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Year 3 revision > Drugs summary - difficult things > Flashcards

Drugs summary - difficult things Flashcards

1
Q

indication of furosemide

A

OVERLOAD - e.g. pulmonary oedema, CHF, renal/liver disease, oedema

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2
Q

contra-indication of both loop and thiazide diuretics

A

gout (decreases uric acid secretion)

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3
Q

3 other contraindications of furosemide

A

hepatic encephalopathy
low potassium and sodium
hypovolaemia

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4
Q

ENT side effect of furosemide

A

tinnitus

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5
Q

what drug interacts with all diuretics

A

digoxin (decreases potassium levels)

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6
Q

what drug interacts with both loop and potassium sparing diuretics

A

lithium

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7
Q

3 other drugs interacting with furosemide

A

aminoglycosides
lidocaine
phenytoin

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8
Q

indication of thiazides

A

hypertension (if not with CCB, or alongside CCB/ACEi/ARB)

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9
Q

when to use thiazides instead of CCB for hypertension

A

oedema or HF

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10
Q

2 side effects of thiazides

A

arrhythmias (low Na+/K+)

male impotence

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11
Q

2 interactions of thiazides (apart from digoxin)

A 
NSAIDs 
loop diuretics (low K+)
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12
Q

side effect of amiloride (potassium sparing - use for low K+)

A

androgen effects

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13
Q

interaction of amiloride (apart from digoxin and lithium)

A

drugs increasing K+ e.g. aldosterone antagonists

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14
Q

effect of beta blockers on renin secretion

A

decreases

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15
Q

3 indications of beta blockers

A

anything with high heart rate e.g. SVT, AF
heart disease e.g. IHD, angina, ACS, CHF
high BP second line

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16
Q

big contraindication of beta blockers

A

ASTHMA

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17
Q

what type of beta blocker can’t you use for COPD

A

propanolol (can use B1 selective ones)

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18
Q

side effect of beta blockers that is the same as thiazides

A

male impotence

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19
Q

5 cardiovascular drugs which are excreted by liver (others are solely by kidneys)

A 
beta blockers
nitrates (GTN)
antidysrhythmics (amiodarone)
warfarin
statins
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20
Q

interaction of beta blockers

A

CCBs = asystole, bradycardia

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21
Q

3 examples of CCBs

A

amlodipine
diltiazem
verpamil

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22
Q

3 indications of CCBs

A

hypertension
stable angina (or beta blockers)
SVT/atrial flutter

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23
Q

4 contraindications of CCBs

A

HF
heart block
unstable angina
severe aortic stenosis (SAME as nitrates)

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24
Q

side effect of verpamil

A

constipation

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25
Q

2 side effects of all CCBs AND nitrates (GTN, ISM)

A

oedema

flushing

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26
Q

2 CCBs not to prescribe with beta blockers

A

diltiazem

verpamil

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27
Q

4 indications of ACEis and ARBs

A

hypertension
IHD
diabetic nephropathy
CKD

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28
Q

3 contraindications of ACEis and ARBs

A

renal artery stenosis
AKI
pregnant/breastfeeding

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29
Q

2 interactions of ACEis and ARBs

A

potassium increasing drugs e.g. amiloride

NSAIDs (increase renal failure risk)

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30
Q

how are nitrates similar to CCBs

A

both decrease Ca2+

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31
Q

3 indications of nitrates

A

angina + prophylaxis
ACS
pulmonary oedema

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32
Q

2 drugs to give for pulmonary oedema alongside nitrates

A

furosemide

O2

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33
Q

2 contraindications for nitrates

A

severe aortic stenosis

hypotension

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34
Q

interaction of nitrates

A

phosphodiesterase inhibitors e.g. sildenafil = increase hypotension

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35
Q

elimination of nitrates apart from LIVER

A

RBCs

vascular wall

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36
Q

example of a cardiac glycoside (decrease heart rate)

