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Indications, Mechanisms, Adverse And Warnings Flashcards

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1
Q

Acetylecysteine mechanism

A

Replenishes supply of glutathione

Also antioxidant - why helps in contrast nephropathy

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2
Q

Adverse effect when large dose of Acetylcyteine for paracetamol poisoning

A

Anaphylactic

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3
Q

When Acetylcyteine administered as mucolytic what is a possible adverse reaction

A

Bronchospasm

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4
Q

Acetylcyteine dose for contrast nephropathy prophylaxis

A

600-1200mg 12 hourly for 2 days

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5
Q

Acetylcyteine dose for mucolysis

A

2.5-5 ml 10% solution by nebuliser every 6 hours

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6
Q

Acetylcyteine dose for paracetamol poisoning

A

Slow drip over 21 hours - consult BNF

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7
Q

Monitoring for paracetamol poisoning after Acetylcyteine

A

INR most sensitive marker for ongoing liver injury

ALT, creatinine conc

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8
Q

Activated charcoal uses

A

Reduce absorption of certain poisons / drugs in overdose from gut
Increase elimination of poisons (if readily diffuse back into gut)

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9
Q

Mechanisms of activated charcoal

A

Molecules are adsorbed onto surface of charcoal -> reduced absorption

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10
Q

Activated charcoal adverse effects

A

Black stools and vomiting
Intestinal obstruction
Aspiration -> pneumonitis, bronchospasm, airway obstruction

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11
Q

Who shouldn’t get activated charcoal

A

Reduced consciousness / persistent vomiting (aspiration)

Reduced GI motility (obstruction)

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12
Q

How do you prescribe Activated charcoal

A

Within 1 hour of injection of clinically significant amount of substance
50g orally in 250ml water suspension (drink)

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13
Q

When use adenosine

A

Supraventricular tachycardia

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14
Q

Adenosine mechanism

A

Increases AV node refractoriness -> breaks re entry circuit -> allows normal depolarisation

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15
Q

Adenosine adverse effects

A

Bradycardia - often like ‘sinking feeling in chest’ ->

Breathlessness

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16
Q

Who can’t receive adenosine

A

Hypotensive, Coronary ischemia, Decompensated heart failure (bradycardia)
Asthma (bronchospasm)
Heart transplant - very sensitive to effects

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17
Q

What blocks uptake of adenosine?

Effect?

A

Dipyridamole -> prolongs effect (should half dose)

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18
Q

Adenosine prescribing

A

6mg IV - increased to 12 if ineffective

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19
Q

What’s needed for administration of adenosine

A

Resuscitation facilities

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20
Q

What to tell patient p you are giving adenosine

A

Hopefully ‘reset heart’ to normal

Will make them feel terrible for about 30 seconds

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21
Q

Monitoring for adenosine

A

Continuous cardiac rhythm strip

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22
Q

Adrenaline uses

A

Cardiac arrest
Anaphylaxis
Local - vasoconstriction (eg stop mucosal bleeding), prolong local anaesthesia (with lidocaine)

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23
Q

Adrenaline mechanism

A

Agonist a1,a2,b1,b2

  • > redistribution of blood favouring heart
  • > bronchodilation and suppression of inflammatory mediator release from mast cells
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24
Q

