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Year 3 > Block 31 Pharmacology > Flashcards

Block 31 Pharmacology Flashcards

1
Q

Thiazide diuretics e.g.s?

A
  • Bendroflumethiazide
  • Chlortalidone
  • Indapamide
  • Metolazone
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2
Q

use of thiazide diuretics?

A

Hypertension, chronic heart failure, oedema

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3
Q

how do thiazide diuretics work?

A

inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys by blocking the thiazide-sensitive Na+-Cl− symporter

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4
Q

thiazide like diuretics?

A

chlorthalidone and metolazone

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5
Q

contraindications of thiazide diuretics?

A
  • Addison’s disease
  • hypercalcaemia
  • hyponatraemia
  • symptomatic hyperuricaemia
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6
Q

side effects of thiazide diuretics?

A
  • dizziness
  • electrolyte imbalance
  • erectile dysfunction
  • hyperglycaemia
  • hyperuricaemia
  • postural hypotension
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7
Q

diuretics can cause?

A

gout - hyperuricaemia

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8
Q

drugs used for bacterial endocarditis?

A
  • Benzylpenicillin
  • Amoxicillin
  • Gentamicin
  • Vancomycin
  • Flucloxacillin
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9
Q

penicillins mechanism of action?

A
  • binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall
  • preventing cross linkage
  • causes cell lysis by autolysins
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10
Q

gentamicin mechanism of action?

A
  • aminoglycoside
  • inhibits 30S ribosome
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11
Q

vancomycin mechanism?

A
  • glycopeptide
  • binds to D-Ala-D-Ala peptide motif of the peptidoglycan precursor
  • prevents transglycosylation of the cell wall
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12
Q

side effects of the penicillins?

A
  • hypersensitivity
  • nausea
  • skin reactions
  • thrombocytopenia
  • vomiting
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13
Q

cautions for penicillins?

A

history of allergy

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14
Q

CI of aminoglycosides?

A

MG - aminoglycosides impair NM transmission

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15
Q

side effects of aminoglycosides

A
  • ototoxicity
  • nephrotoxicity
  • haemoptysis
  • tinnitus
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16
Q

vancomycin CI?

A
  • prev hearing loss w IV use
  • abs can be enhanced with inflammatory disorders of intestinal mucosa
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17
Q

side effects of vancomycin?

A
  • nephrotoxicity
  • vancomysin infusion reaction
  • agranulocytosis
  • tinnitus
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18
Q

warfarin mechanism?

A
  • Vit K antanogist
  • II, VII, IX, and X have decreased clotting ability
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19
Q

warfarin indications?

A
  • Prevention of venous thromboembolism,
  • treatment of DVT and PE,
  • myocardial infarction, unstable coronary disease,
  • anticoagulation in valvular and nonvalvular AF
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20
Q

warfarin contra-indications?

A
  • haemorrhagic stroke
  • sig bleeding
  • within 48 hrs post-partum
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21
Q

side effects of warfarin?

A
  • haemorrhage
  • Blue Toe syndrome
  • skin necrosis
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22
Q

DOACs?

A
  • Apixaban
  • Rivaroxaban
  • Dabigatran
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23
Q

dabigatran mechanism?

A
  • reversible direct thrombin inhibitor (DTI) that competitively inhibits thrombin - factor IIa
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24
Q

DOAC indications?

A
  • Prevention of venous thromboembolism, treatment of DVT and PE,
  • anticoagulation in non-valvular AF
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25
Q

dabigatran CI?

A
  • Antiphospholipid syndrome
  • active bleeding
  • do not use for prosthetic heart valve
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26
Q

dabigtran side effects?

A
  • haemorrhage
  • abn hepatic function
  • nausea, diarrhoea, GI discomfort
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27
Q

apixaban CI?

A
  • anti-phospholipid syndrome
  • bleeding/ risk of bleeding
  • prosthetic HV
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28
Q

SE of apixaban?

A
  • anemia
  • haemorrhage
  • nausea
  • skin reacrions
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29
Q

SE of rivaroxaban?

A
  • hypotension
  • menorrhagia
  • oedema
  • renal impairment
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30
Q

loop diuretics?

A
  • Furosemide
  • Bumetanide
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31
Q

indications of loop diuretics?

A
  • Acute pulmonary oedema,
  • chronic heart failure,
  • diuretic resistant oedema,
  • resistant hypertension
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32
Q

Loop diuretics mechanism?

