Pharmacology Flashcards
1
Q
Key side effects of methotrexate
A
Bone marrow suppression
and leukopenia and highly teratogenic
Gastro-intestinal disturbance
Folate deficiency - anaemia
Long term- Pulmonary fibrosis, Liver/renal/GI toxicity, Interstitial pneumonitis
Stomatitis – discontinue (sign of severe marrow depression)
2
Q
Key side effects of Leflunomide
A
Hypertension and peripheral neuropathy
3
Q
Key side effect of Sulfasalazine
A
Male infertility (reduces sperm count),Myelosuppression
Nausea
Rash
Oral ulcers
4
Q
Key side effects of Hydroxychloroquine
A
Nightmares and reduced visual acuity and rash
5
Q
Key side effects of biologics/ Anti-TNF medications
A
immunosuppression, Reactivation of TB or hepatitis B,Allergic reaction, reaction at infusion site
6
Q
Key side effects of Rituximab (Anti-CD20 )
A
Night sweats and thrombocytopenia
7
Q
Key side effects of steroids
A
Cushing Syndrome, Avascular necrosis, Addisons,Osteoporosis
Retardation of growth
Thin skin, easy bruising
Immunosuppression
Cataracts and glaucoma
Oedema
Suppression of HPA axis
Teratogenic
Emotional disturbance (including psychosis
Rise in BP
Obesity (truncal)
Increased hair growth (hirsutism)
Diabetes mellitus
Striae
8
Q
neuronic to remember steroid effects
A
STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.
9
Q
Key side effects of cyclosporin
A
Gingival hypertrophy, hypertrichosis, nephrotoxicity
10
Q
Key side effects of Tacrolimus
A
cardiomyopathy, peripheral neuropathy, diabetes
11
Q
Key side effect of Anthracyclines (doxorubicin, daunorubicin)
A
cardiomyopathy
(MOA :prevention of the DNA double helix from being resealed)
12
Q
Key side effects of Platinum agents (cisplatin, carboplatin)
A
peripheral neuropathy and sensorineural hearing loss, nephrotoxicity
(MOA: DNA-binding alkylating agents)
13
Q
key side effects of Cyclophosphamides
A
haemmorhagic cystitis and transitional cell carcinoma of the bladder.
(MOA: alkylating agent)
14
Q
Key side effect of tamoxifen
A
increases the risk of endometrial cancer and VTE
vaginal dryness, hot flushes ,weight gain, fatigue .
agranulocytosis and liver failure- rare
15
Q
Key side effect of bleomycin
A
lung fibrosis
16
Q
Key side effects of bisphosphonates
A
esophageal ulcer
atrial fibrillation, osteonecrosis of the jaw, atypical femoral stress fractures
Avoid in CKD because renally excreted
17
Q
medications that can worsen MG
A
Beta-blockers, several antibiotics and antimalarials, Lithium and other drugs used in psychiatric disorders
18
Q
Riluzole is used in the treatment for
A
Motor neuron disease
(antiglutamatergic drug which dampens motor nerve firing)
19
Q
Drugs causing ototoxicity
A
Caused by aminoglycoside antibiotics (eg. gentamicin, vancomycin) and loop diuretics (eg. furosemide), most commonly.
20
Q
treatment for Parkinson disease where there isn’t significant motor symptoms
A
MAO-B monoamine a oxidase inhibitors ,Monoamine Oxidase Type B (MAO-B) is an enzyme in our body that breaks down several chemicals in the brain, including dopamine. By giving a medication that blocks the effect of MAO-B, an MAO-B inhibitor), more dopamine is available to be used by the brain.
(Selegiline/Rosagiline)
21
Q
COMT inhibitors MOA
A
Prolong effects of Levodopa by preventing it from breaking down, so given as adjuvant therapy
eg tolcapone and entacapone
22
Q
physiological effects of Dopamine
A
Cognition
prevents lactation
emetic function (causes nausea)- example of an antagonist is Metoclopramide
inhibits gastric stimulation (anti-kinetic effect) – example of an antagonist is Domperidone
cardiac stimulation effects and peripheral vasoconstriction- dopamine is converted to norepinephrine/noradrenaline
23
Q
CI/side effects of co-careldopa/co-beneldopa
A
CI: breast feeding and severe psychiatric illness
cautioned in endocrine disorders as well as severe pulmonary or cardiovascular diseases.
side effects: nausea, vomiting and anorexia. Disturbances in sleep,dizziness, syncope and arhythmias.
Important side effects:
Involuntary movements, or dyskinesia,
postural hypotension and psychological effects which includes dementia, depression and schizophrenia-like syndrome with delusions and hallucinations
24
Q
Levodopa interactions with other medications
A
risk of a hypertensive crisis when used with MAOI.
Risk of arrythmias with a general anaesthetic
with antihypertensives there is the increased risk of hypotension.
25
Why should you never stop Parkinson’s drug treatment abruptly?
Neuroleptic Malignant Syndrome
=sudden Depletion of dopamine in the hypothalamus/nigrostriatal pathway
Signs and symptoms: intense rigidity, causes fever, altered GCS- confusion
26
drug monitoring for sodium valproate
Monitor LFTs before and during first 6 months
Measure FBC before surgery to assess bleeding risk
27
Cautions for lamotrigine
Can exacerbate myoclonic seizures and Parkinson’s disease
Renal failure and hepatic failure (reduced dose) renally excreted
28
Alteplase Absolute contraindications for ischaemic stroke
Intracranial haemorrhage, neurosurgery/head trauma/stroke in past 3 months, uncontrolled hypertension, previous intracranial haemorrhage, known AV malformation/neoplasm/aneurysm, active internal bleeding, suspected endocarditis, bleeding diathesis, abnormal blood glucose
29
Alteplase Relative contraindications for ischaemic stroke
Minor/rapidly improving symptoms, seizure at stroke onset, severe stroke, major surgery or serious trauma in previous 2 weeks, previous GI/urinary tract haemorrhage in previous 3 weeks, recent lumbar puncture or arterial puncture at non-compressible site, post MI pericarditis which can turn hemorrhagic , pregnancy
30
Caution use of Atorvastatin in
Elderly patients
High alcohol intake or liver disease
Hypothyroidism (increases the risk of myositis with statins)
Patients at risk of muscle toxicity
Haemorrhagic stroke
Fibrates with statin increases rhabdomyolysis risk
31
Side effects Atorvastatin
GI disturbance
CNS effects – dizziness, headache, blurred vision
Colchicine (increased risk of rhabdomyolysis)
Hepatic effects
Muscle effects
Skin reactions
Hyperglycaemia
Weight change
Epistaxis
32
benzylpenicillin mainly effective against
aerobic gram-positive bacteria, with some activity against gram-negative cocci eg meningococcus and anaerobic organisms (no activity against gram-negative bacilli.)
