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Flashcards in PSA Deck (19):
1

what are the contraindacations for taking Metformin?

chronic kidney disease
recent myocardial infarction, sepsis, acute kidney injury and severe dehydration
iodine-containing x-ray contrast media
alcohol abuse

chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)

metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration

iodine-containing x-ray contrast media: examples include peripheral arterial angiography, coronary angiography, intravenous pyelography (IVP); there is an increasing risk of provoking renal impairment due to contrast nephropathy; metformin should be discontinued on the day of the procedure and for 48 hours thereafter
alcohol abuse is a relative contraindication

2

what are the adverse effects assoicated with taking metformin?

gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%
reduced vitamin B12 absorption - rarely a clinical problem
lactic acidosis* with severe liver disease or renal failure

3

How do Sulfonylureas work?

oral hypoglycaemic drugs used in the management of type 2 diabetes mellitus. They work by increasing pancreatic insulin secretion and hence are only effective if functional B-cells are present. On a molecular level they bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.

4

What are common and rare side effects of sulfoylureas ?

Common adverse effects
hypoglycaemic episodes (more common with long acting preparations such as chlorpropamide)
weight gain

Rarer adverse effects
syndrome of inappropriate ADH secretion
bone marrow suppression
liver damage (cholestatic)
peripheral neuropathy

5

Dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g. Vildagliptin, sitagliptin)

Key points
oral preparation
trials to date show that the drugs are relatively well tolerated with no increased incidence of hypoglycaemia
do not cause weight gain

NICE guidelines on DPP-4 inhibitors
NICE suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated or the person has had a poor response to a thiazolidinedione

6

What are thiazide common and rare adverse effects?

Common adverse effects
dehydration
postural hypotension
hyponatraemia, hypokalemia, hypercalcaemia
gout
impaired glucose tolerance
impotence

Rare adverse effects
thrombocytopaenia
agranulocytosis
photosensitivity rash
pancreatitis

7

What are loop diuretics adverse effects?

Adverse effects

hypotension
hyponatraemia
hypokalaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout

8

What are the Spironolactone Indications?

Indications
ascites: patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used

hypertension: used in some patients as a NICE 'step 4' treatment

heart failure (see RALES study below)
NYHA III + IV, patients already taking ACE inhibitor
low dose spironolactone reduces all cause mortality

nephrotic syndrome
Conn's syndrome



9

What are Spironolactone adverse effects?

Adverse effects
hyperkalaemia
gynaecomastia

10

What is the common dose of:
Paracetamol
ibuprofen
Codeine
Co-codamol
Co-codamol

Paracetamol 1g qds
Ibuprofen 200-400mg tds
Codeine 30-60mg qds
Co-codamol 8/500
Co-codamol 30/500 2 tabs qds

11

What is the common dose of:
cyclizine
Metoclopramide
Amoxicillin
Clarithromycin

cyclizine 50mg tds
Metoclopramide 10mg tds
Amoxicillin 500mg tds
Clarithromycin 500mg bd

12

What is the common dose of:

Lansoprazole
Omeprazole
Levothyroxine
Metformin

Lansoprazole 15-30mg od
Omeprazole 20-40mg od
Levothyroxine 25-200mcg od
Metformin 500mg od - 1g bd

13

What is the common dose of:

Aspirin
Clopidogrel
Simvastatin
Atenolol
Ramipril
Bendroflumethiazide*
Furosemide

Cardiovascular drugs

Aspirin 75-300mg od
Clopidogrel 75-300mg od
Simvastatin 10-80mg on
Atenolol 25-100mg od
Ramipril 1.25-10mg od
Bendroflumethiazide* 2.5mg od
Furosemide 20mg od - 80mg bd**
Amlodipine 5-10mg od

14

What drugs may worsen seizure control in patients with epilepsy?

The following drugs may worsen seizure control in patients with epilepsy:

alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid

15


What drugs cannot be prescribed in pregnant patients?

Antibiotics
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies

Other drugs
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents

The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk

16

What drugs cannot be prescribed in HF patients?

The following medications may exacerbate heart failure:

thiazolidinediones*: pioglitazone is contraindicated as it causes fluid retention

verapamil: negative inotropic effect

NSAIDs**/glucocorticoids: should be used with caution as they cause fluid retention

class I antiarrhythmics; flecainide (negative inotropic and proarrhythmic effect)

*pioglitazone is now the only thiazolidinedione on the market

**low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks

17

What drugs should not be prescribed in patients with asthma?

A number of drugs should be used with caution in patients with asthma:
NSAIDs
beta-blockers
adenosine

18

What factors may exacerbate psoriasis?

The following factors may exacerbate psoriasis:
trauma
alcohol

drugs:
beta blockers,
lithium,
antimalarials (chloroquine and hydroxychloroquine), NSAIDs
ACE inhibitors,
infliximab

withdrawal of systemic steroid

19

What are the side effects of Sodium valproate?


gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatitis
pancreatitis
thromobcytopaeni
teratogenic
hyponatraemia