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Phase 2A > Pharmacology - Drug List > Flashcards

Pharmacology - Drug List Flashcards

1
Q

Explain 3 effects β-blockers have on the body

A

Reduced force and speed of contraction in the heart (relieving myocardial ischaemia), prolongation of the refractory period of AV node (slowing ventricular rate) and reduction of renin secretion from the kidney (lowering blood pressure)

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2
Q

Which receptors do β-blockers act upon?

A

β1-adrenoreceptors (G-protein linked receptor)

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3
Q

How are β-blockers administered?

A

Usually orally as regular medication however they can be administered IV when rapid effect necessary

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4
Q

Name 5 adverse effects of β-blockers

A

Cold extremities, headaches, nausea, fatigue, sleep disturbance/nightmares

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5
Q

2 situations when β-blockers should not be used

A

In patients with asthma (can cause life threatening bronchospasm) and should not be used with non-dihydropyridine calcium channel blockers (can cause heart failure and bradycardia)

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6
Q

Name 2 relatively selective β-blockers and one non selective

A

Atenolol and Bisoprolol are relatively β-1 selective

Propranolol is non selective

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7
Q

Name 5 conditions ACEIs are used for

A

Hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy and CKD with proteinuria

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8
Q

How do ACEIs work?

A

Block ACE, prevent conversion of angiotensin 1 to angiotensin 2 (vasoconstrictor and stimulates aldosterone). Blocking it’s production reduces afterload which lowers blood pressure. Reduction of aldosterone promotes sodium and water excretion which reduces preload

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9
Q

Name 3 side effects of ACEIs

A

Hypotension (especially after first dose), persistent dry cough (increased bradykinin which is usually inactivated by ACE) and hyperkalaemia (low aldosterone level promotes potassium retention)

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10
Q

Which drugs shouldn’t be prescribed with ACEIs?

A

Potassium elevation drugs, including potassium supplements and potassium sparing diuretics
(NSAIDs will also increase the risk of renal failure so should be avoided)

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11
Q

How are ACEIs administered?

A

Orally

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12
Q

Name 3 ACEIs

A

Ramipril, lisinopril, perindopril

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13
Q

What is digoxin used for?

A

In atrial fibrillation/atrial flutter to reduce ventricular rate (however a non dihydropyridine calcium channel blocker is more effective).
In severe heart failure when patient is already taking ACEI, BB and aldosterone antagonist/ARB

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14
Q

Name 5 conditions beta blockers are used for

A

Ischaemic heart disease, chronic heart failure, atrial fibrillation, supraventricular tachycardia, hypertension (when CCBs/ACEIs insufficient)

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15
Q

How does digoxin work?

A

Negatively chronotrophic (decreases heart rate), positively inotrophic (increases force of contraction) and reduces conduction at AV node to reduce ventricular rate

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16
Q

Name 5 adverse effects of digoxin

A

Bradycardia, dizziness, GI disturbance, rash, visual disturbance (blurred or yellow vision)

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17
Q

Name 4 drugs that can increase the plasma concentration of digoxin and therefore increase the risk of toxicity

A

amiodarone, CCBs, spironolactone, quinine

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18
Q

Name 3 conditions where loop diuretics would be prescribed

A

Relief of breathlessness in pulmonary oedema, fluid overload in acute heart failure, fluid overload in other oedematous states (due to renal disease or liver failure)

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19
Q

Which part of the nephron do loop diuretics act on?

A

Ascending limb of loop of henle where they inhibit Na/K/2Cl co-transporter, preventing sodium, potassium and chloride ions crossing from the lumen into the epithelial cells therefore inhibiting the transport of water and providing a potent diuretic effect

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20
Q

As well as acting on the nephron, what other effect do loop diuretics have on the body?

A

Direct effect on blood vessels causing dilatation of capacitance veins, reducing preload and improving contractile function of overstretched heart muscle

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21
Q

Name 2 loop diuretics

A

Furosemide, Bumetanide

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22
Q

Name 4 adverse effects of loop diuretics

A

Dehydration, hypotension, low electrolyte state (Na/K/Cl/Ca/Mg), at high doses tinnitus/hearing loss

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23
Q

When should loop diuretics not be prescribed?

A

In patients with severe hypovolemia or dehydration. In patients with gout and hepatic encephalopathy they should be used with caution

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24
Q

When would potassium sparing diuretics be prescribed?

