Term
|
Definition
|
|
Term
|
Definition
| 100-800mg OD, high fluid intake. |
|
|
Term
| Important interactions of ALLOPURINOL |
|
Definition
| CYP inhibitor. Inhib AZOTHIAPRINE met (decr dose). Renal toxicity w Thiazide |
|
|
Term
| Adverse effects of ALLOPURINOL |
|
Definition
| Goutogenic. Rash (>10%). Hepatitis, GI (1-10%) |
|
|
Term
| Mechanism of action of ALLOPURINOL |
|
Definition
| Competetive and non-competitive xanthine oxidase inhibitor. Inhibits production of uric acid from xanthine. |
|
|
Term
|
Definition
| F>0.8, t1/2=0.5-2hrs (metabolyte 10-40hrs) |
|
|
Term
| Precautions, contraindications of ALLOPURINOL |
|
Definition
| Acute gout. Reduce dose in renal impairment. |
|
|
Term
| Class/mechanism of AMITRYPTILINE |
|
Definition
| Tricyclic antidepressant. Inhibit uptake of NA and 5-HT. |
|
|
Term
|
Definition
| Start 25mg nocte. Incr to 75-150mg as nec. |
|
|
Term
| Kinetics of AMITRYPTILINE |
|
Definition
| F=0.5, Hepatic metab 2D6. |
|
|
Term
| Important interactions of AMITRYPTILINE |
|
Definition
| SSRIs-->serotin syndrome. MOAIs-->HTN, pyrexia. |
|
|
Term
| Adverse reactions of AMITRYPTILINE |
|
Definition
| 5-HT sydrome. Dose dependent anticholinergic. Rare heam and endo. |
|
|
Term
| Precautions/contra AMITRYPTILINE |
|
Definition
| narrow angle glaucoma, prostatism, conduction irreg. |
|
|
Term
| AMITRYPTILINE overdose (Sx and Rx) |
|
Definition
Anticholinergic. Dilated pupils, arrythmias, CV depression, seizure->coma->death.
NaHCO3. Benzo. Defrib. |
|
|
Term
| Classes/Mechanisms of ASPIRIN |
|
Definition
NSAID.
Analgesic (antiprostaglandin), Antiplatelet (irreversible inhibitor of Thromboxane A2) |
|
|
Term
| Doses of ASPIRIN (different uses) |
|
Definition
MI, TIA prophylaxis: 75-300mg EC, OD.
Pain relief: up to 300-900mg q3-4h. |
|
|
Term
|
Definition
F=0.6. t1/2=15-30min (but antiplatelet effects up to 7/7). Hepatic metab.
Protein bound. Saturable kinetics. |
|
|
Term
| First line antihypertensive (ceteris paribus) |
|
Definition
|
|
Term
| Adverse effects of ASPIRIN |
|
Definition
| Gastritis. GI bleeding. Impaired heamostasis. Hypersensitivity (asthma, assoc nasal polyps). |
|
|
Term
| Precautions/Contraindications of ASPIRIN |
|
Definition
| Active bleeding. Hypersensitity. Asthma. G6PD. Children. |
|
|
Term
| Class/mechanism of BENDROFLUMATHIAZIDE |
|
Definition
Diuretic/Antihypertensive. Inhibits Na, Cl, and H20 absorb in distal loop.
Antihypertensive mech poorly understood (MedSafe) |
|
|
Term
| Dose of BENDROFLUMETHIAZIDE |
|
Definition
|
|
Term
| Kinetics of BENDROFLUMETHIAZIDE |
|
Definition
| F=1. t1/2=3-4hrs (effect longer). ru=0.3. 94% Plasma bound. |
|
|
Term
| Interactions of BENDROFLUMETHIAZIDE |
|
Definition
Incr. Lithium-->don't combine.
Vasculitis c ALLOPURINOL-->careful.
Reduces effect of oral anti-glycaemics. |
|
|
Term
| Adverse effects of BENDROFLUMETHIAZIDE |
|
Definition
| Diabetogenic, goutogenic, hypokalaemia. |
|
|
Term
| Precautions/Contraindications of BENDROFLUMETHIAZIDE. |
|
Definition
Contra-Lithium, hypokalaemia.
Prec-diabetes, gout, renal imp, hepatic imp. |
|
|
Term
| Mechanism/Class of codeine |
|
Definition
| Opioid analgesic. Hepatically metabolised to morphine. Also weak opioid receptor agonist in unchanged form. |
|
|
Term
| Indication/Dose of CODEINE |
|
Definition
Relief of mild-moderate pain, antidiarrhoeal, antitussive-->16-60mg up to q4h up to max of 240mg/day (120mg/day antitussive).
