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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
Drugs that worsen mysasthenia gravis weakness
B blockersGentamicinPhenytoinMacrolides Tetracyclines Opiates
26
Acute treatment of cluster headaches
Sumatriptan subcut or nasal (NOT ORAL)100% oxygen
27
Prophylaxis of cluster headache
Verapamil or prednisolone
28
Side effects of sodium valproate
Appetite increase (and weight)Liver failure (monitor LFTs over first 6 months)PancreatitisReversible hair loss OedemaAtaxiaTertaogenicity, thrombocytopenia, tremorEncephalopathy
29
Initial treatment of cryptococcal meninigitis
Amphotericin B and flucytosineFollow up treatment with fluconazole If HIV infeected also optimise ARVs
30
Treatment of toxoplasmosis
Pyrimethamine, sulfadiazine, folate
31
First line options for treatment of neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin
32
First line for 'rescue therapy' in neuropathic pain
Tramadol
33
Common side effects of triptans
Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
34
Contraindications for use of triptans
Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease
35
Essential tremor is improved by...
Propranolol and alcohol
36
Drug that shows survival benefit in motor neuron disease
Riluzoleprevents stimulation of glutamate receptorsused mainly in amyotrophic lateral sclerosisprolongs life by about 3 months
37
Management of motor neurone disease
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
Enzyme inhibitors
Sodium valproateIsoniazidCimetidineKetoconazoleFluconazoleAlcohol..binge drinking/Allopurinol ChloramphenicolErythromycinSulfonamidesCiprofloxacinOmeprazoleMetronidazole
39
Enzyme inducers
CarbamezapineRifampicinAlcohol (chronic)PhenytoinGriseofulvinPhenobarbitalSulphonylureas
40
Key side effects of thiazides
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
NICE fluid requirments recommendations for maintenance fluids
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
Drugs that preciptate gout
NSAIDs, diuretics (thiazides), cytotoxics, pyrazinamide.
43
Treatment of acute gout
First line: NSAID (diclofenac or indomethacin) Second line: ColchiconeIn renal impairment: steroids (NSAID and colchicine CI)
44
Common s/e of colchicine
Diarrhoea
45
Prevention of gout (medications)
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
Side effects of xanthine oxidase inhibitors
Rash, fever, reduced WCC with azathioprine.
47
Non ergot-derived dopamine agonists used in PD
Pramipexole, ropinirole, and rotigotine
48
Treatment of pseudogout
AnalgesiaNSAIDsPO, IM or intra-articular steroids
49
Treatment of psoriatic arthritis
NSAIDs MTX, sulfasalazine, ciclosporin
50
Treatment of reactive arthritis
NSAIDsLocal steroids Relapse may require sulfasalazine or MTX
51
Treatmement of polymyositis and dermatomyositis
Steroids Cytotoxics: AZT, MTX
52
Drugs that induce lupus
Procainamide PhenytoinHydralazine Isoniazid
53
Treatment of anti-phsopholipid syndrome
Low dose aspirin Warfarin if higher risk (e.g. recurrent thromboses) target INR 2-3
54
SLE management
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
Treatment of GCA
High dose steroids (e.g. pred 40-60mg oral) and taper slowly. PPI and alendronate cover
56
Treatment of polymyalgia rheumatica
15mg/day oral prednisolone and then taper according to ESR and symptoms PPI and alendronate cover
57
Treatment of granulomatosis with polyangiitis
Immunosuppression: Cyclophsphamide, Rituximab, MTX Azathioprine, Rituximab or MTX for maintenance.
58
Treatment of Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Prednisolone Cyclophosphamide is severe multi-organAzathioprine or MTX for maintenance
59
Women should avoid pregnancy for at least... months after stopping MTX
3 months (men should use contraception for the same duration)
60
Treatment of warm AIHA
Immunosuppression Splenectomy
61
Drugs that trigger haemolysis in G6PD deficiency
Antimalarials, henna, dapsone, sulphonamides
62
Management of sickle cell anaemia (chronic)
Pen V 250mg BD Folate 5mg OD Hydroxycarbamide if frequent crises
63
Treatment of Hodgkin's lymphoma
A – doxorubicin (Adriamycin ®)B – bleomycinV – vinblastine (Velbe ®)D – dacarbazine (DTIC).Possibly add radiotherapy.
64
Immunisations post splenectomy
Pneumovax (repeat every 5 years)Hib if not done in childhood Men C if not done in childhood Yearly flu
65
Contraindications for thrombolysis (STEMI)
AGAINSTAortic dissection GI bleeding Allergic reaction previously Iatrogenic (recent surgery)Neuro: cerebral neoplasm of CVA Hx Severe HTN (200/120)Trauma (including CPR)
66
Clopidogrel post MI: How long to continue post..STEMINSTEMI
STEMI with stenting: 12 months STEMI with medical management: 1 month NSTEMI: 12 months
67
1st line treatments of stable angina (in addition to GTN)
CCB or B blocker
68
2nd line treatments of stable angina
a long-acting nitrate orivabradine ornicorandil orranolazine.
69
Drugs causing lung fibrosis
BANS MEBleomycin/busulfanAmiodarone Nitrofurantoin Sulfasalazine MEthotrexate
70
Prednisolone dose following:Asthma exacerbation COPD exacerbation
40mg OD for at least 5 days 30mg OD for 7-14 days
71
Duration of treatment for Scarlet fever
10 days
72
Treatment of CMV retinitis
Oral valganciclovir if sight threatened add intravitreal injections of ganciclovir or foscarnet
73
Drug used for CMV prophylaxis in renal transplant
Valgancyclovir
74
Treatment of chronic hepatitis B
Nucleoside analogue (e.g. tenofovir) or interferon
75
Clinical features of cholera
Rice water stools Shock, acidosis, renal failure
76
Antibiotics most likely to cause C.diff
Clindamycin Ciprofloxacin Cephalosporins
77
Treatment of giardiasis
Tinidazole, metronidazole, or nitazoxanide
78
Treatment of amoebic dysentery
Metronidazole (800mg TDS) 5 days or 10 days if liver abscessTinidazole
79
Midodrine is used to treat
Orthostatic hypotension

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