Medication GP Flashcards
DPP4 inhibitors - MOA, agents, side effects
MOA: DPP4 inhibitor - increases endogenous incretin effect by inhibiting DPP4 that breaks down GLP-1, causing increased insulin secretion, decreased glucagon secretion, delayed gastric emptying. Used to treat T2DM
Agents: Linagliptin (trajgenta), sitagliptin, saxagliptin, alogliptin
Side effects: Diarrhoea, constipation, urinary infections, worsening renal function, increased satiety
SNRI - Class, MOA, agents, indications, side effects
Class: antidepressant
MOA: Inhibit serotonin and noradrenaline reuptake
in synaptic cleft, increasing serotonin and noradrenaline levels
Agents: duloxetine, venlafaxine, milnacipran
Indications: MDD, GAD, neuropathic pain, (with milnacipran) fibromyalgia, stress incontinence in women
Side effects: Insomnia, strange dreams, nightmares, increased BP, GI upset, SIADH, sexual dysfunction, increased cholesterol and triglycerides
SSRI - Class, MOA, agents, indications, side effects
Class: Antidepressant
MOA: Inhibit the presynaptic reuptake of serotonin (5-hydroxytryptamine, 5HT), increasing serotonin levels
Agents: Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxamine
Indications: MDD, GAD, OCD, PTSD, panic disorder, premature ejaculation, binge eating disorder, bulimia nervosa, SAD, gambling disorder
Side effects: Headache, N+V, diarrhea, agitation, anxiety (these should resolve within 1 week). Sexual dysfunction; serotonin syndrome - tremor, nausea; SIADH.
Meloxicam (mobic, moxicam, melobic)
Selective COX-2 inhibitor NSAID
NSAIDS - MOA, agents, side effects, contraindications
MOA: Analgesic, antipyretic and anti-inflammatory actions. Inhibit synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX) present as COX1 and COX2
- Inhibition of COX1 results in impaired gastric cytoprotection and antiplatelet effect
- inhibition of COX2 results in anti-inflammatory and analgesic action
- Reduction in GFR and renal blood flow occurs with both COX1 and COX2 inhibition
Most NSAIDs are nonselective, inhibiting both COX1 and COX2. Reversible inhibition of COX1 and COX 2 causes decreased prostaglandin synthesis. Aspirin irreversible.
Agents: Ibuprofen, diclofenac, indomethacin, naproxen, meloxicam, piroxicam, ketorolac, aspirin
Side effects: Gastric and duodenal ulcers, increased risk of heart attack and stroke (not with aspirin and naproxen), renal function impairment (prostaglandins maintain renal blood flow by vasodilating afferent arterioles)
Contraindications: Acute haemmorhage, gastroduodenal ulcers, renal failure, pregnancy, pre-surgery (cease 1-3 days prior)
Selective COX-2 inhibitor NSAIDs - MOA, agents, indications, side effects, contraindications
MOA: selectively inhibit COX-2 enzyme with no or minimal inhibition of COX-1. (COX-2 found in cells that mediate pain and inflammation - macrophages, leukocytes; and vascular endothelial cells)
Analgesic and anti-inflammatory, advantageous over non-selective due to no anti-platelet effect, minimal gastric side effects and reduced risk of gastric ulcers
Agents: Celecoxib
Indications: RA, OA, acute pain, patients with history of peptic ulcer disease and platelet disorders
Side effects: increased risk of thrombosis, MI, stroke; sulfa drug reaction
Contraindications: Severe HF, recent MI or GI bleed, sulfa drug allergy
Indometacin
nonselective NSAID
Diclofenac
Nonselective NSAID
Xanthine oxidase inhibitors - MOA, agents, indication, side effects
MOA: Inhibit xanthine oxidase which reduces production of uric acid, lowering serum urate concentration and allowing acute flares and crystal deposits to resolve if long-term serum urate <0.36mmol/L
Agents: Allopurinol (preferred first line treatment), febuxostat
Indication: Urate-lowering therapy, gout
Side effects: Rash, stevens-Johnson syndrome/toxic epidermal necrolysis
Allopurinol: class + indications
Xanthine oxidase inhibitor
Indications: symtomatic hyperuricemia (gout)
Febuxostat (class + indications)
Xanthine oxidase inhibitor
Indications: symtomatic hyperuricemia (gout) - second line behind allopurinol
Cefalexin (cephalex, ibilex, keflex, cephalexin) - class and indications
Cephalosporin
Staphylococcal and streptococcal infections in people with mild to moderate penicillin allergy, UTI, epididymo-orchitis (urinary tract source)
Cefazolin - class
Cephalosporin (Abx)
Cefaclor - class
Cephalosporin (Abx)
Cephalosporins - MOA, agents, coverage, indications, side effects
MOA: Broad-spectrum. Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death; bactericidal.
