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deck_6633276 Flashcards

1
Q

Metformin: Drug classInsulin sensitiser or secretagogue MOA

A

BiguanideInsulin sensitiser Incompletely understood but:Decreases gluconeogenesis Increases peripheral glucose useDecreases LDL and VLDL

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2
Q

Key side effects of metformin

A

Lactic acidosis (care in renal failure and with contrast dye)GI upset

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3
Q

Pioglitazone:Drug classInsulin sensitiser or secretagogue MOA

A

ThiazolidinedioneInsulin sensitisation (peripheral) PPAR gamma ligand. PPAR is involved in glucose and lipid homeostasis.

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4
Q

Gliclazide Drug classInsulin sensitiser or secretagogue MOA

A

Sulphonylureas Insulin secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

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5
Q

Repaglinide Drug classInsulin sensitiser or secretagogue MOA

A

Meglitinides Insulin Secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

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6
Q

Key side effects on sulphonylureas

A

Hypos (can be prolonged) Weight gain GI upsetHeadache

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7
Q

Key side effect of pioglitazone

A

Weight gain Deranged LFTs/ hepatotoxicity Fluid retention May exacerbate heart failure

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8
Q

Key side effects of repaglinide

A

Hypoglycaemia (also very short acting)

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9
Q

ExenatideDrug classInsulin sensitiser or secretagogue MOA

A

GLP-1 analogue/ Insulin secretagogues Both GLP-1 analogueGLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells Increases insulin sensitivity

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10
Q

Key side effects of exenatide

A

Hypoglycaemia GI upset (also needs to be given by subcut injection)

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11
Q

Sitagliptin

A

DPP4 Inhibitor Insulin secretagogue Inhibits DPP4 which breaks down endogenous GLP-1. GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells and increases insulin sensitivity

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12
Q

Key side effects of the DPP4 inhibitors

A

Hypoglycaemia GI upset

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13
Q

For exenatide to be continued long term initially there must be clear metabolic benefit demonstrated by…

A

Weight fall of at least 3% and HbA1c fall of at least 11mmol (1%)

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14
Q

Which oral hypoglycaemic should not be used with insulin

A

Pioglitazone

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15
Q

Stepwise treatment of COPD (inhaled therapies)

A

For all patients: Vaccinations, smoking cessation, pulmonary rehab if person is functionally limited by COPD. 1: PRN SABA (or SAMA)2: If FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.Stop any SAMA. 3: If FEV1 ≥ 50% predicted consider LABA+ICS in a combination inhalerconsider LAMA in addition to LABA where ICS is declined or not tolerated4: Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.

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16
Q

Vaccinations to be offered to patients with COPD

A

Pneumococcal booster and annual influenza

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17
Q

When to use theophylline in COPD

A

Theophylline should only be used after a trial of short-acting bronchodilators and long-acting bronchodilators, or in patients who are unable to use inhaled therapy, as there is a need to monitor plasma levels and interactions

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18
Q

When to use carbocisteine in COPD

A

Mucolytic drug therapy should be considered in patients with a chronic cough productive of sputum. They should not be used to prevent exacerbations.

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19
Q

When to start long term oxygen therapy in COPD

A

Non smokers!!! and any of the following: Clinically stable with PaO2<7.3 (2 occasions >3/52 apart) PaO2 7.3-8 with: PHT, cor pulmonale, polycythaemia, nocturnal hypoxaemia. Terminally ill

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20
Q

MRSA eradication

A

Mupirocin (nasal) and chlorhexidine wash.

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21
Q

Acute management of non-self limiting seizures (if no IV access)

A

Rectal diazepam 10mg. Repeated if necessary after 10-15 minutes.

