Pharmacology Flashcards
How should U+Es be monitored on starting ACE-inhibitors? What creatinine/ egfr increase is acceptable?
An increase in serum creatinine up to 30% from baseline is acceptable when initiating ACE inhiclbitor treatment or up to egfr rise 25%
So U+Es 1 weeks after starting treatment and 1 weeks after each dose change. Once a maintenance dose has been established check 12m
FIrst line for ascites secondary to cirrhorisis and why?
Spironolactone
patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used
What low blood result would make you concerned about digoxin toxicity?
Digoxin toxicity is more likely to occur in the presence of hypokalaemia. This is because digoxin and potassium compete for binding sites on the Na+/K+ ATPase pump, which is inhibited by digoxin as part of its mechanism of action. When potassium levels are low, there is less competition for these binding sites, allowing more digoxin to bind and exert its effects, thus increasing the risk of toxicity
Describe GLP-1 mimetics - examples, method of action, advantages, risks and when to use.
eg Exenatide, Liraglutide
increase insulin secretion and inhibit glucagon secretion.
Cause weight loss so cannot have unless BMI over 35. Can only trial if diabetes not controlled by triple PO therapy. specialist only. Can cause pancreatitis
GULP down tide pods = mnemonic
Describe DDP-4 inhibitors- examples and mechanisms of action and adverse effects
e.g. Vildagliptin, sitagliptin
DPP-4 inhibitors increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown which leads to increase insulin reuptake and inhibition of glucagon
Lipton ice tea makes you pp4 more times = mnemonic
Adverse effect: pancreatitis, UTI
How often are digoxin levels monitored upon starting?
digoxin level is not monitored routinely, except in suspected toxicity
What are examples of SGLT-2 inhibitors? When are they used? What are the risks?
Flozins eg dapagliflozin
Used in patients with CVD/ HF/ qrisk >10% - indicated once metformin titrated no matter the blood sugar level
SGLT2-inhibitors should be avoided in active foot disease (such as skin ulceration, osteomyelitis, or gangrene) due to the possible increased risk of lower limb amputation (mainly toes). Also put at risk of fornier’s gangrene, UTI and thrush
Risk of euglycaemic DKA
When is pioglitazone CI?
CI in HF as can cause fluid retention/ wt gain
Also CI if hx of bladder cancer
Increase fracture risk
Example of sulfonylureas? CI? adverse effects
eg Gliclazide, glimepiride
Ide take your sulfonylureas if I was you
Work by increasing insulin release
CI in severe renal failure also make you at risk of hypoglycaemia. caution in BMI over 35
Commonly cause weight gain and hypos. Can als cause SIADH
diabetic drug with highest risk of causing a hypo!!!
What are second line agent for diabetes? IF not established control on or there is a CI to metformin.
if the patient has a risk of CVD, established CVD or chronic heart failure:
SGLT-2 monotherapy
if the patient doesn’t have a risk of CVD, established CVD or chronic heart failure:
DPP-4 inhibitor or pioglitazone or a sulfonylurea
SGLT-2 may be used if certain NICE criteria are met
What medications should be avoided in breastfeeding?
Can Tom Catch Silly Lions before Apples can make sweet Apple:
Cipro/ chloramphenicol/ colchicine
Tetracycline
Sulphonamides
Lithium
Benzos
Aspirin
Carbimazole/ cytotoxic drugs
Methotrexate
Sulfonylureas/ sulphonamides
Amiodarone
What are the antidotes to these OD?:
Salicylate
Benzodiazepines
Tricyclic antidepressants
Heparin
Beta-blockers
Ethylene glycol
Methanol
Pesticides
Digoxin
Lead
Iron
CO
Cyanide
Salicylate - IV bicrbonate, HD
Benzodiazepines - Flumazenil
TCA - IV bicarbonate
Heparin - Protamine
Beta blockers - atropine if bradycardic, glucagon
Ethylene- 1st line fomepizole, ethanol 2nd line, HD
Methanol - ethanol/ fomepizole, HD
PEsticides- atropine
Dig- Digoxin-specific antibody fragments
Iron - Desferrioxamine, a chelating agent
Lead- Dimercaprol, calcium edetate
CO - oxygen
Cyanide- Hydroxocobalamin
WHat are the rules for bisphosphonate holidays/ when to stop?
After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true:
Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score <-2.5 after treatment
If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs.
What drugs can induce pancreatitis?
