P34 Flashcards

Question

Empagliflozin

Answer 1

SGLT2 inhibitor Action: decreased blood glucose. Decreases BP via osmotic diuresis MOA: inhibitor of subtype 2 sodium glucose transport proteins (SGLT2) which are responsible for renal glucose absorption. Glucose is eliminated in urine Use: T2DM Side effects: increased UTI and genital infections. Decreased BP. Increased urination. Increased LDL and may increase risk of DKA

Answer 2

DPP4 inhibitor Actions: antidiabetic. Lowers blood sugar MOA: competitive inhibition of DIPEPTIDYL PEPTIDASE 4 that breaks down GLP-1 hormones released in response to a meal. Stopping GLP1 deactivation, increased insulin secretion and decreased glucagon Use: T2DM Side effects: rare. nausea, headache, hypersensitivity reaction

Answer 3

Dopamine reuptake inhibitor Action: atypical antidepressant. elevated mood MOA: relatively selective inhibitor of neuronal dopamine reuptake. Also antagonist at NICOTINIC receptors Use: depression, smoking cessation SE: Agitation, dry mouth, tremor, nausea, insomnia

Answer 4

Start 1-2 weeks before stopping Action: decreases cravings, decrease pleasure from tobacco MOA: nicotinic receptor partial agonist Less effect on dopamine than nicotine SE: mild nausea, headaches, difficulty sleeping, nightmares Use: smoking cessation

Answer 5

Patches, gum, nasal spray, mouth spray, inhalation, lozenge, sublingual tablet Most effective the behavioural interventions Contraindicated in CV disease or recent stroke SE: Nausea, dizziness, flu like symptoms, palpitations, dyspepsia

Answer 6

Aldosterone antagonist. MoA: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium chloride and water excretion while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well. ``` Use: - Oedema in cirrhosis - Severe heart failure - Conn's syndrome (temporary treatment) - Resistant hypertension ``` SE: - Hyperkalaemia - Hyperchloraemic acidosis - Gynaecomastia

Answer 7

Class: Aldosterone (mineralocorticoid receptor) antagonist MoA: The potassium-sparing diuretics spironolactone and eplerenone compete with aldosterone for the mineralocorticoid receptor (MR), blocking the induction by aldosterone of the expression and activity of the epithelial Na+ channel (ENaC), the basolateral Na+/K+-ATPase pump and other aldosterone-induced proteins (AIP) Use: - Oedema in cirrhosis - Severe heart failure - Conn's syndrome (primary hyperaldosteronism in patients awaiting surgery or when surgery not option) - Resistant hypertension SE: - Hyperchloraemic acidosis - Gynaecomastia, amenorrhoea - Hyperkalaemia - Vasculitis - Erythematous maculopapular rash - Steven-Johnson syndrome (T-cell mediated hypersensitivity reaction) - Renal insufficiency - Hepatotoxicity - Agranulocytosis

Answer 8

Loop diuretic Inhibits Na/K/2Cl cotransporter in the luminal membrane of the ascending loop of henle - Increases Na+, Cl-, water, Mg+ and Ca2+ excretion Indication: - Acute pulmonary oedema - Chronic heart failure - Diuretic resistant oedema - Resistant hypertension (rarely used) SE: - Hyponatraemia - Hypokalaemic acidosis - Hypochloraemic alkalosis - Hyperuricaemia - Hypovolaemia - Hypotension in elderly - Renal impairment (from dehydration + direct toxic effect) - Hyperglycaemia (less common than with thiazides) - Gout - Reversible ototoxicity (uncommon)

Answer 9

ACEi Indication: - Hypertension - Chronic heart failure (adjunct) - Prophylaxis after MI - Nephropathy - Secondary prevention in IHD / AMI / Stroke SE: - Dry cough 10-20% secondary to increased bradykinin which is usually inactivated by ACE - Hypotension - Hyperkalaemia (lower aldosterone promotes K+ retention) - Worsen renal failure - Angioedema - Other anaphylactoid reactions MoA: - Its active metabolite reversibly binds to ACE preventing angiotensin I to become angiotensin II - Decreased angiotensin II enhances natriuresis, lowers blood pressure, and prevents remodeling of smooth muscle and cardiac myocytes Effects: - Lowered arterial and venous pressure reduces preload and afterload - ACE inhibitors interfere with the degradation of bradykinin (a peptide which causes vasodilation) - ACE inhibitors inhibit the production of angiotensin II and ARBs block angiotensin II receptors. Therefore, both classes of medication cause vasodilation of the efferent arteriole

