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4 Clinical Pharmacology and Intro to Prescribing > CPT Drugs > Flashcards

CPT Drugs Flashcards

1
Q

Give the names of 2 ACE inhibitors.

A

naproxen= NSAID

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3
Q

Explain why a patient may get a dry cough as a result of taking lisinopril or ramipril.

A
  1. Bradykinin is a substrate for ACE aswell as ACEi.
  2. Use of ACEi potentiates bradykinin
  3. Bradykinin causes vasodilation via NOS/NO and prostacyclin (vasodilator)
  4. Dry cough due to build up of bradykinin
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4
Q

What are some of the contraindications of ACE inhibitors? (5) Who should they not be given to? (3)

A

Contraindications

  1. Hypotension
  2. Dry cough
  3. Hyperkalaemia (low aldosterone)
  4. Renal failure (renal artery stenosis)
  5. AKD

Who should we not give ACE inhibitors to?

  1. Patients w./ CKD
  2. Pregnancy
  3. Breastfeeding
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5
Q

Give 2 examples of angiotensin II receptor blockers (ARBs).

A
  1. Candesartan
  2. Losartan
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6
Q

How do ARBs act to reduce BP?

(ARBs= Angiotensin-II blockers= AT1 Receptor blockers)

A

Angiotensin II acts on AT1 and AT2 receptors

Directly target AT1 receptors (more effective at inhibiting Angiotensin II mediated vasoconstriction - chymase production)

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7
Q

Why do ARBs not cause a dry cough or angioedema but ACE inhibitors do?

Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes

A

ARBs have no effect on bradykinin

Less effective in low- renin hypertensives

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8
Q

What are some of the important drug interactions with ACEi to note?

A
  1. Drugs that increase K+
  2. NSAIDs
  3. Other antihypertensive agents
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10
Q

How do CCBs (calcium channel blockers) work to reduce hypertension?

A

CCBs- target calcium initiated smooth muscle contraction

Different classes (3) interact with different sites on α1 subunit of VOCC

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11
Q

Outline the mechanism/site of action of the 3 classes of CCBs which are used to treat hypertension:

  • State the names of drugs in each class
  • State how they work
  • Which class is the first line CCB in hypertension
  • Which drug has selectvity for cerebral vasculature
  • Which drug is use to treat arrythmia and angina
A
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13
Q

What are the 2 important drug interactions to know for the dihydropyridine class of CCBs?

A
  • Amlodipine + simvastatin - increase effect of statin
  • Other antihypertensive agents
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15
Q

What are some of the contraindications of ACE inhibitors? (3) Who should they not be given to? (3)

A

Contraindications

  • Hyperkalaemia (low aldosterone)
  • Renal failure (renal artery stenosis)
  • AKD

Who should we not give ACE inhibitors to?

  • Patients w./ CKD
  • Pregnancy
  • Breastfeeding
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16
Q

Give the name of a thiazide diuretic and a thiazide like diuretic.

A

Thiazide diuretic: bendroflumethiazide

Thiazide like diuretic: indapamide

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17
Q

What are some of the important drug interactions with ARBs to note?

A
  1. Drugs that increase K+
  2. NSAIDs
  3. Other antihypertensive agents
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19
Q

Why are CCBs used in the first instances to treat hypertension in over 55s and those of black African and Caribbean groups?

A

These populations have low levels of renin in first place- not ideal target system in first instance (RAAS)

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21
Q

What drugs can be used to treat resistant hypertension (stage 4)? (3) Which of these should be used if blood potassium is >4.5 mmol/l and if blood potassium is <4.5 mmol/l?

A
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22
Q

What are some of the side effects of dihydropyridines and who should it not be given to (contraindications)?

A

Side effects:

Ankle swelling

Flushing

Headaches

Palpitations

Contraindications:

Unstable angina

Severe aortic stenosis

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24
Q

What are some of the side effects of phenylalkylamines and who should it not be given to (contraindications)?

A

Side effects:

  • Constipation
  • Bradycardia (iv)
  • Heart block
  • Cardiac failure

Contraindications:

  • Poor left ventricular function
  • AV nodal conduction delay
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25
Q

What are 3 important drug interactions with phenylalkylamines that we should be aware of?

A
  • β-blockers
  • Other hypertensives
  • Other antiarrythmics
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27
Q

Identify some drugs used to treat and manage heart failure:

A
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28
Q

What are some of the side effect of thiazides and what are their 2 important drug interactions?