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22
Q

Side effects of sulfasalazine due to the sulphapyridine moiety

A

Rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia

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23
Q

2nd Line pharmacological treatment of IBS

A

Low dose tricyclic

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24
Q

Summarise the symptomatic treatment of MS

A

Fatigue: Modafanil Depression: SSRI Pain: Amitryptylline or gabapentin Spasticity: Physio, baclofen (1st line drug), dantrolene, Botox Urinary Urgency/frequency: Oxybutynin, tolterodine ED: Sildenafil Tremor: Clonazepam

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25
Q

Drugs that worsen mysasthenia gravis weakness

A

B blockersGentamicinPhenytoinMacrolides Tetracyclines Opiates

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26
Q

Acute treatment of cluster headaches

A

Sumatriptan subcut or nasal (NOT ORAL)100% oxygen

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27
Q

Prophylaxis of cluster headache

A

Verapamil or prednisolone

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28
Q

Side effects of sodium valproate

A

Appetite increase (and weight)Liver failure (monitor LFTs over first 6 months)PancreatitisReversible hair loss OedemaAtaxiaTertaogenicity, thrombocytopenia, tremorEncephalopathy

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29
Q

Initial treatment of cryptococcal meninigitis

A

Amphotericin B and flucytosineFollow up treatment with fluconazole If HIV infeected also optimise ARVs

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30
Q

Treatment of toxoplasmosis

A

Pyrimethamine, sulfadiazine, folate

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31
Q

First line options for treatment of neuropathic pain

A

amitriptyline, duloxetine, gabapentin or pregabalin

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32
Q

First line for ‘rescue therapy’ in neuropathic pain

33
Q

Common side effects of triptans

A

Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

34
Q

Contraindications for use of triptans

A

Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

35
Q

Essential tremor is improved by…

A

Propranolol and alcohol

36
Q

Drug that shows survival benefit in motor neuron disease

A

Riluzoleprevents stimulation of glutamate receptorsused mainly in amyotrophic lateral sclerosisprolongs life by about 3 months

37
Q

Management of motor neurone disease

A

Riluzoleprevents stimulation of glutamate receptorsused mainly in amyotrophic lateral sclerosisprolongs life by about 3 monthsRespiratory carenon-invasive ventilation (usually BIPAP) is used at nightstudies have shown a survival benefit of around 7 months50% of patients will die within 3 years.

38
Q

Enzyme inhibitors

A

Sodium valproateIsoniazidCimetidineKetoconazoleFluconazoleAlcohol..binge drinking/Allopurinol ChloramphenicolErythromycinSulfonamidesCiprofloxacinOmeprazoleMetronidazole

39
Q

Enzyme inducers

A

CarbamezapineRifampicinAlcohol (chronic)PhenytoinGriseofulvinPhenobarbitalSulphonylureas

40
Q

Key side effects of thiazides

A

HYPER effects in serum:HYPERuricemia (precipitate acute gouty arthritis)HYPERcalcemia (renal calcium resorption, decrease calcium in urine)HYPERglycemiaHYPERlipidemia (increase choleterol and LDL)HYPO effects in serum:HYPOkalemiaHYPOtension (decreases blood volume and peripheral vascular resistance)

41
Q

NICE fluid requirments recommendations for maintenance fluids

A

In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:25-30 ml/kg/day of water andapproximately 1 mmol/kg/day of potassium, sodium and chloride andapproximately 50-100 g/day of glucose to limit starvation ketosis

42
Q

Drugs that preciptate gout

A

NSAIDs, diuretics (thiazides), cytotoxics, pyrazinamide.

43
Q

Treatment of acute gout

A

First line: NSAID (diclofenac or indomethacin) Second line: ColchiconeIn renal impairment: steroids (NSAID and colchicine CI)

44
Q

Common s/e of colchicine

45
Q

Prevention of gout (medications)

A

1st line: Xanthine oxidase inhibitors. Allopurinol first choice. Febuxostat is hypersensitivity.2nd line: Uricosuric drugs. Probenicid, Losartan. These are rarely used. Recombinant urate oxidase may be used before cytotoxic therapy.

46
Q

Side effects of xanthine oxidase inhibitors

A

Rash, fever, reduced WCC with azathioprine.

