PSA Flashcards
What drug may be given in an anaphylactoid reaction?
Chlorphenamine
MOA of chlorphenamine
Antihistamine
What drug may be given in an anaphylactoid reaction with significant bronchospasm?
Salbutamol
How would a patient with repeated anaphylactoid reactions to acetylcysteine be managed?
Prophylactic antihistamines (chlorphenamine and ranitidine)
First line drug for anaphylaxis, with dose and administration
Adrenaline 0.5mL 1 in 1000 IM
Anti-hypertensives in pregancy
Labetalol, Methyldopa, Nifedipine
Advice to women on antihypertensive who are planning pregnancy
Risk of congenital malformations so consider switching to a safer drug
Drugs that cause hyperkalaemia
ACEi
ARB
Spironolactone / Eplerenone / Amiloride
Co-amilofruse
Drugs that cause hypokalaemia
Bendroflumethiazide / Indapamide
Furosemide
What vitamin should be prescribed in pregnancy (and dose)
Folic acid 5mg PO OD
Vitamin C name
Ascorbic acid
Vitamin K drug name
Menadiol
Advice for patients taking long term steroids
Don’t stop suddenly
Drugs that cause hyponatraemia
PPIs SSRIs ACEi Diuretics Carbamazepine
Tests before starting amiodarone
CXR, U&Es, TFTs
Concerning ADR of statins
Rhabdomyolysis
Tests before adalimumab
CXR, CRP, FBC
ADRs of thiazides
Common adverse effects: dehydration postural hypotension hyponatraemia, hypokalaemia, hypercalcaemia* gout impaired glucose tolerance impotence
Rare adverse effects: thrombocytopaenia agranulocytosis photosensitivity rash pancreatitis
Indication for mycophenolate mofetil
Prevention of transplant rejection
MOA of dipyrimadole
Anti-platelet
MOA of ticagrelor
Anti-platelet
MOA of prasugrel
Anti-platelet
What drug is used in scabies?
Permethrin
MOA of metoclopramide
Dopamine receptor antagonist (anti-emetic)
Contraindication of metoclopramide
Parkinson’s
Children
Indications for metoclopramide
Nausea
GORD
Gastroparesis secondary to diabetic neuropathy / migraine
ADRs of metoclopramide
Parkinsonism / tardive dyskinesia
Prolonged QT
ADRs of digoxin
GI upset
Arrhythmias
Yellow vision
Gynaecomastia
MOA of cetuximab
Monoclonal antibody against epidermal growth factor receptor
Indications of cetuximab
Metastatic colorectal or head and neck cancer
MOA of infliximab
Anti-TNF antibody
Indications for infliximab
RA and Crohns
MOA of rituximab
Anti-CD20 antibody
Indications for rituximab
RA and non-Hodgkin lymphoma
MOA of trastuzumab
HER2 receptor antagonist
Indications for trastuzumab
HER2 positive breast cancer
ADRs of beta-2 agonists
Angioedema, arrhythmias, tremor, rash, hypokalaemia
Contraindications for beta-2 agonists
Cardiovascular disease, arrhythmias, hypokalaemia
ADRs of muscarinic antagonists
Constipation, cough, dry mouth, GI disturbance, headache
Contraindications of muscarinic antagonists
Arrhythmias, heart failure, recent MI
MOA of ondansetron
Serotonin receptor antagonist (anti-emetic)
Indication for ondansetron
Nausea
MOA of mycophenolate
Immunosuppressant
Indications for mycophenolate
Prevention of transplant rejection Inflammatory arthritis (off label)
Drug that reduces desire to drink
Naltrexone
ADRs of PPIs
Short term: Diarrhoea, Nausea
Long term: increased risk of pneumonia and hip fractures
ADRs of histamine antagonists
Headache, Diarrhoea, Dizziness, Tolerance
Indication for cabergoline
Prolactinoma
Indication for tolvaptan
SIADH
Contraindication of carbimazole
First trimester of pregnancy
How often is methotrexate taken?
Weekly
What should be co-prescribed with methotrexate?
