z - drugs Flashcards
BB combination with verapamil (rate limiting CCB)
can potentially cause profound bradycardia and asystole
BB and asthma
contraindicated!
migraine prevention
propanolol or topiramate. propanolol in child brearing age females
bells palsy
prednisalone 1mg/kg for 10days prescribed within 72hours of onset +eye care
seizure
start antiepileptics following second seizure
focal - carbamazepine (not in absent!) or lamotragene
generalised - sodium valporate
preferred antiplatelet for secondary prevention following stroke/tia
clopidogrel
2nd line = aspirin in combo with modified release dipyridamole
severe cases of neuroleptic malignant syndrome
dantrolene
DVT/PE prophylaxis in nephrotic syndrome?
LMWH
pioglitizone
CI in bladder Ca (can cause it) and heart failure
treatment of nephrogenic DI
thiazides and low salt/protein diet (desmopressin in central DI)
ACEi/ARB as 1st line antihypertensive in…
<55 and T2DM (including afro-caribbean if T2DM)
ototoxicity associated with
loop diuretics
gentamicin
cataracts is a SE of which drug class?
corticosteroids
max dose of amlodipine
10mg
what needs to be considered when starting phenytoin?
cardiac monitoring. arrhythmic effects
drugs that increase the risk of GORD
tricyclincs, anti-cholonergics, nitrates
What is the most important advice to give to a patient starting carbimazole?
return for urgent medical review if develop any symptoms of infection. particularly sore throat or fever. are but serious side effect of carbimazole is agranulocytosis so patients must be counselled regarding this. If the patient develops any symptoms of an infection, particularly sore throat or fever then must seek urgent medical review and a FBC must be performed to check the neutrophil count
what is the prophalaxic treatment of spontaneous bacterial peritonitis?
oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved. or patients who have had an ep of SBP
uses of metoclopramide
anti-emetic and pro-kinetic:
- GORD
- gastroparesis in T2DM
- often combined with analgesics to treat migraine
SE: extrapyramidal effects, tardive dyskinesia, Parkinson, hyperprolactinaemia
first line treatment for PBC
ursodeoxycholic acid
treatment for pruritis
cholestyramine
treatment of c,diff infection?
oral metronidazole for 14 days. if not improved then oral vancomycin
(both together is the treatment for v severe)
drug to prevent variceal bleeding?
propanolol
other than clindamycin what antibiotics can cause c.diff?
cephalosporins e.g. ceftriaxone, cefaclor
burn resusitation fluid if >15% SA covered
first 24hrs use parkland formula:
4ml x (total SA) x (body weight in kg)
50% in first 8 hours
50% in next 16 hours
treatment of thyrotoxicosis in pregnancy
ropylthiouracil is used in the first trimester of pregnancy in place of carbimazole, as the latter drug may be associated with an increased risk of congenital abnormalities. At the beginning of the second trimester, the woman should be switched back to carbimazole’
drugs common cause erectile dysfunction
SSRI’s and BB
treatment of SBP
IV cefotaxime
penacillamine is used in the Rx of?
Wilson’s disease. aids in the elimination of copper
management of hepatorenal syndrome
vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation
volume expansion with 20% albumin
transjugular intrahepatic portosystemic shunt
Offer prophylactic intravenous antibiotics for people with cirrhosis who have upper gastrointestinal bleeding
quinalone
inhibit DNA synthesis and are bactericidal in nature.
e.g ciprofloxacin; levofloxacin
SEs = tendon rupture, prolonged QT, lower seizure threshold in epileptics
what medications are key in the management of proteinuria?
ACEi/ARB
3mg/mmol if co-existent diabetes, an ACR >30 mg/mmol if co-existent hypertension or an ACR>70mg/mmol.
Therefore ramipril is the correct answer
treatment for constipation in children
advice on diet/fluids + movicol paediatric plan
macrogels if first line
what should you monitor in achild on methylphenidate for ADHD?
growth
what is the moa of loperamide?
