Pharmacology Flashcards by Izzy Hope

What do you need to remember about naloxone?

1/2 life only minutes (may need infusion/repeat doses)
Pt will go crazy (security?)
Pt will be in pain
Lowers pt seizure threshold

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What is amiodarone?

Class II anti-arrhythmic
K+ channel blocker
Used in chemical cardioversion
Prolong QT interval
Inhibits hepatic enzymes (be careful if used with digoxin)

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What is flecainide?

Na+ channel blocker

Class I C anti-arrhythmic

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What is sotalol?

Non cardio-selective ß-blocker
Class III anti-arrhythmic (rhythm control)
Prolongs QT interval
Renally excreted

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What is verapamil?

Non-dihydropyridine Ca2+ channel blocker
Class IV anti-arrhythmic
Hepatic metabolism
Can cause AV block
Rate limiting

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What receptors does noradrenaline work on?

+++ alpha-1
+++ alpha-2
+ ß1

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What receptors does adrenaline work on?

+++ alpha-1
++ alpha-2
+++ ß1
++ ß2

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What receptors does dopamine work on?

\++ alpha-1
\+ alpha-2
\++ ß1
\+++ ß2
\+++ DA

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What receptors does dobutamine work on?

+ alpha-1
+++ ß1
+ ß2

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What receptors does isoproterenol work on?

++ ß1

++ ß2

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Why is verapamil and bisoprolol a bad combination?

Verapamil causes AV block

Combined with ß-blocker-> bradycardia

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What is ciprofloxacin?

A quinolone Abx
Broad spectrum (gram+ and -)
Gram -ve sepsis, skin, UTI, resp
Can be used in penicillin allergy (instead of tazocin)
SE: thrush, D&amp;V, MRSA promotion

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Issues with metformin in an acute patient?

Can potentiate hypoglycaemia
Raises lactate (confuses clinical picture)

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Warfarin and diclofenac co-prescription is bad because:

Both highly protein bound, compete with eachother, more free drug
Diclofenac also causes gastritis, warfarin can cause bleeding-> GI bleeds

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What drugs should not be combined in someone with renal issues?

NSAIDs, ACEi and betablockers

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Causes of poor pain relief

Inadequate assessment
Poor choice of analgesic
Incorrect dose
Wrong frequency (24hr clock)
Wrong mode of delivery (eg orally in a pt with an ileus)

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What is the 1st step in the WHO analgesia ladder?

Paracetamol

NSAID

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What is the 2nd step in the WHO analgesia ladder?

Weak opioid (codeine)
Paracetamol
NSAID

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What is the 3rd step in the WHO analgesia ladder?

Strong opioid
Paracetamol
NSAID

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What is the 4th step in the WHO analgesia ladder?

Nerve block
Epidurals
PCA pump
Spinal stimulators

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What is the proper name for paracetamol?

Acetaminophen

Dose of paracetamol

1g/6hrly in adults >50kg
60mg/kg/day max if <50kg
90mg/kg/day max in children

SE of NSAIDs

COX-2 SE-> platelet function (increases risk of bleeding), gut mucosal damage (peptic ulceration), renal impairment, bronchospasm.

Contraindications of NSAIDs

Allergy, asthma, GI upset, coagulopathy, renal impairment, CVS disease

Why is effect of codeine variable?

Metabolism varies between individuals with codeine via CYP2D6. Oral only. Synergism with paracetamol.

What opioid is best in renal failure

Fentanyl (doesn't accumulate)

Which opioid is best in obstetrics

Pethidine

Which opioid is better tolerated that codeine?

Oxycodone

SE of opioids

n&v, bradycardia, pruritis, constipation, dizziness, sedation, hallucinations, respiratory depression, tolerance/dependence/addiction.

What is a PCA?

Patient controlled anaesthesia Syringe driver with button (locks off for 5 mins) Fentanyl/oxycodone/morphine

Contraindications to local anaesthetics

Patients refusal, shock, sepsis, coagulopathy, neuro disease

What are other meds used for pain relief

Amitriptyline & gabapentin for neuropathic pain Ketamine Clonidine Entonox (for procedures, rapid)

Contraindications to entonox

Pneumothorax Bowel obstruction Air embolus

Define MRSA

Meticillin, flucloxicillin resistant staph aureus | De-colonisation treatment is given to eradicate is esp pre operatively, if admitted to a ward, in susceptible patients.

What predisposes someone to C.diff?

* Broad spectrum/cephalosporin antibiotic use * Bowel surgery * PPI use * Malnutrition * TPN

Treatment of C.diff

Metronidazole | Complicated: Vancomycin/fidaxomycin orally for 14 days

Complications of C.diff

Can develop into toxic megacolon/pseudomembranous colitis

What antibiotics should be avoided in 1st trimester of pregnancy?

Co-trimoxazole, trimethoprim, rifampicin Tetracyclines Quinolones

What abx should be avoided in 2nd and 3rd trimester of pregnancy?

chloramphenicol, co-trimoxazole, nitrofurantoin, rifampicin Tetracyclines Quinolones

How much Na is required per day?

1-2mmol/kg/day

When would a fit person die with water and no food?

60 days

What should be taken into consideration when prescribing maintenance fluid?

* Age * Weight * Co-morbidity, eg heart failure * Clinical situation (well/ill) * Medications * Anticipated ‘nil by mouth’ period

How much potassium is needed per day?

0.7-1mmol/kg/day

How many calories are needed per day (baseline)

25kCal/kg/day

How much chloride is needed?

Same at sodium | 1-2mmol/kg/day

What fluid is used to treat hypoglycaemia in diabetes?

20% dextrose + insulin

When is fluid loss 'pure water'?

Fever, dehydration, hyperventilation

What do you become deficient in with vomiting and NG tube loss?

Chloride Potassium H+ = metabolic alkalosis

What do you become deficient in with biliary drainage loss

Na+ K+ Cl- HCO3-

What do you become deficient in with inappropriate urinary loss

K+ H+ (variable)

Diarrhoea loss?

Na+ K+ HCO3-

When should fluids be given in a pt with ileus?

1L every 12hrs through 3rd space losses if you have a paralytic ileus. Cautious about reintroduction of fluids, due to pooling of fluid, vomiting and aspiration. 24-48hrs after, wait for bowels to open.