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Drugs Flashcards

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1
Q

Abx Side Effects

A

Amoxicillin
SE: rash with infectious mononucleosis

Co-amoxiclav
SE: cholestasis

Flucloxacillin
SE: cholestasis (several weeks after use)

Erythromycin
SE: GI upset, ^QT

Ciprofloxacin
SE: v seizure threshold, tendonitis

Trimethoprim
SE: rash, itchy, photosensitivity, suppress haematopoiesis

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2
Q

Abx - mechanisms

A

Cell wall synthesis
= penicillins, cephalosporins, carbapanems (beta-lactam), vancomycin (glycopeptide)

Nucleic acid synthesis
= sulphonamides, trimethoprim, quinolones, rifampicin

Protein synthesis
30S = tetracyclines, aminoglycosides
50S = macrolide, clindamycin

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3
Q

ACE Inhibitors

A

U&E prior to treatment, dose increase and annually

SE - ^K, chronic cough, v BP, AKI

Teratogenic = renal dysgenesis, craniofacial abnormalities

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4
Q

Adrenaline

A

Sympathomimetic amine, stimulates alpha and beta adrenergic receptors

^CO, ^total peripheral resistance, vasoconstriction in the skin and kidneys (narrow pulse pressure)

Used in anaphylaxis, cardiac arrest

Phentolamine for reversal (distal ischaemia)

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5
Q

Allopurinol

A

Xanthine oxidase inhibitor

Used in gout, Lesch-Nyhan syndrome

SE: stop allopurinol immediately if rash,
severe cutaneous adverse reaction (SCAR), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome

Chinese, Korean and Thai increased risk

Interacts - Azathioprine (^levels of 6-mercaptopurine, use 25% dose), cyclophosphamide (marrow toxicity), theophylline

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6
Q

Alpha blockers

A

Doxazosin and tamsulosin
Used for - benign prostatic hyperplasia and hypertension

SE - postural hypotension, drowsiness, SOB, cough

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7
Q

Amiodarone

A

MOA - class III antiarrhythmic, blocks potassium channels and inhibits repolarisation, prolongs AP, also blocks sodium channels, 20-100d HL

SE - thyrotoxicosis (stop drug), hypothyroidism, corneal deposits, optic neuritis, pulmonary fibrosis, pneumonitis, liver fibrosis, hepatitis, peripheral neuropathy, myopathy, photosensitivity, slate-grey skin, thrombophlebitis, bradycardia, ^QT

Interacts - warfarin (^INR), ^digoxin levels

TFT and LFT 6monthly (+ baseline with U&E and CXR)

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8
Q

Aspirin

A

COX-1 and 2 inhibitor

Blocks prostaglandin, prostacyclin and thromboxane A2 formation

Used in IHD

SE - Reye’s syndrome (<16yrs), haemorrhage, peptic ulcers, gastritis, tinnitus

Interacts - potentiated by oral hypoglycaemics, warfarin, steroids

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9
Q

Azathioprine

A

MOA - metabolised to active mercaptopurine, inhibits purine synthesis

SE: bone marrow depression, n+v, pancreatitis, non-melanoma skin cancer

Interacts with allopurinol (lower dose of azathioprine)

SAFE in pregnancy

Monitor
TPMT test
FBC, LFT baseline and 3monthly
FBC weekly for first month

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10
Q

Beta-blockers

A

SE: bronchospasm (esp. asthma), fatigue, cold peripheries, v BP, v HR, worsens acute HF

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11
Q

Calcium channel blockers

A

dihydropyridines (nifedipine and amlodipine)
non-dihydropyridines (diltiazem and verapamil)

SE: headache, flushing, ankle oedema

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12
Q

Nifedipine, amlodipine, felodipine

A

Used for hypertension, angina, Raynaud’s

Affects peripheral vascular smooth muscle more than myocardium

SE - flushing, headache, ankle swelling, reflex tachycardia (nifedipine, shorter acting)

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13
Q

Verapamil, diltiazem

A

Verapamil
Used for angina, HTN, arrhythmias
SE - HF, constipation, v BP, v HR, flushing
Contra with b-blockers (heart block)

