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Its the final countdown > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Aciclovir
Group
Use (2)
conditions (3)
prophylaxis (2)

A

Antiviral
HSV/VZV
Oral/genital herpes, Encephalitis, Eye infection
Immunocompromised, PEP VZV

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2
Q

Ad-Cal-D3
group/contains
Use
conditions
Key ( administer with what other medication?)

A

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

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3
Q

Adenosine
Class
Mechanism of action
Use
CI
Key: Dose and route of administration

A

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

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4
Q

Indapamide
Class
Mode of action
Condition

A

Class – Thiazide- like diuretic

Mode of action
Antihypertensive - Vasodilation is more prominent that diuresis

Condition: Essential hypertension

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5
Q

Alendronate (alendronic acid)
Class: Bisphosphonate
Mode of action:
Use: (3)
Dose:

Key:
Adverse effect x3
Alternative where bisposphonate CI/not tolerated/not effecive

A

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

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6
Q

Alendronate (alendronic acid)
Key:
Directions for administration:
* CI: (3)
* Avoid in: (3)
* Monitoring: (1)
* important marker(s) before administration

A

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

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7
Q

Colchicine
Use/ Condition:
Key - Common side effect (1)

A

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

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8
Q

Allopurinol (MSK/Rheum)
Class:
Mode of action:
Use/conditions: (3)

A

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

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9
Q

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)

A

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%)
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10
Q

Amiodarone
Class:
Use: (2)

A

Class: Antiarrhythmic class III

Use: Treatment of arrhythmia (not 1st line), Ventricular fibrillation/ Pulseless ventricular tachycardia (that’s refractory to defib)

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11
Q

Amitriptyline
Class:
Use: (2 groups)
Conditions: 1 - 3 conditions, 2- 2 conditions
dose ranges condition group 1, 2

A

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)

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12
Q

amitriptyline
Key:
* CI: (4)
* S/E (3x common), (1xrare)
* OD: outcome

A

Key:
* CI: Mania (in BPD), Arrhythmia, heart block, immediately following MI
* S/E common: Anticholinergic syndrome, drowsiness, QT interval prolongation, Rare: Agranulocytosis
* OD: fatal

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13
Q

Amlodipine
Class: (x2 others in same class)
Mode of action:
Use/Condition: (x2)

Key info:
#Caution: in Elderly
#Main S/E x3

A

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

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14
Q

What drugs give EPSE
what are the EPSE ( 4)

A

Atypical antipsychotics ( haloperidol), prokinetic antiemetics ( metoclopramide)

Akinesia
dystonic reactions ( muscle spasms face, neck, back Dyskinesia (blinking/ twitching)
Akathesia ( unable to sit still)

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15
Q

Tx in H. Pylori infection

A

Triple therapy PPI + 2 Abx
e.g. Omepraxole + Amoxicillin + Clarithromycin/ Metronidazole

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16
Q

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

A
  1. IM/IV Benzylpenecillin
  2. Cefotaxime + Amoxixillin (listeria)/ Vancomycin
  3. > 3m- Ceftriaxone
  4. Dexamethasone QDS, 4 days - prevent hearing loss/ neuro damage
  5. Single dose ciprofloxacin
  6. Supportive tx - Aciclovir (if HSV meningitis)

cef0taxime (0-3 months) and vancOmycin
cefTRIaxone (>3m) (w/ dex)
ciprofloxacin
2cefs and 1 sip

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17
Q

Abx in IE

A

Intravenous broad-spectrum antibiotics (e.g., amoxicillin and optional gentamicin)

if cultured specific organism, use specific Abx

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18
Q

Amoxicillin
Class:(x2 others in group)
Use:
Conditions x10
Key
Don’t use in x 4 conditions, S/E

A

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

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19
Q

Tranexamic acid
Class:
Mechanism of action:
Use/Conditions: (4)

A

Tranexamic acid
Class: Antifibrinolytic
Mechanism of action: Prevents dissolving of fibrin  reduces bleeding
Use/Conditions:
* Local fibrinolysis
* Menorrhagia
* Epistaxis
* Significant haemorrhage in trauma

