EXTRA REVISION NOTES Flashcards
Normal Serum Potassium levels:
3.5 - 5.3 mmol/L
6 DRUGS CAUSING HYPOKALEAMIA -
A - AMINOPHYLLINE/THEOPHYLLINE B - BETA AGONISTS E.G. Salbutamol C - CORTICOSTEROIDS D - DIURETICS - LOOP + THIAZIDE E - ERYTHROMYCIN & MACROLIDES I - INSULIN
Imbalance causes cardiac SE e.g.
palpitations, arrhythmias
Hypokaleamia predisposes patients
taking to digoxin toxicity
TREATMENT
-Mild-moderate: Oral replacement
therapy (Sando-K tabs)
-Severe: IV Potassium (KCL) in Nacl
6 DRUGS CAUSING HYPERKALEMIA
T - TRIMETHOPRIM H - HEPARINS A - ACE/ARBS N - NSAIDS Ks - K+ SPARRING DIURETICS e.g. spironolactone, amiloride B - BETA BLOCKERS
TREATMENT - Acute Severe Hyperkaleamia (>6.5mmol/L) - Urgent Hospital treatment - IV Cacl /Calcium gluconate - IV soluble insuling with glucose - Salbutamol (nebulisation or slow IV injection)
Mild to moderate -
- Ion exchange resins to remove
excess potassium (calcium
resonium)
Normal Serum Sodium levels:
133-146 mmol/L
4 DRUGS CAUSING HYPONATREMIA
★ SSRIs
★ DIURETICS
★ DESMOPRESSIN/ VASOPRESSIN
★ CARBAMAZEPINE
Lithium - hyponatremia predisposes to
lithium toxicity
Effects - headache, confusion, seizures
TREATMENT -
● Mild to moderate - Oral supplements
(sodium chloride/bicarbonate)
● Severe - IV NACL
4 DRUGS CAUSING HYPERNATREMIA
❖ Sodium bicarbonate / chloride ❖ Corticosteroids ❖ Effervescent formulations ❖ Androgens + Oestrogens Effects - Thirst, fatigue, confusion Reduce dietary sodium intake
Normal Serum Calcium levels:
2.20 - 2.60 mmol/L
DRUGS CAUSING HYPOCALCEMIA
❖ Rifampin ❖ Phenytoin ❖ Phenobarbital ❖ Alendronate, risedronate, zoledronic acid
Mild-moderate hypocalceamia -
oral calcium supplements often given with
Vit D
Severe Hypocalceamia - IV slow calcium
gluconate 10% (to prevent arrhythmias) with
ECG monitoring
DRUGS CAUSING HYPERCALCEAMIA
❖ Hydrochlorothiazide and other thiazide diuretics ❖ Lithium ❖ Excessive intake of vitamin D, A, calcium
TREATMENT - - Correct dehydration with IV NaCl - Bisphosphonates and pamidronate used - Discontinue drugs causing hypercalceamia
Normal Serum Magnesium levels:
0.6 - 1.00 mmol/L
PPIs can cause HYPOMAGNESIA
DRUGS WHICH PROLONG QT-INTERVAL (Extended interval between the heart contracting and relaxing + can increase risk of abnormal heart rhythms and sudden cardiac arrest)
Clue - 7 ANTI drug classes + 1 ABX + I NTD
❖ Lithium
❖ Macrolide antibiotics - erythromcyin
❖ Anti-psychotics - Haloperidol,
Quinine, Chlorpromazine
❖ Antihistamines - hydroxyzine
❖ Antidepressants - Venlafaxine,
SSRIs, TCAs
❖ Antiarrhythmics - Amiodarone,
flecainide, sotalol
❖ Anti-emetics - Domperidone,
Ondansetron
❖ Anti-fungals - Fluconazole,
ketoconazole
❖ Anti-malarials - Chloroquine,
Mefloquine
❖ Sildenafil
❖ Methadone
PHOTOXIC DRUGS - Increases sensitivity of the skin to sunlight
➔ Quinine ➔ Amiodarone ➔ Retinoids ➔ Tetracyclines e.g. Doxycyline ➔ Sulfasalzine ➔ Hydrochlorothiazide
DRUGS THAT IMPACT EYESIGHT
- LINEZOLID
- ETHAMBUTOL
- ISOTRETINION ( DRUY EYES)
OVERDOSE ANTIDOTES !!!!
★ Opioids - Naloxone ★ Benzodiazepines - Flumazenil ★ Iron - Desferrioxamine ★ Paracetamol - Acetylcysteine ★ Warfarin - Phytomenadione ★ Unfractionated Heparin - Protamine ★ Apixaban/edoxaban/rivaroxoban - Andexanet Alfa ★ Dabigatran - Idarucuzimab ★ Methotrexate - Folinic acid ★ Copper - Penicillamine ★ Digoxin - DigiFab ★ BB + CCB - Glucagon
NEPHROTOXICITY SIGNS+SYMPTOM
➢ Nausea / Vomiting ➢ Diarrhoea ➢ Dehydration ➢ Reduced urination ➢ Confusion ➢ Drowsiness Monitor CrCl or eGFR
NEPHROTOXIC DRUGS
NEPHROTOXIC DRUGS -
Cardiovascular drugs:
- ACE-Inhibitors
- ARBs
- Diuretics
Antibiotics:
- Aminoglycosides (e.g.Gentamicin)
- Gylcopeptides (e.g. Vancomycin)
- Nirofurantoin (Avoid if eGFR<45ml/m)
- Trimethoprim / Tetracyclines
Immunosuppressants:
- Ciclosporin
- Tacrolimus
- Methotrexate
Lithium / NSAIDs / Metformin
DRUGS EXACERBATING AKI - DAMN
D - Diuretics
A - ACE Inhibitors
M - Metformin
N - NSAIDS
HEPATOXICITY SIGNS+SYMPTOMS
➢ Jaundice - yellowing of skin + eye ➢ Itching (Pruritis) ➢ Abdominal pain in the upper right quadrant ➢ Fatigue / Loss of appetite ➢ N+V / Rash / Fever / Weight loss ➢ Dark or tea colored urine
Monitor LFTs, Creatinine Kinase, Serum
Transaminases
HEPATOTOXIC DRUGS -
Anti-epileptics: Sodium Valproate,
Carbamazepine, Phenytoin
Anti-fungals: Fluconazole, Ketoconazole
Antibiotics: Isoniazid, Rifampicin,
tetracyclines
***Risk of cholestatic jaundice and
hepatitis with:
- Flucloxacillin
- Co-amoxiclav
Antipsychotics, sotalol, Amiodarone, labetolol, methotrexate,
paracetamol, pioglitazone
ANTI-MUSCARINIC DRUGS -
❖ Antimuscarinics - Tiotropium, umeclidinium, glycopyronium, Atropine, Scopolamine, Ipratropium, oxybutynin, hyoscine, tolterodine, solifenacin
CI (systemic) - Angle-closure glaucoma,
Severe UC, urinary retention
❖ Anti-histamines -
Sedating - Chlorphenamine, hydroxyzine,
promethazine, cyclizine
❖ Antipsychotics
1st Generation: Chlorpromazine,
prochlorperazine, haloperidol
2nd Generation: Clozapine
❖ Tricyclic antidepressants
Amitriptyline, clomipramine
ANTIMUSCARINIC EFFECTS
➢ Dry mouth ➢ Constipation ➢ Blurred vision ➢ Drowsiness ➢ Nausea OR vomiting ➢ Urinary Retention
SEDATING ANTIHISTAMINES
SEDATING ANTIHISTAMINES Causes sedation as they are highly lipid soluble and readily cross the BBB: ➔ Sedative activity used where sleep maybe disturbed due to pruritus ➔ Sedating antihistamines also have significant antimuscarinic activity
Examples of sedating antihistamines: ● Chlorphenamine (e.g. Piriton) ● Hydroxyzine ● Ketotifen ● Promethazine (E.g. Phenergan) ● Diphenhydramine (E.g. benadryl)
** Performance of skilled tasks such as
operating machinery or driving maybe
affected ***
NON-SEDATING ANTIHISTAMINES
Penetrate the blood-brain barrier only to
a slight extent - less sedative effects
1st line choice -
★ Cetirizine (e.g. Piriteze)
★ Loratadine (e.g. Claritin)
★ Fexofenadine (e.g. Allegra)
Other non-sedating antihistamines -
● Acrivastine
● Desloratadine
MHRA MEDICATION RECALL
CLASSES →
Class 1 - Defect presents a
life-threatening or serious risk to health
** Requires Immediate action **
Class 2 - Defect may cause
mistreatment or harm to patient but is
not life-threatening or serious
** Action recall within 48hrs **
Class 3 - Defect is unlikely to cause
harm to patient
** Action recall within 5 days **
Class 4 - No threat to patient
** Advise caution with use **
4 ANTIFOLATE DRUGS -
(Concomitant use will lead to
teratogenicity + blood dysrcasias):
❖ Phenytoin
❖ Methotrexate
❖ Trimethoprim
❖ Co-Trimoxazole
GI BLEED SIGNS + SYMPTOMS
★ Vomiting bright red blood ★ Vomiting coffee-like material ★ Passing Black tarry stools ★ Rectal bleeding ★ Lightheadedness ★ Shortness of breath ★ Abdominal Pain *Risk minimized by co-prescribing PPI to suppress stomach acid production
DRUGS THAT INCREASE THE RISK OF
GI BLEED -
● Corticosteroids ● Carbocisteine ● DOAC e.g Rivaroxaban ● Anti-platelets e.g. Aspirin ● Warfarin ● NSAIDs ● SSRIs
4 ANTIPSYCHOTICS THAT INDUCE
HYPERGLYCEMIA - CiROQ
C - Clozapine
R - Risperidone
O - Olanzapine
Q - Quetiapine
DRUGS THAT COLOUR URINE -
● Senna – red/yellow ● Dantron containing preparations e.g. co-danthramer, co-danthrusate – red ● Sulfasalazine – yellow-orange ● Phenindione – pink/orange ● Triamterene containing preparations e.g. co-triamterzide, Frusene – blue in some lights ● Levodopa containing preparations e.g. co-beneldopa, co-careldopa – reddish/darker in colour ● Entacapone – reddish-brown ● Nefopam – pink ● Clofazimine – red ● Nitrofurantoin – yellow/brown ● Rifabutin – orange-red ● Rifampicin – orange-red ● Deferiprone – reddish-brown
DRUGS CAUSING RESPIRATORY
DEPRESSION (RD)
➔ Pregabalin / Gabapentin ➔ Opioids - morphine, tramadol, heroin, or fentanyl ➔ Benzodiazepines - tamazepam ➔ Alcohol ➔ Barbiturates - phenobarbital
SIGNS + SYMPTOMS OF RESPIRATORY DEPRESSION
● Fatigue ● Confusion ● Headache / Dizziness ● Nausea and/or vomiting ● Fluctuations in BP ● Abnormal breathing sounds e.g. whistling or crackling sound ● Apnea (abnormally long pauses in between breaths followed by a long sigh) ● Bluish or grayish skin ● Rapid heart rate
MORPHINE SIDE EFFECTS -
M - Myosis O - Out of it (Sedation) R - Respiratory Depression P - Pneumonia (Aspiration) H - Hypotension I - Infrequency (Constipation) N - Nausea E - Emesis
DRUGS THAT CAUSE WEIGHT GAIN -
● Insulin ● Sulphonylureas ● Steroids ● Antipsychotics ● Carbamazepine
DRUGS WHICH LOWER SEIZURE
THRESHOLD -
❖ Antidepressants
❖ Antipsychotics
❖ Opioids - especially tramadol
❖ Quinolones e.g. ciprofloxacin + NSAID combo
CYP 450 ENZYME INDUCERS These will induce the enzyme to clear substrates, leading to a decreased concentration SCRAP GPS
3 ANTI-EPILEPTICS 1 HERBAL 1 ABX 1 ANTIDIABETIC MED 1 ANTIFUNGAL
S - ST.JOHN’S WORT C - CARBAMAZEPINE R - RIFAMPICIN / RIFABUTIN A - ALCOHOL (CHRONIC) P - PHENYTOIN
G - GRISEOFULVIN
P - PHENOBARBITAL
S - SULPHONYLUREAS
CYP 450 ENZYME INHIBITORS
These will inhibit the enzyme from clearing
substrates leading to an increased concentration
SICKFACES.COM GAVID
S - SODIUM VALPROATE I - ISONIAZID C - CIMETIDINE K - KETOCONAZOLE F - FLUCONAZOLE A - ALCOHOL (BINGE) C - CHLORAMPHENICOL E - ERYTHROMYCIN (macrolides) S - SULFANAMIDE -TRIMETHOPRIM . C - CIPROFLOXACIN O - OMEPRAZOLE M - METRONIDAZOLE
G - GRAPEFRUIT A - AMIODARONE V - VERAPAMIL I - ITRACONAZOLE D - DILTIAZEM
CYP 450 ENZYME SUBSTRATES
- INHIBITORS WILL INCREASE THEIR CONC
- INDUCERS WILL REDUCE THEIR CONC
➔ STATINS ➔ WARFARIN ➔ ORAL CONTRACEPTIVES ➔ TRICYCLIC ANTIDEPRESSANTS
SEPSIS
SEPSIS - ★ Sepsis is a life-threatening reaction to an infection. It happens when your immune system overreacts to an infection and starts to damage your body's own tissues and organs. ★ If not treated immediately, sepsis can result in organ failure and death. Yet with early diagnosis, it can be treated with antibiotics. HOW TO SPOT SEPSIS IN ADULTS - ❖ Slurred speech or confusion ❖ Extreme shivering or muscle pain ❖ Passing no urine (in a day) ❖ Severe breathlessness ❖ It feels like you’re going to die ❖ Skin mottled or discoloured high temperature (fever) or low body temp, a fast heartbeat, fast breathing
HOW TO SPOT SEPSIS IN CHILDREN 1. Is breathing very fast 2. Has a ‘fit’ or convulsion 3. Looks mottled, bluish, or pale 4. Has a rash that does not fade when you press it 5. Is very lethargic or difficult to wake 6. Feels abnormally cold to touch If you spot any of these signs, call 999 or go straight to A&E
A child under 5 may have sepsis if he or she: 1. Is not feeding 2. Is vomiting repeatedly 3. Has not passed urine for 12 hours
SHOCK
SHOCK - A serious life threatening condition where vital organs in the body are not getting enough blood flow resulting n organ failure
Causes:
Bleeding, cardiac event, loosing bodily
fluids e.g. severe vomiting, allergic rct
Signs of shock:
- Cold clammy skin
- Sweating
- Rapid shallow breathing
- Weakness + dizziness
- Nausea or vomiting
- Thirst
- Yawning
SEPTIC SHOCK - Life-threatening
condition that happens when your blood
pressure drops to a dangerously low
level after an infection
ANAPHYLAXIS:
Anaphylaxis is a severe, life-threatening,
hypersensitivity reaction.
Signs & Symptoms ?
★ Feeling lightheaded or faint ★ breathing difficulties: fast / shallow breathing ★ a fast heartbeat ★ clammy skin ★ confusion and anxiety ★ collapsing or losing consciousness ★ other allergy symptoms: an itchy, raised rash (hives), angioedema
ANAPHYLAXIS TREATMENT
TREATMENT - ★ Start cardiopulmonary resuscitation (CPR) immediately. ★ Call 999 for an ambulance 999 ★ Begin initial treatment for anaphylaxis:
Intramuscular adrenaline /epinephrine
should be given as 1st line treatment for
anaphylaxis.
A repeat dose of intramuscular adrenaline/epinephrine (1mg/ml) should be given after a 5-minute interval if there is no improvement in the patient’s condition.
ADRENALINE DOSES:
➔ 5 years or below: 150 mcg
➔ 6-11 years: 300 mcg
➔ 12+ years: 500 mcg
MUMPS
MUMPS
Contagious viral infection
SYMPTOMS - ● painful swellings in the side of the face under the ears (the parotid glands) ● Headaches ● Joint pain ● a high temperature
TREATMENT - No cure ● Plenty of rest and fluids ● Painkillers e.g. Paracetamol ● Warm or cool compress to the swollen glands to help relieve pain
MEASLES
MEASLES Usually starts with cold-like symptoms, followed by a rash a few days later. Some people may also get small spots in their mouth. The first symptoms of measles include: ● a high temperature ● a runny or blocked nose ● sneezing ● a cough ● red, sore, watery eyes Small white spots (KOPLIK spots) may appear inside the cheeks and on the back of the lips a few days later.
Measles rash - (Not itchy) & Red/brown ❖ Starts on the face and behind the ears before spreading to the rest of the body. ❖ The spots of the measles rash are sometimes raised and join together to form blotchy patches
RUBELLA “German Measles”
RUBELLA “German Measles” A red or pink spotty rash that feels rough. - swollen glands in your neck, aching fingers, wrists, or knees and a high temperature. MMR Vaccine - 2 doses can give lifelong protection against measles, mumps, and rubella.
MENINGITIS
MENINGITIS
An infection of the protective membranes
that surround the brain and spinal cord
(meninges).
Symptoms of meningitis develop suddenly and can include: ● a high temperature ● cold hands and feet ● vomiting ● confusion ● breathing quickly ● muscle and joint pain ● pale, mottled or blotchy skin ● spots or a rash ● headache ● a stiff neck ● a dislike of bright lights ● being very sleepy or difficult to wake ● fits (seizures) Babies may also: ● refuse feeds / be irritable ● have a high-pitched cry ● stiff body/ floppy or unresponsive ● have a bulging soft spot on the top of their head (Fontanele) Meningitis rash starts as small, red pinpricks before spreading quickly into red or purple blotches.
The meningitis glass test - ● Press the side of a clear glass firmly against the skin ● Spots/rash may fade at first ● Keep checking ● Fever with spots/rash that do not fade under pressure is a medical emergency
Call 999 for an ambulance or go to your
nearest A&E if you think you or your child
might be seriously ill.
SCARLET FEVER
SCARLET FEVER The first signs can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck).
A blanching rash usually develops on the trunk 12–48 hours after initial symptoms, before spreading to the rest of the body and flexures.
the rash is red/pink and makes your skin feel
rough, like sandpaper.
White coating on tongue aka - strawberry tongue
Refer to GP for Treatment with antibiotics e.g. phenoxymethylpenicillin
IMPETIGO
IMPETIGO
Highly contagious skin infection that often
starts with sores or blisters on the face or
hands that burst and leave crusty,
golden-brown patches.
They can look a bit like cornflakes stuck to
your skin.
Treatment -
- topical fusidic acid
- if widespread oral flucloxacillin
GLANDULAR FEVER
Glandular fever
Mostly affects teenagers and young adults.
It gets better without treatment, but it can
make you feel very ill and last for weeks.
SYMPTOMS: ● a very high temperature or you feel hot and shivery ● a severe sore throat ● swelling either side of your neck – swollen glands ● extreme tiredness or exhaustion ● tonsillitis that is not getting better
Don’t treat sore throat with ABX e.g. amoxicillin as it can cause maculopapular rash if glandular fever
PARACETAMOL MAX DOSAGE
PARACETAMOL MAX DOSAGE ● 3-5 Months - 60mg ● 6-23 Months - 120mg ● 2-3 Years - 180 mg ● 4-5 years - 240 mg ● 6-7 years - 250 mg ● 8-9 years - 375 mg ● 10-11 years - 500 mg ● 12-15 years - 750 mg ● 16+ years - 1000mg
Maximum of 4 times a day
IBUPROFEN MAX DOSAGE
IBUPROFEN MAX DOSAGE ● 3-5 months: 50mg TDS (150 mg) ● 6-11 months: 50mg QDS (200 mg) ● 1-3 years: 100mg TDS (300 mg) ● 4-6 years: 150mg TDS (450 mg) ● 7-9 years: 200mg TDS (600 mg) ● 10-11 years: 300mg TDS (900 mg) ● 12-17 years: 400mg QDS (1200mg)
Montelukast
MHRA - risk of neuropsychiatric reactions
Be alert of speech impairment and ocd symptoms, hallucinations, sleep disorders and suicidal behaviour
Adrenaline doses
1 month - 5 yrs = 150mcg
6-11yrs = 300mcg
12+ = 500mcg
Repeat adrenaline after 5 min interval if necessary
Urinalysis antispasmodics
Solifenacin or tolterodine
Ulcerative colitis acute flare up to avoid
Loperamide or codeine die to paralytic ileus as it increases risk of toxic mega colon
Ulcerative colitis inflammation location
Rectum and colon
Proctitis treatment
Inflammation of rectum
Give suppositories
1st line aminosalicyclate (rectal) mesalazine or sulfasalazine
Extensive colitis treatment
Oral treatment
High dose oral aminosalicylate
Left sided colitis
Enemas
Proctosigmoditis
Foam preparation
Crohns disease location
Inflammation of GI tract from mouth to anus
PPI cautions
Lansoprazole - take 30-60 mins before food
PPI cautions -
- mask symptoms of gastric cancer
- increased risk of fractures and osteoporosis
- increased risk of GI infections e.g C. difficile
- hypomagnesia
