Oral Assessment 1 Flashcards
(93 cards)
1
Q
What drug class does Rosuvastatin belong to?
A
Statin
2
Q
What is the primary mechanism of action for Rosuvastatin?
A
Competitively inhibits HMG-CoA reductase, increasing hepatic cholesterol uptake from blood. Leads to a decrease in total cholesterol, LDL and triglycerides (slightly), also a slight increase in HDL
3
Q
What are the indications for Rosuvastatin?
A
- Hypercholesterolaemia
- Risk of coronary heart disease with or without hypercholesterolaemia
4
Q
What is the usual dosage range for Rosuvastatin?
A
- Initial: 5 or 10mg OD
- Maintenance: 5-20mg, up to 40mg OD
5
Q
What counseling points should be considered for patients taking Rosuvastatin?
A
- Generally well tolerated
- Avoid stopping in patients with ACS (acute coronary syndrome, further increased risk of cardiac events)
- Seek medical help if you experience dark urine (proteinuria) or muscle pain (myalgia or rhabdomyolysis)
6
Q
What are the common adverse drug events (ADEs) associated with Rosuvastatin?
A
- Myalgia
- Mild transient GI symptoms (bloating, gas, n, d, constipation)
- Elevated transferases
- Myopathy
- Rhabdomyolysis
- Renal failure
- Hepatitis
7
Q
What should you monitor for in rosuvastatin?
A
- Liver tests (ALT/AST) → Stop if >3× ULN.
- Muscle pain? Check CK → Stop if >10× ULN.
- Kidney function (esp. in renal impairment).
- Check cholesterol levels (baseline & regularly).
8
Q
Can rosuvastatin be used in pregnancy or breastfeeding?
A
Preg: Not in pregnancy, planning to conceive or using ineffective contraception - cholesterol is important in foetal development
BF: avoid
Can be used under specialist advice where risk outweighs benefit (very high CVD risk)
9
Q
What is the drug class of Clopidogrel?
A
Antiplatelet / P2Y12 antagonist
10
Q
How does Clopidogrel work?
A
Irreversibly binds to the platelet P2Y12 receptor, inhibiting platelet aggregation
11
Q
What are the indications for Clopidogrel?
A
- History of symptomatic atherosclerosis
- Acute coronary syndrome (with aspirin)
12
Q
What is the typical dosage for Clopidogrel in the prevention of vascular ischemic events?
A
75mg OD
13
Q
What is the typical dosage for Clopidogrel in Acute Coronary Syndrome?
A
Loading dose: 300mg
Then: 75mg with aspirin 100mg OD for 1 to 12 months (plus)
14
Q
What should patients avoid while taking Clopidogrel?
A
Other drugs affecting the clotting process, except aspirin. Also grapefruit juice (reduced efficacy)
15
Q
What are the common ADEs of Clopidogrel?
A
- Bleeding
- Skin reactions e.g. urticaria, rash
- GI ulcer
Rare: angioedema, thrombotic thrombocytopenic purpura, aplastic anaemia
16
Q
What are the signs and symptoms of bleeding (as an adverse effect)?
A
- Nosebleeds
- Bleeding gums
- Blood in the urine, stools or vomit
- Bruising
- Pain, usually in the head or gut
- Dizziness
- Chest pain
17
Q
What should you monitor for in Clopidogrel?
A
- For adverse effects (as above, esp bleeding risk)
- Rash
18
Q
Can Clopidogrel (w or w/out aspirin) be used in preg or BF?
A
Limited data - specialist advice (?)
19
Q
What drug class does Irbesartan belong to?
A
Sartan / ARB (angiotensin receptor blocker)
20
Q
What is the primary action of Irbesartan?
A
Competitively blocks angiotensin II binding to type 1 angiotensin receptors. Reduces angiotensin II-induced vasoconstriction, sodium reabsorption and aldosterone release
21
Q
What are the indications for Irbesartan?
A
- Hypertension
- Chronic heart failure with reduced ejection fraction (when patient is unstable to ACEis)
- Reduction of renal progression in T2 Diabetes (w/ HTN and microalbuminuria or proteinuria)
22
Q
What is the typical dose for Irbesartan in hypertension?
A
150mg OD
then can increase to 300mg OD
Age 75+: 75mg initially
23
Q
What counseling points are important for patients taking Irbesartan?
A
- May cause dizziness
- Avoid potassium supplements
- Use NSAIDs sparingly
- Tell your doctor if you develop severe or chronic diarrhoea
24
Q
What are the common ADEs associated with Irbesartan?
A
- Dizziness
- Hyperkalemia
- Headache
Infrequent:
* 1st dose hypotension
* Rash
* Diarrhoea
* Renal impairment
25
What should you monitor for in Irbesartan?
