Pharmacology Flashcards
What are thiazolidinediones and what are the side effects?
PPAR-gamma receptor agonists that lead to increased storage of fatty acids, reducing circulating fatty acids making the body more dependent on glucose and so reducing peripheral insulin resistance therefore used in the treatment of type 2 DM. e.g. Pioglitazone
Side-effects: Weight Gain (leptin levels are decreased), liver impairment (monitor LFTs), Fluid retention (contraindicated in heart failure), increased risk of fractures, bladder cancer (pioglitazone)
Describe verapamil, its uses, side-effects and contraindications.
A Centrally acting Calcium Channel Blockers used second-line in the treatment of supraventricular tachycardias, may also have a role in Angina, and in place of beta-blockers in prophylaxis post-MI.
Side Effects: Constipation, hypotension, bradycardia (caution in heart failure), flushing
Contraindications: Broad complex tachycardia, acute porphyria, heart failure.
What are the side-effects of diltiazem?
hypotension, bradycardia (caution in heart failure), ankle swelling
What are the side-effects of dihydropyridines (e.g. nifedipine, amlodipine)?
flushing, headache, ankle swelling
Which drugs must be avoided during breastfeeding?
Aspirin, Sulphonylureas, Carbimazole, benzodiazepines, lithium, sulphonamides, tetracycline, ciprofloxacin, amiodarone, cytotoxics.
What are the side-effects of loop diuretics?
hypotension, hypokalaemia, hyponatraemia, otoxicity, hypocalcaemia, renal impairment, hyperglycaemia, gout
What are the side-effects of LMWH and UFH?
Increased Bleeding, heparin-induced thrombocytopenia, osteporosis with long-term use. HIT and osteporosis less common with LMWH than UFH. Also hyperkalaemia
What is tamsulosin?
Tamsulosin is an alpha1-blocker used in the treatment of BPH. It acts to relax smooth muscle in BPH leading to an increase in urinary flow-rate and an improvement in obstructive symptoms.
Contra-indicated in patients with a history of postural hypotension.
What is citalopram and what are its side effects?
A type of Selective Serotonin Re-uptake Inhibitors used in depression and panic disorder. Can prolong QT interval. Can also cause hepatitis and general GI upset.
What are the side effects of alpha1 selective blockers.
Drowsiness, hypotension, syncope, headache, dry mouth, depression
What are some side effects of chloroquine?
Headache, psychosis, retinopathy (chronic use)
What are some side-effects of primaquine?
Epigastric pain, haemolysis if G6PD deficient, methaemoglobinaemia
What are the main types of anti-fungals?
Triazole antifungals e.g. fluconazole, itraconazole, posaconazole, and voriconazole. Voriconazole is broad-spectrum anti-fungal used for life-threatening infection.
Polyene antifungals e.g. Amphotericin B used for CNS fungal infections and cryptococcal meningitis.
What are the main types of anti-biotics?
- Beta-lactams
- Penicillins (-cillin)
- Cephalosporins (cef-)
- Carbapenems (-penem)
- Quinolones (-acin)
- Macrolides (-thromycin)
- Aminoglycosides (-micin)
What are the main penicillins?
Benzylpenicillin is a useful narrow spectrum antibiotic mainly against gram+ve organisms. It is poorly absorbed orally and is usually given IV.
Flucloxacillin is indicated in infection cause by penicillinase-producing penicillin resistant staphyloccoi. Which includes most hospital acquired staphylococcal infections, SEs include Cholestasis
Ampicillin and Amoxicllin are broad-spectrum penicillins active against non-beta lactamase producing gram+ve bacteria and because they diffuse into gram-ve bactera more readily than benzylpenicilin they are also active against many strains of E.coli, haemophilus, and salmonella. For oral amoxicllin (SEs rash with infectious mononucleosis) is the drug of choice for IV ampicillin. Co-amoxiclav can be used for resistant strains, SEs include Cholestasis.
What are the main Cephalosporins?
Used for the treatment of meningitis, pneumonia, and septicaemia. Ceftriaxone is a third generation which is active against staphs, most streps, enterococci, pneumoccoci and gram-ve such as shigella haemophilus, klebsiella, some proteus and e.coli.
What are the main Carbapenems?
Meropenem is a carbapenem but is high resistant to most beta-lactamases, it has a wide spectrum and it bactericidal against most gram-ve and gram+ve, only occasional pseudomonas and MRSA are resistant. It is given IV.
What are the main Macrolides?
Erythromycin and Clarithromycin can be given either orally or IV. They have a narrow spectrum mainly active against gram+ve can be used as an alternate in pen-allergic patients. but they are ineffective in meningitis. They are very safe drugs. Erythromycin may cause gastrointestinal upset and prolonged QT interval.
What are the main Aminoglycosides?
Gentamicin is the most important its main use is in life-threatening gram-ve infections. AmiKacin is used in gentamicin resistant gram-ve infection. Streptomycin is used in mycobacterium multiple resistant TB. Be wary of Ototoxicity and Kidney damage.
What are the main Quinolones?
Ciprofloxacin is well absorbed orally and can be given intravenously it is excreted mainly by the kidneys unchanged and so can be used in UTIs. They are useful for intracellular organisms. SEs include decreased seizure thershold and achilles tendonitis
What are the side effects of rifampicin?
- decreased liver function ( stop if bilirubin increases small AST rise is OK)
- thrombocytopenia
- orange discolouration of urine, tears
- inactivation of Pill
- flu-like symptoms
What are the side effects of isoniazid?
- decreased liver function
- decreased white cell count
- neuropathy (stop and give pyridoxine (vitaminB6))
What are the side effects of ethambutol?
Optic neuritis with deterioration of colour vision first
What are the side effects of pyrazinamide?
- hepatitis
* arthralgia (hyperuricaemia so CI in acute gout it porphyria)
Describe Lithium, its indications, side effects, and monitoring.
Used in acute manic or hypomanic episode or mood stabiliser to prevent recurrence of mania/hypomania/depression in Bipolar-Affective Disorder. It takes 7-14 days to work.
Side-effects: N+V, Diarrhoea, fine tremor, nephrotoxicity (polydipsia/polyuria secondaary to nephrogenic diabetes insipidus), thyroid enlargement (hypothyroidism) T wave inversion, weight gain.
Toxicity: severe drowsiness, coarse hand tremor, muscle twitching, myoclonus, cogwheel rigidity, vomiting, loss of appetite, ataxia, nystagmus, seizures, coma and death.
Monitoring:
- Renally excreted, thiazide diuretics, ACE-i, NSAIDs can increased lithium levels as they compete for the same extraction channel.
- before perscribing check ECG, TFTs. Therapeutic range 0.4-1mmol/L
- Check lithium blood levels every week for a month, and then every month for 3 months if stable monitor every 3 months and monitor U+Es, TFTs every 6 months, check level 12hours post dose.
What are the classes of antidepressants and give some examples?
