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Drugs > I M Ar 2 > Flashcards

I M Ar 2 Flashcards

1
Q

Amiodarone mechanism

A

Blocks sodium, calcium, potassium channels

Antagonism of a/b adrenergic receptors

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2
Q

Amiodarone adverse effects during IV infusion

A

Hypotension

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3
Q

Amiodarone adverse effects when taken chronically

A

Pneumonitis, bradycardia, hepatitis, photo sensitivity, thyroid abnormalities

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4
Q

Who shouldn’t take amiodarone

A

Severe hypotension
Heart block
Thyroid disease

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5
Q

Amiodarone interactions

A

Increase plasma conc of digoxin, diltiazem, verapamil

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6
Q

Prescription of amiodarone needs

A

Senior involvement (f1 not on own)

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7
Q

Amiodarone for cardiac arrest

A

300mg followed by flush

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8
Q

If repeated IV of amiodarone indicated how is it administered? Why?

A

Central line

Peripheral can cause phlebitis

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9
Q

Why should you not copy the preceding dose on prescription of amiodarone

A

May be a loading dose

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10
Q

ACEi egs

A

Ramipril, lisinopril, perindopril

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11
Q

ACEi uses

A

Hypertension
Chronic heart failure / ischemic heart disease
Diabetic nephropathy / CKD with pronteinuria

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12
Q

Mechanism of ACEi

A

Presents conversion of angiotensin I -> II

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13
Q

ACEi adverse effects

A

Hypotension (can be profound after first dose)
Dry cough
Hyperkalaemia
Cause / worsen renal failure (especially with renal artery stenosis)
Rarely - angiodema , anaphylaxis

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14
Q

Wh should not get ACEi

A

Renal artery stenosis
Acute kidney injury
Pregnant / breastfeeding
Chronic kidney disease (use lower dose)

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15
Q

ACEi interactions

A

Avoid potassium elevating drugs

NSAIDs -> increas risk of renal failure

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16
Q

How are ACEi prescribed - dose

A

Usually around 2.5mg daily titrated up to 10mg over few weeks

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17
Q

Dose of ramipril for heart failure / neohropathy

A

1.25mg daily

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18
Q

What to tell patients getting ACEi

A 
Dizzy - especially after first dose 
Dry cough 
Tell someone if allergic signs 
Avoids NSAIDs eg ibuprofen 
Will need blood test monitoring
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19
Q

What should be checked before starting ACEi

A

Electrolytes and renal functions

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20
Q

Angiotensin receptor blockers egs

A

Losartan, candesartan, irbesartan

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21
Q

ARBs uses

A

Hypertension
Chronic heart failure / ischemic heart disease
Diabetic nephropathy / CKD with pronteinuria

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22
Q

ARBs mechanism

A

Block action of angiotensin II on AT1 receptor

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23
Q

ARBs adverse effects

A

Hypertension (especially first dose)
Hyperkalaemia
Renal failure

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24
Q

Why do ARBs not cause a dry cough

A

Do not affect ACEi (involved in bradykinin metabolism )

-> also less likely to cause angiodema

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25
Q

Who should not get ARBs

A

Renal artery stenosis
Acute kidney injury
Pregnant / breastfeeding
CKD - use lower doses

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26
Q

ARBs interactions

A

Don’t use with potassium elevating drugs

Risk of renal failure with NSAIDs

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27
Q

Prescription on ARBs

A

50mg orally daily titrated up

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28
Q

Losartan in heart failure

A

Start on 12.5mg daily

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29
Q

What to tell patients getting ARBs

A

Dizziness
Will need blood test monitoring
Avoid taking NSAIDs

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30
Q

What should be checked before starting ARBs

A

Electrolytes and renal function

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31
Q

In what ethnic group are ARBs preferable to ACEi

A

Black African / Caribbean as risk of angiodema is 5x higher then general population with ACEi

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32
Q

SSRIs egs

A

Citalopram
Fluoxetine
Sertraline
Escitalopram

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33
Q

SSRIs uses

A

Moderate - severe depression (mild if other treatments fail)
Panic disorder
OCD

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34
Q

SSRIs mechanism

A

Inhibit neuronal reputable of serotonin

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35
Q

Why are SSRIs generally preferred to tricyclics

A

Fewer adverse effects and less dangerous in overdose

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36
Q

SSRIs adverse effects

A 
GI upset, weight / appetite disturbance 
Hypersensitivity 
Suicidal thoughts 
Lower seizure threshold 
Can prolong QT interval -> arrythmias 
Increase risk of bleeding 
Serotonin syndrome
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37
Q

What is serotonin syndrome

A

Autonomic hyperactivity
Altered mental state
Neuromuscular excitation

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38
Q

When should you be cautious of precribing SSRIs

A

Epileptics
Peptic ulcer disease
Young people
Hepatic impairment (as metabolised)

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39
Q

Which drugs should not be given with SSRIs ? Why?

