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
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
3
Q
What type of compound is insulin
A
Anabolic
3
Q
Name 2 drugs which have a potential severe interaction with insulin to cause hypoglycaemia
A
Clarithromycin
Metreleptin
Beta blockers?
4
Q
What are SGLT-2 inhibitors used to treat
A
Type 2 diabetes
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
6
Q
What is the ending of SGLT-2 inhibitors
A
-liflozin
7
Q
Name 4 examples of SGLT2 inhibitors
A
Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin
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
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
10
Q
What do GLP-1 inhibitors end in
A
- lutide
- atide
11
Q
Name 2 of the additional benefits of GLP-1 inhibitors
A
Weight loss
Blood pressure reduction
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
13
Q
Name 3 drug interactions of GLP-1 inhibitors
DELETE CARD
A
Beta-blockers
Paracetamol
Warfarin
14
Q
Describe the general mechanism of action of metformin
A
Increases peripheral sensitivity to insulin
15
Q
Describe the 4 parts of the mechanism of action of metformin
A
- Inhibition of hepatic gluconeogenesis = decrease production of glucose
- Enhance insulin sensitivity = decrease insulin resistance
- Mitochondrial actions
- Weight loss
16
Q
What is a main risk of metformin
A
Lactic acidosis
17
Q
Name 3 drug interactions of metformin
A
Alcohol - Increases risk of lactic acidosis
Beta-blockers
Topiramate
18
Q
Name 2 risk of metformin
A
Lactic acidosis
Low vitamin B12 levels on increased dose
19
Q
Why should beta blockers be avoided with antidiabetic medication
A
Can mask the warning signs of hypoglycaemia
20
Q
What condition are DPP-4 inhibitors used to treat
A
Type 2 diabetes
21
Q
What do DPP-4 inhibitor drug names end in
A
-liptin
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
23
Q
What are the contradictions and cautions of DPP-4 inhibitors
DELETE CARD
A
Ketoacidosis
Hepatic impairment
Heart failure
24
Name 5 interactions of DPP-4 inhibitors
DELETE CARD
Beta blockers
ACE inhibitors
Digoxin
Ketoconazole
Rifampicin
25
Describe the 1st line medical management for type 2 diabetes
High-risk of CVD/chronic heart failure = metformin + SGLT-2 inhibitor
Not above = metformin
26
What do you do if metformin is not tolerated such as due to GI side effects
Switch to modified-release metformin
27
What is 2nd line medical treatment for type 2 diabetes
Add one of:
DPP-4 inhibitors
Pioglitazone
Sulfonylurea
SGLT-2 inhibitor
28
What is 3rd line medical treatment of type 2 diabetes
Add another drug (from the 2nd line drug treatment list)
OR
Start insulin-based treatment
29
At what % Q-risk would a patient who is on metformin be prescribed as an add on a SGLT-2 inhibitor
QRISK > 10%
30
Describe the action of thrombolysis with alteplase
Alteplase = tissue plasminogen activator - rapidly breaks down clots
31
What are the side effects of thrombolysis with alteplase
Risk of intracranial or systemic haemorrhage
32
When can thrombolysis with alteplase be given and for what condition
4.5 hours after symptom onset
For ischemic stroke (must have ruled out haemorrhagic stroke)
33
In which type of stroke much blood pressure be sorted
Yes - aggressive haemorrhagic stroke
NO - ischaemic stroke
34
Describe the role of atorvastatin
Statin
Lower cholesterol and other lipids
35
Describe the general role of antiplatelets
Inhibit thrombus formation
36
Name 2 antiplatelet medications
Aspirin
Clopidogrel
37
Describe antiplatelet used in prevention
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
38
What combination of antiplatelet can be used in an acute MI ST-elevation
Clopidogrel and low dose aspirin
39
Describe the mechanism of action of clopidogrel
Antiplatelet
Inhibit the binding of ADP to its platelet P2Y12 receptor + blocks platelet activation and aggregation
40
When is clopidogrel used
Peripheral artery disease
MI
Ischaemic stroke
41
When is clopidogrel not prescribed
Active pathological bleeding e.g. peptic ulcer, intracranial haemorrhage
Renal/hepatic impairment
42
Describe the mechanism of action of aspirin
Antiplatelet
Irreversibility inhibits cyclo-oxygenase and blocks production of thromboxane
43
What use in aspirin indicated for
NOT indicated in primary prevention
Acute MI/unstable angina
TIA
Stroke
+ secondary prevention
44
What is aspirin contraindicated for
Asthmatics
45
What is the dose of aspirin
300mg then 75mg
46
Describe salbutamol
Short acting beta-2 agonist
Rapid onset (5 minutes)
Lasts up to 4 hours
47
Describe the mechanism of action of salbutamol
Bronchodilation
Stimulates beta-2 adrenoreceptors in the bronchial muscles = relaxation of bronchial smooth muscle + dilation of airways
48
What is the 1st line management in hypertension
Lifestyle
49
What is the 1st medical step of treatment of hypertension in a man with type 2 diabetes OR < 55, not black ethnicity
ACEi or ARB
50
What is the 2nd medical step of treatment of hypertension in a man with type 2 diabetes OR < 55, not black ethnicity
ACEi or ARB
+
CCB or thiazide diuretic
51
What is the 1st medical step of the treatment of hypertension in someone without diabetes + > 55 or black ethnicity
CCB
52
What is the 2nd medical step of the treatment of hypertension in someone without diabetes + > 55 or black ethnicity
CCB
+
ACEi or ARB or thiazide-like diuretic
53
What is the 3rd medical step in the treatment of hypertension
ACEi or ARB + CCB + thiazide diuretic
54
What is the 4th medical step in the treatment of hypertension
Confirm resistant hypertension
+
low dose spironolactone or alpha block or beta blocker
55
What is the role of an ARB
Allows blood vessels to relax + widen
Angiotensin II receptor blocker
56
Name an example of an ACEi
Ramipril
57
Name an example of a CCB
Amlodipine
58
What is the role of a thiazide diuretic
Helps the kidneys pass more fluid
59
What is the role of spironolactone
Potassium receptor antagonist
Diuretic
60
Describe the mechanism of action of Ramipril
Look at this is the bottom bit in relation to an ARB
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
61
What medication must Ramipril be careful being prescribed with due to decreasing blood pressure
Diuretics
62
What do ACEi end in
pril
63
What 3 things are ACEi contraindicated against
DELETE
Angio-oedema
Diabetes < 60 eGFR
Pregnant women/breastfeeding
64
What type of medication is amlodipine
Calcium channel blocker
65
Describe the mechanism of action of amlodipine
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
66
Name the contraindications in amlodipine
DELETE CARD
Cardiogenic shock
Significant aortic stenosis
Unstable angina
Elderly - STOPP criteria
67
Name 2 examples of a PPI
Lansoprazole
Omeprazole
68
Name 2 examples of a H2 receptor antagonist
Ametidine
Ranitidine
69
In what condition would H2 receptor antagonist be used
GORD
70
What type of drug is lansoprazole
PPI
71
Describe the mechanism of action of lansoprazole
Inhibits the membrane enzyme H+/K+ ATPase in gastric parietal cells = reduced stomach acid
72
What are the two main drugs in the treatment of autoimmune conditions in rheumatology
DMARDs
Biological agents
73
Describe the role of DMARDS
Disease modifying anti-rheumatic drugs
Dampen the immune system to reduce inflammation - aim to control disease progression
74
Describe how DMARDs can be taken
More than one can be used in combination
Oral or subcut
75
Name 4 examples of DMARDs
Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine
76
Name the side effects of methotrexate
DMARD
Bone marrow suppression
Neutropenia/neutropenic sepsis
Highly teratogenic
Toxic effects
77
Name the side effects of leflunomide
DMARD
Hypertension
Peripheral neuropathy
78
Name the side effects of sulfasalazine
Orange urine
Male infertility - reduces sperm count
79
Name the side effects of hydroxychloroquine
DMARD
Retinal toxicity
Blue-grey skin pigmentation
Hair bleaching
80
What must methotrexate be co-prescribed with
Folic acid
= reduce toxic effects
81
Describe the mechanism of action of methotrexate
Inhibits several enzymes responsible for nucleotide synthesis = suppresses inflammation and prevents cell division
82
When are biological agents given in autoimmune rheumatology
