tricyclics, tamoxifen, heparin, lorazepam, haloperidol, ACEi Flashcards
sedative tricyclic examples
- amitriptyline
- clomipramine
- dosulepin
less sedative tricyclic examples
- imipramine
- nortriptyline
- lofepramine
adverse effects of tricyclics
blockade of antimuscarinic receptor:
- dry mouth
- constipation
- urinary retention
- blurred vision
Blockade of H1 and α1 receptors:
- sedation
- hypotension
- prologation of QT + QRS
- convulsions, hallucinations, mania
- breast changes, sexual dysfunction
TCA overdose effects
severe hypotension, arrhythmias, convulsions, coma
and respiratory failure
TCA sudden withdrawal sx
GI upset, neuro + influenza-like sx and sleep disturbance
TCA should not be given with what drug
monoamine oxidase inhibitors
what is venlafaxine
SNRI
serotonin and noradrenaline reuptake inhibitor
what is mirtazapine
antagonist of inhibitory pre-synaptic α2-adrenoceptors.
how does venlafaxine and mirtazipine work
Both drugs increase availability of monoamines for
neurotransmission
important adverse effects of venlafaxine and mirtazipine
- GI upset
- headache, abnormal dreams, convulsopms
- Suicidal thoughts and behaviour
when should mirtazapine be taken
at night ot minimus its sedative effects
the most common adverse effects of statins
headache and GI disturbance
more serious effects of statins
myopathy
rhabdomyolysis
rise in ALT
important interactions with statins
The metabolism of statins is reduced by cytochrome P450
inhibitors, such as amiodarone, diltiazem, itraconazole, macrolides
amlodipine
when are statins taken
evening, as there is some evidence
that they have a greater effect when dietary intake is at its lowest.
what should pts on statins avoid drinking
grapefruit juice
how should efficacy of statins be monitored
checking target cholesterol levels are achieved
for safety, what should be measured at baseline and again at 3 and 12 months when on a statin
ALT
check TFT before starting
methotrexate adverse effects
- mucosal damage
(e. g. sore mouth, gastrointestinal upset) - bone marrow
suppression (neutropenia and an
increased risk of infection)
long term use of methotrexate can result in what
hepatic cirrhosis or pulmonary fibrosis
important interaction of methotrexate
e toxicity is more likely if it is prescribed with drugs that
inhibit its renal excretion, e.g. NSAIDs, penicillins
Co-prescription
with other folate antagonists, e.g. trimethoprim and phenytoin,
increases the risk of haematological abnormalities
prescription of methotrexate
once weekly
IV or intrathecal
Folic acid 5 mg can be prescribed to be
taken on the 6 days where methotrexate is not taken
monitoring with methotrexate
full blood count, liver and renal function before starting
treatment, then 1–2 weekly until treatment is established and
2–3 monthly thereafter
what should pts on tamoxifen be warned of
- the risk of endometrial cancer and told to report relevant symptoms promptly
- symptoms of thromboembolism and advised to report sudden breathlessness and any pain in the calf of one leg.
