PSA Flashcards
1
Q
First line treatment for BPE after lifestyle changes?
A
alpha-blockers
2
Q
Second line treatment for BPE?
A
5a-reductase inhibitors
3
Q
What symptoms 5a-reductase inhibitors relieve?
A
Improve lower urinary symptoms; can take 6 months for this to show
4
Q
Usual dose 5a-reductase inhibitors?
A
5mg OD
5
Q
Example of 5a-reductase inhibitors?
A
Finasteride and dutasteride
6
Q
Alpha blockers usual indications?
A
BPE and resistant hypertension (after CCB, ACE inhibitors and diuretics), Raynaud’s (prazosin)
7
Q
Examples of alpha blockers?
A
Doxazosin, tamsulosin (BPE only), alfuzosin
8
Q
Important adverse effects from alpha blockers?
A
Postural HT, dizziness and syncope (don’t give to those with postural hypotension), aim to take before bed; anxiety, back pain, flu-like, myalgia
9
Q
Alpha blockers interactions?
A
Hypotension with other antihypertensives (particularly beta blockers)
10
Q
Dose for alpha blockers?
A
1mg OD and increased at 1-2 wks after response; tamsulosin = 400ug daily
11
Q
Indications for acetylcholinesterase inhibitors?
A
Mild to moderate parkinsons and mild to moderate dementia in PD (rivastigmine)
12
Q
Examples of acetylcholinesterase inhibitors?
A
Donepezil and rivastigmine
13
Q
Adverse SEs achase inhibitors?
A
N+V, diarrhoea (increased ach in peripheral NS); some asthma and COPD exacerbated; can develop tremor
14
Q
Achase inhibitors interactions?
A
NSAIDs and steroids = higher risk of peptic ulcers; antipsychotics = neuroleptic syndrome risk; heart block and brady = risk increased with rate limiting meds (beta blockers)
15
Q
Achase inhibitors dose?
A
Prescribed and managed by specialist; 5mg OD = donepezil, 1.5mg 12 hourly = rivastigmine; dose titrated up after 2-4wks
16
Q
Indication for acetylcysteine?
A
Antidote for paracetamol poisoning; prevent contrast nephropathy (renal injury from contrast for scans); reduce viscosity of resp secretions (oral carbocisteine)
17
Q
Adverse effects of acetylcysteine?
A
Produces anaphylactoid reaction (like anaphylaxis but no IgE mediated); if this happens, let it settle and give it at a lower rate; if nebulised can cause bronchospasm so give with bronchodilator
18
Q
Dose for acetlycysteine?
A
Weight adjusted in 3 components for paracetamol OD for 21 hours; not recommended in contrast nephropathy; resp secretions = 2.5ml 10% solution neb every 6 hours
19
Q
Activated charcoal indication?
A
For absorption of poisons or elimination with multiple doses (benzos or methotrexate)
20
Q
Adverse effects activated charcoal?
A
If inhaled - pneumonitis, bronchospasm, airway obstruction; also GI obstruction, black stools and vomiting
21
Q
Warnings activated charcoal?
A
Not to reduced consciousness and persistent vomiting as aspiration risk; not to reduced gut motility
22
Q
Dose activated charcoal?
A
Single dose within 1 hour of ingested poison (50mg in 250ml water); can also give later/additional dose for drugs delaying gastric emptying (aspirin, TCAs, opioids); for multiple (carbamazepine, quinine, theophyline) 50mg 4 hourly
23
Q
Adenosine indication?
A
First-line diagnostic and therapeutic agent for SVT (regular, narrow-complex tachy); reduces automaticity and increases refractoriness
24
Q
Adverse effects of adenosine?
A
Can induce brady and asystole as interferes with SA and AV node, feels like having an MI
25
Contraindications of adenosine?
Not to those intolerant of brady - hypotension, coronary ishchaemia, decompensated HF; avoided if poss in asthma and COPD
26
Adenosine interactions?
Dipyridamole (blocks uptake of adenosine - dose halved as prolongs half life); theophylline and aminophylline competitive antagonists (may need more adenosine)
27
Adenosine dose?
IV initial = 6mg; then 12mg if ineffective; if central line = lower dose; has to be by specialists and followed by saline
28
Adrenaline indications?
Cardiac arrest, anaphylaxis immediate management, vasoconstriction in surgery and prolong effects of local anaesthesia
29
Adrenaline adverse effects?
In cardiac arrest can get adrenaline-induced HT; can cause anxiety, tremor, headache, palps
30
Warnings adrenaline?
Careful with heart disease, don't use in peripheries as can cause tissue necrosis from vasoconstriction
31
Interactions adrenaline?
Can get widespread vasoconstriction if on beta blockers
32
Adrenaline prescription?
Prescribed after given in life-threatening (1mg/10ml IV after 3rd shock followed by saline flush and repeated 3-5 mins after - ), same if rhythm not shockable; anaphylaxis = 500ug IM repeated after 5 mins if necessary (in thigh); for use with analgesia = 5ug/ml
33
Types of aldosterone antagonists?
Spironolactone and eplerenone
34
Aldosterone antagonists indications?
Oedema from liver cirrhosis, chronic HF, primary hyperaldosteronism (Conn's); eplerenone only for HF, nephrotic syndrome
35
Important aldosterone antagonist adverse effects?
Hyperkalaemia (muscle weakness, arrythmias) and gynaecomastia; less common with eplerenone; can cause liver impairment and jaundice and stevens-johnson syndrome
36
CIs aldosterone antagonists?
Renal impairment, hyperkalaemia, Addison's, pregnancy
37
Aldosterone antagonists interactions?
K+ elevating drugs (ACE inhibitors and ARBs) or K+
38
Dose for spironolactone?
25mg start dose HF and 100mg for anything else; taken with food oral
39
Indications for aliginates and antacids?
GORD and dyspepsia
40
Types of alginates and antacids?
Gaviscon and peptac
41
Alginates and antacids SEs?
Magnesium salts = diarrhoea, aluminium salts = constipation
42
Interactions alginates and antacids?
Can bind to drugs reducing absorption; ACE inhibitors, abx, bisphosphonates, digoxin, levothyroxine, PPIs and increase aspirin and lithium excretion
43
Dose alginates and antacids?
Chewable tablets and usually after meals or when sxs occur; check ingredients for renal impairment/diabetes
44
Allopurinol indications?
Prevent recurrent gout attacks, prevent uric acid and oxalate renal stones, prevent hyperuricaemia and tumour lysis syndrome from chemo
45
Allopurinol SEs?
Can worsen gout attack (can reduce if given with NSAID or colchicine); skin rash, stevens-johnson syndrome, allopurinol hypersensitivity reaction, hepatotoxicity
46
Allopurinol warnings?
Don't give if acute gout attack, recurrent skin rash, severe hypersensitivity, renal and hepatic impairment, stay hydrated
47
Allopurinol interactions?
Azathioprine has toxicity increased, ACE inhibitors and thiazides increases hypersensitive risk and amoxicillin increase skin rash
48
Allopurinol dose?
Start at 100mg and titrate up to 200-600mg OD; take after food and lots of fluids
49
Types of aminoglyosides?
Gentamicin, amikacin, neomycin
50
Aminoglycoside indications?
Systemic infections by gram positive and some gram negative anaerobes
51
Aminoglycoside SEs?
Nephrotoxicity and ototoxicity
52
Aminoglycoside warnings?
Neonates, elderly, renal impairment and mysathenia gravis
53
Aminoglycosides interactions?
Ototoxicity = vancomycin and loop diuretics, nephrotoxicity = ciclosporin, vancomycin and cephalosporin
54
Aminoglycoside dose?
Less in renal impairment; intermittent IV infusion if severe and parenteral if not; one dose (5mg/kg over 30 mins) every 24 hours if normal renal for 7 days
55
Aminosalicylates types?
Mesalazine, sulfasalazine, olsalazine, balsalazide
56
Aminosalicylates indications?
Ulcerative colitis and rheumatoid arthritis
57
Aminosalicylates SEs?