A

Monoamine oxidase inhibitors (also increase serotonin -> serotonin syndrome risk)
Drugs that prolong QT interval eg. Antipsychotics
Carful with aspirin / NSAIDs (due to bleeding risk)

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40
Q

Prescribing SSRIs (citalopram)

A

20mg orally daily increased as needed

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41
Q

What to tell patient getting SSRIs

A

May need psychological therapy for longer term benefits
Carry on with SSRIs for 6 months after feel better
Not to stop suddenly -> tummy upset, flu like symptoms

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42
Q

Which SSRIs have fewer interactions

A

Citalopram and escitalopram

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43
Q

Tricyclics egs

A

Amitriptyline

Lofepramine

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44
Q

Tricyclics indications

A

Moderate - sever depression when SSRIs don’t work

Neuropathic pain

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45
Q

Tricyclics mechanism

A

Inhibit neuronal reuptake of serotonin and noradrenaline

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46
Q

Tricyclics mechanism which causes adverse effects

A

Block muscarinic, H1, A1/2, D2 receptors

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47
Q

Triclyclics adverse effects ? (Receptor blocked)

A

Dry mouth, constipation, urinary retention, blurred vision (antimuscarinic).
Sedation, hypotension (a1/H1).
Arrythmias, ECG changes.
Convulsions, hallucinations, mania.
Breast changes sexual dysfunction, extra pyramidal eg tremor / dyskinesia (dopamine)

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48
Q

Sudden withdrawal of tricyclics causes

A

GI upset, flu like

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49
Q

Who should tricyclics be used with caution

A

Elderly, CV disease, epilepsy, constipation, prostatic hyper trophy, raised intraoccular pressure

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50
Q

Which drugs should not be given with tricyclics

A

Mono amine oxidase inhibitors

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51
Q

Amytriptyline dose for neuropathic pain? Depression?

A

10mg at night

75mg daily

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52
Q

What needs to be thought about when prescribing tricyclics

A

Very dangerous in overdose -> prescribe small quantity at a time

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53
Q

What to tell patients getting tricyclics

A

Takes a few weeks for symptom improvement
May need psychological therapy
Keep taking for 6 months after better
Don’t stop suddenly

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54
Q

Amiodarone uses

A

Tachyarrythmias (usually when other treatments none suitable)

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55
Q

What to tell patients getting tricyclics

A

Will improve symptoms over a few weeks.
May need psychological therapy for long term benefits.
Keep taking for 6months after symtoms improve
Don’t stop treatment suddenly -> flu like withdrawal

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56
Q

Venlafaxine and mirtazepine uses

A 
Major depression (SSRIs not effective) 
generalised anxiety disorder (venlafaxine only)
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57
Q

Mechanisms of venlafaxine and mirtazapine

A

Increase availability of monoamines for neurotransmisson

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58
Q

Venlafaxine and mirtazapine adverse effects

A

GI upset
CNS effects - headache, abnormal dreams, convulsions….
Less common - hyponatraemia, serotonin syndrome

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59
Q

Venlafaxine and mirtazapine sudden withdrawal ->

A

GI upset and flu like symptoms

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60
Q

Venlafaxine and mirtazapine caution with who?

A

Elderly, hepatic /renal impairment, Cv disease (Venlafaxine associated with arrythmias)

61
Q

Venlafaxine and mirtazapine interactions

A

SSRIs -> serotonin syndrome

62
Q

Prescribing venlafaxine and mirtazepine

A

Low dose titrated up
V - 37.5 twice daily up to 375 daily
M- 15mg daily up to 45

63
Q

Venlafaxine and mirtazapine tell patients

A

Improve symptoms over a few weeks
May need psychological therapy
Keep taking for 6 months after improvement
Not stop taking suddenly

64
Q

Egs of d2 receptor antagonists (antiemetics)

A

Metoclopramide , domperidone

65
Q

What is the main receptor in the chemoreceptor trigger zone

66
Q

D2 antagonist uses

A

Nausea and vommiting - especially in reduced gut motility

67
Q

D2 antagonists adverse effects

A

Diarrhoea (as promoted gastric emptying)
Short term - acute dystonic reaction
Extra pyramidal symptoms

68
Q

D2 antagonist - who is more likely to get extra pyramidal symptoms

A

Children and young adults

69
Q

Prokinetic effects of d2 antagonists mean they are contraindicated in who

A

GI obstruction / perforation

70
Q

Risk of extra pyramidal symtoms increases with metoclopramide and what other class

A

Antipsychotics (same mechanism)

