Pharmacology Flashcards
What is a common Side effect of alendronic acid?
GI upset
Jaw necrosis
Atypical Fractures
What is a Side effect of sertraline?
GI bleeding
Hyponatremia
QT increase
Increase risk of suicidal thoughts initially
When should Bisphosphonates be taken?
30 before eating
must maintain upright position after eating for further 30mins
In the setting of taking alendronic acid, and G.I upset, what should your management be?
Immediate withdrawal of alendronic acid
start PPI.
List some common medications that are associated with G.I symptoms:
Amlodipine
- constipation
Alendronic acid
Sertraline
List the most common drugs that cause dyspepsia and G.I bleeds:
NSAIDs
Antiplatelets
Anticoagulants
Cox2 inhibitors
- celecoxib
corticosteroids
SSRis
Ca2+ blockers
Nitrates
Define Polypharmacy:
When a patient is prescribed multiple medicines at once.
>5 or more
the more drugs the more risk of drug to drug interactions
- thus steps have to be taken to reduce this
List three reasons why polypharmacy is increasing:
Aging population
Chronic disease burden
Preventative medications
When carrying out medication reviews, what measures should be checked?
The right medication
The right reason for the medication
At the right dose
By the right route
at the right frequency
at the right time
at the right place
What are the types of polypharmacy?
Appropriate
Inappropriate
Give two broad reasons why the elderly are at increased risk of polypharmacy:
Pharmacokinetics:
- reduced break down
- reduced clearance
Pharmacodynamics:
- Increased potency of the drugs (Pseudoephrine) (Morphine)
Name a common tool used in the UK that is used to screen for those at risk in polypharmacy:
STOPP/START
When are thiazide diuretics used in the management of hypertension, what is their mechanism of action and list some common side effects associated with them:
3rd line treatment or used 2nd line when a person can’t tolerate Ca2+ channel blocker.
Block Na2+/Cl- co-transporter on DCT
Side effects:
- Hyponatremia
- hypokalemia
- hypercalamia
- hyperuricemia
List some common indications for use of Loop diuretics, how they work and list some side effects:
Step 4 in HTN management
Acute heart failure
Pulmonary oedema
Hypercalemia - flush the Ca2+ out
Block Na/K/2Cl channel on the Thick ascending loop
Side effects:
- Dehydration
- Hypermagnesemia
- Hypokalemia
- Hypocalamia
Hyperuricemia
List two indications for using DOAC, list some common side effects and contrast this with warfarin along with important interactions and contraindications.
Venous Thromboembolism
AF
Side effects:
- increased risk of G.I bleeding (this is more so than warfarin, there is however a decreased risk of intracerebral hemorrhage compared to warfarin)
Not used in pregnancy
Not used in renal failure
Xa agonists are contraindicated with macrolides due to their P450 enzyme break down
List the indications for use of aspirin and its mechanism of action.
list some common side effects and contraindications:
ACS treatment
Ischemic Stroke
Prevention of thrombotic arterial events
Irreversibly binds to COX preventing thromboxane A2 being released. Preventing Platelet aggregation.
Also inhibits prostaglandins forming - preventing pain activation and dilation of blood vessels (anti inflammatory)
Side effects:
- G.I bleeding
- Bronchospasm
- Angioedema
Contraindicated in:
- children (Reye’s syndrome)
- 3rd trimester pregnancy
- Gout - can trigger acute attacks
List the indications of use of clopidogrel and ticagrelor, explain mechanism of action and list some side effects and contraindications:
ACS
Long term prevention of thrombotic arterial events
Binds to ADP receptors on platelets preventing aggregation.
Side effects:
- bleeding
- dyspepsia
- thrombocytopenia
Contraindications:
- bleeding
- elective surgery
- Renal/ hepatic impairment
**note that the drug is pro-drug and broken down by CYP450 enzymes. any drugs that interact with this may reduce effectiveness.
List the indications for use of warfarin, its mechanism of action and side effects along with contraindications:
DVT prophylaxis
Thrombotic arterial preventions
Blocks Vitamin K Epoxide reductase - which restores Vit K to its reduced form which is needed for synthesis of coagulation factors
Side effects:
- bleeding
- warfarin necrosis - lack of Proteins C and S
Contraindicated in:
- pregnancy
- liver failure
Outline the indications of use for methotrexate, and some important information on mechanism of action and usage of drug:
DMARD - for RA
Chemotherapy agent
Psoriasis
Blocks dihydrofolate reductase, inhibing tetrahydrofolate = reduced DNA synthesis.
Lower does also inhibits cytokines namely, IL6, IL8 and TNF alpha.
Side effects:
- mucosal damage
- pulmonary fibrosis
- bone marrow suppression
- Hepatic toxicity
Contraindicated in:
- pregnancy
- severe renal failure
- *note that this drug is taken ONCE a week for DMARD effects.
- therefore risk of overdose.