If DMARDs fail
83
Describe the role of biological agents in autoimmune rheumatology
Target specific signalling pathways/molecules
May be used in monotherapy or in combination with DMARDs
Expensive
Can develop antibodies to the drug overtime
84
Name 2 examples of biological agents in autoimmune rheumatology
Tumour necrosis factor inhibitors (anti-TNF)
B-cell direct
85
Name examples of tumour necrosis factor inhibitors (anti-TNF)
Adalimumab
Infliximab
Etanercept
86
Name an example of B-cell direct biological drug
Rituximab
87
Name 2 side effects of rituximab
Night sweats
Thrombocytopenia
88
Name the overall side effects of biological drugs
Immunosuppression
Opportunistic infection
Neutropenic sepsis
Reactivation of latent infections (e.g. TB)
Higher lifetime risk of cancer
89
What is the mechanism of action of rituximab
Monoclonal antibody that targets CD20, a protein expressed on the surface of B-cells
90
What is folic acid
Systemic form of B9
91
Describe the mechanism of action of folic acid
Biosynthesis of nucleotides for incorporation into DNA/RNA
Remyelination of homocysteine to form methionine
Methylation of substrates
92
Name 2 reasons why folic acid may be prescribed
Prevent neural tube defects
Reduce side effects of methotrexate
93
Describe the mechanism of action of NSAIDs
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
94
Name 5 side effects of NSAIDs
Peptic ulcers
Renal dysfunction
Increased risk of cardiovascular events
Risk of hepatoxicity
Antiplatelet activation
NO - in 3rd trimester of pregnancy
95
What is prednisolone
Synthetic cord corticosteroid
96
Describe the mechanism of action of prednisolone
Decrease inflammation via suppression of inflammatory mediators (suppression of polymorphonuclear leukocytes and reversing increase capillary permeability)
97
When is prednisolone contraindicated
Presence of systemic fungal infection
98
Name 4 side effects of prednisolone
Adrenal suppression
Insomnia
Osteoporosis
Delayed wound healing
99
What is the role of xanthine oxidase inhibitors
Decrease uric acid levels
100
Name 2 examples of xanthine oxidase inhibitors
Allopurinol
Febuxostat - avoid if bad CVD
101
Name a side effect of colchicine
'run before can walk'
Diaorhoea and abdo pain
102
What do beta blockers end in
- olol
103
Name 3 beta blockers
Bisoprolol
Atenolol
Propranolol
104
Describe the mechanism of action of beta blockers
Bind to beta-adrenoceptors to block the binding of norepinephrine and epinephrine = inhibits normal sympathetic response through these receptors
105
Name 3 roles of beta blockers
Decrease:
HR
Myocardial oxygen demand
RAAS activation
106
Name 2 conditions in which beta blockers are contraindicated
Asthma
2nd and 3rd degree AV block
107
When are beta blockers prescribed
All patients with symptomatic HF + reduced LVEF < (or equal to) 40%
108
Describe the mechanism of action of ARBs
Angiotensin-II receptor antagonists
Block action of angiotensin II, hormone causes blood vessels to narrow and raise blood pressure
109
Name 3 examples of ARBs
Sartan
Losartan
Valsartan
110
What do ARBs end in
sartan
111
Name an example of a potassium sparing diuretic
Spironolactone
112
Name an example of a thiazide diuretic
Bendroflumethiazide
113
Name 3 examples of diferrent diuretics
Potassium sparing diuretics - e.g. spironolactone
Thiazide diuretic - e.g. Bendroflumethiazide
Loop diuretic - e.g. furosemide
114
Describe the mechanism of action of a potassium sparing diuretic e.g. spironolactone
Blocks aldosterone receptor in the collecting ducts of the nephron
Prevents K+ loss. Promotes Na+ ad H2O excretion
115
When are potassium sparing diuretics used e.g. spironolactone
Hypertension
HF
Cirrhosis
116
Describe the mechanism of thiazide diuretics e.g. Bendroflumethiazide
Blockage of sodium-chloride channel in the proximal segment of the distal convoluted tubule
117
When are thiazide diuretics used e.g. Bendroflumethiazide
Hypertension
118
Describe the mechanism of action of loop diuretics e.g. furosemide
Inhibits reabsorption in the ascending loop of Henle
119
When are loop diuretics used e.g. furosemide
OEdema
Heart failure
120
What are 2 side effects of diuretics
Electrolyte imbalance
Pancreatitis
121
Describe the management of heart failure
Diuretics if fluid retention
For HFrEF
ACEi + BB
(Add MRA if symptoms continue)
122
What is the role of aminosalicylate
Limit inflammation in the lining of the GI tract
123
Name 2 examples of aminosalicylate
Sulfasalazine
Mesalazine
124
Describe the treatment of flares in UC
1st line
- topical aminosalicylate
2nd line
- oral aminosalicylate or/and prednisolone (corticosteroid)
125
Describe the maintanance of remission in UC
Azathioprine or mercaptopurine
2nd line - biologics
TNF-a inhibitor - infliximab
3rd line - colectomy
126
What is the gold standard treatment in UC
Colectomy
127
What is the management of flares in chrons
Corticosteroids
- mild - prednisolone
- severe - IV hydrocortisone
128
Describe the maintenance of chrons
1st line - azathioprine + methotrexate
2nd line - biologics
- TNF-a inhibitor - rituximab
- IL-12 & 23 inhibitor - ustekinumab
3rd line - last resort surgery
129
What type of medication is azathioprine and mercaptopurine
Immunosuppressants
130
What type of medication is rituximab
TNF-a inhibitor
Biologics
131
What type of medication is ustekinumab
IL-12 & 23 inhibitor
Biologics
132
What medication is given in a paracetamol overdose
Acetylcysteine
133
What medication is given in encephalopathy as a complication of liver failure
Lactulose
134
What medication is given in ascites as a complication of liver failure
Diuretics
135
What medication is given in cerebral oedema as a complication of liver failure
Mannitol
136
What medication is given in bleeding as a complication of liver failure
Vitamin K
137
What medication is given in hypoglycaemia as a complication of liver failure
Dextrose
138
Describe the mechanism of action of mannitol
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
What is 1st line treatment in alcohol withdrawal
Benzodiazepine or carbamazepine
140
Name an example of an alpha blocker
Tamsulosin
141
What do alpha blockers end in
- osin
142
Describe the role of alpha blockers
Relax and widen the blood vessels
Used to treat high blood pressure and enlarged prostate
143
Describe the mechanism of action of alpha blockers
Block transmission of certain nerve impulses by inhibiting the alpha-androgenic receptors.
These receptors are stimulated by the neurotransmitter noradrenaline
144
What 2 conditions are alpha blockers contraindicated in
Postural hypotension
Micturition syncope (BPH)
145
What is a risk associated with alpha blockers
Risk of hypotension - give at bed time
146
Name 2 examples of GnRH agonists
Buserelin, Goserelin
147
What do GnRH agonists end in
- erelin
148
Describe the mechanism of action of GnRH agonists
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
In what conditions are GnRH agonists used
Endometriosis
Prostate cancer
150
Name 2 side effects pf GnRH agonists
Osteoporosis
Side effects associated with menopause
151
Name 2 NSAIDs
Ibuprofen
Diclofenac
152
Name 2 examples of statin
Atorvastatin
Simvastatin
153
What is the role of statins
Lower cholesterol
154
Describe the mechanism of action of statins
Inhibit 3-hydroxy-3-methyglutayl co-enzyme A (HMG CoA) reductase. Enzyme is involved in cholesterol synthesis
155
What is the most serious side effect of statin
Rhabdomyolysis
156
Name 7 nephrotoxic drugs
Aminoglylide antibiotics
ACE-i
ARB
Bisphosphonates
NSAIDs
Loop diuretics
Lithium
157
Name 2 drugs which are renal excreted and may accumulate if there is an issue with the kidneys (e.g. AKI)
Metformin
Opiates
158
What type of medication is tolvaptan
Vasopressin receptor antagonist
159
What is the role of tolvaptan
Can slow the development of cysts and progression to renal failure in PKD
160
Name 3 medications which cause hypothyroidism
Lithium
Amiodarone
Carbimazole
161
What is the role of somatostatin mediators e.g. octreotide
Block release of tumour mediators (endocrine) + counter peripheral effects
162
What is mnemonic to remember the treatment of TB
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
163
Rifampicin
What is it used to treat?
