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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
Q

Stage 4 Tx for HTN if K+ >4.5

A

alpha blocker/beta-blocker

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26
Q

Stage 4 Tx for HTN if K+ <4.5

A

Spironalactone (k+ sparing diuretic)

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27
Q

Beta-blocker indications

A

Coronary heart disease (angina)

Chronic heart failure (improves prognosis)

AF (reduce ventricular rate)

HTN (if other medications fail)

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28
Q

Beta-blocker MOA

A

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)

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29
Q

Side effects of beta-blockers

A

Cold extremeties
Fatigue
Headache

Impotence in men

30
Q

Contra-indications of beta-blockers

A

Asthma (can cause bronchospasm)

Heart block

Haemodynamic instability

31
Q

First line treatment for AF

A

Beta-blockers (e.g. bisprolol, atenolol)

Rate control and some rhythm control

32
Q

Spironolactone MOA

A

Aldosterone antagonist = increase Na+ and H20 excretion (K+ retention)

33
Q

Spironolactone indications

A

CIrrhosis

Chronic heart failure (add-on therapy)

34
Q

Side effects of spironolactone

A

Hyperkalameia
Gynecomastia

DO NOT GIVE IN RENAL IMPAIRMENT

35
Q

Nitrates indication and MOA

A

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
Q

Contraindication for nitrates

A

Aortic stenosis (heart unable to increase CO through narrowed area to maintain pressure)

Hypotension

37
Q

Nitrate side effects

A

Flushing, light-headed, hypotension, headaches (vasodilators)

38
Q

Isosorbide mononitrate indications

A

Third line angina tx if CCB and beta-blockers not-tolerated

39
Q

Furosemide indications

A

Chronic heart failure (tx symptomatic fluid overload, does not improve mortality)

Acute pulmonary oedema to relieve breathlessness

40
Q

Furosemide MOA

A

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
Q

Furosemide side effects

A

Dehydration and hypotension

Low electrolyte states

Hearing loss/tinnitus

CI in AKI/CKD

42
Q

Ivabradine indications

A

Rate lowering

Given in HF or angina on failure of other Tx

43
Q

Digoxin indications

A

AF (add on to CCB/beta-blocker)

Heart failure (add on Tx)

44
Q

Digoxin MOA

A

Negatively chronotropic (reduces HR)

Positively iontropic (increases force of contraction)

45
Q

Digoxin side effects

A

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
Q

Digoxin interactions

A

Loop/thiazide diuretics increase toxicity risk by causing hypokalaemia

CCB/spironalactone = increase plasma concentrations of digoxin, so increase toxicity risk.

47
Q

NOAC (e.g. rivaroxaban, dabigatran) indications

A

AF = to reduce stroke risk with 1+ CHA2DVASc score (20mg daily)

VTE prophylaxis

48
Q

NOAC side effects

A

Bleeding (e.g. epistaxis, GI bleeding)

Anameia, GI upset, elevated liver enzymes

CI IF BLEEDING

LOWER DOSE IN HEPATIC/RENAL IMPAIRMENT

49
Q

NOAC elimination

A

Hepatic, by CYP enzyme

CYP inhibitors (macrolides) = increase effects 
CYP inducers (e.g. phenytoin) = decrease effects
50
Q

Warfarin indications

A

Arterial embolism prevention (AF/prosthetic valves)

VTE prevention

Needs careful monitoring, takes a few days to reach therapeutic dose.

51
Q

Warfarin CI

A 
Liver disease (CYP metabolism) 
Pregnancy
52
Q

Indications for rate-limiting CCB (+ examples)

A

AF

E.g. verapamil/diliazem

53
Q

Amiodarone indications

A

Rhythm control in AF patients with structural heart defects.

Reduces ventricular rate and helps restore sinus rhythm

54
Q

Amiodarone adverse effects

A

dose-dependent hepato/pulmonary fibrosis

thyroid problems (avoid if active disease)

AVOID IN HEART BLOCK

55
Q

Amiodarone interactions

A

Increases plasma levels of digoxin, diltiazem and verapamil (half their doses if starting amiodarone)

56
Q

Atorvostatin indications

A

20mg OD for primary prevention of CVD if QRISK2 >10%

80mg OD for secondary prevention in established disease

57
Q

Statin side effects

A

Mild = headaches/GI disturbances

Muscle effects = aches, myopathy, rhabdomyolysis

Rise in liver enzymes

USE WITH CAUTION/REDUCE DOSE IN LIVER/RENAL IMPAIRMENT

58
Q

Statin interactions

A

CYP inhibitors (macrolides, amiodarone, diliatzem) increase risk of adverse effects

59
Q

Aspirin indications and doses

A

ACS/Acute stroke (300mg OD for 2 weeks )

Secondary prevention of thrombotic events (75mg OD)

ANTI-PLATELET

60
Q

Aspirin adverse effects

A

GI irritation/peptic ulcer (take PPI alongside)
Tinnitus
Bronchospasm (in hypersensitivity)

CAUTION IN GOUT = CAN TRIGGER ATTACK

61
Q

Clopidogrel indications

A

Secondary prevention of thrombotic events

300mg loading dose then 75mg OD, or after 2 weeks of 300mg of aspirin

62
Q

Clopidogrel adverse effects

A

Bleeding
GI upset
Thrombocytopenia

Increased risk with CYP inhibitors

63
Q

Metformin indication and MOA

A

First line for T2DM (500mg/day starting dose)

Lowers blood glucose
Reduces gluconeogenesis and glycogen lysis
Increases skeletal muscle glucose uptake

64
Q

Metformin contraindications

A

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
Q

Metformin side effects

A

GI upset (usually transient)

Lactic acidosis (rare)

66
Q

Gliclazide indications

A

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
Q

Gliclazide MOA

A

Stimulates pancreatic insulin secretion, so can cause weight gain

68
Q

Gliclazide side effects

A

GI upset (mild/infrequent)
Hypoglycaemia
Hypersensitivity (rare)
weight gain

USE WITH CAUTION IN RENAL/HEPATIC IMPAIRMENT

69
Q

Pioglitazone indication and MOA

A

T2DM (monotherapy or with metformin/glicllazide)

Lowers blood glucose by decreasing peripheral insulin resistance

70
Q

Pioglitazone side effects

A

Bone fractures
Increased weight
Fluid retention (CI in HF)
Risk of liver toxicity

71
Q

Tests before starting a statin

A 
Hba1c
LFT
Lipid profile 
Creatinine kinase (CK) 
TFTs
U&Es
72
Q

Monitoring tests for statins

A

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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