Mesalazine = fewer; GI upset and headache, sometimes blood abnormalities and renal failure; ask about oral ulceration, unexplained rash or unusual bruising; sulfasalazine can cause yellow-orange skin discolouration
58
CIs aminosalicylates?
Those who have aspirin hypersensitivity, renal dysfunction, elderly, pregnant and breastfeeding, asthma
59
Aminosalicylates interactions?
Those that alter pH and break down coating prematurely; PPIs and lactulose; leucopenia risk = azathioprine and mercaptopurine
60
Aminosalicylates dose?
Suppository for UC unless more proximal (oral) and 12-hourly for 4-6wks
61
Amiodarone indications?
Tachyarrhythmias when other drugs ineffective; rhythm control in AF, atrial flutter, VT and VF, WPW arrhythmias
62
Amiodarone SEs?
Hypotension; pneumonitis, brady, AV block, hepatitis, photosensitivity, peripheral neuropathy, myopathy, slate grey skin, jaundice, nausea, pulmonary fibrosis
63
CIs amiodarone?
Severe hypotension, heart block, thyroid disease, HF, elderly
64
Amiodarone interactions?
Many; increases dose of diltiazem, verapamil and digoxin so increases brady
65
Amiodarone dose?
Usually done by specialist unless in MI - VF or pulseless VT after 3rd shock (300mg IV followed by 20ml saline); infusions only in 5% glucose not saline
66
Types of ACEi?
Ramipril, lisinopril, perindopril, enalapril
67
ACEi indications?
HT, chronic HF, IHD, CKD with proteinuria and diabetic nephropathy
68
ACEi SEs?
Hypotension, persistent dry cough, hyperkalaemia, renal failure; rare = anaphylactoid, angioedema; cholestatic jaundice/hepatitis
69
ACEi warnings?
Avoided in renal failure, renal artery stenosis, pregnancy, CKD
70
ACEi interactions?
Avoid potassium elevating drugs, with NSAIDs = increased nephrotoxicity, diuretics = increased hypotension; ciclosporin
71
ACEi dose?
Oral, 1.25mg HF and nephropathy, 2.5mg everything else and up to 10mg
72
ARB types?
Candesartan, losartan, irbesartan
73
ARB indications?
Same as ACEi but not tolerated due to cough; but type 2 diabetic nephropathy whereas type 1 in ACEi
74
ARB SEs?
Hypotension, hyperkalaemia, renal failure
75
ARB warnings and interactions?
Same as ACEi
76
ARBs dose?
Oral, losartan = 12.5mg HF and 50mg in everything else and titrated up
77
PC BRAS for enzyme inducers?
phenytoin, carbamazepine, barbiturates, rifampicin, alcohol (chronic excess) sulphonylureas. Others: topiramate, St John’s Wort, and smoking
78
AO DEVICES for enzyme inhibitors?
allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline).
79
SSRIs and antidepressants types?
Citalopram, fluoxetine, sertraline, escitalopram
80
SSRIs indications?
Depression, OCD, panic disorder
81
SSRIs SEs?
GI upset, weight gain, change in appetite, hyponatraemia, lower seizure threshold, prolong QT (citalopram), bleeding, suicidal in first 2 weeks; withdrawal = flu-like, vomit, neuro upset
82
What is serotonin syndrome?
Autonomic hyperactivity, altered mental state, neuromuscular excitability
83
SSRIs warnings?
Young people, epilepsy, peptic ulcer disease, hepatic impairment
84
SSRI interactions?
MAOI and other serotonergic drugs; higher bleeding in NSAIDs/aspirin; don't combine with antipsychotics (QT long), alcohol, theophylline
85
SSRIs dose?
Oral, 20mg starting and titrate up
86
TCAs types?
Amitryptilline and lofepramine and impramine
87
TCAs indications?
Second line depression; neuropathic pain
88
TCAs SEs?
Antimuscarinic (dry mouth, constipation, urinary retention, blurred vision), sedation, hypotension, arrhythmias, ECG changes, extrapyramidal, convulsions, hallucinations, mania, weight gain, neuroleptic malignant syndrome, hyponatraemia esp in elderly
89
TCAs warnings?
Elderly, epilepsy, CVD, prostatic hypertrophy, glaucoma, constipation; discontinue if manic stage of bipolar
90
TCAs interactions?
MAOIs or SSRIs
91
TCAs dose?
Depression starting = 75mg OD, pain = 10mg OD at night; only give 2wks at a time to prevent overdose
92
Venlafaxine and mirtazapine indications?
GAD and major depression after SSRIs
93
Venlafaxine and mirtazapine SEs?
GI upset, neuro effects; rare = serotonin syndrome, hyponatraemia, suicidal thoughts, long QT, VT, venlafaxine= greater risk of withdrawals; SIADH and rhabdomyolysis
94
Venlafaxine and mirtazapine warnings?
Elderly, hepatic/renal impairment, arrhythmias, epilepsy, pregnancy
95
Venlafaxine and mirtazapine interactions?
Other antidepressants, NSAIDs, warfarin, antiepileptics, dopaminergics (selegiline)
96
Venlafaxine and mirtazapine dose?
Oral and by experts; venlafaxine = 37.5mg 12 hourly to 375mg max and mirtazapine = 15mg OD to 45mg max at night (weight gain and sedating)
97
Types of dopamine D2 receptor antagonists?
Metoclopramide and domperidone
98
Dopamine D2 receptor antagonists indications?
N+V in reduced gut motility
99
Dopamine D2 receptor antagonists SEs?
Diarrhoea; metoclopramide = extrapyramidal sxs (like antipsychotics - dystonia etc); domperidone = QT long and arryhthmias
100
Dopamine D2 receptor antagonists warning?
Metoclopramide for no more than 5 days (extra-pyramidal effects), avoided in the young and PD; domperidone = no cardiac conduction problems and hepatic impairment; avoided in intestinal obstruction and perforation
101
Dopamine D2 receptor antagonists interactions?
Antipsychotics extra-pyramidal increases; not with dopaminergic agents; not with drugs increasing QT interval; not with CYP450 inhibitors
102
Dopamine D2 receptor antagonists dose?
10mg 8-hrly either IM (over 3mins) or IV
103
Histamine H1-receptor antagonists types?
Cyclizine, cinnarizine, promethazine
104
Histamine H1-receptor antagonists indications?
N+V, motion sickness, vertigo
105
Histamine H1-receptor antagonists SEs?
Drowsiness (cyclizine least likely to), dry throat, tachy, palps
106
Histamine H1-receptor antagonists warnings?
Hepatic encephalopathy and those susceptible to anticholinergic SEs (prostatic enlargement)
107
Histamine H1-receptor antagonists interactions?
Other sedative drugs; ipratropium and tiotropium increase anticholinergic effects
108
Histamine H1-receptor antagonists dose?
Cyclizine = 50mg 8 hourly (IV, IM, oral); slow IV (2 hours)
109
Serotonin 5-HT3-receptor antagonists types?
Ondansetron, granisetron
110
Serotonin 5-HT3-receptor antagonists SEs?
Rare but sometimes diarrhoea, headaches, constipation
111
Serotonin 5-HT3-receptor antagonists warnings?
Small risk of QT prolongation
112
Serotonin 5-HT3-receptor antagonists interactions?
Avoid drugs QT prolongation
113
Serotonin 5-HT3-receptor antagonists dose?
Ondansetron = 4-8mg 12hourly orally/IV
114
Antifungal types?
Nystatin, clotrimazole, fluconazole
115
Antifungal SEs?
Local irritation; fluconazole = oral so systemic (GI upset, headache, hepatitis, hypersensitivity), rare = hepatotoxicity, long QT, arrhythmia, anaphylaxis, peripheral neuropathy and hypersensitivity
116
Antifungal warnings?
Fluconazole = liver disease, renal impairment, pregnancy
117
Antifungal interactions?
Fluconazole CYP450 inhibitor so don't give with meds metabolised by it or long QT drugs
118
Antifungal dose?
