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Year 3 revision > Drugs summary - difficult things > Flashcards

Drugs summary - difficult things Flashcards

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1
Q

indication of furosemide

A

OVERLOAD - e.g. pulmonary oedema, CHF, renal/liver disease, oedema

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2
Q

contra-indication of both loop and thiazide diuretics

A

gout (decreases uric acid secretion)

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3
Q

3 other contraindications of furosemide

A

hepatic encephalopathy
low potassium and sodium
hypovolaemia

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4
Q

ENT side effect of furosemide

A

tinnitus

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5
Q

what drug interacts with all diuretics

A

digoxin (decreases potassium levels)

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6
Q

what drug interacts with both loop and potassium sparing diuretics

A

lithium

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7
Q

3 other drugs interacting with furosemide

A

aminoglycosides
lidocaine
phenytoin

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8
Q

indication of thiazides

A

hypertension (if not with CCB, or alongside CCB/ACEi/ARB)

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9
Q

when to use thiazides instead of CCB for hypertension

A

oedema or HF

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10
Q

2 side effects of thiazides

A

arrhythmias (low Na+/K+)

male impotence

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11
Q

2 interactions of thiazides (apart from digoxin)

A 
NSAIDs 
loop diuretics (low K+)
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12
Q

side effect of amiloride (potassium sparing - use for low K+)

A

androgen effects

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13
Q

interaction of amiloride (apart from digoxin and lithium)

A

drugs increasing K+ e.g. aldosterone antagonists

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14
Q

effect of beta blockers on renin secretion

A

decreases

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15
Q

3 indications of beta blockers

A

anything with high heart rate e.g. SVT, AF
heart disease e.g. IHD, angina, ACS, CHF
high BP second line

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16
Q

big contraindication of beta blockers

A

ASTHMA

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17
Q

what type of beta blocker can’t you use for COPD

A

propanolol (can use B1 selective ones)

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18
Q

side effect of beta blockers that is the same as thiazides

A

male impotence

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19
Q

5 cardiovascular drugs which are excreted by liver (others are solely by kidneys)

A 
beta blockers
nitrates (GTN)
antidysrhythmics (amiodarone)
warfarin
statins
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20
Q

interaction of beta blockers

A

CCBs = asystole, bradycardia

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21
Q

3 examples of CCBs

A

amlodipine
diltiazem
verpamil

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22
Q

3 indications of CCBs

A

hypertension
stable angina (or beta blockers)
SVT/atrial flutter

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23
Q

4 contraindications of CCBs

A

HF
heart block
unstable angina
severe aortic stenosis (SAME as nitrates)

