PSA drugs Flashcards
1
Q
Electrolyte giving per day?
A
1 salty + 2 sweet / day -1 0.9% saline bag -2 5% dextrose bag
2
Q
What are the common adverse effects of metronidazole?
A
GI upset (N&V), hypersensitivity, neurological (peripheral, optic neuropathy, seizures, encephalopathy)
3
Q
Causes of raised urea?
A
kidney damage, GI bleed, big bloody steak
4
Q
SGLT-2 inhibitors (gliflozins) MOA?
A
inhibits reabsorption of glucose in the kidney
5
Q
Generally, how much fluids do adults require in 24hrs?
A
adults-3L/day elderly- 2L/day
6
Q
What are caution when giving gliclazide?
A
reduce dose in hepatic/ renal impairment; ppl at risk of hypoglycaemia (hepatic impairment, elderly, adrenal or pituitary insufficiency, malnutrition)
7
Q
What are important interactions of insulin?
A
other hypoglycaemics, systemic corticosteroids increases insulin requirements
8
Q
How is metformin monitored?
A
HbA1c every 3 mths, renal function annually
9
Q
How much potassium does a person with normal potassium level require per day?
A
40mmol KCI/day -put 20mmol of KCL in two bags *IV potassium should not be given at more than 10 mmolhr
10
Q
What are the indications of aldosterone?
A
ascites and oedema due to liver cirrhosis, CHF, 1’ hyperaldosteronism
11
Q
What is the MOA of metronidazole?
A
bactericidal by reducing synthesis of DNA by binding to it and causing widespread damage
ONLY in anaerobic bacteria and protozoa
12
Q
What important interactions in loop diuretics?
A
medication renally excreted: lithium, digoxin, aminoglycosides [increased risk of ototoxic and nephrotoxic]
13
Q
Monitoring in phenytoin?
A
plasma concentrations immediately before next dose and then 7 days after
14
Q
How to prescribe erythromycin?
A
250-500mg/ 6hrly
short shelf life
15
Q
MOA of phenytoin?
A
decrease excitability of neurones by inhibiting Na+ influx
16
Q
How much fluid is lost if reduced urine output + tachycardic?
A
1L fluid loss
17
Q
Drugs that cause cholestasis?
A
fluclox, coamox, nitrofurantoin, steroids, sulphonylureas
18
Q
Efficacy of loop diuretics?
A
symptoms improvement; long term monitor symptoms, signs and weight (1kg/day lost)
19
Q
What is MOA of amiodarone?
A
block sodium, calcium and potassium channels and antagonist of a & b adrenergic receptiors=> slow rate, increase resistance to depolorisation (stop spontaneous depolorisation)
20
Q
What caution should you take when prescribing cephalosporins and carbapenems?
A
- people ar risk of C. difficile (admitted and elderly)
- epileptics
- renal impairment (lower dose)
21
Q
What caution to take when prescribing macrolides?
A
CI: hypersensitivity
Reduce dose: renal or hepatic impairment
22
Q
Name the B-blockers and their most common use?
A
bisoprolol: HTN, angina, HF
atenolol
propanolol: migraine prophylaxis, anixety, angina
metroprolol
sotalol: SVT
23
Q
Replacement fluid what to give shocked fro bleeding?
A
Blood transfusion if not blood give colloid
24
Q
Warnings in giving b-blockers?
A
DO NOT GIVE in asthmatics and heart block; careful in HF, haemodynamic instability, hepatic failure
25
What are some possible interactions with ACEi?
do not give with potassium elevating drugs (eg. spironolactone) causes severe hypotension; NSAID and ACEi increases risk of nephrotoxicity
26
What are some caution you have to take when prescribing ACEi?
DO NOT GIVE in renal artery stenosis (rely on efferent vasoconstriction for filtration), AKI
careful when: pregnant, breastfeeding, CKD
27
How do you prescribe cephalosporins?