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20
Q

Aspirin
Group: (x2 different groups - 1 x2 others, 2 x 3 others)
Use/conditions:
* Prevention (4)
* Tx (4)
Key
Caution (1)
C/I (3)

A

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)

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21
Q

Enzyme inducers : Bull SiTS on CRAP GPS (11 drugs)

A

Barbituates

St. Johns Wort
Topiramate
Smoking

Carbamazepine
Rifampicin
Alcohol ( chronic use)
Phenytoin

Griseofulvin
Phenobarbital
Sulfonylureas

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22
Q

AJ GADS’ SICKFACES.COM
used for?
stands for

A

Allopurinol
JG - Grapejuice
Amiodarone
Disulfuram
SSRIs (fluoxetine, sertraline)

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (acute intoxication)
Chloramphenicol
Erythromicin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

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23
Q

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)

A

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)

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24
Q

Atracurium
Class: (specific)
others in the group x2)
Mechanism of action:
Use:
Key info:
* S/E x2, Pregnancy/breastfeeding x1

A

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

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25
Q

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

A

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;

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26
Q

Beclomethasone
Class, x6 others
Use/Conditions (x4 routes and x5 conditions)
Key info:
C/I x1
S/E x 7

A

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)

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27
Q

Bisoprolol (see atenolol)
class and mechanism of action
Use x 3
is it involved in 1st, 2nd, 3rd, or 4th line mx in HTN

A

Class: Selective B-blocker (see atenolol)
Use: HTN, angina, adjunct in HF
Conditions: 4th line in HTN

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28
Q

HTN management
how many steps
age limit to consider alternative
what medication is used in each step

A

4 steps
55 years

  1. ACEi <55> CCB/ thiazide like diuretic
  2. ACEi + CCB/ thiazide like diuretic
  3. ACEi+CCB+ thiazide like diuretic
  4. ACEi+CCB+thiazide like diuretic + A/B-blocker/other diuretic
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29
Q

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

A

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

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30
Q

General tonic-clonic seizure
1st line x1
2nd line (x2)

A

1 - sodium valproate
2 Lamtorigine/ carbamazepine

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31
Q

Focal seizure
1st line x 2
2nd line x2

A

(reverse of generalised tonic-clonic)

1 Carbamazepine/ lamotrigine
2 Sodium valproate/ Keppra

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32
Q

Absence
1st x 2

A

Sodium valproate/ Ethosuximide

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33
Q

Atonic seizure
1st line (x1)
2nd line (x1)

A

sodium valproate
lamotrigine

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34
Q

Myoclonic seizure
1st (x1)
2nd (x3)

A

sodium valproate
lamotriogine, keppra, topiramate

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35
Q

West syndrome
aka
1st line (x2)

A

infantile spasms
prednisolone, Vigabatrin

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36
Q

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

A

Generalised tonic-clonic, Absence, Atonic, myoclonic
2nd - Focal seizures

increases GABA activity –> relaxes brain
S/E
* teratogenic
* liver damage & hepatitis
* hair loss
* tremor

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37
Q

Carbamazepine
1st line
2nd line
S/E (x3)

non-seizure use (x1)

A

AKA Carbagen/Tegretol
1st - focal
2nd - Gen tonic-clonic

Agranulocytosis
Aplastic anaemia
Many drug interactions ( induces the P450 system)

Trigeminal neuralgia

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38
Q

Phenytoin
used in?
Side effects (x2 and the consequences)

A

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

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39
Q

ethosuximide
(shared) 1st line in ….
S/E (x2)

A

Absence seizures ( along with sodium valproate)
Night terrors
rashes

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40
Q

Lamotrigine
1st line
2nd line

S/E x 2

A

1 - focal seizure
2- gen ton-clon, atonic, myoclonic

Stevens-johnson/ DRESS syndrome
Leucopenia

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41
Q

Carbimazole
Mechanism of action:
Use/Conditions: x1
Key info:
How its used: dose and duration

