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FRACP 2023 Cram Homicrons Edition > Medications > Flashcards

Medications Flashcards

1
Q

Treatment for Wilsons Disease

A

Chelating agents:
1. D-Penicillamine
2. Trientine (if allergy)

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2
Q

Induction therapy for Crohns

A
  • Exclusive Enteral Nutrition (EEN) first line
  • Steroids short term
  • Early infliximab use if high risk complicated disease
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3
Q

Crohns disease maintainence

A

Mild: aminosalicylates +/- methotrexate and azathioprine
Severe: methotrexate, 6MP and azathioprine, Infliximab/ adalimumab (anti TNF-a)

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4
Q

What antihypertensive is teratogenic in pregnancy

A

ACEi & ARB

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5
Q

What antihypertensive is contraindicated in asthmatics

A

B blockers
- consider thiazide diuretic instead

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6
Q

Long term side effects with prolonged PPI use

A

(Studies mainly in adults)

Respiratory infections
C diff infections
Bone fractures
Hypomagnesmia + low B12
Tubulointerstitial nephritis

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7
Q

MOA PPI

A

Dose dependant irreversible inhibition of H/K ATPase pump
- >20mg, inhibits all intragastric acid secretion
- CYP450 inhibitor, increases availability of some drugs

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8
Q

Side effects with immunomodulators- AZA/6MP

A

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

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9
Q

Side effects/monitoring for prednisolone

A

Growth delay
Decreased bone density
Hyperglycemia
Hypertension

Ix: annual lipids/BSL, DEXA scan, BP monitoring

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10
Q

Side effects/monitoring for methotrexate

A

Nausea & vomiting, hepatitis
Infection (avoid live vaccines)
BM supression & blood dyscrasias
Pulmonary toxicity
Neurotoxicity
Teratogenicity

Ix: FBE/LFT 3monthly

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11
Q

Side effects/monitoring for hydroxychloroquine

A

Retinal toxicity
Haemolysis if G6PD
Skin/hair discolouration
GI upset
Ix: yearly opthalmology review

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12
Q

Side effects/monitoring for cyclosporine

A

All H:
Hirsutism
gum Hypertrophy
Hyperglycemia
HTN
Harm to kidneys

Mx: monthly UEC, FBE, LFT & BP

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13
Q

Side effects/monitoring for cyclophosphamide

A

Infection
GI toxicity
BM supression
Infertility

Ix/Rx: bactrim prophylaxis, regular FBE

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14
Q

Side effects/monitoring for mycophenylate

A

GI toxicity
BM supression
Infection

3monthly FBE

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15
Q

Side effects/monitoring for rituximab

A

Infection/immunosuppression (B cell lineage)

Requires 3monthly IVIG & B cells 1mo pre/post

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16
Q

Function of ACEi & use in CHF

A

prevent conversion of ang1 to ang2 (potent vasoconstrictor) = reduce afterload

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17
Q

Medication class most likely to cause DRESS?

A

Anticonvulsants
carbamazepine (HLAB5801/Han Chinese), lamotrigine, phenytoin, phenobarbital and allopurinol (HLAA3101/Euro & Han) are the most frequently reported causes

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18
Q

Indications/MoA sodium nitroprusside?

A

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

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19
Q

Drugs that can potentiate seratonin syndrome, MOA

A

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

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20
Q

First trimester teratogens

A
  • Anti epileptics (VALP, CBZ)
  • Lithium (Ebstein’s/Cardiac)
  • Warfarin (skeletal- limb/spine abnormalities, calcifications)
  • Cyclophosphamide
  • Gentamicin
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21
Q

Second trimester teratogens

A
  • ACEi: enalapril (1st- congenital malformations, 2/3rd- renal dysfunc/oligohydramnios)
  • NSAIDS (may cause early PDA closure, renal impairment & platelet aggregation)
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22
Q

What affects tacrolimus levels?

A

Increased:
- Diarrhoea (regulatory P-glycoprotein decreased)

Decreased:
- Sudden change in renal function
- Concurrent sirolimus use

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23
Q

What SC level does aorta branch to form renal arteries?

A

L1
- When inserting umbi line aim high T6-7 or low L4 to avoid coeliac, mesenteric & renal arteries

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24
Q

Side effect of frusemide in preterm infants

A

Deafness

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25
Q

Side effect of chloramphenicol eye drops in preterm infants

A

BM supression

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26
Q

Side effects tacrolimus

A

Alopecia, hypertension, nephrotoxicity, hypercholesterolaemia (lowered by cyclosporine in tranplant), Hyperglycaemia - diabetes, hypomagnesaemia, tremor, parasthesias, neurotoxicity including seizures, hyperkalaemia, gingival hyperplasia, confusion

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27
Q

Side effects of Bevcilizumab (anti CD19)

A

Pancytopenia
TLS
Cytokine storm

28
Q

Side effects calcineurin inhibitors (cyclosporine, tacro)?

