Drugs for FINALS Flashcards
All drugs for finals. (126 cards)
1
Q
Platelet plug formation
A
- PLT adherance
- 1a - collagen 123
- 1b - vWF + microfibrils
- 2b/3a - vWF + fibrinogen
- Monolayer, spheres, a and b granules
- ADP (Adenosine DiPhosphate), thromboxane A2 and 5HT
- Aggregation + vasoconstriction
2
Q
Platelet plug inhibition
A
PGI2 + NO -inhibtits ADP, thomboxane A2, 5HT
vasoconstriction
3
Q
Aspirin mechanism
A
Blocks thromboxane A2 irreversibly
Lasts life of PLT 8-9d
4
Q
Aspirin COUNCILLING
A
- GI: nausea, bleeds (prophylactic PPI)
- Bronchospasm - 20% asthmatics
- Children: Reye’s syndrome
- Gout (cant leAp)
- Ototoxic
- Anticoagulants: bleed
- Antidepressants: bleed [SSRI, Venlafaxin SSNRI - inhibit 5HT from PLTs)
- Cytotoxic drugs : low excretion of methotrexate
5
Q
Thiopyridine mechanism
A
Irreversibly inhibits Adenosine diphosphate (ADP)
6
Q
Thiopyridine examples
A
- Ticlipidine
- Clopidogrel
- Prasugrel
- Ticagrelor
7
Q
Clopidogrel class + mechanism
A
Irrevers. inhibits ADP
8
Q
Prasugrel class + mechanism
A
Irrevers inhibits ADP
9
Q
Thiopyridine COUNCILLING
A
- GI
- Bleeding
- Rash
- Severe hepatic impairment
10
Q
Glycoprotein 2b/3a inhibitor mechanism
A
- Abcliximab - monoclonca AB
- Aptifibatise/ tirofiban - inhibitors
11
Q
Abcliximab class + mechanism
A
Glycoprotein 2b/3a inhibitor
Monoclonal AB
12
Q
Aptifibatise class + mechanism
A
Glycoprotein 2b/3a inhibitor
13
Q
Tirofiban class + mechanism
A
Glycoprotein 2b/3a inhibitor
14
Q
ACEi mechanism
A
BLOCK AG1 to AG2
AG2 functions;
- mass Vasoconstriction (Gq protein)
- ADH (post. pit)
- Aldosterone (adrenal cortex)
- Sympathetic
- Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
15
Q
ACEi examples
A
PRIL
- Ramipril
- Perindopril
- Captopril
- Analapril
- Lisinopril
16
Q
ACEi indications
A
- Hypertension (1st line)
- HF
- Renal Hypertension (1st)
17
Q
ACEi COUNCILLING
A
- Dry Cough 1/10
- First-dose hypotention (start at night)
- +Diuretics/ RAAS – enhances hypotensive effects
- HYPERkalaemia (CI +K supplements/ drugs)
- Angioedema (stop)/ CI Hx
- GI
- Rash (switch, stop)
- Teratogenic
- Renal impairment (stop if Cr >inc>30%/ eGFR dec>25%)
- CI Renovascular disease
- CI Valvular stenosis
- +Lithium toxicity
- +Ciclosporin ARF
- +NAIDS (reduce efficacy)
18
Q
ACEi monitoring
When to stop?
A
BP and U+Es
- 2wks
- Annually
STOP: -Serum Cr >20% -eGFR >15%
19
Q
ARBs mechanism
A
BLOCK AG2 receptor
AG2 functions;
- mass Vasoconstriction (Gq protein)
- ADH (post. pit)
- Aldosterone (adrenal cortex)
- Sympathetic
- Renal NaCL reabsorption (hence water) + K+ excretion (tubules)
aka AG2 receptor antagonists
20
Q
ARBs examples
A
SARTAN’s
- Losartan
- Candesartan
- Irbesartan
- Telmisartan
- Valsartan
21
Q
ARBs indications
A
-2nd line to ACEi
- HF (gold has a b A dvd)
- CKD Hypertension 1st (/ACEi)
22
Q
ARBs COUNCILLING
A
- First-dose hypotention (start at night)
- +Diuretics/ RAAS – enhances hypotensive effects
- HYPERkalaemia (CI +K supplements/ drugs)
- Angioedema (stop)/ CI Hx
- GI
- Rash (switch, stop)
- Teratogenic
- Renal impairment (stop if Cr >inc>30%/ eGFR dec>25%)
- CI Renovascular disease
- CI Valvular stenosis
- +Lithium toxicity
- +Digoxin fluctuations (candesartan)
23
Q
ARBs monitoring
A
BP and U+Es
- 2wks
- Annually
STOP: -Serum Cr >20% -eGFR >15%
24
Q
Aldosterone antagonist mechanism -also known as?
