PSA Flashcards
(157 cards)
1
Q
what drugs are known to cause impaired glucose tolerance
A
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon - alpha
nicotinic acid
antipsychotics
beta blockers cause slight impairment and sould be used with caution in diabetics
2
Q
what drugs cause urinary retention
A
tricyclic antidepressants i.e amitriptyline
anticholinergics e.g antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
3
Q
what drugs cause lung fibrosis
A
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid meds: methotrexate, sulfasalazine
nitrofurantoin
ergot derived dopamine receptor agonists: bromocriptine, cabergoline, pergolide
4
Q
what are the side effects of rifampicin
A
potent liver enzyme inducer
hepatitis
orange secretions
flu like symptoms
5
Q
what is the mechanism of action of rifampicin
A
inhibits bacterial DNA dependent RNA polymerase preventing transcription from DNA to mRNA
6
Q
what is the mechanism of action of isoniazid
A
inhibits mycolic acid synthesis
7
Q
what are the side effects of isoniazid
A
peripheral neuropathy
hepatitis
agranulocytosis
liver enzyme inhibitor
8
Q
what is the mechanism of action of pyrazinamide
A
converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase I
9
Q
what is the mechanism of action of pyrazinamide
A
hyperuricaemia causing gout
arthralgia
myalgia
hepatitis
10
Q
what is the mechanism of action of ethambutol
A
inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
11
Q
what are the side effects of ethambutol
A
optic neuritis
dose needs adjusting in patients wit renal impairment
12
Q
what is the mechanism of action of allopurinol
A
inhibition of xanthine oxidase
13
Q
when is allopurinol prophylaxis started
A
Commencement of ULT is best delayed until inflammation has settled as ULT is better discussed when the patient is not in pain
14
Q
what is the initial dosing of allopurinol
A
initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 300 µmol/l. Lower initial doses should be given if the patient has a reduced eGFR
15
Q
what are the indications for starting on allopurinol
A
the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their first attack of gout
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics
16
Q
what are adverse effects associated with allopurinol
A
severe cutaneous adverse reaction (SCAR)
drug reaction with eosinophilia and systemic symptoms (DRESS)
stephens-Johnson syndrome
17
Q
what drugs do allopurinol interact with
A
azathioprine
cyclophosphamide
theophylline
18
Q
what is the mechanism of action of aspirin
A
blocks cyclooxygenase-1 and 2 preventing prostaglandin production (and prostacyclin and thromboxane)
19
Q
what are the current guidelines for recommending aspirin
A
first line for patients with ischaemic heart disease
-NICE now recommend clopidogrel first line following an ischaemic stroke and PAD
20
Q
what medications does aspirin potentiate
A
oral hypoglycaemics
warfarin
steroids
21
Q
which patient population should not receive aspirin
A
children under 16 due to the risk of Reye syndrome - exception in Kawasaki
22
Q
what are the different kinds of calcium channel blockers
A
verapamil
diltiazem
nifedipine/amlodipine/felodipine
23
Q
what are the indications for use of verapamil
A
angina, hypertension, arrhythmia
24
Q
what are the side effects and cautions for verapamil
A
heart failure
constipation
hypotension
bradycardia
flushing
should NOT be used with beta blockers as it can cause heart block
25
what are the indications for diltiazem
angina
hypertension
26
what are the side effects and cautions of diltiazem
hypotension
bradycardia
heart failure
ankle swelling
not as -ve ionotropic as verapamil but caution should still be exercised when patients have heart failure or on beta blockers
27
what is the indication for nifedipine/amlodipine
hypertension
angina
raynauds
28
what are side effects and cautions of nifedipine/amlodipine
flushing
headache
ankle swelling
affects the peripheral vascular smooth muscle more than myocardium and therefore does not result in worsening of HF
29
what is cyclosporin
Ciclosporin is an immunosuppressant which decreases clonal proliferation of T cells by reducing IL-2 release. It acts by binding to cyclophilin forming a complex which inhibits calcineurin, a phosphatase that activates various transcription factors in T cells
