Pharmacology+perscriptions Flashcards

Question

Adverse drug reactions

Answer 1

Type A: augmented reactions result from exaggeration of drugs normal pharmalogical actions when given at usual dose Type B: bizarre reactions unexpected of drugs actions Type C: continuing reactions persistent for long time Type D: delayed reactions apparent some time after medicine use Type E: end-of-use reactions associated with withdrawals

Answer 2

300mg loading dose aspirin/clopidogrel | continue at 75mg for up to 12 months

Answer 3

Mechanism of action: COX-1 inhibitor which interferes with thromboxane A2 in platelets, preventing platelet aggregation Formulation: tablets Dose range post NSTEMI: 75mg – 300mg Key practice point: someone with a suspected ACS should chew aspirin immediately if available to them usually put on aspirin for life

Answer 4

Mechanism of action: binds to ADP receptors on platelets, preventing the platelet aggregation cascade Formulation: tablets Dose range: 75mg – 300mg Key practice point: a similar drug to aspirin, clopidogrel can be given as monotherapy post NSTEMI if aspirin is contraindicated also given up to 12 months post event

Answer 5

aspirin/clopidogrel Nitrates are used for pain, as they dilate coronary blood vessels Patients should also be given an anticoagulant such as heparin or low molecular weight heparin or fondaparinux Beta-blockers can also offer benefit and should be continued indefinitely A glycoprotein Iib/IIIa inhibitor such as eptifibatide can be given alongside the anticoagulant/antiplatelet in patients at high risk of death. This can also be given to those undergoing PCI ACE inhibitors for left ventricular systolic dysfunction statins to reduce risk of recurrent MI, CAD and need for revascularisation and stroke risk

Answer 6

nitrates are used for pain relief. They dilate the coronary blood vessels, relieving tightness in the chest Patients will be provided with a glyceryl trinitrate (GTN) spray post NSTEMI, which they spray sublingually for quick absorption of the drug and relief of chest tightness Other formulations include tablets (isosorbide mononitrate), and sometimes isosorbide dinitrate is given intravenously if the spray is not effective at relieving pain Many ACS patients continue to use the sublingual GTN spray for ongoing relief of chest pain/tightness. As nitrates dilate blood vessels, they commonly cause headaches and so patients should be made aware of this.

Answer 7

Mechanism of action: inhibit to action of various clotting factors e.g. enoxaparin (a low molecular weight heparin) works to inhibit factor Xa Heparin and low molecular weight heparins (LMWH) Fondaparinux is slightly different to heparin/LMWH,

Answer 8

Most common example: eptifibatide Mechanism of action: reversibly binds to the platelet receptor glycoprotein Iib/IIIa preventing the binding of fibrinogen, VWF and other molecules which lead to platelet adhesion

Answer 9

drug-drug: benefical or adverse phamacodynamics drug-disease: aspirin use in gout patients drug-alcohol: can induce or inhibit enzymes, increases effect with depressants drug-food: often caused by enzyme interactions drug-labatory: changes laboratory test

Answer 10

concomitant of more than 5 drugs | excessive polypharmacy is more than 10 drugs

Answer 11

dose for cardioversion: 50-300mg daily Specific monitoring: regular ECGs one week after starting then after dose changes side effects: visual disturbance, GI smptoms blocks Na channels slowing conduction and HR most common therapeutic choice often better tolerated than other antiarrythmic drugs only used for those with no cardiac defects

Answer 12

dose: 200mg TDS (3x daily) for one week then 200mg BD (2x daily) then 200mg OD (once daily) continuously or lowest dose needed to control arrhythmia Specific monitoring: TFTs and LFTs before and every 6 months after serum potassium before and CXR side effects: corneal microdepositis, thyroid function derangement, hepatotoxicity, pulmonary toxicity works by blocking potassium channels slowing HR prolonging each AP contraindications: severe conduction disturbance, sinus node disease, sinus bradycardia, thyroid dysfunction

Answer 13

As well as slowing the heart (rate control), sotalol also is a type II/III anti-arrhythmic. The latter properties come at higher doses. Mechanism is similar to amiodarone, by blocking potassium channels to slow cardiac conduction Dose (for cardioversion): initially 80mg in divided doses, increased to 160-320mg daily divided doses, gradual increase at intervals of 2-3days Specific monitoring: regular ECGs (every week and after dose change). Can actually cause arrythmias so monitoring is crucial. Side effects: bradycardia, fatigue, cold extremities, light-headedness contraindications: asthma, cardiogenic shock, hypotension, metabolic acidosis, prinzmetals angina, 2nd degree block, severe PAD, sick sinus syndrome, 3rd degree block, uncontrolled HF