33
Cephalosporins MOA
inhibit cell wall synthesis in a similar manner to penicillins but they are more resistant to hydrolysis by beta-lactamases.
succeeding generations having enhanced activity against gram-negative bacilli at the expense of gram-positive activity and increased ability to cross the blood-brain barrier
34
Adverse effects Cephalosporins
•Hypersensitivity
•GI disturbance
•Skin reactions
Cholestatic jaundice (clarythomycin and coamoxiclav can cause this too)
• interstitial nephritis
•Blood disorders
•Antibiotic associated colitis
35
chloramphenicol MOA
Inhibits protein synthesis in bacteria by binding reversibly to the 50S subunit of bacterial ribosomes.
36
Chloramphenicol adverse effects
Used ONLY in life-threatening conditions, because of its toxicity. Biggest unwanted effect is bone marrow toxicity (aplastic anaemia, reversible anaemia).
Can cause “grey baby” syndrome
37
Aciclovir MOA
inhibits synthesis of viral DNA. targets viral DNA polymerase terminating viral DNA synthesis and thus replication.
Most active against HSV.
38
NSAID Side effects
GI disturbance- due to inhibition of mucosal production of COX-1 generated prostaglandins.
Renal insufficiency
Salt/water retention
Hyponatraemia/hyperkalaemia
Cardiovascular effects
Hypersensitivity reactions
Headaches/dizziness
Skin reactions
39
COX 1 and COX 2 difference
COX 1 has a constitutive ‘housekeeping’ role, contributing to the regulation of homeostatic processes, such as renal and gastric blood flow, gastric cytoprotection and platelet aggregation.
COX 2 is expressed only after stimulation by an inflammatory process. The production of these prostaglandins contribute to the inflammatory/painful process, through vasodilation, increasing vascular permeability and sensitisation of nerve fibres to inflammatory mediators.
40
NSAIDS Contra-indications
GI bleeding/ulceration
Hypersensitivity reactions
Severe heart failure ( they cause water retention so NSAID would worsen this)
Severe renal impairment
Varicella zoster infection
Avoid 3rd trimester of pregnancy (inbhibits closure of ductus arteriosus)
41
NSAID cautions and contraindications neumonic
NSAID: No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality)
42
How does Allopurinol reduce the concentration of uric acid?
Xanthine oxidase inhibitor, reducing uric acid formation.
43
Cautioned use of infliximab in
•Malignancy
•Hepatitis B
•Pregnancy
•Tuberculosis
44
Interactions of methotrexate with other dugs
Trimethoprim/Co-trimoxazole (which is also a folic acid antagonist, severe bone marrow depression)
NSAIDs (toxicity)
45
Epidural anaesthesia
Injection or slow infusion via a cannula of an aqueous solution adjacent to the spinal column, but outside the dura mater, produces anaesthesia both above and below the site of injection after 15–30 min
Often used in combination with an opiate
Can be topped up , needs larger doses as it needs to diffuse into spinal cord
46
Spinal anaesthesia
Involves injection of an aqueous solution (1.5–2.5 mL) of local anaesthetic alone (often bupivacaine) or with an opioid into the lumbar subarachnoid space, usually between the third and fourth lumbar vertebrae
Quicker onset of action, lower dose needed
47
Unwanted effects local anaesthesia:
Local:irritation and inflammation, ischaemia from the use of vasoconstrictor agents
Systemic
Cardiovascular: myocardial depression, vasodilatation, hypotension, arrhythmias
CNS: agitation, confusion, tremors, convulsions, respiratory depression
48
Minimum Alveolar Concentration (MAC)
Minimum alveolar concentration at which 50% of the population will fail to respond to a single noxious stimuli
Measure of POTENCY,The lower the MAC the more potent the agent
49
Thiopental
(rarely used now)
Enhances activity at GABA A receptors
•Thiopental diffuses readily into the CNS due to its lipid solubility and predominantly un-ionised state
•Metabolism of thiopental occurs predominantly in the liver and up to 30% of the original dose may remain in the body at 24 h causing a ‘hangover’ effect
•zero-order kinetics- saturation related
50
Propofol
•
Enhances activity at GABA A receptors
Does not accumulate
replaced thiopental as an induction agent
•More rapid recovery and less hangover effect than occurs with thiopental
•Metabolism is by first order kinetics
51
Etomidate
•enhances activity at GABA A receptors
rapid onset of action after intravenous injection
•Its action is terminated by rapid metabolism in plasma and the liver by esterases
•Duration of action is about 6–10 min with minimal hangover
•Less effect on CVS so may be preferred in shocked patients
•Not used as a continuous infusion due to toxicity on adrenals and adrenocortical suppression
52
Ketamine
•Believed to act by blocking activation of the glutamate NMDA receptor, inhibit ACh nicotinic receptors, open 2 pore K channels
•‘dissociative anaesthesia’, in which there is a marked sensory loss and analgesia, as well as amnesia, without complete loss of consciousness
53
Depolarising Neuromuscular blocking drugs
Suxamethonium
54
Non-depolarising Neuromuscular blockers
•Atracurium
•Cisatracurium
•Mivacurium
•Pancuronium
•Rocuronium
•Vecuronium
55
Non-depolarising agents
MOA
Nerve impulse results in release of ach and drug
Drug binds to ach receptor but does not cause depolarisation
Calcium is not released from storage sarcoplasmic reticulum
Contraction does not occur, muscle therefore relaxes
56
Suxamethonium MOA
Nerve impulse results in release of ACh and drug
Drug binds to ach receptor causing depolarization
Drug stays on receptor causing repeated contractions
Calcium returns to storage and muscle isunreposnive to further contraction
A very prolonged paralysis occurs in about 1 in 2000–3000 individuals, who have a genetic deficiency of pseudocholinesterase
57
Neostigmine
the effect of a non-depolarising blocker can be reversed by intravenous injection of neostigmine, an anticholinesterase
An anti-muscarinic such as atropine or glycopyrrolate is given immediately before the neostigmine to prevent bradycardia or excessive salivation produced by stimulation of muscarinic receptors
58
Amiodarone
Class III anti-arrhythmic
•Prolongs cardiac action potential and delays refractory period
•Inhibits K+ channels involved in repolarisation
•Used to prevent myocardium going back into VF or VT
59
Side effects with amiodarone
Gastrointestinal disturbances
Corneal microdeposits
Hypothyroidism
Hyperthyroidism- high iodine content
Skin reactions – photosensitive skin rashes and blue-grey discolouration
Hepatotoxicity
Progressive pneumonitis and lung fibrosis
Proarrhythmic effects
Peripheral neuropathy/myopathy
Too much of it can cause bradycardia and heart blocks
60
Adenosine
has potent effects on the SA node inducing sinus bradycardia and slows impulse conduction through the AV node, with no effect on conduction in the ventricles. Therefore, it is useful in the emergency management of supraventricular tachycardia (SVT) for rapid conversion back to sinus rhythm
61
Adenosine Contra-indications
•Asthma/COPD (can trigger acute bronchospasm)
•Decompensated heart failure
•Long QT syndrome/AV block/sick sinus syndrome
•Severe hypotension
•Many cautions associated with cardiac disease
62
Adenosine side effects
Side effects are common but last less than 1 minute.