See BNF
119
H1 receptor antagonists (antihistamines) types?
Cetirizine, loratadine, fexofenadine, chlorphenamine
120
H1 receptor antagonists (antihistamines) indications?
First-line for allergies, pruritus, urticaria, N+V, adjunct to adrenaline for anaphylaxis
121
H1 receptor antagonists (antihistamines) SEs?
Sedation
122
H1 receptor antagonists (antihistamines) warnings?
Sedating avoided in liver disease (hepatic encephalopathy), pregnancy and breastfeeding
123
H1 receptor antagonists (antihistamines) dose?
Cetirizine = 10mg, loratadine (10mg), chlorphenamine (4mg and 2mg/5ml solution) every 4-6 hours; anaphylaxis = chlorphenamine (10mg IV/IM)
124
Antimotility drugs types?
Loperamide, codeine phosphate
125
Antimotility drug indications?
Diarrhoea usually for IBS or gastroenteritis
126
Antimotility drug SEs?
Codeine = opioid toxicity and dependance
127
Antimotility drugs warnings?
Don't use in acute UC, C.difficile, acute bloody diarrhoea
128
Antimotility drug dose?
Loperamide = 4mg and 2mg with each loose stool to a max 8mg per day
129
Antimuscarinic and bronchodilator types?
Ipratropium, tiotropium, glycopyrronium, aclidinium
130
Antimuscarinic and bronchodilator indicators?
COPD, asthma
131
Antimuscarinic and bronchodilator SEs?
Resp tract irritation; GI disturbance, urinary retention, blurred vision, headaches (lower risk for inhaled)
132
Antimuscarinic and bronchodilator warnings?
Angle-closure glaucoma, arrhythmias, urinary retention
133
Antimuscarinic and bronchodilator dose?
Short-acting anti-muscarinics = QDS PRN; ipratropium = 40ug for stable and 250-500ug 6hrly for attack
134
Antimuscarinic for CVD and gastro types?
Atropine, hyoscine butylbromide, glycopyrronium
135
Antimuscarinic for CVD and gastro indications?
Atropine = first line for severe brady; hyoscine = for IBS and antispasmodic, reduce resp secretions in palliation
136
Antimuscarinic for CVD and gastro SEs?
Tachy, dry mouth, constipation, urinary retention, blurred vision, confusion, drowsiness (parasympathetic)
137
Antimuscarinic for CVD and gastro warnings?
In angle closure glaucoma, bladder outflow obstruction, prostatic hyperplasia and arrhythmias
138
Antimuscarinics for GU types?
Oxybutynin, tolterodine, solifenacin
139
Antimuscarinics for GU indications?
Overactive bladder (urge/frequency) after bladder training
140
Antimuscarinics for GU warnings?
UTI, elderly, dementia, angle closure glaucoma, arrhythmias, urinary retention
141
Antipsychotics typical types?
Haloperidol, chlorpromazine, prochlorperazine
142
Antipsychotics typical indications?
Psychomotor agitation, schizophrenia, bipolar, N+V in palliation
143
Antipsychotics typical SEs?
Extrapyramidal (dystonia, akathisia, neuroleptic malignant syndrome, tardive dyskinesia, drowsiness, QT prolongation, ED, hyperprolactinaemia
144
Antipsychotics typical warnings?
Elderly, dementia, PD, epilepsy
145
Antipsychotics atypical types?
Quetiapine, olanzapine, risperidone, clozapine
146
Antipsychotics atypical indications?
Same as typical other than N+V
147
Antipsychotics atypical SEs?
Sedation, extrapyramidal SEs (less than typical), metabolic disturbance, arrhythmias, QT prolongation, sexual dysfunction, clozapine = agranulocytosis
148
Antipsychotics atypical warnings?
CVD, neutropenia
149
Types of antiviral?
Aciclovir, famciclovir, valaciclovir
150
Antiviral indicators?
Acute herpesvirus (cold sores, genital ulcers, encephalitis, chickenpox), suppression of recurrent herpes simplex
151
Antiviral SEs?
Headache, GI disturbance, dizziness, skin rash, phlebitis, neurotoxicity
152
Antiviral warnings?
Caution in pregnancy and breastfeeding, severe renal impairment and theophylline
153
Types of antiplatelet drugs and ADP receptor antagonists?
Clopidogrel, ticagrelor, prasugrel
154
Indications antiplatelet drugs and ADP receptor antagonists?
Treatment of ACS with aspirin to prevent thrombosis, prevent occlusion of coronary artery stents, prevention of secondary thrombotic events in those with CVD/peripheral artery disease
155
Antiplatelet drugs and ADP receptor antagonists SEs?
Bleeding, GI upset, thrombocytopenia
156
Antiplatelet drugs and ADP receptor antagonists warnings?
Caution in renal and hepatic failure, none if signficant bleeding, stop 7 days before elective surgery; avoid in pregnancy
157
Antiplatelet drugs and ADP receptor antagonists interactions?
Efficacy of clopidogrel reduced by CYP450 inhibitors (omeprazole, cipro, erythromycin, SSRIs and some antivirals); for gastric protection use lansoprazole or pantoprazole; ticagrelor can interact with CYP inhibitors or inducers but not a prodrug; anything that increases bleeding risk
158
Indications aspirin (antiplatelet)?
ACS and ischaemic stroke treatment or secondary prevention thrombosis after CVD, cerebro, peripheral artery disease
159
SEs aspirin?
Bleeding, GI irritation, bronchospasm, tinnitus
160
Warnings aspirin?
Under 16yrs (Reye's syndrome), hypersensitivity, third trimester pregnancy, gout, peptic ulcers
161
Dose aspirin?
For ACS = 300mg loading dose then 75mg daily, ischaemic stroke = 300mg OD 2wks, longterm = 75mg daily, pain = max 4g daily
162
Azathioprine indications?
Crohn's and UC, DMARD for rheumatoid arthritis and other AIs not working with steroids, prevent organ rejection
163
Azathioprine SEs?
Bone marrow suppression, nausea, hypersensitivity, hepatotoxicity, lymphoma, veno-occulsive disease
164
Azathioprine warnings?
Reduced/no TPMT activity (how to break it down - give mercaptopurine instead), hepatic/renal impairment, pregnancy, hypersensitivity reactions
165
Azathioprine interactions?
Careful with steroids, don't use with allopurinol as reduces metabolism, not with trimethoprim or aminosalicylates
166
Types of beta blockers?
Bisoprolol, atenolol, propanolol (non-cardio-selective), metoprolol, carvediol (non-cardioselective)
167
Beta blocker indications?
IHD, chronic HF, AF, SVT, HT (3rd line), angina, MI, hyperthyroidism, migraine prophylaxis
168
Beta blocker SEs?
Fatigue, cold extremities, headache, GI disturbance, sleep disturbance, impotence in men
169
Beta blocker warnings?
Asthma, haemodynamic instability, heart block, hepatic failure
170
Beta blocker interactions?
Verapamil or diltiazem, other antihypertensives, clonidine, alcohol
171
Types of B2 agonists?
Salbutamol, terbutaline, salmeterol, formoterol, indacaterol
172
B2 agonist indications?
Asthma, COPD, hyperkalaemia (with insulin, glucose and calcium gluconate)
173
B2 agonist SEs?
Tachy, palps, anxiety, tremor, higher glucose and lactate; long acting = muscle cramps; arrhythmias, MI, hypokalaemia, lactic acidosis
174
B2 agonist warnings?
LABAs = more asthma deaths if without steroids; careful if CVD; monitor K+ if with theophylline and steroids (hypo); beta blockers reduce efficacy; careful in DM and hyperthyroidism
175
Types of benzos?
Diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
176
Benzo indications?
Seizures/status epilepticus, alcohol withdrawal, sedation for procedure if anaesthesia no, severe anxiety/insomnia
177
Benzo SEs?
Drowsiness, sedation, coma, dependance, withdrawal, airway obstruction, death
178
Benzos warnings?
