Pharmacology Flashcards
Aciclovir
Group
Use (2)
conditions (3)
prophylaxis (2)
Antiviral
HSV/VZV
Oral/genital herpes, Encephalitis, Eye infection
Immunocompromised, PEP VZV
Ad-Cal-D3
group/contains
Use
conditions
Key ( administer with what other medication?)
Colecalciferol (D3) with calcium carbonate (AdCal)
VitD & Calcium deficiency prevention
Osteopenia/ Osteoporosis
Prophylaxis - long-term oral corticosteroids (glucocorticoids); osteoporosis risk .
1st line ( w/ bisphosphonate) in fragility fracture prophylaxis
Adenosine
Class
Mechanism of action
Use
CI
Key: Dose and route of administration
Antiarrhythmic drug
* A1 adenosine receptor – Cardiac AVN tissue (slows impulse transmission)
* A2B recptor - endothelial tissue (Smooth muscle relaxation = vasodilation)
Rapid reversion to sinus rhythm in SVT (inc. conditions w/ accessory pathways e.g. WPW)
Aid Dx of broad/narrow complex SVT
Cardiac stress test in those who cannot exercise
C/I
o Chronic obstructive lung disease
o 2nd/3rd degree AV block
o Severe hypotension (it causes vasodilation)
Key
o 6mg rapid IV
o If needed : 1-2mins 12mg 1-2 mins 12mg
Indapamide
Class
Mode of action
Condition
Class – Thiazide- like diuretic
Mode of action
Antihypertensive - Vasodilation is more prominent that diuresis
Condition: Essential hypertension
Alendronate (alendronic acid)
Class: Bisphosphonate
Mode of action:
Use: (3)
Dose:
Key:
Adverse effect x3
Alternative where bisposphonate CI/not tolerated/not effecive
Bisphosphonate
Reduces rate of bone turnover ( preventin reabsorption of bone through reducing activity of osteoclasts)
Use: Osteoporosis Tx/ prevention
Conditions:
- Postmenopausal osteoporosis
- Osteoporosis
- hypercalcaemia
Dose: 10mg OD, oral tablet
Adverse effects:
* reflux & oesophageal erosion
* atypical fractures
* ostreonecrosis of jaw / external audoirtory canal
Alendronate (alendronic acid)
Key:
Directions for administration:
* CI: (3)
* Avoid in: (3)
* Monitoring: (1)
* important marker(s) before administration
Key:
* Directions for administration: swallow tablets whole, with plenty of water, empty stomach, min 30 mins pre breakfast/ other meds, remain standing/sitting for min 30 mins post administration.
* CI: abnormalities of oesophagus, hypocalcaemia, delayed GI emptying (stricture, achalasia etc)
* Avoid in: pregnancy, breastfeeding renal clearance <35ml/min
* Monitoring: serum-calcium
* Correct electrolytes w/ Ad-Cal-D3 before administration
alternative: denosumab
Colchicine
Use/ Condition:
Key - Common side effect (1)
Use/ Condition: 2nd line acute gout management (1st NSAID, 3rd steroids)
Key:
* Common side effect – Diarrhoea (GI upset). Dose dependent, so begin with lower dose
Allopurinol (MSK/Rheum)
Class:
Mode of action:
Use/conditions: (3)
Allopurinol (MSK/Rheum)
Class: Xanthine oxidase inhibitors
Mode of action: blocks uric acid production lower uric acid levels
Purine hypoxanthine [Xanthine oxidase] Xanthine [Xanthine oxidase] uric acid
Use/conditions:
- Prophylaxis gout (uric acid build up)
- Prophylaxis uric acid & calcium oxalate renal stones
- Prophylaxis hyperuricaemia from chemo
Allopurinol
Key: Acute tx for gout (1st - 3rd line)
* Acute Tx for gout:
* Use in Acute tx
* ?any changes to fluid intake
* S/E: (2x common, 1x rare)
Acute Tx for gout:
o 1st line – NSAIDs (not in renal impairment/HD), 2nd Colchicine (diarrhoea) , 3rd steroids
Only initiate allopurinol prophylaxis after acute attack settled. But if already on allopurinol, continue during acute attack
caution adequate fluid intake (2-3l/dah)
- S/E: common – rash, rare – agranulocytosis, triggers acute flares of gout when started (75%)
Amiodarone
Class:
Use: (2)
Class: Antiarrhythmic class III
Use: Treatment of arrhythmia (not 1st line), Ventricular fibrillation/ Pulseless ventricular tachycardia (that’s refractory to defib)
Amitriptyline
Class:
Use: (2 groups)
Conditions: 1 - 3 conditions, 2- 2 conditions
dose ranges condition group 1, 2
Amitriptyline
Class: Tricyclic antidepressant
Use: Neuropathic pain, Mental health disorders
Conditions:
Neuropathic pain (5-25mg/d, max 75mg)
o abdominal pain/discomfort ( NOT 1st line- laxatives, loperamide, antispasmodics)
o Prophylaxis migraine
o Prophylaxis chronic tension headache
Psych:
o Major depressive disorder (50mg - 150mg/day)
o Emotional liability in MS (max 75mg)
amitriptyline
Key:
* CI: (4)
* S/E (3x common), (1xrare)
* OD: outcome
Key:
* CI: Mania (in BPD), Arrhythmia, heart block, immediately following MI
* S/E common: Anticholinergic syndrome, drowsiness, QT interval prolongation, Rare: Agranulocytosis
* OD: fatal
Amlodipine
Class: (x2 others in same class)
Mode of action:
Use/Condition: (x2)
Key info:
#Caution: in Elderly
#Main S/E x3
Class: Calcium channel blocker [Nifedipine, Diltiazem hydrochloride]
Mode of action:
- Inhibit inward displacement of Ca+ through cell membrane.
- in myocardial cells, conducting sells, vascular smooth muscle.
- reduces
o myocardial contractility
o formation of electrical impulses in the heart
o coronary/ systemic vascular tone
Use/Condition: Angina, HTN
Caution: Elderly STOPP criteria – in persistent postural hypotension
Main S/E
ankle swelling, flushing, headaches
What drugs give EPSE
what are the EPSE ( 4)
Atypical antipsychotics ( haloperidol), prokinetic antiemetics ( metoclopramide)
Akinesia
dystonic reactions ( muscle spasms face, neck, back Dyskinesia (blinking/ twitching)
Akathesia ( unable to sit still)
Tx in H. Pylori infection
Triple therapy PPI + 2 Abx
e.g. Omepraxole + Amoxicillin + Clarithromycin/ Metronidazole
Meningitis Abx regime
1.Suspected meningococcal meningtisi in community
2. <3m ( plus 2nd line Abx)
3. >3m
4. Addition, frequency and duration in >3m confirmed bacterial meningitis on LP
5. PEP ( and duration)
6. Viral meningitis
- IM/IV Benzylpenecillin
- Cefotaxime + Amoxixillin (listeria)/ Vancomycin
- > 3m- Ceftriaxone
- Dexamethasone QDS, 4 days - prevent hearing loss/ neuro damage
- Single dose ciprofloxacin
- Supportive tx - Aciclovir (if HSV meningitis)
cef0taxime (0-3 months) and vancOmycin
cefTRIaxone (>3m) (w/ dex)
ciprofloxacin
2cefs and 1 sip
Abx in IE
Intravenous broad-spectrum antibiotics (e.g., amoxicillin and optional gentamicin)
if cultured specific organism, use specific Abx
Amoxicillin
Class:(x2 others in group)
Use:
Conditions x10
Key
Don’t use in x 4 conditions, S/E
Class: penicillins [Ampicillin, flucloxacillin]
Use: infection
Conditions: ( mostly resp)
* CAP, pneumonia.
* acute exacerbation of bronchiectasis/ COPD
* acute otitis media (1st line Abx)
* Listeria meningitis ( <3m – cefotaxime plus amoxicillin - cover listeria)
* H.Pylori = PPI + 2Abx (amoxicillin & macrolide- clarithromycin/metronidazole)
* Co-amox >5days for acute diverticulitis
* Endocarditis
* UTI ( recurrence prophylaxis, pregnancy, children – not 1st/2nd line)
Key
* ALL, CLL, Glandular fever ( infectious mononucleosis), Cytomegalovirus = Erythematous rash
Tranexamic acid
Class:
Mechanism of action:
Use/Conditions: (4)
Tranexamic acid
Class: Antifibrinolytic
Mechanism of action: Prevents dissolving of fibrin reduces bleeding
Use/Conditions:
* Local fibrinolysis
* Menorrhagia
* Epistaxis
* Significant haemorrhage in trauma
Aspirin
Group: (x2 different groups - 1 x2 others, 2 x 3 others)
Use/conditions:
* Prevention (4)
* Tx (4)
Key
Caution (1)
C/I (3)
Aspirin
Group: Antiplatelet (Ticagrelor, Clopidogrel)/ NSAID (Naproxen, Diclofenac, Ibuprofen)
Use/conditions:
* Prevention
o 2nd line in DVT/ PE (if pts decline anticoag)
o TIA – 300mg OD PO (til Dx)
o Stroke – 300mg aspiring 2weeks
o Pre-eclampsia ( 75-150mg from 12weeks to delivery
* Tx
o Mild-mod pain
o Pyrexia
o Pericarditis ( NSAID + Colchicine)
o Kawasaki ( w/ IgG)
Key
Caution
* NSAID use in older pt on anticoags e.g. Aspirin/ DOAC
C/I
* Peptic ulcer
* Bleeding disorder
* <16 (Reyes syndrome)
Enzyme inducers : Bull SiTS on CRAP GPS (11 drugs)
Barbituates
St. Johns Wort
Topiramate
Smoking
Carbamazepine
Rifampicin
Alcohol ( chronic use)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
AJ GADS’ SICKFACES.COM
used for?
