Asprin - Flashcards
(124 cards)
1
Q
Aspirin mechanism
A
Irreversibly inhibits cyclooxygenase -> reduces platelet aggregation
2
Q
Aspirin adverse effects ? Regular high dose ?
A
GI irritation -> ulceration / haemorrhage
Hypersensitivity -> bronchospasm
Regular high dose -> tinnitus
3
Q
Why should children under 16 not get aspirin ?
A
Risk of Reye’s syndrome
Affects liver and brain
4
Q
Why should aspirin not be given in third trimester of pregnancy
A
Prostaglandin inhibition -> premature closure of ductus arteriosus
5
Q
When should you be cautious giving asthma
A
Peptic ulceration
Gout
6
Q
Aspirin interactions
A
Can act synergistically with other antiplatelets
Eg. Clopidogrel , heparin, warfarin
7
Q
Aspirin prescription in acute coronary syndrome
A
Loading dose of 300mg followed by 75mg once daily
8
Q
Aspirin prescription for ischemic stroke
A
300mg daily for 2 weeks -> 75mg daily
9
Q
Aspirin prescription for long term prevention of thrombosis
A
75mg daily
10
Q
What should often be given wi aspirin ? Especially if on what other drugs
A
Gastroprotection eg omeprazole 20mg daily.
Other drugs - prednisolone /NSAIDS
11
Q
Benzodiazepines egs.
A
Diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
12
Q
Benzodiazepines uses
A
First line seizures and status epilepticus
Alcohol withdrawal
Sedation if general anaesthesia undesirable
Short term treatment of severe anxiety / insomnia
13
Q
Benzodiazepines mechanism
A
Facilitate and enhance binding of GABA to GABAa receptor
14
Q
Benzodiazepines adverse effects
A
Drowsiness, sedation and coma.
15
Q
Benzodiazepine overdose ->
A
Loss of airway reflexes -> obstruction
16
Q
Long term benzodiazepine use ->
A
Dependence and withdrawal reaction similar to alcohol
17
Q
Caution giving benzodiazepines to?
A
Elderly
Respiratory impairment / neuromuscular diseas
Liver failure
18
Q
Benzodiazepines interactions
A
Additive to other drugs causing sedation Eg. Alcohol, opioids.
Cytochrome p450 inhibitors (increases effect)
19
Q
Cytochrome p450 inhibitors
A
Amiodarone, diltiazem, macrolides, fluconazole
20
Q
Which benzodiazepines for seizures
A
Longer acting - lorazepam 4mg IV, diazepam 10mg IV
21
Q
Benzodiazepines for alcohol withdrawal
A
Diazepam or chlordiazepoxide
22
Q
Benzodiazepines for sedation
A
Short acting - midazolam
23
Q
Benzodiazepines for insomnia / anxiety
A
Intermediate acting - temazepam 10mg oral
24
Q
Antagonist of benzodiazepines
A
Flumazenil
25
Beta 2 agonists egs
Salbutamol, salmeterol, formoterol, terbutaline
26
B2 agonist uses
Asthma, COPD, hyperkalaemia
27
B2 agonist mechanism
Smooth muscle relaxation
| Stimulate Na/K-ATPase pumps - K from extra cellular -> intracellular
28
B2 agonist adverse effects
Tachycardia, palpitations, anxiety, tremor (fight or flight)
Long acting - muscle cramps
29
What's needed with long acting b2 agonist in asthma
Inhaled corticosteroid
30
Cation with b2 agonists in who?
Cv disease
31
B2 agonist interactions
B blockers prevent.
| Corticosteroids -> hypokalaemia
32
When giving nebuliser for COPD / asthma, do you give with oxygen or air?
Asthma - oxygen
| COPD - air as risk of co2 retention
33
Beta blockers egs
Bisoprolol, atenolol, propranolol, metoprolol
34
B blocker uses
Ischemic heart disease, chronic heart failure, AF, supra ventricular tachycardia.
Hypertension
35
B blocker mechanism
Reduce force of contraction and speed of conduction in heart .
Prolong refractory period of AV node.
Reduce renin secretion
36
Who should never get b blockers
Asthma
| Heart block
37
Caution using b blockers in who
COPD -(use b1 selective eg atenolol, bisoprolol, metoprolol)
Heart failure
Heamodynamic instability
Hepatic failure
38
B blocker important interaction
Don't use with non-dihydropyridine calcium channel blockers -> heart failure and bradycardia
39
Aspirin uses
Acute coronary syndrome and acute ischemic stroke.
