PSA Flashcards
First line treatment for BPE after lifestyle changes?
alpha-blockers
Second line treatment for BPE?
5a-reductase inhibitors
What symptoms 5a-reductase inhibitors relieve?
Improve lower urinary symptoms; can take 6 months for this to show
Usual dose 5a-reductase inhibitors?
5mg OD
Example of 5a-reductase inhibitors?
Finasteride and dutasteride
Alpha blockers usual indications?
BPE and resistant hypertension (after CCB, ACE inhibitors and diuretics), Raynaud’s (prazosin)
Examples of alpha blockers?
Doxazosin, tamsulosin (BPE only), alfuzosin
Important adverse effects from alpha blockers?
Postural HT, dizziness and syncope (don’t give to those with postural hypotension), aim to take before bed; anxiety, back pain, flu-like, myalgia
Alpha blockers interactions?
Hypotension with other antihypertensives (particularly beta blockers)
Dose for alpha blockers?
1mg OD and increased at 1-2 wks after response; tamsulosin = 400ug daily
Indications for acetylcholinesterase inhibitors?
Mild to moderate parkinsons and mild to moderate dementia in PD (rivastigmine)
Examples of acetylcholinesterase inhibitors?
Donepezil and rivastigmine
Adverse SEs achase inhibitors?
N+V, diarrhoea (increased ach in peripheral NS); some asthma and COPD exacerbated; can develop tremor
Achase inhibitors interactions?
NSAIDs and steroids = higher risk of peptic ulcers; antipsychotics = neuroleptic syndrome risk; heart block and brady = risk increased with rate limiting meds (beta blockers)
Achase inhibitors dose?
Prescribed and managed by specialist; 5mg OD = donepezil, 1.5mg 12 hourly = rivastigmine; dose titrated up after 2-4wks
Indication for acetylcysteine?
Antidote for paracetamol poisoning; prevent contrast nephropathy (renal injury from contrast for scans); reduce viscosity of resp secretions (oral carbocisteine)
Adverse effects of acetylcysteine?
Produces anaphylactoid reaction (like anaphylaxis but no IgE mediated); if this happens, let it settle and give it at a lower rate; if nebulised can cause bronchospasm so give with bronchodilator
Dose for acetlycysteine?
Weight adjusted in 3 components for paracetamol OD for 21 hours; not recommended in contrast nephropathy; resp secretions = 2.5ml 10% solution neb every 6 hours
Activated charcoal indication?
For absorption of poisons or elimination with multiple doses (benzos or methotrexate)
Adverse effects activated charcoal?
If inhaled - pneumonitis, bronchospasm, airway obstruction; also GI obstruction, black stools and vomiting
Warnings activated charcoal?
Not to reduced consciousness and persistent vomiting as aspiration risk; not to reduced gut motility
Dose activated charcoal?
Single dose within 1 hour of ingested poison (50mg in 250ml water); can also give later/additional dose for drugs delaying gastric emptying (aspirin, TCAs, opioids); for multiple (carbamazepine, quinine, theophyline) 50mg 4 hourly
Adenosine indication?
First-line diagnostic and therapeutic agent for SVT (regular, narrow-complex tachy); reduces automaticity and increases refractoriness
Adverse effects of adenosine?
Can induce brady and asystole as interferes with SA and AV node, feels like having an MI
Contraindications of adenosine?
Not to those intolerant of brady - hypotension, coronary ishchaemia, decompensated HF; avoided if poss in asthma and COPD
Adenosine interactions?
Dipyridamole (blocks uptake of adenosine - dose halved as prolongs half life); theophylline and aminophylline competitive antagonists (may need more adenosine)
Adenosine dose?
IV initial = 6mg; then 12mg if ineffective; if central line = lower dose; has to be by specialists and followed by saline
Adrenaline indications?
Cardiac arrest, anaphylaxis immediate management, vasoconstriction in surgery and prolong effects of local anaesthesia
Adrenaline adverse effects?
In cardiac arrest can get adrenaline-induced HT; can cause anxiety, tremor, headache, palps
Warnings adrenaline?
Careful with heart disease, don’t use in peripheries as can cause tissue necrosis from vasoconstriction
Interactions adrenaline?
Can get widespread vasoconstriction if on beta blockers
Adrenaline prescription?
Prescribed after given in life-threatening (1mg/10ml IV after 3rd shock followed by saline flush and repeated 3-5 mins after - ), same if rhythm not shockable; anaphylaxis = 500ug IM repeated after 5 mins if necessary (in thigh); for use with analgesia = 5ug/ml
Types of aldosterone antagonists?
Spironolactone and eplerenone
Aldosterone antagonists indications?
Oedema from liver cirrhosis, chronic HF, primary hyperaldosteronism (Conn’s); eplerenone only for HF, nephrotic syndrome
Important aldosterone antagonist adverse effects?
Hyperkalaemia (muscle weakness, arrythmias) and gynaecomastia; less common with eplerenone; can cause liver impairment and jaundice and stevens-johnson syndrome
CIs aldosterone antagonists?
Renal impairment, hyperkalaemia, Addison’s, pregnancy
Aldosterone antagonists interactions?
K+ elevating drugs (ACE inhibitors and ARBs) or K+
Dose for spironolactone?
25mg start dose HF and 100mg for anything else; taken with food oral
Indications for aliginates and antacids?
GORD and dyspepsia
Types of alginates and antacids?
Gaviscon and peptac
Alginates and antacids SEs?
Magnesium salts = diarrhoea, aluminium salts = constipation
Interactions alginates and antacids?
Can bind to drugs reducing absorption; ACE inhibitors, abx, bisphosphonates, digoxin, levothyroxine, PPIs and increase aspirin and lithium excretion
Dose alginates and antacids?
Chewable tablets and usually after meals or when sxs occur; check ingredients for renal impairment/diabetes
Allopurinol indications?
Prevent recurrent gout attacks, prevent uric acid and oxalate renal stones, prevent hyperuricaemia and tumour lysis syndrome from chemo
Allopurinol SEs?
Can worsen gout attack (can reduce if given with NSAID or colchicine); skin rash, stevens-johnson syndrome, allopurinol hypersensitivity reaction, hepatotoxicity
Allopurinol warnings?
Don’t give if acute gout attack, recurrent skin rash, severe hypersensitivity, renal and hepatic impairment, stay hydrated
Allopurinol interactions?
Azathioprine has toxicity increased, ACE inhibitors and thiazides increases hypersensitive risk and amoxicillin increase skin rash
Allopurinol dose?
Start at 100mg and titrate up to 200-600mg OD; take after food and lots of fluids
Types of aminoglyosides?
Gentamicin, amikacin, neomycin
Aminoglycoside indications?
Systemic infections by gram positive and some gram negative anaerobes
Aminoglycoside SEs?
Nephrotoxicity and ototoxicity
Aminoglycoside warnings?
Neonates, elderly, renal impairment and mysathenia gravis
Aminoglycosides interactions?
Ototoxicity = vancomycin and loop diuretics, nephrotoxicity = ciclosporin, vancomycin and cephalosporin
Aminoglycoside dose?
Less in renal impairment; intermittent IV infusion if severe and parenteral if not; one dose (5mg/kg over 30 mins) every 24 hours if normal renal for 7 days
Aminosalicylates types?
Mesalazine, sulfasalazine, olsalazine, balsalazide
Aminosalicylates indications?
Ulcerative colitis and rheumatoid arthritis
Aminosalicylates SEs?
Mesalazine = fewer; GI upset and headache, sometimes blood abnormalities and renal failure; ask about oral ulceration, unexplained rash or unusual bruising; sulfasalazine can cause yellow-orange skin discolouration
CIs aminosalicylates?
