Drugs Flashcards
Salbutamol
Used for asthma + obstruction
Not for prem labour, preg complications, pulmonary htn and MI risk/heart disease
Hypokalaemia with corticosteroids, diuretics, hypoxia
Can get arrhythmia, headache, nausea, muscle cramps
Ok to breast feed
Gauifenesin or glyceryl guaiacolate
Expectorants for over 6s
Phosphodiesterase inhibitors
Avanafil, sidenafil tadanavil
- erectile dysfunction
Can give low bp, headaches, vasodilation. Not for sickle cell anaemia
Side- pulmonary arterial htn treated too
Tada- also treats bph
Phosphodiesterase inhibitors
Roflumilast
Anti inflammatory and helps with bronchodilators for severe copd and chronic bronchitis
X with cancer immunosuppressant, depression, breastfeeding, pregnancy,hepatic impairment.
Side effects dec appetite, gi issues, headache, insomnia, weight loss
Also theophylline is similar takes p450
Leukotriene receptor antagonists
Adjunct prophylaxis for chronic asthma or symptom management of seasonal allergic rhinitis in those with asthma
Eg ipratropium
In general side effects: diarrhoea, fever, gi discomfort, headache, nausea, skin reaction, upper rti and vomiting. Not for pregnancy nor breastfeeding. Take with food
Ipratropium
Muscarinic antagonist and and anticholinergic
For asthma
Ipratropium bromide 4 asthma and copd.
Don’t give ipratropium with ipratropium bromide
Side effects arrhythmia, constipation, cough, dizzy, dry mouth, headache, nausea
Digoxin
Cardiac glycoside for arrhythmia + symptoms of heart failure
Don’t give with hypomagnesia and Hypokalaemia
For afib flutter and heart failure- increases contraction and reduces conductivity
Half the dose ig with amiodarone, dronedarone, quinine
Risk of hypercalcaemia
Stop in elderly if not improving
Side effects: arrhythmia, cardiac conduction disorder, cerebral impairment, diarrhoea, dizziness, eosinophilia, nausea, skin reaction, visual disturbance, vomiting
Calcium channel blockers: dihydropyridines
Amlodipine, nifedipine, nimodipine
Lowers blood pressure and vascular relaxation
Amylodipine x give W/ heart failure bc can depress cardiac function and increase mortality after MI for left vent + pulmonary congestion
Nifedipine relaxes vascular smooth muscle + dilates coronary and peripheral arteries. More artery focus and doesn’t risk heart failure
Nimodipine prefers cerebral arteries and is used to prevent and treat vascular spasm following aneurysmal subarachnoid haemorrhage
Calcium channel blockers:
Non dihydropyridines
Verapamil hydrochloride, Diltiazem hydrochloride
Lowers blood pressure and vascular relaxation
Verapamil hydrochloride for angina, htn, arrhythmia, x use with beta blockers- can give hypotension and commonly constipation
Diltiazem hydrochloride for most anginas and htn. If betas don’t work. Risk bradycardia
Thiazide diuretics
Inc filtration and flow and dec htn. Inhibits na-cl cotransporter of dct. Relieve oedema from chronic heart failure and in lower doses for reduced blood pressure
Aldosterone antagonist spironolactone potentiates thiazides and loops eg with furosemide
Acts 1-2hrs in, give early in the day so doesn’t affect sleep
Bendroflumethiazide for mild-moderate heart failure
Chlortalidone and indapamide are preferred for htn
Indapamide makes vasodilation
Risk of Hypokalaemia with diuretics
Risk encephalopathy if had alcoholic cirrhosis
X with addisons, hyperkalaemia, hearing loss
Be careful with diabetes mellitus, hyperaldosteronism, malnourishment, nephrotic syndrome, systemic lupus erythematus
Indapamide is better with Dm
Metolazone is good alongside loops but risk of diuresis
Chlortalidone can be used for cirrhosis ascites if stable or nephrotic oedema for htn or heart failure or diabetes insipidus
Loop diuretics
Used in pulmonary oedema due to left ventricular failure. Also chronic heart failure. Loops affect pct na-cl channels
Can make diabetes worse
Furosemide and bumetanide act within 1hr and takes 6hrs.
