Top 100 Drugs II Flashcards
What are the indications for bisphosphonates?
Osteoporosis (those at risk of fragility #’s)
Hypercalcemia of malignancy
Bone mets (myeloma, BCa)
Paget’s disease
How do bisphosphonates work?
Inhibits action of osteoclasts by accumulating in them –> inhibits activity, promotes apoptosis
Important adverse effects of bisphosphonates?
Oesophagitis
Hypophosphatemia
Osteonecrosis of jaw
Atypical femoral #
What are the indications for calcium and vitamin D?
- Osteoporosis
- Hypocalcemia (symptomatic)
- Severe hyperkalemia
- Chronic kidney disease
- Osteomalacia/rickets (vitamin D deficiency)
What is the function of calcium in the setting of severe hyperkalemia?
IT DOES NOT LOWER SERUM POTASSIUM
But it raises myocardial threshold potential which reduces excitability and risk of arrhythmias
Which drugs does calcium reduce intestinal absorption of?
Bisphosphonates
Iron
Levofloxacin
Tetracyclines
What are the indications for calcium channel blockers?
Hypertension
Stable angina
Supraventricular arrhythmias
What are common side effects of dihydropyridines?
Ankle swelling
Flushing
Headache
Palpitations
What are the major side effects of verapamil?
Constipation
Serious S/Es: bradycardia, heart block, cardiac failure
Why should dihydropyridines be avoided in severe aortic stenosis?
Amlodipine and nifedipine can provoke collapse
How do cephalosporins and carbapenems exert their antimicrobial effect?
Inhibits enzyme involved in cross-linking peptidoglycans in bacterial cell walls, causing bacterial swelling, lysis and death
What are the indications for cephalosporins and carbapenems?
2nd/3rd line treatment for urinary and respiratory tract infections
IV treatment for very severe and complicated infections or caused by antibiotic-resistant organisms
What are common side effects of cephalosporins?
GI upset
Abx-associated colitis
Hypersensitivity reactions
Potentiates effect of warfarin
What are the indications for clopidogrel?
- Tx of ACS
- Prevent occlusion of coronary artery stents
- A fib when warfarin/NOACs are contraindicated
- Long-term secondary prevention of CVD, PVD, Cerebrovascular disease
What is the MoA of clopidogrel?
Irreversibly binds to P2Y12 ADP receptor, preventing platelet aggregation
What are the major side effects of clopidogrel?
Bleeding
GI upset
Thrombocytopenia
Why will cytochrome P450 inhibitors reduce efficacy of clopidogrel?
Clopidogrel is a prodrug which requires metabolisation into its active form by CYP450.
Examples of inhibitors include erythromycin, ciprofloxacin, omeprazole etc.
What gastroprotection is given with aspirin and clopidogrel?
Aspirin- omeprazole
Clopidogrel- lansoprazole/pantoprazole (omeprazole causes CYP450 inhibition!)
What are the SEs of long term PPI use?
Increased risk of #’s
Mask symptoms of gastric cancer
Hypomagnesemia (may cause tetany, ventricular arrhythmia)
What are the indications for LABA/ICS inhalers?
Asthma
COPD
What are the important adverse effects of LABA/ICS inhalers?
Oral thrush
Hoarse voice
Systemic adverse effects e.g adrenal suppression, osteoporosis
Long-acting beta-2 agonists may cause tremor, tachycardia, arrhythmias and muscle cramps
What are 4 indications for systemic glucocorticoids?
- Allergic or inflammatory disorders
- Autoimmune disease
- Malignancy (reduce swelling)
- Adrenal insufficiency or hypopituitarism
What are the major side effects of systemic glucocorticoids?
Immunosuppression
Metabolic effects (DM, osteoporosis)
Mood and behavioural changes
Adrenal atrophy
When is the best time to administer daily oral corticosteroid?
Morning
mimc natural circadian rhythm and reduce insomnia
Why is it important for asthma patients to take sufficient inhaled corticosteroids?
Control symptoms
Prevents disease progression (i.e. airway remodelling and fixed airflow osbtruction)
What are the main side effects of digoxin?
Bradycardia GI disturbance Rash Dizziness Visual disturbance Arrhythmias with toxicity
When is digoxin contraindicated?
2nd degree heart block
Complete heart block
Ventricular arrhythmias
What electrolyte abnormalities increase risk of digoxin toxicity?
Hypokalemia
Hypomagnesemia
Hypercalcemia
What are the 2 indications for dypiridamole?
- Secondary prevention of stroke following TIA (where clop is contraindicated)
- Induce tachycardia in myocardial perfusion scanning for diagnosis of ischaemic heart disease
What are 3 indications for loop diuretics?
Acute pulmonary oedema
Chronic heart failure
Other oedematous states e.g. liver/renal failure
What is the MoA of loop diuretics?
Blocks Na+K+2Cl- in TAL
Dilatation of capacitance veins (reduces preload)
In what conditions should loop diuretics be used with caution?
Hypovolemia
Hepatic encephalopathy
Hypokalemia and hyponatremia
Gout
Why do loop diuretics increase risk of hearing loss/tinnitus?
Similar co-transporter responsible for regulating endolymph composition in inner ear
What is the class and mechanism of action of amiloride?
Potassium-sparing diuretic
Inhibits ENaC in DCT (prevents sodium reabsorption)
What is the mechanism of action of ropinirole and pramipexol?
D2 agonist
What are side effects of dopaminergic drugs?
Nausea, drowsiness, confusion, hallucinations, hypotension, wearing-off effect (levodopa), on-off effect
What are the side effects of levodopa? (DOPAMINE)
Dyskinesia On-off effect Psychosis Agitation Mouth dryness Insomnia N&V EDS
What are the indications for fibrinolytic therapy?
Acute ischaemic stroke (within 4.5 hrs)
Acute STEMI (within 12 hrs)
Massive PE with haemodynamic instability
What is the mechanism of action of alteplase?
Catalyses the conversion of plasminogen to plasmin, which dissolves clots and re-canalise vessels
What are the major adverse effects of fibrinolytic agents?
N&V Bruising Hypotension Serious bleeding Allergic reactions Cardiogenic shock Reperfusion injury (cerebral oedema, arrhythmias)
What are the indications for gabapentin and pregabalin?
Focal epilepsies
Neuropathic pain
Gabapentin- migraine prophylaxis
Pregabalin- GAD
What is the mechanism of action of gabapentin?
Binds to voltage-gated Ca2+ channels, inhibits Ca2+ inflow and prevents neurotransmitter release
Why are H2-receptor antagonists better than PPI’s for pre-op patients who have reflux?
Rapid onset of action compared to PPIs; will reduce risk of reflux/aspiration pneumonitis during general anaesthesia
What are the indications for heparin?
VTE prophylaxis and treatment
First line therapy in ACS
What is the mechanism of action of fondaparinux?
Inhibits factor Xa
What are the major side effects of heparin?
BLEEDING
Injection site reactions
Heparin-induced thrombocytopenia
What is the reversal agent for major bleeding associated with heparin?
Protamine (effective for UFH but less for LMWH, ineffective for fondaparinux)
What are the indications for insulin?
T1D
Poorly controlled T2D
Diabetic emergencies
In combo with glucose for hyperkalemia
How is insulin excreted?
Renal excretion
When insulin therapy is combined with systemic corticosteroid therapy, do requirements increase or decrease?
INCREASE
What are the major uses of carbamazepine?
Partial seizures
Trigeminal neuralgia
Bipolar disorder