A
BLOCKS Aldosterone receptor
- Na/K pump (DT+CD)
- Epithelial Na channel (ENaCs)
- Secretes K+
- Secretes H+ for Na+ (regulating pH, bicarb)
Stimulated by AG2, Adrenal cortex
aka Potassium sparing diuretics
25
Aldosterone antag examples
Spironolactone
Eplerenone
26
Aldosterone antag indications
* HF (gold has aba Dvd)
* Post-MI HF
* Hypertension (step 4. K+ \<4.5)
* Ascites (cirrhotic pts develop 2ndary hyperaldosteronism)
* Nephrotic syndrome
* Conn's syndrome (excess aldosterone and low K+ from adrenal cortex)
27
Aldosterone antag COUNCILLING
* HYPERkalaemia (low K diet)
* CI K+ \>4.5 (hyperK = \>5.5)
* Risk: ACEi/ ARBs/ supplements
* CI Addison's disease
* Renal (anuria) (CI, Cr \>220half, \>310stop)
* Hepatic failure (CI, stop)
* GI
* Gynaecomastia (spironolactone progesterone effects)
* Menstrual irregularities
28
Aldosterone antagonist monitoring
4x4wk 3x3m 6m
29
B blocker mechanism
Block sympathetic B-adrenergic input
1. Slowing Nodal Phase 0 -ve chronotrope and Myocardial: -ve inotrope
2. Systemic - lower BP
30
B blocker examples
* Atenolol
* Bisoprolol
* Metoprolol
* Nebivolol
* Carvedilol
31
B blocker indications
* Carvedilol - HF
* Sotalol (2+3) - 1st Rhythm control
* Atenolol - 1st Rate control, MI, Stable Angina(4th), SVT(3rd)
* Bisoprolol - Stable Angina (4th)
* Metoprolol - Stable Angina (4th)
* Propanolol - Migraine prophyl, Anxiety, Thyrotoxicosis
* Last stage of hypertension
32
B blocker COUNCILLING
* Bradycardia (CI 2/3HB, sick sinus)
* Hypotension (CI uncontrolled HF)
* GI
* Cold-extreminies (CI Reynauds, PVD)
* Bronchospasm (CI asthma)
* Sleep disturbance, nightmares (water-soluble)
* CI +Verapamil (severe brady)
* +Thiazide (insulin resistance, monitor)
33
CCB mechanism + types
Inhibit Calcium 'SLOW' channels
Dihydropyridine (DHP) = vascular smooth muscle
* Peripheral vasodilation, Low BP, Low afterload
non-DHP = Myocardium and conduction system
* Nodal Phase O (-ve chronotrope)
* Myocyte Phase 2 (-ve inotrope)
34
DHP CCBs examples
PINEs
* Amlodipine
* Nifedipine
* Felodipine
* Lacidipine
35
Non-DHP CCBs examples
* Diltiazem
* Verapamil
36
CCB indications
* Hypertension (DHP: 1st \>55/ black: Amlopidine)
* Rate control (nonDHP: Diltiazem\>Verapamil)
* Angina 4th (nonDHP: Diltiazem, Verapamil)
* Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker)
* Reynauds (Nifedipine + Diltiazem)
* Cluster prophyl (Verapamil)
37
CCB COUNCILLING
* Non-DHP: Bradycardia (CI 2/3HB, sick sinus)
* Hypotension (CI uncontrolled HF)
* GI (Verapamil: Constipation)
* Flushing
* Ankle oedema (reduce or +ACEi/ARB)
* Gingival hyperplasia
* CI Non-DHP +B-blocker (severe brady)
* CI +Grapefruit juice
38
Nitrate mechanism
VASO+VENO dilation: Coronary + prevent spasm
VASO (low afterload) -VENO (low preload)
39
Nitrate examples
* Glyceryl trinitrate (GTN)
* Isosobide mono/ dinitrate
40
Nitrate indications
Angina to ACS (acutely or every 12hr)
Tolerance: Every 8hrs
41
Nitrate COUNCILLING
* Flushing
* Hypotension (CI)
* Headache (cerebral vasodilation)
* CI Cerebral haemorrhage
* Tolerance (take every 8hr)
* Tachycardia (CI)
* CI Containing heart disease
42
Potassium channel activator mechanism
Vasodilation (opens potassium channels)