Available in combined preparations with PARACETAMOL and IBUPROFEN. |
|
|
Term
|
Definition
| F=0.5, t1/2=3hr, Metabolism-hepatic to morphine plus others. |
|
|
Term
|
Definition
Additive with other CNS depressants.
Loss of efficacy with CYP2D6 inhibitors (lower conversion to morphine) FLOUXETINE, AMIODARONE, IMIDAZOLES, CIMETIDINE. |
|
|
Term
| Adverse effects of CODEINE |
|
Definition
CNS depression (or paradox. stimulation), constipation, nausea,
tachy- or bradycardia, malaise or euphoria, unrinary retention. |
|
|
Term
| Contraindications/Precautions of CODEINE |
|
Definition
| Resp depression, some diarrhoea, head injury, high ICP, acute asthma, B Obst, myasthenia gravis. |
|
|
Term
| Class/Mechanism of DIAZEPAM |
|
Definition
Benzodiazapine.
Indirect enhancer of GABA.
Anxiolytic, muscle relaxant, sedative, anticonvulsant. |
|
|
Term
|
Definition
| F=1,t1/2=43hrs(long-acting benzo), hepatic metabolism with some active metabolytes |
|
|
Term
|
Definition
Variable, keep low as possible (tolerance).
1-5mg for anxiety. 10-20mg ETOH withdrawal. 10-30mg/day for muscle spasm. 5-10mg iv/dose for status epilepticus. |
|
|
Term
| Adverse effects of DIAZEPAM. |
|
Definition
CNS depression-->death w incr. dose.
Dependence. |
|
|
Term
|
Definition
Additive with CNS depressants.
Up of down conc. with inhibitors (CIMETIDINE, SSRIs) and (resp) inducers (CARBEMAZAPINE) |
|
|
Term
| Contraindications/Precautions of DIAZEPAM |
|
Definition
| myasthenia gravis, chronic use, COPD |
|
|
Term
| Class/Mechanism of DICLOFENAC |
|
Definition
| NSAID. COX 1 and 2 inhibitor, thus inhibitor of prostaglandin systhesis. |
|
|
Term
| Dose/Indications of DICLOFENAC |
|
Definition
Mild-moderate pain. Musculoskeletal including inflammatory arthritis.
25-50mg up to tds, to max 150mg/day. Also SR 75mg formulation. |
|
|
Term
|
Definition
| F=0.55, t1/2=1hr, hep met (CYP2D6) 99%PB. |
|
|
Term
| Interactions of DICLOFENAC |
|
Definition
Incr concentration with CYP2D6 inhibitors (eg SSRIs).
Reduces diuretic/antiHTN effects.
Increases GI bleed with WARFARIN.
Increases Li and DIGOXIN conc. |
|
|
Term
| Adverse effects of DICLOFENAC |
|
Definition
Na and water retention-->HTN.
Gastritis/GI ulceration. |
|
|
Term
| Contraindications/Precautions of DICLOFENAC |
|
Definition
| GI bleeding. CV disease. Renal disease. Hypersentivity (including to aspirin). Pregnancy. |
|
|
Term
| Mechanism/class of DIGOXIN |
|
Definition
| Inhibitor of Na+/K+ ATPase. This leads to increased cardiac contractility through increased intracellular Ca2+ (Ca2+ is driven out of the cell by Na+ countertransport). Digoxin also slow heart rate by increasing vagal tone, and altering phases 0 and 4 of cardiac action potential. |
|
|
Term
| Indications/Dose of DIGOXIN |
|
Definition
Atrial fibrillation. Heart failure with arrythmia. (Improves QOL but not mortality in other CHF).
Dose: Maintenance usually 62.5-250mcg OD, calculated wrt CrCl and target concentration. |
|
|
Term
|
Definition
| F=0.7, t1/2=30-40hrs, BIG Vd (500L), renally excreted. |
|
|
Term
|
Definition
Brady arrythmias with B-blockers.
Increased effect with hypokalemia.
Many drugs increase or decrease effect if taken concommitantly. |
|
|
Term
| Adverse effects of DIGOXIN |
|
Definition
Mostly dose dependent.
