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Block 34 Pharm Flashcards

1
Q

Anti-proliferative agents?

A

azathioprine and cyclophosphamide

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2
Q

Calcaneurin inhibitors?

A

Ciclosporin and tacrolimus

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3
Q

Drugs used in transplant immunosuppession?

A
  • ciclosporin
  • tacrolimus
  • azathioprine
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4
Q

Cyclophosphamide uses?

A

treatment of immune based renal disease i.e. Wegener’s granulomatosis, types of glomerulonephritis or SLE

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5
Q

Azathioprine mechanism?

A
  • metabolised to mercaptopurine
  • purine synthesis inhibition
  • inhibits B and T cells
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6
Q

Cautions of azathioprine?

A

reduce dose in elderly and TMPT activity

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7
Q

Azathioprine interactions?

A
  • allopurinol
  • BCG
  • febuxostat
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8
Q

Side effects of azathioprine?

A
  • bone marrow depression
  • leucopenia
  • infections
  • thrombocytopenia
  • pancrwatitis
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9
Q

Screening w azathioprine?

A

TMPT activity - increased risk of myelosuppression w reduced TMPT activity

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10
Q

cyclophosphamide mechanism?

A
  • alkylating agent
  • used to treat lymphomas and leukemias
  • attaches to alkyl groups, fragmenting DNA
  • DNA damage by forming cross links
  • mispairing the nucleotides leading to mutations
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11
Q

cautions of cyclophosphamide?

A
  • acute porphyrias
  • DM
  • haemorrhagic cystitis
  • previous or concurrent mediastinal irradiation—risk of cardiotoxicity
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12
Q

interactions of cyclophosphamide?

A
  • BCG
  • vaccines
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13
Q

side effects of cyclophosphamide?

A
  • alopecia
  • agranylocytosis
  • haemolytic uraemic syndrome
  • sperm abn
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14
Q

cyclosporin mechanism?

A
  • IS
  • calcaneurin inhibitor that inhibits T cell activation
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15
Q

Tacrolimus mechanism?

A

calcaneurin inhibitor

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16
Q

CI of cyclosporin?

A
  • malignancy
  • uncontrolled HTN
  • infections
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17
Q

Ciclosporin interactions?

A
  • aliskiren
  • amiodarone
  • atorvostatin
  • vaccines
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18
Q

side effects of ciclosporin?

A
  • eye inflammation
  • decreased appetite
  • HTN
  • hyperuricaemia
  • renal impairment
  • peptic ulcer
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19
Q

tacrolimus CI?

A
  • malignant skin lesions
  • infection
  • cautions: avoid UV light
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20
Q

Tacrolimus interactions?

A
  • amiodarone
  • BCG
  • cobicstat
  • clarithromycin
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21
Q

SE of tacrolimus?

A
  • inc infections
  • skin reactions
  • sensation abn
  • peripheral neuropathy
  • alopecia
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22
Q

tacrolimus in children?

A

cardiomyopathy - inc risk

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23
Q

Oxybutynin mechanism?

A
  • antimuscarinic
  • reduces detrusor activity, relaxing bladder
  • prevents urge to void
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24
Q

oxybutynin is used for

A

OAB

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25
Q

CI for AMs like oxybutynin?

A
  • closed angle glaucoma
  • GI obstruction
  • MG
  • paralutic ileus
  • sig bladder outflow obst
  • urinary retention
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26
Q

side effects of all antimusacrinics?

A
  • const
  • dry mouth
  • dizziness
  • flushing
  • headache
  • urinary disordrers
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27
Q

oxybutynin side effects?

A
  • diarrhoea
  • dry eye
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28
Q

muscarinic receptor antagonists?

A

Oxybutinin & Tolterodine

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29
Q

Use of antimuscarinics?

A

Overactive bladder syndrome, urge predominant incontinence

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30
Q

Tolteridone is a ?

A

AM

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31
Q

Cautions of tolerodine?

A

QT prolongation

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32
Q

SE of tolterodine?

A
  • bronchitis
  • parasthesia
  • peripheral oedema
  • parasthesia
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33
Q

Alpha1-adrenoceptor antagonists?

A

Doxazosin and tamulosin

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34
Q

Doxazosin and tamulosin used for?

A

BPH

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35
Q

Doxazosin mechanism?

A
  • alpha 1 adrenergic receptor antagonist
  • antagonism causes smooth muscle relaxation in the prostate and bladder, effectively relieving urinary frequency, urgency, weak urinary stream,
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36
Q

Tamulosin mechanism?

A
  • alpha receptor blocker
  • relaxes SM in the prostate allowing urine to flow
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37
Q

Doxazosin CI?

A
  • Postural hypotension
  • history of micturition syncope
  • monotherapy in ppts w overflow bladder
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38
Q

interactions of D?

A
  • Slidenafil and avanafil
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39
Q

side effects of doxazosin?

A
  • arrythmias
  • cystitis
  • dry mouth
  • oedema
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40
Q

Tamsulosin interactions?

A
  • slidenafil
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41
Q

Tamsulosin CI?

A
  • micturition syncrope
  • hisory of postural hypotension
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42
Q

SE of tamsulosin?

A

dizziness and sexual dysfunction

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43
Q

Dutasteride mechanism?

A

inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone.

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44
Q

SE of dutasteride?

A

breast disorders, sexual dysfunction

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45
Q

Finasteride Mx?

A

inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone.

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46
Q

Finasteride safety info?

A

suicidal thoughts and depression

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47
Q

cautions of finasteride?

A

obstructive uropathy

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48
Q

SE of finasteride?

A

sexual dysfunction

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49
Q

What are the 5-AR inhibitors?

