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Drugs > Asprin - > Flashcards

Asprin - Flashcards

1
Q

Aspirin mechanism

A

Irreversibly inhibits cyclooxygenase -> reduces platelet aggregation

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2
Q

Aspirin adverse effects ? Regular high dose ?

A

GI irritation -> ulceration / haemorrhage
Hypersensitivity -> bronchospasm
Regular high dose -> tinnitus

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3
Q

Why should children under 16 not get aspirin ?

A

Risk of Reye’s syndrome

Affects liver and brain

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4
Q

Why should aspirin not be given in third trimester of pregnancy

A

Prostaglandin inhibition -> premature closure of ductus arteriosus

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5
Q

When should you be cautious giving asthma

A

Peptic ulceration

Gout

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6
Q

Aspirin interactions

A

Can act synergistically with other antiplatelets

Eg. Clopidogrel , heparin, warfarin

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7
Q

Aspirin prescription in acute coronary syndrome

A

Loading dose of 300mg followed by 75mg once daily

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8
Q

Aspirin prescription for ischemic stroke

A

300mg daily for 2 weeks -> 75mg daily

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9
Q

Aspirin prescription for long term prevention of thrombosis

A

75mg daily

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10
Q

What should often be given wi aspirin ? Especially if on what other drugs

A

Gastroprotection eg omeprazole 20mg daily.

Other drugs - prednisolone /NSAIDS

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11
Q

Benzodiazepines egs.

A

Diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

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12
Q

Benzodiazepines uses

A

First line seizures and status epilepticus
Alcohol withdrawal
Sedation if general anaesthesia undesirable
Short term treatment of severe anxiety / insomnia

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13
Q

Benzodiazepines mechanism

A

Facilitate and enhance binding of GABA to GABAa receptor

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14
Q

Benzodiazepines adverse effects

A

Drowsiness, sedation and coma.

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15
Q

Benzodiazepine overdose ->

A

Loss of airway reflexes -> obstruction

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16
Q

Long term benzodiazepine use ->

A

Dependence and withdrawal reaction similar to alcohol

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17
Q

Caution giving benzodiazepines to?

A

Elderly
Respiratory impairment / neuromuscular diseas
Liver failure

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18
Q

Benzodiazepines interactions

A

Additive to other drugs causing sedation Eg. Alcohol, opioids.
Cytochrome p450 inhibitors (increases effect)

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19
Q

Cytochrome p450 inhibitors

A

Amiodarone, diltiazem, macrolides, fluconazole

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20
Q

Which benzodiazepines for seizures

A

Longer acting - lorazepam 4mg IV, diazepam 10mg IV

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21
Q

Benzodiazepines for alcohol withdrawal

A

Diazepam or chlordiazepoxide

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22
Q

Benzodiazepines for sedation

A

Short acting - midazolam

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23
Q

Benzodiazepines for insomnia / anxiety

A

Intermediate acting - temazepam 10mg oral

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24
Q

Antagonist of benzodiazepines

A

Flumazenil

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25
Q

Beta 2 agonists egs

A

Salbutamol, salmeterol, formoterol, terbutaline

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26
Q

B2 agonist uses

A

Asthma, COPD, hyperkalaemia

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27
Q

B2 agonist mechanism

A

Smooth muscle relaxation

Stimulate Na/K-ATPase pumps - K from extra cellular -> intracellular

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28
Q

B2 agonist adverse effects

A

Tachycardia, palpitations, anxiety, tremor (fight or flight)
Long acting - muscle cramps

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29
Q

What’s needed with long acting b2 agonist in asthma

A

Inhaled corticosteroid

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30
Q

Cation with b2 agonists in who?

A

Cv disease

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31
Q

B2 agonist interactions

A

B blockers prevent.

Corticosteroids -> hypokalaemia

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32
Q

When giving nebuliser for COPD / asthma, do you give with oxygen or air?

