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43 Cards in this Set
- Front
- Back
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Allopurinol
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Xanthine oxidase inhibitor used to treat hyperuricaemia (gout)
- commence treatment 3-4 weeks after flare up. |
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paracetamol
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I - pain relief, antipyretic
MOA - inhibits cox 2 and activates endogenous cannabanoids half life = 1-4 hours. Dose - 500mg up to 8/day Overdose - N-acetylcysteine |
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acetylsalicylic acid (aspirin)
Ibuprofen (nurofen) diclofenac (voltaren) naproxin meloxicam |
NSAIDS
COX inhibitors SE = GI bleed, renal impairment, NB. aspirin differs from the others in that it is irreversible and effects COX1 more (antiplateet) |
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Celecoxib (celebrex)
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COX 2 inhibitor
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Salazopyrin (Sulfasalazine)
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A derivative of 5-aminosalicylic acid
•Dampens inflammation I = IBD; RA, seronegative spondyloarthropathies. |
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Methotrexate
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anti metabolite (folate)
• Should be used only by specialists • Maintenance treatment of ALL • Treatment of NHL and solid tumours • Severe, treatment resistant psoriasis • DMARD in RA (once a week) • Need to give folic acid after each dose drug interactions - aspirin and NSAIDs, penecillins - reduce excretion other anti folates - trimethoprim Side effects - BM toxic; liver cirrhosis, renal failure, pulmonary toxic |
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long term effects of steroid use
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- Infection – from immunosuppression
- Weight gain with mineralocorticoid – water retention - Hyperglycemia (‘steroid diabetes’) – fm increased gluconeogenesis. - Osteoporosis - Reduced Ca absorption/increased protein catabolism - Muscle wasting/weak skin – protein catabolism. - Cushing’s syndrome (overproduction of cortisol)– Sx similar |
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How do glucocorticoids work
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transactivation - upregulate anti inflammatory proteins in nucleus
transrepression - repress pro-inflammatory cells in cytosol |
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What antibiotic should be used in septic arthritis
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Vancomycin
Gram positives (staph and strep) are most common agent and need to cover MRSA Joint should also be aspirated to dryness as often as necessary. |
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Aspirin dose
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low dose = 75mg od (inhibits THA2)
High dose (analgesia) = 300-900mg every 4-6 hrs (inhibits PG1 and THA2) |
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clopidogrel
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ADP receptor antagonist - inhibits platelet aggregation
I = secondary prevention of atherosclerotic disease- given for at least one month with aspirin post ACS event dose = 75mg QD. |
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what should patients be sent home on post ACS event
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Statin (atorvostatin 80mg)
ACEi - prevents ventricular remodelling Aspirin (75-150mg) + clopidogrel for 1 month Beta Blocker - metoprolol or atenolol +/- spironolactone if EF<40%; CCF; DM |
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Digitalis/ digoxin
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Blocks Na/K ATPase on sarcolemma --> increase Ca in sarcoplasmic reticulum
- positive ionotrope - reduces AV node conduction I= Heart failure caused by decreased ventricular contractility Rate control for supraventricular arrhythmias SE= life threatening arrhythmia (non-re-entrant SVT) - exacerbated by hypokalaemia. treat OD with K or IV lidocaine drugs that impair renal function (ACEi, NSAID) or decrease K (diuretics) |
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loop diuretics (frusemide, lasix)
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Thick ascending limb - NK2Cl (25% of Na)
I= Acute pulmonary oedema; CHF, peripheral oedema (short half life - 4-6 hrs; therefore limited use long term) SE= hypokalaemia, alkalosis, ototoxicity, hypovolaemia. Dose = 20-40mg/day. |
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Thiazide
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Block NaCl cotransporter in distal tubule
First line in uncomplicated HTN SE= hyperuricemia (don't use in gout) hyperglycaemia (don't use in DM); dyslipidemia; hyponatraemia Dose = 12.5-25mg od. |
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K sparing diuretics (spironolactone)
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act act distal concoluted tudule and CCD = aldosterone antagonist
I= K sparing diuretic; has cardiac anti-remodelling effects in CCF (EF<40%) Ascites and oedema in hepatic cirrhosis, CCF. |
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how does low molecular weight heparin work
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activates antithrombin which inhibits factor XA
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how does warfarin work?
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antagonises vitamin K epoxide reductase --> stops Vit K reduction and thus stops carboxylation of Factors 2,7,9,10 protein C and S
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what drugs reduce anitcoagulant effect of warfarin
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rifampicin, st john's wort, phenytoin, carbamazepine, phenobarbital
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who should not be given Beta blockers?
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2nd or 3rd degree heart block,
unstable heart failure DM with frequent hypos anyone taking verapamil |
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what are the Beta 1 selective BBs?
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Atenolol
metoprolol |
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how do Ca channel blockers work?
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inhibit voltage gated Ca channels in smooth muscle causing relaxation and vasodilation
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what are the dihydropine CCBs
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amlodipine (norvasc)
nifedipine (adalat, procardia) reduce peripheral resistance without sig cardiodepression |
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what are the nondihydropines?
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Verapamil - use in angina
diltiazem non-dihydropines are more selective for myocardium - they reduce O2 demand and reverse coronary vasospasm - used in angina |
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what is the drug of choice in stable angina pectoris
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verapamil - if angina is caused by coronary vasospasm.
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what is the main concern with combining ACEi and spironolactone
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hyperkalaemia - both stop aldosterone thus will stop K excretion.
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when should ACEi be avoided
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pregnancy
renal artery stenosis or sig renal impairment |
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what is the normal dose for perindopril (coversyl)
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5-10mg od
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how do fibrates work?
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agonist of the PPAR-alpha receptor in muscle
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person on statins drinks a shitload of grapefruit juice and gets really sore muscles, why?
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grapefruit juice inhibits cypP450 - anything that inhibits cypP450 will increase concentration of statin
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when do troponin T/I peak?
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increase 2-6 hrs after injury
peak 10-12 hours stay for 5-10 days |
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CXR - enlarged cardiac shadow, meniscus sign (pleural effusion), fluid in major fissure, kerley B lines
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congestive cardiac failure
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CXR - widening of the mediastinum
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aortic dissection, lymphoma, tumour, goitre
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how is HR determined on ECG
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300/#of large squares
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what is a pathological Q wave
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hallmark of previous infarct
width >1little square depth >2 little squares (not in VR) |
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ST elevation in leads V1-5
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LAD block causing anterior wall infarct
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ST elevation in V6, aVL
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Lateral wall infarct - L circumflex or LCA
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ST elevation in II, III, aVF
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Inferior wall infarct - RCA
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QRS >120ms / 3 small squares
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BBB
remember triple B triple square |
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flattened P waves widened QRS and peaked T waves
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hyperkalaemia
Rx = Insulin, HCO3, salbutamol |
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low T waves, prominent U waves, prolonget QT
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Hpokalaemia
Rx=KCl |
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what drugs can be used to lower LDL-C
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statins - ezetimibe - bile acid binding resins - nicotinic acid - fibrates - plant sterols.
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what drugs are best for lowering fasting triglycerides
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Fibrates and fish oil
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