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Commonly Prescribed Drugs In Community Flashcards

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1
Q

Describe the antihypertensives ladder

A

<55y/ diabetic= ACEi
>55y / afrocarribean= Calcium channel blocker

Step 2= use both
Step 3= add thiazide like diuretic
Step 4= add spironolactone or alpha/beta blocker

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2
Q

Describe the oral hypoglycaemic ladder

A

Step 1= diet control
Step 2= metformin (sulfonylurea if thin)
Step 3= sulfonylurea, pioglitazone, GLP agonist
Step 4= triple therapy/ insulin

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3
Q

What class of drug is metformin?

A

Biguanide

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4
Q

How does metformin work?

A

Increased insulin sensitivity and suppress gluconeogenesis

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5
Q

What are the side effects of metformin?

A

GI disturbance
Weight loss
Lactic acidosis
Metallic taste

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6
Q

What are the contraindications to metformin?

A

Low BMI
Creatinine >150
GFR <30

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7
Q

Give an example of a sulfonylurea

A

Gliclazide

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8
Q

How do sulfonylureas work?

A

Increased B cell insulin secretion (must be at mealtimes)

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9
Q

What are the side effects of sulfonylureas?

A

Hypos

Weight gain

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10
Q

What are the contraindications to using sulfonylureas?

A

Patients at risk of hypos

Severe hepatic/ renal impairment

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11
Q

What is an example of a thiazolidinedione?

A

Glitazones eg pioglitazone

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12
Q

How does pioglitazone work?

A

PPARy agonist—> increases fat and muscle glucose uptake

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13
Q

What are the side effects of pioglitazone?

A

Fluid retention
Fractures
Hepatotoxic
Weight gain

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14
Q

What are the contraindications to using pioglitazone?

A

Heart failure

History of bladder cancer

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15
Q

What is an example of a DPP4 inhibitor?

A

Sitagliptin

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16
Q

What is the mechanism of action of gliptins?

A

Inhibit DPP4 which breaks down GLP 1 which is a hormone released by the gut to increase insulin after food

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17
Q

What are the side effects of gliptin?

A

Pancreatitis

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18
Q

Give an example of a GLP agonist

A

Exenatide

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19
Q

What is the mechanism of action of exenatide?

A

Mimics GLP 1 which is a hormone released by the gut to increase insulin after food

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20
Q

What are the side effects of exenatide?

A

GI disturbance and indigestion
Pancreatitis
Weight loss

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21
Q

What are the contraindications of exenatide?

A

GFR<50
History of pancreatitis
Severe GI disease

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22
Q

Give an example of an SGLT 2 inhibitor

A

Dapaglifozin, canaglifozin

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23
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Increase urinary glucose excretion

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24
Q

What are the side effects of SGLT 2 inhibitors?

