PSA Flashcards
Acetylcysteine (N-acetylcysteine) Indications MOA SE Warnings Interactions
paracetamol poisoning, prevent renal injury, reduce the viscosity of respiratory secretions
y replenishing the body’s supply of glutathione (allow metabolism of paracetomole)
can cause an anaphylactoid reaction - in large doses
There are no significant adverse drug interactions with acetylcysteine.
INR monitoring needed - most sensitive marker of liver injury
Activated charcoal Indications MOA SE Warnings Interactions
Activated charcoal
used in the first hr of paracetamol overdose
SE : Aspiration of activated charcoal can leadd such as pneumonitis, bronchospasm and airway obstruction.
Do not used in reduced conisousness , persistent vomiting or reduced gastrointestinal motility
Activated charcoal prevents absorption of many drugs taken
therapeutically as well as those taken in overdose.
Adenosine Indications MOA SE Warnings Interactions
As a first-line diagnostic and therapeutic agent in supraventricular
tachycardia (SVT). (6mg IV)
agonist of adenosine receptors on cell surfaces
Adverse effects - bradycardia and even asystole - sense of ‘impending doom.’
CI in h hypotension,
coronary ischaemia, or decompensated heart failure.
reduced dose in asthma or COPD
Interaction with Dipyridamole (half dose to 3mg)
Theophylline, aminophylline and caffeine (may need higher dose)
Mointor with continuous cardiac rhythm strip
Aldosterone antagonists Indications MOA SE Warnings Interactions
Ascites and oedema due to liver cirrhosis: spironolactone is the first-line diuretic.
Chronic heart failure
Primary hyperaldosteronism
inhibit the effect of aldosterone by
competitively binding to the aldosterone receptor
hyperkalaemia; Spironolactone causes gynecomastia; liver impairment; steven jonhstons
contraindicated in patients with severe
renal impairment, hyperkalaemia and Addison’s disease
combination of an aldosterone antagonist with other
potassium-elevating drugs, including ACE inhibitors and angiotensin receptor blockers, increases the risk of hyperkalaemia.
Alginates and antacids Indications MOA SE Warnings Interactions
Gastro-oesophageal reflux disease: for symptomatic relief ofheartburn.
Dyspepsia: for short-term relief of indigestion.
. Magnesium salts can cause
diarrhoea, whereas aluminium salts can cause constipation
reduce concentrations of ACE inhibitors, some antibiotics (e.g. cephalosporins,
ciprofloxacin and tetracyclines), bisphosphonates, digoxin, levothyroxine
and proton pump inhibitors.
take at different time
If there are persistent symptoms or ‘red flags’,
such as bleeding, vomiting, dysphagia and weight loss, then further
investigation and specialist review should be considered
Allopurinol Indications MOA SE Warnings Interactions
To prevent acute attacks of gout.
To prevent uric acid and calcium oxalate renal stones.
To prevent hyperuricaemia and tumour lysis syndrome
associated with chemotherapy
SE skin rash; Starting allopurinol can trigger or worsen an acute attack of gout; s Stevens–Johnson syndrome or toxicepidermal necrolysis. Drug hypersensitivity syndrome (rare)
do not start in acute attack
dose reduced in e renal impairment or hepatic impairment
Do not give with mercaptopurine and its pro-drug azathioprine
Co-prescription of allopurinol with amoxicillin increases the riskof skin rash and with ACE inhibitors or thiazides increases the risk of hypersensitivity reactions.
check serum 4/52 after given or dose change
Alpha-blockers Indications MOA SE Warnings Interactions
benign
prostatic hyperplasia, resistant hypertension
vasodilatation and a fall in blood pressure, and reduced resistance to bladder outflow
SE:postural hypotension, dizziness and syncope
Aminoglycosides (Gentamicin) Indications MOA SE Warnings Interactions
Gram-negative aerobes
Severe sepsis, including where the source is unidentified.
Pyelonephritis and complicated urinary tract infection.
