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Finals > Drugs for FINALS > Flashcards

Drugs for FINALS Flashcards

All drugs for finals.

1
Q

Platelet plug formation

A
  1. PLT adherance
  • 1a - collagen 123
  • 1b - vWF + microfibrils
  • 2b/3a - vWF + fibrinogen
  1. Monolayer, spheres, a and b granules
  • ADP (Adenosine DiPhosphate), thromboxane A2 and 5HT
  • Aggregation + vasoconstriction
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2
Q

Platelet plug inhibition

A

PGI2 + NO -inhibtits ADP, thomboxane A2, 5HT

vasoconstriction

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3
Q

Aspirin mechanism

A

Blocks thromboxane A2 irreversibly

Lasts life of PLT 8-9d

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4
Q

Aspirin COUNCILLING

A
  • GI: nausea, bleeds (prophylactic PPI)
  • Bronchospasm - 20% asthmatics
  • Children: Reye’s syndrome
  • Gout (cant leAp)
  • Ototoxic
  • Anticoagulants: bleed
  • Antidepressants: bleed [SSRI, Venlafaxin SSNRI - inhibit 5HT from PLTs)
  • Cytotoxic drugs : low excretion of methotrexate
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5
Q

Thiopyridine mechanism

A

Irreversibly inhibits Adenosine diphosphate (ADP)

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6
Q

Thiopyridine examples

A
  • Ticlipidine
  • Clopidogrel
  • Prasugrel
  • Ticagrelor
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7
Q

Clopidogrel class + mechanism

A

Irrevers. inhibits ADP

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8
Q

Prasugrel class + mechanism

A

Irrevers inhibits ADP

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9
Q

Thiopyridine COUNCILLING

A
  • GI
  • Bleeding
  • Rash
  • Severe hepatic impairment
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10
Q

Glycoprotein 2b/3a inhibitor mechanism

A
  • Abcliximab - monoclonca AB
  • Aptifibatise/ tirofiban - inhibitors
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11
Q

Abcliximab class + mechanism

A

Glycoprotein 2b/3a inhibitor

Monoclonal AB

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12
Q

Aptifibatise class + mechanism

A

Glycoprotein 2b/3a inhibitor

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13
Q

Tirofiban class + mechanism

A

Glycoprotein 2b/3a inhibitor

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14
Q

ACEi mechanism

A

BLOCK AG1 to AG2

AG2 functions;

  1. mass Vasoconstriction (Gq protein)
  2. ADH (post. pit)
  3. Aldosterone (adrenal cortex)
  4. Sympathetic
  5. Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
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15
Q

ACEi examples

A

PRIL

  • Ramipril
  • Perindopril
  • Captopril
  • Analapril
  • Lisinopril
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16
Q

ACEi indications

A
  • Hypertension (1st line)
  • HF
  • Renal Hypertension (1st)
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17
Q

ACEi COUNCILLING

A
  • Dry Cough 1/10
  • First-dose hypotention (start at night)
  • +Diuretics/ RAAS – enhances hypotensive effects
  • HYPERkalaemia (CI +K supplements/ drugs)
  • Angioedema (stop)/ CI Hx
  • GI
  • Rash (switch, stop)
  • Teratogenic
  • Renal impairment (stop if Cr >inc>30%/ eGFR dec>25%)
  • CI Renovascular disease
  • CI Valvular stenosis
  • +Lithium toxicity
  • +Ciclosporin ARF
  • +NAIDS (reduce efficacy)
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18
Q

ACEi monitoring

When to stop?

A

BP and U+Es

  • 2wks
  • Annually

STOP: -Serum Cr >20% -eGFR >15%

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19
Q

ARBs mechanism

A

BLOCK AG2 receptor

AG2 functions;

  1. mass Vasoconstriction (Gq protein)
  2. ADH (post. pit)
  3. Aldosterone (adrenal cortex)
  4. Sympathetic
  5. Renal NaCL reabsorption (hence water) + K+ excretion (tubules)

aka AG2 receptor antagonists

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20
Q

ARBs examples

A

SARTAN’s

  • Losartan
  • Candesartan
  • Irbesartan
  • Telmisartan
  • Valsartan
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21
Q

ARBs indications

A

-2nd line to ACEi

  • HF (gold has a b A dvd)
  • CKD Hypertension 1st (/ACEi)
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22
Q

ARBs COUNCILLING

A
  • First-dose hypotention (start at night)
  • +Diuretics/ RAAS – enhances hypotensive effects
  • HYPERkalaemia (CI +K supplements/ drugs)
  • Angioedema (stop)/ CI Hx
  • GI
  • Rash (switch, stop)
  • Teratogenic
  • Renal impairment (stop if Cr >inc>30%/ eGFR dec>25%)
  • CI Renovascular disease
  • CI Valvular stenosis
  • +Lithium toxicity
  • +Digoxin fluctuations (candesartan)
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23
Q

ARBs monitoring

A

BP and U+Es

  • 2wks
  • Annually

STOP: -Serum Cr >20% -eGFR >15%

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24
Q

Aldosterone antagonist mechanism -also known as?