A

Asthma - oxygen

COPD - air as risk of co2 retention

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33
Q

Beta blockers egs

A

Bisoprolol, atenolol, propranolol, metoprolol

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34
Q

B blocker uses

A

Ischemic heart disease, chronic heart failure, AF, supra ventricular tachycardia.
Hypertension

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35
Q

B blocker mechanism

A

Reduce force of contraction and speed of conduction in heart .
Prolong refractory period of AV node.
Reduce renin secretion

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36
Q

Who should never get b blockers

A

Asthma

Heart block

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37
Q

Caution using b blockers in who

A

COPD -(use b1 selective eg atenolol, bisoprolol, metoprolol)
Heart failure
Heamodynamic instability
Hepatic failure

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38
Q

B blocker important interaction

A

Don’t use with non-dihydropyridine calcium channel blockers -> heart failure and bradycardia

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39
Q

Aspirin uses

A

Acute coronary syndrome and acute ischemic stroke.
Long term prevention of thrombotic arterial events
AF when warfarin is contraindicated
Mild to moderate pain / fever

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40
Q

BisPhosphonates egs

A

Alendronic acid, disodium pamidronate, zolendronic acid

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41
Q

Bisphosphonates uses

A

Osteoporosis
Hypercalcaemia of malignancy
Myeloma / breast cancer with metastases
Pagets

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42
Q

Bisphosphonates mechanism

A

Inhibit action of osteoclasts -> reduce bone turnover

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43
Q

Bisphosphonates adverse effects

A

Oesophagitis, hypophosphataemia

Rare - osteonecrosis of jaw (good dental hygiene needed), atypical fracture of femur

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44
Q

Who should never get BisPhosphonates

A

Severe renal impairment
Hypocalcaemia
Upper GI disorders

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45
Q

Due to risk of osteonecrosis who should BisPhosphonates be caution in?

A

Smokers

Dental disease

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46
Q

What can limit BisPhosphonate absorption

A

Calcium salts eg milk / antacids

As BisPhosphonates bind calcium

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47
Q

Alendronic acid for osteoporosis prescription

A

70mg once weekly

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48
Q

Bisphosphates prescription for Hypercalcaemia and bone metastases

A

Disodium / zolendronic acid as slow IV infusions (takes several days for results)

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49
Q

How should alendronic acid tablets be taken

A

30 mins before food with plenty water

Stay standing for 30 mins to reduce oesophageal irritation

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50
Q

What should be done before BisPhosphonate treatment in osteoporosis

A

Check and replace calcium / vit D

51
Q

Calcium and vit D uses

A 
Osteoporosis 
Chronic kidney disease 
Severe hyperkalaemia
Symptomatic hypocalcaemia 
Vit D deficiency
52
Q

Why calcium and vit D in CKD

A

Prevent and treat secondary hyperparathyroidism / renal osteodystrophy

53
Q

Calcium and vit D egs

A

Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

54
Q

What controls calcium homeostasis

A

Parathyroid hormone and vit d

55
Q

Calcium adverse effects

A

Constipation and dyspepsia

56
Q

Calcium gluconate adverse effect

A

If given too quickly IV for hyperkalaemia -> cv collapse and local tissue damage if accidentally given IM

57
Q

Which drug cannot be mixed with IV calcium

A

Sodium bicarbonate (risk of precipitation - solid formed from liquid solution)

58
Q

Oral calcium interactions

A

Reduces absorption of many drugs eg. BisPhosphonates, tetracycline, levothyroxine

59
Q

Prescription of calcium and vit d in osteoporosis

A

1g of calcium and 800 units of vit D

60
Q

Hyperkalaemia - calcium prescription

A

10ml of calcium gluconate IV

61
Q

Calcium channel blockers egs

A

Amlodipine, nifedipine, diltiazem, verapamil

62
Q

Calcium channel blockers uses

A

Stable angina
Diltazem / verapamil - supraventricular arrythmias
Amlodipine / nifedipine - hypertension

