antagonist

  • Quetiapine

Antagonism of dopamine type 2 (D2) and serotonin 2A (5HT2A) receptors

  • Clozapine

​5HT2A and domapine antagonist

  • Amisulpride

​5HT7 and Dopamine (D1 & D2) antagonist (mesolimbic pathway)

Indications:

  • Schizophrenia

Side effects/interactions:

  • Extrapyramidal symptoms
  • Hypotension
79
Q

Mood stabilisers

Drugs

MoA

Indications

Side effects/interactions

A
  • Lithium carbonate

MOA unclear

Indications:

  • Bipolar disorder

Side effects/interactions:

  • Tremor
  • Hypothyroidism
  • Interacts with NSAIDs and ACE-inhibitors
80
Q

Cholinesterase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Donepezil
  • Galantamine
  • Rivastigmine

Reversible inhibition of acetylcholinesterase

Indications:

  • Dementia (mild to moderate)
  • Alzheimer’s disease

Side effects:

  • Nausea
  • Vomiting
81
Q

NDMA receptor antagonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Memantine

VD blocker of NDMA receptors

Indications:

  • Dementia (moderate to severe)
  • Alzheimer’s disease

Side effects/interactions:

  • Constipation
  • Hypertension
82
Q

Anxiolytics: Benzodiazepines

Drugs

MoA

Indications

Side effects/interactions

A
  • Lorazepam
  • Midazolam
  • Diazepam
  • Zolpidem (benzodiazepine-like)
  • Temazepam

GABA PAM (y subunit). Enhanced effects of GABA. Co-agonist (positive allosteric modulators) which bind to the y-subunit of the GABAA receptor to increase action of GABA. Reduces neuronal transmission by increasing chloride entry into the cell leading to hyperpolarisation and decreased likelihood of action potential firing.

Indications:

  • Anxiety and related disorders
  • Epilepsy
  • Acute seizures
  • Temazepam: sedation

Side effects/interactions:

  • Drowsiness
  • Dependence
  • Not to be given with sedatives
83
Q

Anxiolytics: Buspirone

MoA

Indications

A

5-HT1A partial agonist

Indications:

  • Anxiety and related disorders
84
Q

Non-benzodiazepine hypnotic

Drugs

MoA

Indications

A
  • Zopiclone

GABA PAM (γ-subunit) Enhanced effects of GABA

Indications:

  • Insomnia

Side effects:

  • Dry mouth
  • Daytime drowsiness
85
Q

Anti-epileptic drugs: calcium channel blockers

Drugs

MoA

Interactions

Side effects/interactions

A
  • Ethosuximide

T-type calcium channel blocker

Indications:

  • Epilepsy: generalised absence seizures first line

Side effects/interactions:

  • Do not use with macrolide antibiotics
  • Nausea
  • Blurred vision
86
Q

Anti-epileptic drugs: sodium channel blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Sodium valproate
    • ​Generalised tonic-clonic seizures (first line)
    • Generalised abscence seizures (first line)
    • Generalised myoclonic seizures (first line)
    • Generalised abscence atypical, generalised tonic and generalised atonic seizures (first line)
  • Lamotrigine
    • Focal and focal to generalised seizures (first line)
    • Generalised tonic-clonic seizures (first line)
  • Carbamazepine
    • ​Focal and focal to generalised seizures (first line)

Sodium channel blockers in inactivated state.

Indications:

  • Epilepsy (see above)

Side effects/interactions:

  • Sodium Valproate: Teratogenicity: foetal developmental defects
  • Cognitive impairment
  • Visual impairment
  • Peripheral neuropathy
  • Gum hyperplasia
  • Anaemia
  • Osteomalacia
  • Macrolide antibiotics
87
Q

Benzodiazepine antagonist

Drugs

MoA

Indications

A
  • Flumazenil

Antagonises GABA signalling

Indications:

  • Reversal of benzodiazepine sedation
88
Q

Barbiturates

Drugs

MoA

Indications

Side effects/interactions

A
  • Phenobarbitone
  • Pentobarbitone
  • Primidone

Co-agonist of the GABAA receptor (B subunit) to increase activity.

Reduces neuronal transmission by enhancing inhibition

Indications:

  • Epilepsy/acute seizures
  • Anaesthesia/anxiolytic

Side effects/interactions:

  • Dizziness/fainting
  • Drowsiness
  • Withdrawal on termination
  • Tolerance and dependency
  • Impaired motor coordination
  • Sedation
  • Impaired cognitive function
  • Retrograde amnesia
  • Interacts with sedatives and anticoagulants
89
Q

Paracetamol

MoA

Indications

Side effects/interactions

A

Possible COX inhibitor, MoA unclear.