A

BLOCKS Aldosterone receptor

  1. Na/K pump (DT+CD)
  2. Epithelial Na channel (ENaCs)
  3. Secretes K+
  4. Secretes H+ for Na+ (regulating pH, bicarb)

Stimulated by AG2, Adrenal cortex

aka Potassium sparing diuretics

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25
Q

Aldosterone antag examples

A

Spironolactone

Eplerenone

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26
Q

Aldosterone antag indications

A
  • HF (gold has aba Dvd)
    • Post-MI HF
  • Hypertension (step 4. K+ <4.5)
  • Ascites (cirrhotic pts develop 2ndary hyperaldosteronism)
  • Nephrotic syndrome
  • Conn’s syndrome (excess aldosterone and low K+ from adrenal cortex)
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27
Q

Aldosterone antag COUNCILLING

A
  • HYPERkalaemia (low K diet)
    • CI K+ >4.5 (hyperK = >5.5)
    • Risk: ACEi/ ARBs/ supplements
  • CI Addison’s disease
  • Renal (anuria) (CI, Cr >220half, >310stop)
  • Hepatic failure (CI, stop)
  • GI
  • Gynaecomastia (spironolactone progesterone effects)
  • Menstrual irregularities
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28
Q

Aldosterone antagonist monitoring

A

4x4wk 3x3m 6m

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29
Q

B blocker mechanism

A

Block sympathetic B-adrenergic input

  1. Slowing Nodal Phase 0 -ve chronotrope and Myocardial: -ve inotrope
  2. Systemic - lower BP
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30
Q

B blocker examples

A
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Nebivolol
  • Carvedilol
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31
Q

B blocker indications

A
  • Carvedilol - HF
  • Sotalol (2+3) - 1st Rhythm control
  • Atenolol - 1st Rate control, MI, Stable Angina(4th), SVT(3rd)
  • Bisoprolol - Stable Angina (4th)
  • Metoprolol - Stable Angina (4th)
  • Propanolol - Migraine prophyl, Anxiety, Thyrotoxicosis
  • Last stage of hypertension
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32
Q

B blocker COUNCILLING

A
  • Bradycardia (CI 2/3HB, sick sinus)
  • Hypotension (CI uncontrolled HF)
  • GI
  • Cold-extreminies (CI Reynauds, PVD)
  • Bronchospasm (CI asthma)
  • Sleep disturbance, nightmares (water-soluble)
  • CI +Verapamil (severe brady)
  • +Thiazide (insulin resistance, monitor)
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33
Q

CCB mechanism + types

A

Inhibit Calcium ‘SLOW’ channels

Dihydropyridine (DHP) = vascular smooth muscle

  • Peripheral vasodilation, Low BP, Low afterload

non-DHP = Myocardium and conduction system

  • Nodal Phase O (-ve chronotrope)
  • Myocyte Phase 2 (-ve inotrope)
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34
Q

DHP CCBs examples

A

PINEs

  • Amlodipine
  • Nifedipine
  • Felodipine
  • Lacidipine
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35
Q

Non-DHP CCBs examples

A
  • Diltiazem
  • Verapamil
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36
Q

CCB indications

A
  • Hypertension (DHP: 1st >55/ black: Amlopidine)
  • Rate control (nonDHP: Diltiazem>Verapamil)
  • Angina 4th (nonDHP: Diltiazem, Verapamil)
    • Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker)
  • Reynauds (Nifedipine + Diltiazem)
  • Cluster prophyl (Verapamil)
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37
Q

CCB COUNCILLING

A
  • Non-DHP: Bradycardia (CI 2/3HB, sick sinus)
  • Hypotension (CI uncontrolled HF)
  • GI (Verapamil: Constipation)
  • Flushing
  • Ankle oedema (reduce or +ACEi/ARB)
  • Gingival hyperplasia
  • CI Non-DHP +B-blocker (severe brady)
  • CI +Grapefruit juice
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38
Q

Nitrate mechanism

A

VASO+VENO dilation: Coronary + prevent spasm

VASO (low afterload) -VENO (low preload)

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39
Q

Nitrate examples

A
  • Glyceryl trinitrate (GTN)
  • Isosobide mono/ dinitrate
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40
Q

