Pharmacology/ Therapeutics Flashcards
Donepazil
S/E (1)
CI (1)
SE
1. insomnia
CI
1. bradycardia
Name as many dopamine agonists as you can (7)
- Bromocriptine (SE cardiac fibrosis)
- Ropinirole
- Capergoline (SE cardiac fibrosis)
- Apomorphine
- Pramipexole
- Transdermal rotogitine
- Pergolide (SE cardiac fibrosis)
BRATCPP
Name 2 MAO B inhibitors
- Rasagaline
2. Selegiline
Name 2 COMT inhibitors
- Entacapone
2. Tolcapone
3 SE of DA
- Excessive sleepiness
- Hallucinations
- Impulse control
Triptans
SE (2)
CI (2)
SE
- Tingling
- Tightness/ heaviness throat and chest
CI
- IHD
- CVD
Long QT causes
SSRIs TCAs/ terfenadine Ondansetron Methadone/ MI/ myocarditis/ macrolides Amiodarone Chloroquine, ciprofloxacin Hypothermia/ haloperidol Low K, Mg, Ca Erythromycin SAH Sotalol
STOMACHLESS
Phenytoin
SE
SE (PRANG HATDD) Peripheral neuropathy Rash - toxic epidermal necrolysis Ataxia Nystagmus Gingival hyperplasia
Hirsutism Anaemia (megaloblastic) Teratogenic Dizziness Diplopia
Sodium valproate
SE
WHAT PLANT Weight gain Hepatotoxicity Ataxia Tremor Thrombocytopaenia Pancreatitis Low Na Alopecia Nausea Teratogenic
PPI S/E (4)
- Low sodium
- Low magnesium
- Clostridium difficile
- Osteoporosis
Sulphasalazine SE (2)
- Oligospermia
2. Pulmonary fibrosis
Name x3 5-ASA
- Sulphasalazine
- Mesalazine
- Olsalazine
AZT
SE (3)
- bone marrow depression
- pancreatitis
- increased risk of non-melanoma skin cancer
MTX
SE (5)
- Myelosuppression
- Mucositis
- Pneumonitis
- Pulmonary fibrosis
- Liver fibrosis
Hydroxychloroquine
S/E (1)
What investigations need to be done before and during taking this medication? How often?
Bulls eye retinopathy - can results in permanent visual loss
Baseline ophthalmological examination and annual screening
BishOsphOnates
SE (3)
OOO
- Osteonecrosis of jaw
- Oesophagitis
- Oeosophageal ulcers
Prednisolone SE (5) Hint: CHOICE
- Cushing’s
- Hirsutism+HTN+ hyperlipidaemia
- Osteoporosis, avascular necrosis femoral head,
- Impaired glucose tolerance, insomnia
- Cataracts
- Eating - weight gain
CHOICE
Mesalazine SE (2)
- Pancreatitis
2. Agranulocytosis
Leflunomide SE
What group of medication is it?
DMARD
- Liver impairment
- Interstitial lung disease
- Hypertension
Gold SE (1)
Proteinuria
Penicillamine SE (2)
Proteinuria
Exacerbation of myasthenia gravis
Etanercept SE (2)
- Demyelination
2. Reactivation of TB
Thiazolidinediones MOA Example CI SE (4)
Pioglitazone, reduces insulin resistance peripherally CI: HF 1. Weight gain 2. Liver impairment 3. Fluid retention 4. Bladder cancer
PIogLItaZONE
Pio = pie = weight gain
LIver impairment
ZONE= transitional cell carcinoma = bladder ca
Lithium SE
- Diabetes insipidus
Finasteride SE (4)
- erectile dysfunction
- reduced libido
- ejaculation problems
- gynaecomastia
Anastrozole SE (3)
- Menopausal symptoms
- Osteoporosis
- Insomnia
Loop diuretics SE (4)
- Ototoxicity
- Gout
- Low calcium/ magnesium/ chloride/ sodium/ BP/ potassium
- Renal impairment
Carbimazole SE
- Agranulocytosis
2. Crosses the placenta - can only be used in small doses in pregnancy
Name six drugs that can cause gynaecomastia
- Spiro
- digoxin
- cannabis
- finasteride
- GnRH agonists e.g. goserelin, buserelin
- oestrogens
Name three medications that can cause raised prolactin
- metoclopramide
- domperidone
- haloperidol
Levothyroxine SE (4)
- hyperthyroidism: due to over treatment
- reduced bone mineral density
- worsening of angina
- atrial fibrillation
Tetracyclines
S/E:
- discolouration of teeth: therefore should not be used in children < 12 years of age
- photosensitivity
- angioedema
- black hairy tongue
P450 enzyme inhibitors and inducers
What is the difference?
