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Phase 2a medicine > Drug treatment > Flashcards

Drug treatment Flashcards

1
Q

What class of drugs are anti-thyroid drugs?

A

Thionamides

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2
Q

Name a thionamide

A

Carbimazole

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3
Q

Name a thyroid hormone

A

Levothyroixine

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4
Q

Name a somatostatin analogue

A

Octreotide

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5
Q

Name a dopamine agonist

A

Cabergoline

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6
Q

Name a GH agonist

A

Pegvisomant

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7
Q

Name an aldosterone agonist

A

Spironolactone

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8
Q

When would you give spironolactone in Conn’s syndrome?

A

4 weeks pre-op to control BP and K+

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9
Q

What do you replace aldosterone with in Addison’s?

A

Fludrocortisone

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10
Q

What do you replace cortisol with in Addison’s?

A

Hydrocortisone

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11
Q

How do you treat cranial DI?

A

Desmopressin

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12
Q

How do you treat nephrogenic DI?

A

Bendroflumethazide

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13
Q

Name a vasopressin receptor antagonist

A

Tolvaptan

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14
Q

What intake issues can lead to hypokalaemia?

A

Fasting

Anorexia

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15
Q

What intake issues can lead to hyperkalaemia?

A

Excessive consumption at a fast rate - IV fluids

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16
Q

What excretion issues can lead to hypokalaemia?

A

High secretion due to high aldosterone

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17
Q

What excretion issues can lead to hyperkalaemia?

A

Low secretion due to low aldosterone, ACEi, AKI

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18
Q

How does insulin cause hypo- and hyperkalaemia?

A

Excess insulin = too much K+ follows insulin into cell therefore hypokalaemia

Deficiency - not enough K+ follows into cell therefore hyperkalaemia

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19
Q

How does pH cause hypo- and hyperkalaemia?

A

Alkalosis - H+ out and K+ in therefore hypokalaemia

Acidosis - H+ in and K+ out therefore hyperkalaemia

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20
Q

How do B2 receptors lead to hypo- and hyperkalaemia?

A

B2 agonists increase B2 pumping of K+ into cell

B blocker - inhibits pumping of K+ into cell

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21
Q

How does cell lysis cause hyperkalaemia?

A

Intracellular condense released

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22
Q

What are the symptoms of hypokalaemia?

A

Everything slows
Constipation
Weakness/cramps
Arrhythmias and palpitations

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23
Q

What are the symptoms of hyperkalaemia?

A

Cramping
Weakness/flaccid paralysis due to over contraction of muscles and them becoming drained of energy
Arrhythmias and arrest

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24
Q

How does hypokalaemia look on an ECG?

A

U waves
No T waves/inversion
Long PR and long QT

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25
Q

How does hyperkalaemia present on an ECG?

A

Tall tented T waves
Small P waves
Wide QRS

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26
Q

How is non-urgent hyperkalaemia treated?

A

Polystyrene sulphonate resin

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27
Q

How is urgent hyperkalaemia treated?

A

Calcium gluconate

Insulin

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28
Q

How do you treat hypercalcaemia?

A

Rehydration
Bisphosphonates
Oral prednisolone

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29
Q

What are the cyanotic congential heart defects?

A

Tetralogy of Fallot
Truncus arteriosus - one single vessel from ventricles
TGA - transposition of great vessels
(Can only be fixed via surgery)

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30
Q

What are the acyanotic congenital heart defects?

A 
PDA
VSD
ASVD
Patent ductus arteriosus
Valve disorders
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31
Q

What are the symptoms of congential heart defects?

A 
Stunted growth in childhood
Failure to thrive
Finger clubbing
Syncope
Central cyanosis
Pulmonary hypertension
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32
Q

What are the symptoms of aortic stenosis?

A

Angina
Loss of consiousness on exertion
HF marked by SOB

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33
Q

What are the signs and symptoms of aortic regurgitation?

