Drugs for FINALS Flashcards
All drugs for finals.
Platelet plug formation
- PLT adherance
- 1a - collagen 123
- 1b - vWF + microfibrils
- 2b/3a - vWF + fibrinogen
- Monolayer, spheres, a and b granules
- ADP (Adenosine DiPhosphate), thromboxane A2 and 5HT
- Aggregation + vasoconstriction
Platelet plug inhibition
PGI2 + NO -inhibtits ADP, thomboxane A2, 5HT
vasoconstriction
Aspirin mechanism
Blocks thromboxane A2 irreversibly
Lasts life of PLT 8-9d
Aspirin COUNCILLING
- 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
Thiopyridine mechanism
Irreversibly inhibits Adenosine diphosphate (ADP)
Thiopyridine examples
- Ticlipidine
- Clopidogrel
- Prasugrel
- Ticagrelor
Clopidogrel class + mechanism
Irrevers. inhibits ADP
Prasugrel class + mechanism
Irrevers inhibits ADP
Thiopyridine COUNCILLING
- GI
- Bleeding
- Rash
- Severe hepatic impairment
Glycoprotein 2b/3a inhibitor mechanism
- Abcliximab - monoclonca AB
- Aptifibatise/ tirofiban - inhibitors
Abcliximab class + mechanism
Glycoprotein 2b/3a inhibitor
Monoclonal AB
Aptifibatise class + mechanism
Glycoprotein 2b/3a inhibitor
Tirofiban class + mechanism
Glycoprotein 2b/3a inhibitor
ACEi mechanism
BLOCK AG1 to AG2
AG2 functions;
- mass Vasoconstriction (Gq protein)
- ADH (post. pit)
- Aldosterone (adrenal cortex)
- Sympathetic
- Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
ACEi examples
PRIL
- Ramipril
- Perindopril
- Captopril
- Analapril
- Lisinopril
ACEi indications
- Hypertension (1st line)
- HF
- Renal Hypertension (1st)
ACEi COUNCILLING
- 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)
ACEi monitoring
When to stop?
BP and U+Es
- 2wks
- Annually
STOP: -Serum Cr >20% -eGFR >15%
ARBs mechanism
BLOCK AG2 receptor
AG2 functions;
- mass Vasoconstriction (Gq protein)
- ADH (post. pit)
- Aldosterone (adrenal cortex)
- Sympathetic
- Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
aka AG2 receptor antagonists
ARBs examples
SARTAN’s
- Losartan
- Candesartan
- Irbesartan
- Telmisartan
- Valsartan
ARBs indications
-2nd line to ACEi
- HF (gold has a b A dvd)
- CKD Hypertension 1st (/ACEi)
ARBs COUNCILLING
- 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)
ARBs monitoring
BP and U+Es
- 2wks
- Annually
STOP: -Serum Cr >20% -eGFR >15%
Aldosterone antagonist mechanism -also known as?
