Drugs

Question 1

MOA of varenicline?

Answer 1

It is a partial nicotinic acetylcholine agonist. It reduces the withdrawal effects and reduces rhe peasure associated with smoking

Question 2

Brand name of verenicline?

Answer 2

Champix

Question 3

Name 2 precription drug opens for smoking cessation

Answer 3

Varenicline and buproprion

Question 4

Explain how buproprion assists in smoking cessation. How effective is it?

Answer 4

Works by inhibiting the neuronal uptake of noradrenaline and dopamine (dopamine = reward and pleasure)
About as effective as NRT

Question 5

Name the thrombolytic drug used in stroke?

Answer 5

Alteplase

Question 6

Dosage regime for alteplase for STEMI?

Answer 6

10mg bolus, then 50mg over first hour and 40mg for next 2 hours. (<1.5mg/kg if less than 65kg)

Question 7

Aspirin dosage for ischaemic strokes?

Answer 7

300mg given within 48 hours. Not within 24 hours of alteplase

Question 8

Orlistat dose?

Answer 8

120mg three times a day (taken with main meals). Can be taken up to one hour after meal. Do not take dose if you skip meal or meal has no fats.

Question 9

Hydrochlorothiazide dose?

Answer 9

12.5 - 25 mg each day in the morning

Question 10

MOA of hydrochlorothiazide in HT?

Answer 10

Peripheral dilation (not used for diuretic effects at these low doses)

Question 11

Enalapril MOA?

Answer 11

Inhibit conversion of angiotensin 1 into angiotensin 2 by inhibiting ACE. Prevents Ang2 from causing vasoconstriction, aldosterone release, etc

Question 12

2 important side effects of ACE inhibitors (-pril)?

Answer 12

Cough and angioedema

Question 13

Which functions should be tested prior to starting an ACE-I and 1-2 weeks after?

Answer 13

Renal function and electrolyte levels

Question 14

Important counselling points for ACE-Is?

Answer 14

Might feel dizzy + orthostatic hypotension. And need to stop potassium Supps

Question 15

Which ACE inhibitor is dosed twice daily instead of once?

Answer 15

Captopril. Start at 12.5mg bd, up to 50mg bd

Question 16

Perindopril starting vs maintenance dose?

Answer 16

5mg once daily, up to 10mg once daily.

Question 17

Ramipril vs perindopril dosing?

Answer 17

Ramipril starts at 2.5mg once daily, up to 5mg with max of 10mg
Perindopril starts at 5mg but also has max of 10mg.

Question 18

Aspirin dose post MI?

Answer 18

300mg stat

Question 19

Ticagrelor dosage post MI?

Answer 19

Loading dose = 180mg, then 90mg BD for at least 12 months in combo with low dose aspirin

Question 20

Clopidogrel dose post MI? (Loading + maintenance)

Answer 20

Loading = 300mg 
Maintenance = 75mg once daily with low dose aspirin

Question 21

Dabigatran dose in AF stroke prevention?

Answer 21

150mg bd. Reduce to 110 bd if CrCl is low.

Question 22

What dose of dabigatran is used if CrCl is below 30?

Answer 22

None. It needs to be avoided

Question 23

Rivaroxaban dose in AF stroke prevention?

Answer 23

20mg once daily.

Question 24

Dose adjustment consideration for Rivaroxaban?

Answer 24

If CrCl is 15-50, use 15mg daily instead of 20.

If below 15, do not use.

Question 25

Apixaban dosage for AF stroke prevention?

Answer 25

5mg twice daily.

Question 26

When would the dose of apixaban need to be reduced?

Answer 26

If patient weight is less than 60kg, if over 80 years old or if serum creatinine is high. Reduce dose to 2.5mg BD if patient has 2 of these

Question 27

Starting dose for warfarin?

Answer 27

5mg once daily for 2 days, then adjust based on INR

Question 28

Target INR for warfarin?

Answer 28

2-3

Question 29

Which patients would need more frequent INR monitoring? Normal monitoring = every 4 weeks

Answer 29

If at high risk of bleeding, if taking other drugs, if high alcohol consumption

Question 30

MOA of digoxin?

Answer 30

Slows conduction at the AV node by increasing PSNS and decreasing SNS. Also increases calcium levels which increases force of contraction

Question 31

Use of digoxin in renal impairment?