- rate 6-12hrly
- route: cephalo: oral, IV, IM, infusion, bolus
carbapenem: IV, infusion
- dose: cefo 2g IV/ 6hrly
carba 1-2mg IV 8hrly
28
What drugs to give for nausea?
Cyclizine 50mg 8-hrly IM/IV/oral - SE: fluid retention Metoclopramide 10mg 8-hrly IM/IV/if HF \*nauseated- regular antiemetic not nauseated- as required
29
What are important interactions in macrolides?
- CP450 inhibitors: clarithromycin, erythromycin
- warfarin, statins
- QT prolonging meds: amiodarone, antipsychotics, quinine, quinolone, SSRI
30
What are the important adverse effects of cephalosporins and carbapenems?
GI upset, abx associated colitis, hypersensitivity (immediate and delayed reactions)
-neurological toxicity (seizures)
31
What is the MOA of cephalosporins and carbapenems?
bactericidal due to B-lactam ring that inhibits cross-linking of peptidoglycans of cell wall causing swelling, lysis and death
32
How should you prescribe aminoglycosides?
intermittnet **IV infusion**/ Once daily
- particularly paying attention to patient age and renal function before prescription
- renal normal: every 24hrs
- renal abnormal: 36-48 hrs
- duration: once-7days
33
What are the different types of diabetes drugs?
6: metformin, sulphonylureas, gliptins, glitazones, SGLUT-2 inhibitor, GLP-1 agonist, thiazolidinediones
34
What are the uses for macrolides?
- rx of resp, skin, soft tissue infections as an alt. to penicillin when CI (eg. allergy)
- severe pneumonia as addition to penicillin to cover atypical (legionella, mycoplasma pneumoniae)
- eradication of helicobacter pylori (conjunction with PPI + metronidazole/ amoxicillin
35
Replacement fluid how much and how fast in tachycardic or hypotensive patient?
500ml bolus -250ml if HF
36
What are the SE of NSAIDs?
No urine (renal failure) systolic dysfunction asthma indigestion dyscrasia (abnormal blood clotting)
37
What are adverse effects of CBB?
vascular: ankle oedema, flushing, headache, palpitations; cardiac: bradycardia, heart block, HF; constipation
38
What is the MOA of macrolides?
bacterialstatic: inhibit protein synthesis via 50s subunit
39
What is the adverse effects of atropine?
tacycardia, dry mouth and constipation, urinary retention, blurred vision, drowsiness, and confusion
40
What is the adverse effects of GLP-1 agonist?
GI(N&V, vomiting, diarrhoea, constipation), pancreatitis, AV block,**weightloss**
41
What are the adverse effects of amiodarone?
hypotension, pneumonitis, bradycardia, AV block, hepatitis, photosensitivity, grey discoloration, thyroid abnormalities, long time for elimination even after drug is stopped (long half-life)
42
How much fluid is lost if reduced urine output + tachycardia+ shocked?
2L of fluid loss
43
What are the indication for aminoglycosides?
Rx of severe infection, particularly gram -ve aerobes + pseudomonas aeruginosa:
1. severe sepsis (even in unknown source)
2. pyelonephritis and complicated UTI
3. Biliary and other intrabdominal sepsis
4. Endocarditis
5. Bacterial skin, eye or external ear infections
44
What are common adverse effects of chloramphenicol?
Topical: stinging, burning, itching
Systemic: (rarely given) bone marrow suppression, aplastic anaemia
- Grey baby syndrome
- optic and peripheral neuritis (prolonged use)
45
When is flecainide CI?
post myocardial infarction
structural heart disease: e.g. heart failure
sinus node dysfunction; second-degree or greater AV block
atrial flutter
46
When to avoid metoclopramide?
PD patients- dopamine antagonist Young women due to risk of dyskinesia
47
How is amiodarone give?
can be IV bolus injection via cannulae; best via central line due to risk of phlebitis
48
What to assess to determine amount and rate of fluids?