* Renal function and electrolytes, especially K+ (before starting, review 1-2 weeks)
* Symptoms of a cough (lesser so than ACEis)
* Efficacy of treatment (peaks in 4-6 weeks)
26
Irbesartan in preg or bf?
No
27
What drug class does Metoprolol belong to?
Beta Blocker (BETA 1 SELECTIVE)
28
What is the primary mechanism of action of Metoprolol?
Competitively blocks beta receptors (heart, bronchi etc), reducing HR, BP, and cardiac contractility
29
What are the indications for Metoprolol?
* Hypertension
* Myocardial infarction
* Angina
* Tachyarrhythmias
* Chronic HFredEF (part of standard Tx)
30
What is the usual dosage range for Metoprolol in HTN and Angina?
HTN
* Initial: 50-100mg in 1 or 2 doses
* Maintenance: 50-100mg OD or BD
Angina
* Initial: 25-50mg BD
* Maintenance: 50-100mg 2-3 times each day
31
What are the main counselling points of Metoprolol?
* Dizziness, on standing etc.
* Don't stop taking suddenly
* May cause bronchospasms, only under specialist advice in asthma or COPD
32
What should be monitored when a patient is on Metoprolol?
* Respiratory symptoms - Bronchospasm
* Bradycardia - monitor HR
* Hypotension - monitor BP
* Dizziness, nausea, vomiting, cold extremities
33
Metoprolol in preg or bf?
Preg: no, use labetalol
BF: Yes, metoprolol, nebivolol and labetolol can be used
34
What drug class do nitrates belong to?
Nitrate
35
What is the primary action of nitrates?
Provides exogenous source of NO, promoting venodilation, reducing venous return and preload to the heart, reducing myocardial oxygen requirement
36
What are the indications for nitrates?
* Prevention and treatment of stable angina
* Heart failure associated with acute MI (IV)
37
What is the typical dosage for sublingual spray nitrate spray for angina treatment?
1 or 2 sprays (400-800mcg) under the tongue at onset of chest pain. If no relief, use a 2nd dose after 5 minutes. If pain persists for 10 minutes despite taking 2 doses of GTN (or pain worsens at any time), take a 3rd then call an ambo
38
What is the typical dosage for sublingual nitrate tablets for angina treatment?
300-600mcg every 3-4 mins prn until pain resolved (max 1800mcg). If pain persists for 10 minutes despite taking 2 doses of GTN (or pain worsens at any time), take a 3rd then call an ambo
39
What is the prophylactic dose of GTN spray and SL tabs prior to exertion?
Spray: 1-2 sprays 5-10 minutes prior
SL tab: 300–600 micrograms 5–10 minutes before activity.
40
What are common ADEs associated with nitrates?
* Headache
* Flushing
* Palpitations
* Orthostatic hypotension
* Fainting
* Oedema
41
Can nitrates be used in pregnancy and breastfeeding?
Preg: Limited data however considered safe to use (may cause uterine relaxation)
42
Give an example of a patient you shouldn't use nitrates in)?
* Taking phosphodiesterase-5 inhibitors (e.g. sildenafil)
* Significant anaemia
* Hypotension
43
What is the typical dosage for Isosorbide Dinitrate for acute treatment?
5-10mg sublingually
Place 1 or 2 tabs under the tongue, do not chew, after angina is relieved, you may spit out what is left of the tabs to avoid ADEs like headache
44
What are the indications of Isosorbide Mononitrate (PO)?
Prevention of angina
45
What is the dosage of Isosorbide Mononitrate?
PO: 30-60mg CR OD
Maximum of 120mg OD
46
What are some counselling points for isosorbide mononitrate (on top of the regular nitrates)?
* Dizziness esp on initiation of Tx – get up slowly from sitting or standing – sit or lie down if dizzy
* Do not operate machinery until you know how this medicine affects you
* Swallow whole; do not crush or chew the tablet.
* Take at time of day where angina is most frequent (night for nocturnal angina or in morning for daytime angina
* BD dosing is NOT recommended as there is no nitrate-free period and tolerance may occur
47
What is the drug class of Spironolactone?
Potassium sparing diuretic
## Footnote
Also known as aldosterone diuretics.
48
How does Spironolactone work?
Antagonises aldosterone thereby inhibiting sodium absorption in the distal tubule
## Footnote
This increases sodium and water excretion while reducing potassium excretion.
49
List three indications for Spironolactone.
* Chronic heart failure with reduced ejection fraction
* Primary hyperaldosteronism
* Refractory edema associated with secondary hyperaldosteronism
50
What is the dose of Spironolactone for heart failure?
## Footnote
In reduced renal function
I: 25mg OD
Increase to 50mg OD after 8 weeks if HF progresses and potassium concentration is less than 5mmol/L.
