- beta receptor agonist - short-acting bronchodilator - Relaxes bronchial smooth muscles through beta 2 receptors

- Anti-inflammatory - used as maintenance therapy

- Blocks the muscarinic acetylcholine receptors - Short-acting inhaled bronchodilator. Relaxes bronchial smooth muscle • Used primarily in COPD • Tiotropium has similar effects but is long-acting

Drugs Flashcards by Tumeric Child

Gold risk in rheumatology

myelosupression
renal toxicity
mouth ulcer
photosensitivity

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MAO inhibitors side effects

Hypertensive reaction to foods high in tyramine (cheese, processed meats…)

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Drugs cause delirium

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Labetalol risks

hypoglycaemia
bradycardia

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Mechanism of ACE inhibitors

inhibits the conversion angiotensin I to angiotensin II
→ decrease in angiotensin II levels → to vasodilation and reduced blood pressure
→ decrease in angiotensin II levels → reduced stimulation for aldosterone release → decrease in sodium and water retention by the kidneys

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renoprotective mechanism ACE inhibitors

angiotensin II constricts the efferent glomerular arterioles
ACE inhibitors therefore lead to dilation of the efferent arterioles → reduced glomerular capillary pressure → decreased mechanical stress on the delicate filtration barriers of the glomeruli
this is particularly important in diabetic nephropathy

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How are ACE inhibitors are activated

phase 1 metabolism in the liver

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Side effects of ACE inhibitors

cough
angioedema
hyperkalmeia
first dose hypotension

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ACE inhibitors cautions and contradictions

pregnancy and breastfeeding - avoid
renovascular disease - may result in renal impairment
aortic stenosis - may result in hypotension
hereditary of idiopathic angioedema
specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L

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Interactions of ACE inhibitors

patients receiving high-dose diuretic therapy (more than 80 mg of furosemide a day)
significantly increases the risk of hypotension

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Mechanism of Adenosine

causes transient heart block in the AV node

agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux

adenosine has a very short half-life of about 8-10 seconds

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Adverse effects adenosine

chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)

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Contradictions of Adenosine

Asthmatics
Causes bronchospasm

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Adenosine should ideally be infused

large-calibre cannula due to it’s short half-life,

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Interactions of adenosine

dipyridamole (antiplatelet agent) and blocked by theophyllines.

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Noticible adverse effects ADP receptor inhibitors

ticagrelor may cause dyspnoea
due to the impaired clearance of adenosine

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Clopidogrel drug contradictions

clopidogrel and proton pump inhibitors, particularly omeprazole and esomeprazole, leading to reducing antiplatelet effects.

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contraindications to prasugrel use.

prior stroke or transient ischaemic attack, high risk of bleeding, and prasugrel hypersensitivity are absolute contraindication

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Salbutamol

beta receptor agonist
short-acting bronchodilator
Relaxes bronchial smooth muscles through beta 2 receptors

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Corticosteroids

Anti-inflammatory
used as maintenance therapy

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Ipratropium

Blocks the muscarinic acetylcholine receptors
Short-acting inhaled bronchodilator. Relaxes bronchial smooth muscle
• Used primarily in COPD
• Tiotropium has similar effects but is long-acting

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Methylxanthines (e.g. theophylline)

Non-specific inhibitor of phosphodiesterase resulting in an increase in cAMP
Given orally or intravenously
• Has a narrow therapeutic index

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Monteleukast, zafirlukast

Blocks leukotriene receptors
Usually taken orally
• Useful in aspirin-induced asthma

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Oxygen saturation targets
acutely ill patients

94-98%

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Oxygen saturation targets patients at risk of hypercapnia (e.g. COPD patients)

88-92%

COPD management O2

prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis adjust target range to 94-98% if the pCO2 is normal

When not to use O2 therapy (no hypoxia present, but conditions diagnoses)

myocardial infarction and acute coronary syndromes stroke obstetric emergencies anxiety-related hyperventilation