For diuretic resistant pulmonary oedema- but not lymph or venous statis or ca blockers- should use tocasemide. Can also use for htn
K+ sparing diuretics
Work with na reabsorption in collecting duct.
Amiloride hydrochloride and triamterene cause retention if potassium and used as an adjunct for resistant cases. Wi k supps ace or arbs leads to hyperkalaemia
Aldosterone antagonist spironolactone
Aldosterone antagonist spironolactone potentiates thiazides and loops eg with furosemide. Good for oedema and cirrhosic ascites and primary hyper aldosteronism /conns syndrome before surgery
Mannitol
Osmotic diuretic for cerebral oedema and inc intraoccular pressure
Fluconazole
For candida balanitis/vaginitis or oropharynx (1 day vs 1-2wks)
Also for tinea pedis, corporis (ringworm), pityriasis versicolour, dermal candidiasis
Don’t give with acute porphyrias
Gi reactions and rash common. X for pregnancy or liver impairment
Can also use ketoconazole transdermally
Angiotensin converting enzyme/ ACE inhibitors
Heart meds to dialate vessels for flow and pressure
X for history of angioedema, diuretics, dialysis, atherosclerosis - risk of Reno vascular disease
Not for elderly with postural drop or hyperkal
Not with dialysis due to anaphylaxis
Can get alopecia, angina, arrhythmia, GI issues, myalgia, dry cough, headache, rash
X for pregnancy
Enalapril, lisinopril, perinaopril
Ramipril also used for prophylaxis after MI
Don’t give w aliskiren/diabetes for gi upset risk of infection and muscle spazm
Angiotensin receptor blockers ARBs
Heart meds to dialate vessels for flow and pressure
Given if aces show side effects.
Possible side effects here = dizziness, headache, cold symptoms.
Includes candesartan, Losartan
Candesartan for htn, heart failure, preventing future strokes, heart attacks, kidney issues. 2nd choice.
X if had diarrhoea or vomiting, kidney transplant, low salt diet, diabetes, liver issues, hypotension, pregnant/trying or breastfeeding.
Not to be used with aspirin, heparin, ibuprofen, celecoxib, diuretics, lithium, spironolactone
Alpha blockers
Competitive for symp activity/ nerves on blood vessels. Some are non competitive- phenoxybenzamine = prolonged action. Makes vasodilation for arteries and veins. Even works for pheochromocytoma. 1st line for htn terazosin and doxazosin
Doxazosin- for htn bph. Be careful with syncope posture or micturition, cataract surgery, pulmonary oedema or heart failure
Side effects- arrhythmia, cough, drowsy, cystitis, gi issues, vertigo and skin reactions
X for breastfeeding
Methotrexate
For DMARD inflammation and cancer chemotherapy. For crohns, rheumatoid arthritis and severe psoriasis.
X give with photosensitivity, dehydration, diarrhoea.
Bone marrow suppression and stomatitis can occur.
Side effects if intrathecal- necrotising demyelinating leukoencephalopathy, neurotoxicity. Orally- anemia, diarrhoea, headache, inc risk of infection
Folic acid can reduce side effects. Not safe for pregnancy nor breastfeeding.
Sodium picosulphate
Stimulant laxative with magnesium citrate increases stool vis inhibit water absorption and activating peristalsis
X give with intestinal obstruction
Can cause diarrhoea, nausea/vomiting
Misoprostol
Synthetic prostaglandin analogue for less secretion of gi and duodenal ulcers. Also uterine stimulant for abortion at 9 weeks after initial dose of mifepristone 24hrs before Can induce labour topically For benign gastric or duodenal ulcer X with cardiovascular disease Can give nausea, rash, vomiting Don’t use if breastfeeding Contraceptive ok
Odansetron
5ht3 R antagonist for Gi and cns nausea/vomiting, eg via chemotherapy, postoperative nausea
X give wi QT elongation. Can get constipation, hot, headaches
X for breastfeeding nor 1st trimester
(H2 receptor antagonists
Famotidine, nizatidine, ranitidine
have same role. Caution wi renal and hepatic impairment. Not with endoscopy. Can interact with azole fungals, protease inhibitors like atazanavir. )
GABA inhibitors
Diazepam, or for sleeping: nitrazepam, flurazepam, long acting loprazolam
D2 dopamine receptor antagonists
Droperidol and metoclopramide
Droperidol sedative used wi opioid analgesics like fentanyl to make calm and cooperative. Also an antiemetic for surgery. Don’t give with acebutolol or cns depressants
Metaclopramide for nausea and vomiting from diabetic gastroperesis, gerd, heartburn, chemo or surgery. X with abacavir or acebutolol or alcohol.