BLOCKS Aldosterone receptor
- Na/K pump (DT+CD)
- Epithelial Na channel (ENaCs)
- Secretes K+
- Secretes H+ for Na+ (regulating pH, bicarb)
Stimulated by AG2, Adrenal cortex
aka Potassium sparing diuretics
Aldosterone antag examples
Spironolactone
Eplerenone
Aldosterone antag indications
- 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)
Aldosterone antag COUNCILLING
- 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
Aldosterone antagonist monitoring
4x4wk 3x3m 6m
B blocker mechanism
Block sympathetic B-adrenergic input
- Slowing Nodal Phase 0 -ve chronotrope and Myocardial: -ve inotrope
- Systemic - lower BP
B blocker examples
- Atenolol
- Bisoprolol
- Metoprolol
- Nebivolol
- Carvedilol
B blocker indications
- 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
B blocker COUNCILLING
- 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)
CCB mechanism + types
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)
DHP CCBs examples
PINEs
- Amlodipine
- Nifedipine
- Felodipine
- Lacidipine
Non-DHP CCBs examples
- Diltiazem
- Verapamil
CCB indications
- 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)
CCB COUNCILLING
- 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
Nitrate mechanism
VASO+VENO dilation: Coronary + prevent spasm
VASO (low afterload) -VENO (low preload)
Nitrate examples
- Glyceryl trinitrate (GTN)
- Isosobide mono/ dinitrate
Nitrate indications
Angina to ACS (acutely or every 12hr)
Tolerance: Every 8hrs
Nitrate COUNCILLING
- Flushing
- Hypotension (CI)
- Headache (cerebral vasodilation)
- CI Cerebral haemorrhage
- Tolerance (take every 8hr)
- Tachycardia (CI)
- CI Containing heart disease
Potassium channel activator mechanism
Vasodilation (opens potassium channels)
- Nicorandil: has nitrate-like venodilation (reducing preload)
Potassium channel activator example
Nicorandil
Potassium channel activator indications
Angina (if failed duotherapy with Ca2+ antag + B blocker)
Potassium channel activator COUNCILLING
- Flushing
- Hypotension (CI HF)
- Headache (cerebral vasodilation)
- CI Pregnancy and breast feeding
- Anal ulceration
Loop diuretic mechanism
Inhibit Na-K-2Cl (NaKCC2) co-transporter in thick ascending loop of Henle
Loop diuretic examples
Frusemide Bumetanide
Loop diuretic indications
- HF (acute IV, chronic PO)
- CKD hypertension/ fluid retention (2ndACEi/ARB)
Loop diuretic COUNSILLING
- HYPOkalaemia
- HYPOtension
- Gout (urea absorption, cant Leap)
- Renal impairment
- Liver impairment
- Elderly (low dose)
- CI Pregnancy
- Ototoxic (frusomide)
Loop diuretic monitoring
- 2wk
- 6m
Thiazide diuretic mechanism
Inhibit NaCL co-transporter in DCT
Onset: 1-2hrs+
Compensatory Inc Ca2+ absorption by NaCa
Thiazide diuretic examples
-thiazide
- Bendroflumethiazide
- Hydrochlorothiazide
- Chlorthalidone
+Indapamide (thiazide-like)
Thiazide diuretic indications
- Hypertension 3rd line (A+C+D)
- Past: HF
Thiazide diuretic COUNCILLING
- 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
Thiazide diuretic monitoring
1m
6m
Potassium sparing diuretic mechanism
Act in DT+CD, 2 types;
- Inhibit NaK exchanger only
* Amiloride, triamterene - aka Aldosterone antagonist
- Spironolactone
- Eplerenone
Aldosterone;
- Na/K pump (DT+CD)
- Epithelial Na channel (ENaCs)
- Secretes K+
- Secretes H+ for Na+ (regulating bicarb)
Stimulated by AG2, Adrenal cortex
Potassium sparing diuretic examples
Weak NaK inhibitors
- Amiloride
- Triamterene
Aldosterone antagonists
- Spironolactone
- Eplerenone
Potassium sparing diuretic indications
- 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)
Potassium sparing diuretic COUNCILLING
- 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
Potassium sparing diuretic monitoring
4x4wk 3x3m 6m
Osmotic diuretic mechanism, example + indication
Inc osmolality: Pulls everything out
- Mannitol IV
- Urea IV
- Glycerin PO
- Isosorbide PO
CEREBRAL OEDEMA
Carbonic anhydrase inhibitors
- Mechanism
- Example
- Indication
Diuretic: Inhibit NaHCO3-
Acetazolamide
- Idiopathic Intracranial Hypertension
- Prophylaxis against mountain sickness
- Glaucoma
Class 1a antiarrhythmic
- Mechanism
- Examples
- Uses
Mechanism
- Block Myocyte Phase 0 Na+ influx (depolarisation)
- Sodium blocker
- Intermediate half life
Examples
- Quinidine
- Procainamide
- Disopyramide
Uses
- SVT, VT
Class 1b antiarrhythmic
- Mechanism
- Examples
- Uses
Mechanism
- Block Myocyte Phase 0 Na+ influx (depolarisation)
- Sodium blocker
- Fast half life/ weak
Examples
- Lidocaine
- Phenytoin
Uses
- MI associated VT
Class 1c antiarrhythmic
- Mechanism
- Examples
- Uses
Mechanism
- Block Myocyte Phase 0 Na+ influx (depolarisation)
- Sodium blocker
- Slow half life/ strong
Examples
- Flecainide
Uses
- Rhythm control
Class 2 antiarrhythmic
- Mechanism
- Examples
- Uses
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
Class 3 antiarrhythmic
- Mechanism
- Examples
- Uses
Mechanism
- Block Myocyte Phase 3 K+ efflux
- Potassium blocker
Examples + Uses
- Sotalol (2+3) - 1st Rhythm control
- Amiodarone - Rhythm control, 1st VT (stable)
Class 4 antiarrhythmic
- Mechanism
- Examples
- Uses
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.