Those who have aspirin hypersensitivity, renal dysfunction, elderly, pregnant and breastfeeding, asthma
Aminosalicylates interactions?
Those that alter pH and break down coating prematurely; PPIs and lactulose; leucopenia risk = azathioprine and mercaptopurine
Aminosalicylates dose?
Suppository for UC unless more proximal (oral) and 12-hourly for 4-6wks
Amiodarone indications?
Tachyarrhythmias when other drugs ineffective; rhythm control in AF, atrial flutter, VT and VF, WPW arrhythmias
Amiodarone SEs?
Hypotension; pneumonitis, brady, AV block, hepatitis, photosensitivity, peripheral neuropathy, myopathy, slate grey skin, jaundice, nausea, pulmonary fibrosis
CIs amiodarone?
Severe hypotension, heart block, thyroid disease, HF, elderly
Amiodarone interactions?
Many; increases dose of diltiazem, verapamil and digoxin so increases brady
Amiodarone dose?
Usually done by specialist unless in MI - VF or pulseless VT after 3rd shock (300mg IV followed by 20ml saline); infusions only in 5% glucose not saline
Types of ACEi?
Ramipril, lisinopril, perindopril, enalapril
ACEi indications?
HT, chronic HF, IHD, CKD with proteinuria and diabetic nephropathy
ACEi SEs?
Hypotension, persistent dry cough, hyperkalaemia, renal failure; rare = anaphylactoid, angioedema; cholestatic jaundice/hepatitis
ACEi warnings?
Avoided in renal failure, renal artery stenosis, pregnancy, CKD
ACEi interactions?
Avoid potassium elevating drugs, with NSAIDs = increased nephrotoxicity, diuretics = increased hypotension; ciclosporin
ACEi dose?
Oral, 1.25mg HF and nephropathy, 2.5mg everything else and up to 10mg
ARB types?
Candesartan, losartan, irbesartan
ARB indications?
Same as ACEi but not tolerated due to cough; but type 2 diabetic nephropathy whereas type 1 in ACEi
ARB SEs?
Hypotension, hyperkalaemia, renal failure
ARB warnings and interactions?
Same as ACEi
ARBs dose?
Oral, losartan = 12.5mg HF and 50mg in everything else and titrated up
PC BRAS for enzyme inducers?
phenytoin, carbamazepine, barbiturates, rifampicin, alcohol (chronic excess) sulphonylureas. Others: topiramate, St John’s Wort, and smoking
AO DEVICES for enzyme inhibitors?
allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline).
SSRIs and antidepressants types?
Citalopram, fluoxetine, sertraline, escitalopram
SSRIs indications?
Depression, OCD, panic disorder
SSRIs SEs?
GI upset, weight gain, change in appetite, hyponatraemia, lower seizure threshold, prolong QT (citalopram), bleeding, suicidal in first 2 weeks; withdrawal = flu-like, vomit, neuro upset
What is serotonin syndrome?
Autonomic hyperactivity, altered mental state, neuromuscular excitability
SSRIs warnings?
Young people, epilepsy, peptic ulcer disease, hepatic impairment
SSRI interactions?
MAOI and other serotonergic drugs; higher bleeding in NSAIDs/aspirin; don’t combine with antipsychotics (QT long), alcohol, theophylline
SSRIs dose?
Oral, 20mg starting and titrate up
TCAs types?
Amitryptilline and lofepramine and impramine
TCAs indications?
Second line depression; neuropathic pain
TCAs SEs?
Antimuscarinic (dry mouth, constipation, urinary retention, blurred vision), sedation, hypotension, arrhythmias, ECG changes, extrapyramidal, convulsions, hallucinations, mania, weight gain, neuroleptic malignant syndrome, hyponatraemia esp in elderly
TCAs warnings?
Elderly, epilepsy, CVD, prostatic hypertrophy, glaucoma, constipation; discontinue if manic stage of bipolar
TCAs interactions?
MAOIs or SSRIs
TCAs dose?
Depression starting = 75mg OD, pain = 10mg OD at night; only give 2wks at a time to prevent overdose
Venlafaxine and mirtazapine indications?
GAD and major depression after SSRIs
Venlafaxine and mirtazapine SEs?
GI upset, neuro effects; rare = serotonin syndrome, hyponatraemia, suicidal thoughts, long QT, VT, venlafaxine= greater risk of withdrawals; SIADH and rhabdomyolysis
Venlafaxine and mirtazapine warnings?
Elderly, hepatic/renal impairment, arrhythmias, epilepsy, pregnancy
Venlafaxine and mirtazapine interactions?
Other antidepressants, NSAIDs, warfarin, antiepileptics, dopaminergics (selegiline)
Venlafaxine and mirtazapine dose?
Oral and by experts; venlafaxine = 37.5mg 12 hourly to 375mg max and mirtazapine = 15mg OD to 45mg max at night (weight gain and sedating)
Types of dopamine D2 receptor antagonists?
Metoclopramide and domperidone
Dopamine D2 receptor antagonists indications?
N+V in reduced gut motility
Dopamine D2 receptor antagonists SEs?
Diarrhoea; metoclopramide = extrapyramidal sxs (like antipsychotics - dystonia etc); domperidone = QT long and arryhthmias
Dopamine D2 receptor antagonists warning?
Metoclopramide for no more than 5 days (extra-pyramidal effects), avoided in the young and PD; domperidone = no cardiac conduction problems and hepatic impairment; avoided in intestinal obstruction and perforation
Dopamine D2 receptor antagonists interactions?
Antipsychotics extra-pyramidal increases; not with dopaminergic agents; not with drugs increasing QT interval; not with CYP450 inhibitors
Dopamine D2 receptor antagonists dose?
10mg 8-hrly either IM (over 3mins) or IV
Histamine H1-receptor antagonists types?
Cyclizine, cinnarizine, promethazine
Histamine H1-receptor antagonists indications?
N+V, motion sickness, vertigo
Histamine H1-receptor antagonists SEs?
Drowsiness (cyclizine least likely to), dry throat, tachy, palps
Histamine H1-receptor antagonists warnings?
Hepatic encephalopathy and those susceptible to anticholinergic SEs (prostatic enlargement)
Histamine H1-receptor antagonists interactions?
Other sedative drugs; ipratropium and tiotropium increase anticholinergic effects
Histamine H1-receptor antagonists dose?
Cyclizine = 50mg 8 hourly (IV, IM, oral); slow IV (2 hours)
Serotonin 5-HT3-receptor antagonists types?
Ondansetron, granisetron
Serotonin 5-HT3-receptor antagonists SEs?
Rare but sometimes diarrhoea, headaches, constipation
Serotonin 5-HT3-receptor antagonists warnings?
Small risk of QT prolongation
Serotonin 5-HT3-receptor antagonists interactions?
Avoid drugs QT prolongation
Serotonin 5-HT3-receptor antagonists dose?
Ondansetron = 4-8mg 12hourly orally/IV
Antifungal types?
Nystatin, clotrimazole, fluconazole
Antifungal SEs?
Local irritation; fluconazole = oral so systemic (GI upset, headache, hepatitis, hypersensitivity), rare = hepatotoxicity, long QT, arrhythmia, anaphylaxis, peripheral neuropathy and hypersensitivity
Antifungal warnings?
Fluconazole = liver disease, renal impairment, pregnancy
Antifungal interactions?
Fluconazole CYP450 inhibitor so don’t give with meds metabolised by it or long QT drugs
Antifungal dose?
See BNF
H1 receptor antagonists (antihistamines) types?
Cetirizine, loratadine, fexofenadine, chlorphenamine
H1 receptor antagonists (antihistamines) indications?
First-line for allergies, pruritus, urticaria, N+V, adjunct to adrenaline for anaphylaxis
H1 receptor antagonists (antihistamines) SEs?
Sedation
H1 receptor antagonists (antihistamines) warnings?
Sedating avoided in liver disease (hepatic encephalopathy), pregnancy and breastfeeding
H1 receptor antagonists (antihistamines) dose?
Cetirizine = 10mg, loratadine (10mg), chlorphenamine (4mg and 2mg/5ml solution) every 4-6 hours; anaphylaxis = chlorphenamine (10mg IV/IM)
Antimotility drugs types?
Loperamide, codeine phosphate
Antimotility drug indications?
Diarrhoea usually for IBS or gastroenteritis
Antimotility drug SEs?
Codeine = opioid toxicity and dependance
Antimotility drugs warnings?
Don’t use in acute UC, C.difficile, acute bloody diarrhoea
Antimotility drug dose?
Loperamide = 4mg and 2mg with each loose stool to a max 8mg per day
Antimuscarinic and bronchodilator types?
Ipratropium, tiotropium, glycopyrronium, aclidinium
Antimuscarinic and bronchodilator indicators?
COPD, asthma
Antimuscarinic and bronchodilator SEs?
Resp tract irritation; GI disturbance, urinary retention, blurred vision, headaches (lower risk for inhaled)
Antimuscarinic and bronchodilator warnings?
Angle-closure glaucoma, arrhythmias, urinary retention
Antimuscarinic and bronchodilator dose?
Short-acting anti-muscarinics = QDS PRN; ipratropium = 40ug for stable and 250-500ug 6hrly for attack
Antimuscarinic for CVD and gastro types?
Atropine, hyoscine butylbromide, glycopyrronium
Antimuscarinic for CVD and gastro indications?
Atropine = first line for severe brady; hyoscine = for IBS and antispasmodic, reduce resp secretions in palliation
Antimuscarinic for CVD and gastro SEs?
Tachy, dry mouth, constipation, urinary retention, blurred vision, confusion, drowsiness (parasympathetic)
Antimuscarinic for CVD and gastro warnings?
In angle closure glaucoma, bladder outflow obstruction, prostatic hyperplasia and arrhythmias
Antimuscarinics for GU types?
Oxybutynin, tolterodine, solifenacin
Antimuscarinics for GU indications?
Overactive bladder (urge/frequency) after bladder training
Antimuscarinics for GU warnings?
UTI, elderly, dementia, angle closure glaucoma, arrhythmias, urinary retention
Antipsychotics typical types?
Haloperidol, chlorpromazine, prochlorperazine
Antipsychotics typical indications?
Psychomotor agitation, schizophrenia, bipolar, N+V in palliation
Antipsychotics typical SEs?
Extrapyramidal (dystonia, akathisia, neuroleptic malignant syndrome, tardive dyskinesia, drowsiness, QT prolongation, ED, hyperprolactinaemia
Antipsychotics typical warnings?
Elderly, dementia, PD, epilepsy
Antipsychotics atypical types?
Quetiapine, olanzapine, risperidone, clozapine
Antipsychotics atypical indications?
Same as typical other than N+V
Antipsychotics atypical SEs?
Sedation, extrapyramidal SEs (less than typical), metabolic disturbance, arrhythmias, QT prolongation, sexual dysfunction, clozapine = agranulocytosis
Antipsychotics atypical warnings?
CVD, neutropenia
Types of antiviral?
Aciclovir, famciclovir, valaciclovir
Antiviral indicators?
Acute herpesvirus (cold sores, genital ulcers, encephalitis, chickenpox), suppression of recurrent herpes simplex
Antiviral SEs?
Headache, GI disturbance, dizziness, skin rash, phlebitis, neurotoxicity
Antiviral warnings?
Caution in pregnancy and breastfeeding, severe renal impairment and theophylline
Types of antiplatelet drugs and ADP receptor antagonists?
Clopidogrel, ticagrelor, prasugrel
Indications antiplatelet drugs and ADP receptor antagonists?
Treatment of ACS with aspirin to prevent thrombosis, prevent occlusion of coronary artery stents, prevention of secondary thrombotic events in those with CVD/peripheral artery disease
Antiplatelet drugs and ADP receptor antagonists SEs?
Bleeding, GI upset, thrombocytopenia
Antiplatelet drugs and ADP receptor antagonists warnings?
Caution in renal and hepatic failure, none if signficant bleeding, stop 7 days before elective surgery; avoid in pregnancy
Antiplatelet drugs and ADP receptor antagonists interactions?
Efficacy of clopidogrel reduced by CYP450 inhibitors (omeprazole, cipro, erythromycin, SSRIs and some antivirals); for gastric protection use lansoprazole or pantoprazole; ticagrelor can interact with CYP inhibitors or inducers but not a prodrug; anything that increases bleeding risk
Indications aspirin (antiplatelet)?
ACS and ischaemic stroke treatment or secondary prevention thrombosis after CVD, cerebro, peripheral artery disease
SEs aspirin?
Bleeding, GI irritation, bronchospasm, tinnitus
Warnings aspirin?
Under 16yrs (Reye’s syndrome), hypersensitivity, third trimester pregnancy, gout, peptic ulcers
Dose aspirin?
For ACS = 300mg loading dose then 75mg daily, ischaemic stroke = 300mg OD 2wks, longterm = 75mg daily, pain = max 4g daily
Azathioprine indications?
Crohn’s and UC, DMARD for rheumatoid arthritis and other AIs not working with steroids, prevent organ rejection
Azathioprine SEs?
Bone marrow suppression, nausea, hypersensitivity, hepatotoxicity, lymphoma, veno-occulsive disease
Azathioprine warnings?
Reduced/no TPMT activity (how to break it down - give mercaptopurine instead), hepatic/renal impairment, pregnancy, hypersensitivity reactions
Azathioprine interactions?
Careful with steroids, don’t use with allopurinol as reduces metabolism, not with trimethoprim or aminosalicylates
Types of beta blockers?
Bisoprolol, atenolol, propanolol (non-cardio-selective), metoprolol, carvediol (non-cardioselective)
Beta blocker indications?
IHD, chronic HF, AF, SVT, HT (3rd line), angina, MI, hyperthyroidism, migraine prophylaxis
Beta blocker SEs?
Fatigue, cold extremities, headache, GI disturbance, sleep disturbance, impotence in men
Beta blocker warnings?
Asthma, haemodynamic instability, heart block, hepatic failure
Beta blocker interactions?
Verapamil or diltiazem, other antihypertensives, clonidine, alcohol
Types of B2 agonists?
Salbutamol, terbutaline, salmeterol, formoterol, indacaterol
B2 agonist indications?
Asthma, COPD, hyperkalaemia (with insulin, glucose and calcium gluconate)
B2 agonist SEs?
Tachy, palps, anxiety, tremor, higher glucose and lactate; long acting = muscle cramps; arrhythmias, MI, hypokalaemia, lactic acidosis
B2 agonist warnings?
LABAs = more asthma deaths if without steroids; careful if CVD; monitor K+ if with theophylline and steroids (hypo); beta blockers reduce efficacy; careful in DM and hyperthyroidism
Types of benzos?
Diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
Benzo indications?
Seizures/status epilepticus, alcohol withdrawal, sedation for procedure if anaesthesia no, severe anxiety/insomnia
Benzo SEs?
Drowsiness, sedation, coma, dependance, withdrawal, airway obstruction, death
Benzos warnings?
Elderly, resp disease, neuromuscular disease and hepatic failure; alcohol and opioids
Benzos interactions?
Don’t use with CYP inhibitors, lorazepam, antihypertensives
Bisphosphonate types?
Alendronic acid, disodium pamidronate, zoledronic acid
Bisphosphonate indications?
Osteoperotic fxs, severe hypercalcaemia of malignancy, myeloma and breast cancer mets, Paget’s disease
Bisphosphonate SEs?
Oesophagitis, hypophosphataemia, atypical stress fx
Bisphosphonate warnings?
Severe renal impairment, hypocalcaemia, smokers and dental disease for osteonecrosis risk
Bisphosphonate interactions?
They bind calcium so absorption reduced with calcium salts, antacids and iron salts; take 30 mins before breakfast and stay sitting/standing for 30 mins
Calcium and vit D types?
Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
Calcium and vit D indications?
Osteoporosis when lifestyle not enough, CKD, secondary hyperparathyroidism, renal osteodystrophy, severe hyperkalaemia, symptomatic hypocalcaemia, vit D low
Calcium and vit D SEs?
Dyspepsia, constipation, CV collapse if given too fast IV
Calcium interactions?
Reduces absorption = iron, bisphosphonates, tetracyclines, levothyroxine
CCB types?
Amlodipine, nifedipine, diltiazem, verapamil, felodipine, lercanidipine
CCB indications?
Amlodipine/nifedipine for 1st/2nd line for HT, symptom control in stable angina, SVT = diltiazem/verapamil
CCB SEs?
Ankle swelling, flushing, headache, palps; dilt and vera = constipation, brady, heart block, cardiac failure
CCB warnings?
Vera and dilt = poor left ventricle, AV nodal conduction delay; amlodipine/nifedipine = unstable angina and severe aortic stenosis
CCB interactions?
B blockers as too much brady/heartblock
Carbamazepine indications?
Seizure prophylaxis in epilepsy (not absence or myoclonic) and first line in trigeminal neuralgia; prophyalxis of bipolar
Carbamazepine SEs?
GI upset, neuro effects, hypersensitivity (Steven Johnson syndrome), oedema, hyponatraemia, ataxia, cardiac conduction disturbances, bone marrow failure
Carbamazepine warnings?
Pregnancy (give folic acid and discuss with specialist), hepatic/renal/cardiac disease = caution; if susceptible to acute angle glaucoma
Carbamazepine interactions?
Induces cyp450 (reduces efficacy of drugs metabolised by this) = warfarin, oestrogens, progestrogens; any drugs reducing seizure threshold and other anti-epileptics
Cephalosporin and carbapenem types?
Cefalexin, cefotaxime, meropenem, ertapenem
Cephalosporin and carbapenem indications?
Second and third line UTIs and RTIs; parenteral for severe and resistant infections
Cephalosporin and carbapenem SEs?
GI upset, abx associated colitis, hypersensitivity (steven johnson syndrome and toxic epidermal necrolysis), neurotoxicity, seizures
Cephalosporin and carbapenem warnings?
At risk of C diff, hx of allergy/anaphylaxis, caution in epilepsy and renal failure
Cephalosporin and carbapenem interactions?
Cephalosporin and carbapenem = warfarin, aminoglycosides and valproate, COCP reduced efficacy
Chloramphenicol indications?
Bacterial conjunctivitis; otitis externa
Chloramphenicol SEs?
Stinging, burning, itching, bone marrow suppression, aplastic anaemia
Chloramphenicol warnings?
Hypersensitivity, bone marrow disorder, third trimester, breastfeeding and <2yrs, hepatic impairment
Types of inhaled corticosteroids?
Beclometasone, budesonide, fluticasone
Inhaled corticosteroids indications?
Asthma, COPD
Inhaled corticosteroids SEs?
Oral candidiasis, hoarse voice and sometimes pneumonia
Inhaled corticosteroids warnings?
Pneumonia hx and children
Systemic corticosteroids types?
Prednisolone, hydrocortisone, dexamethasone
Systemic corticosteroids indications?
Allergic/inflammatory disorders, AI, cancer chemo, HRT in adrenal insufficiency and hypopituitarism
Systemic corticosteroids SEs?
Immunosuppression, metabolic effects, muscle thinning and skin wasting, bruising, mood and behaviour changes, adrenal atrophy = longterm (if withdrawn suddenly = addisonian crisis), fatigue, weight loss, arthralgia
Systemic corticosteroids warnings?
Children, infections and infections
Systemic corticosteroids interactions?
Risk of peptic ulceration with NSAIDs; hypokalaemia in B2 agonists/theophylline,/diuretics; efficacy reduced by CYP450 inducers, warfarin, live vaccines
Topical corticosteroid types?
Hydrocortisone, betamethasone
Topical corticosteroid indications?
Inflammatory skin conditions (eczema)
Topical corticosteroid SEs?
Uncommon, skin thinning etc
Topical corticosteroid warnings?
Infection and facial lesions
Digoxin indications?
AF and flutter (after B blocker or dilt/vera); severe HF (3rd line); ventricular rate control in supraventricular arrhythmias
Digoxin SEs/overdose?
Brady GI disturbance, rash, dizziness, visual disturbance
Digoxin warnings?
CI in heart block, ventricular arrhythmias; increased risk of toxicity = hypokalaemia, hypomagnesaemia, hypercalcaemia (also amiodarone, CCBs, spironolactone, quinine), thyroid disease, WPW, myocarditis, pericarditis, severe resp disease
Dipeptidylpeptidase-4 inhibitor types?
Sitagliptin, linagliptin, saxagliptin
Dipeptidylpeptidase-4 inhibitor indications?
T2DM (in combo with metformin or if metformin CI)
Dipeptidylpeptidase-4 inhibitor SEs?
Usually well tolerated; GI upset, headache, nasopharyngitis, peripheral oedema; hypos, pancreatitis, hepatotoxicity
Dipeptidylpeptidase-4 inhibitor warnings?
T1DM, ketoacidosis, pregnancy, breastfeeding
DOAC types (factor Xa inhibitors)?
Rivaroxaban, apixaban, dabigatran, edoxaban
DOAC indications?
VTE, AF
DOAC SEs?
Bleeding, anaemia, GI upset, dizziness, elevated liver enzymes
DOAC warnings?
Bleeding, hepatic/renal disease, pregnancy/breastfeeding
DOAC interactions?
Antithrombotic agents, CYP inducers/inhibitors; increased anticoag from macrolides, protease inhibitors, fluconazole; decreased from rifampicin and phenytoin
Loop diuretic types?
Furosemide and butemanide and torasemide
Loop diuretic indications?
Acute pulmonary oedema (with O2 and nitrates), fluid overload in CHF/other states, resistant hypertension
Loop diuretic SEs?
Dehydration and hypotension; any low electrolyte state as increases their excretion; hearing loss and tinnitus, nephrotoxicity
Loop diuretic warnings?
Severe hypovolaemia, dehydration; use with care in hepatic encephalopathy, hypokalaemia/natraemia, gout worsened
Loop diuretic interactions?
Lithium levels elevated, digoxin/aminoglycoside toxicity increased risk, antihypertensives and diuretics, NSAIDs for renal reasons
Thiazide diuretic types?
Bendroflumethiazide, indapamide, chlortalidone, hydrochlorothiazide, metolazone
Thiazide indications?
Alternative first line for HT where CCB not appropriate, add-on for HT treatment, oedema in mild-moderate HF
Thiazide SEs?
Hyponatraemia, hypokalaemia, cardiac arrhythmias, impotence, hypercalcaemia, hyperglycaemia, postural hypotension, hypomagnesaemia
Thiazide warnings?
Gout, low K+/Na+
Thiazide interactions and CIs?
