8. Flashcards
(20 cards)
What medications should be used in caution in IHD?
- NSAIDs
- oestrogens: e.g. combined oral contraceptive pill, hormone replacement therapy
- varenicline
What’s type A adverse reaction?
common, predictable and dose-related
What’s type B adverse reaction?
Type B (idiosyncratic)
bizzare and unexpected reaction related to gene/host/environmental factors
P450 system inducers
- antiepileptics: phenytoin, carbamazepine
- barbiturates: phenobarbitone
- rifampicin
- St John’s Wort
- chronic alcohol intake
- griseofulvin
- smoking (affects CYP1A2, reason why smokers require more aminophylline)
P450 inhibitors
- ntibiotics: ciprofloxacin, clarithromycine/erythromycin
- isoniazid
- cimetidine,omeprazole
- amiodarone
- allopurinol
- imidazoles: ketoconazole, fluconazole
- SSRIs: fluoxetine, sertraline
- ritonavir
- sodium valproate
- acute alcohol intake
- quinupristin
SEs of Gentamycin and Vancomycin
- ototoxicity
- nephrotoxicity
SEs of any antibiotics bit most commonly broad-spectrum e.g. Cephalosporins, ciprofloxacin
C difficile colitis
SEs of ACE0 inhibitors
- hypotension
- electrolyte imbalance
- AKI
- dry cough
Do beta-blockers help or worsen heart failure?
- Worsen ACUTE HF
- Help CHRONIC HF
SEs of beta-blockers
- hypotension
- bradycardia
- wheeze in asthmatics
- worsen acute HF (help with chronic)
SEs of Calcium-channel blockers e.g. amlodipine, diltiazem
- hypotension
- bradycardia
- peripheral oedema
- flushing
SEs of diuretics (overal)
- hypotension
- electrolyte abnormalities
- AKI
* then sub-class dependent effects e.g. gynecomastia with spironolactone
SEs of Heparin
- haemorrhage (especially if <50 kg or renal failure)
- heparin-induced thrombocytopenia
What to do when we prescribe Warfarin (at the beginning of the treatment)?
To start with Warfarin has a pro-coagulant effect and it takes few days to become anti-coagulant
Therefore heparin should be prescribed alongside Warfarin - until INR is above 2
SEs of Aspirin
- haemorrhage
- peptic ulcers
- gastritis
- tinnitus (in large doses)
Can NSAIDs and ACE-inhibitors be prescribed together?
No - as both modify renal arteries and can lead to renal impairment
Do not prescribe together, especially in elderly and renal impairment patients
(2) classes of drugs that may cause gastritis and gastric ulcers
- steroids
- NSAIDs
(2) drug classes that cause hyperkalaemia
- potassium sparing diuretics
- ACE inhibitors
(try not to prescribe in combination; if necessary monitor electrolytes regularly, especially after dose adjustment)
SEs of Digoxin
- nausea, vomiting
- diarrhoea
- blurred vision
- confusion and drowsiness
- xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)
