Drugs summary - difficult things Flashcards
indication of furosemide
OVERLOAD - e.g. pulmonary oedema, CHF, renal/liver disease, oedema
contra-indication of both loop and thiazide diuretics
gout (decreases uric acid secretion)
3 other contraindications of furosemide
hepatic encephalopathy
low potassium and sodium
hypovolaemia
ENT side effect of furosemide
tinnitus
what drug interacts with all diuretics
digoxin (decreases potassium levels)
what drug interacts with both loop and potassium sparing diuretics
lithium
3 other drugs interacting with furosemide
aminoglycosides
lidocaine
phenytoin
indication of thiazides
hypertension (if not with CCB, or alongside CCB/ACEi/ARB)
when to use thiazides instead of CCB for hypertension
oedema or HF
2 side effects of thiazides
arrhythmias (low Na+/K+)
male impotence
2 interactions of thiazides (apart from digoxin)
NSAIDs loop diuretics (low K+)
side effect of amiloride (potassium sparing - use for low K+)
androgen effects
interaction of amiloride (apart from digoxin and lithium)
drugs increasing K+ e.g. aldosterone antagonists
effect of beta blockers on renin secretion
decreases
3 indications of beta blockers
anything with high heart rate e.g. SVT, AF
heart disease e.g. IHD, angina, ACS, CHF
high BP second line
big contraindication of beta blockers
ASTHMA
what type of beta blocker can’t you use for COPD
propanolol (can use B1 selective ones)
side effect of beta blockers that is the same as thiazides
male impotence
5 cardiovascular drugs which are excreted by liver (others are solely by kidneys)
beta blockers nitrates (GTN) antidysrhythmics (amiodarone) warfarin statins
interaction of beta blockers
CCBs = asystole, bradycardia
3 examples of CCBs
amlodipine
diltiazem
verpamil
3 indications of CCBs
hypertension
stable angina (or beta blockers)
SVT/atrial flutter
4 contraindications of CCBs
HF
heart block
unstable angina
severe aortic stenosis (SAME as nitrates)
side effect of verpamil
constipation
2 side effects of all CCBs AND nitrates (GTN, ISM)
oedema
flushing
2 CCBs not to prescribe with beta blockers
diltiazem
verpamil
4 indications of ACEis and ARBs
hypertension
IHD
diabetic nephropathy
CKD
3 contraindications of ACEis and ARBs
renal artery stenosis
AKI
pregnant/breastfeeding
2 interactions of ACEis and ARBs
potassium increasing drugs e.g. amiloride
NSAIDs (increase renal failure risk)
how are nitrates similar to CCBs
both decrease Ca2+
3 indications of nitrates
angina + prophylaxis
ACS
pulmonary oedema
2 drugs to give for pulmonary oedema alongside nitrates
furosemide
O2
2 contraindications for nitrates
severe aortic stenosis
hypotension
interaction of nitrates
phosphodiesterase inhibitors e.g. sildenafil = increase hypotension
elimination of nitrates apart from LIVER
RBCs
vascular wall
example of a cardiac glycoside (decrease heart rate)
digoxin
2 indications of digoxin
AF/flutter (monotherapy in paroxysmal AF) severe HF (3rd line)
other drugs to give with digoxin for severe HF
beta blockers
ACEis/ARBs
4 contraindications of digoxin
2nd degree heart block
renal failure
decreased K+/Mg2+
increased Ca2+
2 side effects of digoxin (apart from ones associated with lower HR)
rash
yellow vision
3 interactions of digoxin
loop/thiazide/K+ sparing diuretics (decrease K+)
amiodarone
CCBs
what is amiodarone
antidysrhythmic
indication of amiodarone
tachycardias
3 contraindications of amiodarone
hypotension (because it lowers BP)
heart block
thyroid disease
4 side effects of amiodarone
pneumonitis
hepatitis
photosensitivity
thyroid problems
3 interactions of amiodarone
digoxin
CCBs (diltiazem and verapamil)
grapefruit juice
what NOT to treat AF with
warfarin (use antiplatelets/anticoagulants instead)
can you use antiplatelets in pregnancy
not in third trimester
2 side effects of aspirin
bronchospasm
tinnitus
4 interactions of clopidogrel
cP450 inhibitors
aspirin
heparin
NSAIDs
what is enoxaparin
LMWH
indication of LMWH
VTE
indication of LMWH and fondaparinux
ACS
3 contraindications of heparins
clotting disorders
uncontrolled hypertension
renal impairment
2 indications of warfarin
VTE
fake heart valve
when not to use warfarin
AF
arterial thrombosis
can you use warfarin in pregnancy
not in first trimester
interaction of warfarin
cP450 inhibitors and inducers
can you use statins in pregnancy
no
why can statins increase LFTs
e.g. ALT - eliminated by liver
3 interactions of statins
cP450 inhibitors
amlodipine (accumulation)
grapfruit (like amiodarone)
indication of beta 2 agonists apart from asthma and COPD
hyperkalaemia
what to use LABA (salmeterol, formeterol) with
corticosteroids
why are beta 2 agonists contraindicated in CVD
tachycardia = AF?