A

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

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42
Q

Cefuroxime
Class: (specific)
Mechanism of action:
Use: (type of pathogen
Conditions x3

A

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)

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43
Q

Certirizine
Class: Non-sedating antihistamines
Others in the group: x1
Use: x3

A

Certirizine
Class: Non-sedating antihistamines
Others in the group: loratadine
Use: Sx relief of allergies ( hay fever idiopathic urticaria, atopic dermatitis)

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44
Q

Chloramphenicol
Class: Antibacterial, other
others in the group: x4
Use/ Conditions: x3
Key info:
Avoid in x2

A

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

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45
Q

Chloroquine
Class:
Conditions: x 4
it is 1st line in of these conditions … in what specific group of pts?

A

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

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46
Q

Chlorphenamine
Class: sedating antihistamine
others in the group: x1
Use: x 3

A

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

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47
Q

Give 3 1st gen antipsychotics

A

Chlorpromazine, Haloperidol, Zucpenthixol
1st gen = typical

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48
Q

Give 3 2nd gen antipsychotics

A

Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone
2nd gen = atypical

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49
Q

Main S/E of typical antipsychotics (x1)

A

EPSx

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50
Q

Main S/E atypical antipsychotics (x3)

A

weight gain, glucose intolerance, and hyperprolactinaemia.

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51
Q

Chlorpromazine
Class:
others in the group: x2
Mechanism of action:
Use/ Conditions: x2
Key info:
*x3 Adverse effecrs

A

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

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52
Q

Meds that trigger acute haemolysis in G6PD

A

Primaquine (an antimalarial)
Ciprofloxacin
Nitrofurantoin
Trimethoprim
Sulfonylureas (e.g gliclazide)
Sulfasalazine and other sulphonamide drugs

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53
Q

Ciprofloxacin
Class:
Use/ conditions: (lots, list 4 )

Key info: x3

A

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

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54
Q

Cisplatin
Class: Platinum compound
Use/Conditions: x1
Key info:
S/E x3

A

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

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55
Q

causes of peripheral neuropathy: ABCDE

A

A – Alcohol
B – B12 deficiency
C – Cancer and Chronic Kidney Disease
D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin)
E – Every vasculitis

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56
Q

Citalopram
Class:
others in the group: x4
Mechanism of action:
Use/Conditions: x2
Key info:
dont use in x2
S/E x2

A

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)

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57
Q

Clopidogrel
Class:
others in the group: x3
Mechanism of action:
Use: x4
Key info:
Typical dose: x2
Common S/E: x3

A

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

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58
Q

clopidogrel dose in preventing atherothrombotic events following NSTEMI

A

300mg initially, then 75mg (12/12)

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59
Q

clopidogrel dose in preventing atherothrombotic events following STEMI

A

300mg initially, then 75mg (4/52)

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60
Q

Co-amoxiclav
Class:
Use:

A

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)

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61
Q

Co-trimoxazole

Class:
Common drug name:
Mechanism of action:
Use
Conditions x1 main

A

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

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62
Q

Ciclosporin
Class:
others in the group: x2
Use:
Conditions:
Key info:
x 1 Can cause….

A

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

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63
Q

Dalteparin
Class:
Others in the group: x3
Mechanism of action:

A

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

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64
Q

Dalteparin
Conditions:x4
Key info:
C/I x1
S/E x2

A

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

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65
Q

Dalteparin
Use in pregnant women
When to prescribe in:
* Very high risk
* High risk
Duration:

Any situations when it should be stopped

A

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)

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66
Q

ACS medical management ( drugs and doses)
- acute management
- triple therapy post mi
- meds to consider for long term Mx

A

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

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67
Q

Diamorphine
Class:
Mechanism of action:
Use x3
Key info:
x3 S/E
x2 Caution

A

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

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68
Q

Diamorphine
Med given in dependence
Med given in OD

Signs and mx of OD
o Pinpoint pupils (miosis)
o Antidote – naloxone

A

Med given in dependence
Methadone (tx dendence, also analgesic)
Naloxone

Signs and mx of OD
o Pinpoint pupils (miosis)
o Antidote – naloxone

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69
Q

Diazepam
Class:
others in the group:

Mechanism of action:
Use/Conditions: x4
o route in status epilepticus

Key info:
- x1 risk

A

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

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70
Q

Diclofenac
Class: +x4 others in group
Use: x2

Key info:
Conditions it may be inappropriate/ C/I in x 4

A

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

71
Q

Digoxin
Class:
Mechanism of action:
Use / Conditions: x4
Key info: x1 Common S/E

A

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

72
Q

Diltiazem
Class: x4 others
Conditions: x2

A

Class: CCB = amlodipine, nifedipine, verapamil
Common drug name/ others in the group:
Conditions: Angina, HTN

73
Q

Dobutamine
Class:
Mechanism of action:
Use: x1 general use

A

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

74
Q

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 ….

A

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)

75
Q

Donepezil
Class:
others in the group: x1
Use:

A

Donepezil
Class: reversible AChesterase inhibitor (AChEi)
others in the group: rivastigmine
Use: mild-mod Alzheimer’s

76
Q

Alzheimer’s - medical management:
mild
mod
sev.

A

Mild-mod: AChEi (donepezil, rivastigmine)
Mod- sev: NMDA antagonist (memantine)

77
Q

Doxazosin
Class:
others in the group: x1
Mechanism of action:
Use: x2
Key info:
C/I x1

A

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

78
Q

BPH medical mx
x2
for each:
meds option
funcitons

A

Alpha-blockers (doxasozin, tamsulosin) - relax smooth muscle

5-alpha reductase inhibitors (e.g., finasteride) (e.g., finasteride) - reduce size of the prostate

79
Q

Doxycycline
Class:
Use: x5
Key info:
Tx in; Acne vulgaris, Lyme disease, Uncomplicated Chlamydia, PID
S/E x1
C/I x2

A

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

80
Q

medical mx of PID

A
  1. single dose IM ceftriaxone 1g (gonorrhoea)
  2. 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.
81
Q

Ephedrine ANAESTHETICS
Class:
others in the group: x2
Mechanism of action:
Key info:
* Very potent! Only used in …

A

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

82
Q

Epinephrine/adrenaline
Class:
Common drug name/ others in the group: x4
Mechanism of action:
Use: x1

A

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

83
Q

Erythromycin
Class:
Others in the group:x3
Mechanism of action:
Use:
x1

A

Erythromycin
Class: macrolide
Others in the group:Azithromycin, erythromicine, clarithromycin
Mechanism of action: destroys bacterial ribosomes
Use:
Alternative in penicillin allergy: e.g. RTI

84
Q

Ethinylestradiol
Class:
Mechanism of action:
* x2
Use:
Key info:
S/E or risks x6
C/I x7

A

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

85
Q

Ferrous sulphate
Use: x1
Key info:
x1 S/E
x1 how to increase absorption

A

Ferrous sulphate
Class: iron, oral
Use: iron deficiency anaemia
Key info:
- Dark stools
- conume on empty stomach

86
Q

Finasteride
Class:
Mechanism of action
Use x1
Key info:
S/E sx1
Conception/contraception recommendation

A

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.

87
Q

Flucloxacillin
Class:
Use:
Key info:
Most important S/E …

A

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)

88
Q

Fluconazole
Class:
Use:
- x2

A

Fluconazole
Class: Triazole antifungal
Use:
- Candida infections ( vaginal, mucosal, candida balanitis, dermal e.g. tenea pedis, pityriasis vericolor)
- Prophylaxis in immunocompromised

89
Q

Fludrocortisone
Class:
others : x8
Use: x2
Key info:
C/I – x1
S/E x2

A

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

90
Q

what corticosteroid med is used in adrenal insfufficiency to replace
- glucocorticoids
- mineralocorticoids

A

Glucocorticoids: hydrocortisone
mineralocorticoid: fludrocortisone

(same in CAH)

