Pharmacology and Therapeutics Flashcards
Metformin:
Drug class
Insulin sensitiser or secretagogue
MOA
Biguanide
Insulin sensitiser
Incompletely understood but:
Decreases gluconeogenesis
Increases peripheral glucose use
Decreases LDL and VLDL
Key side effects of metformin
Lactic acidosis (care in renal failure and with contrast dye) GI upset
Pioglitazone:
Drug class
Insulin sensitiser or secretagogue
MOA
Thiazolidinedione
Insulin sensitisation (peripheral)
PPAR gamma ligand. PPAR is involved in glucose and lipid homeostasis.
Gliclazide
Drug class
Insulin sensitiser or secretagogue
MOA
Sulphonylureas
Insulin secretagogue
Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.
Repaglinide
Drug class
Insulin sensitiser or secretagogue
MOA
Meglitinides
Insulin Secretagogue
Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.
Key side effects on sulphonylureas
Hypos (can be prolonged)
Weight gain
GI upset
Headache
Key side effect of pioglitazone
Weight gain
Deranged LFTs/ hepatotoxicity
Fluid retention
May exacerbate heart failure
Key side effects of repaglinide
Hypoglycaemia
also very short acting
Exenatide
Drug class
Insulin sensitiser or secretagogue
MOA
GLP-1 analogue/ Insulin secretagogues
Both
GLP-1 analogue
GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells
Increases insulin sensitivity
Key side effects of exenatide
Hypoglycaemia
GI upset
(also needs to be given by subcut injection)
Sitagliptin
DPP4 Inhibitor
Insulin secretagogue
Inhibits DPP4 which breaks down endogenous GLP-1.
GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells and increases insulin sensitivity
Key side effects of the DPP4 inhibitors
Hypoglycaemia
GI upset
For exenatide to be continued long term initially there must be clear metabolic benefit demonstrated by…
Weight fall of at least 3% and HbA1c fall of at least 11mmol (1%)
Which oral hypoglycaemic should not be used with insulin
Pioglitazone
Stepwise treatment of COPD (inhaled therapies)
For all patients:
Vaccinations, smoking cessation, pulmonary rehab if person is functionally limited by COPD.
1: PRN SABA (or SAMA)
2: If FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA
if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.
Stop any SAMA.
3: If FEV1 ≥ 50% predicted consider LABA+ICS in a combination inhaler
consider LAMA in addition to LABA where ICS is declined or not tolerated
4: Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.
Vaccinations to be offered to patients with COPD
Pneumococcal booster and annual influenza
When to use theophylline in COPD
Theophylline should only be used after a trial of short-acting bronchodilators and long-acting bronchodilators, or in patients who are unable to use inhaled therapy, as there is a need to monitor plasma levels and interactions
When to use carbocisteine in COPD
Mucolytic drug therapy should be considered in patients with a chronic cough productive of sputum.
They should not be used to prevent exacerbations.
When to start long term oxygen therapy in COPD
Non smokers!!! and any of the following:
Clinically stable with PaO2<7.3 (2 occasions >3/52 apart)
PaO2 7.3-8 with: PHT, cor pulmonale, polycythaemia, nocturnal hypoxaemia.
Terminally ill
MRSA eradication
Mupirocin (nasal) and chlorhexidine wash.
Acute management of non-self limiting seizures (if no IV access)
Rectal diazepam 10mg. Repeated if necessary after 10-15 minutes.
Side effects of sulfasalazine due to the sulphapyridine moiety
Rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia
2nd Line pharmacological treatment of IBS
Low dose tricyclic
Summarise the symptomatic treatment of MS
Fatigue: Modafanil
Depression: SSRI
Pain: Amitryptylline or gabapentin
Spasticity: Physio, baclofen (1st line drug), dantrolene, Botox
Urinary Urgency/frequency: Oxybutynin, tolterodine
ED: Sildenafil
Tremor: Clonazepam
Drugs that worsen mysasthenia gravis weakness
B blockers Gentamicin Phenytoin Macrolides Tetracyclines Opiates
Acute treatment of cluster headaches
Sumatriptan subcut or nasal (NOT ORAL)
100% oxygen
Prophylaxis of cluster headache
Verapamil or prednisolone
Side effects of sodium valproate
Appetite increase (and weight) Liver failure (monitor LFTs over first 6 months) Pancreatitis Reversible hair loss Oedema Ataxia Tertaogenicity, thrombocytopenia, tremor Encephalopathy
Initial treatment of cryptococcal meninigitis
Amphotericin B and flucytosine
Follow up treatment with fluconazole
If HIV infeected also optimise ARVs
Treatment of toxoplasmosis
Pyrimethamine, sulfadiazine, folate
First line options for treatment of neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin
First line for ‘rescue therapy’ in neuropathic pain
Tramadol
Common side effects of triptans
Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
Contraindications for use of triptans
Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease
Essential tremor is improved by…
Propranolol and alcohol
Drug that shows survival benefit in motor neuron disease
Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months
Management of motor neurone disease
Riluzole
prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months
Respiratory care
non-invasive ventilation (usually BIPAP) is used at night
studies have shown a survival benefit of around 7 months
50% of patients will die within 3 years.