A

Side effects:

  • Hypokalaemia
  • Hyponatraemia
  • Impaired glucose tolerance
  • Increased cholesterol and triglyceride levels
  • Gout
      • Increased urea and uric acid levels

Interations:

  • NSAIDs
  • Potassium lowering drugs
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29
Q

Thiazides are more likely to be chosen to treat hypertension over CCBs if the patient has what sign/symptom?

A

Oedema

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31
Q

Why are ACE inhibitors or ARBs the first line treatment for hypertension secondary to type 2 diabetes irrespective of age or ethnicity?

A

ACEis and ARBs have added benefits at kidneys

  • Decrease incidence of diabetic nephropathy and CKD w./proteinuria
    • Dilation of efferent glomerular arteriole
      • Reduced intraglomerular pressure
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33
Q

How does spironolactone work? What are its contraindications (2) and what are its important drug interactions to consider?

A

Sprionolactone= aldosterone antoagonist–> stops action of aldosterone at ENaC and also blocks ROMK

​Contraindications:

  1. Hyperkalaemia
  2. Addison’s

Interactions:

  1. Other K+ increasing drugs
  2. ACE inhibitors
  3. ARBs
34
Q

Name 3 β-adrenoreceptor blockers (used to treat hypertension) and explain how beta blockers work to reduce blood pressure.

A
  1. Labetalol (β1, β2 and α1)
    1. Used: preganncy and hypertensive emergencies)
  2. Bisoprolol (β1)
  3. Metoprolol (β1)

How do they work?

  • Block noradrenaline
    • Decrease sympathetic tone
    • Reduce CO
    • Reduce release of renin in kidneys (release= partly regulated by β1- adrenoreceptors)
    • ie REDUCE SYMPATHETIC OUTFLOW
35
Q

With relation to β-blockers give the:

Side effects (5)

Contraindications (4)

Interactions (1)

A

Side effects:

  1. Bronchospasm
  2. Heart block
  3. Raynaud’s
  4. Lethargy
  5. Impotence

Contraindications:

  1. Asthma
  2. COPD
  3. Haemodynamic instability
  4. Hepatic failure

Interactions:

  1. Non-dihydropyridine CCBs
    1. Verapamil
    2. Diltiazem
36
Q

Name 2 α-blocker and describe how they work to treat hypertension. Apart from hypertension what else are they used to treat?

A
  1. Doxazosin
  2. Tamsulosin

How does it work?

  • Selective antagonism- α-1 adrenoreceptors
    • Reduce peripheral vascular resistance

Tamsulosin also used to treat symptoms of BPH

37
Q

State the main contraindications and interactions from α-adrenoreceptor blockers.

A

Contraindications:

  • Postural hypotension

Interactions:

  • Dihydropyridien CCBs- oedema
38
Q

What are the seven different types of diuretic drugs acting on the kidney?

A
  • Carbonic anhydrase inhibitors
  • Osmotic diuretics
  • Loop diuretics
  • Thiazides
  • K+ sparing diuretics
  • Aldosterone antagonists
  • ADH Antagonists
39
Q

Describe the actions (2) and side effects (2) of carbonic anhydrase inhibitors

A

Actions:

  • Sodium bicarbonate diuresis
  • Excretion of Na+, K+ and PO3

Side effects:

  • Metabolic acidosis
  • Hypokalemia
41
Q

Describe the actions and side effects of osmotic agents

Name an example of an osmotic agent.

A

Actions:

  • Filtered at glomerulus
  • Increase osmotic gradient throughout nephron
  • Excessive water loss

Side effects:

  • Hypernatraemia

Example:

  1. Mannitol
42
Q

Describe the actions and side effects of thiazides.

Name 2 examples.

A

Actions:

  • Inhibits NaCl reabsorption
  • Promotes Ca reabsorption

Side effects:

  • Hypokalaemia
  • Hyperuricaemia

Examples:

  1. Bendroflmethiazide
  2. Indapamide
43
Q

Describe the actions and effects of aldosterone antagonists.

Name an example:

A
  • Competes with aldosterone at mineralcorticosteroid receptor
  • Aldosterone increases expression of ENaC and Na/K/ATPasein principal cells of the collecting duct

Example:

Spironolactone (potassium sparing)

44
Q

Outline the action of ADH antagonists. (aquaretics)

Give 2 examples

A

ADH antagonists reduce concentrating ability of urine in collecting ducts

45
Q

Describe the actions and side effects of loop diuretic.

