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Phase 2a medicine > Drug treatment > Flashcards

Drug treatment Flashcards

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1
Q

What class of drugs are anti-thyroid drugs?

A

Thionamides

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2
Q

Name a thionamide

A

Carbimazole

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3
Q

Name a thyroid hormone

A

Levothyroixine

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4
Q

Name a somatostatin analogue

A

Octreotide

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5
Q

Name a dopamine agonist

A

Cabergoline

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6
Q

Name a GH agonist

A

Pegvisomant

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7
Q

Name an aldosterone agonist

A

Spironolactone

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8
Q

When would you give spironolactone in Conn’s syndrome?

A

4 weeks pre-op to control BP and K+

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9
Q

What do you replace aldosterone with in Addison’s?

A

Fludrocortisone

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10
Q

What do you replace cortisol with in Addison’s?

A

Hydrocortisone

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11
Q

How do you treat cranial DI?

A

Desmopressin

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12
Q

How do you treat nephrogenic DI?

A

Bendroflumethazide

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13
Q

Name a vasopressin receptor antagonist

A

Tolvaptan

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14
Q

What intake issues can lead to hypokalaemia?

A

Fasting

Anorexia

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15
Q

What intake issues can lead to hyperkalaemia?

A

Excessive consumption at a fast rate - IV fluids

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16
Q

What excretion issues can lead to hypokalaemia?

A

High secretion due to high aldosterone

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17
Q

What excretion issues can lead to hyperkalaemia?

A

Low secretion due to low aldosterone, ACEi, AKI

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18
Q

How does insulin cause hypo- and hyperkalaemia?

A

Excess insulin = too much K+ follows insulin into cell therefore hypokalaemia

Deficiency - not enough K+ follows into cell therefore hyperkalaemia

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19
Q

How does pH cause hypo- and hyperkalaemia?

A

Alkalosis - H+ out and K+ in therefore hypokalaemia

Acidosis - H+ in and K+ out therefore hyperkalaemia

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20
Q

How do B2 receptors lead to hypo- and hyperkalaemia?

A

B2 agonists increase B2 pumping of K+ into cell

B blocker - inhibits pumping of K+ into cell

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21
Q

How does cell lysis cause hyperkalaemia?

A

Intracellular condense released

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22
Q

What are the symptoms of hypokalaemia?

A

Everything slows
Constipation
Weakness/cramps
Arrhythmias and palpitations

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23
Q

What are the symptoms of hyperkalaemia?

A

Cramping
Weakness/flaccid paralysis due to over contraction of muscles and them becoming drained of energy
Arrhythmias and arrest

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24
Q

How does hypokalaemia look on an ECG?

