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Phase 2a > Prescribing > Flashcards

Prescribing Flashcards

1
Q

Describe the mechanism of action of insulin

A

When binds (beta chains link) = active tyrosine kinase = initiates phosphorylation cascade = GLUT 4 expression = allows uptake of insulin in cells

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2
Q

Name the role of insulin in the body

A

Liver - Decreases gluconeogenesis

Muscle + liver - increase glucogenesis and decrease glycogenolysis

Liver + adipose tissue - Increase glycolysis

Muscle, liver + adipose tissue - Increase amino acid uptake and protein synthesis

Decrease lipolysis

Fatty acids in liver + adipose tissue - increase lipogenesis + esterification

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3
Q

What type of compound is insulin

A

Anabolic

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3
Q

Name 2 drugs which have a potential severe interaction with insulin to cause hypoglycaemia

A

Clarithromycin

Metreleptin

Beta blockers?

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4
Q

What are SGLT-2 inhibitors used to treat

A

Type 2 diabetes

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5
Q

Describe the mechanism of action of SGLT-2 inhibitors

A

Expressed in the proximal renal tubules

Prevent reabsorption of filtered glucose from tubular lumen.

Increases urinary glucose excretion

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6
Q

What is the ending of SGLT-2 inhibitors

A

-liflozin

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7
Q

Name 4 examples of SGLT2 inhibitors

A

Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin

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8
Q

DELETE CARD
When do you not prescribe SGLT-2 inhibitors

A

People with DKA

Moderate/severe renal impairment
- Avoid initiation < 60
- Avoid continuation < 45

Severe hepatic impairment

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9
Q

Describe the mechanism of action of GLP-1 inhibitors

A

Increases levels of hormones ‘incretins’ - stimulates secretion of of insulin and lowers blood glucose levels

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10
Q

What do GLP-1 inhibitors end in

A
  • lutide
  • atide
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11
Q

Name 2 of the additional benefits of GLP-1 inhibitors

A

Weight loss

Blood pressure reduction

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12
Q

Name the contradictions of GLP-1 inhibitors

DELETE

A

Ketoacidosis
Pancreatitis
Renal impairment
Severe hepatic impairment
Severe GI disease

Women childbearing age - contraception

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13
Q

Name 3 drug interactions of GLP-1 inhibitors
DELETE CARD

A

Beta-blockers
Paracetamol
Warfarin

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14
Q

Describe the general mechanism of action of metformin

A

Increases peripheral sensitivity to insulin

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15
Q

Describe the 4 parts of the mechanism of action of metformin

A
  1. Inhibition of hepatic gluconeogenesis = decrease production of glucose
  2. Enhance insulin sensitivity = decrease insulin resistance
  3. Mitochondrial actions
  4. Weight loss
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16
Q

What is a main risk of metformin

A

Lactic acidosis

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17
Q

Name 3 drug interactions of metformin

A

Alcohol - Increases risk of lactic acidosis

Beta-blockers

Topiramate

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18
Q

Name 2 risk of metformin

A

Lactic acidosis

Low vitamin B12 levels on increased dose

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19
Q

Why should beta blockers be avoided with antidiabetic medication

A

Can mask the warning signs of hypoglycaemia

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20
Q

What condition are DPP-4 inhibitors used to treat

A

Type 2 diabetes

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21
Q

What do DPP-4 inhibitor drug names end in

A

-liptin

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22
Q

Describe the mechanism of action in DPP-4 inhibitors

A

Inhibits DPP-4 enzyme = increases beta-cell insulin secretion in the pancreas = reduces the post prandial and fasting hyperglycaemia

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23
Q

What are the contradictions and cautions of DPP-4 inhibitors
DELETE CARD

A

Ketoacidosis

Hepatic impairment

Heart failure

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24
Q

Name 5 interactions of DPP-4 inhibitors
DELETE CARD

A

Beta blockers
ACE inhibitors
Digoxin
Ketoconazole
Rifampicin

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25
Q

Describe the 1st line medical management for type 2 diabetes

A

High-risk of CVD/chronic heart failure = metformin + SGLT-2 inhibitor

Not above = metformin

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26
Q

What do you do if metformin is not tolerated such as due to GI side effects

A

Switch to modified-release metformin

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27
Q

What is 2nd line medical treatment for type 2 diabetes

A

Add one of:

DPP-4 inhibitors
Pioglitazone
Sulfonylurea
SGLT-2 inhibitor

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28
Q

What is 3rd line medical treatment of type 2 diabetes

A

Add another drug (from the 2nd line drug treatment list)

OR

Start insulin-based treatment

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29
Q

At what % Q-risk would a patient who is on metformin be prescribed as an add on a SGLT-2 inhibitor

A

QRISK > 10%

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30
Q

Describe the action of thrombolysis with alteplase

A

Alteplase = tissue plasminogen activator - rapidly breaks down clots

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31
Q

What are the side effects of thrombolysis with alteplase

A

Risk of intracranial or systemic haemorrhage

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32
Q

When can thrombolysis with alteplase be given and for what condition

A

4.5 hours after symptom onset

For ischemic stroke (must have ruled out haemorrhagic stroke)

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33
Q

In which type of stroke much blood pressure be sorted

A

Yes - aggressive haemorrhagic stroke

NO - ischaemic stroke

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34
Q

Describe the role of atorvastatin

A

Statin

Lower cholesterol and other lipids

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35
Q

Describe the general role of antiplatelets

A

Inhibit thrombus formation

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36
Q

Name 2 antiplatelet medications

A

Aspirin

Clopidogrel

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37
Q

Describe antiplatelet used in prevention

A

Primary prevention - atherothrombotic events for people at high risk

Secondary prevention:
- acute coronary syndrome
- stable angina
- peripheral artery disease
- undergoing cardiac interventions
- had a stroke or TIA
- AF

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38
Q

What combination of antiplatelet can be used in an acute MI ST-elevation

A

Clopidogrel and low dose aspirin

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39
Q

Describe the mechanism of action of clopidogrel

A

Antiplatelet

Inhibit the binding of ADP to its platelet P2Y12 receptor + blocks platelet activation and aggregation

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40
Q

When is clopidogrel used

A

Peripheral artery disease
MI
Ischaemic stroke

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41
Q

When is clopidogrel not prescribed

A

Active pathological bleeding e.g. peptic ulcer, intracranial haemorrhage

Renal/hepatic impairment

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42
Q

Describe the mechanism of action of aspirin

A

Antiplatelet

Irreversibility inhibits cyclo-oxygenase and blocks production of thromboxane

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43
Q

What use in aspirin indicated for

A

NOT indicated in primary prevention

Acute MI/unstable angina
TIA
Stroke
+ secondary prevention

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44
Q

What is aspirin contraindicated for

A

Asthmatics

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45
Q

What is the dose of aspirin

A

300mg then 75mg

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46
Q

Describe salbutamol

A

Short acting beta-2 agonist

Rapid onset (5 minutes)

Lasts up to 4 hours

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47
Q

Describe the mechanism of action of salbutamol

A

Bronchodilation

Stimulates beta-2 adrenoreceptors in the bronchial muscles = relaxation of bronchial smooth muscle + dilation of airways

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48
Q

What is the 1st line management in hypertension

A

Lifestyle

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49
Q

What is the 1st medical step of treatment of hypertension in a man with type 2 diabetes OR < 55, not black ethnicity

A

ACEi or ARB

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50
Q

What is the 2nd medical step of treatment of hypertension in a man with type 2 diabetes OR < 55, not black ethnicity

A

ACEi or ARB

+

CCB or thiazide diuretic

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51
Q

What is the 1st medical step of the treatment of hypertension in someone without diabetes + > 55 or black ethnicity

A

CCB

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52
Q

What is the 2nd medical step of the treatment of hypertension in someone without diabetes + > 55 or black ethnicity

A

CCB

+

ACEi or ARB or thiazide-like diuretic

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53
Q

What is the 3rd medical step in the treatment of hypertension

A

ACEi or ARB + CCB + thiazide diuretic

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54
Q

What is the 4th medical step in the treatment of hypertension

A

Confirm resistant hypertension

+

low dose spironolactone or alpha block or beta blocker

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55
Q

What is the role of an ARB

A

Allows blood vessels to relax + widen

Angiotensin II receptor blocker

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56
Q

Name an example of an ACEi

A

Ramipril

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57
Q

Name an example of a CCB

A

Amlodipine

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58
Q

What is the role of a thiazide diuretic

A

Helps the kidneys pass more fluid

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59
Q

What is the role of spironolactone

A

Potassium receptor antagonist

Diuretic

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60
Q

Describe the mechanism of action of Ramipril

Look at this is the bottom bit in relation to an ARB

A

Angiotensin-converting enzyme inhibitor

ACE involved in RAAS - stimulates the conversion of angiotensin I to angiotensin II

Angiotensin II is a vasoconstrictor - when inhibited - blood vessels are dilated and decreased aldosterone secretion

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61
Q

What medication must Ramipril be careful being prescribed with due to decreasing blood pressure

A

Diuretics

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62
Q

What do ACEi end in

A

pril

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63
Q

What 3 things are ACEi contraindicated against

DELETE

A

Angio-oedema

Diabetes < 60 eGFR

Pregnant women/breastfeeding

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64
Q

What type of medication is amlodipine

A

Calcium channel blocker

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65
Q

Describe the mechanism of action of amlodipine

A

Interferes with the inward displacement of calcium ions through the slow channels of active cell membranes.

Influence myocardial cells = decreased myocardial contractility = decrease blood pressure

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66
Q

Name the contraindications in amlodipine

DELETE CARD

A

Cardiogenic shock
Significant aortic stenosis
Unstable angina

Elderly - STOPP criteria

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67
Q

Name 2 examples of a PPI

A

Lansoprazole

Omeprazole

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68
Q

Name 2 examples of a H2 receptor antagonist

A

Ametidine

Ranitidine

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69
Q

In what condition would H2 receptor antagonist be used

A

GORD

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70
Q

What type of drug is lansoprazole

A

PPI

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71
Q

Describe the mechanism of action of lansoprazole

A

Inhibits the membrane enzyme H+/K+ ATPase in gastric parietal cells = reduced stomach acid

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72
Q

What are the two main drugs in the treatment of autoimmune conditions in rheumatology

A

DMARDs

Biological agents

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73
Q

Describe the role of DMARDS

A

Disease modifying anti-rheumatic drugs

Dampen the immune system to reduce inflammation - aim to control disease progression

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74
Q

Describe how DMARDs can be taken

A

More than one can be used in combination

Oral or subcut

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75
Q

Name 4 examples of DMARDs

A

Methotrexate

Leflunomide

Sulfasalazine

Hydroxychloroquine

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76
Q

Name the side effects of methotrexate

A

DMARD

Bone marrow suppression

Neutropenia/neutropenic sepsis

Highly teratogenic

Toxic effects

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77
Q

Name the side effects of leflunomide

A

DMARD

Hypertension

Peripheral neuropathy

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78
Q

Name the side effects of sulfasalazine

A

Orange urine

Male infertility - reduces sperm count

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79
Q

Name the side effects of hydroxychloroquine

A

DMARD

Retinal toxicity

Blue-grey skin pigmentation

Hair bleaching

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80
Q

What must methotrexate be co-prescribed with

A

Folic acid

= reduce toxic effects

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81
Q

Describe the mechanism of action of methotrexate

A

Inhibits several enzymes responsible for nucleotide synthesis = suppresses inflammation and prevents cell division

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82
Q

When are biological agents given in autoimmune rheumatology

A

If DMARDs fail

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83
Q

Describe the role of biological agents in autoimmune rheumatology

A

Target specific signalling pathways/molecules

May be used in monotherapy or in combination with DMARDs

Expensive

Can develop antibodies to the drug overtime

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84
Q

Name 2 examples of biological agents in autoimmune rheumatology

A

Tumour necrosis factor inhibitors (anti-TNF)

B-cell direct

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85
Q

Name examples of tumour necrosis factor inhibitors (anti-TNF)

A

Adalimumab

Infliximab

Etanercept

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86
Q

Name an example of B-cell direct biological drug

A

Rituximab

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87
Q

Name 2 side effects of rituximab

A

Night sweats

Thrombocytopenia

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88
Q

Name the overall side effects of biological drugs

A

Immunosuppression

Opportunistic infection

Neutropenic sepsis

Reactivation of latent infections (e.g. TB)

Higher lifetime risk of cancer

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89
Q

What is the mechanism of action of rituximab

A

Monoclonal antibody that targets CD20, a protein expressed on the surface of B-cells

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90
Q

What is folic acid

A

Systemic form of B9

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91
Q

Describe the mechanism of action of folic acid

A

Biosynthesis of nucleotides for incorporation into DNA/RNA

Remyelination of homocysteine to form methionine

Methylation of substrates

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92
Q

Name 2 reasons why folic acid may be prescribed

A

Prevent neural tube defects

Reduce side effects of methotrexate

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93
Q

Describe the mechanism of action of NSAIDs

A

Non-selective inhibitor of cyclooxygenase (COX). (1 and 2)

COX is involved in synthesis of prostaglandins (mediators of pain and fever) and thromobane (stimulation of blood clotting) via the arachidonic acid pathway

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94
Q

Name 5 side effects of NSAIDs

A

Peptic ulcers
Renal dysfunction
Increased risk of cardiovascular events
Risk of hepatoxicity
Antiplatelet activation

NO - in 3rd trimester of pregnancy

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95
Q

What is prednisolone

A

Synthetic cord corticosteroid

96
Q

Describe the mechanism of action of prednisolone

A

Decrease inflammation via suppression of inflammatory mediators (suppression of polymorphonuclear leukocytes and reversing increase capillary permeability)

97
Q

When is prednisolone contraindicated

A

Presence of systemic fungal infection

98
Q

Name 4 side effects of prednisolone

A

Adrenal suppression
Insomnia
Osteoporosis
Delayed wound healing

99
Q

What is the role of xanthine oxidase inhibitors

A

Decrease uric acid levels

100
Q

Name 2 examples of xanthine oxidase inhibitors

A

Allopurinol

Febuxostat - avoid if bad CVD

101
Q

Name a side effect of colchicine

A

‘run before can walk’

Diaorhoea and abdo pain

102
Q

What do beta blockers end in

A
  • olol
103
Q

Name 3 beta blockers

A

Bisoprolol

Atenolol

Propranolol

104
Q

Describe the mechanism of action of beta blockers

A

Bind to beta-adrenoceptors to block the binding of norepinephrine and epinephrine = inhibits normal sympathetic response through these receptors

105
Q

Name 3 roles of beta blockers

A

Decrease:

HR
Myocardial oxygen demand
RAAS activation

106
Q

Name 2 conditions in which beta blockers are contraindicated

A

Asthma

2nd and 3rd degree AV block

107
Q

When are beta blockers prescribed

A

All patients with symptomatic HF + reduced LVEF < (or equal to) 40%

108
Q

Describe the mechanism of action of ARBs

A

Angiotensin-II receptor antagonists

Block action of angiotensin II, hormone causes blood vessels to narrow and raise blood pressure

109
Q

Name 3 examples of ARBs

A

Sartan

Losartan

Valsartan

110
Q

What do ARBs end in

A

sartan

111
Q

Name an example of a potassium sparing diuretic

A

Spironolactone

112
Q

Name an example of a thiazide diuretic

A

Bendroflumethiazide

113
Q

Name 3 examples of diferrent diuretics

A

Potassium sparing diuretics - e.g. spironolactone

Thiazide diuretic - e.g. Bendroflumethiazide

Loop diuretic - e.g. furosemide

114
Q

Describe the mechanism of action of a potassium sparing diuretic e.g. spironolactone