A
  • reduce sodium chloride reabsorption in the thick ascending limb of the loop of Henle.
  • This is achieved by inhibiting the Na-K-2Cl carrier
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33
Q

Loop diuretics contra-indications?

A
  • anuria
  • severe hypokalaemia
  • severe hyponatreamia
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34
Q

hypokalaemiaa and loop diuretics?

A
  • dangerous in severe CV disease and in patients also being treated w cardiac glycosides
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35
Q

side effects of loop diuretics?

A
  • metabolic alkalosis
  • dizziness
  • muscle spasms
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36
Q

potassoium sparing diuretics examples?

A
  • Amiloride
  • Spironolactone
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37
Q

amiloride Mx?

A
  • Amiloride blocks the epithelial sodium channel (ENaC) in the late distal tubule,
  • > reduced sodium abs and reduced potassium excretion
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38
Q

amiloride and spironolactone contra-indications?

A
  • addisons
  • anuria
  • hyperkalaemia
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39
Q

amiloride side effects?

A
  • angina
  • arrythmia
  • AV block exacerbation
  • gout
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40
Q

indications of K+ sparing diuretics?

A
  • Prevention of hypokalaema alongside a loop or thiazide diuretic [e.g. amiloride]
  • oedema in cirrhosis of liver,
  • severe heart failure,
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41
Q

Conn’s syndrome tx?

A

aldosterone antagonists

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42
Q

spironolactone mechanism?

A
  • aldosterone antagonist
  • promotes sodium and water excretion and potassium retention.
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43
Q

spironolactone side effects?

A
  • AKI
  • agranulocytosis
  • breast neoplasm benign
  • hyperkalaemia - discontinue
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44
Q

BBs examples

A

“Atenolol Propranolol Bisoprolol”

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45
Q

Beta blockers Indications?

A
  • Angina
  • hypertension
  • myocardial infarction
  • arrhythmias
  • heart failure,
    -symptomatic relief of thyrotoxicosis,
  • prophylaxis of migraine
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46
Q

BBs CI ?

A
  • ASTHMA
  • hypotension
  • bradycardia
  • prinzmetal’s angina
  • AV block and SSS
  • PAD
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47
Q

Side effects of BBs?

A
  • bradycardia
  • ED
  • heart failure
  • PVD
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48
Q

cardioselective BBs?

A
  • atenolol
  • bisoprolol
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49
Q

non cardioselective BBs?

A
  • propanolol
  • timolol
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50
Q

CCBs?

A
  • Amlodipine
  • Felodipine
  • Diltiazem
  • Verapamil
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51
Q

CCBs mechanism?

A
  • binds to and blocks L type calcium channels
  • calcium can’t enter cells -> vasodilation and decreased BP
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52
Q

dihydropyridine CCBs?

A
  • anti-hypertensive properties - potent vasodilaor
  • amlodepine
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53
Q

non DHP CCBs?

A
  • verapamil
  • diltiazem
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54
Q

CCBs adverse effects?

A
  • Headache
  • Flushing
  • Dizziness
  • Peripheral oedema
  • Reduced cardiac contractility
  • Constipation
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55
Q

CCB indications?

A
  • Hypertension,
    arrhythmias [e.g. verapamil]
  • angina
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56
Q

CCB CI?

A
  • Cardiogenic shock
  • sig AS
  • unstable angina
  • hypotension
  • AV block
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57
Q

ACEi indications?

A
  • Chronic heart failure,
  • hypertension,
  • diabetic nephropathy,
  • prophylaxis of cardiovascular events
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58
Q

ACEi Mx?

A
  • reduced aldosterone secretion - reduced Na+ and water retention
  • reduced ADH - reduced water reabs
  • reduced vasoconstriction
  • reduced sympathetic activity
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59
Q

ACEi side effects - bradykinin?

A
  • dry cough
  • due to increase in bradykinin within the lungs (ACE breaks down bradykinin).
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60
Q

side effects of ACEi?

A
  • Headache
  • Postural hypotension
  • Rashes
  • Angio-oedema
  • Strongly teratogenic
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61
Q

CI of ACEi?

A
  • angioedema
  • AKI
  • First dose hypertension
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62
Q

ARBs examples?

A

Losartan & Candesartan

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63
Q

ARBs mechanism?

A
  • prevention of angiotensin II binding causes vascular smooth muscle relaxation, lowering blood pressure
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64
Q

Ix of ARBs?

