Medicines 42 Flashcards
What is a COMT inhibitor and how does it work?
Entacapone, Opicapone
There is an enzyme that can break down levodopa medication and stop it from working. COMT inhibitors such as Comtess block that enzyme which can help levodopa to work more effectively.
How does protein affect levodopa in Parkinson’s disease? What dietary tips can improve its effectiveness?
Protein can interfere with levodopa absorption (competes for transport).
Take levodopa 30–60 mins before meals to improve absorption.
If nausea occurs, take with a low-protein snack (e.g., crackers).
Consider protein redistribution diet:
Low protein during the day (when levodopa is most needed)
Higher protein in the evening
⚠️ Do not reduce total protein intake—essential for health.
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What are the symptoms of a sinus headache?
Type of pain:
Dull, throbbing pain
Located in upper half of face (forehead, cheeks, around eyes)
Worsened by:
Bending forward or sudden head movement
Associated symptoms:
Facial tenderness or swelling (eyes, cheeks, forehead)
Halitosis (bad breath)
Nasal congestion or discharge
What allergies/cross sensitivities should be noted with sumatriptan?
Sumatriptan should be used with caution in patients with sensitivity to sulfonamides because:
🔹 Chemical Structure Concern:
Sumatriptan contains a sulfonamide group in its chemical structure, which is similar to that found in sulfonamide antibiotics (e.g., sulfamethoxazole).
🔹 Risk of Hypersensitivity:
Although true cross-reactivity is rare, there is a potential risk of hypersensitivity reactions, including:
Skin rashes
Anaphylaxis (in very rare cases)
What is Zonisamide and what is a key counselling point with it?
Zonisamide is an antiepileptic drug (AED)
Watch out for overheating — Zonisamide can impair your body’s ability to sweat
Avoid overheating and ensure adequate hydration especially in children, during strenuous activity or if in warm environment (fatal cases of heat stroke reported in children).
Whats a common side effect of Baclofen
Drowziness
confusion
hallucinations
What is Diabetes Isipudus
Central DI (Neurogenic)
Caused by a lack of antidiuretic hormone (ADH), also called vasopressin
Due to damage to the hypothalamus or pituitary gland (e.g. trauma, surgery, tumour)
Nephrogenic DI
The kidneys don’t respond to ADH properly
Can be genetic or caused by medications (e.g. lithium), or kidney disease
🔹 Key Symptoms:
Polyuria – excessive urination (often dilute urine)
Polydipsia – excessive thirst
Dehydration and electrolyte imbalance if fluid not replaced
What is the treatment for diabetes insipidus?
Central DI: Desmopressin (synthetic ADH)
Nephrogenic DI: Thiazide diuretics, low-salt diet, NSAIDs (in some cases)
What is the first and second line treatment for hyperthyroidism
Carbimazole is the recommended choice of antithyroid drug, with propylthiouracil considered for those in whom carbimazole is unsuitable.
What is the treatment for Graves Disease?
- An Immune system disorder resulting in the overproduction of thyroid hormone. This causes swelling of thyroid gland, puffy eyes and rapid heartbeat
WRONG CHANGE THIS
🧪 First-Line Treatment
👉 Radioactive iodine is recommended first-line under specialist care,
Unless:
It’s unsuitable ❌
Remission likely with antithyroid drugs ✅
📌 When Remission Likely (e.g. mild/uncomplicated cases):
➡️ Offer a choice:
Carbimazole 💊
Radioactive iodine ☢️
If radioactive iodine or surgery are unsuitable:
➡️ Carbimazole = first-line.
⏳ Carbimazole Regimens (12–18 months):
Block and replace: High-dose carbimazole + levothyroxine 🔁
Titration: Adjust carbimazole based on TFTs 📉
🔍 Then review the need for further treatment.
🔁 If hyperthyroidism persists/relapses:
➡️ Consider radioactive iodine ☢️ or surgery 🔪
🚫 When to use Propylthiouracil (PTU):
✅ If:
Side effects from carbimazole
Pregnant 🤰 or trying to conceive in 6 months
Hx of pancreatitis 🩺
How do you remember the water soluble beta blockers ?
water CANS
Celiprolol:
Atenolol: .
Nadolol: .
Sotalol: .
Which Beta blockers tend to cause less bradycardia than the other beta-blockers and may also cause less coldness of the extremities
Ice PACO
pindolol, acebutolol, Celiprolol hydrochloride and oxprenolol hydrochloride
Whats the treatment for Neutropenia
Granulocyte-colony stimulating factors include
filgrastim,
lenograstim,
pegfilgrastim and
lipegfilgrastim.
What is the treatment for Diverticulitis
DOUBLE CHECK THIS AMG ANTIBACTS OFTEN GIVEN
🔹 Diverticular Disease = Mild symptoms
🛑 No antibiotics
💊 Bulk-forming laxatives if:
High-fibre diet not tolerated 🍞
Constipation/diarrhoea persists
😣 Abdominal pain?
Try paracetamol ✅
Antispasmodics for cramps 🌪️
🚫 Avoid NSAIDs & opioids (↑ perforation risk)
🔍 Persistent symptoms? → Consider alternative diagnosis 🧠
WHat is the treatment for acute diverticulitis?
Acute Diverticulitis = Inflammation ⚠️
🙂 If systemically well:
Use paracetamol
Watchful waiting 🕒
NO routine antibacterials 🚫
🗣️ Re-present if symptoms worsen
📈 Worsening symptoms?