Diltiazem
Used for angina, HTN
SE - v BP, v HR, HF, ankle swelling
Caution with b-blockers (less neg inotropic)

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14
Q

Carbamazepine

A

Teratogen = NTD, craniofacial abnormalities

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15
Q

Chloramphenicol

A

Teratogen = grey-baby syndrome

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16
Q

Ciclosporin

A

Calcineurin inhibitor, decreases clonal proliferation of T cells by reducing IL-2 release

Used for organ transplant, RA, psoriasis, UC, pure red cell aplasia

Trough levels immediately before dose

SE - nephrotoxic, hepatotoxic, fluid retention, hypertension, ^K, hypertrichosis, gingival hyperplasia, tremor, IGT, hyperlipidaemia, immunosuppressed

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17
Q

Cocaine and smoking

A

Teratogen = IUGR, preterm labour

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18
Q

Diabetes Drugs

A

Metformin (biguanide)
SE: GI, lactic acidosis, v appetite

Sulfonylurea (insulin secretagogues - Gliclazide, Tolbutamide, Glipizide)
SE: hypoglycaemia, ^appetite, weight gain, SIADH, cholestasis

Glitazones (PPAR agonists)
SE: weight gain, fluid retention, liver dysfunction, fractures

Gliptins (DPP-4 inhibitors)
SE: pancreatitis

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19
Q

Diclofenac

A

NSAID

SE - increased risk of cardiovascular events

Contra - IHD, PAD, cerebro VD, congestive HF

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20
Q

Digoxin

A

Cardiac glycoside, positive inotropic properties

Used for rate control in AF, symptoms in heart failure.

MOA - v conduction through AVN, slows ventricular rate, ^ force of cardiac muscle contraction (inhibits Na+/K+ ATPase pump), also stimulates vagus nerve

Narrow therapeutic index, monitor in suspected toxicity (8 to 12 hours of last dose)

Monitor serum electrolytes and renal function

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21
Q

Dopamine receptor agonists

A

Bromocriptine, ropinirole, cabergoline, apomorphine

Used in Parkinson’s, prolactinoma, galactorrhea, cyclical breast disease, acromegaly

SE - n+v, postural hypotension, hallucinations, daytime somnolence, ergot-derived (b/ c) associated with pulmonary, retroperitoneal and cardiac fibrosis
-> baseline ESR, creatinine and chest x-ray

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22
Q

Doxazosin

A

SE: postural hypotension

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23
Q

Lithium Monitoring

A

TFT and U&E baseline and 6monthly
Lithium level weekly until stable and then 3mthly

12hours after last dose

Normal serum-lithium concentration of 0.4-1

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24
Q

Lithium

A

Use - mood stabiliser in Bipolar

*Narrow therapeutic range and long half-life

SE: n+v, diarrhoea, fine tremor, diabetes insipidus, hypothyroidism (enlarge), flat/ inverted T wave, weight gain, idiopathic IC HTN, leucocytosis, ^PTH (^Ca)

Teratogenic = Ebstein’s anomaly (atrialised RV)

Toxicity with dehydration, renal failure, thiazides, ACEi/ARB, NSAIDs, metronidazole

