Medication Flashcards
What type of medication is Haloperidol?
First generation antipsychotic
Typical
What is the indication for haloperidol?
Schizophrenia
Acute delirium
Moderate to severe manic episodes associated with bipolar disorder
What’s the dosage for haloperidol in schizophrenia?
2-10mg daily in 1-2 divided doses
But usual is 2-4mg daily
In first episode up to 10mg
What’s the maximum dosage for haloperidol in schizophrenia
Maximum dosage is 20 mg per day
What is the dosage and frequency of haloperidol for moderate to severe manic episodes associated with bipolar disorder
2 to 10 mg daily in 1 to 2 divided doses.
What is the maximum dosage of haloperidol for moderate to severe manic episodes associated with bipolar disorder
Maximum 15 mg per day
What are the contra indications of haloperidol
CNS central nervous system depression, QT interval prolongation, recent acute myocardial infarction, and compensated heart failure, Parkinson’s disease
What are the side effects for haloperidol 
Depression, eye disorders, headache, nausea, neuromuscular dysfunction, psychotic disorder, vision disorders, weight decreased
What are all the side effects for antipsychotic drugs
Agitation, arrhythmia, constipation, dizziness, drowsiness, dry mouth, erectile dysfunction, fatigue, hypoglycaemia, hypersalivation, hypertension, insomnia, movement disorders, muscle rigidity, Neutropenia, parkinsonism, postural hypertension but that dose related, QT interval prolongation, severe rash, seizure, tremors, urinate retention, vomiting, and weight increased
What is the mechanism of action for haloperidol
Haloperidol is an antipsychotic that works by blocking dopamine receptors particularly D2 receptors in the brain. Reduces dopamine activity in the central nervous system which helps alleviate symptoms of positing symptoms of psychosis, agitation and mania
What is the pharmacodynamics of haloperidol
It works by having an antigen antagonising effect on dopamine D2 receptors. Reducing dopamine activity alleviate symptoms of psychosis agitation and delusions
How does haloperidol work in relation to neurotransmitters
It works by reducing dopamine in the brain because psychotic symptoms are related to an overproduction of dopamine
What are the pharmacokinetics of haloperidol
Haloperidol is well absorbed after oral administration with pink plasma concentration is occurring within 2 to 6 hours
Haloperidol is metabolised in the liver

What are the monitoring requirements for haloperidol
A baseline ECG is recommended before treatment initiation
Physical health monitoring including cardiovascular disease risk assessments at least once per year
What are the indications for Lorazepam
Short-term use in anxiety

What type of medication is lorazepam
Short acting benzodiazepine
What are the contra indications of Lorazepam
Central nervous system depression, compromised airway, respiratory depression
What are the cautions of benzodiazepines
Avoid prolonged use and abrupt withdrawal, debilitated patience, history of alcohol dependence or abuse, history of drug dependence, paradoxical effects which may increase hostility and aggression
What are the side effects of Lorazepam
Apnoea, coma, disinhibition, extra pyramidal symptoms, memory loss, speech slurred, alertness decreased, anxiety, confusion, drowsiness, headache, muscle weakness, nausea, withdrawal syndrome
What are the pharmacodynamics of Lorazepam
It enhances the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain.
These GABA receptors Has an inhibitory response that reduces the activity of nerve cells which helps reduce anxiety by making you feel more relaxed and promoting a calming and sedating effect
What are the pharmacokinetics of lorazepam
It is rapidly absorbed after oral administration with peak plasma concentrations reached in two hours your liver process is the medication and it stays in your system for about 12 to 18 hours before being removed by your body through urine
What is the dosage of Lorazepam for short-term use in anxiety
1-4mg daily in divide a doses
what type of medication is Clozapine
Atypical or second generation antipsychotic
what is the indication for Clozapine
treatment resistant schizophrenia,
last resort when trying at least 2 other medications
what is the dosage for clozapine initiation
Day 1 - 12.5mg 1-2 times per day
Day 2 - 25-50mg for day 2
Increase in steps of 25-50g daily (gradually increased over 14-21 days)
Increased up to 300mg daily in divided doses
what is the maximum dosage and when should the larger dose be taken?
900mg per day and night time should the larger dose be taken
what is the usual dose for clozapine?