Confusion, yellow/green visual auras, nausea, vomiting, diarrhoea, urticarial rash. |
|
|
Term
| Treatment of DIGOXIN toxicity |
|
Definition
| Supportive therapy. Atropine for bradyarrythmias. Temporary pacing. DIGBIND (anti digoxin antibody). |
|
|
Term
| Class/mechanism of DILTIAZEM |
|
Definition
| Ca2+ channel blocker. Major effect on vascular smooth muscle-->vasodilatation. Minor effect on SA node--> decr. HR. |
|
|
Term
| Indications for DILTIAZEM |
|
Definition
| Rx of hypertension, or angina. Usually not first line antihypertensive. Use especially if HTN and angina are both present but there is contraindication to B-blocker. (or additive with b-blocker). |
|
|
Term
|
Definition
|
|
Term
|
Definition
| F=0.34-0.54, t1/2 around 5hrs. Hepatically metabolised (CYP3A4) |
|
|
Term
| Prec/ contraindications for DILTIAZEM |
|
Definition
| Heart block, sick sinus syndrome, severe heart failure. |
|
|
Term
| Common or serious side effects of DILTIAZEM. |
|
Definition
Common: headache, gum hyperplasia, bradycardia, postural hypotension.
Serious (rare): blood dyscrasias, blindness, CNS problems. |
|
|
Term
| Interactions of DILTIAZEM |
|
Definition
Inhibits CYP3A4, but is metabolised by the same. (Interaction with Grapefruit, fluoxetine, cimetidine, carbemazepine, rifampicin, phenytoin etc.)
Additive effect with B-blockers. |
|
|
Term
| Class/mechanism/effects of ENALAPRIL |
|
Definition
| ACE inhibitor. Inhibits conversion of angiotensin I to angiotensin II. Multiple effects including vasodilitatation, K+sparing diuresis, and reducing proteinuria, and improving prognosis in heart failure. |
|
|
Term
|
Definition
| F=0.4, converted to active metabolite (enalaprilat) by the liver. t1/2 around 24hrs. ENALAPRILAT renally cleared. |
|
|
Term
|
Definition
| HTN (usually secondline). Heart Failure. Proteinuria. |
|
|
Term
|
Definition
| Start low--2.5-5mg OD, but usually aiming for 10-20mg OD. |
|
|
Term
| Precautions/contraindications for ENALAPRIL |
|
Definition
| Pregnancy-hypocalvaria. Adverse reactions (angiooedema, cough). renal artery stenosis. |
|
|
Term
| Adverse effects of ENALAPRIL |
|
Definition
| Cough (common--bradykinin effect), postural hypotension (esp first dose), angiooedema (rare) |
|
|
Term
| Interactions of ENALAPRIL |
|
Definition
Via additive or competetive effects (K+Sparing diuretics, NSAIDS).
Increases LITHIUM conc. |
|
|
Term
| Interactions of ENALAPRIL |
|
Definition
Via additive or competetive effects (K+Sparing diuretics, NSAIDS).
Increases LITHIUM conc. |
|
|
Term
| Class/mechanism of ERYTHROMYCIN |
|
Definition
| Macrolide antibiotic. Binds to 50s ribosome subunit. Blocks RNA dependent protein synthesis. Also gastric prokinetic. |
|
|
Term
| Inidications of ERYTHROMYCIN |
|
Definition
| Infection by susceptible organisms including: St Pyogenes, St aureus, listeria, legionella pn, chlamydia tr, bordetella per, and mycoplasma pn. Main uses are as penicillin alternative, when EBV is suspected (don't uses AMOXYCILLIN), and in atypical pneumonia. |
|
|
Term
|
Definition
| F=0.35, t1/2=1.6hours, 90% hepatic metabolism (CYP3A4) |
|
|
Term
|
Definition
| hepatic dysfunction, prolonged QT segment. |
|
|
Term
| Adverse effects of ERYTHROMYCIN |
|
Definition
| GI upset, candidias, hypertrophic pyloric stenosis, arrythmias. |
|
|
Term
| Interactions of ERYTHROMYCIN |
|
Definition
|
|
Term
|
Definition
| PO 250-500mg 2-4times daily. IV up to 4g daily. |
|
|
Term
| Recommended maximum ETHANOL intake. |
|
Definition
Men: Not more than 6 units per day, not more than 21 units per week, with alcohol free days.
Women: not more than 4 units per day, not more than 14 per week, with alcohol free days. |
|
|
Term
| Medical indication for ETHANOL |
|
Definition
| Treatment of poisoning with METHANOL or ETHYLENE GLYCOL. |
|
|
Term
| Class/mechanism of FLUOXETINE |
|
Definition
|
|
Term
| Indications/dosage of FLUOXETINE |
|
Definition
| Depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder. 20-80mg OD. OCD and BN often higher doses than depression and PMDD. (?continuos or cyclic/intermittent dosage for PMDD) |
|
|
Term
|
Definition
| F>0.6, t1/2=53hrs, hepatically metabolised (CYP2D6,3A4) |
|
|
Term
| Precautions/contra for FLUOXETINE |
|
Definition
| Other antidepressants (serotonin syndrome), limited evidence for use in children and adolescents. |
|
|
Term
| Adverse effects of FLUOXETINE |
|
Definition
Serotonin syndrome (tachycardia, sweating, anxiety)
Headache, sleep disturbance, decreased libido, suicidal ideation. |
|
|
Term
| Interactions of FLUOXETINE |
|
Definition
| Many via CYP. e.g. markedly decreases effectiveness of codeine. |
|
|
Term
| Class/mechanism of FRUSEMIDE |
|
Definition
| High ceiling/loop diuretic. Blocks Na+/K+/2Cl- cotransporter in ascending loop of henle. |
|
|
Term
| Indications for FRUSEMIDE |
|
Definition
| Oedema associared with heart failure, hypertension, |
|
|
Term
|
Definition
| F=0.6, t1/2=1.5hrs, two-thirds renally cleared, rest glucuronidated. |
|
|
Term
|
Definition
| Start with 20mg OD, but doses of up to 1000mg daily by IV infusion are sometimes required (e.g. renal failure) |
|
|
Term
| Contra/precautions of FRUSEMIDE |
|
Definition
| Hypokalaemia, Na+ of H20 depletion, sulphonamide allergy, anuria, renal failure. |
|
|
Term
| Adverse effects of FRUSEMIDE |
|
Definition
| Postural hypotension, electrolyte imbalance, dehydration. |
|
|
Term
| Adverse effects of FRUSEMIDE |
|
Definition
| Postural hypotension, electrolyte imbalance, dehydration. |
|
|
Term
| Interactions of FRUSEMIDE |
|
Definition
Additive or competitive (e.g. NSAIDs) effects.
Increases Li+ conc.
Increased toxicity of DIGOXIN, GENTAMICIN, and CEPHALOSPORINs. |
|
|
Term
| Class/mechanism of GENTAMICIN |
|
Definition
| Aminoglycaside antibiotic. Binds to 30s ribosome subunit-->impaired protein synthesis-->cell wall failure. |
|
|
Term
| Indications of GENTAMICIN |
|
Definition
Infection with susceptible organisms. May include pseudomonas, E coli, proteus, gram -ve sepsis, and staphylococcus.
Synergist effect with penicillins e.g. in SBE.
Also transtympanic injection to obliterate vestibular sensation in intractable meniere's disease. |
|
|
Term
|
Definition
Only parenteral. Effect proportional to max conc. Effect reduced by frequent repeated dosing.
Usually 3-7mg/kg/day, once daily dosing. |
|
|
Term
|
Definition
| F=0, t1/2=2.5hrs, mostly renal excretion. |
|
|
Term
|
Definition
| Hypersensitivity, renal disease, vestibulo/cochlear problems, neuromuscular problems. |
|
|
Term
| Adverse effects of GENTAMICIN |
|
Definition
| Neuro-/Oto-/Nephrotoxicity. Plus others... |
|
|
Term
| Interactions of GENTAMICIN |
|
Definition
| Increases effect of neuromuscular blockers. Increased nephro-/ototoxicity eg by FRUSEMIDE, CEPHALOSPORINs. |
|
|
Term
| Class/mechanism of GLICLAZIDE |
|
Definition
| Oral antihyperglycaemic. Sulphonylurea. Stimulates insulin release by enhancing tranmembrane Ca+ transfer. |
|
|
Term
| Indications/dose for GLICLAZIDE |
|
Definition
Treatment of non-insulin dependent diabetes mellitus (usually not obese people who would more commonly have METFORMIN)
Start 40-80mg/day. Increase to up to 320mg/day. |
|
|
Term
|
Definition
| F=extensive, t1/2=11hrs, clearance 80-90% CYP3A4. |
|
|
Term
|
Definition
| Hepatic impairment, hypersensitivy, type I diabetes, ketosis, acidosis, surgery. |
|
|
Term
| Class/mechanism of GYCERYL TRINITRATE (GTN) |
|
Definition
| Antianginal. Organic nitrate vasodilator. |
|
|
Term
| Indications for GLYCERYL TRINITRATE |
|
Definition
Registered for treatment of angina pectoris and congestive heart failure.