## Footnote
CrCl 30-50mL/min: 12.5mg OD or 25mg alt days, inc to 25mg OD after 8 weeks if HF progresses and K conc <5mmol/L
Avoid below 30mL/min
51
What should be done if potassium concentration is between 5.5-5.9mmol/L?
## Footnote
Spironolactone
Halve the dose of Spironolactone.
52
What is the dose of Spironolactone for Oedema?
I: 100mg OD
M: 25-200mg
Max 400mg
53
Fill in the blank: The dose of Spironolactone for resistant hypertension is _______.
12.5-50mg OD
54
What counseling point is important for patients taking Spironolactone?
* Don’t take potassium supplements unless doctor tells you to.
* May cause a bit of dizziness or drowsiness – don’t drive or operate machinery until you know how it affects you
* May cause breast tenderness, gynecomastia, menstrual irregularities or decreased libido – it is dose-dependent and usually reversibly upon stopping – tell your doctor if you experience
55
What are common adverse effects of Spironolactone?
* Hyperkalemia
* Hyponatremia
* Weakness
* Headache
* Nausea
* Vomiting
* Mastalgia
56
What are serious adverse effects of Spironolactone?
* Hepatotoxicity
* Urticaria
* Osteomalacia
* Renal impairment
## Footnote
Monitor vitamin D and calcium especially in those predisposed.
57
What effect does Spironolactone have on prostate cancer?
Affects androgen activity and can alter PSA levels
Specialist advice is recommended.
## Footnote
PSA = Prostate-specific androgen
58
Is Spironolactone safe during pregnancy and breastfeeding?
- Avoid in preg – feminisation of male offspring in animal studies
- BF safe
59
What monitoring is required for patients on Spironolactone?
* Monitor electrolytes: potassium, sodium, chloride (Hyperkal, hyponatraemia, hypochoraemia)
* Renal function (renal impairment)
* Vitamin D and Ca (osteomalacia)
* LFTs / transferases (hepatotoxicity)
60
What is the drug class of Warfarin?
Vitamin K antagonist
61
How does warfarin work?
Inhibits the synthesis of vitamin K dependent clotting factors (II, VII, IX, X) and antithrombotic factors (protein C, protein S)
62
What are the indications for Warfarin?
* Prevention and treatment of VTE
* Prevention of thrombo-embolism in patients with prosthetic heart valves
* Prevention of stroke in patients with previous MI and increased embolic risk
63
What is the usual starting dose of Warfarin?
5mg OD for 2 days, then adjust according to INR
64
What is the typical maintenance dose range of Warfarin?
## Footnote
Elderly?
Between 1-10mg OD, adjusted to INR (usually 2-3)
## Footnote
Increased risk of bleeding – lower doses
65
What should patients be counseled about regarding Warfarin?
## Footnote
(6)
* Always use the same brand (Marevan or Coumadin)
* Take at the same time each day
* Record medication intake and INR results
* Inform doctor of missed doses or any illnesses (D, V, inf or fever)
* Maintain a balanced diet with controlled vitamin K intake
* Avoid excessive alcohol consumption; 1-2 standard drinks daily
## Footnote
Illnesses --> may req extra blood tests
66
Is Warfarin safe during pregnancy and breastfeeding?
Avoid in pregnancy unless prosthetic heart valves; it is teratogenic and can cause fetal or placental hemorrhage
BF is safe
67
What is a common adverse drug event (ADE) associated with Warfarin?
## Footnote
Rare:
Bleeding
## Footnote
* Skin necrosis
* Fever
* Rash
* Nausea
* Vomiting
* Diarrhea
68
What should be monitored while a patient is on Warfarin?
* INR
* Renal function (anticoag nephropathy)
* signs and symptoms of allergic reactions
* LFTs / transferases (hepatic dysfunction)
69
What is the drug class of Celecoxib?
NSAID (Selective COX-2 inhibitor)
70
How does Celecoxib exert its anti-inflammatory and analgesic action?
Inhibits synthesis of PGs by inhibiting COX (primarily COX-2) --> anti-inflam, analgesia
71
List the indications for Celecoxib.
* RA
* OA
* Ankylosing spondylitis
* Pain due to dysmenorrhea or injury (postoperative, musculoskeletal or soft tissue)
72
What is the recommended dosing for RA with Celecoxib?
100mg BD PO, can be increased to 200mg BD (short term)
73
For OA and ankylosing spondylitis, what is the maximum dose of Celecoxib?
Up to 200mg daily in 1 or 2 doses
## Footnote
OA – max effects will be seen in 2 weeks, if no result in 3 weeks, try a diff NSAID
74
What is the dose of Celecoxib for Period (and other) pain?
400mg daily in 1 or 2 doses ofn day 1, then 200mg OD or BD if needed to a maximum of 5 days
75
What are key counseling points for Celecoxib use?
* with food
* Don’t take if you are dehydrated (vomiting or diarrhoea) - inc risk of SEs
* If you develop swollen ankles, difficulty breathing, chest pain, black stools or dark coffee-coloured vomit, stop taking and tell your doc immediately
* Don’t take aspirin or any other anti-inflammatories whilst being treated with this medicine
76
What should be monitored before starting chronic treatment with Celecoxib?
Complete blood count, haemoglobin, blood pressure, weight, creatinine, and liver function
## Footnote
Repeat at least once a year during treatment
77
What are some common adverse drug effects (ADEs) of Celecoxib?
* Nausea
* Dyspepsia (reflux)
* GI ulcer or bleed
* Raised liver enzymes
* Diarrhea
* Headache
* Dizziness
* Salt and water retention
* Hypertension
78
What specific risk does Celecoxib pose to the elderly?
Increased risk of adverse drug effects, especially heart failure, GI ulcer, and renal impairment
79
Can Celecoxib be used in pregnancy or breastfeeding?
Preg: No - Increased risk of miscarriage, affect foetal development and delay labour and birth
Breastfeeding: Nonselective is safe, ibuprofen preferred, selective has limited data
80
What drug class is Colchicine in and how does it work?
Anti-gout agent
Inhibits neutrophil migration, chemotaxis, adhesion and phagocytosis in inflamed tissue –> reducing inflammation
81
What is the indications of Colchicine?
Relief of pain in acute gout
Less Common:
* Used at beginning of ULT therapy to reduce chance of acute flares in the first (6) months of therapy
* Instead of NSAIDS in patients with HF as it doesn't cause fluid retention
82
What is the dosage of Colchicine in acute gout?
## Footnote
When can prophylaxis using colchicine be re/started?
Acute gout flare:
1mg PO ASAP, then 500mcg 1 hour later (max 1.5mg per course)
## Footnote
Wait at least 12 hours before starting / resuming prophylaxis
83
How long do you have to wait to repeat an acute gout course of Colchicine?
Do not repeat w/in 3 days (2 weeks in <30mL/min, severe hepatic imp or dialysis)
84
What is the dosage of Cochicine for prophylaxic of gout attacks?
500mcg OD or BD according to response and GI Sx
CrCl <30mL/min: Init 250mcg OD
Dialysis: 250mcg twice weekly
85
What are the top counselling points of Colchicine?
* Avoid grapefruit juice – may inc conc of colchicine in blood & could inc chances of SEs occurring
* Use ASAP at onset of gout attack for optimal results - should subside within 48 hours
86
What should be monitored in Colchicine use?
Esp for long-term use:
* Complete blood count - repeat at 1, 6 and 12 monthly interval
* Creatinine Kinase - repeat if symptoms of myopathy occur
* Vomiting, muscle pain, tenderness or weakness, numbness or tingling in fingers or toes, unusual bleeding or bruising, or infection - stop and tell doc
87
What drug class is Adalimumab in?
How does it work?
TNF-alpha antagonist
Bind to TNF alpha and inhibit its activity. TNF-a is a cytokine involved in inflame and immune response
88
What are the indications of Adalimumab?
* RA (with MTX if possible)
* UC or Crohn's
* JIA
* Ankylosing spondylitis
* Chronic plaque psoriasis
89
What is the usual dose of Adalimumab in RA, Psoriatic arthritis and Ankylosing spondylitis?
## Footnote
When should you see effects?
40mg SC every 2 weeks
RA w/out MTX, can inc to 40mg once weekly or 80mg every 2 weeks
## Footnote
Initial response occurs w/in 1-2 weeks, max by 12-16 wks
90
What is the dosage of Adalimumab for Crohn's and UC?
160mg on day 0, then 80mg on day 14, then 40mg every 2 weeks
91
What is the dosage of Adalimumab for Juvenille Idiopathic Arthritis?
10-30kg, 20mg once every 2 weeks
>30mg, 40mg once every 2 weeks
92
What are the top counselling points for Adalimumab?
* Tell your doctor urgently if you have persistent fever, other signs of infection or bruising or bleeding
* Check vaccination status prior to commencing - Some vaccines should not be given to people receiving a TNF-a antagonist
* Best effects are seen with MTX - also reduces Antibodies that may form against adalimumab
* Stop if severe psoriasis develops and doesn't improve w topical Tx
93
What should you monitor for when using Adalimumab?
* Complete blood count, ALT, AST and Cr before tx – repeat if Sx suggesting inf or blood dyscrasias (stop if dys are confirmed)
* Check for infections, hep b and TB before and during Tx - stop if serious
* Check for skin cancers before and during Tx
