Drugs Flashcards

Question

Gentamicin 1. Indications & dose

Answer 1

1. a. _Bacterial eye infections (staph a, strep pneu? both GP)_ For Adult: **1**  drop at least every **2 hours**, **reduce frequency** as infection is controlled and continue for **48 hours after healing,** less severe infection 3–4x daily is generally sufficient. _b. Bacterial infection in otitis externa (Pseudomonas aeruginosa GN and Staphylococcus aureus GP)_ Ear for Child: **2–3 drops 4–5x day,** (including a dose at **bedtime**). For Adult: Apply 2–3 drops 4–5 times a day, (including a dose at bedtime). _c. Gram-positive bacterial endocarditis or HACEK endocarditis (in combination with other antibacterials)_ IM injection, IV injection, IV infusion Adult: **1 mg/kg** every **12 hrs**, IV injection to be administered over at least **3 minutes**, to be given in a multiple daily dose regimen. **_Septicaemia, Meningitis and other CNS infections, Biliary-tract infection, Acute pyelonephritis, Endocarditis, Pneumonia in hospital patients, Adjunct in listerial (bacteria 3rd commonest cause of) meningitis, Prostatitis_** IV infusion, or by slow IV injection, or by IM injection adult: **3–5 mg/kg/day** in **3 divided doses,** to be given in a multiple daily dose regimen, divided doses to be given every 8 hours, intravenous injection to be administered over at least 3 minutes. By intravenous infusion For Adult Initially 5–7 mg/kg, subsequent doses adjusted according to serum-gentamicin concentration, to be given in a once daily dose regimen. _CNS infections (administered on expert advice)_ Intrathecal injection adult: **1 mg/day**, increased if necessary to 5 mg daily, seek specialist advice. _Surgical prophylaxis_ Slow IV injection adult 1.5 mg/kg, intravenous injection to be administered over at least 3 minutes, administer dose up to 30 minutes before the procedure, dose may be repeated every 8 hours for high-risk procedures; up to 3 further doses may be given. _Surgical prophylaxis in joint replacement surgery_ IV infusion adult: 5 mg/kg for 1 dose, administer dose up to 30 minutes before the procedure.

Answer 2

1. Irreversible damage after **90 minutes** but even 24 hours after symptoms begin, vision can still be saved or partially restored. 2. Common: Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Rare/ hyperacute: Neisseria gonorrhoeae/ meningitidis red sclera gritty fealing

Answer 3

most gram-negative aerobic and facultative anaerobic bacilli not against gram-negative **anaerobes** **most gram-positive bacteria** **e.g. gram negative anaerobe** Prevotella (oral, vaginal, and gut microbiota and) are often recovered from anaerobic infections of the respiratory tract. These infections include aspiration pneumonia, lung abscess, pulmonary empyema, and chronic otitis media and sinusitis.

Answer 4

1. a. **Myasthenia gravis** (aminoglycosides may impair neuromuscular transmission) b. When used by ear: patent grommet, perforated tympanic membrane 2. prevents bacteria from making protein 3. Common: **Hearing impairment** Uncommon: Nausea; skin reactions (very common in children); vomiting Rare: Anaemia; eosinophilia; fever; headache; hypomagnesaemia; paraesthesia; renal impairment Frequency not known: Bronchospasm; confusion; lethargy; **nephrotoxicity**

Answer 5

1. aminoglycosides: risk of auditory or vestibular nerve damage(highest risk streptomycin) 2nd/3rd tri 2. aminoglycosides: Excretion via the kidney and accumulation occurs in renal impairment. **Ototoxicity and nephrotoxicity** occur commonly in patients with **renal failure**.