A

digoxin

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37
Q

2 indications of digoxin

A 
AF/flutter (monotherapy in paroxysmal AF)
severe HF (3rd line)
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38
Q

other drugs to give with digoxin for severe HF

A

beta blockers

ACEis/ARBs

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39
Q

4 contraindications of digoxin

A

2nd degree heart block
renal failure
decreased K+/Mg2+
increased Ca2+

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40
Q

2 side effects of digoxin (apart from ones associated with lower HR)

A

rash

yellow vision

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41
Q

3 interactions of digoxin

A

loop/thiazide/K+ sparing diuretics (decrease K+)
amiodarone
CCBs

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42
Q

what is amiodarone

A

antidysrhythmic

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43
Q

indication of amiodarone

A

tachycardias

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44
Q

3 contraindications of amiodarone

A

hypotension (because it lowers BP)
heart block
thyroid disease

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45
Q

4 side effects of amiodarone

A

pneumonitis
hepatitis
photosensitivity
thyroid problems

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46
Q

3 interactions of amiodarone

A

digoxin
CCBs (diltiazem and verapamil)
grapefruit juice

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47
Q

what NOT to treat AF with

A

warfarin (use antiplatelets/anticoagulants instead)

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48
Q

can you use antiplatelets in pregnancy

A

not in third trimester

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49
Q

2 side effects of aspirin

A

bronchospasm

tinnitus

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50
Q

4 interactions of clopidogrel

A

cP450 inhibitors
aspirin
heparin
NSAIDs

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51
Q

what is enoxaparin

A

LMWH

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52
Q

indication of LMWH

A

VTE

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53
Q

indication of LMWH and fondaparinux

A

ACS

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54
Q

3 contraindications of heparins

A

clotting disorders
uncontrolled hypertension
renal impairment

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55
Q

2 indications of warfarin

A

VTE

fake heart valve

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56
Q

when not to use warfarin

A

AF

arterial thrombosis

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57
Q

can you use warfarin in pregnancy

A

not in first trimester

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58
Q

interaction of warfarin

A

cP450 inhibitors and inducers

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59
Q

can you use statins in pregnancy

A

no

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60
Q

why can statins increase LFTs

A

e.g. ALT - eliminated by liver

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61
Q

3 interactions of statins

A

cP450 inhibitors
amlodipine (accumulation)
grapfruit (like amiodarone)

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62
Q

indication of beta 2 agonists apart from asthma and COPD

A

hyperkalaemia

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63
Q

what to use LABA (salmeterol, formeterol) with

A

corticosteroids

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64
Q

why are beta 2 agonists contraindicated in CVD

A

tachycardia = AF?

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65
Q

2 side effects of beta 2 agonists

A

symptoms of increased HR

increased glucose/lactate

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66
Q

2 interactions of beta 2 agonists

A

beta blockers - decreased effectiveness

theophylline/corticosteroids = decreased K+

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67
Q

2 types of antimuscarinics

A

anticholinergic bronchodilators e.g. tiotropium

cardiovascular/GI e.g. atropine

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68
Q

what do antimuscarinics inhibit

A

ACh = increased HR/conduction and decreased smooth muscle tone, decrease respiratory/GI secretions

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69
Q

what to give antimuscarinics with for COPD/asthma (for secretions)

A

steroids and LABA

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70
Q

2 GI/cardio indications of antimuscarinics

A

bradycardia

IBS (not atropine - use hyoscine instead)

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71
Q

2 interactions of antimuscarinics

A

TCAs
antihistamines

increased adverse effects

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72
Q

what is carbocysteine

A

mucolytic

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73
Q

2 contraindications of carbocysteine

A

gastric ulcer

1st trimester pregnancy

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74
Q

derm side effect of carbocysteine

A

pruritic rash

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75
Q

4 conditions which systemic steroids can cause

A

DM
osteoporosis
hypertension
Addisonian crisis

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76
Q

4 interactions of systemic steroids

A

NSAIDs
beta 2 agonists
diuretics
cP450 inducers

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77
Q

what does theophylline do

A

xanthine derivative - relaxes intercostal muscles - used for asthma, COPD, premature infants