- Tricyclics e.g. amitriptyline, clomipramine, nortriptyline
- Mono-Amine Oxidase Inhibitors (MAOIs) e.g. isocarboxazid, phenelzine
- Selective-Serotonin Re-uptake Inhibitors (SSRIs) e.g. Citalopram, fluoxetine, paroxetine, sertraline
- Miscellaneous e.g. venlafaxine, mirtazapin, moclobemide
Describe Selective Serotonin Reuptake Inhibitors (SSRIs)
- Low risk in overdoes, comparatively safe in heart condition, better SE profile.
- examples are fluoxetine, paroxetine, citalopram
- Associated with increased risk of bleeding (give gastroprotective agent if elderly taking NSAIDs)
- Increased risk of suicide if younger than 30 years
- SEs include insomnia, agitation, dystonia and with paroxetine sexual dysfunction.
- SSRIs should not be used if the patient enters a manic phase.
Describe Mirtazapine
- Often used as a second line agent in depression after an SSRI
- Relatively safe in overdose but not considered as safe as SSRIs
- SEs include drowsiness, weight gain, rarely neutropenia
Describe Venlafaxine
- It is a Serotonin Noradrenaline Reuptake Inhibitor (SNRI).
- Often used as a 2nd/3rd line agent in depression, GAD, and also in patients with acknowledged treatment resistant depression.
- Not as safe as SSRIs in overdose but not as dangerous as Tricyclics.
- higher doses of venlafaxine may exacerbate cardiac arrhythmias
- Monitor blood pressure as possible exacerbation of hypertension.
Describe the four main dopamine pathways in the brain
- Brainstem to Limbic system - too much dopamine is thought to be cause for Positive symptoms of Schizophrenia
- Brainstem to Mesocortical system - too little dopamine is thought to be the cause of negative symptoms in schizophrenia
- Brainstem to Basal Ganglia - blocking dopamine here causes movement disorders (drug induced parkinsonism)
- Brainstem to Hypothalamus - blocking dopamine leads to hyperprolactinaemia
What are Extrapyramidal Side-Effects (EPSEs)?
- Dystonia: sustained involuntary muscle contractions, twisting of neck, limbs, trunk or face. acute form more likely in younger, more ill patients. particular problem in antipsychotic naive patients with predominant negative symptoms. switch to an atypical with less risk of EPSEs. Procyclidine IM or IV in acute situations
- Parkinsonism: akinesia, rigidity, course tremor at rest but no pill rolling, may occur within weeks, remit on withdrawal of drug. Switch to atypical. if not an option consider procyclidine oral
- Akathisia: uncontrolled restlessness with feelings of inability to keep still, constantly shifting posture, may resemble agitation or psychosis, switch to atypical if possible if no consider propranolol.
- Tardive Dyskinesia: Involuntary hyperkinesia, increased with anxiety and relieved by sleep, may be irreversible. symptoms include tics, choreas and dystonias, repetitive involuntary purposeless movements of jaw, neck and tongue. switch to atypical if neccessary consider tetrabenzine.
Describe Clozapine
- Indicated for treatment resistant schizophrenia
- Only anti-psychotic that has been shown to improve negative symptoms of schizophrenia such as apathy and paucity of speech
- requires pre-treatment ECG, FBC then dose titration with BP and pulse monitoring an weekly FBCs
- can cause reversible neutropenia which could progress to agranulocytosis.
- SEs include, sore throat, fever, hypersalivation, constipation, seizures, urinary incontinence, drowsiness, hypotension, tachycardia, weight gain, raised glucose and cholesterol, PE, myocarditis, cardiomyopathy
Describe Polypharmacy
The use of 4 or more medications by a patient typically adults aged over 65 years.
Concerns include:
- increased adverse drug reactions
- drug interactions
- prescribing cascade
- higher costs
Can ultimately lead to decreased quality of life, decreased mobility and cognition. Patients with polypharmacy require regular medication review to ensure that the medications they are on are not causing harm and are still appropriate.
Describe NSAIDs, give some examples and list some Side-effects.
Non-steroidal Anti-Inflammatory Drugs, have analgesic effect, particularly useful in inflammatory arthritides, also used in back pain, and soft-tissue disorders. They work by inhibiting cyclo-oxygenase to reduce the production of prostaglandins. Selective inhibition of COX-2 is associated with less GI SEs
Examples: Ibuprofen is an example it had the lowest risk of GI SEs of non-selective NSAIDs but its anti-inflammatory properties are weaker. Naproxen is one of the first choices due to its good efficacy and low incidence of SEs (though more than ibuprofen). Meloxicam are selective NSAIDs.
Side-Effects: GI discomfort, ulceration, hypersensitivity reactions (bronchospasm), headache, dizziness, depression, sleep change, increased risk of thrombotic events
Which antidepressants also have an anxiolytic effect
First line SSRIs such as Escitalopram , paroxetine, sertraline.
Duloxetine and venlafaxine are SNRIs are also recommended if patients cannot tolerate of have not responded to SSRIs
Describe Diuretics, give some examples, and list some SEs
Thiazides are used to relieve oedema due to chronic heart failure and in lower doses to reduce blood pressure. Examples are Bendroflumethiazide (HF) indapamide (Hypertension)
Loop diuretics are used in pulmonary oedema due to left ventricular failure and in patients with chronic heart failure. Examples are furosemide.
Potassium-Sparing used in conjunction with other diuretics to conserve potassium e.g. amiloride, spironolactone (aldosterone antagonist)
Side-effects: hypokalaemia (in non K-sparing), postural hypotension, hyponatraemia, Hyperuricaemia, hyperglycaemia
Describe Warfarin and some of its SEs
Used as prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation, after insertion of prosthetic heart valve. Also used in treatment and prophylaxis of venous thrombosis and pulmonary embolism, TIAs. Vitamin K dependent factors include protein C+S, Factors II, VII, IX, X. It takes 3-5 days to take maximum effect and C+S may depleted first causing a transient Thrombophilic state. So patient must be covered by LMWH during this period.
Side-effects: Haemorrhage, N+V, diarrohoea, jaundice, pancreatitis, alopecia, purpura, rash.
Describe ACE-inhibitors, gives some examples and list some SEs
Used in heart failure usually in combination with a beta-blocker. Also used in hypertension particularly in younger caucasian patients as first line. Check renal function 2wks after starting, as can cause decline if underlying Renal Artery Stenosis.
Examples include lisinopril, ramipril, enalapril.
Side-effects: hypotension, dizziness, headaches, renal impairment, dry cough, angioedema, hyperkalaemia, pancreatitis, GI upset.
Describe anti-muscarinic SEs
Dry mouth, blurred vision, constipation, urinary retention.
what are some side-effects of tricyclic anti-depressants
Arrhythmias, anxiety, dizziness, agitation, confusion, drowsiness, hallucinations, mania, antimuscarinic SEs, sexual dysfunction, galactorrhea
Describe beta-blockers, give some examples, and list some side-effects
Block beta-adrenoceptor in heart, peripheral vasculature, bronchi, pancreas and liver. Used in hypertension, heart failure, Post MI, anxiety, angina.