Indications:

  • Mild-moderate nociceptive pain
  • Pyrexia

Side effects/interactions:

  • Constipation
  • Interacts with warfarin
90
Q

NSAIDs

Drugs

MoA

Indications

Side effects/interactions

A
  • Ibuprofen
  • Diclofenac
  • Naproxen
  • Aspirin

Block production of prostaglandins by inhibiting cyclo-oxygenase enzyme:

  • COX1 : normal cell function
  • COX2 : inflammation
  • COX3 : fuck knows

Inhibiting COX2 reduces production of inflammatory prostaglandins therefore reduce activation of prostanoid receptor and Na+ channel activation.

Reduced Na+ channel activation leads to decreased depolarisation and less pain transmission.

Indications:

  • Mild to moderate pain
  • Inflammation

Side effects/interactions:

Inhibiting COX1 inhibits production of PGE1 and PGI2 which have a role in normal physiological processes in platelets, endothelium, kidney, stomach and intestinal function.

  • Bleeding
  • Stomach ulcers
  • Heartburn
  • Nausea/ vomiting
  • Diarrhoea
  • Headache
  • Tinnitus
  • Hypertension
  • Interacts with ACE-inhibitors & diuretics
91
Q

COX2 selective NSAIDs

Drugs

MoA

Indications

Side effects/interactions

A
  • Eterocoxib
  • Celecoxib

COX-2 inhibition, localised prostaglandin blockade

Indications:

  • Pain
  • Inflammation

Side effects/interactions:

  • Less GI side effects than normal SAIDs
  • Indigestion
  • Avoid with NSAIDs and SSRIs
92
Q

Weak opioid analgesics

Drugs

MoA

Indications

Side effects/interactions

A
  • Codeine
  • Dihydrocodeine

Mimic endogenous opioids acting on opioid receptors µ, K, delta and ORL-1. Decrease neuronal transmission by:

  • Hyperpolarising the cell so it is less likely to fire AP when simulus arrives:
    • Decreases opening of voltage gated Na+ channels
    • Increases K+ outflow via KATP and KIR channels
    • Reduces exocytosis of transmitters
    • Decreases Ca2+ release from intracellular stores

Indications:

  • Mild to moderate chronic and acute pain

Side effects/interactions:

  • Constipation
  • Nausea
  • Drowsiness
  • Avoid giving with sedatives
93
Q

Strong opioid analgesics

Drugs

MoA

Indications

Side effects/interactions

A
  • Morphine
  • Diamorphine
  • Pethidine
  • Fentanil

Mimic endogenous opioids acting on opioid receptors µ, K, delta and ORL-1. Decrease neuronal transmission by:

  • Hyperpolarises the cell so it is less likely to fire when AP arrives:
    • Decreases opening of voltage gated Ca2+ channels
    • Increases K+ outflow via KATP and KIR channels
    • Reduces exocytosis of transmitter vesicles
    • Decreases Ca2+ release from intracellular stores

Indications:

  • Severe pain
    • Cancer care, palliative care, coronary care

Side effects/interactions:

  • Drowsiness
  • Respiratory depression
  • Constipation
  • Nausea
  • Tolerance and dependance/withdrawal
  • Avoid with sedatives
94
Q

Partial/mixed opioid analgesics

Drugs

MoA

Indications

Side effects/interactions

A
  • Buprenorphine
  • Pentazocine

Modulation of analgesic opioid receptors (agonist for u and antagonist for k)

Indications:

  • Moderate to severe pain
  • Opioid addiction

Side effects/interactions:

  • Constipation
  • Nausea
  • Avoid with sedatives
95
Q

Opioid antagonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Naloxone (shorter half life)
  • Naltrexone (longer half life)

Competitive opioid receptor antagonist

Indications:

  • Opioid overdose, respiratory depression

Side effects/interactions:

  • Nausea
  • Constipation
96
Q

Drugs for the management of opioid addiction

MoA

Indications

Side effects/interactions

A
  • Buprenorphine

µ agonist and k antagonist

  • Methadone

µ agonist, narcotic opioid replacement

Indications:

  • Opioid addiction

Side effects:

  • Constipation
  • Nausea
  • Avoid with sedatives
97
Q

Drugs for neuropathic pain

MoA

Indications

Side effects/interactions

A
  • Pregabalin

VDCC antagonist

  • Gabapentin

VDCC antagonist

  • Amitriptyline

See tricyclic antidepressants

Indications:

  • Neuropathic pain

Side effects/interactions:

  • Dizziness
  • Fatigue
98
Q

Inhaled analgesics: Nitrous Oxide

Drugs

MoA

Indications

Side effects/interactions

A
  • Nitrous oxide

MoA unclear

Indications:

  • Analgesia during childbirth

Side effects/interactions:

