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