Nitrate indications

A

Angina to ACS (acutely or every 12hr)

Tolerance: Every 8hrs

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41
Q

Nitrate COUNCILLING

A
  • Flushing
  • Hypotension (CI)
  • Headache (cerebral vasodilation)
  • CI Cerebral haemorrhage
  • Tolerance (take every 8hr)
  • Tachycardia (CI)
  • CI Containing heart disease
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42
Q

Potassium channel activator mechanism

A

Vasodilation (opens potassium channels)

  • Nicorandil: has nitrate-like venodilation (reducing preload)
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43
Q

Potassium channel activator example

A

Nicorandil

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44
Q

Potassium channel activator indications

A

Angina (if failed duotherapy with Ca2+ antag + B blocker)

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45
Q

Potassium channel activator COUNCILLING

A
  • Flushing
  • Hypotension (CI HF)
  • Headache (cerebral vasodilation)
  • CI Pregnancy and breast feeding
  • Anal ulceration
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46
Q

Loop diuretic mechanism

A

Inhibit Na-K-2Cl (NaKCC2) co-transporter in thick ascending loop of Henle

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47
Q

Loop diuretic examples

A

Frusemide Bumetanide

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48
Q

Loop diuretic indications

A
  • HF (acute IV, chronic PO)
  • CKD hypertension/ fluid retention (2ndACEi/ARB)
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49
Q

Loop diuretic COUNSILLING

A
  • HYPOkalaemia
  • HYPOtension
  • Gout (urea absorption, cant Leap)
  • Renal impairment
  • Liver impairment
  • Elderly (low dose)
  • CI Pregnancy
  • Ototoxic (frusomide)
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50
Q

Loop diuretic monitoring

A
  • 2wk
  • 6m
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51
Q

Thiazide diuretic mechanism

A

Inhibit NaCL co-transporter in DCT

Onset: 1-2hrs+

Compensatory Inc Ca2+ absorption by NaCa

52
Q

Thiazide diuretic examples

A

-thiazide

  • Bendroflumethiazide
  • Hydrochlorothiazide
  • Chlorthalidone

+Indapamide (thiazide-like)

53
Q

Thiazide diuretic indications

A
  • Hypertension 3rd line (A+C+D)
  • Past: HF
54
Q

Thiazide diuretic COUNCILLING

A
  • HYPOkalaemia
  • HYPOtension
  • Gout (urea absorption, canT leap)
  • Renal impairment
  • Liver impairment
  • Elderly (low dose)
  • CI Pregnancy
  • HYPERcalcaemia
  • HYPERglycaemia + Insulin resistance (I pre-/DM)
  • +B-Blocker = Insulin insensitivity (monitor DM)
  • RARE;
  • Thrombocytopaenia
  • Agranulocytosis
55
Q

Thiazide diuretic monitoring

A

1m

6m

56
Q

Potassium sparing diuretic mechanism

A

Act in DT+CD, 2 types;

  1. Inhibit NaK exchanger only
    * Amiloride, triamterene
  2. aka Aldosterone antagonist
  • Spironolactone
  • Eplerenone

Aldosterone;

  1. Na/K pump (DT+CD)
  2. Epithelial Na channel (ENaCs)
  3. Secretes K+
  4. Secretes H+ for Na+ (regulating bicarb)

Stimulated by AG2, Adrenal cortex

57
Q

Potassium sparing diuretic examples

A

Weak NaK inhibitors

  • Amiloride
  • Triamterene

Aldosterone antagonists

  • Spironolactone
  • Eplerenone
58
Q

Potassium sparing diuretic indications

A
  • HF (gold has aba Dvd)
    • Post-MI HF
  • Hypertension (step 4. K+ <4.5)
  • Ascites (cirrhotic pts develop 2ndary hyperaldosteronism)
  • Nephrotic syndrome
  • Conn’s syndrome (excess aldosterone and low K+ from adrenal cortex)
59
Q

Potassium sparing diuretic COUNCILLING

A
  • HYPERkalaemia (low K diet)
    • CI if K+ >4.5 (hyperK = >5.5)
    • Risk: ACEi/ ARBs/ supplements
  • Addison’s disease CI
  • Renal (anuria) (CI, Cr >220half, >310stop)
  • Hepatic failure (CI, stop)
  • GI
  • Gynaecomastia (spironolactone progesterone effects)
  • Menstrual irregularities
60
Q

