Top 100 Drugs Flashcards
(493 cards)
1
Q
what are 2 examples of 5 alpha-reductase inhibitors?
A
finaseteride
dutasteride
2
Q
what drug class is finasteride?
A
5 alpha-reductase inhibitor
3
Q
what are 2 indications for 5 alpha reductase inhibitors?
A
BPH causing LUTS
Androgenetic alopecia - male patterned baldness
4
Q
what is the MOA of 5 alpha reductase inhibitors?
A
inhibits intracellular enzyme 5-alpha-reductase which converts testosterone to the more active dihydrotestosterone, stimulating prostatic growth
5
Q
how long does it take 5-alpha-reductase inhibitors to work?
A
up to 6 months
6
Q
what are 5 adverse effects of 5-alpha-reductase inhibitors?
A
Impotence
Reduced libido
breast tenderness and gynaecomastia
BREAST CANCER
SUICIDAL THOUGHTS
hair growth
7
Q
what are the warnings needed with 5-alpha-reductase inhibitors?
A
NEVER in women - can cause genital birth defects in male foetuses
avoid contact with women of childbearing potential including with SEMEN
8
Q
what is the starting dose of finasteride given for BPH?
A
5mg OD PO
review after 3-6 mon for efficacy then every 6-12 mon
9
Q
what is the dose of dutasteride for BPH?
A
500 micrograms OD PO
10
Q
what is the dose of finasteride for male patterned baldness?
A
10mg OD PO
11
Q
what is the monitoring for 5-alpha reductase inhibitors?
A
review after 3-6 mon for efficacy then every 6-12 mon
12
Q
what are 2 examples of Acetylcholinesterase inhibitors?
A
donepezil
rivastigimine
13
Q
what are 2 indications for Acetylcholinesterase inhibitors?
A
mild to moderate Alzheimers
Mild to moderate dementia in parkinsons - rivastigimine
14
Q
what is the MOA of Acetylcholinesterase inhibitors?
A
Ach is needed for memory and learning. Acetylcholinesterase inhibitors inhibit the breakdown of Acetylcholine in the CNS => increasing the availability of acetylcholine allowing for improved cognitive function and slower decline though this is not universal
15
Q
what drug class is rivastigimine?
A
Acetylcholinesterase inhibitors
16
Q
what drug class is donepezil?
A
Acetylcholinesterase inhibitors
17
Q
what is the most common adverse effect to Acetylcholinesterase inhibitors?
A
GI upset
18
Q
What can Acetylcholinesterase inhibitors cause in asthma and COPD?
A
Bronchospasm
19
Q
what are 3 peripheral side effects of Acetylcholinesterase inhibitors?
A
Peptic ulcers and bleeding
Bradycardia
Heart block
20
Q
what are 4 central cholinergic side effects of Acetylcholinesterase inhibitors?
A
hallucinations
altered/aggressive behaviour
extrapyramidal symptoms
neuroleptic malignant syndrome
21
Q
what are 2 life threatening side effects of Acetylcholinesterase inhibitors?
A
neuroleptic malignant syndrome
Bronchospasm in asthma/COPD
22
Q
what are 2 contraindications to Acetylcholinesterase inhibitors?
A
Sick sinus syndrome
heart block
23
Q
what are 4 cautions in Acetylcholinesterase inhibitors?
A
Asthma
COPD
Peptic ulcers
Parkinsons - rivastigimine may worsen tremor
24
Q
what are 2 medications that interact with Acetylcholinesterase inhibitors to increase risk of peptic ulcers?
A
NSAIDS
Systemic corticosteroids
25
what medications should be used with caution alongside Acetylcholinesterase inhibitors due to increased risk of neuroleptic malignant syndrome?
antipsychotics
26
what medications should be used with caution alongside Acetylcholinesterase inhibitors due to risk of Brady/heart block?
beta blockers
27
what medications can worsen cognitive decline so should not be used with Acetylcholinesterase inhibitors?
anticholinergics - antimuscarinics, tricyclic antidepressants
28
what are 5 medications that should be used with caution with Acetylcholinesterase inhibitors?
NSAIDs
Systemic corticosteroids
Antipsychotics
beta blockers
anticholinergics
29
what is the usual starting dose for donepezil?
5mg OD
30
what is the usual starting dose for rivastigimine?
1.5mg every 12 hours
31
when should donepezil be taken?
at night
may cause vivid dreams, in which case take in morning
32
which Acetylcholinesterase inhibitors is available as a patch?
rivastigimine
33
what is the monitoring for Acetylcholinesterase inhibitors?
review for adverse effects at 2-4 weeks
review for efficacy at 3 months - only continue if effective
34
what are 2 examples of aldosterone antagonists?
Spironolactone
Eplerenone - only licensed for CHF
35
What are 3 indications for aldosterone antagonists?
1 - Ascites and oedema due to liver cirrhosis - Spiro 1'
2 - CHF - Spiro 3' in addition to Beta blocker and ACEi
3 - primary hyperaldosteronism
36
what is aldosterone?
Mineralocorticoids produced in glomerulosa of adrenal cortex and acts on mineralocorticoid receptors in distal tubule of kidney to increase activity of luminal epithelial sodium channel causing increased sodium and water retention and increased potassium excretion
37
what is the MOA of aldosterone antagonists?
Competitively inhibit mineralocorticoid receptors to decrease activity of luminal epithelial sodium channels causing increased sodium and water excretion and increased potassium retention
38
what are 4 adverse effects of aldosterone antagonists?
Hyperkalaemia
Gynaecomastia - SPIRO
Liver impairment and jaundice
Steven Johnsons syndrome - SPIRO
39
what are 5 signs of hyperkalaemia on ECG?
peaked T wave - tall tented
flattened P wave
prolonged PR interval
ST depression
prolonged QRS duration (broad QRS complexes)
40
what are 4 symptoms of hyperkalaemia?
muscle weakness
arrhythmia
cardiac arrest
nausea
41
what are 3 contraindications to aldosterone antagonists?
Renal impairment
Hyperkalaemia
adrenal insufficiency
42
what is one caution to aldosterone antagonists?
should be avoided in pregnancy and breast feeding - can cross placenta
43
what are 2 medications that should be used with caution with aldosterone antagonists?
ACEI and ARBs - also increase risk of hyperkalaemia
44
what is one medication hat should not be taken with aldosterone antagonists?
potassium
45
what is a typical starting dose for Spironolactone in CHF and resistant HTN?
25mg OD PO
46
what is a typical starting dose for spironolactone in ascites or nephrotic syndrome?
100mg OD PO
47
when should spironolactone be taken?
with food
48
what are 2 things patients should be told when starting on Spironolactone (or other aldosterone antagonists)?
May cause gynaecomastia/impotence
Need to come back for potassium monitoring
49
what monitoring is needed for aldosterone antagonists?
For safety - U+E (K+ and Creatinine) - 1 week after initiation and after any dose increase
monthly for first 3 months
then every 3 months for 1 year
then every 6 months
Also monitor for efficacy
50
what are 3 examples of antacids?
sodium bicarbonate
calcium carbonate
magnesium carbonate
51
what are 2 indications for antacids/alginates?
GORD
Dyspepsia
52
what is the MOA of alginates?
increase viscosity of stomach contents and lead to floating 'raft' seperating stomach contents from oesophagus
53
what is the MOA of antacids?
buffer stomach acid
54
what are 2 adverse effects of antacids?
magnesium salts - diarrhoea
Sodium salts - constipation
most compound alginates have few side effects
55
when should alginates/antacids be used with caution?
hyperkalaemia/fluid overload - e.g renal impairment
56
what interactions are there with alginates/antacids? (8)
Can reduce serum conc of:
- ACEI
- Bisphosphonates
- PPIs
- Digoxin
- Levothyroxine
- ABx - Tetracyclines, cephalosporins, ciprofloxacin
Can increase excretion of:
- aspirin
- lithium
Should leave 2 hours between interactive medications
57
what should alginates not be used with as cause too thick stomach contents?
thickened infant formula
58
how are alginates/antacids usually available as?
liquid or chewable tablets
59
what are 4 lifestyle measures to reduce GORD?
eat smaller meals more often
stop smoking
avoid food triggers - fatty, spicy
raise head of bed
60
what are 4 GORD red flags?
bleeding
vomiting
dysphagia
wt loss
61
what are 5 medications that may cause dyspepsia?