BFSoDAMP
Bendroflumethiaide
Furosemide
Sodium valproate/ steroids
Didanosine
Azathioprine
Mesalazine
Pentamidine
Also NSAIDs, opioids and macrolide abx
GLP-1 mimetic, SGLT-2 inhib, DPP4 inhib
What are Aminosalicylate drugs? What adverse effects can they have?
Used to reduce inflammation in UC
eg Sulphasalazine, Mesalazine, Olsalazine
Aminosalicylates are associated with a variety of haematological adverse effects, including agranulocytosis - FBC is a key investigation in an unwell patient taking them.
What drugs can induce thrombocytopenia?
quinine
nitrofurantoin
proporanolol
NSAIDs
thiazide diuretics, furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
When should a statin be started in T1 diabetics?
Individuals with type 1 diabetes who do not have established cardiovascular disease (CVD) risk factors should be offered atorvastatin 20 mg for primary prevention of CVD if they are:
Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)
What drugs raise prolactin?
Anything that reduces dopamine levels - antipsychotics
Prochlorperazine (old fashioned antipsychotic)
metoclopramide, domperidone
haloperidol (old fashioned antipsychotic)
Drugs that increase dopamine eg for parkinsons do opposite eg cabergoline
What drug group has a major interaction with verapamil?
Beta-blockers combined with verapamil can potentially cause profound bradycardia and asystole.
What are the 1st vs 2nd line meds for alzheimers dementia? How does the first line work and therefore what is it CI in?
1st. donepezil, galantamine and rivastigmine - these are acetylcholineesterase inhibitors -> increases the levels of AcetylCholine -> Parasympathetic system uses AcH -> Increased parasympathatetic activity
Therefore CI in bradycardia
2nd - memantine
What is the main CI to triptans?
IHD due to risk of MI - cause vasoconstriction so could cause vasospasm
What does 2% lidocaine mean in terms of strength?
A 2% strength liquid medicine means that 2g of the drug are dissolved in 100ml
What can effect the absorption of levothyroxine?
Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart
What drugs can cause ototoxicity?
aminoglycosides eg gentamicin
furosemide
aspirin
quinine
cytotoxics
macrolides eg clarithromycin
What drugs can cause lung fibrosis?
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate (methotrexate is higher risk)+ sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
Which antihistamines are sedating vs non-sedating
Non-sedating - loratadine, fexofenadine or cetirizine
sedating -chlorphenamine, promethazine, cinnarizine
What test is needed before starting herceptin - trastuzumab (used to tx br cancer)?
Echocardiogram.
A major side effect is cardiomyopathy - require monitoring of left ventricular ejection fraction through serial echocardiograms before and during treatment.
What drug can cause spider naevi?
COCP
What SE can occur from the following RA drugs:
hydroxychloroquine
methotrexate
sulfasalazine
gold
etanercept
infliximab
lefluomonide
ciclosporin
penicillamine?
Hydroxychoroquine - bulls eye retinopathy, corneal deposits
methotrexate -Myelosuppression, Liver cirrhosis, Pneumonitis
Sulfasalazine -Rashes, Oligospermia, Heinz body anaemia, Interstitial lung disease
Gold- proteinuria
Etanercept- Demyelination, Reactivation of tuberculosis
Infliximab- Reactivation of tuberculosis, can exacerbate HF
leflunomide - HTN, hepatitis
ciclosporin- gingival hypertrophy
penicillamine- proteinuria
SE of TB medications?
Rifam-pissin (orange)
Isoneurozid
Liverzinamide
Eyethambutol
What drug can interact with azathioprine to cause toxicity?
Allopurinol
ace-i (myelosuppression)
What are the SE of the follow anti-epileptic drugs:
phenytoin
carbamazepine
topirimate
sodium valproate
lamotrigine?
Phenytoin - SE include peripheral neuropathy, lymphadenopathy, and bleeding gums
Carbamazepine- dizziness, ataxia, and diplopia.
Topiramate- weight loss, cognitive impairment, and kidney stones.
Sodium valproate- gastrointestinal disturbances, tremor, and hair loss.
Lamotrigine-skin rashes (including Stevens-Johnson syndrome)
If someone has oeseophageal SE on alendronate what do u change them to?
risedronate
What do macrolide abx interact with?
statins (myopathy)
amiodarone
(note statins also interact with amiodarone and levels are increased by this)
Which abx lower the seizure threshold?
fluroquinolones eg ofloxacin
Which vaccines are CI in immuncomp patients?