Answer 14

A Vitamin K antagonist which prevents the reduction of Vitamin K which is needed to make clotting factors; fewer clotting factors = increased time to clot dose by mouth; initially 5-10mg day 1. subsequent doses depend on prothrombin time (measured by INR grading and by time in therapeutic range) lower dose given over 3-4weeks in non-rapid cases elderly patients given 3-9mg daily interactions: foods high in vitamin K or supplements, alcohol interaction effect on liver side effects: haemorrhage, alopecia, nausea, vomiting contraindications: post 48hrs of haemorrhagic stroke

Answer 15

Novel Oral Anticoagulant Drugs (‘NOACS’) These directly inhibit a particular clotting factor rather than have a wide ranging effect on other clotting factors. Bleed risk is therefore lower – although there IS still a bleed risk. They can only be used in NON-VALVULAR AF, where valve involvement warfarin is used. licensed for AF: - apixaban - dabigatran - rivaroxaban clear indications for use eg dabigatran required LVEF of less than 40%

Answer 16

Direct inhibitor of Factor Xa Dosed TWICE daily, whereas rivaroxaban is only once daily. This requires patients remember to take two doses a day rather than one. Dose adjustment in renal impairment ``` MHRA advice (2019): increased risk of thrombotic events in patients with antiphospholipid syndrome and a history of thrombosis. MHRA advice (2020): reminder of bleed risk and reversal agents ```

Answer 17

Direct inhibitor of thrombin Has the greatest number of product licenses of the NOACs (i.e. AF but also many other indications) Dosed TWICE daily, whereas rivaroxaban is only once daily. This requires patients remember to take two doses a day rather than one. Dose adjustment in renal impairment MHRA advice from previous slide applies here, too Side effects: abnormal hepatic function, anaemia, diarrhoea, haemorrhage

Answer 18

Direct inhibitor of Factor Xa The first NOAC to market MUST be taken with food Dosed ONCE daily Dose adjustment in renal impairment MHRA advice from previous slide applies here, too Side effects: anaemia, constipation, haemorrhage

Answer 19

can only give up to 20mg simvastatin while pt is on amlodipine (CCB) due to additive effects of drugs

Answer 20

``` beta lactams penicillins cephalosporins glycopeptides carbapenems monobactams ```

Answer 21

lipopeptides | polymixins

Answer 22

``` aminoglycosides tetracyclines macrolides linosamindes chloramphenicol linezolid ```

Answer 23

quinolones fluroquinolones nitrofurantoin

Answer 24

trimethiprim | sulfamethoxazole

Answer 25

Mebendazole – predominantly used for treating threadworm in those aged over 6 months. Given as a single dose (e.g. 100mg tablet or oral solution), and then often a second dose can be given 2 weeks later due to risk of re-infection Mebendazole is also used to treat Hookworms Praziquantel (an unlicensed drug) – used to treat tapeworm infections, and some other worms. Ivermectin – used for strongyloides infection, onchocerciasis (river blindness)

Answer 26

four generations of penicillin (characterised by beta-lactem ring and structural modifications) cephalosporins: A ‘relative’ of the penicillins which also have a beta-lactam ring responsible for their antibacterial action. Carbapenems: ’ often used as last resort: of all the beta-lactams, Monobactams: Aztreonam is only one available in UK

Answer 27

1st generation: 1st discovered and used. Includes penicillin G (benzylpenicillin) given by IV or IM, particularly used in meningitis. others include penicillin V (administered orally) there is now a widespread resistance to 1st gen, caused by bacterial enzyme beta-lactamase which cleaves beta ring rendering drug ineffective Penicillin V still somtimes used often against streptococcal infections following splenectomy

