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drugs Flashcards

1
Q

cardiac arrest –> dose of amiodarone

A

300 mg

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2
Q

amiodarone

A

Treatment of arrhythmias, particularly when other drugs are ineffective or contra-indicated
Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation (for cardiopulmonary resuscitation)

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3
Q

Statins Adverse effects

A

myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase
liver impairment
avoiding statins in patients with a history of intracerebral haemorrhage

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4
Q

Statin contra-indication

A

macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course
pregnancy

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5
Q

statin dose

A

atorvastatin 20mg for primary prevention
increase the dose if non-HDL has not reduced for >= 40%
atorvastatin 80mg for secondary prevention

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6
Q

Statins should be taken at

A

night as this is when the majority of cholesterol synthesis takes place. This is especially true for simvastatin which has a shorter half-life than other statins.

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7
Q

ivabradine

A

Inhibits funny channels so slows pacemaker in SA node
lowers HR
and reduces myocardial O2 demand

used for angina and HF

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8
Q

sacubitril-valsartan

A

is a Neprilysin inhibitor, inhibits breakdown of natriuretic peptide (ANP, BNP) bradykinin and substance P
this results in increase in diuresis, natriuresis, and vasodilation
used for symptomatic HF with reduced ejection fraction

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9
Q

digoxin

A

is a cardiac glycoside that increases the force of myocardial contraction and reduces conductivity within AV node

used for AF/flutter and HF

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10
Q

hydralazine

A 
Moderate to severe hypertension (adjunct)
Heart failure (with long acting nitrate)
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11
Q

ursodeoxycholic acid

A

first-line: Primary biliary cholangitis
mechanisms include the improvement of bile acid transport

Dissolution of gallstones

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12
Q

cholestyramine

A

Bile acid sequestrants act by binding bile acids, preventing their reabsorption; this promotes hepatic conversion of cholesterol into bile acids; the resultant increased LDL-receptor activity of liver cells increases the clearance of LDL-cholesterol from the plasma.

use for: Hyperlipidaemias
Pruritus associated with partial biliary obstruction and primary biliary cirrhosis (for pruritus)

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13
Q

carbimazole

A

Carbimazole is used in the management of thyrotoxicosis. It is typically given in high doses for 6 weeks until the patient becomes euthyroid before being reduced.

Mechanism of action
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

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14
Q

carbimazole adverse effects

A

Adverse effects
agranulocytosis
crosses the placenta, but may be used in low doses during pregnancy

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15
Q

propylthiouracil

A

management of thyrotoxicosis

also has a peripheral action by inhibiting 5’-deiodinase which reduces peripheral conversion of T4 to T3

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16
Q

Verapamil

A

calcium channel blocker
indications: Angina, hypertension, arrhythmias

Highly negatively inotropic

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17
Q

Verapamil side effects & cautions

A 
Should not be given with beta-blockers as may cause heart block
Heart failure, 
constipation, 
hypotension, 
bradycardia, 
flushing
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18
Q

Diltiazem

A

calcium channel blocker

indications: Angina, hypertension

Less negatively inotropic than verapamil but caution should still be exercised when patients have heart failure or are taking beta-blockers

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19
Q

Diltiazem side effects & cautions

A

Hypotension,
bradycardia,
heart failure,
ankle swelling

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20
Q

Nifedipine, amlodipine, felodipine

dihydropyridines

A

calcium channel blocker

indications: Hypertension, angina, Raynaud’s

Affects the peripheral vascular smooth muscle more than the myocardium and therefore do not result in worsening of heart failure but may therefore cause ankle swelling

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21
Q

Nifedipine, amlodipine, felodipine
(dihydropyridines)
side effects & cautions

A

Flushing,
headache,
ankle swelling

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22
Q

Metformin side effects

A

Gastrointestinal side-effects
Lactic acidosis

metformin is associated with an increased risk of lactic acidosis and therefore should be suspended when there is risk eg. dehydration, sepsis, CT with contrast, renal failure, heart failure; particularly if the patient is frail or elderly.

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23
Q

Sulfonylureas (Gliclazide) side effects

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic

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24
Q

Glitazones side effects

Pioglitazone

A 
Weight gain
Heart failure
Fluid retention
Liver dysfunction
Fractures (osteoporosis)
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25
Q

Gliptins side effects

A

Pancreatitis

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26
Q

Severe lithium toxicity is an indication for

A

haemodialysis

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27
Q

Adverse effects of heparins include

A
  • bleeding
  • thrombocytopenia - see below
  • osteoporosis and an increased risk of fractures
  • hyperkalaemia - this is thought to be caused by inhibition of aldosterone secretion
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28
Q

Furosemide

A

inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle

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29
Q

Loop diuretics adverse effects

A 
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
30
Q

Azithromycin prophylaxis is recommended in

A

COPD patients who meet certain criteria and who continue to have exacerbations

31
Q

Amoxicillin is usually the first-line antibiotic in the management of

A

infective exacerbations of COPD.

32
Q

Atropine

A

antimuscarinic (anticholinergic)
used to treat the symptoms of low heart rate (bradycardia), reduce salivation and bronchial secretions before surgery or as an antidote for overdose of cholinergic drugs or mushroom poisoning

33
Q

Never combine B blockers with ..?…. because can increases the risk of cardiovascular adverse effects

A

Verapamil
b/c used for the treatment of angina, hypertension, and arrhythmias. It is a highly negatively inotropic calcium channel-blocker and it reduces cardiac output, slows the heart rate, and may impair atrioventricular conduction

It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers.

also Diltiazem is predicted to increase the risk of cardiodepression when given with bisoprolol.