* Nicorandil: has nitrate-like venodilation (reducing preload)
43
Potassium channel activator example
Nicorandil
44
Potassium channel activator indications
Angina (if failed duotherapy with Ca2+ antag + B blocker)
45
Potassium channel activator COUNCILLING
* Flushing
* Hypotension (CI HF)
* Headache (cerebral vasodilation)
* CI Pregnancy and breast feeding
* Anal ulceration
46
Loop diuretic mechanism
Inhibit Na-K-2Cl (NaKCC2) co-transporter in thick ascending loop of Henle
47
Loop diuretic examples
Frusemide Bumetanide
48
Loop diuretic indications
* HF (acute IV, chronic PO)
* CKD hypertension/ fluid retention (2ndACEi/ARB)
49
Loop diuretic COUNSILLING
* HYPOkalaemia
* HYPOtension
* Gout (urea absorption, cant Leap)
* Renal impairment
* Liver impairment
* Elderly (low dose)
* CI Pregnancy
* Ototoxic (frusomide)
50
Loop diuretic monitoring
* 2wk
* 6m
51
Thiazide diuretic mechanism
Inhibit NaCL co-transporter in DCT
Onset: 1-2hrs+
Compensatory Inc **Ca2+** absorption by NaCa
52
Thiazide diuretic examples
-thiazide
* Bendroflumethiazide
* Hydrochlorothiazide
* Chlorthalidone
+Indapamide (thiazide-like)
53
Thiazide diuretic indications
* Hypertension 3rd line (A+C+D)
* Past: HF
54
Thiazide diuretic COUNCILLING
* HYPOkalaemia
* HYPOtension
* Gout (urea absorption, canT leap)
* Renal impairment
* Liver impairment
* Elderly (low dose)
* CI Pregnancy
* HYPERcalcaemia
* HYPERglycaemia + Insulin resistance (I pre-/DM)
* +B-Blocker = Insulin insensitivity (monitor DM)
* RARE;
* Thrombocytopaenia
* Agranulocytosis
55
Thiazide diuretic monitoring
1m
6m
56
Potassium sparing diuretic mechanism
Act in DT+CD, 2 types;
1. Inhibit NaK exchanger only
* Amiloride, triamterene
1. aka Aldosterone antagonist
* Spironolactone
* Eplerenone
Aldosterone;
1. Na/K pump (DT+CD)
2. Epithelial Na channel (ENaCs)
3. Secretes K+
4. Secretes H+ for Na+ (regulating bicarb)
Stimulated by AG2, Adrenal cortex
57
Potassium sparing diuretic examples
Weak NaK inhibitors
* Amiloride
* Triamterene
Aldosterone antagonists
* Spironolactone
* Eplerenone
58
Potassium sparing diuretic indications
* HF (gold has aba Dvd)
* Post-MI HF
* Hypertension (step 4. K+ \<4.5)
* Ascites (cirrhotic pts develop 2ndary hyperaldosteronism)
* Nephrotic syndrome
* Conn's syndrome (excess aldosterone and low K+ from adrenal cortex)
59
Potassium sparing diuretic COUNCILLING
* HYPERkalaemia (low K diet)
* CI if K+ \>4.5 (hyperK = \>5.5)
* Risk: ACEi/ ARBs/ supplements
* Addison's disease CI
* Renal (anuria) (CI, Cr \>220half, \>310stop)
* Hepatic failure (CI, stop)
* GI
* Gynaecomastia (spironolactone progesterone effects)
* Menstrual irregularities
60
Potassium sparing diuretic monitoring
4x4wk 3x3m 6m
61
Osmotic diuretic mechanism, example + indication
Inc osmolality: Pulls everything out
* Mannitol IV
* Urea IV
* Glycerin PO
* Isosorbide PO
CEREBRAL OEDEMA
62
Carbonic anhydrase inhibitors
* Mechanism
* Example
* Indication
Diuretic: Inhibit NaHCO3-
**Acetazolamide**
* Idiopathic Intracranial Hypertension
* Prophylaxis against mountain sickness
* Glaucoma
63
Class 1a antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Block Myocyte Phase 0 Na+ influx (depolarisation)
