Medications

Question 1

What are the 3 main indications for warfarin prescription?

Answer 1

Three main indications for warfarin prescription:

1. VTE
2. Atrial fibrillation
3. Prosthetic heart valves

Question 2

Antibiotic for MRSA

One consideration in the hospital setting for one of them

Answer 2

Vancomycin - need ID approval before you prescribe
Clindamycin
Trimethoprim/sulfamethoxazole (Bactrim, aka co-trimoxazole)

Question 3

First-line drug for diabetes?
Known effects/mechanism?
Benefit to treatment?
One side-effect?

Answer 3

Metformin
MoA: reduces hepatic gluconeogenesis + enhances peripheral insulin sensitivity by modifying glucose metabolic pathways
Benefit = weight loss
Side-efffect = metformin-associated lactic acidosis - rare

Question 4

Sulfonylureas

• MoA
• Contraindication
• One big side effect

Answer 4

MoA: block ATP-sensitive K+ channels –> depolarisation –> calcium enters –> increased secretion of C-peptide + insulin from beta cells.

Severe CV comorbidity is a contraindication

Side effect: can cause life-threatening hypoglycaemia

Question 5

Gliptins

• What is their full name
• MoA
• Contraindicated
• Benefits
• 2 side effects

Answer 5

DDP4 inhibitors = gliptins

• MoA: indirectly increased endogenous incretin effect by inhibiting DDP4 enzyme which breaks down GLP1 –> increased insulin secretion, decreased glucagon secretion, delays gastric emptying.
• Contraindicated: DKA, T1DM, those with hx of pancreatitis
• No risk of hypoglycaemia with monotherapy
• GI complaints, pancreatitis

Question 6

SGLT 2 inhibitors

• MoA
• Benefits
• Adverse side effects

Answer 6

• MoA: reversibly inhibits sodium-dependent glucose co-transporter 2 in PCT –> glycosuria.
• Weight loss
• Bad for UTIs + genital infections, dehydration from polyuria. Do not use in CKD.

Question 7

GLP1 receptor agonists
What is the example of one (name)?
- MoA
- Benefits
- Adverse effects [3]

Answer 7

Exenatide

• MoA: GLP1 mimetic binds the receptor GLP-1 and makes it resistant to DDP-4 degradation –> increased insulin secretion, decreased glucagon secretion, delay gastric emptying.
• Weight loss + no risk of hypoglycaemia
• GI complains, increased risk of pancreatitis + increased risk of pancreatic ca

Question 8

Which diuretic contraindicated in diabetes?

Answer 8

Thiazides

Question 9

How does tranexamic work (brief - not entire pathophys)?

What is a key contraindication to tranexamic acid?

Answer 9

It is an anti-fibrinolytic

Contraindicated in haematuria – can cause blood clots in urinary tract –> obstructive uropathy.

Question 10

What is DDAVP?
MoA?
Indications?

Answer 10

Demopressin
Stimulates endothelium to released stored F8 and VWF
Indications – i.e. before surgery in mild cases of haemophilia A, VWD

Question 11

Abatacept MoA brief

Answer 11

Blocks T cell co stimulation

Question 12

Rituximab MoA brief

Answer 12

anti-CD20, suppress B cell activity

Question 13

Adalimumab MoA brief + what other names for the same MOA?

Answer 13

Block TNF-Alpha. Also: etanercept, infliximab

Question 14

Anakinra MoA brief

Answer 14

IL1

Question 15

Tocilizumab MoA brief

Answer 15

Block IL6

Question 16

Allopurinol - MoA + major side effects

Answer 16

Allopurinol is a competitive inhibitor of xanthine oxidase –> reduced urate levels in the body.
Major SE: Toxic epidermal necrolysis + Steven Johnson syndomre

Question 17

MoA of aspirin and clinical consideration

What condition is it used to prevent?

Answer 17

Aspirin – irreversible inhibition of COX1 –> reduced conversion of arachidonic acid to TXA2 –> inhibit PLT aggregation

Irreversible inhibition - thus duration of platelet inhibition lasts 7-10 days after drug discontinuation

Colon cancer prophylaxis

Question 18

1 contraindications for NOACs

1 general Rx consideration

Answer 18

Chronic kidney disease/renal impairment [1]

Rx consideration - use warfarin over NOAC in valvular AF