Examples: cardioselective B-blockers e.g. atenolol, bisoprolol may have a lesser effect on airway resistance and be preferred in diabetics. Water-soluble blockers e.g. atenolol, sotalol are less likely to enter the brain and may therefore cause less sleep disturbance and nightmares.
Side-effects: bronchospasm, fatigue, sleep disturbances, nightmares, cold extermities, bradycardia, hypotension
Describe opioid analgesics, give some examples, and list some SEs
Used to relieve moderate to severe pain particularly of visceral origin. Split into normal (morphine, tramadol, fentanyl) and weak opioids (codeine)
Side-effects: N+V, constipation, dry mouth, muscle rigidity in large doses, respiratory depression, hallucinations, mood changes, confusion, urinary retention.
Describe memantine, its indications, dose, and SEs
It is a glutamate receptor antagonist used in moderate to severe dementia in Alzheimer’s disease.
Dose: 5mg OD increased in steps of 5mg every week to 20mg OD
SEs: Constpation, dizziness, drowsiness, dyspnoea, headache, hypertension. May also cause confusion, hallucinations, heart failure and rarely seizures (caution use if history of convulsions)
What is Alendronic Acid and what are the side-effects.
It is a bisphosphonate used in the treatment of osteoporosis and other bone disease (paget’s). It inhibits osteoclast bone resorption.
Contra-indicated in eGFR LESS THAN 35.
Side-Effects: GI ulceration, rarely Steven-Johnson syndrome, osteonecrosis of the jaw.
What are some side-effects of metronidazole?
disulfiram-like Reaction following alcohol ingestion
What are some side-effects and CIs of doxycycline?
SEs: Photosensitivity
CIs: Pregnancy
What are Triptans, their main side effects and contraindications?
5HT1 Agonists constricting cranial arteries can be used in migraines.
Side-effects: nausea, dizziness and dry mouth. Strange sensations such as tingling, flushing, feelings of tightness or heaviness. Rarely can cause angina +/- MI or arrhythmias.
Contra-indications: IHD, coronary spasm, uncontrolled hypertension, recent lithium, SSRIs or ergot use.
Describe tocolytics and their contraindicationsand side effects.
Medications used to suppress premature labour. Nifedipine is effective and associated with less newborn respiratory distress and admission to intensive care. Nifedipine 20mg PO then 10-20mg/6-8h according to uterine activity.
Contraindications: Chorioamnionitis, foetal growth restriction or distress, pre-eclampsia, placenta praevia, abruption, cervix dilated more than 4cm.
SEs include hypotension, headaches flushing, tachycardia so requires BP monitoring acute pulmonary oedema can occur wit B2 agonists for tocolysis particularly in mothers exposed to corticosteroids uses for premature lung maturation
What are the discontinuation symptoms when abruptly stopping SSRIs?
Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating GI upset Paraesthesia
What are some side-effects of ciclosporin?
(Everything increases) Nephotoxicity Hepatotoxicity Fluid retention Hypertension Hyperkalaemia Hypertrichosis Gingival hyperplasia Tremor Impaired glucose tolerance Hyperlipidaemia Increased susceptibility to severe infection
What are the main P450 enzyme inducers?
PC BRAS:
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (Chronic)
- Sulphonylureas, Spironolactone
What are the main P450 enzyme inhibitors?
O-DEVICES:
- Omeprazole
- Disulfiram
- Erthromycin
- Valproate/ Verapamil
- Isoniazid
- Cimetidine/Ciprofloxacin
- Ethanol intoxication
- Sulphonamides
Describe VTE prophylaxis, it’s risk factors, Risk factors for bleeding, and management.
VTE assessment on all inpatients.
Risk factors: reduced mobility e.g. Bed bound, active cancer or cancer treatment, age over 60, critical care admission, dehydration, known thrombophilia, obesity I.e. BMI over 30, one or more significant comorbidities e.g. IHD, Metabolic or endorphin or respiratory pathology, inflammatory conditions, personal or first degree history of VTE, HRT, Oestrogen-containing contraceptive, varicose veins with phlebitis, pregnancy
Risk Factors for bleeding: Active bleeding, liver disease, anticoagulants, lumbar puncture, epidural, spinal expected within 12 hours or had in previous 4 hours, acute stroke, thrombocytopenia, uncontrolled systolic hypertension (230/120mmHg), untreated inherited bleeding disorder e.g.
Management:
-ensure adequate hydration
-encourage to mobilise
-Mechanical VTE prophylaxis e.g. Anti-embolism stockings (CI if peripheral arterial disease, peripheral neuropathy, local skin conditions e.g. Dermatitis, cardiac failure, severe leg oedema or pulmonary oedema, stroke)
- Pharmacological VTE prophylaxis e.g. Fondaparinux 2.5mg SC OD or Dalteparin 2500 units SC OD
-
What are the main side effects of PPIs?
Most common:
- Headache
- GI distubance e.g. Diarrhoea, N+V, abdominal pain.
- increased risk of fracture if used at high doses for more than 1year in elderly.
Less common:
-dry mouth, parietal cell hyperplasia, peripheral oedema, dizziness, sleep disturbances, arthralgia, myalgia.
Describe some types of anti-emetics their uses and side-effects.
Haloperidol good for opiate, general anaesthetic, post operative, chemo/radio, first choice in liver failure. Beware of increased prolactin, Extrapyramidal features, reduced seizure threshold, hypotension and prolonged QT.
Levomepromazine is a broad spectrum useful in resistant cases beware sedation, hypotension, reduced seizure threshold and prolonged QT
Metoclopramide good for GI causes, migraine and drugs e.g opiates. Beware hyperprolactinaemia, Extrapyramidal features (should not be taken for longer than 5 days due to risk of neurological adverse effects) and CI in GI obstruction as increases GI motility.
Domperidone Good for Parkinson’s disease, morning-after pill, chemotherapy beware hyperprolactinaemia, and should not be used for more than 7 days due to risk of cardiac side-effects QT prolongation
Cyclizine is good for GI obstruction, post-op N+V, vestibular disorders. Beware antimuscarinic features and try avoid in IHD.
Ondansetron a serotonin antagonist, good for resistant cases, side effects include headache QT prolongation and constipation and dizziness
On
Describe Metformin, it’s use, side-effects, and contraindications
Biguanide, increases insulin sensitivity without hypoglycaemic affect. Used 1st line in T2DM if diet unsuccessful also used in PCOS. Usually used 500mg OD upto 2g OD.
SEs: GI upset, taste disturbance, rarely Vit B12 deficiency, lactic acidosis
Contraindications: DKA, Shock, Recent MI, General anaesthetic, renal failure, liver failure, sepsis.