Folic acid 5mg once per week (taken on a different day to the methotrexate)
Indications for methotrexate
Inflammatory arthritis
Crohn’s disease
Come leukaemia chemotherapy
ADRs of methotrexate
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis
Pregnancy advice with methotrexate
women should avoid pregnancy for at least 6 months after treatment has stopped
the BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment
Methotrexate monitoring
FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months
Methotrexate interactions
Trimethoprim
Aspirin
Treatment of methotrexate toxicity
Folinic acid
ADRs of dapagliflozin
urinary and genital infection (secondary to glycosuria)
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored
MOA of syntocinon
Synthetic oxytocin
Use of ergometrine
Can be used as alternative to oxytocin in the third stage of labour
Drugs used in medical termination of pregnancy
Mifepristone and misoprostol
Contraindication of pethidine
Renal failure
First line in neuropathic pain
Amitriptyline OR pregabalin
Second line in neuropathic pain
Amitriptyline AND pregabalin
First line in diabetic neuropathic pain
Duloxetine
Metformin ADRs
gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%
reduced vitamin B12 absorption - rarely a clinical problem
lactic acidosis with severe liver disease or renal failure
Metformin contraindications
chronic kidney disease: review if eGFR <45 and stop if eGFR < 30
Recent MI / sepsis / stroke / AKI
iodine-containing x-ray contrast media (day of and two days after procedure due to risk of renal impairment
alcohol abuse is a relative contraindication
How to start metformin
metformin should be titrated up slowly to reduce the incidence of gastrointestinal side-effects
How does sotalol work
Blocks K+ channels
Route of administration of heparin and LMWH
Heparin: IV
LMWH: SC
Duration of action of heparin and LMWH
Heparin: Short
LMWH: Long
Reversal agent for heparin
Protamine sulphate
ADRs of heparin
Bleeding
Heparin-induced thrombocytopaenia (HIT)
Osteoporosis
(lower risk with LMWH)
Three drugs given acutely in anaphylaxis
Adrenaline, hydrocortisone, cholrphenamine
Adrenaline dose in anaphylaxis in adults
500 micrograms (0.5ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
Adrenaline dose in anaphylaxis in children 6-12
300 micrograms (0.3ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
Adrenaline dose in anaphylaxis in children under 6
150 micrograms (0.15ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
Indication for letrozole
Breast cancer in post-menopausal women
MOA of letrozole
Aromatase inhibitor
ADRs of letrozole
Osteoporosis
Flushing
Night sweats
Indication for tamoxifen
Breast cancer in pre-menopausal women
MOA of tamoxifen
Oestrogen receptor blocker
First line in Wilson’s disease
Penicillamine
ADRs of pioglitazone
weight gain
liver impairment (monitor LFTs)
fluid retention (therefore contraindicated in heart failure)
increased risk of fractures and bladder cancer
Common ADRs of beta blockers
bradycardia
dizziness
syncope
Common ADRs of digoxin
arrhythmias
diarrhoea
skin reactions
Common ADRs of ACE inhibitors
cough
angioedema
hyperkalaemia
Common ADRs of furosemide
dizziness
electrolyte imbalance
muscle spasms
Common ADRs of spironolactone
electrolyte imbalance
malaise
skin reactions
Cautions of ACE inhibitors
pregnancy and breastfeeding - avoid
renovascular disease - may result in renal impairment
aortic stenosis - may result in hypotension
hereditary of idiopathic angioedema
potassium >= 5.0 mmol/L - seek specialist advice
Monitoring of ACE inhibitors
urea and electrolytes should be checked before treatment is initiated and after increasing the dose
(a rise in the creatinine and potassium may be expected after starting ACE inhibitors
acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l)
How to start allopurinol
Start 2 weeks after attack of gout has settled
Start on a low dose and titrate up every few weeks
Consider colchicine cover
ADRs of allopurinol
The most significant adverse effects are dermatological and patients should be warned to stop allopurinol immediately if they develop a rash
Allopurinol interactions
Azathioprine
Cyclophosphamide
Theophylline
First line in severe malaria
Artesunate
Follow-up therapy in severe malaria
Riamet
First line in non-severe plasmodium malaria
Riamet or malarone
Main treatment for non falciparum malaria
Quinines
Indication for rasburicase
Tumour lysis syndrome
Indication for colchicine
Gout / pseudogout
Treatment for pseudogout
Joint injection (corticosteroid and lidocaine) useful if symptoms limited to ≤2 joints. Medications (NSAIDS / colchicine) useful if multiple joints affected or joint injection not possible. Corticosteroids second line Recurrent episodes (≥3 annually) may require prolonged treatment with colchicine
Drugs to avoid in G6PD deficiency
- Quinines (for malaria)
- Nitrofurantoin (an abx)
- Quinolones (abx)
- Chloramphenicol (abx)
- Sulfonamides (abx)
Indications for mycophenolate mofetil
Organ transplants
Autoimmune conditions
What drug may be used to close a patent ductus arteriosus
Ibuprofen (reduces prostaglandin)
Symptoms of Meniere’s disease
vertigo, tinnitus, hearing loss and aural fullness
Indication for tolvaptan
PCKD
MOA of tolvaptan
ADH antagonist
What is Augmentin?
Brand name for co-amoxiclav (amoxicillin and clavulanic acid)
MOA of leflunomide
DMARD
What is co-trimoxazole?
sulfamethoxazole and trimethoprim
Common side effect of amlodipine
Ankle swelling
Drug to treat HSV / VZV
Aciclovir
Drug to treat Hep C / RSV
Ribavirin
Drug to treat influenza
Oseltamivir
Screening for osteoporosis in steroid use (who should be screened and how?)
Screen people under 40 on high-dose steroids or under 50 on lower or frequent steroid
DEXA scan
First line antibiotic in a pregnant woman with a UTI
Nitrofurantoin
Tests needed before starting amiodarone
CXR, U&Es, TFTs, LFTs
Monitoring amiodarone
LFTs and TFTs every 6 months
Gentamicin ADRs
Ototoxicity
Nephrotoxicity
Monitoring gentamicin
Peak and trough levels
MOA of ranolazine
Inhibits late inward sodium channels, which reduces calcium overload in cardiomyocytes
Indication for ranolazine
Second line in angina
Drug used in benzodiazepine overdose
Flumazenil
Drug used in amphetamine or cocaine overdose
Benzodiazepines
Drug used to manage opioid overdose
naloxone
MOA of naloxone
Opioid antagonist
Indication for disulfiram
Chronic alcohol use
What does disulfiram do?