63
Q

Calcium channel blockers mechanism

A

Relaxation and vasodilation in arterial smooth muscle
Reduce myocardial contractility
Suppress cardiac conduction
Reduce myocardial oxygen demand

64
Q

Amlodipine / nifedipine adverse effects

A

Ankle swelling, flushing, headache, palpitations

65
Q

Verapamil adverse effects

A

Constipation

Rarely - bradycardia, heart block, Cardiac failure

66
Q

Diltazem adverse effects

A

Same as Amlodipine nifedipine, verapamil

As has vascular and cardiac actions

67
Q

Amlodipine and nifedipine should never be given to who

A

Unstable angina

Severe aortic stenosis

68
Q

Verapamil and diltiazem should be used in caution with who

A

Poor LV function

AV node conduction delay

69
Q

Amlodipine hypertension prescription

A

5-10mg orally

70
Q

Angina diltiazem prescription

A

90mg orally 12 hourly

71
Q

Verapamil prescription for supraventricular arrhythmia

A

40-120mg 8 hourly

72
Q

Carbamazepine uses

A

Epilepsy - focal with /out 2 generalisation. 1 generalised
Trigeminal neuralgia
Bipolar disorder

73
Q

Carbamazepine mechanism

A

Inhibits neuronal sodium channels

74
Q

Carbamazepine adverse effects

A

GI upset, dizzy and ataxia, oedema, hyponatraemia.

Rarely - antiepileptic hypersensitivity syndrome

75
Q

What is antiepileptic hypersensitivity syndrome

A

After taking carbamazepine / phenytoin -> eg Stephen Johnson / fever / lymphadenopathy

76
Q

Caution giving carbamazepine to who

A

Pregnant

Hepatic, cardiac or renal disease - toxicity

77
Q

What enzyme is induced by carbamazepine ? Egs of drugs reduced

A

Cytochrome p450

Warfarin, oestrogens, progesterones

78
Q

What increases effects of carbamazepine (caution)

A

P450 inhibitors (as metabolised) eg macrolides

79
Q

What reduces efficacy of antiepileptics ? Egs

A

Drugs that lower seizure threshold eg SSRIs, tricyclics, antipsychotics, tramadol

80
Q

Prescription of carbamazepine

A

Start at low dose 100-200mg 12hrly

Increase gradually up to max 1.6g / day

81
Q

Usual first choice drug for focal seizures

A

Carbamazepine

82
Q

Cephlasporins eg

A

Cefalexin, cefotaxime

83
Q

Carbapenems egs

A

Meropenem, ertapenem

84
Q

Cephasporins and carbapenems uses

A

Severe / complicated / antibiotic resistant infections

2nd line for uti / Rti

85
Q

Cephlasporins / carbapenems mechanism

A

Due to thier b lactam ring -> bacterial swelling, lysis and death
Resistance to b lactamases

86
Q

Carbapenems / cephlasporins adverse effects

A

C. difficile
Hypersensitivity
Risk of CNS toxicity -> seizures

87
Q

Caution for carbapenems / cephlasporins

A

Epilepsy / renal impairment

NEVER if anaphylaxis to penicillins

88
Q

Cephlasporins / carbapenems interaction

A 
Increase warfarin (as kills gut flora that synthesise vit k) 
Reduce valproate
89
Q

Clopidogrel uses

A

Acute coronary syndrome
Prevent occlusion of coronary artery stents
Long term prevention of thrombotic arterial disease
Reduce risk of embolism from AF

90
Q

Clopidogrel mechanism

A

Prevents platelet aggregation by binding to adenosine diphosphate (ADP) receptors

