Pharmacotherapy Flashcards
Moclobemide
selective MAO A inhibitor
What are the side effects of Varenicline?
Nausea
Insomnia
Suicidal and homocidal attempts
Close monitoring for psychiatric disorders
Types of local anesthetics?
Ester type (short procaine, medium cocaine, long tetracaine) ->PABA
Amide type (Medium lidocaine, long Bupivacaine, Ropivacaine)
Drug cause long QT interval ( Torsade be points)
Quinidine Satolol Class III antiarrhythmics Terfinadine/ astemizole Pimozide Chlorpromazine Ziprasidone Macrolides (Clarithromycin, azithromycin, erythromycin)
Explain the ECG wave
P wave= atrial depolarization
QRS = ventricular depolarization
T wave = phase 3 ventricular reploarization
PR = impulse from atria to purkinj fibers
ST segment = phase 2 Absolute refractory period
QT = mechanical contraction of ventricles
Treatment of Alzheimer’s
Galanthamine
Rivastigmine
Donepezil
Memantine
Bisphosphonate dosing
Alendronate Daily (5mg, 10mg) Weekly (35mg, 70mg). Residronate Daily (5mg), Weekly ( 35mg), 75 mg (2weeks), Monthly (150mg). Pamidronate (30-60 mg) 3 months Zoledronoic acid (5mg ) yearly
Multiple Sclerosis Treatment
Interferon B, Glatiramer Alemtuzumab, Natalizumab Dimethyl fumerate Fingolimod Mitoxantrone Teriflunomide Fampridine
Folic acid antagonists
Methotrexate
Sulpha drug
Trimethoprim
Medications that cause weight loss
Ezetimibe Metformin Topiramate Xenical CNS stimulants Levothyroxine Leflunamide Dementia medications (Rivastigmine, Galantamine)
Causes for hypokalemia?
Vomiting, Diarrhea Diabetic ketoacidosis Laxative abuse Thiazides/loop diuretics B agonist Corticosteroids Insulin Acute kidney failure High aldosterone level Amphotericin B Cisplatin
Conditions should not be treated if a symptomatic?
Increase in Uric acid.
UTI (if in pregnancy Must treat)
Trichomonalis in asymptomatic pregnant woman.
Raynaud Disease.
Dihydropyridine CCB-Nifedipine, Felodipine Alpha Blocker - Prazocin IV PGI2 analogue - iloprost Endothelin 1 inhibitor- Bosentan PDE 5 inhibitor
What is psoriasis?
It is skin condition characterized red scaly patches
Chronic immunologically mediated skin condition
Topical treatment for psoriasis include…..
Oil base products +/- Salicylic acid Vit D (Calcitriol,Calcippotriol) Calcinurin inhibitors (Tacrolimus,Pimecrolimus) Topical CS ( betamethasone" Hydrocortisone) TAT Topical Vit A (Tazarotene) Topical Anthralin Topical Tar
Treatment for severe and resistant psoriasis
Oral Acitretin + phytotherapy Methotrexate Cyclosporine Biological Intralesion corticosteroid=psoriatic plaque
What is meant by acute bronchitis.
Cough -/+ sputum less than 3 weeks
It is resolved without treatment in 10-14 days
Causes of acute bronchitis?
Viral.. RSV, parainfluenza, influenza
Non infectious: Mycoplasma pneumonia, Bordetella, Clamydophilia pneumonia
Chemicals or fumes
Pharmacological treatment of Acute bronchitis?
Analgesic (Acetaminophen,Ibuprofen)
Antitussive (Codeine, dextromethorphan, hydrocodone)
B2 agonist ( Salbutamol, Terbutaline)
Herbal (Pelargonium root , Ginseng)
Not recommended: Antibiotics, Corticosteroids, mucolytic, expectorants
What is the main treatment for different Anxiety disorders?
Panic disorder/ Social Anxiety Disorder/Specific phobia/ Obsessive Compulsive Disorder/ Post Traumatic Stress Disorder (PTSD)/ General Anexity Disoder
SSRI and SNRI
What is the use of propranolol in different anxiety disorders?
For stage fear and public speaking fear
PrevenT PTSD if given few hrs before traumatic event
Drugs used for treatment of General Anxiety Disorders?
DOC- Escitalopram
1st line - SSRI & SNRI
2nd line - Imipramine
Buspirone, pregabalin, Quatipine, hydroxyzine
Attention deficit hyperactivity disorder?
1st- Stimulants (>6yrs)
2nd - Atomoxetine
Bupropion- Venlafaxine- Clonidine
Alzheimer’s Dementia
Mild- Donepezil, Rivastigmine, Galantamine
Moderate/ severe - Memantine
Vit E
Levy body dementia, dementia with Parkinson’s
Rivastigmine
Quetiapine
Examples of Irreversible MAO inhibitors used in depression?
Phenelzine
Tranylcypromine
What is the discontinuation symptoms of antidepressants?
FINISH Flu Insomnia Nausea Imbalance Sensory changes Hyperactivity
Used for Bipolar maniac disorder?
1st - Lithium, Divalproex, QOR (Quetiapine, Olanzapine, Risperidone)
2nd- Carbamazepine
What cause Neuroleptic Malignant Syndrome
Antipsychotics
Management of neuroleptic Malignant syndrome?
Stop antipsychotics
Hydration + cooling
Bromocriptine
Dantrolene
What is Akathisia? Management
Akathesia is restless leg syndrome
Reduce antipsychotics
Propranolol
BDZ
What is acute dystonia?
Sustained muscle contraction
Treatment
Benzotropine
Diphenhydramine
Which antipsychotics has maximum weight gain, maxiumum glucose abnormalities, maximum dyslipidemia?
Clozapine
Olanzapine
How to switch from one antipsychotic to another?
Crossover technique over (2 weeks - 3 months)
What medication used for mild insomnia and jet lag?
Melatonin
Smoking cessation?
1st line:
NRT, Bupropion, Varenicline
2nd line:
Nortryptyline , Clonidine
Management of Anorexia Nervosa? DeME More
Domperidone
Metoclopramide
Erythromycin
Managment of Bulimia Nervousa
SSRI (Fluoxetine)
SNRI (Venlafaxine, Trazodone)
Examples of neuraminidase inhibitors
Oseltamivir
Zanamivir
When does the post vaccination protection from influenza vaccine start?
2 weeks post vaccination and extend for 6 to 8 months
Treatment of chronic Spasticity?
Baclofen ( GABA b agonist) Tizanidine (a-2 agonist) Diazepam & Clonazepam Gabapentin Dantrolene (insufficient evidence) Sativex (cannabis extract) Phenol injection Botulism toxin II
Treatment of NSTEMI: Partial block of coronary artery
Morphine Oxygen Nitroglycerin Asprine B Blockers /CC blockers Heparin, LMWH, fondaparinaux
Patient wth STEMI occluded coronary artery
Asprin
Nitroglycerin
PCI ( available, >75 years, cardiogenic shock, )
Thrombolytics
B blocker
Asprin / Clopidogrel
Heparin, enoxaparin, fondaparinaux (min 48 hrs)
Precaution when administrating floroquinolones
Separate dose of floroquinolones about 8 hours when administering sucralfate or metallic cations .
It is better to avoid these agents when administrating floroquinolones
Patient fentanyl patch fall in bath tub🛁what to do
Contact dr..if not available..patch for patch policy…patient return old patch to get the new patch
Medications used for Alzheimer’s dementia?
Donepezil = DOC Rivastigmine = levy body dementia Galantamine = Vascular dementia
Memantine: NMDA antagonist
Cause of Alzheimer dementia and diagnosis?
Decrease in Acetyl choline and Beta amyloid plaque
Test: Mini- Mental Scale Exam. MMSE
Stages of dementia
Preclinical: mild objective cognitive decline🤔
Mild: Impaired instrumental activity of daily life (IADL)💊🚗📞📱💸💵
Moderate: impaired IADL and Personal activity daily life (PADL)🛁👖👔🍛🚽🚰
Severe: PADL cannot be done even if reminded
Terminal: patient must be fed as that are immobile and mute
Risk factors for Alzheimer?
Family history👨👩👧👦 Age 👴🏽 CVD💔 Diabetes🍭 Sedentary life style🚶🏻♀️ Head trauma🤕🤕
Patient with levy body dementia and hallucination, early Parkinsonism . What to avoid??
Avoid Antipsychotics
Diagnosis of Diabetes?
Fasting plasma glucose >7mmol/L
Random plasma glucose> 11.1 mmol/liter
Plasma glucose level> 11.1 mmol/liter 2hrs 75 mg glucose
He Alc >6.5%
Diabetic ketoacidosis symptoms
> 14mmol/liter Hyperglycemia Ketone urine and blood Volume depletion ( prerenal failure due to dehydration) Acidosis Decrease consciousness
Management of diabetic ketoacidosis
Fluids
KCl
IV insulin ( regular rapid insulin)
Bicarbonate
Management of hyperkalemia
Calcium gluconate - stabilize heart Insulin/dextrose - move K inside cell B agonist - move K inside cell NaHCO3 Diuretic Furosamide Resins Sodium polystyrene sulphonate
Glaucoma Medications
B blocker :Timolol, Betaxolol, Levobunolol
a2 Agonist: Apraclonidine, Brimonidine
Prostaglandin: Bimatoprost, Travoprost, Latanoprost
Carbonic anhydrase inhibitors : acetazolamide, dorzolamide
Some one has cataract 👁👁surgery..what are the post operative medications?
Antibiotics (4th floroquinolones, AG, combined products with dexamethasone)
Dilators/Cycloplegics
Cyclopentolate, phenylephrine, Tropicamide
Anti inflammatory agents NSAIDs / Corticosteroids
What are medications that cause Cycloplegia?
Ciliary muscle paralysis cause loss of accommodation
- Atropine
- Cyclopentolate
- Homatropine
- Scopolamine
- Tropicamide