Diclofena Pain/in ammation in RA, acute gout, post-op , fever/pain in children, dysmenorrhoea, migraine. 1. 2-1 ,8g daily in SEs. GI discomfort/bleeding (should take with meals), hypersensitivity, renal failure From the BNF. Do not rely on this information for prescribing.
CI. Hypersensitivity to any NSAID, severe heart failure. COX2s are CI in some CVS dis- eases now. NSAIDs may interfere with renal function, uid retention 1 . Non-opioid (aspirin, paracetamol, NSAID) adjuvant Mechanism. COX inhibitor, an NSAID. Aniplatelet: stops aggregation.
2. Opioid for mild/mod (eg. co-codamol 30/500 Opioid for mod/ sev ( morphine, diamorphine, fentanyl, oxycodone, hydromor- 300-900mg every 4-6 h, max 4g daily. Alternative : clopidogrel phone) Non-opioid Adjuvant. Oral morphine is drug of choice.
CVS disease as an antiplatelet 75mg daily. Alternative: paracetamol Paracetamol 1g every 4-6 hours PO/IV. Max 4g daily SEs. GI bleeding/irritation (so take after food), bronchospasm Co-codamol 1-2 tablets every 4 hours. Max 8 tablets daily CI.Reyes's syndrome Children < 16y, breat feeding Hypersensitivity Previous reaction to an NSAID e.g. asthma/angiodema Acute pain Morphine sulphate 10mg every 4 hrly subcut/IM. Slow IV : Divide dose Give w cyclizine 50mg PO/IV/IM 3 times daily (TDS). Maximum 150mg in 24h.
Oxycodone At higher doses morphine has poor solubility & oxycodone is preferred.
Morphine available in liquid, tablet, normal and control ed release preparations. Oral mor- Mechanism. Na/Cl co-transporter inhibitor phine should be given every 4h. Breakthrough pain: Pain which occurs btw regular doses: give a dose equivalent to the 4hrly dose.
Titrating morphine : Starting dose is 5-10mg 4 hrly (reduce in elderly or impaired renal Relieve oedema in heart failure Bendro umethiazide 5-10mg daily in morning function). Normal regime continued even if breakthrough dose taken. After 24h the new Hypertension 2.5mg daily in morning.
dose of morphine is the net morphine in that time divided by 6, and the rescue doses SEs. Postural hypotension, K, Ca, Mg, Urate ( gout), impotence Maintenance of pain control: once dose titrated, pt may prefer convenience of con- CI. Hypokalaemia, hyponatraemia, hypercalcaemia, hyperuricaemia, Addisons trol ed release perparation of morphine. The 12hrly control ed release (MST , tradename zomorph) is the 24h oral divided by 2.
Mechanism. Na/2Cl/K co-transporter inhibitor (ascending loop) Pulmonary oedema IV Furosemide 250mg over 1h Chronic stable heart failure Oral furosemide 40mg in morning Oliguria due to renal failure Correct hypovolaemia rst.
Benzylpenicil in Most streps, menigococcus, gonococcus, syphilis, gas gangrene, SEs. Dehydration, Na, K, Ca, ototoxic, urinary retention if enlarged prostate anthrax, actinomycosis, many anaerobes. 300-600mg/6h IV CI. Renal failure with anuria, precomatose states assoc w liver cirrhosis Ampicil in Broader spectrum than penicil in, more active against G-ve rods, but - Amoxicil in Similar to ampicilin but better absorbed Co-amoxiclav (Amoxicil in+clavulinic acid) Confers -lactamase resistance so Inhibit sodium reabsorption in the distal convoluted tubules and collecting Uses. Oedema, potassium conservation w thiazide/loop diuretics Spectrum Most active against staphs, streps, pneumococci, E coli, proteus, Klebsiel s, Haemophilus, Salmonel a, Shigel a. 2Gs (cefuroxime, cefamadole) active against Neis- seria & Haemophilus. 3Gs (cefotaxime, ceftazidine, ceftriaxone) better activity against Uses Cephalosporins (ce acor) rx UTI, pneumonia, otitis media but aren't rst line (unless penicil in al ergic). Major use is parenteral e. g. surgical prophylaxis/post-op ( Ceph & Met ). 3G drugs (e.g. ceftriaxone) may be used in septicaemia.
Mechanism. COX inhibition. It is not an NSAID: does not irritate the lining of the SEs Hypersensitivity, warfarin potentiation stomach, a ect blood coagulation as much as NSAIDs, or a ect function of the kid- Examples Cefalexim, cefotaxime, ceftazidime, ceftriaxone, cefuroxime Oral 0.5-1g every 4-6h to a max 4g daily.
Azithromycin Similar to clarithromycin gonorrhoea Other Can also be given IV infusion, rectum Chloramphenicol Rarely 1st line (3rd line for meningitis after penicil ins, Co-codamol x/y where x is mg of codeine phosphate, and y is mg of paracetamol Cipro oxacin Cystic brosis, typoid, Salmonel a, Campylobacter SEs. Liver damage in overdose. Rashes, blood didorders (e.g. thrombocytopenia).