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24
Q

side effect of verpamil

A

constipation

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25
2 side effects of all CCBs AND nitrates (GTN, ISM)
oedema | flushing
26
2 CCBs not to prescribe with beta blockers
diltiazem | verpamil
27
4 indications of ACEis and ARBs
hypertension IHD diabetic nephropathy CKD
28
3 contraindications of ACEis and ARBs
renal artery stenosis AKI pregnant/breastfeeding
29
2 interactions of ACEis and ARBs
potassium increasing drugs e.g. amiloride | NSAIDs (increase renal failure risk)
30
how are nitrates similar to CCBs
both decrease Ca2+
31
3 indications of nitrates
angina + prophylaxis ACS pulmonary oedema
32
2 drugs to give for pulmonary oedema alongside nitrates
furosemide | O2
33
2 contraindications for nitrates
severe aortic stenosis | hypotension
34
interaction of nitrates
phosphodiesterase inhibitors e.g. sildenafil = increase hypotension
35
elimination of nitrates apart from LIVER
RBCs | vascular wall
36
example of a cardiac glycoside (decrease heart rate)
digoxin
37
2 indications of digoxin
``` AF/flutter (monotherapy in paroxysmal AF) severe HF (3rd line) ```
38
other drugs to give with digoxin for severe HF
beta blockers | ACEis/ARBs
39
4 contraindications of digoxin
2nd degree heart block renal failure decreased K+/Mg2+ increased Ca2+
40
2 side effects of digoxin (apart from ones associated with lower HR)
rash | yellow vision
41
3 interactions of digoxin
loop/thiazide/K+ sparing diuretics (decrease K+) amiodarone CCBs
42
what is amiodarone
antidysrhythmic
43
indication of amiodarone
tachycardias
44
3 contraindications of amiodarone
hypotension (because it lowers BP) heart block thyroid disease
45
4 side effects of amiodarone
pneumonitis hepatitis photosensitivity thyroid problems
46
3 interactions of amiodarone
digoxin CCBs (diltiazem and verapamil) grapefruit juice
47
what NOT to treat AF with
warfarin (use antiplatelets/anticoagulants instead)
48
can you use antiplatelets in pregnancy
not in third trimester
49
2 side effects of aspirin
bronchospasm | tinnitus
50
4 interactions of clopidogrel
cP450 inhibitors aspirin heparin NSAIDs
51
what is enoxaparin
LMWH
52
indication of LMWH
VTE
53
indication of LMWH and fondaparinux
ACS
54
3 contraindications of heparins
clotting disorders uncontrolled hypertension renal impairment
55
2 indications of warfarin
VTE | fake heart valve
56
when not to use warfarin
AF | arterial thrombosis
57
can you use warfarin in pregnancy
not in first trimester
58
interaction of warfarin
cP450 inhibitors and inducers
59
can you use statins in pregnancy
no
60
why can statins increase LFTs
e.g. ALT - eliminated by liver
61
3 interactions of statins
cP450 inhibitors amlodipine (accumulation) grapfruit (like amiodarone)
62
indication of beta 2 agonists apart from asthma and COPD
hyperkalaemia
63
what to use LABA (salmeterol, formeterol) with
corticosteroids
64
why are beta 2 agonists contraindicated in CVD
tachycardia = AF?
65
2 side effects of beta 2 agonists
symptoms of increased HR | increased glucose/lactate
66
2 interactions of beta 2 agonists
beta blockers - decreased effectiveness | theophylline/corticosteroids = decreased K+
67
2 types of antimuscarinics
anticholinergic bronchodilators e.g. tiotropium | cardiovascular/GI e.g. atropine
68
what do antimuscarinics inhibit
ACh = increased HR/conduction and decreased smooth muscle tone, decrease respiratory/GI secretions
69
what to give antimuscarinics with for COPD/asthma (for secretions)
steroids and LABA
70
2 GI/cardio indications of antimuscarinics
bradycardia | IBS (not atropine - use hyoscine instead)
71
2 interactions of antimuscarinics
TCAs antihistamines increased adverse effects
72
what is carbocysteine
mucolytic
73
2 contraindications of carbocysteine
gastric ulcer | 1st trimester pregnancy
74
derm side effect of carbocysteine
pruritic rash
75
4 conditions which systemic steroids can cause
DM osteoporosis hypertension Addisonian crisis
76
4 interactions of systemic steroids
NSAIDs beta 2 agonists diuretics cP450 inducers
77
what does theophylline do
xanthine derivative - relaxes intercostal muscles - used for asthma, COPD, premature infants
78
3 contraindications of theophylline
caffeine/alcohol/smoking 3rd trimester pregnancy CVD
79
4 side effects of theophylline
HR changes seizures rash hyperkalaemia
80
4 interactions of theophylline
