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Year 4 Pharmacology > ACC drugs > Flashcards

ACC drugs Flashcards

1
Q

Adenosine indications

A

SVT - diagnostic and therapeutic

Reduces spontaneous depolarisation + increases resistance to depolarisation, breaking the re-entry circuit.

Will induce cardioversion (SAN resume control of HR) in SVT = can help diagnose it.

Very short acting. Always given IV.

Requires continuous cardiac monitoring

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2
Q

Adenosine side effects and CI

A

Bradycardia/asystole

“impending sense of doom”

CI: hypotension, coronary ischaemia, HF, asthma

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3
Q

Atropine indications and MOA

A

Severe or symptomatic bradycardia (used as an emergency drug in anaesthetics)

Anti-muscarinic = competitively inhibit acetylcholine, preventing parasympathetic “rest and digest” responses.

Increases heart rate.

IV administration and supervision needed.

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4
Q

Atropine side effects and CI

A

SE; tachycardia, dry mouth, constipation, urinary retention, blurred vision.

CI; angle closure glaucoma (increase intraocular pressure), arhythmias

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5
Q

Amiodarone indications and MOA

A

Tachyarrythmias when other other drugs/cardioversion have been unsucessful (incl AF, VF, VT, SVT)

Blocks Na+, Ca2+, K+ channels and is a a and b adrenergic receptor antagonist.

Reduces ventricular rate by reducing spontaneous depolarisation, slowing conduction velocity and increasing resistance to depolarisation.

Increases chance of conversion to and maintenance of sinus rhythm.

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6
Q

Amiodarone SE and and CI

A

Acute SE: hypotension during infusion

Chronic SE: pneumonitis, bradycardia, AV block, hepatitis, photosensitivity, grey discolouration of skin, IODINE ABNORMALITIES

CI: severe hypotension, heart block, thyroid disease

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7
Q

Adrenaline indications

A

Cardiac arrest

Anaphylaxis

Local vasoconstriction to control bleeding/prolong local anaesthetic

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8
Q

Adrenaline MOA

A

Enhances sympathetic nervous system.

Peripheral vasoconstriction and cardiac vasodilation, positively inotropic and chronotropic –> helps redistribute blood towards the heart in cardiac arrest.

Bronchodilation and suppression of inflammatory mediator release from mast cells –> helps in anaphylaxis

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9
Q

Adrenaline SE and CI

A

SE; hypertension, anxiety, tremor, arrhythmias, palpitations

NEVER CI IN CARDIAC ARREST/ANAPHYLAXIS but should be avoided in heart disease for local vasoconstriction

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10
Q

Adrenaline dose in cardiac arrest and anaphylaxis

A

Cardiac arrest: IV 1:10,000 (1mg in 10ml) + 10ml NaCl flush

Anaphylaxis: IM 1:1000 (1mg in 1ml)

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11
Q

Metoprolol indications

A

IV beta blocker of choice for ACS as short half life so more responsive to dose adjustment and can be stopped quickly if necessary (change to bisoprolol once stable)

Negatively inotropic and chronotropic, relieving myocardial work and thus ischaemia.

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12
Q

Metoprolol SE and CI;

A

SE; fatigue, cold extremeties, headache, GI disturbance, sleep disturbance, impotence in men.

CI; asthma, heart block

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13
Q

Calcium chloride indications

A

Cardiac arrest - positively inotropic, so can stabilise contraction of myocytes in cardiac arrest.

Must be given IV

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14
Q

Calcium chloride SE

A

Acidosis

Hypotension (causes peripheral vasodilation)

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15
Q

Nitrates indications

A

Acute angina and ACS
Buccal - GTN
IV - isosorbide mononitrate

Relax venous capitance muscles, reducing cardiac preload, reducing cardiac work and thus myocardial oxygen demand.

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16
Q

Nitrates SE and CI

A

SE: flushing, light headedness, hypotension

CI: aortic stenosis, haemodynamic instability, hypotension

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17
Q

Aspirin indications (+dose)

A

ACS = 300mg loading dose, then 75mg daily

Ischaemic stroke = 300mg daily for 2 weeks

Reduces platelet aggregation and therefore risk of arterial occlusion.