Answer 28

``` have varying resistance to beta-lactamase therefore have more use than 1st gen. include flucloxacillin (500mg four times daily) doses up to 8mg in 3-4 divided doses can be given. higher doses usually needed for osteomyelitis to ensure sufficient concentration of drug side effects: Cholestatic jaundice and hepatitis can rarely occur, even up to 8 weeks after cessation. It is therefore cautioned in those patients with a history of hepatic impairment. ``` Should be taken on an empty stomach

Answer 29

aminopenicillins broader spectrum of activity than 1st and 2nd generation penicillins, with their activity not only against gram positive but also gram negative Two commonly used examples are ampicillin and amoxicillin. Ampicillin is usually given IV or IM, due to poor oral absorption Amoxicillin can be given IV or IM, but is usually administered orally often for community acquired pneumonia and dental infections To increase its effectiveness, amoxicillin is often combined with the beta-lactamase inhibitor ‘clavulanate’ as the produce ‘co-amoxiclav’ which prevents degradation of the lactam ring. side effects can therefore include, cholestatic jaundice can occur

Answer 30

antipseudomonals broad spectrum of activity against a wide range of gram +ve and gram –ve bacteria, and also anaerobes These are only available in combination with a beta-lactamase inhibitor, and are administered intravenously as an infusion One example is ‘piperacillin with tazobactam’, colloquially known as ‘taz’

Answer 31

A ‘relative’ of the penicillins which also have a beta-lactam ring responsible for their antibacterial action. Unlike the penicillins, this is paired with a six rather than five membered ring Active against both gram +ve and –ve bacteria, they are particularly broad spectrum although the antimicrobial ‘cover’ of specific drugs varies There are 5 generations of cephalosporin; as those most often used, only generations 1 through 3 are covered in this lecture Due to structural similarities, between 0.5 and 6.5% of penicillin-sensitive patients will also be allergic to the cephalosporins, although this cross-sensitivity varies from drug to drug

Answer 32

common use is cefalexin Administered orally, it is useful for urinary-tract infections, respiratory-tract infections, otitis media and skin and soft-tissue infections They are examples of cephalosporins which are more likely to trigger an allergic response in penicillin patients

Answer 33

common use include cefaclor (oral administration) and cefuroxime (usually parenteral administration but sometimes oral) Many antibiotics can increase the risk of C. difficile. This is due to disruption of the ‘normal’ gut flora which can lead to an increase in the numbers of C. difficile bacteria 2nd (and 3rd) generation cephalosporins are commonly implicated, as are other classes of antibiotic known as the ‘C’ drugs: cephalosporins; carbapenems; clindamycin; ciprofloxacin; and co-amoxiclav

Answer 34

Compared to 2nd generation, these have increased activity against gram –ve bacteria, but generally less activity against gram +ve than cefuroxime (2nd generation) Examples include cefotaxime and ceftriaxone (both administered parenterally), and both can be used as an alternative to Penicillin G in suspected meningitis Ceftriaxone has the longest half-life of the cephalosporins, so only needs to be given once daily

Answer 35

often used as last resort: of all the beta-lactams, they have the broadest spectrum of activity and greatest potency against both gram +ve and –ve bacteria Similar to the 4th generation penicillins (e.g. ‘taz’), the ‘penems are effective against pseudomonas Very low oral-bioavailability and are therefore administered parenterally Cross-sensitivity in penicillin allergic patients is 1%; lower than the cephalosporins Examples include imipenem, meropenem, and ertapenem

Answer 36

Cilastatin is combined with imipenem (carbapenem AB) to prevent its deactivation by the dehydropeptidase 1 (DHP1) found in the kidneys, and thereby maintain blood concentration of the drug In patients with renal impairment, carbapenem doses should be reduced to prevent nephrotoxicity. Cilastatin also helps prevent nephrotoxicity The carbapenems can also cause seizures, and the risk is greatest with imipenem Imipenem also has a severe drug-drug interaction with the anti-epileptic drug valproate, whereby imipenem reduces the blood concentration of valproate

Answer 37