For how long?
What are the side effects?
TB
6 months
Red/blood urine (haematuria) - think they both start with R
164
Isoniazid
What is it used to treat?
For how long?
What are the side effects?
TB
6 months
Peripheral neuropathy
165
Pyrazinamide
What is it used to treat?
For how long?
What are the side effects?
TB
2 months
Hepatitis and gout
166
Ethambutol
What is it used to treat?
For how long?
What are the side effects?
TB
2 months
Eye problems (optic neuritis)
167
What is the role of amitriptyline
Antidepressant
Analgesic properties
168
Describe the mechanism of action of amitriptyline
Inhibits the reuptake of neurotransmitters in the brain (noradrenaline and serotonin)
169
What is the role of clarithromycin
P450 enzyme inhibitor
170
What drug does clarithromycin have an affect on
Causes a reduction in the metabolism of warfarin
171
What is an important side effect of carbimazole
Sore throat
Can be due to bone marrow suppression causing agranulocytosis
Can lead to life threatening sepsis
172
Describe the mechanism of action of carbimazole
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
Describe the role of carbimazole
reduces the production of T3 and T4
174
What is the name for T3
Triiodothyronine
175
What is the name for T4
Thyroxine
176
What is carbimazole used to treat
Hyperthyroidism
Thyroid storm
177
What is the role of aldosterone
Mineralocorticoid
Action of kidney:
Increases sodium reabsorption from distal tubule
Increases potassium excretion from the distal tubule.
178
What type of hormone is hydrocortisone
What can it be used to replace
Glucocorticoid hormone
Replace cortisol
179
What type of hormone is fludrocortisone
Mineralocorticoid hormone
Replace aldosterone
180
Name the medication of Adcal D3
calcitriol
181
What is Adcal D3 (calcitriol) and what does it do
Calcium + calecalciferol (vitamin D3)
Increase levels of Ca2+ and D3 over time
182
Name 3 conditions in which Adcal D3 may be given
Hypoparathyroidism
Osteoporosis
CKD
183
Name a side effect of Adcal D3
Can decrease the bioavailability of tetracyclines or fluroquinolones
184
For staphylococcus infective endocarditis what antibiotics are used
Flucloxacillin + rifampicin + gentamicin
185
For MRSA infective endocarditis what antibiotics are used
Vancomycin + rifampicin + gentamycin
186
For a non staphylococcus infective endocarditis what antibiotics are used
Benzylpenicillin + gentamicin
187
For an unknown organism infective endocarditis what antibiotics are used
FAG
Flucloxacillin + ampilicin + gentamicin
188
Describe the mechanism of action of colchicine
Binds to neutrophils to prevent them migrating to areas of uric acid accumulation = reduces inflammation and pain
189
Name 3 anticoagulant medications
Warfarin
LMWH
DOACs/NOACs
190
What type of medication is warfarin
Anticoagulant
Vitamin K antagonist
191
When is warfarin given
INR 2-3
192
Describe the mechanism of action of warfarin
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
What type of medication is LMWH
Anticoagulant
194
Describe the mechanism of action of LMWH
Enhances the activity of antithrombin II = inactivates thrombin (IIa) and factor Xa through antithrombin-dependent mechanism
195
Why is LWMH used instead of heparin
More predictable and more coinvent than heparin
196
What type of medication is DOACs/NOACs
Anticoagulants
197
Describe the general mechanism of DOAC/NOACs
Direct and reversible inhibitors of factor Xa = inhibition of factor Xa prevents thrombin generation and thrombus development
198
Name examples of LWMH
- parin
Dalteparin
Tinzaparin
Enoxaparin
199
Name examples of DOACs/NOACs
- aban
Apixaban
Rivaroxaban
Edoxaban
200
What is another name for glyceryl trinitrate
GTN (spray)
201
What is glyceryl trinitrate spray used to treat
Angina
Vasodilator
202
Describe the mechanism of action glyceryl trinitrate spray