stands for
Allopurinol
JG - Grapejuice
Amiodarone
Disulfuram
SSRIs (fluoxetine, sertraline)
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (acute intoxication)
Chloramphenicol
Erythromicin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Atenolol
Class: (specific type), 1 other drug in group
Mechanism of action:
Use/ Conditions: (5x - inc. 1x neuro)
Key info:
(CI/ S/E x 3, pregnancy x 4, breastfeeding x1)
Class: Selective B-blocker - Bisoprolol
Mechanism of action:
* Blocks β1 receptors (cardiac) lower HR, lower force of contraction lower blood pressure
Use/ Conditions:
Key info:
All B-Blockers
* Systemic Sx: e.g. Bronchospasm ( Asthma, COPD), cardiogenic shock, hypotension
* Pregnancy: IUGR, neonatal hypoglycaemia, bradycardia, HTN
* Breastfeeding – water soluble ( atenolol specific)
Atracurium
Class: (specific)
others in the group x2)
Mechanism of action:
Use:
Key info:
* S/E x2, Pregnancy/breastfeeding x1
Class: Non-depolarising (competitive) muscle relaxant - Rocuronium, Vecuronium
Mechanism of action:
Blocks Ach binding site –> prevents depolarisation and contraction
Use: neuromuscular blockade for surgery, intubation, ICU
Key info:
* S/E – hypotension. Flushing
* Pregnancy/breastfeeding – highly ionised art physiological pH, so do not cross placenta/ into milk
Azathioprine
Class:
x2 others in the group: Fluorouracil, Methotrexate
Use: x1immunosuppression – autoimmune conditions, suppress transplant rejection
Conditions: x 5 ( in most common condition, how is azathiprone used (1st or 2nd line etc)
Key info:
S/E x 2
Class: DMARD (antimetabolite/immunosuppressant) - Fluorouracil, Methotrexate
Use: immunosuppression – autoimmune conditions, suppress transplant rejection
Conditions:
* Crohn’s
o 2nd line (combine with steroids ) to induce remission.
o 1st line in maintaining remission
* RA
* prevent renal transplant rejection.
* Severe eczema
* Generalised myasthenia gravis
Key info:
S/E
* immunosuppression: Bone marrow depression (dose-related); infection risk; leucopenia; thrombocytopenia
* pancreatitis;
Beclomethasone
Class, x6 others
Use/Conditions (x4 routes and x5 conditions)
Key info:
C/I x1
S/E x 7
Class: corticosteroid [betamethasone, dexamethasone, fudrocortisone, fluticasone, hydrocortisone, methylprednisolone, prednisolone
Use/Conditions
- Inhalation
o Asthma prophylaxis
o Oral ulcer
- Intranasal
o Prophylaxis/Tx allergic / vasomotor rhinitis
- Topical
o Unresponsive eczema/psoriasis
- Oral
o Adjunct to aminosalicylates in mild-mod UC
Key info:
C/I – Live virus vaccines in those with immunosuppressive doses
S/E
* Inhaled: headache, oral candidiasis [avoid: use spacer device, rinse mouth with water], pneumonia ( in COPD Hx), alered taste/voice)
* Intranasal: epistaxis, altered smell/taste, headache, irritated throat
* Systemic steroid sx (inc cushings)
Bisoprolol (see atenolol)
class and mechanism of action
Use x 3
is it involved in 1st, 2nd, 3rd, or 4th line mx in HTN
Class: Selective B-blocker (see atenolol)
Use: HTN, angina, adjunct in HF
Conditions: 4th line in HTN
HTN management
how many steps
age limit to consider alternative
what medication is used in each step
4 steps
55 years
- ACEi <55> CCB/ thiazide like diuretic
- ACEi + CCB/ thiazide like diuretic
- ACEi+CCB+ thiazide like diuretic
- ACEi+CCB+thiazide like diuretic + A/B-blocker/other diuretic
Bendroflumethiazide
Class: x1 other
Mechanism of action:
Use/ Conditions: x2
Key info:
S/E (lots, think a) loss of solutes, b) loss of water)
x3 conditions this med could lead to
C/I: x5 conditions
Bendroflumethiazide
Class: thiazide-like diuretic [Indapamide ]
Mechanism of action:
* Distal tubule: blocks thiazide sensitive NaCl cotransporter in the lumen of distal tubule –> Na (followed by H20 – also Cl) remain in the filtrate
–> expelled in urine
Use/ Conditions: Oedema, HTN
Key info:
S/E
* (loss of solutes & water)
o Dehydration –> AKI
o Low chloride, sodium, potassium
o Postural hypotension
* (loss of water)
o ↑ glucose (esp. in diabetics)
o ↑ calcium
o ↑ uric acid –> gout
so Bendroflumathiazide= risk of AKI, postural hypotension, gout
C/I: Addison’s disease, hypercalcaemia, hyponatraemia, refractory hypokalaemia, symptomatic hyperuricaemia
General tonic-clonic seizure
1st line x1
2nd line (x2)
1 - sodium valproate
2 Lamtorigine/ carbamazepine
Focal seizure
1st line x 2
2nd line x2
(reverse of generalised tonic-clonic)
1 Carbamazepine/ lamotrigine
2 Sodium valproate/ Keppra
Absence
1st x 2
Sodium valproate/ Ethosuximide
Atonic seizure
1st line (x1)
2nd line (x1)
sodium valproate
lamotrigine
Myoclonic seizure
1st (x1)
2nd (x3)
sodium valproate
lamotriogine, keppra, topiramate
West syndrome
aka
1st line (x2)
infantile spasms
prednisolone, Vigabatrin
sodium valproate
1st ine in which forms of epilepsy (x4)
2nd line in which forms of epilepsy (1)
Mode of action
x 4 S/E
Generalised tonic-clonic, Absence, Atonic, myoclonic
2nd - Focal seizures
increases GABA activity –> relaxes brain
S/E
* teratogenic
* liver damage & hepatitis
* hair loss
* tremor
Carbamazepine
1st line
2nd line
S/E (x3)
non-seizure use (x1)
AKA Carbagen/Tegretol
1st - focal
2nd - Gen tonic-clonic
Agranulocytosis
Aplastic anaemia
Many drug interactions ( induces the P450 system)
Trigeminal neuralgia
Phenytoin
used in?
Side effects (x2 and the consequences)
last line status epilepticus
community: Buccal midazolam/ Rectal diazepam
1 - 4mg IV lorazepam
2 (10 mins later) - 4mg IV lorazepam
3 (10 mins later IV phenytoin
Folate deficiency –> megaloblastic anaemia
Vitamin D deficiency –> osteomalacia
ethosuximide
(shared) 1st line in ….
S/E (x2)
Absence seizures ( along with sodium valproate)
Night terrors
rashes
Lamotrigine
1st line
2nd line
S/E x 2
1 - focal seizure
2- gen ton-clon, atonic, myoclonic
Stevens-johnson/ DRESS syndrome
Leucopenia
Carbimazole
Mechanism of action:
Use/Conditions: x1
Key info:
How its used: dose and duration
Carbimazole
Mechanism of action:
* Antithyroid: reduces uptake & concentration of iodine in thyroid & formation of T3 (di-iodotyrosine) and T4 (thyroxine )
Use/Conditions: Hyperthyroid
Key info:
Dose: 15-40mg daily
Used until pt euthyroid: 4-8weeks
Cefuroxime
Class: (specific)
Mechanism of action:
Use: (type of pathogen
Conditions x3
Cefuroxime
Class: Second generation Cephalosporins (antibacterials)
Common drug name/ others in the group:
Mechanism of action:
* Attach to penicillin-binding proteins interrupt cell wall biosynthesis cell lysis
* Broad spec antibiotic
Use: G+ve and G-ve bacterial infections (as broad-spec)
Conditions:
* lyme disease – 1st line in CNS Sx , otherwise Doxycycline for rash only (1st line)
* UTI ( lower, catheter associated, acute pyelonephritis) – 1st line IV
* Meningitis ( with vancomycin in 0-3m)
Certirizine
Class: Non-sedating antihistamines
Others in the group: x1
Use: x3
Certirizine
Class: Non-sedating antihistamines
Others in the group: loratadine
Use: Sx relief of allergies ( hay fever idiopathic urticaria, atopic dermatitis)
Chloramphenicol
Class: Antibacterial, other
others in the group: x4
Use/ Conditions: x3
Key info:
Avoid in x2
Chloramphenicol NOT TO BE CONFUSED WITH THE SEDATING ANTIHISTAMINE CHLORAMPHENAMINE
Class: Antibacterial, other
others in the group: co-trimoxazole, fusidic acid, nitrofurantoin, trimethoprim
Mechanism of action:
* Broad-spec
Use/ Conditions:
* Superficial eye infection ( eye drop)
* Otitis externa
* Typhoid
Key info:
* Pregnancy
o Avoid in 3rd trimester grey baby syndrome (rare, life-threatening conditions following build up of chloramphenicol)
* Breastfeeding – bone marrow toxicity
Chloroquine
Class:
Conditions: x 4
it is 1st line in of these conditions … in what specific group of pts?
