Pharmacology Flashcards
Simvastatin MOA
inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
Broad complex tachycardia Mx
stable - amiodarone
unstable - DC cardioversion
Regular Narrow complex tachycardia Mx
1st - vagal manoeuvre
2nd - adenosine
3 - B Blocker
if unstable - DCCV
Irregular narrow complex tachycardia Mx
<48hours - Cardiovert (DC/ Chemical)
B Blocker - rate control
Bradycardia Mx
1 - atropine 500mg IV (up to 3mg)
2 - transcutaneous pacing
3 - isoprenaline/ adrenaline
Chronic Heart failure Mx
1 - ACEi/ ARB + B Block
2 - Aldosterone antagonist (spironolactone/ eplerenone)
Extra: annual influenza vaccine, one-off pneumococcal vaccine
Post ACS long term Mx (secondary prevention)
DAPT (inc Aspirin)
ACEi
beta-blocker
statin
Ca Channel Blocker SE
headache, flushing, ankle oedema
paracetamol OD Mx
activated charcoal if <1hr ago
n-acetylcysteine
liver transplant
salicylate (aspirin) OD
Fx
Mx
Fx - hyperventilation, tinnitus
Mx - IV Bicarbonate, haemodialysis
Benzodiazepines OD Mx
Flumazenil
Tricyclic antidepressants OD Mx
IV Bicarbonate
Lithium OD Mx
haemodialysis
Warfarin OD Mx
Vit K, prothrombin complex
Heparin OD Mx
protamine sulphate
B blocker OD Mx
1st atropine
2nd glucagon
Ethylene glycol (anti freeze) Od Mx
fomepizole
Organophosphate insecticide OD Mx
atropine
Digoxin OD Mx
Digoxin specific antibodies
Iron OD Mx
Desferrioxamine
Lead OD Mx
Dimercaprol
Cyanide OD Mx
hydroxocobalamin
Lithium in pregnancy leads to what abnormality
Ebsteins anomaly (cardiac defect)
Rifampicin
MOA
SE
MOA prevent transcription of DNA into mRNA
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms
Isoniazid
MOA
SE
MOA - inhibits mycolic acid synthesis
SE - peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor
Pyrazinamide
MOA
SE
MOA: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
Ethambutol
MOA
SE
MOA - inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
SE - optic neuritis: check visual acuity before and during treatment
dose needs adjusting in patients with renal impairment
P450 inducers
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
P450 Inhibitors
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
Digoxin toxicity precipitatnts
hypokalaemia
CCB - verapamil, diltiazem
amiodarone, spirinolactone
AKI
Azathioprine + Allopurinol lead to…
azathioprine toxicity = pancytopenia
liver transplant for paracetamol overdose criteria
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
cocaine toxicity
benzodiazepine
+ GTN (if chest pain)
+ nitroprusside (if HTN)
Tamoxifen SE
Hot flushes
menstrual disturbance - PV bleed, amenorrhea
endometrial Ca
VTE
Heart failure drug exacerbators
Flecainide
NSAIDs/ glucocorticoids (apart from low dose aspirin)
verapamil
pioglitazone - causes fluid retention
Aminoglycoside (gentamicin) SE (2)
ototoxicity
nephrotoxicity
Fluroquinolones (ciprofloxacin) SE
connective tissue damage eg achilles tendon rupture
Macrolides (erythromycin, clarithromycin) SE
myopathy (muscle weakness), prolonged QT
Tetracyclines (Doxycycline) SE
photosensitivity
Finasteride
MOA
SE
MOA - 5 alpha reductase inhib
SE - gynaecomastia, sexual dysfunction
Lithium toxicity precipitated by drugs
dehydration
AKI
diuretics (esp thiazides), ACEi/ ARB, NSAIDS, Metronidazole
HRT facts
progesterone essential to prevent endometrial ca (due to unopposed oestrogen)
If hysterectomy - oestrogen-only is given
cyclical HRT for perimenopause (<1yr LMP)
Amitriptyline toxicity
Fx
Mx
prolonged QRS
tachycardia, dry mouth, dilated pupils
Mx - sodium bicarbonate
Apirin (salicylate toxicity)
Fx
Mx
hyperventilation, tinnitus, sweating
respiratory alkalosis followed by metabolic acidosis
Mx - sodium bicarbonate, haemodialysis
myasthenia gravis Mx
Pyridostigmine (acetylcholinesterase inhibitor)
Arsenic toxicity antidote
dimercarpol
Drug induced jaundice
nitrofurantoin
erythromycin
isonazid
methyldopa
Amiodarone SE
night glare
taste disturbance (metallic)
hypoKal
steroids
loop diuretics
ACEi SE
HyperKal
hypotension
Digoxin toxicity ECG
ST depression + T wave inversion (reverse tick)