Enzyme inhibitors
Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol..binge drinking/Allopurinol Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole
Enzyme inducers
Carbamezapine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbital Sulphonylureas
Key side effects of thiazides
HYPER effects in serum:
HYPERuricemia (precipitate acute gouty arthritis)
HYPERcalcemia (renal calcium resorption, decrease calcium in urine)
HYPERglycemia
HYPERlipidemia (increase choleterol and LDL)
HYPO effects in serum:
HYPOkalemia
HYPOtension (decreases blood volume and peripheral vascular resistance)
NICE fluid requirments recommendations for maintenance fluids
In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:
25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis
Drugs that preciptate gout
NSAIDs, diuretics (thiazides), cytotoxics, pyrazinamide.
Treatment of acute gout
First line: NSAID (diclofenac or indomethacin)
Second line: Colchicone
In renal impairment: steroids (NSAID and colchicine CI)
Common s/e of colchicine
Diarrhoea
Prevention of gout (medications)
1st line: Xanthine oxidase inhibitors. Allopurinol first choice. Febuxostat is hypersensitivity.
2nd line: Uricosuric drugs. Probenicid, Losartan. These are rarely used.
Recombinant urate oxidase may be used before cytotoxic therapy.
Side effects of xanthine oxidase inhibitors
Rash, fever, reduced WCC with azathioprine.
Non ergot-derived dopamine agonists used in PD
Pramipexole, ropinirole, and rotigotine
Treatment of pseudogout
Analgesia
NSAIDs
PO, IM or intra-articular steroids
Treatment of psoriatic arthritis
NSAIDs
MTX, sulfasalazine, ciclosporin
Treatment of reactive arthritis
NSAIDs
Local steroids
Relapse may require sulfasalazine or MTX
Treatmement of polymyositis and dermatomyositis
Steroids
Cytotoxics: AZT, MTX
Drugs that induce lupus
Procainamide
Phenytoin
Hydralazine
Isoniazid
Treatment of anti-phsopholipid syndrome
Low dose aspirin
Warfarin if higher risk (e.g. recurrent thromboses) target INR 2-3
SLE management
Severe flares (pericarditis, CNS disease, AIHA, nephritis): IV cyclophosphamide, High dose prednisolone.
Cutaneous: topical steroids to treat, sun cream for prevention
Maintenance for joints and skin: NSAIDs, hydroxychloroquine, low dose steroids (option)
Lupus nephritis: ACEi for proteinuria. Immunosupression if aggressive GN
Treatment of GCA
High dose steroids (e.g. pred 40-60mg oral) and taper slowly.
PPI and alendronate cover
Treatment of polymyalgia rheumatica
15mg/day oral prednisolone and then taper according to ESR and symptoms
PPI and alendronate cover
Treatment of granulomatosis with polyangiitis
Immunosuppression:
Cyclophsphamide, Rituximab, MTX
Azathioprine, Rituximab or MTX for maintenance.
Treatment of Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Prednisolone
Cyclophosphamide is severe multi-organ
Azathioprine or MTX for maintenance
Women should avoid pregnancy for at least… months after stopping MTX
3 months (men should use contraception for the same duration)
Treatment of warm AIHA
Immunosuppression
Splenectomy
Drugs that trigger haemolysis in G6PD deficiency
Antimalarials, henna, dapsone, sulphonamides
Management of sickle cell anaemia (chronic)
Pen V 250mg BD
Folate 5mg OD
Hydroxycarbamide if frequent crises
Treatment of Hodgkin’s lymphoma
A – doxorubicin (Adriamycin ®)
B – bleomycin
V – vinblastine (Velbe ®)
D – dacarbazine (DTIC).
Possibly add radiotherapy.
Immunisations post splenectomy
Pneumovax (repeat every 5 years)
Hib if not done in childhood
Men C if not done in childhood
Yearly flu
Contraindications for thrombolysis (STEMI)
AGAINST
Aortic dissection GI bleeding Allergic reaction previously Iatrogenic (recent surgery) Neuro: cerebral neoplasm of CVA Hx Severe HTN (200/120) Trauma (including CPR)
Clopidogrel post MI: How long to continue post..
STEMI
NSTEMI
STEMI with stenting: 12 months
STEMI with medical management: 1 month
NSTEMI: 12 months
1st line treatments of stable angina (in addition to GTN)
CCB or B blocker
2nd line treatments of stable angina
a long-acting nitrate or
ivabradine or
nicorandil or
ranolazine.
Drugs causing lung fibrosis
BANS ME
Bleomycin/busulfan Amiodarone Nitrofurantoin Sulfasalazine MEthotrexate
Prednisolone dose following:
Asthma exacerbation
COPD exacerbation
40mg OD for at least 5 days
30mg OD for 7-14 days
Duration of treatment for Scarlet fever
10 days
Treatment of CMV retinitis
Oral valganciclovir
if sight threatened add intravitreal injections of ganciclovir or foscarnet
Drug used for CMV prophylaxis in renal transplant
Valgancyclovir
Treatment of chronic hepatitis B
Nucleoside analogue (e.g. tenofovir) or interferon
Clinical features of cholera
Rice water stools
Shock, acidosis, renal failure
Antibiotics most likely to cause C.diff
Clindamycin
Ciprofloxacin
Cephalosporins
Treatment of giardiasis
Tinidazole, metronidazole, or nitazoxanide
Treatment of amoebic dysentery
Metronidazole (800mg TDS) 5 days or 10 days if liver abscess
Tinidazole
Midodrine is used to treat
Orthostatic hypotension