Arrhythmias, chest discomfort/pain, dizziness, dyspnoea, flushing, headache, hypotension, apprehension/impending doom, sweating, metallic taste, blurred vision, nausea/vomiting, cardiac arrest, apnoea, loss of consciousness
63
Atropine MOA
Muscarinic antagonist.
Blockade of muscarinic receptors reduces the inhibitory effect of the vagus nerve on the heart, increasing the rate of firing of the SA node and increasing conduction through the AV node.
64
Atropine side effects
Eyes (pupillary dilatation): blurred vision, mydriasis, angle closure glaucoma
GI tract (decreased motility/secretions/tone): constipation, abdominal distension, nausea, vomiting, dysphagia
CVS (increased HR, contractility, BP): tachycardia, palpitations, angina, hypertension, arrhythmias
Secretions (decreased sweat/salivary gland secretion): dry mouth, anhidrosis, thirst, increased body temperature
Urinary tract (decreased detrusor function and increased sphincter tone): urinary retention,
CNS: confusion, hallucination
65
Atropine contraindications
•GI: obstruction, paralytic ileus, pyloric stenosis, severe ulcerative colitis, toxic megacolon
•Urinary tract: bladder outflow obstruction, prostatic enlargement, retention
•Myasthenia gravis
66
Mirabegron
B3 adrenergic agonist, relaxes detrusor muscle, does not have anticholinergic effects, more expensive
67
Why is Aspirin not prescribed for children?:
Reyes syndrome
•Rare
•Usually occurs in children between 5 and 14 years of age
•Acute encephalopathy and fatty degeneration of the liver
•Usually follows viral illness, with rapid deterioration
•Overall mortality rate ~ 20%
68
Choice of Analgesia in Children ladder
1. paracetamol
2. paracetamol + NSAID eg ibuprofen
3. Pareceamol NSAID +opiod (eg morphine)
69
Codeine use in children
restricted due to reports of morphine toxicity.
Codeine should only be used to relieve acute moderate pain in children >12 years and only if it cannot be relieved by other analgesic agents.
life-threatening adverse reactions have been identified in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy
Codeine not recommended for children with conditions that may compromise breathing (neuromuscular, cardiorespiratory, etc).
70
Gastric pH in children
Neutral at birth due to residual amniotic fluid. Continues to be neutral during neonatal period due to decreased gastric acid production. Adult values achieve around 2-3 years. This high pH means increased absorption of weak base drugs such as penicillins, resulting in lower doses needed whereas higher doses of acidic drugs will be required. Premature neonates have higher gastric pH due to immature gastric mucosa with reduced secretion of gastric acid.
71
Bile acid secretion neonates
decreased due to immaturity
Reducing fat absorption and therefore absorption of fat-soluble drugs such as diazepam.
72
Paracetamol metabolism in neonates
the predominant pathway is via sulphation.
In neonates CYP450 is immature so paracetamol is not metabolised via this route, resulting in less toxic metabolites and lower risk in overdose.
73
Vancomycin adverse effects
Nephrotoxicity
ototoxicity
Thrombophlebitis
Neutropenia
Thrombocytopenia
red man syndrome; occurs on rapid infusion of vancomycin
Moa:prevents bacteria making cell walls
74
Aminoglycoside MOA
Inhibit bacterial protein synthesis by binding to the 30S subunit of the ribosome irreversibly.
eg Gentamicin
75
Macrolides MOA
Inhibit bacterial protein synthesis by binding to the 50S subunit of the ribosome, preventing ribosomal translocation and therefore protein elongation eg Clarithromycin, Erythromycin, Azithromycin
76
Quinolones MOA
Inhibit bacterial DNA duplication through inhibition of topoisomerases, which interfere with DNA unwinding and therefore transcription and translation. eg Ciprofloxacin,
used mainly for Gram-negative infections
77
Quinolones side effects
GI upset
Prolonged QT interval
High risk of C. difficile
tendon damage (especially in patients > 60 and those with renal impairment or taking steroids)
Aortic aneurysm / dissection
Quinolones should also be used with caution in patients with epilepsy as they may lower the seizure threshold
78
Metronidazole MOA
inhibits bacterial DNA synthesis.specific antibiotic for anaerobic infections eg c difficile
79
Metronidazole Cautions/Contraindications
Alcohol must not be drunk while on metronidazole and for ~48 hours after the end of the course. Metronidazole interferes with alcohol metabolism leading to acetaldeyhyde accumulation and gives severe side effects as a result.
Use with caution in severe liver disease
80
Trimethoprim MOA
Inhibits bacterial folate synthesis through inhibition of dihydrofolate reductase.
81
Trimethoprim side effects
Commonly causes a skin rash
GI upset
Hypersensitivity is common and can be severe
Hyperkalaemia
82
Penicillin common side effects
GI upset, including antibiotic-associated C. difficile infection.
A degree of allergy to penicillin is very common, affecting up to 10% of the population.
Neurological toxicity (including convulsions and coma) can occur with very high-dose therapy or accumulation due to severe renal impairment.
83
Potential risks of SSRIs in pregnancy:
First-trimester use has a link with congenital heart defects
First-trimester use of paroxetine has a stronger link with congenital malformations
Third-trimester use has a link with persistent pulmonary hypertension in the neonate
Neonates can experience withdrawal symptoms, usually only mild
84
Metoclopramide
- a D2 receptor antagonist mainly used in the management of nausea.
- gastro-oesophageal reflux disease
- prokinetic action is useful in gastroparesis secondary to diabetic neuropathy
- often combined with analgesics for the treatment of migraine
85
Enzyme inducers: PC BRAS
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
alcohol (chronic excess)
sulphonylureas.
