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MBBS - Year 1 > Pharmacology - Pharmacology and Patient Safety > Flashcards

Pharmacology - Pharmacology and Patient Safety Flashcards

1
Q

Sources of info for dug hx

A 
From patient or relatives 
From medical notes 
From clinic letter/ discharge summaries 
From computer print-out or shard care record 
Checking the bottle/ packets
Nursing home drug charts
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2
Q

Drugs w/ high risk of error

A

Insulin and warfarin

Bivaribale doses w/ daily adjustment and its individualised (no find dose)

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3
Q

Cross-checking drugs

A

Check interactions w/ other drugs
Match against hx of allergy, or poor response to similar drugs
Suitability to individual – risk factors for adverse reaction, renal/ liver disease

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4
Q

Steps to choosing a drug

A

Identify classes of drugs
Compare the groups
Select formulation and trearment duration

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5
Q

Comparing groups of drugs

A

How they work, what level of efficacy
Safety – adverse effects, interactions
Suitability/ convenience – tablets/ injections, once daily etc
Cost

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6
Q

Avoiding harm

A

Lowest effective dose, shorter period
Deliver drug directly to site (skin creams, asthma inhalers)
Reduce risk – e.g. give bone protection if pt is on corticosteroids that cause osteoporosis
Consider non-drug options

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7
Q

Drugs that. may cause a haemorrhage if used together

A

Aspirin – knocks out platelets
Corticosteroid – thins the stomach lining
NSAIDs – dissolves stomach lining

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8
Q

Therapeutic effects of NSAIDs

A

Anti-infl
Analgesic
Antipyretic

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9
Q

Anti-infl effects of NSAIDs

A

Decreases PGE2 and PG1E (COX -1,2,3 inhibitors)

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10
Q

Prostacyclin

A

PGI2

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11
Q

Analgesic effects of NSAIDs

A

Decreased prostaglandins makes nerves less sensitive to infl mediators (bradykinin, 5-HT)

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12
Q

Antipyretic effects of NSAIDs

A

Decreased IL-1

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13
Q

Imprecise targets of NSAIDs

A

Block COX enzymes –> reduces (too many) PG

Useful/ friendly PG blocked

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14
Q

What happens when useful PG are blocked

A

Stomach – acid gets through, ulcer occurs

Platelet activity – less clotting, more bleeds

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15
Q

How do NSAIDs damage the stomach

A

Direct erosion of gastric lining

Indirect – block prostaglandins – unable to make protective mucus barrier against acid

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16
Q

Off target problems w/ NSAIDs

A

Kidney failure

Heart failure

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17
Q

Toxicity of corticosteroids

A

Little GI toxicity on their own

High risk together w/ NSAIDs

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18
Q

Drugs given for Gout

A

NSAIDs, colchicine for acute flare-ups

Allopurinol for chronic prevention

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19
Q

Drugs gives for osteoporosis

A

Bisphosphonates

Denosumab

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20
Q

Efficacy of NSAIDs for Gout

A

Moderate to good

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21
Q

Safety of NSAIDs for Gout

A

Short-term OK, but can cause GI bleed, renal failure, heart failure if high dose or longer-term

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22
Q

Suitability of NSAIDs for Gout

A

Inexpensive, easy to take, but contraindication in GI or cardiac disease

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23
Q

Dose of NSAIDs for Gout

A

Ibuprofen 400-800 mg tds

Naproxen 750 mg stat, then 250 mg tds for 7 days

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24
Q

Colchicine mechanism

A

Decreases infl by inhibition of granulocyte migration and inhibition of lymphocyte migration and division
Depolarisation of microtubules

