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40 Cards in this Set
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- Back
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GIT
3 drugs that will worsten GORD? |
NSAIDs
CCBs Nitrates Theophylline |
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GIT
Which dopamine antagonists increase gastric motility? |
Domperidone (Motilium)
Metoclopramide (Pramin, Maxalon) NOT prochlorperazine (Stemetil, Stemzine) |
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GIT
When might motility agents be useful? |
bloating or early satiety
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GIT
Why is testing for H. pylori recommended in patients who require long term PPI treatment for GORD? |
Because profound acid suppression may accelerate the progression of H. pyori-induced atrophic gastritis, increasing the risk of cancer.
N.B. there is no consistent evidence of an association between GORD and H. pylori |
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GIT
If GORD is inadequately controlled with a PPI, is it more effective to increase the dose of PPI or add a H2A? |
Increase the dose of PPI. However, addinga H2A may be useful.
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GIT
What regimen is first line for erradication of H. Pylori? What if there is an allergy? |
First Line = 7 days
1g amoxycillin bd PPI standard dose bd 400mg clarithromycin bd e.g. Nexium Hp7 If allergy, substitute metronidazole for either amoxycillin (still bd course for 7 days) or clarithromycin (tds course of 14 days) |
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GIT
What is Cytotec and what is it for? What dose? What SEs limit use? |
misoprostol
prostaglandin E1 ANALOGUE (thus not needing a warrant to prescribe) prevention of NSAID-related ulcers 200mcg tabs - 2-4 tabs daily in 2-4 doses 800mcg d is more effective than 400mcg but less well tolerated Use limited by diarrhoea, abdo pain, cramps, flatulence, n/v (n.b. these are the ONLY common SEs) can also be used to treat PUD |
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GIT
Besides Cytotec, what other drugs can be used for prevention of NSAID induced ulcers? |
PPIs
H2As at double the normal dose (i.e. bd dosing. more expensive than just using a PPI) |
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GIT
What is the best time to take an antacid? |
Between meals or at bedtime, when symptoms occur or you expect they might occur
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GIT
In general, which medicines should be taken at least 2 hours apart from antacids? |
"They should not be taken at the same time as other drugs taken orally" (AMH 2008 p799_
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GIT
Name a S/E of the following antacid ingredients - Calcium - Magnesium - Aluminium |
- Calcium: constipation > diarrhoea
- Magnesium: diarrhoea - Aluminium: constipation, may accumulate in renal disease and cause osteomalacia and encephalopathy |
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GIT
What other ingredients are often found in antacids & what do they do? |
Simethicone - relieve flatulence
Alginic acid - form a 'raft' that helps impair reflux both have limited evidence |
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Bismuth subcitrate (SAS) & Sucralfate (Ulcyte)
- what causes their toxicities? - What are their indications? - what is their administration advice? |
bismuth accumulation -->toxicity
sucralfate: aluminium accumulation (190g per 1g tablet) QID on an empty stomach |
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GIT
How does cimetidine (Magicul, Tagamet) cause D/Is? |
Enzyme inhibitor
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GIT
What is the nature of the DI between PPIs and clopidogrel & which PPI is preferred? |
PPI reduces effectiveness of clopidogrel by reducing coversion of clopidogrel to active metabolite.