Long term prevention of thrombotic arterial events
AF when warfarin is contraindicated
Mild to moderate pain / fever
40
BisPhosphonates egs
Alendronic acid, disodium pamidronate, zolendronic acid
41
Bisphosphonates uses
Osteoporosis
Hypercalcaemia of malignancy
Myeloma / breast cancer with metastases
Pagets
42
Bisphosphonates mechanism
Inhibit action of osteoclasts -> reduce bone turnover
43
Bisphosphonates adverse effects
Oesophagitis, hypophosphataemia
| Rare - osteonecrosis of jaw (good dental hygiene needed), atypical fracture of femur
44
Who should never get BisPhosphonates
Severe renal impairment
Hypocalcaemia
Upper GI disorders
45
Due to risk of osteonecrosis who should BisPhosphonates be caution in?
Smokers
| Dental disease
46
What can limit BisPhosphonate absorption
Calcium salts eg milk / antacids
| As BisPhosphonates bind calcium
47
Alendronic acid for osteoporosis prescription
70mg once weekly
48
Bisphosphates prescription for Hypercalcaemia and bone metastases
Disodium / zolendronic acid as slow IV infusions (takes several days for results)
49
How should alendronic acid tablets be taken
30 mins before food with plenty water
| Stay standing for 30 mins to reduce oesophageal irritation
50
What should be done before BisPhosphonate treatment in osteoporosis
Check and replace calcium / vit D
51
Calcium and vit D uses
```
Osteoporosis
Chronic kidney disease
Severe hyperkalaemia
Symptomatic hypocalcaemia
Vit D deficiency
```
52
Why calcium and vit D in CKD
Prevent and treat secondary hyperparathyroidism / renal osteodystrophy
53
Calcium and vit D egs
Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
54
What controls calcium homeostasis
Parathyroid hormone and vit d
55
Calcium adverse effects
Constipation and dyspepsia
56
Calcium gluconate adverse effect
If given too quickly IV for hyperkalaemia -> cv collapse and local tissue damage if accidentally given IM
57
Which drug cannot be mixed with IV calcium
Sodium bicarbonate (risk of precipitation - solid formed from liquid solution)
58
Oral calcium interactions
Reduces absorption of many drugs eg. BisPhosphonates, tetracycline, levothyroxine
59
Prescription of calcium and vit d in osteoporosis
1g of calcium and 800 units of vit D
60
Hyperkalaemia - calcium prescription
10ml of calcium gluconate IV
61
Calcium channel blockers egs
Amlodipine, nifedipine, diltiazem, verapamil
62
Calcium channel blockers uses
Stable angina
Diltazem / verapamil - supraventricular arrythmias
Amlodipine / nifedipine - hypertension
63
Calcium channel blockers mechanism
Relaxation and vasodilation in arterial smooth muscle
Reduce myocardial contractility
Suppress cardiac conduction
Reduce myocardial oxygen demand
64
Amlodipine / nifedipine adverse effects
Ankle swelling, flushing, headache, palpitations
65
Verapamil adverse effects
Constipation
| Rarely - bradycardia, heart block, Cardiac failure
66
Diltazem adverse effects
Same as Amlodipine nifedipine, verapamil
| As has vascular and cardiac actions
67
Amlodipine and nifedipine should never be given to who
Unstable angina
| Severe aortic stenosis
68
Verapamil and diltiazem should be used in caution with who
Poor LV function
| AV node conduction delay
69
Amlodipine hypertension prescription
5-10mg orally
70
Angina diltiazem prescription
90mg orally 12 hourly
71
Verapamil prescription for supraventricular arrhythmia
40-120mg 8 hourly
72
Carbamazepine uses
Epilepsy - focal with /out 2 generalisation. 1 generalised
Trigeminal neuralgia
Bipolar disorder
73
Carbamazepine mechanism
Inhibits neuronal sodium channels
74
Carbamazepine adverse effects
GI upset, dizzy and ataxia, oedema, hyponatraemia.
