Mon 11th Jan Flashcards
Ciprofloxacin
CI: G6PD deficiency
Paracetamol overdose: poor prognosis
increased Prothrombin time
arterial pH
creatinine
encephalopathy
Vancomycin
requires therapeutic drug monitoring > accumulation + toxicity in renal impairment
Heparin-induced thrombocytopenia
auto-antibodies = heparin + platelet factor IV
switch to: direct thrombin inhibitor = argatroban
Amiodarone: adverse effects
thyroid dysfunction: hypothyroidism + hyper-thyroidism corneal deposits pulmonary fibrosis/pneumonitis liver fibrosis/hepatitis peripheral neuropathy, myopathy photosensitivity 'slate-grey' appearance thrombophlebitis and injection site reactions bradycardia lengths QT interval
Amiodarone: drug interactions
decreased metabolism of warfarin > increased INR
increased digoxin levels
Ethylene glycol: poisoning
in antifreeze
attempted suicide
Metabolic acidosis with a high anion gap and high osmolar gap
Diclofenac
contraindicated = any form of cardiovascular disease
Proton pump inhibitors
hypomagnesaemia
PDE 5 inhibitors = sildenafil
contraindicated = nitrates and nicorandil
Pulmonary fibrosis: drug-induced
> Antibiotics = nitrofurantoin
Amiodarone
Chemotherapy
Anti-Rheumatoid: Methotrexate + sulfasalazine
Cytotoxic agents: busulphan, bleomycin
Ergot-derived dopamine receptor agonists: (bromocriptine, cabergoline, pergolide)
Severe lithium toxicity
excess of 2 mmol/L
neurological symptoms or renal failure are present
haemodialysis
Cyclical combined HRT
LMP was less than 1 year ago
Adult Life Support (ALS): Adrenaline doses
anaphylaxis: 0.5ml 1:1,000 IM
cardiac arrest: 10ml 1:10,000 IV or 1ml of 1:1000 IV
Severe pain
V morphine titrated in 1-2mg boluses until comfortable
Lithium toxicity
precipitated by thiazides
Absolute contraindication to the use of regional anaesthesia
Therapeutic anticoagulation
Within 1 hour of Paracetamol ingestion
Activated charcoal
prevent further paracetamol being absorbed into the circulation
Immediate N-acetylcysteine (NAC)
Paracetamol overdose = staggered or if there is doubt about the chronology of the overdose
Amitriptyline
cause urinary retention
Ecstasy poisoning
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
hyperthermia = give dantrolene
rhabdomyolysis
Hypokalaemia
predisposes patients to digoxin toxicity
Methanol poisoning
fomepizole or ethanol
haemodialysis
Digoxin
Digoxin-specific antibody fragments
Isoniazid
Peripheral neuropathy is a commonly recognised side effect
Rifampicin
Most common side effects: Orange bodily fluids, rash, hepatotoxicity, drug interactions
Gentamicin
Ototoxicity + nephrotoxicity
Contraindications = myasthenia gravis
Sildenafil
Side effects: headaches, facial flushing, dyspepsia, transient blue-green tingeing of vision
Tricyclic antidepressants: Overdose
IV bicarbonate
Paracetamol: Overdose
Start NAC immediately if:
> uncertainty about the time of overdose, but it is potentially toxic
> staggered over a time period longer than an hour
> plasma-paracetamol level is over the treatment line on the treatment graph
> 8-36 hours before presenting
Tuberculosis: treatment
Liver functions tests should be checked in all cases
St John’s Wort
inducer of the P450 system and can decrease ciclosporin levels, leading to transplant rejection
Amiodarone
SE: both corneal opacities and optic neuritis
Ciclosporin
SE: cause nephrotoxicity
Digoxin toxicity
within 8 to 12 hours of the last dose
Cyclizine: caution
heart failure as it may cause a fall in cardiac output
Salicylate poisoning
first causes respiratory alkalosis
Metformin: CI
contraindicated in those with eGFR < 30
Ciprofloxacin: SE
lowers the seizure threshold
Clinical features of digoxin toxicity
GIT: nausea, vomiting, anorexia, diarrhoea
Visual: blurred vision, yellow/green discolouration, haloes
CVS: palpitations, syncope, dyspnoea
CNS: confusion, dizziness, delirium, fatigue
Bendroflumethiazide: SE
Hyponatraemia
Atenolol: SE
Cold peripheries
Ecstasy: Overdose
Serotonin syndrome
Ethambutol: SE
optic neuropathy and development of colour blindness
discontinued
or pyridoxine (vitamin B6) is given concurrently
Lithium overdose: risk factors
Dehydration
Aspirin
Blocking the action of both cyclooxygenase-1 and 2.
Cyclooxygenase is responsible for prostaglandin, prostacyclin and thromboxane synthesis
blocking of thromboxane A2 formation in platelets reduces the ability of platelets to aggregate
Metoclopramide
Dopamine antagonist
treat migraines
prokinetic agent to speed up gastric motility
Histamine-1 antagonist
treat hayfever
Sinus congestion
Alpha agonist
Salicylates: Overdose
tinnitus,
anxiety
diaphoresis
Respiratory alkalosis initially due to hyperventilation,
Then > Metabolic acidosis due to lactic acid accumulation
Sodium valproate: SE
enzyme INhibitor so can INcrease warfarin levels if used concurrently
Paracetamol overdose: acute alcohol intake
Not associated with an increased risk of developing hepatotoxicity and may actually be protective
DPP4-inhibitors
Gliptins
Sitagliptin
Sitagliptin: SE
acute pancreatitis and should be stopped if it is suspected and reported by Yellow Card
Finasteride
5 alpha reductase inhibitor which converts testosterone into DHT
treat: benign prostatic hyperplasia