91
Q

Flumenazil
Class:
Use: x1
Key info:
C/I x2

A

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)

92
Q

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

A

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)

93
Q

Folic acid
Use:
- x4

A

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

94
Q

Furosemide
Class:
Common drug name/ others in the group: x1
Mechanism of action:
Use: x1
Key info:
Caution – can exacerbate… x2
S.E

A

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

95
Q

Gabapentin
Class:
others x7
Mechanism of action:
Use: x4

A

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

96
Q

Gentamicin
Class:
others in the group:
Use:

A

Gentamicin
Class: Aminoglycoside G-ve bacteria
Common drug name/ others in the group: streptomycin
Use: broad spec antibiotic

97
Q

Gliclazide
Class:
Mechanism of action:
Use:
Key info:
S/E x2

A

Gliclazide
Class: Sulfonylurea
Mechanism of action: augment insulin secretion.
Use: T2DM
Key info:
S/E
- Hypoglycaemia
- Weight gain

98
Q

Glucagon
Class:
Mechanism of action:
Use:
- x4

A

Glucagon
Class: glycogenolytic hormone
Mechanism of action: peptide hormone which raises glycaemic levels
Use:
- diabetic hypoglycaemia
- severe: hypotension. Heart failure, cardiogenic shock

99
Q

Glyceryl trinitrate
Class:
Mechanism of action:
Use: x3
Key info:
C/I x4
Common S/E –x4

A

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

100
Q

4 steps for taking GTN

A

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

101
Q

Goserelin
Class:
Others: x1
Mechanism of action:
Use:
* x5
Key info:
S/E –x3
C/I x1

A

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

102
Q

Haloperidol
Class:
Common drug name/ others in the group: x4
Use:
* x3
Key info:
* C/I: x2`

A

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

103
Q

name 2 Aminoglycosides

name 1 key Side effect (in an ENT condition)

A

gentamicin, neomycin

aminoglycosides can be ototoxic, so may cause hearing loss if used topically in otitis externa here the tympanic membrane is perforated

104
Q

Hydrocortisone
Class:
others in the group:
Use: x6

A

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

105
Q

Hydroxocobalamin
Class:
others x2
Use: x2

A

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

106
Q

Hyoscine butylbromide
Class:
Mechanism of action:
Use:
* x3
Key info:
x1 drug class not to be combined with

A

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

107
Q

Ibuprofen
Class:
others in the group: x4
Mechanism of action:
Use: x3 unbrella uses
Key info:
* S/E x3
* Pregnancy:
* C/I x2

A

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

108
Q

Insulin
Mechanism of action:
Use:
x2
Key info:
S/E x3

A

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)

109
Q

Ipratropium bromide
Class:
Common drug name:
others in the group: x2
Mechanism of action:
Use:
x3 and route
Key info:
Common S/E x2

A

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

110
Q

Isofluorane
Class:
Common drug name/ others in the group: x2
Use: x1
Key info:
x2

A

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

111
Q

Isosorbide mononitrate
Class:
Common drug name/ others in the group: x2
Mechanism of action:
Use:
x1

A

Isosorbide mononitrate
Class: Nitrate
Common drug name/ others in the group: GTN, isosorbide dinitrate
Mechanism of action: long-acting nitrate
Use:
- Stable angina (prophylaxis)

112
Q

Lactulose
Class:
others in the group:
Mechanism of action:
Use x2
Key info:
- x1 CI, condition to avoid
- 1 key information for patient

A

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

113
Q

Lamotrigine
Class:
others in the group:
Use:
1st line –… x1
2nd line – …. x3

A

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

114
Q

Lansoprazole
Class:
others: x2
Mechanism of action:
Use: x5
Key info:
* x2

A

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)

115
Q

Levodopa
Class:
Common drug name:
Use:
Key info:
* SE x1
* OD S/E

A

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)

116
Q

paracetoml OD, when can activated charcoal be given

A

charcoal : <1hr of OD, function - reduces

UNLES: staggered overdose

117
Q

paracetamol OD, when can N-acetyl cysteine eb given

A
  • 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
118
Q

N-acetylcysteine was previously infused over 15mins
- what is the adverse effect
- how can this be avoided

A

anaphylactoid (non-IgE mediated mast cell release)
if it occurs: stop infusion, restart at slower rate

geneeally: now infused over 1hr

119
Q

Levonogestrel
Class:
others in the group: x2
Mechanism of action:
x2
Use:
Key info:
* when is a pill classed as missed?