HR, urine output, BP
49
PReSCRIBER for pitfalls and traps in PSA
Patient details REaction Sign the front of the chart check for Contraindications to each drug check Route for each drug prescribe Intravenous fluids if needed prescribe Blood clot prophylaxis if needed prescribe antiEmetic if needed prescribe pain Relief if needed
50
Enzyme Inducers
PC BRAS: Phenytoin Carbamezapine Barbituate Rifampacin Alcohol (chronic excess) Sulphonylureas
51
What is the adverse effect of insulin?
hypoglycemia; lipohypertrophy in SC site, weight gain
52
What is the adverse effects of flecainide?
negatively inotropic (decreases contraction force)
bradycardia
proarrhythmic
oral paraesthesia
visual disturbances
53
What is the spectrum of metronidazole?
anaerobes and protozoa
54
What is the MOA of chloramphenicol?
bacterial static
55
What is the treatment regime for H. Pylori?
Triple therapy:
1. PPI+ amoxicillin+ clari/metro
2. can repeat 1st line second time
3. PPI+ amoxicillin+ tetra or levofloxacin
56
How do you monitor efficacy of macrolides?
resolution of symptoms: pt report, examination, bloods (CRP, WBC)
57
What is the adverse effects of SGLT-2 inhibitors?
UTI, constipation, hypo, RARE: fournier's gangrene, **weightloss**
58
What is the MOA of aminoglycosides?
bind **irreversibly** to bacterial ribosome (30s subunit) and inhibit protein synthesis
- oxygen dependent (aerobic)
- therefore logically streptococci and anaerobic bacteria are resistant
59
What are the indications of digoxin?
AF, Atrial flutter, severe HF
60
How to prescribe clarithromycin?
250-500mg/ 12hrly
61
Advice to pt with b-blockers?
SE: dizziness, impotence; warn HF pt about risk of initial deterioration and safety net, COPD pts safety net
62
What are adverse effects of b-blockers?
GI disturbance, fatigue, cold extremities, headache, impotence, sleep disturbance, nightmares, **bradycardia**
63
What are some caution to take when prescribing chloramphenicol?
CI: hypersensitivity reactions
bone marrow disorders
third trimester of pregnancy
neonates
breastfeeding
Reduce dose: hepatic impairment
64
Causes of neutrophilia?
bacterial infection, tissue damage (inflammation/infarct/malignancy), steroids
65
How do you monitor for chloramphenicol?
FBC--\> watching out for myelosuppression
66
When to give CCB?
HTN, stable angina, SV arrythmias rate control
67
What are important interactions with amiodarone?
Many, most notably increase risk of brady, AV block, HF if given with digoxin, diltiazem and verapamil
68
How much insulin is given in DKA?
Actrapid 50 units in 0.9% sodium chloride 50mL; rate: 6units/hr
69
Advice when taking ACEi?
take it sitting down or first does before bed, dizziness, dry cough, do not take with NSAIDs, need blood test monitoring, possible allergic reactions
70
What are the adverse effects of aminoglycosides?
nephrotoxicity (tubular toxic), ototoxicity (cochlear and vestibular hair cells)
- nephro can be reversible
- oto may not be due to late findings
71
What advice to give pt taking amiodarone?
- explain high risks of adverse effects
- aware of weightloss, jaundice, SOB, minimise exposure to sunlight, thyroid symptoms
72
What is the MOA of ACEi?
inhibits Ang1 --\> 2 conversion; decreases peripheral resistance, dilates efferent arteriole of glomeruli, decrease aldosterone causing hyperkalaemia, promotes water and sodium excretion.
73
What is the MOA of flecainide?
potent sodium channel blocker=\> causes QRS complex broadening and PR prolongation
74
How to prescribe azithromycin?
