medications

Question 1

Verapamil

Indications and side effects

Answer 1

= block voltage-dependent calcium channels

Angina, hypertension, arrhythmias
Highly negatively inotropic

Should not be given with beta-blockers as may cause heart block

SE - Heart failure, constipation, hypotension, bradycardia, flushing

Question 2

Diltiazem

Indications and side effects

Answer 2

= calcium channel blocker
Angina, hypertension

Less negatively inotropic than verapamil but caution should still be exercised when patients have heart failure or are taking beta-blockers

SE Hypotension, bradycardia, heart failure, ankle swelling

Question 3

Nifedipine, amlodipine, felodipine

dihydropyridines

Answer 3

= calcium channel blocker

SE Flushing, headache, ankle swelling

Question 4

sodium-glucose transport protein 2 -inhibitor - nagliflozin, dapagliflozin and empagliflozin.

adverse effects

Answer 4

ie canagliflozin, dapagliflozin and empagliflozin.
SGLT2 inhibitors prevent the resorption of glucose from the proximal renal tubule, resulting in more glucose being secreted in the urine.

Important adverse effects include
urinary and genital infection (secondary to glycosuria). Fournier’s gangrene has also been reported
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored

contra-indicated in patients with recurrent thrush

Question 5

Warfarin interactions

Answer 5

General factors that may potentiate warfarin
liver disease
P450 enzyme inhibitors (see below)
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs

Question 6

Inducers of the P450 system include - (decrease inr when on warfarin)

Answer 6

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

Question 7

Quinolones adverse effects

Answer 7

Adverse effects
lower seizure threshold in patients with epilepsy
tendon damage (including rupture) - the risk is increased in patients also taking steroids
cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children
lengthens QT interval

Question 8

Drugs which impair wound healing:

Answer 8

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

Question 9

Medications for trigem neuralgia

Answer 9

carbamazepine is first-line

failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology