Top 100 Drugs Flashcards by Amy Forster

what are 2 examples of 5 alpha-reductase inhibitors?

finaseteride
dutasteride

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what drug class is finasteride?

5 alpha-reductase inhibitor

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what are 2 indications for 5 alpha reductase inhibitors?

BPH causing LUTS
Androgenetic alopecia - male patterned baldness

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what is the MOA of 5 alpha reductase inhibitors?

inhibits intracellular enzyme 5-alpha-reductase which converts testosterone to the more active dihydrotestosterone, stimulating prostatic growth

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how long does it take 5-alpha-reductase inhibitors to work?

Up to 6 months

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what are 5 adverse effects of 5-alpha-reductase inhibitors?

Impotence
Reduced libido
breast tenderness and gynaecomastia
BREAST CANCER
SUICIDAL THOUGHTS
hair growth

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what are the warnings needed with 5-alpha-reductase inhibitors?

NEVER in women - can cause genital birth defects in male foetuses

avoid contact with women of childbearing potential including with SEMEN

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what is the starting dose of finasteride given for BPH?

5mg OD PO
review after 3-6 mon for efficacy then every 6-12 mon

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what is the dose of dutasteride for BPH?

500 micrograms OD PO

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what is the dose of finasteride for male patterned baldness?

10mg OD PO

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what is the monitoring for 5-alpha reductase inhibitors?

review after 3-6 mon for efficacy then every 6-12 mon

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what are 2 examples of Acetylcholinesterase inhibitors?

donepezil
rivastigimine

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what are 2 indications for Acetylcholinesterase inhibitors?

mild to moderate Alzheimers
Mild to moderate dementia in parkinsons - rivastigimine

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what is the MOA of Acetylcholinesterase inhibitors?

Ach is needed for memory and learning. Acetylcholinesterase inhibitors inhibit the breakdown of Acetylcholine in the CNS => increasing the availability of acetylcholine allowing for improved cognitive function and slower decline though this is not universal

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what drug class is rivastigimine?

Acetylcholinesterase inhibitors

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what drug class is donepezil?

Acetylcholinesterase inhibitors

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what is the most common adverse effect to Acetylcholinesterase inhibitors?

GI upset

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What can Acetylcholinesterase inhibitors cause in asthma and COPD?

Bronchospasm

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what are 3 peripheral side effects of Acetylcholinesterase inhibitors?

Peptic ulcers and bleeding
Bradycardia
Heart block

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what are 4 central cholinergic side effects of Acetylcholinesterase inhibitors?

hallucinations
altered/aggressive behaviour
extrapyramidal symptoms
neuroleptic malignant syndrome

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what are 2 life threatening side effects of Acetylcholinesterase inhibitors?

neuroleptic malignant syndrome
Bronchospasm in asthma/COPD

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what are 2 contraindications to Acetylcholinesterase inhibitors?

Sick sinus syndrome
heart block

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what are 4 cautions in Acetylcholinesterase inhibitors?

Asthma
COPD
Peptic ulcers
Parkinsons - rivastigimine may worsen tremor

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what are 2 medications that interact with Acetylcholinesterase inhibitors to increase risk of peptic ulcers?

NSAIDS
Systemic corticosteroids

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what medications should be used with caution alongside Acetylcholinesterase inhibitors due to increased risk of neuroleptic malignant syndrome?

antipsychotics

what medications should be used with caution alongside Acetylcholinesterase inhibitors due to risk of Brady/heart block?

beta blockers

what medications can worsen cognitive decline so should not be used with Acetylcholinesterase inhibitors?

anticholinergics - antimuscarinics, tricyclic antidepressants

what are 5 medications that should be used with caution with Acetylcholinesterase inhibitors?

NSAIDs Systemic corticosteroids Antipsychotics beta blockers anticholinergics

what is the usual starting dose for donepezil?

5mg OD

what is the usual starting dose for rivastigimine?

1.5mg every 12 hours

when should donepezil be taken?

at night may cause vivid dreams, in which case take in morning

which Acetylcholinesterase inhibitors is available as a patch?

Rivastigimine

what is the monitoring for Acetylcholinesterase inhibitors?

review for adverse effects at 2-4 weeks review for efficacy at 3 months - only continue if effective

what are 2 examples of aldosterone antagonists?

Spironolactone Eplerenone - only licensed for CHF

What are 3 indications for aldosterone antagonists?

1 - Ascites and oedema due to liver cirrhosis - Spiro 1' 2 - CHF - Spiro 3' in addition to Beta blocker and ACEi 3 - primary hyperaldosteronism

what is aldosterone?

