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Phase 1c: Conditions > Pharmacology and Electrolytes > Flashcards

Pharmacology and Electrolytes Flashcards

1
Q

What are the side effects of ACEi?

A

Cough (due to raised bradykinin levels)
Angioedema
Hyperkalaemia
First dose hypotension - more common in patients taking diuretics

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2
Q

When should ACEi be avoided?

A

Pregnancy and breastfeeding
Renovascular disease
Aortic stenosis

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3
Q

What are some causes of hyperkalaemia?

A

AKI
Drugs: ACEi, ARB, potassium sparing diuretics, spiranolactone
Metabolic acidosis
Addison’s disease
Rhabdomyolysis
Massive blood transfusion

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4
Q

What are the ECG changes seen in hyperkalaemia?

A

Tall tented T-waves
Small P waves
Widened QRS
Asystole
Ventricular fibrillation

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5
Q

how is hyperkalaemia treated?

A

IV 10ml 10% calcium gluconate
insulin/dextrose infusion

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6
Q

What are the ECG features of hypokalaemia?

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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7
Q

What are some causes of hypokalaemia with alkalosis?

A

vomiting
thiazide and loop diuretics
Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)

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8
Q

What are some causes of hypokalaemia with acidosis?

A

diarrhoea
renal tubular acidosis
acetazolamide
partially treated diabetic ketoacidosis

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9
Q

What are some side effects of thiazide-like diuretics?

A

Hypokalaemia, hyponatraemia, hypercalcaemia
dehydration
postural hypotension
gout
impaired glucose tolerance
impotence

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10
Q

What are the types of calcium channel blockers?

A

Dihydropyridine (nifedipine, amlodipine) - vasodilation of peripheral blood vessels
Non-dihydropyridine (diltiazem, verapamil) - decrease heart rate and myocardial contractility

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11
Q

What are the side effects of dihydropyridines?

A

Symptoms caused by vasodilation of peripheral blood vessels
Short-acting dihydropyridines (e.g. nifedipine) can cause reflex tachycardia
Flushing
Headache
Ankle swelling

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12
Q

What are dihydropyridines used to treat?

A

Hypertension
Angina
Raynaud’s phenomenon

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13
Q

What is the difference between positive and negative inotropes?

A

Positive inotropes increase heart contractility
Negative inotropes decrease heart contractility

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14
Q

What are the indications for verapamil?

A

Angina, hypertension, arrhythmias - it is highly negatively ionotropic

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15
Q

What are the indications for diltiazem?

A

Angina, hypertension - less negatively ionotropic than verapamil

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16
Q

What are the contraindications and side effects of verapamil?

A

Use with beta-blockers can cause heart block
Heart failure
Constipation
Hypotension
Bradycardia
Flushing

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17
Q

What are the contraindications and side effects of diltiazem?

A

Hypotension
Bradycardia
Heart failure
Ankle swelling

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18
Q

What are the side effects of amiodarone?

A

Hypothyroidism and hyperthyroidism
Corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Bradycardia
Lengthens QT
Photosensitivity
‘slate grey’ appearance

19
Q

What are the adverse interactions of amiodarone?

A

Decreased metabolism of warfarin, therefore increased INR
increased digoxin levels

20
Q

What are the side effects of beta blockers?

A

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

21
Q

What are the contraindications for beta blockers?

A

uncontrolled heart failure
asthma
sick sinus syndrome
concurrent verapamil use: may precipitate severe bradycardia

22
Q

What are the features of hypocalcaemia?

A

prolonged QTc interval
tetany: muscle twitching, cramping, spasm
perioral paraesthesia
Trousseau’s sign
Chvostek’s sign

23
Q

what are the features of hypercalcaemia?

A

shortened QTc interval
hypertension
stones
depression
abdominal pain

24
Q

how is hypercalcaemia treated?

A

rehydration with normal saline - typically 3-4l/day
following rehydration, bisphosphonates
furosemide if patients can’t handle aggressive fluid resuscitation

25
Q

what are the contraindications for statins?

A

macrolides (e.g. clarithromycin, vancomycin)
pregnancy

26
Q

what are the adverse effects of statins?

A

myopathy
liver impairment - check LFTs at baseline, 3 months and 12 months
?risk of intracerebral haemorrhage

27
Q

what are the side effects of nitrates?

A

hypotension
tachycardia
headaches
flushing

28
Q

what are the side effects of sodium valproate?

A

teratogenic
hair loss
weight gain
ataxia
tremor
GI: nausea

29
Q

what are the side effects of lamotrigine?

A

Steven-Johnsons syndrome

30
Q

what are the side effects of carbamazepine?

A

dizziness and ataxia
drowsiness
headache
visual disturbances (diplopia)
Steven-Johnson syndrome
hyponatraemia

31
Q

what are the side effects of adenosine?

A

chest pain
bronchospasm
flushing

32
Q

what are the causes of metabolic acidosis with normal anion gap?

A

GI bicarbonate loss
renal tubular acidosis
ammonium chloride injection
Addison’s disease

33
Q

what are the causes of metabolic acidosis with raised anion gap?

A

raised lactate: sepsis, shocks, burns, hypoxia, metformin
ketones: DKA, alcohol
urate: renal failure
acid poisoning: salicylates, methanol

34
Q

what are the causes of metabolic alkalosis?

A

vomiting/aspiration - vomiting can also lead to hypokalaemia
diuretics
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome

35
Q

what are the causes of respiratory acidosis?

A

COPD, severe asthma
neuromuscular disease, e.g. myasthenia gravis, DMD
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose

36
Q

what are the causes of respiratory alkalosis?

A

anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning - mixed respiratory alkalosis and metabolic acidosis
CNS disorders: stroke, encephalitis
altitude
pregnancy

37
Q

what are the side effects of metoclopramide?

A

extrapyramidal effects - acute dystonia
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonianism
avoid in bowel obstruction!

38
Q

what are the symptoms of hyponatraemia?

A

headache
lethargy
nausea, vomiting
dizziness
confusion
muscle cramps
late: seizures, coma, respiratory arrestt

39
Q

how is chronic hypovolaemic hyponatraemia treated?

A

0.9% NaCl
if serum sodium rises, supports diagnosis of hypovolaemic hyponatraemia
if serum sodium falls, suggests SIADH

40
Q

how is euvolaemic hyponatraemia treated?

A

fluid restrict to 500-1000mL/day
consider: vaptans (ADH receptor antagonist, increases diuresis), demeclocycline

41
Q

how is hypervolaemic hyponatraemia treated?

A

fluid restrict tot 500-1000mL/day
consider: vaptans, loop diuretics

42
Q

how is acute hyponatraemia treated?

A

hypertonic saline (3% NaCl)

43
Q

what are the complications of hyponatraemia management?

A

central pontine myelinolysis due to over-correction of severe hyponatraemia
irreversible symptoms:
dysarthria
dysphagia
paraparesis
seizures
confusion
coma

Phase 1c: Conditions (18 decks)

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