Pantoprazole is preferred, more data is needed. |
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GIT
I need a PPI in a patient who can't swallow tablets. What are my options? |
Nexium - dispersed in water
Zoton - its a dispersable tablet Omepral/Losec/Acimax - dispersed in water, orange juice or yoghurt NOT Pariet or Somac |
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GIT
Which is better for stomach cramping - hyoscine butylbromide or paracetamol? |
Neither
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GIT
Peppermint oil capsules (Mintec) - indications, administration, dose? |
smooth muscle relaxant for GI spasms / IBS - 0.2mL per capsule, take 1-2 half an hour before meals tds
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Colofac/colese
What's in it? Administration? Does it work? |
mebeverine - SM relaxant for GIT
135mg just before or during a meal tds Limited evidence that SM relaxants are more effective than placebo for IBS |
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GIT
N/V of pregnancy - what is the treatment algorithm? |
Royal women's hospital:
- Vit B6 50mg up to qid or as a single night time dose (e.g. Blackmores product with ginger and B6) - Add restavit 1/2-1 nocte & up to 1/2 bd & 1 nocte as needed - Add Phenergan - Add maxolon or stemetil |
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CVS
In HF, what drug improves survival in a patient on a BB, ACEI/AT2A & frusemide +/- digoxin? |
Spirinolactone (low dose)
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CVS
How does digoxin work & what is its clinical benefit in HF? |
Negative chronotropic and positive inotropic effect
Decreases hospitalisation but does not improve survival |
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CVS
What is an unusual clinical indication for frusemide? |
Hypercalcaemia
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CVS
In renal impairment, which diuretics are/are not used? |
Frusemide - higher doses are required for same effect (Thus Urex forte 500mg tabs; max oral dose is 1g d)
Thiazide diuretics do not work Spirinolactone is CI in RF and may cause hyperkalaemia in renal impairment All diuretics CI in anuria |
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CVS
How does Ikorel (Nicorandil) work? When do you use it? |
It has a nitrate moiety and also affects potassium channels reducing smooth muscle tone.
For IHD when you can't use a nitrate or when a nitrate + BB/CCB is inadequate |
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CVS
Perhexiline Caution because of ...? When do you use it? Dose? |
Slow metabolisers. Use when can't do surgery or other drugs. Start on a loading dose (200-300mg d for 5-7 days) then reduce to 100-200mg daily or 50-100mg weekly for slow metabolisers
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CVS
A person who has CAD should be maintained on what therapies? |
ACEI/AT2A
BB Statin Aspirin/clopidogrel/both |
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CVS
What drugs are first line for HTN? |
ACE/Sartan
CCB Thiazide (if over 65) |
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CVS
Why are thiazides not recommended as first line in younger patients? Why are BBs not first line? |
Thiazides:Because of their association with diabetes
BB: reduces protection against stroke & association with diabetes |
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CVS
Propranolol - Unlike most other BBs it can cross the Blood brain barrier, causing what SE? - what unusual indications does it have? |
- nightmares
- essential tremor, migraine prevention, control of symptoms associated with anxiety and hyperparathyroidism, phaeochromocytoma |
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CVS
When are ACEIs/Sartans CI? |
Pregnancy - major fetal malformations in first trimetster; renal dysfunction & death in second and third trimesters
Bilateral renal artery stenosis |
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CVS
Which antihypertensives can be used in pregnancy? |
Methyldopa
Labetalol |
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CVS
Does dihydropyridine induced peripheral oedema require treatment? |
No. Treatment may put the patient at risk of volume depletion.
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CVS
How does verapamil and diltiazem cause DIs? |
Inhibition of CYP3A4
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CVS
How do you manage a reased creatinine kinase level when the patient is taking a statin? |
If >10x normal stop and do not rechallenge
If mild, stop & restart 4 weeks after levels return to normal. May try a reduced dose or a different statin. Stop statin if persistent muscle pain occurs even if CK levels are normal. |
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CVS
Which statins are metabolised mainly by which enzymes? |
Atorvastatin & simvastatin - CYP3A4
Rosuvastatin & pravastatin - not Fluvastatin - CYP2C9 |
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CVS
What is the maximum dose of simvastatin with either fibrate (AMH)? |
10mg
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CVS
Questran (cholestyramine) is useful for what? |
hypercholesterolaemia
Itch associated with partial biliary tract obstruction Diarrhoea following ilial resection |
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CVS
Questran may exacerbate what condition? |
Hypertriglyceridaemia
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CVS
Questran should be seperated from other medicines by what amound of time? |
Take 1 hour after other medicines or 4-6hours before other medicines
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