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78
Q

3 contraindications of theophylline

A

caffeine/alcohol/smoking
3rd trimester pregnancy
CVD

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79
Q

4 side effects of theophylline

A

HR changes
seizures
rash
hyperkalaemia

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80
Q

4 interactions of theophylline

A

cimetidine
phenytoin
erythromycin
fluoroquinolones (e.g. ciprofloxacin)

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81
Q

which is the only respiratory drug to be eliminated by the liver

A

theophylline (take with food)

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82
Q

side effects of Mg and Al salts in gaviscon

A 
Mg = diarrhoea
Al = constipation
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83
Q

what does gaviscon do to drugs

A

decreases serum concentrations

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84
Q

what can H2 receptor antagonists do to gastric cancer

A

disguise symptoms

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85
Q

3 side effects of H2 receptor angatonigst

A

diarrhoea
headache
dizziness

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86
Q

contraindication of PPIs

A

osteoporosis (increase fracture risk)

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87
Q

2 side effects of PPIs

A

increase C. diff risk

hypomagnesaemia

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88
Q

interaction of PPIs

A

decrease effect of clopidogrel

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89
Q

abdominal drugs eliminated by liver

A

PPIs
aminosalicylates
antiemetics

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90
Q

3 contraindications of diarrhoeal agents

A

acute UC (toxic megacolon?)
C. diff colitis
dysentery (HUS?)

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91
Q

interaction of diarrhoeal agents

A

opioids - increased risk of opioid toxicity because it also is an opioid u-receptor antagonist

92
Q

example of a stimulant, osmotic and bulk-forming laxative

A 
stimulant = senna
osmotic = lactulose
bulk-forming = ispaghula husk
93
Q

example of when to use osmotic laxatives

A

hepatic encephalopathy

94
Q

example of when to use bulk forming laxatives

A

ileus

95
Q

what is melanosis coli

A

side effect of laxatives - brown colon

96
Q

effect of osmotic laxatives on warfarin

A

increase effects of warfarin

97
Q

what is mesalazine

A

aminosalicylate

98
Q

indication of aminosalicylate

A

UC

99
Q

contraindication of aminosalicylate

A

aspirin hypersensitivity

100
Q

5 side effects of aminosalicylates

A 
GI 
renal impairment 
oligospermia
hypersensitivity
leucopenia
101
Q

2 contraindications of antiemetics (metoclopramide)

A 
GI obstruction (perforation)
haemorrhage
102
Q

4 side effects of antiemetics

A

diarrhoea
movement abnormalities
hormonal changes
acute dystonic reaction

103
Q

what do alpha blockers all end in

A

-osin e.g. tamsulosin, doxazocin

104
Q

2 indications of alpha blockers

A

BPH

resistant hypertension

105
Q

3 side effects of alpha blockers

A

postural hypotension
dizziness
syncope

106
Q

2 interactions of alpha blockers

A

antihypertensives

beta blockers

107
Q

elimination of both alpha blockers and 5-alpha reductase inhibitors

A

LIVER

108
Q

what is finasteride

A

5 alpha reductase inhibitor - testosterone to dihydrotestosterone blocked

109
Q

2 indications of finasteride

A

BPH (2nd line)

difficulty urinating

110
Q

can you use finasteride in pregnancy

A

no - genital abnormalities

111
Q

what are the side effects of finasteride grouped as

A

lower testosterone e.g. gynaecomastia, impotence etc

112
Q

3 contraindications of NSAIDs

A

severe renal/hepatic impairment
HF
PUD/bleeding etc

113
Q

why do NSAIDs interact with steroids

A

ulcers

114
Q

3 interactions of NSAIDs (apart from steroids, aspirin/warfarin etc)

A

SSRIs/venlaxafine (antidepressants)
ACEis
diuretics

115
Q

3 side effects of NSAIDs

A

renal impairment
increased CVD events
hypertension (from increased fluid)

116
Q

elimination of NSAIDs and opiates

A

liver (opiates also kidneys)

117
Q

what to use opiates with for acute pulmonary oedema

A

O2, furosemide, nitrates

118
Q

3 contraindications of opiates

A

hepatic/renal/resp failure
biliary colic
epilepsy (tramadol)