μ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut
reduce gastric motility through stimulation of opiod receptors
statins in pregnancy
STOP
treatment of prostatitis
fluroquinalone (ciprofloxacin) for 14days . consider testing for STI
treatment for itch
cholestyramine
non-sedating anti-histmaines
citirizine, loratidine, fexofenadine
anti-emetics used in pregnancy
1 - promethazine/cyclizine
2 - prochloperazine
3 - metoclopramide
anti-emetics ised post op
1 - ondansetron
2 - cyclizine
3 - prochloperazine
anti-emetic drug induces/ radiation
metoclopramide
anti-emetic cytptoxic
triple therapy ondansetron, dexamethasone, apreptide +/- metoclopramide
anti-emetic GI causes
metoclopramide
motion sickness
1-hyocine
2-cyclizine
vestibular disease
beta histine or cyclizine
blood products in ruptured aaa
6 units crossmatched
if pt has AF with stroke what long term medication should you start
doac.
300mg aspirin for 2 weeks then 75mg clopidogrel (and 80mg atorvostatin) if no AF
treatment of infective exacerbation of COPD
prednisolone
amoxicillin, clarithromycin or doxycyclin
don’t use clarithro if prolonged QT
what is the antibiotic prophylaxis used in copd
azithromycin
(usually 250 mg 3 times a week) for people with COPD if they do not smoke, have optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and experience frequent (typically 4 or more per year) exacerbations with sputum production
drugs that can slow the progression of IPF
pirfenidone - antifibrotic and anti-inflammatory
nintedanib - monoclonal antibody
first line management of COPD
inhaled salbutamol or ipratropium
acute alcoholic hepatitis
prednisolone
treatment of idiopathic intracranial htn
Acetazolamide
whooping cough
erythromycin
chlamydia psittici
1- doxy
2- erythromycin
Qfever/ coxeilla
doxy
legionella
levofoxacin or clarithromycin+rifampicin
active or prophylactic treatment of pneumocysitis pneumonia
co-trimoxazole
pseudomonas
ciprofloxacin
treatment and SEs of active pulmonary TB
‘RIPE’
- Rifampacin (body fluids orange)
- Isoniazid (peripheral neuropathy: co-prescribe Pyridoxine (vitamin B6))
- Pyrazinamide (can cause hyperuricaemia (high uric acid levels) resulting in gout/hepatitis/arthralgia)
- Ehanbutol (colour blindness and reduced visual acuity. ON)
*Rifampacin/isoniazid/pyrazinamide can all cause hepatotoxicity
all 4 for 2 months. rifampacin and isoniazide for further 4
(SEs learn as ONGO - orange, neuropathy, gout, ON)
drug that can reactivate TB
anti-TNF e.g. infliximab
treatment of carcinoid syndrome
tumours that release serotonin into the system. octrotide - somatostatin analogue that helps decrease the secretion of seratonin
prophylaxis in cluster headache
verapamil (CCB)
acute attacks = 100% O2 and SC triptan… triptans are CI in coronary heart disease as they can cause vasospasm
CI in heart failure
non-hydropyridine CCB (verapamil and diltiazem)
why might there be significant renal impairment after starting ACEi?
may occur if the patient has undiagnosed bilateral renal artery stenosis
Bilateral renal artery stenosis should always be considered in a patient with risk factors for, and evidence of, atherosclerotic vascular disease. In particular, if they are diagnosed later in life with hypertension and have an acute significant drop in renal function following the commencement of an ACE inhibitor
cause of hallucination in PD
dopamine agonists
advice when atarting sertraline
new antidepressant drug therefore less addictive
can take up to 3 weeks to feel benefit
can experience headache and nausea symptoms in first week of using it, nothing the second and you might think it is not working but you should start to feel benefits after the 3rd week. assess pt risk!! review in 2-3weeks. shouldnt be sedating but if you experience then get back in touch. expect to be on it for at least 3months
azathioprine and colchicine together?