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25
Methotrexate
MOA - inhibits dihydrofolate reductase and thymidylate synthesis SE: myelosuppression, mucositis, liver/ lung fibrosis FBC, U&E, LFT baseline, weekly and then 2-3monthly
26
Sodium valproate
SE: liver toxicity LFT and FBC baseline, LFT periodically in first 6mths Teratogen = NTD, craniofacial abnormalities
27
Statins
LFT Baseline, 3 month, 12 month SE: myopathy, rhabdomyolysis Caution in liver disease Contra with macrolides
28
Drugs that cause IGT
thiazides, furosemide (less common) steroids tacrolimus, ciclosporin interferon-alpha nicotinic acid antipsychotics Beta-blockers
29
Drug-induced thrombocytopenia
quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin
30
Drug-induced urinary retention
tricyclic antidepressants e.g. amitriptyline anticholinergics e.g. antipsychotics, antihistamines opioids NSAIDs disopyramide
31
Drug-induced photosensitivity
thiazides tetracyclines (doxy), sulphonamides, ciprofloxacin amiodarone NSAIDs e.g. piroxicam psoralens sulphonylureas
32
O&G drugs - Syntocinon, Ergometrine, Mifepristone
Syntocinon = Synthetic oxytocin, stimulates uterine contraction (v PPH) Used for active management of third stage, induces labour Ergometrine = Ergot alkaloid, stimulates a/d/serotonin receptors, constricts vascular smooth muscle Used for active management of third stage SE - coronary artery spasm Mifepristone = Prostaglandin analogue, competitive progesterone receptor antagonist Used with misoprostol to terminate pregnancy SE - menorrhagia
33
Serotonin agonists
sumatriptan = 5-HT1D agonist, acute treatment of migraine ergotamine = partial agonist of 5-HT1 receptors
34
Serotonin antagonist
pizotifen = 5-HT2 receptor antagonist, migraine prophylaxis cyproheptadine = 5-HT2 receptor antagonist, control diarrhoea in carcinoid syndrome ondansetron = 5-HT3 receptor antagonist, antiemetic
35
Finasteride
5 alpha-reductase inhibitor (stops testosterone to dihydrotestosterone) Used for BPH, male-pattern baldness SE - impotence, v libido, ejaculation disorders, gynaecomastia, breast tenderness, v PSA levels
36
Flecainide
Vaughan Williams class 1c antiarrhythmic MOA - slows AP conduction by acting as a potent sodium channel blocker = wide QRS and PR Used in AF, accessory SVT e.g. WPW Contra - post-MI, SHD (HF), sinus node dysfunction, second-degree or greater AV block, atrial flutter SE - negatively inotropic, v HR, proarrhythmic, oral paraesthesia, visual disturbances
37
Gentamicin
Aminoglycoside Abx SE - ototoxic (auditory/ vestibular nerve damage, irreversible), nephrotoxic (via acute tubular necrosis) Caution - renal failure Contra - myasthenia gravis peak (1 hour after administration) and trough levels (just before the next dose) are measured Teratogenic = ototoxic
38
Heparin
activate antithrombin 3 SE - bleeding, thrombocytopenia, osteoporosis, ^K (v aldosterone secretion) UF Inhibits thrombin, Xa, IXa, XIa and XIIa IV, short action APTT to monitor ^risk of thrombocytopenia and osteoporosis LMWH Inhibits Xa only SC, longer action
39
HRT
Used for menopausal symptoms (+ P if uterus) and in premenopause (until 50yrs) PO, patch (better if risk of VTE) or gel SE - reduced risk of colorectal cancer
40
Macrolides
E.g., erythromycin, clarithromycin, azithromycin MOA - inhibit bacterial protein synthesis, block translocation, bacteriostatic SE - ^QT, GI, cholestatic jaundice, hearing loss/ tinnitus (azithro) !!P450 inhibitor Interacts - stop statins (^myopathy/ rhabdo)
41
Pain ladder
1. paracetamol, NSAIDs 2. weak opioid (codeine) 3. strong opioid (morphine) Acute/ post-op 1. strong + anaesthetics 2. oral route 3. peripherally acting only