71
Q

Metoclopramide antagonises effect of what drugs (contraindicated)

A

Dopaminergic agents for Parkinson’s

72
Q

Starting dose for metoclopramide and domperidone

A

10mg three times daily

73
Q

Eg of h1 antagonist antiemetics

A

Cyclizine, cinnarizine, promethazine

74
Q

H1 antiemetics uses

A

Nausea and vommiting - especially with motion sickness or vertigo

75
Q

H1 antagonist antiemetics mechanism

A

Block h1 receptors in vomiting centre and communication with vestibular system

76
Q

H1 antiemetics adverse effects

A

Drowsiness
Dry throat and mouth
Tachycardia (palpitations)

77
Q

Warnings with h1 antagonist antiemetics

A 
Prostatic hyper trophy (antimuscarinic may lead to retention) 
Hepatic encephalopathy (due to sedation)
78
Q

Eg of phenothiazines (antiemetics)

A

Prochlorperazine

Chlorpromazine

79
Q

Phenothiazines uses

A

Nausea and vomiting especially with vertigo

Psychotic disorders

80
Q

Phenothiazines mechanism

A

Mostly by d2 antagonist in vomiting centre and vestibular system

81
Q

Phenothiazines adverse effects

A 
Drowsiness 
Postural hypotension 
Extrapyramidal symptoms 
Short term - acute dystonic reaction 
QT prolongation
82
Q

Who should not get phenothiazines

A

Sever liver disease - never
Prostatic hyper trophy - retention
Elderly

83
Q

Which drugs interact with phenothiazines

A

Any that prolong QT

Antipsychotics, amiodarone , Ciproflaxacin, macrolides, quinine, SSRIs

84
Q

Egs of 5HT-3 antagonists

A

Ondansetron, granisetron

85
Q

5HT3 antagonists mechanism

A

High amount of 5ht3 receptors in chemoreceptor trigger zone.
Serotonin also key transmitter in gut

86
Q

5ht3 antagonists warning

A

Prolong QT interval at high doses

Avoid other drugs that do this

87
Q

Drugs that prolong QT

A

Antipsychotics, amiodarone , Ciproflaxacin, macrolides, quinine, SSRIs, phenothiazines, 5ht3 antagonists

88
Q

Prescription of ondansetron

A

4-8mg every 12 hours

89
Q

Antiemetics potential for morning sickness as minimal risk to baby

A

Ondasetron

90
Q

Antifungals egs

A

Nystatin, clotrimazole, fluconazol

91
Q

What is found in fungal membranes but not human cells and therefore target of antfungals

A

Ergosterol

92
Q

Nystatin / clotrimazole adverse effects

A

Local irritation where applied

93
Q

Fluconazole adverse effects

A

GI upset, headache, hepatitis

Rarely - prolonged QT

94
Q

Fluconazole contraindications

A

NEVER in pregnancy - malformations

Liver disease / renal impairment

95
Q

Interactions with fluconazole

A

Any metabolised by P450 (as inhibits)

Drugs that prolong QT

96
Q

Eg of drugs metabolised by p450

A

Phenytoin, carbamazepine, warfarin, diazepam, simvastatin, sulphonyureas

97
Q

How is nystatin usually prescribed

A

Oral suspension for oral candidiasis

Cream for skin infections

98
Q

How is clotrimazole prescribed? What for ?

A

Cream

Tinea (ringworm ), candidia

99
Q

H1 antagonist uses

A

Allergies
Relieve pruritus, urticaria
Anaphylaxis (after adrenaline)
Nausea and vomiting

100
Q

Antihistamines eg

A

Cetirizine, loratadine, fexofenadine, chlorphenamine

101
Q

Which cells release histamine

102
Q

Which antihistamine causes some sedation? Why do others (2nd gen) not ?

A

Chlorphenamine

Others don’t cross blood brain barrier

103
Q

Who should not get get chlorphenamine

A

People with severe liver disease

104
Q

Eg of anti motility drugs

A

Loperamide, codeine phosphate

105
Q

Anti motility used to treat

106
Q

Anti motility mechanism

A

Agonist of opioid u receptors in GI.

So transit of bowel contents + increase anal sphincter tone

107
Q

When should loperamide not be used

A

Acute UC / C. difficile as increases risk of mega colon.