Answer 10

Pharmacodynamic drug–drug interactions occur when interacting drugs have either additive effects, in which case the overall effect is increased, or opposing effects, in which case the overall effect is decreased or even ‘cancelled out’. Pharmacokinetic drug–drug interactions occur when one drug changes the systemic concentration of another drug, altering ‘how much’ and for ‘how long’ it is present at the site of action. Summary: - Pharmacodynamic: additive or reductive drug interaction - Pharmacokinetic: drug interaction in which one drug alters the systemic concentration of another causing increased or decreased duration of effect.

Answer 11

NSAID-induced inhibition of PG-mediated afferent vasodilation and reduction in peritubular blood flow may also increase the risk of ischaemic acute tubular necrosis (ATN) or other nephrotoxin-induced tubular injury from drugs such as aminoglycosides, amphotericin B, hydroxyethyl starch, and radiocontrast material.

Answer 12

Stage 1 with normal or high GFR (GFR > 90 mL/min) Stage 2 Mild CKD (GFR = 60-89 mL/min) Stage 3A Moderate CKD (GFR = 45-59 mL/min) Stage 3B Moderate CKD (GFR = 30-44 mL/min) Stage 4 Severe CKD (GFR = 15-29 mL/min) Stage 5 End Stage CKD (GFR <15 mL/min)

Answer 13

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors MoA: - Prevents glucose re-uptake in renal tubules - Increases glucose loss in urine Side effects: - Recurrent thrush - UTIs - Diabetic ketoacidosis Constradictiatinons: - eGFR <60

Answer 14

Thiazolidinediones (glitazones) Sulfonylureas Meglitinides

Answer 15

SGLT-2 inhibitors GLP-1 mimetics DPP-4 inhibitors

Answer 16

Glucagon-like-peptide-1 (GLP-1) mimetics

Answer 17

Meglitinides (glinides)

Answer 18

Sulphonylureas

Answer 19

Thiazolidinediones

Answer 20

Dipeptidyl peptidase-4 (DPP-4) inhibitors

Answer 21

Sodium-glucose co-transporter-2 (SGLT-2) inhibitors

Answer 22

- glitazone (thiazolidinediones) - glinide (meglitinides) - gliptin (DPP-4 inhibitors) - gliflozin (SGLT-2 inhibitors)

Answer 23

(-glitazone): - Thiazolidinediones - Pioglitazone, lobeglitazone, rosiglitazone (-glinide): - Meglitinides - Repaglinide, nateglinide (-gliptin): - DPP-4 inhibitors - Sitagliptin, saxagliptin (-gliflozin): - SGLT-2 inhibitors - Canagliflozin, empagliflozin. dapagliflozin -------------------------------------------------------- The others don't have a notable prefix/suffix Biguanide: - Metformin Sulfonylureas: - Gliclazide - Glimepiride GLP-1 mimetics: - Exanatide - Liraglutide

Answer 24

- Biguanides - Thiazolidinediones (glitazones) - Sulfonylureas - Meglitinides (glinides) - Dipeptidyl peptidase-4 (DPP-4) inhibitors - Glucagon like peptide-1 (GLP-1) mimetics - Sodium-glucose cotransporter-2 (SGLT-2) inhibitors

Answer 25

Sensitisers: - Biguanides - Thiazolidinediones (glitazones) Secretagogues: - Sulfonylureas - Meglitinides (glinides) - Dipeptidyl peptidase-4 (DPP-4) inhibitors - Glucagon like peptide-1 (GLP-1) mimetics Other (renal excretor): - Sodium-glucose cotransporter-2 (SGLT-2) inhibitors

Answer 26

Stage 1: creatinine 1.5-2x normal, urine output <0.5mL/kg/hr for 6 hours Stage 2: 2-3x normal, urine output <0.5mL/kg/hr for 12 hours Stage 3: >3x or RRT, urine output <0.3mL/kg/hr for 24 hours or anuria for 12 hours