Core Drugs Flashcards
Inhaled salbutamol:
Action?
Administration and dose?
SE?
Short acting B2 agonist (SABA)
Action
Acts to bronchodilate airways in Asthma and COPD
-Stimulates membrane-bound adenylate cyclase this increased intracellular cAMP
Administration/doses
Inhalation: 200-400mcg of powder 6/8hrly
Nebulised: 2.5-5mg of solution 6 hrly
SE
CVS: At high doses B1 actions –> positive inotropic and chronoptropic effects. At low doses –> b2 effects decrease peripheral vascular resistance
Fine tremor
Anxiety insomnia
Beclomethasone: Dose? Indication? Cause? SE
Corticosteroid.
Dose
200–400micrograms/12h INH
Indication Chronic asthma (step 2 BTS guidelines)
Caution
TB
SE
Oral candidiasis, hoarse voice, paradoxical bronchospasm (rare)
Prednisolone: Dose? Indication? CI? Caution? SE? Interaction?
Corticosteroid.
Dose Initially -10–20mg/24h mane PO though often 30–40mg/24 PO in severe disease (up to 60mg/24h); Maintenance -2.5–15mg/24h PO
Indication
Suppression of inflammatory and allergic disorders (eg IBD, asthma, COPD), immunosuppression
ContraIndication
Systemic infection without antibiotic cover
Caution
Adrenal suppression
SE
Peptic ulceration, Cushing’s syndrome, DM, osteoporosis
Interaction
Duration of action decreased by rifampicin, carbamazepine, phenytoin
Duration of action increased by erythromycin, ketoconazole, ciclosporin
Salmeterol: Dose Indication Caution SE
Long-acting β2 agonist.
Dose
50–100micrograms/12h INH
Indication
Chronic asthma, reversible airway obstruction
Caution
Cardiovascular disease, DM, hyperthyroidism
SE
Fine tremor, nervous tension, headache, palpitation, muscle cramps.
Tiotropium Dose? Indication? Caution? SE?
Antimuscarinic (anti-M3).
Dose
18 micrograms/24h INH; solution for inhalation also available (see BNF)
Indication
Maintenance treatment of COPD
Caution
Renal impairment, glaucoma, prostatic hypertrophy, cardiac rhythm disorders
SE
Minimal antimuscarinic effects.
Aspirin Dose: Anti-platelet? ACS/MI? Non-haemorrhagic stroke? Indication? CI? Caution? SE?
Aspirin; antiplatelet
NSAID.
Dose
Antiplatelet: 75mg/24h PO;
ACS/MI: 300mg/STAT PO;
Non-haemorrhagic stroke: 300mg/24h PO for 14d then 75mg/24h PO
Indication
Secondary prevention of thrombotic cerebrovascular and cardiovascular events
CI
Active bleeding, children under 16 (Reye’s syndrome)
Caution
Pregnancy, breastfeeding, asthma, peptic ulceration, concomitant use of other anticoagulants
SE
Bronchospasm, GI irritation/haemorrhage.
Warfarin Class? Dose? Indication? CI? Caution? SE? Interaction
Warfarin
Vit K antagonist –> blocks synthesis of factor II, VII, IX and X.
Dose
Loading: Continue with LMWH for 72hrs, monitor INR
Maintenance: Typically 1–5mg/24h PO dictated by the patient’s INR (though higher doses and dosing on alternative days are not uncommon)
Indication
Prophylaxis of thromboembolism (atrial fibrillation, mechanical heart valves, etc), treatment of venous thrombosis or pulmonary embolism
CI
Pregnancy, peptic ulcers, severe hypertension, bacterial endocarditis
Caution
Breastfeeding, hepatic or renal impairment, conditions in which risk of bleeding is increased (eg GI bleeding, peptic ulcer, recent surgery, recent ischaemic stroke, postpartum, bacterial endocarditis), uncontrolled hypertension recent
SE
Haemorrhage, rash, alopecia
Interaction
Avoid cranberry juice (↑anticoagulant effect)
Info
Warfarin is available in tablets of 0.5mg (white), 1mg (brown), 3mg (blue), and 5mg (pink) but check which tablets are stocked locally.
Statins Class? Dose? Indication? Caution? SE? Interaction?
First choice: Atorvastatin
Action: HMG CoA reductase inhibitor
Dose Initially 10mg/24h PO up to max 80mg/24h PO
Indications
Dyslipidaemias, primary and secondary prevention of cardiovascular disease (irrespective of serum cholesterol)
Caution
Pregnancy, breastfeeding, hypothyroidism, hepatic impairment, high alcohol intake,
SE
Myalgia, myositis (in severe cases rhabdomyolysis), GI disturbance, pancreatitis, altered LFTs (rarely hepatitis/jaundice)
Interaction
Avoid concomitant use of macrolide antibiotics and amiodarone (possible increased risk of myopathy).