Potassium sparing diuretic monitoring

A

4x4wk 3x3m 6m

61
Q

Osmotic diuretic mechanism, example + indication

A

Inc osmolality: Pulls everything out

  • Mannitol IV
  • Urea IV
  • Glycerin PO
  • Isosorbide PO

CEREBRAL OEDEMA

62
Q

Carbonic anhydrase inhibitors

  • Mechanism
  • Example
  • Indication
A

Diuretic: Inhibit NaHCO3-

Acetazolamide

  • Idiopathic Intracranial Hypertension
  • Prophylaxis against mountain sickness
  • Glaucoma
63
Q

Class 1a antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Intermediate half life

Examples

  • Quinidine
  • Procainamide
  • Disopyramide

Uses

  • SVT, VT
64
Q

Class 1b antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Fast half life/ weak

Examples

  • Lidocaine
  • Phenytoin

Uses

  • MI associated VT
65
Q

Class 1c antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 0 Na+ influx (depolarisation)
  • Sodium blocker
  • Slow half life/ strong

Examples

  • Flecainide

Uses

  • Rhythm control
66
Q

Class 2 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block sympathetic adrenergic input
  • Slowing Nodal Phase 0
  • B-blockers

Examples + Uses

  • Carvedilol - HF Sotalol (2+3) - 1st Rhythm control
  • Atenolol - Rate control, MI, Stable Angina (4th), SVT (3rd)
  • Bisoprolol - Stable Angina (4th)
  • Metoprolol - Stable Angina (4th)
  • Propanolol - Migraine prophyl
  • Last stage of hypertension
67
Q

Class 3 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Block Myocyte Phase 3 K+ efflux
  • Potassium blocker

Examples + Uses

  • Sotalol (2+3) - 1st Rhythm control
  • Amiodarone - Rhythm control, 1st VT (stable)
68
Q

Class 4 antiarrhythmic

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  • Non-DHP Calcium ‘SLOW’ channels
  • Nodal Phase O (-ve chronotrope)
  • Myocyte Phase 2 (-ve inotrope)

Examples + Uses

  • Rate control (Diltiazem> Verapamil)
  • SVT(2nd)/ asthmatic (Verapamil)
  • Angina 4th (Diltiazem, Verapamil)
  • Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker)
  • Reynauds (Diltiazem + DHP: Nifedipine)
  • Cluster prophyl (Verapamil)

DHP CCB are not Class 4 antiarrhythmics.

69
Q

Cardiac Glycosides

  • Mechanism
  • Examples
  • Uses
A

Mechanism

  1. ++Parasympathetic to SA node (-chronotrope)
  2. ++NaCa exchange, increasing intracellular Ca and force of contraction (+inotrope)

Example + Use

  • Digoxin - Rate control(2)
70
Q

Adenosine

  • Mechanism
  • Uses
A

Mechanism

  • Opens Nodal K+ INFLUX -> HyPERpolarisation
  • Short half life
  • C: Total stop

Uses

  • Narrow Complex Tachy/ SVTs (stable)
    • (asthmatic: Verapamil)
71
Q

Magnesium Sulphate Indications

A

MgSO4 uses

  • Torsades de Pointes
  • Hypomagnesium
  • Asthma: Severe Exacerbation
  • Pre-Eclampsia: Severe/ neuro signs
72
Q

Magnesium Sulphate

  • Signs of Toxicity
  • Management of Toxicity
A

Toxicity Signs

  • Loss of reflexes ← Monitor every 4-6hrs
  • Flushing
  • Double vision
  • Slurred speech

Treatment

  • Stop MgSO4 infusion
  • Calcium gluconate → relieves vascular spasm
73
Q

Atropine

  • Mechanism
  • Uses
A

Mechanism

  • Anti-muscarinic Inhibits parasympathetic input to NODES

Uses

  • Bradycardia

IM/SC - initial M1 presynaptic block prevents reuptake⇒ bradycardia

74
Q

Digoxin

  • Contraindications
  • Toxicity Signs
A

CI due to toxicity risk

  • Hypokalaemia (monitor U+Es)
  • Renal dysfunction

Toxicity Signs

  • N+V+D
  • Xanthopsia (yellow haze)
  • Diplopia
  • Blood digoxin >2nmol/L
75
Q

B2 Agonist Mechanism (Resp)

A

+Adenylyl Cyclase converting ATP to cAMP

cAMP activates PKA -> Bronchodilation

76
Q

B2 Agonist Examples + SEs (Resp)

A

SABA: Salbutamol, Terbutaline

LABA: Salmeterol, Formoterol

SABA Overuse

  • Tremor, headache, muscle cramps, palpitations
  • HyPOkalaemia
  • Myocardial ischaemia?