A

Finasteride and dutasteride

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50
Q

Antimicrobial agents for urinary infections ?

A
  • Trimethoprim (UTI)
  • Nitrofurantoin (UTI)
  • Co-amoxiclav (pyelonephritis)
  • Ciprofloxacin (pyelonephritis)
  • Gentamicin (serious gram -ve infections)
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51
Q

Drugs used for UTIs?

A

trimethoprim and nitrofurantoin

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52
Q

Drugs used for Pyelo?

A

ciprofloxacin and Co-amoxiclav

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53
Q

Drugs used for severe gram - UTI?

A

gentamicin

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54
Q

Trimethoprim?

A
  • dihydrofolate reductase inhibitor preventing synthesis of nucleic acids
  • bacteriacidal activioty
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55
Q

CI of trimethoprim?

A

blood dyscrasias

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56
Q

Cautions of trimethoprim?

A

acute porphyrias, predisposition to folate def

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57
Q

Int of trimethoprim?

A
  • azathioprine
  • clozapine
  • methotrexate
  • warfarin
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58
Q

SE of trimethoprim?

A
  • diarrhoea
  • electrolyte imbalance
  • headache
  • skin reactions
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59
Q

trimethoprim can cause?

A
  • agranulocytsosis
  • angiodema
  • haemolysis
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60
Q

Trimethoprim is a ?

A

teratogen. Risk in T1

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61
Q

nitrofurantoin mechanism?

A
  • inhibit the citric acid cycle as well as synthesis of DNA, RNA, and protein
  • rapidly reduced to produce reactive intermediates that attack DNA
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62
Q

nitrofurantoin safety info?

A

resp symptoms and acute pulmonary reactions

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63
Q

CI of nitrofurantoin?

A
  • GDP6 deficiency
  • acute porphyrias
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64
Q

cautions of nitrofurantoin?

A
  • DM
  • folate def
  • vitamin B def
  • pulm disease
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65
Q

SE of nitrofurantoin?

A
  • agranulocytosis
  • angiodeme
  • aplastic anaemia
  • pulm reaction
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66
Q

Nitrofurantoin - avoid at?

A

term - can produce neonatal haemolysis

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67
Q

Co-amoxiclav mechanism?

A
  • inhibits PBP preventing corss linkage of subunits
  • clauvanic acid: beta lactamse inhibitor used to enhance effectiveness of beta lactams
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68
Q

CI of co-amox?

A
  • history of co-amoc assoc jaundice or hepatic dysfunction
  • history of penicillin assoc jaundice or hepatic dysfunction
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69
Q

Cautions of co-amox?

A
  • ALL - risk of rashes
  • CLL - rashes
  • hydration
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70
Q

interactions of co-amox?

A

methotrexate

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71
Q

SE of co-amoxiclav?

A

diarrhoea, hypersen, skin reactions, thrombocytopenia

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72
Q

common side effect of co-amox?

A

inc risk of infection, diarrhoea

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73
Q

ciprofloxain is a ?

A

quinolone

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74
Q

TWO

CI of quinolones?

A
  • QT prolongation
  • UV exposure
  • GPD6 def
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75
Q

side effects of quinolones?

A
  • dec appetite
  • asthenia
  • constipation
  • QT prolongation
  • peripheral neuropathy
  • C diff
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76
Q

ciprofloxacin mechanism?

A
  • bacterial topoisomerase II (DNA gyrase) and 4
  • Targeting DNA gyrase prevents supercoiling the DNA
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77
Q

gentamicin mechanism?

A
  • aminoglycoside
  • 30s ribosome inhibition
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78
Q

CI of aminoglycosides?

A
  • MG - they impair NM transmission
  • auditory disorders
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79
Q

SE of all aminoglycosides?

A
  • aphonia
  • bronchospasm and cpigh
  • haemoptysis
  • RI
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80
Q

Imp side effects of AG?

A
  • ototoxicity
  • nephrotoxicity - occurs more w RI
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81
Q

Phosphodiesterase type 5 inhibitors?

A
  • Sildenafil & Tadalafil
  • for Erectile dysfunction
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82
Q

Slidenafil and Tadalfil mechanism?

A
  • PDE-5 inhibition
  • leads to SM relaxation - vasodilation
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83
Q

Slidenafil CI?

A
  • recent MI or stroke
  • degenerative retinal disorders
  • hypotension
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84
Q

cautions of slidenafil?

A
  • active peptic ulceration
  • autonomic dysfunction
  • bleeding disorders
  • myeloma
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85
Q

slidenafil interactions?

A
  • clarithromycin
  • cobicstat
  • doxazosin
  • GTN and other vasodilators
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86
Q

SE of slidenafil?

A
  • alopecia
  • GI disorders
  • infection
  • night sweats
  • vasodilation
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87
Q

Tadalafil CI?

A
  • acute MI
  • hypotension
  • optic neuropathy
  • HF
  • recent stroke
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88
Q

tadalafil SE?

A
  • flushing
  • GI discomfort
  • headaches
  • nasal congestion
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89
Q

alprostadil mechanism?

A
  • Prostaglandin E1 agonist
  • relaxes SM
  • promotes vasodilation
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90
Q

Humulin-S ?

A

quick acting human insulin

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91
Q

Insulin lispro?

A

analogue quick acting

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92
Q

Insulin aspart?

A

analogue quick acting

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93
Q

Insulatard?

A

human iosphane

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94
Q

Humulin M3?

A

Human biphasic

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95
Q

Humalog Mix25?

A

analogue biphasic

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96
Q

Insulin glargine?

A

anologue long acting

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97
Q

Insulin degludec?

A

analogue long acting

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98
Q

insulin mechanism?

