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Year 4 Pharmacology > ACC drugs > Flashcards

ACC drugs Flashcards

1
Q

Adenosine indications

A

SVT - diagnostic and therapeutic

Reduces spontaneous depolarisation + increases resistance to depolarisation, breaking the re-entry circuit.

Will induce cardioversion (SAN resume control of HR) in SVT = can help diagnose it.

Very short acting. Always given IV.

Requires continuous cardiac monitoring

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2
Q

Adenosine side effects and CI

A

Bradycardia/asystole

“impending sense of doom”

CI: hypotension, coronary ischaemia, HF, asthma

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3
Q

Atropine indications and MOA

A

Severe or symptomatic bradycardia (used as an emergency drug in anaesthetics)

Anti-muscarinic = competitively inhibit acetylcholine, preventing parasympathetic “rest and digest” responses.

Increases heart rate.

IV administration and supervision needed.

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4
Q

Atropine side effects and CI

A

SE; tachycardia, dry mouth, constipation, urinary retention, blurred vision.

CI; angle closure glaucoma (increase intraocular pressure), arhythmias

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5
Q

Amiodarone indications and MOA

A

Tachyarrythmias when other other drugs/cardioversion have been unsucessful (incl AF, VF, VT, SVT)

Blocks Na+, Ca2+, K+ channels and is a a and b adrenergic receptor antagonist.

Reduces ventricular rate by reducing spontaneous depolarisation, slowing conduction velocity and increasing resistance to depolarisation.

Increases chance of conversion to and maintenance of sinus rhythm.

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6
Q

Amiodarone SE and and CI

A

Acute SE: hypotension during infusion

Chronic SE: pneumonitis, bradycardia, AV block, hepatitis, photosensitivity, grey discolouration of skin, IODINE ABNORMALITIES

CI: severe hypotension, heart block, thyroid disease

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7
Q

Adrenaline indications

A

Cardiac arrest

Anaphylaxis

Local vasoconstriction to control bleeding/prolong local anaesthetic

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8
Q

Adrenaline MOA

A

Enhances sympathetic nervous system.

Peripheral vasoconstriction and cardiac vasodilation, positively inotropic and chronotropic –> helps redistribute blood towards the heart in cardiac arrest.

Bronchodilation and suppression of inflammatory mediator release from mast cells –> helps in anaphylaxis

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9
Q

Adrenaline SE and CI

A

SE; hypertension, anxiety, tremor, arrhythmias, palpitations

NEVER CI IN CARDIAC ARREST/ANAPHYLAXIS but should be avoided in heart disease for local vasoconstriction

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10
Q

Adrenaline dose in cardiac arrest and anaphylaxis

A

Cardiac arrest: IV 1:10,000 (1mg in 10ml) + 10ml NaCl flush

Anaphylaxis: IM 1:1000 (1mg in 1ml)

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11
Q

Metoprolol indications

A

IV beta blocker of choice for ACS as short half life so more responsive to dose adjustment and can be stopped quickly if necessary (change to bisoprolol once stable)

Negatively inotropic and chronotropic, relieving myocardial work and thus ischaemia.

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12
Q

Metoprolol SE and CI;

A

SE; fatigue, cold extremeties, headache, GI disturbance, sleep disturbance, impotence in men.

CI; asthma, heart block

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13
Q

Calcium chloride indications

A

Cardiac arrest - positively inotropic, so can stabilise contraction of myocytes in cardiac arrest.

Must be given IV

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14
Q

Calcium chloride SE

A

Acidosis

Hypotension (causes peripheral vasodilation)

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15
Q

Nitrates indications

A

Acute angina and ACS
Buccal - GTN
IV - isosorbide mononitrate

Relax venous capitance muscles, reducing cardiac preload, reducing cardiac work and thus myocardial oxygen demand.

