Pharmacology Flashcards
What drugs are used for secondary prevention following an MI?
Aspirin
Statins
B-blockers
ACE- Inhibitors
What drug/ class is associated with causing hyperkalaemia?
ACE inhibitors
Clopidogrel is often co-prescribed with proton pump inhibitors (PPIs) for the treatment of oesophageal reflux/ The combination of which PPI and clopidogrel should be avoided?
Omeprazole and clopidogrel
Which drugs need to be used with caution in patients with renal impairment?
Allopurinol
ACE inhibitors
(allopurinol and ACE Inhibitors are both excreted by the kidneys)
Simvastatin (largely metabolised by the liver but should still be used in caution in patients with renal conditions)
Metformin
When is steady-state plasma concentration achieved?
When rate of administration equals the rate of elimination
Highly lipophilic drugs tend to have a large or low volume of distribution?
Highly lipophilic drugs tend to have a large volume of distribution
(this is due to the partitioning into fat which reduces the plasma concentration)
In first order elimination kinetics, the half-life of a drug is independent of the dose (until saturation occurs). T/F?
True
What is meant by the loading dose?
The loading dose is an initial higher dose of a drug given at the beginning of a course of treatment before stepping down to a lower maintenance dose
Sildenafil (viagra) interacts with isorbide mononitrate to cause what adverse effect?
Too much vasodilation - may lead to collapse
What medication is associated with exacerbating gout?
Diuretics - bendroflumethiazide and furosemide
This is because competition between the diuretics and urate for transport by OATs elevates the plasma levels of urate
What fruit should be avoided in patients taking statins?
Grapefruit
This is because grapefruits are p450 inducers which prolong the effects of statins. This can present with adverse effects related to statins such as muscle pains.
The effectiveness of which drug class may be decreased by impaired renal function?
Diuretics e.g furosemide
How are acute flares of gout managed?
NSAIDs/ colchicine are first line
Possible NSAIDs include naproxen but these should not be given in cases involving renal impairment
PO/IM/ Intra-articular steroids can be given
If the patient is already taking allopurinol this should be continued
What is the first line medication for urate lowering therapy (long-term gout management)?
Allopurinol
Febuxostat can be given to patients who cannot tolerate allopurinol
What is gout?
Form of microcrystal synovitis caused by monosodium urate deposition in the synovium
What are some of the possible causes of gout?
Drugs (diuretics)
Chronic kidney disease
Lead toxicity
Myeloproliferative disorders
Severe psoriasis
Which drug is most suitable for pain management in patients on warfarin?
Paracetamol
Why are NSAIDs not recommended in patients on warfarin?
NSAIDs increase the blood thinning effect
Give 4 examples of NSAIDs
Aspirin
Diclofenac
Ibuprofen
Naproxen
How long should warfarin be stopped before surgery?
5 days before surgery
How is paracetamol overdose treated?
IV N-acetylcysteine
How is aspirin overdose treated?
Alkaline diuresis
What is Ephedrine used for?
Ephedrine is a medication used to bring the blood pressure back up if a patient becomes hypotensive following spinal anaesthetic
How does Ephedrine work?
Ephedrine has mixed effects on both alpha 1 and beta receptors.
It is also an indirectly acting sympathomimetic which causes release of noradrenaline
Is volume of distribution higher in men or women?
Volume of distribution is higher in women
this is because they have more body fat :(
How is volume of distribution affected by BMI?
Volume of distribution is increased by BMI
Vd may exceed the total volume of the body. T/F
True
How does spinal anaesthesia most commonly cause hypotension?
Blockage of sympathetic transmission to blood vessels causing vasodilation
Which drugs must be avoided in renal failure?
Allopurinol
Rampril
Metformin
Simvastatin
Clopidogrel shouldn’t be co-prescribed with which PPI?
Omeprazole
What secondary prevention should be given post MI?
2x antiplatelets
Statin
ACE inhibitor
B-blocker
What effect do ACE inhibitors have on potassium levels and what effect do loop diuretics have?
ACE Inhibitors - HYPERkalaemia
Loop diuretics (e.g furosemide) - HYPOkalaemia