Elderly, resp disease, neuromuscular disease and hepatic failure; alcohol and opioids
179
Benzos interactions?
Don't use with CYP inhibitors, lorazepam, antihypertensives
180
Bisphosphonate types?
Alendronic acid, disodium pamidronate, zoledronic acid
181
Bisphosphonate indications?
Osteoperotic fxs, severe hypercalcaemia of malignancy, myeloma and breast cancer mets, Paget's disease
182
Bisphosphonate SEs?
Oesophagitis, hypophosphataemia, atypical stress fx
183
Bisphosphonate warnings?
Severe renal impairment, hypocalcaemia, smokers and dental disease for osteonecrosis risk
184
Bisphosphonate interactions?
They bind calcium so absorption reduced with calcium salts, antacids and iron salts; take 30 mins before breakfast and stay sitting/standing for 30 mins
185
Calcium and vit D types?
Calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
186
Calcium and vit D indications?
Osteoporosis when lifestyle not enough, CKD, secondary hyperparathyroidism, renal osteodystrophy, severe hyperkalaemia, symptomatic hypocalcaemia, vit D low
187
Calcium and vit D SEs?
Dyspepsia, constipation, CV collapse if given too fast IV
188
Calcium interactions?
Reduces absorption = iron, bisphosphonates, tetracyclines, levothyroxine
189
CCB types?
Amlodipine, nifedipine, diltiazem, verapamil, felodipine, lercanidipine
190
CCB indications?
Amlodipine/nifedipine for 1st/2nd line for HT, symptom control in stable angina, SVT = diltiazem/verapamil
191
CCB SEs?
Ankle swelling, flushing, headache, palps; dilt and vera = constipation, brady, heart block, cardiac failure
192
CCB warnings?
Vera and dilt = poor left ventricle, AV nodal conduction delay; amlodipine/nifedipine = unstable angina and severe aortic stenosis
193
CCB interactions?
B blockers as too much brady/heartblock
194
Carbamazepine indications?
Seizure prophylaxis in epilepsy (not absence or myoclonic) and first line in trigeminal neuralgia; prophyalxis of bipolar
195
Carbamazepine SEs?
GI upset, neuro effects, hypersensitivity (Steven Johnson syndrome), oedema, hyponatraemia, ataxia, cardiac conduction disturbances, bone marrow failure
196
Carbamazepine warnings?
Pregnancy (give folic acid and discuss with specialist), hepatic/renal/cardiac disease = caution; if susceptible to acute angle glaucoma
197
Carbamazepine interactions?
Induces cyp450 (reduces efficacy of drugs metabolised by this) = warfarin, oestrogens, progestrogens; any drugs reducing seizure threshold and other anti-epileptics
198
Cephalosporin and carbapenem types?
Cefalexin, cefotaxime, meropenem, ertapenem
199
Cephalosporin and carbapenem indications?
Second and third line UTIs and RTIs; parenteral for severe and resistant infections
200
Cephalosporin and carbapenem SEs?
GI upset, abx associated colitis, hypersensitivity (steven johnson syndrome and toxic epidermal necrolysis), neurotoxicity, seizures
201
Cephalosporin and carbapenem warnings?
At risk of C diff, hx of allergy/anaphylaxis, caution in epilepsy and renal failure
202
Cephalosporin and carbapenem interactions?
Cephalosporin and carbapenem = warfarin, aminoglycosides and valproate, COCP reduced efficacy
203
Chloramphenicol indications?
Bacterial conjunctivitis; otitis externa
204
Chloramphenicol SEs?
Stinging, burning, itching, bone marrow suppression, aplastic anaemia
205
Chloramphenicol warnings?
Hypersensitivity, bone marrow disorder, third trimester, breastfeeding and <2yrs, hepatic impairment
206
Types of inhaled corticosteroids?
Beclometasone, budesonide, fluticasone
207
Inhaled corticosteroids indications?
Asthma, COPD
208
Inhaled corticosteroids SEs?
Oral candidiasis, hoarse voice and sometimes pneumonia
209
Inhaled corticosteroids warnings?
Pneumonia hx and children
210
Systemic corticosteroids types?
Prednisolone, hydrocortisone, dexamethasone
211
Systemic corticosteroids indications?
Allergic/inflammatory disorders, AI, cancer chemo, HRT in adrenal insufficiency and hypopituitarism
212
Systemic corticosteroids SEs?
Immunosuppression, metabolic effects, muscle thinning and skin wasting, bruising, mood and behaviour changes, adrenal atrophy = longterm (if withdrawn suddenly = addisonian crisis), fatigue, weight loss, arthralgia
213
Systemic corticosteroids warnings?
Children, infections and infections
214
Systemic corticosteroids interactions?
Risk of peptic ulceration with NSAIDs; hypokalaemia in B2 agonists/theophylline,/diuretics; efficacy reduced by CYP450 inducers, warfarin, live vaccines
215
Topical corticosteroid types?
Hydrocortisone, betamethasone
216
Topical corticosteroid indications?
Inflammatory skin conditions (eczema)
217
Topical corticosteroid SEs?
Uncommon, skin thinning etc
218
Topical corticosteroid warnings?
Infection and facial lesions
219
Digoxin indications?
AF and flutter (after B blocker or dilt/vera); severe HF (3rd line); ventricular rate control in supraventricular arrhythmias
220
Digoxin SEs/overdose?
Brady GI disturbance, rash, dizziness, visual disturbance
221
Digoxin warnings?
CI in heart block, ventricular arrhythmias; increased risk of toxicity = hypokalaemia, hypomagnesaemia, hypercalcaemia (also amiodarone, CCBs, spironolactone, quinine), thyroid disease, WPW, myocarditis, pericarditis, severe resp disease
222
Dipeptidylpeptidase-4 inhibitor types?
Sitagliptin, linagliptin, saxagliptin
223
Dipeptidylpeptidase-4 inhibitor indications?
T2DM (in combo with metformin or if metformin CI)
224
Dipeptidylpeptidase-4 inhibitor SEs?
Usually well tolerated; GI upset, headache, nasopharyngitis, peripheral oedema; hypos, pancreatitis, hepatotoxicity
225
Dipeptidylpeptidase-4 inhibitor warnings?
T1DM, ketoacidosis, pregnancy, breastfeeding
226
DOAC types (factor Xa inhibitors)?
Rivaroxaban, apixaban, dabigatran, edoxaban
227
DOAC indications?
VTE, AF
228
DOAC SEs?
Bleeding, anaemia, GI upset, dizziness, elevated liver enzymes
229
DOAC warnings?
Bleeding, hepatic/renal disease, pregnancy/breastfeeding
230
DOAC interactions?
Antithrombotic agents, CYP inducers/inhibitors; increased anticoag from macrolides, protease inhibitors, fluconazole; decreased from rifampicin and phenytoin
231
Loop diuretic types?
Furosemide and butemanide and torasemide
232
Loop diuretic indications?
Acute pulmonary oedema (with O2 and nitrates), fluid overload in CHF/other states, resistant hypertension
233
Loop diuretic SEs?
Dehydration and hypotension; any low electrolyte state as increases their excretion; hearing loss and tinnitus, nephrotoxicity
234
Loop diuretic warnings?
Severe hypovolaemia, dehydration; use with care in hepatic encephalopathy, hypokalaemia/natraemia, gout worsened
235
Loop diuretic interactions?
Lithium levels elevated, digoxin/aminoglycoside toxicity increased risk, antihypertensives and diuretics, NSAIDs for renal reasons
236
Thiazide diuretic types?
Bendroflumethiazide, indapamide, chlortalidone, hydrochlorothiazide, metolazone
237
Thiazide indications?
Alternative first line for HT where CCB not appropriate, add-on for HT treatment, oedema in mild-moderate HF
238
Thiazide SEs?
Hyponatraemia, hypokalaemia, cardiac arrhythmias, impotence, hypercalcaemia, hyperglycaemia, postural hypotension, hypomagnesaemia
239
Thiazide warnings?
Gout, low K+/Na+
240
Thiazide interactions and CIs?