Agents:
1st generation: Cephalexin (oral), cefazolin (IV, IM)
2nd generation: Cefaclor, cefuroxime (oral)
Coverage: Highly active against gram +ve bacteria, 1st - 3rd gen most to least active. Active against some gram -ve bacteria (proteus mirabalis, e coli, klebsiella pneumoniae, no atypical coverage (chlamydia, mycoplasma, legionella). Indications: Cefazolin for perioperative wound infection prophylaxis (covers s. aureus). Ceftriaxone specifically has good CNS penetrance - meningitis, also used for gonnorhea and lyme disease
Side effects: Vitamin K deficiency, autoimmune hemolytic anemia
Carbapenems - MOA, agents, coverage, indications, side effects
MOA: Inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins, the affinities for which differ between the carbapenems and may affect their activity in vitro; usually bactericidal.
Agents: Imipenem, meropenem, ertapenem, doripenem (all IV)
Coverage: Broad spectrum w intrinsic beta lactamase resistance; gram positive cocci (except for MRSA, enterococcus fecalis and enterococcus faecium) gram -ve rods, anaerobes
Indications: Last resort drugs (used in life threatening infections or after other antibiotics due to significant adverse effects)
Side effects: Secondary fungal infections, CNS toxicity - can lower seizure threshold at high serum concentrations, GI upset, rash, thrombophlebitis
Macrolides - MOA, agents, coverage, indications, side effects, special considerations, contraindications
MOA: Bacteriostatic; inhibit bacterial protein synthesis by binding to the 23S ribosomal RNA molecule of the 50S ribosomal subunit leading to inhibition of bacterial protein synthesis. They also have immunomodulatory and anti-inflammatory effects.
Agents: Erythromycin, azithromycin, clarithromycin (oral or IV), roxithromycin (oral).
Coverage: Atypical pneumonia caused by mycoplasma pneumonia, legionella pneumonia, chlamydophilia pneumoniae; bordetella pertussis, chlamydia, gram +ve cocci (esp streptococcal infection in pts allergic to penicillin), neisseria (dual therapy with ceftrizxone for N. gonorrhea - azithromycin, mycobacterium avium, h pylori
Side effects: GI upset (increased intestinal motility), QT interval prolongation (arrhythmia), eosinophillia, rash, increased risk of hypertrophic pyloric stenosis (erythromycin and azithromycin) in infants up to 6 weeks of age
Special considerations:
Poor CNS penetration, biliary elimination, short half life
CI’s: Pregnancy (erythromycin and clarithromycin (teratogenic), hepatic failure, children <12, renal failure
Azithromycin
Macrolide
Clarithromycin
Macrolide
Erythromycin
Macrolide
Natural penicillin - MOA, agents, coverage, indications, side effects
MOA: Bactericidal; interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.
Agents: Natural: Penicillin G (benzylpenicillin) - IV (crystalline penicillin G), IM (procaine penicillin G, benzathine penicillin G)
; penicillin V (phenoxymethylpenicillin) - oral.
Coverage: Gram +ve aerobes (esp streptococcus pyogenes, strep pneumoniae). Gram -ve cocci (esp neisseria meningitidis). Spirochetes (esp. treponema pallidum). Branching gram +ve anaerobes (esp actinomyces)
Side effects: Hypersensitivity reactions, hemolytic anemia positive direct coombs test, drug induced interstitial nephritis, seizures
Amoxicillin - class and indications
Penicillin
Indications - exacerbation of chronic bronchitis, CAP, acute otitis media, sinusitis, gonococcal infection, epididymo-orchitis, acute prostatitis, acute pyelonephritis, UTI, endocarditis prophylaxis in high risk patients, acute cholecystitis, peritonitis, eradication of H pylori
Amoxicillin with clavulanic acid (amoxiclav) MOA
Clavulanic acid inhibits beta-lactamase, which extends spectrum of activity of amoxicillin with clavulanic acid to cover some beta-lactamase-producing organisms.
Amoxiclav indications
HAO, epididymo-orchitis (urinary tract source), PID (not sexually acquired), UTI, bites and clenched fist injuries, acute otitis media, sinusitis (unresponsive to amoxicillin), acute cholecystitis, melioidosis
Ampicillin - class
Penicillin
What is lexapro?
Escilatopram - SSRI
What is targin?
Oxycodone with naloxone - opioid analgesic
Oxycodone class, indications
Opioid analgesic
Severe pain
Naloxone - class, MOA, indication
Class: Opioid receptor antagonist
MOA: High binding affinity to the mu opioid receptor
Indication: used to reverse opioid overdose. Short duration of action
Penicillinase-resistant penicillins: Special characteristics, agents, coverage, side effects,
Special characteristics: B-lactamase resistant through addition of bulkt side chains which prevent bacterial beta lactamase from hydrolyzing the beta lactam ring
Agents: Nafcillin, dicloxacillin, oxacillin, floxacillin, methicillin
Coverage: Narrow spectrum; gram +ve aerobes (esp. staph aureus (non MRSA)). Not effective against streptococcus viridans, enterococci or listeria
Side effects: Interstitial nephritis, hypersensitivity reactions
Aminopenicillins (penicillinase-sensitive penicillins) - agents, coverage, side effects
Susceptible to degradation by beta lactamase
Agents: Amoxicillin (oral or VI) - can be combined with clavulanate; ampicillin (IV or IM) (with or without sulbactam)
Coverage: Gram +ve aerobes,
Gram -ve rods (not effective against enterobacter spp). Most effective against; h pylori, h influenzae, e coli, listeria monocytogenes, proteus miribalis, salmonella, shigella, enterococcu, spirochetes
Side effects: diarrhea, pseudomembranous colitis, hypersensitivity reactions, drug induced rash.
Aminopeniciilin therapy HHEELPSSS.
Midazolam - class
Class: Short acting, sedative-hypnotic benzodiazepine with anxiolytic and amenstic properties
Benzodiazepines - MOA, agents, indications, side effects, special considerations
MOA: Indirect GABAa receptor agonists that bind to GABA-A receptors, increasing affinity of GABA to bind to GABAa receptors, increasing opening of chloride channels, leading to hyperpolarization of postsynaptic neuronal membrane, decreased neuronal excitability. Decrease duration of N3 phase NREM sleep. Effects; anxiolysis, sedation, hypnotic action, muscle relaxation, anticonvulsant, amnesia
Agents: Short acting (half-life 1-12 hrs); midazolam, triazolam, intermediate (half life 12-40 hrs); lorazepam, temazepam, oxazepam; long acting (half life >40hrs); diazepam, clonazepam, tetrazepam, flurazepam, chloridiazepoxide
Indications: Anxiety disorders, insomnia, alcohol withdrawal, seizures and status elipticus, preoperative and procedural sedation.
Side effects: anterograde amnesia, confusion, blunted affect, residual sedation, paradoxical reactions (incl restlessness, irritability)
Special considerations: all metabolised by the liver, but Lorazepam, oxazepam and temazepam undergo biotransformation through glucoronidation, not CYP450 activation and are less affected by liver disease
Four classes of anti-arrhythmic drugs with examples and uses
Class 1: Fast sodium channel blockers (negative dromotropy). Class 1a: E.g Quinidine, procainamide, disopyramide, ajmaline. Use: PSVT, ectopic SVT, atrial fibrillation and atrial flutter, ventricular arrhythmias. Class1b: lidocaine, phenytoin, mexiletine
Class1c: Flecanide, propafenone.
Class 2: Beta blockers; inhibit beta-adrenergic activation of adenylate cyclase, causes decreased cAMP, decreased Ca2+, decreased SA and AV node activity. Prolong AV node repolarization (prolongation of PR interval). Slow conduction velocity. E.g. Metroprolol, esmolol, propanolol, atenolol, timolol, carvedilol, sotalol. Use: atrial fibrillation, atrial flutter, PSVT. Side effects: AV block, bradycardia, heart failure, exacerbation of asthma/COPD, sedation, CNS depression
Class 3: Potassium channel blockers; inhibit delayed rectifier potassium currents, prolong QT interval, no effect on conduction velocity. E.g Amiodarone, sotalol, bretylium, ibutilide, dofetilide. Uses: ventricular tachycardia (amiodarone and sotalol, AF, Aflutter
Class 4: Calcium channel blockers; inhibit slow calcium channels, prolong AV node repolarization, prolong PR interval. E.g verapamil, diltiazem, nifedipine
Which SGLT2-I’s have cardiovascular benefit?