Produces unpleasant effects when alcohol is consumed (decreasing desire to drink)
Reversal of warfarin
Vitamin K, prothrombin complex concentrate
Management of lithium overdose
Volume resuscitation
Dialysis if severe
Management of digoxin toxicity
Digoxin-specific antibody fragments
Second line meds in tonic clonic epilepsy
Levetiracetam, Clobazam and Topiramate
First line in focal epilepsy
Carbamazepine
Monitoring when starting clozapine
FBC weekly for 18 weeks (risk of agranulocytosis)
Drugs that can be used in hypercalcaemia
Bisphosphonates
Calcitonin
Length of action of bisphosphonates
Long term (weeks)
ADRs of baclofen
GI side-effects (constipation/diarrhoea), confusion, low mood, dry mouth, headache, paraesthesia or rarely bradyarrhythmias and hypothermia
Indication for baclofen
spasticity
Medication to consider stopping in gout
Thiazides
ADRs of sodium valproate
drug-induced liver injury, pancreatitis, agranulocytosis, severe cutaneous reactions, confusion, abnormal behaviour and increased suicide risk
Administration method of aminophylline
Loading dose followed by slow IV injection
Tests before starting biologics
Bloods and CXR to check it’s safe e.g. check there’s no latent TB
MOA of celecoxib
NSAID
Indication for densosomab
Osteoporosis, prevention of pathological fractures in patients with bony mets
Method of administration of densusomab
SC injection
Either every 6 months (for osteoporosis) or every 4 weeks (for bony mets)
First line in osteoporosis
Bisphosphonates e.g. alendronate
Side effects of bisphosphonates
GI disturbance
Oesophagitis
Headache
Osteonecrosis of the jaw
Patient advice for taking bisphosphonates
All patients should be advised to swallow tablets whole with plenty of water while sitting or standing, which should be done on an empty stomach at least 30 minutes before breakfast. They should then remain stood or sat upright for 30 minutes post dose.
First line in myasthenia gravis
Acetylcholinesterase inhibitors e.g. pyridostigmine
Meds that can precipitate worsening myasthenia gravis
Abx
Cardiac meds
Neuromuscular meds
Steroids
What drug is usually given with levodopa and why?
dopa decarboxylase inhibitor to prevent break down of levodopa
Alternative to levodopa in younger adults with parkinsons
Dopamine agonists
ADRs of older dopamine agonists
Fibrotic disease e.g. lung / kidney fibrosis
MOA of tamsulosin
alpha blocker
ADRs of tamsulosin
Postural hypotension
Ejaculatory dysfunction
MOA of finasteride
5-alpha reductase inhibitor (reduces DHEA, an androgen)
Indications for finasteride
BPH
ADRs of finasteride
Can result in reduced libido, erectile dysfunction and less commonly ejaculatory dysfunction
How long does finasteride take to work?
Up to 6 months
Length of treatment in a UTI
3 days in females
7 days in pregnancy, catheterised patients or males
Trade name of viagra
sildenafil
First line in erectile dysfunction
sidenafil
Contraindications for sildenafil
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (previous 6 months)
ADRs of sildenafil
visual disturbances nasal congestion flushing gastrointestinal side-effects headache
Drugs associated with agranulocytosis
antiepileptics e.g.g carbamazepine
antithyroid drugs e.g. carbimazole
antibiotics e.g. penicillin, chloramphenicol
antipsychotics e.g. clozapine
Drugs associated with anaemia
causing bleeding e.g. NSAIDs
myelosuppression e.g. cytotoxic drugs
inducing haemolysis e.g. methyldopa, high-dose penicillin
Monitoring of lithium
Serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter.
Indication for lithium
Mood stabiliser
Symptoms of lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma
MOA of pyridostigmine
Acetylcholinesterase inhibitor
ADRs of pyridostigmine
cholinergic side-effects including excess secretions, diarrhoea, GI upset, bronchospasm, sweating and urinary incontinence.
Indication for memantine
Moderate to severe alzheimers
Contraindication of statins
Acute liver failure or decompensated cirrhosis
Anticoagulant of choice in DVT
DOAC first line
If not suitable then LMWH
ADRs of isoniazid
Polyneuropathy
Hepatotoxic
ADRs of rifampicin
Pink secretions
Hepatotoxicity
ADRs of pyrazinamide
Gout
Hepatotoxicity
ADRs of ethambutol
Optic neuritis
Monitoring of TB meds
Baseline LFTs then routine LFT monitoring
What should be co-prescribed with isoniazid?
pyridoxine (reduce risk of neuropathy)
Second line to statins
Ezetimibe
MOA of ezetimibe
Reduces bile secretion to minimise fat absorption
MOA of ivabradine
Inhibits funny current to reduce heart rate
MOA of nicorandil
Calcium channel blocker
MOA of ransolazine
Sodium channel blocker
Medication following an MI
Beta-blocker
ACE inhibitor
Statin
Anti-platelet for a year
What is entresto?
a combination of sacubitril and valsartan which acts as a diuretic and ARB
Medication to treat prolactinoma
Cabergoline
MOA of cabergoline
Dopamine agonist
MOA of tolvaptan
ADH inhibitor
Medication to treat SIADH
tolvaptan
First line medication in hyperthyroidism
Carbimazole
Second line medication in hyperthyroidism
Propylthiouracil
Contraindication to carbimazole
First trimester
What allergies are contraindications to naseptin?
Peanut and soya
First line in Wilson’s disease
D-penicillamine
MOA of D-penicillamine
Copper chelating agent (increases excretion)
Contraindication of ramipril
Severe renal failure
Test prior to starting ramipril
U&Es
Monitoring of ramipril
U&Es 1-2 weeks after initiation or increasing dose (check for renal damage)
MOA of phenobarbital
Anti-convulsant
First line in most epilepsy
Sodium valroate
First line in focal epilepsy
Carbamazepine
Second line anti-epileptics
carbamazepine, lamotrigine, levetiracetam and phenytoin
MOA of carbamazepine
Anti-epileptic
MOA of phenytoin
Anti-epileptic
MOA of levetiracem
Anti-epileptic
MOA of lamotrigine
Anti-epileptic
What is in tazocin?
Penicillin and tazobactam
What is in co-amoxiclav?
Amoxicillin and cluvanic acid
Pre-eclampsia medication to avoid around birth
Methyl-dopa
Second line meds in pre-eclampsia
Nifedipine or methy-dopa
Indication for Hydroxycarbamide/Hydroxyurea
Sickle cell (various indications)
Medication for pre-eclampsia prophylaxis
Aspirin
What meds should be given prior to anticipated pre-term labour?
Steroids or magnesium sulphate (helps with lung maturation)
Abx used in bacterial vaginosis
Metronidazole
Abx used in siphilis
Single dose IM penicillin
Abx used in gonorrhoea
Single dose of IM ceftriaxone
First line in manic episode
Antipsychotic
Medication to reduce intraocular pressure
IV acetazolamide
Indications for denosumab
Osteoporosis
Hypercalcaemia of malignancy
Diuretic of choice in ascites
Aldosterone antagonist e.g. spironolactone
ADRs of sulphonamides
hyperkalaemia
headache
rash
MOA of bivalirudin
Anticoagulant
MOA of paclitaxel
Microtubule modifier
MOA of irinotecan
Topoisomerase inhibitor
MOA of cyclophosphamide
Alkylating agent / immunosuppressant
Monitoring of letrozole
Bone density monitoring before and during treatment
Serious ADR of tamoxifen
Endometrial cancer
MOA of flourouracil
Antimetabolite
MOA of imatinib
Tyrosine kinase inhibitor
Indication for imatinib
CML
Indication for trastuzumab
HER2 positive breast cancer
MOA of trastuzumab
Monoclonal antibody against HER2 receptor
MOA of sipuleucel-T
Dendritic cell therapy
Anti-epileptic safest in pregnancy
Lamotrigine
Route of administration of fentanyl
Patch / tablet / spray / lozenge
Indication for oxycodone (over morphine)
Renal failure
Hallucinations / itching with morphine
Adjustment of morphine dose for oxycodone
Halve morphine dose
Typical starting prescription for morphine
10mg oramorph PO 4 hourly (5 if frail or not previously on opioid)
10mg hourly PRN breakthrough doses
Conversion of morphine dose to sustained release morphine (MST / zomorph)
Total morphine in 24 hours divided by 2 = MST dose BD
What is MST?
Modified release morphine
What is zomorph?
Modified release morphine
Typical dose titration in morphine
Increase baseline and breakthrough dose by 30 - 50% (typically 10mg -> 15mg -> 20mg)
Conversion of oral morphine dose to SC dose
Halve oral morphine dose
Early signs of opioid toxicity
Sleepiness
Hallucinations
Myoclonic jerks
Confusion or mental clouding
Management if bony pain in oncology
Analgesic ladder
Radiotherapy typically very effective after a couple of weeks
Consider bisphosphonates or surgical fixation
Effect of metoclopramide on gastric emptying
Speeds up gastric emptying
MOA of donperidone
Anti-emetic
MOA of cyclizine
Histamine antagonist and anticholinergic (anti-emetic)
First line in “chemical” nausea
Haloperidol
First line in nausea due to raised ICP
Cyclizine (and dexamethasone to reduce ICP)
First line in vestibular nausea
Cyclizine
First line in cortical (anxiety) nausea
Lorazepam
First line in obstructed bowel nausea
Buscopan (reduce gut motility)
Haloperidol (anti-emetic)
First line in delayed gastric emptying nausea
metoclopramide
Indication for pirfenidone
Pulmonary fibrosis
Medications associated with hyopnatraemia
Diuretics, ACE inhibitors, amitriptyline, anti-psychotics, anti-epileptics, chemotherapy, PPIs
Medications associated with hypercalcaemia
Thiazides, lithium, vitamin D, vitamin A, calcium
Medications associated with hypokalaemia
Loop diuretics, thiazide diuretics, insulin, salbutamol
Medications associated with hyperkalamia
ACE inhibitors, ARBs, NSAIDs, aspirin, K+ sparing diuretics, beta blockers
Symptoms of serotonin syndrome
Neuromuscular excitation e.g. tremor / hypertonia
Autonomic symptoms e.g. sweating
Psychiatric symptoms e.g. agitation
Contraindications for COCP
Over 50 Migraine with aura Smoker over 30 Within 6 weeks of birth More than 1 risk factors for heart disease (e.g. HTN, smoking, diabetes, obesity) History of clots
MOA of amphotericin
Anti-fungal
ADRs of hyoscine butyl bromide
constipation, dry mouth, and urinary retention
MOA of hyoscine butyl bromide
Anti muscarinic
Indication for hyoscine butyl bromide
Abdominal cramping
MOA of prochlorperazine
Anti emetic
Route of administration of triptans in adults
Oral
Route of administration or triptans in under 18s
Nasal
MOA of pentoxifylline
Peripheral vasodilator
Indication for oral pentoxifylline
Venous ulcer
ADRs of azathioprine
bone marrow depression
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
What drug seriously interacts with azathioprine?
