Top 100 Drugs II

Question 1

What are the indications for bisphosphonates?

Answer 1

Osteoporosis (those at risk of fragility #’s)
Hypercalcemia of malignancy
Bone mets (myeloma, BCa)
Paget’s disease

Question 2

How do bisphosphonates work?

Answer 2

Inhibits action of osteoclasts by accumulating in them –> inhibits activity, promotes apoptosis

Question 3

Important adverse effects of bisphosphonates?

Answer 3

Oesophagitis
Hypophosphatemia

Osteonecrosis of jaw
Atypical femoral #

Question 4

What are the indications for calcium and vitamin D?

Answer 4

1. Osteoporosis
2. Hypocalcemia (symptomatic)
3. Severe hyperkalemia
4. Chronic kidney disease
5. Osteomalacia/rickets (vitamin D deficiency)

Question 5

What is the function of calcium in the setting of severe hyperkalemia?

Answer 5

IT DOES NOT LOWER SERUM POTASSIUM

But it raises myocardial threshold potential which reduces excitability and risk of arrhythmias

Question 6

Which drugs does calcium reduce intestinal absorption of?

Answer 6

Bisphosphonates
Iron
Levofloxacin
Tetracyclines

Question 7

What are the indications for calcium channel blockers?

Answer 7

Hypertension
Stable angina
Supraventricular arrhythmias

Question 8

What are common side effects of dihydropyridines?

Answer 8

Ankle swelling
Flushing
Headache
Palpitations

Question 9

What are the major side effects of verapamil?

Answer 9

Constipation

Serious S/Es: bradycardia, heart block, cardiac failure

Question 10

Why should dihydropyridines be avoided in severe aortic stenosis?

Answer 10

Amlodipine and nifedipine can provoke collapse

Question 11

How do cephalosporins and carbapenems exert their antimicrobial effect?

Answer 11

Inhibits enzyme involved in cross-linking peptidoglycans in bacterial cell walls, causing bacterial swelling, lysis and death

Question 12

What are the indications for cephalosporins and carbapenems?

Answer 12

2nd/3rd line treatment for urinary and respiratory tract infections
IV treatment for very severe and complicated infections or caused by antibiotic-resistant organisms

Question 13

What are common side effects of cephalosporins?

Answer 13

GI upset
Abx-associated colitis
Hypersensitivity reactions
Potentiates effect of warfarin

Question 14

What are the indications for clopidogrel?

Answer 14

1. Tx of ACS
2. Prevent occlusion of coronary artery stents
3. A fib when warfarin/NOACs are contraindicated
4. Long-term secondary prevention of CVD, PVD, Cerebrovascular disease

Question 15

What is the MoA of clopidogrel?

Answer 15

Irreversibly binds to P2Y12 ADP receptor, preventing platelet aggregation

Question 16

What are the major side effects of clopidogrel?

Answer 16

Bleeding
GI upset
Thrombocytopenia

Question 17

Why will cytochrome P450 inhibitors reduce efficacy of clopidogrel?

Answer 17

Clopidogrel is a prodrug which requires metabolisation into its active form by CYP450.
Examples of inhibitors include erythromycin, ciprofloxacin, omeprazole etc.

Question 18

What gastroprotection is given with aspirin and clopidogrel?

Answer 18

Aspirin- omeprazole

Clopidogrel- lansoprazole/pantoprazole (omeprazole causes CYP450 inhibition!)

Question 19

What are the SEs of long term PPI use?

Answer 19

Increased risk of #’s
Mask symptoms of gastric cancer
Hypomagnesemia (may cause tetany, ventricular arrhythmia)

Question 20

What are the indications for LABA/ICS inhalers?

Answer 20

Asthma

COPD

Question 21

What are the important adverse effects of LABA/ICS inhalers?

Answer 21

Oral thrush
Hoarse voice
Systemic adverse effects e.g adrenal suppression, osteoporosis
Long-acting beta-2 agonists may cause tremor, tachycardia, arrhythmias and muscle cramps

Question 22

What are 4 indications for systemic glucocorticoids?

Answer 22

1. Allergic or inflammatory disorders
2. Autoimmune disease
3. Malignancy (reduce swelling)
4. Adrenal insufficiency or hypopituitarism

Question 23

What are the major side effects of systemic glucocorticoids?

Answer 23

Immunosuppression
Metabolic effects (DM, osteoporosis)
Mood and behavioural changes
Adrenal atrophy

Question 24

When is the best time to administer daily oral corticosteroid?