200-450mg daily
what happens if a Clozapine dose is missed
If missed after 48 hours then restart titration
what are the contra indications for clozapine
cardiac disorders, uncontrolled epilepsy, drug intoxication, bone marrow disorders, severe respiratory disease, severe CNS depression, history of agranulocytosis (severely low netrphils –> increase risk to infection
What are the cautions of clozapine
neutropenia and potentially fatal agranulocytosis reported
myocarditis- inflammation of heart muscle, intestinal obstruction - constipation, severe respiratory disease, diabetes- may raise blood glucose, history of jaundice, cardiovascular disease, conditions predisposing to seizures
what are the side effects of clozapine
hypertension, anxiety, agitation, fatigue, constipation, QT interval prolongation, muscle rigidity, parkinsonism, hypertension, urinary disorder, arrhymias, nausea, speech impairment, blurred vision, abnormal sweating, temperature regulation disorders, hypersalivation, insomnia, seizure, tremoir, weight retention, dry mouth
what are the monitoring requirements for Clozapine in terms of bloods
blood tests every week for 18 weeks to monitor for white blood cell count
then every 2 weeks for up to one year
then monthly
what other monitoring requirements are there other than blood tests
Cardiac monitoring- ECG to monitor for myocarditis - heart muscle becomes inflames making it harder to the heart to pump
particularly important as the risk of myocarditis is higher within the first month of treatment
what symptom should prompt observation for indicators of myocarditis
persistent tachycardia in first 2 months
what happens if myocarditis is suspected when taking clozapine
it should be stopped gradually reduce dosage over 1-2 weeks to avoid risk of rebound psychosis
what factors can affect the dosage of clozapine given to a patient
smoking- reduces clozapine levels in the blood due to an enzyme in the liver metabolising clozapine therefore smokers need a higher dose
if a patient stops smoking while on clozapine, blood levels may increase rapidly
Patients with liver impairment may process clozapine more slowly, requiring lower doses and careful monitoring for toxicity
Reduced kidney function may slow the excretion of clozapine’s active metabolites, leading to higher blood levels.
what are the pharmacodynamics rof clozapine
antagonising effect on dopamine and serotonin receptors
dopamine is associated with positive symptoms of schizophrenia
reduces excessive serotonin activity that can suppress dopamine function in areas like the prefrontal cortex, thus improving symptoms such as emotional withdrawal, lack of motivation, and impaired thinking.
what are the pharmacokinetics of clozapine
undergoes almost complete absorption with time to maximum plasma concentration of 1.5-2 hours in which maximum effect works 4 hours after administration
metabolised via hepatic pathway in the liver with a half life of 12-16 hours
route of elimination - excreted in the urine and faeces
what medication is olanzapine
atypical antipsychotic
second generation
what are the indications for olanzapine
schizophrenia and bipolar disorder
what is the usual dosage for olanzapine
5-20mg daily
what is the maximum dosage for olanzapine
20mg
when might you consider a lower initial dosage of olanzapine
females, elderly and non-smoker
what are the cautions of olanzapine
cardiovascular disease, respiratory disease, history of jaundice, low leucocyte count, CNS depression
what are the contra indications of olanzapine
central nervous system depression, severe hepatic impairment, acute myocardial infacrtion, bradycardia and severe hypotension, unstable angina
what are the side effects of olanzapine
hypersomnia weight gain, appetite increased, fever, oedema, sexual dysfunction, agitation, fatigue, anticholinergic syndrome- ACS toxic syndome leading to agitation and delirium and confusion and restlessness
what are the pharmacodynamics of olanzapine
involves blocking dopamine D2 receptors and serotonin receptors to help balance neurotransmitter levels
this improves symptoms of hallucinations and delusions
effect on serotonin receptors prevents the onset of anhedonia, flat affect, alogia and avolition and poor attention
what are the pharmacokinetics of olanzapine
Absorption- well aborbed reaching peak plasma concentration 6 hours after oral administration
large distribution throughout the body
metabolised in the liver which represents around 40% of the administered dose
route of elimination- mainly through metabolism hence only 7% is found as the unchanged form
mainly excreted in urine 53% and 30% faeces
half life- 30 hours average
what type of medication is Venlafaxine
a serotonin and noradrenaline re uptake inhibitor