A
  • Chronic heart failure,
  • hypertension,
  • diabetic nephropathy
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65
Q

ARB antagonists CI?

A
  • with aliskiren for AKI and DM
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66
Q

SE of ARBs?

A
  • abd pain
  • cough
  • hyperkalaemia
  • postural hypertension
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67
Q

Alpha blockers?

A
  • Doxazosin
  • Tamsulosin (benign prostatic hyperplasia)”
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68
Q

Alpha blockers mechanism?

A
  • blockage of alpha 1 receptors
  • Reduced arteriolar tone - lowering peripheral vascular resistance.
  • Venous dilation - reducing venous return and cardiac output.
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69
Q

alpha blockers side effects?

A
  • Postural hypotension
  • Headaches
  • Dizziness
  • Nausea
  • Rhinitis
  • Urinary frequency
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70
Q

CI of Alpha blockers?

A
  • micturition syncope (in patients with benign prostatic hypertrophy);
  • postural hypotension
  • doxasocin: overflow bladder or anuria
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71
Q

indications of alpha blockers?

A
  • Resistant hypertension,
  • prostatic hyperplasia
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72
Q

statins Ix?

A

reduction of CV risk

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73
Q

statins?

A

“Simvastatin Atorvastatin Rosuvastatin”

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74
Q

statins mechanism?

A
  • competitively inhibiting HMG-CoA reductase
  • reduction of LDL cholestrol
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75
Q

statins cautions?

A

Risk factors for muscle toxicity, including myopathy or rhabdomyolysis

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76
Q

side effects of statins?

A
  • arthralgia
  • GI discomfort
  • thrombocytopenia
  • muscle complaints
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77
Q

fibrates?

A
  • Bezafibrate
  • Fenofibrate
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78
Q

Ix of fibrates?

A

reduction of CV risk

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79
Q

fibrates mechanism of action?

A
  • Activating PPARs induces the transcription of a number of genes that facilitate lipid metabolism.
  • inhibit hepatic synthesis of triglycerides
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80
Q

fibrates CI?

A
  • GB disease
  • hypoalbuminaemia
  • nephrotic syndrome
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81
Q

fibrate SE?

A
  • decreased appetite
  • GI disorder
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82
Q

Ezetemibe Ix?

A

reduction of CV risk

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83
Q

ezetimibe mechanism?

A
  • blocks NPC1L1 receptor
  • cholesterol abs inhibitor
  • reduces total cholesterol, LDL, Ao-B
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84
Q

ezetimibe side effects?

A
  • asthenia
  • GI discomfort
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85
Q

Parenteral anticoagulants?

A
  • Unfractionated heparin
  • Dalteparin
  • Fondaparinux
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86
Q

parenteral AC Ix?

A
  • Prevention of venous thromboembolism,
    -treatment of DVT and PE,
  • myocardial infarction,
  • unstable coronary disease
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87
Q

UFH mechanism?

A
  • forms a complex wth AT preventing fibrin formation
  • inhibition of several activated blood coagulation factors: thrombin (factor IIa), factor IXa, Xa, XIa and XIIa
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88
Q

dalteparin mechanism?

A
  • inc antithombin III activity
  • which inhibits factor 2A, and 10A
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89
Q

fondaparinux mechanism?

A
  • selectively INHIBITS FACTOR 10
  • Inhibits thrombin formation
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90
Q

fondaparinux CI?

A

active bleeding and bacterial endocarditis

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91
Q

side effects of fondaparinux?

A

anemia and haemorrhage

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92
Q

UFH/ dalteparin CI?

A
  • bac endocarditis
  • haemophilia/ other haemorrhagic disorders
  • recent surgery
  • thrombocytopenia
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93
Q

side effects of heparins?

A
  • Haemorrhage
  • heparin-induced thrombocytopenia
  • skin reactions
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94
Q

BBs Ix?

A
  • Ischaemic heart disease,
  • angina,
  • hypertension,
  • myocardial infarction,
  • arrhythmias, heart failure,
  • anxiety conditions,
  • symptomatic relief of thyrotoxicosis,
    -prophylaxis of migraine
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95
Q

tinolol machanism?

A
  • beta 2 blockage -> decreased peripheral resistance
  • reduces occular pressure by decreases AH secretion
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96
Q

BBs used in HF?

A
  • Bisoprolol and Carvedilol
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97
Q

Anti-anginals?

A
  • BBs
  • CCBs
  • nitrates
  • nicronadil
  • ivabradine
  • ransolazine
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98
Q

Nitrates?

