Pharmacology Flashcards
Side effects of SSRIs
Erectile dysfunction
Impaired psychomotor function (elderly)
Orthostatic hypotension
Hyponatremia
Taper and stop if pregnant
Ramsay Hunt Syndrome - symptons and treatment
Reactivation of dormant varicella-zoster in the facial nerves
Symptoms: facial palsy, intense ear pain, blisters inside ear canal, painful rash in face, mouth and ear
Treatment: aciclovir, corticosteroid
Medications used for opioid abuse
Naloxone (injectable) - acute opioid overdose
Naltrexone (oral) - to prevent relapse in opioid-dependent people who have remained opioid free for at least 7-10 days
Methadone or burprenorphine (oral) - for detoxification in active opioid dependence
Postherpetic neuralgia - definition, symptoms and treatment
More than 3 months after infection VZ virus
Burning pain due to nerve impairment
Treatment: amitriptilyne/duloxetine/gabapentin/pregabalin + steroids + tramadol (acute pain rescue)
UKMEC for contraception devices
Levonorgestel IU - UKMEC 2 for <20y
IUCD - UKMEC 2 for < 20y
Depot medroxyprogesterone acetate - UKMEC 2 for < 18y (increased risk of fracture because peak bone mass is not obtained yet)
Effects and time of use for emergency contraception (IUCD, POP, EllaOne)
IUCD - within 5 days (inhibits fertilization and implantation)
POP (levonorgestrel) - within 3 days (inhibits ovulation)
EllaOne (Ullipristal acetate) - within 5 days (inhibits and delays ovulation)
Symptoms of aspirin overdose
Tinnitus, deafness
Nausea, vomiting
Increased respiratory rate
Cardiac arrhythmias
Confusion
Lactic acidosis
Symptoms of amitriptyline overdose
Cardiac arrhythmias
Urinary retention
Nystagmus
Convulsion
Sinus tachycardia
Drowsiness
Dry mouth
Dilated pupils
Myoclonus
Respiratory arrest
Symptoms of paracetamol overdose
Nausea, vomiting
Abdominal pain after 12-36h
Hepatic necrosis (right subcostal pain, tenderness, jaundice, encephalopathy)
Acute kidney injury
Labs: abnormal LFTs, acidosis, hypoglycaemia, clotting abnormalities, elevated creatinine
Symptoms of cocaine overdose
Tachycardia, hypertension, chest pain, cardiac dysrhythmias
Dilated pupils, sweating, vomiting
Euphoria, delirium, hallucinations
Key: perforation of the nasal septum due to method of use
Which medications shouldn’t be combined with clarithromycin?
Clarithromycin is potent CYP3A4 inhibitor.
Avoid combining with statins (rabdomyolysis), lithium (increased QT interval), methadone (increased QT interval), salbutamol (hypokalaemia), warfarin (increased INR)
Which laxatives shouldn’t be used for opioid-induced constipation?
Bulk forming laxatives (isphagula husk), because they can cause abdominal pain and intestinal obstruction.
What is the treatment for faecal impactation (hard and soft stools)?
Hard stools - macrogol + stimulant laxative once soft; or glycerol suppositories + bisacodyl suppositories
Soft stools - stimulant laxatives (bisacodyl, senna, picosulfate) or bisacodyl suppositories
After, phoshate enemas, which may need to be repeated to clear the impacted faeces.
What are the 4 groups of laxatives and its main indications?
- Stool bulking agents (Isphagula husk)
- increase stool bulk by drawing water around their fibres
- requires adequate fluid intake
- useful as prophylaxis for constipation
- useful for small hard stools if fibre cannot be increased in the diet
- less useful in treating established constipation
- specially useful for constipation causing anal fissures and haemorrhoids
.
. - Osmotic laxatives (lactulose, macrogol)
- draw water into the intestinal lumen, which increased volume will encourage peristalsis
- requires adequate fluid intake
- don’t use for palliative care patients as it requires 2-3 L per day to function well, and lactulose may cause bloating and flatus if immobile
.
. - Stool softeners (docusate sodium, glycerol)
- retained in stool
- especially useful for patients with haemorrhoids or anal fissures
- useful if stools are rocky hard
- docusate sodium has both stimulant and stool-softening properties
- glycerol suppositories have both stimulant and stool-softening properties
.
. - Stimulant laxatives (senna, bisacodyl)
- stimulates motility
- best used as an as-required basis rather than regularly as may cause laxative dependence
- useful if bulky, soft faecal overloading
- avoid if hard rocky stools
- avoid if bowel obstruction
- bisacodyl is a rectal stimulant, it’s inserted rectally and in direct contact with the rectal mucosa. If placed correctly, it should stimulate evacuation within one hour
What are the common uses for procyclidine, baclofen, botox, diazepam and lorazepam?
Procyclidine (anticholinergic drug) - drug-induced parkinsonism, drug-associated extrapyramidal symptoms, akathisia (tremors and agitation), acute dystonia (involuntary muscle contractions)
Baclofen - muscle spasms associated with conditions such as multiple sclerosis, spinal lesions, cerebral palsy and motor neuron disease
Botox - muscle spasms in chronic migraine, limp spasticity in stroke, severe hyperhidrosis
Diazepam - acute muscle spasm, anxiety, seizures
Lorazepam - anxiety, panic attacks, seizures