Describe Statins, the indications, side-effects, and monitoring.
HMG-CoA reductase inhibitors that lower cholesterol by decreasing synthesis, reduce LDL by increase in uptake and mildly reduce TGs. Atorvastatin recommended first line
Indications: Primary (Q-RISK over 10%, CKD, T1DM) and Secondary Prevention of IHD, CVA, PVD.
SEs: Hepatitis, myositis, headache, GI upset,
Monitoring: Monitor LFTs at baseline, 3 months, 12 Months and CK if myositis-like symptoms develop.
What is Tramadol and what are the main side-effects?
It is a synthetic opioid that typically causes less constipation that other opioids but causes more nausea.
Side-effects: Constipation, nausea, dry mouth, serotonin syndrome, lowers seizure threshold
What is the maximum dose of lignocaine?
3mg/kg, 10ml is about 100mg 1% solution = 10mg/ml
7mg/kg if given with adrenaline
What are the main types of medication used in the pharmacological management of Type 2 Diabetes Mellitus?
- Biguanides e.g. Metformin
- Sulphonyureas (Ka channel inhibitor) e.g. Glicazide
- Glitazones (PPAR-agonist) e.g. Pioglitazone
- Gliptins (DPP-4) e.g. Sitagliptin
- GLP mimetics (GLP-1) e.g. Exenatide
- Gliflozins (SGLT-2) e.g. Dapagliflozin
Describe Sulfonylureas and their side effects
Inhibit Ka channels leading to depolarisation of Islet cells and secretion of insulin. E.g. Gliclazide
Side-effects: Hypoglycaemia, weigh gain, hyponatraemia
Describe gliptins and their side-effects
DPP-4 inhibitors, they increased incretin levels which inhibit glucagon secretion. E.g. Sitagliptin
Side-effects: pancreatitis
Describe gliflozins and their side-effects
SGLT-2 inhibitors, they inhibit reabsorption of glucose in the kidney. E.g. Dapaglifozin
Side-effects: UTI, Hypoglycaemia
Describe glucagon mimetics and their side-effects
GLP-1 Agonists, incretin mimetic which inhibits glucagon secretion can cause weight loss e.g. Exenatide
Side-effects: Nausea and vomiting, pancreatitis.
Describe Azothioprine, its indications, and side-effects.
Azothioprine is metabolised to mercaptopurine a purine analogue that inhibits purine synthesis. It is metabolised by thioprine methyltransferase, so patient should be screened for TPMT defiance to avoid toxicity
Indications: inflammatory Bowel disease, RA
Side-effects: Bone marrow suppression, nausea and vomiting, pancreatitis, interacts with allopurinol.
Describe Adenosine, its indications, side-effects and contraindications.
It is a purine nucleoside that slows AVN conduction time and dilates coronary arteries.
Indications: Management of paroxysmal SVT, and diagnosis of SVT by slowing rate to reveal underlying rhythm.
SE’s: bronchospasm, hypotension, flushing, chest pain, SOB, arrhythmia.
CI’s: Asthma, COPD, Heart failure, Hypotension, Prolonged QT, 2nd-3rd AV block, sick-sinus syndrome
Describe Amiodarone, its indications, side-effects, and contraindications.
A class III antiarrhytmic it increases refractory period of conducting system.
Indications: tachyarrhythmias especially paroxysmal SVT, AF, atrial flutter, nodal tachycardias, VT and VF. Also in CPR/periarrest arrhythmias.
SEs: N+V, bradycardia, hypotension, TFT disturbance, thyrotoxic and hypothyroidism, also cause of interstitial lung disease, hepatotoxicity, photosensitive skin ‘grey-slate appearance’, tremor, sleep disorders, optic neuritis, peripheral neuropathy, blood disorders.
CIs: Sinus bradycardia, Sinoatrial HB, SAN disease Hx of thyroid disease/iodine sensitivity.
Describe Digoxin, its indications, side-effects and contraindications.
A cardiac glycoside that decreases HR by slowing AVN Conduction and increasing vagal tone also a weak inotrope (increased force of heart contraction)
Indication: AF and HF
SEs: GI upset, arrhythmias/HB, blurred vision green/yellow haloes, gynaecomastia, hallucinations. Toxicity is precipitated by hypokalaemia and hypercalcaemia.
Contraindications: complete HB, 2nd degree HB, VF, VT, HOCM, SVT secondary to WPW. Cautious use in Amyloid as binds irreversibly to Amyloid fibrils. I
Describe Flecainide, its indications, side-effects, and contraindications.
A class Ic Antiarrhythmic, local anaesthetic that decreases conduction.
Indications: VT, SVT, paroxysmal AF
SEs: GI upset, syncope, dyspnoea, oedema, vision/mood disturbances, fever, arrhythmias
CIs: SAN dysfunction, HB (not 1st degree), BBB, AF post cardiac surgery, chronic AF, valvular heart disease, heart failure
What are the side effects of clindamycin?
Diarrhoea (must be stopped), oesophagitis, antibiotic-associated colitis, jaundice, leukopenia, thrombocytopeania, polyarthritis, anaphylaxis, stevens-johnson syndrome.
Describe Varenicline, and its side-effects
A nicotinic receptor partial agonist, used in smoking cessation. commenced one week before patient target stop date. Course of treatment is 12 week.
Side-effects: Nausea, headache, insomnia, abnormal dreams, caution use in patient with history of depression or self-harm due to possible risk of increased suicidal behaviour. It is contraindicated in pregnancy and breast feeding
Describe Bupropion and it side-effects.
A noradrenaline and dopamine reuptake inhibitor, and nicotinic antagonist used in smoking cessation. Should be started 1-2 weeks before patients target stop date.
Side-effects: Small risk of seizures (1/1000), contraindicated in epilepsy, pregnancy, and breast-feeding. Eating disorders is a relative contraindication.
What is the dose of adrenaline?
IM 0.5mg, 0.5ml of 1/1000
IV 1mg, 10ml of 1/10000
What is the dose of lactulose, what are its contra-indications and side-effects.
Dose: 15ml BD
Contra-indications: galactosaemia, intestinal obstruction
Side-effects: Nausea and vomiting, flatulance, cramps, abdominal discomfort.
What is the dose of movicol
1-3 satchets throughout day
What are nitrates, dose, side-effects, and contra-indications.
Nitrates can be used in angina, as a potent coronary vasodilator. Sublingual is one of the most effective drugs for providing rapid symptomatic relief of angina, but it’s effects lasts only for 20-30 minutes, also available as aerosol spray. Many patients on long-acting nitrates develop tolerance.
Dose: Sublingual 0.3-1mg PRN
IVI 10-200micrograms/minute max 400micro/min
Side-effects: Flushing, headache, and postural hypotension. Dizziness.
Contra-indications: HOCM, AS, Cardiac tamponade, hypovolaemia, MS, raised ICP
What types of drugs work on Alpha receptors?
