Drugs Flashcards
Abx Side Effects
Amoxicillin
SE: rash with infectious mononucleosis
Co-amoxiclav
SE: cholestasis
Flucloxacillin
SE: cholestasis (several weeks after use)
Erythromycin
SE: GI upset, ^QT
Ciprofloxacin
SE: v seizure threshold, tendonitis
Trimethoprim
SE: rash, itchy, photosensitivity, suppress haematopoiesis
Abx - mechanisms
Cell wall synthesis
= penicillins, cephalosporins, carbapanems (beta-lactam), vancomycin (glycopeptide)
Nucleic acid synthesis
= sulphonamides, trimethoprim, quinolones, rifampicin
Protein synthesis
30S = tetracyclines, aminoglycosides
50S = macrolide, clindamycin
ACE Inhibitors
U&E prior to treatment, dose increase and annually
SE - ^K, chronic cough, v BP, AKI
Teratogenic = renal dysgenesis, craniofacial abnormalities
Adrenaline
Sympathomimetic amine, stimulates alpha and beta adrenergic receptors
^CO, ^total peripheral resistance, vasoconstriction in the skin and kidneys (narrow pulse pressure)
Used in anaphylaxis, cardiac arrest
Phentolamine for reversal (distal ischaemia)
Allopurinol
Xanthine oxidase inhibitor
Used in gout, Lesch-Nyhan syndrome
SE: stop allopurinol immediately if rash,
severe cutaneous adverse reaction (SCAR), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome
Chinese, Korean and Thai increased risk
Interacts - Azathioprine (^levels of 6-mercaptopurine, use 25% dose), cyclophosphamide (marrow toxicity), theophylline
Alpha blockers
Doxazosin and tamsulosin
Used for - benign prostatic hyperplasia and hypertension
SE - postural hypotension, drowsiness, SOB, cough
Amiodarone
MOA - class III antiarrhythmic, blocks potassium channels and inhibits repolarisation, prolongs AP, also blocks sodium channels, 20-100d HL
SE - thyrotoxicosis (stop drug), hypothyroidism, corneal deposits, optic neuritis, pulmonary fibrosis, pneumonitis, liver fibrosis, hepatitis, peripheral neuropathy, myopathy, photosensitivity, slate-grey skin, thrombophlebitis, bradycardia, ^QT
Interacts - warfarin (^INR), ^digoxin levels
TFT and LFT 6monthly (+ baseline with U&E and CXR)
Aspirin
COX-1 and 2 inhibitor
Blocks prostaglandin, prostacyclin and thromboxane A2 formation
Used in IHD
SE - Reye’s syndrome (<16yrs), haemorrhage, peptic ulcers, gastritis, tinnitus
Interacts - potentiated by oral hypoglycaemics, warfarin, steroids
Azathioprine
MOA - metabolised to active mercaptopurine, inhibits purine synthesis
SE: bone marrow depression, n+v, pancreatitis, non-melanoma skin cancer
Interacts with allopurinol (lower dose of azathioprine)
SAFE in pregnancy
Monitor
TPMT test
FBC, LFT baseline and 3monthly
FBC weekly for first month
Beta-blockers
SE: bronchospasm (esp. asthma), fatigue, cold peripheries, v BP, v HR, worsens acute HF
Calcium channel blockers
dihydropyridines (nifedipine and amlodipine)
non-dihydropyridines (diltiazem and verapamil)
SE: headache, flushing, ankle oedema
Nifedipine, amlodipine, felodipine
Used for hypertension, angina, Raynaud’s
Affects peripheral vascular smooth muscle more than myocardium
SE - flushing, headache, ankle swelling, reflex tachycardia (nifedipine, shorter acting)
Verapamil, diltiazem
Verapamil
Used for angina, HTN, arrhythmias
SE - HF, constipation, v BP, v HR, flushing
Contra with b-blockers (heart block)
Diltiazem
Used for angina, HTN
SE - v BP, v HR, HF, ankle swelling
Caution with b-blockers (less neg inotropic)
Carbamazepine
Teratogen = NTD, craniofacial abnormalities
Chloramphenicol
