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FRACP 2023 Cram Homicrons Edition > Medications > Flashcards

Medications Flashcards

(67 cards)

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1
Q

Treatment for Wilsons Disease

A

Chelating agents:
1. D-Penicillamine
2. Trientine (if allergy)

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2
Q

Induction therapy for Crohns

A
  • Exclusive Enteral Nutrition (EEN) first line
  • Steroids short term
  • Early infliximab use if high risk complicated disease
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3
Q

Crohns disease maintainence

A

Mild: aminosalicylates +/- methotrexate and azathioprine
Severe: methotrexate, 6MP and azathioprine, Infliximab/ adalimumab (anti TNF-a)

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4
Q

What antihypertensive is teratogenic in pregnancy

A

ACEi & ARB

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5
Q

What antihypertensive is contraindicated in asthmatics

A

B blockers
- consider thiazide diuretic instead

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6
Q

Long term side effects with prolonged PPI use

A

(Studies mainly in adults)

Respiratory infections
C diff infections
Bone fractures
Hypomagnesmia + low B12
Tubulointerstitial nephritis

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7
Q

MOA PPI

A

Dose dependant irreversible inhibition of H/K ATPase pump
- >20mg, inhibits all intragastric acid secretion
- CYP450 inhibitor, increases availability of some drugs

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8
Q

Side effects with immunomodulators- AZA/6MP

A

Common toxicities
Gastrointestinal symptoms
Hepatitis – monitor
Decreased cell counts – monitor
Pancreatitis

Less common
Risk of malignancy = HL, NHL, NMSC
Slight increased risk of EBV associated lymphoma
Minimal if any risk of NHL
Benefit in maintaining remission lymphoma risk
No increased risk of colorectal malignancy
Risk of skin infections = HSV, HPV

Need to check TMPT genotype (thiopurine methyltransferase) – genetically controlled enzyme activity; may identify patients at risk of drug-induced neutropenia

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9
Q

Side effects/monitoring for prednisolone

A

Growth delay
Decreased bone density
Hyperglycemia
Hypertension

Ix: annual lipids/BSL, DEXA scan, BP monitoring

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10
Q

Side effects/monitoring for methotrexate

A

Nausea & vomiting, hepatitis
Infection (avoid live vaccines)
BM supression & blood dyscrasias
Pulmonary toxicity
Neurotoxicity
Teratogenicity

Ix: FBE/LFT 3monthly

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11
Q

Side effects/monitoring for hydroxychloroquine

A

Retinal toxicity
Haemolysis if G6PD
Skin/hair discolouration
GI upset
Ix: yearly opthalmology review

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12
Q

Side effects/monitoring for cyclosporine

A

All H:
Hirsutism
gum Hypertrophy
Hyperglycemia
HTN
Harm to kidneys

Mx: monthly UEC, FBE, LFT & BP

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13
Q

Side effects/monitoring for cyclophosphamide

A

Infection
GI toxicity
BM supression
Infertility

Ix/Rx: bactrim prophylaxis, regular FBE

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14
Q

Side effects/monitoring for mycophenylate

A

GI toxicity
BM supression
Infection

3monthly FBE

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15
Q

Side effects/monitoring for rituximab

A

Infection/immunosuppression (B cell lineage)

Requires 3monthly IVIG & B cells 1mo pre/post

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16
Q

Function of ACEi & use in CHF

A

prevent conversion of ang1 to ang2 (potent vasoconstrictor) = reduce afterload

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17
Q

Medication class most likely to cause DRESS?

A

Anticonvulsants
carbamazepine (HLAB5801/Han Chinese), lamotrigine, phenytoin, phenobarbital and allopurinol (HLAA3101/Euro & Han) are the most frequently reported causes

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18
Q

Indications/MoA sodium nitroprusside?

