Pharmacology Flashcards
(27 cards)
acetylcysteine
indication
mechanism
adverse reaction
indication - paracetemol overdose, renal injury when giving contrast, reduce resp secretions - mucolytic
mech - replenishes glutathione
adverse - anaphylactOID reaction - nausea tachy rash wheeze. not CI, just give antihistamine
acetylcysteine
prescription
monitoring
paracet - local guidelines
contrast nephropathy - guideliness, usually 600-1200mg 12hrly for 2 days
resp secr - 2.5 - 5mL 10% solution in neb every 6 hours
monitor for anaphyactoid reaction, INR and ALT for liver function
activated charcoal
indication
mechanism
adverse reaction
contraindicated
reduce absorption of poison in gut. can increase elimination if multiple doses - gut dialysis
weakly ionic things absorbed - BZPD, MTZ
adverse - if aspirated, bad. intestinal obstruction. common - back stools and vomiting
NOT indicated for rediced level of consciousness (unless intubated) or persistent vomiting due to aspiration risk. reduced GI motility incr risk of obstruction.
activated charcoal
prescription
administration
one dose within 1 hour of the toxin
drugs that delay gastric emptying - eg aspirin, opiodes, tricic antidep, then can be 2 hours
mix with 250ml of water
adenosine
indication mechanism adverse effects warnings interactions
for SVT
decreases spontenous depolarisation - slows sinus rate. increases AV node refactoriness - breaks any re entry. so normal heart rate can resume - cardioversion.
CI in hypotension, coronoray ischaemia, decompensaed heart failure.
be careful as it may induce bronchospasm in asthma, COPD. heart transplant very sensitive to adenosine.
interacts
- dipyridomole - potentiates it effect
- theophylline, aminophylline and caffeina re competitive agonists of it, decr its effects
adenosine
prescription
adminsitration
communication
monitorings
always IV
once only section
6mg IV to start
resus on hand. large bore cannula. effect will be immediate.
comm that it will be terrible for 30sec-60.
monitor for bradycardia, transient asystole. continuous cardiac rhythm strip
adrenaline
indication
mechanism
adverse effects
for cardiac arrest, anaphylaxis.
a1 a2 b1 b2 agonist
vasconstrict (skin, mucosa, abdo viscera). heart - incr contractility excitability. vasodil heart vessels and muscles. bronchodilate and suppress inflammatory mediators
adverse - adrenaline induced HTN. can cause anxiety, tremor, headache and palp.
can cause angina, MI, arrhythmias.
no CI for use. caution with heart disease. not use in areas supplied by end artery.
with beta blocker, may be more vasoconstricted
adrenaline
prescription
administration
in cardiac arrest w shockable rhythm (v fib or p. v tachy) – 1mg IV 1:10,000 [10 ml] after 3rd shock, then repeat after every other cycle. [with flush after]
non shockable rhythm - 1mg IV as soon as IV access, repeat every other cycle.
anaphylaxis - 500mcg IM 1:1000 [0.5ml]. not IV
aldosterone antagonist eg spironolactone
indication mechanism adverse effects warning interaction
for ascites, oedema due to liver cirrhosis
& chronic heart failure
& primary hyperaldosteronism
on distal tubule. aldosterone wants to remove k+ and keep salt and water, antagonist keeps potassium and excretes salt and water.
SE - hyperkalaemia, gynaecomastia
NOT for severe renal impairment, hyperkal, addisons. avoid in pregnancy
interact - caution with other potassium rising drugs - ACE inhibitrs, ARB.
aldosterone antagonist - spironolactone, eplenorone
prescribing
administeration
comm
monitor
100mg for ascites
25mg daily for heart faulyre
only oral
elpenerone only for HF
comm about side effects and regular bloods.
monitor for these and for efficacy
alginates and antacids
indication mechanism adverse warnings interaction
for GORD, dyspepsia (indegestion relief)
buffering stomach acids. alginates increase stomach contents viscosity - less reflux up.
advserse - magnesium diarrhoea, aluminium constipation
warnings - safe for infants, but do not use with thickened milk prep - can give very thick stomach contents and discomfort. be careful if it contains NA or K.
interacts - cam bind to drugs and make them less effective - eg ACEi, sme antibiotics, bisphosphnates, digoxin, levothyroxin
alginates and antactics - Gaviscon, Peptac
prescrip
comm
oral, by brand, symptomatic relief. temp pessure
with lifestyle measures to avoud reflux. leave gap of 2 hours between other meds if interacts
monitor for any red flag symptoms
allopurinol
indications mechanism adverse effects warnings interact
- to prevent gout
- -prevent renal stones: uric acid and calcium oxalate
- prevent chemo related hyperuricaemia and tumour lysis sydrome
xanthine oxidase inhibitor, less uric acid.
adverse - skin rash (SJS / TEN). can worse or trigger acute gout
warnings - dont take with acute episode, not with recurrent skin rash. be caureful with renal impairment
interact - mercaptopurine with azathiprine - need xanthine oxidase. allopurinol inhibits this.