2 side effects of beta 2 agonists
symptoms of increased HR
increased glucose/lactate
2 interactions of beta 2 agonists
beta blockers - decreased effectiveness
theophylline/corticosteroids = decreased K+
2 types of antimuscarinics
anticholinergic bronchodilators e.g. tiotropium
cardiovascular/GI e.g. atropine
what do antimuscarinics inhibit
ACh = increased HR/conduction and decreased smooth muscle tone, decrease respiratory/GI secretions
what to give antimuscarinics with for COPD/asthma (for secretions)
steroids and LABA
2 GI/cardio indications of antimuscarinics
bradycardia
IBS (not atropine - use hyoscine instead)
2 interactions of antimuscarinics
TCAs
antihistamines
increased adverse effects
what is carbocysteine
mucolytic
2 contraindications of carbocysteine
gastric ulcer
1st trimester pregnancy
derm side effect of carbocysteine
pruritic rash
4 conditions which systemic steroids can cause
DM
osteoporosis
hypertension
Addisonian crisis
4 interactions of systemic steroids
NSAIDs
beta 2 agonists
diuretics
cP450 inducers
what does theophylline do
xanthine derivative - relaxes intercostal muscles - used for asthma, COPD, premature infants
3 contraindications of theophylline
caffeine/alcohol/smoking
3rd trimester pregnancy
CVD
4 side effects of theophylline
HR changes
seizures
rash
hyperkalaemia
4 interactions of theophylline
cimetidine
phenytoin
erythromycin
fluoroquinolones (e.g. ciprofloxacin)
which is the only respiratory drug to be eliminated by the liver
theophylline (take with food)
side effects of Mg and Al salts in gaviscon
Mg = diarrhoea Al = constipation
what does gaviscon do to drugs
decreases serum concentrations
what can H2 receptor antagonists do to gastric cancer
disguise symptoms
3 side effects of H2 receptor angatonigst
diarrhoea
headache
dizziness
contraindication of PPIs
osteoporosis (increase fracture risk)
2 side effects of PPIs
increase C. diff risk
hypomagnesaemia
interaction of PPIs
decrease effect of clopidogrel
abdominal drugs eliminated by liver
PPIs
aminosalicylates
antiemetics
3 contraindications of diarrhoeal agents
acute UC (toxic megacolon?)