Mineralocorticoids produced in glomerulosa of adrenal cortex and acts on mineralocorticoid receptors in distal tubule of kidney to increase activity of luminal epithelial sodium channel causing increased sodium and water retention and increased potassium excretion

what is the MOA of aldosterone antagonists?

Competitively inhibit mineralocorticoid receptors to decrease activity of luminal epithelial sodium channels causing increased sodium and water excretion and increased potassium retention

what are 4 adverse effects of aldosterone antagonists?

Hyperkalaemia Gynaecomastia - SPIRO Liver impairment and jaundice Steven Johnsons syndrome - SPIRO

what are 5 signs of hyperkalaemia on ECG?

peaked T wave - tall tented flattened P wave prolonged PR interval ST depression prolonged QRS duration (broad QRS complexes)

what are 4 symptoms of hyperkalaemia?

muscle weakness arrhythmia cardiac arrest nausea

what are 3 contraindications to aldosterone antagonists?

Renal impairment Hyperkalaemia adrenal insufficiency

what is one caution to aldosterone antagonists?

should be avoided in pregnancy and breast feeding - can cross placenta

what are 2 medications that should be used with caution with aldosterone antagonists?

ACEI and ARBs - also increase risk of hyperkalaemia

what is one medication hat should not be taken with aldosterone antagonists?

Potassium

what is a typical starting dose for Spironolactone in CHF and resistant HTN?

25mg OD PO

what is a typical starting dose for spironolactone in ascites or nephrotic syndrome?

100mg OD PO

when should spironolactone be taken?

with food

what are 2 things patients should be told when starting on Spironolactone (or other aldosterone antagonists)?

May cause gynaecomastia/impotence Need to come back for potassium monitoring

what monitoring is needed for aldosterone antagonists?

For safety - U+E (K+ and Creatinine) - 1 week after initiation and after any dose increase monthly for first 3 months then every 3 months for 1 year then every 6 months Also monitor for efficacy

what are 3 examples of antacids?

sodium bicarbonate calcium carbonate magnesium carbonate

what are 2 indications for antacids/alginates?

GORD Dyspepsia

what is the MOA of alginates?

increase viscosity of stomach contents and lead to floating 'raft' seperating stomach contents from oesophagus

what is the MOA of antacids?

buffer stomach acid

what are 2 adverse effects of antacids?

magnesium salts - diarrhoea Sodium salts - constipation most compound alginates have few side effects

when should alginates/antacids be used with caution?

hyperkalaemia/fluid overload - e.g renal impairment

what interactions are there with alginates/antacids? (8)

Can reduce serum conc of: ACEI Bisphosphonates PPIs Digoxin Levothyroxine ABx - Tetracyclines, cephalosporins, ciprofloxacin Can increase excretion of: aspirin lithium Should leave 2 hours between interactive medications

what should alginates not be used with as cause too thick stomach contents?

thickened infant formula

how are alginates/antacids usually available as?

liquid or chewable tablets

what are 4 lifestyle measures to reduce GORD?

eat smaller meals more often stop smoking avoid food triggers - fatty, spicy raise head of bed

what are 4 GORD red flags?

bleeding vomiting dysphagia wt loss

what are 5 medications that may cause dyspepsia?

NSAIDs antimuscarinics aspirin bisphosphonates corticosteroids

what are 3 indications of allopurinol?

1 - gout prevention 2- prevention of uric acid and calcium oxalate renal stones 3 - prevent hyperuricaemia and tumour lysis syndrome in chemo

when is allopurinol used in gout prevention?

2+ attacks a year OR joint damage OR renal impairment

what is the MOA of allopurinol?

xanthine oxidase inhibitor xanthine oxidase metabolises xanthine (from purines) to uric acid

what is second line to allopurinol?

febuxostat non-purine xanthase oxidase inhibitor

what are 5 adverse effects of allopurinol?

May trigger gout attack on initiation Skin rash Steven's johnson syndrome/TEN Allopurinol hypersensitivity syndrome

what are 3 contraindications to allopurinol?

acute gout attack (can continue but do not start treatment) Recurrent skin rash Severe hypersensitivity

what are 2 cautions for use of allopurinol?

renal impairment hepatic impairment

Co-prescription of allopurinol and what medication increases risk of toxic levels of the drug due to it being metabolised by xanthine oxidase?

azathioprine

Co-prescription of allopurinol and what 2 medications causes increased risk of hypersensitivity reaction?

ACEi thiazides

Co-prescription of allopurinol and what medication causes increased risk of skin rash?

amoxicillin

what is the starting dose of allopurinol for gout?

100mg OD PO titrate up to 200-600mg in 1/2 divided doses

Top 100 Drugs Flashcards

(73 cards)