A

UTIs, ketoacidosis

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25
What are the contraindications of SGLT2 inhibitors?
GFR<30
26
Which hypoglycaemics are safe in pregnancy?
Metformin and insulin
27
What HbA1c do we aim for with the patient on oral hypoglycaemics?
48-58mmol/mol
28
Describe the asthma ladder
Step 1- SABA + inhaled steroid Step 2- SABA+ ICS+ LABA Step 3- trial of increasing ICS, LAMA, LTRA, SR theophylline Step 4- daily steroid tablet
29
Describe the COPD ladder
Step 1: SABA(salbutamol)+ SAMA(ipratropium) FEV1>50%- LABA— add ICS Or LAMA FEV1<50%- LAMA Or LABA+ICS Step 3: LABA+LAMA+ICS
30
What does seretide consist of?
Salmeterol+ fluticasone
31
What does symbicort consist of?
Formeterol+ budesonide
32
What does fostair consist of?
Formoterol+ beclometasone
33
How can HRT be given?
Systemic Oral Transdermal Vaginal
34
Which HRT do you give to a lady without a uterus?
Oestrogen only HRT (oral or transdermal)
35
Which type of HRT do you give to a woman with a uterus?
Perimenopausal—> cyclical HRT (oestrogen everyday but progesterone given also for 12-14 days at end of every menstrual cycle if still having regular periods, or every 13 weeks if having irregular periods Post menopausal (no periods for >1 yr or cyclical HRT for > 1 yr)—> give continuous HRT (continious oestrogen and progesterone, no bleed)
36
What are the contraindications to HRT?
``` Undiagnosed PV bleeding Pregnancy/ breastfeeding Oestrogen dependent cancer Active liver disease Uncontrolled hypertension History of breast cancer History of VTE Recent stroke/ MI/ angina ```
37
What are the side effects of HRT?
Vaginal bleeding, premenstrual syndrome, breast tenderness, leg cramps, nausea/bloating
38
What are the long term risks of HRT?
``` Increased VTE risk Increased stroke risk Increased breast cancer risk with time Increased ovarian cancer risk >5y Increased endometrial cancer risk if unopposed oestrogen ```
39
What is an example of an SSRI?
Fluoxetine Citalopram Paroxetine Sertraline
40
How do SSRIs work?
Increased extracellular serotonin by limiting its reabsorption
41
What are the side effects of SSRIs?
Sexual dysfunction Withdrawal Insomnia Hyponatraemia
42
What do you need to be careful about with SSRIs?
May increase suicide risk | Safe in overdose
43
What is an example of an SNRI?
Duloxetine, venlafaxine
44
How do SNRIs work?
Increased extracellular serotonin and noradrenaline by limiting their reabsorption
45
What are the side effects of SNRIs?
``` Hypertension Sexual dysfunction Insomnia Withdrawal Hyponatraemia ```
46
What is an example of a tricyclic antidepressant?
Amitryptylline
47
How do TCAs work?
Block serotonin and NA transporters resulting in elevation in their synaptic concentrations
48
What are the side effects of TCAs?
Antimuscarinic effects: Dry mouth, constipation, blurred vision, urinary retention Hyponatraemia
49
What must you be cautious of in prescribing amytrptylline>
Dangerous in overdose
50
What is an example of a monoamine oxidase inhibitor?
Selegiline, phenelzine
51
How do MAOIs work?
Inhibits monoamine oxidase (an enzyme that oxidises monoamines to inactivate them)
52
What are the side effects of monoamines?
Hypertension Hepatocellular jaundice Hyperthermia
53
What must you warn the patient about if prescribing MAOIs?
Do not eat tyramine containing foods eg cheeses and cured meats as they may trigger a hypertensive crisis.
54
What is the first line drug for lowering cholesterol?
Statins
55
What are some examples of statins?
Atorvastatin Fluvastatin Pravastatin Simvastatin
56
How do statins work?
Inhibit HMG CoA reductase which is an enzyme involved in hepatic cholesterol synthesis
57
What are the indications for statin use?
``` Any vascular disease Any lipid disorder QRISK >10% T1 diabetic if >40y/ had diabetes >10 years? Nephropathy/ CVS risk factors CKD Ratio of total cholesterol: HDL >6 ```
58
What are the side effects of statins?
Maylgia and rhabdo myolysis | Hepatotoxicity and increased liver enzymes
59
What is the 2nd line management for high cholesterol?
Ezetimibe
60
How does ezetimibe work?
Decreases cholesterol absorption in small intestine
61
What are the indications for ezetimibe use?
Primary hypercholesterolaemia if statin not tolerated or contraindicated In conjunction with statin if statin fails to control total cholesterol o LDL cholesterol alone
62
What are the side effects of ezetimibe?
Headache | Diarrhoea (steattorhoea)
63
What is the 3rd line medication for statins?
Fibrates
64
How do fibrates work?
Act in liver to reduce cholesterol synthesis Reduce VlDL secretion and increase their removal from the blood Increases plasma HDL
65
What are the indications for fibrate use?
``` Isolated triglyceridaemia (>10mmol/L) Hypercholesterolaemia if statin not tolerated ```
66
What are the side effects of fibrates?
GI disturbance | Myalgia and rhabdomyolysis
67
What are the cautions in prescribing fibrates?
Do not use with statins
68
What medications are first line for heart failure?
ACEi, beta blocker, diuretic
69
What medications are second line for heart failure?
Aldosterone antagonist eg spironolactone
70
What medication is 3rd line for heart failure?
Digoxin
71
How does haemostasis work?
3 factors: Vascular spasm Platelet plug formation Coagulation Intrinsic pathway: damaged surface—> factor 7,11,9,8–> factor 10 converts prothrombin to thrombin, thrombin converts fibrinogen to fibrin Extrinsic pathway: tissue damage—> thromboplastin—> factor 7–> factor 10, converts prothrombin to thrombin, converts fibrinogen to fibrin.
72
How does clot dissolution work?
Plasminogen—-> plasmin, | Also protein C&S, heparin and antithrombin
73
What are the vitamin K dependent clotting factors?
2,7,9,10 (and protein C&S)
74