C. diff colitis
dysentery (HUS?)
interaction of diarrhoeal agents
opioids - increased risk of opioid toxicity because it also is an opioid u-receptor antagonist
example of a stimulant, osmotic and bulk-forming laxative
stimulant = senna osmotic = lactulose bulk-forming = ispaghula husk
example of when to use osmotic laxatives
hepatic encephalopathy
example of when to use bulk forming laxatives
ileus
what is melanosis coli
side effect of laxatives - brown colon
effect of osmotic laxatives on warfarin
increase effects of warfarin
what is mesalazine
aminosalicylate
indication of aminosalicylate
UC
contraindication of aminosalicylate
aspirin hypersensitivity
5 side effects of aminosalicylates
GI renal impairment oligospermia hypersensitivity leucopenia
2 contraindications of antiemetics (metoclopramide)
GI obstruction (perforation) haemorrhage
4 side effects of antiemetics
diarrhoea
movement abnormalities
hormonal changes
acute dystonic reaction
what do alpha blockers all end in
-osin e.g. tamsulosin, doxazocin
2 indications of alpha blockers
BPH
resistant hypertension
3 side effects of alpha blockers
postural hypotension
dizziness
syncope
2 interactions of alpha blockers
antihypertensives
beta blockers
elimination of both alpha blockers and 5-alpha reductase inhibitors
LIVER
what is finasteride
5 alpha reductase inhibitor - testosterone to dihydrotestosterone blocked
2 indications of finasteride
BPH (2nd line)
difficulty urinating
can you use finasteride in pregnancy
no - genital abnormalities
what are the side effects of finasteride grouped as
lower testosterone e.g. gynaecomastia, impotence etc
3 contraindications of NSAIDs
severe renal/hepatic impairment
HF
PUD/bleeding etc
why do NSAIDs interact with steroids
ulcers
3 interactions of NSAIDs (apart from steroids, aspirin/warfarin etc)
SSRIs/venlaxafine (antidepressants)
ACEis
diuretics
3 side effects of NSAIDs
renal impairment
increased CVD events
hypertension (from increased fluid)
elimination of NSAIDs and opiates
liver (opiates also kidneys)
what to use opiates with for acute pulmonary oedema
O2, furosemide, nitrates
3 contraindications of opiates
hepatic/renal/resp failure
biliary colic
epilepsy (tramadol)
skin manifestation of opiates
pruritus
type of opiates causing anaphylaxis
IV codeine/dihydrocodeine
2 interactions of opiates
sedating drugs
SSRIs (seizures)
2 indications of xanthine oxidase inhibitors (allopurinol)
gout/renal stone prophylaxis
tumour lysis syndrome (from chemotherapy)
3 contraindications AND side of allopurinol (they’re the same)
acute gout
rash - including SJS/TEN
severe hypersensitivity
5 interactions of allopurinol
mercaptopurine azathioprine (toxicity) ACEis thiazides amoxicillin
what can happen if you give allopurinol and amoxicillin together
rash
indication of insulin that’s not diabetes
hyperkalaemia (drives K+ into cells - use with glucose)
interaction of insulin
corticosteroids - decreases insulin conc. in body
3 endocrinology drugs that are excreted by the LIVER
insulin (also kidneys)
sulphonylureas
thyroid hormones (also brain, kidneys, muscle)
what is gliclazide
sulphonylurea - increases pancreatic insulin secretion etc. for type 2 diabetes
2 contraindications of gliclazide
hepatic/renal/adrenal/pituitary impairment
malnutrition/elderly
3 interactions of gliclazide
metformin
insulin
hyperglycaemics (prednisolone, diuretics)
what does metformin do
for type 2 diabetes - increases insulin sensitivity and decreases glucose production
3 contraindications of metformin
AKI/renal/hepatic impairment
tissue hypoxia
alcohol abuse
what can happen with metformin before/48 hours after IV contrast media
lactic acidosis
2 interactions of metformin
prednisolone
diuretics
what is liothyronine
T3 (active form), levothyroxine = T4
contraindication of thyroid hormones
coronary artery disease
3 interactions of thyroid hormones
antacids/calcium/iron salts (GI absorption)