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16
Q

Nitrates SE and CI

A

SE: flushing, light headedness, hypotension

CI: aortic stenosis, haemodynamic instability, hypotension

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17
Q

Aspirin indications (+dose)

A

ACS = 300mg loading dose, then 75mg daily

Ischaemic stroke = 300mg daily for 2 weeks

Reduces platelet aggregation and therefore risk of arterial occlusion.

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18
Q

Aspirin SE and CI

A

SE: GI irritation (e.g. peptic ulcer), bronchospasm (hypersensitivity)
PRESCRIBE GASTRIC PROTECTION (PPI) ALONGSIDE

CI: children under 16, third trimester of pregnancy

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19
Q

Ticagrelor indications

A

ACS = in combination with aspirin as rapid platelet aggregation inhibition can prevent/limit arterial thrombosis.

Use 300mg loading dose, then 75mg daily

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20
Q

Ticagrelor SE and CI

A

SE: bleeding, GI upset, thrombocytopenia

CI: active bleeding

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21
Q

LMWH indications

A

ACS = to reduce clot prevention or maintain revascularisation

VTE prophylaxis

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22
Q

LMWH SE

A

SE; haemorrhage, hyperkalaemia

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23
Q

Vitamin K (phytomenadione) indications

A

Reverse anti-coagulation effect of warfarin (give alongside prothombin comlplex in major bleeding)

Provides a fresh supply of vitamin K for synthesis of vitamin K dependent clotting factors.

MUST BE GIVEN IV IN MAJOR OR MINOR BLEEDING

10mg IV given in major bleeding.

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24
Q

Alteplase indications and MOA

A

Acute ischaemic stroke (within 4.5 hrs)

STEMI (within 12 hrs if PCI not immediately available)