Answer 6

1. _Mild to moderate susceptible infections, Throat infections, Otitis media, Cellulitis,_ IM injection, slow IV injection, or by IV infusion adult: **0.6–1.2 g (can inc)** every **6 hrs**, single doses **over 1.2 g** IV only _Endocarditis_ (+/- antibacterial if necessary) slow IV injection/ IV infusion adult: **1.2 g** every **4 hrs**, if necessary to **2.4 g every 4 hr**s _Anthrax (Bacillus anthracis)_ Slow IV injection/ IV infusion adult: **2.4 g every 4 hrs.** _Intrapartum prophylaxis against group B streptococcal infection_ slow IV injection/ IV infusion adult: **3 g** for **1 dose**, then **1.5 g every 4hrs until delivery.** _Meningitis, Meningococcal disease_ slow IV injection/ IV infusion adult: **2.4 g every 4 hrs**

Answer 7

Skin: **small blister** with surrounding swelling that often turns into a painless **ulcer** with a black center. Lungs: fever, chest pain, & SOB GI: diarrhea which may contain blood, abdominal pains, & N+V Injection: fever & an abscess at puncture site

Answer 8

1. Common: **Diarrhoea**; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting Uncommon: Antibiotic associated **colitis**; leucopenia Rare: Agranulocytosis; angioedema; haemolytic anaemia; hepatic disorders; nephritis tubulointerstitial; neutropenia; seizure; severe cutaneous adverse reactions (SCARs) 2. Common: Fever; **Jarisch-Herxheimer reaction** Rare: Neurotoxicity Frequency not known: Coma 3. safe 4. Accumulation of sodium from injection can occur in renal failure. High doses may cause neurotoxicity, including cerebral irritation, convulsions, or coma.

Answer 9

1. a. _Infections due to beta-lactamase-producing staphylococci including otitis externa, Adjunct in **pneumonia**, Adjunct in **impetigo**, Adjunct in **cellulitis**_ PO adult: 250–500 mg 4x/day IM injection: 250–500 mg every 6 rs slow IV injection, infusion adult: **0.25–2 g** every **6 hrs** b. _Endocarditis (+ antibacterial)_ slow IV injection/ IV infusion adult: (body-weight up to 85 kg) **8 g/day** in 4 divided doses (body-weight 85 kg and above) **12 g/d**ay in 6 divided doses _c. Osteomyelitis_ IV injection/IV infusion adult: Up to **8 g** daily in 3–4 divided doses. _Surgical prophylaxis_ slow IV injection/ IV infusion Adult: **1–2 g**, to be administered up to 30 mins before the procedure, then (by mouth or by intramuscular injection or by slow intravenous injection or by intravenous infusion) 500 mg every 6 hours if required for up to 4 further doses in high risk procedures.

Answer 10

1. _Anaerobic infections adult:_ **PO: 400 mg** every **8 hrs**, alternatively **500 mg** every **8 hrs** usually treated for 7 days (for 10–14 days in C.difficile infection) **PR:** **1 g** 3 times a day for 3 days, then 1 g twice daily, for usual total treatment duration of 7 day **IV:** **500 mg** every **8 hrs,** 7 days (10–14 days in c.difficile infection), to be given over 20 minutes _**Helicobacter pylori eradication**; in combination with clarithromycin and esomeprazole; or in combination with clarithromycin and lansoprazole; or in combination with amoxicillin and lansoprazole; or in combination with clarithromycin and omeprazole; or in combination with clarithromycin and pantoprazole; or in combination with clarithromycin and rabeprazole_ PO: **400 mg 2**xday _H.pylori eradication; in combination with **amoxicillin & omeprazole**_ PO: **400 mg** **3**xday _Fistulating **Crohn's** disease_ PO: 10–20 mg/kg daily in divided doses, usual dose **400–500 mg 3xday** usually given for **1 month** but no longer than 3 months because of concerns about peripheral neuropathy. _Leg ulcers & pressure sores_ PO adult: 400 mg every 8 hrs for 7 days. _Bacterial vaginosis (notably Gardnerella vaginalis infection)_ PO: 400–500 mg twice daily for 5–7 days, alternatively 2 g for 1 dose. _Bacterial vaginosis_ PV vaginal gel: 1 applicatorful daily for 5 days, dose to be administered at night. _PID_ PO: 400 mg twice daily for 14 days. _Acute ulcerative gingivitis_ 400 mg every 8 hours for 3 days _Invasive intestinal amoebiasis, Extra-intestinal amoebiasis (including liver abscess)_ _Urogenital trichomoniasis_ _Giardiasis_ _Established case of tetanus_ _rosacea_ _surgical prophylaxis_

