PSA Flashcards
side effects of spironolactone
dizziness
anti-androgenic (ie stops M hormones working) - gynaecomastia
could switch to eplerenone
amiodarone use and side effects
anti-arrhythmic med - wide complex supra-ventricular tachycardias
SEs
thyrotoxicosis- need TFTs monitoring
contains iodine
can be affected by grapefruit
sensitive to sunlight
Hypothyroidism (more common than hyperthyroidism)
Hyperthyroidism
Corneal deposits
Stevens-Johnson syndrome
Grey discoloration of the skin
Liver failure
Pneumonitis
Pulmonary fibrosis
what drug do you give for chemotherapy induced nausea
Any adverse affects
ondansetron (5-HT3-receptor antagonist)
adverse affect is prolonged QT interval, constipation is common
can you take verapamil and BBs at the same time? why?
no
possibility of heart block + fatal arrest
nicorandil
for angina tx
which abx can cause cholestasis
co-amoxiclav
flucloxacillin
erythromycin
what to check when starting a patient on azathioprine or mercaptopurine (for crohns)
+TPMT activity (an enzyme that metabolises these drugs, some ppl are deficient + wld have more adverse effects)
SE of adenosine
flushing, nausea, sweating, bronchospasm and also chest pain
warn about chest pain
short half life of 8-10 secs
CI of adenosine
asthma
The effects of adenosine are enhanced by dipyridamole (antiplatelet agent) and blocked by theophyllines.
what medication combo might cause rhabdomyolysis?
macrolides (clarithromycin) and statins
(Clarithromycin is an inhibitor of the P450 CYP3A4 isoenzyme -> increased levels of atorvastatin through reduced metabolism)
even higher risk in those w CKD
caution w isotretinoin (accutaine)
teratogenic
can you have ACEis b4 surgery
NO stop them
can get severe hypotension following anaesthesia
common SE of metformin
diarrhoea
what drug can reduce hypoglycaemic awareness
BBs
what anticoag to use w mechanical heart valves
warfarin
adverse effects of PPIs
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
how do PPIs work
cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.
what medications might cause or worsen hypercalcaemia
thiazide diuretics
lithium
calcium
over-the-counter antacids
large doses of vitamin D
what is a risk of overreplacement with thyroxine
osteoporosis
how to prevent nitrate tolerance
px who take standard-release isosorbide mononitrate sld use an asymmetric dosing interval
(not needed if take OD modified release)
when are nitrates contraindicated
if hypotension < 90 systolic
inferior MIs
increased intracranial pressure
severe anemia
what are the rules whilst on steroids
DON’T – Don’t stop taking steroids abruptly. There is a risk of adrenal crisis.
S – Sick Day Rules.
T – Treatment Card.
O – Osteoporosis prevention with bisphosphonates and supplemental calcium and vitamin D.
P – Proton pump inhibitor for gastric protection.
contraception on methotrexate
Patients using methotrexate require effective contraception during and for at least 6 months after treatment in men or women
what cannot be prescribed w methotrexate
trimethoprim
(co-trimoxazole contains this)
(both folate antagonists + increase the risk of bone marrow suppression when prescribed together)
high dose aspirin
adverse effects of methotrexate
mucositis
myelosuppression
pneumonitis
- the most common pulmonary manifestation
- similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens
- typically develops within a year of starting treatment, either acutely or subacutely
- presents with non-productive cough, dyspnoea, malaise, fever
pulmonary fibrosis
liver fibrosis
what to co-prescribe w methotrexate
folic acid 5mg once weekly, taken more than 24 hrs after methotrexate dose
how often to take methotrexate
weekly
what to monitor whilst on methotrexate
FBC, U&E and LFTs
before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months
what is the starting dose of methotrexate
7.5 mg weekly
tx for methotrexate toxicity
folinic acid
which abx is assoc w tendon disorders
quinolones - eg ciprofloxacin
TRIPflocloxacin
what drug can cause Dupuytren’s contracture
phenytoin
what are some side effects of adenosine
chest pain, impending feeling of doom, bronchospasm, transient flushing.
what drug enhances the affects of adenosine
dipyridamole (antiplatelet agent)
what drug blocks the affects of adenosine
theophyllines
what is the mechanism of action of adenosine
causes transient heart block in the AV node
agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux
adenosine has a very short half-life of about 8-10 seconds
what cannula to use for adenosine + why
large-calibre due to its short half life
what drugs to avoid in HOCM
ACEis + nitrates
what to avoid in elderly px taking warfarin + why
NSAIDs
risk of a life-threatening gastrointestinal haemorrhage
which drugs should you avoid in renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
which drugs are likely to accumulate in CKD - need dose adjustment
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
which drugs are safe in CKD
antibiotics: erythromycin, rifampicin
diazepam
warfarin
what opioid to use in renal failure
eGFR < 30 –> Oxycodone
eGFR < 15 –> Fentanyl
mechanism of action of aspirin
non-selective cyclooxygenase (COX) inhibitor that blocks the production of thromboxane A2 by platelets.