Massive PE with haemodynamic instability

PATIENTS MUST BE MONITORED IN HIGH DEPENDENCY UNIT

MOA; dissolves fibrinous clots

25
Alteplase SE and CI
SE: n+v, bruising, hypotension, bleeding, cardiogenic shock. Reperfusion of infarcted brain = cerebral oedema Reperfusion of infarcted heart = arrythmias CI: bleeding, intracranial haemorrhage
26
Prednisolone indications
Anaphylaxis Acute asthma Modify the immune response and suppress inflammation
27
Nimodipine indications
SAH Ca2+ channel blocker, reduces vasospasm
28
Pharmacological management of acute asthma
O-SPIM ``` Oxygen Salbutamol nebs (5mg) back to back Prednisolone (PO) or IV hydrocortisone Ipratropium (if severe) Mg2+ IV if not improving ```
29
Pharmacological management of acute COPD exacerbation
COSICAAR ``` Controlled oxygen Salbutamol nebs (5mg) Ipratropium Corticosteriods (prednisolone PO or hydrocortisone IV) Antibiotics Aminophylline (if not improving) Respiratory support (e.g. NIV) ```
30
Octaplex indications
Warfarin overdose. Used when rapid correction is required Contains vitamin K dependent clotting factors (1972 - X, IX, VII, II)
31
Warfarin indications
VTE Tx (after initial tx with heparin - warfarin takes several days to fully establish anti-coagulation) Secondary VTE prophylaxis Prophylaxis of arterial embolism in AF Inhibits production of vitamin K dependent clotting factors
32
Warfarin SE and CI
SE: bleeding (from minor trauma) CI: first trimester of pregnancy, patients at immediate risk of bleeding, use with caution in liver disease. Check INR
33
Tranexamic acid (TXA) indications and MOA
Given alongside packed RBC transfusion to reduce coagulopathy and increase survival. Works by preventing fibrinolysis §
34
Clopidogrel indications and dose
ACS in combination with aspirin Rapid inhibition of platelet aggregation can limit arterial thrombosis and improve mortality. 300mg loading dose used, then 75mg for maintenance
35
Entonox indications
Analgesia (short term for painful procedures such as acute trauma) 50:50 Nitrous oxide: oxygen
36
CI of entonox
Can raise ICP so do not use in head injury Also avoid in pneumothorax/intestinal obstruction --> expansion of air would be dangerous
37
Ketamine indications in trauma
Reduces pain and agitation (produces dissociative sedation) Can make patient unaware of their surroundings, while also allowing them to maintain their own airway Facilitates painful, short ED procedures
38
Morphine in ED
Acute, severe pain treatment 2-10mg IV initial dose
39
N-acetylcystine indications and MOA
Paracetamol poisoning (weight-adjusted dose, given IV) Replenishes glutathione supplies so that it can bind to the hepatotoxic paracetamol metabolite (NAPQI) and detoxify it. CAUTION; can produce anaphylactoid reaction
40
Naloxone indications and MOA
Opioid overdose 400-1200 micrograms IV (titrated to effect) CAUTION; can cause opioid withdrawal if patient has opioid dependence
41
Diazepam indications in A&E and doses
First line for alcohol withdrawal reactions (dose is individual dependent) First line for management of seizures/status epilepticus (10mg IV) Short term treatment of agitation/anxiety (lowest possible dose)
42
Diazepam SE and CI
SE; drowziness, sedation, coma, long-term use can produce dependence AVOID in elderly, respiratory impairment, neuromuscular disease and liver failure.
43
Sodium bicarbonate indications and MOA
Tricyclic anti-depressent (e.g. amitryptiline) overdose Helps correct hypotension and prevent arrythmias
44
Insulin dextrose indications, dose and MOA
Hyperkalaemia 10 units ACTRAPID in 25g of dextrose (25g in 100ml) infused over 15 mins Insulin drives cellular K+ uptake, must be given alongside dextrose to prevent hypoglycaemia
45
Insulin therapy for DKA
1 unit/ml = 50 units ACTRAPID in 50ml 0.9% NaCl Adjust infusion rate as necessary
46
Inotropes indications, MOA and examples
Low CO, causing tissue hypoperfusion and shock (e.g. cardiogenic shock following MI) Increase force/strength of myocardial contractility, increasing CO, MAP and vital organ perfusion E.g. dobutamine
47
Lorezapam indications
Seizures/status epilepticus (4mg IV)
48
Haloperidol indications in A&E
Acute agitation/violent behaviour (anti-psychotic) Give single dose (amount depends on clinical context and patient) use with caution in elderly patients who are particularly sensitive (+ dementia/Parkinsons)
49
Indications for packed RBC
Acute blood loss Symptomatic anaemia 1 unit increases Hb by 10g/L
50
Indications for FFP
DIC Haemorrhage secondary to liver disease All massive haemorrhages (usually given after 2nd unit of packed red cells) Give over 30 mins
51
Indications for platelets
Haemorrhagic shock in trauma patient Thrombocytopenia Given over 30 mins
52
First choice antibiotics for COPD exacerbation
Amoxicillin (500mg TDS for 5 days) Doxycycline (200mg then 100g OD for 5 days) Clarythromycin (500mg BD for 5 days)
53
Antibiotic management of meningitis in community vs hospital
Community = IM benzylpenicillin ASAP hospital = IV ceftriaxone
54
Antibiotics for cellulitis
Flucloxacillin 500-1000mg QDS for 5-7 days | Clarythromycin if penicillin allergy
55
Antibiotics for CAP and HAP
CAP: co-amoxiclav/clarythromycin for 7 days HAP: IV aminoglycoside (gentamycin) and cephalosporin
56
Antibiotics for cystitis
trimethoprim/nitrofurantoin 3 days for women 7 days for men
57
Antibiotics for pyelonephritis
Co-amoxiclav (broad-spectrum), then according to local guidelines
58
Prothrombin complex concentrate (PCC) indications
Reverse warfarin when the INR is high. Contains clotting factors X, IX, VII, II Give alongside vitamin K in major bleeding

Year 4 Pharmacology (6 decks)

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