Chloroquine
Class: Antimalarial
Use:
Conditions:
* Malaria prophylaxis
* Active RA - alternative to DMARD in mild RA/ in addition to DMARD if unresponsive, 1st line in pregnancy (safe where as methotrexate teratogenic)
* Systemic/ discoid lupus erythematosus – 1st line mild SLE
Chlorphenamine
Class: sedating antihistamine
others in the group: x1
Use: x 3
Chlorphenamine NOT TO BE CONFUSED WITH THE ANTIBIOTIC CHLORAMPHENICOL
Class: sedating antihistamine (Promethazine)
Use:
* Sx relief of allergy ( hayfever, urticaria, food allergy, drug reactions)
* Itch relief (chickenpox)
* Anaphylaxis
Give 3 1st gen antipsychotics
Chlorpromazine, Haloperidol, Zucpenthixol
1st gen = typical
Give 3 2nd gen antipsychotics
Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone
2nd gen = atypical
Main S/E of typical antipsychotics (x1)
EPSx
Main S/E atypical antipsychotics (x3)
weight gain, glucose intolerance, and hyperprolactinaemia.
Chlorpromazine
Class:
others in the group: x2
Mechanism of action:
Use/ Conditions: x2
Key info:
*x3 Adverse effecrs
Class: 1st gen (typical) antipsychotic
others in the group: Haloperidol, Zuclopenthixol
Mechanism of action: ?block dopamine-2 receptors
Use/ Conditions:
* Schizophrenia
* Psychosis
Key info:
* NMS
* EPS
* QT-interval prolongation
Meds that trigger acute haemolysis in G6PD
Primaquine (an antimalarial)
Ciprofloxacin
Nitrofurantoin
Trimethoprim
Sulfonylureas (e.g gliclazide)
Sulfasalazine and other sulphonamide drugs
Ciprofloxacin
Class:
Use/ conditions: (lots, list 4 )
Key info: x3
Ciprofloxacin
Class: Quinolone
Mechanism of action:
Use/ conditions:
* Superficial bacterial eye infection
* Close contact with confirmed bacterial meningitis
* Otitis externa
* Pyelonephritis
*
Key info:
* 1 of the meds that triggers acute haemolysis in G6PD deficiency.
* Prolong QT interval
* Reduce seizure threshold
Cisplatin
Class: Platinum compound
Use/Conditions: x1
Key info:
S/E x3
Class: Platinum compound (chemotherapy)
Use/Conditions: Cancer: testicular, ovarian, lung, bladder, SCC head & neck, cervical
Key info:
S/E
* peripheral neuropathy
* sensorineural hearing loss (ototoxicity)
* nephrotoxicity
causes of peripheral neuropathy: ABCDE
A – Alcohol
B – B12 deficiency
C – Cancer and Chronic Kidney Disease
D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin)
E – Every vasculitis
Citalopram
Class:
others in the group: x4
Mechanism of action:
Use/Conditions: x2
Key info:
dont use in x2
S/E x2
Citalopram PSYCH
Class: SSRI
others in the group: Escitalopram, Fluoxetine, paroxetine, sertraline
Mechanism of action: inhibits the reuptake of serotonin (5-HT)
Use/Conditions:
* depression
* panic disorder
Key info:
dont use in:
* epilepsy (porly controlled)
* Mania
S/E:
* QT-interval prolongation
* Sexual dysfunction ( even after Tx stopped)
Clopidogrel
Class:
others in the group: x3
Mechanism of action:
Use: x4
Key info:
Typical dose: x2
Common S/E: x3
Clopidogrel
Class: anti-platelet
Common drug name/ others in the group: aspirin, dipyridamole, ticagrelor
Mechanism of action:
Blocks glycoprotein GPIIb/IIIa complex pathway –> reduced platelet aggregation
Use:
* Post-MI triple therapy (Aspirin, clopidogrel, anticoagulant)
* Prevention: MI/Stroke
* Peripheral arterial disease
* Preventing atherothrombotic events during PCI (if pt not already on clopidogrel)
*
Conditions:
Key info:
Typical dose:
* 75mg
* Loading dose 300mg
Common S/E:
* Diarrhoea, GI discomfort, haemorrhage
clopidogrel dose in preventing atherothrombotic events following NSTEMI
300mg initially, then 75mg (12/12)
clopidogrel dose in preventing atherothrombotic events following STEMI
300mg initially, then 75mg (4/52)
Co-amoxiclav
Class:
Use:
Co-amoxiclav
Class: penecillins – amoxicillin and clavulanic acid
Use:
* beta-lactamase-producing strains, where amoxicillin alone not appropriate
* broad spec Abx – esp for anaerobic bacteria – unlike simple penecillins (e.g. amoxicillin/ flucloxacillin)
Co-trimoxazole
Class:
Common drug name:
Mechanism of action:
Use
Conditions x1 main
NOT TO BE CONFUSED WITH ANTIFUNGAL CLOTRIMAZOLE
Class: Sulfamethoxazole & trimethoprim = sulphonamide
AKA Septrin
Use: lots of infections
Conditions:
* Prophylaxis / Tx Pneumocystis jirovecii pnemonia
Key info: N/A
Ciclosporin
Class:
others in the group: x2
Use:
Conditions:
Key info:
x 1 Can cause….
Ciclosporin
Class: calcineurin inhibitor (immunosuppressant)
Common drug name/ others in the group: Pimecrolimus, tacrolimus
Use: steroid sparing immunosuppressant - transplants/ severe -acute presentations of conditions
Conditions:
* Transplants (organ/bone marrow)
* Ulcerative colitis
* Rheumatoid arthritis
* Atopic dermatitis
* Psoriasis
* SLE
Key info:
Can cause Hirsutism
Dalteparin
Class:
Others in the group: x3
Mechanism of action:
Dalteparin
Class: heparin
Others in the group: Heparin, Enoxaparin, Tinzaparin
Mechanism of action:
Binds to antithrombin –> binds to Factor Xa –> prevents Factor Xa converting prothrombin to thrombin (factor IIa) –> prevents fibrinogen (factor I) to fibrin –> prevents clotting
Dalteparin
Conditions:x4
Key info:
C/I x1
S/E x2
Conditions:
* DVT tx
* PE prevention/ tx
* VTE prophylaxis in pregnant women
* Unstable coronary artery disease
Key info:
C/I
* Acute bacterial endocarditis
S/E
* HIT – heparin induced thrombocytopenia.
* Haemorrhage
Dalteparin
Use in pregnant women
When to prescribe in:
* Very high risk
* High risk
Duration:
Any situations when it should be stopped
Use in pregnant women
* Very high risk – immediately
* High risk – 28 weeks
* Continue until 6ks postpartum
* Stop temporarily during labour (and delivery in postpartum haemorrhage, spinal/epidural)
ACS medical management ( drugs and doses)
- acute management
- triple therapy post mi
- meds to consider for long term Mx
Acute = MOAN
Morphine (10mg in 10ml, titrate for pain)
O2 (if below ideal sats)
Aspirin (300mg loading dose, then 75mg OD)
Nitrites (GTN - in not hypotensive, then PRN)
triple therapy
1 - antiplatelet: Aspirin
2 -Antiplatelet: Clopidogrel/ticagrelor
3 - Anticoagulant: Fundaparinoux/ Heparin
long term: B-blocker/ ACE-i/Statin
Diamorphine
Class:
Mechanism of action:
Use x3
Key info:
x3 S/E
x2 Caution
Diamorphine
Class: Opioids
Mechanism of action: Opioid receptor agonist (binds to the Mu, kappa, delta opioid receptors)
Use
* Acute pain
* Chronic pain
* ACS: (MOAN) – Initial management in ACS
Key info:
S/E
* Respiratory depression (OD) &sleep apnoea
* Nausea
* constipation
Caution:
* Benzos &opioids = risk of potentially fatal respiratory depression
* dependence
Diamorphine
Med given in dependence
Med given in OD
Signs and mx of OD
o Pinpoint pupils (miosis)
o Antidote – naloxone
Med given in dependence
Methadone (tx dendence, also analgesic)
Naloxone
Signs and mx of OD
o Pinpoint pupils (miosis)
o Antidote – naloxone
Diazepam
Class:
others in the group:
Mechanism of action:
Use/Conditions: x4
o route in status epilepticus
Key info:
- x1 risk
Diazepam
Class: Benzo
others in the group: Chlordiazepoxide, Clonazepam, Lorazepam, Midazolam
Mechanism of action: binds to GABA receptors (GABA is an inhibitory neurotransmitter) –> inhibits transmission across neurones –> sedation.