A

Blocks aldosterone receptor in the collecting ducts of the nephron

Prevents K+ loss. Promotes Na+ ad H2O excretion

115
Q

When are potassium sparing diuretics used e.g. spironolactone

A

Hypertension

HF

Cirrhosis

116
Q

Describe the mechanism of thiazide diuretics e.g. Bendroflumethiazide

A

Blockage of sodium-chloride channel in the proximal segment of the distal convoluted tubule

117
Q

When are thiazide diuretics used e.g. Bendroflumethiazide

A

Hypertension

118
Q

Describe the mechanism of action of loop diuretics e.g. furosemide

A

Inhibits reabsorption in the ascending loop of Henle

119
Q

When are loop diuretics used e.g. furosemide

A

OEdema

Heart failure

120
Q

What are 2 side effects of diuretics

A

Electrolyte imbalance

Pancreatitis

121
Q

Describe the management of heart failure

A

Diuretics if fluid retention

For HFrEF

ACEi + BB
(Add MRA if symptoms continue)

122
Q

What is the role of aminosalicylate

A

Limit inflammation in the lining of the GI tract

123
Q

Name 2 examples of aminosalicylate

A

Sulfasalazine
Mesalazine

124
Q

Describe the treatment of flares in UC

A

1st line
- topical aminosalicylate

2nd line
- oral aminosalicylate or/and prednisolone (corticosteroid)

125
Q

Describe the maintanance of remission in UC

A

Azathioprine or mercaptopurine

2nd line - biologics
TNF-a inhibitor - infliximab

3rd line - colectomy

126
Q

What is the gold standard treatment in UC

A

Colectomy

127
Q

What is the management of flares in chrons

A

Corticosteroids
- mild - prednisolone
- severe - IV hydrocortisone

128
Q

Describe the maintenance of chrons

A

1st line - azathioprine + methotrexate

2nd line - biologics
- TNF-a inhibitor - rituximab
- IL-12 & 23 inhibitor - ustekinumab

3rd line - last resort surgery

129
Q

What type of medication is azathioprine and mercaptopurine

A

Immunosuppressants

130
Q

What type of medication is rituximab

A

TNF-a inhibitor

Biologics

131
Q

What type of medication is ustekinumab

A

IL-12 & 23 inhibitor

Biologics

132
Q

What medication is given in a paracetamol overdose

A

Acetylcysteine

133
Q

What medication is given in encephalopathy as a complication of liver failure

A

Lactulose

134
Q

What medication is given in ascites as a complication of liver failure

A

Diuretics

135
Q

What medication is given in cerebral oedema as a complication of liver failure

A

Mannitol

136
Q

What medication is given in bleeding as a complication of liver failure

A

Vitamin K

137
Q

What medication is given in hypoglycaemia as a complication of liver failure

A

Dextrose

138
Q

Describe the mechanism of action of mannitol

A

Lowers intracranial pressure = osmotic diuretic

Inhibits sodium reabsorption in proximal tubule + loop of Henle

Elevates blood plasma osmolality = increase water flow from the tissue to interstitial fluid + plasma

139
Q

What is 1st line treatment in alcohol withdrawal

A

Benzodiazepine or carbamazepine

140
Q

Name an example of an alpha blocker

A

Tamsulosin

141
Q

What do alpha blockers end in

A
  • osin
142
Q

Describe the role of alpha blockers

A

Relax and widen the blood vessels

Used to treat high blood pressure and enlarged prostate

143
Q

Describe the mechanism of action of alpha blockers

A

Block transmission of certain nerve impulses by inhibiting the alpha-androgenic receptors.

