Diseases and Conditions Flashcards
Osteoporosis management
- aims of treatment (1)
- classes of drugs (4)
- main or serious side effects for each
Aim: reduce risk of fragility fracture
Treatment:
. Calcium salts + Vit D (Colecalciferol)
- main ADR: hypercalcaemia (arrhythmias)
. Bisphophenates
- Serious ADR: atypical femoral fx, jaw osteonecrosis, EAM osteonecrosis
- other adv effects: oesophageal abnormalities, hypocalcaemia (spasms, cramping, seizures etc)
. (HRT)
- Serious ADR: inc. risk of thromboembolism/DVT
Diabetes I and II
- insulin-dependant:
routes (1), types of drugs (3) (and names), sources of drugs (3), particular characteristic (1) of these drugs that make insulin better suited for these patients; - Non insulin-dependant:
routes (1), types of drugs (5) (and names), side effects, tolerance/contra-indications, interactions, risks
. Insulin-dependant (most DM-I): Insulin injections (cannot be oral) - Short, Intermediate and Long acting
Insulin produced from Human (biosynthetic - E. Coli, Yeast - has altered DNA to change absorption); used to come from bovine and porcine sources
. Non-insulin-dependant (most DM-II): oral anti-diabetics
Lifestyle changes (diet, weight loss, exercise etc)
Oral antidiabetics require functioning beta cells
- Biguanides (Metformin - drug of choice)
- Sulphenylureas
- Glitazones (Pioglitazone - slow onset… months/year)
- Gliptins (Sita-, Saxa-, Vilda-, Lina-, Alo-)
- Acarbose (along with other antidiabetics, eg. metformin) delays digestion + absorption of starches
Biguanides: Metformin - (no weight gain -> weight loss);
. side effects: fewer hypo events (hypoglycaemia very rare); GIT disturbances; may cause lactic acidosis, esp. with patients with renal impairment - should not be taken, even if mild renal impairment
Sulphenalureas: Gli-/-(z)ide (Gliclazide, Glimepiride, Glipizide, Tolbutamine)
. side effects: hypoglycaemia (if too high dose), weight gain (inc. appetite), GI disturbances, skin allergies/rashes
(rarely: bone marrow damage)
. Interactions causing hypoglycaemia: alcohol, other antidiabetic drugs, some antibiotics and antifungals
. Other drugs may cause a decrease in effect
Glitazones risks: bone Fx, HF and bladder CA
side effects: weight gain, fluid retention
Glitpins side effects: GIT, rashes, infections, liver disease, back pain, joint pain
Risks of hypoglycaemia (less than sulphenalureas)
Acarbose side effects: GI disturbance
OA
- 1st line treatment for pain relief
. paracetamol 1st line (pain relief)
. NSAIDs if severe and ass. w. inflammation
inflammatory arthritides
- main drug classes used, and actions (3)
- names of drugs of the 3rd class
. NSAIDs (pain relief)
. steroids (inflammation control)
. Antibody therapies and other to suppress disease process (allow reduction of NSAIDs and steroids)
Examples:
. hydroxychloroquine (anti-malarial), Gold salts, penicillamine, sulphasalazine, methotrexate
Constipation
- 2 main aims of treatment, order of treatment
- drug families (4) (names)
- side effects
1- Diet, Fluid intake
2- Laxatives
. Pushers (stimulate motility) - Bulk Laxatives (husk) and Stimulant laxatives (Senna, Bisacodyl) ADRs: abd. cramps
. Softeners - Osmotic Laxatives (Lactulose; Docusate) ADRs (Lactulose): diarrhoea, teeth rotting, abd cramps, weight gain
Vomiting, Nausea
- types of neurotransmitters involved (4) and action
- types of drugs (3) (and names and main usage)
-
Antiemetics - receptor antagonists
Range of neurotransmitters involved
Histamine 1, Dopamine, 5HT3 (Serotonin), Ach
Examples:
H1RA: Cyclizine (motion sickness) - ADRs: drowsiness
D2RA: Domperidone, Metoclopramide - ADRs: dystonia, gynaecomastia, menstrual changes
5HT3: Ondansetron (used with cytotoxic drugs)
GORD, Dyspepsia, Ulceration
- types of drugs (3) (and names)
- causes (3 main)
- testing and treatments
- chances of recurrence