Allopurinol
Drug used in general anaesthesia
Propofol
First line in anti phospholipid syndrome
Heparin
What anticoagulant is used in pregnancy
Heparin
Indication for methylphenidate
ADHD
Medication co-prescribed with levodopa
Carbidopa
MOA of disodium pamidronate
Bisphosphonate
MOA of zolendronic acid
Bisphosphonate
Serious ADR of tamoxifen
Blood clots
Contraindications of benzodiazepines
Severe renal / liver failure
CNS / respiratory depression
Sleep apnoea
Indication for zopiclone
Short term insomnia
Contraindications of zopiclone
Severe renal / liver failure
CNS / respiratory depression
Sleep apnoea
Risks of rapid tranquilisation
- Over-sedation causing loss of consciousness
- Loss of airway
- Cardiovascular collapse:
- Arrhythmias / Hypotension / Sudden death
- Respiratory depression
- Acute dystonia
- Neuroleptic Malignant Syndrome
- Interaction with medication (prescribed or illicit including alcohol)
- Damage to the therapeutic relationship
- Underlying coincidental physical disorders
First line for rapid tranquilisation
IM lorazepam
Second line in rapid tranquilisation if no response
IM haloperidol / olanzapine
Second medication in rapid sedation if partial response
Repeat IM lorazepam
MOA of procyclidine
Anti cholinergic
Pain meds in palliative care
SC Morphine first line
SC Oxycodone second line
Anxiety medications in palliative care
SC midazolam
Nausea medications in palliative care
SC cyclizine
SC levomepromazine
SC haloperidol
Respiratory secretions medications in palliative care
SC glycopyrronium
SC hyoscine butyl bromide
Ibandronic acid MOA
Bisphosphonate
Prothrombin complex concentrate dosing
Based on INR and weight
Dalteparin MOA
Anticoagulant
Tinzaparin MOA
Anticoagulant
Monitoring of heparin
Potassium levels at least once per week
Platelets at least once per week
ADRs of heparin
Hyperkalaemia
Heparin induced thrombocytopenia
Bleeding
Management of anticoagulants prior to surgery
Discussion with haematology. Consider cover with a shorter acting anticoagulant
Management of insulin prior to surgery
Hold on morning of surgery and use sliding scale
Management of oral hypoglycaemics prior to surgery
Hold on day of surgery. Consider if sliding scale is necessary
Management of anti-platelets prior to surgery
Hold for 7 days prior to surgery
Management of diuretics prior to surgery
Hold on day of surgery
Management of ACEi / ARBs prior to surgery
Hold on day of surgery
MOA of teicoplanin
Glycopeptide antibiotic
MOA of vancomycin
Glycopeptide antibiotic
Mirtazepine MOA
Antidepressant
Indication for bromocriptine
Prolactinoma
Drugs affected by acetlyator status
isoniazid procainamide hydralazine dapsone sulfasalazine
MOA of Adalimumab
Anti-TNF antibody
Indication for adalimumab
Crohns
RA
MOA of etanercept
Anti-TNF
Indication of etanercept
Crohns
RA
MOA of bevacizumab
Anti VEGF antibody
Indications of bevacizumab
Colorectal cancer
Some renal cancer
Amiloride MOA
Potassium soaring diuretic
Bumetanide MOA
Loop diuretic
Misoprostol MOA
Prostaglandin analogue
Misoprostol ADRs
Diarrhoea
Abdo pain
Effect of progesterone only pill on mensturation
Can cause irregular bleeding
ADRs of mifepristone
Abdo pain
Diarrhoea
Tranexamic acid MOA
Anti fibrinolytic
At what level of HbA1c is metformin started?