GHHHERD

A

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

29
Q

Side effects diuretics (loop- frusemide)

A

Na/K/Cl cotransporter blocked
- Low everything (K/Cl/Na/Mg/Ca)
- High BSL/lipids

30
Q

Side effects diuretics (thiazide- i.e HCT)

A

Na/Cl cotransporter blocked
- Low Na/Cl, K
- High Ca/uric acid - stones/gout
- High BSL/lipids

31
Q

Side effects diuretics (K+ sparing- Spiro)

A

Block aldosterone in DCT/CD
- Stop H20 reabsorption
- High K+
- Gynaecomastia
- Androgen receptor blocker- anti-acne

32
Q

Side effects methotrexate

A

Anti-metabolite, inhibit purine synthesis

BM supression
Hepatic fibrosis
Mucositis
ILD- pneumonitis

33
Q

Side effects mycophenylate

A

Anti transplant rejection
- Inhibitor of inosine-5’-monophosphate dehydrogenase
- Prevents T/B cell proliferation

Severe diarrhoea
Leukopenia
ILD- pulmonary fibrosis

34
Q

Side effects azathioprine

A

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

35
Q

Side effects cyclophosphamide?

A

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

36
Q

Medication for SOS/VOD?

A

Defibrotide
- adenosine receptor agonist activity modulating thrombin and thrombomodulin

Reduces rates of SOS by 40%

37
Q

Antidote for isoniazid OD?

A
  • Isoniazid= ↓ brain pyridoxal-5-phosphate (cofactor for GABA) = GABA deficiency = excito-toxicity
  • Pyridoxine= ↑ pyridoxine-5-phosphate
38
Q

Antidote for organophosphate poisoning

A

Cholinergic toxicity

Atropine: muscarinic effects
Pralidoxime: nicotinic effects

39
Q

Antidote for B-blocker overdose

A

Glucagon

40
Q

Side effects of meropenem

A

Seizures
Dec. levels of valproate
- pseudomonas resistence
- FP DAT
- cytopenia
- parasthesia
- hepatic toxicity/GI SFx

41
Q

Is mesalazine or sulfasalazine preferred in UC treatment?

A

Mesalazine- less side effects

42
Q

Side effects of iNO

A
  • 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
43
Q

Migraine prophylaxis prohibitied in basilar/hemiplegic migraines

A

Basilar and hemiplegic migraines are theorised to be due to vasoconstrictive effects and thus could be potentiated by ergotamine or triptans.

44
Q

Effect of lamotrigine on CBZ

A

Increases concentration of CBZ & toxicity

45
Q

Effect of CBZ on lamotrigine

A

Decreases concentration of lamotrigine & efficacy

46
Q

Effect of valproate on lamotrigine

A

Increases concentration of lamotrigine & toxicity

47
Q

Side effects of valproate

A

Vomiting
Alopecia
Liver Toxicity
Pancytopaenia, low platelets/pancreatitis
Really fat (weight gain)
Oedema
Appetite increase
Tremor
Enzyme inducer (Liver)

48
Q

Why is valproate avoided in children <3

A

Risk of fatal liver toxicity secondary to undiagnosed
underlying metabolic condition.

  • Levetiracetam = preferred first
    line especially while awaiting
    results of investigations.
  • Carbamazepine = second line.
49
Q

Why is valproate avoided in children <3

A

Risk of fatal liver toxicity secondary to undiagnosed
underlying metabolic condition.

  • Levetiracetam = preferred first
    line especially while awaiting
    results of investigations.
  • Carbamazepine = second line.
50
Q

Effect of CBZ on clonazepam

A

Decreases concentration and efficacy

51
Q

Competitive inhibitor of muscarinic receptors

A

Ipratropium

52
Q

5-lipooxygenase pathway inhibitor (blocks
conversion of arachidonic acid to leukotrienes)

A

Montelukast

53
Q

Phosphodiesterase inhibitor (asthma med)

A

Aminophylline

53
Q

Phosphodiesterase inhibitor (asthma med)

A

Aminophylline

54
Q

Prophylaxis required when using eculizumab? MOA & use?

A

Eculizumab = anti C5
Useful in atypical HUS- blocks terminal complement pathway (MAC)
Increased risk infection with encapsulated organisms- req. meningococcal prophylaxis

55
Q

Medication class: Losartan
Side effects in pregnancy?

A

Angiotension II receptor blocker

Fetal effects include anuria,
oligohydramnios with resultant limb and
craniofacial abnormalities, pulmonary
hypoplasia, IUGR, prematurity, PDA.

56
Q

Medication class: Captopril
Side effects in pregnancy?

A

ACE inhibitor

Fetal effects include anuria,
oligohydramnios with resultant limb and
craniofacial abnormalities, pulmonary
hypoplasia, IUGR, prematurity, PDA.

57
Q

Medication class: Celecoxib
Side effects in pregnancy?

A

COX 2 inhibitor

Impedes production of prostaglandins= anuria and oligohydramnios through a similar mechanism to NSAIDs.

58
Q

Medication class:
Side effects in pregnancy?

A
59
Q

Medication class:
Side effects in pregnancy?

A
60
Q

MOA sodium benzoate in treating hyperammonemia?

A

Sodium benzoate reduces ammonia content in the blood by conjugating with glycine to form hippuric acid, which is rapidly excreted by the kidneys.

61
Q

Live vaccines

A

Rotavirus, MMR, varicella

62
Q

SE of adenosine?

A

Headache
Dyspnoea
Bronchospasm
Can trigger atrial fibrillation

63
Q

SE/contraindications digoxin

A

Risk of arrhythmias
Not to be given in WPW

64
Q

Contraindications CCBs?

A

Children < 12 months 🡪 can precipitate cardiac arrest
With beta blockers

65
Q

SE amiodarone

A

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

66
Q

What antiarrythmic blocks both K+ channel/B adrenergic receptors?

A

Sotolol

FRACP 2023 Cram Homicrons Edition (29 decks)

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