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Year 4 Pharmacology > GP Pharmacology > Flashcards

GP Pharmacology Flashcards

1
Q

B2-agonists (SABA, LABA) MOA

A

Smooth muscle relaxation

Improves airflow in constricted airways, reducing breathlessness

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2
Q

SABA (e.g. salbutamol) indications and dose

A

First-line relief of breathlessness in COPD and asthma

100-200 micrograms up to 4 times/day
1 puff = 100 micrograms

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3
Q

B2-agonist side effects

A 
Tachycardia
Palpitations 
Anxiety
Tremor
Muscle cramps (LABA)
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4
Q

LABA (e.g. salmeterol) indications

A

Chronic asthma, when ICS alone insufficient (must be given with ICS)

Second-line to reduce symptoms/exacerbations in COPD

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5
Q

B-2 agonists interactions

A

Beta blockers can reduce efficacy of SABA/LABA

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6
Q

SAMA (ipratropium bromide) indications

A

COPD = first line to reduce exacerbations

Asthma = in acute exacerbations to relieve breathlessness

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7
Q

LAMA (tiotropium bromide) indications

A

COPD = to prevent exacerbations if no features of asthma/steroid reversibility

Asthma = add to ICS and LABA therapy if 1+ exacerbation per year

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8
Q

Theophylline

A

Oral bronchodilator

For chronic, uncontrolled by other therapies asthma/COPD

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9
Q

Criteria for LTOT in COPD

A 
O2 <92% on RA 
Pulmonary oedema 
Non-smoker 
Polycythaemia (secondary) 
Hypoxia/hypercapnia
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10
Q

ACEi MOA

A

Prevents conversion of angiotensin I to angiotensin II (vasoconstrictor)

Reduces PVR

Reduces aldosterone = Na+ and H20 excretion, lowering BP (can be beneficial to kidneys).

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11
Q

Contraindications of ACEi/ARBs

A

Renal artery stenosis
AKI
Pregnancy/breastfeeding

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12
Q

Side effects of ACEi

A

Hypotension = sit/lie down for first dose

Dry cough

Hyperkalaemia

RARE: angioedema/anaphylactoid reaction

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13
Q

Dose of ACEi (ramipril)

A

1.25-2.5mg OD

Increased up to 10mg (max daily dose)

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14
Q

ACEi/ARBs fist line for which HTN patients

A

ALL with T2DM

<55 and NOT black/caribbean

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15
Q

Calcium channel blocker indications

A

HTN

Angina

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16
Q

Calcium channel blocker MOA

A

Relax/dilate arterial smooth muscle by decreasing Ca2+ entry into vascular/cardiac cells (lowers BP)

Reduce myocardial contractility, reducing rate and myocardial oxygen demand (prevents angina)

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17
Q

Side effects of calcium channel blockers (e.g. amlodipine)

A

Ankle swelling, flushing, headaches, palpitations (vasodilation and compensatory tachycardia).

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18
Q

Calcium channel blockers for vasculature

A

Dihydropyridines (amlodipine/nifedipine)

HTN

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19
Q

Calcium channel blockers for the heart

A

Non-dihydropyridines (verapamil/diltiazem)

Rate limiting = Angina

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20
Q

Amlodipine contra-indications

A

Unstable angina (tachycardia induced by vasodilation can increase myocardial oxygen demand)

Aortic stenosis (can cause collapse

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21
Q

CCB first line for which HTN patients?

A

> 55

Black/Caribbean

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22
Q

Thiazide diuretics for HTN in which patients?

A

Add on when HTN not controlled by CCB + ACEi/ARB

When CCB unsuitable for HTN due to oedema/other features of HF

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23
Q

Examples of thiazide diuretics

A

Bendroflumethiazide

Indapamide

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24
Q

Side effects of thiazide diuretics

A

Hyponatraemia (prevention of Na+ reabsorption)
Hypokalemia causing cardiac arrythmias