A
  • promotes glucose and AA uptake into muscle and adipose tissues
  • except liver and brain
  • inhibits gluconeogenesis in the liver
  • anabolic role in stimulating glycogen, FA and protein synthesis
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99
Q

insulin interactions?

A
  • clarithromycin
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100
Q

side effects of all insulins?

A
  • oedema
  • lipodystrophy
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101
Q

Sulfonylureas?

A
  • Gliclazide
  • Glimepiride
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102
Q

Glicazide mechanism?

A
  • binds to the SUR1 receptor blocking ATP sensitive k+ channels
  • decreased potassium eflux -> depolarisation of b cells
  • exocytosis of insulin granules
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103
Q

glimepiride?

A
  • SU
  • promotes insulin secretion by binding to potassium channels
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104
Q

CI of all sulfonreas?

A

Ketoacidosis

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105
Q

cautions of all sulfonylureas?

A
  • elderly
  • can cause weight loss
  • GDP6 def
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106
Q

side effects of all SU?

A
  • abd pain
  • diarrhoea
  • hypoglycaemia
  • nausea
  • agranulocytosis
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107
Q

Meglitinides?

A

Repaglinide

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108
Q

Repaglinide mechanism?

A
  • potentiates the effect of EC glucose on K+ channels
  • closes K+ channels, depolarising B cells, opening Ca+ channels, causing calcium influx -> insulin secretion
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109
Q

CI of Repaglinide?

A

ketoacidosis

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110
Q

Repaglinide interactions?

A

clopidogrel

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111
Q

side effects of Repaglinide?

A
  • abd pain
  • diarrhoea
  • hypogly
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112
Q

Metformin mechanism?

A
  • decreasing gluconeogenesis in hepatocytes
  • increases peripheral utilisation of glucose
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113
Q

CI of metformin?

A
  • acute metabolic acidosis - lactic acidosis and DKA
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114
Q

metformin - RF for lactic acidosis?

A
  • chronic hF
  • drugs that impair renal function
  • interrupt tx if dehydration occurs
  • tissue hypoxia
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115
Q

Long term use can lead to…

metformin SE?

A
  • abd pain
  • dec appetite
  • diarrhoea
  • b12 def
  • lactic acidosis
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116
Q

GI side effects of metformin?

A

Gastrointestinal side-effects are most frequent during treatment initiation and usually resolve spontaneously. A slow increase in dose may improve tolerability.

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117
Q

biguanide =

A

metformin

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118
Q

Thiazolidinediones =

A

pioglitazone

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119
Q

pioglitazone mechanism?

A
  • PPAR agonist -> transcription of insulin genes
  • reduces hepatic gluconeogenesis
  • in adipose tissues, skeletal muscle and liver
  • reduced peripheral resistance to insulin
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120
Q

pioglitazone safety info?

A
  • HF espec when past MI
  • risk of bladder cancer
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121
Q

CI of pioglitazone?

A
  • DKA
  • HF
  • prev/ active nladder cancer
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122
Q

cautions of pioglitazone?

A
  • use w insulin - risk of HF
  • risk of bC
  • Elderly
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123
Q

interactions of pioglitazone?

A
  • clopidogrel
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124
Q

side effects of pioglitazone?

A
  • bone factures
  • infections
  • numbness
  • increased weight
  • bladder cancer
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125
Q

How does this drug class work?

Linagliptin?

A
  • DPP-4 inhibitor -> slows breakdown of GLP-1 and GIP
  • GLP1 and GIP stimulate insulin release and prevent glucagon release
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126
Q

linagliptin is not

A

affected by renal impairment

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127
Q

DPP4 inhibitorS?

A
  • Linagliptin (not affected by renal function) – Sitagliptin
  • Saxagliptin
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128
Q

cautions of linagliptin?

A

pancreatitis

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129
Q

SE of linagliptin?

A
  • angioedema
  • cough
  • nasopharngitis
  • panc
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130
Q

Saxagliptin SE?

A
  • abd pain
  • fatigue
  • panc
  • vomiting
  • angioedema
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131
Q

Side effects of sitagliptin?

A
  • renal impairment
  • acute panc
  • angioedema
  • headache
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132
Q

Acarbose mechanism?

A
  • inhibitor of alpha glucosidases and amylase
  • delays and prevents digestion and abs of starch and carbs -> reducing BG
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133
Q

CI of acarbose?

A
  • hernia
  • IBD
  • malabs
  • intestinal obst
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134
Q

cautions of acarbose?

A
  • can enhance hypoglycaemia when used w insulin and SU
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135
Q

Hypoglycaemia with acarbose is treated w?

A

oral glucose but not sucrose

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136
Q

side effects of acarbose?

A
  • Diarrhoea
  • GI discomfort
  • GI disorders
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137
Q

ɑ-Glucosidase inhibitors =

A

acarbose

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138
Q

SGLT2 inhib?

A
  • Canagliflozin
  • Empagliflozin
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139
Q

SGLT2 inhib mechanism?

A
  • SGLT2 found in PCT
  • inhibition lowers reabs of flitered glucose in the body -> inc glucose excretion in urine
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140
Q

Canagliflozin safety info?

A
  • DKA
  • lower limb amputation
  • Fournier’s gangrene
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141
Q

CI of canagliflozin?

A
  • DKA
  • T1D - inc DKA risk
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142
Q

SE of canagliflozin?

A

-const
- dyslipidemia
- hypoglycaemia - when used w insulin or SU
- infections, urosepsis

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143
Q

empagliflozin CI?

A
  • dka
  • t1d
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144
Q

side effects of empagliflozin?