A 
Palpitations
SOB on exertion
Angina
Water hammer pulse
Murmur
Quinke's sign - pulsating nail bed
De Musset's sign - head nodding with heart beat
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34
Q

Mitral stenosis symptoms and signs

A 
Progressive SOB
Increased risk of vessel rupture marked haemoptysis
AF
Jugular vein pulsations
Diastolic murmur
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35
Q

Signs and symptoms of mitral regurgitation

A

Dyspnoea on exertion
Fatigue
Symptoms of congestive HF
AF

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36
Q

Immediate management of MI

A 
MNAC
Morphine
Nitrates
Aspirin
Clopidogrel
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37
Q

STEMI ECG changes

A

ST elevation
Tall T waves
Pathological Q waves

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38
Q

NSTEMI ECG changes

A

ST depression

T inversion

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39
Q

Atrial flutter ECG changes

A

Saw tooth

40
Q

Treatment of tachycardias

A

Beta blockers - slow heart

Amiodarone controls rhythm

41
Q

Aortic dissection symptoms

A

Tearing pain to back
Fast onset
Emergency - risk of bleeding out
Risk of hypovolaemic shock

42
Q

Coarctation of aorta symptoms

A 
Tearing pain to back
Narrowing of aorta restricting carotid flow
Fast onset
Emergency
Radio-femoral delay
43
Q

Dilated cardiomyopathy causes

A

Alcohol
Ischaemia
Previous MI

Dilated LV leading to poor contraction of heart

44
Q

Restricted cardiomyopathy causes

A

Idiopathic
Sarcoidosis

Rigid myocardium causes decreased ventricular volume

45
Q

Hypertrophic cardiomyopathy causes

A

Autosomal dominant mutation of sarcomere genes

Impaired diastolic filling

46
Q

Arrhythmogenic cardiomyopathy causes

A

Most likely genetic

RV replaced by fat causing inflammatory response

47
Q

Cardiomyopathies presentation

A 
Dyspnoea
Fatigue
HF
Risk of sudden death
Arryhthmia
Thromboembolism
48
Q

Pericarditis causes

A

Infections

  • Viral - adenoviruses
  • Bacterial - TB
  • Fungal - only in immunosuppressed

Non-infectious

  • Autoimmune - SLE, RA
  • Metastatic cancer
  • Iatrogenic - PCI, pacemaker, radiotherapy
  • Direct trauma
49
Q

Pericarditis presentation

A 
Severe pleuritic, sharp chest pain
Dyspnoea
Hiccups due to phrenic involvement
Fever
Tachycardia
Pulsus paradoxurus 
Pericardial effusion
Cardiac tamponade
50
Q

Pericarditis ECG

A

Saddle shaped ST elevation

PR depression

51
Q

Causes of IE

A

IVDU (S aureus)
Poor dental hygiene (Strep viridans)
Congenital heart defects
Pseudomonas aeruginosa

52
Q

IE presentation

A 
Valve defect - characterised by murmur
Clubbing
Sepsis
Embolism
Osler's nodes
Janeway lesions
Splinter haemorrhages
53
Q

Anaphylactic shock presentation

A 
Swollen tongue/lips, hives
Warm peripheries
Tachycardia
Hypotension
Profound vasodilation
54
Q

Septic shock presentation

A 
Pyrexia
Rigors
Nausea and vomiting
Vasodilation
Bounding pulse
Tachycardia
Warm peripheries
55
Q

Cardiogenic shock presentation

A

Galloping rhythm
Raised JVP
Signs of HF

56
Q

Cardiogenic shock causes

A

When heart isn’t pumping properly

Cardiac tamponade
MI
PE
Fluid overload

57
Q

Hypovolaemic shock presentation

A 
Pallor, cold skin
Drowsy
Tachycardia
Sweating
Hypotension
58
Q

Hypovolaemic shock causes

A

Loss of fluid

Major blood loss (haemorrhagic shock)
Vomiting and diarrhoea
Burns
Pancreatitis

59
Q

Name an ACEi

A

Ramipril
Enalapril
Lisonipril

60
Q

Main side effects of ACEi

A

Dry cough
Bradykinin rash
Hypotension

61
Q

Anticoagulants

A

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

62
Q

ARBs

A

Candesartan

63
Q

Antiarrhythmics

S/E

A

Amiodarone

QT prolongation which can be fatal

64
Q

Beta blockers

A

Bisoprolol
Propranolol
Metoprolol
Atenolol

65
Q

Main S/E of beta blockers

A

Headache
Fatigue
Bradycardia

66
Q

When are beta blockers CI?