Answer 11

1. TOP: avoid exposure to strong sunlight or UV light PV: avoid **intravaginal** preparations (particularly those that require the use of an applicator) in **young girls who are not sexually active**, unless there is no alternative (in children); not recommended during menstruation; some systemic absorption may occur with vaginal gel

Answer 12

_Common_ IV: dry mouth; **myalgia**; nausea; oral disorders; taste metallic; **vomiting** PV: pelvic discomfort; vulvovaginal **candidiasis**; vulvovaginal disorders _Uncommon_ IV: asthenia(physical weakness/lack of energy); headache; leucopenia (with long term or intensive therapy) PV: menstrual cycle **irregularities**; vaginal **haemorrhage** _Rare_ IV: **agranulocytosis**; angioedema; appetite decreased; ataxia; diarrhoea; dizziness; drowsiness; encephalopathy; epigastric pain; epileptiform seizure (with long term or intensive therapy); hallucination; hepatic disorders; meningitis aseptic; mucositis; neutropenia; optic neuropathy; pancreatitis; pancytopenia; peripheral neuropathy (with long term or intensive therapy); severe cutaneous adverse reactions (SCARs); skin reactions; thrombocytopenia; urine dark; vision disorders PO: agranulocytosis; ataxia; cerebellar syndrome; confusion; dizziness; drowsiness; encephalopathy; flushing; hallucination; headache; hepatic disorders; myalgia; neutropenia; pancreatitis; pancytopenia; psychotic disorder; seizure; skin reactions; thrombocytopenia; urine dark; vision disorders PR: agranulocytosis; ataxia; cerebellar syndrome; dizziness; drowsiness; encephalopathy; flushing; hallucination; headache; hepatic disorders; myalgia; neutropenia; pancreatitis; pancytopenia; psychotic disorder; seizure; skin reactions; thrombocytopenia; urine dark; vision disorder

Answer 13

_Symptomatic treatment of **nausea and vomiting** including that associated with **acute** **migraine**, Delayed (but not acute) **chemotherapy**-induced nausea & vomiting, **Radiotherapy**-induced nausea and vomiting, Prevention of **postoperative** nausea and vomiting_ PO, IM injection, slow IV injection: Adult (body-weight \<60 kg): Up to **500 micrograms/kg/day** in **3 divided** doses, when administered by slow IV injection, to be given over at least 3 mins Adult (body-weight =\< 60 kg ): **10 mg** up to **3x day** _Hiccup in palliative care_ PO, IM, SC adult: **10 mg** every **6–8 hrs** _Nausea and vomiting in palliative care_ PO: **10 **mg 3xday SC infusion: **30–100 mg/24 hrs** 2. risk of neurological effects such as **extrapyramidal disorders & tardive dyskinesia** outweigh the benefits in long-term or high-dose treatment

Answer 14

1. 3–4 days after GI surgery, GI haemorrhage, GI obstruction, GI perforation; phaeochromocytoma 2. **Asthma**; atopic allergy; bradycardia; cardiac conduction disturbances; children; elderly; epilepsy; may mask underlying disorders such as cerebral irritation; Parkinson's disease; uncorrected electrolyte imbalance; young adults (15–19 yrs old) 3. ANTIEMETIC: **antagonist** activity at **D2 receptors** in the chemoreceptor trigger zone in the central nervous system Gastroprokinetic: D2 receptor antagonist activity, and 5-HT4 receptor agonist activity **inc** the tone of the **LOS** inc peristalsis of the duodenum & jejunum, increases tone and amplitude of gastric contractions relaxes the pyloric sphincter and duodenal bulb