These receptors are stimulated by the neurotransmitter noradrenaline

144
Q

What 2 conditions are alpha blockers contraindicated in

A

Postural hypotension
Micturition syncope (BPH)

145
Q

What is a risk associated with alpha blockers

A

Risk of hypotension - give at bed time

146
Q

Name 2 examples of GnRH agonists

A

Buserelin, Goserelin

147
Q

What do GnRH agonists end in

A
  • erelin
148
Q

Describe the mechanism of action of GnRH agonists

A

Provide continuous serum levels of GnRH - override the pusility of endogenous GnRH.

Initially stimulates the pituitary gland to release FSH, LH.

Then desensitizes it + reduces seceretion of gonadotrophs and sex hormones

Result = suppression of hormone production in the ovaries and testes

149
Q

In what conditions are GnRH agonists used

A

Endometriosis

Prostate cancer

150
Q

Name 2 side effects pf GnRH agonists

A

Osteoporosis

Side effects associated with menopause

151
Q

Name 2 NSAIDs

A

Ibuprofen
Diclofenac

152
Q

Name 2 examples of statin

A

Atorvastatin

Simvastatin

153
Q

What is the role of statins

A

Lower cholesterol

154
Q

Describe the mechanism of action of statins

A

Inhibit 3-hydroxy-3-methyglutayl co-enzyme A (HMG CoA) reductase. Enzyme is involved in cholesterol synthesis

155
Q

What is the most serious side effect of statin

A

Rhabdomyolysis

156
Q

Name 7 nephrotoxic drugs

A

Aminoglylide antibiotics
ACE-i
ARB
Bisphosphonates
NSAIDs
Loop diuretics
Lithium

157
Q

Name 2 drugs which are renal excreted and may accumulate if there is an issue with the kidneys (e.g. AKI)

A

Metformin
Opiates

158
Q

What type of medication is tolvaptan

A

Vasopressin receptor antagonist

159
Q

What is the role of tolvaptan

A

Can slow the development of cysts and progression to renal failure in PKD

160
Q

Name 3 medications which cause hypothyroidism

A

Lithium
Amiodarone
Carbimazole

161
Q

What is the role of somatostatin mediators e.g. octreotide

A

Block release of tumour mediators (endocrine) + counter peripheral effects

162
Q

What is mnemonic to remember the treatment of TB

A

RIPE

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

163
Q

Rifampicin

What is it used to treat?
For how long?
What are the side effects?

A

TB

6 months

Red/blood urine (haematuria) - think they both start with R

164
Q

Isoniazid

What is it used to treat?
For how long?
What are the side effects?

A

TB

6 months

Peripheral neuropathy

165
Q

Pyrazinamide

What is it used to treat?
For how long?
What are the side effects?

A

TB

2 months

Hepatitis and gout

166
Q

Ethambutol

What is it used to treat?
For how long?
What are the side effects?

A

TB

2 months

Eye problems (optic neuritis)

167
Q

What is the role of amitriptyline

A

Antidepressant
Analgesic properties

168
Q

Describe the mechanism of action of amitriptyline

A

Inhibits the reuptake of neurotransmitters in the brain (noradrenaline and serotonin)

169
Q

What is the role of clarithromycin

A

P450 enzyme inhibitor

170
Q

What drug does clarithromycin have an affect on

A

Causes a reduction in the metabolism of warfarin

171
Q

What is an important side effect of carbimazole

A

Sore throat

Can be due to bone marrow suppression causing agranulocytosis

Can lead to life threatening sepsis

172
Q

Describe the mechanism of action of carbimazole

A

Prodrug that is converted to methimazole, which inhibits thyroid hormone synthesis

Binds to thyroid peroxidase and prevents iodination and coupling of tyrosine residues on thyroglobulin

173
Q

Describe the role of carbimazole

A

reduces the production of T3 and T4

174
Q

What is the name for T3

A

Triiodothyronine

175
Q

What is the name for T4

A

Thyroxine

176
Q

What is carbimazole used to treat

A

Hyperthyroidism
Thyroid storm

177
Q

What is the role of aldosterone

A

Mineralocorticoid

Action of kidney:

Increases sodium reabsorption from distal tubule

Increases potassium excretion from the distal tubule.