A
  • const
  • hypo
  • hypovolaemia
  • fourner’s gangrene
  • urosepsis
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145
Q

Glucagon like peptide-1 (GLP-1) mimetics

A
  • Dulaglutide
  • Liraglutide
  • Semaglutide
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146
Q

Dulaglutide action?

A
  • helps glucose dependent insulin secretion
  • slows gastric emptying
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147
Q

GLP-1 analogues safety info?

A
  • DKA when used w insulin especially on discontinuation of insulin
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148
Q

CI of dulaglutide?

A

severe GI disease

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149
Q

SE of dulaglutide?

A
  • appetite decreased
  • const
  • hypoglycaemia
  • GB
  • acute panc
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150
Q

CI of liraglutide?

A
  • IBD
  • diabetic gastroparaesis
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151
Q

SE of liraglutide?

A
  • asthenia
  • const
  • GB disorders
  • panc
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152
Q

semaglutide=

A

ozempic

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153
Q

semaglutide CI?

A

DKA, pancreatitis

154
Q

SE of semaglutide?

A
  • cholethiasis
  • hypoglycaemia when used w other drugs
  • weight loss
  • panc
155
Q

glucagen hypokit=

156
Q

CI of glucagen hypokit (glucagon)

A
  • starvation
  • adrenal insufficiency
  • glucagoma
157
Q

interaction of glucagen hypokit?

158
Q

SE of glucagen hypokit?

A
  • nausea
  • vomiting
  • tachycardia, HTN, hypotension
159
Q

glucagon mechanism?

A
  • raised BG through activation of hepatic glucagon receptors stimulating glycogenolysis and release of glucose
160
Q

when is glucagon used?

A

hypoglycaemia

161
Q

IV Glucose =

A

Intravenous 20% Glucose

162
Q

glucose cautions?

A
  • prolonged use can lead to hyponatreamia
163
Q

SE of glucose?

A
  • chills
  • electrolyte imbalance
  • venous thrombosis
  • polyuria
164
Q

glucose mechanism?

A
  • converted to fat -> energy source
  • in liver and muscles -> glycogen
165
Q

Carbamazole safety info?

A
  • neutropenia and agranulocytosis
  • congenital malformations
  • risk of acute panc
166
Q

SE of carbimazole?

A
  • bone marrow disorders
  • haemolytic anaemia
  • SCARs
  • angranulocytosis
167
Q

carbimazole mechansim?

A
  • decreases iptake of iodine by thyrpid
  • prevents thyroid perioxidase from iodinating tyrosine residues on thyroglobulin
    -> red production of T3 and T4
168
Q

Thionamides =

A
  • Carbimazole
  • Propylthiouracil
169
Q

proprylthiouracil mechanism?

A
  • binds to thyroid perioxidase inhibiting conversion of iodide to iodine
  • inhibts production of new thyroid hormones
170
Q

propylthiouracil SE?

A
  • agranulocytosis
  • BM disorders
  • glomerulonephrotis
  • hearing impairment
  • hepatic reactions
171
Q

which thionamide is safe in pregnancy?

172
Q

B blocker used for hyperthyroidism?

A

propanolol

173
Q

Radioiodine and oral iodine solutions =

A
  • Radioiodine (I131)
  • Aqueos Iodine oral solution
174
Q

Radioiodine I-131 indications?

A

Tx of hyperthyroidism and thyroid carcinomas

175
Q

mechanism of radioiodine?

A
  • iodine concentrates in thyroid via soidum/ iodide transporte
  • destruction of thyroidal tissue by beta emission of sodium iodidie
176
Q

radioiodine SE?

A
  • conjunctivitis
  • ED
  • influenza like illness
  • rash
177
Q

levothyroxine CI?

A

thryotoxicosis

178
Q

side effects of levothyroxine?

A
  • angina
  • hyperhidrosis
  • palpitations
  • thryotoxic crisis
  • weight loss
179
Q

levothryoxine mechanism?

A
  • inc metabolic rate
  • decreases TSH production
180
Q

Hydrocortisone has equal?

A

gluco and mineralocorticoid action

181
Q

hydrocortisone ix?

A
  • thyrotoxic crisis
  • adrenal insufficency
  • adrenal crisis
  • asthma
182
Q

CI of all corticosteroids?

A
  • live caccines in those receiving immunosppresive doses
  • systemic infection
183
Q

SE of all corticosteroids?

A
  • cushings syndrome
  • fluid retention
  • HTN
  • osteoporsis
  • hirtutism
  • peptic ulcr
184
Q

steroids - adrenal suppression?

A
  • prolonged use -> adrenal atrophy
  • abrupt withdrawal -> adrenal insufficiency, death or hypotension
185
Q

other side effects of steroids?

A
  • psychiatric - euphoria, insomnia, mood lability, suicidal thoughts, psychotic reactions
  • infections
186
Q

glucocorticoids =

A
  • Hydrocortisone
  • Prednisolone
  • Dexamethasone
187
Q

corticosteroids mechanism?

A
  • dec vasodilation
  • inhibition of neutrophils
  • inhibit phospholipase A2
188
Q

prednisolone exerts…

A

predominantly glucocorticoid effects with minimal mineralocorticoid effects.

189
Q

SE of pred?

A
  • diarrhoea
  • dyslipidaemia
  • protein catabolism
190
Q

dexamethasone has a….

A

very high glucocorticoid activity and insignificant mineralocorticoid activity.

191
Q

Fludrocortisone is a

A

mineralacorticoid

192
Q

fludrocortisone Mx?

A
  • binds to mineralocorticoid receptors causing inc density of Na/K/ ATPase
  • inc BP, inc sodium levels
  • decreased plasma K+
193
Q

synthetic human GH =

A

Somatropin

194
Q

somatotropin Mx

A
  • HGH
  • stimulates prod of IGF-1, inc conc of glucose amd FFA
195
Q

Somatotropin indications?