A
  • Glyceryl trinitrate (GTN)
  • Isosorbide dinitrate
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99
Q

GTN/ Isosorbide dinitrate mechanism?

A
  • relaxation of vascular SM -> vasodilation
  • converted to NO
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100
Q

NITRATES CI?

A
  • aortic stenosis
  • constrictive pericarditis
  • hypertrophic cardiomyopathy
  • mitral stenosis
  • raised ICP
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101
Q

nitrates are also CI for

A

toxic pulmonary oedema

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102
Q

side effects of nitrates?

A
  • arrhythmias
  • flushing
  • cerebral ischaemia
  • hypotension
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103
Q

Nicorandil mechanism?

A
  • relaxes vascular SM by increasing CGMP levels
  • activates potassium channels causing hyperpolarization -> vasodilation
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104
Q

nicorandil CI?

A
  • acute Pulm oedema
  • LV dysfunction
  • severe hypotension
  • shock and hypovolaemia
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105
Q

side effects of nicronadil?

A
  • vasodilation
  • headache - espec on initation
  • Flushing
  • Anal ulceration
106
Q

ivabradine mechanism?

A
  • lowers heart rate and reduces oxygen demand in the heart
  • selectively inhibits funny channel pacemaker current in SAN
107
Q

CI of ivabradine?

A
  • acute MI
  • second and third degree AV block, SSS
  • severe hypotension
  • unstable angina
  • acute HF
108
Q

side effects of ivabradine?

A
  • visual effects, particular luminous phenomena, are common
  • headache
  • bradycardia, heart block
109
Q

ranolazine mechanism?

A
  • inhibits sodium and potassium ion channel currents.
  • vasodilator
110
Q

ranolazine cautions?

A
  • severe congestive hF
  • QT interval prolongation
111
Q

side effects of ranolazine?

A
  • asthenia
  • constipation
  • headache
  • vomiting
112
Q

Antiplatelets?

A
  • Aspirin
  • Clopidogrel
  • Ticagrelor
  • Dipyridamole
  • Tirofiban
113
Q

Ix of anti-platelets?

A
  • Secondary prevention of cardiovascular events,
  • prevention of atherothrombotic events post PCI
114
Q

aspirin mechanism?

A
  • irreversible inhibition of COX-1
  • which is needed to make precursors of thromboxane within platelets
  • thromboxane needed for platelet aggregation
115
Q

aspirin CI?

A
  • acute PUD
  • bleeding
  • under 16s - risk of Reye’s syndrome
  • severe cardiac failure - analgesic dose
116
Q

side effects of aspirin?

A
  • dyspepsia
  • haemorrhage
117
Q

aspirin overdose?

A

hyperventilation, tinnitus, deafness, vasodilatation, and sweating

118
Q

Clopidogrel and ticagrelor?

A
  • inhibition of P12Y12 ADP receptors on platelets preventing aggregation
  • ticagrelor reversibly inhibits
119
Q

SE of clopidogrel?

A
  • diarrhoea
  • GI discomfory
  • haemorrhage
  • skin reactions
120
Q

ticagrelor SE?

A

- gout and hyperuricaemia
- hypotension
- syncope
- dysponea

121
Q

dipyridamole mechanism?

A
  • inhibits function of phosphodiesterase and adenosine deaminase
  • prevents cAMP degradation
  • which is an inhibitor of platelet function
122
Q

cautions of dipyridamole?

A
  • lV outflow obst
  • HF
  • myasthenia gravis
  • recent MI
123
Q

Side effects of dipyridamole?

A
  • angina
  • myalgia
  • vomiting
  • skin reactions
124
Q

tirofiban mechanism?

A
  • reversible, competitive inhibitor of GP IIb/IIIa receptors,
  • exerting its effects via the prevention of the binding of fibrinogen
125
Q

tirofiban CI?

A
  • Abn bleeding, haemorrhagic stroke
  • inc INR
  • thrombocytopenia
  • severe HTN
126
Q

SE of tirofiban?

A
  • ecchymosis
  • fever
  • haemorrhage
  • thrombocytopenia
127
Q

thrombolytic drugs Ix?

A

Thrombolysis in STEMI and massive pulmonary embolism

128
Q

What are the thrombolytic drugs?

A
  • Alteplase
  • Tenecteplase
129
Q

alteplase and tenecteplase mechanism?

A
  • converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen
130
Q

fibrinolytics CI?