* Sodium blocker
* Intermediate half life
Examples
* Quinidine
* Procainamide
* Disopyramide
Uses
* SVT, VT
64
Class 1b antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Block Myocyte Phase 0 Na+ influx (depolarisation)
* Sodium blocker
* Fast half life/ weak
Examples
* Lidocaine
* Phenytoin
Uses
* MI associated VT
65
Class 1c antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Block Myocyte Phase 0 Na+ influx (depolarisation)
* Sodium blocker
* Slow half life/ strong
Examples
* Flecainide
Uses
* Rhythm control
66
Class 2 antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Block sympathetic adrenergic input
* Slowing Nodal Phase 0
* B-blockers
Examples + Uses
* Carvedilol - HF Sotalol (2+3) - 1st Rhythm control
* Atenolol - Rate control, MI, Stable Angina (4th), SVT (3rd)
* Bisoprolol - Stable Angina (4th)
* Metoprolol - Stable Angina (4th)
* Propanolol - Migraine prophyl
* Last stage of hypertension
67
Class 3 antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Block Myocyte Phase 3 K+ efflux
* Potassium blocker
Examples + Uses
* Sotalol (2+3) - 1st Rhythm control
* Amiodarone - Rhythm control, 1st VT (stable)
68
Class 4 antiarrhythmic
* Mechanism
* Examples
* Uses
Mechanism
* Non-DHP Calcium 'SLOW' channels
* Nodal Phase O (-ve chronotrope)
* Myocyte Phase 2 (-ve inotrope)
Examples + Uses
* Rate control (Diltiazem\> Verapamil)
* SVT(2nd)/ asthmatic (Verapamil)
* Angina 4th (Diltiazem, Verapamil)
* Angina 5th Duo (DHP: Nifedipine mod. release + B-blocker)
* Reynauds (Diltiazem + DHP: Nifedipine)
* Cluster prophyl (Verapamil)
DHP CCB are not Class 4 antiarrhythmics.
69
Cardiac Glycosides
* Mechanism
* Examples
* Uses
Mechanism
1. ++Parasympathetic to SA node (-chronotrope)
2. ++NaCa exchange, increasing intracellular Ca and force of contraction (+inotrope)
Example + Use
* Digoxin - Rate control(2)
70
Adenosine
* Mechanism
* Uses
Mechanism
* Opens Nodal K+ INFLUX -\> HyPERpolarisation
* Short half life
* C: Total stop
Uses
* Narrow Complex Tachy/ SVTs (stable)
* (asthmatic: Verapamil)
71
Magnesium Sulphate Indications
MgSO4 uses
* **Torsades de Pointes**
* **Hypomagnesium**
* **Asthma:** Severe Exacerbation
* **Pre-Eclampsia:** Severe/ neuro signs
72
Magnesium Sulphate
* Signs of Toxicity
* Management of Toxicity
Toxicity Signs
* Loss of reflexes ← Monitor every 4-6hrs
* Flushing
* Double vision
* Slurred speech
Treatment
* Stop MgSO4 infusion
* Calcium gluconate → relieves vascular spasm
73
Atropine
* Mechanism
* Uses
Mechanism
* Anti-muscarinic Inhibits parasympathetic input to NODES
Uses
* Bradycardia
IM/SC - initial M1 presynaptic block prevents reuptake⇒ bradycardia
74
Digoxin
* Contraindications
* Toxicity Signs
CI due to toxicity risk
* Hypokalaemia (monitor U+Es)
* Renal dysfunction
Toxicity Signs
* N+V+D
* Xanthopsia (yellow haze)
* Diplopia
* Blood digoxin \>2nmol/L
75
B2 Agonist Mechanism (Resp)
+Adenylyl Cyclase converting ATP to cAMP
cAMP activates PKA -\> Bronchodilation
76
B2 Agonist Examples + SEs (Resp)
SABA: Salbutamol, Terbutaline
LABA: Salmeterol, Formoterol
**SABA Overuse**
* Tremor, headache, muscle cramps, palpitations
* HyPOkalaemia
* Myocardial ischaemia?