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25
Efficacy of colchicine for Gout
V good
26
Safety of colchicine for Gout
Nausea and diarrhoea very common | Bone marrow suppression and renal failure over longer term
27
Suitability of colchicine for Gout
Good option if cannot take NSAIDs; similar efficacy to naproxen but 2x greater diarrhoea
28
Colchicine prescription
Colchicine 0.5mg tds for 3-4 tds Stop if diarrhoea/ vomiting Shouldn’t exceed total 6mg in one course Low dose can be used longer period e.g. colchicine 0.5mg daily for a few weeks to stop recurrent flares
29
Other uses of colchicine
Pericarditis (infl of lining of the heart) Bechet’s disease (urogenital ulcers, arthritis) Reduce infl after heart attack
30
Corticosteroids in gout
Anti-infl Local injection if only single joint affected e.g. wrist Systemic (tablets) i.e. oral prednisolone if severe
31
Efficacy of corticosteroids for Gout
Good
32
Safety of corticosteroids for Gout
Short-term is generally ok
33
Suitability of corticosteroids for Gout
Those who cannot have NSAIDs or colchicine (e.g. older patients w/ multiple co-morbidities)
34
Canakinumab
Selective inhibitor of IL-1 receptor Subcutaneous injection, can last up to 12 weeks For patients affected by frequent, severe acute gout that isn’t relieved by other drugs
35
Prevention of Gout
Reg treatment to Lowe uric acid levels | Preventative therapy
36
Drugs used in Gout attacks
Allopurinol | Febuxostat
37
Allopurinol pharmacology
Xanthine oxidase inhibitor | Reduces uric acid production and therefore lowers serum levels
38
Efficacy of allopurinol for Gout
Very good, adjust dose by serum levels (100 - 600 mg daily) and renal function
39
Safety of allopurinol for Gout
Good; on rare instances – serious allergy
40
Interactions w/ allopurinol
Purine analogues | Theophylline
41
Suitability slitty of allopurinol for Gout
First-choice drug; often given life-long
42
Allopurinol prescription
Allopurinol 100mg daily initially Check uric acid in a couple of weeks Up-titrate to desired level Caution: dose adjustment needed in renal failure
43
Febuxostat
Newest drug on the marker, expensive Non-purine xanthine oxidase inhibitor However, increased risk of cardiovascular problems w/ febuxostat
44
When is febuxostat recommended by NICE
Can’t take allopurinol for medical reasons or | Side effects of allopurinol so bad that person can’t take the recommended amount
45
Bisphosphonates pharmacology
Analogues of pyrophosphate | Attach to bone crystals – inhibit osteoclast breakdown of bone
46
Efficacy of bisphosphonates for osteoporosis
Very good
47
Safety of bisphosphonates for osteoporosis
GI upset is main problem
48
Suitability of bisphosphonates for osteoporosis
Inexpensive, widely used but long-term adherence difficult
49
Zolendronic acid
Type of bisphosphonate | Once a year iv injection is available
50
Denosumab pharmacology
Monoclonal antibody – RANK Ligand inhibitor | Reduces osteoclast activation, differentiation and survival
51
Efficacy of denosumab for osteoporosis
V good
52
Suitability of denosumab for osteoporosis
Recommend by NICE if phosphonate; only need 1 subcut injection every 6 months
53
Less widely used NICE approved drugs
'Oestrogen' like molecules - rafloxifene | Teriparatide
54
Teriparatide
Recombinant parathyroid hormone – intermittent use activates osteoblast to deposit bone
55
Therapy for infl arthritis
Surgery DMARDs e.g MTX, SSX, LFN, anti-TNF, gold Non DMARDs e.g NSAID, paracetamol
56
Therapeutic targets in infl arthritis
Relieve pain, swelling and other symptoms e.g. fatigue Avoid permanent joint damage Reduce systemic complications of chronic infl e.g. anaemia of chronic disease, amyloidosis
57
When are local injection of corticosteroids suitable
Single, large joint | Toxicity w/ repeated use
58
Efficacy of MTX for infl arthritis
V good
59
Safety of MTX for infl arthritis
Major problems – immunosuppression, liver toxicity, lung damage Folic acid given on another day – can reduce toxicity Regular monitoring required
60
Suitability of MTX for infl arthritis
Avoid if liver problems
61
Drug interaction of MTX
Trimethoprim
62
Possible dosage regimens of MTX
Methotrexate on Mondays e.g. 7.5 mg once a week (oral or subcutaneous injection) Folic acid 5 mg on Friday (this varies considerably amongst hospitals) Check full blood count, renal and liver function within a few weeks Can titrate up to 20 mg over some months if inadequate
63
Main TNF-alpha blocking agents
Infliximab Etanerceprt Adalimumab
64
Etanercept
Recombinant DNA human TNF-alpha receptor binds to TNF to stop its activity
65
NICE guidance of TNF-alpha inhibitors
Active RhA disease activity Tried at least 2 DMARDs (incl methotrexate) for >6 months Should normally be used together w/ methotrexate
66
Efficacy of TNF-alpha inhibitors for infl arthritis
V good
67
Safety of TNF-alpha inhibitors for infl arthritis
Injection reactions, immunosuppression
68
Suitability of TNF-alpha inhibitors for infl arthritis
Expensive, needs infusion or injection
69
If TNF-alpha inhibitors fail
• Lots of drugs directed at other targets CD20 – rituximab IL-6 – tocilizumab Janus Kinase (JAK) – tofacitinib, baricitinib (these can be given orally, so more convenient for patients)
70
Drugs in Ankylosing Spondylitis (AS)
Adalimumab or etanercept
71
Drugs in PsA
Adalimumab or etanercept or infliximab
72
Drugs in juvenile idiopathic arthritis
Etanercept and newer agents e.g. golimumab and tocilizumab
73
Drugs in SLE
Belimumab (inhibits B-cell activating factor), hydroxychloroquine, corticosteroid
74
Steroid local injections in rheumatology
Triamcinolone | Methylprednisolone
75
Steroid oral tablets in rheumatology
Prednisolone; e.g. 30 mg daily for 2 weeks in acute flares
76
Intravenous forms of steroid in rheumatology
Hydrocortisone | Methylprednisolone (e.g. 1 g a day for 3 days)
77
Topical steroid in rheumatology
Multiple formulations of different strength
78
Major safety problems w/ corticosteroids
Cushing's disease - tapering of steroid is too slow | Addison's disease - tapering of steroids is too fast
79
Medication errors
Errors of omission | Errors of commission
80
Errors of omission
Omitted dose or failure to adequately monitor
81
Errors of commission
Errors in wrong medication or wrong dosage
82
Factors contributing to drug errors
Distractions in environment Training and eduction Medication products and packaging Inability to read drug administration chart
83
How prescribers can reduce errors
``` Write legibly Checking of computer-generated prescriptions Check the dosage and frequency Confirm the route Consider drug interactions Identify drug allergies ```
84
When is diclofenac prescribed
Post-op, good for acute pain, but not long term as increases risks of cardiovascular event Apply topically
85
Routes of administering NSAIDs
Orally Topically s/l Per rectum

MBBS - Year 1 (93 decks)

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