Others: topiramate, St John’s Wort, and smoking.
Eg if someone takes st johns wort and warfarin, St John’s Wort is a P450 inducer so will reduce the concentration of warfarin, meaning the INR will decrease, increase warfarin metabolism and risk of clots.
86
Enzyme inhibitors: AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
ethanol (acute intoxication)
sulphonamides.
Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline).
eg these decrease warfarin metabolism and increase bleeding risk
87
Etodimate, propofol and thiopental MOA
enhance activity at GABA A receptors
88
what is zero order kinetics
constant amount (e.g. in grams / milligrams / micrograms) of drug is eliminated per unit of time (e.g. seconds / minutes). The metabolism is independent of the concentration of the reactant.
89
examples of zero kinetic drugs
Constantly aspiring to phone ethan
Constant ( zero order kinetics)
Aspirin (e.g. high-dose aspirin)
Phenytoin
Ethanol
Others: heparin, fluoxetine,omeprazole
90
Half life
Half life is the time taken to metabolise 50% of the drug
91
what is First order kinetics
drug elimination is proportional to the plasma concentration of drug
This means that the higher the drug concentration, the higher its elimination rate.the HALF-LIFE is constant
92
examples of first order kinetics
majority of drugs exhibiting 'first-order' elimination kinetics eg amitriptyline, ampicillin, apixaban, atenolol
93
Clinical features of lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
Polyuria
Visual disturbance
CNS disturbance including seizures, impaired co-ordination, dysarthria
arrythmias
coma
94
Rasburicase
Intravenous prophylaxis against gout during cancer chemotherapy
95
haemophilia A
deficiency in clotting factor VIII
96
HIV entry inhibitors
prevent HIV-1 from entering and infecting immune cells
maraviroc (binds to CCR5, preventing an interaction with gp41)
enfuvirtide (binds to gp41, also known as a 'fusion inhibitor')
97
factor IX
haemophilia B, also called christmas disease
98
Nucleoside analogue reverse transcriptase inhibitors (NRTI)
Acting as a chain-terminator to stop reverse transcription. examples: zidovudine (AZT), abacavir, emtricitabine
99
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Block the action of reverse transcriptase.transcriptase enzyme.examples: nevirapine, efavirenz
100
Protease inhibitors (PI)
These drugs inhibit HIV protease,
examples: indinavir, nelfinavir, ritonavir, saquinavir
101
Integrase inhibitors
block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell
examples: raltegravir, elvitegravir, dolutegravir
102
Drugs causing hyperkalaemia
Aldosterone inhibitors ( aldosterone normally promotes K secretion)
heparin (inhibits aldosterone secretion)
ACEi and ARB ( decrease aldosterone)
Potassium sparing diuretics ( drugs that cause diuresis without causing K loss)
Trimethoprim
103
Monitoring for statins
LFTs are checked before a statin is initiated, again within 3 months of initiation, and then 12 months after it was first prescribed.
QRISK 2 calculator for patients up to and including 84 years of age.
Non hdl/ Ldl should improve by 40 %, reduction
104
Statin MOA
inhibit 3-hydroxy-3-methylglutaryl co-enzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis. Inhibition of HMG CoA reductase reduces low density lipoprotein cholesterol (LDL-C) levels by slowing down the production of cholesterol in the liver and increasing the liver's ability to remove the LDL-C already in the blood
105
Desferrioxamine
indicated in:
Patients with serum iron level > 90umol/l or 60-90umol/l, who are symptomatic or have persistent iron on abdominal x-ray despite whole bowel irrigation or any patient with shock, coma or metabolic acidosis
106
CI statins
Do not prescribe atorvastatin to:
People with active liver disease, or unexplained persistent elevations of transaminases that are three or more times the upper limit of normal.
Women who are pregnant or breastfeeding.
Women of child-bearing potential not using appropriate contraception.
107
Key side effect of topiramate
weight loss
108
TB treatment
R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months
109
Causes of agranulocytosis
Associated with depleted levels of basophils and eosinophils.
Drug causes:
Carbamazepine
Carbimazole
Clozapine
110
h pylori treatment
Omeprazole (PPI) 20mg bd + Clarithromycin 500mg bd + Amoxicillin 1gram bd or Metronidazole
111
Warfarin anticoagulation reversal
Vitamin K1, start with this
Prothrombin complex concentrate can be used to reverse eg beriplex
(fresh frozen plasma)
112
Factor Xa inhibitors reversal
Andexanet alfa
113
Dabigatran (Direct thrombin inhibitor) reversal
Idarucizumab (monoclonal antibody fragment)
114
Digoxin MOA
Blocks NA/K ATPase
induces an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility (positively inotropic) ,decreases heart rate ( negatively chronotropic)
reduces conduction at the atrioventricular (AV) node, preventing some impulses from being transmitted to the ventricles, thereby reducing the ventricular rate.
115
Antidysrhythmic drugs
Class I
Class II
Class III
Class IV
Class I – sodium channel blocker, lidocaine, is considered ‘membrane stabilising’.
Class II – are the B-blockers.
Class III – k channel blocker/ widen AP duration. amiodarone and sotolol. they act on both supraventricular and ventricular arrhythmias
Class IV – calcium channel blockers.
116
Thiazide and thiazide related diuretics MOA
inhibit sodium reabsorption (Na/cl cotransporter) at the beginning of the distal convoluted tubule.This prevents reabsorption of sodium and its osmotically associated water. Also causes vasodilation. The increased delivery of sodium to the distal tubule, where it can be exchanged for potassium, increases urinary potassium losses and may therefore cause hypokalaemia.
Thiazides reduce the clearance of uric acid, and raise the levels of uric acid in the blood.
117
HyperGLUC mnemonic for side effects of thiazides
→ hyperglycemia
→ Hyperlipidaemia
→ hyperuricemia
→ hypercalcemia
It can have HYPO effects in serum: including HYPOkalemia, HYPOnatremia and HYPOtension
118
dihydropyridines
selectively bind to Ca2+ channels in vascular smooth muscle in its inactivated state.
including amlodipine and nifedipine
119
non-dihydropyridine
more selective for the heart. reduce myocardial contractility.
bind in open state
Eg verapamil and diltiazem
120
Doxazosin, tamsulosin MOA
Alpha adrenoceptor blockers,blockade induces relaxation. α1-blockers therefore cause vasodilatation and a fall in blood pressure (BP), and reduced resistance to bladder outflow.