Erythromycin Macrolide used in penicil in al ergy, atypical pneumonia Clarithromycin A macrolide like eythromycin, used for S aurues, Mycoplasma, H Co-trimoxazole (sulfamethoxazole trimethroprim) P carini m toxoplasmosis Doxycycline Travel er's diarrhea, Chlamydia, leptospirosis, suphilis Fusidic acid Anti-staph used in osteomyelitis Metronidazole First choice for anaaerobes, Gardnerel a Rifampicin Mycobacteria, prophylaxis in meningitis contacts Tetracyline Chronic bronchitis, chlamydia, Lyme disease Vancomycin Pseudomembranous colitis if metronidazole is contraindicated, MRSA Acute Rx. OH SHIT: Oxygen High- ow (100%), Salbutamol (5mg nebs), Hydrocorti- SEs. GI distrubance, altered liver function, headache, dizziness, rash, tiredness sone (or prednisolone 40 mg PO), Ipratropium (500 micrograms nebs), Theophyl ine.
Repeat salbutamol every 1 5 mins, monitor PEFR/SATs Mechanism. Inhibit the conversion of angiotensin I to angiotensin II Step 2 Low dose inh steroids: 100-400 micrograms Beclometasone inh twice daily Uses. Heart failure, hypertension, diabetic nephropathy, prophylaxis of CVS events] Step 3 Salmeterol inh 50 micrograms (2 pu s) twice daily Step 4 High dose inh steroids: Beclometasone 1000 micrograms (in divided doses).
Hypertension/heart failure Captopril 25mg bd Or oral theophyline, or leukotriene receptor antagonist SEs. Cough, hypotension, renal impairment, anaphylaxis, rash, pancreatitis, URT sx, GI Step 5 Regular prednisolone tablets. Initial y 10-20mg (after breakfast). Mainte- CI. Hypersensitivity, renovascular disease SEs.Salbutamol Tremor, tachycardia, headache Ipratropium Antimuscarinic: dry mouth, nausea, constipation, headache Inhaled steroids Adrenal suppression (pt's should have a steroid card, may need corticosteroids during il ness), groth retardation, glaucoma, oral hoarseness/candidi- SEs. Postural hypotension, HR, headache, dizziness CI. Hypersensitivity, hypotension, hypertrophic cardiomyopathy, aortic stenosis, cardiac Bulk forming Increasing the mass peristalsis. It's like eating more bre (so get the pt to try this rst). E.g. Ispaghula husk (TN e. g. Fybogel) Motility. Often cause cramp so avoid in obstruction. Excessive use can cause diarrhoea (and hence hypokalaemia). E.g. Senna Osmotic Increase water in the large bowel. E.g. lactulose (also useful in hepatic Mechanism. Block beta receptors in heart, vasculature, bronchi, pancreas, liver Uses. Hypertension, angina, MI, arrhythmias (by attenuating the SNS), heart failure, Inhibit gastric acid secretion by blocking H-K pump.
Uses. E ective short term rx for gastric/duodenal ulcers. Also used for eradication of H SEs. Precpitate asthma, fatigue, coldness of extremities, nightmares Asthma, uncontrolled heart lure, bradycardia, hypotension, severe peripheral arterial GI disturbances (nausea, vomiting, abdo pain. .), headache, dizziness Mechanism. Decreasing the conduction of electrical impulses through the AV node Uses. Heart failure, supraventricular arrhythmias Uses. Depression, panic disorder, anxiety SEs. Usual y excessive dosage: anorexia, nausea, vomiting, diarrhoea, abdo pain, visual SEs. GI (e.g. nausea, vomiting), Antimuscarinic (fewer than TCAs), cardiotoxic in over- CI. Heart block (cos of e ect on on AV node), WPW, VT/VF, hypertrophic cardiomy- CI. Not if < 18y (except uoxetine).
Uses. Cholesterol, lipids, symptomatic CVS disease ( risk irrespective of initial level), Moderate-severe depression assoc w psychomotor/physiological changes (e. g.
asymptomatic prophylaxis of risk CVS disease, consider in diabetes sleep/apetite disturbance), nocturnal enuresis in children. E. g. Imipramine SEs. Cardiac (arryhythmiax, heart block), antimuscarinic (dy mouth, blurred vision, con- SEs. Reversible myositis, headache, LFTs, paraesheisa, GI Uses. DVT/PE, AF (or other at-risk), mechanical valves. Take 48-72h.
Ultra-fast (use w meals) Humalog, novarapid Recurrent DVT/PE, mechanical valves INR 3.5 Soluble (30m before meals) Humilin S, Actrapid SEs. Haemorrhage, hypersensitivity, rash, alopecia Pregnancy (teratogenic in rst trimester), peptic ulcer, severe hypertension, bacterial Long acting analogue Lanctus/inslin glargine Uses. Hypnotic, short term relief of severe anxiety, panic disorders. Longer acing e.g.
diazepam, shorter acting e.g. lorazepam.