Teratogen = grey-baby syndrome
Ciclosporin
Calcineurin inhibitor, decreases clonal proliferation of T cells by reducing IL-2 release
Used for organ transplant, RA, psoriasis, UC, pure red cell aplasia
Trough levels immediately before dose
SE - nephrotoxic, hepatotoxic, fluid retention, hypertension, ^K, hypertrichosis, gingival hyperplasia, tremor, IGT, hyperlipidaemia, immunosuppressed
Cocaine and smoking
Teratogen = IUGR, preterm labour
Diabetes Drugs
Metformin (biguanide)
SE: GI, lactic acidosis, v appetite
Sulfonylurea (insulin secretagogues - Gliclazide, Tolbutamide, Glipizide)
SE: hypoglycaemia, ^appetite, weight gain, SIADH, cholestasis
Glitazones (PPAR agonists)
SE: weight gain, fluid retention, liver dysfunction, fractures
Gliptins (DPP-4 inhibitors)
SE: pancreatitis
Diclofenac
NSAID
SE - increased risk of cardiovascular events
Contra - IHD, PAD, cerebro VD, congestive HF
Digoxin
Cardiac glycoside, positive inotropic properties
Used for rate control in AF, symptoms in heart failure.
MOA - v conduction through AVN, slows ventricular rate, ^ force of cardiac muscle contraction (inhibits Na+/K+ ATPase pump), also stimulates vagus nerve
Narrow therapeutic index, monitor in suspected toxicity (8 to 12 hours of last dose)
Monitor serum electrolytes and renal function
Dopamine receptor agonists
Bromocriptine, ropinirole, cabergoline, apomorphine
Used in Parkinson’s, prolactinoma, galactorrhea, cyclical breast disease, acromegaly
SE - n+v, postural hypotension, hallucinations, daytime somnolence, ergot-derived (b/ c) associated with pulmonary, retroperitoneal and cardiac fibrosis
-> baseline ESR, creatinine and chest x-ray
Doxazosin
SE: postural hypotension
Lithium Monitoring
TFT and U&E baseline and 6monthly
Lithium level weekly until stable and then 3mthly
12hours after last dose
Normal serum-lithium concentration of 0.4-1
Lithium
Use - mood stabiliser in Bipolar
*Narrow therapeutic range and long half-life
SE: n+v, diarrhoea, fine tremor, diabetes insipidus, hypothyroidism (enlarge), flat/ inverted T wave, weight gain, idiopathic IC HTN, leucocytosis, ^PTH (^Ca)
Teratogenic = Ebstein’s anomaly (atrialised RV)
Toxicity with dehydration, renal failure, thiazides, ACEi/ARB, NSAIDs, metronidazole
Methotrexate
MOA - inhibits dihydrofolate reductase and thymidylate synthesis
SE: myelosuppression, mucositis, liver/ lung fibrosis
FBC, U&E, LFT baseline, weekly and then 2-3monthly
Sodium valproate
SE: liver toxicity
LFT and FBC baseline, LFT periodically in first 6mths
Teratogen = NTD, craniofacial abnormalities
Statins
LFT Baseline, 3 month, 12 month
SE: myopathy, rhabdomyolysis
Caution in liver disease
Contra with macrolides
Drugs that cause IGT
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
Beta-blockers
Drug-induced thrombocytopenia
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
Drug-induced urinary retention
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
Drug-induced photosensitivity
thiazides
tetracyclines (doxy), sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas
O&G drugs - Syntocinon, Ergometrine, Mifepristone
Syntocinon
= Synthetic oxytocin, stimulates uterine contraction (v PPH)
Used for active management of third stage, induces labour
Ergometrine
= Ergot alkaloid, stimulates a/d/serotonin receptors, constricts vascular smooth muscle
Used for active management of third stage
SE - coronary artery spasm
Mifepristone