Use/Conditions:
* Muscle spasms
* Anxiety
* Drug induced dystonic activity
* Status epilepticus
o Rectal diazepam as alternative to 4mg IV lorazepam
Key info:
- Risks when benzos+opioids = increased risk of sedation, respiratory depression, coma, death
Diclofenac
Class: +x4 others in group
Use: x2
Key info:
Conditions it may be inappropriate/ C/I in x 4
Diclofenac
Class: NSAID – aspirin, ibuprofen, mefenamic acid, naproxen
Mechanism of action:
Use:
Analgesia
- IV/IM post-op injection, collickey pain (ureteric colic)
Eye surgery
- Inhibit intra-op miosis
- Post-op inflammation prophylaxis
Key info:
- IV diclofenac = analgesia in renal stone
- Conditions it may be inappropriate/ C/I in
o Asthma
o Renal impairment
o Heart disease
o Stomach ulcers
Digoxin
Class:
Mechanism of action:
Use / Conditions: x4
Key info: x1 Common S/E
Digoxin
Class: Antiarrhytmic - cardiac glycoside
Mechanism of action: positive ionotrope (increases force of myocardial contration) and reduces conductivity in the AVN
Use / Conditions: SVT, Atrial flutter/ fibrillation, heart failure
Key info:
Common SE: arrhythmia
Diltiazem
Class: x4 others
Conditions: x2
Class: CCB = amlodipine, nifedipine, verapamil
Common drug name/ others in the group:
Conditions: Angina, HTN
Dobutamine
Class:
Mechanism of action:
Use: x1 general use
Dobutamine
Class: cardiac stimulant
Mechanism of action: acts of B1 receptors in cardiac muscle increases contractility
Use: inotropic support in: infarction, cardiac surgeries, cardiomyopathy, shock (septic/cardiogenic), PEEP
Domperidone
Class: x3 labels
others in the group:
Use/Conditions: x2
Key info:
* Common S/E x1
* Metoclopramide 1st line except in …
* Not to be combined with ….
Domperidone
Class: Dopamine receptor antagonist (anti-emetic), pro-kinetic
Common drug name/ others in the group: metoclopramide (both are prokinetic GI motility
Use/Conditions: N&V/ GI pain in palliative care
Key info:
* Common S/E – dry mouth
* Metoclopramide 1st line except in
o Parkinson’s (domperidone has no EPSE)
* Not to be combined with meds which slow motility (Ach inhibitors): hyoscine butylbromide, cyclizine, levomepromazine, ondansetron)
Donepezil
Class:
others in the group: x1
Use:
Donepezil
Class: reversible AChesterase inhibitor (AChEi)
others in the group: rivastigmine
Use: mild-mod Alzheimer’s
Alzheimer’s - medical management:
mild
mod
sev.
Mild-mod: AChEi (donepezil, rivastigmine)
Mod- sev: NMDA antagonist (memantine)
Doxazosin
Class:
others in the group: x1
Mechanism of action:
Use: x2
Key info:
C/I x1
Doxazosin
Class: alpha blocker
Common drug name/ others in the group: Tamsulosin
Mechanism of action: block alpha receptors relaxation of smooth muscle
Use:
* HTN (last line addition)
* BPH - relaxes muscle
Key info:
C/I in Hx micturition syncope
BPH medical mx
x2
for each:
meds option
funcitons
Alpha-blockers (doxasozin, tamsulosin) - relax smooth muscle
5-alpha reductase inhibitors (e.g., finasteride) (e.g., finasteride) - reduce size of the prostate
Doxycycline
Class:
Use: x5
Key info:
Tx in; Acne vulgaris, Lyme disease, Uncomplicated Chlamydia, PID
S/E x1
C/I x2
Doxycycline
Class: tetracycline
Use: infections: CAP/HAP, UTI, human/animal bites, acne vulgaris, STIs
Key info:
Acne vulgaris: doxyclyline( or lymecycline) – 6months
Lyme disease: 21 days when suspected.
Uncomplicated Chlamydia: 1st line doxycline 100mg BD 7/7
PID – part of triple therapy
S/E – sun sensitivity
C/I preggers/ breastfeeding
medical mx of PID
- single dose IM ceftriaxone 1g (gonorrhoea)
- Doxycycline 100mg BD 14/7 (chlamydia and Mycoplasma genitalium)
3.Metronidazole 400mg BD 14/7 (anaerobes e.g Gardnerella vaginalis)
Ceftriaxone and doxycycline will cover many other bacteria, including H. influenzae and E. coli.
Ephedrine ANAESTHETICS
Class:
others in the group: x2
Mechanism of action:
Key info:
* Very potent! Only used in …
Ephedrine ANAESTHETICS
Class: Sympathomimetic, vasoconstrictor ( CNS stimulant)
Common drug name/ others in the group: adrenaline/ epinephrine, phenyephrine
Mechanism of action: combined α&β-adrenergic agonist vasoconstriction
Key info:
* Very potent! Only used in arrests/ITU/? Tx hypotension during surgery - when BP and HR are low
Epinephrine/adrenaline
Class:
Common drug name/ others in the group: x4
Mechanism of action:
Use: x1
Epinephrine/adrenaline
Class: Sympathomimetic (combined α&β-adrenergic agonist), vasoconstrictor
Common drug name/ others in the group: Ephedrine, phenylephrine, metaraminol, noradrenaline,
Mechanism of action: combined α&β-adrenergic agonist; Vasoconstriction (α effects), raised HR and contractility (β1 effects), peripheral vasodilation (β2 effects)
Use: acute anaphylaxis
Erythromycin
Class:
Others in the group:x3
Mechanism of action:
Use:
x1
Erythromycin
Class: macrolide
Others in the group:Azithromycin, erythromicine, clarithromycin
Mechanism of action: destroys bacterial ribosomes
Use:
Alternative in penicillin allergy: e.g. RTI
Ethinylestradiol
Class:
Mechanism of action:
* x2
Use:
Key info:
S/E or risks x6
C/I x7
Ethinylestradiol
Class: oestrogen combined with progestogens ( COCP)
Mechanism of action:
* Prevents ovulation (1ᴼ mechanism of action)
* Progesterone thickens cervical mucus, inhibits proliferation of endometrium
Use: contraception
Key info:
S/E or risks
* Unscheduled bleeding in 1st 3 months
* Breast pain/ tenderness
* Mood changes/depression
* Headaches
* HTN, VTE, MI, Stroke
* Increased breast & cervical cancer
risk
* C/E uncontrolled HTN
* Migraine with are (increased stroke risk)
* Major surgery w/ prolonged immobility
* >35 yo & >15 cigs/ day
* VTE/ Vasc disease/ stroke/ IHD, Cardiomyopathy. AF Hx
* Liver cirrhosis/tumour
* SLE/ Antiphosp[holi[pid syndrome
Ferrous sulphate
Use: x1
Key info:
x1 S/E
x1 how to increase absorption
Ferrous sulphate
Class: iron, oral
Use: iron deficiency anaemia
Key info:
- Dark stools
- conume on empty stomach
Finasteride
Class:
Mechanism of action
Use x1
Key info:
S/E sx1
Conception/contraception recommendation
Finasteride
Class: 5α- reductase inhibitor
Mechanism of action: 5α- reductase metabolises testosterone to dihydrotestosterone (more potent androgen). Finasteride inhibits that
Use: BPH
Key info:
S/E sexual dysfunction
Conception/contraception – finasteride is excreted in semen – so use condom if partner is pregnant/ likely to become pregnant.
Flucloxacillin
Class:
Use:
Key info:
Most important S/E …
Flucloxacillin
Class: penicillin
Use: infections, esp. staph. Aureus caused e.g., cellulitis, secondary bacterial infection of eczema, diabetic foot infection
Key info:
Most important S/E hypersensitivity (rashes and anaphylaxis)
Fluconazole
Class:
Use:
- x2
Fluconazole
Class: Triazole antifungal
Use:
- Candida infections ( vaginal, mucosal, candida balanitis, dermal e.g. tenea pedis, pityriasis vericolor)
- Prophylaxis in immunocompromised
Fludrocortisone
Class:
others : x8
Use: x2
Key info:
C/I – x1
S/E x2
Fludrocortisone
Class: mineralocorticoid
Common drug name/ others in the group: beclomethasone, betamethasone, budesonide, hydrocortisone, prednisolone, dexamethasone, fluticasone(inhalers), methylprednisolone.