ACE inhibitors: Enalapril Fosinopril Lisinopril Perindopril erbumine Perindopril arginine Ramipril
Doses?
Indications?
Cautions?
SE?
Enalapril
Dose Initially 5mg/24h PO up to max 40mg/24h PO
Fosinopril
Dose Initially 10mg/24h PO up to max 40mg/24h PO
Lisinopril
Dose Initially 5–10mg/24h PO up to max 80mg/24h PO
Perindopril erbumine
Dose Initially 4mg/24h PO up to max 8mg/24h PO
Perindopril arginine
Dose Initially 5mg/24h PO up to max 10mg/24h PO
Ramipril
Dose Initially 1.25–2.5mg/24h PO up to max 10mg/24h PO
Indications
Heart failure, hypertension, diabetic nephropathy, prophylaxis of cardiovascular events
Caution
Pregnancy and breastfeeding, patients already taking diuretics, renal artery stenosis/renal impairment, aortic stenosis, hyperkalaemia, known allergy to ACEi. May not be effective in African-Caribbean patients
SE
Postural hypotension, renal impairment and hyperkalaemia, dry cough, taste disturbance, urticaria and angio-oedema. If cough is problematic for the patient, consider AT II receptor antagonist, or other antihypertensive agent.
B-blockers
Cardioselective: Atenolol 25-50mg/24hrs PO max Bisoprolol 5-10mg/24hr PO Non-cardioselective: Propanolol 40-80mg/12h PO
Diuretics: Amiloride Bendroflumethiazide Furosemide Mannitol Spironolactone
Amiloride:
Potassium-sparing diuretic.
Dose: 5–10mg/24h PO (max 20mg/24h PO)
Bendroflumethiazide
Thiazide diuretic
In oedema: 5–10mg/ alternate days PO
In hypertension: 2.5mg/24h PO
Furosemide
Loop diuretic
Dose: 20-80mg/24hr PO/IV
Mannitol
Osmotic diuretic
Dose: 0.25-2g/kg/4-8hrs over 30-60 mins IV
Spironolactone
K+ sparing diuretic (aldosterone antagonist)
Dose: 100-200mg/24h PO
Calcium channel blockers: Dihydropyridines
Dose Indication CI Caution SE Info
Drugs: Amlodipine, nifedipine, felodipine
Dose: Initially 5mg/24hr PO
Indications
↑BP, prophylaxis of angina
CI
Unstable angina, cardiogenic shock, significant aortic stenosis, acute porphyria
Caution
Pregnancy, breastfeeding, heart failure
SE
Abdominal pain, N+V, flushing, palpitations, ↓BP, oedema, headache, sleep disturbance, fatigue
Info
The dihydropyridines relax smooth muscle and dilate both coronary and peripheral arteries. Nimodipine preferentially acts upon cerebral vascular smooth muscle and is used
Thyroxine:
Dose Indication CI Caution SE Interaction
Thyroid hormone (T4).
Dose
Typically 50–200micrograms/24h PO at breakfast
Indication
Hypothyroidism
CI
Thyrotoxicosis
Caution
Pregnancy, breastfeeding, panhypopituitarism, adrenal insufficiency, cardiovascular disorders, DM
SE
Hyperthyroid-like symptoms; GI disturbance, tremors, restlessness, flushing
Interaction
Increases effects of TCAs and warfarin, decreases effects of propranolol.
Metformin
Dose Indication CI Caution SE
Biguanide to potentiate release of insulin in DM T2
Dose
Initially: 500mg/24h PO with breakfast;
After 1wk: 500mg/12h PO;
After further 1wk: 500mg/8h PO if required (max 2g/24 in divided doses)
Indication
Type 2 DM, polycystic ovarian syndrome
CI
Hepatic or renal impairment
Caution
Ketoacidosis, potential increased risk of lactic acidosis, iodine-containing contrast, general anaesthesia
SE
GI disturbance, metallic taste.
Gliclazide
Class Dose Indication CI Caution SE Info
Class: Sulphonylureas
Dose
Glipizide: 2.5-5mg 24h PO
Tolbutamide: 0.5-1.5g PO with meals
Gliclazide: 40-80mg 24hr PO mane
Indications
Type 2 DM
CI
Ketoacidosis
Caution
Pregnancy, breastfeeding, hepatic or renal impairment, porphyria; should not be 1st-line agents in obese patients as will encourage further weight gain
SE
N+V, diarrhoea, constipation, hyponatraemia, hypoglycaemia, hepatic dysfunction, weight gain
Info
Hypoglycaemia resulting from sulfonylureas can persist for many hours and must always be treated in hospital; sulfonylureas should not be given on the day of surgery due to the risk of hypoglycaemia.
