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Phase 3a/3b > PSA > Flashcards

PSA Flashcards

1
Q

First line treatment for BPE after lifestyle changes?

A

alpha-blockers

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2
Q

Second line treatment for BPE?

A

5a-reductase inhibitors

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3
Q

What symptoms 5a-reductase inhibitors relieve?

A

Improve lower urinary symptoms; can take 6 months for this to show

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4
Q

Usual dose 5a-reductase inhibitors?

A

5mg OD

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5
Q

Example of 5a-reductase inhibitors?

A

Finasteride and dutasteride

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6
Q

Alpha blockers usual indications?

A

BPE and resistant hypertension (after CCB, ACE inhibitors and diuretics), Raynaud’s (prazosin)

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7
Q

Examples of alpha blockers?

A

Doxazosin, tamsulosin (BPE only), alfuzosin

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8
Q

Important adverse effects from alpha blockers?

A

Postural HT, dizziness and syncope (don’t give to those with postural hypotension), aim to take before bed; anxiety, back pain, flu-like, myalgia

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9
Q

Alpha blockers interactions?

A

Hypotension with other antihypertensives (particularly beta blockers)

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10
Q

Dose for alpha blockers?

A

1mg OD and increased at 1-2 wks after response; tamsulosin = 400ug daily

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11
Q

Indications for acetylcholinesterase inhibitors?

A

Mild to moderate parkinsons and mild to moderate dementia in PD (rivastigmine)

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12
Q

Examples of acetylcholinesterase inhibitors?

A

Donepezil and rivastigmine

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13
Q

Adverse SEs achase inhibitors?

A

N+V, diarrhoea (increased ach in peripheral NS); some asthma and COPD exacerbated; can develop tremor

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14
Q

Achase inhibitors interactions?

A

NSAIDs and steroids = higher risk of peptic ulcers; antipsychotics = neuroleptic syndrome risk; heart block and brady = risk increased with rate limiting meds (beta blockers)

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15
Q

Achase inhibitors dose?

A

Prescribed and managed by specialist; 5mg OD = donepezil, 1.5mg 12 hourly = rivastigmine; dose titrated up after 2-4wks

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16
Q

Indication for acetylcysteine?

A

Antidote for paracetamol poisoning; prevent contrast nephropathy (renal injury from contrast for scans); reduce viscosity of resp secretions (oral carbocisteine)

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17
Q

Adverse effects of acetylcysteine?

A

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

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18
Q

Dose for acetlycysteine?

A

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

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19
Q

Activated charcoal indication?

A

For absorption of poisons or elimination with multiple doses (benzos or methotrexate)

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20
Q

Adverse effects activated charcoal?

A

If inhaled - pneumonitis, bronchospasm, airway obstruction; also GI obstruction, black stools and vomiting

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21
Q

Warnings activated charcoal?

A

Not to reduced consciousness and persistent vomiting as aspiration risk; not to reduced gut motility

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22
Q

Dose activated charcoal?

A

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

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23
Q

Adenosine indication?

A

First-line diagnostic and therapeutic agent for SVT (regular, narrow-complex tachy); reduces automaticity and increases refractoriness

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24
Q

Adverse effects of adenosine?

A

Can induce brady and asystole as interferes with SA and AV node, feels like having an MI

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25
Q

Contraindications of adenosine?

A

Not to those intolerant of brady - hypotension, coronary ishchaemia, decompensated HF; avoided if poss in asthma and COPD

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26
Q

Adenosine interactions?

A

Dipyridamole (blocks uptake of adenosine - dose halved as prolongs half life); theophylline and aminophylline competitive antagonists (may need more adenosine)

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27
Q

Adenosine dose?

A

IV initial = 6mg; then 12mg if ineffective; if central line = lower dose; has to be by specialists and followed by saline

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28
Q

Adrenaline indications?

A

Cardiac arrest, anaphylaxis immediate management, vasoconstriction in surgery and prolong effects of local anaesthesia

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29
Q

Adrenaline adverse effects?

A

In cardiac arrest can get adrenaline-induced HT; can cause anxiety, tremor, headache, palps

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30
Q

Warnings adrenaline?

A

Careful with heart disease, don’t use in peripheries as can cause tissue necrosis from vasoconstriction

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31
Q

Interactions adrenaline?

A

Can get widespread vasoconstriction if on beta blockers

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32
Q

Adrenaline prescription?

A

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

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33
Q

Types of aldosterone antagonists?

A

Spironolactone and eplerenone

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34
Q

Aldosterone antagonists indications?

A

Oedema from liver cirrhosis, chronic HF, primary hyperaldosteronism (Conn’s); eplerenone only for HF, nephrotic syndrome

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35
Q

Important aldosterone antagonist adverse effects?

A

Hyperkalaemia (muscle weakness, arrythmias) and gynaecomastia; less common with eplerenone; can cause liver impairment and jaundice and stevens-johnson syndrome

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36
Q

CIs aldosterone antagonists?

A

Renal impairment, hyperkalaemia, Addison’s, pregnancy

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37
Q

Aldosterone antagonists interactions?

A

K+ elevating drugs (ACE inhibitors and ARBs) or K+

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38
Q

Dose for spironolactone?

A

25mg start dose HF and 100mg for anything else; taken with food oral

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39
Q

Indications for aliginates and antacids?

A

GORD and dyspepsia

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40
Q

Types of alginates and antacids?

A

Gaviscon and peptac

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41
Q

Alginates and antacids SEs?

A

Magnesium salts = diarrhoea, aluminium salts = constipation

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42
Q

Interactions alginates and antacids?

A

Can bind to drugs reducing absorption; ACE inhibitors, abx, bisphosphonates, digoxin, levothyroxine, PPIs and increase aspirin and lithium excretion

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43
Q

Dose alginates and antacids?

A

Chewable tablets and usually after meals or when sxs occur; check ingredients for renal impairment/diabetes

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44
Q

Allopurinol indications?

A

Prevent recurrent gout attacks, prevent uric acid and oxalate renal stones, prevent hyperuricaemia and tumour lysis syndrome from chemo

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45
Q

Allopurinol SEs?

A

Can worsen gout attack (can reduce if given with NSAID or colchicine); skin rash, stevens-johnson syndrome, allopurinol hypersensitivity reaction, hepatotoxicity

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46
Q

Allopurinol warnings?

A

Don’t give if acute gout attack, recurrent skin rash, severe hypersensitivity, renal and hepatic impairment, stay hydrated

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47
Q

Allopurinol interactions?

A

Azathioprine has toxicity increased, ACE inhibitors and thiazides increases hypersensitive risk and amoxicillin increase skin rash

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48
Q

Allopurinol dose?

A

Start at 100mg and titrate up to 200-600mg OD; take after food and lots of fluids

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49
Q

Types of aminoglyosides?

A

Gentamicin, amikacin, neomycin

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50
Q

Aminoglycoside indications?

A

Systemic infections by gram positive and some gram negative anaerobes

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51
Q

Aminoglycoside SEs?

A

Nephrotoxicity and ototoxicity

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52
Q

Aminoglycoside warnings?

A

Neonates, elderly, renal impairment and mysathenia gravis

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53
Q

Aminoglycosides interactions?

A

Ototoxicity = vancomycin and loop diuretics, nephrotoxicity = ciclosporin, vancomycin and cephalosporin

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54
Q

Aminoglycoside dose?

A

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

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55
Q

Aminosalicylates types?

A

Mesalazine, sulfasalazine, olsalazine, balsalazide

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56
Q

Aminosalicylates indications?

A

Ulcerative colitis and rheumatoid arthritis

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57
Q

Aminosalicylates SEs?

A

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

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58
Q

CIs aminosalicylates?

A

Those who have aspirin hypersensitivity, renal dysfunction, elderly, pregnant and breastfeeding, asthma

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59
Q

Aminosalicylates interactions?

A

Those that alter pH and break down coating prematurely; PPIs and lactulose; leucopenia risk = azathioprine and mercaptopurine

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60
Q

Aminosalicylates dose?

A

Suppository for UC unless more proximal (oral) and 12-hourly for 4-6wks

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61
Q

Amiodarone indications?

A

Tachyarrhythmias when other drugs ineffective; rhythm control in AF, atrial flutter, VT and VF, WPW arrhythmias

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62
Q

Amiodarone SEs?

A

Hypotension; pneumonitis, brady, AV block, hepatitis, photosensitivity, peripheral neuropathy, myopathy, slate grey skin, jaundice, nausea, pulmonary fibrosis

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63
Q

CIs amiodarone?

A

Severe hypotension, heart block, thyroid disease, HF, elderly

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64
Q

Amiodarone interactions?

A

Many; increases dose of diltiazem, verapamil and digoxin so increases brady

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65
Q

Amiodarone dose?

A

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

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66
Q

Types of ACEi?

A

Ramipril, lisinopril, perindopril, enalapril

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67
Q

ACEi indications?

A

HT, chronic HF, IHD, CKD with proteinuria and diabetic nephropathy

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68
Q

ACEi SEs?

A

Hypotension, persistent dry cough, hyperkalaemia, renal failure; rare = anaphylactoid, angioedema; cholestatic jaundice/hepatitis

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69
Q

ACEi warnings?

A

Avoided in renal failure, renal artery stenosis, pregnancy, CKD

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70
Q

ACEi interactions?

A

Avoid potassium elevating drugs, with NSAIDs = increased nephrotoxicity, diuretics = increased hypotension; ciclosporin

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71
Q

ACEi dose?

A

Oral, 1.25mg HF and nephropathy, 2.5mg everything else and up to 10mg

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72
Q

ARB types?

A

Candesartan, losartan, irbesartan

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73
Q

ARB indications?

A

Same as ACEi but not tolerated due to cough; but type 2 diabetic nephropathy whereas type 1 in ACEi

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74
Q

ARB SEs?

A

Hypotension, hyperkalaemia, renal failure

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75
Q

ARB warnings and interactions?

A

Same as ACEi

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76
Q

ARBs dose?

A

Oral, losartan = 12.5mg HF and 50mg in everything else and titrated up

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77
Q

PC BRAS for enzyme inducers?

A

phenytoin, carbamazepine, barbiturates, rifampicin, alcohol (chronic excess) sulphonylureas. Others: topiramate, St John’s Wort, and smoking

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78
Q

AO DEVICES for enzyme inhibitors?

A

allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline).

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79
Q

SSRIs and antidepressants types?

A

Citalopram, fluoxetine, sertraline, escitalopram

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80
Q

SSRIs indications?

A

Depression, OCD, panic disorder

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81
Q

SSRIs SEs?

A

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

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82
Q

What is serotonin syndrome?

A

Autonomic hyperactivity, altered mental state, neuromuscular excitability

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83
Q

SSRIs warnings?

A

Young people, epilepsy, peptic ulcer disease, hepatic impairment

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84
Q

SSRI interactions?

A

MAOI and other serotonergic drugs; higher bleeding in NSAIDs/aspirin; don’t combine with antipsychotics (QT long), alcohol, theophylline

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85
Q

SSRIs dose?

A

Oral, 20mg starting and titrate up

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86
Q

TCAs types?

A

Amitryptilline and lofepramine and impramine

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87
Q

TCAs indications?

A

Second line depression; neuropathic pain

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88
Q

TCAs SEs?

A

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

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89
Q

TCAs warnings?

A

Elderly, epilepsy, CVD, prostatic hypertrophy, glaucoma, constipation; discontinue if manic stage of bipolar

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90
Q

TCAs interactions?

A

MAOIs or SSRIs

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91
Q

TCAs dose?

A

Depression starting = 75mg OD, pain = 10mg OD at night; only give 2wks at a time to prevent overdose

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92
Q

Venlafaxine and mirtazapine indications?

A

GAD and major depression after SSRIs

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93
Q

Venlafaxine and mirtazapine SEs?

A

GI upset, neuro effects; rare = serotonin syndrome, hyponatraemia, suicidal thoughts, long QT, VT, venlafaxine= greater risk of withdrawals; SIADH and rhabdomyolysis

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94
Q

Venlafaxine and mirtazapine warnings?

A

Elderly, hepatic/renal impairment, arrhythmias, epilepsy, pregnancy

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95
Q

Venlafaxine and mirtazapine interactions?

A

Other antidepressants, NSAIDs, warfarin, antiepileptics, dopaminergics (selegiline)

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96
Q

Venlafaxine and mirtazapine dose?

A

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)

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97
Q

Types of dopamine D2 receptor antagonists?

A

Metoclopramide and domperidone

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98
Q

Dopamine D2 receptor antagonists indications?

A

N+V in reduced gut motility

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99
Q

Dopamine D2 receptor antagonists SEs?

A

Diarrhoea; metoclopramide = extrapyramidal sxs (like antipsychotics - dystonia etc); domperidone = QT long and arryhthmias

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100
Q

Dopamine D2 receptor antagonists warning?

A

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

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101
Q

Dopamine D2 receptor antagonists interactions?

A

Antipsychotics extra-pyramidal increases; not with dopaminergic agents; not with drugs increasing QT interval; not with CYP450 inhibitors

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102
Q

Dopamine D2 receptor antagonists dose?

A

10mg 8-hrly either IM (over 3mins) or IV

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103
Q

Histamine H1-receptor antagonists types?

A

Cyclizine, cinnarizine, promethazine

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104
Q

Histamine H1-receptor antagonists indications?

A

N+V, motion sickness, vertigo

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105
Q

Histamine H1-receptor antagonists SEs?

A

Drowsiness (cyclizine least likely to), dry throat, tachy, palps

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106
Q

Histamine H1-receptor antagonists warnings?

A

Hepatic encephalopathy and those susceptible to anticholinergic SEs (prostatic enlargement)

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107
Q

Histamine H1-receptor antagonists interactions?

A

Other sedative drugs; ipratropium and tiotropium increase anticholinergic effects

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108
Q

Histamine H1-receptor antagonists dose?

A

Cyclizine = 50mg 8 hourly (IV, IM, oral); slow IV (2 hours)

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109
Q

Serotonin 5-HT3-receptor antagonists types?

A

Ondansetron, granisetron

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110
Q

Serotonin 5-HT3-receptor antagonists SEs?

A

Rare but sometimes diarrhoea, headaches, constipation

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111
Q

Serotonin 5-HT3-receptor antagonists warnings?

A

Small risk of QT prolongation

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112
Q

Serotonin 5-HT3-receptor antagonists interactions?

A

Avoid drugs QT prolongation

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113
Q

Serotonin 5-HT3-receptor antagonists dose?

A

Ondansetron = 4-8mg 12hourly orally/IV

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114
Q

Antifungal types?

A

Nystatin, clotrimazole, fluconazole

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115
Q

Antifungal SEs?

A

Local irritation; fluconazole = oral so systemic (GI upset, headache, hepatitis, hypersensitivity), rare = hepatotoxicity, long QT, arrhythmia, anaphylaxis, peripheral neuropathy and hypersensitivity

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116
Q

Antifungal warnings?

A

Fluconazole = liver disease, renal impairment, pregnancy

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117
Q

Antifungal interactions?

A

Fluconazole CYP450 inhibitor so don’t give with meds metabolised by it or long QT drugs

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118
Q

Antifungal dose?

A

See BNF

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119
Q

H1 receptor antagonists (antihistamines) types?

A

Cetirizine, loratadine, fexofenadine, chlorphenamine

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120
Q

H1 receptor antagonists (antihistamines) indications?

A

First-line for allergies, pruritus, urticaria, N+V, adjunct to adrenaline for anaphylaxis

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121
Q

H1 receptor antagonists (antihistamines) SEs?

A

Sedation

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122
Q

H1 receptor antagonists (antihistamines) warnings?

A

Sedating avoided in liver disease (hepatic encephalopathy), pregnancy and breastfeeding

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123
Q

H1 receptor antagonists (antihistamines) dose?

A

Cetirizine = 10mg, loratadine (10mg), chlorphenamine (4mg and 2mg/5ml solution) every 4-6 hours; anaphylaxis = chlorphenamine (10mg IV/IM)

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124
Q

Antimotility drugs types?

A

Loperamide, codeine phosphate

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125
Q

Antimotility drug indications?

A

Diarrhoea usually for IBS or gastroenteritis

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126
Q

Antimotility drug SEs?

A

Codeine = opioid toxicity and dependance

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127
Q

Antimotility drugs warnings?