Aztreonam The only monobactam commercially available in the UK, and is effective against gram-negative aerobic bacteria including pseudomonas and haemophilus influenzae Administered via intravenous infusion, intravenous injection, or deep intramuscular injection (e.g. a 1g stat dose for gonorrhoea). Can also be inhaled via a nebuliser for pulmonary pseudomonas/other severe infections in patients who have cystic fibrosis If for inhalation, monitor patient for bronchospasm. There is also a risk of haemoptysis

Answer 38

Vancomycin given IV usually Used for infections caused by many different gram +ve aerobes and anaerobes. Due to a MW>500 (VERY LARGE), vancomycin cannot penetrate the outer member of gram –ve bacteria An option for MRSA associated infections Due to being a large molecule, absorption from the GI tract is limited so it is generally administered IV. Can be administered orally for GI infections e.g. C. Difficile Weight-based dosing (typically 15-20mg/kg every 8-12 hours), with dose adjustments made based on serum vancomycin measurement Risk of drug accumulation with pts with impaired renal function leading to toxicity so must be closely monitored Can cause nephrotoxicity, ototoxicity and ‘red man syndrome’ = flushing, erythematous rash, mild to profound hypotension and rarely cardiac arrest

Answer 39

Similar to vancomycin, but semi-synthetic. limited to use in gram+ve aerobes and anaerobes and also an option for MRSA associated infections has a longer duration of action than vancomycin, which enables once daily administration after a period of ‘loading’ (termed ‘loading dose’) Example dose for serious gram+ve infections: 6mg/kg every 12 hours for 3 doses, then 6mg/kg once daily. Dose adjustment required in the renally impaired patient. can cause nephrotoxicity (lower incidence than vancomycin)

Answer 40

activity against both gram+ve and gram-ve bacteria, but not anaerobic organisms Not absorbed from the gut and so administered parenterally, they inhibit protein synthesis of the bacterial cell by binding to the 30S ribosomal subunit, causing the mRNA codon to be misread Examples include: Streptomycin (one of the first drugs used for tuberculosis) Neomycin (too toxic for parenteral administration) Kanamycin Gentamicin Tobramycin Amikacin very water soluble meaning very little of any administered dose moves into fatty tissues and there is increased risk of toxicity. For this reason, we used weight-based dosing and monitor drug serum concentrations Use adjusted body weight scale for obese patients because of this Side effects: Ototoxicity and nephrotoxicity can occur Dose reduction for those who have: renal impairment; elderly; frail or haemodynamically compromised e.g. dehydrated

Answer 41

Use has reduced due to increasing resistance, although they do still have a role in the management of some conditions Administered orally, they interfere with RNA binding contraindicated prescribed to those under <12 years old, as they bind to calcium and therefore deposit in bone and teeth – of which the latter causes staining For the same reason, they should not be given to pregnant or breastfeeding women They are all cautioned in hepatic impairment, patients with myasthenia gravis (muscle weakness may be increased), systemic lupus erythematosus (may be exacerbated). Minocycline is most likely to cause the latter Rare side effects include: benign intracranial hypertension

Answer 42

Interfere with RNA synthesis Active against gram +ve, minimal activity against gram-ve Commonly used in patients who are allergic to penicillin Common side effects are: nausea, diarrhoea, decreased appetite QT prolongation is something to be aware of, particularly if used in combination with other QT prolonging drugs

Answer 43

Erythromycin: used for a broad range of infections; can cause ototoxicity in high doses Clarithromycin – a derivative of erythromycin with slightly more actiivty: used for a broad range of infections, often used for Helicobacter Pylori infection Azithromycin – enhanced gram-ve activity, long half-life with deep tissue penetration: used in combination with zinc acetate as a topical formulation to treat acne; can be prescribed 250mg three times per week in patients susceptible to chest infections e.g. those with COPD/cystic fibrosis; 1g stat doses used for chlamydia/gonorrhoea Spiramycin – used for toxoplasmosis Erythromycin and clarithromycin are potent Cytochrome P450 enzyme inhibitors, and therefore can lead to an increase in serum concentration of other drugs

Answer 44

Oxytetracycline – often used for acne Minocycline – broader spectrum than the other tetracyclines Doxycycline – sometimes used for URTIs and malaria prophylaxis, first line for most presentations of Lyme disease Lymecycline – often used for acne

Answer 45