30
what are the adverse effects of cyclosporin
nephrotoxicity
hepatotoxicity
fluid retention
hypertension
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
31
what are the indications for use of cyclosporin
organ transplant
Rheumatoid arthritis
psoriasis
ulcerative colitis
pure red cell aplasia
32
what is the mechanism of action of digoxin
decreases condition through the AVN which slows ventricular rate in A.fib and flutter
increases force of cardiac muscle contraction
stimulates vagus nerve
narrow therapeutic index
33
when should digoxin levels be monitored
if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose
34
what are the features of digoxin toxicity
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
35
what are precipitating factors of digoxin toxicity
classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
36
what drugs can increase risk of digoxin toxicity
amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
37
what is the management of digoxin toxicity
digibind
correct arrhythmias
monitor potassium
38
what type of antibiotic is gentamicin
it is an aminoglycoside
39
what are the adverse effects of gentamicin
ototoxicity
nephrotoxicity
40
what are contraindications to giving gentamicin
myasthenia gravis
41
how do you monitor dosing of gentamicin
both peak (1 hour after administration) and trough levels (just before the next dose) are measured
if the trough (pre-dose) level is high the interval between the doses should be increased
if the peak (post-dose) level is high the dose should be decreased
42
what is the difference between unfractionated heparin and low molecular weight heparin
Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa. LMWH however only increases the action of antithrombin III on factor Xa
43
what are the adverse effects of heparins
bleeding
thrombocytopenia
osteoporosis and increased fracture risk
hyperkalaemia
44
How is
a. standard heparin
b. LMWH
administered
a. IV
b. SC
45
what is the duration of action of
a. standard heparin
b. LMWH
a. short
b. long
46
what are the side effects of
a. standard heparin
b. LMWH
a. bleeding, HIT, osteoporosis
b. bleeding, lower risk of HIT and osteoperosis
47
what is the monitoring like for
a. standard heparin
b. LMWH
a. APTT
b. Anti-factor Xa
48
what is heparin induced thrombocytopenia (HIT)
it is immune mediated - antibodies form against complexes of platelet factor 4 and heparin. These antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors
49
what are features of HIT
greater than 50% reduction in platelets
thrombosis
skin allergy
50
how can heparin overdose be reversed
protamine sulphate
51
what is the therapeutic range of lithium
0.4-1.0 mmol/L
52
what can lithium toxicity be precipitated by
dehydration
renal failure
drugs: diuretics, ACEi/ARBs, NSAIDs, metronidazole
53
what are features of lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
54
what is the management of mild-moderate lithium toxicity
mild-moderate toxicity may respond to volume resuscitation with normal saline
IV fluids with isotonic saline, until euvolemic, then typically twice maintenance rate
monitor serum sodium closely (every 4 hours with serial lithium concentrations) if there is a concern about lithium-induced nephrogenic diabetes insipidus
55
what is the management of severe lithium toxicity
haemodialysis may be needed
sodium bicarb is also used sometimes
56
what are examples of macrolides
erythromycin
clarithromycin
azithromycin
57
what is the mechanism of action of macrolides
act by inhibiting bacterial protein synthesis by blocking translocation
58
what are adverse effects of macrolides
prolongation of the QT interval
gastrointestinal side-effects are common. Nausea is less common with clarithromycin than erythromycin
cholestatic jaundice: risk may be reduced if erythromycin stearate is used
P450 inhibitor (see below)
azithromycin is associated with hearing loss and tinnitus
59
what are common drug interactions with macrolides
statins should be stopped whilst taking a course of macrolides. Macrolides inhibit the cytochrome P450 isoenzyme CYP3A4 that metabolises statins. Taking macrolides concurrently with statins significantly increases the risk of myopathy and rhabdomyolysis.