Inducers = breaks down other drugs more quickly
Inhibitors = leads to toxicity of other drugs, as prevents the breakdown
Rifampicin
Inducer/ inhibitor
SE (2)
potent liver enzyme inducer
hepatitis
orange secretions
isoniazid
inducer/ inhibitor
SE (3)
peripheral neuropathy - prevent with pyridoxine (Vitamin B6)
hepatitis
agranulocytosis
liver enzyme inhibitor
pyrazinamide
SE (3)
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
ethambutol
SE (1)
optic neuritis: check visual acuity before and during treatment
Two antimalarials CI if has epilepsy
Chloroquine
Mefloquine
Isotretinoins SE (7) Cannot be used which which medication and why?
- Teratogenic (use two forms of contraception)
- Dry skin/ eyes/ lips/ mouth
- Low mood
- Raised triglycerides
- Hair thinning
- Epistaxis
- Photosensitivity
Cannot be combined with tetracycline as risk of intracranial HTN
CCB
SE
- Flushing
- Ankle oedema
- Headache
- Constipation
Monitoring What drugs (3) will you need to monitor the LFTs?
Statins LFTs at baseline, 3 months and 12 months
Sodium valproate
Glitazones
Monitoring
What drug will you need to monitor the U&E?
ACE
U&E prior to treatment
U&E after increasing dose
U&E at least annually
Monitoring
TFT, LFT
Amiodarone
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
Monitoring
FBC, LFT, U&E
MTX
FBC, U&Es and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’
Monitoring
FBC, LFT
AZT
FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months
Monitoring
Level, TFT, U&E
Lithium
TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months
- Headaches
- N&V
- Vertigo
- Confusion
- Weakness
- Pink skin and mucosae
CO poisoning
CO poisoning Ix (2)
Mx
Venous or arterial blood gas
ECG
Mx
- 100% O2 non rebreather for 6 hours, target sats 100%
- Hyperbaric oxygen if severe (>30%)
Overdose and poisoning: management
Paracetamol
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
Overdose and poisoning: management
Salicyclate
urinary alkalinization with IV bicarbonate
haemodialysis
Overdose and poisoning: management
Opioid/opiates
Benzodiazepines
Naloxone
Flumezanil (supportive care only if not severe or iatrogenic)
Overdose and poisoning: management
Tricyclic antidepressants
IV bicarbonate
Overdose and poisoning: management
Lithium
mild-moderate toxicity: volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
Overdose and poisoning: management
Warfarin
Heparin
Vitamin K, prothrombin complex
Protamine sulphate
Overdose and poisoning: management
BB
Organophosphate insecticides
If bradycardic then atropine
in resistant cases glucagon may be used
atropine
Overdose and poisoning: management
Ethylene glycol
Methanol poisoning
- fomepizole, an inhibitor of alcohol dehydrogenase
- Ethanol
- Haemodialysis
Overdose and poisoning: management
Lead
Dimercaprol, calcium edetate
Overdose and poisoning: management
Cyanide
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
Quinolones
MOA (1)
CI (3)
SE (3)
inhibit topoisomerase II (DNA gyrase) and topoisomerase IV
CI pregnant, breasfeeding, G6PD
- Long QT
- Lowers seizure threshold
- Tendon damage/ rupture, increased risk if also taking steroids
Macrolides Cannot be used with? Why? SE (2) Inhibitor/ inducer? Azithro SE (2)
CI not to use with statins as macrolides are inzyme inhibitors therefore reduce breakdown of statins and increase risk of myopathy and rhabdomylysis.