A
  • turner syndrome
  • GH def
196
Q

CI of somatotropin?

A
  • evid of tumour activity
197
Q

SE of somatotropn?

A
  • CTS
  • fluid retention
  • lipoatrophy
  • oedema
  • parasthesia
198
Q

Somatotropin - fundoscopy when

A

Funduscopy for papilloedema recommended if severe or recurrent headache, visual problems, nausea and vomiting occur - benign intercranial hypertension

199
Q

Tetracosactide =

A

synthetic ACTH

200
Q

Tetracosactide indications?

A
  • adrenal insufficiency
201
Q

Tetracosactide CI?

A
  • Acute porphyrias
  • asthma
  • cushins
  • peptic ulcer
  • primary adrenal insufficiency
202
Q

Tetracosactide SE?

A
  • angiodema
  • fractures
  • worseneed diabetes
  • exopthalmus
  • cushings
203
Q

Tetracosactide mechanism?

A
  • diagnosis of adrenal insufficiency
  • synthetic ACTH
  • in normal ppts, causes synthesis of adrenal cteroids
  • doesn’t inc plasma cortisol conc w primary or secondary AI
204
Q

Cabergoline mechanism?

A
  • dopamine agonist
  • D2 receptors
  • Dopamine inhibits prolactin
205
Q

indications of cabergoline?

A
  • prevents and suppresses lactation
206
Q

safety info w cabergoline?

A
  • Cabergoline has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions.
  • impulse control disorders
207
Q

CI of cabergoline?

A
  • pericardial fibrosis
  • psychosis
  • pre-eclampsia
  • peptic ulcers
208
Q

cabergoline interactions?

A

clarithro, erythromycin

209
Q

cabergoline SE?

A
  • angina
  • confusion
  • sexual dysfunction
  • hallucinations
210
Q

D2 agonists =

A

Cabergoline & Quinagolide

211
Q

Sustanon =

A

test esters

212
Q

Testosterone (sustanon and testogel) ix?

A

androgen def

213
Q

testosterone interactions?

A
  • alc
  • daleteparin
  • enoxaparin
214
Q

Bisphosphonates =

A
  • Alendronic acid
  • Residronate
  • Zolendronic acid
215
Q

bisphosphonates indications?

A
  • post meno osteoporosis
  • osteoporosis in men
216
Q

bisphosphonates safety info?

A
  • atypical femoral fractures
  • osteonecrosis of the jaw and external auditory canal
217
Q

CI of bisphosphonates?

A
  • hypocal
  • oesophageal abn
  • strictures and achalasia
218
Q

Bisphosphonates SE?

A
  • ANAEMIA
  • Oesophageal ulcer
  • oesophagitis
  • renal impairment
219
Q

vitamin D compounds?

A
  • Alfacalcidol (1a-hydroxycholecalciferol)
  • Calcitriol (1,25-dihydroxycholecalciferol)
  • Ergocalciferol (vitamin D2)”
220
Q

alfacalcidol =

A

1a-hydroxycholecalciferol, needs activating

221
Q

calcitrol =

A

1,25-dihydroxycholecalciferol = ACTIVATED

222
Q

ergocalciferol =

A

vitamin D2, inactivated vitamin D

223
Q

ergocalciferol Indications?

A
  • primary prev of Vitamin D def
  • treatment of vitamin D def
  • hypocalcaemia of hypoparathyroidism
224
Q

CI of all vitamin D analogues - calciferols?

A
  • hypercal
  • metastatic calcification
225
Q

side effects of all vitamin D analogues?

A
  • abd pain
  • hypercal
  • hypercalciuria
  • skin reactions
226
Q

symptoms of vitamin D overdose?

A
  • anorexia
  • lassitude
  • nausea and vomiting
  • polyuria
  • thirsy
227
Q

alfacalciferols Mx?

A
  • in chronic RF, hypoparathyroidism, rickets, hydroxylation capacity is impaired
  • active vitamin D so restores functions of endogenous 1,25-dihydroxyvitamin D
228
Q

alfacalcidol indications?

A
  • renal impairment requiring Vitamin D
  • hypoparathyroisism
229
Q

SE of alfacalcidol?

A
  • abd discomfory
  • hyperphosphataemia
  • pustular rash
230
Q

calcitrol Ix?

A
  • psoriasis
  • renal osteodystrophy
  • PM osteoporosis
231
Q

calcitrol SE?

A
  • UTI
  • drowsiness
  • paralytic ileus
  • polydipsia
  • psychiatric disorder
232
Q

vasopressin analogues?

A

Desmopressin and Terlipressin

233
Q

desmopressin Ix?

A
  • DI
  • diagnosis of DI - water deprivation test
  • Idiopathic polyuria
234
Q

desmopressin CI?

A
  • cardiac insufficiency
  • hyponatreamia
  • SIADH
235
Q

desmopressin interactions?

A

lamotrigine

236
Q

desmopressin side effects?

A
  • headache
  • hyponatreamia
  • nausea
237
Q

drug used for cranial diabetes insipidus

A

desmopressin

238
Q

drug used for oesophageal bleeding

A

telipressin

239
Q

bleeding reduction in mild to moderate haemophilia =

A

desmopressin

240
Q

desmopressin mechanism?

A
  • binds to V2 receptors, synthetic ADH
  • causes increased insertion of aquaporins into the collecting duct
241
Q

telipressin mechanism?

A
  • used to treat oesophageal varices
  • synthetic vasopressin analogue
  • causes vasoconstriction in these vessels reducing portal pressure
242
Q

telipressin safety info?

