cpt stuff Flashcards
1
Q
first line antihypertensive if have type 2 diabetes
A
ACEi
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
3
Q
which antihypertensve pregnancy
A
labetelol
4
Q
which antihypertensive causes damage while breastfeeding
A
nifedipine
5
Q
aminoglycosides and loop
A
ototoxicity, nephrotoxicity
6
Q
digoxin and thiazide/loop
A
hypokalaemia
7
Q
b blockers and thazide
A
hyperglycaemia, hyperlipidemia, hyperuricaemia
8
Q
steroid and thiazide and loop
A
hypokalaemia
9
Q
carbemazapine and thiazide
A
hyponatraemia
10
Q
ADR thiazide
A
gout, hyperglycaemia, ED, increased LDL, hypercalcaemia
11
Q
ADR frusemide
A
ototoxocity, alkalosis, increaed LDL, gout
12
Q
SE alpha blocker
A
postural hypotension, dizziness, fatigue
13
Q
drug interactions alpha blocker
A
people affected by dihydropiridine CCB, makes oedema worse
14
Q
contraindications beta blockers
A
hepatic failure, haemodynamic instability, asthma
15
Q
SE phenylalkamines
A
heart block, cardiac failure, bradycardia, constipation
16
Q
thiazide SE
A
hypokalaemia, hyponatraemia, gout, arrhythmia, increased glucose
17
Q
warnings thiazdie
A
hypokalaemia, hyponatriaema, gout
18
Q
DI statins
A
CYP 3A4 important – amiodarone, diltiazem, macrolides - increases [plasma] statin Remember amlodipine (CCB) also increases [plasma] statin
19
Q
nocte
A
at night
20
Q
why take statins nocte
A
most cholesterol made at night
21
Q
aim of statin treatment
A
> 40% reduction in non HDL-C at three months
22
Q
when is ezetimibe combined with statin
A
in CKD and secondary CVS prevention, those who can only tolerate low dose statin
23
Q
when is fibrates and statin used
A
famiilial hypercholesterolaemia
24
Q
aim of secondary prevention LDL levels
A
1.8mmol/L LDL-C (<2.5mmol/L non HDL-C)
25
which foods naturally lower cholesteron
fish oils, fibre, vitamin c/e
26
what absolute cholesterol level triggers treatment
5mmol/L
27
what affects COCP effectiveness
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
28
effect of oestrogen on PR
increases
29
effect of progesterone on ER
decreases
30
contraindicatons and warnings metformin
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
31
which diabetic drugs cause weight gain and how
glitazones - fat cell differentiation
| sulfonurea- increased anabolic effects of insulin
32
which diabetic drug pancreatitis
dipeptidyl peptidase 4 inhibitors- sitagliptin, saxagliptin
33
why dipeptidyl peptidase 4 inhbitors lower hypoglycaemia risk
does not stimulate insulin production at normal glucose levels as is glucose dependent
34
which diabetic drugs cause weight loss and how
metformin- suppress appetite
GLP-1 agonist- reduced appetite
SGLT2
35
mechanism glitazones
insulin sensitisation, upregulation of ppary
36
SE, W, DI DPP4 inhibitors
se- pancreatitis
w- pregnancy, Hx pancreatitis
DDI- thiazide/loop as increase glucose, other hypoglycaemics
37
SE, W, DI sulfonurea
se- hyopoglycaemia and gi upset
w- hepatic impairment
di- other hypoglycaemics, thiazide and loop diuretics
38
se, w, di GLP-1 agonists
se- weight loss, hypoglycaemia
w- renal impair,emt
di- other hypoglycaemics
39
how are GLP-1 administered
subcutaneously- as hormone
40
why is renal SE/DI so important for metformin?
it is only renally excreted unchanged
41
half life equation
t1/2= (0.693 x Vd ) / CL
42
loading dose equation
loading dose =( Css x Vd ) bioavalibility (usually 1)
| Css= desired concentration in plasma
43
maintenence dose
(clearance x [plasma] wanted /bioavalibility) x dose interval
44
theraputic index
toxic dose/ theraputic index
45
volume of distribution =
Vd = dose / plasma concentration drug in L/Kg(!!!)
46
which drug ventricular ectopic beat
bisoprolol
47
cardiac and ecg effects class IV
reduce phase 4, reduce AV, increase APD
| increase PR
48
ECG class III sotalol
increase QT
49
use class Ic
WPW, atrial fluttter/fibrillations, premature ventricular contractions
50
use class Ib
ventricular tachycardia
51
cardiac effects Ib
increase qrs
52
warnings and contraindications ADP receptor antaognist
high bleed risk, hepatic and renal impairment
53
transplantation drugs
calcineurin inhibitor, mycophenolate mofetil
54
IBS drugs
azathioprine, sulfasalazine
55
skin drugs
calcineurin inhbibitors, methotrexate
56
RA drugs
methotrexate
57
effect of NSAIDs on RA management
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
which drug has weekly dosing
methotrexate
59
how do prostoglandins cause ADR when taking NSAID
- prostoglandins dilate afferent,. when NSAID removes them renal blood flow reduces causing reduced GFR
- NSAIDs also constrict afferent arteriole, increasing effect seen
60
compare ipratropium and tiotropium
ipratropium is SAMA, tiotropium is LAMA
61
prescribing considerations LABA
must be given alongside ICS to prevent masking of life threatening symptoms
62
why difference in delivery of nebulised ipratroprium bromide COPD and asthma patients
if patient is hypercapnic, nebuliser is driven by air not o2
63
why fentanyl godo
- patches
- short half lfie
- high affinity and potency
64
isobride mononitrate
nitrate
65
tranexamic acid
inhibits the activation of plasminogen from plasmin
66
tetrabluine
SABA
67
long acting muscarinic
tiotropium bromide
68
short acting muscarinic
ipratropium bromide
69
fluticasone
corticosteroid inhaled
70
midazolam
buccal benzodiazapine
71
diamorphine, methadone, tramadol
opoid receptor agonist
72
rapid insulin
insulin aspart
73
short insulin
soluble- actrapid/humulin s
74
intermediate insulin
isophane insulin
75
long acting insulin
insulin degludec, insulin glargine
76
oestrogen steroid hormone
estradiol
77
synthetic progesterone
desogestrel, medroxyprogesterone acetate, norethisterone, levonorgestrel
78
Interaction metronidazole and warfarin
Metronidazole inhibits CYP2C9 and warfarin is broken down by CYP2C9
This increases warfarin concentration
79
What does CYP3A4 affect
Statins, verapamil
80
What does CYP 2C9 affect
Warfarin
81
Drugs with CYP2D6
Antidepressants, antipsychotics, b blockers, opioid analgesics
82
CYP 450 inducers (4)
Rifampicin
Carbemazapine
Omeprazole
Phenytoin
83
Cyp 450 inhibitors
```
Ciprofloxacin
Antifungals
Fluoxetine
Paraoxetine
HIV antivirals
```
84
Cyclophosphamide and cyps
Pro drug, needs CYP 45 to activate it
85
CYP 1A2 substrates, inducers and inhibitors
Substrates- haloperidol, naproxen, paracetamol, theophylline, verapamil
Inducers- carbemazapine
Inhibitors- amiodarone, grapefruit juice
86
CYP 2C8 substrates, inducers and inhibitors
Substrate- montelukast
Inducers- phenobarbital, rifampicin
Inhibitors- montelukast, trimethoprim
87
CYP 2C9 substrates, inducers and inhibitors
Substrates- celecoxib, diclofenac, ibuprofen, losartan, S-warfarin
Inducers- carbemazapine, rifampicin, St. Johns wort
Inhibitors- amiodarone, metronidazole, valproric acid
88
CYP 2C19 substrates, inducers and inhibitors
Substate- clopidogrel, cyclophosphamide, diazepam, gliclazide, omeprazole, phenytoin, warfarin
Inducers - rifampicin, St. John’s wort
Inhibitors- fluoxetine, omeprazole, oral contraceptives
89
CYP 2D6 substate, inducers and inhibitors
Substrate- bisoprolol, codeine, flecainide, haloperidol, metoprolol, ondansetron, propranolol, tramado
Inducers- carbemazapine, phenytoin, rifampicin
Inhibitor- amiodarone, fluoxetine, some antivirals
90
CYP2E subtrates, inducers, inhibitors
Substate- ethanol, gaseous anaesthetics, paracetamol
Inducers- ethanol
Inhibitors- ethanol
91
CYP3A4 substrate, inducer, inhibitor
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
Theophylline cyps
Cyp450 inhibitors increase concentration of theophylline
93
What cyp is involved with warfarin
CYP2C9
94
Which CYP statins
CYP3A4
95
Which CYP fentanyl
CYP3A4
96
Which CYP codeine
CYP 2D6 pro drug
97
Which CYP buprenorphine
CYP 3A4
98
Which CYP ADP RA
Clopidogren needs CYP activation
Caution with omeprazole, cipofloaxin (CYP inhibitors)
99
Interaction omeprazoel and CYP
Omeprazole is a CYP inhibitor, reduces clopidogrel action
100
Movicol vs lactulose
Movicol retains fluid that came with lactulose increases water entry
101
Action of opioid receptor agonist in gut
Reduces tone longitudinal and circular smooth muscle, reduce peristalsis and gastronomic reflux
Increasesegmental contraction
102
What class is mesalazine
Ainosalicylate
103
Action, SE, W, DI aminosalicylate
Action- release 5- aminosalsylic acid at colon to treat UC
SE- nausea, dyspepsia, leukopenia
W- hypersensitivity
DI-breakdown quicker when PPi present
104
SE ranitidine
Headache diarrhoea
105
Al vs Mg
Mg- diarrhoea
| Al- constipation
106
drugs motion sickness
cinnirazine, hysoscine hydrobromide
107
prokinetics for GORD/ileus
domperidone, metoclopramide
108
general antiemetics for gut problems
ondansetron, cyclizine, dexamethasone
109
drugs hyperemesis gravidarum
promethazine/prochloroperazine
add metoclopramide
add ondansteron
110
drugs chemo low risk
dexamethasone, rescue: metoclopramide
111
drugs chemo high risk
dexamethasone plus ondansteron. rescue: metoclopramide
112
high risk chemo drugs
dexamethasone, ondansetron, aprepitant. rescue: metoclopramide
113
Mechanism unfractionaed heparin
Binding to ATIII, increasing its activity via conformational change
Inhibits IIa by binding to ATIII and IIa
114
Compare half life of two heparin
LMWH is longer
115
SE, W, DI heparin
SE- thrombocytopenia, bleeding, hyperkalaemia, osteoporosis
W- clotting disorders/ renal impairment
DI- other anti thrombotic drugs, ACEi, ARB, amiloride, spironolactone
116
SE, W, DI warfarin
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
What does protamine sulphate work for
UFH only
118
Examples of DOAC
Xa- apixaban, edoxaban, rivaroxaban
IIa- dabigatran
119
SE, W, DI DOAC
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
action quinolones
inhibits topisomerase II and so produces no negative supercoil
121
Pain and swelling in 1st MCP joint
Gout
122
First step in treating suspected PE
Rivaroxaban/ apixaban (DOAC)
123
use lamotrogine
focal seizures
124
SE sodium valproate
pancreatitis, lethargy, fatigue
125
SE phenytoin
zero order kinetics, arrhythmias w iv use, bone marrow supression, hypotension
126
mechanism levetiracetam
prevents release of glutamate at synapse
127
use levetiracetam
focal and generalised seizures
128
admin of diff benzos
lorazepam- IV
diazepam- rectal
midazolam- buccal
129
side effects anti epileptics
hypotension, nausea, suicide ideation, osteoperosis, bone marrow failure
130
mechanism COMT inhibitors
prevent peripheral breakdown of levadopa
131
examples COMT
opicapone, entacapone
132
examples dopamine agonists
non ergot- ropinoprole
patch- rotigotine
subcutaneous- apomorphine
133
mechanism and SE amantadine
- treat levadopa indued dyskinesia
| - hallucinations, confusion