Things lowering K+/Na+, NSAIDs, impotence, blood disorders, renal impairment, Addison’s
Dopaminergic drugs?
Levodopa, ropinirole, pramipexol
Dopaminergic indications?
Early PD (dopamine agonists preferred over levadopa); later PD = levadopa; secondary parkinsonism
Dopaminergic SEs?
Nausea, drowsiness, confusion, hallucinations, hypotension; too much = dyskinesias; wearing off effect towards end of dose = sxs worsen; schizophrenic and huntington’s effects
Dopaminergic warnings?
Elderly, psych disease, CVD use with care; breastfeeding
Dopaminergic interactions?
Don’t give with typical antipsychotic or metoclopramide as opposing effects; give levodopa with decarboxylase inhibitor (carbidopa); MAOIs and antihypertensives
Emollients types?
Aqueous cream, liquid paraffin
Emollients indications?
Dry/scaling skin disorders; eczema and psoriasis
Emollients SEs?
Greasiness and can exacerbate acne
Fibrinolytic types?
Alteplase and streptokinase
Fibrinolytic indications
Acute ischaemic stroke within 4.5 hours; acute ST elevation MI within 12 hours (usually PCI now tho); massive PE with haemodynamic instability
Fibrinolytic SEs?
N+V, bruising, hypotension, serious bleeding, cardiogenic shock, cardiac arrest
Fibrinolytic warnings?
Recent bleed/surgery; intracranial haemorrhage; previous streptokinase treatment
Gabapentin and pregabalin indications?
Add-ons for focal epilepsy or other epileptic drugs fail; neuropathic pain; GAD
Gabapentin and pregabalin SEs?
Drowsiness, dizziness, ataxia, ach symptoms, HT, leucopenia
Gabapentin and pregabalin warnings?
Reduced dose in renal impairment, DM, elderly, severe CHF, pregnancy, breastfeeding, hx of psychosis
H2 receptor antagonist type?
Ranitidine, cimetidine, famotidine, nizatidine
H2 receptor antagonist indications?
Peptic ulcer disease (PPIs preferred), GORD and dyspepsia
H2 receptor antagonist SEs?
Not many; bowel disturbance, headache, dizziness
H2 receptor antagonist warnings?
Reduced in renal impairment; investigate cause as can mask sxs cancer; cimetidine gives gynaecomastia and impotence and is a CYP450 inhibitor
Heparins and fondaparinux types?
Enoxaparin, dalteparin, fondaparinux, unfractionated heparin
Heparins and fondaparinux indications?
Prevention DVT, PE, VTE; treatment for VTE until oral coag established; ACS
Heparins and fondaparinux SEs?
Haemorrhage (protamine sulphate is direct antidote), occasionally hyperkalaemia, sometimes heparin-induced thrombocytopenia
Heparins and fondaparinux warnings?
Clotting disorders, severe uncontrolled HT, recent surgery/trauma; caution in renal/hepatic failure
Heparins and fondaparinux reversal?
Protamine; andexanet for LMWH and fondaparinux
Insulin names?
Insulin aspart, insulin glargine, biphasic insulin, soluble insulin
Insulin indications?
T1DM, T2DM if poor control, diabetic emergency, hyperkalaemia with glucose
Insulin SEs?
Hypoglycaemia and lipohypertrophy
Insulin warnings?
If renal failure more likely to have hypo
Insulin interactions?
Need more if on steroids; also beta blockers enhance effect
Iron types?
Ferrous fumarate, ferrous sulfate
Iron indications?
Iron-deficiency anaemia (treatment and prophylaxis with high RFs)
Iron SEs?
GI upset (nausea, epigastric pain, constipation, diarrhoea), black stools
Iron warnings?
Can upset intestinal disease bowel movements more; use IV with care in anaphyactics
Iron interactions?
Reduce absorption of levothyroxine and bisphosphonates
Lamotrigine indications?
First line prophylaxis for epilepsy (simple and partial seizures); bipolar depression only
Lamotrigine SEs?
Headache, drowsiness, irritability, blurred vision, dizziness, GI; can get skin rash due to hypersensitivity reaction that needs immediate treatment (SJS and toxic epidermal necrolysis); BM failure
Lamotrigine warnings?
Avoided in pts with hypersensitivity to other drugs, dose reduction in hepatic and renal impairment
Lamotrigine interactions?
Reduced effect from higher glucuronidation: carbamazepine, phenytoin, oestrogens, rifampicin, protease inhibitors; toxicity risk: valproate; TCAs, SSRIs, MAOIs, St John’s Wort
Osmotic laxative types?
Lactulose, macrogol, phosphate enema
Osmotic laxative indications?
Constipation/faecal impaction, bowel prep before procedure, hepatic encephalopathy
Osmotic laxative SEs?
Wind, abdo cramps, nausea, diarrhoea, electrolyte disturbance
Osmotic laxative warnings?
Intestinal obstruction; used with caution in HF, ascites, electrolyte disturbances
Stimulant laxative types?
Senna, bisacodyl, glycerol suppositories, docusate sodium
Stimulant laxative indications?
Constipation and faecal impaction
Stimulant laxative warnings?
Intestinal obstruction; caution in rectal prep for haemorrhoids/anal fissures
Leukotriene receptor antagonist type?
Montelukast
Leukotriene receptor antagonist indications?
Adults = add on for asthma (with LABA and steroids); 5-12yrs = add on for asthma (instead of LABA with steroid); under 5 = first line for asthma prevention not able to take steroids
Leukotriene receptor antagonist SEs?
Headache, abdo pain; unlikely = RTIs, chrug strauss syndrome (rare), hypersensivity, seizures, depression, agranulocytosis
Levetiracetam indications?
Seizure prophylaxis in epilepsy; some cases of status epilepticus if benzo not worked
Levetiracetam SEs?
Not common = drowsiness, weakness, dizziness, headache
Levetiracetam warnings?
Dose reduction in renal and hepatic impairment; breastfeeding and pregnancy; antidepressants
Lidocaine indications?
Local anaesthetic; sometimes antiarrhythmic for VT and VF
Lidocaine SEs?
Stinging; not usual but drowsiness, restlessness, tremor, fits
Lidocaine interactions?
Effects prolonged by adrenaline (vasoconstrictor)
Macrolide types?
Clarithromycin, erythromycin, azithromycin
Macrolide indications?
Infections where penicillin CI, severe penumonia add-on to penicillin, for H.pylori with PPI and amoxicillin/metronidazole
Macrolide SEs?
Irritant, N+V, abdo pain, diarrhoea, thrombophlebitis if IV; others = cholestatic jaundice, long QT, ototoxicity, abx-associated colitis, hepatoxicity, SJS and toxic epidermal necrolysis
Macrolide warnings?
Caution in renal/hepatic impairment; they are CYP inhibitors; anything prolonging QT
Metformin indications?
T2DM (>25 BMI and <25 if not working alone on sulphonylureas)
Metformin SEs?
GI upset and rarely lactic acidosis if AKI
Metformin warnings?
Not for: AKI, severe tissue hypoxia; caution: renal/hepatic impairment (contrast), drunk, chronic alcohol abuse
Metformin interactions?
Anything that impairs renal function use with caution (MAOI and ACEi)
Methotrexate indications?
DMARD for RA, chemo (leukaemia/lymphoma), severe resistant psoriasis, Crohn’s
Methotrexate SEs?
Mucosal damage, bone marrow suppression; longterm = hepatic cirrhosis or pulmonary fibrosis or pericarditis; N+V, alopecia, stomatitis
Methotrexate warnings?
None: pregnancy, severe renal impairment; caution in hepatic impairment
Methotrexate interactions?