Live attenuated -
yellow fever
polio PO
intranasal influenza
varicella
MMR
What medication is commonly linked to avascular necrosis?
corticosteroids long-term use
Which medications cause eye issues?
Cataracts- steroids
Corneal opacities - amiodarone; indomethacin
Optic neuritis- ethambutol ; amiodarone; metronidazole
Retinopathy- quinine
Sildenafil can cause both blue discolouration and non-arteritic anterior ischaemic neuropathy
What is given with isoniazid to prevent complications?
Pyridoxine- vitamin B6 to reduce chance of peripheral neuropathy
What drugs cause tinnitus?
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine
What drugs can trigger psoriasis?
beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
What common medication does clopidogrel interact with?
omeprazole + esomeprazole )make less effective) —> change to lansoprazole
When is metformin CI?
metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration
What are the p450 enzyme inductors?
CRAP GPs
Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas / st John wort/ smokers
What are Inhibitors of the P450 system?
SICKFACES.COM
Sodium valproate/ sertraline
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (acute) & Grapefruit juice / amiodarone / allopurinol
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Metformin mechanism of action?
Increase glycolysis and peripheral glucose uptake and inhibits gluconeogenesis
Which NSAID has the highest risk of causing CVD?
diclofenac
Anticholinergic medications with burden of 2 or 3?
ACB score of 2:
sertraline
prochlorperazine
cetirtizine
ACB score of 3:
tolteridine
trospium
oxybutynin
promethazine
chlorpheneramine
amitryptiline
solifenacin
Can lead to headaches, memory impairment, anxiety, insomnia + confusion
Why can nasal decongestents only be use short term?
They cause vasoconstriction of blood vessels in the nose, long term use means nasal congestion from overuse so there is rebound whenever they stop using the medication
Which SSRI has the longest half life and therefore needs the longest gap between titrating between different anti-depressants?
fluoxetine - needs 7 days between antidepressants
Which asthma inhaler, by itself can lead to worsening asthma exacerbations?
LABAs, needs ICS prescribed alongside to avoid this risk
SE of montelukast?
diarrhoea, fever, headache, nausea
psychiatric reactions eg depression, OCD, speech impairment
bad dreams
Which abx puts you more at risk of CVD - MI/ stroke?
clarithromycin - ruptures existing plaques
Which abx can cause oesophagitis?
doxycycline
What SE can procyclodine cause?
if OD can cause anticholinergic SE - confused, agitated, poor sleep, pupils dilated, dry mouth, constipated, blurred vision,
Rare severe SE of chloramphenicol drops?
bone marrow suppression - aplastic anaemia, pancytopenia
What is ocreotide used to treat? What SEs can it cause?
somatostatin analogue
Used to treat acromegaly, carcinoid tumours, + glucagonomas
SE: gallstones
What important adverse effect can carbimazole have?
agranulocytosis
Which antiepileptic is most associated with agranulocytosis
carbamazepine
Which abx prolongs the QT interval?
clarithromycin
at what INR should a DOAC be started when switching from a DOAC to warfarin?
<2
when do you need to wean steroids for an asthma/ copd exacerbation?
if more than 3 courses of steroids in last yr consider weaning
What drugs can cause SIADH?
NSAID, nicotine, diuretic, carbamazepine, TCA, SSRI, vincristine, cyclophosphamide, sulphonylureas
What drugs can cause gynaecomastia? Which drugs can treat it?
Gynaecomastia can be treated with tamoxifen. Drugs that can CAUSE include - finasteride, metronidazole, spironolactone, digoxin, amiodarone, isoniazid, CCB, methyldopa, TCA, antipsychotics, flutamide
What hypertensive drug interacts with simvastatin?
Amlodipine doubles the effects of simvastatin, so the maximum dose you can prescribe of simvastatin with amlodipine in 20mg
Causes of gingival hyperplasia
phenytoin, ciclosporin, CCB
What is the max amount of lidocaine?
7mg/ kg = max amount lidocaine
Which drugs are most strongly associated with c. diff?
C DIFF most strongly associated with penicillins (co-amox especially), cephalosporins, fluoroquinolones and clindamycin
Which drugs can worsen glycaemic control?
BB and thiazides can worsen glycaemic control
Different types of breast cancer meds and adverse effects
Herceptin - cardio toxic
tamoxifen - risk for endometrial cancer, hot flushes
anastrazole - risk for OP