Alpha-1 Agonist: Decongestants e.g. Phenylephrine, oxymetazoline
Alpha-2 Agonist: Glaucoma e.g. Topical brimonidine
Alpha-antagonist (a-blockers): BPH e.g. Tamsulosin, Hypertension e.g. Doxazosin
What type drugs work on beta adrenergic receptors?
Beta-1 Agonists: Inotropes e.g. Dobutamine
Beta-1 Antagonist: non-selective and selective beta-blockers e.g. Atenolol, bisoprolol
Beta-2 Agonist: Bronchodilators e.g. Salbutamol
Beta-2 Antagonist: Non-selective beta blockers, e.g. Propranolol, labetalol
What type of drugs act on dopamine receptors?
Dopamine Agonists: Parkinson’s disease e.g. Ropinirole, prolactinoma
Dopamine Antagonists: Schizophenia antipsychotics e.g. Haloperidol, also anti-emetics e.gg. Metoclopramide and domperidone
Which type of dugs act on GABA receptors?
GABA Agonists: Benzodiazepines, baclogen
GABA Antagonists: Flumazenil
Which type of drugs act on histamine receptors?
Histamine-1 Antagonists: Antiistamines e.g. Loratidine
Histamine-2 Antagonists: Antacids e.g. Ranitidine
Which types of drugs act on muscarnic receptors?
Muscarinic agonists: Glaucoma e.g. Pilocarpine
Muscarinic Antagonists: Atropine (e.g. For bradycardia) Bronchodialtor e.g. Ipratropium, Urge incontinence e.g. Oxybutynin
Which types of drugs act on serotonin receptors?
Serotonin Agonists: Triptans for acute migraine
Serotonin Antagonists: Anti-emetics e.g. Ondansetron
Describe the Vaughan Williams classification of anti-arrhythmics.
Class I: Membrane-stabilising interfere with sodium channels further divided into
- 1a which lengthen the action potential procainamide, disopyramide
- 1b lidocaine shortens the action potential
- 1c does not significantly affect the action potential e.g. flecainide
Class II: reduce adrenergic input e.g. Beta-blockers
Class III: potassium blockers, e.. amiodarone and sotalol
Class IV: calcium influx blockers e.g. Verapamil
What important side effects of amitryptilline?
Postural hypotension,
What are some equivalent anti-inflammatory doses of corticosteroids?
Prednisolone 5mg = Dexamethasone 750mcg = Hydrocortisone 20mg = Methylpredniolone 4mg
What are the side-effects of quinine?
Hypoglycaemia
Cinchonism i.e. Tinnitus, hearing loss, vertigo
Visual disturbance
What are some drug causes of Constipation?
Verapamil, Oxybutynin, opiates, iron, calcium, diuretics, anti-muscarinics (including those with anti-muscarinic side effects e.g. Anti-psychotics)
What are the side-effects of steroids?
Diabetes, Hypertension, Cushings, Osteoporosis, Proximal myopathy, pancreatitis, cataract, glaucoma, infection, striae, acne, addisonian crisis on withdrawal, buffalo hump , euphoria, bruising/thin skin
Describe Midodrine, its indications and side-effects.
An alpha 1 agonist used for severe orthostatic hypotension.
Side-effects:
-supine Hypertension, stomatitis, urinary disorder, dyspepsia
What are some photosensitising drugs?
Antibiotics e.g tetracyclines, quinolones, sulfonamides NSAIDs Diuretics e.g. Frusemide, bumetanide Retinoids e.g. Isotretinoin Sulfonylureas Amiodarone Diltiazem Quinine Enalapril Dapsone Hydroxychloroquine
Which anti-depressant is recommended in patients with previous MI?
Sertraline
What is creatinine clearance and when should it be used?
More accurate estimate of kidney function. Use when patient is less than 60kg or drugs are more nephrotoxic.
CrCl = F x (140-Age) x W(kg)/Creatinine
Where F is 1.04 in females, and 1.23 in Males
What is the mechanism of action of the common NOAC’s?
DabigaTran = direct Thrombin inhibitor RivaroXaban = Direct factor Xa inhibitor ApiXaban = Direct factor Xa inhibitor
Which vaccines are live?
MMR BOY V
Measles, Mumps, Rubella, BCG, Oral Polio, Yellow fever, Varicella
Which drug can be used for osteoporosis if bisphosphonates are CI or not tolerated?
Raloxifene
Describe Tamoxifen, its indications and side-effects.
A selective oestrogen receptor modulator which acts as an oestrogen receptor antagonist and partial agonist.
Indication: management of oestrogen receptor positive breast cancer in pre and perimenopausal women. Typically used for 5 years following surgical management.
Side-effects: Menstruated disturbance e.g. Vaginal bleeding, amenorrhoea, hot flushes, VTE, endometrial cancer (Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer)
What are some common drugs that can exacerbate psoriasis ?
Beta-blockers
Anti-malarials (chloroquine + hydroxychloroquine)
NSAIDs
ACE-I
Infliximab
Which drugs can worsen seizure control in patients with epilepsy?
Alcohol, cocaine, amphetamines Ciproflaxacin levofloxacin Aminophylline theophylline Buproprion Methylphenidate (ADHD) Mefenemic acid
What are the main side-effects of Phenytoin?
Dizziness, Nystagmus, Ataxia, dyskinesia
Coarse facial features, acne, hirsutism, Gum Hypertrophy (Due toincreased expression of platelet derived growth factor, PDGF)
Osteomalacia due to enhanced vitamin D metabolism
Increased Hair growth
Megaloblastic Anaemia (Anti-folate)
Peripheral neuropathy
Describe cholestyramine and its side-effects
Bile acid sequestration used in second line management of hyperlipidaemia in those not tolerant of statin.
Side-effects: constipation, bad taste, gallstones, reduced absorption of fat-soluble vitamins.
Describe Omeprazole, its indications, and side-effects
A proton-pump inhibitor.
Indications: PUD, GORD, Zollinger-Ellison syndrome, upper GI bleed post endoscopy
SEs:
- GI upset e.g. Nausea vomiting, diarrhoea, constipation
- Osteoporosis with prolonged use
- headache
- increased risk of c.diff
What are some drug causes on anaphylactoid reactions?
N-acetylcysteine
Opiates
IV contrast
Vancomycin
Describe Trastuzamab and its side effects.
Aka Herceptin a monoclonal antibody directed against the HER2/neu receptor. It is used mainly in metastatic breast cancer although some patients with early disease are now also given trastuzumab.
SE’S:
- Flu-like symptoms and diarrhoea are common
- cardiotoxicity (more common when anthracyclines have also been used, an echo is usually performed before starting treatment.
What are the side-effects of carboplatin
Vestibulocochlear nerve palsy
Neurotoxicity
Nephrotoxicity
Which common anti-hypertensives are contraindicated in pregnancy?
ACE-inhibitors and amlodipine
What are the side-effects of donepezil?