A

Asthma

67
Q

Diuretics

A

Bendroflumethiazide - acts on distal convoluted tubule

Furosemide - loop

68
Q

Antiplatelets

A

Clopidogrel

P2Y12 inhibitor, stops platelets activating and sticking to endothelium

69
Q

CCBs

A

Amlodipine
Diltiazem
Nifedipine

70
Q

Main side effects of CCBs

A

Flushing
Headache
Bradycardia

71
Q

What differentiates AML?

A

Myeloblasts
Most common in adults (40+)
Gum hypertrophy
Auer rods on bone marrow biopsy

72
Q

What differentiates ALL?

A 
Lymphoblasts
Children 2-4
Associated with Down's syndrome
CNS involvement
SVC obstruction - red face, dilated superficial chest veins
Treated with intrathecal drugs
73
Q

What differentiates CML?

A 
Neutrophils, basophils, eosinophils, macrophages
40-60
Massive hepatosplenomegaly
Philadelphia chromosome
Treated with tyrosine kinase inhibitor
74
Q

What differentiates CLL?

A 
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
75
Q

Multiple myeloma

A 
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
76
Q

Lymphoma

A

T and B cells in lymph nodes

77
Q

Hodgkin’s lymphoma

A 
Bimodal
CXR - wide mediastinum
Reed sternberg cells
Chemotherapy
Autologous marrow transplant
78
Q

Non-Hodgkin’s lymphoma

A

GI and skin involvement
Steroids
Adults 40+
Monoclonal antibodies to CD20 (rituximab)

79
Q

Ann Arbor staging

A

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

80
Q

Side effects of chemo

A 
Constipation/diarrhoea
Cytopaenia (anaemia, neutropaenia, thrombocytopaenia)
Alopecia
Secondary malignancies
Nausea
Infertility
81
Q

Acute sickle cell disease

A

Painful crises
Sickle chest syndrome
CVA

82
Q

Chronic sickle cell disease

A

Renal impairment
Pulmonary hypertension
Joint damage

83
Q

Management of sickle cell

A

Hydroxyurea
Transfusions
Stem cell transplant

84
Q

Secondary polycythaemia

A

Low FiO2
High EPO
Smoking
Lung disease

85
Q

Polycythaemia presentation

A

Red face
Thrombosis
Itching
Splenomegaly

86
Q

ITP tests and treatment

A

Increase megakaryocytes in marrow
Antiplatelet antibodies often present
Low platelet count

Immunosuppression - steroids/IV immunoglobulin

87
Q

TTP

A

ADAMTS13

Microangiopathic haemolytic anaemia
Decrease platelets
AKI
Neurological symptoms
Fever
Schistocytes

Urgent plasma exchange replenishing ADAMTS13

88
Q

Symptoms of iron deficiency

A

Koilonychia
Angular stomatitis
Atrophic glossitis
Brittle hair and nails

89
Q

Voiding symptoms

A 
SHED
Stream changes
Hesitancy
Emptying incomplete
Dribbling
90
Q

Storage symptoms

A 
FUND
Frequency
Urgency
Nocturia
Dysuria
91
Q

Alpha blockers

A

Relax smooth muscle improving flow symptoms (only improves symptoms)

Tamsulosin
Alfuzosin
Doxazosin

Orthostatic
Hypotension
Ejaculation dysfunction

92
Q

5-alpha reductase inhibitors

A

Finasteride

Gynaecomastia
Sexual dysfunction
Low mood

Also prevent disease progression

93
Q

Androgen deprivation therapy

A

For prostate cancer

GnRH agonists (suppress GnRH and LH production) and anti-androgen

94
Q

Urinary tract malignancy

A

Painless haematuria - bladder cancer
Haematuria + loin pain - renal cell carcinoma/stones
Testicle lump +/- pain - testicular tumour (seminom)

95
Q

Renal cell carcinoma

A

BP increased due to increased renin secretion
FBC increased erythropoietin
CT, MRI
CXR - cannon ball mets

96
Q

Bladder cancer

A

T1 - TURBT
T2/3 radical cystectomy
T4 palliative +/- chemotherapy/radiotherapy

Phase 2a medicine (13 decks)

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