Pharmacology Flashcards
Orlistat (Indications?)
- Age 18-75
- BMI of 28 or more w/ risk factors
- BMI of 30 or more
- -
Orlistat (How does it work)
Lipase inhibitor (reduces absoprtion of dietary fat)
Orlistat (Contraindications)
Chronic Malabsorption syndrome
Cholestasis
Breastfeeding
Which SSRI can affect/cause HTN?
Venlafaxine
What is Malarone and what are the side effects?
Anti-malarial containing a combination of atovaquone and proguanil.
**Side effects: GI upset, headaches, skin rash, mouth ulcers **
What is Mefloquine and what are the side effects?
Antimalarial drug.
**Side effects: Dizziness, Sleep disturbances (Insomnia, vivid dreams) and neuropsychiatric disturbance (anxiety, depression, panic attacks, hallucinations)
**
Contraindicated in epilepsy
What is chloroquine and what are the side effects?
Antimalarial
Rarely used now
Side effects: Headache
Contraindicated in epilepsy
SAFER OPTION TO USE IN PREGNANCY - but high levels of resistance
Antimalarials in pregnancy
If travel cannot be avoided:
- Chloroquine can be taken
- Proguanil: folate supplementation (5mg od) should be given
Malarone (atovaquone + proguanil): the BNF advises to avoid these drugs unless essential. If taken then folate supplementation should be given
mefloquine: caution advised
doxycycline is contraindicated
Lithium side effects
Nausea/vomiting, diarrhoea
Fine tremor
Weight gain
Nephrotoxicity - polyuria
Thyroid enlargement (can cause hypothyroid)
Hyperparathyroidism + hypercalcaemia
IIH
ECG: T wave flattening/inversion
Leucocytosis
Lithium monitoring
- When should lithium levels be checked
- How often monitorng when starting/dose change
- How often once stable and what other blood tests?
Lithium levels should be checked 12 hours post-dose
Lihtium levels should be done weekly after starting and after each dose change until concentrations stable
Lithium levels should normally be checked every 3 months
TFT and renal funciton should be checked every 6 months
Precipitants for lithium toxicity?
Dehydration
Renal failure
Drugs - Metronidazole, ACE-I, NSAIDs, Thiazide diuretics (MANT)
Features of lithium toxicity?
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma
Management of lithium toxicity?
Mild-moderate - IV fluids
Severe - Haemodyalisis
Sodium bicarbonate is sometimes used.
Methotrexate side effects?
Mucositis
Myelosuppression
Pneumonitis (typically 1 year after trt)
Pulmonary fibrosis
Liver fibrosis
May affect fertility
Methotrexate contraindications
Pregnancy (Teratogenic)
- Women should avoid pregnancy for at least 6 months after treatment stopped
- Men should use contraception for 6 months after treatment
Breastfeeding
Active Infeciton
**Immunodeficinecy **
Methotrexate monitoring?
FBC, U&Es, LFTs at start and every 2 weeks until dose stable for 6 weeks (also at dose increases)
Then check monthly for 3 months and then 3 monthly
Sulphasalazine - Indications?
IBD, RA
Sulphasalazine - Side effects
Rashes
Oligospermia
Headache
Heinz body anaemia
Megaloblastic anaemia
Lung fibrosis
Sulphasalazine - Pregnancy/breastfeeding?
Thoeretical risk of neonatal haemolysis in third trimester
Adequate folate supplements should be given
Also theoretical risk of neonatal haemolysis through breastfeeding
Pioglitazone - Contraindications
Heart Failure
Bladder Cancer/uninvestigated haematuria
Hepatic impairment
Pioglitazone - what is it?
**Thiazolidinedione **
They are agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance.
Pioglitazone - Side effects
Weight gain
Liver impairment: monitor LFTs
Fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin
Increased risk of fractures
Increased risk of bladder cancer
Dapagliflozin - what type of medication + how does it work?
SLGT-2 inhibitor
Reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
Dapagliflozin/SGLT-2 - side effects
Urinary and genital infection (secondary to glycosuria).
Fournier’s gangrene has also been reported
Normoglycaemic ketoacidosis
Increased risk of lower-limb amputation: feet should be closely monitored
Dapagliflozin - contraindications?
DKA
Active foot disease (Skin ulceration/osteomyelitis)
Renal/hepatic impairment
Exenatide? - Type
GLP-1 agonist
Exenatide - Contraindications
Ketoacidosis
Pancreatitis
Renal/Hepatic impairment
Severe GI disease (IBD/gastroparesis)
Exenatide - Side effects
Weight loss
Nausea/vomiting
Pancreatitis
Renal impairment
Cardiac - AV block, sinus tachycardia
SKin rash
Methylphenidate - weight monitoring?
Every 3 months in children 10 or less
3 months then 6 months after treatment started, and every 6 months thereafter in everyone aged over 10
Methylphenidate - height monitoring frequency?
Every 6 months in children and young people
Methylphenidate - BP/HR monitoring
Before and after each dose change
Routinely every 6 months
Methylphenidate - what aspects need to be monitored?
Weight, height, BP/Pulse
Digoxin - MOA?
Decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
Increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump.
Digoxin toxicity - precipitating factors?
LOW - Pot, Mg, albumin, temp, thyroid
High - Calcium, sodium
Drugs - Amiodarone, Qunidine, Verapamil, Diltiazem, Spironolactone (Drugs that cause hypokalaemia - thiazides + loop)
Digoxin toxicity - features?
Generally unwell
- Lethargy, nausea & vomiting, anorexia, confusion,
Yellow-green vision
Arrhythmias (e.g. AV block, bradycardia)
Gynaecomastia
Leflunomide - Contraindications/cautions
Pregnancy - the BNF advises: ‘Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men (plasma concentration monitoring required’
Caution should also be exercised with pre-existing lung and liver disease
Triptans - side effects
Dyspnoea
Flushing
Fatigue
Sensations of tingling/hot/cold
Triptans - contraindications
IHD
HTN
MI
CVA - TIA/Stroke
Gynaecomastia - Drug causes?
Got DISCO Fever
- GnRH ag - goserelin
- Digoxin
- Isoniazid
- Spiro
- Cimetidine
- Omeprazole/ oestrogens
- Finasteride
Tinnitus - Drug Causes?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
