Year 3 > Block 34 Pharm > Flashcards

Block 34 Pharm Flashcards

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1
Q

Anti-proliferative agents?

A

azathioprine and cyclophosphamide

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2
Q

Calcaneurin inhibitors?

A

Ciclosporin and tacrolimus

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3
Q

Drugs used in transplant immunosuppession?

A
  • ciclosporin
  • tacrolimus
  • azathioprine
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4
Q

Cyclophosphamide uses?

A

treatment of immune based renal disease i.e. Wegener’s granulomatosis, types of glomerulonephritis or SLE

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5
Q

Azathioprine mechanism?

A
  • metabolised to mercaptopurine
  • purine synthesis inhibition
  • inhibits B and T cells
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6
Q

Cautions of azathioprine?

A

reduce dose in elderly and TMPT activity

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7
Q

Azathioprine interactions?

A
  • allopurinol
  • BCG
  • febuxostat
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8
Q

Side effects of azathioprine?

A
  • bone marrow depression
  • leucopenia
  • infections
  • thrombocytopenia
  • pancrwatitis
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9
Q

Screening w azathioprine?

A

TMPT activity - increased risk of myelosuppression w reduced TMPT activity

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10
Q

cyclophosphamide mechanism?

A
  • alkylating agent
  • used to treat lymphomas and leukemias
  • attaches to alkyl groups, fragmenting DNA
  • DNA damage by forming cross links
  • mispairing the nucleotides leading to mutations
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11
Q

cautions of cyclophosphamide?

A
  • acute porphyrias
  • DM
  • haemorrhagic cystitis
  • previous or concurrent mediastinal irradiation—risk of cardiotoxicity
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12
Q

interactions of cyclophosphamide?

A
  • BCG
  • vaccines
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13
Q

side effects of cyclophosphamide?

A
  • alopecia
  • agranylocytosis
  • haemolytic uraemic syndrome
  • sperm abn
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14
Q

cyclosporin mechanism?

A
  • IS
  • calcaneurin inhibitor that inhibits T cell activation
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15
Q

Tacrolimus mechanism?

A

calcaneurin inhibitor

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16
Q

CI of cyclosporin?

A
  • malignancy
  • uncontrolled HTN
  • infections
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17
Q

Ciclosporin interactions?

A
  • aliskiren
  • amiodarone
  • atorvostatin
  • vaccines
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18
Q

side effects of ciclosporin?

A
  • eye inflammation
  • decreased appetite
  • HTN
  • hyperuricaemia
  • renal impairment
  • peptic ulcer
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19
Q

tacrolimus CI?

A
  • malignant skin lesions
  • infection
  • cautions: avoid UV light
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20
Q

Tacrolimus interactions?

A
  • amiodarone
  • BCG
  • cobicstat
  • clarithromycin
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21
Q

SE of tacrolimus?

A
  • inc infections
  • skin reactions
  • sensation abn
  • peripheral neuropathy
  • alopecia
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22
Q

tacrolimus in children?

A

cardiomyopathy - inc risk

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23
Q

Oxybutynin mechanism?

A
  • antimuscarinic
  • reduces detrusor activity, relaxing bladder
  • prevents urge to void
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24
Q