Toxicity increased by: inhibit renal excretion (NSAIDs and penicillins), folate antagonists (trimethoprim and phenytoin), live vaccines and clozapine
Metronidazole indications?
Abx colitis, oral infections, aspiration pneumonia, surgical/gynae infections, protozoal infx; anaerobic infections
Metronidazole SEs?
GI upset; high dose/long time = seizures, encephalopathy, hepatitis, pancreatitis, peripheral and optic neuropathy
Metronidazole warnings?
Don’t have with alcohol and reduce in severe hepatic impairment; pregnancy and breastfeeding
Metronidazole interactions?
Cyp inhibitor, clozapine, alcohol
Naloxone indications?
Treatment opioid toxicity
Naloxone SEs?
Opioid withdrawal (pain, restlessness, N+V, dilated pupils, piloerection)
Naloxone warnings?
Careful in palliative care as could be more preferable to allow OD
Nicotine replacement and related drug types?
Nicotine, varenicline, bupropion
Nicotine replacement and related drug indications?
Smoking cessation
Nicotine replacement and related drug SEs?
Local irritation, GI upset, palps; varenicline = nausea, headaches, insomnia, abnormal dreams; bupropion = dry mouth, GI upset, neuro and psych sxs
Varenicline mechanism?
Partial agonist of nicotinic receptor so less withdrawal and rewarding sxs smoking
Bupropion mechanism?
Increased conc noradrenaline and dopamine in synapse
Nicotine replacement and related drug warnings?
Haemodynamically unstable, risk of seizures, psych disease, renal/hepatic impairment
Nitrates types?
Isosorbide mononitrate (long acting), glyceryl trinitrate (short acting)
Nitrate indications?
Short acting = angina, ACS; long acting = prophylaxis angina 3rd line; pulmonary oedema with furosemide and oxygen
Nitrate SEs?
Flushing, headaches, dizziness, hypotension; tolerance
Nitrate warnings?
CI: severe aortic stenosis, haemodynamic instability, hypotension
Nitrate interactions?
Caution with antihypertensives and never with sildenafil
Nitrofurantoin indications?
First choice UTI and also for prophylaxis of recurrent
Nitrofurantoin SEs?
GI upset, urine yellow/brown, peripheral neuropathy, pulmonary fibrosis, hypersensitivity reactions, haemolytic anaemia
Nitrofurantoin warnings?
CI: pregnant women, less than 3months, renal impairment
NSAID types?
Naproxen, ibuprofen, etoricoxib
NSAID indications?
Mild to moderate pain; pain related inflammation
NSAID SEs?
GI toxicity, renal impairment, CVD events, bronchospasm
NSAID warnings?
CI: severe renal impairment, HF, liver failure, hypersensitivity; warnings: peptic ulcer disease, GI bleed, CVD, renal impairment, asthma
NSAID interactions?
Peptic ulcers = aspirin, steroids; GI bleeds = anticoag, SSRIs; renal impairment = ACEi, diuretics; lithium, antidepressants
Ocular lube types?
Hypromellose, carbomers, liquid and white soft paraffin
Ocular lube indications?
Dry eye conditions (keratoconjunctivitis sicca and Sjogrens)
Oestrogens and progestrogen types?
Combined ethinylestradiol products, desogestrel
Oestrogens and progestrogen indications?
HRT for early menopause and menopausal sxs; hormonal contraception
Oestrogens and progestrogen SEs?
Irregular bleeds, mood changes; oestrogen = higher risk VTE/CVD/stroke/breast and cervical cancer
Oestrogens and progestrogen warnings?
CI: breast cancer; caution in VTE risk and CVD disease and migraines with aura
Oestrogens and progestrogen interactions?
Lamotrigine efficacy reduced; cyp450 inducers reduce its efficacy
Strong opioid types?
Morphine and oxycodone
Strong opioid indications?
Acute severe pain, chronic pain relief last line, SOB relief in palliation, SOB in pulmonary oedema with O2, furosemide and nitrates
Strong opioid SEs?
Resp depression, euphoria, neuro depression, N+V, pupillary constriction, biliary/ureteric spasm, dysphoria, sweating, constipation, itching, tolerance, dependence and withdrawal
Strong opioid warnings?
Hepatic/renal failure, elderly, resp failure, biliary colic, prostatic hypertrophy, IBD, convulsive disorders, pregnancy, raised ICP
Weak/moderate opioid types?
Tramadol, codeine, dihydrocodeine
Weak/moderate opioid indications?
Mild-moderate pain, diarrhoea and cough suppression
Weak/moderate opioid SEs?
Same as strong
Weak/moderate opioid interactions?
Sedating drugs, drugs lowering seizure threshold, serotonergic drugs (serotonin syndrome)
Oxygen indications?
Acute hypoxaemia, accelerate reabsorption of pleural gas in pneumothorax, CO poisoning
Oxygen SEs?
Mask discomfort, dry throat
Oxygen warnings?
T2 resp failure = resp acidosis and tissue hypoxia
Paracetamol indications?
Acute and chronic pain; antipyretic
Paracetamol SEs?
Liver failure in OD; rare = blood disorders (thrombocytopenia, leucopenia, neutropenia)
Paracetamol interactions?
CYP inducers = risk of OD; chronic alcohol
Penicillin types?
Benzylpenicillin and phenoxymethylpenicillin
Penicillin indications?
Strep infections (tonsillitis, pneumonia, endocarditis, skin and soft tissue infx); meningooccal infx; clostridial infx
Penicillin SEs?
Allergy (rash and sometimes hypersensitivity); neuro toxicity at high doses
Penicillin interactions?
Reduce renal excretion methotrexate
Antipseudomonal penicillin types?
Piperacillin with tazobactam (tazocin)
Antipseudomonal penicillin indications?
Severe infections where broad spectrum bacteria involved, immunocompromised; LRTI/UTI/intraabdo sepsis/skin and soft tissue infx
Antipseudomonal penicillin SEs?
GI upset, abx associated colitis
Antipseudomonal penicillin warnings?
Caution = C diff risk, renal impairment
Broad spectrum abx types?
Amoxicillin, co-amoxiclav
Broad spectrum abx indications?
Amoxicillin = uncomplicated pneumonia, otitis media, sinusitis, UTI, H. pylori; co-amoxiclav = severe, resistant HAP
Broad spectrum abx SEs?
Same as other penicillins
Penicillinase-resistant penicillin types?
Flucloxacillin
Penicillinase-resistant penicillin indications?
Staph infection; cellulitis, osteomyelitis, septic arthritis, endocarditis
Phosphodiesterase type 5 inhibitor types?
Sildenafil
Phosphodiesterase type 5 inhibitor indications?
ED, primary pulmonary HT
Phosphodiesterase type 5 inhibitor SEs?
Flushing, dizziness, headache, nasal congestion, hypotension, tachy, palps, CVD events, priapism, visual disorders
Phosphodiesterase type 5 inhibitor warnings?
CI = stroke, ACS, CVD, nitrates, nicorandil; caution = hepatic/renal impairment, CYP inhibitors, vasodilators
Prostaglandin analogue eye drop types?
Latanoprost and bimatoprost
Prostaglandin analogue eye drop indications?
Open angle glaucoma and ocular HT
Prostaglandin analogue eye drop SEs?
Blurred vision, conjunctival reddening (hyperaemia), occular irritation, pain
PPI types?
Omeprazole, lansoprazole, pantoprazole
PPI indications?
Prevention and treatment of peptic ulcer disease, dyspepsia, GORD, H. pylori, Zollinger-Ellison syndrome
PPI SEs?
GI disturbance, headache, hypomagnesaemia if prolonged use
PPI warnings?
Caution in pts at risk osteoporosis, pregnancy and breastfeeding
PPI interactions?