91
Q

What is usually prescribed alongside clopidogrel

A

Aspirin as clopidogrel doesn’t effect COX pathway so synergistic together

92
Q

Clopidogrel adverse effects

A

Bleeding
GI upset
Thrombocytopenia

93
Q

How long before elective surgery should clopidogrel be stopped

A

7 days

94
Q

When should be cautious for clopidogrel

A

Renal / hepatic impairment

95
Q

What needs to happen for clopidogrel to be activated

A

Requires metabolism by p450

96
Q

P450 inhibitors egs

A

Omeprazole, Ciproflaxacin, erythromycin, some antifungals, SSRIs

97
Q

Clopidogrel dose

A 
75mg daily 
(May need loading dose 300mg
98
Q

Compound b2-agonist - corticosteroid inhalers adverse effects

A

Local - horse voice, oral thrush
Long term - systemic from steroids
B2 - tremor, tachycardia, muscle cramps

99
Q

Systemic effects from long term inhaled corticosteroids

A

Adrenal suppression, growth retardation in children, osteoporosis

100
Q

Cautious of combined inhalers in who

A

COPD with Hx of pneumonia (increased risk)
Children (growth)
Cv disease

101
Q

Egs of combined inhalers

A

Seretide, symbicort

102
Q

Tell Pt getting combined inhalers

A

Need to take without fail - takes hours / days to notice improvement
Rinse mouth and gargle to help mouth side effects

103
Q

Egs of systemic corticosteroids

A

Prednisolone, hydrocortisone, dexamethasone

104
Q

Systemic glucocorticoids uses

A

Allergy / inflammatory
Autoimmune
Cancer - reduce tumour related swelling
Hormone replacement - adrenal insufficiency / hypopituitarism

105
Q

Adverse effects of systemic corticosteroids

A

Immunosupression
Metabolic - diabetes / osteoporosis
Weakness, easy bruising, mood and behavioural
Mineralcorticoid - hypertension, hypokalaemia, oedema
Adrenal atrophy (suppression of ACTH from pit)

106
Q

Sudden withdrawal of systemic corticosteroids ->

A

Addisonian crisis -> cv collapse

107
Q

Cautious with systemic corticosteroids in who

A

People with infection

Children (growth)

108
Q

Systemic Corticosteroids mechanisms

A

Upregulate anti inflammatory
Down regulate pro inflammatory
Metabolic - increased gluconeogensis from catabolism of muscle / fat
Mineralcorticoid - Na / water retention and k excretion

109
Q

What drugs reduce efficacy of systemic corticosteroids

A

P450 inducers - phenytoin, carbamazepine, rifampicin

110
Q

Which is the most potent systemic corticosteroid

A

Dexamethasone (750 micrograms = pred 5mg = hydro 20mg)

111
Q

What to tell patients getting systemic corticosteroids

A

Not to stop suddenly

Should start to feel better in 1-2 days

112
Q

Inhaled corticosteroid egs

A

Beclometasone, budesonide, fluticasone

113
Q

Inhaled corticosteroid effects in lungs

A

Reduces mucosal inflammation, bronchodilation, reduce mucus secretion

114
Q

Adverse effects of inhaled corticosteroids

A

Oral thrush
Horse voice
May increase risk of pneumonia

115
Q

Inhaled corticosteroid caution in

A

Hx of pneumonia

Children

116
Q

Inhaled corticosteroid how many times daily

A

Twice

117
Q

Needs to be checked with any inhaler

A

Technique

118
Q

Poorly controlled airway inflammation in asthma ->?

A

Airway remodelling

119
Q

Topical corticosteroid egs

A

Hydrocortisone

Betamethasone

120
Q

Topical corticosteroid uses

A

Eczema / inflammatory skin conditions

121
Q

Local adverse effects of topical corticosteroids

A

Skin thinning
Telangiectasia
Contact dermatitis

122
Q

Withdrawal of topical corticosteroids

A

Rebound worsening of underlying condition

123
Q

Should not use topical corticosteroids in who

A

Where infection

Facial lesions

124
Q

How to use right amount of corticosteroid cream

A

Squeeze tip of finger to first crease -> area double size of Palm

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