Use: Neuropathic postural hypotension, adrenocortical insufficiency
Key info:
C/I – avoid live vaccines if receiving immunosuppressive doses (all steroids)
S/E prolonged therapy adrenal atrophy
Increased risk of infections
what corticosteroid med is used in adrenal insfufficiency to replace
- glucocorticoids
- mineralocorticoids
Glucocorticoids: hydrocortisone
mineralocorticoid: fludrocortisone
(same in CAH)
Flumenazil
Class:
Use: x1
Key info:
C/I x2
Flumenazil
Class: Benzodiazepine antagonist
Use: reduce sedative effects of benzos ( peri-op/ICU)
Key info:
C/I life-threatening conditions controlled by benzos ( raised ICP, Status epilepticus)
Fluoxetine
Class: SSRI
Common drug name/ others in the group: x3
Mechanism of action:
Use: x4
Key info:
C/I x2
x1 rare S/E
Fluoxetine
Class: SSRI
Common drug name/ others in the group: Citalopram, escitalopram, sertraline NOT DULOXETINE – SNRI, LLIKE VENLAFAXINE
Mechanism of action: inhibits the reuptake of serotonin (5-HT)
Use: Major depression, bulimia nervosa, OCD, menopausal sx
Key info:
C/I
- Poorly controlled epilepsy
- Mania ( do not use SSRIs in manic phase)
Serotonin syndronme ( rare S/E - marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop)
Folic acid
Use:
- x4
Folic acid
Use:
- Folate-deficient megaloblastic anaemia
- Pregnancy – neural tube defect prophylaxis
- Methotrexate use – prevention of S/E of methotrexate ( e.g. rheumatic disease, Crohn’s, psoriasis)
- Deficiency prophylaxis in: chronic haemolytic states/ dialysis, PEN
Furosemide
Class:
Common drug name/ others in the group: x1
Mechanism of action:
Use: x1
Key info:
Caution – can exacerbate… x2
S.E
Furosemide
Class: loop-diuretic
Common drug name/ others in the group: bumetanide
Mechanism of action: inhibit reabsorption form the ascending loop of Henle
Use: oedema
Key info:
Caution – can exacerbate, diabetes & gout
S.E - hypokalaemia
Gabapentin
Class:
others x7
Mechanism of action:
Use: x4
Gabapentin
Class: antiepileptic
Common drug name/ others in the group: Pregabalin ,Carbamazepine, Ethosuximide, lamotrigine, phenytoin, sodium valproate, topiramate
Mechanism of action:
Use:
- Peripheral neuropathic pain (e.g. diabetic neuropathy)
- Anticonvulsant
- Multiple sclerosis – oscillopsia / spasticity
- MND – muscular symptoms
Gentamicin
Class:
others in the group:
Use:
Gentamicin
Class: Aminoglycoside G-ve bacteria
Common drug name/ others in the group: streptomycin
Use: broad spec antibiotic
Gliclazide
Class:
Mechanism of action:
Use:
Key info:
S/E x2
Gliclazide
Class: Sulfonylurea
Mechanism of action: augment insulin secretion.
Use: T2DM
Key info:
S/E
- Hypoglycaemia
- Weight gain
Glucagon
Class:
Mechanism of action:
Use:
- x4
Glucagon
Class: glycogenolytic hormone
Mechanism of action: peptide hormone which raises glycaemic levels
Use:
- diabetic hypoglycaemia
- severe: hypotension. Heart failure, cardiogenic shock
Glyceryl trinitrate
Class:
Mechanism of action:
Use: x3
Key info:
C/I x4
Common S/E –x4
Glyceryl trinitrate
Class: Nitrate
Mechanism of action: organic nitrate vasodilator
Use:
* Angina (prophylaxis/tx)
* Anal fissure
* IV infusion in – HTN/MI control during peri-cardiac op/ congestive HF/ unstable angina
Key info:
C/I – cardiac tamponade, constructive pericarditis, hypertrophic cardiomyopathy, hypotensive conditions
Common S/E – headaches ,dizziness, flushing, hypotension
4 steps for taking GTN
1) Take the GTN when the symptoms start
2)repeat after 5 mins in Sx remain
3) Repeat step 2
4) Call an ambulance after a further 5 minutes if the symptoms remain
Goserelin
Class:
Others: x1
Mechanism of action:
Use:
* x5
Key info:
S/E –x3
C/I x1
Goserelin
Class: Gonadotrophin releasing hormone
Others: leuprorelin
Mechanism of action: (GnRH agonist = gonadorelin analogues) initial phase of stimulation down-regulation of GnRH receptors reduced release of gonadotrophins (FSH and LH) inhibition of androgen and oestrogen production.
Use:
* Endometriosis – hormonal tx for symptomatic relief
* IVF – suppression of the menstrual cycle in
* Fibroids – reduce size of fibroids before surgery.
* Prostate cancer – one of the hormones therapies used to reduce androgens (as this stimulates the cancer growth)
* Breast cancer: alternative TX options in oestrogen-receptor positive breast cancer
Key info:
S/E – gynaecomastia, hot flush, sexual dysfunction
C/I undiagnosed vaginal bleeding
Haloperidol
Class:
Common drug name/ others in the group: x4
Use:
* x3
Key info:
* C/I: x2`
Haloperidol
Class: 1st gen (typical) antipsychotic
Common drug name/ others in the group: chlorpromazine, flupentixol, prochlorperazine, zuclopenthixol
Use:
* Antiemetic (palliative care, post-op nausea& vom (tx/prophylaxis)
* Psych: schizophrenia, mania, schizoaffective disorder
* Delirium
Key info:
* C/I: Parkinsons, DwLB
name 2 Aminoglycosides
name 1 key Side effect (in an ENT condition)
gentamicin, neomycin
aminoglycosides can be ototoxic, so may cause hearing loss if used topically in otitis externa here the tympanic membrane is perforated
Hydrocortisone
Class:
others in the group:
Use: x6
Hydrocortisone
Class: corticosteroid
Common drug name/ others in the group: beclomethasone, betamethasone, dexamethasone, fludrocortisone, fluticasone, methylprednisolone, prednisolone
Mechanism of action: glucocorticoid and mineralocorticoid activity
Use: Thyrotoxic crisis ,adrenal insufficiency, adrenal crises, CAH adjunct to adrenalin in acute hypersensitivity reactions, asthma etc
Hydroxocobalamin
Class:
others x2
Use: x2
Hydroxocobalamin
Class: Vitamin B
Common drug name/ others in the group: (Thiamine, Vitamin B)
Use:
* Prophylaxis macrocytic anaemia ass. w/ B12 vitamin deficiency
* IM for Macrocytic anaemia Tx
Hyoscine butylbromide
Class:
Mechanism of action:
Use:
* x3
Key info:
x1 drug class not to be combined with
Hyoscine butylbromide
Class: Antimuscarinic
others in the group: hyoscine butylbromide (Buscopan – IBS)
Mechanism of action: binds to muscarinic receptors (M3 in GI System) preventing Ach from binding, so preventing activation.
Use:
* Sx relief of GI/GU disorders caused by smooth muscle spasm (IBS)
* Palliative care: excess resp secretion
* Palliative care: Bowel colic
Key info:
Not to be combined with prokinetics ( e.g. metoclopramide/ domperidone
Ibuprofen
Class:
others in the group: x4
Mechanism of action:
Use: x3 unbrella uses
Key info:
* S/E x3
* Pregnancy:
* C/I x2
Ibuprofen
Class: NSAID
Common drug name/ others in the group: aspirin, diclofenac, mefenamic acid, naproxen
Mechanism of action: non-selective COX inhibitor (inhibits COX-1&2) inhibits prostaglandin synthesis (which mediates inflammation, pain, fever and swelling)
Use:
* Pain, Fever, inflammation
* Arthritis, 1st line for pain & fever Mx in infections e.g. tonsilitis, otisi media
Key info:
* S/E GI discomfort,GI ulceration, skin reactions
* Pregnancy: no to be used. Inhibits Cox 2 inhibits prostaglandins (which keep ductus arteriosus patent)
* C/I -IM in active bleeding (esp intracranial/gasto-intestinal, Hx hypersensitivity to other NSAID
Insulin
Mechanism of action:
Use:
x2
Key info:
S/E x3
Insulin
Mechanism of action: bind to insulin receptor signals Glut-4 receptor opens and transports glucose into cell
Use:
* DM (1st line type 1, 4th line type 2)
* DKA
Key info:
S/E oedema, lipodystrophy, hupoglycaemia (in OD)
Ipratropium bromide
Class:
Common drug name:
others in the group: x2
Mechanism of action:
Use:
x3 and route
Key info:
Common S/E x2
Ipratropium bromide
Class: antimuscarinic
Common drug name(SAMA)
others in the group: tiotropium, glycopyrronium
Mechanism of action: antagonist of muscarinic Ach receptor inhibits parasympathetic nervous system (generates bronchial secretion, & constriction) bronchodilation and less secretions.
Use:
Reversible airway obstruction
- COPD (inhaler)
- Acute bronchospasm (nebuliser)
- Severe/life-threatening asthma (nebuliser)
Key info:
Common S/E – GI motility disorder, throat complaints
Isofluorane
Class:
Common drug name/ others in the group: x2
Use: x1
Key info:
x2
Isofluorane
Class: General (volatile liquid) anaesthetics
Common drug name/ others in the group: Desflurane, Sevoflurane
Use: general anaesthetic - hypnosis, sedation SLEEP ( the 3rd of the forms of anaesthetics)
Key info:
* cheapest of the inhaled anaesthetics that put patients to sleep.
