deck_6633276 Flashcards
Metformin: Drug classInsulin sensitiser or secretagogue MOA
BiguanideInsulin sensitiser Incompletely understood but:Decreases gluconeogenesis Increases peripheral glucose useDecreases LDL and VLDL
Key side effects of metformin
Lactic acidosis (care in renal failure and with contrast dye)GI upset
Pioglitazone:Drug classInsulin sensitiser or secretagogue MOA
ThiazolidinedioneInsulin sensitisation (peripheral) PPAR gamma ligand. PPAR is involved in glucose and lipid homeostasis.
Gliclazide Drug classInsulin sensitiser or secretagogue MOA
Sulphonylureas Insulin secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.
Repaglinide Drug classInsulin sensitiser or secretagogue MOA
Meglitinides Insulin Secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.
Key side effects on sulphonylureas
Hypos (can be prolonged) Weight gain GI upsetHeadache
Key side effect of pioglitazone
Weight gain Deranged LFTs/ hepatotoxicity Fluid retention May exacerbate heart failure
Key side effects of repaglinide
Hypoglycaemia (also very short acting)
ExenatideDrug classInsulin sensitiser or secretagogue MOA
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
Key side effects of exenatide
Hypoglycaemia GI upset (also needs to be given by subcut injection)
Sitagliptin
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
Key side effects of the DPP4 inhibitors
Hypoglycaemia GI upset
For exenatide to be continued long term initially there must be clear metabolic benefit demonstrated by…
Weight fall of at least 3% and HbA1c fall of at least 11mmol (1%)
Which oral hypoglycaemic should not be used with insulin
Pioglitazone
Stepwise treatment of COPD (inhaled therapies)
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.
Vaccinations to be offered to patients with COPD
Pneumococcal booster and annual influenza
When to use theophylline in COPD
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
When to use carbocisteine in COPD
Mucolytic drug therapy should be considered in patients with a chronic cough productive of sputum. They should not be used to prevent exacerbations.
When to start long term oxygen therapy in COPD
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
MRSA eradication
Mupirocin (nasal) and chlorhexidine wash.
Acute management of non-self limiting seizures (if no IV access)
Rectal diazepam 10mg. Repeated if necessary after 10-15 minutes.
Side effects of sulfasalazine due to the sulphapyridine moiety
Rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia
2nd Line pharmacological treatment of IBS
Low dose tricyclic
Summarise the symptomatic treatment of MS
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
Drugs that worsen mysasthenia gravis weakness
B blockersGentamicinPhenytoinMacrolides Tetracyclines Opiates
Acute treatment of cluster headaches
Sumatriptan subcut or nasal (NOT ORAL)100% oxygen
Prophylaxis of cluster headache
Verapamil or prednisolone
Side effects of sodium valproate
Appetite increase (and weight)Liver failure (monitor LFTs over first 6 months)PancreatitisReversible hair loss OedemaAtaxiaTertaogenicity, thrombocytopenia, tremorEncephalopathy
Initial treatment of cryptococcal meninigitis
Amphotericin B and flucytosineFollow up treatment with fluconazole If HIV infeected also optimise ARVs
Treatment of toxoplasmosis
Pyrimethamine, sulfadiazine, folate
First line options for treatment of neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin