extras Flashcards
enzyme inhibitors (potentiate) ODEVICES
Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin/Cimetidine Ethanol (acutely) Sulphonamides
enzyme inducers (decrease efficacy) - PCBRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas
alpha 1 adrenoreceptor agonist
decongestgants eg phenylephrine
vasopressors eg metraminol/norad
alpha 1 adrenoreceptor antagonist
antagonist:
BPH eg tamsulosin
HTN eg doxasozin
beta 1 adrenoceptor agonist
inotropes eg dobutamine
beta 1 adrenoceptor antagonist
selective beta blockers eg bisoprolol
beta 2 adrenoceptor agonist
bronchodilators eg salbutamol
beta 2 adrenoceptor antagonist
non-selective beta blockers eg propanolol
dopamine agonist
PD eg ROPINIROLE
prolactinomas eg BROMOCRIPTINE
dopamine antagonist
antipsychotics eg HALOPERIDOL
anti-emetics eg METOCLOPRAMIDE
GABA agonist
benzodiazepines
GABA antagonist
flumazenil
Histamine-1 Antagonist
antihistamines eg cetirizine
Histamine-2 Antagonist
Antacids eg ranitidine
mACh agonist
Glaucoma eg pilocarpine
mACh antagonist
Brady eg atropine
Bronchodilators eg ipratropium
Urge incontinence eg oxybutynin
nACh agonist
Smoking cessation eg varenicicline
Depolarising muscle relaxant eg suxamethonium
nACh antagonist
Non-depolarising muscle relaxant eg atracurium
Serotonin agonist
acute migraine eg sumatriptan
Sertonin antagonist
Anti-emetics eg ondansetron (5HT3A antagonist)
oral codeine or oral tramadol to oral morphine
divide by 10
oral morphine to oral oxycodone
divide by 1.5
- preferred in mild-moderate renal impairment (eGFR 30-60)
- causes less sedation/vomiting/pruritus
oral morphine to SC morphine
divide by 2
oral morphine to SC diamorphine
divide by 3
oral morphine to fentanyl 100 patch
dividie by 100 (over 24h)
SE of opiates x3
nausea (transient)
vomiting (transient)
constipation (persistent)
opiate for use if eGFR <30
alfentanil, fentanyl, buprenorphine
starting tx doses for opiods in palliative care - MR morphine, IR oromorph + one more thing
15mg MR morphine BD (= total 30mg oral morphine)
+
1/6 of 30 = 5mg IR oromorph (for breakthrough pain)
+
laxative
general prescribing for nauseated individual
1st line: cyclizine 50mg 8 hourly (except in cardiac cases as can worsen fluid retention)
2nd line: metoclopramide, 10mg 8 hourly
(avoid in PD, use domperidone instead, and avoid in young women, risk of acute dystonia)
general prescribing in vomiting without nausea
cyclizine 50mg up to 8 hourly
metoclopramide 10mg up to 8 hourly
N&V in palliative care: GASTRIC STASIS causes + drug of choice
causes; opiods
drugs; metoclopramide (CI - BOWEL OBSTR), domperidone
N&V in palliative care: CHEMICAL causes + drug of choice
causes; opiods, hypercalcaemia, chemo
drugs; ondansetron, haloperidol, levomepromazine
N&V in palliative care: VISCERAL/SEROSAL causes + drug of choice
causes; constipation, oral candidiasis
drugs; cyclizine, levopromazine
N&V in palliative care: RAISED ICP causes + drug of choice
causes; cerebral metastasis
drugs; cyclizine +/- dexamethasone
N&V in palliative care: VESTIBULAR causes + drug of choice
causes; motion-related, base of skull tumours
drugs; cyclizine
N&V in palliative care: CORTICAL causes + drug of choice
causes; anxiety, pain, fear, anticipatory nausea
drugs; BDZ (lorazepam), cyclizine
bony mets pain x3
1st - analgesia
2nd - bisphosphonates
3rd - radiotherapy
antihistamines; target, example, indications + SE
target H1>M>D2
acts on CTZ, vestibular, VC
PROMETHAZINE
- INDIC: motion sickness, labyrinth disorders, hyperemesis gravidarum, pre- and post-operatively
- SE: dizziness, fatigue, tinnitus, sedation
D2 receptor antagonist; examples x2
METOCLOPRAMIDE (avoid in BO - prokinetic), DOMPERIDONE
D2 receptor antagonist; target, indications + SE
target D2»H1»>M
acts on CTZ
INDIC: GI motility disorders, uraemia, radiation sickness, cancer chemo
SE: CNS - EPSEs, drowsy, dizzy, anxiety
Endo - hyperprolactinaemia, galactorrhoea
M receptor antagonist - target + example
M»>D2/H1
acts on CTZ, vestibular, VC
-Hyoscine/scopolamine + Diphenhydramine
(little effect once nausea est)
M receptor antagonist; indication + SE
indication: pre-op medication, motion sickness
SE: antimuscarinic - dry mouth, mydriasis, constipation, drowsy
5-HT3 receptor antagonist - target, example, indication + SE
5-HT3 receptor antagonist, 5 HT2, acts on CTZ, peripherals
ondansetron (mild nausea use alone, severe nausea combine with steroids)
indication: chemo sickness, RT sickness, post-op N&V
SE: headache, flushing, constipation
