Drugs Flashcards
How can you treat endometriosis
NSAIDs for pain, Norethisterone or COCP (4 packets run together),
Secondary Care-Danazol and GnRH agonists, Surgery.
How do you treat fibroids
Tranexamic Acid, COCP/LARCs
- Clomiphene
Ovulatory stimulant - causes ovulation to happen
how do you treat hyperprolactinaemia
Bromocriptine which is a dopamine agonist
Alpha 1 adrenergic blocker
- Tamulosin
- • This is an antagonist to the alpha 1 receptor, this causes the smooth muscle to relax and allow the outflow of the urine from the bladder, improves urine outflow
5 alpha reductase inhibitors
- Finasteride
- Dutasteride
- can reduce the amount of growth in the prostate
- these inhibit 5 alpha reductase which is responsible for the conversion of testosterone into DHT
- DHT drives the proliferation of the epithelial cells so without this apoptosis commences as there is now a less high ratio between DHT and oestradiol allowing apoptosis to be driven
How does viagra work
It inhibits PDE5 therefore slowing the breakdown of cGMP
Phosphodiesterase type 5 inhibitor. o Sildenafil (Viagra) o Vardenafil (Levitra) o Taladafil (Cialis)
- Takes 20-60 minutes and lasts for 6 hours
How do you treat peryronies disease
o Non-surgical
Stretching – break down sar tissue
Para-aminobenzoate – b vitamin that you can take and rub on, increases oxygen to the penis and improves the scar tissue
Topical verapamil
o surgical
how do you manage VZV
- prevention
- varicella zoster immunoglobulin (post exposure)
- vaccination (pre exposure)
Treatment (val) acyclovir – safe during pregnancy
What is the treatment of toxoplasmosis
- spyramicin, pyrimethamine/sulfadiazine/folinic acid
* depends on trimester
How do you treat syphilis
- Penicillin
What do you give someone who has group b streptocoosus during labour
• Benzylpenicillin in labour
How do you treat urinary tract infections
- Penicillins
- Cephalosporins
- Nitrofurantoin
- BE CAREFUL – trimethoprim teratogenic therefore avoided in the first weeks of pregnancy
What is the treatment of chylmydai and gonnorhea
• Azithromycin (tetracyclines are teratogenic)
How do you manage failure to progress in labour
Powers – ‘uterine inertia’
= give Syntocinon judiciously – artificial oxytoxcin, 3 to 4 in 10 lasting a minute each
Passenger – ‘malpresentation’ or ‘malposition’
= consider ECV/ rotational forceps or ventouse delivery/ Caesarean section
Passages – ‘contracted pelvis’ or ’rigid cervix’
= Caesarean section
list the uterotonics that can be used and what with
- Syntometrine – drug that is commonly used (made up of oxytocin and ergometrine)
IVI syntocinon 40units in 500ml over 4 hours – drug that causes the uterus to contract (sometimes used in labour)
PGE1 misoprostol 800mg PR - give 4 or 5 tablets into the rectum and this can cause the uterus to go into contraction
PGF2α carboprost 250mcg IM - this causes the uterus to go into contraction, can give 8 doses every 15 minutes in order to control the bleeding
Give IV/IM ergometrine 500 mcg - this causes vasoconstriction
How do you control fits
Loading Dose: MgSO4 (8mls + 12mls saline) over 20 minutes
Maintenance Dose: 1-2g MgSO4/hr (20 + 30).
o Maintain for 24 hours post-delivery.
Therapeutic Levels: 2-4mmol/litre.
What are the potential targets for neuroprotection
- Decrease energy depletion - increase glucose, use hypothermia and barbiturates.
- Glutamate (inhibition of release). = via calcium channel blockers, magnesia, adenosine, hypothermia, free radical scavengers
- Inhibition of leukocyte/microglial/cytokine effects. = hypothermia, free radical synthesis inhibitors
• Blockage of downstream cellular events.
o Free radical synthesis inhibitors
o Free radic
what is the prevention dn treatment of GBS
• Main principles of prevention of vertical transmission
– Intrapartum antibiotic prophylaxis to women who show carriage during screening in pregnancy
– Other risk factors
• Treatment
– Benzylpenicillin with amikacin or gentamicin
how do you treat hypoglycaemia in small for gestational age babies
Feeds
Bolus of dextrose + IV infusion if very low glucose
what antibiotics can you give for GBS, E.coli and listeria
- for older children
- and young infants les than 3 months old
• Older children – Ceftriaxone – covers all 3 • Young infants (<3 months old) – Cefotaxime or ceftriaxone – Amoxicillin (penicillin derivate) also needed for Listeria cover
How do you treat empyema caused by pneumoccoal
- use a chest drain and urokinase
- use video assistant thoracoscopic surgery (VATS)
What are the two vaccinations used for pneumococcal
- Pneumococcal Polysaccharide Vaccine (PPV) = adults
* Pneumococcal Conjugate Vaccine (PCV). = children
How do you treat candida and ring worm
Treat both with topical antifungal (nystatin).