Answer 31

Will need dose reduction (depends on creatinine clearance)

Question 32

Loading dose of digoxin? And why would it be needed

Answer 32

250-500 mcg every 4-6 according to response. | Used for rapid control of ventricular rate in AF

Question 33

Maintenance dose of digoxin?

Answer 33

125-250 mcg once daily. | Needs to be reduced for elderly

Question 34

Is monitoring required for digoxin?

Answer 34

Yes, concentration monitoring to ensure pt is in steady state - because it has a low therapeutic index

Question 35

Why should electrolyte disturbances be corrected before starting anti-arrhythmic treatment?

Answer 35

Because these disturbances increase the risk of arrhythmias

Question 36

Should amiodarone be used with caution in patients with renal or hepatic impairment?

Answer 36

Hepatic. | Reduced hepatic function = less metabolism, accumulation of drug and hepatotoxicity

Question 37

Major precautions for beta blocker use?

Answer 37

Renal impairment, asthma, diabetes, pregnancy + breastfeeding

Question 38

Atenolol dose?

Answer 38

25-50mg once daily. Reduce in renal impairment

Question 39

Beta blocker ADRs?

Answer 39

sludge BBB

Question 40

Bisoprolol dose titration?

Answer 40

Initial = 1.25mg daily for 1 week | Slowly increase until at 10mg daily for maintenance.

Question 41

Carvediol dosage? Initial + maintence

Answer 41

``` Initial = 12.5mg daily for 2 days Maintenance = 25mg once daily ```

Question 42

Metoprolol dosing?

Answer 42

50-100mg daily. In one or two doses.

Question 43

Site of action of beta blockers in AF?

Answer 43

Slows conduction at AV node

Question 44

Heparin dose for VTE prevention?

Answer 44

5000 units injected SC, 2 or 3 times daily for 7-10 days after the surgery

Question 45

Heparin ADRs?

Answer 45

HITS | Bleeding, bruising at injection site, allergic reaction

Question 46

Enoxaparin dose for VTE prevention in surgical patients

Answer 46

20mg SC injection once a day for 7-10 days

Question 47

Enoxaparin ADRs?

Answer 47

Bleeding, bruising at injection site, hyperkalaemia | HITS

Question 48

Enoxaparin in renal impairment?

Answer 48

Will require dose reduction

Question 49

ADRs of ticagrelor?

Answer 49

Bleeding, skin reactions (itchy rash) | Raised uric acid levels (gout aggregation)

Question 50

Clopidogrel ADRs?

Answer 50

GI ulcer, bleeding, itchy rash, angioedema

Question 51

Diltiazem drug class?

Answer 51

Non-dihydropyridine calcium channel blocker.

Question 52

Monitoring required for diltiazem?

Answer 52

None

Question 53

Diltiazem ADR?

Answer 53

Bradycardia, AV block, worsened arrhythmia, nausea, headache, hypotension

Question 54

Verapamil class?

Answer 54

Non-dihydropyridine CCB

Question 55

Amlodipine class?

Answer 55

Dihydropyridine CCB

Question 56

Which CCB class is more selective for the heart?

Answer 56

Non-dihydropyridine

Question 57

Side effects of non-dihydropyridine CCBs?

Answer 57

Reduced cardiac contractility and conduction

Question 58

Side effects of dihydropyridine CCBs?

Answer 58

Due to peripheral vasodilation= | Headaches, oedema, flushing, dizziness, nausea

Question 59

Atorvastatin dose?

Answer 59

10-80mg once daily

Question 60

Atorvastatin ADRs?

Answer 60

Sleep disturbances, myalgia, rhabdomyolysis, renal failure

Question 61

Monitoring required for statins?

Answer 61

Monitor aminotransferase (ALT -liver function) and CK levels (testing for muscle degradation)

Question 62

Simvastatin dose?

Answer 62

10-40 mg once daily

Question 63

Class of drugs with rhabdomyolysis as a potential ADR?

Answer 63

Statins. | Rhabdomyolysis = muscle breakdown

Question 64

Rosuvastatin dose?

Answer 64

Most potent. | 5-20 mg once daily. 40mg max with specialist supervision

Question 65

Comment on renal impairment and statin use

Answer 65

Renal impairment increases the risk of myopathy and rhabdomyolysis. Start at low dose and monitor renal function and CK levels regularly

Question 66

Irbesartan dose?

Answer 66

150mg once daily (up to 300 if necessary)