56
What level of HbA1c with metformin indicates adding another drug
58
Criteria for starting GLP-1 mimetic
3 other drugs not controlling diabetes
BMI over 35
Or BMI under 35 and insulin would have occupational implications
Criteria for continuing a GLP-1 mimetic
HbA1c fall by at least 11 and 3% weight loss in 6 months
Indications for cytarabine
AML
Indication for hydroxycarbamide
Sickle cell
MOA of bleomycin
Antibiotic
MOA of doxorubicin
Antibiotic
ADRs of methotrexate
Myelosuppression, mucositis, liver and lung fibrosis
ADRs of cyclophosphamide
Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
ADRs of fluorouracil
Myelosuppression, mucositis, dermatitis
MOA of cytarabine
Anti metabolite
MOA of vincristine
Microtubule inhibitor
MOA of vinblastine
Microtubule inhibitor
MOA of docetaxel
Microtubule inhibitor
Azathioprine ADRs
Bone marrow depression
N&V
Pancreatitis
Non melanoma skin cancer
Enzyme to test before starting azathioprine
Thiopurinemethyltransferase test (TPMT) as deficiency in this enzyme increases risk of toxicity
Use of thiopental
Anaesthetic
Use of etomidate
Anaesthetic
First line in maturity onset diabetes of the young
Sulfonylurea
Sulfonylureas ADRs
Hypoglycaemia
Weight gain
Less commonly, hyponatraemia, myelosuppression, hepatotoxicity, neuropathy
ADRs of erythromycin
GI side effects
Cholestatic jaundice
Indication for stemetil
Vertigo / sickness
Indication of cholestryramine
Itch in patients with liver disease
MOA of felodipine
Calcium channel blocker
Indication of felodipine
HTN
Medication to treat iron overload in haemochromatosis
Desferrioxamine
MOA of desferrioxamine
Iron cheating agent
Medication used in Wilson’s disease
Trientine
MOA of trientine
Copper chelating agent
ADRs of metoclopromide
extrapyramidal effects: oculogyric crisis. This is particularly a problem in children and young adults
hyperprolactinaemia
tardive dyskinesia
parkinsonism
Contraindications of tetracyclines
Children under 12
Pregnancy women
(Due to risk of tooth discolouration)
ADRs of tetracyclines
discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue
Management of hepatotoxicity in patients being treated for TB
Stop all TB meds
Once LFTs have stabilised re-start meds with a reintroduction or alternate regime
Felodipine MOA
Calcium channel blocker
What is septrin?
Cotrimoxazole
Cisplatin MOA
Damages DNA
Propofol MOA
Potentiates GABA receptors
Propofol ADRs
Pain on injection
Hypotension
Why might bupivacaine be chosen over lidocaine?
Longer duration of action
What drug is often added to bupivacaine to improve the action
Diamorphine
What is xylocaine?
Combination of lidocaine and adrenaline
What type of anaesthetic is ketamine?
General
Cautions / contraindications for contrast
Asthma
Renal impairment
Metformin
Iodine allergy
MOA of carbocysteine
Mucolytic
MOA of pigvisomant
Growth hormone antagonist
MOA of bromocriptine
Dopamine agonist
ADR of chloramphenicol
Aplastic anaemia
MOA of solifenacin
Anticholinergic
MOA of tolterodine
Anticholinergic
MOA of oxybutynin
Anticholinergic
MOA of mirabegron
Beta agonist
Drugs associated with agranulocytosis
Antithyroid drugs - carbimazole, propylthiouracil
Antipsychotics - atypical antipsychotics (CLOZAPINE)
Antiepileptics - carbamazepine
Antibiotics - penicillin, chloramphenicol, co-trimoxazole
Antidepressant - mirtazapine
Cytotoxic drugs - methotrexate
MOA of dasatinib
Tyrosine kinase inhibitor
MOA of nilotinib
Tyrosine kinase inhibitor
MOA of bosutinib
Tyrosine kinase inhibitor
First line in ITP
Steroids
Common ADRs of hydroxyurea
Myelosuppression
Medications that interact with warfarin
Amiodarone
Many antibiotics and antiepileptics
Foods that can interact with warfarin
Green leafy veg
Fruit juices eg cranberry / grapefruit/ green tea
Management of major bleeding in patient on warfarin
ABCDE, stop warfarin, commence IV vitamin K and IV prothrombin complex concentrate
Management of INR >8 in patient with no bleeding or minor bleeding
Vitamin K. Stop warfarin, restart once INR < 5.0. The INR should be rechecked in 24 hours and if still high then repeat vitamin K
Management of INR 5-8 with no bleeding or minor bleeding
stop warfarin and recommence when INR < 5.0
ADRs of warfarin
Jaundice, hepatic necrosis, haemorrhage, hypersensitivity, rash, diarrhoea, and skin necrosis.
Contraindications of warfarin
Pregnancy, bacterial endocarditis, severe hypertension, peptic ulcer
What pain medication may be used in severe renal failure?
Alfentanil
ADRs of aromatase inhibitors
Joint aches
Bone thinning
ADRs of tamoxifen
Hot flushes Weight gain Fatigue Increased risk of VTE Increased risk of endometrial cancer
ADRs of trastuzumab
Cardiac toxicity
MOA and indication for strontium ranelate
Inhibitor bone resorption so used in oesteoporosis
MOA and indication for teriparatide
Synthetic PTH used in osteoporosis
Administration method of densusomab
SC injection every 6 months
Denosumab ADRs
Dyspnoea
Diarrhoea
Indication for olaparib
Some patients with BRCA mutations
MOA of methodone
Mu receptor agonist
MOA of naloxone
Mu receptor antagonist
MOA of flumazenil
GABA antagonist
MOA of memantine
NMDA antagonist
MOA of benzodiazepines
GABA agonist
First line drug option in urge incontinence
Oxybutynin
Medication option in stress incontinence
Duloxetine
Medication to add after ICS in childhood asthma
Montelukast
MOA of quetiapine
Antipsychotic
MOA of venlafaxine
Antidepressant
MOA of mirtazepine
Antidepressant
Effect of POP on periods
Lighter
Effect of IUS on periods
Lighter but may be irregular
ADRs of NSAIDs
Bronchospasm
Renal complications
Dyspepsia
Skin reactions
First line antibiotic in C.diff
Vancomycin (oral)
Antibiotic of choice for prophylaxis against group B strep in neonates of colonised mothers
Benzyl penicillin
MOA of exenatide
SC
Is warfarin safe in pregnancy?