**LABA** ⇒ Above + **Increase asthma-related adverse events**
* Do not start before Steroid, and do not stop Steroid while on LABA
77
B2 Agonist Indications (Resp)
Asthma 1st: SABA
3rd: LABA
Severe: Nebulised COPD: 1st
1. **SABA**
2. **Inhaled Steroid** (200-800mcg/d)
3. **LABA**
4. **+ Increase Inhaled Steroid** (upto 200mcg/d)
**+** **Leukotriene receptor agonist**
or **+ Theophylline** (methylxanthine PDE inhibitor)
5. **Prednisolone** Tablet
78
Anticholinergics Mechanism (Resp)
Muscarinic antagonist Inhibit bronchial mucus secretion
79
Anticholinergic Examples (Resp)
* Ipratropium
* Tiotropium
80
Anticholinergic Indications (Resp)
Asthma Severe: Nebulised Ipratropium
COPD: 1st
81
Methylxanthine Mechanism (Resp)
Inhibits phosphodiesterase
STOPs cAMP to AMP conversion
Increasing cAMP -\> Activates PKA -\> Bronchodilations
82
Methylxanthine Examples + SEs (Resp)
* Theophylline
* Aminophylline
* Therapeutic plasma concentration = 10-20mg/L
SEs
* N+V
* Tremor
* Palpitations + Arrythmias
Increased serum levels
* HF + Hepatic failure
* Elderly
* P450 inhibitors (cimetidine, ciprofloxacin, erythromycin)
Decreased serum levels
* P45 inducers (phenytoin, carbamazepine, rifampicin)
83
Methylxanthine Indications (Resp)
Asthma: 4th
COPD: 2nd
84
Glucocorticoid Mechanism (Resp)
Bind glucocorticoid receptor, modify gene transription;
* Inhibit COX2, cytokines, cell adhesion moleules
* Inhibit IL4,5,13 from Th2 cells
* ++anti-inflammatory genes
85
Glucocorticoid Examples + SEs (Resp)
* Inhaled: Beclometasone, Fluticasone, Budesonide
* Ciclesonide (pressurized MDI), Mometasone (dry-powder inhaler)
* Oral: Prednisolone, Hydrocortisone
Inhaled **Local** SEs
* **Oral candidiasis**, sore mouth, dysphonia, **hoarseness**
* Reduced using **large-volume spacer** (filters)
* +**Wash mouth** after use
Inhaled **Systemic** SEs
* **Osteoporosis** (exercise, calcium, stop smoking)
* **HPA** suppression
Inhaled **Child Systemic** SEs
* Initial slowing, final height not affects
* **\>100ug/d** ⇒ Growth suppression + Adrenal crisis
* **Very rare: Hyperactivity,** behavioural problems, sleep, anxiety, depression
Oral (especially \>3m/ frequent)
* **_C_**entral obesity **+ Weight gain**
* **_U_**UUN face
* ****_S_**kin - thin, easy bruising, acne, hirsutism**
* _H_**yPERglycaemia + DM + HyPERtension**
* **_I_**nsufficient muscles **(proximal weakness)**
* **_N_**eck buffalo + supraclavicular lump
* ****_G_**onadal dysfunction** +**Glaucoma/ Cateracts**
* ****_O_**steoporosis**
* **_I_**mmunosuppresion + Infections
* **_D_**epression
86
Glucocorticoid Indications (Resp)
Chronic asthma
* 2nd: **Inhaled Low-Dose 200ug twice daily** (Beclometasone)
* \<12: 100ug twice daily
* 5th: Oral Prenisolone
Acute asthma
* Prednisolone tablet 40mg (max 60mg) for 5d
or IV hydrocortisone (preferably Sodium Succinate) 100mg slow IV bolus if severe or more
* Prednisolon daily dose
or Hydrocortisone 6hrly
* Discharge: Oral steroids 5d