A

U waves
No T waves/inversion
Long PR and long QT

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25
How does hyperkalaemia present on an ECG?
Tall tented T waves Small P waves Wide QRS
26
How is non-urgent hyperkalaemia treated?
Polystyrene sulphonate resin
27
How is urgent hyperkalaemia treated?
Calcium gluconate | Insulin
28
How do you treat hypercalcaemia?
Rehydration Bisphosphonates Oral prednisolone
29
What are the cyanotic congential heart defects?
Tetralogy of Fallot Truncus arteriosus - one single vessel from ventricles TGA - transposition of great vessels (Can only be fixed via surgery)
30
What are the acyanotic congenital heart defects?
``` PDA VSD ASVD Patent ductus arteriosus Valve disorders ```
31
What are the symptoms of congential heart defects?
``` Stunted growth in childhood Failure to thrive Finger clubbing Syncope Central cyanosis Pulmonary hypertension ```
32
What are the symptoms of aortic stenosis?
Angina Loss of consiousness on exertion HF marked by SOB
33
What are the signs and symptoms of aortic regurgitation?
``` Palpitations SOB on exertion Angina Water hammer pulse Murmur Quinke's sign - pulsating nail bed De Musset's sign - head nodding with heart beat ```
34
Mitral stenosis symptoms and signs
``` Progressive SOB Increased risk of vessel rupture marked haemoptysis AF Jugular vein pulsations Diastolic murmur ```
35
Signs and symptoms of mitral regurgitation
Dyspnoea on exertion Fatigue Symptoms of congestive HF AF
36
Immediate management of MI
``` MNAC Morphine Nitrates Aspirin Clopidogrel ```
37
STEMI ECG changes
ST elevation Tall T waves Pathological Q waves
38
NSTEMI ECG changes
ST depression | T inversion
39
Atrial flutter ECG changes
Saw tooth
40
Treatment of tachycardias
Beta blockers - slow heart | Amiodarone controls rhythm
41
Aortic dissection symptoms
Tearing pain to back Fast onset Emergency - risk of bleeding out Risk of hypovolaemic shock
42
Coarctation of aorta symptoms
``` Tearing pain to back Narrowing of aorta restricting carotid flow Fast onset Emergency Radio-femoral delay ```
43
Dilated cardiomyopathy causes
Alcohol Ischaemia Previous MI Dilated LV leading to poor contraction of heart
44
Restricted cardiomyopathy causes
Idiopathic Sarcoidosis Rigid myocardium causes decreased ventricular volume
45
Hypertrophic cardiomyopathy causes
Autosomal dominant mutation of sarcomere genes Impaired diastolic filling
46
Arrhythmogenic cardiomyopathy causes
Most likely genetic RV replaced by fat causing inflammatory response
47
Cardiomyopathies presentation
``` Dyspnoea Fatigue HF Risk of sudden death Arryhthmia Thromboembolism ```
48
Pericarditis causes
Infections - Viral - adenoviruses - Bacterial - TB - Fungal - only in immunosuppressed Non-infectious - Autoimmune - SLE, RA - Metastatic cancer - Iatrogenic - PCI, pacemaker, radiotherapy - Direct trauma
49
Pericarditis presentation
``` Severe pleuritic, sharp chest pain Dyspnoea Hiccups due to phrenic involvement Fever Tachycardia Pulsus paradoxurus Pericardial effusion Cardiac tamponade ```
50
Pericarditis ECG
Saddle shaped ST elevation | PR depression
51
Causes of IE
IVDU (S aureus) Poor dental hygiene (Strep viridans) Congenital heart defects Pseudomonas aeruginosa
52
IE presentation
``` Valve defect - characterised by murmur Clubbing Sepsis Embolism Osler's nodes Janeway lesions Splinter haemorrhages ```
53
Anaphylactic shock presentation
``` Swollen tongue/lips, hives Warm peripheries Tachycardia Hypotension Profound vasodilation ```
54
Septic shock presentation
``` Pyrexia Rigors Nausea and vomiting Vasodilation Bounding pulse Tachycardia Warm peripheries ```
55
Cardiogenic shock presentation
Galloping rhythm Raised JVP Signs of HF
56
Cardiogenic shock causes
When heart isn't pumping properly Cardiac tamponade MI PE Fluid overload
57
Hypovolaemic shock presentation
``` Pallor, cold skin Drowsy Tachycardia Sweating Hypotension ```
58
Hypovolaemic shock causes
Loss of fluid Major blood loss (haemorrhagic shock) Vomiting and diarrhoea Burns Pancreatitis
59
Name an ACEi
Ramipril Enalapril Lisonipril
60
Main side effects of ACEi
Dry cough Bradykinin rash Hypotension
61
Anticoagulants
