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ESA 4 missing > cpt stuff > Flashcards

cpt stuff Flashcards

1
Q

first line antihypertensive if have type 2 diabetes

A

ACEi

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2
Q

why do loop and thiazides cause hypokalaemia

A

block Na+ reabsorption and therefore more Na+ in tubule. more reabsorbed by ENaC, more K+ excreted by ROMK

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3
Q

which antihypertensve pregnancy

A

labetelol

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4
Q

which antihypertensive causes damage while breastfeeding

A

nifedipine

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5
Q

aminoglycosides and loop

A

ototoxicity, nephrotoxicity

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6
Q

digoxin and thiazide/loop

A

hypokalaemia

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7
Q

b blockers and thazide

A

hyperglycaemia, hyperlipidemia, hyperuricaemia

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8
Q

steroid and thiazide and loop

A

hypokalaemia

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9
Q

carbemazapine and thiazide

A

hyponatraemia

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10
Q

ADR thiazide

A

gout, hyperglycaemia, ED, increased LDL, hypercalcaemia

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11
Q

ADR frusemide

A

ototoxocity, alkalosis, increaed LDL, gout

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12
Q

SE alpha blocker

A

postural hypotension, dizziness, fatigue

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13
Q

drug interactions alpha blocker

A

people affected by dihydropiridine CCB, makes oedema worse

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14
Q

contraindications beta blockers

A

hepatic failure, haemodynamic instability, asthma

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15
Q

SE phenylalkamines

A

heart block, cardiac failure, bradycardia, constipation

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16
Q

thiazide SE

A

hypokalaemia, hyponatraemia, gout, arrhythmia, increased glucose

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17
Q

warnings thiazdie

A

hypokalaemia, hyponatriaema, gout

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18
Q

DI statins

A 
CYP 3A4 important – amiodarone, diltiazem, macrolides - increases [plasma] statin
Remember amlodipine (CCB) also increases [plasma] statin
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19
Q

nocte

A

at night

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20
Q

why take statins nocte

A

most cholesterol made at night

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21
Q

aim of statin treatment

A

> 40% reduction in non HDL-C at three months

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22
Q

when is ezetimibe combined with statin

A

in CKD and secondary CVS prevention, those who can only tolerate low dose statin

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23
Q

when is fibrates and statin used

A

famiilial hypercholesterolaemia

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24
Q

aim of secondary prevention LDL levels

A

1.8mmol/L LDL-C (<2.5mmol/L non HDL-C)

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25
Q

which foods naturally lower cholesteron

A

fish oils, fibre, vitamin c/e

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26
Q

what absolute cholesterol level triggers treatment

A

5mmol/L

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27
Q

what affects COCP effectiveness

A

oral contraceptive efficacy is reduced by enzyme inducing drugs
– carbamazepine or phenytoin;
– rifampicin and rifabutin and
– St John’s Wort
• increase the production of hepatic CYP450

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28
Q

effect of oestrogen on PR

A

increases

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29
Q

effect of progesterone on ER

A

decreases

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30
Q

contraindicatons and warnings metformin

A

X excreted unchanged by kidneys – stop if eGFR < 30 mL/min, alcohol intoxication

• Δ ACEi, diuretics, NSAIDs – drugs that may impair renal function
loop and thiazide like diuretics ↑glucose so can reduce metformin action

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31
Q

which diabetic drugs cause weight gain and how

A

glitazones - fat cell differentiation

sulfonurea- increased anabolic effects of insulin

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32
Q

which diabetic drug pancreatitis

A

dipeptidyl peptidase 4 inhibitors- sitagliptin, saxagliptin

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33
Q

why dipeptidyl peptidase 4 inhbitors lower hypoglycaemia risk

A

does not stimulate insulin production at normal glucose levels as is glucose dependent

