Data interpretation Flashcards
1
Q
Cautions and contraindications of ACEis
A
Pregnancy and breast feeding
Renovascular disease -> renal impairment
Aortic stenosis (may cause hypotension) (CAUTION)
idiopathic angioedema
2
Q
Aminophylline infusions
Loading dose:
A
5 mg/kg given by slow IV over at least 20 minutes
3
Q
Maintenance infusion of aminophylline
Dose:
A
1g in 1L -> 1mg/ml
500-700mcg/kg/hour
4
Q
Key regular investigation for a patient taking Aminosalicylates (sulphasalazine/mesalazine)
A
FBC
5
Q
Adverse effects of AMIODARONE -BITCH
A
Bradycardia/Blue man
Interstitial Lung Disease
Thyroid (hyper and hypo)
Corneal (ocular)/Cutaneous (skin)
Hepatic/Hypotension when IV (due to solvents)
Thyroid dysfunction - both hypo and hyper thyroidism
Corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
slate-grey appearance
bradycardia
Lengthens QT interval
6
Q
Angina management: what should ALL patients received (in the absence of any other contraindication)
A
Aspirin and Statin
7
Q
Angina management:
Reliever:
Maintenance:
A
GTN
CCB or BB
If used in combination, CCB should always be a DIHYDROPYRIDINE CCB
8
Q
If patient cannot tolerate addition of BB or CCB in angina which drugs should be considered:
A
Long-acting nitrate
Ivabradine
Nicorandil
Ranolazine
9
Q
Nitrate tolerance: What should be done
A
if taking isosorbide mononitrate - use asymmetric dosing -> daily nitrate free time of 10-14 hours
10
Q
Anti-platelets: ACS
1)
2)
A
1) Aspirin (lifelong) and Ticagrelor (12 months)
2) If aspirin contraindicated -> CLOPIDOGREL lifelong
11
Q
Anti-platelets: TIA or ischaemic stroke
1)
2)
A
1) CLOPIDOGREL (lifelong)
2) Aspirin and Dipyridamole (lifelong)
12
Q
Anti-platelets: Peripheral arterial disease
A
1) Clopidogrel (lifelong)
2) Aspirin (lifelong)
13
Q
Anti-platelets: Post PCI
A
Aspirin (lifelong) & prasugrel or Ticagrelor
2) clopidogrel if Aspirin CI
14
Q
AF: rhythm or rate control
A
Rate first for most
15
Q
AF rate control:
If one drug does not control
A
BB or CCB (diltiazem)
ADD:
A betablocker
Diltiazem (CCB)
Digoxin
in combination
16
Q
What test should be done prior to starting a patient on AZATHIOPRINE
A
TPMT test
17
Q
Is azathioprine safe in pregnancy
What drug should be monitored closely for interaction with azathioprine
A
Yes
ALLOPURINOL
18
Q
Side effects of BBs
A
Sleep disturbances - nightmares
Erectile dysfunction
Bronchospasm
Cold peripheries
Fatigue
19
Q
Contraindications of Beta blockers
A
Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent verapamil use - severe bradycardia
20
Q
Uses of Bisphosphonates
A
Prevention and treatment of osteoporosis
Hypercalcaemia
Paget’s disease
Pain from bone metastasis
21
Q
Adverse effects of bisphosphonates
A
Oesophageal reactions: oesophagitis
Osteonecrosis of jaw
atypical fractures - proximal femoral shaft
22
Q
Advice for taking bisphosphonates
A
23
Q
Advice for taking bisphosphonates
A
Swallowed with plenty of water while sitting or standing on an empty stomach 30 mins before breakfast
24
Q
Uses of CARBAMAZEPINE
A
First line in PARTIAL seizures
First line in Trigeminal neuralgia
Bipolar disorder?
25
Blood dyscrasias from carbamazepine?
Leucopaenia
Agranulocytosis
26
Adverse effects of carbimazole
AGRANULOCYTOSIS
crosses placenta but may be used in small doses in pregnancy
27
Heart failure: first line Mx
ACEi AND BB
one drug started at a time
28
Heart failure: second line therapy
Aldosterone antagonist: SPIRONOLACTONE
29
What must be monitored for a Pt. on Spironolactone and ACEi
U&Es - Hyperkalaemia may ensue
30
Heart failure 3rd line therapy
To be initiated by a specialist
Ivabradine
Sacubitril-Valsartan
Digoxin
Hydralazine (++ useful in afrocaribbean patients)
31
Aside from medications, what other interventions should be offered in CHF
ONE OFF pneumococcal vaccine
ANNUAL flu vaccine
32
What commonly prescribed medication for GORD is known to interact with CLOPIDOGREL
PPIs - make it less effective (lanzoprazole less so)
33
C.difficile risk factor medication other than antibiotics
PPIs
34
Current antibiotic therapy for C.difficile
Vancomycin (ORAL) 10 days
Second line: FIDAMOXICIN
Third-line: oral Vancomycin + IV Metronidazole (ALSO for life threatening C.dif)
35
COPD stable management
SABA or SAMA as required
ATOPY? = SABA or SAMA PLUS LABA and ICS
No ATOPY= SABA PLUS (LABA/LAMA)
3) SABA as req. LABA + LAMA + ICS
36
Antibiotic prophylaxis in COPD patients?
