Drugs Flashcards
Donepazil MOA in dementia
Prevents breakdown of acetylycholine by inhibiting acetylcholinesterase
Increased acetylcholine helps neurons communicate better, improving cognitive symptoms in dementia
CI donepazil
Heart problems: bradycardia, SVT, sick sinus syndrome, heart block, unexplained syncope and concurrent drugs that reduce heart rate (because donepazil causes bradycardia and AV block)
Lung problems: Asthma/ COPD
Peptic Ulcers
Drugs used to treat idiopathic pulmonary fibrosis
Prifenidone - antiforbritic used as regular medication
Bleomycin - chemotherapy for acute exacerbations
Corticosteroids - acute exacerbations
What is the life-threatening complication of carbimazole?
What should you make patients aware of?
Bone marrow suppression (neutropenia)
Can occur at any stage of treatment, must immediately report symptoms of infection, including sore throat, mouth ulcers, bruising, fever, malaise or illness (you must get a FBC)
Which drug can cause kernicterus (bilirubin in brain) if given in the third trimester?
Aspirin - imapairs platelet function in fetus and causes haemorrhage
Levels of which asthmatic drug increase on smoking ceassation?
Why is this dangerous?
How is this managed on smoking ceassation?
Theophylline (smoking induced the enzyme that metobilises it)
Causes fatal arrythmias
Close blood monitoring of theophylline levels for several weeks after ceassation until steady state level reached- will need to reduce theophyline dose by 1/ 4 to 1/3
This class of anti-hypertensives is CI in gout
Thiazides
This anti-hypertensive is contra-indicated in urinary incontinence
Doxazosin
Which diuretics should be used in caution in asthmatics
BB
NSAIDS can do what to platelets?
Cause immune-mediated thrombocytopenia
Calcium channel blockers are contra-indicated in who?
Heart failure
Prior MI
Before prescribing enoxaparin which two lab values should be checked?
Platelets - under 50, reduce dose
Creatinine clearance - under 30, review dose
List three dopamine antagonists
Haloperidol
Metoclopramide
Prochlorperazine
Which class of drugs are contra-indicated in Parkinson’s?
List 3 examples
Dopamine antagonists
Metoclopramide
Promethazine
Prochlorperazine
Loop diuretics are toxic to which sensory organ?
Ears - cause tinnitus and hearing loss
Ciprofloxacin makes you more likely to develop this infection
C.diff
Which antibiotics are ototoxic?
List examples
Macrolides - azithromycin, clarithromycin, erythromicin
Aminoglycosides - gentamicin
NSAIDS SE
Ototoxic
COCP makes which 2 drugs less effective
Lisinopril
Warfarin
Which 2 drugs make the pill less effective
Rifampicin (and other rifamycins)
Carbamazepine
BB SE
Impotence
Wheeze
Fatigue
Worsening asthma
Amioderone SEs
Sun-sensitivity
Grey-blue skin
Pulmonary toxicity - fibrosis/ pneumonitis
Thyroid dysfunction (hypo and hyper thyroidism)
Abnormal LFTs
Corneal microdeposits
Which common drugs reduce the absorption of levothyroxine?
How do we prevent this?
Ferrous fumarate and antacids
Take at least 4 hours apart
Which drugs need serum monitoring?
Theophylline - needs to check levels are within the therapeutic window 5 days after commencing, and 3 days after any dose adjustment
What can PPIs cause a false negative result of and how is this prevented?
False negative H.pylori test
Stop PPIs for 2 weeks before checking for H.pylori
Which 5 drugs should patients be started on after an acute MI
ACEi
BB
2 antiplatelets: aspirin, clopidogrel, ticagrelor
Statins
Describe how you would monitor a patient on azthioprine and why
- On starting, FBC every week for 4 weeks
- Thereafter, FBC every 3 months
- Causes myelosuppression (bone marrow suppression/ pancytopenia)
Describe how you would monitor a patient on methotrexate and why
Weekly blood test until therapy stabilises
3 monthly FBC, LFTs and UEs
Causes myelosuppression, hepatotoxicity
Describe amioderone monitoring before and during treatment
LFTS and TFTs and CXR before treatment
LFTs and TFTs every 6 months during treatment
SEs amioderone?
Liver dysfunction
Thyroid dysfunction
Respiratory disease
Skin reactions
Describe lithium monitoring before starting treatment
UEs
FBCs
TFTs
ECG
Describe lithium monitoring during treatment
UEs - 3m
TFTS - 6m
Lithium levels - 3m
Treatment of first presentation Chron’s
Prednisolone
What are the 4 classes of stable angina management?