risk of rash /hypersesitivity with amox, ACE inhibitors and thiazide
allopurinol
presciption
administer
comminication
monitoring
start at 100mg daily, titrate to maintenance of 200-600 as needed by uric acid levels.
adminster -after meals, with good fluids of 2-3 L per day. comm about what is for and rash. can usually go away on stopping drug but can be serious. stop as soon as a rash develops.
monitoring - serum uric acid levels 4 weeks after starting. lower them to less than 300umol/L.
thiazide / loop diuretics can incr uric acid and cause gout. low dose aspirin inhibits renal excretion of uric acid and can also trigger.
alpha blockers
drugs? indication mech adverse effects warnings interaction
doxazosin, tamulosin, afuzosin
for BPH
add on for resistent hypertension
mainly smooth muscle (a1) - vasodilation and reduced resistence to bladder outflow.
Advese - postural hypotension, dizziness, syncope. after 1st dose very prominent
warnings - not for postural hypotension
alpha blockers
doxazosin, tamulosin, alfuzosin
prescription
administration
comunication
monitor
prescript - 1mg increased accordingly weekly
tamulson is only for BPH - 200 mcg daily. less blood pressure lower effect
adminster at bedtime
communicate that it may cause dizziness on standing after 1st dose
monitor - BP, adverse effects
aminoglycosides
indication mechanism adverse effects warnings interaction
indic - severe sepsis, unknown pyelonephritis / complicated UTI biliary sepsis intra abdominal endocarditis
aminoglycosides don’t work afaist strep & anaerobes - so combine with penicillin (and maybe metronidazole) if organism is unknown.
mech - bacterial ribosomes, inhibit protein synthesis. agaost gram negative aeorbic, staph and myco
adverse - nephro and oto toxicity. oto is often irreversable
warnings - be cautious in neoates, elderly, renal impair due to renal impair. also myasythenia gravis
ototox more likely if loop diuretics or vancomycin co prescib
nephrotox more likely if cyclosporin, platinum chemo, cephalosporin, vanc
aminoglycosides - gent and amikacin
prescription
administer
communication
monitor
prescript - OD IV (cant cross lipid membranes). dep on renal function and dose by weight.
admin - diluted with NaCl 50mL over 30 min
commun - any change in hearing ringing dizziness
aminosalicylates
indication brief mech adverse effects warnings interaction
ind
ulcerative colitis - melsalazine
RA - sulfasalazine as DMARD
mech - 5-ASA - unknown, but anti indlam and immunosuppressive in gut
adverse GI upset, headache blood - leucopenia, thrombocytopenia renal impair low sperm
like aspirin, these are salicylates - don’t take if have aspirin hypersensitivity
have pH sensitive coating - so sensitive to PPI - broken down early and lactulose - prevent breakdown
aminosalicylates
prescription
monitoring
acute attack of rectal ulcerative colitis , enema / suppositiary - oD / BD for 4-6 weeks. can be given orally - see local huidelines
efficacy - pt symptoms
RA - CRP and disease severity score
safety - renal function, FBC and liver
amiodarone
indication mech brief adverse effects warnings interaction
tachyarrythmias - AF, Aflutter, SVT, VT
many effects on myocardial cells - na, ca, K blockade, antag of a and beta adregic receptors. reduce spontan depolarisation, slows conduction velocity, increases refractoriness - so AV node conducts less. can help resotre sinus rhythm
adverse - chronic - pneumonitis, bradycardia, heartblock, hepatitis, skin photosensitivity and grey discolouration. can cause thryoid rpblems - both. very long half life
warnings with hypotension, heart block,active thyroid disease
interacts with loads of drugs, notably incr conc of digoxin, dlitazem and verapamil - hald these if amiodarone is started
amiodarone
prescription
administration
communication
monitoring
prescip - with senior involv always. except with cardiac arrest - VF or pulseless VT after 3rd shock - 300mg IV followed by 20mL of NaCL or 5% glucose flush.
admin - IV in emergency. oral - 200mg daily maintanenct - more for loading
communication - what its for, side effects, no grapefuit juice, avoid exposure of skin to direct sunlight
monitor - efficacy HR Rhyth,
safety - IV infusion cardiac monitoring. long term - renal, liver and thryoid, also chest x ray, repeat bloods 6 monthly.
sodium chloride
what for
monitor
expands ECF
circ compromise
KCl
what for - what to look for with this adverse effevts warnings interactions
prescrip
monitor
k depl
caused by diar vom, secondary hyperaldos
severe - arrthymias, muscel weakness, paralysis.
given with nacl and glucose
is an irritant to veins - no more than 20mmol/hour
dangerous with renal impair - susceptible to hyperkal
be careful with pot raising drugs - aldost antag (=mineralocorticoid antag = potassium sparing - spironolactone, epelernone) / ACEi and ARB
20mmol in 1L NaCl (0.15%)
M - levels and ECG