Cardiac Glycosides
- Mechanism
- Examples
- Uses
Mechanism
- ++Parasympathetic to SA node (-chronotrope)
- ++NaCa exchange, increasing intracellular Ca and force of contraction (+inotrope)
Example + Use
- Digoxin - Rate control(2)
Adenosine
- Mechanism
- Uses
Mechanism
- Opens Nodal K+ INFLUX -> HyPERpolarisation
- Short half life
- C: Total stop
Uses
- Narrow Complex Tachy/ SVTs (stable)
- (asthmatic: Verapamil)
Magnesium Sulphate Indications
MgSO4 uses
- Torsades de Pointes
- Hypomagnesium
- Asthma: Severe Exacerbation
- Pre-Eclampsia: Severe/ neuro signs
Magnesium Sulphate
- Signs of Toxicity
- Management of Toxicity
Toxicity Signs
- Loss of reflexes ← Monitor every 4-6hrs
- Flushing
- Double vision
- Slurred speech
Treatment
- Stop MgSO4 infusion
- Calcium gluconate → relieves vascular spasm
Atropine
- Mechanism
- Uses
Mechanism
- Anti-muscarinic Inhibits parasympathetic input to NODES
Uses
- Bradycardia
IM/SC - initial M1 presynaptic block prevents reuptake⇒ bradycardia
Digoxin
- Contraindications
- Toxicity Signs
CI due to toxicity risk
- Hypokalaemia (monitor U+Es)
- Renal dysfunction
Toxicity Signs
- N+V+D
- Xanthopsia (yellow haze)
- Diplopia
- Blood digoxin >2nmol/L
B2 Agonist Mechanism (Resp)
+Adenylyl Cyclase converting ATP to cAMP
cAMP activates PKA -> Bronchodilation
B2 Agonist Examples + SEs (Resp)
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
B2 Agonist Indications (Resp)
Asthma 1st: SABA
3rd: LABA
Severe: Nebulised COPD: 1st
- SABA
- Inhaled Steroid (200-800mcg/d)
- LABA
-
+ Increase Inhaled Steroid (upto 200mcg/d)
+ Leukotriene receptor agonist
or + Theophylline (methylxanthine PDE inhibitor) - Prednisolone Tablet
Anticholinergics Mechanism (Resp)
Muscarinic antagonist Inhibit bronchial mucus secretion
Anticholinergic Examples (Resp)
- Ipratropium
- Tiotropium
Anticholinergic Indications (Resp)
Asthma Severe: Nebulised Ipratropium
COPD: 1st
Methylxanthine Mechanism (Resp)
Inhibits phosphodiesterase
STOPs cAMP to AMP conversion
Increasing cAMP -> Activates PKA -> Bronchodilations
Methylxanthine Examples + SEs (Resp)
- 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)
Methylxanthine Indications (Resp)
Asthma: 4th
COPD: 2nd
Glucocorticoid Mechanism (Resp)
Bind glucocorticoid receptor, modify gene transription;
- Inhibit COX2, cytokines, cell adhesion moleules
- Inhibit IL4,5,13 from Th2 cells
- ++anti-inflammatory genes
Glucocorticoid Examples + SEs (Resp)
- 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
Glucocorticoid Indications (Resp)
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
Anti-leukotriene Mechanism (Resp)
- Zileuton
* Inhibits 5-lipoxygenase (enzyme that converts arachidonic acid to Leukotriene A4) - Zafirlukast, Montelukast
* Inhibits CysLT1 (receptor for Leukotrienes)
Anti-leukotriene Examples + SEs (Resp)
- Zileuton (inhibits 5-lipoxygenase)
- Zafirlukast (inhibits CysLT1)
- Montelukast (inhibits CysLT1)
SEs
- Zafirlukast: Liver toxicity (any signs do ALT)
- N+V, malaise, jaundice