oxybutynin is used for

A

OAB

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25
CI for AMs like oxybutynin?
- closed angle glaucoma - GI obstruction - MG - paralutic ileus - sig bladder outflow obst - urinary retention
26
side effects of all antimusacrinics?
- const - dry mouth - dizziness - flushing - headache - urinary disordrers
27
oxybutynin side effects?
- diarrhoea - dry eye
28
muscarinic receptor antagonists?
Oxybutinin & Tolterodine
29
Use of antimuscarinics?
Overactive bladder syndrome, urge predominant incontinence
30
Tolteridone is a ?
AM
31
Cautions of tolerodine?
QT prolongation
32
SE of tolterodine?
- bronchitis - parasthesia - peripheral oedema - parasthesia
33
Alpha1-adrenoceptor antagonists?
Doxazosin and tamulosin
34
Doxazosin and tamulosin used for?
BPH
35
Doxazosin mechanism?
- alpha 1 adrenergic receptor antagonist - antagonism causes smooth muscle relaxation in the prostate and bladder, effectively relieving urinary frequency, urgency, weak urinary stream,
36
Tamulosin mechanism?
- alpha receptor blocker - relaxes SM in the prostate allowing urine to flow
37
Doxazosin CI?
- Postural hypotension - history of micturition syncope - monotherapy in ppts w overflow bladder
38
interactions of D?
- Slidenafil and avanafil
39
side effects of doxazosin?
- arrythmias - cystitis - dry mouth - oedema
40
Tamsulosin interactions?
- slidenafil
41
Tamsulosin CI?
- micturition syncrope - hisory of postural hypotension
42
SE of tamsulosin?
dizziness and sexual dysfunction
43
Dutasteride mechanism?
inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone.
44
SE of dutasteride?
breast disorders, sexual dysfunction
45
Finasteride Mx?
inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone.
46
Finasteride safety info?
suicidal thoughts and depression
47
cautions of finasteride?
obstructive uropathy
48
SE of finasteride?
sexual dysfunction
49
What are the 5-AR inhibitors?
Finasteride and dutasteride
50
Antimicrobial agents for urinary infections ?
- Trimethoprim (UTI) - Nitrofurantoin (UTI) - Co-amoxiclav (pyelonephritis) - Ciprofloxacin (pyelonephritis) - Gentamicin (serious gram -ve infections)
51
Drugs used for UTIs?
trimethoprim and nitrofurantoin
52
Drugs used for Pyelo?
ciprofloxacin and Co-amoxiclav
53
Drugs used for severe gram - UTI?
gentamicin
54
Trimethoprim?
- dihydrofolate reductase inhibitor preventing synthesis of nucleic acids - bacteriacidal activioty
55
CI of trimethoprim?
blood dyscrasias
56
Cautions of trimethoprim?
acute porphyrias, predisposition to folate def
57
Int of trimethoprim?
- azathioprine - clozapine - methotrexate - warfarin
58
SE of trimethoprim?
- diarrhoea - electrolyte imbalance - headache - skin reactions
59
trimethoprim can cause?
- agranulocytsosis - angiodema - haemolysis
60
Trimethoprim is a ?
teratogen. Risk in T1
61
nitrofurantoin mechanism?
- inhibit the citric acid cycle as well as synthesis of DNA, RNA, and protein - rapidly reduced to produce reactive intermediates that attack DNA
62
nitrofurantoin safety info?
resp symptoms and acute pulmonary reactions
63
CI of nitrofurantoin?
- GDP6 deficiency - acute porphyrias
64
cautions of nitrofurantoin?
- DM - folate def - vitamin B def - pulm disease
65
SE of nitrofurantoin?
- agranulocytosis - angiodeme - aplastic anaemia - pulm reaction
66
Nitrofurantoin - avoid at?
term - can produce neonatal haemolysis
67
Co-amoxiclav mechanism?
- inhibits PBP preventing corss linkage of subunits - clauvanic acid: beta lactamse inhibitor used to enhance effectiveness of beta lactams
68
CI of co-amox?
- history of co-amoc assoc jaundice or hepatic dysfunction - history of penicillin assoc jaundice or hepatic dysfunction
69
Cautions of co-amox?
- ALL - risk of rashes - CLL - rashes - hydration
70
interactions of co-amox?
methotrexate
71
SE of co-amoxiclav?
diarrhoea, hypersen, skin reactions, thrombocytopenia
72
common side effect of co-amox?
inc risk of infection, diarrhoea
73
ciprofloxain is a ?
quinolone
74
# TWO CI of quinolones?
- QT prolongation - UV exposure - GPD6 def
75
side effects of quinolones?
- dec appetite - asthenia - constipation - QT prolongation - peripheral neuropathy - C diff
76
ciprofloxacin mechanism?
- bacterial topoisomerase II (DNA gyrase) and 4 - Targeting DNA gyrase prevents supercoiling the DNA
77
gentamicin mechanism?
- aminoglycoside - 30s ribosome inhibition
78
# A NM condition CI of aminoglycosides?
- MG - they impair NM transmission - auditory disorders
79
SE of all aminoglycosides?
- aphonia - bronchospasm and cpigh - haemoptysis - RI
80
Imp side effects of AG?
- ototoxicity - nephrotoxicity - occurs more w RI
81
Phosphodiesterase type 5 inhibitors?
- Sildenafil & Tadalafil - for Erectile dysfunction
82
Slidenafil and Tadalfil mechanism?
- PDE-5 inhibition - leads to SM relaxation - vasodilation
83
Slidenafil CI?
- recent MI or stroke - degenerative retinal disorders - hypotension
84
cautions of slidenafil?
- active peptic ulceration - autonomic dysfunction - bleeding disorders - myeloma
85
slidenafil interactions?
- clarithromycin - cobicstat - doxazosin - GTN and other vasodilators
86
SE of slidenafil?
- alopecia - GI disorders - infection - night sweats - vasodilation
87
Tadalafil CI?
- acute MI - hypotension - optic neuropathy - HF - recent stroke
88
tadalafil SE?
- flushing - GI discomfort - headaches - nasal congestion
89
alprostadil mechanism?
- Prostaglandin E1 agonist - relaxes SM - promotes vasodilation
90
Humulin-S ?
quick acting human insulin
91
Insulin lispro?
analogue quick acting
92
Insulin aspart?
analogue quick acting
93
Insulatard?
human iosphane
94
Humulin M3?
Human biphasic
95
Humalog Mix25?
analogue biphasic
96
Insulin glargine?
anologue long acting
97
Insulin degludec?
analogue long acting
98
insulin mechanism?
- promotes glucose and AA uptake into muscle and adipose tissues - except liver and brain - inhibits gluconeogenesis in the liver - anabolic role in stimulating glycogen, FA and protein synthesis
99
insulin interactions?
- clarithromycin
100
side effects of all insulins?
- oedema - lipodystrophy
101
Sulfonylureas?
- Gliclazide - Glimepiride
102
Glicazide mechanism?
- binds to the SUR1 receptor blocking ATP sensitive k+ channels - decreased potassium eflux -> depolarisation of b cells - exocytosis of insulin granules
103
glimepiride?
- SU - promotes insulin secretion by binding to potassium channels
104
CI of all sulfonreas?
Ketoacidosis
105
cautions of all sulfonylureas?
- elderly - can cause weight loss - GDP6 def
106
side effects of all SU?
- abd pain - diarrhoea - hypoglycaemia - nausea - agranulocytosis
107
Meglitinides?
Repaglinide
108
Repaglinide mechanism?
- potentiates the effect of EC glucose on K+ channels - closes K+ channels, depolarising B cells, opening Ca+ channels, causing calcium influx -> insulin secretion
109
CI of Repaglinide?
ketoacidosis
110
Repaglinide interactions?
clopidogrel
111
side effects of Repaglinide?
- abd pain - diarrhoea - hypogly
112
Metformin mechanism?
- decreasing gluconeogenesis in hepatocytes - increases peripheral utilisation of glucose
113
CI of metformin?
- acute metabolic acidosis - lactic acidosis and DKA
114
metformin - RF for lactic acidosis?
- chronic hF - drugs that impair renal function - interrupt tx if dehydration occurs - tissue hypoxia
115
# Long term use can lead to... metformin SE?
- abd pain - dec appetite - diarrhoea - b12 def - lactic acidosis
116
GI side effects of metformin?
Gastrointestinal side-effects are most frequent during treatment initiation and usually resolve spontaneously. A slow increase in dose may improve tolerability.
117
biguanide =
metformin
118
Thiazolidinediones =
pioglitazone
119
pioglitazone mechanism?
- PPAR agonist -> transcription of insulin genes - reduces hepatic gluconeogenesis - in adipose tissues, skeletal muscle and liver - reduced peripheral resistance to insulin
120
pioglitazone safety info?
- HF espec when past MI - risk of bladder cancer
121
CI of pioglitazone?
- DKA - HF - prev/ active nladder cancer
122
cautions of pioglitazone?
- use w insulin - risk of HF - risk of bC - Elderly
123
interactions of pioglitazone?
- clopidogrel
124
side effects of pioglitazone?
- bone factures - infections - numbness - increased weight - bladder cancer
125
# How does this drug class work? Linagliptin?
- DPP-4 inhibitor -> slows breakdown of GLP-1 and GIP - GLP1 and GIP stimulate insulin release and prevent glucagon release
126
linagliptin is not
affected by renal impairment
127
DPP4 inhibitorS?
- Linagliptin (not affected by renal function) -- Sitagliptin - Saxagliptin
128
cautions of linagliptin?
pancreatitis
129
SE of linagliptin?
- angioedema - cough - nasopharngitis - panc
130
Saxagliptin SE?
- abd pain - fatigue - panc - vomiting - angioedema
131
Side effects of sitagliptin?
- renal impairment - acute panc - angioedema - headache