  • Decreased vitamin B12 synthesis
99
Q

General anaesthetics

Drugs

MoA

Indications

Side effects/interactions

A
  • Propofol (IV): MoA unclear
  • Isoflurane (inhaled): MoA unclear
  • Sevoflurane (inhaled): MoA unclear
  • Ketamine (IV) : NDMA receptor blockade

Indications:

  • Induction of anaesthesia for major surgery
  • Propofol: maintenance of anaesthesia

Side effects/interactions:

  • Decreased cardiac contractility
  • Respiratory depression (in overdose leading to respiratory failure and death)
  • Decreased CNS function
  • Reduced sympathetic activity
100
Q

Local anaesthetics

Drugs

MoA

Indications

Side effects/interactions

A
  • Lidocaine
  • Bupivicaine
  • Levobupivaine

Voltage-gated sodium channel blockade in 2 ways:

  • Directly entering open sodium channels (use-dependence, more channels open = bigger the effect)
  • Accessing sodium channels by crossing axonal membrane and binding from the inside

Indications:

  • Local anaesthesia:
    • Lidocaine: regional IV anaesthesia, nerve block, dental and topical.
    • Bupivicaine/levobupivicaine: local infiltration, regional IV anaesthesia, epidural, peripheral nerve block, sympathetic block.

Side effects/interactions:

  • Rash
101
Q

Non-depolarising neuromuscular blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Atracurium besolate
  • Vecuronium

Competitive antagonists of Ach receptors preventing depolarisation, blocking the effect of Ach.

Also act presynaptically to reduce Ca2+ entry, reducing its release in vesicles into the synaptic cleft.

3-4 min time to max block, 40-45 min duration.

Indications:

  • Tracheal intubation and mechanical ventilation during surgery

Side effects/interactions:

  • No CNS side effects due to inability to cross BBB
  • Vecuronium has active metabolite that may produce residual paralysis
  • Hypotension
  • Skin flushing
102
Q

Depolarising neuromuscular blockers

Drugs

MoA

Indications

Side effects/interactions

A
  • Neostigmine

​Non-competitive block of acetylcholinesterase (AchE) breakdown of Ach to increase levels of Ach in the junctional cleft. Causes muscle paralysis by overloading the system, activating all Ach receptors at maximum and leaving no room for additional movement; similar to depolarising NMBs.

  • Suxamethonium

Rapid action, muscle relaxation within 1 minute: needs continuous infusion.

Non-competitive agonists of ACh receptors causing prolonged depolarisation (causes receptor to close and repolarise despite receptor still being bound) and blockage of the receptor preventing further depolarisation and muscle contraction.

Indications:

  • Tracheal intubation and ventilation during surgery
  • Relaxes muscles by blocking ACh at the NMJ

Side effects:

  • Initial depolarisation causes fasciculations and increased likelihood of pain on recovery
  • Increase parasympathetic activity:
    • Bradycardia
    • Increased secretion and peristalsis
103
Q

Drugs for reversing neuromuscular block

MoA

Indications

Side effects/interactions

A
  • Neostigmine

​Anticholinesterase

Reverses the effects of non-polarising NMB but prolongs the effects of polarising NMB suxamethonium.

  • Sugammadex

​Selective relaxant binding agent, binds to the drug to form a complex, encapsulating and inactivating it and preventing it from working at the NMJ.

Rapid action, rapidly cleared from plasma and excreted in urine

No effect on the cholinergic nervous system, minimises risk of residual paralysis.

Indications:

  • Sugammadex: Immediate reversal of NMB to reduce post-operative pulmonary compications
  • Neostigmine: reversal of non-polarising NMB. Also used in myasthenia gravis.

Side effects/interactions:

  • Neostigmine: bradycardia due to muscarinic effects on PNS.
104
Q

Sedatives/muscle relaxants: Dexmedetomidine

MoA

Indications

Side effects/interactions

A

By binding to the presynaptic α-2 adrenoceptors in the brain, dexmedetomidine inhibits the release of noradrenaline, and terminates the propagation of pain signals. Activation of the postsynaptic α-2 adrenoceptors inhibits the sympathetic activity, decreasing blood pressure and heart rate.

Indications:

  • Used as a sedative in intensive care if the patient needs to maintain verbal responsiveness.
  • Maintain sedation and relaxed muscle tone

Side effects/interactions:

  • Bradycardia
105
Q

Muscle relaxants/sedatives: opioids

Drugs

MoA

Indications

Side effects/interactions

A
  • Fentanil
  • Alfentanil
  • Remifentanil

Opioid receptor agonists

Indications:

  • Maintenance of sedation and relaxed muscle tone
  • Fentanil: used for severe pain

Side effects/interactions:

  • Respiratory depression
  • Constipation
106
Q

Anti-emetics: H1 receptor antagonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Cyclizine

Histamine H1 receptor blockade

Indications:

  • Nausea
  • Vomiting

Side effects/interactions:

  • Dry mouth
  • Sedation
  • High as a kite if taken IV
107
Q

Anti-emetics: D2 receptor antagonists

Drugs

MoA

Indications

Side effects/interactions

A
  • Domperidone

Dopamine D2 receptor blockade in the Chemoreceptor Trigger Zone.