119
Q

skin manifestation of opiates

A

pruritus

120
Q

type of opiates causing anaphylaxis

A

IV codeine/dihydrocodeine

121
Q

2 interactions of opiates

A

sedating drugs

SSRIs (seizures)

122
Q

2 indications of xanthine oxidase inhibitors (allopurinol)

A

gout/renal stone prophylaxis

tumour lysis syndrome (from chemotherapy)

123
Q

3 contraindications AND side of allopurinol (they’re the same)

A

acute gout
rash - including SJS/TEN
severe hypersensitivity

124
Q

5 interactions of allopurinol

A 
mercaptopurine 
azathioprine (toxicity)
ACEis
thiazides 
amoxicillin
125
Q

what can happen if you give allopurinol and amoxicillin together

A

rash

126
Q

indication of insulin that’s not diabetes

A

hyperkalaemia (drives K+ into cells - use with glucose)

127
Q

interaction of insulin

A

corticosteroids - decreases insulin conc. in body

128
Q

3 endocrinology drugs that are excreted by the LIVER

A

insulin (also kidneys)
sulphonylureas
thyroid hormones (also brain, kidneys, muscle)

129
Q

what is gliclazide

A

sulphonylurea - increases pancreatic insulin secretion etc. for type 2 diabetes

130
Q

2 contraindications of gliclazide

A

hepatic/renal/adrenal/pituitary impairment

malnutrition/elderly

131
Q

3 interactions of gliclazide

A

metformin
insulin
hyperglycaemics (prednisolone, diuretics)

132
Q

what does metformin do

A

for type 2 diabetes - increases insulin sensitivity and decreases glucose production

133
Q

3 contraindications of metformin

A

AKI/renal/hepatic impairment
tissue hypoxia
alcohol abuse

134
Q

what can happen with metformin before/48 hours after IV contrast media

A

lactic acidosis

135
Q

2 interactions of metformin

A

prednisolone

diuretics

136
Q

what is liothyronine

A

T3 (active form), levothyroxine = T4

137
Q

contraindication of thyroid hormones

A

coronary artery disease

138
Q

3 interactions of thyroid hormones

A

antacids/calcium/iron salts (GI absorption)
insulin
warfarin

139
Q

indication of alendronic acid

A

osteoporotic fractures

140
Q

indication of disodium pamidronate and zoldronic acid (both bisphosphonates)

A

malignant hypercalcaemia

141
Q

3 other indications of bisphonates

A

myeloma
breast cancer mets
Paget’s disease of bone

142
Q

4 contraindications of bisphosphonates

A

renal impairment
hypocalcaemia
smokers
dental disease

143
Q

4 side effects of bisphosphonates

A

jaw osteonecrosis
oesophagitis
hypophosphataemia
atypical femoral fractures

144
Q

2 interactions of bisphosphonates

A

calcium/iron salts

antacids

145
Q

6 indications of calcium and vitamin D

A 
osteoporosis/osteomalacia
CKD
HPT
hyperkalaemia
hypocalcaemia
rickets
146
Q

3 side effects of calcium and vitamin D

A 
dyspepsia 
constipation
cardiovascular collapse (with calcium gluconate)
147
Q

3 interactions of calcium and vitamin D

A

bisphosphonates
tetracyclines
levothyroxine

148
Q

3 contraindications of dopaminergic drugs e.g. levodopa, madopar, sinemet

A

glaucoma risk
psychiatric/cognitive disease
CVD

149
Q

3 side effects of dopaminergic drugs

A

drowsiness/confusion/hallucinations
hypotension
dyskinesia

150
Q

2 interactions of dopaminergic drugs

A

antipsychotics

metoclopramide

151
Q

what always to give levodopa with

A

peripheral dopa-decarboxylase inhibitor

152
Q

elimination of both dopaminergic drugs and anticonvulsants

A

liver (dopaminergic also intestines and stomach)