34
Q

Cimetidine

A

histamine H₂ receptor antagonist that inhibits stomach acid production
For peptic ulcers

35
Q

Dabigatran can be reversed by using

A

idarucizumab

36
Q

Andexanet alfa

A

is a recombinant form of factor Xa, used for reversing bleeding in patients taking rivaroxaban or apixaban.

37
Q

Protamine sulphate

A

is used as a reversal agent in patients bleeding on heparin, enoxaparin or dalteparin.

38
Q

Vitamin K is used for reversal of

A

a raised INR from warfarin

39
Q

Dabigatran is an oral anticoagulant that works by

A

being a direct thrombin inhibitor

40
Q

Carvedilol

A

is a mixed alpha- and beta-blocker. It is also used for hypertension and angina, as well as playing a role in the management of chronic heart failure

41
Q

Metoclopramide is a

A

D2 receptor antagonist* mainly used in the management of nausea. Other uses include:
gastro-oesophageal reflux disease
prokinetic action is useful in gastroparesis secondary to diabetic neuropathy
often combined with analgesics for the treatment of migraine (migraine attacks result in gastroparesis, slowing the absorption of analgesics)

42
Q

canagliflozin, dapagliflozin and empagliflozin.

are

A

SGLT-2 inhibitors

43
Q

SGLT-2 inhibitors side effects

A

Important adverse effects include
urinary and genital infection (secondary to glycosuria). Fournier’s gangrene has also been reported
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored

44
Q

Pirfenidone

A

is an anti-fibrotic. It can be used in idiopathic pulmonary fibrosis.

45
Q

Minimal glucocorticoid activity, very high mineralocorticoid activity,

A

Fludrocortisone

46
Q

Glucocorticoid activity, high mineralocorticoid activity,

A

Hydrocortisone

47
Q

Predominant glucocorticoid activity, low mineralocorticoid activity

A

Prednisolone

48
Q

Very high glucocorticoid activity, minimal mineralocorticoid activity

A

Dexamethasone

Betmethasone

49
Q

Glucocorticoid side-effects

A

endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome: moon face, buffalo hump, striae
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts
suppression of growth in children
intracranial hypertension
neutrophilia

50
Q

Mineralocorticoid side-effects

A

fluid retention

hypertension

51
Q

the BNF suggests gradual withdrawal of systemic corticosteroids if patients have: received more than

A

0mg prednisolone daily for more than one week, received more than 3 weeks treatment or recently received repeated courses

52
Q

antibiotic for Exacerbations of chronic bronchitis

A

Amoxicillin or tetracycline or clarithromycin

53
Q

antibiotic for Uncomplicated community-acquired pneumonia

A

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

54
Q

antibiotic for Pneumonia possibly caused by atypical pathogens

A

Clarithromycin

55
Q

antibiotic for Hospital-acquired pneumonia

A

Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

56
Q

antibiotic for Lower urinary tract infection

A

trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin

57
Q

antibiotic for Acute pyelonephritis

A

Broad-spectrum cephalosporin or quinolone

58
Q

antibiotic for Acute prostatitis

A

Quinolone or trimethoprim

59
Q

Orlistat

A

a lipase inhibitor, reduces the absorption of dietary fat.
Adjunct in obesity (in conjunction with a mildly hypocaloric diet in individuals with a body mass index (BMI) of 30 kg/m2 or more or in individuals with a BMI of 28 kg/m2 or more in the presence of other risk factors such as type 2 diabetes, hypertension, or hypercholesterolaemia)

120 mg up to 3 times a day, dose to be taken immediately before, during, or up to 1 hour after each main mea

60
Q

Icatibant

A

Acute attacks of hereditary angioedema in patients with C1-esterase inhibitor deficiency

61
Q

tranexamic acid

A

Prevention and treatment of significant haemorrhage following trauma
Hereditary angioedema
Menorrhagia

62
Q

Rifaximin

A

non-absorbable gut specific antibiotic which changes gut flora (Used as second line for Hepatic encephalopathy)

63
Q

orlistat. It should only be prescribed as part of an overall plan for managing obesity in adults who have:

A

BMI of 28 kg/m^2 or more with associated risk factors, or
BMI of 30 kg/m^2 or more
continued weight loss e.g. 5% at 3 months
orlistat is normally used for < 1 year

64
Q

Ondansetron

A

specific 5HT3-receptor antagonist
for nausea and vomiting
for Moderately emetogenic chemotherapy or radiotherapy

65
Q

metoclopramide

A

dopamine antagonist
Symptomatic treatment of nausea and vomiting
Metoclopramide stimulates gut motility

66
Q

Tamoxifen

A

is a SERM which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer.

67
Q

Tamoxifen Adverse effects

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

68
Q

Anastrozole and letrozole

A

are aromatase inhibitors that reduces peripheral oestrogen synthesis. This is important as aromatisation accounts for the majority of oestrogen production in postmenopausal women and therefore anastrozole is used for ER +ve breast cancer in this group.

69
Q

Anastrozole and letrozole Adverse effects

A 
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
70
Q

icatibant

A

inhibits bradykinin

for the symptomatic treatment of acute attacks in patients with hereditary angioedema

Medicine (3 decks)

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