A
  • Acute panc
  • bacterial endocarditis
  • recent surgery
  • severe HTN
131
Q

SE of fibrinolytics?

A
  • anaphylactic reactions
  • angina
  • cardiac arrest
  • ecchymosis
  • pericarditis
  • pulm oedema
132
Q

digoxin Ix?

A

Heart failure, supraventricular arrhythmias [AF and atrial flutter]

133
Q

Digoxin mechanism - positive ionotropic?

A
  • increase force of contraction
  • by reversibly inhibiting Na-K ATPase pump
  • causes inc in IC sodium which causes influx of calcium
  • increases contractility and cardiac output
134
Q

Digoxin mechanism - AV node inhibition?

A
  • vagomimetic effects
  • stimulates PSNS slowing electrical conduction, decreasing HR
135
Q

Digoxin CI?

A
  • constrictive pericarditis
  • hypertrophic cardiomyopathy
  • complete HB, second degree block
  • SV arrhythmias like WPW, ventricular tachycardias or fibrillaion
136
Q

SE of digoxin?

A
  • arrythmias
  • cerbebral impairment
  • vision disorders
  • gynaenomastia
137
Q

Anti-dysrhythmic drugs?

A
  • Amiodarone
  • Lidocaine
  • Flecainide
  • Sotalol
  • Adenosine
  • Atropine
138
Q

beta-2 adrenreceptor agonist?

A
  • Salbutamol
  • Terbutaline
  • Salmeterol
  • Formoterol
139
Q

beta 2 agonists indications?

A

asthma, copd

140
Q

salbutamol mechanism?

A
  • short acting b2 agonist
  • potent SM relaxant properities -> inhibits bronchial SM contraction
141
Q

salbutamol cautions?

A
  • QT prolongation
  • diabetes - hyperglycaemia and ketoacidosis
  • CV disease
  • hyperthyroidism
142
Q

what else can happen w beta 2 agonist therapy?

A

hypokalaemia - Particular caution is required in severe asthma or COPD, because this effect may be potentiated by concomitant treatment with theophylline, corticosteroids, diuretics, and by hypoxia.

143
Q

side effects of all beta-2 agonists?

A
  • arrhythmias
  • headache
  • palpitations
  • tremor
144
Q

terbutaline mechanism?

A
  • beta 2 agonist
  • bronchodilator

SABA

145
Q

terbutaline side effects?

A
  • hypokalaemia
  • hypotension
  • muscle spasms
  • MI: rarely
146
Q

monitoring w terbutaline?

A
  • hypokalaemia w asthma
  • In patients with diabetes, monitor blood glucose (risk of hyperglycaemia and ketoacidosis, especially when beta2 agonist given intravenously).
147
Q

salmetrol mechanism?

148
Q

Formoterol mechanism?

149
Q

antimuscarinic bronchodilators examples?

A
  • Ipratropium
  • Tiotropium
150
Q

ipatropium?

A
  • ACh antagonist - muscarinic
  • SM relaxation in airways
  • SAMA
151
Q

tiotropium =

152
Q

cautions for all inhaled antimuscarinics?

A
  • bladder outflow obst
  • paradoxical bronchospasm
  • prostatic hyperplasia
  • susceptibility to angle closure glaucoma
153
Q

cautions for ipatropium - inhaled?

154
Q

glaucoma and ipatropium?

A

Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists); care needed to protect the patient’s eyes from nebulised drug or from drug powder.

155
Q

interactions of ipatropium?

A

clozapine - both have antimuscarinic effects

156
Q

side effects of all inhaled antimuscarinics?

A
  • arrhythmias
  • constipation
  • cough
  • dizziness
  • dry mouth
157
Q

theophyllines?

A
  • Aminophylline
  • Modified release theophylline
  • Asthma and COPD
158
Q

Aminophyllines/ theophylline mechanism?

A
  • inhibits phosphodiesterase - PDE
  • results in bronchodilation
  • Theophylline also binds to the adenosine A2B receptor and blocks adenosine mediated bronchoconstriction.
159
Q

aminophylline cautions?

A
  • arrhythmias following rapid IV injection
  • elderly
  • epilepsy
  • peptic ulcer
  • risk of hypokalaemia
160
Q

aminophylline side effects?

A
  • abd pain
  • arrhythmia (more common when given too rapidly by intravenous injection)
  • delirium
  • confusion
  • hypotension
  • mania
161
Q

theophylline overdose?