* Slower on & offset than desflurane/sevflurane
Isosorbide mononitrate
Class:
Common drug name/ others in the group: x2
Mechanism of action:
Use:
x1
Isosorbide mononitrate
Class: Nitrate
Common drug name/ others in the group: GTN, isosorbide dinitrate
Mechanism of action: long-acting nitrate
Use:
- Stable angina (prophylaxis)
Lactulose
Class:
others in the group:
Mechanism of action:
Use x2
Key info:
- x1 CI, condition to avoid
- 1 key information for patient
Lactulose
Class: Osmotic laxative
others in the group: macrogol,
Mechanism of action: increases gut motility & has osmotic effect ( softening stool)
Use:
- Constipation
- Cirrhosis : To reduce ammonia, aim is 2-3 soft stools daily (increased clearance = less absorption of ammonia)
Key info:
- IBS: avoid, as it can cause bloating
- May take 48 hrs to act
- CI in GI obstruction/ perforation
Lamotrigine
Class:
others in the group:
Use:
1st line –… x1
2nd line – …. x3
Lamotrigine
Class: antiepileptic
Common drug name/ others in the group: carbamazepine, ethosuximide, Keppra, phenytoin, sodium valproate, topiramate
Use:
1st line – focal seizures (or carbamazepine)
2nd line – gen tonic-clonic (or carbamazepine), atonic seizures, myoclonic
Lansoprazole
Class:
others: x2
Mechanism of action:
Use: x5
Key info:
* x2
Lansoprazole
Class: PPI
Common drug name/ others in the group: Omeprazole, pantoprezole
Mechanism of action: inhibits gastric acid secretion by blocking the proton pump’) (the ‘hydrogen-potassium adenosine triphosphatase enzyme system) of the gastric parietal cell.
Use:
* H. pylori (2 Abx & PPI – metronidazole, amoxicillin, PPI)
* GORD
* Gastric/ Duodenal ulcer
* Prophylaxis NSAID/ steroid associated gastric ulcer
* dyspepsia
Key info:
* fracture risk (particularly when used at high doses for over a year in the elderly)
* GI infection risk (including C. diff)
Levodopa
Class:
Common drug name:
Use:
Key info:
* SE x1
* OD S/E
Levodopa
Class: synthetic dopamine
Common drug name: typically prescribed as co-careldopa or co-beneldopa
Mechanism of action:
Use: parkinsons
Key info:
* Increases excessive daytime sleepiness, consider with driving
* Overdose – dyskinesia ( chorea, dystonia, athetosis)
paracetoml OD, when can activated charcoal be given
charcoal : <1hr of OD, function - reduces
UNLES: staggered overdose
paracetamol OD, when can N-acetyl cysteine eb given
- plasma paracetaol concentration >= tx line ( joins points of 100mg/L at 4hrs and 15mg/L @ 15hrs
- staggered overdose
- 8-24hrs post OD >150mg/kg @( in plasma-para conc unavaiolable
- present >24hrs later in jaundinced/hepatic tenderness/ ALT>normal
N-acetylcysteine was previously infused over 15mins
- what is the adverse effect
- how can this be avoided
anaphylactoid (non-IgE mediated mast cell release)
if it occurs: stop infusion, restart at slower rate
geneeally: now infused over 1hr
Levonogestrel
Class:
others in the group: x2
Mechanism of action:
x2
Use:
Key info:
* when is a pill classed as missed?
Levonogestrel
Class: Progestogens
Common drug name/ others in the group: Desogestrel, progesterone
Mechanism of action:
1. Inhibit ovulation by suppressing gonadotrophins
2. Thickens cervical mucus
Use: contraception
Key info:
* Take same time each day, if >3hr indow, counts as a missed pill
Levothyroxine
Class:
Mechanism of action:
Use:
x2
Key info:
C/I in
Levothyroxine
Class: thyroid hormone
Mechanism of action: synthetic T4 ( hormone secreted by thyroid gland)
Use:
* primary hypothyroidism
* blocking-replacement regimen in hyperthyroidism (combined with carbimazole)
Key info:
C/I thyrotoxicosis
Lignocaine
Class:
Common drug name/ others in the group:
Mechanism of action:
Use:
Lignocaine
Class: local anaesthetics
Common drug name/ others in the group: Lignocaine aka Lidocaine
Mechanism of action: inhibits conduction of impulses across nerves
Use: local anaesthetic
Lithium
Use: x4
Key info:
Use in pregnancy
Lithium
Use: mood stabiliser – treatment and prophylaxis in
* mania
* bipolar
* recurrent depression
* aggressive/ self-harming behaviour
Key info:
can be used in pregnancy, but avoid where possible (esp. in 1st trimester) risks increased in pregnancy of:
o Congenital anomalies (esp.Ebstein’s anomaly)
o miscarriage
o Neurodevelopmental impairments
Lithium
side effects x7
tocxicity x4
what is the therapeutic range
what is the toxic range
- Side effects (LITHIUM) – @ therapeutic dose
o Leukocytosis (long term).
o Insipidus (diabetes, nephrogenic).
o Tremors (fine if side effect, coarse if toxicity).
o Hydration (easily dehydrates, need to drink a lot as renally cleared).
o Increased GI motility (nausea, vomiting, diarrhoea).
o Underactive thyroid (hypothyroidism, long term)
o Mums beware (teratogenic, Ebstein’s anomaly).
Toxicity
o Coarse tremor
o CNS disturbance (seizure, impaired coordination, dysarthtia
o Arrhythmias
o Visual disturbance
therapeutic : 0.4-1.0
Toxicity >1.5mmol/L
lithium, give 3 drug groups to be avoided
Interactions
* NSAIDs, ACEi, ARBs + diuretics may increase lithium levels –
* Diuretics beware of dehydration, NSAIDs beware of renal damage.
lithium monitoring regime
Monitoring
* Baseline measurements –
* FBC, U+Es, eGFR, TFTs (free T4, TSH), weight + height + ECG if indicated.
Regular monitoring –
* Weekly serum lithium after initiation + after each dose change until concentrations stable
then every 3m for a year
then every 6m.
- Sample taken 12h after dose.
- 6/12 – free T4, TSH, U+Es + eGFR.
- Annual – height + weight (BMI).
Loperamide
drug description
Use: x2
Loperamide
Long-acting antidiarrheal
Use:
- Sx tx for acute/ chronic diarhoea (in IBD/ gastroenteritis
- Bowel colic pain in palliative care
Losartan
Class:
others in the group: x1
Mechanism of action:
Use:
- x3
Losartan
Class: ARB (Angiotensin II receptor antagonist)
others in the group: candesartan,
Mechanism of action:
Competitively binds to angiotensin II receptors > vascular smooth muscle relaxation > lowered BP
Use:
- HTN
- chronic HF ( where ACEi unsuitable/ CI)
- Diabetic nephropathy
Key info:
- Switched tofrom ACEi pts w/ cough
Medroxyprogesterone
Class:
others in the group: x3
Mechanism of action: x2 outcomes
Use:
- x3
Key info:
Contraindications x2
Medroxyprogesterone
Class: progestogens
Common drug name/ others in the group: desogestrel, levonorgestrel, progesterone
Mechanism of action:
inhibits gonadotropin (LH, FSH) production
1) inhibits follicular maturation & ovulation
2) thins endometrium.
Use:
- contraception
- abnormal uterine bleeding
- mild-mod endometriosis
Key info:
Contraindications
- thromboembolism Hx (if taken orally)
- undiagnosed vag bleed
Metformin
Class:
Mechanism of action: x3 methods
Use: x2
Key info:
SE x4
Metformin
Class: biguanide
Mechanism of action: - decreases blood glucose by:
- decreases gluconeogenesis.
- decreases intestinal absorption of glucose.
- While increasing peripheral uptake and use of glucose (increasing insulin sensitivity)
Use: 1st line medical mx in T2DM , PCOS`
Key info:
SE
- GI disturbance, nausea, decreased appetite, B12 deficiency
Methadone
Class:
Use:
x3
Methadone
Class: opioids
Use:
- palliative care: severe pain, cough
- adjunct in opioid dependency tx
Methotrexate
Class:
others in the group: x3
Use:
- x3
Key info:
Interferes with which vitamin? - subsequent prophylactic mx
Common SE
- x4
Methotrexate
Class: DMARD
others in the group: azathioprine, daunorubicin, fluorouracil,
Use:
- crohn’s – maintenance of remission ( 2nd line – 1st line is azathiprineq/ mercaptopurine)
- rheumatoid arthritis ( 1st line, other 1st line alternatives: leflunomide or sulfasalazine)
- medical management in ToP in <35mm, 1000-1500 b-hCG
-
Key info:
Interferes with which vitamin? – folate, so give Folic acid 5mg once/ week on different days
Common SE
- Mouth ulcers & mucositis
- Liver toxicity
- Bone marrow suppression & leukopenia
- Teratogenic ( avoid in men AND women pre conception )
Metoclopramide
Class:
others in the group: x1
Mechanism of action:
Use:
- x3
Key info:
- Do not co-prescribe with…
Metoclopramide
Class: Dopamine receptor antagonists (prokinetic antiemetic)
Common drug name/ others in the group: Domperidone
Mechanism of action: inhibit D2 (dopamine) and 5-HT3 (serotonin) receptors in the chemoreceptor trigger zone in the brain.