``` Enzyme inducers ↑ metabolism of other drugs ↓ blood levels of those other drugs INDUCERS – CRAP GPS induces rage Carbemazepine Rifampacin Alcohol (chronic use) Phenytoin ``` Griseofulvin Phenobarbital Sulphonylureas

Answer 46

``` Enzyme inhibitors ↓ metabolism of other drugs ↑ blood levels of those other drugs INHIBITORS – SICKFACES.COM Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (binge drinking) Chloramphenicol Erythromycin Sulfonamides .Ciprofloxacin Omeprazole Metronidazole ```

Answer 47

Clindamycin is the only example used clinically, with a similar mechanism to the macrolides Activity against gram+ve bacteria and anaerobes; good concentration in the bone so useful for osteomyelitis Often used at doses of up to 150mg – 450mg every 6 hours for osteomyelitis and other serious infections One of the ‘C’ drugs which is more likely than other antibiotics to cause C. Difficile Monitor liver and renal function if treatment exceeds 10 days

Answer 48

Inhibits RNA synthesis Ocular administration of drops or ointment, most commonly for bacterial conjunctivitis Can be purchased over the counter for children >2 years (<1 year of age for many pharmacies with a Minor Ailments Scheme in place); but generally for <2 years it must be prescribed Can be given intravenously, but this is incredibly rare due to the risk of agranulocytosis/bone marrow disorders. Used to be fairly common to administer intravenously

Answer 49

An oxazolidinone (synthetic) Inhibits protein synthesis Administered PO or via IV infusion Optic neuropathy can occur if linezolid is used for longer than 28 days, but is rare

Answer 50

``` Nalidixic acid was used for UTI in 1960s but not really used now The fluoroquinolones (next generation beyond quinolones) are the only quinolones now available in the UK ```

Answer 51

available in the UK are: Ciprofloxacin – active against both gram+ve and –ve, particularly gram –ve including salmonella and shigella. It also has activity against some mycobacteria. Ofloxacin – used for urinary-tract infections, LRTI, gonorrhoea, NGU and cervicitis Levofloxacin – active against both gram+ve and -ve Moxifloxacin – active against both gram+ve and –ve, greater activity against gram+ve than ciprofloxacin. Not active against MRSA or pseudomonas aeruginosa

Answer 52

Convulsion risk in those with or without history of convulsions; NSAIDs together can further the risk Tendon damage; reported rarely and can occur within 48 hours or months later. Increased risk when used with corticosteroids Small risk of aortic aneurysm and dissection Other disabling and potentially long-lasting or irreversible side effects e.g. muscle weakness and peripheral neuropathy – stop if so! Can prolong QT interval Renal impairment: reduce dose

Answer 53

RNA/DNA inhibitor Used exclusively for urinary tract infections; length of treatment often varies between men and women; be wary of this For standard release preparations, dosing in adults is typically 50mg QDS for 3-7 days For prolonged release preparations, dosing in adults is typically 100mg BD for 3-7 days Counselling point: can colour urine red Renal impairment: avoid if eGFR <45mL/minute; can be used with caution if eGFR 30-44mL/minute for 3-7 days

Answer 54

A bacteria-specific dihydrofolate reductase (DHFR) inhibitor thereby preventing DNA synthesis Renal impairment: use half dose after 3 days if eGFR 15-30mL/min

Answer 55

An example of a sulphonamide. The sulphonamides are no longer used on their own due to resistance and toxicity Sulfamethoxazole is used in combination with trimethoprim due to synergy (5:1 ratio) for a range of infections including Pneumocystis jirovecii which occurs in immunosuppressed patients Dose in adults is typically 960mg BD Notable side effects: fungal overgrowth (common); agranulocytosis (rare) Renal impairment: avoid if eGFR<15mL/min, use half normal dose if eGFR 15-30mL/min Hepatic impairment: avoid in severe liver disease

Answer 56

Isoniazid: cheap and highly effective; always included unless contraindicated Rifampicin: also always included unless CI during first two months 'initial phase' can cause liver function disturbance or more serious liver toxicity needed change in treatment intermittent treatment side effects: 20-30% PTs experience influenza like abdominal and respiratory symptoms, shock, renal failure, thrombocytopenic purpura. rifabutin: indicated for prophylaxis agaist M.avium infections in pts with low CD4 count and pulmonary TB pyrazinamide: only active against dividing forms of Mycobacterium TB only effects over 2-3months. Not active against M.bovis. Is useful in TB menigitis due to good meningeal penetration Ethambutol included is isoniazid resistance is suspected Streptomycin rarely used now in UK except for resistant organisms

Answer 57

Used for systemic fungal infections such as Aspergillosis and invasive candidiasis Due to poor solubility of amphotericin B, the medicine used (Fungizone®) includes deoxycholate to increase solubility The drug causes nephrotoxicity via a direct effect on the epithelia of the renal tubule and glomerulus, which leads to reduced renal blood flow and filtration rate1. A test dose (small amount and slowly infused) is always given before higher treatment doses as infusion-related reactions can occur e.g. chest pain or flushing Different lipid formulations available, including the liposomal preparation AmBisome® used in the NHS Developed to reduce nephrotoxicity and infusion toxicity of the drug May be tried in patients allergic to Fungizone®, but again a test dose is always used as reactions can also occur The different preparations of Amphotericin B are not interchangeable