A
  • Theophylline drugs in overdose can cause vomiting (which may be severe and intractable), agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. - More serious effects are haematemesis, convulsions, and supraventricular and ventricular arrhythmias.
  • Severe hypokalaemia may develop rapidly.
162
Q

Theophylline side effects?

A
  • anx
  • diarrhoea
  • hyperuricaemia
  • palpitations
  • urinary disoeders
163
Q

monitoring requirements for theophylline?

A
  • plasma monitoring required
  • Plasma-theophylline concentration is measured 5 days after starting oral treatment and at least 3 days after any dose adjustment.
  • A blood sample should usually be taken 4–6 hours after an oral dose of a modified-release preparation
164
Q

inhaled corticosteroids?

A
  • Beclometasone
  • Fluticasone
  • COPD and asthma
165
Q

CI for all corticosteroids?

A
  • avoid live virus vaccines in those receiving immunosuppressive doses (serum antibody response diminished)
  • systemic infection (unless specific therapy given)
166
Q

beclomethasone interactions?

A
  • amiodarone
  • amphotericin B
  • apiprazole
167
Q

side effects of all inhaled corticosteroids?

A
  • headache
  • oral candidasis
  • pneumonia in COPD patients
  • altered taste
  • voice alteration
168
Q

reducing risk of candidasis w inhaled steroids?

A
  • use spacer device
  • rinsing the mouth with water after inhalation of a dose
169
Q

side effect of beclomethasone?

A

throat irritation

170
Q

budesonide/ Fluticasone mechanism?

A
  • inc transcription of IL10
  • Supress inflammatory gene activation by promoting histone deacetylation -> tighter coiling of DNA -> reduced transcription
171
Q

steroids and bronchospasm?

A
  • Mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).
172
Q

Sodium cromoglicate?

173
Q

side effects of Sodium cromoglicate?

A
  • arthralgia
  • nausea
  • rash
174
Q

Sodium cromoglicate mechanism?

A
  • inhibits degranulation of mast cells
  • preventing release of histamine and mediators of type 1 allergic reactions
  • reduces inflammatory leukotrienes
175
Q

montelukast?

A
  • leukotriene receptor antagonist
  • asthma
176
Q

risk of ? in ppl taking montelukast?

A
  • neuropsychiatric reactions
  • speech impairmenet
  • OCD
177
Q

montelukast interactions?

A

clopidogrel

178
Q

side effects of montelukast?

A
  • diarrhoea
  • GI discomfort
  • skin reactions
  • URTI
181
Q

? syndrome can rarely occur w montelukast use?

A
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) has occurred very rarely in association with the use of montelukast; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy.
  • development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.
181
Q

common ab used in resp disease?

A
  • Amoxicillin
  • Co-amoxiclav
  • Clarithromycin
  • Doxycycline
  • Cefuroxime
182
Q

amoxicillin mechanism?

A
  • comp inhibition of PBP-1
  • Which are resp for cross linkage of subunits in the cell wall
183
Q

cautions for amoxicillin?

A
  • allergy
  • lymphocytic leukemia
  • cytomeg virus
  • glandular fever
  • inc risk of rashes w these ^
184
Q

amoxicllin interactions?

A
  • methotrexate
  • warfarin
185
Q

side effects of all penicillins?

A
  • diarrhoea
  • hypersenitivity
  • thrombocytopenia
  • vomitinh
  • nausea
186
Q

rare amoxicillin side effects?

A
  • agranulocytosis
  • angioedema
  • haemolytic anemia
  • nephritis
187
Q

diarrhoea and penicllin?

A

Diarrhoea frequently occurs during oral penicillin therapy. It is most common with broad-spectrum penicillins, which can cause antibiotic-associated colitis.

188
Q

co-amoxiclav mechanism?

A
  • clavanic acid is a beta lactamase inhibitor used to enhance effectiveness of beta lactam ab
189
Q

CI of co-amoxiclav?

A
  • history of C-A associated jaundice or hepatoc dysfunction
  • history of penicillin assoc jaundice/ dysfunction
190
Q

side effects of co-amoxiclav?

A
  • inc infection risk
  • dyspepsia
  • dizziness
191
Q

clarithromycin mechanism?

A
  • macrolide
  • 50s inhibitors
192
Q

macrolides cautions?

A
  • Electrolyte disturbances (predisposition to QT interval prolongation)
  • may aggravate myasthenia gravis
  • predisposition to QT interval prolongation
193
Q

clarithryomycin interactions?