= Prostaglandin analogue, competitive progesterone receptor antagonist
Used with misoprostol to terminate pregnancy
SE - menorrhagia
Serotonin agonists
sumatriptan
= 5-HT1D agonist, acute treatment of migraine
ergotamine
= partial agonist of 5-HT1 receptors
Serotonin antagonist
pizotifen
= 5-HT2 receptor antagonist, migraine prophylaxis
cyproheptadine
= 5-HT2 receptor antagonist, control diarrhoea in carcinoid syndrome
ondansetron
= 5-HT3 receptor antagonist, antiemetic
Finasteride
5 alpha-reductase inhibitor (stops testosterone to dihydrotestosterone)
Used for BPH, male-pattern baldness
SE - impotence, v libido, ejaculation disorders, gynaecomastia, breast tenderness, v PSA levels
Flecainide
Vaughan Williams class 1c antiarrhythmic
MOA - slows AP conduction by acting as a potent sodium channel blocker = wide QRS and PR
Used in AF, accessory SVT e.g. WPW
Contra - post-MI, SHD (HF), sinus node dysfunction, second-degree or greater AV block,
atrial flutter
SE - negatively inotropic, v HR, proarrhythmic, oral paraesthesia, visual disturbances
Gentamicin
Aminoglycoside Abx
SE - ototoxic (auditory/ vestibular nerve damage, irreversible), nephrotoxic (via acute tubular necrosis)
Caution - renal failure
Contra - myasthenia gravis
peak (1 hour after administration) and trough levels (just before the next dose) are measured
Teratogenic = ototoxic
Heparin
activate antithrombin 3
SE - bleeding, thrombocytopenia, osteoporosis, ^K (v aldosterone secretion)
UF
Inhibits thrombin, Xa, IXa, XIa and XIIa
IV, short action
APTT to monitor
^risk of thrombocytopenia and osteoporosis
LMWH
Inhibits Xa only
SC, longer action
HRT
Used for menopausal symptoms (+ P if uterus) and in premenopause (until 50yrs)
PO, patch (better if risk of VTE) or gel
SE -
reduced risk of colorectal cancer
Macrolides
E.g., erythromycin, clarithromycin, azithromycin
MOA - inhibit bacterial protein synthesis, block translocation, bacteriostatic
SE - ^QT, GI, cholestatic jaundice, hearing loss/ tinnitus (azithro)
!!P450 inhibitor
Interacts - stop statins (^myopathy/ rhabdo)
Pain ladder
- paracetamol, NSAIDs
- weak opioid (codeine)
- strong opioid (morphine)
Acute/ post-op
1. strong + anaesthetics
2. oral route
3. peripherally acting only
Maternal DM
Teratogen = macrosomia, NTDs, polyhydramnios, preterm labour, caudal regression syndrome
Metformin
Used in T2DM (titrate up slowly)
MOA - biguanide, activates AMP-activated protein kinase, ^insulin sens, v hep gluconeogenesis
SE - nausea, anorexia, diarrhoea, v B12 absorption, lactic acidosis
No weight gain or hypos
Caution - severe liver disease/ renal failure
Contra - CKD (stop if GFR <30, reduce <45), post-MI, AKI, sepsis, severe dehydration, iodine-containing contrast (day of to 48hrs after), alcohol abuse
Oculogyric crisis
Dystonic reaction
Causes - antipsych, metoclopramide, post-encephalopathic Parkinson’s
Management - stop med, IV benztropine/ procyclidine (antimuscanics)
CYP450 System
Inhibitors (SICKFACES.COM)
Sodium valproate, SSRIs
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (binge), amiodarone, allopurinol
Chloramphenicol
Erythromycin
Sulphomanides
Ciprofloxacin
Ommeprazole
Metronidazole
Inducers (CRAP GPS)
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas, St John’s Wort
Smoking (affects CYP1A2, why smokers need more aminophylline)
Pharmacokinetics - reactions
Phase I reactions: oxidation, reduction, hydrolysis (by P450 enzymes, alcohol dehydrogenase, xanthine oxidase etc.)