132
Acarbose mechanism?
- inhibitor of alpha glucosidases and amylase - delays and prevents digestion and abs of starch and carbs -> reducing BG
133
CI of acarbose?
- hernia - IBD - malabs - intestinal obst
134
cautions of acarbose?
- can enhance hypoglycaemia when used w insulin and SU
135
Hypoglycaemia with acarbose is treated w?
oral glucose but not sucrose
136
side effects of acarbose?
- Diarrhoea - GI discomfort - GI disorders
137
ɑ-Glucosidase inhibitors =
acarbose
138
SGLT2 inhib?
- Canagliflozin - Empagliflozin
139
SGLT2 inhib mechanism?
- SGLT2 found in PCT - inhibition lowers reabs of flitered glucose in the body -> inc glucose excretion in urine
140
Canagliflozin safety info?
- DKA - lower limb amputation - Fournier's gangrene
141
CI of canagliflozin?
- DKA - T1D - inc DKA risk
142
SE of canagliflozin?
-const - dyslipidemia - hypoglycaemia - when used w insulin or SU - infections, urosepsis
143
empagliflozin CI?
- dka - t1d
144
side effects of empagliflozin?
- const - hypo - hypovolaemia - fourner's gangrene - urosepsis
145
Glucagon like peptide-1 (GLP-1) mimetics
- Dulaglutide - Liraglutide - Semaglutide
146
Dulaglutide action?
- helps glucose dependent insulin secretion - slows gastric emptying
147
GLP-1 analogues safety info?
- DKA when used w insulin especially on discontinuation of insulin
148
CI of dulaglutide?
severe GI disease
149
SE of dulaglutide?
- appetite decreased - const - hypoglycaemia - GB - acute panc
150
CI of liraglutide?
- IBD - diabetic gastroparaesis
151
SE of liraglutide?
- asthenia - const - GB disorders - panc
152
semaglutide=
ozempic
153
semaglutide CI?
DKA, pancreatitis
154
SE of semaglutide?
- cholethiasis - hypoglycaemia when used w other drugs - weight loss - panc
155
glucagen hypokit=
- glucagon
156
CI of glucagen hypokit (glucagon)
- starvation - adrenal insufficiency - glucagoma
157
interaction of glucagen hypokit?
warfarin
158
SE of glucagen hypokit?
- nausea - vomiting - tachycardia, HTN, hypotension
159
glucagon mechanism?
- raised BG through activation of hepatic glucagon receptors stimulating glycogenolysis and release of glucose
160
when is glucagon used?
hypoglycaemia
161
IV Glucose =
Intravenous 20% Glucose
162
glucose cautions?
- prolonged use can lead to hyponatreamia
163
SE of glucose?
- chills - electrolyte imbalance - venous thrombosis - polyuria
164
glucose mechanism?
- converted to fat -> energy source - in liver and muscles -> glycogen
165
Carbamazole safety info?
- neutropenia and agranulocytosis - congenital malformations - risk of acute panc
166
SE of carbimazole?
- bone marrow disorders - haemolytic anaemia - SCARs - angranulocytosis
167
carbimazole mechansim?
- decreases iptake of iodine by thyrpid - prevents thyroid perioxidase from iodinating tyrosine residues on thyroglobulin -> red production of T3 and T4
168
Thionamides =
- Carbimazole - Propylthiouracil
169
proprylthiouracil mechanism?
- binds to thyroid perioxidase inhibiting conversion of iodide to iodine - inhibts production of new thyroid hormones
170
propylthiouracil SE?
- agranulocytosis - BM disorders - glomerulonephrotis - hearing impairment - hepatic reactions
171
which thionamide is safe in pregnancy?
PTU
172
B blocker used for hyperthyroidism?
propanolol
173
Radioiodine and oral iodine solutions =
- Radioiodine (I131) - Aqueos Iodine oral solution
174
Radioiodine I-131 indications?
Tx of hyperthyroidism and thyroid carcinomas
175
mechanism of radioiodine?
- iodine concentrates in thyroid via soidum/ iodide transporte - destruction of thyroidal tissue by beta emission of sodium iodidie
176
radioiodine SE?
- conjunctivitis - ED - influenza like illness - rash
177
levothyroxine CI?
thryotoxicosis
178
side effects of levothyroxine?
- angina - hyperhidrosis - palpitations - thryotoxic crisis - weight loss
179
levothryoxine mechanism?
- inc metabolic rate - decreases TSH production
180
Hydrocortisone has equal?
gluco and mineralocorticoid action
181
hydrocortisone ix?
- thyrotoxic crisis - adrenal insufficency - adrenal crisis - asthma
182
CI of all corticosteroids?
- live caccines in those receiving immunosppresive doses - systemic infection
183
SE of all corticosteroids?
- cushings syndrome - fluid retention - HTN - osteoporsis - hirtutism - peptic ulcr
184
steroids - adrenal suppression?
- prolonged use -> adrenal atrophy - abrupt withdrawal -> adrenal insufficiency, death or hypotension
185