A
  • risk of resp failure and septic shock in type 1 hepatorenal syndrome
243
Q

cautions of telipressin?

A
  • QT prolongation
  • resp disease
  • septic shock
  • uncontrolled HTN
244
Q

SE of telipressin?

A
  • abd cramps
  • HTN, hypotension
  • peripheal ischaemia
  • vasoconstriction
245
Q

tolvaptan mechanism?

A
  • selective V2 antagonist (vasopressin ant)
  • blocks aquaporin insertion preventing water reabs
  • decreases urine conc and urine osmolarity
246
Q

tolvaptan CI?

A
  • anuria
  • hypernatreamia
  • volume depletion
247
Q

use of tolvaptan?

A

hyponatraemia secondary to SIADH

248
Q

SE of tolvaptan?

A
  • asthenia
  • reflux
  • gout
  • hypernatreaia, hyperglycaemia
  • hepatic disorders
249
Q

tolvaptan - stop treatment if ? occurs

A

Interrupt treatment and perform liver-function tests promptly if symptoms of hepatic impairment occur (anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, pruritus)

250
Q

paracetamol indications?

A
  • pyrexia
  • pain
251
Q

paracetamol interactions?

A
  • alcohol
  • dalteparin
  • enoxaparin
  • fluoxacillin
252
Q

side effects of paracteamol?

A
  • thrombocytopenia
  • hypotension
  • angioedema
  • liver injury
253
Q

paracetamol mechanism?

A
  • COX1 and COX2 inhibition -> reduced PG syntheis -> less pain
  • COX-3 inhibition
  • direct effect on heat regulating centers -> peripheral vasodilation
254
Q

co-codamol Ix?

255
Q

CI of co-codamol?

A
  • UC
  • ab assoc colitis
  • ultra-rapid codiene metabolisers
256
Q

codiene interactions?

A
  • clozapine
  • naltrexone
  • buprenorphine
257
Q

SE of co-codamol?

A
  • abd pain
  • addiction
  • thrombocytopenia
  • pancreatitis
258
Q

NSAIDs used for

A

acute, chronic and neuropathic pain

259
Q

CI of ibuprofen?

A
  • active bleeding or ulceration
  • Haemorrhage
  • severe HF
260
Q

Ibuprofen interactions?

A
  • aprostadil
  • alteplase
  • apixaban
  • aspirin
261
Q

SE of ibuprofen?

A

Gi discomfort, skin reactions, rash, ulcers

262
Q

ibuprofen mechanism?

A
  • NSAID
  • non selective COX-1 and COX-2 inhibitor
263
Q

naproxen mechanism?

A
  • COX-1 and COX-2 inhibition
  • COX-2 inhibition -> antipyretic, anti-inflammatory, and analgesic properties
264
Q

COX enzymes?

A
  • 1 is const active, found in normal stomach lining
  • 2 is inducible and produces prostaglandins that mediate pain, fever and inflammation
265
Q

CI of naproxen?

A
  • active bleeding or ulceration
  • severe HF
266
Q

Side effects of naproxen?

A
  • agranulocytosis
  • angioedema
  • aplastic anaemia
  • asthma
  • ulcers
267
Q

Opiod analgesics?

A
  • acute and chronic moderate to severe pain, WHO pain ladder
  • Codeine phosphate
  • Morphine sulfate
  • Diamorphine
  • Tramadol
268
Q

codiene mechanism?

A
  • agonist of mu opiod receptor -> hyperpolarizes the neuron -> inhibits release of nociceptive NTs
  • metabolised in the liver to morphine
269
Q

codiene indications?

A
  • dry or painful cough
  • diarrhoea
    -ST pain relief
270
Q

CI of codiene?

A
  • active UC
  • ab assoc colitis
  • ultra rapid metabolisers
  • conditions where abd distention develops
271
Q

SE of all opiods?

A
  • constipation
  • dry mouth
  • hyperhidrosis
  • miosis
  • nausea on initiation
  • urinary retention
  • resp despresion
272
Q

morphine mechanism?

A
  • mu and kappa opiod receptors
  • acts on NA delta opiod receptors to activate reward pathway
273
Q

SE of morphone?

A
  • insomnia
  • malaise
  • NM dysfunction
  • asthenia
274
Q

diamorphine mechanism?

A
  • oral: FPM by liver
  • crosses BBB
  • mu opiod agonist -> activates descendin inihib pathways
275
Q

diamorphine indications?

A
  • acute pain
  • pulm oedema
  • MI
276
Q

CI of diamorphine?

A
  • delayed gastric emptying
  • phaechromocytoma
277
Q

Diamorphine SE?

A
  • Biliary spasm
  • circ depression
  • inc ICP
  • postural hypotension
278
Q

tramadol mechanism?

A
  • SNRI and centrally acting opiod
  • MOR agonist
279
Q

CI of tramadol?

A
  • acute alcohol intoxication
  • hypnotic intoxication
  • opiod intox
  • analgesic intox
280
Q

SE of tramadol?

281
Q

Non opiod non NSAID analgesics?

A
  • Amitriptyline
  • Duloxetine
  • Gabapentin
  • Carbamazepine
  • Capsaicin

chronic and neuropathic pain

282
Q

Amitryptyline Ix?

A
  • abd pain
  • depression
  • neuropathic pain
  • migrain prophylaxis
283
Q

CI of amitryptyline?

A
  • manic phase of bipolar
  • HB
  • arrythmias
284
Q

SE of amitryptiline?

A
  • anticholinergic syndrome
  • QT proolongation
  • drowsiness
  • agranulocytosis
285
Q

amitryptiline overdose?

A
  • dry mouth
  • coma
  • hypotension
  • hypothermia
  • hyperreflexia
  • resp failures
286
Q

amitrip mechanism?