AZITHROMYCIN
LFTs and ECG should also carried out to exclude long QT syndrome/ elongation as Azithromycin can prolong the QT
37
STEROID SIDE EFFECTS: 'CUSHINGOID'
Cataracts
Ulcers (peptic ulceration)
Skin: striae, thinning, bruising
Hypertension/ hirsutism/hyperglycaemia
Infections - immunocompromised
Necrosis - avascular necrosis of femoral head
Glycosuria
Osteoporosis/obesity
Immunosuppression
Diabetes
38
Steroid dose for pts. with intercurrent illness
Dose DOUBLED
39
T2DM if pts. has CV risk what should be added once established on metformin
SGLT-2 inhibitor
40
Diabetic neuropathy mx.
1) Amitriptyline, duloxetine, gabapentin, pregabalin
If one doesn't work try another
TRAMADOL may be used as 'rescue therapy' for exacerbations of neuropathic pain
41
Diabetic - GI autonomic neuropathy mx.
Gastroparesis: Prokinetic agents - metoclopramide, domperidone
42
Drugs which decrease serum potassium
Loop diuretics
Acetazolamide
Thiazide diuretics
43
Drugs which INCREASE serum potassium
ACEi/ARBs
Spironolactone
Amiloride
Potassium supplements: Sando K
43
Drugs which INCREASE serum potassium
ACEi/ARBs
Spironolactone
Amiloride
Potassium supplements: Sando K
44
Drugs causing peripheral neuropathy
Amiodarone
Isoniazid
Vincristine
Nitrofurantoin
Metronidazole
45
Generalised tonic clonic seizures Mx.
Males: Sodium Valproate
Females: Lamotrigine or Levetiracetam
46
Focal seizures Mx.
Leviteracetam or Lamotrigine
2) Carbamazepine
47
Absence seizures Mx.
1) Ethosuximide
2) Sodium Valproate (M)
2) Lamotrigine or Levetiracetam
48
Which anti-epileptic may exacerbate ABSENCE SEIZURES
CARBAMAZEPINE
49
Essential tremor first line tx.
PROPRANOLOL
50
What is EZETIMIBE
Lipid lowering drug - decreases cholesterol absorption in the small intestine by inhibiting cholesterol receptors
51
Main use for ezetimibe
Primary heterozygous-familial and non-familial hypercholesterolaemia
52
Maintenance fluids
25-30 ml/Kg day of water
1mmol/kg/day of potassium, sodium and chloride
50-100 g a day of GLUCOSE to limit starvation ketosis
53
Drugs to avoid in G6PD deficiency
CIPROFLOXACIN
Sulph-drugs - sulphonamides, sulphasalazine, sulfonylureas
Antimalarials - Primaquin
54
GORD management
Endoscopically proven oesophagitis
Endoscopically negative reflux disease: Full dose PPI one month -> if Negative, double dose
Endoscopically positive -> Full dose PPI one month ->
No response -> Prokinetics or H2 receptor antagonist
55
In which two groups should thyroxine therapy be started at a lower dose
ELDERLY
IHD patients
56
Starting dose of Thyroxine (non-IHD/elderly)
50-100 mcg OD
57
Pregnant women on thyroxine should have their dose ___ by ___
INCREASED
25-50 mcg
Due to increased demands of pregnancy
58
Side effects of THYROID therapy
Reduced bone mineral density
Worsening of angina
Atrial fibrillation
59
Main interaction of Levothyroxine to look out for
Iron + calcium carbonate
60
What is the effect of the iron/calcium interaction with Levothyroxine and how can this be mitigated
Absorption of levothyroxine REDUCED
Give at least 4 hours apart
61
Which common cardiac medication commonly reduces HYPOGLYCAEMIC awareness
B-Blockers
62
Electrolyte disturbances with LOOP diuretics
HYPONATRAEMIA
HYPOKALAEMIA
HYPOMAGNESAEMIA
HYPOCALCAEMIA
Low everything
63
Metabolic disturbance from LOOP diuretics
Hypochloraemic alkalosis
Can cause GOUT
64
Meningitis: suspected bacterial meningitis prior to hospital transfer tx.