other side effects of steroids?
- psychiatric - euphoria, insomnia, mood lability, suicidal thoughts, psychotic reactions - infections
186
glucocorticoids =
- Hydrocortisone - Prednisolone - Dexamethasone
187
corticosteroids mechanism?
- dec vasodilation - inhibition of neutrophils - inhibit phospholipase A2
188
prednisolone exerts...
predominantly glucocorticoid effects with minimal mineralocorticoid effects.
189
SE of pred?
- diarrhoea - dyslipidaemia - protein catabolism
190
dexamethasone has a....
very high glucocorticoid activity and insignificant mineralocorticoid activity.
191
Fludrocortisone is a
mineralacorticoid
192
fludrocortisone Mx?
- binds to mineralocorticoid receptors causing inc density of Na/K/ ATPase - inc BP, inc sodium levels - decreased plasma K+
193
synthetic human GH =
Somatropin
194
somatotropin Mx
- HGH - stimulates prod of IGF-1, inc conc of glucose amd FFA
195
Somatotropin indications?
- turner syndrome - GH def
196
CI of somatotropin?
- evid of tumour activity
197
SE of somatotropn?
- CTS - fluid retention - lipoatrophy - oedema - parasthesia
198
Somatotropin - fundoscopy when
Funduscopy for papilloedema recommended if severe or recurrent headache, visual problems, nausea and vomiting occur - benign intercranial hypertension
199
Tetracosactide =
synthetic ACTH
200
Tetracosactide indications?
- adrenal insufficiency
201
Tetracosactide CI?
- Acute porphyrias - asthma - cushins - peptic ulcer - primary adrenal insufficiency
202
Tetracosactide SE?
- angiodema - fractures - worseneed diabetes - exopthalmus - cushings
203
Tetracosactide mechanism?
- diagnosis of adrenal insufficiency - synthetic ACTH - in normal ppts, causes synthesis of adrenal cteroids - doesn't inc plasma cortisol conc w primary or secondary AI
204
Cabergoline mechanism?
- dopamine agonist - D2 receptors - Dopamine inhibits prolactin
205
indications of cabergoline?
- prevents and suppresses lactation
206
safety info w cabergoline?
- Cabergoline has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions. - impulse control disorders
207
CI of cabergoline?
- pericardial fibrosis - psychosis - pre-eclampsia - peptic ulcers
208
cabergoline interactions?
clarithro, erythromycin
209
cabergoline SE?
- angina - confusion - sexual dysfunction - hallucinations
210
D2 agonists =
Cabergoline & Quinagolide
211
Sustanon =
test esters
212
Testosterone (sustanon and testogel) ix?
androgen def
213
testosterone interactions?
- alc - daleteparin - enoxaparin
214
Bisphosphonates =
- Alendronic acid - Residronate - Zolendronic acid
215
bisphosphonates indications?
- post meno osteoporosis - osteoporosis in men
216
bisphosphonates safety info?
- atypical femoral fractures - osteonecrosis of the jaw and external auditory canal
217
CI of bisphosphonates?
- hypocal - oesophageal abn - strictures and achalasia
218
Bisphosphonates SE?
- ANAEMIA - Oesophageal ulcer - oesophagitis - renal impairment
219
vitamin D compounds?
- Alfacalcidol (1a-hydroxycholecalciferol) - Calcitriol (1,25-dihydroxycholecalciferol) - Ergocalciferol (vitamin D2)"
220
alfacalcidol =
1a-hydroxycholecalciferol, needs activating
221
calcitrol =
1,25-dihydroxycholecalciferol = ACTIVATED
222
ergocalciferol =
vitamin D2, inactivated vitamin D
223
ergocalciferol Indications?
- primary prev of Vitamin D def - treatment of vitamin D def - hypocalcaemia of hypoparathyroidism
224
CI of all vitamin D analogues - calciferols?
- hypercal - metastatic calcification
225
side effects of all vitamin D analogues?
- abd pain - hypercal - hypercalciuria - skin reactions
226
symptoms of vitamin D overdose?
- anorexia - lassitude - nausea and vomiting - polyuria - thirsy
227
alfacalciferols Mx?
- in chronic RF, hypoparathyroidism, rickets, hydroxylation capacity is impaired - active vitamin D so restores functions of endogenous 1,25-dihydroxyvitamin D
228
alfacalcidol indications?
- renal impairment requiring Vitamin D - hypoparathyroisism
229
SE of alfacalcidol?
- abd discomfory - hyperphosphataemia - pustular rash
230
calcitrol Ix?
- psoriasis - renal osteodystrophy - PM osteoporosis
231
calcitrol SE?
- UTI - drowsiness - paralytic ileus - polydipsia - psychiatric disorder
232
vasopressin analogues?
Desmopressin and Terlipressin
233
desmopressin Ix?
- DI - diagnosis of DI - water deprivation test - Idiopathic polyuria
234
desmopressin CI?
- cardiac insufficiency - hyponatreamia - SIADH
235
desmopressin interactions?