A
  • TCAD
  • SNRI
  • increased GABA transmission through increased noradrenaline levels
287
Q

Duloxetine mechanism?

A

SNRI reuptake inhibitor

288
Q

indications of duloxetine?

A
  • MDD
  • GAD
  • diabetic neuropathy
  • stress UI
289
Q

SE of duloxetine?

A
  • decreased appetite
  • const
  • diarrhoea
  • palpitations
  • galactrorrgoea
290
Q

gabapentin indications?

A
  • seizures
  • MS
  • pain
291
Q

gabapentin safety info?

A
  • risk of suicidal thoughts
  • risk of severe resp depression
292
Q

cautions of gabapentin?

A
  • DM
  • substance abuse
  • resp depression
293
Q

SE of gabapentin?

A
  • anx
  • confusion
  • HTN
  • sexual dysfunction
294
Q

gabapentin mechanism?

A
  • enhanced GABA synthesis
  • reduces neuropathic pain and epiliepsy
295
Q

carbamazepine mechanism?

A
  • inc GABA transmission
296
Q

indications of carbamazepine?

A
  • diabetic neuropathy
  • epilepsy
  • trigeminal neuralgia
  • BPD
297
Q

CI of carbamazepine?

A
  • AV abn
  • history of bone marrow depression
298
Q

SE of carbamazepine?

A

siADH-> hyponatreamia

299
Q

Capsaicin mechanism?

A
  • reduces amount of substance P
  • Defunctionalization of nocicpetive fibers by inducing a topical hypersensitivity reaction
300
Q

Capsaicin indications?

A

localised neuropathic pain (topical drug)

301
Q

SE of Capsaicin?

A
  • AV block
  • eye irritation
  • palpitations
  • peripheral oedema
302
Q

alkylating agents =

A

Cyclophosphamide

303
Q

uses of cyclophosphamide?

A

-Cancer chemotherapy
- Autoimmune and conective tissue disorders

304
Q

cyclophosphamide cautions?

A
  • DM
  • acut porphyrias
  • haemorrhagic cystitis
  • prev/ concurrent mediastinal irradiation - risk of cardiotoxicity
305
Q

SE of cyclophosphamide?

A
  • agranulocytosis
  • alopecia
  • cystitis
  • HUS
306
Q

Cytotoxic antibiotics =

A

Doxorubicin

307
Q

doxorubicin mechanism?

A
  • interupts topoisomerase II mediated DNA repair
  • generates free radicals damaging cellular membranes
308
Q

doxorubicin uses?

A
  • NHL
  • acute leukemias
  • BC
309
Q

SE of doxorubicin?

A
  • alopecia
  • Cardiomyopathy
  • BM depression
  • vasodilation
310
Q

anti-metabolites =

A

Methotrexate

311
Q

Methotrexate mechanism?

A
  • DHFR inhibitor -> prevents synthesis of purines and pyrimidines
  • cancer chemo and DMARD
312
Q

methotrexate indications?

A
  • CD
  • RA
  • Cancer
313
Q

Methotrexate safety info?

A
  • photsensitivity reactions including phototoxicity
314
Q

CI of methotrexate?

A
  • active infection
  • ascites
  • immunodef
315
Q

Methotrexate cautions?

A
  • blood count - bone marrow suppression
  • GI toxicity - stomatitis or diarrhoea
  • photosensitivity
316
Q

SE of methotrexate?

A
  • seziures
  • leucopenia
  • throat ulcers
  • pulm and liver toxicity
317
Q

Anti-oestrogens?

A
  • Tamoxifen
  • Anastrazole
  • breast cancer
318
Q

Tamoxifen mechanism?

A
  • induces gonadotropin release by occupying oestrogen receptors in hypothalamus
319
Q

CI of tamoxifen?

A
  • thromboembolism
320
Q

Tamoxifen interacts w

321
Q

SE of tamoxifen?

A
  • Embolism and thrombosis
  • ischaemia
  • neoplasms
  • agranulocytosis
322
Q

tamoxifen - risks?

A
  • endometrial changes - prompt Ix if abnormal vaginal bleeding including menstrual irregularities, vaginal discharge, and pelvic pain
  • risk of thromboembolism
323
Q

Anastrazole CI?

A

premenopausal women, susceptibility to oestoporosis

324
Q

SE of anastrazole?

A
  • alopecia
  • bone pain
  • CTS
  • vaginal haemorrhage
  • hot flush
325
Q

anastrazole Mx?

A
  • aromatase inhibitor
  • preventing synthesis of oestrogen -> stops growth of hormone receptor positive tumours
326
Q

ferrous sulphate Mx?

A
  • IDA
  • transported across DMT-1 to be incorporated into ferritin
  • combines w porphyrin and globin chains to form hb
327
Q

safety info w iV iron?

A

serious hypersen and anaphylactic rractions

328
Q

CI of all iron?

A
  • dist in utilisation or iron
  • iron overload
329
Q

SE of all iron?

A
  • dizziness
  • flushing
  • HTN
  • hypophosphataemia
330
Q

iron sucrose is given by

A

iv injection or IV infusion

331
Q

Side effect of ferrous sulphate?

A
  • constipation
  • GI discomfort
  • nausea
332
Q

constipation w iron?

A
  • can lead to faecal impactation
  • can exacerbate diarrhoea in ppts w IBD
333
Q

Monitoring w ferrous sulphate?

A
  • monitor hb conc within first 4 weeks of treat then every 4 weeks
  • once hb is within normal range, continue treatment for a further 3 months to replenish further iron stores
334
Q

hydroxocobalamin mechanism?