insulin
warfarin
indication of alendronic acid
osteoporotic fractures
indication of disodium pamidronate and zoldronic acid (both bisphosphonates)
malignant hypercalcaemia
3 other indications of bisphonates
myeloma
breast cancer mets
Paget’s disease of bone
4 contraindications of bisphosphonates
renal impairment
hypocalcaemia
smokers
dental disease
4 side effects of bisphosphonates
jaw osteonecrosis
oesophagitis
hypophosphataemia
atypical femoral fractures
2 interactions of bisphosphonates
calcium/iron salts
antacids
6 indications of calcium and vitamin D
osteoporosis/osteomalacia CKD HPT hyperkalaemia hypocalcaemia rickets
3 side effects of calcium and vitamin D
dyspepsia constipation cardiovascular collapse (with calcium gluconate)
3 interactions of calcium and vitamin D
bisphosphonates
tetracyclines
levothyroxine
3 contraindications of dopaminergic drugs e.g. levodopa, madopar, sinemet
glaucoma risk
psychiatric/cognitive disease
CVD
3 side effects of dopaminergic drugs
drowsiness/confusion/hallucinations
hypotension
dyskinesia
2 interactions of dopaminergic drugs
antipsychotics
metoclopramide
what always to give levodopa with
peripheral dopa-decarboxylase inhibitor
elimination of both dopaminergic drugs and anticonvulsants
liver (dopaminergic also intestines and stomach)
3 anticonvulsants
carbamazepine
phenytoin
sodium valproate
type of anticonvulsant to use for absence seizures
sodium valproate
type of anticonvulsant to use for status epilepticus
phenytoin
2 non-convulsing conditions to use anticonvulsants for
bipolar trigeminal neuralgia (carbamazepine)
3 contraindications of all anticonvulsants
pregnancy
hepatic/renal impairment
contraindication of carbamazepine
CVD
contraindication of phenytoin
foetal hydantoin syndrome
3 side effects of all anticonvulsants
tremor
ataxia
behavioural changes
5 side effects of carbamazepine
rash/SJS fever lymphadenopathy oedema hyponatraemia
3 side effects of phenytoin
hirsutism
osteomalacia
cardio/resp collapse
5 side effects of sodium valproate
thrombocytopenia increased LFTs hair loss pancreatitis BM failure
2 drugs having a decreased effect if taken with anticonvulsants
warfarin
oestrogen/progesterone
since are metabolised by cP450 enzymes
4 cP450 inhibitors interacting with anticonvulsants
macrolides
amiodarone
diltiazem
fluconazole
4 drugs decreasing seizure threshold if taken with anticonvulsants
SSRIs
TCAs
antipsychotics
tramadol
2 TCAs
amitriptyline
lofepramide
difference between action of TCAs and SSRIs
SSRIs = only block serotonin reuptake TCAs = block serotonin and noradrenaline reuptake
2 indications of TCAs
2nd line depression
neuropathic pain
5 contraindications of TCAs
CVD epilepsy constipation (side effect) BPH (causes urinary retention) increased ICP (can cause blurred vision and hallucinations)
2 interactions of TCAs
MAO inhibitors (increases serotonin) hypertension/hyperthermia
elimination of both TCAs and SSRIs
liver
3 contraindications of SSRIs
epilepsy (can cause seizures)
PUD
hepatic impairment
4 side effects of SSRIs (not exhaustive list)
hyponatraemia
seizures
increased QT interval
bleeding
3 interactions of SSRIs
MAO inhibitors
aspirin/NSAIDs
antipsychotics
4 indications of benzos
insomnia
status epilepticus/seizures
anxiety
alcohol withdrawal
increase GABA effect
3 contraindications of benzos
liver failure
neuromuscular disease
respiratory impairment (can cause airway block/coma)
interaction of benzos
cP450 inhibitors
what is donepezil
ACh-ase inhibitor (increases ACh at synapses)
indication of donepezil
AD
3 contraindications of donepezil
heart disease/arrhythmias
COPD/asthma
PUD
4 side effects of donepezil
GI
sleep
cramps
anorexia
interaction of donepezil
NSAIDs
what are penicillins ineffective against
s. aureus
some E. coli
side effect of penicillins
N+V/diarrhoea
what does penicillin do to methotrexate
increases toxicity
what do penicillins AND cephalosporins do to warfarin