Male impotence

Increase plasma glucose, LDL and triglycerides

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25
Stage 4 Tx for HTN if K+ >4.5
alpha blocker/beta-blocker
26
Stage 4 Tx for HTN if K+ <4.5
Spironalactone (k+ sparing diuretic)
27
Beta-blocker indications
Coronary heart disease (angina) Chronic heart failure (improves prognosis) AF (reduce ventricular rate) HTN (if other medications fail)
28
Beta-blocker MOA
Reduce force of heart contraction, reducing cardiac work and oxygen demand, relieving cardiac ischaemia (treat angina) Prolong refractory period of AV node and terminate SVT (treat AF) Reduce renal renin secretion (lowers BP)
29
Side effects of beta-blockers
Cold extremeties Fatigue Headache Impotence in men
30
Contra-indications of beta-blockers
Asthma (can cause bronchospasm) Heart block Haemodynamic instability
31
First line treatment for AF
Beta-blockers (e.g. bisprolol, atenolol) Rate control and some rhythm control
32
Spironolactone MOA
Aldosterone antagonist = increase Na+ and H20 excretion (K+ retention)
33
Spironolactone indications
CIrrhosis Chronic heart failure (add-on therapy)
34
Side effects of spironolactone
Hyperkalameia Gynecomastia DO NOT GIVE IN RENAL IMPAIRMENT
35
Nitrates indication and MOA
Angina/MI chest pain Relax venous capacitance muscles, reducing pre-load and LV filling, reducing cardiac work and O2 demand. Relieve coronary vasospasm Relax systemic arteries
36
Contraindication for nitrates
Aortic stenosis (heart unable to increase CO through narrowed area to maintain pressure) Hypotension
37
Nitrate side effects
Flushing, light-headed, hypotension, headaches (vasodilators)
38
Isosorbide mononitrate indications
Third line angina tx if CCB and beta-blockers not-tolerated
39
Furosemide indications
Chronic heart failure (tx symptomatic fluid overload, does not improve mortality) Acute pulmonary oedema to relieve breathlessness
40
Furosemide MOA
Loop diuretic = inhibit Na+/K+/2Cl- co-transporter in the ascending limb of the loop of Henle, preventing their (and H20) reabsorption Dilate capacitance veins = reduces pre-load in HF and increases contractility of the heart
41
Furosemide side effects
Dehydration and hypotension Low electrolyte states Hearing loss/tinnitus CI in AKI/CKD
42
Ivabradine indications
Rate lowering Given in HF or angina on failure of other Tx
43
Digoxin indications
AF (add on to CCB/beta-blocker) Heart failure (add on Tx)
44
Digoxin MOA
Negatively chronotropic (reduces HR) Positively iontropic (increases force of contraction)
45
Digoxin side effects
Bradycardia, dizziness, rash, GI disturbance Toxicity = range of arrhythmias (digoxin has narrow therapeutic index) DO NOT GIVE IN HEART BLOCK DOSE REDUCTION IN RENAL IMPAIRMENT
46
Digoxin interactions
Loop/thiazide diuretics increase toxicity risk by causing hypokalaemia CCB/spironalactone = increase plasma concentrations of digoxin, so increase toxicity risk.
47
NOAC (e.g. rivaroxaban, dabigatran) indications
AF = to reduce stroke risk with 1+ CHA2DVASc score (20mg daily) VTE prophylaxis
48
NOAC side effects
Bleeding (e.g. epistaxis, GI bleeding) Anameia, GI upset, elevated liver enzymes CI IF BLEEDING LOWER DOSE IN HEPATIC/RENAL IMPAIRMENT
49
NOAC elimination
Hepatic, by CYP enzyme ``` CYP inhibitors (macrolides) = increase effects CYP inducers (e.g. phenytoin) = decrease effects ```
50
Warfarin indications
Arterial embolism prevention (AF/prosthetic valves) VTE prevention Needs careful monitoring, takes a few days to reach therapeutic dose.
51
Warfarin CI
``` Liver disease (CYP metabolism) Pregnancy ```
52
Indications for rate-limiting CCB (+ examples)
AF E.g. verapamil/diliazem
53
Amiodarone indications
Rhythm control in AF patients with structural heart defects. Reduces ventricular rate and helps restore sinus rhythm
54
Amiodarone adverse effects
dose-dependent hepato/pulmonary fibrosis thyroid problems (avoid if active disease) AVOID IN HEART BLOCK
55
Amiodarone interactions
Increases plasma levels of digoxin, diltiazem and verapamil (half their doses if starting amiodarone)
56
Atorvostatin indications
20mg OD for primary prevention of CVD if QRISK2 >10% 80mg OD for secondary prevention in established disease
57
Statin side effects
Mild = headaches/GI disturbances Muscle effects = aches, myopathy, rhabdomyolysis Rise in liver enzymes USE WITH CAUTION/REDUCE DOSE IN LIVER/RENAL IMPAIRMENT
58
Statin interactions
CYP inhibitors (macrolides, amiodarone, diliatzem) increase risk of adverse effects
59
Aspirin indications and doses
ACS/Acute stroke (300mg OD for 2 weeks ) Secondary prevention of thrombotic events (75mg OD) ANTI-PLATELET
60
Aspirin adverse effects
GI irritation/peptic ulcer (take PPI alongside) Tinnitus Bronchospasm (in hypersensitivity) CAUTION IN GOUT = CAN TRIGGER ATTACK
61
Clopidogrel indications
Secondary prevention of thrombotic events 300mg loading dose then 75mg OD, or after 2 weeks of 300mg of aspirin
62
Clopidogrel adverse effects
Bleeding GI upset Thrombocytopenia Increased risk with CYP inhibitors
63
Metformin indication and MOA
First line for T2DM (500mg/day starting dose) Lowers blood glucose Reduces gluconeogenesis and glycogen lysis Increases skeletal muscle glucose uptake
64
Metformin contraindications
Renal/hepatic impairment (reduce dose if eGFR <45) Chronic alcohol abuse (risk of hypo) WITHHOLD IF: - AKI - severe tissue hypoxia (e.g. sepsis/MI) - IV contrast media - acute alcohol intoxication
65
Metformin side effects
GI upset (usually transient) Lactic acidosis (rare)
66
Gliclazide indications
Monotherapy for T2DM if metformin not tolerated (40-80mg OD starting dose) Dual therapy (combination with metformin)if single agent not giving adequate glucose control
67
Gliclazide MOA
Stimulates pancreatic insulin secretion, so can cause weight gain
68
Gliclazide side effects
GI upset (mild/infrequent) Hypoglycaemia Hypersensitivity (rare) weight gain USE WITH CAUTION IN RENAL/HEPATIC IMPAIRMENT
69
Pioglitazone indication and MOA
T2DM (monotherapy or with metformin/glicllazide) Lowers blood glucose by decreasing peripheral insulin resistance
70
Pioglitazone side effects
Bone fractures Increased weight Fluid retention (CI in HF) Risk of liver toxicity
71
Tests before starting a statin
``` Hba1c LFT Lipid profile Creatinine kinase (CK) TFTs U&Es ```
72
Monitoring tests for statins
LFTs at 3 and 12 months after commencing Tx CK if unexplained muscular Sx Hba1c if risk of diabetes

Year 4 Pharmacology (6 decks)

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