A

For the treatment of hypokalemia arising from loop/thiazide like diuretic use. Spiranolactone may be used as an alternative

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25
Q

Name a potassium sparing diuretic and how it is administered

A

Amiloride (commonly prescribed as co-amilofruse which contains furosemide aswell) and is taken orally

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26
Q

How do potassium sparing diuretics work?

A

They act on the distal convoluted tubule inhibiting the resorption of sodium, and therefore water, by epithelial sodium channels.

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27
Q

Which drugs should not be prescribed alongside potassium sparing diuretics?

A

Potassium elevating drugs including supplements and aldosterone antagonists due to the risk of hyperkalaemia.

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28
Q

Who shouldn’t potassium sparing diuretics be prescribed to?

A

Patients with severe renal impairment, hyperkalaemia or hypovolemia

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29
Q

Name 3 adverse effects of potassium sparing diuretics

A

Hypotension, GI upset, urinary symptoms

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30
Q

Name 1 thiazide diuretic and 2 thiazide like diuretics

A

Bendroflumethiazide (thiazide) , indapamide, chlortalidone

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31
Q

Which condition are thiazide like diuretics prescribed for?

A

Hypertension, either when a CCB is unsuitable (oedema/heart failure) or as an add on treatment when inadequately controlled by CCB + ARB/ACEI

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32
Q

How do thiazide diuretics work?

A

Act on distal convoluted tubule, inhibiting Na/Cl transporter preventing sodium (and water) reabsorption. Long term anti-hypertensive effects are not completely understood but are likely due to vasodilatory mechanisms

33
Q

Name 3 side effects of thiazide diuretics

A

Hyponatraemia, hypokalaemia, cardiac arrhythmias

34
Q

Which class of drugs reduces the effectiveness of thiazide diuretics?

A

NSAIDs

35
Q

What is acetylcysteine most commonly prescribed for?

A

Paracetamol overdose

36
Q

How does acetylcysteine work?

A

Replenishes body with glutathione which can conjugate with hepatotoxic NAPQI to detoxify it

37
Q

How is acetylecysteine administered?

A

Intravenously as a weight adjusted dose

38
Q

List 3 conditions aldosterone antagonists are used for

A

Ascites/oedema due to liver cirrhosis (Spiranolactone is first line diuretic), chronic heart failure (in addition to a BB + ACEI/ARB), primary hyperaldosteronism

39
Q

How do aldosterone antagonists work?

A

Competitively binds to aldosterone receptor, increasing sodium and water excretion, and potassium retention

40
Q

Name 2 main adverse effects of spiranolactone

A

Hyperkalaemia (can lead to muscle weakness, arrhythmias and cardiac arrest) and gynaecomastia

41
Q

When shouldn’t aldosterone antagonists be used?

A

Patients with severe renal impairment, hyperkalaemia or addisons disease

42
Q

What is amiodarone used for?

A

Tachyarrhythmias - AF, atrial flutter, supraventricular tachycardia, ventricular tachycardia, and ventricular fibrillation

43
Q

2 effects amiodarone has on myocardial cells

A

Blockade of sodium, calcium and potassium channels.

Antagonism of α and β-adrenergic receptors

44
Q

6 adverse effects of amiodarone

A

Pneumonits, bradycardia, AV block, hepatitis, photosensitivity, thyroid abnormalities

45
Q

When are angiotensin receptor blockers prescribed?

A

When ACEI is not tolerated due to cough. Same indications (Hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy & CKD with proteinuria)

46
Q

How do ARBs work?

A

Block the action of angiotensin 2 on AT1 receptor, reducing afterload which lowers blood pressure. Dilates efferent glomerular arteriole reducing intraglomerular pressure and reducing progression of CKD.

47
Q

3 adverse effects of ARBs

A

Hypotension (particularly after first dose), hyperkalaemia and renal failure. No cough because ACE (and therefore bradykinin) is not affected

48
Q

What shouldn’t be prescribed with ARBs?

A

Potassium elevating drugs including supplements and potassium sparing diuretics

49
Q

Name 4 calcium channel blockers

A

Amlodipine, nifedipine, diltiazem, verapamil

50
Q

3 indications for calcium channel blockers

A

Hypertension (amlodipine and nifedipine), stable angina, supraventricular arrhythmias (diltiazem and verapamil)

51
Q

How do calcium channel blockers work?