A

Don’t use in acute UC, C.difficile, acute bloody diarrhoea

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128
Q

Antimotility drug dose?

A

Loperamide = 4mg and 2mg with each loose stool to a max 8mg per day

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129
Q

Antimuscarinic and bronchodilator types?

A

Ipratropium, tiotropium, glycopyrronium, aclidinium

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130
Q

Antimuscarinic and bronchodilator indicators?

A

COPD, asthma

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131
Q

Antimuscarinic and bronchodilator SEs?

A

Resp tract irritation; GI disturbance, urinary retention, blurred vision, headaches (lower risk for inhaled)

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132
Q

Antimuscarinic and bronchodilator warnings?

A

Angle-closure glaucoma, arrhythmias, urinary retention

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133
Q

Antimuscarinic and bronchodilator dose?

A

Short-acting anti-muscarinics = QDS PRN; ipratropium = 40ug for stable and 250-500ug 6hrly for attack

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134
Q

Antimuscarinic for CVD and gastro types?

A

Atropine, hyoscine butylbromide, glycopyrronium

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135
Q

Antimuscarinic for CVD and gastro indications?

A

Atropine = first line for severe brady; hyoscine = for IBS and antispasmodic, reduce resp secretions in palliation

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136
Q

Antimuscarinic for CVD and gastro SEs?

A

Tachy, dry mouth, constipation, urinary retention, blurred vision, confusion, drowsiness (parasympathetic)

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137
Q

Antimuscarinic for CVD and gastro warnings?

A

In angle closure glaucoma, bladder outflow obstruction, prostatic hyperplasia and arrhythmias

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138
Q

Antimuscarinics for GU types?

A

Oxybutynin, tolterodine, solifenacin

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139
Q

Antimuscarinics for GU indications?

A

Overactive bladder (urge/frequency) after bladder training

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140
Q

Antimuscarinics for GU warnings?

A

UTI, elderly, dementia, angle closure glaucoma, arrhythmias, urinary retention

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141
Q

Antipsychotics typical types?

A

Haloperidol, chlorpromazine, prochlorperazine

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142
Q

Antipsychotics typical indications?

A

Psychomotor agitation, schizophrenia, bipolar, N+V in palliation

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143
Q

Antipsychotics typical SEs?

A

Extrapyramidal (dystonia, akathisia, neuroleptic malignant syndrome, tardive dyskinesia, drowsiness, QT prolongation, ED, hyperprolactinaemia

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144
Q

Antipsychotics typical warnings?

A

Elderly, dementia, PD, epilepsy

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145
Q

Antipsychotics atypical types?

A

Quetiapine, olanzapine, risperidone, clozapine

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146
Q

Antipsychotics atypical indications?

A

Same as typical other than N+V

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147
Q

Antipsychotics atypical SEs?

A

Sedation, extrapyramidal SEs (less than typical), metabolic disturbance, arrhythmias, QT prolongation, sexual dysfunction, clozapine = agranulocytosis

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148
Q

Antipsychotics atypical warnings?

A

CVD, neutropenia

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149
Q

Types of antiviral?

A

Aciclovir, famciclovir, valaciclovir

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150
Q

Antiviral indicators?

A

Acute herpesvirus (cold sores, genital ulcers, encephalitis, chickenpox), suppression of recurrent herpes simplex

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151
Q

Antiviral SEs?

A

Headache, GI disturbance, dizziness, skin rash, phlebitis, neurotoxicity

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152
Q

Antiviral warnings?

A

Caution in pregnancy and breastfeeding, severe renal impairment and theophylline

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153
Q

Types of antiplatelet drugs and ADP receptor antagonists?

A

Clopidogrel, ticagrelor, prasugrel

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154
Q

Indications antiplatelet drugs and ADP receptor antagonists?

A

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

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155
Q

Antiplatelet drugs and ADP receptor antagonists SEs?

A

Bleeding, GI upset, thrombocytopenia

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156
Q

Antiplatelet drugs and ADP receptor antagonists warnings?

A

Caution in renal and hepatic failure, none if signficant bleeding, stop 7 days before elective surgery; avoid in pregnancy

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157
Q

Antiplatelet drugs and ADP receptor antagonists interactions?

A

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

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158
Q

Indications aspirin (antiplatelet)?

A

ACS and ischaemic stroke treatment or secondary prevention thrombosis after CVD, cerebro, peripheral artery disease

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159
Q

SEs aspirin?

A

Bleeding, GI irritation, bronchospasm, tinnitus

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160
Q

Warnings aspirin?

A

Under 16yrs (Reye’s syndrome), hypersensitivity, third trimester pregnancy, gout, peptic ulcers

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161
Q

Dose aspirin?

A

For ACS = 300mg loading dose then 75mg daily, ischaemic stroke = 300mg OD 2wks, longterm = 75mg daily, pain = max 4g daily

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162
Q

Azathioprine indications?

A

Crohn’s and UC, DMARD for rheumatoid arthritis and other AIs not working with steroids, prevent organ rejection

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163
Q

Azathioprine SEs?

A

Bone marrow suppression, nausea, hypersensitivity, hepatotoxicity, lymphoma, veno-occulsive disease

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164
Q

Azathioprine warnings?

A

Reduced/no TPMT activity (how to break it down - give mercaptopurine instead), hepatic/renal impairment, pregnancy, hypersensitivity reactions

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165
Q

Azathioprine interactions?

A

Careful with steroids, don’t use with allopurinol as reduces metabolism, not with trimethoprim or aminosalicylates

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166
Q

Types of beta blockers?

A

Bisoprolol, atenolol, propanolol (non-cardio-selective), metoprolol, carvediol (non-cardioselective)

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167
Q

Beta blocker indications?

A

IHD, chronic HF, AF, SVT, HT (3rd line), angina, MI, hyperthyroidism, migraine prophylaxis

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168
Q

Beta blocker SEs?

A

Fatigue, cold extremities, headache, GI disturbance, sleep disturbance, impotence in men

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169
Q

Beta blocker warnings?

A

Asthma, haemodynamic instability, heart block, hepatic failure

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170
Q

Beta blocker interactions?

A

Verapamil or diltiazem, other antihypertensives, clonidine, alcohol

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171
Q

Types of B2 agonists?

A

Salbutamol, terbutaline, salmeterol, formoterol, indacaterol

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172
Q

B2 agonist indications?

A

Asthma, COPD, hyperkalaemia (with insulin, glucose and calcium gluconate)

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173
Q

B2 agonist SEs?

A

Tachy, palps, anxiety, tremor, higher glucose and lactate; long acting = muscle cramps; arrhythmias, MI, hypokalaemia, lactic acidosis

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174
Q

B2 agonist warnings?

A

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

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175
Q

Types of benzos?

A

Diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

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176
Q

Benzo indications?

A

Seizures/status epilepticus, alcohol withdrawal, sedation for procedure if anaesthesia no, severe anxiety/insomnia

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177
Q

Benzo SEs?

A

Drowsiness, sedation, coma, dependance, withdrawal, airway obstruction, death

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178
Q

Benzos warnings?

A

Elderly, resp disease, neuromuscular disease and hepatic failure; alcohol and opioids

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179
Q

Benzos interactions?

A

Don’t use with CYP inhibitors, lorazepam, antihypertensives

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180
Q

Bisphosphonate types?

A

Alendronic acid, disodium pamidronate, zoledronic acid

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181
Q

Bisphosphonate indications?

A

Osteoperotic fxs, severe hypercalcaemia of malignancy, myeloma and breast cancer mets, Paget’s disease

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182
Q

Bisphosphonate SEs?

A

Oesophagitis, hypophosphataemia, atypical stress fx

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183
Q

Bisphosphonate warnings?

A

Severe renal impairment, hypocalcaemia, smokers and dental disease for osteonecrosis risk

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184
Q

Bisphosphonate interactions?

A

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

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185
Q

Calcium and vit D types?

A

Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

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186
Q

Calcium and vit D indications?

A

Osteoporosis when lifestyle not enough, CKD, secondary hyperparathyroidism, renal osteodystrophy, severe hyperkalaemia, symptomatic hypocalcaemia, vit D low

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187
Q

Calcium and vit D SEs?

A

Dyspepsia, constipation, CV collapse if given too fast IV

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188
Q

Calcium interactions?