| Rarely - antiepileptic hypersensitivity syndrome
75
What is antiepileptic hypersensitivity syndrome
After taking carbamazepine / phenytoin -> eg Stephen Johnson / fever / lymphadenopathy
76
Caution giving carbamazepine to who
Pregnant
| Hepatic, cardiac or renal disease - toxicity
77
What enzyme is induced by carbamazepine ? Egs of drugs reduced
Cytochrome p450
| Warfarin, oestrogens, progesterones
78
What increases effects of carbamazepine (caution)
P450 inhibitors (as metabolised) eg macrolides
79
What reduces efficacy of antiepileptics ? Egs
Drugs that lower seizure threshold eg SSRIs, tricyclics, antipsychotics, tramadol
80
Prescription of carbamazepine
Start at low dose 100-200mg 12hrly
| Increase gradually up to max 1.6g / day
81
Usual first choice drug for focal seizures
Carbamazepine
82
Cephlasporins eg
Cefalexin, cefotaxime
83
Carbapenems egs
Meropenem, ertapenem
84
Cephasporins and carbapenems uses
Severe / complicated / antibiotic resistant infections
| 2nd line for uti / Rti
85
Cephlasporins / carbapenems mechanism
Due to thier b lactam ring -> bacterial swelling, lysis and death
Resistance to b lactamases
86
Carbapenems / cephlasporins adverse effects
C. difficile
Hypersensitivity
Risk of CNS toxicity -> seizures
87
Caution for carbapenems / cephlasporins
Epilepsy / renal impairment
| NEVER if anaphylaxis to penicillins
88
Cephlasporins / carbapenems interaction
```
Increase warfarin (as kills gut flora that synthesise vit k)
Reduce valproate
```
89
Clopidogrel uses
Acute coronary syndrome
Prevent occlusion of coronary artery stents
Long term prevention of thrombotic arterial disease
Reduce risk of embolism from AF
90
Clopidogrel mechanism
Prevents platelet aggregation by binding to adenosine diphosphate (ADP) receptors
91
What is usually prescribed alongside clopidogrel
Aspirin as clopidogrel doesn't effect COX pathway so synergistic together
92
Clopidogrel adverse effects
Bleeding
GI upset
Thrombocytopenia
93
How long before elective surgery should clopidogrel be stopped
7 days
94
When should be cautious for clopidogrel
Renal / hepatic impairment
95
What needs to happen for clopidogrel to be activated
Requires metabolism by p450
96
P450 inhibitors egs
Omeprazole, Ciproflaxacin, erythromycin, some antifungals, SSRIs
97
Clopidogrel dose
```
75mg daily
(May need loading dose 300mg
```
98
Compound b2-agonist - corticosteroid inhalers adverse effects
Local - horse voice, oral thrush
Long term - systemic from steroids
B2 - tremor, tachycardia, muscle cramps
99
Systemic effects from long term inhaled corticosteroids
Adrenal suppression, growth retardation in children, osteoporosis
100
Cautious of combined inhalers in who
COPD with Hx of pneumonia (increased risk)
Children (growth)
Cv disease
101
Egs of combined inhalers
Seretide, symbicort
102
Tell Pt getting combined inhalers
Need to take without fail - takes hours / days to notice improvement
Rinse mouth and gargle to help mouth side effects
103
Egs of systemic corticosteroids
Prednisolone, hydrocortisone, dexamethasone
104
Systemic glucocorticoids uses
Allergy / inflammatory
Autoimmune
Cancer - reduce tumour related swelling
Hormone replacement - adrenal insufficiency / hypopituitarism
105
Adverse effects of systemic corticosteroids
Immunosupression
Metabolic - diabetes / osteoporosis
Weakness, easy bruising, mood and behavioural
Mineralcorticoid - hypertension, hypokalaemia, oedema
Adrenal atrophy (suppression of ACTH from pit)
106
Sudden withdrawal of systemic corticosteroids ->
Addisonian crisis -> cv collapse
107
Cautious with systemic corticosteroids in who
People with infection
| Children (growth)
108
Systemic Corticosteroids mechanisms
Upregulate anti inflammatory
Down regulate pro inflammatory
Metabolic - increased gluconeogensis from catabolism of muscle / fat
Mineralcorticoid - Na / water retention and k excretion
109
What drugs reduce efficacy of systemic corticosteroids
P450 inducers - phenytoin, carbamazepine, rifampicin
110
Which is the most potent systemic corticosteroid
Dexamethasone (750 micrograms = pred 5mg = hydro 20mg)
111
What to tell patients getting systemic corticosteroids
Not to stop suddenly
| Should start to feel better in 1-2 days
112
Inhaled corticosteroid egs
Beclometasone, budesonide, fluticasone
113
Inhaled corticosteroid effects in lungs
Reduces mucosal inflammation, bronchodilation, reduce mucus secretion
114
Adverse effects of inhaled corticosteroids
Oral thrush
Horse voice
May increase risk of pneumonia
115
Inhaled corticosteroid caution in
Hx of pneumonia
| Children
116
Inhaled corticosteroid how many times daily
Twice
117
Needs to be checked with any inhaler
Technique
118
Poorly controlled airway inflammation in asthma ->?
Airway remodelling
119
Topical corticosteroid egs
Hydrocortisone
| Betamethasone
120
Topical corticosteroid uses
Eczema / inflammatory skin conditions
121
Local adverse effects of topical corticosteroids
Skin thinning
Telangiectasia
Contact dermatitis
122
Withdrawal of topical corticosteroids
Rebound worsening of underlying condition
123
Should not use topical corticosteroids in who
Where infection
| Facial lesions
124
How to use right amount of corticosteroid cream
Squeeze tip of finger to first crease -> area double size of Palm
