Medications Flashcards
Treatment for Wilsons Disease
Chelating agents:
1. D-Penicillamine
2. Trientine (if allergy)
Induction therapy for Crohns
- Exclusive Enteral Nutrition (EEN) first line
- Steroids short term
- Early infliximab use if high risk complicated disease
Crohns disease maintainence
Mild: aminosalicylates +/- methotrexate and azathioprine
Severe: methotrexate, 6MP and azathioprine, Infliximab/ adalimumab (anti TNF-a)
What antihypertensive is teratogenic in pregnancy
ACEi & ARB
What antihypertensive is contraindicated in asthmatics
B blockers
- consider thiazide diuretic instead
Long term side effects with prolonged PPI use
(Studies mainly in adults)
Respiratory infections
C diff infections
Bone fractures
Hypomagnesmia + low B12
Tubulointerstitial nephritis
MOA PPI
Dose dependant irreversible inhibition of H/K ATPase pump
- >20mg, inhibits all intragastric acid secretion
- CYP450 inhibitor, increases availability of some drugs
Side effects with immunomodulators- AZA/6MP
Common toxicities
Gastrointestinal symptoms
Hepatitis – monitor
Decreased cell counts – monitor
Pancreatitis
Less common
Risk of malignancy = HL, NHL, NMSC
Slight increased risk of EBV associated lymphoma
Minimal if any risk of NHL
Benefit in maintaining remission lymphoma risk
No increased risk of colorectal malignancy
Risk of skin infections = HSV, HPV
Need to check TMPT genotype (thiopurine methyltransferase) – genetically controlled enzyme activity; may identify patients at risk of drug-induced neutropenia
Side effects/monitoring for prednisolone
Growth delay
Decreased bone density
Hyperglycemia
Hypertension
Ix: annual lipids/BSL, DEXA scan, BP monitoring
Side effects/monitoring for methotrexate
Nausea & vomiting, hepatitis
Infection (avoid live vaccines)
BM supression & blood dyscrasias
Pulmonary toxicity
Neurotoxicity
Teratogenicity
Ix: FBE/LFT 3monthly
Side effects/monitoring for hydroxychloroquine
Retinal toxicity
Haemolysis if G6PD
Skin/hair discolouration
GI upset
Ix: yearly opthalmology review
Side effects/monitoring for cyclosporine
All H:
Hirsutism
gum Hypertrophy
Hyperglycemia
HTN
Harm to kidneys
Mx: monthly UEC, FBE, LFT & BP
Side effects/monitoring for cyclophosphamide
Infection
GI toxicity
BM supression
Infertility
Ix/Rx: bactrim prophylaxis, regular FBE
Side effects/monitoring for mycophenylate
GI toxicity
BM supression
Infection
3monthly FBE
Side effects/monitoring for rituximab
Infection/immunosuppression (B cell lineage)
Requires 3monthly IVIG & B cells 1mo pre/post
Function of ACEi & use in CHF
prevent conversion of ang1 to ang2 (potent vasoconstrictor) = reduce afterload
Medication class most likely to cause DRESS?
Anticonvulsants
carbamazepine (HLAB5801/Han Chinese), lamotrigine, phenytoin, phenobarbital and allopurinol (HLAA3101/Euro & Han) are the most frequently reported causes
Indications/MoA sodium nitroprusside?
Ix:
Acute hypertensive crisis
Perioperative BP control
Left ventricular failure
MoA
Potent vasodilator
Prodrug bioactivation to nitric oxide (NO) in erythrocytes by NO synthase
GC converts GTP –> cGMP
Vasodilates, prevents Ca influx
Drugs that can potentiate seratonin syndrome, MOA
Increases 5HT formation: tryptophan
Increases 5HT release: stimulants (coke/meth), levodopa
Impairs 5HT reuptake: stimulants, tramadol, SSRI, SNRI, TCA, St Johns wort, 5HT3- ondansetron, metaclopramide, valproate/CBZ, buproprion
Impairs 5HT metabolism: MOAIs, linezolid
5HT direct agonist: fentanyl, LSD, triptans
Increased post-synaptic sensitivity: lithium
First trimester teratogens
- Anti epileptics (VALP, CBZ)
- Lithium (Ebstein’s/Cardiac)
- Warfarin (skeletal- limb/spine abnormalities, calcifications)
- Cyclophosphamide
- Gentamicin
Second trimester teratogens
- ACEi: enalapril (1st- congenital malformations, 2/3rd- renal dysfunc/oligohydramnios)
- NSAIDS (may cause early PDA closure, renal impairment & platelet aggregation)
What affects tacrolimus levels?
Increased:
- Diarrhoea (regulatory P-glycoprotein decreased)
Decreased:
- Sudden change in renal function
- Concurrent sirolimus use
What SC level does aorta branch to form renal arteries?
L1
- When inserting umbi line aim high T6-7 or low L4 to avoid coeliac, mesenteric & renal arteries
Side effect of frusemide in preterm infants
Deafness
Side effect of chloramphenicol eye drops in preterm infants
BM supression
Side effects tacrolimus
Alopecia, hypertension, nephrotoxicity, hypercholesterolaemia (lowered by cyclosporine in tranplant), Hyperglycaemia - diabetes, hypomagnesaemia, tremor, parasthesias, neurotoxicity including seizures, hyperkalaemia, gingival hyperplasia, confusion
Side effects of Bevcilizumab (anti CD19)
Pancytopenia
TLS
Cytokine storm
Side effects calcineurin inhibitors (cyclosporine, tacro)?
GHHHERD
Gingival hyperplasia
Hirstutism
HTN
Headache/tremor/parasthesia
Electrolytes: low Mg, high K+
Renal- nephrotoxicity
Diarrhoea/deranged LFTs
Tacro- CYP450 inh at high conc, high BSL/DM, seizures
Siro- delayed wound closure, pancytopenia, ulcers
Side effects diuretics (loop- frusemide)
Na/K/Cl cotransporter blocked
- Low everything (K/Cl/Na/Mg/Ca)
- High BSL/lipids
Side effects diuretics (thiazide- i.e HCT)
Na/Cl cotransporter blocked
- Low Na/Cl, K
- High Ca/uric acid - stones/gout
- High BSL/lipids
Side effects diuretics (K+ sparing- Spiro)
Block aldosterone in DCT/CD
- Stop H20 reabsorption
- High K+
- Gynaecomastia
- Androgen receptor blocker- anti-acne
Side effects methotrexate
Anti-metabolite, inhibit purine synthesis
BM supression
Hepatic fibrosis
Mucositis
ILD- pneumonitis
Side effects mycophenylate
Anti transplant rejection
- Inhibitor of inosine-5’-monophosphate dehydrogenase
- Prevents T/B cell proliferation
Severe diarrhoea
Leukopenia
ILD- pulmonary fibrosis
Side effects azathioprine
Purine analogue/antimetabolite
DMARD- RA/Chrons/UC, SLE & GPSA
- Anti transplant rejection
BM suppression (inc risk if TPMT genotype)
Agranulocytosis
4x risk of lymphoma
Pancreatitis- 30% discontinuation
Side effects cyclophosphamide?
Alkylating agent (cross links DNA inhibits protein synthesis- apoptosis)
Rx: lymphoma, MM, leukemia, neuroblastoma, sarcoma, GPA, nephrotic syndrome, post transplant
Leukopenia- FBE first 4-8wks
Hemorrhagic cystitis
Sterility
BM suppression
Increased risk of leukemia
Alopecia
Medication for SOS/VOD?
Defibrotide
- adenosine receptor agonist activity modulating thrombin and thrombomodulin
Reduces rates of SOS by 40%
Antidote for isoniazid OD?
- Isoniazid= ↓ brain pyridoxal-5-phosphate (cofactor for GABA) = GABA deficiency = excito-toxicity
- Pyridoxine= ↑ pyridoxine-5-phosphate
Antidote for organophosphate poisoning
Cholinergic toxicity
Atropine: muscarinic effects
Pralidoxime: nicotinic effects
Antidote for B-blocker overdose
Glucagon
Side effects of meropenem
Seizures
Dec. levels of valproate
- pseudomonas resistence
- FP DAT
- cytopenia
- parasthesia
- hepatic toxicity/GI SFx
Is mesalazine or sulfasalazine preferred in UC treatment?
Mesalazine- less side effects
Side effects of iNO
- Prolonged bleeding time (direct ^ platelet aggregation)
- Methaemoglobinemia (if high doses NO binds to haem- oxidised to met, higher in prems due to less metHb reductase, <20ppm safe)
- Rebound pulmonary vasospasm >10ppm
- Pulmonary oedema
Migraine prophylaxis prohibitied in basilar/hemiplegic migraines
Basilar and hemiplegic migraines are theorised to be due to vasoconstrictive effects and thus could be potentiated by ergotamine or triptans.
Effect of lamotrigine on CBZ
Increases concentration of CBZ & toxicity
Effect of CBZ on lamotrigine
Decreases concentration of lamotrigine & efficacy
Effect of valproate on lamotrigine
Increases concentration of lamotrigine & toxicity
Side effects of valproate
Vomiting
Alopecia
Liver Toxicity
Pancytopaenia, low platelets/pancreatitis
Really fat (weight gain)
Oedema
Appetite increase
Tremor
Enzyme inducer (Liver)
Why is valproate avoided in children <3
Risk of fatal liver toxicity secondary to undiagnosed
underlying metabolic condition.
- Levetiracetam = preferred first
line especially while awaiting
results of investigations. - Carbamazepine = second line.
Why is valproate avoided in children <3
Risk of fatal liver toxicity secondary to undiagnosed
underlying metabolic condition.
- Levetiracetam = preferred first
line especially while awaiting
results of investigations. - Carbamazepine = second line.
Effect of CBZ on clonazepam
Decreases concentration and efficacy
Competitive inhibitor of muscarinic receptors
Ipratropium
5-lipooxygenase pathway inhibitor (blocks
conversion of arachidonic acid to leukotrienes)
Montelukast
Phosphodiesterase inhibitor (asthma med)
Aminophylline
Phosphodiesterase inhibitor (asthma med)
Aminophylline
Prophylaxis required when using eculizumab? MOA & use?
Eculizumab = anti C5
Useful in atypical HUS- blocks terminal complement pathway (MAC)
Increased risk infection with encapsulated organisms- req. meningococcal prophylaxis
Medication class: Losartan
Side effects in pregnancy?
Angiotension II receptor blocker
Fetal effects include anuria,
oligohydramnios with resultant limb and
craniofacial abnormalities, pulmonary
hypoplasia, IUGR, prematurity, PDA.
Medication class: Captopril
Side effects in pregnancy?
ACE inhibitor
Fetal effects include anuria,
oligohydramnios with resultant limb and
craniofacial abnormalities, pulmonary
hypoplasia, IUGR, prematurity, PDA.
Medication class: Celecoxib
Side effects in pregnancy?
COX 2 inhibitor
Impedes production of prostaglandins= anuria and oligohydramnios through a similar mechanism to NSAIDs.
Medication class:
Side effects in pregnancy?
Medication class:
Side effects in pregnancy?
MOA sodium benzoate in treating hyperammonemia?
Sodium benzoate reduces ammonia content in the blood by conjugating with glycine to form hippuric acid, which is rapidly excreted by the kidneys.
Live vaccines
Rotavirus, MMR, varicella
SE of adenosine?
Headache
Dyspnoea
Bronchospasm
Can trigger atrial fibrillation
SE/contraindications digoxin
Risk of arrhythmias
Not to be given in WPW
Contraindications CCBs?
Children < 12 months 🡪 can precipitate cardiac arrest
With beta blockers
SE amiodarone
K+ channel blocker
Very large volume of distribution (very lipophilic, long elimination ½ life)
Potent CYP3A4 inhibitor
Pulmonary toxicity, thyroid dysfunction, hepatotoxicity, optic neuropathy
QT prolongation
What antiarrythmic blocks both K+ channel/B adrenergic receptors?
Sotolol