Things lowering K+/Na+, NSAIDs, impotence, blood disorders, renal impairment, Addison's
241
Dopaminergic drugs?
Levodopa, ropinirole, pramipexol
242
Dopaminergic indications?
Early PD (dopamine agonists preferred over levadopa); later PD = levadopa; secondary parkinsonism
243
Dopaminergic SEs?
Nausea, drowsiness, confusion, hallucinations, hypotension; too much = dyskinesias; wearing off effect towards end of dose = sxs worsen; schizophrenic and huntington's effects
244
Dopaminergic warnings?
Elderly, psych disease, CVD use with care; breastfeeding
245
Dopaminergic interactions?
Don't give with typical antipsychotic or metoclopramide as opposing effects; give levodopa with decarboxylase inhibitor (carbidopa); MAOIs and antihypertensives
246
Emollients types?
Aqueous cream, liquid paraffin
247
Emollients indications?
Dry/scaling skin disorders; eczema and psoriasis
248
Emollients SEs?
Greasiness and can exacerbate acne
249
Fibrinolytic types?
Alteplase and streptokinase
250
Fibrinolytic indications
Acute ischaemic stroke within 4.5 hours; acute ST elevation MI within 12 hours (usually PCI now tho); massive PE with haemodynamic instability
251
Fibrinolytic SEs?
N+V, bruising, hypotension, serious bleeding, cardiogenic shock, cardiac arrest
252
Fibrinolytic warnings?
Recent bleed/surgery; intracranial haemorrhage; previous streptokinase treatment
253
Gabapentin and pregabalin indications?
Add-ons for focal epilepsy or other epileptic drugs fail; neuropathic pain; GAD
254
Gabapentin and pregabalin SEs?
Drowsiness, dizziness, ataxia, ach symptoms, HT, leucopenia
255
Gabapentin and pregabalin warnings?
Reduced dose in renal impairment, DM, elderly, severe CHF, pregnancy, breastfeeding, hx of psychosis
256
H2 receptor antagonist type?
Ranitidine, cimetidine, famotidine, nizatidine
257
H2 receptor antagonist indications?
Peptic ulcer disease (PPIs preferred), GORD and dyspepsia
258
H2 receptor antagonist SEs?
Not many; bowel disturbance, headache, dizziness
259
H2 receptor antagonist warnings?
Reduced in renal impairment; investigate cause as can mask sxs cancer; cimetidine gives gynaecomastia and impotence and is a CYP450 inhibitor
260
Heparins and fondaparinux types?
Enoxaparin, dalteparin, fondaparinux, unfractionated heparin
261
Heparins and fondaparinux indications?
Prevention DVT, PE, VTE; treatment for VTE until oral coag established; ACS
262
Heparins and fondaparinux SEs?
Haemorrhage (protamine sulphate is direct antidote), occasionally hyperkalaemia, sometimes heparin-induced thrombocytopenia
263
Heparins and fondaparinux warnings?
Clotting disorders, severe uncontrolled HT, recent surgery/trauma; caution in renal/hepatic failure
264
Heparins and fondaparinux reversal?
Protamine; andexanet for LMWH and fondaparinux
265
Insulin names?
Insulin aspart, insulin glargine, biphasic insulin, soluble insulin
266
Insulin indications?
T1DM, T2DM if poor control, diabetic emergency, hyperkalaemia with glucose
267
Insulin SEs?
Hypoglycaemia and lipohypertrophy
268
Insulin warnings?
If renal failure more likely to have hypo
269
Insulin interactions?
Need more if on steroids; also beta blockers enhance effect
270
Iron types?
Ferrous fumarate, ferrous sulfate
271
Iron indications?
Iron-deficiency anaemia (treatment and prophylaxis with high RFs)
272
Iron SEs?
GI upset (nausea, epigastric pain, constipation, diarrhoea), black stools
273
Iron warnings?
Can upset intestinal disease bowel movements more; use IV with care in anaphyactics
274
Iron interactions?
Reduce absorption of levothyroxine and bisphosphonates
275
Lamotrigine indications?
First line prophylaxis for epilepsy (simple and partial seizures); bipolar depression only
276
Lamotrigine SEs?
Headache, drowsiness, irritability, blurred vision, dizziness, GI; can get skin rash due to hypersensitivity reaction that needs immediate treatment (SJS and toxic epidermal necrolysis); BM failure
277
Lamotrigine warnings?
Avoided in pts with hypersensitivity to other drugs, dose reduction in hepatic and renal impairment
278
Lamotrigine interactions?
Reduced effect from higher glucuronidation: carbamazepine, phenytoin, oestrogens, rifampicin, protease inhibitors; toxicity risk: valproate; TCAs, SSRIs, MAOIs, St John's Wort
279
Osmotic laxative types?
Lactulose, macrogol, phosphate enema
280
Osmotic laxative indications?
Constipation/faecal impaction, bowel prep before procedure, hepatic encephalopathy
281
Osmotic laxative SEs?
Wind, abdo cramps, nausea, diarrhoea, electrolyte disturbance
282
Osmotic laxative warnings?
Intestinal obstruction; used with caution in HF, ascites, electrolyte disturbances
283
Stimulant laxative types?
Senna, bisacodyl, glycerol suppositories, docusate sodium
284
Stimulant laxative indications?
Constipation and faecal impaction
285
Stimulant laxative warnings?
Intestinal obstruction; caution in rectal prep for haemorrhoids/anal fissures
286
Leukotriene receptor antagonist type?
Montelukast
287
Leukotriene receptor antagonist indications?
Adults = add on for asthma (with LABA and steroids); 5-12yrs = add on for asthma (instead of LABA with steroid); under 5 = first line for asthma prevention not able to take steroids
288
Leukotriene receptor antagonist SEs?
Headache, abdo pain; unlikely = RTIs, chrug strauss syndrome (rare), hypersensivity, seizures, depression, agranulocytosis
289
Levetiracetam indications?
Seizure prophylaxis in epilepsy; some cases of status epilepticus if benzo not worked
290
Levetiracetam SEs?
Not common = drowsiness, weakness, dizziness, headache
291
Levetiracetam warnings?
Dose reduction in renal and hepatic impairment; breastfeeding and pregnancy; antidepressants
292
Lidocaine indications?
Local anaesthetic; sometimes antiarrhythmic for VT and VF
293
Lidocaine SEs?
Stinging; not usual but drowsiness, restlessness, tremor, fits
294
Lidocaine interactions?
Effects prolonged by adrenaline (vasoconstrictor)
295
Macrolide types?
Clarithromycin, erythromycin, azithromycin
296
Macrolide indications?
Infections where penicillin CI, severe penumonia add-on to penicillin, for H.pylori with PPI and amoxicillin/metronidazole
297
Macrolide SEs?
Irritant, N+V, abdo pain, diarrhoea, thrombophlebitis if IV; others = cholestatic jaundice, long QT, ototoxicity, abx-associated colitis, hepatoxicity, SJS and toxic epidermal necrolysis
298
Macrolide warnings?
Caution in renal/hepatic impairment; they are CYP inhibitors; anything prolonging QT
299
Metformin indications?
T2DM (>25 BMI and <25 if not working alone on sulphonylureas)
300
Metformin SEs?
GI upset and rarely lactic acidosis if AKI
301
Metformin warnings?
Not for: AKI, severe tissue hypoxia; caution: renal/hepatic impairment (contrast), drunk, chronic alcohol abuse
302
Metformin interactions?
Anything that impairs renal function use with caution (MAOI and ACEi)
303
Methotrexate indications?
DMARD for RA, chemo (leukaemia/lymphoma), severe resistant psoriasis, Crohn's
304
Methotrexate SEs?
Mucosal damage, bone marrow suppression; longterm = hepatic cirrhosis or pulmonary fibrosis or pericarditis; N+V, alopecia, stomatitis
305
Methotrexate warnings?
None: pregnancy, severe renal impairment; caution in hepatic impairment
306
Methotrexate interactions?