42
Maternal DM
Teratogen = macrosomia, NTDs, polyhydramnios, preterm labour, caudal regression syndrome
43
Metformin
Used in T2DM (titrate up slowly) MOA - biguanide, activates AMP-activated protein kinase, ^insulin sens, v hep gluconeogenesis SE - nausea, anorexia, diarrhoea, v B12 absorption, lactic acidosis No weight gain or hypos Caution - severe liver disease/ renal failure Contra - CKD (stop if GFR <30, reduce <45), post-MI, AKI, sepsis, severe dehydration, iodine-containing contrast (day of to 48hrs after), alcohol abuse
44
Oculogyric crisis
Dystonic reaction Causes - antipsych, metoclopramide, post-encephalopathic Parkinson's Management - stop med, IV benztropine/ procyclidine (antimuscanics)
45
CYP450 System
Inhibitors (SICKFACES.COM) Sodium valproate, SSRIs Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (binge), amiodarone, allopurinol Chloramphenicol Erythromycin Sulphomanides Ciprofloxacin Ommeprazole Metronidazole Inducers (CRAP GPS) Carbamazepine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas, St John's Wort Smoking (affects CYP1A2, why smokers need more aminophylline)
46
Pharmacokinetics - reactions
Phase I reactions: oxidation, reduction, hydrolysis (by P450 enzymes, alcohol dehydrogenase, xanthine oxidase etc.) = active, toxic products Phase II reactions: conjugation = inactive products, excreted in urine or bile ^Mostly occur in liver
47
Pharmacokinetics - first pass
Concentration greatly reduced before reaching systemic circulation due to hepatic metabolism - need larger doses PO than other routes aspirin isosorbide dinitrate glyceryl trinitrate lignocaine propranolol verapamil isoprenaline testosterone hydrocortisone Zero order - phenytoin, salicylates (e.g. high-dose aspirin), heparin, ethanol
48
Phosphodiesterase type V (PDE5) inhibitors
E.g., sildenafil, tadalafil, vardenafil Used for erectile dysfunction, pulm HTN MOA - vasodilation, ^cGMP leads to smooth muscle relaxation in blood vessels SE - blue vision, anterior ischaemic neuropathy, nasal congestion, flushing, GI, headache, priapism Contra - nitrates, nicorandil, v BP, recent stroke/ MI
49
Potassium-sparing diuretics
ENaC blockers (amiloride, triamterene) in DCT Used with other diuretics to balance v K Aldosterone antagonists (spironolactone) in CD Used in ascites (cirrhosis -> secondary hyperaldosteronism), HF, nephrotic, Conn's Caution - ACEi (risk of ^K)
50
Drugs in renal failure
AVOID Tetracycline, nitrofurantoin NSAIDs Lithium Metformin ADJUST DOSE (might accumulate in CKD) Most Abx Digoxin, atenolol Methotrexate Sulphonylureas Furosemide Opioids MOSTLY SAFE Erythromycin, rifampicin Diazepam Warfarin
51
Harmful drugs in pregnancy
Abx Tetracyclines (tooth discolouration) Aminoglycosides Sulphonamides and trimethoprim Quinolones Others ACE inhibitors, ARBs Statins Warfarin (craniofacial) Sulfonylureas Retinoids (including topical) cytotoxic agents
52
Quinolones
E.g., ciprofloxacin, levofloxacin MOA - inhibits DNA synthesis, inhibits topoisomerase 2 and 4, bactericidal SE - v seizure threshold, tendinopathy/ rupture (esp. + steroids), cartilage damage (avoid in children), lengthens QT interval Contra - pregnant/ BF, G6PD definiciency
53
Thiazides
SE: gout, v K, v Na, IGT
54
Tamoxifen
Selective Estrogen Receptor Modulator (oes receptor antagonist and partial agonist) Used for Oes receptor +ve breast cancer (continue 5yrs after removal) SE: vaginal bleeding, amenorrhoea, hot flushes, VTE, endometrial cancer Raloxifene is a pure oes receptor antagonist = lower risk of endometrial cancer
55
Theoophylline toxicity
