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Flashcards in deck_6633276 Deck (79):
1

Metformin: Drug classInsulin sensitiser or secretagogue MOA

BiguanideInsulin sensitiser Incompletely understood but:Decreases gluconeogenesis Increases peripheral glucose useDecreases LDL and VLDL

2

Key side effects of metformin

Lactic acidosis (care in renal failure and with contrast dye)GI upset

3

Pioglitazone:Drug classInsulin sensitiser or secretagogue MOA

ThiazolidinedioneInsulin sensitisation (peripheral) PPAR gamma ligand. PPAR is involved in glucose and lipid homeostasis.

4

Gliclazide Drug classInsulin sensitiser or secretagogue MOA

Sulphonylureas Insulin secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

5

Repaglinide Drug classInsulin sensitiser or secretagogue MOA

Meglitinides Insulin Secretagogue Blocks hyperpolarising K channels on B cells. Leads to depolarisation and insulin release.

6

Key side effects on sulphonylureas

Hypos (can be prolonged) Weight gain GI upsetHeadache

7

Key side effect of pioglitazone

Weight gain Deranged LFTs/ hepatotoxicity Fluid retention May exacerbate heart failure

8

Key side effects of repaglinide

Hypoglycaemia (also very short acting)

9

ExenatideDrug classInsulin sensitiser or secretagogue MOA

GLP-1 analogue/ Insulin secretagogues Both GLP-1 analogueGLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells Increases insulin sensitivity

10

Key side effects of exenatide

Hypoglycaemia GI upset (also needs to be given by subcut injection)

11

Sitagliptin

DPP4 Inhibitor Insulin secretagogue Inhibits DPP4 which breaks down endogenous GLP-1. GLP-1 induces B-cells to release insulin in response to rising glucose levels. It also restores glucose sensitivity to B cells and increases insulin sensitivity

12

Key side effects of the DPP4 inhibitors

Hypoglycaemia GI upset

13

For exenatide to be continued long term initially there must be clear metabolic benefit demonstrated by...

Weight fall of at least 3% and HbA1c fall of at least 11mmol (1%)

14

Which oral hypoglycaemic should not be used with insulin

Pioglitazone

15

Stepwise treatment of COPD (inhaled therapies)

For all patients: Vaccinations, smoking cessation, pulmonary rehab if person is functionally limited by COPD. 1: PRN SABA (or SAMA)2: If FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.Stop any SAMA. 3: If FEV1 ≥ 50% predicted consider LABA+ICS in a combination inhalerconsider LAMA in addition to LABA where ICS is declined or not tolerated4: Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.

16

Vaccinations to be offered to patients with COPD

Pneumococcal booster and annual influenza

17

When to use theophylline in COPD

Theophylline should only be used after a trial of short-acting bronchodilators and long-acting bronchodilators, or in patients who are unable to use inhaled therapy, as there is a need to monitor plasma levels and interactions

18

When to use carbocisteine in COPD

Mucolytic drug therapy should be considered in patients with a chronic cough productive of sputum. They should not be used to prevent exacerbations.

19

When to start long term oxygen therapy in COPD

Non smokers!!! and any of the following: Clinically stable with PaO2<7.3 (2 occasions >3/52 apart) PaO2 7.3-8 with: PHT, cor pulmonale, polycythaemia, nocturnal hypoxaemia. Terminally ill

20

MRSA eradication

Mupirocin (nasal) and chlorhexidine wash.

21

Acute management of non-self limiting seizures (if no IV access)

Rectal diazepam 10mg. Repeated if necessary after 10-15 minutes.