+add inhaled steroid to regular medication
**COPD**: 2nd Beclometasone
87
Anti-leukotriene Mechanism (Resp)
1. Zileuton
* Inhibits 5-lipoxygenase (enzyme that converts arachidonic acid to Leukotriene A4)
1. Zafirlukast, Montelukast
* Inhibits CysLT1 (receptor for Leukotrienes)
88
Anti-leukotriene Examples + SEs (Resp)
* Zileuton (inhibits 5-lipoxygenase)
* Zafirlukast (inhibits CysLT1)
* Montelukast (inhibits CysLT1)
SEs
* Zafirlukast: Liver toxicity (any signs do ALT)
* N+V, malaise, jaundice
89
Anti-leukotriene Indications (Resp)
Asthma: 4th
90
Anti-IgE Mechanism and Example (Resp)
Omalizumab
* Humanized monoclonal anti-human IgE
* Suppressing mast cell sensitisation and degranulation
91
Cromone Mechanism, Example, SEs (Resp)
Sodium **Cromoglicate**, **Nedocromil**
1. Stabilise Mast Cell
2. Inhibit Sensory Nerves (blocks Cl- channel)
Used regularly 4/d (not reliever)
**Dry-powder Sodium Cromoglicate** may cause **bronchospasm** (use **SABA** a few minutes prior to use)
92
Naftidrofuryl Oxalate Mechanism and Indication
Vasodilator Medical: PVD
93
Bigaunide
* Mechanism
* Example
* COUNCILLING
Mechanism
* Inc insulin sensitivity
Example
* Metformin
COUNCILLING
* Nausea (titrate dose up)
* Lactic acidosis (monitor renal function)
* Serm Cr \>150
* eGFR \<30
* NO angiography
* High risk of contract induced nephropathy
* Stop on the day + 48hrs
94
Sulphonylureas
* Mechanism
* Example
* Indications
* COUNCILLING
Mechanism
* Inc insulin release
Example
* Gliclazide
* Glimepiride
Indications
* 2nd line after Metformin
COUNCILLING
* HYPOglycaemia (inform DVLA)
* CI Goods drivers
95
Thiazolidinediones
* Mechanism
* Example
* Indication
* COUNCILLING
Mechanism
* Inc insulin sensitivity
Example
* Pioglitazone - bladder cancer
* Rosiglitazone (no longer used - CV affects)
Indication
* 3rd line: HbA1C \>7.5% or \>58mmol/L
COUNCILLING
* Weight gain + fracture
* Liver impairment (monitor LFTs)
* Fluid retention (CI in HF)
* + Insulin = Peripheral oedema
96
DPP-4 Inhibitors
* Mechanism
* Example
* Indications
* COUNCILLING
Mechanism
* Inhibits DPP-4 ⇒ Inc Incretins
* Inhibit Glucagon ⇒ Inc INSULIN
Example - GLIPTINS
* Sitagliptin
Indications
* Only used with other drugs (1,2,3)
* 4th line
* Only continue if HbA1C drops 0.5%/6m
COUNCILLING
* GI
* Flu-like symptoms
* Rare: Acute Pancreatitis
* Rare: Hypoglycaemia
97
GLP-1 analogues
* Mechanism
* Example
* Indications
* COUNCILLING
Mechanism
* mimics Incretin
* Inhibit Glucagon ⇒ Inc INSULIN
Example
* Exenatide SUBCUTANEOUS
Indications
* Only used with other drugs (1,2,3)
* BMI \>35kg/m2 or Can't do insulin
* 5th line
COUNCILLING
* GI
* Dizziness, headache, jittery
* Rare: Acute pancreatitis
* Rare: Hypoglycaemia
98
SGLT2 inhibitors
* Mechanism
* Example
* Indications
* COUNCILLING
Mechanism
* Increase renal excretion of GLUCOSE
Example - GLIFLOZIN
* Dopagliflozin
Indications
* Only used with something else (any drug or insulin) (NOT with 1+2 together!)