Answer 15

1. Common: **Asthenia**; depression; diarrhoea; drowsiness; hypotension; **menstrual cycle irregularities**; **movement disorders**; **parkinsonism** Uncommon: Arrhythmias; hallucination; hyperprolactinaemia; level of consciousness decreased Rare: Confusion; galactorrhoea; seizure Frequency not known: Atrioventricular block; blood disorders; cardiac arrest; gynaecomastia; hypertension; neuroleptic malignant syndrome; QT interval prolongation; shock; syncope 2. safe, avoid 3. avoid or use low dose

Answer 16

1. _Nausea, Vomiting, **Vertigo, Motion sickness, Labyrinthine disorders**_ PO adult: **50 mg up to 3 x day**, for motion sickness, take **1–2 hrs before departure.** IV injection, IM injection adult: 5**0 mg 3 x day** _Nausea & vomiting associated with palliative care (adult)_ SC: 150 mg, dose to be given over 24 hours. PO: 50 mg up to 3 times a day 2. **Neonate** (due to significant **antimuscarinic** activity) (in neonates) 3. Rare: Angle closure glaucoma; depression 4.

Answer 17

_Unstable CAD (including NSTEMI)_ SC injection adult: **120 units/kg every 12 hrs** (max. per dose 10 000 units twice daily) for up to 8 days. _Patients with unstable CAD (including NSTEMI) awaiting **angiography** or **revascularisation** and having already had **8 days** treatment with dalteparin_ SC: Adult (body-weight =\>70 kg & **male**) **7500 units every 12 hour**s until the day of the procedure (max. 45 days) Adult (body-weight 80 kg and above and female) **7500 units every 12 hour**s until the day of the procedure (max. 45 days). _Prophylaxis of **DVT** in surgical patients—**moderate risk**_ SC adult: Initially 2500 units for 1 dose, dose to be given 1–2 hours before surgery, then 2500 units every 24 hours. _Prophylaxis of **DVT** in surgical patients—**high risk**_ SC adult: Initially 2500 units for 1 dose, dose to be administered 1–2 hours before surgery, followed by 2500 units after 8–12 hours, then 5000 units every 24 hours, alternatively initially 5000 units for 1 dose, dose to be given on the evening before surgery, followed by 5000 units after 24 hours, then 5000 units every 24 hours. _**Prophylaxis** of **DVT** in medical patients_ SC adult: **5000 units** every **24 hrs**. _Treatment of deep-vein thrombosis, Treatment of pulmonary embolism_ SC adult: (body-weight 69–82 kg) **15 000 units** once daily until adequate oral anticoagulation with vitamin K antagonist established (at least 5 days of combined treatment is usually required). (body-weight 83 kg and above) **18 000 units** _Extended treatment of DVT and prevention of recurrence in patients with **solid tumours**_ _Treatment of venous thromboembolism in pregnancy -\> not licensed_

Answer 18

1. Acute bacterial **endocarditis**; after major trauma; epidural **anaesthesia** with treatment doses; **haemophilia** and other **haemorrhagic** disorders; peptic ulcer; recent cerebral haemorrhage; recent **surgery** to eye; recent surgery to nervous system; severe hypertension; spinal anaesthesia with treatment doses; thrombocytopenia (including history of heparin-induced thrombocytopenia) 2. not know to be harmful but best to avoid 3. kidneys - unfractionated heparin may be preferable.

Answer 19

• Healthy individuals ◦ Between **4.0 - 5.4** mmol/L when fasting ◦ Up to **7.8** mmol/L 2 hours after eating • People with diabetes ◦ Before meals: **4 - 7** mmol/L (T1DM/T2DM) ◦ After meals: \<**9** mmol/L (T1DM) / \<**8.5** mmol/L (T2DM) • Blood ketones ◦ \<0.6 = normal ◦ 0.6 -1.5 = extra insulin ◦ **\>1.5** = DKA