Also noted: oesophageal spasm, raynaud's, anal fissures. |
|
|
Term
| Dosage/administration of GLYCERYL TRINITRATE in angina episode |
|
Definition
2 puffs sublingually (0.4-0.8mg), if pain remains after 5minutes repeat, if remains after 10 minutes, repeat and call ambulance. Also available in sublingual tablets, as transdermal patches, and as infusion.
Important to have daily nitrate free period to prevent tolerance. |
|
|
Term
| Precautions/contra for GLYCERYL TRINITRATE (GTN) |
|
Definition
| Raised ICP, HOCM, hypovolaemia, inferior MI, glaucoma, SILDENAFIL... |
|
|
Term
| Interactions fo GLYCERYL TRINITRATE |
|
Definition
Additive antihypotensive effects (including with SILDENAFIL).
GTN may reduce effectiveness of HEPARIN. |
|
|
Term
|
Definition
| Postural drop, headache, weakness, 'dizzyness', reflex tachycardia-->arrythmia. |
|
|
Term
| Class/mechanism of HALOPERIDOL |
|
Definition
| Typical antipsychotic. Dopaminergic blockage through the CNS. |
|
|
Term
| Indications/dosage to HALOPERIDOL |
|
Definition
Rx of chronic psychiatric disorders including schizophrenia, other psychoses and tourette's.
Acute management of delusional, confused, hallucinating states, and associated agitation and aggression.
Rarely as antiemetic or neurolepticanalgesia.
Acute dose 2-10mg, not more than 100mg/day.
Maintanence usually 1-15mg.
Available, oral, IM, IV, or IM depot.
Watch for arrythmias (long QT, TdPoint). |
|
|
Term
|
Definition
| Plasma t1/2 around 24hrs. Highly fat soluble. Both hepatic and renal clearance. |
|
|
Term
| Contra/prec for HALOPERIDOL |
|
Definition
| CNS or psych depression, parkinsonism, prolactin dependent tumours, long QT, syndrome, hypersensitivity incl neuroleptic-malignant syndrome, plus others. |
|
|
Term
| Adverse effects of HALOPERIDOL |
|
Definition
Extra pyramidal (akathisia, parkinsonism, dystonia), hallucinations, tiredness, tardive dyskinesis. Rarely neuroleptic malignant syndrome.
Plus many other systems (CVS, haem, GI, resp, endo, derm, autonomic, ocular) |
|
|
Term
| Interactions of HALOPERIDOL |
|
Definition
Kinetic via CYP3A4, 2D6.
Dynamic: many--see www.medsafe.govt.nz. |
|
|
Term
| Class/mechanism of HEPARIN |
|
Definition
| Anticoagulant; potentiates effect of antithrombin, plus neutralises other clotting factors. |
|
|
Term
| Indications/dose for HEPARIN |
|
Definition
Treatment of arterial and venous thrombosis. Prophylaxis of VTE. Topically applied to blood-exposed tubing to maintain patency.
Unfractionated--monitored and titrated to appropriate APTT.
LMWH (ENOXAPARIN) more predictable. 20-40mg/day SC for prophylaxis. 1.5-2mg/kg/day for treatment. |
|
|
Term
|
Definition
| Nil oral availability, saturable hepatic clearance. |
|
|
Term
|
Definition
| Uncontrolled bleeding. Thrombcytopenia. History of HEPARIN induced thrombocytopenia. |
|
|
Term
| Adverse effects of HEPARIN |
|
Definition
| Bleeding, easy bruising, HEPARIN induced thrombocytopenia. |
|
|
Term
| Class/mechanism of LIGNOCAINE |
|
Definition
| Local anaesthetic. Blockade of neuronal Na+ channels. (Also sometimes used for antiarrythmic effects--previously more common) |
|
|
Term
|
Definition
| By local injection, avoid intravascular injection, usually 20-100mg, side effects after 4-7mg/kg total dose. |
|
|
Term
| Kinetics/duration of effect for LIGNOCAINE |
|
Definition
Highly lipophilic, plasma t1/2=1.6hrs.