= active, toxic products
Phase II reactions: conjugation
= inactive products, excreted in urine or bile
^Mostly occur in liver
Pharmacokinetics - first pass
Concentration greatly reduced before reaching systemic circulation due to hepatic metabolism - need larger doses PO than other routes
aspirin
isosorbide dinitrate
glyceryl trinitrate
lignocaine
propranolol
verapamil
isoprenaline
testosterone
hydrocortisone
Zero order - phenytoin, salicylates (e.g. high-dose aspirin), heparin, ethanol
Phosphodiesterase type V (PDE5) inhibitors
E.g., sildenafil, tadalafil, vardenafil
Used for erectile dysfunction, pulm HTN
MOA - vasodilation, ^cGMP leads to smooth muscle relaxation in blood vessels
SE - blue vision, anterior ischaemic neuropathy, nasal congestion, flushing, GI, headache, priapism
Contra - nitrates, nicorandil, v BP, recent stroke/ MI
Potassium-sparing diuretics
ENaC blockers (amiloride, triamterene) in DCT
Used with other diuretics to balance v K
Aldosterone antagonists (spironolactone) in CD
Used in ascites (cirrhosis -> secondary hyperaldosteronism), HF, nephrotic, Conn’s
Caution - ACEi (risk of ^K)
Drugs in renal failure
AVOID
Tetracycline, nitrofurantoin
NSAIDs
Lithium
Metformin
ADJUST DOSE (might accumulate in CKD)
Most Abx
Digoxin, atenolol
Methotrexate
Sulphonylureas
Furosemide
Opioids
MOSTLY SAFE
Erythromycin, rifampicin
Diazepam
Warfarin
Harmful drugs in pregnancy
Abx
Tetracyclines (tooth discolouration)
Aminoglycosides
Sulphonamides and trimethoprim
Quinolones
Others
ACE inhibitors, ARBs
Statins
Warfarin (craniofacial)
Sulfonylureas
Retinoids (including topical)
cytotoxic agents
Quinolones
E.g., ciprofloxacin, levofloxacin
MOA - inhibits DNA synthesis, inhibits topoisomerase 2 and 4, bactericidal
SE - v seizure threshold, tendinopathy/ rupture (esp. + steroids), cartilage damage (avoid in children), lengthens QT interval
Contra - pregnant/ BF, G6PD definiciency
Thiazides
SE: gout, v K, v Na, IGT
Tamoxifen
Selective Estrogen Receptor Modulator (oes receptor antagonist and partial agonist)
Used for Oes receptor +ve breast cancer (continue 5yrs after removal)
SE: vaginal bleeding, amenorrhoea, hot flushes, VTE,
endometrial cancer
Raloxifene is a pure oes receptor antagonist = lower risk of endometrial cancer
Theoophylline toxicity
Metabolised by P450 enzymes
Causes - acute illness, ciprofloxacin, erythromycin
= vomiting, agitation, dilated pupils, ^HR, ^glucose, v K
-> activated charcoal (regardless of time of presentation), antiemetics, definitive treatment is with haemodialysis
Trastuzumab
Herceptin, mAb against HER2/neu receptor
Used in met breast cancer
SE: flu-like, diarrhoea, cardiotoxicity
ECHO before treatment
Cyclophosphamide
MOA - Alkylating agent, causes cross-linking in DNA
SE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
Bleomycin
MOA - degrades preformed DNA
SE: lung fibrosis
Anthracyclines e.g., doxorubicin
MOA - stabilizes DNA-topoisomerase II complex, inhibits DNA & RNA synthesis
SE: cardiomyopathy
Anti-metabolites
Methotrexate
MOA - inhibits dihydrofolate reductase and thymidylate synthesis
SE: myelosuppression, mucositis, liver/ lung fibrosis
Fluorouracil (5-FU)
MOA - pyrimidine analogue, induces cell cycle arrest and apoptosis (during S phase)
SE: myelosuppression, mucositis, dermatitis