NSAIDs
antimuscarinics
aspirin
bisphosphonates
corticosteroids
62
what are 3 indications of allopurinol?
1 - gout prevention
2- prevention of uric acid and calcium oxalate renal stones
3 - prevent hyperuricaemia and tumour lysis syndrome in chemo
63
when is allopurinol used in gout prevention?
2+ attacks a year
OR joint damage
OR renal impairment
64
what is the MOA of allopurinol?
xanthine oxidase inhibitor
xanthine oxidase metabolises xanthine (from purines) to uric acid
65
what is second line to allopurinol?
febuxostat
non-purine xanthase oxidase inhibitor
66
what are 5 adverse effects of allopurinol?
May trigger gout attack on initiation
Skin rash
- Steven's johnson syndrome/TEN
Allopurinol hypersensitivity syndrome
67
what are 3 contraindications to allopurinol?
acute gout attack (can continue but do not start treatment)
Recurrent skin rash
Severe hypersensitivity
68
what are 2 cautions for use of allopurinol?
renal impairment
hepatic impairment
69
Co-prescription of allopurinol and what medication increases risk of toxic levels of the drug due to it being metabolised by xanthine oxidase?
azathioprine
70
Co-prescription of allopurinol and what 2 medications causes increased risk of hypersensitivity reaction?
ACEi
thiazides
71
Co-prescription of allopurinol and what medication causes increased risk of skin rash?
Amoxicillin
72
what is the starting dose of allopurinol for gout?
100mg OD PO
titrate up to 200-600mg in 1/2 divided doses
73
what should be co-prescribed with allopurinol?
NSAIDs or Colchicine to prevent acute attack in first month/till uric acid levels stabalise
74
how should allopurinol be taken?
After meals
Maintain good hydration - 2-3L/day
75
what is the monitoring of allopurinol?
Uric acid levels after 4 weeks from starting/dose change
76
what uric acid level is aimed for in gout?
<300 umol/L
77
what are 3 medication that can trigger gout?
Increase serum uric acid conc:
-Thiazide diuretics
-Loop diuretics
Decrease uric acid excretion:
-Aspirin
78
What are 3 examples of alpha blockers?
Tamsulosin
Doxazosin
alfuzosin
79
what are 2 indications of alpha blockers?
1 - To improve LUTS in BPH
2 - resistant HTN - 4th line after ACEI, CCB and thiazide diuretic
80
what is the MOA of alpha blockers?
Highly selective inhibitors of alpha1-adrenoreceptors causing smooth muscle relaxation in both blood vessels and urinary vessels
81
what are 3 adverse effects of alpha blockers?
Dizziness
syncope
Postural hypotension
Due to effect on vascular smooth muscle
82
who should not be given alpha blockers?
people with postural hypotension
83
what is an important consideration when starting alpha blockers?
May need to omit dose of antihypertensive or Beta-blocker to prevent 1st dose postural hypotension
Also may need to advise on risk of hypotension in combination with phosphodiesterase-5 inhibitors (sildenafil)
84
which alpha blocker is licenced for both BPH and HTN?
Doxazocin
85
which alpha blocker is licenced in BPH only?
Tamsulosin
86
what is the dose of doxazocin for HTN?
1mg OD and then increase after 1/2 weeks to 2mg then to response up to max of 16mg OD
87
what is the dose of doxazocin for BPH?
1mg OD and titrate 1/2 weekly to response up to max of 16mg OD
88
what is the dose of tamsulosin?
400micrograms OD
89
when should alpha blockers be taken?
At night due to effect on BP
90
What are 3 examples of aminoglycosides?
gentamicin
amikacin
neomycin
91
what type of bacteria do aminoglycosides treat?
gram negative aerobes
including pseudomonas aeruginosa
92
what are 5 indications for aminoglycosides?
1 - Sepsis
2 - Pyelonephritis - NOT 1st line
3 - Intrabdominal infections - diver with metro and co-amox
4 - Endocarditis
5 - Otitis externa - neomycin
93
what is the spectrum of activity of aminoglycosides?
treat gram negative aerobes, staph and mycobacteria
NO ACTIVITY AGAINST - strep and anaerobes - often used in combo with penicillin and metronidazole
94
what is the MOA of aminoglycosides?
Bind irreversibly to bacterial ribosomes and inhibit protein synthesis
Enter cells through oxygen-dependent transport systems so only work in aerobes and staph
95
what are 2 adverse effects of aminoglycosides?
ototoxicity
nephrotoxicity
Accumulate in tubular epithelial cells and cochlear and vestibular hair cells
96
what are 4 cases where aminoglycosides can be used but with caution?
Neonates
Elderly
Renal impairment
Myasthenia Gravis - can impair neuromuscular transmission
97
what 2 medications increase risk of ototoxicity in aminoglycosides?
loop diuretics
glycopeptide antibiotics - vancomycin, teicoplanin, etc
98
what 4 medications increase the risk of nephrotoxicity in aminoglycosides?
loop diuretics
glycopeptide antibiotics - vancomycin, teicoplanin, etc
Cephalosporins - cephalexin, ceftriaxone
NSAIDs
Other nephrotoxic drugs
99
How are aminoglycosides administered?
Parenterally as NOT absorbed by gut
Usually OD IV over 30 minutes - given every 24 hours but can be up to 48 hourly in renal impairment
can be given locally
100
what need to be measured before administering aminoglycosides?
renal function
101
what monitoring is needed for aminoglycosides?
Trough levels taken 18-24 hours after dose or mid interval concentration taken 6-14 hours after dose to determine whether it is safe to give the next dose and when
102
what is the safe trough level of gentamicin?
<1 mg/mL
103
How do you calculate adjusted body weight?
[ideal body weight] + 0.4x [actual body weight] - [ideal body weight]
104
what weight is used to calculate aminoglycosides doses?
adjusted body weight
105
what are 2 aminosalicylates?
Mesalazine
Sulfasalazine
106
what are 2 indications for aminosalicylates?
1 - For mild-moderate UC - Mesalazine 1ST LINE - Sulfasalazine can also be used
2 - For RhA - Sulfasalazine - DMARD
107
What is the MOA of aminosalicyclates?
release 5-aminosalicylic acid - exat MOA unknown but thought to have local anti-inflammatory and immunosuppressive properties
108
what are 6 side effects of aminosalicyclates?
GI upset - most common - more with sulfasalazine
Headache
Blood abnormalities - leukopenia, thrombocytopenia
renal impairment
oligospermia
hypersensitivity reaction
109
what medication are aminosalicyclates related to?
ASPIRIN
110
who cannon take aminosalicyclates?
people with Aspirin allergies as also a salicylate
111
what are 2 medications that may interact with aminosalicyclates?
PPIs - may cause premature capsule breakdown
Lactulose - may cause delayed capsule breakdown
in tablets with pH sensitive coating
112
what is the prescription for aminosalicyclates in mild/moderate UC?
1st line - Mesalazine enema/suppository every 12/24 hours for 4-6 weeks to induce remission
can also be taken orally if preferred
113
what monitoring should be done with aminosalicyclates?
Mesalazine - renal function
Sulfasalazine - FBC and LFTs
114
what is amiodarone used for?
AF
Atrial flutter
supraventricular tachycardia
ventricular tachycardia
refractory ventricular fibrillation
usually not 1st line
115
What is the MOA of amiodarone?
effects myocardial cells including blockading sodium, calcium and potassium channels
Also Antagonises alpha and beta adrenergic receptors
Reduces spontaneous depolarisation and increases refractor period
116
What are 6 long term side effects of amiodarone?
Pneumonitis
Bradycardia
AV block
Hepatitis
Skin - photosensitivity and grey discolouration
Thyroid abnormalities - due to iodine content
117
What is amiodarone's half life like?
long - 25 to 100 days
118
What is a short term side effect of IV amiodarone?
Hypotension
119
When should amiodarone be avoided? (3)
Severe Hypotension
heart block
active thyroid disease
120
What are 3 medications that amiodarone increases plasma concentrations of ?
Digoxin
Diltiazem
Verapamil
Dose should be halved if starting amiodarone
121
What food should be avoided with amiodarone?
Grapefruit juice
Down regulates cytochrome P450 3A4 increasing amiodarone exposure
Long half life so should be avoided after exposure
122
When is amiodarone given in ALS?
In cardiac arrest with VF OR pulseless VT
Give immediately after 3rd shock
123
What is the dose of amiodarone given in ALS?
300mg IV
Followed by 20ml 0.9% saline or 5% glucose flush
124
what is a complication of peripheral administration of amiodarone?
phlebitis
125
How is amiodarone usually administered?
through central line
126
What should always be done when administering amiodarone?
continuous cardiac monitoring
127
what is the monitoring for long term amiodarone?
Renal, liver and thyroid monitoring baseline and 6 monthly
Baseline CXR
128
What are 3 examples of local anaesthetics?
lidocaine
Bupivacaine
levobupivacaine
129
what are 3 indications for local anaesthetics?
Surface anaesthesia
SC local anaesthesia
Regional anaesthesia - spinal/epidural
130
For what non-anaesthetic purpose can lidocaine be used?
2nd line for ventricular tachycardia
131
what is the MOA of local anaesthetics?
reversibly inhibit voltage gated sodium channels on plasma membranes
Prevents initiation and propagation of action potentials in neurones
132
What property of lidocaine makes it good for topical anaesthesia?
readily absorbed through epithelia and has rapid onset
133
what local anaesthetic is good for blocks and epidurals?
bupivacaine
high affinity to binding sites and long duration
134
what is the most common side effect of local anaesthetics?
stinging at injection site
135
what are 6 effects of IV administration of local anaesthetics?
drowsiness
restlessness
tremor
seizures
Hypotension
arrhythmia
136
what are 5 complications of local anaesthetics for blocks/epidruals?
infection
bleeding
higher than intended anaesthetic level
Hypotension and bradycardia - blockage of sympathetic fibres
weakness/paralysis
137
what are 2 cases in which local anaesthetics should be used with caution?
Hepatic impairment
cardiac failure
metabolised hepatically and reliant on hepatic blood flow
138
what medication can be given with local anaesthetics to prolong their effect?
Vasoconstrictors - adrenaline
139
what local anaesthetic is usually used for SC local anaesthesia and what dose?
1% (10mg/ml) solution of lidocaine hydrochloride up to a max dose of 3mg/kg or 200mg (whatever is lower)
If combined with adrenaline can go up to 7mg/kg or 500mg
140
what is the brand name of topical anaesthetic cream?
Emla 5%
141
What are 3 examples of angiotensin receptor blockers (ARBs)?
losartan
candesartan
irbesartan
142
what are 4 indications for ACEI/ARBs?
1 - hypertension - 1st/2nd line
2 - heart failure
3 - secondary prevention of cardiac events
4 - diabetic nephropathy and CKD with proteinuria
143
what is the MOA of ARBs?
blocks action of angiotensin II on angiotensin type I receptor
angiotensin II causes vasoconstriction so blocking it's effect leads to vasodilation including of the efferent arteriole in the kidney reducing pressures. Also reduces amount of aldosterone secreted leading to increased sodium and water excretion which is beneficial in heart failure
144
what are 3 adverse effects of ARBs?
hyperkalaemia
hypotension
renal failure - in renal artery stenosis due to inadequate filtration pressures
145
what are 2 cases where ACEI/ARBs should be avoided?
Renal artery stenosis
AKI
146
what are 3 cases where ACEI/ARBs should only be used with caution?
Pregnancy
breast feeding
CKD - use lower doses and monitor closely
147
what are 4 medications that ARBs shouldn't be prescribed with?
Potassium supplements
aldosterone antagonists
potassium sparing diuretics
NSAIDs - due to nephrotoxicity risk
148
what is the usual starting dose for losartan in heart failure?
12.5mg OD
149
what is the usual starting dose for losartan HTN and as secondary prevention?
50mg OD
150
what is the max dose of losartan?
100mg
151
what is the safety monitoring for ARBs?
take baseline U+Es and renal function then take at 1-2 weeks and after dose adjustment
152
at what GFR or creatinine should ACEI/ARBs be stopped?
If serum creatinin conc rises >30%
If GFR falls >25%
153
at what serum potassium level should ACEI/ARBs be reduced and at what level should they be stopped?
reduce at 5 mmol/L
STOP at 6 mmol/L
154
what are 3 examples of Angiotensin converting enzyme inhibitors (ACEI)
ramipril
lisinopril
peridopril
155
what is the MOA of ACEI?
inhibit action of angiotensin converting enzyme reducing the conversion of angiotensin I to angiotensin II
156
what are 6 adverse reactions to ACEIs?
hypotension
hyperkalaemia
renal failure
dry cough
angioedema
anaphylaxis
157
what is a common starting dose for ramipril in heart failure?
1,25mg od
158
what is a common starting dose for ramipril in HTN?
2.5mg OD
159
what is the max dose for ramipril?
10mg
160
What are 4 examples of selective serotonin reuptake inhibitors (SSRIs)?
Sertraline
Fluoxetine
Citalopram
Escitalopram
161
what are 3 indications for SSRIS?
depression - 1st line in moderate/severe and 2nd after CBT in mild
Panic disorder/PTSD/Social anxiety
OCD
162
What is the MOA of SSRIs?
inhibit neuronal uptake of 5-hydroxytraptamine (5-HT)from the synaptic cleft
163
what are 9 side effects of SSRIs?
GI upset
appetite/weight change
hypersensitivity reaction
Hyponatraemia
Suicidal thoughts/behaviour in first few weeks
lowered seizure threshold
Prolonged QT - citalopram
increase bleeding risk
serotonin syndrome
164
what are 4 side effects of SSRI withdrawal?
GI disturbance
neurological symptoms - zaps
flu-like symptoms
sleep disturbance
165
which SSRI causes long QT?
citalopram
166
when are 4 times SSRIs should be used with caution?
Hepatic impairment
young people - children - limited efficacy
epilepsy
peptic ulcer disease
167
what medications interact with SSRIs?
monoamine oxidase inhibitors
serotonergic drugs - triptans, tramadol
Bleeding risk - aspirin, nsaids, anticoagulants - also gastroprotection
Drugs that prolong QT (antipsychotics) and citalopram
168
what is the typical starting dose for sertraline?
50mg OD
169
what is the typical starting dose for citalopram?
20mg OD
170
does citalopram have higher bioavailability in tablets or drops? what is the dosage difference?
DROPS!
20mg tablets equivalent to 16mg drops
171
what is the monitoring of SSRIs?
review after 1-2 weeks
maintain dose for 6-8 weeks before changing
continue therapy till at least 6 months after symptoms have gone
172
what SSRI can be stopped suddenly due to longer half life?
fluoxetine
173
how should SSRIs be stopped?
slowly over 4 weeks reducing dose or frequency
174
what 2 SSRIs shouldn't be prescribed with tamoxifen?
paroxetine
fluoxetine
as they inhibit CYP2D6
175
what drug class are duloxetine and venlofaxine?
serotonin noradrenaline reuptake inhibitors (SNRIs)
176
what drug class is mertazipine?
tetracyclic antidepressant
177
what SNRI can be used for diabetic neuropathy?
duloxetine
178
what is mirtazapine indicated for?
depression
179
what are venlefaxine and duloxetine indicated for?
Depression
Generalised anxiety disorder
diabetic neuropathy - duloxetine
180
what is the MOA of mirtazapine (tetracyclic antidepressant)?
antagonises inhibitory pre-synaptic alpha adrenoreceptors. Increases availability of monoamines for neurotransmission
fewer antimuscarinic side effects than tricyclics
181
what are side effects of SNRIs and mirtazapine?
GI upset
dry mouth
neurological effects - headache, insomnia, abnormal dreams
hyponatraemia
serotonin syndrome
182
which SNRI can cause long Q-T?
Venlafaxine
183
what is a serious side effect of mirtazapine?
bone marrow suppression
184
what SNRI is associated with greater risk of withdrawal symptoms?
venlafaxine
185
in what 4 cases should SNRIs/Mirtazapine be used with cation?
Older people
renal impairment
hepatic impairment
arrythmias
186
what medications shouldn't be used with SNRIs/Mirtazapine?
other antidepressants
187
what is the typical starting dose for duloxetine in neuropathic pain?
60mg OD
188
When should mirtazapine be taken?
at night as can be sedating
189
what are 3 tricyclic antidepressants?
amitriptyline
nortriptyline
lofepramine
190
what class of medication is trazodone?
serotonin-antagonist-and-reuptake-inhibitor
191
what are 4 indications of tricyclic antidepressants?
depression
neuropathic pain
IBS - 2nd line after antispasmodic (antimuscarinic or mebeverine)
Migraine prophylaxis - Amitryptiline - 3rd line
192
what is the MOA of tricyclic antidepressants?
inhibit neuronal uptake of 5-hydroxytriptamine (serotonin) and noradrenaline
Block muscarininc, adrenergic, dopamine and histamine receptors
193
what are 12 side effects of tricyclic antidepressants?
Dry mouth
constipation
urinary retention
cognitive impairment
sedation
hypotension
arrhythmias - long QT
breast changed
extrapyramidal symptoms - tremor, dyskinesia
sexual dysfunction
194
what are 6 patients that tricyclic antidepressants should be used with caution in?
Older people
epilepsy
cardiovascular disease
constipation
glaucoma
prostate enlargement
195
what medications should tricyclic antidepressants NOT be given with?
monoamine oxidase inhibitors - increase risk of hypertension, hyperthermia and serotonin syndrom
196
what is the typical starting dose of amitriptyline in neuropathic pain?
10mg OD at night
197
what formulations are tricyclic antidepressants available as?
tablets and oral solution
198
when should tricyclic antidepressants be taken?
at night due to drowsiness
199
what kind of medication are dopamine D2 receptor antagonists?
Antiemetics
200
what are 3 examples of dopamine D2 receptor antagonists?
metoclopramide
prochlorperazine
domperidone
201
what cause of nausea are dopamine D2 receptor antagonists especially good at dealing with?
reduced gut motility
202
What is the MOA of D2 receptor antagonists?
triggering of vomiting centre in medulla which receives inputs from the chemoreceptor trigger zone (CTZ), the vagus nerve, vestibular system and higher centres. Dopamine D2 receptor is the main receptor in the chemoreceptor trigger zone which senses emetogenic substances. Dopamine also leads to gut relaxation and reduced motility. Therefore antagonism of dopamine receptors leads to increased gut motility and reduced triggering of CTZ.
203
what are the 2 different types of D2 receptor antagonists?
Benzamides - metoclopramide, domperidone
phenothiazines - prochlorperazine
204
what is the most common side effect of D2 receptor antagonists?
Diarrhoea
205
which 2 D2 receptor antagonists can cause extrapyramidal side effects?
metoclopramide
Prochlorperazine
Cross BBB
206
Which D2 receptor antagonists doesn't cause extrapyramidal side effects and why?
Domperidone
Doesn't cross BBB
207
which D2 receptor antagonists can cause drowsiness?
prochlorperazine
208
which D2 receptor antagonists can cause long QT and arrhythmias?
domperidone
209
which D2 receptor antagonists can be used in parkinsons?
Domperidone - doesn't cross BBB
210
what conditions are all D2 receptor antagonists contraindicated in due to their prokinetic nature?
Bowel obstruction and perforation
211
who should metoclopramide be avoided in?
Neonates always!
Children and young adults
212
what condition should metoclopramide and prochlorperazine be avoided in?
PARKINSONS (and Lewy body dementia)
213
when is domperidone contraindicated?
severe hepatic impairment
cardiac conduction defects
children <12 years
Weight <35kg
214
what are 5 medications that inhibit cytochrome P450 enzymes?
amiodarone
Diltiazem
Macrolides - erythromycin, clarithromycin
fluconazole
protease inhibitors
215
what are 6 examples of medications that increase QT interval?
D2 receptor antagonists
Antipsychotics
SSRIs
Quinine
Amiodarone
Macrolides
216
what are 4 types of medications that shouldn't be prescribed with D2 receptor antagonists?
Antipsychotics
Dopaminergic agents for parkinson's - cancel each other out
Drugs that prolong QT
Drugs than inhibit cytochrome P450
217
what is the maximum duration of D2 receptor antagonists?
5-7 days
218
what is the stating dose for metoclopramide and domperidone?
10mg 8 hourly (TDS) PO if >60kg
500 micrograms <60kg
219
what is the dosing for IM and IV metoclopramide?
same as oral
give IVs slowly over 3 mins
220
what are 3 examples of Histamine H1 receptor antagonists used as antiemetics?
Cyclizine
Promethazine
Cinnarazine
221
what are Histamine H1 receptor antagonists used for in antiemesis?
prophylaxis of nausea and vomiting especially motion sickness and vertigo
222
what is the MOA of Histamine H1 receptor antagonists in antiemesis?
Histamine and muscarinic Ach are used in communication between vomiting centre and vestibular system so antagonism of histamine receptors inhibits nausea
223
what are 3 side effects of Histamine H1 receptor antagonists as antiemetics?
Drowsiness
Anticholinergic - dry mouth and throat, urinary retention, constipation, confusion
Tachycardia - after IV injection
224
what are 2 contraindications to Histamine H1 receptor antagonists used as antiemetics?
Prostatic enlargement - due to anticholinergic effect
Hepatic encephalopathy - due to drowsiness
225
what are 2 medication classes that interact with Histamine H1 receptor antagonists?
sedatives - benzos, opioids - may increase drowsiness
Anticholinergics - ipratropium, tiotropium
226
what is a typical prescription of cyclizine for nausea?
50mg 8 hourly PRN
227
what is the dosing for cyclizine IM and IV?
same as oral
228
How should iv cyclizine be administered?
slowly over 2 minutes
229
what are 2 examples of 5HT3 (serotonin) receptor antagonists?
Ondansetron
Granisetron
230
what are 5HT3 (serotonin) receptor antagonists used for?
nausea and vomiting particularly with chemo and general anaesthetics
231
what is the MOA of 5HT3 (serotonin) receptor antagonists?
There are 5HT3 receptors in chemoreceptor trigger zone which are stimulated by emetogenic substances in bloodstream. 5HT (serotonin) is a key neurotransmitter in gut which stimulates vagus nerve to activate vomiting centre. Blockade of these pathways reduces nausea.
Not effective in motion sickness as no involvement in vestibular system
232
what are 3 common side effects of 5HT3 (serotonin) receptor antagonists?
Constipation
Headache
Flushing
233
At what dose may ondansetron prolong QT?
>16 mg
234
what can ondasetron cause in pregnancy?
congenital defects - cleft lip and palate, heart defects
235
what are 2 contraindications to 5HT3 (serotonin) receptor antagonists?
Pregnancy - congenital defects
Long QT
236
what medications shouldn't be prescribed with 5HT3 (serotonin) receptor antagonists?
Those than prolong QT
SSRIs
Antipsychotics
Quinine
D2 receptor antagonists (antiemetics - metoclopramide)
237
what is the typical starting dose of ondansetron?
4-8mg 12 hourly oral or IV
dosage depends on indication - usually higher for chemo induced nausea
238
what are 3 examples of antifungals?
nystatin
clotrimazole
fluconizole
239
what is the MOA of antifungals?
target ergosterol on fungal cell membranes either by binding to it and creating a polar pore (nystatin) or by inhibiting ergosterol synthesis (clotrimazole, fluconizole)
240
what are 6 side effects of fluconazole?
GI upset
headache
increased liver enzymes
hypersensitivity and anaphylaxis
severe hepatotoxicity
prolonged QT and arrythmias
241
what are 4 contraindications to fluconazole?