Toxicity increased by: inhibit renal excretion (NSAIDs and penicillins), folate antagonists (trimethoprim and phenytoin), live vaccines and clozapine
307
Metronidazole indications?
Abx colitis, oral infections, aspiration pneumonia, surgical/gynae infections, protozoal infx; anaerobic infections
308
Metronidazole SEs?
GI upset; high dose/long time = seizures, encephalopathy, hepatitis, pancreatitis, peripheral and optic neuropathy
309
Metronidazole warnings?
Don't have with alcohol and reduce in severe hepatic impairment; pregnancy and breastfeeding
310
Metronidazole interactions?
Cyp inhibitor, clozapine, alcohol
311
Naloxone indications?
Treatment opioid toxicity
312
Naloxone SEs?
Opioid withdrawal (pain, restlessness, N+V, dilated pupils, piloerection)
313
Naloxone warnings?
Careful in palliative care as could be more preferable to allow OD
314
Nicotine replacement and related drug types?
Nicotine, varenicline, bupropion
315
Nicotine replacement and related drug indications?
Smoking cessation
316
Nicotine replacement and related drug SEs?
Local irritation, GI upset, palps; varenicline = nausea, headaches, insomnia, abnormal dreams; bupropion = dry mouth, GI upset, neuro and psych sxs
317
Varenicline mechanism?
Partial agonist of nicotinic receptor so less withdrawal and rewarding sxs smoking
318
Bupropion mechanism?
Increased conc noradrenaline and dopamine in synapse
319
Nicotine replacement and related drug warnings?
Haemodynamically unstable, risk of seizures, psych disease, renal/hepatic impairment
320
Nitrates types?
Isosorbide mononitrate (long acting), glyceryl trinitrate (short acting)
321
Nitrate indications?
Short acting = angina, ACS; long acting = prophylaxis angina 3rd line; pulmonary oedema with furosemide and oxygen
322
Nitrate SEs?
Flushing, headaches, dizziness, hypotension; tolerance
323
Nitrate warnings?
CI: severe aortic stenosis, haemodynamic instability, hypotension
324
Nitrate interactions?
Caution with antihypertensives and never with sildenafil
325
Nitrofurantoin indications?
First choice UTI and also for prophylaxis of recurrent
326
Nitrofurantoin SEs?
GI upset, urine yellow/brown, peripheral neuropathy, pulmonary fibrosis, hypersensitivity reactions, haemolytic anaemia
327
Nitrofurantoin warnings?
CI: pregnant women, less than 3months, renal impairment
328
NSAID types?
Naproxen, ibuprofen, etoricoxib
329
NSAID indications?
Mild to moderate pain; pain related inflammation
330
NSAID SEs?
GI toxicity, renal impairment, CVD events, bronchospasm
331
NSAID warnings?
CI: severe renal impairment, HF, liver failure, hypersensitivity; warnings: peptic ulcer disease, GI bleed, CVD, renal impairment, asthma
332
NSAID interactions?
Peptic ulcers = aspirin, steroids; GI bleeds = anticoag, SSRIs; renal impairment = ACEi, diuretics; lithium, antidepressants
333
Ocular lube types?
Hypromellose, carbomers, liquid and white soft paraffin
334
Ocular lube indications?
Dry eye conditions (keratoconjunctivitis sicca and Sjogrens)
335
Oestrogens and progestrogen types?
Combined ethinylestradiol products, desogestrel
336
Oestrogens and progestrogen indications?
HRT for early menopause and menopausal sxs; hormonal contraception
337
Oestrogens and progestrogen SEs?
Irregular bleeds, mood changes; oestrogen = higher risk VTE/CVD/stroke/breast and cervical cancer
338
Oestrogens and progestrogen warnings?
CI: breast cancer; caution in VTE risk and CVD disease and migraines with aura
339
Oestrogens and progestrogen interactions?
Lamotrigine efficacy reduced; cyp450 inducers reduce its efficacy
340
Strong opioid types?
Morphine and oxycodone
341
Strong opioid indications?
Acute severe pain, chronic pain relief last line, SOB relief in palliation, SOB in pulmonary oedema with O2, furosemide and nitrates
342
Strong opioid SEs?
Resp depression, euphoria, neuro depression, N+V, pupillary constriction, biliary/ureteric spasm, dysphoria, sweating, constipation, itching, tolerance, dependence and withdrawal
343
Strong opioid warnings?
Hepatic/renal failure, elderly, resp failure, biliary colic, prostatic hypertrophy, IBD, convulsive disorders, pregnancy, raised ICP
344
Weak/moderate opioid types?
Tramadol, codeine, dihydrocodeine
345
Weak/moderate opioid indications?
Mild-moderate pain, diarrhoea and cough suppression
346
Weak/moderate opioid SEs?
Same as strong
347
Weak/moderate opioid interactions?
Sedating drugs, drugs lowering seizure threshold, serotonergic drugs (serotonin syndrome)
348
Oxygen indications?
Acute hypoxaemia, accelerate reabsorption of pleural gas in pneumothorax, CO poisoning
349
Oxygen SEs?
Mask discomfort, dry throat
350
Oxygen warnings?
T2 resp failure = resp acidosis and tissue hypoxia
351
Paracetamol indications?
Acute and chronic pain; antipyretic
352
Paracetamol SEs?
Liver failure in OD; rare = blood disorders (thrombocytopenia, leucopenia, neutropenia)
353
Paracetamol interactions?
CYP inducers = risk of OD; chronic alcohol
354
Penicillin types?
Benzylpenicillin and phenoxymethylpenicillin
355
Penicillin indications?
Strep infections (tonsillitis, pneumonia, endocarditis, skin and soft tissue infx); meningooccal infx; clostridial infx
356
Penicillin SEs?
Allergy (rash and sometimes hypersensitivity); neuro toxicity at high doses
357
Penicillin interactions?
Reduce renal excretion methotrexate
358
Antipseudomonal penicillin types?
Piperacillin with tazobactam (tazocin)
359
Antipseudomonal penicillin indications?
Severe infections where broad spectrum bacteria involved, immunocompromised; LRTI/UTI/intraabdo sepsis/skin and soft tissue infx
360
Antipseudomonal penicillin SEs?
GI upset, abx associated colitis
361
Antipseudomonal penicillin warnings?
Caution = C diff risk, renal impairment
362
Broad spectrum abx types?
Amoxicillin, co-amoxiclav
363
Broad spectrum abx indications?
Amoxicillin = uncomplicated pneumonia, otitis media, sinusitis, UTI, H. pylori; co-amoxiclav = severe, resistant HAP
364
Broad spectrum abx SEs?
Same as other penicillins
365
Penicillinase-resistant penicillin types?
Flucloxacillin
366
Penicillinase-resistant penicillin indications?
Staph infection; cellulitis, osteomyelitis, septic arthritis, endocarditis
367
Phosphodiesterase type 5 inhibitor types?
Sildenafil
368
Phosphodiesterase type 5 inhibitor indications?
ED, primary pulmonary HT
369
Phosphodiesterase type 5 inhibitor SEs?
Flushing, dizziness, headache, nasal congestion, hypotension, tachy, palps, CVD events, priapism, visual disorders
370
Phosphodiesterase type 5 inhibitor warnings?
CI = stroke, ACS, CVD, nitrates, nicorandil; caution = hepatic/renal impairment, CYP inhibitors, vasodilators
371
Prostaglandin analogue eye drop types?
Latanoprost and bimatoprost
372
Prostaglandin analogue eye drop indications?
Open angle glaucoma and ocular HT
373
Prostaglandin analogue eye drop SEs?
Blurred vision, conjunctival reddening (hyperaemia), occular irritation, pain
374
PPI types?
Omeprazole, lansoprazole, pantoprazole
375
PPI indications?
Prevention and treatment of peptic ulcer disease, dyspepsia, GORD, H. pylori, Zollinger-Ellison syndrome
376
PPI SEs?
GI disturbance, headache, hypomagnesaemia if prolonged use
377
PPI warnings?