A
  • atorvastatin: rhabdo
  • betamethasone
  • bromocriptine
  • buspirone
  • carbamazepine
194
Q

side effects of all macrolides?

A
  • dec appetite
  • dizziness
  • hearing imp
  • pancreatitis
  • vasodilation
  • vision disorders
195
Q

side effects of clarithromycin?

A
  • burping
  • dry mouth
  • muscle complaints
  • oral disorders
  • tremor
  • tooth and urine discoloration
196
Q

psychiatric side effects of macrolides?

A
  • agranulocytosis
  • depersonalisation
  • depression
  • mania
  • psychotic disorder
197
Q

doxycycline cautions?

A
  • alc dependence
  • 8 -11 yrs kids bc it deposits in growing bone and teeth, by binding to calcium, causes staining and occasionally dental hypoplas
198
Q

doxycline interactions?

A
  • alcohol
  • ciclosporin
  • dalteparin
  • lithium
199
Q

side effects of all tetracyclines?

A
  • panc
  • angiodema
  • pericaritis
  • photosensitivity reactions
200
Q

side effects of doxy?

A
  • hypotension
  • tachy
  • dyspnoea
  • peripheral oedema
  • tooth discoloration
201
Q

doxy mechanism?

A
  • 30s inhibition
  • tetracyclne
202
Q

Cefuroxime mechanism?

A
  • cephlasporin (beta lactam)
  • broad spectrum
  • binds to PBPs, prevents cell wall synthesis -> autolysins destroy the cell wall
203
Q

side effects of all cephlasporins?

A
  • abd pain
  • eosinophilia
  • leucopenia
  • pseudomembranous enterocolitis;
204
Q

cefuroxime side effect?

A

inc risk of infection

205
Q

what are the nitrates?

A
  • Glyceryl trinitrate (GTN)
  • Isosorbide dinitrate
206
Q

what are the nitrates used for?

A

Off loading in severe heart failure with significant hypertension

207
Q

nitrates CI?

A
  • aortic stenosis
  • cardiac tamponade
  • hypotension
  • hypovolaemia
  • raised ICP
  • pulm oedema
208
Q

cautions for all nitrates?

A
  • HF due to obstruction
  • cardioversion
  • recent MI
  • hypothermia
  • hypothyroidism
  • tolerance
209
Q

nitrates and tolerance?

A
  • usually long acting/ transdermal nitrates
210
Q

Nitrates CI?

A

slidenafil - hypotension risk

211
Q

side effects of all nitrates?

A
  • asthenia
  • cerebral ischemia
  • headache
  • flushing
  • nausea
  • vomiting
  • hypotension
212
Q

GTN mechanism?

A
  • converted to NO
  • potent vasodilator
  • relazation of SM in blood vessels
213
Q

Isosorbide dinitrate common reaction w oral use?

A

peripheral oedema

214
Q

what are the anti-dysrhythmic drugs?

A
  • Amiodarone
  • Lidocaine
  • Flecainide
  • Sotalol
  • Adenosine
  • Atropine
215
Q

Anti-dysrhythmic drugs =

A
  • Amiodarone
  • Lidocaine
  • Flecainide
  • Sotalol
  • Adenosine
  • Atropine
216
Q

use of antidysrhythmic drugs

A

Ventricular arrhythmias, supraventricular arrhythmias

217
Q

amiodarone mechansim?

A
  • class 3 antiarrythmic
  • blocks potassium currents preventing repolasirsation
  • inc duration of AP as well as refractory period
  • reduced cardiac excitability
218
Q

amiodarone Ix?

A
  • vent fib or pulseless VT
  • arrythmias
219
Q

CI of amiodarone?

A
  • severe conduction disorders
  • SAN disease
  • iodine sensitivity
  • sinus bradycardia unless in cardiac arrest
  • thryoid dysfunction
220
Q

SE of amiodarone?

A
  • arrhytmias
  • hepatic disorders
  • hyperthyroidism
  • resp disorders
221
Q

lidocaine Ix?

A
  • CP resus as an alt to amiodarone
  • vent arrythmias
  • anaesthesia
222
Q

CI of lidocaine?

A
  • severe myocardial dispression
  • SAN disorders
  • AV block
223
Q

lidocaine SE?

A
  • AV block
  • cardiac arrest
  • methamoglobinaemia
224
Q

Flecanide mechanism?