A

Ix:
Acute hypertensive crisis
Perioperative BP control
Left ventricular failure

MoA
Potent vasodilator
Prodrug bioactivation to nitric oxide (NO) in erythrocytes by NO synthase
GC converts GTP –> cGMP
Vasodilates, prevents Ca influx

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19
Q

Drugs that can potentiate seratonin syndrome, MOA

A

Increases 5HT formation: tryptophan

Increases 5HT release: stimulants (coke/meth), levodopa

Impairs 5HT reuptake: stimulants, tramadol, SSRI, SNRI, TCA, St Johns wort, 5HT3- ondansetron, metaclopramide, valproate/CBZ, buproprion

Impairs 5HT metabolism: MOAIs, linezolid

5HT direct agonist: fentanyl, LSD, triptans

Increased post-synaptic sensitivity: lithium

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20
Q

First trimester teratogens

A
  • Anti epileptics (VALP, CBZ)
  • Lithium (Ebstein’s/Cardiac)
  • Warfarin (skeletal- limb/spine abnormalities, calcifications)
  • Cyclophosphamide
  • Gentamicin
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21
Q

Second trimester teratogens

A
  • ACEi: enalapril (1st- congenital malformations, 2/3rd- renal dysfunc/oligohydramnios)
  • NSAIDS (may cause early PDA closure, renal impairment & platelet aggregation)
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22
Q

What affects tacrolimus levels?

A

Increased:
- Diarrhoea (regulatory P-glycoprotein decreased)

Decreased:
- Sudden change in renal function
- Concurrent sirolimus use

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23
Q

What SC level does aorta branch to form renal arteries?

A

L1
- When inserting umbi line aim high T6-7 or low L4 to avoid coeliac, mesenteric & renal arteries