Biliary and other intra-abdominal sepsis.
Endocarditis.
The most important adverse effects are nephrotoxicity and
ototoxicity dose adjustment is essential to prevent renal, cochlear and vestibular damage, particularly in neonates a
Aminosalicylates Indications MOA SE Warnings Interactions
Mesalazine is used first-line in the treatment of mild-to-moderate
ulcerative colitis;
Sulfasalazine is one of several options for the management of
rheumatoid arthritis
gastrointestinal upset (e.g. nausea, dyspepsia) and headache
- rare but serious blood
abnormalities (e.g. leucopenia, thrombocytopenia) and renal
impairment.
Patients who
have aspirin hypersensitivity should not take these drugs.
Amiodarone Indications MOA SE Warnings Interactions
management of a wide range of tachyarrhythmias, including atrial fibrillation (AF), atrial flutter, supraventricular tachycardia (SVT), ventricular tachycardia (VT)
SE hypotension during IV infusion
chronic use: lungs (pneumonitis), heart (bradycardia, AV block), liver (hepatitis)
and skin (photosensitivity and grey discolouration - tyroid
avoided in patients with severe hypotension, heart block and active thyroid disease.
t increases plasma concentrations of digoxin, diltiazem and
verapamil. This may increase the risk of bradycardia, AV block and
heart failure. The doses of these drugs should be halved if amiodarone
is started.
Angiotensin receptor blockers Indications MOA SE Warnings Interactions
e generally used when ACE
inhibitors are not tolerated due to cough. The indications are the same:
ARBs block the action of angiotensin II on the AT1 receptor
ARBs can cause hypotension (particularly after the first dose), hyperkalaemia and renal failure.
ARBs should be avoided in patients with renal artery stenosis or
acute kidney injury; in women who are, or could become,
pregnant; and those who are breastfeeding
For safety, check electrolytes and renal function
before starting treatment. Repeat this 1–2 weeks into treatment and
after increasing the dose
Antidepressants, selective serotonin reuptake inhibitors
SE
Warnings
Interactions
Common adverse effects include gastrointestinal upset, appetite and weight disturbance (loss or gain) and hypersensitivity reactions,including skin rash. Hyponatraemia
SSRIs lower the seizure threshold and some (e.g.
citalopram) prolong the QT interval
SSRIs should not be given with monoamine oxidase inhibitors
They should not be combined
with other drugs that prolong the QT interval, such as
antipsychotic
Antidepressants, tricyclics and related drugs
SE
Warnings
Interactions
Blockade of antimuscarinic receptors causes dry mouth, constipation,urinary retention and blurred vision.
Blockade of H1 and α1 receptorscauses sedation and hypotension.
cation in e elderly,
people with cardiovascular disease or epilepsy, and people with
constipation, prostatic hypertrophy or raised intraocular
pressure
Tricyclic antidepressants should not be given with monoamine
oxidase inhibitors
Antiemetics, dopamine D2-receptor antagonists
metoclopramide, domperidone
SE
Warnings
Interactions
Diarrhoea the most common
Metoclopramide can induce extrapyramidal syndromes ie acute dystonic reaction
contraindicated in patients with gastrointestinal obstruction and perforation.
not be combined with dopaminergic agents for Parkinson’s disease
Antiemetics, histamine H1-receptor antagonists
cyclizine, cinnarizine, promethazine
SE
Warnings
Interactions
Prophylaxis and treatment of nausea and vomiting, particularly in
the context of motion sickness or vertigo
most common adverse effect is drowsiness.
dry throat and mouth
transient
tachycardia, which the patient may notice as palpitations
e avoided in patients
at risk of hepatic encephalopathy. and ine avoided in patients
at risk of hepatic encephalopathy.
Sedation may be greater when combined with other sedative drugs
(e.g. benzodiazepines, opioids). Anticholinergic effects may be more
pronounced in patients taking ipratropium or tiotropium