A

Reduces absorption = iron, bisphosphonates, tetracyclines, levothyroxine

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189
Q

CCB types?

A

Amlodipine, nifedipine, diltiazem, verapamil, felodipine, lercanidipine

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190
Q

CCB indications?

A

Amlodipine/nifedipine for 1st/2nd line for HT, symptom control in stable angina, SVT = diltiazem/verapamil

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191
Q

CCB SEs?

A

Ankle swelling, flushing, headache, palps; dilt and vera = constipation, brady, heart block, cardiac failure

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192
Q

CCB warnings?

A

Vera and dilt = poor left ventricle, AV nodal conduction delay; amlodipine/nifedipine = unstable angina and severe aortic stenosis

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193
Q

CCB interactions?

A

B blockers as too much brady/heartblock

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194
Q

Carbamazepine indications?

A

Seizure prophylaxis in epilepsy (not absence or myoclonic) and first line in trigeminal neuralgia; prophyalxis of bipolar

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195
Q

Carbamazepine SEs?

A

GI upset, neuro effects, hypersensitivity (Steven Johnson syndrome), oedema, hyponatraemia, ataxia, cardiac conduction disturbances, bone marrow failure

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196
Q

Carbamazepine warnings?

A

Pregnancy (give folic acid and discuss with specialist), hepatic/renal/cardiac disease = caution; if susceptible to acute angle glaucoma

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197
Q

Carbamazepine interactions?

A

Induces cyp450 (reduces efficacy of drugs metabolised by this) = warfarin, oestrogens, progestrogens; any drugs reducing seizure threshold and other anti-epileptics

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198
Q

Cephalosporin and carbapenem types?

A

Cefalexin, cefotaxime, meropenem, ertapenem

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199
Q

Cephalosporin and carbapenem indications?

A

Second and third line UTIs and RTIs; parenteral for severe and resistant infections

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200
Q

Cephalosporin and carbapenem SEs?

A

GI upset, abx associated colitis, hypersensitivity (steven johnson syndrome and toxic epidermal necrolysis), neurotoxicity, seizures

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201
Q

Cephalosporin and carbapenem warnings?

A

At risk of C diff, hx of allergy/anaphylaxis, caution in epilepsy and renal failure

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202
Q

Cephalosporin and carbapenem interactions?

A

Cephalosporin and carbapenem = warfarin, aminoglycosides and valproate, COCP reduced efficacy

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203
Q

Chloramphenicol indications?

A

Bacterial conjunctivitis; otitis externa

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204
Q

Chloramphenicol SEs?

A

Stinging, burning, itching, bone marrow suppression, aplastic anaemia

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205
Q

Chloramphenicol warnings?

A

Hypersensitivity, bone marrow disorder, third trimester, breastfeeding and <2yrs, hepatic impairment

206
Q

Types of inhaled corticosteroids?

A

Beclometasone, budesonide, fluticasone

207
Q

Inhaled corticosteroids indications?

A

Asthma, COPD

208
Q

Inhaled corticosteroids SEs?

A

Oral candidiasis, hoarse voice and sometimes pneumonia

209
Q

Inhaled corticosteroids warnings?

A

Pneumonia hx and children

210
Q

Systemic corticosteroids types?

A

Prednisolone, hydrocortisone, dexamethasone

211
Q

Systemic corticosteroids indications?

A

Allergic/inflammatory disorders, AI, cancer chemo, HRT in adrenal insufficiency and hypopituitarism

212
Q

Systemic corticosteroids SEs?

A

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

213
Q

Systemic corticosteroids warnings?

A

Children, infections and infections

214
Q

Systemic corticosteroids interactions?

A

Risk of peptic ulceration with NSAIDs; hypokalaemia in B2 agonists/theophylline,/diuretics; efficacy reduced by CYP450 inducers, warfarin, live vaccines

215
Q

Topical corticosteroid types?

A

Hydrocortisone, betamethasone

216
Q

Topical corticosteroid indications?

A

Inflammatory skin conditions (eczema)

217
Q

Topical corticosteroid SEs?

A

Uncommon, skin thinning etc

218
Q

Topical corticosteroid warnings?

A

Infection and facial lesions

219
Q

Digoxin indications?

A

AF and flutter (after B blocker or dilt/vera); severe HF (3rd line); ventricular rate control in supraventricular arrhythmias

220
Q

Digoxin SEs/overdose?

A

Brady GI disturbance, rash, dizziness, visual disturbance

221
Q

Digoxin warnings?

A

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

222
Q

Dipeptidylpeptidase-4 inhibitor types?

A

Sitagliptin, linagliptin, saxagliptin

223
Q

Dipeptidylpeptidase-4 inhibitor indications?

A

T2DM (in combo with metformin or if metformin CI)

224
Q

Dipeptidylpeptidase-4 inhibitor SEs?

A

Usually well tolerated; GI upset, headache, nasopharyngitis, peripheral oedema; hypos, pancreatitis, hepatotoxicity

225
Q

Dipeptidylpeptidase-4 inhibitor warnings?

A

T1DM, ketoacidosis, pregnancy, breastfeeding

226
Q

DOAC types (factor Xa inhibitors)?

A

Rivaroxaban, apixaban, dabigatran, edoxaban

227
Q

DOAC indications?

A

VTE, AF

228
Q

DOAC SEs?

A

Bleeding, anaemia, GI upset, dizziness, elevated liver enzymes

229
Q

DOAC warnings?

A

Bleeding, hepatic/renal disease, pregnancy/breastfeeding

230
Q

DOAC interactions?

A

Antithrombotic agents, CYP inducers/inhibitors; increased anticoag from macrolides, protease inhibitors, fluconazole; decreased from rifampicin and phenytoin

231
Q

Loop diuretic types?

A

Furosemide and butemanide and torasemide

232
Q

Loop diuretic indications?

A

Acute pulmonary oedema (with O2 and nitrates), fluid overload in CHF/other states, resistant hypertension

233
Q

Loop diuretic SEs?

A

Dehydration and hypotension; any low electrolyte state as increases their excretion; hearing loss and tinnitus, nephrotoxicity

234
Q

Loop diuretic warnings?

A

Severe hypovolaemia, dehydration; use with care in hepatic encephalopathy, hypokalaemia/natraemia, gout worsened

235
Q

Loop diuretic interactions?

A

Lithium levels elevated, digoxin/aminoglycoside toxicity increased risk, antihypertensives and diuretics, NSAIDs for renal reasons

236
Q

Thiazide diuretic types?

A

Bendroflumethiazide, indapamide, chlortalidone, hydrochlorothiazide, metolazone

237
Q

Thiazide indications?

A

Alternative first line for HT where CCB not appropriate, add-on for HT treatment, oedema in mild-moderate HF

238
Q

Thiazide SEs?

A

Hyponatraemia, hypokalaemia, cardiac arrhythmias, impotence, hypercalcaemia, hyperglycaemia, postural hypotension, hypomagnesaemia

239
Q

Thiazide warnings?

A

Gout, low K+/Na+

240
Q

Thiazide interactions and CIs?

A

Things lowering K+/Na+, NSAIDs, impotence, blood disorders, renal impairment, Addison’s

241
Q

Dopaminergic drugs?

A

Levodopa, ropinirole, pramipexol

242
Q

Dopaminergic indications?

A

Early PD (dopamine agonists preferred over levadopa); later PD = levadopa; secondary parkinsonism

243
Q

Dopaminergic SEs?

A

Nausea, drowsiness, confusion, hallucinations, hypotension; too much = dyskinesias; wearing off effect towards end of dose = sxs worsen; schizophrenic and huntington’s effects

244
Q

Dopaminergic warnings?

A

Elderly, psych disease, CVD use with care; breastfeeding

245
Q

Dopaminergic interactions?

A

Don’t give with typical antipsychotic or metoclopramide as opposing effects; give levodopa with decarboxylase inhibitor (carbidopa); MAOIs and antihypertensives

246
Q

Emollients types?

A

Aqueous cream, liquid paraffin

247
Q

Emollients indications?

A

Dry/scaling skin disorders; eczema and psoriasis

248
Q

Emollients SEs?

A

Greasiness and can exacerbate acne

249
Q

Fibrinolytic types?

A

Alteplase and streptokinase

250
Q

Fibrinolytic indications

A

Acute ischaemic stroke within 4.5 hours; acute ST elevation MI within 12 hours (usually PCI now tho); massive PE with haemodynamic instability

251
Q

Fibrinolytic SEs?

A

N+V, bruising, hypotension, serious bleeding, cardiogenic shock, cardiac arrest

252
Q

Fibrinolytic warnings?

A

Recent bleed/surgery; intracranial haemorrhage; previous streptokinase treatment

253
Q

Gabapentin and pregabalin indications?

A

Add-ons for focal epilepsy or other epileptic drugs fail; neuropathic pain; GAD

254
Q

Gabapentin and pregabalin SEs?

A

Drowsiness, dizziness, ataxia, ach symptoms, HT, leucopenia

255
Q

Gabapentin and pregabalin warnings?

A

Reduced dose in renal impairment, DM, elderly, severe CHF, pregnancy, breastfeeding, hx of psychosis

256
Q

H2 receptor antagonist type?

A

Ranitidine, cimetidine, famotidine, nizatidine

257
Q

H2 receptor antagonist indications?

A

Peptic ulcer disease (PPIs preferred), GORD and dyspepsia

258
Q

H2 receptor antagonist SEs?

A

Not many; bowel disturbance, headache, dizziness

259
Q

H2 receptor antagonist warnings?

A

Reduced in renal impairment; investigate cause as can mask sxs cancer; cimetidine gives gynaecomastia and impotence and is a CYP450 inhibitor

260
Q

Heparins and fondaparinux types?

A

Enoxaparin, dalteparin, fondaparinux, unfractionated heparin

261
Q

Heparins and fondaparinux indications?

A

Prevention DVT, PE, VTE; treatment for VTE until oral coag established; ACS

262
Q

Heparins and fondaparinux SEs?

A

Haemorrhage (protamine sulphate is direct antidote), occasionally hyperkalaemia, sometimes heparin-induced thrombocytopenia

263
Q

Heparins and fondaparinux warnings?

A

Clotting disorders, severe uncontrolled HT, recent surgery/trauma; caution in renal/hepatic failure

264
Q

Heparins and fondaparinux reversal?

A

Protamine; andexanet for LMWH and fondaparinux

265
Q

Insulin names?

A

Insulin aspart, insulin glargine, biphasic insulin, soluble insulin

266
Q

Insulin indications?

A

T1DM, T2DM if poor control, diabetic emergency, hyperkalaemia with glucose

267
Q

Insulin SEs?

A

Hypoglycaemia and lipohypertrophy

268
Q

Insulin warnings?

A

If renal failure more likely to have hypo

269
Q

Insulin interactions?

A

Need more if on steroids; also beta blockers enhance effect

270
Q

Iron types?

A

Ferrous fumarate, ferrous sulfate

271
Q

Iron indications?

A

Iron-deficiency anaemia (treatment and prophylaxis with high RFs)

272
Q

Iron SEs?

A

GI upset (nausea, epigastric pain, constipation, diarrhoea), black stools

273
Q

Iron warnings?

A

Can upset intestinal disease bowel movements more; use IV with care in anaphyactics

274
Q

Iron interactions?

A

Reduce absorption of levothyroxine and bisphosphonates

275
Q

Lamotrigine indications?

A

First line prophylaxis for epilepsy (simple and partial seizures); bipolar depression only

276
Q

Lamotrigine SEs?

A

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

277
Q

Lamotrigine warnings?

A

Avoided in pts with hypersensitivity to other drugs, dose reduction in hepatic and renal impairment

278
Q

Lamotrigine interactions?

A

Reduced effect from higher glucuronidation: carbamazepine, phenytoin, oestrogens, rifampicin, protease inhibitors; toxicity risk: valproate; TCAs, SSRIs, MAOIs, St John’s Wort

279
Q

Osmotic laxative types?

A

Lactulose, macrogol, phosphate enema

280
Q

Osmotic laxative indications?

A

Constipation/faecal impaction, bowel prep before procedure, hepatic encephalopathy

281
Q

Osmotic laxative SEs?

A

Wind, abdo cramps, nausea, diarrhoea, electrolyte disturbance

282
Q

Osmotic laxative warnings?

A

Intestinal obstruction; used with caution in HF, ascites, electrolyte disturbances

283
Q

Stimulant laxative types?

A

Senna, bisacodyl, glycerol suppositories, docusate sodium

284
Q

Stimulant laxative indications?

A

Constipation and faecal impaction

285
Q

Stimulant laxative warnings?

A

Intestinal obstruction; caution in rectal prep for haemorrhoids/anal fissures

286
Q

Leukotriene receptor antagonist type?

A

Montelukast

287
Q

Leukotriene receptor antagonist indications?

A

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

288
Q

Leukotriene receptor antagonist SEs?

A

Headache, abdo pain; unlikely = RTIs, chrug strauss syndrome (rare), hypersensivity, seizures, depression, agranulocytosis

289
Q

Levetiracetam indications?

A

Seizure prophylaxis in epilepsy; some cases of status epilepticus if benzo not worked

290
Q

Levetiracetam SEs?

A

Not common = drowsiness, weakness, dizziness, headache

291
Q

Levetiracetam warnings?

A

Dose reduction in renal and hepatic impairment; breastfeeding and pregnancy; antidepressants

292
Q

Lidocaine indications?

A

Local anaesthetic; sometimes antiarrhythmic for VT and VF

293
Q

Lidocaine SEs?

A

Stinging; not usual but drowsiness, restlessness, tremor, fits

294
Q

Lidocaine interactions?

A

Effects prolonged by adrenaline (vasoconstrictor)

295
Q

Macrolide types?

A

Clarithromycin, erythromycin, azithromycin

296
Q

Macrolide indications?

A

Infections where penicillin CI, severe penumonia add-on to penicillin, for H.pylori with PPI and amoxicillin/metronidazole

297
Q

Macrolide SEs?

A

Irritant, N+V, abdo pain, diarrhoea, thrombophlebitis if IV; others = cholestatic jaundice, long QT, ototoxicity, abx-associated colitis, hepatoxicity, SJS and toxic epidermal necrolysis

298
Q

Macrolide warnings?

A

Caution in renal/hepatic impairment; they are CYP inhibitors; anything prolonging QT

299
Q

Metformin indications?

A

T2DM (>25 BMI and <25 if not working alone on sulphonylureas)

300
Q

Metformin SEs?

A

GI upset and rarely lactic acidosis if AKI

301
Q

Metformin warnings?

A

Not for: AKI, severe tissue hypoxia; caution: renal/hepatic impairment (contrast), drunk, chronic alcohol abuse

302
Q

Metformin interactions?

A

Anything that impairs renal function use with caution (MAOI and ACEi)

303
Q

Methotrexate indications?

A

DMARD for RA, chemo (leukaemia/lymphoma), severe resistant psoriasis, Crohn’s

304
Q

Methotrexate SEs?

A

Mucosal damage, bone marrow suppression; longterm = hepatic cirrhosis or pulmonary fibrosis or pericarditis; N+V, alopecia, stomatitis

305
Q

Methotrexate warnings?

A

None: pregnancy, severe renal impairment; caution in hepatic impairment

306
Q

Methotrexate interactions?

A

Toxicity increased by: inhibit renal excretion (NSAIDs and penicillins), folate antagonists (trimethoprim and phenytoin), live vaccines and clozapine

307
Q

Metronidazole indications?

A

Abx colitis, oral infections, aspiration pneumonia, surgical/gynae infections, protozoal infx; anaerobic infections

308
Q

Metronidazole SEs?

A

GI upset; high dose/long time = seizures, encephalopathy, hepatitis, pancreatitis, peripheral and optic neuropathy

309
Q

Metronidazole warnings?

A

Don’t have with alcohol and reduce in severe hepatic impairment; pregnancy and breastfeeding

310
Q

Metronidazole interactions?

A

Cyp inhibitor, clozapine, alcohol

311
Q

Naloxone indications?

A

Treatment opioid toxicity

312
Q

Naloxone SEs?

A

Opioid withdrawal (pain, restlessness, N+V, dilated pupils, piloerection)

313
Q

Naloxone warnings?

A

Careful in palliative care as could be more preferable to allow OD

314
Q

Nicotine replacement and related drug types?

A

Nicotine, varenicline, bupropion

315
Q

Nicotine replacement and related drug indications?

A

Smoking cessation

316
Q

Nicotine replacement and related drug SEs?

A

Local irritation, GI upset, palps; varenicline = nausea, headaches, insomnia, abnormal dreams; bupropion = dry mouth, GI upset, neuro and psych sxs

317
Q

Varenicline mechanism?

A

Partial agonist of nicotinic receptor so less withdrawal and rewarding sxs smoking

318
Q

Bupropion mechanism?

A

Increased conc noradrenaline and dopamine in synapse

319
Q

Nicotine replacement and related drug warnings?

A

Haemodynamically unstable, risk of seizures, psych disease, renal/hepatic impairment

320
Q

Nitrates types?

A

Isosorbide mononitrate (long acting), glyceryl trinitrate (short acting)

321
Q

Nitrate indications?

A

Short acting = angina, ACS; long acting = prophylaxis angina 3rd line; pulmonary oedema with furosemide and oxygen

322
Q

Nitrate SEs?

A

Flushing, headaches, dizziness, hypotension; tolerance

323
Q

Nitrate warnings?

A

CI: severe aortic stenosis, haemodynamic instability, hypotension

324
Q

Nitrate interactions?

A

Caution with antihypertensives and never with sildenafil

325
Q

Nitrofurantoin indications?

A

First choice UTI and also for prophylaxis of recurrent

326
Q

Nitrofurantoin SEs?

A

GI upset, urine yellow/brown, peripheral neuropathy, pulmonary fibrosis, hypersensitivity reactions, haemolytic anaemia

327
Q

Nitrofurantoin warnings?

A

CI: pregnant women, less than 3months, renal impairment

328
Q

NSAID types?

A

Naproxen, ibuprofen, etoricoxib

329
Q

NSAID indications?

A

Mild to moderate pain; pain related inflammation

330
Q

NSAID SEs?

A

GI toxicity, renal impairment, CVD events, bronchospasm

331
Q

NSAID warnings?

A

CI: severe renal impairment, HF, liver failure, hypersensitivity; warnings: peptic ulcer disease, GI bleed, CVD, renal impairment, asthma

332
Q

NSAID interactions?

A

Peptic ulcers = aspirin, steroids; GI bleeds = anticoag, SSRIs; renal impairment = ACEi, diuretics; lithium, antidepressants

333
Q

Ocular lube types?

A

Hypromellose, carbomers, liquid and white soft paraffin

334
Q

Ocular lube indications?

A

Dry eye conditions (keratoconjunctivitis sicca and Sjogrens)

335
Q

Oestrogens and progestrogen types?

A

Combined ethinylestradiol products, desogestrel

336
Q

Oestrogens and progestrogen indications?

A

HRT for early menopause and menopausal sxs; hormonal contraception

337
Q

Oestrogens and progestrogen SEs?

A

Irregular bleeds, mood changes; oestrogen = higher risk VTE/CVD/stroke/breast and cervical cancer

338
Q

Oestrogens and progestrogen warnings?

A

CI: breast cancer; caution in VTE risk and CVD disease and migraines with aura

339
Q

Oestrogens and progestrogen interactions?

A

Lamotrigine efficacy reduced; cyp450 inducers reduce its efficacy

340
Q

Strong opioid types?

A

Morphine and oxycodone

341
Q

Strong opioid indications?

A

Acute severe pain, chronic pain relief last line, SOB relief in palliation, SOB in pulmonary oedema with O2, furosemide and nitrates

342
Q

Strong opioid SEs?

A

Resp depression, euphoria, neuro depression, N+V, pupillary constriction, biliary/ureteric spasm, dysphoria, sweating, constipation, itching, tolerance, dependence and withdrawal

343
Q

Strong opioid warnings?

A

Hepatic/renal failure, elderly, resp failure, biliary colic, prostatic hypertrophy, IBD, convulsive disorders, pregnancy, raised ICP

344
Q

Weak/moderate opioid types?

A

Tramadol, codeine, dihydrocodeine

345
Q

Weak/moderate opioid indications?

A

Mild-moderate pain, diarrhoea and cough suppression

346
Q

Weak/moderate opioid SEs?

A

Same as strong

347
Q

Weak/moderate opioid interactions?

A

Sedating drugs, drugs lowering seizure threshold, serotonergic drugs (serotonin syndrome)

348
Q

Oxygen indications?

A

Acute hypoxaemia, accelerate reabsorption of pleural gas in pneumothorax, CO poisoning

349
Q

Oxygen SEs?

A

Mask discomfort, dry throat

350
Q

Oxygen warnings?

A

T2 resp failure = resp acidosis and tissue hypoxia

351
Q

Paracetamol indications?

A

Acute and chronic pain; antipyretic

352
Q

Paracetamol SEs?

A

Liver failure in OD; rare = blood disorders (thrombocytopenia, leucopenia, neutropenia)

353
Q

Paracetamol interactions?

A

CYP inducers = risk of OD; chronic alcohol

354
Q

Penicillin types?

A

Benzylpenicillin and phenoxymethylpenicillin

355
Q

Penicillin indications?

A

Strep infections (tonsillitis, pneumonia, endocarditis, skin and soft tissue infx); meningooccal infx; clostridial infx

356
Q

Penicillin SEs?

A

Allergy (rash and sometimes hypersensitivity); neuro toxicity at high doses

357
Q

Penicillin interactions?

A

Reduce renal excretion methotrexate

358
Q

Antipseudomonal penicillin types?

A

Piperacillin with tazobactam (tazocin)

359
Q

Antipseudomonal penicillin indications?

A

Severe infections where broad spectrum bacteria involved, immunocompromised; LRTI/UTI/intraabdo sepsis/skin and soft tissue infx

360
Q

Antipseudomonal penicillin SEs?

A

GI upset, abx associated colitis

361
Q

Antipseudomonal penicillin warnings?

A

Caution = C diff risk, renal impairment

362
Q

Broad spectrum abx types?

A

Amoxicillin, co-amoxiclav

363
Q

Broad spectrum abx indications?

A

Amoxicillin = uncomplicated pneumonia, otitis media, sinusitis, UTI, H. pylori; co-amoxiclav = severe, resistant HAP

364
Q

Broad spectrum abx SEs?

A

Same as other penicillins

365
Q

Penicillinase-resistant penicillin types?

A

Flucloxacillin

366
Q

Penicillinase-resistant penicillin indications?

A

Staph infection; cellulitis, osteomyelitis, septic arthritis, endocarditis

367
Q

Phosphodiesterase type 5 inhibitor types?

A

Sildenafil

368
Q

Phosphodiesterase type 5 inhibitor indications?

A

ED, primary pulmonary HT

369
Q

Phosphodiesterase type 5 inhibitor SEs?

A

Flushing, dizziness, headache, nasal congestion, hypotension, tachy, palps, CVD events, priapism, visual disorders

370
Q

Phosphodiesterase type 5 inhibitor warnings?

A

CI = stroke, ACS, CVD, nitrates, nicorandil; caution = hepatic/renal impairment, CYP inhibitors, vasodilators

371
Q

Prostaglandin analogue eye drop types?

A

Latanoprost and bimatoprost

372
Q

Prostaglandin analogue eye drop indications?

A

Open angle glaucoma and ocular HT

373
Q

Prostaglandin analogue eye drop SEs?

A

Blurred vision, conjunctival reddening (hyperaemia), occular irritation, pain

374
Q

PPI types?

A

Omeprazole, lansoprazole, pantoprazole

375
Q

PPI indications?

A

Prevention and treatment of peptic ulcer disease, dyspepsia, GORD, H. pylori, Zollinger-Ellison syndrome

376
Q

PPI SEs?

A

GI disturbance, headache, hypomagnesaemia if prolonged use

377
Q

PPI warnings?

A

Caution in pts at risk osteoporosis, pregnancy and breastfeeding

378
Q

PPI interactions?

A

Reduce effect of clopidogrel of omeprazole

379
Q

Type of quinine?

A

Quinine sulfate

380
Q

Quinine indications?

A

Night time leg cramps, malaria

381
Q

Quinine SEs?

A

Toxic in OD, tinnitus, deafness, blindness, GI upset, prolongs QT, hypoglycaemia

382
Q

Quinine warnings?