Onset 2-5mins, peak around 20mins, effect lasts up to 1-2 hours. |
|
|
Term
| Symptoms/sign of LIGNOCAINE toxicity |
|
Definition
| Periocular tingling-->generalised parasthesia/twitching, hypotension, bradycardia, euphoria, drowsiness-->siezure-->coma-->death. |
|
|
Term
| Class/mechanism of METFORMIN |
|
Definition
| Oral antihyperglycaemic. Biguanide. Sensitises to insulin, rather than increases concentration. Exact mechanism not fully understood. |
|
|
Term
| Indications for METFORMIN |
|
Definition
| NIDDM when diet control has failed, or adjunct to insulin therapy. Especially in overweight people. (Also to enhance fertility in PCOS). |
|
|
Term
|
Definition
| Start 500mg BID, increase 500mg/week up to 2500mg. (Careful of renal function) |
|
|
Term
|
Definition
| F=0.5, t1/2=2-6hrs, renal excretion. |
|
|
Term
|
Definition
| Renal failure, and any other acute of chronic condition where lactic acidosis is likely. |
|
|
Term
| Adverse effects of METFORMIN |
|
Definition
| Nausea/GI upset ('METFORMIN BELLY'), lactic acidosis, (No reported hypoglycaemia) |
|
|
Term
| Class/Mechanism of METOPROLOL |
|
Definition
| B-adrenergic antagonist (B-blocker). Antihypertensive. Antianginal. |
|
|
Term
| Indications for METOPROLOL |
|
Definition
| Angina, hypertension, thyrotoxicosis, some tachyarrythmias, migraine. |
|
|
Term
|
Definition
BETALOC (controlled release) available in 23.75,45.5,95,190mg. (use up to 190mg OD)
LOPRESSOR available in 50mg, 100mg and 200mg (daily dose up to 400mg).
Up to 20mg BETALOC as 20mL IV at 1-2mL/min for tachyarrythmias. |
|
|
Term
|
Definition
| Asthma, peripheral vascular disease, bradyarrythmias, unstable heart failure. |
|
|
Term
| Adverse effects of METOPROLOL |
|
Definition
| Postural hypotension, bradycardia, cold peripheries, erectile dysfunction, lethargy, impaired concentration |
|
|
Term
| Interactions of METOPROLOL |
|
Definition
| Metabolism via CYP2D6, additive effects with Ca2+-blockers, digoxin. |
|
|
Term
| Class/mechanism of METRONIDAZOLE |
|
Definition
| Antimicrobial (esp some bacteria, and protazoa). Nitroimidazole. Causes breakdown of DNA helices. |
|
|
Term
| Indications/dose for METRONIDAZOLE |
|
Definition
| Infection with susceptible organisms. Especially anaerobes (e.g. infection from GI flora) and protazoa (giardia, trichomonas). Adult doses of 600mg-2000mg per day, often divided. |
|
|
Term
| Kinetics of METRONIDAZOLE |
|
Definition
| F=almost 1, t1/2=8.5hrs, hepatic metabolism via active metabolytes. |
|
|
Term
| Prec/contra for METRONIDAZOLE |
|
Definition
| Use of alcohol (disulphram reaction), CNS, hepatic, haem disease. |
|
|
Term
| Adverse effects of METRONIDAZOLE |
|
Definition
| Nausea, diarrhoea, vomiting, headache, rarely seizures (+other CNS), |
|
|
Term
| Interactions of METRONIDAZOLE |
|
Definition
| Ethanol (disulphram reaction), others via enzyme effects, e.g. WARFARIN, anticonvulsants... |
|
|
Term
| Class/mechanism of MORPHINE |
|
Definition
| Opiate analgesic. Agonist especially of mu-opioid receptors. |
|
|
Term
| Indications/dose for MORPHINE |
|
Definition
Analgesia (when pain not controlled by lower level analgesics), surgery, off-licence use for relieving dyspnoea in terminal patients.
Available SC, PO, IV, IM and in rapid or slow acting formulations.
