Drug Review

1. Drug Review Semester 1 2011

2. Cephalexin Class MOA Uses S/E - Cephalosporin antibiotic • - Interfere with bacterial cell wall peptidoglycan synthesis • - Staphylococcal and streptococcal infections in people with mild-to-moderate penicillin allergy • - UTIs due to susceptible Gram-negative bacteria • - Epididymo-orchitis(urinary tract source) • - cholestatichepatitis (rare)

3. Salbutamol Class MOA Uses S/E - Short actine beta agonist • - Relax bronchial smooth muscle by stimulating beta2adrenoceptors - Acute asthma, exercise induced asthma, COPD • common: tremor, palpitations, headache • infrequent: hyperglycaemia (high dose), tachycardia, muscle cramps, agitation, hyperactivity in children, insomnia • Rare: paradoxical bronchospasm, allergic reactions including urticaria, angioedema and anaphylaxis, lactic acidosis

4. Imiquimod Class MOA Uses S/E - • - Enhances immune response to viral infections and tumours by inducing immune system cells as well as interferon and other cytokines. • - External genital and perianal warts • - Superficial basal cell carcinoma where surgery is considered inappropriate (primary treatment) • - Actinic keratoses of the face and scalp • -Common: local skin reactions including erythema, itch, burning sensation, erosion, ulceration, blisters, exfoliation, skin hardening, oedema, scabbing • - Infrequent: paraesthesia, flu-like symptoms, alopecia at or near treatment site • - Rare: hypo- or hyperpigmentation (may be permanent), skin necrosis, allergic reaction

5. Pamindronate Class MOA Uses S/E - bisphosphonate • - Decrease bone resorption by inhibiting osteoclasts. • - Paget’s disease of bone • - Hypercalcaemiaof malignancy • - Osteolyticbone metastases from breast cancer or advanced multiple myeloma • - Prevention and treatment of osteoporosis (including postmenopausal and corticosteroid-induced) • -Common • nausea, vomiting, diarrhoea, headache, hypocalcaemia, musculoskeletal pain (may rarely be severe and/or disabling) • IV, fever, flu-like symptoms, injection site reaction, increased creatinine concentration, hypophosphataemia, myalgia, bone pain, hypertension • Infrequent • oesophagitis, oesophageal erosions and ulcers (mainly with alendronate), gastritis, duodenitis, glossitis, iritis, uveitis, scleritis, rash • IV, hypotension, rarely leading to syncope or circulatory collapse, hypomagnesaemia, hypokalaemia • Rare • heart failure, renal impairment, osteonecrosis of the jaw (below), allergic reactions including angioedema • Osteonecrosis of the jaw • Risk appears to be associated with the type and total dose of bisphosphonate and a history of trauma, dental surgery or dental infection. Most reports have followed the use of IV pamidronate or zoledronic acid in patients with multiple myeloma or bony metastases. The risk seems higher with zoledronic acid than with pamidronate. There have also been reports associated with oral bisphosphonates. • Atrial fibrillation • It is possible that bisphosphonates slightly increase the risk of AF: • risk of serious AF was increased in postmenopausal women with osteoporosis treated with zoledronic acid in a randomised placebo-controlled trial • alendronate was also associated with AF in an observational study. • However, this association was not found in all studies; further research is needed.

6. pravastatin Class MOA Uses S/E - Statin • -Competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (a rate-limiting enzyme in cholesterol synthesis). Increase hepatic cholesterol uptake from blood, reduce concentrations of total cholesterol, LDL and triglyceride (modest), and produce a small increase in HDL concentrations. • - Hypercholesterolaemia • - Mixed hyperlipidaemia • - High risk of coronary heart disease, with or without hypercholesterolaemia • - Common: myalgia, mild transient GI symptoms, headache, insomnia, dizziness, elevated transaminase concentrations (below) • - Rare: myopathy(below), rhabdomyolysis (below), renal failure, hepatitis, liver failure, pancreatitis, alopecia, paraesthesia, peripheral neuropathy, impotence, amnesia, nightmares, gynaecomastia, hypersensitivity, anaphylaxis, angioedema, toxic epidermal necrolysis • - Myopathy, rhabdomyolysis: Risk of myopathy (with or without creatinekinase elevation) and rhabdomyolysis are dose-related. Risk is also increased by illness (see Precautions), and certain drug interactions (see Statins).

