Pharmacology Flashcards by Harry Nuttall

Spironolactone: electrolyte disturbances

hyperkalaemia (especially if also on ACEi)

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NSAIDs: electrolyte disturbance

hyperkalaemia (via prostaglandin synthesis)

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trimethoprim: electrolyte disturbance

hyperkalaemia

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digoxin: electrolyte disturbance

hyperkalaemia (inhibits Na-K ATPase)

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thiazides: electrolyte disturbance

hypokalaemia
hyponatraemia (hypovolaemic)
hypercalcaemia
metabolic alkalosis (mild - due to chloride loss)
hyperuricaemia (caution in gout)

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loop diuretics: electrolyte disturbance

hypokalaemia
hypernatraemia (hypovolaemic)
hypomagnesaemia
hypocalcaemia
metabolic alkalosis (due to chloride loss)

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TURP syndrome: electrolyte disturbance

hyponatraemia

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ACE inhibitors: electrolyte disturbance

hyponatraemia (hypovolaemic)
hyperkalaemia

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carbonic anhydrase inhibitor: electrolyte disturbance

type 2 (proximal) renal tubular acidosis (hypokalaemia and osteomalacia)

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PPI: electrolyte disturbance

hyponatraemia
hypomagnesaemia

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warfarin: interactions

enzyme modifying drugs (amiodarone, ciprofloxacin)
NSAIDS

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warfarin: side effects

haemorrhage
skin necrosis
purple toes

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warfarin: recommendations around pregnancy

pregnancy = contra-indicated (teratogenic)
breast feeding = safe

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DOAC: side effects

haemorrhage
GI upset

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aspirin: side effects

GI upset
haemorrhage, haemoptysis or haematemesis
heartburn
rash

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aspirin: interactions

potentiates oral hypoglycaemics, warfarin, steroids#
other NSAIDs

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loop diuretics: side effects

hypotension
ototoxicity
renal impairment (direct and due to dehydration)
hyperuricaemia (gout)
hyperglycaemia (rate)

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thiazide diuretics: side effects

dehydration and postural hypotension
hyperuricaemia (gout)
hyperglycaemia (common)
erectile dysfunction

Rare SEs include thrombocytopenia, agranulocytosis, photosensitivity rash, pancreatitis

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spironolactone: side effects

gynaecomastia (not eplerenone)

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ACE inhibitor: side effects

first dose hypotension
dry cough
angioedema

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ACE inhibitor: recommendations around pregnancy

pregnancy = contra-indicated
breast feeding = contra-indicated

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ACE inhibitor: contra-indications

renovascular disease or aortic stenosis (perpetuates AKI)

calcium channel blockers: interactions

beta blockers (causes heart block)

beta blockers: interactions

calcium channel blockers (causes heart block)

beta blockers: contra-indications

- asthma - acute HF with shock OR HR < 50 OR 2nd/3rd deg heart block

beta blockers: side effects

- cool peripheries [propranolol] - bronchospasm - fatigue and sleep disturbance - erectile dysfunction

beta blockers: side effects

- cool peripheries [propranolol] - bronchospasm - fatigue and sleep disturbance - erectile dysfunction

beta blockers: electrolyte disturbance

mild hyperkalaemia

PPI: side effects

- diarrhoea - osteoporosis - microscopic colitis - C difficile infections - aspiration pneumonia

statin: side effects

- myopathy (myalgia and myositis, rhabdomyolysis) - liver impairment

statin: recommendations around pregnancy

pregnancy = contraindicated (teratogenic) breast feeding = contraindicated

statin: monitoring

Baseline, 3mo and 12mo LFT

amiodarone: side effects

- bradycardia - hypo or hyperthyroidism - pulmonary fibrosis or pneumonitis - liver fibrosis or hepatitis - jaundice - change to taste - slate grey skin discolouration - raised transaminases - nausea and constipation

warfarin: monitoring

For VTE or AF, aim INR 2.5 For recurrent VTE, aim INR 3.5 For mechanical valve, follow manufacturer's guidelines If INR >8, stop and give oral Vit K, re-check in 24hrs

Rivaroxaban, Apixaban and Edoxaban: mechanism of action, effects on clotting assays and antidote

Factor Xa inhibitors Increase in PT > APTT Give andexanet alfa

Dabigatran: mechanism of action, effects on clotting assays and antidote

Factor IIa (thrombin) inhibitor Increase in APTT > PT Give idarucizumab

warfarin: side effects

- GI upset

warfarin: sick day rules

stop for intercurrent illness, dehydration or AKI

gliptin (e.g. sitagliptin): effects on weight

weight neutral

gliptin (e.g. sitagliptin): hypo risk

low risk

gliptin (e.g. sitagliptin): side effects

- GI disturbance - pancreatitis - urticaria

gliptin (e.g. sitagliptin): mechanism of action

prolongs the half-life of GLP-1

pioglitazone: mechanism of action

increases peripheral insulin sensitivity

pioglitazone: effects on weight

weight gain

pioglitazone: contra-indications

HF (due to fluid retention -> oedema)

pioglitazone: hypo risk

low risk

sulfonylurea (e.g. glicazide): mechanism of action

increases insulin secretion

sulfonylurea (e.g. glicazide): hypo risk

high risk

sulfonylurea (e.g. glicazide): contra-indications

CKD 3+ CVD

SGLT2 inhibitor (glifozins): effect on weight

weight loss

SGLT2 inhibitor (glifozins): side effects

- GU infections - Fournier's gangrene - Euglycaemic DKA

SGLT2 inhibitor (glifozins): beneficial side effects

reduces BP and helps in HF and CKD

pioglitazone: beneficial side effects

increases HDL and reduces NASH