10-200mg divided through the day. Start low, titrate to pain, monitor for respiratory depression. |
|
|
Term
|
Definition
| F=0.24, t1/2=2hrs, hepatic metabolism (with some active metabolytes). |
|
|
Term
| Precautions/contra for MORPHINE |
|
Definition
| Respiratory disease, head injury with chance of raised ICP, biliary colic. |
|
|
Term
| Adverse effects of MORPHINE |
|
Definition
| Respiratory depression, confusion, nausea, vomiting, constipation, bradycardia, hypotension. |
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Term
| Treatment of MORPHINE overdose |
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Definition
| NALOXONE and supportive cares. |
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Term
| Class/mechanism of OMEPRAZOLE |
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Definition
| Proton pump inhibitor (PPI). Reduces gastric acidity by inhibiting H+/K+ATPase in gastric parietal cells. |
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Term
| Indications/dose for OMEPRAZOLE |
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Definition
Peptic ulcer disease, acid-related dyspepsia, reflux oesophagitis: 10-40mg OD.
Zollinger-Ellison syndrome 60-120mg TDS. |
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Term
| Adverse effects of OMEPRAZOLE |
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Definition
| angina, tachy-/bradycardia, rash, GI upset, renal disturbance. |
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Term
| Class/mechanism of PARACETAMOL |
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Definition
| Analgesic/antipyretic. Central COX inhibitor. |
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Term
| Indications/dose for PARACETAMOL |
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Definition
First line analgesia for many forms of mild-moderate pain.
Also febrile illness.
PRN or regular up to 1g QID. (Children 15mg/kg QID) |
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Term
|
Definition
| F=almost 1, t1/2=2hrs, hepatic metabolism (with toxic intermediate metabolyte) |
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Term
| Precautions/contra for PARACETAMOL |
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Definition
| Glucose6Phosphate deficiency (causes haemolysis), and liver disease. |
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Term
| Adverse effects of PARACETAMOL |
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Definition
All less than 1%.
Hypersensitivy, rash, hepatic and renal damage in OD.
(Recent NZ study linking heavy PARACETAMOL use to childhood asthma but no clear causal link) |
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Term
| Class/mechanism of PENICILLIN |
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Definition
| B-lactam antibiotic. Attaches to penicillin binding proteins (PBPs) in cell wall leading to degredation of wall and cell death. |
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Term
| Indications/doses of PENICILLIN |
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Definition
Infection with susceptible organism. Most non-B-lactam producing Gram+, plus menigococcus, gonococcus, and spirochetes (eg syphillis).
PENICILLIN G (injectable) anything from 1.2g-24g daily, IV or IM (small doses only).
PENICLLIN V (oral) 1-3g daily (in 4-6 doses). Prophylaxis of RhFever, recurrent tonsillitis, or post splenectomy 250mg BD. |
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Term
|
Definition
| F=0.6, t1/2=30min, mixed hepatic/renal excretion. |
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Term
| Precautions/contr PENICILLIN |
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Definition
|
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Term
| Adverse effects of PENICILLIN |
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Definition
| Urticarial rash not uncommon, anaphalaxis rare, seizures at very high doses, can promote infection by non-susceptible organisms (candida, pseudomonas) |
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Term
| Class/mechanism of PHENYTOIN |
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Definition
| Anticonvulsant (and antiarrythmic). Blocks Na+ channels-->membrane stabilisation. |
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Term
| Indications/dose of PHENYTOIN |
|
Definition
Epilepsy, other seizure disorders, arrythmias.
200-400mg day orally for prophylaxis--saturable kinetics so slow increase!
Up to 1500mg/24hr to control active siezures. |
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Term
|
Definition
| F=0.9, t1/2=average 22hrs but saturable, hepatic metabolism. |
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Term
| Interactions of PHENYTOIN |
|
Definition
Power CYP inducer.
Increased conc with CYP inhibitors (AMIODARONE, FLUOXETINE, ANTIFUNGALs etc.)
Decreased conc with cyp inducers (CARBEMAZIPINE, RIFAMPACIN etc.) |
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Term
| Prec/contra for PHENYTOIN |
|
Definition
Pregnancy (but all antiepileptics are teratogenic, and seizures can harm foetus).
Bradycardia, heart block.
Sensitivity. |
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Term
| Adverse effects of PHENYTOIN |
|
Definition
CNS-tired,drowsy
GI-constipation, nausea, vomiting
Rarely hypotension, arrythmias, ataxia. |
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Term
| Class/mechanism of PREDNISONE |
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Definition
| Synthetic corticosteroid. Anti-inflammatory and immunosuppressive. |
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Term
| Indications/doses of PREDNISONE |
|
Definition
Replacement therapy in andrenal insufficiency. Inflammatory and autoimmune conditions including asthma, RA, temporal arteritis, PMR, ...
Lowest dose for shortest time to acheive result.