COUNCILLING
* **UTIs**
99
Glinides
* Mechanism
* Example
* Indications
* COUNCILLING
Mechanism
* Inc Insulin SECRETION quickly (30mins before meal)
Example - GLINIDES
* Nateglinide/ mitiglinide
Indications
* Erratic lifestyle
COUNCILLING
* Hypoglycaemia
* Weight gain
100
Gastroparesis management
* Metoclopramide
* Domperidone
* Erythromycin
101
Neuropathic pain treatment
First line;
Only 1 at a time;
* Gabapentin
* Amitriptyline (10-75mg at night)
* Pregabalan
* Duloxetine (SNRI)
Rescue therapy;
* Tramadol
Localised;
* Capsaicin topical (Axsain)
102
Corticosteroid
Types + Effects (not examples)
**Glucocorticoid** = Cortisol
1. +Gluconeogenesis
2. +Glycogen phosphorylase (allowing adrenaline +glycogenolysis)
3. -IL2 receptor -Th2 responce (⇒Th1 dominance, and less AB production)
Mineralocorticoid = Aldosterone
1. Na/K pump (DT+CD)
2. Epithelial Na channel (ENaCs)
3. Secretes K+
4. Secretes H+ for Na+ (regulating pH, bicarb)
103
Corticosteroid
Examples + SEs
**High Minero-**
* Fludrocortisone
* Hydrocortisone
* Prednisolon
* DXM + Betmethasone
**High Gluco-**
SEs
**High Gluco**corticoid (ie **Cushings**)
* **_C_**entral obesity +Weight gain
* **_U_**UUN face
* **_S_**kin - thin, easy bruising, acne, hirsutism
* ****_H_**yPER**glycaemia + DM + **HyPER**tension
* **_I_**nsufficient muscles (proximal weakness)
* **_N_**eck buffalo + supraclavicular lump
* **_G_**onadal dysfunction +Glaucoma/ Cateracts
* **_O_**steoporosis
* **_I_**mmunosuppresion + Infections
* **_D_**epression
**High Mineralo**corticoid (ie **Conns**)
* Hypertension + Fluid retension
* HYPOkalaemia
* Hypotonia, Hyporeflexia, Tetany
* Muscle weakness + Cramps
* Palpitations
104
Corticosteroid
Topical Ladder
Mild
* **Hydrocortisone 1%**
* Fucidin H
* Timodine
* Synalar 1:10
Moderate
* Clobetasone butyrate Eumovate
* Alcometasone diproprionate (Modrasone)
* Trimovate
Potent
* **Betamethasome valerate (Betnovate)**
* Mometasone furoate (Elocon)
* Hydrocortisone butyrate (Locoid)
* Fluocinolone acetonide (Synalar)
Very Potent
* Clobestasol propionate (Dermovate)
105
B Blocker overdose management
Bradycardic: Atropine
2nd: Glucagon
106
Paracetamol overdose management
Kings College Hospital criteria for liver transplantation
Treat with **Acetylecysteine IV over 1 hour** if;
* **Over the Treatment Line** on normgram
100mg/L at 4hr ⇒ 15mg/L at 15hrs
* **Staggered** (\>1hr) overdose or **Doubt about timing**
Kings College Hospital criteria
1. pH \<7.3 24hrs after ingestion
2. Or all of;
1. Prothrombin time \>100s
2. Creatube \<300umol/L
3. Grade 3 or 4 encephalopathy
107
RA management
General ladder
1. NSAID
+ Steroid to bridge gap
2. Combination of 2 DMARDS (Methotrexate + 1)
* Hydroxychloroquine
* **Methotrexate**
* Sulfasalazine
* Gold salts
* Azathioprine
* Penicillamine
* Leflunomide
3. TNFa inhibitors
* Etenercept (decoy receptor for TNFa)
* Infliximab (monoclonal AB binds TNFa)
* Adalimumab (monoclonal AB)
4. Rituximab (anti-CD20 B-Cell)
108
Hydroxychloroquine
SEs + Councilling + Monitoring
* **Retinopathy** due to corneal deposits: visual disturbance (annual optometrist)
* **Tinnitus**
* Rash + GI
109
Methotrexate
SEs + Councilling + Monitoring
* **Myelosuppression**
* Sore throat come back
* **FBC 3x2wk, monthly**
* Hepatotoxic
* **LFTs 3x2wk, monthly**
* Stop: ALT doubles or \>80
* Renal impairment
* **U+Es 3monthly**
* Teratogenic
* Dont get pregnant
* Low folate
* 5mg Folic acid on non-methotrexate day
* **Pneumonitis & Fibrosis**
* Rash + GI
**CI**
* +Trimethoprim (low folate)
* +NSAIDs (inhibits excretion)
110
Sulfasalazine
SEs + Councilling + Monitoring
* Myelosuppression + Heinz-body anaemia
* Sore throat come back
* **FBC 3x2wk, monthly**
* Hepatotoxic
* **LFTs 3x2wk, monthly**
* Renal impairment