A

Decrease Ca entry into vascular/cardiac cells reducing intracellular calcium concentration causing relaxation and vasodilation. Reduce myocardial contractility and suppress cardiac conduction across AV node slowing ventricular rate. Reduced rate, afterload and contractility reduces oxygen demand preventing angina.

52
Q

How are the calcium channel blockers split into classes?

A

Dihydropyridines (amlodipine and nifedipine) are relatively selective for vessels whereas non-dihydropyridines are more selective for the heart (verapamil more so that diltiazem)

53
Q

4 adverse effects of dihydropyridines

A

Flushing, headaches, ankle swelling and palpitations

54
Q

4 adverse effects of verapamil

A

Constipation, bradycardia, heart block and cardiac failure

55
Q

What class of drug should non-dihydropyridines be prescribed with?

A

β-blockers - both drugs are negatively inotropic and chronotrophic and may cause heart failure, bradycardia and asystole

56
Q

4 indications for clopidogrel

A

Acute coronary syndrome, prevent occlusion of coronary artery stents, long term secondary prevention of thrombotic arterial events (patients with cardiovascular, cerebrovascular and peripheral arterial disease) and to reduce the risk of embolic stroke in AF when warfarin contraindicated

57
Q

How does clopidogrel work?

A

Prevents platelet aggregation by binding irreversibly to ADP receptors on the surface of platelets. This process is independent of the cyclooxygenase pathway and is synergistic with the actions of aspirin

58
Q

3 adverse effects of clopidogrel

A

Bleeding, GI upset, thrombocytopenia

59
Q

What may reduce the efficacy of clopidogrel?

A

Cytochrome p450 inhibtors

60
Q

Name 3 systemic corticosteroids

A

Prednisolone, hydrocortisone, dexamethasone

61
Q

6 indications for systemic corticosteroids

A

Allergic disorders, inflammatory disorders, autoimmune disease, some cancers, adrenal insufficiency, hypopituitarism

62
Q

Which receptors do corticosteroids act upon?

A

Cytosolic glucocorticoid receptors (nuclear)

63
Q

How do corticosteroid receptors work?

A

Upregulate anti-inflammatory genes and downregulate pro-inflammatory genes (TNFα, cytokines)

64
Q

8 adverse effects of corticosteroids

A

Immunosuppression increases risk and severity of infection, diabetes mellitus, osteoporosis, muscle weakness, skin thinning, gastritis, mood changes, hypertension, insomnia

65
Q

Name 3 inhaled corticosteroids

A

Beclametasone, budesonide, fluticasone

66
Q

Two indications when inhaled corticosteroids would be prescribed

A

Asthma (2nd step after SABA), COPD (in combinations with LABA)

67
Q

3 effects inhaled corticosteroids have to improve asthma symptoms?

A

Reduced mucosal inflammation, widening of airways, reduced mucus secretion

68
Q

2 adverse effects of inhaled corticosteroids

A

Oral candidiasis, hoarse voice

69
Q

When would dipyramidole be prescribed?

A

First line therapy for TIA , second line therapy following an ischaemic stroke where clopidogrel is contraindicated, to induce tachycardia during a myocardial perfusion scan

70
Q

How does dipyramidole work?

A

antiplatelet effect - increased cAMP inhibits platelet aggregation. Blocks uptake of adenosine - vasodilatory effect

71
Q

5 adverse effects of dipyramidole

A

Headaches, flushing, dizziness, GI upset, thrombocytopenia

72
Q

Name 2 nitrates

A

Isosorbide mononitrate, Glyceryl trinitrate

73
Q

2 indications for GTN

A

Acute angine, acute coronary syndrome

74
Q

1 indication for isosorbide mononitrate

A

angina prophylaxis where BB/CCB is intolerated

75
Q

How do nitrates work?

A

Converted to NO which increases cGMP synthesis and reduces intracellular calcium in vascular smooth muscle cells causing them to relax. This leads to venous and arterial vasodilatation, reducing cardiac preload/work therefore relieving angina

76
Q

3 conditions where nitrates should not be prescribed?

A

Severe aortic stenosis, haemodynamic instability, hypotension

77
Q

Name 3 NSAIDs

A

naproxen, ibuprofen, etoricoxib

78
Q

How do NSAIDs work?

A

Inhibit synthesis of prostaglandins from arachidonic acid by inhibiting COX

Phase 2A (9 decks)

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