Académique Documents
Professionnel Documents
Culture Documents
Sarah Foster
Aims
Core pharmacology
Antibiotics
HIV
TB
Hepatitis
Malaria
Quiz
Pharmacology - Cardiac
BP = CO X PVR
CO = HR X SV
Pharmacology - Cardiac
Hypertension
Angina
MI
Clotting
Hypercholesterolaemia
AF
Pharmacology - HTN
ACEi
ARB
Diuretics
Pharmacology - HTN
ACE inhibitors
What?
Inhibit ACE in the lungs
Function? Reduces BP, vNa/H2O retention
Example? Ramipril
SE?
Cough due to bradykinin -> switch to ARB
ARBs
What:
Function?
Example?
SE?
Pharmacology - HTN
Calcium channel blockers
What?
Block influx of Ca into cells
Function? Reduces BP, Vasodilatation,
- Ionotrope (v contractn) - Dromotrope (v HR)
Example? Verapamil/diltiazem/amlodipine
SE?
Ankle swelling
Diuretics
PCT
CA
Loop
NKCC2
DCT
NCC
C.duct ENaC
Pharmacology - Angina
Nitrates
What?
Function?
Example?
SE?
Generates NO
Cause Vasodilatation = v PVR -> vBP
Glyceryl Trinitrate (GTN) spray
Postural Hypotension, Headaches
Myocardial Infarction
MORPHINE Pain relief, some vasodilatation
OXYGEN
NITRATES
ASPIRIN
Vasodilatation
Pharmacology - MI
Pharmacology - Clotting
ANTIPLATELETS
Clopidogrel Platelet aggregation inhibitor (ADP cant bind)
Ticagrelor Platelet aggregation inhibitor (binds P2Y12
receptor -> ADP cant bind)
Aspirin
Inhibits thromboxane production, lasts 7 days
ANTICOAGULANTS
Dalteparin Direct thrombin inhibitor, LMWH
Warfarin
Vitamin K inhibitor (Clotting factors II, VI, XI,X)
-> monitor INR, interactions
Dabigatran Direct thrombin inhibitor
Rivaroxaban Factor Xa Inhibitor
Pharmacology - ^Cholesterol
STATINS
What?
Function?
Reduce cholesterol
Stabilise plaque
Anti-inflammatory properties
Example?
Simvastatin
SE?
Rhabdomyolysis
->Muscles break down
->Haematuria
Pharmacology - AF
What:
Why:
PC:
Pharmacology - AF
Types:
PAROXYSMAL
PERSISTENT
PERMANENT
Ix:
ECG
Pharmacology - AF
Tx:
Pharmacology - AF
CHA2DS2-VASc
SCORE
O = Low risk
1 = Moderate risk
2+ = High risk
No treatment
Oral anticoagulants e.g. Aspirin
Oral anticoagulants e.g. Dabigatran
Pharmacology - AF
BETA BLOCKERS
What?
Block beta adrenoreceptors
Function? v HR and force of contraction, v BP
Example? Bisoprolol
SE?
Bradycardia -> dizzy
CARDIOVERSION
What?
Drugs/Transthoracic electrical shock
Function? Restore sinus rhythm
Example? Pharmacological e.g. Amiodarone
Electrical
SE?
Failure, VF with ECV, emboli
Pharmacology - Respiratory
Asthma
COPD
Pneumonia
TB
Pharmacology Asthma
What:
Tx:
Pharmacology Asthma
Steroids (Beclemetasone, Budesonide) -> PREVENT
AIRWAY INFLAMMATION
INFLAMMATION
Pharmacology Asthma
Tx:
Poor control:
LABA (Salmetarol)
Leukotriene Receptor Antagonist (Montelukast)
Oral Steroids
LAMA (Ipratropium Bromide = Atrovent)
Pharmacology COPD
What:
Tx:
Stop smoking
Inhaled LABA, SABA and LAMA
Mucolytics (Carbocysteine)
O2
Vaccines
Pharmacology - Neuro
Epilepsy
Myasthenia Gravis
Parkinsons Disease
Huntingtons Disease
Alzheimers Disease
Headaches
Pharmacology - Epilepsy
What:
Types:
Pharmacology - Epilepsy
FOCAL
Tx:
IDIOPATHIC 1o GENERALISED
Tx:
Pharmacology - Epilepsy
Carbamazepine
Function:
SE:
Sodium Valproate
Function:
SE:
Lamotrigine
Function:
SE:
Pharmacology - MG
What:
PC:
Ix:
Tx:
Pharmacology - PD
What:
PC:
Ix:
Tx:
Pharmacology - HD
What:
PC:
Tx:
Pharmacology Alzheimers
What:
Tx:
Pharmacology - Headache
Cluster
Triptans e.g. Sumatriptan (5HT agonists vasoconstrict -> v inflamm)
Ca Channel blockers e.g. Verapamil
Trigeminal Neuralgia
Antiepileptics e.g. Carbamazepine
Headache
COX1 Inhibitor e.g. Aspirin
Triptans
Ergotamine (vasoconstriction, inhibit trigeminal NT)
Pharmacology - Headache
Temporal Arteritis
Steroids e.g. Prednisolone ASAP before Bx
Bacterial Meningitis
3rd generation Cephalosporin e.g. Ceftriaxone ASAP
Pharmacology - GI
Vomiting
Constipation
Pharmacology - Vomiting
ANTI-EMETICS
H2 Receptor Antagonist e.g. Cyclizine
(v gastric acid)
D2 Receptor Antagonist e.g. Metoclopramide, Domperidone
(CTZ in CNS)
5HT antagonists
(vagus nerve and CTZ)
e.g. Ondansetron
Pharmacology - Constipation
LAXATIVES
Bulking agents
e.g. Methylcellulose, Fybogel
(^ faecal mass = ^ peristalsis)
Stimulants
(^motility)
Stool softeners
Osmotic
e.g. Lactulose, Phosphate enema
(retain fluid in bowel)
Pharmacology - MSK
RHEUMATOID ARTHRITIS
What:
Ix:
Tx:
Pharmacology - MSK
TNF alpha INHIBITORS
Why?
