Therapeutics Flashcards
What are some drugs that are known to have teratogenic effects?
thalidomide – phocomelia
DES syndrome – causes cervical/vaginal adenocarcinoma + hypogonadism/hypospadias/varicoceles
What are some medications that can be used to treat hypermesis?
IV fluids (rehydration)
cariban (B6 + histamine mixture)
antiemetics
steroids
peripheral nutrition
What is the first line tx for bacterial meningitis? How would you prescribe it?
ceftriaxone
1-2 g QD given IV
What is the first line tx for alcohol withdrawal? How would you prescribe it?
benzodiazepines for acute alcohol withdrawal
chloridazepoxide or lorazepam 25-50 mg PO 1-2 every hour
What are the classifications of adverse drug reactions?
augmented (dose related) - ie warfarin + bleeding
bizarre (not dose related)
chronic (persists for a long time)
delayed
end of use
What are some examples on non-opioid analgesia?
paracetamol (COX-3inhibition in the brain, producing analgesic effects)
NSAIDs (COX inhibition)
What would we prescribe for stronger analgesic effects?
weak opioids - codeine, tramadol
strong opioids - morphine, oxycodone
How do we calculate steady state concentration of a drug?
dosing rate (mg/h) / clearance (mL/h)
The _______ pathway is key in the development of psoriasis
IL-23 - Th17
Psoriasis is associated with an increased risk of
vascular inflammation, especially in liver + joints
What are some novel treatments for psoriasis?
MTX
TNF-alpha inhibitors
What is the ladder of pain management?
Step 1: non-opioid analgesia
Step 2: weak opioids (codeine) + non-opioid
Step 3: strong opioid (morphine) + non-opioid
How does liver disease affect drug pharmacokinetics?
change in structure of injured liver cells reduces hepatic uptake and metabolism
changes in drug absorption via GIT
changes in drug distribution due to lower proteins in blood
changes in liver blood flow due to portosystemic shunting
changes in renal excretion due to renal elimination of hydrophilic drugs
What is the first line treatment of nausea in pregnancy?
Doxylamine-pyridoxine is a combination of an antihistamine (doxylamine) and vitamin B6 (pyridoxine) that has been found to be both safe and effective in treating nausea and vomiting during pregnancy.
Which laxative is contraindicated in pregnancy?
senna - not an osmotic laxative
What type of pain is aching, often constant, throbbing, worsened with movement and well localized?
somatic pain
caused by fracture or soft tissue injury
What type of pain is diffuse, poorly localized, referred, constant or crampy/aching/stabbing and pressure type pain?
visceral pain
causes include inflamed gallbladder, bowel obstruction
What type of pain is neuropathic pain?
burning, tingling shooting, complex, referred pain, allodynia, hyperalgesia
can be caused by sciatica, peripheral neuropathy, neuralgia
Is all pain in cancer patients caused by the cancer?
no
can have direct/indirect of cancer or treatment
What is the golden rule for pain management in cancer treatment?
do not blindly treat pain if the cause is unknown
What is the main difference b/w sustained vs immediate release opioids?
sustained release: 12 hour action (BD dosing)
immediate release: 4 hour action (PRN or every 4 hour dosing) used for breakthrough pain
What is the MOA of ondansetron?
antiemetic
binds to 5-HT3 receptor in GIT
What is the MOA of cyclizine?
antiemetic
histaminergic (H1) in the vomiting centre + vestibular apparatus
List some alternative off label drugs for nausea
dexamethasone
aprepitant
cannabinoids
olanzapine (atypical antipsychotic)
octreotide (Decreases GI secretions)
List treatments for constipation
Bulk-Forming agents (Methylcellulose, bran): Add bulk, retain water → stools bulkier → trigger GI contractions
Osmotic Laxative (milk of magnesia/ magnesium salts): Help Stools retain fluid → soften stools.
Stimulant / Irritant laxatives (Senna, bisacodyl, glycerol): Stimulate myenteric nerves and motility (stretch & peristalsis). Can cause “lethargic colon” if overused (laxative abuse).
Stool softeners/emollients (Arachis oil, docusate sodium, glycerol): Lower surface tension of bowel fluids. Useful in management of anal fissure and hemmorhoids. Usually combined with other agents.
What results from a interaction with diuretics and ACE inhibitors?
increased risk of hyperkalemia
What results from a interaction b/w opioids and benzos?
increased risk of drowsiness and respiratory depression
What results from a interaction between lithium and thiazide diuretics?
lithium toxicity
List drugs that can be used as antiemetics?
ondansetron (5-HT3)
haloperidol/metoclopramide (D2)
cyclizine (muscarinic, histaminergic)
dexamethasone
aprepitant (neurokinin antagonist)
cannabis
olanzapine
octreotide
When is the use of ivabradine indicated and what are some interactions?
SA node inhibitor to reduce heart rate, alternative to beta blocker
indicated in ACS
interacts w/ macrolides + CYP3A4 inhibitors
When is the use of ranolazine indicated and what are its interavtions?
inhibits sodium current + reduces intracellular calcium + used in ACS/angina
reduce dose in elderly + renal impairment
What is rivaroxaban?
inhibitor of Xa and used as an anticoagulant to treat DVT/PE or stroke prevention in AFib
List the fibrinolytics
alteplase (tPA) - 5-10 minute onset of action, activates plasminogen to plasmin, first line tx
reteplase
tenecteplase
How do we manage respiratory exacerbations?
SABAs: short term relief of bronchospasm
LAMAs: long term control by blocking ACh at muscarinic receptors