A

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

120
Q

Levothyroxine
Class:
Mechanism of action:
Use:
x2
Key info:
C/I in

A

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

121
Q

Lignocaine
Class:
Common drug name/ others in the group:
Mechanism of action:
Use:

A

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

122
Q

Lithium
Use: x4

Key info:
Use in pregnancy

A

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

123
Q

Lithium
side effects x7
tocxicity x4

what is the therapeutic range
what is the toxic range

A
  • 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

124
Q

lithium, give 3 drug groups to be avoided

A

Interactions
* NSAIDs, ACEi, ARBs + diuretics may increase lithium levels –
* Diuretics beware of dehydration, NSAIDs beware of renal damage.

125
Q

lithium monitoring regime

A

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).
126
Q

Loperamide
drug description
Use: x2

A

Loperamide
Long-acting antidiarrheal
Use:
- Sx tx for acute/ chronic diarhoea (in IBD/ gastroenteritis
- Bowel colic pain in palliative care

127
Q

Losartan
Class:
others in the group: x1
Mechanism of action:
Use:
- x3

A

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

128
Q

Medroxyprogesterone
Class:
others in the group: x3
Mechanism of action: x2 outcomes
Use:
- x3
Key info:
Contraindications x2

A

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

129
Q

Metformin
Class:
Mechanism of action: x3 methods
Use: x2
Key info:
SE x4

A

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

130
Q

Methadone
Class:
Use:
x3

A

Methadone
Class: opioids
Use:
- palliative care: severe pain, cough
- adjunct in opioid dependency tx

131
Q

Methotrexate
Class:
others in the group: x3
Use:
- x3
Key info:
Interferes with which vitamin? - subsequent prophylactic mx

Common SE
- x4

A

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 )

132
Q

Metoclopramide
Class:
others in the group: x1
Mechanism of action:
Use:
- x3
Key info:
- Do not co-prescribe with…

A

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

133
Q

sulfasalazine should be prescribed with caution in patients with allergies to what drug?

A

aspirin
sulfasalazine and aspirin are structurally similar so potential of cross-sensitivity

134
Q

NSAIDs S/E ( sorted into 3 organs/systems)

A

GI - gastritis, peptic ulcers –> Upper GI bleed

Renal –> AKI/ CKD

CV - HTN ( blocks prostaglandins, which cause vasodilation), HF, MI, Stroke

135
Q

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?

A

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)

136
Q

Mirtazapine
Class:
Use: x1
Key info:
S/E –x2

A

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)

137
Q

psych meds and which are key for their side effects

  • depressed w/ pain
  • depressed/ anxious and not eating
A
  • depressed w/ pain - FLUOXETINE
  • depressed/ anxious and not eating - MIRTAZAPINE

extra:
- depressed but pregnant/ breastfeeding - PAROXETINE

138
Q

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

A

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.

139
Q

Naloxone
Class:
others in the group: x1
Mechanism of action:
Key info:
what effect does this have on person who has not taken opioids

A

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

140
Q

Nefopam
Class:
Use:
Key info:
To be used in caution in: x 3

A

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

141
Q

Nicorandil
Class:
Use:
x1: 2nd line Mx in ….?

A

Nicorandil
Class: Potassium-channel openers ( vasodilator)
Use:
2nd line in long-term Sx Mx in stable angina ( 2nd to B-blocker +/ CCB)

142
Q

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.

A

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.