Caution in pts at risk osteoporosis, pregnancy and breastfeeding
378
PPI interactions?
Reduce effect of clopidogrel of omeprazole
379
Type of quinine?
Quinine sulfate
380
Quinine indications?
Night time leg cramps, malaria
381
Quinine SEs?
Toxic in OD, tinnitus, deafness, blindness, GI upset, prolongs QT, hypoglycaemia
382
Quinine warnings?
Caution = hearing/visual impairment, not in first trimester, G6PD
383
Quinolone types?
Ciprofloxacin, moxifloxacin, levofloxacin
384
Quinolone indications?
UTI, severe gastroenteritis, LRTI; 2nd/3rd line treatment; gram -ve and +ve
385
Quinolone SEs?
GI upset, neuro effects, damage to tendons, prolong QT, c diff colitis, headache
386
Quinolone warnings?
Caution: at risk of seizures, children, psych illness, pregnancy, G6PD deficiency
387
Quinolone interactions?
Can be a cyp inhibitor = theophylline toxicity; NSAIDs = risk of seizures; prednisolone = tendon rupture
388
Serotonin 5-HT1-receptor antagonist types?
Sumatriptan
389
Serotonin 5-HT1-receptor antagonist indications?
Acute migraine
390
Serotonin 5-HT1-receptor antagonist SEs?
Pain in chest/throat, N+V, fatigue, dizziness, HT; rare = MI
391
Serotonin 5-HT1-receptor antagonist warnings?
CI = coronary artery disease, cerebrovascular disease, hemiplegic/basilar migraines
392
Serotonin 5-HT1-receptor antagonist interactions?
Increase risk of serotonin toxicity
393
Sex hormone antagonists for breast cancer types?
Tamoxifen, anastrozole, letrozole
394
Sex hormone antagonists for breast cancer indications?
ER positive; aromatase inhibitors in post-menopausal women only
395
Sex hormone antagonists for breast cancer SEs?
Vaginal dryness, hot flushes, osteoporosis, VTE, endometrial cancer, GI upset
396
Sex hormone antagonists for breast cancer warnings?
CI = pregnancy, lactation
397
Sex hormone antagonists for breast cancer interactions?
Inhibits cyp so don't use with = warfarin, fluoxetine, paroxetine; aromatase inhibitors no interactions
398
Statin types?
Simvastatin, atorvastatin, prevastatin, rosuvastatin
399
Statin indications?
Primary/secondary prevention CVD events, primary hyperlipidaemia
400
Statin SEs?
Headache, GI disturbance, myalgia, myopathy and sometimes rhabdomylolysis; rise in liver enzymes
401
Statin warnings?
Caution: renal/hepatic impairment, pregnancy and breastfeeding
402
Statin interactions?
Metabolism reduced by cyp inhibitors
403
Sulphonylurea types?
Gliclazide, glipizide, tolbutamide, glibenclamide
404
Sulphonylurea indications?
T2DM 2nd line/adjuvant to metformin
405
Sulphonylurea SEs?
GI upset, hypos, weight gain, hyponatremia, hepatotoxic, hypersensitivity, careful in renal impairment and ketoacidosis
406
Drugs elevating blood glucose?
Prednisolone, thiazide, loop diuretics
407
Tetracycline types?
Doxycycline, lymecycline
408
Tetracycline indications?
Acne, LRTI, pneumonia and atypical, PID, chylamydial infection, typhoid, anthrax, malaria, lyme disease
409
Tetracycline SEs?
N+V, diarrhoea, oesophageal irritation, photosensitivity, hypoplasia tooth enamel in kids, hepatotoxicity
410
Tetracycline warnings?
CI = pregnancy, breastfeeding, under 12s, hepatic impairment
411
Tetracycline interactions?
Not given with 2 hours of calcium/antacids/iron as stops absorption; enhances warfarin; ciclosporin, retinoids (increased risk ICP)
412
Thyroid hormone types?
Levothyroxine, liothryonine
413
Thyroid hormone indications?
Hypothyroidism
414
Thyroid hormone SEs?
OD = GI upset (diarrhoea, N+V), cardiac (arrhythmias, tachy, angina), neuro (tremor, insomnia)
415
Thyroid hormone warnings?
Caution in coronary artery disease and hypopituitarism (need steroid before so not addisonian crisis), DI, DM
416
Thyroid hormone interactions?
Absorption reduced by antacids/calcium/iron; higher dose needed if on cyp inducers; may need higher sugar intake for DM; enhances effects of warfarin
417
Trimethoprim types?
Also co-trimoxazole
418
Trimethoprim indications?
UTI and prophylaxis; also acne/RTI/prostatis/pneumocystitis pneumonia prophylaxis in immunosuppression
419
Trimethoprim SEs?
GI upset, skin rash, megaloblastic anaemia (folate inhibitor), hyperkalaemia; avoid in pregnancy, neonates and elderly
420
Sodium valproate/valproic acid indications?
Seizure prophylaxis in epilepsy, sometimes status epilepticus after benzo, manic episodes of bipolar
421
Sodium valproate/valproic acid SEs?
GI upset, neuro/psych effects (tremor, ataxia, behaviour), thrombocytopenia, elevated liver enzymes, pancreatitis
422
Sodium valproate/valproic acid warnings?
CI = child-bearing age, first trimester; hepatic/renal impairment, SLE
423
Sodium valproate/valproic acid interactions?
Risk of toxicity with lamotrigine; inhibits cyp450; is also metabolised by cyp
424
Vancomycin indications?
Treatment gram +ve infection and abx associated colitis, MRSA and C diff and endocarditis
425
Vancomycin SEs?
Thrombophlebitis, rapid = red man syndrome; IV = nephrotoxicity, ototoxicity, neutropenia
426
Vancomycin interactions?
Ototoxicity risk = aminoglycosides, loop diuretics, ciclosporin
427
Vitamin types?
Folic acid, thiamine, hydroxocobolamin, phytomenadione
428
Vitamin indications?
Thiamine = wernickes encephalopathy, korsakoffs; folic = megaloblastic anaemia, neural tube defects; hydroxocobolamin = megaloblastic anaemia, subacute degeneration of cord; phytomenadione (vit k) = reversal warfarin
429
Warfarin indications?
VTE, prevent embolism in AF or prosthetic heart valves, TIA
430
Warfarin warnings?
Liver disease and pregnancy; is metabolised by cyp, low therapeutic index
431
Z-drug types?
Zopiclone, zolpidem
432
Z-drug indications?
Short-term insomnia treatment
433
Z-drug SEs?
Fatigue, rebound insomnia after stopping, headache, confusion, nightmares; taste disturbance (zopiclone), GI upset (zolpidem); dependence, withdrawal, OD
434
Z-drug warnings?
CI = OSA, resp muscle weakness, resp depression; warning = elderly
435
Z-drug interactions?
Metabolised by cyp, enhance hypotensives
436
Colloid types?
Gelatins and albumin
437
Colloid indications?
To expand circulating vol in impaired tissue perfusion but after sodium lactate/chloride; albumin = cirrhotic liver disease to stop hypovolaemia in paracentesis
438
Colloid SEs?
Oedema, pulmonary oedema, hypersensitivity
439
Colloid warnings?
Caution = rapid infusion in HF and renal impairment (can cause oedema and vol overload)
440
What is compound sodium lactate?
Hartmann's solution
441
Hartmann's indications?
Sodium and water to pts unable to take oral; fluid challenger to expand circ vol in impaired tissue perfusion
442
Hartmann's SEs?
Oedema
443
Hartmann's warnings?
HF, renal impairment and liver caution
444
Glucose/dextrose infusion types?
Glucose 5%/10%/20%/50%
445
Dextrose indications?
5% for water as can't oral and diluting drugs; 10/20/50% for hypos and hyperkalaemia with calcium gluconate
446
Dextrose SEs?
50% = irritant to veins (pain/phlebitis/thrombosis); hyperglycaemia
447
Dextrose warnings?
If thiamine deficient then can get wernickes; caution = renal failure, hyponatraemia, children, brain injuries
448
Potassium chloride indications?