230-500mg/daily
75
GLP-1 agonist MOA?
incretin mimetic which inhibits glucagon secretion
76
How do you monitor and prevent adverse reaction of aminoglycosides?
- drug level monitoring with plasma drug concentration after 18-24hrs of first dose
- renal function before and after dose
\*however, can be given before results if pt \<65 and normal renal function
77
78
What are caution when giving digoxin?
DO NO GIVE: 2nd degree heart block, intermittent complete heart block, ventricular arrythmias; caution: **hypokalemia**, hypomagnesaemia, hypercalcaemia
79
MOA of sulfonylureas?
stimulate pancreas beta cells to secrete insulin
80
What is the MOA of digoxin?
-ve chronotropic (decrease HR), +ve ionotropic (increase contractility)
81
What are the cautions for antimuscarinics?
angle closure glaucoma, arrythmias
82
Indications of flecainide?
AF, SVT with accessory pathway (WPW)
83
List common macrolides
clarithromycin, erythromycin, azithromycin
84
What are important interactions of metronidazole?
is a mild CYP450 inhibitor so don't use with warfarin/ phenytoin;
do not use with CYP450 inducers or lithium
85
What is the spectrum of activity of cephalosporins?
broad spectrum abx, type of b-lactam (higher resistance to b-lactamases)
-rx against gram -ve/+ve and pseudomonas
86
Indications of phenytoin?
status epilepticus, epilepsy
87
How much fluid is lost if reduced urine output? (oliguric \<30mL/hr, anuric 0mL)
500mL fluid loss
88
Replacement fluid what to give shocked with systolic BP \<90?
Gelofusine (colloid) -high osmotic content keeps fluid intravascularly, maintains BP for longer
89
What caution should you take when prescribing aminoglycosides?
renal excretion therefore neonates, elderly and renal impairment pt
-do not give to myasthenia gravis pt as can impair neuromuscular transmission
90
How do you monitor efficacy of aminoglycosides?
symptoms and signs (eg. pyrexia) and blood inflammatory markers (C-reactive protein)
91
Drugs that cause cholestasis?
paracetamol overdose, statins, rifampicin
92
What are the adverse effects of aldosterone?
**hyperkalemia** (muscle weakness, arrhythmias, cardiac arrest), gynaecomastia, liver impairment and jaundice, Steven-Johnson syndrome
93
Replacement fluid what to give pt with ascites?
Human-albumin solution (HAS) -albumin maintains oncotic pressure -high sodium content (0.9% saline) will worsen ascites
94
What are caution when giving amiodarone?
risk-benefit is justified due to serious SE, avoided in severe hypotension, heart block, thyroid disease
95
Safety of loop diuretics?
U&E (renal function, sodium and potassium) for first few weeks
96
How do you monitor amiodarone?
short: cardiac monitoring, heart rate and rhythym
long: FBC, LFT, thyroid function, U&E, CXR
97
How do you measure efficacy of ACEi?
symptoms improvement--\> SOB (HF), BP (HTN)
98
Causes of hypokalamia?
DIRE: diuretics, inadequate intake or intestinal loss, renal tubular acidosis, endocrine (Cushings, conn's)
99
Advice of DM patients for sick days?
monitor bloods more frequently, drink lots of water, drink sugary drinks if cannot eat solids, have a phone with you in case of emergency (DKA); DO NOT STOP taking meds even if you aren't eating much
100
Advice when giving thiazides?
take in morning for max effects, impotence, careful with NSAIDs, **ask about mobility [cuz will make them pee a lot])**
101
Enzyme Inhibitor
AODEVICES: Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (actue intoxication) Sulphoamides
102
Interactions in B-blockers?
DO NOT GIVE WITH non-dihyropyridine CCB (verapamil, diltiazem)
103
Glucose management in acute illness?
may need to change to insulin while impatient as shorter half-life and easy to adjust dose
104
When do you not prescribe drugs that increase bleeding (aspirin, heparin, warfarin) ?
active bleeding, suspected bleeding, risk of bleeding
105
What are the adverse effects of metformin?