Prokinetic effects ( on D2 antagonism, 5-HT4 agonism & muscarinic receptor antagonism) release of ACh increased LES & gastric tone accelerated gastric emptying
Use:
- 1st line in Nausea and vomiting in gastric stasis in palliative care
- N&V in migraine)
- prevention of post-op nausea
Key info:
- Do not co-prescribe with cyclizine, hyoscine butylbromide, levomepromazine, ondansetron – s they slow gut motility
sulfasalazine should be prescribed with caution in patients with allergies to what drug?
aspirin
sulfasalazine and aspirin are structurally similar so potential of cross-sensitivity
NSAIDs S/E ( sorted into 3 organs/systems)
GI - gastritis, peptic ulcers –> Upper GI bleed
Renal –> AKI/ CKD
CV - HTN ( blocks prostaglandins, which cause vasodilation), HF, MI, Stroke
Metronidazole
Targets what type of microorganisms?
Use:
* x5
Key info:
* Triple therapy in H. Pylori
* Triple therapy in PID
* Avoid in what substance mi?use
* What type of reaction will occur when taken with alcohol?
Metronidazole
targets anaerobes
Use:
* Anaerobic infections: Gastroenteritis by Giardiasis, 1st line in bacteria vaginosis, Tx in trichomoniasis ( STI caused by protozoa t. vaginalis )
* Mod- severe diabetic foot infection
* H. Pylori – triple therapy
* PID – triple therapy
* Breast abscess ( Co-amox OR erythromycin/clarithromycin + metronidazole ( for anaerobes)
Key info:
* Triple therapy in H. Pylori 2x Ab + PPI = metronidazole + amoxicillin + omeprazole
* Triple therapy in PID – 1g IM Ceftriaxone stat, Doxycylcine 100mg BD 14days, Metronidazole 400mg BD 14days ( gonorrhoea, Chlamydia + mycoplasma genitalium, anaerobes e.g. G. Vaginalis)
* Avoid in chronic alcohol use
* Do not consume alcohol during the duration of treatment: Alcohol + Metronidazole = disulfiram-like reaction ( N&V, flushing, + sometimes severe Sx shock & angioedema)
Mirtazapine
Class:
Use: x1
Key info:
S/E –x2
Mirtazapine
Class: TCA – atypical antidepressant
Use: severe depression (1st line depression – SSRI, 2nd line – SSRI, 3rd line can use mirtazapine or other drug)
Key info:
S/E – fatigue, increased appetite & weight gain (may be used e.g. in anxiety for this side effect profile)
psych meds and which are key for their side effects
- depressed w/ pain
- depressed/ anxious and not eating
- depressed w/ pain - FLUOXETINE
- depressed/ anxious and not eating - MIRTAZAPINE
extra:
- depressed but pregnant/ breastfeeding - PAROXETINE
N-acetylcysteine
Use (& route)
* >1hr OD <4 hrs:
* within 4-8 hours & dose >150mg/kg:
* Ingestion within 8-24 hours + dose >150mg/kg
* Ingestion >24 hours:
* Staggered OD
* Pt at increased risk of toxicity following paracetamol OD (e.g., DHx long-term enzyme inducers, regular alcohol excess, pre-existing liver disease, glutathione-deplete states: eating disorders, malnutrition and HIV):
Key info:
Acetyl cysteine can be used w/o finding the treatment line if:
* x4
N-acetylcysteine
Use: IV N-acetylcysteine used in paracetamol poisoning
* >1hr OD <4 hrs:: Wait until 4 hrs > take serum paracetamol level > Tx based on level
* 4-8 hours & dose >150mg/kg: Start N-acetylcysteine immediately if there is going to be a delay of ≥8 hours in obtaining the paracetamol level
* Ingestion within 8-24 hours + dose >150mg/kg: Start N-acetylcysteine immediately
* Ingestion >24 hours: Start N-acetylcysteine immediately in liver damage signs (jaundice, RUQ tenderness, elevated ALT, INR >1.3) or paracetamol conc. is detectable
* Staggered overdose: Start N-acetylcysteine immediately
* Pt at increased risk of toxicity following paracetamol OD (e.g., DHx long-term enzyme inducers, regular alcohol excess, pre-existing liver disease, glutathione-deplete states: eating disorders, malnutrition and HIV): N-acetylcysteine should also be administered immediately
Key info:
Acetyl cysteine can be used without finding the treatment line if:
* Lab cannot provide measurement within 8 hours of OD
* Hx suggests hepatic damage risk (e.g. jaundice, raised ALT)
* Pregnancy
* given via a two-bag regimen over 12 hours/ three bag regimen over 21 hours, according to local protocols.
Naloxone
Class:
others in the group: x1
Mechanism of action:
Key info:
what effect does this have on person who has not taken opioids
Naloxone
Class: opioid receptor antagonist
others in the group: Naltrexone
Mechanism of action: competitive inhibitor of µ-opioid receptor, and antagonises the opioid action, reversing their effects
Key info:
- does not have significant effects on person who has not taken opioids
Nefopam
Class:
Use:
Key info:
To be used in caution in: x 3
Nefopam
Class: analgesic
Mechanism of action:
Use: non-opioid analgesic used for mod - severe pain ( post-surgical pain, dental ache) – used when simple analgesia doesn’t help
Key info:
To be used in caution in:
* Angle-closure glaucoma
* Elderly
* urinary retention
Nicorandil
Class:
Use:
x1: 2nd line Mx in ….?
Nicorandil
Class: Potassium-channel openers ( vasodilator)
Use:
2nd line in long-term Sx Mx in stable angina ( 2nd to B-blocker +/ CCB)
Nitrofurantoin
Class:
Use: Lx1
Key info:
- CI in (x3)
- Pregnancy : when & why should it NOT be used
- Breastfeeding
- Avoid in what eGFR level
- Triggers haemolysis in which condition?
- Can cause what pulmonary condition.
Nitrofurantoin
Class: antibacterials (other-
Use: LOWER UTIs 1st line or trimethoprim (in kids other options are: cefalexin/ amoxicillin)
- catheter- associated.
- severe/ recurrent
- prophylaxis ( e.g. recurrent/ GU surgery)
Key info:
- CI – acute porphyrias, G6PD, <3m old
- Pregnancy – 3rd trimester, risk of neonatal haemolysis NiTRIofurantoin
- Breastfeeding – avoid (haemolysis in G6PD infants)
- Avoid in eGFR <45
- Trigger haemolysis so should be avoided in G6PD.
- Can cause pulmonary fibrosis.
Nitrofurantoin
Class: antibacterials
Use: LOWER UTIs 1st line or trimethoprim (in kids other options are: cefalexin/ amoxicillin)
- catheter- associated.
- severe/ recurrent
- prophylaxis ( e.g. recurrent/ GU surgery)
- pregnancy
Key info:
- CI – acute porphyrias, G6PD, <3m old
- Pregnancy – 3rd trimester, risk of neonatal haemolysis NiTRIofurantoin
- Breastfeeding – avoid (haemolysis in G6PD infants)
- Avoid in eGFR <45
- Trigger haemolysis so should be avoided in G6PD.
- Can cause pulmonary fibrosis.
Nitrous oxide
Class:
others in the group: x3
Use: x2
Key info:
- Gas and air consists of …
- Use during delivery (potential consequence to fetus)
- S/E – x3
Nitrous oxide
Class: volatile liquid anaesthetics
Common drug name/ others in the group: desflurane, isoflurane, sevoflurane
Use:
- maintenance of anaesthesia (in conjunction w/ other anaesthetic agents)
- analgesia
Key info:
- Gas and air (e.g., Entonox) – 50% nitrous oxide, 50% oxygen
- Use during delivery – may depress neonatal respiration.
- S/E – light-headedness, nausea, sleepiness
Nystatin
Class:
Use: x1
Nystatin
Class: antifungal
Use: particularly Candida infections
- Oral candida
- - oral/ perioral infections
- Candida of the nipple
Key info:
Commonly either Miconazole or nystatin in candida infections
Ondansetron
Class:
Mechanism of action:
Use: x3
Key info:
CI: x1
Ondansetron
Class: serotonin (5HT3) receptor antagonist
Mechanism of action: serotonin ( 5-HT3) receptor antagonist - 5-HT3 is release by chemo/radiotherapy –> stimulation of the 5HT3 receptors –> vomiting reflex
Use: antiemetic in chemotherapy & post-op
Antiemetic
* prophylactic/ rescue antiemetic peri-operatively
* Hyperemisis gravidum ( 3rd line – prochlorperazine, cyclizine, ondansetron, metoclopramide
Key info:
CI: Pt with prolonged QT interval
Oxybutynin
Class:
Mechanism of action:
Use: x4
Key info: common side-effects
Oxybutynin
Class: antimuscarinic
Mechanism of action: antimuscarinic (inhibits muscarinic action of Ach on smooth muscle) reduces detrusor muscle activity bladder relaxation inhibiting urge to void.
