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PSA Flashcards

1
Q

side effects of spironolactone

A

dizziness

anti-androgenic (ie stops M hormones working) - gynaecomastia

could switch to eplerenone

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2
Q

amiodarone use and side effects

A

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

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3
Q

what drug do you give for chemotherapy induced nausea

Any adverse affects

A

ondansetron (5-HT3-receptor antagonist)

adverse affect is prolonged QT interval, constipation is common

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4
Q

can you take verapamil and BBs at the same time? why?

A

no

possibility of heart block + fatal arrest

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5
Q

nicorandil

A

for angina tx

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6
Q

which abx can cause cholestasis

A

co-amoxiclav

flucloxacillin
erythromycin

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7
Q

what to check when starting a patient on azathioprine or mercaptopurine (for crohns)

A

+TPMT activity (an enzyme that metabolises these drugs, some ppl are deficient + wld have more adverse effects)

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8
Q

SE of adenosine

A

flushing, nausea, sweating, bronchospasm and also chest pain

warn about chest pain

short half life of 8-10 secs

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9
Q

CI of adenosine

A

asthma

The effects of adenosine are enhanced by dipyridamole (antiplatelet agent) and blocked by theophyllines.

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10
Q

what medication combo might cause rhabdomyolysis?

A

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

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11
Q

caution w isotretinoin (accutaine)

A

teratogenic

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12
Q

can you have ACEis b4 surgery

A

NO stop them

can get severe hypotension following anaesthesia

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13
Q

common SE of metformin

A

diarrhoea

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14
Q

what drug can reduce hypoglycaemic awareness

A

BBs

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15
Q

what anticoag to use w mechanical heart valves

A

warfarin

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16
Q

adverse effects of PPIs

A

hyponatraemia, hypomagnasaemia

osteoporosis → increased risk of fractures

microscopic colitis

increased risk of C. difficile infections

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17
Q

how do PPIs work

A

cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.

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18
Q

what medications might cause or worsen hypercalcaemia

A

thiazide diuretics
lithium
calcium
over-the-counter antacids
large doses of vitamin D

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19
Q

what is a risk of overreplacement with thyroxine

A

osteoporosis

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20
Q

how to prevent nitrate tolerance

A

px who take standard-release isosorbide mononitrate sld use an asymmetric dosing interval

(not needed if take OD modified release)

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21
Q

when are nitrates contraindicated

A

if hypotension < 90 systolic

inferior MIs

increased intracranial pressure

severe anemia

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22
Q

what are the rules whilst on steroids

A

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.

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23
Q

contraception on methotrexate

A

Patients using methotrexate require effective contraception during and for at least 6 months after treatment in men or women

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24
Q

what cannot be prescribed w methotrexate

A

trimethoprim
(co-trimoxazole contains this)
(both folate antagonists + increase the risk of bone marrow suppression when prescribed together)

