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PHRM4012 > Drug and Clinical Knowledge > Flashcards

Drug and Clinical Knowledge Flashcards

(65 cards)

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1
Q

What is GOUT?

A

A chronic disease that involves the deposition of mono sodium urate crystals in the body.

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2
Q

Which drugs can inhibit the renal excretion of Uric acid?

A

Thiazide diuretics, loop diuretics, cyclosporine

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3
Q

What monitoring should be undertaken for people with GOUT?

A

Renal function, serum uric acid

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4
Q

What changes should be made to a patients urate lowering therapy when they are being treated for an acute gout attack?

A

No changes

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5
Q

What is the dosing regimen for prednisolone for an acute gout attack?

A

15 - 30mg daily until symptoms abate (typically 3-5 days)

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6
Q

What is the dosing regimen for colchicine for an acute gout attack?

A

1mg then 0.5mg 1 hour later (1.5mg total dose)

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7
Q

What is the first line drug and dosing regimen for long term management of GOUT?

A

Allopurinol (xanthine oxidase inhibitor). 50mg daily for 1-2 weeks then increase by 50mg daily every 2-4 weeks or 100mg every 4 weeks until the target serum urate concentration has been achieved. Max dose of 900mg daily

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8
Q

What is the serum urate target for non-tophaceous gout?

A

<0.36mmol/L

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9
Q

What is the serum urate target for tophaceous gout?

A

<0.3mmol/L

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10
Q

Which 2 drugs are contraindicated for use with Allopurinol and why?

A

Azathioprine and mercaptopurine. Allopurinol reduces the metabolism of these drugs resulting in increased risk of bone marrow toxicity.

Note: if this combination is unavoidable, decrease dose of azathioprine or mercaptopurine to 1/3 or 1/4 of original dose

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11
Q

Which drug can be added to Allopurinol if serum urate target cannot be achieved and what is its mechanism?

A

Probenecid. Blocks the renal tubular absorption of uric acid (uricosuric) and increases renal excretion of uric acid.

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12
Q

Which drug and what dose is recommend and prophylaxis for an acute gout attack when commencing on urate lowering therapy?

A

Colchicine 500mcg daily or bd

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13
Q

What are the four classes of drugs which are first line for hypertension?

A

ACE-I
ARBs
Non-dihydropyridine CCBs
Thiazide diuretics

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14
Q

Drug with the suffix (-gliptin) are found in which class?

A

DPP4-inhibitors (dipeptidyl peptidase)

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15
Q

What class of drugs have the suffix (-glutide)?

A

GLP-1 analogues (glucagon like peptide)

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16
Q

What is the mechanism of DPP-4 inhibitors?

A

Inhibit DPP-4 which results in:
- increase in glucose dependant insulin secretion
- reduced glucagon production

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17
Q

Can DPP-4 inhibitors be taken without food?

A

Yes

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18
Q

Biguanides, DPP-4 inhibitors and alpha 1 glucosidase inhibitors (acarbose) all have what in common?

A

They are weight neutral

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19
Q

Treatment with a sulfonylurea or insulin increases the risk of hypoglycaemia when combined with which class of drugs?

A

DPP-4 inhibitors

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20
Q

What is the dose of Linagliptin?

A

5mg daily

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21
Q

DPP-4 ADRs?

A
  • hypoglycaemia
  • GI disturbances
  • headache
  • muscle pain
  • pancreatitis
  • rash
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22
Q

What is the dose of Sitagliptin?

A

100mg daily

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23
Q

When should the dose of sitagliptin be reduced?

A

In renal impairment

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24
Q

What is the dose of Vildagliptin?