IM Pen V
65
IV antibiotics for meningitis
3 months - 50 years = CEFOTAXIME
>50 years or < 3 months = CEFOTAXIME PLUS AMOXICILLIN listeria cover)
66
What adjunctive drug should be considered along side antibiotics in meningitis
IV dexamathasone
67
Meningitis prophylaxis?
CIPROFLOXACIN OR RIFAMPICIN
Unless pneumococcal meningitis in which no prophylaxis is needed
68
Side effects of Methotrexate
Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis
69
How long should men and women be off MTX before attempting to conceive
6 months
70
When is methotrexate taken
WEEKLY (common source of error in prescribing)
71
What is co-prescribed with methotrexate
Folic acid
72
Interactions of methotrexate to be aware of:
Avoid co-prescribing TRIMETHOPRIM or CO-TRIMOXAZOLE concurrently - Increased risk of marrow aplasia
High dose aspirin can cause methotrexate toxicity due to reduced excretion
73
Methotrexate toxicity treatment of choice
FOLINIC ACID
74
Metoclopramide - MoA and resultant side effects
D2 RECEPTOR ANTAGONIST - as acts on dopamine pathway -> EPSE (acute dystonia etc.) -> parkinsonism -> tardive dyskinesia
Diarrhoea
Hyperprolactinaemia
75
First-line Tx. ACUTE MIGRAINE
combination therapy w/ oral TRIPTAN and NSAID
76
Prophylaxis for MIGRAINES
When to give?
IF more than 2 attacks per month
77
Prophylaxis for MIGRAINES:
PROPRANOLOL OR TOPIRAMATE
78
Which of the migraine prophylactic drugs should be given to women of childbearing age:
PROPRANOLOL -> topiramate may be teratogenic
79
Myasthenia Gravis first line medication:
PYRIDOSTIGMINE
80
STEMI management: all patients to receive
ASPIRIN
CLOPIDOGREL
Unfractionated HEPARIN if going for PCI
81
Fluids given as prophylaxis in those at risk of contrast induced nephrotoxicity
0.9% sodium chloride 1 ml/kg/hour for 12 HOURS pre and post procedure
82
Which drugs may worsen psoriasis
B blockers
ACEi
Lithium
NSAIDs
Antimalarials (chloroquine)
Withdrawal of systemic steroids
83
Nicorandil contraindication
LEFT ventricular failure
84
Nitrate side effects
Hypotension
Tachycardia
Headaches
Flushing
85
Palliative care prescribing: PAIN
1) Offer pts. w/ advanced progressive disease regular oral modified release or immediate release Morphine
2) IF no comborbidities: use 20-30 mg of MR a day with 5 mg for breakthrough pain
86
What should always be prescribed with pts. on strong opioids:
Laxatives
87
Which patient group should opioids be used only with caution
CKD pts.
88
What is used in preference to morphine for CKD patients
OXYCODONE
89
What is used for pain relief in SEVERE renal impairment
Fentanyl, alfentanil, buprenorphine
90
When increasing the dose of opioids, what dose percentage increase should be used
30-50%
91
Drug treatment for Parkinson's:
If affecting QoL
If NOT affecting QoL
Levodopa
Dopamine agonists (ropinirole, pramipexole) Levodopa or MAO-Bi
92
If a patient continues to have symptoms despite optimal LEVODOPA treatment
Adjunct with Dopamine agonist (ROPINIROLE), MAO-B inhibitor or COMT
93
What is LEVODOPA usually combined with and why:
Carbidopa -> to prevent peripheral metabolism of levodopa to dopamine outside of the brain and reduce side effects
94
Common side effects of LEVODOPA
Dry mouth
Anorexia
Palpitations
Postural hypotension
Psychosis
95
Adverse effects of PPIs
Hyponatraemia, Hypomagnesaemia
Osteoporosis -> increased risk of fractures
Microscopic colitis
Increased risk of C. Difficile infections
96
Enzyme inducers (PC BRAS)
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulfonlyureas (gliclazide)
97
Enzyme inhibitors (AO-DEVICES)
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides
98
Drugs to stop prior to surgery (ILACKOP)
Insulin
Lithium
Anti-coagulants/ antiplatelets (aspirin 7 days before)
COCP/HRT - 4 weeks before
K+ sparing diuretics (on day of surgery)
Oral hypoglyacaemics (metformin -> lactic acidosis)
Phytonadione (Vit K) one day before INR > 1.5
99
UTI antibiotics to avoid in reduced renal function
NITROFURANTOIN
100
Which drugs tend to cause anticholinergic side effects
Amitryptiline
Paroxetine
Anti-muscarinics
Anti-psychotics (CLOZAPINE)
101