Metabolised by P450 enzymes Causes - acute illness, ciprofloxacin, erythromycin = vomiting, agitation, dilated pupils, ^HR, ^glucose, v K -> activated charcoal (regardless of time of presentation), antiemetics, definitive treatment is with haemodialysis
56
Trastuzumab
Herceptin, mAb against HER2/neu receptor Used in met breast cancer SE: flu-like, diarrhoea, cardiotoxicity ECHO before treatment
57
Cyclophosphamide
MOA - Alkylating agent, causes cross-linking in DNA SE: haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
58
Bleomycin
MOA - degrades preformed DNA SE: lung fibrosis
59
Anthracyclines e.g., doxorubicin
MOA - stabilizes DNA-topoisomerase II complex, inhibits DNA & RNA synthesis SE: cardiomyopathy
60
Anti-metabolites
Methotrexate MOA - inhibits dihydrofolate reductase and thymidylate synthesis SE: myelosuppression, mucositis, liver/ lung fibrosis Fluorouracil (5-FU) MOA - pyrimidine analogue, induces cell cycle arrest and apoptosis (during S phase) SE: myelosuppression, mucositis, dermatitis 6-mercaptopurine MOA - purine analogue, v purine synthesis SE: myelosuppression Cytarabine MOA - pyrimidine antagonist, inhibits DNA polymerase, S phase SE: myelosuppression, ataxia
61
Vincristine/ Vinblastine
MOA - inhibits formation of microtubules SE Vincristine: peripheral neuropathy (reversible) , paralytic ileus Vinblastine: myelosuppression
62
Docetaxel
MOA - prevents microtubule depolymerisation & disassembly, decreasing free tubulin SE: neutropenia
63
Topoisomerase inhibitors e.g., Irinotecan
MOA - inhibits topoisomerase I which prevents relaxation of supercoiled DNA SE: myelosuppression
64
Cisplatin
MOA - causes cross-linking in DNA SE: ototoxicity, peripheral neuropathy, hypomagnesaemia
65
Hydroxyurea (hydroxycarbamide)
MOA - inhibits ribonucleotide reductase, decreasing DNA synthesis SE: myelosuppression
66
Spironolactone
Used in ascites, HTN, HF, nephrotic syndrome, Conn's MOA - aldosterone antagonist, acts in collecting duct SE: ^K, gynaecomastia (eplerenone)
67
Renal Transplant - IS
Ciclosporin - calcineurin inhibitor, SE: HTN, ^lipids, gingival hyperplasia, hirsutism Tacrolimus - less acute rejection, HTN and high lipids, SE: IGT, DM, alopecia Mycophenolate - inhibits purine synthesis, v b and t cells, SE: GI, bone marrow suppression Monoclonal Ab - selective IL2 inhibitors, daclizumab/ basilximab
68
SSRI
E.g., citalopram, fluoxetine (best in young), sertraline (best post-MI), paroxetine Use - depression SE: GI, bleeding (PPI), v Na, anxiety, agitation, ^QT (citalo) Interact with NSAIDs, warfarin, heparin, aspirin, triptans, MAOI Teratogen = T1 CHD (^parox), T3 persistent pulm HTN
69
Starting or Stopping an SSRI
Review after 2 weeks (1 week if <30/ ^risk of suicide) Take for 6months post-remission, 1 year if old, 2 years if recurrent depression Must gradually reduce over 4 week period (not needed with fluoxetine) Discontinuation syndrome = mood change, restless, insomnia, unsteady, sweating, abdo pain, d+v, paraesthesia
70
SNRI
Inhibit 5HT and NA reuptake E.g., venlafaxine, duloxetine
71
Clozapine
Atypical antipsychotic, only use as 3rd choice SE: agranulocytosis (monitor FBC), neutropenia, constipation, v seizure threshold, myocarditis, hypersalivation Smoking cessation can increase blood levels of the drug Differential white blood cell weekly for 18 weeks, 2wkly for year, then monthly (clozapine patient monitoring service)
72
Z Drugs
Similar effects to benzos but structurally different, act on α2-subunit of GABA receptor Imidazopyridines: e.g. zolpidem Cyclopyrrolones: e.g. zopiclone Pyrazolopyrimidines: e.g. zaleplon SE: like benzos, falls in elderly
73
TCA