what is the usual dosage for venlafaxine for depression
75mg in 2 divided doses then inreased if necessary up to 375mg daily in 2 divided doses
what are the indications for venlafaxine
major depression, generalised anxiety disorder
what is the usual dosage for venlafaxine for depression
75mg once daily then increased up t 225mg once daily
what are the associated risks with SNRIs
increase the risk of bleeding due to their effect on platelet function
what are the contra indications for venlafaxine
uncontrolled hypertension
what are the cautions for venlafaxine
conditions associated with high risk of cardiac arrhythmias, diabetes heart disease (monitor blood pressure), history of bleeding disorders, history of epilepsy, history of mania, susceptibility to angle closure glaucoma
what are the side effects of venlafaxine
anxiety, appetite decreased, arrhythmias, confusion, constipation, diarrhoea, dizziness, dry mouth, headache, hypertension, movement disorder, nausea, palpitations, sedation, sexual dysfunction, skin reactions, sleep disorders, weight changes, vomiting, tremor, urinary disorders
what is the pharmacodynamics of venlafaxine
works by increasing the levels of serotonin and norepinephrine. This is done by inhibiting the reuptake of both serotonin and norepinephrine at the presynaptic terminal = more neurotransmitters in the synapse for it to be absorbed
what are the pharmacokinetics of venlafaxine
Absorption- well absorbed after with bioavailability of 45%
volume of distribution- steady state
undergoes liver metabolism
half life- of about 5 hours
elimination - urine and faeces
what type of medication is sertraline
an antidepressant- selective serotonin reuptake inhibitor
what is the indication for sertraline
depression, ocd, ptsd , social anxiety disorder
what is the dose for sertraline
initially its 50mg once daily then increased in 50mg intervals at least 1 week if required and maintenance is 50mg once daily
what is the maximum dosage for sertraline
200mg per day
contra indications for SSRI sertraline
poorly controlled epilepsy and should not be used if patient enters manic phase
what aer the cautions for SSRI
cardiac disease, concurrent electroconvulsive therapy, diabetes, epilepsy, history of bleeding disorders, history of mania,
what are the side effects of sertraline
Chest pain, gastrointestinal disorders,
impaired concentration, diarrhoea, dry mouth, constipation, fever, vasodilation where the vessels widen- lower blood pressure, emotional blunting, dry mouth, headache, dizziness, weight gain/loss
Also monitor for first 2 weeks as it can increase suicidal ideation
what to do if you want to come off sertraline
dose should be reduced gradually over 4 weeks or longer if withdrawal symptoms emerge
what are the pharmacodynamics of sertraline
improves or relieves the symptoms of depression, OCD, PTSD by inhibiting the serotonin reuptake
Blocks the serotonin transporter which reduces serotonin reuptake in the presynaptic neuron –> increase availability in the synampse enhancing serotonergic neurotransmission
what is salbutamol
short-acting beta 2 adrenergic agonist
bronchodilator
what are the indications for salbutamol
chronic asthma, acute asthma, prophylaxis of allergen,
what is the dosage for chronic asthma via aerosol and nebuliser
aerosol- 100-200 micrograms taken for symptomatic relief
2.5-5mg initiated by specialist via nebuliser
what are the different routes for salbutamol
inhaled by aerosol, powder or nebuliser but must be indicated by a specialist or slow intravenous injection in acute asthma
what is the dosage for acute asthma for aerosol and powder salbutamol
aerosol or inhaler - 100 micrograms every 30seconds to 1 minute for up to 10 doses
each dose must be inhaled separately via a spacer
Repeat every 10-20 minutes or when required
Or alternatively 200 micrograms every 30 seconds- 1 minute for up to 5 doses
what is the dosage for acute asthma for slow intravenous injection salbutamol
250 micrograms to be administered over 5-10 minutes dose can be repeated if necessary
what is the dosage for acute asthma for continuous intravenous injection salbutamol
initially 5 micrograms per minute but adjusted to response and tolerance,
usual dose is 3-20 micrograms per minute
what is the dosage for acute asthma for nebuliser of salbutamol
2.5-5mg repeat every 15-30 minutes or when required
give via oxygen-driver nebiliser
what is the dosage for prophylaxis of allergen via aerosol and nebuliser
200 micrograms taken every 10-15 minutes
what are the contra indications of salbutamol
severe cardiovascular conditions because it can raise heart rate
uncomplicated premature labour, allergies to any of the salbutamol ingredients, pregnant and breast feeding unless agreed by doctor