* **U+Es** **monthly**
* Azoospermia
* Rash + GI
111
Gold Salts
SEs + Councilling + Monitoring
* Proteinuria (nephrotic syndrome)
* Urinalysis at each injection
* Thrombocytopenia
* FBC at each injection
112
Azathioprine
SEs + Councilling + Monitoring
* Myelosuppression
* Sore throat come back
* **FBC 6x1wk ⇒ 3x2wk, monthly**
* Liver impairment
* **LFTs 6x1wk ⇒ 3x2wk, monthly**
* Renal impairment
* **U+Es 3monthly**
* Teratogenic
* Dont get pregnant
* Basal Cell Carcinoma
* Lymphoma
* Azoospermia
* GI + rash
113
Penicillamine
SEs + Councilling + Monitoring
* Myelosuppresion
* +Aplastic anaemia
* Sore throat come back
* **FBC 3x2wk, monthly**
* Glomerulonephritis + Proteinuria
* **U+Es + Urinalysis 3x2wk, monthly**
* SLE
* CI Myasthenia Gravis exacerbation
* GI + rash
114
Leflunomide
SEs + Councilling + Monitoring
* Myelosuppression
* Sore throat come back
* **FBC 3x2wk, monthly**
* Hepatotoxic
* **LFTs 3x2wk, monthly**
* Interstitial lung disease
* Hypertension
* Measure at appointments
115
RA management in pregnancy
* Sulfasalazine + Hydroxychloroquine
* Low dose steroids
* \<32wks NSAIDs
116
TNF inhibitor
SEs + councilling
ALL = **TB reactivation**
* Etanercept - **demyelination**
* Infliximab
* Adalimumab
117
Rituximab
SEs + councilling
* Infusion reactions
118
TB management
Two months RIPE
* Rifampicin
* Isoniazid
* Pyrazinamide
* Ethambutol (ischiara prior)
Continuation 4 months
* Rifampicin
* Isoniazid
Latent: 6months Isoniazid
Meningeal TB: 12months + Steroids
119
Rifampicin
Mechanism + SEs
Mechanism
* Inhibit DNA dependent RNA polymerase preventing transcription of DNA into mRNA
SEs
* Potent liver enzyme inducer
* Hepatitis
* Orange secretions
* Flu-like symptoms
* Inactivates OCP
120
Isoniazid
Mechanism + SEs
Mechanism
Inhibits mycolic acid synthesis
SEs
* Peripheral neuropathy (prevent with pyridoxine vitamin B6)
* Hepatitis
* Agranulocytosis
* Liver enzyme inhibitor
121
Pyrazinamide
Mechanism + SEs
Mechanism
* Converted by pyrazinamidase to pyrazinoid acid
* Which inhibits fatty acid synthase (FAS) 1
SEs
* Hyperuricaemia + Gout
* Arthralgia
* Myalgia
* Hepatitis
122
Ethambutol
Mechanism + SEs
Mechanism
* Inhibits enzyme Arabinosyl transferase which polymerized arabinose into arabinan
SEs
* Optic neuritis (check visual acuity + Ishihara test)
* Low dose if renal impairment
123
N+V treatment in pregnancy
1. Promethazine (anti-histamine)
2. Ginger + P6 wrist accupuncture
124
Stress Incontinence
Management
* Conservative
* Loos weight, address cough
* Pelvic floor muscle training 3m physio
* Vaginal 'cones'/ sponges
* Medical
* Duloxetine SNRI - enhances sphincter control via CNS
* Conservative
* Tension-free vaginal tape (TVT)
[over pubis]
* Trans-obturator tape (TOT)
[through obturator foramen]
* Injectable periurethral bulking agents
125
Urge incontinence
Management
* Conservative
* Bladder retaining min 6wks (inc time between voids)
* Medical
* Antimuscarinics
* Oxybutynin
* Tolterodine (less dry mouth)
* Solifenacin
* Post-menopause: Intravaginal Oestrogens
* Surgical
* Neuromodulation + S3 nerve stimulation
* Botolinum toxin A injections (idiopathic only)
* Augmentation cystoplasty
126
Antimuscarinics
* Mechanism
* Indications
* SEs
Mechanism - block muscarinic acetylcholine receptors
Indications
* Bradycardia
* Atropine (blocks M2 parasym to SA node)
* IM/SC: initial M1 presynaptic block prevents reuptake⇒ bradycardia
* Urge incontinence
* Oxybutynin
* Tolteradine
* Solifenacin
* Bronchodilators
* Ipratropium bromide
* Triotropium
* Parkinsonism - tremor + rigidity
* Procyclidine
* Benztropine
* Trihexyphenidyl (benzhexol)
* Anti-psychotic drug extra-pyramidal SEs
* Procyclidine
* IBS anti-spasmodic (only works on bowel muscle)
* Mebeverine
* Alverine