Anti-leukotriene Indications (Resp)
Asthma: 4th
Anti-IgE Mechanism and Example (Resp)
Omalizumab
- Humanized monoclonal anti-human IgE
- Suppressing mast cell sensitisation and degranulation
Cromone Mechanism, Example, SEs (Resp)
Sodium Cromoglicate, Nedocromil
- Stabilise Mast Cell
- 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)
Naftidrofuryl Oxalate Mechanism and Indication
Vasodilator Medical: PVD
Bigaunide
- Mechanism
- Example
- COUNCILLING
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
Sulphonylureas
- Mechanism
- Example
- Indications
- COUNCILLING
Mechanism
- Inc insulin release
Example
- Gliclazide
- Glimepiride
Indications
- 2nd line after Metformin
COUNCILLING
- HYPOglycaemia (inform DVLA)
- CI Goods drivers
Thiazolidinediones
- Mechanism
- Example
- Indication
- COUNCILLING
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
DPP-4 Inhibitors
- Mechanism
- Example
- Indications
- COUNCILLING
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
GLP-1 analogues
- Mechanism
- Example
- Indications
- COUNCILLING
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
SGLT2 inhibitors
- Mechanism
- Example
- Indications
- COUNCILLING
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
Glinides
- Mechanism
- Example
- Indications
- COUNCILLING
Mechanism
- Inc Insulin SECRETION quickly (30mins before meal)
Example - GLINIDES
- Nateglinide/ mitiglinide
Indications
- Erratic lifestyle
COUNCILLING
- Hypoglycaemia
- Weight gain
Gastroparesis management
- Metoclopramide
- Domperidone
- Erythromycin
Neuropathic pain treatment
First line;
Only 1 at a time;
- Gabapentin
- Amitriptyline (10-75mg at night)
- Pregabalan
- Duloxetine (SNRI)
Rescue therapy;
- Tramadol
Localised;
- Capsaicin topical (Axsain)
Corticosteroid
Types + Effects (not examples)
Glucocorticoid = Cortisol
- +Gluconeogenesis
- +Glycogen phosphorylase (allowing adrenaline +glycogenolysis)
- -IL2 receptor -Th2 responce (⇒Th1 dominance, and less AB production)
Mineralocorticoid = Aldosterone
- Na/K pump (DT+CD)
- Epithelial Na channel (ENaCs)
- Secretes K+
- Secretes H+ for Na+ (regulating pH, bicarb)
Corticosteroid
Examples + SEs
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
Corticosteroid
Topical Ladder
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)
B Blocker overdose management
Bradycardic: Atropine
2nd: Glucagon
Paracetamol overdose management
Kings College Hospital criteria for liver transplantation
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
- pH <7.3 24hrs after ingestion
- Or all of;
- Prothrombin time >100s
- Creatube <300umol/L
- Grade 3 or 4 encephalopathy
RA management
General ladder
- NSAID
+ Steroid to bridge gap - Combination of 2 DMARDS (Methotrexate + 1)
- Hydroxychloroquine
- Methotrexate
- Sulfasalazine
- Gold salts
- Azathioprine
- Penicillamine
- Leflunomide
- TNFa inhibitors
- Etenercept (decoy receptor for TNFa)
- Infliximab (monoclonal AB binds TNFa)
- Adalimumab (monoclonal AB)
- Rituximab (anti-CD20 B-Cell)
Hydroxychloroquine