- side effects
1- Antacids (alkalis) - early stage GORD, Dyspepsia (Gaviscon)
2- PPIs (Omeprazole, Lanzoprazole… -zole)
3- H2RA (Ranitidine, Cimetidine, Famotidine, Nizatidine… -tidine)
can be due to long term use of NSAIDs and/or H. Pylori bacterial infection; alcohol/smoking/diet
- test for H. Pylori (breathing tests, faeces sample)
- eradicate H. Pylori (-> 2 AB + PPIs)
- Lifestyle: diet, stop smoking/alcohol
- relapse is common
- Bleeding = red flag
Side effects:
- antacids: burping (belching) due to CO2
- PPIs: GI disturbances, h/a, skin rash
- H2RAs: GI disturbances (diarrhoea), dizz, h/a
Pain relief
- types of drugs (4) and 1st line of use for each
- names
- side effects and how we mitigate them
- risks
Paracetamol (rare side effects) 1st line for single dose
NSAIDs
. Non-selective, incl. Aspirin (-> GIT Tract, bruising, bleeding) - must be taken with PPIs; e.g. ibuprofen, naproxen, diclofenac
. Selective COX-2 (- > no side effects, but inc. risk of MI) - ‘coxibs’ e.g. Celecoxib, Etoricoxib
Costicosteroids (-> Cushing’s, osteoporosis, diabetes)
. e.g. hydrocortisone, prednisolone (long-term disease supression), dexamethasone, beclomethasone (asthma)
Opioids (-> major adv effects: tolerance, dependence, respiratory depression, sedation and euphoria)
. e.g. morphine, diamorphine, codeine, pethidine, tramadol, fentanyl
Asthma
(and COPD, may co-exist)
- physiological changes (acute asthma, COPD)
- symptoms for each condition
- aim of treatment for each condition (drugs, non-drugs)
- drug types (3; symptoms and prevention) and used for…
(acute exacerbation, reduce inflammation, reduce mucus secretions)
- routes
- methods of diagnosis and monitoring for both conditions
- side effects
- Asthma management / therapies and dosage
Physiological changes:
. Asthma: inflammatory - several triggers (stress, allergens, exertion etc) - reversible airflow obstruction
. COPD: fixed, irreversible airflow obstruction (acute exacerbation symptoms may be reversible => bronchodilators) - exercise related stress (breathlessness) - main cause is smoking.
Diagnosis, Monitoring:
. Asthma - peak flow measurments; regular reviews
. COPD - Lung function tests
Goals:
. Asthma: control inflammation to reduce attacks; symptoms; treat attacks
. COPD: prevent further lung decline; control symptoms and attacks; smoking cessation, lung rehab, vaccination
Symptoms:
. Acute asthma attack: wheezing, coughing - inflammatory
. COPD: cough, breathlessness, exacerbations
Asthma Method:
1- Relievers: Blue inhaler (acute) beta2 adrenoreceptor AGONISTS (SABAs, LABAs)
2- Preventers: Brown inhaler (steroids - long-term to reduce airway inflammation and reduce exacerbations)
Other: acute + chronic asthma, and COPD
3- Anticholinergics (inhibit ParaSymp = reduce excessive bronchial secretions) - COPD
COPD:
1- acute symptoms (beta2 recep agonists)
2- prevention of exacerbations (steroids)
3- reduce mucus production: mucolytics, anticholinergics
4- other drugs: Roflumilast (target cells and mediators believed to be important in COPD)
Step-wise management therapy (from diagnosis to graded dosage of corticosteroid therapy)
1- Acute Asthma symptoms control (and COPD reversible)
. Beta2 adrenoreceptor agonists => bronchodilation, vasodilation (+/- inc. heart rate, visceral smooth muscle relaxation, glycogenolysis, muscle tremor)
. side effects: hypokalaemia (Na/K pump)
. Types:
- SABA (short acting beta agonists): salbutamol, terbutaline, fenoterol - for infants, attacks
- LABA (long acting beta agonists): salmeterol, formoterol - for maintenance (additional)
. By inhaled route (usually)
2- Corticosteroids - predominantly for asthma (COPD: if coexists and exacerbations); most important effect in asthma is inflammatory response reaction to allergens
E.g. Beclometasone d., Budesonide, Ciclesonide, Fluticasone p. , Mometasome f.