121
Monitoring of Azathioprine and methotrexate
Need to measure TMPT enzyme before starting treatment with azathioprine because some people are deficient which could result in toxic level. FBC and LFT every 3 months, U&E every 6 months ( 3 months for methotrexate)
122
Azathioprine, methotrexate Side effects
Increased susceptibility to infections,bone marrow suppression, potential risk of lymphoma, increased risk of sunburn, increased risk of cervical abnormalities ,hypersensitivity reactions, increased risk of non melanoma skin cancer
123
Oxybutynin, tolterodine
MOA
Contraction of the smooth muscle of the bladder is under parasympathetic control. Blocking muscarinic receptors therefore promotes bladder relaxation, increasing bladder capacity.
124
Oxybutynin, tolterodine
Side effects
( due to muscarinic blockage) include dry mouth, tachycardia, constipation, blurred vision .In elderly may get cholinergic burden and its when they are on too many of anticholinergic drugs leading to confusion leading to increase in falls et
125
Anastrozole MOA
aromatase inhibitor , blocks production of oestrogen from testosterone , this inhibits signals to the breast cancer,ineffective method in pre menopause
126
SSRI side eddects
GI upset, changes in appetite,
Hypersensitivity
Hyponatremia
suicidal thoughts and behaviour (<30 yrs increased risk) ,
may lower seizure threshold,
prolong QT interval (especially associated with citalopram)
increase the risk of bleeding due to their effect on platelet function.
Gastric ulcer
Sexual dysfunction
Anxiety, angitation
127
Non selective MAOIS side effects
Postural hypotension
Headache
Insomnia
Sexual dysfunction
Dry mouth, urinary retention
'Cheese reaction' with dietary tyramine - life-threatening hypertensive crisis
128
Methylphenidate
Dopamine and noradrenaline reuptake inhibitors
Used in ADHD
129
Drugs used for managing opioid withdrawal
Methadone ( long acting opioid agonist )
Buprenorphine ( partial agonist) available alone (subutex) or with naloxone ( suboxone , quick acting opioid antagonist)
Naltrexone is a long acting opioid antagonist
130
Drugs used for smoking cessation
Nicotine replacement therapy
Bupropion → enhancing mesocorticolimbic dopaminergic activity; it also has nicotine receptor antagonist activity, norepinephrine/dopamine-reuptake inhibitor,Reduces cravings and helps relieve withdrawal symptoms
Varenicline → partial agonist at nicotinic receptors,smoking doesn't provide the desired effects.
131
Drugs used for alcohol withdrawa
Chlordiazepoxide (long acting BDZ)
Acamprosate (used for maintenance of abstinence, unclear moa , NMDA receptor antagonist and positive allosteric modulator of GABAA receptors.)
Naltrexone ( opioid receptor antagonist)
Disulfiram (Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption.)
132
Lithium adverse effects
thyroid disorders eg hypothyroidism
mild cognitive and memory impairment.
Nephrogenic Diabetes Insipidus
cardiac
diuretic treatment (risk of toxicity)
elderly (reduce dose)
epilepsy (may lower seizure threshold) myasthenia gravis
psoriasis (risk of exacerbation)
QT interval prolongation
Ebstein’s anomaly
133
Lithium side effects
Metallic taste, Fine tremor, Weight gain, Hypothyroidism,, Idiopathic intracranial hypertension, Leukocytosis, Hyperparathyroidism and hypercalcaemia,arrhythmias, hyperglycaemia, peripheral oedema,sexual dysfunction, polyuria,peripheral neuropathy
134
Anticholinesterases
Inhibit acetylcholinesterase and enhance cholinergic transmission in cerebral cortex and hippocampus
Examples:Donepezil, Rivastigmine
135
Conventional antipsychotic drugs Side effects
extrapyramidal effects- movement abnormalities that arise from D2 blockade in the nigrostriatal pathway
acute dystonic reactions ( involuntary parkinsonia movements or muscle spasm),
akathisia (inner restlessness)
neuroleptic malignant syndrome and seizures
tardive dyskinesia ( includes movements that are pointless involuntary )
sedative effect, Drowsiness, hypotension, QT interval prolongation, erectile dysfunction, hyperprolactinemia symptoms
Metabolic - weight gain, increased risk of T2DM, hyperlipidaemia, increased risk of metabolic syndrome
Anticholinergic - tachycardia, blurred vision, dry mouth, constipation, urinary retention
136
pharmacodynamics
What the drug does to the body, power of the drug
137
pharmacokinetics
What body does to drug, how the drug moves around the body
138
Valproate side effects
Valproate
Appetite increase, so weight gain
Liver failure (monitor LFTs during 1st 6 months)
Pancreatitis
Reversible hair loss (grows back curly, apparently)
Oedema
Ataxia
Teratogenicity, Tremor, Thrombocytopaenia
Encephalopathy (due to hyperammonaemia) / Enzyme inducer
139
Antacids and Alginates
Magnesium trisilicate
Aluminium/magnesium mixtures (Maalox)
Use: dyspepsia and GORD
140
H2-receptor antagonists
Ranitidine
Use:dyspepsia, GORD, peptic ulceration, prophylaxis of NSAID associated peptic ulceration
141
Proton pump inhibitors
Lansoprazole
Omeprazole
Use: dyspepsia, GORD, oesophagitis, peptic ulceration, prophylaxis of NSAID associated peptic ulceration, H. pylori eradication
142
Aminosalicylate
Mesalazine
Use: IBD
143
Cytokine inhibitors
Infliximab
Adalimumab
Use:Crohns
144
Antimuscarinic agent for IBS
Hyoscine (Buscopan)
145
antispasmodics
Mebeverine
Peppermint oil
Use:IBS
146
Anti-fungal agents
Nystatin
Fluconazole
147
Antiprotozoal agents
Metronidazole
148
Antibiotics used to treat C. difficile associated diarrhoea (colitis)
Metronidazole
Vancomycin
149
treatment of immune based renal disease i.e. Wegener's granulomatosis, types of glomerulonephritis or SLE
