DRUGS Flashcards
Examples of DMARDS?
Methotrexate and sulfasalazine
Examples of ACE inhibitors?
Rampiril (stop if renaly) impaired) and lisinopril
What can ACE inhibitors cause and what alternative medicine can be used?
A dry cough (also hyperkalaemia and hyponatraemia) and angiotensin 2 inhibitors can be used instead
What do ACE inhibitors do?
Stop angiotensin 2 being formed meaning blood vessels relax and the kidneys reabsorb less water
Examples of angiotensin 2 inhibitors?
Candersartan and valsartan
What do vasodialtors do and give examples?
Dilate blood vessels and include amlodipine and verapamil
What conditions are DMARDS used for?
Rheumatoid arthritis, Chron’s, SLE, Sjogren’s and immune thrombocytopenia
What do Beta blockers do?
They block adrenaline so the heart beats more slowly and with less force. This reduces blood pressure
Beta blocker examples?
Atenolol (not with asthma) and bisoprolol
What do GTN sprays do?
Glyceryl trinitrate relaxes and widens blood vessels in the heart
What do ACE inhibitors stop degranulation of?
Bradykinin which cause itching and a rash
Examples of calcium channel blockers?
Amlododipine, felodipine and verapamil
What does lower molecular weight heparin work?
It inhibits clotting factor Xa and thrombin
Examples of LMW heparin?
Dalteparin and tinzaparin
What is an alternative to warfarin?
Dabigatron
How does Warfarin work?
It inhibits the ability to make vitamin K dependant clotting factors
Examples of anticoagulants?
Aspirin, clopidogrel, warparin and heparin
Give examples of loop diuretic?
Furosemide and bumetanide
How do loop diuretics work?
They act on the ascending limb of the loop of Henle and inhibit Na/K/2Cl
Give an example of a thiazide diuretic?
Bendroflumethiazide
How does a thiazide work?
Acts on Na/Cl transport
Examples of K+ sparing diurectics?
Amiloride and spironolactone
Where do K+ sparing diuretics act on?
The distal convoluted tubules to inhibit sodium uptake
What is the treatment of asthma?
Short acting beta 2 then go to inhaled corticosteroids (beclomemetasone) then leukotriene receptor agonist then long acting beta agonists
What is the treatment of COPD?
SABA then if FEV>50% then give LABA then if FEV<50% then give LABA then inhaled corticosteroids
What is the treatment for cystic fibrosis?
Azithromycin to regulate the immune system and mucolytic (rhDNase), broncholiators, vitamin supplements, physiotherapy
What is the treatment of ischaemic heart disease?
Antiplatelet (aspirin, clopidogrel), statin, ACE inhibitor and a beta blocker
Acute coronary syndrome treatment?
M- morphine
O- Oxgen
N- Nitrates
A- Aspirin-300mg
Heart Failure treatment?
Diuretics, CCB (amlodipine), ACE inhibitor, beta blockers, ARB, Aldosterone inhibitor (spiranolactone) , digoxin
What does digoxin do and what is it used for?
It’s a rate controller and increases the force of contraction of the heart that is used for AF
What is general Arrhythmia treatment?
Reduce alcohol intake, digoxin, cardioversion
What is the mechanism for Ondarsetron and what is it’s use?
SHT3 antagonist and it’s a anti nausea and vomiting used during chemo
What is the treatment for thrombosis?
Thrombolytic therapy (streptokinase or altoplase), 5 days of LMWH and fondaparinux plus Rivaroxaban to reduce risk Lifestyle changes
what is the treatment for gastro oesophageal reflux disease?
Antacids, PPI -lansoprazole (4-8 weeks) then add H2 blocker
Life style changes
Examples of PPIs?
Omeprazole and lansoprazole
Anti-acid examples?
Magnesium trisilicate mixture or Gaviscon (alginates)
Treatment of ulcers?
No NSAIDs! If caused by H.Pylori use amoxicillin, clarithromycin and metronidazole, then PPI or H2RA
What is the treatment for ascites?
Restrict fluid, low salt diet, spironolactone and frusemide making sure to measure U+Es often
What is the treatment for rheumatoid arthritis?
2 DMARDs including one being methotrexate and short term glucocorticoids
What is the treatment for GOUT?
Acute= High dose NSAIDs or can use Colchicine. (If renally impaired use steroids) Prophylaxis= Allopurinol (Xanthine oxidase inhibitor)
How does the analgesic ladder work?
None opioid- eg. aspirin, paracetamol or NSAID
Weak opiod- eg. codeine and can add none opioid
Strong opiod- eg. morphineanc can add non-opioid
What are the 5 principles of pain management?
- Oral forms prefered where possible
- give at regular intervals not on demand
- Follow the principles of the ladder
- Base therapy on the patient’s needs
- closely monitor the patient
What is the treatment of epilepsy?