Reduce effect of clopidogrel of omeprazole
Type of quinine?
Quinine sulfate
Quinine indications?
Night time leg cramps, malaria
Quinine SEs?
Toxic in OD, tinnitus, deafness, blindness, GI upset, prolongs QT, hypoglycaemia
Quinine warnings?
Caution = hearing/visual impairment, not in first trimester, G6PD
Quinolone types?
Ciprofloxacin, moxifloxacin, levofloxacin
Quinolone indications?
UTI, severe gastroenteritis, LRTI; 2nd/3rd line treatment; gram -ve and +ve
Quinolone SEs?
GI upset, neuro effects, damage to tendons, prolong QT, c diff colitis, headache
Quinolone warnings?
Caution: at risk of seizures, children, psych illness, pregnancy, G6PD deficiency
Quinolone interactions?
Can be a cyp inhibitor = theophylline toxicity; NSAIDs = risk of seizures; prednisolone = tendon rupture
Serotonin 5-HT1-receptor antagonist types?
Sumatriptan
Serotonin 5-HT1-receptor antagonist indications?
Acute migraine
Serotonin 5-HT1-receptor antagonist SEs?
Pain in chest/throat, N+V, fatigue, dizziness, HT; rare = MI
Serotonin 5-HT1-receptor antagonist warnings?
CI = coronary artery disease, cerebrovascular disease, hemiplegic/basilar migraines
Serotonin 5-HT1-receptor antagonist interactions?
Increase risk of serotonin toxicity
Sex hormone antagonists for breast cancer types?
Tamoxifen, anastrozole, letrozole
Sex hormone antagonists for breast cancer indications?
ER positive; aromatase inhibitors in post-menopausal women only
Sex hormone antagonists for breast cancer SEs?
Vaginal dryness, hot flushes, osteoporosis, VTE, endometrial cancer, GI upset
Sex hormone antagonists for breast cancer warnings?
CI = pregnancy, lactation
Sex hormone antagonists for breast cancer interactions?
Inhibits cyp so don’t use with = warfarin, fluoxetine, paroxetine; aromatase inhibitors no interactions
Statin types?
Simvastatin, atorvastatin, prevastatin, rosuvastatin
Statin indications?
Primary/secondary prevention CVD events, primary hyperlipidaemia
Statin SEs?
Headache, GI disturbance, myalgia, myopathy and sometimes rhabdomylolysis; rise in liver enzymes
Statin warnings?
Caution: renal/hepatic impairment, pregnancy and breastfeeding
Statin interactions?
Metabolism reduced by cyp inhibitors
Sulphonylurea types?
Gliclazide, glipizide, tolbutamide, glibenclamide
Sulphonylurea indications?
T2DM 2nd line/adjuvant to metformin
Sulphonylurea SEs?
GI upset, hypos, weight gain, hyponatremia, hepatotoxic, hypersensitivity, careful in renal impairment and ketoacidosis
Drugs elevating blood glucose?
Prednisolone, thiazide, loop diuretics
Tetracycline types?
Doxycycline, lymecycline
Tetracycline indications?
Acne, LRTI, pneumonia and atypical, PID, chylamydial infection, typhoid, anthrax, malaria, lyme disease
Tetracycline SEs?
N+V, diarrhoea, oesophageal irritation, photosensitivity, hypoplasia tooth enamel in kids, hepatotoxicity
Tetracycline warnings?
CI = pregnancy, breastfeeding, under 12s, hepatic impairment
Tetracycline interactions?
Not given with 2 hours of calcium/antacids/iron as stops absorption; enhances warfarin; ciclosporin, retinoids (increased risk ICP)
Thyroid hormone types?
Levothyroxine, liothryonine
Thyroid hormone indications?
Hypothyroidism
Thyroid hormone SEs?
OD = GI upset (diarrhoea, N+V), cardiac (arrhythmias, tachy, angina), neuro (tremor, insomnia)
Thyroid hormone warnings?
Caution in coronary artery disease and hypopituitarism (need steroid before so not addisonian crisis), DI, DM
Thyroid hormone interactions?
Absorption reduced by antacids/calcium/iron; higher dose needed if on cyp inducers; may need higher sugar intake for DM; enhances effects of warfarin
Trimethoprim types?
Also co-trimoxazole
Trimethoprim indications?
UTI and prophylaxis; also acne/RTI/prostatis/pneumocystitis pneumonia prophylaxis in immunosuppression
Trimethoprim SEs?
GI upset, skin rash, megaloblastic anaemia (folate inhibitor), hyperkalaemia; avoid in pregnancy, neonates and elderly
Sodium valproate/valproic acid indications?
Seizure prophylaxis in epilepsy, sometimes status epilepticus after benzo, manic episodes of bipolar
Sodium valproate/valproic acid SEs?
GI upset, neuro/psych effects (tremor, ataxia, behaviour), thrombocytopenia, elevated liver enzymes, pancreatitis
Sodium valproate/valproic acid warnings?
CI = child-bearing age, first trimester; hepatic/renal impairment, SLE
Sodium valproate/valproic acid interactions?
Risk of toxicity with lamotrigine; inhibits cyp450; is also metabolised by cyp
Vancomycin indications?
Treatment gram +ve infection and abx associated colitis, MRSA and C diff and endocarditis
Vancomycin SEs?
Thrombophlebitis, rapid = red man syndrome; IV = nephrotoxicity, ototoxicity, neutropenia
Vancomycin interactions?
Ototoxicity risk = aminoglycosides, loop diuretics, ciclosporin
Vitamin types?
Folic acid, thiamine, hydroxocobolamin, phytomenadione
Vitamin indications?
Thiamine = wernickes encephalopathy, korsakoffs; folic = megaloblastic anaemia, neural tube defects; hydroxocobolamin = megaloblastic anaemia, subacute degeneration of cord; phytomenadione (vit k) = reversal warfarin
Warfarin indications?
VTE, prevent embolism in AF or prosthetic heart valves, TIA
Warfarin warnings?
Liver disease and pregnancy; is metabolised by cyp, low therapeutic index
Z-drug types?
Zopiclone, zolpidem
Z-drug indications?
Short-term insomnia treatment
Z-drug SEs?
Fatigue, rebound insomnia after stopping, headache, confusion, nightmares; taste disturbance (zopiclone), GI upset (zolpidem); dependence, withdrawal, OD
Z-drug warnings?
CI = OSA, resp muscle weakness, resp depression; warning = elderly
Z-drug interactions?
Metabolised by cyp, enhance hypotensives
Colloid types?
Gelatins and albumin
Colloid indications?
To expand circulating vol in impaired tissue perfusion but after sodium lactate/chloride; albumin = cirrhotic liver disease to stop hypovolaemia in paracentesis
Colloid SEs?
Oedema, pulmonary oedema, hypersensitivity
Colloid warnings?
Caution = rapid infusion in HF and renal impairment (can cause oedema and vol overload)
What is compound sodium lactate?
Hartmann’s solution
Hartmann’s indications?
Sodium and water to pts unable to take oral; fluid challenger to expand circ vol in impaired tissue perfusion
Hartmann’s SEs?
Oedema
Hartmann’s warnings?
HF, renal impairment and liver caution
Glucose/dextrose infusion types?
Glucose 5%/10%/20%/50%
Dextrose indications?
5% for water as can’t oral and diluting drugs; 10/20/50% for hypos and hyperkalaemia with calcium gluconate
Dextrose SEs?
50% = irritant to veins (pain/phlebitis/thrombosis); hyperglycaemia
Dextrose warnings?
If thiamine deficient then can get wernickes; caution = renal failure, hyponatraemia, children, brain injuries
Potassium chloride indications?
