Pharmacology/Therapeutics 2 Flashcards
SE ACE inhibitors (2)
What blood tests for monitoring? and how often?
What percentage increase in creatinine is acceptable
Cough
Hyperkalaemia
check U&E before starting and after increase in dose. Can allow up to 30% increase in creatinine rise or potassium up to 5.5
SE Bendroflumethiazide (4)
Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
SE Beta-blockers (4)
CI (3)
Bronchospasm (especially in asthmatics)
Cold peripheries
Sleep disturbances
Erectile dysfunction
CI uncontrolled heart failure, asthma, sick sinus syndrome
SE Doxazosin (1)
postural hypotension
nitrates SE (3)
Headache
Postural hypotension
Tachycardia
Nicorandil SE (3) CI (1)
Headache
Flushing
Anal ulceration
CI left ventricular failure
Drugs that can cause impaired glucose tolerance (7)
- thiazides, furosemide (less common)
- steroids
- tacrolimus, ciclosporin
- interferon-alpha
- nicotinic acid
- antipsychotics
- BBs
Drugs causing lung fibrosis (5)
- amiodarone
- cytotoxic agents: busulphan, bleomycin
- anti-rheumatoid drugs: methotrexate, sulfasalazine
- nitrofurantoin
- ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
Drugs causing optic neuritis (3)
ethambutol
amiodarone
metronidazole
drugs causing Corneal opacities (2)
amiodarone
indomethacin
Drugs causing Retinopathy (2)
chloroquine, quinine
What can cause both blue discolouration and non-arteritic anterior ischaemic neuropathy?
Sildenafil
Drugs causing photosensitivity (5)
- thiazides
- tetracyclines, sulphonamides, ciprofloxacin
- amiodarone
- NSAIDs
- sulphonylureas
Ecstasy poisoning Features: Neuro (4) Cardio (2) Other (3)
Mx
- neurological: agitation, anxiety, confusion, ataxia
- cardiovascular: tachycardia, hypertension
- hyponatraemia
- hyperthermia
- rhabdomyolysis
Mx supportive, dantrolene for hypothermia
Lithium toxicity can be precipitated by?
- dehydration
- renal failure
- diuretics (especially thiazides)
- ACE inhibitors/angiotensin II receptor blockers
- NSAIDs
- metronidazole.
Lithium toxicity features (6)
coarse tremor (a fine tremor is seen in therapeutic levels) hyper reflexia acute confusion polyuria seizure coma
mixed respiratory alkalosis and metabolic acidosis can be seen in what overdose?
Salicyclate
Overdose in what can cause these symptoms? hyperventilation (centrally stimulates respiration) tinnitus lethargy sweating, pyrexia* nausea/vomiting hyperglycaemia and hypoglycaemia seizures coma
Salicyclate overdose features (8)
Breastfeeding
Contraindicated
Safe
CI cipro chloramphenicol sulphonamides tetracycline lithium benzos aspirin carbimazole MTX sulfonyureas amiodarone cyototoxic drugs clozapine
Safe penicillins cephalosporins trimethroprim steroids thyroxine TCAs antipsychotics BBS hydralazine warfarin heparin digoxin theophylines
Drugs to avoid in renal failure
tetracycline nitrofurantoin NSAIDs lithium metformin
Medications which might exacerbate heart failure
- Verapamil
- Antiarrythmics e.g flecainide
- Pioglitazone
- NSAIDs
- Steroids
What poisoning?
Salivation Lacrimation Urination Defecation/diarrhoea cardiovascular: hypotension, bradycardia also: small pupils, muscle fasciculation
Mx
Organophosphate insecticide poisoning
atropine
Sildenafil CI (3)
taking nitrates or CCB e.g nicorandil
hypotension
stroke or myocardial infarction within last 6 months
Sildenafil SE (5)
visual disturbances e.g. blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
headache
Cocaine Adverse effects Heart (5) Neuro (4) Psych (3) Other (4) - hints, hot or cold, metabolic acidosis or alkalosis, what can happen to the kidney, and the abdomen
myocardial infarction both tachycardia and bradycardia may occur hypertension QRS widening and QT prolongation aortic dissection
seizures
mydriasis
hypertonia
hyperreflexia
agitation
psychosis
hallucinations
ischaemic colitis
hyperthermia
metabolic acidosis
rhabdomyolysis
Cocaine toxicity mx
- benzodiazepines
If CP + GTN
If HTN + sodium nitroprusside
Digoxin toxicity
When to measure levels?
Features (5)
Mx (3)
If suspected toxicity measure 8-12hrs post dose
generally unwell lethargy, nausea & vomiting, anorexia, confusion yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia
Digibind
correct arrhythmias
monitor potassium
Digoxin toxicity
Name the classical precipitating factor for toxicity
classically: hypokalaemia
Dopamine receptor agonists Adverse effects (4)
nausea/vomiting
postural hypotension
hallucinations
daytime somnolence
Mefloquine
Used in?
Adverse effects
CI
Anti-malarial
neuropsychiatric e.g nightmares, anxiety, suicidal
mefloquine should not be used in patients with a history of anxiety, depression schizophrenia or other psychiatric disorders
Metformin CI (4)
- CKD
dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min) - Recent myocardial infarction, sepsis, acute kidney injury and severe dehydration due to risk of lactic acidosis
- contrast imaging
- should be discontinued on the day of the procedure and for 48 hours thereafter - alcohol abuse is a relative contraindication
1st line treatment in opioid detoxification
How is compliance monitored?
methadone or buprenorphine
compliance is monitored using urinalysis
