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Drugs Flashcards

1
Q

Abx Side Effects

A

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

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2
Q

Abx - mechanisms

A

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

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3
Q

ACE Inhibitors

A

U&E prior to treatment, dose increase and annually

SE - ^K, chronic cough, v BP, AKI

Teratogenic = renal dysgenesis, craniofacial abnormalities

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4
Q

Adrenaline

A

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)

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5
Q

Allopurinol

A

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

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6
Q

Alpha blockers

A

Doxazosin and tamsulosin
Used for - benign prostatic hyperplasia and hypertension

SE - postural hypotension, drowsiness, SOB, cough

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7
Q

Amiodarone

A

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)

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8
Q

Aspirin

A

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

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9
Q

Azathioprine

A

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

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10
Q

Beta-blockers

A

SE: bronchospasm (esp. asthma), fatigue, cold peripheries, v BP, v HR, worsens acute HF

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11
Q

Calcium channel blockers

A

dihydropyridines (nifedipine and amlodipine)
non-dihydropyridines (diltiazem and verapamil)

SE: headache, flushing, ankle oedema

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12
Q

Nifedipine, amlodipine, felodipine

A

Used for hypertension, angina, Raynaud’s

Affects peripheral vascular smooth muscle more than myocardium

SE - flushing, headache, ankle swelling, reflex tachycardia (nifedipine, shorter acting)

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13
Q

Verapamil, diltiazem

A

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)

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14
Q

Carbamazepine

A

Teratogen = NTD, craniofacial abnormalities

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15
Q

Chloramphenicol

A

Teratogen = grey-baby syndrome

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16
Q

Ciclosporin

A

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

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17
Q

Cocaine and smoking

A

Teratogen = IUGR, preterm labour

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18
Q

Diabetes Drugs

A

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

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19
Q

Diclofenac

A

NSAID

SE - increased risk of cardiovascular events

Contra - IHD, PAD, cerebro VD, congestive HF

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20
Q

Digoxin

A

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

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21
Q

Dopamine receptor agonists

A

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

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22
Q

Doxazosin

A

SE: postural hypotension

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23
Q

Lithium Monitoring

A

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

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24
Q

Lithium

A

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

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25
Q

Methotrexate

A

MOA - inhibits dihydrofolate reductase and thymidylate synthesis

SE: myelosuppression, mucositis, liver/ lung fibrosis

FBC, U&E, LFT baseline, weekly and then 2-3monthly

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26
Q

Sodium valproate

A

SE: liver toxicity

LFT and FBC baseline, LFT periodically in first 6mths

Teratogen = NTD, craniofacial abnormalities

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27
Q

Statins

A

LFT Baseline, 3 month, 12 month

SE: myopathy, rhabdomyolysis

Caution in liver disease

Contra with macrolides

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28
Q

Drugs that cause IGT

A

thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
Beta-blockers

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29
Q

Drug-induced thrombocytopenia

A

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

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30
Q

Drug-induced urinary retention

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

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31
Q

Drug-induced photosensitivity

A

thiazides
tetracyclines (doxy), sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas

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32
Q

O&G drugs - Syntocinon, Ergometrine, Mifepristone

A

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

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33
Q

Serotonin agonists

A

sumatriptan
= 5-HT1D agonist, acute treatment of migraine

ergotamine
= partial agonist of 5-HT1 receptors

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34
Q

Serotonin antagonist

A

pizotifen
= 5-HT2 receptor antagonist, migraine prophylaxis

cyproheptadine
= 5-HT2 receptor antagonist, control diarrhoea in carcinoid syndrome

ondansetron
= 5-HT3 receptor antagonist, antiemetic

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35
Q

Finasteride

A

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

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36
Q

Flecainide

A

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

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37
Q

Gentamicin

A

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

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38
Q

Heparin

A

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

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39
Q

HRT

A

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

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40
Q

Macrolides

A

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)

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41
Q

Pain ladder

A
  1. paracetamol, NSAIDs
  2. weak opioid (codeine)
  3. strong opioid (morphine)

Acute/ post-op
1. strong + anaesthetics
2. oral route
3. peripherally acting only

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42
Q

Maternal DM

A

Teratogen = macrosomia, NTDs, polyhydramnios, preterm labour, caudal regression syndrome

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43
Q

Metformin

A

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

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44
Q

Oculogyric crisis

A

Dystonic reaction

Causes - antipsych, metoclopramide, post-encephalopathic Parkinson’s

Management - stop med, IV benztropine/ procyclidine (antimuscanics)

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45
Q

CYP450 System

A

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)

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46
Q

Pharmacokinetics - reactions

A

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

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47
Q

Pharmacokinetics - first pass

A

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

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48
Q

Phosphodiesterase type V (PDE5) inhibitors

A

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

49
Q

Potassium-sparing diuretics

A

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)

50
Q

Drugs in renal failure

A

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

51
Q

Harmful drugs in pregnancy

A

Abx
Tetracyclines (tooth discolouration)
Aminoglycosides
Sulphonamides and trimethoprim
Quinolones

Others
ACE inhibitors, ARBs
Statins
Warfarin (craniofacial)
Sulfonylureas
Retinoids (including topical)
cytotoxic agents

52
Q

Quinolones

A

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

53
Q

Thiazides

A

SE: gout, v K, v Na, IGT

54
Q

Tamoxifen

A

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

55
Q

Theoophylline toxicity

A

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

56
Q

Trastuzumab

A

Herceptin, mAb against HER2/neu receptor

Used in met breast cancer

SE: flu-like, diarrhoea, cardiotoxicity

ECHO before treatment

57
Q

Cyclophosphamide

A

MOA - Alkylating agent, causes cross-linking in DNA

SE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

58
Q

Bleomycin

A

MOA - degrades preformed DNA
SE: lung fibrosis

59
Q

Anthracyclines e.g., doxorubicin

A

MOA - stabilizes DNA-topoisomerase II complex, inhibits DNA & RNA synthesis

SE: cardiomyopathy

60
Q

Anti-metabolites

A

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

61
Q

Vincristine/ Vinblastine

A

MOA - inhibits formation of microtubules
SE
Vincristine: peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression

62
Q

Docetaxel

A

MOA - prevents microtubule depolymerisation & disassembly, decreasing free tubulin

SE: neutropenia

63
Q

Topoisomerase inhibitors e.g., Irinotecan

A

MOA - inhibits topoisomerase I which prevents relaxation of supercoiled DNA

SE: myelosuppression

64
Q

Cisplatin

A

MOA - causes cross-linking in DNA

SE: ototoxicity, peripheral neuropathy, hypomagnesaemia

65
Q

Hydroxyurea (hydroxycarbamide)

A

MOA - inhibits ribonucleotide reductase, decreasing DNA synthesis

SE: myelosuppression

66
Q

Spironolactone

A

Used in ascites, HTN, HF, nephrotic syndrome, Conn’s

MOA - aldosterone antagonist, acts in collecting duct

SE: ^K, gynaecomastia (eplerenone)

67
Q

Renal Transplant - IS

A

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

68
Q

SSRI

A

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

69
Q

Starting or Stopping an SSRI

A

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

70
Q

SNRI

A

Inhibit 5HT and NA reuptake

E.g., venlafaxine, duloxetine

71
Q

Clozapine

A

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)

72
Q

Z Drugs

A

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

73
Q

TCA

A

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

74
Q

MAOI

A

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

75
Q

Mirtazapine

A

Use - depression (v SE so good for elderly)

MOA - blocks a2-adrenergic receptors

SE: sedation, ^appetite

76
Q

Benzos

A

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

77
Q

Atypical Antipsychotics

A

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)

78
Q

Typical Antipsychotics

A

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)

79
Q

Antipsychotic: Other Side Effects

A
  • dry mouth, blurred vision, urinary retention, constipation
  • ^prolactin
  • IGT (^olanzapine)
  • neuroleptic malignant syndrome (fever, stiff)
  • ^QT interval
80
Q

Levothyroxine

A

SE: hyperthyroidism, v bone mineral density, worsens angina, AF

Interacts with iron and calcium carbonate

81
Q

Finasteride

A

Women of childbearing age should not handle it due to toxic effects on male foetus

82
Q

Bisphosphonates

A

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

83
Q

Atropine

A

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)

84
Q

Nitrates

A

Nitrates are contraindicated in aortic stenosis

85
Q

Vancomycin: SE

A

Ototoxic and nephrotoxic

86
Q

Goserelin (Zoladex)

A

GnRH Agonist

Use - prostate cancer anti-androgen therapy

SE: gynaecomastia, tumour flare in first 2-3weeks (bone pain, BOO)

