Top 100 drugs Flashcards
what is activated charcoal used for?
Emergancy treatment of poisoning
what are important adverse effects of activated charcoal?
pneumonitis, bronchospasm and airway obstruction
black stools
vomiting
what are warnings of activated charcoal use?
- patients with reduced level of consciousness unless the airway is protected
- persistant vomiting due to aspiration
- reduced GI motility
what is the mechanism of action for activated charcoal?
using van de waals forces molecules are adsorbed onto the surface of the charcoal as it moves through the gut but is only helpful for poisons that are likely to be adsorbed
what are angiotensin converting inhibitors typically used for?
- hypertension
- chronic heart failure
- ischaemic heart disease
- diabetic nephropathy and CKD with proteinurea
what is the mechanism of action for ACE inhibitors?
Block the action of angiotensin converting enzyme, meaning angiotensin I to angiotensin II.
ACE inhibitors stop the formation of angiotensin II, what are the actions of angiotensin II?
- vasoconstriction
- stimulates aldosterone secretion
Blocking angiotensin II reduces afterload helping reduce hypertension
why are ACE inhibitors helpful in heart failure?
reduces blood pressure because it reduces afterload
reduces aldosterone levels meaning it promotes sodium and water excretion helping reduce preload
why are ACE inhibitors helpful in CKD?
blocking angiotensin II means dilation of the efferent glomerular arteriole which reduces intraglomerular pressure which slows progression
what are the adverse effects of ACE inhibitors?
hypotension, persistant dry cough, hyperkalaemia, renal failure, angiodema
why can ACE inhibitors cause a dry cough?
normally bradykinin is inactivated by ACE but it’s inactivated so levels will build up
why can ACE inhibitors cause hyperkalaemia?
no AGII means lower aldosterone levels, this promotes potassium retention.
what patients should avoid ACE inhibitors?
Renal artery stenosis, acute kidney injury, pregnant women and breastfeeding.
Lower doses in patients with chronic kidney disease.
what are examples of ACE inhibitors?
Ramipril, Lisinopril, perindopril
What are the common indications for aspirin?
- treat acute coronary syndrome
- treat ischaemic stroke
- long term secondary prevention of arterial events
- reduce the risk of intracardiac thrombus and embolic stroke in atrial fibirillation when warfaring is contraindications
- control mild to moderate pain and fever.
in brief what is the mechanism of action for aspirin?
Irreversibly inhibits COX to reduce production of thromboxane from arachidonic acid which reduces platelet aggregation and risk of arterial occlusion
what are the important adverse effects of aspirin?
- GI irritation
- GI ulcers
- hypersensitivity reactions like bronchospasm
- tinnitus
what are the warnings of aspirin?
Shouldn’t be given to Children under 16
Shouldnt be given to people with aspirin sensitivity
Avoided in 3rd trimester
why should aspirin not be given to children?
A risk of reyes syndrome which affects the liver and brain
why should aspirin not be given in the 3rd trimester?
Prostaglandin inhibit can lead to premature closure of the ductus arteriousus
what are the indications for acetyl cysteine?
Antidote for paracetomal poisoning
prevent renal injury due to contrast radiography
reduce the viscosity of respiratory secretions
What is the mechanism of action for acetyl cysteine?
It works by replenishing the bodies stores of glutathione this is important in paracetomal overdose as it detoxifies NAPQI
Antioxidant effect protects the body against contrast agents
How is paracetomal metabolised and why is acetyl cysteine important in overdose?
Normally paracetomal is conjugated with glucuronic acid and sulfate. Some is converted to toxic NAPQI but this is converted by conjugation with glutathione. Acetylcysteine replenishes the bodies glutathione supply.
what are the important adverse effects of acetylcysteine?
- when given in a large dose for paracetomal poisoning causes an anaphylactoid reaction.
- in nebulised form can cause bronchospasm
why should salbutamol be given before giving acetylcysteine in nebulised form?
Acetylcysteine can cause bronchospasm
Salbutomal is a bronchodilator so prevents this
what are the common indications for calcium and vitamin D?
- osteoporosis (along with bisphosphonates)
- chronic kidney disease
- in the form of calcium gluconate for hyperkalaemia
- hypocalcaemia
- vit D deficiency
why is calcium gluconate given for severe hyperkalaemia?
to prevent life threatening arrhythmias
what is the mechanism of action for calcium?
calcium homeostasis is controlled by PTH and vitamin D which increase plasma calcium levels, calcitonin decreases plasma calcium.
In osteoporosis there is loss of bone mass so you are restoring this.
what are important adverse effects of calcium?
dyspepsia, constipation.
what are the indications for oxygen?
- To increase tissue oxygen delivery in hypoxaemia
- to increase reabsorption of plural gas in pneumothorax
- to reduce the half life of carboxyhaemoglobin in carbon monoxide poisoning.
what is the mechanism of action of supplemental oxygen?
Increases partial pressure of oxygen in the alveoli will increase diffusion of oxygen into the blood for hypoxaemia
In pneumothorax it reduces the fraction of nitrogen in the alveoli increases the diffusion of nitrate out of the body.
what are warnings of supplemental oxygen?
Patients with COPD can get high carbon dioxide levels
what type of drug is salbutomal?
A beta 2 agonist
What are beta 2 agonists given for?
- Ashtma
- COPD
- hyperkalaemia
When are beta 2 agonists given for ashtma?
Short acting are used to relieve breathlessness. Long acting are used as step 3 treatment for chronic ashtma with inhaled corticosteroids
what is the mechanism of action for beta 2 agonists?
beta 2 receptors are found in the smooth muscle of the bronchi, GI, uterus and blood vessels. It’s a G protein coupled receptor and stimulation leads to smooth muscle relaxation improving airflow.
Like insulin is stimulates the Sodium/potassium ATPase pump causing a potassium shift.
What are shrt acting beta 2 agonists?
Salbutomal, terbutaline
what are long acting beta 2 agonists?
Salmeterol, formoterol
What are important adverse effects of beta 2 agonists?
tachycardia, palpitations, anxiety, tremor.
they promote glycogenolysis
what should be given with long acting beta 2 agonists when used for ashtma?
An inhaled corticosteroid
what are the indications for corticosteroids (glucocorticoids)?
- treat allergic or inflammatory disorders like anaphylaxis and ashtma
- suppress autoimmune disease
- given for some cancers
- adrenal insufficiency and hypopituitarism
what is the mechanism of action for corticosteroids?
Bind to cytosolic glucocorticoid receptors which translocate to the nucleus and bind to regulate gene expression, mainly upregulating anti-inflammatory genes and down regulatory pro-inflammatory genes
- suppress circulating monocytes and eosinophils
- stimulate sodium and water retention and potassium excretion
what are examples of pro-inflammatory genes that corticosteroids downregulate?
TNF alpha, cytokines
what are important adverse effects of glucocorticoids?
- immunosuppression
- diabetes mellitus
- osteoporosis
- hypertension, hypokalaemia and oedema due to their mineralocorticoid like actions
why should you be careful when giving NSAIDS with corticosteroids?
increase the risk of peptic ulceration and GI bleeding
what type of drug is prednisolone?
A corticosteroids
what are examples of corticosteroids?
Prednisolone, hydrocortisone and dexamethasone
what is the most potent corticossteroid in terms of anti inflammatory?
Dexamethasone