how do you treat candidaemia
- IV anti fungal treatment
what are the treatments of malaria
- Artemisinin
- Combination treatment (eg Coartem: artemether-lumefantrine)
- More rapid reduction in parasitaemia
How do you treat retinoblastoma
- small tumours = cryotherapy, laser therapy or thermotherapy is used
- in more advanced tumours - chemotherapy, surgery and radiation is used
- Systemic or intraocular chemotherapy can be used to shrink tumours before cryotherapy or laser therapy
what is the treatment for a neuroblastoma
- Surgery, chemotherapy, radiation therapy
- High risk disease – high dose chemotherapy and stem cell transplantation
- Targeted therapy – crizotinib against ALK mutations
- Immunotherapy
What is the treatment for acute lymphoblastic leukaemia
• Patients stratified into risk groups according to clinical, biological and genetic features
• Therapies of varying intensities applied to different risk groups
• Standard treatment phases:
-Induction (e.g.Vincristine, Corticosteroid, L-asparaginase, Anthracycline)
- Consolidation; CNS directed treatment(e.g.Cyclophosphamide, Cytarabine, Mercaptopurine, Methotrexate; Dexamethasone)
- Maintenance(e.g. Mercaptopurine, Methotrexate) - Bone marrow transplantation
How to you treat consitpation
- use high dose laxatives or enemas to clear out then use maintenance therapy Maintenance therapy • Softener – Movicol (PEG 4000) • Stimulant – Senna or picosulphate • Rectal washout - Enemas/Peristeem
what is the medical treatment of GORD
- most do not need treatment
- positioning of the infant while eating
- thickening of food
- reduce acids using H1 antagonists, proton pump inhibitors
- promotility agents such as domperidone can be used
what is the surgical treatment of GORD
- Jejunostomy feeds
- Nissen’s fundoplication. - this is when you wrap the stomach around the base of the oesophagus therefore preventing food from going back up
what is the treatment of eosinophilic oesophagitis
• Dietary
o Food exclusions
o Pragmatic trials.
- Oral budesonide
- Monteleukast.
what is the treatment for h.pylori
- triple therapy
- use 2 antibiotics amoxycillin and clarithromycin for 2 weeks
- and a proton pump inhibitors or H2 antagonists such as laproprozole
- then repeat the stool test for HP antigen 3/12 after treatment to ensure it has gone
how do you induce remission in IBD
• Exclusive enteral nutrition (Chron’s)
o Reduce inflammation
o Correct undernutrition
o 6/52 of milk based formula
- Steroids
- 5-ASA
- Biologicals (e.g. anti-TNF infliximab).
what is the pharmacological treatment of ADHD
- Offer methylphenidate (either short or long acting) as the first line pharmacological treatment for children aged 5years and over and young people with ADHD
- Consider switching to lisdexamfetamine (prodrug version of methylphenidate)
How do you manage idiopathic short stature
• Administration of GH
• Oxandrolone - anabolic steroid used for a long time and extradites growth but doesn’t increase adult height
o Very little change in most cases.
who does NICE recommend be given somatostatin as treatment
Have growth hormone deficiency.
Have Turner syndrome.
Have Prader-Willi syndrome.
Have chronic kidney disease.
Are born small for gestational age with subsequent growth failure at 4 years of age or later.
Have short stature homeobox-containing gene (SHOX) deficiency
How do you treat disseminated HSV
- IV Aciclovir
How do you treat CMV
For babies with symptomatic disease:
- IV ganciclovir (requires a central line) or oral valganciclovir (pro-drug of ganciclovir) – inhibits DNA synthesis
How do you reduce the risk of HepB transmission at birth
- give Hep B virus vaccine at birth and then at 1 month of age
- and HBIG as well (hepatitis B immunoglobulin)
What is the treatment for bronchiolitis
Palivizumab (monoclonal Ab) for RSV prophylaxis - given monthly as an injection to high risk babies which prevents them from getting RSV infection
what vaccines can now be used for rotavirus
RotaTeq
RotaRix (included in UK schedule since 2013
What is the treatment of chlamydia trachomatis
Azithromycin, Doxycycline
How do you manage genital warts
Vaccination
Management
- Topical podophyllotoxon, imiquimod
- Cryotherapy - freeze them of
What is the treatment of HSV
Aciclovir
Famciclovir - prodrugs
Valaciclovir - prodrugs
What is the treatment of syphlis
Penicillin - injections
Doxycycline - for allergic to penicillin, slightly less efficous
what makes up HAART treatment
- protease inhibitors
- integrase inhibitors
- nucleoside reverse transcriptase inhibiters
- fusion inhibitors
- Non-Nucleoside RT inhibitor
