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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
Q

Efficacy of colchicine for Gout

A

V good

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26
Q

Safety of colchicine for Gout

A

Nausea and diarrhoea very common

Bone marrow suppression and renal failure over longer term

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27
Q

Suitability of colchicine for Gout

A

Good option if cannot take NSAIDs; similar efficacy to naproxen but 2x greater diarrhoea

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28
Q

Colchicine prescription

A

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

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29
Q

Other uses of colchicine

A

Pericarditis (infl of lining of the heart)
Bechet’s disease (urogenital ulcers, arthritis)
Reduce infl after heart attack

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30
Q

Corticosteroids in gout

A

Anti-infl
Local injection if only single joint affected e.g. wrist
Systemic (tablets) i.e. oral prednisolone if severe

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31
Q

Efficacy of corticosteroids for Gout

A

Good

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32
Q

Safety of corticosteroids for Gout

A

Short-term is generally ok

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33
Q

Suitability of corticosteroids for Gout

A

Those who cannot have NSAIDs or colchicine (e.g. older patients w/ multiple co-morbidities)

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34
Q

Canakinumab

A

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

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35
Q

Prevention of Gout

A

Reg treatment to Lowe uric acid levels

Preventative therapy

36
Q

Drugs used in Gout attacks

A

Allopurinol

Febuxostat

37
Q

Allopurinol pharmacology

A

Xanthine oxidase inhibitor

Reduces uric acid production and therefore lowers serum levels

38
Q

Efficacy of allopurinol for Gout

A

Very good, adjust dose by serum levels (100 - 600 mg daily) and renal function

39
Q

Safety of allopurinol for Gout

A

Good; on rare instances – serious allergy

40
Q

Interactions w/ allopurinol

A

Purine analogues

Theophylline

41
Q

Suitability slitty of allopurinol for Gout

A

First-choice drug; often given life-long

42
Q

Allopurinol prescription

A

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
Q

Febuxostat

A

Newest drug on the marker, expensive
Non-purine xanthine oxidase inhibitor
However, increased risk of cardiovascular problems w/ febuxostat

44
Q

When is febuxostat recommended by NICE

A

Can’t take allopurinol for medical reasons or

Side effects of allopurinol so bad that person can’t take the recommended amount

45
Q

Bisphosphonates pharmacology

A

Analogues of pyrophosphate

Attach to bone crystals – inhibit osteoclast breakdown of bone

46
Q

Efficacy of bisphosphonates for osteoporosis

47
Q

Safety of bisphosphonates for osteoporosis

A

GI upset is main problem

48
Q

Suitability of bisphosphonates for osteoporosis

A

Inexpensive, widely used but long-term adherence difficult

49
Q

Zolendronic acid

A

Type of bisphosphonate

Once a year iv injection is available

50
Q

Denosumab pharmacology

A

Monoclonal antibody – RANK Ligand inhibitor

Reduces osteoclast activation, differentiation and survival

51
Q

Efficacy of denosumab for osteoporosis

52
Q

Suitability of denosumab for osteoporosis

A

Recommend by NICE if phosphonate; only need 1 subcut injection every 6 months

53
Q

Less widely used NICE approved drugs

A

‘Oestrogen’ like molecules - rafloxifene

Teriparatide

54
Q

Teriparatide

A

Recombinant parathyroid hormone – intermittent use activates osteoblast to deposit bone

55
Q

Therapy for infl arthritis

A

Surgery
DMARDs e.g MTX, SSX, LFN, anti-TNF, gold
Non DMARDs e.g NSAID, paracetamol

56
Q

Therapeutic targets in infl arthritis

A

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
Q

When are local injection of corticosteroids suitable

A

Single, large joint

Toxicity w/ repeated use

58
Q

Efficacy of MTX for infl arthritis

59
Q

Safety of MTX for infl arthritis

A

Major problems – immunosuppression, liver toxicity, lung damage
Folic acid given on another day – can reduce toxicity
Regular monitoring required

60
Q

Suitability of MTX for infl arthritis

A

Avoid if liver problems

61
Q

Drug interaction of MTX

A

Trimethoprim

62
Q

Possible dosage regimens of MTX

A

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
Q

Main TNF-alpha blocking agents

A

Infliximab
Etanerceprt
Adalimumab

64
Q

Etanercept

A

Recombinant DNA human TNF-alpha receptor binds to TNF to stop its activity

65
Q

NICE guidance of TNF-alpha inhibitors

A

Active RhA disease activity
Tried at least 2 DMARDs (incl methotrexate) for >6 months
Should normally be used together w/ methotrexate

66
Q

Efficacy of TNF-alpha inhibitors for infl arthritis

67
Q

Safety of TNF-alpha inhibitors for infl arthritis

A

Injection reactions, immunosuppression

68
Q

Suitability of TNF-alpha inhibitors for infl arthritis

A

Expensive, needs infusion or injection

69
Q

If TNF-alpha inhibitors fail

A

• 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
Q

Drugs in Ankylosing Spondylitis (AS)

A

Adalimumab or etanercept

71
Q

Drugs in PsA

A

Adalimumab or etanercept or infliximab

72
Q

Drugs in juvenile idiopathic arthritis

A

Etanercept and newer agents e.g. golimumab and tocilizumab

73
Q

Drugs in SLE

A

Belimumab (inhibits B-cell activating factor), hydroxychloroquine, corticosteroid

74
Q

Steroid local injections in rheumatology

A

Triamcinolone

Methylprednisolone

75
Q

Steroid oral tablets in rheumatology

A

Prednisolone; e.g. 30 mg daily for 2 weeks in acute flares

76
Q

Intravenous forms of steroid in rheumatology

A

Hydrocortisone

Methylprednisolone (e.g. 1 g a day for 3 days)

77
Q

Topical steroid in rheumatology

A

Multiple formulations of different strength

78
Q

Major safety problems w/ corticosteroids

A

Cushing’s disease - tapering of steroid is too slow

Addison’s disease - tapering of steroids is too fast

79
Q

Medication errors

A

Errors of omission

Errors of commission

80
Q

Errors of omission

A

Omitted dose or failure to adequately monitor

81
Q

Errors of commission

A

Errors in wrong medication or wrong dosage

82
Q

Factors contributing to drug errors

A

Distractions in environment
Training and eduction
Medication products and packaging
Inability to read drug administration chart

83
Q

How prescribers can reduce errors

A 
Write legibly 
Checking of computer-generated prescriptions 
Check the dosage and frequency 
Confirm the route 
Consider drug interactions 
Identify drug allergies
84
Q

When is diclofenac prescribed

A

Post-op, good for acute pain, but not long term as increases risks of cardiovascular event
Apply topically

85
Q

Routes of administering NSAIDs

A

Orally
Topically
s/l
Per rectum

MBBS - Year 1 (93 decks)

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