A

50mg bd

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25
What monitoring is important for vildagliptin?
Liver enzymes
26
What is the MOA of GLP-1 analogues?
- increase glucose dependant insulin secretion - suppress inappropriate glucagon secretion - delay gastric emptying (slows glucose absorption and decreases appetite)
27
Which other drug class has a similar MOA to GLP-1 analogues and as such, the combination is generally avoided?
DPP-4 inhibitors
28
Which diabetes medication class commonly causes GI symptoms upon commencement but generally decreases over time?
GLP-1 analogues
29
Weight loss is an often desirable side effect of which classes of diabetes medications?
- GLP-1 analogues - SGLT-2 inhibitors
30
What is the MOA for the SGLT2 - inhibitors?
Decrease glucose absorption in the kidneys
31
The -flozins belong to which class of diabetes drugs?
SGLT-2 inhibitors
32
WHat is the dose of empagliflozin?
10mg daily (25mg max)
33
What is the dose of dapagliflozin?
10mg daily
34
Which class of diabetes drugs would you NOT commence when a patient is acutely unwell?
SGLT-2 inhibitors (ketoacidosis)
35
WHich diabetes drug class is cardio and Reno protective?
SGLT-2 inhibitors
36
What are some of the common ADRs for SGLT-2 inhibitors?
Genital infection, GI disturbanaces, ketoacidosis, dehydration, dizziness, weight loss
37
What are some of the beneficial ADRs of GLP-1 analogues?
- weight loss - low risk of hypoglycaemia - BP lowering
38
ADRs of GLP-1 analogues
- weight loss - N & V - injection site reaction - increased HR
39
What are the three common GLP-1 analogues?
- Duloglutide - Semaglutide - Liraglutide
40
What drugs are first line for Parkinson’s disease? And what is the dose?
1. Levodopa/benserazide (50/12.5mg tds ➡️ 100/25mg tds) 1. Levodopa/carbidopa (50/12.5mg tds ➡️ 100/25mg tds)
41
Nausea is a common side effect of anti Parkinson’s medications. Which drug would be an appropriate treatment option if a a patient experiences nausea and what is it’s dosing regimen?
Domperidone 10mg tds for 1 week
42
What are the second line treatment options for Parkinson’s disease?
2. Pramipexole (dopamine agonist) 2. Rotigotine (dopamine agonist - patch, suitable for patients who are nil by mouth)
43
If a patient has a penicillin allergy. What is another appropriate drug therapy for H.pylori?
Metronidazole 400mg bd
44
What is the common first line treatment for eradication of H.pylori?
- esomeprazole 20mg bd - amoxicillin 1g bd - clarythromycin 500mg bd (For 7-14 days)
45
Donepezil, Rivastigmine (oral and transdermal), galantamine and memantine are used for cognitive impairment in which condition?
Dementia
46
Donepezil dose for cognitive impairment
5mg d nocte for 4 weeks, increasing to a max of 10mg nocte
47
Acetylcholinesterase inhibitors are the drug of choice in dementia. What are their effects in the short term?
Modestly improve or stabilise cognition, alertness and function
48
What are some of the ADRs for acetylcholinesterase inhibitors? Think (DUCTBVG)
Dizziness, drowsiness, urinary incontinence, cramps, tremor, bradycardia, vivid dreams, GI Sx
49
In which situation would you choose rivastigmine over other anticholinesterase inhibitors?
If the patient can’t swallow (this medication comes in patches!)
50
What is the dose of memantine?
5mg initially, titrating up to 20mg
51
What is the dose of Galantamine MR? (DIMENTIA)
8mg (max 24 mg daily)
52
Which acetylcholinesterase inhibitor should not be used in dementia with Lewy bodies?
Galantamine
53
Which 2 antipsychotic therapies are used for the management of aggression, agitation or psychoses of dimentia? (NOT LEWY BODY THO)
Risperidone - 0.25mg bd Olanzapine - 2.5mg d
54
What is an appropriate antipsychotic choice for dementia with Lewy body’s and which is also accepted for neuropsychiatric symptoms in Parkinson’s disease?
Quetiapine 12.5 - 25mg d or bd
55
Which class of antidepressants may be used in dimentia (however limited evidence)
SSRIs (citalopram, escitalopram, sertraline)
56
Outline the stepwise approach for drug therapy in COPD.
1. PRN SABA therapy 2. Regular LAMA or LABA 3. Dual therapy: LABA + LAMA 4. Triple therapy: LAMA + LABA + ICS
57
What is the first line treatment option for a COPD exacerbation?
Salbutamol 100mcg up to 8 times
58
What is the one thing that can slow the progression of COPD?
Smoking cessation
59
Pramipexole and rotigotine are second line anti-Parkinson’s agents. What is their class/Moa?
Dopamine agonists
60
Rasagiline, safinamide and selegiline belong to which class of drugs and MAY be used for treatment of Parkinson’s disease?
Monoamine oxidase inhibtiors
61
When would you consider using Pramipexole over first line agents (levodopa) in Parkinson’s?
If a patient strongly prefers/wants once daily dosing
62
When would you use rotigitine in parksions disease?
If a patient can’t swallow (transdermal formulation)
63
Which two antipsychotics may be trialled for neuropsychiatric symptoms of Parkinson’s disease?
Clozapine Quetiapine
64
Which drugs may be trialled for DIMENTIA in Parkinson’s disease?
Acetylcholinesterase inhibitors - Donepezil - rivastigmine oral or transdermal
65
MOA of sulfonylureas
Increase pancreatic insulin secretion

PHRM4012 (6 decks)

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