Answer 58

Used exclusively via oral administration Primary indication is oral candidiasis, with 100,000units (1mL) of the suspension dropped into the mouth four times daily for a week Oral candidiasis infection is most common in children, the elderly and the immunocompromised Important that contact with the oral candidiasis plaques is maintained for as long as possible

Answer 59

Accumulates in Keratinocytes, limiting its use to dermatophytes e.g. trichophyton rubrum which causes tinea pedis (athletes foot) Due to its mechanism of action, it continues to be investigated as an anti-cancer agent

Answer 60

used for severe systemic fungal infections and for cryptococcal meningitis, and often in combination with amphotericin B Gut flora can convert 5-FC to 5-FU, which can lead to nausea, vomiting and diarrhoea and bone marrow suppression Monitoring of blood counts required (5-FU is cytotoxic)

Answer 61

The most commonly used antifungals which have a role in the treatment of most fungal skin infections The azoles also inhibit human CYP enzymes, meaning the azoles have many drug-drug interactions

Answer 62

CANESTEN By far the most common treatment for vaginal candidiasis (thrush) and balanitis, with many formulations available Often different preparations used in combination to both clear infection and manage symptoms Clotrimazole creams are often used alongside a fluconazole capsule (described later)

Answer 63

Indicated for skin infections e.g. fungal sweat rash, nail infections, and vaginal/vulval candidiasis (thrush), which are usually treated with a cream formulation Another common indication, athletes foot is often treated with miconazole powder or spray Indicated for oral/intestinal candidiasis treated using an oral gel Potential adverse events tend to be the result of interaction with other drugs, is a potent P450 enzyme inhibitor if taken concomitantly with drugs that are metabolised by those enzymes e.g. warfarin, the blood concentration of those drugs can increase Should not use this over-the-counter alongside warfarin

Answer 64

Indicated for fungal skin infections, including ringworm, Pityriasis versicolor, seborrhoeic dermatitis and dandruff Can be administered orally using a tablet, but that should only be for endogenous Cushing’s syndrome (ketoconazole is a potent inhibitor of cortisol and aldosterone) Side-effects from topical use are uncommon/rare and include folliculitis and hair changes Also rare but serious, with oral administration hepatic disorders can occur and adrenal insufficiency. If used orally, monitoring includes LFT, adrenal function and ECG

Answer 65

Perhaps the most commonly used azole, with a wide range of indications including: balanitis, vaginal candidiasis, mucosal candidiasis (e.g. oropharyngeal, oesophagitis, candiduria) Often used to prevent fungal infections in immunocompromised patients e.g. those on chemotherapy Single dose of 150mg given for balanitis/thrush and can be purchased over the counter Longer treatment courses are used e.g. 50mg daily for 4 weeks. With those longer courses, drug interactions are more of a concern

Answer 66

Itraconazole (1992) – derived from ketoconazole; effectiveness against molds. Often used second line when fluconazole ineffective. Voriconazole (2002) – also derived from ketoconazole Indicated in invasive aspergillosis and other serious infections such as invasive fluconazole-resistant Candida infection Posaconazole (2006) – used third line for infections that do not respond to itraconazole or Amphotericin B, or where those drugs can not be tolerated Isavuconazole (2016) – indicated for invasive aspergillosis and mucormycosis in patients for whom Amphotericin B is inappropriate

Answer 67

less common treatment option, the echinocandins work by targeting the fungal cell wall example: Micafungin inhibits key structural components of the fungal cell wall Indicated for oesophageal and invasive candidiasis, and prophylaxis of candidiasis for those undergoing bonemarrow transplantation who are expected to be neutropenic for >10 days

Answer 68

Pressurised metered dose inhaler (pMDI) Breath actuated metered dose inhaler (BA-MDI) Dry powder inhalers (DPI) – at least 9 different types e.g. Turbohaler and Nexthaler Soft-mist metered dose inhaler (SMI) Some inhalers are ‘combination inhalers’ where 2 or 3 different drugs with different pharmacological action are delivered from the same device.

