Pre-reg meds Flashcards
lamivudine
Indications (2): in adults and children 3 months of age and older.
1) epivir (oral solution or tablets) - HIV infection in combination WITH other anti viral drugs.
2) Zeffix: chronic hep B infection either with compensated liver disease( with evidence of viral replication and histology of active live inflammation or fibrosis) when first line treatments cannot be used or in combination with another antiviral drug without cross-resistance to lamivudine with compensated liver disease. 100mg OD
150-mg tablets BD
300-mg tablets OD
10-mg/mL oral solution. An oral solution is a mixture of a medicine and a liquid that can be taken by mouth.
MOA: Nucleoside Reverse Transcriptase Inhibitors. By blocking reverse transcriptase, NRTIs prevent HIV from multiplying and can reduce the amount of HIV in the body.
side effects: alopecia, muscle disorders, nasal symptoms, periphery neuropathy
warnings: buildup of lactic acid in the blood (lactic acidosis), severe liver problems, and inflammation of the pancreas (pancreatitis) in children at risk for pancreatitis.( cautioned)
ezetimibe
indications: to treat high cholesterol however given with a statin.
MOA:
You should not use ezetimibe if you have moderate to severe liver disease. You should not use ezetimibe with a “statin” cholesterol medicine if you have active liver disease, or if you are pregnant or breast-feeding a baby.
works by decreasing cholesterol absorption in the small intestine
side effects: 10mg OD
relevant warnings: contra indicated in sever to moderate liver disease. should not be used with a statin in liver disease pregnant or breastfeeding.
cyanocobalamin
Indication: (man made form of vit b12) metabolism, blood cells, and nerves. can be bought OTC
50mg-150 mcg daily to be taken between meals
or injection: 1mg initially every 2-3 days for 11 doses maintenance 1mg every month.
MOA: absorbed in the small intestines- Vitamin B12 deficiency may occur in certain health conditions (such as intestinal/stomach problems, poor nutrition, cancer, HIV infection, pregnancy, old age, alcoholism ( as alcohol over time destroys the lining of the gi). It may also occur in people who follow a strict vegetarian (vegan) diet.
Side effects:
Relevant warnings: Some forms of the tablet aren’t suitable for vegans ironically.
sucralfate
Indication: Short term 8 weeks
To treat active duodenal ulcers . treatment of gastroesophageal reflux disease and stress ulcers
MOA: Sucralfate is a gastric protective agent. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach.
Side effects/relevant warnings
sucralfate
Indication: used to treat duodenal ulcers/ GORD/ stress ulcers
Benign gastric ulceration and chronic gastritis.
children 15-17 or Adults:
2g bd daily. once when *rising and at bedtime
OR
1g QDS for 4-6 weeks or in really bad ulcers 12 weeks. with QDS take once before meals and once at bedtime
in prophylaxis of stress ulcers: 1g 6 times daily
max 8g daily.
MOA: Sucralfate is a sucrose sulfate-aluminium complex that binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus. It also promotes bicarbonate production and acts like an acid buffer with cytoprotective properties.
relevant warnings: bezoar formation ( S/E) especially in icu patients.
Also check for interactions as it has many. main one: Acenocoumarol.
linagliptin
Indication: anti- diabetic in type 2 diabetes when you cant give metformin or in combination with metformin
5mg OD but may need to reduce dose if taken with insulin or sulfonylurea
MOA: dipeptidyl peptidase-4 (DPP-4) inhibitors. It works by increasing the amounts of certain natural substances that lower blood sugar when it is high
Relevant warnings: containdicated in type 1 diabetes or acidosis. check interactions
cosmofer also known as ….
indication : Iron dextran- CosmoFer® 50mg/ml solution for infusion and IM injection to be injected in the gluteal muscle. strong iron injections when oral preparations can not be used .
must calculate dose according to body weight and iron deficiency
also comes as iv injection or slow infusion.
MOA:
relevant warnings; some serious hypersensitivity reactions have be documented recently.- patients going in to anaphylactic shock. there must monitor very closely for signs of a reaction in the first 30 minutes, reaction risk is increased in patients with history severe asthma, eczema or atopic allergy/ anti immune disorders.
contraindicated in active RA, asthma, eczema, history of disorders and infection.
Ibuprofen
Indication:
Pyrexia *(but mostly Paracetamol) , inflammation, in rheumatic disease and other musculoskeletal disorders . mild to moderate pain (dysmenorrhea -period pain/migraine/dental pain)
ADULT: 300-400mg TDS-QDS daily (usually)
MAX: 600mg QDS.
CHILDREN- 2month-12 years:
MAX 30MG/KG/daily
3-11 months: 50mg TDS or QDS 1-3 years: 100mg TDS or QDS 4-6 years: 150mg TDS or QDS 7-9 years: 200mgTDS or QDS 10-11 years: 300mg TDS or QDS 12-17 years: ADULT DOSING
MOA:
N-SAID non-steroidal-anti- inflammatory drugs. non selective inhibition of cox enzymes. COX is constantly expressed in the body it is considered a ‘house keeping’ enzyme as it regulates many physiological processes in the body. i.e. stomach lining, where prostaglandins protects the stomach mucosa from being eroded by its own acid.