Adult doses of 5-80mg/day. |
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Term
|
Definition
| F=0.8, t1/2=3.6hrs, metabolism via active metabolyte (PREDNISOLONE) by liver. |
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Term
| Contra/precautions for PREDNISONE |
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Definition
| Uncontrolled infection, osteoporosis, diabetes, peptic ulcer |
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Term
| Adverse effects of PREDNISONE |
|
Definition
Short term: immunosuppression-->infection, psychosis, glucose intolerance, electrolyte problems, physiological dependence.
Long term: Osteoporosis, cushings syndrome (diabetes, truncal obesity, buffalo hump, fluid retention etc.), cataracts, glaucoma, ... |
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Term
| Class/mechanism for SALBUTAMOL |
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Definition
| B2-adrenergic agonists. Bronchodilator. |
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Term
| Indications/dose for SALBUTAMOL (not just the obvious) |
|
Definition
Asthma, COPD, prevention of premature labour.
Metered dose inhaler, 100-400mcg doses, 1-2 PRN.
Also available as nebulisers and SR oral. |
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Term
| Prec/contra for SALBUTAMOL |
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Definition
| Hypersensitivity, hyperthyroidism, tachyarrythmias, diabetes. |
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Term
| Adverse effects of SALBUTAMOL |
|
Definition
| Tachycardia, palpitations, tremor, anxiety, GI upset, CNS (stim or depr)... |
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Term
| Interactions of SALBUTAMOL |
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Definition
| B-blockers, increased effect with IPRATROPRIUM, increased toxicity with TCAs, MAOIs. |
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Term
| Class/mechanism of SIMVASTATIN |
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Definition
| Lipid lowering agent. Lowers LDL, icreases HDL. Inhibits HMG-CoA reductase, a rate limiting enzyme in the production of cholesterol. |
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Term
| Indications/dose for SIMVASTATIN |
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Definition
| Hypercholesterolaemia, prevention of CHD. Daily doses of 5-80mg in the evening with or without food. |
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Term
|
Definition
| Metabolised via active metabolyte in Liver (CYP3A4) |
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Term
| Prec/contra for SIMVASTATIN |
|
Definition
| Hypersensitivity, liver disease, pregnancy (teratogen). |
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Term
| Interactions of SIMVASTATIN |
|
Definition
| Increased toxicity (-->rhabdomyolysis) with CYP3A4 inhibitors, e.g. GRAPEFUIT juice, macrolides, antifungals, protease inhibitors |
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Term
| Adverse effects of SIMVASTATIN |
|
Definition
| myalgia-->myocytis-->rhabdomyolysis. Liver damage, Foetal abnormalities. |
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|
Term
| Class/mechanism of VALPROATE |
|
Definition
| Antiepileptic, mood stabiliser. Increases GABA signalling, decreases glutamet signalling via complex mechanisms. |
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Term
| Indications/Dose of VALPROATE |
|
Definition
Epilepsy, bipolar affective disorder, (migraine prophylaxis--unregistered use)
1000-2000mg daily (divided doses), start lower. |
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|
Term
|
Definition
| F=0.95, t1/2=14hrs, hepatic metabolism (glucuronidation) |
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|
Term
| Precautions/contra for VALPROATE |
|
Definition
| Liver disease, pregnancy (Neural tube defects--but seizures almost bad for mother and foetus) |
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|
Term
| Adverse effects of VALPROATE |
|
Definition
| GI upset, disordered menstruation, other <1% eg drowsiness, liver damage, ataxia, rash |
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Term
| Class/mechanism of WARFARIN |
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Definition
| Coumarin anticoagulant. Prolongs prothrombin time (PT, INR) by preventing the reduction vit K, and thus the production of vit K dependent clotting factors 2,7,9,10. |
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Term
| Indications/dose of WARFARIN |
|
Definition
Treatment or long term prophylaxis of DVT/VTE. Prophylaxis of aterial thromboembolus in AF, or with artificial heart valves.
Maintanence dose usually 2-10mg/day, titrated to INR, usually 2-3 (3-4 with mechanical heart valves) |
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Term
|
Definition
| F=0.93, t1/2=40hrs, hepatic metabolism. |
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Term
| Precautions/contra for WARFARIN |
|
Definition
| Pregnancy, haemorrhage, protein C deficiency (necrosis) |
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Term
| Adverse effects of WARFARIN |
|
Definition
| Bleeding, foetal abnormalities, GI upset, alopecia, rarely agranulocytosis, skin necrosis. |
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