Drugs Flashcards
Thiazides diuretics
Inhibit sodium reabsorption in distal convoluted tubule
Blocks Na/Cl transporter
Hypokalemia due to increase sodium reaching collecting ducts
Heparin
Activates anti thrombin III
Clopidogrel
P2Y12 inhibitor
Inhibits ADP mediated platelet aggregation
in ACS
SE neutropenia
Abcixima
Glycoprotein IIb/IIIa inhibitor
Dabigatran
Direct thrombin inhibitor
Rivaroxaban
Direct factor X inhibitor
Furosemide
Inhibits Na/K/Cl transporter in thick ascending loop of Henle
Act on NKCC2
Reduces absorption of NaCl
Sulfonylureas
Increase pancreas insulin secretion
SE hypos, increased appetite and weight gain
Metformin
Biguanide, improves glucose tolerance - increased insulin sensitivity, decreased hepatic gluconeogenesis, May decrease absorption carbs
SE: GI upset, lactic acidosis, diarrhoea at high dose
CI: CKD, alcoholics, tissue hypoxia
Thiazidinediones
PPAR gamma receptors
Reduce peripheral insulin resistance
SE wt gain, deranged LFTS, fluid retention (CI in HF)
Rosiglitazone CI in IHD or PAD.
Only continue it reduction >0.5 in HbA1c in 6/12
GLP1 minetics
Usually released by SI. Incredible effect
Eg exenatide
Increase insulin secretion and inhiibit glucagon
SC 60 mins before meal
SE vomiting, severe pancreatitis, renal impairment
Adenosine
Half life 8-10seconds
Acts on adenosine receptors that activate K channels in SA and AV nodes
Used in SVT (and to differentiate from VT)
- bronchospasm (NOT IN ASTHMATICS)
- anxiety
- chest tightness
- flushing
Aliskiren
Direct renin inhibitor
Use in essential HTN
SE renal impairment, hyperkalemia
Amiodarone
To control SVT and ventricular arrhythmia Iodine containing, half life 26-127days IV hours, PO days Prolongs refractory period and QT Increased affect phenytoin and warfarin
SE: arrhythmia, ataxia, alveolitis, hepatitis, hypo/hyperthyroidism, peripheral neuropathy, photosensitivity, pulmonary fibrosis, metallic taste, reversible corneal micro deposits, slate grey skin
ACE-I
Reduce mortality in HF and post MI, slow diabetic neuropathy
CI: RAS and caution in severe renal impairment
- 20% dry cough (kinins)
- angioedema
- raised potassium due to inhibition of aldosterone
ARB
Beneficial: HF, post MI, HTN, diabetic neuropathy
May precipitate acute renal failure
Angioedema less common than ace-I
Digoxin
Delays AV conduction
Use in AF to slow ventricular rate
May accumulate in renal impairment, narrow therapeutic index, risk gynaecomastia
Toxicity with amiodarone, quinine
- anorexia, n&v, arrhythmia, yellow vision, diarrhoea
ECG: reverses tick normal and 1st degree HB. Bigeminy (ectopic plus normal QRS) toxicity
Statins
Inhibit HMG Co reductase (rate limiting step in cholesterol synthesis), reduce LDL and increase cholesterol clearance and HDL
Reduce mortality after MI, Or other CVD RFs
Risk rhabdomyolysis and hepatitis
Target cholesterol <4 and LDL <2
Ivabradine
If channel (Na/K) in SA node to reduce HR Tx angina
CI: bradycardia, sick sinus syndrome, B blocker or rate limiting CCB (diltiazem, verapamil)
Nicorandil
k channel opener
Arterial vasodilation in angina
SE: headache, flushing and dizziness
In large doses hypotension and tachycardia
Thiazides
Lower BP
Dose dependent:
- low Na/K/Mg, hypochloraemjc alkalosis
- increased urate
- erratic BMs: reduced insulin release and increased resistance
- photo sensitivity, postural hypotension, impotence
Dose independent
- agranulocytosis, pancreatitis, thrombocytopenia
Carbimazole
Inhibits a perozidase that catalysed all phases of thyroid hormone production
Takes 6 weeks to work
SE: agranulocytosis at 16wls, crosses placenta (goitre and hypothyroidism)
Exenatide
Potentiates release of insulin
Acarbose
Inhibits intestinal alpha-glycosidase
Delays absorption of starch and sucrose
Reduced post prandial hyperglycaemic in T1DM and adjunct in T2DM
SE: flatus
Sitagliptin
DPP4 inhibitor
Increases insulin secretion and inhibits glucagon secretion
Sulfasazine
Sulphonamide plus 5ASA
Tx UC and in RA
SE: GI upset, oligospermia (usually reversible), orange discolouration bodily fluids
Steven Johnson syndrome, agranulocytosis, aplasia, nephrotic syndrome
Zero order kinetics
Phenytoin
Salicylates
Heparin
Ethanol
First pass metabolism
Concentration much lower once reaches systemic circulation
Aspirin, GTN, isosorbide dinitrate Propranolol Lignocaine Verapamil Isoprenaline Testosterone Hydrocortisone
Acetylator status
50% deficient in hepatic N-acetyltransferase
Isoniazid Procainamide Hydralazine Dapsone Sulfasalazine
Paracetamol OD
NAC
Salicylate OD
Haemodialysis
Benzodiazepines OD
Flumazenil - risk of seizures
Usually supportive
Tricyclics antidepressants OD
IV bicarbonate to reduce risk of seizures and arrhythmia
Dialysis
Quinidine and flecainide CI as prolong depolarisation, avoid class III as prolong QT
Lithium OD
IVF
Haemodialysis
Sodium bicarbonate to increase alkalinity of urine and promote lithium excretion
Heparin OD
Protamine sulphate
Ethylene glycol OD
Ethanol compete for alcohol dehydrogenase limiting formation of toxic metabolites
Fomepizole first line
Organophosphate insecticide
Atropine
Iron OD
Desfferioxamine, cheating agent
Cyanide poisoning
Hydroxocobalanin (amyl nitrite, sodium nitrite, sodium thiosulfate)