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34
Q

which diabetic drugs cause weight loss and how

A

metformin- suppress appetite
GLP-1 agonist- reduced appetite
SGLT2

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35
Q

mechanism glitazones

A

insulin sensitisation, upregulation of ppary

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36
Q

SE, W, DI DPP4 inhibitors

A

se- pancreatitis
w- pregnancy, Hx pancreatitis
DDI- thiazide/loop as increase glucose, other hypoglycaemics

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37
Q

SE, W, DI sulfonurea

A

se- hyopoglycaemia and gi upset
w- hepatic impairment
di- other hypoglycaemics, thiazide and loop diuretics

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38
Q

se, w, di GLP-1 agonists

A

se- weight loss, hypoglycaemia
w- renal impair,emt
di- other hypoglycaemics

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39
Q

how are GLP-1 administered

A

subcutaneously- as hormone

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40
Q

why is renal SE/DI so important for metformin?

A

it is only renally excreted unchanged

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41
Q

half life equation

A

t1/2= (0.693 x Vd ) / CL

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42
Q

loading dose equation

A

loading dose =( Css x Vd ) bioavalibility (usually 1)

Css= desired concentration in plasma

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43
Q

maintenence dose

A

(clearance x [plasma] wanted /bioavalibility) x dose interval

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44
Q

theraputic index

A

toxic dose/ theraputic index

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45
Q

volume of distribution =

A

Vd = dose / plasma concentration drug in L/Kg(!!!)

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46
Q

which drug ventricular ectopic beat

A

bisoprolol

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47
Q

cardiac and ecg effects class IV

A

reduce phase 4, reduce AV, increase APD

increase PR

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48
Q

ECG class III sotalol

A

increase QT

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49
Q

use class Ic

A

WPW, atrial fluttter/fibrillations, premature ventricular contractions

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50
Q

use class Ib

A

ventricular tachycardia

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51
Q

cardiac effects Ib

A

increase qrs

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52
Q

warnings and contraindications ADP receptor antaognist

A

high bleed risk, hepatic and renal impairment

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53
Q

transplantation drugs

A

calcineurin inhibitor, mycophenolate mofetil

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54
Q

IBS drugs

A

azathioprine, sulfasalazine

55
Q

skin drugs

A

calcineurin inhbibitors, methotrexate

56
Q

RA drugs

A

methotrexate

57
Q

effect of NSAIDs on RA management

A

NSAIDs reduce prostoglandins, reduce dilation of afferent arteriole, and so reduce renal blood flow, causing kidney damage

they displace streroids from binding sites, increasing blood levels

58
Q

which drug has weekly dosing

A

methotrexate

59
Q

how do prostoglandins cause ADR when taking NSAID

A
  • prostoglandins dilate afferent,. when NSAID removes them renal blood flow reduces causing reduced GFR
  • NSAIDs also constrict afferent arteriole, increasing effect seen
60
Q

compare ipratropium and tiotropium

A

ipratropium is SAMA, tiotropium is LAMA

61
Q

prescribing considerations LABA

A

must be given alongside ICS to prevent masking of life threatening symptoms

62
Q

why difference in delivery of nebulised ipratroprium bromide COPD and asthma patients

A

if patient is hypercapnic, nebuliser is driven by air not o2

63
Q

why fentanyl godo

A
  • patches
  • short half lfie
  • high affinity and potency
64
Q

isobride mononitrate

A

nitrate

65
Q

tranexamic acid

A

inhibits the activation of plasminogen from plasmin

66
Q

tetrabluine

A

SABA

67
Q

long acting muscarinic

A

tiotropium bromide

68
Q

short acting muscarinic

A

ipratropium bromide

69
Q

fluticasone

A

corticosteroid inhaled

70
Q

midazolam

A

buccal benzodiazapine

71
Q

diamorphine, methadone, tramadol

A

opoid receptor agonist

72
Q

rapid insulin

A

insulin aspart

73
Q

short insulin

A

soluble- actrapid/humulin s

74
Q

intermediate insulin

A

isophane insulin

75
Q

long acting insulin

A

insulin degludec, insulin glargine

76
Q

oestrogen steroid hormone

A

estradiol

77
Q

synthetic progesterone

A

desogestrel, medroxyprogesterone acetate, norethisterone, levonorgestrel

78
Q

Interaction metronidazole and warfarin

A

Metronidazole inhibits CYP2C9 and warfarin is broken down by CYP2C9
This increases warfarin concentration