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24
Q

Side effect of frusemide in preterm infants

A

Deafness

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25
Side effect of chloramphenicol eye drops in preterm infants
BM supression
26
Side effects tacrolimus
Alopecia, hypertension, nephrotoxicity, hypercholesterolaemia (lowered by cyclosporine in tranplant), Hyperglycaemia - diabetes, hypomagnesaemia, tremor, parasthesias, neurotoxicity including seizures, hyperkalaemia, gingival hyperplasia, confusion
27
Side effects of Bevcilizumab (anti CD19)
Pancytopenia TLS Cytokine storm
28
Side effects calcineurin inhibitors (cyclosporine, tacro)? GHHHERD
Gingival hyperplasia Hirstutism HTN Headache/tremor/parasthesia Electrolytes: low Mg, high K+ Renal- nephrotoxicity Diarrhoea/deranged LFTs Tacro- CYP450 inh at high conc, high BSL/DM, seizures Siro- delayed wound closure, pancytopenia, ulcers
29
Side effects diuretics (loop- frusemide)
Na/K/Cl cotransporter blocked - Low everything (K/Cl/Na/Mg/Ca) - High BSL/lipids
30
Side effects diuretics (thiazide- i.e HCT)
Na/Cl cotransporter blocked - Low Na/Cl, K - High Ca/uric acid - stones/gout - High BSL/lipids
31
Side effects diuretics (K+ sparing- Spiro)
Block aldosterone in DCT/CD - Stop H20 reabsorption - High K+ - Gynaecomastia - Androgen receptor blocker- anti-acne
32
Side effects methotrexate
Anti-metabolite, inhibit purine synthesis BM supression Hepatic fibrosis Mucositis ILD- pneumonitis
33
Side effects mycophenylate
Anti transplant rejection - Inhibitor of inosine-5'-monophosphate dehydrogenase - Prevents T/B cell proliferation Severe diarrhoea Leukopenia ILD- pulmonary fibrosis
34
Side effects azathioprine
Purine analogue/antimetabolite DMARD- RA/Chrons/UC, SLE & GPSA - Anti transplant rejection BM suppression (inc risk if TPMT genotype) Agranulocytosis 4x risk of lymphoma Pancreatitis- 30% discontinuation
35
Side effects cyclophosphamide?
Alkylating agent (cross links DNA inhibits protein synthesis- apoptosis) Rx: lymphoma, MM, leukemia, neuroblastoma, sarcoma, GPA, nephrotic syndrome, post transplant Leukopenia- FBE first 4-8wks Hemorrhagic cystitis Sterility BM suppression Increased risk of leukemia Alopecia
36
Medication for SOS/VOD?
Defibrotide - adenosine receptor agonist activity modulating thrombin and thrombomodulin Reduces rates of SOS by 40%
37
Antidote for isoniazid OD?
* Isoniazid= ↓ brain pyridoxal-5-phosphate (cofactor for GABA) = GABA deficiency = excito-toxicity * Pyridoxine= ↑ pyridoxine-5-phosphate
38
Antidote for organophosphate poisoning
Cholinergic toxicity Atropine: muscarinic effects Pralidoxime: nicotinic effects
39
Antidote for B-blocker overdose
Glucagon
40
Side effects of meropenem
Seizures Dec. levels of valproate - pseudomonas resistence - FP DAT - cytopenia - parasthesia - hepatic toxicity/GI SFx
41
Is mesalazine or sulfasalazine preferred in UC treatment?
Mesalazine- less side effects
42
Side effects of iNO
- Prolonged bleeding time (direct ^ platelet aggregation) - Methaemoglobinemia (if high doses NO binds to haem- oxidised to met, higher in prems due to less metHb reductase, <20ppm safe) - Rebound pulmonary vasospasm >10ppm - Pulmonary oedema
43
Migraine prophylaxis prohibitied in basilar/hemiplegic migraines
Basilar and hemiplegic migraines are theorised to be due to vasoconstrictive effects and thus could be potentiated by ergotamine or triptans.
44
Effect of lamotrigine on CBZ
Increases concentration of CBZ & toxicity
45
Effect of CBZ on lamotrigine
Decreases concentration of lamotrigine & efficacy
46
Effect of valproate on lamotrigine
Increases concentration of lamotrigine & toxicity
47
Side effects of valproate
Vomiting Alopecia Liver Toxicity Pancytopaenia, low platelets/pancreatitis Really fat (weight gain) Oedema Appetite increase Tremor Enzyme inducer (Liver)
48
Why is valproate avoided in children <3
Risk of fatal liver toxicity secondary to undiagnosed underlying metabolic condition. * Levetiracetam = preferred first line especially while awaiting results of investigations. * Carbamazepine = second line.
49
Why is valproate avoided in children <3
Risk of fatal liver toxicity secondary to undiagnosed underlying metabolic condition. * Levetiracetam = preferred first line especially while awaiting results of investigations. * Carbamazepine = second line.
50
Effect of CBZ on clonazepam
Decreases concentration and efficacy
51
Competitive inhibitor of muscarinic receptors
Ipratropium
52
5-lipooxygenase pathway inhibitor (blocks conversion of arachidonic acid to leukotrienes)
Montelukast
53
Phosphodiesterase inhibitor (asthma med)
Aminophylline
53
Phosphodiesterase inhibitor (asthma med)
Aminophylline
54
Prophylaxis required when using eculizumab? MOA & use?
Eculizumab = anti C5 Useful in atypical HUS- blocks terminal complement pathway (MAC) Increased risk infection with encapsulated organisms- req. meningococcal prophylaxis
55
Medication class: Losartan Side effects in pregnancy?
Angiotension II receptor blocker Fetal effects include anuria, oligohydramnios with resultant limb and craniofacial abnormalities, pulmonary hypoplasia, IUGR, prematurity, PDA.
56
Medication class: Captopril Side effects in pregnancy?
ACE inhibitor Fetal effects include anuria, oligohydramnios with resultant limb and craniofacial abnormalities, pulmonary hypoplasia, IUGR, prematurity, PDA.
57
Medication class: Celecoxib Side effects in pregnancy?
COX 2 inhibitor Impedes production of prostaglandins= anuria and oligohydramnios through a similar mechanism to NSAIDs.
58
Medication class: Side effects in pregnancy?
59
Medication class: Side effects in pregnancy?
60
MOA sodium benzoate in treating hyperammonemia?
Sodium benzoate reduces ammonia content in the blood by conjugating with glycine to form hippuric acid, which is rapidly excreted by the kidneys.
61
Live vaccines
Rotavirus, MMR, varicella
62
SE of adenosine?
Headache Dyspnoea Bronchospasm Can trigger atrial fibrillation
63
SE/contraindications digoxin
Risk of arrhythmias Not to be given in WPW
64
Contraindications CCBs?
Children < 12 months 🡪 can precipitate cardiac arrest With beta blockers
65
SE amiodarone
K+ channel blocker Very large volume of distribution (very lipophilic, long elimination ½ life) Potent CYP3A4 inhibitor Pulmonary toxicity, thyroid dysfunction, hepatotoxicity, optic neuropathy QT prolongation
66
What antiarrythmic blocks both K+ channel/B adrenergic receptors?
Sotolol

FRACP 2023 Cram Homicrons Edition (29 decks)

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