GI upset (N&V, diarrhoea, anorexia, taste disturbance), lactic acidosis
106
What advice given when giving aldosterone?
gynaecomastia, impotence
107
What are interactions of aldosterone?
other potassium elevating drugs (ACEi, ARB); potassium supplements
108
Caution when giving CCB?
amlodipine, nifedipine: DO NOT GIVE in severe aortic stenosis, unstable angina; verapamil, diltiazem: caution in poor LV function, AVN delay
109
Name CCB?
amlodipine, nifedipine, diltiazem, verapamil (rate limiting; cardioselective)
110
Important interactions of digoxin?
loop and thiazide diuretics increase toxicity=\> hypokalameia; amiodarone, CCB, spironolactone and quinine increase concentration=\> toxicity
111
DPP-4 inhibitors (gliptins) MOA?
increases incretin levels which inhibit glucagon secretion
112
What should you ask patients who are prescribed aminoglycosides daily?
Any changes in hearing, ringing in the ears, dizziness
113
How do you monitor ACEi?
blood tests (U&E): 1-2wks initally
114
How is insulin given?
SC injection; units
115
What are cation you have to take when prescribing metronidazole?
metabolised by CYP450
reduce dose: liver disease
**DO NOT** take with alcohol as cause disulfiram-like reaction (flushing, headache, nausea, vomiting)
116
What is the MOA of insulin?
glucose uptake into cells, stimulate glycogen, lipids and protein synthesis, inhibits gluconeogenesis and ketogenesis; drive K+ into cells temporarily in hyperkalemia while other treatment is started.
117
What are the indication for metronidazole?
- abx associated colitis (c. dif)
- oral infection or aspiration pneumonia (gram -ve anaerobes)
- surgical or gynae infections (gram-ve anaerobes)
- protozoal infections: trichomonas vaginalis, amoeba, giardiasis
118
How much insulin is given rx of hyperkalaemia?
given as dextrose/insulin infusion: 50mL of 50% dextrose w/ 10 units of soluble human insulin over 15min
119
What are the common aminoglycosides?
gentamicin, amikacin, neomycin
120
What are the common adverse effects of ACEi?
dry cough, **hypotension** (initially), **hyperkalaemia,** may cause or worsen renal failure, angioedema, anapyhlactoid reactions
121
What are important interactions of aminoglycosides?
- higher risk of ototoxicity if prescribed with loop diuretics or vancomycin
- higher risk of nephrotoxicity if prescribed with ciclosporin, chemo, cephalosporins, or vancomycin
122
What are the adverse effects of sulphonylureas?
GI (diarrhoea, nausea, abdo px), weight gain, **hypoglycaemia**, hyponatremia; rare hypersensitivty (hepatic toxicity, drug hypersensitivity syndrome, haem [agranulocytosis])
123
What is chloramphenicol used for?
- bacterial conjunctivitis (drops/ointment)
- otitis externa (drops)
124
What are the MOA of aldosterone?
competitive inhibitor of aldosterone receptor in renal distal tubule; ENaC
125
Interactions with phenytoin?
warfarin, osterogens and progestogens, CP450 inhibitors (amiodarone, diltiazem and fluconazole; drugs lower seizure threshold (SSRI, TCA, antipsychotics, tramadol)
126
How do you prescribe chloramphenicol?
**topical use**
eye drops: 0.5% 1drop/2hrly--\> 3-4 times/day
eye ointment: 1% 3-4 times/daily
continue for 48hrs after healing
otitis externa: 5-10%, 3-4 drops/ 2-3times/day
one week
127
Causes of raised ALP?
ALKPHOS: Any fracture, Liver damage (posthepatic), Kancer, Paget's disease of bone and pregnancy, Hyperparathyroidism, Osteomalacia, Surgery
128
What are the indications of insulin use?
