Drugs Flashcards
What other drug should be prescribed if BB are being used for hypertension in phaeochromocytoma?
Phenoxybenzamine - to reduce risk of hypertensive crisis
When is esmolol used?
Cardioselective, short duration of action.
Supraventricular arrhythmias, sinus tachycardia or hypertension.
When is sotalol used?
Non-cardioselective
Prophylaxis in paroxysmal supraventricular arrhythmias.
Suppression of ventricular ectopic beats and non-sustained ventricular tachycardia.
Which are the water-soluble BB?
Atenolol
Celiprolol
Nadolol
Sotalol
What is an advantage of water-soluble BB?
Less likely to cross BBB, so less likely to cause sleep disturbance + nightmares.
What is a disadvantage of water-soluble BB?
Excreted by kidney.
Dose reduction required in renal impairment.
Which BBs cause less bradycardia and coldness of the extremities due to intrinsic sympathomimetic activity?
Celiprolol
Pindolol
Aceburolol
Oxprenolol
Which BB have a longer duration of action so can have OD dosing?
Atenolol
Bisoprolol
Celiprolol
Nadolol
Which BB are cardioSELECTIVE (not specific) ?
Atenolol
Bisoprolol
Metoprolol
Nebivolol
What are 9 BB side effects?
Fatigue Bradycardia GI disturbance Dry eyes Erectile dysfunction Coldness of extremities Sleep disturbance/nightmares Hypoglycaemia / hyperglycaemia Masked symptoms of hypoglycaemia.
When are BB contraindicated (10)?
Second/third degree heart blocks Uncontrolled diabetes Uncontrolled HF Asthma Bradycardia Metabolic acidosos Severe peripheral arterial disease Phaeochromocytoma Sick sinus syndrome Prinzmetal's angina
What should you monitor before starting amiodarone?
Thyroid function (T3, T4 and TSH)
LFT
Potassium
Chest x-ray
What should you monitor when using amiodarone?
Thyroid functions tests (every 6 months)
LFT (every 6 months)
IV use - ECG monitoring
What are SEs of amiodarone?
Skin reactions Corneal microdeposits Thyroid function changes Hepatotoxicity Pulmonary toxicity
What should you counsel the patient when prescribed amiodarone?
Phototoxicity
Driving impairment (dur to corneal microdeposits)
When prescribed concurrently with sofosbuvir - know signs of bradycardia and heart block.
What is the most common SE of verapamil?
Constipation
What are common SE associated with dihydropyridine CCBs?
Flushing, headache, ankle oedema.
Which are rate limiting CCB?
Verapamil
Diltiazem
Which are dihydropyridine CCBs?
Amlodipine, felodipine, nimodipine, lacidipine etc.
What are 3 MHRA alerts associated with bisphosphonates?
- Risk of atypical femoral fractures - pts should report thigh, hip or groin pain.
- Osteonecrosis of the jaw (higher risk with IV in cancer pts) - should have dental check ups
- Osteonecrosis of the external auditory canal - associated with long term therapy (>2 years). Risk factors: steroid use, chemotherapy, infection, ear operation, cotton-bud use. Report any pain or discharge from ear.
What are 5 counselling points for bisphosphonates?
Atypical femoral fractures
Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate.
Osteonecrosis of the jaw
During bisphosphonate treatment patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms.
Osteonecrosis of the external auditory canal
Patients should be advised to report any ear pain, discharge from ear or an ear infection during treatment with a bisphosphonate.
Dizziness can occur - warn about skilled tasks
Oesophageal reactions: stop taking and see doctor if dysphagia, heatburn, pain on swallowing etc. Stand/sit up for 30 mins after taking, take 30 mins before breakfast.