Liver disease
QT prolongation
Renal impairment - requires dose reduction
Pregnancy - can cause foetal malformation
242
what medications does fluconazole interact with?
inhibits cytochrome p450 so increases concentration of anything metabolised through this pathway
- carbamezapine
- phenytoin
- Warfarin
- diazepam
- simvastatin
- sulphonureas
may reduce activity of colpidogrel as prodrug is metabolised through liver
Do not prescribe with medications that prolong QT
243
what is the dose of nystatin for oral thrush?
100 000 units - 1mL - oral suspension dropped into the mouth QDS for 7 days
244
what is the dosage for clotrimazole cream?
1% (1g in 100g)
Applied BD/TDS for 1-2 weeks
245
what is the dose for fluconazole in vaginal thrush?
150mg orally once
246
what is the dose of fluconazole for other infections?
50mg OD for 1-2 weeks
247
when should oral nystatin be administered?
After food
248
what are 4 H1-receptor antagonists used as amtihistamines?
certifizine
fexofenadine
loratadine
chlorphenamine
249
what are 3 indications for H1-receptor antagonists (antihistamines)?
1st line for tx of allergies particularly hayfever
for pruritus and urticaria
For skin symptoms in anaphylaxis
250
what is the MOA of H1-receptor antagonists ?
Block H1 receptor and therefore blocking the effects of histamine.
Histamine is release from storage granules in mast cells in response to antigens binding to IgE on the cell surface
251
which antihistamines causes sedation?
1st generation - chlorphenamine
252
which antihistamines don't cross BBB?
fexofenadine
certirizine
loratadine
Do not cause drowsiness
253
In what condition are chlorphenamine antihistamines contraindicated?
severe liver disease due to risk of hepatic encephalopathy
254
what is the dose of certirizine?
10mg tablet once daily
255
what is the dose of chlorphenamine?
4mg tablets
2mg/5ml solution
every 4-6 hours
256
what is the dose of loratidine?
10mg tablets once daily
257
what are 4 examples of antimuscarinics used as bronchodilators?
tiotropium
umeclidinium
glycopyrronium
ipraropium
258
what are 2 respiratory uses of antimuscarinics?
COPD for acute breathlessness
Acute severe asthma and 3rd line in chronic management
259
what is the MOA of antimuscarinics?
competitively inhibit muscarinic receptors in place of acetylcholine
cause increase HR and conduction, reduced smooth muscle tone (GI, GU, Resp), reduce respiratory secretions, relax pupillary and cilliary muscles preventing accomodation
260
what are 5 adverse effects of antimuscarinics?
dry mouth, cough and hoarse voice
Tachycardia
constipation
urinary retention
blurred vision
Drowsiness and confusion
Less likely to have adverse effects when inhaled than with systemic use
261
what are 4 contraindications to antimuscarinics?
angle-closure glaucoma - can cause dangerous rise in orbital pressure
Arrythmias
Urinary retention and BPH
Older age and dementia
262
what type of antimuscarinic is ipratropium?
short acting
263
what dose of ipratropium is prescribed in stable COPD?
50micrograms every 6 hours via INH
264
what dose of ipratropium if prescribed in acute asthma/COPD exacerbations?
500micrograms nebulised every 4-6 hours as require - max dose 2mg
265
what antimuscarinic is used for muscle spasms in IBS?
hyoscine butylbromide
266
what medication is second line for muscle spasm in IBS?
meverine - may be better tolerated than hyoscine butylbromide
267
what antimuscarinics are used for reducing resp secretions in palliative care?
hyoscine butylbromide
Glycopyrronium bromide
268
what antimuscarinics are used for treatment of bradycardia?
Atropine
Glycopyrronium bromide
269
what medication can antimuscarinics interact with?
increased side effects when used in combination with medications with antimuscrinic side effects like TRICYCLIC ANTIDEPRESSANTS
270
what antimuscarinic and at what dose is usually given for bradycardia?
Atropine IV 500 micrograms every 5 mins up to max of 3mg
glycopyronium can also be given but is less readily available
271
what antimuscarinic is usually given or IBS and at what dose?
hyoscine butylbromide (buscapan) 10mg 8 hourly
272
what are 3 examples of antimuscarinics used for overactive bladder syndrome?
solifenacin
Oxybutynin
tolterodine
273
which antimuscarinic used for overactive bladder crossess the BBB and therefore causes confusion?
oxybutynin
274
what is the 1st line management for overactive bladder?
Bladder retraining
avoid caffeine
weight loss
275
what would a typical prescription for overactive bladder be?
tolterodine 2mg PO every 12 hours
276
how long can antimuscarinics used for overactive bladder take to work?
At least 4 weeks
277
What are 4 examples of anti-platelet medications?
Clopidogrel
Ticagrelor
Parasugrel
Aspirin
278
what are 3 indications for anti-platelets?
1 - Treatment of ACS
2 - Secondary prevention of major adverse cardiovascular event
3 - Prevention of stent occlusion
279
what class of medication are clopidogrel, ticagrelor and parasugrel?
ADP-receptor antagonists
280
what is the MOA of non-aspirin anti-platelets (e.g. clopidogrel)?
prevent platelet aggregation by irreversibly (clopidogrel and parasugrel) or reversibly (ticagrelor) binding to adenosine diphosphate (ADP) receptors on the surface of platelets
281
what are 3 adverse effects of non-aspirin antiplatelets?
Bleeding
GI upset - dyspepsia, pain, diarrhoea
Thrombocytopenia rarely
282
what are 4 contraindications to non-aspirin antiplatets?
bleeding - absolute contraindication
Elective surgery in next 7/52
renal impairment
hepatic impairment - especially with impaired clotting
283
co-prescribing non-aspirin antiplatelets with which 3 medication types increases bleeding risk?
anticoagulants
antiplatelets - aspirin
NSAIDs
284
what medications interact with clopidogrel?
any cytochrome P450 inhibitors reduce metabolism from prodrug
omeprazole
ciprofloxacin
erythromycin
antifungals
some SSRIs
Grapefruit juice
285
what PPIs are safe to use with clopidogrel?
lansoprazole
pantoprazole
286
what preparation is clopidogrel available as?
oral only
287
what is the loading dose of clopidogrel?
300mg once
288
what is the maintenance dose of clopidogrel?
75mg OD PO
289
how long should antiplatelets be given after a drug eluting stent is placed?
12 months - to reduce risk of stent thrombosis
290
How long are dual antiplatelets given after CV event or stroke?
12 months
then continue aspirin and stop ADP-receptor antagonist in CVD and vice versa in stroke
291
what is the MOA of Apirin?
irreversibly inhibits cyclooxygenase (COX) to reduce synthesis of the pro-aggregatory factor thrombane from arachidonic acid, reducing platelet aggregation
as irreversibly bound > lasts for lifetime of platelet 7-10 days
292
what are 4 side effects of aspirin?
GI upset
peptic ulceration and haemorrhage
Hypersensitivity and bronchospasm
Tinnitus - in high doses
293
what are the symptoms of aspirin (salicylate) overdose?
Hyperventilation
hearing changes
metabolic acidosis
confusion
cardiovascular collapse
respiratory arrest
294
what are 5 contraindications to aspirin?
Children <16 - Reye's syndrome
Pregnancy in 3rd trimester - may precipitate premature closing od ductus arteriosus
Aspirin/NSAID hypersensitivity
Peptic ulceration
Gout - can trigger attack
295
what formulations of aspirin are available?
oral or rectal
296
what is the loading dose of aspirin?
300mg once
297
what is the usual dose of aspirin?
75mg OD PO
298
what is the maximum daily dose of aspirin?
4g
299
when should gastroprotection be considered in aspirin therapy?
>65 years
comorbidities - diabetes, CVD
previous gastric ulcer
concurrent therapy with other gastric irritant medications - prednisolone, NSAIDs
300
How should aspirin be taken?
after food
301
what are 3 examples of typical (1st gen) antipsychotics?