AV block
What is DRESS syndrome?
Drug Reaction with Eosinophilia and Systemic Symptoms.
Caused by exposure to certain medications that may result in a rash, fever, inflammation of internal organs, lymphadenopathy, thrombocytopenia.
What are some drug causes of Gingival Hyperplasia?
Phenytoin
Ciclosporin
Calcium Channel blockers especially nifedipine
Describe Teicoplanin, its indications and side-effects
Glycopeptide antibiotic against aerobic and anaerobic Gram-positive bacteria including MRSA, similar to vancomycin but has longer duration of action allowing once daily administration after loading dose
Dose 400mg every 12 hours for 3 doses followed by 400g OD should not be given orally
Side-effects include pruritus, rash, eosinophilia, nephrotoxicity
Describe Vancomycin, its indications, side-effects, and monitoring.
Glycopeptide bactericidal against aerobic and anaerobic Gram-positive bacteria including MRSA. Penetration into CSF is poor. Given as IV infusion. Loading dose is dependent on patients weight, maintainence dose is dependant on creatinine clearance.
Side effects include nephrotoxicity, blood disorders including neutropenia, ototoxicity.
Monitoring: All patients require plasma-vancomycin measurement after 2-3 days if renal function normal more frequent if renal impairment. Pre dose trough concentration should be 10-15mg/L (15-20mg/L for endocarditis or MRSA). If dose is under or over therapeutic window move up or down the maintainence dose chart.
Describe Cyclophosphamide and its side-effects.
An Alkylating agent used in the management of cancer and autoimmune conditions. It works by cross-linking DNA.
Side-effects:
- Haemorrhagic Cystitis - incidence reduce with hydration and Mesna
- Myelosuppression
- Transitional cell carcinoma
Describe Mesna and its mechanism of action.
2-MErcaptoethane Sulfonate Na
A metabolite of cyclophosphamide called acrolein is toxic to urothelium Mesna binds to and inactivated acrolein helping to prevent haemorrhagic cystitis.
Describe Ciclosporin it indications and side-effects.
An immunosuppressant which decreases clinal proliferation of T cells by reducing IL-2 release. It acts by binding to cylophilin forming a complex which inhibits calcineurin, a phosphotase that activates various transcription factors in T cells.
Indications:
- Organ transplantation
- RA
- Psoriasis
- Ulcerative Colitis
- Pure red cell aplasia
Side-effects: (everything increases BP, Fluid, K, Hair, Glucose, Gums)
- Nephrotoxicity
- Hepatotoxicity
- Fluid Retention
- Hypertension
- Hyperkalaemia
- Hypertrichosis
- Gingival hyperplasia
- Tremor
- Impaired glucose tolerance
- Hyperlipidaemia
- Infection
Describe Dopamine Receptor Agonists and their role in Parkinson’s Disease and side effects.
E.g. Bromocriptine, Ropinirole, Carbergoline, Apomorphine.
Ergot-derived dopamine receptor agonists e.g. Bromocriptine, Cabergoline have been associated with pulmonary, retro Peritoneal and cardiac fibrosis. Echo ESR creatinine and CXR should be obtained prior to treatment and closely monitored.
Patients should be warned about the potential for dopamine receptors agonists to cause impulse control disorders and excessive daytime somnolence.
More likely than levodopa to cause hallucination in older patients and nasal congestion and postural hypotension may be seen.
Describe Levodopa is role in Parkinson’s disease and side effects.
Usually combined with a decarboylase inhibitor e.g. Carbidopa or benserazide to prevent peripheral metabolism.
Reduced effectiveness with time usually by 2 years.
Side-effects: dyskinesia, on-off effect, dry mouth, anorexia, palpitation, postural hypertension, psychosis and drowsiness.
Not used in neuroleptic induced Parkinsonism
Describe Monoamine Oxidase-B inhibitors and their roles in Parkinson’s.
E.G. Selegiline
Inhibits breakdown of dopamine secreted by dopaminergic neurons.
Describe Catechol-O-Methyl Transferase Inhibtors.
E.g. Entacapone, tolcapone
COMT is an enzyme involved in breakdown of dopamine and hence may be used as an adjunct to levodopa therapy.
Describe Nicorandil and its side effects.
An anti-angina mediation that acts as a nitrate and K+ATP channel agonist. Causing vasodilation
Side effects: Headache, Flushing, Anal ulceration
What is the dose of naloxone used in opioid toxicity?
Initially 400mcg and then 800mcg for up to two doses at 1 minute intervals or until the patient is conscious and has a normal respiratory rate. If two doses of 800mcg do not work then consider 2mg for one dose or up to 4mg for seriously toxic patients. If respiratory rate is not normalised after 5-10mg of naloxone consider alternative diagnosis.
Naloxone infusion can be started at 60% of the initial resuscitation dose per hours. The initial resuscitation dose is the amount need to restore respiratory rate of 15 minutes.
Describe Methotrexate and its side-effects
An Anti-metabolite which interferes with normal cellular metabolism of nucleic acids by inhibiting dihydrofolate reductase (
PPIs can delay excretion of methotrexate
Side-effects: myelosuppression, mucosa this, liver fibrosis, lung fibrosis.
To reduce risk of myelosupression folic acid 1-5mg/day is given alongside treatment. In case of acute methotrexate toxicity folinic acid rescue is given typically 12-36hrs after methotrexate infusion.
Describe Arachnidonic acid metabolism and describe the roles of its products.
Arachnidonic acid is produced from phospholipids via phospholipase A2. Two main enzymes act on Arachnidonic acid lipoxygenase and COX-1/-2.
Lipoxygenase pathway: Arachnidonic acid via this enzymes produces HPETEs which goon to produce Leukotrines. LB4 plays a role in neutrolphil chemotaxis and LA4, LC4, LD4, LE4 all play a role in bronchoconstriction. Remember B4 leukocytes comes LTB4.
COX-1/-2 Pathway: Arachnidonic acid via this enzyme produces endoperoxides. Prostacyclin (PGI2) which causes decreased Platelet aggregation and decreased uterine tone. Prostaglandin (PGE2) which causes increased pain/temperature/uterine tone, gastric mucus/ decreased gastric acid and various effects on vascular smooth muscle and airways. Thrombocytes cause thrombosis by increase Platelet aggregation and causing vasoconstriction.
What are the side-effects of thyroxine therapy?
- Hyperthyroidism due to over treatment
- Reduced bone mineral density
- Worsening of angina
- Atrial fibrillation
What are the main side-effects of Calcineurin inhibitors?
Both Tacrolimus + Ciclosporin:
- HTN
- Neuro
- Hyperkalaemia
- Nephrotoxicity CKD.
Tacrolimus specific:
- New Onset Diabetes after transplantation
- Diarrhoea
Ciclosporin Specific:
- Gum hypertrophy
- Hirsutism
Describe oseltamivir and it’s side effects
An oral neuraminidase inhibitor used in the treatment of flu. It acts to prevent new viral particles from being released by infected cells.