A
  • blocks sodium channels prolonging refractory period and shortening duration of potentials
  • prevents potassium channels from opening
225
Q

flecainide Ix?

A
  • SVT
  • vent arrhytmias
226
Q

CI of flecanide?

A
  • BBB
  • abn function
  • history of mI
  • heart failure
227
Q

flecanide interacts w?

A
  • BB
  • amiodarone
228
Q

SE of flecanide?

A
  • arrhythmias
  • dizziness
  • fever
  • oedema
  • QT prolongation
229
Q

sotalol safety info?

A
  • QT prolongation
  • avoid hypokalaemia and hypomag
230
Q

sotalol Ix?

A
  • tachyarrythmias
  • Life-threatening arrhythmias including ventricular tachyarrhythmias
231
Q

CI of BB?

A
  • Asthma
  • cardiogenic shock
  • hypotension
  • PAD
232
Q

CI of sotalol?

A

long QT and torsades de pointes

233
Q

SE of sotalol?

A
  • chest pain
  • arrhythmia
  • sexual dysfunction
  • torsades - inc risk in females
234
Q

sotalol mechanism?

A
  • B1 blockage
  • blocks K channels slowing repolarisation and lengthening QT interval -> class three agent
235
Q

adenosine Ix?

236
Q

Adenosine CI?

A
  • asthma
  • COPD
  • long QT
  • AV block
237
Q

SE of adenosine?

A
  • abd discomfort
  • AV block
  • chest pain - discontinue
  • hypotension - discontinue
238
Q

adenosine mechanism?

A
  • agonism of adenosine A1 and A2 receptors reduces conduction time in the AVN
  • by inducing potassium efflux and inhibiting calcium influx
  • dec condution time -> antiarrythmic effecr
239
Q

Atropine mechanism?

A

muscarinic antagonist

240
Q

atropine Ix?

A
  • bradycardia- overdose of BB
  • Bradycardia
241
Q

SE of atropine?

A
  • anhidrosis
  • arrythmias
  • hallucination
  • hyperthermia
242
Q

drugs used in cardiac arrest?

A
  • Adrenaline
  • Amiodarone
  • Atropine (bradycardia)
  • 8.4% sodium bicarbonate (hyperkalaemia)
  • Calcium chloride (hyperkalaemia)
  • Magnesium sulfate (hypomagnesaemia, Torsades de pointe, digoxin toxicity)
243
Q

adrenaline mechanism?

A
  • alpha and beta receptor and inc HR contractility
  • causes peripheral vasodilation - beta -2 effect
  • vasoconstriction - alpha effect
244
Q

adrenaline Ix?

A
  • CP resus
  • acute hypotension
  • anaphylaxis
245
Q

adrenaline interacts w

246
Q

SE of adrenaline?

A
  • angina
  • anx
  • CNS haemorrhage
  • metabolic acidosis
  • pulm oedema - excess dose or extreme sensitivity
247
Q

8.4% sodium bicarbonate is used for

A

hyperkalaemia

248
Q

sodium bicarb CI?

A
  • Hypokal
  • salt restricted diet
249
Q

sodium bicarb interactions?

250
Q

side effects of sodium bicarb?

A
  • anx
  • dizziness
  • fluid retention
  • metabolic alkalosis
  • pulm oedema
251
Q

sodium bicarb mechanism?

A
  • raise blood pH and shift EC potassium unto cells
252
Q

calc chloride is used for?

A

hyperkalaemia

253
Q

cal chloride indications?

A
  • acute hypocalcaemia
  • acute severe hyperkalaemia
254
Q

SE of calcium?

A
  • constipation
  • diarrhoea
  • hypercal
  • nausea
255
Q

Mg sulfate is used for

A
  • hypomagnesaemia
  • Torsades de pointe,
  • digoxin toxicity
256
Q

Mg sulfate indications?

A
  • hypomag
  • prevention and treatment of seizures
  • serious arrhythmias
257
Q

CI of mg sulfate?

A

In rapid bowel evacuation—acute gastro-intestinal conditions

258
Q

side effects of Mg sulfate?

A
  • paralytic ileus
  • bone demineralisation
  • diarrhoea
259
Q

Mg sulfate - symptoms of hypermg?

A

nausea, vomiting, flushing, thirst, hypotension, drowsiness, confusion, reflexes absent (due to neuromuscular blockade), respiratory depression, speech slurred, diplopia, muscle weakness, arrhythmias, coma, and cardiac arrest.

Year 3 (45 decks)

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