Pharmacology Flashcards
Side effects of SSRIs?
- Erectile dysfunction
- Impaired psychomotor function (elderly)
- Orthostatic hypotension
- Hyponatremia
- Taper and stop if pregnant
Ramsay Hunt Syndrome - symptoms and treatment
➜ Reactivation of dormant varicella-zoster in the facial nerves.
Symptoms:
- facial palsy,
- intense ear pain,
- blisters inside ear canal,
- painful rash in face, mouth and ear
Treatment:
- aciclovir,
- corticosteroid
Medications used for opioid abuse
Naloxone (injectable) - acute opioid overdose
Naltrexone (oral) - to prevent relapse in opioid-dependent people who have remained opioid free for at least 7-10 days
Methadone or burprenorphine (oral) - for detoxification in active opioid dependence
Postherpetic neuralgia - definition, symptoms and treatment
More than 3 months after infection VZ virus
Burning pain due to nerve impairment
Treatment: amitriptilyne/duloxetine/gabapentin/pregabalin + steroids + tramadol (acute pain rescue)
UKMEC for contraception devices
Levonorgestel IU - UKMEC 2 for <20y
IUCD - UKMEC 2 for < 20y
Depot medroxyprogesterone acetate - UKMEC 2 for < 18y (increased risk of fracture because peak bone mass is not obtained yet)
Effects and time of use for emergency contraception (IUCD, POP, EllaOne)
IUCD - within 5 days (inhibits fertilization and implantation)
POP (levonorgestrel) - within 3 days (inhibits ovulation)
EllaOne (Ullipristal acetate) - within 5 days (inhibits and delays ovulation)
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Which medications shouldn’t be combined with clarithromycin?
Clarithromycin is potent CYP3A4 inhibitor.
Avoid combining with:
- statins (rabdomyolysis),
- lithium (increased QT interval),
- methadone (increased QT interval),
- salbutamol (hypokalaemia),
- warfarin (increased INR)
Which laxatives shouldn’t be used for opioid-induced constipation?
Bulk forming laxatives (isphagula husk), because they can cause abdominal pain and intestinal obstruction.
What are the common uses for:
- procyclidine,
- baclofen,
- botox,
- diazepam
- lorazepam
Procyclidine (anticholinergic drug)
- drug-induced parkinsonism,
- drug-associated extrapyramidal symptoms,
- akathisia (tremors and agitation),
- acute dystonia (involuntary muscle contractions)
Baclofen
Muscle spasms associated with conditions such as:
- multiple sclerosis,
- spinal lesions,
- cerebral palsy
- motor neuron disease
Botox
Muscle spasms in:
- chronic migraine,
- limp spasticity in stroke,
- severe hyperhidrosis
Diazepam
- acute muscle spasm,
- anxiety,
- seizures
Lorazepam
- anxiety,
- panic attacks,
- seizures
What are contraindications for taking sodium valproate?
Whar test should be ordered prior to prescribing it for the first time?
Contraindications:
- Personal or family history of severe liver dysfunction,
- Urea cycle disorders,
- Mitochondrial disorders,
- Acute porphyrias,
- Pregnancy
Prior to starting:
- Liver function
How to treat paracetamol overdose?
Single ingestion > 36h ago
- obtain paracetamol levels
- if jaundiced, start NAC asap
Single ingestion > 15h ago or staggered ingestion ened > 24h ago
- start NAC within 1 hour
Staggered ingestion or if timing is uncertain
- start NAC within 1 hour
Ingestion < 1h ago and dose > 150 mg/kg
- activated charcoal orally and intravenous antiemetic
- take blood samples 4 hours post-ingestion
- if paracetamol levels are above treatment line, start NAC
Ingestion < 4h ago
- delay any blood sampling until 4h post-ingestion
- if paracetamol levels are above treatment line, start NAC
Would paracetamol levels be available within 8 hours of ingestion?
- YES: obtain paracetamol leves, if they are above treatment line, start NAC
- NO: obtain paracetamol levels, start NAC, continue NAC if above treatment line
MAXIMUN DOSE PER DAY IN ADULT: 4g
“All patients with a timed plasma paracetamol level on or above a single treatment line joining points of 100 mg/l at 4h and 15 mg/l at 15 hours after ingestion should receive NAC based on a new treatment guide, regardless of risk factors”
Different anti-emetics indicated for each cause of vomit
Metabolic causes (renal failure, hypercalcaemia), drug-induced or toxin-induced
- haloperidol (typical antiphychotic)
- levomepromazine (antipsychitic, phenothiazines, also used for insomnia and pain)
Radiotherapy
- ondansetron (serotonin 5-HT3 receptor antagonist)
- haloperidol
Chemotherapy
- ondansetron
- metoclopramide (prokinetic agent, antidopaminergic, also used for hiccups and migraine)
Conditions causing raised intracranial pressure
- cyclizine
- dexamethasone (corticosteroid, reduces perilesional oedema, helps with nausea and headache)
