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Drugs Flashcards

1
Q

Donepazil MOA in dementia

A

Prevents breakdown of acetylycholine by inhibiting acetylcholinesterase

Increased acetylcholine helps neurons communicate better, improving cognitive symptoms in dementia

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2
Q

CI donepazil

A

Heart problems: bradycardia, SVT, sick sinus syndrome, heart block, unexplained syncope and concurrent drugs that reduce heart rate (because donepazil causes bradycardia and AV block)

Lung problems: Asthma/ COPD

Peptic Ulcers

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3
Q

Drugs used to treat idiopathic pulmonary fibrosis

A

Prifenidone - antiforbritic used as regular medication

Bleomycin - chemotherapy for acute exacerbations

Corticosteroids - acute exacerbations

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4
Q

What is the life-threatening complication of carbimazole?

What should you make patients aware of?

A

Bone marrow suppression (neutropenia)

Can occur at any stage of treatment, must immediately report symptoms of infection, including sore throat, mouth ulcers, bruising, fever, malaise or illness (you must get a FBC)

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5
Q

Which drug can cause kernicterus (bilirubin in brain) if given in the third trimester?

A

Aspirin - imapairs platelet function in fetus and causes haemorrhage

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6
Q

Levels of which asthmatic drug increase on smoking ceassation?

Why is this dangerous?

How is this managed on smoking ceassation?

A

Theophylline (smoking induced the enzyme that metobilises it)

Causes fatal arrythmias

Close blood monitoring of theophylline levels for several weeks after ceassation until steady state level reached- will need to reduce theophyline dose by 1/ 4 to 1/3

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7
Q

This class of anti-hypertensives is CI in gout

A

Thiazides

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8
Q

This anti-hypertensive is contra-indicated in urinary incontinence

A

Doxazosin

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9
Q

Which diuretics should be used in caution in asthmatics

A

BB

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10
Q

NSAIDS can do what to platelets?

A

Cause immune-mediated thrombocytopenia

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11
Q

Calcium channel blockers are contra-indicated in who?

A

Heart failure
Prior MI

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12
Q

Before prescribing enoxaparin which two lab values should be checked?

A

Platelets - under 50, reduce dose
Creatinine clearance - under 30, review dose

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12
Q

List three dopamine antagonists

A

Haloperidol
Metoclopramide
Prochlorperazine

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13
Q

Which class of drugs are contra-indicated in Parkinson’s?

List 3 examples

A

Dopamine antagonists

Metoclopramide
Promethazine
Prochlorperazine

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14
Q

Loop diuretics are toxic to which sensory organ?

A

Ears - cause tinnitus and hearing loss

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15
Q

Ciprofloxacin makes you more likely to develop this infection

A

C.diff

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16
Q

Which antibiotics are ototoxic?

List examples

A

Macrolides - azithromycin, clarithromycin, erythromicin

Aminoglycosides - gentamicin

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17
Q

NSAIDS SE

A

Ototoxic

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18
Q

COCP makes which 2 drugs less effective

A

Lisinopril

Warfarin

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19
Q

Which 2 drugs make the pill less effective

A

Rifampicin (and other rifamycins)
Carbamazepine

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20
Q

BB SE

A

Impotence
Wheeze
Fatigue
Worsening asthma

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21
Q

Amioderone SEs

A

Sun-sensitivity
Grey-blue skin
Pulmonary toxicity - fibrosis/ pneumonitis
Thyroid dysfunction (hypo and hyper thyroidism)
Abnormal LFTs
Corneal microdeposits

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22
Q

Which common drugs reduce the absorption of levothyroxine?

How do we prevent this?

A

Ferrous fumarate and antacids

Take at least 4 hours apart

23
Q

Which drugs need serum monitoring?

A

Theophylline - needs to check levels are within the therapeutic window 5 days after commencing, and 3 days after any dose adjustment