Haloperidol
chlorpromazine
Flupentixol
302
what are 4 indications for typical antipsychotics?
Rapid tranquillisation
Schizophrenia - especially when metabolic side effects of atypicals are problematic
Bipolar - particularly acutely
Nausea and vomiting - palliative particularly
303
what is the MOA of typical antipsychotics?
block post synaptic dopamine (D2) receptors in 3 pathways - mesolimbic, nigrostriatal, tuberohypophyseal
304
blockade of which neural pathway causes exrapyramidal side effects by antipsychotics?
nigrostriatal pathway - connects substantia nigra to corpus striatum in basal ganglia
305
what are 4 extrapyramidal side effects?
acute dystonia - involuntary contractions
Akathisia - restlessness
Neuroleptic malignant syndrome
Tardive dyskinesia - automatisms e.g. lip smacking
306
what are 6 side effects of typical antipsychotics?
Extrapyramidal side effects
Long QT > Arrhythmias
Drowsiness
hypotension
erectile dysfunction
hyperprolactinaemia
307
what are 3 symptoms of hyperprolactinaemia?
galactorrhoea
menstrual disturbance
breast pain
308
what are 3 cautions in using typical antipsychotics?
older age
Dementia
parkinsons disease
309
what medications interact with typical antipsychotics?
MANY!!
Any that prolong QT - amiodarone, macrolides
310
what is the starting dose for haloperidol in agitation in the elderly?
500 micrograms IM or PO
311
what is the dose of haloperidol in agitation for adults?
1-10mg IM or PO
312
what monitoring is needed for typical antipsychotics?
prolactin at baseline, 6 months and yearly
baseline ECG
313
what medication can be used for intractable hiccups in palliative care?
chlorpromazine 25mg TDS
314
what are 4 examples of atypical antipsychotics?
quetiapine
olanzapine
risperidone
clozapine
315
what are 2 indications for atypical antipsychotics?
Schizophrenia - especially if had extrapyramidal side effects on typicals
Bipolar - particularly acutely
316
what is the difference in the MOA between typical and atypical antipsychotics?
atypicals work on same pathways but also affect 5HT2 receptors and bind more losely to D2 receptors meaning there are fewer side effects and are better at treating treatment resistant schizophrenia
317
what 3 side effects are less common in atypical antipsychotics?
drowsiness
cognitive impairement
extrapyramidal side effects
318
what are 4 side effects of atypical antipsychotics?
Extrapyramidal side effects - less common
Metabolic side effects - more common
long QT > Arrhythmias
Breast symptoms
319
what atypical antipsychotic often causes breast symptoms?
risperidone
320
what atypical antipsychotic often causes metabolic disturbance?
olanzapine
321
what are 2 rare side effects of clozapine?
agranulocytosis - low neutrophils
myocarditis
322
what are 3 metabolic disturbances common with atypical antipsychotics?
diabetes mellitus
weight gain
lipid changes
323
what are 2 contraindications to clozapine?
neutropenia
severe heart disease
324
when should atypical antipsychotics be used with caution?
cardiovascular disease
325
what are 2 medications that atypical antipsychotics should not be prescribed with?
D2 receptor antagonists - antiemetics
drugs that prolong QT
Other sedating drugs
326
How should atypical antipsychotics be taken?
at same time every day - if make drowsy, take at night
327
what monitoring should be done for atypical antipsychotics?
prolactin baseline, 6 months, yearly
Weight, lipid profile, fasting blood glucose baseline, 3 monthly, yearly
328
what extra monitoring is needed for clozapine?
FBC weekly for 18 weeks, then 2/52 for 1 year then monthly
329
what lifestyle factor can alter clozapine metabolism?
Smoking increases metabolism >> stopping smoking can cause rise in clozapine levels
330
what are 2 indications for aciclovir?
Treatment of herpes virus infections including HSV and VZV
Suppression of recurrent herpes simplex attacks happening more that 6x per year
331
what kind of viruses are herpes viruses?
DNA
Includes HSV1, HSV2 and VZV
332
what is the MOA of aciclovir?
enters herpes infected cells and inhibits herpes specific DNA polymerase stopping further replication
333
what are 6 side effects of aciclovir?
headache
dizziness
GI upset
rash
phlebitis - if IV
AKI - can precipitate in renal tubules, minimise risk by infusing slowly into well hydrated patient
334
what are 3 cautions for aciclovir?
pregnancy
breast feeding
severe renal impairment - renally excreted
335
what are 2 interactions for aciclovir?
can increase plasma conc of aminophylline and thenophylline
other nephrotoxic drugs - NSAIDs, methotrexate, antibiotics - aminoglycosides, cephalosporins, trimeth, vacomycin
336
what is the dose of aciclovir for oral or genital HSV outbreaks?
200mg 5x per day PO
337
what is the dose of aciclovir for suppression of recurrent disease?
400mg every 12 hours PO
338
what is the dose of aciclovir in herpes simplex encephalitis?
10mg/kg IV 8 hourly
for 14-21 days
339
what is the dose of aciclovir for VZV treatment?
800mg 5x per day for 7 days
340
what blood need to be monitored for safety in IV aciclovir?
renal function
341
what are 4 bits of self care advice for cold sores and genital herpes?
stay hydrated
topical analgesia
barrier preparations
OTC analgesia
342
what are 5 examples of antivirals?
Oseltamivir
nirmatrelavir
tenofovir
efaverezn
atanazavir
343
what are 3 indications for antivirals?
Treatment of viral infections - e.g. COVID
PrEP or PEP
Treatment to suppress load of hep A/B or HIV
344
what are 4 side effects of all antivirals?
Dizziness
GI upset
Sleep problems
Skin reactions
345
what is a side effect of inhaled zanamivir?
bronchospasm
346
what are 4 adverse effects of long term antivirals?
dyslipidaemia
hyperglycaemia
hypertension
weight gain
^^CVD risk factors
347
what are 4 adverse immune mediated effects of antivirals?
hypersensitivity reaction
hepatitis
blood diseases
severe cutaneous reactions
348
what is the MOA of oseltamivir and zanamivir?
inhibit neuroamidases - surface enzymes needed for viral entry and exit of host cells
349
what is the MOA of molnuparvir and remdesivir?
nucleotide analoges that block viral RNA synthesis
350
what are 2 examples of antiretrovirals?
emtricitibine
tenofovir
efavirenz
351
what is the MOA of antiretrovirals?
non/nucleoside reverse transcriptase inhibitors => inhbit synthesis of DNA from viral RNA
352
non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors are contraindicated in what 2 conditions?
acute porphoria
QT prolongation
353
what is the dose of antiviral for influenza in adults?
oseltamivir 75mg po
zanamivir 10mg IHR
BD for 5 days for treatment
OD for 10 days for prophylaxis
354
what antigen can be tested for to reduce risk of hypersensitivity reaction to abacavir in those who carry it?
human leukocyte antigen
355
what ar 4 examples of benzodiazepines?
chlorodiazepoxide
lorazopam
midazolam
diazepam
356
what are 4 indications for benzodiazepines?
status epilepticus - 1st line
alcohol withdrawal reactions - 1st line
Sedation in palliative care, procedures or rapid tranquilization
Short term treatment of anxiety of insomnia
357
what is the MOA of benzodiazepines?
change shape of GABA receptors to facilitate binding and increase resistance to depolarisation of cells. Causes widespread depression of synaptic transmission leading to clinical effects of anti-anxiety, seizure cessation, sedation and sleepiness
358
How does alcohol affect GABA?
alcohol also increases binding of gaba and increased resistance to depolarisation leading to tolerance. When alcohol is abruptly withdrawn there is a decrease in GABA binding and therefore an increase in neuronal excitability leading to symptoms of alcohol withdrawal
359
what are 4 adverse effects of benzodiazepines?
drowsiness, sedation, coma
overdose - resp depression (less than opioids) and death due to loss of airway reflexes
Dependance
withdrawal effects
360
what is the best choice of benzo in liver failure?
lorazepam - less dependant on liver for elimination
361
what are 4 conditions to be cautious with when prescribing benzodiazepines?
the elderly - may need reduced dose
Respiratory impairement
Neuromuscular disease
Liver failure
362
363
using benzodiazepines with what medications may increase their effects?
cytochrome P450 inhibitors - amiodarone, macrolides, diltiazem, fluconizole, protease inhibitors
364
365
366
what medication(s) and what dose is usually given for stopping a seizure?
lorazepam 4mg IV
Diazepam 10mg IV
Midazolam 10mg buccally
367
what are 3 choices of benzodiazepines in alcohol withdrawal?
chlordiazepoxide - usually
Lorazepam
Diazepam
368
what benzodiazepine is preferred for procedural sedation?
midazolam as short acting
369
what is the antagonist to benzodiazepines?