22

Side effects of sulfasalazine due to the sulphapyridine moiety

Rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia

23

2nd Line pharmacological treatment of IBS

Low dose tricyclic

24

Summarise the symptomatic treatment of MS

Fatigue: Modafanil Depression: SSRI Pain: Amitryptylline or gabapentin Spasticity: Physio, baclofen (1st line drug), dantrolene, Botox Urinary Urgency/frequency: Oxybutynin, tolterodine ED: Sildenafil Tremor: Clonazepam

25

Drugs that worsen mysasthenia gravis weakness

B blockersGentamicinPhenytoinMacrolides Tetracyclines Opiates

26

Acute treatment of cluster headaches

Sumatriptan subcut or nasal (NOT ORAL)100% oxygen

27

Prophylaxis of cluster headache

Verapamil or prednisolone

28

Side effects of sodium valproate

Appetite increase (and weight)Liver failure (monitor LFTs over first 6 months)PancreatitisReversible hair loss OedemaAtaxiaTertaogenicity, thrombocytopenia, tremorEncephalopathy

29

Initial treatment of cryptococcal meninigitis

Amphotericin B and flucytosineFollow up treatment with fluconazole If HIV infeected also optimise ARVs

30

Treatment of toxoplasmosis

Pyrimethamine, sulfadiazine, folate

31

First line options for treatment of neuropathic pain

amitriptyline, duloxetine, gabapentin or pregabalin

32

First line for 'rescue therapy' in neuropathic pain

Tramadol

33

Common side effects of triptans

Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

34

Contraindications for use of triptans

Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

35

Essential tremor is improved by...

Propranolol and alcohol

36

Drug that shows survival benefit in motor neuron disease

Riluzoleprevents stimulation of glutamate receptorsused mainly in amyotrophic lateral sclerosisprolongs life by about 3 months

37

Management of motor neurone disease

Riluzoleprevents stimulation of glutamate receptorsused mainly in amyotrophic lateral sclerosisprolongs life by about 3 monthsRespiratory carenon-invasive ventilation (usually BIPAP) is used at nightstudies have shown a survival benefit of around 7 months50% of patients will die within 3 years.

38

Enzyme inhibitors

Sodium valproateIsoniazidCimetidineKetoconazoleFluconazoleAlcohol..binge drinking/Allopurinol ChloramphenicolErythromycinSulfonamidesCiprofloxacinOmeprazoleMetronidazole

39

Enzyme inducers

CarbamezapineRifampicinAlcohol (chronic)PhenytoinGriseofulvinPhenobarbitalSulphonylureas

40

Key side effects of thiazides

HYPER effects in serum:HYPERuricemia (precipitate acute gouty arthritis)HYPERcalcemia (renal calcium resorption, decrease calcium in urine)HYPERglycemiaHYPERlipidemia (increase choleterol and LDL)HYPO effects in serum:HYPOkalemiaHYPOtension (decreases blood volume and peripheral vascular resistance)

41

NICE fluid requirments recommendations for maintenance fluids

In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:25-30 ml/kg/day of water andapproximately 1 mmol/kg/day of potassium, sodium and chloride andapproximately 50-100 g/day of glucose to limit starvation ketosis

42

Drugs that preciptate gout

NSAIDs, diuretics (thiazides), cytotoxics, pyrazinamide.

43

Treatment of acute gout

First line: NSAID (diclofenac or indomethacin) Second line: ColchiconeIn renal impairment: steroids (NSAID and colchicine CI)

44

Common s/e of colchicine

Diarrhoea

45

Prevention of gout (medications)

1st line: Xanthine oxidase inhibitors. Allopurinol first choice. Febuxostat is hypersensitivity.2nd line: Uricosuric drugs. Probenicid, Losartan. These are rarely used. Recombinant urate oxidase may be used before cytotoxic therapy.

46

Side effects of xanthine oxidase inhibitors

Rash, fever, reduced WCC with azathioprine.