This impairs platelet aggregation.
mechanism of action of warfarin
vitamin K antagonist that inhibits the vitamin K-dependent coagulation factors (II, VII, IX and X)
mechanism of action of bisphosphonates
analogues of pyrophosphate, a molecule which decreases demineralisation in bone
They inhibit osteoclasts (which chew bone) by reducing recruitment and promoting apoptosis
adverse effects of bisphosphonates
oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
acute phase response: fever, myalgia and arthralgia may occur following administration
hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant
counselling for px taking bisphosphonates
‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’
what to correct before starting bisphosphonates
Hypocalcemia/vitamin D deficiency
However, when starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate. Vitamin D supplements are normally given.
when to stop taking bisphosphonates after 5 years
patient is < 75-years-old
femoral neck T-score of > -2.5
low risk according to FRAX/NOGG
what drugs to not take with lithium
diuretics (especially thiazides)
ACEis/ARBs
NSAIDs
metronidazole
on what occasions do you give anti hypertensive treatment
aged less than 80 years with stage 1 hypertension (<135/85) with one or more of:
- target organ damage
- established cardiovascular disease
- renal disease
- diabetes
- 10 year cardiovascular risk of 10% or more.
stage2 HTN regardless of age (>150>95)
which drugs can cause SIADH
sulfonylureas - glimepiride and glipizide
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
side effect of hydroxychloroquine
bull’s eye retinopathy - irreversible damage to retina causes loss of central vision
side effect of digoxin
yellow-green vision
side effects of levodopa
reddish discolouration of urine upon standing
dyskinesia
‘on-off’ effect
hypotension
side effect of Sildenafil
visual disturbances such as blue discolouration or non-arteritic anterior ischaemic neuropathy
what tests to do before starting amiodarone
TFTs,LFTs,CXR,ECG
what drugs can cause liver cholestasis
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
what drugs can cause liver cirrhosis
methotrexate
methyldopa
amiodarone
what drugs to stop if you suspect a px has AKI
DAMN
Diuretics + digoxin
ACEi/ARBs
Metformin + methotrexate
NSAIDs
Contrast media
Some abx
allopurinol
what do cytochrome p450 inducers do
speed up the metabolism of some drugs that use p450 to metabolise
examples of cytochrome p450 inducers
CRAP GPs
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
St John’s Wort/Sulfonylureas/Smoking
examples of cytochrome p450 inhibitors
SICKFACES.COM
Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole (+fluconazole)
Fluoxetine (+sertraline)
Amiodarone/ Allopurinol
Ciprofloxacin
Erythromycin
Sulfonamides
Chloramphenicol
Omeprazole
Metronidazole
what change in bloods can corticosteroids cause
neutrophilia
SEs Nicorandil
may cause ulceration anywhere in the gastrointestinal tract
(a vasodilatory drug used to treat angina)
most common indications for DOACs
Stroke prevention in patients with AF
Treatment of DVT and PE
Prophylaxis of venous thromboembolism (DVTs and PEs) after a hip or knee replacement
target INR for AF
2-3
what is INR
international normalised ratio
used to assess how anticoagulated the px is by warfarin
calculates the px’s prothrombin time compared with the prothrombin time of an average healthy adult
1 = a normal prothrombin time. 2 = a prothrombin time twice that of an average healthy adult (it takes them twice as long to form a blood clot)
how can INR be affected by other drugs and why
The metabolism of warfarin involves the cytochrome P450 system in the liver.
Therefore, the INR will be affected by other drugs that influence the activity of the P450 system, including many antibiotics.
what foods can affect INR
those that contain VK e.g. leafy green veg
those that affect the P450 system, such as cranberry juice and alcohol
warfarin half-life
1-3 days
adverse affects of statins
myopathy- includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase.
liver impairment
some evidence that statins may increase the risk of intracerebral haemorrhage in patients who’ve previously had a stroke (so avoid if hx IC haemorrhage)
CI to statins
macrolides (e.g. erythromycin, clarithromycin) - stop until course is completed
pregnancy
statins mechanism of action
inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.
what to check + when if on statins
checking LFTs at baseline, 3 months and 12 months
tx should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range
indications for statins
all people with established CVD (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
anyone with a 10-year cardiovascular risk >= 10%
patients with T2DM should now be assessed using QRISK2, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
when to take statins
at night when the majority of cholesterol synthesis takes place
what might you see on ECG w cardiac tamponade
electrical alternans - different amplitude QRSs
what drugs are RF for long QT syndrome
citalopram (+ other SSRIs)
amiodarone
TCAs
fluconazole
erythromycin
metaclopramide
quinidine
haloperidol
methadone
ondansetron
SEs quinolone antibiotics eg ofloxacin, levofloxacin and ciprofloxacin (gd g-ve cover)
Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy)
causes of drug induced lupus
Most common causes
procainamide
hydralazine
Less common causes
isoniazid
minocycline
phenytoin
do you take HRT before surgery
stop it 4 weeks before surgery
do you take COCP before surgery
stop it 4 weeks before surgery
when to avoid nitrofurantoin
renal failure
i.e. eGFR < 45
SEs interferon alpha
flu-like symptoms and depression
drugs that can cause lymphadenopathy
allopurinol
phenytoin
atenolol
carbamazepine
what happens on ECG w digoxin
downsloping ST depression (reverse tick)
how to change levothyroxine dose according to TSH level
target range = 0.5-5
unless grossly hypo/hyper, change by smallest increment offered
what can long term steroid use cause
avascular necrosis of hip
what to check before tx w azathoprine
check for thiopurine methyltransferase deficiency (TPMT)
- otherwise px may be prone toxicity
what to do before starting someone on hydroxychloroquinine
baseline ophthalmologic examination - risk of bull’s eye retinopathy
what time of day to give pred
morn
when to check ketones in T1DM
if BM > 15
key thing to tell px on insulin for T1DM
seek urgent medical help if unable to drink fluids due to N&V