153
Q

3 anticonvulsants

A

carbamazepine
phenytoin
sodium valproate

154
Q

type of anticonvulsant to use for absence seizures

A

sodium valproate

155
Q

type of anticonvulsant to use for status epilepticus

A

phenytoin

156
Q

2 non-convulsing conditions to use anticonvulsants for

A 
bipolar
trigeminal neuralgia (carbamazepine)
157
Q

3 contraindications of all anticonvulsants

A

pregnancy

hepatic/renal impairment

158
Q

contraindication of carbamazepine

A

CVD

159
Q

contraindication of phenytoin

A

foetal hydantoin syndrome

160
Q

3 side effects of all anticonvulsants

A

tremor
ataxia
behavioural changes

161
Q

5 side effects of carbamazepine

A 
rash/SJS
fever
lymphadenopathy 
oedema
hyponatraemia
162
Q

3 side effects of phenytoin

A

hirsutism
osteomalacia
cardio/resp collapse

163
Q

5 side effects of sodium valproate

A 
thrombocytopenia 
increased LFTs
hair loss 
pancreatitis 
BM failure
164
Q

2 drugs having a decreased effect if taken with anticonvulsants

A

warfarin
oestrogen/progesterone

since are metabolised by cP450 enzymes

165
Q

4 cP450 inhibitors interacting with anticonvulsants

A

macrolides
amiodarone
diltiazem
fluconazole

166
Q

4 drugs decreasing seizure threshold if taken with anticonvulsants

A

SSRIs
TCAs
antipsychotics
tramadol

167
Q

2 TCAs

A

amitriptyline

lofepramide

168
Q

difference between action of TCAs and SSRIs

A 
SSRIs = only block serotonin reuptake 
TCAs = block serotonin and noradrenaline reuptake
169
Q

2 indications of TCAs

A

2nd line depression

neuropathic pain

170
Q

5 contraindications of TCAs

A 
CVD
epilepsy
constipation (side effect)
BPH (causes urinary retention)
increased ICP (can cause blurred vision and hallucinations)
171
Q

2 interactions of TCAs

A 
MAO inhibitors (increases serotonin)
hypertension/hyperthermia
172
Q

elimination of both TCAs and SSRIs

A

liver

173
Q

3 contraindications of SSRIs

A

epilepsy (can cause seizures)
PUD
hepatic impairment

174
Q

4 side effects of SSRIs (not exhaustive list)

A

hyponatraemia
seizures
increased QT interval
bleeding

175
Q

3 interactions of SSRIs

A

MAO inhibitors
aspirin/NSAIDs
antipsychotics

176
Q

4 indications of benzos

A

insomnia
status epilepticus/seizures
anxiety
alcohol withdrawal

increase GABA effect

177
Q

3 contraindications of benzos

A

liver failure
neuromuscular disease
respiratory impairment (can cause airway block/coma)

178
Q

interaction of benzos

A

cP450 inhibitors

179
Q

what is donepezil

A

ACh-ase inhibitor (increases ACh at synapses)

180
Q

indication of donepezil

A

AD

181
Q

3 contraindications of donepezil

A

heart disease/arrhythmias
COPD/asthma
PUD

182
Q

4 side effects of donepezil

A

GI
sleep
cramps
anorexia

183
Q

interaction of donepezil

A

NSAIDs

184
Q

what are penicillins ineffective against

A

s. aureus

some E. coli

185
Q

side effect of penicillins

A

N+V/diarrhoea

186
Q

what does penicillin do to methotrexate

A

increases toxicity

187
Q

what do penicillins AND cephalosporins do to warfarin

A

increases activity

188
Q

what to use for biliary tract infections

A

cephalosporins

189
Q

4 contraindications of cephalosporins

A

hypersensitivity (10% overlap with penicillins)
epilepsy
pregnant
renal impairment

190
Q

2 side effects of cephalosporins

A

antibiotic associated colitis

diarrhoea

191
Q

interaction of cephalosporins (apart from warfarin)

A

increases nephrotoxicity of aminoglycosides (gentamicin, amikacin)

192
Q

3 indications of trimethoprim

A

UTI
bronchitis
pneumocystitis pneumonia

193
Q

4 contraindications of trimethoprim

A

blood dyscrasias
renal impairment
pregnant
porphyria

194
Q

4 side effects of trimethoprim

A

N+V (same in nitro)
rash/pruritus (same in nitro)
hyperkalaemia
photosensitivity

195
Q

interaction of trimethoprim

A

folate deficiency (dihydrofolate reductase inhibitor - unlike nitrofurantoin which damages DNA instead of preventing it from being replicated)

