Pharmacology and Electrolytes Flashcards by Sreenithi Balaji

What are the side effects of ACEi?

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

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When should ACEi be avoided?

Pregnancy and breastfeeding
Renovascular disease
Aortic stenosis

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What are some causes of hyperkalaemia?

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

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What are the ECG changes seen in hyperkalaemia?

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

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how is hyperkalaemia treated?

IV 10ml 10% calcium gluconate
insulin/dextrose infusion

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What are the ECG features of hypokalaemia?

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

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What are some causes of hypokalaemia with alkalosis?

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

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What are some causes of hypokalaemia with acidosis?

diarrhoea
renal tubular acidosis
acetazolamide
partially treated diabetic ketoacidosis

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What are some side effects of thiazide-like diuretics?

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

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What are the types of calcium channel blockers?

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

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What are the side effects of dihydropyridines?

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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What are dihydropyridines used to treat?

Hypertension
Angina
Raynaud’s phenomenon

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What is the difference between positive and negative inotropes?

Positive inotropes increase heart contractility
Negative inotropes decrease heart contractility

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What are the indications for verapamil?

Angina, hypertension, arrhythmias - it is highly negatively ionotropic

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What are the indications for diltiazem?

Angina, hypertension - less negatively ionotropic than verapamil

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What are the contraindications and side effects of verapamil?

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

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What are the contraindications and side effects of diltiazem?

Hypotension
Bradycardia
Heart failure
Ankle swelling

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What are the side effects of amiodarone?

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

What are the adverse interactions of amiodarone?

Decreased metabolism of warfarin, therefore increased INR
increased digoxin levels

What are the side effects of beta blockers?

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

What are the contraindications for beta blockers?

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

What are the features of hypocalcaemia?

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

what are the features of hypercalcaemia?

shortened QTc interval
hypertension
stones
depression
abdominal pain

how is hypercalcaemia treated?

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

what are the contraindications for statins?

macrolides (e.g. clarithromycin, vancomycin) pregnancy

what are the adverse effects of statins?

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

what are the side effects of nitrates?

hypotension tachycardia headaches flushing

what are the side effects of sodium valproate?

teratogenic hair loss weight gain ataxia tremor GI: nausea

what are the side effects of lamotrigine?

Steven-Johnsons syndrome

what are the side effects of carbamazepine?

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

what are the side effects of adenosine?

chest pain bronchospasm flushing

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

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

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

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

what are the causes of metabolic alkalosis?

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

what are the causes of respiratory acidosis?

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

what are the causes of respiratory alkalosis?

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

what are the side effects of metoclopramide?

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

what are the symptoms of hyponatraemia?

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

how is chronic hypovolaemic hyponatraemia treated?

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

how is euvolaemic hyponatraemia treated?

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

how is hypervolaemic hyponatraemia treated?

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

how is acute hyponatraemia treated?

hypertonic saline (3% NaCl)

what are the complications of hyponatraemia management?

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