Focal- carbamazepine or lamotrigine
Tonic Clonic- sodium valproate or lamotrigine
Absence- sodium valproate or ethosuximide
Myoclonic- sodium valporate
Tonic or Atonic- sodium valproate or lamotrigine
What is the treatment for diabetes type 2?
1st- lifestyle, diet, exercise and weight loss
2nd- Mertformin
3rd- HbA1c>58 Metformin + 1 of DPP4 inhibitor, piglitazone, sulphonylurea or SGLT-2i
4th- Metformin + usually sulphonylurea + 1 more
Treatment of Graves disease?
Beta blocker to correct pulse then carbimazole to correct thyroid (can get hypothyroid so give levothyroxine.
Treatment of hypothyroidism?
Healthy + young= levothyroxine
Old + IDH= levothyroxine precipitates angina so give 25mg at a time
Treatment of eczema?
Emollients, topical corticosteroids, soft clothing, avoid triggers, avoid overheating and manage stress
Example of short acting beta agonist?
salbutamol
Example of a long acting beta agonist?
salmeterol and formoterol
Examples of corticosteroids?
Prednisolone, methylprednisolone, dexamethasone
What are leukotriene receptor antagonist used for and what is an example?
Asthma and an example is zileuton
Anti-IgE example and use?
Omalizumab used for extreme asthma
How do corticosteroids work?
They upregulate anti-inflam genes and down regulate pro-inflam genes
How do statins work?
They inhibit HMG CoA Reductase so the liver makes less cholesterol
What 4 drugs are used to treat TB?
Rifampicin, Isoniazid, Pyrazinamide and Ethambutol
What side effects do these drugs have?
Rifampicin- Hepatitis
Isoniazid- peripheral neuropathy or hepatitis
Pyrazinamide- hepatitis
Ethambutol- Optic neuritis
What most commonly causes tonsillitis?
A virus but if it is bacterial it is often strep pyogenes
What’s an example of a H2 blocker?
Rantidine
What should be given with methodrexate?
The contraceptive pill
What does Rituximab do?
It attaches to CD20 on B cells
What does an antiemetic do?
Reduces nausea and vomitting
What antibiotic should be used in pregnancy for UTIs?
Trimethoprin
What is a prodrug?
Metabolised to form an active agent
Where does elimination occur?
Via the kidneys, biliary circulation and the lungs
What is the clearance equation?
Clearance= rate of appearance in urine/plasma concetration
What do cholinergic receptors do?
Para- rest and digest
What do adrenergic pharmacology do?
Sympathetic- fight or flight
What do alpha 1 receptors do?
Cause vasoconstriction in the skin, kidneys and brain
Sphincter contraction bladder and GI
What do alpha 2 receptors do?
Inhibit nor adrenaline release by negative feedback
Where do beta 1 receptors work on?
HEART and renin from kidneys
What is a beta 1 blocker?
Propanolol
Where do beta 2 receptors effect?
The bronchi causing relaxation and fight or flight areas
What is an example of a beta 2 agonist?
Salbutamol
How dies a potassium sparing diuretic work?
It inhibits aldosterone
How do statins work?
Inhibit HMG-CoA reductase and increases the number of LDL receptors in the liver
What is used as rate control in AF?
Beta blockers like atenolol and bisoprolol
What does digoxin do?
Decreases heart rate and controls AF
Who shouldn’t have aspirin and clopidogrel?
Children and those with asthma
Can cause GI irritation
When are thromboytic used?
Before 4.5 hours of a thrombotic stroke and within 120 mins of a STEMI with no PCI
What is better about low, molecular weight heparin?
It is more bio available and a longer half life
How is LMW heparin removed?
Renally so dose based on creatinine clearance
Examples of factor Xa inhibitor?
RivaroXAban and edoXAban
What are the side effects of beta 2 adrenergic agonists?
Tremor, tachycardia and hypokalaemia
What is a short acting muscarinic receptor antagonist?
Ipratropium bromide
What is a long acting muscarinic receptor antagonist?
Tiatropium bromide
What is an inhaled corticosteroid?
Beclometasone
What are issues with magnesium salts?
The are ant acids but cause diarrhoea
What is an issue with aluminium salt antacids?
Cause constipation
What are types of antiemetics?
5-HT3 receptor antagonists
H1 receptor antagonists
Muscarinic antagonists
Dopamine receptor antagonist
What is an example of a laxative?
Lactulose or magnesium sulphate
What can help with IBS
Hyoscine butylbromide- spasmolytics
What is the drug treatment for IBD?
Prednisolone
Aminosalicylates like sulfasalazine
DMARDs- methotrexate
TNF- alpha blockers- Infliximab