E.g., amitriptyline, clomipramine Use - neuropathic pain, less often for depression MOA - inhibit reuptake of 5HT and NA, also antagonise histamine, muscarinic and adrenergic receptors SE - drowsy, dry mouth, blurred vision, constipation, urinary retention, postural hypotension, ^QT
74
MAOI
MOA - prevent monoamine oxidase metabolising 5HT and NA in presynaptic cell E.g., tranylcypromine, phenelzine SE: hypertensive reactions with tyramine foods (cheese, Bovril, Oxo, marmite), anti-cholinergic effects
75
Mirtazapine
Use - depression (v SE so good for elderly) MOA - blocks a2-adrenergic receptors SE: sedation, ^appetite
76
Benzos
E.g., clonazepam, diazepam, lorazepam MOA - enhance the inhibitory effect of GABA by increasing the frequency of chloride channels Use - sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant SE: tolerance, withdrawal Withdrawal = insomnia, irritable, tremor, v appetite, tinnitus, sweating, seizures *Switch to diazepam, steps of 1/8 daily dose fortnightly
77
Atypical Antipsychotics
E.g., clozapine, olanzapine (^lipids, obese), risperidone, quetiapine, amisulpride, aripiprazole (best for SE, v galatorrhea) SE: weight gain, agranulocytosis (cloz), ^prolactin, v seizure threshold, ^risk of VTE and stroke in elderly, ^IGT (baseline glucose)
78
Typical Antipsychotics
E.g., haloperidol, chlorpromazine MOA - D2 receptor antagonists SE: extrapyramidal e.g., parkinsonism, acute dystonia (torticollis/ oculogyric -> procyclidine), akathisia, tardive dyskinesia (late onset, chewing/ jaw pouting)
79
Antipsychotic: Other Side Effects
- dry mouth, blurred vision, urinary retention, constipation - ^prolactin - IGT (^olanzapine) - neuroleptic malignant syndrome (fever, stiff) - ^QT interval
80
Levothyroxine
SE: hyperthyroidism, v bone mineral density, worsens angina, AF Interacts with iron and calcium carbonate
81
Finasteride
Women of childbearing age should not handle it due to toxic effects on male foetus
82
Bisphosphonates
E.g., alendronic acid (70mg OW), risedronate, zoledronic acid (OY infusion) Use - OP, hypercalcaemia, bone mets, Paget's MOA - v osteoclastic activity to ^bone density SE: GI, oesophagitis, osteonecrosis of the jaw, atypical stress fractures Contra - v Ca, v vit D, severe CKD, pregnancy/ BF, gastric ulcers, oes structural disorder Administration: take on empty stomach 30min before breakfast, with full glass of water, sit up for 30mins Monitoring: regular dentist, renal function, Mg, PO4
83
Atropine
Use - terminate SVT MOA - transient heart block in AV node, agonist of A1 receptor in AVN, increasing outward potassium flux, 8-10sec half life (needs large cannula) SE: chest pain, bronchospasm, transient flushing, can enhance conduction down accessory pathways (^V rate e.g., in WPW) Interaction - effects are enhanced by dipyridamole (AP) and blocked by theophyllines Contra - asthma (bronchospasm)
84
Nitrates
Nitrates are contraindicated in aortic stenosis
85
Vancomycin: SE
Ototoxic and nephrotoxic
86
Goserelin (Zoladex)
GnRH Agonist Use - prostate cancer anti-androgen therapy SE: gynaecomastia, tumour flare in first 2-3weeks (bone pain, BOO)
87
Bicalutamide
Non-steroidal anti-androgen, blocks the androgen receptor Use - prostate cancer
88
Gonadotrophins, Clomifene
Use - infertility MOA - stimulate follicles and induce ovulation, clomifene is a SERM (anti + oes properties) SE: ovarian hyperstimulation syndrome
89
Combined Oral Contraceptives
E.g., Ethinylestradiol with levorgesterol/ norgestimate/ drospirenone MOA - inhibits ovulation SE: VTE, stroke, IHD, breast and cervical cancer, headache, breast pain *lower risk of ovarian, endometrial, CRC Condom with rifampicin
90
Progesterone Only Oral Contraceptives
E.g., desogestrel based (cer-), levonorgestrel MOA - thickens mucus SE: irregular bleeding, breast pain, ovarian cysts, breast cancer
