cpt stuff Flashcards
first line antihypertensive if have type 2 diabetes
ACEi
why do loop and thiazides cause hypokalaemia
block Na+ reabsorption and therefore more Na+ in tubule. more reabsorbed by ENaC, more K+ excreted by ROMK
which antihypertensve pregnancy
labetelol
which antihypertensive causes damage while breastfeeding
nifedipine
aminoglycosides and loop
ototoxicity, nephrotoxicity
digoxin and thiazide/loop
hypokalaemia
b blockers and thazide
hyperglycaemia, hyperlipidemia, hyperuricaemia
steroid and thiazide and loop
hypokalaemia
carbemazapine and thiazide
hyponatraemia
ADR thiazide
gout, hyperglycaemia, ED, increased LDL, hypercalcaemia
ADR frusemide
ototoxocity, alkalosis, increaed LDL, gout
SE alpha blocker
postural hypotension, dizziness, fatigue
drug interactions alpha blocker
people affected by dihydropiridine CCB, makes oedema worse
contraindications beta blockers
hepatic failure, haemodynamic instability, asthma
SE phenylalkamines
heart block, cardiac failure, bradycardia, constipation
thiazide SE
hypokalaemia, hyponatraemia, gout, arrhythmia, increased glucose
warnings thiazdie
hypokalaemia, hyponatriaema, gout
DI statins
CYP 3A4 important – amiodarone, diltiazem, macrolides - increases [plasma] statin Remember amlodipine (CCB) also increases [plasma] statin
nocte
at night
why take statins nocte
most cholesterol made at night
aim of statin treatment
> 40% reduction in non HDL-C at three months
when is ezetimibe combined with statin
in CKD and secondary CVS prevention, those who can only tolerate low dose statin
when is fibrates and statin used
famiilial hypercholesterolaemia
aim of secondary prevention LDL levels
1.8mmol/L LDL-C (<2.5mmol/L non HDL-C)
which foods naturally lower cholesteron
fish oils, fibre, vitamin c/e
what absolute cholesterol level triggers treatment
5mmol/L
what affects COCP effectiveness
oral contraceptive efficacy is reduced by enzyme inducing drugs
– carbamazepine or phenytoin;
– rifampicin and rifabutin and
– St John’s Wort
• increase the production of hepatic CYP450
effect of oestrogen on PR
increases
effect of progesterone on ER
decreases
contraindicatons and warnings metformin
X excreted unchanged by kidneys – stop if eGFR < 30 mL/min, alcohol intoxication
• Δ ACEi, diuretics, NSAIDs – drugs that may impair renal function
loop and thiazide like diuretics ↑glucose so can reduce metformin action
which diabetic drugs cause weight gain and how
glitazones - fat cell differentiation
sulfonurea- increased anabolic effects of insulin
which diabetic drug pancreatitis
dipeptidyl peptidase 4 inhibitors- sitagliptin, saxagliptin
why dipeptidyl peptidase 4 inhbitors lower hypoglycaemia risk
does not stimulate insulin production at normal glucose levels as is glucose dependent
which diabetic drugs cause weight loss and how
metformin- suppress appetite
GLP-1 agonist- reduced appetite
SGLT2
mechanism glitazones
insulin sensitisation, upregulation of ppary
SE, W, DI DPP4 inhibitors
se- pancreatitis
w- pregnancy, Hx pancreatitis
DDI- thiazide/loop as increase glucose, other hypoglycaemics
SE, W, DI sulfonurea
se- hyopoglycaemia and gi upset
w- hepatic impairment
di- other hypoglycaemics, thiazide and loop diuretics
se, w, di GLP-1 agonists
se- weight loss, hypoglycaemia
w- renal impair,emt
di- other hypoglycaemics
how are GLP-1 administered
subcutaneously- as hormone
why is renal SE/DI so important for metformin?
it is only renally excreted unchanged
half life equation
t1/2= (0.693 x Vd ) / CL
loading dose equation
loading dose =( Css x Vd ) bioavalibility (usually 1)
Css= desired concentration in plasma
maintenence dose
(clearance x [plasma] wanted /bioavalibility) x dose interval
theraputic index
toxic dose/ theraputic index
volume of distribution =
Vd = dose / plasma concentration drug in L/Kg(!!!)