7. Verapamil Class MOA Uses S/E - Calcium channel blocker • - Block inward current of calcium into cells in vascular smooth muscle, myocardium and cardiac conducting system via L-type calcium channels. • Calcium channel blockers differ in their chemical nature, sites of action and therapeutic effects. • Verapamilhas greater cardiac effects, reducing contractility, heart rate and conduction with less effect on vascular smooth muscle. • - SVT with atrioventricular nodal re-entry • - AF or atrial flutter (ventricular rate control) • - Hypertension, including combination with trandolapril • - Angina • - Common: peripheral oedema, rash, headache, fatigue, dizziness, flushing, nausea, abdominal pain, gingival hyperplasia, bradycardia (diltiazem, verapamil), constipation (verapamil) • - Infrequent: verapamil, elevation of hepatic enzymes, atrioventricular block, development or worsening of heart failure • - Rare: parkinsonism • verapamil, gynaecomastia, hepatitis, gingival hyperplasia

8. Warfarin Class MOA Uses S/E - anticoagulant • - Inhibits synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and the antithrombotic factors protein C and protein S. • - Prevention and treatment of VTE (deep venous thrombosis and pulmonary embolism) • - Prevention of thromboembolism in patients with prosthetic heart valves • - Primary prevention of stroke in patients with AF associated with mitral valvulopathy or other risk factors • - Secondary prevention of stroke in patients with AF • - Prevention of thromboembolism before and after cardioversion for AF • - Prevention of stroke in patients with previous MI and increased embolic risk  • - Common: bleeding • - Rare: skin necrosis, purple discolouration of toes, allergic reactions, alopecia, fever, rash, nausea, vomiting, diarrhoea, hepatic dysfunction

9. Hydrocortisone Class MOA Uses S/E - Corticosteroid • - Corticosteroids regulate gene expression which results in: • glucocorticoideffects, eggluconeogenesis, proteolysis, lipolysis, suppression of inflammation and • immune responses • mineralocorticoideffects, eg hypertension, sodium and water retention, potassium loss. • Corticosteroids may have predominantly glucocorticoid effects (egdexamethasone), mineralocorticoid effects [fludrocortisone], or a combination of both (eg hydrocortisone). • - Where corticosteroids are indicated, eg anaphylaxis (as adjunct to management), acute severe asthma, autoimmune or inflammatory disease, adrenal insufficiency • - Common: adrenal suppression, increased susceptibility to infection, masking of signs of infection, sodium and water retention, oedema, hypertension, hypokalaemia, hyperglycaemia, dyslipidaemia, osteoporosis, fractures, increased appetite, dyspepsia, delayed wound healing, skin atrophy, bruising, acne, hirsutism, growth retardation in children, myopathy, muscle weakness and wasting, fat redistribution (producing cushingoid appearance), weight gain, amenorrhoea, psychiatric effects • - Infrequent: osteonecrosis, particularly of the femoral and humeral heads • Intra-articular injection: headache, flushing, rashes, acute post-injection flare reactions, injection site irritation, joint discomfort (brief), increased blood glucose concentration (temporary) • - Rare: peptic ulceration, posterior subcapsular cataracts, glaucoma, hypersensitivity reactions • Intra-articular injection: periarticular calcification (reversible), arthropathies, progressive cartilage damage, muscle wasting, skin and subcutaneous tissue atrophy, skin pigmentation changes, sterile abscess formation • - Psychiatric effects: Include euphoria, hypomania, depression, disturbances of mood, cognition, sleep and behaviour. Delirium or psychosis are less common.

10. Omeprazole Class MOA Uses S/E - Proton pump inhibitor • - Irreversibly inactivate the hydrogen/potassium ATPase enzyme system (proton pump), suppressing both stimulated and basal acid secretion. When PPIs are stopped, acid secretion is restored by synthesis of new hydrogen/potassium ATPase. • - Peptic ulcer disease (PUD) • - GORD • - Zollinger–Ellison syndrome • - H. pylori eradication, as part of an effective regimen • - Treatment and prevention of peptic ulcer and erosion associated with NSAIDs • - PPIs are generally well tolerated. • - Common: headache, nausea, vomiting, diarrhoea, abdominal pain, constipation, flatulence • - Infrequent: rash, itch, dizziness, fatigue, drowsiness, insomnia, dry mouth, decreased absorption of cyanocobalamin (vitamin B12) with long term use

11. Aspirin Class MOA Uses S/E • - aka acetylsalicylic acid • - Aspirin has analgesic, antipyretic, anti-inflammatory and antiplatelet actions. It is a nonselective NSAID, preventing synthesis of prostaglandins by noncompetitively inhibiting both forms of cyclo-oxygenase (COX), COX-1 and COX-2. • - Inhibition of platelet aggregation (see Aspirin) • - Mild-to-moderate pain • - Fever • - Rheumatic fever • - Rheumatoid arthritis, seek specialist advice • - Kawasaki’s disease, seek specialist advice • -Common: nausea, dyspepsia, vomiting, GI ulceration or bleeding, asymptomatic blood loss, increased bleeding time, headache, dizziness, tinnitus (common with high doses) • - Infrequent: skin reactions including Stevens–Johnson syndrome, iron deficiency anaemia, renal impairment, oesophageal ulceration • - Rare: major haemorrhage (GI or other), blood dyscrasias, Reye’s syndrome with subsequent encephalopathy and severe hepatic injury has been associated with aspirin use in children • - Allergy: Bronchospasm, angioedema, urticaria and rhinitis have been precipitated by aspirin, particularly in people with asthma; there is cross-reactivity with other NSAIDs.