178
Q

What type of hormone is hydrocortisone

What can it be used to replace

A

Glucocorticoid hormone

Replace cortisol

179
Q

What type of hormone is fludrocortisone

A

Mineralocorticoid hormone

Replace aldosterone

180
Q

Name the medication of Adcal D3

A

calcitriol

181
Q

What is Adcal D3 (calcitriol) and what does it do

A

Calcium + calecalciferol (vitamin D3)

Increase levels of Ca2+ and D3 over time

182
Q

Name 3 conditions in which Adcal D3 may be given

A

Hypoparathyroidism
Osteoporosis
CKD

183
Q

Name a side effect of Adcal D3

A

Can decrease the bioavailability of tetracyclines or fluroquinolones

184
Q

For staphylococcus infective endocarditis what antibiotics are used

A

Flucloxacillin + rifampicin + gentamicin

185
Q

For MRSA infective endocarditis what antibiotics are used

A

Vancomycin + rifampicin + gentamycin

186
Q

For a non staphylococcus infective endocarditis what antibiotics are used

A

Benzylpenicillin + gentamicin

187
Q

For an unknown organism infective endocarditis what antibiotics are used

A

FAG

Flucloxacillin + ampilicin + gentamicin

188
Q

Describe the mechanism of action of colchicine

A

Binds to neutrophils to prevent them migrating to areas of uric acid accumulation = reduces inflammation and pain

189
Q

Name 3 anticoagulant medications

A

Warfarin

LMWH

DOACs/NOACs

190
Q

What type of medication is warfarin

A

Anticoagulant

Vitamin K antagonist

191
Q

When is warfarin given

A

INR 2-3

192
Q

Describe the mechanism of action of warfarin

A

Inhibits enzyme vitamin K epoxide reductase = necessary for activation of vitamin K

Without vitamin K = reduction of clotting factors II, VII, IX and X

193
Q

What type of medication is LMWH

A

Anticoagulant

194
Q

Describe the mechanism of action of LMWH

A

Enhances the activity of antithrombin II = inactivates thrombin (IIa) and factor Xa through antithrombin-dependent mechanism

195
Q

Why is LWMH used instead of heparin

A

More predictable and more coinvent than heparin

196
Q

What type of medication is DOACs/NOACs

A

Anticoagulants

197
Q

Describe the general mechanism of DOAC/NOACs

A

Direct and reversible inhibitors of factor Xa = inhibition of factor Xa prevents thrombin generation and thrombus development

198
Q

Name examples of LWMH

A
  • parin

Dalteparin
Tinzaparin
Enoxaparin

199
Q

Name examples of DOACs/NOACs

A
  • aban

Apixaban
Rivaroxaban
Edoxaban

200
Q

What is another name for glyceryl trinitrate

A

GTN (spray)

201
Q

What is glyceryl trinitrate spray used to treat

A

Angina

Vasodilator

202
Q

Describe the mechanism of action glyceryl trinitrate spray

A

Rapid acting organic nitrite that relaxes vascular smooth muscle

203
Q

What therapy is used to prevent heart attacks and strokes

A

Dual antiplatelet therapy

Antiplatelet + P2Y 12 receptor inhibitor

Aspirin + clopidogrel

204
Q

Name the 1st line conservative management and 1st line pharmacological management in IBS-D

A

Conservative - low fibre, low FODMAP diet and avoid trigger foods

Pharmacological - Antimotility agents e.g. loperamide/Imodium

205
Q

Name the 1st line conservative management and 1st line pharmacological management in IBS-C

A

Conservative - increase fibre intake > 30g/day

Pharmacological
1st = bulk forming laxatives e.g. ispaghula hulk
2nd = stimulant laxatives e.g. senna

206
Q

What medication can be given for abdominal pain

A

Antispasmodics

e.g. mebevarine, buscopan (anticholinergics)