Describe the medical management
Lifestyle
Medications:
- beta blockers or calcium channel blocker are first line (second line is both)
- has to be either amlodipine or modified-release nifidipine/ felodipine - because these are long acting and if you take a BB with a CCB you can get bradycardia)
- aspirin
- statin
- GTN
PCI
Surgery
Which calcium channel blocker must never be given with a beta blocker?
Diltiazem can never be given with a beta blocker - can cause life threatening bradycardia and heart failure
List who cannot have aspirin
Children under 12- reye syndrome
Breast-feeding mothers
Severe liver impairment - increases bleeding Asthma - can exacerbate symptoms
Isosorbide mononitrate should not be used with this drug … because …
Sidenafil (viagra) - causes cardiovascular collapse
When a patient is on methotrexate, what must they be counselled to report and why?
Symptoms of liver, lung and bone marrow failure
- Nausea, vomiting, abdominal discomfort, dark urine, stomatitis
- SOB
- Sore throat, bruising, mouth ulcers
- If have any, need to stop treatment
SE of methotrexate
Photosensitivity
Bone marrow suppression: low WCC/ platelets/ RBC (sore throat, bruising, mouth ulcers)
Liver cirrhosis
Pulmonary toxicity: SOB, cough, fever
Which classes of drugs should not be taken with methotrexate?
Anti-folates like trimethoprim
Mefloquine is associated with which group of symptoms?
Neuropsychiatric:
Psychosis
Hallucinations
Panic attacks
Convulsions
Loop diuretic side effects
Hyperglycemia - be aware in diabetics
Hypokaleamia
SS digoxin toxicity
Reduced appetite
Nausea
Vomiting
Confusion
Change in yellow-green colour perception
Blurred vision
Fatigue
Arrythmia
Lithium side effects and how are they managed
Hypothyroidism - which is why TFTs need to be checked before treatment and every 6m on the treatment
Weight gain
Acne
Tremor
Leukocytosis
Polydipsia - nephrogenic diabetes insipidus
Polyuria - nephrogenic diabetes insipidus
Ankle oedema
Weight gain
Metallic taste in mouth
Renal toxicity - check UEs before and 3 months during treatment
Lithium has a narrow therapeutic window so levels need to be checked every 3 months routinely and 5 days after a dose change or on signs of toxicity
Metoclopramide
Oculogyric Crisis - a rare neurological condition that causes the eyes to move involuntarily and remain fixed in a position, usually upwards, can last from seconds to hours
Dystonia - involuntary contractions causing abnormal postures
Most common in young girls/ women and elderly
Remember do not give dopamine blockers to patients with parkinsonism
POP CI
Acute porphyria
Severe arterial disease
Undiagnosed vaginal bleeding
COCP CI
PE/ DVT/ CVA
HD
HF
HTN
Liver disease
Migraines
Cancer
Hx of breast cancer
Diabetes
Over 35 and smokes
Breast feeding/ post partum
Vascular disease
Why is aspirin CI in patients with liver disease?
All NSAIDS are CI in liver disease - make it worse
First line treatment of absence seizures
Ethosuximibe - women and girls mof childbearing age
Men - ethosuzimibe or sodium valproate
Verapamil is a calcium channel blocker which must never be given with class of anti-hypertensives?
Why?
Beta blockers - asystole, severe hypotension and heart failure
Teratogenic drugs
Carbimazole
Sumatriptan CI
ischaemic heart disease - MOA is vasoconstriction
Accutane/ Isotretinoin monitoring and why
How can this be ensured?
Highly teratogenic
Must confirm not preg 3 days before starting treatment
Check not pregnant every month on treatment
Check not pregnant 5 weeks after stopping treatment
Can only give 30 pills at a time - repeat/ fax prescriptions not allowed and must be dispensed within 7 days
On accutane how long do you have to be on contraception
What should you advise re/ contraceptive choice
Start one month before starting treatment, stop one month after stopping treatment
Use 2 contraceptive methods
Progesterone only methods are not effective
Also advise women if become pregnant on isotretinoin or 1 month after stopping it - seek medical advice
which class of antibiotics should be avoided in kidney failure and which drug is the exception
Tetracyclines - they raise urea levels, cause nephrons to die and cause salt and water excretion
Exception - doxycycline
Apart from the tetracyclines, which antibiotic should be avoided in kidney failure?
nitrofurantoin - prone to reach toxic levels, in kidney failure this occurs more readily so can develop toxic side effects like peripheral neuropathy