Answer 69

short acting beta 2 agonists; short term relief for those with very mild, intermittent asthma; Salbutamol (100-200mcg up to 4 times/day inhalation or 4mg, 2mg in elderly, up to 8mg/day), terbutaline sulfate. typically dosed 4x daily (QDS) If using more than 3 doses a week, consider increasing to next step of management side effects are uncommon but can include headache, trembling, palpitations and hypokalaemia

Answer 70

Inhaled corticosteroids Initiated at low doses and closely monitored dosed 2x daily fluticasone propionate; 5-15year 50-100mcg 2xdaily max per dose 200mcg; 16+ 100-500mcg 2xdaily max per dose 1mg, beclometasone diproprionate; 5-11 years 100-200mcg 2xdaily; 12+ 200-400mcg 2xdaily side effects: sore mouth/throat, hoarse voice, oral thrush

Answer 71

Long acting beta agonists added to existing treatment of SABA and ICS. LABA used in the clinic: Formoterol (2-3 minute onset; 12 hour action 6+ years = 12mcg 2xdaily up to 24mcg) Salmeterol (10-14 minute onset; 12 hour action; 5+ years 50mcg twice daily; in 12+ can be increased up to 100mcg 2x daily if needed) Vilanterol (5-12 minute onset; 24 hour action) LABA cannot be used without ICS as there is increased risk of mortality Side effects: : trembling, headaches, palpitations, hypokalaemia

Answer 72

Alternative approach is MART; combination of LABA and ICS for maintenance and relief Beclometasone with formoterol; 1 inhalation 2xdaily maintenance and 1 inhalation PRN for relief maximum 8 inhalation/day) in single inhaler. recommended to improve adherence and ensure LABA is not taken alone. BTS/SIGN also recommend to be considered with a history of asthma attacks on medium dose ICS alone or fixed ICS and LABA regimen.

Answer 73

leukotriene receptor antagonist (LTRA) in addition to ICS treatment; such as montelukast (15+ 10mg once in evening, 6-14 5mg once in evening, 6months-5years 4mg once in evening; review in 4-8 weeks) Side effects: headache, gastro issues (stomach pain, diarrhoea etc), upper respiratory infection

Answer 74

increasing ICS dose from low to medium OR adding LTRA such as montelukast (15+ 10mg once in evening, 6-14 5mg once in evening, 6months-5years 4mg once in evening; review in 4-8 weeks) If LABA is showing no signs of benefit, consider stopping this.

Answer 75

``` Tiotropium bromide (long-acting muscarinic antagonist - LAMA) Ipratropium bromide (short-acting muscarinic antagonist – SAMA) – generally of no value Theophylline – narrow therapeutic index whereby the toxic dose is close to therapeutic dose, measure plasma concentration 5 days after initiating and 3 days after any dose adjustment. The plasma concentration is decreased in smokers and by alcohol. Aminophylline – this is a mixture of theophylline and ethylenediamine which is added to increase water solubility, enabling intravenous administration Nedocromil Monoclonal antibodies (e.g. anti-IgE) ```

Answer 76

Varies depending on the severity, but the following are options: ß2 agonist to be given to all patients with acute asthma and as earlier as possible If poor response to ß2 agonists, nebulised ipratropium bromide can be added Oral prednisolone daily until recovery (minimum of 5 days) IV magnesium is an option for patients with acute severe asthma, but only after consultation with senior medical staff If hypoxaemic, Oxygen should be given to maintain SpO2 level of 94-98%

Answer 77

can’t see, can’t pee, can’t spit, can’t sh*t | visual disturbance, constipation, decreased urine output and decreased saliva production

Answer 78

SABA or SAMA to reduce breathlessness and improve exercise capacity With asthmatic features: LABA plus ICS; Without asthmatic features: combined LABA and LAMA Triple inhaled therapy (LAMA + LABA + ICS) to people with COPD with asthmatic features suggesting steroid responsiveness who remain breathless or have exacerbations despite taking LABA+ICS = trimbow In both groups only consider combination inhalers if non-pharmacological options, vaccinations and smoking cessation have been addressed

Answer 79

Theophylline - relaxes smooth muscle and relieves bronchial spasm Mucolytic therapy - chronic productive cough; an adjuntive therapy for excessive viscous mucus - carbocisteine (mucolytic that helps you cough up phlegm. It works by making your phlegm less thick and sticky. ) Prophylactic antibiotics - discussion with respiratory specialist

Answer 80

Xylometazoline, pseudoephedrine and phenylephrine act as sympathomimetics Bind to receptors in nasal mucosa causing vasodilation and opening nasal passage

Answer 81

``` Aspirin Diclofenac Celecoxib Ibuprofen Indomethacin Naproxen Mefenamic acid Etoricoxib ```

Pharmacology+perscriptions Flashcards

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