79
Q

What does CYP3A4 affect

A

Statins, verapamil

80
Q

What does CYP 2C9 affect

A

Warfarin

81
Q

Drugs with CYP2D6

A

Antidepressants, antipsychotics, b blockers, opioid analgesics

82
Q

CYP 450 inducers (4)

A

Rifampicin
Carbemazapine
Omeprazole
Phenytoin

83
Q

Cyp 450 inhibitors

A 
Ciprofloxacin
Antifungals
Fluoxetine
Paraoxetine
HIV antivirals
84
Q

Cyclophosphamide and cyps

A

Pro drug, needs CYP 45 to activate it

85
Q

CYP 1A2 substrates, inducers and inhibitors

A

Substrates- haloperidol, naproxen, paracetamol, theophylline, verapamil

Inducers- carbemazapine

Inhibitors- amiodarone, grapefruit juice

86
Q

CYP 2C8 substrates, inducers and inhibitors

A

Substrate- montelukast

Inducers- phenobarbital, rifampicin

Inhibitors- montelukast, trimethoprim

87
Q

CYP 2C9 substrates, inducers and inhibitors

A

Substrates- celecoxib, diclofenac, ibuprofen, losartan, S-warfarin

Inducers- carbemazapine, rifampicin, St. Johns wort

Inhibitors- amiodarone, metronidazole, valproric acid

88
Q

CYP 2C19 substrates, inducers and inhibitors

A

Substate- clopidogrel, cyclophosphamide, diazepam, gliclazide, omeprazole, phenytoin, warfarin

Inducers - rifampicin, St. John’s wort

Inhibitors- fluoxetine, omeprazole, oral contraceptives

89
Q

CYP 2D6 substate, inducers and inhibitors

A

Substrate- bisoprolol, codeine, flecainide, haloperidol, metoprolol, ondansetron, propranolol, tramado

Inducers- carbemazapine, phenytoin, rifampicin

Inhibitor- amiodarone, fluoxetine, some antivirals

90
Q

CYP2E subtrates, inducers, inhibitors

A

Substate- ethanol, gaseous anaesthetics, paracetamol

Inducers- ethanol

Inhibitors- ethanol

91
Q

CYP3A4 substrate, inducer, inhibitor

A

Substrate- amlodipine, atorvastatin, carbamazepine, ciclosporin, COCPs, diazepam, diltiazem, midazolam, macrolides, opioids, simvastatin, tacrolimus, tamoxifen

Inducer- carbemazapine, phenytoin, pioglitaozne, rifampicin, St. John’s wort

Inhibitor- amiodarone, sone antivirals, clarithromycin, grapefruit, verapamil

92
Q

Theophylline cyps

A

Cyp450 inhibitors increase concentration of theophylline

93
Q

What cyp is involved with warfarin

A

CYP2C9

94
Q

Which CYP statins

A

CYP3A4

95
Q

Which CYP fentanyl

A

CYP3A4

96
Q

Which CYP codeine

A

CYP 2D6 pro drug

97
Q

Which CYP buprenorphine

A

CYP 3A4

98
Q

Which CYP ADP RA

A

Clopidogren needs CYP activation

Caution with omeprazole, cipofloaxin (CYP inhibitors)

99
Q

Interaction omeprazoel and CYP

A

Omeprazole is a CYP inhibitor, reduces clopidogrel action

100
Q

Movicol vs lactulose

A

Movicol retains fluid that came with lactulose increases water entry

101
Q

Action of opioid receptor agonist in gut

A

Reduces tone longitudinal and circular smooth muscle, reduce peristalsis and gastronomic reflux