Answer 20

1. T2DM 2. ◦ Effective, safe, inexpensive and may reduce the risk of CVS events and death ◦ Has beneficial effects on HbA1C, weight and CVS mortality 3. ◦ With food usually breakfast and evening meal 4. • Only biguanide on the market ◦ Metform IR (immediate release) - taken up to TDS ◦ Metformin SR (slow release) - taken OD 5. ◦ Prevents the production of glucose in the **liver** ◦ Improves body’s **sensitivity** towards insulin- benefits for weight management and not hypoglycaemia ◦ Reduces amount of sugar absorbed into the **intestine** 6. ◦ **GI upset** - main reason it may not be tolerated ◦ **Lactic acidosis** ◦ Distortion of sense of **taste** ◦ Reports of altered LFTs ◦ Hepatitis ◦ Skin reactions ◦ Reduced vitamin B12 absorption 7. Need to monitor renal function before and at least annually during treatment

Answer 21

1. gliclazide, glipizide, glimepiride, tolbutamide 2. ◦ **Stimulates insulin release from ß cells** of the pancreas by closing ATP-sensitive K+ channels and opening of voltage dependent Ca2+ channels: ‣ Require functioning ß cells to work ‣ Need to be taken with meals to prevent hypo ‣ Risk of accumulation and hypo in renal impairment (ELDERLY) 3. Just before food with breakfast and evening meal 4. **◦ Hypoglycaemia** ◦ GI upset ◦ Skin reactions ◦ Reports of decreased hepatic function ◦ Abnormalities ◦ Hepatic failure ◦ Hepatitis ◦ Jaundice ◦ Blood abnormalities **Obesity** as a result of increased plasma insulin concentration 5. Metabolised by liver with urinary excretion of metabolites, so should be used cautiously in the presence of **renal or hepatic dysfunction**

Answer 22

1. Takes **6 wks** to work ◦ Improves metabolic control in patients through improvement of **insulin sensitivity** ◦ **Reduces** insulin **resistance** in **adipose tissues/fat, muscle and liver** 2. ◦ Water retention ◦ Weight gain ◦ Eyesight problems ◦ Reduced sense of touch ◦ Chest pain and infections ◦ Allergic skin reactions 3. including HF, macular oedema, **_bone fractures and bladder cancer_** 4. CVS parameters, such as lipids, BP, inflammatory biomarkers, endothelial function and fibrinolytic status but oedema can occur therefore not recommended for patients who have any degree of heart disease

Answer 23

1. sitagliptin, saxagliptin, linagliptin, alogliptin 2. **Blocks** the action of enzyme **DPP4** which destroys hormone **incretin** (a natural hormone that tells the body to release insulin when needed such as after eating and reduces the amount of glucose being produced by the liver when it is not needed) More incretin ‣ Which **inhibits glucagon release** ‣ Which **increases insulin secretion** ‣ **Decreases gastric emptying** 3. ◦ Potential risk of acute **pancreatitis** ◦ **GI problems** - nausea, diarrhoea and abdo pain ◦ Flu-like symptoms, signs of URTI, joint pain ◦ Skin reactions/hives ◦ Signs of UTIs/blood in urine 4. ◦ Renal dose adjustment required but can be used in renal impairment (eGFR \< 30) - no dose adjustment for **linagliptin** but adjustment is required for the others

Answer 24

1. dapa**gliflozin**, cana**gliflozin**, empa**gliflozin** 2. Blocks SGLT2 which reduces the reabsorption of glucose by kidneys and increases glucose excretion in the urine 3. T2DM not for T1DM ◦ Low risk of hypoglycaemia ◦ Reduction in CVS disease and HF risk ◦ Not recommended for people with kidney disease (not in **eGFR \< 60**) 4. ◦ Amputations - stop in diabetic foot ◦ Kidney injury (eGFR \>45-60) ◦ Genital and **UTI** (W\>M) can lead to blood infections ◦ **Lactic acidosis** ◦ **Bone fractures** **◦ Bladder cancer risk** 5. ◦ SGLT2 in rare cases lead to **DKA**, this may occur whether the glucose levels are high or healthy (euglycaemic DKA as SGLT2 normalises glucose level in DKA) ◦ Caution with loop diuretics