what are the cautions of salbutamol - beta 2 adrenoceptor agonists
arrhythmias, cardiovascular disease, diabetes (risk of hyperglycaemia and ketaacidosis, hypertension, hyperthryroidism, hypokalaemia (low blood potassium), susceptibility to QT interval prolongation
what are the side effects of salbutamol
tachycardiam muscle tremors, hypotension due to peripheral vasodilation, hypokalemia , hyperglycemia
what are the monitoring requirements when on salbutamol
heart rate, muscle tremors, blood pressure due to it causing hypotension, serum potassium levels due to hypokalemia as a side effect and blood glucose levels
what are the pharmacodynamics of salbutamol
short acting beta 2 agonist
binds to beta 3 adreno receptors stimulating a protein in the smooth muscle of the airways causing it to relax and therefore allowing fo bronchodilation. This results in making it easier to breathe due to less airway resistance, more gas exchange can occur
pharmacokinetics of salbutamol
adsorption- absorbed in the lungs and gastrointestinal tract
lasts for 3-4 hours
quick acting
weakly bound to plasma proteins
metabolised in the liver and excreted via urine
2-5 hours half life
what type of medication Ipratropium bromide
anticholinergic - bronchodilatr
what are the indications of Ipratropium bromide
reversible airway obstruction in asthma and COPD, acute bronchospasm and severe acute asthma
what is the dosage for Ipratropium bromide via aerosol
20-40micrograms 2-4 times a day
what is the dosage required for Ipratropium bromide via nebulised solution
250-500 micrograms 3-4 times a day
what is the dosage of Ipratropium bromide for severe or life threatening acute asthma
500 micrograms every 4-6 hours as required via nebuliser
what are the cautions of Ipratropium bromide
avoid spraying near eyes, Glaucoma - chronic eye disease,
cystic fibrosis
via intranasal use
bladder outflow obstruction, susceptibility to angle closure glaucoma
what are the contra indications of Ipratropium bromide
hypersensitivity, glaucoma- eye condition, urinary retention, gastrointestinal obstruction
–> cautiously in urinary retention because of its anticholinergic effects it can relax bladder muscles and impair ability to contract
what are the pharmacodynamics of Ipratropium bromide
blocks aceytylcholine at the muscarinic receptors which
inhibits the parasympathetic nervous system to undergo bronchoconstriction therefore this inhibition leads to bronchodilation and decreases mucus secretion = airflow improved
it stops acetylcholine actioning on the muscles causing them to contract and producing a narrow airway therefore ipatropium stop this and prevents smooth muscle from contracting and therefore produces them to relax
what are the pharmacokinetics of Ipratropium bromide
absorption- poorly absorbed agent
serum levels of ipatropium is low after administration
lasts around 4-6 hours
low bioavailability of 2%
metabolised in the gastrointestinal tract and excreted unchanged
excreted mainly via urine
short half life of 1.6 hours
what are the side effects of Ipratropium bromide
constipation, diarrhoea, nausea, vomiting, difficulty passing urine, , gastrointestinal motility disorder, throat complaints, headaches
what type of medication is Carbocisteine
mucolytic- cause mucus to be less sticky and easy to cough up
what is the indication of Carbocisteine
reduction of sputum viscosity
what are the contra indications of Carbocisteine
active peptic ulceration
what are the cautions of Carbocisteine
history of peptic ulceration
what are the side effects of Carbocisteine
gastrointestinal haemorrhage, skin reactions , vomiting
what are the pharmacodynamics of Carbocisteine
it reduces sputum viscosity by breaking down the bonds in mucus glycoproteins which makes it less sticky
it helps alleviate symptoms such as coughing and breathlessness caused by mucus buildup
what are the pharmacokinetics of Carbocisteine
rapidly absorbed in the gastrointestinal tract when taken orally
peak serum concentrations achieved within 1-7 hours
volume of distributes well into the lung and bronchial secretions
excreted via urine with 30-60% being unchanged
short half life
what is amoxicillin
penicilin antibiotic
what are the indications for Amoxicillin
susceptible infectons, acute exacerbation of COPD, acute cough,
what is the dosage of Amoxicillin for susceptible infections
500mg every 8 hours
increased to 1g every 8 hours if necessary
what is the dose for Amoxicillin in acute exacerbations of COPD
500mg 3 times a day for 5 days
increased if necessary to 1g 3 times a day
what are the cautions of Amoxicillin
glandular fever, increased risk of rashes, maintain adequate hydration with high doses, hepatic impairment renal impairment
what are the contra indications of Amoxicillin