47

Non ergot-derived dopamine agonists used in PD

Pramipexole, ropinirole, and rotigotine

48

Treatment of pseudogout

AnalgesiaNSAIDsPO, IM or intra-articular steroids

49

Treatment of psoriatic arthritis

NSAIDs MTX, sulfasalazine, ciclosporin

50

Treatment of reactive arthritis

NSAIDsLocal steroids Relapse may require sulfasalazine or MTX

51

Treatmement of polymyositis and dermatomyositis

Steroids Cytotoxics: AZT, MTX

52

Drugs that induce lupus

Procainamide PhenytoinHydralazine Isoniazid

53

Treatment of anti-phsopholipid syndrome

Low dose aspirin Warfarin if higher risk (e.g. recurrent thromboses) target INR 2-3

54

SLE management

Severe flares (pericarditis, CNS disease, AIHA, nephritis): IV cyclophosphamide, High dose prednisolone. Cutaneous: topical steroids to treat, sun cream for preventionMaintenance for joints and skin: NSAIDs, hydroxychloroquine, low dose steroids (option)Lupus nephritis: ACEi for proteinuria. Immunosupression if aggressive GN

55

Treatment of GCA

High dose steroids (e.g. pred 40-60mg oral) and taper slowly. PPI and alendronate cover

56

Treatment of polymyalgia rheumatica

15mg/day oral prednisolone and then taper according to ESR and symptoms PPI and alendronate cover

57

Treatment of granulomatosis with polyangiitis

Immunosuppression: Cyclophsphamide, Rituximab, MTX Azathioprine, Rituximab or MTX for maintenance.

58

Treatment of Features of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Prednisolone Cyclophosphamide is severe multi-organAzathioprine or MTX for maintenance

59

Women should avoid pregnancy for at least... months after stopping MTX

3 months (men should use contraception for the same duration)

60

Treatment of warm AIHA

Immunosuppression Splenectomy

61

Drugs that trigger haemolysis in G6PD deficiency

Antimalarials, henna, dapsone, sulphonamides

62

Management of sickle cell anaemia (chronic)

Pen V 250mg BD Folate 5mg OD Hydroxycarbamide if frequent crises

63

Treatment of Hodgkin's lymphoma

A – doxorubicin (Adriamycin ®)B – bleomycinV – vinblastine (Velbe ®)D – dacarbazine (DTIC).Possibly add radiotherapy.

64

Immunisations post splenectomy

Pneumovax (repeat every 5 years)Hib if not done in childhood Men C if not done in childhood Yearly flu

65

Contraindications for thrombolysis (STEMI)

AGAINSTAortic dissection GI bleeding Allergic reaction previously Iatrogenic (recent surgery)Neuro: cerebral neoplasm of CVA Hx Severe HTN (200/120)Trauma (including CPR)

66

Clopidogrel post MI: How long to continue post..STEMINSTEMI

STEMI with stenting: 12 months STEMI with medical management: 1 month NSTEMI: 12 months

67

1st line treatments of stable angina (in addition to GTN)

CCB or B blocker

68

2nd line treatments of stable angina

a long-acting nitrate orivabradine ornicorandil orranolazine.

69

Drugs causing lung fibrosis

BANS MEBleomycin/busulfanAmiodarone Nitrofurantoin Sulfasalazine MEthotrexate

70

Prednisolone dose following:Asthma exacerbation COPD exacerbation

40mg OD for at least 5 days 30mg OD for 7-14 days

71

Duration of treatment for Scarlet fever

10 days

72

Treatment of CMV retinitis

Oral valganciclovir if sight threatened add intravitreal injections of ganciclovir or foscarnet

73

Drug used for CMV prophylaxis in renal transplant

Valgancyclovir

74

Treatment of chronic hepatitis B

Nucleoside analogue (e.g. tenofovir) or interferon

75

Clinical features of cholera

Rice water stools Shock, acidosis, renal failure

76

Antibiotics most likely to cause C.diff

Clindamycin Ciprofloxacin Cephalosporins

77

Treatment of giardiasis

Tinidazole, metronidazole, or nitazoxanide

78

Treatment of amoebic dysentery

Metronidazole (800mg TDS) 5 days or 10 days if liver abscessTinidazole

79

Midodrine is used to treat

Orthostatic hypotension