Cyclophosphamide (anti-proliferative agent)
150
Transplant immunosuppression
ciclosporin- (calcineurin inhibitor)
tacrolimus- (calcineurin inhibitor)
azathioprine - (anti-proliferative agent)
151
Muscarinic receptor antagonists
Oxybutinin
Tolterodine+E19
Used in Overactive bladder syndrome, urge predominant incontinence
152
Alpha1-adrenoceptor antagonists
Doxazosin
Tamsulosin
used in BPH
153
5∝-reductase inhibitors
Dutasteride
Finasteride
used in BPH
154
Antimicrobial agents for urinary infections
Trimethoprim (UTI)
Nitrofurantoin (UTI)
Co-amoxiclav (pyelonephritis)
Ciprofloxacin (pyelonephritis)
Gentamicin (serious gram -ve infections)
155
Phosphodiesterase type 5 inhibitors
Sildenafil
Tadalafil
Erectile dysfunction
156
Alprostadil
synthetic prostaglandin E1 analogue
Erectile dysfunction
157
Thionamides
Carbimazole
Propylthiouracil
158
Fludrocortisone
Mineralocorticoids
159
Synthetic human growth hormone
Somatropin (synthetic human GH)
used to replace growth hormone (a natural hormone produced by your body) in adults and children with growth hormone deficienc
160
Synthetic ACTH
Tetracosactide
used in the diagnosis of adrenocortical insufficiency
ACTH will stimulate healthy adrenal glands to produce cortisol .A failure of cortisol to rise indicates primary adrenal insufficiency (Addison’s disease)
161
Dopamine D2 agonists
Cabergoline
Quinagolide
162
Testosterone and its esters
Sustanon 250® (testosterone esters - IM depot)
Testogel® (testosterone - transdermal)
163
Bisphosphonates
Alendronic acid
Residronate
Zolendronic acid
164
Vitamin D compounds
Alfacalcidol (1a-hydroxycholecalciferol)
Calcitriol (1,25-dihydroxycholecalciferol)
Ergocalciferol (vitamin D2)
165
Calcium salts
Calcichew® (oral supplement)
Calcium gluconate (Parenteral - IV)
Calcium chloride (Parenteral - IV)
166
Vasopressin analogues
Desmopressin
Terlipressin
uses:cranial diabetes insipidus [desmopressin], oesophageal bleeding [terlipressin], bleeding reduction in mild to moderate haemophilia [desmopressin]
167
Opiate/opioid based analgesics
Codeine phosphate
Morphine sulfate
Diamorphine
Tramadol
168
Non-opioid non-NSAID analgesics
Amitriptyline
Duloxetine
Gabapentin
Carbamazepine
Capsaicin
169
Antiemetics (antihistamines, antimuscarinic agents, dopamine receptor antagonists, 5-HT3 receptor antagonists, neurokinin 1 receptor antagonists and cannabinoids)
Cyclizine (antihistamine)
Hyoscine (antimuscarinic)
Metoclopramide (dopamine receptor antagonist)
Prochlorperazine (dopamine receptor antagonist)
Ondansetron (5-HT3 receptor antagonist)
Aprepitant (neurokinin 1 receptor antagonist)
Nabilone (cannabinoid)
170
Cyclophosphamide
Alkylating drugs
171
Doxorubicin
Cytotoxic antibiotics
172
Anti-oestrogens
Tamoxifen
Anastrazole
173
Tamoxifen
Tamoxifen is a oestrogen antagonist, commonly indicated for ER+ positive breast cancers. However, it also works as an agonist on endometrial tissue which can result in endometrial proliferation
174
Iron forms
Oral - ferrous sulphate
Parenteral - iron sucrose
175
Thiazide and thiazide-related diuretics
Bendroflumethiazide
Chlortalidone
Indapamide
Metolazone
Use:Hypertension, chronic heart failure
176
Loop diuretics
Furosemide
Bumetanide
Use:Acute pulmonary oedema, chronic heart failure, diuretic resistant oedema, resistant hypertension
177
Potassium-sparing diuretics
Amiloride
Spironolactone
Use:Prevention of hypokalaema alongside a loop or thiazide diuretic [e.g. amiloride]; oedema in cirrhosis of liver, severe heart failure, Conn's syndrome [aldosterone antagonists]
178
Beta-adrenoceptor blockers
Atenolol
Propranolol
Bisoprolol
use:Angina, hypertension, myocardial infarction, arrhythmias, heart failure, anxiety conditions, symptomatic relief of thyrotoxicosis, prophylaxis of migraine
179
Calcium channel blockers
Amlodipine
Felodipine
Diltiazem
Verapamil
180
ACE inhibitors
Ramipril
Lisinopril
Use:Chronic heart failure, hypertension, diabetic nephropathy, prophylaxis of cardiovascular events
181
Monitoring requirements for ACEi
UE renal function should be checked before starting or increasing the dose
also monitored during treatment
182
Angiotensin receptor blockers
Losartan
Candesartan
183
Alpha-adrenoceptor blockers
Doxazosin
Tamsulosin (benign prostatic hyperplasia)
Use: Resistant hypertension, prostatic hyperplasia
184
Drugs to reduce cardiovascular risk
Statins, vibrates, exetemibe
185
Parenteral anticoagulants
Unfractionated heparin
Dalteparin
Fondaparinux
Use: Prevention of venous thromboembolism, treatment of DVT and PE, myocardial infarction, unstable coronary disease
186
Vitamin K antagonist
Warfarin
Use: Prevention of venous thromboembolism, treatment of DVT and PE, myocardial infarction, unstable coronary disease, anticoagulation in valvular and non-valvular AF
187
Directly acting oral anticoagulants
Apixaban
Rivaroxaban
Dabigatran
Use: Prevention of venous thromboembolism, treatment of DVT and PE, anticoagulation in non-valvular AF
188
Common antibiotics for bacterial endocarditis
Benzylpenicillin
Amoxicillin
Gentamicin
Vancomycin
Flucloxacillin
189
Nitrates
Glyceryl trinitrate (GTN)
Isosorbide dinitrate
Use: angina
190
Potassium channel openers
Nicorandil
Use: angina
191
Ivabridine & Ranolazine
Use: angina
192
Anti-platelet agents
Aspirin
Clopidogrel
Ticagrelor
Dipyridamole
Tirofiban
Use:Secondary prevention of cardiovascular events, prevention of atherothrombotic events post PCI
193
Thrombolytic (fibrinolytic) drugs
Alteplase
Tenecteplase
Use: Thrombolysis in STEMI and massive PE
194
Cardiac glycoside
Digoxin
