Pharm - CKD

Question 1

What are statins?

Answer 1

selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase

Question 2

What are some examples of statins?

Answer 2

Simvastatin

Artorvastatin

Question 3

What is the primary mechanism of action for statins?

Answer 3

• competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for converting HMG-CoA to mevalonate in the cholesterol synthesis pathway
• By reducing hepatic cholesterol synthesis, an upregulation of LDL-receptors and increased hepatic uptake of LDL-cholesterol from the circulation occurs



Question 4

What is the drug target for statins?

Answer 4

Hydroxymethylglutaryl-CoA (HMG-CoA) reductase

Question 5

What are the main side effects of statins?

Answer 5

• Muscle toxicity (however the likelihood increases with higher doses)
• Constipation
• Diarrhoea
• Other gastrointestinal symptoms

Question 6

What are the uses of statins?

Answer 6

reducing the risk of adverse cardiac events in people

Question 7

What should patients using statins be followed up for?

Answer 7

monitor for hyperkalaemia + acute renal failure

Question 8

What can increase statin serum concentrations?

Answer 8

Coadministration with potent 3A4 inhibitors

Question 9

What is the primary mechanism of aspirin?

Answer 9

• Irreversible inactivation of COX enzyme
• Prevents oxidation of arachidonic acid to produce prostaglandins
• Reduction of thromboxane A2 in platelets reduces aggregation.
• Reduction of PGE2 (i) at sensory pain neurones reduces pain and sensation and (ii) in the brain decreases fever

Question 10

What is the drug target for aspirin?

Answer 10

cyclo-oxygenase

Question 11

What are the main side effects of aspirin?

Answer 11

Dyspepsia
Haemorrhage

In the elderly, avoid doses greater than 160mg daily (increased risk of bleeding) and coadminister PPI if past history of peptic ulcer.

Question 12

Why can aspirin cause GI side effects?

Answer 12

Blockade of COX1 in gastric mucosal cells reduces mucus/bicarbonate production which can expose the stomach lining to acid.

Question 13

What is the primary mechanism of action of trimethoprim?

Answer 13

Direct competitor of the enzyme dihydrofolate reductase
Inhibits the reduction of dihydrofolic acid to tetrahydrofolic acid (active form) – a necessary component for synthesising purines required for DNA and protein production.

Question 14

What is the drug target for trimethoprim?

Answer 14

dihydrofolate reductase

Question 15

What are the main side effects of trimethoprim?

Answer 15

diarrhoea

skin reactions

Question 16

What needs to be monitored with trimethoprim?

Answer 16

• blood counts with long term use or in those at risk of folate deficiency
• serum electrolytes in patients at risk of developing hyperkalaemia

Question 17

What is the primary mechanism for gentamicin?

Answer 17

Binds to the bacterial 30s ribosomal subunit disturbing the translation of mRNA leading to the formation of dysfunctional proteins

Question 18

What is the drug target for gentamicin?

Answer 18

30s ribosomal subunit

Question 19

What are the side effects of gentamicin?

Answer 19

Ototoxicity

Nephrotoxicity

Question 20

What is gentamicin?

Answer 20

aminoglycoside antibiotic - can pass through gram negative cell membrane in an oxygen dependent manner

Question 21

What can gentamicin be used to treat?

Answer 21

endocarditis
septicaemia
meningitis
pneumonia
surgical prophylaxis