cimetidine phenytoin erythromycin fluoroquinolones (e.g. ciprofloxacin)
81
which is the only respiratory drug to be eliminated by the liver
theophylline (take with food)
82
side effects of Mg and Al salts in gaviscon
``` Mg = diarrhoea Al = constipation ```
83
what does gaviscon do to drugs
decreases serum concentrations
84
what can H2 receptor antagonists do to gastric cancer
disguise symptoms
85
3 side effects of H2 receptor angatonigst
diarrhoea headache dizziness
86
contraindication of PPIs
osteoporosis (increase fracture risk)
87
2 side effects of PPIs
increase C. diff risk | hypomagnesaemia
88
interaction of PPIs
decrease effect of clopidogrel
89
abdominal drugs eliminated by liver
PPIs aminosalicylates antiemetics
90
3 contraindications of diarrhoeal agents
acute UC (toxic megacolon?) C. diff colitis dysentery (HUS?)
91
interaction of diarrhoeal agents
opioids - increased risk of opioid toxicity because it also is an opioid u-receptor antagonist
92
example of a stimulant, osmotic and bulk-forming laxative
``` stimulant = senna osmotic = lactulose bulk-forming = ispaghula husk ```
93
example of when to use osmotic laxatives
hepatic encephalopathy
94
example of when to use bulk forming laxatives
ileus
95
what is melanosis coli
side effect of laxatives - brown colon
96
effect of osmotic laxatives on warfarin
increase effects of warfarin
97
what is mesalazine
aminosalicylate
98
indication of aminosalicylate
UC
99
contraindication of aminosalicylate
aspirin hypersensitivity
100
5 side effects of aminosalicylates
``` GI renal impairment oligospermia hypersensitivity leucopenia ```
101
2 contraindications of antiemetics (metoclopramide)
``` GI obstruction (perforation) haemorrhage ```
102
4 side effects of antiemetics
diarrhoea movement abnormalities hormonal changes acute dystonic reaction
103
what do alpha blockers all end in
-osin e.g. tamsulosin, doxazocin
104
2 indications of alpha blockers
BPH | resistant hypertension
105
3 side effects of alpha blockers
postural hypotension dizziness syncope
106
2 interactions of alpha blockers
antihypertensives | beta blockers
107
elimination of both alpha blockers and 5-alpha reductase inhibitors
LIVER
108
what is finasteride
5 alpha reductase inhibitor - testosterone to dihydrotestosterone blocked
109
2 indications of finasteride
BPH (2nd line) | difficulty urinating
110
can you use finasteride in pregnancy
no - genital abnormalities
111
what are the side effects of finasteride grouped as
lower testosterone e.g. gynaecomastia, impotence etc
112
3 contraindications of NSAIDs
severe renal/hepatic impairment HF PUD/bleeding etc
113
why do NSAIDs interact with steroids
ulcers
114
3 interactions of NSAIDs (apart from steroids, aspirin/warfarin etc)
SSRIs/venlaxafine (antidepressants) ACEis diuretics
115
3 side effects of NSAIDs
renal impairment increased CVD events hypertension (from increased fluid)
116
elimination of NSAIDs and opiates
liver (opiates also kidneys)
117
what to use opiates with for acute pulmonary oedema
O2, furosemide, nitrates
118
3 contraindications of opiates
hepatic/renal/resp failure biliary colic epilepsy (tramadol)
119
skin manifestation of opiates
pruritus
120
type of opiates causing anaphylaxis
IV codeine/dihydrocodeine
121
2 interactions of opiates
sedating drugs | SSRIs (seizures)
122
2 indications of xanthine oxidase inhibitors (allopurinol)
gout/renal stone prophylaxis | tumour lysis syndrome (from chemotherapy)
123
3 contraindications AND side of allopurinol (they're the same)
acute gout rash - including SJS/TEN severe hypersensitivity
124
5 interactions of allopurinol
``` mercaptopurine azathioprine (toxicity) ACEis thiazides amoxicillin ```
125
what can happen if you give allopurinol and amoxicillin together
rash
126
indication of insulin that's not diabetes
hyperkalaemia (drives K+ into cells - use with glucose)
127
interaction of insulin
corticosteroids - decreases insulin conc. in body
128
3 endocrinology drugs that are excreted by the LIVER
insulin (also kidneys) sulphonylureas thyroid hormones (also brain, kidneys, muscle)
129
what is gliclazide
sulphonylurea - increases pancreatic insulin secretion etc. for type 2 diabetes
130
2 contraindications of gliclazide
hepatic/renal/adrenal/pituitary impairment | malnutrition/elderly
131
3 interactions of gliclazide
metformin insulin hyperglycaemics (prednisolone, diuretics)
132
what does metformin do
for type 2 diabetes - increases insulin sensitivity and decreases glucose production