Dysentery - as likely bacterial infection

108
Q

Usual dose of loperamide

A

4mg followed by 2mg after each lose stool

109
Q

What to tell patient getting loperamide

A

Treats diarrhoea but not underlying cause

110
Q

Eg of bronchodilator muscarinics

A

Ipatropium, Tiotropium, glycopyrronium

111
Q

Uses of bronchodilators

A

COPD p, asthma

112
Q

Mechanism of bronchodilators

A

Competitive inhibitor of acetyl choline

-> reduce smooth muscle tone / secretions

113
Q

Bronchodilators adverse effects

114
Q

Bronchodilators caution in

A

Patients susceptible to angle-closure glaucoma

115
Q

Which bronchodilators are short acting / long

A

Short - ipatropium

Long - tiotropium / glycopyrronium

116
Q

What needs to be monitored with bronchodilators

A

Inhaler technique

117
Q

Anti muscarinics for GI / cardio uses egs

A

Atropine, hyoscine butyl bromide, glycopyrronium

118
Q

What is atropine used to treat

A

Bradycardia

119
Q

First line treatment for IBS

A

Hyoscine butyl bromide

120
Q

What is used to treat copious respiratory secretions

A

Hyoscine butyl bromide

121
Q

Mechanism of GI / cV antimuscarinics

A

Competitive inhibitor of acetyl choline

Increase heart rate, reduce smooth muscle tone, reduce secretions

122
Q

Adverse effects of GI / cv antimuscarinics

A

Tachycardia, dry mouth, constipation, urinary retention, blurred vision, drowsiness and confusion

123
Q

Who should antimuscarinics be cautious with

A

Susceptible to angle-closure glaucoma

Arrythmias

124
Q

Preciption of atropine for bradycardia

A

300-600 micrograms every 2 minutes until acceptable heart rate

125
Q

Antimuscarinics for IBS prescription

A

10mg 8 hourly (hyoscine butyl bromide )

126
Q

GU antimuscarinic egs

A

Oxybutynin, tolterodine, solifenacin

127
Q

Which receptor are GU antimuscarinics selective (ish) for

A

M3 - promotes bladder relaxation

128
Q

Adverse effects of GU antimuscarinics

A

Dry mouth, tachycardia, constipation, blurred vision

129
Q

When should GU antimuscarinics be avoided

A

Never in UTI

Cautious in elderly, angle-closure glaucoma, arrythmias, urinary retention

130
Q

What should be done before prescribing antimuscarinics for urge incontinence

A

Adequate bladder training

131
Q

Eg of first gen antipsychotics

A

Haloperidol, chlorpromazine, prochlorperazine

132
Q

1antipsychotics uses

A

Psychomotor agitation, schizophrenia , bipolar, nausea and vomiting

133
Q

Mechanism of 1antipsychotics

A

Block post synaptic d2

134
Q

3 dopaminergic pathways in CNS

A

Mesolimbic / mesocortical - midbrain and limbic / frontal cortex.
Nigrostriatal - substantia nigra and corpus striatum (basal ganglia).
Tuberohypophyseal - hypothalamus and pituitary

135
Q

Main drawback / adverse effect of 1antipsychotics ? Which pathway ?

A

Extrapyramidal effects - movement abnormalities from blockade of d2 in nigrostriatal

136
Q

Types of Extrapyramidal in 1antipsychotics

A

Acute dystonic reactions - Parkinsonism movements / spasms.
Akathisia - state of inner restlessness.
Neuroleptic malignant syndrome - confusion, autonomic disregulation and pyrexia (life threatening)
Tardive dyskinesia - (late onset) pointless repetitive movements eg. Lip smacking

137
Q

Which Extrapyramidal symptom may not stop after stopping treatment

A

Tardive dyskinesia

138
Q

Adverse effects of 1amtipsychotics

A

Extrapyramidal

Drowsiness, hypotension, QT prolongation, erectile dysfunction, hyperprolactinaemia

139
Q

When should you be cautious of 1antipsychotics

A

Elderly - start lower dose
Dementia
Parkinson’s - due to Extrapyramidal

140
Q

Drug interactions with 1 antipsychotics

A

Any that prolong QT

141
Q

Second gen antipsychotics egs

A

Quetiapine, olanzapine, risperidone, clozapine

142
Q

2antipsychotic uses

A

Psychomotor agitation
Schizophrenia
Bipolar

143
Q

Mechanism of 2antipsychotics

A

Block post synaptic d2 receptors

144
Q

Main adverse effect of 2antipsychotics

A

Metabolic disturbance - weight gain, diabetes

145
Q

2antipsychotic adverse effects

A

Sedation, Extrapyramidal, metabolic disturbance, prolong QT, sexual dysfunction / breast symptoms

146
Q

Clozapine specific adverse effect

A

1% agranulocytosis (deficiency of neutrophils

Myocarditis

147
Q

Clozapine not used in which patients

A

Neutropenia

Severe heart disease

148
Q

2antipsychotics caution in ?

A

Cv disease

149
Q

2antipsychotics interactions

A

Should not be combined with dopamine blocking antiemetics / drugs that prolong QT

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