What pathway does PT and INR measure?
Extrinsic pathway
75
What pathway does APTT measure?
intrinsic
76
How does warfarin work?
Reduces the synthesis of vitamin K dependent clotting factors
77
How is warfarin action monitored?
INR
78
What is warfarin used for?
AF VTE Metallic heart valves
79
What are the advantages and disadvantages of warfarin?
Easily reversible Regular INRs required Under/over coagulation CYP450 interactions
80
Give an example of a direct thrombin inhibitor
Dabigatran
81
How does dabigatran work?
Inhibits thrombin
82
How is dabigatran reversed?
Praxbind
83
What is dabigatran used for?
AF, VTE, post op VTE prophylaxis
84
What are the advantages and disadvantages of dabigatran
Quick onset/offset, no monitoring required Irreversible, renally cleared
85
Give an example of a direct oral anticoagulant
Rivaroxaban | Apixaban
86
How do DOACs work?
Inhibits factor Xa
87
What monitoring is required for DOACs?
None
88
Can DOACs be reversed?
No
89
what are the indications for DOACs?
AF | VTE, post op VTE prophylaxis
90
What are the advantages and disadvantages of DOACs?
Quick onset/offset No monitoring required Irreversible Renally cleared
91
How does unfractionated heparin work?
Natural anticoagulant that potentiates antithrombin (inactivates factors 2,9,10,11,12) and inactivates thrombin
92
How is unfractionated heparin reversed?
Stop infusion | Protamine sulfate
93
What is unfractionated heparin used for?
Peri-op in patients requiring full anticoagulation for a high risk indication eg metallic heart valve
94
What are the advantages and disadvantages of unfractionated heparin?
Very fast onset, very fast reversal by stopping infusion. SC unfractionated heparin maay be used in patients with renal impairment instead of LMWH Regular APTRs required
95
How does LMWH work?
Consists of short chain heparins so binds to a specific part of antithrombin which results in inhibition of Xa only
96
How is heparin reversed?
Protamine sulfate
97
What is LMWH used for?
VTE | VTE prophylaxis
98
What are the advantages and disadvantages of LMWH?
Predictable effect Doesnt need routine monitoring Safe in pregnancy Renally cleared
99
What INR target do we aim for in DVT/PE?
2-3
100
What INR target do we aim for in AF?
2-3
101
What INR target do we aim for in patients with a mechanical heart valve?
2.5-3.5
102
What INR target do we aim for in patients with a mitral metallic heart valve?
3-4
103
How do we reverse warfarin when there is a major bleed?
Stop warfarin | Prothrombin complex concentrate, 5-10mg IV vitamin K
104
How do we reverse warfarin with the following INRs? INR>8 INR6-8 INR3-6
INR>8 stop warfarin, 0.5-2.5mg PO vitamin K if no other risk factors for bleeding INR 6-8 stop warfarin INR 3-6 reduce/ stop warfarin
105
What are the contraindications for the COCP?
Absolute: smoker>35 years, <6 weeks postpartum, breast feeding, hypertensive, current or past VTE, migraine with aura, CVD, current breast ca, liver cirrhosis. Relative: adequately controlled hypertension, migraine >35, BMI >35, enzyme inducing medications
106
How does the COCP work?
Stops ovulation Increased cervical mucus Thins endothelium
107
How are the COCP and other variants given?
Pill: take daily 3 weeks on, 1 week off Patch: change weekly. One free week per month Ring: leave in for 3 weeks then one ring free week
108
What are the side effects of COCP?
``` Hormonal SEs Blood clots Increased risk of breast/ cervical cancer Periods may become lighter Local irritation from patch ```
109
What are the missed pill rules?
Take ASAP even with the next one. If next one on time its fine If miss two, take one pill immediately and use a condom for 7 days. If in 1st week of packet will need emergency contraception if had sex in pill free interval or 1st week of pill packet. 2nd week: no action 3rd week: omit the pill free week.
110
What are some contraindications to Progesterone only pill?
Forgetfulness Breast cancer Undiagnosed PV bleeding Liver disease
111
How does the progesterone only pill work?
Increased cervical mucus | Thins endothelium
112
When do you take the POP?
Take daily at same time each day with no breaks
113
What are the side effects of the POP?
Hormonal SEs | Periods either stop, irregular, light, more frequent
114
What are the missed pill rules for POP?
Take ASAP even if with next one. If > 3 hours late use condom for 2 days and consider emergency contraception if had sex in 2-3 days before missed pull or had sex since missed pill
115
What are the contraindications for the copper coil or the mirena coil?
``` Pelvic infection/ PID < 3 months ago Gynae cancer Small uterine cavity Undiagnosed PV bleeding Copper allergy ```
116
How does the copper coil work?
Copper acts as a spermicide and also causes intrauterine inflammation
117
How long do the copper coil and mirena coil last for?
5 years
118
What are the side effects of the copper coil?
Coil insertion risks, periods may be heavier
119
What are the important things to know about the coils?
Check for string monthly STI check before inserting Put in anytime if not had sex since period, or within first 5 days since start of period If fitted >40y can stay in place until menopause
120
What are the contraindications for progesterone implant?
Liver/genital/ breast cancer Liver disease Undiagnosed PV bleeding
121
What is the mechanism of action of progesterone implants?
Stops ovulation Thickened cervical mucus Thins endothelium
122
How long does the progesterone implant work for?
3 years
123
How long does the progesterone injection work for/
3 months
124
What are the side effects of progesterone implants/ depot?
Irregular periods Hormonal SEs Bruising/infection after insertion

Oscestop Revision (3 decks)

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