196
Q

4 contraindications of nitrofurantoin

A

acute porphyria
G6PD deficiency (haemolysis)
3rd trimester and infants <3 months
renal impairment

197
Q

3 side effects of nitrofurantoin

A

chronic pulmonary reactions
hepatitis
peripheral neuropathy

198
Q

side effect of nitrofurantoin in neonates

A

haemolytic anaemia

199
Q

5 indications of tetracyclines

A 
malaria prophylaxis
chlamydia
Lyme disease
syphilis
acne/rosacea
200
Q

4 contraindications of tetracyclines

A

pregnant/breastfeeding
myasthenia gravis
SLE
renal impairment

201
Q

antibiotic for prostatitis and bacterial endocarditis

A

aminoglycosides (gentamicin, amikacin)

202
Q

3 contraindications for aminoglycosides

A

myasthenia gravis
pregnancy/neonates
renal impairment

203
Q

3 side effects of aminoglycosides

A

electrolyte disturbances
ototoxicity (neonates)
nephrotoxicity

204
Q

what happens if taking aminoglycosides with loop diuretics/vancomycin

A

increased ototoxicity

205
Q

what happens if taking cyclosporin, chemo, cephalosporins, vancomycin with aminoglycosides

A

increased nephrotoxicity

206
Q

5 indications of macrolides (erythromycin, clarithromycin, azithromycin)

A

whooping cough
legionella
chlamydia
skin infections

207
Q

what to give for penicillin allergic LRTIs

A

macrolides e.g. erythromycin

208
Q

2 contraindications of macrolides

A

renal/hepatic impairment

pregnant/neonates

209
Q

5 side effects of macrolides

A 
N+V/diarrhoea
colitis
ototoxicity
cholestatic jaundice
increased QT interval (like SSRIs)
210
Q

4 drugs increasing QT interval which interact with macrolides

A

amiodarone
SSRIs
antipsychotics
quinine

211
Q

how do macrolides interact with warfarin and statins

A

they’re metabolised by cP450 - inhibit enzymes and therefore increase bleeding

212
Q

2 examples of quinolones

A

ciprofloxacin
levofloxacin

very good for gram -ve

213
Q

2 GI infections quinolones are used for

A

shigella

campylobacter

214
Q

antibiotic for gonorrhoea

A

quinolones

215
Q

4 contraindications of quinolones

A

tendon damage (also a side effect)
increase seizure risk (also a side effect)
myasthenia gravis
pregnant/children (arthropathy)

216
Q

3 side effects of quinolones

A

GI
rash/pruritus
increased QT interval (arrhythmias?)

217
Q

drug interacting with quinolones to increase risk of tendon rupture

A

prednisolone

218
Q

drug interacting with quinolones to increase risk of convulsions

A

NSAIDs

219
Q

1st line antibiotic for C. diff and giardiasis

A

metronidazole - anaerobic antimicrobial

giardiasis is a protozoa and it works for that too

220
Q

3 contraindications of metronidazole

A

alcohol
pregnancy
porphyria

221
Q

why is hepatic impairment a contraindication of metronidazole

A

metabolised by p450 - therefore excreted by LIVER

222
Q

3 side effects of metronidazole

A

GI
peripheral/optic neuropathy
seizures/encephalopathy

223
Q

interaction of metronidazole

A

decreases metabolism of warfarin and phenytoin (p450)

224
Q

antibiotic that works against multi-resistant staphylococci

A

glycopeptides - vancomycin

225
Q

2 contraindications of vancomycin

A

previous hearing loss (elderly?)

renal impairment

226
Q

4 side effects of vancomycin

A

blood disorders (thrombocytopenia)
neutropenia
interstitial nephritis
nephro/ototoxicity

227
Q

3 drugs interacting with vancomycin which increase risk of nephro/ototoxicity

A

aminoglycosides
loop diuretics
cyclosporin

Year 3 revision (9 decks)

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