Dapaglifozin
Empaglifozin
Treatment of migraine (migraine-specific agents)
Triptans (sumatriptan, zolmitriptan, almotriptan, rizatriptan) - vasoconstriction of (dilated) cranial and basilar arteries, inhibition of trigeminal nerve nociception, inhibition of vasoactive peptide secretion
- Most effective if taken at onset of headache
- Also effective for cluster headaches
Ergotamine, dihyroergotamine
Pharmacological treatment of mild-moderate headache
NSAIDs, paracetamol, aspirin
Pharmacological treatment of moderate to severe headache
Parenteral antidopaminergics:
Metocopramide
Prochlorperazine
Routine 2 month old vaccinations
Diptheria, Tetanus, Pertussis (DPT)
Hep B
HIB
Polio
Pneumococcus
Rotavirus
Routine 4 month old vaccinations
Diptheria, Tetanus, Pertussis (DPT)
Hep B
HIB
Polio
Pneumococcus
Rotavirus
Routine 6 month old vaccinations
Diptheria, Tetanus, Pertussis (DPT)
Hep B
HIB
Polio
Routine 12 month old vaccinations
Measles, mumps, rubella
Meningococcal ACWY
Pneumococcus
Routine 18 month old vaccinations
Measles, mumps, rubella
Diptheria, Tetanus, Pertussis (DPT)
Chickenpox
HIB
Routine 4 year old vaccinations
Diptheria, Tetanus, Pertussis (DPT)
Polio
Types of live attenuated vaccines and contraindications
MMR
Varicella (VZV) or zoster
Yellow fever
Rotavirus
Smallpox
Adenovirus
BCG
Typhoid
CI’s: not indicated in children <9 months (rotavirus is an exception)
- Immunodeficient individuals
- Pregnant women
- HIV-positive individuals can be vaccinated with live attenuated vaccines if their CD4 cell count is >= 200 cells/mm3
Types of inactivated vaccines
Polio
Hepatitis A
Rabies
Influenza
Pertussis
HPV
Diptheria
Tetanus
Pneumoccocal
Meningococcal
Cholera
Multiple doses required
May be combined with other vaccines without any time interval in between
Types of viral vector vaccines
Ebola virus vaccine
COVID-19 vaccine
Nucleic acid vaccines
COVID-19 vaccines
When can hepatitis B vaccination be given to a preterm infant?
Vaccination should be delayed by a month or until hospital discharge for infants weighing < 2 kg born to HBsAg-negative mothers
How does hormonal contraception work?
Uses progestin with or without estrogen to prevent conception through one or a combination of the following:
- Prevention of ovulation
- Thickening of cervical mucus
- Creation of an inhospitable intrauterine environment
Types of hormonal contraception
Hormonal intrauterine device
Combined hormonal contraception
Progestin only pill
Implant
Injection
Types and MOA non-hormonal contraception
Prevents conception without altering natural hormones
The mechanism of action depends on the method.
- Copper IUD: creation of an inhospitable intrauterine environment
- Barrier methods: prevention of sperm reaching the uterus
- Behavioral methods: avoidance of sex during the fertile window
- Sterilization: blockage of the passage of gametes
Noncontraceptive benefits of COCP
PCOS
Endometriosis
Abnormal uterine bleeding, heavy menstrual bleeding
Primary dysmenorrhea
Uterine leiomyomas
Hyperandrogenism including hirsutism and acne
Menstrual related migraine (without aura)
Menstrual acne
Contraindications to COC use
Existing or history of CV or cerebrovascular disease
Diabetes with circulatory problems
History of thromboembolism
Severe liver disease
Breast cancer
Uncontrolled HTN
Focal migraine
Women >35 years smoking >15 cigarettes per day
Prolonged immobilisation
Malabsorption syndrome
Indications for progestogen only pill (minipill)
Women whom estrogens are contraindicated, not tolerated or do not want to take a COCP
Choice of oral contraception in women with strong family history of venous thromboembolism
Women with a history of VTE should never be prescribed a COCP
Screening to exclude thrombophilias before commencing
Women undergoing pelvic surgery or procedures requiring extensive immobilisation
COCP side effects
Nausea - initial side effect - take pill at night time
Unscheduled bleeding
Headaches
VTE
HTN
Hepatocellular adenoma development
?weight gain - no evidence