133
3 contraindications of metformin
AKI/renal/hepatic impairment tissue hypoxia alcohol abuse
134
what can happen with metformin before/48 hours after IV contrast media
lactic acidosis
135
2 interactions of metformin
prednisolone | diuretics
136
what is liothyronine
T3 (active form), levothyroxine = T4
137
contraindication of thyroid hormones
coronary artery disease
138
3 interactions of thyroid hormones
antacids/calcium/iron salts (GI absorption) insulin warfarin
139
indication of alendronic acid
osteoporotic fractures
140
indication of disodium pamidronate and zoldronic acid (both bisphosphonates)
malignant hypercalcaemia
141
3 other indications of bisphonates
myeloma breast cancer mets Paget's disease of bone
142
4 contraindications of bisphosphonates
renal impairment hypocalcaemia smokers dental disease
143
4 side effects of bisphosphonates
jaw osteonecrosis oesophagitis hypophosphataemia atypical femoral fractures
144
2 interactions of bisphosphonates
calcium/iron salts | antacids
145
6 indications of calcium and vitamin D
``` osteoporosis/osteomalacia CKD HPT hyperkalaemia hypocalcaemia rickets ```
146
3 side effects of calcium and vitamin D
``` dyspepsia constipation cardiovascular collapse (with calcium gluconate) ```
147
3 interactions of calcium and vitamin D
bisphosphonates tetracyclines levothyroxine
148
3 contraindications of dopaminergic drugs e.g. levodopa, madopar, sinemet
glaucoma risk psychiatric/cognitive disease CVD
149
3 side effects of dopaminergic drugs
drowsiness/confusion/hallucinations hypotension dyskinesia
150
2 interactions of dopaminergic drugs
antipsychotics | metoclopramide
151
what always to give levodopa with
peripheral dopa-decarboxylase inhibitor
152
elimination of both dopaminergic drugs and anticonvulsants
liver (dopaminergic also intestines and stomach)
153
3 anticonvulsants
carbamazepine phenytoin sodium valproate
154
type of anticonvulsant to use for absence seizures
sodium valproate
155
type of anticonvulsant to use for status epilepticus
phenytoin
156
2 non-convulsing conditions to use anticonvulsants for
``` bipolar trigeminal neuralgia (carbamazepine) ```
157
3 contraindications of all anticonvulsants
pregnancy | hepatic/renal impairment
158
contraindication of carbamazepine
CVD
159
contraindication of phenytoin
foetal hydantoin syndrome
160
3 side effects of all anticonvulsants
tremor ataxia behavioural changes
161
5 side effects of carbamazepine
``` rash/SJS fever lymphadenopathy oedema hyponatraemia ```
162
3 side effects of phenytoin
hirsutism osteomalacia cardio/resp collapse
163
5 side effects of sodium valproate
``` thrombocytopenia increased LFTs hair loss pancreatitis BM failure ```
164
2 drugs having a decreased effect if taken with anticonvulsants
warfarin oestrogen/progesterone since are metabolised by cP450 enzymes
165
4 cP450 inhibitors interacting with anticonvulsants
macrolides amiodarone diltiazem fluconazole
166
4 drugs decreasing seizure threshold if taken with anticonvulsants
SSRIs TCAs antipsychotics tramadol
167
2 TCAs
amitriptyline | lofepramide
168
difference between action of TCAs and SSRIs
``` SSRIs = only block serotonin reuptake TCAs = block serotonin and noradrenaline reuptake ```
169
2 indications of TCAs
2nd line depression | neuropathic pain
170
5 contraindications of TCAs
``` CVD epilepsy constipation (side effect) BPH (causes urinary retention) increased ICP (can cause blurred vision and hallucinations) ```
171
2 interactions of TCAs
``` MAO inhibitors (increases serotonin) hypertension/hyperthermia ```
172
elimination of both TCAs and SSRIs
liver
173
3 contraindications of SSRIs
epilepsy (can cause seizures) PUD hepatic impairment
174
4 side effects of SSRIs (not exhaustive list)
hyponatraemia seizures increased QT interval bleeding
175
3 interactions of SSRIs
MAO inhibitors aspirin/NSAIDs antipsychotics
176
4 indications of benzos
insomnia status epilepticus/seizures anxiety alcohol withdrawal increase GABA effect
177
3 contraindications of benzos
liver failure neuromuscular disease respiratory impairment (can cause airway block/coma)
178
interaction of benzos
cP450 inhibitors
179
what is donepezil
ACh-ase inhibitor (increases ACh at synapses)
180
indication of donepezil
AD
181
3 contraindications of donepezil
heart disease/arrhythmias COPD/asthma PUD
182
4 side effects of donepezil
GI sleep cramps anorexia
183