Prevention: inhaled
Acute reaction: oral
side effects: rare; oral thrush (candidiasis)
3- Anticholinergics: Ipratropium bromide, Tiotropium
side effects: constipation, dry mouth, cough, GI dist, h/a, sinusitis
Blood pressure (hypertension)
- physiology aims
- targeted organs (3) and drug families (p2,h2,k3)
- side effects of BB and ACE-I
due to increased peripheral resistance, increased blood volume (water/electrolytes) and increased heart activity
. Smooth muscles:
- Alpha blockers (vasodilation)
- Ca channel blockers (amlodipine) incl. coronary vessels
. Heart (Myocardium):
- Beta blockers (slows HR and contraction force)
- Ca channel blockers (varepamil, diltiazem)
. Kidneys:
- ACE inhibitors (decrease sodium reabsorption) (1st line when < 55’s) (e.g. Captopril, Ramipril, Enalapril etc)
- Diuretics (decrease fluid retention) e.g. Amiloride, Spironolactone
- ARBs: vasodilation
ACE inhibitors side effects: - first dose hypotension, postural hypotension - renal dysfunction - hyperkalaemia . COUGH (not present with ARBs)
Beta-blockers (beta2 - peripheral) side effects:
- bronchi dilatation (C.I. in asthma!)
- Constipation
- Cold extremities
Clotting/Thromboembolism/DVT
- classes, names of drugs (6); antidotes
- other uses
- main drug: side effects (3), interactions (2), contra-indications (7)
Blood thinners, anticoagulants
1- Heparin (hospitals) - IV or subcutaneous
2- Vit K inhibitors: Warfarin (community) - requires INR checks (levels must be between 2 and 3); (antidote: inc. Vit K)
3- newer: Factor Xa Inhibitors: Rivaroxaban, Apixaban (no need of INR monitoring) (Community) (no antidotes)
4- Aspirin: non-selective COX inhibitor - CVD prevention
5- Clopidogrel - CVD prevention
6- newer: Thrombin inhibitors: Dabigatran (antidote available)
Other uses: Warfarin: Atrial Fibrillations (risks of stroke)
Warfarin interactions: multiple
- diet rich in Vit K (green leafy vegetables)
- alcohol
Warfarin side effects: bruising, bleeding, blood too thin
Warfarin C.I.:
- pregnancy (change to heparin if planning to be pregnant)
- uncorrected or risks of major bleeding (ulcers, aneurysms etc)
- recent surgery
- recent stroke
- severe renal impairment
- severe liver impairment
- allergy/hypersensitivity to Warfarin
Heparin side effects: osteoporosis with long-term use
Bacterial infections
- prescription considerations:
Likely microbe, Patient’s, The drug
- Common classes (6), (action), names, usages, side effects, interactions
- Cochrane review on sore throat treated with AB
- Anti-microbial resistance
Antibiotics
Prescription considerations:
- The likely microbe to treat:
. culture, epidemiology, gram (+, -)
- The patient:
. ALLERGIES
. Females: PREGNANCY, breastfeeding, taking ORAL PILL
. Kidney, Liver impairment
. etc
- Antibiotic:
. Dose (age, weight, infection, severity, hep/renal function)
. Route (severity, access - e.g. paraenteral if vomiting)
. Duration (microbe and response)
e.g.: some UTI’s may need only 1 dose
e.g.: TB and osteomyelitis: need prolonged (months)
1- Beta-Lactams (-cillin)
. Oral: Penicillin, Amoxicillin, Ampicillin, Flucloxacillin
. IV/IM: Benzylpenicillin
. used for: respiratory and skin infections, incl. sepsis and meningitis, and h. pylori
. bacteria response: beta-lactamase inhibit beta-lactam
So need to prescribe clavulanic acid to fight back, with Amoxicillin in Co-Amoxiclav
. Side effects:
- Allergies: 10%
- Diarrhoeas: frequent
- Anaphylaxis: 0.05%
. Interactions:
- Oral Contraceptive: dec. contraceptive effect
- Gastric activity: dec. absorption of AB, of other drugs
“False allergy” (gastric discomfort?)
