Side effects of calcium channel blockers (4)
- Headache
- Flushing
- Ankle oedema
- Constipation
Side effects of beta-blockers (4)
- Bronchospasm (especially in asthmatics)
- Fatigue
- Cold peripheries
- Sleep disturbances
Side effects of nitrates (3)
- Headache
- Postural hypotension
- Tachycardia
Side effects of Nicorandil (3)
- Headache
- Flushing
- Anal ulceration
Nicorandil - potassium channel activator -> known by its vasodilator properties
Site of action of Furosemide
Furosemide - inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle
- hypotension
- hyponatraemia
- hypokalaemia, hypomagnesaemia
- hypochloraemic alkalosis
- ototoxicity
- hypocalcaemia
- renal impairment (from dehydration + direct toxic effect)
- hyperglycaemia (less common than with thiazides)
- gout
Cyclizine
- class
- use
- caution
- pregnancy use
Class: H1 receptor antagonist -> blocks histamine receptors in CTZ
Use: nausea, vomiting
Caution: may cause a drop in cardiac output and increase in HR - to be careful in HF
Safe to use in pregnancy
What is steroid psychosis?
- A rare side effect related to steroid therapy
- Steroid psychosis is unrelated to previous mental health history and can affect any age. Women are slightly more likely to be affected than men
*managed with lithium or typical anti-psychotics
Drug management of hepatic encephalopathy
- treat any underlying precipitating cause
- lactulose first-line, with the addition of rifaximin for the secondary prophylaxis of hepatic encephalopathy
*lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
*antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
- other options include embolisation of portosystemic shunts and liver transplantation in selected patients
(3) antibiotics that can be used in treatment of MRSA
- vancomycin
- teicoplanin
- linezolid
Can Verapamil be given with B blockers?
NO as it is rate limiting - extreme brady
Can Diltiazem be given with B blocker?
Although Diltiazem is a rate-limiting CCB, it sometimes can be given with CCB (with caution!)
Carbimazole
Use
MoA
Side effects
Carbimazole
- used in the management of thyrotoxicosis
- given in high doses for 6 weeks until the patient becomes euthyroid before being reduced
Mechanism of action
- blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
Side effects: agranulocytosis, crosses the placenta (but may be used during pregnancy in low doses)
Folic acid as a supplementary treatment to methotrexate
- dose
- when to take
Dose: 5 mg folic acid a week (once a week)
When to take: at least 24 hours (or more) after last dose of methotrexate
How long do the men and women need to wait before they are advised to conceive after stopping methotrexate?
At least 6 months after treatment
What (3) medications we should avoid prescribing in a patient on methotrexate?
- avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
- high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
Contraindications to tetracyclines (2)
- pregnancy
- children under 12 y old
At what levels of a) Hb and b) platelets the transfusion will be indicated?
- St John’s Wort*
- -* use
- MoA
- shown to be as effective as tricyclic antidepressants in the treatment of mild-moderate depression
- mechanism: thought to be similar to SSRIs (although noradrenaline uptake inhibition has also been demonstrated)
Is use of St John’s Wort advised?
- NICE advise ‘may be of benefit in mild or moderate depression, but its use should not be prescribed or advised because of uncertainty about appropriate doses, variation in the nature of preparations, and potential serious interactions with other drugs’
Adverse effects of St John’s Wort use
- can cause serotonin syndrome
- inducer of P450 system, therefore decreased levels of drugs such as warfarin, ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced
Common SE of Amoxicillin (1)
Rash with infectious mononucleosis
Common SE of co-amoxiclav (1)
cholestasis
Common SE of Flucloxacillin
Cholestasis (usually develops several weeks after use)