SEs + Councilling + Monitoring
- Retinopathy due to corneal deposits: visual disturbance (annual optometrist)
- Tinnitus
- Rash + GI
Methotrexate
SEs + Councilling + Monitoring
-
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)
Sulfasalazine
SEs + Councilling + Monitoring
- Myelosuppression + Heinz-body anaemia
- Sore throat come back
- FBC 3x2wk, monthly
- Hepatotoxic
- LFTs 3x2wk, monthly
- Renal impairment
- U+Es monthly
- Azoospermia
- Rash + GI
Gold Salts
SEs + Councilling + Monitoring
- Proteinuria (nephrotic syndrome)
- Urinalysis at each injection
- Thrombocytopenia
- FBC at each injection
Azathioprine
SEs + Councilling + Monitoring
- 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
Penicillamine
SEs + Councilling + Monitoring
- Myelosuppresion
- +Aplastic anaemia
- Sore throat come back
- FBC 3x2wk, monthly
- Glomerulonephritis + Proteinuria
- U+Es + Urinalysis 3x2wk, monthly
- SLE
- CI Myasthenia Gravis exacerbation
- GI + rash
Leflunomide
SEs + Councilling + Monitoring
- Myelosuppression
- Sore throat come back
- FBC 3x2wk, monthly
- Hepatotoxic
- LFTs 3x2wk, monthly
- Interstitial lung disease
- Hypertension
- Measure at appointments
RA management in pregnancy
- Sulfasalazine + Hydroxychloroquine
- Low dose steroids
- <32wks NSAIDs
TNF inhibitor
SEs + councilling
ALL = TB reactivation
- Etanercept - demyelination
- Infliximab
- Adalimumab
Rituximab
SEs + councilling
- Infusion reactions
TB management
Two months RIPE
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol (ischiara prior)
Continuation 4 months
- Rifampicin
- Isoniazid
Latent: 6months Isoniazid
Meningeal TB: 12months + Steroids
Rifampicin
Mechanism + SEs
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
Isoniazid
Mechanism + SEs
Mechanism
Inhibits mycolic acid synthesis
SEs
- Peripheral neuropathy (prevent with pyridoxine vitamin B6)
- Hepatitis
- Agranulocytosis
- Liver enzyme inhibitor
Pyrazinamide
Mechanism + SEs
Mechanism
- Converted by pyrazinamidase to pyrazinoid acid
- Which inhibits fatty acid synthase (FAS) 1
SEs
- Hyperuricaemia + Gout
- Arthralgia
- Myalgia
- Hepatitis
Ethambutol
Mechanism + SEs
Mechanism
- Inhibits enzyme Arabinosyl transferase which polymerized arabinose into arabinan
SEs
- Optic neuritis (check visual acuity + Ishihara test)
- Low dose if renal impairment
N+V treatment in pregnancy
- Promethazine (anti-histamine)
- Ginger + P6 wrist accupuncture
Stress Incontinence
Management
- 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
- Tension-free vaginal tape (TVT)
Urge incontinence
Management
- Conservative
- Bladder retaining min 6wks (inc time between voids)
- Medical
- Antimuscarinics
- Oxybutynin
- Tolterodine (less dry mouth)
- Solifenacin
- Post-menopause: Intravaginal Oestrogens
- Antimuscarinics
- Surgical
- Neuromodulation + S3 nerve stimulation
- Botolinum toxin A injections (idiopathic only)
- Augmentation cystoplasty
Antimuscarinics
- Mechanism
- Indications
- SEs
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