6-mercaptopurine
MOA - purine analogue, v purine synthesis
SE: myelosuppression
Cytarabine
MOA - pyrimidine antagonist, inhibits DNA polymerase, S phase
SE: myelosuppression, ataxia
Vincristine/ Vinblastine
MOA - inhibits formation of microtubules
SE
Vincristine: peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression
Docetaxel
MOA - prevents microtubule depolymerisation & disassembly, decreasing free tubulin
SE: neutropenia
Topoisomerase inhibitors e.g., Irinotecan
MOA - inhibits topoisomerase I which prevents relaxation of supercoiled DNA
SE: myelosuppression
Cisplatin
MOA - causes cross-linking in DNA
SE: ototoxicity, peripheral neuropathy, hypomagnesaemia
Hydroxyurea (hydroxycarbamide)
MOA - inhibits ribonucleotide reductase, decreasing DNA synthesis
SE: myelosuppression
Spironolactone
Used in ascites, HTN, HF, nephrotic syndrome, Conn’s
MOA - aldosterone antagonist, acts in collecting duct
SE: ^K, gynaecomastia (eplerenone)
Renal Transplant - IS
Ciclosporin - calcineurin inhibitor, SE: HTN, ^lipids, gingival hyperplasia, hirsutism
Tacrolimus - less acute rejection, HTN and high lipids, SE: IGT, DM, alopecia
Mycophenolate - inhibits purine synthesis, v b and t cells, SE: GI, bone marrow suppression
Monoclonal Ab - selective IL2 inhibitors, daclizumab/ basilximab
SSRI
E.g., citalopram, fluoxetine (best in young), sertraline (best post-MI), paroxetine
Use - depression
SE: GI, bleeding (PPI), v Na, anxiety, agitation, ^QT (citalo)
Interact with NSAIDs, warfarin, heparin, aspirin, triptans, MAOI
Teratogen = T1 CHD (^parox), T3 persistent pulm HTN
Starting or Stopping an SSRI
Review after 2 weeks (1 week if <30/ ^risk of suicide)
Take for 6months post-remission, 1 year if old, 2 years if recurrent depression
Must gradually reduce over 4 week period (not needed with fluoxetine)
Discontinuation syndrome
= mood change, restless, insomnia, unsteady, sweating, abdo pain, d+v, paraesthesia
SNRI
Inhibit 5HT and NA reuptake
E.g., venlafaxine, duloxetine
Clozapine
Atypical antipsychotic, only use as 3rd choice
SE: agranulocytosis (monitor FBC), neutropenia, constipation, v seizure threshold, myocarditis, hypersalivation
Smoking cessation can increase blood levels of the drug
Differential white blood cell weekly for 18 weeks, 2wkly for year, then monthly (clozapine patient monitoring service)
Z Drugs
Similar effects to benzos but structurally different, act on α2-subunit of GABA receptor
Imidazopyridines: e.g. zolpidem
Cyclopyrrolones: e.g. zopiclone
Pyrazolopyrimidines: e.g. zaleplon
SE: like benzos, falls in elderly
TCA
E.g., amitriptyline, clomipramine
Use - neuropathic pain, less often for depression
MOA - inhibit reuptake of 5HT and NA, also antagonise histamine, muscarinic and adrenergic receptors
SE - drowsy, dry mouth, blurred vision, constipation, urinary retention, postural hypotension, ^QT
MAOI
MOA - prevent monoamine oxidase metabolising 5HT and NA in presynaptic cell
E.g., tranylcypromine, phenelzine
SE: hypertensive reactions with tyramine foods (cheese, Bovril, Oxo, marmite), anti-cholinergic effects
Mirtazapine
Use - depression (v SE so good for elderly)
MOA - blocks a2-adrenergic receptors
SE: sedation, ^appetite
Benzos
E.g., clonazepam, diazepam, lorazepam