143
Q

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

A

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

144
Q

Nystatin
Class:
Use: x1

A

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

145
Q

Ondansetron

Class:
Mechanism of action:
Use: x3

Key info:
CI: x1

A

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

146
Q

Oxybutynin
Class:
Mechanism of action:
Use: x4
Key info: common side-effects

A

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

147
Q

Give 4 different options for providing oxygen therapy

A

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)

148
Q

Oxytocin
Use:
- x3

Key info:
CI x2

A

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

149
Q

Paracetamol
Use:
- x2
Key info:
* OD mx
o <1hr
o 8-24 hrs, and substantial OD (150mg/kg),

A

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)

150
Q

epilepsy in pregnancy. which drugs are safe to use? (x3)

A

Levetiracetam, lamotrigine and carbamazepine

151
Q

epilepsy in pregnancy: what 2 adverse effects are assiociated with sodium valproate

A

neural tube defect
developmental delay

152
Q

epilepsy in pregnancy: what 2 adverse effects are associated with phenytoin

A

cleft lip and palate

153
Q

Phenytoin
Class:

Use:
x2
Key info:
S/E – x4
CI x1

A

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

154
Q

Prednisolone
Class:
Use:

Key info:
CI – what medical tx should not be give to pts on logn term, immunosuppressive doses of steroids

A

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

155
Q

what 4 medications are used in neuropathic pain

A

amitryptyline ( TCA)
Duloxetine ( SNRI)
Gabapentin (anticonvulsants)
pregabalin (anticonvulsants)

156
Q

Pregabalin
Class:
Use: x3

A

Pregabalin
Class: antiepileptic
Use:
- Neuropathic pain
- Adjunct in focal seizures
- GAD

157
Q

give examples of antimuscarinic effects

A

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

158
Q

Prochlorperazine
Class:
others in the group: x2
Use:
- x5
Key info:
S/E:

A

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

159
Q

Propofol
Class:
Use:
x2
Key info:
- Common side effects: x6
- quick or slow onset ?

A

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

160
Q

what medications may cause neutropenia

A

Oncology
- chemotherapy
- Rituxumab ( autoimmune/ cancer)
- inflixamab ( autoimmune)

Psych - schizophrenia
- clozapine

MSK - RA
- Hydroxychloroquine
- Sulfasalazine
- Methotrexate

Endo - hyperthryroidism
- Carbimazole

Infectious disease - Malaria
- Quinine

161
Q

what UTI medication should not be prescribed in a patient taking methotrexate?

A

trimethoprim + methotrexate = increased risk of bone marrow suppression.

162
Q

Quinine
Class:
others in the group: x4
Use: x2
Key info:
CI – x4
SE – x1

1st & 2nd line Rx in
Uncomplicated malaria

Complicated malaria

A

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

163
Q

Ramipril
Class:
Mechanism of action:
Use: x4
Key info:
S/E x1

A

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

164
Q

Rifampicin
Use:
X2

Key info:
SE X2

A

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)

165
Q

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)

A

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

166
Q

Carbimazole
- method of action
- key adverse effect

A

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

167
Q

what is adverse effect of the 2nd line anti-thyroid drug makes carbimazole preferable?

A

both propylthyouracil (2nd line) and carbimazole cause agranulocytosis

propylthyouracil can cause liver reactions and death

168
Q

ACEi inhibitors can be nephrotoxic and nephroprotective, so what are the appropriate steps in

AKI pt on ramipril
CKD patient on ramipril

A

AKI - STOP ( nephrotoxic)
CKD - continue ( protective)

169
Q

Levothyroxine
- starting dose
- changes in pregnancy
- when to check TFTs

SE x3

interactions x 2

A

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

170
Q

what is the treatment regime of hyperthyroidism in pregnancy

A

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)

171
Q

after what duration of missed doses does clozapine have to be retitrated

A

48 hrs

172
Q

non-sedating antihistamines

A

cetirizine, loratadine, and fexofenadine

173
Q

penicillin allergy can cause a cross reaction to which medications

A

cephalosporins
carbapenems

174
Q
A

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