COX2 is expressed in inflammation though its expression fluctuates.it is the inhibition of COX2 that causes anti-inflammatory effects in the body.
stomach bleeds/ulcers MOA in NSAIDS:
When nonselective COX-1/COX-2 inhibitors (such as aspirin, ibuprofen, and naproxen) lower stomach prostaglandin levels, ulcers of the stomach or duodenum internal bleeding can result.
Contra- indication:
•Peptic ulcer or stomach bleeding.
•Uncontrolled hypertension.
•Kidney disease.
•People that suffer with inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
•Past transient ischemic attack (excluding aspirin)
•Past stroke (excluding aspirin)
Cautions and points of interest:
UNLICENSED USE!: orphan license for the injection for closure of ductus arteriosus in premature neonates less than 34 wks corrected gestational age.
not licensed for use in children under 3 months or body weight under 5 kg.
however maximum dose for systemic juvenile idiopathic arthritis is unlicensed.
declofenac is not first line as it was found to be linked to cv events.
Disease related interaction: nsaids cause bronchospasms and prevent the moa of salbutamol. therefore is it is prescribed with caution in asthmatics.
Tinzaparin
Indication: prophylaxis of deep- vein Thrombosis
MOA: Lower molecular weight heparin. anti coagulant- stops aggregation of platelet in the blood.
“blood thinner”
DOSING: general surgery: dose to be given 2 hours before surgery and od after. <50kg= 3500units 50kg-100kg= 4500units od <100kg= 4500 BD
orthopedic surgery:
initially 4500 units for 1 dose, dose to be given 12 hours before surgery, then 4500 units every 24 hours. (follow above dosing regime)
in VTE in pregnancy:
175 units/kg once daily, dose based on early pregnancy body-weight, treatment regimens do not require anticoagulation monitoring.
side effect: Alopecia (on prolonged use): anaphylaxis,hyperkalaemia
contra-indication: after major trauma; epidural anaesthesia with treatment doses; haemophilia, post surgery to the eye.
cautions and points of interest:
caution in the elderly
haemorrhages- protamine sulfate is a specific antidote (but only partially reverses the effects of low molecular weight heparins).
thrombocytopenia- 30% reduction of platelet count, thrombosis, or skin allergy. stop tinz swap to other anticoag.
cyclizine
INDICATIONS :Nausea, Vomiting, Vertigo, Motion sickness Labyrinthine disorders (is inflammation of the inner ear.).
DOSING:: motion sickness- 50 mg 3 times a day.
n+v- 150 mg, dose to be given over 24 hours.
MOA: piperazine derivative with histamine H1-receptor (antihistamine) activity.
SIDE EFFECTS: sleepiness, dry mouth, constipation, and trouble with vision. hypotention and urinary retention
CAUTIONS/POINTS OF INTEREST:
C/I in neonates and Acute porphyrias
caution in epilepsy
avoid in pregnancy.
ondansatron
INDICATION: Prevention of postoperative nausea and vomiting, vertigo
MOA Ondansetron is a specific 5HT3-receptor antagonist which blocks 5HT3 receptors in the gastrointestinal tract and in the CNS.
DOSE:
PROPHYLAXIS OF POST-OP N+V:
Adult
16 mg, dose (ORAL OR IM/IV) 1 hour before anaesthesia, then 4 g at induction.
TREATMENT OF POST-OP N+V:
stat 1g im/iv injection.
EMESIS DUE TO CHEMO:
By mouth
Adult
Initially 8 mg ( or in severe cases 24mg), dose to be taken 1–2 hours before treatment, then 8 mg every 12 hours for up to 5 days.
By rectum- double the oral dose.
Adult
Initially 16 mg, dose to be taken 1–2 hours before treatment, then 16 mg daily for up to 5 days.
adult/elderly IV/IM injections
initially 8 mg dose to be administered immediately before treatment. then (by mouth or rectum) 8 mg bd for up to 5 days.
check specific age dosing for 65-74 and 75 and older for imiv.
SIDE EFFECTS:
Constipation; flushing; headache; injection site-reactions
also careful with cardio patients as can cause Arrhythmias; bradycardia; chest pain;
with im/iv (very rare) transient blindness.
POINT OF INTEREST:
consult lit when using with corticosteroid - ie prednisolone or beclomethasone.
C/I : Congenital long QT syndrome- also search other meds used in conjunction that cause this.also any electrolyte disturbances.
Tramadol
INDICATION:
sever pain
DOSING:
Adult/ Child 12–17 years
Initially 100 mg, then 50–100 mg every qds to 6x a day usually max 400 mg/24 hours.
IM/IV same dose given over 2-3 minutes
chronic pain you start lower and adjust up accordingly.
postoperative pain specifically:
iv inj always over 2-3 min:
Adult- FIRST HOUR:- give 100mg then 3, 50mg every 10-20min if required ( max 250mg if required).
the 50-100mg qds-6x daily- max 600 mg daily.