Use:Heart failure, supraventricular arrhythmias [AF and atrial flutter]
195
Anti-dysrhythmic drugs
Amiodarone
Lidocaine
Flecainide
Sotalol
Adenosine
Atropine
Use:Ventricular arrhythmias, supraventricular arrhythmias
196
Drugs used during cardiac arrest
Adrenaline
Amiodarone
Atropine (bradycardia)
8.4% sodium bicarbonate (hyperkalaemia)
Calcium chloride (hyperkalaemia)
Magnesium sulfate (hypomagnesaemia, Torsades de pointe, digoxin toxicity)
197
Aldosterone antagonists
Spironolactone
Eplerenone
Use:HF
198
Topical emollients
E45® cream
Diprobase® cream
Emulsifying ointment
Use: Atopic dermatitis and psoriasis
199
Topical corticosteroids
Mild- hydrocortisone 0.5% 1% and 2.5%
Moderate- eumovate (clobetasone butyrate 0.05%)
Potent- betnovate (betamethasone valerate 0.1%)
Very potent -dermovate (clobetasol propionate 0.05%)
Use:Atopic and contact dermatitis and psoriasis
200
Topical calcineurin inhibitors in term
Tacrolimus 0.03% or 0.1% ointment used in atopic dermatitis ( excema)
201
Immunosuppressant drugs in dermatology
Ciclosporin
Methotrexate
Use: Atopic dermatitis and psoriasis
202
Topical Vitamin D analogues
Calcipotriol ointment for psoriasis
203
Topical retinoids
Tazarotene
Isotretinoin
Use: Atopic dermatitis and psoriasis
204
Oral retinoids
Alitretinoin for acne vulgaris and psoriasis
205
Tazarotene/coal tar ( not used a lot because its messy) called evorex lotion
psoriasis
206
Dithranol
vit a analogue, for psoriasis
207
Topical antibiotics for acne
Clindamycin 1% cream
Mupirocin
208
Systemic antibiotics for dermatological conditions
Oxytetracycline
Doxycycline
Flucloxacillin
Erythromycin
209
Beta2-adrenoceptor agonists
Salbutamol
Terbutaline
Salmeterol
Formoterol
210
Antimuscarinic bronchodilators
Ipratropium
Tiotropium
211
Inhaled corticosteroids
Beclometasone
Fluticasone
212
Systemic corticosteroids
Hydrocortisone
Prednisolone
213
Common antibiotics used in respiratory disease
Amoxicillin
Co-amoxiclav
Clarithromycin
Doxycycline
Cefuroxime
214
Cromolyn sodium
mast cell stabilizer
Use: bronchial asthma, allergic rhinitis, and certain allergic eye conditions such as vernal conjunctivitis, keratitis, and keratoconjunctivitis.
215
Antituberculous drugs
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
216
Benzodiazepines
Diazepam
Lorazepam
Temazepam
217
Selective serotonin reuptake inhibitors
Citalopram
Fluoxetine
Paroxetine
Sertraline
218
Serotonin and noradrenaline reuptake inhibitors
Duloxetine
Venlafaxine
219
Selective noradrenaline reuptake inhibitors
Reboxetine
220
Presynaptic α2-adrenoceptor blockers
Mirtazapine
221
Tricyclic antidepressants
Amitriptyline
Imipramine
Lofepramine
222
Non-selective MAOIs
Phenelzine
223
reversible inhibitors of monoamine oxidase A (RIMAs)
Moclobemide
224
Drugs used for managing opioid withdrawal
Methadone
Buprenorphine
225
Drugs used for smoking cessation
Nicotine replacement therapy
Bupropion
Varenicline
226
Drugs used for acute alcohol withdrawal
Chlordiazepoxide
Pabrinex®
Thiamine
Acamprosate
Naltrexone
Disulfiram
227
Mood stablising anticonvulsant drugs
Sodium valproate
Carbamazepine
Lamotrigine
228
Antipsychotic drugs uses
Psychosis, schizophrenia, rapid tranquillisation, mania
229
Atypical antipsychotic drugs
Risperidone
Olanzapine
Clozapine
Aripiprazole
Quetiapine
230
Conventional antipsychotic drugs
Haloperidol (a butyrophenone)
Chlorpromazine (a phenothiazine)
Flupentixol (a thioxanthine)
Sulpiride (a substituted benzamide)
231
Goserelin
Gonadorelin analogues
Use:Testosterone reduction in prostate cancer, preparation for IVF
232
Drugs used for infertility
Clomifene
Human Menopausal Gonadotrophins (HMG) for super ovulation
233
Oestrogen based (combined) oral contraceptives
Gedarel (Ethinylestradiol with desgestorel [20/150 or 30/150])
Mercilon (Ethinylestradiol with desgestorel)
Yasmin (Ethinylestradiol with drospirenone)
Femodene (Ethinylestradiol with gestodene)
Cilest (Ethinylestradiol with norgestimate)
Microgynon 30 (Ethinylestradiol with levonorgesterol)
234
Progestogen-only oral contraceptives
Desogestrel based (Cerelle, Ceravette,)
Levonorgestrel based (Norgeston)
235
Long-acting reversible contraceptives
Nexplanon (etonogestrel) implant (3 years)
Depo-Provera (medroxyprogesterone) IM depot inj (3 months)
236
Spermicidal contraceptives
Nonoxinol '9' (Gygel)
237
Spermicidal contraceptives
Nonoxinol '9' (Gygel)
238
Contraceptive devices and intra-uterine systems
Mirena (IUS) - levonorgestrel based (5 years)
Jaydess (IUS) - levonorgestrel based (3 years)
Nova-T 380 (copper coil) (5 years)
TT 380 slimline (copper coil) (10 years)
239
Emergency contraception
Levonorgestrol
Ulipristal
Copper intra-uterine contraceptive device
240
Emergency contraception
Levonorgestrol
Ulipristal
Copper intra-uterine contraceptive device
241
Gemeprost (PGE1 analogue)
Prostaglandin derivative for Induction of abortion
242
Mifepristone
Progesterone receptor antagonists for Induction of abortion
243
Hormonal therapy for HRT
Oestradiol alone or with progestogens
Raloxifene
Tibolone
244
Antidepressants used for peri menopausal symptoms
Fluoxetine (SSRI)
Citalopram (SSRI)
Venlafaxine (SNRI)
245
Drugs for induction of labour
Oxytocin and Dinoprostone (exogenous PGE2)
246
Prevention and treatment of post-partum haemorrhage drugs
Ergometrine
Oxcytocin
(Syntometrine®)
Carboprost (prostaglandin)
247
Myometrial relaxants (tocolytics)
Atosiban (oxcytocin receptor antagonist)
Nifedipine (dihydropyridine calcium channel blocker)
Salbutamol (beta2 agonist)
preterm labour
248
Anti-emetics used in pregnancy
Promethazine (1st line)
Cyclizine (1st line)
Metoclopramide (2nd line)
Ondansetron (2nd line)
249