Side-effects:
Nausea, vomiting, diarrhoea, Headaches
Describe zanamivir and it’s side effects.
An inhaled neuraminidase inhibitor used in treatment of influenza. It acts to prevent new viral particles from being released by infected cells.
Side effects:
May induce bronchospasm in asthmatics
What is the relationship in terms of strength of furosemide and bumetanide
Bumetanide is 40times more potent than furosemide
I.e. 40mg Furosemide = 1mg Bumetanide
What is Anakinra?
An IL-2 Inhibitor used in Acute Complex gout, RA, Adult onset Stills disease, Macrophage activation syndrome.
Describe Endothelin Receptor Antagonists and their uses.
Three main types exists.
- Selective ETa Receptor Antagonist e.g. Sitaxentan, atrasentan, Ambrisentan.
- Selective ETb Receptor Antagonists which are used in research but not yet clinically.
- Dual anatagonists (Bosentan) working on both A and B receptors.
Sitaxentan, ambrisentan and bosentan are mainly used for the treatment of pulmonary arterial hypertension.
Atrasentan is an experimental anti-cancer drug.
Describe Ivabradine and its side-effects, and uses.
A new class of anti-anginal/HF drug which works by reducing the heart rate. Acts on the If (funny) ion current which is highly expressed in the sinoatrial node, reducing cardiac pacemaker activity.
Side-effects: Visual affects (particularly luminous phenomena), headache, bradycardia. Atrial fibrillation
Uses: Heart failure, Angina, Some evidence for its use in Inappropriate Sinus Tachycardia.
What is acetylator status and which drugs can it affect?
Many drugs are metabolised in the liver by acetylation. However unto 50% of the UK population is deficiency in hepatitic N-acetyltransferase, meaning they are more likely to accumulate drugs that require acetylation. These patients are known as slow acetylators.
Drugs affected include (PS HID):
- Procainamide
- Sulfasalazine, Sulphonamides
- Hydralazine
- Isoniazid
- Dapsone
What is First-pass metabolism and which drugs does it affect?
This is a phenomenon where the concentration of a drug is greatly reduced before it reaches the systemic circulation due to hepatic metabolism. As a consequence much larger disease are needed orally than if given by other routes. This effect is seen in many drugs including:
- Aspirin
- Isosorbide Dinitrate
- Glyceryl Trintrate
- Lignocaine
- Propanalol
- Verapamil
- Isoprenaline
- Testosterone
- Hydrocortisone
What is zero-order kinetics and which drugs does it affect?
Zero-order kinetics describes metabolism which is independent of the concentration of the reactant. This is due top metabolic pathways becoming saturated resulting in a constant amount of drug being eliminated per unit time. This explains why people may fail a breathalyser test in the morning if they have been drinking the night before. Drugs exhibiting zero-order kinetics include:
- Phenytoin
- Salicylates (e.g. high dose aspirin)
- Heparin
- Ethanol
What is the mechanism of drug metabolism?
Drug metabolism usually involves two types of biochemical reactions - Phase I and II reactions.
- Phase I reactions : Oxidation, reduction, hydrolysis. Mainly performed by the P450 enzymes but some drugs are metabolised by specific enzymes, for example alcohol dehydrogenase and xanthine oxidase. Products of Phase I reactions are typically more active and potentially toxic.
- Phase II reactions: Conjugatuon. Products are typically inactive and excreted in urine or bile. Glucuronyl, acetyl, methyl, sulphate and other groups are typically involved.
Describe Trimethoprim, its mechanism of action, and side effects
Trimethoprim is an antibiotic, mainly used in the management of urinary tract infections
Mechanism of action: Interferes with DNA synthesis by inhibiting dihydrofolate reductase
Adverse effects:
- myelosupression
- Transient rise in creatinine, trimethoprim competitively inhibits the tubular secretion of creatinine resulting in a temporary increase which reverse upon stopping the drug
Describe Nicotinic Acid and its side-effects.
Nicotinic acid is used in the treatment of patients with hyperlipidaemia, although its use is limited by side-effects. As well as lowering cholesterol and triglyceride concentrations it also raises HDL levels.
Side-effects:
- Flushing
- Myositis
- Impaired glucose tolerance
Describe Aminosalicylate drugs, the main types and the side-effects of each.
5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an anti-inflammatory. The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis.
Sulphasalazine:
- A combination of Sulphapyridine (A sulphonamide) and 5-ASA.
- Side-effects include Rashes, oligospermia, headache, heinz body anaemia, megaloblastic anaemia, lung fibrosis (Mostly due to the sulphonamide aspect). Also side-effects common to 5-ASA drugs
Mesalazine:
- a delayed release form of 5-ASA
- Sulphapyridine side-effects seen with sulfasalazine are avoided
- Mesalazine is still associated with GI Upset, Headache, Agranulocytosis, Pancreatitis (7 times more common in mesalazine than sulfasalazine), interstitial nephritis
Olsalazine:
-Two molecules of 5-asa linked by a diazo bond, which is broken by colonic bacteria.
Describe Octreotide, its uses and side effects
Long acting analogue of somatostatin. Somatostatin is release from D cells of pancreas and inhibits the release of growth hormone, glucagon and insulin.
Uses:
-acute treatment of farcical haemorrhage, acromegaly, carcinoid syndrome, prevent complications following pancreatic surgery, VIPomas, refractory diarrhoea.
Side-effects:
-Gallstones secondary to biliary stasis.
Describe Meglitinides and theirs side effects
Diabetic medications e.g. Repaglinide, nateglinide. Insulin secretagogues like sulphonylureas they bind to an ATP-dependent K Chanel on the cell membrane of pancreatic beta cells. Often used for patients with an erratic lifestyle.
Side effects: Weight gain and hypoglycaemia (less so than sulfonylureas)
What is Naftidrofuryl?
A vasodilator used in the management of peripheral arterial disease. The drug acts as a selective 5-HT2A receptor antagonist.
Side effects include nausea, abdominal pain and rash. Rarely hepatitis and liver failure have been reported.
What is ethosuximide?
An antiepileptic particularly indicated in patients with absence seizures. It blocks T-type calcium channels in the thalamic neurones.
Describe Aminophylline, its mechanism of actions, indications and side effects.
Acts as a bronchodilator, a short acting less potent version of theophylline. aka to decreased sedative effects of propofol and decrease topiramate anti-seizure action
Indications: IECOPD, Exacerbation of Asthma.
Mechanism of action:
- Competitive non-selective phosphodiesterase inhibitors, which raises intracellular cAMP, activates pKA, inhibits TNF-a and leukotriene synthesis, reduces inflammation.
- Non-selectie adenosine receptor antagonist.
- This leads to bronchodilation, diuresis, cardiac stimulation (increases heart rate and contractility), gastric acid secretion.