24
What can PPIs cause a false negative result of and how is this prevented?
False negative H.pylori test Stop PPIs for 2 weeks before checking for H.pylori
25
Which 5 drugs should patients be started on after an acute MI
ACEi BB 2 antiplatelets: aspirin, clopidogrel, ticagrelor Statins
26
Describe how you would monitor a patient on azthioprine and why
- On starting, FBC every week for 4 weeks - Thereafter, FBC every 3 months - Causes myelosuppression (bone marrow suppression/ pancytopenia)
27
Describe how you would monitor a patient on methotrexate and why
Weekly blood test until therapy stabilises 3 monthly FBC, LFTs and UEs Causes myelosuppression, hepatotoxicity
28
Describe amioderone monitoring before and during treatment
LFTS and TFTs and CXR before treatment LFTs and TFTs every 6 months during treatment
29
SEs amioderone?
Liver dysfunction Thyroid dysfunction Respiratory disease Skin reactions
30
Describe lithium monitoring before starting treatment
UEs FBCs TFTs ECG
31
Describe lithium monitoring during treatment
UEs - 3m TFTS - 6m Lithium levels - 3m
32
Treatment of first presentation Chron's
Prednisolone
33
What are the 4 classes of stable angina management? Describe the medical management
Lifestyle Medications: - beta blockers or calcium channel blocker are first line (second line is both) - has to be either amlodipine or modified-release nifidipine/ felodipine - because these are long acting and if you take a BB with a CCB you can get bradycardia) - aspirin - statin - GTN PCI Surgery
34
Which calcium channel blocker must never be given with a beta blocker?
Diltiazem can never be given with a beta blocker - can cause life threatening bradycardia and heart failure
35
List who cannot have aspirin
Children under 12- reye syndrome Breast-feeding mothers Severe liver impairment - increases bleeding Asthma - can exacerbate symptoms
36
Isosorbide mononitrate should not be used with this drug ... because ...
Sidenafil (viagra) - causes cardiovascular collapse
37
When a patient is on methotrexate, what must they be counselled to report and why?
Symptoms of liver, lung and bone marrow failure - Nausea, vomiting, abdominal discomfort, dark urine, stomatitis - SOB - Sore throat, bruising, mouth ulcers - If have any, need to stop treatment
38
SE of methotrexate
Photosensitivity Bone marrow suppression: low WCC/ platelets/ RBC (sore throat, bruising, mouth ulcers) Liver cirrhosis Pulmonary toxicity: SOB, cough, fever
39
Which classes of drugs should not be taken with methotrexate?
Anti-folates like trimethoprim
40
Mefloquine is associated with which group of symptoms?
Neuropsychiatric: Psychosis Hallucinations Panic attacks Convulsions
41
Loop diuretic side effects
Hyperglycemia - be aware in diabetics Hypokaleamia
42
SS digoxin toxicity
Reduced appetite Nausea Vomiting Confusion Change in yellow-green colour perception Blurred vision Fatigue Arrythmia
43
Lithium side effects and how are they managed
Hypothyroidism - which is why TFTs need to be checked before treatment and every 6m on the treatment Weight gain Acne Tremor Leukocytosis Polydipsia - nephrogenic diabetes insipidus Polyuria - nephrogenic diabetes insipidus Ankle oedema Weight gain Metallic taste in mouth Renal toxicity - check UEs before and 3 months during treatment Lithium has a narrow therapeutic window so levels need to be checked every 3 months routinely and 5 days after a dose change or on signs of toxicity
44
Metoclopramide
Oculogyric Crisis - a rare neurological condition that causes the eyes to move involuntarily and remain fixed in a position, usually upwards, can last from seconds to hours Dystonia - involuntary contractions causing abnormal postures Most common in young girls/ women and elderly Remember do not give dopamine blockers to patients with parkinsonism
45
POP CI
Acute porphyria Severe arterial disease Undiagnosed vaginal bleeding
46
COCP CI
PE/ DVT/ CVA HD HF HTN Liver disease Migraines Cancer Hx of breast cancer Diabetes Over 35 and smokes Breast feeding/ post partum Vascular disease
47
Why is aspirin CI in patients with liver disease?
All NSAIDS are CI in liver disease - make it worse
48
First line treatment of absence seizures
Ethosuximibe - women and girls mof childbearing age Men - ethosuzimibe or sodium valproate
49
Verapamil is a calcium channel blocker which must never be given with class of anti-hypertensives? Why?
Beta blockers - asystole, severe hypotension and heart failure
50
Teratogenic drugs
Carbimazole
51
Sumatriptan CI
ischaemic heart disease - MOA is vasoconstriction
52
Accutane/ Isotretinoin monitoring and why How can this be ensured?
Highly teratogenic Must confirm not preg 3 days before starting treatment Check not pregnant every month on treatment Check not pregnant 5 weeks after stopping treatment Can only give 30 pills at a time - repeat/ fax prescriptions not allowed and must be dispensed within 7 days
53
On accutane how long do you have to be on contraception What should you advise re/ contraceptive choice
Start one month before starting treatment, stop one month after stopping treatment Use 2 contraceptive methods Progesterone only methods are not effective Also advise women if become pregnant on isotretinoin or 1 month after stopping it - seek medical advice
54
which class of antibiotics should be avoided in kidney failure and which drug is the exception
Tetracyclines - they raise urea levels, cause nephrons to die and cause salt and water excretion Exception - doxycycline
55
Apart from the tetracyclines, which antibiotic should be avoided in kidney failure?
nitrofurantoin - prone to reach toxic levels, in kidney failure this occurs more readily so can develop toxic side effects like peripheral neuropathy

misra (17 decks)

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