60
What is metformin used in
Type 2 diabetes
PCOS
non alcoholic fatty liver disease
61
what is the mechanism of action of metformin
acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates
62
what are the adverse effects of metformin
gastrointestinal upsets are common - nausea, anorexia, diarrhoea
reduced vitamin B12 absorption
lactic acidosis with severe liver/renal failure
63
what are contraindications for metformin use
Chronic kidney disease -if eGFR under 45 then review and stop under 30
alcohol abuse is a relative contraindication
metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia
64
what should be done when starting metformin
metformin should be titrated up slowly to reduce GI SA
if patients develop unacceptable side effects then modified release metformin should be considered
65
what is octreotide
it is a long acting analogue of somatostatin - inhibits the release of growth hormone, glucagon and insulin
66
what is octreotide used in
acute treatment of variceal haemorrhage
acromegaly
carcinoid syndrome
prevent complications following pancreatic surgery
VIPomas
refractory diarrhoea
67
what is the adverse effects of octreotide
gallstones - secondary to biliary stasis
68
how do you treat paracetamol overdose
- activated charcoal if ingested under 1 hr ago
- N-acetylcysteine
- liver transplant
69
what is the treatment for salicylate overdose
IV bicarbonate
haemodialysis
70
how do you treat opioid overdose
naloxone
71
how do you treat benzodiazepine overdose
flumanezil
72
what is the treatment for tricyclic antidepressant overdose
IV bicarbonate
dialysis
73
what is the treatment for lithium overdose
mild/moderate - volume resuscitation
haemodialysis
sodium bicarbonate sometimes
74
how do you treat warfarin overdose
vitamin K, prothrombin complex
75
how do you treat heparin overdose
protamine sulphate
76
how do you treat beta blocker overdose
if bradycardic give atropine
in resistant cases use glucagon
77
what is given for methanol poisoning
fomepizole or ethanol
haemodialysis
78
what is the treatment for antifreeze/coolant ingestion
ethanol - competes with ethylene glycol for the enzyme alcohol dehydrogenase
fomepizole
haemodialysis
79
what is given for organophosphate insecticide poisoning
atropine
80
what is done for digoxin toxicity
digoxin specific antibody fragments
81
what is the treatment of iron toxicity
desferrioxamine
82
what is given for lead poisoning
dimercaprol, calcium edetate
83
what is given for carbon monoxide poisoning
100% oxygen
hyperbaric oxygen
84
what is given for cyanide poisoning
hydroxocobalamin
also a combination of amyl nitrate, sodium nitrite and sodium thiosulfate
85
what are inducers of the P450 system
antiepileptics: phenytoin and carbamazepine
Barbiturates: phenobarbitone
rifampicin
st johns wort
chronic alcohol intake
griseofulvin
smoking
86
what are inhibitors of the P450 system
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine, omeprazole
amiodarone
allopurinol
ketoconazole, fluconazole
SSRIs
ritonavir
sodium valproate
acute alcohol intake
quinupristin
87
what is the management of paracetamol overdose
give NAC - acetylcysteine
88
when should acetylcysteine be given in paracetamol overdose
if the plasma concentration is on or above the treatment line (100mg/L at 4 hours and 15mg/L at 15 hours)
if there is a staggered overdose
patients presenting 8-24 hours after ingestion of acute overdose of more than 150mg/kg of paracetamol
patients presenting over 24 hours with symptoms
89
how is acetylcysteine infused in a paracetamol overdose
infuse over 1 hours (rather than 15 mins)
90
why is acetylcysteine transfused over 1 hour
to present adverse affects - most commonly an anaphylactoid reaction (non-IgE mediated mast cell release)
91
what is the Kings college hospital criteria for liver transplantation in paracetamol liver failure
arterial pH under 7.3 24hrs post ingestion
or all of the following:
prothrombin time over 100 seconds
creatinine over 300 umol/l
grade 3/4 encephalopathy
92
what are phosphodiesterase type V inhibitors used to treat
erectile dysfunction
(they are also used in the management of pulmonary hypertension)
93
how do PDE5 inhibitors work
they cause vasodilation through an increase in cGMP leading to smooth muscle relaxation in blood vessels
94
what are examples of PDE5 inhibitors
sildenafil - viagra
tadalafil
verdenafil
95
what are contraindications to taking PDE5 inhibitors
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or MI
96
what are side effects of PDE5 inhibitors
visual disturbance - blue discolouration, non arteritic anterior ischaemic neuropathy
nasal congestion
flushing
Gi side effects
headache
priapism
97
what are the two types of potassium sparing diuretic
epithelial sodium channel blockers (amiloride and triamterene)
aldosterone antagonists (spironolactone and eplerenone)
98
what medication should potassium sparing diuretics be used in caution with
ACE inhibitors as they can precipitate hyperkalaemia
99
how does Amiloride work
it blocks the epithelial sodium channel in the distal convoluted tubule. It is a weak diuretic and is often given thiazides or loop diuretics
100
how do aldosterone antagonists work
they act in the cortical collecting duct and inhibit the effects of aldosterone on the kidney
101
what are the indications for the use of aldosterone antagonists
ascites
heart failure
nephrotic syndrome
conns syndrome
102
what drugs should be used in caution in patients with asthma
NSAIDS
beta blockers
adenosine
103
what can be used instead of adenosine in patients with asthma/COPD
verapamil
104
what drugs may worsen seizure control in patients with epilepsy
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (ADHD meds)
mefenamic acid
some medications such as benzodiazepines, baclofen and hydroxyzine may provoke seizures while being withdrawn
105
what medications may exacerbate heart failure
thiazolidinediones - pioglitazone is contraindicated as it causes fluid retention
verapamil - negative inotropic effect
NDAIDs/glucocorticoids - may cause fluid retention (low dose aspirin is the exception)
class 1 antiarrhythmics
106
what medications are contraindicated in ischaemic heart disease
NSAIDs
oestrogens
varenicline
107
what drugs should you avoid in renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
108
what drugs are likely to accumulate in CKD and therefore need dose adjusting
most antibiotics - penicillin's, cephalosporins, vancomycin, gentamycin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
109
what drugs are relatively safe in CKD
antibiotics: erythromycin, rifampicin
diazepam
warfarin
110
what antibiotics are harmful in pregnancy
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones
111
what other medications are harmful to give during pregnancy
ACE inhibitors, ARBs
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents
majority of antiepileptics are known to be potentially harmful however stopping treatment is difficult due to risk of uncontrolled epilepsy
112
how do quinolones work
they are a group of antibiotics that work by inhibiting DNA synthesis and are bactericidal
113
what are examples of quinolones
ciprofloxacin
levofloxacin
114
what is the mechanism of action of quinolones
inhibit topoisomerase II (DNA gyrase) and topoisomerase IV
115
what are mechanisms of resistance to quinolones
mutations to DNA gyrase, efflux pumps which reduce quinolone concentration
116
what are adverse effects of quinolones
lower seizure threshold in patients with epilepsy
tendon damage
cartilage damage
lengthens QT interval
117
what are contraindications to quinolones
avoided in pregnancy and breastfeeding
avoid in G6PD
118
what is tamoxifen
it is a selective oestrogen receptor modulator which is used in the management of oestrogen receptor positive breast cancer
119
what are adverse effects of tamoxifen
menstrual disturbance: bleeding, amenorrhoea
hot flushes
VTE
endometrial cancer
120
what other pure oestrogen receptor antagonist carries a lower risk of endometrial cancer
raloxifene
121
what is trastuzumab
it is a monoclonal antibody against the Her2 receptor (Herceptin)
122
what is trastuzumab used in
metastatic breast cancer
123
what are adverse effects of trastuzumab
flu like symptoms
diarrhoea
cardiotoxicity
124
what are 5-HT3 antagonists used for
they are used as antiemetics (mainly in chemo based nausea)
125
where do 5-HT antagonists act
in the chemoreceptor trigger zone area of the medulla oblongata
126
what are examples of 5-HT3 antagonists
ondansetron
palonosetron
127
what are the adverse effects of 5-HT3 antagonists
prolonged QT interval
constipation is common
128
what is the mechanism of action of ACE inhibitors
it inhibits the conversion of angiotensin I to angiotensin II