Use: Urinary frequency/ urgency/ incontinence, nocturnal enuresis associated with overactive bladder
Key info: common side-effects diarrhoea (oxybutynin), (for all antimuscarinics: ) Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting
Give 4 different options for providing oxygen therapy
nasal cannula: 24-44% oxygen (1, 2 or4 l/min)
simple face mask: 40-60% oxygen (5 or 8 l/min)
Venturi mask: 24-60% oxygen (2,4,6,8,10,15 l/min)
Non-rebreather mask: 80-95% ( 8 or 95 l/min)
Oxytocin
Use:
- x3
Key info:
CI x2
Oxytocin
Common names:
Use:
- induction of labour ( induces & improves uterine contractions)
- prevention of PPH after delivery of the placenta
- tx of PPH
Key info:
- CI
o where spontaneous labour/ vaginal delivery are no advisable ( e.g. major uterine scar)
o foetal distress
Paracetamol
Use:
- x2
Key info:
* OD mx
o <1hr
o 8-24 hrs, and substantial OD (150mg/kg),
Paracetamol
Use:
- mild-mod pain
- post-immunisation pyrexia in infants
Key info:
* OD
o <1hr – activated charcoal (reduces absorption)
o 8-24 hrs, and substantial OD (150mg/kg), N-acetylcysteine (plasma-paracetamol conc. not needed)
epilepsy in pregnancy. which drugs are safe to use? (x3)
Levetiracetam, lamotrigine and carbamazepine
epilepsy in pregnancy: what 2 adverse effects are assiociated with sodium valproate
neural tube defect
developmental delay
epilepsy in pregnancy: what 2 adverse effects are associated with phenytoin
cleft lip and palate
Phenytoin
Class:
Use:
x2
Key info:
S/E – x4
CI x1
Phenytoin
Class: antiepileptic
Common drug name/ others in the group: carbamazepine, ethosuximide, gabapentin, lamotrigine, Keppra, pregabalin, sodium valproate, topiramate, vigabatrin
Use:
- Status epilepticus
- Tonic clonic/ focal seizures
Key info:
S/E – may cause gingival hyperplasia, hirsutism, folate/ vit D deficiency.
CI – pregnancy: causes cleft lip and palate
Prednisolone
Class:
Use:
Key info:
CI – what medical tx should not be give to pts on logn term, immunosuppressive doses of steroids
Prednisolone
Class: steroid - glucocorticoid
Use:
- Severe croup
- Adrenocortical insufficiency
- Bells palsy (within 72hrs of Sx – high dose e.g. 50mg for 10 days)
- Ramsay hunt syndrome (prednisolone & acyclovir)
- 2nd line prevention for cluster headaches ( 1st – verapamil, 2nd – occipital nerve block, prednisolone, lithium)
- GCA – high dose (prednisolone, 60mg)
- Tx inn autoimmune hepatitis ( high dose)
- Acute exacerbation of COPD
- Anti-inflammatory/ allergic ( vasculitis, UC, Crohns acute Mx, polymyalgia rheumatica)
- Myasthenia gravis
Key info:
CI – do not give pts on immunosuppressants live vaccines
what 4 medications are used in neuropathic pain
amitryptyline ( TCA)
Duloxetine ( SNRI)
Gabapentin (anticonvulsants)
pregabalin (anticonvulsants)
Pregabalin
Class:
Use: x3
Pregabalin
Class: antiepileptic
Use:
- Neuropathic pain
- Adjunct in focal seizures
- GAD
give examples of antimuscarinic effects
Antimuscarinic effects
* Mouth
o Dry mouth
o Thirst
o Difficulty swallowing
* Eyes:
o Dilation
o Difficulty accommodating
o Sensitivity to light
o Increased intraocular pressure.
* Skin
o Dry
o Hot
o Flushed
* Cardiac
o Arrhythmias ( Bradycardia followed by tachycardia & palpitations)
* Bladder and bowel
o Urinary retention
o Constipation
Prochlorperazine
Class:
others in the group: x2
Use:
- x5
Key info:
S/E:
Prochlorperazine
Class: 1st gen antipsychotic
Common drug name/ others in the group: Haloperidol, Zuclopenthixol
Use:
- Schizophrenia
- Psychosis
- Mania
- Vertigo (used short term – 3days)
- Anti-emetic (palliative care)
Key info:
S/E:
* EPSE
* Drowsiness
* Anti-muscarinic effects
* Postural hypotension
* QT-prolongation
Propofol
Class:
Use:
x2
Key info:
- Common side effects: x6
- quick or slow onset ?
Class: Intravenous anaesthetic – hypnotic agent
Use:
- Induction of anaesthesia
- Maintenance of anaesthesia/ sedation
Key info:
- Log-term sedative
- Quick onset
- Common side effects:
o Apnoea, arrhythmias, headache, hypotension, localised pain, N&V
what medications may cause neutropenia
Oncology
- chemotherapy
- Rituxumab ( autoimmune/ cancer)
- inflixamab ( autoimmune)
Psych - schizophrenia
- clozapine
MSK - RA
- Hydroxychloroquine
- Sulfasalazine
- Methotrexate
Endo - hyperthryroidism
- Carbimazole
Infectious disease - Malaria
- Quinine
what UTI medication should not be prescribed in a patient taking methotrexate?
trimethoprim + methotrexate = increased risk of bone marrow suppression.
Quinine
Class:
others in the group: x4
Use: x2
Key info:
CI – x4
SE – x1
1st & 2nd line Rx in
Uncomplicated malaria
Complicated malaria
Quinine
Class: antimalarials
others in the group: Artemether, chloroquine, primaquine, proguanil
Use:
* non-falciparum malaria (10mg/kg TD – max 700mg/dose)
* Nocturnal leg cramps (low dose 200-300mg ON)
Key info:
CI – haemoglobinuria, MG, optic neuritis, tinnitus
SE – agranulocytosis
Order of prescription in malaria
Uncomplicated malaria
* 1st line – Oral Artemether w/ lumefantrine
* 2nd line Oral Quinine + doxycycline/ clindamycin
Complicated malaria (HDU/ICU – IV Tx)
* Artesunate
* Quinine dihydrochloride
Ramipril
Class:
Mechanism of action:
Use: x4
Key info:
S/E x1
Ramipril
Class: ACEi
Mechanism of action:
* inhibits the RAAS system by: inhibiting ACE thereby preventing the conversion of angiotensin I to angiotensin II
Use:
* 1st line HTN in <55/non-afrocaribbean
* Adjunct in Sx HF
* Prophylaxis after MI
* Prophylaxis of CV events in atherosclerosis / DM
Key info:
S/E dry cough (as ACE normally breaks down bradykinin) so give ARB
Rifampicin
Use:
X2
Key info:
SE X2
Rifampicin
Use:
TB – 6months ( RIPE regime )
Acute osteomyelitis ( 6Wks fluclox w/ rifampicin/fusidic acid for 2wks)
Key info:
- Causes red secretions
- Activates cytochrome P45O pathway reduced drug metabolism ( e.g. COCP)
Rivaroxaban
Mechanism of action:
Use:
x3 ( incl. 1st line in…)
Key info:
CI: x3 main + 1 broad group
Difference between DOAC and warfarin x 2
DOACs & surgery …
drug to reverse uncontrolled bleeding on DOAC (Xa inhibitor)
Mechanism of action: factor Xa inhibitor
Use:
Suspected DVT/PE: 1st line interim anticoag in DVT (Apixaban/ rivaroxaban/LMWH for at least 5 days)
Confirmed DVT: maintenance treatment with an oral anticoagulant (warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban) for at least 3 months.
VTE prophylaxis (e.g. post joint replacement surgery)
Key info:
CI: antiphospholipid syndrome (risk of recurrent thrombotic events), pregnancy, renal impairment (CR clearance <15ml/min)
other causes of high-risk bleed (e.g. malignant neoplasms, oesophageal varices)
Difference between DOAC and warfarin: frequent monitoring and dose adjustment are not required.
DOACs Stopped 24-72 hours post surgery
In uncontrolled bleed, DOACs ( Xa inhibitors) are reversible by Andexanet alfa
Carbimazole
- method of action
- key adverse effect
mode of action
bocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
S/E
agranulocytosis
others: acute pancreatitis, bone marrow supression, teratogenic
what is adverse effect of the 2nd line anti-thyroid drug makes carbimazole preferable?
both propylthyouracil (2nd line) and carbimazole cause agranulocytosis
propylthyouracil can cause liver reactions and death
ACEi inhibitors can be nephrotoxic and nephroprotective, so what are the appropriate steps in
AKI pt on ramipril
CKD patient on ramipril
AKI - STOP ( nephrotoxic)
CKD - continue ( protective)
Levothyroxine
- starting dose
- changes in pregnancy
- when to check TFTs
SE x3
interactions x 2
Age >50 Initial dose 25mcg OD, slowly titrate
Age <50: initial dose 50-100mcg OD
Pregnancy - increase dose by 25-50mcg
Check TFT 8-12wks following change of dose
S/E
Hyperthyroidism
Reduced BMD
Cardiac: AF, worsened angina
Interaction
Iron, calcium carbonate - reduce absorpton of L-thyroxine, so give 4 hr apart
what is the treatment regime of hyperthyroidism in pregnancy
propylthiouracil - 1st trimester ONLY ( as carbimazole teratogenic, and propythiouracil causes severe hepatic injury)
carbimazole - from 2nd trimester
( HCG highest in 1st trimester, activating TSH recptor)
after what duration of missed doses does clozapine have to be retitrated
48 hrs
non-sedating antihistamines
cetirizine, loratadine, and fexofenadine
penicillin allergy can cause a cross reaction to which medications
cephalosporins
carbapenems