91
LARC
MOA - inhibits ov and thickens mucus Nexplanon implant *Affected by rifampicin Depo-Provera (medroxyprogesterone) IM SE: irregular bleeding, weight gain, OP, slow reversal
92
Spermicidal Contraception
Nonoxinol
93
IUS/ IUD
Mirena 5yrs, Jaydess 3yrs Levonorgestrel MOA - prevents endometrial prolif and thickens mucus Copper coil 5 or 10yrs MOA - v sperm motility and survival
94
Emergency Contraception
Levonorgestrol Ulipristal Copper IUD
95
Mifepristone
MOA - progesterone receptor antagonist Use - induction of labour in IU death, termination (with prostaglandin), missed miscarriage
96
HRT
Oestradiol alone or with progestogens, raloxifene, tibolone (o/p/ androgenic) SE: nausea, breast pain, fluid retention, weight gain, breast cancer (^w/ p), endometrial cancer (v w/ p), VTE (v patch), stroke, IHD if 10yr post-menopause
97
Oxytocin
Use - induction and augmentation of labour, PPH Monitoring of fetal heart rate and uterine motility, and for DIC after parturition
98
Dinoprostone
MOA - exogenous PGE2, vaginal prostaglandin Use - induction and augmentation of labour
99
Ergometrine
MOA - ergot alkaloid Use - PPH with uterine atony
100
Carboprost
Use - refractive PPH due to atony MOA - prostaglandin analogue Contra - cardiac or pulmonary disease
101
Tocolytics
Use - myometrial relaxation E.g., atosiban (oxytocin receptor ant), nifedipine, salbutamol
102
Topical Antibacterial (Eye)
Gentamicin Chloramphenicol Ciprofloxacin Fusidic acid Neomycin
103
Topical Eye (others)
Antiviral - aciclovir Steroids - dex, pred Anti-Histamine - antazoline, levocabastine Anaesthetics - oxybuprocaine, lidocaine, tetracaine
104
Entacapone
MOA - Catechol-O-methyltransferase inhibitors, v breakdown of dopamine Use - Parkinson's
105
Phenobarbital
Barbituate MOA - GABA agonist, increase duration of Cl channels
106
Topiramate
Glutamate receptor antagonist Use - migraine prophylaxis, anti-epileptic SE: teratogenic
107
DMARDs
Sulfasalazine Hydroxychloroquine (anti-malarial) Leflunomide Methotrexate (anti-metabolite) Sodium aurothiomalate (Gold) Azathioprine (anti-metabolite) Ciclosporin (calcineurin inhibitor) Penicillamine
108
Sulphasalazine
Use - DMARD for RA, IBD MOA - pro-drug for 5ASA, v neutrophil chemotaxis and v lymphocyte proliferation SE: oligospermia, rash, steven-johnson, lung fibrosis, colour tears Caution - G6PD deficicency, allergy to aspirin/ sulpha drugs SAFE in pregnancy and BF
109
Hydroxychloroquine
Use - DMARD for RA, SLE SE: bull's eye retinopathy, corneal deposits *Baseline eye exam, annual screening SAFE in pregnancy
110
Leflunomide
Use - DMARD for RA SE: liver impairment, interstitial lung disease, HTN
111
Penicillamine
SE: proteinuria, worsens myasthenia gravis
112
Anti-TNFa
Adalimumab Etanercept Infliximab SE: reactivate TB
113
Rituximab
Anti-CD20 B cell depleter SE: infusion reactions
114
Xanthine Oxidase Inhibitors
E.g., allopurinol, febuxostat Use - gout SE: stop if rash (SCAR, DRESS, steven-johnson) Start long-term treatment when acute episode is over Interactions - azathioprine (6mer not oxidised), cyclophosphamide (v renal clearance), theophylline (v breakdown)
115
Rasburicase
Use - proph/ treat hyperuricaemia (tumour lysis syndrome) Contra G6PD deficiency
116
IV Opioids in Anaesthetics
Fentanyl Remifentanil
117
Nitrofurantoin
AVOID if GFR <45
118
Stopping warfarin for surgery
Warfarin is usually stopped 5 days before elective surgery + phytomenadione (vitamin K1) by mouth the day before surgery if the INR is ≥1.5
119
Furosemide: best way to monitor
weight (reduction)

PPT (3 decks)

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