A

Caution = hearing/visual impairment, not in first trimester, G6PD

383
Q

Quinolone types?

A

Ciprofloxacin, moxifloxacin, levofloxacin

384
Q

Quinolone indications?

A

UTI, severe gastroenteritis, LRTI; 2nd/3rd line treatment; gram -ve and +ve

385
Q

Quinolone SEs?

A

GI upset, neuro effects, damage to tendons, prolong QT, c diff colitis, headache

386
Q

Quinolone warnings?

A

Caution: at risk of seizures, children, psych illness, pregnancy, G6PD deficiency

387
Q

Quinolone interactions?

A

Can be a cyp inhibitor = theophylline toxicity; NSAIDs = risk of seizures; prednisolone = tendon rupture

388
Q

Serotonin 5-HT1-receptor antagonist types?

A

Sumatriptan

389
Q

Serotonin 5-HT1-receptor antagonist indications?

A

Acute migraine

390
Q

Serotonin 5-HT1-receptor antagonist SEs?

A

Pain in chest/throat, N+V, fatigue, dizziness, HT; rare = MI

391
Q

Serotonin 5-HT1-receptor antagonist warnings?

A

CI = coronary artery disease, cerebrovascular disease, hemiplegic/basilar migraines

392
Q

Serotonin 5-HT1-receptor antagonist interactions?

A

Increase risk of serotonin toxicity

393
Q

Sex hormone antagonists for breast cancer types?

A

Tamoxifen, anastrozole, letrozole

394
Q

Sex hormone antagonists for breast cancer indications?

A

ER positive; aromatase inhibitors in post-menopausal women only

395
Q

Sex hormone antagonists for breast cancer SEs?

A

Vaginal dryness, hot flushes, osteoporosis, VTE, endometrial cancer, GI upset

396
Q

Sex hormone antagonists for breast cancer warnings?

A

CI = pregnancy, lactation

397
Q

Sex hormone antagonists for breast cancer interactions?

A

Inhibits cyp so don’t use with = warfarin, fluoxetine, paroxetine; aromatase inhibitors no interactions

398
Q

Statin types?

A

Simvastatin, atorvastatin, prevastatin, rosuvastatin

399
Q

Statin indications?

A

Primary/secondary prevention CVD events, primary hyperlipidaemia

400
Q

Statin SEs?

A

Headache, GI disturbance, myalgia, myopathy and sometimes rhabdomylolysis; rise in liver enzymes

401
Q

Statin warnings?

A

Caution: renal/hepatic impairment, pregnancy and breastfeeding

402
Q

Statin interactions?

A

Metabolism reduced by cyp inhibitors

403
Q

Sulphonylurea types?

A

Gliclazide, glipizide, tolbutamide, glibenclamide

404
Q

Sulphonylurea indications?

A

T2DM 2nd line/adjuvant to metformin

405
Q

Sulphonylurea SEs?

A

GI upset, hypos, weight gain, hyponatremia, hepatotoxic, hypersensitivity, careful in renal impairment and ketoacidosis

406
Q

Drugs elevating blood glucose?

A

Prednisolone, thiazide, loop diuretics

407
Q

Tetracycline types?

A

Doxycycline, lymecycline

408
Q

Tetracycline indications?

A

Acne, LRTI, pneumonia and atypical, PID, chylamydial infection, typhoid, anthrax, malaria, lyme disease

409
Q

Tetracycline SEs?

A

N+V, diarrhoea, oesophageal irritation, photosensitivity, hypoplasia tooth enamel in kids, hepatotoxicity

410
Q

Tetracycline warnings?

A

CI = pregnancy, breastfeeding, under 12s, hepatic impairment

411
Q

Tetracycline interactions?

A

Not given with 2 hours of calcium/antacids/iron as stops absorption; enhances warfarin; ciclosporin, retinoids (increased risk ICP)

412
Q

Thyroid hormone types?

A

Levothyroxine, liothryonine

413
Q

Thyroid hormone indications?

A

Hypothyroidism

414
Q

Thyroid hormone SEs?

A

OD = GI upset (diarrhoea, N+V), cardiac (arrhythmias, tachy, angina), neuro (tremor, insomnia)

415
Q

Thyroid hormone warnings?

A

Caution in coronary artery disease and hypopituitarism (need steroid before so not addisonian crisis), DI, DM

416
Q

Thyroid hormone interactions?

A

Absorption reduced by antacids/calcium/iron; higher dose needed if on cyp inducers; may need higher sugar intake for DM; enhances effects of warfarin

417
Q

Trimethoprim types?

A

Also co-trimoxazole

418
Q

Trimethoprim indications?

A

UTI and prophylaxis; also acne/RTI/prostatis/pneumocystitis pneumonia prophylaxis in immunosuppression

419
Q

Trimethoprim SEs?

A

GI upset, skin rash, megaloblastic anaemia (folate inhibitor), hyperkalaemia; avoid in pregnancy, neonates and elderly

420
Q

Sodium valproate/valproic acid indications?

A

Seizure prophylaxis in epilepsy, sometimes status epilepticus after benzo, manic episodes of bipolar

421
Q

Sodium valproate/valproic acid SEs?

A

GI upset, neuro/psych effects (tremor, ataxia, behaviour), thrombocytopenia, elevated liver enzymes, pancreatitis

422
Q

Sodium valproate/valproic acid warnings?

A

CI = child-bearing age, first trimester; hepatic/renal impairment, SLE

423
Q

Sodium valproate/valproic acid interactions?

A

Risk of toxicity with lamotrigine; inhibits cyp450; is also metabolised by cyp

424
Q

Vancomycin indications?

A

Treatment gram +ve infection and abx associated colitis, MRSA and C diff and endocarditis

425
Q

Vancomycin SEs?

A

Thrombophlebitis, rapid = red man syndrome; IV = nephrotoxicity, ototoxicity, neutropenia

426
Q

Vancomycin interactions?

A

Ototoxicity risk = aminoglycosides, loop diuretics, ciclosporin

427
Q

Vitamin types?

A

Folic acid, thiamine, hydroxocobolamin, phytomenadione

428
Q

Vitamin indications?

A

Thiamine = wernickes encephalopathy, korsakoffs; folic = megaloblastic anaemia, neural tube defects; hydroxocobolamin = megaloblastic anaemia, subacute degeneration of cord; phytomenadione (vit k) = reversal warfarin

429
Q

Warfarin indications?

A

VTE, prevent embolism in AF or prosthetic heart valves, TIA

430
Q

Warfarin warnings?

A

Liver disease and pregnancy; is metabolised by cyp, low therapeutic index

431
Q

Z-drug types?

A

Zopiclone, zolpidem

432
Q

Z-drug indications?

A

Short-term insomnia treatment

433
Q

Z-drug SEs?

A

Fatigue, rebound insomnia after stopping, headache, confusion, nightmares; taste disturbance (zopiclone), GI upset (zolpidem); dependence, withdrawal, OD

434
Q

Z-drug warnings?

A

CI = OSA, resp muscle weakness, resp depression; warning = elderly

435
Q

Z-drug interactions?

A

Metabolised by cyp, enhance hypotensives

436
Q

Colloid types?

A

Gelatins and albumin

437
Q

Colloid indications?

A

To expand circulating vol in impaired tissue perfusion but after sodium lactate/chloride; albumin = cirrhotic liver disease to stop hypovolaemia in paracentesis

438
Q

Colloid SEs?

A

Oedema, pulmonary oedema, hypersensitivity

439
Q

Colloid warnings?

A

Caution = rapid infusion in HF and renal impairment (can cause oedema and vol overload)

440
Q

What is compound sodium lactate?

A

Hartmann’s solution

441
Q

Hartmann’s indications?

A

Sodium and water to pts unable to take oral; fluid challenger to expand circ vol in impaired tissue perfusion

442
Q

Hartmann’s SEs?

A

Oedema

443
Q

Hartmann’s warnings?

A

HF, renal impairment and liver caution

444
Q

Glucose/dextrose infusion types?

A

Glucose 5%/10%/20%/50%

445
Q

Dextrose indications?

A

5% for water as can’t oral and diluting drugs; 10/20/50% for hypos and hyperkalaemia with calcium gluconate

446
Q

Dextrose SEs?