NICE failed 2 DMARDs after adequate trial
Examples: Infliximab
anti-TNF antibody
Etanercept
TNF alpha receptor
Adalimumab Monoclonal TNF Ig
Issues:
Expensive, 35% no response
RITUXIMAB
What?
Anti-CD20 monoclonal antibody -> B cell cytopenia
+MTX in severe RA if no response MTX/anti-TNF
Pharmacology - Endocrine
Acromegaly
Thyroid
Conns Syndrome
Hypokalaemia
Hyperkalaemia
Pharmacology - Acromegaly
What: Excessive growth hormone after fusion of epiphyses
(growth plates)
Why: Pituitary adenoma (99%)
PC:
O/E:
Pharmacology - Acromegaly
Ix:
Tx:
Issues: DM
Vascular (HTN, Cardiomyopathy, HF)
OP
OSA
Pharmacology - Thyroid
HYPERTHYROID
Thyroidectomy
Radioactive Iodine
Carbimazole
->stops coupling and iodination of thyroglobulin by TPO
-> Reduce T3 and T4
HYPOTHYROID
Thyroxine
T4, metabolised slowly so OD
Replaces deficiency
Pharmacology Conns
What: Primary Hyperaldosteronism
Ix:
Tx:
Pharmacology - HypoK
What:
Why:
PC:
Asymptomatic
Generalised weakness, muscle pain, constipation
Muscle weakness/paralysis, resp failure, ileus
Pharmacology - HypoK
Ix:
Tx:
K+ replacement Sando K
Pharmacology - HyperK
What:
>5.5mmol/L
MEDICAL EMERGENCY
Myocardial excitability -> VF -> Arrest
Why:
PC:
K + sparing
Addisons
Haemolysis of sample
Pharmacology - HyperK
Ix:
Bloods - ^K+
ECG
Tx:
Microbiology
BACTERIA
Obligate IC ?
Gram Stain?
C.Trachomatis
Yes
No
M. Tuberculosis
Rods
Cocci
Clostridium, Listeria
E.coli, Salmonella,
Shigella, Pseudomonas
Helicobacter
Staph, Strep
Neisseria
Microbiology
GRAM + COCCI
Chains?
Clusters?
Streptococcus
Staphylococcus
Blood agar?
Coagulase/DNAse?
Alpha haemolysis
Optochin?
Beta haemolysis
Positive
Negative
Strep. Pyogenes (GBS) S.Aureus
S.epidermidis
Tx: Flucloxacillin/Vancomycin MRSA
+ Strep. Pneumoniae
Microbiology
GRAM RODS
Ferment lactose on Maclonkey/CLED?
Yes
Escherichia Coli
No
Oxidase?
+
Pseudomonas
Proteus
Antibiotics
INHIBIT CELL WALL SYNTHESIS = Beta lactams
e.g. Penicillins, Cephalosporins, Carbapanems
Antibiotics
INJURE PLASMA MEMBRANE
e.g. Antifungals - Nystatin
Antibiotics
INHIBIT NUCLEIC ACID REPLICATION
e.g. DNA Gyrases Ciproflaxacin (C.diff) Rifampicin
Antibiotics
INHIBIT PROTEIN SYNTHESIS
e.g. Chloramphenicol, Erythromycin, Doxycycline (teeth)
Antibiotics
INHIBIT METABOLITE PRODUCTION
e.g. Trimethoprim for UTIs (creatinine)
TUBERCULOSIS (TB)
What:
Who:
How:
Airborne droplets.