Adrenaline adverse effects

A

Hypertension, tremor,manliest, headache, palpitations, arrythmias, angina

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25
When should adrenaline not be used
Areas supplied by end artery (eg fingers and toes) -> necrosis Cautious in heart disease
26
Adrenaline interactions
B blocker -> widespread vasoconstriction
27
Adrenaline prescription for cardiac arrest
1mg IV after third shock | Repeated every 3-5 mins after
28
Adrenaline prescription anaphylaxis
500mg IM
29
Aldosterone antagonists uses
Ascites and odema due to liver cirrhosis Chronic heart failure Primary hyperaldosteronism
30
Aldosterone antagonists adverse effects
Hyperkalaemia -> weakness, arrythmias | Gynaecomastia
31
When not to use aldosterone antagonists
Hyperkalaemia Addison's disease Renal impairment Breastfeeding women - crosses into milk
32
Aldosterone antagonists interactions
Potassium elevating drugs (ACEi, ARBs)
33
Eg of aldosterone antagonists
Spironolactone | (epleronone - only for heart failure)
34
Starting dose of spironolactone Ascites? Heart failure?
100mg daily for ascities | 25mg daily for heart failure
35
What to tell men getting spironolactone
Growth and tenderness of tissue under vessels Impotence Benign and reversible
36
Issue with spironolactone effects? How to counteract
Takes several days for effect -> prescribed with a loop / thiazide diuretic
37
Alginates and antacids uses
GORD | Dyspepsia
38
How do alginates work
Increase viscosity of stomach contents
39
How do ant acids work
Buffer stomach acids
40
Eg of antacids
Sodium bicarbonates Calcium carbonates Magnesium salts Aluminium salts
41
Antacid adverse effects
Magnesium - constipation | Aluminium - diarrhoea
42
When not to use alginates
Thickened milk preparations
43
Sodium / potassium antacids should not be used when?
Fluid overload / Hypercalcaemia eg. Renal failure
44
Alginates interactions ? How to prevent
Reduce serum conc of many drugs - check book Take at different times gap of at least 2 hours
45
Eg of name alginates and antacids
Gaviscon | Peptac
46
Allopurinol uses
Prevent acute attacks of gout Prevent Uric acid and calcium oxalate renal stones Prevent hyperuricaemia and tumour lysis syndrome associate with chemo
47
Mechanism of allopurinol
Xanthine oxidase inhibitor
48
Allopurinol adverse effects
Skin rash - maybe Stevens Johnson syndrome | Can trigger / worsen acute gout attack
49
When should allopurinol be avoided
Acute attacks of gout | Recurrent skin rash / signs of hypersensitivity
50
When should allopurinol dose be reduced
Renal / hepatic Impairment as excreted / metabolised
51
Allopurinol interactions
Mercaptopurine (and pro-drug azathiopine) as use xanthine oxidase
52
How is allopurinol prescribed
100mg daily oral. Titrate up according to serum Uric acid
53
When starting allopurinol for gout what else should be prescribed
NSAID / colchicine
54
When should allopurinol be started when used with chemo
Before chemo starts
55
When should allopurinol be taken
After meals - encourage good fluid intake 2-3 l per day
56
What should be told to patients getting allopurinol
Seek medical advice if they get a rash
57
Target of Uric acid concentrations with allopurinol
58
Which drugs increase serum Uric acid
Thiazide and loop diuretics | Low dose aspirin inhibits renal Uric acid excretion
59
Egs of alpha blockers
Doxazosin Tamsulosin Alfuzosin
60
Alpha blockers use
Benign prostatic hyperplasia | Add on treatment in resistant hypertension
61
Mechanism of alpha blockers
Highly sensitive to a1 (mainly smooth muscle) | -> vasodilation and reduced resistance to bladder outflow
62
Alpha blockers adverse effects
Postural hypotension Dizziness Syncope
63
When should alpha blockers not be used
Patients with postural hypotension
64
Doxazosin dose
1mg daily and increased at 1-2 week intervals dependent on response
65
Tamulosin only licensed for? Dose?
BPH | 400mg daily
66
When is doxazosin ideally administered
Bed time - due to blood pressure lowering
67
Aminogycosides eg
Gentamycin | Amikacin
68
Amino glycosides uses
Severe sepsis Pyelonephritis / complicated UTI Biliary / intraabdominal sepsis Endocarditis
69
Organism unknown in endocarditis - what should be given with amino glycosides
Penicillin / metronidazole
70
Mechanism of aminoglycosides
Bind irreversibly to bacterial ribosomes
71
Aminoglycosides adverse effects
Nephrotoxicity and ototoxicity
72
How does nephrotoxicity present
Reduced urine output and rising serum creatinine / urea
73
How does ototoxicity present
Hearing loss, tinnitus, vertigo | MAY BE IRREVESIBLE
74
Be careful with aminoglycosides in
``` Neonate, elderly, renal impaired Myasthenia gravis (can impair neuromuscular transmission) ```
75
When is ototoxicity more likely with aminoglycosides
When prescribed with loop diuretics / vancomycin
76
When is nephrotoxicity more likely with aminoglycosides
Prescribed with Vancomycin / cephlasopins
77
How are aminoglycosides administered
IV - can't give oral as highly polarised (don't cross lipid membrane)
78
Why are aminoglycosides diluted and administered slowly
Prevents ear exposure to high concentrations
79
What to tell patients with aminoglycosides
Tell you if any ringing / hearing changes / dizziness
80
Acetylcysteine indications
Paracetamol poisoning Prevent renal injury during contrast nephropathy Reduced viscosity of respiratory secretions
81
Amionosalicyates use
Ulcerative colitis | Rheumatoid arthritis
82
Eg of aminosalicyates
Mesalazine | Sulfasalazine
83
Aminosalicyates mechanism
Release 5-aminosalicylic acid -> anti inflammatory and immunosuppressive effects
84
Aminosalicyates adverse effects
GI upset Headache Rarely - thrombocytopenia / leucopenia, renal impairment , reduced sperm count Hypersensitivity
85
Who should not take aminosalicyates
People with aspirin hypersensitivity (both are salicyates)
86
Aminosalicyates drug interactions
PPI - may cause coating to be broken down early | Lactulose - lowers stool ph -> may prevent release
87
Acute attack of UC how is mesalazine prescribed
Suppository 1-2 times daily for 4-6 weeks | Can be taken orally
88
What should be checked in patients getting oral mesalazine
Renal function
89
What should be checked in patients getting sulfasalazine
FBC and liver profile
90
Which aminosalicyates causes the lease adverse effects
Mesalazine

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