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Acute Care > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What do you need to remember about naloxone?

A

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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2
Q

What is amiodarone?

A 
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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3
Q

What is flecainide?

A

Na+ channel blocker

Class I C anti-arrhythmic

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4
Q

What is sotalol?

A

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

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5
Q

What is verapamil?

A 
Non-dihydropyridine Ca2+ channel blocker
Class IV anti-arrhythmic
Hepatic metabolism
Can cause AV block
Rate limiting
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6
Q

What receptors does noradrenaline work on?

A

+++ alpha-1
+++ alpha-2
+ ß1

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7
Q

What receptors does adrenaline work on?

A

+++ alpha-1
++ alpha-2
+++ ß1
++ ß2

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8
Q

What receptors does dopamine work on?

A 
\++ alpha-1
\+ alpha-2
\++ ß1
\+++ ß2
\+++ DA
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9
Q

What receptors does dobutamine work on?

A

+ alpha-1
+++ ß1
+ ß2

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10
Q

What receptors does isoproterenol work on?

A

++ ß1

++ ß2

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11
Q

Why is verapamil and bisoprolol a bad combination?

A

Verapamil causes AV block

Combined with ß-blocker-> bradycardia

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12
Q

What is ciprofloxacin?

A 
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&V, MRSA promotion
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13
Q

Issues with metformin in an acute patient?

A 
Can potentiate hypoglycaemia
Raises lactate (confuses clinical picture)
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14
Q

Warfarin and diclofenac co-prescription is bad because:

A

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

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15
Q

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

A

NSAIDs, ACEi and betablockers

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16
Q

Causes of poor pain relief

A
  • 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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17
Q

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

A

Paracetamol

NSAID

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18
Q

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

A

Weak opioid (codeine)
Paracetamol
NSAID

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19
Q

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

A

Strong opioid
Paracetamol
NSAID

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20
Q

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

A

Nerve block
Epidurals
PCA pump
Spinal stimulators

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21
Q

What is the proper name for paracetamol?

A

Acetaminophen

22
Q

Dose of paracetamol

A

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

23
Q

SE of NSAIDs

A

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

24
Q

Contraindications of NSAIDs

A

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

25
Q

Why is effect of codeine variable?

A

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

26
Q

What opioid is best in renal failure

A

Fentanyl (doesn’t accumulate)

27
Q

Which opioid is best in obstetrics

A

Pethidine

28
Q

Which opioid is better tolerated that codeine?

A

Oxycodone

29
Q

SE of opioids

A

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

30
Q

What is a PCA?

A

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

31
Q

Contraindications to local anaesthetics

A

Patients refusal, shock, sepsis, coagulopathy, neuro disease

32
Q

What are other meds used for pain relief

A

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

33
Q

Contraindications to entonox

A

Pneumothorax
Bowel obstruction
Air embolus

34
Q

Define MRSA

A

Meticillin, flucloxicillin resistant staph aureus

De-colonisation treatment is given to eradicate is esp pre operatively, if admitted to a ward, in susceptible patients.

35
Q

What predisposes someone to C.diff?

A
  • Broad spectrum/cephalosporin antibiotic use
  • Bowel surgery
  • PPI use
  • Malnutrition
  • TPN
36
Q

Treatment of C.diff

A

Metronidazole

Complicated: Vancomycin/fidaxomycin orally for 14 days

37
Q

Complications of C.diff

A

Can develop into toxic megacolon/pseudomembranous colitis

38
Q

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

A

Co-trimoxazole, trimethoprim, rifampicin
Tetracyclines
Quinolones

39
Q

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

A

chloramphenicol, co-trimoxazole, nitrofurantoin, rifampicin
Tetracyclines
Quinolones

40
Q

How much Na is required per day?

A

1-2mmol/kg/day

41
Q

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

A

60 days

42
Q

What should be taken into consideration when prescribing maintenance fluid?

A
  • Age
  • Weight
  • Co-morbidity, eg heart failure
  • Clinical situation (well/ill)
  • Medications
  • Anticipated ‘nil by mouth’ period
43
Q

How much potassium is needed per day?

A

0.7-1mmol/kg/day

44
Q

How many calories are needed per day (baseline)

A

25kCal/kg/day

45
Q

How much chloride is needed?

A

Same at sodium

1-2mmol/kg/day

46
Q

What fluid is used to treat hypoglycaemia in diabetes?

A

20% dextrose + insulin

47
Q

When is fluid loss ‘pure water’?

A

Fever, dehydration, hyperventilation

48
Q

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

A

Chloride
Potassium
H+
= metabolic alkalosis

49
Q

What do you become deficient in with biliary drainage loss

A

Na+
K+
Cl-
HCO3-

50
Q

What do you become deficient in with inappropriate urinary loss

A

K+
H+
(variable)

51
Q

Diarrhoea loss?

A

Na+
K+
HCO3-

52
Q

When should fluids be given in a pt with ileus?

A

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.

Acute Care (11 decks)

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