47
Q

Non ergot-derived dopamine agonists used in PD

A

Pramipexole, ropinirole, and rotigotine

48
Q

Treatment of pseudogout

A

AnalgesiaNSAIDsPO, IM or intra-articular steroids

49
Q

Treatment of psoriatic arthritis

A

NSAIDs MTX, sulfasalazine, ciclosporin

50
Q

Treatment of reactive arthritis

A

NSAIDsLocal steroids Relapse may require sulfasalazine or MTX

51
Q

Treatmement of polymyositis and dermatomyositis

A

Steroids Cytotoxics: AZT, MTX

52
Q

Drugs that induce lupus

A

Procainamide PhenytoinHydralazine Isoniazid

53
Q

Treatment of anti-phsopholipid syndrome

A

Low dose aspirin Warfarin if higher risk (e.g. recurrent thromboses) target INR 2-3

54
Q

SLE management

A

Severe flares (pericarditis, CNS disease, AIHA, nephritis): IV cyclophosphamide, High dose prednisolone. Cutaneous: topical steroids to treat, sun cream for preventionMaintenance for joints and skin: NSAIDs, hydroxychloroquine, low dose steroids (option)Lupus nephritis: ACEi for proteinuria. Immunosupression if aggressive GN

55
Q

Treatment of GCA

A

High dose steroids (e.g. pred 40-60mg oral) and taper slowly. PPI and alendronate cover

56
Q

Treatment of polymyalgia rheumatica

A

15mg/day oral prednisolone and then taper according to ESR and symptoms PPI and alendronate cover

57
Q

Treatment of granulomatosis with polyangiitis

A

Immunosuppression: Cyclophsphamide, Rituximab, MTX Azathioprine, Rituximab or MTX for maintenance.

58
Q

Treatment of Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

A

Prednisolone Cyclophosphamide is severe multi-organAzathioprine or MTX for maintenance

59
Q

Women should avoid pregnancy for at least… months after stopping MTX

A

3 months (men should use contraception for the same duration)

60
Q

Treatment of warm AIHA

A

Immunosuppression Splenectomy

61
Q

Drugs that trigger haemolysis in G6PD deficiency

A

Antimalarials, henna, dapsone, sulphonamides

62
Q

Management of sickle cell anaemia (chronic)

A

Pen V 250mg BD Folate 5mg OD Hydroxycarbamide if frequent crises

63
Q

Treatment of Hodgkin’s lymphoma

A

A – doxorubicin (Adriamycin ®)B – bleomycinV – vinblastine (Velbe ®)D – dacarbazine (DTIC).Possibly add radiotherapy.

64
Q

Immunisations post splenectomy

A

Pneumovax (repeat every 5 years)Hib if not done in childhood Men C if not done in childhood Yearly flu

65
Q

Contraindications for thrombolysis (STEMI)

A

AGAINSTAortic dissection GI bleeding Allergic reaction previously Iatrogenic (recent surgery)Neuro: cerebral neoplasm of CVA Hx Severe HTN (200/120)Trauma (including CPR)

66
Q

Clopidogrel post MI: How long to continue post..STEMINSTEMI

A

STEMI with stenting: 12 months STEMI with medical management: 1 month NSTEMI: 12 months

67
Q

1st line treatments of stable angina (in addition to GTN)

A

CCB or B blocker

68
Q

2nd line treatments of stable angina

A

a long-acting nitrate orivabradine ornicorandil orranolazine.

69
Q

Drugs causing lung fibrosis

A

BANS MEBleomycin/busulfanAmiodarone Nitrofurantoin Sulfasalazine MEthotrexate

70
Q

Prednisolone dose following:Asthma exacerbation COPD exacerbation

A

40mg OD for at least 5 days 30mg OD for 7-14 days

71
Q

Duration of treatment for Scarlet fever

72
Q

Treatment of CMV retinitis

A

Oral valganciclovir if sight threatened add intravitreal injections of ganciclovir or foscarnet

73
Q

Drug used for CMV prophylaxis in renal transplant

A

Valgancyclovir

74
Q

Treatment of chronic hepatitis B

A

Nucleoside analogue (e.g. tenofovir) or interferon

75
Q

Clinical features of cholera

A

Rice water stools Shock, acidosis, renal failure

76
Q

Antibiotics most likely to cause C.diff

A

Clindamycin Ciprofloxacin Cephalosporins

77
Q

Treatment of giardiasis

A

Tinidazole, metronidazole, or nitazoxanide

78
Q

Treatment of amoebic dysentery

A

Metronidazole (800mg TDS) 5 days or 10 days if liver abscessTinidazole

79
Q

Midodrine is used to treat

A

Orthostatic hypotension

PSA (15 decks)

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