MOA - enhance the inhibitory effect of GABA by increasing the frequency of chloride channels
Use - sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant
SE: tolerance, withdrawal
Withdrawal = insomnia, irritable, tremor, v appetite, tinnitus, sweating, seizures
*Switch to diazepam, steps of 1/8 daily dose fortnightly
Atypical Antipsychotics
E.g., clozapine, olanzapine (^lipids, obese), risperidone, quetiapine, amisulpride, aripiprazole (best for SE, v galatorrhea)
SE: weight gain, agranulocytosis (cloz), ^prolactin, v seizure threshold, ^risk of VTE and stroke in elderly, ^IGT (baseline glucose)
Typical Antipsychotics
E.g., haloperidol, chlorpromazine
MOA - D2 receptor antagonists
SE: extrapyramidal e.g., parkinsonism, acute dystonia (torticollis/ oculogyric -> procyclidine), akathisia, tardive dyskinesia (late onset, chewing/ jaw pouting)
Antipsychotic: Other Side Effects
- dry mouth, blurred vision, urinary retention, constipation
- ^prolactin
- IGT (^olanzapine)
- neuroleptic malignant syndrome (fever, stiff)
- ^QT interval
Levothyroxine
SE: hyperthyroidism, v bone mineral density, worsens angina, AF
Interacts with iron and calcium carbonate
Finasteride
Women of childbearing age should not handle it due to toxic effects on male foetus
Bisphosphonates
E.g., alendronic acid (70mg OW), risedronate, zoledronic acid (OY infusion)
Use - OP, hypercalcaemia, bone mets, Paget’s
MOA - v osteoclastic activity to ^bone density
SE: GI, oesophagitis, osteonecrosis of the jaw, atypical stress fractures
Contra - v Ca, v vit D, severe CKD, pregnancy/ BF, gastric ulcers, oes structural disorder
Administration: take on empty stomach 30min before breakfast, with full glass of water, sit up for 30mins
Monitoring: regular dentist, renal function, Mg, PO4
Atropine
Use - terminate SVT
MOA - transient heart block in AV node, agonist of A1 receptor in AVN, increasing outward potassium flux, 8-10sec half life (needs large cannula)
SE: chest pain, bronchospasm, transient flushing, can enhance conduction down accessory pathways (^V rate e.g., in WPW)
Interaction - effects are enhanced by dipyridamole (AP) and blocked by theophyllines
Contra - asthma (bronchospasm)
Nitrates
Nitrates are contraindicated in aortic stenosis
Vancomycin: SE
Ototoxic and nephrotoxic
Goserelin (Zoladex)
GnRH Agonist
Use - prostate cancer anti-androgen therapy
SE: gynaecomastia, tumour flare in first 2-3weeks (bone pain, BOO)
Bicalutamide
Non-steroidal anti-androgen, blocks the androgen receptor
Use - prostate cancer
Gonadotrophins, Clomifene
Use - infertility
MOA - stimulate follicles and induce ovulation, clomifene is a SERM (anti + oes properties)
SE: ovarian hyperstimulation syndrome
Combined Oral Contraceptives
E.g., Ethinylestradiol with levorgesterol/ norgestimate/ drospirenone
MOA - inhibits ovulation
SE: VTE, stroke, IHD, breast and cervical cancer, headache, breast pain
*lower risk of ovarian, endometrial, CRC
Condom with rifampicin
Progesterone Only Oral Contraceptives
E.g., desogestrel based (cer-), levonorgestrel
MOA - thickens mucus
SE: irregular bleeding, breast pain, ovarian cysts, breast cancer
LARC
MOA - inhibits ov and thickens mucus
Nexplanon implant
*Affected by rifampicin
Depo-Provera (medroxyprogesterone) IM
SE: irregular bleeding, weight gain, OP, slow reversal