interaction of donepezil
NSAIDs
184
what are penicillins ineffective against
s. aureus | some E. coli
185
side effect of penicillins
N+V/diarrhoea
186
what does penicillin do to methotrexate
increases toxicity
187
what do penicillins AND cephalosporins do to warfarin
increases activity
188
what to use for biliary tract infections
cephalosporins
189
4 contraindications of cephalosporins
hypersensitivity (10% overlap with penicillins) epilepsy pregnant renal impairment
190
2 side effects of cephalosporins
antibiotic associated colitis | diarrhoea
191
interaction of cephalosporins (apart from warfarin)
increases nephrotoxicity of aminoglycosides (gentamicin, amikacin)
192
3 indications of trimethoprim
UTI bronchitis pneumocystitis pneumonia
193
4 contraindications of trimethoprim
blood dyscrasias renal impairment pregnant porphyria
194
4 side effects of trimethoprim
N+V (same in nitro) rash/pruritus (same in nitro) hyperkalaemia photosensitivity
195
interaction of trimethoprim
folate deficiency (dihydrofolate reductase inhibitor - unlike nitrofurantoin which damages DNA instead of preventing it from being replicated)
196
4 contraindications of nitrofurantoin
acute porphyria G6PD deficiency (haemolysis) 3rd trimester and infants <3 months renal impairment
197
3 side effects of nitrofurantoin
chronic pulmonary reactions hepatitis peripheral neuropathy
198
side effect of nitrofurantoin in neonates
haemolytic anaemia
199
5 indications of tetracyclines
``` malaria prophylaxis chlamydia Lyme disease syphilis acne/rosacea ```
200
4 contraindications of tetracyclines
pregnant/breastfeeding myasthenia gravis SLE renal impairment
201
antibiotic for prostatitis and bacterial endocarditis
aminoglycosides (gentamicin, amikacin)
202
3 contraindications for aminoglycosides
myasthenia gravis pregnancy/neonates renal impairment
203
3 side effects of aminoglycosides
electrolyte disturbances ototoxicity (neonates) nephrotoxicity
204
what happens if taking aminoglycosides with loop diuretics/vancomycin
increased ototoxicity
205
what happens if taking cyclosporin, chemo, cephalosporins, vancomycin with aminoglycosides
increased nephrotoxicity
206
5 indications of macrolides (erythromycin, clarithromycin, azithromycin)
whooping cough legionella chlamydia skin infections
207
what to give for penicillin allergic LRTIs
macrolides e.g. erythromycin
208
2 contraindications of macrolides
renal/hepatic impairment | pregnant/neonates
209
5 side effects of macrolides
``` N+V/diarrhoea colitis ototoxicity cholestatic jaundice increased QT interval (like SSRIs) ```
210
4 drugs increasing QT interval which interact with macrolides
amiodarone SSRIs antipsychotics quinine
211
how do macrolides interact with warfarin and statins
they're metabolised by cP450 - inhibit enzymes and therefore increase bleeding
212
2 examples of quinolones
ciprofloxacin levofloxacin very good for gram -ve
213
2 GI infections quinolones are used for
shigella | campylobacter
214
antibiotic for gonorrhoea
quinolones
215
4 contraindications of quinolones
tendon damage (also a side effect) increase seizure risk (also a side effect) myasthenia gravis pregnant/children (arthropathy)
216
3 side effects of quinolones
GI rash/pruritus increased QT interval (arrhythmias?)
217
drug interacting with quinolones to increase risk of tendon rupture
prednisolone
218
drug interacting with quinolones to increase risk of convulsions
NSAIDs
219
1st line antibiotic for C. diff and giardiasis
metronidazole - anaerobic antimicrobial giardiasis is a protozoa and it works for that too
220
3 contraindications of metronidazole
alcohol pregnancy porphyria
221
why is hepatic impairment a contraindication of metronidazole
metabolised by p450 - therefore excreted by LIVER
222
3 side effects of metronidazole
GI peripheral/optic neuropathy seizures/encephalopathy
223
interaction of metronidazole
decreases metabolism of warfarin and phenytoin (p450)
224
antibiotic that works against multi-resistant staphylococci
glycopeptides - vancomycin
225
2 contraindications of vancomycin
previous hearing loss (elderly?) | renal impairment
226
4 side effects of vancomycin
blood disorders (thrombocytopenia) neutropenia interstitial nephritis nephro/ototoxicity
227
3 drugs interacting with vancomycin which increase risk of nephro/ototoxicity
aminoglycosides loop diuretics cyclosporin

Year 3 revision (9 decks)

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