Prevention of potassium depletion; hypokalaemia
Potassium chloride SEs?
Hyperkalaemia and therefore arryhthmias; irritant to veins
Sodium chloride types?
0.9% and 0.45%
Sodium chloride indications?
Provide sodium and water unable to oral; expand circ vol in inadequate tissue perfusion; diluting drugs
Sodium chloride SEs?
Oedema, hypercloraemia leading to acidosis
Sodium chloride warnings?
HF and renal impairment
Drugs to stop before elective surgery (I LACK OP)?
Insulin, Lithium (day before), Anticoag/antiplatelets (variable and occasionally continued), COCP/HRT (4wks before surgery), K+-sparing diuretics and ACEi (day of surgery), Oral hypoglycaemics (variable), Perindopril and ACEi
PReSCRIBER mnemonic for writing prescriptions?
Patient details, Reaction (allergy plus reaction), Sign the front of the chart, Contraindications to each drug, Route for each drug, IV fluids given if necessary, Blood clot prophylaxis if necessary, antiEmetic if needed and pain Relief if needed
SEs of steroids?
mnemonic STEROIDS: Stomach ulcers, Thin skin, Oedema, Right and left HF, Osteoporosis, Infection, Diabetes and Cushing’s Syndrome
NSAID safety CIs?
NSAID: No urine (renal failure), Systolic dysfunction, Asthma, Indigestion and Dyscrasia (clotting abnormal)
Causes of hypokalaemia (DIRE)?
Drugs (loop and thiazide diuretics), Inadequate intake/intestinal loss (V and diarrhoea), Renal tubular acidosis, Endo (cushing’s/conn’s)
Causes of hyperkalaemia (DREAD)?
Drugs (potassium sparing diuretics and ACEi), Renal failure, Endo (addison’s), Artefact, DKA (when insulin given to treat it)
Causes of raised alkaline phosphate (ALKPHOS)?
Any fracture, Liver damage, K for kancer, Paget’s disease of the bone and pregnancy, Hyperparathyroidism, Osteomalacia and Surgery
What is the formula for volume of distribution?
total amount of drug in body divided by plasma-drug conc
Amounts of fluids and electrolytes needed to calculate maintenance fluids?
Fluid = 25-30ml/kg/day, Electrolytes (Na, K, Cl) = 1mmol/kg/day, glucose = 5-10g/day
Types of potassium channel activator?
Nicorandil
Nicorandil indications?
Long term treatment of chronic stable angina pectoris in patients with at least one of the
following risk factors: previous MI / previous CABG / confirmed coronary heart diease AND
LVH, LVdysfunction, diabetes mellitus, hypertension or peripheral vascular disease
Nicorandil SEs?
Flushing, dizziness, headache, tachycardia, nausea, rectal bleeding, weakness; skin/mucosal/eye ulceration, haemorrhage/fistula/abscess
Nicorandil CIs?
Caution in hypovolaemia and acute MI; avoid in hypotension, cardiogenic shock and LVF
Nicorandil interactions?
Sildenafil/tadalafil/vardenafil
Drug class of dipyridamole?
Antiplatelet
Dipyridamole indications?
VTE prophylaxis with warfarin in prosthetic heart valves; with aspirin for secondary prevention TIA and stroke
Dipyridamole SEs?
GI disturbance, haemorrhage, hypotension, worsening of coronary artery disease sxs
Dipyridamole CIs?
Angina, AS, recent MI, LV outflow obstruction, HF, coagulation disorders/drugs
Dipyridamole interactions?
Adenosine, antiplatelets, anticoags, fibrinolytics
Systemic nasal decongestants name?
Pseudoephedrine
Pseudoephedrine indications?
Nasal and sinus decongestant
Pseudoephedrine SEs?
Anxiety, headache, HT, insomnia, N+V, restlessness, tachy; hallucinations, angle-closure glaucoma, retention
Pseudoephedrine CIs?
DM, HT, hyperthyroidism, IHD, prostatic hypertrophy, risk of angle-closure glaucoma
Pseudoephedrine interactions?
Alpha blockers (less hypotensive effect), MAOIs (HT crisis)
Lithium drug class?
Mood stabiliser
Lithium indications?
Mania and bipolar
Lithium SEs?
GI upset, fine tremor, weight gain, hypothyroidism, hyperparathyroidism, hypercalcaemia
Lithium toxicity S+Ss?
Blurred vision, muscle weakness, drowsy, coarse tremor, slurred speech, ataxia, confusion, N+V, ECG changes
Lithium toxicity management?
Stop, check levels/serum creatinine/U+Es, refer to A+E, advice from psych for re-intiation
CIs lithium?
Elderly, psoriasis, myasthenia gravis, serious CVD, addison’s, renal impairment, pregnancy, breastfeeding; reduce in diarrhoea, vomiting, infection
Lithium interactions?
Metronidazole, tetracyclines, co-trimoxazole, NSAIDs, ACEi, ARBs, diuretics, amiodarone; drugs decreasing lithium levels = xanthines, theophylline, aminophylline, caffeine, sodium salts, acetazolamide
Phenytoin indications?
All epilepsy other than absence seizures; status epilepticus
Phenytoin adverse effects?
PHENYTOIN - P450 interactions, hirsutism, enlarged gums, nystagmus, yellow-browning of skin, teratogenic, osteomalacia, interferes with folate metabolism, neuropathies
Phenytoin CIs?
Enteral feeding caution, Han Chinese/Thai, discontinue if leucopenia
Phenytoin interactions?
Is a CYP450 inducer - OCP = reduced contraceptive effect; reduced theophylline and phenytoin efficacy; reduced phenytoin with cimetidine; reduced phenytoin with amiodarone
Example of an NMDA receptor antagonist?
Memantine
Memantine use?
Slow deterioration of Alzheimer’s
Memantine SEs?
Constipation, dizziness, drowsy, confusion, headache, HT, thrombosis, HF
Memantine CIs?
Cardiac disease, renal impairment, convulsion hx
Memantine interactions?
Amantadine, ketamine both increase CNS toxicity
Trimethoprim interactions?
ACEi, ARBs, amiodarone, phenytoin, azathioprine, methotrexate, mercaptopurine
GLP-1 analogues?
Liraglutide and exenatide
GLP-1 analogues indications?
2nd/3rd line DMT2
GLP-1 analogues SEs?
GI disturbance, hypos, ab formation against it, severe pancreatitis
GLP-1 analogues caution?
Renal impairment, DKA, GI disease, gastroparesis an stop if pt gets pancreatitis
GLP-1 analogues interactions?
Warfarin and other antidiabetics
Types of thiazolidinediones?
Pioglitazone
Pioglitazone indications?
3rd line for DMT2, 2nd line DMT2 if sulphonylurea CI
Pioglitazone SEs?
anaemia, arthralgia, GI disturbance, haematuria, impotence, vertigo, visual disturbance, weight gain, liver dysfunction
Pioglitazone CIs?
CVD, hepatic impairment, stop if jaundice
Pioglitazone interactions?
Insulin, beta blockers
Carbimazole others?
Propylthiouracil
Carbimazole indications?
Hyperthyroidism
Carbimazole SEs?
GI disturbance, arthritis, fever, rash, pruritus, jaundice, agranulocytosis, neuropenia
Carbimazole CIs?
Hepatic impairment, pregnancy, severe blood disorders
Colchicine indications?
Acute gout, pericarditis
Colchicine SEs?
GI disturbance, GI haemorrhage at high dose, renal/hepatic damage, myopathy, peripheral neuropathy, bone marrow suppression
Colchicine CIs?
Elderly, hepatic/renal impairment, GI/cardiac disease