lamotrigine
236
desmopressin side effects?
- headache - hyponatreamia - nausea
237
drug used for cranial diabetes insipidus
desmopressin
238
drug used for oesophageal bleeding
telipressin
239
bleeding reduction in mild to moderate haemophilia =
desmopressin
240
desmopressin mechanism?
- binds to V2 receptors, synthetic ADH - causes increased insertion of aquaporins into the collecting duct
241
telipressin mechanism?
- used to treat oesophageal varices - synthetic vasopressin analogue - causes vasoconstriction in these vessels reducing portal pressure
242
telipressin safety info?
- risk of resp failure and septic shock in type 1 hepatorenal syndrome
243
cautions of telipressin?
- QT prolongation - resp disease - septic shock - uncontrolled HTN
244
SE of telipressin?
- abd cramps - HTN, hypotension - peripheal ischaemia - vasoconstriction
245
tolvaptan mechanism?
- selective V2 antagonist (vasopressin ant) - blocks aquaporin insertion preventing water reabs - decreases urine conc and urine osmolarity
246
tolvaptan CI?
- anuria - hypernatreamia - volume depletion
247
use of tolvaptan?
hyponatraemia secondary to SIADH
248
SE of tolvaptan?
- asthenia - reflux - gout - hypernatreaia, hyperglycaemia - hepatic disorders
249
tolvaptan - stop treatment if ? occurs
Interrupt treatment and perform liver-function tests promptly if symptoms of hepatic impairment occur (anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, pruritus)
250
paracetamol indications?
- pyrexia - pain
251
paracetamol interactions?
- alcohol - dalteparin - enoxaparin - fluoxacillin
252
side effects of paracteamol?
- thrombocytopenia - hypotension - angioedema - liver injury
253
paracetamol mechanism?
- COX1 and COX2 inhibition -> reduced PG syntheis -> less pain - COX-3 inhibition - direct effect on heat regulating centers -> peripheral vasodilation
254
co-codamol Ix?
pain
255
CI of co-codamol?
- UC - ab assoc colitis - ultra-rapid codiene metabolisers
256
codiene interactions?
- clozapine - naltrexone - buprenorphine
257
SE of co-codamol?
- abd pain - addiction - thrombocytopenia - pancreatitis
258
NSAIDs used for
acute, chronic and neuropathic pain
259
CI of ibuprofen?
- active bleeding or ulceration - Haemorrhage - severe HF
260
Ibuprofen interactions?
- aprostadil - alteplase - apixaban - aspirin
261
SE of ibuprofen?
Gi discomfort, skin reactions, rash, ulcers
262
ibuprofen mechanism?
- NSAID - non selective COX-1 and COX-2 inhibitor
263
naproxen mechanism?
- COX-1 and COX-2 inhibition - COX-2 inhibition -> antipyretic, anti-inflammatory, and analgesic properties
264
COX enzymes?
- 1 is const active, found in normal stomach lining - 2 is inducible and produces prostaglandins that mediate pain, fever and inflammation
265
CI of naproxen?
- active bleeding or ulceration - severe HF
266
Side effects of naproxen?
- agranulocytosis - angioedema - aplastic anaemia - asthma - ulcers
267
Opiod analgesics?
- acute and chronic moderate to severe pain, WHO pain ladder - Codeine phosphate - Morphine sulfate - Diamorphine - Tramadol
268
codiene mechanism?
- agonist of mu opiod receptor -> hyperpolarizes the neuron -> inhibits release of nociceptive NTs - metabolised in the liver to morphine
269
codiene indications?
- dry or painful cough - diarrhoea -ST pain relief
270
CI of codiene?
- active UC - ab assoc colitis - ultra rapid metabolisers - conditions where abd distention develops
271
SE of all opiods?
- constipation - dry mouth - hyperhidrosis - miosis - nausea on initiation - urinary retention - resp despresion
272
morphine mechanism?
- mu and kappa opiod receptors - acts on NA delta opiod receptors to activate reward pathway
273
SE of morphone?
- insomnia - malaise - NM dysfunction - asthenia
274
diamorphine mechanism?
- oral: FPM by liver - crosses BBB - mu opiod agonist -> activates descendin inihib pathways
275
diamorphine indications?
- acute pain - pulm oedema - MI
276
CI of diamorphine?
- delayed gastric emptying - phaechromocytoma
277
Diamorphine SE?
- Biliary spasm - circ depression - inc ICP - postural hypotension
278
tramadol mechanism?
- SNRI and centrally acting opiod - MOR agonist
279
CI of tramadol?
- acute alcohol intoxication - hypnotic intoxication - opiod intox - analgesic intox
280
SE of tramadol?
- fatigue
281
Non opiod non NSAID analgesics?
- Amitriptyline - Duloxetine - Gabapentin - Carbamazepine - Capsaicin chronic and neuropathic pain
282