If overweight start with metformin (SE: slimming), if underweight start with sulfonylurea SEs. Dependence, drowsiness, confusion, ataxia, amnesia, muscle weakness Insulin sensitivity (also rx for PCOS).
SE: GI (anorexia, nausea. .), lactic acidosis. CI: liver/renal impairment (lactic aci- CI. Resp depression, sleep apnoea, sev hepatic impairment dosis), recent MI, XR contrast, general anaesthesia, pregnancy, breast feeding Insulin secretion. SE: GI, liver function ( SEs. Corneal microdeposits (rarely interfere with vision), nausea, vomiting, slate-grey cholestasis). CI: liver/renal impirment, breast-feeding, pregnancy, ketoacidosis CI. Bradycardia, sino-atrial block, thyroid dysfunction.
Mechanism. Block inward travel of Ca through slow channels in myocardium & smooth muscle: contractility, electrical impulses, vascular tone 2. Enquire: Sexual y active, partner, consenting relationship (if underaged), last period Verapamil Angina, hypertension, arrhythmias. SE: constipation, heart failure (neg- 3. Options, failures, SEs, how to take pil reliably, what to do if miss pil , extra pro- Nifedipine/amlodipine Angina, hypertension. SE: vasospasm, vasodilatation tection w abx. Do u have any questions or concerns , arrange follow up Failure : IUD (1 %), CoC (5%), Male condoms (1 4%), Diaphragm+spermicide (20%), Diltiazem Angina, hypertension. SE: bradycardia Cap+spermicide (20-40%), 'Natural' (35%).
Verapamil/diltiazem avoid use in heart failure, bradycardia (so consider use on when beta-blockers), hypotension, heart block, sick-sinus syndrome, WPW CoC If <12h late protection maintained. If >12h take as soon as possible but use barrier for 7d (if that 7d runs in to pil -free, than continue next packet w/o break).
Vomiting within 2h of taking pil : advice for missed pil s.
PoC Take as soon as possible and resume normal schedule. If >3h late use backup.
Dose. 100-200 micrograms daily before breakfast Progesterone only Levorgestrel 1.5mg as soon as possinle CI. thyrotoxicosis. Cautions: Panhypopituitarism (initiate steroids rst) CoC (E and P): prevent ovulation, thicken cervical mucus, dec receptivity.
Generalised. Sodium valproate lamotrigine. Also: sodium valproate/ethosuximide for tive, reversible, convenient, relief of menstrual probs/less ovarian/endometrial Ca, pro- Headaches, BP, breakthrough bleeding, wt gain, breast tender- Partial (focal) 2 generalisation. Carbamezepine sodium valproate ness, acne, mood swings, no protection for STDs. Risks: TED, MI/stroke, br Ca, cer- 1 . CVS: hx or FH of thrombosis, clotting disorders, IHD, valvular hrt disease, AF, 3. Hepatic: abn LFTs, jaundice of pregnancy 4. Other: hormone dependent carcinoma, pregnancy, undiagnosed vaginal bleeding 5. Relative CIs: DM, BP, smoking, age> 35, obesity Mechanism. Beta blocker-like and calcium channel blocker-like actions on the SA and Interactions: dose if broad spectrum abx, enzyme inducers (eg. carbamezepine, AV nodes, increases the refractory period via sodium- and potassium-channel e ects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel Preliminary: Measure BP beforehand, ask about smoking Uses. SVT, Refractory VF, haemodynamical y stable VT, AF (acutely rhythm conver- PoP (eg. norethisterone, levonorgestrel): same method.
nient, avoid CVS e ects of E, used if contraI to CoC, can use during br feeding.
Amenorrhoea/breakthrough bleeding, needs to be taken same time daily, inc ovarian Dose. Oral maintenance. IV infusion (5mg/kg subsequent given) Injectables (eg. Depo-Provera): long acting P prevents ovulation, thicken mucus, dec Levonorgestrel IUD (Mirena): T shaped, 5y, reduces endometrial growth and pre- E ective, convenient, reversible, reduces blood loss and dysmen- strual irregularities common, wt gain common.
Menstrual irreg for rst m's, prestegenic SEs, ovarian cyst.
Subdermal implant (Implanon): A prog rod Similar to injectables, but long duration.
Insertion before intercouse al ows spontaneity, protect against IUD Cu wire. Left in 5y. Induces in ammatory response in uterus.
Planning, lacks spontaneity, cooperation from after tting), reversible, convenient.
Bleeding btw periods, menorrhagia rst few cycles, uterine perforation ( rst 20d, ectopic pregnancy (if failure, so low absolute risk).


2012-09-12 - pcb e f avante

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