LABA ⇒ Above + Increase asthma-related adverse events

  • Do not start before Steroid, and do not stop Steroid while on LABA
77
Q

B2 Agonist Indications (Resp)

A

Asthma 1st: SABA

3rd: LABA

Severe: Nebulised COPD: 1st

  1. SABA
  2. Inhaled Steroid (200-800mcg/d)
  3. LABA
  4. + Increase Inhaled Steroid (upto 200mcg/d)
    + Leukotriene receptor agonist
    or + Theophylline (methylxanthine PDE inhibitor)
  5. Prednisolone Tablet
78
Q

Anticholinergics Mechanism (Resp)

A

Muscarinic antagonist Inhibit bronchial mucus secretion

79
Q

Anticholinergic Examples (Resp)

A
  • Ipratropium
  • Tiotropium
80
Q

Anticholinergic Indications (Resp)

A

Asthma Severe: Nebulised Ipratropium

COPD: 1st

81
Q

Methylxanthine Mechanism (Resp)

A

Inhibits phosphodiesterase

STOPs cAMP to AMP conversion

Increasing cAMP -> Activates PKA -> Bronchodilations

82
Q

Methylxanthine Examples + SEs (Resp)

A
  • Theophylline
  • Aminophylline
  • Therapeutic plasma concentration = 10-20mg/L

SEs

  • N+V
  • Tremor
  • Palpitations + Arrythmias

Increased serum levels

  • HF + Hepatic failure
  • Elderly
  • P450 inhibitors (cimetidine, ciprofloxacin, erythromycin)

Decreased serum levels

  • P45 inducers (phenytoin, carbamazepine, rifampicin)
83
Q

Methylxanthine Indications (Resp)

A

Asthma: 4th

COPD: 2nd

84
Q

Glucocorticoid Mechanism (Resp)

A

Bind glucocorticoid receptor, modify gene transription;

  • Inhibit COX2, cytokines, cell adhesion moleules
  • Inhibit IL4,5,13 from Th2 cells
  • ++anti-inflammatory genes
85
Q

Glucocorticoid Examples + SEs (Resp)

A
  • Inhaled: Beclometasone, Fluticasone, Budesonide
    • Ciclesonide (pressurized MDI), Mometasone (dry-powder inhaler)
  • Oral: Prednisolone, Hydrocortisone

Inhaled Local SEs

  • Oral candidiasis, sore mouth, dysphonia, hoarseness
  • Reduced using large-volume spacer (filters)
  • +Wash mouth after use

Inhaled Systemic SEs

  • Osteoporosis (exercise, calcium, stop smoking)
  • HPA suppression

Inhaled Child Systemic SEs

  • Initial slowing, final height not affects
  • >100ug/d ⇒ Growth suppression + Adrenal crisis
  • Very rare: Hyperactivity, behavioural problems, sleep, anxiety, depression

Oral (especially >3m/ frequent)

  • Central obesity + Weight gain
  • UUUN face
  • Skin - thin, easy bruising, acne, hirsutism
  • HyPERglycaemia + DM + HyPERtension
  • Insufficient muscles (proximal weakness)
  • Neck buffalo + supraclavicular lump
  • Gonadal dysfunction +Glaucoma/ Cateracts
  • Osteoporosis
  • Immunosuppresion + Infections
  • Depression
86
Q

Glucocorticoid Indications (Resp)

A

Chronic asthma

  • 2nd: Inhaled Low-Dose 200ug twice daily (Beclometasone)
    • <12: 100ug twice daily
  • 5th: Oral Prenisolone

Acute asthma

  • Prednisolone tablet 40mg (max 60mg) for 5d
    or IV hydrocortisone (preferably Sodium Succinate) 100mg slow IV bolus if severe or more
  • Prednisolon daily dose
    or Hydrocortisone 6hrly
  • Discharge: Oral steroids 5d
    +add inhaled steroid to regular medication

COPD: 2nd Beclometasone

87
Q

Anti-leukotriene Mechanism (Resp)

A
  1. Zileuton
    * Inhibits 5-lipoxygenase (enzyme that converts arachidonic acid to Leukotriene A4)
  2. Zafirlukast, Montelukast
    * Inhibits CysLT1 (receptor for Leukotrienes)
88
Q

Anti-leukotriene Examples + SEs (Resp)

A
  • Zileuton (inhibits 5-lipoxygenase)
  • Zafirlukast (inhibits CysLT1)
  • Montelukast (inhibits CysLT1)

SEs

  • Zafirlukast: Liver toxicity (any signs do ALT)
    • N+V, malaise, jaundice
89
Q

Anti-leukotriene Indications (Resp)