A
  • synthetic B12
  • used to treat B12 deficiency and perinicous anaemia
335
Q

hydroxocobalamin SE?

A
  • diarrhoea
  • dizziness
  • hot flush
  • urine discoloration
336
Q

Folic acid indications?

A
  • folate deficiency megaloblastic anaemia
  • prevention of nT defects in pregnancy
  • prevention of methotrexate induced side effects
337
Q

cautions of folate?

A

Should never be given alone for pernicious anaemia or other megaloblastic anaemias caused by vitamin B12 deficiency (may precipitate subacute combined degeneration of the spinal cord)

339
Q

SE of folic acid?

A
  • abd distension
  • B12 def exacerbated
  • flatulence
340
Q

folic acid mechanism?

A
  • Folic acid, as it is biochemically inactive, is converted to tetrahydrofolic acid and methyltetrahydrofolate by dihydrofolate reductase (DHFR
  • synthesis of purines
341
Q

use of Erythropoietins?

A

Renal anaemia

342
Q

Darbepoetin =

A
  • EPO
  • inc red cell production
  • activates JAK-STAT pathway
343
Q

Darbepoetin safety info?

A
  • risk of severe cutaneous adverse reactions
  • overcorrection of hb
344
Q

CI of all epoetins?

A
  • pure red cell aplasia following EPO therapy
  • uncontrolled HTN
345
Q

SE of all epoetins?

A
  • embolism and thrombosis
  • HTN
  • stroke
  • influenza like illness
346
Q

darbepoetin common SE?

347
Q

Antiemetics?

A
  • Cyclizine (antihistamine)
  • Hyoscine (antimuscarinic)
  • Metoclopramide (dopamine receptor antagonist)
  • Prochlorperazine (dopamine receptor antagonist)
  • Ondansetron (5-HT3 receptor antagonist)
  • Aprepitant (neurokinin 1 receptor antagonist)
  • Nabilone (cannabinoid)”
348
Q

Used for?

Cyclizine?

A
  • nausea and vomiting
  • motion sickness
349
Q

cautions of cyclizine?

A
  • eplipesy
  • severe HF
  • urinary retention
350
Q

cyclizine side effects?

A
  • dec conciousness
  • agranulocytosis
  • bronchospasm
  • hepatic disorders
  • haemolytic anaemia
351
Q

cyclizine mechanism?

A
  • h1 receptor antagonist
352
Q

uses of anti-emetics?

A

-motion sickness, postoperative vomiting, drug-induced vomiting, cytotoxic drug-induced vomiting, pregnancy-induced vomiting

353
Q

Hyoscine mechanism?

A
  • antimuscarinic
  • competitive inhibitor
354
Q

Antimuscarinics (hyoscine) CI?

A
  • Closed angle closure
  • GI obst
  • paralytic ileus
  • urinary retention
355
Q

SE of antimuscarinics?

A
  • constipation
  • dry mouth
  • urinary disorders
  • tachycardia
356
Q

Metoclopramide mechanism?

A
  • D2 antagonist and serotonin antagonist in the chemoreceptor trigger zone
357
Q

CI of metoclopramude?

A
  • GI obst
  • GI haemorrhage
  • GI perf
358
Q

Side effects of metoclopramide?

A
  • depression
  • hypotension
  • menstryal irreg
  • parkinsonism
359
Q

Metclopramide can cause ? reactions

A
  • acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises
  • more common in women, the young and the very old
360
Q

Prochlorperazine mechanism?

A
  • D2 antagonist in the CTZ
  • AP
361
Q

CI of Prochlorperazine?

A

cns depression and comatose states

362
Q

side effects of prochlorperazine?

A
  • SIADH
  • Hyponatreama
  • photosensitivity reaction
363
Q

Ondansetron =

A
  • 5HT3 receptor antagonist
364
Q

ondansteron safety info?

(pregnancy)

A

inc risk of cleft lip following use in the first 12 weeks of pregnancy

365
Q

ondansteron CI?

A

Congenital long QT

366
Q

side effects of ondansteron?

A
  • const
  • feeling hot
  • sens abn
  • QT prolongation
367
Q

Aprepitant mechanism?

A
  • neurokinin 1 receptor antagonist
368
Q

SE of Aprepitant?

A
  • decreased appetite
  • constipation
  • GI discomoft
  • hiccups
369
Q

Nabilone mechanism?

A
  • cannabinoid
  • CB1 receptor
370
Q

Nabilone cautions?

A
  • history of psych disorder
  • adverse effects on mental state
  • heart disease
371
Q

Nabilone SE?

A
  • Abd pain
  • confusion
  • dry mouth
  • hallucination
372
Q

calcium salts?

A
  • Calcichew (oral supplement)
  • Calcium gluconate (Parenteral - IV)
  • Calcium chloride (Parenteral - IV)”
373
Q

what are calcium salts used for?

A

bone disease

374
Q

calcichew?

A
  • oral
  • colecalciferol
  • calc carbonate
375
Q

calcium gluconate indications?

A
  • severe hypocalcaemia
  • acute severe hyperkalaemia
376
Q

CI of all calcium salts?

A
  • hypercalcaemia - malignancy?
377
Q

SE of calcium?

A
  • diarrhoea
  • nausea
  • const
  • hypercal
378
Q

side effect of calcium gluconate?

A
  • arrythmias
  • circ collapse
  • hypotension
  • vasodilation
379
Q

monitoring w calcium gluconate?

A

Plasma-calcium and ECG monitoring required for administration by slow intravenous injection (risk of arrhythmias if given too rapidly)

380
Q

calc chloride indications?

A
  • hyperkal >6.5
  • acute severe hypocalcaemia

Year 3 (45 decks)

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