Anti-rheumatoid drugs: which drug causes oligospermia
Sulfasalazine
102
Anti-rheumatoid drugs: Which drug causes HEINZ BODY ANAEMIA
Sulfasalazine
103
Anti-rheumatoid drugs: Which drug causes retinopathy and corneal deposits
Hydroxychloroquine
104
Anti-rheumatoid drugs: drugs causing proteinuria
Gold
Penicillamine
105
As well as BBs, which drugs can commonly cause bronchospasm in asthmatics
NSAIDs
106
NSAIDS adverse effects mnemonic
Nausea, dyspepsia
Swelling
Allergy
Impaired renal function
Damaged stomach wall
Stroke/heart attack
107
SIADH: Malignancy causes
Small cell lung cancer
Pancreas/prostate cancer
108
Drug caused of SIADH (water retention)
Sulfonylurea
SSRIs, Tricyclics
Carbamazepine
Vincristine
Cyclophosphamide
109
MoA Sodium valproate
Increases GABA activity
110
Adverse effects of sodium valproate (VALPROATE)
Vomiting
Alopecia
Liver toxicity
Pancreatitis
Retention of fat (weight gain)
Oedema
Appetite increase
Tremor - TERATOGENIC
Enzyme inducer
111
Spironolactone adverse effects:
GYNAECOMASTIA: less common with Eplerenone
HyperKALAEMIA
112
Statins adverse effects (HMG CoA RI)
Hepatotoxicity
Myopathy (myalgia, myositis)
GI upset (nausea, vomiting, diarrhoea)
Cataracts
Rhabdomyolysis
Increased risk of diabetes
*RI = Reductase inhibitors in mnemonic
112
Statins adverse effects (HMG CoA RI)
Hepatotoxicity
Myopathy (myalgia, myositis)
GI upset (nausea, vomiting, diarrhoea)
Cataracts
Rhabdomyolysis
Increased risk of diabetes
*RI = Reductase inhibitors in mnemonic
113
What are SULPHONAMIDES
Class of drug which work by inhibiting dihydropteroate synthetase (antibiotic and non-antibiotic forms
In form of antibiotics: SULFAMETHOXAZOLE
Co-tromoxazole = combination with trimethroprim which is used in treatment of Pneumocystitis Jiroveci pneumonia
114
Non-antibiotics sulphonamides
Sulfasalazine
Sulfonylureas
115
Common side effects of Sulfonylurea
Hypoglycaemia
Weight gain
116
Rarer adverse effects of sulfonylureas
Hyponatraemia -> secondary to SIADH
Bone marrow suppression
Hepatotoxicity
Peripheral neuropathy
117
Are sulphonylureas given in breastfeeding and pregnancy
No, should be avoided
118
Thiazide diuretics common adverse effects
Dehydration
Postural hypotension
Hyponatraemia, hypokalaemia
Gout
Impaired glucose tolerance
Impotence
119
Thiazide diuretics effect on calcium
HYPERCALCAEMIA -> which translates to hypocalciuria (may be useful in reducing the incidence of renal stones)
120
Thiazolidinediones main concerns
Fluid retention -> contraindicated in heart failure
Bladder cancer (pioglitazone)
Weight gain
121
MoA of thrombolytic drugs
Activate plasminogen to form plasmin which degrades FIBRIN and helps break up thrombi
122
Contraindications to THROMBOLYSIS (ALTEPLASE, STREPTOKINASE, TENECTEPLASE)
Active internal bleeding
Recent haemorrhage, trauma or surgery
Coagulation or bleeding disorders
Intracranial neoplasms
Stroke < 3 months
Aortic dissection
Recent head injury
severe hypertension
123
Triptans - prescribing points:
When should they be taken
Should be taken as soon as possible after the onset of headache rather than at onset of aura
124
Adverse effects of triptans:
'Triptan sensations' tingling, heat, tightness (Throat and chest), heaviness, pressure
125
Contraindications of TRIPTANS
Pts. w/ history or risk factors for IHD or CVD
126
Variceal haemorrhage management
ABC
Correct clotting: FFP, VitK, Platelets
Vasoactive agents: TERLIPRESSIN
127
What should be used prophylactically following an acute variceal bleed
Antibiotics -> IV QUINOLONE
128
Following resus, clotting correction and terlipressin, what should be done to correct variceal bleed
Endoscopic band LIGATION
If uncontrolled haemorrhage: Sengstaken-blakemore tube
TIPSS if all above measures fail
129
Prophylaxis of variceal haemorrhage
Propranolol (reduced rebleeding and mortality)
130
Warfarin indications
Mechanical heart valves: target INR depends on type of valve
Second line after DOACs
131
Juice which potentiates warfarin
CRANBERRY
132
Side effects of WARFARIN
Haemorrhage
Teratogenic (although safe in breastfeeding)
Skin NECROSIS
Purple toes