207
Q

What type of antidepressant can be given in IBS

A

Tricyclic antidepressants e.g. amitriptyline

208
Q

Name 2 antimotility agents

A

Loperamide
Imodium

209
Q

Name a bulk forming laxative

A

Ispaghula hulk

210
Q

Name a stimulant laxative

A

Senna

211
Q

What treatment is given for a h. pylori infection

A

CAP triple therapy

Clarithromycin 500mg + amoxicillin 1g + PPI (omeprazole)

If allergic to penicillin - metronidazole 400mg

212
Q

What treatment is given for a h. pylori infection if the patient has a penicillin allergy

A

Clarithromycin 500mg + metronidazole 400mg + PPI (omeprazole)

213
Q

Describe the role of amoxicillin

A

Used to treat gram positive bacteria

214
Q

Describe the mechanism of action of amoxicillin

A

Competitively inhibits penicillin-binding proteins = upregulation of autolytic enzymes + inhibition of cell wall synthesis

215
Q

Describe the contraindications/side effects of amoxicillin

A

No if allergy

Do not give if infective mononucleosis (can develop rash)

216
Q

Describe how NSAIDs effect the stomach

A

COX inhibitor - inhibits prostaglandin synthesis = less mucous secretion

217
Q

What is amiodarone known to cause

A

Hypo (more common) and hyperthyroidism

Brittle hair/nails

218
Q

Name the treatment for generalise tonic clonic seizures

A

Males - sodium valproate

Females - lamotrigine or levetiracetam

219
Q

Who can sodium valproate not be prescribed to

A

Teratogenic - not given to women of childbearing age

220
Q

Name the 1st line treatment for focal seizures

A

lamotrigine or levetiracetam

221
Q

What antiepileptic drug can exacerbate absence seizures

A

Carbamazepine

222
Q

What is the 1st line treatment for absence seizures

A

Ethosuximide

223
Q

What is the treatment for myoclonic seizures

A

Males - sodium valproate

Females - levetiracetam

224
Q

What is the treatment for tonic or clonic seizures

A

Males - sodium valproate

Females - lamotrigine

225
Q

Describe the medical management (3 steps) of status epilepticus

A
  1. IV Lorazepam - repeat after 10 minutes
  2. IV Levetiracetam - other options phenytoin or sodium valproate.
  3. Alter second line med, GA or phenobarbital
226
Q

Name 3 examples of mineralocorticoid receptor antagonist

A

Spironolactone
Eplerenone
Finerenone

227
Q

Name a common side effect of metformin

A

GI upset

Diarrhoea

228
Q

Name a common side effect of statins

A

Muscle aches and pains

229
Q

What is riluzole used to treat

A

Increases survival in motor neurone disease

Do not think need to know anyone information.

Glutamate agonist - inhibits action of glutamate, inactivates the voltage-dependent sodium channels

230
Q

What is the management of encephalitis

A

IV Aciclovir

231
Q

Describe the 3 steps of the pain ladder

A
  1. Non opioid with or without adjuvant analgesic
  2. Opioid for mild to moderate pain + non-opioid with or without an adjuvant analgesic
  3. Opioid for moderate to severe pain + non opioid with or without adjuvant analgesic
232
Q

Name 3 weak opioids

A

Codeine
Dihydrocodeine
Tramadol

233
Q

Name 5 strong opioids

A

Morphine
Oxycodone
Methadone
Fentanyl
Buprenorphine

234
Q

What opioid is given if someone has renal impairment and why?

A

Oxycodone

Metabolised by the liver

235
Q

What should be done if someone has mild renal or hepatic impairment

A

Doses reduced by 50%

236
Q

Describe the order of pain prescribing

A
  1. Paracetamol
  2. NSAID (+/- PPI)
    • Codeine/co-codamol
    • Trial tramadol
  5. Remove tramadol and start morphine
  6. Refer to pain management specialists
237
Q

What are 4 medications that can be given for neuropathic pain

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

238
Q
A

Phase 2a (15 decks)

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