Aspirin - COX inhibitor, stops platelets sticking together Warfarin - vit K antagonist, stops 1972 (requires strict monitoring of INR 2-3) Apixaban - NOAC, doesn't need INR monitoring so used in place of warfarin
62
ARBs
Candesartan
63
Antiarrhythmics S/E
Amiodarone QT prolongation which can be fatal
64
Beta blockers
Bisoprolol Propranolol Metoprolol Atenolol
65
Main S/E of beta blockers
Headache Fatigue Bradycardia
66
When are beta blockers CI?
Asthma
67
Diuretics
Bendroflumethiazide - acts on distal convoluted tubule Furosemide - loop
68
Antiplatelets
Clopidogrel P2Y12 inhibitor, stops platelets activating and sticking to endothelium
69
CCBs
Amlodipine Diltiazem Nifedipine
70
Main side effects of CCBs
Flushing Headache Bradycardia
71
What differentiates AML?
Myeloblasts Most common in adults (40+) Gum hypertrophy Auer rods on bone marrow biopsy
72
What differentiates ALL?
``` Lymphoblasts Children 2-4 Associated with Down's syndrome CNS involvement SVC obstruction - red face, dilated superficial chest veins Treated with intrathecal drugs ```
73
What differentiates CML?
``` Neutrophils, basophils, eosinophils, macrophages 40-60 Massive hepatosplenomegaly Philadelphia chromosome Treated with tyrosine kinase inhibitor ```
74
What differentiates CLL?
``` B cells Most common leukaemia 70+ In those with low immunity and long term immunosuppression Often asymptomatic Enlarged, rubbery non-tender nodes FBC - high WCC with high lymphocytes Blood film - small mature lymphocytes ```
75
Multiple myeloma
``` Plasma cells 75+ CRAB - hypercalaemia (> 2.75 mmol/L) AKI, constipation, renal impairment, anaemia, bone lesions (pepperpot skull) Persistently high ESR Rouleaux formation Serum and/or urine electrophoresis Bence Jones protein Bisphosphonate treatment ```
76
Lymphoma
T and B cells in lymph nodes
77
Hodgkin's lymphoma
``` Bimodal CXR - wide mediastinum Reed sternberg cells Chemotherapy Autologous marrow transplant ```
78
Non-Hodgkin's lymphoma
GI and skin involvement Steroids Adults 40+ Monoclonal antibodies to CD20 (rituximab)
79
Ann Arbor staging
I - confined to single lymph node region II - involvement of two or more nodal areas on the same side of diaphragm III - involvement of nodes on both sides of diaphragm IV - spread beyond the lymph nodes eg liver and bone marrow A - no systemic symtoms B - systemic B symptoms
80
Side effects of chemo
``` Constipation/diarrhoea Cytopaenia (anaemia, neutropaenia, thrombocytopaenia) Alopecia Secondary malignancies Nausea Infertility ```
81
Acute sickle cell disease
Painful crises Sickle chest syndrome CVA
82
Chronic sickle cell disease
Renal impairment Pulmonary hypertension Joint damage
83
Management of sickle cell
Hydroxyurea Transfusions Stem cell transplant
84
Secondary polycythaemia
Low FiO2 High EPO Smoking Lung disease
85
Polycythaemia presentation
Red face Thrombosis Itching Splenomegaly
86
ITP tests and treatment
Increase megakaryocytes in marrow Antiplatelet antibodies often present Low platelet count Immunosuppression - steroids/IV immunoglobulin
87
TTP
ADAMTS13 ``` Microangiopathic haemolytic anaemia Decrease platelets AKI Neurological symptoms Fever Schistocytes ``` Urgent plasma exchange replenishing ADAMTS13
88
Symptoms of iron deficiency
Koilonychia Angular stomatitis Atrophic glossitis Brittle hair and nails
89
Voiding symptoms
``` SHED Stream changes Hesitancy Emptying incomplete Dribbling ```
90
Storage symptoms
``` FUND Frequency Urgency Nocturia Dysuria ```
91
Alpha blockers
Relax smooth muscle improving flow symptoms (only improves symptoms) Tamsulosin Alfuzosin Doxazosin Orthostatic Hypotension Ejaculation dysfunction
92
5-alpha reductase inhibitors
Finasteride Gynaecomastia Sexual dysfunction Low mood Also prevent disease progression
93
Androgen deprivation therapy
For prostate cancer GnRH agonists (suppress GnRH and LH production) and anti-androgen
94
Urinary tract malignancy
Painless haematuria - bladder cancer Haematuria + loin pain - renal cell carcinoma/stones Testicle lump +/- pain - testicular tumour (seminom)
95
Renal cell carcinoma
BP increased due to increased renin secretion FBC increased erythropoietin CT, MRI CXR - cannon ball mets
96
Bladder cancer
T1 - TURBT T2/3 radical cystectomy T4 palliative +/- chemotherapy/radiotherapy

Phase 2a medicine (13 decks)

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