MOA: 2 modes of action:
1) Opioid- It is a synthetic benzenoid opioid which is metabolised to desmetramadol- acts as a weak opioid receptor agonist. In the body it is metabolized to
2) SNRI inhibitor: serotonin–norepinephrine reuptake inhibitor
SIDE EFFECTS: think opioid!: respiratory depression! Biliary spasm; bradycardia; confusion; constipation; dependence; dizziness; drowsiness;
serious: seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction- long term use can lead to hypogonadism and adrenal insufficiency
POINTS OF INTEREST/ CONTRA INDICATIONS:
schedule 3 drug- words/figures law applies, however does not go on the cd register. see emergency supply + wholesale dealing laws for exam!
First line in postoperative pain- usually codeine/ co codamol or tramadol. however switch to oxycodone if neuropathic side effects occur ie hallucinating. see pain ladder.
Hyperalgesia: sensitivity to pain- to treat reduce dose of opioid or switch refer to pain team.
metoclopramide - MHRA
INDICATION: Symptomatic treatment of nausea and vomiting including that associated with acute migraine
post-op n+v prophylaxis.
DOSE: oral/iv (over 3 min) /im:
<60kg= 500mcg/kg in 3 divided doses
>60kg 10mg up to tds
PALLIATIVE:
hiccups: 10mg qds-tds
N+V: 30-100mg/24hrs
Usual dose is 10 mg, tds. max. daily dose is 500 micrograms/kg;
MHRA:
causes neurological effects- eg extrapyramidal/ dyskinsesias. there for long/high dose term use risk outweighs benefit to reduce neuro adverse effects recommended restrictions in indication/osing/duration has been made
over 18yrs= used in prophylaxis post op,chem (but not acute) /radio/migraine ( may also improve absorption of oral analgesics. only prescribe meto for 5 DAYS!
MOA: D2 receptor antagonist in the chemoreceptor trigger zone. Also increases the tone of the lower esophageal sphincter.
SIDE EFFECTS:
Extrapyramidal effects especially in young. galactorrhoea (breast secretion) ; gynaecomastia ( male breast enlargement) ; hyperprolactinaemia (elevated prolactin) ; menstrual changes
kinda like an antipsych.
POINTS OF INTEREST:
C/I 3–4 days after gastrointestinal surgery; gastrointestinal haemorrhage; gastrointestinal obstruction etc.
cautioned in elderly; epilepsy; may mask underlying disorders such as cerebral irritation; Parkinson’s disease and young people 12-17yrs.especially dystonic s/e in young girls/ women- Injection of an antiparkinsonian drug such as procyclidine will abort dystonic attacks.
Avoid or use small dose in severe impairment, due to increased risk of extrapyramidal reactions.
DOMPERIDONE
INDICATION: N+V
DOSING:
Adult (children): >35kg= 10mg tds max 30mg
children<35kg =250mcg/kg tds max 750mcg/kg/24hrs
>35kg=
MHRA:risk of cardiac s/e- restricted indication/dose/duration
1- domperidone should only be used in n+v.
2- lowest dose possible, not exceeding max 1 wk.
3-c/i in cardiac conduction issues
-concomitantly with drugs that prolong the QT interval or potent CYP3A4 inhibitors
-sever hepatic impairment
MOA: peripherally selective dopamine D2 receptor antagonist
S/E: Drowsiness, dry mouth, malaise, agitation; amenorrhoea; convulsions; extrapyramidal disorders; gynaecomastia, nervousness, oculogyric crisis; QT-interval prolong.
POINTS OF INTEREST: reduce frequency in renally impaired patients.
oxycodone
INDICATION: sever post-op pain/ palliative care
DOSING:
Adult:ORAL- 5mg to start qds-6x a day. can increase if needed. max 400mg/day
modified release- Initially 10 mg BD (max. per dose 200 mg bd)
IV- 1-10 mg every 4hrs prn
can be used on PCA- check rf protocol.
MOA: semisynthetic opioid synthesized from thebaine.
S/E: abdominal pain; anorexia; anxiety; lack of energy, bronchospasm; chills; diarrhoea;
POINTS OF INTEREST: there is modified release preps which are bd and 24hr preparations. both come as 10mg- dont confuse.
c/i; for all opioids-
- respiratory depression;
- comatose patients;
- head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment);
- raised intracranial pressure (same reason as above); 5. risk of paralytic ileus- bowel obstruction.
caution dependence.
milds hepatic impairment Max. 2.5 mg qds in patients (not on other opioids) AVOID IN MODERATE TO SEVERE IMPAIRMENT.
renal same as above
Opioid effects increased and prolonged and increased cerebral sensitivity occurs.Avoid if eGFR less than 10 mL/minute/1.73 m 2 .
oxycontin- modified release- for longer term pain management.
5mg/10mg
oxynorm- immediate release liquid used to treat breakthrough pain- 5mg/ml and 10mg/ml