prior anaphylactic reactions or severe skin reactions
what are the side effects of Amoxicillin
hypersensitivity, nausea, skin reactions, vomiting, diarrhoea, extreme tiredness,
what are the pharmacodynamics of amoxicillin
antibiotic that inhibits bacterial cell wall synthesis. This leads to cell wall weakening and therefore stops the growth of bacteria
what are the pharmacokinetics of amoxicillin
absorption: rapidly absorbed
approximately 60% bioavailability
half life 1 hour
minimal metabolism occurs
excreted through the kidneys
what type of medication is Prednisolone
corticosteroid that mimics the action of cortisol
has anti inflammatory effects
what are the indications of Prednisolone
acute exacerbation of COPD
acute asthma
surpression of inflammatory and allergic disorders
what is the dosage of Prednisolone for COPD
30mg once daily for 5 days
what is the dosage of Prednisolone for acute asthma
40-50mg once daily for at least 5 days
what are the contra indications of Prednisolone
hypersensitivity, live vaccines (avoid if immunosuppressed), untreated systematic infections as it can worsen infections because it suppresses the immune system
what are the cautions of Prednisolone
diabetes melltus ( can raise blood sugar), hypertension or heart disease (fluid retention and increase BP), peptic ulcers, severe affective disorders (can be steroid induced),
what are the side effects of Prednisolone
diarrhoea, dizziness, weight gain, mood changes such as irritability, insomnia, increased blood sugar, indigestion, prolonged use can increase susceptibility to infections
what are the pharmacodynamics of Prednisolone
binding to intracellular gluococorticoid receptors
which surpress inflammatory and immune responses
what are the pharmacokinetics of prednisolone
absorption - well absorbed has a bioavailability of 70%
widely distributed and highly bound to proteins
metabolised in the liver
excreted in the urine and
half life is around 2-4 hours
what type of medication is Mannitol
osmotic diuretic
what are the indications of Mannitol
rcerebral oedema, reduce intracranial pressure (inside the head), intraocular pressure (pressure of fluid in the eyes) or promoting diuresis in acute kidney injury
what is the route of administration of intracranial pressure
intravenous infusion
what is the dosage of Mannitol
0.25-2g per kg
can be administered over 30-60 minutes
dose may be repeated 1-2 times after 4-8 hours
what are the contra indications of Mannitol
anuria (lack or urine output), intracranial bleeding (head bleeding), severe cardiac failure, severe dehydration, severe pulmonary oedema
what are the cautions of Mannitol
extravasation causes inflammation, heart failure, renal impairment, dehydration risk, hypersensitivity reactions, can cause sodium and potassium disturbances
what are the side effects of Mannitol
cough, headache, vomiting, dehydration, electrolyte imbalance,
what are the monitoring requirements for Mannitol
monitor fluid and electrolyte balance, serum osmolality, cardiac, pulmonary and renal function
what are the pharmacodynamics of Mannitol
increases the osmolarity of plasma= water moves out of cells into the blood stream
= this reduces intracranial pressure by creating an osmatic gradient
what are the pharmacokinetics of Mannitol
absorption- via intravenously so not absorbed via gastrointestinal tract
only slightly metabolised
primarily excreted unchanged in the urine
half life of 4.5 hours
what type of medication is paracetamol
analgesic (painkiller) and antipyretic (reduces fever)
what is the indication of paracetamol
mild to moderate pain
pyrexia- fever
what is the dosage of paracetamol
500mg - 1 gram every 4-6 hours
maximum 4g per day
what are the cautions for paracetamol
check when paracetamol was last administered and cumulative paracetamol dose over previous 24 hours, body weight under 50kg, chronic alcohol consumption, chronic dehydration, chronic malnutrition, long term use
some people under 50kg are at increased risk of toxicity
what are the contra indications for paracetamol
liver disease, hypersensitivity, severe renal impairment, alcohol abuse
what are the side effects of paracetamol
gastrointestinal issues eg nausea, stomach pain, kidney problems, allergic reaction, liver damage, rash,
what are the pharmacodynamics of paracetamol
inhibits an enzyme in the brain which results in decreased production of prostaglandins involved in pain but instead stops chemical messengers by reduce the intensity of pain signals to the brain
paracetamol has minimal effect in relieving inflammation.
what is the pharmacokinetics of paracetamol
absorption- 88% bioavailability
excreted via urine- 90%
half life- 2.5 hours after
if overdose- can range from 4-8 hours