Flumazenil
not usually used as can precipitate seizures
370
what are 4 examples of beta-agonists?
Salbutamol
Salmeterol
Formeterol
Indacaterol
371
what are 2 indications for beta agonists?
Asthma
COPD
372
what is the MOA of beta-agonists?
acts on beta receptors in smooth muscle of bronchi, gut, uterus and blood vessels leading to smooth muscle relaxation and bronchodilation
Also cause increased action of ATPase which shifts K+ into intracellular compartment causing hypokalaemia - beneficial in Tx of hyperkalaemia
373
what are 9 side effects of beta-agonists?
Fine tremor
tachycardia
palpitations
anxiety
headache
Hypokalaemia
Raised lactate
hyperglycaemia
muscle cramps - LABAs
374
what should always be prescribed with a LABA?
steroids
375
when should there be caution in prescribing beta-agonists?
in CVD as tachycardias may lead to tachyarrhythmias
376
what is a usual PRN prescription for salbutamol?
100-200 micrograms IHR PRN
377
what is the usual nebulised prescription of salbutamol?
2.5 mg nebulised 4 hourly
378
How long before LABA therapy can be 'stepped down'?
3 months
379
what are 2 medications that when used with beta-agonists can increase risk of hypokalaemia?
thenophylline
corticosteroids
380
what are 5 examples of beta blockers?
Atenolol
Bisoprolol
Propanolol
Metoprolol
Carvedilol
381
what are 7 indications for beta blockers?
ischaemic heart disease - improves outcomes in angina and ACS
Heart failure - improves prognosis
AF - reduces ventricular rhythm and increases time spent in sinus
SVT - to restore sinus rhythm
Resistant HTN - 4th line
Prophylaxis of migraine
Thyrotoxicosis - for symtoms
382
what is the MOA of beta blockers?
act on beta1 adrenoreceptors to decrease heart rate and contractility
383
what are 7 side effects of beta blockers?
cold peripheries
fatigue
headache
GI upset
sleep disturbance
nightmares
impotence
384
what are 3 contraindications to beta blockers?
asthma
heart block
hypotension
385
what are 2 conditions to be cautious when prescribing beta blockers in?
Heart failure - start slowly and titrate
hepatic failure - may need dose reduction
386
what medication should not be used with beta blockers?
non-dihydropyridine calcium channel blockers - verapamil, diltiazem
may cause heart failure, bradycardia, asystole
387
when may IV beta blockers be needed?
SVT and AF - when quick action is needed
388
what advice should be given to those with heart failure being prescribed a beta blocker?
symptoms may initially get worse - seek medical advice is this occurs
389
what HR should be aimed for with beta blockers in IHD?
55-60 BPM
390
what measurement can be useful in initiation of beta blockers in heart failure?
daily weights for accumulation of fluids
391
How should beta blockers be stopped?
slowly over 2 weeks
abrupt withdrawal can lead to increased risk of Myocardial ischaemia
392
what are 4 examples of bisphosphonates?
alendronic acid
risendronate
disodium pamidronate
Zolendronic acid
393
what are 4 indications for bisphosphonates?
osteoporosis prevention - alendronic acid or risendronate 1st line
Hypercalcaemia due to malignancy - zolendronic acid and pamidronate
Bone mets - myeloma and breast Ca - reduce risk of pathological fracture
Paget's disease of the bone
394
what is the MOA of bisphosphonates?
reduce bone turn over by inhibiting osteoclast activity and promoting apoptosis
395
what are 4 side effects of bisphosphonates?
Osteonecrosis of jaw - more common with IV
oesophagitis
hypophosphataemia
atypical femoral fractures
396
How are bisphosphonates excreted?
renally
397
what are 3 contraindications to bisphosphonates?
severe renal impairment
hypocalcaemia - check levels before commencing
upper GI disorders
398
what are 2 cautions in prescribing bisphosphonates?
smokers - increased risk of osteonecrosis of jaw
dental disease
399
what are 3 things that bisphosphonates interact with?
calcium salts including in milk
antacids
iron salts
should not be taken with any of these
400
who can take a weekly dose of bisphosphonate?
women
401
what is the usual dose of alendronic acid for osteoporosis?
10mg OD PO or 70mg once weekly PO
once weekly only in women
402
How long may it take for bisphosphonates to lower calcium levels in hypercalcaemia?
up to 1 week/10 days
403
How should bisphosphonates be taken orally?
Swallowed whole at least 30 minutes before breakfast or any other medications and taken with plenty of water
The patient should remain upright for at least 30 minutes after taking them
404
what advice needs to be given to people taking bisphosphonates?
Indication
Advice on how to take
symptoms of osophagaetis
Advise to see dentist
Advice on dosing especially in once weekly preparations
405
what needs to be monitored in bisphosphonates?
DEXA every 3-5 years
side effect monitoring
Blood for calcium levels
406
what are 2 vitamin D formulations?
colecalciferol
alfacalcidol
407
what are 2 types of calcium tablets?
calcium carbonate
calcium gluconate
408
what are 4 indications for calcium and vitamin D?
osteoporosis
CKD - for secondary hyperparathyroidism and renal osteodystrophy
Severe Hyperkalaemia - to prevent life threatening arrythmia
Hypocalcaemia - <1.9, or symptomatic
Vitamin D deficiency prevention and treatment
409
what are 5 symptoms of hypocalcaemia?
tetany - involuntary muscle contractions
seizure
parasthaesia
confusion
stiff, achy muscles
410
How does vitamin D help to absorption of calcium?
stimulating intestinal calcium and phosphorus absorption
stimulates bone calcium mobilization, increases renal reabsorption of calcium in the distal tubule
411
what are 2 side effects of oral calcium?
dyspepsia
constipation
412
what are 2 side effects of IV calcium gluconate?
tissue damage if accidentally given SC
Hypotension with rapid administration
413
what are 4 medications that oral calcium decreases absorption of?
Iron
bisphosphonates
levothyroxine
tetracyclines (doxy)
414
what is one medication that should not be mixed IV with calcium?
sodium bicarb - can cause precipitation
415
what is a usual dose of calcium in osteoporosis?
1 -1.2 g OD PO
416
what is the usual dose of vitamin D in osteoporosis?
400-800 units OD PO
417
what are the 2 different types of vitamin D?
D2 - from plant sources
D3 - from animal fats
418
what is the dose of calcium in severe hyperkalaemia?
30 ml calcium gluconate 10% for slow IV injection
419
How far apart should calcium and interacting medications be taken?
4 hours apart
420
what are 3 foods that could interact with calcium tablets and how far apart should they be eaten?
spinach
whole cereals
bananas
2 hours apart
421
what is the monitoring required for calcium administration?
ECG monitoring if IV
Serum calcium levels at regular intervals
422
how much stronger is calcium gluconate compared to calcium carbonate?
3X more calcium
423
what is the loading dose of vitamin d in deficiency?
50 000 units for 6 weeks
424
what are 5 examples of calcium channel blockers?
amlodipine
finodipine
nifedipine
diltiazem
verapamil
425
what are 3 indications of calcium channel blockers?