which drug ventricular ectopic beat
bisoprolol
cardiac and ecg effects class IV
reduce phase 4, reduce AV, increase APD
increase PR
ECG class III sotalol
increase QT
use class Ic
WPW, atrial fluttter/fibrillations, premature ventricular contractions
use class Ib
ventricular tachycardia
cardiac effects Ib
increase qrs
warnings and contraindications ADP receptor antaognist
high bleed risk, hepatic and renal impairment
transplantation drugs
calcineurin inhibitor, mycophenolate mofetil
IBS drugs
azathioprine, sulfasalazine
skin drugs
calcineurin inhbibitors, methotrexate
RA drugs
methotrexate
effect of NSAIDs on RA management
NSAIDs reduce prostoglandins, reduce dilation of afferent arteriole, and so reduce renal blood flow, causing kidney damage
they displace streroids from binding sites, increasing blood levels
which drug has weekly dosing
methotrexate
how do prostoglandins cause ADR when taking NSAID
- prostoglandins dilate afferent,. when NSAID removes them renal blood flow reduces causing reduced GFR
- NSAIDs also constrict afferent arteriole, increasing effect seen
compare ipratropium and tiotropium
ipratropium is SAMA, tiotropium is LAMA
prescribing considerations LABA
must be given alongside ICS to prevent masking of life threatening symptoms
why difference in delivery of nebulised ipratroprium bromide COPD and asthma patients
if patient is hypercapnic, nebuliser is driven by air not o2
why fentanyl godo
- patches
- short half lfie
- high affinity and potency
isobride mononitrate
nitrate
tranexamic acid
inhibits the activation of plasminogen from plasmin
tetrabluine
SABA
long acting muscarinic
tiotropium bromide
short acting muscarinic
ipratropium bromide
fluticasone
corticosteroid inhaled
midazolam
buccal benzodiazapine
diamorphine, methadone, tramadol
opoid receptor agonist
rapid insulin
insulin aspart
short insulin
soluble- actrapid/humulin s
intermediate insulin
isophane insulin
long acting insulin
insulin degludec, insulin glargine
oestrogen steroid hormone
estradiol
synthetic progesterone
desogestrel, medroxyprogesterone acetate, norethisterone, levonorgestrel
Interaction metronidazole and warfarin
Metronidazole inhibits CYP2C9 and warfarin is broken down by CYP2C9
This increases warfarin concentration
What does CYP3A4 affect
Statins, verapamil
What does CYP 2C9 affect
Warfarin
Drugs with CYP2D6
Antidepressants, antipsychotics, b blockers, opioid analgesics
CYP 450 inducers (4)
Rifampicin
Carbemazapine
Omeprazole
Phenytoin
Cyp 450 inhibitors
Ciprofloxacin Antifungals Fluoxetine Paraoxetine HIV antivirals
Cyclophosphamide and cyps
Pro drug, needs CYP 45 to activate it
CYP 1A2 substrates, inducers and inhibitors
Substrates- haloperidol, naproxen, paracetamol, theophylline, verapamil
Inducers- carbemazapine
Inhibitors- amiodarone, grapefruit juice
CYP 2C8 substrates, inducers and inhibitors
Substrate- montelukast
Inducers- phenobarbital, rifampicin
Inhibitors- montelukast, trimethoprim
CYP 2C9 substrates, inducers and inhibitors
Substrates- celecoxib, diclofenac, ibuprofen, losartan, S-warfarin
Inducers- carbemazapine, rifampicin, St. Johns wort
Inhibitors- amiodarone, metronidazole, valproric acid
CYP 2C19 substrates, inducers and inhibitors
Substate- clopidogrel, cyclophosphamide, diazepam, gliclazide, omeprazole, phenytoin, warfarin
Inducers - rifampicin, St. John’s wort
Inhibitors- fluoxetine, omeprazole, oral contraceptives
CYP 2D6 substate, inducers and inhibitors
Substrate- bisoprolol, codeine, flecainide, haloperidol, metoprolol, ondansetron, propranolol, tramado
Inducers- carbemazapine, phenytoin, rifampicin
Inhibitor- amiodarone, fluoxetine, some antivirals
CYP2E subtrates, inducers, inhibitors
Substate- ethanol, gaseous anaesthetics, paracetamol
Inducers- ethanol
Inhibitors- ethanol
