Pharmacology Flashcards
How should U+Es be monitored on starting ACE-inhibitors? What creatinine increase is acceptable?
An increase in serum creatinine up to 30% from baseline is acceptable when initiating ACE inhibitor treatment
So U+Es 2 weeks after starting treatment and 2 weeks after each dose change. Once a maintenance dose has been established urea and electrolytes should be checked at 1, 3 and 6 months.
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.
Exenatide and Liraglutide are examples. These drugs increase insulin secretion and inhibit glucagon secretion. One of the major advances of GLP-1 mimetics is that they typically result in weight loss. Risks are assocation with pancreatitis.
Due to its weight negative effect, it is recommended for patients who do not have adequate glycaemic control despite triple therapy with metformin and two other oral antidiabetic drugs and a BMI of >35. They are only started by specialists
Describe DDP-4 inhibitors- examples and mechanisms of action
e.g. Vildagliptin, sitagliptin
DPP-4 inhibitors increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
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% that could benefit from extra diabetic control (hba1c >48) + on metformin
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
When is pioglitazone CI?
CI in HF
Example of sulfonylureas? CI? adverse effects
eg Gliclazide, glimepiride
CI in severe renal failure also make you at risk of hypoglycaemia.
Commonly cause weight gain and hypos
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
Tetracycline
Sulphonamides
Lithium
Benzos
Aspirin
Carbimazole/ cytotoxic drugs
Methotrexate
Sulfonylureas/ sulphonamides
Amiodarone
What are the antidotes to:
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
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.