DMI, DMII, DKA, HHS, perioperative (sometimes), hyperkalaemia rx with glucose
129
What routes are there for giving macrolides?
oral
IV: dilute in large volume
eg. 500mg in 250mL 0.9% NaCI- over 1 hr
**DO NOT give as bolus IV or IM** (risk of arrythmias)
\*but always try to aim to switch to oral ASAP
130
When do you not give compression stocking as VTE prophylaxis?
peripheral arterial disease- absent foot pulses as can cause acute limb ischaemia
131
Name thiazide diuretics and their use?
bendroflumethiazide, indapamide, chlortalidone; HTN
132
Drugs with narrow therapeutic index?
digoxin, theophylline, lithium, phenytoin, gentamicin, vancomycin
133
Adverse effects of loop diuretics?
dehydration, hypotension, low electrolyte state [hyponatraemia, hypokalemia, hypocalcemia, hypochloremia, hypomagnaesaema and metabolic acidosis], hearing loss and tinnitus
134
Causes of hypernatremia?
dehydration, drips, sodium content tablets, DI
135
What are the different types of insulin?
rapid acting (NovoRapid), short acting (Actrapid), intermediate acting (Humulin I), long acting (Lantus, Levemir), biphasic insulin (rapid + intermediate mix) (NovoMix); IV soluble insulin (Actrapid) used
136
CI for antimuscarinics?
DO NOT GIVE with TCA
137
What are common adverse effects of macrolides?
irritant (oral): nausea, vomiting, abdo px, diarrhoea
IV: thrombophlebitis
- allergy
- abx associated colitis
- deranged LFTs: cholestatic jaundice, prolonged QT interval, ototoxicity
138
What is the adverse effects of digoxin?
bradycardia, GI disturbance, rash, dizziness, visual disturbance, toxicity (low therapeutic index) causing arrhythmias
139
Medications you should not give if pt has asthma?
B-blockers, NSAIDs, contrast
140
Caution in administering insulin?
renal impairment--\> reduced clearance, increased risk of hypoglycaemia
141
What are caution in phenytoin?
decrease dose in liver disease, low-therapeutic index, caution in pregnancy
142
What are the SE of steroids?
STEROIDS: stomach ulcers thin skin oedema right and left heart failure osteoporosis infection (including candida) diabetes (hyperglycaemia--\>diabetes) Cushings syndrome
143
Replacement fluid what to give in hypernatremic/hypoglycaemic pt?
5% dextrose
144
Prescribing amiodarone as FY1?
always consult senior with dose, continuation
145
What are the indications for antimuscarinics CVS and GI (atropine, hyosine butylbromide, glycopyrronium)?
symptomatic bradycardia, anterior uveitis, cycloplegia, IBS, copious resp. secretions
146
Adverse effects of phenytoin?
PHENYTOIN: P450 interactions, Hirtuism, Enlarged gums, Nystagmus, yellow-brown skin, Teratogenicity, Osteomalacia, Interference with B12 (anemia), Neuropathies: ataxia, vertigo, headache; antiepileptic hypersensitivity syndrome, respiratory depression, CVS collapse
147
Types of diuretics?
loop, thiazide, thiazide-like
148
What are adverse effects of pioglitazone?
bone fracture, weight increase, increase risk of infection, visual impairment, fluid retention
149
Causes of hyperkalemia?
DREAD: potassium sparing diuretics and ACEi, Renal failure, Endocrine (Addison's), Artefact (very common due to clotted sample), DKA
150
What are important interactions of metformin?
other hypodrugs (metformin, DPP-4, thiazolidinediones, insulin, alcohol); b-blockers, efficacy reduced and increased glucose by prednisolone, thiazide, loop diuretics
151
What is the spectrum of activity of aminoglycosides?
main action against **gram -ve** aerobic bacteria
are inactive against streptococci and anaerobes so should be combined with penicillin and metronidazole when unknown organism
152
Some changes in ECG for digoxin?
reverse tick: ST depression
-NORMAL
153
What are some caution in prescribing metformin?
do not give in AKI, severe tissue hypoxia (MI, sepsis, resp), acute alochol intoxication; caution in renal/hepatic impairment, chronic alcohol use
154
What are adverse effects of thiazides?
hyponatraemia, hypokalemia =\> arrythmias, impotence
155
What is the spectrum of macrolides?
broad spectrum: gram+ve/-ve, haem. influenzae
156
What are the uses of ACEi?