87
Q

Bicalutamide

A

Non-steroidal anti-androgen, blocks the androgen receptor

Use - prostate cancer

88
Q

Gonadotrophins, Clomifene

A

Use - infertility

MOA - stimulate follicles and induce ovulation, clomifene is a SERM (anti + oes properties)

SE: ovarian hyperstimulation syndrome

89
Q

Combined Oral Contraceptives

A

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

90
Q

Progesterone Only Oral Contraceptives

A

E.g., desogestrel based (cer-), levonorgestrel

MOA - thickens mucus

SE: irregular bleeding, breast pain, ovarian cysts, breast cancer

91
Q

LARC

A

MOA - inhibits ov and thickens mucus

Nexplanon implant
*Affected by rifampicin

Depo-Provera (medroxyprogesterone) IM
SE: irregular bleeding, weight gain, OP, slow reversal

92
Q

Spermicidal Contraception

A

Nonoxinol

93
Q

IUS/ IUD

A

Mirena 5yrs, Jaydess 3yrs
Levonorgestrel

MOA - prevents endometrial prolif and thickens mucus

Copper coil 5 or 10yrs

MOA - v sperm motility and survival

94
Q

Emergency Contraception

A

Levonorgestrol
Ulipristal
Copper IUD

95
Q

Mifepristone

A

MOA - progesterone receptor antagonist

Use - induction of labour in IU death, termination (with prostaglandin), missed miscarriage

96
Q

HRT

A

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

97
Q

Oxytocin

A

Use - induction and augmentation of labour, PPH

Monitoring of fetal heart rate and uterine motility, and for DIC after parturition

98
Q

Dinoprostone

A

MOA - exogenous PGE2, vaginal prostaglandin

Use - induction and augmentation of labour

99
Q

Ergometrine

A

MOA - ergot alkaloid

Use - PPH with uterine atony

100
Q

Carboprost

A

Use - refractive PPH due to atony

MOA - prostaglandin analogue

Contra - cardiac or pulmonary disease

101
Q

Tocolytics

A

Use - myometrial relaxation

E.g., atosiban (oxytocin receptor ant), nifedipine, salbutamol

102
Q

Topical Antibacterial (Eye)

A

Gentamicin
Chloramphenicol
Ciprofloxacin
Fusidic acid
Neomycin

103
Q

Topical Eye (others)

A

Antiviral - aciclovir
Steroids - dex, pred
Anti-Histamine - antazoline, levocabastine

Anaesthetics - oxybuprocaine, lidocaine, tetracaine

104
Q

Entacapone

A

MOA - Catechol-O-methyltransferase inhibitors, v breakdown of dopamine

Use - Parkinson’s

105
Q

Phenobarbital

A

Barbituate

MOA - GABA agonist, increase duration of Cl channels

106
Q

Topiramate

A

Glutamate receptor antagonist

Use - migraine prophylaxis, anti-epileptic

SE: teratogenic

107
Q

DMARDs

A

Sulfasalazine
Hydroxychloroquine (anti-malarial)
Leflunomide
Methotrexate (anti-metabolite)
Sodium aurothiomalate (Gold)
Azathioprine (anti-metabolite)
Ciclosporin (calcineurin inhibitor)
Penicillamine

108
Q

Sulphasalazine

A

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

109
Q

Hydroxychloroquine

A

Use - DMARD for RA, SLE

SE: bull’s eye retinopathy, corneal deposits

*Baseline eye exam, annual screening

SAFE in pregnancy

110
Q

Leflunomide

A

Use - DMARD for RA

SE: liver impairment, interstitial lung disease, HTN

111
Q

Penicillamine

A

SE: proteinuria, worsens myasthenia gravis

112
Q

Anti-TNFa

A

Adalimumab
Etanercept
Infliximab

SE: reactivate TB

113
Q

Rituximab

A

Anti-CD20 B cell depleter

SE: infusion reactions

114
Q

Xanthine Oxidase Inhibitors

A

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)

115
Q

Rasburicase

A

Use - proph/ treat hyperuricaemia (tumour lysis syndrome)

Contra G6PD deficiency

116
Q

IV Opioids in Anaesthetics

A

Fentanyl
Remifentanil

117
Q

Nitrofurantoin

A

AVOID if GFR <45

118
Q

Stopping warfarin for surgery

A

Warfarin is usually stopped 5 days before elective surgery

+ phytomenadione (vitamin K1) by mouth the day before surgery if the INR is ≥1.5

119
Q

Furosemide: best way to monitor

A

weight (reduction)

PPT (3 decks)

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