2- Cephalosporins (Cef-)
. 2nd/3rd gen: cefotaxime, ceftriaxone (meningitis)
. broad spectrum, similar to penicillin
. used for: septicaemia, pneumonia, meningitis, biliary-tract infections, peritonitis, UTIs… (i.e. internal, visceral, systemic)
. side effects: ALLERGIES (m/c); 0.5-6.5% of patients allergic to penicillin will be allergic to cephalosporins
3- Macrolides (-mycin)
Act on bacterial ribosomes
!!! Useful on patients with Allergy to Penicillin!
- erythromycin, clarithromycin, azithromycin
4- Metronidazole
Disrupt DNA; Anaerobic, Protozoa
. Used for: H. Pylori eradication, giardiasis, leg ulcers, bowel infections… (i.e. ulcerations and GIT)
. Interactions: Alcohol -> make you feel very ill: severe flushing, h/a, dizziness, nausea and vomiting, breathlessness, palpitations - avoid Alcohol for 48 hours!
5- Tetracyclines => Acne!
Bacterial ribosomes
. Doxycycline: also for gums, and anti-malarial
. C.I.: children < age 8
. side effects: bone and teeth discolouration
6- Chloramphenicol
. Broad spectrum
. Used in life-threatening infections
. Common usage: eye drops in conjuctivitis
. Rarely used orally (d/t bone marrow toxicity)
side effects (oral): anaemia (reversible); bone marrow damage (irreversible unless transplant)
Cochrane review:
. Sore throat - using AB only improves symptoms by 16 hours; NNTT Tonsillar abscess: 3000; Otitis Media: 200
=> judging risks vs. benefits
Anti-microbial resistance:
. Now also in community (used to be hospital only - MRSA); E. Coli
. Linked to overuse and inappropriate use
- not finishing course of AB
- overuse in livestock and fishing industries
- poor hygiene and sanitation
- lack of new AB being developped
Cholesterol
- most common drug families (and names)
- aims of treatment (outcome on LDL and CVD)
- side effects: classic, general and serious
- Interactions
- other drug types (2nd line; 2 types)
Statins
. Aim: reduce LDL by 40% (dose varies)
. 1st line (other: Fibrates; bile acid sequestrant resins)
. Classic side effects: myalgia, muscle cramp
Rhabdomyolysis, Myositis - rare, m/l to occur within first 3 months
. other side effects: h/a, GIT disturbances
. Interactions: other lipid lowering drugs; grapefruit
Common names:
atorvastatin
fluvastatin
lovastatin
pravastatin
pitavastatin
simvastatin
rosuvastatin
Allergies and Hypersensitivities
- drugs and routes
- side effects
Corticosteroids (oral, topical/inhalers)
Risk: addisionian crisis if withdrawn suddenly
Other risks: Cushing’s, osteoporosis, diabetes
Addison’s disease
(primary adrenals failure)
- drug family used (1)
- risks and side effects
Corticosteroids
Risk: addisionian crisis if withdrawn suddenly
Other risks: Cushing’s, osteoporosis, diabetes
