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GPEP > Drugs > Flashcards

Drugs Flashcards

1
Q

How do TCAs treat depression

A

by increasing levels of serotonin and norepinephrine or just norepinephrine within the synaptic cleft, thus increasing the activity of postsynaptic neurons.

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2
Q

Indications to use TCAs

A

Depression (SSRI still first line)
OCD
Migraines
Peripheral neuropathy

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3
Q

What are the unwanted side effects of TCAs

A
  • Sedation
  • Orthostatic hypotension
  • Atropine like symptoms: dry mouth, tachycardia, urinary retention, confusion, and hallucinations
  • serotonin syndrome: flushing, rigidity, hyperthermia, coma, agitation, seizures
  • QT prolongation + arrhythmias
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4
Q

Dose and regime to initiate warfarin (AF vs DVT)

A
  • Low thrombosis risk (AF): Start with 3 mg daily, with baseline and weekly INR testing for the first two weeks.
  • High thrombosis risk (DVT): Start with 5 mg daily and concurrent LMWH (enoxaparin), with daily INR testing for the first five days.

adjust doses at least four days apart to allow for changes in steady state.

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5
Q

What medications interact with warfarin

A

Numerous medicines interact with warfarin

either by altering the INR (e.g. antibiotics) or by increasing the risk of bleeding (e.g. NSAIDs or SSRIs).

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6
Q

How to monitor lithium levels, and what do the levels indicate

A

Serum concentration should be measured five to seven days after dose initiation or dose change,** then every six months**

blood sample should be taken 12 hours after dosing.

0.6 – 0.8 mmol/L - for stable patients
0.8 – 1.0 mmol/L - for acute mania or relapse
> 1.2 mmol/L - toxic
> 2.0 mmol/L - medical emergency

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7
Q

how to withdraw a benzodiazepine?

A

The dose should be withdrawn in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight.

If experiencing difficulty switch patients to the equivalent dose of diazepam

reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg
time needed for withdrawal can vary from 4 weeks to a year or more

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8
Q

SSRI side effects

A

Sexual dysfunction 30%
gi upset 10-30%
Transient: insomnia, increased suicidal thoughts, anxiety and nausea

Discontinuation SE’s: dizziness, nausea, anxiety, vivid dreams and headache

*Paroxetine has more discontinuation Sx due to a short half life, fluoxetine has less due to a long half life

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9
Q

What is the role of buspirone

A
  • Second line medication (after antidepressants) for anxiety when other agents are contraindicated or have failed
  • lack of withdrawal symptoms, low potential for abuse / dependence and it doesnt mix with alcohol or hypnotics (unlike benzos
  • as effective as benzodiazepine for GAD (but may be less effective if pt recently used benzos
  • Special authority
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10
Q

Side effects of benzos

A

Sedation
cognitive impairment and ataxia in elderly people
amnesia
Dependence / addiction

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11
Q

First line stimulant medication for ADHD

A

methylphenidate
- Short acting: MORN + MIDDAY dosing
- Long acting: MORN (however may impact sleep)

Dexamphetamine
- MORNING DOSING ONLY

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12
Q

Side effects of stimulants methylphenidate and dexamphetime

A

Reduced appetite - can lead to weight loss and reduced height
Insomnia
Nervousness
GI sx
Tics, mood changes

Height reduction is reversible and improves once medication is stopped

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13
Q

Meds likely to cause falls

A
  • Benzos
  • Antidepressants (especially TCA’s, do not use amitriptyline in elderly**)
  • sedatives (zopis, opiods)
  • antipsychotics

Try switch amitrip to nortriptyline or an alternative agent in elderly

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14
Q

Best antipsychotics for the elderly

A

Quetiapine or risperidone

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15
Q

sedating antihistamine

A

promethazine

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16
Q

What medications can cause rhabdomyolysis w statins and why

A

statins break down muscle. These medications can inhibit the metabolism of statins (CYP3A4 inhibitor)

  • macrolides
  • oral antifungals
  • ## non-dyhydro CCBs
17
Q

Side effects of bupropion

used for smoking cessation and depression

A

Insomnia (30-40%)
dry mouth (10%)
nausea

do not use in cirrhosis, epilepsy, during drug withdrawal

18
Q

What antibiotics should be avoided in a patient on methotrexate and why

A

trimethoprim and co-trimoxazole

due to the risk of bone marrow atresia

19
Q

Contraindications to NOACs

A

Active serious bleeding
Certain bleeding-associated co-morbidities, e.g. severe thrombocytopenia or severe anaemia
History of recent high-risk bleeding event (ICH)
Pregnancy
Mechanical heart valves
Moderate-to-severe mitral stenosis
Severe liver disease

Dabi <30 CrCl
Riva <15 CrCl

20
Q

drugs that cause hyponatraemia

A

diuretics (thiazide) and SSRIs

nsaids, ACE/ARBs, antipsychotics (polydipsia)
(non specific fatigue/nausea sx)

loop diuretics can caue HYPERNa

21
Q

side effects of phosphodiesterase-5 inhibitors

A

flushed face, headaches, blocked nose, altered colour vision (mainly with sildenafil) and gastric reflux.

do not mix with nitrates for risk of large BP drop

22
Q

Oral to Subcutaneous morphine

A

2:1
the subcutaneous dose is half the oral dose

(so if converting to a syringe driver then half the total daily dose of morphine or oxycodone)

23
Q

Codeine to Morphine ratio

A

10:1

24
Q

tramadol to Morphine

A

10:1

25
Q

contraindication to triptans

A

patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

26
Q

adverse effects of triptans

A

‘triptan sensations’ - tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

27
Q

What is the long term issue with levodopa

A

effectiveness (after 2 yrs) and reliability/motor fluctuations (4-5yrs)

long term patients usually need higher doses/multiple drugs and experience motor complications and drug-induced dyskinesias.

28
Q

COCP and cancer risk

A

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

B and C, O and E

29
Q

how does allopurinol work

A

xanthine oxidase inhibitor

stops the metabolism of purines to uric acid

30
Q

Main side effects of ACEi’s

A

Dry cough - 15% of patients and may occur up to a year after starting treatment
Angioedema - up to a year post starting
Hyperkalemia
Hypotension - especially after the first dose
Renal impairment

31
Q

Main side effects of CCBs

A

Peripheral oedema
Headache and flushing
Constipation
Dizziness or lightheadedness
Bradycardia (verapamil or diltiazem)
Gingival hyperplasia

32
Q

Beta blocker common side effects

A

Fatigue and weakness
Bradycardia
Cold hands and feet
Dizziness
Shortness of breath (especially in patients with asthma or COPD)

33
Q

ARB side effects

A

hypotension
dizziness
hyperkalaemia

GPEP (27 decks)

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