Topical beta-blockers in glaucoma
Betaxolol
Timolol
250
Brimonidine
Topical sympathomimetics in glaucoma
251
Carbonic anhydrase inhibitors
Acetazolamide
Brinzolamide
Dorzolamide
Use:glaucoma
252
Prostaglandin analogues in glaucoma
Latanoprost
Travoprost
253
Pilocarpine
Miotic drugs (muscarinic agonists) in glaucoma
254
Drugs for Pupil dilation for fundoscopy
(antimuscarinics)
Atropine
Cyclopentolate
Homatropine
Tropicamide
255
Phenylephrine
Sympathomimetic used in cataract surgery
256
Phenylephrine
Sympathomimetic used in cataract surgery
257
Topical antibacterial agents in ocular infections
Gentamicin
Chloramphenicol
Ciprofloxacin
Fusidic acid
Neomycin
258
Topical corticosteroids for uveitis/scleritis
Dexamethasone
Prednisolone
259
Topical antihistamines for Allergic conjunctivitis
Antazoline
Levocabastine
260
Topical ocular anaesthetics
Oxybuprocaine
Lidocaine
Tetracaine
261
Oral and nasal antihistamines for allergic rhinitis
Cetirizine (oral)
Loratidine (oral)
Azelastine (nasal)
262
Nasal corticosteroids for allergic rhinitis
Beclometasone
Fluticasone
263
Drugs for Vertigo and Ménière’s disease
Promethazine (anti-histamine)
Cinnarizine (anti-histamine)
Prochlorperazine (phenothiazine)
Bendroflumethiazide
264
Levodopa and associated DOPA decarboxylase inhibitors
Co-beneldopa (Levodopa + benserazide)
Co-careldopa (Levodopa + carbidopa)
PD
265
Dopamine-receptor agonists in PD
Pramipexole
Ropinirole
Rotigotine
266
Catechol-O-methyltransferase inhibitors
Entacapone
267
Antimuscarinic drugs in PD
Orphenadrine
Procyclidine
268
Epilepsy Sodium channel blocking drugs
Carbamazepine
Phenytoin
Lamotrigine
269
Epilepsy GABA receptor agonists
Clonazepam (benzodiazepine)
Diazepam (benzodiazepine)
Lorazepam (benzodiazepine)
Phenobarbital (barbiturate)
270
other GABA receptor related antiepileptic drugs
Vigabatrin (GABA transaminase inhibitor)
Sodium valproate (GABA potentiator and Na channel blockade)
Gabapentin (GABA analogue)
Pregabalin (GABA analogue)
271
Topiramate
Glutamate receptor antagonist
Epilepsy
272
Ethosuximide
Neuronal calcium channel blocker
Epilepsy
273
Levetiracetam
Epilepsy
274
Acute treatment of migraine
Sumatriptan
Zolmitriptan
275
Prophylaxis of migraine
Propranolol
Topiramate (antiepileptic drug)
Sodium valproate (antiepileptic drug)
Gabapentin (antiepileptic drug)
Amitriptyline (tricyclic antidepressant)
276
Zolpidem and Zopiclone
Non-benzodiazepine hypnotics that modulate the GABA-A/chloride channel
for insomnia
277
Temazepam
BDZ for insomnia
278
Antibiotics for CNS infections
Benzylpenicillin
Ceftriaxone
Cefotaxime
Ampicillin
279
Dexamethsaone in neurology
Bacterial meningitis, space occupying lesions with local cerebral oedema
280
Alzheimer's disease drugs
Anticholinesterase drugs:
Donepezil
Galantamine
Rivastigmine
NMDA receptor antag:Memantine
281
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen (non-selective)
Naproxen (non-selective)
Celecoxib (Cox2-selective inhibitor)
282
Disease-modifying antirheumatic drugs (DMARDs)
Sulfasalazine
Hydroxychloroquine (anti-malarial)
Leflunomide
Methotrexate (anti-metabolite)
Sodium aurothiomalate (Gold)
Azathioprine (anti-metabolite)
Ciclosporin (calcineurin inhibitor)
Penicillamine
283
Antibodies against tumour necrosis factor α in RA
Adalimumab
Etanercept
Infliximab
284
Other biological agents used in the treatment of rheumatoid arthritis
Anakinra (Interleukin-1 receptor antagonist)
Tocilizumab (Interleukin-6 receptor antagonist)
Abatacept (T-cell co-stimulation modulator)
Rituximab (Anti-CD20 B-cell depleter)
285
Colchicine
Acute gout
286
Allopurinol and Febuxostat
Xanthine oxidase inhibitors
Used for Hyperuricaemia and prevention of gout
287
Rasburicase
Intravenous prophylaxis against gout during cancer chemotherapy
288
Local anaesthesia for suturing
Lidocaine
Bupivacaine
289
Intravenous anaesthetics
Etomidate
Ketamine
Propofol
Thiopental
290
Intravenous opioids during anaesthesia
Fentanyl
Remifentanil
291
Inhalational anaesthetics
Desflurane
Halothane
Isoflurane
Nitrous oxide
Sevoflurane
292
Depolarising neuromuscular-blocking drugs
Suxamethonium (succinylcholine)
Use:Endotracheal intubation, muscle relaxation during surgery or on the ICU
293
Competitive N2 receptor antagonists (non-depolarising blockers)
Atracurium
Cisatracurium
Mivacurium
Pancuronium
Rocuronium
Vecuronium
294
Edrophonium
Acetylcholinesterase inhibitor
to test the therapeutic response to AChE inhibitors in myasthenia gravis
295
Neostigmine
Acetylcholinesterase inhibitor
Reversal of musle relaxants used during general anaesthesia
296
Pyridostigmine
Acetylcholinesterase inhibitor
Reversal myasthenia gravis
297
LFT Hepatocellular drugs (PASS):
Paracetamol, Alcohol, Sodium Valproate and Statins
298
Long term proton pump inhibitor therapy can cause
hypomagnesaemia
299
drugs that tend to cause a hepatocellular picture
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
300
drugs that tend to cause cholestasis (+/- hepatitis):
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine
301
drugs causing liver cirrhosis
methotrexate
methyldopa
amiodarone
302
side effects of cyclosporin 5H's
Hypertrophy of the gums, Hypertrichosis, Hypertension, Hyperkalaemia and Hyperglycaemia (diabetes)
303
Tamoxifen
Tamoxifen is a oestrogen antagonist, commonly indicated for ER+ positive breast cancers. However, it also works as an agonist on endometrial tissue which can result in endometrial proliferation
304
Typical antibiotics for meningitis
Under 3 months – cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy)
Above 3 months – ceftriaxone
GP-(IM or IV) of benzylpenicillin