Theophylline poisoning

acidosis, hypokalaemia vomiting tachycardia, arrhythmias seizures

Management of theophylline poisoning

- consider gastric lavage if <1 hour prior to ingestion activated charcoal - whole-bowel irrigation can be performed if theophylline is sustained release form charcoal haemoperfusion is preferable to haemodialysis

Potential mechanism of theophylline

theophyllines may be a non-specific inhibitor of phosphodiesterase resulting in an increase in cAMP. Other proposed mechanisms include antagonism of adenosine and prostaglandin inhibition

canakinumab

* monoclonal antibody targeted at IL-1 beta * used systemic juvenile idiopathic arthritis and adult-onset Still's disease

anakinra

* IL-1 receptor antagonist * used in the management of rheumatoid arthritis

What are antipsychotics used for?

Management of schizophrenia, psychosis, mania, and agitation

How are antipsychotics categorized?

Typical and atypical antipsychotics

What is a key reason for the development of atypical antipsychotics?

To reduce extrapyramidal side effects associated with typical antipsychotics

What is the mechanism of action of typical antipsychotics?

Dopamine D2 receptor antagonists, blocking dopaminergic transmission

List common adverse effects of typical antipsychotics.

* Extrapyramidal side effects * Hyperprolactinaemia

What are common examples of typical antipsychotics?

* Haloperidol * Chlorpromazine

What are the common extrapyramidal side effects (EPSEs)?

* Parkinsonism * Acute dystonia * Akathisia * Tardive dyskinesia

What is tardive dyskinesia?

Late onset of choreoathetoid movements, may occur in 40% of patients

What are the specific warnings for antipsychotics in elderly patients?

* Increased risk of stroke * Increased risk of venous thromboembolism

What are common side effects of atypical antipsychotics?

* Weight gain * Hyperprolactinaemia * Agranulocytosis (in clozapine)

What is the first-line treatment for schizophrenia according to 2005 NICE guidelines?

Atypical antipsychotics

What is the primary action of benzodiazepines?

Enhance the effect of GABA by increasing the frequency of chloride channels

List the uses of benzodiazepines.

* Sedation * Hypnotic * Anxiolytic * Anticonvulsant * Muscle relaxant

What is the recommended duration for prescribing benzodiazepines?

Short period of time (2-4 weeks)

What is benzodiazepine withdrawal syndrome?

Condition similar to alcohol withdrawal syndrome with symptoms like insomnia and anxiety

What are common adverse effects of clozapine?

* Agranulocytosis * Neutropaenia * Seizures * Constipation * Myocarditis

What is the therapeutic range for lithium?

0.4-1.0 mmol/L

What are common adverse effects of lithium?

* Nausea/vomiting * Fine tremor * Nephrotoxicity * Thyroid enlargement * Weight gain

What should be monitored in patients on lithium therapy?

* Lithium levels * Thyroid function * Renal function

What are SSRIs primarily used for?

First-line treatment for depression

Name two preferred SSRIs.

* Citalopram * Fluoxetine

What are common adverse effects of SSRIs?

* Gastrointestinal symptoms * Increased risk of gastrointestinal bleeding

What are the risks associated with citalopram?

Dose-dependent QT interval prolongation

What is the mechanism of action for SNRIs?

Inhibit the reuptake of serotonin and noradrenaline

What are tricyclic antidepressants (TCAs) primarily used for?

Depression and neuropathic pain

What is a common low-dose TCA used for neuropathic pain?

Amitriptyline

What are Z drugs?

Drugs that have similar effects to benzodiazepines but act on the α2-subunit of the GABA receptor

List the groups of Z drugs.

* Imidazopyridines (e.g., zolpidem) * Cyclopyrrolones (e.g., zopiclone) * Pyrazolopyrimidines (e.g., zaleplon)

What are common adverse effects of Z drugs?

* Similar to benzodiazepines * Increased risk of falls in the elderly