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Module 308 > Drugs in medicine > Flashcards

Drugs in medicine Flashcards

1
Q

Which drugs can reduce the anticoagulant effects of Warfarin?

A

Cytochrome p450 inducers e.g.

  • Carbamazepine
  • Rifampicin
  • Amiodarone
  • Phenytoin
  • Citalopram
  • Alcohol (chronic)
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2
Q

Which drugs can increase the anticoagulant effects of Warfarin?

A

Cytochrome p450 inhibitors e.g.

  • Metronidazole
  • Amiodarone
  • Ciprofloxacin
  • Erythro/clarithromycin
  • Fluconazole
  • Isonazid
  • Alcohol (acute)
  • Grapefruit juice
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3
Q

What are some examples of drugs reliant on hepatic metabolism?

A

Morphine sulphate

Methotrexate

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4
Q

What are two examples of Cytochrome p450 drugs that have a NTI?

A

Warfarin

Aminophylline

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5
Q

What drug class is Warfarin? MoA?

A

Vitamin K antagonist.

Prevents gamma-carboxylation of clotting factors 2, 7, 9 and 10 and prolongs the extrinsic pathway

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6
Q

What is the target INR when on warfarin?

A
  1. 5 for DVT/PE

3. 5 for recurrent VTE or metal heart valves

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7
Q

How is Warfarin usually loaded?

A

With LMW heparin cover as can take >3d to reach therapeutic levels

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8
Q

How is the effect of warfarin reversed?

A
  • If life threatening bleed - give activated prothrombin complex (Octaplex), vitamin K
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9
Q

When should warfarin be avoided?

A

In pregnancy - it is teratogenic - use LMWH instead

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10
Q

Side effects of Warfarin

A
  • Haemorrhage risk
  • Minor bleeding
  • Skin necrosis
  • Alopecia
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11
Q

How does heparin work?

A

It is a mucopolysaccharide that potentiates anti-thrombin.

Irreversibly inactivates factors 2a (thrombin) and 10a

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12
Q

How are Unfractionated and LMW heparin administered?

A

Unfrac. - IV infusion

LMW - Sub cut injections

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13
Q

Three other examples of parental anticoagulants

A

Hirudin (used in place of heparin in patients with HIT)
Heparinoids e.g. Danaparoid
Fondaparinux - potentiates anti-thrombin, inhibits factor Xa

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14
Q

Which heparin is safe in renal failure?

A

Unfractionated heparin

LMWH - must have a creatinine clearance >30ml/min)

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15
Q

Two examples of DOACs

A

Rivaroxaban

Dabigatran

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16
Q

What is Rivaroxaban?

A

a DOAC

Direct factor Xa inhibitor - causes irreversible anticoagulation

17
Q

Dosing of rivaroxaban

A

15mg BD for 3w then 20mg OD

18
Q

What drug class is Dabigatran?

A

Direct thrombin inhibitor

19
Q

Dosing of dabigatran

A 
150mg BD (treatment dose)
110mg BD (prophylaxis dose)
20
Q

What is the reversal agent for dabigatran?

A

Praxbind (Idarucizumab)

21
Q

At what CHADSVASC score should a DOAC or warfarin be given

A

> or =2

22
Q

When is rhythm control for AF preferred?

A
  • Symptom improvement
  • Younger patient
  • Heart failure related to AF
  • Adequacy of rate control
23
Q

When is Ezetimibe monotherapy recommended?

A

treating primary hypercholesterolaemia in adults in whom statin therapy is contraindicated or not tolerated

24
Q

What are some examples of PCSK9 inhibitors?

A

Alirocumab, Evolocumab

25
Q

How do PCSK9 inhibitors work?

A

Prevent PCSK9 from binding to LDLRs (PCSK9 promotes LDLR degradation in the liver, meaning the LDL-C blood levels increase)

26
Q

What can be used as an addition to or replacement of a beta blocker in HF if the heart rate is still too high? (>75)

A

Ivabradine

27
Q

What can be used instead of ACEi/ARBs (e.g. if they are contraindicated, or in Black people)

A

Hydralazine + nitrate

28
Q

Beta blocker administration in acute HF treatment

A

Beta blockers should be continued but don’t initiate them

29
Q

When are ACEi/ARBs contraindicated?

A

In pregnancy/breastfeeding - use an alternative e.g. labetalol

30
Q

Target blood pressure in hypertension

A

140/90 or less in under 80s

150/90 or less in over 80s

31
Q

What is a hypertensive emergency?

A

Severe HTN > 180/120 with acute damage to target organs (lower BP within minutes to hours)

32
Q

What is hypertensive urgency?

A

Severe HTN without acute damage to target organs

- Lower BP after a review within 7 days

33
Q

Examples of acute target organ damage in severe HTN

A 
Eyes - papilloedema
Brain - encephalopathy, stroke
Heart - pulmonary oedema, MI
Kidneys - AKI
Aortic dissection
34
Q

Treatment of hypertensive emergency

A

IV therapy - labetalol, GTN, sodium nitroprusside, esmolol

Target BP of 160/100 within 6h

35
Q

Blood tests to do before statin initiation

A 
Lipid measurement
LFTs
Renal function
HbA1c
TSH
CK
36
Q

How is hypertriglyceridaemia treated?

A

Exclude excess alcohol and poor glycaemic control
If over >20 refer to specialist.
If 10-20, do a fasting sample (if that is over >10 then refer)
Fenofibrates and omega-3 acid under specialist supervision

37
Q

What are some examples of antiplatelet drugs? and MoA? (5)

A

Aspirin (COX inhibitor)
Clopidogrel (ADP receptor blocker)
Dipyramidole (Inhibits phosphodiesterase)
Prostacyclin (stimulates adenylate cyclase)
Glycoprotein IIa/IIb inhibitors e.g. adciximab

Module 308 (2 decks)

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