PHARMACOLOGY Flashcards
ADR: Dry Mouth
MAOIs
Anti-histamines
Phenothiazines
Amphetamines
Treat with Pilocarpine (Muscarinic Receptor Agonist)
What are the PY450 Inhibitors?
Sodium Valproate Isonazids Cimetidine Ketonazole + Fluconazole (anti-fungals) Fluoxetine Alcohol Clarithromycin Erythromycin Sulphonamides Ciprofloxacin Omeprazole Metronidazole
What are the PY450 Inducers?
Carbemazapine Rifampicin Alcohol (chronic) Phenytoin Sulphonylureas and St. John's
What are the ADRs of ACEi?
Cough
Urticaria
Hyperkalaemia
What are the ADRs of CCBs?
Flushing
Ankle swelling (so don’t give in peripheral oedema)
Headache
What are the ADRs of Thiazides?
Hyponatraemia and kalaemia
Dehydration
Gout
What are the ADRs of A2RBs?
Hyperkalaemia
Carbimazole
Carbimazole
Carbimazole is used in the management of thyrotoxicosis. It is typically given in high doses for 6 weeks until the patient becomes euthyroid before being reduced.
Adverse effects
agranulocytosis
crosses the placenta, but may be used in low doses during pregnancy
What are the ADRs of Methotrexate?
mucositis myelosuppression pneumonitis pulmonary fibrosis liver cirrhosis
Ciprofloxacin
Achilles tendon rupture
ADRs of Rifampicin
LFT derangement
Red secretions
ADRs of Isonazid
Peripheral neuropathy (give with pyroxidine)
ADRs of Pyrazinamide
Hepatotoxic
ADRs Ethanbutol
Optic neuritis
ADRs of COCP
Phenytoin may reduce effectiveness
Hepatocecullar carcinoma and jaundice
Chloasma: increased facial and areolar pigmentation
What drugs can cause photosensitivity?
Amiodarone Chorprompamide Sulphonamides Quinine Psoralens
What are the ADRS of ACEi?
Cough
Hyperkalaemia
What are the ADRS of Bendroflumethiazide?
Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
What are the ADRS of Calcium Channel Blockers?
Headache
Flushing
Ankle oedema
What are the ADRS of Beta Blockers?
Bronchospasm (especially in asthmatics)
Fatigue
Cold peripheries
What is the ADR of Doxazocin?
Postural hypotension
What drugs may induce Hypoglycaemia?
Alcohol
B-Blockers
Pentamidine
Quinine
ACEi and renal function
fall in GFR up to 25%
or
rise in creatinine up to 30% is acceptable
ADR: Gallstone
- Ceftriaxone
- Ecterotide
- Cholestyramine due to increased cholesterol in bile
Iron overdose
Desferrioxamine
ARDs: SSRIs
GI&STRESS GI: bleeds, nausea, dyspepsia, bloating, flatulence, diarrhoea and constipation Sweating Tremor Rashes Extrapyramidal Sexual dysfunction Somnolence Hyponatraemia
ARDs: SNRIs
HTN/HoTN Sweating Cardiotoxic in overdose- long QTc Nausea Dry mouth Headache and dizziness Sexual dysfunction
ADRs: Mirtazapine
Increase appetite-weight gain Drowsiness Dry mouth Postural hypotension Tachycardia and palpitations Oedema
ANTIDEPRESSANTS
Overall pretty much all cause sexual dysfunction. Many have cholinergic type sympathetic (fight or flight) stimulation resulting in sweating, dry mouth, constipation urinary retention, cardiac response. SSRIs cause GI upsets. SNRIs can be cardiotoxic. All except SSRIs and SNRIs can cause significant appetite stimulation and subsequent weight gain.
There are two MAO enzymes
A: adrenaline, noradrenaline, serotonin, tyramine and dopamine
B: dopamine
ADRs: TCAs
They essentially activate the FIGHT or FLIGHT response due to their activity on the cholinergic receptors. Can also cause CONVULSIONS and MOVEMENT DISORDERS.
CLOSED-ANGLE GLAUCOMA due to ANTICHOLINERGICS properties. Pupul dilates and compresses the Schlemm canals so aqueous humour cannot flow through causing a rapid build-up of pressure.
SEROTONIN SYNDOME
! SEROTONIN SYNDROME: Rare but life-threatening complication of increased serotonin activity occurring minutes after taking medication, often two serotonin affecting drugs simultaneously (SSRIs most commonly but also TCA and lithium) STOP DRUG IMMEDIATELY
1. COGNITIVE EFFECTS-> headache, agitation, hypomania, confusion, hallucinations and coma
2. AUTONOMIC EFFECTS-> shivering, sweating, hyperthermia, hypertension and tachycardia
3. SOMATIC EFFECTS-> myoclonus (muscle twitching), hyperreflexia and tremor
eventually leads to death
ALPHA-BLOCKERS
e.g. DOXAZOSIN
Postural HoTN
Drowsiness
Dyspnoea
Cough
B-BLOCKER OVERDOSE
- bradycardia
- hypotension
- heart failure
- syncope
if bradycardic then ATROPINE
in resistant cases GLUCAGON may be used
ADRs: Verapamil
- Heart failure
- constipation
- hypotension
- bradycardia, flushing
ADRs: Amlodipine
- Ankle swelling
- Headache
- Flushing
ADRs: Diltiazem
- Ankle swelling
- Heart failure
- HoTN
- Bradycardia
DIGOXIN TOXICITY
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
PRECIPITATED BY HYPOKALAEMIA and RENAL FAILURE
DOPAMINE RECEPTOR AGONISTS INDICATIONS
Parkinson’s disease
prolactinoma/galactorrhoea
acromegaly
ADRs: DOPAMINE RECEPTOR AGONISTS
nausea/vomiting
postural hypotension
hallucinations
daytime somnolence
drugs that cause URINARY RETENTION
TCAs anticholinergics opioids NSAIDs disopyramide
drug that cause CATARACTS
steroids
drug that cause CORNEAL OPACITIES
amiodarone
drugs that cause OPTIC NEURITIS
Metronidazole
Amiodarone
Ethambutol
durgs that cause RETINOPATHY
chloroquine
quinine
SILDENAFIL (Viagra)
blue vision
anterior ischaemic neuropathy
ADRs: Gentamicin
ototoxicity
nephrotoxicity
ADRs: Heparin
Bleeding
STANDARD:
Osteoporosis
Heparin-induce thrombocytopaenia
LITHIUM TOXICITY
coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion seizure coma
ADRs: Macrolides
GI.
erythromycin: nausea
cholestatic jaundice
P450 inhibitor (see below)
ADRs: amoxicillin
in mono results in RASH
ADRs: Co-amoxiclav
Flucloxacillin
Cholestasis
ADRs: Erythromycin
GI
Long QT
ADRs: Ciprofloxacin
Low seizure threshold
Tendonitis
ADRs: Metronidazole
Reacts with alcohol
ADRs: Doxycycline
Photosensitivity
ADRs: Trimethoprim
Photosensitivity
Rashes and Pruritis
Surpresses haematopoiesis
ADRs: Antipsychotics
- Parkinsonism
- acute dystonia (e.g. torticollis, oculogyric crisis)
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, most common is chewing and pouting of jaw)
- antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain - raised prolactin: galactorrhoea, impaired glucose tolerance
- neuroleptic malignant syndrome
- reduced seizure threshold (greater with atypicals)
- prolonged QT interval (particularly haloperidol)
NEUROLEPTIC MALIGNANT SYNDROME
pyrexia, muscle stiffness