Spermicidal Contraception
Nonoxinol
IUS/ IUD
Mirena 5yrs, Jaydess 3yrs
Levonorgestrel
MOA - prevents endometrial prolif and thickens mucus
Copper coil 5 or 10yrs
MOA - v sperm motility and survival
Emergency Contraception
Levonorgestrol
Ulipristal
Copper IUD
Mifepristone
MOA - progesterone receptor antagonist
Use - induction of labour in IU death, termination (with prostaglandin), missed miscarriage
HRT
Oestradiol alone or with progestogens, raloxifene, tibolone (o/p/ androgenic)
SE: nausea, breast pain, fluid retention, weight gain, breast cancer (^w/ p), endometrial cancer (v w/ p), VTE (v patch), stroke, IHD if 10yr post-menopause
Oxytocin
Use - induction and augmentation of labour, PPH
Monitoring of fetal heart rate and uterine motility, and for DIC after parturition
Dinoprostone
MOA - exogenous PGE2, vaginal prostaglandin
Use - induction and augmentation of labour
Ergometrine
MOA - ergot alkaloid
Use - PPH with uterine atony
Carboprost
Use - refractive PPH due to atony
MOA - prostaglandin analogue
Contra - cardiac or pulmonary disease
Tocolytics
Use - myometrial relaxation
E.g., atosiban (oxytocin receptor ant), nifedipine, salbutamol
Topical Antibacterial (Eye)
Gentamicin
Chloramphenicol
Ciprofloxacin
Fusidic acid
Neomycin
Topical Eye (others)
Antiviral - aciclovir
Steroids - dex, pred
Anti-Histamine - antazoline, levocabastine
Anaesthetics - oxybuprocaine, lidocaine, tetracaine
Entacapone
MOA - Catechol-O-methyltransferase inhibitors, v breakdown of dopamine
Use - Parkinson’s
Phenobarbital
Barbituate
MOA - GABA agonist, increase duration of Cl channels
Topiramate
Glutamate receptor antagonist
Use - migraine prophylaxis, anti-epileptic
SE: teratogenic
DMARDs
Sulfasalazine
Hydroxychloroquine (anti-malarial)
Leflunomide
Methotrexate (anti-metabolite)
Sodium aurothiomalate (Gold)
Azathioprine (anti-metabolite)
Ciclosporin (calcineurin inhibitor)
Penicillamine
Sulphasalazine
Use - DMARD for RA, IBD
MOA - pro-drug for 5ASA, v neutrophil chemotaxis and v lymphocyte proliferation
SE: oligospermia, rash, steven-johnson, lung fibrosis, colour tears
Caution - G6PD deficicency, allergy to aspirin/ sulpha drugs
SAFE in pregnancy and BF
Hydroxychloroquine
Use - DMARD for RA, SLE
SE: bull’s eye retinopathy, corneal deposits
*Baseline eye exam, annual screening
SAFE in pregnancy
Leflunomide
Use - DMARD for RA
SE: liver impairment, interstitial lung disease, HTN
Penicillamine
SE: proteinuria, worsens myasthenia gravis
Anti-TNFa
Adalimumab
Etanercept
Infliximab
SE: reactivate TB
Rituximab
Anti-CD20 B cell depleter
SE: infusion reactions
Xanthine Oxidase Inhibitors
E.g., allopurinol, febuxostat
Use - gout
SE: stop if rash (SCAR, DRESS, steven-johnson)
Start long-term treatment when acute episode is over
Interactions - azathioprine (6mer not oxidised), cyclophosphamide (v renal clearance), theophylline (v breakdown)
Rasburicase
Use - proph/ treat hyperuricaemia (tumour lysis syndrome)
Contra G6PD deficiency
IV Opioids in Anaesthetics
Fentanyl
Remifentanil
Nitrofurantoin
AVOID if GFR <45
Stopping warfarin for surgery
Warfarin is usually stopped 5 days before elective surgery
+ phytomenadione (vitamin K1) by mouth the day before surgery if the INR is ≥1.5
Furosemide: best way to monitor
weight (reduction)