high dose aspirin

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25
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
26
what to co-prescribe w methotrexate
folic acid 5mg once weekly, taken more than 24 hrs after methotrexate dose
27
how often to take methotrexate
weekly
28
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
29
what is the starting dose of methotrexate
7.5 mg weekly
30
tx for methotrexate toxicity
folinic acid
31
which abx is assoc w tendon disorders
quinolones - eg ciprofloxacin TRIPflocloxacin
32
what drug can cause Dupuytren's contracture
phenytoin
33
what are some side effects of adenosine
chest pain, impending feeling of doom, bronchospasm, transient flushing.
34
what drug enhances the affects of adenosine
dipyridamole (antiplatelet agent)
35
what drug blocks the affects of adenosine
theophyllines
36
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
37
what cannula to use for adenosine + why
large-calibre due to its short half life
38
what drugs to avoid in HOCM
ACEis + nitrates
39
what to avoid in elderly px taking warfarin + why
NSAIDs risk of a life-threatening gastrointestinal haemorrhage
40
which drugs should you avoid in renal failure
antibiotics: tetracycline, nitrofurantoin NSAIDs lithium metformin
41
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
42
which drugs are safe in CKD
antibiotics: erythromycin, rifampicin diazepam warfarin
43
what opioid to use in renal failure
eGFR < 30 --> Oxycodone eGFR < 15 --> Fentanyl
44
mechanism of action of aspirin
non-selective cyclooxygenase (COX) inhibitor that blocks the production of thromboxane A2 by platelets. This impairs platelet aggregation.
45
mechanism of action of warfarin
vitamin K antagonist that inhibits the vitamin K-dependent coagulation factors (II, VII, IX and X)
46
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
47
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
48
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'
49
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.
50
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
51
what drugs to not take with lithium
diuretics (especially thiazides) ACEis/ARBs NSAIDs metronidazole
52
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)
53
which drugs can cause SIADH
sulfonylureas - glimepiride and glipizide SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
54
side effect of hydroxychloroquine
bull's eye retinopathy - irreversible damage to retina causes loss of central vision
55
side effect of digoxin
yellow-green vision
56
side effects of levodopa
reddish discolouration of urine upon standing dyskinesia 'on-off' effect hypotension
57
side effect of Sildenafil
visual disturbances such as blue discolouration or non-arteritic anterior ischaemic neuropathy
58
what tests to do before starting amiodarone
TFTs,LFTs,CXR,ECG
59
what drugs can cause liver cholestasis
combined oral contraceptive pill antibiotics: flucloxacillin, co-amoxiclav, erythromycin anabolic steroids, testosterones phenothiazines: chlorpromazine, prochlorperazine sulphonylureas fibrates
60
what drugs can cause liver cirrhosis
methotrexate methyldopa amiodarone
61
what drugs to stop if you suspect a px has AKI
DAMN Diuretics + digoxin ACEi/ARBs Metformin + methotrexate NSAIDs Contrast media Some abx allopurinol
62
what do cytochrome p450 inducers do
speed up the metabolism of some drugs that use p450 to metabolise
63
examples of cytochrome p450 inducers
CRAP GPs Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbitone St John's Wort/Sulfonylureas/Smoking
64
examples of cytochrome p450 inhibitors
SICKFACES.COM Sodium Valproate Isoniazid Cimetidine Ketoconazole (+fluconazole) Fluoxetine (+sertraline) Amiodarone/ Allopurinol Ciprofloxacin Erythromycin Sulfonamides Chloramphenicol Omeprazole Metronidazole
65
what change in bloods can corticosteroids cause
neutrophilia
66
SEs Nicorandil
may cause ulceration anywhere in the gastrointestinal tract (a vasodilatory drug used to treat angina)
67
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
68
target INR for AF
2-3
69
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)
70
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.
71
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
72
warfarin half-life
1-3 days
73
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)
74
CI to statins
macrolides (e.g. erythromycin, clarithromycin) - stop until course is completed pregnancy
75
statins mechanism of action
inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.
76
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
77
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
78
when to take statins
at night when the majority of cholesterol synthesis takes place
79
what might you see on ECG w cardiac tamponade
electrical alternans - different amplitude QRSs
80
what drugs are RF for long QT syndrome
citalopram (+ other SSRIs) amiodarone TCAs fluconazole erythromycin metaclopramide quinidine haloperidol methadone ondansetron
81
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)
82
causes of drug induced lupus
Most common causes procainamide hydralazine Less common causes isoniazid minocycline phenytoin
83
do you take HRT before surgery
stop it 4 weeks before surgery
84
do you take COCP before surgery
stop it 4 weeks before surgery
85
when to avoid nitrofurantoin
renal failure i.e. eGFR < 45
86
SEs interferon alpha
flu-like symptoms and depression
87
drugs that can cause lymphadenopathy
allopurinol phenytoin atenolol carbamazepine
88
what happens on ECG w digoxin
downsloping ST depression (reverse tick)
89
how to change levothyroxine dose according to TSH level
target range = 0.5-5 unless grossly hypo/hyper, change by smallest increment offered
90
what can long term steroid use cause
avascular necrosis of hip
91
what to check before tx w azathoprine
check for thiopurine methyltransferase deficiency (TPMT) - otherwise px may be prone toxicity
92
what to do before starting someone on hydroxychloroquinine
baseline ophthalmologic examination - risk of bull's eye retinopathy
93
what time of day to give pred
morn
94
when to check ketones in T1DM
if BM > 15
95
key thing to tell px on insulin for T1DM
seek urgent medical help if unable to drink fluids due to N&V

finals (27 decks)

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