severe interaction causing bone marrow suppression (pancytopaenia)
hydroxychloraquine SE
bulls eye retinopathy. all pts should have opthalmology assessment before commencing. +annual screening
drug causes of drug induced lupus
procainamide
hydralazine
paediatric constipation
(MSO)
Movicol (specific osmotic for pediatric)
Stimulant (eg.senna)
Osmotic (Eg.lactulose)
statin and lft’s
can cause off lfts
aye drop used to dilate pupil and relieve pn in uveitis and keratitis etc
cyclopentolate
atropine (anti-parasympathetic)
mx of dresslers syndrome
aspirin (NSAID in pericarditis)
steroids and fbc
cna cause increased WBCs, typically neutrophils
treatment to prevent pathological fractures in bony mets
Bisphosphonates
denosumab if low gfr <30
treatment of intestinal bacterial overgrowth ( diagnosed with hydrogen breath test)
rifaximin because rifaximin is poorly absorbed via the gastrointestinal tract therefore allowing a large dose of antibiotic to reach its intra-luminal target without systemically high concentrations. Moreover, there are low levels of rifaximin resistance in SIBO
Co-amoxiclav or metronidazole are also effective
antidepressant of choice in child/adolescant
fluoxetine
antidepressants first line after MI(safest)
sertraline
co-prescribed with SSRI if pt taking nsaid
PPI
antidepressant recommended if pt on warfarin or aspirin?
mirtazipine
antibiotic for mycoplasma pneumonia
clarithromycin/erythromycin child and adult
doxycyclin older child and adult
inhibitors of the p450 system (increase INR)?
ciprofloxacin erythromycin isoniazid cimetidine omeprazole amiodarone allupurinol fluconazole SSRI ritonavir sodium valproate acute alcohol intake quinupristin
inducers of the p450 system (drops INR; reduce effectiveness of COCP)?
phenytoin carbamazepine phenobarbitone rifampicin st johns wort chronic alcohol intake griseofulvin smoking
moa of aspirin
non reversible COX 1 and 2 inhibitor
COX is responsible for prostoglandin, prostocyclin and thromboxane synthesis. blocking of thromboxane A2 formation in platlets reduces the ability of platelets to aggregate which has lead to the widespread use of low-dose aspirin in CVD.
clopidogrel is now 1st line following ischamic stroke or PAD.
why dont prescribe doxycyclin to <12?
teeth discolouration
SE of doxycyclin in adults?
sensitivity to light
given in QRS prolongation associated with TCA OD
sodium bicarbonate - helps to reverse metabolic acidosis
medication to avoid with ssri
triptans. risk of seratoinin syndrome
dabigatran reversal agent
Idarucizumab
antibiotics for PROM
erythromycin for 10 days
thiazide diuretics and gout
contraindicated
therapeutic cooling in neonates
Therapeutic cooling at 33-35 degrees attempts to reduce the chances of severe brain damage in neonates with hypoxic injury
black carribean on CCB and needs next line?
add ARB>ACEi
drug to avoid in HoCM
acei
used to encourage closure of a patent ductus arteriosus
Indomethacin or ibuprofen
(PDA with no cyanosis - indomethacin
PDA with cyanosis - Prostaglandins/alprostadil)
diclofenac is contraindicated in the following conditions…
ischaemic heart disease
peripheral arterial disease
cerebrovascular disease
congestive heart failure (New York Heart Association classification II-IV)
treatment of Allergic bronchopulmonary aspergillosis
prednisolone
2nd line = itraconazole
analgesia low back pain
Offer a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen first-line, if there are no contraindications. An NSAID should be used at the lowest effective dose for the shortest possible time. Gastroprotective treatment should also be offered while an NSAID is being used.
If an NSAID is contraindicated, not tolerated, or ineffective, offer codeine with or without paracetamol, taking into account the risk of opioid dependence and adverse effects such as constipation.
Do not offer paracetamol alone for managing low back pain
weight gain, constipation, lethargy on amioderone
can cause thyroid dysfunction (hypothyroid) due to high iodine contect
cellulitis
fluclox
clarithromycin, erythromycin (pregnancy) or doxy
cyclizine caution
heart failure
