Medications Flashcards
Which chemotherapy drugs cause secondary malignancy?
- Cyclophosphamide.
- Etoposide (AML).
What is the most common long term side effect of cyclosporin?
- Hirsuitism.
Side effects of asparginase?
- Pancreatitis, hyperglycaema, allergies, coagulopathy, encephalopathy.
Side effects of cyclophosphamide?
- Myelosuppression, haemorrhagic cystitis, secondary malignancy, sterility, lung fibrosis, SIADH.
Side effects of doxorubicin?
- Myelosuppression, necrosis on extravasation, cardiotoxicity, radiation recall.
Side effects of vincristine?
- Peripheral neuropathy, ptosis, constipation, jaw and bone pain, extravasation injury.
Side effects of 6-mercaptopurine?
- Myelosuppression, hepatic necrosis.
Which hepatic enzyme is induced by St Johns Wort?
- CYP3A4
Which hepatic enzyme does cyclosporin inhibit?
- CYP3A4
What medication is used as first line treatment for threadworm/pinworm (Enterobius vermiculars)?
- Pyrantel or mebendazole.
- Shower on the night medication and again in the morning to remove eggs laid overnight.
How many half lives does it take for a drug to reach steady state?
5
Which antiepileptic should not be used in JME?
- Carbemazapine.
- Known to cause deterioration in 68% of patients with JME.
Side effects of Vigabatrin?
- Visual field constriction from peripheral retinal atrophy.
- Optic neuritis.
- Vision loss (rods > cones so predominantly night vision).
Side effects of Carbamazepine?
- Nausea and vomiting.
- Dizziness.
- Drowsiness.
- Liver dysfunction.
- Hyponatraemia (SIADH).
Side effects of Gabapentin?
- Somnolence.
- Dizziness.
- Tremor/ataxia.
Side effects of Lamotrigine?
- Rash.
- Nausea.
- Dizziness.
- Tremor.
- Diplopia.
Side effects of Sodium Valproate?
- Weight gain.
- Hair loss.
- Tremor.
- Dizziness.
- Nausea and vomiting.
- Easy bruising.
- Birth defects.
What medications increase cyclosporin levels?
- Ketoconazole, erythromycin, warfarin, itraconazole and fluconazole.
What medications decrease cyclosporin levels?
- Phenytoin, phenobarbitol, carbamazepine, rifampicin, alcohol abuse, sulphynyureas, St Johns Wort.
What are side effects of hydroxycholoquine?
- Nausea - most common side effect and may stop children from eating. Wean the dose and advise to give at night.
- Corneal toxicity - reversible.
- Retinal toxicity - rare, loss of colour vision and blindness. Irreversible.
How does Tocilizumab work?
- Tocilizumab is a recombinant humanized anti-human monoclonal antibody directed against IL-6 receptor.
How does Infliximab work?
- Chimeric monoclonal antibody that binds TNFa.
- Etnercept also binds TNFa but is a recombinant protein.
How does Anakinra work?
- IL1 inhibitor.
- Canakinumab and Rilanocept are also IL1 inhibitors.
Why does topiramate cause nephrolithiasis?
- Inhibits carbonic anhydrase leading to metabolic acidosis.
- Defect in renal tubular acidification as a result of loss of carbonic anhydrase impairs compensatory drop in urine pH.
- This leads to development of calcium phosphate nephrolithiasis.
What is the mechanism of action of penicillins?
- Inhibit cell wall synthesis.
- Irreversibly bind to DD transpeptidase (penicillin binding protein) and prevent transpeptidation.
What antibiotics are used for MRSA?
- Glycopeptides (vancomycin and teicoplanin).
What are the relative potencies of glucocorticoids compared to cortisol?
- Prednisilone 4:1
- Betamethasone 25:1
- Dexamethasone 25:1
Omeprazole affects gastric parietal cell function by inhibition of which pathway?
- Inhibits H+K+ ATPase (proton pump) by irreversibly binding on the luminal surface.
- Blocks the final step in gastric acid secretion by parietal cells.
What features are associated with in utero alcohol exposure?
-short palpebral fissures, blepharoptosis. epicanthal folds, telcanthus, smooth philtrum, small upper lip.
What features are associated with in utero phenytoin exposure?
- Craniofacial abnormalities, hypoplastic phalanges/nails.
What features are associated with in utero sodium valproate exposure?
- Spina bifida, preaxial defects, low IQ.
What features are associated with in utero warfarin exposure?
- Nasal hypoplasia, stippled epiphyses, CNS defects secondary to cerebral haemorrhage.
What antibiotic does not have action against Pseudomonas?
- Cefotaxime
Which antiepileptics are inducers?
- Phenytoin, phenobarbital and carbemazepine.
Which chemotherapy agent is most likely to cause renal Fanconi syndrome
- Ifosfamide.
- Particularly doses >54g/m2.
- Hypophosphataemia, hypokalaemia, glycosuria, proximal RTA, hypouricaemia.
- Decreased tubular reabsorption on PO4 and increased fractional excretion of Na, K and Ca.
- Increased urinary amino acids and HCO3.
- Can cause glomerular and tubular toxicity.
- Proximal tubular dysfunction is prominent and characterised by Fanconi syndrome and hypophosphataeimic ricketts.
- IFO dose >100g/m2, age <5y and combination therapy with platins increase risk.
What is a bacteriostatic antibiotic?
- Antibiotic that limits the growth of bacteria by interfering with the bacterial protein production.
- Examples: Macrolides, sulfonamides, trimethoprim, chloramphenicol, licosamides (clindamycin).
What is a bacteriocidal antibiotic?
- Kill bacteria.
- Examples: aminoglycosides, b-lactams, fluoroquinolones, nitrofurantoin, vancomycin, daptomycin.
What medications and drugs are serotinergic?
- SSRI and SNRI antidepressants.
- TCA’s.
- Amphetamines, MDMA and cocaine.
- Tramadol.
- St Johns Wort.
- Triptans.
- Metocloparmide and ondansetron.
What are features of serotonin syndrome?
- Fever, tachycardia, sweating.
- Dilated pupils.
- Agitation, confusion, hypomania.
- Tremor, myoclonus and increased reflexes.
- Also develop nausea and diarrhoea.
Side effects of cytarabine?
- Fever is a common side effect.
- Oral mucocytis.
