Drug treatment Flashcards
What class of drugs are anti-thyroid drugs?
Thionamides
Name a thionamide
Carbimazole
Name a thyroid hormone
Levothyroixine
Name a somatostatin analogue
Octreotide
Name a dopamine agonist
Cabergoline
Name a GH agonist
Pegvisomant
Name an aldosterone agonist
Spironolactone
When would you give spironolactone in Conn’s syndrome?
4 weeks pre-op to control BP and K+
What do you replace aldosterone with in Addison’s?
Fludrocortisone
What do you replace cortisol with in Addison’s?
Hydrocortisone
How do you treat cranial DI?
Desmopressin
How do you treat nephrogenic DI?
Bendroflumethazide
Name a vasopressin receptor antagonist
Tolvaptan
What intake issues can lead to hypokalaemia?
Fasting
Anorexia
What intake issues can lead to hyperkalaemia?
Excessive consumption at a fast rate - IV fluids
What excretion issues can lead to hypokalaemia?
High secretion due to high aldosterone
What excretion issues can lead to hyperkalaemia?
Low secretion due to low aldosterone, ACEi, AKI
How does insulin cause hypo- and hyperkalaemia?
Excess insulin = too much K+ follows insulin into cell therefore hypokalaemia
Deficiency - not enough K+ follows into cell therefore hyperkalaemia
How does pH cause hypo- and hyperkalaemia?
Alkalosis - H+ out and K+ in therefore hypokalaemia
Acidosis - H+ in and K+ out therefore hyperkalaemia
How do B2 receptors lead to hypo- and hyperkalaemia?
B2 agonists increase B2 pumping of K+ into cell
B blocker - inhibits pumping of K+ into cell
How does cell lysis cause hyperkalaemia?
Intracellular condense released
What are the symptoms of hypokalaemia?
Everything slows
Constipation
Weakness/cramps
Arrhythmias and palpitations
What are the symptoms of hyperkalaemia?
Cramping
Weakness/flaccid paralysis due to over contraction of muscles and them becoming drained of energy
Arrhythmias and arrest
How does hypokalaemia look on an ECG?
U waves
No T waves/inversion
Long PR and long QT
How does hyperkalaemia present on an ECG?
Tall tented T waves
Small P waves
Wide QRS
How is non-urgent hyperkalaemia treated?
Polystyrene sulphonate resin
How is urgent hyperkalaemia treated?
Calcium gluconate
Insulin
How do you treat hypercalcaemia?
Rehydration
Bisphosphonates
Oral prednisolone
What are the cyanotic congential heart defects?
Tetralogy of Fallot
Truncus arteriosus - one single vessel from ventricles
TGA - transposition of great vessels
(Can only be fixed via surgery)
What are the acyanotic congenital heart defects?
PDA VSD ASVD Patent ductus arteriosus Valve disorders
What are the symptoms of congential heart defects?
Stunted growth in childhood Failure to thrive Finger clubbing Syncope Central cyanosis Pulmonary hypertension
What are the symptoms of aortic stenosis?
Angina
Loss of consiousness on exertion
HF marked by SOB
What are the signs and symptoms of aortic regurgitation?
Palpitations SOB on exertion Angina Water hammer pulse Murmur Quinke's sign - pulsating nail bed De Musset's sign - head nodding with heart beat
Mitral stenosis symptoms and signs
Progressive SOB Increased risk of vessel rupture marked haemoptysis AF Jugular vein pulsations Diastolic murmur
Signs and symptoms of mitral regurgitation
Dyspnoea on exertion
Fatigue
Symptoms of congestive HF
AF
Immediate management of MI
MNAC Morphine Nitrates Aspirin Clopidogrel
STEMI ECG changes
ST elevation
Tall T waves
Pathological Q waves
NSTEMI ECG changes
ST depression
T inversion
Atrial flutter ECG changes
Saw tooth
Treatment of tachycardias
Beta blockers - slow heart
Amiodarone controls rhythm
Aortic dissection symptoms
Tearing pain to back
Fast onset
Emergency - risk of bleeding out
Risk of hypovolaemic shock
Coarctation of aorta symptoms
Tearing pain to back Narrowing of aorta restricting carotid flow Fast onset Emergency Radio-femoral delay
Dilated cardiomyopathy causes
Alcohol
Ischaemia
Previous MI
Dilated LV leading to poor contraction of heart
Restricted cardiomyopathy causes
Idiopathic
Sarcoidosis
Rigid myocardium causes decreased ventricular volume
Hypertrophic cardiomyopathy causes
Autosomal dominant mutation of sarcomere genes
Impaired diastolic filling
Arrhythmogenic cardiomyopathy causes
Most likely genetic
RV replaced by fat causing inflammatory response
Cardiomyopathies presentation
Dyspnoea Fatigue HF Risk of sudden death Arryhthmia Thromboembolism
Pericarditis causes
Infections
- Viral - adenoviruses
- Bacterial - TB
- Fungal - only in immunosuppressed
Non-infectious
- Autoimmune - SLE, RA
- Metastatic cancer
- Iatrogenic - PCI, pacemaker, radiotherapy
- Direct trauma
Pericarditis presentation
Severe pleuritic, sharp chest pain Dyspnoea Hiccups due to phrenic involvement Fever Tachycardia Pulsus paradoxurus Pericardial effusion Cardiac tamponade
Pericarditis ECG
Saddle shaped ST elevation
PR depression
Causes of IE
IVDU (S aureus)
Poor dental hygiene (Strep viridans)
Congenital heart defects
Pseudomonas aeruginosa
IE presentation
Valve defect - characterised by murmur Clubbing Sepsis Embolism Osler's nodes Janeway lesions Splinter haemorrhages
Anaphylactic shock presentation
Swollen tongue/lips, hives Warm peripheries Tachycardia Hypotension Profound vasodilation
Septic shock presentation
Pyrexia Rigors Nausea and vomiting Vasodilation Bounding pulse Tachycardia Warm peripheries
Cardiogenic shock presentation
Galloping rhythm
Raised JVP
Signs of HF
Cardiogenic shock causes
When heart isn’t pumping properly
Cardiac tamponade
MI
PE
Fluid overload
Hypovolaemic shock presentation
Pallor, cold skin Drowsy Tachycardia Sweating Hypotension
Hypovolaemic shock causes
Loss of fluid
Major blood loss (haemorrhagic shock)
Vomiting and diarrhoea
Burns
Pancreatitis
Name an ACEi
Ramipril
Enalapril
Lisonipril
Main side effects of ACEi
Dry cough
Bradykinin rash
Hypotension
Anticoagulants
Aspirin - COX inhibitor, stops platelets sticking together
Warfarin - vit K antagonist, stops 1972 (requires strict monitoring of INR 2-3)
Apixaban - NOAC, doesn’t need INR monitoring so used in place of warfarin
ARBs
Candesartan
Antiarrhythmics
S/E
Amiodarone
QT prolongation which can be fatal
Beta blockers
Bisoprolol
Propranolol
Metoprolol
Atenolol
Main S/E of beta blockers
Headache
Fatigue
Bradycardia
When are beta blockers CI?