- decrease in angiotensin II leads to vasodilation and reduced blood pressure
- it also decreases aldosterone release thus decreasing sodium and water retention by the kidneys
129
how are ACEII inhibitors renoprotective
ACE inhibitors lead to dilation of the efferent arterioles reducing the glomerular capillary pressure and therefore stress on the filtration barriers
130
how are ACE inhibitors activated
by phase 1 metabolism of the liver
131
what are the side effects of ACE inhibitors
cough
angioedema
hyperkalaemia
first dose hypotension
132
when should caution be taken with prescribing ACE inhibitors
in pregnancy and breastfeeding - avoid
renovascular disease
aortic stenosis
hereditary of idiopathic angioedema
specialist advice sought before starting ACE inhibitors in patients with a potassium over 5.ommol/L
133
what interactions does ACE inhibitors have
patients receiving high dose diuretics can significantly increase the risk of hypotension
134
what monitoring needs to happen for ACE inhibitors
U+Es before treatment start and when increasing the dose
135
what are examples of ACE inhibitors
ramipril
enalapril
lisinopril
136
what is the classification of moderate asthma attack
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
137
what is the classification of severe asthma attack
PEFR 33 - 50% best or predicted
Can't complete sentences
RR > 25/min
Pulse > 110 bpm
138
what is the classification for life threatening asthma
PEFR < 33% best or predicted
Oxygen sats < 92%
'Normal' pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
139
what is the management of asthma attack
all patients with life threatening should be admitted to hospital
- oxygen if hypoxaemic with 15L o2 via non rebreathe mask
- high dose inhaled SABA via oxygen driven nebs
- all patients should receive 40-50mg pred orally
- ipratropium bromide
- IV magnesium sulphate
- IV aminophylline
- ITU/HDU support
140
what is the criteria for discharge post asthma attack
been stable on their discharge medication for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted
141
what is the common management of all patients with acute coronary syndrome
aspirin 300mg
oxygen if sat are below 94%
morphine given in severe pain
nitrates - sublingually or IV
142
what is the management of STEMI
aspirin 300mg
if PCI is available within 120 mins then do PCI, if not then fibrinolysis
143
what is the management of NSTEMI/Unstable angina
aspirin 300mg
estimate the 6 month mortality. If low risk then conservative management and give ticagrelor
if risk is immediate or high risk then send for PCI
144
what is adenosine used for
adenosine is most commonly used to terminate supraventricular tachycardias
145
what is the mechanism of action of adenosine
it causes a transient heart block in the AV node
it is an agonist of the A1 receptor in the AV node which causes hyperpolarisation by increasing K+ efflux
146
which group of patients should adenosine be avoided in
asthmatics due to possible bronchospasm
147
what are the adverse effects of adenosine
chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways resulting in increased ventricular rate
148
what are aminophylline infusions used for
it is used in the management of acute asthma and COPD
- 1st a loading dose is given (5mg/kg) over 20 mins
- then maintenance infusion of 1g added to 1 litre of saline
149
what are aminosalicylate drugs used in
in IBD - 5-aminocalicyclic acid (5-ASA) is released in the colon and not absorbed acting locally as an anti-inflammatory
150
what is sulphasalazine
it is a combination of sulphapyridine and 5-ASA
151
what are side effects of sulphasalazine
rashes
oligospermia
headache
heinz body anaemia
megaloblastic anaemia
lung fibrosis
152
what is mesalazine
it is a delayed release form of 5-ASA
153
what are side effects associated with mesalazine
GI upset
headache
agranulocytosis
pancreatitis
interstitial nephritis
154
what is amiodarone
it is a class III antiarrhythmic used in the treatment of atrial, nodal and ventricular tachycardias by blocking potassium channels
155
what are the limitations of amiodarone
very long half life - loading doses used
should ideally be given into central veins
has proarrhythmic effects due to lengthening QT interval
interacts with drugs i.e warfarin
numerous long term effects
156
what monitoring happens for patients taking amiodarone
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
157