A

50% = irritant to veins (pain/phlebitis/thrombosis); hyperglycaemia

447
Q

Dextrose warnings?

A

If thiamine deficient then can get wernickes; caution = renal failure, hyponatraemia, children, brain injuries

448
Q

Potassium chloride indications?

A

Prevention of potassium depletion; hypokalaemia

449
Q

Potassium chloride SEs?

A

Hyperkalaemia and therefore arryhthmias; irritant to veins

450
Q

Sodium chloride types?

A

0.9% and 0.45%

451
Q

Sodium chloride indications?

A

Provide sodium and water unable to oral; expand circ vol in inadequate tissue perfusion; diluting drugs

452
Q

Sodium chloride SEs?

A

Oedema, hypercloraemia leading to acidosis

453
Q

Sodium chloride warnings?

A

HF and renal impairment

454
Q

Drugs to stop before elective surgery (I LACK OP)?

A

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

455
Q

PReSCRIBER mnemonic for writing prescriptions?

A

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

456
Q

SEs of steroids?

A

mnemonic STEROIDS: Stomach ulcers, Thin skin, Oedema, Right and left HF, Osteoporosis, Infection, Diabetes and Cushing’s Syndrome

457
Q

NSAID safety CIs?

A

NSAID: No urine (renal failure), Systolic dysfunction, Asthma, Indigestion and Dyscrasia (clotting abnormal)

458
Q

Causes of hypokalaemia (DIRE)?

A

Drugs (loop and thiazide diuretics), Inadequate intake/intestinal loss (V and diarrhoea), Renal tubular acidosis, Endo (cushing’s/conn’s)

459
Q

Causes of hyperkalaemia (DREAD)?

A

Drugs (potassium sparing diuretics and ACEi), Renal failure, Endo (addison’s), Artefact, DKA (when insulin given to treat it)

460
Q

Causes of raised alkaline phosphate (ALKPHOS)?

A

Any fracture, Liver damage, K for kancer, Paget’s disease of the bone and pregnancy, Hyperparathyroidism, Osteomalacia and Surgery

461
Q

What is the formula for volume of distribution?

A

total amount of drug in body divided by plasma-drug conc

462
Q

Amounts of fluids and electrolytes needed to calculate maintenance fluids?

A

Fluid = 25-30ml/kg/day, Electrolytes (Na, K, Cl) = 1mmol/kg/day, glucose = 5-10g/day

463
Q

Types of potassium channel activator?

A

Nicorandil

464
Q

Nicorandil indications?

A

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

465
Q

Nicorandil SEs?

A

Flushing, dizziness, headache, tachycardia, nausea, rectal bleeding, weakness; skin/mucosal/eye ulceration, haemorrhage/fistula/abscess

466
Q

Nicorandil CIs?

A

Caution in hypovolaemia and acute MI; avoid in hypotension, cardiogenic shock and LVF

467
Q

Nicorandil interactions?

A

Sildenafil/tadalafil/vardenafil

468
Q

Drug class of dipyridamole?

A

Antiplatelet

469
Q

Dipyridamole indications?

A

VTE prophylaxis with warfarin in prosthetic heart valves; with aspirin for secondary prevention TIA and stroke

470
Q

Dipyridamole SEs?

A

GI disturbance, haemorrhage, hypotension, worsening of coronary artery disease sxs

471
Q

Dipyridamole CIs?

A

Angina, AS, recent MI, LV outflow obstruction, HF, coagulation disorders/drugs

472
Q

Dipyridamole interactions?

A

Adenosine, antiplatelets, anticoags, fibrinolytics

473
Q

Systemic nasal decongestants name?

A

Pseudoephedrine

474
Q

Pseudoephedrine indications?

A

Nasal and sinus decongestant

475
Q

Pseudoephedrine SEs?

A

Anxiety, headache, HT, insomnia, N+V, restlessness, tachy; hallucinations, angle-closure glaucoma, retention

476
Q

Pseudoephedrine CIs?

A

DM, HT, hyperthyroidism, IHD, prostatic hypertrophy, risk of angle-closure glaucoma

477
Q

Pseudoephedrine interactions?

A

Alpha blockers (less hypotensive effect), MAOIs (HT crisis)

478
Q

Lithium drug class?

A

Mood stabiliser

479
Q

Lithium indications?

A

Mania and bipolar

480
Q

Lithium SEs?

A

GI upset, fine tremor, weight gain, hypothyroidism, hyperparathyroidism, hypercalcaemia

481
Q

Lithium toxicity S+Ss?

A

Blurred vision, muscle weakness, drowsy, coarse tremor, slurred speech, ataxia, confusion, N+V, ECG changes

482
Q

Lithium toxicity management?

A

Stop, check levels/serum creatinine/U+Es, refer to A+E, advice from psych for re-intiation

483
Q

CIs lithium?

A

Elderly, psoriasis, myasthenia gravis, serious CVD, addison’s, renal impairment, pregnancy, breastfeeding; reduce in diarrhoea, vomiting, infection

484
Q

Lithium interactions?

A

Metronidazole, tetracyclines, co-trimoxazole, NSAIDs, ACEi, ARBs, diuretics, amiodarone; drugs decreasing lithium levels = xanthines, theophylline, aminophylline, caffeine, sodium salts, acetazolamide

485
Q

Phenytoin indications?

A

All epilepsy other than absence seizures; status epilepticus

486
Q

Phenytoin adverse effects?

A

PHENYTOIN - P450 interactions, hirsutism, enlarged gums, nystagmus, yellow-browning of skin, teratogenic, osteomalacia, interferes with folate metabolism, neuropathies

487
Q

Phenytoin CIs?

A

Enteral feeding caution, Han Chinese/Thai, discontinue if leucopenia

488
Q

Phenytoin interactions?

A

Is a CYP450 inducer - OCP = reduced contraceptive effect; reduced theophylline and phenytoin efficacy; reduced phenytoin with cimetidine; reduced phenytoin with amiodarone

489
Q

Example of an NMDA receptor antagonist?

A

Memantine

490
Q

Memantine use?

A

Slow deterioration of Alzheimer’s

491
Q

Memantine SEs?

A

Constipation, dizziness, drowsy, confusion, headache, HT, thrombosis, HF

492
Q

Memantine CIs?

A

Cardiac disease, renal impairment, convulsion hx

493
Q

Memantine interactions?

A

Amantadine, ketamine both increase CNS toxicity

494
Q

Trimethoprim interactions?

A

ACEi, ARBs, amiodarone, phenytoin, azathioprine, methotrexate, mercaptopurine

495
Q

GLP-1 analogues?

A

Liraglutide and exenatide

496
Q

GLP-1 analogues indications?

A

2nd/3rd line DMT2

497
Q

GLP-1 analogues SEs?

A

GI disturbance, hypos, ab formation against it, severe pancreatitis

498
Q

GLP-1 analogues caution?

A

Renal impairment, DKA, GI disease, gastroparesis an stop if pt gets pancreatitis

499
Q

GLP-1 analogues interactions?

A

Warfarin and other antidiabetics

500
Q

Types of thiazolidinediones?

A

Pioglitazone

501
Q

Pioglitazone indications?

A

3rd line for DMT2, 2nd line DMT2 if sulphonylurea CI

502
Q

Pioglitazone SEs?

A

anaemia, arthralgia, GI disturbance, haematuria, impotence, vertigo, visual disturbance, weight gain, liver dysfunction

503
Q

Pioglitazone CIs?

A

CVD, hepatic impairment, stop if jaundice

504
Q

Pioglitazone interactions?

A

Insulin, beta blockers

505
Q

Carbimazole others?

A

Propylthiouracil

506
Q

Carbimazole indications?

A

Hyperthyroidism

507
Q

Carbimazole SEs?

A

GI disturbance, arthritis, fever, rash, pruritus, jaundice, agranulocytosis, neuropenia

508
Q

Carbimazole CIs?

A

Hepatic impairment, pregnancy, severe blood disorders

509
Q

Colchicine indications?

A

Acute gout, pericarditis

510
Q

Colchicine SEs?

A

GI disturbance, GI haemorrhage at high dose, renal/hepatic damage, myopathy, peripheral neuropathy, bone marrow suppression

511
Q

Colchicine CIs?

A

Elderly, hepatic/renal impairment, GI/cardiac disease

Phase 3a/3b (9 decks)

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