Side effects - confusion, restlessness, tired, diarrhoea, raised bp, dystonia. X for asthmatic.
Allopurinol
Prophylaxis of gout and uric acid + calcium oxalate renal stones and hyperuricaemia from chemotherapy. Not for acute gout. May develop a rash.
Methyl prednisolone
For iv suppression of inflammatory and allergic conditions, cerebral oedema with malignancy.
It’s a corticosteroid also used for multiple sclerosis
Avoid live vaccines, benzyl alcohol, immunosuppressants.
Risk of cardiovascular collapse, systemic sclerosis that can lead to scleroderma renal crisis.
Orally, depression is common. Confusion, hallucination, karposi’s sarcoma, dyslipidemia. With also risk angioedema, cataract, embolism and thrombosis
Lithium carbonate
Treatment and prophylaxis of mania, bipolar, chronic depression, aggressive or self harming behaviour
X with Addisons, arrhythmia, heart failure, dehydration, family history of brugada syndrome, untreated htn, low sodium diet, diuretics, myasthenia gravis, prolonged qt
Avoid abrupt end, lower threshold for a seizure
Manage thyroid if taken long term
X with aceclofenac, amifampridine, citalopram, clarithromycin
Cyclosporine
Calcineurin inhibitor- anti inflammatory immunosuppressant for organ rejection, crohns, nephrotic syndrome, psoriasis, rheumatoid arthritis
X with kidney disease, uncontrolled htn, cancer or puva uvb, radiation, methotrexate, coal tar, antivirals, birth control, seizure meds, antibiotics, cholesterol treatments
Can pass into breast milk
Side effects- acne, shaking, nausea, diarrhoea, bp, hair, painful gums
Trip tans ssra
For acute migrane and also headaches
Sumatriptan and naproxen nsaid together approved for acute and long term
Side effects numbness leg cramps
Clopidogrel
Prevent athero thrombosis in per cutaneous coronary intervention when used with aspirin. Can be used in TIA with an aspirin hypersensitivity and ppi not working. Preventative also after a MI
GI symptoms can arise. X with a high risk of bleeding
Naproxen
NSAID for pain, menstrual cramps, inflammatory disease and fever, ankylosing spondylitis, tendinitis, bursitis, gout
Also inc risk heart disease- don’t use with htn and around a heart bypass
Prednisolone
Glucocorticoid with minimal mineralocorticoid effects
Give with acute asthma and copd, croup, idiopathic thrombocytopenic purpura, ulcerative colitis, crohns, myasthenia, temporal arteritis, dialated arteries, lupus
Don’t give to neonates or those with live vaccinations,
risk heart failure, cushings, anxiety, cataract issues, GI issues, osteoporosis, adrenal suppression, infection - that’s in all corticosteroids
Methyl prednisolone
Corticosteroid For IV suppression of inflammatory and allergic conditions and cerebral oedema with malignancy, multiple sclerosis
X with live vaccine, benzyl alcohol, immunosuppressants
Risk of cardiovascular collapse, systemic sclerosis > scleroderma renal crisis
Orally, common to get depression, confusion, hallucination, karposi sarcoma, dyslipidema
IV also risk of angioedema, cataract, embolism and thrombosis
Morphine
All ages past 1m for pain. Can be used to constipate in rectal cancer
Risk in benzodiazepines and opioids of respiratory depression
X with head injury, raised icp, heart failure from lung disease, delayed gastric emptying, pheochromocytoma
Side effects arrhythmia, constipation, dizziness, headache, vertigo, GI issues
If respiratory depression- reverse with naloxone or ventilation if needed
Carvedilol
Betablocker for high blood pressure, angina and heart failure.
Not safe for asthma, p/bf, liver or kidney dysfunction, hypotension, diabetes, psoriasis, myasthenia gravis, heart block, prinzmetals angina.
Common side effects for more than 1/10 is dizzy, tired, headache, heart failure, nausea, cold extremities.