Pharmacology

Question 1

What is a common Side effect of alendronic acid?

Answer 1

GI upset

Jaw necrosis

Atypical Fractures

Question 2

What is a Side effect of sertraline?

Answer 2

GI bleeding

Hyponatremia

QT increase

Increase risk of suicidal thoughts initially

Question 3

When should Bisphosphonates be taken?

Answer 3

30 before eating

must maintain upright position after eating for further 30mins

Question 4

In the setting of taking alendronic acid, and G.I upset, what should your management be?

Answer 4

Immediate withdrawal of alendronic acid

start PPI.

Question 5

List some common medications that are associated with G.I symptoms:

Answer 5

Amlodipine
- constipation

Alendronic acid

Sertraline

Question 6

List the most common drugs that cause dyspepsia and G.I bleeds:

Answer 6

NSAIDs

Antiplatelets

Anticoagulants

Cox2 inhibitors
- celecoxib

corticosteroids

SSRis

Ca2+ blockers

Nitrates

Question 7

Define Polypharmacy:

Answer 7

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

Question 8

List three reasons why polypharmacy is increasing:

Answer 8

Aging population

Chronic disease burden

Preventative medications

Question 9

When carrying out medication reviews, what measures should be checked?

Answer 9

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

Question 10

What are the types of polypharmacy?

Answer 10

Appropriate

Inappropriate

Question 11

Give two broad reasons why the elderly are at increased risk of polypharmacy:

Answer 11

Pharmacokinetics:

• reduced break down
• reduced clearance

Pharmacodynamics:
- Increased potency of the drugs (Pseudoephrine) (Morphine)

Question 12

Name a common tool used in the UK that is used to screen for those at risk in polypharmacy:

Answer 12

STOPP/START

Question 13

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:

Answer 13

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

Question 14

List some common indications for use of Loop diuretics, how they work and list some side effects:

Answer 14

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

Question 15

List two indications for using DOAC, list some common side effects and contrast this with warfarin along with important interactions and contraindications.

Answer 15

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

Question 16

List the indications for use of aspirin and its mechanism of action.
list some common side effects and contraindications:

Answer 16

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

Question 17

List the indications of use of clopidogrel and ticagrelor, explain mechanism of action and list some side effects and contraindications:

Answer 17

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.

Question 18

List the indications for use of warfarin, its mechanism of action and side effects along with contraindications:

Answer 18

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

Question 19

Outline the indications of use for methotrexate, and some important information on mechanism of action and usage of drug:

Answer 19

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.