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Pharmacology > Top 100 Drugs II > Flashcards

Top 100 Drugs II Flashcards

1
Q

What are the indications for bisphosphonates?

A

Osteoporosis (those at risk of fragility #’s)
Hypercalcemia of malignancy
Bone mets (myeloma, BCa)
Paget’s disease

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2
Q

How do bisphosphonates work?

A

Inhibits action of osteoclasts by accumulating in them –> inhibits activity, promotes apoptosis

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3
Q

Important adverse effects of bisphosphonates?

A

Oesophagitis
Hypophosphatemia

Osteonecrosis of jaw
Atypical femoral #

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4
Q

What are the indications for calcium and vitamin D?

A
  1. Osteoporosis
  2. Hypocalcemia (symptomatic)
  3. Severe hyperkalemia
  4. Chronic kidney disease
  5. Osteomalacia/rickets (vitamin D deficiency)
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5
Q

What is the function of calcium in the setting of severe hyperkalemia?

A

IT DOES NOT LOWER SERUM POTASSIUM

But it raises myocardial threshold potential which reduces excitability and risk of arrhythmias

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6
Q

Which drugs does calcium reduce intestinal absorption of?

A

Bisphosphonates
Iron
Levofloxacin
Tetracyclines

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7
Q

What are the indications for calcium channel blockers?

A

Hypertension
Stable angina
Supraventricular arrhythmias

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8
Q

What are common side effects of dihydropyridines?

A

Ankle swelling
Flushing
Headache
Palpitations

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9
Q

What are the major side effects of verapamil?

A

Constipation

Serious S/Es: bradycardia, heart block, cardiac failure

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10
Q

Why should dihydropyridines be avoided in severe aortic stenosis?

A

Amlodipine and nifedipine can provoke collapse

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11
Q

How do cephalosporins and carbapenems exert their antimicrobial effect?

A

Inhibits enzyme involved in cross-linking peptidoglycans in bacterial cell walls, causing bacterial swelling, lysis and death

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12
Q

What are the indications for cephalosporins and carbapenems?

A

2nd/3rd line treatment for urinary and respiratory tract infections
IV treatment for very severe and complicated infections or caused by antibiotic-resistant organisms

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13
Q

What are common side effects of cephalosporins?

A

GI upset
Abx-associated colitis
Hypersensitivity reactions
Potentiates effect of warfarin

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14
Q

What are the indications for clopidogrel?

A
  1. Tx of ACS
  2. Prevent occlusion of coronary artery stents
  3. A fib when warfarin/NOACs are contraindicated
  4. Long-term secondary prevention of CVD, PVD, Cerebrovascular disease
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15
Q

What is the MoA of clopidogrel?

A

Irreversibly binds to P2Y12 ADP receptor, preventing platelet aggregation

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16
Q

What are the major side effects of clopidogrel?

A

Bleeding
GI upset
Thrombocytopenia

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17
Q

Why will cytochrome P450 inhibitors reduce efficacy of clopidogrel?

A

Clopidogrel is a prodrug which requires metabolisation into its active form by CYP450.
Examples of inhibitors include erythromycin, ciprofloxacin, omeprazole etc.

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18
Q

What gastroprotection is given with aspirin and clopidogrel?

A

Aspirin- omeprazole

Clopidogrel- lansoprazole/pantoprazole (omeprazole causes CYP450 inhibition!)

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19
Q

What are the SEs of long term PPI use?

A

Increased risk of #’s
Mask symptoms of gastric cancer
Hypomagnesemia (may cause tetany, ventricular arrhythmia)

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20
Q

What are the indications for LABA/ICS inhalers?

A

Asthma

COPD

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21
Q

What are the important adverse effects of LABA/ICS inhalers?

A

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

22
Q

What are 4 indications for systemic glucocorticoids?

A
  1. Allergic or inflammatory disorders
  2. Autoimmune disease
  3. Malignancy (reduce swelling)
  4. Adrenal insufficiency or hypopituitarism
23
Q

What are the major side effects of systemic glucocorticoids?

A

Immunosuppression
Metabolic effects (DM, osteoporosis)
Mood and behavioural changes
Adrenal atrophy

24
Q

When is the best time to administer daily oral corticosteroid?