A

Asthma: 4th

90
Q

Anti-IgE Mechanism and Example (Resp)

A

Omalizumab

  • Humanized monoclonal anti-human IgE
  • Suppressing mast cell sensitisation and degranulation
91
Q

Cromone Mechanism, Example, SEs (Resp)

A

Sodium Cromoglicate, Nedocromil

  1. Stabilise Mast Cell
  2. Inhibit Sensory Nerves (blocks Cl- channel)

Used regularly 4/d (not reliever)

Dry-powder Sodium Cromoglicate may cause bronchospasm (use SABA a few minutes prior to use)

92
Q

Naftidrofuryl Oxalate Mechanism and Indication

A

Vasodilator Medical: PVD

93
Q

Bigaunide

  • Mechanism
  • Example
  • COUNCILLING
A

Mechanism

  • Inc insulin sensitivity

Example

  • Metformin

COUNCILLING

  • Nausea (titrate dose up)
  • Lactic acidosis (monitor renal function)
    • Serm Cr >150
    • eGFR <30
  • NO angiography
    • High risk of contract induced nephropathy
    • Stop on the day + 48hrs
94
Q

Sulphonylureas

  • Mechanism
  • Example
  • Indications
  • COUNCILLING
A

Mechanism

  • Inc insulin release

Example

  • Gliclazide
  • Glimepiride

Indications

  • 2nd line after Metformin

COUNCILLING

  • HYPOglycaemia (inform DVLA)
    • CI Goods drivers
95
Q

Thiazolidinediones

  • Mechanism
  • Example
  • Indication
  • COUNCILLING
A

Mechanism

  • Inc insulin sensitivity

Example

  • Pioglitazone - bladder cancer
  • Rosiglitazone (no longer used - CV affects)

Indication

  • 3rd line: HbA1C >7.5% or >58mmol/L

COUNCILLING

  • Weight gain + fracture
  • Liver impairment (monitor LFTs)
  • Fluid retention (CI in HF)
    • Insulin = Peripheral oedema
96
Q

DPP-4 Inhibitors

  • Mechanism
  • Example
  • Indications
  • COUNCILLING
A

Mechanism

  • Inhibits DPP-4 ⇒ Inc Incretins
  • Inhibit Glucagon ⇒ Inc INSULIN

Example - GLIPTINS

  • Sitagliptin

Indications

  • Only used with other drugs (1,2,3)
  • 4th line
  • Only continue if HbA1C drops 0.5%/6m

COUNCILLING

  • GI
  • Flu-like symptoms
  • Rare: Acute Pancreatitis
  • Rare: Hypoglycaemia
97
Q

GLP-1 analogues

  • Mechanism
  • Example
  • Indications
  • COUNCILLING
A

Mechanism

  • mimics Incretin
  • Inhibit Glucagon ⇒ Inc INSULIN

Example

  • Exenatide SUBCUTANEOUS

Indications

  • Only used with other drugs (1,2,3)
  • BMI >35kg/m2 or Can’t do insulin
  • 5th line

COUNCILLING

  • GI
  • Dizziness, headache, jittery
  • Rare: Acute pancreatitis
  • Rare: Hypoglycaemia
98
Q

SGLT2 inhibitors

  • Mechanism
  • Example
  • Indications
  • COUNCILLING
A

Mechanism

  • Increase renal excretion of GLUCOSE

Example - GLIFLOZIN

  • Dopagliflozin

Indications

  • Only used with something else (any drug or insulin) (NOT with 1+2 together!)

COUNCILLING

  • UTIs
99
Q

Glinides

  • Mechanism
  • Example
  • Indications
  • COUNCILLING
A

Mechanism

  • Inc Insulin SECRETION quickly (30mins before meal)

Example - GLINIDES

  • Nateglinide/ mitiglinide

Indications

  • Erratic lifestyle

COUNCILLING

  • Hypoglycaemia
  • Weight gain
100
Q

Gastroparesis management

A
  • Metoclopramide
  • Domperidone
  • Erythromycin
101
Q

Neuropathic pain treatment

A

First line;

Only 1 at a time;

  • Gabapentin
  • Amitriptyline (10-75mg at night)
  • Pregabalan
  • Duloxetine (SNRI)

Rescue therapy;

  • Tramadol

Localised;

  • Capsaicin topical (Axsain)
102
Q

Corticosteroid

Types + Effects (not examples)

A

Glucocorticoid = Cortisol

  1. +Gluconeogenesis
  2. +Glycogen phosphorylase (allowing adrenaline +glycogenolysis)
  3. -IL2 receptor -Th2 responce (⇒Th1 dominance, and less AB production)