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18
Q

Aspirin SE and CI

A

SE: GI irritation (e.g. peptic ulcer), bronchospasm (hypersensitivity)
PRESCRIBE GASTRIC PROTECTION (PPI) ALONGSIDE

CI: children under 16, third trimester of pregnancy

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19
Q

Ticagrelor indications

A

ACS = in combination with aspirin as rapid platelet aggregation inhibition can prevent/limit arterial thrombosis.

Use 300mg loading dose, then 75mg daily

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20
Q

Ticagrelor SE and CI

A

SE: bleeding, GI upset, thrombocytopenia

CI: active bleeding

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21
Q

LMWH indications

A

ACS = to reduce clot prevention or maintain revascularisation

VTE prophylaxis

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22
Q

LMWH SE

A

SE; haemorrhage, hyperkalaemia

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23
Q

Vitamin K (phytomenadione) indications

A

Reverse anti-coagulation effect of warfarin (give alongside prothombin comlplex in major bleeding)

Provides a fresh supply of vitamin K for synthesis of vitamin K dependent clotting factors.

MUST BE GIVEN IV IN MAJOR OR MINOR BLEEDING

10mg IV given in major bleeding.

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24
Q

Alteplase indications and MOA

A

Acute ischaemic stroke (within 4.5 hrs)

STEMI (within 12 hrs if PCI not immediately available)

Massive PE with haemodynamic instability

PATIENTS MUST BE MONITORED IN HIGH DEPENDENCY UNIT

MOA; dissolves fibrinous clots

25
Q

Alteplase SE and CI

A

SE: n+v, bruising, hypotension, bleeding, cardiogenic shock.
Reperfusion of infarcted brain = cerebral oedema
Reperfusion of infarcted heart = arrythmias

CI: bleeding, intracranial haemorrhage

26
Q

Prednisolone indications

A

Anaphylaxis
Acute asthma

Modify the immune response and suppress inflammation

27
Q

Nimodipine indications

A

SAH

Ca2+ channel blocker, reduces vasospasm

28
Q

Pharmacological management of acute asthma

A

O-SPIM

Oxygen
Salbutamol nebs (5mg) back to back
Prednisolone (PO) or IV hydrocortisone 
Ipratropium (if severe)
Mg2+ IV if not improving
29
Q

Pharmacological management of acute COPD exacerbation

A

COSICAAR

Controlled oxygen 
Salbutamol nebs (5mg)
Ipratropium 
Corticosteriods (prednisolone PO or hydrocortisone IV)
Antibiotics 
Aminophylline (if not improving) 
Respiratory support (e.g. NIV)
30
Q

Octaplex indications

A

Warfarin overdose.

Used when rapid correction is required

Contains vitamin K dependent clotting factors (1972 - X, IX, VII, II)

31
Q

Warfarin indications

A

VTE Tx (after initial tx with heparin - warfarin takes several days to fully establish anti-coagulation)

Secondary VTE prophylaxis

Prophylaxis of arterial embolism in AF

Inhibits production of vitamin K dependent clotting factors

32
Q

Warfarin SE and CI

A

SE: bleeding (from minor trauma)

CI: first trimester of pregnancy, patients at immediate risk of bleeding, use with caution in liver disease.

Check INR

33
Q

Tranexamic acid (TXA) indications and MOA

A

Given alongside packed RBC transfusion to reduce coagulopathy and increase survival.

Works by preventing fibrinolysis §

34
Q

Clopidogrel indications and dose

A

ACS in combination with aspirin

Rapid inhibition of platelet aggregation can limit arterial thrombosis and improve mortality.