Answer 24

Morning

mimc natural circadian rhythm and reduce insomnia

Question 25

Why is it important for asthma patients to take sufficient inhaled corticosteroids?

Answer 25

Control symptoms | Prevents disease progression (i.e. airway remodelling and fixed airflow osbtruction)

Question 26

What are the main side effects of digoxin?

Answer 26

``` Bradycardia GI disturbance Rash Dizziness Visual disturbance Arrhythmias with toxicity ```

Question 27

When is digoxin contraindicated?

Answer 27

2nd degree heart block Complete heart block Ventricular arrhythmias

Question 28

What electrolyte abnormalities increase risk of digoxin toxicity?

Answer 28

Hypokalemia Hypomagnesemia Hypercalcemia

Question 29

What are the 2 indications for dypiridamole?

Answer 29

1. Secondary prevention of stroke following TIA (where clop is contraindicated) 2. Induce tachycardia in myocardial perfusion scanning for diagnosis of ischaemic heart disease

Question 30

What are 3 indications for loop diuretics?

Answer 30

Acute pulmonary oedema Chronic heart failure Other oedematous states e.g. liver/renal failure

Question 31

What is the MoA of loop diuretics?

Answer 31

Blocks Na+K+2Cl- in TAL Dilatation of capacitance veins (reduces preload)

Question 32

In what conditions should loop diuretics be used with caution?

Answer 32

Hypovolemia Hepatic encephalopathy Hypokalemia and hyponatremia Gout

Question 33

Why do loop diuretics increase risk of hearing loss/tinnitus?

Answer 33

Similar co-transporter responsible for regulating endolymph composition in inner ear

Question 34

What is the class and mechanism of action of amiloride?

Answer 34

Potassium-sparing diuretic Inhibits ENaC in DCT (prevents sodium reabsorption)

Question 35

What is the mechanism of action of ropinirole and pramipexol?

Answer 35

D2 agonist

Question 36

What are side effects of dopaminergic drugs?

Answer 36

Nausea, drowsiness, confusion, hallucinations, hypotension, wearing-off effect (levodopa), on-off effect

Question 37

What are the side effects of levodopa? (DOPAMINE)

Answer 37

``` Dyskinesia On-off effect Psychosis Agitation Mouth dryness Insomnia N&V EDS ```

Question 38

What are the indications for fibrinolytic therapy?

Answer 38

Acute ischaemic stroke (within 4.5 hrs) Acute STEMI (within 12 hrs) Massive PE with haemodynamic instability

Question 39

What is the mechanism of action of alteplase?

Answer 39

Catalyses the conversion of plasminogen to plasmin, which dissolves clots and re-canalise vessels

Question 40

What are the major adverse effects of fibrinolytic agents?

Answer 40

``` N&V Bruising Hypotension Serious bleeding Allergic reactions Cardiogenic shock Reperfusion injury (cerebral oedema, arrhythmias) ```

Question 41

What are the indications for gabapentin and pregabalin?

Answer 41

Focal epilepsies Neuropathic pain Gabapentin- migraine prophylaxis Pregabalin- GAD

Question 42

What is the mechanism of action of gabapentin?

Answer 42

Binds to voltage-gated Ca2+ channels, inhibits Ca2+ inflow and prevents neurotransmitter release

Question 43

Why are H2-receptor antagonists better than PPI's for pre-op patients who have reflux?

Answer 43

Rapid onset of action compared to PPIs; will reduce risk of reflux/aspiration pneumonitis during general anaesthesia

Question 44

What are the indications for heparin?

Answer 44

VTE prophylaxis and treatment | First line therapy in ACS

Question 45

What is the mechanism of action of fondaparinux?

Answer 45

Inhibits factor Xa

Question 46

What are the major side effects of heparin?

Answer 46

BLEEDING Injection site reactions Heparin-induced thrombocytopenia

Question 47

What is the reversal agent for major bleeding associated with heparin?

Answer 47

Protamine (effective for UFH but less for LMWH, ineffective for fondaparinux)

Question 48

What are the indications for insulin?

Answer 48

T1D Poorly controlled T2D Diabetic emergencies In combo with glucose for hyperkalemia

Question 49

How is insulin excreted?

Answer 49

Renal excretion

Question 50

When insulin therapy is combined with systemic corticosteroid therapy, do requirements increase or decrease?

Answer 50

INCREASE

Question 51

What are the major uses of carbamazepine?

Answer 51

Partial seizures Trigeminal neuralgia Bipolar disorder