No it’s teratogenic
Is LMWH safe in pregnancy and breastfeeding?
Yes but caution if the mother may go into Labour (as it’s difficult to reverse)
Drugs used in medical miscarriage
Mifepristone and misoprostol
Medication for pre eclampsia prophylaxis
Aspirin
Drugs to avoid in pregnancy
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
Ipratropium length of action
Short acting
Length of action of tiotropium
Long
First line in uterine hyperstimulation
Terbutaline
First line to delay delivery in preterm labour
Nifedipine
Monitoring of methylphenidate
Growth
Pulse and BP
Next step in management of COPD with symptoms on salbutamol and no asthmatic features
Add LAMA and LABA
First line in DVT
DOAC
What medication is contraindicated in gout?
Thizides
Treatment of scabies in close contacts
2 doses permethrin a week apart
Can ACE inhibitors be used in pregnancy?
No
Can ACE inhibitors be used in breastfeeding?
No
Can statins be taken in pregnancy?
No
Drug that interacts with statins
Clarithromycin / erythromycin
Indication for statin
Established cardiovascular disease
QRISK2 score indicates over 10% risk of CVD in the next 10 years
T1DM diagnosed over 10 years ago
What time of day to take statins
Night
Indication for isotretinoin
Severe acne
Drugs to stop in AKI
ACE inhibitors ARBs NSAIDs Diuretics Aminoglycosides Lithium Metformin
First line pharmacological cardioversion in AF
Amiodarone
Antidepressants contraindicated in patients on alteplase
SSRIs or SNRIs
ADRS of SSRIs
GI upset Prolonged QT Sexual dysfunction Insomnia Headache
Test before starting SSRIs
ECG to look for long QT
ADRs of SNRIs
GI upset Sexual dysfunction Insomnia Headache HTN
What patients typically benefit from mirtazapine as an antidepressant?
Patients with sleep problems or poor appetite
ADRs of mirtazapine
Increased appetite and weight gain
Sedative
Sexual dysfunction
Indication for procyclidine
ADRs from antipsychotics (e.g. oligouric crisis)
First line in hypomania
Quetiapine
first line mood stabiliser
Lithium
Second line mood stabiliser
Sodium valproate
What does disulfiram do?
Causes vomiting with alcohol to act as a deterrent
Treatment of local anaesthetic reaction
Lipid emulsion
Contraception options in woman after childbirth
POP, IUD, IUS
Drug that may be used alongside insulin in T1DM
Dapagliflozin
How long for POP to be effective?
48 hours
What is filgrastim?
A granulocyte-colony stimulating factor used in neutropaenia
What anaesthetic is good in haemodynamically unstable patients?
Ketamine
Dose of adrenaline in cardiac arrest
1mg
EPO ADRs
Bone ache, skin rash, flu-like symptoms
Adenosine ADRs
Chest pain
Bronchospasm
Flushing
First line in patients with angina and heart failure
Atenolol
What shouldn’t be prescribed with verapamil?
Beta blocker
What drug should be held for 48 hours prior to contrast
Metformin
Which beta blocker is used first line in thyrotoxicosis prophylaxis?
Propanolol
Medication that may be used in stress incontinence
Duloxetine
Levodopa ADRs
N&V, hypotension, sleep disturbance, confusion, hallucinations, delusions, dyskinesias, dystonia, tolerence
What is co-careldopa?
Levodopa and carbidopa
What is co-beneldopa?
Levodopa and benserazide
What class of drugs are often second line in Parkinsons
Dopamine agonists
What routes can dopamine agonists be administered via?
Oral, patch, injections
ADRs of dopamine agoinsts
nausea, constipation, hypotension, headache, dyskinesias, sudden sleep, hallucinations, impulse control disorders
Pamiprexole MOA
Dopamine agonist
Ropinerole MOA
Dopamine agonist
Rotigotine MOA
Dopamine agonist
Apomorphine MOA
Dopamine agonist
Interactions of monoamine oxidase B inhibitors
Antidepressants, decongestants
ADRs of MAO-B inhibitors
GI disturbance, hypotension, urinary frequency, mood changes
MOA of rasagiline
MOA-B inhibitor
MOA of selegiline
MOA-B inhibitor
MOA of safinamind
MOA-B inhibitor
MOA of entacapone
COM-T inhibitor (potentiates levodopa)
MOA of opicapone
COM-T inhibitor (potentiates levodopa)
MOA of tolcapone
COM-T inhibitor (potentiates levodopa)
What medication is COM-T inhibitors taken with?