Indications:

  • Nausea and vomiting

Side effects/interactions:

  • Cardiac disease
108
Q

Beta Lactams: Penicillins

Drugs

MoA

Indications

Side effects/interactions

A
  • Benzylpenicillin
  • Amoxicillin: LRTIs
  • Coamoxiclav: mixed infections e.g. dental abscesses and complicated LRTIs
  • Penicillin: tonsilitis
  • Flucloxacillin: SSTIs
  • Piperacillin/tazobactam: Complex LRTI

Bacteriocidal, target bacterial cell wall- block cell wall synthesis causing cell lysis.

Poor activity against intracellular organisms (e.g. legionella) or those with abnormal cell wall (e.g. chlamydia)

Side effects/interactions:

  • Avoid use in patients with penicillin or cephalosporin induced anaphylaxis.
  • Rash/hypersensitivity
  • Interact with warfarin and methotrexate
109
Q

Beta lactams: cephalosporins

Drugs

MoA

Indications

Side effects/interactions

A
  • Ceftriaxone

Bacteriocidal: cause cell lysis by blocking cell wall synthesis

Indications:

  • Abdominal sepsis
  • Gram -ve infections
  • Bacterial meningitis
  • Orthopaedic infections

Side effects/interactions:

  • Around 10% with penicillin allergy also have allergy to cephalosporins
  • Increased risk of CDAD
  • GI disturbances
  • Colitis
  • Interacts with warfarin
110
Q

Beta lactams: carbapenems

Drugs

MoA

Indications

Side effects/interactions

A
  • Meropenem

Bacteriocidal- block cell wall synthesis causing cell lysis.

Indications:

  • Complex and multi drug resistant UTIs
  • Infections in intensive care
  • Hospital acquired septicaemia

Side effects/interactions:

  • Abdominal pain
  • Pruritis
111
Q

Antifolate antibiotic

Drug

MoA

Indications

Side effects/interactions

A
  • Trimethoprim

Inhibition of dihydrofolate reductase. Bacteriostatic.

Indications:

  • UTI (uncomplicated)

Side effects/interactions:

  • Rash
  • GI disturbances
  • Interacts with methotrexate
  • Contraindicated in pregnancy
112
Q

Fluoroquinolones

Drugs

MoA

Indications

Side effects/interactions

A
  • Ciprofloxacin

Bactericidal if high dose: Inhibition of bacterial DNA gyrase enzyme, targets DNA structure and function.

Indications:

  • Respiratory tract infections
  • Gram -ve infections excluding anaerobes
  • MRSA

Side effects/interactions:

  • Nausea
  • Convulsions
  • Interacts with iron salts, NSAIDs
113
Q

Macrolide antibiotics

Drugs

MoA

Indications

Side effects/interactions

A
  • ​Erythromycin
  • Azithromycin

Bacteriostatic: target RNA and inhibition of bacterial protein synthesis.

Indications:

  • LRTI
  • URTI
  • SSTI (in place of penicillins)
  • Atypical LRTIs (intracellular organisms)

Side effects/interactions:

  • GI disturbance
  • Headaches
  • Interacts with digoxin, theophylline, statins
114
Q

Tetracycline antibiotic

Drugs

MoA

Indications

Side effects/interactions

A
  • Doxycycline

Bacteriostatic: target RNA and inhibit bacterial protein synthesis

Indications:

  • Atypical bacteria that lack the normal cell wall:
    • Chlamydia
    • Mycoplasmia
    • Rickettsia
      • e.g Typhus
    • CAP

Side effects/interactions:

  • Use limited by GI intolerance
  • Photosensitivity
115
Q

Nitrofuran antibiotic

Drug

MoA

Indications

Side effects/interactions

A
  • Nitrofurantoin

Interferes with bacterial DNA synthesis- bactericidal if high dose

Indications:

  • Uncomplicated UTI

Side effects/interactions:

  • Peripheral neuropathy
116
Q

Aminoglycosides

Drugs

MoA

Indications

Side effects/interactions

A
  • Gentamicin

Bactericidal if high dose: targets RNA, inhibition of bacterial protein synthesis

Indications:

  • Severe gram -ve infections
  • Synergistic treatment for bacterial endocarditis
  • Opthalmic infection

Side effects/interactions:

  • Use limited by renal toxicity and need for monitoring of drug levels
117
Q

Glycopeptides

Drugs

MoA

Indications

Side effects/interactions

A
  • Vancomycin

Bactericidal: target bacterial cell wall in gram +ve bacteria

Indications:

  • Multi drug resistant gram +ve cocci
    • E.g MRSA
  • C difficile infection

Side effects/interactions:

  • Use limited by renal toxicity and need for monitoring of drug levels
  • Neutropenia
  • Renal impairment
118
Q

Nitroimidazoles

Drugs

MoA

Indications

Side effects/interactions

A
  • Metronidazole

Bactericidal if high dose: inhibition of bacterial DNA synthesis

Indications:

  • Anaerobic bacterial infections:
    • Leg ulcers
    • Pressure sores
    • Abscesses
    • Bacterial vaginosis

Side effects/interactions:

  • Alcohol contraindicated
119
Q

Antituberculosis drugs

MoA

Indications

Side effects/interactions

A
  • Isoniazid

Inhibition of bacterial cell wall synthesis

  • Ethambutol

Inhibition of bacterial cell wall synthesis

  • Rifampicin

Inhibition of mycobacterial RNA synthesis

  • Pyrazinamide

Indications:

  • Tuberculosis

Side effects/interactions:

  • Hepatotoxicity
120
Q

Therapeutic cytokines

Drugs

MoA

Indications

Side effects/interactions

A
  • Interferon alpha

Activation of antiviral intracellular and immune responses

Indications:

  • Hepatitis B
  • Hepatitis C
  • Viral hepatitis from chronic CMB and EBV infections

Side effects/interactions:

  • Flu-like symptoms
  • Loss of appetite
  • Fever
  • Lethargy
  • Depression
    • Secondary to night sweats -> sleep deprivation
121
Q

DNA polymerase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Aciclovir
  • Ganciclovir

Virus replication blockade. Aciclovir is converted to is triphosphate form (aciclovir triphosphate- ACV-TP) which competitively inhibits viral DNA polymerase, incorporates into and terminates the growing viral DNA chain and inactivates the viral DNA polymerase.

Indications:

  • Herpes simplex infection

Side effects/interactions:

  • Nausea
  • Diarrhoea
122
Q

Neuraminidase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Oseltamivir

Prevention of viral budding and infectivity

Indications:

  • Influenza

Side effects/interactions:

  • Nausea and vomiting
123
Q

Nucleoside analogues

Drugs

MoA

Indications

A
  • Ribavirin

Disrupts viral RNA synthesis

Indications:

  • Hepatitis C
  • RSV
124
Q

Nucleoside reverse transcriptase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Tenofovir

Blockade of viral reverse transcriptase function for viral replication

Indications:

  • HIV infection

Side effects/interactions:

  • Rash
  • Steven-Johnson syndrome
125
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

Drugs

MoA

Indications

Side effects/interactions

A
  • Efavirenz

Blockade of viral reverse transcriptase function for viral genetic replication

Indications:

  • HIV infection

Side effects:

  • Rash
  • Steven-Johnson syndrome
126
Q

Viral protease inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Lopinavir

Blockade of viral protease required for virus particle assembly

Indications:

  • HIV infection

Side effects/interactions:

  • GI bleeding
127
Q

Integrase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Dolutegravir

Disrupts integration of HIV genome into host chromosomes

Indications:

  • HIV
128
Q

Viral fusion inhibitors

Drugs

MoA

Indications

Side effects

A
  • Enfuvirtide

Blockade of virus fusion to target cell membrane

Indications:

  • HIV

Side effects/interactions:

  • Pancreatitis
129
Q

Chemokine receptor/CC5 antagonists

Drugs

MoA

Indications

Side effects

A
  • Maraviroc

Blockade of HIV binding to co- factor for cell entry

Indications:

  • HIV

Side effects/interactions:

  • Nausea
  • Diarrhoea
130
Q

Triazole anti-fungal agent

Drug

MoA

Indication

Side effects/interactions

A
  • Fluconazole

Disruption of fungal membrane function

Indication:

  • Candida infection

Side effects:

  • Nausea
  • Abdominal pain
131
Q

Insulin

MoA

Indication

Side effects/interactions

A

Increases uptake of glucose by cells

Indications:

  • T1 & T2DM

Side effects/interactions:

  • Hypoglycaemia
  • Interacts with digoxin, beta blockers
132
Q

Oral biguinade

Drug

MoA

Indications

Side effects/interactions

A
  • Metformin

Increases insulin sensitivity & inhibits hepatic gluconeogenesis

Indications:

  • T2DM

Side effects:

  • Nausea and vomiting
  • Interacts with digoxin, diuretics
133
Q

Sulphonyureas

Drugs

MoA

Indications

Side effects/interactions

A
  • Gliclizide

Stimulates pancreatic insulin secretion

Indications:

  • T2DM

Side effects/interactions:

  • Hypoglycaemia
  • Interacts with warfarin, NSAIDs
134
Q

Thiazolidinediones

Drugs

MoA

Indications

Side effects/interactions

A
  • Pioglitazone

Increases insulin sensitivity in muscle and adipose tissue

Indications:

  • T2DM

Side effects/interactions:

  • Weight gain
135
Q

Glucagon-like peptide-1 receptor (GLP-1) agonist

Drugs

MoA

Indications

Side effects/interactions

A
  • Exenatide

Incretin analogue- improves glucose control

Indications:

  • T2DM

Side effects/interactions:

  • Asthenia
136
Q

Dipeptidyl peptidase-4 (DPP-4) Inhibitor

Drugs

MoA

Indications

Side effects/interactions

A
  • Sitaliptin

Reduces inactivation of incretins

Indications:

  • T2DM

Side effects/interactions:

  • Headache
137
Q

Lipase inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Orlistat

Inhibition of GI uptake of dietary fat

Indications:

  • Obesity, especially in the presence of T2DM

Side effects:

  • Steatorrhoea
  • Faecal urgency
138
Q

Thyroid hormones

Drugs

MoA

Indications

Side effects/interactions

A
  • Levothyroxine sodium (T4)
  • Liothyronine sodium (T3)

Synthetic hormones to replace deficiency

Indications:

  • Hypothyroidism

Side effects/interactions:

  • Diarrhoea
  • Vomiting
  • Interacts with oral anticoagulants
139
Q

Disease modifying anti-rheumatic drugs: antifolate antiproliferatives

Drugs

MoA

Indications

Side effects/interactions

A
  • Methotrexate

Inhibition of dihydrofolate reductase and DNA synthesis for lymphocyte proliferation

Indications:

  • Rheumatoid arthritis
  • Broad spectrum of malignancies

Side effects/interactions:

  • Nausea
  • Hair loss
  • Interacts with warfarin and corticosteroids
140
Q

DMARDS: antimetabolite immunosuppressant

Drug

MoA

Indications

Side effects/interactions

A
  • Azathioprine

MoA unclear

Indications:

  • Rheumatoid arthritis
  • Crohn’s disease

Side effects:

  • Alopecia
141
Q

DMARDS: cytokine modulators

Drugs

MoA

Indications

Side effects/interactions

A
  • Adalimumab
  • Infliximab
  • Etanercept

Blockade of TNF-alpha

Indications:

  • Rheumatoid arthritis

Side effects/interactions:

  • Infections
142
Q

DMARDS: aminosalicylates

Drugs

MoA

Indications

Side effects/interactions

A
  • Sulfasalazine
  • Mesalazine

MoA unclear: possible COX inhibition; possible free radical scavenging, T cell suppression.

Indications:

  • Rheumatoid arthritis
  • Crohn’s disease

Side effects/interactions:

  • Nausea
  • Interacts with digoxin, warfarin
143
Q

Combined oral contraceptive pill

Drug

MoA

Indications

Side effects/interactions

A
  • Desogestrel and ethinyl-estradiol

Mimics ovulation, minimises LH and FSH.

Indications:

  • Contraception
  • Polycystic ovary syndrome (PCOS)

Side effects/interactions:

  • Weight gain
  • Depression
  • Increased DVT risk
144
Q

Oral mini-contraceptive pill: progesterone only

MoA

Indications

Side effects/interactions

A
  • Desogestrel
  • Levonorgestrel (emergency contraception)

Mimics ovulation, decreases LH and FSH, endometrial changes.

Indication:

  • Hormonal contraception

Side effects/interactions:

  • Depression
145
Q

Implants/injectable contraception

Drugs

MoA

Indications

Side effects/interactions

A
  • Etonogestrel (subcutaneous implant)

Mimics ovulation, decreases LH and FSH

Indications:

  • Hormonal contraception

Side effects:

  • Weight gain
  • Depression
146
Q

Hormone replacement therapy

Drugs

MoA

Indications

Side effects/interactions

A
  • Estradiol
  • Norethisterone
  • Medroxyprogesterone

Restores decreased hormone level and function

Indications:

  • Menopause

Side effects/interactions:

  • Weight gain
  • Depression
147
Q

Dinoprostone

MoA

Indications

A
  • Dinoprostone

Prostaglandin E2: stimulates cervical ripening

Indications:

  • Delay in labour
148
Q

Augmentation of labour drugs

MoA

Indications

Side effects/interactions

A
  • Oxytocin

Stimulates uterine contractions

Indications:

  • Delayed labour

Side effects/interactions:

  • Nausea
  • Arrhythmias
149
Q

Antiprogestogen/prostaglandin for medical termination

Drug

MoA

Side effects/interactions

A
  • Misoprostol with mifepristone

Steroidal antiprogestogen in combination with synthetic prostadlandin

Indication:

