Top 100 Drugs

Question 1

Class of drugs (+ example) used 2nd line for symptom relief in Benign prostatic enlargement

Answer 1

5 alpha reductase inhibitor
E.g. finasteride

Question 2

Adverse effects finasteride, dutasteride

Answer 2

Loss of libido
Impotence
Breast enlargement & tenderness
(Hair growth)

Rare but important: breast ca, suicidal ideation

Question 3

Important warnings for Finasteride, dutasteride

Answer 3

Abnormal male foetus development so…

NOT to be handled/taken by women of childbearing potential
No unprotected sex with man taking these (if of childbearing potential)

Question 4

Example 5 alpha reductase inhibitor prescription

Answer 4

Finasteride 5mg PO, OD

(1mg if used for male pattern baldness)

Question 5

Relevant patient info for: Finasteride, Dutasteride

Answer 5

Swallow whole
Broken/damaged tablets NOT to be handled by pregnant/potentially pregnant women
Can take up to 6m for effect

Question 6

Indications for Acetylcholinesterase inhibitor

Answer 6

Mild to moderate Alzheimer’s disease
Mild to moderate dementia in Parkinson’s disease (rivastigmine only)

Question 7

Examples of acetylcholinesterase inhibitor

Answer 7

Donepezil
Rivastigmine

Question 8

Adverse effects of Donepezil, Rivastigmine

Answer 8

GI upset - most common
Worsening bronchospasm in asthma/COPD
Worsened tremor in Parkinson’s (rivastigmine only)

Less common:
Peptic ulcers
Bleeding
Bradycardia
Heart block
hallucinations, altered behaviour

Rare - neuroleptic malignant syndrome

Question 9

Safety info/cautions for Donepezil, rivastigmine

Answer 9

Caution using in: asthma, COPD patients, risk of Peptic ulcers
Avoid in: Heart block, sick sinus syndrome

Question 10

Acetylcholinesterase inhibitor Example prescription

Answer 10

Donepezil 5mg OD at night (usually) or
Rivastigmine 1.5mg every 12 hours

Question 11

Patient info for Donepezil, rivastigmine

Answer 11

Not curative - modest improvement, limits progression.

Report any abnormal movements or agitated/aggressive behaviour to Dr.

If issues vidid dreams, take in AM instead.

Question 12

Donepezil, rivastigmine monitoring

Answer 12

Review for SE at 2-4 weeks after start/dose change
Repeat cognitive assessment at 3m

Question 13

Paracetamol overdose treatment regime

Answer 13

Acetylcysteine IV, Weight adjusted e.g. for 50kg child
150mg/kg over 1 hour THEN 50mg/kg over 4 hours THEN 100mg/kg over 16 hours

Total infusion time 21 hours

Question 14

Adverse effect of (N-) acetylcysteine

Answer 14

Anaphylactoid reaction - stop infusion, give antihistamine +/- bronchodilator
Can restart infusion at slower rate once resolved

Question 15

Monitoring of Acetylcysteine treatment

Answer 15

INR
serum ALT
creatinine

All at baseline and Tx completion

+ regular observation for anaphylactoid reaction

Question 16

Examples aldosterone antagonist

Answer 16

Spironolactone
Eplerenone

Question 17

Indications for Spironolactone, epleronone

Answer 17

Heart failure - moderate+ severity or within 1m of MI
Ascites, oedema d/t Cirrhosis
Primary hyperaldosteronism (whilst awaiting surgery or if surgery not appropriate)

Question 18

Drug interactions for Spironolactone, elpleronone

Answer 18

K+ elevating agents: ARB, ACEi

Question 19

Spironolactone example prescriptions - HF, ascites

Answer 19

HF: Spironolactone 25mg OD
Ascites: 100mg OD

Question 20

Patient advice for Spironolactone, epleronone

Answer 20

Take with food
Warn of gynaecomastia (esp high dose) - Spironolactone
Importance of attending for blood tests d/t high K+ risk

Question 21

Monitoring of aldosterone antagonists

Answer 21

U&E - monitor potassium
Consider dose reduction or stopping if high K+ or renal impairment

Question 22

Contraindications to aldosterone antagonists

Answer 22

Adrenal insufficiency
Hyperkalaemia
Severe renal impairment

Avoid: Pregnant or breastfeeding

Question 23

Drugs contraindicated in asthma

Answer 23

NSAIDs
Beta blockers
Adenosine

Caution: large doses opioid based medications or BDZ - resp depression