Mineralocorticoid = Aldosterone

  1. Na/K pump (DT+CD)
  2. Epithelial Na channel (ENaCs)
  3. Secretes K+
  4. Secretes H+ for Na+ (regulating pH, bicarb)
103
Q

Corticosteroid

Examples + SEs

A

High Minero-

  • Fludrocortisone
  • Hydrocortisone
  • Prednisolon
  • DXM + Betmethasone

High Gluco-

SEs

High Glucocorticoid (ie Cushings)

  • Central obesity +Weight gain
  • UUUN face
  • Skin - thin, easy bruising, acne, hirsutism
  • HyPERglycaemia + DM + HyPERtension
  • Insufficient muscles (proximal weakness)
  • Neck buffalo + supraclavicular lump
  • Gonadal dysfunction +Glaucoma/ Cateracts
  • Osteoporosis
  • Immunosuppresion + Infections
  • Depression

High Mineralocorticoid (ie Conns)

  • Hypertension + Fluid retension
  • HYPOkalaemia
    • Hypotonia, Hyporeflexia, Tetany
    • Muscle weakness + Cramps
    • Palpitations
104
Q

Corticosteroid

Topical Ladder

A

Mild

  • Hydrocortisone 1%
  • Fucidin H
  • Timodine
  • Synalar 1:10

Moderate

  • Clobetasone butyrate Eumovate
  • Alcometasone diproprionate (Modrasone)
  • Trimovate

Potent

  • Betamethasome valerate (Betnovate)
  • Mometasone furoate (Elocon)
  • Hydrocortisone butyrate (Locoid)
  • Fluocinolone acetonide (Synalar)

Very Potent

  • Clobestasol propionate (Dermovate)
105
Q

B Blocker overdose management

A

Bradycardic: Atropine

2nd: Glucagon

106
Q

Paracetamol overdose management

Kings College Hospital criteria for liver transplantation

A

Treat with Acetylecysteine IV over 1 hour if;

  • Over the Treatment Line on normgram
    100mg/L at 4hr ⇒ 15mg/L at 15hrs
  • Staggered (>1hr) overdose or Doubt about timing

Kings College Hospital criteria

  1. pH <7.3 24hrs after ingestion
  2. Or all of;
    1. Prothrombin time >100s
    2. Creatube <300umol/L
    3. Grade 3 or 4 encephalopathy
107
Q

RA management

General ladder

A
  1. NSAID
    + Steroid to bridge gap
  2. Combination of 2 DMARDS (Methotrexate + 1)
    • Hydroxychloroquine
    • Methotrexate
    • Sulfasalazine
    • Gold salts
    • Azathioprine
    • Penicillamine
    • Leflunomide
  3. TNFa inhibitors
    • Etenercept (decoy receptor for TNFa)
    • Infliximab (monoclonal AB binds TNFa)
    • Adalimumab (monoclonal AB)
  4. Rituximab (anti-CD20 B-Cell)
108
Q

Hydroxychloroquine

SEs + Councilling + Monitoring

A
  • Retinopathy due to corneal deposits: visual disturbance (annual optometrist)
  • Tinnitus
  • Rash + GI
109
Q

Methotrexate

SEs + Councilling + Monitoring

A
  • Myelosuppression
    • Sore throat come back
    • FBC 3x2wk, monthly
  • Hepatotoxic
    • LFTs 3x2wk, monthly
    • Stop: ALT doubles or >80
  • Renal impairment
    • U+Es 3monthly
  • Teratogenic
    • Dont get pregnant
  • Low folate
    • 5mg Folic acid on non-methotrexate day
  • Pneumonitis & Fibrosis
  • Rash + GI

CI

  • +Trimethoprim (low folate)
  • +NSAIDs (inhibits excretion)
110
Q

Sulfasalazine

SEs + Councilling + Monitoring

A
  • Myelosuppression + Heinz-body anaemia
    • Sore throat come back
    • FBC 3x2wk, monthly
  • Hepatotoxic
    • LFTs 3x2wk, monthly
  • Renal impairment
    • U+Es monthly
  • Azoospermia
  • Rash + GI
111
Q

Gold Salts

SEs + Councilling + Monitoring

A
  • Proteinuria (nephrotic syndrome)
    • Urinalysis at each injection
  • Thrombocytopenia
    • FBC at each injection
112
Q

Azathioprine

SEs + Councilling + Monitoring

A
  • Myelosuppression
    • Sore throat come back
    • FBC 6x1wk ⇒ 3x2wk, monthly
  • Liver impairment
    • LFTs 6x1wk ⇒ 3x2wk, monthly
  • Renal impairment
    • ​U+Es 3monthly
  • Teratogenic
    • Dont get pregnant
  • Basal Cell Carcinoma
  • Lymphoma
  • Azoospermia
  • GI + rash
113
Q