Prevention of potassium depletion; hypokalaemia
449
Potassium chloride SEs?
Hyperkalaemia and therefore arryhthmias; irritant to veins
450
Sodium chloride types?
0.9% and 0.45%
451
Sodium chloride indications?
Provide sodium and water unable to oral; expand circ vol in inadequate tissue perfusion; diluting drugs
452
Sodium chloride SEs?
Oedema, hypercloraemia leading to acidosis
453
Sodium chloride warnings?
HF and renal impairment
454
Drugs to stop before elective surgery (I LACK OP)?
Insulin, Lithium (day before), Anticoag/antiplatelets (variable and occasionally continued), COCP/HRT (4wks before surgery), K+-sparing diuretics and ACEi (day of surgery), Oral hypoglycaemics (variable), Perindopril and ACEi
455
PReSCRIBER mnemonic for writing prescriptions?
Patient details, Reaction (allergy plus reaction), Sign the front of the chart, Contraindications to each drug, Route for each drug, IV fluids given if necessary, Blood clot prophylaxis if necessary, antiEmetic if needed and pain Relief if needed
456
SEs of steroids?
mnemonic STEROIDS: Stomach ulcers, Thin skin, Oedema, Right and left HF, Osteoporosis, Infection, Diabetes and Cushing’s Syndrome
457
NSAID safety CIs?
NSAID: No urine (renal failure), Systolic dysfunction, Asthma, Indigestion and Dyscrasia (clotting abnormal)
458
Causes of hypokalaemia (DIRE)?
Drugs (loop and thiazide diuretics), Inadequate intake/intestinal loss (V and diarrhoea), Renal tubular acidosis, Endo (cushing’s/conn’s)
459
Causes of hyperkalaemia (DREAD)?
Drugs (potassium sparing diuretics and ACEi), Renal failure, Endo (addison’s), Artefact, DKA (when insulin given to treat it)
460
Causes of raised alkaline phosphate (ALKPHOS)?
Any fracture, Liver damage, K for kancer, Paget’s disease of the bone and pregnancy, Hyperparathyroidism, Osteomalacia and Surgery
461
What is the formula for volume of distribution?
total amount of drug in body divided by plasma-drug conc
462
Amounts of fluids and electrolytes needed to calculate maintenance fluids?
Fluid = 25-30ml/kg/day, Electrolytes (Na, K, Cl) = 1mmol/kg/day, glucose = 5-10g/day
463
Types of potassium channel activator?
Nicorandil
464
Nicorandil indications?
Long term treatment of chronic stable angina pectoris in patients with at least one of the
following risk factors: previous MI / previous CABG / confirmed coronary heart diease AND
LVH, LVdysfunction, diabetes mellitus, hypertension or peripheral vascular disease
465
Nicorandil SEs?
Flushing, dizziness, headache, tachycardia, nausea, rectal bleeding, weakness; skin/mucosal/eye ulceration, haemorrhage/fistula/abscess
466
Nicorandil CIs?
Caution in hypovolaemia and acute MI; avoid in hypotension, cardiogenic shock and LVF
467
Nicorandil interactions?
Sildenafil/tadalafil/vardenafil
468
Drug class of dipyridamole?
Antiplatelet
469
Dipyridamole indications?
VTE prophylaxis with warfarin in prosthetic heart valves; with aspirin for secondary prevention TIA and stroke
470
Dipyridamole SEs?
GI disturbance, haemorrhage, hypotension, worsening of coronary artery disease sxs
471
Dipyridamole CIs?
Angina, AS, recent MI, LV outflow obstruction, HF, coagulation disorders/drugs
472
Dipyridamole interactions?
Adenosine, antiplatelets, anticoags, fibrinolytics
473
Systemic nasal decongestants name?
Pseudoephedrine
474
Pseudoephedrine indications?
Nasal and sinus decongestant
475
Pseudoephedrine SEs?
Anxiety, headache, HT, insomnia, N+V, restlessness, tachy; hallucinations, angle-closure glaucoma, retention
476
Pseudoephedrine CIs?
DM, HT, hyperthyroidism, IHD, prostatic hypertrophy, risk of angle-closure glaucoma
477
Pseudoephedrine interactions?
Alpha blockers (less hypotensive effect), MAOIs (HT crisis)
478
Lithium drug class?
Mood stabiliser
479
Lithium indications?
Mania and bipolar
480
Lithium SEs?
GI upset, fine tremor, weight gain, hypothyroidism, hyperparathyroidism, hypercalcaemia
481
Lithium toxicity S+Ss?
Blurred vision, muscle weakness, drowsy, coarse tremor, slurred speech, ataxia, confusion, N+V, ECG changes
482
Lithium toxicity management?
Stop, check levels/serum creatinine/U+Es, refer to A+E, advice from psych for re-intiation
483
CIs lithium?
Elderly, psoriasis, myasthenia gravis, serious CVD, addison's, renal impairment, pregnancy, breastfeeding; reduce in diarrhoea, vomiting, infection
484
Lithium interactions?
Metronidazole, tetracyclines, co-trimoxazole, NSAIDs, ACEi, ARBs, diuretics, amiodarone; drugs decreasing lithium levels = xanthines, theophylline, aminophylline, caffeine, sodium salts, acetazolamide
485
Phenytoin indications?
All epilepsy other than absence seizures; status epilepticus
486
Phenytoin adverse effects?
PHENYTOIN - P450 interactions, hirsutism, enlarged gums, nystagmus, yellow-browning of skin, teratogenic, osteomalacia, interferes with folate metabolism, neuropathies
487
Phenytoin CIs?
Enteral feeding caution, Han Chinese/Thai, discontinue if leucopenia
488
Phenytoin interactions?
Is a CYP450 inducer - OCP = reduced contraceptive effect; reduced theophylline and phenytoin efficacy; reduced phenytoin with cimetidine; reduced phenytoin with amiodarone
489
Example of an NMDA receptor antagonist?
Memantine
490
Memantine use?
Slow deterioration of Alzheimer's
491
Memantine SEs?
Constipation, dizziness, drowsy, confusion, headache, HT, thrombosis, HF
492
Memantine CIs?
Cardiac disease, renal impairment, convulsion hx
493
Memantine interactions?
Amantadine, ketamine both increase CNS toxicity
494
Trimethoprim interactions?
ACEi, ARBs, amiodarone, phenytoin, azathioprine, methotrexate, mercaptopurine
495
GLP-1 analogues?
Liraglutide and exenatide
496
GLP-1 analogues indications?
2nd/3rd line DMT2
497
GLP-1 analogues SEs?
GI disturbance, hypos, ab formation against it, severe pancreatitis
498
GLP-1 analogues caution?
Renal impairment, DKA, GI disease, gastroparesis an stop if pt gets pancreatitis
499
GLP-1 analogues interactions?
Warfarin and other antidiabetics
500
Types of thiazolidinediones?
Pioglitazone
501
Pioglitazone indications?
3rd line for DMT2, 2nd line DMT2 if sulphonylurea CI
502
Pioglitazone SEs?
anaemia, arthralgia, GI disturbance, haematuria, impotence, vertigo, visual disturbance, weight gain, liver dysfunction
503
Pioglitazone CIs?
CVD, hepatic impairment, stop if jaundice
504
Pioglitazone interactions?
Insulin, beta blockers
505
Carbimazole others?
Propylthiouracil
506
Carbimazole indications?
Hyperthyroidism
507
Carbimazole SEs?
GI disturbance, arthritis, fever, rash, pruritus, jaundice, agranulocytosis, neuropenia
508
Carbimazole CIs?
Hepatic impairment, pregnancy, severe blood disorders
509
Colchicine indications?
Acute gout, pericarditis
510
Colchicine SEs?
GI disturbance, GI haemorrhage at high dose, renal/hepatic damage, myopathy, peripheral neuropathy, bone marrow suppression
511
Colchicine CIs?
Elderly, hepatic/renal impairment, GI/cardiac disease