Amitryptyline Ix?
- abd pain - depression - neuropathic pain - migrain prophylaxis
283
CI of amitryptyline?
- manic phase of bipolar - HB - arrythmias
284
SE of amitryptiline?
- anticholinergic syndrome - QT proolongation - drowsiness - agranulocytosis
285
amitryptiline overdose?
- dry mouth - coma - hypotension - hypothermia - hyperreflexia - resp failures
286
amitrip mechanism?
- TCAD - SNRI - increased GABA transmission through increased noradrenaline levels
287
Duloxetine mechanism?
SNRI reuptake inhibitor
288
indications of duloxetine?
- MDD - GAD - diabetic neuropathy - stress UI
289
SE of duloxetine?
- decreased appetite - const - diarrhoea - palpitations - galactrorrgoea
290
gabapentin indications?
- seizures - MS - pain
291
gabapentin safety info?
- risk of suicidal thoughts - risk of severe resp depression
292
cautions of gabapentin?
- DM - substance abuse - resp depression
293
SE of gabapentin?
- anx - confusion - HTN - sexual dysfunction
294
gabapentin mechanism?
- enhanced GABA synthesis - reduces neuropathic pain and epiliepsy
295
carbamazepine mechanism?
- inc GABA transmission
296
indications of carbamazepine?
- diabetic neuropathy - epilepsy - trigeminal neuralgia - BPD
297
CI of carbamazepine?
- AV abn - history of bone marrow depression
298
SE of carbamazepine?
siADH-> hyponatreamia
299
Capsaicin mechanism?
- reduces amount of substance P - Defunctionalization of nocicpetive fibers by inducing a topical hypersensitivity reaction
300
Capsaicin indications?
localised neuropathic pain (topical drug)
301
SE of Capsaicin?
- AV block - eye irritation - palpitations - peripheral oedema
302
alkylating agents =
Cyclophosphamide
303
uses of cyclophosphamide?
-Cancer chemotherapy - Autoimmune and conective tissue disorders
304
cyclophosphamide cautions?
- DM - acut porphyrias - haemorrhagic cystitis - prev/ concurrent mediastinal irradiation - risk of cardiotoxicity
305
SE of cyclophosphamide?
- agranulocytosis - alopecia - cystitis - HUS
306
Cytotoxic antibiotics =
Doxorubicin
307
doxorubicin mechanism?
- interupts topoisomerase II mediated DNA repair - generates free radicals damaging cellular membranes
308
doxorubicin uses?
- NHL - acute leukemias - BC
309
SE of doxorubicin?
- alopecia - Cardiomyopathy - BM depression - vasodilation
310
anti-metabolites =
Methotrexate
311
Methotrexate mechanism?
- DHFR inhibitor -> prevents synthesis of purines and pyrimidines - cancer chemo and DMARD
312
methotrexate indications?
- CD - RA - Cancer
313
Methotrexate safety info?
- photsensitivity reactions including phototoxicity
314
CI of methotrexate?
- active infection - ascites - immunodef
315
Methotrexate cautions?
- blood count - bone marrow suppression - GI toxicity - stomatitis or diarrhoea - photosensitivity
316
SE of methotrexate?
- seziures - leucopenia - throat ulcers - pulm and liver toxicity
317
Anti-oestrogens?
- Tamoxifen - Anastrazole - breast cancer
318
Tamoxifen mechanism?
- induces gonadotropin release by occupying oestrogen receptors in hypothalamus
319
CI of tamoxifen?
- thromboembolism
320
Tamoxifen interacts w
warfarin
321
SE of tamoxifen?
- Embolism and thrombosis - ischaemia - neoplasms - agranulocytosis
322
tamoxifen - risks?
- endometrial changes - prompt Ix if abnormal vaginal bleeding including menstrual irregularities, vaginal discharge, and pelvic pain - risk of thromboembolism
323
Anastrazole CI?
premenopausal women, susceptibility to oestoporosis
324
SE of anastrazole?
- alopecia - bone pain - CTS - vaginal haemorrhage - hot flush
325
anastrazole Mx?
- aromatase inhibitor - preventing synthesis of oestrogen -> stops growth of hormone receptor positive tumours
326
ferrous sulphate Mx?
- IDA - transported across DMT-1 to be incorporated into ferritin - combines w porphyrin and globin chains to form hb
327
safety info w iV iron?
serious hypersen and anaphylactic rractions
328
CI of all iron?
- dist in utilisation or iron - iron overload
329
SE of all iron?
- dizziness - flushing - HTN - hypophosphataemia
330
iron sucrose is given by
iv injection or IV infusion
331
Side effect of ferrous sulphate?
- constipation - GI discomfort - nausea
332
constipation w iron?
- can lead to faecal impactation - can exacerbate diarrhoea in ppts w IBD
333
Monitoring w ferrous sulphate?
- monitor hb conc within first 4 weeks of treat then every 4 weeks - once hb is within normal range, continue treatment for a further 3 months to replenish further iron stores