Levodopa
How long after pregnancy before starting COCP
21 days
First line in acute pericarditis
NSAID and colchicine
Management of thyroxine in pregnancy
Increase dose (typically by up to 50% in first 4-6 weeks
Which areas should emollients be applied to?
Whole skin
ADRs of topical steroids
Skin thinning / striae
Topical immunomudulators
Tacrolimus / pimecrilimus
Topical treatments in mild acne (commedones)
Benzoyl peroxide, retinoin, abx
When to use oral abx in acne
Papules / pustules not cleared with topical therapy
Isotretinoin indication
Severe acne
ADR of isotretinoin
Teratogenic, dry lips
Indication for cyproterone acetate
Seborrhoea in women with acne
Topical treatments considered in psoriasis
Emollients, Salicylic acid (helps other treatments), steroids, tar preparations, dithranol (specialist), vitamin D/A
Who should be treated with permethrin?
All household contacts
How to apply treatment for scabies / lice
Two courses a week apart
First line in delirium
Haloperidol
First line in delirium for patients with Parkinsons
Lorazepam
Tests before IV acyclovir
renal function
Donepezil MOA
Acetylcholine esterase inhibitor
Rivastigmine MOA
Acetylcholine esterase inhibitor
Galantamine MOA
Acetylcholine esterase inhibitor
ADRs of Acetylcholine esterase inhibitors
GI upset
Cautions for Acetylcholine esterase inhibitors
Asthma / COPD, some arrhythmias or conduction disorders
Memantine ADRs
Dizziness, balance issues, headache, drowsiness
What shouldn’t be co-prescribed with verapamil?
Beta blocker
Anticoagulation after ablation of AF
Continue as per CHADsVASc
Vancomycin moniotring
Trough levels and renal function
What should be given with co-trimoxazole?
Anti-emetic
Co-trimoxazole ADRs
N&V, rash, bone marrow suppression, hepatotoxicity, hypoglycaemia
Co-trimoxazole monitoring
FBC, U&Es, LFTs
Digoxin toxicity symptoms
Nausea, vomiting, diarrhoea, hallucination, visual disturbance, drowsiness
Dose conversion codeine to morphine
Divide by 10
Tamsulosin ADRs
dizziness, postural hypotension, dry mouth, depression
Finasteride ADRs
Erectile dysfunction and ejaculation problems, reduced libido, gynaecomastia
Budesonide MOA
ICS
Dantrolene indication
Neuroleptic malignant syndrome
Phenytoin monitoring
Trough levels if dose change or concern of toxicity
Paroxetine MOA
SSRI
Venlafaxine MOA
SNRI
Clomipramine MOA
TCA
Clomipramine indication
OCD
Monitoring of statins
LFTs at baseline, 3 months and 12 months
Which antibiotic shouldn’t be mixed with alcohol?
Metronidazole
Glimepiride MOA
Sulfonylurea
Methylphenidate monitoring
Height and weight
Methylphenidate key ADR
Growth restriction
Important ADR of hydroxychloroqiune
Retinopathy
Chlorpromazine MOA
Antipsychotic
Mesalazine ADRs
GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis
Which antipsychotic is less likely to cause weight gain?
Aripiprazole
When to stop antidepressants
6 months after symptoms resolved
Carbamazepine ADRs
rash, dizziness, hyponatremia, hair thinning. Also inhibits COCP.
Lamotrigine ADRs
rash, flu-like symptoms and destruction/ulcers in mucous membranes (Stevens-Johnson syndrome)
Gabapentin ADRs
drowsiness, abnormal eye movements, GI upset, dry mouth
Valproate ADRs
tremor, weight gain and hair thinning, teratogenic
Phenytoin ADRs
Gum hypertrophy and hirsutism, coarse face and acne. Also inhibits COCP
Antibiotic associated with tendon rupture
Ciprofloxacin
What medications to avoid with SSRI (as increases risk of serotonin syndrome)
Triptans
Orlistat MOA
Lipase inhibitor
Severe C diff treatment
Oral vancomycin and IV metronidazole
Strontium ranelate indication
Osteoporosis
Strontium ranelate MOA
Inhibits osteoclasts
Phenoxybenzamine MOA
Alpha blocker
Colchicine ADRs
GI side effects
Allopurinol ADRs
Rash
What drug is antabuse?
Disulfiram
Acamprosate indication
Reduces alcohol cravings
What can be used as alternative to methadone?
Buprenorphine
RA medication in pregnancy
Hydroxychloroquine
Drugs to improve prognosis in MND
Riluzole, Edaravone
Management of HRT prior to surgery
Stop 4 weeks prior to elective surgery to reduce risk of VTE
Nifedipine MOA
Calcium channel blocker
Medication to avoid in chickenpox
NSAIDs
Solifenacin MOA
Anticholinergic
Treatment of DVT in pregnancy
Enoxaparin
What type of heparin does LMWH reverse?
Unfractionated
Pyrazinamide ADRs
Gout, arthropathy, hepatotoxicity
Medication to consider in warts
Topical salicylic acid
Bupropion indication
Smoking cessation
Second line mood stabiliser
Sodium valproate