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48 Cards in this Set
- Front
- Back
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Phenytoin
- For.. and not for? - MoA - Side Effects - Disadv |
MoA: Na ch blocker
Good for most seizure except absence seizure Side Effects Him RIcbG -Hirsutism -impaired muscle co-ord -Rash -Impaired cognition & behavior -Gum Hypertrophy Disadv: - non-linear saturation kinetic - narrow therapeutic range - difficult to titrate |
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Carbamazepine
- MoA - Good for... - Side Effects - Disadv |
MoA: Na ch blocker
Good for: esp. good for complex partial seizure Side Effects: DR NHD - dizziness - rash - nausea - headache - double vision Disadv: - potent enz inducer - difficult to titrate - interact with other common drugs |
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Drug for rescue tx for hypothyroid coma?
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liothyronine (sodium salt of T3)
- acts more quickly than thyroxine |
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Medication for hyperthyroidism?
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Carbimazole (antithyroid)
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Main advantage of condom?
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the only proven protection against STI
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Disadvantage of condom?
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• Condoms with spermicide do not protect as effectively against HIV transmission
• Reduces glans sensation • Occasional leaks/breaks may occur • Latex allergy (non-latex condoms are available) |
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How does COC work?
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- suppress ovulation
- thickens cervical mucus - thins endometrium |
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What is the benefit of COC?
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Reduced incidence of:
- menstrual cycle disorder - endometrial & ovarian cancer - endometriosis & ovarian cyst |
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What are the major risk of COC?
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- venous thrombosis (PE, DVT)
- thrombotic stroke (CVA) - MI - hypertension - breast, cervical & liver cancer |
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Low dose Progestogen only pill (POP)
i) give an example ii) MoA iii) Risk iv) Side Effects |
i) Noriday
ii) - thickens cervical mucus - thins endometrium - inhibit tubal mobility - VARIABLE effect on ovulation iii) ovarian cyst, ?ectopic pregnancy iv) Menstrual irregularities Progestagenic effect - Amenorrhea (HIGH DOSE) - Headache - low Libido - Acne - low Mood - Breast tenderness |
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High dose POP
i) give an example ii) MoA |
i) cerazette
ii) - suppress ovulation - thickens cervical mucus - thins endometrium - and inhibit tubal mobility |
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Depo Provera
i) what is it? ii) route of admin, duration of efficacy iii) Safety iv) Side effects |
i) high dose progestogen only contraceptive
ii) IM, 90d intervals iii) - long term use: bone density concern - breast cancer iv) progestagenic side-effects - irreg PV bleeding HLAMB - headache - acne - low mood - breast tenderness |
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Jadelle
i) what is it? ii) route of admin, duration of efficacy iii) Risks iv) Side effects |
i) high dose progestogen implant
ii) subdermal 2 rods, effective for 5yrs iii) insertion risk, ovarian cyst iv) irreg PV bleed amenorrhea Common progestagenci effects HLAMB: - headache - low libido - acne - low mood - breast tenderness |
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Mirena
i) what is it? ii) duration of efficacy iii) Benefits iv) Risk v) Side effects |
i) IUD with low dose progestogen
*currently unavailable in NZ (2011) ii) 5yrs iii) reduce heaviness of menstrual cycle iv) VIP P - Vasovagal rxn with insertion - Infertility - Perforation uterus - PID v) - irreg spotting initially - amenorrhea - progestogenic side effects HLAMB: headache, low libido, acne, low mood, breast tenderness |
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Diaphragm
i) Recommended to use in conjunction with? ii) Contraindication |
i) spermicide
ii) vaginal abnormalities, recurrent UTI |
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IUD Multiload Cu375
i) MoA ii) Contraindications iii) Side effect |
Available in NZ
i) Cu with foreign body rxn inhibits sperm progression & implantation ii) MAP UP: - genital Malignancy - Active gonorrhea/chlamydia - PID - Undiagnosed vaginal bleeding - Pregnancy iii) Heavier menstrual period |
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Characteristics of Patients With Ischemic Stroke Who Could Be Treated With rtPA are:
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- Diagnosis of ischemic stroke causing measurable neurological deficit
- The neurological signs should not be clearing spontaneously - The neurological signs should not be minor and isolated - Caution should be exercised in treating a patient with major deficits - The symptoms of stroke should not be suggestive of subarachnoid hemorrhage - Onset of symptoms 3 hours before beginning treatment - No head trauma or prior stroke in previous 3 months - No myocardial infarction in the previous 3 months - No gastrointestinal or urinary tract hemorrhage in previous 21 days - No major surgery in the previous 14 days - No arterial puncture at a noncompressible site in the previous 7 days - No history of previous intracranial hemorrhage - Blood pressure not elevated (systolic 185 mm Hg and diastolic 110 mm Hg) - No evidence of active bleeding or acute trauma (fracture) on examination - Not taking an oral anticoagulant or if anticoagulant being taken, INR 1.7 - If receiving heparin in previous 48 hours, aPTT must be in normal range - Platelet count 100 000 mm3 - Blood glucose concentration 50 mg/dL (2.7 mmol/L) - No seizure with postictal residual neurological impairments - CT does not show a multilobar infarction (hypodensity 1⁄3 cerebral hemisphere) - The patient or family understand the potential risks and benefits from treatment |
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1st line tx for obese T2DM patients
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metformin, acarbose or TZD
-latter 2 for metformin-intolerant patients |
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1st line tx for non-obese T2DM patients
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metformin or sulfonylureas
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1st line tx: if monotx fails...
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metformin, acarbose & TZD recommended
-if target still not achieved, insulin secretagogue may be added |
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Sulphonylureas (SU)
-e.g. -MoA |
e.g. Gliclazide (2nd gen)
-insulin secretagogue [require pancreatic function] --inhibits ATP-sensitive K ch on Beta-cell; depol, insulin vesicle release -ineffective in insulin resistance -may be ineffective in obesity |
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Sulphonylureas:
-ADR -drug-drug interactions |
ADR:
-hypoglycemia: esp in elderly -use other class/adj dose -use short acting SU -GI disturbances Interactions: -altered metabolism: alcohol, MAOI -highly prot-bound: altered plasma protein binding -> augment SU's hypoglycemic effect: -antibacterial (sulfonamide, chloramphenicol) -NSAIDs |
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Biguanide
-e.g. -MoA |
e.g. Metformin
-decr hepatic glucose synth, incr insulin-med peripheral glucose uptake (GLUT4) -MoA unclear -1st line drug in most cases -most effective in overwt, obese -must be taken with food Benefits: -doesn't cause hypoglycemia (cf. SU) -small decr in LDL, cholesterol & TG -decr macrovasc events (MI) |
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Metformin ADRs
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-GI: diarrhea & abd discomfort
-lactic acidosis: -contraindicated: impaired renal function, hepatic failure, cardiac failure |
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alpha-glucosidase inhibitors
-e.g. -MoA -ADR |
e.g. acarbose
-reduce glucose level by reducing CHO (starch) digestion in SI & reduce CHO absorption -used to control post-prandial glucose levels not adequately controlled by diet & SU ADR: -GI upset & flatulence |
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Thiazolidinediones
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-incr muscle sensitivity to insulin & reduce hepatic glucose synth
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Short acting insulin analogues
-e.g. -features |
e.g. Insulin aspart & insulin lispro
Compared to standard insulin: -less tendency to aggregate -faster onset & offset of action -onset ~15min, clearance in 2-5hrs |
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Describe Insulin aspart
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-a.a. substitution (proline to asp) creates charge repulsion & steric hindrance
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Long acting insulin analogues
-e.g. |
e.g. insulin glargine
-contains 2 extra arginine at end of B-chain -this alters isoelectric pt, reducing solubility, reducing clearance Suitable for Once-daily admin: -insulin lvl rises slowly to a plateau in 6-8hrs and remain unchanged for 24hrs |
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Describe an Insulin regimen
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-basal bolus of glargine (long-acting) in evening
with -multiple regular doses of aspart (short-acting) before meal times |
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Insulin injections
-sites of admin |
subcut admin: "a tua"
-arms -thigh -upper buttocks -abdomen NB: -ROTATE SITE -absorption rate may be diff e.g. arm & abdomen faster than thigh & buttock -SC admin bypasses effect on hepatic metabolic process -doesn't mimic rapid rise & fall with endogen insulin response to glucose |
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Insulin ADRs
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ADRs mainly related to hypoglycemia due
-insulin OD -missed meal -other drug combo affecting caloric intake Others: -weight gain -lipo-atrophy/hypertrophy -insulin edema (Na retention) -transient deterioration in retinopathy (VEGF permissive) -local cutaneous allergy -IgG-med insulin resistance |
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Symptoms of hypoglycemia
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SHHHITT WAVE
Sweating Headache Hunger HR inc'rd Irritability Tiredness Trembling Weakness Anxiety blurred Vision ringing in Ears |
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Frusemide PK
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PO: max effect 1-2h, duration 4-6h
-extensively protein bound *=warfarin, propranolol, nephrotic -reach glomerular filtrate via organic acid transporter *=cephalosporins -high Na load presented to DT also incr loss of H+ & K+ |