Risks:
Pulmonary TB
Macrophages + lymphocytes
seal in and contain and kill
Infecting bacilli
Bacilli settle
in lung Apex
The Lungs
Pulmonary TB
In apex of lung there
Is more air and less
blood supply
Bacilli settle
in apex and
granuloma
forms
Bacilli taken in
lymphatics
to hilar lymph
nodes
The Lungs
Granuloma + Lymphatics + Lymph nodes = Primary Complex
Miliary TB
Bacilli settle
in lung Apex
Bacilli taken
to hilar lymph
nodes
Pleural TB
The Lungs
Genito urinary TB
TB
PC:
General
Weight loss
Night sweats
Lethargy
Pulmonary TB
Haemoptysis
Chest pain
Chronic dry cough
TB Meningitis
MSK Tb
Potts Disease
Septic Arthritis
Abdominal TB
Peritonitis
Ascites
Genitourinary TB
Dysuria
Sterile Pyuria
TB
Ix:
Sputum culture x 3
CXR
Mantoux test
Quantiferon
Ziehl Neelson/
Lowenstein-Jenson stain
Latent/vaccination
TB
Tx:
HIV
What: Retrovirus (RNA) affecting CD4 cells (Th)
Who:
How:
Mother to child
Risky sexual behaviour
Blood-blood (transfusions/ IVDUs)
HIV
PC:
HIV
HIV - AIDS
What:
PC:
HIV
Ix:
Tx:
Malaria
What: Blood borne parasitic infection
Vector: Female anopheles mosquito saliva
Types: Plasmodium falciparum
Plasmodium Malariae
Plasmodium Vivax
Plasmodium Ovale
Malaria
Lifecycle:
Hypnozoites
RELAPSE
Malaria
Who: Pregnancy, kids, foreign travelers, HIV
PC: Fever in a returning traveller
Myalgia, Malaise, D&V, Headache
OE: Splenomegaly
Jaundice
Anaemia
Hypoglycaemia
Tachycardia
Tachypnoea
Malaria
Ix:
Tx:
ABCDE Supportive
Antimalarials e.g. Quinine, Artesenate
Malaria
Prevention:
1. Vector Control
e.g. mosquito nets, residual spraying
2. Appropriate anti-malarial prophylaxis
e.g. Malarone, Doxycycline, Chloroquine
Hepatitis
What: Inflammation of the liver
Why:
PC:
OE:
Hepatitis
Types:
Who:
Tx:
Supportive
Prevent hepatic failure
Hepatitis Serology
Core Antigen cAg = ACUTE ^^^ Virus replication
Envelope Antigen eAg = Over time
Surface Antigen sAg =
Protection, clearance, vaccination
Hepatitis Serology
^^^LFTs, AntiHBc IgM = ACUTE
^LFTs, AntiHBc IgG = CARRIER
N LFTs, AntiHBs = VACCINATION
N LFTs, AntiHBs, Anti HBc IgG = RECOVERY
Quiz
Arthur, 60 year old male diabetic has sore, hot red leg
after tripping over 3 days ago. No calf tenderness, leg
swelling or chest pain.
What:
Bug:
Ix:
Tx:
?
?
?
?
Quiz
Arthur, 60 year old male diabetic has sore, hot red leg
after tripping over 3 days ago. No calf tenderness, leg
swelling or chest pain.
What:
Bug:
Ix:
Tx:
Cellulitis
Staphylococcus Aureus/Epidermidis
Blood cultures, wound swab
Flucloxacillin/Vancomycin
Quiz
Scarlett, 18 year old female student, 2 day history of fever,
vomiting and headache.
What:
Bug:
Ix:
Tx:
?
?
?
Quiz
Scarlett, 18 year old female student, 2 day history of fever,
vomiting and headache.
What:
Meningitis
Bug:
NHS N.Meningitides
Ix:
Tx:
H. Influenzae
Strep.Pneumoniae
LP, Bloods, blood cultures, ABG, ECG
Benzylpenicillin, CEFTRIAXONE STAT
Quiz
Betty, an adorable 87 year old lady has had a cough for
3/7. She becomes very short of breath, pyrexic and is
coughing up green sputum.
What:
Bug:
Ix:
Tx:
Issues:
?
?
?
?
?
Quiz
Betty, an adorable 87 year old lady has had a cough for
3/7. She becomes very short of breath, pyrexic and is
coughing up green sputum.
What:
Bug:
Ix:
Tx:
Issues:
Quiz
Andy, a 22 year old med student has just got back from his
elective in Namibia. He is feeling very tired and has a
fever.
What:
Bug:
Ix:
Tx:
?
?
?
?
Quiz
Andy, a 22 year old med student has just got back from his
elective in Namibia. He is feeling very tired and has a
fever.
What:
Bug:
Ix:
Tx:
Quiz
Andys friend Lee, went to Ibiza for a lads holiday. He has
had R-sided chest pain, SOB and a dry cough for 8/7. He
now has a headache, chills and myalgia.
HR 125, BP 75/50, RR 40, Temp 38.5oC, O2 89%
What:
Ix:
Bug:
Tx:
?
?
?
?
Quiz
Andys friend Lee, went to Ibiza for a lads holiday. He has
had R-sided chest pain, SOB and a dry cough for 8/7. He
now has a headache, chills and myalgia.
HR 125, BP 75/50, RR 40, Temp 38.5oC, O2 89%
What:
Ix:
Bug:
Tx:
An atypical pneumonia
CXR (Right apex), Bloods (vNa), Cultures (Gram -)
Legionella Pneumophila
IV Erythromycin