- Long QT
- cholestatic jaundice
Azithromycin - hearing loss and tinnitus
P450 inducers (therefore reduce efficacy of other drugs due to increased breakdown)
BullShit CRAP GPS
Barbiturates St John Warts Carbamezapine Rifampacin Alcohol (chronic) Phenytoin Griseofluvin Phenobarbitol Sulfonylureas + smoking
P4550 inhibitors (therefore increase toxicity risk)
SICKFACES.COM
Sodium valproate Isoniazid Cipro Ketoconazole Fluconazole Acute alcohol Chloramphenicol Erythro Sulfonamides Cimetidine Omeprazole Metronidazole
Adrenaline doses in anaphylaxis and cardiac arrest
anaphylaxis: 0.5ml 1:1,000 IM
cardiac arrest: 1ml of 1:1000 IV or 10ml 1:10,000 IV
Mx alcohol Acute withdrawal (2) To encourage abstinence (1) CI (2) Reduces craving, known to be a weak antagonist of NMDA receptors (1)
Thiamine Benzo Disulfram - can cause severe reaction if also drinks ETOH CI IHD, psychosis acamprosate
Amiodorone SE (10) - name as many as you can
Drug interactions (2)
- Slate grey appearance
- Hypo/ hyperthyroidism
- Pulmonary fibrosis
- Liver fibrosis
- Corneal deposits
- Peripheral neuropathy
- Photosensitivity
- Long QT
- Thrombophlebitis
- Bradycardia
Warfarin - increases INR
Digoxin - increases digoxin levels
Aspirin potentiates? (3)
- PO hypoglycaemics
- warfarin
- steroids
Diclofenac contraindications (4) Should be switched to?
- ischaemic heart disease
- peripheral arterial disease
- cerebrovascular disease
- congestive heart failure
Naproxen or ibuprofen or topical diclofenac
Name an inhibitor of 5 alpha-reductase
Indications (2)
SE (5)
Finasteride
benign prostatic hyperplasia
male-pattern baldness
- impotence
- decrease libido
- ejaculation disorders
- gynaecomastia
- breast tenderness
Gentamicin is what type of abx?
Adverse effects (2)
CI (1)
Monitoring
Aminoglycoside
1. Ototoxicity
2. Nephrotoxicity
Myasthenia gravis
Peak and trough
Peak 1 hour post dose
Trough to be checked just before next dose due
If trough raised, interval should be increased
If peak raised, dose should be decreased
Heparin
SE
Heparin-induced thrombocytopaenia (HIT) will occur after how long of use of heparin?
- bleeding
- thrombocytopenia
- osteoporosis/ risk of fractures
- hyperkalaemia
5-10 days
Tamoxifen
MOA
SE (4)
How long is it used for?
oestrogen receptor antagonist and partial agonist
menopausal symptoms
VTE
endometrial cancer
5 years post tumour removal
St John’s Wort is used in?
Inhibitor/ inducer
Mild-moderate depression
Inducer, therefore reduces effectiveness of warfarin/ ciclosporin/ COCP
SE Metformin (2)
lactic acidosis
GI effects
SE sulfonylureas (4)
Hypoglycaemic episodes
Increased appetite and weight gain
SIADH
Liver dysfunction (cholestatic)
SE glitazones (4)
Weight gain
Fluid retention
Liver dysfunction
Fractures
SE gliptins
Pancreatitis
SE trimethoprim (3)
Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis
SE metro
reaction after drinking ETOH
SE Erythromycin
prolongs QT