Increasesegmental contraction

102
Q

What class is mesalazine

A

Ainosalicylate

103
Q

Action, SE, W, DI aminosalicylate

A

Action- release 5- aminosalsylic acid at colon to treat UC

SE- nausea, dyspepsia, leukopenia

W- hypersensitivity

DI-breakdown quicker when PPi present

104
Q

SE ranitidine

A

Headache diarrhoea

105
Q

Al vs Mg

A

Mg- diarrhoea

Al- constipation

106
Q

drugs motion sickness

A

cinnirazine, hysoscine hydrobromide

107
Q

prokinetics for GORD/ileus

A

domperidone, metoclopramide

108
Q

general antiemetics for gut problems

A

ondansetron, cyclizine, dexamethasone

109
Q

drugs hyperemesis gravidarum

A

promethazine/prochloroperazine

add metoclopramide

add ondansteron

110
Q

drugs chemo low risk

A

dexamethasone, rescue: metoclopramide

111
Q

drugs chemo high risk

A

dexamethasone plus ondansteron. rescue: metoclopramide

112
Q

high risk chemo drugs

A

dexamethasone, ondansetron, aprepitant. rescue: metoclopramide

113
Q

Mechanism unfractionaed heparin

A

Binding to ATIII, increasing its activity via conformational change

Inhibits IIa by binding to ATIII and IIa

114
Q

Compare half life of two heparin

A

LMWH is longer

115
Q

SE, W, DI heparin

A

SE- thrombocytopenia, bleeding, hyperkalaemia, osteoporosis

W- clotting disorders/ renal impairment

DI- other anti thrombotic drugs, ACEi, ARB, amiloride, spironolactone

116
Q

SE, W, DI warfarin

A

SE- bleeding

W- pregnancy, hepatic disease

DI- CYP2C9

  • amiodarone, clopidogrel, alcohol
  • celaphosprins that reduce vitamin K
  • NSAIDS that reduce GI absorption of vitamin K
  • acceleration of warfarin metabolism - barbiturates, phenytoin, rifampicin, St. John’s wort
117
Q

What does protamine sulphate work for

A

UFH only

118
Q

Examples of DOAC

A

Xa- apixaban, edoxaban, rivaroxaban

IIa- dabigatran

119
Q

SE, W, DI DOAC

A

SE- bleeding

W- low Cr clearance, pregnancy/breastfeeding

DI- CYP inhibitors/inducers
Concentration reduced by carbemazapine, phenytoin and barbiturates

concentration increased by macro lines

120
Q

action quinolones

A

inhibits topisomerase II and so produces no negative supercoil

121
Q

Pain and swelling in 1st MCP joint

A

Gout

122
Q

First step in treating suspected PE

A

Rivaroxaban/ apixaban (DOAC)

123
Q

use lamotrogine

A

focal seizures

124
Q

SE sodium valproate

A

pancreatitis, lethargy, fatigue

125
Q

SE phenytoin

A

zero order kinetics, arrhythmias w iv use, bone marrow supression, hypotension

126
Q

mechanism levetiracetam

A

prevents release of glutamate at synapse

127
Q

use levetiracetam

A

focal and generalised seizures

128
Q

admin of diff benzos

A

lorazepam- IV
diazepam- rectal
midazolam- buccal

129
Q

side effects anti epileptics

A

hypotension, nausea, suicide ideation, osteoperosis, bone marrow failure

130
Q

mechanism COMT inhibitors

A

prevent peripheral breakdown of levadopa

131
Q

examples COMT

A

opicapone, entacapone

132
Q

examples dopamine agonists

A

non ergot- ropinoprole
patch- rotigotine
subcutaneous- apomorphine

133
Q

mechanism and SE amantadine

A
  • treat levadopa indued dyskinesia

- hallucinations, confusion

ESA 4 missing (5 decks)

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