  • Medical termination of pregnancy

Side effects:

  • GI cramps
  • Uterine contractions
  • Vaginal bleeding
150
Q

Antifibrinolytic for menorrhagia

MoA

Side effects/interactions

A
  • Tranexamic acid

Inhibits fibrin clot breakdown by fibrin

Indication: menorrhagia

Side effects/interactions:

  • Nausea
151
Q

NSAID for dysmenorrhoea

MoA

Side effects/interactions

A
  • Mefenamic acid

Inhibition of prostaglandin synthesis

Indications: dysmenorrhoea

Side effects/interactions:

  • GI bleeding
152
Q

Alpha-1 blocker

Drug

MoA

Indications

Side effects/interactions

A
  • Tamsulosin

Smooth muscle relaxant acting on Alpha-1a adrenoceptors in the prostate and and alpha-1d adrenoceptors in the detrusor muscle.

Indications:

  • BPH
  • Urinary retention

Side effects/interactions:

  • Dizziness
  • Avoid with hypotensive drugs
153
Q

Urinary antispasmodic (antimuscarinic)

Drug

MoA

Indications

Side effects/interactions

A
  • Oxybutynin

Blockade of acetylcholine receptors leading to relaxation of smooth muscle in the bladder neck.

Indications:

  • Overactive bladder

Side effects/interactions:

  • Dry mouth
  • Tachy cardia preceded by transient bradycardia
154
Q

Beta-3 agonist

Drug

MoA

Indications

Side effects/interactions

A
  • Mirabegron

Stimulatin of Beta-3 adrenergic receptors, leading to relaxation of detrusor smooth muscle.

Indications:

  • Overactive bladder

Side effects/interactions:

  • Bladder pain
155
Q

Anti-androgen

Drug

MoA

Indications

Side effects/interactions

A
  • Finasteride

5-alpha reductase inhibitor

Inhibition of synthesis of dihydrotestosterone

Indications:

  • BPH

Side effects/interactions:

  • Impotence
156
Q

Anti-histamines

Drugs

MoA

Indications

Side effects/interactions

A
  • Chloramphenamine

H1 histamine receptor blockade

Indications:

  • Hay fever
  • Urticaria

Side effects/interactions:

  • Dry mouth
  • Sedation
  • Interacts with TCAs
157
Q

Glucocorticoids

Drugs

MoA

Indications

Side effects/interactions

A
  • Prednisolone
  • Hydrocortisone
  • Dexamethasone

Intracellular transcription factor interactions, gene expression

Indications:

  • Suppression of inflammatory diseases:
    • Crohn’s
    • RA

Side effects/interactions:

  • Weight gain
  • Muscle atrophy
  • Interacts with oral antidiabetics
158
Q

Calcineurin inhibitors

Drugs

MoA

Indications

Side effects/interactions

A
  • Cyclosporin
  • Tacrolimus

Inhibition of T cell signalling

Indications:

  • Solid organ transplantation
  • Eczema (topical form)

Side effects/interactions:

  • Hypertension
  • Interacts with aspirin
159
Q

Antineoplastic drugs: classical alkylating agents

Drugs

MoA

Indications

Side effects/interactions

A
  • Cyclophosphamide

DNA crosslinking

Indications:

  • Broad spectrum of malignancies

Side effects/interactions:

  • Hair loss
  • Nausea
  • Bone marrow suppression
160
Q

Antineoplastic drugs: taxanes

Drugs

MoA

Indications

Side effects/interactions

A
  • Paclitaxel
  • Docetaxel

Inhibition of microtubule assembly in the mitotic spindle

Indication:

  • Broad spectrum of malignancies

Side effects/interactions:

  • Hair loss
  • Nausea
  • Bone marrow suppression
161
Q

Anti-neoplastic drugs: Vinca Alkaloids

Drugs

MoA

Indications

Side effects/interactions

A
  • Vincristine
  • Vinblastine

Inhibition of microtubule assembly in mitotic spindle

Indications:

  • Broad spectrum of malignancies

Side effects/interactions:

  • Hair loss
  • Nausea
  • Bone marrow suppression
162
Q

Anti-neoplastic drugs: Antipyramidines

Drugs

MoA

Indications

Side effects/interactions

A
  • Fluorouracil
  • Cytarabine

Inhibition of RNA and DNA synthesis

Indications:

  • Broad spectrum of malignancies

Side effects/interactions:

  • Hair loss
  • Bone marrow suppression
  • Nausea
163
Q

Anti-neoplastic drugs: Antipurines

Drugs

MoA

Indications

Side effects/interactions

A
  • Mercaptopurine
  • Thioguanine

Inhibition of DNA and RNA synthesis

Indications:

  • Broad spectrum of malignancies

Side effects/interactions:

  • Hair loss
  • Nausea
  • Bone marrow suppression
164
Q

Anti-neoplastic drugs: Anthracycline antibiotics

Drugs

MoA

Indications

Side effects/interactions

A
  • Doxorubicin

DNA intercalation; Inhibition of RNA and DNA synthesis

Indications:

  • Broad spectrum of malignancies

Side effects:

  • Hair loss
  • Bone marrow suppression
  • Nausea
165
Q

Antineoplastic monoclonal antibodies: Trastuzumab

Drugs

MoA

Indications

Side effects/interactions

A
  • Trastuzumab

Targets cells that overexpress Human Epidermal Growth Factor Receptor-2 (HER2) for tumour reduction and destruction.

Indications:

  • Early breast cancer

Side effects/interactions:

  • Fever
  • Chills
166
Q

Antineoplastic monoclonal antibodies: Rituximab

MoA

Indications

Side effects/interactions

A
  • Rituximab

Targeted destruction of CD20+ B cells

Indications:

  • Follicular lymphoma
  • Non-Hodgkins lymphoma

Side effects/interactions:

  • Fever
  • Chills
167
Q

Antineoplastic monoclonal antibodies: Nivolumab

MoA

Indications

Side effects/interactions

A
  • Nivolumab

Stimulation of anti-tumour responses via blocking PD-1

Indications:

  • Melanoma

Side effects/interactions:

  • Fever
  • Chills
168
Q

Antineoplastic drugs: immunomodulators

Drugs

MoA

Indications

Side effects/interactions

A
  • Lenolidamide

Stimulation of T cell responses

Indications:

  • Myeloma

Side effects/interactions:

  • Foetal risk
169
Q

Anti-neoplastic drugs: Selective oestrogen receptor modulation (SERM)

Drugs

MoA

Indications

A
  • Tamoxifen

Inhibition of oestrogen receptor function and cell proliferation in the breast

Indications:

  • Breast cancer
170
Q

Antineoplastic drugs: Luteinising hormone releasing hormone (LHRH) receptor agonist

Drug

MoA

Indications

A
  • Goserelin

Synthetic analogue of LHRH. Activates LHRH receptor function leading to sustained reduction in testosterone

Indications:

  • Prostate cancer
171
Q

Drugs for treatment of bone and calcium homeostasis: therapeutic hormones

Drugs

MoA

Indications

Side effects/interactions

A
  • Calcitonin

Inhibits mobilisation of calcium from bones

Indications:

  • Osteoporosis
  • Hypercalcaemia

Side effects/interactions:

  • Abdominal pain
  • Interacts with antacids
172
Q

Bisphosphonates

Drugs

MoA

Indications

A
  • Alendronate
  • Pamidronate

Inhibits osteoclast function and bone resorption

Indications:

  • Osteoporosis
  • Hypercalcaemia
173
Q

Drugs for hypocalcaemia

MoA

Indications

A
  • IV calcium gluconate
  • Parathyroid hormone
  • Vitamin D

Restoration of calcium levels and metabolism

Indications:

  • Hypocalcaemia
  • Bone loss
174
Q

Drugs for vitamin D deficiency

MoA

Indications

Side effects/interactions

A
  • Vitamin D
    • Colecalciferol
    • Calcitriol
    • 1,25-dihydroxy vitamin D (usually only in the cases of advanced CKD)

Restoration of vitamin D levels

Indications:

  • Vitamin D deficiency
175
Q

Selective oestrogen receptor modulator for osteoporosis

Drug

MoA

Indications

Side effects/interactions

A
  • Raloxifene

Stimulation of oestrogen function in bone

Indications:

  • Osteoporosis
  • Prevention of bone fractures

Side effects/interactions:

  • Hot flushes
  • Interacts with warfarin
176
Q

Drugs for treatment of calcium and bone homeostasis: monoclonal antibody

MoA

Indication

Side effects/interactions

A
  • Denosumab

Inhibition of osteoclast function and bone resorption

Indications:

  • Osteoporosis

Side effects/interactions:

  • Hypocalcaemia
177
Q

Ferrous sulphate

Class

MoA

Indications

Side effects/interactions

A

Ferrous sulphate

Class: Oral iron compound

Iron provision

Indications:

  • Iron deficiency anaemia

Side effects/interactions:

  • Constipation
  • Interacts with antacids (reduced absorption)
178
Q

Folic acid

Class

MoA

Indications

A

Folic acid

Water soluble vitamin

Supports nucleic acid synthesis

Indications:

  • Folate-deficient anaemia
179
Q

Parenteral Vitamin B12

MoA

Indications

A

Watersoluble vitamin, enzyme cofactor

Indications:

  • Pernicious anaemia

Drugs List (6 decks)

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