A

Morning

mimc natural circadian rhythm and reduce insomnia

25
Q

Why is it important for asthma patients to take sufficient inhaled corticosteroids?

A

Control symptoms

Prevents disease progression (i.e. airway remodelling and fixed airflow osbtruction)

26
Q

What are the main side effects of digoxin?

A 
Bradycardia
GI disturbance
Rash
Dizziness
Visual disturbance
Arrhythmias with toxicity
27
Q

When is digoxin contraindicated?

A

2nd degree heart block
Complete heart block
Ventricular arrhythmias

28
Q

What electrolyte abnormalities increase risk of digoxin toxicity?

A

Hypokalemia
Hypomagnesemia
Hypercalcemia

29
Q

What are the 2 indications for dypiridamole?

A
  1. Secondary prevention of stroke following TIA (where clop is contraindicated)
  2. Induce tachycardia in myocardial perfusion scanning for diagnosis of ischaemic heart disease
30
Q

What are 3 indications for loop diuretics?

A

Acute pulmonary oedema
Chronic heart failure
Other oedematous states e.g. liver/renal failure

31
Q

What is the MoA of loop diuretics?

A

Blocks Na+K+2Cl- in TAL

Dilatation of capacitance veins (reduces preload)

32
Q

In what conditions should loop diuretics be used with caution?

A

Hypovolemia
Hepatic encephalopathy
Hypokalemia and hyponatremia
Gout

33
Q

Why do loop diuretics increase risk of hearing loss/tinnitus?

A

Similar co-transporter responsible for regulating endolymph composition in inner ear

34
Q

What is the class and mechanism of action of amiloride?

A

Potassium-sparing diuretic

Inhibits ENaC in DCT (prevents sodium reabsorption)

35
Q

What is the mechanism of action of ropinirole and pramipexol?

A

D2 agonist

36
Q

What are side effects of dopaminergic drugs?

A

Nausea, drowsiness, confusion, hallucinations, hypotension, wearing-off effect (levodopa), on-off effect

37
Q

What are the side effects of levodopa? (DOPAMINE)

A 
Dyskinesia
On-off effect
Psychosis
Agitation
Mouth dryness
Insomnia
N&V
EDS
38
Q

What are the indications for fibrinolytic therapy?

A

Acute ischaemic stroke (within 4.5 hrs)
Acute STEMI (within 12 hrs)
Massive PE with haemodynamic instability

39
Q

What is the mechanism of action of alteplase?

A

Catalyses the conversion of plasminogen to plasmin, which dissolves clots and re-canalise vessels

40
Q

What are the major adverse effects of fibrinolytic agents?

A 
N&V 
Bruising
Hypotension
Serious bleeding
Allergic reactions
Cardiogenic shock
Reperfusion injury (cerebral oedema, arrhythmias)
41
Q

What are the indications for gabapentin and pregabalin?

A

Focal epilepsies
Neuropathic pain
Gabapentin- migraine prophylaxis
Pregabalin- GAD

42
Q

What is the mechanism of action of gabapentin?

A

Binds to voltage-gated Ca2+ channels, inhibits Ca2+ inflow and prevents neurotransmitter release

43
Q

Why are H2-receptor antagonists better than PPI’s for pre-op patients who have reflux?

A

Rapid onset of action compared to PPIs; will reduce risk of reflux/aspiration pneumonitis during general anaesthesia

44
Q

What are the indications for heparin?

A

VTE prophylaxis and treatment

First line therapy in ACS

45
Q

What is the mechanism of action of fondaparinux?

A

Inhibits factor Xa

46
Q

What are the major side effects of heparin?

A

BLEEDING
Injection site reactions
Heparin-induced thrombocytopenia

47
Q

What is the reversal agent for major bleeding associated with heparin?

A

Protamine (effective for UFH but less for LMWH, ineffective for fondaparinux)

48
Q

What are the indications for insulin?

A

T1D
Poorly controlled T2D
Diabetic emergencies
In combo with glucose for hyperkalemia

49
Q

How is insulin excreted?

A

Renal excretion

50
Q

When insulin therapy is combined with systemic corticosteroid therapy, do requirements increase or decrease?

A

INCREASE

51
Q

What are the major uses of carbamazepine?

A

Partial seizures
Trigeminal neuralgia
Bipolar disorder

Pharmacology (5 decks)

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