300mg loading dose used, then 75mg for maintenance

35
Q

Entonox indications

A

Analgesia (short term for painful procedures such as acute trauma)

50:50 Nitrous oxide: oxygen

36
Q

CI of entonox

A

Can raise ICP so do not use in head injury

Also avoid in pneumothorax/intestinal obstruction –> expansion of air would be dangerous

37
Q

Ketamine indications in trauma

A

Reduces pain and agitation (produces dissociative sedation)

Can make patient unaware of their surroundings, while also allowing them to maintain their own airway

Facilitates painful, short ED procedures

38
Q

Morphine in ED

A

Acute, severe pain treatment

2-10mg IV initial dose

39
Q

N-acetylcystine indications and MOA

A

Paracetamol poisoning (weight-adjusted dose, given IV)

Replenishes glutathione supplies so that it can bind to the hepatotoxic paracetamol metabolite (NAPQI) and detoxify it.

CAUTION; can produce anaphylactoid reaction

40
Q

Naloxone indications and MOA

A

Opioid overdose
400-1200 micrograms IV (titrated to effect)

CAUTION; can cause opioid withdrawal if patient has opioid dependence

41
Q

Diazepam indications in A&E and doses

A

First line for alcohol withdrawal reactions (dose is individual dependent)

First line for management of seizures/status epilepticus (10mg IV)

Short term treatment of agitation/anxiety (lowest possible dose)

42
Q

Diazepam SE and CI

A

SE; drowziness, sedation, coma, long-term use can produce dependence

AVOID in elderly, respiratory impairment, neuromuscular disease and liver failure.

43
Q

Sodium bicarbonate indications and MOA

A

Tricyclic anti-depressent (e.g. amitryptiline) overdose

Helps correct hypotension and prevent arrythmias

44
Q

Insulin dextrose indications, dose and MOA

A

Hyperkalaemia

10 units ACTRAPID in 25g of dextrose (25g in 100ml) infused over 15 mins

Insulin drives cellular K+ uptake, must be given alongside dextrose to prevent hypoglycaemia

45
Q

Insulin therapy for DKA

A

1 unit/ml = 50 units ACTRAPID in 50ml 0.9% NaCl

Adjust infusion rate as necessary

46
Q

Inotropes indications, MOA and examples

A

Low CO, causing tissue hypoperfusion and shock (e.g. cardiogenic shock following MI)

Increase force/strength of myocardial contractility, increasing CO, MAP and vital organ perfusion

E.g. dobutamine

47
Q

Lorezapam indications

A

Seizures/status epilepticus (4mg IV)

48
Q

Haloperidol indications in A&E

A

Acute agitation/violent behaviour (anti-psychotic)

Give single dose (amount depends on clinical context and patient)

use with caution in elderly patients who are particularly sensitive (+ dementia/Parkinsons)

49
Q

Indications for packed RBC

A

Acute blood loss
Symptomatic anaemia

1 unit increases Hb by 10g/L

50
Q

Indications for FFP

A

DIC
Haemorrhage secondary to liver disease
All massive haemorrhages (usually given after 2nd unit of packed red cells)

Give over 30 mins

51
Q

Indications for platelets

A

Haemorrhagic shock in trauma patient

Thrombocytopenia

Given over 30 mins

52
Q

First choice antibiotics for COPD exacerbation

A

Amoxicillin (500mg TDS for 5 days)
Doxycycline (200mg then 100g OD for 5 days)
Clarythromycin (500mg BD for 5 days)

53
Q

Antibiotic management of meningitis in community vs hospital

A

Community = IM benzylpenicillin ASAP

hospital = IV ceftriaxone

54
Q

Antibiotics for cellulitis

A

Flucloxacillin 500-1000mg QDS for 5-7 days

Clarythromycin if penicillin allergy

55
Q

Antibiotics for CAP and HAP

A

CAP: co-amoxiclav/clarythromycin for 7 days

HAP: IV aminoglycoside (gentamycin) and cephalosporin

56
Q

Antibiotics for cystitis

A

trimethoprim/nitrofurantoin
3 days for women
7 days for men

57
Q

Antibiotics for pyelonephritis

A

Co-amoxiclav (broad-spectrum), then according to local guidelines

58
Q

Prothrombin complex concentrate (PCC) indications

A

Reverse warfarin when the INR is high.

Contains clotting factors X, IX, VII, II

Give alongside vitamin K in major bleeding

Year 4 Pharmacology (6 decks)

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