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PSA > Top 100 Drugs > Flashcards

Top 100 Drugs Flashcards

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1
Q

what are 2 examples of 5 alpha-reductase inhibitors?

A

finaseteride
dutasteride

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2
Q

what drug class is finasteride?

A

5 alpha-reductase inhibitor

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3
Q

what are 2 indications for 5 alpha reductase inhibitors?

A

BPH causing LUTS
Androgenetic alopecia - male patterned baldness

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4
Q

what is the MOA of 5 alpha reductase inhibitors?

A

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

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5
Q

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

A

Up to 6 months

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6
Q

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

A

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

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7
Q

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

A

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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8
Q

what is the starting dose of finasteride given for BPH?

A

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

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9
Q

what is the dose of dutasteride for BPH?

A

500 micrograms OD PO

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10
Q

what is the dose of finasteride for male patterned baldness?

A

10mg OD PO

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11
Q

what is the monitoring for 5-alpha reductase inhibitors?

A

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

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12
Q

what are 2 examples of Acetylcholinesterase inhibitors?

A

donepezil
rivastigimine

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13
Q

what are 2 indications for Acetylcholinesterase inhibitors?

A

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

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14
Q

what is the MOA of Acetylcholinesterase inhibitors?

A

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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15
Q

what drug class is rivastigimine?

A

Acetylcholinesterase inhibitors

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16
Q

what drug class is donepezil?

A

Acetylcholinesterase inhibitors

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17
Q

what is the most common adverse effect to Acetylcholinesterase inhibitors?

A

GI upset

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18
Q

What can Acetylcholinesterase inhibitors cause in asthma and COPD?

A

Bronchospasm

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19
Q

what are 3 peripheral side effects of Acetylcholinesterase inhibitors?

A

Peptic ulcers and bleeding
Bradycardia
Heart block

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20
Q

what are 4 central cholinergic side effects of Acetylcholinesterase inhibitors?

A

hallucinations
altered/aggressive behaviour
extrapyramidal symptoms
neuroleptic malignant syndrome

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21
Q

what are 2 life threatening side effects of Acetylcholinesterase inhibitors?

A

neuroleptic malignant syndrome
Bronchospasm in asthma/COPD

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22
Q

what are 2 contraindications to Acetylcholinesterase inhibitors?

A

Sick sinus syndrome
heart block

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23
Q

what are 4 cautions in Acetylcholinesterase inhibitors?

A

Asthma
COPD
Peptic ulcers
Parkinsons - rivastigimine may worsen tremor

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24
Q

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

A

NSAIDS
Systemic corticosteroids

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25
what medications should be used with caution alongside Acetylcholinesterase inhibitors due to increased risk of neuroleptic malignant syndrome?
antipsychotics
26
what medications should be used with caution alongside Acetylcholinesterase inhibitors due to risk of Brady/heart block?
beta blockers
27
what medications can worsen cognitive decline so should not be used with Acetylcholinesterase inhibitors?
anticholinergics - antimuscarinics, tricyclic antidepressants
28
what are 5 medications that should be used with caution with Acetylcholinesterase inhibitors?
NSAIDs Systemic corticosteroids Antipsychotics beta blockers anticholinergics
29
what is the usual starting dose for donepezil?
5mg OD
30
what is the usual starting dose for rivastigimine?
1.5mg every 12 hours
31
when should donepezil be taken?
at night may cause vivid dreams, in which case take in morning
32
which Acetylcholinesterase inhibitors is available as a patch?
Rivastigimine
33
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
34
what are 2 examples of aldosterone antagonists?
Spironolactone Eplerenone - only licensed for CHF
35
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
36
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
37
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
38
what are 4 adverse effects of aldosterone antagonists?
Hyperkalaemia Gynaecomastia - SPIRO Liver impairment and jaundice Steven Johnsons syndrome - SPIRO
39
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)
40
what are 4 symptoms of hyperkalaemia?
muscle weakness arrhythmia cardiac arrest nausea
41
what are 3 contraindications to aldosterone antagonists?
Renal impairment Hyperkalaemia adrenal insufficiency
42
what is one caution to aldosterone antagonists?
should be avoided in pregnancy and breast feeding - can cross placenta
43
what are 2 medications that should be used with caution with aldosterone antagonists?
ACEI and ARBs - also increase risk of hyperkalaemia
44
what is one medication hat should not be taken with aldosterone antagonists?
Potassium
45
what is a typical starting dose for Spironolactone in CHF and resistant HTN?
25mg OD PO
46
what is a typical starting dose for spironolactone in ascites or nephrotic syndrome?
100mg OD PO
47
when should spironolactone be taken?
with food
48
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
49
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
50
what are 3 examples of antacids?
sodium bicarbonate calcium carbonate magnesium carbonate
51
what are 2 indications for antacids/alginates?
GORD Dyspepsia
52
what is the MOA of alginates?
increase viscosity of stomach contents and lead to floating 'raft' seperating stomach contents from oesophagus
53
what is the MOA of antacids?
buffer stomach acid
54
what are 2 adverse effects of antacids?
magnesium salts - diarrhoea Sodium salts - constipation most compound alginates have few side effects
55
when should alginates/antacids be used with caution?
hyperkalaemia/fluid overload - e.g renal impairment
56
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
57
what should alginates not be used with as cause too thick stomach contents?
thickened infant formula
58
how are alginates/antacids usually available as?
liquid or chewable tablets
59
what are 4 lifestyle measures to reduce GORD?
eat smaller meals more often stop smoking avoid food triggers - fatty, spicy raise head of bed
60
what are 4 GORD red flags?
bleeding vomiting dysphagia wt loss
61
what are 5 medications that may cause dyspepsia?
NSAIDs antimuscarinics aspirin bisphosphonates corticosteroids
62
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
63
when is allopurinol used in gout prevention?
2+ attacks a year OR joint damage OR renal impairment
64
what is the MOA of allopurinol?
xanthine oxidase inhibitor xanthine oxidase metabolises xanthine (from purines) to uric acid
65
what is second line to allopurinol?
febuxostat non-purine xanthase oxidase inhibitor
66
what are 5 adverse effects of allopurinol?
May trigger gout attack on initiation Skin rash Steven's johnson syndrome/TEN Allopurinol hypersensitivity syndrome
67
what are 3 contraindications to allopurinol?
acute gout attack (can continue but do not start treatment) Recurrent skin rash Severe hypersensitivity
68
what are 2 cautions for use of allopurinol?
renal impairment hepatic impairment
69
Co-prescription of allopurinol and what medication increases risk of toxic levels of the drug due to it being metabolised by xanthine oxidase?
azathioprine
70
Co-prescription of allopurinol and what 2 medications causes increased risk of hypersensitivity reaction?
ACEi thiazides
71
Co-prescription of allopurinol and what medication causes increased risk of skin rash?
amoxicillin
72
what is the starting dose of allopurinol for gout?
100mg OD PO titrate up to 200-600mg in 1/2 divided doses
73

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