334
hydroxocobalamin mechanism?
- synthetic B12 - used to treat B12 deficiency and perinicous anaemia
335
hydroxocobalamin SE?
- diarrhoea - dizziness - hot flush - urine discoloration
336
Folic acid indications?
- folate deficiency megaloblastic anaemia - prevention of nT defects in pregnancy - prevention of methotrexate induced side effects
337
cautions of folate?
Should never be given alone for pernicious anaemia or other megaloblastic anaemias caused by vitamin B12 deficiency (may precipitate subacute combined degeneration of the spinal cord)
338
339
SE of folic acid?
- abd distension - B12 def exacerbated - flatulence
340
folic acid mechanism?
- Folic acid, as it is biochemically inactive, is converted to tetrahydrofolic acid and methyltetrahydrofolate by dihydrofolate reductase (DHFR - synthesis of purines
341
use of Erythropoietins?
Renal anaemia
342
Darbepoetin =
- EPO - inc red cell production - activates JAK-STAT pathway
343
Darbepoetin safety info?
- risk of severe cutaneous adverse reactions - overcorrection of hb
344
CI of all epoetins?
- pure red cell aplasia following EPO therapy - uncontrolled HTN
345
SE of all epoetins?
- embolism and thrombosis - HTN - stroke - influenza like illness
346
darbepoetin common SE?
oedema
347
Antiemetics?
- Cyclizine (antihistamine) - Hyoscine (antimuscarinic) - Metoclopramide (dopamine receptor antagonist) - Prochlorperazine (dopamine receptor antagonist) - Ondansetron (5-HT3 receptor antagonist) - Aprepitant (neurokinin 1 receptor antagonist) - Nabilone (cannabinoid)"
348
# Used for? Cyclizine?
- nausea and vomiting - motion sickness
349
cautions of cyclizine?
- eplipesy - severe HF - urinary retention
350
cyclizine side effects?
- dec conciousness - agranulocytosis - bronchospasm - hepatic disorders - haemolytic anaemia
351
cyclizine mechanism?
- h1 receptor antagonist
352
uses of anti-emetics?
-motion sickness, postoperative vomiting, drug-induced vomiting, cytotoxic drug-induced vomiting, pregnancy-induced vomiting
353
Hyoscine mechanism?
- antimuscarinic - competitive inhibitor
354
Antimuscarinics (hyoscine) CI?
- Closed angle closure - GI obst - paralytic ileus - urinary retention
355
SE of antimuscarinics?
- constipation - dry mouth - urinary disorders - tachycardia
356
Metoclopramide mechanism?
- D2 antagonist and serotonin antagonist in the chemoreceptor trigger zone
357
CI of metoclopramude?
- GI obst - GI haemorrhage - GI perf
358
Side effects of metoclopramide?
- depression - hypotension - menstryal irreg - parkinsonism
359
Metclopramide can cause ? reactions
- acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises - more common in women, the young and the very old
360
Prochlorperazine mechanism?
- D2 antagonist in the CTZ - AP
361
CI of Prochlorperazine?
cns depression and comatose states
362
side effects of prochlorperazine?
- SIADH - Hyponatreama - photosensitivity reaction
363
Ondansetron =
- 5HT3 receptor antagonist
364
ondansteron safety info? (pregnancy)
inc risk of cleft lip following use in the first 12 weeks of pregnancy
365
ondansteron CI?
Congenital long QT
366
side effects of ondansteron?
- const - feeling hot - sens abn - QT prolongation
367
Aprepitant mechanism?
- neurokinin 1 receptor antagonist
368
SE of Aprepitant?
- decreased appetite - constipation - GI discomoft - hiccups
369
Nabilone mechanism?
- cannabinoid - CB1 receptor
370
Nabilone cautions?
- history of psych disorder - adverse effects on mental state - heart disease
371
Nabilone SE?
- Abd pain - confusion - dry mouth - hallucination
372
calcium salts?
- Calcichew (oral supplement) - Calcium gluconate (Parenteral - IV) - Calcium chloride (Parenteral - IV)"
373
what are calcium salts used for?
bone disease
374
calcichew?
- oral - colecalciferol - calc carbonate
375
calcium gluconate indications?
- severe hypocalcaemia - acute severe hyperkalaemia
376
CI of all calcium salts?
- hypercalcaemia - malignancy?
377
SE of calcium?
- diarrhoea - nausea - const - hypercal
378
side effect of calcium gluconate?
- arrythmias - circ collapse - hypotension - vasodilation
379
monitoring w calcium gluconate?
Plasma-calcium and ECG monitoring required for administration by slow intravenous injection (risk of arrhythmias if given too rapidly)
380
calc chloride indications?
- hyperkal >6.5 - acute severe hypocalcaemia
381
Year 3
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