PAKT Extra Notes PDF - Pharmacology, Cardiovascular System, Drugs

Cardiovascular system STEMI -​ 300mg aspirin loading dose STAT -​ Either medical management or reperfusion therapy -​ Medical management: aspirin + ticagrelor (low bleeding risk) or clopidogrel with aspirin (higher bleeding risk) or aspirin (very high bleeding risk)...

Cardiovascular system STEMI -​ 300mg aspirin loading dose STAT -​ Either medical management or reperfusion therapy -​ Medical management: aspirin + ticagrelor (low bleeding risk) or clopidogrel with aspirin (higher bleeding risk) or aspirin (very high bleeding risk) -​ Reperfusion therapy: angiography with follow on primary PCI (if PCI can be delivered in 120 mins) then prasugrel + aspirin (if not taking anticoagulant) or clopidogrel + aspirin (if taking anticoagulant) -​ Reperfusion therapy: fibrinolysis in the form of an antithrombin drug (if PCI can’t be delivered in 120 mins) then aspirin + ticagrelor (low bleeding risk) or clopidogrel with aspirin (higher bleeding risk) or aspirin (very high bleeding risk) NSTEMI -​ 300mg aspirin loading dose STAT -​ Fondaparinux or unfractionated heparin (if serum creatinine > 265umol/l) -​ GRACE scoring system to predict 6-month mortality -​ If low mortality: -​ Aspirin + ticagrelor (low bleeding risk) or clopidogrel with aspirin (higher bleeding risk) or aspirin (very high bleeding risk) -​ Angiography with follow on primary PCI -​ If high mortality: -​ Angiography with follow on primary PCI -​ Prasugrel/ticagrelor + aspirin (if not taking anticoagulant) or clopidogrel + aspirin (if taking anticoagulant) Secondary prevention -​ ACEi/ARB -​ DAPT -​ Beta-blocker/CCB -​ Statin DVT -​ Apixaban or rivaroxaban HF diagnostics -​ NT-proBNP < 400ng/l = HF not confirmed -​ NT-proBNP > 400ng/l = possible HF, confirm with TTE HFpEF -​ Lifestyle advice and manage comorbidities HFrEF -​ ACEi/ARB/hydralazine+nitrate + beta-blocker -​ MRA if symptoms continue -​ If EF remains ibuprofen > diclofenac > naproxen > celecoxib Cardiac toxicity NSAIDs -​ Diclofenac > ibuprofen > mefenamic acid > naproxen > celecoxib GI toxicity NSAIDs -​ Diclofenac > ibuprofen > naproxen > mefenamic acid > celecoxib AKI diagnostic -​ 50% increase in serum creatinine from baseline over 7 days -​ Serum creatinine increase by 26 in 48 hours csDMRD -​ Methotrexate -​ Sulfasalazine -​ Chloroquine -​ Leflunomide bDMARD -​ Monoclonal antibodies -​ Fusion proteins tsDMARD -​ JAK inhibitors Wait time between using different eye drops -​ 5 mins Opioid breakthrough pain dose -​ One-tenth to one-sixth of the regular 24-hour dose, repeated every 2–4 hours as required Warfarin INR target range -​ 2-3 -​ 3-4 if mitral valve replacement Parkinsons first line if under 65 -​ Dopamine agonists Anti-epileptic neural tube defect -​ Valproate Benzo overdose treatment -​ Flumazenil Dose adjustment for levothyroxine in pregnancy -​ Increase by 25-50% Why pioglitazone contraindicated in HF -​ Causes fluid retention First line for overactive bladder -​ Oxybutinin PPI safest in pregnancy -​ Omeprazole Acute closed angle glaucoma first line -​ Acetazolamide What vaccines cant have in pregnancy -​ Live ones - MMR chicken pox Local anaesthetic toxicity treatment -​ Intralipid Amiodarone persistent dry cough and breathlessness -​ Pulmonary fibrosis If INR too high on warfarin -​ Stop warfarin and give 1-5mg oral vitamin K Phenytoin toxicity -​ Ataxia, confusion, nystagmus Hold metformin before and after contrast media -​ Contrast media causes AKI and this causes metformin lactic acidosis Why avoid trimethoprim in pregnancy -​ Antagonises folate to cause neural tube defects H.pylori triple therapy -​ PPI -​ Amoxicillin or metronidazole -​ Clarithromycin What vaccine is needed yearly for adults over 65 -​ Influenza Athletes food first line -​ Terbinafine CYP1A2 -​ Substrates: Theophylline, Caffeine, Clozapine, Olanzapine -​ Inducers: Smoking, Rifampicin, Carbamazepine, Char-grilled meats  -​ Inhibitors: Fluvoxamine, Ciprofloxacin, Cimetidine CYP2C9 -​ Substrates: Warfarin, NSAIDs (e.g., Diclofenac, Ibuprofen), Phenytoin, Sulfonylureas (e.g., Glipizide) -​ Inducers: Rifampicin, Carbamazepine, Phenobarbital -​ Inhibitors: Fluconazole, Amiodarone, Metronidazole CYP2D6 -​ Substrates: Codeine, Tamoxifen, Tramadol, Antipsychotics (Haloperidol, Risperidone), Beta-blockers (Metoprolol, Propranolol) -​ Inducers: [Not inducible] -​ Inhibitors: Fluoxetine, Paroxetine, Amiodarone, Ritonavir CYP3A4/5 -​ Substrates: Statins (Atorvastatin, Simvastatin), Macrolides, Benzodiazepines, Calcium channel blockers, Immunosuppressants (Tacrolimus, Cyclosporine) -​ Inducers: Rifampicin, Carbamazepine, Phenytoin, St John's Wort -​ Inhibitors: Clarithromycin, Erythromycin, Ketoconazole, Grapefruit juice, Ritonavir Aminoglycoside contraindication -​ Worsen myasthenia gravis Antibiotics that cause c.diff -​ Clindamycin -​ Cephalosporins -​ Broad spectrum penicillins -​ Carbapenems -​ Fluoroquinolones First line for streptococcal pharyngitis -​ Penicillin V Chemotherapy-induced nausea -​ Ondansetron Acute exacerbation COPD -​ SABA -​ Oral corticosteroids -​ Maybe antibiotics if exacerbated by infection First line in RA -​ MTX