Name 2 examples.

A

Actions:

  • Thick ascending limb loop of Henle
  • Inhibit NaCl reabsorption (block Na/K/2Cl co-transporter)
  • Concurrent Ca/Mg excretion

Side effects:

  • Hypokalaemia (CD)

Examples:

  1. Bumetanide
  2. Furosemide
49
Q

Identify 5 common specific ADRs from thiazides

A
  • Gout
  • Hyperglycaemia
  • Erectile dysfunction
  • ↑LDL & TG
  • Hypercalcaemia
50
Q

Identify 3 common specific ADRs from spironolactone

A
  • Hyperkalaemia
  • Impotence
  • Painful gynaecomastia (male breasts)
51
Q

Identify 4 common specific ADRs from furosemide (loop diuretic)

A
  • Ototoxicity
  • Alkalosis
  • ↑LDL & TG
  • Gout
52
Q

Identify a common specific ADRs from bumetanide (loop diuretic)

A

Myalgia

53
Q

Explain the effect of ACE Inhibitors interacting with K+ sparing diuretics

A

Increased hyperkalaemia → cardiac problems

54
Q

What is the effect of aminoglycosides interacting with loop diuretics?

A
  • Ototoxicity
  • Nephrotoxicity
55
Q

Explain the effect of digoxin interacting with thiazide and loop diuretics

A

Hypokalaemia → increased digoxin binding & toxicity

56
Q

What is the effect of β- Blockers interacting with thiazide diuretics?

A
  • Hyperglycemia
  • Hyperlipidemia
  • Hyperuricaemia
57
Q

What is the effect of steroids interacting with thiazide & loop diuretics?

A

Increased risk of hypokalaemia

58
Q

What is the effect of lithium interacting with thiazide & loop diuretics?

A
  • Lithium toxicity (thiazides)
  • Reduced lithium levels (loop)
59
Q

What is the effect of carbamazepine interacting with thiazide diuretics?

A

Increased risk of hyponatraemia

60
Q

Which diuretics are commonly used to treat hypertension? Why are loop diuretics not usually used?

A
  • Thiazide diuretics (vasodilatation as well as diuresis)
  • Spironolactone

(Loop diuretics) - don’t work well as body compensates quickly

61
Q

Which diuretics are commonly used to treat heart failure?

A
  • Loop diuretics
  • Spironolactone (non-diuretic benefits)

(ACE inhibitors/ ARBs)

(Beta- blockers)

62
Q

Which diuretics are commonly used to treat decompensated liver disease?

A
  • Spironolactone
  • Loop diuretics
63
Q

Useful table for drug-drug interactions with diuretics:

A
64
Q

Which diuretics are commonly used to treat nephrotic syndrome?

A
  • Loop diuretic (often big doses needed)
  • ± Thiazides
  • ± K+ sparing diuretic / K+ supplements
65
Q

Which diuretics are commonly used to treat Chronic Kidney Disease?

A
  • Loop diuretics
  • ± Thiazide-like
  • Generally avoid K+ sparing diuretics

(Alkalosis and kalliuretic effects potentially beneficial)

Kalliuretic= getting rid of potassium in urine)

66
Q

Identify four potentially nephrotoxic drugs

A
  • Aminoglycosides e.g gentamicin
  • Vancomycin (IV only)
  • Aciclovir (antiviral)
  • NSAIDs
67
Q

What are SGLT2 inhibitors used for?

A

Treating type 2 diabetes

Get rid of uric acid

68
Q

Identify four drugs which can exacerbate renal dysfunction

A
  • ACE-Inhibitors
  • Diuretics
  • NSAIDs
  • Metformin
70
Q

Apart from spironolactone, give another example of a potassium sparing diuretic and state how is works:

A

Amiloride

Block ENaC at luminal surface of renal tubule

71
Q

What are carbonic anhydrase inhibitors used to treat?

A
  • Glaucoma
  • Mountain sickness

(BUT tolerance builds up in 2-3 days)

72
Q

Mannitol is an osmotic agent (diuretic), what is it used for?

(need to be careful as patients can become hypernaetraemic)

A

Used as diuretic in ITU to 1) relieve ICP and to 2) force urine production in people with acute (sudden) kidney failure

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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