Rapid acting organic nitrite that relaxes vascular smooth muscle
203
What therapy is used to prevent heart attacks and strokes
Dual antiplatelet therapy
Antiplatelet + P2Y 12 receptor inhibitor
Aspirin + clopidogrel
204
Name the 1st line conservative management and 1st line pharmacological management in IBS-D
Conservative - low fibre, low FODMAP diet and avoid trigger foods
Pharmacological - Antimotility agents e.g. loperamide/Imodium
205
Name the 1st line conservative management and 1st line pharmacological management in IBS-C
Conservative - increase fibre intake > 30g/day
Pharmacological
1st = bulk forming laxatives e.g. ispaghula hulk
2nd = stimulant laxatives e.g. senna
206
What medication can be given for abdominal pain
Antispasmodics
e.g. mebevarine, buscopan (anticholinergics)
207
What type of antidepressant can be given in IBS
Tricyclic antidepressants e.g. amitriptyline
208
Name 2 antimotility agents
Loperamide
Imodium
209
Name a bulk forming laxative
Ispaghula hulk
210
Name a stimulant laxative
Senna
211
What treatment is given for a h. pylori infection
CAP triple therapy
Clarithromycin 500mg + amoxicillin 1g + PPI (omeprazole)
If allergic to penicillin - metronidazole 400mg
212
What treatment is given for a h. pylori infection if the patient has a penicillin allergy
Clarithromycin 500mg + metronidazole 400mg + PPI (omeprazole)
213
Describe the role of amoxicillin
Used to treat gram positive bacteria
214
Describe the mechanism of action of amoxicillin
Competitively inhibits penicillin-binding proteins = upregulation of autolytic enzymes + inhibition of cell wall synthesis
215
Describe the contraindications/side effects of amoxicillin
No if allergy
Do not give if infective mononucleosis (can develop rash)
216
Describe how NSAIDs effect the stomach
COX inhibitor - inhibits prostaglandin synthesis = less mucous secretion
217
What is amiodarone known to cause
Hypo (more common) and hyperthyroidism
Brittle hair/nails
218
Name the treatment for generalise tonic clonic seizures
Males - sodium valproate
Females - lamotrigine or levetiracetam
219
Who can sodium valproate not be prescribed to
Teratogenic - not given to women of childbearing age
220
Name the 1st line treatment for focal seizures
lamotrigine or levetiracetam
221
What antiepileptic drug can exacerbate absence seizures
Carbamazepine
222
What is the 1st line treatment for absence seizures
Ethosuximide
223
What is the treatment for myoclonic seizures
Males - sodium valproate
Females - levetiracetam
224
What is the treatment for tonic or clonic seizures
Males - sodium valproate
Females - lamotrigine
225
Describe the medical management (3 steps) of status epilepticus
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
Name 3 examples of mineralocorticoid receptor antagonist
Spironolactone
Eplerenone
Finerenone
227
Name a common side effect of metformin
GI upset
Diarrhoea
228
Name a common side effect of statins
Muscle aches and pains
229
What is riluzole used to treat
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
What is the management of encephalitis
IV Aciclovir
231
Describe the 3 steps of the pain ladder
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
Name 3 weak opioids
Codeine
Dihydrocodeine
Tramadol
233
Name 5 strong opioids
Morphine
Oxycodone
Methadone
Fentanyl
Buprenorphine
234
What opioid is given if someone has renal impairment and why?
Oxycodone
Metabolised by the liver
235
What should be done if someone has mild renal or hepatic impairment
Doses reduced by 50%
236
Describe the order of pain prescribing
1. Paracetamol
2. NSAID (+/- PPI)
3. + Codeine/co-codamol
4. + Trial tramadol
5. Remove tramadol and start morphine
6. Refer to pain management specialists
237
What are 4 medications that can be given for neuropathic pain
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
238