CYP3A4 substrate, inducer, inhibitor
Substrate- amlodipine, atorvastatin, carbamazepine, ciclosporin, COCPs, diazepam, diltiazem, midazolam, macrolides, opioids, simvastatin, tacrolimus, tamoxifen
Inducer- carbemazapine, phenytoin, pioglitaozne, rifampicin, St. John’s wort
Inhibitor- amiodarone, sone antivirals, clarithromycin, grapefruit, verapamil
Theophylline cyps
Cyp450 inhibitors increase concentration of theophylline
What cyp is involved with warfarin
CYP2C9
Which CYP statins
CYP3A4
Which CYP fentanyl
CYP3A4
Which CYP codeine
CYP 2D6 pro drug
Which CYP buprenorphine
CYP 3A4
Which CYP ADP RA
Clopidogren needs CYP activation
Caution with omeprazole, cipofloaxin (CYP inhibitors)
Interaction omeprazoel and CYP
Omeprazole is a CYP inhibitor, reduces clopidogrel action
Movicol vs lactulose
Movicol retains fluid that came with lactulose increases water entry
Action of opioid receptor agonist in gut
Reduces tone longitudinal and circular smooth muscle, reduce peristalsis and gastronomic reflux
Increasesegmental contraction
What class is mesalazine
Ainosalicylate
Action, SE, W, DI aminosalicylate
Action- release 5- aminosalsylic acid at colon to treat UC
SE- nausea, dyspepsia, leukopenia
W- hypersensitivity
DI-breakdown quicker when PPi present
SE ranitidine
Headache diarrhoea
Al vs Mg
Mg- diarrhoea
Al- constipation
drugs motion sickness
cinnirazine, hysoscine hydrobromide
prokinetics for GORD/ileus
domperidone, metoclopramide
general antiemetics for gut problems
ondansetron, cyclizine, dexamethasone
drugs hyperemesis gravidarum
promethazine/prochloroperazine
add metoclopramide
add ondansteron
drugs chemo low risk
dexamethasone, rescue: metoclopramide
drugs chemo high risk
dexamethasone plus ondansteron. rescue: metoclopramide
high risk chemo drugs
dexamethasone, ondansetron, aprepitant. rescue: metoclopramide
Mechanism unfractionaed heparin
Binding to ATIII, increasing its activity via conformational change
Inhibits IIa by binding to ATIII and IIa
Compare half life of two heparin
LMWH is longer
SE, W, DI heparin
SE- thrombocytopenia, bleeding, hyperkalaemia, osteoporosis
W- clotting disorders/ renal impairment
DI- other anti thrombotic drugs, ACEi, ARB, amiloride, spironolactone
SE, W, DI warfarin
SE- bleeding
W- pregnancy, hepatic disease
DI- CYP2C9
- amiodarone, clopidogrel, alcohol
- celaphosprins that reduce vitamin K
- NSAIDS that reduce GI absorption of vitamin K
- acceleration of warfarin metabolism - barbiturates, phenytoin, rifampicin, St. John’s wort
What does protamine sulphate work for
UFH only
Examples of DOAC
Xa- apixaban, edoxaban, rivaroxaban
IIa- dabigatran
SE, W, DI DOAC
SE- bleeding
W- low Cr clearance, pregnancy/breastfeeding
DI- CYP inhibitors/inducers
Concentration reduced by carbemazapine, phenytoin and barbiturates
concentration increased by macro lines
action quinolones
inhibits topisomerase II and so produces no negative supercoil
Pain and swelling in 1st MCP joint
Gout
First step in treating suspected PE
Rivaroxaban/ apixaban (DOAC)
use lamotrogine
focal seizures
SE sodium valproate
pancreatitis, lethargy, fatigue
SE phenytoin
zero order kinetics, arrhythmias w iv use, bone marrow supression, hypotension
mechanism levetiracetam
prevents release of glutamate at synapse
use levetiracetam
focal and generalised seizures
admin of diff benzos
lorazepam- IV
diazepam- rectal
midazolam- buccal
side effects anti epileptics
hypotension, nausea, suicide ideation, osteoperosis, bone marrow failure
mechanism COMT inhibitors
prevent peripheral breakdown of levadopa
examples COMT
opicapone, entacapone
examples dopamine agonists
non ergot- ropinoprole
patch- rotigotine
subcutaneous- apomorphine
mechanism and SE amantadine
- treat levadopa indued dyskinesia
- hallucinations, confusion