Answer 25

1. * Exenatide (byetta & bydureon) * liraglutide (victoza) * lixisenatide * dulaglutide (IV) 2. GLP-1 receptor agonists, are normally prescribed for pt who have **not been able to control** their condition with **tablet medication (last resort?)** 3. * Stimulates release of insulin by pancreas, * inhibits release of gulcagon, * stomach emptying slows (more satisfied after eating) 4. ◦ Relatively **low risk of hypo** ◦ Strong efficacy/**HbA1c reduction** ◦ **Weight loss** ◦ Other possible benefits (ß cell preservation, CVS benefit) being investigated 5. ◦ **Diarrhoea** ◦ **N + V** ◦ Headaches ◦ Dizziness ◦ Increased sweating ◦ Indigestion ◦ **Constipation** ◦ Loss of appetite 6. ◦ Delivered by **injection** ◦ Nausea/**GI s/e** (~ decreasing over time) ◦ More **expensive** than sulphonylureas/metformin ◦ Possibility of slight association with pancreatitis

Answer 26

1. Within **5 mins** of a meal ◦ Novorapid/Aspart ◦ Humalog/Lispro ◦ Apidra/Glulisine ◦ Fiasp/Aspart 2. **30 mins** before food or bed ◦ Insulatard ◦ Humulin I ◦ Insuman Basal 3. Unusual to have no fast acting insulins with a BG insulin ◦ Lantus/Abasaglar ◦ Levemir//Detemir ◦ Toujeo 300 units/ml ◦ Degludec/Tresiba 4. ‣ Humalog mix 25 ‣ Humalog mix 50 ‣ Novomix 30 - 30% FA and 70% LA 5. Peaks at 1-8 hrs - may stay in system for up to 24 hours (shake thoroughly) ‣ Humulin M3 - given on feeds ‣ Insuman comb 15/25/50

Answer 27

**_Statins_** **E.g.** **atorvastatin (Lipitor)**, fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), simvastatin (Zocor), **Mechanism** = inhibits cholesterol **synthesis** in hepatocytes by acting on **HMG-CoA reductase** which also leads to increased clearance of LDLs **S/e** = inc **transaminase** levels, myopathy, GI complaints, **arthralgies**, headaches Atorvastatin - 10mg (can be increased to 80mg) if QRISK \>20% 20mg given in ACS primary prevention, 80mg in secondary prevention ◦ Uses = IHD, angina, ACS, TIA, stroke ◦ Simvastatin (take at night), rosuvastatin **_Nicotonic acid_** • Mechanism = inhibits lipoprotein synthesis and raises HDLs, reduces coronary events • Side effects = flushing, itching, headache, N+V, hepatotoxicity, GI or peptic ulcer, hyperglycaemia, decreased insulin sensitivity **_Ezetimibe_** • Mechanism = cholesterol lipase inhibitor which selectively inhibits intestinal cholesterol absorption • Side effects = headache, abdominal pain, diarrhoea • Dose = 10mg **_PCSK9 inhibitors_** • Mechanism = reduces LDL receptors - more cholesterol removed • Side effects = nasal complaints, oropharyngeal pain, pulmonary reactions, skin reactions • E.g. alirocumab, evolocumab

Answer 28

Calcium channel blocker -\> relaxing the blood vessels HTN, angina Dizziness; flushing; **headache**; nausea; palpitations; peripheral oedema; rash; **tachycardia; vomiting**

Answer 29

* Apixaban (Eliquis®) * Dabigatran (Pradaxa®) * Rivaroxaban (Xarelto®) * Edoxaban (SavaysaTM)

Answer 30

LMWH Enoxaparin binds to and potentiates **antithrombin** (a circulating anticoagulant) to form a complex that irreversibly inactivates clotting factor **Xa**. It has less activity against factor IIa (thrombin) compared to unfractionated heparin (UFH) due to its low molecular weight.

Drugs Flashcards

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