increases activity
what to use for biliary tract infections
cephalosporins
4 contraindications of cephalosporins
hypersensitivity (10% overlap with penicillins)
epilepsy
pregnant
renal impairment
2 side effects of cephalosporins
antibiotic associated colitis
diarrhoea
interaction of cephalosporins (apart from warfarin)
increases nephrotoxicity of aminoglycosides (gentamicin, amikacin)
3 indications of trimethoprim
UTI
bronchitis
pneumocystitis pneumonia
4 contraindications of trimethoprim
blood dyscrasias
renal impairment
pregnant
porphyria
4 side effects of trimethoprim
N+V (same in nitro)
rash/pruritus (same in nitro)
hyperkalaemia
photosensitivity
interaction of trimethoprim
folate deficiency (dihydrofolate reductase inhibitor - unlike nitrofurantoin which damages DNA instead of preventing it from being replicated)
4 contraindications of nitrofurantoin
acute porphyria
G6PD deficiency (haemolysis)
3rd trimester and infants <3 months
renal impairment
3 side effects of nitrofurantoin
chronic pulmonary reactions
hepatitis
peripheral neuropathy
side effect of nitrofurantoin in neonates
haemolytic anaemia
5 indications of tetracyclines
malaria prophylaxis chlamydia Lyme disease syphilis acne/rosacea
4 contraindications of tetracyclines
pregnant/breastfeeding
myasthenia gravis
SLE
renal impairment
antibiotic for prostatitis and bacterial endocarditis
aminoglycosides (gentamicin, amikacin)
3 contraindications for aminoglycosides
myasthenia gravis
pregnancy/neonates
renal impairment
3 side effects of aminoglycosides
electrolyte disturbances
ototoxicity (neonates)
nephrotoxicity
what happens if taking aminoglycosides with loop diuretics/vancomycin
increased ototoxicity
what happens if taking cyclosporin, chemo, cephalosporins, vancomycin with aminoglycosides
increased nephrotoxicity
5 indications of macrolides (erythromycin, clarithromycin, azithromycin)
whooping cough
legionella
chlamydia
skin infections
what to give for penicillin allergic LRTIs
macrolides e.g. erythromycin
2 contraindications of macrolides
renal/hepatic impairment
pregnant/neonates
5 side effects of macrolides
N+V/diarrhoea colitis ototoxicity cholestatic jaundice increased QT interval (like SSRIs)
4 drugs increasing QT interval which interact with macrolides
amiodarone
SSRIs
antipsychotics
quinine
how do macrolides interact with warfarin and statins
they’re metabolised by cP450 - inhibit enzymes and therefore increase bleeding
2 examples of quinolones
ciprofloxacin
levofloxacin
very good for gram -ve
2 GI infections quinolones are used for
shigella
campylobacter
antibiotic for gonorrhoea
quinolones
4 contraindications of quinolones
tendon damage (also a side effect)
increase seizure risk (also a side effect)
myasthenia gravis
pregnant/children (arthropathy)
3 side effects of quinolones
GI
rash/pruritus
increased QT interval (arrhythmias?)
drug interacting with quinolones to increase risk of tendon rupture
prednisolone
drug interacting with quinolones to increase risk of convulsions
NSAIDs
1st line antibiotic for C. diff and giardiasis
metronidazole - anaerobic antimicrobial
giardiasis is a protozoa and it works for that too
3 contraindications of metronidazole
alcohol
pregnancy
porphyria
why is hepatic impairment a contraindication of metronidazole
metabolised by p450 - therefore excreted by LIVER
3 side effects of metronidazole
GI
peripheral/optic neuropathy
seizures/encephalopathy
interaction of metronidazole
decreases metabolism of warfarin and phenytoin (p450)
antibiotic that works against multi-resistant staphylococci
glycopeptides - vancomycin
2 contraindications of vancomycin
previous hearing loss (elderly?)
renal impairment
4 side effects of vancomycin
blood disorders (thrombocytopenia)
neutropenia
interstitial nephritis
nephro/ototoxicity
3 drugs interacting with vancomycin which increase risk of nephro/ototoxicity
aminoglycosides
loop diuretics
cyclosporin