Side-effects:
-N+V, Diarrhoea, Headache, Restlessness, flushing, tachycardia, hypotension, hypokalaemia, dilated pupils, arrhythmias.
Describe Carbamazepine and its side-effects
A common anti-epileptic, act by blocking voltage gated sodium channels preventing repetitive and sustained firing of an action potential.
Side-effects: N+V, Cerebellar toxicity, teratogenic, SIADH, Agranulocytosis, increased risk of suicide.
What is Eculizumab?
Monoclonal antibody used in the treatment of Paroxysmal Nocturnal Haemoglobinuria and Atypical Haemolytic Uraemic Syndrome.
Which foods must be avoided in patients taking MAO-inhibitors?
Monoamine Oxidase inhibitors can lead to increased tyramine levels which can result in critically hight blood pressure.
Foods high in tyramine:
- Meat products: Liver, Fermented sausages, luncheon meats.
- Fish products: Caviar, cured fish, shrimp paste
- Milk Products: aged cheeses, sour cream, yoghurt
- Fruits and vegetables: Avocados, bananas,, fava beans, green beans, snow peas, sauerkraut.
- Alcohol: red wines, sherry, beer
- Yeasted foods: Miso, Soy, Marmites
What are thioamides?
A group of drugs used to control thyrotoxicosis. They inhibit the enzyme thyroid peroxidase in the thyroid reducing the synthesis of t3 and T4. They also block iodine release from peripheral hormone.
Examples include, Carbimazole, and propylthiouracil
What are the drugs used in alcohol dependance?
Acamprosate : GABA agonist + NMDA antagonist to prevent relapse
Naltrexone: Partial Opioid Antagonist reduced high from alcohol
Disulfiram: Produces unpleasant reaction with alcohol.
Describe Aprepitant and its side-effects
An antiemetic Substance P antagonists that works by blocking the neurokinin 1 receptor. It is used for the management of chemotherapy induced nausea and vomiting.
Side-effects: Constipation, Asthenia, Dyspepsia, Headache, Hiccups.
Which HIV medication is most associated with lipoatrophy?
Stavudine
Describe Vigabatrin and its side effects:
An antiepileptic drug that inhibits breakdown of GABA by acting as a suicide inhibitor of GABA-T.
Side Effects: Visual field defects,
What is Haem arginate?
Haem arginate is a compound of Haem and arginate used in the treatment of acute porphyria. Haem arginate is a haem compound whereby L-arginine is added to prevent rapid degredation. It is given IV and its action of mechanism is to reduce the over production of Delta-aminolevulinic acid which can cause the acute symptoms in an attack of the acute porphyria.
What is alitretinoin?
A retinoids. (Form of vitamin A) licensed for the treatment of chronic hand eczema resistant to topical steroids or oral immunosuppressants
What are the characteristic side effects of cisplatin?
Ototoxicity
Peripheral neuropathy
Hypomagnesaemia
What are Neprilysin inhibitors?
Neprilysin is a neutral endopeptidase and its inhibition increases the bioavailablity of natriuretic peptides, bradykinin, and substance P. Resulting in natriuretic, vasodilatory and anti-proliferative effects. These effects produce a powerful ventricular unloading and antihypertensive response.
What is moxonidine and its side effects?
Alpha-2/imadazoline receptor agonist, anti hypertensive. May have a role when thiazides, betablockers, ACE-inhibitors and calcium channel blockers are not appropriate.
Side-effects: Dry mouth, headache, fatigue, intermittent facial oedema. Sleep disturbance, dizziness.
Describe obeticholic acid and its use
A semi-synthetic bile acid analogies, a farnesoid X receptor agonist, used to treat primary biliary cirrhosis.
What is cilostazol?
A quinolinone derivative used in the alleviation of symptoms of intermittant cluadiaction in PVD. Not liscenced by NICE
Describe Fibrate and their mechanism of action,
Amphipathic carboxylic acids which activate lipoprotein lipase to increase levels of HDL and lower triglyceride levels. Used in the treatment of resistant hyper cholesterolaemia or those intolerant of statins.
What is pergolide and its side effects/
An ergo line-based dopamine receptor agonist sometimes used in the treatment of Parkinson’s disease
Associated with pericarditis/ cardiac fibrosis.
Describe Indinavir and its side-effects
A Protease inhibitor used in HAART to treat HIV/AIDs
Side-effects:
- GI Upset
- Malaise
- Intratubular crystal obstruction )Nephrolithiasis
- Hyperlipidaemia
- Hyperglycaemia
- Lipodystrophy (Crix belly)
Describe Griseofulvin and its side effects.
An oral antifungal Medication that works by inhibiting the mitotic spindle of the fungus and is used for the treatment of dermatopytes
Side-effectsL
- P450 Enzyme inducer
- Allergic reactions
- GI Upset
- Insomnia
What are some drugs known to reduce the clearance of theophylline?
Allopurinol Cimetidine Ciprofloxacin Corticosteroids Diltiazem Erythromycin Frusemide Isoprenaline Oral Contraceptives Thiabendazole Verapamil
Describe Orlistat and its uses
A drug used in the treatment of obesity, it works by preventing the absorption of fats from diet acting as a lipase Inhibitor, thereby reducing caloric intake.
Side-effects: Steatorhoea, Flatbush, GI upset.
Should be stopped if patient continues to gain weight
Describe Pegylated interferon, and its side effects.
Used in treatment of Hep B/C (usually in combination with ribivarin) and multiple sclerosis.
Side-effects: VTE, Depression / Suicide. (Can be substituted for amantidine in MS)
Describe some HLA related drug reaction.
HLA B1502 is associated with Stevens-Johnson in patient of chines origin taking phenytoin
HLA A3101 is associated with Stevens-Johnson syndrome in European or Japanese patients treated with carbamazepine
HLA B5701 is assoacited with abacavir hypersensitivity, which resulted in the development of HLA screening before the medication was initiated for HIV.
HLA B5801 is associated with allopurinol hypersensitivity
What are the main side-effects of Rituximab?
Flu-like symptoms during the infusion Hypotension during the infusion Nausea + Vomiting Tumour Pain Allergic reactions Facial flushing during the infusion
Describe Quinidine and its use, and side effects.
A class 1A Antiarrhythmic that slows the rapid depolarisation that occurs during phase 0 of the cardiac potential.
It is used for the treatment of atrial and ventricular arrhytmias and is related to the antimalarials quinine.
Side-effects: Cinchonism (skin rashes, deafness, decreased visual acuity, anaphylactic shock, QT prolongation.)
Which Statins are lipophilic and due to this property what specific side effect do they have?
Simvastatin and Atorvastatin
Increased abnormal dreams and CNS Side-effects
Describe Teriparatide and its side-effects
A form of Reombinant Parathyroid hormone. Effective anabolic agent used in second/third line osteoporsis to promote bone formation.
Side-effects: Headache, Nausea, Limb pain