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Tx use of Loop diuretics
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-Hypertension - in impaired renal function
-Renal failure - acute/chronic -Nephrotic syndrome - frusemide generally used -Congestive HF (mod-severe) -Acute Pulm Edema -Hyperkalemia -Hypercalcemia -Drug OD = incr urine flow |
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ADR of Loop diuretics
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Incr'd Na to DT:
-Metabolic alkalosis (incr'd H+ loss) -Hypokalemia (incr'd K+ loss) =>arrythmia & digoxin toxicity Li retention & toxicity due Na loss Mg & Ca loss Prolonged use: -ototoxicity: loss of endolymph electrolyte = hearing loss -renal toxicity - cephalosporin antibiotics -displace plasma prot binding = warfarin, heparin |
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ADR: mechanism of Ca & Mg loss by Loop diuretic
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Normally, apical ROMK and basolat CLC-K2
->lumen-positive transepith potential difference ->drives paraC reabs of cations Ca&Mg Loop diuretics disrupts this +ve transepith potential -> Ca&Mg loss |
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Thiazide
e.g. -ineffective when... -2ndary effect... |
e.g. bendrofluazide, chlorothiazide
-ineffective when GFR<30-40mL/min -2ndary effect on PT due inhibiting carbonic anhydrase: -inhibit NaHCO3 reabs & incr delivery of Na to MD |
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Thiazide effect on GFR
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Thiazide inhibits NaHOC3 reabs at PT, incr Na delivery to MD
->thus acute thiazide tx reduces GFR = this transient effect can be blocked with ACEI Chronic use: -extraC vol decr ->incr Na&water reabs ->decr Na delivery to MD Resutl: return GFR to baseline |
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Thiazide PK
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-excreted in PT via organic acid transporter = probenicid
-diuresis in 1hr |
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Tx use of Thiazide
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Frontline tx for hypertension along with:
-ACEI & CCB Acute pulm hypertension Nephrogenic DI with high urine output: -low dose thiazide: decr intravasc vol -> decr GFR & conseq modest decr in urine flow & vol Hypercalciuria = calculus -promote DT Ca reabs via incr apical Ca ch |
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Thiazide ADR
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Generally due high doses
K loss: digoxin toxicity H loss: metabolic alkalosis Na loss: Li toxicity Hypercalcemia Uric a retention -> gout Impaired glucose tolerance: -exacerbate diabetes via impairing insulin secr or periph insulin sensitivity QT prolonged - torsade de pointes Dehydration & postural hypotension Hyponatremia |
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Spironolactone ADR
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-Hyperkalemia - avoid excessive K+ supplemenation when on this drug
-Androgen-like effects due steroid structure -gynecomastia -GI disturbances |
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Tx use of Spironolocatone
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Liver failure
Heart failure Hyperaldosteronism Resistant hypertension Proteinuria |
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Amiloride
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-inhibit eNaC channels under aldosterone influence in CD/late DT
-action complementary with thiazide; augments Na+ loss but limits K+ loss |
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ACEI ADR
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FHK CARD
initial hypotension hyperKalemia Fetal anomalies Cough Angioedema Rash Dysgeusia |
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ACEI - cautions
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Renal impairm: Decr ACEI dose
-enalapril metabolites excreted in urine Bilat Renal artery stenosis: -AngII is vital for constr of efferent arteriole to maintain GFR -inhibiting this can lead to acute renal failure if uncorrected -in setting of acute renal artery stenosis, there's acute drop in GFR cf. smaller change in hypertensive setting |
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ARB ADR
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initial hypotension
impaired renal function fetal morbidity/mortality low risk of angioedema |