Penicillamine

SEs + Councilling + Monitoring

A
  • Myelosuppresion
    • +Aplastic anaemia
    • Sore throat come back
    • FBC 3x2wk, monthly
  • Glomerulonephritis + Proteinuria
    • U+Es + Urinalysis 3x2wk, monthly
  • SLE
  • CI Myasthenia Gravis exacerbation
  • GI + rash
114
Q

Leflunomide

SEs + Councilling + Monitoring

A
  • Myelosuppression
    • Sore throat come back
    • FBC 3x2wk, monthly
  • Hepatotoxic
    • LFTs 3x2wk, monthly
  • Interstitial lung disease
  • Hypertension
    • Measure at appointments
115
Q

RA management in pregnancy

A
  • Sulfasalazine + Hydroxychloroquine
  • Low dose steroids
  • <32wks NSAIDs
116
Q

TNF inhibitor

SEs + councilling

A

ALL = TB reactivation

  • Etanercept - demyelination
  • Infliximab
  • Adalimumab
117
Q

Rituximab

SEs + councilling

A
  • Infusion reactions
118
Q

TB management

A

Two months RIPE

  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol (ischiara prior)

Continuation 4 months

  • Rifampicin
  • Isoniazid

Latent: 6months Isoniazid

Meningeal TB: 12months + Steroids

119
Q

Rifampicin

Mechanism + SEs

A

Mechanism

  • Inhibit DNA dependent RNA polymerase preventing transcription of DNA into mRNA

SEs

  • Potent liver enzyme inducer
  • Hepatitis
  • Orange secretions
  • Flu-like symptoms
  • Inactivates OCP
120
Q

Isoniazid

Mechanism + SEs

A

Mechanism

Inhibits mycolic acid synthesis

SEs

  • Peripheral neuropathy (prevent with pyridoxine vitamin B6)
  • Hepatitis
  • Agranulocytosis
  • Liver enzyme inhibitor
121
Q

Pyrazinamide

Mechanism + SEs

A

Mechanism

  • Converted by pyrazinamidase to pyrazinoid acid
  • Which inhibits fatty acid synthase (FAS) 1

SEs

  • Hyperuricaemia + Gout
  • Arthralgia
  • Myalgia
  • Hepatitis
122
Q

Ethambutol

Mechanism + SEs

A

Mechanism

  • Inhibits enzyme Arabinosyl transferase which polymerized arabinose into arabinan

SEs

  • Optic neuritis (check visual acuity + Ishihara test)
  • Low dose if renal impairment
123
Q

N+V treatment in pregnancy

A
  1. Promethazine (anti-histamine)
  2. Ginger + P6 wrist accupuncture
124
Q

Stress Incontinence

Management

A
  • Conservative
    • Loos weight, address cough
    • Pelvic floor muscle training 3m physio
    • Vaginal ‘cones’/ sponges
  • Medical
    • Duloxetine SNRI - enhances sphincter control via CNS
  • Conservative
    • Tension-free vaginal tape (TVT)
      [over pubis]
    • Trans-obturator tape (TOT)
      [through obturator foramen]
    • Injectable periurethral bulking agents
125
Q

Urge incontinence

Management

A
  • Conservative
    • Bladder retaining min 6wks (inc time between voids)
  • Medical
    • Antimuscarinics
      • Oxybutynin
      • Tolterodine (less dry mouth)
      • Solifenacin
    • Post-menopause: Intravaginal Oestrogens
  • Surgical
    • Neuromodulation + S3 nerve stimulation
    • Botolinum toxin A injections (idiopathic only)
    • Augmentation cystoplasty
126
Q

Antimuscarinics

  • Mechanism
  • Indications
  • SEs
A

Mechanism - block muscarinic acetylcholine receptors

Indications

  • Bradycardia
    • Atropine (blocks M2 parasym to SA node)
    • IM/SC: initial M1 presynaptic block prevents reuptake⇒ bradycardia
  • Urge incontinence
    • Oxybutynin
    • Tolteradine
    • Solifenacin
  • Bronchodilators
    • Ipratropium bromide
    • Triotropium
  • Parkinsonism - tremor + rigidity
    • Procyclidine
    • Benztropine
    • Trihexyphenidyl (benzhexol)
  • Anti-psychotic drug extra-pyramidal SEs
    • Procyclidine
  • IBS anti-spasmodic (only works on bowel muscle)
    • Mebeverine
    • Alverine

Finals (23 decks)

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