→ Reassess in primary care
🏥 Consider hospital referral
🚑 URGENT Referral if:
Complications (e.g. uncontrolled pain)
Significant rectal bleeding
🚫 Do NOT use:
Aminosalicylates
Prophylactic antibiotics
What Cytotoxics cause a sore mouth ( oral mucocitis) ?
🗣️ Sore mouth is a common complication of cancer chemotherapy.
🚨 High-risk drugs:
Fluorouracil (5-FU)
Methotrexate (MTX)
Anthracyclines (e.g. Doxorubicin, Daunorubicin)
🧠 Mnemonic: “FMA = Feels Mouth Ache”
F → Fluorouracil
M → Methotrexate
A → Anthracyclines
Which Cytotoxics dont cause Bone Marrow Suppression?
“Valuing Bones”
bleomycin & vincristine sulfate
What are the contraindications with all benzodiazepines?
⚠️ Benzodiazepine Contraindications 💊
❌ Do NOT use in:
Acute pulmonary insufficiency
Marked neuromuscular respiratory weakness
Sleep apnoea syndrome
Unstable myasthenia gravis
Chronic psychosis (not for use alone)
Depression or anxiety with depression (not for use alone)
Phobic or obsessional states
🧠 Mnemonic: “Benzos SPASM UP”
S → Sleep apnoea
P → Pulmonary insufficiency (acute)
A → Anxiety with depression (alone use = ✖️)
S → Severe myasthenia gravis (unstable)
M → Marked neuromuscular weakness
U → Use in chronic psychosis (alone = ✖️)
P → Phobic & obsessional states
What are the uses, contraindications, and important safety considerations for Prostaglandins E1 and E2?
Prostaglandin E1 (misoprostol) and E2 (dinoprostone) are used to induce labour, ripen the cervix, and manage postpartum haemorrhage.
⚠️ Contraindications:
Contraindicated in:
Women of childbearing potential not using contraception
Pregnant women (if not using for labour induction)
Breastfeeding (use with caution)
Also contraindicated in:
Previous uterine surgery (e.g., C-section) due to risk of uterine rupture
Unexplained vaginal bleeding
Severe asthma (use with caution)
Cardiovascular disease (due to systemic vasodilation effects)
What is Alprostadil used for and what are its key safety considerations?
Also a Prostaglandin E1
Applied to the penis for ED (caverject an example)
ALPRO allows for ALPROmilk
What is the difference between cyclophospamide and chlorpromazine?
⚕️ Cyclophosphamide
Class: Alkylating agent (chemotherapy drug)
Used for:
Cancers (e.g. lymphoma, leukemia, breast cancer)
Autoimmune conditions (e.g. lupus nephritis, vasculitis)
Mechanism: Cross-links DNA, preventing cell replication — especially in rapidly dividing cells
Key Side Effects:
Bone marrow suppression
Hemorrhagic cystitis (due to toxic metabolite acrolein — prevented with mesna)
Infertility
Alopecia (hair loss)
Risk of secondary malignancies
🧠 Chlorpromazine
Class: Typical antipsychotic (phenothiazine group)
Used for:
Schizophrenia and psychosis
Severe nausea/vomiting
Intractable hiccups
Acute agitation
Mechanism: Dopamine D2 receptor antagonist in the brain
Key Side Effects:
Extrapyramidal symptoms (EPS): tremor, rigidity, dystonia
Sedation
Anticholinergic effects: dry mouth, constipation
Hypotension
Photosensitivity
Neuroleptic malignant syndrome (rare, but serious)
When is parenteral iron used, and how does it compare to oral iron?
💉 Parenteral Iron Formulations:
Iron dextran
Iron sucrose
Ferric carboxymaltose
Ferric derisomaltose
✅ Indications (When to Use Parenteral Iron):
Patient can’t tolerate oral iron (GI side effects)
Patient doesn’t comply with oral treatment
Malabsorption syndromes
Ongoing blood loss
Chemotherapy-induced anaemia (with erythropoietins, in specific cases)
Chronic kidney disease (especially those on haemodialysis or peritoneal dialysis)
⚖️ Effectiveness:
No faster haemoglobin response than oral iron (if oral is taken reliably and absorbed well)
Exception: Patients with severe renal failure on haemodialysis may benefit more from IV iron
What are the cardioselectove Beta Blockers?
Cardioselective Beta Blockers Are MEAN
Celiprolol
Bisoprolol
Betaxolol
Acebutolol
Metoprolol
Esmolol
Atenolol
Nebivolol
What are the least to most emetogenic cytotoxic drugs?
🎈 Mildly Emetogenic (FEM-ViR)
Think: “Few Episodes Might Very Rarely make you sick.”
F – Fluorouracil
E – Etoposide
M – Methotrexate (low dose, <100 mg/m²)
V – Vinca alkaloids
R – Radiotherapy (Abdominal)
💡 Low risk, generally doesn’t cause a lot of nausea.
🟡 Moderately Emetogenic (TDC-MM)
Think: “The Dose Can Make Me Miserable.”
T – Taxanes
D – Doxorubicin
C – Cyclophosphamide (intermediate or low doses)
M – Mitoxantrone
M – Methotrexate (high dose: 0.1–1.2 g/m²)
⚠️ Medium risk—often needs prophylactic antiemetics.
🔴 Highly Emetogenic (CCD)
Think: “Can’t Control the Dizziness.”
C – Cisplatin
C – Cyclophosphamide (high doses)
D – Dacarbazine
🚨 High risk—requires strong antiemetic support (e.g., 5-HT3 antagonist, dexamethasone, NK1 antagonist).