HTN, CHF, IHD, DM nephropathy, CKD w/proteinuria
157
How do you monitor for efficacy of cephalosporins and carbapenems?
-symptoms relief and bloods ( ↓ CRP, WBC)
158
159
What is the MOA of atropine?
antimuscarinic, anticholinergic: increase heart rate, conduction, reduce muscle tone and peristaltic contraction, reduce secretions
160
What is the MOA of loop diuretics?
inhibition of Na+/K+/Cl- co-transporter==\> diuretic, K+ loss, Ca2+ loss, dilatation of capacitance veins
161
What caution to take in loop diuretics?
DO NOT GIVE in hypovolemia, dehydration; caution in hypokalamia, hyponatremia, gout (due to uric acid accumulation)
162
What are important interactions of CCB?
verapamil, diltiazem: do not give with b-blockers=\> HF, brady, asystole
163
What is the MOA of thiazolidnediones (pioglitazone)?
activate PPAR-gamma receptor in adipocytes to promote adipogenesis and FFA uptake
164
What drugs should you stop before surgery?
I LACK OP: Insulin (variable) - sliding scale Lithium (day before) Anticoagulants/antiplatelets (varies) COCP/HRT (4wks before) K-sparing diuretics (day of surgery) Oral hypoglycaemics Perindopril & other ACE inhibitors
165
What important interactions of cephalosporins and carbapenems?
- enhance warfarin effect
- increase risk of nephrotoxic of aminoglycosides (cephalo)
- reduce efficacy of valproate (carba)
166
What are important interactions of metformin?
stop for 48 hrs before and after contrast imaging; ACEi, NSAIDs, diuretics increase risk of renal impairment when used in combination; prednisolone, thiazide, loop diuretics increase glucose levels, decrease efficacy
167
What are some caution when giving aldosterone?
DO NOT GIVE: severe renal impairment, hyperkalemia, Addison's disease; caution in pregnant or lactating women
168
Name loop diuretics and their use?
furosemide, bumetanide; acute pulmonary oedema, CHF, other oedematous states (liver, renal)
169
What are the drugs that cause bradycardia?
B-blockers, CCB, digoxin, amiodarone, clonidine, verapamil
170
When do you use amiodarone?
tachyarrythmias: AF, atrial flutter, SVT, VT, VF as last line
171
What are the adverse effects of sitagliptin?
headache, pancreatitis, constipation, dizziness
172
MOA of thiazides?
inhibition of Na+/Cl- co-transporter in distal convoluted tubule; longer term is vasodilation (not completely understood)
173
What caution when giving thiazides?
NSAIDs reduce efficacy, do not give with other potassium lowering drug
174
Advise patients taking insulin?
lifestyle, hypos, eat sugary then starch
175
Replacement fluid what to give in all patients?
0.9% saline (normal saline or crystalloid)
176
What is the spectrum of activity of chloramphenicol?
broad activity against gram-ve/+ve, aerobic and anaerobic organisms
-NOT used systemic first line for any infection due to high risk of toxicity
177
Causes of neutropenia?
viral infection, chemo or radiotherapy, clozapine, carbimazole
178
Name cephalosporins and carbapenems
cefalexin, cefotaxim, meropenem, ertapenem
179
Causes of neutrophilia
Bacterial infection, tissue damage (inflmmation/infarct/malignancy)
180
181