Asthma
Diuretics
Bendroflumethiazide - acts on distal convoluted tubule
Furosemide - loop
Antiplatelets
Clopidogrel
P2Y12 inhibitor, stops platelets activating and sticking to endothelium
CCBs
Amlodipine
Diltiazem
Nifedipine
Main side effects of CCBs
Flushing
Headache
Bradycardia
What differentiates AML?
Myeloblasts
Most common in adults (40+)
Gum hypertrophy
Auer rods on bone marrow biopsy
What differentiates ALL?
Lymphoblasts Children 2-4 Associated with Down's syndrome CNS involvement SVC obstruction - red face, dilated superficial chest veins Treated with intrathecal drugs
What differentiates CML?
Neutrophils, basophils, eosinophils, macrophages 40-60 Massive hepatosplenomegaly Philadelphia chromosome Treated with tyrosine kinase inhibitor
What differentiates CLL?
B cells Most common leukaemia 70+ In those with low immunity and long term immunosuppression Often asymptomatic Enlarged, rubbery non-tender nodes FBC - high WCC with high lymphocytes Blood film - small mature lymphocytes
Multiple myeloma
Plasma cells 75+ CRAB - hypercalaemia (> 2.75 mmol/L) AKI, constipation, renal impairment, anaemia, bone lesions (pepperpot skull) Persistently high ESR Rouleaux formation Serum and/or urine electrophoresis Bence Jones protein Bisphosphonate treatment
Lymphoma
T and B cells in lymph nodes
Hodgkin’s lymphoma
Bimodal CXR - wide mediastinum Reed sternberg cells Chemotherapy Autologous marrow transplant
Non-Hodgkin’s lymphoma
GI and skin involvement
Steroids
Adults 40+
Monoclonal antibodies to CD20 (rituximab)
Ann Arbor staging
I - confined to single lymph node region
II - involvement of two or more nodal areas on the same side of diaphragm
III - involvement of nodes on both sides of diaphragm
IV - spread beyond the lymph nodes eg liver and bone marrow
A - no systemic symtoms
B - systemic B symptoms
Side effects of chemo
Constipation/diarrhoea Cytopaenia (anaemia, neutropaenia, thrombocytopaenia) Alopecia Secondary malignancies Nausea Infertility
Acute sickle cell disease
Painful crises
Sickle chest syndrome
CVA
Chronic sickle cell disease
Renal impairment
Pulmonary hypertension
Joint damage
Management of sickle cell
Hydroxyurea
Transfusions
Stem cell transplant
Secondary polycythaemia
Low FiO2
High EPO
Smoking
Lung disease
Polycythaemia presentation
Red face
Thrombosis
Itching
Splenomegaly
ITP tests and treatment
Increase megakaryocytes in marrow
Antiplatelet antibodies often present
Low platelet count
Immunosuppression - steroids/IV immunoglobulin
TTP
ADAMTS13
Microangiopathic haemolytic anaemia Decrease platelets AKI Neurological symptoms Fever Schistocytes
Urgent plasma exchange replenishing ADAMTS13
Symptoms of iron deficiency
Koilonychia
Angular stomatitis
Atrophic glossitis
Brittle hair and nails
Voiding symptoms
SHED Stream changes Hesitancy Emptying incomplete Dribbling
Storage symptoms
FUND Frequency Urgency Nocturia Dysuria
Alpha blockers
Relax smooth muscle improving flow symptoms (only improves symptoms)
Tamsulosin
Alfuzosin
Doxazosin
Orthostatic
Hypotension
Ejaculation dysfunction
5-alpha reductase inhibitors
Finasteride
Gynaecomastia
Sexual dysfunction
Low mood
Also prevent disease progression
Androgen deprivation therapy
For prostate cancer
GnRH agonists (suppress GnRH and LH production) and anti-androgen
Urinary tract malignancy
Painless haematuria - bladder cancer
Haematuria + loin pain - renal cell carcinoma/stones
Testicle lump +/- pain - testicular tumour (seminom)
Renal cell carcinoma
BP increased due to increased renin secretion
FBC increased erythropoietin
CT, MRI
CXR - cannon ball mets
Bladder cancer
T1 - TURBT
T2/3 radical cystectomy
T4 palliative +/- chemotherapy/radiotherapy