Tx of HTN
Angina control in IHD
Diltiazem and verapamil only - Rhythm control for supraventricular arrhythmias
426
what is the MOA of calcium channel blockers?
decrease calcium ion entry into vascular and cardiac cells reducing intracellular calcium concentration which causes relaxation and vasodilation in arterial smooth muscle
reduce cardiac contractility in heart by suppressing cardiac conduction through AV node => reduces myocardial demand => reduces angina
427
what type of calcium channel blockers are more selective for the heart?
non-dihydropyridines - verapamil (most cardio-selective), diltiazem
428
what type of calcium channel blockers are more selective for the vessels?
dihydropyridines - amlodipine, felodipine
429
what are 4 common side effects of amlodipine and nifedipine?
ankle swelling
flushing
headache
palpitations
430
what are 4 side effects of verapamil?
constipation
bradycardia
heart block
heart failure
431
what is the side effect profile of diltiazem?
can have all calcium channel blocker side effects
ankle swelling, flushing, headache, palpitations, constipation, bradycardia, heart block and heart failure
432
what are 2 conditions where verapamil and diltiazem should be used with caution?
impaired L ventricular function
Heart block/Av node delay
433
what are 2 contraindications to amlodipine and nifedipine?
unstable angina - vasodilation causes reflex increase in HR => increases angina
severe aortic stenosis - can cause collapse
434
what medication should non-dihydropyridine calcium channel blockers be prescribed with?
Beta blockers - both negatively inotropic
435
what is the only calcium channel blockers that can be given IV?
verapamil
436
how should modified release calcium channel blockers be prescribed?
with the brand name as bioequivalence differs
437
what is a standard dose of amlodipine for HTN?
5-10mg PO OD
438
what is a standard dose of MR diltiazem for angina?
90mg PO 12 hourly
439
what is the dose of verapamil for supraventricular arrhythmias?
40-120mg PO 8 hourly
440
what should be communicated with the patient when prescribing calcium channel blockers?
indication
measures to reduce other CVD risk factors
common side effects - ankle swelling
441
what are 2 indications for carbamezpine?
Seizures - 2nd line in focal
Trigeminal neuralgia
442
what is the MOA of carbamezapine?
not fully known
inhibits neuronal sodium channels stabilising resting membrane potentials and inhibiting repeated firing
443
what are 6 side effects of carbamezpine?
GI upset
neurological effects - dizzy, ataxia
oedema
hyponatraemia
skin rashes
hypersenitivity reactions and SJS/TEN
444
what genetic component is associated with carbamezpine and Steven johnson syndrome and what population is most affected?
HLA B-1502 allele
Han Chinese and Thai people
445
what can carbamezapine cause in pregnancy?
neural tube defects
cardiac and urinary tract abnormalities
cleft palate
446
what are 3 conditions to use carbamezapine with caution in?
hepatic, renal or cardiac disease
increased risk of toxicity
447
what medications does carbamezapine interact with?
is a cytochrome P450 INDUCER
reduces - warfarin, oestrogen, progesterones - metabolised by CYP450
carbamezpine conc is increased by CYP450 INHIBITORS - as also metabolised by CYP450
efficacy reduced by drugs that lower seizure threshold - antipsychotics, tramadol
interacts with other antiepileptics
448
how can carbamezapine be administered?
oral or rectal
449
what is the max dose of carbamezapine?
1.6g per day in divided doses
450
what is the usual starting dose of carbamezapine?
100-200mg OD PO
increase gradually to tolerance
451
what symptoms should patients started on carbamezapine be warned of?
signs of hypersensitivity
skin rashes, bruising, bleeding
high temperature, mouth ulcers - blood toxicity
reduced appetitie, abdo pain - liver toxicity
CONTRACEPTION
452
what is the driving advice for focal seizure epilepsy?
12 months seizure free or 6 months after withdrawal/change of medication
453
what are 3 cephalosporins?
cefalexin
ceftriaxone
cefuroxime
454
what are 2 carbopenems?
meropenem
ertapenem
455
what are oral cephalosporins used for?
2nd/3rd line in UTI and pneumonia/other resp tract infection (epiglotitis)
456
what are IV cephalosporins and carbopenems used for?
Very severe/complicated infections or antibiotic resistant infections
457
what is the activity of cephalosporins and carbopenems?
broad spectrum
increasing generations of cephalosporins increase activity against gram negatives
458
what is the MOA of cephalosporins and carbopenems?
contain BETA LACTAM RING
inhibit enzymes responsible for cross linking of peptidoglycan walls which weakens bacterial cell wall
459
what are 4 side effects of cephalosporins and carbopenems?
GI upset
C.Diff and antibiotic associated collitis
Hypersensitivity reaction - not concern for mild penicillin allergies
seizures
460
what are 2 cautions for cephalosporins and carbopenems?
renal impairment - requires dose reduction
at risk of C. DIff - older
461
what are 2 interactions for cephalosporins and carbopenems?
Enhance effect of warfarin - kill normal gut flora that synthesise vit K
Carbapenems - reduce plasma conc and efficacy of valporate
462
what is the usual adult dose of cephalosporin for bacterial meningitis?
Ceftriaxone 4mg IV OD
463
what is ertapenem?
a carbopenem that is administered once daily
464
what are the formulations of meropenem?
IV
465
what are the formulations of cephalosporins?
oral - suspension, tablet, capsule
IV/IM injection
466
what are 2 indications for general anaesthetic agents?
general anaesthesia
sedation
467
what are 3 IV general anaesthetics?
propofol
thiopental
ketamine
468
what are 2 inhaled general anaesthetic agents?
sevoflurane
nitrous oxide
469
what is the general MOA of general anaesthetics?
lipid soluble molecules that disrupt neuronal cell membranes especially potassium channels either directly or indirectly though disrupting crystallin lipids that surround them
Either enhance action of GABA (inhibitory neurotransmitter) or decrease action of NMDA (excitatory neurotransmittter) or nichotinic cholinergic receptors
470
what is one key side effect of propofol?
pain on injection
471
what are 3 common side effects of general anaesthetics?
bradycardia
Hypotension
vasodilations
472
which general anaesthetics does not cause brady, hypotension and vasodilation?
Ketamine - may cause hypertension and tachy
473
what is a common post operative side effect of general anaesthetics?
nausea and vomiting
474
what classification system is often used for anaesthetic ris§k?
american society of anaesthesiologists classification
475
what medications do general anaesthetics enhance the effect of?
other medications that reduce consciousness and cardiorespiratory function - benzos, opioids
476
what monitoring is needed with general anaesthetics?
BP
HR
RR
sats
Temp
ECG
End tidal CO2 - capnograph
477
what is the MOA of chloramphenicol?
Binds to ribosomes therefore inhibiting protein synthesis
bacteriostatic and can be bacteriocidal
478
what are 3 side effects of topical chloramphenicol?
stinging
burning
itching
479
what are 4 side effects of systemic chloramphenicol?
Dose related bone marrow suppression
Aplastic anaemia
Grey baby syndrome - neonates cannot alway metabolise
optical and peripheral neuritis
480
what are 5 contraindications to chloramphenicol?
Hypersensitivity
Bone marrow disorder
3rd trimester pregnancy
Breastfeeding
< 2 years
481
what is 1 caution in systemic chloramphenicol use?
hepatic impairement
482
what are 2 thing to communicate with patients having chloramphenicol eye drops?
may blur vision and do not drive is vision blurred
Avoid use of contact lenses
483
ho long should a course of chloramphenicol eye drop be?
48 hours after healing
484
what is the spectrum of clindamycin?
gram positive aerobes and anaerobes
485
what is the MOA of clindamycin?
binds to ribosomes and prevents protein synthesis
486
what are 6 side effects of clindamycin?
diarrhoea
Abdo pain
rashes and SJS
Abnormal liver enzymes
Antibiotic related colitis - C. diff
487
what is 1 contraindication to clindamycin?
acute porphyria
488
what is 1 condition to use clindamycin with caution in?
IBD
489
what is one interaction with clindamycin?
can increase effect of neuromuscular blocking drugs => delays postoperative recovery
490
what dose of topical clindamycin is used in acne?
1/2% once a day applied thinly
491
how should clindamycin be administered IV?
diluted in 5% glucose or normal saline and given over 10-60mins
492
what is the length of clindamycin course in acne?
6 months minimum
493
